KLINIK MITRA BHAKTI

JL. BHAKTI IV NO 12 KEL. GAGA, LARANGAN

TELP : 021 - 7344 4972

SURAT KETERANGAN SAKIT

Yang bertanda tangan dibawah ini menerangkan :
Nama : .......................................................
Umur : .......................................................
Perlu beristirahat karena sakit selama ....................................................................................................................................
hari
Terhitung tanggal .........................................................................
s/d ...........................................................................................
harap yang berkepentingan maklum.

Larangan, ...............................

(dr. ..............................)