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PEMERINTAH KABUPATEN MAJALENGKA

RUMAH SAKIT UMUM DAERAH MAJALENGKA


Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR PESERTA PELATIHAN


HOSPITAL DISASTER PLAN

PERTEMUAN : Pelatihan Hospital Disaster Plan


BIDANG : Akreditasi
HARI : Rabu
TANGGAL : 25 Januari 2017
JAM : 08.00 wib s.d selesai
TEMPAT : Aula R.M Nera

NO NAMA JABATAN TANDA TANGAN


1 dr. H.Harizal F Harahap, MM Direktur 1 ......................
2 H. Ida Heriyani, SKM.,MH.Kes Ka.Bag. Tata Usaha 2 .....................
3 Abd. Rachman Rosidi,SKM.,MKM Ka.Bid. Perlitbang 3 .....................
4 Sunarpi, SKM Ka.Inst. PROMKES 4 .....................
5 Tengku Muhamad Tapip N, AMTe Ka. Inst. IPSRS 5 .....................
6 Mamat Slamet M,S.Kep.,Ners Ka. Ruang ICU 6 .....................
7 Rd. Dewi Yeni Laksmi,S.Kep Ka. Subag Perlengkapan 7 .....................
8 Muharam Budi Laksono,S.Si., MSi Ka.Inst. Radiologi 8 .....................
9 Savitri Susilowati,S.Kep.,Ners Tim PPI 9 .....................
10 Iip Saripudin, S.Kep.,Ners Ka.Inst.Rawat Inap 10 .....................
11 Tjutju Rosmalia, AMKL Ka. Inst Sanitasi 11 .....................
12 Yani Meilani Nalle, Amd.Kep Ka.Ruang Nusa Indah 12 .....................
13 Eni Nuroniah,AMKL Sanitarian 13 .....................
14 Asep Sonhaji, ST IT 14 .....................
15 Yoga Purbadi, AMK,.SKM Staf Promkes 15 .....................
16 dr.Henny Kodariyah Susilo Dokter 16 .....................
17 Iis Yuliatiningsih, S.Kep.Ners Ka.Subag Umum 17 .....................
18 Imas Masuroh, S.Kep.Ners Ka. Sie Keperawatan 18 .....................
19 Sumarni, S.Kep.,Ners Perawat 19 .....................
20 Hj. Entar Sutarmi, Amd.Kep Perawat 20 .....................
21 Taufikurrohman S.Sos,Msi Ka. Inst. Rekam Medis 21 .....................
22 H. Asep Zaki Mulyatno,SKM,.MKM Ka. Sie PEP 22 .....................
23 dr. H. Ade Zulkarnaen Ka. Inst. Rawat Jalan 23 .....................
24 Iwan Hermawan,S.Kep.Ners Perawat 24 .....................
NO NAMA JABATAN TANDA TANGAN
25 Muhaemin, S.ST Perawat 25 .....................
26 Cucu Hilmawati Romli, AMK Perawat 26 .....................
27 Lalan Suklan Satpam 27 .....................
28 dr. Dewi Nurmala Sari Ka. Inst. Gawat Darurat 28 .....................
Ka.Sie. Pelayanan Medis non
29 dr. Dini Azora, MARS 29 .....................
Medis
30 Mimin, S.ST Ka. Inst. IGD 30 .....................
31 Alek Solihul Mubarok, S.Kep Perawat 31 .....................
32 Agus Abduladi, S.Kep Perawat 32 .....................
33 Eso Satori Sopir Ambulan 33 .....................
34 Dadi Ismail Satpam 34 .....................
35 M. Nuralim, AMTe Staf IPSRS 35 .....................
36 Eneng Fatuh Roswatika, STr.Keb Bidan 36 .....................
37 Dian Nendhiawati, A.Md.Keb Bidan 37 .....................
38 Hj. Imas Maslahat, AMK.,SKM Ka.Bid Keuangan 38 .....................
39 dr. Deassy Arifiani Ka.Sie. Keperawatan 39 .....................
40 Nendi Sumardi, S.IP Satpam 40 .....................

Majalengka, ...........................
Penanggungjawab Pertemuan,

.....
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR PESERTA PELATIHAN


HOSPITAL DISASTER PLAN

PERTEMUAN : Pelatihan Hospital Disaster Plan PERTEMUAN


BIDANG : Akreditasi BIDANG
HARI : Rabu HARI
TANGGAL : 25 Januari 2017 TANGGAL
JAM : 13.00 wib s.d selesai JAM
TEMPAT : Aula R.M Nera TEMPAT

NO NAMA JABATAN TANDA TANGAN NO


1 dr. H.Harizal F Harahap, MM Direktur 1 ...................... 1
2 H. Ida Heriyani, SKM.,MH.Kes Ka.Bag. Tata Usaha 2 ..................... 2
3 Abd. Rachman Rosidi,SKM.,MKM Ka.Bid. Perlitbang 3 ..................... 3
4 Sunarpi, SKM Ka.Inst. PROMKES 4 ..................... 4
5 Tengku Muhamad Tapip N, AMTe Ka. Inst. IPSRS 5 ..................... 5
6 Mamat Slamet M,S.Kep.,Ners Ka. Ruang ICU 6 ..................... 6
7 Rd. Dewi Yeni Laksmi,S.Kep Ka. Subag Perlengkapan 7 ..................... 7
8 Muharam Budi Laksono,S.Si., MSi Ka.Inst. Radiologi 8 ..................... 8
9 Savitri Susilowati,S.Kep.,Ners Tim PPI 9 ..................... 9
10 Iip Saripudin, S.Kep.,Ners Ka.Inst.Rawat Inap 10 ..................... 10
11 Tjutju Rosmalia, AMKL Ka. Inst Sanitasi 11 ..................... 11
12 Yani Meilani Nalle, Amd.Kep Ka.Ruang Nusa Indah 12 ..................... 12
13 Eni Nuroniah,AMKL Sanitarian 13 ..................... 13
14 Asep Sonhaji, ST IT 14 ..................... 14
15 Yoga Purbadi, AMK,.SKM Staf Promkes 15 ..................... 15
16 dr.Henny Kodariyah Susilo Dokter 16 ..................... 16
17 Iis Yuliatiningsih, S.Kep.Ners Ka.Subag Umum 17 ..................... 17
18 Imas Masuroh, S.Kep.Ners Ka. Sie Keperawatan 18 ..................... 18
19 Sumarni, S.Kep.,Ners Perawat 19 ..................... 19
20 Hj. Entar Sutarmi, Amd.Kep Perawat 20 ..................... 20
21 Taufikurrohman S.Sos,Msi Ka. Inst. Rekam Medis 21 ..................... 21
22 H. Asep Zaki Mulyatno,SKM,.MKM Ka. Sie PEP 22 ..................... 22
23 dr. H. Ade Zulkarnaen Ka. Inst. Rawat Jalan 23 ..................... 23
24 Iwan Hermawan,S.Kep.Ners Perawat 24 ..................... 24
NO NAMA JABATAN TANDA TANGAN NO
25 Muhaemin, S.ST Perawat 25 ..................... 25
26 Cucu Hilmawati Romli, AMK Perawat 26 ..................... 26
27 Lalan Suklan Satpam 27 ..................... 27
28 dr. Dewi Nurmala Sari Ka. Inst. Gawat Darurat 28 ..................... 28
Ka.Sie. Pelayanan Medis
29 dr. Dini Azora, MARS 29 ..................... 29
non Medis
30 Mimin, S.ST Ka. Inst. IGD 30 ..................... 30
31 Alek Solihul Mubarok, S.Kep Perawat 31 ..................... 31
32 Agus Abduladi, S.Kep Perawat 32 ..................... 32
33 Eso Satori Sopir Ambulan 33 ..................... 33
34 Dadi Ismail Satpam 34 ..................... 34
35 M. Nuralim, AMTe Staf IPSRS 35 ..................... 35
36 Eneng Fatuh Roswatika, STr.Keb Bidan 36 ..................... 36
37 Dian Nendhiawati, A.Md.Keb Bidan 37 ..................... 37
38 Hj. Imas Maslahat, AMK.,SKM Ka.Bid Keuangan 38 ..................... 38
39 dr. Deassy Arifiani Ka.Sie. Keperawatan 39 ..................... 39
40 Nendi Sumardi, S.IP Satpam 40 ..................... 40

a, ........................... Majalengka, ...........................


gjawab Pertemuan, Penanggungjawab Pertemuan,

..............................................
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA RU
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info E-ma

DAFTAR HADIR PESERTA PELATIHAN


HOSPITAL DISASTER PLAN

PERTEMUAN : Pelatihan Hospital Disaster Plan PERTEMUAN


BIDANG : Akreditasi BIDANG
HARI : Kamis HARI
TANGGAL : 26 Januari 2017 TANGGAL
JAM : 08.00 wib s.d selesai JAM
TEMPAT : Aula Pertemuan RSUD Majalengka TEMPAT

NAMA JABATAN TANDA TANGAN NO


dr. H.Harizal F Harahap, MM Direktur 1 ...................... 1
H. Ida Heriyani, SKM.,MH.Kes Ka.Bag. Tata Usaha 2 ..................... 2
Abd. Rachman Rosidi,SKM.,MKM Ka.Bid. Perlitbang 3 ..................... 3
Sunarpi, SKM Ka.Inst. PROMKES 4 ..................... 4
Tengku Muhamad Tapip N, AMTe Ka. Inst. IPSRS 5 ..................... 5
Mamat Slamet M,S.Kep.,Ners Ka. Ruang ICU 6 ..................... 6
Rd. Dewi Yeni Laksmi,S.Kep Ka. Subag Perlengkapan 7 ..................... 7
Muharam Budi Laksono,S.Si., MSi Ka.Inst. Radiologi 8 ..................... 8
Savitri Susilowati,S.Kep.,Ners Tim PPI 9 ..................... 9
Iip Saripudin, S.Kep.,Ners Ka.Inst.Rawat Inap 10 ..................... 10
Tjutju Rosmalia, AMKL Ka. Inst Sanitasi 11 ..................... 11
Yani Meilani Nalle, Amd.Kep Ka.Ruang Nusa Indah 12 ..................... 12
Eni Nuroniah,AMKL Sanitarian 13 ..................... 13
Asep Sonhaji, ST IT 14 ..................... 14
Yoga Purbadi, AMK,.SKM Staf Promkes 15 ..................... 15
dr.Henny Kodariyah Susilo Dokter 16 ..................... 16
Iis Yuliatiningsih, S.Kep.Ners Ka.Subag Umum 17 ..................... 17
Imas Masuroh, S.Kep.Ners Ka. Sie Keperawatan 18 ..................... 18
Sumarni, S.Kep.,Ners Perawat 19 ..................... 19
Hj. Entar Sutarmi, Amd.Kep Perawat 20 ..................... 20
Taufikurrohman S.Sos,Msi Ka. Inst. Rekam Medis 21 ..................... 21
H. Asep Zaki Mulyatno,SKM,.MKM Ka. Sie PEP 22 ..................... 22
dr. H. Ade Zulkarnaen Ka. Inst. Rawat Jalan 23 ..................... 23
Iwan Hermawan,S.Kep.Ners Perawat 24 ..................... 24
NAMA JABATAN TANDA TANGAN NO
Muhaemin, S.ST Perawat 25 ..................... 25
Cucu Hilmawati Romli, AMK Perawat 26 ..................... 26
Lalan Suklan Satpam 27 ..................... 27
dr. Dewi Nurmala Sari Ka. Inst. Gawat Darurat 28 ..................... 28
Ka.Sie. Pelayanan Medis
dr. Dini Azora, MARS 29 ..................... 29
non Medis
Mimin, S.ST Ka. Inst. IGD 30 ..................... 30
Alek Solihul Mubarok, S.Kep Perawat 31 ..................... 31
Agus Abduladi, S.Kep Perawat 32 ..................... 32
Eso Satori Sopir Ambulan 33 ..................... 33
Dadi Ismail Satpam 34 ..................... 34
M. Nuralim, AMTe Staf IPSRS 35 ..................... 35
Eneng Fatuh Roswatika, STr.Keb Bidan 36 ..................... 36
Dian Nendhiawati, A.Md.Keb Bidan 37 ..................... 37
Hj. Imas Maslahat, AMK.,SKM Ka.Bid Keuangan 38 ..................... 38
dr. Deassy Arifiani Ka.Sie. Keperawatan 39 ..................... 39
Nendi Sumardi, S.IP Satpam 40 ..................... 40

........................... Majalengka, ...........................


jawab Pertemuan, Penanggungjawab Pertemuan,

..............................................
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info E

DAFTAR HADIR PESERTA PELATIHAN


HOSPITAL DISASTER PLAN

PERTEMUAN : Pelatihan Hospital Disaster Plan PERTEMUAN


BIDANG : Akreditasi BIDANG
HARI : Kamis HARI
TANGGAL : 26 Januari 2017 TANGGAL
JAM : 13.00 wib s.d selesai JAM
TEMPAT : Aula Pertemuan RSUD Majalengka TEMPAT

NAMA JABATAN TANDA TANGAN NO


dr. H.Harizal F Harahap, MM Direktur 1 ...................... 1
H. Ida Heriyani, SKM.,MH.Kes Ka.Bag. Tata Usaha 2 ..................... 2
Abd. Rachman Rosidi,SKM.,MKM Ka.Bid. Perlitbang 3 ..................... 3
Sunarpi, SKM Ka.Inst. PROMKES 4 ..................... 4
Tengku Muhamad Tapip N, AMTe Ka. Inst. IPSRS 5 ..................... 5
Mamat Slamet M,S.Kep.,Ners Ka. Ruang ICU 6 ..................... 6
Rd. Dewi Yeni Laksmi,S.Kep Ka. Subag Perlengkapan 7 ..................... 7
Muharam Budi Laksono,S.Si., MSi Ka.Inst. Radiologi 8 ..................... 8
Savitri Susilowati,S.Kep.,Ners Tim PPI 9 ..................... 9
Iip Saripudin, S.Kep.,Ners Ka.Inst.Rawat Inap 10 ..................... 10
Tjutju Rosmalia, AMKL Ka. Inst Sanitasi 11 .................... 11
Yani Meilani Nalle, Amd.Kep Ka.Ruang Nusa Indah 12 ..................... 12
Eni Nuroniah,AMKL Sanitarian 13 ..................... 13
Asep Sonhaji, ST IT 14 ..................... 14
Yoga Purbadi, AMK,.SKM Staf Promkes 15 .................... 15
dr.Henny Kodariyah Susilo Dokter 16 ..................... 16
Iis Yuliatiningsih, S.Kep.Ners Ka.Subag Umum 17 ..................... 17
Imas Masuroh, S.Kep.Ners Ka. Sie Keperawatan 18 ..................... 18
Sumarni, S.Kep.,Ners Perawat 19 .................... 19
Hj. Entar Sutarmi, Amd.Kep Perawat 20 ..................... 20
Taufikurrohman S.Sos,Msi Ka. Inst. Rekam Medis 21 ..................... 21
H. Asep Zaki Mulyatno,SKM,.MKM Ka. Sie PEP 22 ..................... 22
dr. H. Ade Zulkarnaen Ka. Inst. Rawat Jalan 23 .................... 23
Iwan Hermawan,S.Kep.Ners Perawat 24 ..................... 24
NAMA JABATAN TANDA TANGAN NO
Muhaemin, S.ST Perawat 25 ..................... 25
Cucu Hilmawati Romli, AMK Perawat 26 ..................... 26
Lalan Suklan Satpam 27 .................... 27
dr. Dewi Nurmala Sari Ka. Inst. Gawat Darurat 28 ..................... 28
Ka.Sie. Pelayanan Medis
dr. Dini Azora, MARS 29 ..................... 29
non Medis
Mimin, S.ST Ka. Inst. IGD 30 ..................... 30
Alek Solihul Mubarok, S.Kep Perawat 31 .................... 31
Agus Abduladi, S.Kep Perawat 32 ..................... 32
Eso Satori Sopir Ambulan 33 ..................... 33
Dadi Ismail Satpam 34 ..................... 34
M. Nuralim, AMTe Staf IPSRS 35 .................... 35
Eneng Fatuh Roswatika, STr.Keb Bidan 36 ..................... 36
Dian Nendhiawati, A.Md.Keb Bidan 37 ..................... 37
Hj. Imas Maslahat, AMK.,SKM Ka.Bid Keuangan 38 ..................... 38
dr. Deassy Arifiani Ka.Sie. Keperawatan 39 .................... 39
Nendi Sumardi, S.IP Satpam 40 ..................... 40

a, ........................... Majalengka, ...........................


ngjawab Pertemuan, Penanggungjawab Pertemuan,

..............................................
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info E

DAFTAR HADIR PESERTA PELATIHAN


HOSPITAL DISASTER PLAN

PERTEMUAN : Pelatihan Hospital Disaster Plan PERTEMUAN


BIDANG : Akreditasi BIDANG
HARI : Jum'at HARI
TANGGAL : 27 Januari 2017 TANGGAL
JAM : 08.00 wib s.d selesai JAM
TEMPAT : Aula Pertemuan RSUD Majalengka TEMPAT

NAMA JABATAN TANDA TANGAN NO


dr. H.Harizal F Harahap, MM Direktur 1 ...................... 1
H. Ida Heriyani, SKM.,MH.Kes Ka.Bag. Tata Usaha 2 ..................... 2
Abd. Rachman Rosidi,SKM.,MKM Ka.Bid. Perlitbang 3 ..................... 3
Sunarpi, SKM Ka.Inst. PROMKES 4 ..................... 4
Tengku Muhamad Tapip N, AMTe Ka. Inst. IPSRS 5 ..................... 5
Mamat Slamet M,S.Kep.,Ners Ka. Ruang ICU 6 ..................... 6
Rd. Dewi Yeni Laksmi,S.Kep Ka. Subag Perlengkapan 7 ..................... 7
Muharam Budi Laksono,S.Si., MSi Ka.Inst. Radiologi 8 ..................... 8
Savitri Susilowati,S.Kep.,Ners Tim PPI 9 ..................... 9
Iip Saripudin, S.Kep.,Ners Ka.Inst.Rawat Inap 10 ..................... 10
Tjutju Rosmalia, AMKL Ka. Inst Sanitasi 11 .................... 11
Yani Meilani Nalle, Amd.Kep Ka.Ruang Nusa Indah 12 ..................... 12
Eni Nuroniah,AMKL Sanitarian 13 ..................... 13
Asep Sonhaji, ST IT 14 ..................... 14
Yoga Purbadi, AMK,.SKM Staf Promkes 15 .................... 15
dr.Henny Kodariyah Susilo Dokter 16 ..................... 16
Iis Yuliatiningsih, S.Kep.Ners Ka.Subag Umum 17 ..................... 17
Imas Masuroh, S.Kep.Ners Ka. Sie Keperawatan 18 ..................... 18
Sumarni, S.Kep.,Ners Perawat 19 .................... 19
Hj. Entar Sutarmi, Amd.Kep Perawat 20 ..................... 20
Taufikurrohman S.Sos,Msi Ka. Inst. Rekam Medis 21 ..................... 21
H. Asep Zaki Mulyatno,SKM,.MKM Ka. Sie PEP 22 ..................... 22
dr. H. Ade Zulkarnaen Ka. Inst. Rawat Jalan 23 .................... 23
Iwan Hermawan,S.Kep.Ners Perawat 24 ..................... 24
NAMA JABATAN TANDA TANGAN NO
Muhaemin, S.ST Perawat 25 ..................... 25
Cucu Hilmawati Romli, AMK Perawat 26 ..................... 26
Lalan Suklan Satpam 27 .................... 27
dr. Dewi Nurmala Sari Ka. Inst. Gawat Darurat 28 ..................... 28
Ka.Sie. Pelayanan Medis
dr. Dini Azora, MARS 29 ..................... 29
non Medis
Mimin, S.ST Ka. Inst. IGD 30 ..................... 30
Alek Solihul Mubarok, S.Kep Perawat 31 .................... 31
Agus Abduladi, S.Kep Perawat 32 ..................... 32
Eso Satori Sopir Ambulan 33 ..................... 33
Dadi Ismail Satpam 34 ..................... 34
M. Nuralim, AMTe Staf IPSRS 35 .................... 35
Eneng Fatuh Roswatika, STr.Keb Bidan 36 ..................... 36
Dian Nendhiawati, A.Md.Keb Bidan 37 ..................... 37
Hj. Imas Maslahat, AMK.,SKM Ka.Bid Keuangan 38 ..................... 38
dr. Deassy Arifiani Ka.Sie. Keperawatan 39 .................... 39
Nendi Sumardi, S.IP Satpam 40 ..................... 40

......................... Majalengka, ...........................


wab Pertemuan, Penanggungjawab Pertemuan,

..............................................
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info E-

DAFTAR HADIR PESERTA PELATIHAN


HOSPITAL DISASTER PLAN

PERTEMUAN : Pelatihan Hospital Disaster Plan PERTEMUAN


BIDANG : Akreditasi BIDANG
HARI : Jum'at HARI
TANGGAL : 27 Januari 2017 TANGGAL
JAM : 13.00 wib s.d selesai JAM
TEMPAT : Aula Pertemuan RSUD Majalengka TEMPAT

NAMA JABATAN TANDA TANGAN NO


dr. H.Harizal F Harahap, MM Direktur 1 ...................... 1
H. Ida Heriyani, SKM.,MH.Kes Ka.Bag. Tata Usaha 2 ..................... 2
Abd. Rachman Rosidi,SKM.,MKM Ka.Bid. Perlitbang 3 ..................... 3
Sunarpi, SKM Ka.Inst. PROMKES 4 ..................... 4
Tengku Muhamad Tapip N, AMTe Ka. Inst. IPSRS 5 ..................... 5
Mamat Slamet M,S.Kep.,Ners Ka. Ruang ICU 6 ..................... 6
Rd. Dewi Yeni Laksmi,S.Kep Ka. Subag Perlengkapan 7 ..................... 7
Muharam Budi Laksono,S.Si., MSi Ka.Inst. Radiologi 8 ..................... 8
Savitri Susilowati,S.Kep.,Ners Tim PPI 9 ..................... 9
Iip Saripudin, S.Kep.,Ners Ka.Inst.Rawat Inap 10 ..................... 10
Tjutju Rosmalia, AMKL Ka. Inst Sanitasi 11 ..................... 11
Yani Meilani Nalle, Amd.Kep Ka.Ruang Nusa Indah 12 ..................... 12
Eni Nuroniah,AMKL Sanitarian 13 ..................... 13
Asep Sonhaji, ST IT 14 ..................... 14
Yoga Purbadi, AMK,.SKM Staf Promkes 15 ..................... 15
dr.Henny Kodariyah Susilo Dokter 16 ..................... 16
Iis Yuliatiningsih, S.Kep.Ners Ka.Subag Umum 17 ..................... 17
Imas Masuroh, S.Kep.Ners Ka. Sie Keperawatan 18 ..................... 18
Sumarni, S.Kep.,Ners Perawat 19 ..................... 19
Hj. Entar Sutarmi, Amd.Kep Perawat 20 ..................... 20
Taufikurrohman S.Sos,Msi Ka. Inst. Rekam Medis 21 ..................... 21
H. Asep Zaki Mulyatno,SKM,.MKM Ka. Sie PEP 22 ..................... 22
dr. H. Ade Zulkarnaen Ka. Inst. Rawat Jalan 23 ..................... 23
Iwan Hermawan,S.Kep.Ners Perawat 24 ..................... 24
NAMA JABATAN TANDA TANGAN NO
Muhaemin, S.ST Perawat 25 ..................... 25
Cucu Hilmawati Romli, AMK Perawat 26 ..................... 26
Lalan Suklan Satpam 27 ..................... 27
dr. Dewi Nurmala Sari Ka. Inst. Gawat Darurat 28 ..................... 28
Ka.Sie. Pelayanan Medis
dr. Dini Azora, MARS 29 ..................... 29
non Medis
Mimin, S.ST Ka. Inst. IGD 30 ..................... 30
Alek Solihul Mubarok, S.Kep Perawat 31 ..................... 31
Agus Abduladi, S.Kep Perawat 32 ..................... 32
Eso Satori Sopir Ambulan 33 ..................... 33
Dadi Ismail Satpam 34 ..................... 34
M. Nuralim, AMTe Staf IPSRS 35 ..................... 35
Eneng Fatuh Roswatika, STr.Keb Bidan 36 ..................... 36
Dian Nendhiawati, A.Md.Keb Bidan 37 ..................... 37
Hj. Imas Maslahat, AMK.,SKM Ka.Bid Keuangan 38 ..................... 38
dr. Deassy Arifiani Ka.Sie. Keperawatan 39 ..................... 39
Nendi Sumardi, S.IP Satpam 40 ..................... 40
41
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awab Pertemuan, Penanggungjawab Per 43
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NAMA JABATAN TANDA TANGAN NO
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PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA R
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info E-m

DAFTAR HADIR PESERTA

PERTEMUAN : PERTEMUAN
BIDANG : BIDANG
HARI : HARI
TANGGAL : TANGGAL
JAM : JAM
TEMPAT : TEMPAT

NAMA JABATAN TANDA TANGAN NO


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NAMA JABATAN TANDA TANGAN NO
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47...............
48...............
49...............
50...............
51...............
52...............
53...............
54...............
55...............
56...............
57...............
58...............
59...............
60...............
61...............
62...............
NAMA JABATAN TANDA TANGAN NO
63...............
64...............
65...............
66...............
67...............
68...............
69...............
70...............
71...............
72...............
73...............
74...............
75...............
76..............
77...............
78...............
79...............
80...............

Majalengka, ...........................
Penanggungjawab Pertemuan,
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR PESERTA PELATIHAN


HOSPITAL DISASTER PLAN

PERTEMUAN : PERTEMUAN
BIDANG : BIDANG
HARI : HARI
TANGGAL : TANGGAL
JAM : JAM
TEMPAT : TEMPAT
:
NAMA JABATAN TANDA TANGAN NO
81 ...................... 1
82 ..................... 2
83 ..................... 3
84 ..................... 4
85 ..................... 5
86 ..................... 6
87 ..................... 7
88 ..................... 8
89 ..................... 9
90 ..................... 10
91 ..................... 11
92 ..................... 12
93 ..................... 13
94 ..................... 14
95 ..................... 15
96 ..................... 16
97 ..................... 17
98 ..................... 18
99 ..................... 19
100 ..................... 20
101..................... 21
102..................... 22
103 ..................... 23
104 ..................... 24
NAMA JABATAN TANDA TANGAN NO
105..................... 25
106..................... 26
107..................... 27
108 ..................... 28

109..................... 29

110..................... 30
111 ..................... 31
112..................... 32
113 ..................... 33
114..................... 34
115 ..................... 35
116..................... 36
117..................... 37
118 ..................... 38
119 ..................... 39
120 ..................... 40

Majalengka, ...........................
Penanggungjawab Pertemuan,

...
NAMA JABATAN TANDA TANGAN NO

...........................
jawab Pertemuan,
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR PESERTA PELATIHAN


HOSPITAL DISASTER PLAN

PERTEMUAN : PERTEMUAN
BIDANG : BIDANG
HARI : HARI
TANGGAL : TANGGAL
JAM : JAM
TEMPAT : TEMPAT

NAMA JABATAN TANDA TANGAN NO


dr. H.Harizal F Harahap, MM Direktur 1 ...................... 1
H. Ida Heriyani, SKM.,MH.Kes Ka.Bag. Tata Usaha 2 ..................... 2
Abd. Rachman Rosidi,SKM.,MKM Ka.Bid. Perlitbang 3 ..................... 3
Sunarpi, SKM Ka.Inst. PROMKES 4 ..................... 4
Tengku Muhamad Tapip N, AMTe Ka. Inst. IPSRS 5 ..................... 5
Mamat Slamet M,S.Kep.,Ners Ka. Ruang ICU 6 ..................... 6
Rd. Dewi Yeni Laksmi,S.Kep Ka. Subag Perlengkapan 7 ..................... 7
Muharam Budi Laksono,S.Si., MSi Ka.Inst. Radiologi 8 ..................... 8
Savitri Susilowati,S.Kep.,Ners Tim PPI 9 ..................... 9
Iip Saripudin, S.Kep.,Ners Ka.Inst.Rawat Inap 10 ..................... 10
Tjutju Rosmalia, AMKL Ka. Inst Sanitasi 11 ..................... 11
Yani Meilani Nalle, Amd.Kep Ka.Ruang Nusa Indah 12 ..................... 12
Eni Nuroniah,AMKL Sanitarian 13 ..................... 13
Asep Sonhaji, ST IT 14 ..................... 14
Yoga Purbadi, AMK,.SKM Staf Promkes 15 ..................... 15
dr.Henny Kodariyah Susilo Dokter 16 ..................... 16
Iis Yuliatiningsih, S.Kep.Ners Ka.Subag Umum 17 ..................... 17
Imas Masuroh, S.Kep.Ners Ka. Sie Keperawatan 18 ..................... 18
Sumarni, S.Kep.,Ners Perawat 19 ..................... 19
Hj. Entar Sutarmi, Amd.Kep Perawat 20 ..................... 20
Taufikurrohman S.Sos,Msi Ka. Inst. Rekam Medis 21 ..................... 21
H. Asep Zaki Mulyatno,SKM,.MKM Ka. Sie PEP 22 ..................... 22
dr. H. Ade Zulkarnaen Ka. Inst. Rawat Jalan 23 ..................... 23
Iwan Hermawan,S.Kep.Ners Perawat 24 ..................... 24
NAMA JABATAN TANDA TANGAN NO
Muhaemin, S.ST Perawat 25 ..................... 25
Cucu Hilmawati Romli, AMK Perawat 26 ..................... 26
Lalan Suklan Satpam 27 ..................... 27
dr. Dewi Nurmala Sari Ka. Inst. Gawat Darurat 28 ..................... 28
Ka.Sie. Pelayanan Medis
dr. Dini Azora, MARS 29 ..................... 29
non Medis
Mimin, S.ST Ka. Inst. IGD 30 ..................... 30
Alek Solihul Mubarok, S.Kep Perawat 31 ..................... 31
Agus Abduladi, S.Kep Perawat 32 ..................... 32
Eso Satori Sopir Ambulan 33 ..................... 33
Dadi Ismail Satpam 34 ..................... 34
M. Nuralim, AMTe Staf IPSRS 35 ..................... 35
Eneng Fatuh Roswatika, STr.Keb Bidan 36 ..................... 36
Dian Nendhiawati, A.Md.Keb Bidan 37 ..................... 37
Hj. Imas Maslahat, AMK.,SKM Ka.Bid Keuangan 38 ..................... 38
dr. Deassy Arifiani Ka.Sie. Keperawatan 39 ..................... 39
Nendi Sumardi, S.IP Satpam 40 ..................... 40
41
Majalengka, ................... 42
Penanggungjawab Perte 43
44
..................... 45
b Pertemuan, 46
.... 47
48
49
50
NAMA JABATAN TANDA TANGAN NO
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR

PERTEMUAN :
BIDANG :
HARI :
TANGGAL :
JAM :
TEMPAT :

NAMA JABATAN TANDA TANGAN


1 ......................
2 .....................
3 .....................
4 .....................
5 .....................
6 .....................
7 .....................
8 .....................
9 .....................
10 .....................
11 .....................
12 .....................
13 .....................
14 .....................
15 .....................
16 .....................
17 .....................
18 .....................
19 .....................
20 .....................
21 .....................
22 .....................
23 .....................
24 .....................
NAMA JABATAN TANDA TANGAN
25 .....................
26 .....................
27 .....................
28 .....................

29 .....................

30 .....................
31 .....................
32 .....................
33 .....................
34 .....................
35 .....................
36 .....................
37 .....................
38 .....................
39 .....................
40 .....................
41............................
42......................
43...........................
44………………
45...........................
46………………
47............................
48………………
49............................
50 .....................

Majalengka, ...........................
Penanggungjawab Pertemuan,

(...............................................................)
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGK
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengk

DAFTAR HADIR
ORIENTASI PEGAWAI BARU TAHUN 2018

NO NAMA 13-Aug-18
1 RADEN ADI ICE PUSPITA,SE

2 DINDA RAHMANURARISASI,SE

3 RECKY ROSDIANA HERAWAN,SIP

4 IDA SA'ADAH,S.farm.,Apt

5 RIA ANGGRAENI,A.Md.AK
PEMERINTAH KABUPATEN MAJALENGKA
AH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
u.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR
RIENTASI PEGAWAI BARU TAHUN 2018

14-Aug-18 15-Aug-18 16-Aug-18 18-Aug-18

Majalengka, ...........................

Penanggungjawab Pertemuan,

..............................................
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR PESERTA

PERTEMUAN : ...................................................
BIDANG :....................................................
HARI : ...................................................
TANGGAL : ...................................................
JAM : ..................................................
TEMPAT : ...................................................

NO NAMA JABATAN TANDA 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 .....................
21 21 .....................
22 22 .....................
23 23 .....................
24 24 .....................
NO NAMA JABATAN TANDA TANGAN
25 25 .....................
26 26 .....................
27 27 .....................
28 28 .....................

29 29 .....................

30 30 .....................
31 31 .....................
32 32 .....................
33 33 .....................
34 34 .....................
35 35 .....................
36 36 .....................
37 37 .....................
38 38 .....................
39 39 .....................
40 40 .....................
41 41....................
42 42...................
43 43................
44 44...............
45 45...............
46 46...............
47 47...............
48 48...............
49 49...............
50 50...............
51 51...............
52 52...............
53 53...............
54 54...............
55 55...............
56 56...............
57 57...............
58 58...............
59 59...............
60 60...............
61 61...............
62 62...............
NO NAMA JABATAN TANDA TANGAN
63 63...............
64 64...............
65 65...............
66 66...............
67 67...............
68 68...............
69 69...............
70 70...............
71 71...............
72 72...............
73 73...............
74 74...............
75 75...............
76 76..............
77 77...............
78 78...............
79 79...............
80 80...............
81 81..................
82 82..................
83 83....................
84 84...................
85 85....................
86 86..................
87 87...................
88 88...................
89 89..................
90 90..................
91 91.................
92 92...................
93 93..................
94 94...................
95 95..................
96 96...................
97 97..................
98 98...................
99 99..................
100 100..................
NO NAMA JABATAN TANDA TANGAN
Majalengka, ...........................
Penanggungjawab Pertemuan,

..............................................
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR

PERTEMUAN : Round Table Discusion


HARI / TANGGAL : Rabu / 6 Februari 2019
JAM : 12.30 WIB s.d Selesai
TEMPAT : AULA I RSUD Majalengka

NO NAMA JABATAN TANDA TANGAN


1 dr. R Dody M Turmudzi, Sp.PD Dokter Spes.Peny.Dalam 1 ......................
2 dr. Melindah, Sp.PD Dokter Spes.Peny.Dalam 2 .....................
3 dr. Afdi M Syam, Sp.PD Dokter Spes.Peny.Dalam 3 .....................
4 dr. Endang Widajanti, Sp.A Dokter Spes.Anak 4 .....................
5 dr. Wiwin Winiar, Sp.A.,M.Kes Dokter Spes.Anak 5 .....................
6 dr. Dewi Fitriani, Sp.A Dokter Spes.Anak 6 .....................
7 dr. Erny Rachmawati Dokter Spes.Syaraf 7 .....................
8 dr. H.Ade Zulkarnaen Dokter Umum 8 .....................
9 dr. Sri Dewi Utami Dokter Umum 9 .....................
10 dr. Heny kodariah Susilo Dokter Umum 10 .....................
11 dr. Dewi Nurmalasari Dokter Umum 11 .....................
12 dr. Masganjar Nugraha Dokter Umum 12 .....................
13 dr. Ani Purwati Paligar Dokter Umum 13 .....................
14 dr. Rafi Rizki Dokter Umum 14 .....................
15 dr. Dicky Andrie C Dokter Umum 15 .....................
16 dr. Iis Aisyah Dokter Umum 16 .....................
17 dr. Delila Rola Dokter Umum 17 .....................
18 dr. Yeremia Rerung K Dokter Umum 18 .....................
19 dr. Nidya Erlandiany Dokter Umum 19 .....................
20 dr. Anindito Sidhy Andaru Dokter Umum 20 .....................
21 dr. Galuh Krisna Wahyudi Dokter Umum 21 .....................
22 dr. Ade Triyadi Dokter Umum 22 .....................
23 dr. Firman Fauzi Dokter Umum 23 .....................
24 dr. Rikha Vebrianti Dokter Umum 24 .....................
25 dr. H. Harizal FH, MM Direktur 25 ........................
26 dr. Hj. Erni Harleni, MARS Kabid Pelayanan 26 ....................
27 dr. Dini Azora, MARS Kasie Pelayanan 27 ........................
28 dr. Ega Bramasta Akidapi,M.M.RS Kabid Perlitbang 28 ....................
29 dr. Deasy Arifiani Kasie Litbang 29 ........................
30 Ika Yanuar hapsari, S.Farm., Apt. apoteker 30 ....................
31 Neti Siti Latifah, S. Farm., Apt apoteker 31 .........................
32 Opi Sopiah,S.Kep.,Ners katim mawar 32 ......................
33 Lia Maria Ulfa,Amd.Kep katim melati 33 .........................
34 Ina Herdiana,S.ep.,Ners katim bougenvile 34 .........................
35 Sri Ratnawati,S.kep.,Ners katim anggrek 35 ........................

Majalengka, ...........................
Penanggungjawab Pertemuan,

(...............................................................)
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR

PERTEMUAN :
HARI / TANGGAL :
JAM :
TEMPAT :

NO NAMA JABATAN TANDA 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 ...................
21 21 .....................
22 22 ...................
23 23 ....................
24 24 ...................
25 25 ........................
26 26 ...............
27 27 ........................
28 28 ................
29 29...................
30 30 .................

Majalengka, ...........................
Penanggungjawab Pertemuan,
NO NAMA JABATAN TANDA TANGAN

( .....................................................................)
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR

PERTEMUAN :
HARI / TANGGAL :
JAM :
TEMPAT :

NO NAMA JABATAN TANDA 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 ...................
21 21 .....................
22 22 ...................
23 23 ....................
24 24 ...................
25 25 ........................
26 26 ...............
27 27 ........................
28 28 ................
29 29...................
30 30 .................
31 31...................
32 32...................
33 33...................
34 34....................
NO NAMA JABATAN TANDA TANGAN
35 35...................
36 36....................
37 37...................
38 38....................
39 39...................
40 40....................
41 41...................
42 42....................
43 43...................
44 44....................
45 45...................
46 46....................
47 47...................
48 48...................
49 49...................
50 50...................
51 51...................
52 52...................
53 53...................
54 54...................
55 55...................
56 56...................
57 57...................
58 58...................
59 59...................
60 60...................
61 61...................
62 62...................
63 63...................
64 64...................
65 65...................
66 66...................
67 67...................
68 68...................
69 69...................
70 70...................

Majalengka, ...........................
Penanggungjawab Pertemuan,

(......................................................)
PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR

PERTEMUAN : Evaluasi Survey Verifikasi Akreditasi


HARI / TANGGAL : Jumat / 1 November 2019
JAM : 12.30 WIB s.d Selesai
TEMPAT : AULA RSUD Majalengka

NO NAMA JABATAN TANDA 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 ...................
21 21 .....................
22 22 ...................
23 23 ....................
24 24 ...................
25 25 ........................
26 26 ...............
27 27 ........................
28 28 ................
29 29...................
30 30 .................
NO NAMA JABATAN TANDA TANGAN
31 31...................
32 32...................
33 33...................
34 34....................
35 35...................
36 36....................
37 37...................
38 38....................
39 39...................
40 40....................
41 41...................
42 42....................
43 43...................
44 44....................
45 45...................
46 46....................
47 47...................
48 48...................
49 49...................
50 50...................
51 51...................
52 52...................
53 53...................
54 54...................
55 55...................
56 56....................
57 57...................
58 58....................
59 59...................
60 60....................
61 61...................
62 62....................
63 63...................
64 64....................
65 65....................
66 66....................
67 67...................
68 68....................
69 69...................
70 70....................
71 71...................
NO NAMA JABATAN TANDA TANGAN
72 72....................
73 73...................
74 74.....................
75 75...................
76 76....................
77 77....................
78 78....................
79 79...................
80 80....................
81 81...................
82 82.....................
83 83...................
84 84....................
85 85...................
86 86.....................
87 87....................
88 88.....................
89 89....................
90 90....................
91 91...................
92 92.....................
93 93...................
94 94....................
95 95....................
96 96....................
97 97...................
98 98....................
99 99....................
100 100..................

Majalengka, ...........................
Penanggungjawab Pertemuan,

( dr. DEASSY ARIFIANI )


PEMERINTAH KABUPATEN MAJALENGKA
RUMAH SAKIT UMUM DAERAH MAJALENGKA
Jalan Kesehatan No. 77 Majalengka 45411
Telp. (0233) 281043-281189. Fax. (0233) 282741
E-mail : rsu.majalengka@gmail.com Website : www.rsudmajalengka.info

DAFTAR HADIR

PERTEMUAN : Survey Verifikasi Akreditasi Ke - 2


HARI / TANGGAL : Jumat, 11 Oktober 2019
JAM : 08.00 WIB s.d Selesai
TEMPAT : RSUD Majalengka

NO NAMA JABATAN TANDA 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 ...................
21 21 .....................
22 22 ...................
23 23 ....................
24 24 ...................
25 25 ........................
26 26 ...............
27 27 ........................
28 28 ................
29 29...................
30 30 .................
NO NAMA JABATAN TANDA TANGAN
31 31...................
32 32...................
33 33...................
34 34....................
35 35...................
36 36....................
37 37...................
38 38....................
39 39...................
40 40....................
41 41...................
42 42....................
43 43...................
44 44....................
45 45...................
46 46....................
47 47...................
48 48...................
49 49...................
50 50...................
51 51...................
52 52...................
53 53...................
54 54...................
55 55...................
56 56....................
57 57...................
58 58....................
59 59...................
60 60....................
61 61...................
62 62....................
63 63...................
64 64....................
65 65....................
66 66....................
67 67...................
68 68....................
69 69...................
70 70....................
71 71...................
NO NAMA JABATAN TANDA TANGAN
72 72....................
73 73...................
74 74.....................
75 75...................
76 76....................
77 77....................
78 78....................
79 79...................
80 80....................
81 81...................
82 82.....................
83 83...................
84 84....................
85 85...................
86 86.....................
87 87....................
88 88.....................
89 89....................
90 90....................
91 91...................
92 92.....................
93 93...................
94 94....................
95 95....................
96 96....................
97 97...................
98 98....................
99 99....................
100 100..................
101 101.................
102 102...................
103 103.................
104 104...................
105 105.................
106 106...................
107 107.................
108 108...................
109 109.................
110 110...................
111 111.................
112 112................
NO NAMA JABATAN TANDA TANGAN
113 113.................
114 114...................
115 115.................
116 116...................
117 117.................
118 118..................
119 119................
120 120...................
121 121.................
122 122...................
123 123.................
124 124...................
125 125.................
126 126...................
127 127.................
128 128...................
129 129.................
130 130..................
131 131.................
132 132...................
133 133.................
134 134...................
135 135.................
136 136...................
137 137.................
138 138...................
139 139.................
140 140...................
141 141.................
142 142...................
143 143.................
144 144...................
145 145.................
146 146...................
147 147.................
148 148...................
149 149.................
150 150...................
151 151.................
152 152...................
153 153.................
NO NAMA JABATAN TANDA TANGAN
154 154...................
155 155.................
156 156...................
157 157.................
158 158...................
159 159.................
160 160...................
161 161.................
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Majalengka, ...........................
Penanggungjawab Pertemuan,

( dr. DEASSY ARIFIANI )


DAFTAR HADIR

PERTEMUAN :
HARI / TANGGAL :
JAM :
TEMPAT :

NO NAMA JABATAN TANDA TANGAN


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Majalengka, 2019
Penanggung Jawab

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