PEMERINTAH KABUPATEN PACITAN

DINAS KESEHATAN
PUSKESMAS WONOKARTO
Jl. Lorok-Ponorogo km 9 Wonokarto, Ngadirojo, Pacitan (63572)
Telp+6281217411941 Email : pkmwonokarto@gmail.com

NOTULEN
NAMA KEGIATAN :......................................................................................................................
HARI/TANGGAL KEGIATAN :......................................................................................................................
JAM KEGIATAN :......................................................................................................................
LOKASI KEGIATAN :......................................................................................................................
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SUSUNAN ACARA : 1. .................................................................................................................
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PIMPINAN KEGIATAN
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PENCATAT :......................................................................................................................
PESERTA :(terlampir dalam daftar hadir)

1. PEMBUKAAN .....................................................................................................................................................
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2. NOTULEN
SEBELUMNYA ...................................................................................................................................................
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3. PEMBAHASAN
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4. DISKUSI
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5. RENCANA TINDAK LANJUT
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Mengetahui,
Plt. Kepala Puskesmas Wonokarto Pelaksana Kegiatan,

dr. DERRY HERDHIMAS ............................................

NIP. 1991 1231 201903 1 011