PT.

BANGUN JAYA ALAM PERMAI 3

OIL PALM PLANTATION & MILLING INDUSTRY

Kepada
Yth ____________________________
Di _____________________________

Dengan hormat,
Mohon pemeriksaan dan penatalaksanaan lebih lanjut, atas karyawan kami atas nama:
Nama :
Umur / Jenis Kelamin :
Keluhan:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Diagnosis:
________________________________________________________________________________
________________________________________________________________________________
Penanganan yang sudah diberikan
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Catatan
________________________________________________________________________________
________________________________________________________________________________
Atas perhatian dan kerjasamanya, kami ucapkan terima kasih.

_____________, _______________________

(_______________________)
 Dokter Pemeriksa

PT. BEST AGRO INTERNATIONAL

OIL PALM PLANTATION & MILLING INDUSTRY

Kepada
Yth ____________________________
Di _____________________________

Dengan hormat,
Mohon pemeriksaan dan penatalaksanaan lebih lanjut, atas karyawan kami atas nama:
Nama :
No.BPJS :
Umur / Jenis Kelamin :
Keluhan:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Diagnosis:
________________________________________________________________________________
________________________________________________________________________________
Penanganan yang sudah diberikan
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Catatan
________________________________________________________________________________
________________________________________________________________________________
Atas perhatian dan kerjasamanya, kami ucapkan terima kasih.

_____________, _______________________
(_______________________)
Dokter