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CONTOH ;

DAFTAR TINDAKAN – TINDAKAN YANG PERLU INFORMED

CONSENT

Sesuai Undang – Undang no 44 tahun 2009 tentang rumah sakit, terdapatbeberapa

tindakan kedokteran dan kedokteran gigi yang wajib diberikaninformed

consent.

Tindakan tersebut yaitu :

. Semua Tindakan !embedahan dan Tindakan "n#asi#e

$. Semua Tindakan nestesi % Sedasi & Sedasi Sedang dan Sedasi 'a(am )

*. Semua Tindakan !emberian !roduk 'arah % +omponen 'arah

'. Semua Tindakan!-/$T 1ang $erisiko Tinggi.

A. Tindakan P!bda"an dan Tindakan In#a$i# %an&

!!'()kan informed consent an*a'a (ain+

NO

KSM,INSTALA

SI,UNIT

TINDAKAN

KSM -da"

Sa'a

mygda(a 3ypocampectomy &-pi(epsi)

2 nterior Temporomesia( obectomi &-pi(epsi)5 $iopsi Saraf Tepitot4 $(ok Saraf !erifer "6 *ingu(otomy &!sichiatric)7 *orpus *a((osotomi &-pi(epsi)8 'ebrimen ekonstruksi u(nus +u(it +epa(a

; 'ekompresi Saraf Tepi9 'ekompresi Tu(ang 'urameter0 'ekortikasi Sinus ie(oke(4 -ksisi +ista ?inak +u(it +epa(a


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6 -ksisi steomasteositosis7 -(e#asi +raniotomi


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4 >esencepha(ectomy &!ain)42 >ikrodisekktomi 3!45 >' &>icro#ascu(ar 'ecompression)44 eurektomieuro(ise

46 euroendoskopi &tak,Spina()47 europ(asti48 maya drain

N

O

KSMI,INSTA

LASI,UNIT

TINDAKAN

4; !a((idotomi &mo#ement 'isorder)49 !ara#ertebra( $(ok !erkutan60 !emasangan Traksi Ser#ika(6 !enAahitan Saraf Tepi62 !unksi *airan tak65 eseksi -@traCTempora( &-pi(epsi)64 e#isi ! Shunt66 hiDotomi Se(ektif &Spastisitas)67 hiDotomy &!ain)68 Se(ecti#e er#e oot $(ock6; Se(ecti#e Tha(amotomi &>o#ement

'isorder)69 Simpatektomi pen &!ain)70 Simpatektomi !erkutan7 ST372 Stereotactic b(ati#e !rocedure

&!sichiatric)75 Subtha(amotomy &>o#ement 'isorder)74 Suturektomi +raniostenosis76 Tha(omotomy &!ain)77 Transposisi kraniostenosis,dengan orbita(ad#ancement78 Transposisi kraniostenosis,tanpa orbita(ad#ancement 7; Trepanasi *edera +epa(a


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&E4Aam)79 Trepanasi *edera +epa(a &B4Aam)80 Trepanasi * $(eeding8 Trepanasi ke(ainan Saraf +rania(

82 Trepanasi +e(ainan ascu(ar tak85 Trepanasi Tumor tak84 Shunt86 ! Shunt >u(tip(e

87 ! Shunt Satu Sisi

N

O

KSM,INSTA

LASI,UNIT

TINDAKAN

/. KSM -da"

K0a(a L"'

F rch $arr2 F rch $arr dan suspensi maksi(a5 $iopsy "nsisiona( dengan anastesi (oka(4 'eseksi submandibu(a6 'iseksi (eher radika(radika( neck dissection7 -ksisi g(d submandibu(a8 -ksisi higroma (eher; -ksisi kista tirog(osus

9 -ksisi (uas tumor ganas bibir denganrekontruksi0 Gap (oka( -ksisi (uas tumor ganas dengan

rekontruksi Gap Aauh2 -ksisi (uas tumor ganas ku(it dengan

rekontruksi5 Gap (oka(4 -ksisi (uas tumor ganas rongga mu(ut

dengan6 rekontruksi Gap (oka(7 -ksisi parsia(Hmarsupia(isasi anu(a8 -ksisi tumor ganas ku(it dengan Gap (oca(

atau graft; ku(it


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9 -ksisi tumor ganas ku(it dengan Gap (oca(

Aauh20 -ksisi tumor ganas ku(it tanpa rekontruksi2 -ksisi tumor Ainak dengan anastesi (oka(

22 -kskok(easi epu(is25 -kskok(easi kista fo(iku(er24 -kskok(easi kista radiku(er26 -kstirpasieksisi tumor Ainak Aaringan

(unak ukuran E2cm27 -kstirpasi kista dermoid28 -ndoscopic thyroidectomy2;


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29


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7; ekontruksi aksi(a >u(tip(e79 ekontruksi aksi(a Sederhana80 hinop(asti8 inotomi atera(H>aksi(ektomi >edia(

82 ekontruksi aring Trakea85 eposisi


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55 rthrodesis of unspeciIed Aoint

54 rthrop(asty of carpocarpa( or

carpometacarpa( Aoint Kith imp(ant56 rthrop(asty of carpocarpa( or

carpometacarpa( Aoint Kithout imp(ant57 rthrop(asty of metacarpopha(angea( and

interpha(angea( Aoint Kith imp(ant58 rthrop(asty of metacarpopha(angea( and

interpha(angea( Aoint Kithout imp(ant5; rthroscopy59 rthrotomy for remo#a( of prosthesis

Kithout rep(acement40 spiration of bursa4 spiration of bursa of hand

42 spiration of other soft tissue45 spiration of other soft tissue of hand44 t(asCa@is spina( fusion46 $iopsy of bone47 $iopsy of Aoint structure

48 $iopsy of spina( cord or spina( meninges4; $one graft49 $one marroK or hematopoietic stem ce((

transp(ant &a(( procedures inc(uded in this

c(ass

60 $unionectomy Kith soft tissue correctionand arthrodesis6 $unionectomy Kith soft tissue correction

and osteotomy of the Irst metatarsa(62 $ursectomy

65 $ursectomy of hand64 $ursotomy

NO KSM,INSTAL

ASI,UNIT

TINDAKAN

66 $ursotomy of hand67 *arporadia( fusion68 *(osed reduction of dis(ocation


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C/enera( anaesthesia6; *(osed reduction of dis(ocation of

ank(e69 *(osed reduction of dis(ocation of

e(boK70 *(osed reduction of dis(ocation of foot

and toeC genera( anaesthesia7 *(osed reduction of dis(ocation of foot

and toeC(oca( anaesthesia72 *(osed reduction of dis(ocation of

hand and IngerC genera( anaesthesia75 *(osed reduction of dis(ocation of

hand and IngerC (oca( anaesthesia

74 *(osed reduction of dis(ocation of hip76 *(osed reduction of dis(ocation of

knee77 *(osed reduction of dis(ocation of

other speciIed sitesCgenera( anaesthesia78 *(osed reduction of dis(ocation of

other speciIed sitesC(oca( anaesthesia7; *(osed reduction of dis(ocation of

other speciIed sitesC(oca( anaesthesia79 *(osed reduction of dis(ocation of

shou(der80 *(osed reduction of dis(ocation of

Krist8 *(osed reduction of dis(ocationCoca(

anaesthesia82 *(osed reduction of fracture Kith

interna( I@ation C *arpa( and metacarpa(

85 *(osed reduction of fracture Kith interna(

I@ation C


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I@ation C 3umerus &inc(uding : "nter(ocking

nai(, T-, >"!)

NO KSM,INSTAL

ASI,UNIT

TINDAKAN

86 *(osed reduction of fracture Kith interna(

I@ation C "ntrarticu(ar >aAor $one87 *(osed reduction of fracture Kith interna(

I@ation C !ha(ang of foot88 *(osed reduction of fracture Kith interna(

I@ation C !ha(ang of hand8; *(osed reduction of fracture Kith interna(

I@ation C adius and u(na &>"!, T-)

89 *(osed reduction of fracture Kith interna(I@ation C Tarsa( and metatarsa(

;4 -@cision of bone for graft;6 -@cision of inter#ertebra( disc;7 -@cision of (esion of musc(e;8 -@cision of (esion of musc(e of hand;; -@cision of (esion of other soft tissue;9 'orsa( and dorso(umbar fusion of the

anterior co(umn, anterior techniLue90 'orsa( and dorso(umbar fusion of the

posterior co(umn, posterior techniLue9 -@cision of bone for graft92 -@cision of inter#ertebra( disc95 -@cision of (esion of musc(e94 -@cision of (esion of musc(e of hand96 -@cision of (esion of other soft tissue97 -@cision of (esion of tendon sheath98 -@cision of (esion of tendon sheath of hand,

/ang(ionectomy of tendon sheath &Krist)C

/enera( anaesthesia

9; -@cision of (esion of tendon sheath of hand,/ang(ionectomy of tendon sheath &Krist)Coca(

naestesi

99 -@cision of musc(e or fascia for graft00 -@cision of musc(e or fascia of hand for

graft


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0 -@cision of other (esion of soft tissue

of hand

NO KSM,INSTAL

ASI,UNIT

TINDAKAN

02 -@cision of semi(unar carti(age of knee05 -@cision of tendon for graft04 -@cision of tendon of hand for graft06 -@cision or correction of bunionette,

That Kith osteotomy07 -@cision or destruction of inter#ertebra(

disc, unspeciIed08 -@p(oration of tendon sheath

0; -@p(oration of tendon sheath of hand09 -@p(oratory thoracotomy0


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27 "mp(antation or rep(acement of

periphera( neurostimu(ator (ead &s)

28 "mp(antation or rep(acement of spina(

neurostimu(ator (ead&s)2; "ncision and drainage of pa(mar or

thenar space29 "nAection of anesthetic into periphera(

ner#e for ana(gesia

NO KSM,INSTAL

ASI,UNIT

TINDAKAN

50 "nAection of anesthetic into spina( cana( for

ana(gesia5 "nAection of destructi#e agent into spina(

cana(52 "nAection of (oca((yCacting therapeutic

substance into other soft tissue55 "nAection of other agent into spina( cana(,

"ntratheca( inAection of steroid, Subarachnoid

perfusion of refrigerated sa(ine54 "nAection of therapeutic substance into

bursa56 "nAection of therapeutic substance into

bursa of hand57 "nAection of therapeutic substance into

Aoint or (igament58 "nAection of therapeutic substance into

tendon5; "nAection of therapeutic substance into

tendon of hand59 "nsertion of bone groKth stimu(ator40 "nsertion of bone #oid I((er4"nsertion of catheter into spina( cana( for

infusion of therapeutic or pa((iati#e substances,

"nsertion of catheter into epidura(,

subarachnoid, or subdura( Space of spine Kith

intermittent or continuous infusion of drug


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&Kith creation of any reser#oir)42 "nsertion of interbody spina( fusion de#ice45 "nsertion of other spina( de#ices44 "nsertion of partia( spina( disc prosthesis,

cer#ica(

46 "nsertion of partia( spina( disc prosthesis,(umbosacra(47 "nsertion of recombinant bone

morphogenetic protein48 "nsertion of spina( disc prosthesis, not

otherKise speciIed, ep(acement of spina(

disc, S4; "nsertion of spina( disc prosthesis, thoracic49 "nsertion of sterna( I@ation de#ice Kith

rigid p(ates

60 "nsertion of tota( spina( disc prosthesis,cer#ica(

62 "nsertion of tota( spina( disc prosthesis,

(umbosacra(65 "nsertion or rep(acement of &cement) spacer64 "nsertion or rep(acement of facet rep(acement

de#ice&s)

NO KSM,INSTALASIUNIT

TINDAKAN

66 "nsertion or rep(acement of interspinous

process de#ice&s)67 "nsertion or rep(acement of pedic(eCbased

dynamic stabi(iDation de#ice&s)68 "nsertion or rep(acement of ske(eta(

musc(e stimu(ator6; "nterna( I@ation of bone Kithout fracture

reduction69 "nterpha(angea( fusion70 "nterthoracoscapu(ar amputation,


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74 imb shortening procedures76 oca( e@cision of (esion or tissue of bone77 oKer (eg or ank(e reattachment78 oKer (imb amputation, not otherKise

speciIed

7; umbar and (umbosacra( fusion of theanterior co(umn, anterior techniLue79 umbar and (umbosacra( fusion of the

anterior co(umn, posterior techniLue80 umbar and (umbosacra( fusion of the

posterior co(umn, posterior techniLue8 ysis of adhesions of hand82 ysis of adhesions of musc(e, tendon,

fascia, and bursa85 ysis of adhesions of spina( cord and ner#e

roots84 >etacarpocarpa( fusion86 >etacarpopha(angea( fusion87 >etatarsopha(angea( fusion88 >idtarsa( fusion8; >usc(e transfer or transp(antation

89 >yotomy

;0 >yotomy of hand; eurectasis

NO KSM,INSTAL

ASI,UNIT

TINDAKAN

;2 pen biopsy of crania( or periphera( ner#e or

gang(ion;5 pen biopsy of soft tissue;4 pen reduction of dis(ocation of ank(e C

eg(ected dis(ocation;6 pen reduction of dis(ocation of e(boK C


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eg(ected dis(ocation;9 pen reduction of dis(ocation of knee C

eg(ected dis(ocation90 pen reduction of dis(ocation of knee C


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Segmenta(207 pen reduction of fracture Kith

interna( I@ationC other speciIed bone

&"ntraartiku(ar >aAor $one )

208 pen reduction of fracture Kithinterna( I@ationC pha(anges of foot C simp(e

imp(ants &+CKire)20; pen reduction of fracture Kith

interna( I@ationC pha(anges of footC!(ate %

ScreKs209 pen reduction of fracture Kith

interna( I@ationC pha(anges of handC !(ate

% ScreKs20 pen reduction of fracture Kith

interna( I@ationC pha(anges of handC simp(e

imp(ants2 pen reduction of fracture Kith

interna( I@ationC tarsa(s and metatarsa(sC

!(ate % ScreKs22 pen reduction of fracture Kith

interna( I@ationC tarsa(s and metatarsa(sC

simp(e imp(ants25 pen reduction of fracture Kith

interna( I@ationCtibia and Ibu(a CSimp(e

fracture24 pen reduction of fracture Kith

interna( I@ationCtibia and Ibu(aC

*omminuti#e or Segmenta(26 pen reduction of fracture Kithout

interna( I@ation27 pen reduction of separated epiphysis28 steoc(asis &correction of bone

deformity)2; ther29 ther &periphera() #ascu(ar shunt or

bypass220 ther amputation be(oK knee22 ther anastomosis of crania( or


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periphera( ner#e222 ther and unspeciIed repair of the

anu(us Ibrosus225 ther arthrotomy224 ther bunionectomy

22; ther change in hand musc(e or tendon (ength229 ther change in musc(e or tendon (ength250 ther destruction of inter#ertebra(

NO KSM,INSTAL

ASI,UNIT

TINDAKAN

25 ther diagnostic procedures on Aoint

structures252 ther diagnostic procedures on musc(e,

tendon, fascia, and bursa, inc(uding that of

hand255 ther di#ision of bone254 ther e@cision of Aoint256 ther e@cision of soft tissue257 ther e@cision of soft tissue of hand258 ther e@cision or a#u(sion of crania( and

periphera( ner#es25; ther e@cision, fusion and repair of toes259 ther e@p(oration and decompression of

spina( cana(, 'ecompression240 ther fasciectomy24 ther fasciectomy of hand242 ther fusion of foot245 ther hand musc(e transfer or

transp(antation244 ther hand musc(e transposition

246 ther hand tendon transfer ortransp(antation247 ther hand tendon transposition248 ther incision of bone Kithout di#ision24; ther incision of soft tissue249 ther incision of soft tissue of hand260 ther inAection of (oca((yCacting


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2;2 ther tota( shou(der rep(acement

2;5 !artia( hip rep(acement2;4 !artia( shou(der rep(acement

2;6 !ate((ar stabi(iDation2;7 !ercutaneous dener#ation of facet

2;8 !ercutaneous #ertebra( augmentation

2;; !ercutaneous #ertebrop(asty2;9 !eriphera( ner#e inAection, not otherKise

speciIed290 !(astic operation on hand Kith graft of musc(e

or fascia29 !(astic operation on hand Kith other graft or

imp(ant292 !o((iciDation operation carrying o#er ner#es

and b(ood supp(y295 Muadricepsp(asty294 eattachment of musc(e

296 eattachment of musc(e of hand297 eattachment of tendon298 eattachment of tendon of hand29; efusion of at(asCa@is spine

299 efusion of dorsa( and dorso(umbar spine, anterior

co(umn, anterior techniLue

NO KSM,INSTALA

SI,UNIT

TINDAKAN

500 efusion of dorsa( and dorso(umbar spine, posterior

co(umn, posterior techniLue

50 efusion of (umbar and (umbosacra( spine, anterior

co(umn, anterior techniLue

502 efusion of (umbar and (umbosacra( spine, anterior


505 efusion of (umbar and (umbosacra( spine, posterior


504 efusion of other cer#ica( spine, anterior co(umn,

anterior techniLue

506 efusion of other cer#ica( spine, posterior co(umn,

posterior techniLue507 efusion of spine, not e(seKhere c(assiIed508 efusion of spine, not otherKise speciIed

50; e(ease of carpa( tunne(509 e(ease of c(ubfoot, not e(seKhere c(assiIed

50 e(ease of tarsa( tunne(5 emo#a( of &cement) spacer

52 emo#a( of bone groKth stimu(ator &in#asi#e)55 emo#a( of foreign body from spina( cana(


22/52


23/52

545 epair of #ertebra( fracture, -(e#ation of spina(

bone fragments, eduction of fracture of #ertebrae,

emo#a( of bony spicu(es from spina( cana(

544 ep(acement of Aoint of foot and toe546 esurfacing hip, partia(, acetabu(um, 3ip

resurfacing arthrop(asty, partia(, acetabu(um

547 esurfacing hip, partia(, femora( head548 e#ision of tota( knee rep(acement, tibia( insert

&(iner), ep(acement of tibia( insert&(iner)

54; e#ision or rep(acement of artiIcia( spina( disc

prosthesis, cer#ica(

549 e#ision or rep(acement of artiIcia( spina( disc

prosthesis, (umbosacra(


prosthesis, not otherKise speciIed


prosthesis, thoracic562 otator cuF repair

565 Separation of eLua( conAoined tKins564 Separation of uneLua( conAoined tKins566 SeLuestrectomy

567 Spina( fusion, not otherKise speciIed568 Subta(ar fusion

56; Subta(ar Aoint arthroereisis

569 Suture of rtery570 Suture of capsu(e or (igament of ank(e and

foot

NO KSM,INSTALAS

I,UNIT

TINDAKAN

57 Suture of capsu(e or (igament of

other (oKer e@tremity572 Suture of capsu(e or (igament of

upper e@tremity

575 Suture of crania( and periphera(ner#es574 Suture of musc(e or fascia of hand576 Suture of tendon sheath577 Suture of tendon sheath of hand578 Suture of ein57; Syno#ectomy


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579 Tarsometatarsa( fusion580 Tendon graft58 Tendon pu((ey reconstruction582 Tendon pu((ey reconstruction585 Tendon transfer or transp(antation584 Tenotomy of hand586 Thigh reattachment587 Thumb reattachment58; Toe reattachment589 Tota( ank(e rep(acement5;0 Tota( e(boK rep(acement5; Tota( ostectomy5;2 Tota( Krist rep(acement5;5 Transp(ant from cada#er

5;4 Transposition of crania( andperiphera( ner#es C er#e

transp(antation5;9 Triad knee repair590 Trip(e arthrodesis59 UnspeciIed operation on bone

inAury592 Upper arm reattachment595 Upper (imb amputation, not

otherKise speciIed

594 Jedge osteotomy

NO KSM,INSTALAS

I,UNIT

TINDAKAN

5 KSM -EDAH

THORAKS DAN

KARDIO6ASKULA

R

$iopsi Terbuka $ronkhus2 $iopsi Terbuka 'iafragma5 $iopsi Terbuka >ediastinum4 $iopsi Terbuka !aru6 $iopsi Terbuka !(eura

7 $iopsi Terbuka !(eura dengan TS8 $iopsi Terbuka Tumor 'inding Thoraks; 'ebridement >ediastinum &Sternotomi)9 -ksisi !ada $ronkhus0 -ksisi !ada !aru &ung o(ume eduction) -ksisi !ada !aru dengan TS2 -ksisi Tumor 'inding 'ada dengan

ekonstruksi 'inding 'ada


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5 -ksisi Tumor >ediastinum &Thymoma,

Teratoma, eurogenic dsb)4 -kstraksi *orpus (ienum di egio Toraks6 -kstraksi *orpus (ienum di egio Toraks

dengan TS

7 -#akuasi -fusi !(eura-mpyema secara Torakoskopik &TS)8


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42 Thoracocentesis45 Thymectomy44 Thymectomy dengan TS46 Torakop(asti &ir !(umbage>usc(e !(umbage)47 Torakotomi sternotomi -ksp(orasi48 Torakotomi -ksp(orasi pada Trauma

Aantungepair aserasi ?antung

4; $edah +ardio &?antung)49 ortic a(#e epair &)60 ortic a(#e epair &) dengan

$ioprosthesis a(#e6 ortic a(#e epair &) dengan >echanica(

a(#e62 tria( septa( 'efect &S') *(osure65 $idirectiona( *a#oC!u(monary Shunt &$*!S)64 $iopsi ?antung66 $iopsi !erikardium

67 $(a(ockCTaussing Shunt &$T Shunt)68 *oronary rtery $ypass /raft &*$/)6; -ksisi *ardiac >y@oma69 aker !ermanen &di(uar

a(at)79 !ericardiocentesis80 !erikardiektomi

8 !erikardiotomi!ericardia( JindoK82 !u(mona( a(#e epair &!)85 !u(mona( a(#e epair &!) dengan

$ioprosthesis a(#e84 !u(mona( a(#e epair &!) dengan

>echanica( a(#e86 !u(monary rtery $anding &!)


27/52

NO KSM,INSTALA

SI,UNIT

TINDAKAN

87 aste((i !rocedure &right entric(eC!u(onary

rtery *onduit)

88 epair &-ksisi) neurisma ?antung8; epair orta Toraka(is &5;.54)89 epair trio#entricu(ar Septa( 'efect &56.64);0 epair Tota( noma(ous !u(moanry enous

*onnection &T!*) &56.;2); epair Transposition of /reat rteries &T/)

&56.;4);2 epair Trunkus rteriosus &56.;5);5 e#isiF !ace >aker !ermanen &di(uar a(at)

&58.;9);4 Septostomi Terbuka Septum trium &56.4);6 Tota( +oreksi Tetra(ogy of


28/52

egio ser#ika( &+arotis, ?ugu(ar) &di(uar a(at)9 -#akuasi 3ematom di -kstremitas &!asca

!ungsi 3' Traumatik)0 uti(asi 'igiti -kstermitas

NO KSM,INSTALA

SI,UNIT

TINDAKAN

5 !asang 'oub(e umen 3emodia(isis &3')

&di(uar a(at)4 !asang "mp(antab(e *entra( enous ccess

&di(uar a(at: porthCaCcath, ce(site)6 !emasangan *entra( enous *atheter &**)

&di(uar a(at)

7 !emasangan "ntra ortic $a(oon !ump &"$!)

&di(uar a(at)8 !emasangan !eritonea( 'ya(isis &!')

*atheter &di(uar a(at); !embedahan Te(eangiectasis9 epair neurisma &Truefa(se) -kstremitas

Superior &di(uar graft)20 epair neurisma orta bdomina(is &'i(uar

!rotesa)2 epair !embu(uh 'arah egio Ser#ika(

&+arotis, ?ugu(ar)22 epair uptur !embu(uh rteri bdomina(25 e#isi rterio#enous Shunt24 Sk(eroterapi ena &arises, 3emangioma)26 Stripping arises -kstremitas "nferior27 ascu(ar Shunting &Sp(enorena( Shunt, 'e

!a(ma Shunt)28 ena !unctie, +anu(asi, Sectie

8 KSM -EDAH

DIGESTI6E

bdomina( pu(( through &sIngter sa#ing

procedure)2 bdominoperinea( resection &mi(es) dengan

penyu(it mayor

5 bdominoperinea( resection &mi(es) denganpenyu(it minor4 bdominoperinea( resection &mi(es) tanpa

penyu(it6 bdominop(asty7 pendektomi8 pendektomi dgn penyu(it maAor; pendektomi dgn penyu(it minor


29/52

9 pendektomi (aparoskopik0 $i(ioCdifgestif anastomosis tanpa penyu(it $i(iodigestif dengan penyu(it mayor2 $i(iodigestif dengan penyu(it minor5 $iopsi insisiona(, (oca( anastesi4 $iopsi rectum6 -ksisi hemoroid eksterna7 -ksp(orasi duktus bi(ier % cho(angiograI intra

operatif8 -sofagotomi;


30/52

4; eseksi anterior dengan penyu(it mayor49 eseksi anterior dengan penyu(it minor60 eseksi anterior tanpa penyu(it6 eseksi esofagusCco(on i(eum transposisi62 eseksi esofagusCend to end65 eseksi esofagusCesofagoCgastrectomy64 eseksi hati66 Second (ook (aparoscopy67 Sp(enektomi sp(enoraphy traumatika68 Sp(enektomi non trauma6; Termina( esofagus proksima( gastrektomi

&T-!/)69 Tota( gastrektomi

NO KSM,INSTALASI,UNI

T

TINDAKAN

70 Tota( pantreaktomi7 Tota( proktoCko(ektomi

72 Tutup burst abdomen &tanpa a(at)

75 Tutup burst abdomen dengan penyu(it mayor74 Tutup burst abdomen dengan penyu(it minor

76 Tutup ko(ostomi i(eostomi77 Tutup ko(ostomi i(eostomi dengan penyu(it

mayor78 Tutup ko(ostomi i(eostomi dengan penyu(it minor

7; epair orta Toraka(is &5;.54)79 epair trio#entricu(ar Septa( 'efect &56.64

9 KSM,-EDAH

UROLOGI

drena(ektomi

2 drena(ektomi &bdominotoraka()5 nastomosis end to end Ureter4 ugmentasi $u(i

6 $iopsi /inAa( perkutan7 $iopsi /inAa( Terbuka

8 $iopsi !enis; $iopsi !rostat

9 $iopsi Testis0 $(adder eck ekonstruksi

$uried !enis2 $usinasi'i(atasi Uretra

5 *abut '? Stent4 'efooring +ista /inAa( per aparoskopi

6 'erooIngUnrooIng +ista7 'iseksi +e(enAar /etah $ening "nguina(

8 'iseksi +e(enAar /etah $ening pe(#is

; 'iseksi +e(enAar /etah $ening !e(#is per

aparoskopi

9 'i#ertiku(ektomi $u(i20 'i#ertiku(um Uretra

2 'orsumsisi


31/52

22 'rainase !eriureter

25 -ksisi *hordae*hordektomi24 -ksisi icrosurgery)66 imfadenektomi "(ioinguina(

67 imfadenektomi etroperitonea(!'

68 itho(apaksi6; ithotripsi

69 >asase !rostat70 >eatop(asti

7 >eatotomi

72 >>+S(ing Uretra75 efrektomi

74 efrektomi 'onor Transp(ant76 efrektomi !arsia(


32/52

77 efrektomi per aparoskopi

78 efrektomi adia(7; efropeksienopeksi

79 efrostomi !erkutanTemporer80 efrostomi Terbuka!ermanen

8 efroureterektomi

82 eob(adder85 perasi !riapismus &prosedur Jinter)

84 perasi epair $u(i Trauma86 perasi Sistoke(

NO KSM,INSTALASI,

UNIT

TINDAKAN

87 perasi Trauma /inAa(88 perasi Urakhuseseksi urakhus8; rkhidektomi89 rkhidektomi e@tended;0 rkhidektomi igasi Tinggi; rkhidektomi Subkapsu(er;2 rkhidopeksi &Torsio Testis);5 rkhidopeksi &U'T);4 rkhidopeksi per aparoskopi;6 !asang +ateter;7 !asang +ateter dengan >andrain;8 !asang +ateter TenckhoF untuk *!';; !*!

;9 !enektomi !arsia(90 !enektomi Tota(mputasi !enis9 !- &!rimary -ndoscopic ea(ignment)92 !ie(oka(ikotomi95 !ie(o(itotomi94 !ie(op(asti96 !ie(op(asti per aparoskopi97 !rostatektomi adika(98 !rostatektomi etropubik9; !rostatektomi Terbuka99 !rostatektomi Terbuka dan Sectio (ta00 !soas 3itch$oari


33/52

0; epair


34/52

MATA 4 spirasi >assa ensa6 $(efarop(asty &2 +e(opak >ata)7 *(aK ens8 *ryope@y +ornea; *yc(o *ryo9 'acryocystorinostomi &Jithout Si(icon Tube)0 'ekompresi rbita(atera( rbitotomi 'isisi spirasi % "2 -**-5 -**- % "4 -ksenterasi6 -ksisi 3ordeo(um *ha(aDion

7 -kstirpasi *orpus (ienum di +ornea

8 -kstirpasi !terygium H /raft +onAungti#a

NO KSM,INSTALASI,UNIT TINDAKAN; -kstripasi *orpus (ienum di $i(ik >ata 'epan

9 -nuk(easi-#iscerasi &'ata argin

29 ?ahit +ornea

50 +eratop(asti &*ornea( Transp(antation)

5 +onAungti#a(


35/52

48 Sk(era( $uck(e

4; Socket epair &*ontracted Socket)

49 Trabeku(ektomi

60 Trabeku(etomi % ((ogen

6 Trabu(ektomi % /oniotomi pada !ediatric /(aucoma

62 Tube Shunt &-@press)

65 iscocanu(ostomy

64 itrektomi HHH

66 itrektomi engkap % Sk(era( $uck(e

67 Jide -ksisi Tumor +e(opak >ata

68 Jide -ksisi Tumor +e(opak >ata H amaH*7 "nsisi bsces >astitis oka(

8 ' astectomy H Tram odiIed adica( >astectomy H odiIed adica( >astectomy Sing(e

2 Muadrantectomy !artia( >astectomy

22 Simp(e >astektomy H astektomy Sing(e

24 Tram


36/52

56 mputasi H 'iseksi +/$

57 mputasi ?ari H enta(68 "nsersi *hest Tube6; "smu(obectomy69 +emoterapi !erinfus70 atissimus 'orsi andibu(a78 otation


37/52

79 Sub Tota( Thyroidectomy80 SuperIcia( !arotidectomy8 Thoraco bdomina(


38/52

9 -ksisi soft tissue tumor tanpa

penyu(it20 -ksisi teratoma dengan penyu(it

dan rekonstruksi

2 -ksisi teratoma tanpa penyu(it22 -ksisi tumor Ainak KaAah25 -ksisi urachus24 -kstirpasi Iste( pre auriku(ae26 -kstirpasiranu(a27 -ndoskopik diagnostik28 -ndoskopik terapeutik2; /astrostomi29 3emiko(ektomi

50 3erniotomi e(ektif tanpa penyu(it5 3erniotomi (aparoskopik

NO KSM,INSTALAS

I,UNIT

TINDAKAN

52 3ernitomi dgn penyu(it

komp(ikasi

55 3idroko(ektomi54 "ntraoperatif ko(angiograI56 "ntraoperatif ko(angiograI

(aparoskopik57 ?eAenostomi i(eostomi dengan

penyu(it mayor58 ?eAenostomi i(eostomi dengan

penyu(it minor5; ?eAenostomi i(eostomi tanpa

penyu(it59 +o(edokotomi dengan penyu(it

mayor40 +o(esistektomi4 +o(esistektomi (aparoskopik42 +o(ostomi sigmoidostomi &47.)


39/52

45 '' peration &64.96)44 aparoskopik diagnostik &7.7)46 igasihemoroid &49.4)47 perasi ke(ainan umbi(ika( (ain

&64.5)48 rchidope@y &72.6)4; rchidope@y (aparoskopik &72.6 H

7.7)49 ther epair of bdomina( Ja((

&epair mphace(e) &964.82)60 !o(ipektomi &4;.57)6 !osterosagita( anorectop(asty

&49.89)

62 !osterosagita( anorectop(astyurethro #aginop(asty &80.89)65 !otong ko(ostomi &47.4)64 !otong Stump &;4.5)66 !rosedur 3e((er &44.7)67 !rosedur +asai &6.58)68 epair atresia esofagus &42.6)6; epair defek diafragma &65.;)

69 epair ekstroIa bu(i &68.;)70 epair hernia diafragma &65.865.;)

NO KSM,INSTALAS

I,UNIT

TINDAKAN

7 epair of /astrochisis &64.8)72 !' &40.69)

75 Separasi conAoined tKin &;4.9)74 Sirkumsisi dengan genera( anesthesia

&74.0)76 Sirkumsisi dengan (oca( anesthesia

&74.0)77 Sp(enektomi &4.6)78 Sp(enorena( shunt &59.)


40/52


41/52

20 -ks mamma aberan bi(atera(2 -ksisi neop(asma Ainak &(ipoma,

atheroma d(()22 -ksisi (uas H 'e(topectora( Gap25 -ksisi (uas H usku(ocutan Gap26 -ksisi (uas H rekonstruksi dengan

bedah mikro#asku(ar27 -ksisi ma(formasi (ymphatik #asku(er28 -kstraksi ateroma ke(oid2; -kstraksi korpus a(ienum29 -(e#asi ear rim carti(ago50 -@cise hemangioma H rekonstruksi5 -@cise intra ke(oid52 -@cise po(ydacty(y

55 -@cise reduksi (ymedema54


42/52

62 >astope@i65 >entop(asty64 >icrosurgery66 >u(tip(e facia( fraktur H imp(ant67 >usku(okutaneus Gap68 >yokutaneus Gappectora(is mayor Gap6; asa( repair dan rekonstruksi69 eo #agina70 perasi bedah mikro7 rif fraktur Dygoma72 rif fraktur hand75 rif fraktur mandibu(a74 rif fraktur ma@i((a76 rif maksi(a p(ating77 rif mandibu(a p(ating78 rif mandibu(a Kiring7; rif orbita( Ka((

79 rif orbita( Ka((80 rif Dygoma Kiring8 steotomy craniosynostosis

reconstruction82 steotomy facia( rekonstruksi85 steotomy geniop(asti tanpa tarif bahan84 steotomy maksi(a e fort "86 steotomy maksi(a e fort ""87 !a(atop(asti bi(atera( komp(it88 !a(atop(asti bi(atera( tak komp(it8; !a(atop(asti uni(atera( komp(it

89 !a(atop(asti uni(atera( tak komp(it;0 !a(atoraphy; !asang archbar;2 !asang back s(abfore s(ab;5 !asang castgips tanpa reposisi;4 echei(oraphy;6 ekonstruksi dengan a((op(astic materia(;7 ekonstruksi facia( c(eft;8 ekonstruksi nasa(

NO KSM,INSTALASI,

UNIT

TINDAKAN

;; ekonstruksi pa(pebra;9 e(eased buried penis


43/52

90 e(eased syndacty(y komp(eks9 epair cana(is (acrima(is &Kithout si(icon

tube)92 epair co(oboma pa(pebra &skinmucosa(

graft)

95 epair ductus naso(acrima(is94 epair Ingertip inAury96 epair Iste( urethra97 ep(antation98 eposisi fraktur nasa( sederhana9; eposisi fraktur os nasa(is &comp(icated)99 eseksi mandibu(a H bone graft00 hinop(asty0 otation Gap02 Sagita( Sp(it osteotomi mandibu(a05 Simp(e bone grafting04 Simp(e skin grafting

06 Skin Gap07 Skin graft B6 cm08 Skin graft sedang 6 cm0; Skin grafting keci(09 Skin grafting (uas0 Skin grafting sedang Skin grafting Kith comp(ication2 Tendon reconstruction5 Tendon transfer4 Tendon transfer Kith comp(ication6 Tennoraphy

7 Tennoraphy Kith comp(ication8 T>? arthrop(asty; T>? arthrostomy9 Tram Gap20 Jound 'ressing2 Jound epair

NO KSM,INSTALASI,

UNIT

TINDAKAN

1 KSM O-GYN *auter ser#iks2 *ordosentesis5 'ebu(king tumor o#arium4 -ksp(orasi #agina6 -mbryotomi7 -@tirpasi H kuret po(ip


44/52

endoser#iks8 -@tirpasi geboren mioma; -@tirpasi geboren

miomaHkuiretasi

9 3isteroctomy pada mo(a chorio*a0 3isteroctomy radika( +istektomi2 +onisasi ser#iks5 +uret abortus incomp(etes4 ap op: myomektomi6 aparoskopi &+istektomi

#arium, Sa(phingektomi,

dhesio(isis)7 aparoskopi 3isterektomi8 aparoskopi steri(; aparoskopik 'iagnostik9 aparotomi dengan penyu(it

mayor20 aparotomi dengan penyu(it

minor2 aparotomi tanpa penyu(it

22 --!25 >icro kuretase 'U$24 >ikrokuret26 >iomectomy27 eo#agina28 perasi *a #agina2; perasi kanker corpus uteri29 perasi tumor ganas o#arium50 perati#e histeroscopyb(asi

endometrium5 #erectomi

NO KSM,INSTALASI, TINDAKAN


45/52

UNIT

52 !ain(ess (abor55 !ersa(inan norma(54 !ersa(inan norma( dengan

penyu(it56 !ersa(inan per#aginam tindakan

operatif57 !ersa(inan sungsang58 ekana(isasi5; ekana(isasi tuba59 Sa(Ingektomi uni(atera(40 Sa(#ingoo#arectomi uni(atera(4 Secound (ook surgery *a

o#arium42 Seksio sesaria45 Seksio sesaria dengan penyu(it

penyu(it44 Sirk(ase ser#iks46 Seksio sesaria dengan penyu(it

penyu(it47 Sirk(ase ser#iks

48 Supra #agina( hyterectomy4; Surgica( staging49 T3H$S dengan !enyu(it60 T3H$S dengan !enyu(it

!emasangan Tampon bdomen6 Tota( abdomina(

hysterectomyHbi(atera(

sa(Ingektomi62 Tubektomi k(inik

65 Tutup burst abdomen


46/52


47/52

24 aksi(a H =ygoma H

>andibu(a &be(um termasukimp(ant)57 "< >aksi(a !(ating &be(um

termasuk imp(ant)58 "< >andibu(a !(ating &be(um

termasuk imp(ant)5; "< =ygoma !(ating &be(um

termasuk imp(ant)59 steotomi >aksi(a (e


48/52

4 ena sectie6 !ungsi (umba(7 !ungsi# !(eura

7 +S> !-1+"T ?TU/ %

!->$UU3 ' 'iagnostik +ateterisasi ?antung

2 !T>*5 !T*Stenting4 !acemaker Temporer%!ermanen6 "$!7 !erikardiosintesis8 !emasangan SKan /anD +ateter; !emasangan

mp(atDer'*oi((ing9 **

0 !e(epasan rch $ar&"ntermaksi(a ? *indakan %an& !!'()kan in4'!d

@4n$n* *'$b)* an*a'a (ain+

a. Semua tindakan anestesi dan sedasi di da(am kamar operasi

b. Semua tindakan anestesi dan sedasi di "*U

Tindakan An$*$i di ICU

!emasangan intubasi #enti(ator

!emasangan #ena centra(!emasangan *T!emasangan SKan /anD &+ateter rteri !u(mona()!emasangan "ntra rteria( *atheher &+ateter "ntra rteria()!emasangan !ercutaneous 'i(atationa( Tracheostomy!emasangan 'rain "ntra Thoraka(!unksi Thora@!emasangan "$!


49/52

!emasangan 'rain "ntra bdomina(!emasangan /emo*ardio#ersi$ronchoskopiC


50/52

7 !emasangan nasogastrik tube

/ THT2KL

!emeriksaan udiometri2 !emeriksaan Timpanometri5 !emeriksaan udiometri Tutur4 !emeriksaan Sisi%Tore 'ecay6 !emeriksaan !endengaran !ada nak7 !emeriksaan $rainstem -#oked esponse

udiometry

1 KSM PATOLOGI

ANATOMI


51/52

KSM

P)(!4n4(4&i

dan I(!)

Kd4k*'anR$0i'a$i

2 Tindakan kemotherapi5 Thoracoscopy4 *ontra enti(JS'6 !unctie !(eura7


52/52

IRNA Biwa 6 Tindakan terapi e(ektroconfusi7 !emeriksaan kandungan Dat narkotika8 estraint

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