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PEMERINTAH KABUPATEN BARITO UTARA

DINAS KESEHATAN
UPT PUSKESMAS TUMPUNG LAUNG
Jl. Kihajar Dewantara No. 04 RT.VIII Tumpung Laung II Kec. Montallat Kode Pos 73861

KEPUTUSAN KEPALA UPT PUSKESMAS TUMPUNG LAUNG


Nomor : 450/ /SK/PKM-TPL/2019

TENTANG
.....................................................................
UPT PUSKESMAS TUMPUNG LAUNG

DENGAN RAHMAT TUHAN YANG MAHA ESA

KEPALA UPT PUSKESMAS TUMPUNG LAUNG,

Menimbang : a. bahwa .............................................................................


.........................................................................................;
b. bahwa .............................................................................
.........................................................................................;
c. bahwa..............................................................................
..........................................................................................

Mengingat : 1. ........................................................................................
.........................................................................................;
2. ........................................................................................
.........................................................................................;
3. ........................................................................................
.........................................................................................;
4. ........................................................................................
.........................................................................................;
5. ........................................................................................
.........................................................................................
MEMUTUSKAN

Menetapkan : KEPUTUSAN KEPALA PUSKESMAS TENTANG (ketik judul


SK)
. .....................................................................................................
.....................................................................................................

Kesatu : . .....................................................................................................
......................................................................................................
......................................................................................................

Kedua : . .....................................................................................................
......................................................................................................
......................................................................................................

Ketiga : Keputusan ini berlaku sejak tanggal ditetapkan dan apabila


dikemudian hari terdapat kekeliruan dalam keputusan ini, akan
diadakan perbaikan atau perubahan sebagaimana mestinya.

Ditetapkan di : TUMPUNG LAUNG


Pada tanggal :
KEPALA UPT PUSKESMAS TUMPUNG LAUNG

RIXSON PANDIANGAN

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