BERITA ACARA PRESENTASI PORTOFOLIO

Pada hari ini tanggal : ........................................................................ telah dipresentasikan portofolio oleh: Nama : ......................................................................................................................................... No ID Peserta : ............................................................................................................................ dengan judul/ topik : ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... No. ID dan Nama Pendamping : ................................................ (Dr. Pendamping atau staf ahli lainnya) No. ID dan Nama Wahana : ........................................................................................................ Nama Peserta Presentasi No. ID Peserta Tanda tangan

1. ..................................... ..................................... ...................................................................... 2. ..................................... ..................................... ...................................................................... 3. ..................................... ..................................... ...................................................................... 4. ..................................... ..................................... ...................................................................... 5. ..................................... ..................................... ...................................................................... Berita acara ini ditulis dan disampaikan sesuai dengan yang sesungguhnya.

dr. . NIP .