Bok Sri Puji 2015

PEMERINTAH KABUPATEN PENAJAM PASER UTARA
DINAS KESEHATAN
PUSKESMAS PETUNG
JL.NEGARA KM. 18 KEC.PENAJAM KODE POS 76144 TELP.0543-5232949
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ IV/2015
Tanggal : 07 April 2015
Yang bertanda tangan dibawah ini :

Nama : H. Sukardi, SKM
Nip : 19660922198811003
Jabatan : Ka. UPT. Puskesmas Petung
Memberikan Tugas Kepada :

No Nama / Nip TANGGAL Tempat Maksud Perjalanan
Tujuan
Sri Puji Lestari, Amd. Kep Penyuluhan PHN
1 7-Apr-15 Petung
Nip. 198204222009042002 PasienTn.Bakran
Yuni Wardana Penyuluhan PHN
2 7-Apr-15 Petung
Nip.198406202006042006 PasienTn.Bakran
Pembiayaan Perjalanan
Dibebankan pada : D I P A Satker Dinas Kesehatan Kab. 024.03.4.169217/20 /2015
Demikian Surat tugas ini di buat untuk dapat dilaksanakan sebaik-baiknya
Mengetahui, Ka. UPT. Puskesmas Petung
H.Sukardi,SKM
Nip.196609221988011003
DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
``
` Nama : H. Sukardi, SKM
Nip : 19660922198811003

Tujuan
1 11-Apr-15 Petung
Nip. 198204222009042002 pasien Ny.Becce
Asriani,Amd.Gizi Penyuluhan PHN
2 11-Apr-15 Petung
Nip. 198204042005022007 pasien Ny.Becce
Dibebankan pada : D I P A Satker Dinas Kesehatan Kab. 024.03.4.169217/2015
H.Sukardi,SKM
Nip.196609221988011003
``````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````
DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Tanggal : 13 april 2015

Nip : 19660922198811003

Tempat
No Nama / Nip TANGGAL Maksud Perjalanan
Tujuan
1 13-Apr-15 Petung
Nip. 198204222009042002 Pasien an. Ny. Anneng
Viky Indra Yanti,Amd.Kep Penyuluhan PHN
2 13-Apr-15 Petung
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ V/2015
Tanggal : 21 april 2015

Nip : 19660922198811003

Tempat
Tujuan
1 21-Apr-15 Petung
Nip. 198204222009042002 Pasien an. Bp.Kallo
Yuni wardana,Amd.Kep Penyuluhan PHN
2 21-Apr-15 Petung
Nip : 198406202006042006 Pasien an. Bp.Kallo

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
1 25-Apr-15 Petung
Nip. 198204222009042002 Pasien an. Ny. Ehha
Viky Indra Yanti, Amd. Kep Penyuluhan PHN
2 25-Apr-15 Petung
Nip : 198909262011012001 Pasien an. Ny. Ehha

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ VI /2015
Tanggal : 12 JUNI 2015

Nip : 19660922198811003

Tempat
Tujuan
1 12 Juni 2015 Petung
Nip. 198204222009042002 Pasien an. An. Bp Bakran
yuni Wardana,Amd.Kep Penyuluhan PHN
Nip : 198406202006042006 Pasien an. An. Bp Bakran

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ VI/2015
Tanggal : 17 juni 2015

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien an. Ny. Becce
Viki Indri Yanti,Amd.Kep Penyuluhan PHN
Nip : 198909262011012001 Pasien an. Ny. Becce

Ka. UPT. Puskesmas Petung
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Tanggal : 18 Juni 2015

Nip : 19660922198811003

Tempat
Tujuan
Asriani, Amd. Gizi Penyuluhan PHN
Nip : 197309162005022002 Pasien an. Ny. Anneng

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Tanggal : 22 juni 2015

Nip : 19660922198811003

Tempat
Tujuan
Sri puji lestari Penyuluhan PHN
Nip : 198204222009042002 Pasien an.Bp.Kallo

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Tanggal : 27 Juni 2015

Nip : 19660922198811003

Tempat
Tujuan
Muhammad Said, S.ST Penyuluhan PHN
Nip : 198411112009041002 Pasien an. Ny. Ehha
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ VIII /2015
Tanggal : 11 Agustus 2015

Nip : 19660922198811003

Tujuan
Muhammad Said Penyuluhan PHN
1 11 Agustus 2015 Petung
Nip. 198411112009041002 Pasien an. Bp.Bakran
Yuni Wardana,Amd.Kep Penyuluhan PHN
Nip. 198406202006042006 Pasien an. Bp.Bakran
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tujuan
Nip. 198411112009041002 Pasien an. Ny. Becce
Yuni Wardana, Amd. Kep Penyuluhan PHN
Nip : 198406202006042006 Pasien an. Ny. Becce
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Tariyun Penyuluhan PHN
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip : 198406202006042006 Pasien an. An. Santoso
Tariyun,Amd.Kep Penyuluhan PHN
Nip : 197309071994021002 Pasien an. An. Santoso

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Tanggal : 26 agustus 2015

Nip : 19660922198811003

Tempat
Tujuan
Nip : 197309071994021002 Pasien an. Ny. Anneng
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198411112009041002 Pasien an. Ny.Ehha
Nip : 197309071994021002 Pasien an. Ny.Ehha
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ X /2014
Tanggal : 18 Oktober 2014

Nip : 19660922198811003

Tempat
Tujuan
1 18 Oktober 2014 Petung
Nip. 198204222009042002 Pasien an. Ny. Kartini
Nip : 198909262011012001 Pasien an. Ny. Kartini
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ XI /2014
Tanggal : 13 Nopember 2014

Nip : 19660922198811003

Tempat
Tujuan
1 13 November 2014 Petung
Nip. 198204222009042002 Pasien an. Ny. Barlian
Hasnawati, Amd. Kep Penyuluhan PHN
Nip : 198010282006042019 Pasien an. Ny. Barlian
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien an. Ny. Musriah
Nip : 198909262011012001 Pasien an. Ny. Musriah
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien an. Tn. Kallo
Nip : 197309162005022002 Pasien an. Tn. Kallo
H.Sukardi,SKM
Nip.196609221988011003
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DINAS KESEHATAN
PUSKESMAS PETUNG
LAPORAN PELAKSANAAN TUGAS
1. Dasar Penugasan : Surat Tugas No: / UPT.PKM. Pt / IV /2015

2. Nama Petugas ; Sri Puji Lestari , Yuni wardana
3. Tujuan Perjalan : Untuk melaksanakan PHN
4. Tanggal Perjalanan :7 April 2015
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Tn.Bakran
6. Pejabat yang ditemui : Staf kelurahan , Orang Tua Pasien,
7. Hasil Kunjungan antara lain :
a. Proses Pelaksanaan :
- Kunjungan PHn di laksanakan oleh petugas Progranm PHN dan berkerja sma dengan
petugas program lainnya yang terkait
b. Permasalahan yang dihadapi :

- Kurangnya pengetahuan tentang pentingnya menjaga kesehatan
c. Kesimpulan / Saran Perbaikan

dengan diadakan Kunjungan PHN ke Rumah Pasien an. Tn.Bakran di Harapkan
Keluarga pasien lebih memperhatikan dan memahami tentang kesehatan
Mengetahui, Petung, 07 April 2015

Ka. UPT. Puskesmas Petung Pelapor,
Sri Puji Lestari, Amd. Kep ……………

H.Sukardi,SKM
Nip.196609221988011003 yuni wardana,Amd.kep ……………
DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Sri Puji Lestari , asriani
3. Tujuan Perjalan : Untuk melaksanakan Kunjungan PHN
4. Tanggal Perjalanan : 11 April 2015
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Ny. Becce
6. Pejabat yang ditemui : Staf kelurahan , Pasien dan keluarga
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Ny. NNy.Becce
dan memberikan penyuluhan tentang penyakit yang didg diderita(DM tipe 2)


dengan diadakan Kunjungan PHN ke Rumah Pasien an.Ny. Becce di Harapkan
lebih memperhatikan dan memahami tentang kesehatannya


H.Sukardi,SKM
Nip.196609221988011003 asriani,Amd.Gizi ……………
DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas Sri puji lestari,Viky Indra Yanti
4. Tanggal Perjalanan 13 april 2015
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Ny. Anneng
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Ny. B.Ny Anneng
dan memberikan penyuluhan tentang penyakit yang diderita ( Dx. Hipertensi )

- Malas memeriksakan ke Puskesmas atau Pusbant untuk kontrol Tekanan Darah
dengan diadakan Kunjungan PHN ke Rumah Pasien an.Ny. Becce di Harapkan


H.Sukardi,SKM
Nip.196609221988011003 viky Indra Yanti,Amd.kep ……………
DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Sri Puji Lestari , Yuni Wardana
4. Tanggal Perjalanan 21 April 2015
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an.Tn.Kallo
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Ny.B .Tn.Kallo
dan memberikan penyuluhan tentang penyakit yang diderita ( Dx. Diabetes Melitus )


dengan diadakan Kunjungan PHN ke Rumah Pasien an.an.Tn.Kallo diharapkan
- Lebih Rajin memeriksakan penyakitnya di puskesmas atau di pusbant


H.Sukardi,SKM
Nip.196609221988011003 Yuni Wardana,Amd.kep ……………
DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Sri Puji Lestari , Viki Indra yanti
4. Tanggal Perjalanan 25 April 2015
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Ny.Ehha
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Ny.KaNy.Ehha
dan memberikan penyuluhan tentang penyakit yang dide
g diderita (TB paru )


dengan diadakan Kunjungan PHN ke Rumah Pasien an.Ny.Ehha diharapkan


H.Sukardi,SKM
Nip.196609221988011003 Viky Indra.Y , Amd. Kep ……………
```
`
DINAS KESEHATAN
PUSKESMAS PETUNG
1. Dasar Penugasan : Surat Tugas No: / UPT.PKM. Pt / VI/2015

2. Nama Petugas ; Sri Puji Lestari , Yuni wardana
4. Tanggal Perjalanan : 12 juni 2015
- Kunjungan PHn di laksanakan oleh petugas Progranm PHN dan berkerja sma dengan


dengan diadakan Kunjungan PHN ke Rumah Pasien an an.Tn.Bakran diharapkan pasien
lebih memperhatikan dan memahami tentang kesehatannya.
Mengetahui, petung,12 juni 2015 15


H.Sukardi,SKM
Nip.196609221988011003 yuni wardana,Amd.kep ……………
DINAS KESEHATAN
PUSKESMAS PETUNG
1. Dasar Penugasan : Surat Tugas No: / UPT.PKM. Pt / VI /2015

2. Nama Petugas ; Sri Puji Lestari , Viki Indri Yanti
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Ny. Becce
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Ny. NNy.Becce
dan memberikan penyuluhan tentang penyakit yang dide
g diderita (Diabetus Meletus)


dengan diadakan Kunjungan PHN ke Rumah Pasien an an.Ny.Becce diharapkan
Mengetahui, petung,17 juni 2015


H.Sukardi,SKM
Nip.196609221988011003 Viki Indra Yanti,Amd kep ……………
DINAS KESEHATAN
PUSKESMAS PETUNG
1. Dasar Penugasan : Surat Tugas No: / UPT.PKM. Pt / VI /2015

2. Nama Petugas ; Sri Puji Lestari , Asriani
4. Tanggal Perjalanan 18 juni 2015
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Ny. BNy.Anneng

- Malas memeriksakan ke Puskesmas atau Pusbant untuk kontrol Tekanan Darah
dengan diadakan Kunjungan PHN ke Rumah Pasien an.Ny. Anneng di Harapkan
Mengetahui, Petung,18 juni 2015


H.Sukardi,SKM
Nip.196609221988011003 Asriani,Amd.Gizi ……………
DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Sri Puji Lestari , Viky Indra Yanti
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Tn.Kallo
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an.Tn.Kallo
dan memberikan penyuluhan tentang penyakit yang diderita ( Dx. Diabetes Melitus )


dengan diadakan Kunjungan PHN ke Rumah Pasien an. An. Tn.Kallo di Harapkan
Mengetahui, Petung, 22 juni 2015


H.Sukardi,SKM
Nip.196609221988011003 viky Indra Yanti,Amd.kep ……………
DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ;Sri puji lestari,Nilwana
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Ny.Ehha
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Ny.Ehha
dan memberikan penyuluhan tentang penyakit yang diderita ( Dx. TB Paru )

- Malas memeriksakan ke Puskesmas atau Pusbant Tentang penyakit yang diderita
dengan diadakan Kunjungan PHN ke Rumah Pasien an. Ny. Ehha di Harapkan

Sri puji lestari, Amd. Kep ……………

H.Sukardi,SKM
Nip.196609221988011003 Muhammad Said, S.ST ……………
`
```

DINAS KESEHATAN
PUSKESMAS PETUNG
1. Dasar Penugasan : Surat Tugas No: / UPT.PKM. Pt / VIII /2015

2. Nama Petugas ; Muhammad Said , Yuni wardana
4. Tanggal Perjalanan : 11 Agustus 2015
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Tn.Bakran
dan memberikan penyuluhan tentang penyakit yang diderita ( Dx. hipertensi )

dengan diadakan Kunjungan PHN ke Rumah Pasien an. Tn.Bakran di Harapkan
Mengetahui, Petung, 11 Agustus 2015

Muhammad Said, S.ST ……………

H.Sukardi,SKM
DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Muhammad Said , Yuni Wardana
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Ny.Becce
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Tn.Bakran
dan memberikan penyuluhan tentang penyakit yang diderita ( Dx. Diabetes meletus )


dengan diadakan Kunjungan PHN ke Rumah Pasien an. Ny. Becce di Harapkan


H.Sukardi,SKM

DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Tariyun ,Yuni Wardana
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Tn.Kallo
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Tn.Kallo
dan memberikan penyuluhan tentang penyakit yang diderita ( Dx.Diabetes Meletus )

- Malas memeriksakan ke Puskesmas atau Pusbant untuk kontrol DM
dengan diadakan Kunjungan PHN ke Rumah Pasien an. Tn.Kallo di Harapkan

Tariyun, Amd. Kep ……………
H.Sukardi,SKM
Nip.196609221988011003 Yuni Wardana, Amd. Kep ……………

DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Yuni Wardana , Tariyun
4. Tanggal Perjalanan 25 Agustus 2015
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Tn.Santoso
- Kunjungan PHn di laksanakan oleh petugas Progranm PHN dan berkerja sama dengan
petugas program lainnya yang terkait (DX.Skizofren)


dengan diadakan Kunjungan PHN ke Rumah Pasien an. Tn.Santoso di Harapkan
Orang Tua si anak lebih memperhatikan dan memahami tentang kesehatan anaknya

Yuni Wardana, Amd. Kep ……………
H.Sukardi,SKM
Nip.196609221988011003 Tariyun , Amd. Kep ……………

DINAS KESEHATAN
PUSKESMAS PETUNG
1. Dasar Penugasan : Surat Tugas No: / UPT.PKM. Pt / VIII/2015

2. Nama Petugas ; Muhammad Said ,Tariyun
4. Tanggal Perjalanan :26 Agustus 2015
6. Pejabat yang ditemui : Staf kelurahan , Keluarga Pasien,


dengan diadakan Kunjungan PHN ke Rumah Pasien an. Ny. Anneng di Harapkan
Keluarga pasien lebih memperhatikan dan memahami tentang kesehatannya

H.Sukardi,SKM
Nip.196609221988011003 Tariyun , Amd. Kep ……………

DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Muhammad Said,Tariyun
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an.Ny.Ehha
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Ny.Ehha
dan memberikan penyuluhan tentang penyakit yang diderita ( TB Paru )


dengan diadakan Kunjungan PHN ke Rumah Pasien an.Ny.Ehha di Harapkan

H.Sukardi,SKM
Nip.196609221988011003 Tariyun ,Amd kep ……………

DINAS KESEHATAN
PUSKESMAS PETUNG
1. Dasar Penugasan : Surat Tugas No: / UPT.PKM. Pt / XI /2014

2. Nama Petugas ; Sri Puji Lestari , Asriani
4. Tanggal Perjalanan : 15 Nopember 2014
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. An. Nur Halisa
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. An. Nur Halisa
dan memberikan penyuluhan tentang penyakit yang diderita ( Dx. Dermatitis Alergika )

dengan diadakan Kunjungan PHN ke Rumah Orang Tua Pasien an. An.Nur Halisa di Harapkan
Mengetahui, Petung, 15 Nopember 2014


H.Sukardi,SKM
Nip.196609221988011003 Asriani, Amd. Gizi ……………

DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Sri Puji Lestari , Hasnawati
4. Tanggal Perjalanan : 13 Nopember 2014
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Ny. Barlian


dengan diadakan Kunjungan PHN ke Rumah Pasien an. Ny. Musriah di Harapkan
Orang Tua si anak lebih memperhatikan dan memahami tentang kesehatan anaknya


H.Sukardi,SKM
Nip.196609221988011003 Hasnawati , Amd. Kep ……………
``````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````
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DINAS KESEHATAN
PUSKESMAS PETUNG
KWITANSI
1. Th. Anggaran : 2015
2. Bukti Kas No. : /BOK/ UPT.PKM-PT/XI/ 2015
Sudah terima dari :Pengelola Keuangan BOK UPT. Puskesmas Petung

Uang sebesar : Rp. 40.000
Trebilang : Empat Puluh Ribu Rupiah
Untuk pembayaran : Biaya Perjalanan Dinas dalam Rangka Penyuluhan PHN ke Kel. Petung
Pasien an. n.Tn.Enneng
( Bantuan Operasional Kesehatan ) Bulan A Nov-15
Lunas di Bayar, Petung, 2015

Pengelola Keuangan B O K
UPT. Puskesmas Petung Yang menerima
Erwin Sulistiah, Amd. Kep Sri Puji Lestari, Amd. Kep

Nip.197801052006042025 Nip. 198204222009042002
Mengetahui / Menyetujui,
H.Sukardi,SKM
Nip.196609221988011003
DAFTAR LAMPIRAN TANDA TERIMA BIAYA TRANSFORT PETUGAS
DALAM RANGKA PENYULUHAN PHN MENGGUNAKAN DANA BANTUAN OPERASIONAL KESEHATAN ( B O K )
TANGGAL 7 April 2015
`
NO TGL Kegiatan Uraian Kegiatan Lokasi Petugas Unit cost (Rp) Tanda Tangan
1 07 April 2015 Penyuluhan PHN Petung Sri Puji Lestari Rp 20,000 ………....
2 Pasien an. Tn Bakran yuni wardana Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung,07 April 2015

Ka. UPT. Puskesmas Petung Bendahara BOK UPT. Puskesmas Petung
`
H.Sukardi,SKM Erwin Sulistiah, Amd. Kep

Nip.196609221988011003 Nip.197801052006042025
2 Pasien an. Ny. Becce Asriani Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
2 Pasien an. Ny. Anneng Viky Indra Y Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
2 Pasien an. Tn.Kallo Yuni wardana Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
2 Pasien an. Ny.Ehha Viky Indra Yanti Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
TANGGAL 12 juni 2015
1 12 juni 2015 Penyuluhan PHN Petung Sri Puji Lestari Rp 20,000 ………....
2 Pasien an. Tn.Bakran Yuni wardana Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
TANGGAL 17 Juni 2015
2 Pasien an. Ny. Becce Viki Indra Y Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 17 Juni 2015


Nip.196609221988011003 Nip.197801052006042025
2 Pasien an. Ny. Anneng Asriani Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
TANGGAL 22 juni 2015
1 22 juni 2015 Penyuluhan PHN Petung sri puji lestari Rp 20,000 ………....
2 Pasien an. Tn.Kallo Viky Indra Yanti Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
1 27 Juni 2015 Penyuluhan PHN Petung Sri Puji Lestari Rp 20,000 ………....
2 Pasien an. Ny. Ehha Muhammad Said Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, ``27 Juni 2015


Nip.196609221988011003 Nip.197801052006042025
TANGGAL 11 Agustus 2015
NO NAMA Nip Golongan Unit Kerja / Asal Unit cost (Rp) Tanda Tangan
1 Muhammad Said 198411112009041002 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
2 Yuni Wardana 198406202006042006 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000
Mengetahui, Petung, 11 Agustus 2015 ``


Nip.196609221988011003 Nip.197801052006042025
2 Yuni wardana 198406202006042006 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
` Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
1 Tariyun 197309071994021002 Penata III/C UPT. Puskesmas Petung Rp 20,000 ………....
2 198406202006042006 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....

Yuni Wardana
TOTAL Rp 40,000
Mengetahui, Petung,22 Agustus 2015


Nip.196609221988011003 Nip.197801052006042025
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
2 Tariyun 197309071994021002 Penata III /C UPT. Puskesmas Petung Rp 20,000 ………....
` Rp 40,000


Nip.196609221988011003 Nip.197801052006042025

TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
``````````

TANGGAL 16 OKTOBER 2014
1 Sri Puji Lestari 19820423 200904 2 002 Pengatur Tk I II/d UPT. Puskesmas Petung Rp 20,000 ………....
2 Asriani 19730916 200502 2 002 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000
Mengetahui, Petung, 16 Oktober 2014

Nip.196609221988011003 Nip.197801052006042025

TANGGAL 06 Nopember 2014
2 Ana Fatmawati 19820404 200502 2 007 P3ngatur II/c UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000
Mengetahui, Petung, 06 Nopember2014


Nip.196609221988011003 Nip.197801052006042025

2 Viky Indra Yanti 19890926 201101 2 001 P3ngatur II/c UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025

2 Mud' mainah 19730120 200604 2 003 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025

TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
2 Hasnawati 19801028 200604 2 019 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000
Mengetahui, Petung, 13 201Nopember 2014


Nip.196609221988011003 Nip.197801052006042025
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
copy bulan agustus

TANGGAL 11 AGUSTUS 2015
`
1 11 Agustus 2015 Penyuluhan PHN Petung Muhammad Said Rp 20,000 ………....
2 Pasien an. Tn Bakran yuni wardana Rp 20,000 ..…………
TOTAL Rp 40,000

`

Nip.196609221988011003 Nip.197801052006042025

2 Pasien an. Ny. Becce yuni wardana Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025

1 22 Agustus 2015 Penyuluhan PHN Petung Tariyun Rp 20,000 ………....
2 Pasien an. Tn.Kallo Yuni Wardana Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025

1 25 Agustus 2015 Penyuluhan PHN Petung Yuni wardana Rp 20,000 ………....
2 Pasien an. Tn.Santoso Tariyun Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025

2 Pasien an. Ny.Anneng Tariyun Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
2 Pasien an. Tn.Ehha Tariyun Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 27 Agusus 2015


Nip.196609221988011003 Nip.197801052006042025
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
BULAN :APRIL TAHUN 2015
Pasien an. Tn.Bakran Yuni Wardana Rp 20,000 ..…………
Pasien an. Ny. Becce Asriani Rp 20,000 ..…………
Pasien an. Ny. Anneng Viky Indra Y Rp 20,000 ..…………
Pasien an. Tn.Kallo Yuni Wardana Rp 20,000 ..…………
Pasien an. Ny. Ehha Viky Indra Yanti Rp 20,000 ..…………
TOTAL Rp 200,000
Mengetahui, Petung,30 April 2015


Nip.196609221988011003 Nip.197801052006042025
BULAN : JUNI TAHUN 2015
Pasien an. Ny. Becce Viky Indra Y Rp 20,000 ..…………
Pasien an. Ny. Anneng Asriani Rp 20,000 ..…………
4 22 Juni 2015 Penyuluhan PHN Petung sri puji lestari Rp 20,000 ………....
Pasien an. Tn.Kallo Viky Indra Yanti Rp 20,000 ..…………
Pasien an. Ny. Ehha Muhammad Said Rp 20,000 ..…………
TOTAL Rp 200,000


Nip.196609221988011003 Nip.197801052006042025
BULAN : AGUSTUS TAHUN 2015

Pasien an. Ny. Becce Yuni Wardana Rp 20,000 ..…………
3 22 Agustus 2015 Penyuluhan PHN Petung Tariyun Rp 20,000 ………....

Pasien an. Tn. Kallo Yuni Wardana Rp 20,000 ..…………
4 25 Agustus 2015 Penyuluhan PHN Petung Yuni Wardana Rp 20,000 ………....

Pasien an. Santoso Tariyun Rp 20,000 ..…………
5 26 Agustus 2015 Penyuluhan PHN Petung muhammad Said Rp 20,000 ………....

Pasien an. Ny. Anneng Tariyun Rp 20,000 ..…………
6 27 Agustus 2015 Penyuluhan PHN Petung muhammad Said Rp 20,000 ………....

Pasien an. Ny. Ehha Tariyun Rp 20,000 ..…………
TOTAL Rp 240,000


Nip.196609221988011003 Nip.197801052006042025

BULAN : NOPEMBER TAHUN 2014
1 06 November 2014 Penyuluhan PHN Petung Sri Puji Lestari Rp 20,000 ………....
Pasien an. Ny. Nafiah Ana Fatmawati Rp 20,000 ..…………
Pasien an. Ny. Bariah Viky Indra . Y Rp 20,000 ..…………
Pasien an. Ny. Kartini Mud'mainah Rp 20,000 ..…………
Pasien an. Ny. Musriah Viky Indra . Y Rp 20,000 ..…………
Pasien an. Ny. Barian Hasnawati Rp 20,000 ..…………
Pasien an. Tn. Kallo Asriani Rp 20,000 ..…………
Pasien an. Nur Halisa Asriani Rp 20,000 ..…………
TOTAL Rp 280,000

Nip.196609221988011003 Nip.197801052006042025
DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tujuan
1 8-Oct-15 Petung
Nip. 198204222009042002 PasienNy.Siti Aminah
Asriani Penyuluhan PHN
2 8-Oct-15 Petung
Nip.197309162005022002 Pasien Ny.Siti Aminah
H.Sukardi,SKM
Nip.196609221988011003
DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ X/2015
Tanggal: 13 Oktober 2015
``
` Nama : H. Sukardi, SKM
Nip : 19660922198811003

Tujuan
1 13-Oct-15 Petung
Nip. 198204222009042002 pasien Ny.Bariah
Mudmainah ,Amd.kep Penyuluhan PHN
2 13-Oct-15 Petung
Nip. 197301202006042003 pasien Ny.Bariah
H.Sukardi,SKM
Nip.196609221988011003
``````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````
DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
1 15-Oct-15 Petung
2 15-Oct-15 Petung
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
1 20-Oct-15 Petung
Nip. 198204222009042002 Pasien Ny.Becce
Fiky Indra Yanti,Amd.Kep Penyuluhan PHN
2 20-Oct-15 Petung
Nip : 198909102011011001 Pasien Ny.Becce

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/X/2015

Nip : 19660922198811003

Tempat
Tujuan
1 21-Oct-15 Petung
Nip. 198204222009042002 Pasien Tn.Anneng
2 21-Oct-15 Petung
Nip : 198406202006042006 Pasien Bpk.Anneng

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien an. Ny Sapagantin
yuni Wardana,Amd.Kep Penyuluhan PHN
Nip : 198406202006042006 Pasien an.. Ny Sapagantin

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ XI/2015
Tanggal : 11 November 2015

Nip : 19660922198811003
: Ka. UPT. Puskesmas Petung

Tempat
Tujuan
Nip. 198204222009042002 Pasien Ny.Siti aminah
Ariani,Amd.Gizi Penyuluhan PHN
Nip : 197309162005022002 Pasien Ny.Siti aminah

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ XI/2015

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien Ny.Bariah
Mudmainah,Amd.kep Penyuluhan PHN
Nip : 197301202006042003 Pasien Ny.Bariah

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Sri Puji Lestari,Amd.kep Penyuluhan PHN
Nip : 198204222009042002 Pasien Ny.Ehha

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien Ny.Becce
Asriani ,Amd.Gizi Penyuluhan PHN
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tujuan
Nip. 198204222009042002 Pasien Bp.Enneng
Asriani ,Amd.Gizi Penyuluhan PHN
Nip : 197309162005022002 Pasien Bp.Enneng
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tujuan
Nip. 198204222009042002 Pasien Ny.sapangatun
Nip : 198406202006042006 Pasien Ny.sapangatun
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS
Nomor : /UPT. PKM-Pt/ XII /2015
Tanggal : 11 Desember 2015

Nip : 19660922198811003

Tempat
Tujuan
Sri puji Lestari,Amd.kep Penyuluhan PHN
1 11 Desember 2015 Petung
Yuni Wardana,Amd.kep Penyuluhan PHN
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan

H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Mudmainah,Amd.kep Penyuluhan PHN
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien Tn.Anneng
Nip : 198909262011012001 Pasien Tn.Anneng
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Sri Puji Lestari, Amd. Kep 22-Dec-15 Penyuluhan PHN
1 Petung
Nip. 198204222009042002 Pasien Ny.Sapangatun
Nip : 198909262011012001 Pasien Ny.Sapangatun
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien an. Ny. Musriah
Nip : 198909262011012001 Pasien an. Ny. Musriah
H.Sukardi,SKM
Nip.196609221988011003

DINAS KESEHATAN
PUSKESMAS PETUNG
SURAT TUGAS

Nip : 19660922198811003

Tempat
Tujuan
Nip. 198204222009042002 Pasien an. Tn. Kallo
Nip : 197309162005022002 Pasien an. Tn. Kallo
H.Sukardi,SKM
Nip.196609221988011003
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DINAS KESEHATAN
PUSKESMAS PETUNG
KWITANSI
1. Th. Anggaran : 2015
2. Bukti Kas No. : /BOK/ UPT.PKM-PT/ XI/ 2015
Sudah terima dari : Pengelola Keuangan BOK UPT. Puskesmas Petung

Uang sebesar : Rp. 40.000
Trebilang : Empat Puluh Ribu Rupiah
Untuk pembayaran : Biaya Perjalanan Dinas dalam Rangka Penyuluhan PHN ke Kel. Petung
Pasien Ny. Sapangatun dengan Anggaran Dana Bantuan BOK
( Bantuan Operasional Kesehatan ) Bulan November 2015
Lunas di Bayar, Petung,

Pengelola Keuangan B O K
UPT. Puskesmas Petung Yang menerima
Antung Ashary S, Amd. Kep Sri Puji Lestari, Amd. Kep

Nip.198810092015042002 Nip : 198204222009042002
Mengetahui / Menyetujui,
H.Sukardi,SKM
Nip.196609221988011003
TANGGAL 8 OKTOER 2015
`
1 8 oktober 2015 Penyuluhan PHN Petung Sri Puji Lestari Rp 20,000 ………....
2 Pasien Ny.Siti aminah asriani Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung,08 november 2015

`
H.Sukardi,SKM Antung Ashary S, Amd. Kep

Nip.196609221988011003 Nip.198810092015042002
2 Pasien Bariah mudmainah Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 13 oktober 2015


Nip.196609221988011003 Nip.198810092015042002
2 Pasien an. Ny.Ehha Asriani Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 13 Oktober 2015 2015


Nip.196609221988011003 Nip.198810092015042002
2 Pasien Ny.Becce Viky Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 20 oktober 2015


Nip.196609221988011003 Nip.198810092015042002
2 Pasien Ny.Enneng Yuni Wardana Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 17 november 2015


Nip.196609221988011003 Nip.198810092015042002
2 Pasien Ny.Sapangatun Asriani Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 19 November 2015


Nip.196609221988011003 Nip.198810092015042002
TANGGAL 11 DESEMBER 2015
1 11 Desember 2015 Penyuluhan PHN Petung Sri Puji Lestari Rp 20,000 ………....
2 Pasien Ny. Siti Aminah yuni Wardana Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 11 desember 2015


Nip.196609221988011003 Nip.198810092015042002
2 Pasien . Ny. Bariah Tariyun Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 12 Desember 2015


Nip.196609221988011003 Nip.198810092015042002
1 15 desember 2015 Penyuluhan PHN Petung sri puji lestari Rp 20,000 ………....
2 Pasien Ny.Ehha Mudmainah Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 15 Desember 2015


Nip.196609221988011003 Nip.198810092015042002
2 Pasien Ny. Becce Tariyun Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 16 desember 2015


Nip.196609221988011003 Nip.198810092015042002
TOTAL Rp 40,000
Mengetahui, Petung, 11 Agustus 2015 ``


Nip.196609221988011003 Nip.198810092015042002
2 Yuni wardana 198406202006042006 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
` Rp 40,000


Nip.196609221988011003 Nip.198810092015042002
2 198406202006042006 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....

Yuni Wardana
TOTAL Rp 40,000


Nip.196609221988011003 Nip.198810092015042002
TOTAL Rp 40,000


Nip.196609221988011003 Nip.198810092015042002
2 Tariyun 197309071994021002 Penata III /C UPT. Puskesmas Petung Rp 20,000 ………....
` Rp 40,000


Nip.196609221988011003 Nip.198810092015042002

TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
``````````

TOTAL Rp 40,000
Mengetahui, Petung, 16 Oktober 2014

Nip.196609221988011003 Nip.197801052006042025

2 Ana Fatmawati 19820404 200502 2 007 P3ngatur II/c UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000
Mengetahui, Petung, 06 Nopember2014


Nip.196609221988011003 Nip.197801052006042025

TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025

2 Mud' mainah 19730120 200604 2 003 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025

TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
2 Hasnawati 19801028 200604 2 019 Penata Muda III/a UPT. Puskesmas Petung Rp 20,000 ………....
TOTAL Rp 40,000
Mengetahui, Petung, 13 201Nopember 2014


Nip.196609221988011003 Nip.197801052006042025
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
copy bulan agustus

`
1 17 Desember 2015 Penyuluhan PHN Petung Muhammad Said Rp 20,000 ………....
2 PasienTn.Enneng Asriani Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung,17 Desember 2015

`

Nip.196609221988011003 Nip.198810092015042002

1 22 Desember 2015 Penyuluhan PHN Petung Muhammad Said Rp 20,000 ………....
2 Pasien an. Ny. Sapangatun Viky Indra Yanti Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 22 Desemer 2015


Nip.196609221988011003 Nip.197801052006042025

TANGGAL 11 November 2015 2015
1 11 November 2015 Penyuluhan PHN Petung sri puji lestari Rp 20,000 ………....
2 Pasien an. Ny.Siti Aminah Asriani Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.198810092015042002

TANGGAL 12 NOVEMBER 2015
2 Pasien an. Ny.Bariah Mudmainah Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.198810092015042002

2 Pasien an. Ny.Anneng Tariyun Rp 20,000 ..…………
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
2 Pasien an. Tn.Ehha Tariyun Rp 20,000 ..…………
TOTAL Rp 40,000
Mengetahui, Petung, 27 Agusus 2015


Nip.196609221988011003 Nip.197801052006042025
TOTAL Rp 40,000


Nip.196609221988011003 Nip.197801052006042025
DINAS KESEHATAN
PUSKESMAS PETUNG

2. Nama Petugas ; Sri puji lestari, Yuni Wardana
4. Tanggal Perjalanan : 19 November 2015
5. Maksud Perjalanan : Untuk Kunjungan PHN Pasien an. Ny.Sapangatun
- Kunjungan PHN di laksanakan oleh petugas Program PHN kerumah pasien an. Tn.B Ny.Sapangatun


dengan diadakan Kunjungan PHN ke Rumah Pasien an. Ny. Sapangatun di Harapkan

Sri Puji lestari,Amd.Kep ……………

H.Sukardi,SKM
BULAN :OKTOBER TAHUN 2015
1 08 Oktober 2015 Penyuluhan PHN Petung Sri Puji Lestari Rp 20,000 ………....
Pasien an. Ny.Siti Aminah Asriani Rp 20,000 ..…………
Pasien an.Ny.Bariah Mudmainah Rp 20,000 ..…………
Pasien an.Ny.Ehha Asriani Rp 20,000 ..…………
Pasien an.Ny.Becce Rp 20,000 ..…………
Viky Indra Yanti
Pasien.an.Anneng Yuni Wardana Rp 20,000 ..…………
Pasien an. Ny.Sapangatun asriani Rp 20,000 ..…………
TOTAL Rp 240,000
Mengetahui, Petung,31 Oktober 2015


Nip.196609221988011003 Nip.198810092015042002

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