LAPORAN ASUHAN KEPERAWATAN PADA…………………….

DENGAN ………………….....……...…………….……………….

DI …………………………………………………………….

TANGGAL ………......…………..s.d ………….....…….

OLEH:

NI MADE SINTA FEBRINA

1902621009

PROGRAM STUDI SARJANA KEPERAWATAN DAN PROFESI NERS

FAKULTAS KEDOKTERAN UNIVERSITAS UDAYANA

DENPASAR

2019
 CATATAN KEPERAWATAN DI MASYARAKAT (CMHN)

Nama pasien : ………………............................................................

Alamat Pasien : ....................................................................................
Nama puskesmas : ……………………………………….........................
Tanggal : .....................................................................................

DATA FOKUS
Data Subjektif:
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Data Objektif:
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DIAGNOSIS KEPERAWATAN
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 RENCANA TINDAKAN KEPERAWATAN

No. Diagnosa Tujuan dan Kriteria Hasil Intervensi Rasional

Keperawatan
 IMPLEMENTASI, EVALUASI, RENCANA TINDAK LANJUT

No. Hari, tanggal Implementasi Evaluasi Rencana Tindak Lanjut

Nama : …………………………………
Tanda Tangan : ....................................................