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    4 views1 page

    Form Rujukan

    Uploaded by

    ali rahmat

    Copyright:

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

    PEMERINTAH KOTA BAUBAU

    RUMAH SAKIT UMUM DAERAH


    Jl.Drs.H.La Ode Manarfa No.- Tlp.(0402)2825356 Fax.(0402)2825357
    Email : rsudkotabaubau@gmail.com

    FORMULIR PERMINTAAN RUJUKAN PEMERIKSAAN LABORATORIUM

    Nama pasien : Nomor RM :

    Umur : Jenis spesimen :


    Jenis kelamin : Tgl pengambilan :
    Alamat :

    Manalu,....................................2017

    Baubau,....................

    Dokter / Pengirim

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