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FORMULIR MEDICAL CHECK UP MATA
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FORMULIR MEDICAL CHECK UP MATA
form pemeriksaan mataFull description...
Author:
rekam medis selaras
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MEDICAL CHECK UP
MATA
NAMA PASIEN JENIS KELAMIN
: ……………….......................…… No. RM :
Laki - laki
TGL LAHIR
:
/
/
TGL MASK
:
/
/
JAM MELAKKAN M! :
:
Aler"i
Perempuan
Ti#ak $a
TEMPELKAN LABEL ALERGI DISINI
% &u& Korek&i A#i&i Gerakan 'ola ma(a Ke#u#ukan Palpe'ra !on)un*+,a !ornea !A Pupil Iri& Len&a %i(reou& un#u& T.I. !ampu& Te&( u(a Ma(a
Normal Re# Green 0e1*ien*2 u(a 3arna To(al
Ke&impulan
:
An)uran
:
Dokter
(………………………….)
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