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FORMAT LAPORAN DISKUSI REFLEKSI KASUS (DRK)

RUANG RAWAT : ...........................................

Nama Ruangan

Tanggal Pelaksanaan

Topik Diskusi Kasus :


A. Masalah/ Isu yang Muncul :
1. ...................................................................................................................
2. ...................................................................................................................
3. ...................................................................................................................
4. ...................................................................................................................
5. dst
B. Pembahasan:

C. Rencana Tindak Lanjut:

No
1.
2.

3.
4.
dst

Peserta DRK
1.

Isu

Kegiatan

Indikator

(....................................
..)
2
(....................................
...)
3
(....................................
...)
4
(....................................
....)
ds
t

(....................................
....)
............,................
Kepala Ruangan

( .........................)