2. LP 3 (OS-8MS) - BROWN 8 MS (226mm x 330mm) (EDIT) - 2,200pcs (EDIT)

PERKHIDMATAN PERGIGIAN (L.P. 3-Pin.1/83)
KAD RAWATAN PEMBEDAHAN MULUT
IN- PATIENT

No. Daftar Perg. No. Daftar
Tarikh
No. Rujukan Tarikh Masuk

Nama Tarikh Keluar
No. Kad Pengenalan
Alamat Tarikh Lahir Umur
Jantina
No. X’ray Keturunan
Pekerjaan
KESAKITAN SEKARANG Dirujuk oleh

CATATAN PERUBATAN YANG LAMPAU CATATAN PERGIGIAN YANG LAMPAU
(Tanda dimana sesuai)
INDEKS PENYAKIT
Blood Dyscrasias
Allergic Tendemcies
Congenital Heart
Heart Disease
Diabetes
Jaundice
Hypertension
Toxic Goitre
Lain-lain Penyakit

On Any Drug

PENENTUAN PENYAKIT



(L.P. 4)

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Tarikh Catatan

(L.P. 4)

Nama : ............................................................................................................ No. Daftar : ..............................................................

Tarikh Catatan

(L.P. 4)

Nama : ............................................................................................................ No. Daftar : ..............................................................

Tarikh Catatan

(L.P. 4)

Nama : ............................................................................................................ No. Daftar : ..............................................................

Tarikh Catatan

(L.P. 4)

Nama : ............................................................................................................ No. Daftar : ..............................................................

Tarikh Catatan

(L.P. 4)

Nama : ............................................................................................................ No. Daftar : ..............................................................

Tarikh Catatan