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Jl.YC. Oevang Oeray Jl.YC.

Oevang Oeray
Telp (0565) 2030018 Telp (0565) 2030018
Eka Juliani, S. Farm., Apt. Eka Juliani, S. Farm., Apt.
SIPA: 448/002/SIPA/DPMPTSP/2019 SIPA: 448/002/SIPA/DPMPTSP/2019

No. Tgl : / / Keterangan : No.


/ Tgl : / / Keterangan :

OBAT LUAR – JANGAN DIMINUM


_____________________________________________ _____________________________________________

x SEHARI salep/tetes/semprot x SEHARI salep/tetes/semprot

MATA KANAN MATA KANAN


TELINGA KIRI TELINGA KIRI
HIDUNG HIDUNG

Jl.YC. Oevang Oeray Jl.YC. Oevang Oeray


Telp (0565) 2030018 Telp (0565) 2030018
Eka Juliani, S. Farm., Apt. Eka Juliani, S. Farm., Apt.
SIPA: 448/002/SIPA/DPMPTSP/2019 SIPA: 448/002/SIPA/DPMPTSP/2019

No. Tgl : / / Keterangan :


No. Tgl : / / Keterangan :

_____________________________________________ _____________________________________________

x SEHARI salep/tetes/semprot x SEHARI salep/tetes/semprot

MATA KANAN MATA KANAN


TELINGA KIRI TELINGA KIRI
HIDUNG HIDUNG

Jl.YC. Oevang Oeray Jl.YC. Oevang Oeray


Telp (0565) 2030018 Telp (0565) 2030018
Eka Juliani, S. Farm., Apt. Eka Juliani, S. Farm., Apt.
SIPA: 448/002/SIPA/DPMPTSP/2019 SIPA: 448/002/SIPA/DPMPTSP/2019

No. Tgl : / / Keterangan : No. Tgl : / / Keterangan :

_____________________________________________ _____________________________________________

x SEHARI salep/tetes/semprot x SEHARI salep/tetes/semprot


MATA KANAN MATA KANAN
TELINGA KIRI TELINGA KIRI
HIDUNG HIDUNG

Jl.YC. Oevang Oeray Jl.YC. Oevang Oeray


Telp (0565) 2030018 Telp (0565) 2030018
Eka Juliani, S. Farm., Apt. Eka Juliani, S. Farm., Apt.
SIPA: 448/002/SIPA/DPMPTSP/2019 SIPA: 448/002/SIPA/DPMPTSP/2019

No. Tgl : / / Keterangan : No. Tgl : / / Keterangan :

_____________________________________________ _____________________________________________

x SEHARI salep/tetes/semprot x SEHARI salep/tetes/semprot

MATA KANAN MATA KANAN


TELINGA KIRI TELINGA KIRI
HIDUNG HIDUNG

Jl.YC. Oevang Oeray Jl.YC. Oevang Oeray


Telp (0565) 2030018 Telp (0565) 2030018
Eka Juliani, S. Farm., Apt. Eka Juliani, S. Farm., Apt.
SIPA: 448/002/SIPA/DPMPTSP/2019 SIPA: 448/002/SIPA/DPMPTSP/2019

No. Tgl : / / Keterangan : No. Tgl : / / Keterangan :

_____________________________________________ _____________________________________________

x SEHARI salep/tetes/semprot x SEHARI salep/tetes/semprot

MATA KANAN MATA KANAN


TELINGA KIRI TELINGA KIRI
HIDUNG HIDUNG

Jl.YC. Oevang Oeray Jl.YC. Oevang Oeray


Telp (0565) 2030018 Telp (0565) 2030018
Eka Juliani, S. Farm., Apt. Eka Juliani, S. Farm., Apt.
SIPA: 448/002/SIPA/DPMPTSP/2019 SIPA: 448/002/SIPA/DPMPTSP/2019

No. Tgl : / / Keterangan : No. Tgl : / / Keterangan :

_____________________________________________ _____________________________________________

x SEHARI salep/tetes/semprot x SEHARI salep/tetes/semprot

MATA KANAN MATA KANAN


TELINGA KIRI TELINGA KIRI
HIDUNG HIDUNG

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