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ANALISA DATA

Nama : No. RM :
Diagnosa Medis: Tgl Pengkajian :

No Data Penunjang Penyebab Masalah

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DIAGNOSA KEPERAWATAN

Nama : No. RM :
Diagnosa Medis: Tgl Pengkajian :

No. Diagnosa Keperawatan TTD

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INTERVENSI KEPERAWATAN

Nama : No. RM :
Diagnosa Medis : Tgl Pengkajian :

No. Diagnosa Keperawatan NOC NIC

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IMPLEMENTASI DAN EVALUASI KEPERAWATAN

Nama : No. RM :
Diagnosa Medis : Tgl Pengkajian:

Tgl No. Tgl


Implementasi Evaluasi TTD
Jam Dx Jam

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