1. Resep Keperawatan Baru.docx
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Rumah Sakit ___________________________________
Puskesmas___________________________________
RESEP KEPERAWATAN
RESEP KEPERAWATAN
Nama Perawat
:
__________________________
Tanggal Resep
:______________________
Nama Perawat
:
__________________________
Tanggal Resep
:______________________
SIP
:
__________________________
Ruangan
:______________________
SIP
:
__________________________
Ruangan
:______________________
R/
R/
1. ______________________________________________________ Waktu___________________
1. ______________________________________________________ Waktu___________________
2. ______________________________________________________ Waktu___________________
2. ______________________________________________________ Waktu___________________
3. ______________________________________________________ Waktu___________________
3. ______________________________________________________ Waktu___________________
4. ______________________________________________________ Waktu___________________
4. ______________________________________________________ Waktu___________________
5. ______________________________________________________ Waktu___________________
5. ______________________________________________________ Waktu___________________
6. ______________________________________________________ Waktu___________________
6. ______________________________________________________ Waktu___________________
7. ______________________________________________________ Waktu___________________
7. ______________________________________________________ Waktu___________________
8. ______________________________________________________ Waktu___________________
8. ______________________________________________________ Waktu___________________
9. ______________________________________________________ Waktu___________________
9. ______________________________________________________ Waktu___________________
10. ______________________________________________________ Waktu___________________
10. ______________________________________________________ Waktu___________________
Nama Pasien
:
__________________________
Nama Pasien
:
__________________________
Tanggal Lahir
:
__________________________
Tanggal Lahir
:
__________________________
Alamat
:
________________________________________________________________________
Alamat
:
________________________________________________________________________
Tanda Tangan
:______________________
Tanda Tangan
:______________________
Puskesmas___________________________________
RESEP KEPERAWATAN
RESEP KEPERAWATAN
Nama Perawat
:
__________________________
Tanggal Resep
:______________________
Nama Perawat
:
__________________________
Tanggal Resep
:______________________
SIP
:
__________________________
Ruangan
:______________________
SIP
:
__________________________
Ruangan
:______________________
R/
R/
1. ______________________________________________________ Waktu___________________
1. ______________________________________________________ Waktu___________________
2. ______________________________________________________ Waktu___________________
2. ______________________________________________________ Waktu___________________
3. ______________________________________________________ Waktu___________________
3. ______________________________________________________ Waktu___________________
4. ______________________________________________________ Waktu___________________
4. ______________________________________________________ Waktu___________________
5. ______________________________________________________ Waktu___________________
5. ______________________________________________________ Waktu___________________
6. ______________________________________________________ Waktu___________________
6. ______________________________________________________ Waktu___________________
7. ______________________________________________________ Waktu___________________
7. ______________________________________________________ Waktu___________________
8. ______________________________________________________ Waktu___________________
8. ______________________________________________________ Waktu___________________
9. ______________________________________________________ Waktu___________________
9. ______________________________________________________ Waktu___________________
10. ______________________________________________________ Waktu___________________
10. ______________________________________________________ Waktu___________________
Nama Pasien
:
__________________________
Nama Pasien
:
__________________________
Tanggal Lahir
:
__________________________
Tanggal Lahir
:
__________________________
Alamat
:
________________________________________________________________________
Alamat
:
________________________________________________________________________
Tanda Tangan
:______________________
Tanda Tangan
:______________________
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