LAPORAN HARIAN

PRAKTIK KLINIK POLI

Nama
Umur
Jenis Kelamin
Agama
Alamat
1.

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No. Rekam Medis : ..............................................

Ruang Rawat
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Tgl. Masuk RS : ..............................................
Tgl. Keluar RS : ..............................................
Diagnosa Medis : ..............................................

Keluhan Utama
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2.

Riwayat Penyakit Sekarang

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3.

Riwayat Penyakit Dahulu

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4.

Pemeriksaan Diagnosis
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5.

Pemeriksaan Fisik
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6.

Terapi Yang Diberikan

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7.

Diagnosa Keperawatan Saat Pasien Dirawat

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8.

Tindakan Keperawatan Selama Pasien Dirawat

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9.

Evaluasi
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