(wb.11) Pengamatan Transfusi Darah
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WB.11 PENGAMATAN TRANSFUSI DARAH 1. 2. 3. 4. 5.
Jenis Jumlah kolf Diberikan Gol Darah Jumlah /cc
Kolf I
:…………………………………………….. :…………………………………………….. :……………………………………………... :……………………………………………... :……………………………………………… Kolf II
Kolf III
Kolf IV
Kolf V
No. PMI
No. PMI
No. PMI
No. PMI
No. PMI
Tgl :……….. Jam :……….
Tgl :………. Jam :………
Tgl :…….. Jam :…….
Tgl :…….. Jam :……..
Tgl :………. Jam :………
Paraf perawat jaga
6.
Paraf perawat jaga
Paraf perawat jaga
Paraf perawat jaga
Paraf perawat jaga
Asal PMI : ………………………………………………………………………………… Kelainan pada penderita setelah mendapat transfusi darah
7.
………………………………………………………………………………… Sisa transfuse darah kembali ke laboratorium : ………………………………………………………………………………… Mojowarno, Tanggal……………jam : …… Perawat / Bidan ( ) Tanda Tangan & Nama Terang
Jenis Jumlah kolf Diberikan Gol Darah Jumlah /cc
Kolf I
:…………………………………………….. :…………………………………………….. :……………………………………………... :……………………………………………... :……………………………………………… Kolf II
Kolf III
Kolf IV
Kolf V
No. PMI
No. PMI
No. PMI
No. PMI
No. PMI
Tgl :……….. Jam :……….
Tgl :………. Jam :………
Tgl :…….. Jam :…….
Tgl :…….. Jam :……..
Tgl :………. Jam :………
Paraf perawat jaga
6.
Paraf perawat jaga
Paraf perawat jaga
Paraf perawat jaga
Paraf perawat jaga
Asal PMI : ………………………………………………………………………………… Kelainan pada penderita setelah mendapat transfusi darah
7.
………………………………………………………………………………… Sisa transfuse darah kembali ke laboratorium : ………………………………………………………………………………… Mojowarno, Tanggal……………jam : …… Perawat / Bidan ( ) Tanda Tangan & Nama Terang
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