HEALTH CERTIFICATE
Keluhan Sekarang
Nama (name) : Jalu Satria Pratama (Present Illness)
Umur (Age) : 1999-11-11 / 22 Th (Year)
1 Demam (Fever) : Yes(...) / No(√)
Jenis Kelamin (Sex) : LAKI - LAKI
2 Sesak Nafas Shortness of breath : Yes(...) / No(√)
Kebangsaan (Nationality) : Indonesia
3 BatukCough : Yes(...) / No(√)
No. KTP (Passport No.) : 3308031111990001
4 Pilek Cold : Yes(...) / No(√)
Alamat (Address) : Dusun Gesikan RT/RW 001/002
5 Sakit Tenggorokan Sore Throat : Yes(...) / No(√)
6 Diare Diarrhea : Yes(...) / No(√)
7 Lemas Malaise : Yes(...) / No(√)
8 Nyeri otot Muscle Pain : Yes(...) / No(√)
9 Mual atau muntah Nausea or Vomit : Yes(...) / No(√)
Jl. Pulo Mas Timur K No.2 RT4/RW.14, Kayu Putih, Kec. Pulo Gadung, Kota Jakarta Timur,Daerah Khusus Ibukota Jakarta 13210
(021) 4703333