Surat+Pengantar+ke+poliklinik
1
UNIVERSITAS AIRLANGGA RUMAH SAKIT Kampus C Mulyorejo Surabaya 60115, Telp. 031-5916291, fax. 031-5916291 Email: [email protected], website: www.rumahsakit.unair.ac.id KONTROL KE POLI :............................................ TANGGAL :............................................ SURAT PENGANTAR BEROBAT KE POLIKLINIK Kepada Yth : Dokter poliklinik.......................... RS Universitas Airlangga Di tempat Menghadapkan pasien atas nama :................................................umur :............................. L/P Alamat :.......................................................................................................................................... Datang ke URD/URI hari :............................tanggal :.................................................................... Dengan keluhan...................................................diagnosa di UGD/URI :..................................... Telah diberikan terapi :.................................................................................................................. ......................................................................................................................... Mohon tindak lanjut penanganan terhadap pasien tersebut. Sekian terima kasih. Surabaya, …………………….. Dokter (..........................................................) Catatan : Semua hasil pemeriksaan LABORAT/ FOTO RONTGEN harap dibawa saat kontrol.
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Transcript of Surat+Pengantar+ke+poliklinik
UNIVERSITAS AIRLANGGA RUMAH SAKIT
Kampus C Mulyorejo Surabaya 60115, Telp. 031-5916291, fax. 031-5916291 Email: [email protected], website: www.rumahsakit.unair.ac.id
KONTROL KE POLI :............................................ TANGGAL :............................................
SURAT PENGANTAR BEROBAT KE POLIKLINIK
Kepada Yth :
Dokter poliklinik..........................
RS Universitas Airlangga
Di tempat
Menghadapkan pasien atas nama :................................................umur :............................. L/P
Alamat :..........................................................................................................................................
Datang ke URD/URI hari :............................tanggal :....................................................................
Dengan keluhan...................................................diagnosa di UGD/URI :.....................................
Telah diberikan terapi :..................................................................................................................
.........................................................................................................................
Mohon tindak lanjut penanganan terhadap pasien tersebut. Sekian terima kasih.
Surabaya, ……………………..
Dokter
(..........................................................)
Catatan :
Semua hasil pemeriksaan LABORAT/ FOTO RONTGEN harap dibawa saat kontrol.
