LEMBAR MONITORING DAN ANALISIS HASIL CAKUPAN PROGRAM UKM

OLEH KEPALA PUSKESMAS DAN PENANGGUNG JAWAB UKM KEPADA PELAKSANA PROGRAM
UPT PUSKESMAS CANGKOL

PROGRAM : Diare
BULAN / TAHUN : Januari 2018

1. HASIL KEGIATAN
TARGET TARGET sd CAPAIAN BULAN CAPAIAN BULAN CAPAIAN sd KETERANGAN
TAHUNAN BULAN INI LALU INI BULAN INI
NO INDIKATOR PROGRAM
Sasaran % Absolut % Absolut % Absolut % Absolut % Tercapai/ RW yang belum mencapai
Tidak target

2. ANALISIS HASIL CAKUPAN

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3. RENCANA TINDAK LANJUT

NO KEGIATAN SASARAN WAKTU TEMPAT KETERANGAN
4. REKOMENDASI PJ UKM
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5. REKOMENDASI KEPALA PUSKESMAS
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Mengetahui, Cirebon ,02 Februari 2018

Kepala UPT Puskesmas Cangkol Penanggung Jawab UKM Esensial dan Perkesmas Pelaksana Program

dr. Nurhidayat .............................. Ahmad Syafii

NIP. 19690616 200701 1 017 NIP. ....................... NIP. 19781010 200501 1 015