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Permintaan Laboratorium
Permintaan Laboratorium
MIKROBIOLOGI MIKROBIOLOGI
Preparat BTA Preparat BTA
Sputum SPS Sputum SPS
....................................... .......................................
NIP. ............................... NIP. ...............................
PEMERINTAH KABUPATEN INDRAMAYU
DINAS KESEHATAN
UPTD PUSKESMAS KROYA
Jl. PU Kroya No.50 Kecamatan Kroya
PERMINTAAN PEMERIKSAAN
Nama : ....................................................
Umur : ....................................................
Alamat : ....................................................
unit Pengirim : ....................................................
No. BPJS : ....................................................
MIKROBIOLOGI
Preparat BTA
Sputum SPS
Kroya, ..........................2020
Poli .................................
.......................................
NIP. ...............................
PEMERINTAH KABUPATEN INDRAMAYU
DINAS KESEHATAN
UPTD PUSKESMAS KROYA
Jl. PU Kroya No.50 Kecamatan Kroya
PERMINTAAN PEMERIKSAAN
Nama : ....................................................
Umur : ....................................................
Alamat : ....................................................
unit Pengirim : ....................................................
No. BPJS : ....................................................
MIKROBIOLOGI
Preparat BTA
Sputum SPS
Kroya, ..........................2020
Poli .................................
.......................................
NIP. ...............................
PEMERINTAH KABUPATEN INDRAMAYU
DINAS KESEHATAN
UPTD PUSKESMAS KROYA
Jl. PU Kroya No.50 Kecamatan Kroya
PERMINTAAN PEMERIKSAAN
Nama : ....................................................
Umur : ....................................................
Alamat : ....................................................
unit Pengirim : ....................................................
No. BPJS : ....................................................
MIKROBIOLOGI
Preparat BTA
Sputum SPS
Kroya, ..........................2020
Poli .................................
.......................................
NIP. ...............................