Name : Surya Rahman

Class : S1 Keperawatan Reguler (B)

NPM : 1814201110073

1. Tolong anda buatkan pertanyaan untuk data-data demographic diatas?

Answer :
a. What is your name? My name is Carl Vincent Velasques
b. What is your age? 6 years old
c. What’s your parent’s name? my father’s name is Noel Velasquez and my
mother’s name is Aneth Velasquez
d. Where your address? My address is San Agustin, Arayat, Pampanga.
e. What is your date of birth? My date of birth is September 21, 2003.
f. Where is your place of birth? My Place of birth is Dr. Rmingdio C.Cruz
Sr.Memorial Hospital, Arayat , Pampanga.
g. What is your nationality? Filipino
h. When did your enter this place? December 09, 2009.
i. When does your leave this place? December 12,2009/
j. Who provided this information? Aneth Velasquez (Mother).

2. Patient Record Card

Example 1 :
a. Number : 003
b. Name : Ny. D
c. Birth Of Date : 12-03-2020
d. Address : Jalan Raya Sayange No 7, RT 007, RW 007, Jakarta 77777
e. Phone : 70007007
f. acute illness : Maag
g. Allergy : crab

Example 2 :

h. Number : 010
i. Name : Tn. N
j. Birth Of Date : 15-01-2020
k. Address : Jalan Belimbing Raya No 5, Rt 001 RW 001 Tabalong 9999
l. Phone : 30033300
m. acute illness : Maag
n. Allergy : Chicken