Kartu Rawat Jalan

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KARTU RAWAT JALAN

NAMA : ..........................................................................................................
TGL. LAHIR : ..........................................................................................................
ALAMAT : ..........................................................................................................
NO. KIS / KK : ..........................................................................................................

UMUR UMUR
TGL DIAGNOSA PENGOBATAN TGL DIAGNOSA PENGOBATAN
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KARTU RAWAT JALAN

UMUR UMUR
TGL DIAGNOSA PENGOBATAN TGL DIAGNOSA PENGOBATAN
BB BB

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