RUMAH SAKIT MEDIKA BSD
FORMULIR ISIAN DOKTER
Nama
: dr. Sekar CiptaningrumTempat / tgl Lahir
: Jakarta/30 Januari 1988Alamat Rumah
: Reni Jaya blok E7/7 Pondok petir, bojong sari,
DepokTelepon
-. Rumah
: _______________________________-. Kantor
: _______________________________-. HP
: 08170946403Keahlian
Spesialis
: _______________________________ Umum
: dokter umum Gigi
: Umum
Spesialis _______________ Lulusan Dokter Umum / Gigi
-. FK
: FK UPN Veteran-. Tahun
: 2013Lulusan Dokter Spesialis
-. FK
: _______________________________-. Tahun
: _______________________________Izin Dokter (Umum, Gigi,
Spesialis): 1. 3121100114144629
2. _____________________________
3. _____________________________
Bila belum ada
: Dalam proses pengurusan
Belum pernah di prosesRiwayat Tugas formil / pekerjaan :1.
Internsip di RS Sari Asih Arrahmah, Tangerang2. Internsip di
Puskesmas Cipondoh, Tangeerang3. Puskesmas Bakti Jaya, Tangerang
Selatan4.
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5.
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Tempat praktek dan tempat tempat lain untuk dihubungi :
1.
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2.
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3.
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4.
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5.
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Saran-saran :
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BSD City,
( dr. Sekar Ciptaningrum )CREDENTIALING & PREVILEGING
COMMITTEE
(For RSMBSD)
Dear doctor, could you please highlight to us some of the
following information regarding your practice :
1. The 5 most common procedures (for surgical disciplines) or
types of cases (for medical disciplines), managed by you over the
past 1 year and the approximate number :NoProcedures / types of
casesNumber
1Dengue Fever1
2Thypoid Fever2
3Diarrhea with dehidration3
4Hecting4
5Limpoma Surgical7
6Nail Removal5
7Intubation, Endotracheal tube6
2. Any special procedures / techniques that you would like to
highlight :
3. Please state your current terms of practice :
4. Preference of practice (please tick)
Resident ( full time )
Sessional ( part time)
Thank you for your cooperation
dr. Sekar Ciptaningrum
