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RM 2.1.

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RUMAH SAKIT
INSAN PERMATA
Jl. Bhayangkara 1 No. 68 Kel.Pakujaya, Kec. Serpong Utara – Tangerang Selatan
Telp. 021 – 53121344 Fax. 021 – 5396733
Email. Rsinsanpermata17@gmail.com

KARTU TITIP RUANGAN / KELAS


No. Rekam Medis : ......................................................

No. Kartu BPJS : ......................................................

Nama Pasien : ......................................................

Hak Kelas Pasien : ......................................................

Titip ke Kelas / Ruangan : ......................................................

Dokter Yang Merawat : ......................................................

Keterangan : ......................................................

Serpong, ..............................

Penanggung Jawab / Keluarga Petugas Pendaftaran

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