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BIO DATA KADER POSYANDU REMAJA

PUSKESMAS BIDARA CINA I

I IDENTITAS

1 NAMA : ................................................................................

2 TEMPAT TANGGAL LAHIR : ................................................................................

3 UMUR : ................................................................................

4 ALAMAT : : ................................................................................

RT : ................................................................................

RW : ................................................................................

KELURAHAN : BIDARA CINA

KECAMATAN : JATINEGARA

NO TELP : ................................................................................

5 PENDIDIKAN : ................................................................................

6 JABATAN DI POSYANDU : ................................................................................

7 LAMANYA BERTUGAS DI POSYANDU : .........................TAHUN MULAI DARI TAHUN.........

8 PERNAH MENGIKUTI PELATIHAN : 1..............................................................................

2..............................................................................

3...............................................................................

4...............................................................................

5...............................................................................

II DATA POSYANDU

1 NAMA POSYANDU : ................................................................................

2 ALAMAT POSYANDU :

JAKARTA, 2021

FOTO 4X6

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