Special Study Process Assessment By Supervisor Title Exam Date/Time Student Name Student ID Number Supervisor Assessment No.

1 2 : Penanganan Bedah Minor pada Cedera Akibat Filum Cnidaria (Jellyfish dan Terumbu Karang) : Sabtu, 28 Januari 2012 : Yan Sista Wangi : 0902005103 : dr. Putu Anda Tusta Adiputra, Sp. B (K) Onk : Item assessment Log Book Observation: - Communication - Attendance - Gesture and posture Ability to find the literature TOTAL Range Score 0-30 0-40 Score

The process are approximately as follows:

0-30 0-100

Final Result (Score) Criteria Result Range : A B C D E : 80-100 : 70-79 : 55-69 : 45-54 : 0-44 Supervisor, dr. Putu Anda Tusta Adiputra, Sp. B (K) Onk NIP. :A B C D E (please circling the criteria)

Special Study Process Assessment By Supervisor Title Exam Date/Time Student Name Student ID Number Supervisor Assessment No. 1 2 : Aplikasi Teknik Bedah Minor pada Penatalaksanaan Onychocryptosis : Sabtu, 28 Januari 2012 : I Gusti Ayu Dwi Aryani : 0902005093 : dr. Putu Anda Tusta Adiputra, Sp. B (K) Onk : Item assessment Log Book Observation: - Communication - Attendance - Gesture and posture Ability to find the literature TOTAL Range Score 0-30 0-40 Score

The process are approximately as follows:

0-30 0-100

Final Result (Score) Criteria Result Range : A B C D E : 80-100 : 70-79 : 55-69 : 45-54 : 0-44 Supervisor, dr. Putu Anda Tusta Adiputra, Sp. B (K) Onk NIP. :A B C D E (please circling the criteria)

Special Study Process Assessment By Supervisor Title Exam Date/Time Student Name Student ID Number Supervisor Assessment No. 1 2 : Trauma Akibat Bulu Babi (Echinoidea) : Sabtu, 28 Januari 2012 : Dewa Gede Windu Sanjaya : 0902005130 : dr. Putu Anda Tusta Adiputra, Sp. B (K) Onk : Item assessment Log Book Observation: - Communication - Attendance - Gesture and posture Ability to find the literature TOTAL Range Score 0-30 0-40 Score

The process are approximately as follows:

0-30 0-100

Final Result (Score) Criteria Result Range : A B C D E : 80-100 : 70-79 : 55-69 : 45-54 : 0-44 Supervisor, dr. Putu Anda Tusta Adiputra, Sp. B (K) Onk NIP. :A B C D E (please circling the criteria)

Special Study Process Assessment By Supervisor Title Exam Date/Time Student Name Student ID Number Supervisor Assessment No. 1 2 : Penanganan Bedah Minor pada Cedera Surfing : Sabtu, 28 Januari 2012 : I Ketut Agus Suanjaya : 0902005157 : dr. Putu Anda Tusta Adiputra, Sp. B (K) Onk : Item assessment Log Book Observation: - Communication - Attendance - Gesture and posture Ability to find the literature TOTAL Range Score 0-30 0-40 Score

The process are approximately as follows:

0-30 0-100

Final Result (Score) Criteria Result Range : A B C D E : 80-100 : 70-79 : 55-69 : 45-54 : 0-44 Supervisor, dr. Putu Anda Tusta Adiputra, Sp. B (K) Onk NIP. :A B C D E (please circling the criteria)