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LETTER OF VACCINE DETAILS

No: 006/KET.S/RSA/IV/2018

With this letter, we has provided the MR vaccine (Measless and Rubella vaccine) at:

Name: Mr. Agus Purnomo

Age: 26 y.o / 21-08-1991

Address: Sambeng 2/4, Bayan, Purworejo

Vaccine has been done through intramusculary at Aisyiyah Hospital Purworejo on April 4,
2018.
So this letter we made to be used properly.

Purworejo, April 4, 2018

Best regards

Dr. D. Sandi Aji

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