lllness Letter

Illness Letter Sample

Dinas Kesehatan Kabupaten Subang
UPTD Puskesmas Tanjungsiang
Jalan Raya Tanjungsiang - Subang -Indonesia
Tlp. 0260-480391


No.:123/120/SICK/II/2017               February 28, 2017


I, the undersigned, hereby certify that Sutarmaji, holder of passport number N2456789 was temporarily diagnosed for HNP Susp. on February 28, 2017 and he is not fit for duty for a month due to the diagnose of illness mentioned above.


Chief Physician,


dr. Prana Pramudya
NIP 123 456 789

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Aji Sutarmaji,
Apr 14, 2014, 6:42 PM