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Form Balance Cairan 24 Jam [PDF]

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Form Balance Cairan 24 Jam [PDF]

RM.

LOGO RSIA

BALANCE CAIRAN 24 JAM Nama Lengkap : ...............................................................

Um

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RM.



LOGO RSIA



BALANCE CAIRAN 24 JAM Nama Lengkap : ...............................................................



Umur .........



No. RM



Ruangan/ Kelas : ...................................................................



SUHU



JAM



NADI



TANGGAL



: ..............................................................



TENSI



: ............................................................................



INPUT



RR INFUS



TRANFUSI



KET



OUTPUT MINUM



URINE



DRAIN



M.S



JUMLAH :



RSIA ATHAYA MEDIKA