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CV.

PRIMA DELTA KENCANA


KLINIK PRIMA MEDIKA
JL. Ahmad Yani No. 4D Gedangan Sidoarjo
E-mail : primamedika4d@gmail.com
Telp. 085107858998 / 081216000549

KARTU PROLANIS

Nama : ....................................................................................
Alamat :.....................................................................................
Tanggal Lahir :.....................................................................................
No. Telepon :.....................................................................................
No. Kartu BPJS :.....................................................................................

Tanggal BB TB Tensi Gula Asam Cholesterol


Darah Urat
CV. PRIMA DELTA KENCANA
KLINIK PRIMA MEDIKA
JL. Ahmad Yani No. 4D Gedangan Sidoarjo
E-mail : primamedika4d@gmail.com
Telp. 085107858998 / 081216000549

Tanggal BB TB Tensi Gula Asam Cholesterol


Darah Urat

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