√Perihal Lampiran
: Permohonan Kewenangan Klinik Dokter Umum : 1 Berkas
Kepada Yth: Direktur Rumah Sakit Umum Daerah Maalengka Di tempat Dengan hormat! Dengan ini kami mengaukan permohonan kewenangan klinik dokter umum se"agai sta# medis Rumah Sakit Umum Daerah Maalengka $Paruh waktu% Purna waktu&'( Demikianlah permohonan ini kami sampaikan( )tas perhatiann*a diu+apkan terima kasih(
Maalengka! ,,,,,,,(( Pemohon!
Dr( Dewi -urmalasari
Keterangan: & .oret *ang dianggap tidak perlu & Berkas *ang dilampirkan: #oto+op* S/R! #oto+op* Surat Pindah% SK Pensiun! #oto+op* ia0ah dan .
KEWENANGAN KLINIK DOKTER UMUM
D2K/3R Y)-4 Y)-4 M3-4)5UK)M3-4)5U K)- : dr( Re*neer Re*ne er / LULUS): -o Kewenangan Klinik 1 7 8 9
)ngina pe+tor is is Unsta"le angina M*o+ardial :n# ar+tion ar+tion mminent M*o+ardial n#ar+tion *sm .ardia+ aneur *sm 6eart # ailu ailure
; < = > ? 1@ 11 17
/)6U- LULUS :
Permohonan Kemampuan Klinik 1 7 8 9
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.ardiorespirator* .ardiorespirator* arrest tenosis Mitral stenosis Mitral regur gitat gitation stenosis )orti+ stenosis )orti+ regurgitation
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2ther AalAular heart diseases
18 19 1; 1<
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SD )SD dia Sinus ta+h*+ar dia
√
SupraAentri+ular dia ta+h*+ar dia
1= )trial #i"rillation 1> )trial #lutter 1? SupraAentri+ular 7@ 71 77 78 79 7; 7< 7= 7> 7? 8@ 81 87 88 89 8; 8< 8= 8> 8? 9@ 91 97 98 99 9; 9< 9= 9> 9?
√ √ √
etras*stole entri+ular etras*stole
BBB 2ther arr h*thmias h*thmias 3ndo+arditis Peri+arditi Peri+arditis M*o+ard M*o+arditis .ardiom*o path* 3ssential h*pertension Se+ondar* h*per tensio tension Pulmonar* h*per tensio tension Ra*naudCs disease )rterial throm"osis .oar+tation o# the aorta BurgerCs disease )rterial em"olism )theros+lerosis ome Su"+laAian steal s*ndr ome )orti+ aneur*sm Disse+ting aneur*sm .laudi+atio .ardiogeni+ sho+k Septi+ sho+k 6*poAolemi+ sho+k ari+es $primar*!se+onda r*' etur n 2"stru+ted Aenous r etur hrom"o sis Deep Aein throm"osis is /hrom"ophle"it /hrom"ophle"itis L*mphangit L*mphangitis enitis L*mphadenitis L*mphedema! primar* and
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Disetuui Kemampuan Klinik 1 7 8 9
;@ ;1 ;7 ;8 ;9 ;; ;< ;= ;> ;? <@ <1 <7 <8 <9 <; << <= <>
se+ondar* Un+ompli+ated Pulmonar* +ulosis /u "er +ulo
√ √
/B. with 6 /B. with pneumot hora hora )+ute Bron+hitis
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Bron+hiolitis Bron+hial asthma Status asmati+us Lung emph*s ema )tele+tasis Bron+hie+tasis .2PD
√ √ √ √ √ √ √ √
S)RS Pneumonia )Aian in#luen0ae Lung a"s+ess Pulmonar* em"olism Lung in#ar+tion Pleuris* /B. Pleuris* .an+er Pleuris* Lu pu puss Pneumothora .*sti+ #i"rosis )spiration pneumoni a .le#t lip and palate
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Mi+rognatia and ma+rognatia Leuko plak ia ia .andidiasis .andidia sis
√ √ √
Mouth ul+ers $aphthous! her pes'
=> 4lossitis =? 3sophageal atresia >@ )+halasia >1 .orrosiAe lesions o# >7 >8 >9 >; >< >= >> >? ?@ ?1 ?7 ?8 ?9 ?; ?< ?= ?> ?? 1@@ 1@1 1@7 1@8 1@9
esophageus 3sophageal Aar i+es i+es 3sophageal rupture Re#lu esophaghitis Diaphramati+ hernia 6iatus hernia :ng uinal hernia! dire+t and indire+t emoral hernia E Bedah 3pigastri+ hernia n+isional hernia Um"ili+al hernia Peritonitis )"s+ess in pou+h o# Douglas
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leus ation Per#or at Salphingitis )+ute appendi+it appendi+itis )ppendi+ular a"s+ess Mesenteri+ l*m phad enitis enitis 4astritis 4astri+%duodenal ul+er 4astrointestinal "leeding FollingerGellison s*ndrome Mallor*Gweiss s*ndr ome
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1@; 1@< 1@= 1@> 1@? 11@ 111 117 118 119 11; 11< 11= 11> 11? 17@
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4astroenter iti itis
att* liAer 6epatitis ) Un+ompli+ated 6epatitis B )+tiAe 6epatitis . .irrhosis hepatis )moe"i+ liAer a "s+ess ailure LiAer # ailu .hole$do+ho'lithiasis )+ute +hole+*stit is gall "ladder 6*drops o# gall "ladd 3mp*ema o# gall "ladder Pan+reatitis ntestinal atresia Me+kelCs diAerti+ulum
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Um"ili+al #istula! omphalo+oeleGgastros+hisis Malr ota otation 3nteritis rrita"le "owel s*ndrome -e+roti0ing entero+olitis
171 177 178 179 17; DiAerti+ulosis%diAerti+ulitis 17< .olitis 17= Re+tal! anal prola pse 17> Pro+titis 17? 6emorrhoids 18@ $peri'anal anal a"s+ess 181 istula 187 )nal #issure 188 3sophagea 3sophageal atresia 189 ntestinal atresia 18; )nal atresia 18< Diapragmati+ hernia 18= 18> 18? 19@
$+ongenital' P*lori+ stenosis 4astroGesophageal 4astroGenter iti itis
√ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
re#lu
√
4astroGenteritis dengan dehidrasi Hor ms ms Deh*dra tion Mala "sor"sion ood intoleran+e )+ute a"domen
191 197 198 199 19; 19< leus 19= Peritonitis tu"er+ulosis 19> Peritonitis pan+reatitis 19? :ntussuss+eption 1;@ Malrotation 1;1 Um"ili+al hernia 1;7 Me+kellCs diAerti+ulum 1;8 .rohnCs disease 1;9 Ul+eratiAe +olitis 1;; 6irs+hsprungCs disease 1;< Biliar* atresia 1;= 6epatitis 6epatitis 1;> Re*eCs s*ndrome 1;? .irrhosis o# the liAer 1<@ ood allerg* 1<1 )+ute renal #ailure
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1<7 .hroni+ renal #ailure 1<8 -ephroti+ s*ndrome 1<9 )+ute glomerulonephritis 1<; .hroni+ glomerulonephritis nephritis 1<< nterstitial nephritis nephri tis 1<= Renal +oli+ 1<> Urinar* stone diseases or urinar* +al+uli without without +oli+ 1
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mptomati+ s* mptomati+
1=@ 1=1 1=7 1=8 1=9 1=; 1=< 1== 1=> 1=? 1>@ 1>1 1>7 1>8 1>9 1>; 1>< 1>= 1>> 1>? 1?@ 1?1 1?7 1?8 1?9 1?; 1?< 1?= 1?> 1?? 7@@ 7@1
√ √
lonephritis P*elonephritis Urinar* in+ontinen+e -o+turnal and diurnal enur esis esis Prostatit Prostatitis 6*pospad ia 3pispadia Undes+ended testes% +r*ptor+hidism Retra+tile testes /orsion o# testis 3pidid*mitis Spermato+ele i+o+ele 1ar i+o+ele 6*dro+ele Phimosis Phimosis Para phimosis phimosis Ruptur ur etra etra Ruptur kandung ken+ing
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Ruptur ginal Striktura uretra Priapismus Pen*akit peironi 3kstrophia Aesi+ae
n#ertilit* 3re+tion disorders 3a+ulation disorders ulAitis D*stroph* o# AulAa .*st o# "artholin! a"s+ess o# "artholinCs gland )"s+ess o# hair #olli+le or se"a+eous gland .ond*lomata a+uminata .ongenital mal#ormations
7@7 7@8 7@9 aginitis 7@; Ba+terial Aaginosis 7@< .*st o# gar tner tner 7@= .*sto+oele 7@> Re+to+oele 7@? 3ntero+oele 3ntero+oele 71@ 71@ ist istul ulaa $Aes $Aesi+ i+oG oGAa Aagi gina nal! l! 711 717
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Urinar* tra+t in#e+tion #e+ti on )+ute tu"ular ne+rosis 6orse shoe kidne* Un+ompli+ated
ureteroGAaginal! ureteroGAaginal! re+toG Aaginal #istula' oreign "od*
.erAi+itis
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718 719 71; 71< 71= 71> 71? 77@ 771 777 778 779 77;
Pol*ps -a"othian +*st .ongenital mal#ormations Uterine prolaps 6emato+olpo s 3ndometrio sis Salpingitis )dhesions
2Aarian +*st Pol*+*sti+ oAarian disease .ar+inoma o# oAar* 3+topi+ pregnan+* /orsion tumour % oAarian +*st 77< Rupture o# oAarian +*st % tu"o G oAarian a"s+ess 77= Uterine "leeding at 77> 77? 78@ 781 787 788 789 78; 78< 78= 78> 78? 79@ 79@ 791 797 798 799 79; 79< 79= 79> 79? 7;@ 7;1 7;7 7;8 7;9 7;; 7;< 7;= 7;> 7;? 7<@ 7<1 7<7 7<8 7<9 7<; 7<< 7<=
oAulation :n# lammati lammations o# "reast Masto pat h* )plasti+%h*poplasti+ anemia ron de#i+ien+* anemia Ma+ro+*ti+ anemia 6emol*ti+ anemia 6emoglo "inopath*
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)nemia asso+iated with +hroni+ diseases
Pol*+*temia /hrom"o+*topenia /hrom"o+*tosis 6emophilia on wille"randCs disease
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D. )granulo+*tosis 6aemorheologi+ disorder s )ntiphospholipid s*ndrome Un+ompli+ated SL3
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.ompli+ated SL3 S+leroder ma ma Pol*arteritis nodosa as+ulitis Lupus Pol*m*algia rheumat i+a Rheumatoid arthr iti itis )naph*la+ti+ rea+tion Rheumati+ #eAer 5uAenile +hroni+ arthr iti itis 6eno+hGs+hoenlein purpura orme 3r*thema multi# orme )to p* SteAen ohnsonCs s*ndrome Transplantation immunol ogy ogy DownCs s*ndr ome ome /urnerCs s*ndr ome Kline#elterCs s*ndrome 4onadal *G * Gd*sgenesis /esti+ular # emini0ati emini0ation ragile s*ndrome Ketonuria' PKU $Phen*l Ketonu 4ala+tosemia 4l*+ogen storage disease
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7<> 7 7=? 7>@ 7>1 7>7 7>8 7>9 7>; 7>< 7>= 7>> 7>? 7?@ 7?1 7?7 7?8 7?9 7?; 7?< 7?= 7?> 7?? 8@@ 8@1 8@7 8@8 8@9 8@; 8@< 8@= 8@> 8@? 81@ 811 817 818 819 81; 81< 81= 81> 81?
2ther storage diseases Spina "i#ida
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)nen+epha l* 6*dro+ephalus
.le#t palate and%or lip Mar#anCs s*ndrome 6*pothermia Ba+teraemia and septi+emia septi+emia Respirator* stress s*ndrome Bron+hopulmonar* d*splasia )spiration pneu monia Pneumo thora )pnea atta+ks 5aundi+e o# new"orn SeAere neonatal aundi+e $kern i+terus' 6*pogl*+emia .hild o# dia"eti+ mother mother -eonatal +onAulsion -e+roti0ing entero+olitis ematur it* it* Retinopath* o# pr ematur )nemia "ilit* Rhesus in+ompati "ilit* Blood group in+ompat i"ilit* itamine k de##i+ien+* .ere"ral hemorrhage .onu+tiAitis n#e+tion o# um"ili+us Sudden in#ant death
s*ndrome $sids' DDM -DDM .ompli+ation o# DM $a+ute and +hroni+'
6*pogl*+emia Dia"etes in+ipidus )+romegal*! gigantism 4rowth hormone de# i+ien+* i+ien+* 6*perparat 6*perparath*roidi sm 6*poparat h*roidism 6*perth*roidism 6*poth*roidism /h*roiditi roiditis .ushingCs disease #ailure )drenal +orte #ailure Primar* h*peraldosteroid ism Phaeo+hromo+*toma Phaeo+hro mo+*toma Pre+o+ious pu "ert* /esti+ular # emini0at emini0at ion s*ndrome 6*pogonad ism ome )drenogenital s*ndr ome )ddisonCs disease Multiple endo+rinologi+al neoplasia $men s*ndrome'
/umor with e+topi+ produ+tion o# hormone Kwashiorkor itamin de#i+ien+ies de#i+ien+ies
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87@ 871 877 878 879 87; 87< 87= 87> 87? 88@ 881 887 888 889 88; 88< 88= 88> 88? 89@
6*perlipo proteinemia Porph*r ia ia 4out 2"esit*
Meta"oli+ 3n+ephalo path* .omatou s Brain death /ension heada+he Migr ain aine .ranial arter itis itis /rigemina /rigeminal neur algi algia .luster heada+he
/) .ere"ral in# ar+ti ar+tion ntra+ere"ral hematoma Su"ara+hnoid hemmorhag e
6*pertensiAe en+ephalo path* BelsI pals* Brain stem lesions MenierCs disease
Benign paro*smal positional Aertigo
891 897 898 899 89; 89< 89= 89> 89? 8;@ 8;1 8;7 8;8 8;9 8;; 8;< 8;= 8;> 8;?
ertigo .entral as+ular dementia )l0heimerCs disease Pi+kCs disease ParkinsonCs disease /remor Se+ondar* park insonism insonism 6untington disease .horea s*denham D*stonia 6emi#a+ial spasm o+al epileps* 4enerali0ed epileps* )"sen+e sei0ure Status epilepti+us -ar+oleps* Sleep apnea s*ndrome
Multiple s+lerosis 2pti+ neurom*elitis $DeAi+Cs disease'
8<@ 8<1 8<7 8<8 8<9 8<; 8<< 8<= 8<> 8
)m*otrphi+ lateral s+lerosis $)LS' .omplete spinal transe+tion Brown seJuard s*ndrome .auda eJuina s*ndrome -eurogeni+ "ladd er S*ringom*elia M*elo path* Dorsal root s*ndrome
Medulla +ompression a+ute Radi+ular s*ndrome%6-P Spondilitis /B 6orner s*ndrome .arpal tunnel s*ndrome /arsal tunnel s*ndrome -europa th* Peroneal pals*
8=< 4uillain Barre s*ndrome 8== M*asthenia gr aA aAis 8=> Pol*m*ositis 8=? Du+henne mus+ular 8>@ 8>1 8>7 8>8 8>9 8>; 8>< 8>= 8>> 8>? 8?@ 8?1 8?7 8?8 8?9 8?; 8?< 8?= 8?> 8?? 9@@ 9@1 9@7 9@8 9@9 9@; 9@< 9@= 9@>
d*stro ph* -euro#i"romatosis $Aon re+kling hausen disease'
Meningitis 3n+epha litis Malaria +ere"ral /et /etanus .ere"ral /ooplasmosis /u"er+uloma Brain a "s+ess
6 )DS 6*dro+ephalus Spina "i#ida etonuria Phen*l k eton
Meningitis 3n+epha litis .ere"ral a"s+ess 3pilepsi n#antile spasms Petit mal epileps* e"rile +onAulsion
Du+hene mus+ular
oph* d*str oph*
Poliom*elitis .ere"ral pals* us Kerni+ter us Mental Retardation )utism
)D6D )mnesia Pas+a tr auma auma )#asia M. $Mild .ognitiAe :mpairment'
9@? 91@ 911 917
. $as+ular .ognitiAe :mpairment' 3pidural hematom Su"dural hematom
S)6 $Su" )ra+hnoid 6emorrhage'
918 919 91; 91< 91= 91> 91? 97@ 971 977 978 979 97; 97< 97= 97> 97? 98@
/rauma Medula Spinalis /umor primer /umor sekunder -*eri -osisepti -osisepti# # -*eri neuropatik Buta mendadak Diplopia
isual #ield disorders n#lammation o# auri+le 6erpes 0oster oti+us PreGauri+ular # istula istula oreign "od* in ear Ha $serumen' 2titis eterna )+ute otitis media 2titis media serous $glue ear' .hroni+ otitis media Per#orated t*mpani+ mem"rane
981 987 988 989 98; 98< 98= 98> 98? 99@ 991 997 998 999 99; 99< 99= 99> 99? 9;@ 9;1 9;7 9;8 9;9 9;; 9;< 9;= 9;> 9;? 9<@ 9<1 9<7 9<8 9<9 9<; 9<< 9<= 9<> 9 9=? 9>@ 9>1 9>7 9>8 9>9 9>; 9>< 9>=
Bullous m*ringitis
2tos+lerosis /*mphanos+ler osis osis .holesteatoma .holesteatoma Pres"*a+usis Mastoid oiditi itis La"*rinthitis tigo Benign postural Aer tig Motion si+kness MeniereCs diseases esti"ular neuritis )+ousti+ neuroma )+ute a+ousti+ trauma 3ar! other trauma
Per+eptiAe hearing loss .ondu+tiAe hearing loss .ongenital dea #ness a+ial pals* or paral*sis 3pistais urun+le o# nose
)+ute rhinitis $+ommon +old' asomotor rhinitis )llergi+ rhinitis .hroni+ rhinitis Rhinitis medi+amentosa )+ute #rontal sinusitis )+ute maillar* sinusitis )+ute ethmoiditis .hroni+ sinusitis DeAiation o# nasal septum .hoanal atresia oreign "od* in nose Phar*angitis
/onsilitis 6*pertroph* o# adenoids PseudoG+roop a+ute epiglo titis Medial and lateral "ran+hial +*st and # istula istula .*sti+ h*gr oma oma
/orti+ollis
.*st /iroid 4oitre 4oitre 6*perth*roidism 6*perpa rath*roidi sm 6*popa rath*roidism )spiration oreign "odies /ra+heitis .onun+tiAa! # oreign oreign "od * .onun+tiAitis! allerg* .onun+tiAitis! A iral .onun+tiAitis! "a+terial Pter*gium Pter*gium
Su"+onun+tiAal haemorrhag e Blepharitis 6ordeo lum .hala0ion 3*elid la+eration
9>> 9>? 9?@ 9?1 9?7 9?8 9?9 9?; 9?< 9?= 9?> 9?? ;@@ ;@1 ;@7 ;@8 ;@9 ;@; ;@< ;@= ;@> ;@? ;1@ ;11 ;17 ;18 ;19 ;1; ;1< ;1= ;1> ;1? ;7@ ;71 ;77 ;78 ;79 ;7; ;7< ;7= ;7> ;7? ;8@ ;81 ;87 ;88 ;89 ;8; ;8< ;8= ;8>
3ntropion /ri+hiasis Lagophtalmos 3pi+anthus Ptosis etra+tion 3*elid r etra anthelasma Da+r*oadenitis Da+r*oadenitis Da+r*o+*stitis Da+r*ostenosis La+rimal du+t! la+eration
S+leritis%epis+leritis 3rosion
.ornea! #oreign "od* Burn
Keratitis KeratoG+onun+tiAitis si++a .orneal oedema .orneal d*stroph* Kerato+onus
3ndophtalmitis Mi+rophtalmos Buphtalmos 6*phaema 6*pop*on
rido+*+litis! iritis /umour o# iris 4lau+oma! +ongenital Simple glau+oma )+ute glau+oma Se+ondar* glau+oma .atara+t )phakia Psudoaphakia $arti#i+ial lens' Lens dislo+ation opia 6*permetr opia M*o pia )stigmatism Pres"*o pia opia )nisometr opia )m"l*opia Diplopia Suppresion "lindness -ightG "lindnes S+otoma 6emianopia! "itemporal and homon*mous Loss o# Aision and "lindness deta+hment Retinal deta+hment
Retina! Aessel o++lusion or "leeding Degeneration o# dependent dependent
ma+ula! age
Retinopath* o# prematurit* $ro p'
;8? Dia"eti+ retinopath* ;9@ 6*pertensiAe retinopath* ;91 .horioretinitis ;97 itreous haemmorrha ge ;98 2pti+ dis+ +upping
;99 Papilloedema ;9; 2pti+ atro ph* ;9< 2pti+ neur opa opa th* ;9= 2pti+ neur iti itis ;9> .onta+t dermatitis irritant ;9? .onta+t dermatitis allergi+a ;;@ )topi+ dermatitis $ke+uali re+al+itrant' ;;1 -ummular dermatitis ;;7 Li+hen simple +hroni+us ;;8 -apkin e+0ema ;;9 Psoriasis Aulgaris ;;; Plamoplantar pustulosis ;;< Se"orrhei+ dermatitis ;;= Pit*riasis rosea ;;> )+ne Aulgaris ;;? Rosa+ea ;<@ 6idradenitis suppuratiAa ;<1 Perioral dermatitis ;<7 Miliaria ;<8 erru+a Aulgaris .ond*loma a++uminata ;<9 Mo llus+um +ontagiosum ;<; 6erpes 0oster ;<< :m petigo ;<= Ul+eratiAe impetigo $e+t h*ma'
;<> Super#i+ial #olli+ulitis ; /inea .r .ruris ;=? ;=? Mu Mu+o +o+u +uta tane neou ouss +andi +andidi dias asis is ;>@ /inea pedis ;>1 /inea Ae Aersi+olor ;>7 Pedi+ul +ulosis +a +apit pitis ;>8 Pedi+ul +ulosis pu"is ;>9 S+a"ies ;>; ;>; ns nse+t e+t "ite "itess rea rea+t +tio ions ns ;>< Pemphigus Aulgaris ;>= Pemphigoid ;>> ;>> Derma ermattiti itis herp herpet eti# i#oormi rmis ;>? ;>? /oi+ i+ epid epider erma mall ne+ ne+ro rol* l*si siss ;?@ ;?@ SteA SteAen ensG sGo ohn hnso sonC nCs disea isease se ;?1 Dermatom*ositis ;?7 S*stemi+ s+lerosis ;?8 S+ler oderma%mo oderma%mor phea ;?9 Lupus er *t *th ematosus ;?; )lope+ia areata ;?< )ndrogeni+ alope+ ia ;?= /ri+ho /ri+hotillomania ;?> /elogen e #lluAium ;?? +hth*osis Aulgaris <@@ Li+hen planus
<@1 <@7 <@8 <@9 <@; <@< <@= <@> <@? <1@
4ranuloma annulare Mo rphea
Li+hen s+lerosus er atrphi+us 3anthematous drug eru p tion ied drug eru ption itiligo Melas Mel as ma
)l"inism PostGin#lammator* h *perpigmentation PostGin#lammator* h *popi gmentation *popigmenta
<11 Paron*+hia <17 SuppuratiAe tenos*noAitis <18 6uman "ite <19 SuppuratiAe par otit otitis <1; SuppuratiAe +erAi+al adenitis <1< Peritonsilar a"s+ess <1= LudwigCs angina <1> Be0old a"s+ess <1? Super#i+ial in#e+tions! in+luding #olli+ulitis! hidradenitis suppuratiAa! <7@ <71 <77 <78 <79 <7; <7< <7= <7> <7? <8@ <81 <87 <88 <89 <8; <8< <8= <8> <8? <9@ <91 <97 <98 <99 <9; <9< <9= <9> <9? <;@ <;1 <;7
"un+le( +ar 2steom*elitis
Staph*lo+o++al pneu monia Staph*lo+o++al "a+ter em emia Rheumati+ #eAer Sinusitis! otitis media! mastoiditis! pertonsilar a"s+ess G /6/ Rheumati+ heart disease Meningitis $neuro' -asophar*ngitis hea 4onorr he
Urinar* tra+t in#e+tion $U/' /*phoid # eAer D*sentr* "a+illi .holera Pertuss is Plague $Pes' .han+r oid oid
Diphteria $/6/' /etanus $pediatri' /u"er+ulosis kutis Le pr os* os* Lepra rea+ti on
S*philis Yaws osis Le ptospir osis
)+tinom*+osis .hromo"last .hromo"lastom*+osis Madurom*+osis
n#luen0a aAian in#luen0a $/6/' oenter itis 1iral gastr oenter itis
Poliom*elitis Ra"ies Mor"i Mo r"i lli
<;8 ari+ella <;9 6erpes 0oster <;; 6erpes sim ple <;< Mumps <;= .M1 in#e+tio ns <;> Dengue hemorrhagi+ #eAer $ D6'
<;? <<@ <<1 <<7
6G)DS )me"iasis Malaria Leishmaniasis dan nos omiasis tripanos
<<8 /ooplasmosis <<9 4iardiasis <<; /ri+homo ri+homoniasis <<< 6ookworm diseases <<= Strong*loidiasis <<> )s+ariasis < Multiple m*eloma <=? LangerhansC +ell histio+*tosis <>@ Bron+hogeni+ +ar+inoma <>1 Bron+hoalAeolar +ar+inoma <>7 -euroendo+rine tumor $+ar+inoid tumor' <>8 Mesothelioma <>9 Leukoplakia <>; Pol*ps <>< -asophar*n +ar+inoma <>= Pleomophi+ ad enom enoma <>> Harthins tumor <>? Benign pol*ps <>@ SJuamous +ell +ar+inoma <>1 )deno+ar+inoma <>7 .ar+inoid tumor <>8 L*mphoma <>9 LiAer +ell adenoma <>; 6e pato+el lular +ar+inoma +ar+inoma <>< .holangio+ar+i noma <>= .ar+inoma o# the pan+ pan +reas <>> .orti+al ad enoma <>? Renal +ell +ar +in +inoma 3tramammar* PagetCs disease
=@? =1@ =11 =17 =18 =19 =1; =1< =1= =1> =1? =7@ =71 =77 =78 =79 =7; =7< =7= =7> =7? =8@ =81 =87 =88 =89 =8; =8< =8= =8> =8? =9@ =91 =97 =98 =99 =9; =9< =9= =9> =9? =;@ =;1 =;7 =;8 =;9 =;; =;<
3ndometrial h*perplasia +ar+inoma 3ndometrial +ar+in 2Aarial teratoma $dermoid +*st' 2Aarian +ar+in oma 6*datidi#orm mole .horio+ar+ rio+ar+inoma i"ro+*sti+ +hange i"roadenoma mammae Ph*llodes tumor Breast +ar+inoma PagetCs disease o# the "reast 4*ne+omastia enoma Somatotropi+ ad enom a+tinoma Prola+ti /h*roid adenoma /h*roid +ar +i +inoma /h*moma Benign epithelial tumors Se"orrhei+ keratosis
3pithelial +*st )+tini+ kerat osis BowenCs dis ease SJuamous +ell +ar+ inoma Basal +ell +ar+inoma anthoma 6emangioma L*mphan gioma )ngi osar+oma ungoides M*+osis # un
Masto+*tosis LangerhansC +ell histio+*tosis
ntigo Lentig -eAus pigmentosus Malignant melanoma 2steoma 2steoid osteoma 2steo"lastoma 2steosar+oma 2steo+hond o+ho ndr om oma .hondro"lastoma .hondr osar+ osar+oma i"rous d*splasia i"rosar+oma and m# h 3wing sar+oma 4iant +ell tumor 4anglion +*st Lipo Lip oma Lip osar+oma i"romatosis Desmoid tumor i"roma Dr i"rosar+ i"rosar+oma Benign #i"rous histio+ *to *toma ous Malignant # i"r i"r ous histio+*toma $m# h' h' Rha" dom*osar+oma Leiom*oma Leiom*osar +oma S*noAial sar +oma
=;= )stro+*toma )stro+*toma =;> 2ligodendroglio ma =;? 3pend*moma =<@ Medullo "lastoma =<1 Retino" lastoma =<7 Meningioma =<8 -eur o#i o#i "r oma "r om =<9 S+hwannoma =<; Mental de#i+ien+* =<< )utisti+ disorder =<= Disorder o# int elle+tua l skills =<> Disorder o# motor =
d eAelopmen men t Disorder o# +oodination
BehaAior and attention ders disor de
==1 ==7 ==8 ==9 ==;
)noreia ner Aosa Aosa Bulimia Pi+a Rumination in in#an+* 4illes de la tourette s *ndrome
==<
.hroni+ motor o# Ao+al Ao+al ti+ ders disor de
=== /ransient ti+ dis orders ==> un+tional en+o perasis rasis ==? un+tional enuresis =>@ Un+oordinated s pee+h =>1 Stammer =>7 S+hi0ophrenia =>8 2ther ps*+hoses in+luding rea+tiAe ps*+hosis and puer pera l ps ps *+hosis *+hosis
=>9 =>;
Bipolar disorder! mani+ episode Bipolar disorder! depressiAe ep isode
=>< =>= =>> =>? =?@
.*+loth*mi+ disor der der 3ndogenous depression! single episode and r e+urrent e+urrent D*sth*mi+ disorder $or ession' neuroti+ d epr ess DepressiAe disorder not otherwise +lassi#ied Pani+ disorder with agorapho" ia
=?1
Pani+ disorder without agorapho"ia
=?7
)gorapho"ia without histor* o# pani+ disor der der
=?8 =?9 =?;
So+ial pho"ia Simple pho"ia
=?< =?= =?> =?? >@@
2"sessiAe +ompulsiAe disorder $neur osis' osis' Post traumati+ stress disor der der Di##use aniet* dis order )niet* disorder not otherwise +lassi#ied Disorder o# "od* "od* s ensation .onAersion disorder $h*steri+al neu rosis'
>@1
6*po+hondriasis
>@7 >@8 >@9
osis' $h*po+hondria+al neur osis' Somatisation disor der der Somato#orm pain disor der der Un di# # eren tiate d somato#orm # ere disor der der
>@;
Somato#orm disorder not otherwise +lassi#ied
>@< Multiple p Multiple p ersonalit ersonalit* >@= ugu states >@> Ps*+hogeni+ amnesia >@? Depersonalisation disorder or dep ersonalisation neur osis osis
>1@ Disso+iatiAe disorder! no+ >11 Paraphilia Paraphilia >17 Disorder o# seual desir e >18 Disorder o# seual eitement >19 Disorder o# orgasm >1; Seual pain disorders isorders >1< Seual d*s#u+tions! n o+ >1= Seual disorders! no+ >1> :nsomnia >1? 6* pers persomnia >7@ SleepGwake +*+le istur"an+es distur"an+ es -ight -igh tmares -ight terrors
>71 >77 >78 Sleep walking >79 Paranoid pers personali t* >7; S+hi0oid personalint* >7< S+hi0ot *pal personalit* >7= )ntiso+ial pers person onalit* >7> Borderline pers pers onalit* >7? 6isterioni+ pers pers onalit* >8@ -ar+isisti+ personalit personalit* >81 )Aoidan+e pers person onalit* >87 Dependent pe rson onalit* Dependent pers >88 2"sessiAeG+ompulsiAe personalit*
>89
PassiAeGaggressiAe pers pers onalit*
>8; >8< >8= >8> >8?
Personalit* disorders! no+ 3trap*ramidal side e##e+ts $eg( )+ute d*stonia! tradiAe d*skenia! parkins onism' )nti+holinergi+ side e##e+ts SedatiAe side e# #e+ts #e+ts Malignant neurolepti+ s *ndr ome
>9@
orensi+ Knowledge o# # ore ps*+hiatr*
>91
Knowledge o# indi+ation inAoluntar* admission or inAoluntar* # or t o hospital
>97
Knowledge o# "asi+ prin+iples o# methods m ethods used "* di##erent ps*+hotherapeuti+ ps*+hotherapeuti+ s+hools $eg( Rogerrian! ps*+hoanal*ti+! et+'
>98 Pseudo+onstipation >99 3n+o presis presis >9; )noreia ner Aosa Aosa >9< Bulemia >9= /i+s! neuropathi+ "eh aAior >9> 6*perkineti+ s *ndrome >9? Primar* in#antile autis m >;@ Disorders o# motherG+hild lationshi p p relation >;1 Disorders due to so+ial depriAati on
>;7 >;8
+hil hood -euroti+ disorder o# +hilhood Breath holding due to eitement
>;9
.ongenital dislo+ation o# the hips
>;; )rthritis >;< 4enu Aarum $"ow legs' >;= 4enu Aalgum $kno+k knee' >;> Pes planu planu s >;? S+oliosis ><@ K*phosis ><1 Lor do dosis ><7 /erthes disease ><8 Slipped epiph* iph*sis ><9 2sgoodGs+hlatter diseaseA ><; .hondromala+ia patellae ><< .lu" #o ot ><= Mar#anCs disease ><> 2steogenesis imper#e+ta >=@ )+hon droplasia >=1 Ri+kets! osteomala+ia >=7 2steoporosis >=8 i"rous d*splasia >=9 PagetCs disease >=; Ph*si+al oAerload >=< )septi+ ne+rosis o# "one >== 2steom*elitis! a+ute >=> )rthritis >=? /rauma o# oint +artilage artilage >>@ /rauma o# oint +apsule >>1 4anglion >>7 Primar* "one tumo mors rs >>8 Bone metastasis >>9 Pathologi+al #ra+tur e >>; )rthrosis de# orm ormans >>< .r*stal arthr op opath* >>= Rheumatoid arthritis >>> Be+hterew disease >>? Spina "i#ida >?@ Sa+ro+o++* geal ter atoma atoma >?1 S+oliosis >?7 K*phosis >?8 Lor do dosis >?9 Spond*larthrosis! s pond pond*losis *losis >?; Spond*litis! s pond *lodis+itis >?< 6ernia o# nu+leus pulposus >?= Spond*lolisthesis >?> Spond*lol*sis
>?? ?@@ ?@1 ?@7 ?@8 ?@9 ?@; ?@<
Metastases # rom rom elsewhere Pathologi+al #ra+tur es es ra+tures and dislo+ations o# spine Spinal transa+tion .ongenital hip dislo+ati +ation 6ip d*s plasia emoral head ne+rosis ntermittent arthritis o# the hip
?@= ra+tures o# pelAis ?@> ra+tures o# hip ?@? Dislo+ation o# hip ?1@ Ligamentous lesions o# hip ?11 )rthritis o # hi p p ?17 ra+tures o# #emu #emur ?18 ra+tures! +apsule! tendon and ligament lesions o # knee
?19 ?1; ?1< ?1= ?1> ?1? ?7@ ?71 ?77 ?78 ?79 ?7; ?7< ?7= ?7> ?7? ?8@ ?81 ?87 ?88 ?89
Lesion o# menis+us! medial and lateral )"normal patellear +arti +artilage 4enu Aarum! genu Aalgum 2steo+hondritis disse+ans )rthritis o# the knee )+hilles tendonitis
Rupture o# a+hilles tendon s* ndr ome ome /arsal tunnel s*nd nsta"ilit* o# ankl e n growing toe nail Pes planus .lu" #oot oot .law # oo 6allu Aalgus 6ammer toe Met atarsalgi a 2n*+ho 2n*+hogr*posis )nisomeli a ne um .aput su++edaneum
Bra+hial pleus inur* ra+ture $+laAi+le! humerus! ri"'
?8; Drowning Drowning ?8< 6ead inur* ?8= Burning ?8> Poisoning ?8? Su## o+atio o+ation ?9@ Bleeding ?91 6*poAolemi+ sho+k ?97 Dislo+ation o# aw ?98 ra+ture o# aw aw ?99 Dislo+ation o# k ne nee ?9; Dislo+ation o# pate lla ?9< Prepatellar "ursitis ?9= ra+tures o# ti"ia ?9> Ri" #ra+tures%+ontusion ?9? nur* +aused "* ri" #ra+tures ?;@ Sternal # r r a+ture a+tures ?;1 ra+tures o# toes ?;7 .rush inur* to the heel $in en' +hildr en'
?;8 ra+tures o# #i"ula ?;9 Hhiplash ?;; ra+tures! +apsule! tendon and ligament lesions o # ?;< >;= >;> >;? ><@ ><1 ><7
ankle Pneumoth ora 6emothor a a
nur* to spe+i#i+ internal organs! su+h as li Aer! kidne*! lung! et+ Aes nur* o# peripheral ner Ae ra+tures o# shoulder Dislo+ation o# shoulder shoulder Ligamentous lesions o# shoulder shoulder
><8 ><9 ><; ><< ><=
><> >
>=@ >=1 >=7 >=8 >=9 >=; >=< >== >=> >=? >>@ >>1 >>7 >>8 >>9 >>; >>< >>= >>> >>? >?@ >?1 >?7 >?8 >?9 >?;
nsta"ilit* o# shoulder shoulder ro0en shoulder ra+ture o# +laAi+le +laAi+le ra+ture o# humerus ra+ture o# radius%ulna ra+tures! +apsule! tendon! ligament "ow lesions o# el " ra+tures! +apsule! tendon! ligament lesions o# wrist ra+tures! +apsule! tendon! ligament lesions o# #ingers and th um" Lateral epi+ond*litis $tennis el"ow' Dislo+ation o# distal radius
Dislo+ation o# wrist ProgressiAe in#lammation o# # inge inger #ollowing inur* 2le+ranon "ursitis s* ndr ome .arpal tunne l s*nd nur* to #inger tendon! e(g( B outonn ier eGde#ormit* Mallet # i nger Dupu*trenCs +ontra+ +ontra+ture ture
-ail loss Su"ungual hematome /raumati+ Aessel inur* 6ead inuries Di##use "rain da mage .ere"ral +on+ussion and +ontusi +ontusion Brain death hemorr hag 3tradural hemo hage Su"dura l hemorrha ge Basilar #ra+ture s+ alp )+ute traumati+ s pinal transa+tion nur* o# pleus and periphera l nerAes erAes
S*phillis Ru " ella .M in#e+tio n /oo p lasmosis
)DS
>?< >?= >?> >?? ?@@
4onorr ho hoea
6erpes Airus in#e+tion t*pe 7 6epatitis B Mother taking to "a++o Mother taking drugs o# addi+ti on
?@1 ?@7
Mother taking to "a++o Mother taking drugs o# addi+ti on
?@8 ?@9 ?@; ?@< ?@= ?@> ?@? ?1@ ?11 ?17 ?18 ?19 ?1; ?1< ?1=
preAia asa preAi )"ruptio pla+enta G S2L .erAi+a l in+ompeten ompeten+e Pol*h*dramnio n 5aundi+e late in pregnan+* e+tion Urinar* tra+t in# e+tio P*elitis in pregnan+* ron di#i+ien+* anaemia Megalo"lasti+ anaemia Dead #et us Premature +ontr a+ a+tions Premature deliAer* Rupture o# uter us us Postmature in#ant Premature rupture o# anes mem "r ane
?1> ?1? ?7@ ?71 ?77 ?78 ?79
Unsta"le lie % malposition a#ter 8< weeks D*sto+ia! #etal and passage etus Malpresentation o# # etus Prolonged deli Aer* Primar* mild +ontra+tions E M-Se+ondar* mild +ontra+tions .ord presentation % +ord prol a pse
?7; ?7<
6*poia o# # etus etus ailure to rotate % in+orre+t r ot otation
?7= ?7> ?7? ?8@ ?81 ?87 ?88 ?89 ?8; ?8< ?8= ?8> ?8? ?9@
Rupture o# +erAi Rupture o# perineum Shoulder distortion! in#ant Retained pla+enta Retained pla+ental tissue Uterine inAe inAersion Postpartum ha emorrhage em"o lism /hrom"o E em"olism Blood group in+ompati "ili "ilit* Mastitis .ra+ked nipple ipp le nAerted n pp do metritis 3ndome
n#lammation o# pelAis $salpingitis! p elAiperitonitis! onitis! perimetritis et+'
?91 ?97 ?98 ?99 ?9; ?9<
n+ontinen+e o# urine n+ontinen+e o# # ae+es om"osis Deep Aenous thr om"o /hrom"ophle "itis 3m " olism is m ps *+hos es PostGnatal ps
?9= PostGnatal de pr ess ession ?9> Su"inAolution o# uterus
K3/3R)-4)- K3M)MPU)- KL-K D2K/3R UMUM : /ingkat Kemampuan 1 : Mengenali gam"aranGgam"aran klinik sesuai pen*akit /ingkat kat Kem Kemam amppuan uan 7 : Ma Mampu me mem"uat uat di diagnos nosis kl klinik /ing /ingkat kat Kemam Kemampua puann 8 : Mam Mampu pu mendi mendiag agno nosi siss kli klini nik! k! mem" mem"eri eri terap terapi!i! pend pendahu ahulu luan an /ing /ingkat kat Kemam Kemampua puann 9 : Mam Mampu pu mend mendia iagn gnosi osiss kli klini nik! k! memu memutu tuska skann dan dan mam mampu pu mena menang ngan anii pro"lem itu se+ara mandiri hingga tuntas
-o 1
Kewenangan Klinik
Permohonan Kemampuan Klinik
/indakan kan Resusi susittasi asi 5antung 1 Paru 7 Penanganan sesak na napas ringan sampai "erat $tanpa Aentilator' 8 Penanganan awal kegawatdaruratan pada antung 9 Penanganan Pasien dengan S*ok ; Menahit lu luka ri ringan sa sampai sedang < Pemasangan tampon hidung "agian anterior = Partus no normal dengan po posisi kepala sudah di pintu Aagina > Penanganan awal luka "akar ? Penanganan keang 1@ Pena Penang ngan anan an kera kera+u +una nann dan dan gigitan "inatang 11 Pena Penang ngan anan an awal awal trau trauma ma kepala 17 Pena Penang ngan anan an awal awal #rak #raktu turr ter"uka dan #raktur tertutup
7
8
9
Disetuui Kemampuan Klinik 1
7
8
9
K3/3R)-4)- K3/3R)MPL)- KL-K D2K/3R UMUM : /ingka ngkatt Ket Keter eram ampi pillan 1 : Mem Memil iliiki pen penge gettahua ahuann teo teori riti tiss /ing /ingkat kat Kete Keteram rampi pila lann 7 : Pern Pernah ah meli melihat hat!! ata atauu did didem emon onst stra rasi sikan kan kete keteram rampi pila lann ini ini /ingka ngkatt Ket Keter eram ampi pillan 8 : Men Mener erap apka kann di di"awa "awahh sup super erAi Aisi si /ing /ingkat kat Kete Keteram rampi pila lann 9 : Mam Mampu pu menan menanga gani ni pro"l pro"lem em itu itu se+a se+ara ra mandi mandiri ri hingg hinggaa tunt tuntas as .)/)/)-: a( Mengkonsultas Mengkonsultasikan ikan semua ke"utuhan ke"utuhan pasien pasien rawat inap kepada DP5P "( )pa"ila dokter DP5P tidak "isa dihu"ungi! dokter aga "oleh mem"erikan terapi sesuai dengan keluhann*a( +( Dokter Dokter aga 4D dan Dokter Dokter aga aga rawat inap inap meruuk meruuk pasien pasien ke RS lain lain dengan #asili #asilitas tas *ang le"ih lengkap setelah dikonsultasikan ke dokter spesialis *ang "erkaitan d( Dilu Diluar ar kewen kewenan angan gan klin klinis is diat diatas as dokte dokterr umum umum wai" wai" meng mengkon konsul sulta tasi sika kann ke dokt dokter er spesialis sesuai dengan kewenangan klinis dokter spesialis terse"ut( e( Sudah Sudah mengikut mengikutii pelatiha pelatihann )/ )/LS% ).LS ).LS%% PP4D
Bitung!,,,,,,,((( Ketua Komite Medik ,,,,,,,,,,,
-omor : ,,% Kred % KMGRSM5L % ,,( ,,( % 7@,(( Peri Periha hall : Kewe Kewena nang ngan an Klin Klinik ik Dokt Dokter er Umum Umum Lamp Lampir iran an : 1 Ber Berka kass Kepada Yth! Ketua Komite Medik RSUD Maalengka Di /empat Dengan 6ormat! Mengan Menganai ai permohon permohonan an dr. Dewi Nurmalasari Nurmalasari ! se"agai dokter umum *ang melamar untuk menadi sta## medis di RSUD Maalengka! setelah kami mengeAaluasi kompetensi! perilaku etis dan dan kele kelengk ngkap apan an "erka "erkasG" sG"erk erkas as perm permoh ohona onann *ang *ang "ersa "ersangk ngkut utan an!! maka maka deng dengan an ini ini kami kami merekomendasikan untuk mem"erikan % tidak mem"erikan % "elum mem"erikan& kewenangan klinik se"agai dokter umum! purna waktu % paruh waktu& dengan alasan: ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,(( ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,(( ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,(( Untuk itu dapat diproses penugasan klinik sesuai dengan ketentuan% prosedur *ang "erlaku( )dapun wewenang klinis *ang dapat di"erikan terlampir( • • •
Maalengka!,,,,,,,,,,,(( Ketua Komite Kredensial
,,,,,,,,,,,,,,,,,,,,, )nggota: 1( ,,,,,,,,,,,,(( 7( ,,,,,,,,,,,,((
Keterangan: & .oret *ang dianggap tidak perlu
-omor Perihal Lampiran
: ,((% KMGRSM5L% ,(% 7@, : Ke Kewenangan Kl Klinik Do Dokter Um Umum : 1 $satu' "erkas
Kepada Yth! Direktur RSUD Maalengka Di tempat Dengan 6ormat! Set Setelah elah Kom Komite Rekr Rekred eden ensi sial al!! mela melaku kuka kann kred kreden ensi sial alin ing! g! maka aka deng dengan an ini kami kami merekomendasi merekomendasiklan klan nama dokter umum dr. Dewi Nurmalasari dapat di"erikan kewenangan klinik $terlampir' se"agai sta## medis di Rumah Sakit Umum Daerah Maalengka( Untuk itu diusulkan kepada Direktur Rumah Sakit Umum Maalengka untuk dapat memproses penugasan klinik( Demikian surat ini kami sampaikan! atas perhatiann*a diu+apkan terimakasih( Maalengka!,,,,,,,,,, 6ormat Kami!
Ketua Komite Medik
