Dr. dr. I WAYAN MEGADHANA, Sp.

OG (K)
Spesialis Kandungan dan Penyakit Kandungan
HP. 08123917002

This the undersigned physician, Dr. dr. I Wayan Megadhana, Sp. OG (K), this explains the
fact:
Name :
Age : years old
Address :
Id :
Position :

Name of Husband :
Age : years old
Address :
Id :
Position :

Indeed have been treated in My work up program with detail of treatment below:
……….. 2016 Diagnose :
Medicine :
Result :

………. 2016 Diagnose :

Medicine :
Result :

They are under our treatment for infertility problem since ………..2016 until
………2016. With Negatif (-) Result.

Denpasar, 23th September 2016

The treating physician,

( Dr.dr. I Wayan Megadhana, Sp.OG (K) )