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Surat Kesehatan
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  PEMERINTAH KABUPATEN MAGETAN

DINAS KESEHATAN

PUSKESMAS ............................................. 

SURAT KETERANGAN DOKTER

 Nomor : 445/889/90.899/SKD/2018

Yang bertanda tangan dibawah ini ,kami dokter Pemerintah pada Puskesmas
..................................... Kabupaten Magetan , menerangkan bahwa :

 Nama :.......................................................................................
Umur :...............Tahun
Pekerjaan :.......................................................................................
Alamat :.......................................................................................

Pada tanggal ........................................................kami lakukan pemeriksaan

dengan hasil : sehat

Surat keterangan ini dipergunakan untuk...........................................................

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