7/25/2019 Print Out Siha

1/12

7/25/2019 Print Out Siha

2/12

7/25/2019 Print Out Siha

3/12

7/25/2019 Print Out Siha

4/12

7/25/2019 Print Out Siha

5/12

7/25/2019 Print Out Siha

6/12

7/25/2019 Print Out Siha

7/12

7/25/2019 Print Out Siha

8/12

7/25/2019 Print Out Siha

9/12

7/25/2019 Print Out Siha

10/12

7/25/2019 Print Out Siha

11/12

IDENTITAS PASIEN PITC

NAMA :.......................................................

TANGGAL LAHIR :.......................................................

UMUR :.......................................................

ALAMAT SEKARANG:.......................................................

ASAL :.......................................................

ANAK :.......................................................

7/25/2019 Print Out Siha

12/12

NO. KTP :.......................................................

NO. REKAM MEDIS :.......................................................

NO. REGISTER :.......................................................

NO. TELEPON :...................................................................................