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it m.s aiui~naouniuan?uniwao~~dau!n'ii6in"suo~d5"nvi~a~~~1o~n.il'ivlu1u~~a"a r.d M E ~ { ~ ~ ~ ~ I ~ I ~ ~ ~ " u M ' ~ u R I ~ L ~ ~ ~ ~ ~ w ~ ~ ~ ~ I ~ ~ ~ ~ ~ ~ " ~ . ~ a i u i s n a ~ o n i i w t ~ ~ u n i ~ T n ~ ~ u i u i ~ l 6 ~ a i u i i ~ ~
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b.b a i u i s n ~ ~ " n s ~ a ~ ; ~ ~ u a : : d m n n i ~ d b ~ ~ ~ u ~ u ~ ~ { d a u ~ n u ~ $ ~ ~ " s r u i m ~ ~ i u CD uo4Oa6ni5oui~u
Ian (WHO) !n%.il'i?in
m.91u~lwlilu
gl.a aiui5~hwunsM"ae1syrn~nisdi~liiu rraraQn~oani5hw~iu~n"
dsrlslwnis<iwliiu (Discharge Type) d'ianou6au
With approval
Ayainst adv~ce
By escape
By transfer (say)
P Other (ssy)
- * Death autopsy
Death no autopsy
Stillb~rth
aniurnis.il'ivldiu (Discharge Status) d=ianou6au
L L ' - Complete recovery F - . -
Improved
Not improved 81.b~ iU-'i:~~ufi~ir)~i 13
' . .. ~. fi3~un- _ . , . . . ~ ..... . .- .-
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, . . , . .; ' - . * a** d
a*->. . i . - :ai -A- "_<+ - L,>-
Normal delivery . . Undelivered
. .. . .. . ~ > . . .. Normal child, discharge with mother
, ? ~... . . . . . . , . , - Nona l child, discharge separately
.. . Dead
m.b aiuisnunr~nni5~1wiiu(il2u~n' d. qqM~ninuqMalud~uuasni&~q~n~'~u
(i.~ ~ I U A ~ M I L ~ ~ U
<.am aiu i~nmsa~aou~baru~u<~~anis~iuf iod~~ua mnsauu Admission center
d.a.b a i u i s n m ~ a ~ a ~ u ~ ~ a ~ ~ n r ~ . i i ~ ~ a u ~ ~ ~ i l a u i ~ ~ Admit sinsruui~auuanuiPusauu (ilauhr rpiu nis5i i~~ub6oa6~ j~ius4'a ICD "~o~o~r?lni~ouiGuIan (WHO) uaauo~dszrwm!wu 51u& aisl~5nu"uw"nnisu~~~o~ardu~~uIn" d u isn, l o uww~r$iae.jl.ii aaum~u
d.a.m % ~ ~ I ~ ~ ~ ~ ~ L < ~ ~ ( ~ ~ ~ ~ ~ ~ ~ ~ ~ I U I ~ ~ ~ ~ ~ ? " P ~ ~ U R S L ~ ~ ~ ~ J M Y L < U U Q ~ S ~ ~
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d siunaa~um.iioqaaoani~6iu L ~ U Yuw, rani sn d
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, . d.b.cr~ aiuisn~w"nnu~orrwmu'd5!au5"nwi~duId d.b.d n s ~ { i l a w a u ~ 5 ' n w i o ~ d p 9 a ~ d a u aiuisnu"ufin / rrMdan I~uTu'jM'a ICD uoa
oan'ni~ou-iGuian (WHO) raasaoadgaawdnu sau~aa~u~sosa~lm%o"~n'm *:
p.:-: ..: d.b.6 aiuisnaouniuuslafiuw' ~ua~d.iiunisdis"nww~iuia' uoa~ilauuiaasiu1n"aiun2a
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, .. ~ d.b.aa a i s l i s n ~ ~ u M " n ~ i s ~ ~ d ~ u ~ ~ r ~ a ~ ~ i ~ n i s ~ r w m v ' (Nurse note)% . ~
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. . d m ~ 1 ~ ~ 1 ~ ~ 1 8
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ri'.&.b aiui5nu"uw"naaa~rrfla.u"oqa~w"aT,~~1uasni~ii~~ / M'mnnis ai~iUMqni~miu~dau2uU miu
5% ICD %o~o~dni~ouiGuban (WHO) aaasuo~dsoamdmu d.9.m ii=isuuni4iiP1~15fia ICD ~ ~ ~ ~ ~ A n i ~ ~ u i ~ u ~ a n (WHO) dijd~dn96ni~ LS~U~UMIG~EI
Common nameda~lias ~~oiitl~i6aia~5fia!n" d.e.d aiui~naouniu~aa~uw'~iu1o(dau~u d ~ i ~ l j i u m i ~ n ~ u ~ i u uas~o(~~au\& d.&.&ai~i5ns~.a%ni5u"un'nfu / d.aduiavsar~uu(dauKu ~ n u n i 5 h w " n ~ ~ ~iol.a"afl$o.a
i1uu13Km g : , ~ i . ~ G ~ W l a a n a i ~
d.5.a 81~15nh~ i Sticker Laas3 Barcode dlw?u$hu'Lu!n" d.a.b aiuimduw'uuudoiufi wTou.u"oqari'altI (socia( Data) "uos~IJauuauiUMa~4aurdu
Medical Record Form, Nurse Note Form Lflufiu c q ~ ~ n ~ ~ a ~ u h u u a ~ n ~ ~ ~ ~ a ~ ~ ~ ~ ~ u a a ~ u ~ i u ~ ~
&.s ssuuL2v5sL~uu &am ~1u15n~ounlud5s~n"a~d%o~( i r~u (Social Data) dwoidauln'
&.b aauuGa~dfjGini5 aiui~n~w"n$oqan15a~n~a0ni.aGo.ad~u~ni~~n'
&b.b ai~li~slaouniuuazGuw'era LAB ao.a~daufui]ogu"u uasaiuisngwn6auwn'illA a -
IS.^ a i u i ~ n ~ u . a " o q a ~ i u n i ~ ~ 1 ~ ~ ~ ) ~ a a F i i u ~ n i ~ n i ~ ~ o ~ d ~ ~ m n i ~dow' i lua~d5i~ni ' id7 ?flwwuw1aln"
. . . &.m 5 ~ u u & a ~ w u l L, c;..cn.@ a i u i s n u " u w " n a i u n i ~ d ~ ~ ~ a ~ ~ 1 i ~ T ~ ~ ? ~ u i ~ n '
&.m.b ~ i ~ i 5 ~ L L ~ i ~ ~ ~ ~ 5 i ~ ~ i ~ ~ i 5 ~ 5 ~ O ~ 1 d 5 " ~ ~ ~ ~ ~ i ~ 0 9 ~ d ~ ~ ~ 6
&.cn.m a i ~ i s n ~ u $ o ~ a . i i u n i ~ m ~ a ~ u a ~ d i ? n v i ~ u i u i ~ ~ i . t ~ ~ ~ 5aIJM"9$8qaml~ Clinic dh~flu ~ ~ o ~ ' i l u a ~ \ 1 ~ i u n i ~ d i ~ n 1 ~ i w u i u i a . . :. ,
~ . ( ( r ~ s u u i i G ~ ~ ~ ~ : : ~ i c y ~ ,,:,<..
c d . m aiui5nu"u~"n (set i i ~ s l n ) d~o[daul& ..: .... I-
. . . .. &,&I aiui~nUVUGn /u~v~i~uni5Giici iw, ~i(oui i6n d~o(dat11X . . . . . . . . . . . . . . . . . . . . i: . . . .
:.: : .?. ct..d.m a i u i 5 n ~ u ~ o q a n i 5 ~ 3 n i 5 ~ d ~ ~ ~au6vt'oqani.a clinic dbia9u ~ ~ 0 i i K u a ~ d 5 i ~ n i 5 ; . ', .: .:(: . . % :;:
. , ....... di?nviwuiuia!6 FJUW , . 1 . - .i;. . '2- .. -.... ....-.- .................. ds-s?unnun ,f .*-,.: ,..:: * a
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I m. Gayawupu
0.o aiu15n6iwun~ayani~?nwin"~5M"~~mnni~ IcD uasasn'nimui5uIan (WHO) In" 0.14 aiui5n~1~9um~ayani~i?nmmiun~udi5'nvi~ui~ia w?audier~n15k%
v d d v - 0.m aiuian6iwun+a;aa~wnu' wui~iaara~~OY7~ui~ M S U W ~ S I ~ U % U M " D ~ ~ I K ( ~ ~ M ~ ~ M " O Q ~ ~ " ~ $ ~ " 0.d ~ 1 s l 1 5 f l 6 1 ~ ~ ( i l ~ ~ ~ ~ 5 1 ~ ~ 1 5 ~ 1 ~ ~ : : ~ ? ' ~ 1 n " ~ ~ ~ f l ~ M " ~ ~ ~ n " . < . ~ ~ , :.:q+ , L.,.
. ~
, , 0.c aiui~n6iwun$ayavO(ilni~w'iK(il, ~ ? i u d s ~ a u u o ~ n i ~ ~ i ~ m , Consciousness, Respiration, ,?2L?;2~!,. i - . . - ,>.,.: . Complication, Airway Problem, Agent ;z:::<:~ .. ,:.. ~ . 1 . . . . % .-, -,c .- .,, 7 . .
b, ~ I ~ ~ ~ V I S L ~ ~ U ..,:,r*,. , . . A , . :, . . ':=,.,:$; 8
$ - -. . ., --- . 14.0 ~ l ~ i 5 ~ 5 Z Q ~ 6 ~ i b ~ ~ ~ d ? ~ ~ ~ ~ P 9 ~ ~ ~ d ? ~ ~ d ~ ~ 1 5 ~ ~ d i ~ ( i l
. . " w , b.b a i u i s n ~ ~ i ~ a $ a ~ d ~ u ~ i d ~ d i ~ ~ n " a u ~ u i u ~ n u d ~ s 6 i m a ~ d ? u (HN), ~ 9 % $a~ba::uiu~~a ~45040
~ 4 a u i u a ~ a M~FJ ~ui~~auUvrnsd~s~iK~ds::vi~~u bmuija;ad~ansln"aari %a-qa, aiq, datjuosid'illu ....... ,! ,.+%? xg.. I
b.m aiui5nGuw"ndaya51~ni5ni~dsdiKm, ?id/aaaidim'n, uwnu'{83, M"asd~ini~diKm,,~aiu~is(iiau, :< . .Y~~.*<$F
, - Coma score, Consciousness, Respiration . .:.;j ...... R- -5, ; . ...... . , . . , ,. . ... : . . . . I ,> .: .:* e: ,. . . *L...~,
m. n14u'uin$ayarieun15ej15~ uaaGaya3argg . . I . '. . . m.a aiui~nu'uM"n$ayani~~~m~i~ni~dsdim"rn ~~~~d~uuaniu: :n i~~i$( i l ln" . .
... :9, . . . . ... -. .~ m.14 R i ~ i 5 ~ u " u M " ~ d ~ ; ~ ~ i 2 n " n ~ 5 ~ ~ ~ ~ ~ ~ i 5 w ' i ~ ~ ~ n " b.du NPO Date Time, fl?iu~a4n,qmwqii, RR,
'k: . . .. .-7z- ,.; ... I. .
HR, BW biluiu t>..
m.m aiui5n9~~~~n+aya~d~~3~iu~~a::[f~u~~er3~1u~~~3n~5~dg{ m.d ~iui~n~~"nGa~a~ud~a::~~aini~IP;i~~ni'i~i;g{~~a~ni~~i~(il I6arr-i
~ d r a a a ~ a a i f f ~ ~ ~ u ~ ~ i P ; i ~ s ~ i ~ ( i l (Time in)
~udaiaur~a idduni5 IM"~^~ni~~~y~
~udnnrr~aid{~~udu~(ilni51M"u~ni~~~y~ m.G: aiui~fih?Jin+aya Physical Status, aniwiisniuuaqidau (American Society
qd
Technique, -iiuni~a?.aK~~, UI w%u~qa8ni-d+ vdm: v d d a.s aiui~nPTP1M'n+a;ani~PM"~5ni~w"~1fini~, L&W~IM"~M"U~~I~, -JUMLSU, aumba7q w
m.d aiaisn~uM'n$aya Complication a u d .I.
m.d aiuimu'uw'nGaya Airway Problem !;bin ?unaaasb?ai, iltymi, nisu6ilcgwi ,. i;
m.a aiui~ncuM"n+aya Agent w?auia<iu?u m.eo Biui~fi~u?Jin~aya Blood Give 164~6 acnsih~, Rh, Type, Unit, diu?u m.oa aiui5nu~ms~~~su"uM"n / uMu$'ayani~?a"~$n"
d n15PJuBn+aqani>d1;m d.o a i u ~ s n ~ ( i l ~ ~ u ~ ~ ; a ~ M ' i n i ~ d i m " ~ ~ ~ a ~ ~ ~ a u d i ~ ~ Inuldil"in"no"iu?uynnn s-Ju$Gaya{dau do v d
wuieria WMI~UIYI Instrument Nurse, Circulate Nurse, Swab Count Nurse La:: Scrub nurse
d.~s a i u i ~ n ~ ~ n ~ a ~ a T u d ~ a ~ ~ ~ a i n i ~ I M " ~ 5 n i ~ n i ~ w ' i K m ln"uti
?"udraaa~aaid~udi~m
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Tudr~a~~~aid{dauaan~inM"a~~iK(il (Time Out) Jh- ............................... 7 h . Z ~ ~ i l ~ ~ ~ j i ~ l j
& - v ............................... -. .... . . ~ -- fl549Jf)12 ~- ~ ~. . a* ~~ ~ . ~ hi; \ \ yak .. , ..................... .... - .. * ,+..- : ,,.n~~un-i$ -
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" d d d d.b ~ ~ ~ ~ ~ a r r ~ i ~ u l n ~ ~ n ~ 3 u ' 0 9 n " ' 1 ) n 1 3 d 1 ~ ~ aiu150hM'n Note L~IILWU I I ? ~ L ~ ) J L Z U ~ ~ ~ ~ I W V ~ C I
~ d x ~ l n ' d b a 1 u 1 ~ n ~ v ~ M ' n ~ 0 ~ a n i 5 i i ~ ~ ~ a 1 ~ b ~ ~ ~ ~ a Lab/X-Ray 16 d.d aiuisnraansunau"uffn / rr~p1u'~qnni~din"nm"~1K d.d aiuisnXinni5unrGnn7~cjidi(il
& ~ I ~ ' P I Q ~ & I # ~ % ~ ~ Q W ' ~ ~ % U v d d a.a aiui~n~ru~"n~~~niiidaaasr~ni~~~w"~~~"nBu, ~draas r~n iaona in~ '~ i l~ "n4~1 , ra"7~uinn~ua,
I RR score, aniusngu, Complication ~uw"04w'nduTn"
,- b. n w a a ~ l n ~ u & t y
b.a aiui~na~uniu51u~~~daur~asia~an15cj1~~ uunniu~u~, miuGa~cji(fi"(il16 b.b aiui~o~ran~dss%n1sFii(fi"(il1n"
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d.s. ais-liinuan~u'aqa~aId%o~~d~u dsanoun'x, vuiuravd~s~ima~d7u (HN), =ia-uiuaqa[d~u B J . ~ a i u i ~ n s ~ ' ~ i n ~ a + n ~ ~ ~ 1 d d ~ ~ 1 ~ ~ ~ m " d.m aiuirnu"uM"nu'~yani~u"(il~uiu G Q ~
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a.b a l u l ~ n 6 l w ~ n $ ~ & j a Membrane rdu . . . . . . . , , . . , . . .
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m.s nisrJinm%sbi - ..~?. . - ~ ~ ~ . ...... .. *
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