KARTU PERIKSA KARTU PERIKSA

KLINIK PRATAMA H.MAHMUD KLINIK PRATAMA H.MAHMUD

No. RM : No. RM :

Nama : ....................................................... (L/ P) Nama : ....................................................... (L/ P)

Umur : .................................. Tahun/ Bulan/ Hari Umur : .................................. Tahun/ Bulan/ Hari
No. Hp : .................................................................. No. Hp : ..................................................................
Alamat : .................................................................. Alamat : ..................................................................
.................................................................. ..................................................................

BILA PERIKSA KARTU HARAP SELALU DIBAWA BILA PERIKSA KARTU HARAP SELALU DIBAWA

KARTU PERIKSA KARTU PERIKSA

KLINIK PRATAMA H.MAHMUD KLINIK PRATAMA H.MAHMUD

No. RM : No. RM :

Nama : ....................................................... (L/ P) Nama : ....................................................... (L/ P)

Umur : .................................. Tahun/ Bulan/ Hari Umur : .................................. Tahun/ Bulan/ Hari
No. Hp : .................................................................. No. Hp : ..................................................................
Alamat : .................................................................. Alamat : ..................................................................
.................................................................. ..................................................................

BILA PERIKSA KARTU HARAP SELALU DIBAWA BILA PERIKSA KARTU HARAP SELALU DIBAWA

KARTU PERIKSA KARTU PERIKSA

KLINIK PRATAMA H.MAHMUD KLINIK PRATAMA H.MAHMUD

No. RM : No. RM :

Nama : ....................................................... (L/ P) Nama : ....................................................... (L/ P)

Umur : .................................. Tahun/ Bulan/ Hari Umur : .................................. Tahun/ Bulan/ Hari
No. Hp : .................................................................. No. Hp : ..................................................................
Alamat : .................................................................. Alamat : ..................................................................
.................................................................. ..................................................................

BILA PERIKSA KARTU HARAP SELALU DIBAWA BILA PERIKSA KARTU HARAP SELALU DIBAWA

KARTU PERIKSA KARTU PERIKSA

KLINIK PRATAMA H.MAHMUD KLINIK PRATAMA H.MAHMUD

No. RM : No. RM :

Nama : ....................................................... (L/ P) Nama : ....................................................... (L/ P)

Umur : .................................. Tahun/ Bulan/ Hari Umur : .................................. Tahun/ Bulan/ Hari
No. Hp : .................................................................. No. Hp : ..................................................................
Alamat : .................................................................. Alamat : ..................................................................
.................................................................. ..................................................................

BILA PERIKSA KARTU HARAP SELALU DIBAWA BILA PERIKSA KARTU HARAP SELALU DIBAWA