NOTULEN

Nama Kegiatan :
Tanggal Kegiatan :
Tempat Kegiatan :

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

Mengetahui :
Kepala UPT. Puskesmas Jatisrono I Pelaksana Kegiatan

dr. Kristiawan Teguh Wibowo ------------------------------------------

NIP. 19770421 200801 1 007
 PEMERINTAH KABUPATEN WONOGIRI
DINAS KESEHATAN
UPT PUSKESMAS JATISRONO I
Jl. Jatisrono – Jatiroto Kenteng Gunungsari
Jatisrono Wonogiri
Tlp.(0273) 411056 Kode Pos 57691
e_mail : puskesmasjatisrono1@yahoo.co.id

Nomor : 005/ I / 2016 Jatisrono, 18 Januari 2016

Lampiran : - Kepada Yth.
Perihal : Undangan
Karyawan Puskesmas Jatisrono I

Di
Tempat

Mengharap dengan hormat, atas kehadiran saudara untuk dapat mengikuti pertemuan

yang akan dilaksanakan besok pada :

Hari : Kamis

Tanggal : 21 Januari 2016

Jam : 11.00 WIB

Tempat : Aula Puskesmas Jatisrono I

Keperluan : Lokakarya Mini Puskesmas

Demikian atas perhatian dan kerja sama yang baik kami sampaikan terima kasih.

Mengetahui :
Kepala UPT. Puskesmas Jatisrono I

dr. Kristiawan Teguh Wibowo

NIP. 19770421 200801 1 007
 DAFTAR HADIR
Nama Kegiatan : Sosialisasi kegiatan kepada masyarakat, kelompok masyarakat, dan
sasaran UKM
Tanggal Kegiatan :
Tempat Kegiatan : UPT. Puskesmas Jatisrono I

NO NAMA ALAMAT TANDA TANGAN

1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
8. 8.
9. 9.
10. 10.
11. 11.
12. 12.
13. 13.
14. 14.
15. 15.
16. 16.
17. 17.
18. 18.
19. 19.
20. 20.
21. 21.
22. 22.
23. 23.
24. 24.
25. 25.
26. 26.
27. 27.
28. 28.
29. 29.
30. 30.

Mengetahui :
Kepala UPT. Puskesmas Jatisrono I Penanggung Jawab UKM
dr. Kristiawan Teguh Wibowo
Hudayanah Umri, SKM
NIP. 19770421 200801 1 007
NIP. 19771219 200604 2 002