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    kop surat

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    3 views1 page

    AMicrosoft Word

    Uploaded by

    chairul
    kop surat

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    PEMERINTAH KOTA BINJAI

    RUMAH SAKIT UMUM DAERAH Dr. RM. DJOELHAM


    ( AKREDITASI DEP. KES. RI NO : YM.01.10/III/3139/09 TGL 13 AGUSTUS 2009 )
    Jl. Sultan Hasanuddin No. 9
    Telp. 061 – 8821372 Faks 061 – 8830461 Kode Pos 20713
    BINJAI

    PERMINTAAN PEMERIKSAAN RADIOLOGI

    Nama : Ruangan :
    Tangga lahir/ Umur : SEP :
    Kelamin : No.KTP/BPJS :
    No.CM : Pengirim :
    Pemeriksaan : CT-SCAN Kepala Tanggal pemeriksaan :

    TS Yth,

    Hasil Pemeriksaan Ct.Scan Kepala irisan Axial sejajar OM Line tanpa Kontras :

    Salam Sejawat

    Dr Juliamor Sinulingga Sp Rad

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