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Nomor Ijazah Nasional (Diploma Number) :

Nomor SKPI (Diploma Suppliment Number) :

POLITEKNIK KESEHATAN KEMENTERIAN KESEHATAN BANJAR


STATUS AKREDITASI : TERAKREDITASI B
Berdasarkan Keputusan BAN-PT No. 471/SK/BAN-PT/Akred/PT/XII/2018

Surat Kelerangan Pendamping ljazah (SKPI) adalah pelengkap ijazah yang menerangkan pencapaian aka
kualifikasi
The Diploma dariSupplement
pemegang ijazah.
accompanies a higher edducation diploma providing a description of the academ
achievement or qualification of its holder.
A IDENTITAS DIRI PEMEGANG SKPI
Identity of Diploma Supplement Holder

1 Nama :
Name
2 Tempat, Tanggal Lahir :
Place and Date of Birth
3 Nomor Induk Mahasiswa :
Student Number
4 Tanggal Masuk :
Date of Enrollment
5 Tanggal Kelulusan :
Date of Completion
6 Gelar :
Degree

B IDENTITAS PENYELENGGARA PROGRAM


Identity of Institution

1 Jurusan :
Department
2 Program Studi :
Study Program
3 Akreditasi Program Studi :

Study Program Acreditation


4 Jenis Pendidikan :
Type of Education
5 Program Pendidikan Tinggi :
Program of Education
6 Peringkat Kompetensi sesuai dengan KKNI :
Level in Indonesian Qualification Framework (IQF)
7 Bahasa Pengantar Kuliah :
Language of Instruction
8 Sistem Penilaian :
Grading System
9 Jenis dan Jenjang Pendidikan Lanjutan :
Type and Program of Further Higher Education

C INFORMASI TENTANG KUALIFIKASI DAN HASIL YANG DICAPAI


Information of Qualification and Learning Outcome

Capaian Pembelajaran
Learning Outcomes

Sarjana Terapan
(KKNI LEVEL 6)

1 SIKAP
1.1 Bersikap etis, profesional, bertanggungjawab terhadap keamanan dan
kenyamanan pasien (patient safety).
1.2 Bertanggung jawab terhadap kualitas proses setiap tahapan
pemeriksaan laboratorium kesehatan, untuk menjamin validitas hasil
pemeriksaan laboratorium kesehatan.
1.3 Bertanggung jawab terhadap hasil dan kerahasiaan laboratorium
sesuai kode etik profesi.
1.4 Memiliki integritas yang tinggi dalam komunikasi pada pelayanan
laboratorium kesehatan.
1.5 Bertanggungjawab terhadap hasil pengumpulan dan pengolahan data
secara deskriptif pada penelitian dasar dan terapan bidang kesehatan.

2 KETERAMPILAN UMUM
Bertanggungjawab pada pekerjaan sendiri dan dapat diberi tanggungjawab
atas pencapaian hasil kerja kelompok.
2.1 Menguasai perencanaan. Pengelolaan dan pengendalian mutu
kegiatan laboratorium kesehatan dalam lingkup kecil.
2.2 Menguasai penyusunan, pelaporan hasil pemeriksaan laboratorium
kesehatan.
2.3 Mampu bekerjasama dalam tim mengelola tim kecil dan menjadi
tenaga kesehatan.
2.4 Menguasai kewirausahaan dalam bidang teknis layanan laboratorium
kesehatan.

3 PENGUASAAN PENGETAHUAN
Menguasai konsep teoritis bidang pengetahuan tertentu secara umum dan
konsep teoritis bagian khusus dalam bidang pengetahuan tersebut secara
mendalam, serta mampu memformulasikan penyelesaian masalah prosedural.
3.1 Menguasai pengetahuan tentang anatomi dan fisiologi tubuh manusia.
3.2 Menguasai pengetahuan tentang metode analisis laboratorium bidang
kimia klinik, hematologi, imunoserologi, bakteriologi, virologi, mikologi,
parasitologi, sitohistoteknologi, toksikologi, analisis air, analisis kimia
makanan dan minuman, dan biomolekuler menggunakan instrumentasi
sederhana dan otomatis secara terampil.
3.3 Menguasai konsep pengendalian mutu hasil pengujian laboratorium
medis.
3.4 Menguasai konsep dan teknik komunikasi dan promosi kesehatan.
3.5 Menguasai konsep metodologi penelitian dan statistika, teknik
pengumpulan data dan pengolahannya.

4 KETERAMPILAN KHUSUS
Mampu mengaplikasikan bidang keahliannya dan memanfaatkan ilmu
pengetahuan, teknologi, dan/atau seni pada bidangnya dalam penyelesaian
masalah
4.1 serta mampu
Mampu beradaptasi
melakukan terhadap
pengambilan dan situasi yang dihadapi.
penanganan spesimen untuk
pemeriksaan laboratorium kesehatan untuk mendapatkan sampel yang
representatif dengan menerapkan patient safety.
4.2 Mampu melakukan pemeriksaan laboratorium kesehatan di bidang
kimia klinik, hematologi, imunoserologi, imunohematologi, bakteriologi,
virologi, mikologi, parasitologi, sitohistoteknologi, toksikologi, analisis
air, analisis kimia makanan dan minuman, serta biomolekuler dengan
menggunakan instrumen sederhana dan otomatis secara terampil
dengan menerapkan kesehatan dan keselamatan kerja.
4.3 Mampu melakukan tindakan pencegahan terjadinya kesalahan teknik
laboratorium medis dan mampu memecahkan masalah teknis
pemeriksaan laboratorium kesehatan.
4.4 Mampu menyampaikan informasi pelayanan laboratorium kesehatan
melalui komunikasi secara efektif baik interpersonal maupun
profesional kepada pasien, teman sejawat, klinisi dan masyarakat.
4.5 Mampu melakukan pengumpulan dan pengolahan data secara
deskriptif dan analitik pada penelitian dasar dan terapan di bidang
laboratorium medik.
D Kerangka Kalifikasi Nasional Indonesia
Indonesian Qualification Framework
● Kerangka Kualifikasi Nasional (KKNI) adalah penjenjangan capaian
yang menyetarakan, luaran pendidikan formal, non formal, informal
atau pengalaman kerja dalam rangka pengakuan kompetensi kerja
sesuai dengan struktur pekerjaan di berbagai sektor. Jenjang
kualifikasi adalah tingkat capaian pembelajaran yang disepakati secara
nasional, disusun berdasarkan ukuran hasil pendidikan dan atau
pelatihan yang diperoleh melalui pendidikan formal, non formal,
informal, atau pengalaman kerja.
● KKNI merupakan perwujudan mutu dan jatI diri Bangsa Indonesia
terkait dengan sistem pendidikan dan pelatihan nasional yang dimiliki
Indonesia. KKNI terdiri dari 9 (sembilan) jenjang kualifikasi, dimulai dari
Kualfikasi-1 sebagai kualifikasi terendah dan Kualfikasi-9 sebagai
kualifikasi tertinggi.
● Jenjang kualifikasi adalah tingkat capaian pembelajaran yang
disepakati secara nasional, disusun berdasarkan ukuran hasil
pendidikan dan/atau pelatihan yang diperoleh melalui pendidikan
formal, nonformal atau pengalaman kerja.

E Prestasi/Penghargaan
Achievement
1 KURIKULER
1.1 Pengenalan Kehidupan Kampus Mahasiswa Baru (PKKMB) 2018
1.2 Peserta Praktik Kerja Nyata Kesehatan (PKN Kes) di UPT Puskesmas
Astambul Tahun 2021
Peserta Praktik Kerja Lapangan (PKL) di Instalasi Laboratorium
1.3
Patologi Klinik RSUD Ulin Banjarmasin Tahun 2022
2 KOKURIKULER
2.1 Peserta Latihan Dasar Kepemimpinan Mahasiswa (LDKKM) Jurusan
Analis Kesehatan Tahun 2018
2.2 Peserta Kegiatan Training Motivasi dengan Tema “It’s Not How Good
You Are, It’s How Good You Want To Be”
2.3 Peserta Kegiatan PERSAMI ( Perkemahan Sabtu-Minggu)
2.4 Peserta Seminar Kesehatan Nasional dalam Rangka HKN 2018
dengan Tema “Peran Dan Tanggung Jawab Tenaga Kesehatan Dalam
Memberikan Penatalaksanaan Penyakit HIV/AIDS

2.5 Peserta Lomba Poster Nasional “Nuclear Science Competition 2018”

2.6 Peserta Lomba Esai HUT Visi Teliti Seksama

2.7

2.8 Peserta Mentoring Kerohanian Islam

2.9

2.10 Panitia Diesnatalis Poltekkes Kemenkes Banjarmasin Ke-18 “Gemilau


Generasi Muda Menginspirasi”

2.11 Tim Pemantik Aksi Serentak Peringatan Hari Kesaktian Pancasila oleh
Forkompi Indonesia

2.12 Peserta Kongres Nasional Forkompi ke VIII “Hamemayu Hayuning


Peseduluran Ing Bumi Kabudayaan”
2.13 Peserta Seminar Kesehatan Nasional “Tantangan Tenaga Kesehatan
di Era Industri 4.0”
2.14 Peserta Seminar PATELKI “Peranan Ahli Teknologi Laboratorium
Medik (ATLM) Terhadap Teknologi Dan Keilmuan Dalam Era
Globalisasi”
2:15

2.16

2.17 Peserta Kegiatan Seminar Hasil Penelitian PKM


2.18

2.19 Panitia Kegiatan Pengenalan Kehidupan Kampus Mahasiswa Baru


(PKKMB)

2.20

2.21 Koordinator Seksi Kesekretariatan LDKM “BRAVE (Brilliant,


Responsive, Active, Valuable, Empathy)

2.22 Panitia Kegiatan Seminar Bela Negara “Pembangunan Kesehatan


Dalam Upaya Bela Negara”
2.23 Peserta Seminar Nasional “ Peran ATLM dalam Diagnosa Dini Kanker”

2.24

2.25 Peserta Kegiatan Webinar Laboratory Service in Covid-19 Pandemic


2.26 Peserta Webinar Rapid Test Vs PCR dan Pengendalian Covid-19
2.27 Peserta Webinar “Kenali Metode Pemeriksaan COVID-19 dan Peran
Teknologi Laboratorium Medis di Masa Kebiasaan Baru”

2.28 Panitia Kegiatan Serah Terima Jabatan BEM


2.29

2.30

2:31 Peserta Webinar Nasional dengan Tema “Peranan ATLM Dalam


Pelayanan Bank Darah Dalam Mengatasi Infeksi Menular Melalui
Transfusi Darah (IMLTD)”
2.32 Peserta Webinar PATELKI dengan Tema “Maintain Standar of Patient
Care Through the QC Program”
2.33 Peserta Webinar PATELKI dengan Tema “Pengembangan SDM
Menyongsong Trend Teknologi Laboratorium di Era Telemedicine”

2.34 Peserta Webinar Internasional dengan Tema “What We Know to


Combat COVID-19”
2.35 Peserta Webinar PATELKI dengan Tema “Molecular Diagnostic Test
for Coronavirus Disease and SARS-COV2 New Variant”
3 EKSTRA KURIKULER
3.1 Panitia Try Out Sipenmaru 2019 “Prepare Yourself for The Test adn
Reach Your Dream to be The Best”
3.2 Pelaksana Lapangan Kegiatan Sosialisasi Kampus 2019 “Change Your
Life Today. Don’t Gamble on the Future. Act now, Without Delay”
3.3 Panitia Kegiatan Expo Pada Stand Poltekkes Kemenkes Banjarmasin

3.4 Ketua Pelaksana Kegiatan Seminar dan Pelatihan Jurnalisitik


“Membangun Banua Ciptakan Jurnalis Muda”
3.5 Panitia Kegiatan Hari Danus Nasional ke 55 “Generasi Sehat,
Indonesia Unggul”

3.6 Panitia Kegiatan Hari Danus Nasional ke 55 “Generasi Sehat,


Indonesia Unggul”
3.7 Panitia Peserta Lomba Essay “Pekan Karya, Prestasi Milenial Kala
Pandemi”

3:08 Ketua DPW Wilayah Kalimantan Selatan IMATELKI

3:09

F Sertifikat Keahlian
Certificate of Recognition

Ditetapkan di Banjarbaru pada tanggal 2022


Issued in Banjarbaru on 2022

Direktur
Director

Dr. H. Mahpolah, M.Kes


NIP. 196310161988031001
05164/SKPI/S.Tr.TLM/405022/2022

KEMENTERIAN KESEHATAN BANJARMASIN


REDITASI : TERAKREDITASI B
N-PT No. 471/SK/BAN-PT/Akred/PT/XII/2018

h pelengkap ijazah yang menerangkan pencapaian akademik atau


ducation diploma providing a description of the academic

Warda Hafiz

Jaya Karet, 30 September 2000

P07134218164

03 SEPTEMBER 2018

Sarjana Terapan Kesehatan (S.Tr.Kes)


Applied Bachelor of Health Science (S.Tr.Kes)

Analis Kesehatan
Health Analyst
Teknologi Laboratorium Medis
Medical Laboratory Technology
Terakredirasi Baik Sekali (0700/LAM-PTKes/Akr/Dip/XII/2021,
Tanggal 31 Desember 2021)
Accredited "Excellent"
Vokasi
Vocational
Sarjana Terapan
Applied Bachelor
Jenjang 6
Level 6
Bahasa Indonesia
Bahasa
Skala 0-4: A=4; B+=3,5; B=3; C+=2,5; C=2; D+=1,5; D=1; E=0
Scale 0-4: A=4; B+=3,5; B=3; C+=2,5; C=2; D+=1,5; D=1; E=0
Program Magister Terapan; Program Magister
Applied Master's Program; Master's Program

L YANG DICAPAI
me

Applied Bachelor
(IQF LEVEL 6)

ATTITUDES
Behave ethically, professional, responsible for the safety and comfort of the
patient ( patient safety ).
Responsible for the quality of the process at any stages of medical laboratory
tests to ensure the validity of medical laboratory test results.

Responsible for the laboratory results and confidentiality according to the


profession's code of ethics.
Have high integrity in communication in the service of health laboratory.

Responsible for the results of data collection and descriptive data processing
on basic and applied research in health.

GENERAL SKILLS
Responsible for their own work and can be given responsibility for the
achievement of the work of the group.
Master the planning, management, and quality control of the activities of a
medical laboratory in a small scope.
Master the preparation, reporting the result of laboratory test result and
documentation systems as well as laboratory’s information systems.
Able to work with a team, managing a small team, and serve as health
worker.
Master of entrepreneurship in the technical field of medical laboratory
service.

KNOWLEGDE
Fluent in theoretical concepts of certain field of knowledge generally and
specific part of theretical concept in the science in deep also able to
formulate solution to procedural problem.
Fluent in knowledge of the anatomy and physiology of the human body.
Fluent in knowledge about methods of laboratory analysis in the field of
clinical chemistry, hematology, immunocerologi, bacteriology, virology,
mycology, parasitology, sitohistotechnology and toxicology using simple and
automatic instrumentation competently.

Master the concept of the quality control of laboratory test results.

Master the concepts and techniques of communication and health promotion.


Fluent concept of basic research methodology and statistics, data collection
technique, and data processing.

SPECIFIC SKILLS
Able to apply their competence and utilize science, technology, and arts in
problem solving also able to adapt to the recent situation.
Able to collect and handle specimens for medical laboratory tests to obtain
representative samples by implementing patient safety.
Able to conduct medical laboratory tests in the field of clinical chemistry,
hematology, immunocerology, immunohematology, bacteriology, virology,
mycology, parasitolog , sitohistotechnology, toxicology, as well as water,
food, and drink analysis skillfully by using simple and automated instruments
by implementing health and work safety.

Able to take preventive action for error in medical laboratory technique and
able to solve the technical problems of medical laboratory tests.

Able to deliver information of health laboratory services through effective


communication either interpersonal or professional to patients, peers,
clinicians and community.
Able to conduct data collection and data process descriptively and analitically
in basic and applied research in the field of medical laboratory.

The National Qualification Framework is the leveling of achievement which


standardized the graduates of formal, non formal, and informal education or
working experience in order to acknowledge the working competence
according to the job structures in various sectors. Qualification level is the
level of learning output which has been approved in the national level,
assembled based on the dimension of education and/or training output from
formal, non formal, and informal education or working experience.

KKNI is an implementation of the quality and identity of the nation in regard


to the Indonesian education and national training system. KKNI consists of
nine qualification level, with Qualification-1 as the lowest qualification and
Qualification-9 as the highest.

Qualification level, a nationally legalized learning outcomes, is composed by


the results of education and training activities (formal, nonformal) or working
experiences.

CURRICULAR
Participant Introducing New Student Campus Life in 2018
Participants of Real Health Pratice (PKN Kes) at the Astambul Health Center
in 2021
Participants of Field Work Practice (PKL) at the Clinical Pathology
Laboratory Installation RSUD Ulin Banjarmasin 2022
CO CURRICULAR
Participant of Basic Leadership and organization Training Department of
Health Analys in 2018
Participants of Motivational Training Activities with the Theme "It's Not How
Good You Are, It's How Good You Want To Be"
PERSAMI Activity Participants (Saturday and Sunday Camp)
Participants of the National Health Seminar in the Context of HKN 2018 with
the theme "Roles and Responsibilities of Health Workers in Providing
Management of HIV/AIDS Disease"

Participants of the National Poster Competition "Nuclear Science


Competition 2018"
Participants in the Essay Competition for the Anniversary of the Vision
Thoroughly Research

Islamic Spiritual Mentoring Participants

The 18th Banjarmasin Ministry of Health Poltekkes Diesnatalis Committee


“The Sparkling Young Generation Inspires

Tim Pemantik Aksi Serentak Peringatan Hari Kesaktian Pancasila oleh


Forkompi Indonesia

Participant of the VIII National Forkompi National Congress “Hamemayu


Hayuning Peseduluran Ing Bumi Kakulturan”
Participants of the National Health Seminar "The Challenges of Health
Workers in the Industrial Era 4.0"
Participants of the PATELKI Seminar "The Role of Medical Laboratory
Technology Experts (ATLM) on Technology and Science in the Era of
Globalization"

Participants of the PKM Research Results Seminar


Head of Organizing Seminar and Training of Journalists “Building Banua to
Create Young Journalists”
New Student Campus Life Introduction Activity Committee (PKKMB)

55th National Danus Day Activity Committee "Healthy Generation, Excellent


Indonesia"
LDKM Secretariat Section Coordinator “BRAVE (Brilliant, Responsive,
Active, Valuable, Empathy)

Committee for the Seminar on State Defense "Health Development in Efforts


to Defend the State"
Participants of the National Seminar "The Role of ATLM in Early Diagnosis of
Cancer"
FORKOMPI Visual Communications Staff

Participants of the Webinar Laboratory Service in Covid-19 Pandemic


Participants of the Webinar Rapid Test Vs PCR and Covid-19 Control
Participant of the Webinar “Recognizing the COVID-19 Examination Method
and the Role of Medical Laboratory Technology in the Age of New Habits”

BEM Position Handover Activity Committee


Committee for Essay Contest Participants "Work Week, Millennial
Achievements During a Pandemic"

Head of DPW for South Kalimantan IMATELKI

Participants of the National Webinar with the Theme "The Role of ATLM in
Blood Bank Services in Overcoming Infectious Infections Through Blood
Transfusions (IMLTD)"
Participants of the PATELKI Webinar with the Theme “Maintain Standards of
Patient Care Through the QC Program”
Participants of the PATELKI Webinar with the Theme "Human Resources
Development to Meet the Trend of Laboratory Technology in the
Telemedicine Era"

International Webinar Participants with the Theme “What We Know to


Combat COVID-19”
Participants of the PATELKI Webinar with the Theme “Molecular Diagnostic
Test for Coronavirus Disease and SARS-COV2 New Variant”
EXTRA CURRICULAR
The 2019 Sipenmaru Try Out Commuter “Prepare Yourself for The Test and
Reach Your Dream to be The Best”
Implementing the 2019 Campus Socialization Activity Field "Change Your
Life Today. Don't Gamble on the Future. Act now, Without Delay”
Committee for Expo Activities at the Poltekkes Stand of the Ministry of Health
Banjarmasin
“Havana Night Party” Farewell Event Committee

Ketua Jurusan
Head of Department

H. Akhmad Muntaha,S.Pd.,MM
NIP. 195911061989031003
P07134218164
Warda Hafiz
No NIM Nama
1 P07134218120 Ajrina Tri Yuniarti
2 P07134218121 Akhmad Rida’an
3 P07134218122 Amalia Nor Afifah
4 P07134218123 Amanda Safira Novitasari
5 P07134218124 Anggi Safira Maulida
6 P07134218125 Annisa Fitriani
7 P07134218126 Dariati
8 P07134218127 Dina Sulistia
9 P07134218128 Dita Marlia Andini
10 P07134218129 Fakhir Surya Adha
11 P07134218130 Farahhana Adiba
12 P07134218132 FX. Agung Pinto Laksono
13 P07134218133 Ghina Nu’ma Nabiela
14 P07134218134 Gina Ananda
15 P07134218135 Hafiz Manshari
16 P07134218136 Husnul Khotimah
17 P07134218137 Irna Melati
18 P07134218138 Maisyarah
19 P07134218139 Mega Indriyani. M
20 P07134218140 Mentari Salsabila
21 P07134218142 Muhammad Ehsan
22 P07134218144 Muhammad Ihza Saputra
23 P07134218145 Muhammad Ridha
24 P07134218146 Mutia Apriliyanti
25 P07134218147 Nelza Medyasva Wintyaswan
26 P07134218148 Nidha Pusvita
27 P07134218149 Nili Norhafiizhah
28 P07134218150 Norhafizah Mulia Sari
29 P07134218151 Nur Hikmah
30 P07134218152 Nur Rizka Adriana
31 P07134218153 Nurlianti Azmi
32 P07134218154 Radina Hayati
33 P07134218155 Rahmayunita
34 P07134218156 Reza Pertiwi
35 P07134218157 Rizka Ariani
36 P07134218158 Rizka Aulia
37 P07134218160 Sahri Rahman
38 P07134218161 Sarleni
39 P07134218162 Septi Putri Nursari
40 P07134218163 Siti Husniar Alifah Humaira
41 P07134218164 Warda Hafiz
42 P07134218165 Witta Luspianasari
43 P07134218166 Zahratannujhah
Tempat, Tanggal Lahir Nomor Ijazah Nasional
Tanah Laut, 27 Juni 2000
Tanah Grogot, 8 Agustus 2000
Tanah Laut, 10 Maret 2001
Binju, 26 Nopember 1999
Banjarmasin, 14 Oktober 2000
Banjarmasin, 14 januari 2000
Batulicin, 07 Desember 1999
Tanah Laut, 2 November 2000
Tabak Kanilan, 27 Maret 2000
Banjarmasin, 17 Maret 2000
Martapura, 19 Juli 2000
Pelaihari, 20 Maret 2000
Rantau Karau Hilir, 12 Juni 2000
Banjarmasin, 17 September 2000
Banjarmasin, 26 November 1999
Kuala Kapuas, 27 Juli 2000
Penajam, 21 Februari 1999
Tanah Grogot, 11 Desember 1999
Sanipah, 03 Desember 1999
Banjarmasin, 07 Maret 2001
Tanah Laut, 13 Mei 2000
Kotabaru, 24 April 2000
Tabalong, 26 Februari 2000
Banjarmasin, 9 April 2000
Banjarbaru, 17 Oktober 2000
Banjarmasin, 25 Februari 2000
Dahai, 19 Maret 2000
Rantau Karau Hilir, 31 Oktober 2000
Tanah Grogot, 7 April 2000
Banjarbaru, 20 Desember 1999
Banjarmasin, 15 April 1999
Muara Baruh, 6 Juli 2000
Bawahan Selan, 21 Mei 2000
Banjarmasin, 11 Februari 2001
Rantau, 15 September 2000
Banjarbaru, 24 November 2000
Banjarmasin, 19 November 2000
Kelumpang, 14 Juni 2000
Bangkuang, 12 September 1999
Banjarbaru, 06 Mei 2000
Jaya Karet, 30 September 2000
Guntung Payung, 05 Mei 1999
Tabalong, 22 Februari 2000
Nomor SKPI Tanggal Masuk Tanggal Kelulusan
05120/SKPI/S.Tr.TLM/405022/2022 03 SEPTEMBER 2018
05121/SKPI/S.Tr.TLM/405022/2022 03 SEPTEMBER 2018
05122/SKPI/S.Tr.TLM/405022/2022 03 SEPTEMBER 2018
05123/SKPI/S.Tr.TLM/405022/2022 03 SEPTEMBER 2018
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