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FORM HARIAN WAKTU LAPOR HASIL KRITIS LABORATORIUM
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Tanggal
*
MM
/
DD
/
YYYY
Bulan
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Choose
January
February
March
April
May
June
July
August
September
October
November
December
No RM Pasien
*
Your answer
Nama Pasien
*
Your answer
Nama Pelapor
*
Your answer
Penerima Laporan
*
Your answer
Jam Hasil Lab Selesai dan Telah dibaca Dokter Sp.PK / Petugas yang Berwenang
*
Time
:
AM
PM
Waktu dilaporkan ke Dokter yang Meminta Pemeriksaan
*
Time
:
AM
PM
Waktu Lapor (Menit). (Num)
*
Your answer
Parameter yang dinilai
*
Your answer
Hasil Lab Kritis :
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Your answer
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