Form Hand Over Rsud 2018 Oke

FORMULIR HAND OVER PER SHIFT
NO MR : RUANGAN :
NAMA :
TANGGAL LAHIR : HARI/TANGGAL :
PAGI SORE MALAM
Situation Situation Situation
Background Background Background

Dx/ Medis.....................................................................…………………… Dx/ Medis.....................................................................…………………… Dx/ Medis.....................................................................……………………
DPJP...........................................................................:…………………… DPJP...........................................................................:…………………… DPJP...........................................................................:……………………
Asesmen : Asesmen : Asesmen :

Kesadaran :………………………...GCS……………………....................... Kesadaran :………………………...GCS……………………....................... Kesadaran :………………………...GCS…………………….......................
Tanda Vital : TD =………...............mmHg; HR =…….................... X/mnt Tanda Vital : TD =………...............mmHg; HR =…….................... X/mnt Tanda Vital : TD =………...............mmHg; HR =…….................... X/mnt
Suhu:............................……..°C; RR =…………............................X/mnt; Suhu:............................……..°C; RR =…………............................X/mnt; Suhu:............................……..°C; RR =…………............................X/mnt;
Oksigen:………L/mnt; Oksigen:………L/mnt; Oksigen:………L/mnt;
Infus : ……………..................................................................................... Infus : ……………..................................................................................... Infus : …………….....................................................................................
Tranfusi:……............................................................................................. Tranfusi:……............................................................................................. Tranfusi:…….............................................................................................
Kateter: ...........................................NGT:................................................. Kateter: ...........................................NGT:................................................. Kateter: ...........................................NGT:.................................................
Drain:......................................................................................................... Drain:......................................................................................................... Drain:.........................................................................................................
Makan/minum:........................................................................................... Makan/minum:........................................................................................... Makan/minum:...........................................................................................
BAB:.......................................BAK:....................................... BAB:.......................................BAK:....................................... BAB:.......................................BAK:.......................................
Aktifitas/ Gerak:......................................................................................... Aktifitas/ Gerak:......................................................................................... Aktifitas/ Gerak:.........................................................................................
Skore Jatuh......................Skore Nyeri........................ Skore Jatuh......................Skore Nyeri........................ Skore Jatuh......................Skore Nyeri........................
DxKeperawatan/Kebidanan:........................................................................ DxKeperawatan/Kebidanan:..................................................................... DxKeperawatan/Kebidanan:........................................................................
............................................................................................................... .................................................................................................................. ...............................................................................................................
Tingkat Ketergantungan Tingkat Ketergantungan Tingkat Ketergantungan
Recomendation Recomendation Recommendation
/
Pemberi Operan Penerima Operan Pemberi Operan Penerima Operan Pemberi Operan Penerima Operan
( ) ( ) ( ) ( ) ( ) ( )
FORMULIR HAND OVER PER SHIFT
NO MR : RUANGAN :
NAMA :
TANGGAL LAHIR : HARI/TANGGAL :
Pemberi Operan Penerima Operan Pemberi Operan Penerima Operan Pemberi Operan Penerima Operan
( ) ( ) ( ) ( ) ( ) ( )

Form Hand Over Rsud 2018 Oke

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Form Hand Over Rsud 2018 Oke

Diunggah oleh

Hak Cipta:

Format Tersedia

FORMULIR HAND OVER PER SHIFT

Background Background Background

Asesmen : Asesmen : Asesmen :

Anda mungkin juga menyukai