YAYASAN SAMODRA ILMU CENDEKIA

STIKES WIRA MEDIKA BALI

PROGRAM STUDI ILMU KEPERAWATAN
Jln. Kecak no. 9A Gatot Subroto Timur Denpasar-Bali 80239
PENGKAJIAN KEPERAWATAN KELUARGA
I. IDENTITAS UMUM KELUARGA
1. Identitas Kepala Keluarga
Nama

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

Pendidikan

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

Umur

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

Pekerjaan

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

Agama

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

Alamat

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

Suku

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

No Telpon

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

2. Komposisi Keluarga
No

3. Genogram

Nama

L/P

Umur

Hub.
Dgn KK

Pendidikan

Pekerjaan

II.

Pengkajian
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III.

Diagnosa
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