LAPORAN PKD PASIEN PUSKESMAS PADURESO

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LAPORAN PKD PASIEN PUSKESMAS PADURESO

MOHON DI ISI BIDAN DESA YANG BERTUGAS

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TANGGAL KUNJUNGAN PKD *

MM

/

DD

/

YYYY

CARA BAYAR *

UMUM

BPJS

NAMA LENGKAP *

Your answer

JENIS KELAMIN *

LAKI-LAKI

PEREMPUAN

TANGGAL LAHIR ATAU UMUR *

Your answer

DESA *

BALINGASAL

PEJENGKOLAN

MERDEN

SIDOTOTO

KALIGUBUG

KALIJERING

SENDANG DALEM

RAHAYU

PADURESO

DIAGNOSA (JIKA PENYAKIT PASIEN LEBIH DARI SATU TULISKAN SEMUA)

Your answer

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