KOMITE PENINGKATAN MUTU & KESELAMATAN PASIEN (PMKP) RSIA KEMANG JL. AMPERA RAYA NO 34 JAKARTA SELATAN FORMULIR PENGAJUAN SPO (STANDAR PROSEDUR OPERASIONAL) 1. NAMA UNIT : ......................................... .......................................... 2. JENIS PENGAJUAN SPO(PILIH SALAH SATU) BARU (TULIS JUDUL ) : .................................................... ...................................... REVISI : o JUDUL SPO LAMA : ......................................... ......................................................... ............... ......................................................... ........................................................ ......................................................... ........................................................ ......................................................... ........................................................ o NOMOR & TAHUN PEMBUATAN SPO LAMA : ................................................. ......................................................... ....... ......................................................... ........................................................ ......................................................... ........................................................ 3. ALASAN PENGAJUAN SPO/REVISI SPO : (deskripsikan dengan jelas)

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KOMITE PENINGKATAN MUTU & KESELAMATAN PASIEN (PMKP)RSIA KEMANGJL. AMPERA RAYA NO 34 JAKARTA SELATANFORMULIR PENGAJUAN SPO (STANDAR PROSEDUR OPERASIONAL)1. NAMA UNIT: ...................................................................................2. JENIS PENGAJUAN SPO(PILIH SALAH SATU) BARU (TULIS JUDUL ) : .......................................................................................... REVISI:o JUDUL SPO LAMA: ....................................................................................................................................................................................................................................................................................................................................................................................................................................................................o NOMOR & TAHUN PEMBUATAN SPO LAMA :...................................................................................................................................................................................................................................................................................................................................................3. ALASAN PENGAJUAN SPOREVISI SPO: (deskripsikan dengan jelas)Jakarta , ................................................NB : H!"!# $%&'"(!)!* $+),-'* .!-! $!* "!*/!*0!* $+),-'* 1!",. J!1!(!*K!.U*%(K!R,K!.B!0K!. B%$K!.K+-%('M'*0'(!2,%D%"')(,"M'$%&D%"')(,"U-,-M'*0'(!2,%K'(,!K+-%('PMKPD%"')(," U(!-!N!-!T!*$!T!*0!*