Sistem Informasi Kesehatan Pelabuhan

Balai Kekarantinaan Kesehatan/Rumah Sakit

Soekarno Hatta / Bandara Halim Perdanakusuma-Jakarta Timur

No. Dokumen

L00-0376237

Barcode Number

L00-0376237

This is to certify that [Name]

Farahmitha Aulia Prijadi

Date Of Birth

1st April 1997

Sex

Female

Nationality

INDONESIA

National Identification Documents, If Applicable

PASPORT

Whose Signature Follows

-

Has on the date indicated been vaccinated or received prophylaxis againts: (name of disease or condition)

YF

Vaccine or Prophy	Date	Signature and profesional status of supervising clinican	Manufacture and batch no. of vaccine or prophylaxis	Certificate valid until	Official stamp of the administering centre	Disease targeted	Date	Manufacture, brand name and batch no. of vaccine	Next Booster (date)	Official stamp and signature
YELLOW FEVER	13th June 2023	DR.UFFAH MARLIANTY	W3H111V	-	Soekarno Hatta/Bandara Halim Perdanakusuma-Jakarta Timur	-	-	-	-	-

International Certificate Vaccination Or Prophylaxis