8/16/2019 Assesmen Awal Medik Dan Keperawatan Gawat Darurat

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ASSESMEN AWAL MEDIK 

DAN KEPERAWATAN

GAWAT DARURAT

□□ MERAH

□□ KUNING

□□ HIJAU

□□ HITAM

RIWAYAT ALERGI

□ TIDAK 

□ YA, JENISNYA

1. .........................

2. .........................

IDENTITAS PASIEN

 NOMOR MEDREK : NAMA :

TANGGAL LAHIR/UMUR :

ALAMAT :

Tgl & Ja Ma!"# Tgl & Ja K$l"a%  

RIWAYAT KESEHATAN

K$l"a' U(aa :

R)*a+a( P$'+a#)( Da"l" :

PRIMARY SUREY K$a-aa' U" :

TD :...........Hg

 N :........./$')(

R :........./$')(

S :.........⁰

S0O₂ :...............

GS :......E

......M .......

K$!a-a%a' : ...........

.................

□ D$a( O' A%%)al

Ta'-a #$)-"0a'

345

D$'+"( 'a-) 345

R$6l$# 7aa+a 34/45

EKG a!)!(8l

AIRWAY

□ T)-a# a-a !"a%a

'a6a!

□ 9%a#("% S$%)#al

□ a)%a'

 $%"0a ..................

□ ;$'-a A!)'g :

□

M"l"( ....................

..

□

H)-"'g ..................

....

□

T$'gg8%8#a' .........

.......

□ T%)a!"!

□ ;a("# 0%8-"#()6 

□ L)-a 2 -$()# 

□ P"7a(

□ M"'(a/M$'7%$(

□ P$')'g#a(a' JP

□ H$'()

8/16/2019 Assesmen Awal Medik Dan Keperawatan Gawat Darurat

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□ N+$%) a#"(

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