RM.RI. 20 RUMAH SAKIT BAPTIS BATU Jl. Raya Tlekung No. 1 Tlekung Junrejo Batu Telp. (0341) 594161 Fax. (0341) 598911 PENGKAJIAN SPIRITUAL PASIEN Nama : L P No. Register : Umur : Ruang : Lantai : No. Rekam Medik : RSBB 2013 1.Pengkajian spiritual pasien dilakukan tanggal.........................Jam...................... WIB oleh......................................... 2.Keyakinan pasien terhadap Tuhan yang memotivasi kesembuhan pasien: ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 3.Nilai-nilai hidup pasien: .................................................................................................................................................................................. .................................................................................................................................................................................. .................................................................................................................................................................................. 4.Tujuan Hidup Pasien: .................................................................................................................................................................................. .................................................................................................................................................................................. ............................................................................................................................................................................... 5.Kepercayaan Pasien: . . .. Tanggal / Jam selesai pengkajian ........................... / .................WIB Nama Lengkap & Tandatangan