LAMPIRAN 3: FORMAT RESUME (Laporan Poli)

A. Identitas Pasien : ......................................................................

.................................................................................................

B. Keluhan Utama : ......................................................................

.................................................................................................

C. Riwayat Penyakit Sekarang : ......................................................

.................................................................................................

D. Riwayat Penyakit Dahulu : .........................................................

.................................................................................................

E. Riwayat Penyakit Keluarga : .......................................................

..................................................................................................
F. Analisa Data
Data Etiologi Problem

G. Diagnosa Keperawatan Prioritas

H. Implementasi Keperawatan
No. Tgl /
Implementasi Respon TTd
Dx Jam
I. Evaluasi Keperawatan

No. Tgl / Evaluasi TTd

Dx Jam