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  • Bahar Jalil

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    Kartika Pelango
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    This document is a referral letter from a primary care physician to a specialist requesting further examination and treatment for a patient named Bahar Jalil. The 51-year-old male patient has been diagnosed with non-insulin dependent diabetes mellitus with renal complications. The referral is valid for one visit until November 29, 2022. The specialist is asked to provide a return referral letter with recommended follow up care, medications, need for hospitalization, or need for further consultation.

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    This document is a referral letter from a primary care physician to a specialist requesting further examination and treatment for a patient named Bahar Jalil. The 51-year-old male patient has been diagnosed with non-insulin dependent diabetes mellitus with renal complications. The referral is valid for one visit until November 29, 2022. The specialist is asked to provide a return referral letter with recommended follow up care, medications, need for hospitalization, or need for further consultation.

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    © All Rights Reserved
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    6 views1 page

    Bahar Jalil

    Uploaded by

    Kartika Pelango
    This document is a referral letter from a primary care physician to a specialist requesting further examination and treatment for a patient named Bahar Jalil. The 51-year-old male patient has been diagnosed with non-insulin dependent diabetes mellitus with renal complications. The referral is valid for one visit until November 29, 2022. The specialist is asked to provide a return referral letter with recommended follow up care, medications, need for hospitalization, or need for further consultation.

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    of 1

    Kedeputian Wilayah REGIONAL IX - MAKASSAR

    Kantor Cabang KENDARI

    Surat Rujukan FKTP

    No. Rujukan : 190106020922P000002

    *190106020922P000002*
    FKTP : LAOSU(19010602)

    Kabupaten / Kota :
    KAB. KONAWE(0348)

    Kepada Yth. TS Dokter : PENYAKIT DALAM

    Di : RSUD KOTA KENDARI

    Mohon pemeriksaan dan penangan lebih lanjut pasien :

    Nama : BAHAR JALIL Umur : 51 Tahun : 28-Oct-1970

    No. Kartu BPJS : 0003287180856 Utama/Tanggunan


    Status : 2 L (L / P)
    Diagnosa : Non-insulin-dependent diabetes
    mellitus with renal complications
    Catatan :
    (E11.2)
    Telah diberikan :

    Atas bantuannya, diucapkan terima kasih Salam sejawat,


    01 September 2022
    Tgl. Rencana Berkunjung : 01-Sep-2022

    Jadwal Praktek : Kamis : 10:00 - 14:00


    dr. KARTIKA PELANGO,S.Ked
    Surat rujukan berlaku 1[satu] kali kunjungan, berlaku sampai dengan : 29-Nov-2022

    SURAT RUJUKAN BALIK

    Teman sejawat Yth.


    Mohon kontrol selanjutnya penderita :

    Nama : BAHAR JALIL

    Diagnosa : .....................................................................................................................................

    Terapi : .....................................................................................................................................

    Tindak lanjut yang dianjurkan

    Pengobatan dengan obat- obatan : Perlu rawat inap

    ................................................................................... Konsultasi selesai

    Kontrol kembali ke RS tanggal : ................................


    ................................tgl........................................
    Lain-lain : ...................................................................

    Dokter RS,

    (.....................................................)

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