Daftar Cek-list Operasi Pre-operasi

 NAMA PASIEN  NO. RM. UMUR RUANG/KELAS DOKTER HARI/TANGGAL

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DAFTAR CEK-LIST PRE-OPERASI

Tanggal : ................... ......... .................... ..................... ................. ...... Jenis Operasi............ .................... .......... .................... ..................... ..................... .................... .................... .......... ............................ .......................................... ............................. .............................. ............................. ............................. .............................. ............................. ............................. ............................. ..................... ....... Lengkap Tiak !a Tiak apa" ilaksanakan PENGE#EKAN

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PERA$AT RUANGAN

PERA$AT KAMAR %EDA

Ien"i Ien"i"as "as '.s '.s s(a) s(a) lengka lengkap p an an *enar  *enar  S.I.O S.I.O )ar( )ar(ss s(a) s(a) i"an i"ana"a a"anga ngani ni S(a S(a) ) aa aa -a"a -a"a"a "an n aler alergi gi '.s '.s O*serasi O*serasi T.N.S.P "erak)ir "erak)ir s(a) aa an

i ser"ai O.K  0 Pen-(k Pen-(k(ra (ran n s(a) s(a) ilak( ilak(kan kan 1 Pre2eikasi Pre2eikasi s(a) i*erikan i*erikan33 i-a"a" i-a"a" an ikiri2 ikiri2 Ser"akan "erapi lis" ke O.K. 4 Gigi Gigi Pals(3 Pals(3 ra2*( ra2*("" pals( pals( '.s '.s s(a) s(a) iang iangka" ka" 5 K'n"a K'n"ak k Lens Lens 6 ka-a ka-a 2a"a 2a"a s(a s(a) ) ilep ilepas as 7 Pr'"es Pr'"ese/a e/ala" la" *an" *an"( ( s(a) s(a) iangk iangka" a" &8 #a" k(k( k(k( 6 2ake (p (p s(a) s(a) i*ersi) i*ersi)kan kan && Segala Segala per)iasan per)iasan ilepaska ilepaskan9i* n9i*erikan erikan kepaa kepaa kel(arga a"a( kepala r(angan 6 i -a"a" &+ #in-in #in-in ilepaskan ilepaskan33 *ila -in-in -in-in ka;in ka;in "iak "iak apa" ilepas3 ples"er kain paa (s engan : ........................................................Se*an=ak .......................## Tanpa Laa2en

Laa2en Rena)

Laa2en Tinggi

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%er)asil

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Per2in"aan ara) Pkl : .................................................. Dara) i"eri2a Pkl : ...................................................... Tana "angan Pera;a" R(angan

Tana "angan Pera;a" Ka2ar %ea)

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