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    130 views1 page

    Surat Keterangan Sakit

    Uploaded by

    darmawan
    oke

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    PEMERINTAH KABUPTEN BOMBANA

    DINAS KESEHATAN DAN KABUPATEN BOMBANA


    PUSKESMAS KABAENA TIMUR
    Kel. Dongkala Jln. Pendidikan

    SURAT KETERANGAN SAKIT


    Nomor : / / /2018

    Yang bertanda tangan dibawah ini, dokter Puskesmas Kecamatan Kabaena Timur

    menerangkan bahwa :

    Nama : ……………………………………………..

    Tempat/Tanggal Lahir : ……………………………………………..

    Jenis Kelamin : …… ……………………………………….

    Pekerjaan : ……………………………………………..

    Alamat : ……………………………………………..

    Diagnosa : ……………………………………………..

    Berdasarkan Anamnesis dan hasil pemeriksaan Fisik di diagnosa :

    ……………………………………………………………………………………………….

    Sehingga memerlukan bedrest selama …… hari, mulai Tanggal…………………………s/d

    …………………………2018

    Dongkala, 2018
    Dokter Puskesmas Kabaena Timur

    dr. SOPIANITA HEALTHY GINTING


    NIP .19850201 2017 04 2010

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