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  • Akreditasi BAB I

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    Akreditasi BAB I

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    Akreditasi BAB I

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views4 pages

    Akreditasi BAB I

    Uploaded by

    rahma chibok
    Akreditasi BAB I

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 4

    SURVEY KEBUTUHAN MASYARAKAT DIWILAYAH KERJA

    DINAS KESEHATAN
    PUSKESMAS BONTONOMPO II
    TAHUN 2016
    A. DATA RESPONDEN
    1. Nama Responden
    :
    2. Umur
    :.
    3. Jenis kelamin
    :
    4. Pendidikan terakhir
    :
    5. Pekerjaan
    :
    6. Status Perkawinan
    :
    7. Alamat
    :
    8. Tanda tangan
    : ..
    B. KEBUTUHAN PELAYANAN
    No.

    Jenis Pelayanan

    1 Pelayanan pengobatan umum


    2 pelayanan pengobatan gigi
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16

    DIBUTUHKAN

    TIDAK DIBUTUHKAN

    17
    18
    19
    20
    21
    22
    23
    24
    25
    26
    27
    28
    29
    30

    H KERJA

    KETERANGAN

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