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LAPORAN PERJALANAN DINAS

KEPADA YTH : KEPALA PUSKESMAS REJOSARI KOTA PEKANBARU


DARI : ...................................................................... ......................................
TANGGAL : ............................................................................................................
PERIHAL : .............................................................................................................

I. DASAR
a. PMK No 42 Tahun 2022 tentang Petunjuk Teknis penggunaan dana DAK Non
Fisik bidang kesehatan TA 2023
b. Surat Perintah Tugas Nomor : 905/PKM-R/……/2023
c. DPA PUSKESMAS No. 1.02.0.00.0.00.01.0009.1.02.02.1.02.02.2.02.1.02.02.2.02.33 TA. 2023.
II. WAKTU DAN TEMPAT
Waktu : Pukul….....................................................................................................................

Tempat : ...........................................................................................................................

III. MANFAAT & TUJUAN KEGIATAN


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IV. URAIAN KEGIATAN
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V. REKOMENDASI / RENCANA TINDAK LANJUT


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Demikian Laporan ini disampaikan untuk dapat menjadi Periksa.

Pekanbaru, 2023

Yang Melapor,

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