RUMAH SAKIT IBU DAN ANAK RUMAH SAKIT IBU DAN ANAK

MUKTI HUSADA MUKTI HUSADA RM 08 K

Jl Kabupaten 68 Pamekasan kode RM 08 K Jl Kabupaten 68 Pamekasan kode
p o s ( 6 9 3 1 6 ) HP 082337919788 p o s ( 6 9 3 1 6 ) HP 082337919788
Email husada.mukti@gmail.com Email husada.mukti@gmail.com

SURAT PENGANTAR OPERASI

SURAT PENGANTAR OPERASI

Menerangkan bahwa :
Menerangkan bahwa :
Nama : …...................................................... L/P: …….………………………
Nama : ………………………………………………………. L/P: …………………
Tgl lahir : .........................................................................................
Tgl lahir : .........................................................................................
No. RM : ………………………………………………………………………………
No. RM : …………………………………………………………………………………
Diagnosa : .........................................................................................
Diagnosa : .........................................................................................
Rencana Tindakan : ………………………………………………………………………………
Rencana Tindakan : ………………………………………………………………………………
Tgl Operasi : .........................................................................................
Tgl Operasi : .........................................................................................
Tgl MRS : .........................................................................................
Tgl MRS : .........................................................................................
Pesanan Operasi : .........................................................................................
Pesanan Operasi : .........................................................................................
(Pemeriksaan .........................................................................................
(Pemeriksaan .........................................................................................
Pre op,alat,dll) .........................................................................................
Pre op, alat, dll) .........................................................................................
.........................................................................................
...........................................................................................
Pamekasan, …………………………………. 20 …………
Pamekasan,………………………………. 20 …………

( …………………………………….)
( …………………………………….)