| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | REKAP ANGGOTA KELOMPOK STAF KEPERAWATAN (KSK) | |||||||||||||||||||||||||||||||||||||||||
2 | ||||||||||||||||||||||||||||||||||||||||||
3 | NAMA KSK :KARDIOVASKULER | |||||||||||||||||||||||||||||||||||||||||
4 | NAMA KEPALA KSK : ARI KUSUMANTORO | Alamat Email : kskcardio@gmail.com | ||||||||||||||||||||||||||||||||||||||||
5 | NAMA SEKRETARIS KSK: NURUL FAUZIAH | Alamat Email : kskcardio@gmail.com | ||||||||||||||||||||||||||||||||||||||||
6 | ||||||||||||||||||||||||||||||||||||||||||
7 | NO | NAMA ANGGOTA | NIP/NIK | NOMER REGISTRASI ANGGOTA | RUANG | LEVEL PK/BP | PENDIDIKAN | STATUS KEPEGAWAIAN | 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 Keperawatan Kardiovaskuler Jantung Dasar | Bantuan Hidup Jantung Lanjut | Pelatihan Keperawatan Penyakit Jantung Bawaan | Pelatihan Keperawatan Penyakit Jantung Koroner | Pelatihan Keperawatan Penyakit Katup Jantung | Pelatihan Keperawatan Kardiovaskuler Tingkat Lanjut I | Pelatihan Keperawatan Kardiovaskuler Tingkat Lanjut II | |||||||||||||||||||||||||||
9 | 1 | Amin Zuhri | 198801262022031001 | KSK.KDV.0001 | Poliklinik & Cath Lab | PK 3 | Ners | PNS | LU00000954720790 | seumur hidup | NR33742511003992 | 27/01/2031 | YP.03.02/D.X.2/971/2026 | 27/01/2029 | 67/TAKK-6/DIKLAT/2017-62 | 22/08/2020 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-30 | 077241/DL.03.01/PL/2022 | 130/PEL.CATHLAB.LI.II/DIKLAT/XI/2021-01 | 1086/INTERVENSI INSERVICE/DIKLAT/XI/2023-1 | ||||||||||||||||||||||
10 | 2 | Anis Heru Santiko | 198201012005011002 | KSK.KDV.0002 | Instalasi Bedah Sentral | PK 3 | Ners | PNS | 140171222-4369423 | 01/01/2027 | 449.2/1819/DPM-PTSP/IP.1819/VIII/2022 | 01/01/2027 | YP.03.02/D.X.2/7129/2025 | 01/01/2027 | 102/TAKK-7/DIKLAT/2017-213 | 03/01/2021 | 2492/DPP.PPNI/SK/K.S/X/2022 | 69/Pelatihan.Perfusi/Diklat/XII/2020-01 | ||||||||||||||||||||||||
11 | 3 | Ari Kusumantoro | 198102212005011004 | KSK.KDV.0003 | Instalasi Jantung | PK 3 | Ners | PNS | IL00000920634436 | seumur hidup | NR33742411008914 | 22/02/2030 | YP.03.02/D.X.2/465/2025 | 22/02/2028 | 42/TAKK/DIKLAT/XI/2014-209 | 01/09/2017 | DL.01.03.1.3.1.01/07.1749 | 148818/DL.03.01/PL/2023 | 21/CATHLAB/DIKLAT/II/2015-02 | |||||||||||||||||||||||
12 | 4 | Asrul Zulmi | 198303102010122003 | KSK.KDV.0004 | Elang Lt.1 | PK 3 | Ners | PNS | VM00001249846399 | seumur hidup | NR33742412001516 | 10/03/2030 | YP.03.02/D.XI.02/1480/2026 | 10/03/2029 | 110/TAKK-10/DIKLAT/2019-36 | 25/10/2022 | 57958/H/Q.31/203030105/XI/2019 | 1538/DPP.PPNI/SK/K.S/XI/2019 | ||||||||||||||||||||||||
13 | 5 | Astuti Handayani | 198203042023212002 | KSK.KDV.0005 | Garuda lantai 4 | PK 3 | D3 Kep | PPPK | 140152223-4597931 | 04/03/2028 | 449.2/326/DPM-PTSP/IP.326/II/2023 | 04/03/2028 | YP.03.02/D.X.2/645/2025 | 04/03/2028 | 74/TAKk-4/Diklat/2018-41 | 08/24/2021 | 09/CVS/DIKLAT/VI/2006 | |||||||||||||||||||||||||
14 | 6 | Bambang Turyanto | 197010141994031004 | KSK.KDV.0006 | Poliklinik & Cath Lab | PK 3 | D3 Kep | PNS | QG00000620645301 | seumur hidup | 449.2/1317/DPM-PTSP/IP.1317/X/2021 | 14/10/2026 | YP.03.02/D.X.2/8363/2024 | 14/10/2026 | 25/TAKK-1/DIKLAT/2017-152 | 19/02/2021 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-18 | 2494/DPP.PPNI/SK/K.S/X/2022 | 80/PEL CATHLAB.LI.I/DIKLAT/XI/2021-04 | 123/JANTUNGTKLANJUTII/DIKLAT/XII/2021-1 | ||||||||||||||||||||||
15 | 7 | Bangun Dwiyana Rosa | 198112162006041005 | KSK.KDV.0007 | Instalasi Jantung | PK 3 | Ners | PNS | 140171221-4094672 | 16/12/2026 | 449.2/1648/DPM-PTSP/IP.1648/XII/2021 | 16/12/2026 | YP.03.02/II/439/2023 | 16/12/2026 | DL.01.03.1.3.1.01/08.1806 | 076/SK/KOLEGIUMJPDI/2018 | 13/KARVAS/Diklat/VII/2012 | |||||||||||||||||||||||||
16 | 8 | Bangun Hari Pradono | 198306192007011006 | KSK.KDV.0008 | Instalasi Bedah Sentral | PK 3 | Ners | PNS | LD00000832088895 | SEUMUR HIDUP | NR33742501003585 | 20/06/2030 | YP.03.02/D.X.2/2491/2025 | 20/06/2028 | 102/TAKK-7/DIKLAT/2017-212 | 03/01/2021 | 67/KARDIO/DIKLAT/XII/2013-27 | 2495/DPP.PPNI/SK/K.S/X/2022 | ||||||||||||||||||||||||
17 | 9 | Budi Prayitno | 198310152005011004 | KSK.KDV.0009 | Instalasi Bedah Sentral | PK 3 | Ners | PNS | DH0000674360664 | SEUMUR HIDUP | SK/210/DPM-PTSP/SIP/III/2024 | 15/10/2029 | YP.03.02/D.X.2/7990/2024 | 15/10/2027 | 42/TAKK/DIKLAT/XI/2014-225 | 01/09/2017 | 67/KARDIO/DIKLAT/XII/2013-29 | 077251/DL.03.01/PL/2022 | ||||||||||||||||||||||||
18 | 10 | Dewi Rohmawati | 198709092023212008 | KSK.KDV.0010 | Elang Lt.1 | PK 3 | Ners | PPPK | 140172222-4303591 | 09/09/2027 | 449.2/1156/DPM-PTSP/IP.1156/VI/2022 | 09/09/2027 | YP.03.02/II/2140/2023 | 09/09/2027 | 105/TAKK-9/DIKLAT/2019-49 | 12/09/2022 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-13 | |||||||||||||||||||||||||
19 | 11 | Dina Wijayanti | 198607022009122002 | KSK.KDV.0011 | Elang Lt. 2 | PK 3 | Ners | PNS | 1401722224471574 | 02/07/2027 | 449.2/1621/DPM-PTSP/IP.1621/IX/2023 | 02/07/2027 | YP.03.02/II/2684/2023 | 02/07/2026 | 25/TAKK-1/Diklat/2017-141 | 19/02/2021 | 35/KARDIO DASAR-1/DIKLAT/VI/2021-20 | 2493/DPP-PPNI/SK/K.S/X/2022 | ||||||||||||||||||||||||
20 | 12 | Dwi Purwanti | 198812062020122006 | KSK.KDV.0012 | Elang Lt.1 | PK 3 | Ners | PNS | 140172222-4423252 | 06/12/2027 | 449.2/2915/DPM-PTSP/IP.2915/XI/2022 | 06/12/2027 | YP.03.02/II/3673/2023 | 15/10/2026 | 105/TAKK-9/DIKLAT/2019-55 | 12/09/2022 | 64/KARDIODASAR-3/DIKLAT/IX/2021-31 | |||||||||||||||||||||||||
21 | 13 | Dwi Titik Widyaningrum | 198204282006042017 | KSK.KDV.0013 | Elang Lt.1 | PK 3 | Ners | PNS | 140172219-3011231 | seumur hidup | SK/475/DPM-PTSP/SIP/IV/2024 | 4/28/2029 | YP.03.02/II/2196/2022 | 4/28/2025 | 26/TAKK-1/DIKLAT/2019-51 | 20/02/2022 | 0592/DPP.PPNI.SK/K.S/III/2023 | 0767/DPP.PPNI/SK/K.S/IV/2023 | ||||||||||||||||||||||||
22 | 14 | Dwi Vitriawati | 198905032010122001 | KSK.KDV.0014 | Instalasi Bedah Sentral | PK 3 | D3 Kep | PNS | 140152222-4230590 | 03/05/2027 | 449.2/829/DPM-PTSP/IP.829/IV/2022 | 03/05/2027 | YP.03.02/II/1317/2023 | 03/05/2026 | 41/TAKK-3/DIKLAT/2019-43 | 28/03/2022 | 64251/H/D/203021400/XI/2017 | DL.02.01/8.21/1.02.04.1/035/2018 | ||||||||||||||||||||||||
23 | 15 | Emi Nurharyanti | 197508072005012002 | KSK.KDV.0015 | Instalasi Bedah Sentral | PK 3 | D3 Kep | PNS | NC00000373952922 | Seumur Hidup | 449.2/479/DPM-PTSP/IP.479/II/2024 | 07/08/2028 | YP.03.02/D.X.2/7343/2024 | 07/08/2027 | 102/TAKK-7/Diklat/2017-181 | 03/01/2021 | 2493/DPP.PPNI/SK/K.S/X/2022 | 077301/DL.03.01/PL/2022 | ||||||||||||||||||||||||
24 | 16 | Evi Dwi Mulyani | 198310072010122002 | KSK.KDV.0016 | Elang Lt.1 | PK 3 | Ners | PNS | 140172221-3407207 | 07/10/2026 | 449.2/525/DPM-PTSP/IP.525/IV/2021 | 10/07/2026 | YP.03.02/II/3306/2023 | 07/10/2026 | 42/TAKK/DIKLAT/IX/2014-214 | 01/09/2017 | 64/KARDIODASAR-3/DIKLAT/IX/2021-21 | |||||||||||||||||||||||||
25 | 17 | Ferry Irawan | 198002112005011003 | KSK.KDV.0017 | Poliklinik & Cath Lab | PK 3 | D3 Kep | PNS | 140151221-3484465 | 11/02/2026 | NR33742602011130 | 11/02/2031 | YP.03.01/II/929/2022 | 11/02/2026 | 25/TAKK-1/DIKLAT/2017-150 | 19/02/2021 | DL.01.03.1.3.1.01/07.1750 | 076/SK/KolegiumJPDI/2018 | 44/CATHLAB/DIKLAT/X/2014-06 | |||||||||||||||||||||||
26 | 18 | Imam Junaedi | 198905052019021001 | KSK.KDV.0018 | Instalasi Bedah Sental | PK 3 | Ners | PNS | BY00000822416328 | Seumur Hidup | 449.2/950/DPM-PTSP/IP.950/IV/2022 | 05/05/2027 | YP.03.02/D.X.2/XXXX/2025 | 05/05/2027 | 41/TAKK-3/DIKLAT/2019-56 | 28/10/2022 | 67/KARDIO/DIKLAT/XII/2013-28 | 2495/DPP.PPNI/SK/K.S/X/2022 | 69/Pelatihan.Perfusi/DIKLAT/XII/2020-04 | |||||||||||||||||||||||
27 | 19 | Indah Ariyani | 198007252005012021 | KSK.KDV.0019 | Elang Lt.1 | PK 3 | Ners | PNS | 140152222-4194552 | 25/07/2027 | 449.2/298/DPM-PTSP/IP.298/III/2022 | 7/25/2027 | YP.03.02/D.X.2/6816/2024 | 25/07/2027 | 01/TAKK-3/DIKLAT/2016-29 | 01/02/2019 | 64/KARDIODASAR-3/DIKLAT/IX/2021-25 | |||||||||||||||||||||||||
28 | 20 | Isna Nurmilusari | 198704232008122003 | KSK.KDV.0020 | Poliklinik & Cath Lab | PK 3 | Ners | PNS | 140172223-4752157 | 23-04/2028 | 449.2/40/DPM-PTSP/IP.40/I/2024 | 23/04/2028 | YP.03.02/D.X.2/2069/2024 | 23/04/2027 | 44/TAKK-4/DIKLAT/2016-77 | 26/07/2019 | 64/KARDIODASAR-3/DIKLAT/IX/2021/3 | |||||||||||||||||||||||||
29 | 21 | Khoirun Nisak | 197411171998032002 | KSK.KDV.0021 | Poliklinik & Cath Lab | PK 3 | D3 Kep | PNS | CR00000956629732 | Seumur Hidup | 449.2/1617/DPM-PTSP/IP.1617/XI/2021 | 17/11/2026 | YP.03.02/D.X.2/5405/2025 | 17/11/2026 | 34.A/TAKK/DIKLAT/VI/2014-431 | 31/12/2015 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-6 | 077296/DL.03.01/PL/2022 | 1311/DPP.PPNI/SK/K.S/VII/2023 | |||||||||||||||||||||||
30 | 22 | Kiswidayati | 196404161989022001 | KSK.KDV.0022 | Poliklinik & Cath Lab | PK 3 | Ners | PNS | 140172221-3464650 | 16/04/2026 | 449.2/688/DPM-PTSP/IP.688/V/2021 | 16/04/2026 | YP.03.02/II/767/2023 | 16/04/2026 | 25/TAKK-1/DIKLAT/2017-133 | 19/02/2021 | Pensiun per 1 Mei 2024 | |||||||||||||||||||||||||
31 | 23 | Kristin Sri Hartanti | 198403282023212003 | KSK.KDV.0023 | Elang Lt.1 | PK 3 | Ners | PPPK | 140152221-3489557 | 28/03/2026 | NR33742509019328 | 3/29/2031 | YP.03.02/D.XI.2/1561/2026 | 29/03/2029 | 25/TAKK-1/DIKLAT/2017-144 | 19/02/2021 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-16 | 076/SK/KOLEGIUM/PDI/2018 | ||||||||||||||||||||||||
32 | 24 | Marzuki | 198103102006041012 | KSK.KDV.0024 | Poliklinik & Cath Lab | PK 3 | D3 Kep | PNS | HL.00000937368618 | Seumur hidup | 499.2/376/DPM-PTSP/IP.376/III/2021 | 03/10/2026 | YP.03.02/D.X.2/1175/2024 | 03/10/2026 | 25/TAKK-1/DIKLAT/2017-154 | 19/02/2021 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-13 | 2495/DPP.PPNI/SK/K.S/X/2022 | 108/PEL.CHATHLAB.LI.III/DIKLAT/XII/2021-04 | 0615/DPP.PPNI/SK/K.S/III/2023 | ||||||||||||||||||||||
33 | 25 | Mega Idawati | 198306302023212005 | KSK.KDV.0023 | Elang Lt.1 | PK 3 | Ners | PPPK | CG00000736728312 | Seumur hidup | SK/692/DPM-PTSP/SIP/V/2024 | 6/30/2029 | YP.03.02/D.X.2/2680/2025 | 6/30/2028 | 81/TAKK-5/DIKLAT/2018-17 | 20/09/2021 | 64/KARDIODASAR-3/DIKLAT/IX/2021-16 | 2494/DPP.PPNI/SK/K.S/X/2022 | ||||||||||||||||||||||||
34 | 26 | Mila Cahyasari Dewi | 198510082020122003 | KSK.KDV.0026 | Elang Lt. 2 | PK 3 | D3 Kep | PNS | 1401522224321698 | 08/10/2027 | 449.2/2044/DPM-PTSP/IP.2044/VIII/2022 | 08/10/2027 | YP.03.02/D.X.2/8186/2024 | 08/10/2027 | 25/TAKK-1/Diklat/2017-131 | 19/02/2021 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-4 | 2494/DPP.PPNI/SK/K.S/XI/2022 | ||||||||||||||||||||||||
35 | 27 | Muarifin | 196912021991031006 | KSK.KDV.0027 | Poliklinik & Cath Lab | PK 3 | D3 Kep | PNS | 140151221-4110240 | 02/12/2026 | 449.2/1782/DPM-PTSP/IP.1782/XII/2021 | 02/12/2026 | YP.03.01/II/928/2022 | 02/12/2026 | 25/TAKK-1/DIKLAT/2017-153 | 19/02/2021 | DL.02.02.035.0811 | 076/SK/KolegiumJPDI/2018 | ||||||||||||||||||||||||
36 | 28 | MUKHAMAD ALI ZABIDI | 197402231998031003 | KSK.KDV.0028 | Instalasi Bedah Sentral | PK 3 | D3 Kep | PNS | VE00000283342229 | Seumur hidup | 449.2/2197/DPM-PTSP/IP.2197/XII/2023 | 23/02/2028 | YP.03.02/D.X.2/1031/2024 | 23/02/2027 | 102/TAKK-7/Diklat/2017-212 | 03/01/2021 | DL.02.02.035.BJ.0001 | 2494/DPP.PPNI/SK/K.S/X/2022 | ||||||||||||||||||||||||
37 | 29 | Nina Istiqomah | 198712042024212014 | KSK.KDV.0029 | Elang Lt.1 | PK 3 | D3 Kep | PPPK | 140152222-4412357 | 04/12/2027 | 449.2/2830/DPM-PTSP/IP.2830/XI/2022 | 12/04/2027 | YP.03.02/D.X.2/6490/2025 | 04/12/2027 | 81/TAKK-5/DIKLAT/2018-8 | 20/09/2021 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-22 | 2492/DPP.PPNI/SK/K.S/X/2022 | ||||||||||||||||||||||||
38 | 30 | Novita Purwaningsari | 13881557 | KSK.KDV.0030 | Elang Lt.1 | PK 3 | Ners | PPPK | 1401722224346179 | 07/11/2027 | 449.2/1512/DPM-PTSP/IP.1512/VII/2022 | 07/11/2027 | YP.03.02/II3390/2023 | 07/11/2026 | 105/TAKK-9/DIKLAT/2019-54 | 12/09/2022 | 35/KARDIODASAR-1/DIKLAT/VI/2021-37 | |||||||||||||||||||||||||
39 | 31 | Nurul Fauziah | 198908302020122004 | KSK.KDV.0031 | Elang Lt.1 | PK 3 | Ners | PNS | 140172223-4680831 | 30/08/2028 | 449.2/1133/DPM-PTSP/IP.1133/VII/2023 | 30/08/2028 | YP.03.02/II/3195/2023 | 30/08/2026 | 105/TAKK-9/DIKLAT/2019-53 | 12/09/2022 | 64/KARDIODASAR-3/DIKLAT/IX/2021-32 | 148826/DL.03.01/PL/2023 | ||||||||||||||||||||||||
40 | 32 | Oktrida Riyana,AMK | 198910022010122002 | KSK.KDV.0032 | Elang Lt. 2 | PK 3 | D3 Kep | PNS | OW00001088359381 | Seumur Hidup | NR33742504005872 | 03/10/2030 | YP.03.02/D.X.2/4488/2025 | 03/10/2028 | 105/TAKK-9/DIKLAT/2019-50 | 12/09/2022 | 35/KARDIODASAR-1/DIKLAT/VI/2021-10 | 148827/DL.03.01/PL/2023 | - | - | - | - | ||||||||||||||||||||
41 | 33 | Purwaka | 197301011994031003 | KSK.KDV.0033 | Poliklinik dan cathlab | PK 3 | Ners | PNS | 140171220-3348514 | seumur hidup | NR33742411008919 | 02/01/2030 | YP.03.02/D.X.2/10027/2024 | 02/01/2028 | 25/TAKK-1/DIKLAT/2017-151 | 19/02/2021 | 64/KARDIODASAR-3/DIKLAT/IX/2021-5 | 148828/DL.03.01/PC/2023 | 108/PEL CHATLAB.LI.III/DIKLAT/XII/2021-05 | DL.02.02.035.KH.111 | ||||||||||||||||||||||
42 | 34 | Purwati | 197505192002122001 | KSK.KDV.0034 | Elang Lt.1 | PK 3 | Ners | PNS | EG00001359450754 | Seumur Hidup | 449.2/885/DPM-PTSP/IP.885/VII/2021 | 5/19/2026 | YP.03.02/D.X.2/2110/2025 | 19/05/2026 | 64/KARDIODASAR.3/DIKLAT/IX/2021-11 | BT&CLS/SESI/IX/2023/00008694 | ||||||||||||||||||||||||||
43 | 35 | Rini Damayanti | 19851232014022002 | KSK.KDV.0035 | Elang Lt.1 | PK 3 | Ners | PNS | 140172222-4470977 | 23/01/2027 | 449.2/3070/DPM-PTSP/IP.3070/XI/2022 | 23/01/2027 | YP.03.02/D.X.2/5178/2025 | 23/01/2027 | 81/TAKK-5/DIKLAT/2018-5 | 20/09/2021 | 64/KARDIODASAR-3/DIKLAT/IX/2021-24 | |||||||||||||||||||||||||
44 | 36 | Riska Tri mutia Sari | 198612312019022001 | KSK.KDV.0036 | Elang Lt.1 | PK 3 | Ners | PNS | 140152222-4512703 | 31/12/2027 | 449.2/3142/DPM-PTSP/IP.3142/XII/2022 | 12/31/2027 | YP.03.02/D.X.2/4385/2023 | 31/12/2026 | 105/TAKK-9/DIKLAT/2019-56 | 12/09/2022 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-32 | 077247/DL.03.01/PL/2022 | ||||||||||||||||||||||||
45 | 35 | Sapta Darmadi | 197306201993031001 | KSK.KDV.0037 | Elang Lt. 2 | PK 3 | Ners | PNS | 140171121-3490911 | 20/06/2026 | 449.2/979/DPM-PTSP/IP.979/VII/2021 | 20/06/2026 | YP.03.02/D.X.2/4734/2024 | 20/06/2026 | 25/TAKK-1/DIKLAT/2017-146 | 19/02/2021 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-9 | 2492/DPP.PPNI/SK/K.S/X/2022 | ||||||||||||||||||||||||
46 | 38 | Sawini | 196612111987032001 | KSK.KDV.0038 | Merpati Lt. Dasar | PK 3 | D3 Kep | PNS | 140152221-4065504 | 11/12/2026 | 449.2/1714/DPM-PTSP/IP.1714/XII/2021 | 11/12/2026 | YP.03.01/II/5668/2021 | 11/12/2024 | 102/TAKK-7/DIKLAT/2017-48 | 03/01/2021 | 08/KARDIO DASAR/DIKLAT/IV/2016-31 | |||||||||||||||||||||||||
47 | 39 | Siti Hajar | 198211252015032001 | KSK. KDV. 0039 | ICCU | PK 3 | Ners | PNS | 140172222-4175474 | 25/11/2027 | 449.2/893/DPM-PTSP/IP.893/IV/2022 | 25/11/2027 | YP.03.02/D.X.2/9507/2024 | 25/11/2027 | 25/TAKK-1/DIKLAT/2017-136 | 19/02/2021 | 64/KARDIOLOGIDASAR-3/DIKLAT/IX/2021-20 | |||||||||||||||||||||||||
48 | 40 | Subadriyah | 197511272008122001 | KSK. KDV. 0040 | Instalasi Bedah Sentral | PK 3 | D3 Kep | PNS | 140152222-4427589 | 27/11/2027 | 449.2/2538/DPM-PTSP/IP.2538/IX/2022 | 27/11/2027 | YP.03.02/D.X.2/6304/2025 | 27/11/2027 | 42/TAKK/DIKLAT/XI/2014-190 | 01/09/2017 | ||||||||||||||||||||||||||
49 | 41 | Suhrodi | 197109091992031003 | KSK. KDV. 0041 | Poliklinik | PK 3 | Ners | PNS | 140171222-4490961 | 09/09/2027 | 449.2/1305/DPM-PTSP/IP.1305/X/2021 | 09/09/2027 | YP.03.02/II/2682/2023 | 09/09/2026 | 25/TAKK-1/DIKLAT/2017-128 | 19/02/2021 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-9 | 148833/DL.03.01/PL/2023 | ||||||||||||||||||||||||
50 | 42 | Sukroni | 196808021992031003 | KSK. KDV. 0042 | Merpati Lt. Dasar | PK 3 | D3 Kep | PNS | 140151221-3488251 | 02/08/2026 | 449.2/783/DPM-PTSP/IP.783/VI/2021 | 02/08/2026 | YP.03.02/II/1836/2023 | 02/08/2026 | 25/TAKK-1/DIKLAT/2017-130 | 19/02/2021 | PPNI.33.02/III/2016/SKP/106 | |||||||||||||||||||||||||
51 | 43 | Sumantri Edhi | 198010062023211001 | KSK.KDV.0043 | Elang Lt.1 | PK 3 | D3 Kep | PPPK | 140151222-4424159 | 06/10/2027 | 449.2/2981/DPM-PTSP/IP.2981/XI/2022 | 06/10/2027 | YP.03.01/II/8347/2022 | 06/10/2025 | 81/TAKK-5/DIKLAT/2018-6 | 20/09/2021 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-17 | 092939/DL.03.01/PL/2022 | ||||||||||||||||||||||||
52 | 44 | Sumarni | 198210092012122001 | KSK.KDV.0044 | Elang Lt.1 | PK 3 | Ners | PNS | 14052222-4303592 | 09/10/2027 | 449.2/1157/DPM-PTSP/IP.1157/VI/2022 | 10/09/2027 | YP.03.01/II/3152/2023 | 09/10/2026 | 105/TAKK-9/DIKLAT/2019-52 | 22/09/2022 | 64/KARDIODASAR-3/DIKLAT/IX/2021-29 | 148834/DL.03.01/PL/2023 | ||||||||||||||||||||||||
53 | 45 | Suyono | 198108152006041011 | KSK.KDV.0045 | ICU | PK 3 | Ners | PNS | 140171221-3522808 | 15/08/2026 | 449.2/792/DPM-PTSP/IP.792/VI/2021 | 15/08/2026 | YP.03.02/D.X.2/7346/2024 | 15/08/2026 | 25/TAKK-1/DIKLAT/2017-132 | 19/02/2021 | 35/KARDIODASAR-1/DIKLAT/VI/2021-23 | 138/ACLSINSERVICE/DIKLAT/XI/2022-10 | 44/CATHLAB/DIKLAT/X/2014-05 | |||||||||||||||||||||||
54 | 46 | Titin Kurniawati | 198603202008122003 | KSK.KDV.0046 | Elang Lt. 2 | PK 3 | D3 Kep | PNS | FE00001063613016 | Seumur Hidup | 449.2/449/DPM-PTSP/IP.449/III/2022 | 03/20/2027 | YP.03.02/D.X.2/981/2025 | 03/20/2027 | 81/TAKK-5/DIKLAT/2018-7 | 09/20/2021 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-22 | 148837/DL.03.01/PL/2023 | ||||||||||||||||||||||||
55 | 47 | Tri Wahyuni | 198106182008012010 | KSK.KDV.0047 | Poliklinik & Cath Lab | PK 3 | D3 Kep | PNS | 140152222-4260132 | 18/06/2027 | 449.2/1021/DPM-PTSP/IP.1021/V/2022 | 18/06/2027 | YP.03.02/D.X.2/4733/2024 | 18/06/2027 | 67/TAKK-6/DIKLAT/2017-295 | 02/08/2020 | 35/KARDIODASAR-1/DIKLAT/VI/2021-5 | 07724/DL.03.01/PL/2022 | 80/PEL.CATHLAB.L1/DIKLAT/XI/2021-07 | 123/JANTUNG TK II/DIKLAT/XII/2021-2 | ||||||||||||||||||||||
56 | 48 | Ullil Komariah | 198406012023212008 | KSK.KDV.0048 | Elang Lt.1 | PK 3 | Ners | PPPK | 140172222-4172595 | 01/06/2027 | 449.2/721/DPM-PTSP/IP.721/IV/2022 | 01/06/2027 | YP.03.02/D.X.2/4534/2024 | 01/06/2027 | 25/TAKK-1/DIKLAT/2017-135 | 19/02/2021 | 64/KARDIODASAR-3/DIKLAT/IX/2021-8 | 077290/DL.03.01/PL/2022 | ||||||||||||||||||||||||
57 | 49 | Umi Nurhasanah | 197605241998032001 | KSK.KDV.0049 | Elang Lt. 2 | PK 3 | Ners | PNS | ZC00001079287381 | Seumur Hidup | 449.2/580/DPM-PTSP/IP.580/IV/2021 | 24/05/2026 | YP.03.02/II/1316/2023 | 24/05/2026 | 34.A/TAKK/DIKLAT/VI/2014-353 | 31/12/2015 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-21 | 148839/DL.03.01/PL/2023 | ||||||||||||||||||||||||
58 | 50 | Wayan Wardiyana | 198806042012122001 | KSK.KDV.0050 | Elang Lt. 2 | PK 3 | Ners | PNS | 150172223-4651841 | 04/06/2028 | 449.2/610/DPM-PTSP/IP.610/IV/2023 | 04/06/2028 | YP.03.02/II/1587/2023 | 04/06/2026 | 105/TAKK-9/DIKLAT/2019-51 | 12/09/2022 | 35/KARDIO.DASAR-1/DIKLAT/VI/2021-2 | 2492/DPP.PPNI/SK/K.S/X/2022 | ||||||||||||||||||||||||
59 | 51 | Wiwid Widiyan Tri Perwiranto | 12881189 | KSK.KDV.0051 | ICCU | PK 3 | Ners | PPPK | AE00000163513914 | Seumur Hidup | 449.2/1930/DPM-PTSP/IP.1930/XI/2023 | 01/12/2028 | YP.03.02/II/723/2023 | 01/12/2026 | 81/TAKK-5/DIKLAT/2018-15 | 20/09/2021 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-33 | 0030/1506/DPP.PPNI/SK/K.S/VI/2022 | ||||||||||||||||||||||||
60 | 52 | Yuli Astuti | 197207272002122001 | KSK.KDV.0052 | Poliklinik dan cathlab | PK 3 | Ners | PNS | EL00001034882580 | Seumur Hidup | 449.2/1261/DPM-PTSP/IP.1261/IX/2021 | 27/07/2026 | YP.03.02/D.X.2/7153/2024 | 27/07/2026 | 25/TAKK-1/DIKLAT/2017-139 | 19/02/2021 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-18 | 2493/DPP.PPNI/SK/K.S/X/2022 | ECHO-00711/DPW.PPNI/SK/KS/111/2019 | TREADMILL-513/DPW.PPNI/SK/K.S/VII/2019 | ||||||||||||||||||||||
61 | 53 | Roh'anna | 198505292014022001 | KSK.KDV.0053 | Elang Lt. 2 | PK 3 | Ners | PNS | ML00000862143460 | Seumur Hidup | 449.2/164/DPM-PTSP/IP.164/II/2023 | 29/05/2028 | YP.03.02/D.X.2/2197/2025 | 29/05/2028 | 81/TAKK-5/DIKLAT/2018-11 | 20/09/2021 | 50/KARDIODASAR-2/DIKLAT/VIII/2021-14 | |||||||||||||||||||||||||
62 | 54 | Andy Kristiyan | 197607072003121002 | KSK.KDV.0054 | IGD | PK 3 | Magister | PNS | VXOOOO1067641526 | Seumur hidup | 449.2/814/DPM-PTSP/IP.814/III/2024 | 07/07/2029 | YP.03.02/D.X.2/9719/2024 | 07/07/2027 | 80/TAKK-5/DIKLAT/2016-6 | 19/12/2019 | DL.0103.030.1.01/05.1478 | |||||||||||||||||||||||||
63 | 55 | Junait | KSK.KDV.0055 | yankep | PK 4 | Magister | PNS | KS00000960038634 | Seumur Hidup | 449.2/2022/DPM-PTSP/IP.2022/VIII/2022 | 07/09/2027 | YP.03.02/II/3499/2023 | 09/09/2026 | 25//TAKK-1/Diklat/2017-147 | 19/02/2021 | 09/KD/KhususI/Diklat/II/2018-3 | ||||||||||||||||||||||||||
64 | 56 | Muchlis Sujudi | KSK.KDV.0056 | Pelayanan Penunjang | PK 4 | Magister | PNS | 1401712203291681 | 21/07/2025 | 449.2/666/DPM-PTSP/IP.666/V/2021 | 21/07/2025 | YP.03.02/II/3477/2023 | 21/07/2025 | 016/SK/KolegiumPERKI/I/2014 | ||||||||||||||||||||||||||||
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76 | Petunjuk Pengisian Tabel : | |||||||||||||||||||||||||||||||||||||||||
77 | 1. | Nama Anggota : Di isi dengan nama anggota dan gelar terakhir sesuai SK. | ||||||||||||||||||||||||||||||||||||||||
78 | 2. | NIP : Penulisan diawali dengan tanda ('). | ||||||||||||||||||||||||||||||||||||||||
79 | 3. | Nomer Registrasi Anggota : Di isi sesuai dengan nomer registrasi anggota. | ||||||||||||||||||||||||||||||||||||||||
80 | 4. | Ruang : Di isi dengan nama ruangan saat ini anggota KSK bekerja. | ||||||||||||||||||||||||||||||||||||||||
81 | 5. | Level PK/BP : Di isi dengan level PK/BP saat ini sesuai dengan SPK | ||||||||||||||||||||||||||||||||||||||||
82 | 6. | Pendidikan : Di isi dengan level pendidikan terakhir, sesuai dengan SK | ||||||||||||||||||||||||||||||||||||||||
83 | 7. | Status Kepegawaian : Di isi dengan status pegawai sesuai SK | ||||||||||||||||||||||||||||||||||||||||
84 | 8. | Nomer STR : Di isi nomer STR sesuai dengan yang tertera di STR anggota KSk | ||||||||||||||||||||||||||||||||||||||||
85 | 9. | Nomer SIPP/SIPB : Di isi nomer SIPP/SIPB sesuai dengan yang tertera di SIPP/SIPB anggota KSk | ||||||||||||||||||||||||||||||||||||||||
86 | 10. | Nomer SPK : Di isi nomer yang tertera di SPK terakhir yang dimiliki anggota KSk | ||||||||||||||||||||||||||||||||||||||||
87 | 11. | Tanggal masa berlaku habis : Di Isi dengan format : Tanggal/Bulan/Tahun atau Seumur Hidup | ||||||||||||||||||||||||||||||||||||||||
88 | 12. | Nama Pelatihan sesuai persyaratan KSK : Di isi sesuai dengan nama pelatihan berdasarkan buku putih yang sudah diikuti oleh anggota KSK, | ||||||||||||||||||||||||||||||||||||||||
89 | jika pelatihan sudah diikuti maka tuliskan tanggal pelaksanaan pelatihan, jika belum mengikuti maka tuliskan "Belum" | |||||||||||||||||||||||||||||||||||||||||
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