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LAPORAN HASIL PEMANTAUAN

PELAKSANAAN KEGIATAN UKM

Nama kegiatan yang di pantau :


Tempat kegiatan yang di pantau :
Jadwal Pemantauan :
Petugas Pemantauan :

Jadwal kegiatan terlaksana sesuai dengan jadwal yang direncanakan? 1. Ya 2. Tidak

Permasalahan/kendala yang ditemui selama kegiatan berlangsung


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Penyebab terjadinya permasalahan/ kendala selama kegiatan berlangsung


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Mengetahui Penanggung Jawab UKM Koordinator Program


Kepala UPTD Puskesmas….

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NIP. NIP. NIP.

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