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DINAS KESEHATAN KABUPATEN GARUT

PUSKESMAS CIKELET
Jl. Cikelet Garut Telp (0261) 521508

FORM LAPORAN DINAS

1. Dasar Penugasan : 800 / / PKM / 2016


2. Nama Petugas/Tim : dr. Hendy Rachman B
3. Tujuan Perjalanan Dinas : Desa Karangsari
4. Tanggal Perjalanan Dinas : 15 Desember 2016
5. Maksud Perjalanan Dinas : Kunjungan Lapangan Pemicuan SBABS RT 6
6. Pejabat yang ditemui :

7. Hasil Kunjungan antara lain :


a. Proses Pelaksanaan :
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b. Permasalah yang dihadapi :
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c. Dokumen yang didapat :
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d. Kesimpulan / Saran Perbaikan :
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Pejabat yang berwenang Garut, 15 Desember 2016


Pelapor :
1. dr. Hendy Rachman B ...............

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