surat pengantar skl

RUMAH SAKIT Hi

RUMAH SAKIT Hi. KAMINO

YAYASAN SYAFAQILLAH

Jl. Sriwijaya No. 56 Setia Negara Kec. Baradatu Kab. Way Kanan ( rs_hajikamino@yahoo.co.id ( 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