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  • Dian Permata Putri Limit Bing Form

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    Puput Dian
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    Dinda Husein, a 19-year-old female student from Kendari, Sulawesi Tenggara, Indonesia, registered as a new patient at Rumkit Bhayangkara TK.III Kendarion June 28, 2021. She provided her personal details including her full name, date and place of birth, address, religion, marital status, education, occupation, citizenship, and emergency contact which was her father, Husein Alatas. Dinda agreed to be examined and receive necessary medical treatment at the general clinic.

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    Original Title

    DIAN PERMATA PUTRI LIMIT BING FORM

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    Dinda Husein, a 19-year-old female student from Kendari, Sulawesi Tenggara, Indonesia, registered as a new patient at Rumkit Bhayangkara TK.III Kendarion June 28, 2021. She provided her personal details including her full name, date and place of birth, address, religion, marital status, education, occupation, citizenship, and emergency contact which was her father, Husein Alatas. Dinda agreed to be examined and receive necessary medical treatment at the general clinic.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views3 pages

    Dian Permata Putri Limit Bing Form

    Uploaded by

    Puput Dian
    Dinda Husein, a 19-year-old female student from Kendari, Sulawesi Tenggara, Indonesia, registered as a new patient at Rumkit Bhayangkara TK.III Kendarion June 28, 2021. She provided her personal details including her full name, date and place of birth, address, religion, marital status, education, occupation, citizenship, and emergency contact which was her father, Husein Alatas. Dinda agreed to be examined and receive necessary medical treatment at the general clinic.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    RUMKIT BHAYANGKARA TK.

    III KENDARI
    JL. Y. Wayong No. 7 Kec. Mandonga, Kota Kendari
    Sulawesi Tenggara 93117, Telepon : (0401) 3121253

    NEW PATIENT REGISTRATION FORM

    NO.RM
    2 5 1

    (Filled by officer)
    (fill in below according to ID card data)

    Full Name : Dinda Husein


    th
    Place And Date Of Birth : Kendari, July, 12 , 2002

    Gender : Female

    Addres : City Hall Road 3 RT 03 RW 20


     Village : Kadia Subdistrict : Kadia
     District/city : Kendari Phone number : 082346579961

    Religion : Islam

    Marital status : Single

    Last Education : Studying

    Profession : Student

    Citizenship : Indonesia

    Payment Method : Cash

    The Name Of The Person In Charge : Husein Alatas

    Phone number : 085324879913

    Destination Clinic : General

    Hereby declare that I agree to be examined and necessary actions in an effort to heal if I
    am the patient

    Kendari, 28, June, 2021

    (Dinda Husein)
    kkkkkkkkkk

    Name : Dian Permata Putri


    Class : XII MIA OLIM 2
    Task : LIMIT English

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