ANALISIS DATA

No Data Etiologi Masalah

 INTERVENSI

No. Tujuan dan Kriteria Hasil Intervensi

 IMPLEMENTASI DAN EVALUASI
Nama Klien : No. Rekam Medik
Diagnosa Medis : Tanggal
No.
Dx. Kep
Jam Tindakan Keperawatan
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
:
:
Evaluasi (S, O, A, P) Ttd
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................