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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
R E G I S T RAS I RAWAT I NAP R E G I S T RAS I RAWAT I NAP
NAMA PASIEN NAMA PASIEN
PATIENT NAME PATIENT NAME
TEMPAT / TGL LAHIR TEMPAT / TGL LAHIR
PLACE / DATE OF BIRTH PLACE / DATE OF BIRTH
UMUR / SEX UMUR / SEX
RM.
AGE / GENDER AGE / GENDER
ALAMAT ALAMAT
ADDRESS ADDRESS
DIAGNOSIS AWAL KELUHAN UTAMA
INITIAL DIAGNOSIS CHIEF COMPLAINT
DPJP DPJP
ATTENDING PHYSICIAN ATTENDING PHYSICIAN
MASUK TANGGAL / DATE JAM / TIME MASUK TANGGAL / DATE JAM / TIME
CHECK-IN CHECK-IN

DIAGNOSIS AWAL DIAGNOSIS


DEPOSIT DEPOSIT
DEPOSIT DEPOSIT
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

DEPOSIT T O TAL
PASIEN / PATIENT DOKTER / PHYSICIAN PASIEN / PATIENT DOKTER / PHYSICIAN

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

REGISTRASI RAWAT JALAN RSU MANADO MEDICAL CENTER 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
R E G I S T RAS I RAWAT I NAP - MAS U K R E G I S T RAS I RAWAT I NAP - MAS U K
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
BIAYA / COST BIAYA / COST
TINDAKAN TYPE OF INTERVENTION TINDAKAN TYPE OF INTERVENTION
INTERVENTION INTERVENTION

JENIS INJEKSI JENIS INJEKSI


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

SURAT KETERANGAN SURAT KETERANGAN


MEDICAL CERTIFICATE MEDICAL CERTIFICATE

T O TAL T O TAL
PASIEN / PATIENT DOKTER / PHYSICIAN PASIEN / PATIENT DOKTER / PHYSICIAN

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

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

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