PEMERINTAH KOTA BATU

DINAS KESEHATAN
UPT PUSKESMAS BEJI
JL. Ir. Soekarno No.30 Beji Kec. Junrejo Kota Batu (65326)
Telp.(0341)592374e-Mail : bejipuskesmas@gmail.com

LAPORAN HASIL KEGIATAN

Dasar :

Nama Petugas :

Nama Kegiatan :

Pelaksana Kegiatan :

1. Rencana Realisasi
RENCANA REALISASI KET.
WAKTU TEMPAT SASARAN WAKTU TEMPAT SASARAN

2. Masalah dan Kemungkinan Solusi

NO MASALAH SOLUSI

3. Masukan / Umpan Balik / Keluhan : .........................................................................................................................

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

4. Rencana Tindak Lanjut : .........................................................................................................................

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

5. Tahapan Pelaksanaan
NO KEGIATAN / TAHAPAN REALISASI KETERANGAN

Batu, .................................. 2019

Pelaksana
Mengetahui,

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NIP.