Lamp Surat Pendelegasian.docx

SURAT PENDELEGASIAN

1. Identitas Pasien a. Nama

:

b. Umur

:

c. Jenis Kelamin

:

d. Alamat

:

e. Pekerjaan

:

f. Agama

:

g. Diagnosa

:

h. Tanggal Masuk

:

i. No. Register

:

2. Masalah yang ditemukan a............................................................................................................................... b. ............................................................................................................................. c. .............................................................................................................................

3. Tindakan yang sudah dilaksanakan a............................................................................................................................... b. .............................................................................................................................

4. Masalah yang sudah teratasi a............................................................................................................................... b. .............................................................................................................................

5. Masalah yang belum teratasi a............................................................................................................................... b. .............................................................................................................................

6. Keadaan pasien saat diperiksa a. Status Kesehatan

: ..............................................................................

b. Status Respirasi

: ..............................................................................

c. Status Sirkulasi

: ..............................................................................

d. Status Nutrisi dan Cairan : .............................................................................. e. Status Perkemihan

: ..............................................................................

7. Rencana selanjutnya a............................................................................................................................... b. ............................................................................................................................. c. .............................................................................................................................

Perawat yang mendapat pendelegasian

Semarang, April 2019 Mahasiswa yang mendelegasi

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