FORMULIR PENDAMPINGAN BULIN

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FORMULIR PENDAMPINGAN BULIN

PANGKALAN 2026

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* Indicates required question

NAMA DESA *

MEDALSARI

MULANGSARI

KERTASARI

CINTAASIH

JATILAKSANA

CIPTASARI

TAMANSARI

TAMAN MEKAR

JENIS LAPORAN *

CATIN

BUMIL

BULIN

BADUTA

NO *

Your answer

KELOMPOK TIM *

1

2

3

4

5

6

PDP *

1

2

NAMA SASARAN *

Your answer

UMUR (tahun ) *

Your answer

ALAMAT SASARAN *

Your answer

MLAKUKAN PEMERIKSAAN *

Y

T

BB /LILA SASARAN *

Your answer

TB & LP SASARAN *

Your answer

HB SASARAN *

Your answer

USIA KANDUNGAN SAAT MELAHIRKAN (di isi minggu ) *

Your answer

PROSES MELAHIRKAN *

CAESAR

NORMAL

BERAT BAYI LAHIR *

Your answer

KBPP *

Your answer

JAMINAN SOSIAL *

BPJS

KIS

AIR BERSIH *

Y

T

JAMBAN SEHAT *

Y

T

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