Sistem Informasi Kesehatan Pelabuhan

Balai Kekarantinaan Kesehatan/Rumah Sakit

KKP Kelas I Tanjung Priok

No. Dokumen

K00-999077

Barcode Number

K00-999077

This is to certify that [Name]

RAHMAT ALFAHRY

Date Of Birth

28th June 2002

Sex

Male

Nationality

INDONESIA

National Identification Documents, If Applicable

-

Whose Signature Follows

-

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

YELLOW FEVER

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 August 2025	dr. Regina Listyarini	26042017	-	KKP Kelas I Tanjung Priok	-	-	-	-	-
TYPHIM VI	29th August 2025	dr. Regina Listyarini	-	29th August 2028	KKP Kelas I Tanjung Priok	-	-	-	-	-
CHOLERA	03rd September 2025	dr. Regina Listyarini	-	03rd September 2028	KKP Kelas I Tanjung Priok	-	-	-	-	-

International Certificate Vaccination Or Prophylaxis