Surat Biasa

PUSDIKKES KODIKLAT TNI AD
RUMAH SAKIT PENDIDIKAN Jakarta, Agustus 2006

Nomor : ! ! "III ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : La&ora' &)'+$str$,us$a' t)m&at
t$+ur &as$)' ,a'tua' -a&r)s RI. K)&a+a
/t*. Da'&us+$kk)s
Ko+$k#at TNI AD
+$
Jakarta
0. Dasar.
a. Surat P)r$'ta* As#og Kasa+ Nomor S&r$' ! 0212 ! "III !
2006 ta'gga# 2 Agustus 2006, t)'ta'g &)'+$str$,us$a' t)m&at
t$+ur &as$)' ,a'tua' -a&r)s RI.
,. Surat D$rk)sa+ Nomor ! 0360 ! "I ! 2006 ta'gga# 26 Ju'$ 2006
t)'ta'g &)rmo*o'a' &)')r,$ta' surat &)r$'ta* &)'+$str$,us$a' t)m&at t$+ur
&as$)' ,a'tua' -a&r)s RI
2. S)sua$ +)'ga' +asar +$ atas, +)'ga' $'$ +$#a&orka' ,a*4a
Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD t)#a* m)')r$ma t)m&at t$+ur ,a'tua'
-a&r)s RI s),a'5ak )m&at ,ua* &a+a ta'gga# 20 Ju'$ 2006 +ar$ 6u+a'g Pusat 0
D$tk)sa+ 7 %oto 8o&5 ta'+a &)'5)ra*a' mat)r$$# t)r#am&$r 9.
3. D)m$k$a' u'tuk m)':a+$ka' &)r$ksa.
Kabag Bekkes

KEPALA RUMAH SAKIT PENDIDIKAN
+r. I-AN TURNIA-AN, MARS
MA/OR ;KM NRP 320<0
T)m,usa' :
( Kas$m$' Pus+$kk)s.
RUMAH SAKIT PENDIDIKAN Jakarta, S)&t)m,)r 2006
Nomor : ! ! I= ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : La&ora' &)')r$maa'
%ram) ka8a mata. K)&a+a
/t*. Da'&us+$kk)s
Ko+$k#at TNI AD
+$
Jakarta
0. Dasar Surat Kas$ Tuu+ 6u&us I D$tk)sa+ Nomor ! <6 !"III ! 2006 ta'gga#
01 Agustus 2006, t)'ta'g ukt$ P)'g)#uara' Matk)s .
2. S)*u,u'ga' +)'ga' ,ut$r satu +$ atas, +)'ga' $'$ +$#a&orka' ,a*4a
Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD t)#a* m)')r$ma >ram) Ka8a mata &r$a
+a' 4a'$ta s):um#a* 100 ,ua* +)'ga' r$'8$a' s),aga$ ,)r$kut:

a. >ram) Pr$a m)ta# "$8tor$a uk 26!0? 000 ,ua* ,.
>ram) Pr$a ;)##u#o$+ uk 21!0? 200 ,ua* 8. >ram)
-a'$ta m)ta# uk 21!06 20 ,ua* +. >ram) -a'$ta
m)ta# uk 000(22!06 20 ,ua*
Jum#a* 100 ,ua*

MA/OR ;KM NRP 320<0
T)m,usa' :
0. Kas$m$' Pus+$kk)s.
2. Kaurm$'#og Rumk$t+$k Pus+$kk)s.

Nomor : ! ! I= ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)m$':ama' 3 7t$ga9 ,ua* ra'kar. K)&a+a

/t*. Ka RS R$+4a' M)ur)ksa
+$
Jakarta
0. Dasar Program D$tk)sa+ ta*u' 2006 t)'ta'g ATLS.
2. S)*u,u'ga' +)'ga' ,ut$r satu +$ atas, +$a:uka' &)m$':ama'
3 7t$ga9 ,ua* ,ra'kar u'tuk m)'+uku'g &)#aksa'aa' ATLS 5a'g aka'
+$#aksa'aka' &a+a *ar$ Jumat ta'gga# 02 ( < ( 2006 s.+. M$'ggu 0@ ( < (
2006.

MA/OR ;KM NRP 320<0
T)m,usa' :
0. Da'&us+$kk)s Ko+$k#at TNI AD
3. Da'k$ma Pus+$kk)s
1. Paurm$'#og Rumk$t+$k Pus+$kk)s
Nomor : ! ! I= ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)m$':ama' 3 7t$ga9 ,ua* ra'kar. K)&a+a

/t*. Ka RS ;$:a'tu'g
+$
Jakarta
0. Dasar Program D$tk)sa+ ta*u' 2006 t)'ta'g ATLS.
2. S)*u,u'ga' +)'ga' ,ut$r satu +$ atas, +$a:uka' &)m$':ama'
3 7t$ga9 ,ua* ,ra'kar u'tuk m)'+uku'g &)#aksa'aa' ATLS 5a'g aka'
+$#aksa'aka' &a+a *ar$ Jumat ta'gga# 02 ( < ( 2006 s.+. M$'ggu 0@ ( < (
2006.

MA/OR ;KM NRP 320<0
T)m,usa' :
RUMAH SAKIT PENDIDIKAN Jakarta, >),ruar$ 2006
Nomor : ! ! ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' Duku'ga' A#k)s.
Ruma* Sak$t P)'+$+$ka' K)&a+a
/t*. Da'&us+$kk)s Ko+$k#at TNI AD
+$
Jakarta
0. Dasar k),utu*a' a#at k)s)*ata' Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD.
2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$atas, +)'ga' $'$ +$a:uka' a#at k)s)*ata' s),aga$
,)r$kut :
a. Pu#s) OA5m)tr$ BBBBBBBBB 0 s)t
,. M)s$' A')st)s$ BBBBBBBBB 0 s)t
8. )+s$+) Mo'$tor BBBBBBBBB 2 s)t
+. EK6 BBB.....BBBBBBBBB 2 s)t
). Su8t$o' ! "a88um BBBBBBBB. 2 s)t
7 K. O&)rs$ +a' K),$+a'a' 9
%. S&)8tro >otom)tr$ BBBBBBBB 0 s)t
g. I'ku,ator BBBBBBBBB. B. . 0 s)t
*. D)%$,r$#ator BBBBBBBBBB.. 0 s)t
$. Auto8#aC BBBBBBBBBBB.. 2 s)t
:. M$8ros8o&) $'o8u##ar BBBBBB 0 s)t
k. St)r$#$sator BBBBBBBBBBB 2 s)t
#. La&aratom5 s)t BBBBBBBBB. 0 s)t
m. S)8s$o s)t BBBBBBBBBBB.. 0 s)t
'. Do&#)r s)tBBBBBBBBBBB. 0 s)t
o. Tr)a+m$# BBBBBBBBBBB... 0 s)t
&. A#at Ro 200 MA B.BBBBBBB. 0 s)t
D. Pa'oram$8 BBBBBBBBBBB. 0 s)t
r. US6 BBBBBBBBBBBBBB 0 s)t
3. D)m$k$a' u'tuk m)':a+$ka' &)r$ksa +a' &)'5)#)sa$a' #),$* #a':ut.

MA/OR ;KM NRP 320<0
T)m,usa' :
RUMAH SAKIT PENDIDIKAN Jakarta, No&)m,)r 2006
Nomor : ! ! ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' Duku'ga' A#k)s
+$
Jakarta
2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$atas, +)'ga' $'$ +$a:uka' a#at
k)s)*ata' s),aga$ ,)r$kut :
a. Pu#s) OA5m)tr$ BB 0 s)t :. M$8ros8o&) $'o8u##ar B.. 0 s)t
,. M)s$' A')st)s$ BB 0 s)t k. St)r$#$sator BBBBBB 2 s)t
8. )+s$+) Mo'$tor B.. 2 s)t #. La&aratom5 s)t BBBB.. 0 s)t
+. EK6 BBB.....B.... 2 s)t m. S)8s$o s)t BBBBBB.. 0 s)t
). Su8t$o' ! "a88um B 2 s)t '. Do&#)r s)tBBBBBB.. 0 s)t
7 K. O&)rs$ +a' K),$+a'a' 9 o. Tr)a+m$# BBBBBB.... 0 s)t
%. S&)8tro >otom)tr$ B. 0 s)t &. A#at Ro 200 MA B.BB. 0 s)t
g. I'ku,ator BBBB. 0 s)t D. Pa'oram$8 BBBBBB. 0 s)t
*. D)%$,r$#ator BBB. 0 s)t r. US6 BBBBBBBB.. 0 s)t
$. Auto8#aC BBBB.. 2 s)t


MA/OR ;KM NRP 320<0
T)m,usa' :
RUMAH SAKIT PENDIDIKAN Jakarta, D)s)m,)r 2006
Nomor : ! ! =II ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' Duku'ga' A#k)s.
+$
Jakarta
2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, +)'ga' $'$ +$a:uka' a#at k)s)*ata'
s),aga$ ,)r$kut :
a. Pu#s) OA5m)tr$ BBBBBBBBB 0 s)t
,. M)s$' A')st)s$ BBBBBBBBB. 0 s)t
8. )+s$+) Mo'$tor BBBBBBBBB 2 s)t
+. EK6 BBB.....BBBBBBBBB. 2 s)t
). Su8t$o' ! "a88um BBBBBBBB. 2 s)t
7 K. O&)ras$ +a' K),$+a'a' 9
%. S&)8tro >otom)tr$ BBBBBBBB 0 s)t
g. I'ku,ator BBBBBBBBB. B... 2 s)t
*. D)%$,r$#ator BBBBBBBBBB.. 0 s)t
$. Auto8#aC BBBBBBBBBBBB 2 s)t
:. M$8ros8o&) $'o8u##ar BBBBBB. 0 s)t
k. La&aratom5 s)t BBBBBBBBB.. 0 s)t
#. S)8s$o s)t BBBBBBBBBBB... 0 s)t
m. Do&#)r s)tBBBBBBBBBBB.. 0 s)t
'. Tr)a+m$# BBBBBBBBBBB..... 0 s)t
o. A#at Ro 020 ( 200 MA B.BBBBB.. 0 s)t
&. P)sa4at Ro g$g$ Pa'oram$8 BBBBB 0 s)t
D. US6 BBBBBBBBBBBBBB 0 s)t
r. N),u#$E)r BBBBBBBBBBBB 0 s)t
! s. UK6 ! D$at)rm$ B
2
s. UK6 ! D$at)rm$ BBBBBBBBB.. 0 s)t
t. I'%ra R)+ BBBBBBBBBBBB. 0 s)t
u. Us ;u#tra Sou'+ BBBBBBBBB. 0 s)t
C. T)'s BBBBBBBBBBBBBB 0 s)t
4. 6a#Ca'$k ! >ara+$k BBBBBBBB.. 0 s)t
A. Traks$ 7 N)8k ' Lum,a# 9 BBBBBB 0 s)t
5. Autamat$8 Pro8)ss$'g B. BBBBBB 0 s)t

MA/OR ;KM NRP 320<0
T)m,usa' :
RUMAH SAKIT PENDIDIKAN Jakarta, D)s)m,)r 2006
Nomor : ! ! =II ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' +uku'ga' a#at
u'tuk &)m,ua'ga' #$m,a* 8a$r
+a' #$m,a* &a+at. K)&a+a
/t*. Da'&us+$kk)s
Ko+$k#at TNI AD
+$
Jakarta
0 Dasar Surat a+a' P)'go#a*a' L$'gku'ga' H$+u& Da)ra* 7 PLHD
9 Kotama+5a Jakarta T$mur No. 0?1 ! 0.@@1.020 ta'gga# 2? Ju#$ 2006 t)'ta'g
P)m,)r$ta*ua' ,aku mutu #$m,a* 8a$r.

2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, mo*o' Koma'+a' ,)rk)'a' u'tuk
m)#a':utka' surat &)rmo*o'a' +uku'ga' a#at u'tuk &)m,ua'ga' #$m,a* 8a$r +a'
#$m,a* &a+at k)&a+a D$r)ktur K)s)*ata' A'gkata' Darat.

MA/OR ;KM NRP 320<0
T)m,usa' :
( Paurm$'#og Rumk$t+$k Pus+$kk)s
RUMAH SAKIT PENDIDIKAN Jakarta, 01 D)s)m,)r 2006
Nomor : ! ! =II ! 2006
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)'ggu'aa' Sa#+o Ak*$r TA .2006
K)&a+a
/t*. Da'&us+$kk)s
Ko+$k#at TNI AD
+$
Jakarta
0 Dasar :
a. Juk#ak Kasa+ No.1 ! I= ! 2003 ta'gga# 0 S)&t)m,)r 2003 t)'ta'g
&)'g)#o#aa' +a'a /a'k)smasum.
,. Ra&at sta% Rumk$t+$k Pus+$kk)s ta'gga# 2@ NoC)m,)r 2006.

2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, mo*o' Koma'+a' ,)rk)'a' u'tuk
m)'5)tu:u$ &)'ggu'aa' sa#+o ak*$r TA.2006 u'tuk &)m,)#$a' a#k)s 5a$tu 0 u'$t
E#)ktro8ar+$ogra&* ;ar+$oC$t AT (0 sta'+ar+, sa#+o sam&a$ +)'ga' ,u#a'
NoC)m,)r 2006 s),)sar R&.03.202.<06,.&)rk$raa' sa#+o sam&a$ +)'ga' ,u#a'
D)s)m,)r 2006 s),)sar R&.01.202.<06,.,7Harga E#)ktro8ar+$ogra&* ;ar+$oC$t AT(
0 sta'+ar+ s),)sar R&.0@.30?.100,. k)kura'ga' aka' +$am,$#ka' +ar$ +a'a
/a'k)smasum9.

MA/OR ;KM NRP 320<0
T)m,usa' :
0. )'+a*ara4a' /a'k)smasum
RUMAH SAKIT PENDIDIKAN Jakarta, Mar)t 200@
Nomor : ! ! III ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)'a4ara' k)r:asama &)#a5a'a'
ra4at $'a&, ru:uka' +a' +okt)r
&)rusa*aa'.
K)&a+a
/t*. PT. T$rta I'C)stama

+$
Jakarta
0. Dasar :
a. R)'8a'a k)r:a Ruma* Sak$t D$k Pus+$kk)s Ko+$k#at TNI AD TA.
200@ ta'gga# 30 Ja'uar$ 200@
,. Program mark)t$'g Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD.

2. S)*u,u'ga' +)'ga' +asar +$ atas, kam$ m)'5am&a$ka' &)'a4ara'
k)r:asama &)#a5a'a' ra4at $'a&, ru:uka' +a' +okt)r &)rusa*aa' u'tuk t)'aga
&)#a5a'a' k)s)*ata' &o#$k#$'$k ADua D)&o K)m,a'ga' Jakarta T$mur. 7 Da%tar
tar$% t)r#am&$r9
3. S)t)#a* m)m&)#a:ar$ :um#a* kar5a4a' +a' 4aktu &)#a5a'a' ADua D)&o
K)m,a'ga' 5a'g m)'8aku& :uga ADua D)&o M)ru5a Kam$ m)'ga:uka'
&)'a4ara' :asa &)#a5a'a' +okt)r, s),)sar 60.000,( &)r:am +a' tra's&ortas$
30.000,( s)t$a& ku':u'ga'. U'tuk ADua +)&o K)m,a'ga' +)'ga' ku':u'ga'
&)#a5a'a' 1 A 2 :am ! m$'ggu maka $m,a# :asa +okt)r &)r,u#a' s),)sar
2.100.000,(. P)'a4ara' t)rs),ut t$+ak t)rmasuk PPN 00 F 7 Data +okt)r 5a'g
kam$ tugaska' t)r#am&$r 9.
1. D)m$k$a' +$sam&a$ka', atas &)r*at$a' +a' k)r:asama'5a +$u8a&ka' t)r$ma
kas$*.

KODIKLAT TNI AN6KATAN DARAT
MA/OR ;KM NRP 320<0
PUSAT PENDIDIKAN KESEHATAN Jakarta, Mar)t 200@
Nomor : ! ! III ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : Data ko'+$s$ ruma* sak$t Tk.III D$k
Pus+$kk)s Ko+$k#at TNI AD. K)&a+a
/t*. D$r)ktur K)s)*ata'
A'gkata' Darat
+$
Jakarta
U&. Kasu,+$t,$'5a'k)s.
0. Dasar. Surat D$rk)sa+ Nomor ! 112 ! III ! 200@ ta'gga# @ Mar)t 200@
t)'ta'g &)rm$'taa' +ata Ko'+$s$ Ruma* Sak$t TNI AD.
2. S)*u,u'ga' +)'ga' +asar +$ atas, +)'ga' $'$ +$#a&orka' +ata
ko'+$s$ Ruma* Sak$t Tk. III D$k Pus+$kk)s Ko+$k#at TNI AD
TA. 200@, 7 t)r#am&$r 9.

A.'. KOMANDAN PUSAT PENDIDIKAN KESEHATAN
KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
( Da'&us+$kk)s Ko+$k#at TNI AD.
RUMKITDIK Jakarta, A&r$# 200@
Nomor : ! ! I" ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : I'+)ks )kk)s. K)&a+a
/t*. Da'&us+$kk)s
Ko+$k#at TNI AD
+$
Jakarta
0. Dasar. Surat D$rk)sa+ Nomor ! 221 ! III ! 200@ ta'gga# 22 Mar)t 200@
t)'ta'g &)rm$'taa' I'+)ks )kk)s.
2. S)*u,u'ga' +)'ga' +asar +$ atas, +)'ga' $'$ +$#a&orka' +ata ,$a5a
$'+)ks )kk)s ra4at :a#a' &)r ku':u'ga' +)'ga' $'+)ks ra4at mo'+ok &)r *ar$
ra4at, 7 t)r#am&$r 9.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
( D$rk)sa+ u.& Kasu,+$t,$'5a'k)s D$tk)sa+
RUMAH SAKIT PENDIDIKAN Jakarta, M)$ 200@
Nomor : ! ! " ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : Ja4a,a' t)'ta'g &)'ga'tar
R)s$+)'s$ +$ RS D$k Pus+$kk)s. K)&a+a
/t*. K)tua Program Stu+$
A+m$'$stras$ Ruma* Sak$t
URINDO
+$
Jakarta
1. Dasar :
a. Surat K)tua Program Stu+$ A+m$'$stras$ Ruma* Sak$t Nomor
030!MARS(PPS(UNR!I"!0@ ta'gga# 2? A&r$# 200@ t)'ta'g &)'ga'tar
R)s$+)'s$.
,. P)rt$m,a'ga' sta% Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD.

2. S)*u,u'ga' +)'ga' +asar t)rs),ut +$ atas, &a+a $'t$'5a Rumk$t+$k Pus+$kk)s
Ko+$k#at TNI AD t$+ak k),)rata' u'tuk m)#aksa'aka' R)s$+)'s$ +a' Ma5or ;KM
+r. I4a' Tur'$a4a', MARS 7Karumk$t+$k Pus+$kk)s Ko+$k#at TNI AD9 s),aga$
&)m,$m,$'g +$ #a&a'ga'.
3. D)m$k$a' u'tuk +$mak#um$.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
RUMKITDIK Jakarta, M)$ 200@
Nomor : ! ! " ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : Satu *)#a$
P)r$*a# : U'+a'ga' Ra&at. K)&a+a
/t*. Para +okt)r s&)s$a#$s +a#am
+a%tar #am&$ra'
+$
Jakarta
0. K)&a#a Ruma* Sak$t D$k Pus+$kk)s Ko+$k#at TNI AD +)'ga' *ormat
m)'gu'+a'g &ara +okt)r s&)s$a#$s 5a'g t)r8a'tum &a+a #am&$ra' surat $'$ u'tuk
m)'g*a+$r$ rapat dalam rangka membahas surat ijin praktek atau surat tugas dari
Direktur Rumah Sakit /Ka Dinas Kesehatan , 5a'g aka' +$#aksa'aka' :
Har$, ta'gga# : Kam$s, 00 M)$ 200@
Puku# : 00.00 -I
T)m&at : Rua'g Ra&at Rumk$t+$k Pus+$kk)s

3. D)m$k$a' mo*o' +$mak#um$.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :

Lam&$ra' Surat Karumk$t+$k
Nomor ! ! " ! 200@
Ta'gga# M)$ 200@
RUMKITDIK
DA>TAR NAMA DOKTER SPESIALIS /AN6 DIUNDAN6
PADA A;ARA RAPAT TAN66AL 00 MEI 200@
DI RUMKITDIK PUSDIKKES
NO NAMA DOKTER ALAMAT
0 2 3
0.
2.
3.
1.
2.
6.
@.
?.
<.
00.
00.
02.
03.
01.
02.
06.
+r. A6US SUTARMAN, S&.
+r. IRHAMNI, S&.
+r. SUHARTONO, S&.
+r. JURSAL HARUN, S&.OT
+r. >LORA, S&.P
+r. /AH/A, S&.P
+r. /USTIN SUMITO, S&.KK
+r. AM. SEA/AN6, S&.THT
+r. AMAN6 S, S&.A
+r. ISMU6I, S&.JP >IHA
+r. EN/AMIN S T, S&.PD
+r. I 6EDE KOTA, S&.Ra+
+r. RONALD, S&.Ra+
+r. MUNIR, S&.Ra+
+r. SET/O,S&.O6
+r. ASSAN66A, S&.O6

RS KESDAM ;IJANTUN6
RS RID-AN MEUREKSA
RS ISLAM ;EMPAKA PUTIH
RSPAD 6ATOT SOEROTO
RS RUSPAU
RS R.S. SUKAMTO
PUSKESMAS KRAMAT JATI
PENSIUNAN RSPAD
RS KOJA
RS R.S. SUKAMTO
RS KOJA
MAES ;ILAN6KAP
RS MITRA KELUAR6A
RS R.S SUKAMTO
RS HERMINA JATI NE6ARA
RS HERMINA DEPOK
KARUMKITDIK
MA/OR ;KM NRP 320<0
Nomor : ! ! " ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' +okt)r s&)s$a#$s
u'tuk &rakt)k +$ Rumk$t+$k
Pus+$kk)s Ko+$k#at TNI AD K)&a+a
/t*. K)&a#a Ruma* Sak$t
R$+4a' M)ur)ksa
+$
Jakarta
0 Dasar :
a. U'+a'g(u'+a'g R)&u,#$k I'+o')s$a No. 2< ta*u' 2001 ta'gga# 6
Okto,)r 2001 t)'ta'g &rakt)k k)+okt)ra'.
,. K),utu*a' Dokt)r S&)s$a#$s +a#am m)m,)r$ka' &)#a5a'a'
k)s)*ata' +$ Ruma* Sak$t P)'+$+$ka' Pus+$kk)s Ko+$k#at TNI AD u'tuk
&ra:ur$t +a' PNS ,)s)rta k)#uarga'5a s)rta mas5arakat s)k$tar.

2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, mo*o' ,a'tua' K)&a#a RS R$+4a'
M)ur)ksa agar +a&at m)'ugaska' Dokt)r S&)s$a#$s )+a* A.'. +r. Ir*am'$, S&.
gu'a m)'+uku'g k)#a'8ara' +a#am &)#a5a'a' m)+$s 7s&)s$a#$s9 +$ Rumk$t+$k
Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor ! ! " ! 200@
Ta'gga# M)$ 200@
RUMAH SAKIT PENDIDIKAN
DA>TAR NAMA DOKTER SPESIALIS
NO NAMA DOKTER ALAMAT
0 2 3
0.
2.
3.
1.
2.
6.
@.
?.
<.
00.
00.
02.
03.
01.
+r. A6US SUTARMAN, S&.
+r. IRHAMNI, S&.
+r. JURSAL HARUN, S&.OT
+r. >LORA, S&.P
+r. /AH/A, S&.P
+r. /USTIN SUMITO, S&.KK
+r. AM. SEA/AN6, S&.THT
+r. ISMU6I, S&.JP >IHA
+r. EN/AMIN S T, S&.PD
+r. I 6EDE KOTA, S&.Ra+
+r. RONALD, S&.Ra+
+r. MUNIR, S&.Ra+
+r. SET/O,S&.O6
+r. ASSAN66A, S&.O6

RSPAD 6ATOT SOEROTO
RS RID-AN MEUREKSA
RSPAD 6ATOT SOEROTO
RS RUSPAU
RS R.S. SUKAMTO
PUSKESMAS KRAMAT JATI
PENSIUNAN RSPAD
RS R.S. SUKAMTO
RS KOJA
MAES TNI ;ILAN6KAP
RS MITRA KELUAR6A
RS R.S SUKAMTO
RS >ATMA-ATI
RS HERMINA DEPOK
KARUMKITDIK
MA/OR ;KM NRP 320<0
KODIKLAT TNI AN6KATAN DARAT
PUSAT PENDIDIKAN KESEHATAN Jakarta, M)$ 200@
Nomor : ! ! " ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : Data t)'ta'g /a'k)s$'
+$ Rumk$t+$k Pus+$kk)s
Ko+$k#at TNI AD. K)&a+a
/t*. Da'&us+$kk)s
Ko+$k#at TNI AD
+$
Jakarta

0. Dasar. Surat T)#)gram D$rk)sa+ Nomor ST ! 20 ! 200@ ta'gga# 20 A&r$#
200@ t)'ta'g &)rm$'taa' +ata /a'k)s$' +$ #$'gku'ga' K)s)*ata' TNI.
2. S)*u,u'ga' +)'ga' +asar +$ atas, +)'ga' $'$ +$#a&orka' +ata
/a'k)s$' +$ Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD ,u#a' Ja'uar$ 200@ s.+. ,u#a'
A&r$# 200@, N$*$#..

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
( D$rk)sa+. U.&. Kasu,+$t,$'5a'k)s D$tk)sa+
RUMKITDIK
Nomor ! ! " ! 200@
Ta'gga# M)$ 200@
DATA /ANKESIN ULAN JANUARI 200@ S.D. ULAN APRIL 200@
DI RUMKITDIK PUSDIKKES KODIKLAT TNI AD
NO NAMA RUMAH SAKIT JUMLAH IA/A KET
( Rumk$t+$k Pus+$kk)s Ko+$k#at
TNI AD
NIHIL
JUMLAH IA/A NIHIL

KARUMKITDIK
MA/OR ;KM NRP 320<0
Nomor : ! ! " ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' +okt)r s&)s$a#$s
u'tuk &rakt)k +$ Rumk$t+$k
Pus+$kk)s Ko+$k#at TNI AD K)&a+a
R$+4a' M)ur)ksa
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s +a#am m)m,)r$ka' &)#a5a'a'

2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, mo*o' ,a'tua' K)&a#a RS R$+4a'
M)ur)ksa agar +a&at m)'ugaska' Dokt)r S&)s$a#$s )+a* A.'. +r. Ir*am'$, S&.
gu'a m)'+uku'g k)#a'8ara' +a#am &)#a5a'a' m)+$s 7s&)s$a#$s9 +$ Rumk$t+$k
Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
RUMAH SAKIT PENDIDIKAN Jakarta, 2< M)$ 200@
Nomor : ! ! " ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : Ja4a,a' P)'a4ara'
P)m)r$ksaa' K)s)*ata'
R)krutm)' P)ga4a$ 200@. K)&a+a
/t*. PH. D)&ut$ Ma'a:)r SDM G
A+m$'$stras$
PT. PLN 7 P)rs)ro 9
+$
Jakarta
0. Dasar. Surat PH. D)&ut$ Ma'a:)r SDM G A+m$'$stras$ PT. PLN
7 P)rs)ro 9 Nomor 33? ! 010 ! RJK ! 2@, ta'gga# 2? M)$ 200@ t)'ta'g &)'a4ara'
&)m)r$ksaa' k)s)*ata' r)krutm)' &)ga4a$ 200@.
2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, &a+a +asar'5a Rumk$t+$k Pus+$kk)s
Ko+$k#at TNI AD t$+ak k),)rata' +)'ga' &)'a4ara' k)r:a sama u'tuk m)#akuka'
&)m)r$ksaa' k)s)*ata' t)r*a+a& &)#amar 20 ora'g +)'ga' $t)m &)m)r$ksaa'
5a'g +$m$'ta, +)'ga' $'$ kam$ m)m,)r$ka' &)'a4ara' *arga satua' ,$a5a
&)rora'ga' s),aga$ ,)r$kut :
a. ( A'am')sa r$4a5at s)kara'g, +a*u#u R& 02.000,(
+a' r$4a5at &)'5ak$t &a+a k)#uarga.
( P)m)r$ksaa' %$s$k #)'gka&
( T)st ,uta -ar'a
,. P)m)r$ksaa' La,orator$um 7#$*at #am&$ra'9 R& 22<.000,(
8. P)m)r$ksaa' t)r*a+a& &)'ggu'aa' R& @2.000,(
'arkot$k G Eat a+$t$% #a$''5a.
+. T)st &)'+)'gara' +a' k)s)$m,a'ga' R& 30.000,(
). EK6 R& 20.000,(
%. T*oraA >oto R& 22.000,(

Jum#a* R& 121.000,(
7 T)r,$#a'g : Em&at ratus +ua &u#u* )m&at r$,u ru&$a* 9

KARUMKITDIK
MA/OR ;KM NRP 320<0
Nomor ! ! " ! 200@
Ta'gga# M)$ 200@
HAR6A PEMERIKSAAN LAORATORIUM

NO JENIS PEMERIKSAAN HAR6A SATUAN KET
0 2 3 1
0. 6u#a +ara* s)4aktu R& 6.000.(
2. S6OT R& 03.000,(
3. S6PT R& 03.000,(
1. ;r)at$'$' R& 00.000,(
2. Asam urat R& 06.000,(
6. ;*oH)st)ra R& 03.000,(
@. HDL R& 20.000,(
?. LDL R& 20.000,(
<. T6 R& 26.000,(
00. HsAg R& 21.000,(
00. A't$ H;" R& 2?.000,(
02. 6M R& 22.000,( U'tuk &)r)m&ua'
03. Ur$') #)'gka& R& 2.000,(
01. H, R& 2.000,(
02. L)ukos$t R& 6.000,(
06. Trom,os$t R& 6.000,(
0@. Er$tros$t R& 6.000,(
0?. H)matokr$t R& 6.000,(
0<. LED R& 6.000,(
20. D$%8ou't R& 6.000,(

Jumlah R& 22<.000,(

I T3 J R& 020.000,(
T1 J R& 020.000,(

KARUMKITDIK
MA/OR ;KM NRP 320<0
RUMAH SAKIT PENDIDIKAN Jakarta, 2< M)$ 200@
Nomor : ! 1@ ! " ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : Ja4a,a' P)'a4ara'
P)m)r$ksaa' K)s)*ata'
R)krutm)' P)ga4a$ 200@. K)&a+a
/t*. PH. D)&ut$ Ma'a:)r SDM G
A+m$'$stras$
PT. PLN 7 P)rs)ro 9
+$
Jakarta
0. Dasar. Surat PH. D)&ut$ Ma'a:)r SDM G A+m$'$stras$ PT. PLN
7 P)rs)ro 9 Nomor 33? ! 010 ! RJK ! 2@, ta'gga# 2? M)$ 200@ t)'ta'g &)'a4ara'
&)m)r$ksaa' k)s)*ata' r)krutm)' &)ga4a$ 200@.
2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, &a+a +asar'5a Rumk$t+$k Pus+$kk)s
Ko+$k#at TNI AD t$+ak k),)rata' +)'ga' &)'a4ara' k)r:a sama u'tuk m)#akuka'
&)m)r$ksaa' k)s)*ata' t)r*a+a& &)#amar 20 ora'g +)'ga' *arga satua' ,$a5a
&)rora'ga' R&. 160.000,( s)sua$ $t)m &)m)r$ksaa' 5a'g +$m$'ta 5a$tu :
a. A'am')sa r$4a5at s)kara'g, +a*u#u +a' r$4a5at &)'5ak$t &a+a
k)#uarga.
,. P)m)r$ksaa' %$s$k #)'gka&
8. P)m)r$ksaa' P)'u':a'g
+. T)st ,uta -ar'a
). T)st &)'+)'gara' +a' k)s)$m,a'ga'
%. P)m)r$ksaa' t)r*a+a& &)'ggu'aa' 'arkot$k G Eat a+$t$% #a$''5a.

3. D)m$k$a' u'tuk m)':a+$ka' &)r$ksa G &)'5)#)sa$a' #),$* #a':ut.

KARUMKITDIK
MA/OR ;KM NRP 320<0
RUMAH SAKIT PENDIDIKAN Jakarta, 30 M)$ 200@
Nomor : ! 13 ! " ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rs)tu:ua' &)m,a*arua' $kata'
k)r:asama 7IKS9.
K)&a+a
/t*. K)&a#a D$'as K)s)*ata'
Pro&. DKI Jakarta
+$
Jakarta
0. Dasar. Surat K)&a#a D$'as K)s)*ata' Pro&$'s$ DKI Jakarta
Nomor @3?0!0.@@?.00 ta'gga# 02 M)$ 200@ t)'ta'g &)m,a*arua' $kata'
k)r:asama.
2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, +)'ga' $'$ +$sam&a$ka' ,a*4a
Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD &a+a +asar'5a t$+ak k),)rata' +)'ga'
a+a'5a &)m,a*arua' Ikata' K)r:a Sama 7 IKS 9 +a#am &)#a5a'a' k)s)*ata'
k)&a+a k)#uarga m$sk$' +a' kura'g mam&u.

KARUMKITDIK
MA/OR ;KM NRP 320<0
RUMAH SAKIT PENDIDIKAN Jakarta, Ju'$ 200@
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' R)kom)'+as$
A.'. +r. Ir*am'$, S&. K)&a+a
R$+4a' M)ur)ksa
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s )+a* +a#am m)m,)r$ka' &)#a5a'a'

2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, mo*o' ,a'tua' R)kom)'+as$
K)&a#a RS. R$+4a' M)ur)ksa k)&a+a +r. Ir*am'$, S&. gu'a m)'+uku'g
k)#a'8ara' +a#am &)#a5a'a' Po#$k#$'$k S&)s$a#$s )+a* +$ Rumk$t+$k Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :

Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' Surat Tugas
A.'. +r.Jursa# Haru', S&.OT
+kk 0 ora'g . K)&a+a
/t*. K)&a#a RSPAD
6atot So),roto
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s ,)+a* tu#a'g +a' S&)s$a#$s )+a*
+a#am m)m,)r$ka' &)#a5a'a' k)s)*ata' +$ Ruma* Sak$t P)'+$+$ka'
Pus+$kk)s Ko+$k#at TNI AD u'tuk &ra:ur$t +a' PNS ,)s)rta k)#uarga'5a
s)rta mas5arakat s)k$tar.

K)&a#a Ruma* Sak$t Pusat Aa'gkata' Darat 6atot So),roto k)&a+a +r.Jursa#
Haru', S&.OT +a' +r. Agus Sutarma' S&. gu'a m)'+uku'g k)#a'8ara' +a#am
&)#a5a'a' Po#$k#$'$k S&)s$a#$s )+a* Tu#a'g +a' S&)s$a#$s )+a* +$ Rumk$t+$k
Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
0. Da'&us+$kk)s Ko$k#at TNI AD
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
A.'. +r.Jursa# Haru', S&.OT
+kk 0 ora'g . K)&a+a
/t*. K)&a#a RSPAD
6atot So),roto
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s ,)+a* tu#a'g +a' S&)s$a#$s )+a*
+a#am m)m,)r$ka' &)#a5a'a' k)s)*ata' +$ Ruma* Sak$t P)'+$+$ka'
Pus+$kk)s Ko+$k#at TNI AD u'tuk &ra:ur$t +a' PNS ,)s)rta k)#uarga'5a
s)rta mas5arakat s)k$tar.

K)&a#a Ruma* Sak$t Pusat Aa'gkata' Darat 6atot So),roto k)&a+a :
a. +r. Jursa# Haru', S&.OT
,. +r. Agus Sutarma' S&.
gu'a m)'+uku'g k)#a'8ara' +a#am &)#a5a'a' Po#$k#$'$k S&)s$a#$s )+a* Tu#a'g
+a' S&)s$a#$s )+a* +$ Rumk$t+$k Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
A.'. +r./a*5a, S&.P +kk.
2 ora'g. K)&a+a
/t*. K)&a#a Ruma* Sak$t R.S.
Sukamto
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s Paru, S&)s$a#$s Ja'tu'g +a' S&)s$a#$s
Ra+$o#og$ +a#am m)m,)r$ka' &)#a5a'a' k)s)*ata' +$ Ruma* Sak$t
P)'+$+$ka' Pus+$kk)s Ko+$k#at TNI AD u'tuk &ra:ur$t +a' PNS ,)s)rta
k)#uarga'5a s)rta mas5arakat s)k$tar.

K)&a#a Ruma* Sak$t R.S Sukamto k)&a+a :
a. +r./a*5a, S&.P
,. +r. Ismug$, S&.JP >IHA
8. +r. Mu'$r, S&.Ra+
gu'a m)'+uku'g k)#a'8ara' +a#am &)#a5a'a' Po#$k#$'$k S&)s$a#$s Paru , S&)s$a#$s
Ja'tu'g +a' S&)s$a#$s Ra+$o#og$ +$ Rumk$t+$k Pus+$kk)s.
KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
A.'. +r. S)t5o, S&.O6 K)&a+a
>atma4at$
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s Ka'+u'ga' +a#am m)m,)r$ka'
&)#a5a'a' k)s)*ata' +$ Ruma* Sak$t P)'+$+$ka' Pus+$kk)s Ko+$k#at TNI
AD u'tuk &ra:ur$t +a' PNS ,)s)rta k)#uarga'5a s)rta mas5arakat s)k$tar.

K)&a#a RS. >atma4at$ k)&a+a +r. S)t5o, S&.O6 gu'a m)'+uku'g k)#a'8ara'
+a#am &)#a5a'a' Po#$k#$'$k S&)s$a#$s Ka'+u'ga' +$ Rumk$t+$k Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
A.'. +r. Assa'gga, S&.O6 K)&a+a
H)rm$'a D)&ok
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s Ka'+u'ga' +a#am m)m,)r$ka'

K)&a#a RS.H)rm$'a D)&ok k)&a+a +r. Assa'gga, S&.O6 gu'a m)'+uku'g
k)#a'8ara' +a#am &)#a5a'a' Po#$k#$'$k S&)s$a#$s Ka'+u'ga' +$ Rumk$t+$k
Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
A.'. +r. >#ora, S&.P K)&a+a
Pusat A'gkata' U+ara
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s Paru +a#am m)m,)r$ka' &)#a5a'a'

K)&a#a Ruma* Sak$t Pusat A'gkata' U+ara k)&a+a
+r. >#ora, S&.P gu'a m)'+uku'g k)#a'8ara' +a#am &)#a5a'a' Po#$k#$'$k S&)s$a#$s
Paru +$ Rumk$t+$k Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
A.'. +r. )'5am$' S T, S&.PD K)&a+a
/t*. Ka. RS. Ko:a
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s P)'5ak$t Da#am +a#am m)m,)r$ka'

K)&a#a RS. Ko:a k)&a+a +r. )'5am$' ST, S&.PD gu'a m)'+uku'g k)#a'8ara'
+a#am &)#a5a'a' Po#$k#$'$k S&)s$a#$s P)'5ak$t Da#am +$ Rumk$t+$k Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
A.'. +r./ust$' Sum$to, S&.KK K)&a+a
/t*. Ka. Su+$'5a'k)s
Jakarta T$mur
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s Ku#$t +a' K)#am$' +a#am m)m,)r$ka'

K)&a#a Suku D$'as P)#a5a'a' K)s)*ata' Jakarta T$mur k)&a+a +r. /ust$'
Sum$to, S&.KK gu'a m)'+uku'g k)#a'8ara' +a#am &)#a5a'a' Po#$k#$'$k s&)s$a#$s
Ku#$t +a' K)#am$' +$ Rumk$t+$k Pus+$kk)s.

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' Surat P)r$'ta*
,)'+a*ara /a'k)smasum
s)m)'tara. K)&a+a
/t*. Da'&us+$kk)s
Ko+$k#at TNI AD
+$
Jakarta
0 Dasar. ST Kasa+ Nomor : ST ! ?21 ! 200@ ta'gga# 0? Ju'$ 200@ t)'ta'g
&)r$'ta* m)'g$kut$ D$k Sus&a,uk TA 200@ A.'. Ka&t)' 7K9 ;KU >a:ar
Ar$5a'$, Am+ Nr& 2<000361@6 Kaur P)rs#og ag Tuu+ Ku&us I D$tkua+
7 )'+a*ara /a'k)smasum Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD 9.
2. S)sua$ +)'ga' +asar +$ atas, mo*o' Koma'+a' ,)rk)'a' m)m,uat surat
&)r$'ta* A.'. PNS Su4ar'$ 6o#. II!+ ,)'+a*ara ra4at :a#a' /a'k)smasum
Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD s),aga$ ,)'+a*ara /a'k)smasum
s)m)'tara, u'tuk m)'gga't$ka' Ka&t)' 7K9 ;ku >a:ar Ar$5a'$ s)#ama 5a'g
,)rsa'gkuta' m)#aksa'aka' &)'+$+$ka' +$ Pus+$kku.

MA/OR ;KM NRP 320<0
T)m,usa' :
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' Surat Tugas A.'
+r. N)$#C5 Rat'a D)4$, S&O6
;s 0 ora'g K)&a+a
/t*. Ka. D$'as K)s)*ata'
Kota a'+u'g
J#. Su&ratma' No. @3
a'+u'g
D)'ga' *ormat,
)rka$ta' +)'ga' ,a'5ak'5a kasus +$,ag$a' k),$+a'a' +a' ka'+u'ga' +$ Ruma* Sak$t Sar$'$'gs$*
+a' ,)#um m)m&u'5a$ Dokt)r Jaga +$ ag$a' t)rs),ut maka )rsama $'$ kam$ m)'ga:uka'
&)rmo*o'a' agar k)&a+a :
0. +r. N)$#C5 Rat'a D)4$, S&O6
2. +r. -$+5astut$ H K D, S&O6, M.K)s
D$,)r$ka' surat tugas u'tuk m)'g$s$ k)kura'ga' t)'aga t)rs),ut 7 &)rs5arata' t)r#am&$r 9
Atas k),$:aksa'aa' K)&a#a D$'as kam$ *aturka' t)r$ma kas$*.
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' Surat Tugas
A.'. +r./ust$' Sum$to, S&.KK K)&a+a
/t*. K)&a#a Suku D$'as K)s)*ata'
Jakarta T$mur
+$
Jakarta
0. Dasar :
,. K),utu*a' Dokt)r S&)s$a#$s Ku#$t +a' K)#am$' +a#am m)m,)r$ka'

2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, mo*o' ,a'tua' K)&a#a Suku
D$'as K)s)*ata' u'tuk m)m,)r$ka' Surat Tugas k)&a+a
+r. /ust$' Sum$to, S&.KK gu'a m)'+uku'g k)#a'8ara' +a#am &)#a5a'a' Po#$k#$'$k
s&)s$a#$s Ku#$t +a' K)#am$' +$ Rumk$t+$k Pus+$kk)s.

MA/OR ;KM NRP 320<0
T)m,usa' :
0. Da'&us+$kk)s Ko+$k#at TNI AD.
RUMKITDIK Jakarta, Ju'$ 200@
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : P)rmo*o'a' +uku'ga'
O,at ( o,ata' 5a'g
m)'+)kat$ EA&.Dat). K)&a+a
/t*. S)s+$tk)sa+
+$
Jakarta
0. Dasar. )r$ta t)#)&o' +ar$ Ka,ag#og D$tk)sa+ t)'ta'g o,at(o,ata' 5a'g
m)'+)kat$ EA&. Dat).
2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, +)'ga' $'$ +$a:uka' &)rmo*o'a'
o,at(o,ata' s),aga$ ,)r$kut :
a. R)ota# S.R 100 mg BBBBBBBBBBB360 ta,#)t
,. L)Co&ro't s$ru& BBBBBBBBBBBB...00 %#s
8. ;ata&r)s BBBBBBBBBBBBBBB.200 ta,#)t
+. Tr)m)'Ea s$ru& BBBBBBBBBBBB..021 %#s
). P5raE$'am$+) 200 mg BBBBBBBBBB600 ta,#)t
%. Tram)+ ta,#)t BBBBBBBBBBBBB.?00 ta,#)t
g. P)*a+oA$' BBBBBBBBBBBBBB0200 ta,#)t
*. ;o#sa'8)t$') t)t)s mata BBBBBBBBBB?1 %#s
$. M)tro'$+aEo#) ta,#)t BBBBBBBBBB...200 ta,#)t
:. Ka'am58$' $': 0 gram ! 2 gram ! 1 gram B..16!10!6 C$a#
k. R)Ca'o# BBBBBBBBBBBBBBBB.31 %#s

KARUMKITDIK
MA/OR ;KM NRP 320<0
T)m,usa' :
2. Ka,ag#og D$tk)sa+
Nomor : ! ! "I ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : H$,a* a#at Ro'tg)' 7#ama9
+ar$ Su,,agk)s S)t:)' D)&*a'
k)&a+a Rumk$t+$k Pus+$kk)s. K)&a+a
/t*. Da'&us+$kk)s Ko+$k#at TNI
AD
+$
Jakarta
0. Dasar. Has$# koor+$'as$ Karumk$t+$k Pus+$kk)s +a' Ko#o')# ;km +r. I 6)+)
Kota, S&Ra+ 7 Dokt)r Ra+$o#og$ Rumk$t+$k Pus+$kk)s !
Pa,a' " K)s S#og TNI 9 +)'ga' Kasu,,agk)s S)t:)' D)&*a'
L)tko# ;km +r. I N5oma' -$'ata t)'ta'g *$,a* a#at Ro'tg)' 7#ama9 +ar$
Su,,agk)s S)t:)' D)&*a' k)&a+a Rumk$t+$k Pus+$kk)s.
2. S)*u,u'ga' +)'ga' *a# t)rs),ut +$ atas, mo*o' Koma'+a' +a&at
m)'$'+ak #a':ut$ +)'ga' &)'ga:ua' surat k) satua' atas. 7S)t:)' D)&*a' su+a*
m)'5)tu:u$9

MA/OR ;KM NRP 320<0
T)m,usa' :
RUMKITDIK Jakarta, Ju#$ 200@
Nomor : ! ! "II ! 200@
K#as$%$kas$ : $asa
Lam&$ra' : (
P)r$*a# : Ja4a,a' t)'ta'g &)rmo*o'a' +ata
P)#a5a'a' Ra+$o#og$ +$ Rumk$t+$k
Pus+$kk)s Ko+$k#at TNI AD. K)&a+a
/t*. D$r)ktur $'a P)#a5a'a'
P)'u':a'g M)+$k
+$
Jakarta
0. Dasar. Surat D$r)ktur $'a P)#a5a'a' P)'u':a'g M)+$k D)&k)s RI Nomor
LA.00.00.2.3.03<? ta'gga# 2 A&r$# 200@ t)'ta'g P)rmo*o'a' Data P)#a5a'a'
Ra+$o#og$ +$ Ruma* Sak$t.
2. S)*u,u'ga' +)'ga' +asar +$ atas, +)'ga' $'$ +$sam&a$ka' Data
P)#a5a'a' Ra+$o#og$ +$ Rumk$t+$k Pus+$kk)s Ko+$k#at TNI AD,
7 t)r#am&$r 9.

MA/OR ;KM NRP 320<0
T)m,usa' :
0. Da'&us+$kk)s Ko+$k#at TNI AD.
2. Paurm$'#og Rumk$t+$k Pus+$kk)s.
Nomor ! ! "II ! 200@
Ta'gga# Ju#$ 200@
RUMKITDIK
IN"ENTARISASI PERALATAN UNTUK PELA/ANAN RADIOLO6I
DI RUMAH SAKIT DIK PUSDIKKES
Nama Ruma* Sak$t : Ruma* Sak$t D$k Pus+$kk)s
T$'gkat Ruma* Sak$t : K)#as ;
A#amat : J#. Ra5a ogor Kramat Jat$, Jakarta T$mur
Pro&$'s$ : DKI Jakarta
PELA/ANAN RADIODIA6NOSTIK(IMEJIN6
No PERALATAN SPESI>IKASI
ALAT
JUMLAH KONDISI
7AIK!TIDAK AIK9
TAHUN
PEMUATAN
0. P$8k)r =(Ra5 MA : 02 K" : @0 0 a$k 0<2<
2. A8oma =(Ra5 MA : 0? K" : 000 0 a$k 0<<3
3. Asa*$ =(Ra5 +)'ta#
u'$t
MA : 00 K" : 60
2 : 2
0 ,a$k 0<<3
PELA/ANAN RADIOTERAPI
ALAT
JUMLAH KONDISI
7AIK!TIDAK AIK9
TAHUN
PEMUATAN
( ( ( ( (
( ( ( ( (
PELA/ANAN KEDOKTERAN NUKLIR
ALAT
JUMLAH KONDISI
7AIK!TIDAK AIK9
TAHUN
PEMUATAN
( ( ( ( (
( ( ( ( (
2
Nomor ! ! "II ! 200@
Ta'gga# Ju#$ 200@
IN"ENTARISASI SUMER DA/A MANUSIA UNTUK PELA/ANAN RADIOLO6I DI
RUMAH SAKIT DIK PUSDIKKES
PELA/ANAN RADIODIA6NOSTIK(IMEJIN6
NO NAMA TENA6A NIP KUALI>IKASI JAATAN
0. DJUSLINDA DAR-IN 030 0?1 <?1 PNS!RADIO6RA>ER KAA6
2. HARIRI 030 0?2 <6< PNS!KAMAR 6ELAP AN66OTA
3. DENASARI ( HONORER!RADIO6RA>ER AN66OTA
PELA/ANAN RADIOTERAPI
NO NAMA TENA6A NIP KUALI>IKASI JAATAN
( ( ( (
( ( ( (
PELA/ANAN KEDOKTERAN NUKLIR
NO NAMA TENA6A KUALI>IKASI JAATAN
( ( ( (
( ( ( (
RUMAH SAKIT PENDIDIKAN Jakarta, Agustus 2!
N"#"r $ B % % &III % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Re+.a+a keg(ata+ /a'a# ra+gka
Me#*er(+gat( -ar( ke#er/ekaa+

MA/OR ;KM NRP 320<0
Re*ub'(k I+/"+es(a ke,02 2!. Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat Per(+ta- Da+*us/(kkes K"/(k'at TNI AD N"#"r S*r(+ %
21 % &III % 2! ta+gga' ! Agustus 2! te+ta+g *a+(t(a *er'"#baa+ /a'a#
ra+gka #e#*er(+gat( HUT Ke#er/ekaa+ RI ke,02 ta-u+ 2!.

2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /('a*"rka+ re+.a+a
keg(ata+ /a'a# ra+gka #e#*er(+gat( -ar( Ke#er/ekaa+ Re*ub'(k I+/"+es(a
ke,02 ta-u+ 2!.

2. De#(k(a+ u+tuk #e+3a/(ka+ *er(ksa.

RUMAH SAKIT PENDIDIKAN Jakarta, 2 Ju+( 24
N"#"r $ B % 2 % &I % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ /uku+ga+ /a+a. Ke*a/a
Ke*a'a Ru#a- Sak(t Pe+/(/(ka+
/r. I5a+ Tur+(a5a+, MARS
Ma6"r 7k# NRP 228
1t-. .9999.............
99999999
/(
Jakarta
1. Dasar. Surat Per(+ta- Karu#k(t/(k Pus/(kkes K"/(k'at TNI AD N"#"r
S*r(+ % 2 % &I % 24 ta+gga' 2 Ju+( 24 te+ta+g *a+(t(a rekreas( *ega5a(
Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD ta-u+ 24.

2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ /uku+ga+ /a+a /a'a#
ra+gka #e+/uku+g keg(ata+ rekreas( *ega5a( Ru#k(t/(k Pus/(kkes
K"/(k'at TNI AD 6a+g aka+ /('aksa+aka+ ta+gga' 24 s./. 28 Ju+( 24.
: Re+g(at te'a#*(r;
2. De#(k(a+, atas ba+tua+ /a+ *art(s(*as(+6a ka#( u.a*ka+ ter(#a
kas(-.

RUMAH SAKIT PENDIDIKAN Jakarta, Me( 28
N"#"r $ B % % &% 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ /uku+ga+ /a+a /a'a#
Ketua Pa+(t(a
/r. 1u/-a D(*utra
Ma6"r 7k# NRP 228
ra+gka Sert(3ab Da+*us/(kkes
K"/(k'at TNI AD. Ke*a/a
1t-. 999999999
/(
Jakarta
1. Dasar. Surat Per(+ta- Da+*us/(kkes K"/(k'at TNI AD N"#"r S*r(+ %
2< % & % 28 ta+gga' 20 Me( 28 te+ta+g *a+(t(a Sert(3ab Da+*us/(kkes
K"/(k'at TNI AD TA. 28.

2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ ba+tua+ /uku+ga+ /a+a
/ar( reka+a+ )ar#as( % *e/aga+g besar )ar#as( u+tuk *e'aksa+aa+ Sert(3ab
Da+*us/(kkes K"/(k'at TNI AD TA. 28 /ar( K"'"+e' 7k# /r. De/6 A.-/(at
Dasuk(, S*.M ke*a/a K"'"+e' 7k# /r. S.TH.M. Le+gk"+g 6a+g aka+
/('aksa+aka+ *a/a bu'a+ Ju+( 28.

2. De#(k(a+, atas ba+tua+6a ka#( u.a*ka+ ter(#a kas(-.

RUMKITDIK Jakarta, Agustus 2!
N"#"r $ B % % &III % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ surat /ar( Su/(+
1a+kes Pe#k"t Jak,T(#
Let+a+ K"'"+e' 7k# NRP 228
te+ta+g *er#(+taa+ *eserta. Ke*a/a
1t-. Su/(+ 1a+kes Pe#k"t
Jak,T(# S(e =a/ar
Be+.a+a /a+ =ak(+
/(
Jakarta
1. Dasar $
a. Surat Suku D(+as Pe'a6a+a+ Kese-ata+ Pe#er(+ta-
K"ta#a/6a Jakarta T(#ur N"#"r <>< % , 1.!4<.1 ta+gga' 1< Agustus
2! te+ta+g *er#(+taa+ *eserta.
b. Pert(#ba+ga+ sta) Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD.

2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, Ka#( k(r(#ka+ )"r#u'(r
(/e+t(tas *eserta /a'a# *e'aksa+aa+ keg(ata+ *e+(+gkata+ *e+geta-ua+
/a+ ketra#*('a+ kega5at /arurata+ bag( a5a# /a+ a5a#.
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMKITDIK Jakarta, N"*e#ber 2!
N"#"r $ B % % ?I % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ te+ta+g *er#"-"+a+
I@(+ *rakt(k ker3a 'a*a+ga+ :PKL;. Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
, Paur#(+'"g Ru#k(t/(k Pus/(kkes
1t-. Ke*a'a Sek"'a- SMA
D(tkesa/
/(
Jakarta
1. Dasar .
a. Surat Ke*a'a Sek"'a- SMA D(tkesa/ N"#"r B%0%&III%2!
ta+gga' ! Agustus 2! te+ta+g *er#"-"+a+ (@(+ *rakt(k ker3a
'a*a+ga+ : PKL ;.

2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, *a/a (+t(+6a Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD t(/ak keberata+ u+tuk #e'aksa+aka+ *rakt(k
ker3a 'a*a+ga+ : PKL ; /( a*"t(k Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD.
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMKITDIK Jakarta, Agustus 2!
N"#"r $ B % % &III % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
PKL S(s5a ke'as III. Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
1. Da+*us/(kkes K"/(k'at TNI AD.
2. Paur#(+'"g Ru#k(t/(k Pus/(kkes.
1t-. Ke*a'a Sek"'a- SMA Tu+as
Ba+gsa
/(
Jakarta
1. Dasar .
a. Surat Ke*a'a Sek"'a- SMA Tu+as Ba+gsa N"#"r
B%8%TB%&II%2! ta+gga' ! Ju'( 2! te+ta+g *er#"-"+a+ PKL
S(s5a ke'as III.

2. De#(k(a+ u+tuk /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta, Agustus 2!
N"#"r $ B % % ? % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Da)tar +a#a *eserta Rak"r
Karu#k(ta/ B C"rks-"* *era5at
Ma6"r 7k# NRP 228
Te#busa+ $
TA. 2!. Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat D(rkesa/ N". B % 1484 % ? % 2! .

2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /('a*"rka+ re+.a+a
keg(ata+ /a'a# ra+gka #e#*er(+gat( -ar( Ke#er/ekaa+ Re*ub'(k I+/"+es(a
ke,02 ta-u+ 2!.


RUMKITDIK Jakarta, Okt"ber 2!
N"#"r $ B % % ? % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Da)tar +a#a *eserta Rak"r
Karu#k(ta/ B C"rks-"* Pera5at
TA. 2! Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
1t-. Da+ Pus/(kkes K"/(k'at TNI
AD
/(
Jakarta
1. Dasar .
a. Surat D(rkesa/ N"#"r B % 1484 % ? % 2! ta+gga' 18 Okt"ber
2! te+ta+g Rak"r Karu#k(ta/ /a+ C"rks-"* Pera5at TA. 2!.
2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, /(k(r(#ka+ /a)tar +a#a *eserta
Rak"r Karu#k(ta/ B C"rks-"* Pera5at TA. 2! sebaga( ber(kut $
a. Rak"r karu#k(ta/ $ Ma6"r 7k# /r. I5a+ Tur+(a5a+,MARS
b. C"rks-"* Pera5at $ Serka :K; N( Ma/e Sr( Ju+( Ar(

RUMAH SAKIT PENDIDIKAN Jakarta, N"*e#ber 2!
N"#"r $ B % % ?I % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ 1
Per(-a' $ Ja5aba+ *erke+a'a+ /a+
*e+a5ara+ ker3a sa#a Ke*a/a
1t-. D(rektur Uta#a
Ma6"r 7k# NRP 228
Te#busa+ $
1. Kas(#(+ Pus/(kkes
PT. Jasa Neger(
/(
Jakarta
1. Dasar. Surat D(rektur Uta#a PT. Jasa Neger( N"#"r $ 1 % JN % ?I
% !, ta+gga' 2 N"*e#ber 2! te+ta+g Perke+a'a+ /a+ Pe+a5ara+ Ker3a
sa#a.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, *a/a /asar+6a
Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD t(/ak keberata+ /e+ga+ *erke+a'a+
/a+ *e+a5ara+ ker3a sa#a u+tuk #e'akuka+ *e#er(ksaa+ kese-ata+
:Me/(.a' 7-e.k U*;. A/a*u+ b(a6a *e#er(ksaa+ kese-ata+ 7a'"+ Te+aga
Pe#aga+g sesua( ter'a#*(r.

BIA1A PEMERIKSAAN KESEHATAN :MEDI7AL 7HE7K,UP;
La#*(ra+ Surat Karu#k(t/(k
N"#"r B % % ?I % 2!
Ta+gga' N"*e#ber 2!
Ma6"r 7k# NRP 228
Te#busa+ $
N" MA7AM TINDAKAN
JENIS
LAKI,LAKI
KELAMIN
PEREMPUAN
KET
1. Pe#er(ksaa+ )(s(k R*. >.,, R*. >.,,
2. T-"raD A"t" R*. <.,, R*. <.,,
2. EK= R*. <.,, R*. <.,,
<. Lab"rat"r(u# R*. 12.,, R*. 1<>.,, :E; Preg+a+.6
Test
>. A/#(+(stras( R*. 1.,, R*. 1.,,
Jumlah Rp. 270.000,- Rp. 285.000,-
7at $
F Lab"rat"r(u# $ , Ur(+a'6s(s
, &DRL
, Hbs Ag
, TPHA
, Preg+a+.6 Test :*ere#*ua+;
N"#"r $ B % % ?I % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ B(a6a Pe+ag(-a+ Me/(.a'
7-e.k U* PT. Jasa Negara. Ke*a/a
1t-. D(rektur Uta#a
Ma6"r 7k# NRP 228
PT. Jasa Negara
/(
Jakarta
sa#a.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /(ber(ta-uka+ ke*a/a PT.
Jasa Negara ba-5a b(a6a tag(-a+ *e#er(ksaa+ kese-ata+ .a'"+ te+aga
*e#aga+g /( RS D(k Pus/(kkes sebaga( ber(kut $
a. B(a6a *e#er(ksaa+ u+tuk 2< "ra+g Pr(a R* 0.<4.,,

b. B(a6a *e#er(ksaa+ u+tuk 2 "ra+g 5a+(ta R* >!.,,

Jumlah Rp 7.050.000,-
: Terbilang : Tujuh juta lima puluh ribu rupiah ;

N"#"r $ B % % ?I % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
7-e.k U* PT. Jasa Neger(. Ke*a/a
1t-. D(rektur Uta#a
Ma6"r 7k# NRP 228
Te#busa+ $
PT. Jasa Neger(
/(
Jakarta
1. a. Dasar. Surat D(rektur Uta#a PT. Jasa Neger( N"#"r $ 1 %
JN % ?I % !, ta+gga' 2 N"*e#ber 2! te+ta+g Perke+a'a+ /a+
Pe+a5ara+ Ker3a sa#a.
b. Surat Karu#k(t/(k Pus/(kkes K"/(k'at TNI AD N"#"r $
B%100%?I%2!, ta+gga' 0 N"*e#ber 2! te+ta+g Ja5aba+
Perke+a'a+ /a+ Pe+a5ara+ Ker3asa#a.
Jasa Neger( ba-5a b(a6a tag(-a+ *e#er(ksaa+ kese-ata+ .a'"+ te+aga
*e#aga+g /( RS D(k Pus/(kkes ta+gga' 12 N"Ge#ber 2! sebaga(
ber(kut $
, B(a6a *e#er(ksaa+ u+tuk 14 "ra+g Pr(a R* <.40.,,

Jumlah Rp 4.860.000,-
: Terbilang : Empat juta delapan ratu enam puluh ribu rupiah ;

RUMKITDIK Jakarta, N"Ge#ber 2!
N"#"r $ B % % ?I % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
PKL s(s5a ke'as III SMA
Tu+as Ba+gsa. Ke*a/a
Ma6"r 7k# NRP 228
1t-. Ke*a'a Sek"'a- SMA Tu+as
Ba+gsa
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- SMA Tu+as Ba+gsa N"#"r
B%8%TB%&II%2! ta+gga' ! Ju'( 2! te+ta+g *er#"-"+a+ PKL S(s5a
ke'as III.
ker3a 'a*a+ga+ : PKL ; /( a*"tek Ru#k(t/(k /a+ sebaga( k"#*e+sas(
/(ke+aka+ b(a6a PKL sebesar R* 0.,, :e+a# ratus r(bu ru*(a-;
u+tuk > "ra+g s(s5a se'a#a 12 -ar( ker3a.
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta, Dese#ber 2!
N"#"r $ B % % ?II % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
1t-. D(rektur Uta#a
A.+. Ke*a'a Ru#a- Sak(t Pe+/(/(ka+
Pa'ak-ar
/r. B(/(k 7atur Praset6a
Ma6"r 7k# NRP 220
Te#busa+ $
PT. Jasa Neger(
/(
Jakarta
1. a. Dasar. Surat D(rektur Uta#a PT. Jasa Neger( N"#"r $ 1 %
JN % ?I % !, ta+gga' 2 N"Ge#ber 2! te+ta+g Perke+a'a+ /a+
Pe+a5ara+ Ker3a sa#a.
b. Surat Karu#k(t/(k Pus/(kkes K"/(k'at TNI AD N"#"r $
B%100%?I%2!, ta+gga' 0 N"Ge#ber 2! te+ta+g Ja5aba+
*e#aga+g /( RS D(k Pus/(kkes ta+gga' 2 N"Ge#ber 2! sebaga(
ber(kut $
, B(a6a *e#er(ksaa+ u+tuk 20 "ra+g Pr(a R* 8.!2.,,
, B(a6a *e#er(ksaa+ u+tuk 2 "ra+g 5a+(ta R* 4>>.,,

Jumlah Rp !0.575.000,-
: Terbilang : "epuluh juta lima ratu tujuh puluh lima ribu
rupiah #

N"#"r $ B % % ?I % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ 1 'e#bar
Per(-a' $ *erke+a'a+ /a+ *e+a5ara+
ker3a sa#a Ke*a/a
1t-. D(rektur Uta#a
Pa'ak-ar
/r. B(/(k 7atur Praset6a
Ma6"r 7k# NRP 220
PT. O+as(s
I+/"+es(a
/(
Jakarta
1. Dasar. Pe+a5ara+ #e/(.a' .-e.k u* PT. O+as(s I+/"+es(a ta+gga'
2> N"*e#ber 2! te+ta+g Perke+a'a+ /a+ Pe+a5ara+ Ker3a sa#a.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, *a/a /asar+6a
Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD t(/ak keberata+ /e+ga+ *erke+a'a+
/a+ *e+a5ara+ ker3a sa#a u+tuk #e'akuka+ *e#er(ksaa+ kese-ata+
:Me/(.a' 7-e.k U*;. A/a*u+ b(a6a *e#er(ksaa+ kese-ata+ :/a'a#
'a#*(ra+;.

BIA1A PEMERIKSAAN KESEHATAN :MEDI7AL 7HE7K,UP;
N" MA7AM TINDAKAN
JENIS
LAKI,LAKI
KELAMIN
PEREMPUAN
KET
N"#"r B % % ?I % 2!
Ta+gga' N"*e#ber 2!
Be+/a-ara
Aa3ar Ar(6a+(
Ka*te+ 7ku :k; NRP 281140<!2!2
Te#busa+ $
1. Pe#er(ksaa+ )(s(k R*. >.,, R*. >.,,
2. T-"raD A"t" R*. <.,, R*. <.,,
2. EK= R*. <.,, R*. <.,,
<. Lab"rat"r(u# R*. 12.,, R*. 1<>.,, :E; Preg+a+.6
Test
>. A/#(+(stras( R*. 1.,, R*. 1.,,
0. Pe#er(ksaa+ /a+
t(+/aka+ /"kter
s*es(a'(s *aru
R*. 12>.,, R*. 12>.,,
!. Pe#er(ksaa+ /"kter
s*es(a'(s THT R*. >.,, R*. >.,,
4. Pe#er(ksaa+ =('ut
R*. 1>.,, R*. 1>.,,
Jumlah Rp. 460.000,- Rp. 475.000,-
7at $
F Lab"rat"r(u# $
, Ur(+a'6s(s
, &DRL
, Hbs Ag
, TPHA
, Preg+a+.6 Test :*ere#*ua+;
RUMKITDIK Jakarta, Pebruar( 24
N"#"r $ B % % II % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ I+/eks Bekkes. Ke*a/a
1t-. Da+*us/(kkes
Be+/a-ara
Aa3ar Ar(6a+(
Ka*te+ 7ku :k; NRP 281140<!2!2
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat D(rkesa/ N"#"r B % 1<2 % I % 24 ta+gga' 24 Ja+uar(
24 te+ta+g *er#(+taa+ I+/eks Bekkes.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /('a*"rka+ /ata
b(a6a (+/eks Bekkes ra5at 3a'a+ *er ku+3u+ga+ /a+ (+/eks ra5at #"+/"k
*er -ar( ra5at, : ter'a#*(r ;.

RUMKITDIK Jakarta, Aebruar( 24
N"#"r $ B % % II % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#(+taa+ /ata *es"+e'
/"kter s*s(a'(s. Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
, D(rkesa/ u.* Kasub/(tb(+6a+kes D(tkesa/.
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat D(rkesa/ N"#"r B % 2!4 % II % 24 ta+gga' 1>
Aebruar( 24 te+ta+g *er#(+taa+ /ata *ers"+e' /"kter s*es(a'(s.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /('a*"rka+ /a)tar
+"#(+at() *ers"+e' /"kter s*es(a'(s /a+ /"kter g(g( s*es(a'(s M(', PNS,
H"+"rer /a+ K"+su'e+ /( '(+gku+ga+ Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD
:ter'a#*(r;.
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta, Maret 24
N"#"r $ B % % III % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Stu/( ba+/(+g /a'a# ra+gka
akre/(tas( ru#a- sak(t. Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
, D(rkesa/ u.* Kasub/(tb(+.ab D(tkesa/.
1t-. /r. A+g"'a Nusat6a
D(rektur Me/(s
RS St. 7ar"'us
/(
Jakarta
1. Dasar $

a. Re+.a+a ker3a Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD Ta-u+
24.
b. Surat Per(+ta- Karu#k(t/(k Pus/(kkes K"/(k'at TNI AD N"#"r
S*r(+ % > % III % 24 ta+gga' 2 Maret 24 te+ta+g T(# P"k3a
Akre/(tas( Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD ta-u+ 28.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ D(rektur Me/(s RS St.
7ar"'us #e+g(3(+ka+ ka#( u+tuk #e+ga/aka+ stu/( ba+/(+g /a'a# ra+gka
Akre/(tas( Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD. Pa/a ta+gga' 12
Maret 24 U+tuk (tu ka#( #e+g(r(#ka+ *er5ak('a+ A.+. /r. He+gk6 Ira5a+
/kk.
2. De#(k(a+ atas *erke+a++6a ka#( u.a*ka+ ter(#a kas(-.

N"#"r $ B % % III % 24
K'as()(kas( $ B(asa
La#*(ra+ $ Dua 'e#bar
Per(-a' $ Pe+a5ara+ ker3asa#a *e'a6a+a+ u3(
test kese-ata+ se'eks( *e+er(#aa+
taru+a STIP Jakarta. Ke*a/a
Ma6"r 7k# NRP 2228
1t-. Pa+(t(a SIPEN7ATAR
STIP 24
/(
Jakarta
1. Dasar $
a. Re+.a+a ker3a Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD
TA. 24.
b. Pr"gra# #arket(+g Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD.

2. Se-ubu+ga+ /e+ga+ /asar /( atas, ka#( #e+6a#*a(ka+ *e+a5ara+
ker3asa#a *e'a6a+a+ u3( test kese-ata+ se'eks( *e+er(#aa+ .a'"+ taru+a
STIP Jakarta, /a+ sebaga( ba-a+ *ert(#ba+ga+ ka#( 'a#*(rka+ 3e+(s /a+
r(+.(a+ b(a6a *e#er(ksaa+ kese-ata+.
2. De#(k(a+, atas *er-at(a+ /a+ ker3asa#a+6a /(u.a*ka+ ter(#a kas(-.

JENIS /a+ TOTAL BIA1A PEMERIKSAAN KESEHATAN
I Je+(s Pe#er(ksaa+ $
1. R(5a6at Pe+6ak(t : A+a#+esa ;
2. Pe#er(ksaa+ )(s(k :P-6s(.a' Test ;
2. Pe#er(ksaa+ ta3a# *e+g'(-ata+ :G(sus; B buta 5ar+a
Ma6"r 7k# NRP 228
N"#"r B % % III % 24
Ta+gga' Maret 24
<. Pe#er(ksaa+ ta3a# *e+/e+gara+ :Hear(+g test ; ta+*a au/("#etr(
>. Pe#er(ksaa+ Lab"rat"r(u# $
a. Dara- $
, Rut(+, #e'(*ut( $
, La3u e+/a* /ara-
, Hae#"g'"b(+e
, Er(tr"s(t
, Leuk"s(t /a+ -(tu+g 3e+(s
, HBS A= H He*at(t(s
b. Ur(+e $
, Berat Je+(s :BJ;
, Reaks(
, A'bu#(+
, Re/uks(
, Ur"b"'(+
, B('(rub(+
.. Pe#er(ksaa+ M(kr"sk"*(k Se/(#e+ Ur(+e $
, Leuk"
, Er(
, E*(te'
, S('(+/er
, Kr(sta'
, Bakter(
0. Pe#er(ksaa+ 'a(+,'a(+ $
a. Pe#er(ksaa+ Ra/("'"g( :A"t" T"raD;
b. Pe#er(ksaa+ E'ektr" Kar/("gra)( :EK=;
.. Pe#er(ksaa+ =(g(
/. Pe#er(ksaa+ Nark"ba
II. T"ta' B(a6a $ R*. 2!>.,,
: Terb('a+g $ Dua ratus tu3u- *u'u- '(#a r(bu ru*(a- ;
N"#"r $ B % % III % 24
K'as()(kas( $ B(asa
La#*(ra+ $ Satu 'e#bar
Per(-a' $ Ra'at Surat Karu#k(t/(k Ke*a/a
N"#"r $B % 2< % III % 24
Ma6"r 7k# NRP 228
1t-. Para /"kter 3aga U=D Ru#k(t/(k
/a'a# /a)tar 'a#*(ra+
/(
Jakarta
1. Se-ubu+ga+ /e+ga+ surat Karu#k(t/(k Pus/(kkes K"/(k'at
TNI AD N"#"r $ B % 2< % III % 24 ta+gga' 22 Maret 24 te+ta+g u+/a+ga+
ra*at, /e+ga+ (+( /(ber(ta-uka+ ba-5a *a/a surat tersebut ter/a*at
kesa'a-a+ 6a+g *er'u /(ra'at *a/a *asa' 1. sub *asa' a B b. :-ar(, ta+gga',
/a+ *uku'; sebaga( ber(kut $
Se#u'a tertu'(s $
Ka#(s, 2! Maret 24
1. CIB
Se-arus+6a /(tu'(s $
Ka#(s, 2 A*r(' 24
8. CIB
2. De+ga+ /e#(k(a+ #aka surat Karu#k(t/(k Pus/(kkes K"/(k'at TNI AD
N"#"r $ B % 2< % III % 24 ta+gga' 22 Maret 24 te'a- /(ra'at.

DAATAR NAMA DOKTER JA=A U=D RUMKITDIK PUSDIKKES 1AN=
DIUNDAN= PADA A7ARA RAPAT TAN==AL 2 APRIL 24
Ma6"r 7k# NRP 228
N"#"r B % % III % 24
Ta+gga' Maret 24
NO NAMA DOKTER KETERAN=AN
1 2 2
1.
2.
2.
<.
>.
0.
!.
4.
8.
1.
11.
12.
12.
/r. Sutr(s+"
/r. Dr(6"
/r. B(/(k 7atur P
/r. 1u/-a D
/r. S5a+/aru
/r. E+gku+
/r. E#a+ue'
/r. He++6 SK
/r. A3( Aarka R
/r. Sat6a+(+gt6as
/r. L(+gg(-
/r. E+/a+g Sa)ar(
/r. J"esr(

RUMAH SAKIT PENDIDIKAN Jakarta, 2 Ja+uar( 28
N"#"r $ B % ! % I % 28
K'as()(kas( $ B(asa
Per(-a' $ U+/a+ga+ Ra*at. Ke*a/a
Ma6"r 7k# NRP 228
F B('a ber-a'a+ga+ -a/(r Te'*.
1t-. Kaur % Kau+(t % Karu
/(
Jakarta
1. Ke*a'a Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD /e+ga+ -"r#at
#e+gu+/a+g Kaur % Kau+(t % Karu Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD
u+tuk #e+g-a/(r( Ra*at te+ta+g Struktur Orga+(sas( Ru#a- Sak(t D(k
Pus/(kkes, 6a+g aka+ /('aksa+aka+ *a/a $
Har(, ta+gga' $ Ka#(s, 22 Ja+uar( 28
Puku' $ 8. CIB
Te#*at $ Rua+g Ra*at Ru#k(t/(k Pus/(kkes
2. De#(k(a+ #"-"+ /(#ak'u#(.

Ma6"r 7k# NRP 228
N"#"r B % % III % 24
Ta+gga' Maret 24
DAATAR NAMA PERACAT JA=A U=D RUMKITDIK PUSDIKKES 1AN=
DIUNDAN= PADA A7ARA RAPAT TAN==AL MARET 24
NO NAMA PERACAT KETERAN=AN
1 2 2
1.
2.
2.
<.
>.
0.
!.
4.
8.
1.
11.
12.
12.
1<.
1>.
10.
1!.
14.
18.
2.
21.
22.
22.
2<.
2>.
Br. Ra3(#a+
Br. Su6a/(
Br. Da/a+g
Br. S(a+tur(
Br. Agus Su*ar6a+t"
Br. Sutar+"
Br. 7e.e* Ju+ae/(
Br. Ru/( S
Br. Her5a+t"
Br. Bu/( Sa+t"s"
Br. Jau-ar(
Br. Ma#a+ S
Br. =u+a5a+
Br. Ba6u
Br. Bu/( Sa+t"s"
Br. Iu)r(@a' A@(@
Br. D(/k Su*r(a+t"
Br. D(b/a
Br. Ia(+u'
Ir. Kars(6a+t(
Br. Agus Pr(6a+t"
Ir. S(t( Sa"/a-
Ir. E#6 Sub(a+t(
Ir. C(6a+
Ir. L(+a5at(

Ma6"r 7k# NRP 228
N"#"r $ B % % II % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#(+taa+ /ata *es"+e'
/"kter s*s(a'(s. Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat D(rkesa/ N"#"r B % 2!4 % II % 24 ta+gga' 1>
Aebruar( 24 te+ta+g *er#(+taa+ /ata *ers"+e' /"kter s*es(a'(s.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /('a*"rka+ /a)tar
+"#(+at() *ers"+e' /"kter s*es(a'(s /a+ /"kter g(g( s*es(a'(s M(', PNS,
H"+"rer /a+ K"+su'e+ /( '(+gku+ga+ Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD
:ter'a#*(r;.
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMKITDIK Jakarta, Maret 24
Ma6"r 7k# NRP 228
Te#busa+ $
, D(rkesa/ u.* Kasub/(tb(+.ab D(tkesa/.
N"#"r $ B % % III % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Da)tar +a#a *eserta
*e'at(-a+ /e)e+s(Ge /r(G(+g Ke*a/a
1t-. Ke*a'a D(+as Kese-ata+ Pr"G(+s(
Daera- K-usus Ibuk"ta Jakarta
/(
Jakarta
1. Dasar. Surat Ke*a'a D(+as Kese-ata+ Pr"G(+s( Daera- K-usus Ibuk"ta
Jakarta N"#"r 22<0 % ,1.!!4.12, ta+gga' 1! Maret 24 te+ta+g usu'a+ *eserta
*e'at(-a+ /e)e+s(Ge /r(G(+g.
2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, ka#( k(r(#ka+ +a#a +a#a
*eserta *e'at(-a+ /e)e+s(Ge /r(G(+g sebaga( ber(kut $
a. K"*/a D(a+ Mu'(a/6
b. PNS Su5a3(

RUMAH SAKIT PENDIDIKAN Jakarta, A*r(' 24
Ma6"r 7k# NRP 228
Te#busa+ $
1. Da+*us/(kkes K"/(k'at TNI AD
N"#"r $ B % % I& % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
1t-. D(rektur Uta#a
PT. Jasa Neger(
/(
Jakarta
1. Dasar $
a. Surat D(rektur Uta#a PT. Jasa Neger( N"#"r 1 % JN % ?I %
!, ta+gga' 2 N"*e#ber 2! te+ta+g Perke+a'a+ /a+ Pe+a5ara+
Ker3a sa#a.
b. Surat Karu#k(t/(k Pus/(kkes K"/(k'at TNI AD N"#"r
B%100%?I%2!, ta+gga' 0 N"*e#ber 2! te+ta+g Ja5aba+
2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, /(ber(ta-uka+ ke*a/a
PT. Jasa Neger( ba-5a b(a6a tag(-a+ *e#er(ksaa+ kese-ata+ .a'"+
te+aga *e#aga+g /( RS D(k Pus/(kkes ta+gga' 0 Maret 24 seba+6ak 11
"ra+g Pr(a /e+ga+ t"ta' b(a6a R* 2.8!.,, : Terb('a+g $ Dua 3uta
se#b('a+ ratus tu3u- *u'u- r(bu ru*(a- ;

RUMAH SAKIT PENDIDIKAN Jakarta, N"*e#ber 21
Ma6"r 7k# NRP 228
N"#"r $ B % % ?I % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ /uku+ga+ *ers"+e'
Pa#%Pr"G"st /a'a# *e+ga#b('a+
Ua+g O*eras("+a' Ru#k(t/(k
Pus/(kkes. Ke*a/a
1t-. Kas(*a#"*s Pus/(kkes
/(
Jakarta
1. Dasar . Has(' Ra*at Sta) Ru#k(t/(k ta+gga' 1> A*r(' 24
Te+ta+g *er'u+6a *ers"+e' Pa# % Pr"G"st /a'a# *e+ga#b('a+ ua+g
"*eras("+a' Ru#k(t/(k Pus/(kkes /ar( Ba+k Ma+/(r( /a+ BRI.
2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, #"-"+
/uku+ga+ *ers"+e' Pa# % Pr"G"st /a'a# *e+ga#b('a+ ua+g
"*eras("+a' Ru#k(t/(k Pus/(kkes /ar( Ba+k Ma+/(r( /a+ BRI
set(a* a5a' % ak-(r bu'a+ ter-(tu+g #u'a( bu'a+ Me( 24.

Ma6"r 7k# NRP 228
Te#busa+ $
2. Be+/a-ara 1a+kes#asu# Ru#k(t/(k.
N"#"r $ B % % & % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ *e+ga/aaa+
sara+a te'e*-"+e u#u#. Ke*a/a
1t-. P(#*(+a+ PT. Te'k"# Jakarta T(#ur
/(
Jakarta
1. Dasar . Has(' Ra*at Sta) Ru#k(t/(k ta+gga' 22 A*r(' 24
te+ta+g *er'u+6a sara+a te'e*-"+e u#u# /( Ru#k(t/(k Pus/(kkes K"/(k'at
TNI AD.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ /uku+ga+ *e+ga/aa+
sara+a te'e*-"+e u#u# /( Ru#k(t/(k Pus/(kes K"/(k'at TNI AD seba+6ak
2 u+(t.
2. De#(k(a+ /(u.a*ka+ ter(#a kas(- atas ker3a sa#a+6a.

Ma6"r 7k# NRP 228
Te#busa+ $
N"#"r $ B % % & % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ Duku+ga+ A'kes
Ru#a- Sak(t D(k Pus/(kkes. Ke*a/a
1t-. Da+*us/(kkes K"/(k'at TNI
AD
/(
Jakarta
1. Dasar kebutu-a+ a'at kese-ata+ Ru#k(t/(k Pus/(kkes K"/(k'at TNI
AD.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( /(a3uka+ a'at
kese-ata+ sebaga( ber(kut $
a. Be/s(/e M"+(t"r 999999999 1 u+(t
b. Aut".'aG 999999999999.. 1 u+(t
.. US= 99999999999999. 1 u+((t

2. De#(k(a+ u+tuk #e+3a/(ka+ *er(ksa /a+ *e+6e'esa(a+ 'eb(- 'a+3ut.

Ma6"r 7k# NRP 228
Te#busa+ $
1. Kas(#(+ Pus/(kkes.
N"#"r $ B % % & % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ /uku+ga+ A'kes
Ru#a- Sak(t D(k Pus/(kkes. Ke*a/a
AD
/(
Jakarta
1. Dasar. Kebutu-a+ a'at kese-ata+ Ru#k(t/(k Pus/(kkes K"/(k'at TNI
AD.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( /(a3uka+ u'a+g
a'at kese-ata+ sebaga( ber(kut $
a. Pu'se OD6#etr( 999999999. 1 set
b. Mes(+ A+estes( 999999999. 1 set
.. Be/s(/e M"+(t"r 999999999 2 set
/. EK= 999.....999999999.. 2 set
e. Su.t("+ % &a..u# 99999999. 2 set
: K. O*eras( /a+ Keb(/a+a+ ;
). S*e.tr" A"t"#etr( 99999999 1 set
g. I+kubat"r 999999999. 9.... 2 set
-. De)(br('at"r 99999999999 1 set
(. Aut".'aG 999999999999 2 set
3. La*arat"#6 set 999999999. 1 set
k. Se.s(" set 99999999999.. 1 set
'. D"*'er set99999999999.. 1 set
#. Trea/#(' 99999999999..... 1 set
+. A'at R" 1> , 2 MA 9.99999.. 1 set
". Pesa5at R" g(g( Pa+"ra#(. 9999 1 set
*. US= 99999999999999. 1 set
J. Nebu'(@er 999999999999. 1 set
r. UK= % D(ater#( 999999999.. 1 set

2
s. I+)ra Re/ 999999999999. 1 set
t. Us 7u'tra S"u+/ 999999999. 1 set
u. Te+s =a'Ga+(k % Aara/(k 999999 1 set
G. Traks( : Ne.k + Lu#ba' ; 999999 1 set
5. Auta#at(. Pr".ess(+g 9.999999 1 set
2. De#(k(a+ u+tuk #e+3a/(ka+ *er(ksa /a+ *e+6e'esa(a+ 'eb(- 'a+3ut.

Ma6"r 7k# NRP 228
Te#busa+ $
N"#"r $ B % % & % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ ba+tua+
u+tuk #e+/a*atka+
ke'e+gka*a+ akre/(tas(. Ke*a/a
1t-. Ka RSPAD
=at"t S"ebr"t"
/(
Jakarta
1. Dasar $

24.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, gu+a #e+/uku+g ke'e+gka*a+
akre/(tas( Ru#k(t/(k Pus/(kkes #"-"+ ba+tua+ Ka RSPAD u+tuk
/a*at+6a #e#ber(ka+ b(#b(+ga+ /a+ ba-a+ '(#a b(/a+g *e'a6a+a+ ru#a-
sak(t sabaga( s6arat akre/(tas(.
2. De#(k(a+ atas *erke+a++6a ka#( u.a*ka+ ter(#a kas(-.

RUMKITDIK Jakarta, Me( 24
Ma6"r 7k# NRP 2228
Te#busa+ $
N"#"r $ B % >! % & % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#(+taa+ 7a*eg
Para#e/(s D(tkesa/. Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat Per(+ta- Pa+g/a# Ja6a % Ja6akarta N"#"r S*r(+ %
821%&%24 ta+gga' 1> Me( 24 te+ta+g surat *er(+ta- .a'"+ Pega5a(
Neger( S(*(' A+gkata+ Darat.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ K"#a+/a+ berke+a+
#e'a+3utka+ *er#(+taa+ > "ra+g 7a*eg *ara#e/(s D(tkesa/ u+tuk /(
tugaska+ : BP ; /( Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD.
2. De#(k(a+ u+tuk #e+3a/( *er(ksa.

Ma6"r 7k# NRP 228
Te#busa+ $
N"#"r $ B % % & % 24
K'as()(kas( $ B(asa
La#*(ra+ $ Satu 'e#ba
Per(-a' $ Pe+g(s(sa+ )"r#u'(r /ata
*e'a6a+a+ ke)ar#as(a+ Ke*a/a
1t-. Ka Seks( Aar#ak#(+ Su/(+
1a+kes Jak,T(#
/(
Jakarta
1. Dasar. Surat Ka Su/(+ 1a+kes Jakarta T(#ur ta+gga' 12 Me( 24
te+ta+g *er#(+taa+ #e+g(s( )"r#u'(r /ata *e'a6a+a+ ke)ar#as(a+ Ru#a-
Sak(t D(k Pus/(kkes.
*e'a6a+a+ ke)ar#as(a+ Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD. :ter'a#*(r;.

Ma6"r 7k# NRP 228
Te#busa+ $
N"#"r $ B % % & % 24
K'as()(kas( $ B(asa
Per(-a' $ Ja5aba+ te+ta+g
*er#"-"+a+ /ata Ke*a/a
1t-. K"#a+/a+ Pa+gka'a+ TNI AU
Ha'(# Per/a+akusu#a
/(
Jakarta
1. Dasar. Surat K"#a+/a+ Pa+gka'a+ TNI AU Ha'(# Per/a+akusu#a
N"#"r B % !08,11 % I % 1 % Ha'(# ta+gga' 20 Me( 24 te+ta+g *er#"-a+a+
/ata.
sara+a /a+ *rasara+a *"te+s( *erta-a+a+ *e+/uku+g ba+tua+ a/#(+(stras(
kese-ata+ /a+ /ata kekuata+ te+aga #e/(s /a+ *ara #e/(s Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD. :ter'a#*(r;.

RUMAH SAKIT PENDIDIKAN Jakarta, Ju+( 24
Ma6"r 7k# NRP 228
Te#busa+ $
N"#"r $ B % % &I % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ Duku+ga+ A'kes. Ke*a/a
AD
/(
Jakarta
1. Dasar $
a. Kebutu-a+ a'at kese-ata+ Ru#k(t/(k Pus/(kkes K"/(k'at TNI
AD.
b. Has(' K""r/(+as( Karu#k(t D(k Pus/(kkes /e+ga+ Ka/"bekkes
Puskes TNI % Caka Puskes TNI ta+gga' 1 Ju+( 24.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( /(a3uka+ A'kes
sebaga( ber(kut $
a. E#erge+.6 K(t 999999999999999 1 U+(t
b. ?,Ra6 U+(t < MA T6*e MT,<
5(t- #"b('e Sta+/ t6*e PS,! 9...999999999 1 U+(t
2. Se'a+3ut+6a #"-"+ K"#a+/a+ /a*at #e+(+/ak 'a+3ut( /e+ga+
*e+ga3ua+ surat ke Ka*uskes TNI.

<. De#(k(a+ u+tuk #e+3a/(ka+ *er(ksa /a+ *e+6e'esa(a+ 'eb(- 'a+3ut.
Te#busa+ $
N"#"r $ B % % &I % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
7-e.k U* PT.Jasa Negegr(. Ke*a/a
1t-. D(rektur Uta#a
PT. Jasa Neger(
/(
Jakarta
sa#a.
a. B(a6a *e#er(ksaa+ u+tuk 1> "ra+g Pr(a R* <.>.,,

b. B(a6a *e#er(ksaa+ u+tuk > "ra+g 5a+(ta R* 1.<2>.,,

Jumlah Rp 5.475.000,-
: Terbilang : $ima juta empat ratu tujuh puluh lima ribu rupiah #

Ma6"r 7k# NRP 228
N"#"r $ B % % &I % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ te+ta+g
*er#"-"+a+ Ker3asa#a Ke*a/a
1t-. Ketua Pr"gra# Stu/(
A/#(+(stras( Ru#a- Sak(t
URINDO
/(
Jakarta
2. Dasar $
a. Surat Ketua Pr"gra# Stu/( A/#(+(stras( Ru#a- Sak(t
U+(Gers(tas Res*at( I+/"+es(a :URINDO; N"#"r
2>%SB.KPS.MARS%UNR%I&%! ta+gga' 12 Ju+( 24 te+ta+g
*er#"-"+a+ ker3asa#a.

Pus/(kkes K"/(k'at TNI AD t(/ak keberata+ u+tuk beker3asa#a :MOU;
/e+ga+ Pr"gra# Stu/( A/#(+(stras( Ru#a- Sak(t U+(Gers(tas Res*at(
I+/"+es(a URINDO /a'a# res(/e+s( /( Ru#a- Sak(t D(k Pus/(kkes.
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta, Ju'( 24
Ma6"r 7k# NRP 228
Te#busa+ $
2. Paur#(+'"g Ru#k(t/(k Pus/(kkes
N"#"r $ B % % &II % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ s"s(a'(sas( *e#a-a#a+
I+stru#e+ Akre/(tas( > : '(#a ;
Pe'a6a+a+. Ke*a/a
1t-. D(rektur B(+a 1a+ Me/(s
S*es(a'(st(k
De*kes RI
/(
Jakarta
1. Dasar $

24.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ D(rektur #e+u+3uk Sta)
u+tuk /a*at #e#ber(ka+ s"s(a'(sas( *e#a-a#a+ I+stru#e+ Akre/(tas( >
:'(#a; Pe'a6a+a+ /( Ru#a- Sak(t D(k Pus/(kkes *a/a -ar( Ju#at /a+
Sabtu ta+gga' 2> /a+ 20 Ju'( 24 /a'a# ra+gka Akre/(tas( Ru#a- Sak(t
D(k Pus/(kkes K"/(k'at TNI AD.

RUMAH SAKIT PENDIDIKAN Jakarta, 2> Ju'( 24
Te#busa+ $
1. D(r3e+ B(+a Pe'a6a+a+ Me/(k De*kes.
2. D(rektur Eksekut() KARS.
<..Paur#(+'"g Ru#k(t/(k Pus/(kkes
Ma6"r 7k# NRP 228
N"#"r $ B % 02 % &I % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
7-e.k U* PT.Jasa Negegr(. Ke*a/a
1t-. D(rektur Uta#a
PT. Jasa Neger(
/(
Jakarta
sa#a.
a. B(a6a *e#er(ksaa+ u+tuk 24 "ra+g Pr(a =e' II
R* !.>0.,,
P"t"+ga+ 1 K R* !>0.,,

Jumlah Rp 6.840.000,-

b. B(a6a *e#er(ksaa+ u+tuk 8 "ra+g Pr(a =e'. III
Rp 2.4%0.000,-
T&tal 'ia(a Rp ).2%4.000,-
* Terbilang : "embilan juta dua ratu tiga puluh empat ribu rupiah
#

RUMKITDIK Jakarta, Agustus 24
Be+/a-ara5a+
Aa3ar Ar(6a+(
Ka*te+ 7ku :K; NRP 281140<!2!2
N"#"r $ B % % &III % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ u+tuk /('akuka+
u3( )u+gs( /a+ Pa*ara+ ra/(as( Ke*a/a
1t-. Ke*a'a Ba'a( Pe+ga#a+a+ Aas('(tas
Kese-ata+ Jakarta
/(
Jakarta
1. Dasar .Hab(s+6a #asa ber'aku surat (3(+ *e#a+)aata+ te+aga +uk'(r /(
Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD N". 22%PS%140%21 s./. 1 Ju+(
22.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ Ke*a'a Ba'a(
Pe+ga#a+a+ Aas('(tas Kese-ata+ Jakarta u+tuk #e'akuka+ u3( )u+gs( /a+
*a*ara+ ra/(as( ter-a/a* *esa5at s(+ar ? /( Ru#k(t/(k Pus/(kkes K"/(k'at
TNI AD, sebaga( ber(kut $
a. A."#a #"b('e t6*e D,12< T-:*e#buata+ Dese#ber 1882;
b. A."#a #"b('e t6*e D,12< T-:*e#buata+ Me( 188!;
.. Asa-( /e+ta' u+(t t6*e D,41 T- :*e#buata+ Maret 1882;
/. P(.ker ?,ra6 .at.N".A,12 ser(a' N".2181
2. De#(k(a+ #"-"+ /(#ak'u#(.
RUMAH SAKIT PENDIDIKAN Jakarta, Okt"ber 24
Ma6"r 7k# NRP 228
Te#busa+ $
2. Kabag Ra/("'"g( Ru#k(t/(k Pus/(kkes
N"#"r $ B % % ? % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Praktek Ker3a La*a+ga+ PKL Ke*a/a
1t-. Ke*a'a SMA LPK
/(
Jakarta
2. Dasar $
a. Surat Ke*a'a Sek"'a- Me+e+ga- Aar#as( LPK N"#"r
B%>48%LPK%&III%24 ta+gga' 21 Agustus 24 te+ta+g *er#"-"+a+
*raktek ker3a 'a*a+ga+.

Pus/(kkes K"/(k'at TNI AD t(/ak keberata+ u+tuk #e'aksa+aka+ Prakt(k
Ker3a La*a+ga+ : PKL ; /( A*"tek Ru#k(t/(k Pus/(kkes.
2. De#(k(a+ u+tuk /(#ak'u#(.
Ma6"r 7k# NRP 228
Te#busa+ $
N"#"r $ B % % ? % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ /uku+ga+%*art(s(*as(
*e+ga/aa+ tas ker3a Sus Per5(ra Ke*a/a
1t-. D(rektur PT. Tr"*(.a
Mas P-ar#a.eut(.a'
I+/"+es(a
/(
Jakarta
1. Dasar.
a. Pr"gra# Pe+/(/(ka+ Kursus Per5(ra Ma+a3e#e+ Ru#a- Sak(t
Ma/6a Pus/(kkes K"/(k'at TNI AD TA. 24
b. Per(+ta- '(sa+ Da+*us/(kkes K"/(k'at TNI AD u+tuk *e+ga/aa+
ke'e+gka*a+ kursus beru*a tas /a+ (s(+6a.

2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ ba+tua+
/uku+ga+%*art(s(*as( /ar( reka+a+ )ar#as( % *e/aga+g besar )a#as( u+tuk
*e'aksa+aa+ keg(ata+ /a'a# ra+gka *e+/(/(ka+ Sus*a3e#e+ Ru#k(t Ma/6a
beru*a tas ker3a, +"tes b""k /a+ ba''*"(+t se3u#'a- 2> bua-.
2. De#(k(a+, atas ba+tua+ /a+ *art(s(*as(+6a ka#( u.a*ka+ ter(#a
kas(-.

RUMAH SAKIT PENDIDIKAN Jakarta, N"Ge#ber 24
POKJA AKREDITASI
N"#"r $ B % % ?I % 24
K'as()(kas( $ B(asa
Ma6"r 7k# NRP 228
Per(-a' $ U+/a+ga+ S"s(a'(sas(. Ke*a/a
1t-. Para *era5at 3aga U=D Ru#k(t/(k
/(
Jakarta
1. Ketua T(# P"k3a Akre/(tas( Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI
AD /e+ga+ -"r#at #e+gu+/a+g *ara *era5at 3aga U=D Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD u+tuk #e+g-a/(r( rapat sosialisasi akreditasi
Rumkitdik, 6a+g aka+ /('aksa+aka+ *a/a $
Har(, ta+gga' $ Rabu, 18 N"Ge#ber 24
Puku' $ 1. CIB
Te#*at $ Rua+g Ra*at Ru#k(t/(k
P(#*(+a+ $ Karu#k(t/(k % Ka. U=D
2. De#(k(a+ #"-"+ /(#ak'u#(.

POKJA AKREDITASI
Ketua T(# P"k3a Akre/(tas( Ru#k(t/(k
/rg. D6a- K(s5"r(+(
PNS I&%b NIP 2 14> 888
La#*(ra+ Surat Ka*"k3a Akre/(tas(
N"#"r B % % ?I % 24
Ta+gga' N"Ge#ber 24
DAATAR NAMA PERACAT JA=A U=D RUMKITDIK PUSDIKKES 1AN=
DIUNDAN= PADA A7ARA RAPAT TAN==AL 18 MARET 24
1 2 2
1.
2.
2.
<.
>.
0.
!.
4.
8.
1.
11.
12.
12.
1<.
1>.
10.
1!.
14.
18.
Br. Su6a/(
Br. S(a+tur(
Br. Agus Su*ar6a+t"
Br. Sutar+"
Br. 7e.e* Ju+ae/(
Br. Ru/( S
Br. Her5a+t"
Br. Er5(+ S
Br. Bu/( Sa+t"s"
Br. Jau-ar(
Ir. Ir+a R
Br. =u+a5a+
Br. =ust( Ka/ek
Br. Iu)r(@a' A@(@
Br. D(/(k Su*r(a+t"
Br. Aa(sa' Ba6u
Ir. Kars(6a+t(
Br. Agus Pr(6a+t"
Ir. C(6a+

RUMKITDIK Jakarta, 2
N"#"r $ B % % % 2
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Ketua T(# P"k3a Akre/(tas( Ru#k(t/(k
/rg. D6a- K(s5"r(+(
PNS I&%b NIP 2 14> 888
Per(-a' $ Per#"-"+a+ /uku+ga+
*ers"+e'. Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Re+.a+a Akre/(tas( Ru#a- Sak(t D(k Pus/(kkes
K"/(k'at TNI AD ta-u+ 28.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ /uku+ga+ *ers"+e' u+tuk
#e+/u/uk( 3abata+ struktur "rga+(sas( Ru#a- Sak(t D(k Pus/(kkes gu+a
#e+/uku+g ke'e+gka*a+ akre/(tas( /e+ga+ +a#a /a+ 3abata+ sebaga(
ber(kut $
a. Ma6"r 7k# A#b(6", A*t, sebaga( Kau+(t Obat /a+ T-era*-6
Pa+(t(a Kese'a#ata+ Pas(e+ Ru#a- Sak(t D(k Pus/(kkes.
b. Ma6"r 7k# Ar/(3"+, SH, sebaga( K"+su'ta+ Huku# Pa+(t(a
Kese'a#ata+ Pas(e+ Ru#a- Sak(t D(k Pus/(kkes.
.. Ma6"r 7k# He+/(k C(.aks"+", SKe*,MKes, sebaga( Kaur
Ke*era5ata+ /a+ Keb(/a+a+ Ru#a- Sak(t D(k Pus/(kkes.
/. Lettu 7k# :K; /r. Er+a5at(, sebaga( Kat(# Kes'a* U+(t =a/ar
Ru#a- Sak(t D(k Pus/(kkes
2. De#(k(a+ u+tuk /(#ak'u#(.
RUMKITDIK Jakarta, N"Ge#ber 24
N"#"r $ B % % ?I % 24
K'as()(kas( $ B(asa
Ma6"r 7k# NRP 228
Te#busa+ $
, Kas(#(+ Pus/(kkes.
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ /uku+ga+
Pers"+e'. Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Kebutu-a+ ke'a+.ara+ "*eras("+a' *e'a6a+a+ kese-ata+ 2<
3a# /( Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ /a*at /uku+ga+ t(ga
"ra+g s"*(r u+tuk ke'a+.ara+ "*eras("+a' Ru#a- Sak(t D(k Pus/(kkes
/e+ga+ *ert(#ba+ga+ sebaga( ber(kut $
a. S"*(r 6a+g a/a *a/a saat (+( $
1; K"*/a D(a+ Mu'(a/6
2; PNS Mu+(r : sak(t *er#a+e+t ;
2; PNS Su5a3( : sak(t ;
b. Saat (+( tugas 3aga s"*(r se'a#a 2< 3a# /('aksa+aka+ 2 -ar(
seka'(, /e+ga+ ta#ba-a+ t(ga "ra+g s"*(r /(-ara*ka+ 3aga s"*(r /a*at
/('aksa+aka+ > -ar( seka'(.
2. De#(k(a+ u+tuk /(#ak'u#(.
RUMKITDIK Jakarta, 28 N"Ge#ber 24
N"#"r $ B % % ?I % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
I@(+ Prakt(k Ker3a La*a+ga+ :PKL;
Ma6"r 7k# NRP 228
Te#busa+ $
s(s5a SMA D(tkesa/ TP 24%28 Ke*a/a
1t-. Kasub/(tb(+.ab D(tkesa/
/(
Jakarta
1. Dasar .
Surat D(rkesa/ N"#"r B % 22> % ?I % 24 ta+gga' 1!
N"Ge#ber 24 te+ta+g Per#"-"+a+ I@(+ Prakt(k Ker3a La*a+ga+
: PKL ; s(s5a SMA D(tkesa/ TP 24%28.
Pus/(kkes K"/(k'at TNI AD t(/ak keberata+ u+tuk #e'aksa+aka+ Prakt(k
Ker3a La*a+ga+ : PKL ; bag( s(s5a SMA D(tkesa/ /( Ru#k(t/(k Pus/(kkes
K"/(k'at TNI AD.
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMKITDIK Jakarta, Dese#ber 24
N"#"r $ B % % ?II % 24
K'as()(kas( $ B(asa
La#*(ra+ $ Dua Le#bar
Per(-a' $ Ja5aba+ te+ta+g Re+.a+a
Kebutu-a+ A'kes Uta#a
Ma6"r 7k# NRP 228
Te#busa+ $
Ru#k(ta/ TA. 21 Ke*a/a
1t-. D(rkesa/
/(
Jakarta
U.*. Kasub/(tb(+6a+kes D(tkesa/
1. Dasar. Surat D(rkesa/ N"#"r B % 22<8 % ?I % 24 ta+gga' 1!
N"Ge#ber 24 te+ta+g Re+.a+a Pe+ga/aa+ Kebutu-a+ A'kes Uta#a
Ru#k(ta/ TA. 21.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(sa#*a(ka+ Data
Re+.a+a Kebutu-a+ A'kes Uta#a TA. 21 /( Ru#k(t/(k Pus/(kkes K"/(k'at
TNI AD, : ter'a#*(r ;.
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMKITDIK Jakarta, Dese#ber 24
N"#"r $ B % % ?II % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ K"+)(r#as(
Surat Ketera+ga+ Sak(t A.+.
Ma6"r 7k# NRP 228
Te#busa+ $
M"@es Ra/6a+ Sasua+g. Ke*a/a
1t-. P(#*(+a+ PT. BRI
7aba+g K"ta#"bagu
/(
Te#*at

1. Dasar. Surat PT. Ba+k Rak6at I+/"+es(a :Perser";, Tbk. Ka+t"r
7ab. K"ta#"bagu N"#"r B%2280%K7,?II%L?I%12%24 ta+gga' 14
Dese#ber 24 te+ta+g K"+)(r#as( Surat Ketera+ga+ Sak(t A+. M"@es
Ra/6a+ Sasua+g.
2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, Ka#( k"+)(r#as(ka+
ba-5a $
a. Pa/a ta+gga' 8 Dese#ber 24 t(/ak a/a Pas(e+ 6a+g
ber+a#a M"@es Ra/6a+ Sasua+g berku+3u+g :ber"bat; /( Ru#a-
Sak(t D(k Pus/(kkes, /e+ga+ /e#(k(a+ Ka#( t(/ak #e+ge'uarka+
Surat Ist(ra-at Sak(t ke*a/a 6a+g bersa+gkuta+.
b. Ru#a- Sak(t D(k Pus/(kkes t(/ak *er+a- #e#ber(ka+ Surat
Ist(ra-at Sak(t ke*a/a *as(e+ se'a#a 0 -ar( 'a#a+6a.
.. A"r#at Surat Ist(ra-at Sak(t tersebut berbe/a /e+ga+ 6a+g
Ka#( #('(k(. :."+t"- as'( ter'a#*(r;
/. Ta+/a ta+ga+ /r. 1a-6a, S*.P /a'a# surat (st(ra-at sak(t 6a+g
bersa+gkuta+ berbe/a /e+ga+ as'(+6a. :."+t"- ta+/a ta+ga+ as'(
ter'a#*(r;

RUMKITDIK Jakarta, 2
N"#"r $ B % % % 2
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ #e+/a*atka+
sert()(kas( Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
1t-. K"+su(' C('a6a-
DKI Jakarta
/(
Jakarta
1. Dasar. Re+.a+a Akre/(tas( Ru#a- Sak(t D(k Pus/(kkes
K"/(k'at TNI AD ta-u+ 28.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ *e#er(ksaa+ u'a+g
ter-a/a* $
a. Ser()(kas( I+sta'as( '(str(k
b. Sert()(kas( Pe+a+gka' *et(r
.. Sert()(kas( =e+set
2. De#(k(a+ u+tuk /(#ak'u#(.
RUMAH SAKIT PENDIDIKAN Jakarta, Ja+uar( 28
N"#"r $ B % % I % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Persetu3ua+ *er#"-"+a+
*e+ugasa+ :BP; PNS De*kes
Ma6"r 7k# NRP 228
Te#busa+ $
/( Ru#a- Sak(t D(k Pus/(kkes Ke*a/a
1t-. /r. P-ere+a A#a'(a R"-a+(,
S*. Ra/
/(
Jakarta
1. Dasar $
a. Surat 'a#ara+ ker3a /r. P-ere+a A#a'(a R"-a+(, S*.Ra/
ta+gga' 1< Ja+uar( 28 te+ta+g *e+ga3ua+ *er#"-"+a+ *e+ugasa+
:BP; /( Ru#a- Sak(t D(k Pus/(kkes.
b. Kebutu-a+ /"kter s*es(a'(s /a'a# #e#ber(ka+ *e'a6a+a+
kese-ata+ /( Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD u+tuk
*ra3ur(t /a+ PNS beserta ke'uarga+6a serta #as6arakat sek(tar.

2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, *a/a *r(+s(*+6a Ru#a-
Sak(t D(k Pus/(kkes t(/ak keberata+ /a+ #e+er(#a *er#"-"+a+ sau/ar(
u+tuk bertugas :BP; /( Ru#a- Sak(t D(k Pus/(kkes.
2. U+tuk *r"ses a/#(+(stras( Ke*ega5a(a+ /(-ara*ka+ sau/ar( /a*at
#e+6e'esa(ka+ sesua( kete+tua+ /a+ *eratura+ ke*ega5a(a+ 6a+g ber'aku
/ar( te#*at tugas sebe'u#+6a.
<. De#(k(a+ u+tuk /(#ak'u#(.
KODIKLAT TNI AN=KATAN DARAT
PUSAT PENDIDIKAN KESEHATAN Jakarta, Ja+uar( 28
N"#"r $ B % % I % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Data 1a+kes(+ ra5at (+a* /a+
Ma6"r 7k# NRP 228
Te#busa+ $
2. B(r" Ke*ega5a(a+ Sek3e+ De*kes RI
2. Bat( Tuu/
ra5at 3a'a+ Ru#k(t/(k Pus/(kkes
K"/(k'at TNI AD ta-u+ 24 Ke*a/a
1t-. D(rkesa/
/(
Jakarta
1. Dasar. Surat Te'egra# D(rkesa/ N"#"r ST % 2 % 28 ta+gga' 2
Ja+uar( 28 te+ta+g *er#(+taa+ /ata 1a+kes(+ ra5at (+a* /a+ ra5at 3a'a+
Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD ta-u+ 24.
1a+kes(+ ra5at (+a* /a+ ra5at 3a'a+ Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD
ta-u+ 24, N(-('.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % II % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ I3(+ *e+ggu+aa+ ru#a-
A.+. K"#a+/a+ Pusat Pe+/(/(ka+ Kese-ata+
Karu#k(t/(k
Ma6"r 7k# NRP 228
Te#busa+ $
1. D(rkesa/
/(+as Pus/(kkes Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Pe+(+gkata+ Mutu Pe'a6a+a+ Ru#a- Sak(t D(k Pus/(kkes.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, #"-"+ K"#a+/a+
#e#ber(ka+ (3(+ u+tuk #e+ggu+aka+ ru#a- /(+as 6a+g /(te#*at( "'e-
Ma6"r 7k# Ha/( Sutr(s+", Ka*te+ 7k# M. Hara-a* /a+ Mes Pera5at 'a#a
u+tuk /(gu+aka+ sebaga( rua+g &IP, rua+g *era5ata+ be/a-, /a+ rua+g I7U
Ru#a- Sak(t D(k Pus/(kkes.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % II % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ surat
Re)ere+s( Ba+k Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
, Kas(#(+ Pus/(kkes
1t- P(#*(+a+ 7aba+g Ba+k
Ma+/(r( Kra#at Jat(
/(
Jakarta
1. Dasar. Ke'a+.ara+ A/#(+(stras( Keua+ga+ Ru#a- Sak(r D(k
Pus/(kkes
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ *(#*(+a+ .aba+g Ba+k
Ma+/(r( #e#ber(ka+ surat ketera+ga+ ba-5a Ru#a- Sak(t D(k Pus/(kkes
su/a- #e#('(k( =(r" /e+ga+ +"#"r 0,,111,>40,4 a%+ Ru#a- Sak(t D(k
Pus/(kkes.
2. Surat ketera+ga+ tersebut aka+ /(gu+aka+ u+tuk #e#buat Reke+(+g
=(r" baru /( Ba+k BNI.
<. De#(k(a+, atas ba+tua+ /a+ *art(s(*as(+6a ka#( u.a*ka+ ter(#a
kas(-.
RUMAH SAKIT PENDIDIKAN Jakarta, Aebruar( 28
N"#"r $ B % % II % 28
K'as()(kas( $ B(asa
Per(-a' $ U+/a+ga+ Ra*at Ke*a/a
Ma6"r 7k# NRP 228
1t-. Para *era5at 3aga U=D Ru#k(t/(k
/(
Jakarta
1. Ke*a'a Ru#a- Sak(t D(k Pus/(kkes /e+ga+ -"r#at #e+gu+/a+g
*ara *era5at 3aga U=D Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD u+tuk
#e+g-a/(r( undangan Rapat 6a+g aka+ /('aksa+aka+ *a/a $
a. Har(, ta+gga' $ Se+(+, 22 Aebruar( 28
b. Puku' $ 4. CIB
.. Te#*at $ Rua+g Ra*at Ru#k(t/(k
/. P(#*(+a+ $ Karu#k(t/(k % Ka. U=D
2. De#(k(a+ #"-"+ /(#ak'u#(.

DAATAR NAMA PERACAT JA=A U=D RUMKITDIK PUSDIKKES 1AN= DIUNDAN=
PADA A7ARA RAPAT TAN==AL 22 AEBRUARI 28
Kau+(t =a/ar
/r. 1u/-a D(*utra
Ma6"r 7k# NRP 22<
Te#busa+ $
, Karu#k(t/(k Pus/(kkes
La#*(ra+ Surat Kau+(t =a/ar
N"#"r B % % II % 28
Ta+gga' Aebruar( 28
1 2 2
1.
2.
2.
<.
>.
0.
!.
4.
8.
1.
11.
12.
12.
1<.
1>.
10.
1!.
14.
18.
2.
Br. Su6a/(
Br. Agus Su*ar6a+t"
Br. Sutar+"
Br. 7e.e* Ju+ae/(
Br. Ru/( S
Br. Her5a+t"
Br. Er5(+ S
Br. Re+" I.S
Br. Bu/( Sa+t"s"
Br. Jau-ar(
Ir. Ir+a R
Br. =u+a5a+
Br. =ust( Ka/ek
Br. Iu)r(@a' A@(@
Br. D(/(k Su*r(a+t"
Br. Aa(sa' Ba6u
Br. ED+a
Ir. Kars(6a+t(
Ir. C(6a+
Ir. Jat(

N"#"r $ B % % III % 28
K'as()(kas( $ B(asa
Per(-a' $ I+/eks Bekkes Ke*a/a
Kau+(t =a/ar
/r. 1u/-a D(*utra
Ma6"r 7k# NRP 22<
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat D(rkesa/ N"#"r B % >2< % III % 2! ta+gga' 22 Maret
b(a6a (+/eks Bekkes ra5at 3a'a+ *er ku+3u+ga+ /e+ga+ (+/eks ra5at
#"+/"k *er -ar( ra5at, : ter'a#*(r ;.

PUSAT PENDIDIKAN KESEHATAN Jakarta, Maret 28
N"#"r $ B % % III % 28
K'as()(kas( $ B(asa
Ma6"r 7k# NRP 228
Te#busa+ $
, D(rkesa/ u.* Kasub/(tb(+6a+kes D(tkesa/
1t-. D(rkesa/
/(
Jakarta
1. Dasar. Surat D(rkesa/ N"#"r B % <2 % II % 28 ta+gga' 1! Aebruar(
28 te+ta+g Abse+s( I+/eks Bekkes.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /('a*"rka+ /ata b(a6a
(+/eks Bekkes ra5at 3a'a+ *er ku+3u+ga+ /e+ga+ (+/eks ra5at #"+/"k *er
-ar( ra5at, : ter'a#*(r ;.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % III % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ te+ta+g Per#"-"+a+
PKL S(s5a Ke'as II SMA
Karu#k(t/(k
Ma6"r 7k# NRP 228
Te#busa+ $
1. D(rkesa/
Tu+as Ba+gsa Ke*a/a
1t-. Ke*a'a Sek"'a-
SMA Tu+as Ba+gsa
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- SMA Tu+as Ba+gsa N"#"r
8%TB%I%28 ta+gga' 1> Ja+uar( 28 te+ta+g Per#"-"+a+ PKL S(s5a
Ke'as II SMA Tu+as Ba+gsa.
2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, *a/a (+t(+6a Ru#a-
Sak(t D(k Pus/(kkes t(/ak keberata+ u+tuk #e'aksa+aka+ Praktek Ker3a
La*a+ga+ : PKL ; bag( s(s5a Ke'as II SMA Tu+as Ba+gsa /( Ru#a- Sak(t
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta, 2 Me( 28
N"#"r $ B % % & % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Pe+(+3aua+ u'a+g (kata+
Ma6"r 7k# NRP 228
Te#busa+ $
2. Paur/(k'at Ru#k(t/(k Pus/(kkes
2. Paur(+)"kes Ru#k(t/(k Pus/(kkes
ker3a sa#a Ke*a/a
1t-. 9999999..

/(
Jakarta
U.*. 999999.

1. Dasar. Pr"gra# Ker3a Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD
ta-u+ 28.
2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, u+tuk tert(b a/#(+(stras(
Ru#a- Sak(t D(k Pus/(kkes aka+ #e+ga/aka+ *e+(+3aua+ u'a+g ter-a/a*
Ikata+ Ker3a Sa#a 6a+g te'a- /(se*akat( sebe'u#+6a.
2. Ke*a/a *erusa-aa+ 6a+g #as(- berse/(a #e'akuka+ (kata+ ker3a
sa#a /e+ga+ Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD agar segera
#e#buat surat *er3a+3(a+ ker3asa#a :MOU; *a'(+g 'a#bat satu bu'a+
se3ak ta+gga' surat.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % >! % & % 24
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#(+taa+ 7a*eg
Te#busa+ $
2. Para Kaur%Kau+(t Ja3ara+ Ru#k(t/(k Pus/(kkes
Let+a+ K"'"+e' 7k# NRP 228
Para#e/(s D(tkesa/. Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat Per(+ta- Pa+g/a# Ja6a % Ja6akarta N"#"r S*r(+ %
821%&%24 ta+gga' 1> Me( 24 te+ta+g surat *er(+ta- .a'"+ Pega5a(
Neger( S(*(' A+gkata+ Darat.
#e'a+3utka+ *er#(+taa+ > "ra+g 7a*eg *ara#e/(s D(tkesa/ u+tuk /(
tugaska+ : BP ; /( Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD.

RUMKITDIK Jakarta, Maret 28
N"#"r $ B % % III % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#(+taa+ 7a*eg D.III
Ma6"r 7k# NRP 228
Te#busa+ $
Tek+(k =(g( D(tkesa/
:Ar(6u+( D(a- Ta+tr(, A.M/.; Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Sa'(+a+ Ke*utusa+ Kasa/ N"#"r Ke* %12,22%II%28 ta+gga'
18 Aebruar( 28 te+ta+g Pe+ga+gkata+ 7a'"+ Pega5a( Neger( S(*('.
#e'a+3utka+ *er#(+taa+ 1 "ra+g 7a*eg D.III Tek+(k =(g( D(tkesa/ :Ar(6u+(
D(a- Ta+tr(, A.M/.; u+tuk /( tugaska+ : BP ; /( Ru#k(t/(k Pus/(kkes K"/(k'at
TNI AD. De+ga+ *ert(#ba+ga+ sebaga( ber(kut $
a. Pera5at g(g( saat (+( -a+6a 1 "ra+g kare+a 6a+g 1 "ra+g
su/a- *e+s(u+.
b. 1a+g bersa+gkuta+ saat (+( a/a'a- te+aga sukare'a /(
Ru#k(t/(k Pus/(kkes.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % I& % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ b(#b(+ga+ Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
1t-. D(rektur Eksekut() K"#(s(
Akre/(tas( Ru#a- Sak(t
/(
Jakarta
1. Dasar.
a. Re+.a+a ker3a Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD TA. 28.
S*r(+ % > % III % 24, ta+gga' 2 Maret 24 te+ta+g T(# P"k3a
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ D(rektur berke+a+
#e+u+3uk *er5ak('a+ k"#(s( akre/(tas( ru#a- sak(t u+tuk #e+ga/aka+
b(#b(+ga+ akre/(tas( /( Ru#a- Sak(t D(k Pus/(kkes *a/a $
a. Har(, ta+gga' $ Rabu, 12 Me( 28
b. Puku' $ 4. CIB s./. se'esa(
.. Te#*at $ Rua+g Ra*at Ru#k(t/(k Pus/(kkes
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % & % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Pe#buata+ (kata+ ker3a sa#a :MOU;
Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
, Kat(# P"k3a Akre/(tas( Ru#k(t/(k Pus/(kkes
Pe'a6a+a+ kese-ata+ Ke*a/a
1t-. D(rektur PT. Su*er S(+ar
Aba/(

/(
Jakarta
U.*. Ke*a'a Bag(a+ Pers"+a'(a

1. Dasar. Pr"gra# ker3a Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI
AD ta-u+ 28.

2. Se-ubu+ga+ /e+ga+ /asar tersebut /( atas, u+tuk tert(b a/#(+(stras(
Ru#a- Sak(t D(k Pus/(kkes aka+ #e+ga/aka+ *e#buata+ (kata+ ker3a
sa#a /e+ga+ *erusa-aa+ 6a+g su/a- ter3a'(+.
2. Ke*a/a *erusa-aa+ 6a+g berse/(a #e'akuka+ (kata+ ker3a sa#a
/e+ga+ Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD agar segera
#e#buat *er3a+3(a+ ker3asa#a :MOU; *a'(+g 'a#bat satu bu'a+ se3ak
ta+gga' surat.
<. A*ab('a t(/ak a/a MOU /a'a# *e'a6a+a+ kese-ata+ a+tar Ru#a-
Sak(t D(k Pus/(kkes /e+ga+ *erusa-aa+ 6a+g Ba*ak % Ibu *(#*(+ #aka
*as(e+ aka+ /(ke+aka+ *e#ba6ara+ 'a+gsu+g.
>. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % & % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ surGe(%*e+('a(a+ Ke*a/a
Te#busa+ $
Let+a+ K"'"+e' 7k# NRP 228
1t-. D(rektur Eksekut() K"#(s(
Akre/(tas( Ru#a- Sak(t
/(
Jakarta
1. Dasar.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ D(rektur berke+a+
#e+u+3uk *er5ak('a+ k"#(s( akre/(tas( ru#a- sak(t u+tuk #e+ga/aka+
surGe(%*e+('a(a+ akre/(tas( /( Ru#a- Sak(t D(k Pus/(kkes *a/a -ar( Se'asa,
10 Ju+( 28.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % & % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ Duku+ga+
Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
, Kat(# P"k3a Akre/(tas( Ru#k(t/(k Pus/(kkes
Da+a /a+ A'kes. Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar $
a. Petu+3uk '(sa+ As'"g /a+ Caas'"g Pa+g'(#a TNI *a/a saat
ku+3u+ga+ /( Ru#k(t/(k Pus/(kkes *a/a ta+gga' 2! Me( 28.
b. Re+.a+a ker3a /a+ a+ggara+ Ru#k(t/(k Pus/(kkes K"/(k'at
TNI AD ta-u+ 28.
b. Pert(#ba+ga+ Karu#k(t/(k /a+ Sta) Ru#k(t/(k Pus/(kkes.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( /(a3uka+ A'kes
/a+ b(a6a *e+ge#ba+ga+ rua+g *era5ata+ /a+ I7U Ru#k(t/(k Pus/(kkes
sebaga( ber(kut $
a. A'at Kese-ata+
1; US= < D(#e+s( 9...999999999999. 1 U+(t
2; Pesa5at R"+tge+ % ? , Ra6 2 MA t(''(+g tab'e9 1 U+(t
2; M"+(t"r Pat(e+t 9..9...99999999999. > U+(t
<; I+)us("+ Pu#* 99999999999999... < U+(t
>; De)(br('at"r 9999999999999999. 1 U+(t
0; Pa+"ra#(. ? L Ra6 99999999999991 U+(t
!; Aut".'aG 99999999999999999.. 1 Set
4; Me3a O*eras( 999999999999999.. 1 Set
8; Su.t("+ Pu#* 999999999999999. 1 Set
1; La#*u O*eras( 99999999999999.. 1 Set
11; Mes(+ A+est-es( 99999999999999. 1 Set

12; S.rub Stat("+ 2 *ers"+ 99999999999.. 1 Set
12; &e+t('at"r 99999999999999999. 1 Set
1<; 7auter 99999999999999999991 Set
1>; D(ater#( Set 9999999999999999.1 Set
10; A'kes be/a- "rt-"*e/( 99999999999.. 1 Set
b. Pe#ba+gu+a+ rua+g *era5ata+ /a+ rua+g I7U
1; Luas Rua+g *era5ata+ K'as I
, Pa+3a+g 14,0 #M D Lebar18 #M H 2>2.< #M
2; Luas Rua+g *era5ata+ &IP : < Ka#ar ;
, Pa+3a+g 4 #M D Lebar 18 #M H 1>2 #M
2; Luas Rua+g I7U H 200
, Pa+3a+g 1< #M D Lebar 18 #M H 200 #M
T"ta' !!1.< #M
2. Se'a+3ut+6a #"-"+ K"#a+/a+ /a*at #e+(+/ak 'a+3ut( /e+ga+
te#busa+ surat ke As'"g Pa+g'(#a TNI.
<. De#(k(a+ u+tuk #e+3a/(ka+ *er(ksa /a+ *e+6e'esa(a+ 'eb(- 'a+3ut.
N"#"r $ B % % &II % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Pe#(+3a#a+ A'kes Ke*a/a

1t-. Ke*a'a Suku D(+as
Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
2. Kaur3a+gu##e/ Ru#k(t/(k Pus/(kkes
/(
Jakarta
1. Dasar.
2. Se-ubu+ga+ /e+ga+ but(r satu /( atas, /(a3uka+ *e#(+3a#a+ a'at
kese-ata+ k-usus : DeG(br('at("+ ; u+tuk #e+/uku+g *e'aksa+aa+
*e+('a(a+ T(# Akre/(tas( 6a+g aka+ /('aksa+aka+ *a/a -ar( Se+(+ s./.
Rabu ta+gga' 22 Ju+( 28 s./. 2< Ju+( 28.

N"#"r $ B % % &II % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Pe+ge#ba'(a+ A'kes Ke*a/a

1t-. Ka/"bekkes Puskes TNI
Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
/(
Jakarta
1. Dasar. Surat Karu#k(t/(k Pus/(kkes K"/(k'at TNI AD N"#"r B %
>0 % &I % 28, ta+gga' 1! Ju+( 28 te+ta+g Pe#(+3a#a+ A'kes.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( /(ke#ba'(ka+
a'at kese-ata+ k-usus : DeG(br('at("+ ; ke*a/a Ka/"bekkes Puskes TNI.
2. De#(k(a+ u+tuk #e+3a/(ka+ *er(ksa /a+ /(u.a*ka+ ter(#akas(-.

Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
D(k(r(# $
Ta+gga' $
TANDA TERIMA PEN=EMBALIAN BARAN=
Ma.a# *e+ge#ba'(a+ $ 999999999999999999999999999........
999999999999999999999999999........
999999999999999999999999999........
N"#"r%K"/e $ 999999999999999999999999999........
999999999999999999999999999........
999999999999999999999999999........
D(k(r(# Ke*a/a $ 999999999999999999999999999........
999999999999999999999999999........
999999999999999999999999999........
N"#"r $ B % % &II % 28
K'as()(kas( $ B(asa
Per(-a' $ Data Ru#a- Sak(t
PENERIMA
Na#a $ 999999999999999
Pa+gkat $ 999999999999999
Jabata+ $ 999999999999999
Ta+gga' $ 999999999999999
Puku' $ 999999999999999
Ta+/a ta+ga+ $ 999999999999999
D(k Pus/(kkes Ke*a/a
1t-. Drs. S6ar()u/(+ UH,MM
Casek3e+ ARS TNI B POLRI
/(
Jakarta
1. Dasar. Surat Casek3e+ Ass"s(as( Ru#a- Sak(t TNI /a+ POLRI
ta+gga' 2 Ju'( 28 te+ta+g *e+g(s(a+ )"r#u'(r /ata Ru#a- Sak(t.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(k(r(#ka+ /ata Ru#a-
Sak(t D(k Pus/(kkes /a+ satu 'e#bar )"t" Ru#a- Sak(t ta#*ak /e*a+
:ter'a#*(r;.
2. De#(k(a+ u+tuk /(#ak'u#(.

DATA RUMAH SAKIT DIK PUSDIKKES
Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
2. Kaur3a+gu##e/ Ru#k(t/(k Pus/(kkes.
1 NAMA RUMKIT RUMKIT PENDIDIKAN PUSDIKKES KODIKLAT TNI AD
2 TIN=KAT TK. III
2 ALAMAT JL. RA1A BO=OR KRAMAT JATI JAKARTA TIMUR
< KODE POS 12>1
> NOMOR TELPON 21.4822>4
0 NOMOR AA?IMILE 21.4442!<
! ALAMAT Cebs(te 555.*us/(kkes.."#
4 A'a#at E#a(' (+)"N*us/(kkes.."#
8 NAMA KARUMKIT /r. ICAN TURNIACAN, MARS
1 PAN=KAT Letk"' 7k#
11 NO HAND PHONE 412884<8
12 E#a('
12 JUMLAH T.TIDUR a. &&IP $9., b.&IP 9 .. K'as.1 $ 1 /. K'as.2 $ 2
e. K'as.2 $ 20 /. I7U 99 e. La(+,'a(+ 9..
1< PRODUK UN==ULAN ,
1> La(+,'a(+ ,
PUSAT PENDIDIKAN KESEHATAN Jakarta, Ju'( 28
N"#"r $ B % % &II % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ (3(+ A*"tek
Ru#k(t/(k Pus/(kkes. Ke*a/a
Kese-ata+ Jakarta T(#ur
/(
Jakarta
1. Dasar. Re+.a+a ker3a Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD
TA. 28.

2. Se-ubu+ga+ /e+ga+ /asar /( atas, u+tuk tert(b a/#(+(stras( Ru#a-
Sak(t D(k Pus/(kkes #"-"+ ke*a/a Ke*a'a Suku D(+as Kese-ata+ Jakarta
T(#ur #e#ber(ka+ surat (3(+ A*"tek Ru#a- Sak(t D(k Pus/(kkes K"/(k'at
TNI AD /e+ga+ *e+a+ggu+g Ja5ab Ma6"r 7k# Drs. A#b(6", A*t, /e+ga+
*ers6arata+ a/#(+(stras( ter'a#*(r.
2. De#(k(a+ #"-"+ /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta, Se*te#ber 28
N"#"r $ B % % I? % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Persetu3ua+ ker3asa#a Ke*a/a
Karu#k(t/(k
Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
2. Ka A*"tek Ru#k(t/(k Pus/(kkes
1t-. Ke*a'a Puskes#as Ke.a#ata+
Kra#at Jat( Jakarta T(#ur
/(
Jakarta
1. Dasar. Surat Ke*a'a Puskes#as Ke.a#ata+ Kra#at Jat( Jakarta
T(#ur N"#"r <!!< %!2.>>< ta+gga' 1< Agustus 28 te+ta+g
*er#"-"+a+ ker3asa#a.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( /(sa#*a(ka+
ba-5a Ru#a- Sak(t D(k Pus/(kkes #e+er(#a ta5ara+ ker3a sa#a u+tuk
*e#ba.aa+ )('# ra/("'"g( Puskes#as Ke.a#ata+ Kra#at Jat( Jakarta
T(#ur /a+ -a',-a' 6a+g berka(ta+ /e+ga+ a/#(+(stras( aka+ /(t(+/ak 'a+3ut(
/a'a# be+tuk MOU.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % I? % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Pe+g(r(#a+ /ata Ru#a- Sak(t
Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
2. Ka Ra/("'"g( Ru#k(t/(k Pus/(kkes
1t-. Ketua U#u# PERSI
/(
Jakarta
1. Dasar. Surat Ketua U#u# Per-(#*u+a+ Ru#a- Sak(t Se'uru-
I+/"+es(a :PERSI; N"#"r ><1 %17%PP.PERSI%&III%28 ta+gga' < Agustus
28, te+ta+g /ata Ru#a- Sak(t.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( /(k(r(# )"t" /a+
/ata Ru#a- Sak(t D(k Pus/(kkes u+tuk /(terb(tka+ /( buku D(rekt"r( PERSI.
:ter'a#*(r;
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % ? % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Let+a+ K"'"+e' 7k# NRP 228
Te#busa+ $
Per(-a' $ Per#"-"+a+ *e#be'(a+
BBM s"'ar Ke*a/a
1t-. Ke*a'a P"# Be+s(+
/(
Jakarta
1. Dasar. Kebutu-a+ ke'a+.ara+ Ru#a- Sak(t D(k Pus/(kkes.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, Ru#a- Sak(t D(k Pus/(kkes
(+g(+ #e#be'( BBM s"'ar #e#aka( /r(ge+ u+tuk ke*er'ua+ *e+g(s(a+
ge+set.
2. De#(k(a+ u+tuk ke'a+.ara+ /a+ ker3asa#a+6a /(u.a*ka+ ter(#a
kas(-.
RUMAH SAKIT PENDIDIKAN Jakarta, Dese#ber 28
N"#"r $ B % % ?II % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Pe+/(/(ka+ S(ste# =a+/a Ke*a/a
Jakarta Okt"ber 28
Kaur3a+gu##e/
Ba#ba+g Suk"5(6"+"
Ka*te+ 7k# NRP ><24
1t-. Ke*a'a Sek"'a- SMK
Hara*a+ Ba+gsa
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- SMK Hara*a+ Ba+gsa N"#"r 28< %
SMK HB % &II % 28 ta+gga' 1 Se*te#ber 28, te+ta+g Per#"-"+a+
Pe+/(/(ka+ S(ste# =a+/a.
Sak(t D(k Pus/(kkes t(/ak keberata+ u+tuk #e'aksa+aka+ Pe+/(/(ka+
S(ste# =a+/a bag( s(s5a ke'as ?II 3urusa+ )ar#as(, b(/a+g kea-'(a+
)ar#as( kese-ata+ SMK Hara*a+ Ba+gsa /( Ru#a- Sak(t D(k Pus/(kkes
K"/(k'at TNI AD 6a+g aka+ /('aksa+aka+ ta+gga' 21 Dese#ber 28 s./. 2
Ja+uar( 21.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % ? % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
I3(+ Prakt(k Ker3a La*a+ga+ Ke*a/a
1t-. Ke*a'a Sek"'a- SMAK
Tu+as Hara*a+
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- Me+e+ga- A+a'(s Kese-ata+
Tu+as Hara*a+ N"#"r 2.% SMAK TH % ? % 28 ta+gga' 18 Okt"ber
28, te+ta+g Per#"-"+a+ (3(+ Prakt(k Ker3a La*a+ga+.
Sak(t D(k Pus/(kkes t(/ak keberata+ u+tuk #e'aksa+aka+ Prakt(k Ker3a
La*a+ga+ : PKL ; bag( s(s5a SMAK Tu+as Hara*a+ /( Ru#a- Sak(t D(k
Pus/(kkes K"/(k'at TNI AD 6a+g aka+ /('aksaka+ ta+gga' 1 s./ 21
Dese#ber 28.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % ?I % 28
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
2. Ka Lab"rat"r(u# Ru#k(t/(k Pus/(kkes
Prakt(k Ker3a La*a+ga+ Ke*a/a
1t-. Ke*a'a Sek"'a-
SMA IKIAA
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- Me+e+ga- Aar#as( IKIAA N"#"r
12.% PKL%SMA.I % ? % 28 ta+gga' 2! Okt"ber 28, te+ta+g Per#"-"+a+
Prakt(k Ker3a La*a+ga+.bag( S(s5a ke'as III.
La*a+ga+ : PKL ; bag( s(s5a SMA IKIAA /( Ru#a- Sak(t D(k Pus/(kkes
K"/(k'at TNI AD 6a+g aka+ /('aksaka+ *a/a ta+gga' 24 Ju+( s./. 1 Ju'(
21 /a+ *a/a #(+ggu III /a+ I& bu'a+ Dese#ber 21.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % ?I % 28
K'as()(kas( $ B(asa
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
Per(-a' $ Pe+g(s(a+ /ata Ke*a/a
1t-. K"#a+/a+ Pa+gka'a+ TNI AU
Ha'(# Per/a+akusu#a
/(
Jakarta
1. Dasar. Surat K"#a+/a+ Pa+gka'a+ TNI AU Ha'(# Per/a+akusu#a
N"#"r B%1>1,11%1%1%Ha'(#%28 ta+gga' 1! N"Ge#ber 28, te+ta+g
*er#"-"+a+ Data.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(k(r(#ka+ /ata
sara+a /a+ *rasara+a *"te+s( *erta-a+a+ *e+/uku+g ba+tua+ a/#(+(stras(
kese-ata+ /( Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD ter'a#*(r.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % ?I % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
D(tkesa/
/(
Jakarta
1. Dasar .
'a*a+ga+ : PKL ;.

2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % ?II % 2!
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Ma6"r 7k# NRP 228
Te#busa+ $
D(tkesa/
/(
Jakarta
1. Dasar .
'a*a+ga+ : PKL ;.

2. De#(k(a+ u+tuk /(#ak'u#(.

RUMKITDIK Jakarta, Ja+uar( 21
N"#"r $ B % % I % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ I+/eks Bekkes. Ke*a/a
Ma6"r 7k# NRP 228
Te#busa+ $
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat D(rkesa/ N"#"r B % 1<2 % I % 24 ta+gga' 24 Ja+uar(
b(a6a (+/eks Bekkes ra5at 3a'a+ *er ku+3u+ga+ /a+ (+/eks ra5at #"+/"k
*er -ar( ra5at, : ter'a#*(r ;.

N"#"r $ B % % I % 21
K'as()(kas( $ B(asa
Ma6"r 7k# NRP 228
Te#busa+ $
, D(rkesa/ u.* Kasub/(tb(+6a+kes D(tkesa/.
1t-. D(rkesa/
/(
Jakarta
1. Dasar. Surat D(rkesa/ N"#"r B % 22< % ?II % 21 ta+gga'
22 Dese#ber 28, te+ta+g *er#(+taa+ I+/eks Bekkes.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /('a*"rka+ /ata b(a6a
(+/eks Bekkes ra5at 3a'a+ *er ku+3u+ga+ /e+ga+ (+/eks ra5at #"+/"k *er
-ar( ra5at, ter'a#*(r.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % I % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Karu#k(t/(k
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
1. D(rkesa/
Per(-a' $ Pe+g(r(#a+ /ata u+tuk
keg(ata+ 5asr(k Ke*a/a
1t-. Ir3e+ De*-a+
/(
Jakarta
U.*. Sekretar(s Ir3e+ De*-a+.
1. Dasar. Surat Sekretar(s It3e+ De*-a+ N"#"r
B%128%>%0%2%2%It3e+ ta+gga' 1< Ja+uar( 28, te+ta+g *er#(+taa+ /ata
u+tuk keg(ata+ 5asr(k /a+ *e+g(r(#a+ /a)tar *erta+6aa+.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(k(r(#ka+ /ata u+tuk
keg(ata+ 5asr(k, ter'a#*(r.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % II % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Karu#k(t/(k
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
1. Ir3e+ De*-a+
2. Kas(#(+ Pus/(kkes K"/(k'at TNI AD
Per(-a' $ Pe+g(r(#a+ +a#a /a+
+"#"r reke+(+g ba+k Ke*a/a
1t-. Ke*a'a D(+as Kese-ata+
Pr"G(+s( DKI Jakarta
/(
Jakarta
U.*. Sub Bag(a+ Keua+ga+.
1. Dasar. Surat Ke*a'a D(+as Kese-ata+ Pr"G(+s( Daera- K-usus
Ibuk"ta Jakarta N"#"r !4!%!4 ta+gga' 4 Aebruar( 21, te+ta+g tra+s)er
k'a(# tag(-a+ :=ak(+; *a/a RS%RSUD /a+ Puskes#as Ke.a#ata+.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(k(r(#ka+ +a#a /a+
+"#"r reke+(+g Ru#a- Sak(t D(k Pus/(kkes sebaga( ber(kut $
a. Na#a $ Be+/a-ara5a+ RS Pus/(kkes
b. Ba+k $ BNI 7ab. Kra#at Jat(, Jakarta T(#ur
b. N". Reke+(+g $ 122.448.01<
2. De#(k(a+ ka#( sa#*a(ka+, atas *er-at(a+ /a+ ker3asa#a+6a
/(u.a*ka+ ter(#a kas(-.

PUSAT PENDIDIKAN KESEHATAN Jakarta, Aebruar( 21
N"#"r $ B % % I % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,

/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
1. Kab(+a6a+kes#asu# Ru#k(t/(k Pus/(kkes
2. Be+/a-ara 1a+kes#asu# Ru#k(t/(k Pus/(kkes
Per(-a' $ Pe+g(r(#a+ /ata u+tuk
keg(ata+ 5asr(k Ke*a/a
1t-. D(rbeka+ga/
/(
Jakarta
U.*. Sekretar(s D(tbeka+ga/.
1. Dasar. Surat D(rbeka+ga/ N"#"r B % 221 % II % 21 ta+gga' 2
Aebruar( 28, te+ta+g *er#"-"+a+ (3(+ *era5ata+.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, *a/a (+t(+6a Ru#k(t/(k Pus/(kkes
K"/(k'at TNI AD t(/ak keberata+ u+tuk *era5ata+.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % II % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Karu#k(t/(k
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
1. D(rbeka+ga/
Per(-a' $ Per#"-"+a+ *e+ga#b('a+ A'kes Ke*a/a
1t-. Ka/"bekkes Puskes
TNI
/(
Jakarta
1. Dasar.
a. Surat Da+*us/(kkes K"/(k'at TNI AD N"#"r B % >22 % &II %
28 ta+gga' 1> Ju'( 28 te+ta+g *er#"-"+a+ /uku+ga+ A'kes.
b. Kebutu-a+ A'at kese-ata+ Ru#a- Sak(t D(k Pus/(kkes
K"/(k'at TNI AD.
2. Se-ubu+ga+ /asar /( atas, sa#b(' #e+u+ggu *e+6e'esa(a+
a/#(+(stras( bara+g,bara+g tersebut /a*at /(a#b(' /a+ /(*ergu+aka+ u+tuk
#e+/uku+g "*eras("+a' Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD.
2. De#(k(a+ #"-"+ /(#ak'u#(.

DAATAR ALKES 1AN= AKAN DIPINJAM RUMKITDIK PUSDIKKES KODIKLAT TNI AD
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
La#*(ra+ Surat Karu#k(t/(k Pus/(kkes
N"#"r B % % II % 21
Ta+gga' Ju'( 21
NO NAMA BARAN= JUMLAH SATUAN KETERAN=AN
1 2 2 < >
1
2
2
<
>
0
!
4
8
1
11
12
12
1<
1>
10
1!
Tabu+g Oks(ge+
Tr"''6 Oks(ge+
Regu'at"r
Ba3u O*eras(
L(+e+
S*(.e Mask
Or" P-ar6+gea' A(r5a6
S'a+g &e+t('at"r
Bask"# P'ast(k
Ne.k 7"''er
Tabu+g ='ass :Lab;
La#*u O*s P"'(
E'ast(. &erba+
DeG(b'(at"r
Ster('(sat"r
Aut".'aGe
Tabu+g Pe#a/a#
>
1
<
0
1
1
1>
2
1
1
1
1
1
1
1
1
>
Bua-
Bua- Set
Le#bar
D"s
D"s
Bua-
Bua-
Bua-
Bua-
D"s
Set
Set
B"D
Set
Set
Set
Bua-
N"#"r $ B % % III % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ te+ta+g *e+ga3ua+ ker3asa#a
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Praktek Ker3a La*a+ga+ : PKL ; Ke*a/a
1t-. Ke*a'a Sek"'a- SMK
Aar#as( Tu+as Ba+gsa
/(
Jakarta
1. Dasar . Surat Ke*a'a Sek"'a- SMK Aar#as( Tu+as Ba+gsa
N"#"r B % 2 % TB % II % 21 ta+gga' 2 Aebruar( 21, te+ta+g
*e+ga3ua+ ker3asa#a *raktek ker3a 'a*a+ga+.
2. Se-ubu+ga+ /asar /( atas, *a/a (+t(+6a Ru#k(t/(k Pus/(kkes K"/(k'at
TNI AD t(/ak keberata+ u+tuk #e'aksa+aka+ Praktek Ker3a La*a+ga+
: PKL ; ke'as ?II, u+tuk *er("/e 1< Ju+( s./. 1 Ju'( 21 /( Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD.
2. De#(k(a+ u+tuk /(#ak'u#(.

PUSAT PENDIDIKAN KESEHATAN Jakarta, Maret 21
N"#"r $ B % % III % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
1. Para Kaur%Kau+(t%Karu Ru#k(t/(k Pus/(kkes.
2. Ka A*"tek Ru#k(t/(k Pus/(kkes.
Per(-a' $ Ja5aba+ te#ua+ T(# Casr(k It3e+
Ke#-a+ ter-a/a* *e+ge'"'aa+
Da+a 1a+#asu# Ru#k(t/(k
Pus/(kkes TA.28. Ke*a/a
1t-. Ir3e+ Ke#-a+ RI
/(
Jakarta
1. Dasar $
a. Surat Per(+ta- Ir3e+ Ke#-a+ N"#"r S*r(+ ! % I % 21
ta+gga' 4 Ja+uar( 21, te+ta+g *e+ga5asa+ /a+ *e#er(ksaa+
ter-a/a* *e'aksa+aa+ *e+ge'"'aa+ /a+a -as(' 1a+#asu# Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD TA. 28.
b. Te#ua+ T(# Casr(k It3e+ Ke#-a+ ter-a/a* *e+ge'"'aa+ /a+a
1a+#asu# Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD ta+gga' 4 s./. 18
Aebruar( 21.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(k(r(#ka+ 3a5aba+
Te#ua+ T(# Casr(k It3e+ Ke#-a+ ter-a/a* *e+ge'"'aa+ /a+a 1a+#asu#
Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD TA. 28, ter'a#*(r.
2. De#(k(a+ #"-"+ /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta A*r(' 21
N"#"r $ B % % I& % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Karu#k(t/(k
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
1t-. Ke*a'a Sek"'a-
SMA IKIAA
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- Me+e+ga- Aar#as( IKIAA N"#"r
12 % PKL % SMKA.I % ? % 28 ta+gga' 2! Okt"ber 28, te+ta+g
Per#"-"+a+ Prakt(k Ker3a La*a+ga+ bag( S(s5a ke'as III.
La*a+ga+ : PKL ; bag( s(s5a SMA IKIAA /( Ru#a- Sak(t D(k Pus/(kkes
K"/(k'at TNI AD 6a+g aka+ /('aksa+aka+ *a/a ter#(+ I se'a#a /ua #(+ggu
/ar( ta+gga' 24 Ju+( s./. 1 Ju'( 21 /a+ ter#(+ II *a/a #(+ggu III /a+ I&
bu'a+ Dese#ber 21.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % I& % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
Per(-a' $ Pe+ga3ua+ *e+gesa-a+
a'at .a+gg(- US= Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar. Surat Te'egra# D(rektur Kese-ata+ A+gkata+ Darat
N"#"r ST % 02 % 21 ta+gga' 12 A*r(' 21, te+ta+g P"'a keua+ga+
*e+er(#aa+ Negara buka+ *a3ak 1a+kes#asu# RS /( L(+gku+ga+ De*-a+
RI /a+ TNI.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(a3uka+ *e+gesa-a+
a'at .a+gg(- Ru#a- Sak(t D(k Pus/(kkes beru*a US= /ua /(#e+s(, #erek
Me/(s"+, ser( <>
2. De#(k(a+ #"-"+ /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta A*r(' 21
N"#"r $ B % % I& % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ *e+ggu+aa+ /a+a

/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
1. D(rkesa/
<. Be+/a-ara 1a+kes#asu# Ru#k(t/(k Pus/(kkes
Har a'at .a+gg(- TA.28 Ke*a/a
1t-. Da+*us/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Dasar.
a. Juk'ak Me+-a+ N"#"r Juk'ak % 1 % &II % 28 ta+gga' 1 Ju'(
28, te+ta+g *"'a *e+ge'"'aa+ keua+ga+ *e+er(#aa+ Negara buka+
*a3ak *e'a6a+a+ #as6arakat u#u# Ru#a- Sak(t /( '(+gku+ga+
De*-a+ /a+ TNI.
b. Juk'ak Kasa/ N"#"r Juk'ak % < % I? % 22 ta+ga' 1
Se*te#ber 22 te+ta+g *e+ge'"'aa+ /a+a Ru#a- Sak(t -as('
*e'a6a+a+ kese-ata+ #as6arakat u#u# /( '(+gku+ga+ TNI A+gkata+
Darat.

.. Ra*at Sta) Ru#k(t/(k Pus/(kkes ta+ga' 1 Maret 21, te+ta+g
kebutu-a+ a'at kese-ata+ rua+g *era5ata+ be/a-.
#e+6etu3u( *e+ggu+aa+ /a+a Har a'at .a+gg(- TA. 28 se3u#'a- R*
1!.>.,, u+tuk /(gu+aka+ *e#be'(a+ /ua set A'at Kese-ata+ se-arga
R* 10..,, :terb('a+g $ e+a# be'as 3uta ru*(a-; /ar( 12 :t(ga be'as; set
kebutu-a+ A'kes 6a+g /(re+.a+aka+.
2. De#(k(a+ #"-"+ /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta Me( 21
N"#"r $ B % % & % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,

/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
2. Be+/a-ara 1a+kes#asu# Ru#k(t/(k Pus/(kkes
Per(-a' $ Peruba-a+ ta+/a ta+ga+
7ek =(r" Ba+k BRI Ke*a/a
1t-. Ke*a'a 7aba+g PT. Ba+k BRI
:Perser"; Tbk Kra#at Jat(
/(
Jakarta
1. Dasar. Surat Per(+ta- Da+*us/(kkes N"#"r S*r(+ 84 % & % 21
ta+gga' 0 Me( 21, te+ta+g *e+ugasa+ BP Be+/a-ara5a+ Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD A.+. Ka*te+ 7ku Sa'(# NRP 0281<< Kaur 7"k'(t
Bag Da'ku Ku*us II D(tkua/.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(ber(ta-uka+ ke*a/a
Ke*a'a 7aba+g PT. Ba+k Rak6at I+/"+es(a :Perser"; Tbk Kra#at Jat(
ba-5a ta+/a ta+ga+ .ek =(r" 6a+g se#u'a /(ta+/a ta+ga+( "'e- Ka*te+ 7ku
:K; Aa3ar Ar(6a+( NRP 281140<!2!2 /(ga+t( "'e- Ka*te+ 7ku Sa'(# NRP
0281<< ter-(tu+g #u'a( ta+gga' 1! Me( 21.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % & % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
1t-. Ke*a'a Sek"'a-
SMKA AG(.e++a 7('eu+gs(
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- Me+e+ga- Ke3urua+ Aar#as(
AG(.e++a 7('eu+gs( N"#"r 28 % SP % SMKA,A7 % II % 21 ta+gga' 1
Aebruar( 21, te+ta+g Per#"-"+a+ Prakt(k Ker3a La*a+ga+ bag( S(s5a
ke'as III.
La*a+ga+ : PKL ; bag( s(s5a SMKA AG(.e++a 7('eu+gs( ta-u+ *e'a3ara+
21%211 /( Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD 6a+g aka+
/('aksa+aka+ *a/a ta+gga' 1 Ju+( s./. 20 Ju+( 21.
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % & % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
1t-. Ke*a'a Sek"'a-
SMKAK Tu+as Hara*a+
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- Me+e+ga- Ke3urua+ A+a'(s
Kese-ata+ Tu+as Hara*a+ N"#"r 80.1 % SMK A+kes TH % & % 21
ta+gga' 2 Me( 21, te+ta+g Per#"-"+a+ Prakt(k Ker3a La*a+ga+ bag(
S(s5a ke'as III.
La*a+ga+ : PKL ; bag( s(s5a SMKAK Tu+as Hara*a+ /( Ru#a- Sak(t D(k
Pus/(kkes K"/(k'at TNI AD 6a+g aka+ /('aksa+aka+ *a/a Ta+gga' > Ju'(
s./. ! Agustus 21
2. De#(k(a+ u+tuk /(#ak'u#(.

N"#"r $ B % % & % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Persetu3ua+ Prakt(k
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
Ker3a La*a+ga+ Ke*a/a
1t-. Ke*a'a Sek"'a-
SMKA AG(.e++a 7('eu+gs(
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- Me+e+ga- Ke3urua+ Aar#as(
AG(.e++a 7('eu+gs( N"#"r 28 % SP % SMKA,A7 % II % 21 ta+gga' 1
Aebruar( 21, te+ta+g Per#"-"+a+ Praker(+ % Prakt(k Ker3a La*a+ga+
bag( S(s5a%S(s5( ke'as III A.+. Astr( Lut)(a+a S /kk 2 "ra+g.
2. Se-ubu+ga+ /e+ga+ but(r satu /( atas, /(sa#*a(ka+ ba-5a *a/a
*r(+s(*+6a Ke*a'a Ru#a- Sak(t D(k Pus/(kkes #e+g(@(+ka+ *e+ggu+aa+
Aas('(tas Ru#a- Sak(t D(k Pus/(kkes u+tuk *e'aksa+aa+ Praker(+ % Prakt(k
Ker3a La*a+ga+ : PKL ; bag( s(s5a%s(s5( ke'as III Sek"'a- Me+ega-
Ke3urua+ Aar#as( AG(.e++a 7('eu+gs( ta-u+ *e'a3ara+ 21%211 /( A*"tek
Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD 6a+g aka+ /('aksa+aka+ *a/a
ta+gga' 1 Ju+( s./. 20 Ju+( 21.
2. De#(k(a+ u+tuk /(#ak'u#(.

/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
2. Kabe+/a-ara Ru#k(t/(k Pus/(kkes
<. Ka A*"tek Ru#k(t/(k Pus/(kkes
N"#"r $ B % % ? % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Persetu3ua+ Prakt(k Ker3a
I+/ustr( :Praker(+ ; Ke*a/a
1t-. Ke*a'a Sek"'a-
SMKAK 7agar Bu/a6a
/(
Jakarta
1. Dasar. Surat Ke*a'a Sek"'a- SMK A+a'(s Kese-ata+ 7agar
Bu/a6a N"#"r 228 % SMK AK7B%Praker(+% &III % 21 ta+gga' 2 Agustus
21, te+ta+g Per#"-"+a+ (3(+ Prakt(k Ker3a I+/ustr( :Praker(+; SMK A+kes
7agar Bu/a6a TA. 21%211.
2. Se-ubu+ga+ /e+ga+ but(r satu /( atas, /(sa#*a(ka+ ba-5a *a/a
*r(+s(*+6a Ke*a'a Ru#a- Sak(t D(k Pus/(kkes #e+g(@(+ka+ *e+ggu+aa+
Aas('(tas Ru#a- Sak(t D(k Pus/(kkes u+tuk *e'aksa+aa+ Prakt(k Ker3a
I+/ustr( :Praker(+; SMK A+kes 7agar Bu/a6a /( Lab"rat"r(u# Ru#a-
Sak(t D(k Pus/(kkes K"/(k'at TNI AD 6a+g aka+ /('aksa+aka+ ta+gga' 14
Okt"ber s./. 12 N"*e#ber 21.
2. De#(k(a+ u+tuk /(#ak'u#(.

PUSAT PENDIDIKAN KESEHATAN Jakarta, Ju+( 21
N"#"r $ B % % &I % 21
K'as()(kas( $ B(asa
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
Te#busa+ $
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ te#ua+ T(# Casr(k
I+s*ekt"rat K"/(k'at TNI AD TA. 21 Ke*a/a
1t-. I+s*ekt"rat
K"/(k'at TNI AD
/(
Jakarta
1. Dasar $
a. Surat Per(+ta- Ir3e+ Ke#-a+ N"#"r S*r(+ ! % I % 21
ta+gga' 4 Ja+uar( 21, te+ta+g *e+ga5asa+ /a+ *e#er(ksaa+
ter-a/a* *e'aksa+aa+ *e+ge'"'aa+ /a+a -as(' 1a+#asu# Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD TA. 28.
b. Te#ua+ T(# Casr(k It3e+ Ke#-a+ ter-a/a* *e+ge'"'aa+ /a+a
1a+#asu# Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD ta+gga' 4 s./. 18
Aebruar( 21.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(k(r(#ka+ 3a5aba+
Te#ua+ T(# Casr(k It3e+ Ke#-a+ ter-a/a* *e+ge'"'aa+ /a+a 1a+#asu#
Ru#k(t/(k Pus/(kkes K"/(k'at TNI AD TA. 28, ter'a#*(r.
2. De#(k(a+ #"-"+ /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta Ju+( 21
N"#"r $ B % % &I % 21
K'as()(kas( $ B(asa
Karu#k(t/(k
/r. Aau3( Ar(e)
Ma6"r 7k# NRP 22><2
Te#busa+ $
La#*(ra+ $ ,
Per(-a' $ D(s*e+sas( *e#be'(a+
Ba-a+ berba-a6a Ke*a/a
1t-. Ke*a'a D(+as K"*eras(,
Usa-a M(kr" Ke.(' /a+ Me+e+ga-
/a+ Per/aga+ga+
/(
Jakarta
De+ga+ -"r#at,
Se-ub
2. De#(k(a+ u+tuk /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta Ju+( 21
N"#"r $ B % % &I % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
Te#busa+ $
<. Ka Lab"rat"r(u# Ru#k(t/(k Pus/(kkes
Per(-a' $ D(s*e+sas( *e#be'(a+
ba-a+ berba-a6a Ke*a/a
1t-. Ke*a'a D(+as K"*eras(,
Usa-a M(kr" Ke.(' /a+ Me+e+ga-
/a+ Per/aga+ga+
/(
Jakarta
1. Dasar. Kebutu-a+ ba-a+ berba-a6a u+tuk ster('(sas( Ka#ar
O*eras( /a+ a'at kese-ata+ /( Ru#a- Sak(t D(k Pus/(kkes.
2. Se-ubu+ga+ /e+ga+ *eratura+ Me+ter( Per/aga+ga+ Re*ub'(k
I+/"+es(a te+ta+g *e+/(str(bus(a+ >< 3e+(s Ba-a+ Berba-a6a /a+ ke-arusa+
ak-(r #e#be'( /ar( *e+ge.er ter/a)tar, bersa#a (+( Ru#a- Sak(t D(k
Pus/(kkes sebaga( *e+ggu+a ak-(r /ar( ba-a+ berba-a6a, A"r#a'(+, #"-"+
/(s*e+sas( u+tuk #e#be'( 'a+gsu+g ke PT BRATA7O sebaga( D(str(but"r
ter/a)tar Ba-a+ Berba-a6a, u+tuk /(gu+aka+ #e#e+u-( kebutu-a+
ster('(sas( Ka#ar O*eras( /a+ A'at Kese-ata+.
2. De#(k(a+ surat *er#"-"+a+ (+( ka#( a3uka+ u+tuk /a*at /(setu3u(,
atas *er-at(a+ /a+ ker3asa#a ka#( u.a*ka+ ter(#a kas(-.

RUMAH SAKIT PENDIDIKAN Jakarta Ju'( 21
N"#"r $ B % % &II % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
Te#busa+ $
2. Kau+(t Be/a- B A+est-es( Ru#k(t/(k Pus/(kkes
<. Kabe+/a-ara Ru#k(t/(k Pus/(kkes
Per(-a' $ Per#"-"+a+ *e#buata+ Surat
I3(+ Ker3a As(ste+ A*"teker Ke*a/a
1t-. Ke*a'a Suku D(+as Kese-ata+
Jakarta T(#ur
/(
Jakarta
1. Dasar. Ke*utusa+ Me+ter( Kese-ata+ Re*ub'(k I+/"+es(a N"#"r
1M.2.<.2.2.<>2> ta+ga' 14 Se*te#ber 20, te+ta+g Pe#ber(a+ I@(+
Pe+6e'e+ggaraa+ Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, #"-"+ /(buatka+ Surat I3(+
Ker3a As(ste+ A*"teker I+sta'as( Aar#as( Ru#a- Sak(t D(k Pus/(kkes
K"/(k'at TNI AD a.+. PNS Ar(+( Laks#(5at( Pe+ata Tk.I III%/ NIP
21<>224 /kk 0 "ra+g, /ata ter'a#*(r.


DAATAR NAMA AN==OTA INSTALASI AARMASI
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
N"#"r B % % &II % 21
Ta+gga' Ju'( 21
RUMAH SAKIT DIK PUSDIKKES
N NAMA PAN=KAT
% =OL
NRP JABATAN
1 2 2 < >
1.
2.
2.
<.
>.
0.
!.
Ar(+( Laks#(5at(
Aau@(a-
H(/a6atu' =
Para#(t-a Ar(#urt(
Est( Pr(asta+t(
M"-. Agu+g A+5ar A@-ar(
Must(ka+/ar(
PNS % III./
PNS % II./
PHL
PHL
PHL
PHL
PHL
21<>224
222412>
,
,
,
,
,
Ka I+sta'as( Aar#as(
A+gg"ta I+sta'as( Aar#as(

N"#"r $ B % % &II % 21
K'as()(kas( $ B(asa
La#*(ra+ $ Satu Ekse#*'ar
Per(-a' $ Re+.a+a Keg(ata+ *e+gas*a'a+ Ke*a/a
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
1t-. 999999999.

/(
Te#*at
1. Dasar.
a. Pr"gra# Ker3a Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD
ta-u+ 21, te+ta+g *e#e'(-araa+ sara+a /a+ *rasara+a.
b. Per(+ta- L(sa+ Da+*us/(kkes K"/(k'at TNI AD ta+gga' 20 Ju'(
21 te+ta+g *e+gas*a'a+ 3a'a+ sek(tar 'a*a+ga+ b"'a Ru#a- Sak(t
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, #"-"+ /uku+ga+
*art(s(*as( /a'a# *e'aksa+aa+ keg(ata+ tersebut /( atas, Re+.a+a
Keg(ata+ ter'a#*(r

N"#"r $ B % % &II % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Per(-a' $ Ja5aba+ *e+a5ara+ -arga Ke*a/a
1t-. 1. PT. As'*a't H"t#(D
2. Ba*ak Las(#a+

/(
Jakarta
1. Dasar.
a. Surat *e+a5ara+ -arga PT. As'*a't H"t#(D, PT. Aba/( Ja6a
H"t#(D /a+ Ba*ak Las(#a+ ta+gga' 2! Ju'( 21 te+ta+g
*e+gas*a'a+ 3a'a+ sek(tar 'a*a+ga+ b"'a Pus/(kkes.
b. Has(' Ke*utusa+ Da+*us/(kkes K"/(k'at TNI AD ta+gga' 2! Ju'(
21, #e#utuska+ ba-5a 6a+g /(ter(#a ber/asarka+ *e+a5ara+
6a+g tere+/a- 6a(tu R* 2!.,, % #2 /e+ga+ kua'(tas 6a+g sa#a.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, #aka 6a+g /(ter(#a a/a'a-
*e+a5ara+ -arga *e+gas*a'a+ 3a'a+ sek(tar 'a*a+ga+ b"'a Pus/(kkes
K"/(k'at TNI AD /ar( PT. Aba/( Ja6a H"t#(D.
2. De#(k(a+, Ka#( u.a*ka+ ter(#a kas(- atas surat *e+a5ara+ -arga
/a+ #"-"+ #aa) be'u# /a*at beker3a sa#a /a'a# *eker3aa+ se*ert(
tersebut /( atas.

N"#"r $ B % % &II % 21
K'as()(kas( $ B(asa
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
La#*(ra+ $ ,
1t-. Ba*ak Las(#a+
/(
Jakarta
1. Dasar.
a. Surat *e+a5ara+ -arga Ba*ak Las(#a+ ta+gga' 2! Ju'( 21
te+ta+g *e+gas*a'a+ 3a'a+ sek(tar 'a*a+ga+ b"'a Pus/(kkes.
6a+g tere+/a- 6a(tu R* 2!.,, % #2.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( Ka#( #e+er(#a
K"/(k'at TNI AD /ar( PT. Aba/( Ja6a H"t#(D.
2. De#(k(a+, Ka#( u.a*ka+ ter(#a kas(- atas ker3a sa#a+6a /a'a#
*eker3aa+ se*ert( tersebut /( atas.

N"#"r $ B % % &II % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
1t-. PT. Aba/( Ja6a H"t#(D

/(
Jakarta
1. Dasar.
a. Surat *e+a5ara+ -arga PT. As'*a't H"t#(D, PT. Aba/( Ja6a
H"t#(D /a+ Ba*ak Las(#a+ ta+gga' 2! Ju'( 21 te+ta+g
*e+gas*a'a+ 3a'a+ sek(tar 'a*a+ga+ b"'a Pus/(kkes.
6a+g tere+/a- 6a(tu R* 2!.,, % #2 /e+ga+ kua'(tas 6a+g sa#a.
2. Se-ubu+ga+ /e+ga+ -a' tersebut /( atas, /e+ga+ (+( Ka#( #e+er(#a
K"/(k'at TNI AD /ar( PT. Aba/( Ja6a H"t#(D 6a+g *e'aksa+aa++6a /(#u'a(
*a/a ta+gga' 24 s./. 21 Ju'( 21
2.
De#(k(a+, Ka#( u.a*ka+ ter(#a kas(- atas ker3a sa#a+6a.
PUSAT PENDIDIKAN KESEHATAN Jakarta, Agustus 21
N"#"r $ B % % &III % 21
K'as()(kas( $ B(asa
Per(-a' $ Per#asa'a-a+ 6a+g #e+"+3"' Ke*a/a
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
1t-. D(rkesa/
/(
Jakarta
1. Dasar. Surat Te'egra# D(rkesa/ N"#"r ST % 12! % 21 ta+gga' 24
Ju'( 21, te+ta+g *er#(+taa+ *e+g(r(#a+ *er#asa'a-a+ #e+"+3"' 6a+g
ber-ubu+ga+ /e+ga+ *e'a6a+a+ kese-ata+.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /('a*"rka+
*er#asa'a-a+ #e+"+3"' 6a+g ber-ubu+ga+ /e+ga+ *e'a6a+a+ kese-ata+ /(
Ru#a- Sak(t D(k Pus/(kkes, ter'a#*(r.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % I? % 21
K'as()(kas( $ B(asa
Per(-a' $ Data sara+a Ru#a- Sak(t
Karu#k(t/(k
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
1. D(rkesa/
/(
Jakarta
1. Dasar. Surat Ke*a'a D(+as Kese-ata+ Pr"G(+s( DKI Jakarta N"#"r
12202 % , 1.!!4.11 ta+gga' 2< Se*te#ber 21, te+ta+g /ata sara+a Ru#a-
Sak(t.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(k(r(#ka+ /ata sara+a
Ru#a- Sak(t D(k Pus/(kkes, ter'a#*(r.
2. De#(k(a+ u+tuk /(#ak'u#(.

DATA RUMAH SAKIT DIK PUSDIKKES
1 NAMA RUMKIT RUMKIT PENDIDIKAN PUSDIKKES KODIKLAT TNI AD
2 TK. III
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
2. Kaur3a+gu##e/ Ru#k(t/(k Pus/(kkes.
2 JL. RA1A BO=OR KRAMAT JATI JAKARTA TIMUR
< 12>1
> 21.4822>4
0 21.4442!<
! 555.*us/(kkes.."#
4 (+)"N*us/(kkes.."#
8 /r. ICAN TURNIACAN, MARS
1 Letk"' 7k#
11 412884<8
12
12 a. &&IP $9., b.&IP 9 .. K'as.1 $ 1 /. K'as.2 $ 2
e. K'as.2 $ 20 /. I7U 99 e. La(+,'a(+ 9..
1< ,
1> ,
PUSAT PENDIDIKAN KESEHATAN Jakarta Okt"ber 21
N"#"r $ B % % ? % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ te+ta+g *er#"-"+a+ (@(+
Prakt(k Ker3a La*a+ga+ :PKL; s(s5a
SMK SMAK D(tkesa/ TP 21%211 Ke*a/a
1t-. D(rkesa/
/(
Jakarta
1. Dasar. Surat D(rektur Kese-ata+ A+gkata+ Darat N"#"r B %
2<11 % ? % 21 ta+gga' 4 Okt"ber 21, te+ta+g *er#"-"+a+ (@(+ Prakt(k
Ker3a La*a+ga+ :PKL; s(s5a SMK SMAK D(tkesa/ TP 21%211.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, *a/a (+t(+6a Ru#k(t/(k Pus/(kkes
K"/(k'at TNI AD t(/ak keberata+ u+tuk #e'aksa+aka+ Prakt(k Ker3a
La*a+ga+ : PKL ; s(s5a SMK SMAK D(tkesa/ TP 21%211 6a+g aka+
/('aksa+aka+ *a/a ta+gga' 1 s./. 2 N"Ge#ber 21 /( Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD.
2. De#(k(a+ #"-"+ /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta N"*e#ber 21
N"#"r $ B % % ?I % 21
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ Res(/e+s( Ke*a/a
1t-. Ketua Pr"gra# Stu/(
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
2. Ka SMK SMAK D(tkesa/
A/#(+(stras( Ru#a- Sak(t
URINDO
/(
Jakarta
1. Dasar. Surat Ketua Pr"gra# Stu/( A/#(+(stras( Ru#a- Sak(t
U+(Gers(tas Res*at( I+/"+es(a N"#"r >%SB.KPS.MARS%UNR%?%1
ta+gga' 28 Okt"ber 21, te+ta+g Pe+ga+tar Res(/e+s(
2. Se-ubu+ga+ /e+ga+ /asar /( atas, *a/a *r(+s(*+6a Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD t(/ak keberata+ u+tuk #e'aksa+aka+ Res(/e+s(
se'a#a 1 :satu; se#ester a.+. Ma-as(s5a D5( A#bar5at( NPM 8>2!
/kk 1 "ra+g.
2. De#(k(a+ #"-"+ /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta, N"*e#ber 21
N"#"r $ B % % ?I % 21
K'as()(kas( $ B(asa
Per(-a' $ Pe+g(r(#a+ t(+/ak 'a+3ut RS
atas -as(' B(+5as/a' Ke*a/a
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
/(
Jakarta
1. Dasar. Surat Ke*a'a Suku D(+as Kese-ata+ Jakarta T(#ur N"#"r
0<>> % . 1.!!2.< ta+gga' 21 N"*e#ber 21, te+ta+g t(+/ak 'a+3ut RS atas
-as(' B(+5as/a'.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /e+ga+ (+( /(k(r(#ka+ t(+/ak 'a+3ut
atas -as(' B(+5as/a' Ru#a- Sak(t D(k Pus/(kkes K"/(k'at TNI AD, ter'a#*(r.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % & % 211
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ rek"#e+/as(
Pe+eta*a+ Ke'as Ru#a- Sak(t Ke*a/a
/r. Aau3( Ar(e)
Let+a+ K"'"+e' 7k# NRP 22><2
Te#busa+ $
1. Kab(+a6a+kes#asu# Ru#k(t/(k Pus/(kkes.
2. Para Kaur%Kau+(t Ru#k(t/(k Pus/(kkes.
/(
Jakarta
1. Se-ubu+ga+ /e+ga+ aka+ /(a/aka++6a a.ara I'#(a- CSPID /(
Me'b"ur+e Austra'(a, sa6a beserta r"#b"+ga+ /"kter a+ak RS Pus/(kkes
aka+ #e+g(kut( a.ara tersebut u+tuk u*/ate *e+geta-ua+ /"kter a+ak. Ka#(
te'a- #e+u+3uk ONa#(ra TraGe'P u+tuk *e+gurusa+ t(ket, ak"#"/as(, serta
reg(stras(. O'e- kare+a (tu, sa6a #e#(+ta /uku+ga+ ke*a/a PT. ='aD"
S#(t-k'(+e beru*a t(ket /a+ #"-"+ *e#ba6ara++6a /a*at /(se'esa(ka+ ke
ONa#(ra TraGe'P.
2. De#(k(a+ #"-"+ /(#ak'u#(.
N"#"r $ B % % ? % 211
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Pe+u+3uka+ traGe' Na#(ra u+tuk
Pe+gurusa+ eGe+t CSPID Ke*a/a
/r. A#(+ Ibr(@atu+, MARS
Let+a+ K"'"+e' :K; 7k# NRP 22>04
1t-. P(#*(+a+ PT. ='aD"
S#(t-k'(+e
/(
Jakarta
1. Se-ubu+ga+ /e+ga+ aka+ /(a/aka++6a a.ara I'#(a- CSPID /(
Me'b"ur+e Austra'(a, sa6a beserta r"#b"+ga+ /"kter a+ak RS Pus/(kkes
aka+ #e+g(kut( a.ara tersebut u+tuk u*/ate *e+geta-ua+ /"kter a+ak. Ka#(
te'a- #e+u+3uk ONa#(ra TraGe'P u+tuk *e+gurusa+ t(ket, ak"#"/as(, serta
reg(stras(. O'e- kare+a (tu, sa6a #e#(+ta /uku+ga+ ke*a/a PT. ='aD"
S#(t-k'(+e beru*a t(ket /a+ #"-"+ *e#ba6ara++6a /a*at /(se'esa(ka+ ke
ONa#(ra TraGe'P.
2. De#(k(a+ #"-"+ /(#ak'u#(.
N"#"r $ B % 8! % I? % 211
K'as()(kas( $ B(asa
La#*(ra+ $ Satu Be+/e'
Per(-a' $ La*"ra+ bu'a+a+ /ata kes Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD bu'a+
Agustus 211 Ke*a/a
Kaur3a+gu##e/
Sug(ra+
Ka*te+ 7k# NRP 0>2!!
1t-. K"#a+/a+ Pus/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Bersa#a (+( ka#( k(r(#ka+ /ata kese-ata+ Ru#k(t/(k Pus/(kkes K"/(k'at
TNI AD bu'a+ Agustus 211 6a+g ter/(r( /ar( $
a. Be+tuk ? L KR L 11 La*"ra+ Ma.a# Pe+6ak(t /a+ Ju#'a- Pe+/er(ta
b. Be+tuk ? L KR L 12 La*"ra+ Kese3a-teraa+ Ibu /a+ A+ak :KIA;.
.. Be+tuk ? L KR L 12 La*"ra+ Ke#at(a+.
/. Be+tuk ? L KR L 1< La*"ra+ Ke'a-(ra+.
e. Be+tuk ? L KR L 1> La*"ra+ Ra5at M"+/"k.
). Be+tuk ? L KR L 10 La*"ra+ Ra5at Ja'a+%Ku+3u+ga+ P"'(k'(+(k.
g. Be+tuk ? L KR L 1! La*"ra+ &aks(+as(.
-. Be+tuk ? L KR L 14, 18 B 2 La*"ra+ Ku+3u+ga+ P"'(k'(+(k =(g(.
(. La*"ra+ Lab"rat"r(u#.
3. La*"ra+ Ra/("'"g(
k. La*"ra+ Keb(/a+a+ B K"+trase*s(.
2. La*"ra+ (+( berasa' /ar( U+(t Ra5at Ja'a+, U+(t Ra5at M"+/"k /a+ U+(t
=a5at Darurat Ru#(t/(k Pus/(kkes K"/(k'at TNI AD, sebaga( ber(kut $
a. P"'(k'(+(k U#u#.
b. P"'(k'(+(k KIA % Bersa'(+
.. P"'(k'(+(k =(g(
/. P"'(k'(+(k S*es(a'(s
e. Pera5ata+ M"+/"k
). U+(t =a5at Darurat
g. Lab"rat"r(u#
-. Ra/("'"g(
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % 12! % I? % 211
K'as()(kas( $ B(asa
La#*(ra+ $ Satu Be+/e'
Per(-a' $ La*"ra+ bu'a+a+ /ata kes Ru#k(t/(k
Pus/(kkes K"/(k'at TNI AD bu'a+
Se*te#ber 211 Ke*a/a
Let+a+ K"'"+e' 7k# :K; NRP 22>04
Te#busa+ $
1. D(rkesa/, u.*. Kasub/(tb(+6a+kes D(tkesa/.
2. Kakes/a# Ja6a.
2. Kaur3a+gu##e/ Ru#k(t/(k
1t-. K"#a+/a+ Pus/(kkes
K"/(k'at TNI AD
/(
Jakarta
1. Bersa#a (+( ka#( k(r(#ka+ /ata kese-ata+ Ru#k(t/(k Pus/(kkes K"/(k'at
TNI AD bu'a+ Agustus 211 6a+g ter/(r( /ar( $
a. Be+tuk ? L KR L 11 La*"ra+ Ma.a# Pe+6ak(t /a+ Ju#'a- Pe+/er(ta
b. Be+tuk ? L KR L 12 La*"ra+ Kese3a-teraa+ Ibu /a+ A+ak :KIA;.
.. Be+tuk ? L KR L 12 La*"ra+ Ke#at(a+.
/. Be+tuk ? L KR L 1< La*"ra+ Ke'a-(ra+.
e. Be+tuk ? L KR L 1> La*"ra+ Ra5at M"+/"k.
). Be+tuk ? L KR L 10 La*"ra+ Ra5at Ja'a+%Ku+3u+ga+ P"'(k'(+(k.
g. Be+tuk ? L KR L 1! La*"ra+ &aks(+as(.
-. Be+tuk ? L KR L 14, 18 B 2 La*"ra+ Ku+3u+ga+ P"'(k'(+(k =(g(.
(. La*"ra+ Lab"rat"r(u#.
3. La*"ra+ Ra/("'"g(
k. La*"ra+ Keb(/a+a+ B K"+trase*s(.
2. La*"ra+ (+( berasa' /ar( U+(t Ra5at Ja'a+, U+(t Ra5at M"+/"k /a+ U+(t
=a5at Darurat Ru#(t/(k Pus/(kkes K"/(k'at TNI AD, sebaga( ber(kut $
a. P"'(k'(+(k U#u#.
b. P"'(k'(+(k KIA % Bersa'(+
.. P"'(k'(+(k =(g(
/. P"'(k'(+(k S*es(a'(s
e. Pera5ata+ M"+/"k
). U+(t =a5at Darurat
g. Lab"rat"r(u#
-. Ra/("'"g(
2. De#(k(a+ #"-"+ /(#ak'u#(.

RUMAH SAKIT PENDIDIKAN Jakarta Dese#ber 211
N"#"r $ B % % ?II % 211
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Ja5aba+ te+ta+g *e+a5ara+ Mes(+
ED7 u+tuk A*"t(k RS D(k Pus/(kkes Ke*a/a
Let+a+ K"'"+e' 7k# :K; NRP 22>04
Te#busa+ $
1. D(rkesa/, u.*. Kasub/(tb(+6a+kes D(tkesa/.
2. Kakes/a# Ja6a.
2. Kaur3a+gu##e/ Ru#k(t/(k
1t-. Ke*a'a 7aba+g
PT. Ba+k Ma+/(r( :Perser";
Jakarta Kra#at Jat(
/(
Jakarta
1. Ber/asarka+ Surat Ke*a'a 7aba+g PT. Ba+k Ma+/(r( :Perser"; Tbk
Jakarta N"#"r <.SP.JKT % 42 % 211 ta+gga' 21 N"*e#ber 211 te+ta+g
*e+a5ara+ Mes(+ ED7 u+tuk A*"tek RS D(k Pus/(kkes.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, /(sa#*a(ka+ ba-5a Ru#a- Sak(t
D(k Pus/(kkes be'u# b(sa #e#e+u-( *e+a5ara+ tersebut kare+a
*e+ggu+aa+ #es(+ ED7 u+tuk a*"tek Ru#a- Sak(t D(k Pus/(kkes saat (+(
be'u# #e+3a/( *r("r(tas ka#(.
2. De#(k(a+ #"-"+ /(#ak'u#(.

N"#"r $ B % % ?II % 211
K'as()(kas( $ B(asa
La#*(ra+ $ Surat rek"#e+/as(
Per(-a' $ Per#"-"+a+ *er*a+3a+ga+ (3(+
"*eras("+a' ru#a- sak(t Ke*a/a
Let+a+ K"'"+e' 7k# :K; NRP 22>04
/(
Jakarta
1. Dasar $
a. Ke*utusa+ Me+ter( Kese-ata+ Re*ub'(k I+/"+es(a N"#"r
1M.2.<.2.2.<>2> ta+gga' 14 Se*te#ber 20, te+ta+g Pe#ber(a+
I@(+ Pe+6e'e+ggaraa+ Ru#a- Sak(t Tk.III D(k Pus/(kkes K"/(k'at TNI
AD.
b. Surat Ke*a'a Suku D(+as Kese-ata+ Jakarta T(#ur N"#"r
800>%,1.!!22 ta+gga' 2 N"*e#ber 211 te+ta+g rek"#e+/as(
*er*a+3a+ga+ (3(+ *e+6e'e+ggaraa+ Ru#a- Sak(t Pus/(kkes K"/(k'at
TNI AD.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ Ke*a'a D(+as Kese-ata+
Pr"G(+s( DKI Jakarta #e#ber(ka+ surat *er*a+3a+ga+ (3(+ "*eras("+a'
Ru#a- Sak(t Tk.III D(k Pus/(kkes K"/(k'at TNI AD 6a+g su/a- -ab(s #asa
ber'aku ta+gga' 14 Se*te#ber 211.
2. De#(k(a+ #"-"+ /(#ak'u#(.

Te#busa+ $
2. Para Kau+(t%Kaur Ru#k(t/(k Pus/(kkes

N"#"r $ B % % ?II % 211
K'as()(kas( $ B(asa
La#*(ra+ $ ,
Per(-a' $ Per#"-"+a+ Rek"#e+/as(
Pe+eta*a+ Ke'as Ru#a- Sak(t Ke*a/a
Let+a+ K"'"+e' 7k# :K; NRP 22>04
/(
Jakarta
1. Ber/asarka+ Surat Te'egra# D(rkesa/ N"#"r ST % 40 % 211 ta+gga'
2 Me( 211, te+ta+g *er(+ta- #e+ga3uka+ *e+eta*a+ ke'as ru#a- sak(t.
2. Se-ubu+ga+ /e+ga+ /asar /( atas, #"-"+ Ke*a'a D(+as Kese-ata+
Pr"G(+s( DKI Jakarta #e#ber(ka+ rek"#e+/as( u+tuk *e+eta*a+ ke'as
Ru#a- Sak(t Tk.III D(k Pus/(kkes K"/(k'at TNI AD.
2. De#(k(a+ #"-"+ /(#ak'u#(.

Te#busa+ $
2. Ke*a'a Su/(+kes Jakarta T(#ur

Let+a+ K"'"+e' 7k# :K; NRP 22>04

Surat Biasa

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Surat Biasa

Diunggah oleh

Hak Cipta:

Format Tersedia

PUSDIKKES KODIKLAT TNI AD

RUMAH SAKIT PENDIDIKAN Jakarta, Agustus 2006

Anda mungkin juga menyukai