RESUME ASUHAN KEPERAWATAN PADA Tn. ..............

DENGAN DIAGNOSA
............................................... DI RUANG ............................ BRSU TABANAN

PADA TANGGAL

A. IDENTITAS PASIEN
Nama : ...................................................
No. RM : ...................................................
Umur : ...................................................
Tanggal MRS : ...................................................
Jenis Kelamin : ...................................................
Dx. Medis : ...................................................
Alamat : ...................................................

B. DATA FOKUS
Data Subjektif
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Data Objektif
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Diagnosa Keperawatan
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 C. Rencana Keperawatan

NO HARI/TGL DIAGNOSA TUJUAN DAN INTERVENSI NAMA

KEPERAWATAN KRITERIA / TTD
HASIL
 D. Implentasi

N HARI/ NO JAM IMPLEMENTASI EVALUASI RESPON NAMA

O TGL DX / TTD
E. Evaluasi

NO NO. Dx HARI/TGL EVALUASI NAMA/

TTD