RUMAH SAKIT SUAKA INSAN BANJARMASIN

Jl. H. Zafri Zam-Zam No.60 Banjarmasin.

Tel/Faks : 0511- 3353335, email : rssuakainsan@gmail.com

PENGKAJIAN KEPERAWATAN (ACT OF CARE

RM. 08

NAMA (NAME) : NO. RM (NO. RM) :

UMUR (AGE) : RUANGAN (ROOM) :

JENIS KELAMIN (GANDER) : TGL PENGKAJIAN (ENTRY DATE) :

JAM (CLOCK) :

Pengkajian diambil dari Pasien Sendiri Orang Lain

(The study was taken from)

1. RIWAYAT KESEHATAN (MEDICAL HISTORY)

Alasan dirawat (reason for treatment) : .......................................................
Yang dinyatakan klien (which the client declared) : .......................................................
Riwayat Penyakit Sekarang (Disease history now) : .......................................................
..............................................................................................................................................
..............................................................................................................................................

Riwayat Penyakit yang lain (Another history of illness)

Pernah dirawat ( Have treated) Ya Tidak
Sakit Operasi apa
Riwayat Penyakit Keluarga