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TGL. TGL.

ANAMNESIS
NO NO. RM NAMA PASIEN JK NIK NO. BPJS DIAGNOSA TERAPI PARAF
KNJGN LAHIR DATA SUBJEKTIF DATA OBJEKTIF
Pengkajian Fisik :
BB : ...........kg
LL : ...........cm
LP : ...........cm
TD : ...........mmHg
DN : ...........x/m
RR : ...........x/m
T : ...........°C
Skala Nyeri : .........

Pemeriksaan Lab :
GD : ..........mg/dL
AU : ..........mg/dL
Chl : ..........mg/dL
Pengkajian Fisik :
BB : ...........kg
LL : ...........cm
LP : ...........cm
TD : ...........mmHg
DN : ...........x/m
RR : ...........x/m
T : ...........°C
Skala Nyeri : .........

Pemeriksaan Lab :
GD : ..........mg/dL
AU : ..........mg/dL
Chl : ..........mg/dL
Pengkajian Fisik :
BB : ...........kg
LL : ...........cm
LP : ...........cm
TD : ...........mmHg
DN : ...........x/m
RR : ...........x/m
T : ...........°C
Skala Nyeri : .........

Pemeriksaan Lab :
GD : ..........mg/dL
AU : ..........mg/dL
Chl : ..........mg/dL

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