DAFTAR RIWAYAT HIDUP

I. KETERANGAN PERORANGAN

1 Nama Lengkap Evelina Kodrat

2 NIP 011003071
3 Pangkat dan golongan ruang /
4 Tempat Lahir/Tgl. Lahir Takengon, 16 Oktober 1972
5 Jenis Kelamin Wanita
6 Agama Katholik
7 Status Perkawinan Blm Menikah
8 Alamat rumah Green Ville blok AR-14 RT 006 RW 014 Kelurahan Duri Kepa Ke-
camatan Kebon Jeruk Jakarta Barat

II. PENDIDIKAN

1. Pendidikan di Dalam dan di Luar Negeri

No. Tingkat Nama Pendidikan Jurusan STTB/ Tanda Lu- Tempat

lus/Ijazah Tahun
1 S-1 Universitas Katholik Kedokteran Umum 25 Mei 2000 Jakarta
Indonesia Atma Jaya
2 S-1 Universitas Katolik At- Fakultas Kedokteran 25 Mei 2001 Jakarta
majaya
3 Spesialis I Universitas Indonesia Patologi Anatomik 2 Apr 2009 Jakarta
4 Spesialis I Universitas Indonesia Patologi Anatomik 29 Ags 2009 Jakarta
5 Spesialis II Kolegium Patologi In- Patologi Anatomik 16 Jul 2018 Jakarta
donesia
6 Spesialis II Kolegium Patologi In- Patologi Anatomik 16 Jul 2018 Jakarta
donesia Konsultan
7 - Kolegium Patologi In- Patologi Anatomik 15 Apr 2019 Jakarta
donesia
 2. Kursus/Latihan di Dalam dan di Luar Negeri
No. Nama/ Kursus/ Lamanya Ijazah/Tanda Tempat Keterangan
Latihan Tgl/Bln/Thn Lulus/Surat
s/d Tgl/Bln/Thn Keterangan
Tahun

III. RIWAYAT PEKERJAAN

1. Riwayat kepangkatan golongan ruang penggajian

Gol. Berlaku Surat Keputusan

No Pangkat Gaji Pokok
ruang terhi-
peng- tung
gajian mulai
tgl.
Nomor Tanggal
1 Penata Muda Tk. III/b 1 Apr 2.724.400 HK.02.02/IV.1-2 30 Mar 2016
I 2016 /0255/2016
2 Penata Muda Tk. III/b 1 Apr 2.724.400 HK.02.02/IV.1-2 30 Mar 2016
I 2016 /0255/2016
3 Penata III/c 1 Apr 3.172.300 KP.02.01/2/166 24 Feb 2020
2020 9/2020

2. Pengalaman Jabatan/Pekerjaan
Mulai Golongan Surat Keputusan
No Jabatan/ Pekerjaan Gaji Pokok
dan Ruang
Sampai Peng-
gajian
Nomor Tanggal
1 Pengajar 1 Mar KP.03.02/IV.3-2 28 Des 2018
2018 /008952/2018
2 Lektor 1 Ags 1627/UN2.R/SD 20 Jul 2020
2020 M.01.01/2020

IV. TANDA JASA/ PENGHARGAAN

No. Nama Bintang/Satya Lencana/ Tahun Perolehan Nama Negara/Instansi yang memberi
Penghargaan

V. PENGALAMAN
 1. SIMPOSIUM / SEMINAR / PANITIA

No. NAMA KEDUDUKAN / BLN / THN / INSTANSI TEMPAT

PERANAN PENYELENG- PENYELENG-
GARA GARA
1 Simposium Peserta 13 Mar 2004 Departemen Pa- Jakarta
Medikolegal dan tologi Anatomik
Panel Diskusi Aspek FKUI
Patologi
2 The Multidisci- Peserta 1 Des 2004 The Dutch Foun- Jakarta
plinary Cancer dation for Post-
Management of graduate Medical
Solid Tumors: To- Course, Faculty
day and Tomorrow of Medicine Uni-
versitas Indoen-
sia, Cipto Man-
gunkusumo Gen-
eral Hospital.
3 15th Conference of Peserta 21 Ags 2005 PERHIMPUNAN Jakarta
Asian Pacific Associ- PENELITI HATI
ation for the Study INDONESIA
of the Liver (APASL)
4 15th National Peserta 25 Ags 2006 IAPI Semarang
Congress of Indone-
sian Association of
Pathologists: Molec-
ular Pathology From
Basic Science to
Clinical Application
5 Research Poster Peserta 18 Mar 2009 FKUI Jakarta
Competition 2009
6 Kursus Lanjut Pa- Peserta 13 Des 2009 The Interna- Jakarta
tologi Paru dan Pro- tional Academy
stat of Pathology,
Indonesian Divi-
sion
7 Recent Advances Panitia 10 Mei 2010 Departemen Pa- Jakarta
in Pathology: From tologi Anatomik
Morphology to FKUI
Molecular Diagnos-
tic
8 Recent Advances Peserta 10 Mei 2010 Departemen Pa- Jakarta
in Patholoy: From tologi Anatomik
Morphology to FKUI
Molecular Diagnos-
tic
9 Seminar Dosen Peserta 24 Ags 2010 Unit Pendidikan Jakarta
Klinik, Work- Kedokteran FKUI
shop Mini CEX &
Workshop Bedside
Teaching
10 Asialink Interna- Peserta 27 Nov 2010 AsiaLink Bali
tional Conference
on Clinical Epi-
demiology and
Evidence-Based
Medicine in Global
Perspective
11 Clinical Epidemiol- Peserta 27 Nov 2010
ogy and Evidence-
Based Medical in
Global Perspective
12 Pelatihan Peserta 18 Jan 2011 FKUI Jakarta
Penyusunan Ran-
cangan Pengajaran
13 Symposium & 9th Peserta 25 Feb 2011 PERTUMSI Medan
Grand Round Mus-
culoskeletal Tumor
14 A CHALLENGE FOR Peserta 7 Apr 2011 CEEBM, FKUI- Jakarta
US: Migration Path RSCM
to Electronic Medi-
cal Record
15 Kursus Lanjut Pa- Peserta 1 Mei 2011 Kolegium Pa- Jakarta
tologi Kulit tologi Indonesia-
Perhimpunan
Dokter Spesialis
Patologi Indone-
sia
16 Indonesia Advanced Peserta 18 Jun 2011 Departemen Pa- Jakarta
Immunohistochem- tologi Anatomik
istry Wet Workshop FKUI dan
2011 Indonesian
Anatomical
Pathologist Asso-
ciation
17 Indonesian Ad- Panitia 18 Jun 2011 Departemen Pa- Jakarta
vanced Immuno- tologi Anatomik
histochemistry Wet FKUI & Indone-
Workshop 2011 sian Anatomical
Pathologist Asso-
ciation
18 Working Conference Peserta 22 Sep 2011 Indonesian Asso- Bandung
XII-Annual Scien- ciation of Pathol-
tific Meeting 2011: ogist
Quality Improve-
ment in Pathological
Diagnostics through
Empowering Hu-
man Resource and
Better Procedure
19 ABCD Der- Peserta 8 Okt 2011 Asian Academy of Kuala Lumpur,
matopathology Dermatology and Malaysia
course 1/2011 Venereology
20 Workshop Pem- Peserta 20 Okt 2011 FKUI Jakarta
bimbingan Skripsi
Mahasiswa
21 Symposium & Peserta 16 Des 2011 PERTUMSI Solo
Workshop 10th
Grand Round Mus-
culoskeletal Tumor
22 Simposium Der- Peserta 6 Jan 2012 PERDOSKI - De- Jakarta
matopatologi dalam partemen Kulit
Praktik Sehari-Hari dan Kelamin
FKUI/RSCM
23 Kursus Lanjut Pa- Peserta 16 Apr 2012 Kolegium Pa- Jakarta
tologi Tulang dan tologi Indonesia,
Jaringan Lunak IAPI, IAP Indone-
sian Division
24 11th Grand Round Peserta 1 Sep 2012 PERTUMSI Banjarmasin
Musculoskeletal Tu-
mor
25 29th Congress of Peserta 1 Okt 2012 IAP International Cape Town, South
The International Africa
Academy of Pathol-
ogy
26 Kursus & Slide Peserta 8 Nov 2012 Departemen Pa- Jakarta
Seminar Patologi tologi Anatomik
Penyakit infeksi FKUI/RSCM -
Tropikal IAP Indonesia
Division
27 Kursus & Slide Panitia 8 Nov 2012 Departemen Pa- Jakarta
Seminar Patologi tologi Anatomik
Penyakit Infeksi FKUI/RSCM -
Tropikal IAP Indonesian
Division
28 in Pulmonary, Gy- Peserta 5 Apr 2014
naecological and
Bone/Soft Tissue
Pathology at the
Spring Scientific
Meeting 2014
29 Cytomorphology, Peserta 12 Mei 2014
Ancillary Testing
And Moleculer
Pthology Applica-
tions
30 on Immunohis- Peserta 15 Nov 2014
tochemistry &
Moleculer Meth-
ods in Diagnostic
Pathology at the Fall
Scientific Meeting
2014
31 The 13th. Grand Peserta 9 Jan 2015
Round Muscu-
loskeletal Tumor
32 POSTER PRESEN- Peserta 21 Ags 2015
TER Symposium the
23rd Asia Pacific
Cancer Conference (
APCC ) 2015
33 Penuji OSCE ujian Penguji 29 Ags 2015
kompetensi ma-
hasiswa program
profesi dokter
34 Symposium & Wrk- Peserta 2 Okt 2015
shop 14 th GRAND
ROUND MUS-
CULOSKELETAL
TUMOR
35 Bone & Soft Tissue Peserta 1 Jan 2016
Pathology Clinical &
Research fellowship
36 THE INTERNA- Anggota 22 Feb 2016
TIONAL ACADEMY
OF PATHOLOGY IN-
DONESIA DIVISION
37 PathVysion System Peserta 22 Ags 2016
Training
38 Soft Tissue Tu- Peserta 12 Nov 2016
mours and Der-
matopathology at
the fall Scientific
Meeting 2016
39 Annual Scientific Peserta 24 Apr 2017
Meeting-Indonesia
Association of
Pathologists (ASM-
IAPI)and Asia Pa-
cific Society OF
Molekuler Immuno-
histology ( APSMI
)
40 Annual Scientific Moderator 24 Apr 2017
Meeting-Indonesia
Association of
Pathologists (ASM-
IAPI)and Asia Pa-
cific Society OF
Molekuler Immuno-
histology ( APSMI
)
41 Annual Scientific Pembicara 24 Apr 2017
Meeting-Indonesia
Association of
Pathologists (ASM-
IAPI)and Asia Pa-
cific Society OF
Molekuler Immuno-
histology ( APSMI
)
42 Lokakarya I kuriku- Peserta 20 Nov 2017
lum program pen-
didikan dokter
43 Musculoskeletal Peserta 20 Sep 2018
pathology work-
shop. The 19th
nasional congress
& annual meeting
IAPI & INA IAP in
conjunction with
APSMI
44 The 19th National Peserta 20 Sep 2018
Congress & Annual
Meeting IAPI-INA
IAP in conjunction
with APSMI an-
nual meeting 2018.
"Molecular testing
and multidisci-
plinary approach in
diagnostic pathol-
ogy within the
health system"
45 The 59th IAP Thai- Peserta 6 Nov 2019
land annual meet-
ing 2019

2. PUBLIKASI

No JUDUL PERAN(Jmlah Anggota) TAHUN KETERANGAN

1 Gambaran Histopa- Peneliti Utama (0) 2005 Terbit di Majalah Pa-
tologik tumor sel datia tologi Indonesia Volume
tulang (Giant Cell 14 No. 2, April 2005.
Tumor of the Bone):
Evelina
2 Korelasi antara ak- Peneliti Utama (3) 2009 https://sipeg.ui.ac.id/ng/arsip
tivitas proliferasi dan Cat-
indeks apoptosis 8c2eb339da7b21ab90982ab00
dengan subtipe his-
tologik, ukuran dan
lokasi tumor pada
rabdomiosarkoma em-
brional (RMSE) anak.
Evlina, Rino, Nurjati
3 Korelasi antara Ak- Peneliti Utama (2) 2009
tivitas Proliferasi dan
Indeks Apoptosis den-
gan Subtipe Histologik,
Ukuran, dan Lokasi
Tumor pada Rhab-
domiosarkoma Embri-
onal Anak: Evelina,
Nurjati Chaerani Sire-
gar, Rino Patiatta
4 Asosiasi Antara Ek- Peneliti Utama (1) 2012 https://sipeg.ui.ac.id/ng/arsip
spresi Epidermal Cat-
Growth Factor Recep- 976daf4b692770f7b34d1e8849
tor (EGFR) dengan
Angka Kesintasan
pada Karsinoma Sel
Ginjal Subtipe Sel
Jernih. evelina, meila-
nia, budiana tanu-
rahardja,lisnawati,
chaidir
5 Efficacy of Intravitreal
Levofloxacin 0.5
6 The Effect of Bone Anggota (4) 2013 Journal of Indonesian
Morphogenetic Protein- Orthopaedic, Volume 41
2 and Hydroxyapatite Number 1, April 2013
Granules on the Incor-
poration of Autoclaved
Femoral Autografts in
Sprague- Dawley Rats
7 Lipoblastoma and Anggota (8) 2014 Case Report in Or-
Lipoblastomatosis of thopaedics, Volume
the Lower Leg 2014, Article ID 582876,
6 pages
8 Pengaruh Autoclave Anggota (4) 2014 Indonesian Journal of
terhadap Properti Cancer Volume 8, Nomor
Fisik dan Histopa- 1, Januari- March 2014
tologi Tulang : Se-
buah Penelitian dasar
Rekonstuksi.
9 A Modified Buttockec- Anggota (4) 2015 https://indonesianjournalofcan
tomy as a Limb Salvage journal/index.php/ijoc/article/
Procedure in Ischium
Osteosarcoma: A
Case Report ACHMAD
FAUZI KAMAL1, YOSHI
PRATAMA DJAJA1,
EVELINA KODRAT2,
THARIQAH SALAMAH3
10 Embryonal Rhab- Anggota (5) 2015 http://journal.ui.ac.id/index.p
domyosarcoma of The
Forearm: A Diagnostic
Dilemma and Sur-
gical Management.
Achmad F Kamal,
Wahyu Widodo, Adrian
Situmeang, Evelina
Kodrat, Marcel Prase-
tyo
11 Role of Sildenafil in Ac- Anggota (4) 2015 British Journal
celeration of Delayed of Medicine 7
Union Fracture Healing Medical Research
on Sprangue - Dawley 8(5):419-428,Article
Rats Model no.BJMMR.2015.464.
ISSN:2231-0614
12 A Modified Buttockec- Anggota (4) 2016 Indonesian Journal of
tomy as a Limb Sal- Cancer Volume 9 Num-
vage Procedure in Is- ber 2, April 2015
chium Osteosarcoma :
A Case Report
13 Management of aggres- Anggota (4) 2016 International Journal
sive giant cell tumor of of Surgery Case Re-
calcaneal bone: A case port 28 (2016 ) 176
report -181. Link hardcopy:
https://sipeg.ui.ac.id/ng/arsip
Cat-
b6e45b4ca8b318bb37878c28cc
Link website:
https://www.sciencedirect.com
14 Comparison of Re- Anggota (4) 2017 http://www.journalarrb.com/in
generation between
Human Bone Marrow
and Adipose Mes-
enchymal Stem Cells
on Treatment of Criti-
cal Size Bone Defect in
Sprague Dawley Rats.
Ismail Hadisoebroto
Dilogo, Bagus Praman-
tha, Evelina Kodrat,
Ria Anggraini
15 Comparing the Effec- Anggota (6) 2018 https://www.ecronicon.com/ec
tiveness of Intravit- 09-00282.pdf
real Levofloxacin and
Ceftazidime in Exper-
imental Pseudomonas
aeruginosa Endoph-
thalmitis. Elisabeth
Irma DK1, Lukman
Edwar1, Rianto Se-
tiabudy2, Anis Karuni-
awati3,Evelina Kodrat4
and Made Susiyanti1*
16 Post-operative Radio- Anggota (4) 2018 Poster FARO MEETING
therapy for Pigmented 2018
Villonodular Synovi-
tis : a Case Report.
Yuki Andrianto1, Ir-
wan Ramli2, Evelina3,
Ahmad Fauzi Kamal4
17 Telangiectatic Os- Anggota (3) 2018 18th Gradround os Mus-
teosarcoma in Elderly culoskeleteal Oncology
Patient : a Case Report
18 Epithelioid Osteoblas- Anggota (8) 2019 https://www.ncbi.nlm.nih.gov/
toma of the Tempo-
ral Bone: A Case
Report. Attiah M1,
Tucker AM1, Perez-
Rosendahl M2, Niu T1,
Nagasawa DT1, Kodrat
E2, Martin NA1, Nelson
S3.
19 Peran Isocitrate Dehy- Anggota (3) 2019 http://majalahpratistapatologi.
drogenase (IDH) pada
Kondrosarkoma. In-
eke Anggreani, Evelina
Kodrat, Puspita Eka
Wuyung
20 Peran Pulasan Imuno- Anggota (3) 2019 http://majalahpratistapatologi.
histokimia H3K27me3
dalam Diagnosis Malig-
nant Peripheral Nerve
Sheath Tumor. William
Yordana, Evelina Ko-
drat, Kusmardi Kus-
mardi
21 Brown tumors of hy- Anggota (4) 2020 Link website:
perparathyroidism https://www.sciencedirect.com
misdiagnosed as mul- Link hardcopy:
tifocal Giant Cell https://sipeg.ui.ac.id/ng/arsip
Tumors of bone: A case Cat-
report. Achmad Fauzi 54d3a1359037aba507c340b12
Kamal, Putri Amalia
Isdianto, Ali Abdul-
lah, Evelina Kodrat.
Human Pathology:
Case Reports, Volume
21, September 2020,
200385
22 ORBITAL IGG4- Anggota (3) 2020 https://novapublishers.com/sh
RELATED DISEASE: case-reports/
THE FIRST CASE
DIAGNOSED AT
DR. CIPTO MAN-
GUNKUSUMO NA-
TIONAL GENERAL
HOSPITAL INDONESIA
Stella Marleen, Endang
S. R. Hardjolukito* and
Evelina Kodrat
23 Parosteal Osteosar- Anggota (6) 2020 https://www.hindawi.com/jour
coma: A Benign-
Looking Tumour,
Amenable to a Variety
of Surgical Reconstruc-
tion. Yogi Prabowo ,1
Achmad Fauzi Kamal
,1 Evelina Kodrat ,2
Marcel Prasetyo ,3
Samuel Maruanaya ,1
and Toto Suryo Efar.
24 PRIMARY MALIG- Anggota (5) 2020 Case Reports in Surgery,
NANT GIANT CELL ISBN: 978-1-53616-582-
TUMOR OF PROXIMAL 1, 2020 Nova Science
RIGHT TIBIA: A RARE Publishers, Inc
CASE REPORT. Mirna
Albertina Wijaja1,
Nurjati Chairani Sire-
gar1, Evelina Kodrat1,
Yogi Prabowo2 and
Thariqah Salamah3
25 Reconstruction of Anggota (3) 2020 Link web-
osteosarcoma of the site:https://www.sciencedirect.
proximal tibia using Link hardcopy:
bone on polyethylene https://sipeg.ui.ac.id/ng/arsip
hemiarthroplasty knee Cat-
joint system: A case 5c9d5e982094e12dc6f8c3f3818
report. YogiPrabowoa-
Muhammad Rizqi
AdhiPrimaputraaEveli-
naKodratb. Inter-
national Journal of
Surgery Case Reports
Available online 21
May 2020
26 Effectiveness of gran- Anggota (0) 2021 https://www.sciencedirect.com
ulocyte colony stimu-
lating factor to en-
hance healing on de-
layed union fracture
model Sprague-Dawley
rat. Aryadi Kurniawan,
Evelina Kodrat, Yogi Is-
mail Gani

3. PENELITIAN / RISET

No. PENELITIAN - KET - INSTANSI/MITRA WAKTU RISET PENELITI

VI. Keterangan Keluarga

1. Isteri/Suami

No Nama Tempat Tanggal Tanggal Pekerjaan Keterangan

Lahir Lahir Nikah

2. Anak

No Nama Jenis Tempat Tanggal Pekerjaan Keterangan

Kelamin Lahir Lahir

3. Bapak dan Ibu Kandung

No Orang Tua Nama
1 Bapak
2 Ibu

Demikian Daftar Riwayat Hidup ini saya buat dengan sesungguhnya, dan apabila dikemudian hari
terdapat keterangan yang tidak benar, saya bersedia dituntut di muka pengadilan serta bersedia menerima
segala tindakan yang diambil oleh Pemerintah.
Depok, 20 Juni 2022
Yang membuat,

(Evelina Kodrat)