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Praktek Mandiri Bidan

“WELRANKY”
Ds. Sumber Pasir, Pakis Malang
Telp (0341) 787719 / 082234073308
SURAT KETERANGAN KELAHIRAN

Menerangkan dengan sebenarnya bahwa :

Nama : Ny. .........................................................../Tn. ...................................................................


Alamat : ...............................................................................................................................................
Pada hari : ...............................................................................................................................................
Tanggal : ................................................. Jam : ....................................................................
Telah melahirkan seorang laki-laki / perempuan yang ke : ....................................................................
Berat Badan : ......................... gram, panjang badan : ....................................................................
Diberi nama : ...............................................................................................................................................
BIDAN

( Sri Diati Khasanah )


503.1/15/KAB/51PB/2016

Praktek Mandiri Bidan


“WELRANKY”
Ds. Sumber Pasir, Pakis Malang
Telp (0341) 787719 / 082234073308
SURAT KETERANGAN KELAHIRAN

Menerangkan dengan sebenarnya bahwa :

Nama : Ny. .........................................................../Tn. ...................................................................


Alamat : ...............................................................................................................................................
Pada hari : ...............................................................................................................................................
Tanggal : ................................................. Jam : ....................................................................
Telah melahirkan seorang laki-laki / perempuan yang ke : ....................................................................
Berat Badan : ......................... gram, panjang badan : ....................................................................
Diberi nama : ...............................................................................................................................................
BIDAN

( Sri Diati Khasanah )


503.1/15/KAB/51PB/2016

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