Download - Format Dischard Planing
RUMAH SAKIT UMUM Dr. SAIFUL ANWAR MALANG (RSSA)Jalan Jaksa Agung Suprapto 2 Malang - Jatim 65100. Telp. (0341) 362101 -362102. Fax. (0341) 362103. E-mail: [email protected]
DISCHARGE PLANNING (PERENCANAAN PULANG)
Nama: ______________________________________________________Usia: ______________________________________________________Alamat : ______________________________________________________No. MR: ______________________________________________________Tanggal pulang: ______________________________________________________Dx Medis: ______________________________________________________Dx Keperawatan: ____________________________________________________________________________________________________________________________________________________________________Saran setelah pulang : ______________________________________________________ ______________________________________________________ ______________________________________________________Jadwal controlTanggal : ______________________________________________________Tujuan: ______________________________________________________Keterangan: ______________________________________________________ ______________________________________________________Obat yang harus diminum:__________________________________________________________________________________________________________________________________________________________________________________________________________________Makanan khusus: __________________________________________________________________________________________________________________________________________________Lain-lain: _________________________________________________________________________Malang, Penerima Perawat Penyuluh
_____________________________________
1
