Scribd Logo
Upload

Welcome to Scribd!

  • Hamida

    Uploaded by

    AGUS
    5 views1 page
    ff

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    ff

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views1 page

    Hamida

    Uploaded by

    AGUS
    ff

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Divisi Regional REGIONAL VII - SURABAYA

    Kantor Cabang PAMEKASAN

    Rujukan Puskesmas / Dokter Keluarga


    SURAT RUJUKAN PESERTA

    No. Rujukan : 133621010716Y000011


    Puskesmas/Dokter Keluarga : GAYAM Kode : 13362101
    Kabupaten/Kota : KAB. SUMENEP Kode : 0209

    Kepada Yth. TS dr. Poli : Poli Penyakit Jiwa

    Di RSU : RSUD SUMENEP

    Mohon pemeriksaan dan penanganan lebih lanjut penderita :

    Nama : HAMIDAH Umur : 50 Tahun 13-Apr-1966

    No. Kartu BPJS : 0000117439413 Status : 1 Utama/ Tanggungan P (L/P)

    Diagnosa : Mental disorder, nos

    Telah diberikan :

    Demikian atas bantuannya, diucapkan banyak terima kasih


    Salam sejawat, 17 July 2016

    dr. Ita Yunia Ramadhani

    You might also like