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PEMERINTAH KABUPATEN GOWA

DINAS KESEHATAN
UPT PUSKESMAS TINGGIMONCONG
JL.Sultan Hasanuddin No.37 Telp:0417-2220011 Malino 92174

LAPORAN PELAKSANAAN TUGAS


1. Dasar Penugasan : Surat Tugas Nomor 446.18.3/ /UKM
2. Nama Petugas/Tim :
3. Tujuan Perjalanan Dinas :
4. Tanggal Perjalanan :
5. Maksud Perjalanan :
6. Orang Yang Ditemui :
7. Hasil Kunjungan :
a. Proses Pelaksanaan :

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b. Permasalahan yang dihadapi :

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c. Kesimpulan/Saran :

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Tinggimoncong,……………..
Mengetahui Penanggung jawab/ Pelapor
Kepala Puskesmas Tinggimoncong
Ilyas Abdullah, S.Kep, Ns ..............................................
Nip. 19740209 199403 1 005

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