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No. medical record : 17 45 83 Tanggal pengkajian : 15 -05-2018 Pukul
: 08.00
1 DATA DASAR A. Ientitas Pasien 1. Nama 2. usia 3. status perkawinan 4. pekerjaan 5. agama 6. pendidikan 7. suku 8. bahasa yang di gunakan 9. alamat rumah 10. sumber biyaya 11. tanggal masuk rs 12. diagnose medis