RSUD JOMBANG
UNIT KERJA
................
PERMINTAAN
NO.URUT
..........................
TANGGAL
..........................
JAM
..........................
NO. REG ALAT
..........................
KELUHAN
TINDAKAN
KETERANGAN
PETUGAS SIM
WAKTU
TANGGAL MULAI
..................................
JAM
..................................
TANGGAL SELESAI
...................................
JAM SELESAI
....................................
PETUGAS
KEPALA UNIT
RUANGAN
.............................
.....
..............................
....
LEMBAR PERBAIKAN SIM
RSUD JOMBANG
UNIT KERJA
................
(DJOKO
TRILAKSONO)
PERMINTAAN
NO.URUT
..........................
TANGGAL
..........................
JAM
..........................
NO. REG ALAT
..........................
KELUHAN
TINDAKAN
KETERANGAN
WAKTU
TANGGAL MULAI
..................................
JAM
..................................
TANGGAL SELESAI
...................................
JAM SELESAI
....................................
PETUGAS SIM
PETUGAS
RUANGAN
.............................
.....
KEPALA UNIT
..............................
....
LEMBAR PERBAIKAN SIM
RSUD JOMBANG
UNIT KERJA
................
(DJOKO
TRILAKSONO)
PERMINTAAN
NO.URUT
..........................
TANGGAL
..........................
JAM
..........................
NO. REG ALAT
..........................
KELUHAN
TINDAKAN
KETERANGAN
PETUGAS SIM
WAKTU
TANGGAL MULAI
..................................
JAM
..................................
TANGGAL SELESAI
...................................
JAM SELESAI
....................................
PETUGAS
KEPALA UNIT
RUANGAN
.............................
.....
(DJOKO
..............................
TRILAKSONO)
....
LEMBAR PERBAIKAN SIM
RSUD JOMBANG
UNIT KERJA
................
PERMINTAAN
NO.URUT
..........................
TANGGAL
..........................
JAM
..........................
NO. REG ALAT
..........................
KELUHAN
TINDAKAN
KETERANGAN
PETUGAS SIM
.............................
.....
WAKTU
TANGGAL MULAI
..................................
JAM
..................................
TANGGAL SELESAI
...................................
JAM SELESAI
....................................
PETUGAS
KEPALA UNIT
RUANGAN
..............................
....
(DJOKO
TRILAKSONO)