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KARTU KONSULTASI

PEMBIMBING AKADEMIK
KEPANITERAAN KLINIK
(dipegang Dosen PA)

Nama Dokter Muda : .............................................................................................................

NIM : .............................................................................................................

Periode : .............................................................................................................

Homebased : .............................................................................................................

No. Hari, tanggal Semester; Materi Tanda tangan


Tahun Ajaran konsultasi Dosen Dokter Muda
1.

2.

3.

4.

5.

Surakarta, ...........................................

Mengetahui,

Kepala Program Profesi Dosen Pembimbing Akademik


Kepaniteraan Klinik

.......................................... ..................................................

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