PUSKESMAS SAMANENTE
Alamat: Distrik Tor Atas-(Seser)-Email:pkm_smnt@yahoo.com (Papua)
SURAT RUJUKAN
No. 843/030/pkm-smnt/iii/2018
Kepada Yth
.................................................................
.................................................................
di-
.................................
Nama :................................................................................................
Umur :................................................................................................
Alamat :................................................................................................
Anamnesa :................................................................................................
..................................................................................................
..................................................................................................
TD :.................................mmHg
Fisik :.................................................................................................
...................................................................................................
Therapi :..................................................................................................
...................................................................................................
Diagnosa :..................................................................................................
Demikian surat rujukan ini kami buat atas kerjasamnya kami ucapkan terimakasih.
Samanente,.........................................
Pengirim
............................................................
Nip/Nrptt.
DINAS KESEHATAN KABUPATEN SARMI
PUSKESMAS SAMANENTE
Alamat: Distrik Tor Atas(Seser) E-mail:pkm_smnt@yahoo.com (Papua)
SURAT PENGANTAR
No. 445/030/pkm-smnt/iii/ 2018
Kepada Yth
.................................................................
.................................................................
di-
.................................
Nama :................................................................................................
Umur :................................................................................................
Alamat :................................................................................................
Anamnesa :................................................................................................
..................................................................................................
..................................................................................................
TD :.................................mmHg
Fisik :.................................................................................................
...................................................................................................
Therapi :..................................................................................................
...................................................................................................
Diagnosa :..................................................................................................
Demikian surat pengantar ini kami buat atas kerjasamnya kami ucapkan terimakasih.
Samanente,.........................................
Pengirim
............................................................
Nip/Nrptt.