Kartu Kendali

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KARTU KENDALI KETIDAKLENGKAPAN

DOKUMEN REKAM MEDIS

No. RM :
Nama :
Tgl. MRS :
Tgl. KRS :
Tgl. Setor :
Ketidaklengkapan : 1..........................................................
2..........................................................
3..........................................................
...........................................................

Tanda tangan,

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