Form Ekspertise Pemeriksaan Radiologi.docx
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RSIA BUNDA SEJAHTERA Jl. Raya Puri Agung No. 3 Pondok Makmur - 15560 No Telp. : (021) 592 5889 No Fax. : (021) 592 5876
HASIL PEMERIKSAAN RADIOLOGI Pasien Rawat Inap
Tgl.Registrasi
Sex / Umur
: : :
Dokter Pengirim
:
No.Registrasi Nama Pasien
Pemeriksaan Dok/Foto/Ref.
Salam sejawat,
dr. ERIK, SpRad
: :
No.RM
Tangerang,
: :
HASIL PEMERIKSAAN RADIOLOGI Pasien Rawat Inap
Tgl.Registrasi
Sex / Umur
: : :
Dokter Pengirim
:
No.Registrasi Nama Pasien
Pemeriksaan Dok/Foto/Ref.
Salam sejawat,
dr. ERIK, SpRad
: :
No.RM
Tangerang,
: :
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