FORMULIR MONITORING

MELAKUKAN ASSESMEN RISIKO JATUH

BULAN : JANUARI 2018 UNIT: RAWAT INAP

TIDAK SUDAH TANGGAL /
SUDAH
DILAKUKAN DIPAKAIKAN JAM
TANGGAL NAMA PASIEN / DILAKUKAN PELAPORAN Insiden
NO NO. RM ASSESMEN GELANG INSIDEN KETERANGAN
MRS UMUR ASSESMEN KPRS (ya/tidak)
FALL RISK KUNING PASIEN
FALL RISK
JATUH
1 2 3 4 5 6 7 8 9
1 1-1-2018 Ketut Wardika/ 43 th 174358
2 2-1-2018 Wulan Mediantari/ 6 th 171537
3 3-1-2018 Kadek Bayu Cahya 172277
Pranata/ 4,4 th
4 3-1-2018 Ni Luh Kadek Maita 170629
Dewi/ 13 th
5 3-1-2018 Ni Ketut Sukarti/ 71 th 184373
6 3-1-2018 Ni Made Genep/ 44 th 184376
7 3-1-2018 Ni Nyoman Murci/ 57 th 184377
8 4-1-2018 I Made Widra/ 184378
9 4-1-2018 Gede Erawan Pratama/ 184380
10 th
10 6-1-2018 Gusti Ayu Sriartati/ 46th 184388
11 7-1-2018 Gusti Wirama Aditya/ 7 173544
th
12 7-1-2018 I Made Purna/ 50 th 184410
13 8-1-2018 Ni Gusti Ayu Made 172798
Candra/ 47 th
14 8-1-2018 I Made Mesin/ 184418
15 8-1-2018 Wayan Peri/ 15 th 184425
16 9-1-2018 Ni Wayan Marga/ 76 th 171521
17 9-1-2018 Ni Kadek Kartini/ 35 th 184434
18 9-1-2018 I Wayan Darja/ 62 th 184430
19 10-1-2018 I Wayan Suma/ 55 th 171534
20 10-1-2018 I Ketut Teken/ 92 th 184441
21 10-1-2018 Ni Nyoman Bading/ 184449
22 11-1-2018 Putu Bayu Hendrawan/ 184452
26 th
23 12-1-2018 I Kadek Adiana/ 20 th 184455
24 12-1-2018 Gede Susanto/ 42 th 184461
25 13-1-2018 Wayan Sudiasih/ 50 th 184465
26 13-1-2018 Kadek Tiah Maharani/ 184463
19 th
27 13-1-2018 I Made Ferry Agus/ 20 184470
th
28 13-1-2018 I Gede Windu Segara/ 184467
16 th
29 14-1-2018 Ketut Ratna Wati/ 40 th 170428
30 14-1-2018 Made Purusa Esa Putra/ 184471
11 bln
31 14-1-2018 Ketut Ayu Pradnya 184477
Dewi/ 5 th
32 16-1-2018 Putu Risma/ 4 th 172436
33 16-1-2018 Gusti Nyoman Madra/ 173833
62 th
34 16-1-2018 Gede Ngurah Prabawa/ 184486
9 th
35 16-1-2018 Gusti Nyoman Mandra/ 172833
62 th
36 17-1-2018 Komang Monggol/ 171070
37 18-1-2018 Made Werti/ 38 th 174356
38 18-1-2018 Yuliana/ 39 th 160025
39 18-1-2018 Ni Nyoman Wartini/ 47 160214
th
40 19-1-2018 Ketut Sudi/ 67 th 184511
41 19-1-2018 Putu Mega Puspita/ 22 184522
th
42 19-1-2018 Nyoman Nilawati/ 184525
43 19-1-2018 Arya Utari/ 28 th 184528
44 20-1-2018 Yunik Lestari/ 18 th 171867
45 21-1-2018 Ni Wayan Mokra/ 70 th 184536
46 22-01-2018 Ni Made Redi/ 82 th 184540
47 23-1-2018 Komang Agus Andika/ 4 173538
th
48 23-01-2018 Putu Revalina Davici / 4 184548
th
49 23-01-2018 Kadek Agus Suma Arta/ 184551
4 th
50 24-01-2018 Nyoman Gembron/ 71 184563
th
51 25-1-2018 I Wayan Suarya/ 39 th 184564
52 25-1-2018 Komang Sri Lestari/ 7 184561
bln
53 25-1-2018 I Made Suka/ 51 th 184566
54 25-1-2018 I Wayan Budi Laksana/ 184573
14 th
55 25-1-2018 I Wayan Suarma/ 53 th 184553
56 25-1-2018 Putu Ravalina Deria/ 4 184548
th
57 26-1-2018 Ni Nyoman Riris/ 49 th 184548
58 26-1-2018 Ni Wayab Sumini/ 48 th 174230
59 26-1-2018 I Putu Gede Arya W./ 28 184574
th
60 26-1-2018 I Made Suta W./ 54 th 184586
61 26-1-2018 Nyoman Sudiarta/ 42 th 184587
62 26-1-2018 Putu Adi Arya Wangsa/ 184589
8 bln
63 28-1-2018 Ni Wayan Mindri/ 60 th 174319
64 28-1-2018 Pande Bagus 184598
Aristyawan/ 15 th
65 28-1-2018 Komang Ari Sanjaya/ 15 184599
th
66 29-1-2018 Ni Nyoman Pareg/ 184602
67 29-1-2018 Sri Febrianti/ 18 th 184602
68 29-1-2018 Wayan Eka Pramita/ 39 184433
th
69 30-1-2018 Ni Made Wita/ 88 th 184601
70 30-1-2018 Ni Made Toya/ 64 th 184612
71 30-1-2018 A A Ayu Rai/ 45 th 184600
72 30-1-2018 Luh Winermi/ 54 th 184619
73 31-1-2018 Nengah Kasti/ 76 th 172483
74 31-1-2018 Nursimah/ 75 th 184620
75 31-1-2018 Ni Nyoman Peti/ 70 th 184621
VALIDASI: