format laporan perjalanan dinas

1. PEMERINTAH KABUPATEN MERANGIN
PUSKESMAS MUARA MADRAS
KECAMATAN JANGKAT
Jl : kesehatan No : 03 Kode Pos :37372
LAPORAN PERJALANAN DINAS
Nama/Jabatan : 1. Ns Dodo Pebriansyah S.kep
: 2. Taufik Andar Amd. Ak
Pangkat/Golongan : TKS/NS
Daerah yang di kunjungi : SD Negeri No 22/VI Pulau
Tengah I
Waktu kunjungan : Januari 2017
Masalah/Materi :
Pembinaan dan penyuluhan kesekolah
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Mengetahui
Nama :
Jabatan :
1. Ns Dodo Pebriansyah S.kep .................
2.Taufik Andar Amd.Ak .................