GOVERNMENT OF THE MARSHALL ISLANDS
Department of Heaith Services
Name of Patient:
Sax:
Hosp. No. .
Age...
Date af Registration:
Home Atnil (Cauntry):
Full Name of Father:
Maiden Name of Mother:
Jouij im hoitok card in ak kememej number in takta in am ilo ien am
itok im
takta ila Majuro Hospital.
Please bring this card with you or remember your hospital number when
you come ta Majuro Hosoitai for treatment.
KOMMOL TATA/THANK YOU!
itertoa
TRUST TERRITORY OF THE PACIFIC ISLANDS
_
DEPARTMENT OF MEDICAL SERVICES
MONTHLY REPORT OF OISPENSARY
Sistmcr
WOCATION OF SISPENSARY
(Viliaee ave | slave)
MONTH ANG YEAR GF SERVICE
OUT=PATIENTS
€
TYAS OF SERVIC
E
- wisit
TL
RETURN VISITS
N CAL. vean
iN CAL, YEAR
TOTAL
VISITS
INPATIENT SERVICE
NUMBER OF
iNwaAT ENTS
|
|
Ll.
Treaoment af Diseases
|
2.
Treaomenc of Inyurtes
|
|
|
3.
Childbirth - Deliveries
|
|
4.
Other Sernices
|
|
|
|
3. TOTAL
AMOUNT COLLECTED THIS WCNTH:
REMARKS
NAME OF H#AL TH Ace
CUT=-2A TIENT
iNew & TIEN T
|
roT aw
NUM@ER OF
CayYs Carne