RUJUKAN UMUM
4
PEMERINTAH KABUPATEN MEMPAWAH DINAS KESEHATAN PUSKESMAS RAWAT INAP SUNGAI PINYUH Jalan raya Seliung no 13 telp. (0561) 652006 fax..................... kecamatan Sungai Pinyuh Kode Pos 78353 Nomor : 440/ /Rujukan Sungai Pinyuh, ………………………. Kepada Yth……………………………………. …………………………………… Di – ……………………….. Dengan hormat, Bersama ini kami kirimkan seorang pasien: Nama : .................................................................. ................................... Umur : ................................................................. .................................... Jenis kelamin : .................................................................. ................................... Agama : .................................................................. ................................... Pekerjaan : .................................................................. ................................... Alamat : .................................................................. ................................... ......................................... ............................................................. Diagnosa : .................................................................. ...................................
-
Upload
alrahman-joneri -
Category
Documents
-
view
215 -
download
0
description
RUJUKAN UMUM
Transcript of RUJUKAN UMUM
PUSKESMAS
PEMERINTAH KABUPATEN MEMPAWAHDINAS KESEHATAN
PUSKESMAS RAWAT INAP SUNGAI PINYUH
Jalan raya Seliung no 13 telp. (0561) 652006 fax.....................
kecamatan Sungai Pinyuh
Kode Pos 78353
Nomor: 440/ /Rujukan
Sungai Pinyuh,.
Kepada
Yth.
Di
..
Dengan hormat,
Bersama ini kami kirimkan seorang pasien:
Nama
: .....................................................................................................
Umur
: .....................................................................................................
Jenis kelamin
: .....................................................................................................
Agama
: .....................................................................................................
Pekerjaan
: .....................................................................................................
Alamat
: .....................................................................................................
......................................................................................................
Diagnosa
: .....................................................................................................
......................................................................................................
......................................................................................................
Tindakan yang telah diberikan: .....................................................................................................
.....................................................................................................
....................................................................................................
.....................................................................................................
Keterangan
: .....................................................................................................
.....................................................................................................
......................................................................................................
Demikian atas perhatiannya kami ucapkan terima kasih.
Puskesmas Rawat Inap Sungai Pinyuh
(.......................................)
PEMERINTAH KABUPATEN MEMPAWAHDINAS KESEHATAN
PUSKESMAS RAWAT INAP SUNGAI PINYUH
Jalan raya Seliung no 13 telp. (0561) 652006 fax.....................
kecamatan Sungai Pinyuh
Kode Pos 78353
Nomor: 440/ /Rujukan
Sungai Pinyuh,.
Kepada
Yth.
Di
..
Dengan hormat,
Bersama ini kami kirimkan seorang pasien:
Nama
: .....................................................................................................
Umur
: .....................................................................................................
Jenis kelamin
: .....................................................................................................
Agama
: .....................................................................................................
Pekerjaan
: .....................................................................................................
Alamat
: .....................................................................................................
......................................................................................................
Diagnosa
: .....................................................................................................
......................................................................................................
......................................................................................................
Tindakan yang telah diberikan: .....................................................................................................
.....................................................................................................
....................................................................................................
.....................................................................................................
Keterangan
: .....................................................................................................
.....................................................................................................
......................................................................................................
Demikian atas perhatiannya kami ucapkan terima kasih.
Kepala Puskesmas Sungai Pinyuh
dr. NOVITASARI NURLAILA
NIP. 196711292005022001
