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Nyeri                    :  (         
)   tidak    (         
)   ya <o:p></o:p>Skala nyeri          :………………(Intensitas 0 - 10)<o:p></o:p>Karakteristik       :………………………………<o:p></o:p>Lokasi                 :………………………….........<o:p></o:p>Durasi                  : …………………………...........<o:p></o:p>

<span lang="IN" style="font-size:10.0pt;line-height:115%;font-family:"Times New Roman","serif";
mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;mso-ansi-language:
IN;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">Frekuensi             : ...….  x/hari 
(crescendo/decrescendo)<span lang="IN" style="font-size:10.0pt;line-height:115%;font-family:"Times New Roman","serif";
mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;mso-ansi-language:
IN;mso-fareast-language:EN-US;mso-bidi-language:AR-SA"> Nyeri hilang, dengan :[  ] Minum Obat[  ] Istirahat     [  ] Mendengarkan musik[  ] Berubah posisi tidur[  ] Lain-lain, sebutkan ……………………………<span lang="IN" style="font-size:10.0pt;line-height:115%;font-family:"Times New Roman","serif";
mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;mso-ansi-language:
IN;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">

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