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RS. ROYAL PRIMA Jl. Ayahanda No. 68 A Medan 20118 Tlp: (061) 888 13182 – 888 13183 (Hunting) Fax : (061) 800 13181 Web : www.royaprima.com Email : [email protected] Nama : ...................................... ............. L / P* Tgl Lahir : ...................................... ............. No. RM : ...................................... ............. CATATAN OBSERVASI Diagnose Medik : Ruangan : NYERI TANGGAL JAM Tidak Nyeri 0 1 2 3 4 5 6 7 Nadi T.D 200 190 180 170 160 150 140 130 120 110 100 90 80 Temp C 42 0 41 0 40 0 39 0 38 0 37 0 36 0

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RS. ROYAL PRIMA Jl. Ayahanda No. 68 A Medan 20118

Tlp: (061) 888 13182 888 13183 (Hunting)

Fax : (061) 800 13181

Web : www.royaprima.com Email : [email protected]

: ...................................................L / P*

Tgl Lahir : ...................................................No. RM : ...................................................

CATATAN OBSERVASI

Diagnose Medik : Ruangan :

NYERITANGGAL

JAM

Tidak Nyeri 0 1 2 3 4 5 6 7 8 9 10 Sangat NyeriNadiT.D

200190

180

170

160

150

140

130

120

110

100

90

80

70

60

50

40Temp

C

420

410

400

390

380

370

360

350

340

Nafas

NYERI

BAB

KESADARANAlert

Verbal

Pain

Un-Resp

POSISISupine

Mi Ka

Mi Ki

Nama / Paraf

NYERITANGGAL

JAM

Tidak Nyeri 0 1 2 3 4 5 6 7 8 9 10 Sangat NyeriNadiT.D200190

180

170

160

150

140

130

120

110

100

90

80

70

60

50

40Temp

C

420

410

400

390

380

370

360

350

340

Nafas

NYERI

BAB

KESADARANAlert

Verbal

Pain

Un-Resp

POSISISupine

Mi Ka

Mi Ki

Nama / Paraf