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  • Kartu Kontrol

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    10 views1 page

    Kartu Kontrol

    Uploaded by

    Prazz Apriliand
    form kartu kontrol

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    PEMERINTAH KABUPATEN SUMENEP PEMERINTAH KABUPATEN SUMENEP

    DINAS KESEHATAN DINAS KESEHATAN


    PUSKESMAS PANDIAN PUSKESMAS PANDIAN
    Jl. Teuku Umar No. 46 Telp. (0328) 662008 Jl. Teuku Umar No. 46 Telp. (0328) 662008
    SUMENEP SUMENEP

    KARTU KONTROL KARTU KONTROL

    NO. REG : NO. REG :


    NAMA : NAMA :
    UMUR : UMUR :
    ALAMAT : ALAMAT :
    DIAGNOSA : DIAGNOSA :
    OBAT YANG DIBERIKAN : OBAT YANG DIBERIKAN :

    TANGGAL KONTROL KEMBALI : TANGGAL KONTROL KEMBALI :

    SUMENEP, ............................. SUMENEP, .............................


    DOKTER YANG MERAWAT DOKTER YANG MERAWAT

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