PEMERINTAH KABUPATEN KEDIRI

DINAS KESEHATAN
UPTD PUSKESMAS PLOSOKLATEN
Jl. Raya Brenggolo No. 204 Kec Plosoklaten Kediri 64175
Phone (0354) 7419013 Email : uptdpkmplosoklaten@gmail.com

NOTULEN ........................................................................................................................

Tanggal :
Pukul :
Tempat :
Jumlah Peserta :

Susunan Acara

Isi Notulen
Kesimpulan

Rekomendasi

Mengetahui :

Pimpinan Pertemuan Notulen

drg, Dyah Arifianti _____________________

NIP :198001042007012004
 PEMERINTAH KABUPATEN KEDIRI
DINAS KESEHATAN
UPTD PUSKESMAS PLOSOKLATEN
Jl. Raya Brenggolo No. 204 Kec Plosoklaten Kediri 64175
Email : uptdpkmplosoklaten@gmail.com
____________________________________________________________________________

DAFTAR HADIR PERTEMUAN RAPAT

Hari :
Tanggal :
Waktu :
Tempat :
Acara :

Tanda Tangan
No Nama Jabatan/Pangkat Ket

1 Endang Purwatiningsih S.Sos Pejabat Keuangan 1

2 Kristiana Wulandari, Amd.Kep Bendahara Pengeluaran 2

3 dr. Fari Tedy Rahardian dr. PJ Mutu, PJ UKM 3

4 dr.Nanang Muhibuddin, M.Kes PJ UKP 4
5 Ludia Duma S.ST Bendahara Jampersal 5
Bendahara
6 Rita Kurniasari, Amd.Ankes 6
Fungsional/DAU
7 Hakam Nasrullah, Amd.KG PPTK 7
8 Ririn Widyanti, Amd.GZ Bendahara BOK 8

9 Suharliyah Bendahara Penerimaan 9

10 Umi Hanik Arniati, S.ST Bikor 10

11 Iman Supanji Pekor 11

Kediri,
Kepala UPTD
Puskesmas Plosoklaten

drg, Dyah Arifianti

NIP :198001042007012004
 PEMERINTAH KABUPATEN KEDIRI
DINAS KESEHATAN
UPTD PUSKESMAS PLOSOKLATEN
Jl. Raya Brenggolo No.204 Kec.Plosoklaten Kediri 64175
Phone (0354)7419013 Email:uptdpkmplosoklaten@gmail.com

JUDUL NOTULEN

Hari,Tanggal Rapat/ Pertemuan

Peserta : .................. Orang.
Tempat :...............................

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KESIMPULAN :
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RENCANA TINDAK LANJUT

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Mengetahui, Notulensi,
Kepala UPTD Puskesmas Plosoklaten

drg, Dyah Arifianti ........................

NIP :198001042007012004 NIP :
 PEMERINTAH KABUPATEN KEDIRI
DINAS KESEHATAN
UPTD PUSKESMAS PLOSOKLATEN
Jl. Raya Brenggolo No.204 Kec.Plosoklaten Kediri 64175
Phone (0354)7419013 Email:uptdpkmplosoklaten@gmail.com

DAFTAR HADIR
Pertemuan/Rapat :
Hari ,Tanggal :
Tempat :
No Nama Jabatan Alamat Tanda Tangan
drg. Dyah Arifianti
dr. Fari Tedy
Rahardian
dr. Nanang
Muhibuddin, M.Kes
Endang
Purwatiningsih S.Sos
Umi Hanik Arniati,
S.ST
Imam Supandji
Amd.Kep
Aminarti S.ST
Nining SN S.ST
Sri Istiyani S.ST

Mengetahui, Pelaksana,
Kepala UPTD Puskesmas Plosoklaten

drg, Dyah Arifianti ........................

NIP :198001042007012004 NIP :