BERITA ACARA

PELAKSANAAN LONG CASE

PROFESI STASE GADAR DAN KRITIS

Padahari............................tanggal......................bulan.......................tahun.......................................
...................................................... bertempat di ruang ICU RSUD Abdul Wahab Sjaharanie
Samarinda telah dilaksanakan Long Case stase gadar dan kritis tahun
akademik ........................................

Jumlah mahasiswa :........................................

Jumlah yang hadir :........................................
Jumlah yang tidak hadir :........................................

Catatan Pembimbing Akademik selama pelaksaan Long Case

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

Catatan Pembiming Klinik selama pelaksaan Long Case

...........................................................................................................................................................................................
...........................................................................................................................................................................................
...........................................................................................................................................................................................
Demikian berita acara ini dengan sesungguh-sungguhnya dan digunakan sebagaimana mestinya.

Balikpapan, .......................................2021

Pembimbing Akademik Pembimbing Klinik

(......................................................) (....................................................................)

(......................................................)
Lampiran :

LONG CASE STASE GADAR KRITIS

PROGRAM PROFESI NERS ITKES WIYATA HUSADA
SAMARINDA 2020/2021

No Nama Mahasiswa Asal instansi

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 BERITA ACARA
PELAKSANAAN LONG CASE
PROFESI STASE GADAR DAN KRITIS

Padahari............................tanggal......................bulan.......................tahun.......................................
...................................................... bertempat di ruang ICCU RSUD Abdul Wahab Sjaharanie
telah dilaksanakan Long Case stase gadar dan kritis tahun akademik ........................................

Jumlah mahasiswa :........................................

Jumlah yang hadir :........................................
Jumlah yang tidak hadir :........................................

Catatan Pembimbing Akademik selama pelaksaan Long Case

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

Catatan Pembiming Klinik selama pelaksaan Long Case

...........................................................................................................................................................................................
...........................................................................................................................................................................................
...........................................................................................................................................................................................
Demikian berita acara ini dengan sesungguh-sungguhnya dan digunakan sebagaimana mestinya.

Balikpapan, .......................................2021

Pembimbing Akademik Pembimbing Klinik

(......................................................) (....................................................................)

(......................................................) (...................................................................)
Lampiran :

LONG CASE STASE GADAR KRITIS

PROGRAM PROFESI NERS ITKES WIYATA HUSADA
SAMARINDA 2020/2021

No Nama Mahasiswa Asal instansi

1
2
3
4
5
6
7
dst
 BERITA ACARA
PELAKSANAAN LONG CASE
PROFESI STASE GADAR DAN KRITIS

Padahari............................tanggal......................bulan.......................tahun.......................................
...................................................... bertempat di ruang IGD RSUD Abdul Wahab Sjaharanie
telah dilaksanakan Long Case stase gadar dan kritis tahun akademik ........................................

Jumlah mahasiswa :........................................

Jumlah yang hadir :........................................
Jumlah yang tidak hadir :........................................

Catatan Pembimbing Akademik selama pelaksaan Long Case

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

Catatan Pembiming Klinik selama pelaksaan Long Case

...........................................................................................................................................................................................
...........................................................................................................................................................................................
...........................................................................................................................................................................................
Demikian berita acara ini dengan sesungguh-sungguhnya dan digunakan sebagaimana mestinya.

Balikpapan, .......................................2021

Pembimbing Akademik Pembimbing Klinik

(......................................................) (....................................................................)

(......................................................) (...................................................................)
 (...................................................................)

Lampiran :

LONG CASE STASE GADAR KRITIS

PROGRAM PROFESI NERS ITKES WIYATA HUSADA
SAMARINDA 2020/2021

No Nama Mahasiswa Asal instansi

1
2
3
4
5
6
7
dst