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PEMERINTAH KABUPATEN KARANGASEM

DINAS KESEHATAN
UPTD PUSKESMAS SELAT
Jalan Raya Selat, Kode Pos : 80862
Email : selat.pusk@gmail.com No Hp : 082341440012

FORM S-B-A-R (SITUATION-BACKROUND-ASSEMENT-RECOMMENDATION)

Nama Pasien :....................................................................Umur :..................Tahun

S DPJP

Keluhan
: dr/drg. .........................................................................................................

: ...........................................................................................................................

TTV : GCS :...... Tensi :.........mmHg Nadi :........x/menit Suhu :........⁰C

B Pemeriksaan Penunjang :....................................................................................................

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Assesment perawat : ............................................................................................................

A ..........................................................................................................................................................
..........................................................................................................................................................

Inisial tatalaksana/terapi Perawat

R jaga : ..............................................................................................................................................
...........

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