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  • A mVOL7E

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    a_mVOL7E

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    8 views1 page

    A mVOL7E

    Uploaded by

    ienjang
    18

    Copyright:

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

    SURAT ELEGIBILITAS PESERTA

    RSIA BUNDA SURYATNI

    No.SEP : 0133R0260418V000766
    Tgl.SEP : 2018-04-27 Peserta : PNS PUSAT
    No.Kartu : 0002450777095 ( MR. 021808 ) COB :-
    Nama Peserta : bayi ny MARYANY Jns.Rawat : R.Jalan
    Tgl.Lahir : 2018-04-17 Kelamin : Laki-Laki Kls.Rawat :-
    No.Telepon : 087770578328 Penjamin :
    Poli Tujuan : Poli Anak
    Faskes Perujuk : KEMUNING
    Diagnosa Awal : Z09.8 - Follow-up examination after other tre
    Catatan :
    Pasien/Keluarga Pasien
    *Saya menyetujui BPJS Kesehatan menggunakan infomasi medis pasien jika diperlukan.
    SEP Bukan sebagai bukti penjaminan peserta. ________________
    Cetakan ke 1 27-04-2018 08:44:20 wib

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