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Bukti Pelaksanaan Inform Consent
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Bukti Pelaksanaan Inform Consent
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PEMERINTAH KOTA SUBULUSSALAM DINAS DINA S KESEH KESEHAT ATAN AN
PUSKESMAS RUNDING JL. Perjuangan Pasar Rundeng Kode Pos 2!"2. E#a$% & '(#rund$ng)g#a$%.*o#
BUKTI PELAKSANAAN INFORMED CONSENT
NO
TGL
NO R.M
NAMA PASIEN
DIAGNOSA
NAMA PETUGAS
NAMA PENERIMA
HUBUNGAN
KETERANGA
INF.KON
DGN PASIEN
N
TTD
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