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    Puskesmas Kec. Margadana Puskesmas Kec. Margadana

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    Amindzaki Amindzaki
    The document is a request form from Puskesmas Kecamatan Margadana's clinical laboratory for BPJS ProLANIS patient examinations. It requests testing of fasting glucose and 2-hour postprandial glucose for an unnamed patient and thanks the reader in advance for their assistance. The form displays the name, address, and certification information for Puskesmas Kecamatan Margadana.

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    Puskesmas Kec. Margadana Puskesmas Kec. Margadana

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    Amindzaki Amindzaki
    8 views2 pages
    The document is a request form from Puskesmas Kecamatan Margadana's clinical laboratory for BPJS ProLANIS patient examinations. It requests testing of fasting glucose and 2-hour postprandial glucose for an unnamed patient and thanks the reader in advance for their assistance. The form displays the name, address, and certification information for Puskesmas Kecamatan Margadana.

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    Form Prolanis

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    The document is a request form from Puskesmas Kecamatan Margadana's clinical laboratory for BPJS ProLANIS patient examinations. It requests testing of fasting glucose and 2-hour postprandial glucose for an unnamed patient and thanks the reader in advance for their assistance. The form displays the name, address, and certification information for Puskesmas Kecamatan Margadana.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    8 views2 pages

    Puskesmas Kec. Margadana Puskesmas Kec. Margadana

    Uploaded by

    Amindzaki Amindzaki
    The document is a request form from Puskesmas Kecamatan Margadana's clinical laboratory for BPJS ProLANIS patient examinations. It requests testing of fasting glucose and 2-hour postprandial glucose for an unnamed patient and thanks the reader in advance for their assistance. The form displays the name, address, and certification information for Puskesmas Kecamatan Margadana.

    Copyright:

    © All Rights Reserved
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    PEMERINTAH KOTA TEGAL TM

    PEMERINTAH KOTA TEGAL TM

    SAI GLOBAL

    SAI GLOBAL
    Certified System

    Certified System
    DINAS KESEHATAN DINAS KESEHATAN
    PUSKESMAS KEC. MARGADANA ISO 9001 : 2008
    PUSKESMAS KEC. MARGADANA ISO 9001 : 2008

    Jln. Dr. Cipto Mangunkusumo Tegal. Telpon/Fax.(0238) 358604 KAN


    Komite Akreditasi Nasional
    Jln. Dr. Cipto Mangunkusumo Tegal. Telpon/Fax.(0238) 358604 KAN
    Komite Akreditasi Nasional

    Website : www.puskesmas-margadana.com. Website : www.puskesmas-margadana.com.


    Certification Body for Quality System Certification Body for Quality System
    LSSM - 009 - IDN LSSM - 009 - IDN

    PERMINTAN PEMERIKSAAN LABORATORIUM KLINIK PERMINTAN PEMERIKSAAN LABORATORIUM KLINIK


    (BPJS PROLANIS) (BPJS PROLANIS)

    Nama Penderita : Nama Penderita :


    Umur : Umur :
    Jenis Kelamin : L/P Jenis Kelamin : L/P
    Alamat : Alamat :

    JENIS PEMERIKSAAN JENIS PEMERIKSAAN


     Glukosa Puasa *  Glukosa Puasa *

     Glukosa 2 jam PP  Glukosa 2 jam PP

    Demikian atas bantuannya, kami ucapkan terimakasih. Demikian atas bantuannya, kami ucapkan terimakasih.

    Dokter Pemeriksa Dokter Pemeriksa

    Dr. Inka Roekmiasri Dr. Inka Roekmiasri

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