ASSESMENT KOMPETENSI

KOLEGIUM DOKTER PRIMER INDONESIA

HARI/TANGGAL : SABTU - RABU, 17 21 MEI 2014

PETUNJUK 1. Assesment kompetensi hanya diperuntukkan bagi lulusan UKDI Februari 2014 (lulus

CBT dan OSCE)

2. Isilah biodata terlampir dilengkapi dengan foto warna ukuran 4 x 6 cm

3. Assesment kompetensi ini memuat empat materi, antara lain :

a. Kebijakan Jaminan Kesehatan Nasional dan Manual Penyelenggaraan Praktik

b. Komunikasi Efektif

c. Formularium Nasional

d. Kode Etik Kedokteran Indonesia

4. Total soal sebanyak 20 (dua puluh) soal dengan masing-masing materi memiliki 5 (lima)

soal.

5. Pilihlah 1 (satu) soal yang dijawab dari 5 (lima) soal masing-masing materi.

6. Total jumlah soal yang yang harus dijawab adalah 4 (empat) soal, dengan perincian 1

soal materi Kebijakan Jaminan Kesehatan Nasional dan Manual Penyelenggaraan

Praktik, 1 soal Komunikasi Efektif, 1 soal Formularium Nasional dan 1 Soal Kode Etik

Kedokteran Indonesia.

7. Isilah tanggal mengerjakan, nomor halaman, nama dan asal universitas pada setiap

lembar jawaban (bisa memperbanyak lembar jawaban jika lebih dari satu halaman)

8. Jawablah pertanyaan pada lembar jawaban terlampir (tidak timbal balik) menggunakan

ballpoint dengan tulisan tangan sendiri.

9. Tulisan tangan harus jelas dan mudah dibaca.

10. Bekerjalah sendiri. Setiap peserta terindikasi melakukan kecurangan akan dianggap

gugur.

11. Isilah surat pernyataan terlampir dan ditanda tangani di atas materai Rp 6.000,-

12. Seluruh dokumen jawaban dikirim paling lambat tanggal 21 Mei 2014 (cap pos) ke alamat

:

Kolegium Dokter Primer Indonesia

Jalan Sam Ratulangi No. 29 Menteng Jakarta Pusat

Telp. (021) 3140816

13. Dokumen jawaban terdiri atas :

a. Biodata

b. Surat Pernyataan Mengerjakan Sendiri

c. Jawaban Materi Kebijakan Jaminan Kesehatan Nasional dan Manual

Penyelenggaraan Praktik

d. Jawaban Materi Komunikasi Efektif

e. Jawaban Materi Formularium Nasional

f. Jawaban Materi Kode Etik Kedokteran Indonesia

14. Jawaban yang sampai melewati waktu yang ditentukan tidak akan diterima.

BIODATA PESERTA

ASSESMENT KOMPETENSI

KOLEGIUM DOKTER PRIMER INDONESIA

1. N a m a : .......................................................................................

2. Nomor KTP : .......................................................................................

3. Tempat / Tanggal Lahir : .......................................................................................

4. Jenis Kelamin : Laki-Laki/ Perempuan *coret yang tidak perlu

5. Agama : .......................................................................................

6. Alamat Rumah : .......................................................................................

.......................................................................................

.......................................................................................

Kode Pos...................... Telepon : (.............) ..................

7. Alamat Korespondensi : .......................................................................................

.......................................................................................

.......................................................................................

Kode Pos...................... Telepon : (.............) ..................

8. Nomor HP : .......................................................................................

9. E-mail : .......................................................................................

10. Asal Universitas : .......................................................................................

11. Tahun : Masuk : ............................. Lulus : .................................

12. IPK : Sarjana : ........................... Dokter : ...............................

..............................., ..................................... 2014

Yang Membuat,

(.....................................................................)

FOTO 4 x 6 cm

WARNA

SURAT PERNYATAAN MENGERJAKAN SENDIRI ASSESMENT KOMPETENSI

KOLEGIUM DOKTER PRIMER INDONESIA Yang bertanda tangan di bawah ini : N a m a : ....................................................................................... Asal Universitas : ....................................................................................... Menyatakan bahwa :

1. Jawaban soal Assesment Kompetensi ini dibuat dengan tulisan tangan sendiri, dengan

sejujurnya, mengikuti kaidah Etika Akademik serta menjamin bebas Plagiarisme.

2. Saya juga menyadari bahwa jika saya tidak menandatangani surat pernyataan ini

berarti saya tidak berkontribusi dalam pembuatan jawaban soal Assesment

Kompetensi serta bersedia menerima segala konsekuensi karena keteledoran

tersebut.

3. Bila kemudian diketahui saya melanggar, maka saya bersedia dinyatakan tidak

lulus/gagal serta bersedia menerima segala konsekuensi yang disyaratkan oleh

Kolegium Dokter Primer Indonesia.

4. Bila di kemudian hari saya terbukti melanggar, maka saya bersedia menerima sanksi

berupa pencabutan sertifikat kompetensi dengan segala dampak dan akibatnya.

..............................., ..................................... 2014

Yang Membuat,

(.....................................................................)

MATERAI

Rp 6000

Tanggal Mengerjakan : ..................................................... Halaman : ..................................

Nama : ........................................................ Asal Universitas : ..............................................

LEMBAR JAWABAN MATERI KEBIJAKAN JAMINAN KESEHATAN NASIONAL DAN

MANUAL PENYELENGGARAAN PRAKTIK

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Tanggal Mengerjakan : ..................................................... Halaman : ..................................

Nama : ........................................................ Asal Universitas : ..............................................

LEMBAR JAWABAN MATERI KOMUNIKASI EFEKTIF

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Tanggal Mengerjakan : ..................................................... Halaman : ..................................

Nama : ........................................................ Asal Universitas : ..............................................

LEMBAR JAWABAN MATERI FORMULARIUM NASIONAL

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Tanggal Mengerjakan : ..................................................... Halaman : ..................................

Nama : ........................................................ Asal Universitas : ..............................................

LEMBAR JAWABAN MATERI KODE ETIK KEDOKTERAN INDONESIA

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