PEMERINTAH KABUPATEN MALANG
DINAS KESEHATAN
UPT PUSKESMAS AMPELGADING
Jalan Raya Tirtomarto No. 75 Ampelgading Telp: (0341) 851076
Email : pkm.ampelgading1@[Link]
MALANG – 65183
KEPUTUSAN KEPALA UPT PUSKESMAS AMPELGADING
NOMOR : 440/ /KEP/[Link]/2018
TENTANG
.............................................................................................
DENGAN RAHMAT TUHAN YANG MAHA ESA
KEPALA UPT PUSKESMAS AMPELGADING,
Menimbang : a. bahwa ..............................................................................................;
b. bahwa ..............................................................................................;
c. dst.
Mengingat : 1. Undang – Undang Republik Indonesia .........................................;
2. Peraturan Menteri Kesehatan .......................................................;
3. Peraturan Bupati ...........................................................................;
4. dst.
MEMUTUSKAN
Menetapkan : KEPUTUSAN KEPALA UPT PUSKESMAS AMPELGADING
TENTANG ........................................................................................
Kesatu : ...............................................................................................................
Kedua : ...............................................................................................................
Ketiga : dst.
Ditetapkan di : Ampelgading
Pada tanggal : ........................................
KEPALA UPT PUSKESMAS AMPELGADING,
BAYU HANGGA WARDHANA
LAMPIRAN : SURAT KEPUTUSAN KEPALA UPT
PUSKESMAS AMPELGADING
NOMOR : 440/ /KEP/[Link]/2016
TANGGAL : ................................................
TENTANG : ................................................
JUDUL LAMPIRAN
KEPALA UPT PUSKESMAS AMPELGADING,
BAYU HANGGA WARDHANA