Anda di halaman 1dari 1

PEMERINTAH KABUPATEN INDRAMAYU

DINAS KESEHATAN
UPTD PUSKESMASTERISI
Jln. Raya Rajasinga No. 72 B Kec. TerisiKab. IndramayuKodePos 45262
Telp. (0234) 7145147 Email :puskesmas_terisi@yahoo.com Hotline SMS : 0895321788788

LEMBAR DISPOSISI

INDEX : ........................................................... TANGGAL PENYELESAIAN

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

DARI : .........................................................................................................................................

PERIHAL : .........................................................................................................................................

TGL. SURAT : .........................................................................................................................................

NO. SURAT : .........................................................................................................................................

INSTRUKSI / INFORMASI *) DITERUSKAN KEPADA :

Terisi, .............................
Paraf,

(.....................................................)

(* Coret yang tidak perlu

Anda mungkin juga menyukai