KIB

NO RM : NO RM :
KARTU IDENTITAS BEROBAT KARTU IDENTITAS BEROBAT

UPT PUSKESMAS
PANCATENGAH (KIB) UPT PUSKESMAS
PANCATENGAH (KIB)
NAMA :.......................................................................................... NAMA :..........................................................................................
TEMPAT/TGL LAHIR: ....................................................................................L/P TEMPAT/TGL LAHIR: ....................................................................................L/P
ALAMAT: ......................................................................................... ALAMAT: .........................................................................................
KETERANGAN: ......................................................................................... KETERANGAN: .........................................................................................
Kartu ini harus dibawa setiap kali berobat !!! Kartu ini harus dibawa setiap kali berobat !!!
NO RM : NO RM :

UPT PUSKESMAS
PANCATENGAH (KIB)
NAMA :.......................................................................................... NAMA :..........................................................................................
ALAMAT: ......................................................................................... ALAMAT: .........................................................................................
NO RM : NO RM :

UPT PUSKESMAS
PANCATENGAH (KIB)
NAMA :.......................................................................................... NAMA :..........................................................................................
ALAMAT: ......................................................................................... ALAMAT: .........................................................................................
NO RM : NO RM :

UPT PUSKESMAS
PANCATENGAH (KIB)
NAMA :.......................................................................................... NAMA :..........................................................................................
ALAMAT: ......................................................................................... ALAMAT: .........................................................................................
NO RM : NO RM :

UPT PUSKESMAS
PANCATENGAH (KIB)
NAMA :.......................................................................................... NAMA :..........................................................................................
ALAMAT: ......................................................................................... ALAMAT: .........................................................................................
NO RM : NO RM :

UPT PUSKESMAS
PANCATENGAH (KIB)
NAMA :.......................................................................................... NAMA :..........................................................................................
ALAMAT: ......................................................................................... ALAMAT: .........................................................................................

KIB

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NO RM : NO RM :

KARTU IDENTITAS BEROBAT KARTU IDENTITAS BEROBAT

NAMA :.......................................................................................... NAMA :..........................................................................................

TEMPAT/TGL LAHIR: ....................................................................................L/P TEMPAT/TGL LAHIR: ....................................................................................L/P

ALAMAT: ......................................................................................... ALAMAT: .........................................................................................

KETERANGAN: ......................................................................................... KETERANGAN: .........................................................................................

KARTU IDENTITAS BEROBAT KARTU IDENTITAS BEROBAT

NAMA :.......................................................................................... NAMA :..........................................................................................

TEMPAT/TGL LAHIR: ....................................................................................L/P TEMPAT/TGL LAHIR: ....................................................................................L/P

ALAMAT: ......................................................................................... ALAMAT: .........................................................................................

KETERANGAN: ......................................................................................... KETERANGAN: .........................................................................................

KARTU IDENTITAS BEROBAT KARTU IDENTITAS BEROBAT

NAMA :.......................................................................................... NAMA :..........................................................................................

TEMPAT/TGL LAHIR: ....................................................................................L/P TEMPAT/TGL LAHIR: ....................................................................................L/P

ALAMAT: ......................................................................................... ALAMAT: .........................................................................................

KETERANGAN: ......................................................................................... KETERANGAN: .........................................................................................

KARTU IDENTITAS BEROBAT KARTU IDENTITAS BEROBAT

NAMA :.......................................................................................... NAMA :..........................................................................................

TEMPAT/TGL LAHIR: ....................................................................................L/P TEMPAT/TGL LAHIR: ....................................................................................L/P

ALAMAT: ......................................................................................... ALAMAT: .........................................................................................

KETERANGAN: ......................................................................................... KETERANGAN: .........................................................................................

KARTU IDENTITAS BEROBAT KARTU IDENTITAS BEROBAT

NAMA :.......................................................................................... NAMA :..........................................................................................

TEMPAT/TGL LAHIR: ....................................................................................L/P TEMPAT/TGL LAHIR: ....................................................................................L/P

ALAMAT: ......................................................................................... ALAMAT: .........................................................................................

KETERANGAN: ......................................................................................... KETERANGAN: .........................................................................................

KARTU IDENTITAS BEROBAT KARTU IDENTITAS BEROBAT

NAMA :.......................................................................................... NAMA :..........................................................................................

TEMPAT/TGL LAHIR: ....................................................................................L/P TEMPAT/TGL LAHIR: ....................................................................................L/P

ALAMAT: ......................................................................................... ALAMAT: .........................................................................................

KETERANGAN: ......................................................................................... KETERANGAN: .........................................................................................

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