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F/006/004/R/00

KOMITE MEDIK
RSUP FATMAWATI

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PENILAIAN KREDENSIAL TAHAP 2

Nama Calon : ………………………………………………………………………………………………………………..


NIP/PTT : …………………………………………………………………………………………………………………
Kompetensi : Dokter Umum/Dokter Gigi/Dokter Spesialis ……………………………….
Penilai : …………………………………………………………………………………………………………………

Pengetahuan Ketrampilan Perilaku Etika Profesi


(Knowledge) (Skill) (Attitude)
(i) (ii) (iii) (iv)
Nilai
(0 s/d 100) ……………………….. ……………………….. ……………………….. ………………………..
Jumlah
(i)+(ii)+(iii)+(iv) ………………………………………………………………………………………………………………..
Nilai Akhir Jumlah (i)+(ii)+(iii)+(iv): 400 X 100 %

………………………………. %

Jakarta, ……………………..20…
Penilai,

(Dr. ………………………………………..)
Nilai :
80 -100 = A
76-79 = A-
73-75 = B+
70-72 = B
66-69 = B-
63-65 = C+
60-62 = C
56-59 = C-

Nilai Batas Lulus (NBL) ≥ 70