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Puskesmas___________________________________

RESEP KEPERAWATAN
Rumah Sakit ___________________________________ Nama Perawat : __________________________ Tanggal Resep :______________________
SIP : __________________________ Ruangan :______________________
RESEP KEPERAWATAN
Nama Perawat : __________________________ Tanggal Resep :______________________
SIP : __________________________ Ruangan :______________________
R/
1. ______________________________________________________ Waktu___________________
R/ 2. ______________________________________________________ Waktu___________________
3. ______________________________________________________ Waktu___________________
1. ______________________________________________________ Waktu___________________
4. ______________________________________________________ Waktu___________________
2. ______________________________________________________ Waktu___________________
5. ______________________________________________________ Waktu___________________
3. ______________________________________________________ Waktu___________________
6. ______________________________________________________ Waktu___________________
4. ______________________________________________________ Waktu___________________
7. ______________________________________________________ Waktu___________________
5. ______________________________________________________ Waktu___________________
8. ______________________________________________________ Waktu___________________
6. ______________________________________________________ Waktu___________________
9. ______________________________________________________ Waktu___________________
7. ______________________________________________________ Waktu___________________
10. ______________________________________________________ Waktu___________________
8. ______________________________________________________ Waktu___________________
9. ______________________________________________________ Waktu___________________
Nama Pasien : __________________________
10. ______________________________________________________ Waktu___________________ Tanggal Lahir : __________________________ Tanda Tangan :______________________
Alamat : ________________________________________________________________________

Nama Pasien : __________________________


Tanggal Lahir : __________________________ Tanda Tangan :______________________
Alamat : ________________________________________________________________________