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FORM HARIAN WAKTU TUNGGU RAWAT JALAN
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Tanggal
*
MM
/
DD
/
YYYY
Poli Klinik
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Choose
Poli Anak
Poli Anasthesi
Poli Bedah
Poli Gigi
Poli Jantung Pembuluh Darah
Poli Jiwa
Poli Kandungan
Poli Kulit dan Kelamin
Poli Mata
Poli Ortopedi
Poli Paru
Poli Penyakit Dalam
Poli Saraf
Poli THT-KL
Poli Rehab Medik
Poli Gigi Bedah Mulut
Tanggal
*
MM
/
DD
/
YYYY
No RM Pasien
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Your answer
Nama Pasien
*
Your answer
Kontak Dengan Petugas Pendaftaran
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Kontak Dengan Dokter Poliklinik
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Waktu Tungg (Menit)
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Your answer
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