Bukti Pelaksanaan Inform Consent 6t3s65
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PEMERINTAH KOTA SUBULUSSALAM DINAS KESEHATAN
PUSKESMAS RUNDING JL. Perjuangan Pasar Rundeng Kode Pos 24782. Email : [email protected]
BUKTI PELAKSANAAN INFORMED CONSENT
NO
TGL
NO R.M
NAMA PASIEN
DIAGNOSA
NAMA PETUGAS
NAMA PENERIMA INF.KON
HUBUNGAN DGN PASIEN
KETERANGA N
TTD
PUSKESMAS RUNDING JL. Perjuangan Pasar Rundeng Kode Pos 24782. Email : [email protected]
BUKTI PELAKSANAAN INFORMED CONSENT
NO
TGL
NO R.M
NAMA PASIEN
DIAGNOSA
NAMA PETUGAS
NAMA PENERIMA INF.KON
HUBUNGAN DGN PASIEN
KETERANGA N
TTD
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