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PEMERINTAH KOTA PEKANBARU DINAS KESEHATAN Jalan melur No. 103Telepon (0761) 23213 PEKANBARU Nomor : Lembar ke : SURAT PERINTAH PERJALANAN DIN
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   EMERINTAH KOTA EKANBARUDINAS KESEHATAN  Jalan melur No. 103Telepon (0!1 #3#13  EKANBARU  Nomor:Lembar ke: SURAT PERINTAH PERJALANAN DINAS( S P P D ) 1.Pejabat yang memberi Perintah: Plt. KEPALA DINAS KESEHATAN KOTA PEKANBARU 2.Nama/NIP Pegawai yang diperintah mengadakan Perjalanan Dinas:A!INA A#$ / 1%&'12'2 2''('2 2 '')).a.*abatan b.Pangkat/+olongan::Perawat #ahir Penata #,da -k. I / III b.Perjalanan Dinas yang diperintahkan:Dari : P-D P,skesmas 0ail(.-ransportasi yang dig,nakan:Darat.Perjalanan Dinas yang direnanakan:-anggal / -empat : 1.3.#aks,d mengadakan Perjalanan:1. $egiatan Pembinaan Posyand, 4Administrasi Penatatan danPelaporan5&.Perhit,ngan 6iaya Perjalanan:Atas beban: AP6D $ota Pekanbar, 4 DA$ N7N 8I0I$ 5$ode !ekening: %.$eterangan: Pekanbar, 2'1& Plt. $9PALA DINA0 $909A-AN $7-A P9$AN6A! Dr . ZAINI RIZALDY. SNip.1972!1 2212 1 !  KETERANGAN I. DA!I P9*A6A- ;AN+ #9#69!I P9!IN-A : TempatKedudukanPegawai yangdiberi PerintahBerangkatKembaliTanggalTanda tanganTanggalTanda tangan PUSKESMAS SAIL Dr . ZAINI RIZALDY. S19720610 200212 1 006Dr . ZAINI RIZALDY. S19720610 200212 1 006 II. DA!I P9*A6A- DI DA9!A P9N+A0AN ;AN+ DI$N*N+I : Tempat tujuanBerangkatKembaliTanggalTanda tangan LurahTanggalTanda tangan Lurah   Pekanbar, 2'1&Plt. $9PALA DINA0 $909A-AN $7-A P9$AN6A!   Dr . ZAINI RIZALDY. S Nip.1972!1 2212 1 ! LAPORAN PERJALANAN DINAS  KEPADA YTH : Plt. $9PALA DINA0 $909A-AN $7-A P9$AN6A! DARI : A!INA A#$  TAN AL : .................................................................................. PERIHAL : $egiatan Pembinaan Posyand, 4Administrasi Penatatan dan Pelaporan 5 I. DASAR  a.0P- Nomor :  b.DPA No.: II.#AKTU DAN TE$PAT ..................................................................................................................................................................................................................................................................................................................... III.HASIL PELAKSANAAN KE IATAN ..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Demikian Laporan ini disampaikan kepada Ib, ,nt,k dapat menjadi Periksa.Pekanbar, 2'1&;ang #elapor ............................................ Nama/Instansi yang dik,nj,ngi D/a. *l<<<<<...........   EMERINTAH KOTA EKANBARU   DINAS KESEHATAN Jalan melur No. 103 Telepon (0!1 #3#13  EKANBARU SURAT PERINTAH TU AS  Nomor : -anggal : ;ang bertanda tangan dibawah ini memberikan t,gas kepada : NoNama+ol-gl Perjalanan-empat -,j,an1.A!INA A#$III b2& April 2'1&!,mah 0akit AINA6#aks,d Perjalanan : Perjalanan dinas dalam rangka $egiatan 0A!0 40,r=eilens Akti> !,mah 0akit5.  Pembiayaan perjalanan dibebankan pada : Dana 6ant,an 7perasional $esehatan 4 67$ DA$ N7N 8I0I$ 5 -A 2'1&.Demikian s,rat t,gas ini dib,at ,nt,k dapat dilaksanakan sebaik?baiknya. Plt. $9PALA DINA0 $909A-AN $7-A P9$AN6A! Dr. AINI !IALD;. 0 P9#6INA NIP. 1%32'1' 2''212 1 ''
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