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No RM : .........................................................................

DINAS KESEHATAN KABUPATEN BREBES No NIK : .........................................................................


BLUD UPT PUSKESMAS BUMIAYU Nama : ........................................................................
Jln. Kawedanan No. 01 Kalierang-Bumiayu
Jenis Kelamin : ........................................................................
Tanggal Lahir : ........................................................................
Alamat : ........................................................................
Pekerjaan : ........................................................................
PUSKESMAS BENTAR Nama Ayah Kandung : ........................................................................
No. BPJS : .........................................................................
ASUHAN KEPERAWATAN
Ruang :
Tgl/ Jam Subyektif Obyektif Diagnosa Keperawatan Rencana Keperawatan Tindakan Keperawatan Evaluasi

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