33 dr. ISTRIYATI
K
NO NAMA JENIS KETANAGAAN
1 YANVERTY IDDA LISTYANA, S.Farm.Apt. APOTEKER
5 DINA WIRANTI
6 UKHTIARIDA INSANI
16 MARYATI, A.Md.Keb.
23 LORISA, A.Md.Keb
30 RINA, A.Md.Keb
31 DICTA ARIANI
1 NURJANAH,SST 1) Radiografer
2 SUJATMIKO,A.Md
3 ARIS GUNAWAN,A.Md
4
NOVITA FAJARIYAH SYAMSUDIN
5
FITRIYAH,A.Md
4 PONIMAH.A.Md
7 RETNO PALUPI,A.Md
9 RAFIKA AULIA,A.Md
11 MUSLICHATUN
14 SETIYOWATI, APTD
JENIS KEPEGAWAIAN
JENIS SPESIALIS NOMOR SIP TAT TMT
TETAP
33071.56311/DS/
PENYAKIT DALAM 20/9/2016 5/12/2021 V
01/449.1/117/IX/2016
33071.56311/DS/
PENYAKIT DALAM 21/12/2015 20-11-2020 V
01/449.1/097/XII/2015
33071.56311/DS/
PENYAKIT DALAM 01/449.1/0489/XII/ 6/3/2018 17-10-2023 V
2012
33071.56311/
KANDUNGAN DS01/449.1/124/XI/ 9/11/2016 8/2/2022 V
2016
33071.56311/DS/
KANDUNGAN 4/3/2020 20/6/2025 V
01/449.1/008/III/2020
33071.56311/
KANDUNGAN DS01/449.1/006/III/ 8/3/2019 19-12-2023
2019
33071.56311/DS/
ANAK 9/11/2016 12/1/2022 V
01/449.1/122/XI/2016
33071.56311/DS/
ANAK 8/6/2017 11/8/2022
01/449.1/023/VI/2017
33071.56311/DS/
ANAK 8/6/2020 31/1/2025 V
01/449.1/019/VI/2020
33071.56311/DS/
BEDAH 20/11/2017 22-04-2023 V
01/449.1/043/XI/2017
33071.56311/DS/
BEDAH 4/3/2020 8/3/2025
01/449.1/010/III/2020
33071.56311/DS/
RADIOLOGI 30/10/2016 10/8/2022 V
01/449.1/121/X/2016
33071.56311/DS/
RADIOLOGI 17/11/2016 4/5/2022 V
01/449.1/136/XI/2016
33071.56311/DS/
ANESTESI 2/10/2017 23-02-2023 V
01/449.1/033/X/2017
33071.56311/DS/
ANESTESI 01/449.1/0267/VII/ 27/7/2020 5/12/2025
2020
33071.56311/DS/
PATOLOGI KLINIS 19/6/2020 18/11/2025 V
01/449.1/021/VI/2020
33071.56311/DS/
THT-KL 4/10/2019 30/10/2024 V
01/449.1/021/X/2019
33071.56311/DS/
THT-KL 19/10/2017 24-03-2023 V
01/449.1/038/X/2017
33071.56311/DS/
MATA 28/12/2017 18-03-2023 V
01/449.1/054/XII/2017
33071.56311/DS/
SARAF 28/4/2017 14-05-2022 V
01/449.1/015/IV/2017
33071.56311/DS/
KULIT DAN KELAMIN 27/12/2016 11/3/2022 V
01/449.1/148/XII/2016
33071.56311/DS/
PARU-PARU 17/4/2017 19-04-2022 V
01/449.1/008/IV/2017
33071.56311/DS/
ORTHOPAEDI 13/2/2020 25/04/2025
01/449.1/005/II/2020
33071.56311/DS/
JANTUNG DAN PEMBULUH DARAH 2/10/2017 30-01-2023 V
03/449.1/035/X/2017
3307156311/DS/
KESEHATAN JIWA 16/11/2017 29-01-2023 V
01/4491/042/XI/2017
33071.56311/DS/
KESEHATAN JIWA 15/5/2019 28-12-2023 V
01/449.1/009/V/2019
33071.56311/DRG/
GIGI UMUM 6/12/2021 V
01/449.1/122/XI/2016
33071.56311/DRG/
GIGI UMUM 28-01-2022 V
01/449.1/118/XI/2016
33071.56311/DRG/
ORTHODENTI 28-04-2024 V
01/449.1/001/II/2020
33071.56311/DRG/
BEDAH MULUT MAKSILOVASIAL 5/11/2022 V
01/449.1/064/V/2017
33071.56311/DU/
UMUM 31/5/2017 6/2/2022 V
01/449.1/052/V/2017
33071.56311/DU/
UMUM 18/10/2017 20-10-2022 V
01/449.1/099/X/2017
33071.56311/DU/
UMUM 29/10/2016 14-07-2022 V
01/449.1/089/IX/2012
33071.56311/DU/
UMUM 27/3/2017 18-03-2022 V
01/449.1/034/III/2017
33071.56311/DU/
UMUM 29/10/2016 12/4/2023 V
01/449.1/086/IX/2017
KETANAGAAN LAIINYA
JENIS KEPEGAWAIAN
JENIS SPESIALIS NOMOR SIP TAT TMT
TETAP
19830428/
28-04-2021 V
SIPA_33.07/2016/2020
198110108/STRA-
08-01-2021 V
USB/2005/15853
19780303/SIPA_33.07/
3/3/2025 V
I/2020/2011
19740101/SIPA_33.07/
01-01-2021 V
I/2017/2009
19931031/SIPA_33.07/
31-10-2021 V
I/2019/2015
19920405/
4/4/2019 5/4/2025 V
SIPA_33.07/12019/2014
19950807/SIPA_33.07/
07-08-2023
I/2019/2016
19910711/SIPA
11/7/2019
-33.07/I/2017/2025
19900926/SIPA_33.07/
26-09-2023
I/I2017/2027
19880222/SIPA_33.07/
22-02-2023
I/I2017/2024
Dalam proses V
19801109/
SIKTTK_33.07/2016/203 09-11-2021 V
0
19860318/
SIKTTK_33.07/2016/203 19-03-2021 V
3
19760609/
SIKTTK_33.07/2016/203 09-06-2021 V
3
19871102/
SIKTTK_33.07/2016/202 02-11-2021 V
7
19800624/
SIPTTK_33.07/I/ 24/6/2024 V
2020/2014
19831005/
SIKTTK_33.07/2016/203 24/06/2024 V
1
19740814/
SIKTTK_33.07/2016/202 14-08-2020 V
9
19780402/
SIPTTK_33.07/IV/ 2/4/2024 V
2020/2005
19841230/
SIPTTK_33.07/I/ 30/12/2024 V
2020/2013
19951116/
SIPTTK_33.07/I/ 16-11-2023 V
2019/2007
19960813/
SIPTTK_33.07/I/ 13-08-2023 V
2019/1003
19900116/
SIKTTK_33.07/2016/202 16-01-2021
3
19940228/
SIKTTK_33.07/2016/203 28-02-2021
5
1992052511/
SIPTTK_33.07/I/ 25/5/2023
2018/2035
19850727/
SIKTTK_33.07/2016/202 27-07-2021
0
503/001/SIP/DKK-2017 12-08-2021 V
02-03-2022 V
503/015/SIP/DKK-2017 21-03-2022 V
503/010/SIP/DKK-2017 04-03-2022
503/003/DKK-2018 30-11-2021
503/004/SIP/DKK-2018 21-05-2021
503/001/DKK/I/2020 5/10/2024
503/044/SIKB/DKK/
19-10-2022 V
2017
503/022/SIKB/DKK/
19/01/2022 V
2017
V
503/042/01-10-
03-02-2022 V
2022SIKB/DKK-2017
503/023/SIKB/DKK-
06/11/2022 V
2017
503/032/SIKB/DKK-
15/03/2022 V
2017
503/041/SIKB/DKK-
24/11/2022 V
2017
503/025/SIKB/DKK-
27/04/2022 V
2017
503/026/SIKB/DKK-
14/03/2022 V
2017
503/024/SIKB/DKK-
2/10/2022 V
2017
503/035/SIKB/DKK-
23-03-2022 V
2017
503/034/SIKB/DKK-
1/10/2022 V
2017
503/033/SIKB/DKK-
12/8/2022 V
2017
503/029/SIKB/DKK-
25-03-2022 V
2017
503/036/SIKB/DKK-
29-04-2022 V
2017
503/043/SIKB/DKK-
5/6/2021 V
2017
503/037/SIKB/DKK-
20-08-2022
2017
503/027/SIKB/DKK-
18/10/2022
2017
503/031/SIKB/DKK-
20/04/2022
2017
503/028/SIKB/DKK-
12/8/2022
2017
503/040/SIKB/DKK-
20/06/2022
2017
503/030/SIKB/DKK-
2/4/2020
2017
503/039/SIKB/DKK-
11/06/2022
2017
503/038/SIKB/DKK-
20/05/2022
2017
503/038/SIKB/DKK-
22/9/2025
2020
503/0030/SIPB/DKK-
16/11/2024
2019
503/026/SIPB/IX/DKK-
30/4/2025
2020
503/0031/SIPB/DKK-
2/12/2024
2019
503/714/SIKB/DKK-
03-01-2020
2015
503/0028/SIPP/DKK-
6/12/2024
2019
503/0032/SIPB/DKK-
26/8/2024
2019
503/006/SIK/DKK-2017 10-01-2018 V
503/011/SIK/DKK-2017 20-01-2021 V
503/002/SIK/DKK-2018 02-04-2022 V
503/003/SIK/DKK-2018 08-11-2022 V
503/005/SIK//DKK-
30-07-2022 V
2018
503/007/SIK/DKK-2017 21-01-2022 V
503/009/SIK/DKK-2017 24-03-2022 V
503/008/SIK/DKK-2017 20-12-2021 V
Dalam proses V
Dalam proses V
503/037/SIP=ATLM/
25-08-2022 V
DKK/2017
503/018/SIP-ATLM/
3/30/2022 V
DKK/2017
503/019/SIP-ATLM/
2/27/2022 V
DKK/2017
503/034/SIP-ATLM/
10/11/2022 V
DKK/2017
503/015/SIP-ATLM/
6/9/2022 V
DKK/2017
503/016/SIP-ATLM/
5/13/2022 V
DKK/2017
503/017/SIP-ATLM/
4/9/2022 V
DKK/2017
503/033/SIP-ATLM/
13-10-2022 V
DKK/2017
503/020/SIP-ATLM/
1/11/2022 V
DKK/2017
503/032/SIP-ATLM/
6/10/2022 V
DKK/2017
503/15/SIP-ATLM/
2/12/2024
DKK/2019 V
503/13/SIP-ATLM/
4/6/2025
VIII/DKK/2020
503/035/SIP-ATLM/
12/11/2022
DKK/2017
503/01/SIK/2018 10/9/2020
503/277/SIKA/DKK/
09-11-2020
2016
504/01/SIP-ATLM/I/
28-01-2020
DKK/2020
JENIS KEPEGAWAIAN
KETERANGAN
TIDAK TETAP
V
MOU
V
MOU
V
MOU
V
MOU
V
MOU
V
MOU
V
MOU
V
MOU
V
MOU
V
MOU
V
MOU
V
MOU
JENIS KEPEGAWAIAN
KETERANGAN
TIDAK TETAP
V BLUD
V BLUD
V BLUD
V BLUD
V BLUD
V BLUD
V BLUD
V BLUD
V BLUD
V
BLUD
V BLUD
V
BLUD
V BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
V
BLUD
MOU
V
BLUD
V
BLUD
V BLUD
V
BLUD
V
BLUD
Surat Ijin Operasional RS Akreditasi RS
KELAS Jumlah
TMT
TAT KELAS VIP VVIP Kelas I Kelas II Kelas III Kelas I,II ICU PICU
dan III
4 4 14 16 32 6 19 10 12 2
Pelayanan Medik Spesialis Dasar Pelayanan Spesialis Penunjang Medik
3 3 2 3 2 2 1 0 0 1
JUMLAH DOKTER
Pelayanan Medik Spesialis Lain
Jantung
dan Kulit dan Kedokter Orthoped Bedah Bedah
Syaraf Paru Urologi
THT Pembulu Kelamin an Jiwa i Syaraf Plastik
h Darah
2 1 1 1 2 1 1 0 0 1
UMLAH DOKTER
Pelayanan Medik Subspesialis
Jantung
Kedokter
Penyakit Kesehata dan Kulit dan
an Bedah Obgyn Mata THT Syaraf
Dalam n Anak Pembulu Kelamin
Forensik
h Darah
0 0 0 0 0 0 0 0 0 0
sialis Pelayanan Medik Spesialis Gigi dan Mulut
0 0 0 0 0 1 0 1 0 0
s Gigi dan Mulut
JUMLAH
Jumlah Jumlah Jumlah JUMLAH JUMLAH JUMLAH
PENCERTAK
Perawat Bidan Apoteker PIC PIC PRB KODER
SEP
Pedodonsi Penyakit
Mulut
0 0 226 30 9 1 1 2 3
MEMILIKI UNIT PELAYANAN HEMODIALISA
Bila Ya Unit
Ambulan
Jumlah yang
Unit HD Bila Tidak dimiliki
Kerja Sama Tidak
yang
dimiliki
YA 10 6
Surat Ijin
Operasional Klinik Tingkat Pelayanan Ketersediaan Jenis Pelayanan
Utama
NO KATEGORI
1 JUMLAH MESIN HD
2 KEPEMILIKAN HD (KALAU DENGAN PIHAK KETIGA SEBUTKAN NM PIHAK KE 3
3 SHIFT HD 2 shi
KETENAGAAN HD
NAMA
SIP TAT TMT
dr. Arwedi Arwanto, Sp.PD .KGH
33071.56311/DS/
dr. Suprapto, Sp.PD.Finasim 01/449.1/117/IX/2016
20/9/2016 5/12/2021
SENEN
DATA HD LAIINYA
KETERANGAN
10 9 (non HBsAg. 1 (HbSAg)
v
v
v
v
v
v
v
v
v
v
v
dilatih vendor