Keterangan Calon Bayi.docx

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KLINIK UWA MEDICA Izin No : 05/0513/BPTPM Jl. H.R. Subrantas No. 92 Kec Tampan-Pekanbaru Telpon (0761) 7875833

KLINIK UWA MEDICA Izin No : 05/0513/BPTPM Jl. H.R. Subrantas No. 92 Kec Tampan-Pekanbaru Telpon (0761) 7875833

SURAT KETERANGAN NO. .../..../SKH/UM/20

SURAT KETERANGAN NO. .../..../SKH/UM/20

Menerangkan dengan sesungguh nya bahwa Nama : .................................................................... TTL/Umur : .................................................................... Pekerjaan : .................................................................... Jenis kelamin : perempuan Alamat : ....................................................................

Menerangkan dengan sesungguh nya bahwa Nama : .................................................................... TTL/Umur : .................................................................... Pekerjaan : .................................................................... Jenis kelamin : perempuan Alamat : ....................................................................

Pemeriksaan : Tekanan darah : ......../....... mmhg DJJ :................. x/i HPHT : ........................... TTP : ........................... Tafsiran usia kehamilan : ........................... Demikianlah surat keterangan ini dibuat agar dipergunakan sebagaimana mestinya. Terimakasih,

Pemeriksaan : Tekanan darah : ......../....... mmhg DJJ :................. x/i HPHT : ........................... TTP : ........................... Tafsiran usia kehamilan : ........................... Demikianlah surat keterangan ini dibuat agar dipergunakan sebagaimana mestinya. Terimakasih,

Pekanbaru,......../........./20....

Pekanbaru, ........../......../20....

Dokter Pemeriksa

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Dokter Pemeriksa

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