ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA -PROFESI

TANGGAL : .....................................................
TEMPAT : ....................................................

PROGRAM STUDI KEBIDANAN PROGRAM SARJANA

TERAPAN FAKULTAS KESEHATAN UNIVERSITAS
FORT DE KOCK BUKITTINGGI

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 IDENTITAS MAHASISWA

Pas Photo
2x3

Nama Mahasiswa ` : …………………………………….

NIM : ………………………………….....
Tempat/Tgl Lahir : ………………………………….....
Alamat : ………………………………….....
Telepon / Hp : ………………………………….....
Asal Institusi : .........................................................
Riwayat Pendidikan : .........................................................
..........................................................
..........................................................
Pengalaman Praktek Klinik :
..........................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
.......................................
Tanda tangan

____________

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 KATA PENGANTAR

Segala Puji dan Syukur, Kami panjatkan kehadirat Tuhan Yang Maha Esa,
karena berkat rahmat dan karunia-Nyalah. Buku Activity Of Daily Living (ADL)
ditujukan untuk segenap pihak yang berhubungan dengan proses pembelajaran klinis
kebidanan pada Program Studi Pendidikan Profesi Bidan Program Sarjana Terapan
Sekolah Tinggi Ilmu Kesehatan Fort De Kock Bukittinggi.
Buku Activity Of Daily Living (ADL) ini disusun untuk membantu
praktikan dalam membuat strategi kegiatan dan mendokumentasikan kegiatan yang
dilakukan selama praktek pra-profesi. Buku ini juga digunakan bagi institusi
pendidikan sebagai alat evaluasi bagi proses pembelajaran yang dilakukan praktikan
dan proses bimbingan yang dilakukan oleh para pembimbing klinik.
Kami menyadari bahwa tidak mungkin ada sebuah kesempurnaan yang dapat
dicapai manusia. Dengan keinginan yang kuat untuk terus memperbaiki isi dan
struktur buku ini. Kami sangat mengharapkan adanya masukan ataupun saran
terhadap isi maupun struktur buku ini.
Kami sangat berterima kasih pada segenap pihak yang telah bekerja keras
untuk menyelesaikan buku panduan dan tata tertib ini dan kepada seluruh pihak yang
senantiasa memberikan masukan ataupun sarannya untuk perbaikan buku panduan
dan tata tertib ini.
Semoga buku ini dapat bermanfaat bagi seluruh pihak yang menggunakannya.

Diketahui Bukittinggi,......................2021
Ka. Prodi Profesi Bidan Koordinator PL,

Febriyeni S.ST,M.Biomed Sari Ida Miharti, S.ST, M.Keb

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
Program Studi Kebidanan Program Sarjana Terapan
Universitas Fort De Kock Bukittinggi
 ACTIVITY OF DAILY LIVING (ADL)
PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,
Pembimbing Akademik,

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 ( )

ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,
Pembimbing Akademik,

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 ( )

ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,
Pembimbing Akademik

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 ( )
ACTIVITY OF DAILY LIVING (ADL)
PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,
Pembimbing Akademik,

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 ( )

ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,
Pembimbing Akademik,

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 ( )

ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,
Pembimbing Akademik,

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 ( )

ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,
Pembimbing Akademik,

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 ( )

ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 Pembimbing Akademik,

( )

ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 Diketahui,
Pembimbing Akademik,

( )

ACTIVITY OF DAILY LIVING (ADL)

PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 Diketahui,
Pembimbing Akademik,

( )
ACTIVITY OF DAILY LIVING (ADL)
PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 Diketahui,
Pembimbing Akademik,

( )

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 ACTIVITY OF DAILY LIVING (ADL)
PRAKTEK PRA-PROFESI

NAMA MHS :............................................

INSTITUSI :............................................
HARI/TANGGAL : ...........................................

NO KEGIATAN DIAGNOSA URAIAN/TERAPI TDD TDD

CI AKD

Diketahui,
Pembimbing Akademik,

( )

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 LEMBAR REFLEKSI PERASAAN

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 LEMBAR REFLEKSI PERASAAN

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 LEMBAR REFLEKSI PERASAAN

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
 LEMBAR REFLEKSI PERASAAN

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Program Studi Kebidanan Program Sarjana Terapan

Universitas Fort De Kock Bukittinggi
Program Studi Kebidanan Program Sarjana Terapan
Universitas Fort De Kock Bukittinggi