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  • FORM-03 D (Instrumen Evaluasi Portofolio)

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    Oman Hendi
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    The document is a checklist evaluating the portfolio evidence of a nursing student named Riska Nurbayani. It contains a list of criteria with columns to mark whether the student's logbook and patient status documents provide evidence of meeting each criteria. The assessor, Oman Hendi, marked that the student's documents provided evidence for all criteria. The evaluation was conducted on September 1, 2021 at RSUD Cibabat Hospital.

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    07. FORM-03 D (Instrumen Evaluasi Portofolio)

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    The document is a checklist evaluating the portfolio evidence of a nursing student named Riska Nurbayani. It contains a list of criteria with columns to mark whether the student's logbook and patient status documents provide evidence of meeting each criteria. The assessor, Oman Hendi, marked that the student's documents provided evidence for all criteria. The evaluation was conducted on September 1, 2021 at RSUD Cibabat Hospital.

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    12 views4 pages

    FORM-03 D (Instrumen Evaluasi Portofolio)

    Uploaded by

    Oman Hendi
    The document is a checklist evaluating the portfolio evidence of a nursing student named Riska Nurbayani. It contains a list of criteria with columns to mark whether the student's logbook and patient status documents provide evidence of meeting each criteria. The assessor, Oman Hendi, marked that the student's documents provided evidence for all criteria. The evaluation was conducted on September 1, 2021 at RSUD Cibabat Hospital.

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    © All Rights Reserved
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    of 4

    Jl. Jenderal H Amir Machmud No.

    140 Cimahi

    FORM-03 D
    CEKLIST EVALUASI BUKTI PORTOFOLIO

    Nama Peserta : Riska Nurbayani Tanggal/Waktu : 01.September 2021


    Asesor : Oman Hendi, S.Kep., Ners., M.Kep Tempat : RSUD Cibabat

    NO. KUK DOKUMEN Ya Tidak Belum Yakin

    1.1.1 LOGBOOK, STATUS PASIEN V

    1.2.1 LOGBOOK, STATUS PASIEN V


    LOGBOOK, STATUS PASIEN
    1.2.2 V
    LOGBOOK, STATUS PASIEN
    1.3.1 V
    LOGBOOK, STATUS PASIEN
    1.3.2 V
    LOGBOOK, STATUS PASIEN
    1.3.3 V
    LOGBOOK, STATUS PASIEN
    1.4.1 V
    LOGBOOK, STATUS PASIEN
    1.5.1 V
    LOGBOOK, STATUS PASIEN
    1.5.2 V
    LOGBOOK, STATUS PASIEN
    1.6.2 V
    LOGBOOK, STATUS PASIEN
    1.6.3 V
    LOGBOOK, STATUS PASIEN
    1.6.4 V
    LOGBOOK
    2.1.1 V
    LOGBOOK
    2.1.2 V
    LOGBOOK
    2.1.3 V
    LOGBOOK, STATUS PASIEN
    2.2.1 V
    LOGBOOK
    2.2.2 V
    LOGBOOK, STATUS PASIEN
    3.1.1 V
    LOGBOOK
    3.2.1 V
    LOGBOOK, STATUS PASIEN
    3.3.1 V
    LOGBOOK, STATUS PASIEN
    4.1.1 V
    LOGBOOK
    5.1.1 V
    LOGBOOK
    6.1.1 V
    LOGBOOK, STATUS PASIEN
    6.2.1 V
    LOGBOOK
    6.2.2 V
    LOGBOOK
    6.3.1 V
    LOGBOOK
    6.3.2 V
    LOGBOOK
    6.3.3 V
    LOGBOOK
    6.3.4 V
    LOGBOOK
    6.4.1 V
    LOGBOOK
    6.4.2 V
    LOGBOOK
    6.5.1 V
    LOGBOOK
    6.5.2 V
    LOGBOOK
    6.5.3 V

    6.5.4 LOGBOOK V
    LOGBOOK
    6.6.1 V

    6.6.2 LOGBOOK V
    LOGBOOK
    6.7.1 V
    LOGBOOK
    6.7.2 V
    LOGBOOK
    6.8.1 V
    LOGBOOK
    6.8.2 V
    LOGBOOK
    6.9.1 V
    LOGBOOK
    6.9.2 V
    LOGBOOK
    8.1.1 V
    LOGBOOK
    8.1.2 V
    LOGBOOK
    8.2.1 V
    LOGBOOK
    9.1.1 V
    LOGBOOK
    9.1.2 V
    LOGBOOK
    9.2.1 V
    LOGBOOK
    9.2.2 V
    LOGBOOK
    10.1.1 V
    LOGBOOK
    10.1.2 V
    LOGBOOK
    10.2.1 V
    LOGBOOK
    11.1.1 V
    LOGBOOK
    11.1.2 V
    LOGBOOK
    12.1.1 V
    LOGBOOK
    12.1.2 V

    Tanggal evaluasi : 01.09.2021

    Tanda tangan asesor : Tanda tangan asesi :


    RUMAH SAKIT UMUM DAERAH CIBABAT CIMAHI
    Jl. Jenderal H Amir Machmud No.140 Cimahi

    FORM-03 D
    CEKLIST EVALUASI BUKTI PORTOFOLIO

    Nama Peserta : Riska Nurbayani Tanggal/Waktu : 01.09.2021


    Asesor : Oman Hendi, S.Kep., Ners., M.Kep Tempat : RSUD Cibabat

    Belum
    NO. KUK DOKUMEN Ya Tidak
    Yakin
    1.1.1, 1.1.3, 1.2.1, 1.2.2, 1.2.3, 1.3.1, 1.3.2,1.4.1, 1.4.2, 1.4.3,
    1.5.1, 1.5.2, 1.6.1, 1.6.2, 1.6.3, 1.7.1, 1.7.2, 1.7.3, 1.7.4, 3.4.1, LOGBOOK
    V
    3.5.1 STATUS PASIEN

    1.1.2, 2.1.1, 2.1.2, 2.2.1, 2.3.1, 2.3.2, 3.1.1, 3.2.1, 3.3.1, 3.4.1,
    3.5.1, 4.1.1, 4.2.1, 5.1.1, 5.2.1, 6.1.1, 6.2.1, 7.1.1, 7.2.1, 8.1.1,
    LOGBOOK V
    8.1.2, 8.2.1, 8.3.1, 9.1.1, 9.1.2, 9.1.3, 9.2.1, 9.2.2, 9.3.1, 9.3.2,
    9.4.1, 10,1.1

    Tanggal evaluasi : 01.09.2021

    Tanda tangan asesor : Tanda tangan asesi :

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