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PEMERINTAH KABUPATEN LAHAT PEMERINTAH KABUPATEN LAHAT PEMERINTAH KABUPATEN LAHAT

DINAS KESEHATAN DINAS KESEHATAN DINAS KESEHATAN


UPT PUSKESMAS SUKARAMI UPT PUSKESMAS SUKARAMI UPT PUSKESMAS SUKARAMI
JL. Lintas Sumatera Selatan Kec. Gumay Talang 31451 JL. Lintas Sumatera Selatan Kec. Gumay Talang 31451 JL. Lintas Sumatera Selatan Kec. Gumay Talang 31451

Lahat,.................................. Lahat,..................................
Lahat,..................................
dr ................................................ dr ................................................ dr ................................................

R/ R/ R/

Pro :....................................... Pro :....................................... Pro :.......................................


Umur :....................................... Umur :....................................... Umur :.......................................
No.Reg :....................................... No.Reg :....................................... No.Reg :.......................................
Alamat :....................................... Alamat :....................................... Alamat :.......................................

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