Lampiran 11 - FORMAT SOP Fix

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PELAYANAN PUSKESMAS

No. Dokumen : SOP/ADM.KEU/01/2020

No. Revisi : 00
SOP
Tanggal Terbit : ……………….
Halaman : 1 dari 5
UPT
PUSKESMAS TTD Kapus
SUMBERSARI & Cap Stempel
1.Pengertian …………………………………………………………..……………………
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2.Tujuan …………………………………………………………..……………………
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3. Kebijakan …………………………………………………………..……………………
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4. Referensi …………………………………………………………..……………………
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5. Alat dan …………………………………………………………..……………………
Bahan …………………………………………………………..……………………
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6. Langkah - …………………………………………………………..……………………
Langkah …………………………………………………………..……………………
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7. Bagan Alir Bila diperlukan

8. Unit Terkait …………………………………………………………..……………………

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9. Dokumen …………………………………………………………..……………………
Terkait …………………………………………………………..……………………
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10. Rekaman Histori Perubahan

Tanggal Mulai
No Yang Dirubah Isi Perubahan
Diberlakukan
PELAYANAN PUSKESMAS
UPT No. Dokumen : ……………..
PUSKESMAS
No. Revisi : 00
SUMBERSARI SOP
Tanggal Terbit : ………….
Halaman : 2 dari 5

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