KERANGKA ACUAN

PROGRAM.....
PUSKESMAS BULANG

I. PENDAHULUAN

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

II. LATAR BELAKANG

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

III. TUJUAN

A. TUJUAN UMUM :
B. TUJUAN KHUSUS :
1.
2.
3.

IV. KEGIATAN POKOK DAN RINCIAN KEGIATAN

No Kegiatan Pokok Rincian Kegiatan

V. CARA MELAKSANAKAN KEGIATAN DAN SASARAN

A. CARA MELAKSANAKAN KEGIATAN :

..................................................................................................................................
....................................................................................
 B. SASARAN :
1. Anak sekolah dasar di 12 SD/MI mendapat pemeriksaan gigi dan mulut
2. Anak sekolah dasar di 12 SD/MI mendapat kegiatan sikat gigi masal

C. RINCIAN KEGIATAN, SASARAN KHUSUS, CARA MELAKSANAKAN

KEGIATAN :
Cara
Kegiatan Sasaran Rincian
No Sasaran Melaksanakan
Pokok Umum Kegiatan
Kegiatan

VI. JADWAL KEGIATAN

2018
No Kegiatan
Jan Feb Mar Apr Mei Jun Jul Ags Sep Okt Nov Des
1
2
3
4

VII. EVALUASI PELAKSANAAN KEGIATAN DAN PELAPORAN

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

VIII. PENCATATAN, PELAPORAN, DAN EVALUASI KEGIATAN

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