DEPARTEMENT OF EDUCATION UDAYANA UNIVERSITY FACULTY OF MEDECINE __________________________________

OFFICIAL REPORT OF ELECTIVE STUDY ASSESSMENT TodayDate Time . until .. Reffering to Elective Study Assessment Team Assignment Letter Number ..had been done an assessment to a student : Name Student ID Number Semester Elective Study Title : I Gede Bagus Garjita Maesa Putra : 0902005133 : VII : Penanganan dan Pencegahan Pada Kasus High Altitude Illness

By the Faculty of Medicine Udayana University Assessment Team consisting of the following : 1. Name of Supervisor 2. Name of Evaluator : dr. Ida Ayu Ika Wahyuniari, M.Kes : dr. IGK Nyoman Arijana

Final result Supervisor score Evaluator score

: :

(0-100) (0-100)

Thank you for your kind attention. Denpasar,

Supervisor signature .. Evaluator signature Student signature ..