Nama Pasien : .................................``.............. Nama Pasien : ....................................................
Tgl dipasang : .................................................. Tgl dipasang: ..................................................... Jam mulai/selesai : ......................................... Jam mulai/selesai: .............................................. Jenis cairan : ................................................... Jenis cairan : ................................................... Obat tambahan : ............................................ Obat tambahan: ................................................. Jumlah tetesan : ......................... tetes/menit Jumlah tetesan: ............................. tetes/menit Kolf ke : .......................................................... Kolf ke : .............................................................. Nama petugas: .............................................. Nama petugas: ..................................................
Stiker Infus Stiker Infus
Nama Pasien : ................................................ Nama Pasien : .................................................... Tgl dipasang: .............................................. Tgl dipasang: ...................................................... Jam mulai/selesa: .......................................... Jam mulai/selesai: ............................................. Jenis cairan : .................................................. Jenis cairan : ..................................................... Obat tambahan: ............................................ Obat tambahan: ................................................ Jumlah tetesan: ......................... tetes/menit Jumlah tetesan: ............................ tetes/menit Kolf ke : ......................................................... Kolf ke : .............................................................. Nama petugas: ............................................. Nama petugas: ..................................................
Stiker Infus Stiker Infus
Nama Pasien : .................................................... Nama Pasien : ................................................... Tgl dipasang: .................................................... Tgl dipasang : ................................................... Jam mulai/selesai: ................................................ Jam mulai/selesai: .............................................. Jenis cairan : ......................................................... Jenis cairan : ....................................................... Obat tambahan: .................................................... Obat tambahan: ................................................. Jumlah tetesan: .................................tetes/menit Jumlah tetesan: .............................. tetes/menit Kolf ke : .................................................................. Kolf ke : .............................................................. Nama petugas: ....................................................... Nama petugas: ..................................................
Stiker Infus Stiker Infus
Nama Pasien : .................................``.............. Nama Pasien : .................................................... Tgl dipasang : .................................................. Tgl dipasang: ..................................................... Jam mulai/selesai : ......................................... Jam mulai/selesai: .............................................. Jenis cairan : ................................................... Jenis cairan : ................................................... Obat tambahan : ............................................ Obat tambahan: ................................................. Jumlah tetesan : ......................... tetes/menit Jumlah tetesan: ............................. tetes/menit Kolf ke : .......................................................... Kolf ke : .............................................................. Nama petugas: .............................................. Nama petugas: ..................................................
Stiker Infus Stiker Infus
Nama Pasien : ................................................ Nama Pasien : .................................................... Tgl dipasang: .............................................. Tgl dipasang: ...................................................... Jam mulai/selesa: .......................................... Jam mulai/selesai: ............................................. Jenis cairan : .................................................. Jenis cairan : ..................................................... Obat tambahan: ............................................ Obat tambahan: ................................................ Jumlah tetesan: ......................... tetes/menit Jumlah tetesan: ............................ tetes/menit Kolf ke : ......................................................... Kolf ke : .............................................................. Nama petugas: ............................................. Nama petugas: ..................................................
Stiker Infus Stiker Infus
Nama Pasien : .................................................... Nama Pasien : ................................................... Tgl dipasang: .................................................... Tgl dipasang : ................................................... Jam mulai/selesai: ................................................ Jam mulai/selesai: .............................................. Jenis cairan : ......................................................... Jenis cairan : ....................................................... Obat tambahan: .................................................... Obat tambahan: ................................................. Jumlah tetesan: .................................tetes/menit Jumlah tetesan: .............................. tetes/menit Kolf ke : .................................................................. Kolf ke : .............................................................. Nama petugas: ....................................................... Nama petugas: ..................................................