ADDRESS Sidoarjo Menganti Baron CITY STATE Sidoarjo Gresik Jombang Nganjuk PHONE 085707436727 085731107373 08775315 085646090722 RELIGION Islam Islam Islam Islam MARITAL STATUS Single Single Single Single HEALTH INSURANCE - Bumiputra Askes - CURRENT OCCUPATION AND TITLE Student Student Student Student FAMILY KIN Mother Tandhi Fitri Mother DATE AND TIME OF CONTACT Tuesday, 17 Sept 2013 Tuesday, 17 Sept 2013 Tuesday, 17 Sept 2013 Tuesday, 17 Sept 2013
REASON FOR CONTACT - Headache - Worried - Shortness of breathness - Chest tightness, pain, pressure - Pain in the abdomen - Headache - Headache - Vomiting - Anoreksia - DIAGNOSIS Anxiety Asthma Dysmenorrhea Nausea