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    Transfer Antar Ruangan

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    athira
    This document is a transfer form for a patient between rooms at Rumah Sakit Ibu Dan Anak Sayang Bunda hospital. It provides information about the patient's name, room number, date of birth, gender, diagnosis, symptoms, vital signs, medical history, treatments received, recommended care, and signatures of the nurses transferring and receiving the patient.

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    Transfer Antar Ruangan

    Uploaded by

    athira
    10 views1 page
    This document is a transfer form for a patient between rooms at Rumah Sakit Ibu Dan Anak Sayang Bunda hospital. It provides information about the patient's name, room number, date of birth, gender, diagnosis, symptoms, vital signs, medical history, treatments received, recommended care, and signatures of the nurses transferring and receiving the patient.

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    JKL

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    This document is a transfer form for a patient between rooms at Rumah Sakit Ibu Dan Anak Sayang Bunda hospital. It provides information about the patient's name, room number, date of birth, gender, diagnosis, symptoms, vital signs, medical history, treatments received, recommended care, and signatures of the nurses transferring and receiving the patient.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    10 views1 page

    Transfer Antar Ruangan

    Uploaded by

    athira
    This document is a transfer form for a patient between rooms at Rumah Sakit Ibu Dan Anak Sayang Bunda hospital. It provides information about the patient's name, room number, date of birth, gender, diagnosis, symptoms, vital signs, medical history, treatments received, recommended care, and signatures of the nurses transferring and receiving the patient.

    Copyright:

    © All Rights Reserved
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    Flag for inappropriate content
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    of 1

    Rumah Sakit Ibu Dan Anak

    Sayang Bunda
    TRANSFER ANTAR RUANGAN Nama :
    No.RM :
    Tanggal Lahir :
    Jenis Kelamin : LK PK
    DPJP : …………………. Asal Ruangan : …………………
    SITUATION Diagnosa Medis : …………………. Ke Ruangan : …………………
    Tgl. Pindah/jam : …………………
    Keluhan Saat Pindah : …………………………………………………………………………
    BACKGROUND …………………………………………………………………………………………………
    Riwayat Alergi…………………………………………………………………………………
    …………………………………………………………………………………………………
    Tanda-tanda Vital Tensi : ………mmHg Nadi : ……………. x/menit
    Suhu :………. C Pemapasan : ……... ximenit
    Penggunaan 02 :……… It/menit via Saluran :………….. 02 % .
    Nyeri : Ada, Skala …….(Numeric / Wong Baker)  Tidak Ada
    Resiko Jatuh :
    Program Theraphy : 1. …………………………………………………………..
    2. …………………………………………………………...
    3. …………………………………………………………...
    4. …………………………………………………………...
    5. …………………………………………………………...
    IVFD : ……………………………………………………………………..
    ASSESSMENT .

    Alat Kesehatari Yang Terpasang : 1. Line 


    2. .NGT 
    3. Foley Catheter 
    4. Lain-lain …………….
    Tindakan Medis Yang Sudah Dilakukan
    1. ……………………………………………………………………………………
    2. ……………………………………………………………………………………
    3. ……………………………………………………………………………………
    Pemeriksaan Penunjang Yang Sudah Dilakukan Han ml
    1. Laboratonjum ……………… DPJP sudah teninfo  Ya  Tldak
    2.Radiologi…………………… DPJP sudah terinfo  Ya  Tldak

    Direkomendasikan tindakarj medis / keperawatan:


    1. …………………………………………………………………………………
    2. …………………………………………………………………………………
    3. …………………………………………………………………………………
    Hal hal Yang Harus Diperhatikan
    -
    RECOMENDATION
    1. …………………………………………………………………………………
    2. …………………………………………………………………………………
    3. …………………………………………………………………………………

    Perawat Perawat
    Yang menerima Yang menyerahkan

    ______________________ ___________________

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