interve

tanggal tanda nsi

identit masuk jam anamn pemeri skrinin skrinin skrinin
g skrinin keama status skrinin
g
risiko
melari riwaya
form
tangan pengka form form diagno kepera
sis watan
no. no. RM as ruang pengka esis ksaan g nyeri g g risiko t obat dan barthel risiko kepera 3s
pasien rawat jian fisik nutrisi fungsi jatuh nan mental restrai kan obatan nama jian index jatuh
inap onal n diri terang nyeri wtan (slki,
sdki,
siki)
1 1510107 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

2 1937610 1 1 1 1 1 1 1 0 1 1 0 0 1x 1 1 1 1 1 1

3 1925005 1 1 1 1 1 1 1 1 1 1 1 1 1x 1x 1 1 1 1

4 1843835 1 1 1 1 1 0 1 1 1 1 1 1 1x 1x 1 1 0 1

5 1861061 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

6 1613652 1 1 1 1 1 1 1 1 1 1 1 1 1x 0x 1 1 0 1

7 1904643 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

8 1937715 1 1 1 1 1 1 1 1 1 1 1 1 1x 1x 1 1 1 1

9 1501158 1 1 1 1 1 1 0 0 0 0 1 1 1x 1 1 1 1 1 1

10 1911555 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

11 1820122 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

12 1832918 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

13 1802880 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

14 1710465 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

15 1859693 1 1 1 1 1 1 1 1 1 1 1 1 1x 1x 1 1 1 1

16 1407940 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

17 1937231 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1
18 1938075 1 1 1 1 1 1 1 1 1 1 1 1 1x 1x 1 1 1 1

19 1892253 1 1 1 1 1 1 1 1 1 1 1 1 1x 0x 1 1 1 1
20 1938759 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1
 pengg
prosed unaan pengisian
ur singkat <24 jam nama
koreksi
an

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 0

x x 1 0

x x 1 0

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 0

x x 1 1

x x 1 1

x x 1 1
x x 1 1

x x 1 0
x x 1 1
 interve
tanggal tanda nsi
identit masuk jam anamn pemeri skrinin skrinin skrinin
g skrinin keama status skrinin
g
risiko
melari riwaya
form
tangan pengka form form diagno kepera
sis watan
no. no. RM as ruang pengka esis ksaan g nyeri g g risiko t obat dan barthel risiko kepera 3s
pasien rawat jian fisik nutrisi fungsi jatuh nan mental restrai kan obatan nama jian index jatuh
inap onal n diri terang nyeri wtan (slki,
sdki,
siki)
21 1905786 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

22 1937904 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

23 1937311 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

24 1409911 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

25 1937552 1 1 1 1 1 1 1 1 1 1 1 1 1x 1x 1 1 1 1

26 1935642 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

27 1721972 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

28 1937786 1 1 1 1 1 1 1 1 1 1 1 1 1x 1x 1 1 1 1

29 1401986 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

30 1937849 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

31 1934883 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

32 1401024 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

33 1933488 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

34 1933547 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

35 1937958 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

36 1864471 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

37 1931417 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1
38 1893981 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

39 1834216 1 1 1 1 1 1 1 1 1 1 1 1 1x 1x 1 1 1 1
40 1713444 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1
 pengg
prosed unaan pengisian
ur singkat <24 jam nama
koreksi
an

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 1

x x 1 0

x x 1 1

x x 1 1

x x 1 1

x x 1 0

x x 1 0

x x 1 1
x x 1 1

x x 1 1
x x 1 1
 tanggal tanda
identit masuk jam anamn pemeri skrinin skrinin skrinin
g skrinin keama status
skrinin risiko riwaya diagno tangan form form form diagno
g melari sis pengka sis
no. no. RM as ruang pengka esis ksaan g nyeri g fungsi g risiko nan mental restrai kan t obat kepera dan jian barthel risiko kepera
pasien rawat jian fisik nutrisi jatuh obatan nama index jatuh
inap onal n diri watan terang nyeri wtan

41 1914555 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 0

42 1937609 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

43 1934708 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

44 1876615 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

45 1906023 1 1 1 1 1 1 1 1 1 0 1 1 1x 1 1 1 1 1 1

46 1808779 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 0

47 1890926 1 1 1 1 1 1 1 1 1 1 0 0 1x 1 1 1 1 1 1

48 1937788 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

49 1937811 1 1 1 1 1 1 1 1 1 0 0 1 1x 1 1 1 1 1 1

50 1841332 1 1 1 1 1 1 1 1 1 1 1 1 1x 1 1 1 1 1 1

51

52

53

54

55

56

57
58
interve
nsi
kepera prosed pengg
watan unaan pengisian
ur singkat <24 jam
3s koreksi nama
(slki, an
sdki,
siki)
0x x 1 0

1x x 1 1

1x x 1 1

1x x 1 1

1x x 1 1

0x x 1 1

1x x 1 0

1x x 1 0

0x x 1 1

1x x 1 0