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KODE : FORM-PoltekkesTjk/C.002/..........

POLTEKKES TANJUNGKARANG KEMENKES RI


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 : D III Keperawatan

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 D III Keperawatan Tanjungkarang


Ketua,

Ns. Musiana, S.Kep., M.Kes.


NIP 197404061997032001
KODE : Format/PKTjk/J.Kep/03.2/1/2015
POLITEKNIK KESEHATAN TANJUNGKARANG KEMENKES RI TGL : Maret 2015
Formulir REVISI :
Daftar Hadir Bimbingan Klinik / Lapangan HALAMAN : 1 dari 1 Halaman

DAFTAR HADIR MAHASISWA


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

No Nama Mahasiswa Tanggal


1

10

11

12

Paraf Dosen Pembimbing

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


Prodi D III Keperawatan Tanjungkarang Dosen Pembimbing
Ketua,

.......................................................................................
Ns. Musiana, S.Kep., M.Kes. NIP .........................................................................
NIP 197404061997032001

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