239874989 Surat Keterangan Sakit Doc

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    PRAKTEK DOKTER KELUARGA

    dr. Muhammad Rifki El Muammary

    Klinik Benteng (Jl. Sultan Agung no. II)/Puskesmas Sei Duren

    SIP : 441/16/SIP-D/DI!K"S/#$1%

    &an'one: $*11+461$*, el uma: $+41-$6#1#1%

    SA K""A!0A! SAKI

    Yang bertanda tangan di bawah ini menerangkan bahwa :

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

    Umur : ..................................................................................................................

    Kelamin : ..................................................................................................................

    Pekerjaan : ..................................................................................................................

    Alamat : ..................................................................................................................

    Oleh karena sakit, maka memerlukan istirahat selama :..................................(....................) hari,

    terhitung mulai tanggal....................................sampai dengan tanggal..........................................

    arap menjadi maklum.!ambi,...............................

    "#kter $ang memeriksa

    (............................................)

    PRAKTEK DOKTER KELUARGA

    dr. Muhammad Rifki El Muammary

    Klinik Benteng (Jl. Sultan Agung no. II)/Puskesmas Sei Duren

    SIP : 441/16/SIP-D/DI!K"S/#$1%

    &an'one: $*11+461$*, el uma: $+41-$6#1#1%

    SA K""A!0A! SAKIYang bertanda tangan di bawah ini menerangkan bahwa :

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

    Umur : ..................................................................................................................

    Kelamin : ..................................................................................................................

    Pekerjaan : ..................................................................................................................

    Alamat : ..................................................................................................................

    Oleh karena sakit, maka memerlukan istirahat selama :..................................(....................) hari,

    terhitung mulai tanggal....................................sampai dengan tanggal..........................................

    arap menjadi maklum.

    !ambi,...............................

    "#kter $ang memeriksa

    (............................................)