05.06.2013 Views

keputusan menteri kesehatan republik indonesia ... - Digilib AMPL

keputusan menteri kesehatan republik indonesia ... - Digilib AMPL

keputusan menteri kesehatan republik indonesia ... - Digilib AMPL

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

FORM. JB. 2C.<br />

PENGAMBILAN / PENGIRIMAN CONTOH DAN SPECIMEN JASABOGA<br />

Nama Perusahaan : ..........................................................................................<br />

Golongan : ………………………………………………………….<br />

Tanggal pengambilan : ..........................................................................................<br />

Petugas yang mengambil : ..........................................................................................<br />

Uraian contoh yang diambil :<br />

No. Nama contoh /<br />

specimen<br />

Code Banyaknya Untuk<br />

diperiksa<br />

(2) (4) (5)<br />

PENGUSAHA,<br />

(………………………………)<br />

…….…………………., 200……..<br />

PETUGAS<br />

(………………………………….)<br />

Tanggal diterima …………………………….<br />

Petugas Laboratorium<br />

(……………………..)<br />

Catatan<br />

50

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!