C. ( A ) : ..................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
D. ( P/I ) : ..................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Tgl Jam His ( 10’ ) DJJ T.D Suhu Nadi Pemeriksaan Dalam VT
Berapa Kali Lama