DINAS KESEHATAN
UPTD PUSKESMAS PARENGAN
Jl. Cokrokusumo No. 472 Telp (0353) 2899301
E-mail : pkmparengan@gmail.com
TUBAN - 62366
NOTULEN
Nomor : ......./NOT.LOKMIN/I/2018
Kegiatan :
Hari / Tanggal :
Waktu :
Tempat :
Susunan Acara : 1. Pembukaan
2. Pembahasan
- .................
- .................
- .................
- .................
3. Kesimpulan/Rekomendasi
4. Penutup
Pimpinan Rapat : ...................................................................................................
Notulis : ...................................................................................................
Peserta Rapat : (terlampir)
Kegiatan Rapat :
1. Kata Pembukaan:
.................................................................................................................................
.................................................................................................................................
2. Pembahasan:
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
3. Kesimpulan/Rekomendasi:
.................................................................................................................................
.................................................................................................................................
4. Penutup:
Jam Penutupan .......................................................................................................
.................................................................................................................................
.................................................................................................................................
Parengan, ........................
Pimpinan Rapat Notulis
......................................... ................................................
NIP. ...................................... NIP/NR.PTT. ........................