Anda di halaman 1dari 1

SURAT KETERANGAN SAKIT SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan bahwa : Yang bertanda tangan dibawah ini menerangkan bahwa :

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

Jenis Kelamin : ..................................................................................... Jenis Kelamin : .....................................................................................

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

Pekerjaan : ..................................................................................... Pekerjaan : .....................................................................................

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

Perlu beristirahat karena sakit selama......................................(...........................)hari. Terhitung Perlu beristirahat karena sakit selama......................................(...........................)hari. Terhitung
tanggal....................................................s/d............................................................................... tanggal....................................................s/d...............................................................................

Harap yang bekepentingan maklum. Harap yang bekepentingan maklum.

Bolong,........./...................................../20..... Bolong,........./...................................../20.....

Dokter Pemeriksa Dokter Pemeriksa

Dr. Aulia Marlina Dr. Aulia Marlina

Anda mungkin juga menyukai