Anda di halaman 1dari 2

drg.

Rangga Lesmana
Sip : 446/ 1783 / SDK-Diskes /2017
Jl. Sukahening. Kp. Pasanggrahan RT/RW : 03/01
Desa Mangunjaya Kec. Rajapolah Kab. Tasikmalaya

SURAT KETERANGAN SAKIT


Yang bertanda tangan dibawah ini menerangkan bahwa :
Nama :.........................
................................................................................................................
Umur :.........................................................................................................................................
Alamat :.........................................................................................................................................
Perlu istirahat sakit, selama.............................hari
Terhitung tanggal.............................................. s/d.................................................................................
Harap yang berkepentingan maklum
Tasikmalaya,.................20

(______________________)
drg. Rangga Lesmana
Sip : 446/ 1783 / SDK-Diskes /2017
Jl. Sukahening. Kp. Pasanggrahan RT/RW : 03/01
Desa Mangunjaya Kec. Rajapolah Kab. Tasikmalaya

SURAT KETERANGAN SAKIT


Yang bertanda tangan dibawah ini menerangkan bahwa :
Nama :.........................................................................................................................................
Umur :.........................................................................................................................................
Alamat :.........................................................................................................................................
Perlu istirahat sakit, selama.............................hari
Terhitung tanggal.............................................. s/d.................................................................................
Harap yang berkepentingan maklum
Tasikmalaya,.................20

(______________________)
drg. Rangga Lesmana
Sip : 446/ 1783 / SDK-Diskes /2017
Jl. Sukahening. Kp. Pasanggrahan RT/RW : 03/01
Desa Mangunjaya Kec. Rajapolah Kab. Tasikmalaya

SURAT KETERANGAN SAKIT


Yang bertanda tangan dibawah ini menerangkan bahwa :
Nama :.........................................................................................................................................
Umur :.........................................................................................................................................
Alamat :.........................................................................................................................................
Perlu istirahat sakit, selama.............................hari
Terhitung tanggal.............................................. s/d.................................................................................
Harap yang berkepentingan maklum
Tasikmalaya,.................20
(______________________)

Anda mungkin juga menyukai