LAPORAN OPERASI
Dokter Bedah Asisten Bedah I Asisten Bedah II
Tanggal Operasi Jam Operasi di Mulai Jam Operasi Selesai Lamanya Operasi
Keterangan :
Berilah Tanda (v) pada tanda Untuk pilihan yangs sesuai
bersih kontaminasi
Instruksi Post Operasi :
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Nama dan tandatangan Operator
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n tandatangan Operator