13. Konsul Dokter.docx

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PEMERINTAH KOTA LUBUKLINGGAU RSUD SITI AISYAH Jalan Lapter Silampari No. 20A Rt. 01Kelurahan Air Kuti Lubuklinggau 1 Telp. (0733)451902 Fax.(0733) 452776.

NO RM

: …………………………........

NAMA

: …………………………........ L/P

TGL LAHIR : …....……………………........

`

SURAT KONSUL DOKTER Dari Dokter

: ………………………………….. Kamar

: ……… Kelas :……… Lantai : …………

Untuk Dokter

: ………………………………….. Ahli

: ……………………………………………

Tanggal :

Jam :

JAWABAN KONSUL Tanggal :

Jam :

RM 13

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