PEMERINTAH KABUPATEN CIAMIS

DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas No.824/45b/PKM/2015

2. Tujuan Perjalanan : Posyandu Melati III Dsn. Kota RT. 13 RW.05
Desa Buniseuri Kec. Cipaku
3. Tanggal Perjalanan : 4 Maret 2015
4. Maksud Perjalanan : Kunjungan Tim Kesehatan dalam rangka Puskesmas Keliling
(PUSLING)
5. Hasil Kunjungan antara lain : ................................................................................................
a. Proses Pelaksanaan :
 Menyiapkan alat dan bahan
 Menyiapkan kelengkapan administrasi
 Melakukan pemeriksaan fisik/wawancara
 Mencatat hasil
 Melaporkan hasil
b. Permasalahan yang dihadapi : .......................................................................................................
.......................................................................................................
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c. Kesimpulan/Saran Perbaikan : .......................................................................................................
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Mengetahui, Cipaku, 4 Maret 2015

Kepala Puskesmas Cipaku Pelapor

Aang Kurniawan.dr Dadang, AMK

Penata Tk. I NIP.19761028 199703 1 003
NIP. 19761003 200501 1 010
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas No.824/45b/PKM/2015

2. Tujuan Perjalanan : Posyandu Ciheras III Dsn.Ciheras RT. 02 RW. 08
Desa Selacai Kec. Cipaku
3. Tanggal Perjalanan : 5 Maret 2015
4. Maksud Perjalanan : Kunjungan Tim Kesehatan dalam rangka Puskesmas Keliling
(PUSLING)
5. Hasil Kunjungan antara lain : ................................................................................................
a. Proses Pelaksanaan :
 Menyiapkan alat dan bahan
 Menyiapkan kelengkapan administrasi
 Melakukan pemeriksaan fisik/wawancara
 Mencatat hasil
 Melaporkan hasil
b. Permasalahan yang dihadapi : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................

c. Kesimpulan/Saran Perbaikan : .......................................................................................................

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Mengetahui, Cipaku, 5 Maret 2015

Kepala Puskesmas Cipaku Pelapor

Aang Kurniawan.dr Yati Suryati, Am.Keb.

Penata Tk. I NIP.19750729 200701 2 005
NIP. 19761003 200501 1 010
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas No.824/45b/PKM/2015

2. Tujuan Perjalanan : Posyandu Peuntas Dsn. Urug RT. 07 RW.07
Desa Pusakasari Kec. Cipaku
3. Tanggal Perjalanan : 10 Maret 2015
4. Maksud Perjalanan : Kunjungan Tim Kesehatan dalam rangka Puskesmas Keliling
(PUSLING)
5. Hasil Kunjungan antara lain : ................................................................................................
a. Proses Pelaksanaan :
 Menyiapkan alat dan bahan
 Menyiapkan kelengkapan administrasi
 Melakukan pemeriksaan fisik/wawancara
 Mencatat hasil
 Melaporkan hasil
b. Permasalahan yang dihadapi : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
c. Kesimpulan/Saran Perbaikan : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................

Mengetahui, Cipaku, 10 Maret 2014

Kepala Puskesmas Cipaku Pelapor

Aang Kurniawan.dr Yati Suryati, Am.Keb.

Penata Tk. I NIP.19750729 200701 2 005
NIP. 19761003 200501 1 010
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas No.824/45b/PKM/2015

2. Tujuan Perjalanan : Posyandu Cikembang I Dsn. Cikembang RT. 03 RW.14
Desa Selamanik Kec. Cipaku
3. Tanggal Perjalanan : 12 Maret 2015
4. Maksud Perjalanan : Kunjungan Tim Kesehatan dalam rangka Puskesmas Keliling
(PUSLING)
5. Hasil Kunjungan antara lain : ................................................................................................
a. Proses Pelaksanaan :
 Menyiapkan alat dan bahan
 Menyiapkan kelengkapan administrasi
 Melakukan pemeriksaan fisik/wawancara
 Mencatat hasil
 Melaporkan hasil
b. Permasalahan yang dihadapi : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
c. Kesimpulan/Saran Perbaikan : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................

Mengetahui, Cipaku, 12 Maret 2015

Kepala Puskesmas Cipaku Pelapor

Aang Kurniawan.dr Rani Nurhasani. Am.Kep.

Penata Tk. I NIP.19790220 200604 2 016
NIP. 19761003 200501 1 010
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas No.824/45b/PKM/2015

2. Tujuan Perjalanan : Posyandu Cinta Sehat I Dsn. Babakan RT. 01 RW. 13
Desa Jalatrang Kec. Cipaku
3. Tanggal Perjalanan : 17 Maret 2015
4. Maksud Perjalanan : Kunjungan Tim Kesehatan dalam rangka Puskesmas Keliling
(PUSLING)
5. Hasil Kunjungan antara lain : ................................................................................................
a. Proses Pelaksanaan :
 Menyiapkan alat dan bahan
 Menyiapkan kelengkapan administrasi
 Melakukan pemeriksaan fisik/wawancara
 Mencatat hasil
 Melaporkan hasil
b. Permasalahan yang dihadapi : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
c. Kesimpulan/Saran Perbaikan : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................

Mengetahui, Cipaku, 17 Maret 2015

Kepala Puskesmas Cipaku Pelapor

Aang Kurniawan.dr Dadang, AMK.

Penata Tk. I NIP.19761028 199703 1 003
NIP. 19761003 200501 1 010
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas No.824/45b/PKM/2015

2. Tujuan Perjalanan : Posyandu Cempaka Dsn. Padasuka RT. 02 RW. 05
Desa Mekarsari Kec. Cipaku
3. Tanggal Perjalanan : 18 Maret 2015
4. Maksud Perjalanan : Kunjungan Tim Kesehatan dalam rangka Puskesmas Keliling
(PUSLING)
5. Hasil Kunjungan antara lain : ................................................................................................
a. Proses Pelaksanaan :
 Menyiapkan alat dan bahan
 Menyiapkan kelengkapan administrasi
 Melakukan pemeriksaan fisik/wawancara
 Mencatat hasil
 Melaporkan hasil
b. Permasalahan yang dihadapi : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
c. Kesimpulan/Saran Perbaikan : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................

Mengetahui, Cipaku, 18 Maret 2014

Kepala Puskesmas Cipaku Pelapor

Aang Kurniawan.dr Rani Nurhasani. Am.Kep.

Penata Tk. I NIP.19790220 200604 2 016
NIP. 19761003 200501 1 010
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas No.824/45b/PKM/2015

2. Tujuan Perjalanan : Posyandu Bia Sejahtera Dsn. Cijoho RT. 01 RW. 17
Desa Muktisari Kec. Cipaku
3. Tanggal Perjalanan : 23 Maret 2015
4. Maksud Perjalanan : Kunjungan Tim Kesehatan dalam rangka Puskesmas Keliling
(PUSLING)
5. Hasil Kunjungan antara lain : ................................................................................................
a. Proses Pelaksanaan :
 Menyiapkan alat dan bahan
 Menyiapkan kelengkapan administrasi
 Melakukan pemeriksaan fisik/wawancara
 Mencatat hasil
 Melaporkan hasil
b. Permasalahan yang dihadapi : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
c. Kesimpulan/Saran Perbaikan : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................

Mengetahui, Cipaku, 23 Maret 2015

Kepala Puskesmas Cipaku Pelapor

Aang Kurniawan.dr Dadang, AMK.

Penata Tk. I NIP.19761028 199703 1 003
NIP. 19761003 200501 1 010
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas No.824/45b/PKM/2015

2. Tujuan Perjalanan : Posyandu Melati Dsn. Sukasari RT. 02 RW.03
Desa Sukawening Kec. Cipaku
3. Tanggal Perjalanan : 26 Maret 2015
4. Maksud Perjalanan : Kunjungan Tim Kesehatan dalam rangka Puskesmas Keliling
(PUSLING)
5. Hasil Kunjungan antara lain : ................................................................................................
a. Proses Pelaksanaan :
 Menyiapkan alat dan bahan
 Menyiapkan kelengkapan administrasi
 Melakukan pemeriksaan fisik/wawancara
 Mencatat hasil
 Melaporkan hasil
b. Permasalahan yang dihadapi : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
c. Kesimpulan/Saran Perbaikan : .......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................
.......................................................................................................

Mengetahui, Cipaku, 26 Maret 2015

Kepala Puskesmas Cipaku Pelapor

Aang Kurniawan.dr Yati Suryati, Am.Keb.

Penata Tk. I NIP.19750729 200701 2 005
NIP. 19761003 200501 1 010
PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
PUSKESMAS CIPAKU
Jl. Raya Buniseuri No. 131 Buniseuri Telp. ( 0265 ) 791948
Kode Pos : 46252