61.ASSESMEN PRA BEDAH.doc

'2  *ama Jen Jenis -el -elamin Tgl 6a%ir 'uang Alamat

: : : : : :

Tempel 6abel Pasien

ASSESMEN PRA BEDAH

Asesmen Pra Operasi : Jam.................WIB

Tanggal Tanggal :

 Data Subyektif( anamnesis )



D



I

.......................................... ................... .............................................. ............................. ...... 

 Data Obyektif ( pemeriksaan fisik )

R  A



W

.............................................. ..................................................................... .............................................. .............................................. .............................................. ............................................. ......................

A

........................................... .................... .............................................. ..................................... ..............

T

Diagn!sis pra !perasi : "stimasi #aktu yang $ibutu%kan.&am

I N

'enana Operasi :

A

........................................... .................... .............................................. ..................................... ..............

P

........................................... .................... .............................................. ..................................... .............. Berikan tan$a pa$a gambar sesuai penan$aan l!kasi !perasi pa$a tubu% pasien Berikan penan$aan ($engan Spi$!l Permanent) pa$a l!kasi tubu% pasien Deskripsi singkat apabila ti$ak $apat $engan tan$a garis (   ̶ ) tan$a lingkar ( ο ) atau tan$a pana%( → )

$ilakukan penan$aan pa$a tubu% pasien

JA*+A* JA*+A* menggunakan silang ( , ) Sisi

Sisi

-iri

-anan

Belakang

P!sisi pasien $alam !perasi : D!kter Operat!r 

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/01''2'SP'II3405

Depan

Pasien-eluarga

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