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Full Name
*
ID Number (NIK)
*
NIK is needed to invite participants into Plataran Sehat
For Participants who are not willing to fill in the NIK column, they cannot learn and cannot get SKP
The storage an management of NIK data are fully the responsibility of the Ministry of Health
City, Province
*
Institution
*
Member Type
*
== Select Type ==
General Practitioner
Medical Student
Nurse
Perki Jogja Member
Specialist (Sp.JP)
Specialist (Sp.PD)
Phone (Whatsapp Number)
*
E-Mail
*
Please use the same email as the one registered to your Plataran Sehat account. Don't have one?
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