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PEMERINTAH KABUPATEN SITUBONDO

DINAS KESEHATAN
UPTD PUSKESMAS ASEMBAGUS
Jl. Raya Banyuwangi Nomor 01 MOJOSARI Telp. (0338) 453 995 E-Mail : asembagusjempol@yahoo.co.id
ASEMBAGUS – SITUBONDO 68373

NOTULEN

RAPAT : .............................................................................
Hari / Tanggal : .............................................................................
Jam Rapat : .............................................................................
Acara :
1. ............................................................................
2. ............................................................................
3. ............................................................................
4. Penutup

PIMPINAN RAPAT
Ketua : .............................................................................
Sekretaris : .............................................................................
Pencatat : .............................................................................
Peserta Rapat :
1. ............................................................................
2. ............................................................................
3. ............................................................................

KEGIATAN RAPAT :
1. ............................................................................
2. ............................................................................

1. Kata pembukaan : .............................................................................


2. Pembahasan : .............................................................................
3. Diskusi (Tanya Jawab) : ..........................................................................
4. Keputusan : .............................................................................

Asembagus, 2016
PIMPINAN RAPAT
KEPALA UPTD PUSKESMAS ASEMBAGUS

drg. S U G I Y O N O
NIP. 19740202 200501 1 010

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