Nomor Index Rawat.docx
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NOMOR INDEX
NAMA PENDERITA
: ………………………………..
UMUR
: ………………………………..
NAMA KEPALA KELUARGA
: ………………………………..
AGAMA
: ………………………………..
PEKERJAAN
: ………………………………..
JKN/KIS NO
: ………………………………..
ALAMAT
: ………………………………..
TGL
PEMERIKSAAN / DIAGNOSE
PENGOBATAN
B
KETERANGAN L K U
KM
PRF
TGL
PEMERIKSAAN / DIAGNOSE
PENGOBATAN
B
KETERANGAN L K U
KM
PRF
NAMA PENDERITA
: ………………………………..
UMUR
: ………………………………..
NAMA KEPALA KELUARGA
: ………………………………..
AGAMA
: ………………………………..
PEKERJAAN
: ………………………………..
JKN/KIS NO
: ………………………………..
ALAMAT
: ………………………………..
TGL
PEMERIKSAAN / DIAGNOSE
PENGOBATAN
B
KETERANGAN L K U
KM
PRF
TGL
PEMERIKSAAN / DIAGNOSE
PENGOBATAN
B
KETERANGAN L K U
KM
PRF
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