DINAS KESEHATAN
PUSKESMAS PERAWATAN BATUPANGA
Nama
: ..............................................................................................................
Umur
: ..............................................................................................................
Pekerjaan
: ..............................................................................................................
Alamat
: ..............................................................................................................
Setelah dilakukan pemeriksaan yang tersebut namanya diatas dalam keadaan
Sehat / Sakit .
Surat Keterangan ini diperlukan
untuk .............................................................................................................................
.......................................................................................................................................
.........................................................................
Batupanga, .......................................
2016
Dokter Puskesmas Perawatan
Batupanga
dr. SURYANI
Nip : 19850219 201412 2 001
Nama
: ..............................................................................................................
Umur
: ..............................................................................................................
Pekerjaan
: ..............................................................................................................
Alamat
: ..............................................................................................................
Setelah dilakukan pemeriksaan yang tersebut namanya diatas dalam keadaan
Sehat / Sakit .
Surat Keterangan ini diperlukan
untuk .............................................................................................................................
...
.......................................................................................................................................
...........................................................................
Batupanga, .......................................
2016
Dokter Puskesmas Perawatan
Batupanga
dr. SURYANI
Nip : 19850219 201412 2 001