Sensus Harian Rawat Inap Non Rujuk.docx

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SENSUS HARIAN RAWAT INAP Tanggal : ............................................... No 1 1 2 3 4 5

Tempat Tidur Tersedia : 27 TT

PASIEN MASUK RAWAT INAP No RM Kamar No Nama Pasien 3 4 5 6

Nama Pasien 2

No

Nama Pasien

No RM

Kamar

1 1 2 3 4 5

2

3

4

PASIEN KELUAR RAWAT INAP Cara Pasien Keluar Tgl Meninggal DiPulang Masuk Sembuh Lari rujuk paksa <48 jam >48 jam 5 6 7 8 9 10 11

No RM 7

Tujuan Rujukan 12

Kamar 8

Lama dirawat 13

RESUME Pasien awal ................ Pasien masuk ................ Jumlah pasien dirawat................ Pasien masuk keluar padahari yang sama ................

Pasien sembuh .............. Pasien dirujuk .............. Pasien pulang paksa .............. Pasien melarikan diri .............. Jumlah pasien keluar hidup..............

Meninggal <48 jam Meninggal >48 jam Jumlah pasien meninggal Jumlah pasien keluar Jumlah pasien sisa

.............. .............. .............. .............. ..............

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