KIRKES

PEMERINTAH KABUPATEN BERAU Lamp.
Lamp.VI (2 dari 4) Kepmen Keuangan tentang Perjalanan Dinas Dalam Negeri bagi Pejabat Negara Pegawai Negeri Sipil
DINAS KESEHATAN dan Pegawai Tidak Tetap Nomor :7/KMK 02/2003,tanggal 3 Januari 2003
PUSKESMAS SAMBALIUNG I. Berangkat dari tempat kedudukan
Jl.Mangkubumi II RT.07 Sambaliung Pada Tanggal : 27 April 2014
SURAT PERINTAH PERJALANAN DINAS Ke : inaran
1.
2. Nama Pegawai yang diperintahkan
3. a. NIP : #N/A H. Syafrudin. AB
b. Pangkat dan golongan menurut PGPS, 1968 : #N/A NIP. 19590102 198201 1 008
c. Jabatan : #N/A II. Tiba di : inaran Berangkat dari :
d. Tingkat Menurut Peraturan Perjalanan Dinas : Lokal Pada Tanggal : 27 April 2014 Ke :
4. Maksud Perjalanan Dinas : Kegiatan Pely. luar gedung Kepala : Pada Tanggal :
Kepala :
5. Alat angkut yang dipergunakan : Kendaraan Umum

6. a. Tempat berangkat : Puskesmas Sambaliung .......................................
b. Tempat tujuan : inaran
7. a. Lamanya Perjalanan Dinas : 1 ( satu ) Hari III. Tiba di : Berangkat dari :
b. Tanggal berangkat : 27 April 2014 Pada Tanggal : Ke :
c. Tanggal harus kembali : 27 April 2014 Kepala : Pada Tanggal :
8. Pengikut : Nama : Kepala :
9. Pembenaan Anggaran : APBD II IV. Tiba Kembali di Telah diperiksa dengan keterangan bahwa perjalanan
a. Instansi : Dinas Kesehatan Kab. Berau Tersebut diatas benar dilakukan atas perintahnya dan
b. Mata Anggaran : 2014 semata -mata untuk kepentingan jabatan dalam waktu
10 Keterangan lain-lain : sesingkat-singkatnya
Catatan: PEJABAT YANG MEMBERI PERINTAH

1. SPPD ini harus diketahui tanggal tiba dan PADA TANGGAL : 02 Maret 2014 Kepala Puskesmas Sambaliung
berangkat oleh pejabat setempat yang V. Catatan lain-lain
dikunjungi setelah sampai di tempat tujuan Kepala Puskesmas Sambaliung
2. 2 (dua) hari setelah tiba kembali ditempat semula
SPPD harus diserahkan kembali kepada yang H. Syafrudin. AB
memberikan biaya perjalanan NIP. 19590102 198201 1 008 PERHATIAN :
Apabila perintah bepergian diberikan untuk bepergian yang tidak perlu untuk bepergian ongkosnya menurut
peraturan tidak dapat dibayar oleh PEMDA, maka yang memerintahkan Bertanggung jawab atas ongkosnya yang
dikeluarkan (Lihat Artikel No. 74 dari UU.ICW.)
PEMERINTAH KABUPAEN BERAU Lamp.VI (2 dari 4) Kepmen Keuangan tentang Perjalanan Dinas Dalam Negeri bagi Pejabat Negara Pegawai Negeri Sipil
Nomor : 019/KLG / PKM - SBL / IV / 2014
1. Pejabat yang berwenang memberikan perintah : Kepala Puskesmas Sambaliung
2. Nama Pegawai yang diperintahkan : #N/A
Kepala :

9. Pembenaan Anggaran : APBD II IV. Tiba Kembali di : Telah diperiksa dengan keterangan bahwa perjalanan

berangkat oleh pejabat setempat yang Kepala Puskesmas Sambaliung V. Catatan lain-lain
dikunjungi setelah sampai di tempat tujuan
2. 2 (dua) hari setelah tiba kembali ditempat semula H. Syafrudin. AB
SPPD harus diserahkan kembali kepada yang H. Syafrudin. AB NIP. 19590102 198201 1 008
Kepala :

Kepala :


Kepala :


Pejabat Negara Pegawai Negeri Sipil
menu
SURAT PERINTAH TUGAS

Nomor : 019KLG / PKM - SBL / IV / 2014 019
inaran
Puskesmas Sambaliung Kepada :
27 April 2014 1. Nama : #N/A 19
NIP : #N/A
Pangkat/ : #N/A
Jabatan : #N/A
...................................... 2. Nama : #N/A 27

NIP : #N/A
Pangkat/ : #N/A
Jabatan : #N/A
: 3. Nama : #N/A 22
NIP : #N/A
Pangkat/ : #N/A
Jabatan : #N/A
ngan keterangan bahwa perjalanan
s benar dilakukan atas perintahnya dan 4. Nama : #N/A 18
untuk kepentingan jabatan dalam waktu NIP : #N/A
sesingkat-singkatnya Pangkat/ : #N/A
Jabatan : #N/A
AT YANG MEMBERI PERINTAH
s Sambaliung 5. Nama : #N/A 18
NIP : #N/A
Pangkat/ : #N/A
Jabatan : #N/A
Tujuan : Pelayanan Luar gedung

nurut Lokasi : inaran 27
snya yang Lama Perjal : -24 Hari
Tanggal Pel : ###
Tanggal Kem: ### 2
gawai Negeri Sipil Demikian Surat Tugas ini dibuat untuk dapat dipergunakan sebagaimana mestinya.
Dikeluarkan : Sambaliung
Pada Tangga: ###
Kepala Puskesmas,
inaran H. Syafrudin. AB
Puskesmas Sambaliung NIP. 19590102 198201 1 008
27 April 2014
......................................
nar dilakukan atas perintahnya dan
uk kepentingan jabatan dalam waktu
MEMBERI PERINTAH
s Sambaliung
8201 1 008
an ongkosnya menurut
g jawab atas ongkosnya yang
inaran
Puskesmas Sambaliung
27 April 2014
......................................

MEMBERI PERINTAH
s Sambaliung
8201 1 008

inaran
27 April 2014
......................................

MEMBERI PERINTAH
s Sambaliung
8201 1 008
inaran
27 April 2014
......................................
MEMBERI PERINTAH
s Sambaliung
8201 1 008
LAMPIRAN PENERIMAAN BIAYA LUMPSUM PETUGAS DALAM RANGKA
KEGIATAN PELAYANAN KESEHATAN LUAR GEDUNG
PUSKESMAS SAMBALIUNG
KECAMATAN SAMBALIUNG
Puskesmas : Sambaliung
Nama Kampung : inaran
Tanggal Pelaksanaan : ###
IV 2014
NO NAMA PETUJABATAN RINCIAN P JUMLAH TANDA TANGAN
BIAYA AKO DITERIMA
1 2 3 4 5 6
1 #N/A #N/A 1 or x 1 hr x ### 1
2 #N/A #N/A 1 or x 1 hr x ### 2
3 #N/A #N/A 1 or x 1 hr x ### 3
4 #N/A #N/A 1 or x 1 hr x ### 4
5 #N/A #N/A 1 or x 1 hr x ### 5
JUMLAH ###
Sambaliung, ###
Kepala Puskesmas Sambaliung
H. SYAFRUDIN. AB
Nip. 19590102 198201 1 008
4 2014 Sunday 4
4 2014 Wednesday 4
PEMERINTAH KABUPATEN BERAU
DINAS KESEHATAN
PUSKESMAS GUNUNG TABUR
JALAN BANGSAWAN RT. II TELP. (0554) 2703237 GUNUNG TABUR (77352)

Nomor : 040 / PKM - GNT / TU / I / 2011
Kepada :
1. Nama : Suci permata lesatari,S.Kep
NIP : 198308022008012013
Pangkat/Golongan : Pengatur / II d
Jabatan : Pelaksana Perawat
2. Nama : ###
NIP : ###
Pangkat/Golongan : ###
Jabatan : ###
3. Nama : ###
NIP : ###
Jabatan : ###
4. Nama : ###
NIP : ###
Jabatan : ###
5. Nama : ###
NIP : ###
Jabatan : ###
6. Nama : ###
NIP : ###
Jabatan : ###
Tujuan :
Lokasi :
Lama Perjalanan : 65 Hari
Tanggal Pelaksanaan : 27 Januari 2011
Tanggal Kembali : 01 April 2011
Demikian Surat Tugas ini dibuat untuk dapat dipergunakan sebagaimana mestinya.
Dikeluarkan di : GUNUNG TABUR

Pada Tanggal : 27 Januari 2011
Mengetahui :
Lurah Gunung Tabur, Kepala Puskesmas,
Syarifudin. B dr. Hj. Sulistiawati

NIP. 19570910 197810 1 001 NIP. 19761005 200312 2 005
DINAS KESEHATAN
Jl.Mangkubumi II RT.07 Sambaliung
SURAT PERJALANAN DINAS
Nomor : 013/Kesling/BOK / PKM - SBL / I / 2016
Pejabat yang berwenang memberikan perintah Kepala Puskesmas Sambaliung

Nama Pegawai yang diperintahkan #N/A
a. NIP a. #N/A
b. Pangkat dan golongan b. #N/A
c. Jabatan c. #N/A
d. Tingkat Menurut Peraturan Perjalanan Dinas d. Lokal
Maksud Perjalanan Dinas Pelayanan luar gedung
Alat angkut yang dipergunakan Kendaraan Darat

a. Tempat berangkat Puskesmas Sambaliung
b. Tempat tujuan Kamp. Nyapa indah
a. Lamanya Perjalanan Dinas 1 hari
b. Tanggal berangkat 27 Januari 2016
c. Tanggal harus kembali 01 April 2016
Pengikut Nama Umur Hubungan keluarga/Keterangan
Pembenaan Anggaran
a. Instansi a. Dinas Kesehatan Kab. Berau
b. Kode Rekening b.
Keterangan lain-lain
Coret yang tidak perlu Ditetapkan di Sambaliung

Pada tanggal 25 Januari 2016
H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

Nama Pegawai yang diperintahkan Suci permata Lestari,S.Kep
a. NIP a. 198308022008012013
b. Pangkat dan golongan b. Penata Muda / III a
c. Jabatan c. Perawat Pelaksana Lanjutan
Maksud Perjalanan Dinas Kegiatan Pelayanan luar gedung

a. Lamanya Perjalanan Dinas 1 ( satu ) Hari
Pembenaan Anggaran
b. Kode Rekening b. 0

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

Nama Pegawai yang diperintahkan Rudiza Pahlawa
a. NIP a. -
b. Pangkat dan golongan b. PTT
c. Jabatan c. Sopir

Pembenaan Anggaran

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

a. NIP a. #N/A
c. Jabatan c. #N/A

Pembenaan Anggaran


H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008

DINAS KESEHATAN

a. NIP a. #N/A
c. Jabatan c. #N/A

Pembenaan Anggaran
H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
Berangkat dari : Puskesmas Sambaliung
(tempat kedudukan)
Ke : Kamp. Nyapa indah
Kepala : Puskesmas Sambaliung
H. Syafrudin. AB
NIP. 19590102 198201 1 008
II. Tiba di : Kamp. Nyapa indah Berangkat dari : Kamp. Nyapa indah
Pada Tanggal : 27 Januari 2016 Ke : Puskesmas Sambaliung
Kepala : Pada Tanggal : 27 Januari 2016
Kepala :
....................................... ......................................
III. Tiba di : Berangkat dari :

Pada Tanggal : Ke :
Kepala : Pada Tanggal :
Kepala :
....................................... ......................................
IV. Tiba di : Berangkat dari :

Pada Tanggal : Ke :
Kepala :
....................................... ......................................
V. Tiba di : Berangkat dari :

Pada Tanggal : Ke :
Kepala :
....................................... ......................................
VI. Tiba Kembali di : Puskesmas Sambaliung Telah diperiksa dengan keterangan bahwa perjalanan
(tempat kedudukan) Tersebut diatas benar dilakukan atas perintahnya dan
Pada Tanggal : 27 Januari 2016 semata -mata untuk kepentingan jabatan dalam waktu
sesingkat-singkatnya
Kepala Puskesmas Sambaliung Kepala Puskesmas Sambaliung
H. Syafrudin. AB H. Syafrudin. AB
Penata TK.I/III d Penata TK.I/III d
NIP. 19590102 198201 1 008 NIP. 19590102 198201 1 008
VII. Catatan lain-lain :
VIII.PERHATIAN :
Pejabat yang berwenang menerbitkan SPD, pegawai yang melakukan perjalanan dinas, para pejabat yang mengesahkan
tanggal berangkat/tiba, serta bendaharawan bertanggung jawab berdasarkan peraturan-peraturan Keuangan Negara
apabila negara menderita rugi akibat kesalahan, kelalaian, dan kealpaannya.
DINAS KESEHATAN
Jalan. Mangkubumi 2 RT.VII, Kec. Sambaliung, Berau
AKU BANGGA
MEMBANGUN
BERAU

Dasar : Biaya BOK Puskesmas Sambaliung 2016
MEMERINTAHKAN
Kepada :
1. Nama : ###
NIP : ###
Jabatan : ###
2. Nama : Suci permata Lestari,S.Kep

NIP : 198308022008012013
Pangkat/Golongan : Penata Muda / III a
Jabatan : Perawat Pelaksana Lanjutan
3. Nama : Rudiza Pahlawa

NIP : -
Pangkat/Golongan : PTT
Jabatan : Sopir
4. Nama : ###
NIP : ###
Jabatan : ###
5. Nama : ###
NIP : ###
Jabatan : ###
Untuk : Pelayanan luar gedung

Tempat berangkat : Puskesmas Sambaliung
Tempat Tujuan : Kamp. Nyapa indah
Lamanya : 66 hari
Tanggal berangkat : 27 Januari 2016
Beban Anggaran : BOK 2016
Setelah melaksanakan tugas agar membuat laporan.

Demikian Surat Tugas ini diberikan agar dipergunakan sebagaimana mestinya.
Ditetapkan di : Sambaliung
Kepala Puskesmas,
H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN
DINAS KESEHATAN
DINAS KESEHATAN
menu
013 I 2016
27
14
13
21
23
23
26
27 4 1 2016 Saturday
mbaliung 1 4 2016 Saturday

anuari 2016
as,
B
d
1 1 008
DINAS KESEHATAN
PUSAT KESEHATAN MASYARAKAT SAMBALIU
Jl. Mangkubumi II Rt VII Sambaliung
DAFTAR PENGELUARAN RIIL
Yang bertanda tangan dibawah ini :
Nama : #N/A
NIP : #N/A
Jabatan : #N/A
Berdasarkan Surat Perintah Tugas tanggal 06 Januari 2012, Nomor: 003/UKS-II/Pusk

Dengan ini kami menyatakan dengan sesungguhnya bahwa :
1. Biaya transport pegawai dan / atau biaya penginapan dibawah ini yang tidak d
bukti-bukti pengeluaran meliputi :
NO URAIAN
1 Transport dari pusk. Ke
2 Uang Harian
JUMLAH
2. Jumlah uang tersebut pada angka 1 di atas benar-benar dikeluarkan untuk pel
dinas dimaksud dan apabila dikemudian hari terdapat kelebihan atas pembay
untuk menyetorkan kelebihan tersebut ke Kas Negara.
Demikian pernyataan ini kami buta dengan sebenarnya, untuk dipergunakan sebagai
Mengetahui / menyetujui Puskesmas Sambaliung,

Kepala Puskesmas Sambaliung Pejabat Negara / Pegaw
Kab. Berau Prop. Kalimantan Timur Yang melakukan Perjala
TA.2016
H. Syafrudin. AB #N/A
NIP. 19590102 198201 1 008 Nip.
1
DINAS KESEHATAN
Nama : Suci permata Lestari,S.Kep

NIP : 198308022008012013
Jabatan : Perawat Pelaksana Lanjutan

NO URAIAN
2 Uang Harian
JUMLAH

TA.2016
H. Syafrudin. AB Suci permata Les

NIP. 19590102 198201 1 008 Nip.
DINAS KESEHATAN
Nama : Rudiza Pahlawa

NIP : -
Jabatan : Sopir

NO URAIAN
2 Uang Harian
JUMLAH

TA.2016
H. Syafrudin. AB Rudiza Pahl

NIP. 19590102 198201 1 008 Nip.
DINAS KESEHATAN
Nama : #N/A
NIP : #N/A
Jabatan : #N/A

NO URAIAN
2 Uang Harian
JUMLAH

TA.2016
NIP. 19590102 198201 1 008
H. Syafrudin. AB
NIP. 19590102 198201 1 008 Nip.

DINAS KESEHATAN
Nama : #N/A
NIP : #N/A
Jabatan : #N/A

NO URAIAN
2 Uang Harian
JUMLAH

TA.2016
TA.2016
NIP. 19590102 198201 1 008 Nip.
KABUPATEN BERAUPROPINSI KALIMA
ERAU TA. 2016
SAMBALIUNG KWITANSI
aliung
1. Th. Anggaran : 2016
IL 2. Bukti Kas No. :
3. Beban MAK :
Sudah terima dari :

Uang sebesar :
3/UKS-II/Pusk-SBL/I/2012 Utuk Pembayaran : Transport dan uang harian dalam ra

Dians ke Kamp. Nyapa indah
ni yang tidak dapat diperoleh Berdasarkan SPPD
Nomor :
Untuk perjalanan dinas : Pelayanan luar gedung
JUMLAH Tanggal : 27 Januari 2016
Rp 50,000 Terbilang :
Rp 50,000
Rp 100,000
kan untuk pelaksanaan perjalanan Bendahara Pengeluaran

atas pembayaran,kami bersedia Bantuan Operasional Kesehatan
TA. 2016
nakan sebagaimana mestinya Suci Permata Lestari,S.Kep

Nip. 198308022008012013
,Mengetahui
s Sambaliung, .......2016 Kepala Puskesmas Sambaliung
Negara / Pegawai Negeri Kab. Berau Propinsi Kalimantan Timur
akukan Perjalanan Dinas TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
#N/A
#N/A
ERAU PUSKESMAS SAMBALIUNG
SAMBALIUNG TA. 2016
aliung
KWITANSI
IL
2. Bukti Kas No. :
3. Beban MAK :
Sudah terima dari :

Uang sebesar :
3/UKS-II/Pusk-SBL/I/2012
ni yang tidak dapat diperoleh Utuk Pembayaran : Transport dan uang harian dalam ra
Berdasarkan SPPD
JUMLAH Nomor :
Rp 50,000 Untuk perjalanan dinas : Pelayanan luar gedung
Rp 50,000 Tanggal : ###
kan untuk pelaksanaan perjalanan

atas pembayaran,kami bersedia
Bendahara Pengeluaran
Bantuan Operasional Kesehatan
TA. 2016
nakan sebagaimana mestinya
Suci Permata Lestari,S.Kep

s Sambaliung, .......2016 Nip. 198308022008012013
Negara / Pegawai Negeri
akukan Perjalanan Dinas ,Mengetahui
Kab. Berau Propinsi Kalimantan Timur
TA.2016
H. Syafrudin. AB
ci permata Lestari,S.Kep
NIP. 19590102 198201 1 008
198308022008012013
TA. 2016
ERAU KWITANSI
SAMBALIUNG 1. Th. Anggaran : 2016

aliung 2. Bukti Kas No. :
3. Beban MAK :
IL
Sudah terima dari :

Uang sebesar :
Utuk Pembayaran : Transport dan uang harian dalam ra

3/UKS-II/Pusk-SBL/I/2012 Berdasarkan SPPD
Nomor :
ni yang tidak dapat diperoleh Untuk perjalanan dinas : Pelayanan luar gedung
Tanggal : ###
Terbilang :
JUMLAH
Rp 50,000
Rp 50,000
Rp 100,000 Bendahara Pengeluaran
kan untuk pelaksanaan perjalanan TA. 2016

Nip. 198308022008012013
,Mengetahui
TA.2016
s Sambaliung, .......2016
akukan Perjalanan Dinas H. Syafrudin. AB
NIP. 19590102 198201 1 008
Rudiza Pahlawa
-
SAMBALIUNG TA. 2016
aliung
KWITANSI
IL
2. Bukti Kas No. :
3. Beban MAK :
Sudah terima dari :

Uang sebesar :
Berdasarkan SPPD
JUMLAH Nomor :
Rp 50,000 Tanggal : ###

TA. 2016

s Sambaliung, .......2016 Nip. 198308022008012013
TA.2016
H. Syafrudin. AB
#N/A
NIP. 19590102 198201 1 008
H. Syafrudin. AB
NIP. 19590102 198201 1 008
#N/A

SAMBALIUNG TA. 2016
aliung
KWITANSI
IL
2. Bukti Kas No. :
3. Beban MAK :
Sudah terima dari :

Uang sebesar :
Berdasarkan SPPD
JUMLAH Nomor :
Rp 50,000 Tanggal : ###

TA. 2016

s Sambaliung, .......2016 Nip. 198308022008012013
TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
s Sambaliung, .......2016
TA.2016
#N/A H. Syafrudin. AB
NIP. 19590102 198201 1 008
#N/A
MBALIUNG
KALIMANTAN TIMUR
SI
rian dalam rangka perjalanan

apa indah
Puskesmas Sambaliung,......
Yang Menerima
#N/A
Nip. #N/A
i
mbaliung
ntan Timur
AB
01 1 008
MBALIUNG
KALIMANTAN TIMUR
SI

apa indah
Yang Menerima
Suci permata Lestari,S.Kep

Nip. 198308022008012013
i
mbaliung
ntan Timur
AB
01 1 008
MBALIUNG
KALIMANTAN TIMUR
SI

apa indah
Yang Menerima
Rudiza Pahlawa
Nip. -
i
mbaliung
ntan Timur
AB
01 1 008
MBALIUNG
KALIMANTAN TIMUR
SI

apa indah
Yang Menerima
#N/A
Nip. #N/A
i
mbaliung
ntan Timur
AB
01 1 008
AB
01 1 008
MBALIUNG
KALIMANTAN TIMUR
SI

apa indah
Yang Menerima
#N/A
Nip. #N/A
i
mbaliung
ntan Timur
AB
01 1 008
i
mbaliung
ntan Timur
AB
01 1 008
DINAS KESEHATAN
Nomor : 040/UKS/BOK / PKM - SBL / I / 2016

a. NIP a. #N/A
c. Jabatan c. #N/A
Maksud Perjalanan Dinas 0

b. Tempat tujuan 0
a. Lamanya Perjalanan Dinas 66 Hari
Pembenaan Anggaran
b. Kode Rekening b.

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

a. NIP a. #N/A
c. Jabatan c. #N/A

b. Tempat tujuan 0
Pembenaan Anggaran

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

a. NIP a. #N/A
c. Jabatan c. #N/A

b. Tempat tujuan 0
Pembenaan Anggaran

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

a. NIP a. #N/A
c. Jabatan c. #N/A

b. Tempat tujuan 0
Pembenaan Anggaran

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
(tempat kedudukan)
Ke : 0
H. Syafrudin. AB
NIP. 19590102 198201 1 008
II. Tiba di : 0 Berangkat dari : 0
Kepala : Pada Tanggal : 01 April 2016
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................
Pada Tanggal : 01 April 2016 semata -mata untuk kepentingan jabatan dalam waktu
NIP. 19590102 198201 1 008 NIP. 19590102 198201 1 008
VIII.PERHATIAN :
DINAS KESEHATAN
PUSKESMAS SAMBALIUNG m

Nomor : 040/UKS/BOK / PKM - SBL / I / 2016 040
Dasar : Biaya Operasional BOK Puskesmas Sambaliung Tahun 2016

25
Kepada :
1. Nama : ###
NIP : ###
Jabatan : ### 27
2. Nama : ###
NIP : ###
Jabatan : ### 24
3. Nama : ###
NIP : ###
Jabatan : ### 17
4. Nama : ###
NIP : ###
Jabatan : ###
27
Tujuan :
Lokasi :
Lama Perjalanan : 66 Hari 1
Tanggal Pelaksanaan : 27 Januari 2016
Dikeluarkan di : SAMBALIUNG
Kepala Puskesmas,
H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
menu
I 2016
Berdasarkan Surat
Dengan ini kami m
1.
2.
Demikian pernyat
1 1 2016 Wednesday 1 Me
Kepal
Kab. Be
4 4 2016 Friday 1
NIP.
menu
Berdasarkan Surat
Dengan ini kami m
1.
2.
Demikian pernyat
Me
Kepal
Kab. Be
NIP.
Berdasarkan Surat
Dengan ini kami m
1.
2.
Demikian pernyat
Me
Kepal
Kab. Be
NIP.
Berdasarkan Surat
Dengan ini kami m
1.
2.
Demikian pernyat
Me
Kepal
Kab. Be
NIP.
DINAS KESEHATAN
PUSAT KESEHATAN MASYARAKAT SAMBALIUNG
1.
DAFTAR PENGELUARAN RIIL 2.
3.
Nama : #N/A
NIP : #N/A
Jabatan : #N/A
rdasarkan Surat Perintah Tugas tanggal 06 Januari 2012, Nomor: 003/UKS-II/Pusk-SBL/I/2012

ngan ini kami menyatakan dengan sesungguhnya bahwa :
Biaya transport pegawai dan / atau biaya penginapan dibawah ini yang tidak dapat diperoleh
NO URAIAN JUMLAH
1 Transport dari pusk. Ke Rp 50,000
2 Uang Harian Rp 50,000
JUMLAH Rp 100,000
Jumlah uang tersebut pada angka 1 di atas benar-benar dikeluarkan untuk pelaksanaan perjalanan Bendaha
dinas dimaksud dan apabila dikemudian hari terdapat kelebihan atas pembayaran,kami bersedia Bantuan Ope
untuk menyetorkan kelebihan tersebut ke Kas Negara. TA
mikian pernyataan ini kami buta dengan sebenarnya, untuk dipergunakan sebagaimana mestinya Suci Perm
Nip. 19830
Mengetahui / menyetujui Puskesmas Sambaliung, .......2016

Kepala Puskesmas Sambaliung Pejabat Negara / Pegawai Negeri
Kab. Berau Prop. Kalimantan Timur Yang melakukan Perjalanan Dinas
TA.2016
NIP. 19590102 198201 1 008 Nip. #N/A
DINAS KESEHATAN

2.
Yang bertanda tangan dibawah ini : 3.
Nama : #N/A
NIP : #N/A
Jabatan : #N/A

NO URAIAN JUMLAH
JUMLAH Rp 100,000
Jumlah uang tersebut pada angka 1 di atas benar-benar dikeluarkan untuk pelaksanaan perjalanan
dinas dimaksud dan apabila dikemudian hari terdapat kelebihan atas pembayaran,kami bersedia Bendaha
untuk menyetorkan kelebihan tersebut ke Kas Negara. Bantuan Ope
TA
mikian pernyataan ini kami buta dengan sebenarnya, untuk dipergunakan sebagaimana mestinya
Suci Perm
Nip. 19830
TA.2016
NIP. 19590102 198201 1 008 Nip. #N/A
DINAS KESEHATAN

2.
Nama : #N/A
NIP : #N/A
Jabatan : #N/A

NO URAIAN JUMLAH
JUMLAH Rp 100,000
TA
Suci Perm
Nip. 19830
TA.2016
NIP. 19590102 198201 1 008 Nip. #N/A
DINAS KESEHATAN

2.
Nama : #N/A
NIP : #N/A
Jabatan : #N/A

NO URAIAN JUMLAH
JUMLAH Rp 100,000
TA
Suci Perm
Nip. 19830
TA.2016
NIP. 19590102 198201 1 008 Nip. #N/A
KABUPATEN BERAUPROPINSI KALIMANTAN TIMUR
TA. 2016
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :
Utuk Pembayaran : Transport dan uang harian dalam rangka perjalanan

Dians ke 0
Berdasarkan SPPD
Nomor :
Untuk perjalanan dinas : 0
Tanggal : 27 Januari 2016
Terbilang :
Bendahara Pengeluaran Yang Menerima
TA. 2016
Suci Permata Lestari,S.Kep #N/A

Nip. 198308022008012013 Nip. #N/A
,Mengetahui
TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
TA. 2016
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :

Dians ke 0
Berdasarkan SPPD
Nomor :
Tanggal : ###
Terbilang :
TA. 2016

Nip. 198308022008012013 Nip. #N/A
,Mengetahui
TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
TA. 2016
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :

Dians ke 0
Berdasarkan SPPD
Nomor :
Tanggal : ###
Terbilang :
TA. 2016

Nip. 198308022008012013 Nip. #N/A
,Mengetahui
TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
TA. 2016
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :

Dians ke 0
Berdasarkan SPPD
Nomor :
Tanggal : ###
Terbilang :
TA. 2016

Nip. 198308022008012013 Nip. #N/A
,Mengetahui
TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
DINAS KESEHATAN

Nama Pegawai yang diperintahkan dr. Lelly Kusumaningrum
a. NIP a. 19790428 201001 2 012
b. Pangkat dan golongan b. Penata Muda Tk. I / III b
c. Jabatan c. Dokter Pertama

b. Tempat tujuan 0
Pembenaan Anggaran
b. Kode Rekening b.

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

Nama Pegawai yang diperintahkan Suci permata lesatari,S.Kep
a. NIP a. 198308022008012013
b. Pangkat dan golongan b. Pengatur / II d
c. Jabatan c. Pelaksana Perawat

b. Tempat tujuan 0
Pembenaan Anggaran

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

a. NIP a. #N/A
c. Jabatan c. #N/A

b. Tempat tujuan 0
Pembenaan Anggaran

H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
(tempat kedudukan)
Ke : 0
H. Syafrudin. AB
NIP. 19590102 198201 1 008
II. Tiba di : 0 Berangkat dari : 0
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................
NIP. 19590102 198201 1 008 NIP. 19590102 198201 1 008
VIII.PERHATIAN :
DINAS KESEHATAN

Nomor : 040/Kesling/BOK / PKM - SBL / I / 2016 040

25
Kepada :
1 1.Nama : dr. Lelly Kusumaningrum
NIP : 19790428 201001 2 012
Pangkat/Golongan : Penata Muda Tk. I / III b
Jabatan : Dokter Pertama 28
15 2.Nama : Suci permata lesatari,S.Kep

NIP : 198308022008012013
Pangkat/Golongan : Pengatur / II d
Jabatan : Pelaksana Perawat 24
24 3.Nama : ###
NIP : ###
Jabatan : ###
Tujuan :
Lokasi :
Lama Perjalanan : 66 Hari
Tanggal Pelaksanaan : 27 Januari 2016 27
1
Dikeluarkan di : Sambaliung
Kepala Puskesmas,
H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
menu
I 2016
Berdasarkan Su
Dengan ini kam
1.
2.
Demikian pern
1 2016
Ke
Kab.
4 2016
4 2014 #REF! 4
N
menu 4 2014 #REF! 4
Berdasarkan Su
Dengan ini kam
1.
2.
Demikian pern
Ke
Kab.
N
Berdasarkan Su
Dengan ini kam
1.
2.
Demikian pern
Ke
Kab.
N
DINAS KESEHATAN
1.
3.
Nama : dr. Lelly Kusumaningrum

NIP : 19790428 201001 2 012
Jabatan : Dokter Pertama

NO URAIAN JUMLAH
JUMLAH Rp 100,000
Jumlah uang tersebut pada angka 1 di atas benar-benar dikeluarkan untuk pelaksanaan perjalanan Bendaha
dinas dimaksud dan apabila dikemudian hari terdapat kelebihan atas pembayaran,kami bersedia Bantuan Ope
untuk menyetorkan kelebihan tersebut ke Kas Negara. TA
mikian pernyataan ini kami buta dengan sebenarnya, untuk dipergunakan sebagaimana mestinya Suci Perm
Nip. 19830

TA.2016
H. Syafrudin. AB dr. Lelly Kusumaningrum

NIP. 19590102 198201 1 008 Nip. 19790428 201001 2 012
DINAS KESEHATAN

2.
Nama : Suci permata lesatari,S.Kep

NIP : 198308022008012013
Jabatan : Pelaksana Perawat

NO URAIAN JUMLAH
JUMLAH Rp 100,000
TA
Suci Perm
Nip. 19830
TA.2016
H. Syafrudin. AB Suci permata lesatari,S.Kep

NIP. 19590102 198201 1 008 Nip. 198308022008012013
DINAS KESEHATAN

2.
Nama : #N/A
NIP : #N/A
Jabatan : #N/A

NO URAIAN JUMLAH
JUMLAH Rp 100,000
TA
Suci Perm
Nip. 19830
TA.2016
NIP. 19590102 198201 1 008 Nip. #N/A
TA. 2016
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :

dinas ke 0
Berdasarkan SPPD
Nomor :
Terbilang :
TA. 2016
Suci Permata Lestari,S.Kep dr. Lelly Kusumaningrum

Nip. 198308022008012013 Nip. 19790428 201001 2 012
,Mengetahui
TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
TA. 2016
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :

dinas ke 0
Berdasarkan SPPD
Nomor :
Terbilang :
TA. 2016
Suci Permata Lestari,S.Kep Suci permata lesatari,S.Kep

Nip. 198308022008012013 Nip. 198308022008012013
,Mengetahui
Kab. Berau Propinsi Kalimantan Timur TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
TA. 2016
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :

Dinas ke 0
Berdasarkan SPPD
Nomor :
Terbilang :
TA. 2016

Nip. 198308022008012013 Nip. #N/A
,Mengetahui
Kab. Berau Propinsi Kalimantan Timur TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
DINAS KESEHATAN
Nomor : 039/KIA/BOK / PKM - SBL / II / 2016

Nama Pegawai yang diperintahkan 0
a. NIP a. 0
b. Pangkat dan golongan b. 0
c. Jabatan c. 0
Maksud Perjalanan Dinas DITK di PAUD

b. Tempat tujuan Sambaliung
b. Tanggal berangkat 22 April 2016
Pembenaan Anggaran
b. Kode Rekening b.

Pada tanggal 20 April 2016
H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
DINAS KESEHATAN

Nama Pegawai yang diperintahkan dr. Aji Ety Dahlia
a. NIP a. 19781104 201412 2 001
b. Pangkat dan golongan b. 0
c. Jabatan c. 0
Maksud Perjalanan Dinas DITK di PAUD

b. Tempat tujuan Sambaliung
b. Tanggal berangkat 22 April 2016
Pembenaan Anggaran

Pada tanggal 20 April 2016
H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
(tempat kedudukan)
Pada Tanggal : 22 April 2016
Ke : Sambaliung
H. Syafrudin. AB
NIP. 19590102 198201 1 008
II. Tiba di : Sambaliung Berangkat dari : Sambaliung
Pada Tanggal : 22 April 2016 Ke : Puskesmas Sambaliung
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................

Pada Tanggal : Ke :
Kepala :
....................................... ......................................
NIP. 19590102 198201 1 008 NIP. 19590102 198201 1 008
VIII.PERHATIAN :
DINAS KESEHATAN

Kepada :
1. Nama : 0
NIP : 0
Pangkat/Golongan : 0
Jabatan : 0
2. Nama : dr. Aji Ety Dahlia

NIP : 19781104 201412 2 001
Pangkat/Golongan : 0
Jabatan : 0
Tujuan : DITK di PAUD

Lokasi : Sambaliung
Lama Perjalanan : 2 hari
Tanggal Pelaksanaan : 22 April 2016
Dikeluarkan di : Sambaliung
Pada Tanggal : 20 April 2016
Kepala Puskesmas,
H. Syafrudin. AB
Penata TK.I/III d
NIP. 19590102 198201 1 008
menu
039 II 2016
22 4 4 2016 Friday 2
24 4 4 2016 Sunday 2
menu
DINAS KESEHATAN
1.
3.
Nama : 0
NIP : 0
Jabatan : 0
Berdasarkan Surat Perintah Tugas tanggal 11 Februari 2016, Nomor: 039/KIA/BOK/Pusk-SBL/I/2016

1. Biaya transport pegawai dan / atau biaya penginapan dibawah ini yang tidak dapat diperoleh
NO URAIAN JUMLAH
1 Transport dari pusk. Ke PAUD sambaliung Rp 50,000
JUMLAH Rp 100,000
2. Jumlah uang tersebut pada angka 1 di atas benar-benar dikeluarkan untuk pelaksanaan perjalanan Bend
dinas dimaksud dan apabila dikemudian hari terdapat kelebihan atas pembayaran,kami bersedia Bantuan
Demikian pernyataan ini kami buta dengan sebenarnya, untuk dipergunakan sebagaimana mestinya Suci P
Nip. 1
Mengetahui / menyetujui Puskesmas Sambaliung, ..................2016

TA.2016
H. Syafrudin. AB 0
NIP. 19590102 198201 1 008 Nip. 0
DINAS KESEHATAN
1.
3.
Nama : dr. Aji Ety Dahlia

NIP : 19781104 201412 2 001
Jabatan : 0
Berdasarkan Surat Perintah Tugas tanggal 11 Februari 2016, Nomor: 039/KIA/BOK/Pusk-SBL/I/2016

1. Biaya transport pegawai dan / atau biaya penginapan dibawah ini yang tidak dapat diperoleh
NO URAIAN JUMLAH
1 Transport dari pusk. Ke PAUD sambaliung Rp 50,000
JUMLAH Rp 125,000
2. Jumlah uang tersebut pada angka 1 di atas benar-benar dikeluarkan untuk pelaksanaan perjalanan Bend
dinas dimaksud dan apabila dikemudian hari terdapat kelebihan atas pembayaran,kami bersedia Bantuan
Demikian pernyataan ini kami buta dengan sebenarnya, untuk dipergunakan sebagaimana mestinya Suci P
Nip. 1
Mengetahui / menyetujui Puskesmas Sambaliung, ............2016

TA.2016
H. Syafrudin. AB dr. Aji Ety Dahlia

NIP. 19590102 198201 1 008 Nip. 19781104 201412 2 001
TA. 2011
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :
Rp 100,000

Dinas ke Sambaliung
Berdasarkan SPPD
Nomor :
Untuk perjalanan dinas : DITK di PAUD
Tanggal : 22 April 2016
Terbilang :
Seratus Ribu Rupiah
TA. 2016
Suci Permata Lestari,S.Kep 0

Nip. 198308022008012013 Nip. 0
TA. 2011
KWITANSI
Th. Anggaran : 2016

Bukti Kas No. :
Beban MAK :
Sudah terima dari :

Uang sebesar :
Rp 125,000

Dinas ke Sambaliung
Berdasarkan SPPD
Nomor :
Untuk perjalanan dinas : DITK di PAUD
Tanggal : 22 April 2016
Terbilang :
Seratus Ribu Rupiah
TA. 2016
Suci Permata Lestari,S.Kep dr. Aji Ety Dahlia

Nip. 198308022008012013 Nip. 19781104 201412 2 001
,Mengetahui
TA.2016
H. Syafrudin. AB
NIP. 19590102 198201 1 008
DINAS KESEHATAN
Jl. Mangkubumi II Rt.VIISambaliung,77371
email : puskesmassambaliung@gmail.com FB : puskesmassambaliung
PUSKESMAS : SAMBALIUNG
NOMOR : 340 /TU-III/ PKM-SBL /VIII /2017 0
SURAT KETERANGAN KESEHATAN
Yang bertanda tangan di bawah ini, dokter umum pemeriksa kesehatan dalam hal ini menjalankan
tugasnya dengan mengikat sumpah yang telah diucapkan sewaktu menerima jabatan, dengan ini
menerangkan bahwa telah memeriksa dengan teliti seseorang :
Nama : Muh. Risal

Tempat/Tanggal Lahir : Cilellang, 06 Februari 1989
Jenis kelamin : Laki-laki
Pekerjaan : Belum/Tidak Bekerja
Alamat : Sambaliung
Permintaan : Sendiri
Dengan Nomor Surat... Tanggal

Dengan berpendapat bahwa yang bersangkutan dalam keadaan sehat jasmani dan rohani
Surat keterangan ini dibuat untuk : Melamar Pekerjaan
Yang bersangkutan dalam kelas II dalam lampiran AI KEURING-REGLEMENT.
Demikian Surat Keterangan ini dibuat untuk dapat dipergunakan sebagaimana mestinya
Dikeluarkan di Sambaliung
Pada Tanggal : 19 September 2017
Dokter Pemeriksa
dr. Fredy Setyawan

NIP. ..........................................
Surat keterangan ini berlaku hanya 3 (tiga) bulan sejak tanggal dikeluarkan
Berlaku sejak tanggal :
Sampai dengan : 19 September 2017
19 Desember 2017
Keterangan :
: BB : 58.5 Kg
: TB : 183.5 Cm
:
: Gol. Darah
Bebas Buta Warna
340 IX A
2
2
PEKERJAAN
Q19
J19 Laki-laki Pelajar/Mahasiswa
J20 Perempuan Q21
Pegawai Negeri Sipil (PNS)
Q23
Ibu Rumah Tangga
J24 Perpanjangan SIM Q25
J25 Melamar Pekerjaan Karyawan Swasta
J26 Melanjutkan Pendidikan
J27 Persyaratan Nikah
TANGGAL
19 9 2017 Saturday
J50 Bebas Buta Warna

J51 Buta Warna Parsial
DATA PEGAWAI PUSKESMAS Sambaliung
NO NAMA NIP PANGKAT / GOLONGAN

1 dr. Lelly Kusumaningrum 19790428 201001 2 012 Penata Muda Tk. I / III b
2 dr. Fredy Setyawan ..........................................
3 dr. Wiwin 19810825 200803 2 002
4 dr. Aji Ety Dahlia 19781104 201412 2 001
5
6
7
8
9
10
1 Pelajar/Mahasiswa 19761005 200312 2 005 Penata Tk. I / III d
2 Pegawai Negeri Sipil (PNS 19800226 200012 2 001 Penata Muda / III a
3 Mengurus Rumah Tangga 19810102 200502 2 002 Pengatur Tk. I / II d
4 Petani/Pekebun 19810417 200502 2 007 Pengatur Tk. I / II d
5 Karyawan Swasta 19750311 200604 1 007 Pengatur Tk. I / II d
6 Karyawan Honorer 19750321 200604 2 018 Pengatur Tk. I / II d
7 19850623 201001 2 008 Pengatur Tk. I / II d
8 19710808 200701 1 015 Pengatur Muda TK. I / II b
9 19851109 200701 2 001 Pengatur Muda TK. I / II b
10 Ismini,Amd.Kep - PTT
11 Widya Lestari,Amd.KL - PTT
12 Santi 198511092007012001 Pengatur/ II c
13 Rudiza Pahlawa - PTT
14 Suci permata Lestari,S.Kep 198308022008012013 Penata Muda / III a
15 Suci permata lesatari,S.Kep 198308022008012013 Pengatur / II d
01 January 2010 40179
02 January 2010 40180 Column1
12 January 2010 40190 10 March 2010
29 January 2010 40207
30 January 2010 40208
31 January 2010 40209
01 February 2010 40210
02 February 2010 40211
03 February 2010 40212
04 February 2010 40213
05 February 2010 40214
06 February 2010 40215
07 February 2010 40216
08 February 2010 40217
09 February 2010 40218
10 February 2010 40219
11 February 2010 40220
12 February 2010 40221
13 February 2010 40222
14 February 2010 40223
15 February 2010 40224
16 February 2010 40225
17 February 2010 40226
18 February 2010 40227
19 February 2010 40228
20 February 2010 40229
21 February 2010 40230
22 February 2010 40231
23 February 2010 40232
24 February 2010 40233
25 February 2010 40234
26 February 2010 40235
27 February 2010 40236
28 February 2010 40237
01 March 2010 40238
02 March 2010 40239
03 March 2010 40240
04 March 2010 40241
05 March 2010 40242
06 March 2010 40243
07 March 2010 40244
08 March 2010 40245
09 March 2010 40246
10 March 2010 40247
11 March 2010 40248
12 March 2010 40249
13 March 2010 40250
14 March 2010 40251
15 March 2010 40252
16 March 2010 40253
17 March 2010 40254
18 March 2010 40255
19 March 2010 40256
20 March 2010 40257
21 March 2010 40258
22 March 2010 40259
23 March 2010 40260
24 March 2010 40261
25 March 2010 40262
26 March 2010 40263
27 March 2010 40264
28 March 2010 40265
29 March 2010 40266
30 March 2010 40267
31 March 2010 40268
01 April 2010 40269
02 April 2010 40270
03 April 2010 40271
04 April 2010 40272
05 April 2010 40273
06 April 2010 40274
07 April 2010 40275
08 April 2010 40276
09 April 2010 40277
10 April 2010 40278
11 April 2010 40279
12 April 2010 40280
13 April 2010 40281
14 April 2010 40282
15 April 2010 40283
16 April 2010 40284
17 April 2010 40285
18 April 2010 40286
19 April 2010 40287
20 April 2010 40288
21 April 2010 40289
22 April 2010 40290
23 April 2010 40291
24 April 2010 40292
25 April 2010 40293
26 April 2010 40294
27 April 2010 40295
28 April 2010 40296
29 April 2010 40297
30 April 2010 40298
01 May 2010 40299
02 May 2010 40300
03 May 2010 40301
04 May 2010 40302
05 May 2010 40303
06 May 2010 40304
07 May 2010 40305
08 May 2010 40306
09 May 2010 40307
10 May 2010 40308
11 May 2010 40309
12 May 2010 40310
13 May 2010 40311
14 May 2010 40312
15 May 2010 40313
16 May 2010 40314
17 May 2010 40315
18 May 2010 40316
19 May 2010 40317
20 May 2010 40318
21 May 2010 40319
22 May 2010 40320
23 May 2010 40321
24 May 2010 40322
25 May 2010 40323
26 May 2010 40324
27 May 2010 40325
28 May 2010 40326
29 May 2010 40327
30 May 2010 40328
31 May 2010 40329
01 June 2010 40330
02 June 2010 40331
03 June 2010 40332
04 June 2010 40333
05 June 2010 40334
06 June 2010 40335
07 June 2010 40336
08 June 2010 40337
09 June 2010 40338
10 June 2010 40339
11 June 2010 40340
12 June 2010 40341
13 June 2010 40342
14 June 2010 40343
15 June 2010 40344
16 June 2010 40345
17 June 2010 40346
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PEMERINTAH KABUPATEN BERAU Lamp.

5. Alat angkut yang dipergunakan : Kendaraan Umum

Catatan: PEJABAT YANG MEMBERI PERINTAH

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Catatan: PEJABAT YANG MEMBERI PERINTAH

Catatan: PEJABAT YANG MEMBERI PERINTAH

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Catatan: PEJABAT YANG MEMBERI PERINTAH

5. Alat angkut yang dipergunakan : Kendaraan Umum

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SURAT PERINTAH TUGAS

...................................... 2. Nama : #N/A 27

Tujuan : Pelayanan Luar gedung

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SURAT PERINTAH TUGAS

Dasar : Biaya BOK Puskesmas Sambaliung 2016

2. Nama : Suci permata Lestari,S.Kep

3. Nama : Rudiza Pahlawa

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DAFTAR PENGELUARAN RIIL

Yang bertanda tangan dibawah ini :

Berdasarkan Surat Perintah Tugas tanggal 06 Januari 2012, Nomor: 003/UKS-II/Pusk

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DAFTAR PENGELUARAN RIIL

Yang bertanda tangan dibawah ini :

Nama : Suci permata Lestari,S.Kep

Berdasarkan Surat Perintah Tugas tanggal 06 Januari 2012, Nomor: 003/UKS-II/Pusk