Kepada : ........................................................................................
Dari : ........................................................................................
Tanggal : ........................................................................................
Nomor : 001/ND/UMUM/RSBH/II/2019
Lampiran : ........................................................................................
Perihal : ........................................................................................
Isi :
Kendal, ................................
Yang mengajukan, Mengetahui,
__________________ _____________________
Catatan persetujuan
Kendal, .......................
Menyetujui,