Form Monitoring Anestesi Fix 1 RIM
Form Monitoring Anestesi Fix 1 RIM
DINAS KESEHATAN
UPT PUSKESMAS SINGGALANG
Jln. Raya Singgalang Km. 3, Email:pkm.singgalang@gmail.com Kode Pos 27151
FORM MONITORING
STATUS FISIOLOGI PASIEN SELAMA PEMBERIAN ANESTESI LOKAL
Nama Pasien :..................................................................................................
Tanggal Lahir :...............................................................................................L/P
Umur :..................................................................................................
No. RM :..................................................................................................
Alamat :..................................................................................................
Jenis Kasus :.................................................................................................
2 Setelah
anestesi
3 Sebelum
pulang
Perawat Dokter