PEMERINTAH KABUPATEN BARITO UTARA

DINAS KESEHATAN
UPT PUSKESMAS KANDUI
Jl.A.Yani No.175 Rt.IV Desa Kandui Kecamatan Gunung Timang
Telepon : 08125150842 Email :pkmkandui@gmail.com

KEPUTUSAN KEPALA UPT PUSKESMAS KANDUI

Nomor : 800/ /PKM-KDI/ /2017

TENTANG
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Menimbang : a. bahwa....................................................................................................... ;
b. bahwa....................................................................................................... ;
c. bahwa....................................................................................................... ;
d. dst............................................................................................................. .

Mengingat : 1. Undang-Undang....................................................................................... ;
2. Peraturan Pemerintah................................................................................ ;
3. Keputusan Presiden.................................................................................. ;
4. Permen (insidentil).................................................................................... ;
5. Kepmen (insidentil)................................................................................... ;
6. Perda Provinsi (insidentil).......................................................................... ;
7. Keputusan Gubernur (insidentil)................................................................ ;
8. Peraturan Daerah Kabupaten..................................................................... ;

MEMUTUSKAN :
Menetapkan :

KESATU : ............................................................................................................................ .

KEDUA : ............................................................................................................................ .

KETIGA : ............................................................................................................................ .

KEEMPAT : Keputusan ini mulai berlaku sejak tanggal .......... dengan ketentuan apabila
terdapat kekeliruan akan diadakan perbaikan sebagaimana mestinya.

Ditetapkan di Kandui
pada tanggal..........................

Kepala UPT Puskesmas Kandui

FRIT TARONG, SKM

NIP. 19750527 199603 1 006