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Lampiran I

NO ALUR KERJA TAMPILAN


1 Masuk ke alamat web :
https://hfis.bpjs-kesehatan.go.id/hfis/

2 Pilih menu login -> Fasilitas Kesehatan


Kerjasama -> masukan username ->
masukan password -> tulis captcha ->
Sign In

*username dan password = username dan password


P-Care masing-masing FKTP

3 Pilih menu perubahan data pada tampilan


setelah masuk pada user masing-masing
FKTP

4 Pilih menu Tambah Pengajuan


5 Klik menu Kategori Perubahan -> Diagnosa
Non Spesialistik

6 Akan muncul tampilan 144 data


Diagnosa Non Spesialistik yang sudah
tercentang (√)

7 Hilangkan centang (√) pada diagnosa


non spesialistik yang tidak mampu
melakukan penatalaksanaan secara
mandiri dan tuntas oleh masing-masing
FKTP -> Simpan

8 Diagnosa non spesialistik yang sudah


dihilangkan centangnya dan sudah
disimpan, akan muncul pada kolom Data
Pengajuan Perubahan Diagnosa Non
Spesialistik -> Ajukan
STANDAR DIAGNOSA NON SPESIALISTIK YANG MAMPU DITANGANI TUNTAS DAN MANDIRI
PADA FKTP DI KAB. BANYUWANGI

MAMPU
CLINICAL PATHWAY
NO NAMA DIAGNOSA NAMA ICD X KODE ICD X (pada KMK 514/2015
DITANGANI
halaman --)
YA TIDAK
Unspecified abortion, complete, without
1 Abortus spontan komplit O03.9 707 √
complication
2 Alergi makanan Dermatitis due to ingested food L27.2 66 √
Anemia defisiensi besi pada
3 Iron deficiency anaemia D50 693 √
kehamilan
4 Askariasis Ascariaris unspecified B77.9 176 √
5 Asma Bronkial Asthma J45 431 √
6 Astigmatism ringan Astigmatisme H52.2 212 √
7 Bell's Palsy Bells’ palsy G51.0 364 √
8 Benda asing di hidung Foreign body in nostril T17.1 481 √
9 Benda asing di konjungtiva Foreign body on external eye, part unspecified T15.9 209 √
10 Blefaritis Blepharitis H01.0 204 √
11 Bronkitis akut Acute bronchitis, unspecified J20.9 427 √
12 Buta senja Night blindness H53.6 196 √
13 Cutaneus larva migran Hookworm disease, unspecified B76.9 610 √
14 Demam dengue, DHF Dengue haemorrhagic fever A91 79 √
15 Demam tifoid Typhoid fever A01.0 125 √
Dermatitis atopik (kecuali
16 Atopic dermatitis L20 555 √
recalcitrant)
17 Dermatitis kontak iritan Irritant contact dermatitis L24 571 √
18 Dermatitis numularis Other atopic dermatitis L20.8 561 √
19 Dermatitis seboroik Seborrhoeic dermatitis L21 552 √
20 Tinea kapitis Tinea barbae and tinea capitis B35.0 537 √
21 Tinea barbae Tinea barbae and tinea capitis B35.0 537 √
22 Tinea Imbricate Other dermatophytoses B35.8 537 √
23 Tinea korporis Tinea corporis B35.4 537 √
24 Tinea manum Tinea manuum B35.2 537 √
25 Tinea unguium Tinea unguium B35.1 537 √
26 Tinea kruris Tinea cruris B35.6 537 √
27 Tinea pedis Tinea pedis B35.3 537 √
Ada di PMK no.5 tahun 2014
28 Diabetes melitus tipe 1 Diabetes insulin dependent T89 hal. 423

29 Diabetes melitus tipe 2 Non-insulin-dependent diabetes mellitus E11 635 √

30 Disentri basiler dan amuba Acute amoebic dysentery A06.0 144 √


31 Dislipidemia Hiperlipidemia E78.5 652 √
32 Epistaksis Epistaxis R04.0 475 √
Generalized skin eruption due to drugs and
33 Exanthematous drug eruption L27.0 604 √
medicament
34 Faringitis Acute pharyngitis, unspecified J02.9 411 √
35 Filariasis Filariasis B74 42 √
36 Furunkel pada hidung Abscess, furuncle and carbuncle of nose J34.0 485 √
37 Gastritis Gastritis, unspecified K29.7 117 √
Gastroenteritis (termasuk Diarrhoea and gastroenteritis of presumed
38 A09 133 √
kolera, giardiasis) infection origin
39 Gonore Gonococcal infection, unspecified A54.9 763 √
40 Hemoroid grade 1-2 Haemorrhoids I84 154 √
41 Hepatitis A Acute Hepatitis A B15 157 √
Herpes simpleks tanpa
42 Herpesviral infection, unspecified B009 517 √
komplikasi
Herpes zoster tanpa
43 Zoster without complication B02.9 514 √
komplikasi
44 Hipermetropia ringan Hypermetropia H52.0 214 √
45 Hipertensi esensial Essential (primary) hypertension I10 280 √
46 Hiperuricemia (Gout) Gout M10 649 √
47 Hipoglikemia ringan hypoglycaemia unspecified E16.2 646 √
Asymptomatic Human Immunodeficiency
48 HIV AIDS tanpa komplikasi Z21 92 √
Virus (HIV) infection status
Hordeolum and other deep inflammation of
49 Hordeolum H00.0 198 √
eyelid
Omphalitis of newborn with or without mild
50 Infeksi pada umbilikus P38 49 √
haemorrhage
51 Infeksi saluran kemih Urinary tract infection, site not specified N39.0 666 √
52 Influenza Influenza, virus not identified J11 408 √
53 Insomnia Insomnia non organik pada psikiatri F51 396 √
54 Intoleransi makanan Malabsorption due to intolerance K90.4 120 √
55 Kandidiasis mulut Candidiasis unspecified B37.9 52 √
56 Kehamilan normal Single spontaneous delivery, unspecified O80.9 678 √
57 Kejang demam Febrile convulsions R56.0 378 √
58 Keracunan makanan Other Ingested (parts of plant(s)) T62.2 63 √
59 Konjungtivitis Conjunctivitis, unspecified H10.9 201 √
60 Laringitis Acute laryngitis J04.0 416 √
61 Lepra Leprosy [Hansen disease] A30 53 √
Leptospirosis (tanpa
62 Leptospirosis, unspecified A27.9 39 √
komplikasi)
63 Limfadenitis Lymphadenitis Acute B70 104 √
64 Lipoma Benign lipomatous neoplasm D17.9 307 √
65 Luka bakar derajat 1 dan 2 burn and corrosion, body region unspecified T30 613 √
66 Malaria Unspecified malaria B54 35 √
67 Malnutirisi energi-protein Unspecified protein-energy malnutrition E46 662 √
68 Mastitis Inflammatory disorders of breast N61 742 √
69 Mata kering Otherdisorders of lacrimal gland H04.1 193 √
70 Migren Migraine, unspecified G43.9 313 √
71 Miliaria Miliaria, unspecified L74.3 507 √
72 Miopia ringan Myopia H52.1 216 √
73 Moluskum kontagiosum Molluscum contagiosum B08,1 521 √
74 Morbili tanpa komplikasi Measles without complication (Measles NOS). B05.9 29 √
75 Napkin eczema Diaper (napkin) dermatitis L22 575 √
76 Obesitas obesity unspecified E66.9 628 √
77 Otitis eksterna Otitis externa, unspecified H60.9 246 √
78 Otitis media akut Acute serous otitis media H65.0 249 √
79 Parotitis Mumps B26 172 √
80 Pedikulosis kapitis Pediculosis due to Pediculus humanus capitis B85.0 531 √
81 Penyakit cacing tambang Ankylostomiasis B76.0 180 √
82 Perdarahan subkonjungtiva Other specified disorders of eye and adnexa H57.8 207 √
83 Pertusis *tidak ditemukan Panduan Klinis di KMK √
84 Pitiriasis rosea L42 582 √
85 Pitiriasis versikolor Pityriasis versicolor B36.0 541 √
Pneumonia,
86 Bronchopneumonia, unspecified J18.0 457 √
bronkopneumonia
87 Presbiopia Presbyopia H52.4 218 √
88 Reaksi anafilaktik Anaphylactic shock, unspecified T78.2 74 √
89 Reaksi gigitan serangga Venom of other arthropods T63.4 524 √
Gastro-oesophageal reflux disease without
90 Refluks gastroesofageal K21.9 114 √
oesophagitis
91 Rhinitis akut Acute nasopharyngitis (common cold) J00 487 √
92 Rhinitis alergika Allergic rhinitis, unspecified J30.4 494 √
93 Rhinitis vasomotor Vasomotor rhinitis J30.0 491 √
94 Ruptur perineum tingkat 1-2 First degree perineal laceration during delivery O70.0 733 √
95 Serumen prop Impacted cerumen H61.2 259 √
96 Skabies Scabies B86 528 √
97 Skistosomiasis Skistosomiasis unspecified B65.9 184 √
98 Strongiloidiasis Strongyloidiasis B78.9 190 √
99 Taeniasis Taeniasis B68.9 187 √
100 Tension headache Tension–type headache G44.2 309 √
101 Tetanus Other tetanus A35 327 √
102 Tonsilitis Acute tonsillitis J03 421 √
Tuberkulosis paru tanpa Respiratory tuberkulosis, bacteriologically and
103 A15 13 √
komplikasi histologically confirmed
104 Urtikaria (akut & kronis) Urticaria L50 599 √
105 Vaginitis Acute Vaginitis N76.0 767 √
106 Varisela tanpa komplikasi Varicella without complication (Varicella NOS) B01.9 32 √

Vertigo (Benign paroxysmal


107 Dizziness and giddiness R42 319 √
positional vertigo)
108 Veruka vulgaris Viral warts B07 511 √
109 Vulvitis Acute Vaginitis N76.0 771 √
110 Gangguan somatoform Somatoform disorders F45 387 √
111 Trikiasis Entropion and trichiasis of eyelid H02 229 √
112 Episkleritis Episcleritis H15.1 232 √
113 Mabuk perjalanan *tidak ditemukan Panduan Klinis di KMK √
114 Ulkus mulut (aptosa, herpes) Stomatitis and related lesions K12 108 √
Acute tubulo-interstitial nephritis (applicable
115 Pielonefritis tanpa komplikasi N10 669 √
to: acute pyelonephritis)
116 Fimosis Phimosis N47 673 √
117 Parafimosis Paraphimosis N47.2 676 √
Sindrom duh (discharge)
Complication associated with artificial
118 genital (gonore dan N98.9 751 √
fertilization, unspecified
nongonore)
Infeksi saluran kemih bagian Urinary tract infection, site not specified
119 N39.0 666 √
bawah
120 Vaginosis bakterialis Acute Vaginitis N76.0 767 √
121 Salpingitis *tidak ditemukan Panduan Klinis di KMK √
Abses folikel rambut atau
122 *tidak ditemukan Panduan Klinis di KMK √
kelenjar sebasea
Cracked nipple associated with the
O9212;
puerperium; Cracked nipple associated with
123 Cracked nipple 748 √
lactation
O9213

Retracted nipple associated with the


O92.02;
124 Inverted nipple puerperium; Retracted nipple associated with 745 √
O92.03
lactation
125 Defisiensi vitamin *tidak ditemukan Panduan Klinis di KMK √
126 Defisiensi mineral *tidak ditemukan Panduan Klinis di KMK √
127 Anemia defisiensi besi Iron Deficiency Anemias 280 88 √
Varicose veins of lower extremities with ulcer;
128 Ulkus pada tungkai I83.0; L97 618 √
Ulcer of lower limb, notelsewhere classified
129 Sifilis stadium 1 dan 2 *tidak ditemukan Panduan Klinis di KMK √
130 Impetigo Impetigo L01 544 √
131 Impetigo ulseratif (ektima) Impetigo L02 545 √
132 Folikulitis superfisialis Pioderma L08.0 544 √

133 Furunkel, karbunkel Cutaneous abscess, furuncle and carbuncle L02 544 √

134 Eritrasma Erythrasmay L08.1 584 √


135 Erisipelas Erysipelas A46 549 √
136 Skrofuloderma Tuberculosis of skin and subcutaneous tissue A18.4 587 √

137 Kandidosis mukokutan ringan Candidiasis unspecified B37.9 52 √


138 Pedikulosis pubis Pthiriasis B85.3 535 √
139 Akne vulgaris ringan Acne vulgaris L70.0 594 √
140 Hidradenitis supuratif Hidradenitis suppurativa L73.2 590 √
141 Dermatitis perioral Perioral dermatitis L71.0 578 √
142 Vulnus laseratum, punctum Open wound of unspecified body region T14.1 303 √
143 Kekerasan tumpul *tidak ditemukan Panduan Klinis di KMK √
144 Kekerasan tajam *tidak ditemukan Panduan Klinis di KMK √
TOTAL DIAGNOSA NON SPESIALISTIK MAMPU DITANGANI 127 Dx 17 Dx
REKAPITULASI DIAGNOSA NON SPESIALISTIK YANG MAMPU DITANGANI PADA MASING-MASING FKTP
DI KAB. BANYUWANGI

JUMLAH DIAGNOSA NON BELUM MAMPU DITANGANI


NO KODE FASKES NAMA FKTP JENIS FKTP SPESIALISTIK YANG MAMPU
SARANA & PRA
DITANGANI KOMPETENSI
SARANA
1 13330101 WONGSOREJO PUSKESMAS 127 0 17
2 13330102 BAJULMATI PUSKESMAS 139 0 5
3 13330201 KELIR PUSKESMAS 127 0 17
4 13330202 KLATAK PUSKESMAS 127 0 17
5 13330203 MOJOPANGGUNG PUSKESMAS 127 0 17
6 13330301 PASPAN PUSKESMAS 127 0 17
7 13330302 LICIN PUSKESMAS 127 0 17
8 13330401 SOBO PUSKESMAS 136 0 8
9 13330402 SINGOTRUNAN PUSKESMAS 136 0 8
10 13330403 KERTOSARI PUSKESMAS 127 0 17
11 13330501 KABAT PUSKESMAS 127 0 17
12 13330502 BADEAN PUSKESMAS 127 0 17
13 13330601 GITIK PUSKESMAS 134 0 10
14 13330602 GLADAG PUSKESMAS 127 0 17
15 13330701 SINGOJURUH PUSKESMAS 139 0 5
16 13330702 GENDOH PUSKESMAS 127 0 17
17 13330801 SONGGON PUSKESMAS 127 0 17
18 13330901 KEBAMAN PUSKESMAS 127 0 17
19 13330902 PARIJATAHKULON PUSKESMAS 127 0 17
20 13330903 WONOSOBO PUSKESMAS 127 0 17
21 13331001 KEDUNGREJO PUSKESMAS 127 0 17
22 13331002 SUMBERBERAS PUSKESMAS 139 0 5
23 13331003 TAPANREJO PUSKESMAS 127 0 17
24 13331004 TEMBOKREJO PUSKESMAS 127 0 17
25 13331101 TEGALDLIMO PUSKESMAS 127 0 17
26 13331102 KEDUNGWUNGU PUSKESMAS 140 0 4
27 13331201 PURWOHARJO PUSKESMAS 127 0 17
28 13331202 GRAJAGAN PUSKESMAS 127 0 17
29 13331301 BENCULUK PUSKESMAS 140 0 4
30 13331302 TAMPO PUSKESMAS 134 0 10
31 13331401 JAJAG PUSKESMAS 138 0 6
32 13331402 YOSOMULYO PUSKESMAS 127 0 17
33 13331403 TEGALSARI PUSKESMAS 127 0 17
34 13331501 GENTENGKULON PUSKESMAS 136 0 8
35 13331502 KARANGSARI PUSKESMAS 138 0 6
36 13331503 SEMPU PUSKESMAS 136 0 8
37 13331504 KEMBIRITAN PUSKESMAS 127 0 17
38 13331601 SEPANJANG PUSKESMAS 138 0 6
39 13331602 TULUNGREJO PUSKESMAS 127 0 17
40 13331701 KALIBARU KULON PUSKESMAS 127 0 17
41 13331801 KEBONDALEM PUSKESMAS 135 0 9
42 13331802 SAMBIREJO PUSKESMAS 127 0 17
43 13331901 PESANGGARAN PUSKESMAS 141 0 3
44 13331902 SILIRAGUNG PUSKESMAS 127 0 17
45 13331903 SUMBERAGUNG PUSKESMAS 127 0 17
46 0190U002 REZEKIYANTI, DR DPP 127 0 17
47 0190U003 I.B. ENDRAWAN SAPUTRA, DR DPP 127 0 17
48 0190U004 PURWANTO, DR DPP 127 0 17
49 0190U006 MOH. HAMAMI, DR DPP 127 0 17
50 0190U007 MASBUHIN, DR DPP 127 0 17
51 0190U027 KETTY SUTINI, DR DPP 127 0 17
52 0190U031 Nira Ista Dewi (JST) DPP 127 0 17
53 0190U032 YOS HERMAWAN (JST) DPP 127 0 17
54 0190U035 dr. ANDRIYANI HAMZAH DPP 127 0 17
55 0190U037 dr. H. SOEGENG HERY P. DPP 127 0 17
56 0190U038 dr. CINCIN HARI PURWANTI DPP 139 0 5
57 0190U039 dr. MANGESTI UTAMI DPP 127 0 17
58 0190U040 dr. NURUL FARIDA DPP 136 0 8
59 0190U041 dr. LIASTUTIK DPP 127 0 17
60 0190U042 dr. KURNIYANTO DPP 127 0 17
61 0190U048 dr. EDY NURCAHYO SAFI'I DPP 127 0 17
62 0190U049 dr. LURIA WIDIJANA H. DPP 127 0 17
63 0190U051 dr. BAMBANG HARIYONO DPP 127 0 17
64 0190U054 dr. NURANI ANGGRAENI DPP 127 0 17
65 0190U056 dr. DWI DENI YULI ASTUTIK DPP 127 0 17
66 0190U057 DR. YULIA SUNDARIANI SUKANTA DPP 142 0 2
67 0190U059 DR. ETY RETNANINGSIH DPP 127 0 17
68 0190U060 DR. HENKKYE PT KAI BANYUWANGI DPP 127 0 17
69 0190U061 DR. JUNAIDI MALIK DPP 127 0 17
70 0190U062 DR. SYAMSUL MA'ARIF DPP 127 0 17
71 0190U063 DR. SUTRISNO DPP 127 0 17
72 0190U064 DR. ROHMAH EL YUNUSIYAH DPP 127 0 17
73 0190U066 DR. APRIN DWI RISTANTO DPP 127 0 17
74 0190u067 dr. SUSWATI HANIYAH DPP 127 0 17
75 0190u068 dr. INDIATI DPP
76 0190U069 DR. EDY PUJIANTO DPP
77 0190U070 dr. BERY SUKMA PUTRA DPP
78 0190U071 dr. DIAN EKA LESTARI DPP
79 0190U072 DR. MOH. NAJIB ABDULLAH DPP
80 1333U005 HARIJANTO W,DR DPP 127 0 17
81 1333U010 FINDA FERDIANA,DR DPP 127 0 17
82 0190B105 BP SYIFA HUSADA KLINIK PRATAMA 127 0 17
83 0190B001 KHADIJAH PKU MUHAMMADIYAH(JST) KLINIK PRATAMA 127 0 17
84 0190B107 KLINIK AMOUR 2 KLINIK PRATAMA 127 0 17
85 0190U045 KLINIK AS SAKINAH KLINIK PRATAMA 127 0 17
86 0190B104 KLINIK BRAWIJAYA KLINIK PRATAMA 127 0 17
87 0190U044 KLINIK LINAWATI KLINIK PRATAMA 127 0 17
88 0190U046 KLINIK RAHAYU MEDIKA KLINIK PRATAMA 127 0 17
89 0190B108 KLINIK SECANG KLINIK PRATAMA 127 0 17
90 0190B110 KLINIK KALIKEMPIT KLINIK PRATAMA 137 0 7
91 0190B111 KLINIK ANISA BAKTI KLINIK PRATAMA 127 0 17
92 0190B112 KLINIK NAMIRA KLINIK PRATAMA 127 0 17
93 0190B113 KLINIK SHINTA KLINIK PRATAMA 127 0 17
94 0190B114 KLINIK SANGGAR MEDIKA KLINIK PRATAMA 127 0 17
95 0190B115 KLINIK SUMBER SANTOSA KLINIK PRATAMA 127 0 17
96 0190U047 KLINIK SUMBERAYU MEDIKA KLINIK PRATAMA 127 0 17
97 0190B000 NU BINA SEHAT (JST) KLINIK PRATAMA 127 0 17
98 0190B116 KLINIK PRATAMA PRIMA MEDIKA KLINIK PRATAMA
99 0190B117 KLINIK K3 KLINIK PRATAMA
100 0190B118 KLINIK DR DIDIK SULASMONO KLINIK PRATAMA
101 0190B119 KLINIK AL HIKMAH KLINIK PRATAMA
102 0190B120 KLINIK AL HANA KLINIK PRATAMA
103 0190B121 KLINIK ALASMALANG MEDIKA KLINIK PRATAMA
104 01900002 POLRES BANYUWANGI KLINIK POLRI 127 0 17
105 01901103 Balai Pengobatan LANAL BANY KLINIK TNI 127 0 17
106 01900001 POSKES 05.10.18 KLINIK TNI 127 0 17

KET : Merupakan FKTP Baru, dapat mengikuti standar diagnosa non spesialistik yang sudah disepakati