KOMITE MEDIK RSUP FATMAWATI

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PENILAIAN KREDENSIAL TAHAP 2

Nama Calon : ………………………………………………………………………………………………………………..

NIP/PTT : …………………………………………………………………………………………………………………

Kompetensi : Dokter Umum/Dokter Gigi/Dokter Spesialis ……………………………….

Penilai : …………………………………………………………………………………………………………………

Pengetahuan

(Knowledge) (i)

Ketrampilan

(Skill) (ii)

Perilaku

(Attitude) (iii)

Etika Profesi

(iv)

Nilai

(0 s/d 100)

………………………..

………………………..

………………………..

………………………..

Jumlah

(i)+(ii)+(iii)+(iv)

………………………………………………………………………………………………………………..

Nilai Akhir Jumlah (i)+(ii)+(iii)+(iv): 400 X 100 %

………………………………. %

Jakarta, ……………………..20…

Penilai,

(Dr. ………………………………………..)

Nilai :

80 -100 = A

76-79 = A-

73-75 = B+

70-72 = B

66-69 = B-

63-65 = C+

60-62 = C

56-59 = C-

Nilai Batas Lulus (NBL) ≥ 70

F/006/004/R/00