Surat Keterangan Dokter.docx

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PEMERINTAH KABUPATEN WONOSOBO

DINAS KESEHATAN PUSKESMAS SAPURAN Jl. Kalibawang KM.18 Kp sidodadi Telp (0286)611028 Email : [email protected]

SURAT KETERANGAN DOKTER No:…/pus/…/20 Yang bertanda tangan di bawah ini menerangkan bahwa ; Nama

:

Umur

:

Alamat

: :

Tanggal Pemeriksaan

:

Hasil Pemeriksaan

:

Keterangan

:

Tensi

:

mmHg

BB

:

Kg

TB

:

Cm

Gol Darah

:

AB / A / B / O Dokter Pemeriksa

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