[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-id-113":3,"doc-seo-234103-113":41,"doc-detail-234103-id":108},{"code":4,"msg":5,"data":6},0,"success",[7,13,17,21,25,29,33,37],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":4,"slug":12},178,1,"Template","Faktur","faktur",{"id":14,"doc_module":9,"doc_module_name":10,"category_name":15,"show_sort_weight":4,"slug":16},192,"Formulir","formulir-192",{"id":18,"doc_module":9,"doc_module_name":10,"category_name":19,"show_sort_weight":4,"slug":20},180,"Media Sosial","media-sosial",{"id":22,"doc_module":9,"doc_module_name":10,"category_name":23,"show_sort_weight":4,"slug":24},179,"Poster","poster",{"id":26,"doc_module":9,"doc_module_name":10,"category_name":27,"show_sort_weight":4,"slug":28},176,"Presentasi","presentasi",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":4,"slug":32},177,"Resume","resume",{"id":34,"doc_module":9,"doc_module_name":10,"category_name":35,"show_sort_weight":4,"slug":36},182,"Surat","surat-a95d00d3aaf04f3b854ecf140f00d385",{"id":38,"doc_module":9,"doc_module_name":10,"category_name":39,"show_sort_weight":4,"slug":40},183,"Umum","umum-07d1ff437201438088836b2b1ed3c90f",{"code":4,"msg":42,"data":43},"ok",{"site_id":44,"language":45,"slug":46,"title":47,"keywords":48,"description":49,"schema_data":50,"social_meta":101,"head_meta":103,"extra_data":105,"updated_unix":107},113,"id","application-for-practice-permit-sip-medical-laboratory-technology-expert","Permohonan Surat Izin Praktik (SIP) - Ahli Teknologi Laboratorium Medik","","Dokumen formulir permohonan Surat Izin Praktik (SIP) bagi Ahli Teknologi Laboratorium Medik berisi identitas pemohon, data pendidikan, status kepegawaian, nomor STR beserta masa berlaku, serta rekomendasi OP. Formulir juga menetapkan pilihan tempat praktik ke-1 atau ke-2, rincian fasilitas kesehatan (alamat dan lokasi), dan daftar lampiran pendukung seperti KTP/KITAS/Visa dan paspor, KK, NPWP, surat kuasa bermaterai, rekomendasi organisasi profesi, surat keterangan sehat, serta pasfoto ukuran 4x6. Disertai pula surat pernyataan keabsahan data dan kebenaran dokumen serta pernyataan mematuhi peraturan perundang-undangan dan etika profesi.",{"@graph":51,"@context":100},[52,68,83],{"@type":53,"itemListElement":54},"BreadcrumbList",[55,59,62,65],{"item":56,"name":57,"@type":58,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":60,"name":10,"@type":58,"position":61},"https://docshare.wps.com/id/template/",2,{"item":63,"name":35,"@type":58,"position":64},"https://docshare.wps.com/id/template/surat/",3,{"item":66,"name":47,"@type":58,"position":67},"https://docshare.wps.com/id/template/application-for-practice-permit-sip-medical-laboratory-technology-expert/234103/",4,{"url":66,"name":47,"@type":69,"author":70,"headline":47,"publisher":73,"fileFormat":76,"inLanguage":45,"description":49,"dateModified":77,"datePublished":77,"encodingFormat":76,"isAccessibleForFree":78,"interactionStatistic":79},"DigitalDocument",{"name":71,"@type":72},"Jacob","Person",{"url":56,"name":74,"@type":75},"DocShare","Organization","application/pdf","2026-09-10",true,{"@type":80,"interactionType":81,"userInteractionCount":4},"InteractionCounter",{"@type":82},"ViewAction",{"@type":84,"mainEntity":85},"FAQPage",[86,92,96],{"name":87,"@type":88,"acceptedAnswer":89},"Apa saja data yang dimasukkan pada bagian identitas pemohon dalam formulir SIP ini?","Question",{"text":90,"@type":91},"Formulir meminta nama lengkap, alamat rumah, tempat dan tanggal lahir, jenis kelamin, pendidikan, lulusan, tahun lulus, serta tempat bekerja.","Answer",{"name":93,"@type":88,"acceptedAnswer":94},"Dokumen apa saja yang wajib dilampirkan untuk permohonan Surat Izin Praktik (SIP)?",{"text":95,"@type":91},"Lampiran meliputi surat permohonan, surat pernyataan bermaterai tentang kebenaran data, KTP/KITAS/Visa dan paspor, Kartu Keluarga, NPWP, surat kuasa bermaterai (jika ada), KTP penerima kuasa, rekomendasi organisasi profesi, surat keterangan sehat, surat keterangan bekerja/berpraktik, serta pasfoto 4x6 berlatar merah.",{"name":97,"@type":88,"acceptedAnswer":98},"Surat pernyataan apa saja yang disertakan selain permohonan SIP?",{"text":99,"@type":91},"Terdapat surat pernyataan keabsahan dan kebenaran dokumen, serta surat pernyataan mematuhi peraturan perundang-undangan dan melaksanakan etika profesi Ahli Teknologi Laboratorium Medik.","https://schema.org",{"og:url":66,"og:type":102,"og:title":47,"og:site_name":74,"og:description":49},"article",{"robots":104,"canonical":66},"index,follow",{"doc_id":106,"site_id":44},234103,1789083705,{"code":4,"msg":5,"data":109},{"doc_id":106,"user_id":110,"nickname":71,"user_avatar":111,"doc_module":9,"category_id":34,"category_name":35,"doc_title":47,"doc_description":49,"doc_content":112,"file_id":113,"file_url":114,"file_type":115,"file_size":116,"view_count":4,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":117,"language":118,"language_code":45,"site_id":44,"html_lang":45,"table_of_contents":119,"faqs":120,"seo_title":121,"seo_description":49,"update_tm":107,"read_time":61},962084931830,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Prihal : Permohonan Surat Izin Praktik (SIP)  \nAhli Teknologi Laboratorium Medik  \nKepada  \nYth. Kepala Seksi Satlak PTSPKecamatan ........................ di  \nJakarta  \nDengan hormat,  \nYang bertanda tangan di bawah ini,  \nNama Lengkap : ............. .........................................................................  \nAlamat Rumah : Jalan ................................. No ........ RT/RW ............  \nKelurahan ......................... Kecamatan .................... Kota/Kab ............. ............. Provinsi ..........................  \nTempat / tanggal Lahir : ......................................................................................  \n*  \nJenis Kelamin : Laki-laki / Perempuan ( )  \nPendidikan : .................................... ..................................................  \nLulusan : ......................................................................................  \nTahun Lulus : ......................................................................................  \nTempat Bekerja : ......................................................................................  \n*  \nStatus Kepegawaian : PNS/Swasta/TNI/Polri/Pensiunan ( )  \nNomor STR : ......................................................................................  \nMasa Berlaku STR : ......................................................................................  \nNomor Rekomendasi OP : ...................................................................................... Dengan ini mengajukan permohonan untuk mendapatkan Surat Izin Praktik (SIP) untuk  \n*  \ntempat praktik yang ke 1 / 2 ( ) di lokasi:  \nNama Fasilitas Kesehatan : ...................................................................................... Alamat Fasilitas Kesehatan : Jalan ......... ....................... No   RT/RW ...............  \nKelurahan ......................... Kecamatan ...................... Kota/Kab .......................... Provinsi ...........................  \nSebagai bahan pertimbangan bersama ini kami lampirkan :  \n1. Surat permohonan  \n2. Surat pernyataan di atas kertas bermaterai Rp 6.000 tentang kebenaran data dan keabsahan data  \n3. Kartu Tanda Penduduk (KTP) atau Kartu Izin Tinggal Terbatas (KITAS) atau VISA dan Paspor  \n4. Kartu Keluarga (KK)  \n5. Nomor Pokok Wajib Pajak (NPWP)  \n*  \n6. Surat kuasa di atas kertas bermaterai Rp 6.000 ( )  \n*  \n7. KTP orang yang diberi kuasa ( )  \n8. Rekomendasi dari Organisasi Profesi (Persatuan Ahli Teknologi Laboratorium Medik Indonesia) di wilayah tempat praktik  \n9. Surat Keterangan Sehat dari dokter yang memiliki Surat Izin Praktik (SIP)  \n10.Surat Keterangan Bekerja/berpraktik dari pimpinan Fasilitas Kesehatan yang bersangkutan  \n11.Surat Pernyataan di atas kertas bermeterai Rp. 6000 yang menyatakan tundukkepada peraturan yang berlaku  \n12. Pasfoto berwarna terbaru ukuran 4x6 berlatar belakang merah sebanyak 3 (tiga) lembar  \nDemikian permohonan ini kami sampaikan. Atas perhatian Bapak/Ibu kami mengucapkan terima kasih.  \nJakarta .............................  \npemohon ,  \n( ................................ .........)  \nSURAT PERNYATAAN KEABSAHAN DAN KEBENARAN DOKUMEN  \nYang bertanda tangan dibawah ini :  \nNama : ..................................................................................................  \nAlamat : .............................................................. ....................................  \nBidang Usaha : ..................................................................................................  \nJenis Usaha : ......................................................................................... .........  \nSub-Jenis Usaha : ..................................................................................................  \nJabatan : Direktur Utama / Penanggung jawab Usaha  \nMenyatakan dengan sesungguhnya :  \n1. Segala data yang terdapat dalam dokumen Permohonan Surat Izin Praktik (SIP) Ahli Teknologi Laboratorium Medik ini adalah","cbCaieLGOtEwYJ44","https://ap.wps.com/l/cbCaieLGOtEwYJ44","pdf",117092,6,"Indonesian","# Permohonan Surat Izin Praktik (SIP) - Ahli Teknologi Laboratorium Medik\n## Identitas Pemohon\n## Data STR dan Rekomendasi OP\n## Tempat Praktik dan Fasilitas Kesehatan\n## Lampiran yang Diperlukan\n# Surat Pernyataan Keabsahan dan Kebenaran Dokumen\n## Pernyataan Kebenaran Data dan Sanksi","[{\"question\":\"Apa saja data yang dimasukkan pada bagian identitas pemohon dalam formulir SIP ini?\",\"answer\":\"Formulir meminta nama lengkap, alamat rumah, tempat dan tanggal lahir, jenis kelamin, pendidikan, lulusan, tahun lulus, serta tempat bekerja.\"},{\"question\":\"Dokumen apa saja yang wajib dilampirkan untuk permohonan Surat Izin Praktik (SIP)?\",\"answer\":\"Lampiran meliputi surat permohonan, surat pernyataan bermaterai tentang kebenaran data, KTP/KITAS/Visa dan paspor, Kartu Keluarga, NPWP, surat kuasa bermaterai (jika ada), KTP penerima kuasa, rekomendasi organisasi profesi, surat keterangan sehat, surat keterangan bekerja/berpraktik, serta pasfoto 4x6 berlatar merah.\"},{\"question\":\"Surat pernyataan apa saja yang disertakan selain permohonan SIP?\",\"answer\":\"Terdapat surat pernyataan keabsahan dan kebenaran dokumen, serta surat pernyataan mematuhi peraturan perundang-undangan dan melaksanakan etika profesi Ahli Teknologi Laboratorium Medik.\"}]","Permohonan Surat Izin Praktik (SIP) - Ahli Teknologi Laboratorium Medik | PDF"]