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STANDAR OPERASIONAL PROSEDUR

.........................................................
NOMOR SOP
TANGGAL PEMBUATAN
TANGGAL REVISI
TANGGAL EFEKTIF
DISAHKAN OLEH KEPALA PUSKESMAS SELAT

MUHAMAD SAYUTI, S.Kep


DINAS KESEHATAN KABUPATEN BATANGHARI NIP. 19680102 199003 1 007
PUSKESMAS SELAT

NAMA SOP ..................................................

DASAR HUKUM KUALIFIKASI PELAKSANA


1. Permenkes no 75 Tahun 2014 tentang Puskesmas 1. .........................................................................................................................
2. Peraturan Bupati BatangHari No.52 Tahun 2015 Tentang Juklak 2. .........................................................................................................................
Penyusunan Standar Operasional Prosedur Administrasi Pemerintahan. 3. .........................................................................................................................
3. dst........................................... 4. .........................................................................................................................
5. dst....................................................................................................................

KETERKAITAN PERALATAN DAN PERLENGKAPAN


1. ......................................................................................................................... 1. ................................................ 5. ................................................
2. ......................................................................................................................... 2. ................................................ 6. ................................................
3. ......................................................................................................................... 3. ................................................ 7. ................................................
4. dst ................................................................................................................... 4. ................................................ 8. dst...........................................

PERINGATAN PENCATATAN DAN PENDATAAN


Di Simpan Sebagai data Elektronik dan Manual
PELAKSANA MUTU BAKU
NO KEGIATAN
........................... ........................... dst........................ KELENGKAPAN WAKTU

1. ...............................................................

2. ...............................................................

3. ...............................................................

4. ...............................................................

5. dst............................................................
U BAKU
OUT PUT

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