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RUMAH SAKIT BINA KASIH Telah Terakreditasi Tingkat Perdana

Jl. Samanhudi No. 3-5 Telp. 21718, 32195 Certification by KARS.

Sertifikat No. KARS-SERT/202/X/2016
Pekanbaru
Nama : __________________________
No. RM : __________________________
FORMULIR DPJP
Tgl. Lahir : __________________________
(Wajib diisi, atau tempelkan stiker bila ada)

DPJP UTAMA DPJP

DIAGNOSA Tgl. Tgl. Tgl. Tgl. Ket
Nama Nama
Mulai Akhir Mulai Akhir

RM. 10 / Rev. 00

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