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REKAM DATA HIJAMAH / BEKAM Nama
: ______________________________
Usia
: _______________ Tahun ( L / P )
No HP
: ______________________________
Alamat
: ______________________________ ______________________________
KELUHAN :
Titik Hijamah / Bekam
_________________________________ _________________________________ _________________________________
DIAGNOSA : _________________________________ _________________________________ _________________________________
SARAN / ANJURAN TERAPIS : _____________________________________ _____________________________________ _____________________________________
_________________________, _______________2019
( ______________________ ) Yang diterapi
(_______________________ ) Terapis
