BERITA ACARA

Pada hari ini …………. Pukul ……… Bertempat di RS. Restu Ibu Balikpapan, telah dilakukan
kredensial oleh Sub Komite Kredensial RS. Restu Ibu Balikpapan yang dihadiri oleh anggota
Sub Komite Kredensial, Ketua Komite Keperawatan ,Ka.Bid keperawatan,dan Kepala Ruangan
terkait, atas calon perawat/bidan :

Nama :
NIP :
Riwayat Pendidikan :
Perawat :
Bidan :

Dengan kesimpulan sebagai berikut :

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Balikpapan, .........................

Ketua, Sekretaris,

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Penilai
1. Ketua Komite Keperawatan : ..............................................
2. Ka.Bid Keperawatan : ............. .................................
3. Ketua Sub Kredensial Keperawatan : ..............................................
4. Ka.Bag Personalia : ..............................................
5. Kepala Ruangan : ..............................................
6. Tim kredensial keperawatan :..................................................