DATA BB & TEKANAN DARAH

BULAN : ....................................................

TANGGAL
BB YL BB KRG BB PRE BB POST BB YL BB KRG BB PRE BB POST BB YL BB KRG BB PRE BB POST BB YL BB KRG BB PRE BB POST

TD PRE I II TD POST TD PRE I II TD POST TD PRE I II TD POST TD PRE I II TD POST

CATATAN
 DATA PEMBERIAN ERITROPOETIN & LABORATORIUM

BULAN :...........................................

ERITROPOETIN ( RENOGEN ) LABORATORIUM

NO NAMA PASIEN CATATAN
MG I MG II MG III MG IV MG 1 MG II MG III MG IV

2
3
4

5
6

7
8
9
10
11

12
 DATA PEMBERIAN ERITROPOETIN & LABORATORIUM

BULAN :...........................................

ERITROPOETIN ( RENOGEN ) LABORATORIUM

NO NAMA PASIEN CATATAN
pemberian ke I ttd prwt catatan pemberian ke II ttd prwt catatan tgl pemeriksaan hasil Hb
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24