PANDUAN PENGKAJIAN DAN PEMBUATAN

SATUAN ACARA PENYULUHAN (SAP)

TERAPI BERMAIN

1. IDENTITAS ANAK
Nama : ..............................................................................................
Tempat/tanggal lahir : ..............................................................................................
Jenis kelamin : ..............................................................................................
Agama : ..............................................................................................
Pendidikan : ..............................................................................................
Alamat : ..............................................................................................

2. IDENTITAS ORANG TUA

Nama : ..............................................................................................
Umur : .............................................................................................
Jenis kelamin : ..............................................................................................
Agama : ..............................................................................................
Pendidikan : ..............................................................................................
Pekerjaan : ..............................................................................................
Alamat : ..............................................................................................

3. RIWAYAT PERTUMBUHAN DAN PERKEMBANGAN

A. Persoal sosial/kemandirian bergaul
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B. Motorik halus
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C. Bahasa
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D. Motorik kasar
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4. PERMAINAN YANG DISUKAI DI RUMAH
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5. RIWAYAT PENYAKIT DAHULU DAN SEKARANG
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6. RIWAYAT KEHAMILAN, PERSALINAN, DAN NIFAS
A. Kelahiran
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B. Persalinan
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C. Nifas
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7. PERMAINAN YANG DISUKAI DI RUMAH
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8. PERENCANAAN TERAPI BERMAIN
Tujuan Klasifikasi Alat/Sarana Aktivitas Waktu
Bermain
9. PELAKSANAAN TERAPI BERMAIN
Aktivitas Bermain Respon Anak

10. KESIMPULAN
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11. SARAN KEPADA ORANG TUA
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Mahasaiswa

1. ……………………………… (……………..)
2. ……………………………… (……………..)
3. ……………………………… (……………..)

Mengetahui,

Pembimbing Akademik Pembimbing Klinik

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