..........................................................................................................................................................
..........................................................................................................................................................
Target Tercapai
..........................................................................................................................................................
..........................................................................................................................................................
Rekomendasi
..........................................................................................................................................................
..........................................................................................................................................................
Tidak Lanjut
..........................................................................................................................................................
..........................................................................................................................................................
Pasuruan,…...................,.........
Mengetahui Kepala Ruangan
Kepala Instalasi
Pelapor
(........................................) 1.U M A R ( ROCHMAD SUHARI,Skep.Ns )
2................... Nip : 19741117 199703 1 005