Kartu Identitas Pasien Tb.docx

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PENANGGULANGAN TB NASIONAL

T B 02

KARTU IDENTITAS PASIEN TB NAMA LENGKAP

:

Nomor induk

:

Kependudukan (NIK )

:

Alamat Lengkap

:

No Telp/HP

:

Jenis Kelamin

:

Nama Faskes

:

No.Reg.TB Faskes

:

No. Reg.TB Kab/Kota

: ____________________ Propinsi________________________

KLASIFIKASI BERDASARKAN LOKASI ANATOMIS Paru

Ektra paru

KLASIFIKASI BERDASARKAN LOKASI ANATOMIS

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