PEMERINTAH KABUPATEN PANDEGLANG
DINAS KESEHATAN
UPT. PUSKESMAS DTP LABUAN
Jl. Jendral Sudirman-Kp. Karabohong, Ds Labuan –Pandeglang
Kode Pos 42264 Telp. (0253) 808723
Email : [Link]@[Link]
LAPORAN PELAKSANAAN PERJALANAN DINAS
Sumber Dana : ……………………………………………………….
Tahun Anggaran : ........................................................2007
Perjalanan Dinas : Tanggal ............................................
Ke ………………………………………………..
Nomor Surat Perintah : 800 / ……. / [Link] / / 2019
Tujuan Perjalanan Dinas : ………………………………………………………………………………
Uraian Laporan
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Mengetahui ;
Kepala UPT Puskesmas DTP Labuan Yang membuat Laporan
1.
Dr.H. R. DAENG SUGANJAR ______________________
NIP. 19660729 199803 1 004 NIP.
2.
______________________
PEMERINTAH KABUPATEN PANDEGLANG
DINAS KESEHATAN
UPT. PUSKESMAS DTP LABUAN
Jl. Jendral Sudirman-Kp. Karabohong, Ds Labuan –Pandeglang
Kode Pos 42264 Telp. (0253) 808723
Email : [Link]@[Link]
P.
LAPORAN PELAKSANAAN PERJALANAN DINAS
Sumber Dana : ……………………………………………………….
Tahun Anggaran : ........................................................2007
Perjalanan Dinas : Tanggal ............................................
Ke …………………………………
Nomor Surat Perintah : 800 / ……. / [Link] / / 2019
Tujuan Perjalanan Dinas : ………………………………………………………………………………
Uraian Laporan
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Labuan, ……………………… 20 …
Yang membuat Laporan
Kecamatan Labuan,
Dr.H. R. DAENG SUGANJAR 1. ______________________
NIP. 19660729 199803 1 004 NIP.
2. ______________________
NIP.
PEMERINTAH KABUPATEN PANDEGLANG
DINAS KESEHATAN
UPT. PUSKESMAS DTP LABUAN
Jl. Jendral Sudirman-Kp. Karabohong, Ds Labuan –Pandeglang
Kode Pos 42264 Telp. (0253) 808723
Email : [Link]@[Link]
3.
LAPORAN PELAKSANAAN PERJALANAN DINAS
Sumber Dana : …………………………………………..
Tahun Anggaran : Tahun 2019
Perjalanan Dinas : Tanggal ........................... 2019
Ke ………………………………………….
Nomor Surat Perintah : 800 / ……. / [Link] / / 2019
Tujuan Perjalanan Dinas : …………………………………………….
Uraian Laporan
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Kepala UPT Puskesmas DTP LABUAN Yang membuat Laporan
Kecamatan Labuan, 1.
Dr.H. R. DAENG SUGANJAR ______________________
NIP. 19660729 199803 1 004 NIP.
2.
______________________
NIP.
3.
______________________
NIP.
PEMERINTAH KABUPATEN PANDEGLANG
DINAS KESEHATAN
UPT. PUSKESMAS DTP LABUAN
Jl. Jendral Sudirman-Kp. Karabohong, Ds Labuan –Pandeglang
Kode Pos 42264 Telp. (0253) 808723
Email : [Link]@[Link]
LAPORAN PELAKSANAAN PERJALANAN DINAS
Sumber Dana : ………………………………………….
Tahun Anggaran : Tahun 2019
Perjalanan Dinas : Tanggal ........................... 2019
Ke ………………………………
Nomor Surat Perintah : 800 / ……. / [Link] / /2019
Tujuan Perjalanan Dinas : ………………………………………………………………………….
Uraian Laporan
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Yang membuat Laporan
Kecamatan Labuan,
1. ______________________
NIP. 19660729 199803 1 004 NIP.
2. ______________________
NIP.
3. ______________________
NIP.
PEMERINTAH KABUPATEN PANDEGLANG
DINAS KESEHATAN
UPT. PUSKESMAS DTP LABUAN
Jl. Jendral Sudirman-Kp. Karabohong, Ds Labuan –Pandeglang
Kode Pos 42264 Telp. (0253) 808723
Email : [Link]@[Link]
3 P.
LAPORAN PELAKSANAAN PERJALANAN DINAS
Sumber Dana : DAK Non Fisik (BOK 2019)
Tahun Anggaran : Tahun 2019
Perjalanan Dinas : Tanggal ........................... 2019
Ke ………………………………
Nomor Surat Perintah : 800 / ……. / [Link] / VIII /2019
Tujuan Perjalanan Dinas : ………………………………………………………………………………
Uraian Laporan
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Labuan, ……………………… 20 .…
Yang membuat Laporan
Kecamatan Labuan,
Dr.H. R. DAENG SUGANJAR 1. ______________________
NIP. 19660729 199803 1 004 NIP.
2. ______________________
NIP.
PEMERINTAH KABUPATEN PANDEGLANG
DINAS KESEHATAN
UPT. PUSKESMAS DTP LABUAN
Jl. Jendral Sudirman-Kp. Karabohong, Ds Labuan –Pandeglang
Kode Pos 42264 Telp. (0253) 808723
Email : [Link]@[Link]
3.