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  • Formulir Bukti Fisik Pelaksanaan Kegiatan

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    2 views11 pages

    Formulir Bukti Fisik Pelaksanaan Kegiatan

    Uploaded by

    dewi milawati

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 11

    FORMULIR BUKTI FISIK PELAKSANAAN KEGIATAN

    1)Kinerja Profesional
    a. Pelayanan KB
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN

    Mengetahui Wonogiri,
    Verifikator Bidan

    …………………………………………………. Sri Mulyanti, Amd.Keb


    b. Peelayanan Ibu Bersalin (Partograf)
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN

    Mengetahui Wonogiri,
    Verifikator Bidan

    …………………………………………………. Sri Mulyanti, Amd.Keb


    c. Pelayanan Ibu Nifas
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN

    Mengetahui Wonogiri,
    Verifikator Bidan

    …………………………………………………. Sri Mulyanti, Amd.Keb


    d. Pelayanan BBL, Balita, Imunisasi
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN

    Mengetahui Wonogiri,
    Verifikator Bidan

    …………………………………………………. Sri Mulyanti, Amd.Keb


    e. Pelayanan ANC
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN
    NO TANGGAL IDENTITAS ALAMAT SUBJEKTIF OBJEKTIF ANALISA PENATALAKSANAAN

    Mengetahui Wonogiri,
    Verifikator Bidan

    …………………………………………………. Sri Mulyanti, Amd.Keb

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