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LAPORAN PERSALINAN DESA CIPEUYEUM

BULAN :

TGL LAHIR TGL


NO NAMA IBU/ SUAMI NIK ALAMAT G.P.A JK
IBU BERSALIN
BPJS/ KF 1+KN1 KF2+KN3 8- KF3
BB TB KN2 3-7HARI KET
UMUM 6JAM-3HARI 29HARI 36-42HARI
LAPORAN PERSALI

TGL LAHIR
NO NAMA IBU/ SUAMI NIK NO KK
IBU
LAPORAN PERSALINAN BPJS

TGL
NO BPJS NO HP ALAMAT Nama bayi
BERSALIN
JK BB TB

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