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    contoh rujukan internal puskesmas

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    contoh rujukan internal puskesmas

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    4 views3 pages

    Rujukan Internal

    Uploaded by

    dela
    contoh rujukan internal puskesmas

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    PEMERINTAH KABUPATEN TOBA SAMOSIR

    DINAS KESEHATAN
    UPT. PUSKESMAS BORBOR
    Jalan Pasar Borbor, Telepon : 081269689680
    Email : puskesmasborbor12@gmail.com

    FORMULIR RUJUKAN INTERNAL


    NO: / RI / /2019
    Nama Poli pengirim :………………………………………………………………….
    Nama poli yang dituju :………………………………………………………………….
    Nama pasien :………………………umur:………………j. kelamin: L / P
    Alasan di Rujuk :………………………………………………………………….
    …………………………………………………………………..
    …………………………………………………………………..

    Borbor , 2019

    ( )
    Nama & Tanda Tangan petugas

    PEMERINTAH KABUPATEN TOBA SAMOSIR


    DINAS KESEHATAN
    UPT. PUSKESMAS BORBOR
    Jalan Pasar Borbor, Telepon : 081269689680
    Email : puskesmasborbor12@gmail.com

    FORMULIR RUJUKAN INTERNAL


    NO: / RI / /2019
    Nama Poli pengirim :………………………………………………………………….
    Nama poli yang dituju :………………………………………………………………….
    Nama pasien :………………………umur:………………j. kelamin: L / P
    Alasan di Rujuk :………………………………………………………………….
    …………………………………………………………………..
    …………………………………………………………………..

    Borbor , 2019

    ( )
    Nama & Tanda Tangan petugas

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