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  • SRT Rujukan Umum

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    Astri Syauqia Nawawi
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    RUJUK 1

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    Srt Rujukan Umum

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    RUJUK 1

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    3 views1 page

    SRT Rujukan Umum

    Uploaded by

    Astri Syauqia Nawawi
    RUJUK 1

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    DINAS KESEHATAN KOTA KEDIRI

    UPTD PUSKESMAS KOTA WILAYAH UTARA


    Jalan Sam Ratulangi Nomor 12  (0354) 683227 Kediri
    Email: puskesmas.kotautara@gmail.com Website: Puskesmaskotautara.wordpress.com

    Kediri, ……………………………..
    Nomor: 440/ /419.108.6/2019 K e p a d a:
    Sifat : Penting Yth. ……………………………………….
    Lamp. : --- ……………………………………….
    Hal : Rujukan …………………….. ……………………………………….

    Bersama ini kami rujuk :

    N a m a : …………………………………………………………………….
    U m u r : …….…. tahun; Jenis Kelamin : Laki-laki / Perempuan
    Nomor KTP : …………………………………………………………………….
    Dx sementara : …………………………………………………………………….
    …………………………………………………………………….
    …………………………………………………………………….
    Therapy yang sudah diberikan : …………………………………………………..
    …………………………………………………………………….
    …………………………………………………………………….

    Dokter Pengirim,

    ……………………………………..

    JAWABAN RUJUKAN
    N a m a : …………………………………………………………………….
    U m u r : …….…. tahun; Jenis Kelamin : Laki-laki / Perempuan
    Nomor JPS : …………………………………………………………………….
    Diagnosa : …………………………………………………………………….
    …………………………………………………………………….
    Saran : …………………………………………………………………….
    …………………………………………………………………….

    Dokter Penerima,

    …………………………………….

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