FORMAT LAPORAN DISKUSI REFLEKSI KASUS (DRK) RUANG RAWAT : ...........................................

Nama Ruangan :

Tanggal Pelaksanaan :

Topik Diskusi Kasus :

A. Masalah/ Isu yang Muncul :

1. ...................................................................................................................

2. ...................................................................................................................

3. ...................................................................................................................

4. ...................................................................................................................

5. dst

B. Pembahasan:

C. Rencana Tindak Lanjut:

No Isu Kegiatan Indikator

1.

2.

3.

4.

dst

Peserta DRK

1.

(......................................)

2

(.......................................)

3

(.......................................)

4

(........................................)

dst

(........................................)

............,................

Kepala Ruangan

( .........................)

……)