BERITA ACARA PENDAMPINGAN AKREDITASI PUSKESMAS.......................................................

TAHAP............................................................................................................

TAHUN 2019

Pada hari ....................... tanggal ...........................................................................................................

(..............................) Jam ............. WIB bertempat di Puskesmas ...................................................... telah
dilakukan pendampingan tahap .................................................................................... oleh

1. Nama : .................................................................
NIP :..................................................................
Pokja : .................................................................
Jumlah Peserta :..................................................................
Temuan / Masalah :
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 Rekomendasi Pendamping :
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Demikianlah hasil dari pendampingan Akreditasi Puskesmas tahap ............................................................

.......................................................................................... diharapkan dapat menjadi masukan untuk
Puskesmas dan pihak terkait lainya.

Mengetahui
Kepala Puskesmas / Ketua Pokja Pendamping Akreditasi

(..................................................) (..........................................................)
 DAFTAR HADIR

PENDAMPINGAN AKREDITASI PUSKESMAS.......................................................

NO NAMA TUGAS DALAM POKJA TANDA TANGAN

Mengetahui ,

Ketua Pokja .............

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