Lampiran FORM SELF ASSESSMENT REVIEW DIAGNOSA NON SPESIALISTIK YANG MAMPU DITANGANI TUNTAS DI PUSKESMAS. cawea [__MAMPU DiTaNGANi ara TIOAK NAMA DIAGN No IAGosa NAMA IcDx rove1cox) Sinsrai | yg Ps halaman) i, | wean 1 |Abortus spontan komplit Se 003.9 707 2 ie mataron beats doe oneneaTood wa @ Tne desir bai pads 3 panics ron een rena 30 693 = Iastrii care repeated a3 ra 5 [asa ont stn 5 at aston inn stein 122 72 7 [oe Palsy kes e510 364 [oer sng andong Frenne rane Tira a 3 [oerca xing athoningtve [renin on enero gar unspectes | 1159 x9 70 seas Bernt v1 24 2 [onktis aa ste trod capac 7203 a a2 [ava sea ese 1 136 13-[cotanus ona ian eckwer ase pated #763 0 14_ [Osram dengue, CHF erg haenorhoge tr ft 73 15 [Demat Fiori oe 72s emma ston Resa Ya as Be) recalcitrant) seein ed = T7_[Oemates ora Han [ent conc erate Ge an 1” [oeratis numa ote sto erat tao set 13 [oematts seoroke borer dermats zi 352 20 ies ots Hes tarboeand rea pis 350 357 24 [ies brboe [ines tree ad re apts 35.0 557 2 es inbrite ote deans 3538 337 2a ies torpor Few cre 135.4 537 24 Ties mam nes menaon 352 537 2 [nes uni == 35 537 nes rs Fre rs 355 337 27 Tins peas fines eds 353 37 2 [oabetesmettostipe1__foattesinsn opener te [aeapac rms a 25 [batetesmettes tie? Nonodercepener sabres clr a 5 36 [Osertpaster danamua — [pane amoebic ere 7060) a 2 [ostedemia haere 765 es 22 [esl sts ro80 a5 33 |Exanthematous drug eruption ee eee 1270 604 34 Fanats [sesh peed ms a 3 ais Floss 78 @ 26 [rune parting [ices tc andro oor ‘BA 485 37 [eens esa epee me a7 lsstoeenrisfornande —[parinen sed nena pa a 38 hotera, giardiasis) linfection origin 09 38 |[conore sence nor opcted a 753 7 enero pase? oer i a at |oepattisa epson ea = perees simplekstanpa I erpesal infection, unspacte 8 7 = Lkomplikasi eer nes 5u Hares aster tana ster without complication =, fone witout cone v2 aMAMPU DITANGANI ‘cunicat PATHWAY (pada TIDAK No} NAMA DIA \GNOSA NAMA ICD x ames "ane | ye a halaman ~) ree | Sra dan "4_|Hipermetropiarngon pernetona 1520) ze 45_|Wipertensesensial Essential (ximary) hypertension 0 280 6_|Hiperuricemia (Gout) [Gout Ma0. eas 47_|Wipogikema ingen hveopiveaemia unspecified E162 46 tanpa komplitasi _|*8?MPtomatc Human inmurodeficency Virus 48 [HIV Al0Stanpakomplitasi_[fermomomat Hane m2 2 Ties en ar gst aa = fomphatesofnewborn with or without md 50 |infets pada umbithus —_[Omohat P38 43 51 [Infes! sluran hemi sian tract nection, site not spedid n390) 666 52_[inflvensa [nfuenza, vas rot ented a 408 53 Insomnia insomnia nen erga pada pak Fo 396 54 intoleransi makanan Malabsorption duet intolerance Koa 120 35, [Rendidiasis mult [cane unepecio 3379 32 56 |renamian normal sina spontancovs ceiver, unspeciieg 809) ore 37_[Refang damam Feb conaaions REO 378 38 |keracunan makanan Other ingests pats of loti) 622 63 59_[Ronjungivits conjonctvts, wnspectieg 09) 201 60 [laringtis [ace ary 1040 a6 1_flepra Leorosy (Hansen disease] 20 33 Leptosrieods fenpe. Lestospiross,unspecie Sea leptospirosis unspeciied n279 39 3 [limfadeniis ymphodenii heute 370 308 64 [Lipo Benign bpomstourneeplaem D179) 307 65 fluka bakarderaja 2 dan 2 [burnandcoroson, body esion unspecified 130 613 6_|Malora Uaspectied malaria 354) 35 67 [atnutrsenerg-protein [Unspecified protein-eneray malnutrition a6 652 68 |oastits Inlamraory dzorders of breast N61 72 [tata kering [Otheraiscrdor of acriapand Hoa 133 70_[Migren Iieraine, unspecified 6a3.9 313 71_[Milara irs unspecified Ze} 507, 72__[Miopia rngan [Myopia S21 216. 73. [Maluskum kontagiosum | Molvcum contapanum 208.2 521 74 [Mori tanpe komplitasi | Measles wthoutcompication(Measis NOS). | 805.9 23 75 [Napkin eczema [liebe rapln) dermatitis a 55 76 [Obestas lebesty unspeied e669 628 77_[Ottsebsterna [otis enema, unspeciieg 609 246; 7 [Ottis media aku [cate serous ots media 65.0 249) 72 [Paro [Mumps 226, 172, 80 |Pectkutsis kates rediculsis due to Fedicuushumanuscapes | 685.0 Et 81_[Penyattcacing tambong _[Anhyostonibas 8760 180) 82 |Perdaranan subkonjungtiva [other specitedczorders of ye ard acnext Hs78 207 23 peruse sid demu Pandan lined KK [Pasi rosea a 3B 25 [Phriasisvesihotor Paras erseair 2360 Sa 86 eet - leronchopneumonia, unspecifiog 418.0 457 [Presb Presbyon 524 28 ‘86 [Reaksianafiakik [Araphylactic shock, unspecie 782 74MAMPU DITANGANI cuca PATHWAY (pada TIDAK No | _NAMADIAGNOSA NAMA COX Kove ico x) "ern « Gee ralaman-) cant g| Sse don 35 [Rentsi ton seranaa [venom of eterartvopods Tas me Geso-osepragal refi dae iho 20 efsssastroesotageat sestroesofageal [Sontag Ea ne sti but [ce nasopharas common cold) x0 “7 Sins erga terse His wnpeaed oa oe S3_ [ints vasomotor [vasomotor ints 300 a9 94 [ruptur perineum tngkat 1-2 [st degree pernesiacerton uring devery | 0700 3 35 [Semen prop mpacted enone wea 8 36 [sabi sebes 586 328 57 [Skstosoniacs suiesoncs wopeced 359 184 38_[suongiodass srongroiass 3759 190 35 fTenisis Teens 3609) a7 100 [Tension headache Hension-tve Reach Gua 309 on [etnus [over tetanus 135 37 02 ons [we esi 23 a fuberossparatanpa—_jtespatr tubes, tact ond 10 ompliast histlopeayconmed as s 704 [Ura aut Bron) —_[uneara wo 3 105 Vaginits [te vg N70 787 106 [Varies tanpa tompltas! _|varcetawihoutcompeation vancetans) | 8019 2 107 [arg Ge FORT evan ad pine ma 39 108 veruta via Nraiwans o7 sn 308-lits [hae Vous N760 7 110-|Gangavan somatoform __[Serstolom aor rs 387 1 [rss Ereropion and riches of yes 02 229 Tn [pavers essa ma 22 113 [abu peraanan rtdokteman Fanduan Kins vk 14 [utes mau (apse herpes) |stomstis antretatedesons m2 108 118 [rtnettstanpetompian ett oars Horeaite| yup eo 116 [Fimosis Primos na we 117 [Partin Peentinos Mar 6 Snarom aun anager [empteaton assodte with ati 3 el ee net ferezaton unspeced jose = ntks stron Kem agian [unnarract infection, steno speced . nig [ves 80 6 720, Nagnois baker [hie Vasa wes 7 121 [saps ea temuken Pandan tsk [aes olnavambut atau seca tematen Pandan Kini kM 27? Iperarsebaven eae i each ipo associated withthe 123 [cocked ooe cmctnscwcodeemcentoin | SRE | nag fecaton reacted rpple associated wth the osz02; a 124 [inverted nppe jucnersmterocesnepessocneawen | Ssrps s 125 [Desiens vitamin ok temukan Feruan ns MK 126 Jocrsiens! mineral