LAPORAN

1. DASAR PENUGASAN : Surat Tugas Kepala Puskesmas Mangulewa,tanggal, / / 2018

Nomor : 879 / MGLW / / / 2018

2. MAKSUD/TUJUAN : Perjalanan Dinas dalam rangka kegiatan kunjungan rumah bayi/balita resiko
tinggi

3. SASARAN /YANG DITEMUI : Sasaran yang ditemui dalam kegiatan ini adalah :

1) Nama Bayi/Balita :

2) Nama Ibu Bayi/Balita :

3) Nama Ayah Bayi/Balita :

4. TEMPAT DAN WAKTU : Desa..................................., / / 2018

5. HASIL KEGIATAN : Adapun hasil kegiatan yang diperoleh antara lain :

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6. PENUTUP / KESIMPULAN.
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……………………………….., / /2018

MENGETAHUI
Kepala Puskesmas Mangulewa Yang Melaksanakan Tugas,

ANGELA MERICI BHOKI 1. ...................................

NIP. 19780110 200012 2 005