PEMERINTAH KABUPATEN PANGANDARAN

DINAS KESEHATAN
UPTD PUSKESMAS JADIKARYA
Alamat : Jl.Bojong No...Jadikarya Langkaplancar – Pangandaran 46391
Tlp. 081395253600. Email : jadikaryapuskesmas@yahoo.com

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Perintah - Tugas No. 824/ - ST/PKM/XI/2020

2. Nama Petugas : N. Euis Komariah, Am.Keb
3. Tujuan Perjalanan : Desa Cisarua
4. Tanggal Perjalanan : 6 November 2020
5. Maksud Perjalanan : Kunjungan Rumah Bumil Resti
6. Pejabat Yang Ditemui : Kepala Desa Cisarua
7. Hasil Kunjungan :
a. Proses Pelaksanaan
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b. Permasalahan yang Dihadapi
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c. Kesimpulan / Saran Perbaikan
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Mengetahui, Cisarua, 6 November 2020

Kepala UPTD Puskesmas Jadikarya Tempat Yang Dikunjungi Pelapor,

M. Isnaini Pujaananda, S.Kep (_______________________) N. Euis Komariah, Am.Keb

Penata Tk.I – III / d Penata III / c
NIP. 19741204.199403.1.001 NIP. 19720621.199403.2.003