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  • Formulir Pasien Pindah/Pulang: Warna Putih: Pendaftaran Warna Kuning: Status

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    KARTIKA
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    This document is a patient transfer/discharge form in Indonesian. It requests the patient's name, medical record number, current room, room being transferred to, reason for discharge, and date. The possible reasons for discharge listed are recovery, request of patient, death, or transfer to another hospital. The form is dated and includes a space for the nurse's name. It specifies that the white copy is for registration and the yellow copy is for status.

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    Original Title

    FORMULIR PASIEN PINDAH

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    This document is a patient transfer/discharge form in Indonesian. It requests the patient's name, medical record number, current room, room being transferred to, reason for discharge, and date. The possible reasons for discharge listed are recovery, request of patient, death, or transfer to another hospital. The form is dated and includes a space for the nurse's name. It specifies that the white copy is for registration and the yellow copy is for status.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views1 page

    Formulir Pasien Pindah/Pulang: Warna Putih: Pendaftaran Warna Kuning: Status

    Uploaded by

    KARTIKA
    This document is a patient transfer/discharge form in Indonesian. It requests the patient's name, medical record number, current room, room being transferred to, reason for discharge, and date. The possible reasons for discharge listed are recovery, request of patient, death, or transfer to another hospital. The form is dated and includes a space for the nurse's name. It specifies that the white copy is for registration and the yellow copy is for status.

    Copyright:

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

    FORMULIR PASIEN PINDAH/PULANG

    Nama Pasien :……………………………………………………………………………..


    No. Medrek :……………………………………………………………………………..
    Ruangan :……………………………………………………………………………..
    Mutasi Ruangan ke :……………………………………………………………………………..
    Alasan Pulang :……………………………………………………………………………..

    D/……………………………………………
    1. Sembuh
    2. Atas permintaan sendiri
    3. Meninggal
    4. Pindah RS lain
    Tangerang,………………..20……

    Nama perawat: …………………….


    Warna Putih : Pendaftaran
    Warna Kuning : Status

    FORMULIR PASIEN PINDAH/PULANG

    Nama Pasien :……………………………………………………………………………..


    No. Medrek :……………………………………………………………………………..
    Ruangan :……………………………………………………………………………..
    Mutasi Ruangan ke :……………………………………………………………………………..
    Alasan Pulang :……………………………………………………………………………..

    D/………………………………………..
    1. Sembuh
    2. Atas permintaan sendiri
    3. Meninggal
    4. Pindah RS lain
    Tangerang,……………….20….

    Nama perawat: ………………..

    Warna Putih : Pendaftaran


    Warna Kuning : Status

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