CATATAN HARIAN
PRAKTEK KERJA PROFESI APOTEKER (PKPA)
PROGRAM STUDI PROFESI APOTEKER
INSTITUT SAINS DAN TEKNOLOGI NASIONAL
JAKARTA
Nama Mahasiswa : ........................................................................
NPM : ........................................................................
Bidang PKPA : ........................................................................
Tempat PKPA : ........................................................................
Alamat Tempat PKPA : ........................................................................
Nama Pembimbing : ........................................................................
1. Tempat PKPA : ........................................................................
Telepon/HP : ........................................................................
2. ISTN : ........................................................................
Telepon/HP : ........................................................................
CATATAN HARIAN PKPA
Nama Unit : Hari Ke :
Kegiatan : Tanggal :
No. Uraian Kegiatan Lampiran Rincian Hasil/Kesimpulan :
Kegiatan No.
Saran :
Catatan Pembimbing :
Tanggal :
Peserta PKPA Preseptor Di Tempat PKPA
(................................................) (........................................................)
PROGRAM STUDI PROFESI APOTEKER
INSTITUT SAINS DAN TEKNOLOGI NASIONAL
LAMPIRAN RINCIAN PKPA
Nama Unit Kerja : Hari Ke :
Kegiatan : Tanggal :
Rincian Kegiatan No. :
Peserta PKPA : ......................................................Ttd .................................................Tgl.............................
Pembimbing Ditempat PKPA (Preseptor) : .......................................................Tgl...........................
PROGRAM STUDI PROFESI APOTEKER
INSTITUT SAINS DAN TEKNOLOGI NASIONAL
LEMBAR KONSULTASI PEMBUATAN LAPORAN Ttd Mahasiswa
Nama Mahasiswa / NPM : .................................................................../............................
Bidang : ................................................................................................
Tempat PKPA : ................................................................................................
Periode : Tanggal ...................................s/d.......................................
Pembimbing ISTN : ................................................................................................
TTD
No. Hari/Tanggal Uraian Catatan
Pembimbing
PROGRAM STUDI PROFESI APOTEKER
INSTITUT SAINS DAN TEKNOLOGI NASIONAL