DINAS KESEHATAN
UPTD PUSKESMAS RANAP UJUNGJAYA
Jl Rd. Ali Sadikin KM 05 No 02 Ujungjaya-Sumedang Kode Pos 45383
TELP (0233) 8667264 Email : puskesmasujungjaya@yahoo.co.id
SURAT TUGAS
No : 800/ / ST-BOK/ PUSK UJ /VII/ 2022
Tanggal : 19 Juli 2022
Udus Kusnadi,SKM
NIP. 19640703198409 1 001
PEMERINTAH DAERAH KABUPATEN SUMEDANG
DINAS KESEHATAN
UPTD PUSKESMAS RANAP UJUNGJAYA
Jl Rd. Ali Sadikin KM 05 No 02 Ujungjaya-Sumedang Kode Pos 45383
TELP (0233) 8667264 Email : puskesmasujungjaya@yahoo.co.id
Lembar Ke :1
Kode No. :-
Nomor : 800/ / PUSK UJ/ VII/ 2022
Dikeluarkan di : Sumedang
Pada Tanggal : 19 Juli 2022
Kuasa Pengguna Anggaran
Udus Kusnadi,SKM
NIP 19640703198409 1 001
I. Berangkat dari : Desa Cibuluh
(Tempat kedudukan)
Ke : Puskesmas Ujungjaya
Udus Kusnadi,SKM
NIP 19640703198409 1 001
II. Tiba di : Puskesmas Ujungjaya Berangkat dari : Puskesmas Ujungjaya
( ............................................ ) ( ............................................ )
NIP NIP
III. Tiba di : - Berangkat dari : -
( ............................................ ) ( ............................................ )
NIP NIP
IV. Tiba di : - Berangkat dari : -
( ............................................ ) ( ............................................ )
NIP NIP
V. Tiba di : Puskesmas ujungjaya Telah diperiksa dengan keterangan bahwa
perjalanan tersebut atas perintahnya dan semata-mata untuk kepentigan
(Tempat Kedudukan)
jabatan dalam waktu yang
Pada Tanggal : 20 Juli 2022 sesingkat-singkatnya.
PA/KPA yang menerbitkan SPD, Pegawai yang melakukan perjalanan dinas, para pejabat yang mensyahkan tanggal berangkat/tiba serta bendahara
pengeluaran bertanggung jawab berdasarkan peraturan-peraturan Keuangan Negara apabila Negara menderita rugi akibat kesalahan, kelalaian dan
kealpaan.
LAPORAN KEGIATAN
Nama Kegiatan :
Nama Petugas : Nora Fitri,S.Tr.Keb
Jabatan : Bidan Desa
Lokasi :
Tanggal :
URAIAN KEGIATAN
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Yang Melaksanakan Tugas
Nora Fitri,S.Tr.Keb
NIP/NRPTT. -