DINAS KESEHATAN
UPTD PUSKESMAS CEPER
KECAMATAN CEPER
Jl. Ceper - Besole, Sendono, Ceper, Kec. Ceper, Kabupaten Klaten,
Jawa Tengah 57465
Nama : ................................................................................
Name
Umur : ...............................................................................
Age
Perkejaan : ..................................................................................
Occupation
Alamat : .........................................................................
Address
Sakit. Melahirkan
Illnes. delivery
Klaten,............................2023
Dr.Ariani Mardiastuti