Kitir Rawat Jalan A4.xlsx

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BIAYA PELAYANAN RAWAT JALAN/UGD Tanggal :.....................20.... Nama Pasien : Dokter................ No PELAYANAN BIAYA 1 Tindakan Medik Rp. 2 Laboratorium Rp. 3 Fisioterapi Rp. 4 Obat Rp. 5 Ruang Observasi Rp. 6 Rp. 7 Rp. 8 Rp. 9 Rp. TOTAL Rp.

BIAYA PELAYANAN RAWAT JALAN/UGD Tanggal :.....................20.... Nama Pasien : Dokter................ No PELAYANAN BIAYA 1 Tindakan Medik Rp. 2 Laboratorium Rp. 3 Fisioterapi Rp. 4 Obat Rp. 5 Ruang Observasi Rp. 6 Rp. 7 Rp. 8 Rp. 9 Rp. TOTAL Rp.

PETUGAS

PETUGAS

(...........................)

(............................)

BIAYA PELAYANAN RAWAT JALAN/UGD Tanggal :.....................20.... Nama Pasien : Dokter................ No PELAYANAN BIAYA 1 Tindakan Medik Rp. 2 Laboratorium Rp. 3 Fisioterapi Rp. 4 Obat Rp. 5 Ruang Observasi Rp. 6 Rp. 7 Rp. 8 Rp. 9 Rp. TOTAL Rp.

BIAYA PELAYANAN RAWAT JALAN/UGD Tanggal :.....................20.... Nama Pasien : Dokter................ No PELAYANAN BIAYA 1 Tindakan Medik Rp. 2 Laboratorium Rp. 3 Fisioterapi Rp. 4 Obat Rp. 5 Ruang Observasi Rp. 6 Rp. 7 Rp. 8 Rp. 9 Rp. TOTAL Rp.

PETUGAS

PETUGAS

(...........................)

(...........................)

BIAYA PELAYANAN RAWAT JALAN/UGD Tanggal :.....................20.... Nama Pasien : Dokter................ No PELAYANAN BIAYA 1 Tindakan Medik Rp. 2 Laboratorium Rp. 3 Fisioterapi Rp. 4 Obat Rp. 5 Ruang Observasi Rp. 6 Rp. 7 Rp. 8 Rp. 9 Rp. TOTAL Rp.

BIAYA PELAYANAN RAWAT JALAN/UGD Tanggal :.....................20..... Nama Pasien : Dokter................ No BIAYA 1 Tindakan Medik Rp. 2 Laboratorium Rp. 3 Fisioterapi Rp. 4 Obat Rp. 5 Ruang Observasi Rp. 6 Rp. 7 Rp. 8 9 Rp. TOTAL Rp.

PETUGAS

PETUGAS

(...........................)

(...........................)

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