RSU UKI

Informed Consents
Jl. Mayjen Sutoyo Cawang, Jakarta Timur, 13630
JAKARTA TIMUR 13630
Phone : (021)8092317
Fax : (021)8092445

Surat Keterangan Sakit

Medical Sick Leave
Tanggal : 05-Oct-2023
Date : 05-Oct-2023

Surat ini menyatakan bahwa saya telah memeriksa dan mengobati :

This is certify that I have examined and treated :
CHELSHEA MARGARETHA SIANTURI
27-Apr-2003
Yang bersangkutan akan ijin / tidak layak untuk bertugas selama 2 hari di Perusahaan / Sekolah
of Company / School and she/he will absent/unfit for duties for 2 day(s)

Efektif mulai 05-10-2023 sampai 06-10-2023

Effective from 05-10-2023 until 06-10-2023

Diagnosa :
Diagnose :
Fever, unspecified (R50.9)

( Tanda Tangan & Cap )

( General Practice Signature & Stamp )

MEDINFRAS - PM-00127, Print Date/Time:05-Oct-2023/20:29:23, User ID:202302 Page 1 of 1