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(Kop Surat RS/ Klinik /laboratorium Yang Memeriksa) (Wajib Harus Resmi)

The document is a medical certificate that was issued for an individual after they underwent several medical examinations and tests. These tests included basic medical checks, HIV/AIDS diagnosis, tuberculosis testing, hepatitis testing, and allergy testing. The certificate confirms that the individual is in healthy condition and states the date and doctor signature with clinic/hospital stamp.

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114 views3 pages

(Kop Surat RS/ Klinik /laboratorium Yang Memeriksa) (Wajib Harus Resmi)

The document is a medical certificate that was issued for an individual after they underwent several medical examinations and tests. These tests included basic medical checks, HIV/AIDS diagnosis, tuberculosis testing, hepatitis testing, and allergy testing. The certificate confirms that the individual is in healthy condition and states the date and doctor signature with clinic/hospital stamp.

Uploaded by

GOV Zenith
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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(KOP SURAT RS/ KLINIK /LABORATORIUM YANG MEMERIKSA)

(WAJIB HARUS RESMI)


---------------------------------------------------------------------------------------------------

MEDICAL CERTIFICATE
No:pppppppppppppppppP

I, the Undersigned Doctor in Medicine, have examined:

Name :
Place, date of birth :
Age :
Nationality :
Height/weight :
Blood type :

I have found that Mr. /Ms. /Mrs. PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP

is in healthy condition after laboratory researches and tests:

1.The basic medical check-up…………………………………………………...


2.Diagnosis of HIV/ Aids……………………………………………………..
3.Tuberculosis test…………………………………………………………..
4.Hepatitis test…………………………………………………………….
5.Allergy test………………………………………………………………

ppppppppppppppppppppppp2020

(Stamp Rumah sakit/kllinik) (TTD dan Stamp Dokter)

WAJIB WAJIB

pppppppppppppppppp

*)
Copy of laboratory medical check-up result is attached
(KOP SURAT RS/ KLINIK /LABORATORIUM YANG MEMERIKSA)
(WAJIB HARUS RESMI)
---------------------------------------------------------------------------------------------------

MEDICAL CERTIFICATE for HIV/AIDS


No:pppppppppppppppppP

I, the Undersigned Doctor in Medicine, have examined:

Name :
Place, date of birth :
Age :
Nationality :
Height/weight :
Blood type :

I have found that Mr. /Ms. /Mrs. ppppppppppppppppppppppppppppppppppppppppp


In connection with the intended purpose, that the results of laboratory tests using
the RAPID TEST method conducted on ppppppppppppppppp at ppppppppppppppppp
ppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp

"Anti-HIV test results: Non-reactive"

ppppppppppppppppppppppp2020

(Stamp Rumah sakit/kllinik) (TTD dan Stamp Dokter)

WAJIB WAJIB

Pppppppppppppppppp

*)
Copy of laboratory result is attached
(KOP SURAT RS/ KLINIK /LABORATORIUM YANG MEMERIKSA)
(WAJIB HARUS RESMI)
---------------------------------------------------------------------------------------------------

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