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RESEP OBAT PASIEN RAWAT JALAN RESEP OBAT PASIEN RAWAT JALAN

RUMAH SAKIT ISLAM KENDAL RUMAH SAKIT ISLAM KENDAL


(KENDAL ISLAMIC HOSPITAL) (KENDAL ISLAMIC HOSPITAL)
Jl. Ar Rahmah No. 17 Weleri - Kendal Telp. (0294) 642870 Fax. (0294) 644150 Jl. Ar Rahmah No. 17 Weleri - Kendal Telp. (0294) 642870 Fax. (0294) 644150
Email : rsimuhkendal@yahoo.co.id Web. : www.rsimuhkendal.com Email : rsimuhkendal@yahoo.co.id Web. : www.rsimuhkendal.com

Kendal, .....................20.... Kendal, .....................20....


Ruang/Klinik : .... …………………………………………………………………………. Ruang/Klinik : ....………………………………………………………………………….
Dokter : ..... ………………………………………………………………………… Dokter : ....………………………………………………………………………….
Diagnosa : ..... ………………………………………………………………………… Diagnosa : ....………………………………………………………………………….
Alergi : Tidak Ya, nama obat : 1. . ……………………………………… Alergi : Tidak Ya, nama obat : 1. ................……………………………
2. . ……………………………………… 2. .............................................. ……..

R/ R/

Pro : ...................................... Tgl/Lahir/Umur : ........................................ Pro : ...................................... Tgl/Lahir/Umur : ........................................


No. RM : ...................................... Berat Badan : ........................................ No. RM : ...................................... Berat Badan : ........................................
Alamat : ................................................................................................................... Alamat : ...................................................................................................................
No. Telp. : ................................................................................................................... No. Telp. : ...................................................................................................................

PARAF PARAF
SERAH & SERAH &
KEGIATAN TERIMA PENGKAJIAN ETIKET PENYIAPAN KOREKSI PENERIMA KEGIATAN TERIMA PENGKAJIAN ETIKET PENYIAPAN KOREKSI PENERIMA
EDUKASI EDUKASI
OBAT OBAT

JAM JAM

PETUGAS PETUGAS

Resep ini hanya berlaku di lingkungan RSI Kendal Resep ini hanya berlaku di lingkungan RSI Kendal
RMJ.RO RMJ.RO

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