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Pendataan Vaksinasi Civitas Akademika (Mahasiswa) - Universitas Baiturrahmah
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Nama
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NIP / No.KTP
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Fakultas
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FAKULTAS EKONOMI
FAKULTAS KEDOKTERAN
FAKULTAS KEDOKTERAN GIGI
FAKULTAS KESEHATAN MASYARAKAT
FAKULTAS VOKASI
Jurusan / Prodi
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S1 MANAJEMEN
S1 KEWIRAUSAHAAN
S1 PENDIDIKAN DOKTER/PROFESI
S1 PENDIDIKAN DOKTER GIGI/PROFESI
S1 FARMASI KLINIS
S1 KESEHATAN MASYARAKAT
S1 ADMINISTRASI RUMAH SAKIT
D4 KEPERAWATAN ANESTESIOLOGI
D3 KEBIDANAN
D3 RADIOLOGI
Umur (Tahun)
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Penyakit Bawaan
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YA
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Jenis Penyakit Bawaan (Jika Tidak Ada di Kosongkan)
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Vaksinisasi
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Belum
Vaksin 1
Vaksin 2
Lokasi Vaksin
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KAMPUS
PUSKESMAS
KLINIK
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