Formulir Pendaftaran Pasien Baru (English)
AWESOME HOSPITAL JL. MARDITOMO NO.17 KUTOARJO, KAB. PURWOREJO TELP. 0275-641-425/ FAX 0275-6425-60 Medical Record Number :________ Admission Number :________ Date of Admission :________ Name :____________________________________________ Adress :____________________________________________ Date of Birth :____________________________________________ Sex :O female O male Religion :O Islam O Katolik O Kristen O Etc Occupation :____________________________________________ Marietal Status :O Married O Single O Etc Last Educati