DINAS KESEHATAN KABUPATEN TULANG BAWANG BARAT

PUSKESMAS KIBANG BUDI JAYA

KECAMATAN LAMBU KIBANG

SURAT KETERANGAN SEHAT

 Nomor : /PKBJ/SKS/ /2016

Yang beran!a angan !"ba#a$ "n" %o&er Pemer"&'a P('&e'ma' K"bang B(!" Ja)a
Ke*amaan Lamb( K"bang+ Menerang&an:

 Nama :
Um(r :
Jen"' Ke,am"n :
Pe&er-aan :
A,ama :

.a'", emer"&'aan "'"& &am" a!a angga, !" P('&e'ma'

K"bang B(!" Ja)a a!a,a$ 'ebaga" ber"&( :

Bera B a!an :
T"ngg" B a!an :
Te&anan %ara$ :
Go,ongan %ara$ :
"#a)a Pen)a&" :

S(ra Keerangan Se$a "n" !"erg(na&an 'ebaga" 

%em"&"an '(ra &eerangan "n" !"b(a (n(& !aa !"erg(na&an 'ebaga"mana me'"n)a

K"bang B(!" Ja)a+ 2016

%o&er Pemer"&'a

 !r Naa')a Begg) C

 NPTT : 031415005
 DINAS KESEHATAN KABUPATEN TULANG BAWANG BARAT

PUSKESMAS KIBANG BUDI JAYA

KECAMATAN LAMBU KIBANG

SURAT KETERANGAN SEHAT

 Nomor : /PKBJ/SKS/ /2016

Yang beran!a angan !" ba#a$ "n"+ menerang&an :

 Nama :   
Um(r :   T a$(n
Jen"' Ke,am"n : La&",a&"/Perem(an
Pe&er-aan :
 A,ama :
  

.a'", emer"&'aan "'"& &am" a!a angga,2011 a!a,a$ 'ebaga" ber"&( :

Bera Ba!an :&g
T"ngg" Ba!an : *m
Te&anan %ara$ :mm/$g
Go,ongan %ara$ : 
"#a)a Pen)a&" : 
La"n,a"n :
 Ke'"m(,an : S E
HAT

S(ra &eerangan "n" !"erg(na&an 'ebaga" ')ara

%em"&"an '(ra &eerangan "n" &am" b(a (n(& !aa !"&ea$(" !an !"erg(na&an 'ebaga"mana
me'"n)a

K"bang B(!" Ja)a+ 

%o&er Pemer"&'a

!r N",a#a)
 NIP 178509102002122002
 DINAS KESEHATAN KABUPATEN TULANG BAWANG BARAT

PUSKESMAS KIBANG BUDI JAYA

KECAMATAN LAMBU KIBANG

SURAT KETERANGAN SAKIT

Yang beran!a angan !" ba#a$ "n" + menerang&an :

 Nama :   
Um(r :   T a$(n
Jen"' Ke,am"n : La&",a&"/Perem(an
Pe&er-aan :
 A,ama :
   Per,( ber"'"ra$a
'e,ama ; $ar" !ar" angga,'/!
&arena SAKIT Kea!
a )ang ber&een"ngan+ $ara ma&,(m
K"bang B(!" Ja)a+ 
Pemer"&'a

dr. Nilawaty
NIP 197504102002122002