FORMAT RESUME

I. BIODATA
Nama : .................................................................................
Jenis Umur : .................................................................................
Status Perkawinan : .................................................................................
Pekerjaan : .................................................................................
Agama : .................................................................................
Pendidikan : .................................................................................
Alamat : .................................................................................
Tanggal MRS : .................................................................................
Tanggal Pengkajian:.................................................................................
II. PENGKAJIAN
RIWAYAT KESEHATAN PASIEN
1. Keluhan Utama
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2. Riwayat Kesehatan Sekarang
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3. Riwayat Kesehatan Yang Lalu
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4. Riwayat Kesehatan Keluarga
5. .........................................................................................................................
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POLA AKTIVITAS SEHARI-HARI (Data Fokus)
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PEMERIKSAAN FISIK (Data Fokus)
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DATA PSIKOSOSIAL (Data Fokus)
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DATA SPIRITUAL (Data Fokus)

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PEMERIKSAAN PENUNJANG (Data Fokus)
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III. DIAGNOSA KEPERWATAN

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IV. RENCANA TINDAKAN KEPERAWATAN
NO Dx. KEP TUJUAN INTERVENSI RASIONAL
KRITERIA HASIL
V. IMPLEMENTASI
TANGGAL PUKUL NO.DX IMPLEMENTASI TANDA
TANGAN
VI. EVALUASI
TGL/ DX.KEPERAWATAN EVALUASI (SOAPIER)
JAM