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PT.

BUMI SAWINDO PERMAI


Oil Palm Plantation & Palm Oil Mill

SURAT RUJUKAN

Kepada Yth. Dokter : .................................................................................................................................


Di : .................................................................................................................................

Mohon pemeriksaan dan penanganan lebih lanjut terhadap penderita,


Nama : .................................................................................................................................
Jenis Kelamin : .................................................................................................................................
Umur : .................................................................................................................................
Alamat : .................................................................................................................................

Anamnesis : .................................................................................................................................
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Pemeriksaan Fisik : .................................................................................................................................
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Diagnosis Sementara : .................................................................................................................................
Terapi yang telah diberikan : .................................................................................................................................
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Salam Sejawat, .............................. 20.....

dr. Arasy Al-Adnin

Klinik Kesehatan Kerja PT. Bumi Sawindo Permai : Jl. Lintas Sumatera Kecamatan Tanjung Agung Muara Enim, Sumsel

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