DINAS KESEHATAN KABUPATEN/ KOTA………………
Puskesmas …………………………
PEMELIHARAAN BARANG
Nomor :………………Nama
Barang :……………………………………
Unit/ tempat :………………Tgl. Pembelian :……………………………………
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Tanggal |
Perbaikan/ pemeliharaan |
Paraf
pelaksana |
Paraf
Koordinator |
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