SEKOLAH TINGGI ILMU KESEHATAN

STIKES PEMKAB JOMBANG

PROGRAM STUDI S-1 KEPERAWATAN, D-III KEPERAWATAN,
D-III KEBIDANAN, PENDIDIKAN PROFESI NERS
Jalan Raya Pandanwangi, Kecamatan Diwek, Telp/Fax (0321) 870214-JOMBANG
[Link]

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 ANALISA DATA
Nama Pasien :
No. RM :
Dx. Medis :
NO TGL/JAM DATA ETIOLOGI MASALAH
 DAFTAR DIAGNOSA KEPERAWATAN
Nama Pasien :
No. RM :
Dx. Medis :
TANGGAL NO DIAGNOSA DIAGNOSA KEPERAWATAN

DAFTAR PRIORITAS DIAGNOSA KEPERAWATAN

TANGGAL NO DIAGNOSA DIAGNOSA KEPERAWATAN
 RENCANA KEPERAWATAN
Nama Pasien :
No. RM :
Dx. Medis :
NO TGL/JAM DIAGNOSA RENCANA KEPERAWATAN
KEPERAWATAN TUJUAN KERITERIA INTERVENSI RASIONAL
(TARGET WAKTU) HASIL
NO TGL/JAM DIAGNOSA RENCANA KEPERAWATAN
KEPERAWATAN TUJUAN KERITERIA INTERVENSI RASIONAL
(TARGET WAKTU) HASIL
 TINDAKAN KEPERAWATAN
Nama Pasien :
No. RM :
Dx. Medis :
NO DIAGNOSA TGL/JAM TINDAKAN KEPERAWATAN TTD
KEPERAWATAN
NO DIAGNOSA TGL/JAM TINDAKAN KEPERAWATAN TTD
KEPERAWATAN
 CATATAN PERKEMBANGAN
Nama Pasien :
No. RM :
Dx. Medis :
NO DIAGNOSA TGL/JAM CATATAN PERKEMBANGAN TTD
KEPERAWATAN
NO DIAGNOSA TGL/JAM CATATAN PERKEMBANGAN TTD
KEPERAWATAN