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Form Pengaduan

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2110044 Christian A Mailoa

4. FORM PENGADUAN

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PEMERINTAH KABUPATEN HALMAHERA UTARA

PUSKESMAS MAWEA
KECAMATAN TOBELO TIMUR
Website : www.halmaherautarakab.go.id,
https://dinkes.halmaherautarakab.go.id
Email: pkmmawea@gmail.com
Jl. Tobe – Katana KM. 10

FORMULIR PENGADUAN
PADA UNIT PELAYANAN PUSKESMAS MAWEA

NAMA : ……………………………………………………………………………

ALAMAT : ……………………………………………………………………………

NO. TELEPON/WA : ……………………………………………………………………………

PEKERJAAN : ……………………………………………………………………………

HAL YANG DI ADUKAN :

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………………..,...............2023
PELAPOR

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