GOVERNMENT OF THE MARSHALLISLANDS
Oepartment of Health Services
Name of Patient:
Sex: =
Hosp. No.
Age...
Date of Registration:
Home Atnil (Cauntry):
Full Name of Father:
Maiden Name of Mother:
Joug im boitok card in ak kemamej number in takta in am ilo ien
itok im takta ile Majuro Hospital.
Please bring this card with you or remember your hospital number whe
you come to Majura Hospital for treatment.
KOMMOL TATA/THANK YO
ine1a)
oe
|
TRUST TERRITORY OF THE PACIFIC ISLANOS
,
DEPARTMENT CF MEDICAL SERVICES
MONTHLY REPORT Of DISPENSARY
Oster
UGCATION OF OISBENSAAY (Vidlage ave isianad
————
~
TYPE
Wes OF SeaviC
g
| MONTH IANO YEAR OF SERVICE
—————
QUT-PATIENTS
> VISITS
N-CATIENT SERVICE
RETURN VISITS
iy aL. vean
IN Cal. YEAA
ToTaL
VISITS
NUMBER Of
iNwaAT ENTS
=|
|
lL.
Treagmenc of Diseases
|
|
2.
Treaceent of [nunes
|
|
|
3.
Catlddures - Deliveries
|
4.
Other Services
|
3. TOTAL
4aMOUNT COLLECTED THIS WONTH:
FEMARKS
NOME OF HEALTH Ace
{
|
|
QUT <-24 TIENT
|
| N=Pa TIENT
KOT AL
NUMBER CF
cays cane