SURAT PENGANTAR UGD

Kediri, ........................................

Kepada Yth :

TS dokter UGD RS ......................................................................

Bersama ini kami kirimkan pasien :

Nama: ..............................................................................

Umur:...............................................................................

Alamat:...............................................................................

No Kartu:...............................................................................

Disebabkan karena keadaan pasien :.................................................................................................

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Maka, kami arahkan ke UGD tidak ke poli spesialis.

Atas bantuannya , BTK

Hormat kami,

dr. Yoke Retnaningpuri