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RUMAH SAKIT UMUM SINAR KASIH TENTENA

YAYASAN PELAYANAN KESEHATAN MASYARAKAT GKST


Jl. Setia Budi 98 Tentena 94663 Poso, Sulawesi Tengah-Indonesia
Tel. 0458-21051; Fax. 0458-21393 E-mail : sinarkasihttn@gmail.com

SURAT KETERANGAN EMERGENCY


No. 001/RSSK/EMR/I/2018

Nama : ...........................................................................................................

Umur : ............................................................................................................

Alamat : ............................................................................................................

No Kartu BPJS : ............................................................................................................

Diagnosa : ............................................................................................................

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Tentena, 07 Januari 2018

Peserta BPJS/Wali Dokter Jaga IGD

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