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    9 views14 pages

    966 Lampiran

    Uploaded by

    mulyani

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 14

    DAFTAR EVALUASI KESEHATAN PESERTA PROLANIS

    DALAM SENAM SEHAT KOLOSAL 18.8.18 BPJS KESEHATAN TAHUN 2018

    NAMA FKTP :
    NAMA KLUB :
    PIC/PETUGAS PENDAMPING :

    HASIL PEMERIKSAAN
    NO NAMA PESERTA NO KARTU BPJS NO TELP DENYUT TEKANAN LINGKAR TINGGI BERAT
    NADI DARAH PINGGANG BADAN BADAN

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    INDEX MASA TUBUH TANDA TANGAN
    IMT

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    TANDA TERIMA SOUVENIR
    SENAM SEHAT KOLOSAL 18.8.18 BPJS KESEHATAN PATI
    TANGGAL 24 JULI 2018

    NAMA FKTP :
    NAMA KLUB :
    PIC/PETUGAS PENDAMPING :

    NO NAMA PESERTA NO KARTU BPJS NO TELP

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    TANDA TANGAN
    DAFTAR HADIR
    SENAM SEHAT KOLOSAL 18.8.18 BPJS KESEHATAN PATI
    TANGGAL 24 JULI 2018

    NAMA FKTP :
    NAMA KLUB :
    PIC/PETUGAS PENDAMPING :

    NO NAMA PESERTA NO KARTU BPJS NO TELP

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    TANDA TANGAN

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