A. Identitas perawat
1. Nama :
2. Unit kerja :
3. Jabatan :
4. Kualifikasi :
5. Waktu kresensial terakhir :
B. Tugas Pokok :
..........................................................................................................................................
..........................................................................................................................................
C. Uraian Tugas :
1. ....................................................................................................................................
2. ....................................................................................................................................
3. ....................................................................................................................................
4. ....................................................................................................................................
5. Dst...
Cibadak, ............................
Mengetahui,
Kepala ruangan perawat ybs,
(................................) (..............................)