*132207010323P002855*
FKTP : DAWAR BLANDONG(13220701)
Kabupaten / Kota :
KAB. MOJOKERTO(0196)
Di : RS GATOEL
Telah diberikan :
Jadwal Praktek :
Dr. BRAMA SYUKRI PERKASA
Surat rujukan berlaku 1[satu] kali kunjungan, berlaku sampai dengan : 13-Jun-2023
Nama : SUPARAH
Diagnosa : .....................................................................................................................................
Terapi : .....................................................................................................................................
Dokter RS,
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