Format Surat Sakit.docx

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DINAS KESEHATAN KOTA PEKANBARU PUSKESMAS SIMPANG BARU KECAMATAN TAMPAN Jl. Kamboja Panam, No 10 Kecamatan Tampan Pekanbaru

SURAT KETERANGAN SAKIT Yang bertanda tangan dibawah ini Dokter : …………………………………………… Menerangkan bahwa Nama : …………………………………………… Umur : …………………………………………… Pekerjaan : …………………………………………… Alamat : …………………………………………… Perlu beristirahat karena sakit selama………………….………. (……..) hari Terhitung tanggal………………….………s/d…………….…………………… Harap yang berkepentingan maklum.

Pekanbaru, 3 Maret 2019.

(……………..……..……)

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