KOMITE MEDIK
RSUP FATMAWATI
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I. Identitas Kasus
Diagnosa Kasus :
Nama :
Umur :
Jenis Kelamin :
No RM :
III. Penatalaksanaan
IV. Kesimpulan :
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V. Saran-saran :
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Mengetahui Jakarta,................................
Komite Medik RSUP Fatmawati Sub Komite Etik dan Mutu Profesi
Ketua, Ketua,