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NAMA FACILITY ACTIVITY

Rumah Sakit : ...............................................


Tgl Puldat : ...............................................
Enumerator : ...............................................
Tgl Validasi : ...............................................
Validator : ...............................................

Jumlah Cost Driver


No Nama Facility Activity Cost Driver
Seluruh RS Tahun 2016

dst
FORM-1.a
RINCIAN JUMLAH COST DRIVER FORM-1.b
Nama Facility Activity :.......................................
Nama Cost Driver :.......................................

Jumlah Cost Driver Tahun


No Unit/Instalasi/Ruang
2016
1
2
3
4
5
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Total

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