LAPORAN RESUME KEPERAWATAN PADA NY............

DENGAN.................................................................DI POLIKLINIK KANDUNGAN

RUMAH SAKIT................................................................

Hari/ tanggal : ________________________________

Nama : _____________________________
Tgl lahir : ______________________________
No RM : _____________________________
Alamat : ________________________________

A. Ringkasan Kasus
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B. Analisa Data
No Data Masalah Keperawatan

PSPN FKIK UNIVERSITAS MUHAMMADIYAH YOGYAKARTA

C. Diagnosa Keperawatan prioritas:
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Intervensi Keperawatan:
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D. Evaluasi
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O: ....................................................................................................................................
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A: ....................................................................................................................................
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Tanggal: _______________, Jam: _____
Perawat Praktikan

( _____________________________ )
Nama dan Tanda Tangan

PSPN FKIK UNIVERSITAS MUHAMMADIYAH YOGYAKARTA