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FORM PENARIKAN ALAT MEDIK

( RE CALL )

NAMA ALAT : …………………………………………………………….


MERK : …………………………………………………………….
TIPE : ……………………………………………………………
NO SERI : ……………………………………………………………
TAHUN PEROLEHAN : ……………………………………………………………
PEMILIK ALAT : ……………………………………………………………
REKANAN : ……………………………………………………………
DISTRIBUTOR : ……………………………………………………………
TANGGAL : ……………………………………………………………

HASIL TELAAH TEKNISI IPSRS

REKOMENDASI DISTRIBUTOR

TEKNISI IPSAM DISTRIBUTOR

……………………….. ……………………………………

[PANDUAN RECALL] IPS Alat Medik

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