ANALISA DATA

Nama pasien : ………………….. Diagnosa Medis : ……………………………

Jenis kelamin : ………………….. No.Med Record : ……………………………
Kamar/Bed : ………………….. Hari/Tanggal : ……………………………

No Data Senjang Masalah Keperawatan Paraf

Perawat
MASALAH KEPERAWATAN

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DIAGNOSA KEPERAWATAN

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PRIORITAS MASALAH

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 NURSING PLANING

Nama pasien : ………………….. Diagnosa Medis : ……………………………

Jenis kelamin : ………………….. Hari/Tanggal : ……………………………
Kamar/Bed : ………………….. Shif : Pagi / Sore / Malam

No Diagnosa Keperawatan Jam NOC NIC Paraf

(SMART) perawat
 IMPLEMENTASI

Nama pasien : ………………….. Diagnosa Medis : ……………………………

Jenis kelamin : ………………….. Hari/Tanggal : ……………………………
Kamar/Bed : ………………….. Shif : Pagi / Sore / Malam

No Diagnosa Keperawatan Jam Implementasi Evaluasi Paraf

perawat