Surat Keterangan Rawat Inap

PEMERINTAH KABUPATEN LAMONGAN DINAS KESEHATAN U.P.T PUSKESMAS KARANGPILANG KEC. MODO Jl. Raya Babat-Jombang No. 1 T!l". # $%& '(1 )%( MODO - *+(  e-mail : [email protected]

SURAT KETERANGAN RAWAT INAP

 Nomo,  ......................................... ................................................... ..........

ang a ng b!,tan/a tangan /0 baa2 0n0   Nama

 /,. JUDI HARI 3IBO3O

 NIP

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Jabatan

 Ka. UPT P567!6ma6 Ka,ang"0lang

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Alam Al amat at

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D0agno6a

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T!la2 T! la2 /0,aat /0 UPT P567!6ma6 Ka,ang"0lang- Mo/o 6!9a7 tanggal ta nggal ............................... ............................... 6am"a0 /!ngan tanggal ...................................... ......................................  D!m070an 65,at 7!t!,angan 0n0 /0b5at 5nt57 /a"at /0"!,g5na7an 6!baga0 65,at 090n t0/a7 ma657 6!7ola2.

Lamongan: ....................... .................................. ........... K!"ala UPT P567!6ma6 Ka,ang"0lang

dr. JUDI HARI WIBOWO

 NIP. 14**$*$1 $1$$1 1 $$*