Wa0016
Wa0016
DINAS KESEHATAN
UPTD RSUD SULTAN SYARIF MOHAMAD ALKADRIE
Jalan Komodor Yos Sudarso,Kode Pos 78113 Telp.(0561)8127667,Fax.(0561)6783038
E-mail : rsudssma@yahoo.com Website : http/ /www.rsudkotapontianak.com
A. BIODATA PESERTA
Nama :
Asal FK :
Tempat Tanggal lahir :
Periode Internsip di RS :
Periode Internsip di Puskesmas :
B. EVALUASI WAHANA RS
1. Sebelum Mengikuti Internsip, apa yang anda ketahui tentang RSUD Sultan Syarif
Mohammad Alkadrie?
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2. Selama mengikuti Program Internsip di Lingkungan RSUD Sultan Syarif Mohammad
Alkadrie, bagaimana penilaian anda tentang :
a. Pendampingan oleh Pendamping yang ditunjuk :
3. Setelah menyelesaikan internsip di lingkungan UPK Puskesmas Kec. Pontianak Timur, saran
dan masukan apa yang ingin anda sampaikan?
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PEMERINTAH KOTA PONTIANAK
DINAS KESEHATAN
UPTD RSUD SULTAN SYARIF MOHAMAD ALKADRIE
Jalan Komodor Yos Sudarso,Kode Pos 78113 Telp.(0561)8127667,Fax.(0561)6783038
E-mail : rsudssma@yahoo.com Website : http/ /www.rsudkotapontianak.com
4. Mengenai Kota Pontianak sebagai penyelengara Program Internsip Dokter Indonesia, saran
apa yang ingin anda sampaikan kepada Dinas Kesehatan Kota Pontianak?
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