LAPORAN IMUNISASI
NO
JENIS IMUNISASI
1.
HBO
2.
BCG
3.
4.
5.
6.
POLIO 1
7.
POLIO 2
8.
POLIO 3
9.
POLIO 4
10.
CAMPAK
11.
TT 1
12.
TT 2
JUMLAH
KETERANGAN
....................,.............................................2014
Petugas Imunisasi
__________________________________
NIP / NrPTT : .....................................................