Form Lpd Gyssens.docx
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Form Evaluasi Kualitas Penggunaan Antibiotik (Gyssens flowchart)
No Kode
Nama antibiotik
Rejimen Dosis
Rute
pasien
Keterangan Tipe Terapi : P = Antibiotik Profilaksis E = Antibiotik Empiris EE = Antibiotik Extended Empiris D = Antibiotik Definitif
Tipe terapi (P/E/EE/D)
Indikasi
Tgl mulai
Tgl stop
VI
V
IV (A/B/C/D)
Kategori(Gyssens) III A III B
II (A/B/C)
I
0
No Kode
Nama antibiotik
Rejimen Dosis
Rute
pasien
Keterangan Tipe Terapi : P = Antibiotik Profilaksis E = Antibiotik Empiris EE = Antibiotik Extended Empiris D = Antibiotik Definitif
Tipe terapi (P/E/EE/D)
Indikasi
Tgl mulai
Tgl stop
VI
V
IV (A/B/C/D)
Kategori(Gyssens) III A III B
II (A/B/C)
I
0
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