YAYASAN PENDIDIKAN PAYUNG NEGERI PEKANBARU

SEKOLAH TINGGI ILMU KESEHATAN (STIKES)

PAYUNG NEGERI PEKANBARU
PROGRAM STUDI: 1. ILMU KEPERAWATAN 2. ILMU KESEHATAN MASYARAKAT
3. D III KEPERAWATAN 4. D III KEBIDANANA 5. PROFESI NERS
Jl.Tamtama No. 6 Labuh Baru- Pekanbaru, Riau Telp. (0761) 885214 Fax. (0761) 859162
Website: www.payungnegeri.ac.id Email: info@payungnegeri.ac.id

BERITA ACARA
UJIAN PROPOSAL

Pada hari ini .................... tanggal .............................bulan............. tahun....................... bertempat di

.......................................................... Telah dilaksanakan Ujian Proposal pada Mahasiswa Program Studi
............................................................. STIkes Payung Negeri Pekanbaru:

1. Nama : Muhamad Abdul Kodir

2. NIM : 163010077
3. Judul Penelitian : Pengaruh Modifikasi Lingkungan Rumah dengan Risiko Jatuh Pada
Lansia Di PSTW Khusnul Khotimah Pekanbaru

Kejadian-kejadian selama pelaksanaan Ujian:

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Pekanbaru,...............................................2020
Ketua Penguji, Penguji,

Ns. Sri Yanti, M.Kep, Sp.KepMB Veni Dayu Putri M.Si

Pembimbing,

Dr. Ezalina, S.Kep, Ns, M.Kes

 LAPORAN NILAI
UJIAN PROPOSAL

1. Nama : Muhamad Abdul Kodir

2. NIM : 163010077
3. Judul Penelitian : Pengaruh Modifikasi Lingkungan Rumah dengan Risiko Jatuh Pada
Lansia Di PSTW Khusnul Khotimah Pekanbaru
4. Hari/ Tanggal : .........................................................................................
5. Waktu Ujian : ........................................................................................

Hasil Ujian

No Dosen Penguji Nama Angka (Nilai)

1 Ketua Penguji

2 Penguji

3 Pembimbing

TOTAL

Nilai :

jumlah nilai
Jumlah Penguji

Keterangan :

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Pekanbaru,.....................................................2020
STIKes Payung Negeri Pekanbaru

Ns. Hj. DESWINDA, S.Kep, M.Kes