PUSKESMAS PASILAMBENA
1. Identitas Penanya
2. Data Pasien
Umur :…….tahun; Tinggi :……..cm; Berat :……Kg; Jenis Kelamin : L / P
3. Pertanyaan
Uraian pertanyaan :
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Jenis Pertanyaan :
4. Jawaban
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5. Referensi
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