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7 views26 pagesForm Self Assesment AKREDITASI PKM MANTUP
Form Self Assesment AKREDITASI PKM MANTUP
Uploaded by
Seizu AikoCopyright:
© All Rights Reserved
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Download as XLS, PDF, TXT or read online from Scribd
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SKORING AKREDITASI PUSKESMAS KABUPATEN LAMONGAN
TAHUN 2015
PUSKESMAS : MANTUP
TANGGAL :
PENILAI :
BAB : 1
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
1.1 KRITERIA 1.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 5 10 50
EP 6 5 10 50
Jumlah 50 60 83.33333
KRITERIA 1.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 1.1.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 1.1.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 5 10 50
EP 5 5 10 50
Jumlah 40 50 80
KRITERIA 1.1.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 5 10 50
Jumlah 35 40 87.5
1.2 KRITERIA 1.2.1
EP 1 10 10 100
EP 2 10 10 100
Jumlah 20 20 100
KRITERIA 1.2.2
EP 1 10 10 100
EP 2 10 10 100
Jumlah 20 20 100
KRITERIA 1.2.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 5 10 50
EP 6 5 10 50
Jumlah 50 60 83.33333
KRITERIA 1.2.4
EP 1 10 10 100
EP 2 5 10 50
EP 3 5 10 50
Jumlah 20 30 66.66667
KRITERIA 1.2.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 5 10 50
EP 8 5 10 50
EP 9 10 10 100
EP 10 10 10 100
EP 11 10 10 100
Jumlah 100 110 90.91
KRITERIA 1.2.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 5 10 50
Jumlah 35 40 87.5
1.3 KRITERIA 1.3.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 1.3.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
TOTAL SA 530 590 89.83051
SKORING AKREDITASI PUSKESMAS KABUPATEN GRESIK
TAHUN 2015
PUSKESMAS : SUKOMULYO
TANGGAL :
PENILAI :
BAB : 2
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
2.1 KRITERIA 2.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 2.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.1.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.1.4
EP 1 10 10 100
EP 2 5 10 50
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 45 50 90
KRITERIA 2.1.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
2.2 KRITERIA 2.2.1
EP 1 5 10 50
EP 2 10 10 100
EP 3 10 10 100
EP 4 0 10 0
Jumlah 25 40 62.5
KRITERIA 2.2.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
2.3 KRITERIA 2.3.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.3.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.3.3
EP 1 10 10 100
EP 2 10 10 100
Jumlah 20 20 100
KRITERIA 2.3.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
Jumlah 60 60 100
KRITERIA 2.3.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.3.5
EP 1 10 0
EP 2 10 0
EP 3 10 0
Jumlah 30 0
KRITERIA 2.3.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 2.3.7
EP 1 10 10 100
EP 2 10 10 100
EP 3 5 10 50
EP 4 10 10 100
Jumlah 35 40 87.5
KRITERIA 2.3.8
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.3.9
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.3.10
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 2.3.11
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 5 10 50
Jumlah 45 50 90
KRITERIA 2.3.12
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 2.3.13
EP 1 10 10 100
EP 2 10 10 100
EP 3 0 10 0
Jumlah 20 30 66.66667
KRITERIA 2.3.14
EP 1 5 10 50
EP 2 5 10 50
EP 3 5 10 50
EP 4 5 10 50
EP 5 5 10 50
Jumlah 25 50 50
KRITERIA 2.3.15
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
Jumlah 60 60 100
KRITERIA 2.3.16
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 2.3.17
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
2.4 KRITERIA 2.4.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.4.2
EP 1 10 10 100
EP 2 10 10 100
Jumlah 20 20 100
2.5 KRITERIA 2.5.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 2.5.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
2.6 KRITERIA 2.6.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 5 10 50
EP 6 10 10 100
EP 7 0 10 0
EP 8 0 10 0
EP 9 0 10 0
EP 10 10 10 100
Jumlah 65 100 65
TOTAL SA 1110 1210 91.73554
SKORING AKREDITASI PUSKESMAS KABUPATEN GRESIK
TAHUN 2015
PUSKESMAS : SUKOMULYO
TANGGAL :
PENILAI :
BAB : 3
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
3.1 KRITERIA 3.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 3.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 3.1.3
EP 1 10 10 100
EP 2 5 10 50
EP 3 10 10 100
Jumlah 25 30 83.33333
KRITERIA 3.1.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 3.1.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 3.1.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 3.1.7
EP 1 10 10 100
EP 2 5 10 50
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 65 70 92.85714
TOTAL SA 310 320 96.875
SKORING AKREDITASI PUSKESMAS KABUPATEN LAMONGAN
TAHUN 2016
PUSKESMAS : MANTUP
TANGGAL :
PENILAI :
BAB : 4
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
4.1 KRITERIA 4.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
KRITERIA 4.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 4.1.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
4.2 KRITERIA 4.2.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 5 10 50
EP 4 5 10 50
EP 5 5 10 50
Jumlah 35 50 70
KRITERIA 4.2.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 5 10 50
EP 5 5 10 50
Jumlah 40 50 80
KRITERIA 4.2.3
EP 1 0 10 0
EP 2 0 10 0
EP 3 0 10 0
EP 4 0 10 0
EP 5 0 10 0
EP 6 0 10 0
Jumlah 0 60 0
KRITERIA 4.2.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 4.2.5
EP 1 0 10 0
EP 2 0 10 0
EP 3 0 10 0
EP 4 0 10 0
EP 5 0 10 0
Jumlah 0 50 0
KRITERIA 4.2.6
EP 1 0 10 0
EP 2 0 10 0
EP 3 0 10 0
EP 4 0 10 0
EP 5 0 10 0
Jumlah 0 50 0
4.3 KRITERIA 4.3.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
TOTAL SA 345 530 65.09434
SKORING AKREDITASI PUSKESMAS KABUPATEN GRESIK
TAHUN 2015
PUSKESMAS : SUKOMULYO
TANGGAL :
PENILAI :
BAB : 5
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
5.1 KRITERIA 5.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 5.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 5.1.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 5.1.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
KRITERIA 5.1.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
Jumlah 60 60 100
KRITERIA 5.1.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
5.2 KRITERIA 5.2.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 5.2.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 5.2.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
5.3 KRITERIA 5.3.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
KRITERIA 5.3.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 5.3.3
EP 1 5 10 50
EP 2 10 10 100
EP 3 0 10 0
EP 4 0 10 0
Jumlah 15 40 37.5
5.4 KRITERIA 5.4.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 5.4.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
5.5 KRITERIA 5.5.1
EP 1 0 10 0
EP 2 10 10 100
EP 3 10 10 100
EP 4 0 10 0
Jumlah 20 40 50
KRITERIA 5.5.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 5.5.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
5.6 KRITERIA 5.6.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 5.6.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 5.6.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 0 10 0
Jumlah 20 30 66.66667
5.7 KRITERIA 5.7.1
EP 1 10 10 100
EP 2 10 10 100
Jumlah 20 20 100
KRITERIA 5.7.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
TOTAL SA 955 1010 94.55446
SKORING AKREDITASI PUSKESMAS KABUPATEN LAMONGAN
TAHUN 2015
PUSKESMAS : MANTUP
TANGGAL :
PENILAI :
BAB : 6
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
6.1 KRITERIA 6.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
Jumlah 60 60 100
KRITERIA 6.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 6.1.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 6.1.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 6.1.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 6.1.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
TOTAL SA 290 290 100
SKORING AKREDITASI PUSKESMAS KABUPATEN GRESIK
TAHUN 2015
PUSKESMAS : SUKOMULYO
TANGGAL :
PENILAI :
BAB : 7
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
7.1 KRITERIA 7.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
KRITERIA 7.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 5 10 50
Jumlah 55 60 91.66667
KRITERIA 7.1.3
EP 1 10 10 100
EP 2 5 10 50
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
Jumlah 75 80 93.75
KRITERIA 7.1.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 7.1.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
7.2 KRITERIA 7.2.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
Jumlah 80 80 100
KRITERIA 7.2.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 7.2.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
7.3 KRITERIA 7.3.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 7.3.2
EP 1 10 10 100
EP 2 5 10 50
EP 3 5 10 50
Jumlah 20 30 66.66667
7.4 KRITERIA 7.4.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 7.4.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 7.4.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
KRITERIA 7.4.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
7.5 KRITERIA 7.5.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 7.5.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 7.5.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 7.5.4
EP 1 10 10 100
EP 2 10 10 100
Jumlah 20 20 100
7.6 KRITERIA 7.6.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
Jumlah 80 80 100
KRITERIA 7.6.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 7.6.3
EP 1 10 10 100
EP 2 10 10 100
Jumlah 20 20 100
KRITERIA 7.6.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 7.6.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 7.6.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 7.6.7
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
7.7 KRITERIA 7.7.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 7.7.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
7.8 KRITERIA 7.8.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
7.9 KRITERIA 7.9.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 7.9.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 7.9.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
7.10 KRITERIA 7.10.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 5 10 50
EP 4 10 10 100
EP 5 10 10 100
Jumlah 45 50 90
KRITERIA 7.10.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 7.10.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
TOTAL SA Err:520Err:520 Err:520
SKORING AKREDITASI PUSKESMAS KABUPATEN GRESIK
TAHUN 2015
PUSKESMAS : SUKOMULYO
TANGGAL :
PENILAI :
BAB : 8
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
8.1 KRITERIA 8.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 8.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
EP 9 10 10 100
EP 10 10 10 100
EP 11 10 10 100
Jumlah 110 110 100
KRITERIA 8.1.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 8.1.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 8.1.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 8.1.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 8.1.7
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
KRITERIA 8.1.8
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
8.2 KRITERIA 8.2.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
Jumlah 80 80 100
KRITERIA 8.2.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
EP 9 10 10 100
Jumlah 90 90 100
KRITERIA 8.2.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
Jumlah 80 80 100
KRITERIA 8.2.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 8.2.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 8.2.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
8.3 KRITERIA 8.3.1
EP 1 10 10 100
EP 2 10 10 100
Jumlah 20 20 100
KRITERIA 8.3.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 70 70 100
KRITERIA 8.3.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 8.3.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 8.3.5
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
Jumlah 60 60 100
KRITERIA 8.3.6
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
KRITERIA 8.3.7
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
Jumlah 60 60 100
KRITERIA 8.3.8
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
8.4 KRITERIA 8.4.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 8.4.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 8.4.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 8.4.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
8.5 KRITERIA 8.5.1
EP 1 10 10 100
EP 2 5 10 50
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
Jumlah 55 60 91.66667
KRITERIA 8.5.2
EP 1 5 10 50
EP 2 5 10 50
EP 3 5 10 50
EP 4 5 10 50
Jumlah 20 40 50
KRITERIA 8.5.3
EP 1 5 10 50
EP 2 10 10 100
EP 3 5 10 50
EP 4 5 10 50
Jumlah 25 40 62.5
8.6 KRITERIA 8.6.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 5 10 50
Jumlah 35 40 87.5
KRITERIA 8.6.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 5 10 50
EP 4 5 10 50
EP 5 10 10 100
Jumlah 40 50 80
8.7 KRITERIA 8.7.1
EP 1 10 10 100
EP 2 5 10 50
EP 3 10 10 100
EP 4 5 10 50
Jumlah 30 40 75
KRITERIA 8.7.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 5 10 50
Jumlah 25 30 83.33333
KRITERIA 8.7.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 8.7.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 5 10 50
EP 4 5 10 50
Jumlah 30 40 75
TOTAL SA Err:520Err:520 Err:520
SKORING AKREDITASI PUSKESMAS KABUPATEN GRESIK
TAHUN 2015
PUSKESMAS : SUKOMULYO
TANGGAL :
PENILAI :
BAB : 9
STANDAR KRITERIA SKOR SKOR Max % REKOMENDASI
9.1 KRITERIA 9.1.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
EP 9 10 10 100
EP 10 10 10 100
Jumlah 100 100 100
KRITERIA 9.1.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
9.2 KRITERIA 9.2.1
EP 1 10 10 100
EP 2 5 10 50
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
Jumlah 65 70 92.85714
KRITERIA 9.2.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
Jumlah 50 50 100
9.3 KRITERIA 9.3.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 9.3.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
Jumlah 30 30 100
KRITERIA 9.3.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 5 10 50
Jumlah 25 30 83.33333
9.4 KRITERIA 9.4.1
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 9.4.2
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
EP 5 10 10 100
EP 6 10 10 100
EP 7 10 10 100
EP 8 10 10 100
Jumlah 80 80 100
KRITERIA 9.4.3
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
KRITERIA 9.4.4
EP 1 10 10 100
EP 2 10 10 100
EP 3 10 10 100
EP 4 10 10 100
Jumlah 40 40 100
TOTAL SA 540 550 98.18182
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