KARTU RAWAT JALAN (Dr. Helmy)

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KARTU RAWAT JALAN (PATIENT CARD)

Nama/Name : .......................................... Index/Number : .............................................


Nama KK/Name of Father : .......................................... Umur/Age : .............................................
Pekerjaan/Job : .......................................... Agama/Religion : .............................................
Alamat/Adress : ..........................................

ANAMNESA DIAGNOSA THERAPI PARAF


NO
(History of Disease) (Diagnose) (Medical Theurapy) (Signature)

We Care Yout Health

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