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  • Rekam

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    Gian Laksana Putra
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    © All Rights Reserved
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    5 views6 pages

    Rekam

    Uploaded by

    Gian Laksana Putra
    dok

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 6

    DINAS KESEHATAN KABUPATEN GARUT

    UPT PUSKESMAS PEMBANGUNAN


    Jalan Pembangunan No. 216 ' (0262) 231616 Kec. Tarogong Kidul – Garut
    Email : uptdpembangunan@gmail.com

    KARTU REKAM MEDIK

    NOMOR JKN / BPJS

    NAMA PASIEN : L P NAMA KK


    UMUR / TGL.LAHIR : TH BL
    ALAMAT KP. : RT
    DESA/KE : RW
    KEC. : TAROGONG KIDUL KAB :
    HUBUNGAN KELUARGA : STATUS PEKERJAAN :
    NOMOR KTP :
    ALERGI OBAT :

    PARAF
    TANGGAL ANAMNESA, PEMERIKSAAN FISIK, DIAGNOSA TERAPI EDUKASI
    PETUGAS
    PARAF
    TANGGAL ANAMNESA, PEMERIKSAAN FISIK, DIAGNOSA TERAPI EDUKASI
    PETUGAS
    AN KABUPATEN GARUT
    MAS PEMBANGUNAN
    0262) 231616 Kec. Tarogong Kidul – Garut
    pembangunan@gmail.com

    REKAM MEDIK

    PARAF
    PASIEN
    PARAF
    PASIEN
    ANAMNESA, PEMERIKSAAN FISIK, PARAF
    TANGGAL TERAPI EDUKASI
    DIAGNOSA PETUGAS PASIEN
    Catatan :
    PENULISAN IDENTITAS MEMAKAI HURUF KAPITAL

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