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PEMERINTAH KABUPATEN LAHAT

RUMAH SAKIT UMUM DAERAH LAHAT


Jl Letjen Harun Sohar I No 28 Lahat, Kode Pos 31414, Provinsi Sumatera Selatan
Telp/ Fax.(0731) 321785/323080, Email : rsud_lahat@yahoo.co.id

RM. 30

LAPORAN HASIL PEMERIKSAAN USG TRIMESTER I / II / III *

Telah dilakukan pemeriksaan USG pada hari : ........................ : Tanggal : ........................

Nama : .................... Umur............ : No.RM : ........................

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

HASIL PEMERIKSAAN :

Kesan : ......................................................................................................................................

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

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

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

Kesimpulan : .....................................................................................................................................

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

Lahat, 20
Lembar : 1. rekam medis 2. administrasi klaim 3. pasien
Dokter Pemeriksa,

NB : UNTUK DICETAK NCR

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

NIP.

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