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PT.

EL-HAKIM
Rumah Sakit Khusus Bedah
Rawamangun
Terpercaya dan selalu ada dihati

FORM SKRINING DILUAR RS/ via TELEPHON

Tanggal

Jam terima telepon

Nama yang menelphon

No telepon

Nama pasien

Usia pasien

keluhan

pembiayaan

Tindak lanjut IGD ( ), POLIKLINIK ( ), TELEMEDICINE ( )

Petugas

(Nama Jelas )

Jl. Balai Pustaka Raya No. 29 – 31 , Rawamangun – Jakarta Timur 13220

Telp. 021-4893531 Fax. 021-4710918, E-mail: rs.rawamangun@gmail.com

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