Checklist Serah Terima Pasien
Checklist Serah Terima Pasien
Pasien Umum
Pasien BPJS
Pasien Jamkesda
:...........................................
Alamat
:...........................................
Diagnosa
:...........................................
No CM
:...........................................
No CM
:...........................................
Alamat
:...........................................
Alamat
:...........................................
Diagnosa
:...........................................
Diagnosa
:...........................................
Kelengkapan :
Kelengkapan :
Kelengkapan :
Sudah
Sudah
Belum
Belum
Terapi
SEP
SKD
Emergency
Kartu BPJS
Terapi
SEP
SKD
Emergency
Kartu Jamkesda
( R.2 )
KTP ( R.2 )
KK ( R.2 )
Keterangan Lain lain :.................................
...........................................................................
/ SKTM ( R.2 )
KTP ( R.2 )
KK ( R.2 )
SJP Kabupaten
Keterangan Lain lain :.................................
...........................................................................
...........................................................................
Perawat IGD/Poli
Sudah
Belum
Terapi
..........................................................................
Perawat IGD/Poli
Perawat Zall...............
(........................)
(...........................)
............................................................................
(........................)
Perawat Zall...............
Perawat IGD/Poli
Perawat Zall...............
(........................)
(...........................)
(...........................)