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DINAS KESEHATAN
PUSKESMAS PENIMBUNG
Jalan Raya Lilir DEsa Mekarsari Kecamatan Gunung Sar
Kode Post : 83351
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Agama
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Pekerjaan
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Alamat
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Cm
Berat Bdan
Kg
Tekanan Darah
mmhg
Golongan Darah
Visus OD/OS
Penimbung,...../........./ 20
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--------------------------------------------------------------------------------------------------------------------------------------------------PEMERINTAH KABUPATEN LOMBOK BARAT
DINAS KESEHATAN
PUSKESMAS PENIMBUNG
Jalan Raya Lilir DEsa Mekarsari Kecamatan Gunung Sar
Kode Post : 83351
:.................................................................................
: .................................................................................
Jenis Kelamin
: ..................................................................................
Agama
: ..................................................................................
Pekerjaan
: ..................................................................................
Alamat
: ..................................................................................
Cm
Berat Bdan
Kg
Tekanan Darah
mmhg
Golongan Darah
Visus OD/OS
Penimbung,...../........./ 20
Dokter Puskesmas Penimbung
( ............................................ )