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PEMERINTAH KABUPATEN TOBA SAMOSIR

DINAS KESEHATAN
UPT PUSKESMAS TANDANG BUHIT
KECAMATAN BALIGE
Jl. Patuan Nagari - Balige
Telp. (0632) 4320644, Fax. (0632) 4320644, Kode Pos 22313
Email: puskesmastandangbuhit@gmail.com.

LAPORAN PERJALANAN DINAS

1. Nama Petugas/tim :
2. NIP : ………………………………………………………………..
3. Pangkat/Gol : …………………………………………………………………
4. Jabatan : ………………………………………………………………..
5. Nomor SPT : 094/………………./SPT/Pusk/……../2018
6. Maksud Perjalanan : ..................................................................
7. Waktu Kunjungan : ……………………………………………………………….
8. Tempat Tujuan : ………………………………………………………………..
9. Hasil Perjalanan Dinas : -
a. Proses Pelaksanaan :
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b.Permasalahan yang dihadapi: -


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.…….…………………………………………………………………………………………….
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c.Kesimpulan/SaranPerbaikan :-
.......................................................................................................
....……………………………………………………………………………………………….
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Yang Melaksanakan Perjalanan Dinas

.…………………………………………
NIP. ……………………………………