Surat Pengantar SKL
2
RUMAH SAKIT Hi. KAMINO YAYASAN SYAFAQILLAH Jl. Sriwijaya No. 56 Setia Negara Kec. Baradatu Kab. Way Kanan rs_hajikaminoyahoo.co.id 0812 7209 5786 PENGANTAR SURAT KETERANGAN KELAHIRAN Nomor : .... RSHK-SQ/ .... / ........ Dokter Yang Merawat : ............................................................. Nama Bayi : ................................ ............................ Jenis Kelamin : ............................................................. Data (Sesai K!"# Nama $% : ................................ ............................ "eker&aan : ............................................................. Nama 'ya : ................................ ............................ 'lamat )engka* : ................................ ............................ ............................................................. )a ir "a+a Hari : .... ...... ..... ...... ..... .. !anggal : ............................ Jam : ............................ ,$B Berat )a ir : ............................ gram "an&ang Ba+an : ............................ m )a ir Se ara : ............................................................. "erawat/Bi+an ( RSHK # ( ............................. NB : Mas H+a H S +i%agi 0 ya. Ngirit e e
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Pengantar SKL
Transcript of Surat Pengantar SKL
RUMAH SAKIT Hi
RUMAH SAKIT Hi. KAMINO
YAYASAN SYAFAQILLAH
Jl. Sriwijaya No. 56 Setia Negara Kec. Baradatu Kab. Way Kanan ( [email protected] ( 0812 7209 5786PENGANTAR SURAT KETERANGAN KELAHIRANNomor : .... RSHK-SQ/ .... / ........
Dokter Yang Merawat:....................................................................................
Nama Bayi:....................................................................................
Jenis Kelamin:....................................................................................
Data (Sesuai KTP)
Nama Ibu:....................................................................................
Pekerjaan:....................................................................................
Nama Ayah:....................................................................................
Alamat Lengkap :...................................................................................
...................................................................................
Lahir Pada Hari:............................
Tanggal:............................
Jam:............................ WIB
Berat Lahir:............................ gram
Panjang Badan:............................ cm
Lahir Secara:...................................................................................Perawat/Bidan ( RSHK )
( ............................. )NB :
Mas Huda, HVS dibagi 2 ya.
Ngirit hehe
