DINAS KESEHATAN
UPT PUSKESMAS SINDANGRATU
Jln. Raya Bungbulang KM 65 Pakenjeng-Garut 44164
Email : puskesmasdtpsindangratu@gmail.com
Kepada
Yth. Bagian Rawat Inap
UPT Puskesmas Sindangratu
Di Tempat
Nama : .........................................................................................................................
Umur : .........................................................................................................................
Pekerjaan : .........................................................................................................................
Alamat : .........................................................................................................................
Sindangratu, ...............................
Salam Sejawat,
...................................................