BON PEMESANAN MAKANAN PASIEN PAGI / SIANG / SORE

Pemesan : Tgl :

No Kelas Kamar / Nama Px Nomer Diit Paraf

Bed Rekam Medik Perawat
1. VVIP / Tulip Ny.
2. VIP / Alamanda 1 Ny.
2 Ny.
3 Ny.
4 Ny.
3. Kls 1 / Lily 1 1.1 Ny.
1.2 Ny.
4. Kls 1 / Lily 2 2.1 Ny.
2.2 Ny.
5. Kls 1 / Lily 3 3.1 Ny.
3.2 Ny.
6. Kls 2 / Mawar 1 1.1 Ny.
1.2 Ny.
1.3 Ny.
7. Kls 2 / Mawar 2 2.1 Ny.
2.2 Ny.
2.3 Ny.
8. Kls 3 / Anggrek 1 1.1 Ny.
1.2 Ny.
1.3 Ny.
1.4 Ny.
9. Kls 3 / Anggrek 2 2.1 Ny.
2.2 Ny.
2.3 Ny.
2.4 Ny.

Paraf Staf Gizi Paraf Perawat

BON PEMESANAN MAKANAN PASIEN PAGI / SIANG / SORE

Pemesan : Tgl :

No Kelas Kamar / Nama Px Nomer Diit Paraf

Bed Rekam Medik Perawat
1. VVIP / Tulip Ny.
2. VIP / Alamanda 1 Ny.
2 Ny.
3 Ny.
4 Ny.
3. Kls 1 / Lily 1 1.1 Ny.
1.2 Ny.
4. Kls 1 / Lily 2 2.1 Ny.
2.2 Ny.
5. Kls 1 / Lily 3 3.1 Ny.
3.2 Ny.
6. Kls 2 / Mawar 1 1.1 Ny.
1.2 Ny.
1.3 Ny.
7. Kls 2 / Mawar 2 2.1 Ny.
2.2 Ny.
2.3 Ny.
8. Kls 3 / Anggrek 1 1.1 Ny.
1.2 Ny.
1.3 Ny.
1.4 Ny.
9. Kls 3 / Anggrek 2 2.1 Ny.
2.2 Ny.
2.3 Ny.
2.4 Ny.

Paraf Staf Gizi Paraf Perawat