Format Kep Keluarga.docx
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PROGRAM D3 KEPERAWATAN FAKULTAS ILMU KEGURUAN DAN PENDIDIKAN UNIVERSITAS SULTAN AGENG TIRTAYASA KERANGKA ACUAN PRAKTEK KEPERAWATAN KELUARGA MAHASISWA TINGKAT III SEMESTER V TAHUN AKADEMIK 2018/2019
FORMAT PENGKAJIAN KEPERAWATAN KELUARGA I.
Data Umum 1. Nama KK : ...................................................................................... 2. Alamat dan telfon : ...................................................................................... 3. Pekerjaan KK : 4. Pendidikan KK : 5. Tanggal Pengkajian : 6. Komposisi Anggota Keluarga
No
Nama
Jenis Kelaamin
Hubungan Keluarga
Usia
Pendidikan
Ket
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Genogram
Keterangan: ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... .................................................................................................................................. ....................................... ......................................................................................................................................................................... 7.
Tipe Keluarga .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. ..................................................................................................................................................................
FORMAT PENGKAJIAN KEPERAWATAN KELUARGA I.
Data Umum 1. Nama KK : ...................................................................................... 2. Alamat dan telfon : ...................................................................................... 3. Pekerjaan KK : 4. Pendidikan KK : 5. Tanggal Pengkajian : 6. Komposisi Anggota Keluarga
No
Nama
Jenis Kelaamin
Hubungan Keluarga
Usia
Pendidikan
Ket
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Genogram
Keterangan: ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... .................................................................................................................................. ....................................... ......................................................................................................................................................................... 7.
Tipe Keluarga .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. ..................................................................................................................................................................
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