LEMBAR RAWAT KLINIK PRATAMA MENTARI

NO. REG RUANGAN KMR 1 ,2 ,3

NAMA : DOKTER PENANGGUNG JAWAB :
UMUR : CARA MASUK PASIEN/ RUJUKAN

ALAMAT : Kp. .............................. RT :.... / RW: ...... TGL. MASUK : JAM :

Desa : ................................. Kec. ................................

TGL KELUAR : JAM :
No. HP : .....................................................................
ANAMNESI :

DIAGNOSA :

PEMERIKSAAN FISIK :
Tekanan Darah : ...................................................... Respirasi : ..................................... TFU : ......................................
Nadi : ...................................................... Suhu : .................................... DJJ : .......................................

ALAT KESEHATAN TINDAKAN

JENIS KETERANGAN JENIS PENINDAK KET.
INFUS SET MAKRO .................................................. INFUS ................................. .....................
INFUS SET MIKRO .................................................. ................................. .....................
ABOUCATH .................................................. KATETER ................................. .....................
RL .................................................. ................................. .....................
NaCL .................................................. GV ................................. .....................
D5% .................................................. ................................. .....................
O2 / OKSIGEN .................................................. HECTING ................................. .....................
AMBULANCE .................................................. ................................. .....................
PEMERIKSAAN PENUNJANG

TINDAKAN JENIS PARAF KETERANGAN

PEMAKAIAN OBAT INJEKSI

NO. HARI / TANGGAL NAMA OBAT JUMLAH KETERANGAN

CATATAN PERAWAT
NAMA PASIEN : ...................................................

UMUR : .....................................................

CATATAN PERKEMBANGAN PASIEN

NO TANGGA/ JAM URAIAN PARAF