Kb Pil.docx

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KEGIATAN KB PIL

No.

YA

TIDAK

Apakah 1.

Petugas memperkenalkan diri dengan sopan, konseling pasien

2.

Petugas makukan pemeriksaan tanda-tanda vital

3.

Petugas munjukkan macam-macam pil KB

4.

Petugas melakukan Health Education : a. Keuntungan dan kerugian b. Efek samping c. Cara pemakaian pil KB d. Kapan pasien harus kembali ke petugas kesehatan

5.

Petugas emberikan kartu akseptor KB

6.

Petugas melakukan pencatatan ke dalam register KB

7.

Petugas merapikan alat dan dikembalikan ketempat semula

SUMPIUH,..................20....... PENILAI,

(..................................)

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