[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-234300-113":3,"detail-sidebar-cat-1-id-113":80,"doc-detail-234300-id":114},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},113,"id","application-for-nutritionist-practice-permit-siptgz-application-form","Permohonan Surat Izin Praktik Tenaga Gizi (SIPTGz) - Formulir Pengajuan","","Surat permohonan resmi untuk mendapatkan Surat Izin Praktik Tenaga Gizi (SIPTGz) di Kabupaten Bantul. Dokumen memuat identitas pemohon (nama, alamat KTP, domisili, tempat/tanggal lahir, jenis kelamin, tahun lulusan, nomor STRGz, kontak, dan email) serta data fasilitas tempat praktik. Lampiran yang disyaratkan mencakup fotokopi KTP, surat pernyataan domisili, ijazah, STRGz, surat keterangan sehat, pernyataan tempat kerja, foto 4x6, rekomendasi profesi (PERSAGI), rekomendasi Dinas Kesehatan, dan salinan SIPTGz sebelumnya bila ada.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/id/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/id/template/formulir/","Formulir",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/id/template/application-for-nutritionist-practice-permit-siptgz-application-form/234300/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/application-for-nutritionist-practice-permit-siptgz-application-form/234300.png","ImageObject",442,249,{"name":42,"@type":43},"Evangeline","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-19","2026-09-11",true,{"@type":52,"interactionType":53,"userInteractionCount":22},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"Apa tujuan surat permohonan ini?","Question",{"text":62,"@type":63},"Surat ini digunakan untuk mengajukan permohonan agar memperoleh Surat Izin Praktik Tenaga Gizi (SIPTGz).","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Data apa saja yang perlu diisi oleh pemohon?",{"text":67,"@type":63},"Pemohon perlu mengisi identitas diri seperti nama, alamat KTP, alamat domisili, tempat/tanggal lahir, jenis kelamin, tahun lulusan, nomor STRGz, serta kontak (nomor telepon dan email).",{"name":69,"@type":60,"acceptedAnswer":70},"Lampiran apa saja yang harus disertakan?",{"text":71,"@type":63},"Lampiran meliputi fotokopi KTP, surat pernyataan domisili, fotokopi ijazah yang dilegalisir, fotokopi STRGz yang masih berlaku, surat keterangan sehat dari dokter, pernyataan memiliki tempat kerja, foto terbaru 4x6, rekomendasi PERSAGI setempat, rekomendasi Dinas Kesehatan, serta salinan SIPTGz pertama/kedua jika permohonan berikutnya.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},234300,1789085944,{"code":4,"msg":81,"data":82},"success",[83,87,90,94,98,102,106,110],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":4,"slug":86},178,"Faktur","faktur",{"id":88,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":4,"slug":89},192,"formulir-192",{"id":91,"doc_module":22,"doc_module_name":25,"category_name":92,"show_sort_weight":4,"slug":93},180,"Media Sosial","media-sosial",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":4,"slug":97},179,"Poster","poster",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":4,"slug":101},176,"Presentasi","presentasi",{"id":103,"doc_module":22,"doc_module_name":25,"category_name":104,"show_sort_weight":4,"slug":105},177,"Resume","resume",{"id":107,"doc_module":22,"doc_module_name":25,"category_name":108,"show_sort_weight":4,"slug":109},182,"Surat","surat-a95d00d3aaf04f3b854ecf140f00d385",{"id":111,"doc_module":22,"doc_module_name":25,"category_name":112,"show_sort_weight":4,"slug":113},183,"Umum","umum-07d1ff437201438088836b2b1ed3c90f",{"code":4,"msg":81,"data":115},{"doc_id":78,"user_id":116,"nickname":42,"user_avatar":117,"doc_module":22,"category_id":88,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":118,"file_id":119,"file_url":120,"file_type":121,"file_size":122,"view_count":22,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":123,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":124,"faqs":125,"seo_title":126,"seo_description":12,"update_tm":79,"read_time":4},13056703019662,"https://ap-avatar.wpscdn.com/avatar/be000253a8e92610077?_k=1778726343310543188","Perihal : Permohonan Surat Izin Praktik Tenaga Gizi  \nLampiran : 1 (satu) bendel  \nKepada Yth  \nKepala Dinas Penanaman Modal dan Pelayanan Terpadu Kabupaten Bantul  \nDi Bantul  \nDengan hormat,  \nYang bertanda tangan di bawah ini,  \nNama Lengkap : .......................................................... ....................  \nAlamat KTP : .......................................................... ....................  \nAlamat Domisili :    \nTempat, Tgl lahir : .......................................................... ....................  \nJenis Kelamin :    \nTahun Lulusan :    \nNomor STRGz : ................................berlaku s.d   ....................  \nNomor Telepon (SMS) : .......................................................... ....................  \nAlamat Email : ............................................... ....................    \nDengan ini mengajukan permohonan untuk mendapatkan Surat Izin Praktik Tenaga Gizi (SIPTGz) pada :  \nNama Fasilitas :    \nAlamat Praktik : ............................................... ............................  \nNomor Telepon : ............................................... ............................  \nSebagai bahan pertimbangan bersama ini dilampirkan :  \n1. fotokopi Kartu Tanda Penduduk (KTP) pemohon yang masih berlaku;  \n2. surat pernyataan domisili bermaterai yang disahkan oleh desa setempat (bagi yang alamat KTP tidak sesuai dengan alamat tempat tinggal);  \n3. fotokopi ijazah yang dilegalisir;  \n4. fotokopi STRGz yang masih berlaku;  \n5. surat keterangan sehat dari dokter yang memiliki Surat Izin Praktik;  \n6. surat pernyataan memiliki tempat kerja di fasilitas pelayanan kesehatan atau tempat praktik pelayanan gizi secara mandiri:  \n7. Softcopy foto terbaru ukuran 4 x 6 berlatar belakang merah (dalam format jpeg);  \n8. rekomendasi dari organisasi profesi (PERSAGI) setempat;  \n9. rekomendasi dari Dinas Kesehatan (dari Dinas Kesehatan terkirim langsung ke DPMPT); dan  \n10.fotokopi SIPTGz pertama/kedua (untuk permohonan SIPTGz yang kedua/ketiga) .  \nDemikian permohonan ini disampaikan, atas terkabulnya permohonan ini diucapkan terima kasih.  \nBantul, ......................20.. Pemohon  \n...........................................","cbCaiaiuohhg2mDu","https://ap.wps.com/l/cbCaiaiuohhg2mDu","pdf",58094,"Indonesian","# Perihal dan Pengajuan\n## Alamat Tujuan\n## Identitas Pemohon dan Data STRGz\n## Data Fasilitas Praktik\n## Lampiran Persyaratan\n## Penutup dan Tanda Tangan","[{\"question\":\"Apa tujuan surat permohonan ini?\",\"answer\":\"Surat ini digunakan untuk mengajukan permohonan agar memperoleh Surat Izin Praktik Tenaga Gizi (SIPTGz).\"},{\"question\":\"Data apa saja yang perlu diisi oleh pemohon?\",\"answer\":\"Pemohon perlu mengisi identitas diri seperti nama, alamat KTP, alamat domisili, tempat/tanggal lahir, jenis kelamin, tahun lulusan, nomor STRGz, serta kontak (nomor telepon dan email).\"},{\"question\":\"Lampiran apa saja yang harus disertakan?\",\"answer\":\"Lampiran meliputi fotokopi KTP, surat pernyataan domisili, fotokopi ijazah yang dilegalisir, fotokopi STRGz yang masih berlaku, surat keterangan sehat dari dokter, pernyataan memiliki tempat kerja, foto terbaru 4x6, rekomendasi PERSAGI setempat, rekomendasi Dinas Kesehatan, serta salinan SIPTGz pertama/kedua jika permohonan berikutnya.\"}]","Permohonan Surat Izin Praktik Tenaga Gizi (SIPTGz) - Formulir Pengajuan | PDF"]