PENDAFTARAN UMUM PUSK. ALAHAN PANJANG
Rekam Medis Puskesmas Alahan Panjang
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Tanggal Berobat *
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Nama Kepala Keluarga *
Nama  *
Tanggal lahir
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Pasien Lama / Baru
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NIK *
No Rekam Medis (pasien lama)
Alamat *
Keluhan Pasien
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