Sekolah Tinggi Ilmu Kesehatan

BINA USADA BALI

SK. Mendiknas RI. Nomor L 122/D/O/2007
Jalan Kubu Gunung Tegal Jaya Dalung – Badung Telp/Fax (0361) 433132

FORMAT LAPORAN RESUME ASUHAN KEPERAWATAN

Header : Resume Asuhan Keperawatan Tanggal ….. Bulan ….. 20 …..

A. Indentitas Pasien
Nama : ............................... No. RM : .........................
Umur : ............................... Tgl. MRS : .........................
Jenis Kelamin : ............................... Dx. Medis : .........................
Alamat : ...............................

B. Data Fokus
S : (Data Subjektif Pasien)
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O : (Data Objektif Pasien)

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A : (Assesment)
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P : Rencana keperawatan pada hari itu diperlukan untuk mengatasi diagnose pada
point A
Rencana Keperawatan
Tujuan dan Kriteria Hasil Intervensi TTD

I : Implementasi yang dilakukan pada hari itu

Hari No.
Jam Tindakan Keperawatan Evaluasi TTD
/ tgl Dx
 E : Evaluasi hari itu untuk masalah pada point A
Hari/Tgl Jam Evaluasi TTD
S:

O:

A:

P:

Mengetahui
Pembimbing Mahasiswa

Ns. I Made Dwie Pradnya Susila, S.Kep Ni Luh Putu Wirayanti, S.Kep
NIK : 12.10.0059 NIM : C1217005