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PEMERINTAH KABUPATEN ACEH BESAR

DINAS KESEHATAN
PUSKESMAS ARAFAT-LAMTEUBA
Alamat : Jln Lamteuba - Krueng Raya Km 1 Gampong Blangtingkeum Kemukiman Lamteuba
Kode Pos : 23951 Email : Puskesmaslamteuba@gmail.Com

LAPORAN PERJALANAN DINAS

NAMA PETUGAS YANG MELAKSANAKAN :

NIP/PANGKAT/GOLONGAN :

JABATAN :

TUJUAN MENGADAKAN PERJALANAN :

TANGGAL PELAKSANAAN :

TEMPAT YANG DI TUJU :

PEJABAT YANG DI TEMUI :

HASIL PENGAMATAN/ PENILAIAN :


DI LAPANGAN

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KESIMPULAN DAN SARAN

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Mengetahui Lamteuba,................................. 2019

1.
NIP :

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NIP :

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