Uploaded by novarevika13

form instrumen kaji banding

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Format instrument kaji banding
NamaPuskesmas
:……………………………
Mitrakajibanding
:
1. Puskesmas……………………
2. Puskesmas……………………
Lingkupkajibanding
:…………………………….
Waktupelaksanaan
:…………………………….
Petugas yang melaksanakan:……………………………
N
o
DaftarPertanyaan/Ob
servasi
Standar
(yang
seharusn
ya)
Capaian/fak
ta di
puskesmass
aya
Capaian/fakt
a di
Puskesmasm
itra 1
Capaian/fakt Kesenjan
a di
gan
Puskesmasm
itra 2
Sebabterjadikesenj
angan
Rencanatindakl
anjut
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