1. RESUME KEPERAWATAN
NAMA : JENIS KELAMIN : L / P
NO. RM: RUANG :
1. Tanggal masuk RS :
Dokter yang merawat :
Dokter konsultan :
Tanggal KRS :
2. Masa perawatan :
a. Keadaan waktu masuk :
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b. Masalah keperawatan selama dirawat :
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c. Tindakan yang di berikan :
1) Tindakan keperawatan
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2) Tindakan medis:
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3) Pemeriksaan penunjang medis:
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4) Keadaan pasien saat pulang
3. Pasien Pulang
Masalah keperawatan yang perlu di lanjutkan di rumah
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Surabaya, ……………2013
Kepala Ruang /Tim Jaga
(………………………..)