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Cheklist Dokumen dan Serah Terima

Cheklist Dokumen dan Serah Terima

Cheklist Dokumen dan Serah Terima

Pasien Umum

Pasien BPJS

Pasien Jamkesda

Nama Pasien :...........................................


No CM

:...........................................

Alamat

:...........................................

Diagnosa

:...........................................

Nama Pasien :...........................................

Nama Pasien :...........................................

No CM

:...........................................

No CM

:...........................................

Alamat

:...........................................

Alamat

:...........................................

Diagnosa

:...........................................

Diagnosa

:...........................................

Kelengkapan :

Kelengkapan :

Kelengkapan :

Sudah

Sudah

Belum

Belum

Terapi
SEP
SKD
Emergency
Kartu BPJS

Terapi
SEP
SKD
Emergency
Kartu Jamkesda

Keterangan Lain lain :..................................

( R.2 )
KTP ( R.2 )
KK ( R.2 )
Keterangan Lain lain :.................................

...........................................................................

/ SKTM ( R.2 )
KTP ( R.2 )
KK ( R.2 )
SJP Kabupaten
Keterangan Lain lain :.................................

...........................................................................

...........................................................................

Perawat IGD/Poli

Sudah

Belum

Terapi

..........................................................................
Perawat IGD/Poli

Perawat Zall...............

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

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

............................................................................

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

Perawat Zall...............
Perawat IGD/Poli

Perawat Zall...............

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

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

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

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