Surat Rujuk Balik

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SURAT RUJUKAN BALIK

Teman sejawat Yth.

Mohon kontrol selanjutnya penderita :

Nama : .............................................................

Diagnosa : .............................................................

Terapi : .............................................................

Tindak lanjut yang dianjurkan

Pengobatan dengan obat-obatan : Perlu rawat inap

..................................................................................
.................................................................................. Konsultasi selesai
..................................................................................

Kontrol kembali ke RS tanggal : ................................. ............................ Tgl ......................................

Lain-lain : ................................................................... Dokter RS,

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

SURAT RUJUKAN BALIK

Teman sejawat Yth.

Mohon kontrol selanjutnya penderita :

Nama : .............................................................

Diagnosa : .............................................................

Terapi : .............................................................

Tindak lanjut yang dianjurkan

Pengobatan dengan obat-obatan : Perlu rawat inap

Kontrol kembali ke RS tanggal : ................................. ............................ Tgl ......................................

Lain-lain : ................................................................... Dokter RS,

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

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