Surat Pernyataan Kesediaan

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Surat Pernyataan Kesediaan

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SURAT PERNYATAAN KESEDIAAN

Yang bertanda tangan dibawah ini :

Nama FKTP : ...................................................................................................

Nama Pimpinan : ...................................................................................................

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

: ...................................................................................................

No Telp / HP : ...................................................................................................

Email : ...................................................................................................

BERSEDIA
1. Mematuhi Peraturan Perundangan yang berlaku.
2. Memberikan kemudahan akses rekam medis.

Demikian pernyataan kesediaan ini dibuat dengan sebenar benarnya untuk dapat dilaksanakan.

............., .......................... 2018

Yang membuat pernyataan,

.............................................

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