Log Book

DEPARTEMENT OF EDUCATION
UDAYANA UNIVERSITY
FACULTY OF MEDICINE
ELECTIVE STUDY PROGRAM
Head of Program : Dr. dr. I. W. P. Sutirta Yasa, M.Si
Secretary : dr. P. A. Asri Damayanti, M.Kes
Students Name : ede Wa!yu Pratama
Su"er#isor : dr. I de Ketut Sa$inadiyasa, S".PD
S"ecia% Study Program for & 'ee(
N) DAY*DA+, A-+I.I+Y
S/P,0.IS)0S
SINA+/0,
1
&
2
3
4
5
Den"asar, 11 6anuary &712
.erified 8y
Head of Program Secretary,
Dr. dr.I W. P. Sutirta Yasa, M.Si dr. Putu Ayu Asri Damayanti, M.Kes
NIP 121 497 5&: NIP 12& 273 1&7
Elective Stud P!oce"" A""e""#e$t
B Su%e!vi"o!
+it%e : 0esi(o Dan Pencega!an Penu%aran Penya(it +u8ercu%osis Pada
Wisata'an Yang ;er(un$ung Ke Indonesia
,<am Date*+ime : 11 6anuary &712
Student Name : ede Wa!yu Pratama
Student ID Num8er : 177&774724
Su"er#isor : dr. I de Ketut Sa$inadiyasa, S".PD
Assesment :
T&e %!oce"" '!e '%%!o(i#'tel '" )ollo*"+
No, Ite# A""e""#e$t R'$ge Sco!e Sco!e
- Log .ook /01/
2 O."e!v'tio$+
= Co##u$ic'tio$
= Atte$d'$ce
= Ge"tu!e '$d %o"tu!e
/03/
1 A.ilit /01/
Tot'l /0-//
>ina% 0esu%t ?Score@ :
C!ite!i' + A B C D E 4%le'"e ci!cli$g t&e c!ite!i'5
Re"ult !'$ge +
A + 6/0-//
B + 7/078
C + 990:8
D + 39093
E + /033
Su"er#isor,
?dr. I de Ketut Sa$inadiyasa, S".PD@
NIP.
Elective Stud Fi$'l A""e""#e$t
B Ev'lu'to!
+it%e : 0esi(o Dan Pencega!an Penu%aran Penya(it +u8ercu%osis Pada
Wisata'an Yang ;er(un$ung Ke Indonesia
,<am Date*+ime : 11 6anuary &712
Student Name : ede Wa!yu Pratama
Student ID Num8er : 177&774724
Su"er#isor : dr. I de Ketut Sa$inadiyasa, S".PD
Assesment :
T&e %!oce"" '!e '%%!o(i#'tel '" )ollo*"+
No, Ite# A""e""#e$t R'$ge Sco!e Sco!e
- ;u'lit o) #'te!i'l /0:/
2 Stude$t<" i$te!e"t '$d #otiv'tio$ /0-/
1 C!itic'l t&i$ki$g /0-/
3 C'%'.ilit o) i$)o!#'tio$ "e'!c&i$g /0-/
9 Reli'.ilit /0-/
Tot'l /0-//
>ina% 0esu%t ?Score@ :
C!ite!i' + A B C D E 4%le'"e ci!cli$g t&e c!ite!i'5
Re"ult !'$ge +
A + 6/0-//
B + 7/078
C + 990:8
D + 39093
E + /033
,#a%uator,
?AAAAAAAAAAAAAAA.@
NIP
DEPERTEMENT OF EDUCATION
UDAYANA UNIVERSITY
FACULTY OF MEDICINE
OFFICIAL REPORT OF ELECTIVE STUDY ASSESSMENT
+odayAAAAAAAAAAAAA.. DateAAAAAAAAAAAAA
+imeAAAAAAAAAAAAAA unti%AAAAAAAAAAAA...
0effering to S"ecia% Study Assessment +eam Assignment Better Num8er
AAAAAAAAAAAAAAAAAA !ad 8een done an assessment to a student :
Name : ede Wa!yu Pratama
Student ID Num8er : 177&774724
Semester : .
,%ecti#e Study +it%e : 0esi(o Dan Pencega!an Penu%aran Penya(it
+u8ercu%osis Pada Wisata'an Yang ;er(un$ung Ke
Indonesia
;y t!e >acu%ty of Medicine /dayana /ni#ersity Assessment +eam consisting of t!e fo%%o'ing:
1. Name of Su"er#isor : dr. I de Ketut Sa$inadiyasa, S".PD
&. Name of ,#a%uator : AAAAAAAAAAAAAAA.
Fi$'l !e"ult
Su"er#isor Score : AAAAAAAA.. ?7=177@
,#a%uator Score : AAAAAAAA.. ?7=177@
+!an( you for your (ind attention
Den"asar, AAAAAAAAAAAAA.
Su"er#isor signature AAAAAAAAAAAAAAAAAA..
,#a%uator signature AAAAAAAAAAAAAAAAAA...
Student signature AAAAAAAAAAAAAAAAAAA