PEMERINTAH KABUPATEN NGANJUK
DINAS KESEHATAN DAERAH
PUSKESMAS PACE
Jl. Nglirang-Berbek No. 2 KodePos 64472
Email: puskesmaspace@[Link]& Fax. (0358) 322406
KEPUTUSAN KEPALA PUSKESMAS PACE
NOMOR :............................................................
TENTANG
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DENGAN RAHMAT TUHAN YANG MAHA ESA
KEPALA PUSKESMAS PACE,
Menimbang : a. bahwa.....................................................................................
..............................................................................................;
b. bahwa.....................................................................................
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c. dan seterusnya;
Mengingat : 1. Undang-Undang.....................................................................
..............................................................................................;
2. Peraturan Pemerintah............................................................
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3. dan seterusnya;
MEMUTUSKAN :
Menetapkan : Keputusan Kepala Puskesmas Tentang ........................................
KESATU : .......................................................................................................
KEDUA : .......................................................................................................
KETIGA : .......................................................................................................
KEEMPAT : .......................................................................................................
Ditetapkan di :............................
Pada tanggal :............................
Kepala Puskesmas Pace,
dr. Hendriyanto
NIP. 19691108 200312 1 004