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Sheet - Pediatric Nutrition Care

Published on July 2018 | Categories: Documents | Downloads: 9 | Comments: 0
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Bagian Ilmu Kesehatan Anak RUMAH SAKIT UMUM DAERAH DR. MOEWARDI Jalan Kolonel Sutarto 132, Surakarta

PEDIATRIC NUTRITION CARE IDENTITAS PASIEN Nama

:

RM

:

Tanggal Lahir

:

Alamat

:

Umur

Th

Bln

DIAGNOSA PENYAKIT 1. 2. 3. 4. 5. 6. 7.

STATUS NUTRISI Pemeriksaan Pemeriksaan Fisik

Data Antropometrik Berat Badan Tinggi Badan IMT

Hasil Laboratorium Kg

LILA

Cm

     

Diagnosa Status Nutrisi

KEBUTUHAN ZAT GIZI Kebutuhan Kalori

Kebutuhan Protein

mm

Hari

Kebutuhan Cairan

Alternatif Cara Pemberian

RENCANA TERAPI NUTRISI

EVALUASI Tanggal

Berat Badan

CATATAN

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