PEMERINTAH KABUPATEN BOYOLALI

DINAS KESEHATAN
UPTD PUSKESMAS SELO
Alamat: Jl.Kihajar Saloka Km.1 Telp.(0276) 326010

DAFTAR HADIR RAPAT

Hari : ..............................................................................................................
Tanggal : ..............................................................................................................
Waktu : ..............................................................................................................
Tempat : ..............................................................................................................
Acara : ..............................................................................................................

NO NAMA JABATAN/PANGKAT TANDA TANGAN KET

1. dr. S. Ali Ma’shum Kepala Puskesmas

2. Sularsih. S.Sos Kasubag TU

3. dr. Ratna K Dokter umum

4. drg. Wrintami Dokter gigi

5. Aris Prasetyo Ketua Tim Mutu

6. Fitriyanti Fisioterapi

7. Siti Rohminah Perawat gigi

8. Sri Haryanti Bidan Koordinator

9. Zuli Rahmawati Analis Kesehatan

10. Muh. Idris P Perawat

11. Ngatini Perawat

12. Tri Wuryani Perawat

13. Dwi Rahayuningsih Bidan

14. Harning W Petugas gizi

15. Dwiyanto K Perawat

Boyolali,

KEPALA UPTD PUSKESMAS SELO

dr. S. Ali Ma’shum

Penata Tingkat 1
NIP. 19720430 200604 1 001
 PEMERINTAH KABUPATEN BOYOLALI
DINAS KESEHATAN
UPTD PUSKESMAS SELO
Alamat: Jl.Kihajar Saloka Km.1 Telp.(0276) 326010

NOTULEN

RAPAT : Ketersediaan pelayanan dan kemudahan akses bagi

pengguna layanan puskesmas
Hari/Tanggal :
Waktu Panggilan :
Waktu Rapat :
Acara : 1. Pembukaan
2. Sambutan
3. Pembahasan mengenai ketersediaan pelayanan
4. Penutup

PIMPINAN RAPAT

Ketua : dr. S. Ali Ma’shum

Sekretaris : Fitriyanti
Pencatat : Ngatini

Peserta rapat : 1. Kepala UPTD Puskesmas Selo

2. Tim manajemen UPTD Puskesmas sELO

KEGIATAN RAPAT : 1. Ceramah

2. Sosialisasi
3. Diskusi
4. Pengesahan

1. Kata Pembukaan : Acara pembukaan oleh pembawa acara, dan dibuka dengan
bacaan Basmallah bersama-sama

2. Pembahasan : Pada rapat ini dimulai dengan kepala UPTD Puskesmas Selo,
menyampaikan sambutan dilanjunjutkan dengan pembahasan
mengenai bangunan puskesmas.

Ketersediaan ruang untuk pelayanan harus sesuai dengan jenis

pelayanan kesehatan yang disediakan oleh Puskesmas

Pengaturan ruangan harus memperhatikan fungsi, keamanan,

kenyamanan dan kemudahan dalam pemberian pelayanan untuk
memudahkan pasien/keluarga pasien untuk akses yang mudah
termasuk memberi kemudahan pada orang dengan disabilitas,
anak-anak, dan orang usia lanjut, demikian juga memperhatikan
keamanan dan kemudahan bagi petugas dalam memberikan
pelayanan

3. Kesimpulan : Dalam rapat ini diputuskan bahwa akan dilakukan rehap gedung
puskesmas dengan hasil sebagai berikut
 Pimpinan Rapat
Kepala UPTD Puskesmas Selo

dr. S. Ali Ma’shum

Penata Tingkat 1
NIP. 19720430 200604 1 001

Dalam rangka penyusunan visi misi tata nilai dan tujuan UTD Puskesmas Selo

USULAN VISI

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

USULAN MISI

1. ...............................................................................................................................
................................................................................................................................
................................................................................................................................
2. ................................................................................................................................
................................................................................................................................
........................................................................................................
3. ................................................................................................................................
................................................................................................................................
...............................................................................................................................

USULAN TATA NILAI

1. ................................................................................................................................
................................................................................................................................
...............................................................................................................................
 2. ................................................................................................................................
................................................................................................................................
...............................................................................................................................
3. ................................................................................................................................
................................................................................................................................
...............................................................................................................................

USULAN MOTTO

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

USULAN TUJUAN PUSKESMAS

1. ................................................................................................................................
................................................................................................................................
...............................................................................................................................
2. ................................................................................................................................
................................................................................................................................
...............................................................................................................................
3. ................................................................................................................................
................................................................................................................................
...............................................................................................................................

Selo,

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