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Form Penundaan Operasi Elektif
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Bulan
*
Choose
January
February
March
April
May
June
July
August
September
October
November
December
Kamar Operasi
*
Choose
dr. I Nengah Raditha, Sp.B
dr. NANANG WIDODO, Sp.B
dr. Made Artana Sp.OT
dr. I Ketut Sepidiarta, Sp.OG
dr. Iyenni Yosita Simanjuntak, Sp.OG
dr. Kaspan, Sp.OG
dr. Raden Gunawan Effendi, Sp.M.,MM
dr. M. Nurman H. Sp.THT-KL.,M.Si.Med
drg. Leni Ruslaini, Sp.BM
dr. Lalu Aditya Haris Pratama, Sp.THT-KL
dr. Deglana Syabdini Edwiza, Sp.M
Tanggal
*
MM
/
DD
/
YYYY
No RM Pasien
*
Your answer
Nama Pasien
*
Your answer
Jadwal Operasi
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Reschedule
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Operasi tertunda
*
Iya
Tidak
Alasan penundaanÂ
*
Your answer
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