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Laporan

Pemeriksaan IVA Serentak Seluruh Indonesia, Rabu 5 Juli 2017

Ranting : ......................................................................................................
Cabang : ......................................................................................................
Propinsi : ......................................................................................................

No Nama Bidan No. Hp Bidan Tanda Tangan No Nama Klien Tana Tangan

......................,......................2017
Ketua Ranting

(..........................................)

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