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LEMBAR OBSERVASI PEMBERIAN CAIRAN

Nama

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

Umur

Diagnosa
:............................................................
:................................................................

BB

Tanggal
:............................................................
:................................................................
jam

Maca
m
cairan

Jml. Cairan
direncanaka
n

Jml.
Cairan
masuk

tetesa
n

Cairan
per-os

urine

Status Gizi
muntah

defekasi

tensi

nadi

pernafas
an

suhu

keterangan