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dr. DWI SUNARJADI, MKM dr.

DWI SUNARJADI, MKM


dr. MELANIA DESSY SAVITRI dr. MELANIA DESSY SAVITRI
Jl. Datu 598, Tiuh Balak Pasar 
Jl. Datu 598, Tiuh Balak Pasar 
Kecamatan Baradatu, Kabupaten Way Kanan
Kecamatan Baradatu, Kabupaten Way Kanan Lampun !"#$%
Lampun !"#$%

SURAT KETERANGAN SURAT KETERANGAN


MENUNGGU KELUARGA SAKIT MENUNGGU KELUARGA SAKIT

&aya, yan bertandatanan di ba'ah ini, menerankan bah'a ( &aya, yan bertanda tanan di ba'ah ini, menerankan bah'a (
)ama (................................................ )ama (................................................
 *lamat (................................................  *lamat (................................................
Peker+aan (................................................ Peker+aan (................................................

Benarbenar harus menunu an-ta keluaranya yan sakit, Benarbenar harus menunu an-ta keluaranya yan sakit,
yaitu ( yaitu (
)ama (................................................ )ama (................................................
mur (................................................ mur (................................................
 *lamat (................................................  *lamat (................................................
/ubunan kekerabatan (................................................ /ubunan kekerabatan (................................................
Dian-sis ker+a (................................................ Dian-sis ker+a (................................................

Baradatu, ................................... Baradatu, ....................................


.
D-kter yan menerankan,
D-kter yan menerankan,

dr.......................................... .....
dr.......................................... ..... )0P
)0P

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