Put Jenggo.docx

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PANGKALAN UTAMA TNI AL XI RUMKITAL MERAUKE

SURAT KETERANGAN RAWAT INAP No : / / /

Menerangkan bahwa , Nama

:

Umur

:

Diagnosa

:

tanggal dirawat

:

Dokter yang merawat

:

Ruangan

:

Lain-lain

- VIP I

- VIP II

- KELAS I

- KELAS II

:

Atas nama tersebut di atas telah menjalani perawatan di Rumkital Merauke selama …. hari. Demikian surat keterangan ini dibuat dengan sebenarnya.

Merauke, Agustus 2013 A.n. Karumkital Merauke Dokter yang merawat

…………………………………

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