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FORMULIR

FORMULIR

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Dipublikasikan oleh Alan Wijaya

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Published by: Alan Wijaya on Jun 15, 2012
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11/09/2013

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FORMULIR FOOD FREQUENCY

Nama

: ……………………………………….

No. Responden : ………………………………………. Tanggal : ……………………………………….

Nama Bahan Makanan Makanan Pokok : - Beras - Mie - Roti Lauk Pauk : - Daging Ayam - Daging Sapi - Ikan - Telur - Tempe - Tahu - Ikan Teri Sayuran : - Bayam - Kentang - Buncis - Daun Ubi - Kangkung - Sawi

Frekuensi Konsumsi
≥ 1 x/hari 2-5 x/minggu 1 x/bulan Tidak Pernah Keterangan

Buah-buahan : - Nenas - Pepaya - Jambu Biji - Semangka Jenis Jajanan : - Empe-empe - Siomay

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