Lembar Rekam Medis

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PRAKTEK DOKTER UMUM

dr. RINA
SIP : 331815.59152/DU/03/449/092/IV/2022
Ds. Jetak 001/001 Kec. Wedarijaksa, Kab.Pati
Hp / WA : 082143306006

REKAM MEDIS PASIEN No. RM :

Nama : ……………………………………………………………………………………… L / P
TTL : ………………………………………………………………………………………
Alamat : ………………………………………………………………………………………
No.Telp / Hp : ………………………………………………………………………………………
Alergi Obat : ………………………………………………………………………………………

Tgl. S/O A P Paraf

Tgl. S/O/A P Paraf

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