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  • Surat Izin Praktik Dokter (Sip) Mandiri Baru

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    Puskesmas Kandis
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    This document provides a recommendation letter for a practicing physician license for Dr. Ratna Sari Dewi from the Head of the Kandis Community Health Center in Siak Regency, Riau Province, Indonesia. It contains details such as Dr. Ratna's personal information, medical license and education credentials. The recommendation is for her to practice independently at a clinic called PRAKTIK MANDIRI R GLOWSKIN in Kandis. It notes the conditions of following applicable procedures, submitting monthly activity reports to the health center, and cooperating with community health programs.

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    SIP DOKTER

    Original Title

    SURAT IZIN PRAKTIK DOKTER (SIP ) MANDIRI BARU

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    This document provides a recommendation letter for a practicing physician license for Dr. Ratna Sari Dewi from the Head of the Kandis Community Health Center in Siak Regency, Riau Province, Indonesia. It contains details such as Dr. Ratna's personal information, medical license and education credentials. The recommendation is for her to practice independently at a clinic called PRAKTIK MANDIRI R GLOWSKIN in Kandis. It notes the conditions of following applicable procedures, submitting monthly activity reports to the health center, and cooperating with community health programs.

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    11 views1 page

    Surat Izin Praktik Dokter (Sip) Mandiri Baru

    Uploaded by

    Puskesmas Kandis
    This document provides a recommendation letter for a practicing physician license for Dr. Ratna Sari Dewi from the Head of the Kandis Community Health Center in Siak Regency, Riau Province, Indonesia. It contains details such as Dr. Ratna's personal information, medical license and education credentials. The recommendation is for her to practice independently at a clinic called PRAKTIK MANDIRI R GLOWSKIN in Kandis. It notes the conditions of following applicable procedures, submitting monthly activity reports to the health center, and cooperating with community health programs.

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    of 1

    PEMERINTAH KABUPATEN SIAK

    DINAS KESEHATAN
    PUSKESMAS KANDIS
    Jl. Satia Maharaja Kelurahan Telaga Sam Sam Kecamatan Kandis
    Telepon (0761) 8423246 Faks (0761) ................
    E-mail: puskesmaskandis@gmail.com

    REKOMENDASI SURAT IZIN PRAKTIK DOKTER


    NOMOR: 440/PKM.KS-TU/VII/2023/

    Yang bertanda tangan dibawah ini, Kepala Puskesmas Kandis Kecamatan Kandis Kabupaten Siak,
    sesuai Peraturan Menteri Kesehatan Nomor:2052/MENKES/PER/X/2011 tentang Registrasi, Izin
    Praktik dan Pelaksanaan Praktik Kedokteran dengan ini memberikan rekomendasi Surat Izin Praktik
    Dokter Ketiga kepada :

    Nama Lengkap : dr. RATNA SARI DEWI


    Alamat : Jl. Wan Abdurrahman Kel. Airdingin Kec. Bukit Raya Kota Pekanbaru
    Tempat, tanggal lahir : Pekanbaru, 23 Januari 1988
    No. STR : 1421100219157332
    No. Rekomendasi Profesi : TUA/IDI/96
    Masa berlaku STR sampai : 23 Januari 2025

    Nama Sarana Pelayanan : PRAKTIK MANDIRI R GLOWSKIN By dr. RATNA


    Alamat Sarana Pelayanan : Jl. Lintas PKU-Duri Km.73 Kandis Kel. Simpang Belutu
    Kec.Kandis Kab. Siak

    Dan sebagai bahan pertimbangan Bapak bersama ini dilampirkan berkas permohonan tersebut
    dengan ketentuan sebagai berikut :
    a. Mengikuti prosedur dan perundang-undangan yang berlaku;
    b. Memberikan laporan kegiatan secara rutin ke Puskesmas setiap bulan;
    c. Membantu dan bekerja sama dengan Puskesmas delam melaksanakan program kesehatan .

    Demikian atas perhatian Bapak kami ucapkan terima kasih.

    Kandis. 27 Juli 2023

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