SURAT KETERANGAN BERBADAN SEHAT Certificate Of Healthy

Yang bertanda tangan dibawah ini menerangkan bahwa : The Undersigned below explain that :

N a m a : N a m e

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Jenis Kelamin : S e x

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U m u r : A g e

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Alamat : A d d r e s s

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Berdasarkan pemeriksaan fisik yang dilakukan oleh dokter RS Sari Asih dinyatakan : Based on physical examination by doctor in Sari Asih Hospital the patient indicated of

BERBADAN SEHAT

Healty

Untuk : ............................................................................................... For

Catatan Note

Tensi

BB TB

Demikian agar yang berkepentingan menjadi maklum. This letter is for the use of specified person only

Tangerang, ............................................ 20.....

:

: Blood Pressure Weight Of Body Heigh Of Body

:

:

Dokter