KALA.......
I.
PENGKAJIAN
DATA Tanggal/Pukul:........................... WIB Oleh:............
A.
DATA
SUBYEKTIF
......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
B.
DATA
OBYEKTIF
.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
A.
Diagnosa
Kebidanan
...........................................................................................................................................................................................................................................................................................................................................................................................................................
Data Dasar
DS : ...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
DO :
.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
B.
Diagnosa
Masalah
Data Dasar
DS :
...........................................................................................................................................................................................................................................................................................................................................................................................................................
DO :
....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
III.
IDENTIFIKASI
DAN ANTISIPASI DIAGNOSA POTENSIAL
.............................................................................................................................................................................................................................................................................................................................................................................................................................................
IV.
TINDAKAN
SEGERA
a.
Mandiri
..................................................................................................................................................................................................................................................................................
b.
Kolaborasi
..................................................................................................................................................................................................................................................................................
c.
Merujuk
..................................................................................................................................................................................................................................................................................
V.
PERENCANAAN Tanggal
:.................................... Pukul:..........WIB
...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
VI.
PELAKSANAAN Tanggal:.................................... Pukul:............WIB
...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
VII.
EVALUASI Tanggal :................................. Pukul:..............WIB
...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
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