PEMERINTAH KABUPATEN MALANG

DINAS KESEHATAN
UPT PUSKESMAS KROMENGAN
Jalan Nailun Utara No. 104 Karangrejo Kecamatan Kromengan
Telp. 0341 4342036 / 085100532160
Email : puskesmaskromengan@gmail.com
Kode Pos 65191

DAFTAR HADIR PERTEMUAN

Hari : ................................................................................................................
Tanggal : ................................................................................................................
Jam : ................................................................................................................
Tempat : ................................................................................................................
Acara : ................................................................................................................
JABATAN / TANDA
NO NAMA KETERANGAN
INSTANSI TANGAN

JABATAN / TANDA
NO NAMA KETERANGAN
INSTANSI TANGAN
 Kromengan, ................................................
Penanggung Jawab ........................................

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

PEMERINTAH KABUPATEN MALANG

DINAS KESEHATAN
UPT PUSKESMAS KROMENGAN
Jalan Nailun Utara No. 104 Karangrejo Kecamatan Kromengan
Telp. 0341 4342036 / 085100532160
Email : puskesmaskromengan@gmail.com
Kode Pos 65191

DAFTAR HADIR PERTEMUAN

Hari : ................................................................................................................
Tanggal : ................................................................................................................
Jam : ................................................................................................................
Tempat : ................................................................................................................
Acara : ................................................................................................................
TANDA
NO NAMA ALAMAT KETERANGAN
TANGAN
 TANDA
NO NAMA ALAMAT KETERANGAN
TANGAN

Kromengan, ................................................
Penanggung Jawab ........................................

.............................................................
NIP.
 PEMERINTAH KABUPATEN MALANG
DINAS KESEHATAN
UPT PUSKESMAS KROMENGAN
Jalan Nailun Utara No. 104 Karangrejo Kecamatan Kromengan
Telp. 0341 4342036 / 085100532160
Email : puskesmaskromengan@gmail.com
Kode Pos 65191

DAFTAR HADIR LOKAKARYA MINI PUSKESMAS

Hari : ................................................................................................................
Tanggal : ................................................................................................................
Jam : ................................................................................................................
Tempat : ................................................................................................................
Acara : ................................................................................................................
JABATAN / TANDA
NO NAMA KETERANGAN
INSTANSI TANGAN

NO NAMA JABATAN / TANDA KETERANGAN

 INSTANSI TANGAN

Kromengan, ................................................
Kepala Puskesmas Kromengan

drg. Herawati
NIP. 19790310 200604 2 028

PEMERINTAH KABUPATEN MALANG

DINAS KESEHATAN
UPT PUSKESMAS KROMENGAN
Jalan Nailun Utara No. 104 Karangrejo Kecamatan Kromengan
Telp. 0341 4342036 / 085100532160
Email : puskesmaskromengan@gmail.com
Kode Pos 65191

DAFTAR HADIR LOKAKARYA MINI LINTAS SEKTOR

Hari : ................................................................................................................
Tanggal : ................................................................................................................
Jam : ................................................................................................................
Tempat : ................................................................................................................
Acara : ................................................................................................................
JABATAN / TANDA NOMOR
NO NAMA
INSTANSI TANGAN TELEPON

JABATAN / TANDA NOMOR

NO NAMA
INSTANSI TANGAN TELEPON
Kromengan, ................................................
Kepala Puskesmas Kromengan

drg. Herawati