RINCIAN KEWENANGAN KLINIS (DELINEATION OF CLINICAL PRIVILEGE)

KSM ANAK

Nama :
Spesialisasi :
Universitas :
STR berlaku sampai :

Dengan ini saya menyatakan mempunyai kemampuan untuk melakukan pengelolaan kasus-
kasus yang telah diklasifikasikan sesuai dengan kompetensi saya sebagai Dokter Spesialis Anak,
untuk melakukan hal-hal dibawah ini :

RINCIAN Keterampilan Klinis

No KEWENANGAN Permohonan Disetujui
KLINIS 1 2 3 4 5 1 2 3 4 5
CONGENITAL
DISORDERS
1 Esophalgia atresia
2 Intestinal atresia
3 Anal atresia
4 Diapragmatik
5 Pyliric stenosis
GASTRO-HEPATOLOGI
6 Gastro-enteritis
Gastro-enteritis dengan
7 dehidrasi
8 Worm
9 Dehidration
10 Malabsorsion
11 Food intolerance
12 Acute abdomen
13 Ileus
14 Peritonitis tuberculosis
15 Peritonitis pancretritis
16 Intussussception
17 Malrotation
18 Umbilical hernia
19 Meckkle's diverticulum
20 Crohn's disease
21 Ulcerative colitis
22 Hirschprung's disease
23 Billiary atresia
24 Hepatitis
25 Reye's syndrome
26 Cirrhosis of the liver
Food allery
27
 ENDROCRINOLOGICAL
DISORDERS
28 IDDM
Disorders of newbors
29 Hypotermia
Bacteraemia and
30 septicemia
Resoiratory sterss
31 syndrome
Bronchpulmonarry
32 dysplasia
33 Aspiration pneumonia
34 Pneumo thorak
35 Apne attacks
36 Jaudice of newborn
Severe neonatal jaundice
37 (kern icterus)
38 Hypoglycemia
39 Child of diabetic mother
40 Neonatal convulsion
41 Necrotizing enterocolitis
Retinophaty of
42 prematurity
43 Anemia
Blood group
44 incompatibility
45 Vitamine kdefficiency
46 cerebral hemorrhage
47 Conjungtivi
48 nfection of umbilicus
sudden infant death
49 syndrome (sids)
Nutritional Deficiency
50 Marasmus
51 kwashiorkor
52 Vitamin deficiencies
Cardiac Disorders
53 VSD
54 ASD
Pilmonologi
Umncomplicated
55 pulmonary tuberulosis
56 TBC with HIV
57 TBC with pneumothorak
58 acute Bronchitis
59 Bronchiolitis
60 Bronchiolitis asthsma
61 status asmaticus
62 Lung emphyserma
63 atelectasis
64 Bronmchiestasis
65 COPD
66 SARS
67 Pneumonia
68 avian influenzae
69 Lung abscess
70 Pulmonary embolism
71 Lung infaction
72 Pleurisy TBC
73 Pleurisy Cancer
74 Pleurisy Lupus
75 Cystic fibrosis
76 Aspiration pneumonia
epilepsy and other
seizures
77 Focal epilepsy
78 generalizet epilepsy
79 absence seizure
80 Status epilepticus
81 Narcolepsy
82 Sleep apnea syndrome
Acute Abdomen
83 Peritonitis
abcess in pounch of
84 douglas
85 illeus
86 Perforation
87 Salphingitis
88 Acute appendicitis
89 Appendicitis abscess
Mesenteric
90 liymphadenitis
Stomach and duodenum
91 gastritis
92 gastric/duodenal ulcer
93 gastrointestinal bleeding
zollinger-ellison
94 syndrome
95 Molly Weiss Syndrome
96 gastroenteritis
97 Hepatitis A
Uncomplicated hepatitis
98 B
99 Active hepatitis c
100 Colitis
101 Necrotizing entercolitis
Neufrourologi
102 Acute renal failure
103 Chronic renal failure
104 Nephritic syndrome
105 Acute glomerulonephritis
Chronic
106 glamerulonephritis
107 Interstitial nephritis
Urinary stone deseases ot
108 urinary calculi
Polycystic kidnays
109 sympotomatic
110 Urinary trac infection
111 acute tubular necrosis
112 Horse shoe kidney
Uncomplicated
113 pyelonephritis
114 Urinary incontinence
Nocturnal and diumal
115 enuresis
Pediatric neurologic
disorders
116 Meningitis
117 eEncephalitis
118 Cerebral abscess
epilepsy and other
119 seizures
120 Infateli spasms
121 Petit mal epilepsy
122 Febrile convulsion
Duchene muscular
123 dystrophy
124 Poliomyelitis
125 Cerebral palsy
126 Mental retalrdation
127 Autism
128 ADHD
Hematology
Aplastic/hypoplastic
129 anemia
130 Iron deficiens anemia
131 Hemoglobininophathy
Anemia associated with
132 chronic disease
133 Polyctytemia
134 Thrombocytopenia
135 Thrombocytosis
136 Haemophilia
137 Von willebrands disease
138 DIC
139 Agranuloccytosis
Haemorheologic
140 disorders
141 anthiposholipid syndorme
142 meningtis
143 Encpealitis
144 Malaria celebral
Ket : Berilah tanda √ sesuai yang dikehendaki :
1. Kompeten sepenuhnya
2. Kompeten sebagian
3. Memerlukan supervisi
4. Tidak dimintakan kewenangannya karena diluar kompetensi
5. Tidak dimintakan kewenangannya karena fasilitas tidak tersedia

Ket : Berilah tanda √ sesuai yang direkomendasi :

1. Disetujui berwenang penuh
2. Disetujui berwenang sebagian
3. Disetujui dibawah pengawasan
4. Tidak disetujui bukan kompetensinya
5. Tidak disetujui saran tidak memadai

Menyetujui, Lhokseumawe,12 Januari 2019

Sub Komite Ka. KSM Anak Pemohon

dr.Agustina, Sp.PD dr. Sp.A dr.Maghfirah Sp.A

Ketua Komite Medik

dr.Ikhwanuddin Sp.S