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RUMAH SAKIT RUMAH SAKIT

RAUDHAH BANGKO RAUDHAH BANGKO

PELAPORAN PASIEN (KOMUNIKASI) DENGAN SBAR PELAPORAN PASIEN (KOMUNIKASI) DENGAN SBAR

FORMULIR SBAR FORMULIR SBAR


(Situation, Background, Assesment, Recommendation) (Situation, Background, Assesment, Recommendation)

Nama : _______________ Nomor MR : ______________ Nama : _______________ Nomor MR : ______________

S Umur
Diagnosa masuk
Keluhan saat ini
:
:
:
_______________ Tgl Masuk : ______________
_____________________________________________
_____________________________________________
S Umur
Diagnosa masuk
Keluhan saat ini
:
:
:
_______________ Tgl Masuk : ______________
_____________________________________________
_____________________________________________

Situation Situation

B B
Riwayat Penyakit Dahulu :________________________________________ Riwayat Penyakit Dahulu :________________________________________
Alergi :________________________________________ Alergi :________________________________________
Terapi dari DPJP :________________________________________ Terapi dari DPJP :________________________________________

Background Background

Kesadaran :________________________________________ Kesadaran :________________________________________

A Tekanan Darah
Nadi
Nafas
:________________________________________
:________________________________________
:________________________________________
A Tekanan Darah
Nadi
Nafas
:________________________________________
:________________________________________
:________________________________________
Suhu :________________________________________ Suhu :________________________________________
Assesment Assesment

Tindakan (Asuhan Keperawatan yang sudah dilakukan : Tindakan (Asuhan Keperawatan yang sudah dilakukan :

R ______________________________________________________________
Instruksi/Order Dokter : ___________________________________________
______________________________________________________________
_____________________________________________________________
R ______________________________________________________________
Instruksi/Order Dokter : __________________________________________
______________________________________________________________
_____________________________________________________________

Tan Bangko, Tan Bangko,

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