Surat Rujukan Pasien.docx

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PEMERINTAH KOTA TEBING TINGGI

DINAS KESEHATAN

UPTD.PUSKESMAS SRI PADANG Jl. Taman Bahagia Kel. Sri Padang Kec. Rambutan TEBING TINGGI

SURAT RUJUKAN PASIEN Nomor:

/ PUSK – SP / 2019

Tebing Tinggi, 01-04-2019 Kepada Yth : T.S Dr. Poli Penyakit Dalam Di RSU Dr.H.Kumpulan Pane KOTA TEBING TINGGI

Dengan Hormat, Mohon Pemeriksaan dan pengobatan lebih lanjut terhadap penderita : Nama

: Maline Br. Tambunan

Umur

: 68 TAHUN

Alamat

: Jl. Subur Lk. III Kec. Rambutan Kota Tebing Tingi

Diagnosa Sementara : Atas pertolongan T.S kami ucapkan terimakasih

Dokter Puskesmas Sri Padang Kota Tebing Tinggi

dr. HAFIZAH, M.Kes NIP. 19670701 200212 2 001

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