8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
1/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
S+,AT KEP+T+SAN
KEPALA P+SKESMAS -TP PONTANG
N%m% : 800. / /PKM/201
TENTANG
STAN-A,T PELAYANAN P+LIK P+SKESMAS -TP PONTANG
KEPALA P+SKESMAS -TP PONTANG
: a. a3a !&'!# m$!!6#a& #$a"'ia& '$&'a& 3a# 'a&!& aa #$aia& 6a&
#$$&a&a& "$l!!3 i3a# '$#ai' 6alam $&$l$&aaa& $laa&a& !li# a6a
P!"#$ma" -TP PONTANG 6a& 6alam a&#a m$!!6#a& "i"'$m $&$l$&aaa&
$m$i&'a3a& "$"!ai a9a9a9a9 !m!m $&$l$&aa& #$$m$i&'a3a& a& ai#
'$$&!3i&a 3a#3a# ma"aa#a' 6alam m$m$%l$3 $laa&a& !li# "$*aa ma#"imal
"$'a m$!!6#a& a'i"ia"i 6a& #$'aa'a& ma"aa#a' 6alam m$&i&#a'#a& #!ali'a"
$laa&a& !li# ma#a $l! 6i'$'a#a& "'a&6a $laa&a& !li#.
. a3a !aa m$&i&#a'#a& #!ali'a" $laa&a& !li# "$aaima&a 6ima#"!6 3!!; ama#a $l! 6i'$'a#a& S'a&6a P$laa&a& P!li# P!"#$"ma" -TP PONTANG -i&a"
K$"$3a'a& Ka!a'$& SE,ANG 6alam K$!'!"a& K$ala P!"#$"ma" -TP PONTANG.
: 1. +&6a&+&6a& N%m% 8 Ta3!& 1
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
2/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
. P$a'!a& P$m$i&'a3 ,$!li# I&6%&$"ia N%m% 8 Ta3!& 1
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
3/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
1.= P$laa&a& La%a'%i!m
1.4 P$laa&a& P$m$i#"aa& 6a& Ti&6a#a& Gii
1.5 A%'i#
2. +G- 6a& ,aa' I&a
2.1 +G-
2.2 ,aa' I&a
=. +KM
=.1 P$mi&aa& P%"a&6!
=.2 P!"li&
=.= K$"li&
: S'a&6a' P$laa&a& P!li# "$aaima&a 6ima#"!6 6i#'!m KE-+A 6i$!&a#a& "$aai
a*!a& a& 3a!" 6ila#"a&a#a& %l$3 P$'!a" / Aaa' P!"#$"ma" -TP PONTANG.
: K$!'!"a& i&i $la#! "$a# 'a&al 6i'$'a#a& 6a& aaila 6i#$m!6ia& 3ai '$6aa'
#$"ala3a& 6alam #$!'!"a& i&i a#a& 6ia6a#a& $ai#a& "$aaima&a m$"'i&a.
Ditetapkan di : DTP PONTANG
Pada tanggal : 24 Desember 200
KEPA!A PUSKESMAS DTP PONTANG
dr" #$#$N PAN%A &$NANT$
N$P" '(40)') 2002'2 2 004
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
4/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
Lamia& : S!a' K$!'!"a& K$ala P!"#$"ma" -TP PONTANG
N%m% : : 188.4/114/404.102.07/200< Tanggal : 24 Desenber 200
STAN-A, PELAYANAN P+LIK
P+SKESMAS -TP PONTANG
A. PEN-A>+L+AN P!"#$"ma" -TP PONTANG Ka!a'$& SE,ANG a6ala3 $&a&!& aa "$l!!3
!aa $ma&!&a& #$"$3a'a& 6i ilaa3 #$*ama'a&. -alam $la#"a&aa& '$#&i"&a
P!"#$"ma" -TP PONTANG m$m!&ai aaa& a& '$6ii 6ai P!"#$"ma" -TP PONTANG
"$a&a# 12 -$"a -$&a& !mla3 P!"#$"ma" I&6!# 1 !mla3 +G- 1 !a3 "$6a&#a&
!mla3 P!"#$"ma" P$ma&'! = !a3. J!mla3 6a& $&i" S!m$ -aa Ma&!"ia K$"$3a'a&
6i P!"#$"ma" -TP PONTANG "$$"a =< %a& a& '$"$a 6i P!"#$"ma" I&6!# 25
%a& %li&6$" %a& P!#$"ma" P$ma&'! 8 %a&. A6a!& !mla3 S-M K$"$3a'a&
6i$6a#a& m$&!!' 8 #$l%m%# ai'! m$6i" $aa'i6a& ;ama"i i9i '$#&i" m$6i"
"a&i'a"i #$"$3a'a& ma"aa#a' 6a& '$&aa lai&&a. S-M K$"$3a'a& 6i6%mi&a"i %l$3
$aa'i6a& a& !mla3&a m$&*aai 28 %a& "$lai& #a'$%i lai&&a (la'a
$la#a& $&6i6i#a& &%& #$"$3a'a& ai# SMP SMA -1 -= ma!!& S1) a&
m$&*aai < %a&.
P!"#$"ma" m$!a#a& +&i' $la#"a&a $ma&!&a& 6ii6a& #$"$3a'a& a&
m$m!&ai ;!&"i ("$"!ai 6$&a& K$m$$" &%m% 128 'a3!& 2004)
1. P!"a' $&$a# $ma&!&a& $aa"a& #$"$3a'a&
2. P!"a' $m$6aaa& ma"aa#a'
=. P!"a' $laa&a& #$"$3a'a& 'i&#a' $'ama
a. P$laa&a& #$"$3a'a& $%a&a&
. P$laa&a& #$"$3a'a& ma"aa#a'
Ol$3 #a$&a m$m!&ai ;!&"i a& "$lal! $3!!&a& 6$&a& ma"aa#a' 6alam
i6a& #$"$3a'a& ma#a $l! 6i'$i'#a& "!a'! "'a&6a $laa&a&.
1. ?ISI :
T$!!6&a K$*ama'a& -TP PONTANG "$3a' ma&6ii 'a3!& 2010 6i6!#!& 6$&a&
'$&aa #$"$3a'a& a& %;$"i%&al
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
5/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
2. MISI :a. M$&i&#a'#a& #!ali'a" "!m$ 6aa ma&!"ia !&a m$!!6#a& $laa&a& a&
%;$"i%&al
. M$&i&#a'#a& "aa&a 6a& a"aa&a #$"$3a'a& !"#$"ma"
*. M$&!aa#a& $laa&a& #$"$3a'a& a& $m!'! 6$&a& iaa a& '$a&#a!
6. M$&a6i#a& P!"#$"ma" -TP PONTANG "$aai '$ma' !!#a& #$"$3a'a& ai
ma"aa#a'
=. ,+ANG LINGK+P T+GAS :
K$6!6!#a& T!a" @!&"i -a& K$$&a&a& P!"#$"ma" m$!a#a& !&"! $la#"a&a
%'%&%mi 6a$a3 a& 6iimi& %l$3 "$%a& K$ala P!"#$"ma" a& $a6a 6i aa36a& $'a&!&aa #$a6a -i&a" K$"$3a'a&.
P!"#$"ma" m$m!&ai '!a" m$la#"a&a#a& !!"a& $m$i&'a3a& 6a$a3 $6a"a#a&
a"a" %'%&%mi 6a& '!a" $ma&'!a& 6ii6a& #$"$3a'a& 6a& '!a" lai& a& 6i$i#a&
%l$3 !a'i m$lal!i K$ala -i&a" K$"$3a'a&.
P!"#$"ma" m$m!&ai '!a" !'ama m$&$l$&aa#a& !!"a& !ma3 'a&a 6a$a3
6ii6a& #$"$3a'a& m$li!'i !aa %m%'i; $$&'i; #!a'i; 6a& $3aili'a'i; a&
6ila#"a&a#a& ai# %l$3 $m$i&'a3 "a"'a ma!!& ma"aa#a' ("$"!ai 6$&a& P$!
&% =< 'a3!& 2008).
-alam m$&$l$&aa#a& '!a"&a !"#$"ma" m$m!&ai ;!&"i :
a. P!"#$"ma" "$aai !"a' $ma&!&a& $aa"a& #$"$3a'a&. P!"#$"ma" "$aai !"a' $m$6aaa& ma"aa#a'
*. P!"#$"ma" "$aai !"a' $laa&a& #$"$3a'a& 6a"a
+&'!# m$&$l$&aa#a& ;!&"i&a P!"#$"ma" m$m!&ai #$$&a&a& :
a. P$&$l$&aaa& "!aila&" $i6$m%l%i $&$li6i#a& #$a6ia& l!a ia"a "#ala
K$*ama'a&B
. P$&$l$&aaa& P$&*$a3a& 6a& $&a&!la&a& $&a#i' m$&!la "#ala K$*ama'a&B
*. P$&$l$&aaa& P$&*$a3a& 6a& P$&a&!la&a& $&a#i' 'i6a# m$&!la "#ala
K$*ama'a&B
6. P$&$l$&aaa& %$a"i%&al $&a&!la&a& ma"ala3 #$"$3a'a& a#ia' $&*a&a 6a&
aa3 "#ala K$*ama'a&B$. P$&$l$&aaa& $&*$a3a& 6a& $&*$maa& li&#!&a& "#ala K$*ama'a&B
;. P$&$3a'a& li&#!&a&B
. P$&$l$&aaa& "!aila&" i9i !!# "#ala #$*ama'a&B
3. P$&$l$&aaa& $&a&!la&a& i9i !!# "#ala K$*ama'a&B
i. P$ai#a& i9i #$l!aa 6a& ma"aa#a'B
. P$&$l$&aaa& $laa&a& #$"$3a'a& 3ai "#ala K$*ama'a&B
#. P$&$l%laa& $laa&a& #$"$3a'a& 6a"a 6a& !!#a& "$#!&6$ "#ala #$*ama'a&B
l. P$&$l$&aaa& !aa #$"$3a'a& a6a 6a$a3 $a'a"a& '$$&*il aa& #$!la!a&
"#ala #$*ama'a&B
m. P$&$l%laa&/ P$&$l$&aaa& ami&a& $m$li3aaa& #$"$3a'a& "$"!ai #%&6i"i l%#alB
&. P$&$l$&aaa& ami&a& $m$li3aaa& #$"$3a'a& &a"i%&al ('!a" $ma&'!a&)B
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
6/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
%. P$ma&;aa'a& #$"$3a'a& "'a'$i"B. P$&6aa!&aa& '$&aa #$"$3a'a& "#ala #$*ama'a&B
. P$la'i3a& '$#&i" "#ala #$*ama'a&B
. P$&$6iaa& 6a& $&$l%laa& %a' $laa&a& #$"$3a'a& 6a"a ala' #$"$3a'a& 6a"a ala'
#$"$3a'a& $a$&"ia 6a& a#"i&B
". P$&aa"a& 6a& $i"'a"i ma#a&a& mi&!ma& %6!#"i !ma3 'a&aB
'. P$&$l$&aaa& %m%"i #$"$3a'a&B
!. P$la#"a&a SIKB
. M$$&*a&a#a& #$ia'a& "$"!ai ma"ala3 #$"$3a'a& 6i ilaa3 #$*ama'a&B
. M$&$&'!#a& #$ia'a& 6i ilaa3 #$*ama'a&B
D. M$&$&'!#a& 'a$' #$ia'a& "$"!ai #%&6i"i $%a P!"#$"ma"B
. STAN-A, PELAYANAN
-alam $&!"!&a& S'a&6a $laa&a& P!li# 3a!" m$m$&!3i i&6i*a'% " :
1. -a"a 3!#!m "$aai la&6a"a& 6a"a !&'!# m$m$i#a& $laa&a& #$a6a !li#
2. P$"aa'a& a& 6i$l!#a& !&'!# m$&6aa'#a& P$laa&a& a& 6ima#"!6
=. P%"$6! $&a!a& $laa&a& a& 3a!" 6ii#!'i %l$3 "$'ia $la&a&
4. Fa#'! a& *$a' 6a& '$a' !&'!# m$m$i#a& P$laa&a&
5. iaa / Tai; P$laa&a& 6a& Ta'a Caa P$maaa&&a
. S$"i#a"i %6!# / 3a"il $laa&a& a& a#a& 6i'$ima %l$3 $la&a&
7. Saa&a 6a& a"aa&a a& 6i "$6ia#a& ai# !&'!# $la&a& ma!!& !&'!# $'!a"
$laa&a& 6alam %"$" $&$l$"aia& $laa&a& '$ma"!# ;a"ili'a" $laa&a& ai
$&a&6a& *a*a'
8. K%m$'$&"i ma"i&ma"i& $'!a" a& '$lia' 6alam %"$" $m$ia& /
$&$l$"aia& $laa&a&
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
7/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a& K$$&a&a&-i&a" K$"$3a'a&.
5) K$!'!"a& !a'i N%. 0= Ta3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma"
P$aa'a&.
. P$"aa'a& :
-a;'a 6i l%#$'.
*. P%"$6! P$laa&a& :
1) Pa"i$& 6a'a& m$&6a;'a 6i l%#$' "$'a m$l$&#ai a6mi&i"'a"i "$"!ai 6$&a& $&i"
#!&!&a&
2) A&'i 6i !a& '!&! !&i' $laa&a&
=) M$&6aa' $laa&a& $m$i#"aa& / #%&"!l'a"i #$"$3a'a&4) M$&6aa' 'i&6a#a& ila $l! ('$ma"!# $i#"a la%a'%i!m)
5) aa $'i!"i 6a& iaa $laa&a& a& lai& 6i #a"i
) Amil %a' 6i a%'i# la&"!& !la&
6. Fa#'! P$laa&a& :
1) L%#$' : =5 m$&i'
2) +&i' $laa&a& : 510 m$&i'
=) A%'$# : =5m$&i' (#$*!ali $m!a'a& !$)
$. iaa P$laa&a& :
1) S$"!ai 6$&a& P$6a ,$'i!"i &% 24 'a3!& 20022) SK !a'i N%. 0= 'a3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma" P$aa'a&
;. P%6!# Laa&a& :
1) P$aa'a& / $&%a'a& a"i$& !m!m !&i' $laa&a&
2) P$m$i#"aa& #$"$3a'a& ai *al%& P$&a&'i& P$&*ai K$a
=) P$m$i#"aa& #$"$3a'a& >ai Ti&#a' P$'ama
4) P$m$i#"aa& #$"$3a'a& a&a# "$#%la3
5) P$laa&a& #%&"!l'a"i (Kli&i# "a&i'a"i Gi9i K$"$3a'a& ,$%6!#"i ,$maa K$"$3a'a&
Jia 6ll)
. Saa&a 6a& Pa"aa&a :
1) M%il Am!la&*$2) Ala' #$"$3a'a& !&'!# 6ia&%"'i#
=) Oa'%a'a& 6a& $$#ala& @ama"i
4) Ala' $&!&a&
3. K%m$'$&"i $'!a" $m$i $laa&a&
T$&aa m$6i" 6a& Paam$6i" 6ia&'! %l$3 '$&aa a6mi&i"'a'i;
i. P$&aa"a& I&'$&al
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a&
. P$&a&a&a& P$&a6!a& "aa& 6a& ma"!#a& :
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma" a'a!
6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&.
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
8/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
I.2. P$laa&a& Ti&6a#a&a. -a"a >!#!m :
1) K$!'!"a& M$&'$i K$"$3a'a& ,$!li# I&6%&$"ia N%m% 128 / M$$" / SK / II /2004
'$&'a& #$ia#a& 6a"a !"a' #$"$3a'a& ma"aa#a'
2) P$a'!a& -a$a3 Ka!a'$& SE,ANG N%m% 24 Ta3!& 2002 '$&'a& ,$'i!"i P$laa&a&
K$"$3a'a& a6a P!"#$"ma"
=) P$a'!a& -a$a3 Ka!a'$& N%m% 08 Ta3!& 2008 '$&'a& Oa&i"a"i 6a& Ta'a K$a
-i&a" -a$a3 Ka!a'$&
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a&
K$$&a&a& -i&a" K$"$3a'a&.
5) K$!'!"a& !a'i N%. 0= Ta3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma"P$aa'a&
. P$"aa'a& :
S$"!ai 6ia&%"a 6%#'$ $m$i#"a
*. P%"$6! P$laa&a&
1) Pa"i$& 6a'a& m$&6a;'a 6i l%#$' "$'a m$l$&#ai a6mi&i"'a"i "$"!ai 6$&a& $&i"
#!&!&a&
2) A&'i 6i !a& '!&! !&i' $laa&a&
=) M$&6aa' $laa&a& $m$i#"aa& #$"$3a'a&
4) -ila#!#a& 'i&6a#a& "$"!ai 6ia&%"a 6%#'$
5) aa $'i!"i 6a& iaa $laa&a& a& lai& 6i #a"i) Amil %a' 6i a%'i# la&"!& !la&
6. Fa#'! P$laa&a& :
1) L%#$' : =5 m$&i'
2) +&i' $laa&a& : 510 m$&i'
=) Ti&6a#a& i&a& : 15 m$&i'
S$6a& : =0 m$&i'
$a' : 6i!!# #$ !ma3 "a#i'
4) A%'i# : =5m$&i'(#$*!ali $m!a'a& !$)
5) iaa P$laa&a& :
a. S$"!ai 6$&a& P$6a ,$'i!"i &% 24 'a3!& 2002. SK !a'i &% 0= 'a3!& 2004 '$&'a& a#$' P$laa&a& E"$&"ial 6i P!"#$"ma" P$aa'a&.
*. a3a& 3ai" a#ai m$&$"!ai#a& 3aa a"a
$. P%6!# P$laa&a& :
P$laa&a& 'i&6a#a& "$"!ai 6ia&%"a 6%#'$
;. Saa&a 6a& Pa"aa&a :
1) Ala' #$"$3a'a& !&'!# 6ia&%"'i#
2) Oa'%a'a& 6a& $$#ala& @ama"i
=) Ala' $&!&a&
. K%m$'$&"i $'!a" $m$i $laa&a&
T$&aa M$6i" 6a& Paam$6i".
3. P$&aa"a& I&'$&al
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
9/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a&i. P$&a&a&a& $&a6!a& "aa& 6a& ma"!#a&
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma" a'a!
6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&.
I.=. P$laa&a& La%a'%i!m
a. -a"a >!#!m :
1) K$!'!"a& M$&'$i K$"$3a'a& ,$!li# I&6%&$"ia N%m% : 128/M$$"/SK/II/2004
'$&'a& #$ia#a& 6a"a !"a' #$"$3a'a& ma"aa#a'
2) P$a'!a& -a$a3 Ka!a'$& SE,ANG N%m% 24 Ta3!& 2002 '$&'a& ,$'i!"i P$laa&a&
K$"$3a'a& a6a P!"#$"ma"=) P$a'!a& -a$a3 Ka!a'$& N%m% 08 Ta3!& 2008 '$&'a& Oa&i"a"i 6a& Ta'a K$a
-i&a" -a$a3 Ka!a'$&
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a&
K$$&a&a& -i&a" K$"$3a'a&.
5) K$!'!"a& !a'i N%. 0= Ta3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma"
P$aa'a&
. P$"aa'a& :
,!!#a& 6%#'$ / #$ma!a& a"i$& "$&6ii
*. P%"$6! P$laa&a& :
1) Pa"i$& 6a'a& m$&6a;'a 6i l%#$' "$'a m$l$&#ai a6mi&i"'a"i "$"!ai 6$&a& $&i"#!&!&a&.
2) A&'i 6i !a& '!&! !&i' $laa&a&
=) M$&6aa' $laa&a& $m$i#"aa& / #%&"!l'a"i #$"$3a'a&.
4) ,!!#a& #$ la%a'%i!m
5) Amil 3a"il #$mali #$ !&i' $laa&a&
) aa $'i!"i 6a& iaa $laa&a& a& lai& 6i #a"i
7) Amil %a' la&"!& !la&
6. Fa#'! P$laa&a& :
1) L%#$' : =5 m$&i'
2) +&i' $laa&a& : 510 m$&i'=) La%a'%i!m : 5=0 m$&i' ('$a&'!& #a"!" a& 6i$i#"a)
$. iaa P$laa&a& :
1) S$"!ai 6$&a& P$6a ,$'i!"i &% 24 'a3!& 2004
2) SK !a'i N% 0= 'a3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma" P$aa'a&
=) a3a& 3ai" a#ai m$&$"!ai#a& 3aa a"a
;. P%6!# P$laa&a& :
>a"il !i La%a'%i!m S$6$3a&a
. Saa&a 6a& Pa"aa&a :
1) Ala' #$"$3a'a& !&'!# 6ia&%"'i#
2) Oa'%a'a& 6a& $$#ala& @ama"i
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
10/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
=) Ala' $&!&a&3. K%m$'$&"i $'!a" $m$i $laa&a&
T$&aa A&ali"i" La%a'%i!m
i. P$&aa"a& I&'$&al
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a&
. P$&a&a&a& $&a6!a& "aa& 6a& ma"!#a&
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma" a'a!
6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&.
I.4. P$laa&a& P$m$i#"aa& 6a& Ti&6a#a& Gii
a. -a"a >!#!m :1) K$!'!"a& M$&'$i K$"$3a'a& ,$!li# I&6%&$"ia N%m% : 128/M$$"/SK/II/2004
'$&'a& #$ia#a& 6a"a !"a' #$"$3a'a& ma"aa#a'
2) P$a'!a& -a$a3 Ka!a'$& SE,ANG N%m% 24 Ta3!& 2002 '$&'a& ,$'i!"i P$laa&a&
K$"$3a'a& a6a P!"#$"ma"
=) P$a'!a& -a$a3 Ka!a'$& N%m% 08 Ta3!& 2008 '$&'a& Oa&i"a"i 6a& Ta'a K$a
-i&a" -a$a3 Ka!a'$&
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a&
K$$&a&a& -i&a" K$"$3a'a&.
. P$"aa'a& :
-a;'a 6i L%#$'*. P%"$6! P$laa&a& :
1) Pa"i$& 6a'a& m$&6a;'a 6i l%#$' "$'a m$l$&#ai a6mi&i"'a"i "$"!ai 6$&a& $&i"
#!&!&a&.
2) A&'i 6i !a& '!&! !&i' $laa&a&
=) M$&6aa' $laa&a& $m$i#"aa& / #%&"!l'a"i #$"$3a'a& ii.
4) M$&6aa' 'i&6a#a& ila $l! ( '$ma"!# $i#"a la%a'%i!m )
5) aa $'i!"i 6a& iaa $laa&a& a& lai& 6i #a"i
) Amil %a' 6i a%'i# la&"!& !la&
6. Fa#'! P$laa&a& :
1) L%#$' : =5 m$&i'2) +&i' $laa&a& : 5 m$&i'
=) Ti&6a#a& ii : 10 m$&i' ('$a&'!& #a"!" a& 6i'a&a&i)
$. iaa P$laa&a& :
1). S$"!ai 6$&a& P$6a ,$'i!"i &% 24 'a3!& 2004
2). a3a& 3ai" a#ai m$&$"!ai#a& 3aa a"a
;. P%6!# P$laa&a& :
P$aa'a& / $&%a'a& ii 6a& 'i&6a#a& ii ( '!ma'a& ii *a!' ii i&"i"i 6ll )
. Saa&a 6a& Pa"aa&a :
1) Ala' #$"$3a'a& ii
2) Oa'%a'a& 6a& $$#ala& @ama"i
=) Ala' $&!&a& 6a& >P
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
11/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
3. K%m$'$&"i $'!a" $m$i $laa&a& T$&aa m$6i" 6a& Paam$6i" ii
i. P$&aa"a& I&'$&al
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a&
. P$&a&a&a& $&a6!a& "aa& 6a& ma"!#a&
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma" a'a!
6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&.
II. +G- 6a& ,aa' I&a P!"#$"ma"
,aa' i&a P!"#$"ma" '$6ii 6ai 6!a #$ia'a& %#%# m$li!'i : +&i' Gaa' -a!a'
P$laa&a& ,aa' I&a !&'!# a"i$& !m!m.
2.1 +&i' Gaa' -a!a' ( +G- )
a. -a"a >!#!m :
1) K$!'!"a& M$&'$i K$"$3a'a& ,$!li# I&6%&$"ia N%m% : 128/M$$"/SK/II/2004
'$&'a& #$ia#a& 6a"a !"a' #$"$3a'a& ma"aa#a'
2) P$a'!a& -a$a3 Ka!a'$& SE,ANG N%m% 24 Ta3!& 2002 '$&'a& ,$'i!"i P$laa&a&
K$"$3a'a& a6a P!"#$"ma"
=) P$a'!a& -a$a3 Ka!a'$& N%m% 08 Ta3!& 2008 '$&'a& Oa&i"a"i 6a& Ta'a K$a
-i&a" -a$a3 Ka!a'$&
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a&K$$&a&a& -i&a" K$"$3a'a&.
5) K$!'!"a& !a'i N%. 0= Ta3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma"
P$aa'a&
. P$"aa'a& :
-a;'a 6i L%#$'
*. P%"$6! P$laa&a& :
1) Pa"i$& 6a'a& m$&6a;'a 6i l%#$' "$'a m$l$&#ai a6mi&i"'a"i "$"!ai 6$&a& $&i"
#!&!&a&.
2) A&'i 6i !a& '!&! !&i' $laa&a&
=) M$&6aa' $laa&a& $m$i#"aa& #$"$3a'a& 6i !&i' $laa&a&.4) M$&6aa' 'i&6a#a& ila $l! ( '$ma"!# $i#"a la%a'%i!m )
5) aa $'i!"i 6a& iaa $laa&a& a& lai& 6i #a"i
) Amil %a' 6i a%'i# la&"!& !la&
7) -ila#!#a& aa' i&a "$"!ai 6$&a& 6ia&%"a 6%#'$.
6. Fa#'! P$laa&a& :
1) L%#$' : =5 m$&i'
2) +&i' $laa&a& : 5 H 15 m$&i'
$. iaa P$laa&a& :
1) S$"!ai 6$&a& P$6a ,$'i!"i &% 24 'a3!& 2004
2) SK !a'i N% 0= 'a3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma" P$aa'a&
=) a3a& 3ai" a#ai m$&$"!ai#a& 3aa a"a
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
12/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
;. P%6!# P$laa&a& :1) P$aa'a& / $&%a'a& a"i$& !m!m !&i' $laa&a&
2) O"$a"i K$aa'6a!a'a&
. Saa&a 6a& Pa"aa&a :
1) M%il Am!la&*$
2) Ala' #$"$3a'a& !&'!# 6ia&%"'i#
=) Ala' 'i&6a#a&
4) Oa'%a'a& 6a& $$#ala& ;ama"i
5) Ala' $&!&a&
3. K%m$'$&"i $'!a" $m$i $laa&a&
T$&aa m$6i" 6a& Paam$6i" 6ia&'! %l$3 '$&aa a6mi&i"'a'i; i. P$&aa"a& I&'$&al
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a&
. P$&a&a&a& $&a6!a& "aa& 6a& ma"!#a&
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma" a'a!
6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&.
2.2 ,aa' I&a P!"#$"ma"
a. -a"a >!#!m :
1) K$!'!"a& M$&'$i K$"$3a'a& ,$!li# I&6%&$"ia N%m% : 128/M$$"/SK/II/2004
'$&'a& #$ia#a& 6a"a !"a' #$"$3a'a& ma"aa#a'2) P$a'!a& -a$a3 Ka!a'$& SE,ANG N%m% 24 Ta3!& 2002 '$&'a& ,$'i!"i P$laa&a&
K$"$3a'a& a6a P!"#$"ma"
=) P$a'!a& -a$a3 Ka!a'$& N%m% 08 Ta3!& 2008 '$&'a& Oa&i"a"i 6a& Ta'a K$a
-i&a" -a$a3 Ka!a'$&
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a&
K$$&a&a& -i&a" K$"$3a'a&.
5) K$!'!"a& !a'i N%. 0= Ta3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma"
P$aa'a&
. P$"aa'a& :
A6a&a !!#a&*. P%"$6! P$laa&a& :
1) Pa"i$& 6a'a& m$&6a;'a 6i l%#$' "$'a m$l$&#ai a6mi&i"'a"i "$"!ai 6$&a& $&i"
#!&!&a&.
2) A&'i 6i !a& '!&! !&i' $laa&a&
=) M$&6aa' $laa&a& $m$i#"aa& #$"$3a'a& 6i !&i' $laa&a&.
4) M$&6aa' 'i&6a#a& ila $l! ( '$ma"!# $i#"a la%a'%i!m )
5) aa $'i!"i 6a& iaa $laa&a& a& lai& 6i #a"i
) Amil %a' 6i a%'i#
7) ,aa' i&a.
6.Fa#'! P$laa&a& :
1) L%#$' : =5 m$&i'
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
13/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
2) +&i' $laa&a& : 5 H 15 m$&i'=) ?i"i'a"i 6%#'$ 1 3ai "$#ali a'a! "$a#'!a#'! ila a6a a"i$& a& $l! !&'!#
6i#%&"!l'a"i#a& #$ 6%#'$
4) P$aa'a& "$"!ai 6$&a& #$!'!3a& a"i$&
$. iaa P$laa&a& :
1) S$"!ai 6$&a& P$6a ,$'i!"i &% 24 'a3!& 2004
2) SK !a'i N% 0= 'a3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma" P$aa'a&
=) a3a& 3ai" a#ai m$&$"!ai#a& 3aa a"a
;. P%6!# P$laa&a& :
1) P$aa'a& / $&%a'a& a"i$& 6i aa' I&a P!"#$"ma"
2) Gi9i 6i"$"!ai#a& 6$&a& -i$' a"i$&. Saa&a 6a& Pa"aa&a :
1) M%il Am!la&*$
2) Ala' #$"$3a'a& !&'!# 6ia&%"'i#
=) Ala' 'i&6a#a&
4) Oa'%a'a& 6a& $$#ala& ;ama"i
5) Ala' $&!&a&
3. K%m$'$&"i $'!a" $m$i $laa&a&
T$&aa m$6i" 6a& Paam$6i" 6ia&'! %l$3 '$&aa a6mi&i"'a'i;
i. P$&aa"a& I&'$&al
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a& . P$&a&a&a& $&a6!a& "aa& 6a& ma"!#a&
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma"
a'a! 6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&.
III. +KM
=.1 P$mi&aa& P%"a&6!
a. -a"a >!#!m :
1) K$!'!"a& M$&'$i K$"$3a'a& ,$!li# I&6%&$"ia N%m% : 128/M$$"/SK/II/2004
'$&'a& #$ia#a& 6a"a !"a' #$"$3a'a& ma"aa#a'
2) P$a'!a& -a$a3 Ka!a'$& SE,ANG N%m% 24 Ta3!& 2002 '$&'a& ,$'i!"i P$laa&a&
K$"$3a'a& a6a P!"#$"ma"
=) P$a'!a& -a$a3 Ka!a'$& N%m% 08 Ta3!& 2008 '$&'a& Oa&i"a"i 6a& Ta'a K$a
-i&a" -a$a3 Ka!a'$&
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a&
K$$&a&a& -i&a" K$"$3a'a&.
. P$"aa'a&
P$mi&a %"a&6! 6a'a& #$ '$ma' %"a&6!
*. P%"$6! $laa&a&
1) Ka6$ $#!m!l 6i '$ma' %"a&6!
2) P$mi&a m$m$i#a& $&!l!3a&=) M$la#!#a& 'a&a aa a&'aa $mi&a 6a& #a6$
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
14/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
4) M$&a&a#a& $ma"ala3a& a& a6a 6i %"a&6! 6a& *aa $&$l$"aia&&a6. Fa#'!
Fa#'! m$&$"!ai#a& a6al %"a&6!
$. iaa P$laa&a&
Ga'i"
;. P%6!# $laa&a&
1) P$&!l!3a& K$"$3a'a& Ma"aa#a' (PKM)
2) S%"iali"a"i P%am K$"$3a'a&
=) S!$ P$ila#! >i6! $"i3 6a& S$3a' (P>S)
4) P$&ilaia& S'a'a P%"a&6!
. Saa&a 6a& Pa"aa&a :1) M%il Am!la&*$
2) Ala' $&!&a&
3. K%m$'$&"i $'!a" $m$i $laa&a&
P$'!a" P%m#$" T$&aa m$6i" 6a& Paam$6i" i6a&
i. P$&aa"a& I&'$&al
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a&
. P$&a&a&a& $&a6!a& "aa& 6a& ma"!#a&
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma"
a'a! 6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&
=.2 P!"li&a. -a"a >!#!m :
1) K$!'!"a& M$&'$i K$"$3a'a& ,$!li# I&6%&$"ia N%m% : 128/M$$"/SK/II/2004
'$&'a& #$ia#a& 6a"a !"a' #$"$3a'a& ma"aa#a'
2) P$a'!a& -a$a3 Ka!a'$& SE,ANG N%m% 24 Ta3!& 2002 '$&'a& ,$'i!"i P$laa&a&
K$"$3a'a& a6a P!"#$"ma"
=) P$a'!a& -a$a3 Ka!a'$& N%m% 08 Ta3!& 2008 '$&'a& Oa&i"a"i 6a& Ta'a K$a
-i&a" -a$a3 Ka!a'$&
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a&
K$$&a&a& -i&a" K$"$3a'a&.
5) K$!'!"a& !a'i N%. 0= Ta3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma"P$aa'a&
. P$"aa'a& :
-a;'a a6a $'!a"
*. P%"$6! P$laa&a& :
1) Pa"i$& 6a'a& m$&6a;'a 6i $'!a" "$'a m$l$&#ai a6mi&i"'a"i "$"!ai 6$&a& $&i"
#!&!&a&
2) A&'i 6i !a& '!&! !&i' $laa&a&
=) M$&6aa' $laa&a& $m$i#"aa& / #%&"!l'a"i #$"$3a'a&
4) aa $'i!"i a6a $'!a"
5) Amil %a' 6i $'!a" la&"!& !la&
6. Fa#'! P$laa&a& :
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
15/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
+&i' $laa&a& : 510 m$&i'$. iaa P$laa&a& :
1) S$"!ai 6$&a& P$6a ,$'i!"i &% 24 'a3!& 2002
2) SK !a'i N%. 0= 'a3!& 2004 '$&'a& Pa#$' P$laa&a& E"$&"ial 6i P!"#$"ma" P$aa'a&
;. P%6!# Laa&a& :
1) P$aa'a& / $&%a'a& a"i$& !m!m !&i' $laa&a&
2) P$laa&a& #%&"!l'a"i
. Saa&a 6a& Pa"aa&a :
1) M%il Am!la&*$
2) Ala' #$"$3a'a& !&'!# 6ia&%"'i#
=) Oa'%a'a& 6a& $$#ala& @ama"i4) Ala' $&!&a&
3. K%m$'$&"i $'!a" $m$i $laa&a&
T$&aa m$6i" 6a& Paam$6i" 6ia&'! %l$3 '$&aa a6mi&i"'a'i;
i. P$&aa"a& I&'$&al
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a&
. P$&a&a&a& P$&a6!a& "aa& 6a& ma"!#a& :
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma" a'a!
6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&.
=.= K$"li&-a"a >!#!m :
1) K$!'!"a& M$&'$i K$"$3a'a& ,$!li# I&6%&$"ia N%m% : 128/M$$"/SK/II/2004
'$&'a& #$ia#a& 6a"a !"a' #$"$3a'a& ma"aa#a'
2) P$a'!a& -a$a3 Ka!a'$& SE,ANG N%m% 24 Ta3!& 2002 '$&'a& ,$'i!"i P$laa&a&
K$"$3a'a& a6a P!"#$"ma"
=) P$a'!a& -a$a3 Ka!a'$& N%m% 08 Ta3!& 2008 '$&'a& Oa&i"a"i 6a& Ta'a K$a
-i&a" -a$a3 Ka!a'$&
4) K$!'!"a& !a'i SE,ANG N%m% =< Ta3!& 2008 '$&'a& T!a" @!&"i 6a&
K$$&a&a& -i&a" K$"$3a'a&.
. P$"aa'a& P$'!a" m$&6a'a&i '$ma' $m$i#"aa&
P%"$6! $laa&a&
1) P$'!a" m$&6a'a&i '$ma' !&'!# $m$i#"aa& TT+
2) P$'!a" m$&6a'a&i '$ma' !&'!# $m$i#"aa& TPM
=) P$'!a" m$&6a'a&i '$ma' !&'!# $m$i#"aa& TP= $"'i"i6a
4) P$'!a" m$&6a'a&i '$ma' !&'!# $m$i#"aa& Saa&a ai $"i3
5) P$'!a" m$&6a'a&i '$ma' !&'!# $m$i#"aa& !ma3 6a& li&#!&a&
Fa#'! $laa&a&
Fa#'! m$&$"!ai#a& 6$&a& #$!'!3a& $m$i#"aa&
iaa P$laa&a& :
Ga'i"
8/18/2019 KEPALA PUSKESMAS JOGOROGO STANDAR PELAYANAN.docx
16/16
PEMERINTAH KABUPATEN SERANG
PUSKESMAS DTP PONTANG
JL. CIPTAYASA NO 17 KECAMATAN PONTANG TELP (0254) 281081
Email : !"#$"ma".%&'a&mail.*%m
P%6!# Laa&a& :1) P$m$i#"aa& TT+
2) P$m$i#"aa& TPM
=) P$m$i#"aa& TP= $"'i"i6a
4) P$m$i#"aa& !ma3 6a& li&#!&a&
5) I&"$#"i "a&i'a"i "aa&a ai $"i3
) Ti&6a# la&!' #li&i# "a&i'a"i 6ai P +G-/,I
Saa&a 6a& Pa"aa&a :
1) S$$6a M%'%
2) Ala' $&!&a&
K%m$'$&"i $'!a" $m$i $laa&a&P$'!a" #$"$3a'a& li&#!&a&
P$&aa"a& I&'$&al
-ila#!#a& "$*aa !'i& %l$3 K$ala P!"#$"ma" 6a& $#ala %l$3 K$ala -i&a" K$"$3a'a&
. P$&a&a&a& P$&a6!a& "aa& 6a& ma"!#a& :
P$&a6!a& 6a& "aa& 6aa' 6i"amai#a& la&"!& #$a6a K$ala P!"#$"ma" a'a!
6ima"!##a& 6i #%'a# "aa& #$m!6ia& 6i%"$" !&'!# m$&6aa' 'a&aa&.
mailto:[email protected]:[email protected]Top Related