resume medis rawat jalan
Post on 04-Nov-2015
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RUMAH SAKITSARI ASIH
RESUME MEDIS RAWAT JALAN
No. Rekam Medis
Nama Pasien
Tanggal Lahir
Tanggal Pemeriksaan
Klinik / DokterLembar untuk diisi dokter
Anamnesa
Diagnosa
Terapi
Anjuran
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Dengan ini saya selaku pasien / tertanggung, mengizinkan RS. Sari Asih Karawaci untuk memberikan keterangan lengkap mengenai keadaan penyakit / data medis kepada pihak ketiga yang ditunjuk secara sah.
( ____________________ )Pasien / Tertanggung
( ____________________ )DokterPasien
ArsipPerusahaan
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