Nama bayi ..................................................
Nama ibu .................................................. Lahir Pukul .................................................. Jenis kelamin .................................................. Berat badan .................................................. Gr Panjang badan .................................................. Cm Dokter kandungan .................................................. Dokter anak .................................................. Bidan
Nama bayi ..................................................
Nama ibu .................................................. Lahir Pukul .................................................. Jenis kelamin .................................................. Berat badan .................................................. Gr Panjang badan .................................................. Cm Dokter kandungan .................................................. Dokter anak .................................................. Bidan