Nama Mahasiswa :
Nim :
Identitas Pasien
Nama :
Umur :
Jenis Kelamin :
Tanggal Masuk RS :
RIWAYAT
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2. Masalah Keperawatan
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3. Intervensi / Implementasi
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4. Evaluasi
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BREATHING
1. Fungsi Pernafasan
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2. Masalah Keperawatan
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3. Intervensi / Implementasi
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4. Evaluasi
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CIRCULATION
1. Keadaan Sirkulasi
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2. Masalah Keperawatan
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3. Intervensi / Implementasi
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4. Evaluasi
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DISABILITY
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2. Masalah Keperawatan
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3. Intervensi / Implementasi
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4. Evaluasi
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EKSPOSURE
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2. Masalah Keperawatan
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3. Intervensi / Implementasi
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4. Evaluasi
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1. FIVE INTERVENSION
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3. H (1) SAMPLE
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6. HASIL LABORATORIUM
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8. TERAPI DOKTER
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Intervensi / Implementasi
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Evaluasi
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