Contoh Statement Letter

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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 23^rd 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 5^th 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 23^th 2016

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