Y t h Ketua Departemen Komunikasi dan Pengembangan Masyaraki Fakultas Ekologi Manusia- I P B Bogor

S A L I N A N P E R A T U R A N

R E K T O R I N S T I T U T P E R T A N I A N B O G O R N O M O R 1 7 / I T 3 / K M / 2 0 1 9

T E N T A N G

P E D O M A N P R O G R A M P E N Y A N G G A K E S E H A T A N M A H A S I S W A I N S T I T U T P E R T A N I A N B O G O R

R E K T O R I N S T I T U T P E R T A N I A N B O G O R ,

M e n i m b a n g : a . b a h w a d a l a m r a n g k a m e n i n g k a t k a n p e l a y a n a n d a l a r n p e m b e r i a n b i a y a b a n t u a n k e s e h a t a n bagi m a h a s i s w a I n s t i t u t P e r t a n i a n Bogor , I P B t e l a h m e l a k u k a n i n i s i a s i p e n d a f t a r a n k e p e s e r t a a n B P J S K e s e h a t a n s e c a r a ko l ek t i f u n t u k m a h a s i s w a I P B s e r t a m e n g u b a h b e b e r a p a p r o s e d u r p e m b e r i a n b a n t u a n , d a n m e n y e s u a i k a n b e s a r a n b i a y a b a n t u a n k e s e h a t a n y a n g d i b e r i k a n ;

b. b a h w a s e h u b u n g a n dengan a d a n y a p e r u b a h a n s e b a g a i m a n a d i m a k s u d p a d a h u r u f a , m a k a d i p e r l u k a n p e n y e m p u r n a a n t e r h a d a p P e d o m a n P r o g r a m K e s e h a t a n M a h a s i s w a y a n g s e l a m a i n i b e r l a k u ;

c. b a h w a b e r d a s a r k a n p e r t i m b a n g a n s e b a g a i m a n a d i m a k s u d p a d a h u r u f b, p e r l u m e n e t a p k a n P e r a t u r a n R e k t o r I n s t i t u t P e r t a n i a n Bogor t e n t a n g P e d o m a n P r o g r a m P e n y a n g g a K e s e h a t a n M a h a s i s w a I n s t i t u t P e r t a n i a n Bogor ;

Meng inga t : 1. U n d a n g - U n d a n g Nomor 12 T a h u n 2 0 1 2 t e n t a n g P e n d i d i k a n T ingg i ( L e m b a r a n Nega ra R e p u b l i k I n d o n e s i a T a h u n 2 0 1 2 Nomor 158 , T a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 5 3 3 6 ) ;

2 . P e r a t u r a n P e m e r i n t a h Nomor 6 6 T a h u n 2 0 1 3 t e n t a n g S t a t u t a I n s t i t u t P e r t a n i a n Bogor ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 1 3 Nomor 164 , T a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 5 4 5 3 ) ;

3 . P e r a t u r a n P e m e r i n t a h Nomor 4 T a h u n 2 0 1 4 t e n t a n g P e n y e l e n g g a r a a n P e n d i d i k a n T ingg i d a n Penge l o l aan P e r g u r u a n T ingg i ( L e m b a r a n Nega ra R e p u b l i k I n d o n e s i a T a h u n 2 0 1 4 Nomor 16, T a m b a h a n L e m b a r a n Nega ra R e p u b l i k I n d o n e s i a Nomor 5 5 0 0 ) ;

4 . P e r a t u r a n Ma je l i s W a l l A m a n a t I n s t i t u t P e r t a n i a n Bogor Nomor 1 / I T 3 . M W A / O T / 2 0 1 9 t e n t a n g O r g a n i s a s i d a n T a t a K e r j a I n s t i t u t P e r t a n i a n Bogor ;

5. K e p u t u s a n Maje l i s W a l i A m a n a t I n s t i t u t P e r t a n i a n Bogor Nomor 3 6 / I T 3 . M W A / K P / 2 0 1 7 t e n t a n g P e n g a n g k a t a n R e k t o r I n s t i t u t P e r t a n i a n Bogor Per iode 2 0 1 7 - 2 0 2 2 ;

M E M U T U S K A N :

M e n e t a p k a n : P E R A T U R A N R E K T O R I N S T I T U T P E R T A N I A N B O G O R T E N T A N G P E D O M A N P R O G R A M P E N Y A N G G A K E S E H A T A N M A H A S I S W A I N S T I T U T P E R T A N I A N B O G O R .

P a s a l 1

P e d o m a n P r o g r a m P e n y a n g g a K e s e h a t a n M a h a s i s w a I n s t i t u t P e r t a n i a n Bogor a d a l a h s e b a g a i m a n a t e r c a n t u m d a l a m L a m p i r a n y a n g m e r u p a k a n b a g i a n t i d a k t e r p i s a h k a n d a r i P e r a t u r a n R e k t o r i n i .

P a s a l 2

P e d o m a n P r o g r a m P e n y a n g g a K e s e h a t a n M a h a s i s w a I n s t i t u t P e r t a n i a n Bogo r s e b a g a i m a n a d i m a k s u d p a d a P a s a l 1 m e r u p a k a n a c u a n p e l a y a n a n p e m b e r i a n b i a y a b a n t u a n k e s e h a t a n bag i m a h a s i s w a I n s t i t u t P e r t a n i a n Bogor .

P a s a l 3

P a d a s a a t P e r a t u r a n R e k t o r i n i m u l a i b e r l a k u , m a k a :

a . K e p u t u s a n R e k t o r I n s t i t u t P e r t a n i a n Bogor Nomor 0 4 3 / K l 3 / K M / 2 0 0 6 t e n t a n g P e d o m a n P r o g r a m P e n y a n g g a K e s e h a t a n M a h a s i s w a I n s t i t u t P e r t a n i a n Bogor ; d a n

b. K e p u t u s a n R e k t o r I n s t i t u t P e r t a n i a n Bogor Nomor 8 / I T 3 / P P / 2 0 1 5 t e n t a n g P e r u b a h a n B e s a r a n B a n t u a n B i a y a Pengoba tan , P e n a n g g u l a n g a n K e c e l a k a a n , d a n B a n t u a n L a i n p a d a P r o g r a m P e n y a n g g a K e s e h a t a n M a h a s i s w a I n s t i t u t P e r t a n i a n Bogor

d i c a b u t d a n d i n y a t a k a n t i d a k b e r l a k u .

P a s a l 4

P e r a t u r a n R e k t o r i n i m u l a i b e r l a k u p a d a tangga l d i t e t a p k a n .

S a l i n a n s e s u a i d e n g a n a s l i n y a K e p a l a B i r o H u k u m I P B ,

j f r W i d o d o B S ^ u Ajie

mNIP 1 9 7 1 1 1 1 4 2 0 0 5 0 1 1 0 0 2

D i t e t a p k a n d i Bogor p a d a tangga l 2 6 J u n i 2 0 1 9 R E K T O R I N S T I T U T P E R T A N I A N B O G O R ,

ttd.

A R I F S A T R I A

N IP 1 9 7 1 0 9 1 7 1 9 9 7 0 2 1 0 0 3

- 3 -

S a l i n a n P e r a t u r a n R e k t o r i n i d i s a m p a i k a n k e p a d a Y t h . : 1. K e t u a Ma je l i s W a l i A m a n a t ; 2 . K e t u a S e n a t A k a d e m i k ; 3 . K e t u a D e w a n G u r u B e s a r ; 4 . W a k i l R e k t o r B i d a n g P e n d i d i k a n d a n K e m a h a s i s w a a n ; 5. W a k i l R e k t o r B i d a n g S u m b e r d a y a , P e r e n c a n a a n d a n K e u a n g a n ; 6. W a k i l R e k t o r B i d a n g K e r j a s a m a d a n S i s t e m I n f o r m a s i ; 7. W a k i l R e k t o r B i d a n g I n o v a s i , B i s n i s d a n K e w i r a u s a h a a n ; 8. S e k r e t a r i s I n s t i t u t ; 9 . D e k a n F a k u l t a s , D e k a n S e k o l a h ; 10 . K e p a l a L e m b a g a ; 1 1 . D i r e k t u r , K e p a l a B i r o , d a n K e p a l a K a n t o r ; 12 . K e p a l a U n s u r P e n u n j a n g ; d i l i n g k u n g a n I n s t i t u t P e r t a n i a n Bogor.

L A M P I R A N P E R A T U R A N R E K T O R I N S T I T U T P E R T A N I A N B O G O R N O M O R 1 7 / I T 3 / K M / 2 0 1 9 T E N T A N G P E D O M A N P R O G R A M P E N Y A N G G A K E S E H A T A N M A H A S I S W A I N S T I T U T P E R T A N I A N B O G O R

P E D O M A N P R O G R A M P E N Y A N G G A K E S E H A T A N M A H A S I S W A I N S T I T U T P E R T A N I A N B O G O R

L A T A R B E L A K A N G

M a h a s i s w a I n d o n e s i a sebaga i g ene ras i m u d a h a r a p a n b a n g s a

m e r u p a k a n a s e t b a n g s a y a n g m e m i l i k i p e r a n s t ra teg i s bag i k e l a n g s u n g a n

m a s a d e p a n b a n g s a , j i k a m a h a s i s w a I n d o n e s i a s eha t , m a k a n e g a r a k i t a

m e m i l i k i op t im i sme y a n g t inggi m e n a t a p m a s a d e p a n n y a .

M a h a s i s w a I n s t i t u t P e r t a n i a n Bogor ( IPB ) y a n g m e r u p a k a n b a g i a n d a r i

m a h a s i s w a I n d o n e s i a s e c a r a k e s e l u r u h a n , m e m i l i k i p e r a n s t ra t eg i s d i

m a s a d e p a n . D e n g a n d e m i k i a n , m e n g e n a i k u a l i t a s k e s e h a t a n m a h a s i s w a

i n i p e r l u m e n d a p a t k a n p e n a n g a n a n y a n g s u n g g u h - s u n g g u h d a r i p i h a k

m a n a j e m e n I P B , k a r e n a k e s e h a t a n m e r u p a k a n s a l a h s a t u m o d a l d a s a r

bag i m a h a s i s w a d a l a m m e n c a p a i k e b e r h a s i l a n d a l a m m e n e m p u h

s t u d i n y a .

H a l i n i p u n m e n j a d i p e r h a t i a n t e r s e n d i r i bag i I P B u n t u k m e n j a g a

k e s e h a t a n m a h a s i s w a . K a r e n a d i b a l i k t u b u h y a n g s eha t , a d a j i w a y a n g

k u a t . T e n t u n y a h a l i n i s a n g a t b e r i m p l i k a s i t e r h a d a p p r e s t a s i - p r e s t a s i

y a n g d ipe ro l eh m a h a s i s w a I P B , b a i k d i l i n g k u p d a l a m neger i m a u p u n l u a r

neger i . J i k a m a h a s i s w a I P B s eha t , m a k a k i t a m e m p u n y a i h a r a p a n y a n g

b e s a r a k a n l a h i r n y a ide- ide y a n g c emer l ang , k rea t i f , d a n inova t i f s e r t a

p r o d u k t i f d a r i k a l a n g a n m a h a s i s w a I P B .

I P B m e m i l i k i k e p e d u l i a n y a n g t inggi t e r h a d a p m a s a l a h k e s e h a t a n

m a h a s i s w a p a d a s e m u a j e n j a n g p r o g r a m p e n d i d i k a n , b a i k d i p l o m a ,

s a r j a n a , m a u p u n p a s c a s a r j a n a . K e p e d u l i a n t e r s e b u t d i i m p l e m e n t a s i k a n

d e n g a n m e n e t a p k a n P e n y e l e n g g a r a a n P r o g r a m P e n y a n g g a K e s e h a t a n

M a h a s i s w a (PPKM) I P B . P r o g r a m t e r s e b u t d i b e r l a k u k a n m u l a i t a h u n

a k a d e m i k 2 0 0 1 / 2 0 0 2 .

U n t u k m e n i n g k a t k a n p e l a y a n a n d a l a m m e n d u k u n g k e s e h a t a n

m a h a s i s w a , I P B j u g a m e n g i n i s i a s i p e n d a f t a r a n p e s e r t a J a m i n a n

K e s e h a t a n N a s i o n a l ( J K N ) - K a r t u I n d o n e s i a S e h a t ( K I S ) y a n g

d i s e l e n g g a r a k a n o l eh B a d a n Penye l engga ra J a m i n a n S o s i a l ( B P J S )

K e s e h a t a n bag i m a h a s i s w a I P B s e c a r a ko lekt i f . P e n d a f t a r a n s e c a r a

- 2 -

ko l ek t i f t e r s e b u t d a p a t d i l a k u k a n o leh M a h a s i s w a I P B y a n g b e l u m

m e m p u n y a i a s u r a n s i k e s e h a t a n , u n t u k s e l a n j u t n y a d a p a t m e n d a f t a r k a n

d i r i m e l a l u i B P J S ko l ek t i f I P B a t a s n a m a m a h a s i s w a y a n g b e r s a n g k u t a n

t a n p a h a r u s m e n y e r t a k a n anggota k e l u a r g a l a i n n y a . B a g i m a h a s i s w a

y a n g s u d a h te rda f ta r d a l a m P r o g r a m J K N K J S ( B P J S ) ko l ek t i f I P B , l a y a n a n

r a w a t j a l a n d i s e l e n g g a r a k a n oleh K l i n i k P r a t a m a I P B D r a m a g a y a n g

d i k e l o l a o leh U n i t K e s e h a t a n I P B y a n g t e l ah d i t e t a p k a n sebaga i F a s i l i t a s

K e s e h a t a n ( F a s k e s ) T i n g k a t P e r t a m a m u l a i b u l a n November 2 0 1 8 .

I I . T U J U A N D A N K E G I A T A N

P r o g r a m P e n y a n g g a K e s e h a t a n M a h a s i s w a b e r t u j u a n u n t u k m e m e l i h a r a

k e s e h a t a n m a h a s i s w a s e l a m a m a s a s t u d i d i I P B m e l a l u i :

1. p e l a y a n a n r a w a t j a l a n o l eh K l i n i k P r a t a m a I P B D r a m a g a k e p a d a

m a h a s i s w a y a n g m e m e r l u k a n n y a ;

2 . p e m b e r i a n b a n t u a n b i a y a r a w a t i n a p d a n pengoba tan bag i m a h a s i s w a

y a n g m e n g a l a m i s a k i t s eh ingga h a r u s d i r a w a t d i r u m a h s a k i t n a m u n

b i a y a n y a m e l e b i h i p la fon b i a y a y a n g d i b e r i k a n o leh a s u r a n s i k e s e h a t a n

b a i k B P J S K e s e h a t a n , a t a u y a n g l a i n n y a ;

3 . p e m b e r i a n b a n t u a n b i a y a pengoba tan k a r e n a k e c e l a k a a n y a n g d i a l a m i

o l eh m a h a s i s w a b a i k d i d a l a m m a u p u n d i l u a r k a m p u s s e l a m a m a s a

s t u d i d i I P B , s eh ingga h a r u s d i r a w a t d i r u m a h s a k i t ;

4 . p e m b e r i a n b a n t u a n k e p a d a k e l u a r g a m a h a s i s w a I P B y a n g m e n i n g g a l

d u n i a a k i b a t s a k i t m a u p u n k e c e l a k a a n ; d a n

5. p e l a y a n a n p e n d a f t a r a n ko l ek t i f p e s e r t a J a m i n a n K e s e h a t a n N a s i o n a l

( J K N ) - K a r t u I n d o n e s i a S e h a t (K IS ) y a n g d i s e l e n g g a r a k a n o leh B a d a n

Penye l enggara J a m i n a n S o s i a l ( B P J S ) K e s e h a t a n .

I I I . S U M B E R D A N P E N G G U N A A N D A N A

S u m b e r d a n a u n t u k p enye l engga raan P r o g r a m P e n y a n g g a K e s e h a t a n

M a h a s i s w a b e r s u m b e r d a r i D a n a M a s y a r a k a t y a n g d i a j u k a n s e t i ap

t a h u n n y a , s e d a n g k a n d a n a i u r a n k e p e s e r t a a n B P J S b e r s u m b e r d a r i i u r a n

m a h a s i s w a per s emes t e r .

D a n a P P K M I P B d i p e r g u n a k a n u n t u k m e m b i a y a i :

1. o p e r a s i o n a l U n i t K e s e h a t a n I P B ;

2 . b a n t u a n b i a y a r a w a t i n a p d a n p e n a n g g u l a n g a n k e c e l a k a a n ;

3 . a d m i n i s t r a s i ; d a n

- 3 -

4. c a d a n g a n / t a b u n g a n y a n g d i p e r g u n a k a n u n t u k m e n i n g k a t k a n f a s i l i t a s

p e l a y a n a n k e s e h a t a n .

IV . P E L A Y A N A N K E S E H A T A N

P e l a y a n a n k e s e h a t a n bag i m a h a s i s w a I P B d i b e r i k a n d e n g a n k e t e n t u a n

s ebaga i b e r i k u t :

1. P e l a y a n a n pengoba tan r a w a t j a l a n d i b e r i k a n o leh U n i t K e s e h a t a n I P B

K a m p u s B a r a n a n g s i a n g d a n K a m p u s D a r m a g a I P B . I P B t i d a k

m e m b e r i k a n penggan t i an b i a y a pengoba tan r a w a t j a l a n y a n g d i l a k u k a n

o leh p i h a k l a i n .

2 . W a k t u p e l a y a n a n U n i t K e s e h a t a n I P B sebaga i b e r i k u t :

a . Po l i U m u m

H a r i : S e n i n s / d J u m a t

J a m P e l a y a n a n :

- 0 7 . 0 0 s / d 1 4 . 0 0 W I B (shift 1)

- 1 4 . 0 0 s / d 2 1 . 0 0 W I B (shift 2)

H a r i : S a b t u

J a m P e l a y a n a n : 0 7 . 0 0 s / d 14 .00 W I B

b. Po l i G i g i

H a r i : S e n i n s / d J u m a t

J a m P e l a y a n a n : 0 8 . 0 0 s / d 15 .00 W I B

3 . U n t u k m a h a s i s w a y a n g s a k i t d a n m e m e r l u k a n r a w a t i n a p , b e r l a k u

k e t e n t u a n s ebaga i b e r i k u t :

a . U n i t K e s e h a t a n I P B a k a n m e m b e r i k a n s u r a t r u j u k a n k e r u m a h s a k i t

y a n g d i r u j u k o l eh I P B ;

b. I P B a k a n m e m b e r i k a n b a n t u a n b i a y a r a w a t i n a p d a n p e n g o b a t a n

k e p a d a m a h a s i s w a y a n g b e r s a n g k u t a n s e s u a i d e n g a n k e t e n t u a n p a d a

a n g k a V p e d o m a n i n i , s e t e l ah y a n g b e r s a n g k u t a n m e l e n g k a p i

p e r s y a r a t a n y a n g d i p e r l u k a n ;

c. A p a b i l a m a h a s i s w a t e r s ebu t m e r u p a k a n pe s e r t a P r o g r a m J K N - K I S

B P J S K e s e h a t a n , b a i k ko l ek t i f m a u p u n m a n d i r i , a t a u a s u r a n s i

l a i n n y a , m a k a k e p a d a m a h a s i s w a t e r s e b u t d i h a r u s k a n m e n g g u n a k a n

a s u r a n s i t e r s e b u t d a l a m m e l a k u k a n p e r a w a t a n k e s e h a t a n ;

d . D a l a m k e a d a a n d a r u r a t , m a h a s i s w a d a p a t l a n g s u n g m e m i n t a

pe r t o l ongan k e r u m a h s a k i t t e rdeka t .

- 4

4 . U n t u k m a h a s i s w a m e n g a l a m i k e c e l a k a a n d a n m e m b u t u h k a n r a w a t

i n a p , m a h a s i s w a y a n g b e r s a n g k u t a n d a p a t sege ra m e m i n t a pe r t o l ongan

ke r u m a h s a k i t y a n g t e rdeka t .

V . B A N T U A N B I A Y A P E N G O B A T A N D A N P E N A N G G U L A N G A N K E C E L A K A A N

B a n t u a n b i a y a pengoba tan d a n p e n a n g g u l a n g a n k e c e l a k a a n d i b e r i k a n

d e n g a n k e t e n t u a n sebaga i b e r i k u t :

1. M a h a s i s w a y a n g m e n g a l a m i s a k i t a t a u p u n k e c e l a k a a n s e b a g a i m a n a

t e r s e b u t d a l a m a n g k a I V . 3 d a n a n g k a I V . 4 m e n d a p a t k a n b a n t u a n b i a y a

p engoba tan d a n p e n a n g g u l a n g a n k e c e l a k a a n s e b a g a i m a n a t e r c a n t u m

d a l a m T a b e l 1.

T a b e l 1. B a n t u a n B i a y a Pengoba tan d a n P e n a n g g u l a n g a n K e c e l a k a a n

u n t u k M a h a s i s w a I P B

No. Komponen Bantuan Rawat Inap (Sakit/Kecelakaan) Besaran Biaya

Bantuan Maksimal (Rp)

1. Bantuan biaya kamar Biaya kamar rawat (maksimum 10 hari) 250.000/hari

Biaya recovery room (maksimum 5 hari) 100.000/hari

2. Visit dokter Visit dokter umum (maksimum 10 hari) 150.000/hari

Visit dokter spesialis (maksimum 5 hari) 200.000/hari

3. Farmasi (obat-obatan resep/tanpa resep) 2.000.000

4. Tindakan medis dan alat kesehatan 1.500.000

5. Tindakan operasi 5.000.000

6. Transportasi ambulans 500.000

2. B a n t u a n b i a y a pengoba tan d a n p e n a n g g u l a n g a n k e c e l a k a a n d a p a t

d i b e r i k a n l eb ih d a r i 1 (satu ) k a l i d engan t i d a k m e l e b i h i b a t a s m a k s i m u m

b e s a r n y a b a n t u a n b i a y a d a l a m s a t u t a h u n .

3 . B a t a s w a k t u p r o s e s p e n g a j u a n p e r m o h o n a n s e l a m b a t - l a m b a t n y a 1 ( sa tu )

b u l a n s e t e l a h k e j a d i a n s a k i t a t a u k e c e l a k a a n .

B a n t u a n b i a y a p engoba tan d a n p e n a n g g u l a n g a n k e c e l a k a a n t i d a k

d i b e r i k a n t e r h a d a p k e j a d i a n - k e j a d i a n sebaga i b e r i k u t :

a . i m u n i s a s i ;

b. d i a l i s i s ;

c . general check-up;

d. p e l a y a n a n y a n g be rs i f a t k o s m e t i k ;

e. p engoba tan y a n g be lu rn d i a k u i s e c a r a s a h sebaga i c a r a p engoba tan

m e d i s r e s m i ;

f. a l a t b a n t u k e s e h a t a n ;

g. p e m b e r s i h a n k a r a n g gigi;

h . b i a y a o tops i d a n b i a y a visum et repertum;

i . b i a y a a d m i n i s t r a s i r u m a h s a k i t ;

j . s a k i t b a w a a n ;

k . s a k i t a t a u k e l u h a r i a k i b a t p e n y a l a h g u n a a n b a h a n - b a h a n

p s i k o t r o p i k a / NAPZA ;

1. p e r a w a t a n k a r e n a h a m i l / m e l a h i r k a n ;

m . s a k i t a t a u k e l u h a n k e j i w a a n ; d a n

n . k e c e l a k a a n a t a u p e n y a k i t a k i b a t p e r b u a t a n me l angga r h u k u m .

V I . B A N T U A N L A I N

A p a b i l a m a h a s i s w a I P B m e n i n g g a l d u n i a k a r e n a s a k i t a t a u k e c e l a k a a n ,

k e p a d a k e l u a r g a n y a d i b e r i k a n b a n t u a n b i a y a e v a k u a s i d a n p e n g u r u s a n

j e n a z a h s e b a g a i m a n a t e r c a n t u m d a l a m T a b e l 2 .

T a b e l 2 . B a n t u a n B i a y a E v a k u a s i d a n P e n g u r u s a n J e n a z a h u n t u k P r o g r a m

M u l t i s t r a t a I P B

J e n i s B a n t u a n B e s a r a n B a n t u a n M a k s i m a l (Rp)

T r a n s p o r t a s i A m b u l a n s 5 0 0 . 0 0 0

B i a y a P e m u l a s a r a n d a n T r a n s p o r t a s i 2 5 . 0 0 0 . 0 0 0

S a n t u n a n 7 . 5 0 0 . 0 0 0

V I I . P R O S E D U R D A N S Y A R A T - S Y A R A T P E M B E R I A N B A N T U A N

P e r m o h o n a n b a n t u a n b i a y a p engoba tan d a n p e n a n g g u l a n g a n k e c e l a k a a n

d i l a k u k a n d e n g a n p r o s e d u r d a n s y a r a t - s y a r a t sebaga i b e r i k u t :

1. P e r m o h o n a n B a n t u a n B i a y a Pengoba tan

M a h a s i s w a y a n g m e n d e r i t a s a k i t a t a u k e c e l a k a a n d a n p e r l u d i r a w a t i n a p

d i r u m a h s a k i t , d a p a t m e n g a j u k a n p e r m o h o n a n b a n t u a n b i a y a

p engoba tan d e n g a n p r o s e d u r d a n s y a r a t - s y a r a t s ebaga i b e r i k u t :

a . m e l a p o r k a n k e j a d i a n y a n g d i a l a m i k e p a d a p e tugas p e l a y a n a n

P r o g r a m P e n y a n g g a K e s e h a t a n M a h a s i s w a b a i k s e c a r a online d a n

offline;

- 6 -

b. m e l a m p i r k a n b e r k a s p e r s y a r a t a n y a n g d i p e r l u k a n , y a i t u :

1) F o r m u l i r y a n g s u d a h d i u n d u h d a n d i i s i d e n g a n l engkap ;

2) S u r a t K e t e r a n g a n Dok t e r d a r i r u r n a h s a k i t ;

3) K u i t a n s i b i a y a r a w a t i n a p d a n pengoba tan d a r i r u m a h s a k i t ;

4) Fo t okop i K a r t u T a n d a M a h a s i s w a (KTM) ;

5) B u k t i l u n a s p e m b a y a r a n S P P / U K T s e m e s t e r b e r j a l a n ;

6) Fo t okop i B u k u T a b u n g a n d e n g a n n o m o r r e k e n i n g ;

7) B u k t i s u d a h m e n g i s i f o r m u l i r online (screenshot f o r m u l i r y a n g

t e l a h d i i s i ) ; d a n

8) S e m u a b e r k a s p e r s y a r a t a n d i k u m p u l k a n m e l a l u i S t u d e n t S e r v i c e

C e n t e r ( S S C ) .

2 . P e r m o h o n a n B a n t u a n B i a y a E v a k u a s i d a n P e n g u r u s a n J e n a z a h

M a h a s i s w a y a n g m e n i n g g a l d u n i a , p i h a k k e l u a r g a a t a u y a n g m e w a k i l i

m e n g a j u k a n p e r m o h o n a n b i a y a e v a k u a s i d a n p e n g u r u s a n j e n a z a h

d e n g a n p r o s e d u r d a n s y a r a t - s y a r a t sebaga i b e r i k u t :

a . m e l a p o r k a n k e j a d i a n k e p a d a pe tugas p e l a y a n a n b a i k s e c a r a online

d a n offline;

b. m e n g i s i f o r m u l i r p e n g a j u a n b a n t u a n b i a y a y a n g d i t a n d a t a n g a n i o l eh

k e l u a r g a a t a u y a n g m e w a k i l i ;

c. m e l a m p i r k a n b e r k a s p e r s y a r a t a n y a n g d i p e r l u k a n s ebaga i b e r i k u t :

1) S u r a t K e t e r a n g a n K e m a t i a n d a r i pe jabat y a n g b e r w e n a n g ;

2) S u r a t K e t e r a n g a n Dok te r , j i k a s e b e l u m m e n i n g g a l y a n g

b e r s a n g k u t a n d i r a w a t d i R u m a h S a k i t ;

3) Fo tokop i K a r t u T a n d a M a h a s i s w a (KTM) d a n K a r t u T a n d a

P e n d u d u k (KTP ) a l m a r h u m / a h ;

4) Fo t okop i K a r t u K e l u a r g a ( K K ) ;

5) Fo tokop i K a r t u T a n d a P e n d u d u k (KTP ) a h l i w a r i s ;

6) Fo tokop i B u k u T a b u n g a n d engan n o m o r r e k e n i n g ; d a n

7) S e m u a b e r k a s p e r s y a r a t a n d i k u m p u l k a n d i S t u d e n t S e r v i c e C e n t e r

( S S C ) .

V I I I . W A K T U D A N U N I T K E R J A P E L A K S A N A P E M B E R I A N B A N T U A N

P e m b e r i a n b a n t u a n b i a y a pengoba tan d a n p e n a n g g u l a n g a n k e c e l a k a a n

u n t u k M a h a s i s w a I P B d i l a k u k a n d engan k e t e n t u a n w a k t u d a n u n i t k e r j a

p e l a k s a n a sebaga i b e r i k u t :

- 7 -

a . P e m b e r i a n b a n t u a n b i a y a pengoba tan d a n p e n a n g g u l a n g a n k e c e l a k a a n

d i l a k s a n a k a n p a l i n g cepa t 1 (satu ) b u l a n s e t e l ah s e l u r u h b e r k a s

p e r s y a r a t a n p e r m o h o n a n y a n g l engkap d a n b e n a r d i a j u k a n ;

b. P enge l o l aan p e n g a j u a n p e r m o h o n a n b a n t u a n b i a y a p engoba tan d a n

p e n a n g g u l a n g a n k e c e l a k a a n d i l a k s a n a k a n o l eh pe tugas p e l a y a n a n

P r o g r a m Penyangga K e s e h a t a n M a h a s i s w a ;

c. P e n y a l u r a n b a n t u a n b i a y a pengoba tan d a n p e n a n g g u l a n g a n k e c e l a k a a n

d i l a k u k a n o leh p e tugas k e u a n g a n p a d a d i r ek t o r a t y a n g m e m b i d a n g i

k e m a h a s i s w a a n m e l a l u i t r ans f e r ke r e k e n i n g y a n g b e r s a n g k u t a n .

R E K T O R I N S T I T U T P E R T A N I A N B O G O R ,

t td .

A R I F S A T R I A N IP 1 9 7 1 0 9 1 7 1 9 9 7 0 2 1 0 0 3

S a l i n a n s e s u a i d e n g a n a s l i n y a K e p a l a B i r o H u k u m I P B ,

N IP 1 9 7 U 1 1 1 4 2 0 0 5 0 1 1 0 0 2