[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-233740-113":3,"detail-sidebar-cat-1-id-113":74,"doc-detail-233740-id":108},{"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":67,"head_meta":69,"extra_data":71,"updated_unix":73},113,"id","practice-location-certification-letter-form-for-sip-123","Surat Keterangan Tempat Praktik - Formulir - untuk SIP 1/2/3","","Surat Keterangan Tempat Praktik memuat identitas tenaga medis/kesehatan, termasuk nama lengkap, profesi, tempat dan tanggal lahir, NIK, nomor STR beserta masa berlaku, alamat rumah, nomor handphone (WA), serta riwayat lulusan dan tahun. Surat ini berisi pernyataan bahwa data yang tertera adalah benar dan menyatakan tempat berpraktik. Dokumen ditujukan untuk kebutuhan persyaratan administrasi perizinan Surat Izin Praktik (SIP) dengan pilihan 1/2/3, serta memuat bagian diketahui oleh Kepala Fasyankes atau Kepala Dinas Kesehatan yang dapat didelegasikan sesuai ketentuan yang tertulis.",{"@graph":14,"@context":66},[15,34,49],{"@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/surat/","Surat",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/id/template/practice-location-certification-letter-form-for-sip-123/233740/",4,{"url":32,"name":10,"@type":35,"author":36,"headline":10,"publisher":39,"fileFormat":42,"inLanguage":8,"description":12,"dateModified":43,"datePublished":43,"encodingFormat":42,"isAccessibleForFree":44,"interactionStatistic":45},"DigitalDocument",{"name":37,"@type":38},"Theodora","Person",{"url":19,"name":40,"@type":41},"DocShare","Organization","application/pdf","2026-09-10",true,{"@type":46,"interactionType":47,"userInteractionCount":4},"InteractionCounter",{"@type":48},"ViewAction",{"@type":50,"mainEntity":51},"FAQPage",[52,58,62],{"name":53,"@type":54,"acceptedAnswer":55},"Apa saja data identitas yang harus diisi pada Surat Keterangan Tempat Praktik?","Question",{"text":56,"@type":57},"Surat ini mencantumkan nama lengkap, profesi, tempat dan tanggal lahir, NIK, nomor STR, masa berlaku STR, alamat rumah, nomor handphone (WA), serta keterangan lulusan dan tahun.","Answer",{"name":59,"@type":54,"acceptedAnswer":60},"Untuk apa Surat Keterangan Tempat Praktik digunakan?",{"text":61,"@type":57},"Dokumen dibuat sebagai persyaratan administrasi perizinan Surat Izin Praktik (SIP) dengan pilihan 1/2/3.",{"name":63,"@type":54,"acceptedAnswer":64},"Siapa yang harus mengetahui surat dan bagaimana delegasinya?",{"text":65,"@type":57},"Surat diketahui oleh Kepala Fasyankes atau Kepala Dinas Kesehatan. Untuk praktik mandiri, Kepala Dinas Kesehatan mendelegasikan kepada kepala Puskesmas di wilayah kerjanya.","https://schema.org",{"og:url":32,"og:type":68,"og:title":10,"og:site_name":40,"og:description":12},"article",{"robots":70,"canonical":32},"index,follow",{"doc_id":72,"site_id":7},233740,1789080395,{"code":4,"msg":75,"data":76},"success",[77,81,85,89,93,97,101,104],{"id":78,"doc_module":22,"doc_module_name":25,"category_name":79,"show_sort_weight":4,"slug":80},178,"Faktur","faktur",{"id":82,"doc_module":22,"doc_module_name":25,"category_name":83,"show_sort_weight":4,"slug":84},192,"Formulir","formulir-192",{"id":86,"doc_module":22,"doc_module_name":25,"category_name":87,"show_sort_weight":4,"slug":88},180,"Media Sosial","media-sosial",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":4,"slug":92},179,"Poster","poster",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":4,"slug":96},176,"Presentasi","presentasi",{"id":98,"doc_module":22,"doc_module_name":25,"category_name":99,"show_sort_weight":4,"slug":100},177,"Resume","resume",{"id":102,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":4,"slug":103},182,"surat-a95d00d3aaf04f3b854ecf140f00d385",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":4,"slug":107},183,"Umum","umum-07d1ff437201438088836b2b1ed3c90f",{"code":4,"msg":75,"data":109},{"doc_id":72,"user_id":110,"nickname":37,"user_avatar":111,"doc_module":22,"category_id":102,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":112,"file_id":113,"file_url":114,"file_type":115,"file_size":116,"view_count":4,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":117,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":118,"faqs":119,"seo_title":120,"seo_description":12,"update_tm":73,"read_time":4},687197207919,"https://ap-avatar.wpscdn.com/avatar/a000253d6f5f7c60be?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779446848396160552","SURAT KETERANGAN TEMPAT PRAKTIK  \nYang bertanda tangan dibawah ini,  \nNama Lengkap :  \nProfesi :  \nTempat, Tanggal Lahir :  \nNIK :  \nNomor STR :  \nMasa Berlaku STR :  \nAlamat Rumah :  \nNomor Handphone (WA) :  \nLulusan dari, Tahun :  \nMenyatakan dengan sesungguhnya bahwa data saya sebagaimana diatas adalah benar, dan benarberpraktik di   yang beralamatdi    \nDemikian surat keterangan ini dibuat untuk dipergunakan sebagai persyaratan administrasi perizinan Surat Izin Praktik (SIP) ke 1/2/3*  \nMengetahui  \nKepala Fasyankes/Kepala Dinas Kesehatan**  \n...................Tempat................  \n(Tanda tangan + materai 10.000 tenaga medis/kesehatan)  \n(nama lengkap tenaga medis/kesehatan)  \nKeterangan *=pilih salahsat  \n**=Untuk praktik mandiri diketahui kepala dinas Kesehatan mendelegasikan kepada kepalapuskesmas di wilayah kerjanya","cbCaiaparrW0A6Gl","https://ap.wps.com/l/cbCaiaparrW0A6Gl","pdf",75622,"Indonesian","# Surat Keterangan Tempat Praktik\n## Identitas tenaga medis/kesehatan\n## Pernyataan dan tempat praktik\n## Keperluan administrasi SIP 1/2/3\n## Pihak mengetahui dan tanda tangan","[{\"question\":\"Apa saja data identitas yang harus diisi pada Surat Keterangan Tempat Praktik?\",\"answer\":\"Surat ini mencantumkan nama lengkap, profesi, tempat dan tanggal lahir, NIK, nomor STR, masa berlaku STR, alamat rumah, nomor handphone (WA), serta keterangan lulusan dan tahun.\"},{\"question\":\"Untuk apa Surat Keterangan Tempat Praktik digunakan?\",\"answer\":\"Dokumen dibuat sebagai persyaratan administrasi perizinan Surat Izin Praktik (SIP) dengan pilihan 1/2/3.\"},{\"question\":\"Siapa yang harus mengetahui surat dan bagaimana delegasinya?\",\"answer\":\"Surat diketahui oleh Kepala Fasyankes atau Kepala Dinas Kesehatan. Untuk praktik mandiri, Kepala Dinas Kesehatan mendelegasikan kepada kepala Puskesmas di wilayah kerjanya.\"}]","Surat Keterangan Tempat Praktik - Formulir - untuk SIP 1/2/3 | PDF"]