Blanko Resep.docx
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PEMERINTAH KABUPATEN INDRAMAYU DINAS KESEHATAN UPTD PUSKESMAS PATROL Jl. Lapangan Bola Desa Patrol Kec. Patrol - Indramayu Telp. (0234) 610125 Email : [email protected]
Dr. …………………………………………………… R/
No.RM
:
Nama
:
Umur
:
Berat badan
:
Alamat
:
Tanggal :……………………………..
Dr. …………………………………………………… R/
No.RM
:
Nama
:
Umur
:
Berat badan
:
Alamat
:
Tanggal :……………………………..
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