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DATA FOKUS

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No Data Subjektif Data Objektif

1.
ANALISA DATA

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No Data Masalah Etiologi


DIAGNOSA KEPERAWATAN

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No Diagnosa Keperawatan Tanggal Tanggal Paraf &

( P&E) Ditemukan teratasi Nama jelas


RENCANA TINDAKAN KEPERAWATAN

Nama klien / Umur : ...................................................................................

No. tempat tidur : ...................................................................................

Ruang / RS : ...................................................................................

Tanggal No. Tujuan & Rencana tindakan dan Rasional Paraf &
nama
diagnosa Criteria hasil jelas
PELAKSANAAN (CATATAN KEPERAWATAN)

Nama klien / Umur : ...................................................................................

No. tempat tidur : ...................................................................................

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Hari / tanggal No. Jam, Tindakan keperawatan & Paraf &

Diagnosa Hasil nama jelas


EVALUASI (CATATAN PERKEMBANGAN)

Nama klien / Umur : ...................................................................................

No. tempat tidur : ...................................................................................

Ruang / RS : ...................................................................................

No. Hari / tanggal Evaluasi hasil Paraf &

Diagnosa Jam (SOAP) Nama jelas