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  • Lembaran Pemeriksaan Izin

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    Jonrar Jono
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    This document is a checklist for licensing requirements. It lists various types of licenses that can be issued, including licenses for doctors, pharmacists, midwives, nurses, opticians, and various healthcare facilities. For each license type, there are requirements that must be met. The document requires signatures from heads of departments and sections to approve the license. It is dated and signed by the head of the local health department.

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    This document is a checklist for licensing requirements. It lists various types of licenses that can be issued, including licenses for doctors, pharmacists, midwives, nurses, opticians, and various healthcare facilities. For each license type, there are requirements that must be met. The document requires signatures from heads of departments and sections to approve the license. It is dated and signed by the head of the local health department.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    17 views1 page

    Lembaran Pemeriksaan Izin

    Uploaded by

    Jonrar Jono
    This document is a checklist for licensing requirements. It lists various types of licenses that can be issued, including licenses for doctors, pharmacists, midwives, nurses, opticians, and various healthcare facilities. For each license type, there are requirements that must be met. The document requires signatures from heads of departments and sections to approve the license. It is dated and signed by the head of the local health department.

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    © All Rights Reserved
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    of 1

    LEMBARAN PEMERIKSAAN

    NAMA :……………………………………………….. STATUS PERIZINAN : BARU / PERPANJANG

    1. JENIS IZIN
    a. Surat Izin Praktek Dokter g. Surat Izin Apotik
    b. Surat Izin Praktek Apoteker h. Surat Izin Toko Obat
    c. Surat izin Praktek Bidan i. Surat Izin Klinik
    d. Surat Izin Praktek Perawat j. Surat izin Rumah Sakit
    e. Surat Izin Kerja Refraksionis Optisien (SIKRO) k. Surat Izin Optik
    f. Surat Izin Kerja Tenaga Kefarmasian (SIKTTK) l. Surat Izin UMOT
    m. Surat Izin PIRT
    n. ______________________________________________

    2. PERSYARATAN
    a. …………………………………………………………………………………………………………………………………..
    b. …………………………………………………………………………………………………………………………………..
    c. …………………………………………………………………………………………………………………………………..
    d. …………………………………………………………………………………………………………………………………..
    e. …………………………………………………………………………………………………………………………………..
    f. …………………………………………………………………………………………………………………………………..
    g. …………………………………………………………………………………………………………………………………..
    h. …………………………………………………………………………………………………………………………………..
    i. …………………………………………………………………………………………………………………………………..
    j. …………………………………………………………………………………………………………………………………..
    k. …………………………………………………………………………………………………………………………………..
    l. …………………………………………………………………………………………………………………………………..
    m. …………………………………………………………………………………………………………………………………..
    n. …………………………………………………………………………………………………………………………………..

    3. PARAF PERSETUJUAN
    No. NAMA JABATAN PARAF
    1. Johnison Rarsina S.Si.,Apt.,MM Kepala Bidang
    2. Daniel Pattirosamal.,SKM Kepala Seksi
    3. Anita Sahetapy.,Am.Kep Petugas Verifikasi
    4. Marlen Rumakuttile Petugas Informasi

    Piru, ______ ______________________ ___________


    Mengetahui ,
    KEPALA DINAS KESEHATAN

    dr. YOHANIS TAPPANG, M.Kes


    PEMBINA TK.I
    NIP. 196512252000121003

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