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PEMERINTAH DAERAH KABUPATEN PANDEGLANG

DINAS KESEHATAN
PUSKESMAS DTP MUNJUL
Alamat : Jl. Raya Kotadukuh Km. 01 Munjul-Pandeglang 42276
email: puskesmasmunjul@gmail.com

KEPUTUSAN
KEPALA PUSKESMAS DTP MUNJUL
NOMOR : ...........................................

TENTANG
....................................... PUSKESMAS DTP MUNJUL
KEPALA PUSKESMAS DTP MUNJUL,

Menimbang : a. ...................................................................................................................................;
b. ...................................................................................................................................;
c. .............................................................................................................................; dst

Mengingat : 1. ...................................................................................................................................;
2. ...................................................................................................................................;
3. ...................................................................................................................................;
4. ...................................................................................................................................;
5. ...........................................................................................................................; dst

M EM UTUSKAN
Menetapkan : KEPUTUSAN KEPALA PUSKESMAS DTP MUNJUL KABUPATEN
PANDEGLANG TENTANG TIM AKREDITASI TAHUN 2018 *)Sample
Kesatu :
Kedua : Keputusan ini mulai berlaku sejak tanggal ditetapkannya dengan ketentuan apabila
dikemudian hari terdapat kekeliruan dalam keputusan ini akan diadakan perbaikan
sebagaimana mestinya.

Ditetapkan di : Munjul
Tanggal : 2018
Kepala Puskesmas DTP Munjul

Mulyadi
LAMPIRAN KEPUTUSAN KEPALA
PUSKESMAS DTP MUNJUL
NOMOR ..... TENTANG ....

....................................... PUSKESMAS DTP MUNJUL


KEPALA PUSKESMAS DTP MUNJUL,
1. .............................................................................................................................................................................
a. ........................................................................................................................................................
b. ........................................................................................................................................................
c. Dst
2. .............................................................................................................................................................................
a. ........................................................................................................................................................
b. ........................................................................................................................................................
c. Dst