Kuitansi Pembayaran RM
Kuitansi Pembayaran RM
DINAS KESEHATAN
UPTD PUSKESMAS BOJONG
JL.RAYA BOJONG NO .130 TELP (0281)895680 PURBALINGGA
Untuk pembayaran
Pemeriksaan kesehatan : ..................................................................................... Rp........................
Tindakan : ..................................................................................... Rp........................
Laborat : ..................................................................................... Rp........................
Pendaftaran : ..................................................................................... Rp........................
Rp........................
Bojong,.............../........./.........2018
a.n Kepala UPTD Puskesmas bojong
Terbilang Rp :