RUMAH SAKIT UMUM DAERAH SOLOK RUMAH SAKIT UMUM DAERAH SOLOK

INSTALASI LABORATORIUM PATOLOGI ANATOMIK INSTALASI LABORATORIUM PATOLOGI ANATOMIK

Jl. Simp Rumbio, Kota Solok. Jl. Simp Rumbio, Kota Solok.

Form Pengirim Sampel Form Pengirim Sampel

Nama :....................................................... Nama :.......................................................

Umur :....................................................... Umur :.......................................................

Tgl Pengiriman :....................................................... Tgl Pengiriman :.......................................................

RS Pengirim :....................................................... RS Pengirim :.......................................................

Dr. PA Pengirim :....................................................... Dr. PA Pengirim :.......................................................

Jenis Sampel :....................................................... Jenis Sampel :.......................................................

Jumlah Blok :....................................................... Jumlah Blok :.......................................................

No Sediaan :...................................................... No Sediaan :......................................................

Petugas Labor Petugas Labor

RUMAH SAKIT UMUM DAERAH SOLOK RUMAH SAKIT UMUM DAERAH SOLOK

INSTALASI LABORATORIUM PATOLOGI ANATOMIK INSTALASI LABORATORIUM PATOLOGI ANATOMIK

Jl. Simp Rumbio, Kota Solok. Jl. Simp Rumbio, Kota Solok.

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

Form Pengirim Sampel Form Pengirim Sampel

Nama :....................................................... Nama :.......................................................

Umur :....................................................... Umur :.......................................................

Tgl Pengiriman :....................................................... Tgl Pengiriman :.......................................................

RS Pengirim :....................................................... RS Pengirim :.......................................................

Dr. PA Pengirim :....................................................... Dr. PA Pengirim :.......................................................

Jenis Sampel :....................................................... Jenis Sampel :.......................................................

Jumlah Blok :....................................................... Jumlah Blok :.......................................................

No Sediaan :...................................................... No Sediaan :......................................................

Petugas Labor Petugas Labor

dr. Santy Saberko, M. Biomed, Sp. PA
NIP. 19770908 200701 2 008