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  • Heru Purwantoo

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    Jehan Iskandar
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    This medical referral letter refers Heru Purwanto, a 55-year-old male patient, to a cardiologist for further examination and treatment. The patient has been diagnosed with hypertensive heart disease without congestive heart failure. The referring doctor, Dr. Konita, provided some treatment and is requesting the cardiologist's assistance. The referral is valid for one visit until November 16, 2023.

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    This medical referral letter refers Heru Purwanto, a 55-year-old male patient, to a cardiologist for further examination and treatment. The patient has been diagnosed with hypertensive heart disease without congestive heart failure. The referring doctor, Dr. Konita, provided some treatment and is requesting the cardiologist's assistance. The referral is valid for one visit until November 16, 2023.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    10 views1 page

    Heru Purwantoo

    Uploaded by

    Jehan Iskandar
    This medical referral letter refers Heru Purwanto, a 55-year-old male patient, to a cardiologist for further examination and treatment. The patient has been diagnosed with hypertensive heart disease without congestive heart failure. The referring doctor, Dr. Konita, provided some treatment and is requesting the cardiologist's assistance. The referral is valid for one visit until November 16, 2023.

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    of 1

    Kedeputian Wilayah KEDEPUTIAN WILAYAH VI

    Kantor Cabang PEKALONGAN

    Surat Rujukan FKTP

    No. Rujukan : 0167U0510823P000554

    *0167U0510823P000554*
    FKTP : dr. Konita(0167U051)

    Kabupaten / Kota :
    KAB. PEMALANG(0167)

    Kepada Yth. TS Dokter : JANTUNG DAN PEMBULUH DARAH

    Di : RS SITI KHODIJAH

    Mohon pemeriksaan dan penangan lebih lanjut pasien :

    Nama : HERU PURWANTO Umur : 55 Tahun : 11-Sep-1967

    No. Kartu BPJS : 0002242002407 Utama/Tanggunan


    Status : 2 L (L / P)
    Diagnosa : Hypertensive heart disease without
    (congestive) heart failure (I11.9)
    Catatan :

    Telah diberikan :

    Atas bantuannya, diucapkan terima kasih Salam sejawat,


    19 August 2023
    Tgl. Rencana Berkunjung : 21-Aug-2023

    Jadwal Praktek : Senin : 14:00 - 21:00


    dr. Konita
    Surat rujukan berlaku 1[satu] kali kunjungan, berlaku sampai dengan : 16-Nov-2023

    SURAT RUJUKAN BALIK

    Teman sejawat Yth.


    Mohon kontrol selanjutnya penderita :

    Nama : HERU PURWANTO

    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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