Ep7a. Perijinan Alat.docx
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PEMERINTAH KABUPATEN ......................... LOGO PEMKAB.
DINAS KESEHATAN UPTD PUSKESMAS ....................................... Alamat : ..........................................................
DAFTAR PERIJINAN PERALATAN MEDIS DAN NON MEDIS UNIT PELAYANAN ..................................... PUSKESMAS ................ No
Nama Alat
Peruntukan Alat
Spesifikasi Alat
Perijinan Alat Nomor/Tanggal
................., ....................2015 Kepala Puskesmas....... .................................... NIP. ..........................
Pemberi Ijin Alat
DINAS KESEHATAN UPTD PUSKESMAS ....................................... Alamat : ..........................................................
DAFTAR PERIJINAN PERALATAN MEDIS DAN NON MEDIS UNIT PELAYANAN ..................................... PUSKESMAS ................ No
Nama Alat
Peruntukan Alat
Spesifikasi Alat
Perijinan Alat Nomor/Tanggal
................., ....................2015 Kepala Puskesmas....... .................................... NIP. ..........................
Pemberi Ijin Alat
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