PEMERINTAH KOTA PAREPARE

DINAS KESEHATAN
PUSKESMAS PUSAT GUGUS MADISING NA MARIO
PILOT PROJECT DEPARTEMENT OF HEALHT FO SAFE COMMUNITY

Jl Mattirotasi No. 18 KP.91111. Telp. (062-0421) 26855 PAREPARE–INDONESIA Email: madisingnamario@gmail.com

MEDICAL REPORT
( To be retained by the immigration department )

Name : GAFFA Serial Number : 0015/PPGMNM/LAB/I/2018

Sex : LAKI – LAKI Exam Date : 09 FEBRUARI 2018

Photo
Birth Date : TAHUN Passport No. :

Status : Visa No. :

Nationality : Applied For :

District : Supplier :

Province : SULAWESI SELATAN

I have examined the above Medical Report for ………………………………………………………..

To whom I fount

1. Is…………. From the following disease YES NO

HEPATITS

Therefore I recommended that …………………. Be considerate for employment

( If not considerate for employment please state the reason )

Head Office, Laboratory,

dr. HASLINDA KADIR, M. KES TAUFIK HIDAYAT. S.ST

NIP. 19760703 200604 2 026 NIP. 19860717 201101 1 009
 PEMERINTAH KOTA PAREPARE
DINAS KESEHATAN
PUSKESMAS PUSAT GUGUS MADISING NA MARIO
PILOT PROJECT DEPARTEMENT OF HEALHT FO SAFE COMMUNITY

Jl Mattirotasi No. 18 KP.91111. Telp. (062-0421) 26855 PAREPARE–INDONESIA Email: madisingnamario@gmail.com

NIP.1986 0717 2011 01 1 009