No.

DATA SI KECIL
Nama Orang Tua _____________________________________________________
Nama Bayi __________________________________________________________
Jenis Kelamin _______________________________________________________
Tgl Lahir ___________________________________________________________
Jam _______________________________________________________________
Berat Lahir _________________________________________________________
Panjang Lahir _______________________________________________________
Minum Susu ________________________________________________________
Rumah Sakit ________________________________________________________
Dokter Kandungan___________________________________________________
Dokter Anak ________________________________________________________
RSIA SELASIH MEDIKA
BINTARA