BUKTI SERAH TERIMA BERKAS CM BPJS PASIEN RAWAT INAP RS.

MITRA MEDIKA BONDOWOSO

DAFTAR LIST
1. Ina CBG’s 7. Fc. ECHO 13. Fc. Lembar Rujuk Manual
2. Pernyataan Naik Kelas 8. Fc. USG 14. Lembar Ambulance Rujuk
3. Pernyataan Obat Paten 9. Surat Pengantar Rawat Inap 15. Fc. Tranfusi Darah PMI
4. Fc. Laboratorium 10. Resume Medis 16. Kardek
5. Fc.ECG 11. Lembaran Konsultasi 17.
6. Fc. Thorax 12. Laporan Operasi 18.

PENERIMA
N TGL PENYETOR PENERIMA TGL.
NAMA PASIEN NO. RM LIST SETORAN KENDALI
O. MASUK (PARAF) (PARAF) KIRIM
(PARAF)
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
 16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
16, 17, 18