DAFTAR CCEKLIST PEMAKAIAN ALAT/ MATERIL

PRE INTRA DAN BADAST POST OPERASI DI IBS RSUD PASAMAN BARAT

Nama Klien : ........................................ Staff IBS : ........................................

No. MR : ........................................ Diagnosa : ........................................
RRI : ........................................ Tindakan : ........................................
Operator : ........................................
PRE-INTRA OPERASI Post OP
No Nama Alat/ Materil/Instrument Hasil dan Keterangan
Jumlah Masuk I II III IV Jumlah Semua Jumlah Semua
1 Instrument dasar yang
dipakai..............................................................
(Sesuai Label Instrument)
2 Instrument Acessoris yang dipakai
...................................................................
...................................................................
...................................................................
...................................................................
...................................................................
...................................................................
3 Jarum Lepas
4 Jarum Atraumatik
5 Kain Kassa
6 Peack
7 Draan Gauze
8 DEPPERS
9 Tampon
1 Diatermi Mulai dipasang Jam : Dibuka Jam :
2 Tourniquet Mulai dipasang Jam : Dibuka Jam :

Jambak, ...........................2015
RUNNER SRCUB

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