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  • I Ketut Darta1

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    B-28- Tila Wati
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    This document is a referral letter from PUSKESMAS MARGA II to RSUD TABANAN for further examination and treatment of a 62-year-old male patient named I KETUT DARTA with diagnoses of intracranial space-occupying lesion and essential hypertension. The referral is valid for a single visit until August 13, 2023.

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    I KETUT DARTA1 (1)

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    I KETUT DARTA1 (1)

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    This document is a referral letter from PUSKESMAS MARGA II to RSUD TABANAN for further examination and treatment of a 62-year-old male patient named I KETUT DARTA with diagnoses of intracranial space-occupying lesion and essential hypertension. The referral is valid for a single visit until August 13, 2023.

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    © All Rights Reserved
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    1 views1 page

    I Ketut Darta1

    Uploaded by

    B-28- Tila Wati
    This document is a referral letter from PUSKESMAS MARGA II to RSUD TABANAN for further examination and treatment of a 62-year-old male patient named I KETUT DARTA with diagnoses of intracranial space-occupying lesion and essential hypertension. The referral is valid for a single visit until August 13, 2023.

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    © All Rights Reserved
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    of 1

    Kedeputian Wilayah KEDEPUTIAN WILAYAH XI

    Kantor Cabang DENPASAR

    Surat Rujukan FKTP

    No. Rujukan : 220206020523P000692

    *220206020523P000692*
    FKTP : PUSKESMAS MARGA II(22020602)
    Kabupaten / Kota :
    KAB. TABANAN(0226)

    Kepada Yth. TS Dokter : SARAF

    Di : RSUD TABANAN

    Mohon pemeriksaan dan penangan lebih lanjut pasien :

    Nama : I KETUT DARTA Umur : 62 Tahun : 23-Dec-1960

    No. Kartu BPJS : 0003131718849 Utama/Tanggunan


    Status : 1 L (L / P)
    Diagnosa : Intracranial space-occupying lesion (R90.0),
    Essential (primary) hypertension (I10)
    Catatan :

    Telah diberikan :

    Atas bantuannya, diucapkan terima kasih Salam sejawat,


    16 May 2023

    Tgl. Rencana Berkunjung : 16-May-2023

    Jadwal Praktek : Selasa : 07:30 - 14:00, 07:30 - 14:00


    dr. I GST KETUT HADI SURYANTO
    Surat rujukan berlaku 1[satu] kali kunjungan, berlaku sampai dengan : 13-Aug-2023

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