FORMAT RESUME

KEPERAWATAN DASAR PROFESI

STIKES WIRA HUSADA YOGYAKARTA

Nama mahasiswa : ………...……...........................................................

NIM : ………………..........................................................
Tempat praktek : …………………………...………………………...
Tanggal : …………………………………………………......

IDENTITAS PASIEN
Nama/Usia : …………………………………………...…………….......
No. Rekam Medis : …………………………………………...…………….......
Jenis kelamin : …………………………………...………………………...
Bahasa yang dimengerti: …………………………………………...………............
Agama : …………………………………………...………………...
Diagnosa medis :..…………………………………………………………....
Program therapi hari ini: ...........................................................................................

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A:
No. Data Penyebab Masalah

Diagnosa Keperawatan
1.
2.
3.

P = (Rumuskan dalam tujuan, kriteria hasil, intervensi)

No. Tujuan Intervensi
No. Tujuan Intervensi
I = Sertakan jam pelaksanaan tindakan
No. Tanggal/Jam Tindakan

E= SOAP (lakukan di akhir shift jaga)

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Yogyakarta, ……………………..
Mahasiswa,

( ……………………………)
 FORMAT PENGKAJIAN UJIAN

Nama mahasiswa : ………...……...........................................................

Tempat praktek : …………………………...………………………...
Hari/Tanggal : …………………………………………………......
I. IDENTITAS PASIEN
Nama/Usia : …………………………………………...……………............
Tanggal masuk RS : …………………………………………...……………............
Diagnosa medis : ..………………………………………………………….........
Riwayat Masuk RS : …………………………………...………………………........
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Program therapi hari ini: ...............................................................................................
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II. PERNYATAAN SUBYEKTIF KLIEN
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III. PERNYATAAN OBYEKTIF KLIEN
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IV. ANALISA DATA
No. Data Penyebab Masalah
V. DIAGNOSA KEPERAWATAN
1.
2.
3.

VI. PLANNING
No. Tujuan Intervensi
VII. IMPLEMENTASI DAN EVALUASI
NO. Hari/tgl, jam Implementasi Evaluasi (SOAP) akhir shift jaga Ttd dan nama
Dx perawat

Pembimbing akademik Mahasiswa Pembimbing Klinik

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