contoh format laporan kasus

7/23/2019 Contoh Format Laporan Kasus

1/19

CONTOH FORMAT LAPORAN KASUS

Tgl/jam MRS : 5 April 2010/10.00 W!

R"a#g : RC

N$. R%gi&'%r M%(i) *RM+ : ,,.10.10

-. M%(i& : T! Par"

Tgl. P%#g)ajia# : April 2010

. -NTTAS

1. KLN

NAMA : T#. A

UMUR : 50 Ta"#

NS KLAMN : La)i3la)i

A4AMA : &lam

SUKU/!AN4SA : S"#(a/#($&%#&ia

PN--KAN : SMA

PKRAAN : !"r" !a#g"#a#

STATUS M%#i)a


2/19

STATUS : M%#i)a

2. RWA8AT PN8AKT SKARAN4

.................................................................*K%m6a#g)a# (%#ga# m%'$(%P;RST 6ila m%m"#g)i#)a# &%m"a i'%m a'a" 6%6%rapa i'%m &%&"ai

)%6"'"a#+

< P: Palia'i=% pr$=$)a'i>/pr$=$)i#g #?i(%#'

Apa 7a#g m%#7%6a6)a# g%jala@

Apa 7a#g 6i&a m%mp%r6%ra'@

Apa 7a#g 6i&a m%#g"ra#gi@

< ;: ;"a#'i'7 "ali'7

!agaima#a g%jala (ira&a)a#@

S%ja" ma#a g%jala (ira&a)a#@

< R: R%gi$#: ra(ia&i

-i ma#a g%jala (ira&a)a#@

Apa)a m%#7%6ar@

S S%=%ri'7 *S?al%+


3/19

Upa7a 7a#g '%la (ila)")a#.................................Upa7a "#'") m%#g"ra#gi 6ai) 6%r&i>a' ra&i$#al a'a" ira&i$#al

C$#'$:

Kli%# 6a#7a) m%#g)$#&"m&i air a#ga'

Kli%# m%m6%li $6a' 6a'") 7a#g (ij"al 6%6a&

. RWA8AT KSHATAN -AHULU

*7a#g 6%r"6"#ga# (%#ga# p%#7a)i' 7a#g (i(%ri'a )li%# &aa' i#i/p%#7a)i'

7a#g m"#g)i# m%mp%#gar"i a'a" (apa' (ip%#gar"i $l% p%#7a)i' 7a#g

(i(%ri'a )li%#+ 6ai) p%#7a)i' a'a" 'i#(a)a# $p%ra&i

P%r#a m%#(%ri'a T! )%l%#jar 5 'a"# 7a#g lal" '%'api 'i(a) &%l%&ai

m%#gi)"'i pr$gram p%#g$6a'a# T! *a#7a 2 6"la# &aja+

D. RWA8AT ALR4

5. RWA8AT KSHATAN KLUAR4A


4/19

. POLA AKTETAS SHAR3HAR

1. P$la #"'ri&i

Ma)a# S%6%l"m Sa)i' Saa' Sa)i'

Fr%)"%#&i

%#i&

P$r&i

T$'al K$#&"m&i Kal$ri Kal$ri

K%l"a# #'a)% #"'ri&i

i#a(%)"a'a#$r%)&ia

Mi#"m

"mla Li'%r

%#i&

K%l"a#


5/19

. P$la a)'i=i'a&A)'i=i'a& S%6%l"m Sa)i' Saa' Sa)i'

M$6ili'a& R"'i#

Wa)'" &%#gga#g

Ma#(i

!%rpa)aia#

!%ria&

T$il%'i#g

Ma)a# Mi#"m

Ma)a# Mi#"m

Ti#g)a'

K%'%rga#'"#ga#

D. P$la &'iraa' 'i("r

A)'i=i'a& S%6%l"m Sa)i' Saa' Sa)i'

"mla jam 'i("r

i


6/19

P%#(%#gara# GN$rmal GK%r"&a)a# )a/)i GT"li )a/)i GAla' !a#'" -%#gar

GTi#i'"&K%'%ra#ga#.........................................................................

P%#glia'a#: GN$rmal GKa?a Ma'a GL%#&a K$#'a) GK%r"&a)a# )i/)a

GK%6"'aa# )a/)i GKa'ara) )a/)i

K%'%ra#ga#.........................................................................

P%#g%?ap P%#gi(": GN$rmal G4a#gg"a# i#(%ra p%#g%?ap G4a#gg"a#

i#(%ra p%#gi("

K%'%ra#ga#.........................................................................

P%ra6a: GN$rmal G4a#gg"a# i#(%ra p%ra6a

K%'%ra#ga#........................................................................

6. Si&'%m P%r#a>a&a#

Fr%)"%#&i: ....../m )"ali'a&: GN$rmal G-a#g)al GC%pa'

!a'"): 7a/'i(a) S"ara #a>a&: G!%r&i GR$#?i G9%%Ii#g

S"m6a'a# jala# #a>a&: G&p"'"m Gl%#(ir G-ara Gl"(a

Lai#3lai#......................................................

Si ' K (i ) l


7/19

M"l"' (a# T%#gg$r$)a# G N$rmal GL%&i M")$&a:....................

K%mamp"a# M%#g"#7a GN$rmal GK"ra#g GK%&"li'a#K%mamp"a# M%#%la# G N$rmal G N7%ri m%#%la#

P%r"': GN$rmal Hip%rp%ri&'al'i) GTi(a) a(a 6i&i#g "&"&

G )%m6"#g G N7%ri '%)a# )"a(ra#.............../6agia#..............

C$l$# (a# R%?'"m: !A! GN$rmal GK$#&'ipa&i.......ari

G-iar%....../.......jam G#)$#'i#%#&ia G M%l%#a GH%ma'%m%&i&

Lai#3lai#.............................................................................

>. Si&'%m M"&)"l$&)%l%'al

R%#'a#g g%ra) GP%#" GT%r6a'a&

K%&%im6a#ga# (a# ?ara jala#:G T%gap G Ti(a) '%gap

K%mamp"a# m%m%#"i a)'i'a& &%ari3ari GMa#(iri G-i6a#'" &%6agia#

G-i6a#'" &%p%#"#7a GM%#gg"#a)a# ala' 6a#'" 6%r"pa..............

4%#ggama# 'a#ga#: GSama )"a' G L%ma )a#a#/)iri

O'$' Ka)i G &ama )"a' G L%ma )a#a#/)iri

Lai#3lai#.............................................................................

g. Si&'%m #'%g"m%#


8/19

1. PSKOLO4S

P%ra&aa# )li%# &%'%la m%#galami ma&ala i#i a(ala.................. Cara m%#ga'a&i p%ra&aa# '%r&%6"'..............................................

R%#?a#a )li%# &%'%la ma&ala#7a '%r&%l%&ai)a#..........................

i)a r%#?a#a i#i 'i(a) (apa' (ila)&a#a)a#....................................

P%#g%'a"a# )li%# '%#'a#g ma&ala/p%#7a)i' 7a#g a(a.................

2. SOSAL

A)'i'a& a'a" p%ra# )li%# (i ma&7ara)a' a(ala............................

K%6ia&aa# li#g)"#ga# 7a#g 'i(a) (i&")ai a(ala...........................

Cara m%#ga'a&i#7a...................................................................

Pa#(a#ga# )li%# '%#'a#g a)'i'a& &$?ial (i li#g)"#ga##7a.............

. !U-A8A

!"(a7a 7a#g (ii)"'i )li%# a(ala 6"(a7a .......... 7a#g a)'i'aa

a(ala........................

K%6%ra'a###7a (alam m%#gi)"'i 6"(a7a '%r&%6"'

( l


9/19


10/19

a. FORMAT ANALSA -ATA

Nama Pa&i%# : T#. A

Um"r : 55 Ta"#

-iag#$&a M%(i& : T! Par"

N$. RM : ,,.10.10

NO -ATA PN8!A! MASALAH

1 -S:

Kli%# m%#g%l" 6a'")

6%r(aa) &%ja) 2 mi#gg"

7a#g lal"

Kli%# m%#g%l"

(aa)#7a &"li' (i)%l"ar)a#

Kli%# m%#g%l"

#apaa &%ri#g &%&a)

-O:

RR: 2/m%#i'

S%)r%' )%#'al

T%r(apa' 'ari)a#

(i#(i#g (a(a )%(alam

R$#)i p$&i'i>

R%a)&i i#ama&i )"ma# T!

Q

M%m6%#'") )a=i'a& (a#

m%r"&a) par%#)im par"

Q

(%ma 'ra)%al

P%#i#g)a'a# pr$(")&i &%?r%'

Q

!a'") pr$(")'i>

S%&a) #apa&

P%#"r"#a# )%mamp"a# 6a'")

%>%)'i>

K%'i(a) %>%)'ipa#

6%r&ia# jala# #apa&


11/19

6. Pri$ri'a& -iag#$&a K%p%ra9a'a#

1. K%'i(a)%>%)'i>a# 6%r&ia# jala# #apa& 7a#g 6.( &%)r%&i m")"& 7a#g )%#'al

2. K%r"&a)a# p%r'")ara# ga& 6.( )%r"&a)a# m%m6ra# al=%$lar3)apil%r

. P%r"6aa# #"'ri&i: )"ra#g (ari )%6"'"a# '"6" 6.( )%l%'ia# a#$r%)&ia (i&p#%a p%#i#g)a'a# m%'a6$li&m%

'"6"

2 p%#(%)a'a#:

Hirar)i A6raam ma&l$9@

P%#(%)'a# !$(7 &7&'%m *!r%a'i#g 6l$$( 6rai# 6la((%r 6$9%l 6$#%+


12/19


13/19

FORMAT -A4NOSA KPRAWATAN

Nama Pa&i%# : T#. A

Um"r : 55 Ta"#


N$. RM : ,,.10.10

NO T4L MUNCUL -PT4L

TRATASPARAF


14/19


15/19

(.FORMAT NCP *NURSN4 CAR PLAN+

Nama Pa&i%# : T#. A

Um"r : 55 Ta"#


N$. RM : ,,.10.10

NO -PTUUAN KRTRA

HASLNTRENS RASONAL PARAF

1 1 -alam 9a)'" 22D jam

&%'%la (i6%ri)a#

i#'%r=%#&i jala# #apa&

)%m6ali %>%)'i>

-%#ga# )ri'%ria a&il:

3 !a'") 6%r)"ra#g

3 Kli%# mamp"

m%la)")a# 6a'")

%>%)'i>

3 RR #$rmal*1320/m+

'a#pa m%#gg"#a)a#

$'$' 6a#'" p%r#apa&a#

3 !"#7i #apa& #$rmal

*'i(a) a(a r$#)i+

1. Kaji >"#g&i

p%r#apa&a# *6"#7i

#apa& )%?%pa'a#

irama )%(alama# (a#

p%#gg"#aa# $'$' 6a#'"

#apa&+

2. Kaji )%mamp"a#

m%#g%l"ar)a# &%)r%&i

?a'a' )ara)'%r =$l"m%

1. P%#"r"#a# 6"#7i #apa&

m%#"#j"))a# a'%l%)'a&i&

r$#)i m%#"#j"))a#

a)"m"la&i &%?r%' (a# )%'i(a)

%>%)'i>a# p%#g%l"ara# &%)r%&i

7a#g &%la#j"'#7a (apa'

m%#im6"l)a# p%#gg"#aa#

$'$' 6a#'" #apa& (a#

p%#i#g)a'a# )%rja

p%r#apa&a#a#

2. P%#g%l"ara# a)a# &"li'

6ila &%?r%' )%#'al *%>%) i#>%)&i

(a# i(ra&i 7a#g 'i(a)

a(%)"a'+


16/19

&p"'"m

. !%ri)a# p$&i&i

>$9l%r/&%mi>$9l%r 'i#ggi

(a# 6a#'" )li%# 6%rla'i

#apa& (alam (a# 6a'")

%>%)'i>

D. K$la6$ra&i p%m6%ria#$6a' &%&"ai i#(i)a&i

ag%# m")$li'i)

. P$&i&i >$9l%r

m%ma)&imal)a# %)&pa#&i

par" (a# m%#"r"#)a# "pGa7a#apa& =%#'ila&i ma)&imal

m%m6")a ar%a a'%l%)'a&i&

(a# m%#i#g)a')a# g%ra)a#

&%?r%' )% jala# #apa& 6%&ar

"#'") (i)%l"ar)a#

D. Ag%# m")$li'i)

m%#"r"#)a# )%)%#'ala# (a#p%rl%#g)%'a# &%?r%' par"

"#'") m%m"(a)a#

p%m6%r&ia#

%. FORMAT MPLMNTAS

Nama Pa&i%# : T#. A

Um"r : 55 Ta"#

-iag#$&a M%(i& : T! Par"N$. RM : ,,.10.10


17/19

NO

-PHAR/TAN44AL/WAKTU

MPLMNTAS

*RSPON+PARAF

1 S%la&a/ April 2010

0.0 W!

1. Kaji >"#g&i p%r#apa&a# *6"#7i #apa&

)%?%pa'a# irama )%(alama# (a#p%#gg"#aa# $'$' 6a#'" #apa&+

mpl%m%#'a&i:

M%#gi'"#g RR *R%&p$#: RR 2/m

'%ra'"r '%r(apa' 'ari)a# (i#(i#g (a(a

)%(alam +

a. Kaji )%mamp"a# m%#g%l"ar)a# &%)r%&i?a'a' )ara)'%r =$l"m% &p"'"m

6. !%ri)a# p$&i&i >$9l%r/&%mi>$9l%r 'i#ggi

(a# 6a#'" )li%# 6%rla'i #apa& (alam (a#

6a'") %>%)'i>

?. K$la6$ra&i p%m6%ria# $6a' &%&"ai

i#(i)a&i ag%# m")$li'i)


18/19

>. FORMAT EALUAS

Nama Pa&i%# : T#. A

Um"r : 55 Ta"#


N$. RM : ,,.10.10

N$ -P Ta#ggal (a# 9a)'" Ca'a'a# P%r)%m6a#ga# Para>

1 April 2010/0.00

W!

S: Ma&i m%#g%l" 6a'") 6%r(aa) &%&a) 6%r)"ra#g

O: RR 2D/m R$#)i p$&i'i> &%?r%' ma&i )%#'al

A: K%'i(a)%>%)'ipa# 6%r&ia# jala# #apa&

P: R%#?a#a 'i#(a)a# 12D (ila#j"')a#

: 3M%#g)aji >"#g&i p%r#apa&a#

3M%#ga'"r p$&i&i

3M%m6%ri $6a' 6r$#)$(ila'$r

3M%r#gajar)a# 6a'") %>%)'i>

: 3RR 22/m '%ra'"r

3P$&i&i i&'iraa' )li%# >$9l%r

3Kli%# m%#(apa' 6i&$l=$# 500mg


19/19

3Kli%# (apa' m%la)")a# 6a'") %>%)'i>

R: '"j"a# '%r?apai &%6agia# r%#?a#a 'i#(a)a#

(i'%r"&)a#

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