Nama : ..........................................................................................
NIM : ...............................................
Prodi : Kedokteran
Dengan Judul :
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Menyatakan bahwa mahasiswa tersebut diatas benar-benar merupakan anggota dari pohon penelitian
tersebut.
Malang, ...........................................
Mahasiswa,
..............................................
NIM.
Mengetahui,
Pembimbing 1, Pembimbing 2,
............................................... ...............................................