KOMITE KEPERAWATAN

RS. WILLIAM BOOTH SURABAYA

Jalan Diponegoro No 34 Surabaya

FORMAT LAPORAN DISKUSI REFLEKSI KASUS (DRK)

RUANG : ...........................................

Nama Ruangan :
Tanggal Pelaksanaan :
Topik Diskusi Kasus :

A. Masalah/ Isu yang Muncul :

1. ...................................................................................................................
2. ...................................................................................................................
3. ...................................................................................................................
4. ...................................................................................................................
5. ...................................................................................................................
6. ..................................................................................................................
B. Pembahasan:
C. Rencana Tindak Lanjut:

Isu Kegiatan Indikator

No
1.

2.

3.

4.

dst

Peserta DRK

No Nama TT

............,................
Kepala Ruangan

( .........................)