Nama :

STIKES Hafshawaty NIM :

Pesantren Zainul HasanProbolinggo Poli :
RESUME KEPERAWATAN
Pada Tn/Ny/Sdr.........Dengan Kasus .....................

Data diambil tanggal :……………………. Jam………

No. Rekam Medik :…………………….

I. IDENTITAS KLIEN
Nama :……………………………………………………………………..
Umur :…………………………………………………………………….
Jenis Kelamin :…………………………………………………………………….
Suku / Bangsa :………………………………………………………………………
AgamaPekerjaan :………………………………………………………………………
Pendidikan :………………………………………………………………………
Alamat :………………………………………………………………………
No. Register :…………………………………………………………………….
Tanggal MRS :………………………………………………..............................
Diagnosa Medis :………………………………………………..............................
Sumber Informasi :………………………………………………..............................
Penanggung : Askes / Astek / Jamsostek / JPS / Sendiri

II. KELUHAN UTAMA

……………………………………………………………………………………………………………….................……
.
III. RIWAYAT PENYAKIT SEKARANG
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IV. PEMERIKSAAN FISIK FOKUS PADA KASUS

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V. PEMERIKSAAN DIAGNOSTIK / PENUNJANG
.................................................................................................................................................
VI. ASUHAN KEPERAWATAN
S : .................................................................................................................................................................................
.....
.

O : ................................................................................................................................................................................
.......

A : .................................................................................................................................................................................
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P : .................................................................................................................................................................................
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I : ..................................................................................................................................................................................
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E : .................................................................................................................................................................................
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