PEMERINTAH KABUPATEN KONAWE SELATAN

DINAS KESEHATAN
UPTD PUSKESMAS ATARI JAYA
Jl. Poros Pasar Atari Jaya Kecamatan Lalembuu
Email : puskesmasatarijaya6@gmail.com. Kode Pos 93885
PENCATATAN LAPORAN OPERASI / PEMBEDAHAN
NO. REG : ....................................... POLI / UGD : ......................
NAMA : ....................................... LK / PR : ......................
ALAMAT : ........................................ UMUR : ......................
: ........................................ DIAGNOSIS : .....................
KAJIAN PRE OP
KELUHAN UTAMA : ...............................................................................................................
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RPS : ...............................................................................................................
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RPD : ...............................................................................................................
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OPERATOR : ................................................ TEKNIK OPERASI : ...............................

ASISTEN :................................................. JENIS ANESTESI : ...............................
OBAT ANASTESI : ................................
TANGGAL OPERASI : ...........................................
MULAI JAM : ............................................... LAMA OPERASI : ...............................
SELESAI JAM : ............................................... ……….. JAM ………… MENIT

URAIAN OPERASI

OBSERVASI PASCA OPERASI / PEMBEDAHAN

JAM \ MENIT T N RR S KETERANGAN

TTD OPERATOR

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