health statement

HEALTH STATEMENT

            The undersigned below a / n Hospital Director Dr. Soetomo Ngawi district is hereby stated that:

Name                           : Digdo Laksono

ID                                : 432296

Department                :

Company                     : Carnival Cruise Line

            Place and date of birth: Ngawi, 01 Of June 1983

            Gender                          : Male

            Address                       : Ngawi, East Java

            Stating been healthy ever experienced accident on December 11, 2012. Thus the patient has been able to do the activities / work as usual. Such a statement is made with actual, to be used as needed.

Ngawi, January 9, 2013
a / n Director RS Dr.Soetomo

                                                                                                            Dr. Amalia Siahaan