Surat Kontrol Rawat Inap
Surat Kontrol Rawat Inap
DINAS KESEHATAN
RSUD ABUYA KANGEAN
Jl. Raya Pantai Celgung Desa Sambakati Kecamatan Arjasa
SUMENEP
Kode pos 69491
No.RM :..........................................................................
Nama Pasien :..........................................................................
Umur :..........................................................................
Jenis Kelamin :..........................................................................
Alamat :..........................................................................
Tanggal MRS :..........................................................................
Tanggal KRS :..........................................................................
Diagnosa :..........................................................................
Obat Pulang :..........................................................................
KONTROL
Tanggal :..........................................................................
Jam :..........................................................................
Kontrol Ke Poli :..........................................................................
Apabila ada keluhan sebelum tanggal control mohon segera datang ke RSUD Abuya
Kangean.
Sumenep,
Dokter Yang Memeriksa
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