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 : 446.11.3/0001-2023/UKM

2. Nama Petugas : YuLis Rohmani, SKM.
3. Tujuan Perjalanan: ..............................................................................
4. Tanggal PerjaLanan
: ...... ............................ 2023
5. Maksud PerjaLanan: ..............................................................................
..............................................................................
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. YuLis Rohmani, SKM.

NIP : 19771021 2011011001 NIP : 197307152000032006
 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 : ..............................................................................

Lokasi Kegiatan : ..............................................................................
Tanggal Kegiatan : ...... ............................ 2023
Nama Pelaksana : YuLis Rohmani, SKM.
 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

HASIL KEGIATAN
 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

DAFTAR HADIR PENYULUHAN

................................................................................................

No. NAMA ALAMAT TANDATANGAN

10

11

12

13

14

15

16

17

18

19

20

Bontonompo, ...... ............................. 2023

Penanggungjawab

................................................
NIP.
 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

DAFTAR HADIR PENYULUHAN

................................................................................................

No. NAMA ALAMAT TANDATANGAN

10

11

12

13

14

15

16

17

18

19

20

21

22

23
24

25

26

27

28
 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

DAFTAR HADIR PENYULUHAN

................................................................................................

No. NAMA ALAMAT TANDATANGAN

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

Bontonompo, ...... ............................. 2023

Penanggungjawab

................................................
NIP.