PEMERINTAH KABUPATEN CIAMIS

DINAS KESEHATAN
UPTD PUSKESMAS CIGAYAM
Jalan. Raya Cigayam Banjaranyar Tlp. (0265) 2661061
e-mail: uptdpuskesmascigayam@gmail.com
CIAMIS
Kode Pos 46383

LAPORAN HASIL KEGIATAN PERJALANAN DINAS

1. Yang memberi tugas : Kepala UPTD Puskesmas Cigayam Kecamatan Banjaranyar

Daerah yang dikunjungi : ....................................................................................................
Tanggal berangkat : Mei 2022
Tanggal kembali : Mei 2022

2. Yang melaksanakan tugas :

Nama : Ani Rohliani, S.ST
NIP. : 19780915 200801 2 009
Pangkat / Gol : Penata Muda TK I – III/b
Jabatan : Bidan Ahli Pertama

3. Kendaraan yang dipergunakan : Roda Dua

4. Kegiatan yang dilaksanakan : Pelayanan Kesehatan di posyandu
5. Hasil kegiatan : .....................................................................................................
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6. Rencana Tindak Lanjut : ....................................................................................................
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Mengetahui : Cigayam , Mei 2022

Kepala UPTD Puskesmas Cigayam Yang Melaksanakan Tugas

ARI ANGGA RIANTO,S.Kep,Ners ANI ROHLIANI, S.ST

Penata TK I Penata Muda TK I
NIP. 19780510 200604 1 015 Nip. 19780915 200801 2 009
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
UPTD PUSKESMAS CIGAYAM
Jalan. Raya Cigayam Banjaranyar Tlp. (0265) 2661061
e-mail: uptdpuskesmascigayam@gmail.com
CIAMIS
Kode Pos 46383

LAPORAN HASIL KEGIATAN PERJALANAN DINAS

1. Yang memberi tugas : Kepala UPTD Puskesmas Cigayam Kecamatan Banjaranyar

Daerah yang dikunjungi : ....................................................................................................
Tanggal berangkat : Mei 2022
Tanggal kembali : Mei 2022

2. Yang melaksanakan tugas :

Nama : Andri Firmansyah, AMD.Kep
NIP. :-
Pangkat / Gol :-
Jabatan : Pelaksana Perawat

3. Kendaraan yang dipergunakan : Roda Dua

4. Kegiatan yang dilaksanakan : Pelayanan Kesehatan di posyandu
5. Hasil kegiatan : .....................................................................................................
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6. Rencana Tindak Lanjut : ....................................................................................................
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Mengetahui : Cigayam , Mei 2022

Kepala UPTD Puskesmas Cigayam Yang Melaksanakan Tugas

ARI ANGGA RIANTO,S.Kep,Ners ANDRI FIRMANSYAH, AMD.Kep

Penata TK I -
NIP. 19780510 200604 1 015 Nip. -
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
UPTD PUSKESMAS CIGAYAM
Jalan. Raya Cigayam Banjaranyar Tlp. (0265) 2661061
e-mail: uptdpuskesmascigayam@gmail.com
CIAMIS
Kode Pos 46383

LAPORAN HASIL KEGIATAN PERJALANAN DINAS

1. Yang memberi tugas : Kepala UPTD Puskesmas Cigayam Kecamatan Banjaranyar

Daerah yang dikunjungi : Desa Banjaranyar
Tanggal berangkat : 18 Mei 2022
Tanggal kembali : 18 Mei 2022

2. Yang melaksanakan tugas :

Nama : Ani Rohliani, S.ST
NIP. : 19780915 200801 2 009
Pangkat / Gol : Penata Muda TK I – III/b
Jabatan : Bidan Ahli Pertama

3. Kendaraan yang dipergunakan : Roda Dua

4. Kegiatan yang dilaksanakan : Pelayanan Imunisasi Rutin Bayi dan Balita
5. Hasil kegiatan : .....................................................................................................
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6. Rencana Tindak Lanjut : ....................................................................................................
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Mengetahui : Cigayam , 18 Mei 2022

Kepala UPTD Puskesmas Cigayam Yang Melaksanakan Tugas

ARI ANGGA RIANTO,S.Kep,Ners ANI ROHLIANI, S.ST

Penata TK I Penata Muda TK I
NIP. 19780510 200604 1 015 Nip. 19780915 200801 2 009
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
UPTD PUSKESMAS CIGAYAM
Jalan. Raya Cigayam Banjaranyar Tlp. (0265) 2661061
e-mail: uptdpuskesmascigayam@gmail.com
CIAMIS
Kode Pos 46383

LAPORAN HASIL KEGIATAN PERJALANAN DINAS

1. Yang memberi tugas : Kepala UPTD Puskesmas Cigayam Kecamatan Banjaranyar

Daerah yang dikunjungi : Desa Banjaranyar
Tanggal berangkat : 18 Mei 2022
Tanggal kembali : 18 Mei 2022

2. Yang melaksanakan tugas :

Nama : Andri Firmansyah, AMD.Kep
NIP. :-
Pangkat / Gol :-
Jabatan : Pelaksana Perawat

3. Kendaraan yang dipergunakan : Roda Dua

4. Kegiatan yang dilaksanakan : Pelayanan Imunisasi Rutin Bayi dan Balita
5. Hasil kegiatan : .....................................................................................................
............................................................................................................................................................
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6. Rencana Tindak Lanjut : ....................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................

Mengetahui : Cigayam , 18 Mei 2022

Kepala UPTD Puskesmas Cigayam Yang Melaksanakan Tugas

ARI ANGGA RIANTO,S.Kep,Ners ANDRI FIRMANSYAH, AMD.Kep

Penata TK I -
NIP. 19780510 200604 1 015 Nip. -