FORMULARIA
HATOÓ KEIXA
Favor prensia ho lolos
1. Naran Kompletu hato Keixa : ……………………………………………………………………….
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2. Sexu :…………………………………………………………………………
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3. Fatin no Data Moris :…………………………………………………………………………
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4. Posisaun :………………………………………………………………………..
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5. Addresu :…………………………………………………………………………
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6. No Tlp :…………………………………………………………………………
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7. Kronolozia Kazus ( Badak ) :…………………………………………………………………………
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8. Ema hirak mak involve :…………………………………………………………………………
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9. Evidensia neébe iha :…………………………………………………………………………
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10. Iha ona mekasnismu ba
resolve :…………………………………………………………………………
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