NAMEELISBUDIWAHYUFITRIIRFAN
SEXFemaleMaleMaleFemale
ADDRESSSidoarjoMengantiBaron
CITY STATESidoarjoGresikJombangNganjuk
PHONE08570743672708573110737308775315085646090722
RELIGIONIslamIslamIslamIslam
MARITAL STATUSSingleSingleSingleSingle
HEALTH INSURANCE-BumiputraAskes-
CURRENT OCCUPATION AND TITLEStudentStudentStudentStudent
FAMILY KINMotherTandhiFitriMother
DATE AND TIME OF CONTACTTuesday, 17 Sept 2013Tuesday, 17 Sept
2013Tuesday, 17 Sept 2013Tuesday, 17 Sept 2013
REASON FOR CONTACT Headache Worried Shortness of breathness
Chest tightness, pain, pressure Pain in the abdomen Headache
Headache Vomiting Anoreksia
DIAGNOSISAnxietyAsthmaDysmenorrheaNausea
LAILIL OKTAVIA ARDI/P27820112026/II-NONREGULER
