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Daftar Nama Penerima PMT Penyuluhan, Vitamin A, dan Obat Cacing di POSYANDU

Tempat :
Tanggal :

OBAT
Umur VITAMNIN A PMT
CACING Tanda
NO NAMA BALITA Alamat
Tangan
1/2
L P YA TIDAK 1 tab 2 bks 3 bks
tab

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Mengetahui
Kader Posyandu………………….

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