Format Askep Lengkap
Format Askep Lengkap
Format Askep Lengkap
DENGAN..............................................................
DI RUANG............................ RSUD KLUNGKUNG
TANGGAL..............................
I. PENGKAJIAN
A. Identitas Pasien
Nama :
No RM :
Umur :
Jenis Kelamin :
Pekerjaan :
Agama :
Status :
Tanggal MRS :
Tanggal Pengkajian :
B. Keluhan Utama
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
C. Riwayat Kesehatan
1. Riwayat Kesehatan Dahulu
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
2. Riwayat Kesehatan Sekarang
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
3. Riwayat Kesehatan Keluarga
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
II. ANALISA DATA
Ruang :
Nama Pasien :
No. Register :
Klungkung,……………………
Mengetahui, Mahasiswa
Clinical Instructure/CI
NIP : NIM :
Mengetahui,
Pembimbing Akademik
NIP :