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HOSPITAL KULIM TELEFON: 04-4272733, 04-4272804,

JALAN MAHANG 04-4272805, 04-4272806.


09000 KULIM NO.FAX : 04-4900760.
KEDAH DARULAMAN
Ruj. Tuan : SP37/14/LP
Ruj. Kami : (1075/14)dlm.HK/PRP/LP
Tarikh : 01 JUNE 2015

Butiran Pesakit (Patient Particulars):


Nama pesakit (Name of patient) : SIVA KUMAR A/L PERUMAL
No K/P (I/C No): Baru (New): 801111-02-5375
MRN: -78310
Umur (Age): 34 TAHUN
Jantina (Sex): LELAKI (MALE)

Clarification report
 This patient came for review in our clinic complaining of pain at left knee.
He walked into our clinic limping. We refer this patient to orthopaedic clinic
in Hospital Kulim for further management on 07/01/2015.

Laporan disediakan oleh (Report prepared by):


Nama(Name): DR.AHMAD FAKRURROZI BIN MOHAMAD.
No K/P (I/C No): 890228-07-5269.
Jawatan (Designation): PEGAWAI PERGIGIAN U41.
Kelulusan (Qualification): BDS (JORDAN)UST.
Jabatan (Department): BEDAH MULUT DAN MAKSILOFASIAL, HOSPITAL KULIM.

Tandatangan (Signature): ……………………..................................

Cop Rasmi Hospital (Official Hospital Stamp):

S.K.:
SUBRA & PARTNER
PEGUAMBELA & PEGUAMCARA
1ST FLOOR, ROOM H
NO.29, BEACH STREET
10300 PENANG

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