Beruflich Dokumente
Kultur Dokumente
Nomor RM : …………….........................................
Jl. Talaga tomoagu kec.bolangitang barat
Kodepos 95764
ANESTHESIA RECORD
Nama Pasien :
Tanggal Lahir :
42 220
Oper
41 200
Anesth ×
40 180
Resp.
39 160
Pulse
38 140
BP
37 120
Intub T
36 100
Extub _I_
35 80
34 60
33 40
32 20
PREMEDICATION
FLUIDS
Position :
Regional Block :
Urine cc Spinal Epidural
NG Tube cc Caudal Axillary
Proposed Operation Agent :
Operation
Pre- op Daignosis Needle Gauge :
Post-op Diagnosis Interspace :
Surgeons Dermatome Level :
Anesthetist Paresthesia: Yes No
INTAKE TOTAL
Dokter Anestesi
OUTPUT TOTAL
______________________
(Tanda tangan dan nama jelas)