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BATASAN KINERJA KLINIS RENDAH

No.

Pelayanan/ Tindakan

Sembuh hecting extremitas

Nebulizer

Standar

Hasil

Analisa

Kegiatan

7 hari

10 hari

Tidak kontrol

20 menit

25 menit

Tidak diawasi

Mengetahui,
KEPALAUPTD PUSKESMASDTP ANYAR

Dr.HJ.ELVY WAHYU ANDAYANI


NIP.19690903 200604 2 003
LAPORAN HASIL MONITORING MUTU LAYANAN KLINIS DAN
KESELAMATAN PASIEN YANG DISUSUN SECARA PERIODIK

Tanggal

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

Waktu

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

Kasus

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

Daftar Hadir

: ..................................................................................... (terlampir)

Identitas Pasien

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

Nomor RM

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

Kronologis

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

Masalah

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

Evaluasi

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

NO

URAIAN

Pelaksanaan SOP kasus tersebut

Diagnosis kerja

Rencana Tindakan Penunjang

Diagnosis Pasti

Terapi

SESUAI

TIDAK
SESUAI

KETERANGAN

Saran

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

Kesimpulan

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

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