Cover - Copy - Copy.docx
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- Words: 40
- Pages: 2
RUMAH SAKIT UMUM HIKMAH MAKASSAR FORMULIR PERINTAH LISAN/MELALUI TELEPON/PELAPORAN HASIL PEMERIKSAAN KRITIS Ruang
:
Bulan
:
TGL/JAM
Nama Pasien
Rekam Medik
Isi Perintah
Nama Penerima Perintah (Tanda Tangan)
Pemberi Perintah (Tanda Tangan)
Pelaksana Perintah (Tanda Tangan)
Mengetahui Kepala Ruangan
Ket.
:
Bulan
:
TGL/JAM
Nama Pasien
Rekam Medik
Isi Perintah
Nama Penerima Perintah (Tanda Tangan)
Pemberi Perintah (Tanda Tangan)
Pelaksana Perintah (Tanda Tangan)
Mengetahui Kepala Ruangan
Ket.
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