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FORMULIR PENILAIAN BATITA SEHAT
RS MAGUAN HUSADA PRACIMANTORO
3 DESEMBER 2013
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Nama Batita :...................................
Nama Aya :.....................................
Nama I!" :.......................................
Um"# Batita :.......................................
A$amat :.....................................
N% T&$&'%( ) H':
.....................................
*ELOMPO
* UMUR
*RITERIA PENILAIAN NILAI TOTAL NILAI
B"+" *IA 2, - ,0
/ 12 !$(
a. PERSONAL SOSIAL M&ma"++a( !i+"it
& a$am m"$"t T&'"+ ta(a(
M&$am!ai+a( ta(a(
M&(i#"+a( +&iata(
Mi("m a#i a(+i#
M&("(a+a( &(%+
a#'" M&(y"a'i !%(&+a
!. MOTORI* HALUS M&(am!i$ "a +"!"
M&m&a( ( i!"
4a#i a( 4a#i M&(a#" +"!"
ia(+i# M&(%#at %#&t
M&(a#a 2 +"!"
. BAHASA M&(%& at" "+"
+ata 5Pa'a 56 7mama8 #
'&i9i+ 1 +ata
2 +ata
3 +ata
. MOTORI* *ASAR D""+ ta('a
'&a(a( Bi#i &(a(
'&a(a( Ba(+it t# ""+ a(
&!a$i+(ya Bi#i 2 &ti+
Ba$a( ( !ai+
Ba$a( m"("#
&. LAINNA ; '%#ma(&
+&&$"#"a( # "m"m !$(
a. PERSONAL SOSIAL M&("(a+a(
&(%+)a#'"
M&(y"a'i !%(&+a C"i ta(a(
!. MOTORI* HALUS M&(%#at %#&t
M&(a#a ? +"!"
M&(a#a +"!"
. BAHASA L&!i a#i 3 +ata
M&("(4"+ 1 am!a#
M&("(4"+ ? am!a#
Baia( !aia( !aa(
. MOTORI* *ASAR
Ba$a( ( !ai+
Ba$a( m"("#
La#i
M&(&(a( !%$a
+&&'a( M&$%m'at
M&$&m'a# !%$a +& ata
&. LAINNA ; '%#ma(&
+&&$"#"a( # "m"m +"!"
M&(a#i+ a#i @ti+a$
M&(%ya(+a( i!"
4a#i M&(am!a# 5O8
. BAHASA M&("(4"+ ? am!a#
Baia( !aia( !aa(
;< M&(y&!"t a#(a Mi( 1
M&(y&!"t 1 +ata i9at
M&(it"( 1 - 3
. MOTORI* *ASAR
M&$%m'at
M&$&m'a# !%$a +& ata
L%(at 4a" Bi#i 1 +a+i 1 &ti+
Bi#i 1 +a+i 2 &ti+
&. LAINNA ; '%#ma(&
+&&$"#"a( # "m"m
