PEMERINTAH KABUPATEN INDRAMAYU

DINAS KESEHATAN
UPTD PUSKESMAS KANDANGHAUR
Jln. Raya Kandanghaur – Indramayu TELP. (0234) 505553/505627 kode post 45254
email:puskesmaskandanghaur@gmail.com

Nomor : / /Puskesmas Kandanghaur, 2018

Lampiran :
Perihal : Kelas Ibu Hamil

Kepada Yth
Kepala Desa / Kuwu
Se.Wilayah Kerja Puskesmas Kandanghaur
Di –
Kandanghaur

Dengan hormat,
Dalam rangka meningkatkan kualitas pelayanan puskesmas kandanghaur dan untuk
menekan angka kematian ibu dan anak, maka dengan ini kami mengadakan kegiatan kelas ibu
hamil diwilayah UPTD Puskesmas Kandanghaur yang dilaksanakan pada :

Hari :
Tanggal :
Waktu :
Tempat :
Acara : Kelas Ibu Hamil
Untuk kelancaran acara tersebut kami mohon partisipasi dan kehadiran ibu hamil tepat
pada waktunya.

Demikian surat pemberitahuan ini kami buat, atas perhatian dan kerjasamanya kami ucap

kan terima kasih.

Kepala UPTD Puskesmas Kandanghaur

H.SUPRIYADI.SKM
NIP.19730315 199403 1 007
 DAFTAR HADIR PERTEMUAN KELAS IBU HAMIL

DESA WIRAPANJUNAN

Hari / Tanggal :
Waktu :
Tempat :

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

Kepala UPTD Puskesmas Kandanghaur

H.SUPRIYADI.SKM
NIP.19730315 199403 1 007
NOTULEN

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 PEMERINTAH KABUPATEN INDRAMAYU
DINAS KESEHATAN
UPTD PUSKESMAS KANDANGHAUR
Jln. Raya Kandanghaur – Indramayu TELP. (0234) 505553/505627 kode post 45254
email:puskesmaskandanghaur@gmail.com

SURAT KETERANGAN TIDAK KEBERATAN

Yang bertanda tangan di bawah ini, Kepala Puskesmas Kandanghaur menerangkan

bahwa :

Nama : TURINAH, Am.Keb

Jabatan / Pekerjaan : Pelaksana Kebidanan

Alamat : Desa Wirapanjunan, RT : 10 RW :02 Blok Sabrang, Kec :

Kandanghaur, Kab : Indramayu.

Tidak keberatan kepada nama tersebut, untuk menjalankan Praktek Swasta

Perseorangan sebagai Bidan diluar jam Dinas yang bertempat di Desa Wirapanjunan,
RT: 10 RW :02 Blok Sabrang, Kec :Kandanghaur, Kab : Indramayu. (Lingkungan
Puskesmas).

Demikian surat keterangan ini dibuat, untuk dipergunakan sebagaimana mestinya.

Indramayu, 16 April 2019

Kepala Puskesmas Kandanghaur

Kabupaten Indramayu

H.SUPRIYADI.SKM, MM
NIP.19730315 199403 1 007
 PEMERINTAH KABUPATEN INDRAMAYU
DINAS KESEHATAN
UPTD PUSKESMAS KANDANGHAUR
Jln. Raya Kandanghaur – Indramayu TELP. (0234) 505553/505627 kode post 45254
email:puskesmaskandanghaur@gmail.com

SURAT KETERANGAN TIDAK KEBERATAN

Yang bertanda tangan di bawah ini, Kepala Puskesmas Kandanghaur menerangkan

bahwa :

Nama : TURINAH, Am.Keb

Jabatan / Pekerjaan : Pelaksana Kebidanan

Alamat : Desa Wirapanjunan, RT : 10 RW :02 Blok Sabrang, Kec :

Kandanghaur, Kab : Indramayu.

Tidak keberatan kepada nama tersebut, betul betul karyawan Puskesmas Kandanghaur,
yang bertempat di Desa Wirapanjunan, RT: 10 RW :02 Blok Sabrang, Kec :Kandanghaur,
Kab : Indramayu. (Lingkungan Puskesmas).

Demikian surat keterangan ini dibuat, untuk dipergunakan sebagaimana mestinya.

Indramayu, 16 April 2019

Kepala Puskesmas Kandanghaur

Kabupaten Indramayu

H.SUPRIYADI.SKM, MM
NIP.19730315 199403 1 007