Januari 2018
A. Identitas Pasien
Nama :
Umur :
Jenis Kelamin :
Alamat :
No. RM :
Tgl. MRS :
Dx Medis :
B. Data Fokus
S : (Data subjektif pasien)
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
A : (Diagnosa Keperawatan yang muncul)
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
P : (Rencana keperawatan pada hari itu diperlukan untuk mengatasi diagnosa pada point A)
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................