EVALUASI KEGIATAN MAHASISWA KEDOKTERAN KLINIK

BAGIAN ILMU KESEHATAN MATA FAK. KEDOKTERAN UNHAS

Nama :.................................................
No. Pokok :.................................................
Tempat / Tgl lahir :.................................................
Alamat :.................................................
Tanggal masuk :.................................................

NO KEGIATAN PEMBIMBING T. TANGAN

I Status Penderita
1. ......................................................... 1..................
2. ......................................................... ........................... 2...................
3. ......................................................... 3...................

II Status Penderita
4. ......................................................... 4..................
5. ......................................................... ........................... 5..................
6. ......................................................... 6..................

Laporan Kasus
A. ............................................................... A..................
III Status Penderita
7. ......................................................... 7..................
8. ......................................................... ........................... 8..................
9. ......................................................... 9..................

Laporan Kasus
B................................................................. B..................
IV Status Penderita
10. ......................................................... 10..................
11. ......................................................... ........................... 11..................
12. ......................................................... 12..................

Makassar, Oktober 2017

Kepala Bagian Ilmu Kesehatan Mata

Fakultas Kedokteran Unhas

( )
NIP.
Catatan :
Memenuhi / tidak memenuhi syarat
Mengikuti ujian dokter di bagian
Ilmu Kesehatan Mata