PEMERINTAH KABUPATEN NGAWI

RUMAH SAKIT UMUM DAERAH Dr. SOEROTO

Jl. Dr. Wahidin No. 27 Ngawi Telp (0351) 749023
Fax : (0351) 744774

Form Penyelesaian Masalah Etik dan Disiplin Perawat/Bidan

Nama Perawat/Bidan : ........................................
Unit Kerja : ........................................
Jabatan : ........................................

A. Deskripsi Masalah Etik dan Disiplin

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B. Unsur/ Individu yang Terlibat

No. Nama Jabatan Hak/ Kewajiban

1.
2.
3.
4.

C. Langkah Penyelesaian Masalah

1. D (Define the Problem (s)) :

2. E (Ethical Review) :

3. C (Consider the Options) :

 4. I (Investigate Outcomes):

5. D (Decide on Action) :

6. E (Evaluate Results) :

D. Kesimpulan
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E. Tindak Lanjut
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Ngawi, _______________
Perawat yang bersangkutan Ketua Subkomite Etik dan Disiplin
Profesi

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