PEMERINTAH KABUPATEN BANDUNG

DINAS KESEHATAN
UPT PUSKESMAS CIPEDES
JL. Jati Sari No. 5 Desa Cipedes Kecamatan Paseh 40383
Telp. (022) 859662445
E-mail : Pkmcipedes_Bandungkab@yahoo.com

Cipedes, 2019
Nomor : 800/ //PKM/2019 Kepada
Lampriran :- Yth. …………………………….
Perihal : Undangan Rapat Penetapan di
Penanggung Jawab UKM dan UKP Tempat

Sehubungan dengan akan dilaksanakannya rapat penetapan penanggung

jawab UKM dan UKP, maka diharapkan kehadiran Saudara pada :

Hari/Tanggal : 2018

Tempat : Aula UPT Puskesmas Cipedes

Waktu : 13.00 WIB s/d selesai

Demikian surat undangan ini, terimakasih atas perhatiannya.

Kepala UPT Puskesmas Cipedes

H. Odang Rohmat, S.Kep

NIP. 19650203 199703 1 002
 PEMERINTAH KABUPATEN BANDUNG
DINAS KESEHATAN
UPT PUSKESMAS CIPEDES
JL. Jati Sari No. 5 Desa Cipedes Kecamatan Paseh 40383
Telp. (022) 859662445
E-mail : Pkmcipedes_Bandungkab@yahoo.com

DAFTAR HADIR PERTEMUAN RAPAT

Hari :
Tanggal :
Waktu :
Tempat : Aula Puskesmas Cipedes Lt. 2
Acara : Rapat penetapan penanggungjawab UKM dan UKP

JABATAN/ TANDA
NO NAMA KET
PANGKAT TANGAN
1 1.
2 2.
3 3.
4 4.
5 5.
6 6.
7 7.
8 8.
9 9.
10 10.
11 11.
12 12.
13 13.
14 14.
15 15.
16 16.
17 17.
18 18.
19 19.
20 20.

Mengetahui,
Kepala UPT Puskesmas Cipedes Pembuat daftar

H. Odang Rohmat, S.Kep ( )

NIP. 19650203 199703 1 002
 PEMERINTAH KABUPATEN BANDUNG
DINAS KESEHATAN
UPT PUSKESMAS CIPEDES
JL. Jati Sari No. 5 Desa Cipedes Kecamatan Paseh 40383
Telp. (022) 859662445
E-mail : Pkmcipedes_Bandungkab@yahoo.com

Notulen
Kegiatan Sidang/Rapat
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3. Hasil :
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Notulis

( )
NIP.