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PEMERINTAH KABUPATEN SELUMA

DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan Sukaraja

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

Yang bertanda tangan di bawah ini :


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

Memberi tugas kepada :

No Nama /NIP Tanggal Tempat Tujuan Maksud Perjalanan


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

Pembiayaan Perjalanan dibebankan pada : DIPA Satkes Dinas Kesehatan Kabupaten Seluma
tahun 2017

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

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2018

2. Nama Petugas/Tim : . ………………………...

3. Tujuan Perjalanan : ………………………….

4. Tanggal Perjalanan : …………………….........

5. Maksud Perjalanan : Melaksanakan Kegiatan PROMKES

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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2018

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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan Sukaraja

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : / PKM BBT / BOK / / 2018

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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 : .......................................

7. Hasil Kunjungan :

a. Proses pelaksanaan :
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

b. Permasalahan yang dihadapi :

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

c. Kesimpulan/Saran Perbaikan :

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

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

Fahrozan, SKM Sugiyani


NIP : 197602212003122002

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 : .......................................

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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan Sukaraja

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

Yang bertanda tangan di bawah ini :


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

Memberi tugas kepada :

No Nama /NIP Tanggal Tempat Tujuan Maksud Perjalanan


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

Pembiayaan Perjalanan dibebankan pada : DIPA Satkes Dinas Kesehatan Kabupaten Seluma
tahun 2017

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

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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. Hasil Kunjungan :

d. Proses pelaksanaan :
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

e. Permasalahan yang dihadapi :

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

f. Kesimpulan/Saran Perbaikan :

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

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

Mengetahui Pelapor
Kepala KUA Sukaraja

…………………………… …………………...
NIP :……………………..

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 :

d. Proses pelaksanaan :
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

e. Permasalahan yang dihadapi :

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

f. Kesimpulan/Saran Perbaikan :

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

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

Fahrozan, SKM Sugiyani


NIP : 197602212003122002

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 : .......................................

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 UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 :
Melakukan Konseling kepada Pasien Usila tentang penyakit........................................
............................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

b. Permasalahan yang dihadapi:

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

c. Kesimpulan/Saran Perbaikan :

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

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

…………………………… …………………...
NIP :……………………..

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 :
Melayani Pendaftaran pasien Usila dengan jumlah kunjungan...........orang, dengan
rinciaan pasien Laki-laki sebanyak................orang, pasien perempuan
sebanyak................orang dan pasien kunjungan baru sebanyak.............orang.

b. Permasalahan yang dihadapi:

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

c. Kesimpulan/Saran Perbaikan :

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

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

…………………………… …………………...
NIP :……………………..

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 :
- Melakukan penatalaksanaan dan Diagnosa kepada pasien Usila dengan hasil antara
lain didapatkan kesimpulan penyakit Hipertensi..........orang, Artritis...........orang,
DM..............orang, Obesitas..............orang, dan penyakit lainnya.............orang.
- Memberikan Therafi sesuai dengan Kebutuhan pasien.
b. Permasalahan yang dihadapi :

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

c. Kesimpulan/Saran Perbaikan :

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

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

…………………………… …………………...
NIP :……………………..

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001
PEMERINTAH KABUPATEN SELUMA
DINAS KESEHATAN
UPT PUSKESMAS BABATAN
Jln. Raya Bengkulu Seluma Km 19 Kelurahan Babatan kecamatan 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 :
Melakukan pemeriksaan Tanda-tanda Vital (TTV)dengan hasil sbb: Tekanana Darah
Normal...........orang. Tekanan Darah Rendah............Orang, Tekanan Darah
Tinggi..........orang, Nadi Normal........orang, Nadi pelan..........orang, Nadi
cepat............orang, Berat Badan Normal..............orang, Berat badan Lebih..............orang,
berat badan Kurang...........orang.
Selanjutanya melakukan anamnesa keluhan pasien.
b. Permasalahan yang dihadapi :

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

c. Kesimpulan/Saran Perbaikan :

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

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

…………………………… …………………...
NIP :……………………..

Kepala UPT Puskesmas Babatan

Ratna Sari Dewi, SKM.


NIP : 19690929 199101 2 001