Paediatrica Indonesiana

The Indonesian Journal of Pediatrics and Perinatal Medicine

Authors Form

Hereby we acknowledge that each author understands and involved in the contribution of
the original work, and that each has reviewed, read and understood the whole content of
manuscript entitled:
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All authors agree to submit the manuscript to Paediatrica Indonesiana and state that this
does not contain any form of plagiarism.

First author’s signature:

1 ….…………………………………………….………………………………………… (full name and title)

Co-author’s signature(s):

2 . ….…………………………………………….………………………………………….. (full name and title)

3 . ….…………………………………………….………………………………………….. (full name and title)

4 . ….…………………………………………….………………………………………….. (full name and title)

5 . ….…………………………………………….………………………………………….. (full name and title)

IDAI Building. Jl. Salemba I No 5, Jakarta 10430. Phone/Fax:+62-21.391.2577. Email:

enquiry@paediatricaindonesiana.org. Website: http://www.paediatricaindonesiana.org.