Tracer Rm.docx

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TRACER REKAM MEDIK PUSKESMAS SEMPU : Nama Pasien

: ………………………………………………….

No RM

: …………………………………………………

Tanggal Pinjam

: …………………………………………………

Jam Pinjam

:

…………………………………… Tanggal Pengembalian

: ……………………………………………….. Jam Pengembalian :

…………………………………… RM Keluar ke

: …………………………………………………

Nama Petugas RM

Nama Peminjam

( ………………………………………)

TRACER REKAM MEDIK PUSKESMAS SEMPU : (……………………………………….) Nama Pasien

: ………………………………………………….

No RM

: …………………………………………………

Tanggal Pinjam

: …………………………………………………

Jam Pinjam

…………………………………… Tanggal Pengembalian

: ……………………………………………….. Jam Pengembalian :

…………………………………… RM Keluar ke

: …………………………………………………

Nama Petugas RM

( ………………………………………) (……………………………………….)

Nama Peminjam

:

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