SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. H. Faisal Balatif, M.Kes. PA.

SIP. 006./448.1/35.73.063/1980

SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. Ana Rahmawati

 SIP. 446./628.1/35.73.306/2007
SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. Siti Kemala Sari, M.Biomed

SIP. 091./201.1/12.10.363/2000

SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. Edward Kosasi, MARS, PA.

 SIP. 331./281.8/17.23.290/1997
SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. H. Erwin Hakim, M.Kes. PA.

SIP. 200./209.5/27.61.012/1979

SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. Muhammad Irfan

 SIP. 201./274.3/73.58.092/2009
SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. Achmad Ichmal

SIP. 192./228.4/32.21.071/2008

SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. Duma Sari Hutabarat

 SIP. 002./379.6/51.30.408/2000
SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. Muhammad Gema Ramadhan, Sp. PD

SIP. 001./39.8/54.21.209/2002

SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa:

Nama : ................................................................................................................................
Usia : ................................................................................................................................
Jenis kelamin
: .................................................................................................................................
Pekerjaan : ................................................................................................................................
.
Alamat : ................................................................................................................................
.

Berhubung dengan sakit yang diderita, perlu beristirahat selama:

....................... hari, mulai tanggal ................................. s/d .....................................

Mengetahui,

dr. Arfai Laksamana, M.Kes

SIP. 005./802.2/29.34.201/2012