KEMENTERIAN KESEHATAN RI

POLITEKNIK KESEHATAN KEMENKES SURABAYA

JURUSAN KEPERAWATAN
PROGRAM STUDI PENDIDIKAN PROFESI NERS
PROGRAM SARJANA TERAPAN
Jl.Mayjen.Prof.Dr.Moestopo No. 8C – 60280 Website : www.poltekkesdepkes-sby.ac.id
Telp. (031) 5038487 / Fax. (031) 5023956 E-mail : admin@poltekkesdepkes-sby.ac.id
Telp. (031) 5030379 / Fax. (031) 5030379

LEMBAR BIMBINGAN ASUHAN KEPERAWATAN

Nama :............................................................................................................................ ............

NIM :............................................................................................................................ ............
Tingkat/Semester :............................................................................................................................ ...........
Tahun Akademik :........................................................................................................................................
Periode Praktik Ke- :............................................................................................................................ ............
Ruangan/ Rumah Sakit :........................................................................................................................................
Kasus :............................................................................................................................ ............

Hari TTD CI TTD

No. Uraian Bimbingan
Tanggal/Jam Ruangan/Pendidikan Mahasiswa

Surabaya,........................................
CI Ruangan CI Pendidikan

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NIP. NIP.

Mengetahui,
Ketua Progam Studi

Adin Muafiro, S.ST., M.Kes

NIP . 197012171994032002