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,

: :

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