DINAS KESEHATAN KABUPATEN TASIKMALAYA

UPTD PUSKESMAS DTP MANONJAYA

Jl. Tangsi No. 6 Telp. (0265) 381109 Fax.(0265) 381109 Manonjaya 46197

SURAT TUGAS
No : ..................................
Kepala UPTD Puskesmas DTP Manonjaya dengan ini :
MENUGASKAN
Kepada yang namanya tercantum dibawah ini :

NO

NAMA
NIP

PANGKAT
GOLONGAN

JABATAN

Ketua

Anggota

Anggota

Anggota

Untuk : Melaksanakan tugas ................................................. yang akan dilaksanakan pada

:
Hari
: .........................................................................................
Tanggal

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

Tempat: .........................................................................................
Demikian surat tugas ini dibuat untuk dilaksanakan sebagaimana mestinya
Ditetapkan
: .........................................
Pada Tanggal : .........................................
Kepala UPTD Puskesmas ..................................

....................................................
NIP...........................................

DINAS KESEHATAN KABUPATEN TASIKMALAYA

UPTD PUSKESMAS DTP MANONJAYA

Jl.Tangsi No. 6 Telp. (0265) 381109 Fax.(0265) 381109 Manonjaya 46197

LAPORAN KEGIATAN

Hari/Tanggal

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

Tempat

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

Topik

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

Laporan kegiatan penyuluhan :

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Ketua

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NIP.