PENDATAAN VAKSINASI COVID-19 BOOSTER KE-2 DI LINGKUNGAN KANTOR WILAYAH KEMENTERIAN HUKUM DAN HAM JAWA TENGAH
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Nama *
Status Pegawai
 *
NIK *
NIP
Divisi *
Vaksin Covid-19 Tahap I
 *
Tanggal Vaksin Covid-19 Tahap I
 *
MM
/
DD
/
YYYY
Jenis Vaksin Tahap I
Vaksin Covid-19 Tahap II
 *
Tanggal Vaksin Covid-19 Tahap II
MM
/
DD
/
YYYY
Jenis Vaksin Tahap II
Vaksin Covid-19 Tahap III (Booster ke-I)
 *
Tanggal Vaksin Covid-19 Tahap III (Booster ke-I)
MM
/
DD
/
YYYY
Jenis Vaksin Tahap III (Booster ke-I)
Vaksin Covid-19 Tahap IV (Booster ke-II)
 *
Tanggal Vaksin Covid-19 Tahap IV (Booster ke-II)
MM
/
DD
/
YYYY
Jenis Vaksin Tahap IV (Booster ke-II)
Keterangan
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