PEMERINTAH KABUPATEN KENDAL

DINAS KESEHATAN
UPTD PUSKESMAS PLANTUNGAN
Jl Suratman No 21, Tirtomulyo Plantungan, Telp (0294) 3652015, Koe Po! 51362

"#mail $ pu!%e!ma!plantungan001&gmail'om

KEPALA UNIT PELAKSANA TEKNIS DINAS PUSKESMAS PLANTUNGAN

KEPUTUSAN KEPALA UPTD PUSKESMAS PLANTUNGAN

NOMOR : 440.1/SK/C/1/2018/...../Pkm Plt

TENTANG

EVALUASI DAN PERBAIKAN PERILAKU PELAANAN KLINIS

KEPALA UPTD PUSKESMAS PLANTUNGAN!

M"#$m%&#' : &. %&()& *#t*k m"#+&m$# ,"#$#'k&t&# m*t* l&-&#&#

kl$#$ &# k""l&m&t&# ,&$"# t$&k (&#-& $t"#t*k&#
l"( $t"m ,"l&-&#&# t"t&,$ +*'& ,"$l&k* ,"m%"$
l&-&#&#
%. %&()& *#t*k m"#$#'k&tk&# m*t* l&-&#&# kl$#$  &#
k""l&m&t&# ,&$"#! ,"l* $l&k*k&# "3&l*&$ &#
,"%&$k&# ,"$l&k* ,"m%"$ l&-&#&# kl$#$
c. %&()& %"(*%*#'&# "#'&# %*t$ & &# % t""%*t
$&t& m&k& ,"l* m"#"t&,k&# k",*t*&# k",&l&
P*k"m& Pl&#t*#'&# t"#t&#' E3&l*&$ &# P"%&$k&#
P"$l&k* P"l&-&#&# Kl$#$.
M"#'$#'&t : 1. U#&#'U#&#' R",*%l$k I##"$& Nm 56 t&(*#
2007 t"#t&#' K""(&t&# L"m%&&# N"'&& R",*%l$k
I##"$& T&(*# 2007 Nm 144! T&m%&(&#
L"m%&&# N"'&& R",*%l$k I##"$& Nm 9065
2. U#&#'U#&#' R",*%l$k I##"$& Nm 56 T&(*#
2014 t"#t&#' T"#&'& K""(&t&# L"m%&&# N"'&&
R",*%l$k I##"$& T&(*# 2014 Nm 278! T&m%&(&#
L"m%&&# N"'&& R",*%l$k I##"$& Nm 960;
5. U#&#'U#&#' R",*%l$k I##"$& Nm 58 T&(*#
2014 t"#t&#' K","&)&t&# L"m%&&# N"'&& R",*%l$k
I##"$& T&(*# 2014 Nm 50;! T&m%&(&#
L"m%&&# N"'&& R",*%l$k I##"$& Nm 9612
 4. P"&t*&# P "$"# R ",*%l$k I# #"$& Nm ;2
T&(*# 2012 t"#t&#' K""(&t&# N&$#&l
9. P"&t*&# M"#t"$ K""(&t&# R",*%l$k I##"$&
Nm 89; T&(*# 2007 t"#t&#' P"m&# P"#$l&$&#
K$#"+& S*m%" D &- & M&#*$& K""(&t&# D$
P*k"m&
6. P"&t*&# M"#t"$ K""(&t&# R",*%l$k I##"$&
Nm 2092 T&(*# 2011 t"#t&#' I<$# P&kt$k D&#
P"l&k&#&&# P&kt$k K"kt"&#  B"$t& N"'&&
R",*%l$k I##"$& T&(*# 2011 Nm 6;1
;. P"&t*&# M"#t"$ K""(&t&# R",*%l$k I##"$&
Nm 9 T&(*# 2014 t"#t&#' P&#*&# P&kt$k Kl$#$
B&'$ Dkt" D$ =&$l$t& P"l&-&#&# K""(&t&# P"t&m&
8. P"&t*&# M"#t"$ K""(&t&# R",*%l$k I##"$&
Nm ;9 T&(*# 2014 t"#t&#' P*&t K""(&t&#
M&-&&k&t  B"$t& N"'&& R",*%l$k I##"$& T&(*#
2014 Nm 16;6

7. P"&t*&# M"#t"$ K""(&t&# R",*%l$k I##"$&

Nm 45 t&(*# 2016 t"#t&#' St&#&t P"l&-&#&#
M$#$m&l B$&#' K""(&t&#
10. P"&t*&# M"#t"$ K""(&t&# R",*%l$k I##"$&
Nm 44 t&(*# 2016 t"#t&#' P"m &# M&#&'"m"#
P*k"m&
11. P"&t*&# M"#t"$ K""(&t&# Nm 11 t&(*# 201;
t"#t&#' K""l&m&t&# P&$"#
12. P"&t*&# B*,&t$ K"#&l N ;8 t&(*# 2016 t"#t&#'
P"m%"#t*k&#! S**#&# O'&#$&$! T*'& &# =*#'$
"t& T&t& K"+& U#$t P"l&k&#& T"k#$ D$#&

MEMUTUSKAN
M"#"t&,k&# :
K"&t* : U#t*k m "#$#'k&tk&# m *t* , "l&-&#&#  $,"l*k&# E 3&l*&$
&# P"%&$k&# P"$l&k* P"l&-&#&# Kl$#$.
K"*& : P"l&k&#&&# E3&l*&$ &# P"%&$k&# P"$l&k* P"l&-&#
Kl$#$ "%&'&$m&#& &l&m $kt*m ,"t&m& $l&k*k&# ,&&
"m*& $#$k&t ,"$l&k* -&#' t"l&( $t"t&,k&# "t$&, &t*
t&(*# "k&l$.
K"t$'& : P"#&#''*#' +&)&% ,"l&k&#&&# E3&l*&$ &# P"%&$k&#
 P"$l&k* P"l&-&#&# Kl$#$ &&l&( t$m ,"#$#'k&t&# m*t*
L&-&#&# Kl$#$ &# K""l&m&t&# P&$"#.
K""m,&t : K",*t*&# $# $ %" l&k* "+&k t& #''&l $ t"t&,k&#! " #'&#
k"t"#t*&# &,&%$l& $k"m*$&# (&$ t"&,&t k"k"l$*&#
&lm m"l&k&#&k&# k",*t*&# $#$ &k&# $*%&( &#
$,"%&$k$ "%&'&$m&#& m"t$#-&.

D$t"t&,k&# $ : Pl&#t*#'&#
P&& T&#''&l : 6 >&#*&$ 2018

KEPALA UPTD PUSKESMAS

PLANTUNGAN

KARADI
 LAMPIRAN I : KEPUTUSAN KEPALA UPTD
PUSKESMAS PLANTUNGAN
TENTANG EVALAUAI DAN
PERBAIKAN PRILAKU PELAANAN
KLINIS
NOMOR : 440.1/SK/C/1/2018/...../Pkm P lt
TANGGAL : 6 >ANUARI 2018

EVALUASI PERBAIAKAN PRILAKU PELAYANAN KLINIS

No KRITERIA PENILAIAN SELF EVALUASI TIDAK

SESUAI DENGAN TATA EVALUATION LANJUT
NILAI PUSKESMAS YA TIDAK
1 Petugas memenu! "e#a$anan
%engan sen$um %engan tu#us
%a#am mem&e'!(an "e#a$anan
)
* Petugas &e(e'+a %engan
E,e(t!, - e,!s!en %a#am
.a(tu "e#a(sanaan (eg!atan )
/ Petugas mu%a %a#am
mem&e'!(an "e#a$anan )
0 Inoat!, %a#am me#a(sana(an
tugas "e#a$anan )
2 Lo$a# %a#am me#a(sana(an
tugas )

3 I(#as a%a#am mem&e'!(an

"e#a$anan )
4 Rama %a#am mem&e'!(an+
"e#a$anan )

D$t"t&,k&# $ : Pl&#t*#'&#
P&& T&#''&l : 6 >&#*&$ 2018

KEPALA UPTD PUSKESMA PLANTUNGAN

KARADI