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    POIUYTRED

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    POIUYTRED

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    7 views2 pages

    Form Buta Warna

    Uploaded by

    Erni
    POIUYTRED

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    PEMERINTAH KOTA PALEMBANG

    DINAS KESEHATAN
    PUSKESMAS OPI
    Jl. OPI Raya Perum OPI Palembang, Provinsi Sumatera Selatan
    Telp/Fax. (0711) 5620648 Kode Pos 30257
    E-mail: puskesmas_opi@yahoo.co.id

    “SURAT PEMERIKSAAN BUTA WARNA”


    Nomor: / PKM OPI/ / 2022

    Yang bertanda tangan dibawah ini :


    Menerangkan dengan sebenarnya bahwa :
    Nama :
    Jenis Kelamin :
    Alamat :

    Hasil Pemeriksaan :
    Kesan :

    Tanda Tangan Palembang,………….......….2022


    Dokter tersebut diatas,

    ...................................... dr. Weni Sumartini


    NRNPNSD. 2521222018
    SIP. 446/IPD/0989/DPMPTSP-PPK/2020

    PEMERINTAH KOTA PALEMBANG


    DINAS KESEHATAN
    PUSKESMAS OPI
    Jl. OPI Raya Perum OPI Palembang, Provinsi Sumatera Selatan
    Telp/Fax. (0711) 5620648 Kode Pos 30257
    E-mail: puskesmas_opi@yahoo.co.id

    “SURAT PEMERIKSAAN BUTA WARNA”


    Nomor: / PKM OPI/ / 2022

    Yang bertanda tangan dibawah ini :


    Menerangkan dengan sebenarnya bahwa :
    Nama :
    Jenis Kelamin :
    Alamat :

    Hasil Pemeriksaan :
    Kesan :

    Tanda Tangan Palembang,………….......….2022


    Dokter tersebut diatas,

    ...................................... dr. Weni Sumartini


    NRNPNSD. 2521222018
    SIP. 446/IPD/0989/DPMPTSP-PPK/2020

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