LAPORAN HARIAN

Nama mahasiswa

Tempat Praktik

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Waktu Praktik

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Identitas diri klien

Nama

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Umur

: ................................................................................

Jenis kelamin

: ................................................................................

Alamat

: ....................................................................

Status Perkawinan

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Agama

: ................................................................................

Suku

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Pendidikan

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Pekerjaan

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No. RM

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Ruang Rawat

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DX Medis

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Tanggal masuk RS

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Tanggal Pengkajian

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Sumber informasi

: ................................................................................

Riwayat Penyakit
Keluhan utama saat masuk RS :

Riwayat penyakit sekarang:

Riwayat Penyakit Dahulu :

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Pemeriksaan Fisik
Tanda-tanda Vital
1. Suhu

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2. Nadi

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3. Pernafasan

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4. Tekanan Darah : .............................................................................................................

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Terapi yang diberikan :

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Diagnosa Keperawatan :

Tindakan Keperawatan :
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Evaluasi :

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