DINAS KESEHATAN
UPTD PUSKESMAS DTP JATIREJA
JL. RAYA JATIREJA – COMPRENG NO.123
KECAMATAN COMPRENG KODE POS 41258
email : pkmjatireja@gmail.com Whatshapp : 089699588595
Kepada Yth,
Unit Pelayanan..................
Nama :.................................................................................................
Umur : .................................................................................................
Pekerjaan :......................................................................................................
Alamat : ................................................................................................
Mohon dilakukan pemeriksaan / tindakan / perawatan
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Compreng,....................2019
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