Bayi Resti

No Nama / NIP NIP/ NRPTT Pangkat/ Gol.
Ruang Jabatan
1 dr. ANDRI SENTANU 19790716 201001 1 012 Penata, III/c Ka. UPTD Puskesmas
2 H. CECEP MAHPUD,S.Kep,Ns 19760119 199803 1 003 Penata Tk.I/III.D Ka. Sub. Bag. Tata Usaha
3 Hj. NANI IRIYANI,S.St 19620324 198302 2 002 Penata Tk.I/III.D Bidan Muda
4 AHMADI,S.Kep 19670604 198901 1 004 Penata Tk.I/III.D Perawat Penyelia
5 SUKAETI,AM.KG 19670325 198903 2 010 Penata Tk.I/III.D Perawat Gigi Penyelia
6 INA LISTIANA,S.Farm,Apt 19810828 200902 2 008 Penata Tk.I/III.D Apoteker Muda
7 SITI NINGRUM,AMK 19680517 199603 2 002 Penata Tk.I/III.D Perawat Penyelia
8 NIA TARMIATI,AM.Keb 19720202 199203 2 017 Penata Tk.I/III.D Bidan Penyelia
9 SRI BUDIHARTI,AM.Kep 19690612 199503 2 003 Penata Tk.I/III.D Perawat Penyelia
10 ELI MALIAH,AM.Keb 19730402 199301 2 001 Penata Tk.I/III.D Bidan Penyelia
11 RUMIYATI 19670802 199203 2 002 Penata Tk.I/III.D Asisten Apoteker Penyelia
12 ONO DARYONO 19620215 198603 1 018 Penata Muda Tk.I/III.B Pelaksana
13 RASMON 19630415 198511 1 003 Penata Muda Tk.I/III.B Pelaksana
14 Hj. RUSMANAH 19651011 198703 2 004 Penata Muda Tk.I/III.B Pelaksana
15 AZIZ NURHAPIZ,SE 19850813 201001 1 002 Penata Muda Tk.I/III.B Pelaksana
16 drg. WAN PAHLAWAN 198660228 201409 1 001 Penata Muda Tk.I/III.B Dokter Gigi
17 dr. PUTRI AJENG AYU LARASATI 19870630 201409 2 001 Penata Muda Tk.I/III.B Dokter Pertama
18 dr. HUSNU FAJRI FIDYANI 19860508 201409 2 001 Penata Muda Tk.I/III.B Dokter Pertama
19 SUSILAWATI,S.Kep,Ns 19810416 200604 2 010 Penata Muda Tk.I/III.B Perawat Pertama
20 ENDANG MULYANA,S.Kep,Ns 19790831 200312 1 005 Penata Muda Tk.I/III.B Perawat Pertama
21 DODI TATANG,S.Kep,Ns 19800928 200701 1 004 Penata Muda Tk.I/III.B Perawat Pertama
22 A'IM NUR INDAH,AMd.Kep 19750101 199803 2 004 Penata Muda Tk.I/III.B Perawat Pelaksana Lanjutan
Sanitarian Pelaksana
23 Penata Muda Tk.I/III.B
YAYAT NURHAYATI,SKM 19760201 200604 2 006 Lanjutan
24 SRI RAHAYU,AM.Keb 19751217 200501 2 004 Penata Muda, III/a Bidan Pelaksana
25 YENI HERAWATI,AM.Keb 19760319 200501 2 007 Penata Muda, III/a Bidan Pelaksana Lanjutan
26 ERNA KUSTIANAH,AM.Keb 19720801 200604 2 017 Penata Muda, III/a Bidan Mahir
27 LUSI LUSIYANTI,AMK 19840405 200812 2 002 Penata Muda, III/a Perawat Mahir
28 NURAENI,AM.Keb 19740407 200604 2 005 Penata Muda, III/a Bidan Mahir
29 Hj. KHURAIROH ISNAENI,AM.Keb 19751103 200701 2 006 Penata Muda, III/a Bidan Mahir
30 IKAH SETIAWATI,AM.Keb 19740604 200604 2 006 Penata Muda, III/a Bidan Mahir
31 LYNDA YULIANI,A.Md.Keb 19880715 201101 2 001 Pengatur Tk.I/II.D Bidan Terampil
32 L I L I S,AM.Keb 19730518 200604 2 002 Pengatur Tk.I/II.D Bidan Pelaksana
33 YETI MARYATI,AM.Keb 19840608 201704 2 007 Pengatur, II/c Calon Fungsional Bidan
34 ELSA PUSPITA, AM.Keb 19870203 201704 2 002 Pengatur, II/c Calon Fungsional Bidan
35 RIKA DIANI RAHAYU,AM.Keb 19830226 201704 2 001 Pengatur, II/c Calon Fungsional Bidan
36 YULI YULIATIN,AMKeb 19851026 201704 2 001 Pengatur, II/c Calon Fungsional Bidan
37 Tatin Rahmawati,AM.Keb 19861129 201704 2 004 Pengatur, II/c Calon Fungsional Bidan
38 N. Sri Setia Nurasih,AM.Keb 19840923 201704 2 001 Pengatur, II/c Calon Fungsional Bidan
39 RIKA ROSTIKA,AM.Kep 19800820 201409 2 001 Pengatur/ II.C Perawat Terampil
40 JOJO RAHARJO 19720623 200701 1 009 Pengatur/ II.C Pelaksana
41 OON KUSTINI 19791004 201001 2 001 Pengatur Muda Tk.I/II.B Pelaksana
42 HILDAYATI SAMSU 19820321 201409 2 002 Pengatur Muda/ II.A Pelaksana Keperawatan
43 LATIFAH 19790829 201409 2 001 Pengatur Muda/ II.A Calon Fungsional Perawat
44 YAYU SETIAYU,AM.Keb 10.4.048.3959 Pelk. Kebidanan
45 YULIASTRI,AM.Keb 6114 19870719 1 001 Pelk. Kebidanan
46 EMA MEIDA,AM.Keb 873.32.10.11.0646 Pelk. Kebidanan
47 RENA SARI,AM.Keb 873.32.10.11.0663 Pelk. Kebidanan
48 RENI TRISNAWATI,AM.Keb 873.32.10.09.0168 Pelk. Kebidanan
49 SRI MULYAWATI,AM.Keb 873.32.10.10.0488 Pelk. Kebidanan
50 INA RHOTULLAELI,AM.Keb 873.32.10.11.0653 Pelk. Kebidanan
51 ALFIAH AFIFIANTI,AMd 873.32.08.14.3.021 Analis
52 KOMARUDIN - Kategori II Sopir
53 DUDI NURSIDIN,AM.Kep - Magang Pelk. Keperawatan
54 EKA SUSIYANTI,AM.Kep - Magang Pelk. Keperawatan
55 SUDARYANTI,AM.KG - Magang Perawat Gigi
56 DEDEN,AM.Kep - Magang Pelk. Keperawatan
57 YAYAH KODARIYAH,AM.Kep - Magang Pelk. Keperawatan
58 YANTI HERYANTI,S.Kep - Magang Pelk. Keperawatan
59 DILY SUNARJO,AM.Kep - Magang Pelk. Keperawatan
60 LINA ,AM.Keb - Magang Pelk. Kebidanan
61 ULFAH YULIANDINI,AM.Keb - Magang Pelk. Kebidanan
62 HANA NOOR FITRIANI,AM.Keb - Magang Pelk. Kebidanan
63 IKA SITI ROHMAH,AM.Keb - Magang Pelk. Kebidanan
64 DITA PUSPITA DEWI,AMd - Magang Pelk. Gizi
65 EMA MAULINA,AMd.Keb - Magang Pelk. Kebidanan
66 MEYSIN,AM.Keb Magang Pelk. Kebidanan
67 INA Magang Pelk. Kebidanan
68 IIP Magang Pelk. Keperawatan
69 DESI Magang Pelaksana
70 RATNA KOMALADEWI Magang Pelaksana
71 TRIA Pelk. Kebidanan
72 ERMA Pelk. Kebidanan
73 DEDE RISWANTO Sopir
74 ALI Pet. Kebersihan
75 Somantri Pet. Keamanan
76 IIM Pet. Kebersihan
77 MURTIRAH Juru Masak
78 GISKA Pelk. Keperawatan
PEMERINTAH KABUPATEN KUNINGAN
DINAS KESEHATAN
UPTD PUSKESMAS DTP DARMA
Jln. Raya Darma No. 01 Telp. (0232) 8880188 Kec. Darma
Kode Pos 45562
SURAT PERINTAH TUGAS

Nomor : 820/ /V/Pkm Drm
Dasar : 1. Peraturan Menteri Keuangan RI Nomor 113/PMK.05/2012 Tentang

Perjalanan Dinas Dalam Negeri bagi Pejabat Negara, Pegawai Negeri
dan Pegawai Tidak Tetap ;
Peraturan Menteri Kesehatan RI Nomor 61 Tahun 2017 Tentang

Petunjuk Teknis DAK Non Fisik bidang Kesehatan Tahun Anggaran
2018 ;
2.
RKA - DPA kegiatan DAK Non Fisik Bantuan Operasional Kesehatan
Tahun Anggaran 2018 Puskesmas DTP Darma ;
3.
MEMERINTAHKAN
Kepada : Yang tercantum dalam Lampiran Surat Perintah Tugas ini ;
Melaksanakan kegiatan Pemantauan Bayi resti ke Desa Bakom

Untuk :
Lamanya : 1 (Satu ) Hari
Tanggal : 2 Mei 2018
Pembiayaan perjalanan dibebankan pada Anggaran Kegiatan DAK Non Fisik Bantuan Operasional
Kesehatan Tahun Anggaran 2018 Puskesmas DTP Darma Nomor rekening 1.01.02.1.01.02.01.21.40
5.2.2.03.42
Ditetapkan di : Darma
Pada tanggal : 1 Mei 2018
Kepala UPTD Puskesmas DTP
Kecamatan Darma
dr. ANDRI SENTANU

NIP. 19790716 201001 1 012
Tembusan :
1. Bupati dan Wakil Bupati Kuningan ;
2. Kepala Dinas Kesehatan Kabupaten Kuningan ;
3. PPTK Kegiatan DAK Non Fisik Bantuan Operasional Kesehatan Th. 2018
Melaksanakan Kunjungan PUS tidak ber KB ke Desa Cageur
Melaksanakan Kunjungan PUS tidak ber KB ke Desa Sukarasa
LAMPIRAN I : SURAT PERINTAH TUGAS
Dafar Nama Petugas untuk

UPTD Puskesmas Darma
No Nama/ NIP Pangkat/ Golongan Tujuan/ Desa Tanggal

dr. HUSNU FAJRI FIDYANI Penata Muda Karangsari dan
1 ###
19860508 201409 2 001 Tk.I/III.B Kawahmanuk
NURAENI,AM.Keb Karangsari dan
2 Penata Muda, III/a ###
19740407 200604 2 005 Kawahmanuk

Kecamatan Darma
dr. ANDRI SENTANU

NIP. 19790716 201001 1 012
LAMPIRAN I : SURAT PERINTAH TUGAS
Dafar Nama Petugas untuk

Melaksanakan Kunjungan PUS tidak ber KB ke Desa Sukarasa
UPTD Puskesmas Darma
No Nama/ NIP Pangkat/ Golongan Tujuan/ Desa Tanggal

dr. HUSNU FAJRI FIDYANI Penata Muda
1 Sukarasa ###
19860508 201409 2 001 Tk.I/III.B
EMA MEIDA,AM.Keb
2 - Sukarasa ###
873.32.10.11.0646
LAMPIRAN II :
FORM BUKTI KEHADIRAN PELAKSANAAN PERJALANAN DINAS JABATAN

DALAM KOTA SAMPAI DENGAN 8 (DELAPAN) JAM
Pejabat/ Petugas yang mengesahkan

No Pelaksana SPD Hari Tanggal
Tanda tangan
1 dr. HUSNU FAJRI FIDYANI Kepala Desa Karangsari
2 NURAENI,AM.Keb Jum'at 6 April 2018
NANA SUMARJANA
1 dr. HUSNU FAJRI FIDYANI Kepala Desa Kawahmanuk
Sabtu 7 April 2018

2 NURAENI,AM.Keb
JEJE SUDRAJAT
Darma, 7 April 2018

Kepala UPTD Puskesmas DTP Darma
dr. ANDRI SENTANU

NIP. 19790716 201001 1 012
LAMPIRAN II :

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa parung, Kawahmanuk

Jabatan Tanda tangan
1 dr. HUSNU FAJRI FIDYANI
15 JANUARI
Senin Kepala Desa Parung
2018
Osa Maliki
Sabtu 20 JANUARI Kepala Desa

2018 Kawahmanuk
Jeje Sudrajat
Darma,20 Januari 2018

dr. ANDRI SENTANU

NIP. 19790716 201001 1 012
LAMPIRAN II :

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa parung, Kawahmanuk

Jabatan Tanda tangan
1 dr. HUSNU FAJRI FIDYANI
22 JANUARI Kepala Desa

Senin
2018 Cipasung
Nanang
Nuryadi,S.Ag
23 JANUARI Kepala Desa Sakerta

Selasa 2018 Barat
H.Ridwan Fauzi
24 JANUARI Kepala Desa Sakerta

Rabu
2018 Timur
Cucu Sudrajata
Darma,24 Januari 2018

dr. ANDRI SENTANU

NIP. 19790716 201001 1 012
z
DINAS KESEHATAN
Kode Pos 45562
LAPORAN
1. Dasar : Surat Tugas dari Kepala UPTD Puskesmas DTP Darma

Nomor : 820/ /V/Pkm Drm Tanggal 5 April 2018
2. Tujuan Kunjungan/ Rapat Melaksanakan kegiatan Pemantauan Bayi resti ke Desa

Karangsari
:
3. Hasil Kunjungan/ Rapat :
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
4. Kesimpulan/ Saran
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
Pejabat/ Petugas yang ditemui Darma, 06 April 2018

Pelapor,
NANA SUMARJANA NURAENI,AM.Keb

NIP 19740407 200604 2 005
dr. ANDRI SENTANU

NIP. 19790716 201001 1 012
DINAS KESEHATAN
Kode Pos 45562
LAPORAN

Nomor : 820/ /V/Pkm Drm Tanggal 13 Januari 2018
2. Tujuan Kunjungan/ Rapat :
Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa Parung

..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
Pejabat/ Petugas yang ditemui Darma, ###

Pelapor,
Osa maliki NURAENI,AM.Keb

NIP. 19740407 200604 2 005

Kecamatan Darma
dr. ANDRI SENTANU

NIP. 19790716 201001 1 012
DINAS KESEHATAN
Kode Pos 45562
LAPORAN

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa

Kawahmanuk
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
Pejabat/ Petugas yang ditemui Darma, 20 Januari 2018

Pelapor,
Jeje Sudrajat NURAENI,AM.Keb

NIP. 19740407 200604 2 005

Kecamatan Darma
dr. ANDRI SENTANU

NIP. 19790716 201001 1 012
DINAS KESEHATAN
Kode Pos 45562
LAPORAN

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa Cipasung

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

Pelapor,
Nanag Nuryadi,S.Ag NURAENI,AM.Keb

NIP. 19740407 200604 2 005

Kecamatan Darma
dr. ANDRI SENTANU
NIP. 19790716 201001 1 012

DINAS KESEHATAN
Kode Pos 45562
LAPORAN

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa Sakerta

Barat
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................

Pelapor,
H.Ridwan Fauzi NURAENI,AM.Keb

NIP. 19740407 200604 2 005

Kecamatan Darma
dr. ANDRI SENTANU
NIP. 19790716 201001 1 012

DINAS KESEHATAN
Kode Pos 45562
LAPORAN

2. Tujuan Kunjungan/ Rapat : Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa Sakerta

timur
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
Pejabat/ Petugas yang ditemui Pelapor, 24 Januari 2018

Pelapor,
Cucu Sudrajat NURAENI,AM.Keb

NIP. 19740407 200604 2 005

Kecamatan Darma
dr. ANDRI SENTANU
NIP. 19790716 201001 1 012
Melaksanakan kegiatan Pemantauan Bayi resti ke Desa Karangsari dan K
Melaksanakan kegiatan Pemantauan Bayi resti ke Desa Karangsari

Melaksanakan kegiatan Pemantauan Bayi resti ke Desa Kawahmanuk
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resti ke Desa Karangsari dan Kawahmanuk
resti ke Desa Karangsari

resti ke Desa Kawahmanuk

Bayi Resti

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No Nama / NIP NIP/ NRPTT Pangkat/ Gol.

SURAT PERINTAH TUGAS

Dasar : 1. Peraturan Menteri Keuangan RI Nomor 113/PMK.05/2012 Tentang

Peraturan Menteri Kesehatan RI Nomor 61 Tahun 2017 Tentang

Kepada : Yang tercantum dalam Lampiran Surat Perintah Tugas ini ;

Melaksanakan kegiatan Pemantauan Bayi resti ke Desa Bakom

Lamanya : 1 (Satu ) Hari

Tanggal : 2 Mei 2018

dr. ANDRI SENTANU

Dafar Nama Petugas untuk

No Nama/ NIP Pangkat/ Golongan Tujuan/ Desa Tanggal

Kepala UPTD Puskesmas DTP

dr. ANDRI SENTANU

Dafar Nama Petugas untuk

No Nama/ NIP Pangkat/ Golongan Tujuan/ Desa Tanggal

FORM BUKTI KEHADIRAN PELAKSANAAN PERJALANAN DINAS JABATAN

Pejabat/ Petugas yang mengesahkan

2 NURAENI,AM.Keb Jum'at 6 April 2018

Sabtu 7 April 2018

Darma, 7 April 2018

dr. ANDRI SENTANU

FORM BUKTI KEHADIRAN PELAKSANAAN PERJALANAN DINAS JABATAN

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa parung, Kawahmanuk

Pejabat/ Petugas yang mengesahkan

Sabtu 20 JANUARI Kepala Desa

Darma,20 Januari 2018

dr. ANDRI SENTANU

FORM BUKTI KEHADIRAN PELAKSANAAN PERJALANAN DINAS JABATAN

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa parung, Kawahmanuk

Pejabat/ Petugas yang mengesahkan

22 JANUARI Kepala Desa

23 JANUARI Kepala Desa Sakerta

24 JANUARI Kepala Desa Sakerta

Darma,24 Januari 2018

dr. ANDRI SENTANU

1. Dasar : Surat Tugas dari Kepala UPTD Puskesmas DTP Darma

2. Tujuan Kunjungan/ Rapat Melaksanakan kegiatan Pemantauan Bayi resti ke Desa

3. Hasil Kunjungan/ Rapat :

Pejabat/ Petugas yang ditemui Darma, 06 April 2018

NANA SUMARJANA NURAENI,AM.Keb

Kepala UPTD Puskesmas DTP Darma

dr. ANDRI SENTANU

1. Dasar : Surat Tugas dari Kepala UPTD Puskesmas DTP Darma

2. Tujuan Kunjungan/ Rapat :

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa Parung

Pejabat/ Petugas yang ditemui Darma, ###

Osa maliki NURAENI,AM.Keb

Kepala UPTD Puskesmas DTP

dr. ANDRI SENTANU

1. Dasar : Surat Tugas dari Kepala UPTD Puskesmas DTP Darma

2. Tujuan Kunjungan/ Rapat :

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa

Pejabat/ Petugas yang ditemui Darma, 20 Januari 2018

Jeje Sudrajat NURAENI,AM.Keb

Kepala UPTD Puskesmas DTP

dr. ANDRI SENTANU

1. Dasar : Surat Tugas dari Kepala UPTD Puskesmas DTP Darma

2. Tujuan Kunjungan/ Rapat :

Melaksanakan KegiatanPelaksanaan Kelas Ibu ke Desa Cipasung

Pejabat/ Petugas yang ditemui Darma, 22 Januari 2018

Nanag Nuryadi,S.Ag NURAENI,AM.Keb

Kepala UPTD Puskesmas DTP

PEMERINTAH KABUPATEN KUNINGAN