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RUMAH SAKIT

TNI AU dr. DODY SARJOTO LANUD SULTAN HASANUDDIN


Jl. Bandara Baru Telp 0411-553185 Maros, Kode Pos 90511

SURAT KETERANGAN OPNAME


Nomor : /RS/RP/ /2014

Yang bertanda tangan dibawah ini :


Nama : .............................................................................................
No. BPJS : .............................................................................................
No. SEP : .............................................................................................
Pekerjaan : .............................................................................................
Alamat : .............................................................................................

Sementara OPNAME mulai tanggal .......................................................................Sampai sekarang.


Demikian disampaikan untuk dipergunakan sebagaimana mestinya.

Keterangan : Maros, 2015


Dokter
...........................................................
...........................................................
...........................................................
...........................................................
..............................................
...........................................................

RUMAH SAKIT
TNI AU dr. DODY SARJOTO LANUD SULTAN HASANUDDIN
Jl. Bandara Baru Telp 0411-553185 Maros, Kode Pos 90511

SURAT KETERANGAN OPNAME


Nomor : /RS/RP/ /2014

Yang bertanda tangan dibawah ini :


Nama : .............................................................................................
No.BPJS : .............................................................................................
No. SEP : .............................................................................................
Pekerjaan : .............................................................................................
Alamat : .............................................................................................

Sementara OPNAME mulai tanggal .......................................................................Sampai sekarang.


Demikian disampaikan untuk dipergunakan sebagaimana mestinya.

Keterangan : Maros, 2015


Dokter
...........................................................
...........................................................
...........................................................
...........................................................
..............................................
...........................................................

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