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PEMERINTAH KABUPATEN GOWA

DINAS KESEHATAN
UPT. PUSKESMAS BONTONOMPO II
Jln. Bontocaradde, KeL. TamaLLayang ,Kec. Bontonompo, Kab. Gowa, Prop. SuLSeL, KodePos 92153
E-mail : pkmbontonompo2@gmail.com - WA : 081-340-180-008 – Kode Registrasi : 1070457
FB : https://www.facebook.com/PKMBontonompo2 - IG : @pkmbontonompo2
GMaps : https://goo.gl/maps/7WjjL8NXYaH2

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : 446.11.2/00 -2023/UKP


2. Nama Petugas : ..............................................................................
3. Tujuan Perjalanan: ..............................................................................
4. Tanggal PerjaLanan
: ...... ............................ 2023
5. Maksud PerjaLanan: ..............................................................................
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6. Orang Yang Ditemui : ..............................................................................
7. HasiL Kunjungan, antara lain :

a. Proses PeLaksanaan

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b. Permasalahan yang dihadapi
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c. Kesimpulan/Saran
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Mengetahui : Pelapor
Kepala UPT. Puskesmas Bontonompo II

dr. H. Irwanto IL. .............................................


NIP : 19771021 2011011001 NIP./No.SK :
PEMERINTAH KABUPATEN GOWA
DINAS KESEHATAN
UPT. PUSKESMAS BONTONOMPO II
Jln. Bontocaradde, KeL. TamaLLayang ,Kec. Bontonompo, Kab. Gowa, Prop. SuLSeL, KodePos 92153
E-mail : pkmbontonompo2@gmail.com - WA : 081-340-180-008 – Kode Registrasi : 1070457
FB : https://www.facebook.com/PKMBontonompo2 - IG : @pkmbontonompo2
GMaps : https://goo.gl/maps/7WjjL8NXYaH2

FOTO KEGIATAN

Nama Kegiatan : Rujukan pasien atas nama ...........................................................


Rumah Sakit Tujuan : .......................................................................................................
Tanggal Kegiatan : ...... ............................ 2023
Nama Pelaksana : .......................................................................................................

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