ASKEP DI POLIKLINIK JIWA

A. Identitas Klien
1. Nama :
2. No Register :
3. Umur :
4. Jenis Kelamin :
5. Alamat :
6. Dx Medis : axis I
axis II
axis III
axis IV
axis V

B. Identitas Penanggung Jawab

1. Nama :
2. Hub dengan klien :
3. Alamat :

C. Pengkajian
Hari /tanggal :
Tempat :
Sumber Data :

D. Riwayat Penyakit Dahulu

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E. Riwayat Penyakit Sekarang

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F. Genogram
G. Terapi
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H. Analisa Data
No Data Maladaptif Masalah

I. Diagnosa Keperawatan
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J. Rencana Intervensi, Implementasi, Evaluasi

Rencana Intervensi
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Implementasi
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Evaluasi
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