RM Lembar Pemberian Obat Baru

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DINAS KESEHATAN KABUPATEN MUSI RAWAS UTARA

UPT PUSKESMAS PAUH

Jln. Raya Darat Desa Pauh 1 Kecamatan Rawas Ilir Kode Pos 31655
puskesmas.pauh@yahoo.com Puskesmas Pauh Rawas Ilir

INJEKSI
NAMA : ............................................ DX : ................................................................

ALAMAT : ............................................. DOKTER : ................................................................

............................................. RUANG : ................................................................
UMUR : ............................................ No RM : ……………………………………………
JENIS KELAMIN: L / P

TGL : ............................................................. TGL : .............................................................

INJEKSI PAGI SORE MALAM PAGI SORE MALAM
JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET

TGL : ............................................................. TGL : .............................................................

INJEKSI PAGI SORE MALAM PAGI SORE MALAM
JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET
DINAS KESEHATAN KABUPATEN MUSI RAWAS UTARA
UPT PUSKESMAS PAUH
Jln. Raya Darat Desa Pauh 1 Kecamatan Rawas Ilir Kode Pos 31655
puskesmas.pauh@yahoo.com Puskesmas Pauh Rawas Ilir

ORAL
NAMA : ............................................ DX : ................................................................

ALAMAT : ............................................. DOKTER : ................................................................

TGL : ............................................................. TGL : .............................................................

ORAL PAGI SORE MALAM PAGI SORE MALAM
JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET

TGL : ............................................................. TGL : .............................................................

ORAL PAGI SORE MALAM PAGI SORE MALAM
JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET JAM PRF KET

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