Professional Documents
Culture Documents
Format Pengkajian
Format Pengkajian
Tanggal Pengkajian :
Pukul pengkajian :
A. Identitas Pasien
Nama : .....................................................................................
Umur : .....................................................................................
Jenis Kelamin : .....................................................................................
Suku/Bangsa : .....................................................................................
Agama : .....................................................................................
Pekerjaan : .....................................................................................
Pendidikan Terakhir : .....................................................................................
Alamat : .....................................................................................
Gol Darah : .....................................................................................
Jumlah Anggota
Keluarga (Dalam Rumah) : .....................................................................................
B. Riwayat Kesehatan
1. Riwayat Penyakit Sekarang
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2. Riwayat Penyakit Sebelumnya
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