CERTIFICATE OF IMMUNIZATION

NUMBER : 021a/SKI/RSANNA/XI/2018

the undersigned below .

Name : Julizir Moezahar, MD

Position : Pediatrician
Address : Anna Hospital
Pekayon Raya Street Number 36, South Bekasi, Indonesia

With this explains that the concerned below.

Number medical records : 10-30-05

Name : Alvin Garuda Ananda Ristanu
Son of : Heri Ristanu ( Father)
Herfiana Damayanti (Mother)
Place, Date of Birth : Bekasi, 8th June 2012
Age : 6 Years Old
Gender : Male
Address : Branjangan 4 Street Number 8 Halim Perdana Kusuma
East Jakarta 13610 Indonesia

Has been properly immunized in "ANNA" Hospital as listed below:

Date Weigh Age Immunization Doctor
15th June 2012 3,1 Kg 8 Days hepatitis B1 vaccine Julizir
15th July 2012 4,3 Kg 1 Month hepatitis B2 vaccine Julizir
1th August 2012 5,3 Kg 1 Month 3 Weeks Bacillus Calmette Guerin Julizir
th
18 February 2013 7 kg 8 Month PVC (pneumococcal conjugate Julizir
vaccine)
26th March 2013 8 Kg 9 Month measles vaccine Julizir
th
6 August 2014 11 kg 2 Years MMR vaccine (Mumps, Julizir
Measles, Rubella)
Julizir
7th June 2015 14 Kg 3 Years Thypim Vaccine Julizir

Thus this certificate is made in order to be used properly.

Bekasi, 21th November 2018

Best regards

Julizir Moezahar, MD
(Pediatrician)
 CERTIFICATE OF IMMUNIZATION
NUMBER : 021b/SKI/RSANNA/XI/2018

the undersigned below .

Name : Julizir Moezahar, MD

Position : Pediatrician
Address : Anna Hospital
Pekayon Raya Street Number 36, South Bekasi, Indonesia

With this explains that the concerned below.

Number medical records : 14-59-37

Name : Sean Dwi Putra Ristanu
Son of : Heri Ristanu (Father)
Herfiana Damayanti (Mother)
Place, Date of Birth : Bekasi, 2nd June 2015
Age : 3 Years Old
Gender : Male
Address : Branjangan 4 Street Number 8 Halim Perdana Kusuma
East Jakarta 13610 Indonesia

Has been properly immunized in "ANNA" Hospital as listed below:

Date Weigh Age Immunization Doctor
th
7 June 2015 3,8 Kg 5 Days hepatitis B1 vaccine Julizir
12th July 2015 5,2 Kg 1 Month hepatitis B2 vaccine Julizir
31th August 2015 6,7 Kg 2 Month Bacillus Calmette Guerin Julizir
3th October 2015 7,1 Kg 4 Month DPaT I Vacinne ( Difteri, Petrusis & Julizir
Tetanus)
9th January 2016 8,3 Kg 7 Month DPaT III Vacinne ( Difteri, Petrusis Julizir
& Tetanus)
28th February 2016 8,6 kg 8 Month hepatitis B3 vaccine Julizir
th
14 May 2016 9,5 Kg 1 Years measles vaccine Julizir

Thus this certificate is made in order to be used properly.

Bekasi, 21th November 2018
Best regards

Julizir Moezahar, MD
(Pediatrician)
 CERTIFICATE OF IMMUNIZATION
NUMBER : 021c/SKI/RSANNA/XI/2018

the undersigned below .

Name : Julizir Moezahar, MD

Position : Pediatrician
Address : Anna Hospital
Pekayon Raya Street Number 36, South Bekasi, Indonesia

With this explains that the concerned below.

Number medical records : 18-36-52

Name : Adelweiss Ramadhani Ayunda Ristanu
Daughter of : Heri Ristanu (Father)
Herfiana Damayanti (Mother)
Place, Date of Birth : Bekasi, 05th June 2017
Age : 1 Year Old
Gender : Female
Address : Branjangan 4 Street Number 8 Halim Perdana Kusuma
East Jakarta 13610 Indonesia

Has been properly immunized in "ANNA" Hospital as listed below:

Date Weigh Age Immunization Doctor
7th June 2017 3,8 Kg 3 Days hepatitis B1 vaccine Julizir
17th July 2017 4 Kg 15 Days Bacillus Calmette Guerin Julizir
7th October 2017 6,8 Kg 4 Month HIB/DPaT Julizir
22th December 2017 7,4 Kg 6 Month DPaT/IPV/HIB II/HIB III Julizir
14th April 2018 8,3 Kg 10 Month PVC (pneumococcal conjugate Julizir
vaccine)

Thus this certificate is made in order to be used properly.

Bekasi, 21th November 2018
Best regards

Julizir Moezahar, MD
(Pediatrician)