DINAS KESEHATAN
UPT PUSKESMAS GEDANGAN
Jl. Hasanudin No. 60 Gedangan Telp: 085101372323
Email: pkmgedangan@yahoo.com
MALANG- 65178
ISI LAPORAN
1. Pelaksanaan Kegiatan
Dasar : ............................................. Peserta/sasaran : .................................
Hari/tanggal : ............................................. Pelaksana : .................................
Tempat : ............................................. Materi : .................................
2. Hasil Pelaksanaan Kegiatan
a. Rencana pelaksanaan
a.1. Nama Kegiatan : .............................................
a.2. Jumlah sasaran : .............................................
a.2. Waktu : hari................tanggal...............jam..............
a.3. pelaksana : .............................................
b. Proses Pelaksanaan
a.1. Kegiatan ini dilakukan dengan cara
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a.2. Pengumpulan Informasi kebutuhan dan harapan masyarakat
Sumber
No Isi Informasi Keterangan
Informasi
Pelaksana
.....................................
NIP.