PEMERINTAH KABUPATEN BANDUNG
RUMAH SAKIT UMUM DAERAH CICALENGKA
JI. H, Darham No. 35 - Cikopo Desa Tenjolaya Telp. (022) 7952203 Fax (022) 7952204 Kec. Cicalengka 40395
Kabupaten Bandung Provinsi Jawa Barat, E-mail: rsudcicalengka@bandungkab go.id
= emt < ‘Website: www.rsudcicalengka, bandungkab.go.id
SURAT KETERANGAN BERBADAN SEHAT
‘Nomor : 445.91/641/RSUDC-SKBS/IV/2023
“Yang bertanda tangan di bawah ini, Dokter RSUD Cicalengka menerangkan bahwa :
‘Nama ‘ASEP MUHAMMAD IRFAN HILMI, $.Pd.1
No. Rekam Medik 215557
‘Tempat/Tegl. lahir : Bandung, 7 November 1989
Jenis Kelamin 2 Laki-Laki
Alamat : Kp. Warungeina 001/002 Ds. Linggar, Kec. Rancackek,
Kab, Bandung
‘Telah diperiksa kesehatannya saat ini, dengan hasil :
BERBADAN SEHAT
Keterangan ini diberikan untuk Persyaratan Pemberkasan PPPK Guru.
Hasil Pemeriksaan :
Tinggi Badan
Berat Badan
‘Tensi
Nadi
Suhu
Surat Keterangan ini dil
L
—Sa aS fc
Surat Keterangan ini || =
TANPA Pemeriksaan
Dokter Per
RAPID dan atau PCR |
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