Ruang : ..................................................................
Hari/Tgl Pengkajian : ..................................................................
Perawat PJ/Bidan PJ/Jaga : ..................................................................
STOK STOK
No NAMA BARANG JLH UNIT TERPAKAI DICUCI Keterangan
DIRUANGAN DIGUDANG
1 2 3 4 5 6 7 8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
FORMAT PENYERAHAN LINEN KOTOR KE LAUNDRY
Ruang : ...............................................................
Hari/Tgl Serah Terima Laundry : ...............................................................
Perawat PJ/Bidan PJ/Jaga : ...............................................................
Petugas Laundry : ...............................................................
10
11
12
13
14
15
16
17
18
19
20
FORMAT PENYERAHAN LINEN BERSIH KE LAUNDRY
Ruang : ...............................................................
Hari/Tgl Serah Terima Laundry : ...............................................................
Perawat PJ/Bidan PJ/Jaga : ...............................................................
Petugas Laundry : ...............................................................
10
11
12
13
14
15
16
17
18
19
20
Permasalahan dan Pemecahan Masalah di Pelayanan Gizi
No Permsalahan Pemecahan Masalah
1
10
FORMAT EVALUASI KEBUTUHAN LINEN RS. GRAHA HERMINE KE
Hari Pengevaluasian :
Tanggal :
Pukul :
Kebutuhan Laken Rs Graha Hermine
No Immediately Moderat
Nama Barang Biasa Unit Keterangan
(segra) (sedang)
1 2 3 4 5 6 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20