ANALISA DATA

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No. register : .............................................. Umur : ..............................................

No. Data Penyebab Masalah

 PRIORITAS MASALAH

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No. register : .............................................. Umur : ..............................................

Tanggal Nama
No. Diagnosa Keperawatan
Ditemukan Teratasi Perawat

RENCANA KEPERAWATAN
Nama Klien :.................................. No Rekam Medis :......................................
Hari Rawat Ke : .................................

No. Diagnosa Keperawatan Tujuan Intervensi

TINDAKAN KEPERAWATAN DAN CATATAN PERKEMBANGAN

Nama Klien : ....................................... Ruangan /

Kamar : .....................................
No. Tgl/jam Tindakan TT Tgl/jam Catata
Umur : ....................................... No Register
: ....................................
 TINDAKAN KEPERAWATAN DAN CATATAN PERKEMBANGAN

Nama Klien : ....................................... Ruangan / Kamar : .....................................

No. Tgl/jam Tindakan TT Tgl/jam Catatan Perkembangan TT

Umur : ....................................... No Register : ...................................