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: Permohonan Kewenangan Klinik Dokter Umum
: 1 Berkas

Kepada Yth:
Direktur Rumah Sakit Umum Daerah Majalengka
Di tempat
Dengan hormat,
Dengan ini kami mengajukan permohonan kewenangan klinik dokter umum sebagai staf medis
Rumah Sakit Umum Daerah Majalengka (Paruh waktu/ Purna waktu*).
Demikianlah permohonan ini kami sampaikan. Atas perhatiannya diucapkan terima kasih.
Majalengka, …………………..
Pemohon,

Dr. Dewi Nurmalasari

Keterangan:
* Coret yang dianggap tidak perlu
* Berkas yang dilampirkan: fotocopy STR, fotocopy Surat Pindah/ SK Pensiun, fotocopy ijazah
dan CV

KEWENANGAN KLINIK DOKTER UMUM
DOKTER YANG MENGAJUKAN : dr. DEWI NURMALASARI
LULUSAN
:
TAHUN LULUS :
No
Kewenangan Klinik
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Angina pectoris
Unstable angina
Myocardial Infarction
Imminent Myocardial
Infarction
Cardiac aneurysm
Heart failure
Cardiorespiratory arrest
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Other valvular heart
diseases
VSD
ASD
Sinus tachycardia
Supraventricular
tachycardia
Atrial fibrillation
Atrial flutter
Supraventricular
extrasystole
Ventricular extrasystole
BBB
Other arrhythmias
Endocarditis
Pericarditis
Myocarditis
Cardiomyopathy
Essential hypertension
Secondary hypertension
Pulmonary hypertension
Raynaud's disease
Arterial thrombosis
Coarctation of the aorta
Burger's disease
Arterial embolism
Atherosclerosis
Subclavian steal syndrome
Aortic aneurysm
Dissecting aneurysm
Claudicatio
Cardiogenic shock
Septic shock
Hypovolemic shock
Varices (primary,secondary)
Obstructed venous return

Permohonan
Kemampuan Klinik
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Disetujui Kemampuan
Klinik
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herpes) Glossitis Esophageal atresia Achalasia Corrosive lesions of esophageus Esophageal varices Esophageal rupture Reflux esophaghitis Diaphramatic hernia Hiatus hernia Inguinal hernia.45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 Deep vein thrombosis Thrombophlebitis Lymphangitis Lymphadenitis Lymphedema. primary and secondary Uncomplicated Pulmonary Tuberculosis TBC with HIV TBC with pneumothorax Acute Bronchitis Bronchiolitis Bronchial asthma Status asmaticus Lung emphysema Atelectasis Bronchiectasis COPD SARS Pneumonia Avian influenzae Lung abscess Pulmonary embolism Lung infarction Pleurisy TBC Pleurisy Cancer Pleurisy Lupus Pneumothorax Cystic fibrosis Aspiration pneumonia Cleft lip and palate Micrognatia and macrognatia Leukoplakia Candidiasis Mouth ulcers (aphthous. direct and indirect Femoral hernia – Bedah Epigastric hernia Incisional hernia Umbilical hernia Peritonitis Abscess in pouch of Douglas Ileus √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ .

95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 Perforation Salphingitis Acute appendicitis Appendicular abscess Mesenteric lymphadenitis Gastritis Gastric/duodenal ulcer Gastrointestinal bleeding Zollinger-ellison syndrome Mallory-weiss syndrome Gastroenteritis Fatty liver Hepatitis A Uncomplicated Hepatitis B Active Hepatitis C Cirrhosis hepatis Amoebic liver abscess Liver failure Chole(docho)lithiasis Acute cholecystitis Hydrops of gall bladder Empyema of gall bladder Pancreatitis Intestinal atresia Meckel's diverticulum Umbilical fistula. anal prolapse Proctitis Hemorrhoids (peri)anal abscess Fistula Anal fissure Esophageal atresia Intestinal atresia Anal atresia Diapragmatic hernia (congenital) Pyloric stenosis Gastro-esophageal reflux Gastro-enteritis Gastro-enteritis dengan dehidrasi Worms Dehydration Malabsorbsion Food intolerance Acute abdomen Ileus √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ . omphalocoele-gastroschisis Malrotation Enteritis Irritable bowel syndrome Necrotizing enterocolitis Diverticulosis/diverticulitis Colitis Rectal.

147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 Peritonitis tuberculosis Peritonitis pancreatitis Intussussception Malrotation Umbilical hernia Meckell's diverticulum Crohn's disease Ulcerative colitis Hirschsprung's disease Biliary atresia Hepatitis Reye's syndrome Cirrhosis of the liver Food allergy Acute renal failure Chronic renal failure Nephrotic syndrome Acute glomerulonephritis Chronic glomerulonephritis Interstitial nephritis Renal colic Urinary stone diseases or urinary calculi without colic Polycystic kidneys symptomatic Urinary tract infection Acute tubular necrosis Horse shoe kidney Uncomplicated Pyelonephritis Urinary incontinence Nocturnal and diurnal enuresis Prostatitis Hypospadia Epispadia Undescended testes/cryptorchidism Retractile testes Torsion of testis Epididymitis Spermatocele Varicocele Hydrocele Phimosis Paraphimosis Ruptur uretra Ruptur kandung kencing Ruptur ginjal Striktura uretra Priapismus Penyakit peironi Ekstrophia vesicae Infertility Erection disorders √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ .

uretero-vaginal. rectovaginal fistula) Foreign body Cervicitis Polyps Nabothian cyst Congenital malformations Uterine prolaps Hematocolpos Endometriosis Salpingitis Adhesions Ovarian cyst Polycystic ovarian disease Carcinoma of ovary Ectopic pregnancy Torsion tumour / ovarian cyst Rupture of ovarian cyst / tubo . abscess of bartholin's gland Abscess of hair follicle or sebaceous gland Condylomata acuminata Congenital malformations Vaginitis Bacterial vaginosis Cyst of gartner Cystocoele Rectocoele Enterocoele Fistula (vesico-vaginal.197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 240 241 242 243 Ejaculation disorders Vulvitis Dystrophy of vulva Cyst of bartholin.ovarian abscess Uterine bleeding at ovulation Inflammations of breast Mastopathy Aplastic/hypoplastic anemia Iron deficiency anemia Macrocytic anemia Hemolytic anemia Hemoglobinopathy Anemia associated with chronic diseases Polycytemia Thrombocytopenia Thrombocytosis Hemophilia Von willebrand's disease DIC Agranulocytosis Haemorheologic disorders Antiphospholipid syndrome √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ .

244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 Uncomplicated SLE Complicated SLE Scleroderma Polyarteritis nodosa Vasculitis Lupus Polymyalgia rheumatica Rheumatoid arthritis Anaphylactic reaction Rheumatic fever Juvenile chronic arthritis Henoch-schoenlein purpura Erythema multiforme Atopy Steven johnson's syndrome Transplantation immunology Down's syndrome Turner's syndrome Klinefelter's syndrome Gonadal xy-dysgenesis Testicular feminization Fragile x syndrome PKU (Phenyl Ketonuria) Galactosemia Glycogen storage disease Other storage diseases Spina bifida Anencephaly Hydrocephalus Cleft palate and/or lip Marfan's syndrome Hypothermia Bacteraemia and septicemia Respiratory stress syndrome Bronchopulmonary dysplasia Aspiration pneumonia Pneumo thorax Apnea attacks Jaundice of newborn Severe neonatal jaundice (kern icterus) Hypoglycemia Child of diabetic mother Neonatal convulsion Necrotizing enterocolitis Retinopathy of prematurity Anemia Rhesus incompatibility Blood group incompatibility Vitamine k defficiency Cerebral hemorrhage Conjuctivitis Infection of umbilicus Sudden infant death √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ .

gigantism Growth hormone deficiency Hyperparathyroidism Hypoparathyroidism Hyperthyroidism Hypothyroidism Thyroiditis Cushing's disease Adrenal cortex failure Primary hyperaldosteroidism Phaeochromocytoma Precocious puberty Testicular feminization syndrome Hypogonadism Adrenogenital syndrome Addison's disease Multiple endocrinological neoplasia (men syndrome) Tumor with ectopic production of hormone Kwashiorkor Vitamin deficiencies Hyperlipoproteinemia Porphyria Gout Obesity Metabolic Encephalopathy Comatous Brain death Tension headache Migraine Cranial arteritis Trigeminal neuralgia Cluster headache TIA Cerebral infarction Intracerebral hematoma Subarachnoid hemmorhage Hypertensive encephalopathy Bels’ palsy Brain stem lesions Menier's disease Benign paroxysmal positional vertigo Vertigo Central .295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 syndrome (sids) IDDM NIDDM Complication of DM (acute and chronic) Hypoglycemia Diabetes incipidus Acromegaly.

342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 Vascular dementia Alzheimer's disease Pick's disease Parkinson's disease Tremor Secondary parkinsonism Huntington disease Chorea sydenham Dystonia Hemifacial spasm Focal epilepsy Generalized epilepsy Absence seizure Status epilepticus Narcolepsy Sleep apnea syndrome Multiple sclerosis Optic neuromyelitis (Devic's disease) Amyotrphic lateral sclerosis (ALS) Complete spinal transection Brown sequard syndrome Cauda equina syndrome Neurogenic bladder Syringomyelia Myelopathy Dorsal root syndrome Medulla compression acute Radicular syndrome/HNP Spondilitis TB Horner syndrome Carpal tunnel syndrome Tarsal tunnel syndrome Neuropathy Peroneal palsy Guillain Barre syndrome Myasthenia gravis Polymyositis Duchenne muscular dystrophy Neurofibromatosis (von reckling hausen disease) Meningitis Encephalitis Malaria cerebral Tetanus Cerebral Toxoplasmosis Tuberculoma Brain abscess HIV AIDS Hydrocephalus Spina bifida Phenyl ketonuria Meningitis .

393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 Encephalitis Cerebral abscess Epilepsi Infantile spasms Petit mal epilepsy Febrile convulsion Duchene muscular dystrophy Poliomyelitis Cerebral palsy Kernicterus Mental Retardation Autism ADHD Amnesia Pasca trauma Afasia MCI (Mild Cognitive Impairment) VCI (Vascular Cognitive Impairment) Epidural hematom Subdural hematom SAH (Sub Arachnoid Hemorrhage) Trauma Medula Spinalis Tumor primer Tumor sekunder Nyeri Nosiseptif Nyeri neuropatik Buta mendadak Diplopia Visual field disorders Inflammation of auricle Herpes zoster oticus Pre-auricular fistula Foreign body in ear Wax (serumen) Otitis externa Acute otitis media Otitis media serous (glue ear) Chronic otitis media Perforated tympanic membrane Bullous myringitis Otosclerosis Tymphanosclerosis Cholesteatoma Presbyacusis Mastoiditis Labyrinthitis Benign postural vertigo Motion sickness Meniere's diseases Vestibular neuritis Acoustic neuroma Acute acoustic trauma .

bacterial Pterygium Subconjunctival haemorrhage Blepharitis Hordeolum Chalazion Eyelid laceration Entropion Trichiasis Lagophtalmos Epicanthus Ptosis Eyelid retraction Xanthelasma Dacryoadenitis . viral Conjunctivitis. foreign body Conjunctivitis. other trauma Perceptive hearing loss Conductive hearing loss Congenital deafness Facial palsy or paralysis Epistaxis Furuncle of nose Acute rhinitis (common cold) Vasomotor rhinitis Allergic rhinitis Chronic rhinitis Rhinitis medicamentosa Acute frontal sinusitis Acute maxillary sinusitis Acute ethmoiditis Chronic sinusitis Deviation of nasal septum Choanal atresia Foreign body in nose Pharyangitis Tonsilitis Hypertrophy of adenoids Pseudo-croop acute epiglotitis Medial and lateral branchial cyst and fistula Cystic hygroma Torticollis Cyst Tiroid Goitre Hyperthyroidism Hyperparathyroidism Hypoparathyroidism Aspiration Foreign bodies Tracheitis Conjunctiva. allergy Conjunctivitis.444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 Ear.

bitemporal and homonymous Loss of vision and blindness Retinal detachment Retina. congenital Simple glaucoma Acute glaucoma Secondary glaucoma Cataract Aphakia Psudoaphakia (artificial lens) Lens dislocation Hypermetropia Myopia Astigmatism Presbyopia Anisometropia Amblyopia Diplopia Suppresion Night-blindness Scotoma Hemianopia. foreign body Burn Keratitis Kerato-conjunctivitis sicca Corneal oedema Corneal dystrophy Keratoconus Endophtalmitis Microphtalmos Buphtalmos Hyphaema Hypopyon Iridocyclitis.496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 Dacryocystitis Dacryostenosis Lacrimal duct. age dependent Retinopathy of prematurity (rop) Diabetic retinopathy Hypertensive retinopathy Chorioretinitis Vitreous haemmorrhage Optic disc cupping Papilloedema Optic atrophy Optic neuropathy . laceration Scleritis/episcleritis Erosion Cornea. iritis Tumour of iris Glaucoma. vessel occlusion or bleeding Degeneration of macula.

547 548 549 550 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 Optic neuritis Contact dermatitis irritant Contact dermatitis allergica Atopic dermatitis (kecuali recalcitrant) Nummular dermatitis Lichen simplex chronicus Napkin eczema Psoriasis vulgaris Plamoplantar pustulosis Seborrheic dermatitis Pityriasis rosea Acne vulgaris Rosacea Hidradenitis suppurativa Perioral dermatitis Miliaria Verruca vulgaris Condyloma accuminata Molluscum contagiosum Herpes zoster Impetigo Ulcerative impetigo (ecthyma) Superficial folliculitis Furuncle. carbuncle Erythrasma Erysipelas Tinea capitis Tinea barbae Tinea faciale Tinea corporis Tinea Manus Tinea unguium Tinea Cruris Mucocutaneous candidiasis Tinea pedis Tinea versicolor Pediculosis capitis 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 Pediculosis pubis Scabies Insect bites reactions Pemphigus vulgaris Pemphigoid Dermatitis herpetiformis Toxic epidermal necrolysis Stevens-johnson's disease Dermatomyositis Systemic sclerosis Scleroderma/morphea Lupus erythematosus Alopecia areata Androgenic alopecia Trichotillomania 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 .

598 599 600 601 602 603 604 605 606 607 608 609 610 611 612 613 614 615 616 617 618 619 620 621 622 623 624 625 626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 Telogen eflluvium Ichthyosis vulgaris Lichen planus Granuloma annulare Morphea Lichen sclerosus er atrphicus Exanthematous drug eruption Fixed drug eruption Vitiligo Melasma Albinism Post-inflammatory hyperpigmentation Post-inflammatory hypopigmentation Paronychia Suppurative tenosynovitis Human bite Suppurative parotitis Suppurative cervical adenitis Peritonsilar abscess Ludwig's angina Bezold abscess Superficial infections. including folliculitis. hidradenitis suppurativa. mastoiditis. carbuncle.THT Rheumatic heart disease Meningitis (neuro) Nasopharyngitis Gonorrhea Urinary tract infection (UTI) Typhoid fever Dysentry bacilli Cholera Pertussis Plague (Pes) Chancroid Diphteria (THT) Tetanus (pediatri) Tuberculosis kutis Leprosy Lepra reaction Syphilis Yaws Leptospirosis . Osteomyelitis Staphylococcal pneumonia Staphylococcal bacteremia Rheumatic fever Sinusitis. pertonsilar abscess . otitis media.

644 645 646 647 648 649 650 651 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 672 673 674 675 676 677 678 679 680 681 682 683 684 685 686 687 688 689 680 681 682 683 684 685 Actinomycosis Chromoblastomycosis Maduromycosis Influenza avian influenza (THT) Viral gastroenteritis Poliomyelitis Rabies Morbilli Varicella Herpes zoster Herpes simplex Mumps CMV infections Dengue hemorrhagic fever (DHF) HIV-AIDS Amebiasis Malaria Leishmaniasis dan tripanosomiasis Toxoplasmosis Giardiasis Trichomoniasis Hookworm diseases Strongyloidiasis Ascariasis Filariasis Schistosomiasis Cutaneus larva migran Taeniasis Non-hodgkin's lymphoma Hodgkin's lymphoma Acute leukemia Chronic leukemia Myelodysplastic syndromes Multiple myeloma Langerhans' cell histiocytosis Bronchogenic carcinoma Bronchoalveolar carcinoma Neuroendocrine tumor (carcinoid tumor) Mesothelioma Leukoplakia Polyps Nasopharynx carcinoma Pleomophic adenoma Warthins tumor Benign polyps Squamous cell carcinoma Adenocarcinoma Carcinoid tumor Lymphoma Liver cell adenoma Hepatocellular carcinoma .

686 687 688 689 690 691 692 693 694 695 696 697 698 699 700 701 702 703 704 705 706 707 708 709 710 711 712 713 714 715 716 717 718 719 720 721 722 723 724 725 726 727 728 729 730 731 732 733 734 735 736 737 738 Cholangiocarcinoma Carcinoma of the pancreas Cortical adenoma Renal cell carcinoma Wilm's tumor Squamous cell carcinoma Seminoma Teratoma testis Benign prostatic hyperplasia Carcinoma of the prostate Condyloma accuminata Cervical carcinoma Extramammary Paget's disease Endometrial hyperplasia Endometrial carcinoma Ovarial teratoma (dermoid cyst) Ovarian carcinoma Hydatidiform mole Choriocarcinoma Fibrocystic change Fibroadenoma mammae Phyllodes tumor Breast carcinoma Paget's disease of the breast Gynecomastia Somatotropic adenoma Prolactinoma Thyroid adenoma Thyroid carcinoma Thymoma Benign epithelial tumors Seborrheic keratosis Epithelial cyst Actinic keratosis Bowen's disease Squamous cell carcinoma Basal cell carcinoma Xanthoma Hemangioma Lymphangioma Angiosarcoma Mycosis fungoides Mastocytosis Langerhans' cell histiocytosis Lentigo Nevus pigmentosus Malignant melanoma Osteoma Osteoid osteoma Osteoblastoma Osteosarcoma Osteochondroma Chondroblastoma .

739 740 741 742 743 744 745 746 747 748 749 750 751 752 753 754 755 756 757 758 759 760 761 762 763 764 765 766 767 768 769 770 771 772 773 774 775 776 777 778 779 780 781 782 783 784 785 Chondrosarcoma Fibrous dysplasia Fibrosarcoma and mfh Ewing sarcoma Giant cell tumor Ganglion cyst Lipoma Liposarcoma Fibromatosis Desmoid tumor Fibroma Fribrosarcoma Benign fibrous histiocytoma Malignant fibrous histiocytoma (mfh) Rhabdomyosarcoma Leiomyoma Leiomyosarcoma Synovial sarcoma Astrocytoma Oligodendroglioma Ependymoma Medulloblastoma Retinoblastoma Meningioma Neurofibroma Schwannoma Mental deficiency Autistic disorder Disorder of intellectual skills Disorder of motor development Disorder of coodination Behavior and attention disorders Anorexia nervosa Bulimia Pica Rumination in infancy Gilles de la tourette syndrome Chronic motor of vocal tic disorders Transient tic disorders Functional encoperasis Functional enuresis Uncoordinated speech Stammer Schizophrenia Other psychoses including reactive psychosis and puerperal psychosis Bipolar disorder. manic episode Bipolar disorder. depressive .

noc Insomnia Hypersomnia Sleep-wake cycle disturbances Nightmares Night terrors Sleep walking Paranoid personality Schizoid personalinty . noc Sexual disorders. noc Paraphilia Disorder of sexual desire Disorder of sexual exitement Disorder of orgasm Sexual pain disorders Sexual dysfuctions. single episode and recurrent Dysthymic disorder (or neurotic depression) Depressive disorder not otherwise classified Panic disorder with agoraphobia Panic disorder without agoraphobia Agoraphobia without history of panic disorder Social phobia Simple phobia Obsessive compulsive disorder (neurosis) Post traumatic stress disorder Diffuse anxiety disorder Anxiety disorder not otherwise classified Disorder of body sensation Conversion disorder (hysterical neurosis) Hypochondriasis (hypochondriacal neurosis) Somatisation disorder Somatoform pain disorder Undifferentiated somatoform disorder Somatoform disorder not otherwise classified Multiple personality Fugu states Psychogenic amnesia Depersonalisation disorder or depersonalisation neurosis Dissociative disorder.786 787 788 789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 816 817 818 819 820 821 822 823 824 825 episode Cyclothymic disorder Endogenous depression.

826 827 828 829 830 831 832 833 834 835 836 837 838 839 840 841 842 843 844 845 846 847 848 849 850 851 852 853 854 855 856 857 858 859 860 861 862 863 864 865 Schizotypal personality Antisocial personality Borderline personality Histerionic personality Narcisistic personality Avoidance personality Dependent personality Obsessive-compulsive personality Passive-aggressive personality Personality disorders. Rogerrian. parkinsonism) Anticholinergic side effects Sedative side effects Malignant neuroleptic syndrome Knowledge of forensic psychiatry Knowledge of indication for involuntary admission to hospital Knowledge of basic principles of methods used by different psychotherapeutic schools (eg. Acute dystonia. tradive dyskenia. psychoanalytic. etc) Pseudoconstipation Encopresis Anorexia nervosa Bulemia Tics. noc Extrapyramidal side effects (eg. neuropathic behavior Hyperkinetic syndrome Primary infantile autism Disorders of mother-child relationship Disorders due to social deprivation Neurotic disorder of chilhood Breath holding due to exitement Congenital dislocation of the hips Arthritis Genu varum (bow legs) Genu valgum (knock knee) Pes planus Scoliosis Kyphosis Lordosis Terthes disease Slipped epiphysis Osgood-schlatter diseasev Chondromalacia patellae .

866 867 868 869 870 871 872 873 874 875 876 877 878 879 880 881 882 883 884 885 886 887 888 889 890 891 892 893 894 895 896 897 898 899 900 901 902 903 904 905 906 907 908 909 910 911 912 913 914 915 Club foot Marfan's disease Osteogenesis imperfecta Bone cyst Achondroplasia Rickets. spondylodiscitis Hernia of nucleus pulposus Spondylolisthesis Spondylolysis Metastases from elsewhere Pathological fractures Fractures and dislocations of spine Spinal transaction Congenital hip dislocation Hip dysplasia Femoral head necrosis Intermittent arthritis of the hip Fractures of pelvis Fractures of hip Dislocation of hip Ligamentous lesions of hip Arthritis of hip Fractures of femur Fractures. capsule. osteomalacia Osteoporosis Fibrous dysplasia Paget's disease Physical overload Aseptic necrosis of bone Osteomyelitis. tendon and ligament lesions of knee Lesion of meniscus. medial and lateral Abnormal patellear cartilage . acute Arthritis Trauma of joint cartilage Trauma of joint capsule Ganglion Primary bone tumors Bone metastasis Pathological fracture Arthrosis deformans Crystal arthropathy Rheumatoid arthritis Bechterew disease Spina bifida Sacrococcygeal teratoma Scoliosis Kyphosis Lordosis Spondylarthrosis. spondylosis Spondylitis.

capsule. rib) Drowning Head injury Burning Poisoning Suffocation Bleeding Hypovolemic shock Dislocation of jaw Fracture of jaw Dislocation of knee Dislocation of patella Prepatellar bursitis Fractures of tibia Rib fractures/contusion Injury caused by rib fractures Sternal fractures Fractures of toes Crush injury to the heel (in children) Fractures of fibula Whiplash Fractures. humerus. such as liver. genu valgum Osteochondritis dissecans Arthritis of the knee Achilles tendonitis Rupture of achilles tendon Tarsal tunnel syndrome Instability of ankle In growing toe nail Pes planus Club foot Claw foot Hallux valgus Hammer toe Metatarsalgia Onychogryposis Anisomelia Caput succedaneum Brachial plexus injury Fracture (clavicle. kidney. tendon and ligament lesions of ankle Pneumothorax Hemothorax Injury to specific internal organs. etc Injury of peripheral nerves Fractures of shoulder Dislocation of shoulder Ligamentous lesions of shoulder Instability of shoulder Frozen shoulder . lung.916 917 918 919 920 921 922 923 924 925 926 927 928 929 930 931 932 933 934 935 936 937 938 939 940 941 942 943 944 945 946 947 948 949 950 951 952 953 954 955 956 857 858 859 860 861 862 863 864 Genu varum.

Boutonniere-deformity Mallet finger Dupuytren's contracture Nail loss Subungual hematome Traumatic vessel injury Head injuries Diffuse brain damage Cerebral concussion and contusion Brain death Extradural hemorrhage Subdural hemorrhage Basilar fracture scalp Acute traumatic spinal transaction Injury of plexus and peripheral nerves Syphillis Rubella CMV infection Toxoplasmosis AIDS Gonorrhoea Herpes virus infection type 2 Hepatitis B Mother taking tobacco Mother taking drugs of addiction Mother taking tobacco Mother taking drugs of addiction Vasa previa Abruptio placenta . tendon. capsule. ligament lesions of wrist Fractures. ligament lesions of fingers and thumb Lateral epicondylitis (tennis elbow) Dislocation of distal radius Dislocation of wrist Progressive inflammation of finger following injury Olecranon bursitis Carpal tunnel syndrome Injury to finger tendon. tendon. e.865 866 867 868 869 870 871 872 873 874 875 876 877 878 879 880 881 882 883 884 885 886 887 888 889 890 891 892 893 894 895 896 897 898 899 900 901 902 903 904 905 Fracture of clavicle Fracture of humerus Fracture of radius/ulna Fractures. ligament lesions of elbow Fractures.SOL Cervical incompetence . capsule.g. capsule. tendon.

pendahuluan . infant Retained placenta Retained placental tissue Uterine inversion Postpartum haemorrhage Thrombo – embolism Blood group incompatibility Mastitis Cracked nipple Inverted nipple Endometritis Inflammation of pelvis (salpingitis. pelviperitonitis.906 907 908 909 910 911 912 913 914 915 916 917 918 919 920 921 922 923 924 925 926 927 928 929 930 931 932 933 934 935 936 937 938 939 940 941 942 943 944 945 946 947 948 Polyhydramnion Jaundice late in pregnancy Urinary tract infection Pyelitis in pregnancy Iron dificiency anaemia Megaloblastic anaemia Dead fetus Premature contractions Premature delivery Rupture of uterus Postmature infant Premature rupture of membranes Unstable lie / malposition after 36 weeks Dystocia. perimetritis etc) Incontinence of urine Incontinence of faeces Deep venous thrombosis Thrombophlebitis Embolism Post-natal psychoses Post-natal depression Subinvolution of uterus KETERANGAN KEMAMPUAN KLINIK DOKTER UMUM : Tingkat Kemampuan 1 : Mengenali gambaran-gambaran klinik sesuai penyakit Tingkat Kemampuan 2 : Mampu membuat diagnosis klinik Tingkat Kemampuan 3 : Mampu mendiagnosis klinik. fetal and passage Malpresentation of fetus Prolonged delivery Primary mild contractions – IMININ Secondary mild contractions Cord presentation / cord prolapse Hypoxia of fetus Failure to rotate / incorrect rotation Rupture of cervix Rupture of perineum Shoulder distortion. memberi terapi.

memutuskan dan mampu menangani problem itu secara mandiri hingga tuntas Kewenangan Klinik Tindakan Resusitasi Jantung Paru Penanganan sesak napas ringan sampai berat (tanpa ventilator) Penanganan awal kegawatdaruratan pada jantung Penanganan Pasien dengan Syok Permohonan Kemampuan Klinik 1 2 3 4 Disetujui Kemampuan Klinik 1 2 3 4 .Tingkat Kemampuan 4 No 1 2 3 4 : Mampu mendiagnosis klinik.

……………………………………. . Nomor : ……/ Kred / KM-RSMJL / ……. / 20….... 2.5 6 7 8 9 10 11 12 Menjahit luka ringan sampai sedang Pemasangan tampon hidung bagian anterior Partus normal dengan posisi kepala sudah di pintu vagina Penanganan awal luka bakar Penanganan kejang Penanganan keracunan dan gigitan binatang Penanganan awal trauma kepala Penanganan awal fraktur terbuka dan fraktur tertutup KETERANGAN KETERAMPILAN KLINIK DOKTER UMUM : Tingkat Keterampilan 1 : Memiliki pengetahuan teoritis Tingkat Keterampilan 2 : Pernah melihat... Apabila dokter DPJP tidak bisa dihubungi. dokter jaga boleh memberikan terapi sesuai dengan keluhannya. …………………. Pemohon Ketua Komite Kredensial ………………………………………. c. Diluar kewenangan klinis diatas dokter umum wajib mengkonsultasikan ke dokter spesialis sesuai dengan kewenangan klinis dokter spesialis tersebut. ……………………………………. Sudah mengikuti pelatihan ATLS/ ACLS/ PPGD Majalengka. Mengkonsultasikan semua kebutuhan pasien rawat inap kepada DPJP b. e.. atau didemonstrasikan keterampilan ini Tingkat Keterampilan 3 : Menerapkan dibawah supervisi Tingkat Keterampilan 4 : Mampu menangani problem itu secara mandiri hingga tuntas CATATAN: a. …………………………………… Anggota : 1. Dokter jaga IGD dan Dokter jaga rawat inap merujuk pasien ke RS lain dengan fasilitas yang lebih lengkap setelah dikonsultasikan ke dokter spesialis yang berkaitan d.

. 2. Dewi Nurmalasari. Untuk itu dapat diproses penugasan klinik sesuai dengan ketentuan/ prosedur yang berlaku. ………………………………. setelah kami mengevaluasi kompetensi.. maka dengan ini kami merekomendasikan untuk memberikan / tidak memberikan / belum memberikan* kewenangan klinik sebagai dokter umum.. perilaku etis dan kelengkapan berkas-berkas permohonan yang bersangkutan. Ketua Komite Medik RSUD Majalengka Di Tempat Dengan Hormat. Adapun wewenang klinis yang dapat diberikan terlampir. ………………………………. Majalengka. Ketua Komite Kredensial ……………………………………………………… Anggota: 1..Perihal : Kewenangan Klinik Dokter Umum Lampiran : 1 Berkas Kepada Yth.. sebagai dokter umum yang melamar untuk menjadi staff medis di RSUD Majalengka.  ………………………………………………………………………………….……………………………. purna waktu / paruh waktu* dengan alasan:  …………………………………………………………………………………. Menganai permohonan dr.. Keterangan: * Coret yang dianggap tidak perlu .  ………………………………………………………………………………….

………………………… Hormat Kami. Direktur RSUD Majalengka Di tempat Dengan Hormat. maka dengan ini kami merekomendasiklan nama dokter umum dr. Demikian surat ini kami sampaikan. Majalengka. atas perhatiannya diucapkan terimakasih./ KM-RSMJL/ …. Dewi Nurmalasari dapat diberikan kewenangan klinik (terlampir) sebagai staff medis di Rumah Sakit Umum Daerah Majalengka.Nomor : …. Ketua Komite Medik . Untuk itu diusulkan kepada Direktur Rumah Sakit Umum Majalengka untuk dapat memproses penugasan klinik. melakukan kredensialing.. Setelah Komite Rekredensial./ 20… Perihal : Kewenangan Klinik Dokter Umum Lampiran : 1 (satu) berkas Kepada Yth.