Format Kartu Berobat

PEMERINTAH KABUPATEN MANDAILING NATAL
DINAS KESEHATAN
UPT PUSKESMAS SIBANGGOR PEMERINTAH KABUPATEN MANDAILING NATAL
JL.LINTAS SIBANGGOR KODE POS 22952 DINAS KESEHATAN
HP : 085261408467 Email : puskessibanggor@gmail.com UPT PUSKESMAS SIBANGGOR
____________________________________________________________________________________________ JL.LINTAS SIBANGGOR KODE POS 22952
KARTU BEROBAT HP : 085261408467 Email : puskessibanggor@gmail.com
____________________________________________________________________________________________
No. Kartu :................... KARTU BEROBAT
Nama Pasien : ................................................................... No. Kartu :.....................
Umur : ................................................................... Nama Pasien : ...................................................................
Alamat : ................................................................... Umur : ...................................................................
No. NIK : ................................................................... Alamat : ...................................................................
No. BPJS : ................................................................... No. NIK : ...................................................................
No. BPJS : ...................................................................
Kartu Ini Harap Dibawa Setiap Datang Berobat
DINAS KESEHATAN
____________________________________________________________________________________________
No. Kartu :..................... KARTU BEROBAT
Umur : ................................................................... Nama Pasien : ...................................................................
Alamat : ................................................................... Umur : ...................................................................
No. NIK : ................................................................... Alamat : ...................................................................
No. BPJS : ................................................................... No. NIK : ...................................................................
No. BPJS : ...................................................................
DINAS KESEHATAN
____________________________________________________________________________________________
Umur : ................................................................... Nama Pasien : ...................................................................
Alamat : ................................................................... Umur : ...................................................................
No. NIK : ................................................................... Alamat : ...................................................................
No. BPJS : ................................................................... No. NIK : ...................................................................
No. BPJS : ...................................................................
DINAS KESEHATAN
____________________________________________________________________________________________
Umur : ................................................................... Nama Pasien : ...................................................................
Alamat : ................................................................... Umur : ...................................................................
No. NIK : ................................................................... Alamat : ...................................................................
No. BPJS : ................................................................... No. NIK : ...................................................................
No. BPJS : ...................................................................
DINAS KESEHATAN
____________________________________________________________________________________________
Umur : ................................................................... Nama Pasien : ...................................................................
Alamat : ................................................................... Umur : ...................................................................
No. NIK : ................................................................... Alamat : ...................................................................
No. BPJS : ................................................................... No. NIK : ...................................................................
No. BPJS : ...................................................................

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