KUALA TERENGGANU SPECIALIST HOSPITAL

Jalan Kamaruddin, 21300 Kuala Terengganu, Terengganu Darul Iman

Tel: 09-6245353 Fax: 09-6265211

RN: 021776
Reg Date: 31/01/2011
Reg Time: 10:46:18AM

Patient Particular

Client Name : HASNAH BINTI JUSOH Race : MELAYU

Docu No. : 790803-11-5418 Religion : ISLAM
D.O.B : 03/08/79 Citizenship : MALAYSIAN
Age : 31-Y 7-M 29-D
Gender : PEREMPUAN
Marial Status : MARRIED
Occupation : CLERK

Home Address : 6996 JALAN DULANG 3,

BANDAR BARU SERI KERTEH
24300 KERTEH

House Tel. : 09-8262272 HP : 012-9609868

Office Address :

Office Tel :

Additional Info

Blood Group :
Height : Weight :
Allergy : Note :

In Case of Emergency, Contact

Name : Occupation :
Relationship : Home Phone :
Address : HP :

Next of Kin
Name : AHMAD SUBKI BIN HJ. MOHD NOR Occupation :
Relationship : HUSBAND Home Phone : 09-8262272
Address : 6996 JALAN DULANG 3, HP : 012-9009868
BANDAR BARU SERI KERTEH
24300 KERTEH