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  • Izin Praktek

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    Habi Handala Putra, a specialist doctor, is submitting a request for leave (non-practice) from January 1, 1970 to January 1, 1970. He is requesting to be contacted by phone for inpatient consultations and to delegate inpatient visits during his leave. The request must be submitted to the Medical Services Manager through a nurse or midwife at least 1 week before the requested leave dates, except for urgent unpostponable matters.

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    Habi Handala Putra, a specialist doctor, is submitting a request for leave (non-practice) from January 1, 1970 to January 1, 1970. He is requesting to be contacted by phone for inpatient consultations and to delegate inpatient visits during his leave. The request must be submitted to the Medical Services Manager through a nurse or midwife at least 1 week before the requested leave dates, except for urgent unpostponable matters.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    3 views7 pages

    Izin Praktek

    Uploaded by

    inforskiasawojajar
    Habi Handala Putra, a specialist doctor, is submitting a request for leave (non-practice) from January 1, 1970 to January 1, 1970. He is requesting to be contacted by phone for inpatient consultations and to delegate inpatient visits during his leave. The request must be submitted to the Medical Services Manager through a nurse or midwife at least 1 week before the requested leave dates, except for urgent unpostponable matters.

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    of 7

    PERMOHONAN IJIN (TIDAK PRAKTEK)

    DOKTER SPESIALIS

    Kepada
    Yth. Manajer Pelayanan Medis
    di RS Melania

    Bersama ini saya :


    Nama : Habi Handala Putra
    Spesialis :-
    mengajukan permohonan ijin (tidak praktek) pada tanggal

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    01/01/1970 s/d

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    01/01/1970
    dengan alasan -
    Adapun untuk jadwal praktek di poliklinik (harap lingkari salah satu)

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    1. Ditiadakan

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    2. Digantikan Oleh

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    Untuk konsul pasien rawat inap (harap lingkari salah satu)


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    1. Dapat dihubungi melalui telepon / handphone

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    2. Dialihkan kepada

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    Untuk visite pasien rawat inap (harap lingkari salah satu)


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    2. Dititip visite kepada

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    Pemohon

    ( Habi Handala Putra )


    Tanda Tangan dan Nama Jelas
    NB :
    - Dokter yang ijin (tidak praktek) memastikan bahwa Dokter pengganti bersedia untuk menggantikan selama
    Dokter yang bersangkutan ijin (tidak praktek)
    - Dokter pengganti harus memiliki SIP
    - Formulir ijin (tidak praktek) diserahkan ke Manajer Pelayanan Medis melalui perawat / bidan
    - Pengajuan permohonan ijin (tidak praktek) paling lambat 1 minggu sebelum tanggal ijin, kecuali untuk keperluan
    mendadak yang tidak dapat ditunda

    MEL.IV.A.007(Rev02)

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