R U M A H S A K I T

No. RM : ..............................................................
CATATAN OBSERVASI Nama : ..............................................................
Jl. Ipik Gandamanah RT 35 RW 03
Munjul Jaya - Purwakarta Tgl. Lahir : ................................................ (L/P)*

GRAFIK
TGL.
SHIFT P S M P S M P S M
N S
12 18 24 6 12 18 24 6 12 18 24 6
Merah Biru

180 42

160 41

140 40
TANDA - TANDA VITAL

120 39

100 38

80 37

60 36

40 35

TD

RESPIRASI

NYERI : Ya/Tidak

JENIS DIIT

IV.I

IV.II

IV.III
INPUT

Transfusi Darah

Makan/Minum

NGT

Total Input :

Muntah

BAB

NGT
OUTPUT

Urine

Drain I

Drain II

IWL

Total Output

KESEIMBANGAN

TTD/NAMA PERAWAT

RM 9 REV.02/RM/2019