SURAT RUJUKAN
Dengan hormat,
Bersama ini kami kirimkan pasien dengan data-data sebagai berikut :
Nama hewan : .........................................................................................................
Jenis kelamin / Usia : .........................................................................................................
Ras / warna hewan : .........................................................................................................
Nama pemilik : .........................................................................................................
Alamat pemilik : .........................................................................................................
No. telp : .........................................................................................................
Anamnesa : ..........................................................................................................................................
...................................................................................................................................................................
Hasil pemeriksaan / kondisi selama dirawat :
................................................................................. ……………………………………………………………
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
Diagnosa : .............................................................................................................................................
Pengobatan yang sudah diberikan :
....................................................................................................................................................................
....................................................................................................................................................................
Saran : ..............................................................................................................................................
Kami mohon bantuan untuk second opinion dan perawatan lebih lanjut. Atas
perhatian dan kerjasamanya, kami ucapkan banyak terima kasih.
Jakarta, …………………….….………….
Hormat Kami,
(……………………………………………)
AMORE ANIMAL CLINIC 4
Jl Kemang Utara no. 24
Bangka, Mampang Prapatan, Jakarta Selatan 12730
Telp. 0822 6161 3379
Email : clinicamore@gmail.com