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Dokumen berisi identitas pemohon, keterangan perawatan beserta rentang tanggal, serta permohonan agar dokter yang merawat memberikan keterangan tertulis mengenai kerahasiaan kesehatan/penyakit selama perawatan pada tanggal tersebut. Pemohon menyatakan bertanggung jawab penuh atas dibukanya rahasia dan tidak akan menuntut dokter Rumah Sakit Darmo di kemudian hari. Surat ditandatangani dengan materai 6000.",{"@graph":51,"@context":100},[52,68,83],{"@type":53,"itemListElement":54},"BreadcrumbList",[55,59,62,65],{"item":56,"name":57,"@type":58,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":60,"name":10,"@type":58,"position":61},"https://docshare.wps.com/id/template/",2,{"item":63,"name":35,"@type":58,"position":64},"https://docshare.wps.com/id/template/surat/",3,{"item":66,"name":47,"@type":58,"position":67},"https://docshare.wps.com/id/template/power-of-attorney-for-medical-certificate-request-darmo-hospital-surabaya/237049/",4,{"url":66,"name":47,"@type":69,"author":70,"headline":47,"publisher":73,"fileFormat":76,"inLanguage":45,"description":49,"dateModified":77,"datePublished":77,"encodingFormat":76,"isAccessibleForFree":78,"interactionStatistic":79},"DigitalDocument",{"name":71,"@type":72},"River Wang","Person",{"url":56,"name":74,"@type":75},"DocShare","Organization","application/pdf","2026-09-11",true,{"@type":80,"interactionType":81,"userInteractionCount":4},"InteractionCounter",{"@type":82},"ViewAction",{"@type":84,"mainEntity":85},"FAQPage",[86,92,96],{"name":87,"@type":88,"acceptedAnswer":89},"Surat ini digunakan untuk apa?","Question",{"text":90,"@type":91},"Surat kuasa ini digunakan untuk memohon surat keterangan medis dari dokter Rumah Sakit Darmo Surabaya terkait kerahasiaan kesehatan/penyakit selama perawatan.","Answer",{"name":93,"@type":88,"acceptedAnswer":94},"Data apa saja yang perlu diisi dalam surat?",{"text":95,"@type":91},"Surat memuat nama, umur, pekerjaan, alamat, nomor telepon, status dirawat inap/jalan, serta rentang tanggal perawatan di Rumah Sakit Darmo Surabaya.",{"name":97,"@type":88,"acceptedAnswer":98},"Apa tanggung jawab pemohon dalam surat kuasa ini?",{"text":99,"@type":91},"Pemohon menyatakan bertanggung jawab penuh atas dibukanya rahasia kesehatan dan menyatakan tidak akan menuntut dokter Rumah Sakit Darmo Surabaya di kemudian hari.","https://schema.org",{"og:url":66,"og:type":102,"og:title":47,"og:site_name":74,"og:description":49},"article",{"robots":104,"canonical":66},"index,follow",{"doc_id":106,"site_id":44},237049,1789109245,{"code":4,"msg":5,"data":109},{"doc_id":106,"user_id":110,"nickname":71,"user_avatar":111,"doc_module":9,"category_id":34,"category_name":35,"doc_title":47,"doc_description":49,"doc_content":112,"file_id":113,"file_url":114,"file_type":115,"file_size":116,"view_count":4,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":117,"language_code":45,"site_id":44,"html_lang":45,"table_of_contents":118,"faqs":119,"seo_title":120,"seo_description":49,"update_tm":107,"read_time":4},1099514067438,"https://ap-avatar.wpscdn.com/avatar/100002539ee87300030?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780474512215547542","Kepada Yth.  \nDokter   Rumah Sakit Darmo Surabaya  \nPerihal : Permohonan Surat Keterangan Medis  \nDengan hormat,  \nYang bertanda tangan dibawah ini saya,  \nN a m a :  \nUmur :  \nPekerjaan :  \nAlamat :  \nTelp. :  \nDirawat inap / jalan di Rumah Sakit Darmo Surabaya, sejak tanggal   sampai dengan tanggal   dengan ini memohon dan memberi kuasa kepadadokter Rumah Sakit Darmo Surabaya yang telah merawat saya, untuk memberikan keterangan tertulis mengenai segala sesuatu tentang rahasia kesehatan / penyakit saya selama dirawat di Rumah Sakit Darmo Surabaya pada tanggal tersebut diatas.  \nDalam formulir :  \nUntuk keperluan :  \nPada :  \nSaya akan bertanggung jawab sepenuhnya atas akibat dibukanya rahasia tersebut dan saya menyatakan tidak akan menuntut kepada dokter Rumah Sakit Darmo Surabaya dikemudian hari.  \nDemikian surat ini kami buat dengan penuh kesadaran dan tanpa paksaan dari pihak manapun.  \nSurabaya,    \nYang membuat pernyataan,  \nMaterai 6000  \n(…………………………….. )","cbCailXKjRPJZAoX","https://ap.wps.com/l/cbCailXKjRPJZAoX","pdf",66815,"Indonesian","# Isi Surat Kuasa\n## Identitas Pemohon dan Data Perawatan\n## Permohonan Keterangan Tertulis\n## Pernyataan Tanggung Jawab dan Tidak Menuntut\n## Tempat, Tanggal, Materai, dan Tanda Tangan","[{\"question\":\"Surat ini digunakan untuk apa?\",\"answer\":\"Surat kuasa ini digunakan untuk memohon surat keterangan medis dari dokter Rumah Sakit Darmo Surabaya terkait kerahasiaan kesehatan/penyakit selama perawatan.\"},{\"question\":\"Data apa saja yang perlu diisi dalam surat?\",\"answer\":\"Surat memuat nama, umur, pekerjaan, alamat, nomor telepon, status dirawat inap/jalan, serta rentang tanggal perawatan di Rumah Sakit Darmo Surabaya.\"},{\"question\":\"Apa tanggung jawab pemohon dalam surat kuasa ini?\",\"answer\":\"Pemohon menyatakan bertanggung jawab penuh atas dibukanya rahasia kesehatan dan menyatakan tidak akan menuntut dokter Rumah Sakit Darmo Surabaya di kemudian hari.\"}]","Surat Kuasa Permohonan Surat Keterangan Medis Rumah Sakit Darmo Surabaya | PDF"]