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  • 01 - Registrasi - Rawat Jalan

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    Namichan17
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    This document contains a registration form for outpatient care at RSU Manado Medical Center in Manado, Indonesia. The form includes fields for patient name, date of birth, age, gender, address, chief complaint, attending physician, consultation details, diagnosis, fees for consultation, treatment, injections, medical certificates, totals, and verification signatures.

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    01 - Registrasi - Rawat Jalan

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    This document contains a registration form for outpatient care at RSU Manado Medical Center in Manado, Indonesia. The form includes fields for patient name, date of birth, age, gender, address, chief complaint, attending physician, consultation details, diagnosis, fees for consultation, treatment, injections, medical certificates, totals, and verification signatures.

    Direitos autorais:

    © All Rights Reserved
    Baixe no formato PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    6 visualizações1 página

    01 - Registrasi - Rawat Jalan

    Enviado por

    Namichan17
    This document contains a registration form for outpatient care at RSU Manado Medical Center in Manado, Indonesia. The form includes fields for patient name, date of birth, age, gender, address, chief complaint, attending physician, consultation details, diagnosis, fees for consultation, treatment, injections, medical certificates, totals, and verification signatures.

    Direitos autorais:

    © All Rights Reserved
    Baixe no formato PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    de 1

    RSU MANADO MEDICAL CENTER RSU MANADO MEDICAL CENTER

    LIVE FOR A BETTER LIVE NO. LIVE FOR A BETTER LIVE NO.
    Jln. Rajawali No. 8 - Paal 2 - Manado Jln. Rajawali No. 8 - Paal 2 - Manado
    Phone. +62 431 862435 Phone. +62 431 862435
    REGISTRASI RAWAT JALAN REGISTRASI RAWAT JALAN
    NAMA PASIEN NAMA PASIEN
    PATIENT NAME PATIENT NAME
    TANGGAL LAHIR TANGGAL LAHIR
    DATE OF BIRTH DATE OF BIRTH
    UMUR / SEX UMUR / SEX
    AGE / GENDER AGE / GENDER
    ALAMAT ALAMAT
    ADDRESS ADDRESS
    KELUHAN UTAMA KELUHAN UTAMA
    CHIEF COMPLAINT CHIEF COMPLAINT
    DOKTER YG MERAWAT DOKTER YG MERAWAT
    ATTENDING PHYSICIAN ATTENDING PHYSICIAN
    KONSULTASI TANGGAL / DATE JAM / TIME KONSULTASI TANGGAL / DATE JAM / TIME
    CONSULTATION CONSULTATION

    DIAGNOSIS DIAGNOSIS
    BIAYA KONSULTASI BIAYA KONSULTASI
    CONSULTATION FEE CONSULTATION FEE
    JENIS TINDAKAN JENIS TINDAKAN
    TINDAKAN TYPE OF INTERVENTION
    BIAYA / COST TINDAKAN TYPE OF INTERVENTION
    BIAYA / COST
    INTERVENTION INTERVENTION

    JENIS INJEKSI JENIS INJEKSI


    INJEKSI TYPE OF INJECTION
    BIAYA / COST INJEKSI TYPE OF INJECTION
    BIAYA / COST
    INJECTION INJECTION

    SURAT KETERANGAN SURAT KETERANGAN


    MEDICAL CERTIFICATE MEDICAL CERTIFICATE

    TOTAL TOTAL
    PASIEN / PATIENT DOKTER / PHYSICIAN PASIEN / PATIENT DOKTER / PHYSICIAN

    VERIFIKASI VERIFIKASI
    VERIFICATION PERAWAT / NURSE ADMIN VERIFICATION PERAWAT / NURSE ADMIN

    FORMULIR REGISTRASI RAWAT JALAN RSU MANADO MEDICAL CENTER FORMULIR REGISTRASI RAWAT JALAN RSU MANADO MEDICAL CENTER

    RSU MANADO MEDICAL CENTER RSU MANADO MEDICAL CENTER


    LIVE FOR A BETTER LIVE NO. LIVE FOR A BETTER LIVE NO.
    Jln. Rajawali No. 8 - Paal 2 - Manado Jln. Rajawali No. 8 - Paal 2 - Manado
    Phone. +62 431 862435 Phone. +62 431 862435
    REGISTRASI RAWAT JALAN REGISTRASI RAWAT JALAN
    NAMA PASIEN NAMA PASIEN
    PATIENT NAME PATIENT NAME
    TANGGAL LAHIR TANGGAL LAHIR
    DATE OF BIRTH DATE OF BIRTH
    UMUR / SEX UMUR / SEX
    AGE / GENDER AGE / GENDER
    ALAMAT ALAMAT
    ADDRESS ADDRESS
    KELUHAN UTAMA KELUHAN UTAMA
    CHIEF COMPLAINT CHIEF COMPLAINT
    DOKTER YG MERAWAT DOKTER YG MERAWAT
    ATTENDING PHYSICIAN ATTENDING PHYSICIAN
    KONSULTASI TANGGAL / DATE JAM / TIME KONSULTASI TANGGAL / DATE JAM / TIME
    CONSULTATION CONSULTATION

    DIAGNOSIS DIAGNOSIS
    BIAYA KONSULTASI BIAYA KONSULTASI
    CONSULTATION FEE CONSULTATION FEE
    JENIS TINDAKAN JENIS TINDAKAN
    TINDAKAN BIAYA / COST TINDAKAN BIAYA / COST
    TYPE OF INTERVENTION TYPE OF INTERVENTION
    INTERVENTION INTERVENTION

    JENIS INJEKSI JENIS INJEKSI


    INJEKSI BIAYA / COST INJEKSI BIAYA / COST
    TYPE OF INJECTION TYPE OF INJECTION
    INJECTION INJECTION

    SURAT KETERANGAN SURAT KETERANGAN


    MEDICAL CERTIFICATE MEDICAL CERTIFICATE

    TOTAL TOTAL
    PASIEN / PATIENT DOKTER / PHYSICIAN PASIEN / PATIENT DOKTER / PHYSICIAN

    VERIFIKASI VERIFIKASI
    VERIFICATION PERAWAT / NURSE ADMIN VERIFICATION PERAWAT / NURSE ADMIN

    FORMULIR REGISTRASI RAWAT JALAN RSU MANADO MEDICAL CENTER FORMULIR REGISTRASI RAWAT JALAN RSU MANADO MEDICAL CENTER

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