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A B C D E F G H I J K L

1 ghfckafyGLGFIHGwfhlfuo
2 DESA..............................TANGGAL.......................
3 h.kadvhhdv;hvw;gh
4 nbvk.abnl/jwJGP
5 KKJLwg'kt;gpJWUIG[
6 Usia
No. Hari/Tgl KNKLJKJKJLJ Alamat TD BB TB Umum/BPJS Diagnosa Terapi
7 P L
8 .... / ..../..... tn.x ...... th
9 .... / ..../..... ...... th
10 .... / ..../..... njbvcajskbck.hn ...... thnbjbjjbjbjb
11 .... / ..../..... ...... th
12 .... / ..../..... ...... th
13 .... / ..../..... ...... th
14 .... / ..../..... ...... thhhbuhjhuhuhuhuhhhj
15 .... / ..../..... ...... th
16 .... / ..../..... ...... th,mm,m,,m,m,m,m,m,m,m,m,
17 .... / ..../..... ...... th nbbnbn
18 .... / ..../..... ...... th
19 .... / ..../..... ...... th yftdrdrdrd
20 .... / ..../..... ...... th
21 .... / ..../..... ...... th
22 .... / ..../..... ...... thlijg;isvsdgftg
23 .... / ..../..... ...... th
24 .... / ..../..... ...... th
25 .... / ..../..... ...... th
26 .... / ..../..... ...... th
27 .... / ..../..... ...... th
28 .... / ..../..... ...... th
29 .... / ..../..... ...... th
30 .... / ..../..... ...... th
31 .... /..../ ..... ...... th

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