Lampiran Surat

No: 524/VII-03/0418

FORMULIR ASSESMENT REVIEW 144

Dapat Tuntas Ditangani di FKTP
(Beri tanda Checklist (√) pada salah satu
No 144 Diagnosa kolom)

YA TIDAK

Unspecified abortion, complete, √

1 Abortus spontan komplit without complication

2 Alergi makanan Dermatitis due to ingested food √

3 Anemia defisiensi besi pada Anemia defisiensi besi pada √

kehamilan kehamilan

4 Askariasis Ascariaris unspecified √

5 Asma Bronkial Asthma √

6 Astigmatism ringan Astigmatisme √

7 Bell's Palsy Bells’ palsy √

8 Benda asing di hidung Foreign body in nostril √

Foreign body on external eye,

9 Benda asing di konjungtiva √
part unspecified

10 Blefaritis Blepharitis √

11 Bronkitis akut Acute bronchitis, unspecified √

12 Buta senja Night blindness √

13 Cutaneus larva migran Hookworm disease, unspecified √

14 Demam dengue, DHF Dengue haemorrhagic fever √

Typhoid fever
15 Demam tifoid √

16 Dermatitis atopik (kecuali Dermatitis atopik (kecuali √

recalcitrant) recalcitrant)

17 Dermatitis kontak iritan Irritant contact dermatitis √

18 Dermatitis numularis Dermatitis numularis √

Seborrhoeic dermatitis
19 Dermatitis seboroik √

Tinea barbae and tinea capitis √

20 Tinea kapitis

21 Tinea barbae Tinea barbae and tinea capitis √

22 Tinea Imbricate Other dermatophytoses √

Tinea corporis
23 Tinea korporis √

24 Tinea manum Tinea manuum √

25 Tinea unguium Tinea unguium √

 Tinea cruris
26 Tinea kruris √

Tinea pedis
27 Tinea pedis √

28 Diabetes melitus tipe 1 Diabetes insulin dependent √

Non-insulin-dependent
29 Diabetes melitus tipe 2 diabetes mellitus √

30 Disentri basiler dan amuba Acute amoebic dysentery √

31 Dislipidemia Hiperlipidemia √

32 Epistaksis Epistaxis √

Generalized skin eruption due

33 Exanthematous drug eruption √
to drugs and medicament

Acute pharyngitis, unspecified √

34 Faringitis

35 Filariasis Filariasis √

Abscess, furuncle and

36 Furunkel pada hidung carbuncle of nose √

Gastritis, unspecified
37 Gastritis √

38 Gastroenteritis (termasuk kolera, Diarrhoea and gastroenteritis √

giardiasis) of presumed infection origin

Gonococcal infection,
39 Gonore √
unspecified
40 Hemoroid grade 1-2 Haemorrhoids √

41 Hepatitis A Acute Hepatitis A √

42 Herpes simpleks tanpa komplikasi Herpesviral infection, √

unspecified

43 Herpes zoster tanpa komplikasi Zoster without complication √

44 Hipermetropia ringan Hypermetropia √

Essential (primary)
45 Hipertensi esensial hypertension √

46 Hiperuricemia (Gout) Gout √

hypoglycaemia unspecified
47 Hipoglikemia ringan √

Asymptomatic Human
48 HIV AIDS tanpa komplikasi Immunodeficiency Virus (HIV) √
infection status

Hordeolum and other deep

49 Hordeolum √
inflammation of eyelid

Omphalitis of newborn with or √

50 Infeksi pada umbilikus without mild haemorrhage

Urinary tract infection, site not √

51 Infeksi saluran kemih specified

52 Influenza Influenza, virus not identified √

Insomnia non organik pada

53 Insomnia √
psikiatri
 Malabsorption due to
54 Intoleransi makanan √
intolerance

55 Kandidiasis mulut Candidiasis unspecified √

Single spontaneous delivery,

56 Kehamilan normal √
unspecified

57 Kejang demam Febrile convulsions √

Other Ingested (parts of

58 Keracunan makanan √
plant(s))

59 Konjungtivitis Conjunctivitis, unspecified √

60 Laringitis Acute laryngitis √

Leprosy [Hansen disease]

61 Lepra √

62 Leptospirosis (tanpa komplikasi) Leptospirosis, unspecified √

63 Limfadenitis Lymphadenitis Acute √

64 Lipoma Benign lipomatous neoplasm √

burn and corrosion, body

65 Luka bakar derajat 1 dan 2 √
region unspecified

Unspecified malaria
66 Malaria √

Unspecified protein-energy
67 Malnutirisi energi-protein √
malnutrition
 Inflammatory disorders of
68 Mastitis √
breast

Otherdisorders of lacrimal
69 Mata kering √
gland

Migraine, unspecified
70 Migren √

71 Miliaria Miliaria, unspecified √

72 Miopia ringan Myopia √

73 Moluskum kontagiosum Molluscum contagiosum √

Measles without complication √

74 Morbili tanpa komplikasi (Measles NOS).

Diaper (napkin) dermatitis

75 Napkin eczema √

76 Obesitas obesity unspecified √

Otitis externa, unspecified

77 Otitis eksterna √

78 Otitis media akut Acute serous otitis media √

79 Parotitis Mumps √

Pediculosis due to Pediculus

80 Pedikulosis kapitis humanus capitis √

81 Penyakit cacing tambang Ankylostomiasis √

 Other specified disorders of eye
82 Perdarahan subkonjungtiva and adnexa √

83 Pertusis Pertusis √

84 Pitiriasis rosea Pitiriasis rosea √

85 Pitiriasis versikolor Pityriasis versicolor √

Bronchopneumonia,
86 Pneumonia, bronkopneumonia √
unspecified

Presbyopia
87 Presbiopia √

88 Reaksi anafilaktik Anaphylactic shock, unspecified √

89 Reaksi gigitan serangga Venom of other arthropods √

Gastro-oesophageal reflux
90 Refluks gastroesofageal √
disease without oesophagitis

Acute nasopharyngitis
91 Rhinitis akut √
(common cold)

92 Rhinitis alergika Allergic rhinitis, unspecified √

93 Rhinitis vasomotor Vasomotor rhinitis √

First degree perineal laceration

94 Ruptur perineum tingkat 1-2 √
during delivery

95 Serumen prop Impacted cerumen √

96 Skabies Scabies √

97 Skistosomiasis Skistosomiasis unspecified √

98 Strongiloidiasis Strongyloidiasis √

99 Taeniasis Taeniasis √

100 Tension headache Tension–type headache √

101 Tetanus Other tetanus √

102 Tonsilitis Acute tonsillitis √

Respiratory tuberkulosis,
103 Tuberkulosis paru tanpa komplikasi bacteriologically and √
histologically confirmed

104 Urtikaria (akut & kronis) Urticaria √

105 Vaginitis Acute Vaginitis √

Varicella without complication

106 Varisela tanpa komplikasi (Varicella NOS) √

107 Vertigo (Benign paroxysmal Dizziness and giddiness √

positional vertigo)

108 Veruka vulgaris Viral warts √

109 Vulvitis Acute vulvitis √

 Somatoform disorders
110 Gangguan somatoform √

Entropion and trichiasis of

111 Trikiasis √
eyelid

112 Episkleritis Episcleritis √

113 Mabuk perjalanan Mabuk perjalanan √

114 Ulkus mulut (aptosa, herpes) Stomatitis and related lesions √

Acute tubulo-interstitial
115 Pielonefritis tanpa komplikasi nephritis (applicable to: acute √
pyelonephritis)

116 Fimosis Phimosis √

117 Parafimosis Paraphimosis √

Complication associated with

118 Sindrom duh (discharge) genital artificial fertilization, √
(gonore dan nongonore) unspecified

Urinary tract infection, site not

119 Infeksi saluran kemih bagian specified √
bawah

120 Vaginosis bakterialis Acute Vaginitis √

121 Salpingitis Salpingitis √

122 Abses folikel rambut atau kelenjar *tidak ditemukan Panduan √

sebasea Klinis di KMK

Cracked nipple associated with

the
123 Cracked nipple puerperium; Cracked nipple √
associated with lactation
 Retracted nipple associated
with the
124 Inverted nipple puerperium; Retracted nipple √
associated with
lactation

125 Defisiensi vitamin Defisiensi vitamin √

*tidak ditemukan Panduan

126 Defisiensi mineral √
Klinis di KMK

Iron Deficiency Anemias

127 Anemia defisiensi besi √

Varicose veins of lower

extremities with ulcer; Ulcer of √
128 Ulkus pada tungkai lower limb, notelsewhere
classified

129 Sifilis stadium 1 dan 2 SIFILIS √

130 Impetigo Impetigo √

131 Impetigo ulseratif (ektima) Impetigo √

132 Folikulitis superfisialis Pioderma √

Cutaneous abscess, furuncle

133 Furunkel, karbunkel √
and carbuncle

134 Eritrasma Erythrasmay √

135 Erisipelas Erysipelas √

Tuberculosis of skin and

136 Skrofuloderma √
subcutaneous tissue

137 Kandidosis mukokutan ringan Candidiasis unspecified √

 Pthiriasis
138 Pedikulosis pubis √

139 Akne vulgaris ringan Acne vulgaris √

140 Hidradenitis supuratif Hidradenitis suppurativa √

141 Dermatitis perioral Perioral dermatitis √

Open wound of unspecified

142 Vulnus laseratum, punctum √
body region

*tidak ditemukan Panduan

143 Kekerasan tumpul √
Klinis di KMK

*tidak ditemukan Panduan

144 Kekerasan tajam √
Klinis di KMK
REVIEW 144 DIAGNOSA DI FKTP
Keterangan Keterbatasan
(Uraikan Keterangan Alasan Diagnosa Tidak Tertangani di FKTP) Tercantum dalam PPK dokter
di FKTP berdasar KMK
514/2015
Kompetensi Sarana dan Prasarana

3A Belum memadai ADA

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DX Flag
Typhoid fever YA
Bacterial foodborne intoxicati.. YA
Acute amoebic dysentery YA
Tuberculosis of lung, confirme.. YA
Tuberculosis of skin and subcu.. YA
Leptospirosis icterohaemorrhag.. YA
Indeterminate leprosy YA
Other tetanus YA
Whooping cough due to Bordetella pertussis YA
Erysipelas YA
Primary genital syphilis YA
Cardiovascular syphilis YA
Gonococcal infection of lower .. YA
Dengue fever [classical dengue.. YA
Dengue haemorrhagic fever YA
Chikungunya virus disease YA
Herpesviral vesicular dermatit.. YA
Herpesviral infection, unspeci.. YA
Varicella without complication YA
Zoster without complication YA
Measles without complication YA
Viral warts YA
Molluscum contagiosum YA
Hepatitis A with hepatic coma YA
Acute hepatitis B with delta-a.. YA
Acute delta-(super)infection o.. YA
Acute hepatitis C YA
Acute hepatitis E YA
Unspecified human immunodefici.. YA
Mumps orchitis YA
Tinea barbae and tinea capitis YA
Tinea unguium YA
Tinea manuum YA
Tinea pedis YA
Tinea corporis YA
Tinea cruris YA
Dermatophytosis, unspecified YA
Pityriasis versicolor YA
Plasmodium falciparum malaria .. YA
Plasmodium vivax malaria with .. YA
Plasmodium malariae malaria wi.. YA
Plasmodium ovale malaria YA
Unspecified malaria YA
Schistosomiasis due to Schisto.. YA
Taenia solium taeniasis YA
Filariasis due to Wuchereria b.. YA
Ancylostomiasis YA
Hookworm disease, unspecified YA
Pediculosis due to Pediculus h.. YA
Intestinal strongyloidiasis YA
Pediculosis due to Pediculus h.. YA
Phthiriasis YA
Scabies YA
Benign lipomatous neoplasm, un.. YA
Iron deficiency anaemia second.. YA
Anaemia, unspecified YA
Insulin-dependent diabetes mel.. YA
Non-insulin-dependent diabetes.. YA
Hypoglycaemia, unspecified YA
Unspecified protein-energy mal.. YA
Vitamin deficiency, unspecifie.. YA
Copper deficiency YA
Obesity due to excess calories YA
Glycogen storage disease YA
Hyperlipidaemia, unspecified YA
Hyperuricaemia without signs o.. YA
Somatization disorder YA
Migraine without aura [common .. YA
Tension-type headache YA
Disorders of initiating and ma.. YA
Bell's palsy YA
Hordeolum and other deep infla.. YA
Blepharitis YA
Entropion and trichiasis of ey.. YA
Mucopurulent conjunctivitis YA
Conjunctival haemorrhage YA
Episcleritis YA
Keratoconjunctivitis YA
Hypermetropia YA
Myopia YA
Astigmatism YA
Presbyopia YA
Subjective visual disturbances YA
Abscess of external ear YA
Impacted cerumen YA
Otitis media, unspecified YA
Meniere's disease YA
Essential (primary) hypertensi.. YA
Varicose veins of lower extrem.. YA
Internal thrombosed haemorrhoi.. YA
Nonspecific mesenteric lymphad.. YA
Acute nasopharyngitis [common .. YA
Streptococcal pharyngitis YA
Streptococcal tonsillitis YA
Acute laryngitis YA
Influenza with pneumonia, infl.. YA
Adenoviral pneumonia YA
Vasomotor rhinitis YA
Allergic rhinitis, unspecified YA
Abscess, furuncle and carbuncl.. YA
Bronchitis, not specified as a.. YA
Asthma, unspecified YA
Gastro-oesophageal reflux dise.. YA
Other acute gastritis YA
Noninfective gastroenteritis a.. YA
Impetigo [any organism] [any s.. YA
Cutaneous abscess, furuncle an.. YA
Cutaneous abscess, furuncle an.. YA
Cutaneous abscess, furuncle an.. YA
Pyoderma YA
Erythrasma YA
Local infection of skin and su.. YA
Besnier's prurigo YA
Seborrhoea capitis YA
Irritant contact dermatitis du.. YA
Generalized skin eruption due .. YA
Localized skin eruption due to.. YA
Dermatitis due to ingested foo.. YA
Nummular dermatitis YA
Dermatitis, unspecified YA
Pityriasis rosea YA
Allergic urticaria YA
Acne vulgaris YA
Perioral dermatitis YA
Hidradenitis suppurativa YA
Miliaria, unspecified YA
Tubulo-interstitial nephritis .. YA
Urinary tract infection, site .. YA
Redundant prepuce, phimosis an.. YA
Other specified disorders of m.. YA
Inflammatory disorders of brea.. YA
Other signs and symptoms in br.. YA
Acute salpingitis and oophorit.. YA
Acute vaginitis YA
Acute vulvitis YA
Other specified inflammation o.. YA
Abdominal pregnancy YA
Spontaneous abortion, incomple.. YA
Malnutrition in pregnancy YA
First degree perineal lacerati.. YA
Second degree perineal lacerat.. YA
Third degree perineal lacerati.. YA
Fourth degree perineal lacerat.. YA
Cracked nipple associated with.. YA
Epistaxis YA
Febrile convulsions YA
Foreign body in conjunctival s.. YA
Foreign body in nostril YA
Burn of first degree, body reg.. YA
Burn of second degree, body re.. YA
Motion sickness YA
Anaphylactic shock, unspecifie.. YA
Accidental puncture and lacera.. YA
 1 Abortus
spontan
13 Alergi
komplit
makanan
25 Anemia
defisiensi
37 Askariasis
besi pada
49 Asma
kehamilan
Bronkial
61 Astigmatis
m ringan
73 Bell's
Palsy
85 Benda
asing di
97 Benda
hidung
asing di
109 Blefaritis
konjungtiv
121 aBronkitis
akut
133 Buta senja
145 Cutaneus
larva
157 Demam
migran
dengue,
169 Demam
DHF
tifoid
181 Dermatitis
atopik
193 Dermatitis
(kecuali
kontak
205 Dermatitis
recalcitra
iritan
numularis
217 nt)
Dermatitis
seboroik
229 Tinea
kapitis
241 Tinea
barbae
253 Tinea
Imbricate
265 Tinea
korporis
277 Tinea
manum
289 Tinea
unguium
301 Tinea
kruris
313 Tinea
pedis
325 Diabetes
melitus
337 Diabetes
tipe 1
melitus
349 Disentri
tipe 2
basiler
361 Dislipide
dan
mia
373 Epistaksis
amuba
385 Exanthem
atous
Faringitis
drug
397 eruption
409 Filariasis
421 Furunkel
pada
433 Gastritis
hidung
445 Gastroent
eritis
457 Gonore
(termasuk
469 Hemoroid
kolera,
grade 1-2
giardiasis)
481 Hepatitis
A
493 Herpes
simpleks
505 Herpes
tanpa
zoster
komplikas
tanpa
ikomplikas
i
 517 Hipermetr
opia
529 Hipertensi
ringan
esensial
541 Hiperuric
emia
553 Hipoglike
(Gout)
mia AIDS
565 HIV
ringan
tanpa
577 Hordeolu
komplikas
m
589 Infeksi
i
pada
601 Infeksi
umbilikus
saluran
613 Influenza
kemih
Insomnia
625
637 Intolerans
i makanan
649 Kandidiasi
s mulut
661 Kehamila
n normal
673 Kejang
demam
685 Keracuna
n
697 Konjungti
makanan
vitis
709 Laringitis
721 Lepra
733 Leptospir
osis
745 Limfadeni
(tanpa
tis
757 Lipoma
komplikas
i)
769 Luka
bakar
781 Malaria
derajat 1
793 Malnutiris
dan 2
i energi-
805 Mastitis
protein
817 Mata
kering
829 Migren
841 Miliaria
853 Miopia
ringan
865 Molusku
m
877 Morbili
kontagios
tanpa
889 Napkin
um
komplikas
eczema
901 Obesitas
i
913 Otitis
eksterna
925 Otitis
media
937 Parotitis
akut
949 Pedikulosi
s kapitis
961 Penyakit
cacing
973 Perdaraha
tambang
n
985 Pertusis
subkonjun
997 Pitiriasis
gtiva
rosea
1009 Pitiriasis
versikolor
1021 Pneumoni
a,
1033 Presbiopi
bronkopn
a
eumonia
1045 Reaksi
anafilaktik
1057 Reaksi
gigitan
1069 Refluks
serangga
gastroesof
1081 Rhinitis
ageal
akut
1093 Rhinitis
alergika
1105 Rhinitis
vasomoto
1117 Ruptur
rperineum
1129 Serumen
tingkat
prop 1-
1141 Skabies
2
1153 Skistosom
iasis
1165 Strongiloi
diasis
Taeniasis
1177
1189 Tension
headache
1201 Tetanus
1213 Tonsilitis
1225 Tuberkulo
sis paru
1237 Urtikaria
tanpa
(akut &
1249 Vaginitis
komplikas
kronis)
1261 iVarisela
tanpa
1273 Vertigo
komplikas
(Benign
1285 Veruka
iparoxysm
vulgaris
1297 Vulvitis
al
1309 positional
Gangguan
vertigo)
somatofor
1321 Trikiasis
m
1333 Episkleriti
s
1345 Mabuk
perjalana
1357 Ulkus
n
mulut
1369 Pielonefri
(aptosa,
tis tanpa
1381 Fimosis
herpes)
komplikas
1393 Parafimosi
i
s
1405 Sindrom
duh
1417 Infeksi
(discharge
saluran
1429 Vaginosis
)kemih
genital
bakterialis
1441 (gonore
Salpingitis
bagian
dan
1453 bawah
Abses
nongonor
folikel
1465 Cracked
e)
rambut
nipple
1477 Inverted
atau
nipple
kelenjar
1489 Defisiensi
sebasea
vitamin
1501 Defisiensi
mineral
1513 Anemia
defisiensi
1525 Ulkus
besi
pada
1537 Sifilis
tungkai
stadium 1
1549 Impetigo
dan 2
1561 Impetigo
ulseratif
(ektima)
1573 Folikulitis
superfisial
1585 Furunkel,
is
karbunkel
1597 Eritrasma
1609 Erisipelas
1621 Skrofulod
erma
1633 Kandidosi
s
1645 Pedikulosi
mukokuta
sAkne
pubis
1657 n ringan
vulgaris
Hidradeni
1669 ringan
tis
1681 Dermatitis
supuratif
perioral
1693 Vulnus
laseratum
1705 Kekerasan
,tumpul
punctum
1717 Kekerasan
tajam

1 Abortus Unspecifie
spontan d
13 Alergi
komplit
Dermatiti
abortion,
makanan s due to
25 Anemia Ironcomplete,
defisiensi ingested
deficiency
without
37 Askariasis Ascariaris
besi pada food
anaemia
complicati
unspecifie
49 kehamilan Asthma
Asma
on
Bronkial d
61 Astigmatis Astigmati
m ringan sme
73 Bell's Bells’
Palsy palsy
85 Benda Foreign
asing
Benda di body
Foreign in
97 hidung nostril
asing di body on
109 Blefaritis Blephariti
konjungtiv external
sAcute
121 Bronkitis
a eye, part
akut bronchitis,
133 Buta senja unspecifie
Night
unspecifie
Cutaneus d
blindness
Hookwor
145 d
larva
Demam m
Dengue
157 migran disease,
dengue, haemorrh
169 Demam
DHF
Typhoid
unspecifie
agic fever
tifoid fever
181 Dermatitis dAtopic
atopik dermatitis
193 Dermatitis
(kecuali
Irritant
kontak contact
205 Dermatitis
recalcitra
iritan
Other
dermatitis
numularis
nt) atopic
217 Dermatitis Seborrhoe
dermatitis
seboroik ic
229 Tinea Tinea
dermatitis
kapitis
Tinea barbae
Tinea
241 and tinea
barbae barbae
253 Tinea Other
capitis
Imbricate and tinea
dermatop
265 Tinea Tinea
capitis
korporis hytoses
corporis
277 Tinea Tinea
manum
Tinea manuum
Tinea
289
unguium unguium
301 Tinea Tinea
kruris cruris
313 Tinea Tinea
pedis pedis
325 Diabetes Diabetes
melitus insulin
337 Diabetes
tipe
Non-
melitus dependen
1 insulin-
tipe 2 tdependen
t diabetes
mellitus
349 Disentri Acute
basiler amoebic
361 Dislipide
dan
Hiperlipid
dysentery
mia emia
373 Epistaksis
amuba Epistaxis
385 Exanthem Generaliz
atous ed skin
397 Faringitis
drug
Acute
eruption
pharyngiti
409 Filariasis
eruption Filariasis
due
s, to
drugs
421 Furunkel Abscess,
unspecifie and
pada medicame
furuncle
d
433 Gastritis
hidung
Gastritis,
nt
and
Gastroent unspecifie
Diarrhoea
445 carbuncle
d
eritis and
of nose
457 (termasuk Gonococc
Gonore
gastroent
al
469 Hemoroid
kolera, Haemorrh
eritis
infection,of
grade 1-2 oids
481 Hepatitis presumed
giardiasis) Acute
unspecifie
A infection
Hepatitis
d
493 Herpes Herpesvir
origin
A
simpleks al
505 Herpes
tanpa
Zoster
infection,
zoster without
517 Hipermetr
komplikas
tanpa
Hypermet
unspecifie
complicati
opia
Hipertensi ropia
i d
Essential
529 komplikas
ringan on
esensial
i
Hiperuric (primary)
Gout
541 hypertensi
emia
553 Hipoglike
(Gout)
hypoglyca
on
mia AIDS emia
565 HIV
ringan
Asympto
unspecifie
tanpa matic
577 Hordeolu
komplikas
Hordeolu
d
Human
m
Infeksi m and
Omphaliti
589 i Immunod
other
pada sUrinary
of
eficiency
601 Infeksi
umbilikus deep
newborn
saluran tract Virus
inflamma
613 Influenza
kemih
Influenza,
with
(HIV) or
infection,
tion
virus ofnot
625 Insomnia without
Insomnia
infection
site
eyelid not
identified
mild
non
status
specified
637 Intolerans Malabsor
haemorrh
makanan organik
iKandidiasi ption due
Candidiasi
649 age
pada
to
s mulut spsikiatri
661 Kehamila Single
intoleranc
n normal unspecifie
spontane
ed
673 Kejang Febrile
ous
demam
Keracuna convulsio
Other
685 delivery,
ns
n Ingested
unspecifie
697 makanan Conjunctiv
Konjungti
(parts of
vitis d
itis,
709 Laringitis Acute
plant(s))
unspecifie
laryngitis
721 Lepra Leprosy
d
Leptospir [Hansen
Leptospiro
733 disease]
osis sis,
745 Limfadeni
(tanpa
Lymphade
unspecifie
tis nitis Acute
757 Lipoma
komplikas Benign
d
lipomatou
769 i)
Luka burn and
scorrosion,
bakar
781 derajat 1 Unspecifie
Malaria neoplasm
body
Malnutiris d malaria
Unspecifie
793 dan 2 region
i energi- d protein-
unspecifie
805 Mastitis
protein energy
Inflammat
d
ory
817 Mata Otherdiso
malnutriti
disorders
kering
Migren rders
on of
Migraine,
829 of breast
lacrimal
unspecifie
841 Miliaria Miliaria,
gland
d
unspecifie
853 Miopia Myopia
d
ringan
865 Molusku Molluscu
m m
877 Morbili
kontagios
Measles
contagios
tanpa without
um
komplikas um complicati
i on
(Measles
NOS).
 889 Napkin Diaper
eczema (napkin)
901 Obesitas obesity dermatitis
unspecifie
913 Otitis Otitis
d
eksterna externa,
925 Otitis Acute
unspecifie
media
Parotitis serous
Mumps
937 akut d
otitis
949 Pedikulosi Pediculosi
media
sPenyakit
kapitis sAnkylosto
due to
961 Pediculus
cacing miasis
973 Perdaraha
tambang
Other
humanus
n specified
capitis
985 subkonjun *tidak
Pertusis
disorders
ditemuka
997 Pitiriasis
gtiva of
n eye and
rosea adnexa
1009 Pitiriasis Pityriasis
Panduan
versikolor versicolor
1021 Pneumoni Klinis Bronchop di
a, KMK
neumonia
1033 Presbiopi
bronkopn
Presbyopi
,a
aReaksi
1045 eumonia Anaphylac unspecifie
anafilaktik tic d shock,
1057 Reaksi Venom
unspecifie
of
gigitan other
1069 Refluks
serangga
Gastro-
d
arthropod
gastroesof
Rhinitis oesophag
Acute
1081 ageal seal reflux
akut
Rhinitis nasophar
Allergic
1093 disease
yngitis
alergika rhinitis,
without
1105 Rhinitis Vasomoto (common
unspecifie
vasomoto oesophagi
rcold)
rhinitis
1117 Ruptur
rperineum d
First
tis
degree
1129 Serumen
tingkat
Impacted
1- perineal
prop cerumen
1141 Skabies
2 Scabies
laceration
1153 Skistosom Skistosom during
iasis delivery
iasis
1165 Strongiloi Strongyloi
unspecifie
diasis diasis
1177 Taeniasis Taeniasis d
1189 Tension Tension–
headache type
1201 Tetanus Other headache
tetanus
1213 Tonsilitis Acute
tonsillitis
1225 Tuberkulo Respirator
sis paru yUrticaria
1237 Urtikaria
tanpa
(akut & tuberkulo
1249 Vaginitis
komplikas
kronis)
Acute
sis,
Vaginitis
1261 Varisela bacteriolo
i Varicella
tanpa gically
without
1273 komplikas Dizziness
Vertigo
and
(Benign complicati
and
1285 Veruka
iparoxysm Viral histologic
on
vulgaris giddiness
warts
ally
(Varicella
1297 Vulvitis
al Acute
positional confirmed
NOS)
Vaginitis
1309 Gangguan Somatofor
vertigo)
somatofor m
1321 Trikiasis
m
Entropion
disorders
and
1333 Episkleriti Episcleriti
trichiasis
s s*tidak
1345 Mabuk of eyelid
perjalana ditemuka
1357 Ulkus
n
Stomatitis
n
mulut and
1369 (aptosa, Acute
Pielonefri Panduan
tis tanpa related
Fimosis tubulo-
Klinis
Phimosisdi
1381 herpes)
komplikas lesionsinterstitial
KMK
1393 Parafimosi
i Paraphim
nephritis
sSindrom osis (applicabl
Complica
1405
duh e to:
tion
1417 (discharge Urinary
Infeksi
acute
saluran associate
tract
)kemih
genital d pyeloneph
with
infection,
(gonore
bagian ritis)
artificial
site not
dan
bawah fertilizatio
specified
nongonor n,
e) unspecifie
1429 Vaginosis Acute
bakterialis Vaginitis
1441 Salpingitis *tidak
ditemuka
1453 Abses *tidak
n
folikel ditemuka
1465 Cracked
rambut
Cracked
Panduan
n
nipple
Inverted nipple
Klinis di
Retracted
1477 atau Panduan
associate
nipple KMK
nipple
kelenjar *tidak
Klinis
1489 Defisiensi d withdithe
associate
sebasea
vitamin KMK
ditemuka
puerperiu
1501 Defisiensi *tidak
d
n with the
mineral m;
ditemuka
1513 Anemia puerperiu
Iron
Panduan
Cracked
defisiensi nm;
Deficiency
Klinis di
1525 Ulkus
besi
Varicose
nipple
Panduan
Retracted
Anemias
pada KMK
veins
Klinis of
associate
di
1537 Sifilis
tungkai
SIFILIS
nipple
lower
stadium 1 d
KMKwith
associate
Impetigo Impetigo
extremitie
lactation
dan 2 d with
1549 s with
lactation
ulcer;
1561 Impetigo Impetigo
ulseratif Ulcer of
1573 Folikulitis
(ektima)
Pioderma
lower
superfisial limb,
1585 Furunkel,
is
Cutaneou
karbunkel notelsewh
s abscess,
1597 Eritrasma Erythrasm
ere
furuncle
ay
1609 Erisipelas Erysipelas
classified
and
1621 Skrofulod carbuncle
Tuberculo
erma sis of skin
1633 Kandidosi Candidiasi
and
s sPthiriasis
1645 Pedikulosi
mukokuta subcutane
unspecifie
sAkne
pubis ous
1657 n ringan Acned tissue
vulgaris vulgaris
1669 Hidradeni
ringan
Hidradeni
tis tis
1681 Dermatitis
supuratif
Perioral
suppurati
perioral dermatitis
1693 Vulnus Open
va
laseratum wound of
1705 , punctum *tidak
Kekerasan
tumpul unspecifie
ditemuka
1717 Kekerasan *tidak
d
n body
tajam ditemuka
region
Panduan
n
Klinis
Panduandi
KMK
Klinis di
KMK
Diagnosa Pcare (Non Spsesialistik) NO KMK
Malnutrition in pregnancy
139
Mumps orchitis
30
Unspecified protein-energy mal..
60

Nonspecific mesenteric lymphad..

91
Pityriasis rosea 121

Noninfective gastroenteritis a..

105
Dermatitis, unspecified
120
Cutaneous abscess, furuncle an.. 109
Otitis media, unspecified
86

Acute nasopharyngitis [common ..

92
Other acute gastritis
104

Essential (primary) hypertensi..

88

Tuberculosis of skin and subcu..

5
Leptospirosis icterohaemorrhag..
6

Indeterminate leprosy
7
Glycogen storage disease
64
Erysipelas 10
Primary genital syphilis
11

Hyperlipidaemia, unspecified
65
Acne vulgaris

123

Acute salpingitis and oophorit..

133

Dengue fever [classical dengue..

14
Bacterial foodborne intoxicati..
2

Chikungunya virus disease

16
Viral warts
22
Erythrasma
111
Local infection of skin and su.. 112
Tinea unguium 32
Acute vulvitis 135
Acute vaginitis 134

Taenia solium taeniasis

45
Insulin-dependent diabetes mel..
57
Tinea corporis
35

Streptococcal tonsillitis
94

Whooping cough due to Bordetella pertussis

9
Other tetanus
8

Internal thrombosed haemorrhoi..

90
Tinea manuum

33

Plasmodium falciparum malaria ..

39
Plasmodium malariae malaria wi.. 41

Plasmodium ovale malaria

42

First degree perineal lacerati..

140

Gonococcal infection of lower ..

13

Pediculosis due to Pediculus h..

49

Tinea barbae and tinea capitis

31
Schistosomiasis due to Schisto.. 44

Ancylostomiasis
47
Acute laryngitis 95
Other specified disorders of m.. 130
Inflammatory disorders of brea..
131

Vitamin deficiency, unspecifie..

61

Migraine without aura [common ..

68
Phthiriasis
52
Acute hepatitis E
28
Vasomotor rhinitis 98

Tubulo-interstitial nephritis ..

127
Herpesviral vesicular dermatit..
17
Copper deficiency
62

Acute amoebic dysentery

3

Entropion and trichiasis of ey..

74

Disorders of initiating and ma..

70
Bell's palsy
71
Blepharitis
73
Besnier's prurigo 113

Hypoglycaemia, unspecified
59
Hypermetropia 79

Hordeolum and other deep infla..

72

Pityriasis versicolor

38

Unspecified human immunodefici..

29
Obesity due to excess calories
63
Herpesviral infection, unspeci..
18
Conjunctival haemorrhage 76

Dermatophytosis, unspecified
37
Bronchitis, not specified as a..
101
Keratoconjunctivitis
78
Tuberculosis of lung, confirme..
4

Myopia

80
Second degree perineal lacerat.. 141
Abscess of external ear 84
Impacted cerumen 85
Meniere's disease
87
Redundant prepuce, phimosis an.. 129
Other signs and symptoms in br.. 132

Generalized skin eruption due ..

116
Influenza with pneumonia, infl..
96

Varicella without complication

19

Typhoid fever

Tinea pedis
34
Asthma, unspecified 102
Allergic rhinitis, unspecified
99
Abscess, furuncle and carbuncl..
100

Zoster without complication

20

Measles without complication

21
Molluscum contagiosum
23
Acute delta-(super)infection o..
26
Hepatitis A with hepatic coma 24
Acute hepatitis C
27
Acute hepatitis B with delta-a.. 25

Other specified inflammation o..

136

Irritant contact dermatitis du..

115
Dengue haemorrhagic fever
15

Hookworm disease, unspecified

48

Hyperuricaemia without signs o..

66

Somatization disorder
67

Pediculosis due to Pediculus h..

51

Impetigo [any organism] [any s..

106

Urinary tract infection, site ..

128

Streptococcal pharyngitis
93
Cutaneous abscess, furuncle an.. 108
Hidradenitis suppurativa
125
Subjective visual disturbances 83
Unspecified malaria
43
Cardiovascular syphilis 12
Tinea cruris
36
Plasmodium vivax malaria with .. 40
Filariasis due to Wuchereria b.. 46

Intestinal strongyloidiasis

50

Scabies
53
Benign lipomatous neoplasm, un..
54

Iron deficiency anaemia second..

55

Anaemia, unspecified

56

Non-insulin-dependent diabetes..

58
Tension-type headache
69

Mucopurulent conjunctivitis
75

Episcleritis
77
Astigmatism 81

Presbyopia

82

Varicose veins of lower extrem..

89
Adenoviral pneumonia
97
Gastro-oesophageal reflux dise..

103

Cutaneous abscess, furuncle an..

107

Pyoderma
110

Seborrhoea capitis
114
Localized skin eruption due to.. 117

Dermatitis due to ingested foo..

118

Nummular dermatitis

119

Allergic urticaria
122

Perioral dermatitis

124

Miliaria, unspecified
126
Abdominal pregnancy
137

Spontaneous abortion, incomple..

138

Third degree perineal lacerati..

142
Fourth degree perineal lacerat..
143

Cracked nipple associated with..

144
Epistaxis
Febrile convulsions

Foreign body in conjunctival s..

Foreign body in nostril

Burn of first degree, body reg..

Burn of second degree, body re..

Motion sickness

Anaphylactic shock, unspecifie..

Accidental puncture and lacera..

 144 Diagnosa
(SE JUKNIS PEER REVIEW) Nama DX di Pcare yg difalg Non Spesilistik
INDONESIA ENGLISH
Akne vulgaris ringan Acne vulgaris
Acne vulgaris
Disentri basiler dan amuba Acute amoebic
dysentery Acute amoebic dysentery
Laringitis Acute laryngitis
Acute laryngitis
Rhinitis akut Acute
nasopharyngitis Acute nasopharyngitis [common ..
(common cold)

Salpingitis Salpingitis Acute salpingitis and oophorit..

Vaginitis Acute Vaginitis

Acute vaginitis

Vaginosis bakterialis Acute Vaginitis

Acute vaginitis
Vulvitis Acute vulvitis Acute vulvitis
Pneumonia, bronkopneumonia Bronchopneumonia,
unspecified Adenoviral pneumonia
Rhinitis alergika Allergic rhinitis,
unspecified Allergic rhinitis, unspecified

Urtikaria (akut & kronis) Urticaria

Allergic urticaria
Reaksi anafilaktik Anaphylactic shock,
unspecified Anaphylactic shock, unspecifie..

Asma Bronkial Asthma

Asthma, unspecified

Astigmatism ringan Astigmatisme

Astigmatism
Bell's Palsy Bells’ palsy
Bell's palsy

Lipoma Benign lipomatous

neoplasm Benign lipomatous neoplasm, un..
Blefaritis Blepharitis Blepharitis
Bronkitis akut Acute bronchitis,
unspecified Bronchitis, not specified as a..
Luka bakar derajat 1 dan 2 burn and corrosion,
body region Burn of first degree, body reg..
unspecified
Cracked nipple Cracked nipple
associated with the
puerperium; Cracked
nipple associated
with lactation
Cracked nipple associated with..

Furunkel, karbunkel Cutaneous abscess,

furuncle and Cutaneous abscess, furuncle an..
carbuncle

Demam dengue, DHF Dengue

haemorrhagic fever Dengue haemorrhagic fever

Alergi makanan Dermatitis due to

ingested food Dermatitis due to ingested foo..
Dermatitis atopik (kecuali Dermatitis atopik
recalcitrant) (kecuali recalcitrant) Dermatitis, unspecified

Tinea Imbricate Other

dermatophytoses Dermatophytosis, unspecified
Trikiasis Entropion and
trichiasis of eyelid Entropion and trichiasis of ey..
Episkleritis Episcleritis Episcleritis
Epistaksis Epistaxis Epistaxis
Erisipelas Erysipelas Erysipelas
Eritrasma Erythrasmay Erythrasma
Hipertensi esensial Essential (primary)
hypertension Essential (primary) hypertensi..

Kejang demam Febrile convulsions

Filariasis
Ruptur perineum tingkat 1-2
Febrile convulsions
Filariasis
Filariasis due to Wuchereria b..
First degree perineal
laceration during First degree perineal lacerati..
delivery

Benda asing di konjungtiva Foreign body on

external eye, part Foreign body in conjunctival s..
unspecified

Benda asing di hidung Foreign body in

Refluks gastroesofageal
nostril Foreign body in nostril
Gastro-oesophageal
reflux disease
without oesophagitis
Gastro-oesophageal reflux dise..
Exanthematous drug eruption Generalized skin
eruption due to drugs
and medicament Generalized skin eruption due ..

Gonore Gonococcal infection,

unspecified Gonococcal infection of lower ..

Hepatitis A Acute Hepatitis A Hepatitis A with hepatic coma

Herpes simpleks tanpa komplikasi Herpesviral infection,
unspecified Herpesviral infection, unspeci..

Hidradenitis supuratif Hidradenitis

suppurativa Hidradenitis suppurativa

Cutaneus larva migran Hookworm disease,

unspecified Hookworm disease, unspecified

Hordeolum Hordeolum and other

deep inflammation of
eyelid Hordeolum and other deep infla..

Dislipidemia Hiperlipidemia
Hyperlipidaemia, unspecified

Hipermetropia ringan Hypermetropia Hypermetropia

Hipoglikemia ringan hypoglycaemia
unspecified Hypoglycaemia, unspecified

Serumen prop Impacted cerumen Impacted cerumen

Impetigo Impetigo Impetigo [any organism] [any s..
Impetigo ulseratif (ektima) Impetigo
Impetigo [any organism] [any s..
Lepra Leprosy [Hansen
disease] Indeterminate leprosy

Mastitis Inflammatory
disorders of breast Inflammatory disorders of brea..

Influenza Influenza, virus not

identified Influenza with pneumonia, infl..
Diabetes melitus tipe 1 Diabetes insulin
dependent Insulin-dependent diabetes mel..
Strongiloidiasis Strongyloidiasis Intestinal strongyloidiasis
Anemia defisiensi besi Iron Deficiency
Anemias
Iron deficiency anaemia second..
Dermatitis kontak iritan Irritant contact
dermatitis Irritant contact dermatitis du..
Leptospirosis (tanpa komplikasi) Leptospirosis,
unspecified Leptospirosis icterohaemorrhag..
Anemia defisiensi besi pada Anemia defisiensi
kehamilan besi pada kehamilan Malnutrition in pregnancy

Morbili tanpa komplikasi Measles without

complication Measles without complication
(Measles NOS).

Migren Migraine, unspecified

Migraine without aura [common ..

Miliaria Miliaria, unspecified

Miliaria, unspecified
Moluskum kontagiosum Molluscum
contagiosum Molluscum contagiosum
Mabuk perjalanan Mabuk perjalanan Motion sickness
Konjungtivitis Conjunctivitis,
unspecified Mucopurulent conjunctivitis

Parotitis Mumps Mumps orchitis

Miopia ringan Myopia

Myopia

Gastroenteritis (termasuk kolera, Diarrhoea and

giardiasis) gastroenteritis of
presumed infection Noninfective gastroenteritis a..
origin

Diabetes melitus tipe 2 Non-insulin-

dependent diabetes
mellitus
Non-insulin-dependent diabetes..

Limfadenitis Lymphadenitis Acute

Nonspecific mesenteric lymphad..
Dermatitis numularis Dermatitis numularis
Nummular dermatitis
Obesitas obesity unspecified Obesity due to excess calories
Gastritis Gastritis, unspecified
Other acute gastritis

Tetanus Other tetanus

Other tetanus
Otitis media akut Acute serous otitis
media Otitis media, unspecified
Askariasis Ascariaris unspecified
Pediculosis due to Pediculus h..
Pedikulosis kapitis Pediculosis due to
Pediculus humanus
capitis Pediculosis due to Pediculus h..

Dermatitis perioral Perioral dermatitis Perioral dermatitis

Pitiriasis rosea Pitiriasis rosea Pityriasis rosea
Pitiriasis versikolor Pityriasis versicolor Pityriasis versicolor
Presbiopia Presbyopia
Presbyopia
Sifilis stadium 1 dan 2 SIFILIS Primary genital syphilis
Folikulitis superfisialis Pioderma Pyoderma
Fimosis Phimosis

Redundant prepuce, phimosis an..

Skabies Scabies
Scabies
Dermatitis seboroik Seborrhoeic
dermatitis
Seborrhoea capitis

Abortus spontan komplit Unspecified abortion,

complete, without
complication Spontaneous abortion, incomple..

Faringitis Acute pharyngitis,

unspecified Streptococcal pharyngitis

Tonsilitis Acute tonsillitis Streptococcal tonsillitis

Taeniasis Taeniasis
Taenia solium taeniasis
Tension headache Tension–type
headache Tension-type headache
Tinea kapitis Tinea barbae and
tinea capitis Tinea barbae and tinea capitis

Tinea barbae Tinea barbae and

tinea capitis Tinea barbae and tinea capitis

Tinea korporis Tinea corporis

Tinea corporis
Tinea kruris Tinea cruris
Tinea cruris
Tinea manum Tinea manuum Tinea manuum
Tinea pedis Tinea pedis
Tinea pedis
Tinea unguium Tinea unguium Tinea unguium
Skrofuloderma Tuberculosis of skin
and subcutaneous
tissue Tuberculosis of skin and subcu..

Pielonefritis tanpa komplikasi Acute tubulo-

interstitial nephritis
(applicable to: acute
pyelonephritis) Tubulo-interstitial nephritis ..

Demam tifoid Typhoid fever

Typhoid fever
HIV AIDS tanpa komplikasi Asymptomatic
Human
Immunodeficiency
Virus (HIV) infection Unspecified human immunodefici..
status

Malaria Unspecified malaria

Unspecified malaria

Malnutirisi energi-protein Unspecified protein-

energy malnutrition Unspecified protein-energy mal..

Infeksi saluran kemih Urinary tract

infection, site not
specified Urinary tract infection, site ..

Varisela tanpa komplikasi Varicella without

complication
(Varicella NOS) Varicella without complication

Ulkus pada tungkai Varicose veins of

lower extremities
with ulcer; Ulcer of
lower limb, Varicose veins of lower extrem..
notelsewhere
classified

Rhinitis vasomotor Vasomotor rhinitis

Vasomotor rhinitis

Veruka vulgaris Viral warts Viral warts

Defisiensi vitamin Defisiensi vitamin
Vitamin deficiency, unspecifie..
Pertusis Pertusis Whooping cough due to Bordetella pertussis
Herpes zoster tanpa komplikasi Zoster without
complication Zoster without complication
Buta senja Night blindness #N/A
Furunkel pada hidung Abscess, furuncle and
carbuncle of nose #N/A

Hemoroid grade 1-2 Haemorrhoids #N/A

Hiperuricemia (Gout) Gout #N/A
Infeksi pada umbilikus Omphalitis of
newborn with or
without mild #N/A
haemorrhage

Insomnia Insomnia non

organik pada #N/A
psikiatri

Intoleransi makanan Malabsorption due to

intolerance #N/A
Kandidiasis mulut Candidiasis
unspecified #N/A

Kehamilan normal Single spontaneous

delivery, unspecified
#N/A

Keracunan makanan Other Ingested (parts

of plant(s))
#N/A

Mata kering Otherdisorders of

lacrimal gland #N/A
Napkin eczema Diaper (napkin)
dermatitis #N/A

Otitis eksterna Otitis externa,

unspecified #N/A

Penyakit cacing tambang Ankylostomiasis #N/A

Perdarahan subkonjungtiva Other specified
disorders of eye and
adnexa #N/A

Reaksi gigitan serangga Venom of other

arthropods

#N/A

Skistosomiasis Skistosomiasis
unspecified #N/A
Tuberkulosis paru tanpa komplikasi Respiratory
tuberkulosis,
bacteriologically and
histologically #N/A
confirmed

Vertigo (Benign paroxysmal Dizziness and

positional vertigo) giddiness #N/A

Gangguan somatoform Somatoform

disorders #N/A

Ulkus mulut (aptosa, herpes) Stomatitis and

related lesions #N/A

Parafimosis Paraphimosis #N/A

Sindrom duh (discharge) genital Complication
(gonore dan nongonore) associated with
artificial fertilization,
unspecified #N/A

Infeksi saluran kemih bagian Urinary tract

bawah infection, site not
specified #N/A

Abses folikel rambut atau kelenjar *tidak ditemukan

sebasea Panduan Klinis di #N/A
KMK

Inverted nipple Retracted nipple

associated with the
puerperium;
Retracted nipple
associated with #N/A
lactation

Defisiensi mineral *tidak ditemukan

Panduan Klinis di #N/A
KMK

Kandidosis mukokutan ringan Candidiasis

unspecified #N/A
Pedikulosis pubis Pthiriasis

#N/A

Vulnus laseratum, punctum Open wound of

unspecified body #N/A
region
Kekerasan tumpul *tidak ditemukan
Panduan Klinis di #N/A
KMK

Kekerasan tajam *tidak ditemukan

Panduan Klinis di
KMK
#N/A
Nama DX di Pcare Tanpa Flag Non 4A KMK
Spesialistik 524/2015

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ada

ada

Tinea barbae and tinea capitis

ada

ada

ada
ada

ada
 ada

ada

ada

ada

ada

ada

ada

ada

ada

ada

ada
ada

ada
ada

ada
Night blindness ada
Abscess, furuncle and carbuncle of nose
ada
Unspecified haemorrhoids without
complication ada
Idiopathic gout ada

Omphalitis of newborn with or without mild

haemorrhage

ada

Nonorganic insomnia
ada
Malabsorption due to intolerance, not
elsewhere classified ada

Candidiasis, unspecified
ada

Single spontaneous delivery, unspecified

ada

Toxic effect of other ingested (parts of)

plant(s)

ada
Other disorders of lacrimal gland
ada

Diaper [napkin] dermatitis

ada

Otitis externa, unspecified

ada
Ancylostomiasis ada

Other specified disorders of eye and

adnexa

ada

Toxic effect of venom of other arthropods

ada
Schistosomiasis, unspecified
ada
Respiratory tuberculosis unspecified,
confirmed bacteriologically and
histologically

ada

Dizziness and giddiness

ada

Other somatoform disorders

ada

Other forms of stomatitis

ada
Redundant prepuce, phimosis and
paraphimosis ada

Complication associated with artificial

fertilization, unspecified

ada

Urinary tract infection, site not specified

ada

Follicular disorder, unspecified

ada

Retracted nipple associated with childbirth

ada

Deficiency of nutrient element, unspecified

ada
Candidiasis, unspecified
ada

Mixed pediculosis and phthiriasis

ada

Open wound of unspecified body region

ada
Assault by blunt object
ada

Assault by sharp object

ada