LAMPIRAN DAFTAR USULAN KEWENANGAN KLINIS DOKTER SPESIALIS

OBSTETRI DAN GINEKOLOGI

Disetujui
No Diagnosis Diminta Kemampuan Klinis
1 2 3 4
1 Vulvitis
2 Dystrophy of vulva
3 Cyst of bartholin, abcess of bartholins gland
4 Abscess of hair follicle or sebaceous gland
5 Condylomata acuminate dalam kehamilan
6 Congenital malformations
7 Vaginitis dalam kehamilan
8 Bacterial vaginosis
9 Cyst of gartner
10 Cystocoele
11 Rectocoele
12 Enterocoele
13 Fistula (vesico-vaginal, uretero-vaginal, recto-vaginal
fistula)
14 Foreign body
15 Cervicitis
16 Polyps
17 Nabothian cyst
18 Congenital malformations
19 Uterine prolaps
20 Hematocolpos
21 Endometriosis
22 Retained placental tissue
23 Uterine inversion
24 Postpartum haemorrhage
25 Thrombo-embolism
26 Blood group incompatibility
27 Salpingitis
28 Adhesions
29 Ovarian cyst
30 Polycystic ovarian disease
31 Carcinoma of ovary
32 Ectopic pregnancy
33 Torsion tumour / ovarian cyst
34 Rupture of ovarian cyst / tubo ovarian abscess
35 Uterine bleeding at ovulation
36 Condyloma accuminata
37 Cervical carcinoma
38 Extramamamary pegets disease
39 Endometrial hyperplasia
40 Endometrial carcinoma
41 Ovarial teratoma (dermoid cyst)
42 Ovarian carcinoma
43 Hydatidiform mole
44 choriocarcinoma
Disetujui
Diagnosis Diminta Kemampuan Klinis
No
1 2 3 4
Delhvry

45 Premature contractions
46 Premature delivery
47 Rupture of uterus
48 Postmature infant
49 Premature rupture of membranes
50 Unstable tie / malposition after 36 week
51 Dystocial, fetal and passage
52 Malpresentation of fetus
53 Prolonged delivery
54 Primary mild contractions - IMININ
55 Secondary mild contractions
56 C
57
58
59
60
61
62

63 Gastrointestinal bleeding
64 Gastroenteritis
65 Colitis
66 Necrotizing Euterocolitis
67 Nephrotic syndrome
68 Acute glomerulonephritis
69 Chronic glomerulonephritis
70 Interstitial nephritis
71 Renal colic
72 Urinary tract infection
73 Horse shoe kidney
74 Uncomplicated Pyelonephritis
75 Urinary incontinence

Disetujui
No Diagnosis Kemampuan Klinis
Diminta
1 2 3 4
Pediatric Neurologic Disorders
76 Meningitis
77 Encephalitis
78 Epilepsi
79 Infantile spasms
80 Petit mal epilepsy
81 Febrile convultion
82 Poliomyelitis
83 Cerebral Palsy
84 Kernicterus
85 Mental Retardation
86 Autism
87 ADHD
Hematology
88 Iron deficiency anemia
89 Hemoglobinopathy
90 Anemia associated with chronic diseases
91 Thrombocytopenia
Infectious Diseases
92 Meningitis
93 Encephalitis
Congenital Disorders
94 Hydrocephalus
95 Spina brifida
Noses and Sinuses
96 Epistaxis
97 Allergic rhinitis
98 Chronic rhinitis
99 Rhinitis medicamentosa
Larynx and Pharynx
100 Pharyangitis
101 Tonsilitis
Immunological/Allergic Reaction
102 Autoimmune rheumatological and autoimmune
orthopedic disorder
103 Scleroderma
104 Rheumatoid arthritis
105 Anaphylactic reaction
106 Rheumatic fever
107 Juvenile chronic arthritis
108 Henoch-schoenlein purpura
109 Erythema multiforme
110 Atopy

Disetujui
Diagnosis Diminta Kemampuan Klinis
No
1 2 3 4
Disorders of Newborn

111 Asphyxia neonatorum

112 Vomitus
113 Hiperbilirubinemia
114 Neonatal Infeksi
115 Ikterik neonatorium
116 Hipoglikemia
117 Sepsis Neonatorum
118 Hipoksic Ischemic Encephalopathy
119 Hipotherma

Keterangan :
M : Mandiri
DS : Dibawah supervise
 LAMPIRAN
KEPUTUSAN DIREKTUR RUMAH SAKIT
KHUSUS IBU DAN ANAK WIJAYAKUSUMA
NOMOR
TENTANG
PENUGASAN KLINIS DAN RINCIAN
KEWENANGAN KLINIS DOKTER SPESIALIS
ANAK RUMAH SAKIT KHUSUS IBU DAN ANAK
WIJAYAKUSUMA

RINCIAN KEWENANGAN KLINIS DOKTER SPESIALIS ANAK RUMAH SAKIT

KHUSUS IBU DAN ANAK WIJAYAKUSUMA

Rincian Kewenangan Klinis diberikan kepada Dokter Spesialis Anak dalam menjalankan
prosedur teknis dan diberikan dalam rangka peningkatan kualitas pelayanan dan
keselamatan pasien agar supaya Dokter Spesialis Anak bersikap, bertindak dan berperilaku
secara bertanggung jawab dan mentaati semua disiplin dan etika serta moral yang baik
kepada pasien, sejawat dan masyarakat.
Rincian Kewenangan Klinis ini diberikan kepada :
Nama : dr. Wahyu Adiwinanto, M.Si. Med. Sp.A
Kualifikasi : Dokter Spesialis Anak
Kewenangan yang diberikan termasuk inti pelayanan, dengan rincian sebagai berikut :

Disetujui
NO RINCIAN KEWENANGAN KLINIS Mandiri Dibawah Ket
Supervisi
1 Membuat resep (obat kontras hanya diresepkan oleh
dokter spesialis radiologi)
Congenital Disorders
1 Esophagial atresia
2 Intestinal atresia
3 Anal atresia
4 Diapragmatic hernia (congenital)
Gastro-Hepatology
5 Gastro-enteritis
6 Gastro-enteritis dengan dehidrasi
7 Worms
8 Dehydration
9 Malabsorbsion
10 Food intolerance
11 Acute abdomen
12 Ileus
13 Umbilical hernia
14 Meckells diverticulum
15 Hirschsprungs disease
16 Biliary atresia
17 Hepatitis
18 Food allergy
Endrocrinological Disorders

19 IDDM
Disetujui
NO RINCIAN KEWENANGAN KLINIS Mandiri Dibawah Ket
Supervisi
Disorders of Newborns

20 Hipothermia
21 Bacteraemia and septicemia
22 Respiratory stress syndrome
23 Bronchopulmonary dysplasia
24 Aspiration pneumonia
25 Pneumo thorak
26 Apnea attacks
27 Jaundice of newborn
28 Severe neonatal jaundice (kern icterus)
29 Hypoglycemia
30 Child of diabetic mother
31 Neonatal convulsion
32 Necrotizing enterocolitis
33 Retinopathy of prematurity
34 Anemia
35 Rhesus incompatibility
36 Blood group incompatibility
37 Vitamine K defficiency
38 Cerebral hemorrhage
39 Conjuctivitis
Nutritional Deficiency
40 Marasmus
41 Kwashiorkor
42 Vitamin deficiencies
Cardiac Disorders

43 VSD
44 ASD
Pulmonology

45 Acute Bronchitis
46 Bronchial asthma
47 Status asmaticus
48 Pneumonia
49 Aspiration pneumonia
Epilepsy and other Seizures

50 Focal epilepsy
51 Generalizet epilepsy
52 Absence seizure
53 Status epilepticus
54 Sleep apnea syndrome
Acute Abdomen

55 Peritonitis
56 Abscess in pouch of Douglas
57 Illeus
Disetujui
NO RINCIAN KEWENANGAN KLINIS Mandiri Dibawah Ket
Supervisi
58 Perforation
59 Acute appendicitis
60 Appendicitis abscess
Stomach and Duodenum

61 Gastritis
62 Gastric / duodenal ulcer
63 Gastrointestinal bleeding
64 Gastroenteritis
65 Colitis
66 Necrotizing Euterocolitis
67 Nephrotic syndrome
68 Acute glomerulonephritis
69 Chronic glomerulonephritis
70 Interstitial nephritis
71 Renal colic
72 Urinary tract infection
73 Horse shoe kidney
74 Uncomplicated Pyelonephritis
75 Urinary incontinence
Pediatric Neurologic Disorders
76 Meningitis
77 Encephalitis
78 Epilepsi
79 Infantile spasms
80 Petit mal epilepsy
81 Febrile convultion
82 Poliomyelitis
83 Cerebral Palsy
84 Kernicterus
85 Mental Retardation
86 Autism
87 ADHD
Hematology
88 Iron deficiency anemia
89 Hemoglobinopathy
90 Anemia associated with chronic diseases
91 Thrombocytopenia
Infectious Diseases
92 Meningitis
93 Encephalitis
Congenital Disorders
94 Hydrocephalus
95 Spina brifida
Noses and Sinuses
96 Epistaxis
97 Allergic rhinitis
Disetujui
NO RINCIAN KEWENANGAN KLINIS Mandiri Dibawah Ket
Supervisi
98 Chronic rhinitis
99 Rhinitis medicamentosa
Larynx and Pharynx
100 Pharyangitis
101 Tonsilitis
Immunological/Allergic Reaction
102 Autoimmune rheumatological and autoimmune
orthopedic disorder
103 Scleroderma
104 Rheumatoid arthritis
105 Anaphylactic reaction
106 Rheumatic fever
107 Juvenile chronic arthritis
108 Henoch-schoenlein purpura
109 Erythema multiforme
110 Atopy
Disorders of Newborn

111 Asphyxia neonatorum

112 Vomitus
113 Hiperbilirubinemia
114 Neonatal Infeksi
115 Ikterik neonatorium
116 Hipoglikemia
117 Sepsis Neonatorum
118 Hipoksic Ischemic Encephalopathy
119 Hipotherma