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  • Surat Rujukan

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    Rina Nespia
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    5 views1 page

    Surat Rujukan

    Uploaded by

    Rina Nespia

    Copyright:

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

    SURAT RUJUKAN

    Kepada Yth,

    ……………………………………

    RS………………………………..

    Dengan hormat,

    Mohon pemeriksaan dan penatalaksanaan lebih lanjut atas pasien :

    Nama : …………………………………………….

    Umur : …………………………………………….

    Alamat : …………………………………………….

    Anamesis dan pemeriksaan :

    ………………………………………………………………………………………………………………
    ………………………………………………………………………………………………………………
    ………………………………………………………………………………………………………………

    Diagnosis sementara :

    ………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………..

    Terapi / obat yang telah diberikan :

    ………………………………………………………………………………………………………………
    ………………………………………………………………………………………………………………
    ………………………………………………………………………………………………………………

    Demikian surat rujukan ini dibuat, atas perhatiannya, kami ucapkan terima kasih.

    Sungai Buluh, …………………..20...


    Hormat kami,

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