| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | AA | AB | AC | AD | AE | AF | AG | AH | AI | AJ | AK | AL | AM | AN | AO | AP | AQ | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | REKAP ANGGOTA KELOMPOK STAF KEPERAWATAN (KSK) | ||||||||||||||||||||||||||||||||||||||||||
2 | |||||||||||||||||||||||||||||||||||||||||||
3 | NAMA KSK : | ONKOLOGI | |||||||||||||||||||||||||||||||||||||||||
4 | NAMA KEPALA KSK : | AGUS WIDODO | Alamat Email : | ||||||||||||||||||||||||||||||||||||||||
5 | NAMA SEKRETARIS KSK | ENGGAR P | Alamat Email : | ||||||||||||||||||||||||||||||||||||||||
6 | |||||||||||||||||||||||||||||||||||||||||||
7 | NO | NAMA ANGGOTA | NIP/NIK | NOMER REGISTRASI ANGGOTA | RUANG | LEVEL PK/BP | PENDIDIKAN | STR | SIPP/SIPB | SPK TERAKHIR | SERTIFIKAT ASSESMEN KOMPETENSI | SERTIFIKAT PELATIHAN SESUAI PERSYARATAN KSK | KETERANGAN | ||||||||||||||||||||||||||||||
8 | NOMOR STR | TANGGAL MASA BERLAKU HABIS | NOMOR SIPP/SIPB | TANGGAL MASA BERLAKU HABIS | NOMOR SPK | TANGGAL MASA BERLAKU HABIS | NOMOR SERTIFIKAT | TANGGAL MASA BERLAKU HABIS | Pelatihan Kanker Dasar | Tanggal Terbit Sertifikat Kanker Dasar | Pelatihan Kanker dengan Kemoterapi | Tangal Terbit Sertifikat Pelatihan kanker dengan Kemotrapi | Pelatihan Luka kanker | Tanggal Terbit Sertifikat Pelatihan Luka Kanker | Perawatan Kanker Lanjut | Perawatan Paliatif | |||||||||||||||||||||||||||
9 | 1 | Karlina, S. Kep, Ns. | 197912242005012002 | KSK.ONK. 0001 | POLI ONKOLOGI | PK 3 | Ners | XG00001034044590 | Seumur Hidup | NR33742608015119 | 12/25/2031 | YP.03.02/II/4060/2023 | 24 Desember 2026 | 42/TAKK/DIKLAT/IX/2014-191 | 9/1/0207 | ​ | ​ | ​ | 1087/KANKER LANJUT 2023/DIKLAT/XI/2023-9 | KT.03.02/F/4737736/SER/2026 | |||||||||||||||||||||||
10 | 2 | Retno Dwi Yuliana, S. Kep, Ns. | 198607252012122001 | KSK.ONK. 0002 | KASUARI LT. 4 | PK 3 | Ners | ZH00000873907447 | Seumur Hidup | 449.2/629/DPM-PTSP/IP.629/IV/2023 | 7/25/2028 | YP.03.02/D.X.2/2824/2025 | 25 Juli 2028 | 40/ASSESMEN/DIKLAT/VI/2022-9 | 4/14/2024 | SUDAH | 15/2/2018 | BELUM | BELUM | 4/11/2024 | SUDAH | ||||||||||||||||||||||
11 | 3 | Aulia Rahmawati, AMK | 198506012024212018 | KSK.ONK. 0003 | KASUARI LT. 4 | PK 3 | D3 Kep | 1401522224192314 | Seumur Hidup | 449.2/321/DPM-PTSP/IP.321/III/2022 | 1/6/2027 | YP.03.02/D.X.2/2397/2025 | 1 Juni 2027 | 102/TAKK-7/DIKLAT/2017-238 | 1/3/2021 | SUDAH | 15/2/2018 | ​ | ​ | 8/10/2024 | SUDAH | ||||||||||||||||||||||
12 | 4 | Mardiana Daniati, S. Kep, Ns | 198703042023212002 | KSK.ONK. 0004 | KASUARI LT. 4 | PK 3 | Ners | HZ00000451180926 | Seumur Hidup | 449.2/563/DPM-PTSP/IP.563/II/2024 | 3/4/2029 | YP.03.01/II/926/2022 | 4 Maret 2025 | ​ | ​ | ​ | 4/10/2021 | BELUM | |||||||||||||||||||||||||
13 | 5 | Maria Indri Wigatiningsih | 198003241999032001 | KSK.ONK. 0005 | KUTILANG LT.1 | PK 3 | Ners | ME00000979040009 | Seumur Hidup | 449,2/388/DPM-PTSP/IP.388/III/2021 | 3/24/2026 | YP.03.01/II/1658/2022 | 24 Maret 2025 | 34.ATAKK/DIKLAT/VI/2014-557 | 12/31/2015 | ​ | ​ | ​ | 624/DPW.PPNI/W/K/XI/2022---15 NOV 2022 | BELUM | |||||||||||||||||||||||
14 | 6 | Fitri Masruroh , AMK | 198506222023212003 | KSK.ONK. 0006 | KEPODANG DASAR | PK 3 | D3 Kep | UI00001369360856 | Seumur Hidup | 449.2/2344/DPM-PTSP/IP.2344/IX/2022 | 6/22/2027 | YP.03.02/D.X.2/2643/2025 | 22 Juni 2027 | 102/TAKK-7/DIKLAT/2017-65 | 3/1/2021 | SUDAH | 26/7/2024 | BELUM | BELUM | BELUM | BELUM | ||||||||||||||||||||||
15 | 7 | Nindyah Sri Mahastuti, SKep Ns | 197804082002122003 | KSK.ONK. 0007 | MERAK LT. 1 | PK 3 | Ners | CL00000202320909 | SEUMUR HIDUP | 449.2/104/DPM-PTSP/IP.104/I/2024 | 4/8/2028 | YP.03.02/D.X.2/2135/2024 | 8 April 2027 | 102/TAKK-7/DIKLAT/2017-185 | 1/3/2021 | ​ | ​ | ​ | 26/10/2024 (17404/KL GELOMBANG 1/DIKLAT/X/2024 - 23) | 20-01-2026 s/d 24-01-2026 | KT.03.02/F/4747602/SER/2026 | ||||||||||||||||||||||
16 | 8 | Sriyani | 198001182006042015 | KSK.ONK. 0008 | KASUARI LT. 5 | PK 3 | Ners | PU0000689327546 | Seumur Hidup | 449,2/729/DPM-PTSP/IP.729/V/2021 | 1/18/2026 | YP.03,02/D.X.2/90/2024 | 18 Januari 2026 | 42/TAKK/DIKLAT/IX/2014-198 | 9/1/2017 | ​ | ​ | ​ | 624/DPW.PPNI/SK/K.S/X/2022..15/11/2022 | Belum | |||||||||||||||||||||||
17 | 9 | Suyamto | 197310251994031002 | KSK.ONK. 0009 | KASUARI LT. 5 | PK 3 | Ners | SZ00000596979497 | seumur hidup | 449,2/976/DPM-PTSP/IP.976/VII/2021 | 10/25/2026 | YP.03.01/II/8119/2021 | 20 Oktober 2024 | 102/TAKK-7/DIKLAT/2017-13 | ​ | ​ | ​ | ||||||||||||||||||||||||||
18 | 10 | Setiarsih | 198304162007012010" | KSK.ONK. 0010 | KASUARI LT. 5 | PK 3 | Ners | 1401722224131111 | 4/16/2027 | 449.2/2872/DPM-PTSP/IP.2872/XI/2022 | 4/16/2027 | YP.03.01/II/2040/2022 | 16 April 2025 | ​ | ​ | ​ | 382/DPW.PPNI/P/K/XI/2021/004 | BELUM | |||||||||||||||||||||||||
19 | 11 | Nuzulia Asmi Damayanti | 198605262023212009 | KSK.ONK. 0011 | KASUARI LT. 5 | PK 3 | Ners | TB00000505323818 | Seumur Hidup | NR33742411008940 | 5/27/2030 | YP.03.02/D.X.2/2228/2025 | 27 Mei 2028 | 102/TAKK-7/DIKLAT/2017-224 | 1/2/2021 | ​ | ​ | ​ | 15/11/2022 | Sudah | 46/PALIATIVE CARE/DIKLAT/VI/2018-3 | ||||||||||||||||||||||
20 | 12 | Nugroho | 198806062025211075 | KSK.ONK. 0012 | KASUARI LT. 4 | PK 3 | Ners | LT00000646504547 | Seumur Hidup | 449.2/726/DPM-PTSP/IP.726/IV/2022 | 6/6/2027 | YP.03.01/II/4471/2022 | 6 Juni 2027 | 41/TAKK-3/DIKLAT/2019-20 | 6 Juni 2027 | SUDAH | 6/10/2022 | SUDAH | 22/2/2020 | BELUM | 1/11/2024 | sudah | |||||||||||||||||||||
21 | 13 | Ari Relawati | 198706112023212009 | KSK.ONK. 0013 | POLI ONKOLOGI | PK 3 | Ners | AS00000504048076 | Seumur Hidup | 449.2/415/DPM-PTSP/IP.415/III/2022 | 6/11/2027 | YP.03.02/D.X.2/2489/2025 | 3 Juni 2027 | 41/TAKK-3/DIKLAT/2019-28 | 3/28/2022 | SUDAH | 2016 | BELUM | BELUM | 20/11/2023 | SUDAH | KT.03.02/F/5040924/SER/2026 (sertifikat paliatif) | |||||||||||||||||||||
22 | 14 | Edy Sutopo | 198002172023211001 | KSK.ONK. 0014 | KASUARI LT. 5 | PK 3 | D3 Kep | EQ00000711804127 | Seumur Hidup | 449.2/280/DPM-PTSP/IP.280/III/2022 | 2/17/2027 | YP.03.01/II/1610/2022 | 17 Februari 2025 | 41/TAKK-3/DIKLAT/2019-18 | 3/28/2022 | ​ | ​ | ​ | 28 Oktober 2021 | Belum | |||||||||||||||||||||||
23 | 15 | Muhammad Ulul Azmi | 198305262010121004 | KSK.ONK. 0015 | KASUARI LT. 4 | PK 3 | Ners | 140171222-4172616 | Seumur Hidup | 449,2/734/DPM-PTSP/IP.734/2023 | 5/26/2027 | YP.03.01/II/2368/2022 | 26 Mei 2027 | 67/TAKK-6/DIKLAT/2017-332 | 8/2/2020 | ​ | ​ | ​ | 4 November 2021 | ||||||||||||||||||||||||
24 | 16 | Niken Vera Yunita | 198406262023212004 | KSK.ONK. 0016 | POLI ONKOLOGI | PK 3 | D3 Kep | 1401522224296400 | 6/26/2027 | 499,2/1221/DPM-PTSP/IP.1221/VI/2022 | 6/26/2027 | YP.03.01/II/7302/2022 | 26 Juni 2025 | 74/TAKK-4/DIKLAT/2018-34 | 8/24/2021 | ​ | ​ | ​ | BELUM | BELUM | |||||||||||||||||||||||
25 | 17 | AYUK PUJI LESTARI | 198805302012122001 | KSK.ONK. 0017 | KASUARI LT. 4 | PK 3 | Ners | FV00001001525365 | Seumur Hidup | 449.2/1387/DPM-PTSP/IP.1387/VI/2022 | 5/30/2027 | YP.03.02/D.X.2/2194/2025 | 30 Mei 2027 | 41/TAKK-3/DIKLAT/2019-16 | 3/28/2022 | ​ | ​ | ​ | 28 Oktober 2021 | belum | |||||||||||||||||||||||
26 | 18 | PRASASTI ASIH UTAMI, Ners | 198802262014022004 | KSK.ONK. 0018 | KASUARI LT. 5 | PK 3 | Ners | HD00000715032845 | Seumur Hidup | 449.2/341/DPM-PTSP/IP.341/II/2023 | 2/26/2028 | YP.03.02/D.X.2/643/2025 | 26 Februari 2028 | 102/TAKK-7/DIKLAT/2017-234 | 1/3/2021 | SUDAH | 08/02/2019 | SUDAH | 20-23 JULI 2022 | BELUM | 17562/KL GELOMBANG 3/DIKLAT/XI/2024-17 (4-8 NOVEMBER 2024) | SUDAH | KT.03.02/F/5596711/SER/2026 (Sertifikat Paliatif) | ||||||||||||||||||||
27 | 19 | NINIK WAHYUNINGRUM | 198102162003122001 | KSK.ONK. 0019 | KASUARI LT. 3 | PK 3 | D3 Kep | RA00000574621562 | Seumur Hidup | NR33742609001862 | 2/17/2032 | YP.02.03/D.X.2/703/2025 | 16 Februari 2025 | 102/TAKK-7/DIKLAT/2017-200 | 1/3/2018 | ​ | ​ | ​ | 1 November 2024 | sudah | |||||||||||||||||||||||
28 | 21 | AGUS SUGIHARTO | 197206021993031002 | KSK.ONK. 0021 | KASUARI LT. 3 | PK 3 | D3 Kep | 140151222-4146958 | 6/2/2027 | 449.2/273/DPM-PTSP/IP.273/III/2022 | 6/2/2027 | YP.03.01/II/5679/2021 | 2 Juni 2024 | 102/TAKK-7/DIKLAT/2017-12 | 1/3/2021 | ​ | ​ | ​ | 28-10-2021 | BELUM | |||||||||||||||||||||||
29 | 22 | KINASIH | 198303312007012005 | KSK.ONK. 0022 | KASUARI LT. 5 | PK 3 | D3 Kep | PW00000618821646 | Seumur Hidup | 449.2/322/DPM-PTSP/IP.322/III/2022 | 3/31/2027 | YP.03.01/II/2043/2022 | 31 Maret 2025 | 7/1/2018 | ​ | ​ | ​ | 28 Oktober 2021 | |||||||||||||||||||||||||
30 | 23 | ENDAH DWI PRIATINI, Ners | 198903142014022004 | KSK.ONK. 0023 | KASUARI LT. 3 | PK 3 | Ners | 140172222-4181665 | 3/14/2027 | 449.2/319/DPM-PTSP/IP.319/III/2022 | 3/14/2027 | YP.03.02/D.X.2/1164/2024 | 14 Maret 2027 | 15/ASESSMEN/DIKLAT/II/2021-01 | 2/25/2024 | ​ | ​ | ​ | 28 Oktober 2021 | BELUM | |||||||||||||||||||||||
31 | 24 | LITA ANDRITA PURI, AMK | 198502282023212006 | KSK.ONK. 0025 | KASUARI LT 3 | PK 3 | D3 Kep | FB00000507753706 | Seumur Hidup | NR33742609001861 | 3/1/2032 | YP. 03.02/D.X.2/658/2025 | 28 Februari 2027 | 41/TAKK-3/DIKLAT/2019-5 | 3/28/2022 | ​ | ​ | ​ | 1 November 2024 | 07-04-2026 s/d 11-04-2026 | |||||||||||||||||||||||
32 | 25 | DINIA FIKRIYANA | 198603312023212003 | KSK.ONK. 0026 | POLI ONKOLOGI | PK 3 | D3 Kep | WY00000754383033 | Seumur Hidup | 449.2/315/DPM-PTSP/IP.315/III/2022 | 3/31/2027 | 41/TAKK-3/DIKLAT/2019-4 | 3/28/2022 | ​ | ​ | ​ | 4 November 2021 | ||||||||||||||||||||||||||
33 | 20 | FAIZAL MACHRUS | 198610082023211003 | KSK.ONK. 0020 | KASUARI LT. 3 | PK 3 | Ners | AL00000698142078 | Seumur Hidup | SK/228/DPM-PTSP/SIP/III/2024 | 10/8/2029 | YP.03.02/D.X.2/5120/2025 | 8 Oktober 2028 | 41/TAKK-3/DIKLAT/2019-25 | 3/28/2022 | ​ | BELUM | BELUM | 8 November 2024 | sudah | KT.03.02/F/5019471/SER/2026 (Sertifikat paliatif) | ||||||||||||||||||||||
34 | 26 | WACHIT FUJIANTA, AMK | 197407281994031003 | KSK.ONK. 0027 | POLI ONKOLOGI | PK 3 | D3 Kep | SE00001010179824 | Seumur Hidup | 449.2/1775/DPM-PTSP/IP.1775/VII/2022 | 7/28/2027 | YP.03.02/D.X.2/7169/2024 | 28 Juli 2027 | 74/TAKK-4/DIKLAT/2018-22 | SUDAH | 19 September 2019 | ​ | ​ | 8 November 2024 | belum | kanker lanjut 8 november 2024 : *17564/KLGELOMBANG3/DIKLAT/XI/2024-29 | ||||||||||||||||||||||
35 | 27 | RENA WIDYASTUTI | 198707102012122001 | KSK.ONK. 0028 | KASUARI LT.5 | PK 3 | Ners | EM00000598215060 | Seumur Hidup | 449.2/822/DPM-PTSP/IP.822/V/2023 | 7/10/2028 | YP.03.01/II/2948/2022 | 10 Juli 2025 | 41/TAKK-3/DIKLAT/2019-13 | 3/28/2022 | ​ | ​ | ​ | 4 November 2021 | Belum | |||||||||||||||||||||||
36 | 28 | ERY SULISTYANINGSIH | 197509081998032001 | KSK.ONK. 0029 | POLI ONKOLOGI | PK 3 | D3 Kep | AJ00000689893341 | Seumur Hidup | 449.2/772/DPM-PTSP/IP.772/V/2023 | 9/8/2028 | YP.03.02/D.X.2/7820/2024 | 8 September 2027 | 38441/DIKLAT/IX/2026-966 | 9/3/2028 | BELUM | BELUM | BELUM | 15 November 2022 | Belum | |||||||||||||||||||||||
37 | 29 | SRI REZEKI | 197506022001122004 | KSK.ONK. 0030 | POLI ONKOLOGI | PK 3 | D3 Kep | BT00000690937423 | Seumur Hidup | 449-2/442/DPM-PTSP/IP.442/III/2022 | 6/2/2027 | YP. 03.01/II/4472/2022 | 2 Juni 2025 | 102/TAKK-7/DIKLAT/2017-26 | 3 Januar 2018 | SUDAH | 18 Juni 2021 | ​ | ​ | 17410/KL GELOMBANG 1/DIKLAT/X/2024 - 26 | SUDAH | ||||||||||||||||||||||
38 | 30 | P. DWI ROSARIA INDAH | 197408191993032001 | KSK.ONK. 0031 | POLI Radioterapi | PK 3 | D3 Kep | JM00001057104821 | Seumur Hidup | 449.2/811/DPM-DTSP/IP.811/V/2023 | 8/19/2028 | YP.03.01/III/8413/20203 | 19 Agustus 2024 | ​ | ​ | ​ | belum | ||||||||||||||||||||||||||
39 | 31 | VERA PRAMUKTINING DYAH | 198107172009122001 | KSK.ONK. 0032 | KASUARI Lt.4 | PK 3 | Ners | CV00001048245394 | Seumur Hidup | 449.2/1087/DPM-PTSP/IP.1087/V/2022 | 7/17/2027 | YP.03.01/III/5535/2021 | 17 Juli 2024 | 67/TAKK-6/DIKLAT/2017-361 | 8/2/2020 | SUDAH | 14 Februari 2018 | ​ | SUDAH | 056/DPW.PPNI/SK/K.S/I/2020 | 17396/KL GELOMBANG 1/DIKLAT/X/2024-29 | Sudah | KT.03.02/F/4740056/SER/2026 | ||||||||||||||||||||
40 | 32 | FITRIA SISWI AMURWANI | 198207182005012001 | KSK.ONK. 0033 | RAJAWALI 6A | PK 3 | Ners | 1401722213503487 | 7/18/2026 | 449-2/442/DPM-PTSP/IP.1106/VIII/2021 | 7/18/2026 | YP. 03.01/II/6212/2021 | 18 Juli 2024 | 102/TAKK-7/DIKLAT/2017-225 | 1/3/2021 | ​ | ​ | ​ | 4 November 2021 | belum | |||||||||||||||||||||||
41 | 33 | AHMAD SYAKIR | 198011222005011002 | KSK.ONK. 0034 | TPPRI IGD | PK 3 | D3 Kep | 1401512224491808 | 11/22/2027 | 449,2/3069/DPM-PTSP/IP.3069/2022 | 11/22/2027 | YP,03,01/II/920/2022 | 22 November 2025 | ​ | ​ | ​ | BELUM | BELUM | |||||||||||||||||||||||||
42 | 34 | YAYUK SETYANINGSIH | 197503092002122002 | KSK.ONK. 0035 | RAJAWALI 4A | PK 3 | Ners | NX00001354513238 | Seumur Hidup | NR33742412002762 | 3/10/2030 | YP.03.02/D.X.2/1162/2025 | 10 Maret 2028 | SUDAH | 14 Februari 2018 | BELUM | BELUM | 15 November 2022 | Sudah | KT.03.02/F/5983073/SER/2026 (sertifikat paliatif ) | |||||||||||||||||||||||
43 | 35 | ENGGAR PURNANINGSIH | 198105082005012004 | KSK.ONK. 0036 | POLI ONKOLOGI | PK 3 | Magister Spesialis | 140182223468738 | 8/5/2028 | 449-2/1490/DPM-PTSP/IP.1490/V/2024 | 05/31/2029 | yp.03.01/ii/7300/2022 | 5 Agustus 2025 | 41/TAKK-3/DIKLAT/2019-1 | 03/28/2022 | ​ | ​ | ​ | 28 Oktober 2021 | BELUM | |||||||||||||||||||||||
44 | 36 | GANDES DYAH TUTWURI | 198403152009122001 | KSK.ONK. 0037 | KASUARI LT. 5 | PK 3 | Ners | NV00000688391558 | Seumur hidup | 449.2/481/DPM-PTSP/IP.481/III/2022 | 03/15/2027 | YP.03.02/D.X.2/676/2025 | 03/15/2027 | 42/TAKK/DIKLAT/IX/2014-188 | 3/28/2022 | SUDAH | 15 Februari 2018 | ​ | ​ | 1 November 2024 | SUDAH | KT.03.02/F/5017852/SER/2026 | |||||||||||||||||||||
45 | 37 | PUTRI AYU AMBARWATI | 198808062023212003 | KSK.ONK. 0039 | POLI ONKOLOGI | PK 3 | D3 Kep | XL00000959673960 | Seumur Hidup | 449.2/2291/DPM-PTSP/IP.2291/IX/2022 | 8/6/2027 | YP.03.02/D.X.2/3823/2025 | 6 Agustus 2027 | 41/TAKK-3/DIKLAT/2019-6 | 3/28/2022 | SUDAH | 14 Februari 2018 | ​ | ​ | 17558/KL GELOMBANG 3/DIKLAT/XI/2024-20 | KT.03.02/F/5017097/SER/2026 | ||||||||||||||||||||||
46 | 38 | SRI SETYOWATI | 198012152003122002 | KSK.ONK. 0040 | POLI ONKOLOGI | PK 3 | Ners | HL00000646321262 | Seumur Hidup | NR33742606019986 | 12/16/2031 | YP.03.02/D.X.2/9825/2024 | 15 Desember 2026 | 102/TAKK-7/DIKLAT/2017-11 | 3/1/2021 | SUDAH | 14 Februari 2018 | BELUM | BELUM | 8 November 2024 | Sudah | KT.03.02/F/4796378/SER/2026 | |||||||||||||||||||||
47 | 39 | IRA NURVIDHA | 197110071994032001 | KSK.ONK. 0041 | POLI ONKOLOGI | PK 3 | D3 Kep | 140152222-4473410 | 10/7/2027 | 449.2/2989/DPM-PTSP/IP.2989/XI/2022 | 10/7/2027 | YP.03.01/II/6950/2024 | 10 Juli 2027 | 102/TAKK-7/DIKLAT/2017-10 | 10/27/2024 | BELUM | ​ | ​ | KANKER LANJUT 27/10-2021 | ||||||||||||||||||||||||
48 | 40 | T. UDUR ANNA PASARIBU | 197004061989032002 | KSK.ONK. 0042 | POLI ONKOLOGI | PK 3 | Ners | QI00000692028733 | Seumur Hidup | NR33742511004695 | 4/7/2031 | YP.03.02/D.XI.2/1659/2026 | 7 April 2029 | 38446//DIKLAT/IX/2026 - 2526 | 03/09/2028 | SUDAH | BELUM | BELUM | 17517/KL GELOMBANG 2/DIKLAT/XI/2024 - 28 | KT.03.02/F/5034494/SER/2026 | |||||||||||||||||||||||
49 | 41 | INDAH ARI HASTUTI | 198611082023212007 | KSK.ONK. 0043 | RIRA | PK 3 | D3 Kep | VD00001357049895 | Seumur Hidup | 449.2/1464/DPM-PTSP/IP.1464/VII/2022 | 11/8/2027 | YP.03.02/D.X.2/4731/2024 | 8 November 2027 | 41/TAKK-3/DIKLAT/2019-23 | 3/28/2022 | ​ | ​ | ​ | 17403/KL GELOMBANG 1/DIKLAT/X/2024 - 14 | KT.03.02/F/5038429/SER/2026 | |||||||||||||||||||||||
50 | 42 | EDY RIYANTO | 197309071993031001 | KSK.ONK. 0044 | KASUARI LT. 5 | PK 3 | Ners | 1401712224461976 | 9/7/2027 | 449.2/3443/DPM.PTSP/IP.3443/X/2019 | 9/7/2024 | YP.2/03.01/II/4473/2022 | 7 September 2025 | ​ | ​ | ​ | 15 November2022 | Pelatihan Perawatan Kanker Lanjut | |||||||||||||||||||||||||
51 | 43 | MASRIPAH | 196804101989032003 | KSK.ONK. 0045 | POLI ONKOLOGI | PK 3 | Ners | 140172221-4072034 | seumur hidup | 449,2/1430/DPM-PTSP/IP.1430/X/2021 | 4/10/2026 | YP.03.01/Iiii/0522/2022 | 10 April 2024 | 382/DPW.PPNI/SK/K,.S/X/2021-2 | 4/10/2026 | ​ | ​ | ​ | 4 November 2022 | ||||||||||||||||||||||||
52 | 44 | MARIA RETNO KRISTIYO DEWI | 197203311996032002 | KSK.ONK. 0046 | POLI ONKOLOGI | PK 3 | D3 Kep | 1401522224172628 | seumur hidup | 449.2/1963/DPM-PTSP/IP.1963/VIII/2022 | 3/31/2027 | YP. 03.02/D.X.2/18852024 | 31 Maret 2027 | 102/TAKK-7/DIKLAT/2017-15 | 1/3/2021 | ​ | ​ | ​ | 382/DPW.PPNI/P/K/XI/2021/06 (4 November 2021) | KT.03.02/F/5593801/SER/2026 | |||||||||||||||||||||||
53 | 45 | LIZA RIHAYATI | 196809161988032001 | KSK.ONK. 0048 | POLI ONKOLOGI | PK 3 | D3 Kep | ​ | ​ | ​ | |||||||||||||||||||||||||||||||||
54 | 46 | TRISNOWATI UJI | 198712302009122001 | KSK.ONK. 0049 | KASUARI LT. 4 | PK 3 | Ners | IR00001325194490 | seumur hidup | 449.2/2861/DPM-PTSP/IP.2861/XI/2022 | 12/30/2027 | YP.03.02/D.X.2/1124/2025 | 30 Desember 2027 | 382/DPW.PPNI/SK/K.8/X/2021 | 11/4/2024 | ​ | ​ | ​ | 17539/KL.GELOMBANG 3/DIKLAT/XI/2024-28 | KT.03.02/F/4737670/SER/2026 | pelatihan kanker lanjut | ||||||||||||||||||||||
55 | 47 | RINI KURNIASIH | 197204161997032001 | KSK.ONK. 0050 | POLI ONKOLOGI | PK 3 | Ners | KH00000959634669 | seumur hidup | NR33742512002458 | 4/17/2031 | YP.03.02/D.XI.2/1891/2026 | 17 April 2029 | 102/TAKK-7/DIKLAT/2017-14 | 3 Januari 2021 | ​ | ​ | ​ | 1087/KANKER LANJUT 2023/DIKLAT/XI/2023 -15 | KT.03.02/F/4740975/SER/2026 | |||||||||||||||||||||||
56 | 48 | NUNGKI WAHYU PERTIWI, S.kep, Ns. | 198404072023212007 | KSK.ONK. 0051 | KASUARI LT. 4 | PK 3 | Ners | LJ00001045018881 | Seumur Hidup | 449.2/489/DPM-PTSP/IP.489/III/2023 | 4/7/2028 | YP.03.02/D.X.2/674/2025 | 7 April 2028 | 122/Assesmen/DIKLAT/XII/2021-2 | 12/3/2024 | ​ | ​ | ​ | 1087/KANKER LANJUT 2023/DIKLAT/XI/2023-13 | Sudah | KT.03.02/F/5019618/SER/2026 (sertifikat paliatif ) | ||||||||||||||||||||||
57 | 49 | JANI SUMARSIH | 197501201998032001 | KSK.ONK. 0052 | KASUARI LT. 4 | PK 3 | D3 Kep | TF00000942120887 | seumur hidup | NR33742609008629 | 1/21/2032 | YP.03.02/D.X.2/75/2024 | 20 Januari 2027 | 102/TAKK.7/DIKLAT/2017.222 | 1/3/2021 | ​ | ​ | ​ | 381/DPW.PPNI/SK/K.S/2021 | 10/28/2024 | |||||||||||||||||||||||
58 | 50 | DESTI DWI NUHGRAHENI | 198804182025212040 | KSK.ONK. 0053 | POLI ONKOLOGI | PK 3 | D3 Kep | GW00001105982574 | seumur hidup | 449.2/370/DPM-PTSP/IP.370/III/2022 | 4/18/2027 | YP.03.02/D.X.2/1402/2025 | 18 April 2027 | tdk diberikan | tdk ada | ​ | ​ | ​ | 381/DPW.PPNI/SK/K.S/X/2021 | BELUM | |||||||||||||||||||||||
59 | 51 | FARIDA EKO CAHYANINGRUM | 197604252003122001 | KSK.ONK. 0054 | RIRA | PK 3 | D3 Kep | PI00001332169466 | seumur hidup | 449.2/439/DPM-PTSP/IP.439/III/2022 | 4/25/2027 | YP.03.02/II/748/2023 | 25 April 2027 | 34.A/TAKK/DIKLAT/VI/2014-473 | 12/31/2015 | ​ | ​ | ​ | 17451/KL.GELOMBANG 2/DIKLAT/XI/2024 - 10 | KT,03,02/F/4737716/SER/2026 | |||||||||||||||||||||||
60 | SYARIF HIDAYATULLAH | 198505052023211007 | KSK.ONK. 0055 | RIRA | PK 3 | D3 Kep | JE00001319911538 | seumur hidup | 449.2/503/DPM-PTSP/IP.503/III/2022 | 5/5/2027 | YP.03.02/D.X.2/2086/2025 | 5 Mei 2027 | 54/TAKK-1/DIKLAT/VII/2015-250 | 7/1/2018 | SUDAH | ​ | ​ | 382/DPW.PPNI/SK/K.S/X/2021 | |||||||||||||||||||||||||
61 | 53 | SUNOTO | 197408111994031001 | KSK.ONK. 0056 | RIRA | PK 3 | Ners | ZA00001319838282 | seumur hidup | 449.2/1379/DPM-PTSP/IP.1379/VIII/2023 | II/08/2027 | YP.03.02/D.X.2/4335/2025 | 11 Agustus 2027 | 54/TAKK-1/DIKLAT/VII/2015-250 | 7/1/2018 | SUDAH | 449.2/1379/DPM-PTSP/IP.1379/VIII/2023 | BELUM | BELUM | 624/DPW.PPNI/SK/K.S/X/2022 | KT.03.02/F/5591529/SER/2026 | MAGANG RSHS KEDOKTERAN NUKLIR 2018 | |||||||||||||||||||||
62 | 54 | NYONO KHOIRI | 197207161994031004 | KSK.ONK. 0057 | IBS | PK 3 | Ners | 1401712213481036 | 7/16/2026 | 449.2/796/.DPM.PTSP/IP.796/VI/2021 | 7/16/2026 | ​ | ​ | ​ | |||||||||||||||||||||||||||||
63 | 55 | AZIZAH | 197210201993032006 | KSK.ONK. 0058 | IBS | PK 3 | D3 Kep | LF00000676063850 | Seumur hidup | 449.2/1274/DPM-PTSP/IP.1274/VI/2022 | 10/20/2027 | YP.03.01/II/7238/2021 | 20 Oktober 2024 | 01/KOMPETENSI DASAR/DIKLAT/I/2022-1428 | 3/2/2024 | ​ | ​ | ​ | BELUM | ||||||||||||||||||||||||
64 | 56 | WAHYU BUDI UTOMO | 198007152005011004 | KSK.ONK. 0059 | IBS | PK 3 | D3 Kep | 140151220-3245077 | Seumur hidup | 449.2/601/DPM-PTSP/IP.601/VI/2020 | 7/15/2025 | YP.03.01/II/6806/2021 | 15 Juli 2024 | 88/KOMPETENSI.DASAR/DIKLAT/IX/2019-2745 | 9/29/2022 | ​ | ​ | ​ | |||||||||||||||||||||||||
65 | 57 | NIKEN PUSPITASARI | 198304102007012011 | KSK.ONK. 0060 | IBS | PK 3 | D3 Kep | YK0000718570844 | Seumur hidup | 449.2/96/DPM-PTSP/IP.596/IV/2021 | 4/10/2026 | YP.03.01/II/2191/2022 | 10 April 2025 | 54/TAKK-1/DIKLAT/VII/2015-190 | ​ | ​ | ​ | 15973/KANKER DASAR/DIKLAT/VII/2024-27 | Belum | ||||||||||||||||||||||||
66 | 58 | ERLINA DWI LESTARI | 198709252012122001 | KSK.ONK. 0061 | KEPODANG DASAR | PK 3 | Ners | YK00000674459504 | Seumur hidup | 449.2/2505/DPM-PTSP/IP.2505/IX/2022 | 9/25/2027 | YP.03.01/II/8196/2022 | 25 September 2025 | 26/TAK-1/DIKLAT/2019-64 | 2/20/2022 | ​ | ​ | ​ | BELUM | Sudah | 77/IHT.Paliatif/Diklat/XII/2020-072 | ||||||||||||||||||||||
67 | 59 | MUHIMMATUN NASIKHAH | 198402102010122001 | KSK.ONK. 0062 | RAJAWALI 5B | PK 3 | Ners | 1401722234667663 | 2/10/2028 | 449.2/1557/DPM-PTSP/IP.1557/IX/2023 | 2/10/2028 | YP.03.02/D.X.2/4233/2023 | 10 Februari 2026 | 01/TAKK-3/DIKLAT/2016-55 | 2/1/2019 | ​ | ​ | ​ | 15 November 2023 | Belum | |||||||||||||||||||||||
68 | 60 | TITIK SUPRIYANI | 197805272001122004 | KSK.ONK. 0064 | RAJAWALI 4B | PK 3 | D3 Kep | PE00001065719877 | seumur hidup | 449.2/193/DPM-PTSP/IP.193/II/2022 | 5/27/2027 | YP.03.01/II/2367/2022 | 27 Mei 2027 | SUDAH | 14 Februari 2018 | BELUM | BELUM | 17437/KL GELOMBANG 1/DIKLAT/X/2024 - 27 | Sudah | KT.03.02/F/5020582/SER/2026 ( Askep Paliatif Pada Pasien Kanker ) | |||||||||||||||||||||||
69 | 61 | AGUS BAMBANG ASMORO | 198103032015031001 | KSK.ONK. 0065 | RAJAWALI 1B | PK 3 | Ners | NQ00001320419974 | seumur hidup | 449,22/759/DPM-PTSP/IP,759/IV/2022 | 3/3/2027 | YP,03,02/D.X.2/1412/2024 | 3/3/2027 | 102/TAKK-7/DIKLAT/2017-58 | 1/3/2021 | SUDAH | 6 April 2026 | BELUM | BELUM | 4 November 2021 | Sudah | pelatihan askep paliatif pada pasien kanker di yankes 24/1/26 | |||||||||||||||||||||
70 | 62 | NILA DEWI PUSPITASARI | 198810012022032001 | KSK.ONK. 0066 | RAJAWALI 5B | PK 3 | Ners | 140172222-4363167 | 10/1/2027 | 449.2/1768/DPM-PTSP/IP.1768/VII/2022 | 10/1/2027 | YP.03.01/II/5478/2021 | 1 Oktober 2024 | 30/ASSESMEN/DIKLAT/IV/2021-7 | 4/15/2024 | ​ | ​ | ​ | 382/DPW.PPNI/P/K/XI/2021/024 | Belum | |||||||||||||||||||||||
71 | 63 | AGUSTIN SUDIAS RINI | 198108272006042022 | KSK.ONK. 0067 | CENDRAWASIH | PK 3 | Ners | 140172221-4061068 | 8/27/2026 | 449.2/1540/DPM-PTSP/IP.1540/XI/2021 | 8/27/2026 | YP.03.02/II/669/2023 | 27 Agustus 2026 | 25/TAKK-1/Diklat /2017-64 | 2/19/2021 | ​ | ​ | ​ | BELUM | Sudah | 46/ Palliative Care/Diklat/VI/2018-22 | ||||||||||||||||||||||
72 | 64 | TRI LESTARI | 196908021994032001 | KSK.ONK. 0069 | ISSB | PK 4 | Ners | 140172220-3310706 | 8/2/2025 | 449.2/1061/DPM-PTSP/IP.1061/IX/2020 | 2/8 2025 | YP.03.01/II/7239/2021 | 2 Agustus 2024 | ​ | ​ | ​ | 2-4 November 2021 | sudah | pelatihan paliatif care bagi tenaga kesehatan 28 oktober 2021 | ||||||||||||||||||||||||
73 | 65 | AGUS WIDODO | 197412261997031001 | KSK.ONK. 0070 | KASUARI LT.4 | PK 4 | Ners | ES00000132802605 | SEUMUR HIDUP | YP.03.01/II/8397/2021 | 26 Desember 1974 | 51/TAKK-3/DIKLAT/2-18-3 | 5/15/2021 | ​ | ​ | ​ | 2-4 NOVEMBER 2021 | ||||||||||||||||||||||||||
74 | 66 | WIDAYANI | 197310272000032001 | KSK. ONK. 0071 | POLI ONKOLOGI | PK 4 | D4 Kep | YT00000956320598 | Seumur Hidup | NR33742606017293 | 10/28/2031 | 25/TAKK-1/Diklat/2017-52 | 2/19/2021 | ​ | ​ | ​ | 23 November 2023 | Sudah | KT.03.02/F/4742434/SER/2026 (Askep Paliatif Pada Pasien Kanker ) | ||||||||||||||||||||||||
75 | 67 | ELI SUBEKTI | 197211021994031001 | KSK.ONK. 0072 | KASUARI 5 | PK 4 | Ners | 14 01 7 1 2 23-4715935 | SEUMUR HIDUP | 449.2/962/DPM-PTSP/IP.962/VI/2023 | 2/11/2028 | 11 Februari 2024 | ​ | ​ | ​ | Belum | |||||||||||||||||||||||||||
76 | 68 | KUNTARYADI | 197404021994031001 | KSK.ONK. 0073 | ISSB | PK 4 | Magister | 1401722224216050 | Seumur hidup | 449.2/691/DPM-PTSP/IP.691/IV/2022 | 07/04/2027 | YP.03.02/D.X.2/8119/2024 | 02 April 2027 | SUDAH | 2014 | SUDAH | 2023 | ​ | 1087/KANKER LANJUT 2023/DIKLAT/XI/2023 - 11 | ||||||||||||||||||||||||
77 | 69 | ARIF BASUKI RAHMAD | KSK. ONK. 0074 | YANKEP | PK 4 | Magister | ​ | ​ | ​ | ||||||||||||||||||||||||||||||||||
78 | 70 | NADI | KSK.ONK.0075 | POLI ONKOLOGI | PK 3 | ​ | ​ | ​ | |||||||||||||||||||||||||||||||||||
79 | 71 | YAN ADI WIBAWA | 198607222009031002 | KSK.ONK.0076 | CLINICAL RESEARCH UNIT | PK 3 | Magister | ER00001126934592 | Seumur Hidup | 1298/DPM-PTSP/SIP/VIII/2024 | 7/22/2029 | YP.03.02/D.X.2/2192/2025 | 22 Juli 2028 | 05/ASSESSMEN/DIKLAT/IV/2025-1 | BELUM | ​ | SUDAH | 17555/KL GELOMBANG 3/DIKLAT/XI/2024 - 30 | |||||||||||||||||||||||||
80 | 72 | IRNAWATI | 198909232014022007 | RAJAWALI 2A | PK 3 | Ners | BU00001047407292 | Seumur Hidup | NR33742504003895 | 9/24/2030 | YP.03.02/D.X.2/4814/2025 | 23 September 2028 | 135/ASESMEN/DIKLAT/XI/2022-7 | SUDAH | 21 Februari 2018 | BELUM | BELUM | 624/DPW.PPNI/SK/K.S/X/2022 | sudah | KT.03.02/F/5595674/SER/2026 | |||||||||||||||||||||||
81 | |||||||||||||||||||||||||||||||||||||||||||
82 | |||||||||||||||||||||||||||||||||||||||||||
83 | |||||||||||||||||||||||||||||||||||||||||||
84 | Petunjuk Pengisian Tabel : | ||||||||||||||||||||||||||||||||||||||||||
85 | 1. | Nama Anggota : Di isi dengan nama anggota dan gelar terakhir sesuai SK. | |||||||||||||||||||||||||||||||||||||||||
86 | 2. | NIP : Penulisan diawali dengan tanda ('). | |||||||||||||||||||||||||||||||||||||||||
87 | 3. | Nomer Registrasi Anggota : Di isi sesuai dengan nomer registrasi anggota. | |||||||||||||||||||||||||||||||||||||||||
88 | 4. | Ruang : Di isi dengan nama ruangan saat ini anggota KSK bekerja. | |||||||||||||||||||||||||||||||||||||||||
89 | 5. | Level PK/BP : Di isi dengan level PK/BP saat ini sesuai dengan SPK | |||||||||||||||||||||||||||||||||||||||||
90 | 6. | Pendidikan : Di isi dengan level pendidikan terakhir, sesuai dengan SK | |||||||||||||||||||||||||||||||||||||||||
91 | 7. | Status Kepegawaian : Di isi dengan status pegawai sesuai SK | |||||||||||||||||||||||||||||||||||||||||
92 | 8. | Nomer STR : Di isi nomer STR sesuai dengan yang tertera di STR anggota KSk | |||||||||||||||||||||||||||||||||||||||||
93 | 9. | Nomer SIPP/SIPB : Di isi nomer SIPP/SIPB sesuai dengan yang tertera di SIPP/SIPB anggota KSk | |||||||||||||||||||||||||||||||||||||||||
94 | 10. | Nomer SPK : Di isi nomer yang tertera di SPK terakhir yang dimiliki anggota KSk | |||||||||||||||||||||||||||||||||||||||||
95 | 11. | Tanggal masa berlaku habis : Di Isi dengan format : Tanggal/Bulan/Tahun atau Seumur Hidup | |||||||||||||||||||||||||||||||||||||||||
96 | 12. | Nama Pelatihan sesuai persyaratan KSK : Di isi sesuai dengan nama pelatihan berdasarkan buku putih yang sudah diikuti oleh anggota KSK, | |||||||||||||||||||||||||||||||||||||||||
97 | jika pelatihan sudah diikuti maka tuliskan tanggal pelaksanaan pelatihan, jika belum mengikuti maka tuliskan "Belum" | ||||||||||||||||||||||||||||||||||||||||||
98 | |||||||||||||||||||||||||||||||||||||||||||
99 | |||||||||||||||||||||||||||||||||||||||||||
100 | |||||||||||||||||||||||||||||||||||||||||||