PEMERINTAH KABUP KAB UPA ATEN GARUT DINAS KESEHATAN KABUPATEN GARUT
UPTD PUSKESMAS CISURUPAN Jl.Raya cisurupan cisurupan No. 27 Garut Garut Telepon (0262) 577904 Email !lu".pmcisurupan#$mail.com !lu".pmcisurupan#$mail.com KEPUTUSAN KEPALA UPT PUSKESMAS DTP DT P CISURUPAN CISURUPAN Nomor : 299/SK/KA-PKM.CSP/VIII/2016 Lampiran : 4 (EMPAT !"r#a$
TENTAN% TIM PENERIMA KAJI BANDING DAN AKSELERASI KESIAPAN AKREDITASI FKTP PUSKESMAS DI UPTD PUSKESMAS DTP CISURUPAN
&ISMILLA'IA'MANIA'IM KEPALA UPT PUSKESMAS DTP DT P CISURUPAN CISURUPAN
Menimbang
:
a. !a)*a P+$a, K"$")a,an Ma$ara#a, (P+$#"$ma$ aaa) ni, P"a#$ana
T"#ni "#ni$$ (PT (PT ari ari ina ina$$ K"$" K"$")a )a,a ,an n an an m"r+ m"r+pa pa#a #an n p"n""nara p"aanan #"$")a,an ,in#a, p"r,ama (KTP5
3a$i 3a$ii i,a ,a$$
!. !a)*a P+$#"$ma$ aaa) 3a$ii,a$ p"aanan #"$")a,an an m"n""nara#an +paa +paa #"$")a #"$")a,an ,an ma$ar ma$ara#a a#a,, an +paa +paa #"$")a #"$")a,an ,an p"r$"o p"r$"oran ranan an ,in#a ,in#a,, p"r,ama "nan "!i) m"n+,ama#an +paa promo,i3 an pr"7"n,i3 +n,+# m"n8ap m"n8apai ai "raa "raa,, #"$")a #"$")a,an ,an ma$ar ma$ara#a a#a,, an an $",in $",ini-,i i-,in nin inaa i*ia i*iaa) a) #"rana5 8.
!a)* !a)*aa aa aam m ran an#a p"n p"n" ""n "n ara araan an p"a p"a anan anan #"$" #"$")a )a,a ,an n ,"r$ ,"r$"! "!+ +, m"n+na#a m"n+na#an n m+,+ a#r"i,a$i a#r"i,a$i p"aanan p"aanan P+$#"$ma$ P+$#"$ma$ an !"r#"$inam !"r#"$inam!+na !+nan n an p"r+ i +#+n +#+n "nan "nan a#$""ra$i a#$""ra$i #"$iapan a#r"i,a$i a#r"i,a$i KTP p+$#"$ma$ p+$#"$ma$ an !ai# an !"nar5
. !a)*a +n,+# +n,+# apa, apa, ,"r8ip,an ,"r8ip,ana a m+,+ a#r"i,a$i a#r"i,a$i KTP KTP P+$#"$ma P+$#"$ma$$ an !ai# !ai# an !"nar $"r,a !"r#"$inam!+nan i!+,+)#an Tim P"n"rima Kai &anin an A#$"" A#$""ra$ ra$ii K"$iap K"$iapan an A#r"i A#r"i,a$i ,a$i KTP P+$#"$ma$ P+$#"$ma$ i PT P+$#"$ P+$#"$ma$ ma$ TP CISPAN5 ". !a)* !a)*aa aa aam m ran ran#a #a p"a p"a#$ #$an anaa aan n ,"r$ ,"r$"! "!+, +, p"r p"r+ + i,+ i,+an an# #an an aa aam m S+ra S+ra,, K"p+,+$an K"paa PT P+$#"$ma$ TP CISPAN. Mengingat
:
1. na nan n- -n nan an "p+! "p+!i i# # Inon Inon"$ "$ia ia Nomo Nomorr 29 Ta) Ta)+n +n 2004 2004 ,"n, ,"n,an an Pra#, Pra#,i# i# K"o#,"ran5 2. na nan n- -n nan an "p+ "p+! !i# i# Ino Inon" n"$i $ia a Nomo Nomorr 6 Ta)+n a)+n 2009 2009 ,"n, ,"n,an an K"$")a,an5 . P"ra,+ P"ra,+ran ran Pr"$i" Pr"$i"n n "p+!i# "p+!i# Inon"$ Inon"$ia ia Nomor ;2 Ta)+n Ta)+n 2012 ,"n,an ,"n,an Si$,"m Si$,"m K"$")a,an Na$iona5 4. P"ra,+ P"ra,+ran ran Pr"$i Pr"$i"n "n No 12 Ta)+ Ta)+n n 201 pa$a pa$a 42 ,"n,an ,"n,an
=. P"ra,+ran K"m"n,"rian K"$")a,an Nomor ;1 Ta)+n 201 ,"n,an . P"ra,+ran a"ra) Ka!+pa,"n %AT Nomor = Ta)+n 200> ,"n,an p"m!"n,+#an orani$a$i ina$ a"ra) Ka!+pa,"n %AT5
MEMUTUSKAN Menetapkan
:
KEPTSAN KEPALA PSKESMAS TENTAN% TIM PENEIMA KA
K"$a,+
:
M"nan#a, nama-nama an ,"r8an,+m aam #oom 2 +n,+# m"n++#i a!a,an aam #oom 4 ampiran p"r,ama S+ra, K"p+,+$an ini $"!aai para P"nan+na*a! Tim P"n"rima Kai &anin an A#$""ra$i K"$iapan A#r"ia$i KTP P+$#"$ma$ i PT P+$#"$ma$ TP CISPAN5
K"+a
:
S"!aai +paa #"inami$an an #""a$an ara) Tim p"a#$ana paa i8,+m K"$a,+ ma#a paa ampiran #"+a i!+a, S,r+#,+r Tim P"n"rima Kai &anin an A#$""ra$i K"$iapan A#r"ia$i KTP P+$#"$ma$ i PT P+$#"$ma$ TP CISPAN5
K",ia
K""mpa,
n,+# #""a$an ,+a$ #"ra #"++#an ,an+na*a! *"*"nan an #"$inam!+nan #in"ra orani$a$i p"a#$ana paa i8,+m K"+a ma#a paa ampiran #",ia an #""mpa, i!+a, raian T+a$ Po#o# an +n$i aam m"naan#an Tim P"n"rima Kai &anin an A#$""ra$i K"$iapan A#r"ia$i KTP P+$#"$ma$ i PT P+$#"$ma$ TP CISPAN5 :
S+ra, K"p+,+$an ini !"ra#+ $"a# ,ana i,",ap#an "nan #","n,+an apa!ia i#"m+ian )ari ,"rapa, #"#"ir+an an a,a+ #"$aa)an iaamna a#an iaa#an p"r!ai#an/p"r+!a)an $"!aaimana m"$,ina.
i,",ap#an i Paa Tana
: CISPAN : 06 A+$,+$ 2016
KEPALA PT PSKESMAS TP CISPAN
Hj Srie Heryani N,S.Kep,M.Si Nip.19661218 198603 2 003
PEMERINTAH KABUPATEN GARUT DINAS KESEHATAN KABUPATEN GARUT
UPTD PUSKESMAS CISURUPAN Jl.Raya cisurupan No. 27 Garut Telepon (0262) 577904 Email !lu".pmcisurupan#$mail.com LAMPIAN (1 KEPTSAN KEPALA PSKESMAS N?M? 299/SK/KA-PKM.CSP/VIII/2016 TENTAN% : TIM PENEIMA KA
TIM PENERIMA KAJI BANDING DAN AKSELERASI KESIAPAN AKREDITASI FKTP PUSKESMAS DI UPT PUSKESMAS DTP CISURUPAN
N?
NAMA
1
2
I.
+n$iona
-
K",+a Mana"m"n M+,+
2.
P"ra*a,
@a#i Mana"m"n M+,+
-
S"#r",ari$ P"n"oa m+m
2.
P. %ii
o#+m"n,a$i M+,+ S"#r",aria,
.
N+,ri$ioni$
Mana"m"n P"nanaran an
1.
=
MANAJEMEN
1.
II.
KET
Ka.PKM
SEKRETARIAT MUTU
.K"p.
Koor.T
Ta,a %ra)a 4.
&ian
P. K")+ma$an an mana"m"n IKM
=.
&ian
P. A#omoa$iA+i, In",rna KP
6.
P"ra*a,
P. Mana"m"n A8ara a+i, in,"rna am"n
III.
PKJA ADMEN
1.
Sani,arian
Mana"m"n Am"n
2.
A$. Ap,#.
Ano,a
.
&ian
Ano,a
1.
P. %ii
Mana"m"n KM
2.
P"ra*a,
Ano,a
P. Prom#"$
.
Sani,arian
Ano,a
P",. K"$in
4.
&ian
Ano,a
=.
N+,ri$ioni$
Ano,a
&ian KIA P. %iBi
6.
P"ra*a,
Ano,a
P. P2P
Ano,a
P. paa
I!.
;.
P",. ama$i Mana"m"n P?NE
PKJA UKM
P"n"m!.
1 !.
2
4
=
PKJA UKP
1.
o#,"r m+m
Mana"m"n KP
2.
&ian
Ano,a
.
Anai$ Kini$
Ano,a
4.
&ian
Ano,a
P"ra*a,
Mana"m"n A+i, In,"rna
!I.
P",. La!.
TIM AUDIT INTERNAL
1. .
Mana. % an
2.
P"ra*a,
A+i,or In,"rna KP
a*a, Inap
Ket " Tim Ka#i Ban$ing ke %&a' P&(ke(ma( ))) Ket&a Mana#emen M&t& ))*aki% mana#emen M&t& )Tim Mana#emen M&t&
i,",ap#an i Paa Tana
: CISPAN : 06 A+$,+$ 2016
K"paa PT P+$#"$ma$ TP CISPAN
Hj Srie Heryani N,S.Kep,M.Si Nip.19661218 198603 2 003
TUGAS POKOK DAN FUNGSI
STRUKTUR PENERIMA TIM KAJI BANDING
UPT PUSKESMAS CISURUPAN Jl.Raya cisurupan No. 27 Garut
<.aa 8i$+r+pan No. 2; %ar+, T""pon (0262 =;;904 Emai : &+.pm8i$+r+panmai.8om
No. o#+m"n : 001/SK/KA-PKM.CSP/I/2016
PUSKESMAS CISURUPAN DINAS KESEHATAN KAB. GARUT
No. "7i$i : 1
T. T"r!i, : 02
'a.: 1/2
LAMPIAN (2 KEPTSAN KEPALA PSKESMAS N?M? 299/SK/KA-PKM.CSP/VIII/2016 TENTAN% : TIM PENEIMA KA
STRUKTUR TIM PENERIMA KAJI BANDING DAN AKSELERASI KESIAPAN AKREDITASI FKTP PUSKESMAS DI UPT PUSKESMAS DTP CISURUPAN ***KETUA MANAJEMEN MUTU
**WAKIL MANAJEMEN MUTU
*MANAJ. AUDIT INTERNAL
SEKRETARIS PENGEL!LAAN UMUM
AUDIT!R ADMEN
D!KUMENTASI MUTU
MANAJEMEN ACARA .
AUDIT!R UKM
KEHUMASAN ) MANJ. IKM
AK!M!DASI ) K!NSUMSI .
AUDIT!R UKP .
*MANAJEMEN ADMEN
*MANAJEMEN UKM
*MANAJEMEN UKP
ANGG!TA
*ANGG. )PJ. PR!MKES
ANGG!TA
U&n Unaina+, S.T', Keb. *ANGG!TA
. ANGG.) PJ. KESLING
ANGG.) P. LAB.
*ANGG!TA
ANGG. ) PJ. GI(I
*ANGG!TA .
Ket "
.
ANGG. ) PJ. PP
CISPAN 06 A+$,+$ 2016 K"paa PT P+$#"$ma$ TP CISPAN
Tim Ka#i ban$ing ke %&a' P&(ke(ma( ))) Ket&a Mana#emen M&t& ))*aki% mana#emen M&t& )Tim Mana#emen M&t&
ANGG. ) PJ. PENGEMB. .
'<. Sri" '"rani N S.K"p M $i NIP. 1966121>19>60200
TUGAS POKOK DAN FUNGSI
WAKIL MANAJEMEN MUTU
UPT PUSKESMAS CISURUPAN Jl.Raya cisurupan No. 27 Garut
<.aa 8i$+r+pan No. 2; %ar+, T""pon (0262 =;;904 Emai : &+.pm8i$+r+panmai.8om
No. o#+m"n : 001/SK/KA-PKM.CSP/I/2016
PUSKESMAS CISURUPAN DINAS KESEHATAN KAB. GARUT
No. "7i$i : 1
T. T"r!i, : 02
'a.: 1/2
LAMPIAN ( KEPTSAN KEPALA PSKESMAS N?M? 299/SK/KA-PKM.CSP/VIII/2016 TENTAN% : TIM PENEIMA KA
A. KEKAN 1. @a#i Mana"m"n M+,+ !"raa i !a*a) p"m!inaan an !"r,an+n a*a! #"paa Pimpinan Mana"m"n M+,+ (K"paa PT P+$#"$ma$ TP CISPAN. 2. @a#i Mana"m"n M+,+ m"m!a*a)i S"#r",ari$ K"ompo# Mana"m"n M+,+ an Tim A+i,or In,"rna iin#+p PT P+$#"$ma$ TP CISPAN &. T%AS @a#i Mana"m"n M+,+ m"a#$ana#an #oorina$i a,a$ $"+r+) #"ia,an m+,+ p"aanan #"$")a,an i PT P+$#"$ma$ TP CISPAN an aam p"a#$anaan ,+a$ i!an,+ o") Tim S"#r",aria, Tim A+i,or In,"rna an Po#a M+,+ P"aanan : 1. Mana"m"n Amin : m"ip+,i ,+a$ ,"r)aap m+,+ p"aanan amini$,ra$i an mana"m"n p+$#"$ma$5 2. Mana"m"n KM : m"ip+,i ,+a$ ,"r)aap m+,+ p"aanan proram p+$#"$ma$ (paa K"$")a,an Ma$ara#a,/KM5 . Mana"m"n KP : m"ip+,i ,+a$ ,"r)aap m+,+ p"aanan #ini$ p+$#"$ma$ (paa K"$")a,an P"r$"oranan/KP. C. N%SI @a#i Mana"m"n M+,+ m"ma$,i#an imp"m"n,a$i an p"m"i)araan $i$,"m mana"m"n m+,+ an !"r#"an+,an "nan m"a#+#an A+i, In,"rna ma+p+n S"3 A$$"$m"n, M+,+ P+$#"$ma$ $"8ara !"r#aa ,iap 6 !+an ,"r)aap $"+r+) "ni$ p"aanan #"$")a,an i PT P+$#"$ma$ TP CISPAN. . AIAN T%AS 1. M"n+$+n r"n8ana #"ra 2. M"niap#an in$,r+m"n, m+,+ p+$#"$ma$ . P"a#$anaan $"3 a$$"$m"n, ma+p+n a+i, in,"rna 4. Anai$i$ )a$i $"3 a$$"$m"n, ma+p+n a+i, in,"rna =. P"no#+m"n,a$ian )a$i $"3 a$$"$m"n, ma+p+n a+i, in,"rna 6. M"nimpan o#+m"n m+,+ p"aanan p+$#"$ma$ ;. M"r"7i$i ,"r)aap o#+m"n m+,+ p+$#"$ma$ >. M"m!"ri#an $aran p"r!ai#an #"paa p"a#$ana m+,+ p"aanan an i,+an#an aam r"7i$i o#+m"n 9. M"m!"ri#an r"$pon ari $aran a,a+ p"na+an p"anan/#i"n ,"r)aap #"p+a$an p"anan/#i"n 10. M"mp+!i#a$i#an $a$aran m+,+ ,"r,"n,+ an )a$i p"n8apaianna $",iap !+an paa papan in3orma$i aam "+n P+$#"$ma$ #"paa p"n+n+n/p"anan/#i"n. 11. M"apor#an p"r,an+na*a!anna #"paa pimpinan mana"m"n m+,+.
No. o#+m"n :
No. "7i$i : 0
T. T"r!i, : 06 A+$,+$ 2016
'a.: 2/2
299/SK/KA-PKM.CSP/VIII/2016
E. TAN%%N%
@E@ENAN% 1. M"na*a$i an m"n#oorina$i#an $"+r+) #"ia,an M+,+ P"aanan K"$")a,an. 2. M"na+#an +$+an #"paa pimpinan mana"m"n m+,+ ,"n,an Pro$"+r-pro$"+r p"n""naraan m+,+ p"aanan #"$")a,an i PT P+$#"$ma$ TP CISPAN.
%. KALIIKASI ............
CISPAN 06 A+$,+$ 2016 K"paa PT P+$#"$ma$ TP CISPAN
Hj Srie Heryani N,S.Kep,M.Si Nip.19661218 198603 2 003
TUGAS POKOK DAN FUNGSI
SEKRETARIAT, MANAJEMEN ADMIN, UKM, UKP DAN MANAJEMEN AUDIT INTERNAL
UPT PUSKESMAS CISURUPAN Jl.Raya cisurupan No. 27 Garut
<.aa 8i$+r+pan No. 2; %ar+, T""pon (0262 =;;904 Emai : &+.pm8i$+r+panmai.8om
No. o#+m"n : 001/SK/KA-PKM.CSP/I/2016
PUSKESMAS CISURUPAN DINAS KESEHATAN KAB. GARUT
No. "7i$i : 1
T. T"r!i, : 02
'a.: 1/2
LAMPIAN (4 KEPTSAN KEPALA PSKESMAS N?M? 299/SK/KA-PKM.CSP/VIII/2016 TENTAN% : TIM PENEIMA KA
A. KEKAN 1. K"ompo# Mana"m"n !"raa i !a*a) p"m!inaan an !"r,an+n a*a! #"paa @a#i Mana"m"n M+,+ PT P+$#"$ma$ TP CISPAN. 2. M"n#oorina$i#an Tim M+,+ iin#+p PT P+$#"$ma$ TP CISPAN &. T%AS M"a#$ana#an #oorina$i #"ia,an m+,+ p"aanan #"$")a,an i PT P+$#"$ma$ TP CISPAN an aam p"a#$anaan ,+a$ i!an,+ o") Tim M+,+ P"aanan : 1. Mana"m"n Am"n : m"ip+,i ,+a$ ,"r)aap m+,+ p"aanan amini$,ra$i an mana"m"n p+$#"$ma$ "nan m"n#oorina$i#an Tim M+,+ P"aanan an ,"riri ari : a. Tim M+,+ 15 M+,+ P"n""naraan P"aanan P+$#"$ma$ (PPP !. Tim M+,+ 25 M+,+ K"p"mimpinan an Mana"m"n P+$#"$ma$ (KMP 8. Tim M+,+ 5 M+,+ P"nin#a,an M+,+ P+$#"$ma$ (PMP 2.
Mana"m"n KM : m"ip+,i ,+a$ ,"r)aap m+,+ p"aanan proram p+$#"$ma$ (paa K"$")a,an Ma$ara#a,/KM "nan m"n#oorina$i#an Tim M+,+ P"aanan an ,"riri ari : a. Tim M+,+ 45 M+,+ Proram paa P+$#"$ma$ Dan &"rori"n,a$i Sa$aran (PP&S !. Tim M+,+ =5 M+,+ K"p"mimpinan an Mana"m"n paa P+$#"$ma$ (KMPP 8. Tim M+,+ 65 M+,+ Sa$aran Kin"ra M%$ (SKM
.
Mana"m"n KP : m"ip+,i ,+a$ ,"r)aap m+,+ p"aanan #ini$ p+$#"$ma$ (paa K"$")a,an P"r$"oranan/KP. a. Tim M+,+ ;5 M+,+ Laanan Kini$ Dan &"rori"n,a$i Pa$i"n (LK&P !. Tim M+,+ >5 M+,+ Mana"m"n P"n+nan Laanan Kini$ (MPLK 8. Tim M+,+ 95 M+,+ P"nin#a,an M+,+ Kini$ an K"$"ama,an Pa$i"n (PMKP
C. N%SI M"ma$,i#an imp"m"n,a$i an p"m"i)araan $i$,"m mana"m"n m+,+ an !"r#"an+,an "nan m"a#+#an S"3 A$$"$m"n, M+,+ A#r"i,a$i P+$#"$ma$ $"8ara !"r#aa ,iap 6 !+an ,"r)aap $"+r+) p"aanan #"$")a,an $"!aaimana ,"r8an,+m aam ,+a$ Po#a ,"r$"!+, ia,a$ i PT P+$#"$ma$ TP CISPAN. . AIAN T%AS 1. M"n+$+n r"n8ana #"ra 2. M"niap#an in$,r+m"n, m+,+ a#r"i,a$i . P"a#$anaan $"3 a$$"$m"n, an i#oorinirna 4. Anai$i$ )a$i $"3 a$$"$m"n, =. P"no#+m"n,a$ian )a$i $"3 a$$"$m"n, 6. M"nimpan o#+m"n m+,+ p"aanan p+$#"$ma$
No. o#+m"n :
No. "7i$i : 0
T. T"r!i, : 06 A+$,+$ 2016
'a.: 2/2
299/SK/KA-PKM.CSP/VIII/2016
;. >. 9. 10.
M"r"7i$i ,"r)aap o#+m"n m+,+ a#r"i,a$i p+$#"$ma$ M"m!"ri#an $aran p"r!ai#an #"paa p"a#$ana m+,+ p"aanan an i,+an#an aam r"7i$i o#+m"n M"m!"ri#an r"$pon ari $aran a,a+ p"na+an #i"n ,"r)aap #"p+a$an #i"n M"apor#an p"r,an+na*a!anna #"paa @a#i mana"m"n m+,+.
E. TAN%%N%
CISPAN 06 A+$,+$ 2016 K"paa PT P+$#"$ma$ TP CISPAN
Hj Srie Heryani N,S.Kep,M.Si Nip.19661218 198603 2 003
