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    2 views1 page

    Amo h57.9 161017

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    © All Rights Reserved
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    of 1

    Divisi Regional REGIONAL VII - SURABAYA

    Kantor Cabang PAMEKASAN

    Rujukan Puskesmas / Dokter Keluarga

    No. Rujukan : 133621011017Y000325


    Puskesmas/Dokter : GAYAM(13362101)
    Kabupaten/Kota : KAB. SUMENEP(0209)

    Kepada Yth. TS dr. Poli : Poli Penyakit Mata

    Di RSU : RSUD SUMENEP

    Mohon pemeriksaan dan penanganan lebih lanjut penderita :

    Nama : AMORIYANTO Umur : 44 Tahun 15-Jul-1973

    No. Kartu BPJS : 0000197537455 Status : 1 Utama/ Tanggungan L (L/P)

    Diagnosa : Disorder of eye and adnexa, unspecified

    Telah diberikan :

    Demikian atas bantuannya, diucapkan banyak terima kasih


    Salam sejawat, 16 October 2017

    dr.Anwar Lutfi

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