Nomor : Ranggu,.....................
Lampiran : Kepada
Perihal : Yth,...........................
Di,.............................
Kode Pusk :
Kode Kab :
Pemeriksaan Fisik
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Pemeriksaan penunjang
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Diagnosa : ......................................................................................................................
DD/ : ......................................................................................................................
Terapi : ......................................................................................................................
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NB:Mohon diberikan resume selama perawatan.BTK NIP/NRPTT................
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PEMERINTAH KABUPATEN MANGGARAI BARAT
DINAS KESEHATAN
PUSKESMAS RANGGU KECAMATAN KUWUS KAB.MANGGARAI BARAT
S URAT TUGAS
Nomor : 001.2/ -PR/ IV/2015
Dikeluarkan di : Ranggu
Pada Tanggal :20 April 2015
Labuan Bajo, 20 April 2015
Yang Menerima Kepala Puskesmas Ranggu
Kabupaten Manggarai Barat
Tobias Lada
NIP. Nip.19741102 199503 1 001
ordinator