KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

BADAN PENGEMBANGAN DAN PEMBERDAYAAN SDM KESEHATAN

POLITEKNIK KESEHATAN SURAKARTA
JL.Letjend.Sutoyo Mojosongo Surakarta 57127
Website : www.poltekkes-solo.ac.id email : poltekkes_solo@yahoo.co.id,
polkessolo@gmail.com, Telp.0271-853869 Fax .0271-855388 Surakarta
JurusanKeperawatan : 0271-853869 E-mail: keperawatan@poltekkes-solo.ac.id

MONITORING KESEHATAN PROGRAM PROFESI

POLITEKNIK KESEHATAN SURAKARTA
TAHUN AKADEMIK 2021/2022

I. Identitas Diri
Nama : ............................................................................................
NIM : ............................................................................................
Prodi : ............................................................................................
Jurusan : ............................................................................................

II. Monitoring Kesehatan

Tinggi Bada (TB) :.................................... cm
Berat Badan (BB) : .................................... kg
Tekanan Darah : ................/.................... mmHg
Keluhan saat ini :

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

III. Hasil Monitoring Kesehatan

SEHAT / TIDAK SEHAT

Surakarta, ........................................2021
Penanggung Jawab
Ka. Prodi Profesi Ners
Jurusan Keperawatan

Siti Lestari, MN
NIP. 196805071990032001