KETERANGAN KEMAMPUAN KLINIK DOKTER UMUM

Tingkat Kemampuan 1 : Mengenali dan menempatkan gambaran-gambaran klinik sesuai penyakit ini ketika me
literatur.Dalam korespondensi , ia dapat mengenal gambaran klinik ini, dan tahu bagaim
mendapatkan informasi lebih lanjut.
Tingkat Kemampuan 2 : Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan pemeriksaan tam
yang diminta oleh dokter. Mampu merujuk pasien secepatnya ke psesialis yang relevan
mampu menindaklanjuti setelahnya
Tingkat Kemampuan 3 A : Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan pemeriksaan tam
yang diminta oleh dokter. Mampu memutuskan dan memberi terapi pendahuluan serta
merujuk ke psesialis yang relevan ( bukan kasus gawat darurat)

Tingkat Kemampuan 3 B : Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan pemeriksaan tam
yang diminta oleh dokter. Mampu memutuskan dan memberi terapi pendahuluan serta
merujuk ke psesialis yang relevan ( Kasus gawat darurat)

Tingkat Kemampuan 4 : Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan pemeriksaan tam
yang diminta oleh dokter. Dokter dapat memutuskan dan mampu menangani problem
secara mandiri hingga tuntas
nyakit ini ketika membaca
ni, dan tahu bagaimana

n pemeriksaan tambahan
esialis yang relevan dan

n pemeriksaan tambahan
pendahuluan serta

n pemeriksaan tambahan
pendahuluan serta

n pemeriksaan tambahan
menangani problem itu
 KEWENANGAN KLINIK DOKTER UMUM
RSUD DR. KANUJOSO DJATIWIBOWO BALIKPAPAN
Dokter yang mengajukan dr. Novita Nurlita

Lulusan : Fakultas Kedokteran Universitas Mulawarman

Tahun Lulus :2015

Permohonan Disetujui
Kemampuan Kemampuan
No Kewenangan Klinik
Klinik Klinik
1 2 3 4 1 2
Cardiac disorders :
1 Angina Pectoris 3B
2 Unstable angina 3B
3 Myocardial infarction 3B
4 Heart Failure 3B
5 Cardiorespiratory arrest 3B
6 Supraventricular tachycardia 3B
7 Atrial flutter 3B
8 Ventricular extrasystole 3B

Aorta -Arteris disorder

1 Essentialhypertention 4
2 Secondary hypertension 3A
3 Septic shock 3B
4 Hypovolemic shock 3B

Veins
1 Thrombophlebitis 3A
Lymph vessels
1 Lymphangitis 3A
2 Lymphadenitis 3A
3 Lymphadema, primary and secondary 3A

Respiratory
1 Uncomplicated pulmonary TBC 4
2 TBC with HIV 4
3 Acute Bronchitis 4
4 Bronchiolitis 3A
5 Bronchial Asthma 4
6 Status asmaticus 3B
7 Lung emphysema 3A
8 Atelectasis 3B
9 Bronchiectasis 3A
10 COPD 3A
11 SARS 3B
12 Pneumonia 3B
13 Pleurisy TBC 3A
14 Pneumothorax 3B
15 Aspiration Pneumonia 3A
 Gastrointestinal
Mouth
1 Candidiasis 4
2 Mouth ulcers 4
3 Glossitis 3A

Esophagus
1 Corrosive lesion of esophagus 3B
2 Reflux esophagitis 3A

Acute Abdomen
1 Ileus 3B
2 Salphingitis 3A
3 Acute appendicitis 3B
4 Appendicular abscess 3B

Stomach and duodenum

1 Gastritis 4
2 Gatric / duodenal ulcer 3B
3 Gastrointestinal bleeding 3B
4 Gastroenteristis 4

Liver
1 Fatty liver 3A
2 Hepatitis A 3A
3 Uncomplicated hepatitis B 3A
4 Amoeboic liver abscess 3A
5 Acute cholecystitis 3A

Jejunum , ileum , colon

1 Enteristis 4
2 Irritable bowel syndrome 3A
3 Necrotizing enterocolitis 3A
4 Diverticulosis / diverticulitis 3A
5 Colitis 3A
6 Rectal, anal prolapsed 3A
7 Proctitis 3A
8 Hemorrhoids 3A

Pediatrics
1 Gastroesophageal reflux 4
2 Gastroenteritis 4
3 Gastroenteritis dengan dehidrasi 3B
4 Worms 4
5 Dehydration 3B
6 Malabsorbtion 3A
7 Food intolerance 3A
8 Perotonitis tuberculosis 3B
9 Umbilical hernia 3A
10 Hepatitis 3A
11 Cirrhosis of the liver 3A
12 Food allergy 4
 Nefrology
1 Acute glomerulonephritis 3A
2 Chronic glomerulonephritis 3A
3 Renal colic 3A
4 Urinary stone diseases or urinary calculi 3A
without colic
5 Urinary tract infection 4
6 Uncomplicated pyelonephritis 3A
7 Prostatitis 3A

Male genitalia
1 Hypospadia 3A
2 Epispadia 3A
3 Undescended testes / cryptorchidism 3A
4 Retractile of testes 3A
5 Torsion of testes 3B
6 Paraphimosis 3B
7 Ruptur uretra 3B
8 Ruptur VU 3B
9 Ruptur ginjal 3B
10 Striktura 3B
11 Priapismus 4
12 Penyakit peironi 3A
13 Ekstrophia vesicae 3A
14 Infertility 3A

Vulva
1 Vulvitis 3A
2 Cyst of bartholin , abscess of bartholin's gland 4
3 Abscess of hair follicle or sebaceous fland 4
4 Candiloma acuminate 4

Vagina , cervix, uterus,adnexae

1 Vaginitis 4
2 Bacterial vaginosis 4
3 Foreign body 4
4 Cervicitis 4
5 Salphingitis 3A
6 Ovarian cyst 3A

Hematology
1 Iron deficiency anemia 4
2 Macrocytic anemia 3A
3 Hemolytic anemia 3A
4 Anemia associated with chronic disease 3A

Immunology
1 Uncomplicated SLE 3A
2 Vasculitis Lupus 3A
3 Polymyalgia rheumatic 3A
4 Rheumatoid arthritis 3A
5 Anaphylactic reaction 3B
6 Rheumatic fever 3B
7 Atopy 3A
8 Immunodeficiency HIV 3A

Genetics/ New born / chromosomal disorder

1 Hypotermia 4
2 Bacteraemia and septicaemia 3B
3 Respiratory stress syndrome 3B
4 Bronchopulmonary dysplasia 3A
5 Aspiration pneumonia 3A
6 Pneumothorax 3B
7 Apnea attack 3B
8 Jaundice of the newborn 3A
9 Severe neonatal jaundice 3A
10 Hypoglycemia 3B
11 Child of diabetic mother 3A
12 Neonatal convulsion 3B
13 Cerebral hemorrhage 3B
14 Conjunctivitis 4
15 Infection of umbilicus 4
16 SIDS 3B

Indocrine, Metabolic disorder and nutrition

1 IDDM 3A
2 NIDDM 3A
3 Complication of DM 9 Acute & chronic 3A
4 Hypoglycemia 3B
5 Hyperthyroidism 3A
6 Adrenal cortex failure 3B
7 Marasmus 3A
8 Kwashiorkor 3A
9 Vitamin deficiencies 3A
10 Hyperlipoproteinemia 3A
11 Gout 4
12 Obesity 4

Central and peripheral neural system

Liss of consciousness
1 Metabolic encephalopathy 3B
2 Comatous 3B
3 Brain death 3B

Headache
1 Tension headache 4
2 Migraine 3A
3 Cranial arteritis 3B
4 Trigeminal neuralgia 3A
5 Cluster headache 4

Cardiovaskular disease
1 TIA 3B
2 Cerebral infarction 3B
3 Intracerebral hematoma 3B
4 Subarachnoid hemorrhage 3B
5 Hypertensive ebcephalopathy 3B

Cranial nerve and brainstem lesion

1 Bells palsy 4
2 Brain stem lesion 3B

Disorder of vestibular system

1 Meniere's disease 3A
2 BPPV 3A
3 Vertigo central 3A

Movement disorder
1 Parkinson's disease 3A
2 Secondary parkinsonism 3A

Epilepsy and other seizures

1 Generalized epilepsy 3A
2 Absance seizure 3A
3 Status epilepticus 3B

Diseases of spine and spinal cord

1 Complete spinal transaction 3B
2 Neurogenic bladder 3B
3 Myelopathy 3A
4 Medulla compression acute 3B
5 Radicular syndrome / HNP 3A
6 Spondilitis TB 3B

Neuromuscular disease and neuropathy

1 Carpal tunnel syndrome 3A
2 Tarsal tunnel styndrome 3A
3 Neuropathy 3A
4 Peroneal palsy 3A
5 Guillain Bare Sndrome 3B
6 Myasthenia gravis 3A

Infectious disease
1 Meningitis 3B
2 Encephalitis 3B
3 Malaria cerebral 3B
4 Tetanus 3B
5 Cerebral toxoplasmosis 3B
6 HIV-AIDS 3A

Congenital , pediatric neurologic disorders

1 Hydrocephalus 3B
2 Meningitis 3B
3 Enchephalitis 3B
4 cerebral abscess 3B
5 Epilepsi 3A
6 Petit mal epilepsy 3A
7 Febrile convulsion 4
8 Poliomyelitis 3B
9 Cerebral palsy 3B
10 Kernicterus 3B

Neurobehaviour disorders, trauma , tumor CNS, gangguan visual

1 Amnesia pasca trauma 3B
2 Afasia 3B
3 Mild Cognitive impairment 3B
4 Epidural hematom 3B
5 Subdural hematom 3B
6 SAH 3B
7 Trauma medulla spinalis 3B
8 Tumor CNS primer 3B
9 Tumor CNS sekunder 3B
10 Buta mendadak 3B
11 Diplopia 3B

Ear, Nose and Throat

Ear, hearing and equiblirium
1 Inflammation of auricle 3A
2 Herpes zoster oticus 3A
3 Pre- auricular fistula 3A
4 Foreign body in ear 3A
5 Wax (serumen) 3A
6 Otitis externa 4
7 Acute otitis media 4
8 Otitis media serous 3A
9 Chronic otitis media 3A
10 Perforated tympanic membrane 3A
11 Bullous myringitis 3A
12 Otosclerosis 3A
13 Tympanosclerosis 3A
14 Presbyacusis 3A
15 Mastoiditis 3A
16 Benign postural vertigo 3A
17 Motion sickness 4
18 meniere's disease 3A
19 Acute acoustic trauma 3A
20 Ear, other trauma 4
21 Congenital deafness 3A
22 Facial palsy or paralysis 3A

Nosesand sinuses
1 Epitaxis 4
2 Furuncle of nose 4
3 Acute rhinitis (common cold) 4
4 Vasomotor rhinitis 4
5 Allergic rhinitis 4
6 Chronic rhinitis 3A
7 Chronic sinusitis 3A
8 Foreign body in nose 4

Loarynx and pharynx

1 Pharyngitis 4
2 Tonsilitis 4

Neck
1 Medical and lateral brachial cyst and fistula 3A
2 Cystic hygroma 3A
3 Torticollis 3A

Thyroid gland and parathyroid glands

1 Cyst 3A
2 Goitre 3A
3 Hyperthyroidism 3A
4 Hyperparathyroidism 3A
5 Hypoparathyroidism 3A

EYE
Conjunctiva
1 Conjunctiva, foreign body 3B
2 Conjunctivitis, allergy 4
3 Conjunctivitis, Viral 4
4 Conjunctivitis, bacterial 4
5 Pterygium 3A
6 Subconjunctival haemorrhage 3A

Eyelids
1 Blepharitis 3A
2 Herdeolum 4
3 Chalazion 3A
4 Eyelid laceration 4
5 Eyelid retraction 4

Anterior chamber, iris and ciliary body, glaucoma, lens

1 Hyphaema 3A
2 Hypopyon 3A
3 Iridocyclitis, iritis 3A
4 Glaukoma congenital 3A
5 Simple glaukoma 3A
6 Acute glaukoma 3B
7 Secondary glaukoma 3A
8 Cataract 3A
9 Lens dislocation 3B

Refraction and accommodation

1 Hypermetropia 4
2 Myopia 4
3 Astigmatism 3A
4 Presbyopi 4
5 Anisometropia 3A

Vision and visual fields

1 Amblyopia 3A
2 Diplopia 3A
3 Suppresion 3A
4 Night - blindness 3A
5 Scotoma 3A
6 Hemianopia 3A
7 Loss of vision and blindness 3A

Optic disc and optic nerve

1 Papiledema
2 Optic atrophy

Skin
Eczematous dermatitis
1 Contact dermatitis irritant 4
2 Contact dermatitis allergic 3A
3 Atopic dermatitis (kecuali recalcitrant) 4

4 Nummular dermatitis 4
5 Lichen simplex chronicus 3A
6 Napkin eczema 4

Erythrosquamous lesion
1 Psoriasis vulgaris 3A
2 Palmoplantar pustulosis 4
3 Seborrhoic dermatitis 4
4 Pityriasis rosea 4

Disorders of skin eccrine and sebaceous glanda

1 Acne vulgaris 4
2 Rosacea 3A
3 Hidradenitis supurativa 4
4 Perioral dermatitis 4
5 Miliaria 4

Viral skin infection

1 Verruca vulgaris 4
2 Condyyloma accuminata 3A
3 Molluscum contagiosum 4
4 Herpes zoster 4

Bacterial infections
1 Impetigo 4
2 Ulcerative impetigo ecthyma) 4
3 Superficial folliculitis 4
4 Furuncle, carbuncle 4
5 Erythrasma 4
6 Erysipelas 3A

Superficial fungal infection

1 Tinea capitis 4
2 Tinea barbae 4
3 Tinea faciale 4
4 Tinea corporis 4
5 Tinea manus 4
6 Tinea unguinum 4
7 Tinea cruris 4
8 Tina pedis 4
9 Tinea versicolor 4
10 Mucocutaneus candidiasis 4

Insect bites and infestations

1 Pediculosis capitis 4
2 Pediculosis pubis 4
3 Scabies 4
4 Insect bites reactions 4

Allergic skin, autoimmune disease

1 Urticaria 4
2 Angioudema 3B
3 Lupus erythematosus 3A

Disorders of hairs
1 Alopesia areata 3A
2 Androgenic alopecia 3A
3 Trichotillomania 3A
4 Telogen affluvium 3A

Disordesr of keratinizations
1 Ichtyosis vulgaris 3A

Other noninfectious inflammatory skin disorders

1 Lichen planus 3A
2 Granuloma annulare 3A

Drug reactions
1 Exanthematous drug eruption 4
2 Fixed drug eruption 4

Pigmentary disorders
1 Vitiligo 3A
2 Melasma 3A
3 Post inflammatory hyperpigmentation 3A
4 Post inflammatory hypopigmentation 3A

Infectious Abd tropical disease

Localized infections abscess
Infections of the hands
1 Paronichia 4
2 Suppurative tenosynovitis 3A
3 Human bite 4

Infections of the head and neck

1 Suppurative parotitis 4
2 Suppurativecervical adenitis 4
3 Peritonsilar abscess 3A
4 Ludwig's angina 3A
5 Bezold abscess 3A

Grampositive and negative cocci

1 Superficial infection 4
2 Osteomyelitis 3A
3 Staphylococcal pneumonia 4
4 Rheumatic fever 3A
5 Nasopharyngitis 4

Gonococcal infection
1 Gonnorhea 4

Gram negative bacilli

1 Urinary tract infection 4
2 Typhoid fever 4
3 Dysentry bacilli 4
4 Cholera 4
5 Pertussis 4
6 Canchroid 4

Toxin producing bacteria

1 Diptheria (THT) 3B
2 Tetanus (pediatric) 3B

Mycobacterial disease
1 Tuberculosis cutis 3A
2 Leprosy 4
3 Leprareaction 3A

Spirochetal disease
1 Syphilis 4
2 Yaws 4
3 Leptospirosis 3A

Viral infection
1 Influenza 4
2 Avian influenza 3B
3 Viral gastroenteristis 4
4 Poliomyelitis 3B
5 Rabies 3B
6 Morbili 4
7 Varicella 4
8 Harpes zoster 4
9 Harpes simplex 4
10 Mumps 4
11 CMV infection 3A
12 DHF 3B
13 HIV-AIDS 3A

Protozoaal infections
1 Amebiasis 4
2 Malaria 4
3 Leishmaniasis 3A
4 Toxoplasmosis 3A
5 Giardiasis 3A
6 Trichomoniasis 3A

Worm infestasions
1 Hookworm disease 4
2 Strongyloidiasis 4
3 Ascariasis 4
4 Filariasis 4
5 Schistosomiasis 4
6 Cutaneus larva migrant 4
7 Taeniasis 4

Neoplasma
1 Leukoplakia 3A
2 Benign Prostate Hyperplasia 3A
3 Condyloma accuminate 3A
4 Epithelial cyst 3A
5 Mycosis fungoides 3A
6 Mastocytosis 3A
7 Langerhans cell histiocytosis 3A
8 Ganglion cyst 4
9 Liposarcoma 3A

Psychiatri and mental Health

1 Mental deficiency 3A
2 Autistic disorders 3A
3 Transient tic disorders 3A
4 Intoxication 3B
5 Withdarwl syndrome 3A
6 Delirium 3A
7 Dementia 3A
8 Amnestic syndrome 3A
9 Other organic disorders 3A
10 Misuse of psychoactive drugs 3A
11 Skizophrenia 3A
12 Other psychosis 3A
13 Bipolar disorders, manic episode 3A
14 Bipolar disorders, deppresive episode 3A
15 Anxiety disorders 3A
16 Somatic disorders 3A
17 Dissociative disorders 3A
18 Sexual dysfuntion 3A
19 Insomnia 4
20 Hypersomnia 3A
21 Side effects of psychoactive drug therapy 3A
22 Neuropsychiatric and psychosomatic disorders 3A

Musculosceletal system
1 Arthritis 4
2 Osteoporosis 3A
3 Physical overload 3A
4 Osteomyelitis, acute 3B
5 Arthritis 4
6 Fractures of femur 3B

7 Fractures, capsule , tendon and ligamen lesion 3B

of knee
8 Achiles tendonitis 3A
9 Rupture of Achilles tendon 3B
10 Instability of ankle 3A

Traumatology
Birth trauma
1 Caput succedaneum 3B

Trauma
1 Drowning 3B
2 Head injury 3B
3 Burning 3B
4 Poisoning 3B
5 Suffocation 3B
6 Bleeding 3B
7 Hypovolemic shock 3B
8 Dislocation of jaw 3B
9 Dislocation of knee 3B
10 Dislocation of patella 3B
11 Prapatellar bursitis 3B
12 Fractures of tibia 3B
13 Rib fractures / contusion 3B
14 Injury caused by rib fractures 3B
15 Sternal fractures 3B
16 Fractures of toes 3B
17 Crush injury to the heel ( in children) 3B
18 Fractures of fibula 3B
19 Whiplash 3B
20 Fractures, capsule, tendon and ligament lesion of ankle 3B
21 Pneumothorax 3B
22 Hemothorax 3B
23 Injury specific to internal organs )liver, kidney 3B
lung, etc)
24 Injury of peripheral nerves 3B

Neck , shoulder gridle and upper extremities

1 Fractures of shoulders 3B
2 Dislocation of shoulder 3B
3 Ligamentous lesion of shoulders 3B
4 Instability of shoulders 3B
5 Fracture of clavicle 3A
6 Frozen soulder 3A
7 Fracture of humerus , radius, ulna, elbow, wrist, fingers 3B
thumb
8 Lateral epicondyylitis (tennis elbow) 3A
9 Dislocation of distal radius, wrist 3B
10 Progressive inflammation of finger following injury 3A
11 Olecranon bursitis 3A
12 Carpal tunnel syndrome 3A
13 Injury of finger tendon 3A
14 Nail loss 4
15 Subungual hematoma 4
16 Traumatic vessel injury 3B

Accident and emergency neurology

1 Head injuries 3B
2 Diffuse brain damage 3B
3 Cerebral contusions and concussion 3B
4 Brain death 3B
5 EDH 3B
6 SDH 3B
7 Basilar fracture scalp 3B
8 Acute traumatic spinal transaction 3B
9 Injury of plexus and peripheral nerves 3B

Reproduction system
Infection during pregnancy/ delivery
1 Syphilis 3A
2 AIDS 3A

Drugs and harmful substances during pregnancy

1 Mother taking tobacco 4

Pregnancy disorders
1 Incompleted spontaneous abortion 3B
2 Complated spontaneous abortion 4
3 Hyperemesis gravidarum 3B
4 Dysmaturity 3A
5 Polyhydramnion 3A
6 Iron deficiency anemia 4

Delivery
1 Premature contraction 3A
2 Premature delivery 3A
3 Postmature infant 3A
4 Prolonged delivery 3A
5 Primary mild contraction 3A
6 Secondary mild contraction 3A
7 Hypoxia of fetus 3B
8 Rupture of perineum 4
9 Retained placenta 3A

Postpartum
1 Retained placental tissue 3B
2 Postpartum haemorrhage 3B

Puerpurium
1 Mastitis 3A
2 Cracked nipple 4
3 Inverted nipple 4
4 Endometritis 4
5 Inflamation of pelvis 3A
6 Incontinence of urine 3A
7 Incontinence of faeces 3A
8 Post - natal psychoses 3A
9 Post- natal depression 3A
10 Subinvolution of uterus 4
 Disetujui
Kemampuan
Klinik
3 4

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 Permohonan Disetuju
Keterampilan Keteramp
No Kewenangan Klinik
Klinik Klinik
1 2 3 4 1
1 Tindakan Resusitasi jantung-Paru √
2 Penanganan sesak nafas ringan sampai berat (tanpa ventilator) √
3 Penanganan awal kegawatdaruratan pada jantung √
4 Penanganan pasien dengan syok √
5 Menjahit luka ringan sampai sedang √
6 Pemasangan tampon hidung bagian anterior √
7 Partus normal dengan posisi kepala sudah dipintu vagina √
8 Penanganan awal luka bakar √
9 Penanganan kejang √
10 Penanganan keracunan dan gigitan binatang √
11 Penanganan trauma kepala √
12 Penanganan awal fraktur terbuka dan fraktur tertutup. √
13 Penanganan sesak nafas ringan sampai berat (dengan ventilator) √
14 Hemodialisa √ √
15 Pemasangan IV line √
16 Pemasangan NGT √
17 Pemasangan Kateter Urine √
18 Ekstirpasi dan insisi luka √

KETERANGAN KETERAMPILAN KLINIK DOKTER UMUM

Tingkat Keterampilan 1 : Mengetahui dan menjelaskan

Tingkat Keterampilan 2 : Pernah melihat, atau didemonstrasikan keterampilan ini
Tingkat Keterampilan 3 : Pernah melakukan atau pernah Menerapkan dibawah supervisi
Tingkat Keterampilan 4 : Mampu melakukan secara mandiri

Balikpapan, Februari 2017

Pemohon Ketua Subkomite Kredensial

dr. Novita Nurlita Dr. Irma Armenia, Sp.KJ

NIP. 197102272002122002

Peer Group Anggota

dr. Rini Yuliana ..................................

NIP.197704242005022004 Dr. Maurits M, Sp.P
NIP. 197003172009031002

......................................
Dr. Eka Falintina Wati,Sp.M
NIP. 197101102002122002
 Disetujui
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Klinik
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√
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bruari 2017
e Kredensial

a, Sp.KJ
002122002

009031002

............
Wati,Sp.M
002122002