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DataPersetujuanPenundaanPelayanan.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='2500px' border='0' align='center' cellpadding='3px' cellspacing='0' class='tbl_form'><tr class='isi2'><td valign='top' align='center'><font size='4' face='Tahoma'>RS SIMRS KHANZA</font><br>GUWOSARI, Pajangan, Bantul<br>Hp: 08562675039, 085296559963, E-mail : [email protected]<br><br><font size='2' face='Tahoma'>DATA PERSETUJUAN PENUNDAAN PELAYANAN<br><br></font></td></tr></table>
</head>
<body>
<table width="2500px" border="0" align="center" cellpadding="1px" cellspacing="0" class="tbl_form">
<tr class="isi">
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.Pernyataan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.Rawat</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.R.M.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nama Pasien</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Umur</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>J.K.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tgl.Lahir</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tanggal</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nama Penanggung Jawab</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Umur PJ</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.KTP PJ</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Alamat Penanggung Jawab</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.Telp/HP PJ</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Hubungan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Poli/Ruangan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Dokter Pengirim</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pelayanan Yang Akan Dilakukan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Penundaan Pelayanan Dikarenakan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Penundaan Pelayanan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Alternatif Yang Diberikan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Alternatif Yang Diberikan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>NIP</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Petugas Pemberi Informasi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kode Dokter</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Dokter Penanggung Jawab</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
PPP20230503001
</td>
<td valign="top">
2022/08/09/000002
</td>
<td valign="top">
000006
</td>
<td valign="top">
SAKHA HAMIZAN AQILA
</td>
<td valign="top">
5 Th
</td>
<td valign="top">
L
</td>
<td valign="top">
2017-08-03
</td>
<td valign="top">
2023-05-03 08:07:50.0
</td>
<td valign="top">
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</td>
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</td>
<td valign="top">
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</td>
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</td>
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</td>
<td valign="top">
Suami
</td>
<td valign="top">
6
</td>
<td valign="top">
7 wq wq wq wqw
</td>
<td valign="top">
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</td>
<td valign="top">
Kerusakan Alat
</td>
<td valign="top">
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</td>
<td valign="top">
Dijadwalkan Ulang
</td>
<td valign="top">
10
</td>
<td valign="top">
12/09/1988/001
</td>
<td valign="top">
ANJASMARA
</td>
<td valign="top">
D0000004
</td>
<td valign="top">
dr. Hilyatul Nadia
</td>
</tr>
</table>
</body>
</html>