Kartu Rawat Jalan Ktb Tengah.docx
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KARTU RAWAT JALAN
PUSKESMAS SEBATUNG KECAMATAN PULAU LAUT UTARA Jl. Singabana RT. 20 Kel. Kotabaru Tengah Kab. Kotabaru 72113
NOMOR
:……………………………………………………………….
NAMA KK
:……………………………………………………………….
NIK
:……………………………………………………………….
NAMA PASIEN
:………………………………………………………….L / P
TTL/ UMUR
:……………………………………………………………….
PEKERJAAN
:……………………………………………………………….
ALAMAT
:Jl…………………………………………………………..… DESA KOTABARU TENGAH No.
RT RT.
RW
Telp. TANGGAL
DX/ KELUHAN
TINDAKAN/ PENGOBATAN
TANGGAL
DX/ KELUHAN
TINDAKAN/ PENGOBATAN
PUSKESMAS SEBATUNG KECAMATAN PULAU LAUT UTARA Jl. Singabana RT. 20 Kel. Kotabaru Tengah Kab. Kotabaru 72113
NOMOR
:……………………………………………………………….
NAMA KK
:……………………………………………………………….
NIK
:……………………………………………………………….
NAMA PASIEN
:………………………………………………………….L / P
TTL/ UMUR
:……………………………………………………………….
PEKERJAAN
:……………………………………………………………….
ALAMAT
:Jl…………………………………………………………..… DESA KOTABARU TENGAH No.
RT RT.
RW
Telp. TANGGAL
DX/ KELUHAN
TINDAKAN/ PENGOBATAN
TANGGAL
DX/ KELUHAN
TINDAKAN/ PENGOBATAN
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