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Rumah Sakit ___________________________________ Puskesmas___________________________________

RESEP KEPERAWATAN RESEP KEPERAWATAN


Nama Perawat : __________________________ Tanggal Resep :______________________ Nama Perawat : __________________________ Tanggal Resep :______________________
SIP : __________________________ Ruangan :______________________ SIP : __________________________ Ruangan :______________________

R/ R/
1. ______________________________________________________ Waktu___________________ 1. ______________________________________________________ Waktu___________________
2. ______________________________________________________ Waktu___________________ 2. ______________________________________________________ Waktu___________________
3. ______________________________________________________ Waktu___________________ 3. ______________________________________________________ Waktu___________________
4. ______________________________________________________ Waktu___________________ 4. ______________________________________________________ Waktu___________________
5. ______________________________________________________ Waktu___________________ 5. ______________________________________________________ Waktu___________________
6. ______________________________________________________ Waktu___________________ 6. ______________________________________________________ Waktu___________________
7. ______________________________________________________ Waktu___________________ 7. ______________________________________________________ Waktu___________________
8. ______________________________________________________ Waktu___________________ 8. ______________________________________________________ Waktu___________________
9. ______________________________________________________ Waktu___________________ 9. ______________________________________________________ Waktu___________________
10. ______________________________________________________ Waktu___________________ 10. ______________________________________________________ Waktu___________________

Nama Pasien : __________________________ Nama Pasien : __________________________


Tanggal Lahir : __________________________ Tanda Tangan :______________________ Tanggal Lahir : __________________________ Tanda Tangan :______________________
Alamat : ________________________________________________________________________ Alamat : ________________________________________________________________________

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