SNACK 4 APRIL 2016.xlsx

8/18/2019 SNACK 4 APRIL 2016.xlsx

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List Dokument Dept Gizi

No Nama Dokument No. Dokument

1 Buku Penerimaan Informasi Status Pasien FRM/AIC/GZI/01/04

2 Buku Pengantaran Sonde FRM/AIC/GZI/0/01

!it"#en $rder FRM/AIC/%&C/01/02

4 %PMP FRM/AIC/%&C/01/02

' !it"#en $rder FRM/AIC/%&C/01/0

( Reka) Portioning FRM/AIC/%&C/01/0

* Sti"ker Sna"k FRM/AIC/%&C/01/04

+ Mea, C#e"k FRM/ACS/-MS/11/01


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3/66

DAFTAR P

RUANG:

No KAMAR NAMA PASIEN MR DIET A!AL

1

2

4

'

(

*

+

.

10

11

12

1


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FORMULIRo

Re

RMINTAAN MAKAN PASIEN

&g,

a,

PETUGAS GI"

TANGGAL# $A

DIET %ARUMAKAN

PAGI

SNA&KPAGI

MAKANSIANG

SNA&KSORE


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5 FRM/AIC/GZI/02/0

5 01

5 1 Se)tem6er 201'

5 1 of 1

I :

RI:

KETERANGANMAKAN

MALAM


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LA%EL MENU PASIEN

Name : Date : # #

Room : Diet :

MENU:'''''''

MP 5999999999999999999999: 5999999999999999999999

B& 59999999999999999999999

S;R 59999999999999999999999

S$P 5999999999999999999999

B


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Room : Diet :

MENU:'''''''

MP 5999999999999999999999

: 5999999999999999999999

B& 59999999999999999999999

S;R 59999999999999999999999

S$P 5999999999999999999999

B


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LA%EL MENU PASIEN

Name : Date : # #

Room : Diet :

MENU:'''''''

MP 5999999999999999999999: 5999999999999999999999

B& 59999999999999999999999

S;R 59999999999999999999999

S$P 5999999999999999999999

B


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Room : Diet :

MENU:'''''''

MP 5999999999999999999999

: 5999999999999999999999

B& 59999999999999999999999

S;R 59999999999999999999999

S$P 5999999999999999999999

B


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LA%EL MENU PASIEN

Name : Date : # #

Room : Diet :

MENU:'''''''

MP 5999999999999999999999: 5999999999999999999999

B& 59999999999999999999999

S;R 59999999999999999999999

S$P 5999999999999999999999

B


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Room : Diet :

MENU:'''''''

MP 5999999999999999999999

: 5999999999999999999999

B& 59999999999999999999999

S;R 59999999999999999999999

S$P 5999999999999999999999

B


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F

PENGANT

%ate 5 >>>>>>>>>>>>>>>>

NO. NAMA PASIEN NO. KAMAR KOMPOSISI SONDE

1 &n adi 012 S? ( @ 200 "" Pute,

(

)engantar )enerima )engan

anto Zr Rita

2 )engantar )enerima )engan

)engantar )enerima )engan


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o 5 FRM/AIC/GZI/0

Re 5 00

NDE &g, 5 1 Se)tem6er 2

a, 5 1 of 1

>>>>>>>>>>>

!AKTU PEM%ERIAN

12 1' 1+ 21

)engantar )enerima )engantar )enerima )engantar )enerima )engantar )enerima )engantar )enerima )e




15/66

)engantar )enerima )engantar )enerima )engantar )enerima )engantar )enerima )engantar




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&angga, / Eam 5 01 A)ri, 201'

!ode Penge"ekan 5 MC/


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1 Aam !e"a)

2 &e,ur Pindang Serani

Gu,ai &em)e/Ca# &em)e

4

' Su) orte, Bun"is

&angga, / Eam 5

!ode Penge"ekan 5

No Nama item

St+ A/tua0

1 %onat !entang

2 S)i"e Gar,i" Bread

4

'

%e)at123)am4

Fo)ei3nO,5e/t11

264 Foun+ FO7 284&0ea) FO


18/66Mea, Cek makanan %iet 3%M J RG a7i6 di,akukan o,e# A#,i GiDi dan didokumentasi


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FORM

MEAL &$E&K

!a)na 9 %au Rasa Tekstu) Tampi0an

4 4 2 4

4 4 4 4

FORM

MEAL &$E&K

Pa)amete) Ni0ai Pen3e/ekan111264 san3at ku)an3 24 ku)an3 2;4 ,iasa 2


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FORM

MEAL &$E&K

!a)na 9 %au Rasa Tekstu) Tampi0an

FORM

Pa)amete) Ni0ai Pen3e/ekan111264 san3at ku)an3 24 ku)an3 2;4 ,iasa 2


21/66 kan di form


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o 5 FRM/ACS/-MS/11/01

Re 5 00

&g, 5 1* Se)tem6er 2012a, 5 1 of 1

Paraf Pane,is

3AG 3C#ef 3-C

Rema)ks # &omment


Re 5 00

&g, 5 1* Se)tem6er 2012

a, 5 1 of 1

f ,i

Aam kurang matang K dimasak u,ang dan#asi,na $!


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Re 5 00

&g, 5 1* Se)tem6er 2012

a, 5 1 of 1

Paraf Pane,is

3AG 3C#ef 3-C

Rema)ks # &omment



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LA%EL PASIEN

SONDE (OODING 2S(4Name : Date : # # Name :

Room : Diet : Room :

=AM PEM%ERIAN : ..............................

S? 5999999999999999999999 S?

5999999999999999999999

59999999999999999999999

AG AI& AGRS

o 5 FRM/AIC/GZI/02/0( o 5 FR

LA%EL PASIEN

SONDE (OODING 2S(4

Name : Date : # # Name :



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59999999999999999999999

AG AI& AGRS

o 5 FRM/AIC/GZI/02/0( o 5 FR

LA%EL PASIEN

SONDE (OODING 2S(4



=AM PEM%ERIAN : ..............................

S? 5999999999999999999999 S?

5999999999999999999999

59999999999999999999999

AG AI& AGRS

LA%EL PASIEN

SONDE (OODING 2S(4




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LA%EL PASIEN

SDate : # # Name :

Diet : Room :

=AM PEM%ERIAN : .............................. =AM PEM

5999999999999999999999 S? 599999995999999999999999999999 59999999

59999999999999999999999 59999999

AG AI& AGRS AG AI&

/AIC/GZI/02/0( o 5 FRM/AIC/GZI/02/0(

SONDE (OODING 2S(4 S

Date : # # Name :

Diet : Room :


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59999999999999999999999 59999999

AG AI& AGRS AG AI&

/AIC/GZI/02/0( o 5 FRM/AIC/GZI/02/0(

LA%EL PASIEN


Date : # # Name :

Diet : Room :

=AM PEM%ERIAN : .............................. =AM PEM

5999999999999999999999 S? 59999999

5999999999999999999999 59999999

59999999999999999999999 59999999

AG AI& AGRS AG AI&

LA%EL PASIEN


Date : # # Name :

Diet : Room :


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LA%EL PASIEN

NDE (OODING 2S(4Date : # #

Diet :

ERIAN : ..............................

99999999999999999999999999

99999999999999

AGRS

LA%EL PASIEN

NDE (OODING 2S(4

Date : # #

Diet :


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99999999999999

AGRS

LA%EL PASIEN

NDE (OODING 2S(4

Date : # #

Diet :

ERIAN : ..............................

9999999999999

9999999999999

99999999999999

AGRS

LA%EL PASIEN

NDE (OODING 2S(4

Date : # #

Diet :


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LABEL SNACK PASIEN LABEL SNACK PASIEN

Name : Tn. AGUS Date : 4/4/2016 Name : Tn. JERIANTO Date :

Room : 1303 Diet : NT,DM,Rn Room : 130! Diet :

MENU : SNA"# AGI / SORE / MA$AM MENU : SNA"# AGI / SORE / MA$AM

MINUMAN: :%TE&%%%%%%%%%%%%%%%%%%%.. MINUMAN: :%TE&%%%%%%%%%%%%%%%%%

SNA"# : "&I"#EN IE'(RUITE IE SNA"# : "&I"#EN IE ' (RUITE IE

:%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%%%%%%%%%%%%%%

AG AI" AGRS AG AI" AGRS

No. : (RM/AI"/G)I/02/0! No. : (RM/AI"/G)I/02/0!LABEL SNACK PASIEN LABEL SNACK PASIEN

Name : N*. NO+I Date : 4/4/2016 Name : N*. NURU$ Date :

Room : 130 Diet : NT, D$ Room : 1310 Diet :


MINUMAN: :%TE&%%%%%%%%%%%%%%%%%%%%.. MINUMAN: : TE&%%%%%%%%%%%%%%%%%

SNA"# : "&I"#EN U((%%%%%%%%%%%%%%%%%%%.. SNA"# : :%"&I"#EN IE ' (RUITE IE%%%%%%

:%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%%%%%%%%%%%%%%


No. : (RM/AI"/G)I/02/0! No. : (RM/AI"/G)I/02/0!


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Room : 133 Diet : NT Room : 120!2 Diet :



SNA"# : (RUITE IE SNA"# : (RUITE IE

:%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%%%%%%%%%%%%%%




Name : Tn. UMAR Date : 4/4/2016 Name : Tn. JO&AN Date :Room : 1202 Diet : NT DM D$ Room : 12132 Diet :


MINUMAN: :%TE&%%%% DM MINUMAN: :%TE&%%%%%%%%%%%%%%%%%

SNA"# : "&I"#EN U(( SNA"# : "&I"#EN U((

:%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%%%%%%%%%%%%%%




Name : Nn. SUMARNI Date : 4/4/2016 Name : Nn. A$(I Date :


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MINUMAN: :%TE&%%%% DM MINUMAN: :%TE&%%%%%%%%%%%%%%%%%

SNA"# : UDING DM SNA"# : "&I"#EN IE

:%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%%%%%%%%%%%%%%




Name : Tn. AGUS Date : 4/4/2016 Name : Tn. JERIANTO Date :

Room : 1303 Diet : NT,DM,Rn Room : 130! Diet :



SNA"# : "&I"#EN IE'(RUITE IE SNA"# : "&I"#EN IE ' (RUITE IE

:%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%%%%%%%%%%%%%%




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LABEL SNACK PASIEN LAB

4/4/2016 Name : Nn. U$ITA Date : 4/4/2016 Name : Tn. &AIDAR

NT Room : 1306 Diet : $UNA# Room : 130

&ERTIROID

MENU : SNA"# AGI / SORE / MA$AM MENU : SN

%%%.. MINUMAN: :%TE&%%%%%%%%%%%%%%%%%%%%.. MINUMAN: :%TE&%%%%

SNA"# : "&I"#EN IE ' (RUITE IE%%%%%%%%%%%%%%% SNA"# : "&I"#EN U((

%% :%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%

AG AI" AGRS AG AI"

No. : (RM/AI"/G)I/02/0! No. : (RM/AI"/G)I/02/0!LABEL SNACK PASIEN LAB

4/4/2016 Name : Tn. EDI SU-ROTO Date : 4/4/2016 Name : An. "&AR$IE

-- Room : 130 Diet : -, DM Room : 1312

#UDANG


%.. MINUMAN: : TE&%%DM%%%%%%%%%%%%%%%%%.. MINUMAN: :%%TE&%%%

%%%%%%%%% SNA"# : :%%"&I"#EN U(( 2ORSI%%%%%%%%%%%%%%% SNA"# : :%%(RUITE I

%% :%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%

AG AI" AGRS AG AI"



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4/4/2016 Name : N*. &E$MATI Date : 4/4/2016 Name : Nn. JEANE

NT Room : 1330 Diet : NT, RG, RS Room : 1332


%%%.. MINUMAN: :%%TE&%%%%%%%%%%%%%%%%%%%.. MINUMAN: :%%TE&%%%

SNA"# : "&I"#EN U(( SNA"# : (RUITE IE

%% :%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%

AG AI" AGRS AG AI"



4/4/2016 Name : Tn. TA+I+ Date : 4/4/2016 Name : Tn. DARIS

NT, TD Room : 13!3 Diet : NT Room : 13!!


%%%.. MINUMAN: :%%%TE&%%%%%%%%%%%%%%%%%%.. MINUMAN: :%%TE&%%%

SNA"# : (RUITE IE SNA"# : "&I"#EN U((

%% :%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%

AG AI" AGRS AG AI"




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- Room : 120!1 Diet : NT D&( Room : 1202



SNA"# : "&I"#EN U(( SNA"# : (RUITE IE

%% :%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%

AG AI" AGRS AG AI"



4/4/2016 Name : An. "E$INE Date : 4/4/2016 Name : Nn. MI$A--, TD Room : 121!2 Diet : -- Room : 1206

#SEAFOOD



SNA"# : (RUITE IE%%%%%%%%%%%%%%%%%%.. SNA"# : (RUITE IE%

%% :%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%

AG AI" AGRS AG AI"



4/4/2016 Name : An. A$ESANDRO Date : 4/4/2016 Name : Tn. &AIDAR

MENU SNA"# AGI / SORE / MA$AM MENU SN


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SNA"# : (RUITE IE SNA"# : (RUITE IE 2

%% :%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%

AG AI" AGRS AG AI"



4/4/2016 Name : Nn. U$ITA Date : 4/4/2016 Name : Tn. &AIDAR

NT Room : 1306 Diet : $UNA# Room : 130

&ERTIROIDMENU : SNA"# AGI / SORE / MA$AM MENU : SN


SNA"# : "&I"#EN IE ' (RUITE IE%%%%%%%%%%%%%%% SNA"# : (RUITE IE 2

%% :%%%%%%%%%%%%%%%%%%%%%% :%%%%%%%

AG AI" AGRS AG AI"


L SNACK PASIEN


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L SNACK PASIEN

Date : 4/4/2016

Diet : NT, D& II

"# AGI / SORE / MA$AM

%%%%%%%%%%%%%%%%..

2ORSI%%%%%%%%%..

%%%%%%%%%%%%%%%

AGRS

L SNACK PASIEN

Date : 4/4/2016

Diet : NT


%%%%%%%%%%%%%%%%..

%%%%%%%%%%%%%%%%%%%..

%%%%%%%%%%%%%%%

AGRS

D t 4/4/2016


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Date : 4/4/2016

Diet : NT


%%%%%%%%%%%%%%%%..

%%%%%%%%%%%%%%%

AGRS

L SNACK PASIEN

Date : 4/4/2016

Diet : NT RG DM DJ


DM

%%%%%%%%%%%%%%%

AGRS

L SNACK PASIEN

Diet NT TD


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Diet : NT, TD


%%%%%%%%%%%%%%%%..

AUR%%%%%%%%%..

%%%%%%%%%%%%%%%

AGRS

L SNACK PASIEN

Date : 4/4/2016Diet : -


%%%%%%%%%%%%%%%%..

%%%%%%%..

%%%%%%%%%%%%%%%

AGRS

L SNACK PASIEN

Date : 4/4/2016



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%%%%%%%%%%%%%%%%..

ORSI%%%%%%%%%..

%%%%%%%%%%%%%%%

AGRS

L SNACK PASIEN

Date : 4/4/2016

Diet : NT, D& II


%%%%%%%%%%%%%%%%..

ORSI%%%%%%%%%..

%%%%%%%%%%%%%%%

AGRS


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LA%EL MENU PASIEN



PAKET MENU : M&U # $D # OD&

M


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o 5 FRM/AIC/GZI/02/0* o 5 FRM/AI

LA%EL MENU PASIEN




M


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o 5 FRM/AIC/GZI/02/0* o 5 FRM/AI

LA%EL MENU PASIEN




M


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LA%EL MENU PASIEN LA%

Date : # # Name :

Diet : Room :

PAKET MENU : M&U # $D # OD& PAKET M

M


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/GZI/02/0* o 5 FRM/AIC/GZI/02/0*


Date : # # Name :

Diet : Room :


M


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/GZI/02/0* o 5 FRM/AIC/GZI/02/0*


Date : # # Name :

Diet : Room :


M


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L MENU PASIEN LA%EL MENU PA

Date : # # Name :

Diet : Room :

ENU : M&U # $D # OD& PAKET MENU : M&U #

M


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o 5 FRM/AIC/GZI/02/0*


Date : # # Name :

Diet : Room :


M


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o 5 FRM/AIC/GZI/02/0*


Date : # # Name :

Diet : Room :


M


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IEN

Date : # #

Diet :

D # OD&


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IEN

Date : # #

Diet :

D # OD&


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IEN

Date : # #

Diet :

D # OD&


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Tan33a0 :

No

Nama Menu

%F # Ln # Dn %iasa

Asian

A*am #ea5

Te78 in9an Se8ani

G7ai Tem5e/"a; Tem5e

T7mi< =a*am > 7t8en/T7mi< a=7 Siam

S75 o8te -7ni<


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$ea0t-

!este)n

Ro -8ea9 > -7tte8

"8eam M7


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-ae9 otato

-8ai


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FORMULIR

KIT&$EN ORDER

66.>> ? 6@.>>

Lunak &&GRG

%iasa Lunak &&G


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o 5 FRM/AIC/GZI/02/01

Re 5 01

&g, 5 1 Agustus 201'

a, 5 1 of 1

T& : K6

6.>> ? >B.>>

%iasa Lunak &&GRG

%iasa Lunak


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Dite)ima o0e

3C#ef/ C%P/ Cook


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&&G


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SNACK 4 APRIL 2016.xlsx

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Transcript of SNACK 4 APRIL 2016.xlsx