Form Usulan Obat Baru
Form Usulan Obat Baru
KSM :
Mohon untuk disediakan di Instalasi Farnasi Rumah Sakit Permata Hati sediaan obat
Nama Obat :
Kandungan :
Kekuatan :
Bentuk Sediaan : Injeksi / Tablet / Kapsul / Syrup / Infus
Alasan dan pertimbangan
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Duri, ………
Dokter Pemohon
(……………………………)