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    4 views1 page

    Kartu

    Uploaded by

    Denny Try
    prb

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    KARTU PUTIH Jlh Paraf Paraf

    Tgl/Bln/Thn Nama Obat Pasien


    Obat Dokter
    (Kartu Rujuk Balik)
    Khusus Untuk Penyakit Kronis 1.
    Kartu Harus Dibawa Setiap Mengambil Obat 2.

    3.
    Nama : …………………………………………………………….... 4.
    Usia/Kelamin : …………...Th ( L / P ) …………………………......... 5.
    Status : …………………………………………………………..….. 6.
    Alamat : …………………………………………………………..….. 7.
    8.
    NO. BPJS : ……………………………………………………………….
    9.

    10.
    Nama Obat
    11.
    1. …………………………………………………………………………………. 12.

    2. …………………………………………………………………………………. 13.

    3. …………………………………………………………………………………. 14.

    15.
    4. ………………………………………………………………………………….
    16.
    5. ………………………………………………………………………………….
    17.
    6. ………………………………………………………………………………….
    18.
    7. …………………………………………………………………………………. 19.
    8. …………………………………………………………………………………. 20.

    21.

    22.
    2019

    Kepala,

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