ASSESMEN EVALUASI PASIEN

Kelengkapan Pengisian Assesmen Awal Medis dan Keperawatan Pasien Baru

ASSESMEN AWAL MEDIS ASSESMEN AWAL

NO NO REKAM TGL MRS TGL SURVEY KEPERAWATAN
MEDIS
LENGKAP TIDAK LENGKAP LENGKAP
1 21526 01/07/2016 01/07/2016
2 21515 01/07/2016 01/07/2016
3 21522 01/07/2016 01/07/2016
4 21523 01/07/2016 01/07/2016
5 21525 01/07/2016 01/07/2016
6 21527 02/07/2016 02/07/2016
7 21528 02/07/2016 02/07/2016
8 21529 02/07/2016 02/07/2016
9 21529 03/07/2016 03/07/2016
10 17197 03/07/2016 03/07/2016
11 19051 03/07/2016 03/07/2016
12 21533 04/07/2016 04/07/2016
13 18158 05/07/2016 05/07/2016
14 21534 06/07/2016 06/07/2016
15 21535 07/07/2016 07/07/2016
16 21514 08/07/2016 08/07/2016
17 21537 09/07/2016 09/07/2016
18 21543 05/07/2016 05/07/2016
19 21546 06/07/2016 06/07/2016
20 21551 06/07/2016 06/07/2016
21 21550 06/07/2016 06/07/2016
22 21552 06/07/2016 06/07/2016
23 21549 06/07/2016 06/07/2016
24 16197 07/07/2016 07/07/2016
25 21554 07/07/2016 07/07/2016
26 20009 08/07/2016 08/07/2016
27 21563 08/07/2016 08/07/2016
28 14272 08/07/2016 08/07/2016
29 21566 09/07/2016 09/07/2016
30 19158 09/07/2016 09/07/2016
31 21570 10/07/2016 10/07/2016
32 16209 11/07/2016 11/07/2016
33 20408 11/07/2016 11/07/2016
34 21575 11/07/2016 11/07/2016
35 21577 11/07/2016 11/07/2016
36 21571 11/07/2016 11/07/2016
37 21579 11/07/2016 11/07/2016
38 21576 11/07/2016 11/07/2016
39 21578 11/07/2016 11/07/2016
40 21589 11/07/2016 11/07/2016
41 21591 12/07/2016 12/07/2016
42 21583 12/07/2016 12/07/2016
43 21252 12/07/2016 12/07/2016
44 21593 12/07/2016 12/07/2016
45 21592 12/07/2016 12/07/2016
46 21597 13/07/2016 13/07/2016
47 21609 13/07/2016 13/07/2016
48 21552 13/07/2016 13/07/2016
49 21599 13/07/2016 13/07/2016
50 21610 13/07/2016 13/07/2016
51 21607 13/07/2016 13/07/2016
52 21608 13/07/2016 13/07/2016
53 21595 13/07/2016 13/07/2016
54 21598 13/07/2016 13/07/2016
55 21594 13/07/2016 13/07/2016
56 21596 13/07/2016 13/07/2016
57 21590 12/07/2016 12/07/2016
perawatan Pasien Baru

ASSESMEN AWAL
KEPERAWATAN PARAF PETUGS
SURVEY
TIDAK LENGKAP
 NO JAM JAM LAMA
NO TANGGAL JENIS PELAYANAN
TRANSAKSI TRANSAKSI SELESAI WAKTU
1 01/08/2016 567/A/16 8:01:42 10:02:01 2:00:19
2 01/08/2016 568/A/16 8:02:31 10:03:24 2:00:53
3 01/08/2016 569/A/16 8:32:59 9:01:12 0:28:13
4 01/08/2016 570/A/16 9:01:52 10:02:33 1:00:41
5 01/08/2016 571/A/16 10:01:01 10:45:23 0:44:22
6 01/08/2016 572/A/16 10:02:24 10:32:56 0:30:32
7 01/08/2016 573/A/16 10:04:46 10:35:32 0:30:46
8 02/08/2016 322/U/16 8:05:01 10:04:59 1:59:58
9 02/08/2016 560/D/16 8:06:31 8:33:02 0:26:31
10 03/08/2016 323/U/16 8:01:34 8:32:12 0:30:38
11 03/08/2016 574/A/16 8:02:12 8:33:14 0:31:02
12 03/08/2016 561/D/16 10:01:37 11:02:31 1:00:54
13 04/08/2016 324/U/16 8:01:35 10:01:35 2:00:00
14 04/08/2016 575/A/16 8:01:54 10:02:01 2:00:07
15 04/08/2016 325/U/16 8:02:23 10:03:31 2:01:08
16 04/08/2016 562/D/16 8:03:21 8:32:12 0:28:51
17 04/08/2016 563/D/16 8:04:01 10:35:23 2:31:22
18 04/08/2016 326/U/16 11:02:24 11:32:31 0:30:07
19 05/08/2016 576/A/16 8:01:24 8:31:23 0:29:59
20 05/08/2016 577/A/16 8:02:01 9:03:42 1:01:41
21 05/08/2016 327/1/16 10:01:31 10:34:24 0:32:53
22 06/08/2016 578/A/16 10:01:02 12:01:31 2:00:29
23 06/08/2016 579/A/16 10:02:31 12:02:34 2:00:03
24 07/08/2016 565/D/16 9:01:32 11:02:13 2:00:41
25 07/08/2016 580/A/16 9:02:12 11:04:01 2:01:49
26 07/08/2016 566/D/16 10:01:24 11:05:22 1:03:58
27 08/08/2016 567/D/16 8:01:31 8:16:41 0:15:10
28 08/08/2016 568/D/16 8:02:21 10:03:01 2:00:40
29 08/08/2016 569/D/16 8:02:56 9:04:13 1:01:17
30 08/08/2016 570/D/16 9:31:33 10:17:31 0:45:58
31 08/08/2016 571/D/16 9:33:12 10:04:03 0:30:51
32 08/08/2016 582/A/16 10:01:24 12:02:53 2:01:29
33 08/08/2016 582/A/16 14:02:23 14:18:34 0:16:11
34 09/08/2016 572/0/16 9:00:03 9:30:56 0:30:53
35 09/08/2016 580/A/16 9:01:02 9:32:24 0:31:22
36 09/08/2016 584/A/16 9:01:54 10:02:31 1:00:37
37 09/08/2016 328/U/16 10:02:13 10:34:01 0:31:48
38 10/08/2016 585/A/16 8:01:13 10:01:36 2:00:23
39 10/08/2016 573/D/16 8:02:24 8:30:33 0:28:09
40 10/08/2016 586/A/16 9:01:34 9:31:13 0:29:39
41 10/08/2016 587/A/16 11:02:12 11:03:19 0:01:07
42 10/08/2016 588/A/16 12:02:24 14:03:14 2:00:50
43 11/08/2016 574/D/16 8:01:31 8:30:56 0:29:25
44 11/08/2016 329/U/16 8:02:23 10:02:01 1:59:38
45 11/08/2016 575/D/16 8:03:01 10:03:24 2:00:23
46 11/08/2016 576/D/16 8:03:56 10:04:23 2:00:27
47 11/08/2016 589/A/16 8:04:08 10:05:45 2:01:37
48 12/08/2016 590/A/16 8:00:21 10:00:13 1:59:52
49 12/08/2016 577/D/16 8:02:13 10:01:32 1:59:19
50 12/08/2016 591/A/16 8:03:36 9:00:21 0:56:45
51 12/08/2016 592/A/16 8:03:58 10:01:34 1:57:36
52 12/08/2016 593/A/16 8:04:13 9:23:33 1:19:20
53 12/08/2016 578/D/16 8:05:44 9:34:34 1:28:50
54 12/08/2016 594/A/16 9:02:03 11:01:24 1:59:21
 LAYANAN RADIOLOGI DAN PENCITRAAN DIGNOSTIC
Waktu Tunggu Hasil Pelayanan Thorax Foto untuk Pasien Rawat Inap

NO JAM JAM LAMA

NO TANGGAL KETERANGAN
TRANSAKSI TRANSAKSI SELESAI WAKTU
1 04/08/2016 70 U 13:47:23 14:28:42 0:41:19
2 05/08/2016 71 U 08:36:09 09:29:18 0:53:09
3 09/08/2016 174 B 09:32:27 10:09:55 0:37:28
4 11/08/2016 72 U 11:18:54 11:47:41 0:28:47
5 12/08/2016 178 B 13:32:46 14:13:45 0:40:59
6 13/08/2016 180B 10:27:24 11:14:36 0:47:12
7 18/08/2016 74 U 09:43:36 10:22:09 0:38:33
8 23/08/2016 188 B 12:17:49 13:08:53 0:51:04
9 27/08/2016 194 B 10:04:10 10:58:15 0:54:05
6:32:36
392
43.6
 PROSEDUR BEDAH
Kepatuhan Pelaksanaan Sign In, Time Out, dan Sign Out

SIGN IN TIME OUT SIGN OUT

NO REKAM
NO TANGGAL TIDAK LENGKAP TIDAK TIDAK
MEDIS LENGKAP LENGKAP LENGKAP LENGKAP LENGKAP

1 01/08/2016 21769 1 1 1
2 01/08/2016 21759 1 1 1
3 02/08/2016 21773 1 1 1
4 02/08/2016 21778 1 1 1
5 03/08/2016 19632 1 1 1
6 04/08/2016 21685 1 1 1
7 04/08/2016 21790 1 1 1
8 05/08/2016 21797 1 1 1
9 08/08/2016 21810 1 1 1
10 09/08/2016 21820 1 1 1
11 10/08/2016 21825 1 1 1
12 10/08/2016 21818 1 1 1
13 10/08/2016 19688 1 1 1
14 10/08/2016 21843 1 1 1
15 10/08/2016 21824 1 1 1
16 10/08/2016 21839 1 1 1
17 12/08/2016 21855 1 1 1
18 13/08/2016 21860 1 1 1
19 13/08/2016 21864 1 1 1
20 13/08/2016 21867 1 1 1
21 15/08/2016 21874 1 1 1
22 15/08/2016 21882 1 1 1
23 16/08/2016 21902 1 1 1
24 17/08/2016 21908 1 1 1
25 17/08/2016 18192 1 1 1
26 18/08/2016 21912 1 1 1
27 19/08/2016 21660 1 1 1
28 19/08/2016 21929 1 1 1
29 20/08/2016 21928 1 1 1
30 20/08/2016 21933 1 1 1
31 20/08/2016 21943 1 1 1
32 21/08/2016 21942 1 1 1
33 22/08/2016 21947 1 1 1
34 22/08/2016 21895 1 1 1
35 22/08/2016 21954 1 1 1
36 23/08/2016 18482 1 1 1
37 23/08/2016 21962 1 1 1
38 23/08/2016 21850 1 1 1
39 25/08/2016 21983 1 1 1
40 25/08/2016 21859 1 1 1
41 26/08/2016 21001 1 1 1
42 26/08/2016 22004 1 1 1
43 27/08/2016 22008 1 1 1
44 28/08/2016 22013 1 1 1
45 28/08/2016 22020 1 1 1
46 28/08/2016 21917 1 1 1
47 29/08/2016 22030 1 1 1
48 29/08/2016 22032 1 1 1
49 30/08/2016 22036 1 1 1
50 31/08/2016 22041 1 1 1

KETERANGAN:
Lengkap : 68.00
Tidak Lengkap : 32.00

KETERANGAN:
Lengkap : 71.43
Tidak Lengkap : 28.57
KETERANGAN

L
L
L

L
L

L
L
L
L
L

L
L

L
L

L
L
L
L

L
L

L
L
L
L

L
L
L
L
L
L
L

L
 PENGGUNAAN ANTIBIOTIK DAN PENGOBATAN LAIN
Penulisan Resep Obat tidak Sesuai Formularium

JUMLAH R/ SESUAI JUMLAH R/ NON PARAF

NO TANGGAL FORMULARIUM FORMULARIUM PETUGAS

1 01/08/2016 23 1
2 02/08/2016 13 1
3 03/08/2016 15
4 04/08/2016 8 2
5 05/08/2016 8 1
6 06/08/2016 15
7 07/08/2016 9 2
8 08/08/2016 21 4
9 09/08/2016 15
10 10/08/2016 15 2
11 11/08/2016 24 1
12 12/08/2016 23 2
13 13/08/2016 13 1
14 14/08/2016 12
15 15/08/2016 24 4
16 16/08/2016 23 5
17 17/08/2016 16
18 18/08/2016 28 3
19 19/08/2016 18 1
20 20/08/2016 14
21 21/08/2016 12
22 22/08/2016 31 4
23 23/08/2016 22 2
24 24/08/2016 14
25 25/08/2016 13
26 26/08/2016 31 2
27 27/08/2016 21 2
28 28/08/2016 21
29 29/08/2016 20 4
30 30/08/2016 25
31 31/08/2016 12
Jumlah 559 44 603
Prosentase 92.7 7.3
 KESALAHAN OBAT DAN KEJADIAN NYARIS CIDERA
Kesalahan Obat dan Kejadian Nyaris Cidera

RAWAT INAP / PARAF

NO TANGGAL KESALAHAN KETERANGAN
RAWAT JALAN PETUGAS

1 01/08/2016 Sigma tidak lengkap

2 02/08/2016 Nihil
3 03/08/2016 Nihil
4 04/08/2016 Nihil
5 05/08/2016 Sigma tidak lengkap
6 06/08/2016 Sigma tidak lengkap
7 07/08/2016 Sigma tidak lengkap
8 08/08/2016 Nihil
9 09/08/2016 Nihil
10 10/08/2016 Sigma tidak lengkap
11 11/08/2016 Nihil
12 12/08/2016 Sigma tidak lengkap
13 13/08/2016 Sigma tidak lengkap
14 14/08/2016 Nihil
15 15/08/2016 Nihil
16 16/08/2016 Nihil
17 17/08/2016 Sigma tidak lengkap
18 18/08/2016 Sigma tidak lengkap
19 19/08/2016 Nihil
20 20/08/2016 Nihil
21 21/08/2016 Nihil
22 22/08/2016 Sigma tidak lengkap
23 23/08/2016 Sigma tidak lengkap
24 24/08/2016 Sigma tidak lengkap
25 25/08/2016 Nihil
26 26/08/2016 Sigma tidak lengkap
27 27/08/2016 Nihil
 28 28/08/2016 Sigma tidak lengkap
29 29/08/2016 Nihil
30 30/08/2016 Nihil
31 31/08/2016 Sigma tidak lengkap

Keterangan
Jumlah kesalahan penulisan resep/jumlah seluruh resep = 16/31x100% = 51.6%
 PENGGUNAAN ANESTESI DAN SEDASI
Evaluasi Persiapan Pre Anastesi pada Pasien Operasi Elektif dengan
Anastesi Umum

NO REKAM PERSIAPAN PRE ANESTHESI

NO TANGGAL MEDIS
LENGKAP TIDAK LENGKAP
1 01/08/2016 1
2 01/08/2016 1
3 02/08/2016 1
4 04/08/2016 1
5 11/08/2016 1
6 12/08/2016 1
7 12/08/2016 1
8 12/08/2016 1
9 13/08/2016 1
10 13/08/2016 1
11 14/08/2016 1
12 14/08/2016 1
13 14/08/2016 1
14 14/08/2016 1
15 15/08/2016 1
16 15/08/2016 1
17 15/08/2016 1
18 16/08/2016 1
19 16/08/2016 1
20 17/08/2016 1
21 17/08/2016 1
22 18/08/2016 1
23 19/08/2016 1
24 19/08/2016 1
25 19/08/2016 1
26 20/08/2016 1
27 20/08/2016 1
28 20/08/2016 1
29 21/08/2016 1
30 21/08/2016 1
31 21/08/2016 1
32 22/08/2016 1
33 23/08/2016 1
34 23/08/2016 1
35 24/08/2016 1
36 24/08/2016 1
37 24/08/2016 1
38 25/08/2016 1
39 27/08/2016 1
40 30/08/2016 1
41 31/08/2016 1
42 31/08/2016 1
Jumlah 34 8
Prosentase 81.0 19.0
 PENGGUANAAN DARAH PRODUK DARAH
Monitoring Reaksi Transfusi

NO REKAM RUANG
NO TANGGAL REAKSI TRANSFUSI GOL. DARAH DIAGNOSIS KETERANGAN
MEDIS RAWAT
KETERSEDIAAN ISI DAN PENGGUNAAN CATATAN TENTANG PASIEN
Ketepatan Pengambilan Berkas RM Lengkap ≤2x24 Jam Setelah Selesai Pelayanan Rawat Inap

DIKIRIM 48 JAM
KELENGKAPAN SETELAH BPL
NAMA
NO TANGGAL NO. RM DPJP RUANG
PASIEN
TIDAK
LENGKAP LENGKAP YA TIDAK

1 01/08/2016 21688 1
2 21669 1
3 21711 1
4 21662 1
5 21614 1
6 21636 1
7 21728 1
8 21729 1
9 21731 1
10 21743 1
11 21734 1
12 21750 1
13 21752 1
14 21632 1
15 21673 1
16 02/08/2016 21747 1
17 21699 1
18 21751 1
19 03/08/2016 21720 1
20 21594 1
21 21707 1
22 21599 1
23 21171 1
24 21570 1
25 21663 1
26 21577 1
27 21456 1
28 21398 1
29 21735 1
30 21657 1
31 21546 1
32 21693 1
33 04/08/2016 21774 1
34 21684 1
35 21732 1
36 21741 1
37 21719 1
38 21771 1
39 21760 1
40 21756 1
41 21766 1
42 20538 1
43 21708 1
44 18026 1
45 20647 1
46 21745 1
47 21676 1
48 18723 1
49 21670 1
50 16678 1
51 21646 1
52 21753 1
53 21750 1
54 05/08/2016 21703 1
55 21544 1
56 21733 1
57 16093 1
58 19632 1
59 21778 1
60 21138 1
61 10870 1
62 19937 1
63 21643 1
64 06/08/2016 21776 1
65 21791 1
66 21779 1
67 07/08/2016 21796 1
68 21798 1
69 21792 1
70 21730 1
71 08/08/2016 21787 1
72 21802 1
73 09/08/2016 12434 1
74 21775 1
75 21797 1
76 21685 1
77 21728 1
78 21636 1
79 21806 1
80 21790 1
 81 21773 1
82 19726 1
83 21740 1
84 10/08/2016 19937 1
85 13415 1
86 21815 1
87 11/08/2016 21810 1
88 21795 1
89 21821 1
90 21820 1
91 21799 1
92 21769 1
93 12/08/2016 21828 1
94 21827 1
95 21826 1
96 15/08/2016 21848 1
97 15622 1
98 21853 1
99 21853 1
100 21857 1
101 21866 1
102 21862 1
103 21868 1
104 21847 1
105 21789 1
106 20126 1
107 19/08/2016 10205 1
108 15660 1
109 21803 1
110 21784 1
111 21785 1
112 21786 1
113 21983 1
114 21910 1
115 21909 1
116 22/08/2016 21571 1
117 21590 1
118 21695 1
119 21681 1
120 21611 1
121 23/08/2016 21944 1
122 21946 1
123 24/08/2016 21956 1
124 21926 1
125 29/08/2016 22010 1
126 21993 1
127 21984 1
128 22002 1
129 30/08/2016 22009 1
130 22014 1
131 22021 1
132 22023 1
133 21955 1
134 21960 1
135 19937 1
136 15055 1
137 21907 1
138 21916 1
139 16046 1
65 74
141 46.8 53.2
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
KETERANGAN
PENCEGAHAN, PENGENDALIAN, PENGWASAN, SERTA PELAPORAN INFEKSI
Angka Kejadian Plebitis

Plebitis
No. Rungan
Plebitis Jumlh Hari IVL ‰
1 KARTIKA 0.0
2 BRAWIJAYA 0.0
3 HESTI 0.0
4 PERINATOLOGI 0.0
5 HCU 0.0
Jumlah 0 0 0.0
 PENGGADAAN SERTA SUPLAI OBAT-OBATAN PENTING BAGI PASIEN YANG DI BUTUHKAN SECARA
RUTIN
Kekosongan Stok Obat Formularium

NAMA OBAT FORMULARIUM YANG PARAF

NO TANGGAL KETERANGAN
KOSONG PETUGAS

01/08/2016 Nihil
02/08/2016 Nihil
03/08/2016 Nihil
04/08/2016 Nihil
05/08/2016 Nihil
06/08/2016 Nihil
07/08/2016 Nihil
08/08/2016 Nihil
09/08/2016 Nihil
10/08/2016 Nihil
11/08/2016 Nihil
12/08/2016 Nihil
13/08/2016 Nihil
14/08/2016 Nihil
15/08/2016 Nihil
16/08/2016 Nihil
17/08/2016 Nihil
18/08/2016 ondancentron inj pengiriman terlambat
19/08/2016 Nihil
20/08/2016 Nihil
21/08/2016 Nihil
22/08/2016 Nihil
23/08/2016 Nihil
24/08/2016 Nihil
25/08/2016 Nihil
26/08/2016 Nihil
27/08/2016 Nihil
28/08/2016 Nihil
29/08/2016 Nihil
30/08/2016 Nihil
31/08/2016 Nihil
3.2
 KEGIATAN PELAPORAN (YANG DIATUR OLEH UNDANG-UNDANG)
Ketepatan Waktu Pengiriman Laporan Penggunan Narkotika

TANGGAL PENGIRIMAN PARAF

NO BULAN KETERANGAN
LAPORAN NARKOTIKA PETUGAS

1 Agustus 08 Agustus 2016

 MANEGEMENT RESIKO
Peralatan Ukur Medis yang Terkalibrasi Tepat Waktu

UNIT:

TAHUN KETENTUAN WAKTU TANGGAL REALISASI RENCANA KALIBRASI

NO NAMA ALAT MEDIS KONDISI ALAT
PEROLEHAN KALIBRASI KALIBRASI Y.A.D.
 MANEGEMENT UTILISASI
Pemanfaatan Ruang HCU untuk Pasien yang Membutuhkan Perawatan Intensif
tan Intensif
HARAPAN DAN KEPUASAN PASIEN DAN KELUARGA
Survei Tinkat Kepuasan Pasien
HARAPAN DAN KEPUASAN STAFF
Survei Tingkat Kepuasan Pegawai
DEMOGRAFI PASIEN DAN DIAGNOSA KLINIS
Identifikasi Pasien Potensial Wabah Berdasarkan Alamat Tempat Tinggal
 MANAGEMEN KEUANGAN
Kecepatan waktu pemberian informasi tentang tagihan pasien rawat inap

BULAN:
KETENTUAN REALISASI
NO REKAM RUANG
NO TANGGAL WAKTU WAKTU PETUGAS
MEDIS RAWAT TAGIHAN TAGIHAN
 PENCEGAHAN DAN PENGENDALIAN DARI KEJADIAN YANG DAPAT MENIMBULKAN MASLAH BAGI
KELSELAMATAN PASEN, KELUARGA PASIEN DAN STAFF
Inseden Tertusuk Jarum

TANGGA
NO NAMA PETUGAS KRONOLOGIS TEMPAT KEJADIAN TINDAK LANJUT
L
 KETETAPAN IDENTIFIKASI PASIEN
Kepatuhan Identifikasi Pasien di Ruang Rawat Inap

UNIT: BULAN JUNI 2018

PETUGAS PETUGAS
NO TANGGAL PELAKSANAAN YANG KETERANGAN
SURVEY
DISURVEY
Betul Salah
1 6/1/2018 V Santi
2 6/1/2018 V Santi
3 6/1/2018 V Jeni
4 6/1/2018 V Melen
5 6/2/2018 V Sinta
6 6/2/2018 V Aprilia
7 6/3/2018 V Aprilia
8 6/3/2018 V Aprilia
9 6/3/2018 V Rustam
10 6/3/2018 V Rustam
11 6/3/2018 V Dwi Wahyu
12 6/3/2018 V Jeni
13 6/4/2018 V Ulin
14 6/4/2018 V Arlinda
15 6/4/2018 V Risky
16 6/4/2018 V Dwi WAhyu
17 6/4/2018 V Dwi WAhyu
18 6/4/2018 V Siti A.
19 6/4/2018 V Siti A.
20 6/5/2018 V Risky
21 6/5/2018 V Aprilia
22 6/5/2018 V Santi
23 6/5/2018 V Aprilia
24 6/5/2018 V Jeni
25 6/6/2018 V Rustam
26 6/6/2018 V Santi
27 6/6/2018 V Ayuk
28 6/6/2018 V Sugiarto
29 6/6/2018 V Aprilia
30 6/6/2018 V Aprilia
31 6/6/2018 V Aprilia
32 6/6/2018 V Dwi W.
33 6/6/2018 V Dwi W.
34 6/6/2018 V Melen
35 6/6/2018 V Melen
36 6/7/2018 V Aprilia
37 6/7/2018 V Ayuk
38 6/7/2018 V Tyas
39 6/7/2018 V Dwi W.
40 6/7/2018 V TYas
41 6/7/2018 V Melen
42 6/8/2018 V Ulin
43 6/8/2018 V Ulin
44 6/8/2018 V Tyas
45 6/8/2018 V Tyas
46 6/8/2018 V Siti A.
47 6/8/2018 V Sinta
48 6/8/2018 V Sinta
49 6/8/2018 V Santi
50 6/8/2018 V Santi
51 6/8/2018 V Santi
52 6/8/2018 V Melen
53 6/9/2018 V Siti A.
54 6/9/2018 V Santi
55 6/10/2018 V Gugut
56 6/10/2018 V Dwi W.
57 6/10/2018 V Dwi W.
58 6/10/2018 V SInta
59 6/11/2018 V Risky
60 6/11/2018 V Siti A.
61 6/11/2018 V Siti A.
62 6/11/2018 V Santi
63 6/12/2018 V Melen
64 6/15/2018 V Tyas
65 6/16/2018 V Aprilia
66 6/16/2018 V Aprilia
67 6/16/2018 V Ulin
68 6/16/2018 V Ulin
69 6/16/2018 V Sinta
70 6/16/2018 V SInta
71 6/17/2018 V Hadi S.
72 6/18/2018 V Risky
73 6/18/2018 V Risky
74 6/18/2018 V Sinta
75 6/18/2018 V Sinta
76 6/18/2018 V Ulin
77 6/20/2018 V Aprilia
78 6/21/2018 V Siti A.
79 6/21/2018 V Jeni
80 6/21/2018 V Melen
81 6/21/2018 V Aprilia
82 6/22/2018 V Aprilia
 83 6/22/2018 V Aprilia
84 6/22/2018 V Risky
85 6/22/2018 V Risky
86 6/23/2018 V Santi
87 6/24/2018 V Gugut
88 6/24/2018 V Gugut
89 6/24/2018 V Rustam
90 6/24/2018 V Jeni
91 6/24/2018 V Jeni
92 6/25/2018 V Aprilia
93 6/25/2018 V Aprilia
94 6/25/2018 V Melen
95 6/25/2018 V Jeni
96 6/25/2018 V Jeni
97 6/25/2018 V Siti A
98 6/25/2018 V Siti A
99 6/25/2018 V Risky
100 6/26/2018 V Aprilia
101 6/26/2018 V Dwi W.
102 6/26/2018 V Aprilia
103 6/26/2018 V Aprilia
104 6/26/2018 V Jeni
105 6/26/2018 V Jeni
106 6/26/2018 V Sinta
107 6/26/2018 V Sinta
108 6/26/2018 V Ulin
109 6/26/2018 V Melen
110 6/27/2018 V Dwi W.
111 6/27/2018 V Tyas
112 6/28/2018 V Aprilia
113 6/28/2018 V Santi
114 6/28/2018 V Santi
115 6/28/2018 V Aprilia
116 6/28/2018 V Ulin
117 6/28/2018 V Ulin
118 6/28/2018 V Risky
119 6/29/2018 V Gugut
120 6/29/2018 V Gugut
121 6/29/2018 V Sinta
122 6/29/2018 V Sinta
123 6/29/2018 V Risky
124 6/29/2018 V Risky
125 6/29/2018 V Ulin
126 6/30/2018 V Sinta
127 6/30/2018 V Melen
 KETETAPAN IDENTIFIKASI PASIEN
Kepatuhan Identifikasi Pasien di Ruang Rawat Inap

UNIT: BULAN JULI 2018

PETUGAS PETUGAS
NO TANGGAL PELAKSANAAN YANG KETERANGAN
SURVEY
DISURVEY
Betul Salah
1 7/1/2018 V Aprilia
2 7/2/2018 V Aprilia
3 7/2/2018 V Aprilia
4 7/2/2018 V Hadi S.
5 7/2/2018 V Hadi S.
6 7/2/2018 V Jeni
7 7/2/2018 V Ulin
8 7/3/2018 V Aprilia
9 7/3/2018 V Aprilia
10 7/3/2018 V Risky
11 7/3/2018 V Risky
12 7/3/2018 V Jeni
13 7/3/2018 V Jeni
14 7/3/2018 V Gugut
15 7/3/2018 V Gugut
16 7/3/2018 V ULin
17 7/3/2018 V Ulin
18 7/3/2018 V Melen
19 7/3/2018 V Sinta
20 7/4/2018 V Aprilia
21 7/4/2018 V Ardian Dyah
22 7/4/2018 V Aprilia
23 7/4/2018 V Jeni
24 7/4/2018 V Melen
25 7/4/2018 V Jeni
26 7/4/2018 V Santi
27 7/4/2018 V Santi
28 7/4/2018 V Dwi W.
29 7/4/2018 V Dwi W.
30 7/5/2018 V Siti A.
31 7/5/2018 V Sinta
32 7/5/2018 V Siti A.
33 7/5/2018 V Risky
34 7/6/2018 V Aprilia
35 7/6/2018 V Aprilia
36 7/6/2018 V Rustam
37 7/6/2018 V Rustam
38 7/6/2018 V Ulin
39 7/6/2018 V Ulin
40 7/6/2018 V Jeni
41 7/7/2018 V Ulin
42 7/8/2018 V Aprilia
43 7/9/2018 V Santi
44 7/9/2018 V Aprilia
45 7/9/2018 V Aprilia
46 7/9/2018 V Tyas
47 7/9/2018 V Tyas
48 7/9/2018 V Dwi W.
49 7/9/2018 V Jeni
50 7/9/2018 V Jeni
51 7/10/2018 V Sinta
52 7/10/2018 V Sinta
53 7/10/2018 V Risky
54 7/10/2018 V UlinRustam
55 7/10/2018 V Hadi S.
56 7/10/2018 V Hadi S.
57 7/10/2018 V Melen
58 7/10/2018 V Tyas
59 7/10/2018 V Risky
60 7/11/2018 V Aprilia
61 7/11/2018 V Rustam
62 7/11/2018 V Tyas
63 7/12/2018 V Aprilia
64 7/13/2018 V Sugiarto
65 8/13/2018 V Sugiarto
66 9/13/2018 V Siti A.
67 10/13/2018 V Hadi S.
68 7/14/2018 V Aprilia
69 7/14/2018 V Aprilia
70 7/14/2018 V Aprilia
71 7/14/2018 V Ulin
72 7/14/2018 V Ulin
73 7/14/2018 V Ulin
74 7/15/2018 V Aprilia
75 7/15/2018 V Aprilia
76 7/15/2018 V Melen
77 7/15/2018 V Sinta
78 7/15/2018 V Sinta
79 7/15/2018 V Tyas
80 7/15/2018 V Tyas
 81 7/16/2018 V Arlinda
82 7/16/2018 V Aprilia
83 7/16/2018 V Aprilia
84 7/16/2018 V Melen
85 7/16/2018 V Melen
86 7/17/2018 V Tyas
87 7/17/2018 V Tyas
88 7/17/2018 V Jeni
89 7/17/2018 V Jeni
90 7/18/2018 V Dwi W.
91 7/18/2018 V Tyas
92 7/18/2018 V Risky
93 7/18/2018 V Santi
94 7/19/2018 V Aprilia
95 7/19/2018 V Rustam
96 7/19/2018 V Siti A.
97 7/20/2018 V Aprilia
98 7/20/2018 V Aprilia
99 7/20/2018 V Ulin
100 7/20/2018 V Ulin
101 7/20/2018 V Ulin
102 7/20/2018 V Risky
103 7/20/2018 V Risky
104 7/20/2018 V Santi
105 7/20/2018 V Jeni
106 7/20/2018 V Jeni
107 7/21/2018 V Sinta
108 7/21/2018 V Melen
109 7/21/2018 V Melen
110 7/21/2018 V Melen
111 7/22/2018 V Siti A.
112 7/22/2018 V Siti A.
113 7/22/2018 V Jeni
114 7/23/2018 V Aprilia
115 7/23/2018 V Melen
116 7/23/2018 V Aprilia
117 7/23/2018 V Jeni
118 7/23/2018 V Jeni
119 7/23/2018 V Tyas
120 7/23/2018 V Tyas
121 7/23/2018 V Melen
122 7/23/2018 V Risky
123 7/24/2018 V Aprilia
124 7/24/2018 V Aprilia
125 7/24/2018 V Ulin
126 7/24/2018 V Ulin
127 7/24/2018 V Melen
128 7/24/2018 V Melen
129 7/24/2018 V Dwi W.
130 7/24/2018 V Dwi W.
131 7/25/2018 V Rustam
132 7/25/2018 V Rustam
133 7/25/2018 V Jeni
134 7/25/2018 V Siti A.
135 7/25/2018 V Siti A.
136 7/25/2018 V Santi
137 7/25/2018 V Santi
138 7/26/2018 V Melen
139 7/26/2018 V Ardian D.
140 7/26/2018 V Aprilia
141 7/26/2018 V Santi
142 7/26/2018 V Jeni
143 7/26/2018 V Tyas
144 7/26/2018 V Dwi W.
145 7/27/2018 V Aprilia
146 7/27/2018 V Aprilia
147 7/27/2018 V Dewi
148 7/27/2018 V Dewi
149 7/27/2018 V Tyas
150 7/27/2018 V Tyas
151 7/27/2018 V Jeni
152 7/28/2018 V Dewi
153 7/28/2018 V Dewi
154 7/29/2018 V Rustam
155 7/29/2018 V Sugiarto
156 7/29/2018 V Santi
157 7/29/2018 V Santi
158 7/29/2018 V Melen
159 7/30/2018 V Aprilia
160 7/30/2018 V Dwi W.
161 7/30/2018 V Dewi
162 7/30/2018 V Melen
163 7/30/2018 V Melen
164 7/31/2018 V Sugiarto
165 7/31/2018 V Desiana
166 7/31/2018 V Dewi
167 7/31/2018 V Tyas
168 7/31/2018 V Sinta
169 7/31/2018 V Risky
 KETETAPAN IDENTIFIKASI PASIEN
Kepatuhan Identifikasi Pasien di Ruang Rawat Inap

UNIT: BULAN AGUSTUS 2018

PETUGAS PETUGAS
NO TANGGAL PELAKSANAAN YANG KETERANGAN
SURVEY
DISURVEY
Betul Salah
1 8/1/2018 V Tyas
2 8/1/2018 V Tyas
3 8/1/2018 V Jeni
4 8/1/2018 V Jeni
5 8/2/2018 V Melen
6 8/2/2018 V Aprilia
7 8/2/2018 V Aprilia
8 8/2/2018 V Dewi
9 8/2/2018 V Santi
10 8/2/2018 V Dewi
11 8/2/2018 V Dwi W.
12 8/2/2018 V Rustam
13 8/3/2018 V Aprilia
14 8/3/2018 V Aprilia
15 8/3/2018 V Dewi
16 8/3/2018 V Dewi
17 8/3/2018 V Rustam
18 8/4/2018 V Sugiarto
19 8/4/2018 V Sugiarto
20 8/4/2018 V Aprilia
21 8/4/2018 V Jeni
22 8/4/2018 V Jeni
23 8/5/2018 V Rustam
24 8/5/2018 V Sugiarto
25 8/5/2018 V Tyas
26 8/6/2018 V Dewi
27 8/6/2018 V Sinta
28 8/7/2018 V Jeni
29 8/7/2018 V Sinta
30 8/7/2018 V Aprilia
31 8/7/2018 V Dewi
32 8/7/2018 V Rustam
33 8/7/2018 V Rustam
34 8/7/2018 V Sugiarto
35 8/7/2018 V Tyas
36 8/8/2018 V Melen
37 8/8/2018 V Aprilia
38 8/8/2018 V Santi
39 8/8/2018 V Hadi S.
40 8/8/2018 V Rustam
41 8/9/2018 V TYas
42 8/9/2018 V Ulin
43 8/9/2018 V Jeni
44 8/10/2018 V Sugiarto
45 8/10/2018 V Aprilia
46 8/10/2018 V Jeni
47 8/11/2018 V Dewi
48 8/11/2018 V Risky
49 8/12/2018 V Tyas
50 8/12/2018 V Ulin
51 8/12/2018 V Jeni
52 8/12/2018 V Dewi
53 8/13/2018 V Melen
54 8/13/2018 V Aprilia
55 8/13/2018 V Sugiarto
56 8/13/2018 V Risky
57 8/13/2018 V Dwi W.
58 8/14/2018 V Hadi S.
59 8/14/2018 V Gugut
60 8/14/2018 V Aprilia
61 8/14/2018 V Dewi
62 8/14/2018 V Ulin
63 8/14/2018 V Risky
64 8/15/2018 V Herwin
65 8/15/2018 V Tyas
66 8/15/2018 V Siti A.
67 8/16/2018 V Tyas
68 8/16/2018 V Melen
69 8/17/2018 V Herwin
70 8/17/2018 V Dwi W.
71 8/17/2018 V Sugiarto
72 8/17/2018 V Melen
73 8/18/2018 V Santi
74 8/18/2018 V Melen
75 8/18/2018 V Tyas
76 8/18/2018 V Sinta
77 8/18/2018 V Siti A.
78 8/18/2018 V Dwi W.
79 8/19/2018 V Jeni
80 8/19/2018 V Risky
81 8/20/2018 V Aprilia
 82 8/20/2018 V Melen
83 8/20/2018 V Risky
84 8/21/2018 V Aprilia
85 8/22/2018 V Melen
86 8/22/2018 V Risky
87 8/22/2018 V Aprilia
88 8/23/2018 V Dwi W.
89 8/23/2018 V Aprilia
90 8/23/2018 V Gugut
91 8/23/2018 V Herwin
92 8/23/2018 V Tyas
93 8/23/2018 V Melen
94 8/23/2018 V Melen
95 8/24/2018 V Aprilia
96 8/24/2018 V Dwi W.
97 8/24/2018 V Herwin
98 8/24/2018 V Tyas
99 8/24/2018 V Risky
100 8/25/2018 V Sinta
101 8/25/2018 V Melen
102 8/25/2018 V Sinta
103 8/25/2018 V Jeni
104 8/25/2018 V Siti A.
105 8/26/2018 V Tyas
106 8/26/2018 V Arlinda
107 8/26/2018 V Siti A.
108 8/26/2018 V Risky
109 8/26/2018 V Santi
110 8/26/2018 V Jeni
111 8/26/2018 V Dwi W.
112 8/26/2018 V Dwi W.
113 8/27/2018 V Aprilia
114 8/28/2018 V Tyas
115 8/28/2018 V Jeni
116 8/28/2018 V Herwin
117 8/28/2018 V Santi
118 8/28/2018 V Sinta
119 8/28/2018 V Risky
120 8/28/2018 V Siti A.
121 8/29/2018 V Dian Dwi
122 8/29/2018 V Gugut
123 8/29/2018 V Sugiarto
124 8/29/2018 V Santi
125 8/29/2018 V Dwi W.
126 8/29/2018 V Siti A.
 127 8/30/2018 V Santi
128 8/30/2018 V Jeni
129 8/30/2018 V Jeni
130 8/30/2018 V Melen
131 8/30/2018 V Melen
132 8/30/2018 V Tyas
133 8/30/2018 V Tyas
134 8/30/2018 V Risky
135 8/30/2018 V Risky
136 8/30/2018 V Herwin
137 8/31/2018 V Aprilia
138 8/31/2018 V Gugut
139 8/31/2018 V Sugiarto
140 8/31/2018 V Hadi S.
141 8/31/2018 V Hadi S.
142 8/31/2018 V Melen
143 8/31/2018 V Siti A.
144 8/31/2018 V Santi
145 8/31/2018 V Jeni
146 8/31/2018 V Santi

KETETAPAN IDENTIFIKASI PASIEN

Kepatuhan Identifikasi Pasien di Ruang Rawat Inap

UNIT: BULAN SEPTEMBER 2018

PETUGAS PETUGAS
NO TANGGAL PELAKSANAAN YANG KETERANGAN
SURVEY
DISURVEY
Betul Salah Arlinda
1 9/1/2018 V Tyas
2 9/1/2018 V Melen
3 9/1/2018 V Sinta
4 9/2/2018 V Sinta Putri
5 9/2/2018 V Sugiarto
6 9/2/2018 V Sugiarto
7 9/2/2018 V Dwi W.
8 9/2/2018 V Santi
9 9/3/2018 V Jeni
10 9/3/2018 V Tyas
11 9/3/2018 V Santi
12 9/4/2018 V Aprilia
13 9/4/2018 V Rustam
14 9/4/2018 V Sugiarto
15 9/4/2018 V Jeni
16 9/4/2018 V Tyas
17 9/4/2018 V Herwin
18 9/5/2018 V Tyas
19 9/5/2018 V Herwin
20 9/5/2018 V Melen
21 9/5/2018 V Risky
22 9/5/2018 V Risky
23 9/5/2018 V Sinta
24 9/6/2018 V Sugiarto
25 9/6/2018 V Dwi W.
26 9/6/2018 V Hadi S.
27 9/7/2018 V Melen
28 9/7/2018 V Sinta
29 9/7/2018 V Jeni
30 9/7/2018 V Santi
31 9/8/2018 V Siti A.
32 9/8/2018 V Dwi W.
33 9/9/2018 V Ulin
34 9/9/2018 V Siti A.
35 9/9/2018 V Dwi W.
36 9/9/2018 V Santi
37 9/10/2018 V Melen
38 9/10/2018 V Melen
39 9/10/2018 V Retno
40 9/10/2018 V Siti A.
41 9/10/2018 V Jeni
42 9/10/2018 V Herwin
43 9/10/2018 V Santi
44 9/10/2018 V Ulin
45 9/10/2018 V Ulin
46 9/12/2018 V Hadi S.
47 9/12/2018 V Sugiarto
48 9/12/2018 V Gugut
49 9/12/2018 V Rustam
50 9/12/2018 V Jeni
51 9/12/2018 V Sinta
52 9/12/2018 V Tyas
53 9/13/2018 V Sinta
54 9/13/2018 V Tyas
55 9/13/2018 V Tyas
56 9/13/2018 V Herwin
57 9/13/2018 V Herwin
58 9/13/2018 V Melen
59 9/13/2018 V Sugiarto
 60 9/13/2018 V Rustam
61 9/13/2018 V Ulin
62 9/13/2018 V Ulin
63 9/13/2018 V Ulin
64 9/13/2018 V Tyas
65 9/13/2018 V Tyas
66 9/14/2018 V Herwin
67 9/14/2018 V Ulin
68 9/14/2018 V Sugiarto
69 9/14/2018 V Hadi S.
70 9/14/2018 V Melen
71 9/15/2018 V Hadi S.
72 9/15/2018 V Sugiarto
73 9/15/2018 V Sugiarto
74 9/15/2018 V Sinta
75 9/15/2018 V Sinta
76 9/15/2018 V Siti A.
77 9/16/2018 V Aprilia
78 9/16/2018 V Jeni
79 9/17/2018 V Ulin
80 9/17/2018 V Ulin
81 9/17/2018 V Tyas
82 9/17/2018 V Herwin
83 9/17/2018 V Melen
84 9/17/2018 V Santi
85 9/18/2018 V Desiana
86 9/18/2018 V Rustam
87 9/18/2018 V Hadi S.
88 9/18/2018 V Jeni
89 9/18/2018 V Tyas
90 9/19/2018 V Herwin
91 9/19/2018 V Herwin
92 9/19/2018 V Tyas
93 9/19/2018 V Dwi W.
94 9/19/2018 V Jeni
95 9/19/2018 V Ulin
96 9/20/2018 V Jeni
97 9/21/2018 V Tyas
98 9/21/2018 V Siti A.
99 9/22/2018 V Herwin
100 9/22/2018 V Tyas
101 9/22/2018 V Risky
102 9/22/2018 V Ulin
103 9/23/2018 V Hadi S.
104 9/23/2018 V Rustam
 105 9/24/2018 V Dwi W.
106 9/24/2018 V Siti A.
107 9/24/2018 V Risky
108 9/25/2018 V Melen
109 9/25/2018 V Ulin
110 9/25/2018 V Santi
111 9/26/2018 V Aprilia
112 9/26/2018 V Herwin
113 9/26/2018 V Jeni
114 9/26/2017 V Tyas
115 9/27/2018 V Dwi W.
116 9/27/2018 V Siti A.
117 9/27/2018 V Melen
118 9/27/2018 V Melen
119 9/27/2018 V Aprilia
120 9/28/2018 V Jeni
121 9/28/2018 V Tyas
122 9/28/2018 V Santi
123 9/29/2018 V Melen
124 9/29/2018 V Aprilia
125 9/30/2018 V Jeni
126 9/30/2018 V Risky

KETETAPAN IDENTIFIKASI PASIEN

Kepatuhan Identifikasi Pasien di Ruang Rawat Inap

UNIT: BULAN OKTOBER 2018

PETUGAS PETUGAS
NO TANGGAL PELAKSANAAN YANG KETERANGAN
SURVEY
DISURVEY
Betul Salah
1 10/1/2018 V Santi
2 10/1/2018 V Hadi S.
3 10/1/2018 V Sugiarto
4 10/2/2018 V Aprilia
5 10/2/2018 V Aprilia
6 10/2/2018 V Jeni
7 10/2/2018 V Rustam
8 10/2/2018 V Hadi S.
9 10/2/2018 V Dwi W.
10 10/3/2018 V Dewie
11 10/3/2018 V Evi C.
12 10/3/2018 V Aprilia
13 10/3/2018 V Rustam
14 10/3/2018 V Rustam
15 10/3/2018 V Jeni
16 10/3/2018 V Risky
17 10/3/2018 V Sinta
18 10/4/2018 V Dwi W.
19 10/4/2018 V Dwi W.
20 10/4/2018 V Sinta
21 10/4/2018 V Santi
22 10/4/2018 V Melen
23 10/5/2018 V Siti A.
24 10/5/2018 V Aprilia
25 10/5/2018 V Dewi
26 10/5/2018 V Dewi
27 10/5/2018 V Dian D.
28 10/5/2018 V Sinta
29 10/5/2018 V Sinta
30 10/5/2018 V Herwin
31 10/5/2018 V Sugiarto
32 10/5/2018 V Tyas
33 10/5/2018 V Tyas
34 10/5/2018 V Dwi W.
35 10/6/2018 V Hadi S.
36 10/6/2018 V Herwin
37 10/6/2018 V Melen
38 10/6/2018 V Melen
39 10/6/2018 V Ulin
40 10/7/2018 V Desiana
41 10/7/2018 V Jatik
42 10/7/2018 V Dea
43 10/8/2018 V Dewi
44 10/8/2018 V Ulin
45 10/8/2018 V Jeni
46 10/8/2018 V Tyas
47 10/9/2018 V Aprilia
48 10/9/2018 V Aprilia
49 10/9/2018 V Sugiarto
50 10/9/2018 V Evi C.
51 10/9/2018 V Dea
52 10/10/2018 V Dewi
53 10/11/2018 V Herwin
54 10/11/2018 V Dea
55 10/11/2018 V Ulin
56 10/11/2018 V Jeni
57 10/11/2018 V Siti S.
 58 10/12/2018 V Dewi
59 10/12/2018 V Ulin
60 10/14/2018 V Siti A.
61 10/14/2018 V Sinta
62 10/14/2018 V Santi
63 10/14/2018 V Jeni
64 10/14/2018 V Tyas
65 10/14/2018 V Tyas
66 10/14/2018 V Risky
67 10/15/2018 V Aprilia
68 10/15/2018 V Aprilia
69 10/15/2018 V Rustam
70 10/15/2018 V Sugiarto
71 10/15/2018 V Santi
72 10/15/2018 V Dea
73 10/15/2018 V Dea
74 10/16/2018 V Sinta
75 10/16/2018 V Sinta
76 10/16/2018 V Jeni
77 10/16/2018 V Dwi W.
78 10/16/2018 V Tyas
79 10/16/2018 V Tyas
80 10/17/2018 V Melen
81 10/17/2018 V Dea
82 10/17/2018 V Evi C.
83 10/17/2018 V Herwin
84 10/18/2018 V Siti A.
85 10/18/2018 V Siti A.
86 10/18/2018 V Santi
87 10/18/2018 V Sinta
88 10/18/2018 V Ulin
89 10/19/2018 V Aprilia
90 10/19/2018 V Dewi
91 10/19/2018 V Dewi
92 10/19/2018 V Santi
93 10/19/2018 V Jatik
94 10/19/2018 V Rustam
95 10/19/2018 V Sugiarto
96 10/19/2018 V Jeni
97 10/20/2018 V Santi
98 10/20/2018 V Dwi W.
99 10/21/2018 V Sugiarto
100 10/21/2018 V Sugiarto
101 10/21/2018 V Herwin
102 10/22/2018 V Aprilia
103 10/22/2018 V Aprilia
104 10/22/2018 V Tyas
105 10/22/2018 V Jeni
106 10/22/2018 V Jeni
107 10/23/2018 V Aprilia
108 10/23/2018 V Aprilia
109 10/23/2018 V Tyas
110 10/23/2018 V Jeni
111 10/23/2018 V Tyas
112 10/23/2018 V Herwin
113 10/23/2018 V Dea
114 10/24/2018 V Santi
115 10/24/2018 V Sinta
116 10/24/2018 V Santi
117 10/24/2018 V Sinta
118 10/24/2018 V Dwi W.
119 10/24/2018 V Jeni
120 10/24/2018 V Dwi W.
121 10/25/2018 V Dewi
122 10/25/2018 V Herwin
123 10/25/2018 V Uin
124 10/25/2018 V Tyas
125 10/26/2018 V Tyas
126 10/26/2018 V Jeni
127 10/27/2018 V Melen
128 10/27/2018 V Risky
129 10/28/2018 V DEa
130 10/28/2018 V Evi C.
131 10/28/2018 V Sugiarto
132 10/29/2018 V Sinta
133 10/29/2018 V Siti A.
134 10/29/2018 V Ulin
135 10/29/2018 V Ulin
136 10/29/2018 V Dewi
137 10/29/2018 V Santi
138 10/29/2018 V Herwin
139 10/30/2018 V Gugut
140 10/30/2018 V Gugut
141 10/30/2018 V Rustam
142 10/30/2018 V Sugiarto
143 10/31/2018 V Dewi
144 10/31/2018 V Dewi
145 10/31/2018 V Ulin
146 10/31/2018 V Jeni
147 10/31/2018 V Risky
148 10/31/2018 V Melen
 PENINGKATAN KOMUNIKASI EFEKTIF

Kepatuhan penerapan komunikasi dengan metode TUBAK (Tulis, baca , konfirmasi) pada saat menerima perintah /
instruksi lisan atau melalui telepon dan melaporkan hasil kritis pemeriksaan penunjang pasien secara verbal melalui
telepon

SURVEY HARIAN PELAKSANAAN VERIFIKASI KOMUNIKASI

UNIT: BULAN JUNI 2018
TANGGAL NO REKAM TANGGAL VERIFIKASI PETUGAS
NO KETERANGAN
SURVEY MEDIS KOMUNIKASI YA TIDAK SURVEY

1 6/1/2018 028206 6/1/2018 V

2 6/1/2018 028208 6/1/2018 V
3 6/1/2018 028205 6/1/2018 V
4 6/1/2018 028210 6/1/2018 V
5 6/2/2018 028212 6/2/2018 V
6 6/2/2018 024758 6/2/2018 V
7 6/3/2018 028215 6/3/2018 V
8 6/3/2018 028214 6/3/2018 V
9 6/3/2018 025815 6/3/2018 V
10 6/3/2018 028219 6/3/2018 V
11 6/3/2018 028223 6/3/2018 V
12 6/3/2018 028225 6/3/2018 V
13 6/4/2018 025803 6/4/2018 V
14 6/4/2018 028137 6/4/2018 V
15 6/4/2018 028227 6/4/2018 V
16 6/4/2018 028238 6/4/2018 V
17 6/4/2018 028228 6/4/2018 V
18 6/4/2018 028232 6/4/2018 V
19 6/4/2018 028240 6/4/2018 V
20 6/5/2018 028254 6/5/2018 V
21 6/5/2018 026266 6/5/2018 V
22 6/5/2018 028250 6/5/2018 V
23 6/5/2018 027476 6/5/2018 V
24 6/5/2018 028258 6/5/2018 V
25 6/6/2018 027287 6/6/2018 V
26 6/6/2018 026699 6/6/2018 V
27 6/6/2018 028262 6/6/2018 V
28 6/6/2018 028245 6/6/2018 V
29 6/6/2018 027721 6/6/2018 V
30 6/6/2018 028270 6/6/2018 V
31 6/6/2018 028267 6/6/2018 V
32 6/6/2018 027922 6/6/2018 V
33 6/6/2018 028261 6/6/2018 V
34 6/6/2018 028265 6/6/2018 V
35 6/6/2018 026967 6/6/2018 V
36 6/7/2018 017795 6/7/2018 V
37 6/7/2018 028280 6/7/2018 V
38 6/7/2018 028279 6/7/2018 V
39 6/7/2018 028277 6/7/2018 V
40 6/7/2018 025716 6/7/2018 V
41 6/7/2018 028273 6/7/2018 V
42 6/8/2018 028282 6/8/2018 V
43 6/8/2018 028281 6/8/2018 V
44 6/8/2018 028287 6/8/2018 V
45 6/8/2018 016079 6/8/2018 V
46 6/8/2018 028292 6/8/2018 V
47 6/8/2018 028294 6/8/2018 V
48 6/8/2018 028291 6/8/2018 V
49 6/8/2018 028288 6/8/2018 V
50 6/8/2018 028277 6/8/2018 V
51 6/8/2018 028288 6/8/2018 V
52 6/8/2018 028283 6/8/2018 V
53 6/9/2018 026453 6/9/2018 V
54 6/9/2018 028297 6/9/2018 V
55 6/10/2018 021077 6/10/2018 V
56 6/10/2018 028301 6/10/2018 V
57 6/10/2018 028306 6/10/2018 V
58 6/10/2018 028305 6/10/2018 V
59 6/11/2018 025759 6/11/2018 V
60 6/11/2018 028314 6/11/2018 V
61 6/11/2018 028310 6/11/2018 V
62 6/11/2018 028316 6/11/2018 V
63 6/12/2018 028319 6/12/2018 V
64 6/15/2018 028337 6/15/2018 V
65 6/16/2018 028341 6/16/2018 V
66 6/16/2018 016595 6/16/2018 V
67 6/16/2018 026966 6/16/2018 V
68 6/16/2018 028340 6/16/2018 V
69 6/16/2018 028338 6/16/2018 V
70 6/16/2018 015660 6/16/2018 V
71 6/17/2018 028347 6/17/2018 V
72 6/18/2018 016316 6/18/2018 V
73 6/18/2018 028350 6/18/2018 V
74 6/18/2018 028351 6/18/2018 V
75 6/18/2018 015660 6/18/2018 V
76 6/18/2018 024758 6/18/2018 V
77 6/20/2018 028357 6/20/2018 V
78 6/21/2018 028359 6/21/2018 V
79 6/21/2018 027348 6/21/2018 V
80 6/21/2018 028368 6/21/2018 V
81 6/21/2018 027855 6/21/2018 V
82 6/22/2018 028383 6/22/2018 V
83 6/22/2018 028371 6/22/2018 V
84 6/22/2018 028376 6/22/2018 V
85 6/22/2018 016590 6/22/2018 V
86 6/23/2018 028388 6/23/2018 V
87 6/24/2018 021895 6/24/2018 V
88 6/24/2018 028391 6/24/2018 V
89 6/24/2018 028253 6/24/2018 V
 90 6/24/2018 028393 6/24/2018 V
91 6/24/2018 028392 6/24/2018 V
92 6/25/2018 026701 6/25/2018 V
93 6/25/2018 028370 6/25/2018 V
94 6/25/2018 028395 6/25/2018 V
95 6/25/2018 028372 6/25/2018 V
96 6/25/2018 022510 6/25/2018 V
97 6/25/2018 026319 6/25/2018 V
98 6/25/2018 028240 6/25/2018 V
99 6/25/2018 028412 6/25/2018 V
100 6/26/2018 022510 6/26/2018 V
101 6/26/2018 021586 6/26/2018 V
102 6/26/2018 021960 6/26/2018 V
103 6/26/2018 017627 6/26/2018 V
104 6/26/2018 024066 6/26/2018 V
105 6/26/2018 028427 6/26/2018 V
106 6/26/2018 025034 6/26/2018 V
107 6/26/2018 028413 6/26/2018 V
108 6/26/2018 028043 6/26/2018 V
109 6/26/2018 028425 6/26/2018 V
110 6/27/2018 023465 6/27/2018 V
111 6/27/2018 028433 6/27/2018 V
112 6/28/2018 028449 6/28/2018 V
113 6/28/2018 028438 6/28/2018 V
114 6/28/2018 028435 6/28/2018 V
115 6/28/2018 028444 6/28/2018 V
116 6/28/2018 013123 6/28/2018 V
117 6/28/2018 028450 6/28/2018 V
118 6/28/2018 028448 6/28/2018 V
119 6/29/2018 028453 6/29/2018 V
120 6/29/2018 016841 6/29/2018 V
121 6/29/2018 028461 6/29/2018 V
122 6/29/2018 028472 6/29/2018 V
123 6/29/2018 028455 6/29/2018 V
124 6/29/2018 028464 6/29/2018 V
125 6/29/2018 028471 6/29/2018 V
126 6/30/2018 028476 6/30/2018 V
127 6/30/2018 028473 6/30/2018 V

SURVEY HARIAN PELAKSANAAN VERIFIKASI KOMUNIKASI

UNIT: BULAN JULI 2018
TANGGAL NO REKAM TANGGAL VERIFIKASI PETUGAS
NO KETERANGAN
SURVEY MEDIS KOMUNIKASI YA TIDAK SURVEY

1 7/1/2018 028479 7/1/2018 V

2 7/2/2018 028497 7/2/2018 V
3 7/2/2018 028498 7/2/2018 V
4 7/2/2018 027576 7/2/2018 V
5 7/2/2018 028500 7/2/2018 V
 6 7/2/2018 027630 7/2/2018 V
7 7/2/2018 028496 7/2/2018 V
8 7/3/2018 024802 7/3/2018 V
9 7/3/2018 028506 7/3/2018 V
10 7/3/2018 028508 7/3/2018 V
11 7/3/2018 028516 7/3/2018 V
12 7/3/2018 028527 7/3/2018 V
13 7/3/2018 028503 7/3/2018 V
14 7/3/2018 028511 7/3/2018 V
15 7/3/2018 028501 7/3/2018 V
16 7/3/2018 028504 7/3/2018 V
17 7/3/2018 028520 7/3/2018 V
18 7/3/2018 028525 7/3/2018 V
19 7/3/2018 020803 7/3/2018 V
20 7/4/2018 028408 7/4/2018 V
21 7/4/2018 028540 7/4/2018 V
22 7/4/2018 028247 7/4/2018 V
23 7/4/2018 028542 7/4/2018 V
24 7/4/2018 028539 7/4/2018 V
25 7/4/2018 021982 7/4/2018 V
26 7/4/2018 027955 7/4/2018 V
27 7/4/2018 028533 7/4/2018 V
28 7/4/2018 028531 7/4/2018 V
29 7/4/2018 027749 7/4/2018 V
30 7/5/2018 028545 7/5/2018 V
31 7/5/2018 028434 7/5/2018 V
32 7/5/2018 028543 7/5/2018 V
33 7/5/2018 028556 7/5/2018 V
34 7/6/2018 028559 7/6/2018 V
35 7/6/2018 024906 7/6/2018 V
36 7/6/2018 021960 7/6/2018 V
37 7/6/2018 028527 7/6/2018 V
38 7/6/2018 028515 7/6/2018 V
39 7/6/2018 028558 7/6/2018 V
40 7/6/2018 028560 7/6/2018 V
41 7/7/2018 028565 7/7/2018 V
42 7/8/2018 027830 7/8/2018 V
43 7/9/2018 028570 7/9/2018 V
44 7/9/2018 027390 7/9/2018 V
45 7/9/2018 028589 7/9/2018 V
46 7/9/2018 019542 7/9/2018 V
47 7/9/2018 028394 7/9/2018 V
48 7/9/2018 018694 7/9/2018 V
49 7/9/2018 028502 7/9/2018 V
50 7/9/2018 028574 7/9/2018 V
51 7/10/2018 028590 7/10/2018 V
52 7/10/2018 017936 7/10/2018 V
53 7/10/2018 022115 7/10/2018 V
54 7/10/2018 028463 7/10/2018 V
55 7/10/2018 028554 7/10/2018 V
 56 7/10/2018 021620 7/10/2018 V
57 7/10/2018 028605 7/10/2018 V
58 7/10/2018 028591 7/10/2018 V
59 7/10/2018 028521 7/10/2018 V
60 7/11/2018 027265 7/11/2018 V
61 7/11/2018 028596 7/11/2018 V
62 7/11/2018 019412 7/11/2018 V
63 7/12/2018 028619 7/12/2018 V
64 7/13/2018 028628 7/13/2018 V
65 8/13/2018 027309 8/13/2018 V
66 9/13/2018 '028625 9/13/2018 V
67 10/13/2018 022594 10/13/2018 V
68 7/14/2018 026082 7/14/2018 V
69 7/14/2018 028637 7/14/2018 V
70 7/14/2018 016812 7/14/2018 V
71 7/14/2018 028444 7/14/2018 V
72 7/14/2018 028638 7/14/2018 V
73 7/14/2018 028639 7/14/2018 V
74 7/15/2018 028640 7/15/2018 V
75 7/15/2018 016595 7/15/2018 V
76 7/15/2018 028641 7/15/2018 V
77 7/15/2018 024289 7/15/2018 V
78 7/15/2018 028616 7/15/2018 V
79 7/15/2018 027612 7/15/2018 V
80 7/15/2018 022594 7/15/2018 V
81 7/16/2018 028642 7/16/2018 V
82 7/16/2018 028655 7/16/2018 V
83 7/16/2018 028644 7/16/2018 V
84 7/16/2018 028645 7/16/2018 V
85 7/16/2018 028653 7/16/2018 V
86 7/17/2018 028658 7/17/2018 V
87 7/17/2018 028598 7/17/2018 V
88 7/17/2018 028656 7/17/2018 V
89 7/17/2018 022565 7/17/2018 V
90 7/18/2018 028682 7/18/2018 V
91 7/18/2018 028684 7/18/2018 V
92 7/18/2018 023460 7/18/2018 V
93 7/18/2018 028673 7/18/2018 V
94 7/19/2018 028699 7/19/2018 V
95 7/19/2018 028700 7/19/2018 V
96 7/19/2018 028687 7/19/2018 V
97 7/20/2018 025572 7/20/2018 V
98 7/20/2018 028704 7/20/2018 V
99 7/20/2018 028709 7/20/2018 V
100 7/20/2018 028710 7/20/2018 V
101 7/20/2018 028707 7/20/2018 V
102 7/20/2018 028715 7/20/2018 V
103 7/20/2018 028281 7/20/2018 V
104 7/20/2018 028702 7/20/2018 V
105 7/20/2018 028705 7/20/2018 V
106 7/20/2018 028706 7/20/2018 V
107 7/21/2018 028093 7/21/2018 V
108 7/21/2018 022134 7/21/2018 V
109 7/21/2018 028718 7/21/2018 V
110 7/21/2018 028720 7/21/2018 V
111 7/22/2018 028724 7/22/2018 V
112 7/22/2018 028728 7/22/2018 V
113 7/22/2018 023703 7/22/2018 V
114 7/23/2018 028741 7/23/2018 V
115 7/23/2018 018713 7/23/2018 V
116 7/23/2018 025929 7/23/2018 V
117 7/23/2018 028726 7/23/2018 V
118 7/23/2018 028727 7/23/2018 V
119 7/23/2018 028553 7/23/2018 V
120 7/23/2018 020585 7/23/2018 V
121 7/23/2018 028728 7/23/2018 V
122 7/23/2018 024952 7/23/2018 V
123 7/24/2018 028744 7/24/2018 V
124 7/24/2018 028754 7/24/2018 V
125 7/24/2018 028756 7/24/2018 V
126 7/24/2018 028743 7/24/2018 V
127 7/24/2018 028746 7/24/2018 V
128 7/24/2018 028290 7/24/2018 V
129 7/24/2018 027585 7/24/2018 V
130 7/24/2018 028757 7/24/2018 V
131 7/25/2018 026613 7/25/2018 V
132 7/25/2018 028774 7/25/2018 V
133 7/25/2018 028776 7/25/2018 V
134 7/25/2018 028777 7/25/2018 V
135 7/25/2018 028759 7/25/2018 V
136 7/25/2018 028767 7/25/2018 V
137 7/25/2018 026967 7/25/2018 V
138 7/26/2018 028779 7/26/2018 V
139 7/26/2018 028780 7/26/2018 V
140 7/26/2018 028456 7/26/2018 V
141 7/26/2018 028788 7/26/2018 V
142 7/26/2018 028704 7/26/2018 V
143 7/26/2018 028785 7/26/2018 V
144 7/26/2018 028793 7/26/2018 V
145 7/27/2018 028774 7/27/2018 V
146 7/27/2018 027539 7/27/2018 V
147 7/27/2018 028795 7/27/2018 V
148 7/27/2018 016416 7/27/2018 V
149 7/27/2018 023898 7/27/2018 V
150 7/27/2018 028456 7/27/2018 V
151 7/27/2018 026613 7/27/2018 V
152 7/28/2018 020546 7/28/2018 V
153 7/28/2018 014518 7/28/2018 V
154 7/29/2018 028811 7/29/2018 V
155 7/29/2018 028808 7/29/2018 V
 156 7/29/2018 028809 7/29/2018 V
157 7/29/2018 028806 7/29/2018 V
158 7/29/2018 028812 7/29/2018 V
159 7/30/2018 028826 7/30/2018 V
160 7/30/2018 027672 7/30/2018 V
161 7/30/2018 020546 7/30/2018 V
162 7/30/2018 028816 7/30/2018 V
163 7/30/2018 028819 7/30/2018 V
164 7/31/2018 017457 7/31/2018 V
165 7/31/2018 028810 7/31/2018 V
166 7/31/2018 017936 7/31/2018 V
167 7/31/2018 028635 7/31/2018 V
168 7/31/2018 028829 7/31/2018 V
169 7/31/2018 028675 7/31/2018 V

SURVEY HARIAN PELAKSANAAN VERIFIKASI KOMUNIKASI

UNIT: BULAN AGUSTUS 2018
TANGGAL NO REKAM TANGGAL VERIFIKASI PETUGAS
NO KETERANGAN
SURVEY MEDIS KOMUNIKASI YA TIDAK SURVEY

1 8/1/2018 028652 8/1/2018 V

2 8/1/2018 016595 8/1/2018 V
3 8/1/2018 028846 8/1/2018 V
4 8/1/2018 028845 8/1/2018 V
5 8/2/2018 017306 8/2/2018 V
6 8/2/2018 026512 8/2/2018 V
7 8/2/2018 017936 8/2/2018 V
8 8/2/2018 028855 8/2/2018 V
9 8/2/2018 028667 8/2/2018 V
10 8/2/2018 028857 8/2/2018 V
11 8/2/2018 028614 8/2/2018 V
12 8/2/2018 028856 8/2/2018 V
13 8/3/2018 028859 8/3/2018 V
14 8/3/2018 028861 8/3/2018 V
15 8/3/2018 028860 8/3/2018 V
16 8/3/2018 028858 8/3/2018 V
17 8/3/2018 026512 8/3/2018 V
18 8/4/2018 028877 8/4/2018 V
19 8/4/2018 028874 8/4/2018 V
20 8/4/2018 024694 8/4/2018 V
21 8/4/2018 021552 8/4/2018 V
22 8/4/2018 028878 8/4/2018 V
23 8/5/2018 028880 8/5/2018 V
24 8/5/2018 028751 8/5/2018 V
25 8/5/2018 028727 8/5/2018 V
26 8/6/2018 028868 8/6/2018 V
27 8/6/2018 027728 8/6/2018 V
28 8/7/2018 028897 8/7/2018 V
29 8/7/2018 016678 8/7/2018 V
30 8/7/2018 028891 8/7/2018 V
31 8/7/2018 028382 8/7/2018 V
32 8/7/2018 027564 8/7/2018 V
33 8/7/2018 028907 8/7/2018 V
34 8/7/2018 028901 8/7/2018 V
35 8/7/2018 027728 8/7/2018 V
36 8/8/2018 028909 8/8/2018 V
37 8/8/2018 021958 8/8/2018 V
38 8/8/2018 023343 8/8/2018 V
39 8/8/2018 025801 8/8/2018 V
40 8/8/2018 022395 8/8/2018 V
41 8/9/2018 028920 8/9/2018 V
42 8/9/2018 028879 8/9/2018 V
43 8/9/2018 024906 8/9/2018 V
44 8/10/2018 028923 8/10/2018 V
45 8/10/2018 024767 8/10/2018 V
46 8/10/2018 028893 8/10/2018 V
47 8/11/2018 028938 8/11/2018 V
48 8/11/2018 028930 8/11/2018 V
49 8/12/2018 028946 8/12/2018 V
50 8/12/2018 028943 8/12/2018 V
51 8/12/2018 028948 8/12/2018 V
52 8/12/2018 028945 8/12/2018 V
53 8/13/2018 028959 8/13/2018 V
54 8/13/2018 028921 8/13/2018 V
55 8/13/2018 028966 8/13/2018 V
56 8/13/2018 024404 8/13/2018 V
57 8/13/2018 028954 8/13/2018 V
58 8/14/2018 028968 8/14/2018 V
59 8/14/2018 027847 8/14/2018 V
60 8/14/2018 028946 8/14/2018 V
61 8/14/2018 028969 8/14/2018 V
62 8/14/2018 016203 8/14/2018 V
63 8/14/2018 028970 8/14/2018 V
64 8/15/2018 028974 8/15/2018 V
65 8/15/2018 028980 8/15/2018 V
66 8/15/2018 028972 8/15/2018 V
67 8/16/2018 027802 8/16/2018 V
68 8/16/2018 028983 8/16/2018 V
69 8/17/2018 017936 8/17/2018 V
70 8/17/2018 028987 8/17/2018 V
71 8/17/2018 028992 8/17/2018 V
72 8/17/2018 028989 8/17/2018 V
73 8/18/2018 028996 8/18/2018 V
74 8/18/2018 029002 8/18/2018 V
75 8/18/2018 021266 8/18/2018 V
76 8/18/2018 021266 8/18/2018 V
77 8/18/2018 029000 8/18/2018 V
78 8/18/2018 029005 8/18/2018 V
79 8/19/2018 013123 8/19/2018 V
 80 8/19/2018 029016 8/19/2018 V
81 8/20/2018 017892 8/20/2018 V
82 8/20/2018 029026 8/20/2018 V
83 8/20/2018 029025 8/20/2018 V
84 8/21/2018 028974 8/21/2018 V
85 8/22/2018 028976 8/22/2018 V
86 8/22/2018 023838 8/22/2018 V
87 8/22/2018 021266 8/22/2018 V
88 8/23/2018 029046 8/23/2018 V
89 8/23/2018 027182 8/23/2018 V
90 8/23/2018 026593 8/23/2018 V
91 8/23/2018 017936 8/23/2018 V
92 8/23/2018 029042 8/23/2018 V
93 8/23/2018 029044 8/23/2018 V
94 8/23/2018 029054 8/23/2018 V
95 8/24/2018 029041 8/24/2018 V
96 8/24/2018 029057 8/24/2018 V
97 8/24/2018 024169 8/24/2018 V
98 8/24/2018 029070 8/24/2018 V
99 8/24/2018 024502 8/24/2018 V
100 8/25/2018 029062 8/25/2018 V
101 8/25/2018 028983 8/25/2018 V
102 8/25/2018 029067 8/25/2018 V
103 8/25/2018 025413 8/25/2018 V
104 8/25/2018 020284 8/25/2018 V
105 8/26/2018 029088 8/26/2018 V
106 8/26/2018 029086 8/26/2018 V
107 8/26/2018 029092 8/26/2018 V
108 8/26/2018 029089 8/26/2018 V
109 8/26/2018 028975 8/26/2018 V
110 8/26/2018 029091 8/26/2018 V
111 8/26/2018 029085 8/26/2018 V
112 8/26/2018 028983 8/26/2018 V
113 8/27/2018 029101 8/27/2018 V
114 8/28/2018 028976 8/28/2018 V
115 8/28/2018 029091 8/28/2018 V
116 8/28/2018 029036 8/28/2018 V
117 8/28/2018 029114 8/28/2018 V
118 8/28/2018 028889 8/28/2018 V
119 8/28/2018 029032 8/28/2018 V
120 8/28/2018 029116 8/28/2018 V
121 8/29/2018 029117 8/29/2018 V
122 8/29/2018 019734 8/29/2018 V
123 8/29/2018 017936 8/29/2018 V
124 8/29/2018 029121 8/29/2018 V
125 8/29/2018 029128 8/29/2018 V
126 8/29/2018 014413 8/29/2018 V
127 8/30/2018 029135 8/30/2018 V
128 8/30/2018 029143 8/30/2018 V
129 8/30/2018 029139 8/30/2018 V
 130 8/30/2018 029097 8/30/2018 V
131 8/30/2018 029133 8/30/2018 V
132 8/30/2018 029131 8/30/2018 V
133 8/30/2018 029130 8/30/2018 V
134 8/30/2018 029137 8/30/2018 V
135 8/30/2018 029144 8/30/2018 V
136 8/30/2018 028896 8/30/2018 V
137 8/31/2018 022806 8/31/2018 V
138 8/31/2018 029154 8/31/2018 V
139 8/31/2018 029153 8/31/2018 V
140 8/31/2018 029119 8/31/2018 V
141 8/31/2018 029106 8/31/2018 V
142 8/31/2018 029133 8/31/2018 V
143 8/31/2018 029145 8/31/2018 V
144 8/31/2018 029147 8/31/2018 V
145 8/31/2018 029149 8/31/2018 V
146 8/31/2018 029157 8/31/2018 V

SURVEY HARIAN PELAKSANAAN VERIFIKASI KOMUNIKASI

UNIT: BULAN SEPTEMBER 2018
TANGGAL NO REKAM TANGGAL VERIFIKASI PETUGAS
NO KETERANGAN
SURVEY MEDIS KOMUNIKASI YA TIDAK SURVEY

1 9/1/2018 029134 9/1/2018 V

2 9/1/2018 029160 9/1/2018 V
3 9/1/2018 029158 9/1/2018 V
4 9/2/2018 026886 9/2/2018 V
5 9/2/2018 029148 9/2/2018 V
6 9/2/2018 017936 9/2/2018 V
7 9/2/2018 029164 9/2/2018 V
8 9/2/2018 029098 9/2/2018 V
9 9/3/2018 029172 9/3/2018 V
10 9/3/2018 029175 9/3/2018 V
11 9/3/2018 019715 9/3/2018 V
12 9/4/2018 026886 9/4/2018 V
13 9/4/2018 027336 9/4/2018 V
14 9/4/2018 024907 9/4/2018 V
15 9/4/2018 029182 9/4/2018 V
16 9/4/2018 021070 9/4/2018 V
17 9/4/2018 027336 9/4/2018 V
18 9/5/2018 029191 9/5/2018 V
19 9/5/2018 029199 9/5/2018 V
20 9/5/2018 027243 9/5/2018 V
21 9/5/2018 028857 9/5/2018 V
22 9/5/2018 029193 9/5/2018 V
23 9/5/2018 027748 9/5/2018 V
24 9/6/2018 029201 9/6/2018 V
25 9/6/2018 029208 9/6/2018 V
26 9/6/2018 022497 9/6/2018 V
27 9/7/2018 027673 9/7/2018 V
28 9/7/2018 026968 9/7/2018 V
29 9/7/2018 029214 9/7/2018 V
30 9/7/2018 029221 9/7/2018 V
31 9/8/2018 029068 9/8/2018 V
32 9/8/2018 029234 9/8/2018 V
33 9/9/2018 022347 9/9/2018 V
34 9/9/2018 029236 9/9/2018 V
35 9/9/2018 029240 9/9/2018 V
36 9/9/2018 029238 9/9/2018 V
37 9/10/2018 022890 9/10/2018 V
38 9/10/2018 029250 9/10/2018 V
39 9/10/2018 029258 9/10/2018 V
40 9/10/2018 029259 9/10/2018 V
41 9/10/2018 027117 9/10/2018 V
42 9/10/2018 029254 9/10/2018 V
43 9/10/2018 026863 9/10/2018 V
44 9/10/2018 029249 9/10/2018 V
45 9/10/2018 022227 9/10/2018 V
46 9/12/2018 029264 9/12/2018 V
47 9/12/2018 026932 9/12/2018 V
48 9/12/2018 022351 9/12/2018 V
49 9/12/2018 022347 9/12/2018 V
50 9/12/2018 029247 9/12/2018 V
51 9/12/2018 029270 9/12/2018 V
52 9/12/2018 023127 9/12/2018 V
53 9/13/2018 025166 9/13/2018 V
54 9/13/2018 029282 9/13/2018 V
55 9/13/2018 029283 9/13/2018 V
56 9/13/2018 029272 9/13/2018 V
57 9/13/2018 029280 9/13/2018 V
58 9/13/2018 022792 9/13/2018 V
59 9/13/2018 029272 9/13/2018 V
60 9/13/2018 029264 9/13/2018 V
61 9/13/2018 023719 9/13/2018 V
62 9/13/2018 029271 9/13/2018 V
63 9/13/2018 029275 9/13/2018 V
64 9/13/2018 029262 9/13/2018 V
65 9/13/2018 029056 9/13/2018 V
66 9/14/2018 028456 9/14/2018 V
67 9/14/2018 029284 9/14/2018 V
68 9/14/2018 023087 9/14/2018 V
69 9/14/2018 029285 9/14/2018 V
70 9/14/2018 026970 9/14/2018 V
71 9/15/2018 029301 9/15/2018 V
72 9/15/2018 029300 9/15/2018 V
73 9/15/2018 027494 9/15/2018 V
74 9/15/2018 029154 9/15/2018 V
75 9/15/2018 029307 9/15/2018 V
76 9/15/2018 029295 9/15/2018 V
 77 9/16/2018 016028 9/16/2018 V
78 9/16/2018 025575 9/16/2018 V
79 9/17/2018 023955 9/17/2018 V
80 9/17/2018 027076 9/17/2018 V
81 9/17/2018 019347 9/17/2018 V
82 9/17/2018 029321 9/17/2018 V
83 9/17/2018 029311 9/17/2018 V
84 9/17/2018 029319 9/17/2018 V
85 9/18/2018 029239 9/18/2018 V
86 9/18/2018 023372 9/18/2018 V
87 9/18/2018 028133 9/18/2018 V
88 9/18/2018 029275 9/18/2018 V
89 9/18/2018 029326 9/18/2018 V
90 9/19/2018 025416 9/19/2018 V
91 9/19/2018 029340 9/19/2018 V
92 9/19/2018 029333 9/19/2018 V
93 9/19/2018 029331 9/19/2018 V
94 9/19/2018 029339 9/19/2018 V
95 9/19/2018 015800 9/19/2018 V
96 9/20/2018 029347 9/20/2018 V
97 9/21/2018 029356 9/21/2018 V
98 9/21/2018 029359 9/21/2018 V
99 9/22/2018 029368 9/22/2018 V
100 9/22/2018 027406 9/22/2018 V
101 9/22/2018 029369 9/22/2018 V
102 9/22/2018 022565 9/22/2018 V
103 9/23/2018 029352 9/23/2018 V
104 9/23/2018 026947 9/23/2018 V
105 9/24/2018 029385 9/24/2018 V
106 9/24/2018 029374 9/24/2018 V
107 9/24/2018 029349 9/24/2018 V
108 9/25/2018 022636 9/25/2018 V
109 9/25/2018 029396 9/25/2018 V
110 9/25/2018 029381 9/25/2018 V
111 9/26/2018 029406 9/26/2018 V
112 9/26/2018 028893 9/26/2018 V
113 9/26/2018 029397 9/26/2018 V
114 9/26/2017 016402 9/26/2017 V
115 9/27/2018 029411 9/27/2018 V
116 9/27/2018 027389 9/27/2018 V
117 9/27/2018 029408 9/27/2018 V
118 9/27/2018 029420 9/27/2018 V
119 9/27/2018 019937 9/27/2018 V
120 9/28/2018 029434 9/28/2018 V
121 9/28/2018 029436 9/28/2018 V
122 9/28/2018 029429 9/28/2018 V
123 9/29/2018 029452 9/29/2018 V
124 9/29/2018 023580 9/29/2018 V
125 9/30/2018 026769 9/30/2018 V
126 9/30/2018 029317 9/30/2018 V
 SURVEY HARIAN PELAKSANAAN VERIFIKASI KOMUNIKASI
UNIT: BULAN OKTOBER 2018
TANGGAL NO REKAM TANGGAL VERIFIKASI PETUGAS
NO KETERANGAN
SURVEY MEDIS KOMUNIKASI YA TIDAK SURVEY

1 10/1/2018 029462 10/1/2018 V

2 10/1/2018 013092 10/1/2018 V
3 10/1/2018 029468 10/1/2018 V
4 10/2/2018 029491 10/2/2018 V
5 10/2/2018 029392 10/2/2018 V
6 10/2/2018 029505 10/2/2018 V
7 10/2/2018 029507 10/2/2018 V
8 10/2/2018 029501 10/2/2018 V
9 10/2/2018 029503 10/2/2018 V
10 10/3/2018 029518 10/3/2018 V
11 10/3/2018 020309 10/3/2018 V
12 10/3/2018 022323 10/3/2018 V
13 10/3/2018 029522 10/3/2018 V
14 10/3/2018 022087 10/3/2018 V
15 10/3/2018 029520 10/3/2018 V
16 10/3/2018 027813 10/3/2018 V
17 10/3/2018 026761 10/3/2018 V
18 10/4/2018 029539 10/4/2018 V
19 10/4/2018 029527 10/4/2018 V
20 10/4/2018 029541 10/4/2018 V
21 10/4/2018 029534 10/4/2018 V
22 10/4/2018 029548 10/4/2018 V
23 10/5/2018 028697 10/5/2018 V
24 10/5/2018 029565 10/5/2018 V
25 10/5/2018 029570 10/5/2018 V
26 10/5/2018 029577 10/5/2018 V
27 10/5/2018 029412 10/5/2018 V
28 10/5/2018 029573 10/5/2018 V
29 10/5/2018 019542 10/5/2018 V
30 10/5/2018 014091 10/5/2018 V
31 10/5/2018 027331 10/5/2018 V
32 10/5/2018 026301 10/5/2018 V
33 10/5/2018 029564 10/5/2018 V
34 10/5/2018 029568 10/5/2018 V
35 10/6/2018 018735 10/6/2018 V
36 10/6/2018 029583 10/6/2018 V
37 10/6/2018 029581 10/6/2018 V
38 10/6/2018 029588 10/6/2018 V
39 10/6/2018 027117 10/6/2018 V
40 10/7/2018 029582 10/7/2018 V
41 10/7/2018 029589 10/7/2018 V
42 10/7/2018 029590 10/7/2018 V
43 10/8/2018 029554 10/8/2018 V
44 10/8/2018 023719 10/8/2018 V
45 10/8/2018 029511 10/8/2018 V
46 10/8/2018 029607 10/8/2018 V
47 10/9/2018 029623 10/9/2018 V
48 10/9/2018 025252 10/9/2018 V
49 10/9/2018 024052 10/9/2018 V
50 10/9/2018 029624 10/9/2018 V
51 10/9/2018 024905 0 V
52 10/10/2018 028590 10/10/2018 V
53 10/11/2018 029641 10/11/2018 V
54 10/11/2018 026068 10/11/2018 V
55 10/11/2018 029651 10/11/2018 V
56 10/11/2018 029650 10/11/2018 V
57 10/11/2018 029109 10/11/2018 V
58 10/12/2018 029658 10/12/2018 V
59 10/12/2018 029665 10/12/2018 V
60 10/14/2018 029686 10/14/2018 V
61 10/14/2018 023948 10/14/2018 V
62 10/14/2018 029684 10/14/2018 V
63 10/14/2018 023442 10/14/2018 V
64 10/14/2018 019323 10/14/2018 V
65 10/14/2018 016846 10/14/2018 V
66 10/14/2018 029691 10/14/2018 V
67 10/15/2018 029696 10/15/2018 V
68 10/15/2018 029702 10/15/2018 V
69 10/15/2018 029652 10/15/2018 V
70 10/15/2018 029707 10/15/2018 V
71 10/15/2018 029703 10/15/2018 V
72 10/15/2018 029705 10/15/2018 V
73 10/15/2018 023135 10/15/2018 V
74 10/16/2018 029709 10/16/2018 V
75 10/16/2018 029711 10/16/2018 V
76 10/16/2018 029720 10/16/2018 V
77 10/16/2018 029727 10/16/2018 V
78 10/16/2018 029397 10/16/2018 V
79 10/16/2018 029725 10/16/2018 V
80 10/17/2018 029516 10/17/2018 V
81 10/17/2018 023442 10/17/2018 V
82 10/17/2018 029734 10/17/2018 V
83 10/17/2018 029739 10/17/2018 V
84 10/18/2018 029746 10/18/2018 V
85 10/18/2018 029379 10/18/2018 V
86 10/18/2018 029753 10/18/2018 V
87 10/18/2018 020585 10/18/2018 V
88 10/18/2018 029750 10/18/2018 V
89 10/19/2018 022218 10/19/2018 V
90 10/19/2018 029771 10/19/2018 V
91 10/19/2018 029773 10/19/2018 V
92 10/19/2018 029749 10/19/2018 V
93 10/19/2018 029774 10/19/2018 V
 94 10/19/2018 023382 10/19/2018 V
95 10/19/2018 029777 10/19/2018 V
96 10/19/2018 029778 10/19/2018 V
97 10/20/2018 029779 10/20/2018 V
98 10/20/2018 016577 10/20/2018 V
99 10/21/2018 023838 10/21/2018 V
100 10/21/2018 029787 10/21/2018 V
101 10/21/2018 029758 10/21/2018 V
102 10/22/2018 029796 10/22/2018 V
103 10/22/2018 029723 10/22/2018 V
104 10/22/2018 029564 10/22/2018 V
105 10/22/2018 029795 10/22/2018 V
106 10/22/2018 029791 10/22/2018 V
107 10/23/2018 029798 10/23/2018 V
108 10/23/2018 029392 10/23/2018 V
109 10/23/2018 026925 10/23/2018 V
110 10/23/2018 021918 10/23/2018 V
111 10/23/2018 015660 10/23/2018 V
112 10/23/2018 029807 10/23/2018 V
113 10/23/2018 023342 10/23/2018 V
114 10/24/2018 029815 10/24/2018 V
115 10/24/2018 029824 10/24/2018 V
116 10/24/2018 029817 10/24/2018 V
117 10/24/2018 023135 10/24/2018 V
118 10/24/2018 029819 10/24/2018 V
119 10/24/2018 020707 10/24/2018 V
120 10/24/2018 029827 10/24/2018 V
121 10/25/2018 029837 10/25/2018 V
122 10/25/2018 029800 10/25/2018 V
123 10/25/2018 029783 10/25/2018 V
124 10/25/2018 029836 10/25/2018 V
125 10/26/2018 029844 10/26/2018 V
126 10/26/2018 029511 10/26/2018 V
127 10/27/2018 029850 10/27/2018 V
128 10/27/2018 026284 10/27/2018 V
129 10/28/2018 029851 10/28/2018 V
130 10/28/2018 029853 10/28/2018 V
131 10/28/2018 029852 10/28/2018 V
132 10/29/2018 017695 10/29/2018 V
133 10/29/2018 029855 10/29/2018 V
134 10/29/2018 029854 10/29/2018 V
135 10/29/2018 017412 10/29/2018 V
136 10/29/2018 020304 10/29/2018 V
137 10/29/2018 018007 10/29/2018 V
138 10/29/2018 029493 10/29/2018 V
139 10/30/2018 029870 10/30/2018 V
140 10/30/2018 028245 10/30/2018 V
141 10/30/2018 024268 10/30/2018 V
142 10/30/2018 025527 10/30/2018 V
143 10/31/2018 017794 10/31/2018 V
144 10/31/2018 029651 10/31/2018 V
145 10/31/2018 016595 10/31/2018 V
146 10/31/2018 024877 10/31/2018 V
147 10/31/2018 027240 10/31/2018 V
148 10/31/2018 029566 10/31/2018 V
 PENINGKATAN KEAMANAN OBAT YANG PERLU DIWASPADAI
Kepatuhan Pemberian Label Obat High Alert Oleh Farmasi

RUANG RAWAT:
TANGGAL NAMA LABEL PETUGAS
NO KETERANGAN
SURVEY OBAT BENAR SALAH SURVEY
 KEPASTIAN TEPAT LOKASI, TEPAT PROSEDUR TEPAT PASIEN OPERASI
Kepatuhan Pelaksanaan Prosedur Site Marking Sebelum Tindakan Operasi

UNIT: BULAN JUNI 2018

PENANDAAN OLEH PETUGAS TANDA SESUAI KETENTUAN PASIEN TERLIBAT SAAT
TANGGAL TINDAKAN TANGGAL SESUAI KETENTUAN PENANDAAN
NO OPERASI OPERASI PENANDAAN YA TIDAK YA TIDAK YA TIDAK

1 6/1/2018 SC 6/1/2018 V V
2 6/1/2018 SC 6/1/2018 V V
3 6/4/2018 SC 6/4/2018
4 6/4/2018 SC 6/4/2018
5 6/4/2018 SC 6/4/2018
6 6/5/2018 BEDAH 6/5/2018
7 6/5/2018 SC 6/5/2018
8 6/5/2018 SC 6/5/2018
9 6/5/2018 BEDAH 6/5/2018
10 6/5/2018 BEDAH 6/5/2018
11 6/5/2018 BEDAH 6/5/2018
12 6/6/2018 SC 6/6/2018
13 6/6/2018 SC 6/6/2018
14 6/6/2018 SC 6/6/2018
15 6/6/2018 SC 6/6/2018
16 6/7/2018 ORTHO 6/7/2018
17 6/7/2018 SC 6/7/2018
18 6/7/2018 SC 6/7/2018
19 6/8/2018 SC 6/8/2018
20 6/8/2018 SC 6/8/2018
21 6/8/2018 SC 6/8/2018
22 6/8/2018 BEDAH 6/8/2018
23 6/8/2018 BEDAH 6/8/2018
24 8/9/2018 SC 6/9/2018
25 6/10/2018 SC 6/10/2018
26 6/11/2018 SC 6/11/2018
 27 6/11/2018 SC 6/11/2018
28 6/18/2018 ORTHO 6/18/2018
29 6/21/2018 SC 6/21/2018
30 6/21/2018 SC 6/21/2018
31 6/22/2018 ORTHO 6/22/2018
32 6/23/2018 ORTHO 6/23/2018
33 6/23/2018 SC 6/23/2018
34 6/25/2018 SC 6/25/2018
35 6/25/2018 BEDAH 6/25/2018
36 6/25/2018 BEDAH 6/25/2018
37 6/25/2018 BEDAH 6/25/2018
38 6/25/2018 ORTHO 6/25/2018
39 6/25/2018 SC 6/25/2018
40 6/25/2018 SC 6/25/2018
41 6/26/2018 SC 6/26/2018
42 6/26/2018 SC 6/26/2018
43 6/26/2018 BEDAH 6/26/2018
44 6/26/2018 BEDAH 6/26/2018
45 6/27/2018 SC 6/27/2018
46 6/27/2018 ORTHO 6/27/2018
47 6/28/2018 SC 6/28/2018
48 6/29/2018 BEDAH 6/29/2018
49 6/29/2018 SC 6/29/2018
50 6/30/2018 BEDAH 6/30/2018
51 6/30/2018 ORTHO 6/30/2018
52 6/30/2018 SC 6/30/2018

KEPASTIAN TEPAT LOKASI, TEPAT PROSEDUR TEPAT PASIEN OPERASI

Kepatuhan Pelaksanaan Prosedur Site Marking Sebelum Tindakan Operasi

UNIT:
PENANDAAN OLEH PETUGAS PASIEN TERLIBAT SAAT
TANGGAL TINDAKAN TANGGAL TANDA SESUAI KETENTUAN
NO SESUAI KETENTUAN PENANDAAN
OPERASI OPERASI PENANDAAN
 TANGGAL TINDAKAN TANGGAL
NO OPERASI OPERASI PENANDAAN YA TIDAK YA TIDAK YA TIDAK
 KEPASTIAN TEPAT LOKASI, TEPAT PROSEDUR TEPAT PASIEN OPERASI
Kepatuhan Pelaksanaan Prosedur Site Marking Sebelum Tindakan Operasi

UNIT:
PENANDAAN OLEH PETUGAS PASIEN TERLIBAT SAAT
TANGGAL TINDAKAN TANGGAL TANDA SESUAI KETENTUAN
NO SESUAI KETENTUAN PENANDAAN
OPERASI OPERASI PENANDAAN YA TIDAK YA TIDAK YA TIDAK
 KEPASTIAN TEPAT LOKASI, TEPAT PROSEDUR TEPAT PASIEN OPERASI
Kepatuhan Pelaksanaan Prosedur Site Marking Sebelum Tindakan Operasi

UNIT:
PENANDAAN OLEH PETUGAS PASIEN TERLIBAT SAAT
TANGGAL TINDAKAN TANGGAL TANDA SESUAI KETENTUAN
NO SESUAI KETENTUAN PENANDAAN
OPERASI OPERASI PENANDAAN YA TIDAK YA TIDAK YA TIDAK
 KEPASTIAN TEPAT LOKASI, TEPAT PROSEDUR TEPAT PASIEN OPERASI
Kepatuhan Pelaksanaan Prosedur Site Marking Sebelum Tindakan Operasi

UNIT:
PENANDAAN OLEH PETUGAS TANDA SESUAI KETENTUAN PASIEN TERLIBAT SAAT
TANGGAL TINDAKAN TANGGAL SESUAI KETENTUAN PENANDAAN
NO OPERASI OPERASI PENANDAAN YA TIDAK YA TIDAK YA TIDAK
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
 PENGURANGAN RESIKO INFEKSI TERKAIT PELAYANAN KESEHATAN
Presentase Kepatuhan Petugas Kesehatan Dalam Melakukan Kebersihan Tangan Dengan Metode Enam La

UNIT: BULAN JUNI 2018

NAMA PETUGAS
NO TANGGAL YANG DISURVEY LANGKAH 1 LANGKAH 2 LANGKAH 3 LANGKAH 4
BENAR SALAH BENAR SALAH BENAR SALAH BENAR SALAH
* PILIH B/S : BENAR / SALAH

PENGURANGAN RESIKO INFEKSI TERKAIT PELAYANAN KESEHATAN

Presentase Kepatuhan Petugas Kesehatan Dalam Melakukan Kebersihan Tangan Dengan Metode Enam La

UNIT:
NAMA PETUGAS
NO TANGGAL YANG DISURVEY LANGKAH 1 LANGKAH 2 LANGKAH 3 LANGKAH 4
BENAR SALAH BENAR SALAH BENAR SALAH BENAR SALAH
* PILIH B/S : BENAR / SALAH

PENGURANGAN RESIKO INFEKSI TERKAIT PELAYANAN KESEHATAN

Presentase Kepatuhan Petugas Kesehatan Dalam Melakukan Kebersihan Tangan Dengan Metode Enam La

UNIT:
NAMA PETUGAS
NO TANGGAL YANG DISURVEY LANGKAH 1 LANGKAH 2 LANGKAH 3 LANGKAH 4
BENAR SALAH BENAR SALAH BENAR SALAH BENAR SALAH
* PILIH B/S : BENAR / SALAH

PENGURANGAN RESIKO INFEKSI TERKAIT PELAYANAN KESEHATAN

Presentase Kepatuhan Petugas Kesehatan Dalam Melakukan Kebersihan Tangan Dengan Metode Enam La

UNIT:
NAMA PETUGAS
NO TANGGAL YANG DISURVEY LANGKAH 1 LANGKAH 2 LANGKAH 3 LANGKAH 4
BENAR SALAH BENAR SALAH BENAR SALAH BENAR SALAH
* PILIH B/S : BENAR / SALAH

PENGURANGAN RESIKO INFEKSI TERKAIT PELAYANAN KESEHATAN

Presentase Kepatuhan Petugas Kesehatan Dalam Melakukan Kebersihan Tangan Dengan Metode Enam La

UNIT:
NAMA PETUGAS
NO TANGGAL YANG DISURVEY LANGKAH 1 LANGKAH 2 LANGKAH 3 LANGKAH 4
BENAR SALAH BENAR SALAH BENAR SALAH BENAR SALAH
* PILIH B/S : BENAR / SALAH
 ANAN KESEHATAN
Dengan Metode Enam Langkah Dan Lima Momen

PETUGAS
LANGKAH 5 LANGKAH 6 TEPAT MOMEN SURVEY
BENAR SALAH BENAR SALAH BENAR SALAH
 ANAN KESEHATAN
Dengan Metode Enam Langkah Dan Lima Momen

PETUGAS
LANGKAH 5 LANGKAH 6 TEPAT MOMEN SURVEY
BENAR SALAH BENAR SALAH BENAR SALAH
 ANAN KESEHATAN
Dengan Metode Enam Langkah Dan Lima Momen

PETUGAS
LANGKAH 5 LANGKAH 6 TEPAT MOMEN SURVEY
BENAR SALAH BENAR SALAH BENAR SALAH
 ANAN KESEHATAN
Dengan Metode Enam Langkah Dan Lima Momen

PETUGAS
LANGKAH 5 LANGKAH 6 TEPAT MOMEN SURVEY
BENAR SALAH BENAR SALAH BENAR SALAH
 ANAN KESEHATAN
Dengan Metode Enam Langkah Dan Lima Momen

PETUGAS
LANGKAH 5 LANGKAH 6 TEPAT MOMEN SURVEY
BENAR SALAH BENAR SALAH BENAR SALAH
NO TANGGAL
NAMA PASIEN
KRONOLOGIS SINGKAT
TEMPAT KEJADIAN
TINDAK LANJUT