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DINAS KESEHATAN KABUPATEN TASIKMALAYA

UPTD PUSKESMAS DTP KARANGNUNGGAL


Jl. Raya Karangnunggal No. 13 Tlp. (0265) 580 113

RESEP PERAWATAN
Nama : ........................................................................................................................................... .............................................
Umur : ......................................................................................................................................................................... thn / bln
Alamat : Kmp : ....................................................................................................................... Rt / Rw ..................
Desa / Kelurahan : .............................................................................................................................. .........................
Kabupaten / Kota : ........................................................................................................................................................
Diagnosa : ....................................................................................................................................... ................
No Rm : ............................................................................................................................................ ............
No Tgl Nama Nama Obat Signa Jml Harga Praf Tanda-tangan
Dokter Obat Obat
Petugas Penerima
Obat Obat

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