PEDOMAN TATA NASKAH DAN DOKUMEN

KLINIK SATRIA NAMIRA HUSADA 49

KLINIK SATRIA NAMIRA HUSADA 49

TAHUN 2019
 KATA PENGANTAR

Dengan memanjatkan puji syukur kehadirat Allah SWT atas Rahmat dan
Hidayah serta atas petunjuk Nya sehingga Pedoman Tata Naskah dan Dokumen
Klinik telah berhasil disusun untuk digunakan sebagai sarana untuk memantau dan
mengevaluasi sistem manajemen Klinik Satria Namira Husada 49.
Pedoman Tata Naskah dan Dokumen Klinik merupakan salah satu alat
manajemen yang pertama kali harus tersedia dalam persiapan akreditasi klinik untuk
membuat dokumen di klinik.
Dokumen yang dibuat oleh klinik menjadi seragam dan sesuai dengan
perundang-undangan yang berlaku. Selanjutnya diharapkan saran dan kritik yang
membangun, serta partisipasi dari semua pihak khususnya dalam upaya perbaikan
terus menerus agar pelayanan klinik menjadi lebih baik dari waktu ke waktu.
Kepada semua pihak yang telah menyumbangkan pemikiran dan tenaganya
dalam penyusunan Pedoman Tata Naskah dan Penyusunan Dokumen Akreditasi
Klinik kami sampaikan terima kasih dan semoga buku pedoman ini bermanfaat bagi
semua pembaca.

Sidoarjo, 10 Juli 2019

Pimpinan
Klinik Satria Namira Husada 49,

Dr. Endah Nugrohowati

 DAFTAR ISI

KATA PENGANTAR................................................................................................... 2
BAB I ...........................................................................Error! Bookmark not defined.
PENDAHULUAN .........................................................Error! Bookmark not defined.
A. LATAR BELAKANG...........................................Error! Bookmark not defined.
B. TUJUAN PEDOMAN .........................................Error! Bookmark not defined.
C. RUANG LINGKUP PEDOMAN ..........................Error! Bookmark not defined.
D. BATASAN OPERASIONAL ...............................Error! Bookmark not defined.
E. DEFINISI ISTILAH .............................................Error! Bookmark not defined.
BAB II ..........................................................................Error! Bookmark not defined.
TATA NASKAH DAN DOKUMEN................................Error! Bookmark not defined.
A. ASAS TATA NASKAH DAN DOKUMEN ...........Error! Bookmark not defined.
B. PRINSIP PENYELENGGARAAN TATA NASKAH DAN DOKUMEN ....... Error!
Bookmark not defined.
C. TATA PERSURATAN ........................................Error! Bookmark not defined.
1. Pengelolaan Surat Masuk ..............................Error! Bookmark not defined.
2. Pengelolaan Surat Keluar ..............................Error! Bookmark not defined.
3. Tingkat Keamanan Naskah ............................Error! Bookmark not defined.
4. Kecepatan Proses Naskah .............................Error! Bookmark not defined.
5. Penggunaan Kertas Naskah dan Dokumen ...Error! Bookmark not defined.
6. Pengetikan Sarana Administrasi dan Komunikasi Perkantoran ............ Error!
Bookmark not defined.
7. Warna dan Kualitas Kertas ............................Error! Bookmark not defined.
D. PENERAPAN TATA PERSURATAN .................Error! Bookmark not defined.
E. PENGENDALIAN DOKUMEN ...........................Error! Bookmark not defined.
1. Penyusunan Dokumen ...................................Error! Bookmark not defined.
2. Pengesahan Dokumen ...................................Error! Bookmark not defined.
3. Sosialisasi Dokumen ......................................Error! Bookmark not defined.
4. Pencatatan Dokumen, Distribusi, dan Penarikan Dokumen Error! Bookmark
not defined.
5. Tata Cara Penyimpanan Dokumen ................Error! Bookmark not defined.
6. Retensi Penyimpanan Dokumen ....................Error! Bookmark not defined.
7. Penataan Dokumen .......................................Error! Bookmark not defined.
 8. Revisi atau Perubahan Dokumen.................. Error! Bookmark not defined.
F. REKAM IMPLEMENTASI ..................................Error! Bookmark not defined.
BAB III .........................................................................Error! Bookmark not defined.
NASKAH DINAS .........................................................Error! Bookmark not defined.
A. BENTUK NASKAH DINAS ................................Error! Bookmark not defined.
B. SUSUNAN NASKAH DINAS .............................Error! Bookmark not defined.
1. Keputusan Pimpinan Klinik.............................Error! Bookmark not defined.
2. Surat Biasa.....................................................Error! Bookmark not defined.
3. Surat Keterangan ...........................................Error! Bookmark not defined.
4. Surat Perintah ................................................Error! Bookmark not defined.
5. Surat Izin ........................................................Error! Bookmark not defined.
6. Surat Perjanjian..............................................Error! Bookmark not defined.
7. Surat Perintah Tugas .....................................Error! Bookmark not defined.
8. Surat Perintah Perjalanan Dinas ....................Error! Bookmark not defined.
9. Surat Kuasa ...................................................Error! Bookmark not defined.
10. Surat Undangan ..........................................Error! Bookmark not defined.
11. Surat Keterangan Melaksanakan Tugas .....Error! Bookmark not defined.
12. Surat Panggilan ..........................................Error! Bookmark not defined.
13. Nota Dinas ..................................................Error! Bookmark not defined.
14. Nota Pengajuan Konsep Naskah Dinas ......Error! Bookmark not defined.
15. Lembar Disposisi ........................................Error! Bookmark not defined.
16. Telaahan Staf .............................................Error! Bookmark not defined.
17. Pengumuman .............................................Error! Bookmark not defined.
18. Laporan.......................................................Error! Bookmark not defined.
19. Rekomendasi ..............................................Error! Bookmark not defined.
20. Surat Pengantar ..........................................Error! Bookmark not defined.
22. Berita Acara ................................................Error! Bookmark not defined.
23. Notulen .......................................................Error! Bookmark not defined.
24. Memo ..........................................................Error! Bookmark not defined.
25. Daftar Hadir ................................................Error! Bookmark not defined.
26. Piagam........................................................Error! Bookmark not defined.
27. Sertifikat ......................................................Error! Bookmark not defined.
BAB IV.........................................................................Error! Bookmark not defined.
DOKUMEN ..................................................................Error! Bookmark not defined.
 A. JENIS DOKUMEN ............................................ Error! Bookmark not defined.
1. Berdasarkan Sumber .....................................Error! Bookmark not defined.
2. Berdasarkan Akreditasi ..................................Error! Bookmark not defined.
B. BENTUK DOKUMEN.........................................Error! Bookmark not defined.
C. SUSUNAN DOKUMEN......................................Error! Bookmark not defined.
1. Rencana Strategis / Rencana Lima Tahunan.Error! Bookmark not defined.
2. Rencana Tahunan..........................................Error! Bookmark not defined.
3. Keputusan Pimpinan Klinik.............................Error! Bookmark not defined.
4. Manual / Pedoman / Panduan Mutu ...............Error! Bookmark not defined.
5. Standar Operasional Prosedur (SOP) ............Error! Bookmark not defined.
6. Pedoman atau Panduan ................................Error! Bookmark not defined.
7. Kerangka Acuan Kegiatan .............................Error! Bookmark not defined.
BAB V..........................................................................Error! Bookmark not defined.
PENANDATANGANAN NASKAH DINAS ...................Error! Bookmark not defined.
A. PENGGUNAAN DAN KEWENANGAN ATAS NAMA ...... Error! Bookmark not
defined.
B. PARAF, PENULISAN NAMA, PENANDATANGANAN DAN PENGGUNAAN
TINTA UNTUK NASKAH DINAS ..............................Error! Bookmark not defined.
1. Paraf Naskah Dinas .......................................Error! Bookmark not defined.
2. Penulisan Nama .............................................Error! Bookmark not defined.
3. Penandatanganan Naskah Dinas di Lingkungan Klinik Error! Bookmark not
defined.
4. Pendelegasian Pelaksanaan Penandatanganan Naskah Dinas ........... Error!
Bookmark not defined.
5. Penggunaan Tinta untuk Naskah Dinas .........Error! Bookmark not defined.
BAB VI.........................................................................Error! Bookmark not defined.
PENOMORAN NASKAH DINAS DAN DOKUMEN .....Error! Bookmark not defined.
A. PENOMORAN DALAM SUSUNAN SURAT ......Error! Bookmark not defined.
B. PENOMORAN DALAM SUSUNAN PRODUK HUKUM ... Error! Bookmark not
defined.
C. PENGELOLAAN NOMOR .................................Error! Bookmark not defined.
BAB VII........................................................................Error! Bookmark not defined.
STEMPEL ...................................................................Error! Bookmark not defined.
A. JENIS ................................................................Error! Bookmark not defined.
 B. BENTUK, UKURAN, DAN ISI ........................... Error! Bookmark not defined.
C. PENGGUNAAN .................................................Error! Bookmark not defined.
D. KEWENANGAN PEMEGANG DAN PENYIMPAN STEMPEL Error! Bookmark
not defined.
E. PENGAMANAN .................................................Error! Bookmark not defined.
BAB VIII.......................................................................Error! Bookmark not defined.
KOP NASKAH DINAS DAN DOKUMEN .....................Error! Bookmark not defined.
A. JENIS ................................................................Error! Bookmark not defined.
B. BENTUK DAN ISI ..............................................Error! Bookmark not defined.
C. PENGGUNAAN .................................................Error! Bookmark not defined.
BAB IX.........................................................................Error! Bookmark not defined.
SAMPUL NASKAH DINAS DAN DOKUMEN ..............Error! Bookmark not defined.
A. JENIS ................................................................Error! Bookmark not defined.
B. BENTUK, UKURAN, DAN ISI ............................Error! Bookmark not defined.
1. Bentuk ............................................................Error! Bookmark not defined.
2. Ukuran ...........................................................Error! Bookmark not defined.
3. Isi ...................................................................Error! Bookmark not defined.
BAB X..........................................................................Error! Bookmark not defined.
PENGARSIPAN NASKAH DAN DOKUMEN ...............Error! Bookmark not defined.
A. PENGERTIAN ...................................................Error! Bookmark not defined.
B. TUJUAN ............................................................Error! Bookmark not defined.
C. JENIS ................................................................Error! Bookmark not defined.
D. ASAS .................................................................Error! Bookmark not defined.
E. SIKLUS ARSIP ..................................................Error! Bookmark not defined.
F. SISTEM PENGARSIPAN ..................................Error! Bookmark not defined.
G. PERALATAN PENGARSIPAN KERTAS ...........Error! Bookmark not defined.
H. PERALATAN PENGARSIPAN DIGITAL ...........Error! Bookmark not defined.
I. PENEMUAN ARSIP ..........................................Error! Bookmark not defined.
J. PENYIMPANAN ARSIP.....................................Error! Bookmark not defined.
BAB XI.........................................................................Error! Bookmark not defined.
PAPAN NAMA .............................................................Error! Bookmark not defined.
A. JENIS ................................................................Error! Bookmark not defined.
B. BENTUK, UKURAN, DAN ISI ............................Error! Bookmark not defined.
1. Bentuk ............................................................Error! Bookmark not defined.
 2. Ukuran .......................................................... Error! Bookmark not defined.
3. Isi ...................................................................Error! Bookmark not defined.
C. JENIS ................................................................Error! Bookmark not defined.
D. PENEMPATAN ..................................................Error! Bookmark not defined.
BAB XII........................................................................Error! Bookmark not defined.
PERUBAHAN DAN PENCABUTAN ............................Error! Bookmark not defined.
BAB XIII.......................................................................Error! Bookmark not defined.
PELAPORAN ..............................................................Error! Bookmark not defined.
BAB XIV ......................................................................Error! Bookmark not defined.
PEMBINAAN DAN PENGAWASAN ............................Error! Bookmark not defined.
BAB XV .......................................................................Error! Bookmark not defined.
KETENTUAN PENUTUP ............................................Error! Bookmark not defined.
 DAFTAR LAMPIRAN

Lampiran 1. Contoh Format Keputusan Pimpinan Klinik .......... Error! Bookmark not
defined.
Lampiran 2. Contoh Format Surat Biasa ....................Error! Bookmark not defined.
Lampiran 3. Contoh Format Surat Keterangan ..........Error! Bookmark not defined.
Lampiran 4. Contoh Format Surat Perintah ...............Error! Bookmark not defined.
Lampiran 5. Contoh Format Surat Izin .......................Error! Bookmark not defined.
Lampiran 6. Contoh Format Surat Perjanjian .............Error! Bookmark not defined.
Lampiran 7. Contoh Format Surat Perintah Tugas ....Error! Bookmark not defined.
Lampiran 8. Contoh Format Surat Perintah Perjalanan Dinas . Error! Bookmark not
defined.
Lampiran 9. Contoh Format Surat Kuasa...................Error! Bookmark not defined.
Lampiran 10. Contoh Format Surat Undangan ..........Error! Bookmark not defined.
Lampiran 11. Contoh Format Surat Keterangan Melaksanakan Tugas ............ Error!
Bookmark not defined.
Lampiran 12. Contoh Format Surat Panggilan ...........Error! Bookmark not defined.
Lampiran 13. Contoh Format Nota Dinas...................Error! Bookmark not defined.
Lampiran 14. Contoh Format Nota Pengajuan Konsep Naskah Dinas ............. Error!
Bookmark not defined.
Lampiran 15. Contoh Format Lembar Disposisi .........Error! Bookmark not defined.
Lampiran 16. Contoh Format Telaahan Staf ..............Error! Bookmark not defined.
Lampiran 16. Contoh Format Pengumuman ..............Error! Bookmark not defined.
Lampiran 18. Contoh Format Laporan .......................Error! Bookmark not defined.
Lampiran 19. Contoh Format Rekomendasi ..............Error! Bookmark not defined.
Lampiran 20. Contoh Format Surat Pengantar ......... Error! Bookmark not defined.
Lampiran 21. Contoh Format Telegram .................................................................... 2
Lampiran 22. Contoh Format Berita Acara.................Error! Bookmark not defined.
Lampiran 23. Contoh Format Notulen ........................Error! Bookmark not defined.
Lampiran 24. Contoh Format Memo ..........................Error! Bookmark not defined.
Lampiran 25. Contoh Format Daftar Hadir Pertemuan Rapat .. Error! Bookmark not
defined.
Lampiran 24. Contoh Format Daftar Hadir .................Error! Bookmark not defined.
Lampiran 27. Contoh Format Piagam Penghargaan ..Error! Bookmark not defined.
Lampiran 28. Contoh Format Sertifikat ......................Error! Bookmark not defined.
Lampiran 29. Contoh Format SOP .............................Error! Bookmark not defined.