Pasien Narma .
Tamggal Lahir ?,
Cck kesrdaran
ktcnilai CCS
L4c[rlai aldrole srorc
Cek T'l'V
K.;rji rlacruh pcriler i akral
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lungsi nrcnclan
Puaso
Mrlunlr biasa
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li{rkunun cair ........ ...x...........nt1
Srri buah ..,........,..x...,..........-.rr:l
Air putih ...,..,......,.x..,..,........,m1
13ubur rrrrlg
Maktnar lunak
C e k hiti f setiap pembeniln Dll l
( ck rcsidu
(iant i infus
Nsma &
Trnda Tergan