PEMERINTAH KABUPATEN KARAWANG

DINAS KESEHATAN
UPTD PUSKESMAS DTP TIRTAJAYA
Jl. Raya Pisanngsambo – Desa Sabajaya - Kecamatan Tirtajaya - Kabupaten Karawang
E-Mail : pkmtirtajaya@gmail.com Kode Pos 41357

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : Surat Tugas Kepala Puskesmas Tirtajaya No.440/ -

BOK/PKM.TJ/ /2023
2. Nama Petugas / Tim : .....................................................................................................
3. Tujuan Perjalanan : DESA PISANGSAMBO
4. Maksud Perjalanan : Kunjungan rumah bumil anemia, KEK, balita gizi buruk, stunting
Dan obesitas, masalah gizi dan BBLR
5. Tanggal Perjalanan : .....................................................................................................
6. Hasil Kegiatan, antara lain
a. .......................................................................................................................................
b. .......................................................................................................................................
c. .......................................................................................................................................
7. Kesimpulan / Saran Perbaikan
a. .......................................................................................................................................
b. .......................................................................................................................................
c. .......................................................................................................................................

Tirtajaya,......................................2023
Lokasi yang Dikunjungi Pelapor

................................................... Hj. ADE HERAWATI, AM. KEB

NIP : 19780501 200604 2 005