F/006/004/R/00

KOMITE MEDIK
RSUP FATMAWATI
____________________________________________________________________

PENILAIAN KREDENSIAL TAHAP 2
Nama Calon
NIP/PTT
Kompetensi
Penilai

: ………………………………………………………………………………………………………………..
: …………………………………………………………………………………………………………………
: Dokter Umum/Dokter Gigi/Dokter Spesialis ……………………………….
: …………………………………………………………………………………………………………………
Pengetahuan
(Knowledge)
(i)

Nilai
(0 s/d 100)
Jumlah
(i)+(ii)+(iii)+(iv)
Nilai Akhir

Ketrampilan

(Skill)
(ii)

Perilaku

Etika Profesi

(iii)

(iv)

(Attitude)

……………………….. ……………………….. ……………………….. ………………………..
………………………………………………………………………………………………………………..
Jumlah (i)+(ii)+(iii)+(iv): 400 X 100 %
………………………………. %

Jakarta, ……………………..20…
Penilai,

Nilai :
80 -100
76-79
73-75
70-72
66-69
63-65
60-62
56-59

(Dr. ………………………………………..)
=
=
=
=
=
=
=
=

A
AB+
B
BC+
C
C-

Nilai Batas Lulus (NBL)

70

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