GOVERNMENT OF THE MARSHALLISLANDS Oepartment of Health Services Name of Patient: Sex: = Hosp. No. Age... Date of Registration: Home Atnil (Cauntry): Full Name of Father: Maiden Name of Mother: Joug im boitok card in ak kemamej number in takta in am ilo ien itok im takta ile Majuro Hospital. Please bring this card with you or remember your hospital number whe you come to Majura Hospital for treatment. KOMMOL TATA/THANK YO ine1a) oe | TRUST TERRITORY OF THE PACIFIC ISLANOS , DEPARTMENT CF MEDICAL SERVICES MONTHLY REPORT Of DISPENSARY Oster UGCATION OF OISBENSAAY (Vidlage ave isianad ———— ~ TYPE Wes OF SeaviC g | MONTH IANO YEAR OF SERVICE ————— QUT-PATIENTS > VISITS N-CATIENT SERVICE RETURN VISITS iy aL. vean IN Cal. YEAA ToTaL VISITS NUMBER Of iNwaAT ENTS =| | lL. Treagmenc of Diseases | | 2. Treaceent of [nunes | | | 3. Catlddures - Deliveries | 4. Other Services | 3. TOTAL 4aMOUNT COLLECTED THIS WONTH: FEMARKS NOME OF HEALTH Ace { | | QUT <-24 TIENT | | N=Pa TIENT KOT AL NUMBER CF cays cane