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		<![CDATA[select reg_periksa.no_rawat,pasien.no_rkm_medis,pasien.nm_pasien,pasien.jk,pasien.tgl_lahir,reg_periksa.umurdaftar,
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				inner join petugas on surat_pulang_atas_permintaan_sendiri.nip=petugas.nip 
				inner join kelurahan on pasien.kd_kel=kelurahan.kd_kel 
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				<text><![CDATA[PULANG ATAS PERMINTAAN SENDIRI]]></text>
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				<text><![CDATA[Yang bertanda tangan di bawah ini :]]></text>
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				<text><![CDATA[Dengan ini menyatakan bahwa :]]></text>
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				<text><![CDATA[Dengan sadar tanpa paksaan dari pihak manapun meminta kepada pihak Rumah Sakit untuk PULANG ATAS PERMINTAAN SENDIRI yang merupakan hak saya / pasien dengan alasan :]]></text>
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				<text><![CDATA[Saya telah memahami sepenuhnya penjelasan yang diberikan dari pihask Rumah Sakit mengenai penyakit dan kemungkinan / konsekuensi terbaik sampai dengan terburuk atas keputusan yang saya ambil, serta tanggung jawab saya dalam mengambil keputusan ini]]></text>
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