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JADWAL KEGIATAN PTM

NO TANGGAL TUJUAN

1. 02 Agustus 2019 DESA PRINGGACALA


2. 03 Agustus 2019 DESA TANJUNGSARI
3. 08 Agustus 2019 DESA PRINGGACALA
4. 13 Agustus 2019 DESA PRINGGACALA
5. 14 Agustus 2019 DESA KAPLONGAN

KEPALA UPTD PUSKESMAS


KAPLONGAN

dr. UDIN RUSAD NURDIN,MH.Kes


NIP. 19651005 200701 1 021
LAPORAN KUNJUNGAN

1. Dasar : Surat Tugas : Nomor : 090/ 791.1 / Puskesmas


2. Tujuan Kunjungan : Desa Tanjungsari
3. Hasil Kunjungan :

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Indramamayu, 17 April 2019


Pelaksana Kegiatan
Sasaran

…………………………… NURJAJILAH
Nip. 19851024 200902 2 001
LAPORAN HASIL PERJALANAN DINAS

1. Dasar : Surat Tugas : Nomor : 090/ 791.1 / Puskesmas


2. Tujuan Kunjungan : Desa Pringgacala
3. Hasil Kunjungan :

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Indramamayu, 11 April 2019


Pelaksana Kegiatan
Sasaran

…………………………… NURJAJILAH
Nip. 19851024 200902 2 001
LAPORAN HASIL PERJALANAN DINAS

1. Dasar : Surat Tugas : Nomor : 090/ 791.1 / Puskesmas


2. Tujuan Kunjungan : Desa Tanjungpura
3. Hasil Kunjungan :

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Indramamayu, 25 April 2019


Pelaksana Kegiatan
Sasaran

…………………………… NURJAJILAH
Nip. 19851024 200902 2 001
LAPORAN HASIL PERJALANAN DINAS

1. Dasar : Surat Tugas : Nomor : 090/ 791.1 / Puskesmas


2. Tujuan Kunjungan : Desa KaplonganLor
3. Hasil Kunjungan :

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Indramamayu, 13 April 2019


Pelaksana Kegiatan
Sasaran

…………………………… NURJAJILAH
Nip. 19851024 200902 2 001
PTM TANJUNGSARI

TANGGAL 17 APRIL 2019


KEGIATAN PTM
DI DESA TANJUNGSARI
PTM TANJUNGPURA

TANGGAL 25 APRIL 2019


KEGIATAN PTM
DI DESA TANJUNGPURA
PTM PRINGGACALA

TANGGAL 11 APRIL 2019


KEGIATAN PTM
DI DESA PRINGGACALA
PTM KAPLONGAN

TANGGAL 13 APRIL 2019


KEGIATAN PTM
DI DESA KAPLONGANLOR
DAFTAR PENERIMAAN UANG SAKU PNS
KEGIATAN BANTUAN OPERASIONAL KESEHATAN (DAK 2019)
DINAS KESEHATAN KABUPATEN INDRAMAYU
TAHUN ANGGARAN 2019

PUSKESMAS : KAPLONGAN
BULAN : Agustus
KEGIATAN : Kegiatan PTM

JUMLAH UANG SAKU (Rp) PAJAK (Rp) JUMLAH YANG


No NAMA/NIP GOL NOMOR REKENING DIBAYARKAN TANDA TANGAN
8 BULAN UANG SAKU JUMLAH 5% 15% JUMLAH (Rp)

1 2 3 4 5 6 7 8=5x6x7 9 10 11 = 9 + 10 12 = 8 - 11 13
1 IBNU HAJAR II/C
95162436100 5 1 50,000 250,000 12,500 - 12,500 237,500
NIP. 19880727 201903 1 007
-

JUMLAH 250,000.00 12,500.00 - 12,500.00 237,500.00

Terbilang : Dua Ratus Lima Puluh Ribu Rupiah

Indramayu, ...........................................

Mengetahui Setuju Dibayar Lunas Dibayar

KUASA PENGGUNA ANGGARAN PEJABAT PELAKSANA TEKNIS KEGIATAN BENDAHARA PENGELUARAN PEMBANTU
Drs. H. RISTOYO, M.Pd RETNO SULASTRI, SKM, MH.Kes MASTARI, AMKL
NIP. 19640810 199303 1 007 NIP. 19720619 199503 2 002 NIP. 19770909 201001 2 002