Surat Keterangan Sehat Gigi

PEMERINTAH KABUPATEN INDRAMAYU DINAS KESEHATAN

PUSKESMAS SUKRA Jl. Raya Sukra Tel./Fax. Tel./Fax. : (0234)610159 Kode Po : 4525! "#a$l :

SURAT KETERANGAN GIGI GELIGI %a&' era&da a&'a& d$a*a+ $&$, -oker $'$ Puke#a Sukra Kauae& &dra#ayu #e&era&'ka& a+*a :  a#a :    #ur :  Je&$ Kela#$& :     Peke Peker raa aa& & :                la#a : 

K"T"R : : ar$e

X : 7$$&' √ : S$a kar  O : F$ll$&'

-$a'&oa : .. ..     .. T$&daka& ya&' d$erluka& :       Keera&'a& $&$ d$erluka& u&uk : .. .. 

Ta&da Ta&'a& ya&' d$er$ka

&dra#ayu, ..20. -oker Pe#er$ka

(..)

(..) P. . ...