DINAS KESEHATAN KOTA BANDAR LAMPUNG

PUSKESMAS RAJA BASA INDAH

Jl. Pramuka No. 1 Rajabasa Telp ( 0721 ) 8011767

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : SPT Ka. Puskesmas No……………………….Tanggal……………………………………
2. Nama Petugas / Tim : 1. ………………………………………………………………………………………………….
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3. Tujuan Perjalanan : …………………………………………………………………………………………………………..
4. Tanggal Perjalanan : …………………………………………………………………………………………………………..
5. Maksud Perjalanan : …………………………………………………………………………………………………………..
6. Hasil kunjungan,antara lain :
a. Pengkajian Keperawatan keluarga/individu
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b. Diagnosa Keperawatan
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c. Intervensi / Implementasi Keperawatan
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Evaluasi Keperawatan
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Bandar Lampung,…………………………………….
Pelapor :
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