Formulir Metode Taksiran Visual.docx
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FORMULIR METODE TAKSIRAN VISUAL SCALA COMSTOCK Nama Pasien
:
Kamar
:
Diet
:
Tanggal
:
Hari Pengamatan
:
Waktu makan
Pagi
Siang
Malam
jenis makanan
0%
5%
Bubur/Nasi Lauk Hewani Lauk Nabati Sayur Buah Bubur/Nasi Lauk Hewani Lauk Nabati Sayur Buah Bubur/ Nasi Lauk Hewani Lauk Nabati Sayur Buah
Keterangan :
Habis
Tidak Habis
25%
% Sisa Makanan 50% 75%
95%
100%
:
Kamar
:
Diet
:
Tanggal
:
Hari Pengamatan
:
Waktu makan
Pagi
Siang
Malam
jenis makanan
0%
5%
Bubur/Nasi Lauk Hewani Lauk Nabati Sayur Buah Bubur/Nasi Lauk Hewani Lauk Nabati Sayur Buah Bubur/ Nasi Lauk Hewani Lauk Nabati Sayur Buah
Keterangan :
Habis
Tidak Habis
25%
% Sisa Makanan 50% 75%
95%
100%
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