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NOTULEN

Rapat
..........................
Hari/Tanggal
Tanggal Undangan
Waktu Rapat
Acara

: ............................................................................................
: ............... ........................
: ............... ........................
: ..............WIB s.d Selesai
: ................................. Agenda Terlampir
1 Isi Absensi Peserta
2 Materi : ......................................................................
...................
3 Diskusi/Kesepakatan
4 Penutup/Doa

Pimpinan Rapat
:
......................................................................................................................
Ketua
: ............................................................................................
..........................
Sekretaris
: ............................................................................................
..........................
Peserta Rapat :
1
2

Karyawan UPTD Puskesmas Poned Cigasong


Jumlah Orang .......... Absensi Terlampir

Kegiatan Rapat :
1 Isi Absensi Peserta : Undangan hadir sejumlah ........... Orang Undangan
Terlampir
2 Presentasi : .............................................................: Materi
Terlampir
3 Diskusi/Kesepakatan : Kesepakatan Terlampir
4 Penutup/Doa
1
2

Kata Pembukaan :
...........................................................................................................
Pembahasan
:
: ................................................................................................
......................
: ................................................................................................
......................

: ................................................................................................
......................
: ................................................................................................
......................
: ................................................................................................
......................
: ................................................................................................
......................
: ................................................................................................
......................
3

Postest

Peraturan

:
Ada penjelasan lisan dari petugas : Prawat, bidan, sanitarian, ahli gizi, serta
petugas kesehatan laninnya dan lintas sektor/program.
: Dibuat kesepakatan bersama dan ditindaklanjuti.
Cigasong, .......................................
Pertemuan Rapat,
Notulensi,
...............................................
NIP:

KESEPAKATAN

Rapat
..........................

: ............................................................................................

Hari/Tanggal

: ................................................

Tanggal Undangan

: ................................................

Waktu Rapat

: ...................... WIB s.d Selesai

1 ..................................................................................................................................................
2 ..................................................................................................................................................
3 ..................................................................................................................................................
4 ..................................................................................................................................................
5 ..................................................................................................................................................
6 ..................................................................................................................................................
7 ..................................................................................................................................................

Cigasong, .............................................
Pertemuan Rapat
Ketua.
...................................................
NIP: