Saya menyatakan bahwa saya kompeten untuk menangani kasus kasus di bidang spesialisasi
saya, termasuk melayani konsultasi dari dokter lain, serta melakukan prosedur teknis seperti
yang tercantum di bawah ini sebagai kewenangan klinis berdasarkan status kesehatan saat ini,
pendidikan dan atau pelatihan tambahan, serta pengalaman yang saya miliki
Sertifikasi
Universitas: Tanggal:
Kompetensi: Tanggal:
Permohonan Disetujui
Kemampuan Kemampuan
No Rincian Kewenangan Klinis
Klinis Klinis
1 2 3 4 1 2 3 4
1 BBLASR
2 BBLSR
3 NCB KMK
4 NCB SMK
5 NCB SMK
6 Hypothermia
7 Bacteremia and septicemia
8 Espiratory distress syndrome
9 Bronchopulmonary dysplasia
10 Aspiration pneumonia
11 Pneumothorax
12 Apnea attack
13 Jaundice of newborn
14 Severe neonatal jaundice (kern icterus)
15 Hypoglycemia
16 Child of diabetic mother
17 Neonatal convulsion
18 Necrotizing enterocolitis
19 Retinopathy of prematurity
20 Anemia
21 Rhesus incompatibility
22 Blood group incompatibility
23 Vitamin K deficiency
24 Cerebral hemorrhage
25 Conjunctivitis
26 Infection of umbilicus
Congenital Disorders
27 Esophageal atresia
28 Intestinal atresia
29 Anal atresia
30 Diaphragmatic hernia (congenital)
31 Pyloric stenosis
Gastro-hepatology
32 Gastro enteritis
33 Gastro enteritis dengan dehidrasi
34 Worms
35 Dehydration
36 malabsorbsion
37 Food intolerance
38 Acute abdomen
39 Ileus
40 Peritonitis tuberculosis
41 Peritonitis pancreatitis
42 Intuissussception
43 Malrotation
44 Umbilical hernia
45 Meckell’s diverticulum
46 Chron’s disease
47 Ulcerative colitis
48 Hirschprung’s disease
49 Biliary atresia
50 Hepatitis
51 Reye’s syndrome
52 Cirrhosis of the liver
53 Food allergy
Endocrinological disorders
54 IDDM
55 Sidden infant death syndrome (SIDS)
Nutritional deficiency
56 Marasmus
57 Kwashiorkor
58 Vitamin deficiencies
Cardiac disorders
59 VSD
60 ASD
Epilepsy and other seizures
61 Focal epilepsy
62 Generalized epilepsy
63 Absence seizure
64 Status epilepticus
65 Narcolepsy
66 Sleep apnea syndrome
Pulmonology
67 Uncomplicated pulmonary tuberculosis
68 TBC with HIV
69 TBC with pneumothorax
70 Acute bronchitis
71 Bronchiolitis
72 Bronchial asthma
73 Status asthmaticus
74 Lung emphysema
75 Atelectasis
76 Bronchiectasis
77 COPD
78 SARS
79 Pneumonia
80 Avian influenza
81 Lung abscess
82 Pulmonary embolism
83 Lung infarction
84 Pleurisy TBC
85 Pleurisy cancer
86 Pleurisy lupus
87 Pneumothorax
88 Cystic fibrosis
89 Aspiration pneumonia
Acute abdomen
90 Peritonitis
91 Abscess in pouch of douglas
92 Ileus
93 Perforation
94 Salphingitis
95 Acute appendicitis
96 Appendicitis abscess
97 Mesenteric lymphadenitis TBC
Stomach and duodenum
98 Gastritis
99 Gastric / duodenal ulcer
100 Gastrointestinal bleeding
101 Zollinger – Ellison syndrome
102 Mollory weiss syndrome
103 Gastroenteritis
104 Hepatitis A
105 Uncomplicated hepatitis B
106 Active hepatitis C
107 Colitis
108 Necrotizing enterocolitis
Nefrourology
109 Acute renal failure
110 Chronic renal failure
111 Nephrotic syndrome
112 Acute glomerulonephritis
113 Chronic glomerulonephritis
114 Interstitial nephritis
115 Renal colic
116 Urinary stone disease of urinary calculi without
colic
117 Polycystic kidney symptomatic
118 Urinary tract infection
119 Acute tubular necrosis
120 Horse shoe kidney
121 Uncomplicated pyelonephritis
122 Urinary incontinence
123 Nocturnal and diurnal enuresis
Pediatric neurologic disorder
124 Meningitis
125 Encephalitis
126 Cerebral abscess
127 Epilepsy
128 Infantile spasms
129 Febrile convulsion
130 Duchene muscular dystrophy
131 Polio myelitis
132 Cerebral palsy
133 Kern icterus
134 Mental retardation
135 Autism
136 ADHD
Hematology
137 Aplastic / hypoplastic anemia
138 Iron deficiency anemia
139 Hemoglobinopathy
140 Macrocytic anemia
141 Anemia associated with chronic disease
142 Polycitemia
143 Thrombocytopenia
144 Thrombocytosis
145 Hemophylia
146 Von willebrand’s disease
147 DIC
148 Agranulocytosis
149 Haemorheologic disorders
150 Antiphospholipid syndrome
Infectious disease
151 Meningitis
152 Encephalitis
153 Malaria cerebral
154 Tetanus
155 Cerebral toxoplasmosis
156 Tuberculoma
157 Brain abscess
158 HIV AIDS
Congenital disorders
159 Hydrocephalus
160 Spina bifida
161 Phenylketonuria
Noses and sinuses
162 Epistaxis
163 Furuncle of nose
164 Acute rhinitis (common cold)
165 Vasomotor rhinitis
166 Allerghic rhinitis
167 Chronic rhinitis
168 Rhinitis medicamentosa
169 Acute frotal sinusitis
170 Acute maxillary sinusitis
171 Acute ethmoiditis
172 Chronic sinusitis
173 Deviation of nasal septum
174 Choanal atresia
175 Foreign body in nose
Larynx and pharynx
176 Pharyngitis
177 Tonsillitis
178 Hypertrophy of adenoids
179 Pseudo croup acute epiglotitis
Immunological / allergic reaction
180 Autoimmune rheumatological and autoimmune
orthopedic disorder
181 Uncomplicated SLE
182 Complicated SLE
183 Scleroderma
184 Polyarthritis nodosa
185 Vasculitis lupus
186 Polymyalgia rheumatic
187 Rheumatoid arthritis
188 Anaphylactic reaction
189 Rheumatic fever
190 Juvenile chronic arthritis
191 Henoch schonlein purpura
192 Erythema multiforme
193 Atopy
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