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BIDAN

TETI JULIATI STR.Keb

SIP.503/1949/XI/Diskes/2008

Jalan Raya Wanaraja Kp.Padasari Rt .04 Rw.07 Ds.Cinunuk Kec.Wanaraja

No. Register : / /INC/BPM/20...

Tanggal Masuk : ...............................................

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

Nama Suami :................................................

Alamat :................................................

PERINCIAN BIAYA

1. Pertolongan Persalinan Rp.....................


2. Tindakan Persalinan Rp.....................
a...............................
b. .............................
c. .............................

3. Perawatan Bayi baru lahir ( Vit K, Salp Mata Hbo) Rp.......................

4. Perawatan Paska Salin Rp........................

5. Lain – Lain Rp.........................

a. ................................... Rp. .......................

b. .................................... Rp. .......................

c. ................................... Rp. .......................

Jumlah Total Rp. .......................

Garut,...........................20.......

Bidan

Teti Juliati STR,Keb


BIDAN

TETI JULIATI STR.Keb

SIP.503/1949/XI/Diskes/2008

Jalan Raya Wanaraja Kp.Padasari Rt .04 Rw.07 Ds.Cinunuk Kec.Wanaraja

No. Register : / /INC/BPM/20...

Tanggal Masuk : ...............................................

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

Nama Suami :................................................

Alamat :................................................

PERINCIAN BIAYA

1. Pertolongan Persalinan Rp.....................


2. Tindakan Persalinan Rp.....................
a...............................
b. .............................
c. .............................

3. Perawatan Bayi baru lahir ( Vit K, Salp Mata Hbo) Rp.......................

4. Perawatan Paska Salin Rp........................

5. Lain – Lain Rp.........................

a. ................................... Rp. .......................

b. .................................... Rp. .......................

c. ................................... Rp. .......................

Jumlah Total Rp. .......................

Garut,...........................20.......

Bidan

Teti Juliati STR,Keb

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