DINAS KESEHATAN KOTA TANGERANG

UPT PUSKESMAS PONDOK BAHAR

JL. SUNAN GIRI NO. 2 KEL. PONDOK BAHAR – KEC. KARANG
KOTA TANGERANG TELP (021) 55700732

JUDUL KAK

I. Pendahuluan
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II. Latar Belakang

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III. Tujuan
A. Tujuan Umum
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B. Tujuan Khusus
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IV. Kegiatan Pokok dan Rincian Kegiatan

No Kegiatan Pokok Rincian Kegiatan

Dst..
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V. Cara Melaksanakan Kegiatan dan Sasaran

Pelaksanaan Lintas Program Lintas Sektor
No Kegiatan Pokok Ket
Program UKGM Terkait Terkait

Dst..

I. Sasaran
1. Anak Pra Sekolah

1
 2. Ibu Hamil
3. Masyarakat Lanjut Usia

II. Jadwal Pelaksanaan Kegiatan

2018
No Kegiatan
Jan Feb Mar Apr Mei Jun Jul Agu Sep Okt Nov Des
1
2
Dst

III. Evaluasi Pelaksanaan Kegiatan dan Pelaporan

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IV. Pencatatan, Pelaporan dan Evaluasi Kegiatan

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