PEMERINTAH DAERAH KABUPATEN TASIKMALAYA

DINAS KESEHATAN DAN PENGENDALIAN PENDUDUK

UPTD PUSKESMAS MANGUNREJA
Jalan Raya Sukaraja No.51-53 Telepon. (0265) 544709
e-mail : puskesmas_mangunreja@yahoo.co.id.
MANGUNREJA – Kode Pos : 46462

LAPORAN HASIL PERJALANAN DINAS

I. Petugas yang melaksanakan perjalanan dinas :

1. Nama :
2. NIP :
3. Pangkat/Golongan :
4. Jabatan :
II. Tanggal perjalanan dinas :
III. Kantor yang dikunjungi :
IV. Maksud perjalanan dinas :
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V. Uraian hasil perjalanan dinas
a. Proses pelaksanaan:
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b. Permasalahan yang dihadapi :

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c. Kesimpulan/Saran:
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Demikian laporan ini dibuat dengan sebenar-benarnya.

Tasikmalaya, 24 September 2018

Yang membuat laporan,

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