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  • 8/18/2019 Porto Visum Hidup

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    PEMERINTAH PROVINSI KALIMANTAN SELATAN

    RUMAH SAKIT UMUM DAERAH Dr. H. MOCH. ANSARI SALEH

    BANJARMASIN

    Jl. Brigjen Hasan Basri No. 1 Telp (0511) 3300741/3300263, Fa 330074Banjar!asin 70125

    Pro – Justitia

    VISUM et REPERTUM

    "#$/0%%/&&/&' /$ * + /2016

    a-a -ang er an a angan i a a ini, r. in a ias a se agai o er jaga pa a

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    * ara, engan no!or s ra B/0%/&&/2016/ ;9T, anggal 26 Fe r ari 2016, ela

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    ;e erjaan 8 &B* $*+ H T N'' =======================================

    Te!pa Tinggal / 9e ia!an 8 J . 9T $T.21 9# . B NJ $+ &N *T $ , 9>T

    B NJ $+ &N======================================

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    ja! 21.00

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    2. aa iperi sa or an ala! ea aan sa ar (&.2. ).====================================3. Ter apa l a le e e an pa a pelipis !a a anan an !e!ar pa a elopa a as

    !a a anan a i a persen an en a !p l (&.2.g)==================================4. 9elainan pa a poin iga i a as apa !en-e a an l a ringan.====================

    &". ;#N*T*;

    e!i ian "& *+ e $#;#$T*+ ini sa-a a engan ses ngg n-a er asar aneil! an sa-a an engan !enginga s !pa ja a an an er asar an le! aran Negara

    No. 350 a n 1@73.==================================================================

    Banjar!asin, 27 Fe r ari 2016 o er erse i a as

    r. in a ias a

    3