DINAS KESEHATAN
UPT PUSKESMAS SISIR
Jalan Sutan Hasan Halim Kota Batu.KodePos 65314
Telp. (0341) 5025454, e-mail : sisirpuskesmas@gmail.com
RESUME PASIEN
Nama Pasien: L/P No.RM:
Tgl. Lahir/Umur: Alamat:
A. RINGKASAN KEPERAWATAN
NAMA : ................................... NO. BPJS : ...................................
UMUR : ................................... NIK : ...................................
AGAMA : ................................... TGL. MRS : ...................................
PEKERJAAN : ................................... TGL. KRS : ...................................
KEADAAN KRS : ...................................
SEMBUH/RAWAT JALAN/DIRUJUK/PULANG ATAS PERMINTAAN SENDIRI/MELARIKAN
DIRI/MENINGGAL
B. RIWAYAT KEPERAWATAN
1. Masalah Kesehatan pada awal/saat MRS
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2. Tindakan Keperawatan Selama Dirawat
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3. Evaluasi/Perkembangan Pasien
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4. Masalah Potensial Setelah Keluar/Pulang
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5. Nasehat/Saran Saat Keluar/Pulang
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Batu, ..............................
Jam : .............................
Dokter/Perawat/Bidan
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