RSUD Dr. Dr. ACHMAD AC HMAD MOCHTAR BUKITTINGGI Jalan Dr. Dr. A. Rivai – Bukittinggi Telp. (0752) 21720 21720 - 21492 21492 - 21!1 – 21!22 "a#. (0752) 21!21 Telp Dir. Dir. (0752) !!25
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PERMOHONAN IZIN PULANG DALAM JANGKA WAKTU TERTENTU/ CUTI PERAWATAN
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$ela,a &era*a *i luar Ru,a $akit Dr. A,a* /tar Bukittinggi: pa+ien &era*a *i ........................................................................................................................ ............................................................................................................................ ......................./ telep/n %ang &i+a *iu&ungi ................................... Bukittinggi: ............................................
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