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DOKTER PRAKTIK MANDIRI DOKTER PRAKTIK MANDIRI

dr. Putut Himawan dr. Putut Himawan


SIP No. 33094.57381/DU/02/449.1/0059/IV/2021 SIP No. 33094.57381/DU/02/449.1/0059/IV/2021
Pulutan 8/2, Kebonan, Karanggede, Boyolali. HP : 089 66666 1 999 Pulutan 8/2, Kebonan, Karanggede, Boyolali. HP : 089 66666 1 999

SURAT KETERANGAN SURAT KETERANGAN

Yang bertanda tangan dibawah ini, menerangkan bahwa : Yang bertanda tangan dibawah ini, menerangkan bahwa :

Nama : ............................................................................................. Nama : .............................................................................................


Umur : ............................................................................................. Umur : .............................................................................................
Pekerjaan : ............................................................................................. Pekerjaan : .............................................................................................
Alamat : ............................................................................................. Alamat : .............................................................................................

Telah hamil ........................... Minggu, Telah hamil ........................... Minggu,


Partus / Melahirkan diperkirakan tanggal ........................................., 20........ Partus / Melahirkan diperkirakan tanggal ........................................., 20........
Mulai istirahat / Cuti tanggal ................................... s/d ................................. Mulai istirahat / Cuti tanggal ................................... s/d .................................
Keterangan USG : Keterangan USG :
............................................................ ............................................................
............................................................ ............................................................
............................................................ ............................................................
............................................................ ............................................................
Demikian, harap yang berkepentingan maklum adanya, Terimakasih. Demikian, harap yang berkepentingan maklum adanya, Terimakasih.

Karanggede,..................................... 20........ Karanggede,..................................... 20.......


Dokter Pemeriksa, Dokter Pemeriksa,

dr. Putut Himawan dr. Putut Himawan

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