PEMERINTAH KAB.

MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

No : 440 / 364 / 421.103.131 /2014 Tumpang 12 desember 2014

Lampiran :- Kepada

Perihal : Promosi pencegahan Transmisi Yth. Kepala ........ ........................................

penularan penyakit HIV/ AIDS
Di Tempat

Assalamu’alaikum warohmatullahiwabarakatuh.

Dalam rangka meningkatkan pencegahan dan penyebaran penularan penyakit HIV/AIDS di wilayah Kec. Tumpang, maka
kami akan melaksanakan sosialisasi promosi pencegahan transmisi penularan HIV/AIDS. dimohon kehadiran Bapak / Ibu
pada :

Hari / Tanggal : Senin, 15 Desember 2014

Waktu : Pukul 07.30 WIB s/d selesai

Acara : Promosi pencegahan transmisi penularan Penyakit HIV/AIDS

Tempat : Aula Puskesmas Tumpang

Demikian kami sampaikan atas perhatian dan kerjasamanya diucapkan terima kasih.

Kepala Puskesmas Tumpang

dr. Sri Juliati

NIP. 19590731 198802 2 001
 PEMERINTAH KAB. MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

LAPORAN KEGIATAN

1. Dasar : Surat Tugas Nomor : ...................................

Tanggal : 5 s/d 30 Juni 2014

2. Tujuan Kunjungan : Pengambilan spesimen dahak

Desa : Jl. Lucary 16/01 Kebonsari Tumpang

3. Hasil Kunjungan :

a. Proses Pelaksanaan

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............... b. Permasalahan yang ditemui pada waktu melakukan kunjungan
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4. Kesimpulan/ Saran Perbaikan

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Malang, 27 Juni 2014

Yang Dikunjungi Pelapor

( Mistin ) ( Aji Matbudi )

 PEMERINTAH KAB. MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

LAPORAN KEGIATAN

1. Dasar : Surat Tugas Nomor : ...................................

Tanggal : 5 s/d 30 Juni 2014

2. Tujuan Kunjungan : Pengambilan spesimen dahak

Desa : Glagahdowo RT/RW 03/05 Tumpang

3. Hasil Kunjungan :

a. Proses Pelaksanaan

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............... b. Permasalahan yang ditemui pada waktu melakukan kunjungan
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4. Kesimpulan/ Saran Perbaikan

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Malang, 26 Juni 2014

Yang Dikunjungi Pelapor

( Kandek ) ( Eki M )
 PEMERINTAH KAB. MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

LAPORAN KEGIATAN

1. Dasar : Surat Tugas Nomor : ...................................

Tanggal : 5 s/d 30 Juni 2014

2. Tujuan Kunjungan : Pengambilan spesimen dahak

Desa : Glagahdowo RT/RW 03/07 Tumpang

3. Hasil Kunjungan :

a. Proses Pelaksanaan

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.................................................................................................................................
............... b. Permasalahan yang ditemui pada waktu melakukan kunjungan
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4. Kesimpulan/ Saran Perbaikan

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Malang, 25 Juni 2014

Yang Dikunjungi Pelapor

( Sumeh ) ( Eki M )
 PEMERINTAH KAB. MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

LAPORAN KEGIATAN

1. Dasar : Surat Tugas Nomor : ...................................

Tanggal : 5 s/d 30 Juni 2014

2. Tujuan Kunjungan : Pengambilan spesimen dahak

Desa : Wringinsongo RT 08 RW 02 Tumpang

3. Hasil Kunjungan :

a. Proses Pelaksanaan

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

.................................................................................................................................................
................................................................
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.................................................................................................................................
............... b. Permasalahan yang ditemui pada waktu melakukan kunjungan
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4. Kesimpulan/ Saran Perbaikan

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Malang, 22 Juni 2014

Yang Dikunjungi Pelapor

( Pi’i ) ( Siska E )
 PEMERINTAH KAB. MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

LAPORAN KEGIATAN

1. Dasar : Surat Tugas Nomor : ...................................

Tanggal : 5 s/d 30 Juni 2014

2. Tujuan Kunjungan : Pengambilan spesimen dahak

Desa :Wringinsongo RT 08 RW 02 Tumpang

3. Hasil Kunjungan :

a. Proses Pelaksanaan

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

.................................................................................................................................................
................................................................
................................................................................
.................................................................................................................................
............... b. Permasalahan yang ditemui pada waktu melakukan kunjungan
................................................................
.........................................................................................................
.......................................................................................................
..................................................................
..............................................................................................................................................
...........................
.........................................................................................................................................................................

4. Kesimpulan/ Saran Perbaikan

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Malang, 23 Juni 2014

Yang Dikunjungi Pelapor

( Mustakim ) ( Siska E )
 PEMERINTAH KAB. MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

LAPORAN KEGIATAN

1. Dasar : Surat Tugas Nomor : ...................................

Tanggal : 5 s/d 30 Juni 2014

2. Tujuan Kunjungan : Pengambilan spesimen dahak

Desa : Wringinsongo RT 08 RW 02 Tumpang

3. Hasil Kunjungan :

a. Proses Pelaksanaan

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

.................................................................................................................................................
................................................................
................................................................................
.................................................................................................................................
............... b. Permasalahan yang ditemui pada waktu melakukan kunjungan
................................................................
.........................................................................................................
.......................................................................................................
..................................................................
..............................................................................................................................................
...........................
.........................................................................................................................................................................

4. Kesimpulan/ Saran Perbaikan

..............................................................................................................................................
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Malang, 24 Juni 2014

Yang Dikunjungi Pelapor

( Giman ) ( Siska E )
 PEMERINTAH KAB. MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

LAPORAN KEGIATAN

1. Dasar : Surat Tugas Nomor : ...................................

Tanggal : 5 s/d 30 Juni 2014

2. Tujuan Kunjungan : Pengambilan spesimen dahak

Desa : Kambingan Rt 21 Rw 03 Tumpang

3. Hasil Kunjungan :

a. Proses Pelaksanaan

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

.................................................................................................................................................
................................................................
................................................................................
.................................................................................................................................
............... b. Permasalahan yang ditemui pada waktu melakukan kunjungan
................................................................
.........................................................................................................
.......................................................................................................
..................................................................
..............................................................................................................................................
...........................
.........................................................................................................................................................................

4. Kesimpulan/ Saran Perbaikan

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

Malang, 26 Juni 2014

Yang Dikunjungi Pelapor

( Gimah ) ( Aryana Katrin )

 PEMERINTAH KAB. MALANG
DINAS KESEHATAN
PUSKESMAS TUMPANG
Jalan Setiawan No. 227 Kecamatan Tumpang, Telp (0341) 787231 Kode Pos 65156

LAPORAN KEGIATAN

1. Dasar : Surat Tugas Nomor : ...................................

Tanggal : 5 s/d 30 Juni 2014

2. Tujuan Kunjungan : Pengambilan spesimen dahak

Desa : Kambingan RT 21 Rw 03 Tumpang

3. Hasil Kunjungan :

a. Proses Pelaksanaan

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

.................................................................................................................................................
................................................................
................................................................................
.................................................................................................................................
............... b. Permasalahan yang ditemui pada waktu melakukan kunjungan
................................................................
.........................................................................................................
.......................................................................................................
..................................................................
..............................................................................................................................................
...........................
.........................................................................................................................................................................

4. Kesimpulan/ Saran Perbaikan

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

Malang, 26 Juni 2014

Yang Dikunjungi Pelapor

( Ngatemin ) ( Aryana Katrin )