RKK
RKK
Bersama ini saya mengajukan permohonan untuk dapat diberikan kewenangan Klinis sebagai Dokter
Umum / Dokter Gigi / Dokter Spesialis / Dokter gigi Spesialis di Bethsaida Hospital.
Petunjuk
Untuk Dokter : Untuk Ketua Kelompok Staf Medis (KSM) :
Tanda tangan dokter pemohon dibagian bawah Tanda tangan Ketua KSM pada akhir rekomendasi
kewenangan Klinis yang diminta. Ketua KSM
Jika terdapat revisi atau perbaikan, setelah
kewenagan kliknik ini disetujui, maka harus
mengisi kembali formulir yang baru.
PENGAJUAN KEWENANGAN KLINIS (CLINICAL PRIVILAGE)
DOKTER SPESIALIS OBSTETRI DAN GYNEKOLOGI
Dystrophy of vulva
Cyst of bartholin, abcess of bartholin’s gland
Abscess of hair follicle or sebaceous gland
Condylomata acuminate
Congenital malformations
Vaginitis
Bacterial vaginosis
Cyst of gartner
Cystocoele
Rectocoele
Enterocoele
Fistula (vesico-vaginal, uretero-vaginal, recto-
vaginal fistula)
Foreign body
Cervicitis
Polyps
Nabothian cyst
Congenital malformations
Uterine prolaps
Hematocolpos
Endometriosis
Retained placental tissue
Uterine inversion
Postpartum haemorrhage
Thrombo-embolism
Blood group incompatibility
Salpingitis
Adhesions
Ovarian cyst
Polycystic ovarian disease
Carcinoma of ovary
Ectopic pregnancy
Torsion tumour / ovarian cyst
Rupture of ovarian cyst / tubo ovarian abscess
Uterine bleeding at ovulation
Condyloma accuminata
Cervical carcinoma
Extramamamary peget’s disease
Endometrial hyperplasia
Endometrial carcinoma
Ovarial teratoma (dermoid cyst)
Ovarian carcinoma
Hydatidiform mole
Choriocarcinoma
DELIVERY
Premature contractions
Premature delivery
Rupture of uterus
Postmature infant
Premature rupture of membranes
Unstable lie / malposition after 36 week
Dystocial,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, infant
Retained placenta
INFECTION DURING
PREGNANCY/DELIVERY
Syphilis
Rubella
CMV infection
Toxoplasmosis
AIDS
Gonorhoea
Herpes virus infection type 2
Hepatitis B
DRUGS AND HARMFUL SUBSTANCE
DURING PREGNANCY
Mother taking tobacco
Mother taking drugs of addiction
PREGNANCY DISORDERS
Threatened abortion
Incompleted spontaneous abortion
Completed spontaneous abortion
Hyperemesis gravidarum
Blood group incompatibility
Hydatidiform mole
Intra-uterine infection
Prenancy induced hypertension
Prenancy induced diabetes mellitus
Dysmaturity
Placental insufficiency
Placenta previa
Vasa previa
Abruptio placenta-SOL
Cervical incompetence
Polyhydramnion
Jaundice late in pregnancy
Urinary tract infection
Pyelitis in pregnancy
Iron dificiancy anaemia
Megaloblastic anaemia
Dead fetus
PUERPERIUM
Mastitis
Cracked nipple
Inverted nipple
Endometritis
Inflamation of pelvis (salpingitis, pelviperitonitis,
perimetritis etc)
Incontinence of urine
Incontinence of faeces
Deep venous thrombosis
Thrombophlebitis
Embolism
Post-natal psychoses
Post-natal depression
Subinvolution of uterus
Komentar :
Ditolak
Tidak Ada
Alat
Bagian II : Rekomendasi Ketua Kelompok Staf Medis (KSM).
Disetujui dengan
Disetujui. Tidak disetujui.
catatan.
Komentar :
(dr. )
Disetujui dengan
Disetujui. Tidak disetujui.
catatan.
Komentar :