DINAS KESEHATANKABUPATEN SELUMA

PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

SURAT TUGAS
Nomor : / PKM.BBT/ BOK/ /2017
Tanggal :

Yang bertanda tangan di bawah ini :

Nama : Ratna Sari Dewi,SKM.
Jabatan : Kepala UPTD Puskesmas Babatan.
Nip : 19690929 199101 2 001

Memberi tugas kepada :

No Nama /NIP Tanggal Tempat Tujuan Maksud Perjalanan

Kunjungan posyandu
1 dalam rangka pelayanan
Imunisasi
NIP.

Kunjungan posyandu
2 dalam rangka pelayanan
KIA/KB
NIP.
Kunjungan posyandu
dalam rangka pelayanan
3
Gizi
NIP.
Kunjungan posyandu
dalam rangka pelayanan
4
Promosi Kesehatan
NIP.
Kunjungan posyandu
dalam rangka pelayanan
5
Kesehatan Lingkungan
NIP.

Pembiayaan Perjalanan dibebankan pada : DIPA Satkes Dinas Kesehatan Kabupaten Seluma
tahun 2016

Demikianlah Surat Tugas ini dibuat untuk dapat dilaksanakan dengan penuh tanggung jawab.

Kepala UPTD Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001
 DINASKESEHATANKABUPATEN SELUMA
PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2017

2. Nama Petugas/Tim : . ...
3. Tujuan Perjalanan : .
4. Tanggal Perjalanan : .........
5. Maksud Perjalanan : .
6. Pejabat yang ditemui : Kepala Desa...................
7. Hasil Kunjungan :
a. Proses pelaksanaan :
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

b. Permasalahan yang dihadapi :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
c. Kesimpulan/Saran Perbaikan :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

....................................
Mengetahui Pelapor
Kepala Desa..

...
NIP :..

Kepala Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001

DINASKESEHATANKABUPATEN SELUMA
PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
 Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2017

2. Nama Petugas/Tim : . ...
3. Tujuan Perjalanan : .
4. Tanggal Perjalanan : .........
5. Maksud Perjalanan : Melaksanakan Kegiatan Gizi
6. Pejabat yang ditemui : Kepala Desa.......................
7. Hasil Kunjungan :
a. Proses pelaksanaan :
Melakukan Pemantauan Pencapaian Indikator Kinerja Pembinaan Gizi bulanan di
Posyandu dengan hasil yaitu: S =.............D =............O =...........B =...........D =............
N =...........T =..........2T =..........BGM =...........Gikur =...........Bumil KEK =................
............................................................................................................................
...........................................................................................................................

b. Permasalahan yang dihadapi :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
c. Kesimpulan/Saran Perbaikan :

D/S =......................................................................................................................................
.............................................................................................................................................
.........................................................................................................................................

....................................
Mengetahui Pelapor
Kepala Desa..

...
NIP :..

Kepala Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001

DINASKESEHATANKABUPATEN SELUMA
PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2017

2. Nama Petugas/Tim : . ...
3. Tujuan Perjalanan : .
4. Tanggal Perjalanan : .........
5. Maksud Perjalanan : Melaksanakan Kegiatan Imunisasi
6. Pejabat yang ditemui : Kepala Desa..................................
7. Hasil Kunjungan :
a. Proses pelaksanaan :
Memberikan Vaksinasi pada Bayi / Balita / Bumil dengan hasil sebagai berikut : BCG /
Polio I =................orang, DPT HB - Hib I / Polio II = ..................orang, DPT HB
Hib II / Polio III =...................orang, HB Hib II / Polio IV =...................orang,
Campak Dasar = ..................orang, Boster Campak = .......................orang, Boster
Penta Valent = ......................orang, TT Bumil = ........................orang.
............................................................................................................................
...........................................................................................................................

b. Permasalahan yang dihadapi :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
c. Kesimpulan/Saran Perbaikan :

......................................................................................................................................
...........................................................................................................................................
.........................................................................................................................................

....................................
Mengetahui Pelapor
Kepala Desa..

...
NIP :..

Kepala Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001

DINASKESEHATANKABUPATEN SELUMA
PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2017

2. Nama Petugas/Tim : . ...
3. Tujuan Perjalanan : .
4. Tanggal Perjalanan : .........
5. Maksud Perjalanan : Melaksanakan Kegiatan KIA-KB
6. Pejabat yang ditemui : Kepala Desa..................................
7. Hasil Kunjungan :
a. Proses pelaksanaan :
- Melakukan pemeriksaan pada Ibu hamil ( ANC ) sebanyak...................orang, dengan
hasil sebagai berikut : K1 =......................orang, K4 =.........................orang, Ibu
Hamil Risiko tinggi = ......................orang, ibu nifas Risiko tinggi =..........................
 - Memberikan Komunikasi, Informasi, dan Edukasi (KIE)
tentang :.........................................................................................................................
.........
........................................................................................................................................

b. Permasalahan yang dihadapi :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
c. Kesimpulan/Saran Perbaikan :

......................................................................................................................................
...........................................................................................................................................
.........................................................................................................................................

....................................
Mengetahui Pelapor
Kepala Desa..

...
NIP :..

Kepala Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001

DINASKESEHATANKABUPATEN SELUMA
PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2016

2. Nama Petugas/Tim : . ...
3. Tujuan Perjalanan : .
4. Tanggal Perjalanan : .........
5. Maksud Perjalanan : .
6. Hasil Kunjungan :
a. Proses pelaksanaan :
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

b. Permasalahan yang dihadapi :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
c. Kesimpulan/Saran Perbaikan :

.........................................................................................................................................
 .........................................................................................................................................
.........................................................................................................................................

....................................

Mengetahui Pelapor
Kepala KUA Sukaraja

...
NIP :..

Kepala Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001

DINASKESEHATANKABUPATEN SELUMA
PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2016

2. Nama Petugas/Tim : . ...
3. Tujuan Perjalanan : .
4. Tanggal Perjalanan : .........
5. Maksud Perjalanan : .
6. Pejabat yang ditemui : .......................................
7. Hasil Kunjungan :
a. Proses pelaksanaan :
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

b. Permasalahan yang dihadapi :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
c. Kesimpulan/Saran Perbaikan :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

....................................
Kepala Seksi P2P Pelapor
 Dinas Kesehatan Kab. Seluma

Sugiyani
Fahrozan, SKM NIP : 197602212003122002

Kepala Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001

DINASKESEHATANKABUPATEN SELUMA
PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2016

2. Nama Petugas/Tim : . ...
3. Tujuan Perjalanan : .
4. Tanggal Perjalanan : .........
5. Maksud Perjalanan : .
6. Pejabat yang ditemui : .......................................
7. Hasil Kunjungan :
a. Proses pelaksanaan :
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

b. Permasalahan yang dihadapi :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
c. Kesimpulan/Saran Perbaikan :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

....................................
Kepala Seksi P2P Pelapor
Dinas Kesehatan Kab. Seluma

Fahrozan, SKM Icha Oktafia

NIP : 198810262011012008
 Kepala Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001

DINASKESEHATANKABUPATEN SELUMA
PUSKESMAS BABATAN
KECAMATAN SUKARAJA KABUPATEN SELUMA
Alamat :Jln. Raya Bengkulu-Seluma KM. 19 Kel. BabatanKec. Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2017

2. Nama Petugas/Tim : . ...
3. Tujuan Perjalanan : .
4. Tanggal Perjalanan : .........
5. Maksud Perjalanan : Kegiatan Posyandu USILA
6. Pejabat yang ditemui : Kepala Desa...................
7. Hasil Kunjungan :
a. Proses pelaksanaan :
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

b. Permasalahan yang dihadapi :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
c. Kesimpulan/Saran Perbaikan :

.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

....................................
Mengetahui Pelapor
Kepala Desa..

...
NIP :..

Kepala Puskesmas Babatan

Ratna Sari Dewi, SKM.

NIP : 19690929 199101 2 001