Klinik Pratama

 

GLCBCG XPDVDED „DC_SCSDN “_CVC –DC_SDN―

GLCBCG XPDVDED „DC_SCSDN “_CVC –DC_SDN―

GKVD XAGDLKBJDB

GKVD XAGDLKBJDB

Dldedt = Ml. Fr. Zdncfcb bk. ? Valpkb (80>1) 60 6?>3 Xagdlkbjdb  Aedcl   = sctcdcsydnglcbcgprdtdedHjedcl.oke

Dldedt = Ml. Fr. Zdncfcb bk. ? Valpkb (80>1) 606?>3 Xagdlkbjdb  Aedcl   = sctcdcsydnglcbcgprdtdedHjedcl.oke

_QPDV GAVAPDBJDB _ANDV

_QPDV GAVAPDBJDB _ANDV

 Bkekr =……/_G_/……/ =……/_G_/……/

 Bkekr =……/_G_/……/ =……/_G_/……/

Ea Eaba bard rdbj bjgd gdb b `dnw `dnwdd

=

Eabar abardb dbjg jgdb db `dnw `dnwdd

=

 Bded

=…………………………… =…………………………………………… ……………………. …….

 Bded

=……………… =……………………………… ……………………………… …………………. ….

Qeur// mabcs Qeur mabcs galdecb galdecb

= ……..t ……..tdnub dnub/Ldgc /Ldgc-Ldg -Ldgc/Xa c/Xaraepu raepudb db

Qeur/ Qeu r/ mabc mabcss galdecb galdecb

= ……..tdnu ……..tdnub/Ldg b/Ldgc-Ld c-Ldgc/X gc/Xarae araepudb pudb

Xagarmddb

=…………………………………………………

Xagarmddb

=…………………………………………………

Dldedt

=…………………………………………………

Dldedt

=…………………………………………………

Valdn fcparcgsd gasandtdb fdb fcbydtdgdb _ANDV/VCFDG _ANDV fdb surdt

Valdn fcparcgsd gasandtdb fdb fcbydtdgdb _ANDV/VCFDG _ANDV fdb surdt

gatardbjdb sandt cbc fcparjubdgdb ubtug gaparludb …………………………………

gatardbjdb sandt cbc fcparjubdgdb ubtug gaparludb …………………………………

Vcbj Vcbjjc jc `d `dfd fdb b

=……… =……….. ..Oe Oe

Vcbj Vcbjjc jc `d `dfd fdb b

=……… =………..O ..Oe e

@a rrddt ` df df db db

=… …… …….Gj .Gj

@ar dt dt `df db db

=……….Gj .Gj

_unu

=………. ¸O

_unu

=………. ¸O

Vagdbdb Vagd bdb fdrd fdrdn n =……….eeN =……….eeNj j

Vagdbdb Vagd bdb fdrd fdrdn n =……….ee =……….eeNj Nj

@utd wdrbd

@utd wdrbd

= SD

VCFDG  

= SD

VCFDG  

Xagdlkbjdb,…………………08…..

Xagdlkbjdb,…………………08…..

Fkgtar paearcgsd,

Fkgtar paearcgsd,

(……………………………..)

(……………………………..)