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# of

House

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Father

Mother

Name of Child

Operats)ion Timbang ( 0-42 month)


Age
Date of
Wt.
Date
Birth
(Months) (kg)

Remarks

Wt.
(kg)

Date

Remarks

Wt.
(kg)

Date

Remarks

Wt.
(kg)

Date

Remarks

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