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KEMENTERIAN HUKUM DAN HAK ASASI MANUSIA

REPUBLIK INDONESIA
RUMAH SAKIT UMUM PENGAYOMAN CIPINANG
Jalan Raya Bekasi Timur No. 170 B, Jatinegara, Jakarta Timur
Telepon (021) 21015599, Faksimile (021) 85914558
Email : rspengayoman.dki@gmail.com

DAFTAR HADIR PENGAJIAN PASIEN WBP

Hari/ Tanggal :………………, ………………………..


Waktu :……………..WIB s.d. ….................WIB
Tempat :………………………………………….
Nama Ustadz :………………………………………….

No Nama Ruangan Tanda Tangan Keterangan


KEMENTERIAN HUKUM DAN HAK ASASI MANUSIA
REPUBLIK INDONESIA
RUMAH SAKIT UMUM PENGAYOMAN CIPINANG
Jalan Raya Bekasi Timur No. 170 B, Jatinegara, Jakarta Timur
Telepon (021) 21015599, Faksimile (021) 85914558
Email : rspengayoman.dki@gmail.com

NOTULA KEGIATAN PENGAJIAN PASIEN WBP

Hari/ Tanggal :………………, ………………………..


Waktu :……………..WIB s.d. ….................WIB
Tempat :………………………………………….
Peserta : 1. Pasien WBP RSU Pengayoman Cipinang
2. ………………………………………….
3. ……………………………………….....
Tema/ Pembahasan : ……………………………………………………………………………………
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Catatan/ Notula :
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Notulis,

(……………………………….)

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