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  • RESEP

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    rahmawati hj
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    This document appears to be a medical form or record in another language. It contains fields for patient information like name, age, visit date, symptoms, diagnosis, treatment and includes spaces for a medical provider signature. However, most of the fields are blank and it's not clear what specific patient or visit this form is documenting.

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    This document appears to be a medical form or record in another language. It contains fields for patient information like name, age, visit date, symptoms, diagnosis, treatment and includes spaces for a medical provider signature. However, most of the fields are blank and it's not clear what specific patient or visit this form is documenting.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    4 views2 pages

    RESEP

    Uploaded by

    rahmawati hj
    This document appears to be a medical form or record in another language. It contains fields for patient information like name, age, visit date, symptoms, diagnosis, treatment and includes spaces for a medical provider signature. However, most of the fields are blank and it's not clear what specific patient or visit this form is documenting.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 2

    UPT PUS KES MAS US A KEC. PALAKKA UPT PUS KES MAS US A KEC.

    UPT PUS KES MAS US A KEC. PALAKKA UPT PUS KES MAS US A KEC. PALAKKA
    A LA MA T J A LA N POR OS MA KA S S A R - B ONE KM 11 A LA MA T J A LA N POR OS MA KA S S A R - B ONE KM 11 A LA MA T J A LA N POR OS MA KA S S A R - B ONE KM 11

    Em ail : up td p k m us a@g m ail.c om Em ail : up td p k m us a@g m ail.c om Em ail : up td p k m us a@g m ail.c om

    TGL KUNJ UNGAN : − − 2 02 2 TGL KUNJ UNGAN : − − 2 02 2 TGL KUNJ UNGAN : − − 20 22

    J AM MASUK : J AM KELUAR : J AM MASUK : J AM KELUAR : J AM MASUK : J AM KELUAR :

    NO.KARTU J KN : NO.KARTU J KN : NO.KARTU J KN :

    NO.FF : / NO.FF : / NO.FF : /

    N A MA : N A MA : N A MA :

    U MU R : Lk Pr KUNJ UNGAN : B L U MU R : Lk Pr KUNJ UNGAN : B L U MU R : Lk Pr KUNJ UNGAN : B L

    ALAMAT : ALAMAT : ALAMAT :

    TD : m m Hg S : ⁰C TD : m m Hg S : ⁰C TD : m m Hg S : ⁰C

    P : x/m N : x/m P : x/m N : x/m P : x/m N : x/m

    BB : Kg TB : Cm BB : Kg TB : Cm BB : Kg TB : Cm

    KELUHAN : KELUHAN : KELUHAN :

    D IAGNOS A : DIAGN OS A : DIAGN OS A :

    ICD X : ICD X : ICD X :

    O BAT / TIN DAK AN : OBAT / TIN DAK AN : OBAT / TIN D AK AN :

    P e t u g a s P e m e r iks a P e t u g a s P e m e riks a P e t u g a s P e m e riks a

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