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PROMOCIÓN DE HÁBITOS SALUDABLES
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DNI
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NOMBRES
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APELLIDO PATERNO
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APELLIDO MATERNO
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FECHA DE NACIMIENTO
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MM
/
DD
/
YYYY
SEXO
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Masculino
Femenino
CORREO ELECTRÓNICO
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N° DE CELULAR
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PROFESIÓN
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NIVEL EDUCATIVO
*
Universitario
Pedagógico
CONDICIÓN LABORAL
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Nombrado
Contratado
UGEL
*
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INSTITUCIÓN EDUCATIVA
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DEPARTAMENTO
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ESTABLECIMIENTO DE SALUD
*
DIRESA
GERESA
DIRIS
RED DE SALUD
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ESTABLECIMIENTO DE SALUD
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