Formulir Taksiran Sisa Makanan

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Formulir Taksiran Sisa Makanan

RM Ruang
Tgl. Kelas [ ]VIP []1 []2 []3
0 1 2 3 4 5
Waktu Jenis
(0%) (25%) (50%) (75%) (95%) (100%)
Makan Makanan
Pagi Nasi
Lauk Hewani
Lauk Nabati
Sayur
The/ Susu
Siang Nasi
Lauk Hewani
Lauk Nabati
Sayur
Buah/ snack
Sore Nasi
Lauk Hewani
Lauk Nabati
Sayur
Teh/ Susu

Formulir Taksiran Sisa Makanan


RM Ruang
Tgl. Kelas [ ]VIP []1 []2 []3
0 1 2 3 4 5
Waktu Jenis
(0%) (25%) (50%) (75%) (95%) (100%)
Makan Makanan
Pagi Nasi
Lauk Hewani
Lauk Nabati
Sayur
The/ Susu
Siang Nasi
Lauk Hewani
Lauk Nabati
Sayur
Buah / snack
Sore Nasi
Lauk Hewani
Lauk Nabati
Sayur
Teh/ Susu

FORM KEPUASAN PASIEN (Ruang : _______)


NILAI
No Kriteria
1 2 3 4
1 Warna
2 Aroma
3 Rasa
4 Kematangan
5 Keramahan petugas

FORM KEPUASAN PASIEN (Ruang : _______)


NILAI
No Kriteria
1 2 3 4
1 Warna
2 Aroma
3 Rasa
4 Kematangan
5 Keramahan petugas

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