Nama:....................................................................................
Data
Diagnosa
Tanggal
DO:
..../.../....
DS:
DO:
...../..../...
DS
DO:
..../..../....
DS:
Umur:........ Th
Alamat:...........................................................
Rencana/Implementasi
mat:...........................................................
.
(.....................)
Pagi/Sore/Malam
(....................)
Pagi/Sore/Malam
(...................)
(...................)
ASUHAN KEPERAWATAN
Nama:...........................................
Tanggal
Data
DO:
...../...../.....
DS:
DO:
....../...../.....
DS:
DO:
....../...../.....
DS:
Umur:.....................Th
Diagnosa
Alamat:.............................................................................................................
Rencana/Implementasi
AN
..........................................................................................................
Evaluasi
Nama dan Paraf
Pagi/Sore/Malam
(...................)
Pagi/Sore/Malam
(.....................)
Pagi/Sore/Malam
(.....................)