Pengertian, Manfaat, Tujuan Dan Format (Komponen) Dokumentasi Keperawatan (Askep)

<div style="text-align: justify;"> Sebagai seorang perawat tentulah faham dan mengerti betul bagaimana cara pembuatan dokumentasi keperawatan (askep), hal ini telah menjadi kiprah wajib kita disaat melaksanakan proses akademik.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Namun sudahkah teman-teman sekalian tahu apa bekerjsama manfaat dan tujuannya serta bagaimana format yang benar pembuatan dokumentasi keperawatan.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Berikut kami coba paparkan ihwal pengertian, tujuan, manfaat dan format (komponen) dalam pembuatan dokumentasi keperawatan (askep)</div> <div style="text-align: justify;"> <br /></div> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody> <tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrfPISDymQLB-2_IyHTxAo4w_Rwqwq1fbd6ZLU_Txwhi-n4K0B4-ojNB6eISIXX2ZMYwUZ9m602gWgywVqVBtRm0_qH-X-Cz_kaTOWiSJnp0sW2cWrFBJLnQFe-buSzfcEcoTTXH0P1HM_/s1600/dokumentasi+perawat.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="284" data-original-width="285" height="398" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrfPISDymQLB-2_IyHTxAo4w_Rwqwq1fbd6ZLU_Txwhi-n4K0B4-ojNB6eISIXX2ZMYwUZ9m602gWgywVqVBtRm0_qH-X-Cz_kaTOWiSJnp0sW2cWrFBJLnQFe-buSzfcEcoTTXH0P1HM_/s400/dokumentasi+perawat.png" width="400" /></a></td></tr> <tr><td class="tr-caption" style="text-align: center;">Dokumentasi Keperawatan</td></tr> </tbody></table> <div style="text-align: justify;"> Asuhan keperawatan merupakan hal sangat penting bagi seorang perawat. Kemampuan proteksi pelayanan yang baik serta komunikasi ihwal perawatan pasien tergantung pada seberapa baik kualitas isu yang diberikan serta dokumentasi yang disediakan untuk dimanfaatkan oleh semua profesional kesehatan dan antar bidang pelayanan kesehatan, Häyrinena (2010).</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Pengertian dokumentasi keperawatan berdasarkan Carpenito (1999), merupakan suatu rangkaian aktivitas yang rumit dan sangat bermacam-macam serta memerlukan waktu yang cukup banyak dalam proses pembuatannya. Perkiraan waktu pembuatan dokumentasi asuhan keperawatan sanggup mencapai 35-40 menit, hal ini dikarenakan seringnya perawat melaksanakan pencatatan yang berulang¬ulang atau duplikatif. Walaupun demikian, terkadang dokumentasi keperawatan yang dihasilkan masih sering kurang berkualitas.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Dokumentasi asuhan keperawatan ialah Suatu dokumen atau catatan yang berisi data ihwal keadaan pasien yang dilihat tidak saja dari tingkat kesakitan akan tetapi juga dilihat dari jenis, kualitas dan kuantitas dari layanan yang telah diberikan perawat dalam memenuhi kebutuhan pasien (Ali, 2010).</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Dokumentasi Asuhan keperawatan merupakan Rangkaian aktivitas yang dilakukan oleh perawat dimulai dari proses pengkajian, diagnosa, planning tindakan, tindakan keperawatan dan penilaian yang dicatat baik berupa elektronik maupun manual serta sanggup dipertanggungjawabkan oleh perawat.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Dokumentasi asuhan keperawatan merupakan bab dari proses asuhan keperawatan yang dilakukan secara sistematis dengan cara mencatat tahap-tahap proses perawatan yang diberikan kepada pasien. Dokumentasi asuhan keperawatan merupakan catatan penting yang dibentuk oleh perawat baik dalam bentuk elektronik maupun manual berupa rangkaian aktivitas yang dikerjakan oleh perawat mencakup lima tahap yaitu: </div> <ol> <li style="text-align: justify;">pengkajian, </li> <li style="text-align: justify;">penentuan diagnosa keperawatan, </li> <li style="text-align: justify;">perencanaan tindakan keperawatan, </li> <li style="text-align: justify;">pelaksanaan/implementasi planning keperawatan,</li> <li style="text-align: justify;">evaluasi perawatan.</li> </ol> <br /> <div style="text-align: justify;"> Tujuan pendokumentasian keperawatan, antara lain sebagai berikut:</div> <ol> <li style="text-align: justify;">Sebagai media untuk mendefinisikan fokus keperawatan bagi klien dan kelompok.</li> <li style="text-align: justify;">Untuk membedakan tanggung gugat perawat dengan anggota tim kesehatan lainnya.</li> <li style="text-align: justify;">Sebagai sarana untuk melaksanakan penilaian terhadap tindakan yang telah diberikan kepada klien.</li> <li style="text-align: justify;">Sebagai data yang dibutuhkan secara administratif dan legal formal.</li> <li style="text-align: justify;">Memenuhi persyaratan hukum, pengakuan dan professional.</li> <li style="text-align: justify;">Untuk memperlihatkan data yang berkhasiat dalam bidang pendidikan dan penelitian.</li> </ol> <br /> <div style="text-align: justify;"> Komponen dokumentasi asuhan keperawatan yang konsisten harus mencakup beberapa hal berikut ini:</div> <ol> <li style="text-align: justify;">Riwayat keperawatan yang terdiri dari masalah-masalah yang sedang terjadi maupun yang diperkirakan akan terjadi.</li> <li style="text-align: justify;">Masalah-masalah yang positif maupun potensial,.</li> <li style="text-align: justify;">Perencanaan serta tujuan ketika ini dan yang akan datang.</li> <li style="text-align: justify;">Pemeriksaan, pengobatan dan promosi kesehatan untuk membantu pasien mencapai tujuan yang telah ditetapkan sebelumnya.</li> <li style="text-align: justify;">Evaluasi dari tujuan keperawatan serta modifikasi planning tindakan dalam mencapai tujuan yang telah ditetapkan.</li> </ol> <br /> <div style="text-align: justify;"> Secara spesifik lingkup dokumentasi asuhan keperawatan secara spesifik antara lain :</div> <ol> <li style="text-align: justify;">Data awal pasien berupa identitas diri, keluhan yang dirasakan.</li> <li style="text-align: justify;">Riwayat keperawatan dan pemeriksaan.</li> <li style="text-align: justify;">Diagnosis keperawatan yang ditetapkan.</li> <li style="text-align: justify;">Rencana asuhan keperawatan yang terdiri dari planning tindakan, tujuan, planning intervensi serta penilaian dari tindakan keperawatan.</li> <li style="text-align: justify;">Pendidikan kepada pasien.</li> <li style="text-align: justify;">Dokumentasi parameter pemantauan dan intervensi keperawatan lain nya.</li> <li style="text-align: justify;">Perkembangan dari hasil yang telah ditetapkan dan yang diharapkan.</li> <li style="text-align: justify;">Evaluasi perencanaan.</li> <li style="text-align: justify;">Rasionalisasi dari proses intervensi kalau diperlukan.</li> <li style="text-align: justify;">Sistem rujukan.</li> <li style="text-align: justify;">Persiapan pasien pulang.</li> </ol> <br /> <div style="text-align: justify;"> Sedangkan manfaat dokumentasi asuhan keperawatan berdasarkan Nursalam (2008), dokumentasi asuhan keperawatan berdasarkan beberapa aspek berikut :</div> <ol> <li style="text-align: justify;">Aspek aturan : Dokumentasi keperawatan yang dibentuk merupakan aspek legal didepan hukum. Dokumentasi merupakan bukti catatan dari tindakan yang diberikan dan sebagai dasar untuk melindungi pasien, perawat dan institusi.</li> <li style="text-align: justify;">Kualitas pelayanan, komunikasi: Melalui audit keperawatan dokumentasi keperawatan dijadikan alat untuk mengukur dalam membandingkan antara tindakan yang diberikan dengan standar yang dijadikan rujukan. Dengan demikian sanggup diketahui apakah dalam bekerja telah sesuai dengan standar yang ditetapkan.</li> <li style="text-align: justify;">Keuangan: Dokumentasi yang baik dan teliti akan menjadi bukti bahwa tindakah telah dilakukan oleh perawat. Dan dengan dokumentasi ini maka besarnya jasa yang diberikan akan diberikan sesuai dengan aturan yang ditetapkan ditempat masing-masing.</li> <li style="text-align: justify;">Pendidikan: Dokumentasi keperawatan sanggup dijadikan sebagai referensi bagi siswa-siswa perawat.</li> <li style="text-align: justify;">Penelitian: Penelitian keperawatan dengan menggunkan data-data sekunder akan sangat bergantung dengan kualitas dari dokumentasi keperawatan yang dibuat. Kesalahan dalam menciptakan atau pengisian dokumentasi yang tidak lengkap akan menciptakan isu ihwal riwayat pasien menjadi kabur.</li> </ol> <br /> <div style="text-align: justify;"> Terdapat tiga komponen penting yang berperan dalam pembuatan dokumentasi asuhan keperawatan yaitu:</div> <ol> <li style="text-align: justify;">Sarana komunikasi: Komunikasi yang baik antara perawat dengan klien atau keluarganya akan diperoleh isu yang akurat sehingga dokumentasi keperawatan akan dilaksanakan dengan optimal. Dengan komunikasi yang baik akan memudahkan dalam proses pengumpulan data serta tercipta hubungan yang serasi antara perawat dan klien sehingga akan membantu dalam memecahkan duduk masalah yang dihadapi oleh klien.</li> <li style="text-align: justify;">Dokumentasi proses keperawatan: Proses keperawatan merupakan inti dari praktik keperawatan dan juga sebagai isi pokok dokumentasi keperawatan. Beberapa tahap proses keperawatan mencakup beberapa pengelompokan dokumentasi keperawatan : a) dokumentasi pengkajian keperawatan, b) dokumentasi diagnosa    keperawatan,    c)    perencanaan    keperawatan, dokumentasi tindakan keperawatan, e) dokumentasi penilaian keperawatan.</li> <li style="text-align: justify;">Standar keperawatan: Standar keperawatan merupakan citra dari kualitas, karakteristik, sifat, dan kompetensi yang diharapkan dari beberapa aspek dalam praktik keperawatan. Standar keperawatan dibutuhkan oleh perawat alasannya ialah sebagai dasar memilih arah atau petunjuk dalam dokumentasi aktivitas serta dalam pembuatan format pencatatan yang tepat.</li> </ol> <br /> <div style="text-align: justify;"> Terkait dengan model dalam pendokumentasian asuhan keperawatan, berdasarkan Nursalam (2008),terdapat beberapa model dari penerapan dokumentasi asuhan keperawatan yang sering diterapkan di kawasan praktik yaitu: </div> <ol> <li style="text-align: justify;">catatan yang berorientasi pada sumber (source oriented record), </li> <li style="text-align: justify;">catatan yang berorientasi pada perkembangan/kemaj uan pasien (progress oriented record),</li> <li style="text-align: justify;">charting by exception (CBE), </li> <li style="text-align: justify;">Problem Intervention Evaluation (PIE), </li> <li style="text-align: justify;">Process Oriented Sistem (pocus).</li> </ol> <br /> <div style="text-align: justify;"> Agar pelaksanaan aktivitas dokumentasi asuhan keperawatan berjalan efektif hendaknya memperhatikan hal di bawah ini:</div> <ol> <li style="text-align: justify;">Harus memakai standar terminologi yang terdiri dari pengkajian, diagnosis, perencanaan, pelaksanaan/implementasi dan terakhir penilaian dari proses perawatan yang diberikan.</li> <li style="text-align: justify;">Mengumpulan serta mendokumentasikan data yang diperoleh sesuai dengan keadaan yang terjadi pada pasien ke dalam catatan yang permanen.</li> <li style="text-align: justify;">Menegakkan diagnosa keperawatan berdasarkan data yang telah dianalisis dengan cermat dan akurat.</li> <li style="text-align: justify;">Mendokumentasikan hasil observasi secara akurat, lengkap sesuai dengan urutan waktu kejadiannya.</li> <li style="text-align: justify;">Merevisi planning asuhan keperawatan berdasarkan hasil yang diharapkan dan yang ditemukan terhadap pasien</li> </ol> <br /> <div style="text-align: justify;"> Demikian juga dengan pengembangan dokumentasi asuhan keperawatan, yang telah diuji coba dan dikembangkan, dari penilaian yang telah dilakukan terhadap pengguna didapatkan respon yang baik, perawat menjadi terbiasa dan merasa lebih nyaman bekerja dengan memakai komputer (Ammenwerth et al., 2003). Studi yang dilakukan di Kenya terhadap 107 perawat manajer, memperlihatkan bahwa 98% dari perawat manajer tersebut mempunyai perilaku yang positif terhadap penggunaan komputer dalam penyediaan layanan kesehatan, perawat pada umumnya mempunyai perilaku positif terhadap penggunaan sistem komputer (Kivuti-Bitok, 2009). Perawat meyakini bahwa dengan elektronik dokumentasi keperawatan akan sanggup meningkatkan pelayanan dan respon yang positif diberikan terhadap penggunaan dokumentasi elektronik tersebut (De Veer and Francke, 2010).</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Daftar Pustaka</div> <ul> <li style="text-align: justify;">Ali, Z. 2010. Dasar-Dasar Dokumentasi Keperawatan. EGC. Jakarta</li> <li style="text-align: justify;">Carpenito, L. J. 1999. Rencana Asuhan & Dokumentasi Keperawatan : Diagnosa Keperawatan dan Masalah Kolaboratif., EGC. Jakarta.</li> <li style="text-align: justify;">Depkes, R.I. 1997.Instrumen Evaluasi Penerapan Standar Asuhan Keperawatan di Rumah Sakit. Jakarta.</li> <li style="text-align: justify;">Hannah, K. J.et al. 2009. Standardizing Nursing Information in Canada for Inclusion in Electronic Health Record : C-HOBIC. Journal of The American Medical Informatic Assotiation</li> <li style="text-align: justify;">Kristiina Häyrinena, J. L., Kaija Saranto. 2010. Evaluation of electronic nursing documentation—Nursing process model and standardized terminologies as keys to visible and transparent nursing.</li> </ul>

Pengertian, Manfaat, Tujuan Dan Format (Komponen) Dokumentasi Keperawatan (Askep)

Sebagai seorang perawat tentulah faham dan mengerti betul bagaimana cara pembuatan dokumentasi keperawatan (askep), hal ini telah menjadi k...

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Format Dokumentasi Asuhan Keperawatan (Askep) Doc Terlengkap

<div style="text-align: justify;"> Didalam dunia keperawatan askep merupakan sebuah pegangan atau aliran seorang perawat dalam melaksanakan pelayananan berupa asuhan keperawatan untuk sanggup memecahkan problem pasien.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBQNluartBTnHXfSAVONVn7y4M4u3ft3tHGiaKwfiYHKTsk8FXx1wOhnz1wymqjg6km5BD0xb7_SQZUNx1cOclsGwFrkm6nPmpvyEhWn8fqNvhScJsIuICiTv18geP6SBLa9n0ivG-zNzx/s1600/Format+askep.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="297" data-original-width="444" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBQNluartBTnHXfSAVONVn7y4M4u3ft3tHGiaKwfiYHKTsk8FXx1wOhnz1wymqjg6km5BD0xb7_SQZUNx1cOclsGwFrkm6nPmpvyEhWn8fqNvhScJsIuICiTv18geP6SBLa9n0ivG-zNzx/s320/Format+askep.png" width="320" /></a>Dari itu sebagai seorang perawat, haruslah memliki konsep yang terang dalam menyusun sebuah askep, sebuah askep yang seyogyanya merupakan amunisi perawat dalam melaksanakan tindakannya dan sebagai benteng yang bisa membackup nya dari problem dikemudian hari.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Dari itu kita sebagai perawat diharuskan sanggup menyusun askep dengan baik dan benar sesuai dengan format yang telah ditetapkan biar perumusan problem pasien pun sanggup terkerucut dan juga sanggup dituntaskan dengan baik oleh seorang perawat.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Dalam penyusunannya, format askep harus sesuai dengan langkah-langkah asuhan keperawatan yang akan dilakuakan mulai dari pengkajian, diagnosa keperawatan, perencanaan / intervensi, pelaksanaan / implementasi, dan evaluasi.</div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> Untuk mempermudah dalam penyusunan Asuhan keperawatan (Askep) disini kami coba share format asuhan keperawatan, silahkan lihat dibawah :<br /> <br /> <br /></div> <div style="text-align: justify;"> <br /></div> <div style="text-align: justify;"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14pt;">ASUHAN KEPERAWATAN PADA  Tn. …… DENGAN RESIKO INFEKSI B/D ………………….DENGAN DIAGNOSA MEDIS............. DI RUANG …………… RS………. KOTA ………….</span></b> </div> <div class="MsoNormal" style="line-height: normal;"> <div style="text-align: justify;"> <br /></div> </div> <div class="MsoNormal" style="line-height: normal;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Tanggal masuk            : ……</span></div> </div> <div class="MsoNormal" style="line-height: normal;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Jam                            : ……</span></div> </div> <div class="MsoNormal" style="line-height: normal;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">No RM                      : ……</span></div> </div> <div class="MsoNormal" style="line-height: normal;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Tgl pengkajian            : ………</span></div> </div> <div class="MsoNormal" style="line-height: normal;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Jam                            : …………….</span></div> </div> <div class="MsoNormal" style="line-height: normal;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Diagnosa medis          : ………………….</span></div> </div> <div class="MsoNormal" style="line-height: normal;"> <div style="text-align: justify;"> <br /></div> </div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo40; text-indent: -.25in;"> <div style="text-align: justify;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">    A.<span style="font: 7pt "Times New Roman";">    </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pengkajian</span></b></div> </div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 13.5pt; mso-add-space: auto; mso-list: l7 level1 lfo41; text-indent: -13.5pt;"> <div style="text-align: justify;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";">   </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Identitas pasien dan penanggung jawab</span></b></div> </div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 5.4pt; text-align: justify;"><tbody> <tr style="height: 20.65pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; height: 20.65pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 202.5pt;" valign="top" width="270"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Identitas pasien</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; height: 20.65pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 199.8pt;" valign="top" width="266"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Identitas penanggung jawab</span></div> </td> </tr> <tr style="height: 163.75pt; mso-yfti-irow: 1; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; height: 163.75pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 202.5pt;" valign="top" width="270"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Nama               : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Umur               : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: 1.0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Agama             : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Jenis kelamin    : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Alamat            <span style="background-color: #e06666;"></span> : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Suku / bangsa  : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pekerjaan         : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pendidikan      : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Status              : </span></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 163.75pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 199.8pt;" valign="top" width="266"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Nama               : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Umur               : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: 1.0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Agama             : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Jenis kelamin   : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Alamat              : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Suku / bangsa  : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pekerjaan         : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pendidikan      : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Status              : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Hub dgn klien : </span></div> </td> </tr> </tbody></table> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 13.5pt; mso-add-space: auto; mso-list: l7 level1 lfo41; text-indent: -13.5pt;"> <div style="text-align: justify;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"><br /></span></b></div> <div style="text-align: justify;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";">   </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan </span></b></div> </div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto; mso-list: l70 level1 lfo42; text-indent: -.25in;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">a.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Keluhan utama</span></div> </div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………………</span></div> </div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 31.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l70 level1 lfo42; text-indent: -.25in;"> <div style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">b.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan sekarang</span></div> </div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.7pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-indent: -.25in;"> <div style="text-align: justify;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Waktu terjadinya sakit</span></div> </div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <br /></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Proses terjadinya sakit</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………….</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Upaya yang telah di lakukan</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; tab-stops: .75in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………….</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-indent: -.25in;"> <div style="text-align: justify;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Hasil investigasi sementara / sekarang</span></div> </div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………….</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">P     : ……………………</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Q     : ………………………</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">R     : ……………</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">S     : ……………….</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">T     : …………………………</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 31.5pt; margin-right: 0in; margin-top: 0in; mso-list: l70 level1 lfo42; tab-stops: .5in; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">c.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan dahulu</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Penyakit dahulu</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Perlukaan</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Dirawat di RS</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Alergi obat / makanan</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.5pt; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Obat-obatan kini :</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 85.5pt; mso-add-space: auto; mso-list: l56 level1 lfo59; text-align: justify; text-indent: -.25in;"> <span style="font-family: "symbol"; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">         </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………….....</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 85.5pt; mso-add-space: auto; mso-list: l56 level1 lfo59; text-align: justify; text-indent: -.25in;"> <span style="font-family: "symbol"; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">         </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto; mso-list: l70 level1 lfo42; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">d.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan keluarga</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto; mso-list: l70 level1 lfo42; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">e.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Genogram</span></div> <div class="MsoListParagraphCxSpMiddle" style="text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 115%;">           ………………………………..</span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 115%;"></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Keterangan:               </span><br /> <br /> <ul> <li>Laki-laki (hidup)</li> <li>Laki-laki (meninggal)</li> <li>Wanita (hidup)</li> <li>Wanita (meninggal)</li> <li>Pasien</li> <li>Penderita penyakit (.....)</li> <li>Serumah dengan pasien         </li> </ul> (Note : Untuk genogram silahkan dibentuk sendiri sesuai dengan silsilah keluarga pasien dan tanda keterangan silahkan kreasi sendiri)</div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 31.5pt; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; mso-list: l7 level1 lfo41; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";">      </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola fungsi kesehatan</span></b></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">            a.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola administrasi kesehatan – persepsi kesehatan</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Tingkat pengetahuan kesehatan / penyakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Prilaku untuk mengatasi problem kesehatan</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Factor-faktor resiko sehubungan dengan kesehatan</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           b.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola kegiatan dan latihan</span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; tab-stops: .75in; text-align: justify; text-indent: -31.5pt;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;"> Ø<span style="font: 7pt "Times New Roman";">    </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"><i>Sebelum sakit<i></i></i></span></div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 41.4pt; text-align: justify;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Aktifitas</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">0</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">1</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">2</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">3</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">4</span></div> </td> </tr> <tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Makan</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> </tr> <tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Mandi </span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> </tr> <tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Berpakaian</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> </tr> <tr style="mso-yfti-irow: 4;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Eliminasi</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> </tr> <tr style="mso-yfti-irow: 5;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Mobilisasi ditempat tidur</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> </tr> <tr style="mso-yfti-irow: 6;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Berpindah </span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> </tr> <tr style="mso-yfti-irow: 7;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Ambulansi</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> </tr> <tr style="mso-yfti-irow: 8; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 3.5in;" valign="top" width="336"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Naik tangga</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 22.5pt;" valign="top" width="30"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 24.3pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> </tr> </tbody></table> <div class="MsoListParagraph" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <br /></div> <div class="MsoListParagraph" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Saat sakit</span><br /> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Tabel yang dipakai sama dengan tabel sebelum sakit .</span><br /> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"><br /></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Keterangan : </span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l83 level1 lfo46; text-align: justify; text-indent: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">0<span style="font: 7pt "Times New Roman";">                    </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">: Mandiri</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l83 level1 lfo46; text-align: justify; text-indent: -.5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">1<span style="font: 7pt "Times New Roman";">                    </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">: Di bantu sebagian</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l83 level1 lfo46; text-align: justify; text-indent: -.5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">2<span style="font: 7pt "Times New Roman";">                    </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">: Di bantu orang lain</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l83 level1 lfo46; text-align: justify; text-indent: -.5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">3<span style="font: 7pt "Times New Roman";">                    </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">: Di bantu orang dan peralatan</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l83 level1 lfo46; text-align: justify; text-indent: -.5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">4<span style="font: 7pt "Times New Roman";">                    </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">: Ketergantungan / tidak mampu  </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0in 0in 0.0001pt 1.5in; text-align: justify; text-indent: -0.5in;"> </div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           c.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola istirahat tidur</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Sebelum sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"> ………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Saat sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           d.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola nutrisi dan metabolik</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Sebelum sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Selama sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">A: …………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">B: …………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">C:……………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">D:……………… …….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">          e.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola eliminasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Sebelum sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Saat sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           f.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola kognitif dan perceptual</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Sebelum sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Saat sakit.</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………  </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           g.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola konsep diri</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Gambaran diri</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Identitas diri</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Peran diri</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………...</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Ideal diri</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Harga diri</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           h.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola toleransi stress-koping</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Sebelum sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Saat sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">i           .<span style="font: 7pt "Times New Roman";">        </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola reproduksi-seksualitas</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Sebelum sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Saat sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….  </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           j.<span style="font: 7pt "Times New Roman";">        </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola kekerabatan peran</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Sebelum sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Saat sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l25 level1 lfo44; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           k.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pola nilai dan keyakinan</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Sebelum sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Saat sakit</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo40; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">    B.<span style="font: 7pt "Times New Roman";">     </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan fisik</span></b></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; mso-list: l55 level1 lfo47; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Penampakan umum</span></div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 23.4pt; text-align: justify;"><tbody> <tr style="height: 28.3pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; height: 28.3pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 1.25in;" valign="top" width="120"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Keadaan umum</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; height: 28.3pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 294.3pt;" valign="top" width="392"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………..</span></div> </td> </tr> <tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 1.25in;" valign="top" width="120"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Kesadaran</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 294.3pt;" valign="top" width="392"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">……………</span></div> </td> </tr> <tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 1.25in;" valign="top" width="120"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">GCS</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 294.3pt;" valign="top" width="392"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Eye : …..   Verbal:…..   Motorik :…… Total =….</span></div> </td> </tr> <tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 1.25in;" valign="top" width="120"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">BB </span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 294.3pt;" valign="top" width="392"><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0; mso-yfti-lastrow: yes;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 123.35pt;" valign="top" width="164"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"> ……… kg</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 123.4pt;" valign="top" width="165"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">TB: … cm</span></div> </td> </tr> </tbody></table> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"></span></div> </td> </tr> <tr style="mso-yfti-irow: 4;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 1.25in;" valign="top" width="120"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Skala nyeri</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 294.3pt;" valign="top" width="392"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">   ………</span></div> </td> </tr> <tr style="mso-yfti-irow: 5; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 1.25in;" valign="top" width="120"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">TD:….mmHg</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 294.3pt;" valign="top" width="392"><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; width: 337px;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0; mso-yfti-lastrow: yes;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 80.75pt;" valign="top" width="108"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Suhu : …ºC</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 80.75pt;" valign="top" width="108"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">RR : …x/mnt</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 91.55pt;" valign="top" width="122"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Nadi : ….x/mnt</span></div> </td> </tr> </tbody></table> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"></span></div> </td> </tr> </tbody></table> <div class="MsoNormal" style="tab-stops: 22.5pt; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; mso-list: l55 level1 lfo47; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Kepala dan leher</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">            a.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Rambut</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">            b.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Mata </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           c.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Telinga</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">            d.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Hidung</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">            e.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Mulut</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">             f.<span style="font: 7pt "Times New Roman";">       </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Leher</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">            g.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Dada </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..<span style="color: #00b050;"></span></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Perkusi </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: .25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Auskultasi </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: .25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">            h.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Jantung</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: .25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Perkusi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: .25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Auskultasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo48; tab-stops: 27.0pt 31.5pt; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">               i.<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Abdomen</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………..</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Auskultasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: .25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">            …………………………………………………………………….......</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Perkusi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: .25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">           ………………………………………………………………………........</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………………………………………………………………………….</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 27.0pt; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -9.0pt;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">j.<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inguinal dan genetalia</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inpeksi </span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………..</span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi </span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">................................................................................................................</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; mso-list: l1 level1 lfo48; text-align: justify; text-indent: -9.0pt;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">k.</span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Ekstrimitas</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Inspeksi </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; mso-list: l34 level1 lfo43; text-align: justify; text-indent: -.25in;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Palpasi </span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">…………………………………………………………………………</span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; mso-list: l34 level1 lfo43; text-indent: -.25in;"> <div style="text-align: justify;"> <span style="font-family: "wingdings"; font-size: 12pt; line-height: 150%;">Ø<span style="font: 7pt "Times New Roman";">  </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Kekuatan otot</span></div> </div> <table border="0" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 6.75pt; margin-right: 6.75pt; text-align: left;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-bottom-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themecolor: text1; mso-border-right-alt: solid black .5pt; mso-border-right-themecolor: text1; mso-border-right-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 36.45pt;" valign="top" width="49"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-element-anchor-horizontal: page; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: 212.9pt; mso-element-top: 8.85pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">….</span></div> </td> <td style="border-bottom: solid black 1.0pt; border: none; mso-border-bottom-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-left-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 35.55pt;" valign="top" width="47"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-element-anchor-horizontal: page; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: 212.9pt; mso-element-top: 8.85pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">..</span></div> </td> </tr> <tr style="mso-yfti-irow: 1; mso-yfti-lastrow: yes;"> <td style="border-right: solid black 1.0pt; border: none; mso-border-right-alt: solid black .5pt; mso-border-right-themecolor: text1; mso-border-right-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 36.45pt;" valign="top" width="49"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-element-anchor-horizontal: page; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: 212.9pt; mso-element-top: 8.85pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">….</span></div> </td> <td style="border: none; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 35.55pt;" valign="top" width="47"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-element-anchor-horizontal: page; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: 212.9pt; mso-element-top: 8.85pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">….</span></div> </td> </tr> </tbody></table> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify;"> <br /></div> <div class="MsoNormal" style="text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-list: l0 level1 lfo40; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">     C.<span style="font: 7pt "Times New Roman";">    </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Data penunjang</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"> </span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Tanggal ………… (kimia klinik)</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;"></span></b></div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 18.9pt; text-align: justify;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.5pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Pemeriksaan </span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" valign="top" width="114"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Hasil</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 84.0pt;" valign="top" width="112"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Satuan</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 73.5pt;" valign="top" width="98"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Nilai normal</span></div> </td> </tr> <tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.5pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Gula darah sewaktu</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" valign="top" width="114"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">………</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 84.0pt;" valign="top" width="112"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">……..</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 73.5pt;" valign="top" width="98"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">…………..</span></div> </td> </tr> <tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.5pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Ureum</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" valign="top" width="114"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">………..</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 84.0pt;" valign="top" width="112"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">……..</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 73.5pt;" valign="top" width="98"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">……….</span></div> </td> </tr> <tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.5pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Creatinin</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" valign="top" width="114"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">……….. </span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 84.0pt;" valign="top" width="112"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">………..</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 73.5pt;" valign="top" width="98"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;"> ………..</span></div> </td> </tr> <tr style="height: 11.4pt; mso-yfti-irow: 4; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; height: 11.4pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.5pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">SGOT</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 11.4pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" valign="top" width="114"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">………</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 11.4pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 84.0pt;" valign="top" width="112"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">………</span></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 11.4pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 73.5pt;" valign="top" width="98"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">…………</span></div> </td> </tr> </tbody></table> <div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 4.5pt; mso-add-space: auto; mso-list: l0 level1 lfo40; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">   D.<span style="font: 7pt "Times New Roman";">    </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Data fokus</span></b></div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 0.25in; text-align: justify;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 185.4pt;" valign="top" width="247"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Data subyektif</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 204.3pt;" valign="top" width="272"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Data obyektif</span></div> </td> </tr> <tr style="height: 49.0pt; mso-yfti-irow: 1; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; height: 49.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 185.4pt;" valign="top" width="247"><div class="MsoNoSpacing" style="margin-left: .25in; text-align: justify;"> <br /></div> <div class="MsoNoSpacing" style="margin-left: .25in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 49.0pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 204.3pt;" valign="top" width="272"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> </td> </tr> </tbody></table> <div class="MsoNormal" style="text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo40; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">   E.<span style="font: 7pt "Times New Roman";">     </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Analisa data</span></b></div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 5.4pt; text-align: justify;"><tbody> <tr style="height: 16.15pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; height: 16.15pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 142.6pt;" valign="top" width="190"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Symtom</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; height: 16.15pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 129.35pt;" valign="top" width="172"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Etiologi</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; height: 16.15pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.35pt;" valign="top" width="174"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Problem</span></div> </td> </tr> <tr style="height: 16.15pt; mso-yfti-irow: 1; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; height: 16.15pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 142.6pt;" valign="top" width="190"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 12.6pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 16.15pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 129.35pt;" valign="top" width="172"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 16.15pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.35pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <br /></div> </td> </tr> </tbody></table> <div class="MsoListParagraphCxSpFirst" style="margin-left: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo40; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">     F.<span style="font: 7pt "Times New Roman";">     </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Diagnosa keperawatan dan prioritas masalah</span></b></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; mso-list: l66 level1 lfo49; tab-stops: 4.5pt; text-align: justify; text-indent: -.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";">      </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">………..........................................................................................................</span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">2.   ......................................................................................................................</span><br /> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"> </div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo40; tab-stops: 4.5pt; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">    G.<span style="font: 7pt "Times New Roman";">    </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Perencanaan NIC dan NOC</span></b></div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 5.4pt; text-align: justify; width: 559px;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 36.05pt;" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Hr</span></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Tgl</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 37.7pt;" width="50"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Jam</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 20.75pt;" valign="top" width="28"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -2.65pt; margin-right: 0in; margin-top: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">no</span></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -2.65pt; margin-right: 0in; margin-top: 0in;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">dx</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 157.5pt;" width="210"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">NOC / tujuan</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 139.5pt;" width="186"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">NIC / intervensi</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 27.45pt;" width="37"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -.9pt; margin-right: 0in; margin-top: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Ttd</span></div> </td> </tr> <tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 36.05pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 37.7pt;" valign="top" width="50"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -5.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 20.75pt;" valign="top" width="28"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 157.5pt;" valign="top" width="210"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: list 81.0pt 99.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: list 81.0pt 99.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: list 81.0pt 99.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: list 81.0pt 99.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: list 81.0pt 99.0pt; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 139.5pt;" valign="top" width="186"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .3in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .3in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .3in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 27.45pt;" valign="top" width="37"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -5.4pt; margin-right: 0in; margin-top: 0in; text-align: center;"> <br /></div> </td> </tr> <tr style="mso-yfti-irow: 2; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 36.05pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 37.7pt;" valign="top" width="50"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -5.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 20.75pt;" valign="top" width="28"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 157.5pt;" valign="top" width="210"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 139.5pt;" valign="top" width="186"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 12.6pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 12.6pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 12.6pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 27.45pt;" valign="top" width="37"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -5.4pt; margin-right: 0in; margin-top: 0in;"> <br /></div> </td> </tr> </tbody></table> <div class="MsoListParagraphCxSpFirst" style="margin-left: 0in; mso-add-space: auto; tab-stops: 4.5pt; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto; tab-stops: 4.5pt; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto; tab-stops: 4.5pt; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto; tab-stops: 4.5pt; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo40; tab-stops: 4.5pt; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">     H.<span style="font: 7pt "Times New Roman";">    </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Implementasi </span></b></div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 5.4pt; text-align: justify;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: .5in;" width="48"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Hari/tgl</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 40.5pt;" width="54"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">jam</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 27.0pt;" width="36"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">No Dx</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.5pt;" width="174"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Tindakan</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 148.5pt;" width="198"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Respon</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: .5in;" width="48"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -5.4pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Paraf</span></div> </td> </tr> <tr style="height: 31.45pt; mso-yfti-irow: 1; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; height: 31.45pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: .5in;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: -5.4pt; margin-right: 0in; margin-top: 0in; text-align: center;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 31.45pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 40.5pt;" valign="top" width="54"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 31.45pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 27.0pt;" valign="top" width="36"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 31.45pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 130.5pt;" valign="top" width="174"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 10.0pt; margin-left: 8.1pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 10.0pt; margin-left: 8.1pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 10.0pt; margin-left: 8.1pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 10.0pt; margin-left: 8.1pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 31.45pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 148.5pt;" valign="top" width="198"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 31.45pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: .5in;" valign="top" width="48"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify;"> <br /></div> </td> </tr> </tbody></table> <div class="MsoListParagraphCxSpFirst" style="margin-left: 0in; mso-add-space: auto; tab-stops: 0in; text-align: justify;"> <br /> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo40; tab-stops: 0in; text-align: justify; text-indent: -.25in;"> <b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">     I.<span style="font: 7pt "Times New Roman";">       </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12pt; line-height: 150%;">Evaluasi</span></b></div> <table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 5.4pt; text-align: justify; width: 534px;"><tbody> <tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" width="90"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Tgl / hari</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 49.5pt;" width="66"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Jam</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 31.5pt;" width="42"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">No dx</span></div> </td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 211.5pt;" width="282"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">Catatan perkembangan</span></div> </td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-left-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 40.5pt;" width="54"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;"> <span style="font-family: "times new roman" , "serif"; font-size: 12pt;">TTD</span></div> </td> </tr> <tr style="height: 35.5pt; mso-yfti-irow: 1; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; height: 35.5pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" valign="top" width="90"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 35.5pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 49.5pt;" valign="top" width="66"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 35.5pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 31.5pt;" valign="top" width="42"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;"> <br /></div> </td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 35.5pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0in 5.4pt 0in 5.4pt; width: 211.5pt;" valign="top" width="282"><div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: normal; margin-bottom: 10.0pt; text-align: justify;"> <br /></div> </td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.5pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-left-themecolor: text1; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 40.5pt;" valign="top" width="54"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"> <br /></div> </td> </tr> </tbody></table> <div class="MsoNormal" style="line-height: 150%; tab-stops: 4.5pt; text-align: justify;"> <br /> Untuk mendownload Format asuhan keperawatan dalam format doc, silahkan dibawah :<br /> <ul> <li><b><span style="background-color: cyan;">File format asuhan keperawatan (Askep) doc</span>, <a href="https://drive.google.com/file/d/1LxeEeHqeoq-TJyZlmT_n7e265ZpUosdW/view?usp=sharing" target="_blank">(Ambil file)</a></b></li> </ul> <div> Atau</div> <div> <ul> <li><b><a href="https://drive.google.com/file/d/1LxeEeHqeoq-TJyZlmT_n7e265ZpUosdW/view?usp=sharing" target="_blank">Link Alternatif Format askep 1</a></b></li> <li><b><a href="https://drive.google.com/file/d/1LxeEeHqeoq-TJyZlmT_n7e265ZpUosdW/view?usp=sharing" target="_blank">Link Alternatif Format askep 2</a></b></li> </ul> <div> Demikian Format Dokumentasi Asuhan Keperawatan (Askep) doc, kami bagikan semoga bisa membantu dan bermanfaat.</div> </div> </div> <div style="clear: both;"> </div>

Format Dokumentasi Asuhan Keperawatan (Askep) Doc Terlengkap

Didalam dunia keperawatan askep merupakan sebuah pegangan atau aliran seorang perawat dalam melaksanakan pelayananan berupa asuhan keperawa...

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