POLTEKKES TANJUNGKARANG KEMENKES RI KODE : FORM-PoltekkesTjk/C.002/..........

JURUSAN KEPERAWATAN TANJUNGKARANG TGL : Januari 2015

Formulir REVISI : 0
Berita Acara Praktik Klinik / Lapangan HALAMAN : 1 dari 1 Halaman

BERITA ACARA PRAKTIK KLINIK / LAPANGAN

TAHUN AKADEMIK ................./ ..................

Mata Kuliah : .............................................................................. Ruangan : ................................................................

Kode / SKS : .............................................................................. Hari / Jam : ................................................................
Pj. Mata Kuliah : .............................................................................. Kelas : ................................................................
Dosen Pembimbing : .............................................................................. Semester / Prodi : ST Keperawatan / Ners

Pukul Nama Paraf Ket

Jumlah
Minggu.. Dosen Dosen
Ke Tanggal Materi Mhs Wakil
Mulai Berakhir Pembimbin Pembimbin
Hadir Mhs
g g

UTS

UAS
Bandar Lampung, ........ / ........................ / 20.......

Prodi ST Keperawatan Tanjungkarang

Ketua,

Dr. Anita, M.Kep., Sp.Mat

NIP 196902101992122001
 POLITEKNIK KESEHATAN TANJUNGKARANG KEMENKES RI KODE : Format/PKTjk/J.Kep/03.2/1/2015
JURUSAN KEPERAWATAN TANJUNGKARANG TGL : Maret 2015
Formulir REVISI :
Daftar Hadir Bimbingan Klinik / Lapangan HALAMAN : 1 dari 1 Halaman

DAFTAR HADIR MAHASISWA

Mata Kuliah
Kode Mata Kuliah / Sks
Pj. Mata Kuliah
Dosen Pembimbing
BIMBINGAN PRAKTIK KLINIK / LAPANGAN
: ................................................................................................................. Ruangan : ...................................................................................................................
: ................................................................................................................. Kelas : ...................................................................................................................
: ................................................................................................................. Semester / Prodi : ............ / STr / Ners
: ................................................................................................................. Kelompok : ...................................................................................................................

No Nama Mahasiswa Tanggal

1

10

11

12

Paraf Dosen Pembimbing

Mengetahui Bandar Lampung, ........ / ........................ / 20.......

Prodi ST Keperawatan Tanjungkarang Dosen Pembimbing
Ketua,

.......................................................................................
Dr. Anita, M.Kep., Sp.Mat NIP .........................................................................
NIP 196902101992122001