LOGO RSIA ANUGRAH

(Mengunakan Kertas Berkop)

PERATURAN DIREKTUR RSIA ANUGRAH

NOMOR: Nomor/PER/DIR/RSIAA/Bulan/Tahun

TENTANG
..................................................................................

DIREKTUR RSIA ANUGRAH,

Menimbang : a. bahwa .........................................................................................................

;
b. bahwa .........................................................................................................
;

Mengingat : 1. Undang-undang Nomor ........ Tahun ........tentang

......................................;
2. ....................................................................................................................;

MEMUTUSKAN:

Menetapkan : PERATURAN DIREKTUR RSIA ANUGRAH

TENTANG ........................................................................................................
.................

KESATU : ..........................................................................................................................
KEDUA : ..........................................................................................................................
KETIGA : dan seterusnya.

2 Spasi

Ditetapkan di : ..................................
Pada tanggal : ..................................

Direktur RSIA Anugrah,

Tanda Tangan
dan Cap RS

Nama Lengkap, beserta gelar.

 LAMPIRAN

PERATURAN DIREKTUR RSIA ANUGRAH

NOMOR..........................................................

TENTANG.......................................................

BAB I
PENDAHULUAN

A. Latar Belakang
..................................................................................................................................................
..................................................................................................................................................
B. Tujuan Pedoman
C. Ruang Lingkup Pelayanan
D. Batasan Operasional
E. Landasan Hukum
1. .........................................................................................................................
2. .........................................................................................................................
a. ..................................................................................................................
b. ..................................................................................................................
(1). ...........................................................................................................
(2). ...........................................................................................................
a). ......................................................................................................
b). ......................................................................................................

1
 BAB II
STANDAR KETENAGAAN

A. Distribusi Ketenagaan
B. Jadwal Kegiatan, termasuk Pengaturan Jaga (Rawat Inap)

2
 BAB III
STANDAR FASILITAS

A. Denah Ruang
B. Standar Fasilitas

3
 BAB IV
TATA LAKSANA PELAYANAN

4
 BAB V
LOGISTIK

5
 BAB VI
KESELAMATAN PASIEN

6
 BAB VII
KESELAMATAN KERJA

7
 BAB VIII
PENGENDALIAN MUTU

8
 BAB IX
PENUTUP

9
LAMPIRAN 1
Keterangan:
a. Kertas : F4 (Lebar= 216 mm, Tinggi = 330 mm)
b. Font : Arial
c. Ukuran Huruf : 11
d. Spasi : 1.5
e. Margins : Atas = 3 cm , Kiri =3 cm, Bawah = 2 cm, Kanan = 2 cm
f. Align Text : Rata Kiri-Kanan
g. Spasi untuk tanda tangan dan Cap : 5 Spasi
h. Setiap BAB harus dimulai di halaman baru
i. KOP Surat RSIA Anugrah