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PRAKTEK UMUM
DOKTER ************************
Alamat/Address : *************************
Phone : ************************
MEDICAL RECORD
NO : ******************
Personal Identity : **************** Sex : Female
First Name : ****** Age : 55 Th
Family Name : Nationality : Indonesia
Marital Status :
Address in Bali : **************************
Anamnesis : Patient come to hospital
complained of left wrist joint injury
cause by accident
Physical Examination
Head and Neck : Normally
Blood Pressure : 160/100 mmHg, Temp : 36C, RR : 20X/Mnt
Thorax :
Normally
Abdominal : Normally
Extremity : Normally
Others :
Normally
Physical Diagnostic
Laboratory : -
Radiology : -
Others :
Suspect left wrist joint subluxation
Diagnosis : Suspect left wrist joint subluxation
Different Diagnostic :
Therapy :
1. P.O : Nicostan 3 x 500 mg
2. Fixation
3. Aden’s :
Radiology
Remark
The above patient
is the mother of :
Name : ***************
ID : **************
Tabanan, 20 Desember 2016
***********************
General Practitioners
STATEMENT LETTER
On this
day, the 23rd of December 2016, I the undersigned this :
Name : ********************
POSITION : *****************
ID : ****************
Through this statement I Beg to be allowed back to
work at Carnival Cruise Lines as soon as possible, because my mother was sick
at that time and now the state again my mother is improving and I want to get back
on the date 5th January 2017.
I was implored t be allowed back to work in the near
future, Where I was head of the family, and all the needs of the economy
depends on my income.
So I ask you please to be immediately sent a letter of
mine to be able to immediately perform my duties and obligation as a family
head.
Thank you for your time and attention would read and
respond positively to the letter of this statement.
Hopefully always healthy, always happy.
TABANAN, DECEMBER 23th 2016
**********************************
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