CHECK LIST KELENGKAPAN FORMULIR REKAM MEDIS

Kelengkapan Pengisian Rekam Medis oleh Dokter Penanggung Jawab Pelayanan (DPJP) ≤ 24 jam setelah selesai pelayanan raw

Ruang
Bulan
NOTE : beri tanda TDD (tidak dapat diterapkan) jika formulir tidak perlu diisi

Asesmen Awal
Asesmen Formulir Rencana
Medis dan
Nutrisi Awal medis Asesmen Pemulangan
Keperawatan Dokter Ulang Nyeri Pasien
NO DPJP Rawat Inap

L LT L LT L LT L LT L LT

1 dr. Erlina 9 0 9 0 7 2 1 0 4 0
2 dr. Tika 7 0 7 0 6 1 2 0 4 0
3 dr. Wiwi 13 1 14 0 12 2 1 0 8 1
4 dr. Jhony 2 0 2 0 2 0 0 0 0 0
5 dr. Metthew 2 0 2 0 2 0 1 0 1 1
6 dr. Andi 7 0 7 0 5 2 0 0 1 0
7 dr. Mukhlis 14 1 15 0 14 1 0 0 5 0
8 dr. Prawiro 7 0 7 0 7 0 1 0 1 0
9 dr. Suprayadi 4 0 4 0 4 0 0 0 1 0
10 dr. Laras 1 0 1 0 1 0 0 0 0 0
11 dr. Susilo 3 0 3 0 3 0 0 0 0 0
12 dr. Elisabeth 1 0 1 0 1 0 0 0 1 0
telah selesai pelayanan rawat inap

Catatan Perkembangan Pasien Terintegrasi ( CPPT )

Formulir
Pemberian Formulir
Catatan
Edukasi Pasien Care Plan Pengkajian Pemberian
Dan Keluarga Identifikasi Bidan
Tanggal Jam Ulang Obat
Terintegrasi Pasien
(SOAP)

L LT L LT L TL L TL L TL L TL L TL L

9 0 8 0 9 0 9 0 1 8 9 0 9 0 9
7 0 7 0 7 0 7 0 2 5 6 1 7 0 7
14 0 13 0 14 0 14 0 2 12 14 0 14 0 14
2 0 2 0 2 0 2 0 1 1 2 0 2 0 2
2 0 2 0 2 0 2 0 1 1 1 1 2 0 2
7 0 7 0 7 0 7 0 1 6 7 0 7 0 7
15 0 13 2 15 0 15 0 5 10 15 0 15 0 14
7 0 7 0 7 0 6 1 4 3 7 0 6 1 7
4 0 4 0 4 0 4 0 2 2 4 0 4 0 4
1 0 1 0 1 0 1 0 1 0 1 0 1 0 1
3 0 3 0 3 0 3 0 1 2 3 0 3 0 2
1 0 0 0 1 0 1 0 0 1 1 0 1 0 1
 Formulir Asesmen Pra Catatan Catatan
Transfer Asesmen Laporan
Pemberian Resiko Jatuh - Anestesi Keperawatan Keperawatan
Pasien Prabedah
dan Serasi Pra - Operatif Intraoperatif
Pembedahan
Obat

LT L LT L TL L TL L TL L TL L TL L TL

0 8 0 1 0 0 0 0 0 0 0 0 0 0 0
0 5 0 2 0 0 0 0 0 0 0 0 0 0 0
0 14 0 4 0 0 0 0 0 0 0 0 0 0 0
0 2 0 2 0 1 0 1 0 1 0 1 0 1 0
0 2 0 1 0 0 0 0 0 0 0 0 0 0 0
0 6 0 6 0 0 0 0 0 0 0 0 0 0 0
0 15 0 12 0 0 0 0 0 0 0 0 0 0 0
0 6 1 6 0 0 0 0 0 0 0 0 0 0 0
0 4 0 4 0 3 0 3 0 3 0 3 0 3 0
0 1 0 1 0 0 0 0 0 0 0 0 0 0 0
0 2 0 2 0 0 0 0 0 0 0 0 0 0 0
0 1 0 0 0 1 0 1 0 1 0 1 0 1 0
 Informed
Rencana Checklist Pemantauan Consent
Perawatan Keselamatan Anastesi / (Persetujuan / SIMRS MANUAL
Pasca Bedah Operasi Sedasi Penolakan
Tindakan)

L TL L TL L TL L TL L TL L TL TOTAL L

0 0 0 0 0 0 1 0 1 8 240 28 268 90%

0 0 0 0 0 0 1 0 1 6 194 17 211 92%
0 0 0 0 0 0 0 0 1 13 361 60 421 86%
1 0 1 0 1 0 1 0 1 1 68 3 71 96%
0 0 0 0 0 0 0 0 2 0 56 8 64 88%
0 0 0 0 0 0 1 0 3 3 192 21 213 90%
0 0 0 0 0 0 0 0 4 11 419 42 461 91%
0 0 0 0 0 0 0 0 2 7 196 20 216 91%
3 0 3 0 3 0 3 0 2 3 138 11 149 93%
0 0 0 0 0 0 0 0 1 0 31 0 31 100%
0 0 0 0 0 0 0 0 1 2 85 4 89 137%
1 0 1 0 1 0 1 0 0 1 36 2 38 95%
NUAL SIMRS

TL TOTAL L TL

10% 9 9% 89%
8% 7 9% 86%
14% 14 9% 93%
4% 2 9% 50%
13% 2 18% 0%
10% 6 27% 50%
9% 15 36% 73%
9% 9 18% 78%
7% 5 18% 60%
0% 1 9% 0%
4% 3 9% 67%
5% 1 0% 100%