Lampiran BA Peer Review KC Madiun Juli 2019

LAMPIRAN BERITA ACARA
HASIL FOCUS GROUP DISCUSSION PEER REVIEW DIAGNOSA NON SPESIALISTIK

YANG MAMPU DITANGANI OLEH FASILITAS KESEHATAN TINGKAT PERTAMA
Mampu Ditangani
Check/ Diagnosa Non Spesialistik Berdasar SKDI Tahun 2012 Tercantum dalam Penatalksanaan KMK
No. (Beri tanda √ salah satu)
Uncheck Nama Penyakit ICD X 514/2015 Ya
Demam tifoid (A01-Typhoid and paratyphoid fevers) √
(A01.0-Typhoid fever) KMK 514 √
(A01.1-Paratyphoid fever A) √
1
(A01.2-Paratyphoid fever B) √
(A01.3-Paratyphoid fever C)
(A01.4-Paratyphoid fever, unspecified)
Disentri basiler, disentri amuba (A06-Amoebiasis)
(A06.0-Acute amoebic dysentery) KMK 514 √

(A06.1-Chronic intestinal amoebiasis)
(A06.2-Amoebic nondysenteric colitis)
(A06.3-Amoeboma of intestine)
(A06.7-Cutaneous amoebiasis)
(A06.8-Amoebic infection of other sites)
(A06.9-Amoebiasis, unspecified)
2
(A03-Shigellosis)
(A03.0-Shigellosis due to Shigella dysenteriae)
(A03.1-Shigellosis due to Shigella flexneri)
(A03.2-Shigellosis due to Shigella boydii)

(A03.3-Shigellosis due to Shigella sonnei)
(A03.8-Other shigellosis)
(A03.9-Shigellosis, unspecified)
Gastroenteritis (termasuk kolera, (A09-Other gastroenteritis and colitis of

giardiasis) infectious and unspecified origin)
(A09.0-Other and unspecified gastroenteritis KMK 514 √

and colitis of infectious origin)
Mampu Ditangani
(A09.9-Gastroenteritis and colitis of
unspecified origin)
(A08-Viral and other specified intestinal
infections)
(A08.0-Rotaviral enteritis)
3
(A08.1-Acute gastroenteropathy due to
Norwalk agent)
(A08.2-Adenoviral enteritis)
(A08.3-Other viral enteritis)
(A08.4-Viral intestinal infection, unspecified)
(A08.5-Other specified intestinal infections)
(A02-Other salmonella infections)

(A02.0-Salmonella enteritis)
Tuberkulosis paru tanpa (A15-Respiratory tuberculosis, bacteriologically

komplikasi and histologically confirmed)
(A15.0-Tuberculosis of lung, confirmed by KMK 514 √

sputum microscopy with or without culture)
(A15.1-Tuberculosis of lung, confirmed by

culture only)
(A15.2-Tuberculosis of lung, confirmed
histologically)
unspecified means)
(A15.4-Tuberculosis of intrathoracic lymph
nodes, confirmed bacteriologically and
histologically)
Mampu Ditangani
(A15.5-Tuberculosis of larynx, trachea and
bronchus, confirmed bacteriologically and
histologically)
(A15.6-Tuberculous pleurisy, confirmed
bacteriologically and histologically)
(A15.7-Primary respiratory tuberculosis,

confirmed bacteriologically and histologically)
4
(A15.8-Other respiratory tuberculosis,

(A15.9-Respiratory tuberculosis unspecified,

(A16.1-Tuberculosis of lung, bacteriological

and histological examination not done)
(A16.2-Tuberculosis of lung, without mention

of bacteriological or histological confirmation)
(A16.7-Primary respiratory tuberculosis

without mention of bacteriological or
histological confirmation)
(A16.8-Other respiratory tuberculosis, without

mention of bacteriological or histological
confirmation)

Mampu Ditangani
Skrofuloderma (A18-Tuberculosis of other organs)

5
(A18.4-Tuberculosis of skin and subcutaneous KMK 514 √
tissue)
Leptospirosis (tanpa komplikasi) (A27- Leptospirosis)
6 (A27.0-Leptospirosis icterohaemorrhagica)
(A27.8-Other forms of leptospirosis)

(A27.9-Leptospirosis, unspecified) KMK 514 √
Lepra (A30-Leprosy [Hansen disease]) √

(A30.0-Indeterminate leprosy) KMK 514 √
(A30.1-Tuberculoid leprosy) √
(A30.2-Borderline tuberculoid leprosy) √
(A30.3-Borderline leprosy) √
7
(A30.4-Borderline lepromatous leprosy) √
(A30.5-Lepromatous leprosy) √
(A30.8-Other forms of leprosy) √
(A30.9-Leprosy, unspecified) √
(B92-Sequelae of leprosy)
Tetanus (A35-Other tetanus) KMK 514
(Y58.4-Tetanus vaccine) √
(Z11.2-Special screening examination for other
bacterial diseases)
(Z23.5-Need for immunization against tetanus √
alone)
8
Mampu Ditangani
8 (Z27.1-Need for immunization against √

diphtheria-tetanus-pertussis, combined [DTP])
(Z27.2-Need for immunization against

diphtheria-tetanus-pertussis with typhoid- √
paratyphoid [DTP + TAB])

diphtheria-tetanus-pertussis with poliomyelitis √
[DTP + polio])
Pertusis (A37-Whooping cough)

(A37.0-Whooping cough due to Bordetella
pertussis)
9 parapertussis)
(A37.8-Whooping cough due to other KMK 514 √
Bordetella species)
(A37.9-Whooping cough, unspecified)
Erisipelas (A46-Erysipelas) KMK 514 √

10
(O86.8-Other specified puerperal infections )
Sifilis stadium 1 dan 2 (A51-Early syphilis) KMK 514

(A51.3-Secondary syphilis of skin and mucous
membranes)
(A53-Other and unspecified syphilis)
11
(A53.0-Latent syphilis, unspecified as early or
late)
(A53.9-Syphilis, unspecified) KMK 514
(A65-Nonvenereal syphilis)
Mampu Ditangani
Sindrom duh (discharge) genital (A54-Gonococcal infection) √

(gonore dan non gonore)
(A54.0-Gonococcal infection of lower

genitourinary tract without periurethral or
accessory gland abscess)
(A54.3-Gonococcal infection of eye)
(A54.5-Gonococcal pharyngitis)
(A54.6-Gonococcal infection of anus and
rectum)
(A54.8-Other gonococcal infections)
12
(A54.9-Gonococcal infection, unspecified) KMK 514
(A56-Other sexually transmitted chlamydial
diseases)
(A56.0-Chlamydial infection of lower
genitourinary tract)
(A56.2-Chlamydial infection of genitourinary
tract, unspecified)
(A56.8-Sexually transmitted chlamydial
infection of other sites)
(A64-Unspecified sexually transmitted disease)
Gonore (A54-Gonococcal infection) √

13
rectum)
13
Mampu Ditangani
Demam dengue, DHF (A90-Dengue fever [classical dengue])

14
(A91-Dengue haemorrhagic fever) KMK 514
Herpes simpleks tanpa komplikasi (B00-Herpesviral [herpes simplex] infections) √
15
(B00.8-Other forms of herpesviral infection)
(B00.9-Herpesviral infection, unspecified) KMK 514 √
Varisela tanpa komplikasi (B01-Varicella [chickenpox]) √

16 √
(B01.9-Varicella without complication) KMK 514 √
Herpes zoster tanpa komplikasi (B02-Zoster [herpes zoster]) √

17 √
(B02.9-Zoster without complication) KMK 514 √
Morbili tanpa komplikasi (B05-Measles) √

18 √
(B05.9-Measles without complication) KMK 514 √
19 Veruka vulgaris (B07-Viral warts) KMK 514
(B08-Other viral infections characterized by

Moluskum kontagiosum skin and mucous membrane lesions, not
20 elsewhere classified)
(B08.1-Molluscum contagiosum) KMK 514
Hepatitis A (B15-Acute hepatitis A) KMK 514 √

21 √
(B15.9-Hepatitis A without hepatic coma) √
Mampu Ditangani
Parotitis (B26-Mumps) √
22 √
(B26.9-Mumps without complication) √
Tinea kapitis (B35-Dermatophytosis) KMK 514 √

23 √
(B35.0- Tinea barbae and tinea capitis) KMK 514 √
Tinea barbe (B35-Dermatophytosis) √

24 √
Tinea unguium (B35-Dermatophytosis) √

25 √
(B35.1- Tinea unguium) KMK 514 √
Tinea manus (B35-Dermatophytosis) √

26 √
(B35.2-Tinea manuum) KMK 514 √
Tinea pedis (B35-Dermatophytosis) √

27 √
(B35.3- Tinea pedis) KMK 514 √
Tinea korporis (B35-Dermatophytosis) √

28 √ (B35.4-Tinea corporis) KMK 514 √
(B35.5-Tinea imbricata) √
Tinea kruris (B35-Dermatophytosis) √

29 √
(B35.6-Tinea cruris) KMK 514 √
Tinea fasialis (B35-Dermatophytosis) √

30 √ (B35.8-Other dermatophytoses) KMK 514 √
(B35.9-Dermatophytosis, unspecified) √
Pitiriasis versikolor (B36-Other superficial mycoses) √

(B36.0-Pityriasis versicolor) KMK 514 √
Mampu Ditangani
(B36.1-Tinea nigra) √
31 √ (B36.2-White piedra) √
(B36.3-Black piedra) √
(B36.8-Other specified superficial mycoses) √
(B36.9-Superficial mycosis, unspecified) √
Kandidosis mukokutan ringan (B37-Candidal stomatitis) √

(B37.2-Candidiasis of skin and nail)
32
(B37.8-Candidiasis of other sites) √
(B37.9-Candidiasis, unspecified) KMK 514 √
Kandidiasis mulut (B37-Candidiasis) √

33 √ (B37.0-Candidal stomatitis) √
Skistosomiasis (B65-Schistosomiasis [bilharziasis])
(B65.0-Schistosomiasis due to Schistosoma KMK 514

haematobium [urinary schistosomiasis])
(B65.1-Schistosomiasis due to Schistosoma

34 mansoni [intestinal schistosomiasis])

japonicum)
(B65.3-Cercarial dermatitis)
(B65.8-Other schistosomiases) √
(B65.9-Schistosomiasis, unspecified) √
Taeniasis (B68-Taeniasis)
(B68.0-Taenia solium taeniasis)
35
(B68.1-Taenia saginata taeniasis)
(B68.9-Taeniasis, unspecified) KMK 514
Mampu Ditangani
Filariasis (B74-Filariasis)
(B74.0-Filariasis due to Wuchereria bancrofti) KMK 514
(B74.1-Filariasis due to Brugia malayi)

(B74.2-Filariasis due to Brugia timori)
(B74.3-Loiasis)
36
(B74.4-Mansonelliasis)
(B74.8-Other filariases)
(B74.9-Filariasis, unspecified)

protozoal diseases and helminthiases)
Penyakit cacing tambang (B76-Hookworm diseases)

(B76.0-Ancylostomiasis) KMK 514 √
37 (B76.1-Necatoriasis)
(B76.8-Other hookworm diseases)
(B76.9-Hookworm disease, unspecified)
Cutaneus larva migran (B76-Hookworm diseases)

(B76.0-Ancylostomiasis)
(B76.1-Necatoriasis)
38 (B76.8-Other hookworm diseases)
(B76.9-Hookworm disease, unspecified) KMK 514 √
(B87.0-Cutaneous myiasis)
(B87.9-Myiasis, unspecified)
Askariasis (B77-Ascariasis) KMK 514 √

(B77.9-Ascariasis, unspecified)
39
Mampu Ditangani
39
(K93.8-Disorders of other specified digestive
organs in diseases classified elsewhere)
Strongiloidiasis (B78-Strongyloidiasis) KMK 514 √

(B78.0-Intestinal strongyloidiasis)
40 (B78.1-Cutaneous strongyloidiasis)
(B78.7-Disseminated strongyloidiasis)
(B78.9-Strongyloidiasis, unspecified)
Malaria (B85.3-Phthiriasis) √
(B50-Plasmodium falciparum malaria) √
(B50.9-Plasmodium falciparum malaria, √
unspecified)
(B51-Plasmodium vivax malaria) √
(B51.8-Plasmodium vivax malaria with other √
complications)
(B51.9-Plasmodium vivax malaria without √
complication)
(B52-Plasmodium malariae malaria) √
41 (B52.8-Plasmodium malariae malaria with
other complications)
(B52.9-Plasmodium malariae malaria without √
complication)
(B53-Other parasitologically confirmed
malaria)
(B53.0-Plasmodium ovale malaria) √
(B53.1-Malaria due to simian plasmodia)
(B53.8-Other parasitologically confirmed
malaria, not elsewhere classified)
(B54-Unspecified malaria) KMK 514 √
Mampu Ditangani
Pedikulosis pubis (B85-Pediculosis and phthiriasis) √
42 √ (B85.0- Pediculosis due to Pediculus humanus √
capitis)
Pedikulosis kapitis (B85-Pediculosis and phthiriasis) √

(B85.0- Pediculosis due to Pediculus humanus KMK 514 √
capitis)
43 √
(B85.1- Pediculosis due to Pediculus humanus √
corporis)
(B85.4- Mixed pediculosis and phthiriasis) √
44 Skabies (B86-Scabies) KMK 514 √
Lipoma (D17-Benign lipomatous neoplasm) √

(D17.0-Benign lipomatous neoplasm of skin
and subcutaneous tissue of head, face and
neck)
and subcutaneous tissue of trunk)
(D17.2-Benign lipomatous neoplasm of skin √
45 and subcutaneous tissue of limbs)
and subcutaneous tissue of other and √
unspecified sites)
(D17.7-Benign lipomatous neoplasm of other
sites)
(D17.9-Benign lipomatous neoplasm, KMK 514
unspecified)
Anemia defisiensi besi (D50-Iron deficiency anaemia)

(D50.8-Other iron deficiency anaemias)
46
Mampu Ditangani
(D50.9-Iron deficiency anaemia, unspecified) KMK 514 √

46
(D64-Other anaemias)
(D64.8-Other specified anaemias)
(D64.9-Anaemia, unspecified)
Anemia defisiensi besi pada (D50-Iron deficiency anaemia) √

kehamilan
(D50.8-Other iron deficiency anaemias) √
47
(O99.0-Anaemia complicating pregnancy,

childbirth and the puerperium)
Diabetes melitus tipe 1 (E10-Insulin-dependent diabetes mellitus)

48
(E10.9-Insulin-dependent diabetes mellitus
without complications)
Diabetes melitus tipe 2 (E11-Non-insulin-dependent diabetes mellitus) √

49 √
(E11.9-Non-insulin-dependent diabetes KMK 514 √
mellitus without complications)
(E16-Other disorders of pancreatic internal

Hipoglikemia ringan √
secretion)
50 √
(E16.1-Other hypoglycaemia) √
(E16.2-Hypoglycaemia, unspecified) KMK 514 √
Malnutrisi energi-protein (E40-Kwashiorkor)

(E41-Nutritional marasmus)
(E42-Marasmic kwashiorkor)
Mampu Ditangani
(E44-Protein-energy malnutrition of moderate
and mild degree)
51 (E44.0-Moderate protein-energy malnutrition)
(E44.1-Mild protein-energy malnutrition) √
(E46-Unspecified protein-energy malnutrition) KMK 514 √
(E64.0-Sequelae of protein-energy
malnutrition)
Defisiensi vitamin (E50-Vitamin A deficiency)

(E50.0-Vitamin A deficiency with conjunctival
xerosis)
(E50.1-Vitamin A deficiency with Bitot spot and
conjunctival xerosis)
(E50.2-Vitamin A deficiency with corneal
xerosis)
ulceration and xerosis)
(E50.4-Vitamin A deficiency with
keratomalacia)
(E50.5-Vitamin A deficiency with night
blindness)
(E50.6-Vitamin A deficiency with
xerophthalmic scars of cornea)
(E50.7-Other ocular manifestations of vitamin
A deficiency)
(E50.8-Other manifestations of vitamin A
deficiency)
(E50.9-Vitamin A deficiency, unspecified)
(E51-Thiamine deficiency)
(E51.1-Beriberi)
Mampu Ditangani
(E51.8-Other manifestations of thiamine
deficiency)
(E51.9-Thiamine deficiency, unspecified)
52 (E52-Niacin deficiency [pellagra])
(E53-Deficiency of other B group vitamins)
(E53.0-Riboflavin deficiency)
(E53.1-Pyridoxine deficiency)
(E53.8-Deficiency of other specified B group
vitamins)
(E53.9-Vitamin B deficiency, unspecified)
(E54-Ascorbic acid deficiency)
(E55-Vitamin D deficiency)
(E55.0-Rickets, active)
(E55.9-Vitamin D deficiency, unspecified)
(E56-Other vitamin deficiencies)
(E56.0-Deficiency of vitamin E)
(E56.1-Deficiency of vitamin K)
(E56.8-Deficiency of other vitamins)
(E56.9-Vitamin deficiency, unspecified)
(E64-Sequelae of malnutrition and other
nutritional deficiencies)
(E64.1-Sequelae of vitamin A deficiency)
(E64.2-Sequelae of vitamin C deficiency)
(E64.3-Sequelae of rickets)
(E64.8-Sequelae of other nutritional
deficiencies)
(E64.9-Sequelae of unspecified nutritional
deficiency)
Defisiensi mineral (E58-Dietary calcium deficiency)

(E59-Dietary selenium deficiency)
Mampu Ditangani
(E60-Dietary zinc deficiency)
(E61-Deficiency of other nutrient elements)
(E61.0-Copper deficiency)
(E61.1-Iron deficiency)
(E61.2-Magnesium deficiency)
(E61.3-Manganese deficiency)
(E61.4-Chromium deficiency)
(E61.5-Molybdenum deficiency)
(E61.6-Vanadium deficiency)
(E61.7-Deficiency of multiple nutrient
53 elements)
(E61.8-Deficiency of other specified nutrient
elements)
(E61.9-Deficiency of nutrient element,
unspecified)
(E63-Other nutritional deficiencies)
(E63.0-Essential fatty acid [EFA] deficiency)
(E63.1-Imbalance of constituents of food

intake)
(E63.8-Other specified nutritional deficiencies)
(E63.9-Nutritional deficiency, unspecified)
Obesitas (E66-Obesity)
(E66.0-Obesity due to excess calories)
54 (E66.1-Drug-induced obesity)
(E66.8-Other obesity)
(E66.9-Obesity, unspecified) KMK 514 √
Mampu Ditangani
(E78-Disorders of lipoprotein metabolism and
Dislipidemia other lipidaemias)
(E78.0-Pure hypercholesterolaemia) √
(E78.1-Pure hyperglyceridaemia)
(E78.2-Mixed hyperlipidaemia)
(E78.3-Hyperchylomicronaemia)
55 (E78.4-Other hyperlipidaemia)
(E78.5-Hyperlipidaemia, unspecified) KMK 514 √
(E78.6-Lipoprotein deficiency)
(E78.8-Other disorders of lipoprotein
metabolism)
(E78.9-Disorder of lipoprotein metabolism,
unspecified)
(E79-Disorders of purine and pyrimidine

Hiperurisemia metabolism)
(E79.0-Hyperuricaemia without signs of
inflammatory arthritis and tophaceous KMK 514 √
disease)
56
(E79.1-Lesch-Nyhan syndrome)
(E79.8-Other disorders of purine and
pyrimidine metabolism)
(E79.9-Disorder of purine and pyrimidine
metabolism, unspecified)
Gangguan somatoform (F45-Somatoform disorders)

(F45.0-Somatization disorder) KMK 514 √
(F45.1-Undifferentiated somatoform disorder)
(F45.2-Hypochondriacal disorder)
57 (F45.3-Somatoform autonomic dysfunction)

Mampu Ditangani
57
(F45.4-Persistent somatoform pain disorder)
(F45.8-Other somatoform disorders)
(F45.9-Somatoform disorder, unspecified)
Insomnia (F51-Nonorganic sleep disorders)

(F51.0-Nonorganic insomnia) KMK 514 √
(F51.2-Nonorganic disorder of the sleep-wake
58 schedule)
(F51.8-Other nonorganic sleep disorders)
(G47.0-Disorders of initiating and maintaining
sleep [insomnias])
Migren (G43-Migraine) √
(G43.0-Migraine without aura [common √
migraine])
(G43.1-Migraine with aura [classical migraine]) √

59 √
(G43.2-Status migrainosus) √
(G43.8-Other migraine) √
(G43.9-Migraine, unspecified) KMK 514 √
(N94.3-Premenstrual tension syndrome) √
Tension headache (G44-Other Headache Syndromes) √

(G44.1-Vascular headache, not elsewhere
classified)
(G44.2-Tension-type headache) KMK 514 √
(G44.3-Chronic post-traumatic headache)
60
(G44.4-Drug-induced headache, not elsewhere
classified)
60 Mampu Ditangani
(G44.8-Other specified headache syndromes) √
(R51-Headache) √
Bells' palsy (G51-Facial nerve disorders)

61
(G51.0-Bell's palsy) KMK 514 √
Hordeolum (H00-Hordeolum and chalazion) √

62 √ (H00.0-Hordeolum and other deep KMK 514 √
inflammation of eyelid)
Blefaritis (H01-Other inflammation of eyelid) √

63 √
(H01.0-Blepharitis) KMK 514 √
Trikiasis (H02-Other disorders of eyelid)

64
(H02.0-Entropion and trichiasis of eyelid) KMK 514
Mata kering (H04-Disorders of lacrimal system) √

65 √
(H04.1-Other disorders of lacrimal gland) KMK 514 √
Konjungtivitis (H10-Conjunctivitis)
(H10.0-Mucopurulent conjunctivitis)
(H10.1-Acute atopic conjunctivitis) KMK 514 √
(H10.2-Other acute conjunctivitis)
(H10.3-Acute conjunctivitis, unspecified)
(H10.4-Chronic conjunctivitis)
(H10.5-Blepharoconjunctivitis) √
(H10.8-Other conjunctivitis)
66
(H10.9-Conjunctivitis, unspecified)
(B30-Viral conjunctivitis)
(B30.1-Conjunctivitis due to adenovirus )
(B30.2-Viral pharyngoconjunctivitis)
66
Mampu Ditangani
(B30.8-Other viral conjunctivitis )
(B30.9-Viral conjunctivitis, unspecified)
(H13.1-Conjunctivitis in infectious and parasitic
diseases classified elsewhere)
Perdarahan subkonjungtiva (H11-Other disorders of conjunctiva)

(H11.3-Conjunctival haemorrhage)
(H57-Other disorders of eye and adnexa)
67 (H57.8-Other specified disorders of eye and KMK 514
adnexa)
(H57.9-Disorder of eye and adnexa,
unspecified)
Episkleritis (H15-Disorders of sclera) √

68 √
(H15.1-Episcleritis) KMK 514 √
(H52-Disorders of refraction and

Hipermetropia ringan
69 accommodation)
(H52.0-Hypermetropia) KMK 514

Miopia ringan
70 accommodation)
(H52.1-Myopia) KMK 514

Astigmatism ringan
71 accommodation)
(H52.2-Astigmatism) KMK 514

Presbiopia
72 accommodation)
(H52.4-Presbyopia) KMK 514
Mampu Ditangani
Buta senja (H53-Visual disturbances)
73
(H53.6-Night blindness) KMK 514 √
Otitis eksterna (H60-Otitis externa) √

(H60.0-Abscess of external ear)
(H60.3-Other infective otitis externa) √
(H60.5-Acute otitis externa, noninfective) √
(H60.8-Other otitis externa) √
(H60.9-Otitis externa, unspecified) KMK 514 √
(H62-Disorders of external ear in diseases
classified elsewhere)
(H62.0-Otitis externa in bacterial diseases
74
(H62.1-Otitis externa in viral diseases classified
elsewhere)
(H62.2-Otitis externa in mycoses)
(H62.3-Otitis externa in other infectious and

parasitic diseases classified elsewhere)
(H62.4-Otitis externa in other diseases

(H62.8-Other disorders of external ear in
Serumen prop (H61-Other disorders of external ear)

75
(H61.2-Impacted cerumen) KMK 514 √
Otitis media akut (H65-Nonsuppurative otitis media) √

(H65.1-Other acute nonsuppurative otitis KMK 514 √
media)
(H65.9-Nonsuppurative otitis media, √
unspecified)
Mampu Ditangani
(H66-Suppurative and unspecified otitis media) √
(H66.0-Acute suppurative otitis media) KMK 514 √
(H66.4-Suppurative otitis media, unspecified)

76
(H66.9-Otitis media, unspecified) √
(H67-Otitis media in diseases classified
elsewhere)
(H67.0-Otitis media in bacterial diseases
(H67.1-Otitis media in viral diseases classified
elsewhere)
(H67.8-Otitis media in other diseases classified
elsewhere)
77 √ Hipertensi esensial (I10-Essential(primary) hypertension) KMK 514 √
Hemoroid grade 1-2 (I84-Haemorrhoids) √

(I84.2-Internal haemorrhoids without √
complication)
78 √ (I84.5-External haemorrhoids without √
complication)
(I84.9-Unspecified haemorrhoids without √
complication)
Limfadenitis (I88-Nonspecific lymphadenitis)
(I88.0-Nonspecific mesenteric lymphadenitis)
(I88.1-Chronic lymphadenitis, except

mesenteric)
(I88.8-Other nonspecific lymphadenitis)
Mampu Ditangani
(I88.9-Nonspecific lymphadenitis, unspecified)
(L04-Acute lymphadenitis)
79 (L04.0-Acute lymphadenitis of face, head and
neck)
(L04.1-Acute lymphadenitis of trunk)
(L04.2-Acute lymphadenitis of upper limb)
(L04.3-Acute lymphadenitis of lower limb)
(L04.8-Acute lymphadenitis of other sites)
(L04.9-Acute lymphadenitis, unspecified) KMK 514 √
80 √ Rhinitis akut (J00-Acute nasopharyngitis [common cold]) KMK 514 √
Faringitis (J02-Acute pharyngitis) KMK 514 √

(J02.0-Streptococcal pharyngitis)
(J02.8-Acute pharyngitis due to other specified
organisms)
81 (J02.9-Acute pharyngitis, unspecified)
(J31-Chronic rhinitis, nasopharyngitis and
pharyngitis)
(J31.1-Chronic nasopharyngitis)
(J31.2-Chronic pharyngitis)
Tonsilitis (J03-Acute tonsillitis) KMK 514 √

(J03.0-Streptococcal tonsillitis)
(J03.8-Acute tonsillitis due to other specified
organisms)
(J03.9-Acute tonsillitis, unspecified)
Mampu Ditangani
(J35-Chronic diseases of tonsils and adenoids)

82
(J35.0-Chronic tonsillitis)
(J35.1-Hypertrophy of tonsils)
(J35.8-Other chronic diseases of tonsils and
adenoids)
(J35.9-Chronic disease of tonsils and adenoids,
unspecified)
Laringitis (J04-Acute laryngitis and tracheitis) KMK 514 √

(J04.0-Acute laryngitis)
83
(J37-Chronic laryngitis and laryngotracheitis)
(J37.0-Chronic laryngitis)
(J10-Influenza due to other identified influenza

Influenza virus)
(J10.0-Influenza with pneumonia, other KMK 514 √
influenza virus identified)
(J10.1-Influenza with other respiratory

manifestations, other influenza virus identified)
(J10.8-Influenza with other manifestations,

other influenza virus identified)
84
(J11-Influenza, virus not identified)
(J11.0-Influenza with pneumonia, virus not
identified)
manifestations, virus not identified)
virus not identified)
Mampu Ditangani
(A49.2-Haemophilus influenzae infection,
unspecified site)
Pneumonia, bronkopneumonia (J12-Viral pneumonia, not elsewhere classified)
(J12.0-Adenoviral pneumonia)
(J12.1-Respiratory syncytial virus pneumonia)
(J12.2-Parainfluenza virus pneumonia)
(J12.3-Human metapneumovirus pneumonia)
(J12.8-Other viral pneumonia)

(J12.9-Viral pneumonia, unspecified)
(J13-Pneumonia due to Streptococcus
pneumoniae)
(J14-Pneumonia due to Haemophilus
influenzae)
(J15-Bacterial pneumonia, not elsewhere
classified)
(J15.0-Pneumonia due to Klebsiella
pneumoniae)
(J15.1-Pneumonia due to Pseudomonas)
(J15.2-Pneumonia due to staphylococcus)
(J15.3-Pneumonia due to streptococcus, group
B)
(J15.4-Pneumonia due to other streptococci)
(J15.5-Pneumonia due to Escherichia coli)

(J15.6-Pneumonia due to other aerobic Gram-
negative bacteria)
85
(J15.7-Pneumonia due to Mycoplasma
pneumoniae)
85 Mampu Ditangani
(J15.8-Other bacterial pneumonia)
(J15.9-Bacterial pneumonia, unspecified)
(J16-Pneumonia due to other infectious
organisms, not elsewhere classified)
(J16.0-Chlamydial pneumonia)
(J16.8-Pneumonia due to other specified
infectious organisms)
(J17-Pneumonia in diseases classified
elsewhere)
(J17.0-Pneumonia in bacterial diseases
(J17.1-Pneumonia in viral diseases classified
elsewhere)
(J17.2-Pneumonia in mycoses)
(J17.3-Pneumonia in parasitic diseases)
(J17.8-Pneumonia in other diseases classified
elsewhere)
(J18-Pneumonia, organism unspecified)
(J18.0-Bronchopneumonia, unspecified) KMK 514 √
(J18.1-Lobar pneumonia, unspecified)
(J18.2-Hypostatic pneumonia, unspecified)
(J18.8-Other pneumonia, organism

unspecified)
(J18.9-Pneumonia, unspecified)
Bronkitis akut (J20-Acute bronchitis)

(J20.0-Acute bronchitis due to Mycoplasma
pneumoniae)
(J20.1-Acute bronchitis due to Haemophilus
influenzae)
Mampu Ditangani
(J20.2-Acute bronchitis due to streptococcus)
(J20.3-Acute bronchitis due to coxsackievirus)
(J20.4-Acute bronchitis due to parainfluenza

virus)
(J20.5-Acute bronchitis due to respiratory
syncytial virus)
86 (J20.6-Acute bronchitis due to rhinovirus)
(J20.7-Acute bronchitis due to echovirus)
(J20.8-Acute bronchitis due to other specified
organisms)
(J20.9-Acute bronchitis, unspecified) KMK 514 √
(J40-Bronchitis, not specified as acute or
chronic)
(J41-Simple and mucopurulent chronic
bronchitis)
(J41.0-Simple chronic bronchitis)
(J41.1-Mucopurulent chronic bronchitis)
(J41.8-Mixed simple and mucopurulent chronic
bronchitis)
(J42-Unspecified chronic bronchitis)
Rhinitis vasomotor (J30-Vasomotor and allergic rhinitis) KMK 514 √

87 √
(J30.1-Vasomotor rhinitis) √
Rhinitis alergika (J30-Vasomotor and allergic rhinitis)

(J30.2-Allergic rhinitis due to pollen)
(J30.3-Other seasonal allergic rhinitis)
88
(J30.4- Other allergic rhinitis) KMK 514 √
(J30.5-Allergic rhinitis, unspecified)
(J45.0-Predominantly allergic asthma)
Mampu Ditangani
Furunkel pada hidung (J34-Other disorders of nose and nasal sinuses)

89
(J34.0-Abscess, furuncle and carbuncle of KMK 514 √
nose)
Asma bronkial (J45-Asthma)

90 (J45.1-Nonallergic asthma)
(J45.8-Mixed asthma)
(J45.9-Asthma, unspecified) KMK 514 √
Ulkus mulut (aptosa, herpes) (K12-Stomatitis and related lesions) KMK 514 √
(K12.0-Recurrent oral aphthae)
91 (K12.1-Other forms of stomatitis)
(K12.2-Cellulitis and abscess of mouth)
(K12.3-Oral mucositis(ulcerative))
Refluks gastroesofagus (K21-Gastro-oesophageal reflux disease)

92 (K21.9-Gastro-oesophageal reflux disease KMK 514 √
without oesophagitis)
Gastritis (K29-Gastritis and duodenitis)

(K29.1-Other acute gastritis)
(K29.2-Alcoholic gastritis)
(K29.5-Chronic gastritis, unspecified)
93
(K29.6-Other gastritis)
(K29.7-Gastritis, unspecified) KMK 514 √
(K30-Functional dyspepsia)
(R10.1-Pain localized to upper abdomen)
Intoleransi makanan (K90-Intestinal malabsorption)

94
Mampu Ditangani
94 (K90.4-Malabsorption due to intolerance, not KMK 514 √
elsewhere classified)
Impetigo (L01-Impetigo) √
(L01.0-Impetigo [any organism] [any site]) KMK 514 √
95 √
(L01.1-Impetiginization of other dermatoses) √
(L02-cutaneous abscess, furuncle and

Furunkel, karbunkel √
carbuncle)
(L02.0-Cutaneous abscess, furuncle and KMK 514 √
carbuncle of face)
(L02.1-Cutaneous abscess, furuncle and √
carbuncle of neck)
carbuncle of trunk)
carbuncle of buttock)
carbuncle of limb)
carbuncle of other sites)
(L02.9-Cutaneous abscess, furuncle and
96 √
carbuncle, unspecified)
(H04.0-Dacryoadenitis )
(H60.0-Abscess of external ear )
(H04.3-Acute and unspecified inflammation of √
lacrimal passages )
(N76.4-Abscess of vulva) √
(N48.2- Other inflammatory disorders of penis) √

Mampu Ditangani
(N49.2-Inflammatory disorders of scrotum) √
(N49.8-Inflammatory disorders of other √

specified male genital organs )
(N49.9-Inflammatory disorder of unspecified √
male genital organ)
(N61-Inflammatory disorders of breast) √
Abses folikel rambut atau kelenjar (L02-Cutaneous abscess, furuncle, and √

sebasea carbuncle)
carbuncle of face)
carbuncle of neck)
carbuncle of trunk)
97 √
carbuncle of limb)
(L08-Other local infections of skin and

Impetigo ulseratif (ektima) √
subcutaneous tissue)
(L08.0-Pyoderma) KMK 514 √
98 √ (L08.8-Other specified local infections of skin √
and subcutaneous tissue)
(L08.9-Local infection of skin and √
subcutaneous tissue, unspecified)
Mampu Ditangani

Eritrasma √
99 √ subcutaneous tissue)
(L08.1-Erythrasma) KMK 514 √
Dermatitis atopik (kecuali (L20-Atopic dermatitis) √

recalcitrant)
100 (L20.0-Besnier prurigo)
(L20.8-Other atopic dermatitis) KMK 514 √
(L20.9-Atopic dermatitis, unspecified) √
Dermatitis seboroik (L21-Seborrhoeic dermatitis) √

(L21.0-Seborrhoea capitis) KMK 514 √
101 √ (L21.1-Seborrhoeic infantile dermatitis) √
(L21.8-Other seborrhoeic dermatitis) √
(L21.9-Seborrhoeic dermatitis, unspecified) √
102 √ Napkin eczema (L22-Diaper [napkin] dermatitis) KMK 514 √
Dermatitis kontak iritan (L24-Irritant contact dermatitis) √

(L24.0-Irritant contact dermatitis due to KMK 514 √
detergents)
(L24.1-Irritant contact dermatitis due to oils √
and greases)
(L24.2-Irritant contact dermatitis due to
solvents)
cosmetics)
(L24.4-Irritant contact dermatitis due to drugs
in contact with skin)
(L24.5-Irritant contact dermatitis due to other
chemical products)
Mampu Ditangani
(L24.6-Irritant contact dermatitis due to food in
contact with skin)
(L24.7-Irritant contact dermatitis due to plants,
except food)
agents)
103
(L24.9-Irritant contact dermatitis, unspecified
cause)
(L25-Unspecified contact dermatitis)
(L25.0-Unspecified contact dermatitis due to
cosmetics)
drugs in contact with skin)
dyes)
other chemical products)
food in contact with skin)
plants, except food)
other agents)
(L25.9-Unspecified contact dermatitis,
unspecified cause)
Exanthematous drug eruption, (L27-Dermatitis due to substances taken

fixed drug eruption internally)
(L27.0-Generalized skin eruption due to drugs KMK 514
and medicaments)
104
(L27.1-Localized skin eruption due to drugs and
medicaments)
104 Mampu Ditangani
(R21-Rash and other nonspecific skin eruption)
(L27-Dermatitis due to substances taken

Alergi makanan internally)
(L27.2-Dermatitis due to ingested food) KMK 514
(L27.8-Dermatitis due to other substances
taken internally)
(L27.9-Dermatitis due to unspecified substance
105 taken internally)
(T78.1-Other adverse food reactions, not
(T78.4-Allergy, unspecified)
(K52.2-Allergic and dietetic gastroenteritis and
colitis)
Dermatitis numularis (L30-Other dermatitis) √

(L30.0-Nummular dermatitis) √
106 √
(L30.8-Other specified dermatitis) √
(L30.9-Dermatitis, unspecified) √
Pitiriasis rosea (L42-Pityriasis rosea) √

107 √
(L30.5-Pityriasis alba) √
Urtikaria akut (L50-Urticaria) √

(L50.0-Allergic urticaria) KMK 514 √
(L50.2-Urticaria due to cold and heat) √
(L50.3-Dermatographic urticaria) √
(L50.4-Vibratory urticaria) √
(L50.6-Contact urticaria) √
(L50.9-Urticaria, unspecified) √
(L56.3-Solar urticaria) √
108 √
Mampu Ditangani
108 √
(L29-Pruritus) √
(L29.0-Pruritus ani) √
(L29.1-Pruritus scroti) √
(L29.2-Pruritus vulvae) √
(L29.3-Anogenital pruritus, unspecified) √
(L29.8-Other pruritus) √
(L29.9-Pruritus, unspecified) √
(T80.6-Other serum reactions) √
Akne vulgaris ringan (L70-Acne) √

(L70.0-Acne vulgaris) KMK 514 √
(L70.1-Acne conglobata)
(L70.2-Acne varioliformis)
(L70.3-Acne tropica)
(L70.4-Infantile acne)
109 (L70.5-Acné excoriée des jeunes filles)
(L70.8-Other acne)
(L70.9-Acne, unspecified)
(L71-Rosacea)
(L71.1-Rhinophyma)
(L71.8-Other rosacea)
(L71.9-Rosacea, unspecified)
Dermatitis perioral (L71-Rosacea)

110
(L71.0-Perioral dermatitis) KMK 514 √
(L72-Follicular cysts of skin and subcutaneous

Folikulitis superfisialis tissue)
(L72.0-Epidermal cyst)
(L72.1-Trichilemmal cyst)
(L72.2-Steatocystoma multiplex)
Mampu Ditangani
(L72.8-Other follicular cysts of skin and
(L72.9-Follicular cyst of skin and subcutaneous
tissue, unspecified)
111 subcutaneous tissue)
(L08.0-Pyoderma) KMK 514
(L08.8-Other specified local infections of skin
(L08.9-Local infection of skin and
subcutaneous tissue, unspecified)
(L66.2-Folliculitis decalvans )
(L66.3-Perifolliculitis capitis abscedens )
(L66.4-Folliculitis ulerythematosa reticulata)
Hidradenitis supuratif (L73-Other follicular disorders)

(L73.0-Acne keloid)
(L73.1-Pseudofolliculitis barbae)
112 (L73.2-Hidradenitis suppurativa) KMK 514
(L73.8-Other specified follicular disorders)
(L73.9-Follicular disorder, unspecified)
Miliaria (L74-Eccrine sweat disorders)

(L74.0-Miliaria rubra)
(L74.1-Miliaria crystallina)
(L74.2-Miliaria profunda)
113
(L74.3-Miliaria, unspecified) KMK 514 √
(L74.8-Other eccrine sweat disorders)
(L74.9-Eccrine sweat disorder, unspecified)

Mampu Ditangani
(L97-Ulcer of lower limb, not elsewhere

Ulkus pada tungkai KMK 514 √
classified)
(I83-Varicose veins of lower extremities)
(I83.0-Varicose veins of lower extremities with
ulcer)
114 (I83.1-Varicose veins of lower extremities with
inflammation)
both ulcer and inflammation)
(I83.9-Varicose veins of lower extremities
without ulcer or inflammation)
Pielonefritis tanpa komplikasi (N10-Acute tubulo-interstitial nephritis) KMK 514

115 (N12-Tubulo-interstitial nephritis, not specified
as acute or chronic)
Infeksi saluran kemih (N39-Other disorders of urinary system)

(N39.0-Urinary tract infection, site not KMK 514
specified)
(N39.8-Other specified disorders of urinary
system)
(N39.9-Disorder of urinary system,
116 unspecified)
(O08.8-Other complications following abortion

and ectopic and molar pregnancy)
(N37.8-Other urethral disorders in diseases

Infeksi saluran kemih bagian (N39-Other disorders of urinary system)

bawah
Mampu Ditangani
specified)
system)
117 (N39.9-Disorder of urinary system,
unspecified)


(N47-Redundant prepuce, phimosis and

118 √ Fimosis KMK 514 √
paraphimosis)

119 √ Parafismosis KMK 514 √
paraphimosis)
Mastitis (N61-Inflammatory disorders of breast) KMK 514 √

(O91-Infections of breast associated with √
childbirth)
(O91.0-Infection of nipple associated with √
120 childbirth)
(O91.1-Abscess of breast associated with
childbirth)
(O91.2-Nonpurulent mastitis associated with √
childbirth)
Salpingitis (N70-Salpingitis and oophoritis)

(N70.0-Acute salpingitis and oophoritis)
121 (N70.1-Chronic salpingitis and oophoritis)
Mampu Ditangani
121 Uncheck Nama Penyakit ICD X 514/2015 Ya
(N70.9-Salpingitis and oophoritis, unspecified)
Vaginitis (N76-Other inflammation of vagina and vulva)
(N76.0-Acute vaginitis) KMK 514 √

122 (N76.1-Subacute and chronic vaginitis)
(N76.6-Ulceration of vagina)
(N76.8-Other specified inflammation of vagina
and vulva)
Vaginosis bakterialis (N76-Other inflammation of vagina and vulva)

(N76.1-Subacute and chronic vaginitis)
and vulva)
123 (N77-Vulvovaginal ulceration and inflammation

in diseases classified elsewhere)
(N77.1-Vaginitis, vulvitis and vulvovaginitis in

infectious and parasitic diseases classified
elsewhere)
(N77.8-Vulvovaginal ulceration and

inflammation in other diseases classified
elsewhere)
Vulvitis (N76-Other inflammation of vagina and vulva)
(N76.2-Acute vulvitis) √
(N76.3-Subacute and chronic vulvitis)
124
Mampu Ditangani
124
(N76.4-Abscess of vulva)
(N76.6-Ulceration of vulva)
and vulva)
Aborsi spontan komplit (O03-Spontaneous abortion)

(O03.9-Complete or unspecified, without KMK 514 √
complication)
(O04-Medical Abortion)
(O04.9-Complete or unspecified, without
complication)
125
(O05-Other Abortion)
complication)
(O06-Unspecified abortion)
complication)
Ruptur perineum tingkat 1-2 (O70-Perineal laceration during delivery) √

(O70.0-First degree perineal laceration during KMK 514 √
126 √ delivery)
(O70.1-Second degree perineal laceration √
during delivery)
Kehamilan normal (O80-Single spontaneous delivery) √

(O80.0-Spontaneous vertex delivery) √
(O80.1-Spontaneous breech delivery)
(O80.8-Other single spontaneous delivery) √
127 (O80.9-Single spontaneous delivery, KMK 514 √

unspecified)
Mampu Ditangani
127 Check/ Diagnosa Non Spesialistik Berdasar SKDI Tahun 2012 Tercantum dalam Penatalksanaan KMK
(O26.8-Other specified pregnancy-related √
conditions)
(O26.9-Pregnancy-related condition,
unspecified)
(O92-Other disorders of breast and lactation

Inverted nipple associated with childbirth)
128
(O92.0-Retracted nipple associated with KMK 514 √
childbirth)

Cracked nipple associated with childbirth)
(O92.1-Cracked nipple associated with
129 √
childbirth)
(N64-Other disorders of breast)
(N64.0-Fissure and fistula of nipple)
(P38-Omphalitis of newborn with or without

130 √ Infeksi pada umbilikus KMK 514 √
mild haemorrhage)
Epistaksis (R04-Haemorrhage from respiratory passages)

131
(R04.0-Epistaxis) KMK 514 √
Mabuk perjalanan (R11-Nausea and vomiting) √

132 √
(T75.3-Motion sickness) √
Vertigo (Benign paroxysmal (R42-Dizziness and giddiness) KMK 514 √

positional vertigo)
(H81-Disorders of vestibular function) √
(H81.1-Benign paroxysmal vertigo) √
133 (H81.3-Other peripheral vertigo) √
Mampu Ditangani
133 Uncheck Nama Penyakit ICD X 514/2015 Ya
(H81.4-Vertigo of central origin)
(H82-Vertiginous syndromes in diseases
(T75.2-Effects of vibration)
Kejang demam (R56-Convulsions, not elsewhere classified) √
134 (R56.0-Febrile convulsions) KMK 514 √
(R56.8-Other and unspecified convulsions)
Vulnus laseratum, vulnus (T00-Superficial injuries involving multiple √

punctum body regions)
(T00.0-Superficial injuries involving head with
neck) √
(T00.1-Superficial injuries involving thorax with √

abdomen, lower back and pelvis)
(T00.2-Superficial injuries involving multiple √

regions of upper limb(s))
regions of lower limb(s))

135 regions of upper limb(s) with lower limb(s))
(T00.8-Superficial injuries involving other √

combinations of body regions)
(T00.9-Multiple superficial injuries, √
unspecified)
(T14-Injury of unspecified body region) KMK 514
(T14.0-Superficial injury of unspecified body √
region)
Mampu Ditangani
(T14.1-Open wound of unspecified body √
region)
(T14.8-Other injuries of unspecified body √
region)
(T14.9-Injury, unspecified) √
Benda asing di konjungtiva (T15-Foreign body on external eye)

(T15.1-Foreign body in conjunctival sac)
(T15.8- Foreign body in other and multiple
136 parts of external eye)
(T15.9-Foreign body on external eye, part KMK 514 √
unspecified)
Benda asing (T17-Foreign body in respiratory tract)

137
(T17.1-Foreign body in nostril) KMK 514 √
(T30.0-Burn of unspecified body region,

Luka bakar derajat 1 dan 2 unspecified degree)
(T30.1-Burn of first degree, body region KMK 514 √
unspecified)
(T30.2-Burn of second degree, body region √
unspecified)
(T30.4-Corrosion of unspecified body region,
unspecified degree)
(T30.5-Corrosion of first degree, body region
unspecified)
(T30.6-Corrosion of second degree, body
region unspecified)
(T21-Burn and corrosion of trunk)
(T21.0-Burn of unspecified degree of trunk)
(T21.1-Burn of first degree of trunk) √

Mampu Ditangani
(T21.2-Burn of second degree of trunk)
(T21.4-Corrosion of unspecified degree of √
trunk)
(T21.5-Corrosion of first degree of trunk)
(T21.6-Corrosion of second degree of trunk)
(T22-Burn and corrosion of shoulder and upper

limb, except wrist and hand)
(T22.0-Burn of unspecified degree of shoulder

and upper limb, except wrist and hand)
(T22.1-Burn of first degree of shoulder and √

upper limb, except wrist and hand)
(T22.2-Burn of second degree of shoulder and
(T22.4-Corrosion of unspecified degree of
shoulder and upper limb, except wrist and
hand)
(T22.5-Corrosion of first degree of shoulder √

(T22.6-Corrosion of second degree of shoulder √

(T23-Burn and corrosion of wrist and hand)
(T23.0-Burn of unspecified degree of wrist and

hand)
(T23.1-Burn of first degree of wrist and hand) √
(T23.2-Burn of second degree of wrist and

hand)
Mampu Ditangani
(T23.4-Corrosion of unspecified degree of wrist
and hand)
138 (T23.5-Corrosion of first degree of wrist and √
hand)
(T23.6-Corrosion of second degree of wrist and
hand)
(T24-Burn and corrosion of hip and lower limb,
except ankle and foot)
(T24.0-Burn of unspecified degree of hip and
lower limb, except ankle and foot)
(T24.1-Burn of first degree of hip and lower
limb, except ankle and foot)
(T30-Burn and corrosion, body region
unspecified)
(T24.2-Burn of second degree of hip and lower
(T24.4-Corrosion of unspecified degree of hip

and lower limb, except ankle and foot)
(T24.5-Corrosion of first degree of hip and √

(T24.6-Corrosion of second degree of hip and
(T25-Burn and corrosion of ankle and foot)
(T25.0-Burn of unspecified degree of ankle and

foot)
(T25.1-Burn of first degree of ankle and foot) √
(T25.2-Burn of second degree of ankle and

foot)
Mampu Ditangani
ankle and foot)
(T25.5-Corrosion of first degree of ankle and √
foot)
(T25.6-Corrosion of second degree of ankle
and foot)
(T29-Burns and corrosions of multiple body
regions)
(T29.0-Burns of multiple regions, unspecified
degree)
(T29.1-Burns of multiple regions, no more than
first-degree burns mentioned)
second-degree burns mentioned)
(T29.4-Corrosions of multiple regions,
unspecified degree)
(T29.5-Corrosions of multiple regions, no more

than first-degree corrosions mentioned)

than second-degree corrosions mentioned)
(T62-Toxic effect of other noxious substances

Keracunan makanan eaten as food)
(T62.0-Ingested mushrooms)
(T62.1-Ingested berries)
(T62.2-Other ingested(parts of) plant(s)) KMK 514
(T62.8-Other specified noxious substances
eaten as food)
(T62.9-Noxious substance eaten as food,
unspecified)
Mampu Ditangani
(T61-Toxic effect of noxious substances eaten
as seafood)
(T61.0-Ciguatera fish poisoning)
139
(T61.1-Scombroid fish poisoning)
(T61.2-Other fish and shellfish poisoning)
(T61.8-Toxic effect of other seafoods)
(T61.9-Toxic effect of unspecified seafood)
(K52-Other noninfective gastroenteritis and

colitis)
(K52.1-Toxic gastroenteritis and colitis)
(K52.8-Other specified noninfective
gastroenteritis and colitis)
(K52.9-Noninfective gastroenteritis and colitis,
unspecified)
(T63-Toxic effect of contact with venomous

Reaksi gigitan serangga
140 animals)
(T63.4- Venom of other arthropods) KMK 514 √
Reaksi anafilaktik (T78-Adverse effects, not elsewhere classified)
(T78.2-Anaphylactic shock, unspecified) KMK 514 √

(T80.5-Anaphylactic shock due to serum)
141 (T78.0-Anaphylactic shock due to adverse food
reaction)
(T88.6-Anaphylactic shock due to adverse
effect of correct drug or medicament properly
administered)
Kekerasan tajam (X99-Assault by sharp object)

Mampu Ditangani
(X78-Intentional self-harm by sharp object)
(Y28-Contact with sharp object, undetermined

intent)
142 (Y35.4-Legal intervention involving sharp
objects)
(W22-Striking against or struck by other
objects)
(W26.9-Contact with unspecified sharp
object(s))
Kekerasan tumpul (Y00-Assault by blunt object)
(X79-Intentional self-harm by blunt object)
(Y29-Contact with blunt object, undetermined

143 intent)
(Y35.3-Legal intervention involving blunt
objects)
(W22-Striking against or struck by other
objects)
(Z21-Asymptomatic human immunodeficiency KMK 514

HIV AIDS tanpa komplikasi virus [HIV] infection status)
(R75-Laboratory evidence of human

immunodeficiency virus [HIV])
144 (Z11.4-Special screening examination for
human immunodeficiency virus [HIV])
(Z20.6-Contact with and exposure to human
(Z71.7-Human immunodeficiency virus [HIV] √
counselling)
Mampu Ditangani
No Jabatan
1 Kepala Dinas Kesehatan dan Keluarga Berencana Kota Madiun
2 Kepala Dinas Kesehatan Kabupaten Madiun
No Jabatan
3 Kepala Dinas Kesehatan Kabupaten Magetan
4 Kepala Dinas Kesehatan Kabupaten Ngawi

Mampu Ditangani
5 Kepala Dinas Kesehatan Kabupaten Ponorogo
6
Kepala Bidang Pelayanan dan Sumber Daya Kesehatan Dinas
Kesehatan dan Keluarga Berencana Kota Madiun
7
Kepala Bidang Pelayanan Kesehatan Dinas Kesehatan
Kabupaten Madiun
8
Kabupaten Magetan
9
Kabupaten Ngawi
10
Kabupaten Ponorogo
Mampu Ditangani
11
Kepala Bidang Penjaminan Manfaat Primer BPJS Kesehatan
Cabang Madiun
12 Kepala BPJS Kesehatan Kabupaten Madiun

Mampu Ditangani
No Jabatan
13 Kepala BPJS Kesehatan Kabupaten Magetan
14 Kepala BPJS Kesehatan Kabupaten Ngawi
15 Kepala BPJS Kesehatan Kabupaten Ponorogo
16 Anggota IDI Cabang Madiun Perwakilan Kota Madiun
17 Anggota IDI Cabang Madiun Perwakilan Kabupaten Madiun

Mampu Ditangani
18 Anggota IDI Cabang Magetan
19 Anggota IDI Cabang Ngawi
20 Anggota IDI Cabang Ponorogo
21 Anggota Asklin Cabang Madiun Perwakilan Kota Madiun
22 Anggota Asklin Cabang Madiun Perwakilan Kabupaten Madiun

Mampu Ditangani
No Jabatan
23
Anggota Asklin Cabang Madiun Perwakilan Kabupaten
Magetan
24 Anggota Asklin Cabang Madiun Perwakilan Kabupaten Ngawi
25
Ponorogo
GNOSA NON SPESIALISTIK
TAN TINGKAT PERTAMA
Mampu Ditangani
Beri tanda √ salah satu) Keterangan
Tidak
√
√
√
√
√
√
√
√
√
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
"Other" merupakan organ yang belum pasti, FKTP tidak dapat tuntas melaksanakan di
√ setiap organ
Obat berkoordinasi dengan Puskesmas
√ Prothesa alat gerak hanya di FKRTL
"Other" merupakan kondisi yang belum pasti, FKTP tidak dapat tuntas melaksanakan di
√ setiap kondisi
√ Harus ada kultur yang tidak dapat dilaksanakan di FKTP

TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
tidak tepat dan terlalu luas pengelompokannya, tidak semua infeksi masa nifas dapat
√ tuntas di FKTP
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
drirujuk dengan TACC
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ kandidiasis di dalam kuku perlu ada tindakan di FKRTL
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ Lab Penunjang tidak tersedia

√
√
√
√
√
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
dengan catatan berdasar lokasi, kedalaman, diameter, dan jumlah
√ multiple
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√ hanya untuk peserta PRB insulin ada
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√ terkendala obat somatoform tidak tersedia di FKTP
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ obat susah didapatkan, psikotropika
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
hordeolum dengan insisi dapat dirujuk dengan TACC
√ Trikiasis selalu disertai komplikasi

√
√
√
√
√
√
√
√
√ perlu discrapping
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
√ tidak dapat meresepi

TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√ Abses tidak dapat dilakukan tindakan di FKTP
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ harus ada alat suction
√ penegakan harus oleh dokter spesialis PA
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
harus ada tes alergi
√ harus ada tes alergi

TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ hanya penegakan diagnosa

√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
dirujuk dengan TACC
√
√ abses di telinga perlu ditangani oleh THT
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
dirujuk dengan TACC

TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ perlu ada sarana tes alergi
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ Obat berubat obat racikan

√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√ kondisi abortus perlu disepsifikan
2nd -> sampai otot, 3rd-> kena springter
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ Kondisi harus lebih spesifik, agar diketahui kompetensinya
√ Kondisi gangguan harus dispesifikan
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√ Lokasi luka belum jelas

TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√ lokasi terlalu dalam
√ benda asing banyak
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√ zat toxic dari hewan yang belum jelas
√ yang Adverse tidak bisa ditangani
√ hanya menjelaskan sebab bukan kondisi pasien

TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√ Membahayakan diri sendiri tidak dijamin JKN
√ bisa ditangani yg sudah tegak diagnosa dan pendampingan saja
√
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
Tanda Tangan
Berencana Kota Madiun

(................................................)
adiun
(................................................)
Tanda Tangan
agetan
(................................................)
awi
(................................................)
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
norogo
(................................................)
Daya Kesehatan Dinas

ta Madiun
(................................................)
inas Kesehatan
(................................................)
inas Kesehatan
(................................................)
inas Kesehatan
(................................................)
inas Kesehatan
(................................................)
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
imer BPJS Kesehatan
(................................................)
diun
(................................................)
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
Tanda Tangan
getan
(................................................)
wi
(................................................)
orogo
(................................................)
n Kota Madiun
(................................................)
n Kabupaten Madiun
(................................................)
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
(................................................)
(................................................)
(................................................)
kilan Kota Madiun

(................................................)
kilan Kabupaten Madiun

(................................................)
TAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
Tanda Tangan
kilan Kabupaten
(................................................)
kilan Kabupaten Ngawi

(................................................)
kilan Kabupaten
(................................................)
No Jabatan
3 Kepala Dinas Kesehatan Kabupaten Magetan
4 Kepala Dinas Kesehatan Kabupaten Ngawi
5 Kepala Dinas Kesehatan Kabupaten Ponorogo
6
Kepala Bidang Pelayanan dan Sumber Daya Kesehatan Dinas
Kesehatan dan Keluarga Berencana Kota Madiun
7
Kabupaten Madiun
8
Kabupaten Magetan
9
Kabupaten Ngawi
10
Kabupaten Ponorogo
11
Kepala Bidang Penjaminan Manfaat Primer BPJS Kesehatan
Cabang Madiun
12 Kepala BPJS Kesehatan Kabupaten Madiun

No Jabatan
13 Kepala BPJS Kesehatan Kabupaten Magetan
14 Kepala BPJS Kesehatan Kabupaten Ngawi
15 Kepala BPJS Kesehatan Kabupaten Ponorogo
16 Anggota IDI Cabang Madiun Perwakilan Kota Madiun
17 Anggota IDI Cabang Madiun Perwakilan Kabupaten Madiun
18 Anggota IDI Cabang Magetan

19 Anggota IDI Cabang Ngawi
20 Anggota IDI Cabang Ponorogo
21 Anggota Asklin Cabang Madiun Perwakilan Kota Madiun
22 Anggota Asklin Cabang Madiun Perwakilan Kabupaten Madiun

No Jabatan
23
Magetan
24 Anggota Asklin Cabang Madiun Perwakilan Kabupaten Ngawi
25
Ponorogo
Tanda Tangan
agetan
(................................................)
awi
(................................................)
norogo
(................................................)
Daya Kesehatan Dinas

ta Madiun
(................................................)
inas Kesehatan
(................................................)
inas Kesehatan
(................................................)
inas Kesehatan
(................................................)
inas Kesehatan
(................................................)
imer BPJS Kesehatan
(................................................)
diun
(................................................)
Tanda Tangan
getan
(................................................)
wi
(................................................)
orogo
(................................................)
n Kota Madiun
(................................................)
n Kabupaten Madiun
(................................................)
(................................................)
(................................................)
(................................................)
kilan Kota Madiun

(................................................)
kilan Kabupaten Madiun

(................................................)
Tanda Tangan
kilan Kabupaten
(................................................)
kilan Kabupaten Ngawi

(................................................)
kilan Kabupaten
(................................................)
Mampu Ditangani
Check/ Diagnosa Non Spesialistik Berdasar SKDI Tahun 2012 Tercantum dalam Penatalksanaan
No (Beri tanda √
Uncheck Nama Penyakit ICD X KMK 514/2015 Ya
1 Demam tifoid (A01-Typhoid and paratyphoid fevers) √
(A01.0-Typhoid fever) KMK 514 √
(A01.1-Paratyphoid fever A) √
(A01.2-Paratyphoid fever B) √
2 Disentri basiler, disentri amuba (A06-Amoebiasis)
(A06.0-Acute amoebic dysentery) KMK 514 √

(A03-Shigellosis)

Gastroenteritis (termasuk kolera, (A09-Other gastroenteritis and colitis of

3 giardiasis) infectious and unspecified origin)
(A09.0-Other and unspecified gastroenteritis KMK 514 √

(A09.9-Gastroenteritis and colitis of unspecified

origin)
Mampu Ditangani
No (Beri tanda √
(A08-Viral and other specified intestinal
infections)
(A08.1-Acute gastroenteropathy due to Norwalk
agent)

Tuberkulosis paru tanpa (A15-Respiratory tuberculosis, bacteriologically

4 komplikasi and histologically confirmed)
(A15.0-Tuberculosis of lung, confirmed by KMK 514 √


culture only)
(A15.2-Tuberculosis of lung, confirmed
histologically)
unspecified means)
nodes, confirmed bacteriologically and
histologically)

histologically)
Mampu Ditangani
No (Beri tanda √
(A15.7-Primary respiratory tuberculosis,

(A15.8-Other respiratory tuberculosis,


(A16.1-Tuberculosis of lung, bacteriological and

histological examination not done)
(A16.2-Tuberculosis of lung, without mention of

bacteriological or histological confirmation)
(A16.7-Primary respiratory tuberculosis without

confirmation)

confirmation)

5 Skrofuloderma (A18-Tuberculosis of other organs)
(A18.4-Tuberculosis of skin and subcutaneous KMK 514 √

tissue)
Mampu Ditangani
No (Beri tanda √
6 Leptospirosis (tanpa komplikasi) (A27- Leptospirosis)
(A27.0-Leptospirosis icterohaemorrhagica)
(A27.9-Leptospirosis, unspecified) KMK 514 √
7 Lepra (A30-Leprosy [Hansen disease]) √

(A30.0-Indeterminate leprosy) KMK 514 √
(A30.1-Tuberculoid leprosy) √
(A30.2-Borderline tuberculoid leprosy) √
(A30.3-Borderline leprosy) √
(A30.4-Borderline lepromatous leprosy) √
(A30.5-Lepromatous leprosy) √
(A30.8-Other forms of leprosy) √
(A30.9-Leprosy, unspecified) √
8 Tetanus (A35-Other tetanus) KMK 514
(Y58.4-Tetanus vaccine) √
bacterial diseases)
(Z23.5-Need for immunization against tetanus √
alone)
(Z27.1-Need for immunization against √


diphtheria-tetanus-pertussis with typhoid- √
Mampu Ditangani
No (Beri tanda √
diphtheria-tetanus-pertussis with poliomyelitis √
[DTP + polio])
9 Pertusis (A37-Whooping cough)

pertussis)
parapertussis)
(A37.8-Whooping cough due to other Bordetella KMK 514 √
species)
10 Erisipelas (A46-Erysipelas) KMK 514 √
11 Sifilis stadium 1 dan 2 (A51-Early syphilis) KMK 514

membranes)
(A53.0-Latent syphilis, unspecified as early or
late)
(A53.9-Syphilis, unspecified) KMK 514
Sindrom duh (discharge) genital

12 (A54-Gonococcal infection) √

Mampu Ditangani
No (Beri tanda √
rectum)
(A56-Other sexually transmitted chlamydial
diseases)
(A56.0-Chlamydial infection of lower
(A56.2-Chlamydial infection of genitourinary
tract, unspecified)
(A56.8-Sexually transmitted chlamydial infection
of other sites)
13 Gonore (A54-Gonococcal infection) √

rectum)
14 Demam dengue, DHF (A90-Dengue fever [classical dengue])

(A91-Dengue haemorrhagic fever) KMK 514
Mampu Ditangani
No (Beri tanda √
15 Herpes simpleks tanpa komplikasi (B00-Herpesviral [herpes simplex] infections) √
(B00.9-Herpesviral infection, unspecified) KMK 514 √
16 Varisela tanpa komplikasi (B01-Varicella [chickenpox]) √

√
(B01.9-Varicella without complication) KMK 514 √
17 Herpes zoster tanpa komplikasi (B02-Zoster [herpes zoster]) √

√
(B02.9-Zoster without complication) KMK 514 √
18 Morbili tanpa komplikasi (B05-Measles) √

√
(B05.9-Measles without complication) KMK 514 √
19 Veruka vulgaris (B07-Viral warts) KMK 514
(B08-Other viral infections characterized by skin

20 Moluskum kontagiosum and mucous membrane lesions, not elsewhere
classified)
(B08.1-Molluscum contagiosum) KMK 514
21 Hepatitis A (B15-Acute hepatitis A) KMK 514 √

√
(B15.9-Hepatitis A without hepatic coma) √
22 Parotitis (B26-Mumps) √
√
(B26.9-Mumps without complication) √
23 Tinea kapitis (B35-Dermatophytosis) KMK 514 √

√
Mampu Ditangani
No (Beri tanda √
24 Tinea barbe (B35-Dermatophytosis) √

√
25 Tinea unguium (B35-Dermatophytosis) √

√
(B35.1- Tinea unguium) KMK 514 √
26 Tinea manus (B35-Dermatophytosis) √

√
(B35.2-Tinea manuum) KMK 514 √
27 Tinea pedis (B35-Dermatophytosis) √

√
(B35.3- Tinea pedis) KMK 514 √
28 Tinea korporis (B35-Dermatophytosis) √

√ (B35.4-Tinea corporis) KMK 514 √
(B35.5-Tinea imbricata) √
29 Tinea kruris (B35-Dermatophytosis) √

(B35.6-Tinea cruris) KMK 514 √
30 Tinea fasialis (B35-Dermatophytosis) √

√ (B35.8-Other dermatophytoses) KMK 514 √
(B35.9-Dermatophytosis, unspecified) √
31 Pitiriasis versikolor (B36-Other superficial mycoses) √

(B36.0-Pityriasis versicolor) KMK 514 √
(B36.1-Tinea nigra) √
√ (B36.2-White piedra) √
(B36.3-Black piedra) √
(B36.8-Other specified superficial mycoses) √
(B36.9-Superficial mycosis, unspecified) √
Mampu Ditangani
No (Beri tanda √
32 Kandidosis mukokutan ringan (B37-Candidal stomatitis) √
(B37.8-Candidiasis of other sites) √
33 Kandidiasis mulut (B37-Candidiasis) √

√ (B37.0-Candidal stomatitis) √
34 Skistosomiasis (B65-Schistosomiasis [bilharziasis])

(B65.0-Schistosomiasis due to Schistosoma KMK 514
mansoni [intestinal schistosomiasis])
japonicum)
(B65.8-Other schistosomiases) √
(B65.9-Schistosomiasis, unspecified) √
35 Taeniasis (B68-Taeniasis)
(B68.9-Taeniasis, unspecified) KMK 514
36 Filariasis (B74-Filariasis)
(B74.0-Filariasis due to Wuchereria bancrofti) KMK 514

(B74.3-Loiasis)
Mampu Ditangani
No (Beri tanda √

37 Penyakit cacing tambang (B76-Hookworm diseases)

(B76.0-Ancylostomiasis) KMK 514 √
38 Cutaneus larva migran (B76-Hookworm diseases)

(B76.9-Hookworm disease, unspecified) KMK 514 √
39 Askariasis (B77-Ascariasis) KMK 514 √

(K93.8-Disorders of other specified digestive

40 Strongiloidiasis (B78-Strongyloidiasis) KMK 514 √

(B78.1-Cutaneous strongyloidiasis)
Mampu Ditangani
No (Beri tanda √
41 Malaria (B85.3-Phthiriasis) √
(B50-Plasmodium falciparum malaria) √
(B50.9-Plasmodium falciparum malaria, √
unspecified)
(B51-Plasmodium vivax malaria) √
(B51.8-Plasmodium vivax malaria with other √
complications)
(B51.9-Plasmodium vivax malaria without √
complication)
(B52-Plasmodium malariae malaria) √
(B52.8-Plasmodium malariae malaria with other
complications)
(B52.9-Plasmodium malariae malaria without √
complication)
(B53-Other parasitologically confirmed malaria)
(B53.0-Plasmodium ovale malaria) √

(B53.8-Other parasitologically confirmed
(B54-Unspecified malaria) KMK 514 √
42 Pedikulosis pubis (B85-Pediculosis and phthiriasis) √

√ (B85.0- Pediculosis due to Pediculus humanus √
capitis)
43 Pedikulosis kapitis (B85-Pediculosis and phthiriasis) √

(B85.0- Pediculosis due to Pediculus humanus KMK 514 √
capitis)
√
(B85.1- Pediculosis due to Pediculus humanus √
corporis)
(B85.4- Mixed pediculosis and phthiriasis) √
Mampu Ditangani
No (Beri tanda √
44 Skabies (B86-Scabies) KMK 514 √
45 Lipoma (D17-Benign lipomatous neoplasm) √
(D17.0-Benign lipomatous neoplasm of skin and

subcutaneous tissue of head, face and neck)

subcutaneous tissue of trunk)
(D17.2-Benign lipomatous neoplasm of skin and √
subcutaneous tissue of limbs)
subcutaneous tissue of other and unspecified √
sites)
(D17.7-Benign lipomatous neoplasm of other
sites)
(D17.9-Benign lipomatous neoplasm, KMK 514
unspecified)
46 Anemia defisiensi besi (D50-Iron deficiency anaemia)

Anemia defisiensi besi pada

47 (D50-Iron deficiency anaemia) √
kehamilan
(D50.8-Other iron deficiency anaemias) √

Mampu Ditangani
No (Beri tanda √
(O99.0-Anaemia complicating pregnancy,
48 Diabetes melitus tipe 1 (E10-Insulin-dependent diabetes mellitus)

(E10.9-Insulin-dependent diabetes mellitus
49 Diabetes melitus tipe 2 (E11-Non-insulin-dependent diabetes mellitus) √

√
(E11.9-Non-insulin-dependent diabetes mellitus KMK 514 √

50 Hipoglikemia ringan √
secretion)
√
(E16.1-Other hypoglycaemia) √
(E16.2-Hypoglycaemia, unspecified) KMK 514 √
51 Malnutrisi energi-protein (E40-Kwashiorkor)

(E44-Protein-energy malnutrition of moderate
and mild degree)
(E44.0-Moderate protein-energy malnutrition)
(E44.1-Mild protein-energy malnutrition) √
(E46-Unspecified protein-energy malnutrition) KMK 514 √
(E64.0-Sequelae of protein-energy malnutrition)
52 Defisiensi vitamin (E50-Vitamin A deficiency)

Mampu Ditangani
No (Beri tanda √
(E50.0-Vitamin A deficiency with conjunctival
xerosis)
xerosis)
(E50.4-Vitamin A deficiency with keratomalacia)
(E50.5-Vitamin A deficiency with night

blindness)
(E50.6-Vitamin A deficiency with xerophthalmic
scars of cornea)
(E50.7-Other ocular manifestations of vitamin A
deficiency)
(E50.8-Other manifestations of vitamin A
deficiency)
(E51.1-Beriberi)
(E51.8-Other manifestations of thiamine
deficiency)
(E52-Niacin deficiency [pellagra])
(E53.8-Deficiency of other specified B group
vitamins)
Mampu Ditangani
No (Beri tanda √
(E64-Sequelae of malnutrition and other
(E64.8-Sequelae of other nutritional
deficiencies)
(E64.9-Sequelae of unspecified nutritional
deficiency)
53 Defisiensi mineral (E58-Dietary calcium deficiency)

(E61.7-Deficiency of multiple nutrient elements)

Mampu Ditangani
No (Beri tanda √
(E61.8-Deficiency of other specified nutrient
elements)
(E61.9-Deficiency of nutrient element,
unspecified)
(E63.1-Imbalance of constituents of food intake)
54 Obesitas (E66-Obesity)
(E66.1-Drug-induced obesity)
(E66.9-Obesity, unspecified) KMK 514 √

55 Dislipidemia other lipidaemias)
(E78.0-Pure hypercholesterolaemia) √
(E78.4-Other hyperlipidaemia)
(E78.5-Hyperlipidaemia, unspecified) KMK 514 √
(E78.8-Other disorders of lipoprotein
metabolism)
unspecified)
Mampu Ditangani
No (Beri tanda √

56 Hiperurisemia metabolism)

inflammatory arthritis and tophaceous disease) KMK 514 √
(E79.8-Other disorders of purine and pyrimidine
metabolism)
(E79.9-Disorder of purine and pyrimidine
57 Gangguan somatoform (F45-Somatoform disorders)

(F45.0-Somatization disorder) KMK 514 √
(F45.3-Somatoform autonomic dysfunction)

58 Insomnia (F51-Nonorganic sleep disorders)

(F51.0-Nonorganic insomnia) KMK 514 √
schedule)
(G47.0-Disorders of initiating and maintaining
sleep [insomnias])
Mampu Ditangani
No (Beri tanda √
59 Migren (G43-Migraine) √
(G43.0-Migraine without aura [common √
migraine])
(G43.1-Migraine with aura [classical migraine]) √

√
(G43.2-Status migrainosus) √
(G43.8-Other migraine) √
(G43.9-Migraine, unspecified) KMK 514 √
(N94.3-Premenstrual tension syndrome) √
60 Tension headache (G44-Other Headache Syndromes) √

(G44.1-Vascular headache, not elsewhere
classified)
(G44.2-Tension-type headache) KMK 514 √
classified)
(G44.8-Other specified headache syndromes) √
(R51-Headache) √
61 Bells' palsy (G51-Facial nerve disorders)

(G51.0-Bell's palsy) KMK 514 √
62 Hordeolum (H00-Hordeolum and chalazion) √

√ (H00.0-Hordeolum and other deep KMK 514 √
63 Blefaritis (H01-Other inflammation of eyelid) √

√
(H01.0-Blepharitis) KMK 514 √
64 Trikiasis (H02-Other disorders of eyelid)

Mampu Ditangani
No (Beri tanda √
(H02.0-Entropion and trichiasis of eyelid) KMK 514
65 Mata kering (H04-Disorders of lacrimal system) √

√
(H04.1-Other disorders of lacrimal gland) KMK 514 √
66 Konjungtivitis (H10-Conjunctivitis)
(H10.1-Acute atopic conjunctivitis) KMK 514 √
(H10.5-Blepharoconjunctivitis) √
67 Perdarahan subkonjungtiva (H11-Other disorders of conjunctiva)

(H57.8-Other specified disorders of eye and KMK 514
adnexa)
(H57.9-Disorder of eye and adnexa, unspecified)
68 Episkleritis (H15-Disorders of sclera) √

√
(H15.1-Episcleritis) KMK 514 √
Mampu Ditangani
No (Beri tanda √

69 Hipermetropia ringan accommodation)
(H52.0-Hypermetropia) KMK 514

70 Miopia ringan accommodation)
(H52.1-Myopia) KMK 514

71 Astigmatism ringan accommodation)
(H52.2-Astigmatism) KMK 514

72 Presbiopia accommodation)
(H52.4-Presbyopia) KMK 514
73 Buta senja (H53-Visual disturbances)

(H53.6-Night blindness) KMK 514 √
74 Otitis eksterna (H60-Otitis externa) √

(H60.3-Other infective otitis externa) √
(H60.5-Acute otitis externa, noninfective) √
(H60.8-Other otitis externa) √
(H60.9-Otitis externa, unspecified) KMK 514 √
(H62-Disorders of external ear in diseases
(H62.0-Otitis externa in bacterial diseases
elsewhere)
Mampu Ditangani
No (Beri tanda √
(H62.3-Otitis externa in other infectious and

(H62.4-Otitis externa in other diseases classified

elsewhere)
(H62.8-Other disorders of external ear in
75 Serumen prop (H61-Other disorders of external ear)

(H61.2-Impacted cerumen) KMK 514 √
76 Otitis media akut (H65-Nonsuppurative otitis media) √

(H65.1-Other acute nonsuppurative otitis
media) KMK 514 √
(H65.9-Nonsuppurative otitis media, √

unspecified)
(H66-Suppurative and unspecified otitis media) √
(H66.0-Acute suppurative otitis media) KMK 514 √
(H66.9-Otitis media, unspecified) √

(H67-Otitis media in diseases classified
elsewhere)
(H67.0-Otitis media in bacterial diseases
elsewhere)
elsewhere)
Mampu Ditangani
No (Beri tanda √
77 √ Hipertensi esensial (I10-Essential(primary) hypertension) KMK 514 √
78 Hemoroid grade 1-2 (I84-Haemorrhoids) √

(I84.2-Internal haemorrhoids without √
complication)
√ (I84.5-External haemorrhoids without √
complication)
(I84.9-Unspecified haemorrhoids without √
complication)
79 Limfadenitis (I88-Nonspecific lymphadenitis)
(I88.1-Chronic lymphadenitis, except

mesenteric)
(L04.0-Acute lymphadenitis of face, head and
neck)
(L04.9-Acute lymphadenitis, unspecified) KMK 514 √
80 √ Rhinitis akut (J00-Acute nasopharyngitis [common cold]) KMK 514 √
81 Faringitis (J02-Acute pharyngitis) KMK 514 √

Mampu Ditangani
No (Beri tanda √
organisms)
(J02.9-Acute pharyngitis, unspecified)
(J31-Chronic rhinitis, nasopharyngitis and
pharyngitis)
82 Tonsilitis (J03-Acute tonsillitis) KMK 514 √

organisms)
(J35.8-Other chronic diseases of tonsils and
adenoids)
unspecified)
83 Laringitis (J04-Acute laryngitis and tracheitis) KMK 514 √


84 Influenza virus)
(J10.0-Influenza with pneumonia, other KMK 514 √
Mampu Ditangani
No (Beri tanda √



(J11.0-Influenza with pneumonia, virus not
identified)
(J11.8-Influenza with other manifestations, virus
not identified)
(A49.2-Haemophilus influenzae infection,
unspecified site)
85 Pneumonia, bronkopneumonia (J12-Viral pneumonia, not elsewhere classified)

(J13-Pneumonia due to Streptococcus
pneumoniae)
(J14-Pneumonia due to Haemophilus
influenzae)
(J15-Bacterial pneumonia, not elsewhere
classified)
Mampu Ditangani
No (Beri tanda √
(J15.0-Pneumonia due to Klebsiella
pneumoniae)
(J15.3-Pneumonia due to streptococcus, group
B)

(J15.6-Pneumonia due to other aerobic Gram-
negative bacteria)
(J15.7-Pneumonia due to Mycoplasma
pneumoniae)
(J16-Pneumonia due to other infectious
(J16.8-Pneumonia due to other specified
(J17-Pneumonia in diseases classified
elsewhere)
(J17.0-Pneumonia in bacterial diseases classified
elsewhere)
elsewhere)
elsewhere)
(J18.0-Bronchopneumonia, unspecified) KMK 514 √
Mampu Ditangani
No (Beri tanda √
(J18.8-Other pneumonia, organism unspecified)
86 Bronkitis akut (J20-Acute bronchitis)

pneumoniae)
influenzae)
(J20.4-Acute bronchitis due to parainfluenza

virus)
(J20.5-Acute bronchitis due to respiratory
syncytial virus)
(J20.6-Acute bronchitis due to rhinovirus)
organisms)
(J20.9-Acute bronchitis, unspecified) KMK 514 √
(J40-Bronchitis, not specified as acute or
chronic)
(J41-Simple and mucopurulent chronic
bronchitis)
bronchitis)
Mampu Ditangani
No (Beri tanda √
87 Rhinitis vasomotor (J30-Vasomotor and allergic rhinitis) KMK 514 √

√
(J30.1-Vasomotor rhinitis) √
88 Rhinitis alergika (J30-Vasomotor and allergic rhinitis)

(J30.4- Other allergic rhinitis) KMK 514 √
89 Furunkel pada hidung (J34-Other disorders of nose and nasal sinuses)
(J34.0-Abscess, furuncle and carbuncle of nose) KMK 514 √
90 Asma bronkial (J45-Asthma)

(J45.1-Nonallergic asthma)
(J45.9-Asthma, unspecified) KMK 514 √
91 Ulkus mulut (aptosa, herpes) (K12-Stomatitis and related lesions) KMK 514 √
(K12.1-Other forms of stomatitis)
92 Refluks gastroesofagus (K21-Gastro-oesophageal reflux disease)

(K21.9-Gastro-oesophageal reflux disease KMK 514 √
Mampu Ditangani
No (Beri tanda √
93 Gastritis (K29-Gastritis and duodenitis)

(K29.7-Gastritis, unspecified) KMK 514 √
94 Intoleransi makanan (K90-Intestinal malabsorption)

(K90.4-Malabsorption due to intolerance, not KMK 514 √
95 Impetigo (L01-Impetigo) √
(L01.0-Impetigo [any organism] [any site]) KMK 514 √
√
(L01.1-Impetiginization of other dermatoses) √

96 Furunkel, karbunkel √
carbuncle)
carbuncle of face)
carbuncle of neck)
carbuncle of trunk)
carbuncle of limb)
Mampu Ditangani
No (Beri tanda √
(H04.3-Acute and unspecified inflammation of √
lacrimal passages )
(N76.4-Abscess of vulva) √
(N48.2- Other inflammatory disorders of penis) √
(N49.2-Inflammatory disorders of scrotum) √

(N49.8-Inflammatory disorders of other √
(N49.9-Inflammatory disorder of unspecified √
male genital organ)
(N61-Inflammatory disorders of breast) √
Abses folikel rambut atau kelenjar (L02-Cutaneous abscess, furuncle, and

97 √
sebasea carbuncle)
carbuncle of face)
carbuncle of neck)
carbuncle of trunk)
√
carbuncle of limb)
√
Mampu Ditangani
No (Beri tanda √

98 Impetigo ulseratif (ektima) √
(L08.0-Pyoderma) KMK 514 √
√ (L08.8-Other specified local infections of skin √
(L08.9-Local infection of skin and subcutaneous √

99 Eritrasma √
√ subcutaneous tissue)
(L08.1-Erythrasma) KMK 514 √
Dermatitis atopik (kecuali

100 (L20-Atopic dermatitis) √
recalcitrant)
(L20.0-Besnier prurigo)
(L20.8-Other atopic dermatitis) KMK 514 √
(L20.9-Atopic dermatitis, unspecified) √
101 Dermatitis seboroik (L21-Seborrhoeic dermatitis) √

(L21.0-Seborrhoea capitis) KMK 514 √
√ (L21.1-Seborrhoeic infantile dermatitis) √
(L21.8-Other seborrhoeic dermatitis) √
(L21.9-Seborrhoeic dermatitis, unspecified) √
102 √ Napkin eczema (L22-Diaper [napkin] dermatitis) KMK 514 √
103 Dermatitis kontak iritan (L24-Irritant contact dermatitis) √

(L24.0-Irritant contact dermatitis due to KMK 514 √
detergents)
Mampu Ditangani
No (Beri tanda √
(L24.1-Irritant contact dermatitis due to oils and √
greases)
solvents)
cosmetics)
(L24.4-Irritant contact dermatitis due to drugs in
contact with skin)
chemical products)
contact with skin)
(L24.7-Irritant contact dermatitis due to plants,
except food)
agents)
(L24.9-Irritant contact dermatitis, unspecified
cause)
cosmetics)
dyes)
Mampu Ditangani
No (Beri tanda √
other agents)
(L25.9-Unspecified contact dermatitis,
unspecified cause)
Exanthematous drug eruption, (L27-Dermatitis due to substances taken

104 fixed drug eruption internally)
(L27.0-Generalized skin eruption due to drugs KMK 514
and medicaments)
medicaments)

105 Alergi makanan internally)
(L27.2-Dermatitis due to ingested food) KMK 514
(L27.8-Dermatitis due to other substances taken
internally)
(L27.9-Dermatitis due to unspecified substance
taken internally)
(T78.1-Other adverse food reactions, not
(K52.2-Allergic and dietetic gastroenteritis and
colitis)
106 Dermatitis numularis (L30-Other dermatitis) √

(L30.0-Nummular dermatitis) √
√
(L30.8-Other specified dermatitis) √
(L30.9-Dermatitis, unspecified) √
Mampu Ditangani
No (Beri tanda √
107 Pitiriasis rosea (L42-Pityriasis rosea) √
√
(L30.5-Pityriasis alba) √
108 Urtikaria akut (L50-Urticaria) √

(L50.0-Allergic urticaria) KMK 514 √
(L50.2-Urticaria due to cold and heat) √
(L50.3-Dermatographic urticaria) √
(L50.4-Vibratory urticaria) √
(L50.6-Contact urticaria) √
(L50.9-Urticaria, unspecified) √
(L56.3-Solar urticaria) √
√
(L29-Pruritus) √
(L29.0-Pruritus ani) √
(L29.1-Pruritus scroti) √
(L29.2-Pruritus vulvae) √
(L29.3-Anogenital pruritus, unspecified) √
(L29.8-Other pruritus) √
(L29.9-Pruritus, unspecified) √
(T80.6-Other serum reactions) √
109 Akne vulgaris ringan (L70-Acne) √

(L70.0-Acne vulgaris) KMK 514 √
(L70.5-Acné excoriée des jeunes filles)
(L70.8-Other acne)
(L71-Rosacea)
(L71.1-Rhinophyma)
Mampu Ditangani
No (Beri tanda √
110 Dermatitis perioral (L71-Rosacea)

(L71.0-Perioral dermatitis) KMK 514 √

111 Folikulitis superfisialis tissue)
(L72.8-Other follicular cysts of skin and
(L72.9-Follicular cyst of skin and subcutaneous
(L08.0-Pyoderma) KMK 514
(L08.8-Other specified local infections of skin
(L08.9-Local infection of skin and subcutaneous
112 Hidradenitis supuratif (L73-Other follicular disorders)

(L73.0-Acne keloid)
(L73.2-Hidradenitis suppurativa) KMK 514
Mampu Ditangani
No (Beri tanda √
113 Miliaria (L74-Eccrine sweat disorders)

(L74.3-Miliaria, unspecified) KMK 514 √

114 Ulkus pada tungkai KMK 514 √
classified)
ulcer)
inflammation)
(I83.9-Varicose veins of lower extremities
115 Pielonefritis tanpa komplikasi (N10-Acute tubulo-interstitial nephritis) KMK 514

(N12-Tubulo-interstitial nephritis, not specified
116 Infeksi saluran kemih (N39-Other disorders of urinary system)

specified)
system)
Mampu Ditangani
No (Beri tanda √
(N39.9-Disorder of urinary system, unspecified)

Infeksi saluran kemih bagian

117 (N39-Other disorders of urinary system)
bawah
specified)
system)


118 √ Fimosis KMK 514 √
paraphimosis)

119 √ Parafismosis KMK 514 √
paraphimosis)
120 Mastitis (N61-Inflammatory disorders of breast) KMK 514 √

(O91-Infections of breast associated with √
childbirth)
(O91.0-Infection of nipple associated with √
childbirth)
Mampu Ditangani
No (Beri tanda √
(O91.1-Abscess of breast associated with
childbirth)
(O91.2-Nonpurulent mastitis associated with √
childbirth)
121 Salpingitis (N70-Salpingitis and oophoritis)

(N70.1-Chronic salpingitis and oophoritis)
122 Vaginitis (N76-Other inflammation of vagina and vulva)

and vulva)
123 Vaginosis bakterialis (N76-Other inflammation of vagina and vulva)

and vulva)
(N77-Vulvovaginal ulceration and inflammation


elsewhere)
Mampu Ditangani
No (Beri tanda √
inflammation in other diseases classified
elsewhere)
124 Vulvitis (N76-Other inflammation of vagina and vulva)
(N76.2-Acute vulvitis) √
and vulva)
125 Aborsi spontan komplit (O03-Spontaneous abortion)

(O03.9-Complete or unspecified, without KMK 514 √
complication)
complication)
complication)
complication)
126 Ruptur perineum tingkat 1-2 (O70-Perineal laceration during delivery) √

(O70.0-First degree perineal laceration during KMK 514 √
√ delivery)
(O70.1-Second degree perineal laceration √
during delivery)
Mampu Ditangani
No (Beri tanda √
127 Kehamilan normal (O80-Single spontaneous delivery) √
(O80.0-Spontaneous vertex delivery) √
(O80.8-Other single spontaneous delivery) √
(O80.9-Single spontaneous delivery, KMK 514 √
unspecified)
(O26.8-Other specified pregnancy-related √
conditions)
(O26.9-Pregnancy-related condition,
unspecified)

128 Inverted nipple associated with childbirth)
(O92.0-Retracted nipple associated with
childbirth) KMK 514 √

129 Cracked nipple associated with childbirth)
(O92.1-Cracked nipple associated with √
childbirth)

130 √ Infeksi pada umbilikus KMK 514 √
mild haemorrhage)
131 Epistaksis (R04-Haemorrhage from respiratory passages)
(R04.0-Epistaxis) KMK 514 √
132 Mabuk perjalanan (R11-Nausea and vomiting) √

√
(T75.3-Motion sickness) √
Mampu Ditangani
No (Beri tanda √
Vertigo (Benign paroxysmal

133 (R42-Dizziness and giddiness) KMK 514 √
positional vertigo)
(H81-Disorders of vestibular function) √
(H81.1-Benign paroxysmal vertigo) √
(H81.3-Other peripheral vertigo) √
(H82-Vertiginous syndromes in diseases
134 Kejang demam (R56-Convulsions, not elsewhere classified) √
(R56.0-Febrile convulsions) KMK 514 √

Vulnus laseratum, vulnus (T00-Superficial injuries involving multiple body

135 √
punctum regions)
(T00.0-Superficial injuries involving head with √
neck)
(T00.1-Superficial injuries involving thorax with √

regions of upper limb(s) with lower limb(s))
(T00.8-Superficial injuries involving other √

Mampu Ditangani
No (Beri tanda √
(T00.9-Multiple superficial injuries, unspecified) √
(T14-Injury of unspecified body region) KMK 514

(T14.0-Superficial injury of unspecified body √
region)
(T14.1-Open wound of unspecified body region) √
(T14.8-Other injuries of unspecified body √

region)
(T14.9-Injury, unspecified) √
136 Benda asing di konjungtiva (T15-Foreign body on external eye)

(T15.8- Foreign body in other and multiple parts
of external eye)
(T15.9-Foreign body on external eye, part KMK 514 √
unspecified)
137 Benda asing (T17-Foreign body in respiratory tract)

(T17.1-Foreign body in nostril) KMK 514 √

138 Luka bakar derajat 1 dan 2 unspecified degree)
(T30.1-Burn of first degree, body region KMK 514 √
unspecified)
(T30.2-Burn of second degree, body region √
unspecified)
unspecified degree)
unspecified)
Mampu Ditangani
No (Beri tanda √
(T30.6-Corrosion of second degree, body region
unspecified)
(T21.1-Burn of first degree of trunk) √

(T21.4-Corrosion of unspecified degree of trunk) √
(T22-Burn and corrosion of shoulder and upper

(T22.0-Burn of unspecified degree of shoulder

(T22.1-Burn of first degree of shoulder and √

(T22.2-Burn of second degree of shoulder and
hand)
(T22.5-Corrosion of first degree of shoulder and √

(T22.6-Corrosion of second degree of shoulder √


Mampu Ditangani
No (Beri tanda √
(T23.0-Burn of unspecified degree of wrist and
hand)
(T23.1-Burn of first degree of wrist and hand) √
(T23.2-Burn of second degree of wrist and

hand)
(T23.4-Corrosion of unspecified degree of wrist
and hand)
(T23.5-Corrosion of first degree of wrist and √
hand)
(T23.6-Corrosion of second degree of wrist and
hand)
(T24-Burn and corrosion of hip and lower limb,
(T24.0-Burn of unspecified degree of hip and
(T24.1-Burn of first degree of hip and lower
(T30-Burn and corrosion, body region
unspecified)
(T24.2-Burn of second degree of hip and lower
(T24.4-Corrosion of unspecified degree of hip
(T24.5-Corrosion of first degree of hip and lower √
(T24.6-Corrosion of second degree of hip and
(T25.0-Burn of unspecified degree of ankle and
foot)
Mampu Ditangani
No (Beri tanda √
(T25.1-Burn of first degree of ankle and foot) √
(T25.2-Burn of second degree of ankle and foot)
(T25.4-Corrosion of unspecified degree of ankle

and foot)
(T25.5-Corrosion of first degree of ankle and √
foot)
(T25.6-Corrosion of second degree of ankle and
foot)
(T29-Burns and corrosions of multiple body
regions)
(T29.0-Burns of multiple regions, unspecified
degree)
(T29.4-Corrosions of multiple regions,
unspecified degree)



139 Keracunan makanan eaten as food)
(T62.2-Other ingested(parts of) plant(s)) KMK 514
Mampu Ditangani
No (Beri tanda √
(T62.8-Other specified noxious substances
eaten as food)
(T62.9-Noxious substance eaten as food,
unspecified)
(T61-Toxic effect of noxious substances eaten as
seafood)
(K52-Other noninfective gastroenteritis and
colitis)
(K52.8-Other specified noninfective
unspecified)

140 Reaksi gigitan serangga animals)
(T63.4- Venom of other arthropods) KMK 514 √
141 Reaksi anafilaktik (T78-Adverse effects, not elsewhere classified)
(T78.2-Anaphylactic shock, unspecified) KMK 514 √

(T78.0-Anaphylactic shock due to adverse food
reaction)
(T88.6-Anaphylactic shock due to adverse effect
of correct drug or medicament properly
administered)
Mampu Ditangani
No (Beri tanda √
142 Kekerasan tajam (X99-Assault by sharp object)
(Y28-Contact with sharp object, undetermined

intent)
(Y35.4-Legal intervention involving sharp
objects)
(W22-Striking against or struck by other objects)
(W26.9-Contact with unspecified sharp

object(s))
143 Kekerasan tumpul (Y00-Assault by blunt object)
(Y29-Contact with blunt object, undetermined

intent)
(Y35.3-Legal intervention involving blunt
objects)
(Z21-Asymptomatic human immunodeficiency

144 HIV AIDS tanpa komplikasi KMK 514
virus [HIV] infection status)

(Z11.4-Special screening examination for human
Mampu Ditangani
No (Beri tanda √
(Z71.7-Human immunodeficiency virus [HIV] √
counselling)
RA
IAGNOSA NON SPESIALISTIK
HATAN TINGKAT PERTAMA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
RA
Mampu Ditangani
Tidak
"Other" merupakan organ yang belum pasti, FKTP tidak dapat tuntas melaksanakan di
√ setiap organ
RA
Mampu Ditangani
Tidak
√
√
Obat berkoordinasi dengan Puskesmas
"Other" merupakan kondisi yang belum pasti, FKTP tidak dapat tuntas melaksanakan di
√ setiap kondisi

RA
Mampu Ditangani
Tidak
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
drirujuk dengan TACC
√
RA
Mampu Ditangani
Tidak
RA
Mampu Ditangani
Tidak
√
√
√
√

RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
dengan catatan berdasar lokasi, kedalaman, diameter, dan jumlah
√ multiple
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
RA
Mampu Ditangani
Tidak
hordeolum dengan insisi dapat dirujuk dengan TACC

RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√


√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
dirujuk dengan TACC

RA
Mampu Ditangani
Tidak
√
dirujuk dengan TACC

RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak

RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
2nd -> sampai otot, 3rd-> kena springter

RA
Mampu Ditangani
Tidak
√
√
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
√
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
√
√
√
RA
Mampu Ditangani
Tidak
√
√
√
√
√
√ zat toxic dari hewan yang belum jelas, tidak ada tingkatan kondisi pasien
√
RA
Mampu Ditangani
Tidak
√
RA
Mampu Ditangani
Tidak
REFERENSI DIAGNOSA NO
Diagnosa Non Spesialistik Berdasar SKDI Tahun 2012
No Keterangan
Nama Penyakit ICD X %
1 Demam tifoid (A01-Typhoid and paratyphoid fevers) ###
(A01.0-Typhoid fever) KMK 514 ###
(A01.1-Paratyphoid fever A) ###
(A01.2-Paratyphoid fever B) ###
(A01.3-Paratyphoid fever C) ###
(A01.4-Paratyphoid fever, unspecified) ###
2 Disentri basiler, disentri amuba (A06-Amoebiasis) ###
(A06.0-Acute amoebic dysentery) KMK 514 ###

No Keterangan
(A06.1-Chronic intestinal amoebiasis) ###
(A06.2-Amoebic nondysenteric colitis) ###
(A06.3-Amoeboma of intestine) ###
(A06.7-Cutaneous amoebiasis) ###
(A06.8-Amoebic infection of other sites) ###
(A06.9-Amoebiasis, unspecified) ###
(A03-Shigellosis) ###
(A03.0-Shigellosis due to Shigella dysenteriae) ###
(A03.1-Shigellosis due to Shigella flexneri) ###
(A03.2-Shigellosis due to Shigella boydii) ###

No Keterangan
(A03.3-Shigellosis due to Shigella sonnei) ###
(A03.8-Other shigellosis) ###
(A03.9-Shigellosis, unspecified) ###
3 Gastroenteritis (termasuk kolera, (A09-Other gastroenteritis and colitis of ###

giardiasis) infectious and unspecified origin)
(A09.0-Other and unspecified gastroenteritis KMK 514 ###

(A09.9-Gastroenteritis and colitis of unspecified ###

origin)
(A08-Viral and other specified intestinal ###

infections)
(A08.0-Rotaviral enteritis) ###
(A08.1-Acute gastroenteropathy due to Norwalk ###

agent)
No Keterangan
(A08.2-Adenoviral enteritis) ###
(A08.3-Other viral enteritis) ###
(A08.4-Viral intestinal infection, unspecified) ###
(A08.5-Other specified intestinal infections) ###
(A02-Other salmonella infections) ###
(A02.0-Salmonella enteritis) ###
4 Tuberkulosis paru tanpa (A15-Respiratory tuberculosis, bacteriologically ###

komplikasi and histologically confirmed)
(A15.0-Tuberculosis of lung, confirmed by KMK 514 ###

No Keterangan
(A15.1-Tuberculosis of lung, confirmed by ###

culture only)
(A15.2-Tuberculosis of lung, confirmed ###

histologically)
(A15.3-Tuberculosis of lung, confirmed by ###

unspecified means)

nodes, confirmed bacteriologically and ###
histologically)

bronchus, confirmed bacteriologically and ###
histologically)
(A15.6-Tuberculous pleurisy, confirmed ###

(A15.7-Primary respiratory tuberculosis, ###

(A15.8-Other respiratory tuberculosis, ###

(A15.9-Respiratory tuberculosis unspecified, ###

(A16.1-Tuberculosis of lung, bacteriological and ###

No Keterangan
(A16.2-Tuberculosis of lung, without mention of ###


mention of bacteriological or histological ###
confirmation)

mention of bacteriological or histological ###
confirmation)

without mention of bacteriological or ###
5 Skrofuloderma (A18-Tuberculosis of other organs) ###
(A18.4-Tuberculosis of skin and subcutaneous KMK 514 ###

tissue)
No Keterangan
6 Leptospirosis (tanpa komplikasi) (A27- Leptospirosis) ###
(A27.0-Leptospirosis icterohaemorrhagica) ###
(A27.8-Other forms of leptospirosis) ###
(A27.9-Leptospirosis, unspecified) KMK 514 ###
7 Lepra (A30-Leprosy [Hansen disease]) ###
(A30.0-Indeterminate leprosy) KMK 514 ###
(A30.1-Tuberculoid leprosy) ###

No Keterangan
(A30.2-Borderline tuberculoid leprosy) ###
(A30.3-Borderline leprosy) ###
(A30.4-Borderline lepromatous leprosy) ###
(A30.5-Lepromatous leprosy) ###
(A30.8-Other forms of leprosy) ###
(A30.9-Leprosy, unspecified) ###
(B92-Sequelae of leprosy) ###

No Keterangan
8 Tetanus (A35-Other tetanus) KMK 514 ###
(Y58.4-Tetanus vaccine) ###
(Z11.2-Special screening examination for other ###

bacterial diseases)
(Z23.5-Need for immunization against tetanus ###

alone)
(Z27.1-Need for immunization against ###


diphtheria-tetanus-pertussis with typhoid- ###

diphtheria-tetanus-pertussis with poliomyelitis ###
[DTP + polio])
###
No Keterangan
9 Pertusis (A37-Whooping cough) ###
(A37.0-Whooping cough due to Bordetella ###

pertussis)
(A37.1-Whooping cough due to Bordetella ###

parapertussis)
(A37.8-Whooping cough due to other Bordetella KMK 514 ###

species)
(A37.9-Whooping cough, unspecified) ###
###
10 Erisipelas (A46-Erysipelas) KMK 514 ###
(O86.8-Other specified puerperal infections ) ###
###
11 Sifilis stadium 1 dan 2 (A51-Early syphilis) KMK 514 ###

No Keterangan
(A51.3-Secondary syphilis of skin and mucous ###

membranes)
(A53-Other and unspecified syphilis) ###
(A53.0-Latent syphilis, unspecified as early or ###

late)
(A53.9-Syphilis, unspecified) KMK 514 ###
(A65-Nonvenereal syphilis) ###
###
12 Sindrom duh (discharge) genital (A54-Gonococcal infection) ###


genitourinary tract without periurethral or ###
(A54.3-Gonococcal infection of eye) ###
(A54.5-Gonococcal pharyngitis) ###

No Keterangan
(A54.6-Gonococcal infection of anus and ###

rectum)
(A54.8-Other gonococcal infections) ###
(A54.9-Gonococcal infection, unspecified) KMK 514 ###
(A56-Other sexually transmitted chlamydial ###

diseases)
(A56.0-Chlamydial infection of lower ###

(A56.2-Chlamydial infection of genitourinary ###

tract, unspecified)
(A56.8-Sexually transmitted chlamydial infection ###

of other sites)
(A64-Unspecified sexually transmitted disease) ###
13 Gonore (A54-Gonococcal infection) ###

No Keterangan

genitourinary tract without periurethral or ###
(A54.3-Gonococcal infection of eye) ###
(A54.5-Gonococcal pharyngitis) ###
(A54.6-Gonococcal infection of anus and ###

rectum)
(A54.8-Other gonococcal infections) ###
(A54.9-Gonococcal infection, unspecified) KMK 514 ###
(A64-Unspecified sexually transmitted disease) ###
14 Demam dengue, DHF (A90-Dengue fever [classical dengue]) ###
(A91-Dengue haemorrhagic fever) KMK 514 ###

No Keterangan
###
15 Herpes simpleks tanpa komplikasi (B00-Herpesviral [herpes simplex] infections) ###
(B00.8-Other forms of herpesviral infection) ###
(B00.9-Herpesviral infection, unspecified) KMK 514 ###
###
16 Varisela tanpa komplikasi (B01-Varicella [chickenpox]) ###
(B01.9-Varicella without complication) KMK 514 ###
###
17 Herpes zoster tanpa komplikasi (B02-Zoster [herpes zoster]) ###
(B02.9-Zoster without complication) KMK 514 ###

No Keterangan
###
18 Morbili tanpa komplikasi (B05-Measles) ###
(B05.9-Measles without complication) KMK 514 ###
19 Veruka vulgaris (B07-Viral warts) KMK 514 ###
(B08-Other viral infections characterized by skin

20 Moluskum kontagiosum and mucous membrane lesions, not elsewhere ###
classified)
(B08.1-Molluscum contagiosum) KMK 514 ###
###
No Keterangan
21 Hepatitis A (B15-Acute hepatitis A) KMK 514 ###
(B15.9-Hepatitis A without hepatic coma) ###
22 Parotitis (B26-Mumps) ###
(B26.9-Mumps without complication) ###
23 Tinea kapitis (B35-Dermatophytosis) KMK 514 ###
(B35.0- Tinea barbae and tinea capitis) KMK 514 ###

No Keterangan
24 Tinea barbe (B35-Dermatophytosis) ###
(B35.0- Tinea barbae and tinea capitis) KMK 514 ###
25 Tinea unguium (B35-Dermatophytosis) ###
(B35.1- Tinea unguium) KMK 514 ###
26 Tinea manus (B35-Dermatophytosis) ###
(B35.2-Tinea manuum) KMK 514 ###

No Keterangan
27 Tinea pedis (B35-Dermatophytosis) ###
(B35.3- Tinea pedis) KMK 514 ###
28 Tinea korporis (B35-Dermatophytosis) ###
(B35.4-Tinea corporis) KMK 514 ###
(B35.5-Tinea imbricata) ###
29 Tinea kruris (B35-Dermatophytosis) ###
(B35.6-Tinea cruris) KMK 514 ###
###
No Keterangan
30 Tinea fasialis (B35-Dermatophytosis) ###
(B35.8-Other dermatophytoses) KMK 514 ###
(B35.9-Dermatophytosis, unspecified) ###
###
31 Pitiriasis versikolor (B36-Other superficial mycoses) ###
(B36.0-Pityriasis versicolor) KMK 514 ###
(B36.1-Tinea nigra) ###
(B36.2-White piedra) ###
(B36.3-Black piedra) ###
(B36.8-Other specified superficial mycoses) ###

No Keterangan
(B36.9-Superficial mycosis, unspecified) ###
32 Kandidosis mukokutan ringan (B37-Candidal stomatitis) ###
(B37.2-Candidiasis of skin and nail) ###
(B37.8-Candidiasis of other sites) ###
(B37.9-Candidiasis, unspecified) KMK 514 ###
33 Kandidiasis mulut (B37-Candidiasis) ###
(B37.0-Candidal stomatitis) ###
(B37.9-Candidiasis, unspecified) KMK 514 ###

No Keterangan
34 Skistosomiasis (B65-Schistosomiasis [bilharziasis]) ###
(B65.0-Schistosomiasis due to Schistosoma KMK 514 ###

(B65.1-Schistosomiasis due to Schistosoma ###

mansoni [intestinal schistosomiasis])
(B65.2-Schistosomiasis due to Schistosoma ###

japonicum)
(B65.3-Cercarial dermatitis) ###
(B65.8-Other schistosomiases) ###
(B65.9-Schistosomiasis, unspecified) ###
35 Taeniasis (B68-Taeniasis) ###

No Keterangan
(B68.0-Taenia solium taeniasis) ###
(B68.1-Taenia saginata taeniasis) ###
(B68.9-Taeniasis, unspecified) KMK 514 ###
36 Filariasis (B74-Filariasis) ###
(B74.0-Filariasis due to Wuchereria bancrofti) KMK 514 ###
(B74.1-Filariasis due to Brugia malayi) ###
(B74.2-Filariasis due to Brugia timori) ###
(B74.3-Loiasis) ###
No Keterangan
(B74.4-Mansonelliasis) ###
(B74.8-Other filariases) ###
(B74.9-Filariasis, unspecified) ###
(Z11.6-Special screening examination for other ###

37 Penyakit cacing tambang (B76-Hookworm diseases) ###
(B76.0-Ancylostomiasis) KMK 514 ###
(B76.1-Necatoriasis) ###
(B76.8-Other hookworm diseases) ###
(B76.9-Hookworm disease, unspecified) ###

No Keterangan
38 Cutaneus larva migran (B76-Hookworm diseases) ###
(B76.0-Ancylostomiasis) ###
(B76.1-Necatoriasis) ###
(B76.8-Other hookworm diseases) ###
(B76.9-Hookworm disease, unspecified) KMK 514 ###
(B87.0-Cutaneous myiasis) ###
(B87.9-Myiasis, unspecified) ###
39 Askariasis (B77-Ascariasis) KMK 514 ###

No Keterangan
(B77.9-Ascariasis, unspecified) ###
(K93.8-Disorders of other specified digestive ###

40 Strongiloidiasis (B78-Strongyloidiasis) KMK 514 ###
(B78.0-Intestinal strongyloidiasis) ###
(B78.1-Cutaneous strongyloidiasis) ###
(B78.7-Disseminated strongyloidiasis) ###
(B78.9-Strongyloidiasis, unspecified) ###
41 Malaria (B85.3-Phthiriasis) ###

No Keterangan
(B50-Plasmodium falciparum malaria) ###
(B50.9-Plasmodium falciparum malaria, ###

unspecified)
(B51-Plasmodium vivax malaria) ###
(B51.8-Plasmodium vivax malaria with other ###

complications)
(B51.9-Plasmodium vivax malaria without ###

complication)
(B52-Plasmodium malariae malaria) ###
(B52.8-Plasmodium malariae malaria with other ###

complications)
(B52.9-Plasmodium malariae malaria without ###

complication)
(B53-Other parasitologically confirmed malaria) ###
(B53.0-Plasmodium ovale malaria) ###

No Keterangan
(B53.1-Malaria due to simian plasmodia) ###
(B53.8-Other parasitologically confirmed ###

(B54-Unspecified malaria) KMK 514 ###
42 Pedikulosis pubis (B85-Pediculosis and phthiriasis) ###
(B85.0- Pediculosis due to Pediculus humanus ###

capitis)
43 Pedikulosis kapitis (B85-Pediculosis and phthiriasis) ###
(B85.0- Pediculosis due to Pediculus humanus KMK 514 ###

capitis)
(B85.1- Pediculosis due to Pediculus humanus ###

corporis)
No Keterangan
(B85.4- Mixed pediculosis and phthiriasis) ###
44 Skabies (B86-Scabies) KMK 514 ###
45 Lipoma (D17-Benign lipomatous neoplasm) ###
(D17.0-Benign lipomatous neoplasm of skin and ###




subcutaneous tissue of other and unspecified ###
sites)
(D17.7-Benign lipomatous neoplasm of other ###

sites)
No Keterangan
(D17.9-Benign lipomatous neoplasm, KMK 514 ###

unspecified)
46 Anemia defisiensi besi (D50-Iron deficiency anaemia) ###
(D50.8-Other iron deficiency anaemias) ###
(D50.9-Iron deficiency anaemia, unspecified) KMK 514 ###
(D64-Other anaemias) ###
(D64.8-Other specified anaemias) ###
(D64.9-Anaemia, unspecified) ###
47 Anemia defisiensi besi pada (D50-Iron deficiency anaemia) ###

kehamilan
No Keterangan
(D50.8-Other iron deficiency anaemias) ###
(D50.9-Iron deficiency anaemia, unspecified) KMK 514 ###
(O99.0-Anaemia complicating pregnancy, ###

48 Diabetes melitus tipe 1 (E10-Insulin-dependent diabetes mellitus) ###
(E10.9-Insulin-dependent diabetes mellitus ###

49 Diabetes melitus tipe 2 (E11-Non-insulin-dependent diabetes mellitus) ###
(E11.9-Non-insulin-dependent diabetes mellitus KMK 514 ###

No Keterangan

50 Hipoglikemia ringan ###
secretion)
(E16.1-Other hypoglycaemia) ###
(E16.2-Hypoglycaemia, unspecified) KMK 514 ###
51 Malnutrisi energi-protein (E40-Kwashiorkor) ###
(E41-Nutritional marasmus) ###
(E42-Marasmic kwashiorkor) ###
(E44-Protein-energy malnutrition of moderate ###

and mild degree)
(E44.0-Moderate protein-energy malnutrition) ###
(E44.1-Mild protein-energy malnutrition) ###

No Keterangan
(E46-Unspecified protein-energy malnutrition) KMK 514 ###
(E64.0-Sequelae of protein-energy malnutrition) ###
52 Defisiensi vitamin (E50-Vitamin A deficiency) ###
(E50.0-Vitamin A deficiency with conjunctival ###

xerosis)
(E50.1-Vitamin A deficiency with Bitot spot and ###

(E50.2-Vitamin A deficiency with corneal ###

xerosis)
(E50.3-Vitamin A deficiency with corneal ###

(E50.4-Vitamin A deficiency with keratomalacia) ###
(E50.5-Vitamin A deficiency with night ###

blindness)
No Keterangan
(E50.6-Vitamin A deficiency with xerophthalmic ###

scars of cornea)
(E50.7-Other ocular manifestations of vitamin A ###

deficiency)
(E50.8-Other manifestations of vitamin A ###

deficiency)
(E50.9-Vitamin A deficiency, unspecified) ###
(E51-Thiamine deficiency) ###
(E51.1-Beriberi) ###
(E51.8-Other manifestations of thiamine ###

deficiency)
(E51.9-Thiamine deficiency, unspecified) ###
(E52-Niacin deficiency [pellagra]) ###
(E53-Deficiency of other B group vitamins) ###

No Keterangan
(E53.0-Riboflavin deficiency) ###
(E53.1-Pyridoxine deficiency) ###
(E53.8-Deficiency of other specified B group ###

vitamins)
(E53.9-Vitamin B deficiency, unspecified) ###
(E54-Ascorbic acid deficiency) ###
(E55-Vitamin D deficiency) ###
(E55.0-Rickets, active) ###
(E55.9-Vitamin D deficiency, unspecified) ###
(E56-Other vitamin deficiencies) ###
(E56.0-Deficiency of vitamin E) ###

No Keterangan
(E56.1-Deficiency of vitamin K) ###
(E56.8-Deficiency of other vitamins) ###
(E56.9-Vitamin deficiency, unspecified) ###
(E64-Sequelae of malnutrition and other ###

(E64.1-Sequelae of vitamin A deficiency) ###
(E64.2-Sequelae of vitamin C deficiency) ###
(E64.3-Sequelae of rickets) ###
(E64.8-Sequelae of other nutritional ###

deficiencies)
(E64.9-Sequelae of unspecified nutritional ###

deficiency)
No Keterangan
53 Defisiensi mineral (E58-Dietary calcium deficiency) ###
(E59-Dietary selenium deficiency) ###
(E60-Dietary zinc deficiency) ###
(E61-Deficiency of other nutrient elements) ###
(E61.0-Copper deficiency) ###
(E61.1-Iron deficiency) ###
(E61.2-Magnesium deficiency) ###
(E61.3-Manganese deficiency) ###
(E61.4-Chromium deficiency) ###
(E61.5-Molybdenum deficiency) ###

No Keterangan
(E61.6-Vanadium deficiency) ###
(E61.7-Deficiency of multiple nutrient elements) ###
(E61.8-Deficiency of other specified nutrient ###

elements)
(E61.9-Deficiency of nutrient element, ###

unspecified)
(E63-Other nutritional deficiencies) ###
(E63.0-Essential fatty acid [EFA] deficiency) ###
(E63.1-Imbalance of constituents of food intake) ###
(E63.8-Other specified nutritional deficiencies) ###
(E63.9-Nutritional deficiency, unspecified) ###

No Keterangan
54 Obesitas (E66-Obesity) ###
(E66.0-Obesity due to excess calories) ###
(E66.1-Drug-induced obesity) ###
(E66.8-Other obesity) ###
(E66.9-Obesity, unspecified) KMK 514 ###

55 Dislipidemia ###
other lipidaemias)
(E78.0-Pure hypercholesterolaemia) ###
(E78.1-Pure hyperglyceridaemia) ###
(E78.2-Mixed hyperlipidaemia) ###

No Keterangan
(E78.3-Hyperchylomicronaemia) ###
(E78.4-Other hyperlipidaemia) ###
(E78.5-Hyperlipidaemia, unspecified) KMK 514 ###
(E78.6-Lipoprotein deficiency) ###
(E78.8-Other disorders of lipoprotein ###

metabolism)
(E78.9-Disorder of lipoprotein metabolism, ###

unspecified)

56 Hiperurisemia ###
metabolism)

inflammatory arthritis and tophaceous disease) KMK 514 ###
(E79.1-Lesch-Nyhan syndrome) ###

No Keterangan
(E79.8-Other disorders of purine and pyrimidine ###

metabolism)
(E79.9-Disorder of purine and pyrimidine ###

57 Gangguan somatoform (F45-Somatoform disorders) ###
(F45.0-Somatization disorder) KMK 514 ###
(F45.1-Undifferentiated somatoform disorder) ###
(F45.2-Hypochondriacal disorder) ###
(F45.3-Somatoform autonomic dysfunction) ###
(F45.4-Persistent somatoform pain disorder) ###
(F45.8-Other somatoform disorders) ###

No Keterangan
(F45.9-Somatoform disorder, unspecified) ###
58 Insomnia (F51-Nonorganic sleep disorders) ###
(F51.0-Nonorganic insomnia) KMK 514 ###
(F51.2-Nonorganic disorder of the sleep-wake ###

schedule)
(F51.8-Other nonorganic sleep disorders) ###
(G47.0-Disorders of initiating and maintaining ###

sleep [insomnias])
59 Migren (G43-Migraine) ###
(G43.0-Migraine without aura [common ###

migraine])
No Keterangan
(G43.1-Migraine with aura [classical migraine]) ###
(G43.2-Status migrainosus) ###
(G43.8-Other migraine) ###
(G43.9-Migraine, unspecified) KMK 514 ###
(N94.3-Premenstrual tension syndrome) ###
60 Tension headache (G44-Other Headache Syndromes) ###
(G44.1-Vascular headache, not elsewhere ###

classified)
(G44.2-Tension-type headache) KMK 514 ###
(G44.3-Chronic post-traumatic headache) ###

No Keterangan
(G44.4-Drug-induced headache, not elsewhere ###

classified)
(G44.8-Other specified headache syndromes) ###
(R51-Headache) ###
###
61 Bells' palsy (G51-Facial nerve disorders) ###
(G51.0-Bell's palsy) KMK 514 ###
62 Hordeolum (H00-Hordeolum and chalazion) ###
(H00.0-Hordeolum and other deep KMK 514 ###

No Keterangan
63 Blefaritis (H01-Other inflammation of eyelid) ###
(H01.0-Blepharitis) KMK 514 ###
64 Trikiasis (H02-Other disorders of eyelid) ###
(H02.0-Entropion and trichiasis of eyelid) KMK 514 ###
65 Mata kering (H04-Disorders of lacrimal system) ###
(H04.1-Other disorders of lacrimal gland) KMK 514 ###

No Keterangan
66 Konjungtivitis (H10-Conjunctivitis) ###
(H10.0-Mucopurulent conjunctivitis) ###
(H10.1-Acute atopic conjunctivitis) KMK 514 ###
(H10.2-Other acute conjunctivitis) ###
(H10.3-Acute conjunctivitis, unspecified) ###
(H10.4-Chronic conjunctivitis) ###
(H10.5-Blepharoconjunctivitis) ###
(H10.8-Other conjunctivitis) ###
(H10.9-Conjunctivitis, unspecified) ###
(B30-Viral conjunctivitis) ###

No Keterangan
(B30.1-Conjunctivitis due to adenovirus ) ###
(B30.2-Viral pharyngoconjunctivitis) ###
(B30.8-Other viral conjunctivitis ) ###
(B30.9-Viral conjunctivitis, unspecified) ###
(H13.1-Conjunctivitis in infectious and parasitic ###

67 Perdarahan subkonjungtiva (H11-Other disorders of conjunctiva) ###
(H11.3-Conjunctival haemorrhage) ###
(H57-Other disorders of eye and adnexa) ###
(H57.8-Other specified disorders of eye and KMK 514 ###

adnexa)
No Keterangan
(H57.9-Disorder of eye and adnexa, unspecified) ###
68 Episkleritis (H15-Disorders of sclera) ###
(H15.1-Episcleritis) KMK 514 ###

69 Hipermetropia ringan ###
accommodation)
(H52.0-Hypermetropia) KMK 514 ###

70 Miopia ringan ###
accommodation)
(H52.1-Myopia) KMK 514 ###

No Keterangan

71 Astigmatism ringan ###
accommodation)
(H52.2-Astigmatism) KMK 514 ###

72 Presbiopia ###
accommodation)
(H52.4-Presbyopia) KMK 514 ###
73 Buta senja (H53-Visual disturbances) ###
(H53.6-Night blindness) KMK 514 ###

No Keterangan
74 Otitis eksterna (H60-Otitis externa) ###
(H60.0-Abscess of external ear) ###
(H60.3-Other infective otitis externa) ###
(H60.5-Acute otitis externa, noninfective) ###
(H60.8-Other otitis externa) ###
(H60.9-Otitis externa, unspecified) KMK 514 ###
(H62-Disorders of external ear in diseases ###

(H62.0-Otitis externa in bacterial diseases ###

(H62.1-Otitis externa in viral diseases classified ###

elsewhere)
(H62.2-Otitis externa in mycoses) ###

No Keterangan
(H62.3-Otitis externa in other infectious and ###

(H62.4-Otitis externa in other diseases classified ###

elsewhere)
(H62.8-Other disorders of external ear in ###

75 Serumen prop (H61-Other disorders of external ear) ###
(H61.2-Impacted cerumen) KMK 514 ###
76 Otitis media akut (H65-Nonsuppurative otitis media) ###
(H65.1-Other acute nonsuppurative otitis KMK 514 ###

media)
(H65.9-Nonsuppurative otitis media, ###

unspecified)
No Keterangan
(H66-Suppurative and unspecified otitis media) ###
(H66.0-Acute suppurative otitis media) KMK 514 ###
(H66.4-Suppurative otitis media, unspecified) ###
(H66.9-Otitis media, unspecified) ###
(H67-Otitis media in diseases classified ###

elsewhere)
(H67.0-Otitis media in bacterial diseases ###

(H67.1-Otitis media in viral diseases classified ###

elsewhere)
(H67.8-Otitis media in other diseases classified ###

elsewhere)
77 Hipertensi esensial (I10-Essential(primary) hypertension) KMK 514 ###

No Keterangan
78 Hemoroid grade 1-2 (I84-Haemorrhoids) ###
(I84.2-Internal haemorrhoids without ###

complication)
(I84.5-External haemorrhoids without ###

complication)
(I84.9-Unspecified haemorrhoids without ###

complication)
79 Limfadenitis (I88-Nonspecific lymphadenitis) ###
(I88.0-Nonspecific mesenteric lymphadenitis) ###
(I88.1-Chronic lymphadenitis, except ###

mesenteric)
(I88.8-Other nonspecific lymphadenitis) ###

No Keterangan
(I88.9-Nonspecific lymphadenitis, unspecified) ###
(L04-Acute lymphadenitis) ###
(L04.0-Acute lymphadenitis of face, head and ###

neck)
(L04.1-Acute lymphadenitis of trunk) ###
(L04.2-Acute lymphadenitis of upper limb) ###
(L04.3-Acute lymphadenitis of lower limb) ###
(L04.8-Acute lymphadenitis of other sites) ###
(L04.9-Acute lymphadenitis, unspecified) KMK 514 ###
80 Rhinitis akut (J00-Acute nasopharyngitis [common cold]) KMK 514 ###

No Keterangan
81 Faringitis (J02-Acute pharyngitis) KMK 514 ###
(J02.0-Streptococcal pharyngitis) ###
(J02.8-Acute pharyngitis due to other specified ###

organisms)
(J02.9-Acute pharyngitis, unspecified) ###
(J31-Chronic rhinitis, nasopharyngitis and ###

pharyngitis)
(J31.1-Chronic nasopharyngitis) ###
(J31.2-Chronic pharyngitis) ###
82 Tonsilitis (J03-Acute tonsillitis) KMK 514 ###

No Keterangan
(J03.0-Streptococcal tonsillitis) ###
(J03.8-Acute tonsillitis due to other specified ###

organisms)
(J03.9-Acute tonsillitis, unspecified) ###
(J35-Chronic diseases of tonsils and adenoids) ###
(J35.0-Chronic tonsillitis) ###
(J35.1-Hypertrophy of tonsils) ###
(J35.8-Other chronic diseases of tonsils and ###

adenoids)
(J35.9-Chronic disease of tonsils and adenoids, ###

unspecified)
83 Laringitis (J04-Acute laryngitis and tracheitis) KMK 514 ###

No Keterangan
(J04.0-Acute laryngitis) ###
(J37-Chronic laryngitis and laryngotracheitis) ###
(J37.0-Chronic laryngitis) ###

84 Influenza ###
virus)
(J10.0-Influenza with pneumonia, other KMK 514 ###

(J10.1-Influenza with other respiratory ###

(J10.8-Influenza with other manifestations, ###

(J11-Influenza, virus not identified) ###
(J11.0-Influenza with pneumonia, virus not ###

identified)
No Keterangan
(J11.1-Influenza with other respiratory ###

(J11.8-Influenza with other manifestations, virus ###

not identified)
(A49.2-Haemophilus influenzae infection, ###

unspecified site)
85 Pneumonia, bronkopneumonia (J12-Viral pneumonia, not elsewhere classified) ###
(J12.0-Adenoviral pneumonia) ###
(J12.1-Respiratory syncytial virus pneumonia) ###
(J12.2-Parainfluenza virus pneumonia) ###
(J12.3-Human metapneumovirus pneumonia) ###
(J12.8-Other viral pneumonia) ###

No Keterangan
(J12.9-Viral pneumonia, unspecified) ###
(J13-Pneumonia due to Streptococcus ###

pneumoniae)
(J14-Pneumonia due to Haemophilus ###

influenzae)
(J15-Bacterial pneumonia, not elsewhere ###

classified)
(J15.0-Pneumonia due to Klebsiella ###

pneumoniae)
(J15.1-Pneumonia due to Pseudomonas) ###
(J15.2-Pneumonia due to staphylococcus) ###
(J15.3-Pneumonia due to streptococcus, group ###

B)
(J15.4-Pneumonia due to other streptococci) ###
(J15.5-Pneumonia due to Escherichia coli) ###

No Keterangan
(J15.6-Pneumonia due to other aerobic Gram- ###

negative bacteria)
(J15.7-Pneumonia due to Mycoplasma ###

pneumoniae)
(J15.8-Other bacterial pneumonia) ###
(J15.9-Bacterial pneumonia, unspecified) ###
(J16-Pneumonia due to other infectious ###

(J16.0-Chlamydial pneumonia) ###
(J16.8-Pneumonia due to other specified ###

(J17-Pneumonia in diseases classified ###

elsewhere)
(J17.0-Pneumonia in bacterial diseases classified ###

elsewhere)
(J17.1-Pneumonia in viral diseases classified ###

elsewhere)
No Keterangan
(J17.2-Pneumonia in mycoses) ###
(J17.3-Pneumonia in parasitic diseases) ###
(J17.8-Pneumonia in other diseases classified ###

elsewhere)
(J18-Pneumonia, organism unspecified) ###
(J18.0-Bronchopneumonia, unspecified) KMK 514 ###
(J18.1-Lobar pneumonia, unspecified) ###
(J18.2-Hypostatic pneumonia, unspecified) ###
(J18.8-Other pneumonia, organism unspecified) ###
(J18.9-Pneumonia, unspecified) ###

No Keterangan
86 Bronkitis akut (J20-Acute bronchitis) ###
(J20.0-Acute bronchitis due to Mycoplasma ###

pneumoniae)
(J20.1-Acute bronchitis due to Haemophilus ###

influenzae)
(J20.2-Acute bronchitis due to streptococcus) ###
(J20.3-Acute bronchitis due to coxsackievirus) ###
(J20.4-Acute bronchitis due to parainfluenza ###

virus)
(J20.5-Acute bronchitis due to respiratory ###

syncytial virus)
(J20.6-Acute bronchitis due to rhinovirus) ###
(J20.7-Acute bronchitis due to echovirus) ###
(J20.8-Acute bronchitis due to other specified ###

organisms)
No Keterangan
(J20.9-Acute bronchitis, unspecified) KMK 514 ###
(J40-Bronchitis, not specified as acute or ###

chronic)
(J41-Simple and mucopurulent chronic ###

bronchitis)
(J41.0-Simple chronic bronchitis) ###
(J41.1-Mucopurulent chronic bronchitis) ###
(J41.8-Mixed simple and mucopurulent chronic ###

bronchitis)
(J42-Unspecified chronic bronchitis) ###
87 Rhinitis vasomotor (J30-Vasomotor and allergic rhinitis) KMK 514 ###
(J30.1-Vasomotor rhinitis) ###

No Keterangan
88 Rhinitis alergika (J30-Vasomotor and allergic rhinitis) ###
(J30.2-Allergic rhinitis due to pollen) ###
(J30.3-Other seasonal allergic rhinitis) ###
(J30.4- Other allergic rhinitis) KMK 514 ###
(J30.5-Allergic rhinitis, unspecified) ###
(J45.0-Predominantly allergic asthma) ###
89 Furunkel pada hidung (J34-Other disorders of nose and nasal sinuses) ###
(J34.0-Abscess, furuncle and carbuncle of nose) KMK 514 ###

No Keterangan
90 Asma bronkial (J45-Asthma) ###
(J45.0-Predominantly allergic asthma) ###
(J45.1-Nonallergic asthma) ###
(J45.8-Mixed asthma) ###
(J45.9-Asthma, unspecified) KMK 514 ###
91 Ulkus mulut (aptosa, herpes) (K12-Stomatitis and related lesions) KMK 514 ###
(K12.0-Recurrent oral aphthae) ###
(K12.1-Other forms of stomatitis) ###

No Keterangan
(K12.2-Cellulitis and abscess of mouth) ###
(K12.3-Oral mucositis(ulcerative)) ###
92 Refluks gastroesofagus (K21-Gastro-oesophageal reflux disease) ###
(K21.9-Gastro-oesophageal reflux disease KMK 514 ###

93 Gastritis (K29-Gastritis and duodenitis) ###
(K29.1-Other acute gastritis) ###
(K29.2-Alcoholic gastritis) ###
(K29.5-Chronic gastritis, unspecified) ###

No Keterangan
(K29.6-Other gastritis) ###
(K29.7-Gastritis, unspecified) KMK 514 ###
(K30-Functional dyspepsia) ###
(R10.1-Pain localized to upper abdomen) ###
94 Intoleransi makanan (K90-Intestinal malabsorption) ###
(K90.4-Malabsorption due to intolerance, not KMK 514 ###

95 Impetigo (L01-Impetigo) ###
(L01.0-Impetigo [any organism] [any site]) KMK 514 ###

No Keterangan
(L01.1-Impetiginization of other dermatoses) ###

96 Furunkel, karbunkel ###
carbuncle)
(L02.0-Cutaneous abscess, furuncle and KMK 514 ###

carbuncle of face)
(L02.1-Cutaneous abscess, furuncle and ###

carbuncle of neck)

carbuncle of trunk)


carbuncle of limb)


No Keterangan
(H04.0-Dacryoadenitis ) ###
(H60.0-Abscess of external ear ) ###
(H04.3-Acute and unspecified inflammation of ###

lacrimal passages )
(N76.4-Abscess of vulva) ###
(N48.2- Other inflammatory disorders of penis) ###
(N49.2-Inflammatory disorders of scrotum) ###
(N49.8-Inflammatory disorders of other ###

(N49.9-Inflammatory disorder of unspecified ###

male genital organ)
(N61-Inflammatory disorders of breast) ###

No Keterangan
97 Abses folikel rambut atau kelenjar (L02-Cutaneous abscess, furuncle, and ###
sebasea carbuncle)

carbuncle of face)

carbuncle of neck)
(L02.2-Cutaneous abscess, furuncle and KMK 514 ###

carbuncle of trunk)


carbuncle of limb)



98 Impetigo ulseratif (ektima) ###
No Keterangan
(L08.0-Pyoderma) KMK 514 ###
(L08.8-Other specified local infections of skin ###

(L08.9-Local infection of skin and subcutaneous ###


99 Eritrasma ###
(L08.1-Erythrasma) KMK 514 ###
100 Dermatitis atopik (kecuali (L20-Atopic dermatitis) ###

recalcitrant)
(L20.0-Besnier prurigo) ###
(L20.8-Other atopic dermatitis) KMK 514 ###

No Keterangan
(L20.9-Atopic dermatitis, unspecified) ###
101 Dermatitis seboroik (L21-Seborrhoeic dermatitis) ###
(L21.0-Seborrhoea capitis) KMK 514 ###
(L21.1-Seborrhoeic infantile dermatitis) ###
(L21.8-Other seborrhoeic dermatitis) ###
(L21.9-Seborrhoeic dermatitis, unspecified) ###
102 Napkin eczema (L22-Diaper [napkin] dermatitis) KMK 514 ###

No Keterangan
103 Dermatitis kontak iritan (L24-Irritant contact dermatitis) ###
(L24.0-Irritant contact dermatitis due to KMK 514 ###

detergents)
(L24.1-Irritant contact dermatitis due to oils and ###

greases)
(L24.2-Irritant contact dermatitis due to ###

solvents)
(L24.3-Irritant contact dermatitis due to ###

cosmetics)
(L24.4-Irritant contact dermatitis due to drugs in ###

contact with skin)
(L24.5-Irritant contact dermatitis due to other ###

chemical products)
(L24.6-Irritant contact dermatitis due to food in ###

contact with skin)
(L24.7-Irritant contact dermatitis due to plants, ###

except food)
(L24.8-Irritant contact dermatitis due to other ###

agents)
No Keterangan
(L24.9-Irritant contact dermatitis, unspecified ###

cause)
(L25-Unspecified contact dermatitis) ###
(L25.0-Unspecified contact dermatitis due to ###

cosmetics)


dyes)




other agents)
(L25.9-Unspecified contact dermatitis, ###

unspecified cause)
No Keterangan
104 Exanthematous drug eruption, (L27-Dermatitis due to substances taken ###

fixed drug eruption internally)
(L27.0-Generalized skin eruption due to drugs KMK 514 ###

and medicaments)
(L27.1-Localized skin eruption due to drugs and ###

medicaments)
(R21-Rash and other nonspecific skin eruption) ###

105 Alergi makanan ###
internally)
(L27.2-Dermatitis due to ingested food) KMK 514 ###
(L27.8-Dermatitis due to other substances taken ###

internally)
(L27.9-Dermatitis due to unspecified substance ###

taken internally)
No Keterangan
(T78.1-Other adverse food reactions, not ###

(T78.4-Allergy, unspecified) ###
(K52.2-Allergic and dietetic gastroenteritis and ###

colitis)
106 Dermatitis numularis (L30-Other dermatitis) ###
(L30.0-Nummular dermatitis) ###
(L30.8-Other specified dermatitis) ###
(L30.9-Dermatitis, unspecified) ###
107 Pitiriasis rosea (L42-Pityriasis rosea) ###

No Keterangan
(L30.5-Pityriasis alba) ###
108 Urtikaria akut (L50-Urticaria) ###
(L50.0-Allergic urticaria) KMK 514 ###
(L50.2-Urticaria due to cold and heat) ###
(L50.3-Dermatographic urticaria) ###
(L50.4-Vibratory urticaria) ###
(L50.6-Contact urticaria) ###
(L50.9-Urticaria, unspecified) ###
(L56.3-Solar urticaria) ###

No Keterangan
(L29-Pruritus) ###
(L29.0-Pruritus ani) ###
(L29.1-Pruritus scroti) ###
(L29.2-Pruritus vulvae) ###
(L29.3-Anogenital pruritus, unspecified) ###
(L29.8-Other pruritus) ###
(L29.9-Pruritus, unspecified) ###
(T80.6-Other serum reactions) ###
109 Akne vulgaris ringan (L70-Acne) ###

No Keterangan
(L70.0-Acne vulgaris) KMK 514 ###
(L70.1-Acne conglobata) ###
(L70.2-Acne varioliformis) ###
(L70.3-Acne tropica) ###
(L70.4-Infantile acne) ###
(L70.5-Acné excoriée des jeunes filles) ###
(L70.8-Other acne) ###
(L70.9-Acne, unspecified) ###
(L71-Rosacea) ###
(L71.1-Rhinophyma) ###
No Keterangan
(L71.8-Other rosacea) ###
(L71.9-Rosacea, unspecified) ###
110 Dermatitis perioral (L71-Rosacea) ###
(L71.0-Perioral dermatitis) KMK 514 ###

111 Folikulitis superfisialis ###
tissue)
(L72.0-Epidermal cyst) ###
(L72.1-Trichilemmal cyst) ###
(L72.2-Steatocystoma multiplex) ###

No Keterangan
(L72.8-Other follicular cysts of skin and ###

(L72.9-Follicular cyst of skin and subcutaneous ###

(L08-Other local infections of skin and ###

(L08.0-Pyoderma) KMK 514 ###
(L08.8-Other specified local infections of skin ###

(L08.9-Local infection of skin and subcutaneous ###

(L66.2-Folliculitis decalvans ) ###
(L66.3-Perifolliculitis capitis abscedens ) ###
(L66.4-Folliculitis ulerythematosa reticulata) ###

No Keterangan
112 Hidradenitis supuratif (L73-Other follicular disorders) ###
(L73.0-Acne keloid) ###
(L73.1-Pseudofolliculitis barbae) ###
(L73.2-Hidradenitis suppurativa) KMK 514 ###
(L73.8-Other specified follicular disorders) ###
(L73.9-Follicular disorder, unspecified) ###
113 Miliaria (L74-Eccrine sweat disorders) ###
(L74.0-Miliaria rubra) ###
(L74.1-Miliaria crystallina) ###

No Keterangan
(L74.2-Miliaria profunda) ###
(L74.3-Miliaria, unspecified) KMK 514 ###
(L74.8-Other eccrine sweat disorders) ###
(L74.9-Eccrine sweat disorder, unspecified) ###

114 Ulkus pada tungkai KMK 514 ###
classified)
(I83-Varicose veins of lower extremities) ###
(I83.0-Varicose veins of lower extremities with ###

ulcer)

inflammation)

No Keterangan
(I83.9-Varicose veins of lower extremities ###

115 Pielonefritis tanpa komplikasi (N10-Acute tubulo-interstitial nephritis) KMK 514 ###
(N12-Tubulo-interstitial nephritis, not specified ###

116 Infeksi saluran kemih (N39-Other disorders of urinary system) ###
(N39.0-Urinary tract infection, site not KMK 514 ###

specified)
(N39.8-Other specified disorders of urinary ###

system)
(N39.9-Disorder of urinary system, unspecified) ###
(O08.8-Other complications following abortion ###

No Keterangan
(N37.8-Other urethral disorders in diseases ###

117 Infeksi saluran kemih bagian (N39-Other disorders of urinary system) ###
bawah
(N39.0-Urinary tract infection, site not KMK 514 ###

specified)
(N39.8-Other specified disorders of urinary ###

system)
(N39.9-Disorder of urinary system, unspecified) ###
(O08.8-Other complications following abortion ###

(N37.8-Other urethral disorders in diseases ###


118 Fimosis KMK 514 ###
paraphimosis)
No Keterangan

119 Parafismosis KMK 514 ###
paraphimosis)
120 Mastitis (N61-Inflammatory disorders of breast) KMK 514 ###
(O91-Infections of breast associated with ###

childbirth)
(O91.0-Infection of nipple associated with ###

childbirth)
(O91.1-Abscess of breast associated with ###

childbirth)
(O91.2-Nonpurulent mastitis associated with ###

childbirth)
121 Salpingitis (N70-Salpingitis and oophoritis) ###

No Keterangan
(N70.0-Acute salpingitis and oophoritis) ###
(N70.1-Chronic salpingitis and oophoritis) ###
(N70.9-Salpingitis and oophoritis, unspecified) ###
122 Vaginitis (N76-Other inflammation of vagina and vulva) ###
(N76.0-Acute vaginitis) KMK 514 ###
(N76.1-Subacute and chronic vaginitis) ###
(N76.6-Ulceration of vagina) ###
(N76.8-Other specified inflammation of vagina ###

and vulva)
No Keterangan
123 Vaginosis bakterialis (N76-Other inflammation of vagina and vulva) ###
(N76.0-Acute vaginitis) KMK 514 ###
(N76.1-Subacute and chronic vaginitis) ###
(N76.6-Ulceration of vagina) ###

and vulva)
(N77-Vulvovaginal ulceration and inflammation ###


infectious and parasitic diseases classified ###
elsewhere)

inflammation in other diseases classified ###
elsewhere)
124 Vulvitis (N76-Other inflammation of vagina and vulva) ###

No Keterangan
(N76.2-Acute vulvitis) ###
(N76.3-Subacute and chronic vulvitis) ###
(N76.4-Abscess of vulva) ###
(N76.6-Ulceration of vulva) ###

and vulva)
125 Aborsi spontan komplit (O03-Spontaneous abortion) ###
(O03.9-Complete or unspecified, without KMK 514 ###

complication)
(O04-Medical Abortion) ###
(O04.9-Complete or unspecified, without ###

complication)
No Keterangan
(O05-Other Abortion) ###

complication)
(O06-Unspecified abortion) ###

complication)
126 Ruptur perineum tingkat 1-2 (O70-Perineal laceration during delivery) ###
(O70.0-First degree perineal laceration during KMK 514 ###

delivery)
(O70.1-Second degree perineal laceration ###

during delivery)
127 Kehamilan normal (O80-Single spontaneous delivery) ###

No Keterangan
(O80.0-Spontaneous vertex delivery) ###
(O80.1-Spontaneous breech delivery) ###
(O80.8-Other single spontaneous delivery) ###
(O80.9-Single spontaneous delivery, KMK 514 ###

unspecified)
(O26.8-Other specified pregnancy-related ###

conditions)
(O26.9-Pregnancy-related condition, ###

unspecified)

128 Inverted nipple ###
associated with childbirth)
(O92.0-Retracted nipple associated with KMK 514 ###

childbirth)
No Keterangan

129 Cracked nipple ###
associated with childbirth)
(O92.1-Cracked nipple associated with ###

childbirth)
(N64-Other disorders of breast) ###
(N64.0-Fissure and fistula of nipple) ###

130 Infeksi pada umbilikus KMK 514 ###
mild haemorrhage)
131 Epistaksis (R04-Haemorrhage from respiratory passages) ###
(R04.0-Epistaxis) KMK 514 ###

No Keterangan
132 Mabuk perjalanan (R11-Nausea and vomiting) ###
(T75.3-Motion sickness) ###
133 Vertigo (Benign paroxysmal (R42-Dizziness and giddiness) KMK 514 ###
positional vertigo)
(H81-Disorders of vestibular function) ###
(H81.1-Benign paroxysmal vertigo) ###
(H81.3-Other peripheral vertigo) ###
(H81.4-Vertigo of central origin) ###
(H82-Vertiginous syndromes in diseases ###

(T75.2-Effects of vibration) ###

No Keterangan
134 Kejang demam (R56-Convulsions, not elsewhere classified) ###
(R56.0-Febrile convulsions) KMK 514 ###
(R56.8-Other and unspecified convulsions) ###
135 Vulnus laseratum, vulnus (T00-Superficial injuries involving multiple body ###
punctum regions)
(T00.0-Superficial injuries involving head with ###

neck)
(T00.1-Superficial injuries involving thorax with ###

(T00.2-Superficial injuries involving multiple ###


No Keterangan

regions of upper limb(s) with lower limb(s))
(T00.8-Superficial injuries involving other ###

(T00.9-Multiple superficial injuries, unspecified) ###
(T14-Injury of unspecified body region) KMK 514 ###
(T14.0-Superficial injury of unspecified body ###

region)
(T14.1-Open wound of unspecified body region) ###
(T14.8-Other injuries of unspecified body ###

region)
(T14.9-Injury, unspecified) ###
136 Benda asing di konjungtiva (T15-Foreign body on external eye) ###

No Keterangan
(T15.1-Foreign body in conjunctival sac) ###
(T15.8- Foreign body in other and multiple parts ###

of external eye)
(T15.9-Foreign body on external eye, part KMK 514 ###

unspecified)
137 Benda asing (T17-Foreign body in respiratory tract) ###
(T17.1-Foreign body in nostril) KMK 514 ###

138 Luka bakar derajat 1 dan 2 ###
unspecified degree)
(T30.1-Burn of first degree, body region KMK 514 ###

unspecified)
(T30.2-Burn of second degree, body region ###

unspecified)
No Keterangan
(T30.4-Corrosion of unspecified body region, ###

unspecified degree)
(T30.5-Corrosion of first degree, body region ###

unspecified)
(T30.6-Corrosion of second degree, body region ###

unspecified)
(T21-Burn and corrosion of trunk) ###
(T21.0-Burn of unspecified degree of trunk) ###
(T21.1-Burn of first degree of trunk) ###
(T21.2-Burn of second degree of trunk) ###
(T21.4-Corrosion of unspecified degree of trunk) ###
(T21.5-Corrosion of first degree of trunk) ###
(T21.6-Corrosion of second degree of trunk) ###

No Keterangan
(T22-Burn and corrosion of shoulder and upper ###

(T22.0-Burn of unspecified degree of shoulder ###

(T22.1-Burn of first degree of shoulder and ###

(T22.2-Burn of second degree of shoulder and ###


shoulder and upper limb, except wrist and ###
hand)
(T22.5-Corrosion of first degree of shoulder and ###

(T22.6-Corrosion of second degree of shoulder ###

(T23-Burn and corrosion of wrist and hand) ###
(T23.0-Burn of unspecified degree of wrist and ###

hand)
(T23.1-Burn of first degree of wrist and hand) ###

No Keterangan
(T23.2-Burn of second degree of wrist and ###

hand)
(T23.4-Corrosion of unspecified degree of wrist ###

and hand)
(T23.5-Corrosion of first degree of wrist and ###

hand)
(T23.6-Corrosion of second degree of wrist and ###

hand)
(T24-Burn and corrosion of hip and lower limb, ###

(T24.0-Burn of unspecified degree of hip and ###

(T24.1-Burn of first degree of hip and lower ###

(T30-Burn and corrosion, body region ###

unspecified)
(T24.2-Burn of second degree of hip and lower ###

(T24.4-Corrosion of unspecified degree of hip ###

No Keterangan
(T24.5-Corrosion of first degree of hip and lower ###

(T24.6-Corrosion of second degree of hip and ###

(T25-Burn and corrosion of ankle and foot) ###
(T25.0-Burn of unspecified degree of ankle and ###

foot)
(T25.1-Burn of first degree of ankle and foot) ###
(T25.2-Burn of second degree of ankle and foot) ###
(T25.4-Corrosion of unspecified degree of ankle ###

and foot)
(T25.5-Corrosion of first degree of ankle and ###

foot)
(T25.6-Corrosion of second degree of ankle and ###

foot)
(T29-Burns and corrosions of multiple body ###

regions)
No Keterangan
(T29.0-Burns of multiple regions, unspecified ###

degree)
(T29.1-Burns of multiple regions, no more than ###

(T29.2-Burns of multiple regions, no more than ###

(T29.4-Corrosions of multiple regions, ###

unspecified degree)
(T29.5-Corrosions of multiple regions, no more ###

(T29.6-Corrosions of multiple regions, no more ###


139 Keracunan makanan ###
eaten as food)
(T62.0-Ingested mushrooms) ###
(T62.1-Ingested berries) ###

No Keterangan
(T62.2-Other ingested(parts of) plant(s)) KMK 514 ###
(T62.8-Other specified noxious substances ###

eaten as food)
(T62.9-Noxious substance eaten as food, ###

unspecified)
(T61-Toxic effect of noxious substances eaten as ###

seafood)
(T61.0-Ciguatera fish poisoning) ###
(T61.1-Scombroid fish poisoning) ###
(T61.2-Other fish and shellfish poisoning) ###
(T61.8-Toxic effect of other seafoods) ###
(T61.9-Toxic effect of unspecified seafood) ###
(K52-Other noninfective gastroenteritis and ###

colitis)
No Keterangan
(K52.1-Toxic gastroenteritis and colitis) ###
(K52.8-Other specified noninfective ###

(K52.9-Noninfective gastroenteritis and colitis, ###

unspecified)

140 Reaksi gigitan serangga ###
animals)
(T63.4- Venom of other arthropods) KMK 514 ###
141 Reaksi anafilaktik (T78-Adverse effects, not elsewhere classified) ###
(T78.2-Anaphylactic shock, unspecified) KMK 514 ###
(T80.5-Anaphylactic shock due to serum) ###

No Keterangan
(T78.0-Anaphylactic shock due to adverse food ###

reaction)
(T88.6-Anaphylactic shock due to adverse effect

of correct drug or medicament properly ###
administered)
142 Kekerasan tajam (X99-Assault by sharp object) ###
(X78-Intentional self-harm by sharp object) ###
(Y28-Contact with sharp object, undetermined ###

intent)
(Y35.4-Legal intervention involving sharp ###

objects)
(W22-Striking against or struck by other objects) ###
(W26.9-Contact with unspecified sharp ###

object(s))
No Keterangan
143 Kekerasan tumpul (Y00-Assault by blunt object) ###
(X79-Intentional self-harm by blunt object) ###
(Y29-Contact with blunt object, undetermined ###

intent)
(Y35.3-Legal intervention involving blunt ###

objects)
(W22-Striking against or struck by other objects) ###
(Z21-Asymptomatic human immunodeficiency

144 HIV AIDS tanpa komplikasi KMK 514 ###
virus [HIV] infection status)
(R75-Laboratory evidence of human ###

(Z11.4-Special screening examination for human ###

(Z20.6-Contact with and exposure to human ###

No Keterangan
(Z71.7-Human immunodeficiency virus [HIV] ###

counselling)
###
REFERENSI DIAGNOSA NON SPESIALISTIK
Mampu Ditangani
(Beri tanda √ salah satu)
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√ "Other" merupakan organ yang belum pasti, FKTP tidak dapat tuntas melaksanakan di setiap organ
√
Mampu Ditangani
Keterangan
Ya Tidak
√ Obat berkoordinasi dengan Puskesmas
√
Mampu Ditangani
Keterangan
Ya Tidak

Mampu Ditangani
Keterangan
Ya Tidak
√ "Other" merupakan kondisi yang belum pasti, FKTP tidak dapat tuntas melaksanakan di setiap kondisi
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√ drirujuk dengan TACC
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak

Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√ dengan catatan berdasar lokasi, kedalaman, diameter, dan jumlah
√ multiple
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√ hordeolum dengan insisi dapat dirujuk dengan TACC
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak

Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√ dirujuk dengan TACC
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√ dirujuk dengan TACC
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak

Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√ 2nd -> sampai otot, 3rd-> kena springter
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√ zat toxic dari hewan yang belum jelas
√
Mampu Ditangani
Keterangan
Ya Tidak

Mampu Ditangani
Keterangan
Ya Tidak
√
Mampu Ditangani
Keterangan
Ya Tidak
√
LISTIK
Hasil FGD Peer Review berdasar KMK Mampu Penatalaksanaan oleh FKTP
514/2015
Kendala Dokter Keterangan

Puskesmas Puskesmas Puskesmas
Kode Dx Nama DX Klinik Pratama Praktik
Poned Rawat Inap Rawat Jalan Perorangan
A01.0 Typhoid fever √ √ √ √ √
A06.0 Acute amoebic dysentery Tidak ada sarana rawat inap √ √ - - -

514/2015

514/2015

Other and unspecified

A09.0 gastroenteritis and colitis of Tidak ada sarana rawat inap √ √ - - -
infectious origin
514/2015

1. Tidak ada Lab/RO: Uji Gen Expert

Respiratory tuberculosis, Rif, Thorax Foto, kondisi Tak
A15.0 bacteriologically and Membaik, TB MDR √ √ √ √ √
histologically confirmed 2. Obat Prgram, DPP dan Klinik
Koordinasi dengan PKM
514/2015

514/2015

Tuberculosis of skin and Belum ada ada di KMK

A18.4 Belum ada FGD Belum ada FGD Belum ada FGD Belum ada FGD
subcutaneous tissue FGD 514
514/2015

-Penanganan di DPP dan Klinik

koordinasi dengan PKM.
- Indikasi Rujukan:
A27.9 Leptospirosis, unspecified perlu sarana hemodialisa, komplikasi - - - - -
(meningitis, distres nafas,ggl ginjal,
ggl hati,ggl jantung)
- Kasus ringan sangat jarang
A30.0 Indeterminate leprosy √ √ √ √ √

514/2015

514/2015

1. Bila tidak terjadi perbaikan

setelah penanganan pertama
2. Terjadi komplikasi, seperti distres
sistem pernapasan
A35 Other tetanus 3. Rujukan ditujukan ke Fasilitas - - - - -
sekunder yang memiliki dokter
spesialis neurologi (KMK 514/2015),
4. PKM tidak punya fasilitas rawat
inap utk observasi pasien tetanus
514/2015

Whooping cough due to other Belum ada tidak ada di

A37.8 Belum ada FGD Belum ada FGD Belum ada FGD Belum ada FGD
Bordetella species FGD KMK 514
Belum ada ada di KMK

A46 Erysipelas Belum ada FGD Belum ada FGD Belum ada FGD Belum ada FGD FGD 514
Belum ada ada di KMK

A51 Early syphilis Belum ada FGD Belum ada FGD Belum ada FGD Belum ada FGD FGD 514
514/2015

A51.0 Primary genital syphilis
A52 Late syphilis
A53.9 Syphilis, unspecified
Other specified
N89.8 noninflammatory disorders of √ √ √ √ √
vagina
514/2015

Gonococcal infection,
A54.9 √ √ √ √ √
unspecified
514/2015

Membutuhkan Rawat Inap

Pasien Dewasa:
1. Terjadi perdarahan masif
2. Dengan pemberian cairan
krisraloid sampai dosis 15 ml/kg/jam
kondisi belum membaik
3. Terjadi komplikasi atau keadaan
klinis yang tidak lazim, seperti
A91 Dengue haemorrhagic fever kejang, penurunan kesadaran dll √ √ - - -
Pasien anak
1. DBD dengan Syok (terdapat
kegagalan sirkulasi)
2. Bila anak tidak dapat minum
dengan adekuat, asupan sulit,
walaupun tidak terdapat kegagalan
sirkulasi
514/2015

Herpesviral infection,
B00.9 √ √ √ √ √
unspecified
B01.9 Varicella without complication √ √ √ √ √
B02.9 Zoster without complication √ √ √ √ √

514/2015

B05.9 Measles without complication √ √ √ √ √
B07 Viral warts √ √ √ √ √
B08.1 Molluscum contagiosum √ √ √ √ √

514/2015

Dirujuk karena:
1. Penegakan Diagnosis dengan
pemeriksaan penunjang
laboratorium
2. Penderita dengan keluahn ikterik
B15 Acute hepatitis A - - - - -
yang menetap disertai eluhan yang
lain
3. Penderita dengan penurunan
kesadaran dengan kemungkinan ke
arah ensefalopati hepatik
B26.0 Mumps orchitis yang dapat ditangani B26.9 - - - - -
K11.2 Sialoadenitis
B35 Dermatophytosis √ √ √ √ √
514/2015

B35.0 Tinea barbae and tinea capitis √ √ √ √ √
B35.1 Tinea unguium √ √ √ √ √
B35.2 Tinea manuum √ √ √ √ √

514/2015

B35.3 Tinea pedis √ √ √ √ √
B35.4 Tinea corporis √ √ √ √ √
B35.6 Tinea cruris √ √ √ √ √

514/2015

B35.8 Other dermatophytoses √ √ √ √ √
B36.0 Pityriasis versicolor √ √ √ √ √

514/2015

B37.9 Candidiasis, unspecified √ √ √ √ √
B37.9 Candidiasis, unspecified √ √ √ √ √

514/2015

Schistosom due schis

B65.0 haematobium [urin √ √ √ √ √
schistosom]
B68.9 Taeniasis, unspecified √ √ √ √ √

514/2015

1. Tidak ada sarana Tindakan

Operatif, Tidak ada Lab/RO :
Filariasis due to wuchereria
B74.0 identifikasi microfilaria √ √ - - -
bancrofti 2. DPP-Klinik, Keterbatasan obat dan
pemeriksaan penunjang diagnosa
514/2015

B76.0 Ancylostomiasis √ √ √ √ √
514/2015

Hookworm disease,
B76.9 √ √ √ √ √
unspecified
B77.9 Ascariasis, unspecified √ √ √ √ √

514/2015

B78.0 Intestinal strongyloidiasis √ √ √ √ √
Tidak ada obat malaria, program

B54 Unspecified malaria pemerintah √ √ - - -
514/2015

514/2015

B85.3 Phthiriasis √ √ √ √ √
Pediculosis due to pediculus

B85.0 √ √ √ √ √
humanus capitis
514/2015

B86 Scabies √ √ √ √ √
Benign lipomatous neoplasm,

D17.9 √ √ √ √ √
unspecified
514/2015

Iron deficiency anaemia,

D50.9 √ √ √ √ √
unspecified
Iron deficiency anaemia,

D50.9 √ √ √ √ √
unspecified
514/2015

Belum ada tidak ada di

Belum ada FGD Belum ada FGD Belum ada FGD Belum ada FGD FGD KMK 514
Non-insulin-dependent
E11.9 diabetes mellitus without √ √ √ √ √
complications
514/2015

2 jam setelah protokol tx standart

E16.2 Hypoglycaemia, unspecified √ √ - - -
pada fasilitas ranap tak teratasi
Unspecified protein-energy 2 jam setelah protokol tx standart

E46 √ √ - - -
malnutrition pada fasilitas ranap tak teratasi
514/2015

Belum ada Tidak ada di

514/2015

514/2015

514/2015

514/2015


514/2015

514/2015

E66.9 Obesity, unspecified √ √ √ √ √
E78.5 Hyperlipidaemia, unspecified √ √ √ √ √

514/2015

Hyperuricaem without sign

E79.0 inflammarthritis+tophaceous √ √ √ √ √
dis
514/2015

F45.0 Somatization disorder √ √ √ √ √

514/2015

F51.0 Nonorganic insomnia √ √ √ √ √
G43.9 Migraine, unspecified √ √ √ √ √

514/2015

G44.2 Tension-type headache √ √ √ √ √

514/2015

1.Tidak ada sarana lain :

Pemeriksaan Fungsi N VII
2. Dirujuk bila gr V dan VI, Terdapat
G51.0 Bell's palsy - - - - -
komplikasi, Tidak ada perbaikan 4
minggu
3. Tidak ada Fisioterapi
Hordeolum and other deep

H00.0 √ √ √ √ √
inflammation of eyelid
514/2015

H01.0 Blepharitis √ √ √ √ √
Entropion and trichiasis of Tidak ada sarana operasi, operasi

H02.0 - - - - -
eyelid oleh dr mata, ada ulkus, keratitis
Other disorders of lacrimal

H04.1 √ √ √ √ √
gland
514/2015

H10.1 Acute atopic conjunctivitis √ √ √ √ √

514/2015

Other specified disorders of

H57.8 √ √ √ √ √
eye and adnexa
514/2015

H15.1 Episcleritis √ √ √ √ √
Tidak ada alkes : Trial frame dan trial

H52.0 Hypermetropia lenses, perlu koreksi lensa o dr SP - - - - -
Mata

H52.1 Myopia lenses, perlu koreksi lensa o dr SP - - - - -
Mata
514/2015


H52.2 Astigmatism lenses, perlu koreksi lensa o dr SP - - - - -
Mata

H52.4 Presbyopia lenses, perlu koreksi lensa o dr SP - - - - -
Mata
H53.6 Night blindness √ √ √ √ √

514/2015

H60.9 Otitis externa, unspecified √ √ √ √ √

514/2015

H61.2 Impacted cerumen √ √ √ √ √
H65.0 Acute serous otitis media √ √ √ √ √
Other acure nonsuppurative

H65.1 otitis media
H66.0 Acute suppurative otitis media

514/2015

Essential (primary)
I10 √ √ √ √ √
hypertension
514/2015

Internal thrombosed
I84.0 √ √ √ √ √
haemorrhoids
Acute lymphadenitis,
L04.9 √ √ √ √ √
unspecified
514/2015

Acute nasopharyngitis
J00 √ √ √ √ √
[common cold]
514/2015

J02 Acute pharyngitis √ √ √ √ √
J03 Acute tonsillitis √ √ √ √ √

514/2015

J04.0 Acute laryngitis √ √ √ √ √

514/2015

J11.0 Influenza, virus not identified √ √ √ √ √

514/2015

membutuhkan rawat inap

Kriteria rujukan Dewasa:
1. Kriteria CURB (Consiousness,
Ureum, Respiratory rate>30/menit,
sistolik <90mmhg, diastolik
<60mmhg, masing2 bila ada
Bronchopneumonia, kelainan dinilai 1, dirujuk apabila
J18.0 √ √ - - -
unspecified nilai 2)
2. Kriteria POR (Patien outcome
research tema)
Kriteria Rujukan Anak:

1. Peneumonia Berat
2. Penumonia Rawat Inap
514/2015

514/2015

514/2015

514/2015

J20.9 Acute bronchitis, unspecified √ √ √ √ √

514/2015

J30.0 Vasomotor rhinitis √ √ √ √ √

514/2015

J30.4 Allergic rhinitis, unspecified √ √ √ √ √
Abscess, furuncle and

J34.0 √ √ √ √ √
carbuncle of nose
514/2015

J45.9 Asthma, unspecified √ √ √ √ √
K12 Stomatitis and related lesions √ √ √ √ √

514/2015

Gastro-oesophageal reflux
K21.9 √ √ √ √ √
disease without oesophagitis
K29.7 Gastritis, unspecified √ √ √ √ √

514/2015

Malabsorption due to
K90.4 intolerance, not elsewhere √ √ √ √ √
classified
Impetigo [any organism] [any

L01.0 √ √ √ √ √
site]
514/2015

Cutaneous abscess, furuncle

L02.0 √ √ √ √ √
and carbuncle of face
514/2015

514/2015

Cutaneous abscess, furuncle

L02.2 √ √ √ √ √
and carbuncle of trunk
L08.0 Pyoderma √ √ √ √ √
514/2015

L08.1 Erythrasma √ √ √ √ √
L20.8 Other atopic dermatitis √ √ √ √ √

514/2015

L21.0 Seborrhoea capitis √ √ √ √ √
L22 Diaper [napkin] dermatitis √ √ √ √ √

514/2015

Irritant contact dermatitis due

L24.0 √ √ √ √ √
to detergents
514/2015

514/2015

Generalized skin eruption due

L27.0 √ √ √ √ √
to drugs and medicaments
Dermatitis due to ingested

L27.2 √ √ √ √ √
food
514/2015

Belum ada Ada di KMK

L20.8 Other Atopic Dermatitis Belum ada FGD Belum ada FGD Belum ada FGD Belum ada FGD FGD 514
L42 Pityriasis rosea √ √ √ √ √

514/2015

L50.0 Allergic urticaria √ √ √ √ √

514/2015

L70.0 Acne vulgaris √ √ √ √ √

514/2015

514/2015

L71.0 Perioral dermatitis √ √ √ √ √
L08.0 Pyoderma √ √ √ √ √
514/2015

514/2015

L73.2 Hidradenitis suppurativa √ √ √ √ √
L74.3 Miliaria, unspecified √ √ √ √ √

514/2015

Ulcer of lower limb, not

L97 √ √ √ √ √
elsewhere classified
514/2015

Acute tubulo-interstitial
N10 Membutuhkan rujukan segera - - - - -
nephritis
Urinary tract infection, site not

N39.0 √ √ √ √ √
specified
514/2015

Urinary tract infection, site not

N39.0 √ √ √ √ √
specified
Redundant prepuce, phimosis tindakan sirkumsisi

N47 √ √ - - -
and paraphimosis
514/2015

Redundant prepuce, phimosis tindakan sirkumsisi

N47 √ √ - - -
and paraphimosis
Inflammatory disorders of
N61 √ √ √ √ √
breast

514/2015

N76.0 Acute vaginitis √ √ √ √ √

514/2015


514/2015

Spontaneous abortion,
O03.9 Complete or unspecified, Hanya di Poned √ - - - -
without complication
514/2015

First degree perineal laceration Hanya di Poned

O70.0 √ - - - -
during delivery
Single spontaneous delivery,

O80.9 √ √ √ √ √
unspecified
514/2015

Retracted nipple associated

O92.0 √ √ √ √ √
with childbirth
514/2015

Retracted nipple associated

O92.0 √ √ √ √ √
with childbirth
Omphalitis of newborn with or Tidak ada sarana rawat Inap

P38 √ √ - - -
without mild haemorrhage
R04.0 Epistaxis √ √ √ √ √
514/2015


R42 Dizziness and giddiness √ √ √ √ √

514/2015

R56.0 Febrile convulsions Tidak ada sarana rawat Inap √ √ - - -
Open wound of unspecified

T14.1 √ √ √ √ √
body region
514/2015

Foreign body on external eye,

T15.9 √ √ √ √ √
part unspecified
514/2015

T17.1 Foreign body in nostril √ √ √ √ √
Burn of first degree, body

T30.1 √ √ √ √ √
region unspecified
514/2015

514/2015

514/2015

514/2015

514/2015

Other Ingested (parts of Belum ada Ada di KMK

T62.2 Belum ada FGD Belum ada FGD Belum ada FGD Belum ada FGD
plant(s)) FGD 514
514/2015

514/2015

T63.4 Venom of other arthropods √ √ √ √ √
Anaphylactic shock,
T78.2 √ √ √ √ √
unspecified
514/2015


514/2015


1. Setelah dinyatakan terinfeksi HIV,

pasien perlu dirujuk ke pelayanan
Asymptomatic human dukungan pengobatan utk
Z21 immunodeficiency virus [HIV] menjalankan serangkaian layanan - - - - -
infection status yang meliputi penilaian stadium
klinis, imunologis, dan virologi
2. Pasien HIV/AIDS dengan
komplikasi
514/2015

FOCUS GROUP DISCUSSION PEER REVIEW DIAGNOSA NON
YANG MAMPU DITANGANI OLEH FKTP
TIM 2
No Nama Penyakit ICD 10
1 Demam tifoid (A01-Typhoid and paratyphoid fevers)
(A01.0-Typhoid fever)
(A01.1-Paratyphoid fever A)
(A01.2-Paratyphoid fever B)
2 Disentri basiler, disentri amuba (A06-Amoebiasis)
(A06.0-Acute amoebic dysentery)
526
TIM 2
(A03-Shigellosis)
Gastroenteritis (termasuk kolera, giardiasis) (A09-Other gastroenteritis and colitis of infectious and
3 unspecified origin)
(A09.0-Other and unspecified gastroenteritis and

colitis of infectious origin)
(A09.9-Gastroenteritis and colitis of unspecified origin)
(A08-Viral and other specified intestinal infections)
527
TIM 2
(A08.1-Acute gastroenteropathy due to Norwalk agent)
(A15-Respiratory tuberculosis, bacteriologically and

4 Tuberkulosis paru tanpa komplikasi histologically confirmed)
(A15.0-Tuberculosis of lung, confirmed by sputum

microscopy with or without culture)
(A15.1-Tuberculosis of lung, confirmed by culture only)
(A15.2-Tuberculosis of lung, confirmed histologically)
(A15.3-Tuberculosis of lung, confirmed by unspecified

means)
(A15.4-Tuberculosis of intrathoracic lymph nodes,

528
TIM 2
(A15.5-Tuberculosis of larynx, trachea and bronchus,


(A15.7-Primary respiratory tuberculosis, confirmed

(A15.8-Other respiratory tuberculosis, confirmed

(A15.9-Respiratory tuberculosis unspecified, confirmed

(A16.1-Tuberculosis of lung, bacteriological and

(A16.2-Tuberculosis of lung, without mention of


mention of bacteriological or histological confirmation)

(A16.9-Respiratory tuberculosis unspecified, without

5 Leptospirosis (tanpa komplikasi) (A27- Leptospirosis)
(A27.0-Leptospirosis icterohaemorrhagica)
529
TIM 2
(A27.9-Leptospirosis, unspecified)
6 Pertusis (A37-Whooping cough)
(A37.0-Whooping cough due to Bordetella pertussis)

parapertussis)
(A37.8-Whooping cough due to other Bordetella

species)
7 Demam dengue, DHF (A90-Dengue fever [classical dengue])
(A91-Dengue haemorrhagic fever)
8 Hepatitis A (B15-Acute hepatitis A)
(B15.9-Hepatitis A without hepatic coma)
9 Parotitis (B26-Mumps)
(B26.9-Mumps without complication)
530
TIM 2
10 Penyakit cacing tambang (B76-Hookworm diseases)
11 Cutaneus larva migran (B76-Hookworm diseases)
12 Askariasis (B77-Ascariasis)
531
TIM 2
(K93.8-Disorders of other specified digestive organs in

13 Strongiloidiasis (B78-Strongyloidiasis)
(B78.1-Cutaneous strongyloidiasis)
14 Malaria (B85.3-Phthiriasis)
(B50-Plasmodium falciparum malaria)
(B50.9-Plasmodium falciparum malaria, unspecified)
(B51-Plasmodium vivax malaria)
(B51.8-Plasmodium vivax malaria with other

complications)
(B51.9-Plasmodium vivax malaria without

complication)
532
TIM 2
(B52-Plasmodium malariae malaria)
(B52.8-Plasmodium malariae malaria with other

complications)
(B52.9-Plasmodium malariae malaria without

complication)
(B53-Other parasitologically confirmed malaria)
(B53.0-Plasmodium ovale malaria)
(B53.8-Other parasitologically confirmed malaria, not

(B54-Unspecified malaria)
15 Anemia defisiensi besi (D50-Iron deficiency anaemia)
(D50.9-Iron deficiency anaemia, unspecified)
533
TIM 2
16 Diabetes melitus tipe 1 (E10-Insulin-dependent diabetes mellitus)
(E10.9-Insulin-dependent diabetes mellitus without

complications)
17 Diabetes melitus tipe 2 (E11-Non-insulin-dependent diabetes mellitus)
(E11.9-Non-insulin-dependent diabetes mellitus

18 Hipoglikemia ringan (E16-Other disorders of pancreatic internal secretion)
(E16.1-Other hypoglycaemia)
(E16.2-Hypoglycaemia, unspecified)
19 Malnutrisi energi-protein (E40-Kwashiorkor)
(E44-Protein-energy malnutrition of moderate and

mild degree)
534
TIM 2
(E44.0-Moderate protein-energy malnutrition)
(E44.1-Mild protein-energy malnutrition)
(E46-Unspecified protein-energy malnutrition)
(E64.0-Sequelae of protein-energy malnutrition)
20 Defisiensi vitamin (E50-Vitamin A deficiency)
(E50.0-Vitamin A deficiency with conjunctival xerosis)

(E50.2-Vitamin A deficiency with corneal xerosis)
(E50.3-Vitamin A deficiency with corneal ulceration

and xerosis)
(E50.4-Vitamin A deficiency with keratomalacia)
(E50.5-Vitamin A deficiency with night blindness)
(E50.6-Vitamin A deficiency with xerophthalmic scars

of cornea)
(E50.7-Other ocular manifestations of vitamin A

deficiency)
535
TIM 2
(E50.8-Other manifestations of vitamin A deficiency)
(E51.1-Beriberi)
(E51.8-Other manifestations of thiamine deficiency)
(E52-Niacin deficiency [pellagra])
(E53.8-Deficiency of other specified B group vitamins)
536
TIM 2
(E64-Sequelae of malnutrition and other nutritional

deficiencies)
(E64.8-Sequelae of other nutritional deficiencies)
(E64.9-Sequelae of unspecified nutritional deficiency)
537
TIM 2
21 Defisiensi mineral (E58-Dietary calcium deficiency)
(E61.7-Deficiency of multiple nutrient elements)
(E61.8-Deficiency of other specified nutrient elements)
(E61.9-Deficiency of nutrient element, unspecified)
538
TIM 2
(E63.1-Imbalance of constituents of food intake)
22 Obesitas (E66-Obesity)
(E66.1-Drug-induced obesity)
(E66.9-Obesity, unspecified)
(E78-Disorders of lipoprotein metabolism and other

23 Dislipidemia lipidaemias)
(E78.0-Pure hypercholesterolaemia)
539
TIM 2
(E78.4-Other hyperlipidaemia)
(E78.5-Hyperlipidaemia, unspecified)
(E78.8-Other disorders of lipoprotein metabolism)

unspecified)
24 Hiperurisemia (E79-Disorders of purine and pyrimidine metabolism)
(E79.0-Hyperuricaemia without signs of inflammatory

arthritis and tophaceous disease)
(E79.8-Other disorders of purine and pyrimidine

metabolism)
(E79.9-Disorder of purine and pyrimidine metabolism,

unspecified)
25 Gangguan somatoform (F45-Somatoform disorders)
540
TIM 2
(F45.0-Somatization disorder)
(F45.3-Somatoform autonomic dysfunction)
26 Insomnia (F51-Nonorganic sleep disorders)
(F51.0-Nonorganic insomnia)

schedule)
(G47.0-Disorders of initiating and maintaining sleep

[insomnias])
27 Migren (G43-Migraine)
541
TIM 2
(G43.0-Migraine without aura [common migraine])
(G43.1-Migraine with aura [classical migraine])
(G43.2-Status migrainosus)
(G43.8-Other migraine)
(G43.9-Migraine, unspecified)
(N94.3-Premenstrual tension syndrome)
28 Tension headache (G44-Other Headache Syndromes)
(G44.1-Vascular headache, not elsewhere classified)
(G44.2-Tension-type headache)

classified)
(G44.8-Other specified headache syndromes)
(R51-Headache)
542
TIM 2
29 Bells' palsy (G51-Facial nerve disorders)
(G51.0-Bell's palsy)
30 Otitis eksterna (H60-Otitis externa)
(H60.3-Other infective otitis externa)
(H60.5-Acute otitis externa, noninfective)
(H60.8-Other otitis externa)
(H60.9-Otitis externa, unspecified)
(H62-Disorders of external ear in diseases classified

elsewhere)
(H62.0-Otitis externa in bacterial diseases classified

elsewhere)

elsewhere)
(H62.3-Otitis externa in other infectious and parasitic

543
TIM 2
(H62.4-Otitis externa in other diseases classified

elsewhere)
(H62.8-Other disorders of external ear in diseases

31 Serumen prop (H61-Other disorders of external ear)
(H61.2-Impacted cerumen)
32 Otitis media akut (H65-Nonsuppurative otitis media)
(H65.1-Other acute nonsuppurative otitis media)
(H65.9-Nonsuppurative otitis media, unspecified)
(H66-Suppurative and unspecified otitis media)
(H66.0-Acute suppurative otitis media)
(H66.9-Otitis media, unspecified)
(H67-Otitis media in diseases classified elsewhere)
(H67.0-Otitis media in bacterial diseases classified

elsewhere)
544
TIM 2

elsewhere)

elsewhere)
33 Hipertensi esensial (I10-Essential(primary) hypertension)
34 Hemoroid grade 1-2 (I84-Haemorrhoids)
(I84.2-Internal haemorrhoids without complication)
(I84.5-External haemorrhoids without complication)
(I84.9-Unspecified haemorrhoids without

complication)
35 Limfadenitis (I88-Nonspecific lymphadenitis)
(I88.1-Chronic lymphadenitis, except mesenteric)
545
TIM 2
(L04.0-Acute lymphadenitis of face, head and neck)
(L04.9-Acute lymphadenitis, unspecified)
36 Rhinitis akut (J00-Acute nasopharyngitis [common cold])
37 Faringitis (J02-Acute pharyngitis)

organisms)
(J02.9-Acute pharyngitis, unspecified)
(J31-Chronic rhinitis, nasopharyngitis and pharyngitis)
546
TIM 2
38 Tonsilitis (J03-Acute tonsillitis)

organisms)
(J35.8-Other chronic diseases of tonsils and adenoids)

unspecified)
39 Laringitis (J04-Acute laryngitis and tracheitis)
547
TIM 2
40 Influenza (J10-Influenza due to other identified influenza virus)
(J10.0-Influenza with pneumonia, other influenza virus

identified)
(J10.1-Influenza with other respiratory manifestations,

(J10.8-Influenza with other manifestations, other

(J11.0-Influenza with pneumonia, virus not identified)
(J11.1-Influenza with other respiratory manifestations,

virus not identified)
(J11.8-Influenza with other manifestations, virus not

identified)
(A49.2-Haemophilus influenzae infection, unspecified

site)
41 Pneumonia, bronkopneumonia (J12-Viral pneumonia, not elsewhere classified)
548
TIM 2
(J13-Pneumonia due to Streptococcus pneumoniae)
(J14-Pneumonia due to Haemophilus influenzae)
(J15-Bacterial pneumonia, not elsewhere classified)
(J15.0-Pneumonia due to Klebsiella pneumoniae)
(J15.3-Pneumonia due to streptococcus, group B)
549
TIM 2
(J15.6-Pneumonia due to other aerobic Gram-negative

bacteria)
(J15.7-Pneumonia due to Mycoplasma pneumoniae)
(J16-Pneumonia due to other infectious organisms, not

(J16.8-Pneumonia due to other specified infectious

organisms)
(J17-Pneumonia in diseases classified elsewhere)
(J17.0-Pneumonia in bacterial diseases classified

elsewhere)

elsewhere)

elsewhere)
550
TIM 2
(J18.0-Bronchopneumonia, unspecified)
(J18.8-Other pneumonia, organism unspecified)
42 Bronkitis akut (J20-Acute bronchitis)

pneumoniae)

influenzae)
(J20.4-Acute bronchitis due to parainfluenza virus)
(J20.5-Acute bronchitis due to respiratory syncytial

virus)
(J20.6-Acute bronchitis due to rhinovirus)
551
TIM 2

organisms)
(J20.9-Acute bronchitis, unspecified)
(J40-Bronchitis, not specified as acute or chronic)
(J41-Simple and mucopurulent chronic bronchitis)

bronchitis)
43 Rhinitis vasomotor (J30-Vasomotor and allergic rhinitis)
(J30.1-Vasomotor rhinitis)
44 Rhinitis alergika (J30-Vasomotor and allergic rhinitis)
552
TIM 2
(J30.4- Other allergic rhinitis)
45 Furunkel pada hidung (J34-Other disorders of nose and nasal sinuses)
(J34.0-Abscess, furuncle and carbuncle of nose)
46 Asma bronkial (J45-Asthma)
(J45.1-Nonallergic asthma)
(J45.9-Asthma, unspecified)
47 Ulkus mulut (aptosa, herpes) (K12-Stomatitis and related lesions)
553
TIM 2
(K12.1-Other forms of stomatitis)
48 Refluks gastroesofagus (K21-Gastro-oesophageal reflux disease)
(K21.9-Gastro-oesophageal reflux disease without

oesophagitis)
49 Gastritis (K29-Gastritis and duodenitis)
(K29.7-Gastritis, unspecified)
554
TIM 2
50 Intoleransi makanan (K90-Intestinal malabsorption)
(K90.4-Malabsorption due to intolerance, not

51 Pielonefritis tanpa komplikasi (N10-Acute tubulo-interstitial nephritis)
(N12-Tubulo-interstitial nephritis, not specified as

acute or chronic)
52 Infeksi saluran kemih (N39-Other disorders of urinary system)
(N39.0-Urinary tract infection, site not specified)
(N39.8-Other specified disorders of urinary system)
(O08.8-Other complications following abortion and

ectopic and molar pregnancy)
(N37.8-Other urethral disorders in diseases classified

elsewhere)
53 Infeksi saluran kemih bagian bawah (N39-Other disorders of urinary system)
555
TIM 2
(N39.0-Urinary tract infection, site not specified)
(N39.8-Other specified disorders of urinary system)
(O08.8-Other complications following abortion and

ectopic and molar pregnancy)
(N37.8-Other urethral disorders in diseases classified

elsewhere)
54 Salpingitis (N70-Salpingitis and oophoritis)
(N70.1-Chronic salpingitis and oophoritis)
55 Epistaksis (R04-Haemorrhage from respiratory passages)
(R04.0-Epistaxis)
56 Mabuk perjalanan (R11-Nausea and vomiting)
556
TIM 2
(T75.3-Motion sickness)
Vertigo (Benign paroxysmal positional

57 (R42-Dizziness and giddiness)
vertigo)
(H81-Disorders of vestibular function)
(H81.1-Benign paroxysmal vertigo)
(H81.3-Other peripheral vertigo)
(H82-Vertiginous syndromes in diseases classified

elsewhere)
58 Kejang demam (R56-Convulsions, not elsewhere classified)
(R56.0-Febrile convulsions)
59 Benda asing (T17-Foreign body in respiratory tract)
557
TIM 2
(T17.1-Foreign body in nostril)
(T62-Toxic effect of other noxious substances eaten as

60 Keracunan makanan food)
(T62.2-Other ingested(parts of) plant(s))
(T62.8-Other specified noxious substances eaten as

food)
(T62.9-Noxious substance eaten as food, unspecified)
(T61-Toxic effect of noxious substances eaten as

seafood)
558
TIM 2
(K52-Other noninfective gastroenteritis and colitis)
(K52.8-Other specified noninfective gastroenteritis and

colitis)

unspecified)
61 Reaksi anafilaktik (T78-Adverse effects, not elsewhere classified)
(T78.2-Anaphylactic shock, unspecified)
(T78.0-Anaphylactic shock due to adverse food

reaction)
(T88.6-Anaphylactic shock due to adverse effect of

correct drug or medicament properly administered)
(Z21-Asymptomatic human immunodeficiency virus

62 HIV AIDS tanpa komplikasi [HIV] infection status)

(Z11.4-Special screening examination for human


559
TIM 2
(Z71.7-Human immunodeficiency virus [HIV]

counselling)
560
EVIEW DIAGNOSA NON SPESIALISTIK
TANGANI OLEH FKTP
M2
Mampu Ditangani
Tercantum dalam (Beri tanda √ salah
Penatalksanaan satu) Keterangan
KMK 514/2015
Ya Tidak
Ada
Ada
561
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
562
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
563
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
564
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
Ada
565
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
566
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
567
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
568
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
569
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
570
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
571
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
572
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
573
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
574
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
575
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
576
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
577
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
578
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
579
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
580
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
581
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
582
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
583
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
584
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
585
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
586
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
587
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
Ada
588
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
589
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
590
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
591
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
592
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
593
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
594
TANGANI OLEH FKTP
M2
Mampu Ditangani
KMK 514/2015
Ya Tidak
595
TIM 1
1 Skrofuloderma (A18-Tuberculosis of other organs)
(A18.4-Tuberculosis of skin and subcutaneous tissue)
2 Lepra (A30-Leprosy [Hansen disease])
(A30.0-Indeterminate leprosy)
(A30.1-Tuberculoid leprosy)
(A30.2-Borderline tuberculoid leprosy)
(A30.3-Borderline leprosy)
(A30.4-Borderline lepromatous leprosy)
(A30.5-Lepromatous leprosy)
(A30.8-Other forms of leprosy)
(A30.9-Leprosy, unspecified)
3 Tetanus (A35-Other tetanus)
(Y58.4-Tetanus vaccine)
596
TIM 1

bacterial diseases)
(Z23.5-Need for immunization against tetanus alone)
(Z27.1-Need for immunization against diphtheria-

tetanus-pertussis, combined [DTP])

tetanus-pertussis with typhoid-paratyphoid [DTP +
TAB])

tetanus-pertussis with poliomyelitis [DTP + polio])
4 Erisipelas (A46-Erysipelas)
5 Sifilis stadium 1 dan 2 (A51-Early syphilis)

membranes)
(A53.0-Latent syphilis, unspecified as early or late)
(A53.9-Syphilis, unspecified)
597
TIM 1
Sindrom duh (discharge) genital (gonore

6 (A54-Gonococcal infection)
dan non gonore)
(A54.0-Gonococcal infection of lower genitourinary

tract without periurethral or accessory gland abscess)
(A54.6-Gonococcal infection of anus and rectum)
(A54.9-Gonococcal infection, unspecified)
(A56-Other sexually transmitted chlamydial diseases)
(A56.0-Chlamydial infection of lower genitourinary

tract)
(A56.2-Chlamydial infection of genitourinary tract,

unspecified)
(A56.8-Sexually transmitted chlamydial infection of

other sites)
7 Gonore (A54-Gonococcal infection)
(A54.0-Gonococcal infection of lower genitourinary

tract without periurethral or accessory gland abscess)
598
TIM 1
(A54.6-Gonococcal infection of anus and rectum)
(A54.9-Gonococcal infection, unspecified)
8 Herpes simpleks tanpa komplikasi (B00-Herpesviral [herpes simplex] infections)
(B00.9-Herpesviral infection, unspecified)
9 Varisela tanpa komplikasi (B01-Varicella [chickenpox])
(B01.9-Varicella without complication)
10 Herpes zoster tanpa komplikasi (B02-Zoster [herpes zoster])
(B02.9-Zoster without complication)
599
TIM 1
11 Morbili tanpa komplikasi (B05-Measles)
(B05.9-Measles without complication)
12 Veruka vulgaris (B07-Viral warts)
(B08-Other viral infections characterized by skin and

13 Moluskum kontagiosum mucous membrane lesions, not elsewhere classified)
(B08.1-Molluscum contagiosum)
14 Tinea kapitis (B35-Dermatophytosis)
(B35.0- Tinea barbae and tinea capitis)
15 Tinea barbe (B35-Dermatophytosis)
(B35.0- Tinea barbae and tinea capitis)
16 Tinea unguium (B35-Dermatophytosis)
(B35.1- Tinea unguium)
17 Tinea manus (B35-Dermatophytosis)
600
TIM 1
(B35.2-Tinea manuum)
18 Tinea pedis (B35-Dermatophytosis)
(B35.3- Tinea pedis)
19 Tinea korporis (B35-Dermatophytosis)
(B35.4-Tinea corporis)
(B35.5-Tinea imbricata)
20 Tinea kruris (B35-Dermatophytosis)
(B35.6-Tinea cruris)
21 Tinea fasialis (B35-Dermatophytosis)
(B35.8-Other dermatophytoses)
(B35.9-Dermatophytosis, unspecified)
22 Pitiriasis versikolor (B36-Other superficial mycoses)
(B36.0-Pityriasis versicolor)
601
TIM 1
(B36.1-Tinea nigra)
(B36.2-White piedra)
(B36.3-Black piedra)
(B36.8-Other specified superficial mycoses)
(B36.9-Superficial mycosis, unspecified)
23 Kandidosis mukokutan ringan (B37-Candidal stomatitis)
(B37.8-Candidiasis of other sites)
(B37.9-Candidiasis, unspecified)
24 Kandidiasis mulut (B37-Candidiasis)
(B37.0-Candidal stomatitis)
(B37.9-Candidiasis, unspecified)
25 Skistosomiasis (B65-Schistosomiasis [bilharziasis])
602
TIM 1

(B65.1-Schistosomiasis due to Schistosoma mansoni

[intestinal schistosomiasis])
(B65.2-Schistosomiasis due to Schistosoma japonicum)
(B65.8-Other schistosomiases)
(B65.9-Schistosomiasis, unspecified)
26 Taeniasis (B68-Taeniasis)
(B68.9-Taeniasis, unspecified)
27 Filariasis (B74-Filariasis)
(B74.0-Filariasis due to Wuchereria bancrofti)
603
TIM 1
(B74.3-Loiasis)

28 Pedikulosis pubis (B85-Pediculosis and phthiriasis)
(B85.0- Pediculosis due to Pediculus humanus capitis)
29 Pedikulosis kapitis (B85-Pediculosis and phthiriasis)
(B85.0- Pediculosis due to Pediculus humanus capitis)
(B85.1- Pediculosis due to Pediculus humanus

corporis)
(B85.4- Mixed pediculosis and phthiriasis)
30 Skabies (B86-Scabies)
31 Lipoma (D17-Benign lipomatous neoplasm)
604
TIM 1




subcutaneous tissue of other and unspecified sites)
(D17.7-Benign lipomatous neoplasm of other sites)
(D17.9-Benign lipomatous neoplasm, unspecified)
32 Anemia defisiensi besi pada kehamilan (D50-Iron deficiency anaemia)
(D50.9-Iron deficiency anaemia, unspecified)
(O99.0-Anaemia complicating pregnancy, childbirth

and the puerperium)
33 Hordeolum (H00-Hordeolum and chalazion)
(H00.0-Hordeolum and other deep inflammation of

eyelid)
34 Blefaritis (H01-Other inflammation of eyelid)
605
TIM 1
(H01.0-Blepharitis)
35 Trikiasis (H02-Other disorders of eyelid)
(H02.0-Entropion and trichiasis of eyelid)
36 Mata kering (H04-Disorders of lacrimal system)
(H04.1-Other disorders of lacrimal gland)
37 Konjungtivitis (H10-Conjunctivitis)
(H10.1-Acute atopic conjunctivitis)
(H10.5-Blepharoconjunctivitis)
606
TIM 1

38 Perdarahan subkonjungtiva (H11-Other disorders of conjunctiva)
(H57.8-Other specified disorders of eye and adnexa)
(H57.9-Disorder of eye and adnexa, unspecified)
39 Episkleritis (H15-Disorders of sclera)
(H15.1-Episcleritis)
607
TIM 1
40 Hipermetropia ringan (H52-Disorders of refraction and accommodation)
(H52.0-Hypermetropia)
41 Miopia ringan (H52-Disorders of refraction and accommodation)
(H52.1-Myopia)
42 Astigmatism ringan (H52-Disorders of refraction and accommodation)
(H52.2-Astigmatism)
43 Presbiopia (H52-Disorders of refraction and accommodation)
(H52.4-Presbyopia)
44 Buta senja (H53-Visual disturbances)
(H53.6-Night blindness)
45 Impetigo (L01-Impetigo)
(L01.0-Impetigo [any organism] [any site])
608
TIM 1
(L01.1-Impetiginization of other dermatoses)
46 Furunkel, karbunkel (L02-cutaneous abscess, furuncle and carbuncle)
(L02.0-Cutaneous abscess, furuncle and carbuncle of

face)

neck)

trunk)

buttock)

limb)

other sites)
(L02.9-Cutaneous abscess, furuncle and carbuncle,

unspecified)
(H04.3-Acute and unspecified inflammation of lacrimal

passages )
(N48.2- Other inflammatory disorders of penis)
609
TIM 1
(N49.2-Inflammatory disorders of scrotum)
(N49.8-Inflammatory disorders of other specified male

genital organs )
(N49.9-Inflammatory disorder of unspecified male

genital organ)
(N61-Inflammatory disorders of breast)
47 Abses folikel rambut atau kelenjar sebasea (L02-Cutaneous abscess, furuncle, and carbuncle)

face)

neck)

trunk)

buttock)

limb)

other sites)
(L02.9-Cutaneous abscess, furuncle and carbuncle,

unspecified)
(L08-Other local infections of skin and subcutaneous

48 Impetigo ulseratif (ektima) tissue)
(L08.0-Pyoderma)
610
TIM 1
(L08.8-Other specified local infections of skin and

(L08.9-Local infection of skin and subcutaneous tissue,

unspecified)

49 Eritrasma tissue)
(L08.1-Erythrasma)
50 Dermatitis atopik (kecuali recalcitrant) (L20-Atopic dermatitis)
(L20.0-Besnier prurigo)
(L20.8-Other atopic dermatitis)
(L20.9-Atopic dermatitis, unspecified)
51 Dermatitis seboroik (L21-Seborrhoeic dermatitis)
(L21.0-Seborrhoea capitis)
(L21.1-Seborrhoeic infantile dermatitis)
(L21.8-Other seborrhoeic dermatitis)
(L21.9-Seborrhoeic dermatitis, unspecified)
611
TIM 1
52 Napkin eczema (L22-Diaper [napkin] dermatitis)
53 Dermatitis kontak iritan (L24-Irritant contact dermatitis)
(L24.0-Irritant contact dermatitis due to detergents)
(L24.1-Irritant contact dermatitis due to oils and

greases)
(L24.2-Irritant contact dermatitis due to solvents)
(L24.3-Irritant contact dermatitis due to cosmetics)
(L24.4-Irritant contact dermatitis due to drugs in

contact with skin)

chemical products)

contact with skin)
(L24.7-Irritant contact dermatitis due to plants, except

food)
(L24.8-Irritant contact dermatitis due to other agents)
(L24.9-Irritant contact dermatitis, unspecified cause)

cosmetics)
612
TIM 1
(L25.1-Unspecified contact dermatitis due to drugs in

contact with skin)
(L25.2-Unspecified contact dermatitis due to dyes)
(L25.3-Unspecified contact dermatitis due to other

chemical products)
(L25.4-Unspecified contact dermatitis due to food in

contact with skin)
(L25.5-Unspecified contact dermatitis due to plants,

except food)
(L25.8-Unspecified contact dermatitis due to other

agents)
(L25.9-Unspecified contact dermatitis, unspecified

cause)
Exanthematous drug eruption, fixed drug

54 (L27-Dermatitis due to substances taken internally)
eruption
(L27.0-Generalized skin eruption due to drugs and

medicaments)

medicaments)
55 Alergi makanan (L27-Dermatitis due to substances taken internally)
(L27.2-Dermatitis due to ingested food)
(L27.8-Dermatitis due to other substances taken

internally)
613
TIM 1
(L27.9-Dermatitis due to unspecified substance taken

internally)
(T78.1-Other adverse food reactions, not elsewhere

classified)
(K52.2-Allergic and dietetic gastroenteritis and colitis)
56 Dermatitis numularis (L30-Other dermatitis)
(L30.0-Nummular dermatitis)
(L30.8-Other specified dermatitis)
(L30.9-Dermatitis, unspecified)
57 Pitiriasis rosea (L42-Pityriasis rosea)
(L30.5-Pityriasis alba)
58 Urtikaria akut (L50-Urticaria)
(L50.0-Allergic urticaria)
(L50.2-Urticaria due to cold and heat)
614
TIM 1
(L50.3-Dermatographic urticaria)
(L50.4-Vibratory urticaria)
(L50.6-Contact urticaria)
(L50.9-Urticaria, unspecified)
(L56.3-Solar urticaria)
(L29-Pruritus)
(L29.0-Pruritus ani)
(L29.1-Pruritus scroti)
(L29.2-Pruritus vulvae)
(L29.3-Anogenital pruritus, unspecified)
(L29.8-Other pruritus)
(L29.9-Pruritus, unspecified)
(T80.6-Other serum reactions)
59 Akne vulgaris ringan (L70-Acne)
615
TIM 1
(L70.0-Acne vulgaris)
(L70.5-Acné excoriée des jeunes filles)
(L70.8-Other acne)
(L71-Rosacea)
(L71.1-Rhinophyma)
60 Dermatitis perioral (L71-Rosacea)
(L71.0-Perioral dermatitis)
616
TIM 1
61 Folikulitis superfisialis (L72-Follicular cysts of skin and subcutaneous tissue)
(L72.8-Other follicular cysts of skin and subcutaneous

tissue)
(L72.9-Follicular cyst of skin and subcutaneous tissue,

unspecified)

tissue)
(L08.0-Pyoderma)
(L08.8-Other specified local infections of skin and

(L08.9-Local infection of skin and subcutaneous tissue,

unspecified)
62 Hidradenitis supuratif (L73-Other follicular disorders)
617
TIM 1
(L73.0-Acne keloid)
(L73.2-Hidradenitis suppurativa)
63 Miliaria (L74-Eccrine sweat disorders)
(L74.3-Miliaria, unspecified)
64 Ulkus pada tungkai (L97-Ulcer of lower limb, not elsewhere classified)
618
TIM 1
(I83.0-Varicose veins of lower extremities with ulcer)

inflammation)
(I83.2-Varicose veins of lower extremities with both

ulcer and inflammation)
(I83.9-Varicose veins of lower extremities without

ulcer or inflammation)
65 Fimosis (N47-Redundant prepuce, phimosis and paraphimosis)
66 Parafismosis (N47-Redundant prepuce, phimosis and paraphimosis)
67 Mastitis (N61-Inflammatory disorders of breast)
(O91-Infections of breast associated with childbirth)
(O91.0-Infection of nipple associated with childbirth)
(O91.1-Abscess of breast associated with childbirth)
(O91.2-Nonpurulent mastitis associated with

childbirth)
68 Vaginitis (N76-Other inflammation of vagina and vulva)
(N76.0-Acute vaginitis)
619
TIM 1
(N76.8-Other specified inflammation of vagina and

vulva)
69 Vaginosis bakterialis (N76-Other inflammation of vagina and vulva)
(N76.0-Acute vaginitis)

vulva)
(N77-Vulvovaginal ulceration and inflammation in


infectious and parasitic diseases classified elsewhere)
(N77.8-Vulvovaginal ulceration and inflammation in

other diseases classified elsewhere)
70 Vulvitis (N76-Other inflammation of vagina and vulva)
(N76.2-Acute vulvitis)
620
TIM 1

vulva)
71 Aborsi spontan komplit (O03-Spontaneous abortion)

complication)

complication)

complication)

complication)
72 Ruptur perineum tingkat 1-2 (O70-Perineal laceration during delivery)
(O70.0-First degree perineal laceration during delivery)
(O70.1-Second degree perineal laceration during

delivery)
621
TIM 1
73 Kehamilan normal (O80-Single spontaneous delivery)
(O80.0-Spontaneous vertex delivery)
(O80.8-Other single spontaneous delivery)
(O80.9-Single spontaneous delivery, unspecified)
(O26.8-Other specified pregnancy-related conditions)
(O26.9-Pregnancy-related condition, unspecified)

74 Inverted nipple associated with childbirth)
(O92.0-Retracted nipple associated with childbirth)

75 Cracked nipple associated with childbirth)
(O92.1-Cracked nipple associated with childbirth)
622
TIM 1
(P38-Omphalitis of newborn with or without mild

76 Infeksi pada umbilikus haemorrhage)
(T00-Superficial injuries involving multiple body

77 Vulnus laseratum, vulnus punctum regions)
(T00.0-Superficial injuries involving head with neck)
(T00.1-Superficial injuries involving thorax with

(T00.2-Superficial injuries involving multiple regions of

upper limb(s))

lower limb(s))

upper limb(s) with lower limb(s))
(T00.8-Superficial injuries involving other

(T00.9-Multiple superficial injuries, unspecified)
(T14-Injury of unspecified body region)
(T14.0-Superficial injury of unspecified body region)
(T14.1-Open wound of unspecified body region)
(T14.8-Other injuries of unspecified body region)
(T14.9-Injury, unspecified)
623
TIM 1
78 Benda asing di konjungtiva (T15-Foreign body on external eye)
(T15.8- Foreign body in other and multiple parts of

external eye)
(T15.9-Foreign body on external eye, part unspecified)
(T30.0-Burn of unspecified body region, unspecified

79 Luka bakar derajat 1 dan 2 degree)
(T30.1-Burn of first degree, body region unspecified)
(T30.2-Burn of second degree, body region

unspecified)

unspecified degree)

unspecified)
(T30.6-Corrosion of second degree, body region

unspecified)
(T21.1-Burn of first degree of trunk)
624
TIM 1
(T21.4-Corrosion of unspecified degree of trunk)
(T22-Burn and corrosion of shoulder and upper limb,

except wrist and hand)
(T22.0-Burn of unspecified degree of shoulder and

(T22.1-Burn of first degree of shoulder and upper limb,

except wrist and hand)
(T22.2-Burn of second degree of shoulder and upper

(T22.4-Corrosion of unspecified degree of shoulder

(T22.5-Corrosion of first degree of shoulder and upper

(T22.6-Corrosion of second degree of shoulder and

(T23.0-Burn of unspecified degree of wrist and hand)
(T23.1-Burn of first degree of wrist and hand)
(T23.2-Burn of second degree of wrist and hand)
625
TIM 1
(T23.4-Corrosion of unspecified degree of wrist and

hand)
(T23.5-Corrosion of first degree of wrist and hand)
(T23.6-Corrosion of second degree of wrist and hand)
(T24-Burn and corrosion of hip and lower limb, except

ankle and foot)
(T24.0-Burn of unspecified degree of hip and lower

(T24.1-Burn of first degree of hip and lower limb,

(T30-Burn and corrosion, body region unspecified)
(T24.2-Burn of second degree of hip and lower limb,

(T24.4-Corrosion of unspecified degree of hip and

(T24.5-Corrosion of first degree of hip and lower limb,

(T24.6-Corrosion of second degree of hip and lower

(T25.0-Burn of unspecified degree of ankle and foot)
(T25.1-Burn of first degree of ankle and foot)
626
TIM 1
(T25.2-Burn of second degree of ankle and foot)
(T25.4-Corrosion of unspecified degree of ankle and

foot)
(T25.5-Corrosion of first degree of ankle and foot)
(T25.6-Corrosion of second degree of ankle and foot)
(T29-Burns and corrosions of multiple body regions)
(T29.0-Burns of multiple regions, unspecified degree)
(T29.1-Burns of multiple regions, no more than first-

degree burns mentioned)

(T29.4-Corrosions of multiple regions, unspecified

degree)
(T29.5-Corrosions of multiple regions, no more than

first-degree corrosions mentioned)
(T29.6-Corrosions of multiple regions, no more than

second-degree corrosions mentioned)
80 Reaksi gigitan serangga (T63-Toxic effect of contact with venomous animals)
(T63.4- Venom of other arthropods)
81 Kekerasan tajam (X99-Assault by sharp object)
627
TIM 1
(Y28-Contact with sharp object, undetermined intent)
(Y35.4-Legal intervention involving sharp objects)
(W26.9-Contact with unspecified sharp object(s))
82 Kekerasan tumpul (Y00-Assault by blunt object)
(Y29-Contact with blunt object, undetermined intent)
(Y35.3-Legal intervention involving blunt objects)
628
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
629
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
630
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
631
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
Ada
632
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
Ada
Ada
Ada
Ada
633
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
Ada
Ada
Ada
634
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
635
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
636
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
637
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
638
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
Ada
639
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
640
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
Ada
Ada
Ada
641
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
642
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
643
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
644
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
645
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
646
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
647
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
648
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
649
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
650
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
651
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
Ada
Ada
652
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
653
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
654
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
655
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
656
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
Ada
657
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
658
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
659
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
Ada
660
TANGANI OLEH FKTP
M1
Mampu Ditangani
KMK 514/2015
Ya Tidak
661
Daftar Peserta TIM 1
Ketua Tim: dr. Ary Andarwati, M.Mkes.
Kepala Dinas Kesehatan dan Keluarag Laboratorium Sarana Med

Berencana Kota Madiun
IAI Kota Mad
Kepala Dinas Kesehatan Kabupaten Madiun IAI Kabupaten Mad
Kepala Dinas Kesehatan Kabupaten Ngawi IDI Kota Mad
Kabid Yankes Dinkes dan KB Kota Madiun IDI Kabupaten Mad
Dokter Spesialis Bedah IDI Kabupaten Ponoro
Dokter Spesialis Mata Kepala Puskesmas Kota Mad
Dokter Spesialis Obgyn Kepala Puskesmas Kabupaten Mad

TKMKB unsur PDGI Kepala Puskesmas Kabupaten Mage
TKMKB unsur IBI Kepala Puskesmas Kabupaten Nga
Asklin Kota Madiun Asklin Kabupaten Mage
Asklin Kabupaten Madiun Asklin Kabupaten Nga

Daftar Peserta TIM 2
Ketua Tim: dr. Winangku Isparyanto, M.Kes., Sp.S.
Kepala Dinas Kesehatan Kabupaten Magetan Laboratorium Klinik Widodo Med
Kepala Dinas Kesehatan Kabupaten Ponorogo Kepala Puskesmas Kabupaten Ponoro
Kabid Yankes Dinkes Kabupaten Ngawi Klinik Polres Madiun K
Kabid Yankes Dinkes Kabupaten Magetan Poli Klinik Denkesyah Mad
Kabid Yankes Dinkes Kabupaten Ponorogo IAI Kabupaten Maget
Dokter Spesialis Penyakit Dalam IAI Kabupaten Nga

Dokter Spesialis Paru IAI Kabupaten Ponoro
Dokter Spesialis THT Asklin Kabupaten Ponoro
IDI Kabupaten Ngawi TKMKB dari Unsur PP
IDI Kabupaten Magetan
TKMKB Unsur PPNI

r Peserta TIM 1
m: dr. Ary Andarwati, M.Mkes.
Laboratorium Sarana Medika
IAI Kota Madiun

IAI Kabupaten Madiun
IDI Kota Madiun
IDI Kabupaten Madiun
IDI Kabupaten Ponorogo
Kepala Puskesmas Kota Madiun
Kepala Puskesmas Kabupaten Madiun

Kepala Puskesmas Kabupaten Magetan
Kepala Puskesmas Kabupaten Ngawi
Asklin Kabupaten Magetan
Asklin Kabupaten Ngawi

r Peserta TIM 2
Winangku Isparyanto, M.Kes., Sp.S.
Laboratorium Klinik Widodo Medika
Kepala Puskesmas Kabupaten Ponorogo
Klinik Polres Madiun Kota
Poli Klinik Denkesyah Madiun
IAI Kabupaten Magetan
IAI Kabupaten Ngawi

IAI Kabupaten Ponorogo
Asklin Kabupaten Ponorogo
TKMKB dari Unsur PPNI

PKM PKM
No Nama Diagnosa Poned Ranap
1 Acute amoebic dysentery √ √
2 Other and unspecified gastroenteritis and colitis of infectious origin √ √
3 Leptospirosis, unspecified - -
4 Other tetanus - -
5 Dengue fever [classical dengue] √ √
6 Dengue haemorrhagic fever √ √
7 Acute hepatitis A - -
8 Mumps orchitis - -
9 Unspecified malaria √ √
10 Filariasis due to wuchereria bancrofti √ √
11 Hypoglycaemia, unspecified √ √
12 Unspecified protein-energy malnutrition √ √
13 Bell's palsy - -
14 Entropion and trichiasis of eyelid - -
15 Hypermetropia - -
16 Myopia - -
17 Astigmatism - -
18 Presbyopia - -
19 Bronchopneumonia, unspecified √ √
20 Pneumonia, unspecified √ √
21 Acute tubulo-interstitial nephritis - -
PKM PKM
No Nama Diagnosa Poned Ranap
22 Redundant prepuce, phimosis and paraphimosis √ √
23 Complication associated with artificial fertilization, unspecified - -
24 Spontaneous abortion, Complete or unspecified, without complication √
25 First degree perineal laceration during delivery √
26 Omphalitis of newborn with or without mild haemorrhage √ √
27 Febrile convulsions √ √
28 Burn of second degree, body region unspecified √ √
29 Asymptomatic human immunodeficiency virus [HIV] infection status - -
PKM Klinik DPP
Rajal Pratama
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
PKM Klinik DPP
Rajal Pratama
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
Kejang demam
tetanus
HIV AIDS tanpa komplikasi
tens
Jumlah Diagnosa Hasil FGD Peer Review
No. Jenis Faskes Berdasarkan KMK 514/2015
Tidak Mampu Mampu Total Diagnosa

1 Puskesmas Poned 13 132 145
2 Puskesmas Rawat Inap 15 130 145
3 Puskesmas Rawat Jalan 29 116 145
4 Klinik Pratama 29 116 145
5 Dokter Praktik Perorangan 29 116 145
Jumlah Diagnosa Non Spesialistik Berdasar SKDI
Compare dengan Hasil FGD
Belum ada Saat FGD Peer Review Total
Peer Review Sept-18 Diagnosa
Tidak Mampu Mampu
13 12 119 144
13 14 117 144
13 26 105 144
13 26 105 144
13 26 105 144
Kota Madiun
ICD 10 ICD 10 tanpa Nama DX
Nama Penyakit Kunjungan
titik
Demam tifoid A01 A01 Typhoid and paratyphoid fevers 114
A01.0 A010 Typhoid fever 297
A01.1 A011 Paratyphoid fever A 1
A01.2 A012 Paratyphoid fever B 4
A01.3 A013 Paratyphoid fever C -
A01.4 A014 Paratyphoid fever, unspecified 242
-
Disentri basiler, disentri
amuba A06 A06 Amoebiasis 6
A06.0 A060 Acute amoebic dysentery 7
A06.1 A061 Chronic intestinal amoebiasis -
A06.2 A062 Amoebic nondysenteric colitis -
A06.3 A063 Amoeboma of intestine -
A06.7 A067 Cutaneous amoebiasis -
A06.8 A068 Amoebic infection of other sites 2
A06.9 A069 Amoebiasis, unspecified 4
A03 A03 Shigellosis 3
A03.0 A030 Shigellosis due to Shigella dysenteriae 1

A03.1 A031 Shigellosis due to Shigella flexneri -
A03.2 A032 Shigellosis due to Shigella boydii -
A03.3 A033 Shigellosis due to Shigella sonnei -
A03.8 A038 Other shigellosis -
A03.9 A039 Shigellosis, unspecified 2
-
Gastroenteritis
(termasuk kolera, Other gastroenteritis and colitis of
giardiasis) A09 A09 infectious and unspecified origin 4,537
Other and unspecified gastroenteritis and

A09.0 A090 colitis of infectious origin 74
Gastroenteritis and colitis of unspecified
A09.9 A099 origin 148
Viral and other specified intestinal
A08 A08 infections 14
A08.0 A080 Rotaviral enteritis 9
Acute gastroenteropathy due to Norwalk
A08.1 A081 agent -
A08.2 A082 Adenoviral enteritis -
A08.3 A083 Other viral enteritis -
A08.4 A084 Viral intestinal infection, unspecified 6
A08.5 A085 Other specified intestinal infections 3
A02 A02 Other salmonella infections -
A02.0 A020 Salmonella enteritis 1
-
Tuberkulosis paru tanpa Respiratory tuberculosis, bacteriologically
komplikasi A15 A15 and histologically confirmed 456
Tuberculosis of lung, confirmed by

sputum microscopy with or without
A15.0 A150 culture 70
Tuberculosis of lung, confirmed by culture
A15.1 A151 only 22
Tuberculosis of lung, confirmed
A15.2 A152 histologically 3
Tuberculosis of lung, confirmed by
A15.3 A153 unspecified means 97
Tuberculosis of intrathoracic lymph nodes,

confirmed bacteriologically and
Tuberculosis of larynx, trachea and

Tuberculous pleurisy, confirmed
A15.6 A156 bacteriologically and histologically 5
Primary respiratory tuberculosis,

Other respiratory tuberculosis, confirmed

A15.8 A158 bacteriologically and histologically 28
Respiratory tuberculosis unspecified,

Tuberculosis of lung, bacteriological and

A16.1 A161 histological examination not done 1
Tuberculosis of lung, without mention of

bacteriological or histological
A16.2 A162 confirmation 87
Primary respiratory tuberculosis without

Other respiratory tuberculosis, without

Respiratory tuberculosis unspecified,

A16.9 A169 histological confirmation 106
-
Skrofuloderma A18 A18 Tuberculosis of other organs 49
Tuberculosis of skin and subcutaneous
A18.4 A184 tissue 1
-
Leptospirosis (tanpa
komplikasi) A27 A27 Leptospirosis -
A27.0 A270 Leptospirosis icterohaemorrhagica -
A27.8 A278 Other forms of leptospirosis -
A27.9 A279 Leptospirosis, unspecified -
-
Lepra A30 A30 Leprosy [Hansen disease] 14
A30.0 A300 Indeterminate leprosy -
A30.1 A301 Tuberculoid leprosy -
A30.2 A302 Borderline tuberculoid leprosy -
A30.3 A303 Borderline leprosy -
A30.4 A304 Borderline lepromatous leprosy -
A30.5 A305 Lepromatous leprosy -
A30.8 A308 Other forms of leprosy -
A30.9 A309 Leprosy, unspecified 5
B92 B92 Sequelae of leprosy -
-
Tetanus A35 A35 Other tetanus 5
Y58.4 Y584 Tetanus vaccine -
Special screening examination for other
Z11.2 Z112 bacterial diseases -
Need for immunization against tetanus
Z23.5 Z235 alone 19
Need for immunization against diphtheria-

Z27.1 Z271 tetanus-pertussis, combined [DTP] 12

tetanus-pertussis with typhoid-
Z27.2 Z272 paratyphoid [DTP + TAB] 1

tetanus-pertussis with poliomyelitis [DTP
Z27.3 Z273 + polio] 6
-
Pertusis A37 A37 Whooping cough 42
Whooping cough due to Bordetella
A37.0 A370 pertussis 6
Whooping cough due to Bordetella
A37.1 A371 parapertussis 1
Whooping cough due to other Bordetella
A37.8 A378 species -
A37.9 A379 Whooping cough, unspecified 11
-
Erisipelas A46 A46 Erysipelas -
O86.8 O868 Other specified puerperal infections 1
-
Sifilis stadium 1 dan 2 A51 A51 Early syphilis 1
Secondary syphilis of skin and mucous
A51.3 A513 membranes 1
A53 A53 Other and unspecified syphilis 2
A53.0 A530 Latent syphilis, unspecified as early or late 4

A53.9 A539 Syphilis, unspecified 8
A65 A65 Nonvenereal syphilis -
-
Sindrom duh (discharge)

genital (gonore dan non
gonore) A54 A54 Gonococcal infection 6
Gonococcal infection of lower

A54.0 A540 accessory gland abscess 3
A54.3 A543 Gonococcal infection of eye -
A54.5 A545 Gonococcal pharyngitis 1
A54.6 A546 Gonococcal infection of anus and rectum -

A54.8 A548 Other gonococcal infections -
A54.9 A549 Gonococcal infection, unspecified 17
Other sexually transmitted chlamydial
A56 A56 diseases 7
Chlamydial infection of lower
A56.0 A560 genitourinary tract 3
Chlamydial infection of genitourinary
A56.2 A562 tract, unspecified -
Sexually transmitted chlamydial infection
A56.8 A568 of other sites 1
A64 A64 Unspecified sexually transmitted disease 22

-
Gonore A54 A54 Gonococcal infection 6
Gonococcal infection of lower

A54.0 A540 accessory gland abscess 3
A54.3 A543 Gonococcal infection of eye -
A54.5 A545 Gonococcal pharyngitis 1
A54.6 A546 Gonococcal infection of anus and rectum -

A54.8 A548 Other gonococcal infections -
A54.9 A549 Gonococcal infection, unspecified 17
A64 A64 Unspecified sexually transmitted disease 22

-
Demam dengue, DHF A90 A90 Dengue fever [classical dengue] 48
A91 A91 Dengue haemorrhagic fever 18
-
Herpes simpleks tanpa
komplikasi B00 B00 Herpesviral [herpes simplex] infections 133
B00.8 B008 Other forms of herpesviral infection 7
B00.9 B009 Herpesviral infection, unspecified 85
-
Varisela tanpa
komplikasi B01 B01 Varicella [chickenpox] 273
B01.9 B019 Varicella without complication 269
-
Herpes zoster tanpa
komplikasi B02 B02 Zoster [herpes zoster] 270
B02.9 B029 Zoster without complication 79
-
Morbili tanpa komplikasi B05 B05 Measles 11

B05.9 B059 Measles without complication 9
-
Veruka vulgaris B07 B07 Viral warts 24
-
Other viral infections characterized by skin

and mucous membrane lesions, not
Moluskum kontagiosum B08 B08 elsewhere classified 5
B08.1 B081 Molluscum contagiosum 1
-
Hepatitis A B15 B15 Acute hepatitis A 1
B15.9 B159 Hepatitis A without hepatic coma 1
-
Parotitis B26 B26 Mumps 308
B26.9 B269 Mumps without complication 164
-
Tinea kapitis B35 B35 Dermatophytosis 83
B35.0 B350 Tinea barbae and tinea capitis 37
-
Tinea barbe B35 B35 Dermatophytosis 83
B35.0 B350 Tinea barbae and tinea capitis 37
-
Tinea unguium B35 B35 Dermatophytosis 83
B35.1 B351 Tinea unguium 18
-
Tinea manus B35 B35 Dermatophytosis 83
B35.2 B352 Tinea manuum 4
-
Tinea pedis B35 B35 Dermatophytosis 83
B35.3 B353 Tinea pedis 60
-
Tinea korporis B35 B35 Dermatophytosis 83
B35.4 B354 Tinea corporis 148
B35.5 B355 Tinea imbricata 4
-
Tinea kruris B35 B35 Dermatophytosis 83
B35.6 B356 Tinea cruris 97
-
Tinea fasialis B35 B35 Dermatophytosis 83
B35.8 B358 Other dermatophytoses 11
B35.9 B359 Dermatophytosis, unspecified 50
-
Pitiriasis versikolor B36 B36 Other superficial mycoses 52
B36.0 B360 Pityriasis versicolor 7
B36.1 B361 Tinea nigra 13
B36.2 B362 White piedra -
B36.3 B363 Black piedra 1
B36.8 B368 Other specified superficial mycoses 2
B36.9 B369 Superficial mycosis, unspecified 48
-
Kandidosis mukokutan
ringan B37 B37 Candidal stomatitis 39
B37.2 B372 Candidiasis of skin and nail 5
B37.8 B378 Candidiasis of other sites 1
B37.9 B379 Candidiasis, unspecified 53
-
Kandidiasis mulut B37 B37 Candidiasis 39
B37.0 B370 Candidal stomatitis 289
B37.9 B379 Candidiasis, unspecified 53
-
Skistosomiasis B65 B65 Schistosomiasis [bilharziasis] -
Schistosomiasis due to Schistosoma

B65.0 B650 haematobium [urinary schistosomiasis] -
B65.1 B651 mansoni [intestinal schistosomiasis] -
B65.2 B652 japonicum -
B65.3 B653 Cercarial dermatitis 34
B65.8 B658 Other schistosomiases -
B65.9 B659 Schistosomiasis, unspecified -
-
Taeniasis B68 B68 Taeniasis -
B68.0 B680 Taenia solium taeniasis -
B68.1 B681 Taenia saginata taeniasis -
B68.9 B689 Taeniasis, unspecified -
-
Filariasis B74 B74 Filariasis 1
B74.0 B740 Filariasis due to Wuchereria bancrofti -
B74.1 B741 Filariasis due to Brugia malayi -
B74.2 B742 Filariasis due to Brugia timori -
B74.3 B743 Loiasis 1
B74.4 B744 Mansonelliasis -
B74.8 B748 Other filariases -
B74.9 B749 Filariasis, unspecified 1
Special screening examination for other

Z11.6 Z116 protozoal diseases and helminthiases -
-
Penyakit cacing tambang B76 B76 Hookworm diseases -

B76.0 B760 Ancylostomiasis 4
B76.1 B761 Necatoriasis -
B76.8 B768 Other hookworm diseases 2
B76.9 B769 Hookworm disease, unspecified 4
-
Cutaneus larva migran B76 B76 Hookworm diseases -

B76.0 B760 Ancylostomiasis 4
B76.1 B761 Necatoriasis -
B76.8 B768 Other hookworm diseases 2
B76.9 B769 Hookworm disease, unspecified 4
B87.0 B870 Cutaneous myiasis -
B87.9 B879 Myiasis, unspecified -
-
Askariasis B77 B77 Ascariasis 1
B77.9 B779 Ascariasis, unspecified 1
Disorders of other specified digestive

K93.8 K938 organs in diseases classified elsewhere -
-
Strongiloidiasis B78 B78 Strongyloidiasis 1
B78.0 B780 Intestinal strongyloidiasis -
B78.1 B781 Cutaneous strongyloidiasis -
B78.7 B787 Disseminated strongyloidiasis -
B78.9 B789 Strongyloidiasis, unspecified -
-
Malaria B85.3 B853 Phthiriasis 1
B50 B50 Plasmodium falciparum malaria -
Plasmodium falciparum malaria,
B50.9 B509 unspecified -
B51 B51 Plasmodium vivax malaria -
Plasmodium vivax malaria with other
B51.8 B518 complications -
Plasmodium vivax malaria without
B51.9 B519 complication -
B52 B52 Plasmodium malariae malaria 1
Plasmodium malariae malaria with other
B52.8 B528 complications -
Plasmodium malariae malaria without
B52.9 B529 complication -
B53 B53 Other parasitologically confirmed malaria -

B53.0 B530 Plasmodium ovale malaria -
B53.1 B531 Malaria due to simian plasmodia -
Other parasitologically confirmed malaria,
B53.8 B538 not elsewhere classified -
B54 B54 Unspecified malaria -
-
Pedikulosis pubis B85 B85 Pediculosis and phthiriasis 1
Pediculosis due to Pediculus humanus
B85.0 B850 capitis -
-
Pedikulosis kapitis B85 B85 Pediculosis and phthiriasis 1
B85.0 B850 capitis -
B85.1 B851 corporis -
B85.4 B854 Mixed pediculosis and phthiriasis -
-
Skabies B86 B86 Scabies 114
-
Lipoma D17 D17 Benign lipomatous neoplasm 100
Benign lipomatous neoplasm of skin and

subcutaneous tissue of head, face and
D17.0 D170 neck 44
D17.1 D171 subcutaneous tissue of trunk 6
D17.2 D172 subcutaneous tissue of limbs 1

subcutaneous tissue of other and
D17.3 D173 unspecified sites 19
Benign lipomatous neoplasm of other
D17.7 D177 sites 11
D17.9 D179 Benign lipomatous neoplasm, unspecified 55

-
Anemia defisiensi besi D50 D50 Iron deficiency anaemia 47

D50.8 D508 Other iron deficiency anaemias 2
D50.9 D509 Iron deficiency anaemia, unspecified 7
D64 D64 Other anaemias 27
D64.8 D648 Other specified anaemias 13
D64.9 D649 Anaemia, unspecified 39
-
Anemia defisiensi besi
pada kehamilan D50 D50 Iron deficiency anaemia 47
D50.8 D508 Other iron deficiency anaemias 2
D50.9 D509 Iron deficiency anaemia, unspecified 7
Anaemia complicating pregnancy,
O99.0 O990 childbirth and the puerperium 35
-
Diabetes melitus tipe 1 E10 E10 Insulin-dependent diabetes mellitus 1,128

Insulin-dependent diabetes mellitus
E10.9 E109 without complications 636
-
Diabetes melitus tipe 2 E11 E11 Non-insulin-dependent diabetes mellitus 9,185

Non-insulin-dependent diabetes mellitus
E11.9 E119 without complications 20,583
-
Other disorders of pancreatic internal
Hipoglikemia ringan E16 E16 secretion 6
E16.1 E161 Other hypoglycaemia -
E16.2 E162 Hypoglycaemia, unspecified 11
-
Malnutrisi energi-
protein E40 E40 Kwashiorkor 4
E41 E41 Nutritional marasmus 1
E42 E42 Marasmic kwashiorkor -
Protein-energy malnutrition of moderate
E44 E44 and mild degree 1
E44.0 E440 Moderate protein-energy malnutrition -

E44.1 E441 Mild protein-energy malnutrition -
E46 E46 Unspecified protein-energy malnutrition 2
E64.0 E640 Sequelae of protein-energy malnutrition -

-
Defisiensi vitamin E50 E50 Vitamin A deficiency -
Vitamin A deficiency with conjunctival
E50.0 E500 xerosis 2
Vitamin A deficiency with Bitot spot and
E50.1 E501 conjunctival xerosis -
E50.2 E502 Vitamin A deficiency with corneal xerosis -

Vitamin A deficiency with corneal
E50.3 E503 ulceration and xerosis -
E50.4 E504 Vitamin A deficiency with keratomalacia -

E50.5 E505 Vitamin A deficiency with night blindness -
Vitamin A deficiency with xerophthalmic
E50.6 E506 scars of cornea -
Other ocular manifestations of vitamin A
E50.7 E507 deficiency -
Other manifestations of vitamin A
E50.9 E509 Vitamin A deficiency, unspecified 1
E51 E51 Thiamine deficiency -
E51.1 E511 Beriberi -
Other manifestations of thiamine
E51.9 E519 Thiamine deficiency, unspecified -
E52 E52 Niacin deficiency [pellagra] -
E53 E53 Deficiency of other B group vitamins -
E53.0 E530 Riboflavin deficiency -
E53.1 E531 Pyridoxine deficiency -
Deficiency of other specified B group
E53.8 E538 vitamins -
E53.9 E539 Vitamin B deficiency, unspecified 1
E54 E54 Ascorbic acid deficiency -
E55 E55 Vitamin D deficiency -
E55.0 E550 Rickets, active -
E55.9 E559 Vitamin D deficiency, unspecified -
E56 E56 Other vitamin deficiencies 2
E56.0 E560 Deficiency of vitamin E -
E56.1 E561 Deficiency of vitamin K -
E56.8 E568 Deficiency of other vitamins -
E56.9 E569 Vitamin deficiency, unspecified 2
Sequelae of malnutrition and other
E64 E64 nutritional deficiencies -
E64.1 E641 Sequelae of vitamin A deficiency -
E64.2 E642 Sequelae of vitamin C deficiency -
E64.3 E643 Sequelae of rickets -
E64.8 E648 Sequelae of other nutritional deficiencies -

Sequelae of unspecified nutritional
-
Defisiensi mineral E58 E58 Dietary calcium deficiency -
E59 E59 Dietary selenium deficiency -
E60 E60 Dietary zinc deficiency -
E61 E61 Deficiency of other nutrient elements -

E61.0 E610 Copper deficiency -
E61.1 E611 Iron deficiency -
E61.2 E612 Magnesium deficiency -
E61.3 E613 Manganese deficiency -
E61.4 E614 Chromium deficiency -
E61.5 E615 Molybdenum deficiency -
E61.6 E616 Vanadium deficiency -
E61.7 E617 Deficiency of multiple nutrient elements -

Deficiency of other specified nutrient
E61.8 E618 elements -
Deficiency of nutrient element,
E61.9 E619 unspecified -
E63 E63 Other nutritional deficiencies -
E63.0 E630 Essential fatty acid [EFA] deficiency -
E63.1 E631 Imbalance of constituents of food intake -
E63.8 E638 Other specified nutritional deficiencies -

E63.9 E639 Nutritional deficiency, unspecified 4
-
Obesitas E66 E66 Obesity 1
E66.0 E660 Obesity due to excess calories -
E66.1 E661 Drug-induced obesity -
E66.8 E668 Other obesity -
E66.9 E669 Obesity, unspecified 5
-
Disorders of lipoprotein metabolism and
Dislipidemia E78 E78 other lipidaemias 697
E78.0 E780 Pure hypercholesterolaemia 403
E78.1 E781 Pure hyperglyceridaemia 8
E78.2 E782 Mixed hyperlipidaemia 28
E78.3 E783 Hyperchylomicronaemia 3
E78.4 E784 Other hyperlipidaemia 173
E78.5 E785 Hyperlipidaemia, unspecified 607
E78.6 E786 Lipoprotein deficiency 3
E78.8 E788 Other disorders of lipoprotein metabolism 9

Disorder of lipoprotein metabolism,
E78.9 E789 unspecified 167
-
Disorders of purine and pyrimidine
Hiperurisemia E79 E79 metabolism 41
Hyperuricaemia without signs of

inflammatory arthritis and tophaceous
E79.0 E790 disease 161
E79.1 E791 Lesch-Nyhan syndrome -
Other disorders of purine and pyrimidine
E79.8 E798 metabolism -
Disorder of purine and pyrimidine
E79.9 E799 metabolism, unspecified 49
-
Gangguan somatoform F45 F45 Somatoform disorders 16

F45.0 F450 Somatization disorder 3
F45.1 F451 Undifferentiated somatoform disorder -

F45.2 F452 Hypochondriacal disorder -
F45.3 F453 Somatoform autonomic dysfunction -
F45.4 F454 Persistent somatoform pain disorder 1
F45.8 F458 Other somatoform disorders 2
F45.9 F459 Somatoform disorder, unspecified 14
-
Insomnia F51 F51 Nonorganic sleep disorders 6
F51.0 F510 Nonorganic insomnia 24
Nonorganic disorder of the sleep-wake
F51.2 F512 schedule -
F51.8 F518 Other nonorganic sleep disorders -
Disorders of initiating and maintaining
G47.0 G470 sleep [insomnias] 16
-
Migren G43 G43 Migraine 64
Migraine without aura [common
G43.0 G430 migraine] 6
G43.1 G431 Migraine with aura [classical migraine] 2

G43.2 G432 Status migrainosus -
G43.8 G438 Other migraine 4
G43.9 G439 Migraine, unspecified 92
N94.3 N943 Premenstrual tension syndrome -
-
Tension headache G44 G44 Other Headache Syndromes 1,363
Vascular headache, not elsewhere
G44.1 G441 classified 462
G44.2 G442 Tension-type headache 500
G44.3 G443 Chronic post-traumatic headache 14
Drug-induced headache, not elsewhere
G44.4 G444 classified -
G44.8 G448 Other specified headache syndromes 218
R51 R51 Headache 4,807
-
Bells' palsy G51 G51 Facial nerve disorders 19
G51.0 G510 Bell's palsy 23
-
Hordeolum H00 H00 Hordeolum and chalazion 237
Hordeolum and other deep inflammation
H00.0 H000 of eyelid 228
-
Blefaritis H01 H01 Other inflammation of eyelid 69
H01.0 H010 Blepharitis 23
-
Trikiasis H02 H02 Other disorders of eyelid 17
H02.0 H020 Entropion and trichiasis of eyelid 1
-
Mata kering H04 H04 Disorders of lacrimal system 52
H04.1 H041 Other disorders of lacrimal gland 36
-
Konjungtivitis H10 H10 Conjunctivitis 1,213
H10.0 H100 Mucopurulent conjunctivitis 47
H10.1 H101 Acute atopic conjunctivitis 75
H10.2 H102 Other acute conjunctivitis 9
H10.3 H103 Acute conjunctivitis, unspecified 100
H10.4 H104 Chronic conjunctivitis 26
H10.5 H105 Blepharoconjunctivitis 1
H10.8 H108 Other conjunctivitis 13
H10.9 H109 Conjunctivitis, unspecified 739
B30 B30 Viral conjunctivitis 75
B30.1 B301 Conjunctivitis due to adenovirus 5
B30.2 B302 Viral pharyngoconjunctivitis -
B30.8 B308 Other viral conjunctivitis 4
B30.9 B309 Viral conjunctivitis, unspecified 172
Conjunctivitis in infectious and parasitic

H13.1 H131 diseases classified elsewhere -
-
Perdarahan
subkonjungtiva H11 H11 Other disorders of conjunctiva 36
H11.3 H113 Conjunctival haemorrhage 13
H57 H57 Other disorders of eye and adnexa 46
Other specified disorders of eye and
H57.8 H578 adnexa 5
H57.9 H579 Disorder of eye and adnexa, unspecified 39

-
Episkleritis H15 H15 Disorders of sclera 5
H15.1 H151 Episcleritis -
-
Disorders of refraction and
Hipermetropia ringan H52 H52 accommodation 769
H52.0 H520 Hypermetropia 135
-
Miopia ringan H52 H52 accommodation 769
H52.1 H521 Myopia 133
-
Astigmatism ringan H52 H52 accommodation 769
H52.2 H522 Astigmatism 6
-
Presbiopia H52 H52 accommodation 769
H52.4 H524 Presbyopia 39
-
Buta senja H53 H53 Visual disturbances 82
H53.6 H536 Night blindness 1
-
Otitis eksterna H60 H60 Otitis externa 363
H60.0 H600 Abscess of external ear 15
H60.3 H603 Other infective otitis externa 15
H60.5 H605 Acute otitis externa, noninfective 7
H60.8 H608 Other otitis externa 37
H60.9 H609 Otitis externa, unspecified 373
Disorders of external ear in diseases
H62 H62 classified elsewhere 5
Otitis externa in bacterial diseases
H62.0 H620 classified elsewhere -
Otitis externa in viral diseases classified
H62.1 H621 elsewhere -
H62.2 H622 Otitis externa in mycoses 12
Otitis externa in other infectious and

H62.3 H623 parasitic diseases classified elsewhere 3
Otitis externa in other diseases classified
H62.4 H624 elsewhere 1
Other disorders of external ear in diseases
-
Serumen prop H61 H61 Other disorders of external ear 52
H61.2 H612 Impacted cerumen 212
-
Otitis media akut H65 H65 Nonsuppurative otitis media 33
H65.1 H651 Other acute nonsuppurative otitis media 15
H65.9 H659 Nonsuppurative otitis media, unspecified 78
H66 H66 Suppurative and unspecified otitis media 156

H66.0 H660 Acute suppurative otitis media 53
H66.4 H664 Suppurative otitis media, unspecified 50

H66.9 H669 Otitis media, unspecified 271
Otitis media in diseases classified
H67 H67 elsewhere 8
Otitis media in bacterial diseases
Otitis media in viral diseases classified
H67.1 H671 elsewhere -
Otitis media in other diseases classified
H67.8 H678 elsewhere 2
-
Hipertensi esensial I10 I10 Essentialprimary hypertension 24,935
-
Hemoroid grade 1-2 I84 I84 Haemorrhoids 423
Internal haemorrhoids without
I84.2 I842 complication 32
External haemorrhoids without
Unspecified haemorrhoids without
-
Limfadenitis I88 I88 Nonspecific lymphadenitis 9
I88.0 I880 Nonspecific mesenteric lymphadenitis 1
I88.1 I881 Chronic lymphadenitis, except mesenteric 8

I88.8 I888 Other nonspecific lymphadenitis 3
I88.9 I889 Nonspecific lymphadenitis, unspecified 48

L04 L04 Acute lymphadenitis 62
Acute lymphadenitis of face, head and
L04.0 L040 neck 32
L04.1 L041 Acute lymphadenitis of trunk 2
L04.2 L042 Acute lymphadenitis of upper limb 33
L04.3 L043 Acute lymphadenitis of lower limb 2
L04.8 L048 Acute lymphadenitis of other sites 1
L04.9 L049 Acute lymphadenitis, unspecified 73
-
Rhinitis akut J00 J00 Acute nasopharyngitis [common cold] 6,668

-
Faringitis J02 J02 Acute pharyngitis 1,181
J02.0 J020 Streptococcal pharyngitis 145
Acute pharyngitis due to other specified
J02.8 J028 organisms 134
J02.9 J029 Acute pharyngitis, unspecified 6,372
Chronic rhinitis, nasopharyngitis and
J31 J31 pharyngitis 13
J31.1 J311 Chronic nasopharyngitis 1
J31.2 J312 Chronic pharyngitis 25
-
Tonsilitis J03 J03 Acute tonsillitis 316
J03.0 J030 Streptococcal tonsillitis 7
Acute tonsillitis due to other specified
J03.9 J039 Acute tonsillitis, unspecified 475
J35 J35 Chronic diseases of tonsils and adenoids 17

J35.0 J350 Chronic tonsillitis 57
J35.1 J351 Hypertrophy of tonsils 6
Other chronic diseases of tonsils and
J35.8 J358 adenoids 1
Chronic disease of tonsils and adenoids,
J35.9 J359 unspecified 9
-
Laringitis J04 J04 Acute laryngitis and tracheitis 23
J04.0 J040 Acute laryngitis 16
J37 J37 Chronic laryngitis and laryngotracheitis 3

J37.0 J370 Chronic laryngitis 5
-
Influenza due to other identified influenza
Influenza J10 J10 virus 973
Influenza with pneumonia, other
J10.0 J100 influenza virus identified 3,821
Influenza with other respiratory

manifestations, other influenza virus
J10.1 J101 identified 498
Influenza with other manifestations, other
J10.8 J108 influenza virus identified 1,193
J11 J11 Influenza, virus not identified 3,146
Influenza with pneumonia, virus not
J11.0 J110 identified 240
Influenza with other respiratory
J11.1 J111 manifestations, virus not identified 2,297
Influenza with other manifestations, virus
J11.8 J118 not identified 1,956
Haemophilus influenzae infection,
A49.2 A492 unspecified site 2,250
-
Pneumonia,
bronkopneumonia J12 J12 Viral pneumonia, not elsewhere classified 3
J12.0 J120 Adenoviral pneumonia -
J12.1 J121 Respiratory syncytial virus pneumonia -

J12.2 J122 Parainfluenza virus pneumonia 2
J12.3 J123 Human metapneumovirus pneumonia -

J12.8 J128 Other viral pneumonia -
J12.9 J129 Viral pneumonia, unspecified 2
Pneumonia due to Streptococcus
J13 J13 pneumoniae -
Pneumonia due to Haemophilus
J14 J14 influenzae -
Bacterial pneumonia, not elsewhere
J15 J15 classified -
J15.0 J150 Pneumonia due to Klebsiella pneumoniae -

J15.1 J151 Pneumonia due to Pseudomonas -
J15.2 J152 Pneumonia due to staphylococcus -
J15.3 J153 Pneumonia due to streptococcus, group B -

J15.4 J154 Pneumonia due to other streptococci 4
J15.5 J155 Pneumonia due to Escherichia coli -
Pneumonia due to other aerobic Gram-
J15.6 J156 negative bacteria -
Pneumonia due to Mycoplasma
J15.7 J157 pneumoniae -
J15.8 J158 Other bacterial pneumonia -
J15.9 J159 Bacterial pneumonia, unspecified 2
Pneumonia due to other infectious
J16 J16 organisms, not elsewhere classified 41
J16.0 J160 Chlamydial pneumonia 4
Pneumonia due to other specified
J16.8 J168 infectious organisms 5
Pneumonia in diseases classified
J17 J17 elsewhere 7
Pneumonia in bacterial diseases classified
J17.0 J170 elsewhere -
Pneumonia in viral diseases classified
J17.1 J171 elsewhere -
J17.2 J172 Pneumonia in mycoses -
J17.3 J173 Pneumonia in parasitic diseases -
Pneumonia in other diseases classified
J17.8 J178 elsewhere 7
J18 J18 Pneumonia, organism unspecified 31
J18.0 J180 Bronchopneumonia, unspecified 30
J18.1 J181 Lobar pneumonia, unspecified -
J18.2 J182 Hypostatic pneumonia, unspecified -
J18.8 J188 Other pneumonia, organism unspecified -

J18.9 J189 Pneumonia, unspecified 21
-
Bronkitis akut J20 J20 Acute bronchitis 116
Acute bronchitis due to Mycoplasma
J20.0 J200 pneumoniae 3
Acute bronchitis due to Haemophilus
J20.1 J201 influenzae -
J20.2 J202 Acute bronchitis due to streptococcus -
J20.3 J203 Acute bronchitis due to coxsackievirus -

Acute bronchitis due to parainfluenza
J20.4 J204 virus 1
Acute bronchitis due to respiratory
J20.5 J205 syncytial virus -
J20.6 J206 Acute bronchitis due to rhinovirus -
J20.7 J207 Acute bronchitis due to echovirus -
Acute bronchitis due to other specified
J20.9 J209 Acute bronchitis, unspecified 177
Bronchitis, not specified as acute or
J40 J40 chronic 81
Simple and mucopurulent chronic
J41 J41 bronchitis 8
J41.0 J410 Simple chronic bronchitis 10
J41.1 J411 Mucopurulent chronic bronchitis 4
Mixed simple and mucopurulent chronic
J41.8 J418 bronchitis 1
J42 J42 Unspecified chronic bronchitis 115
-
Rhinitis vasomotor J30 J30 Vasomotor and allergic rhinitis 32
J30.1 J301 Vasomotor rhinitis 6
-
Rhinitis alergika J30 J30 Vasomotor and allergic rhinitis 32
J30.2 J302 Allergic rhinitis due to pollen 3
J30.3 J303 Other seasonal allergic rhinitis 55
J30.4 J304 Other allergic rhinitis 183
J30.5 J305 Allergic rhinitis, unspecified -
J45.0 J450 Predominantly allergic asthma 77
-
Furunkel pada hidung J34 J34 Other disorders of nose and nasal sinuses 9
J34.0 J340 Abscess, furuncle and carbuncle of nose 10

-
Asma bronkial J45 J45 Asthma 1,026
J45.0 J450 Predominantly allergic asthma 77
J45.1 J451 Nonallergic asthma 96
J45.8 J458 Mixed asthma 97
J45.9 J459 Asthma, unspecified 574
-
Ulkus mulut (aptosa,
herpes) K12 K12 Stomatitis and related lesions 367
K12.0 K120 Recurrent oral aphthae 39
K12.1 K121 Other forms of stomatitis 274
K12.2 K122 Cellulitis and abscess of mouth 25
K12.3 K123 Oral mucositisulcerative 32
-
Refluks gastroesofagus K21 K21 Gastro-oesophageal reflux disease 31

Gastro-oesophageal reflux disease
K21.9 K219 without oesophagitis 476
-
Gastritis K29 K29 Gastritis and duodenitis 2,174
K29.1 K291 Other acute gastritis 180
K29.2 K292 Alcoholic gastritis 2
K29.5 K295 Chronic gastritis, unspecified 160
K29.6 K296 Other gastritis 112
K29.7 K297 Gastritis, unspecified 2,761
K30 K30 Functional dyspepsia 6,995
R10.1 R101 Pain localized to upper abdomen 64
-
Intoleransi makanan K90 K90 Intestinal malabsorption -
Malabsorption due to intolerance, not
K90.4 K904 elsewhere classified -
-
Impetigo L01 L01 Impetigo 28
L01.0 L010 Impetigo [any organism] [any site] 15
L01.1 L011 Impetiginization of other dermatoses 6
-
cutaneous abscess, furuncle and
Furunkel, karbunkel L02 L02 carbuncle 209
Cutaneous abscess, furuncle and
L02.0 L020 carbuncle of face 72
L02.1 L021 carbuncle of neck 14
L02.2 L022 carbuncle of trunk 12
L02.3 L023 carbuncle of buttock 20
L02.4 L024 carbuncle of limb 19
L02.8 L028 carbuncle of other sites 125
L02.9 L029 carbuncle, unspecified 330
H04.0 H040 Dacryoadenitis 5
H60.0 H600 Abscess of external ear 15
Acute and unspecified inflammation of
H04.3 H043 lacrimal passages 2
N76.4 N764 Abscess of vulva 1
N48.2 N482 Other inflammatory disorders of penis -

N49.2 N492 Inflammatory disorders of scrotum -
Inflammatory disorders of other specified
N49.8 N498 male genital organs -
Inflammatory disorder of unspecified
N49.9 N499 male genital organ -
N61 N61 Inflammatory disorders of breast 22
-
Abses folikel rambut Cutaneous abscess, furuncle, and
atau kelenjar sebasea L02 L02 carbuncle 209
L02.0 L020 carbuncle of face 72
L02.1 L021 carbuncle of neck 14
L02.2 L022 carbuncle of trunk 12
L02.3 L023 carbuncle of buttock 20
L02.4 L024 carbuncle of limb 19
L02.8 L028 carbuncle of other sites 125
L02.9 L029 carbuncle, unspecified 330
-
Impetigo ulseratif Other local infections of skin and
(ektima) L08 L08 subcutaneous tissue 160
L08.0 L080 Pyoderma 68
Other specified local infections of skin and
L08.8 L088 subcutaneous tissue 7
Local infection of skin and subcutaneous
L08.9 L089 tissue, unspecified 53
-
Other local infections of skin and
Eritrasma L08 L08 subcutaneous tissue 160
L08.1 L081 Erythrasma 6
-
Dermatitis atopik
(kecuali recalcitrant) L20 L20 Atopic dermatitis 373
L20.0 L200 Besnier prurigo 3
L20.8 L208 Other atopic dermatitis 122
L20.9 L209 Atopic dermatitis, unspecified 1,357
-
Dermatitis seboroik L21 L21 Seborrhoeic dermatitis 23
L21.0 L210 Seborrhoea capitis -
L21.1 L211 Seborrhoeic infantile dermatitis 3
L21.8 L218 Other seborrhoeic dermatitis 2
L21.9 L219 Seborrhoeic dermatitis, unspecified 59
-
Napkin eczema L22 L22 Diaper [napkin] dermatitis 8
-
Dermatitis kontak iritan L24 L24 Irritant contact dermatitis 660

Irritant contact dermatitis due to
L24.0 L240 detergents 17
Irritant contact dermatitis due to oils and
L24.1 L241 greases 2
L24.2 L242 Irritant contact dermatitis due to solvents 2

Irritant contact dermatitis due to
L24.3 L243 cosmetics -
Irritant contact dermatitis due to drugs in
L24.4 L244 contact with skin -
Irritant contact dermatitis due to other
L24.5 L245 chemical products 1
Irritant contact dermatitis due to food in
L24.6 L246 contact with skin -
Irritant contact dermatitis due to plants,
L24.7 L247 except food -
Irritant contact dermatitis due to other
L24.8 L248 agents 22
Irritant contact dermatitis, unspecified
L24.9 L249 cause 146
L25 L25 Unspecified contact dermatitis 18
Unspecified contact dermatitis due to
L25.0 L250 cosmetics 4
L25.1 L251 drugs in contact with skin -
L25.2 L252 dyes -
L25.3 L253 other chemical products -
L25.4 L254 food in contact with skin 2
L25.5 L255 plants, except food -
L25.8 L258 other agents 2
Unspecified contact dermatitis,
L25.9 L259 unspecified cause 29
-
Exanthematous drug
eruption, fixed drug Dermatitis due to substances taken
eruption L27 L27 internally 1
Generalized skin eruption due to drugs
L27.0 L270 and medicaments -
Localized skin eruption due to drugs and
L27.1 L271 medicaments -
R21 R21 Rash and other nonspecific skin eruption 3

-
Dermatitis due to substances taken
Alergi makanan L27 L27 internally 1
L27.2 L272 Dermatitis due to ingested food -
Dermatitis due to other substances taken
L27.8 L278 internally 3
Dermatitis due to unspecified substance
L27.9 L279 taken internally 1
Other adverse food reactions, not
T78.1 T781 elsewhere classified -
T78.4 T784 Allergy, unspecified 56
Allergic and dietetic gastroenteritis and
K52.2 K522 colitis 3
-
Dermatitis numularis L30 L30 Other dermatitis 367
L30.0 L300 Nummular dermatitis 14
L30.8 L308 Other specified dermatitis 699
L30.9 L309 Dermatitis, unspecified 446
-
Pitiriasis rosea L42 L42 Pityriasis rosea 30
L30.5 L305 Pityriasis alba 5
-
Urtikaria akut L50 L50 Urticaria 468
L50.0 L500 Allergic urticaria 107
L50.2 L502 Urticaria due to cold and heat 11
L50.3 L503 Dermatographic urticaria -
L50.4 L504 Vibratory urticaria -
L50.6 L506 Contact urticaria -
L50.9 L509 Urticaria, unspecified 168
L56.3 L563 Solar urticaria -
L29 L29 Pruritus 38
L29.0 L290 Pruritus ani 7
L29.1 L291 Pruritus scroti -
L29.2 L292 Pruritus vulvae 1
L29.3 L293 Anogenital pruritus, unspecified -
L29.8 L298 Other pruritus 7
L29.9 L299 Pruritus, unspecified 15
T80.6 T806 Other serum reactions -
-
Akne vulgaris ringan L70 L70 Acne 13
L70.0 L700 Acne vulgaris 9
L70.1 L701 Acne conglobata -
L70.2 L702 Acne varioliformis -
L70.3 L703 Acne tropica -
L70.4 L704 Infantile acne -
L70.5 L705 Acné excoriée des jeunes filles -
L70.8 L708 Other acne -
L70.9 L709 Acne, unspecified 10
L71 L71 Rosacea -
L71.1 L711 Rhinophyma -
L71.8 L718 Other rosacea -
L71.9 L719 Rosacea, unspecified -
-
Dermatitis perioral L71 L71 Rosacea -
L71.0 L710 Perioral dermatitis -
-
Follicular cysts of skin and subcutaneous
Folikulitis superfisialis L72 L72 tissue 10
L72.0 L720 Epidermal cyst 11
L72.1 L721 Trichilemmal cyst -
L72.2 L722 Steatocystoma multiplex -
Other follicular cysts of skin and
L72.8 L728 subcutaneous tissue -
Follicular cyst of skin and subcutaneous
Other local infections of skin and
L08 L08 subcutaneous tissue 160
L08.0 L080 Pyoderma 68
Other specified local infections of skin and
L08.8 L088 subcutaneous tissue 7
Local infection of skin and subcutaneous
L66.2 L662 Folliculitis decalvans 1
L66.3 L663 Perifolliculitis capitis abscedens -
L66.4 L664 Folliculitis ulerythematosa reticulata -
-
Hidradenitis supuratif L73 L73 Other follicular disorders 2
L73.0 L730 Acne keloid 1
L73.1 L731 Pseudofolliculitis barbae -
L73.2 L732 Hidradenitis suppurativa -
L73.8 L738 Other specified follicular disorders -
L73.9 L739 Follicular disorder, unspecified 9
-
Miliaria L74 L74 Eccrine sweat disorders -
L74.0 L740 Miliaria rubra 7
L74.1 L741 Miliaria crystallina -
L74.2 L742 Miliaria profunda -
L74.3 L743 Miliaria, unspecified 15
L74.8 L748 Other eccrine sweat disorders -
L74.9 L749 Eccrine sweat disorder, unspecified -
-
Ulcer of lower limb, not elsewhere
Ulkus pada tungkai L97 L97 classified 34
I83 I83 Varicose veins of lower extremities 4
Varicose veins of lower extremities with
I83.0 I830 ulcer -
I83.1 I831 inflammation -
I83.2 I832 both ulcer and inflammation 1
Varicose veins of lower extremities
I83.9 I839 without ulcer or inflammation -
-
Pielonefritis tanpa
komplikasi N10 N10 Acute tubulo-interstitial nephritis 9
Tubulo-interstitial nephritis, not specified
N12 N12 as acute or chronic -
-
Infeksi saluran kemih N39 N39 Other disorders of urinary system 341
N39.0 N390 Urinary tract infection, site not specified 493

Other specified disorders of urinary
N39.8 N398 system 41
N39.9 N399 Disorder of urinary system, unspecified 208
Other complications following abortion

O08.8 O088 and ectopic and molar pregnancy -
Other urethral disorders in diseases
N37.8 N378 classified elsewhere -
-
Infeksi saluran kemih
bagian bawah N39 N39 Other disorders of urinary system 341
N39.0 N390 Urinary tract infection, site not specified 493

Other specified disorders of urinary
N39.8 N398 system 41
N39.9 N399 Disorder of urinary system, unspecified 208
Other complications following abortion

O08.8 O088 and ectopic and molar pregnancy -
Other urethral disorders in diseases
N37.8 N378 classified elsewhere -
-
Redundant prepuce, phimosis and
Fimosis N47 N47 paraphimosis 17
-
Redundant prepuce, phimosis and
Parafismosis N47 N47 paraphimosis 17
-
Mastitis N61 N61 Inflammatory disorders of breast 22
Infections of breast associated with
O91 O91 childbirth 1
Infection of nipple associated with
O91.0 O910 childbirth -
Abscess of breast associated with
O91.1 O911 childbirth 4
Nonpurulent mastitis associated with
O91.2 O912 childbirth 13
-
Salpingitis N70 N70 Salpingitis and oophoritis -
N70.0 N700 Acute salpingitis and oophoritis 1
N70.1 N701 Chronic salpingitis and oophoritis -
N70.9 N709 Salpingitis and oophoritis, unspecified 3

-
Vaginitis N76 N76 Other inflammation of vagina and vulva 30

N76.0 N760 Acute vaginitis 22
N76.1 N761 Subacute and chronic vaginitis 1
N76.6 N766 Ulceration of vagina -
Other specified inflammation of vagina
N76.8 N768 and vulva 24
-
Vaginosis bakterialis N76 N76 Other inflammation of vagina and vulva 30

N76.0 N760 Acute vaginitis 22
N76.1 N761 Subacute and chronic vaginitis 1
N76.6 N766 Ulceration of vagina -
Vulvovaginal ulceration and inflammation

N77 N77 in diseases classified elsewhere 1
Vaginitis, vulvitis and vulvovaginitis in

N77.1 N771 elsewhere 10
Vulvovaginal ulceration and inflammation

N77.8 N778 in other diseases classified elsewhere 13
-
Vulvitis N76 N76 Other inflammation of vagina and vulva 30

N76.2 N762 Acute vulvitis -
N76.3 N763 Subacute and chronic vulvitis 2
N76.4 N764 Abscess of vulva 1
N76.6 N766 Ulceration of vulva -
-
Aborsi spontan komplit O03 O03 Spontaneous abortion 3

Complete or unspecified, without
O03.9 O039 complication 5
O04 O04 Medical Abortion -
O04.9 O049 complication -
O05 O05 Other Abortion 3
O06 O06 Unspecified abortion 5
-
Ruptur perineum tingkat
1-2 O70 O70 Perineal laceration during delivery -
First degree perineal laceration during
O70.0 O700 delivery -
Second degree perineal laceration during
O70.1 O701 delivery -
-
Kehamilan normal O80 O80 Single spontaneous delivery 16
O80.0 O800 Spontaneous vertex delivery 372
O80.1 O801 Spontaneous breech delivery -
O80.8 O808 Other single spontaneous delivery 1
O80.9 O809 Single spontaneous delivery, unspecified 51

Other specified pregnancy-related
O26.8 O268 conditions 4
O26.9 O269 Pregnancy-related condition, unspecified 12

-
Other disorders of breast and lactation
Inverted nipple O92 O92 associated with childbirth 1
Retracted nipple associated with
O92.0 O920 childbirth -
-
Other disorders of breast and lactation
Cracked nipple O92 O92 associated with childbirth 1
O92.1 O921 Cracked nipple associated with childbirth -

N64 N64 Other disorders of breast 9
N64.0 N640 Fissure and fistula of nipple -
-
Omphalitis of newborn with or without
Infeksi pada umbilikus P38 P38 mild haemorrhage -
-
Epistaksis R04 R04 Haemorrhage from respiratory passages 29

R04.0 R040 Epistaxis 64
-
Mabuk perjalanan R11 R11 Nausea and vomiting 1,275
T75.3 T753 Motion sickness -
-
Vertigo (Benign
paroxysmal positional
vertigo) R42 R42 Dizziness and giddiness 526
H81 H81 Disorders of vestibular function 234
H81.1 H811 Benign paroxysmal vertigo 130
H81.3 H813 Other peripheral vertigo 656
H81.4 H814 Vertigo of central origin 444
Vertiginous syndromes in diseases
H82 H82 classified elsewhere 334
T75.2 T752 Effects of vibration -
-
Kejang demam R56 R56 Convulsions, not elsewhere classified 21

R56.0 R560 Febrile convulsions 30
R56.8 R568 Other and unspecified convulsions 21
-
Vulnus laseratum, Superficial injuries involving multiple body
vulnus punctum T00 T00 regions 4
Superficial injuries involving head with
T00.0 T000 neck -
Superficial injuries involving thorax with
T00.1 T001 abdomen, lower back and pelvis -
Superficial injuries involving multiple
T00.2 T002 regions of upper limbs -
T00.3 T003 regions of lower limbs -

T00.6 T006 regions of upper limbs with lower limbs -
Superficial injuries involving other
T00.8 T008 combinations of body regions -
T00.9 T009 Multiple superficial injuries, unspecified 1

T14 T14 Injury of unspecified body region 64
Superficial injury of unspecified body
T14.0 T140 region 14
T14.1 T141 Open wound of unspecified body region 73
T14.8 T148 Other injuries of unspecified body region 1

T14.9 T149 Injury, unspecified 4
-
Benda asing di
konjungtiva T15 T15 Foreign body on external eye 24
T15.1 T151 Foreign body in conjunctival sac 5
Foreign body in other and multiple parts
T15.8 T158 of external eye 8
Foreign body on external eye, part
T15.9 T159 unspecified 14
-
Benda asing T17 T17 Foreign body in respiratory tract 3
T17.1 T171 Foreign body in nostril 1
-
Luka bakar derajat 1 dan Burn of unspecified body region,
2 T30.0 T300 unspecified degree 8
Burn of first degree, body region
Burn of second degree, body region
T30.2 T302 unspecified -
Corrosion of unspecified body region,
T30.4 T304 unspecified degree -
Corrosion of first degree, body region
Corrosion of second degree, body region
T21 T21 Burn and corrosion of trunk -
T21.0 T210 Burn of unspecified degree of trunk -
T21.1 T211 Burn of first degree of trunk -
T21.2 T212 Burn of second degree of trunk -
T21.4 T214 Corrosion of unspecified degree of trunk -

T21.5 T215 Corrosion of first degree of trunk -
T21.6 T216 Corrosion of second degree of trunk -
Burn and corrosion of shoulder and upper
T22 T22 limb, except wrist and hand 1
Burn of unspecified degree of shoulder

T22.0 T220 and upper limb, except wrist and hand 2
Burn of first degree of shoulder and upper
T22.1 T221 limb, except wrist and hand 1
Burn of second degree of shoulder and

T22.2 T222 upper limb, except wrist and hand -
Corrosion of unspecified degree of
T22.4 T224 hand -
Corrosion of first degree of shoulder and

T22.5 T225 upper limb, except wrist and hand -
Corrosion of second degree of shoulder

T22.6 T226 and upper limb, except wrist and hand -
T23 T23 Burn and corrosion of wrist and hand 5
Burn of unspecified degree of wrist and
T23.0 T230 hand -
T23.1 T231 Burn of first degree of wrist and hand -
T23.2 T232 Burn of second degree of wrist and hand -

Corrosion of unspecified degree of wrist
T23.4 T234 and hand -
T23.5 T235 Corrosion of first degree of wrist and hand 2

Corrosion of second degree of wrist and
T23.6 T236 hand -
Burn and corrosion of hip and lower limb,
T24 T24 except ankle and foot 5
Burn of unspecified degree of hip and

T24.0 T240 lower limb, except ankle and foot -
Burn of first degree of hip and lower limb,
T24.1 T241 except ankle and foot -
Burn and corrosion, body region
T30 T30 unspecified 16
Burn of second degree of hip and lower
T24.2 T242 limb, except ankle and foot -
Corrosion of unspecified degree of hip

T24.4 T244 and lower limb, except ankle and foot -
Corrosion of first degree of hip and lower
T24.5 T245 limb, except ankle and foot -
Corrosion of second degree of hip and

T24.6 T246 lower limb, except ankle and foot -
T25 T25 Burn and corrosion of ankle and foot 4
Burn of unspecified degree of ankle and
T25.0 T250 foot 2
T25.1 T251 Burn of first degree of ankle and foot 2
T25.2 T252 Burn of second degree of ankle and foot -

Corrosion of unspecified degree of ankle
T25.4 T254 and foot -
T25.5 T255 Corrosion of first degree of ankle and foot -
Corrosion of second degree of ankle and
T25.6 T256 foot -
Burns and corrosions of multiple body
T29 T29 regions -
Burns of multiple regions, unspecified
T29.0 T290 degree -
Burns of multiple regions, no more than
T29.1 T291 first-degree burns mentioned -
Burns of multiple regions, no more than

T29.2 T292 second-degree burns mentioned -
Corrosions of multiple regions,
T29.4 T294 unspecified degree -
Corrosions of multiple regions, no more

T29.5 T295 than first-degree corrosions mentioned -
Corrosions of multiple regions, no more

than second-degree corrosions
T29.6 T296 mentioned -
-
Toxic effect of other noxious substances
Keracunan makanan T62 T62 eaten as food -
T62.0 T620 Ingested mushrooms -
T62.1 T621 Ingested berries -
T62.2 T622 Other ingestedparts of plants -
Other specified noxious substances eaten
T62.8 T628 as food -
Noxious substance eaten as food,
Toxic effect of noxious substances eaten
T61 T61 as seafood -
T61.0 T610 Ciguatera fish poisoning -
T61.1 T611 Scombroid fish poisoning -
T61.2 T612 Other fish and shellfish poisoning -
T61.8 T618 Toxic effect of other seafoods -
T61.9 T619 Toxic effect of unspecified seafood -
Other noninfective gastroenteritis and
K52 K52 colitis 18
K52.1 K521 Toxic gastroenteritis and colitis -
Other specified noninfective
K52.8 K528 gastroenteritis and colitis 130
Noninfective gastroenteritis and colitis,
K52.9 K529 unspecified 83
-
Toxic effect of contact with venomous
Reaksi gigitan serangga T63 T63 animals -
T63.4 T634 Venom of other arthropods 10
-
Reaksi anafilaktik T78 T78 Adverse effects, not elsewhere classified 2

T78.2 T782 Anaphylactic shock, unspecified -
T80.5 T805 Anaphylactic shock due to serum -
Anaphylactic shock due to adverse food
T78.0 T780 reaction -
Anaphylactic shock due to adverse effect

of correct drug or medicament properly
T88.6 T886 administered -
-
Kekerasan tajam X99 X99 Assault by sharp object -
X78 X78 Intentional self-harm by sharp object -
Contact with sharp object, undetermined
Y28 Y28 intent -
Y35.4 Y354 Legal intervention involving sharp objects -
W22 W22 Striking against or struck by other objects 1
W26.9 W269 Contact with unspecified sharp objects -

-
Kekerasan tumpul Y00 Y00 Assault by blunt object -
X79 X79 Intentional self-harm by blunt object -
Contact with blunt object, undetermined
Y29 Y29 intent -
Y35.3 Y353 Legal intervention involving blunt objects -
W22 W22 Striking against or struck by other objects 1

-
HIV AIDS tanpa Asymptomatic human immunodeficiency

komplikasi Z21 Z21 virus [HIV] infection status -
Laboratory evidence of human
R75 R75 immunodeficiency virus [HIV] -
Special screening examination for human
Z11.4 Z114 immunodeficiency virus [HIV] 1
Contact with and exposure to human
Z20.6 Z206 immunodeficiency virus [HIV] -
Human immunodeficiency virus [HIV]
Z71.7 Z717 counselling -
Kota Madiun Kab. Madiun Kab. Magetan Kab. Ngawi
Rujukan Kunjungan Rujukan Kunjungan Rujukan Kunjungan
7 197 18 1,428 41 1,136

8 595 4 1,066 24 4,315
1 3 1 3 1 30
- - - 5 - 4
- - - - - -
3 65 2 56 18 41
- - - - - -
- 8 1 10 - 7
- 334 1 14 - 101
- 1 - - - 1
- - - - - 1
- - - - - -
- - - - - 2
- 4 - - - -
- 17 2 4 - 3
- 1 - 46 2 4
- 17 1 12 4 28
- 1 - - - -
- - - - - -
- 1 - - - -
- 1 - - - -
- 1 - 6 - 1
- - - - - -
35 5,426 30 6,144 53 6,040
8 120 1 579 9 131
11 136 7 123 5 78
- 1 1 9 2 2
- - - 2 - 24
- 120 - 3 - 9
- 1 1 - - -
- 69 - 2 - -
- - - 1 - 1
1 21 2 5 2 101
- - - 10 1 3
- 5 - 4 - 4
- - - - - -
193 576 210 2,096 237 772
24 1,772 27 683 18 1,669
18 365 114 94 25 424
3 370 107 17 17 107
91 293 235 31 27 154
8 19 16 4 4 27
9 13 10 - - 37
5 56 19 4 3 19
1 4 4 7 5 16
20 66 40 16 15 20
56 179 104 87 67 340
1 2 1 6 4 276
50 108 24 79 62 268
2 3 1 - - 2
2 141 6 19 8 100
68 8 8 96 53 119
- - - - - -
32 21 13 337 84 47
1 36 3 2 2 2
- - - - - -
- - - - - -
- 1 - - - -
- - - - - -
- - - - - 3
- - - - - -
5 18 9 100 36 73
- 13 - 35 - 23
- 14 2 13 6 -
- 1 - - - -
- - - - - -
- - - 3 1 19
- 16 3 87 11 3
- 31 - 1 1 6
5 31 12 22 16 101
- - - 15 7 34
- - - - - -
3 7 1 12 6 40
- - - - - 2
- - - - - -
- 224 2 145 - 97
- 177 1 148 31 100
- 3 - 4 2 2
- 148 - 133 - 44
- - - - - -
4 15 - 24 - 5
- 18 2 - - 17
- - - - - -
- 1 - - - 1
7 20 3 13 2 173
- - - - - -
- 28 - - - 1
1 - - 2 1 2
- - - - - -
1 1 - 1 1 1
- - - 2 2 -
2 - - 3 1 2
4 - - - - -
8 - - 9 9 3
- - - - - -
- - - - - -
- - - 10 2 1
- 5 - 1 - 15
- 10 - 1 - 1
- 6 2 - - 7
- - - - - 1
- - - - - 1
4 3 1 5 2 2
2 6 - 35 11 -
- 17 1 4 1 2
- 9 1 - - 1
- 9 - 1 1 -
4 66 9 171 19 8
- - - - - -
- - - 10 2 1
- 5 - 1 - 15
- 10 - 1 - 1
- 6 2 - - 7
- - - - - 1
- - - - - 1
4 3 1 5 2 2
4 66 9 171 19 8
- - - - - -
11 154 10 251 16 622
7 108 33 267 60 565
- - - - - -
2 18 - 218 14 133
5 32 11 - - 16
1 307 1 61 - 355
- - - - - -
2 198 1 776 1 170

- 560 - 142 - 209
- - - - - -
16 68 3 437 15 109
4 83 - 64 1 108
- - - - - -
2 12 - 31 - 7
- 10 - 2 - 21
- - - - - -
11 13 5 51 12 36
- - - - - -
- 1 - 10 8 -
1 1 - - - 1
- - - - - -
1 15 11 4 2 12
1 - - 5 4 6
- - - - - -
5 137 3 386 5 107
3 111 4 94 - 102
- - - - - -
17 63 1 70 8 30
1 224 - 14 2 35
- - - - - -
17 63 1 70 8 30
1 224 - 14 2 35
- - - - - -
17 63 1 70 8 30
3 32 - 6 3 15
- - - - - -
17 63 1 70 8 30
- 2 - 2 - 1
- - - - - -
17 63 1 70 8 30
- 230 - 90 4 65
- - - - - -
17 63 1 70 8 30
17 400 2 136 4 76
4 5 2 9 - 3
- - - - - -
17 63 1 70 8 30
2 141 1 63 1 151
- - - - - -
17 63 1 70 8 30
2 49 13 3 3 13
- 216 - 23 - 85
- - - - - -
- 6 - 1,105 18 52
- 97 - 130 1 129
- 4 3 37 2 6
- - - - - 3
- - - 1 1 -
- 6 4 - - 5
7 54 - 70 10 77
- - - - - -
7 39 3 54 8 18
3 46 4 2 1 6
1 4 - - - 5
8 38 - 22 3 45
- - - - - -
7 39 3 54 8 18
3 329 3 172 3 125
8 38 - 22 3 45
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- 38 - 9 - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - 2 - -
- 4 - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1 - - 19 1 6
- - - - - -
- - - - - -
- - - - - 7
- 5 - - - 1
- - - - - -
- 1 - - - 3
1 - - 6 1 9
- - - - - -
- - - - - 7
- 5 - - - 1
- - - - - -
- 1 - - - 3
1 - - 6 1 9
- - - - - 4
- - - - - 1
- - - - - -
- 1 - - - -
- 2 - 1 - -
- - - - - 1
- - - - - -
- 1 - - - -
- - - - - -
- 1 1 - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - 1
- - - 2 1 3
- 5 - - - -
- 4 - 5 - -
- - - - - -
- 4 - - - 1
- - - - - -
- - - - - -
- - - - - -
- - - 1 - -
- 1 1 - - -
- - - - - -
- - - - - 2
- 9 1 1 1 -
- - - - - -
- - - - - -
- 2 - - - -
- - - - - -
- - - - - -
- 2 - - - -
- 1 - 1 1 -
- 1 1 - - 1
- - - - - -
10 316 2 622 17 225
- - - - - -
76 114 87 64 61 89
34 37 31 19 17 113
6 14 13 5 5 21
1 8 7 2 2 38
18 17 15 41 40 82
11 95 83 8 8 82
32 49 17 9 7 36
- - - - - -
38 38 2 21 14 93
- 254 9 20 14 57
6 159 15 43 27 142
22 32 10 269 121 71
12 57 50 34 28 101
8 167 4 51 18 95
- - - - - -
38 38 2 21 14 93
- 254 9 20 14 57
6 159 15 43 27 142
28 8 6 8 7 31
- - - - - -
691 1,825 1,135 1,718 705 1,092
534 993 827 331 304 2,343

- - - - - -
1,152 6,891 347 10,745 850 5,064
1,315 26,012 380 19,732 1,205 8,231

- - - - - -
- - - 1 - 2
- 7 5 - - 11
2 12 2 14 3 71
- - - - - -
4 4 - - - 3
1 1 - - - 9
- - - - - 1
- - - 2 2 3
- 5 2 2 - -
- 1 - - - 2
1 3 - - - -
- - - - - -
- - - - - -
- - - 3 - -
2 - - - - -
- 1 1 - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - 2 - -
- - - 3 - -
1 1 - 1 - -
- 2 - 6 - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - 1 - -
- - - - - -
- - - - - -
- - - 1 - -
- 1 - 8 - -
- 4 - - - -
- - - 1 - -
- - - - - -
- - - - - -
- - - 21 - -
- - - 74 - -
- - - - - -
- 2 - 2 - 2
- 27 - 3 - 196
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - 1
- - - - - -
- 1 - - - -
- - - 1 1 -
- - - - - -
- - - - - -
- 1 - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - 1
- - - - - -
- 2 - - - 1
- - - - - 2
4 6 1 - - 9
- - - - - -
- 2 2 3 1 4
- 1 1 2 - 6
- - - - - 1
- 2 1 - - -
3 - - - - 2
- - - - - -
17 151 4 1,065 17 131

34 549 3 962 55 960
4 13 3 9 1 228
6 10 4 7 5 66
- 19 - 63 - 1
44 98 7 16 8 345
36 1,164 1 157 14 1,157
- 1 - - - 2
1 29 1 1 1 -
3 89 - 64 2 80
- - - - - -
2 25 5 72 2 6
4 535 - 135 6 231

- 2 - - - -
- 30 - 2 - 3
7 94 1 1 1 3
- - - - - -
7 6 1 43 3 28
- 17 - 1 - 15
- 2 1 - - 1
- 1 1 - - 4
- 1 1 - - -
- - - - - 6
2 1 - - - 9
13 35 10 29 5 75
- - - - - -
5 15 4 57 13 2
21 37 20 33 12 156
- - - - - 5
- 1 1 - - -
- 113 - 26 2 36
- - - - - -
4 107 2 216 3 238
1 120 - 75 - 411
2 2 - 8 4 3
- - - - - 1
2 137 1 1 1 16
19 464 9 157 16 403
- 22 - 3 - 1
- - - - - -
57 45 11 971 24 224
21 10 2 106 70 21
6 2,072 1 387 - 449
10 16 6 9 8 23
- - - - - 1
18 70 22 375 19 61
72 14,746 33 11,776 157 12,707
- - - - - -
18 23 19 50 40 17
16 86 7 31 11 271
- - - - - -
60 28 11 298 61 190
13 356 9 130 26 245

- - - - - -
4 83 23 85 17 29
2 18 - 10 - 10
- - - - - -
11 10 4 13 2 22
1 8 5 7 1 -
- - - - - -
38 3 - 13 9 4
24 23 9 4 2 9
- - - - - -
25 1,479 5 2,279 37 947
- 526 - 418 3 374
3 22 2 25 1 54
4 105 7 4 1 64
2 187 9 9 2 161
19 18 17 32 18 45
1 2 2 2 2 8
4 110 7 10 1 56
38 436 8 576 31 685
1 39 - 48 2 19
- 27 - 45 1 2
- - - - - -
2 35 - - - 14
1 24 2 16 1 64
- - - - - -
- - - - - -
28 22 7 68 23 38
4 8 3 13 2 15
12 7 6 663 340 134
5 7 1 14 12 74
10 171 32 185 135 148

- - - - - -
4 4 - 4 3 3
- 5 - 1 1 -
- - - - - -
691 82 78 715 637 615

110 16 12 313 269 48
- - - - - -
691 82 78 715 637 615

110 29 21 191 187 136
- - - - - -
691 82 78 715 637 615

5 2 1 10 8 22
- - - - - -
691 82 78 715 637 615

32 20 11 49 43 41
- - - - - -
78 3 3 2 - 91
1 - - - - -
- - - - - -
36 133 5 290 26 146
2 80 1 46 7 36
8 13 3 2 1 23
2 14 1 10 1 15
8 59 4 14 7 64
35 273 24 172 27 210
4 1 - 4 1 2
- 12 2 - - 3
- 30 - 4 - 12
9 2 - 4 - -
1 - - 1 1 2
1 6 2 - - -
- 2 1 - - 8
- - - - - -
17 19 4 78 7 30
48 693 13 486 40 463
- - - - - -
10 19 5 105 25 39
8 13 5 3 2 20
15 10 1 14 5 17
66 40 19 860 179 155

26 112 36 205 82 236
39 30 21 43 39 59
26 375 7 173 34 311
3 2 - 3 1 6
- 8 1 4 4 1
- - - - - 1
1 2 1 - - 6
- - - - - -
158 39,192 66 29,110 263 29,586
- - - - - -
93 404 110 757 192 368
12 44 21 45 27 70
17 48 25 111 47 108
39 56 16 110 38 185
- - - - - -
2 17 1 12 6 22
1 8 - - - 13
6 - - 1 - 8
2 10 4 1 - 28
20 42 16 17 11 34
20 65 13 190 37 46
15 29 12 37 23 51
1 2 - - - -
12 26 7 15 6 33
2 - - - - 5
1 3 1 7 7 2
28 39 11 29 10 43
- - - - - -
6 25,049 4 13,664 1 13,030

- - - - - -
2 522 2 2,029 10 1,515
- 769 - 263 3 1,264
- 50 - 5 - 27
15 1,818 5 1,800 28 4,023
5 8 - 30 5 6
- 1 1 5 1 3
5 57 11 25 19 30
- - - - - -
30 148 12 348 69 223
- 209 1 24 2 223
2 20 2 4 3 133
46 247 36 615 66 366
15 4 3 25 19 39
52 91 57 54 43 179
6 20 17 22 18 17
1 4 4 2 2 6
9 5 4 6 5 7
- - - - - -
5 2 - 36 3 13
3 158 - 10 1 28
3 1 1 2 2 -
4 4 4 6 6 12
- - - - - -
- 1,026 - 1,846 - 854
- 1,460 2 640 - 317
1 3,179 1 95 - 122
3 257 - 84 - 831
2 6,931 - 3,009 2 2,849
1 328 3 949 1 1,248
3 3,297 7 2,371 3 2,608
1 3,647 1 668 - 4,025
3 73 - 78 - 1
- - - - - -
3 8 7 1 - 9
- 4 2 - - 3
- 3 2 1 - 1
2 3 1 4 - -
- - - - - 1
- 13 9 3 3 27
2 15 7 3 3 15
- 1 - 2 2 2
- - - 5 3 2
- 4 4 6 3 3
- - - - - -
- 1 1 - - -
- - - 1 - -
- - - - - 1
- - - - - -
- - - - - -
- - - - - -
- 1 1 - - 2
- 3 3 3 3 1
2 18 8 6 6 6
17 4 - 186 24 15
- - - 28 6 33
2 6 4 12 8 5
4 - - - - 1
- - - 3 2 -
- - - - - 1
- - - - - -
- - - - - -
2 2 2 - - 2
12 46 12 14 4 28
17 46 27 29 21 227
- - - - - -
- - - 1 1 -
- 7 6 - - 4
18 228 52 27 21 49
- - - - - -
75 54 15 550 71 279
- 149 4 33 14 283
- 125 1 9 2 25
- 15 4 - - 7
- - - 137 131 2
- 2 - 3 1 3
- 6 1 - - 2
- 3 - - - 2
- 3 3 - - 9
5 4 1 19 16 23
105 79 35 161 76 380
37 128 4 103 18 1,170
8 6 4 5 4 12
9 14 10 6 5 23
4 13 11 8 6 3
1 3 2 7 6 1
101 121 28 62 46 438
- - - - - -
7 36 1 41 2 9
1 4 1 2 2 4
- - - - - -
7 36 1 41 2 9
1 3 - 1 1 5
17 695 4 5 2 31
7 267 1 34 3 40
- - - - - -
57 229 25 735 143 1,372
- - - - - -
2 6 2 5 3 13
1 33 - 3 - 4
- - - - - -
367 474 46 2,602 281 1,675
57 229 25 735 143 1,372
57 44 27 32 8 155
69 136 75 61 61 51
52 3,035 18 438 46 1,290
- - - - - -
4 386 - 832 5 168

4 49 2 176 2 99
1 428 6 231 5 293
7 48 15 40 23 34
- 9 2 6 - 5
- - - - - -
12 52 7 32 8 100
9 26 9 47 19 217
- - - - - -
50 122 2 7,673 50 3,922
2 5,854 7 788 5 2,770
1 8 - - - 29
115 230 121 87 72 496
10 1,178 33 294 2 1,488
101 11,203 71 6,426 142 9,316
522 7,612 273 6,102 449 7,055
12 10 5 11 8 50
- - - - - -
- - - 1 1 1
- - - - - -
- - - - - -
8 12 - 23 3 9
- 20 - 4 - 15
4 3 3 1 - 5
- - - - - -
42 75 8 440 63 150
2 107 1 35 2 53
6 11 5 12 11 12
4 5 - 5 2 23
8 13 7 10 5 28
16 17 6 13 8 60
4 136 1 28 5 57
59 384 38 98 34 399
4 10 2 4 3 8
2 80 1 46 7 36
- 5 5 - - 2
1 2 1 - - 1
- 1 1 2 2 2
- 7 3 1 1 3
- 1 - - - -
- 1 1 - - -
4 44 - 87 7 35
- - - - - -
42 75 8 440 63 150
2 107 1 35 2 53
6 11 5 12 11 12
4 5 - 5 2 23
8 13 7 10 5 28
16 17 6 13 8 60
4 136 1 28 5 57
59 384 38 98 34 399
- - - - - -
17 93 2 977 23 27
1 78 - 72 - 56
5 28 1 343 12 14
- 75 - 170 2 199
- - - - - -
17 93 2 977 23 27
3 6 - - - -
- - - - - -
39 707 3 493 43 223

- 658 - 48 - 7
18 903 15 45 23 163
76 1,087 26 612 36 324
- - - - - -
9 94 2 26 11 26
- 7 - 1 - 4
3 3 - - - -
1 5 1 4 2 5
29 30 2 20 9 42
- - - - - -
1 9 - 1 - 4
- - - - - -
23 26 - 2,911 33 644
- 117 - 677 6 353
1 3 - 14 - 24
- - - - - 6
- - - 1 1 7
- 1 - - - 4
1 5 - 6 4 181
- 2 - - - 8
- 1 - 2 - 10
3 3 1 11 3 120
5 162 1 445 21 839

4 2 - 133 33 10
1 - - 30 1 5
- 1 - 6 5 1
- - - 16 14 1
- - - 31 30 1
- - - 1 - 4
- - - 4 3 1
- 4 1 2 - 11
5 163 3 2 2 15
- - - - - -
1 - - 2 1 4
- 4 - - - -
- - - - - -
- 2 - 19 1 10
- - - - - -
1 - - 2 1 4
- 9 - 4 - 5
3 - - - - 5
- - - 70 18 7
- - - - - -
- 269 - 98 2 755
- 3 - 2 1 -
- - - - - -
63 106 11 189 30 232
2 165 1 50 3 174
18 62 12 39 11 162
15 1,737 - 224 1 301
- - - - - -
- 3 - - - 3
5 4 - 4 2 2
- - - - - -
14 420 - 601 5 501
- 2,885 1 118 - 905
- 15 - 2 - 5
- 16 1 - - 2
- - - - - -
- 9 1 1 - -
12 448 4 48 4 93
- - - - - -
9 24 1 55 - 64
- - - 2 - 4
- - - - - 1
- - - - - -
- 1 - - - 3
3 5 - 2 - 10
7 28 3 16 4 77
- - - - - -
- - - - - -
7 2 - 13 4 8
3 12 2 5 3 21
- - - - - -
- - - - - -
- - - - - -
- 2 2 - - -
- - - 1 1 1
- - - 1 - 9
3 3 1 6 4 6
- - - - - -
- - - - - 2
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- 3 - - - 2
- - - - - -
9 7 6 19 16 8
11 5 4 10 9 17
- - - - - -
- 1 - - - 1
- 3 3 - - 3
8 12 5 31 30 9
17 93 2 977 23 27
1 78 - 72 - 56
5 28 1 343 12 14
- 75 - 170 2 199
- 2 - - - 4
- - - 1 1 -
- - - - - -
- - - - - -
- - - 1 - 3
- 4 1 2 - -
- - - - - -
- - - - - -
- - - - - 1
1 7 2 5 - 6
- - - - - -
- - - 7 - -
- 2 - 3 - 14
- - - - - 1
- - - - - -
- 112 - 4 - 2
- - - - - -
- - - - - 1
- - - - - -
29 17 13 16 12 14
3 1 1 7 4 4
- - - - - 1
- - - - - -
1 - - - - -
- 1 - - - -
- - - - - -
8 12 9 11 10 50
- 1 - 1 - -
- - - - - -
40 91 18 750 59 384
11 628 9 339 21 986
3 15 6 6 3 89
29 82 35 58 23 82
- - - - - -
- - - - - -
- - - - - -
40 91 18 750 59 384
11 628 9 339 21 986
3 15 6 6 3 89
29 82 35 58 23 82
- - - - - -
- - - - - -
- - - - - -
11 14 5 15 8 23
- - - - - -
11 14 5 15 8 23
- - - - - -
4 44 - 87 7 35
- - - 5 1 3
- 2 - 8 3 1
4 - - - - 8
5 10 - 20 5 19
- - - - - -
- 2 2 1 - 4
1 - - - - 3
- 2 2 - - 2
3 2 1 3 1 5
- - - - - -
6 5 1 73 14 50
2 55 1 50 10 10
1 19 5 4 3 4
- - - - - -
- 15 - - - 5
- - - - - -
6 5 1 73 14 50
2 55 1 50 10 10
1 19 5 4 3 4
- - - - - -
- 15 - - - 5
- - - 1 1 1
6 15 4 13 9 16
2 1 1 3 3 1
- - - - - -
6 5 1 73 14 50
- 18 - 1 - 2
2 - - - - 1
1 2 1 - - 1
- - - - - -
- 15 - - - 5
- - - - - -
3 3 2 15 4 12
5 2 2 2 2 23
- - - 6 5 5
- - - 3 2 1
3 7 5 10 8 10
3 - - - - 1
3 1 1 56 49 11
2 3 3 4 3 38
- - - - - -
- - - - - -
- 1 - 2 1 -
- - - - - -
- - - - - -
1 94 2 210 2 340
1 2,265 1 884 5 1,401
- 1 - 5 1 51
- 23 - - - 78
3 18 - 180 2 638
4 2 2 13 11 4
10 50 3 77 71 43
- - - - - -
- - - 2 - -
- - - 2 - -
- - - - - -
- - - 2 - -
- - - 1 - -
4 5 2 34 12 13
- 1 1 8 3 9
- - - - - -
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- - - - - -
17 7 6 17 7 13
9 78 5 61 15 83
- - - - - -
12 1,277 7 922 25 1,056
- 27 - 107 2 -
- - - - - -
58 78 2 431 37 994
48 6 2 265 16 83
35 415 22 376 33 351
43 512 57 122 8 1,081
78 728 60 707 109 1,420
19 10 2 49 9 516
- - - - - -
- - - - - -
16 65 3 29 20 153
2 165 1 55 12 143
21 32 28 23 19 111
- - - - - -
- - - - - 44
- - - 1 - 18
- 1 - - - 1
- 5 - - - 417
- 49 - - - 589
- 29 - - - -
- - - - - -
- 24 - - - 23
11 1,643 12 127 8 371
2 271 1 174 5 243

5 1,212 19 691 18 198
- 3 - 3 1 38
- 60 6 139 8 69
- - - - - -
23 49 30 19 14 6
5 9 - - - 1
8 2 1 1 1 3
13 32 25 10 10 41
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1 6 2 4 3 2
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3 32 7 11 - 18
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- 4 3 14 4 1
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4 14 - 14 1 15
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- 9 - 18 5 1
- 4 - 1 1 4
- 2 - 4 2 1
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- - - - - -
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- 1 - - - 4
- - - 5 5 41
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- - - - - -
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- - - - - -
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- 1 - 4 - -
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- 1 - - - -
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- 3 2 - - -
- - - 1 - -
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- - - - - -
- - - - - -
6 59 - 39 3 23
- 186 - 2 - 4
5 12 7 2 - 4
1 1,044 1 61 1 55
- - - - - -
- 4 - 7 2 5
- 8 1 1 - 25
- - - - - -
- - - - - -
- 1 - - - 3
- - - - - -
- - - - - 2
- - - - - -
- - - - - -
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- - - - - -
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1 47 4 3 - 408
- - - - - 1
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1 47 4 3 - 408
- - - - - -
- - - 15 - 4
- - - 3 3 2
- 54 - - - 4
- 7 7 3 2 1
- - - - - 1
Kab. Ngawi Kab. Ponorogo
Frekuensi Frekuensi Rujukan
Rujukan Kunjungan Rujukan Kunjungan 2018 2018
22 304 9 3,179 97
19 1,603 20 7,876 75
6 98 5 135 14
1 140 - 153 1
- - - - -
14 358 15 762 52
- - -
- 6 1 37 2
1 27 2 483 4
1 2 1 4 2
1 - - 1 1
- - - - -
- - - 2 -
- - - 6 -
- 4 - 32 2
2 13 - 67 4
- 28 - 86 5
- - - 1 -
- - - - -
- - - 1 -
- - - 1 -
- 5 - 15 -
- - -
34 5,016 34 27,163 186
6 162 8 1,066 32
10 59 5 544 38
- 326 3 352 6
- 1 - 36 -
- 2 - 134 -
- 1 - 2 1
- 24 - 95 -
- 2 - 10 -
1 131 3 261 9
- 111 3 124 4
- 29 - 43 -
- - -
202 745 107 4,645 949
27 1,733 52 5,927 148
279 33 13 938 449
75 16 7 513 209
104 102 51 677 508
27 6 5 64 60
13 90 13 149 45
16 10 10 94 53
5 4 3 32 18
20 5 2 135 97
144 160 42 831 413
73 13 8 298 87
50 516 68 1,058 254
1 4 4 11 8
11 7 6 270 33
71 79 41 408 241
- - -
36 34 15 488 180
- 10 8 51 14
- - -
- 2 1 2 1
- - - 1 -
- - - - -
1 9 5 12 6
- - -
7 74 7 279 64
- 41 - 112 -
- 9 - 36 8
- 1 - 2 -
- - - - -
2 2 - 24 3
- 11 - 117 14
6 - - 38 7
18 112 17 271 68
10 - - 49 17
- - -
9 20 9 84 28
2 - - 2 2
- - - - -
- 15 - 500 2
- 7 - 444 32
- - - 10 2
- 6 - 337 -
- - -
- 3 - 89 4
- - - 41 2
- - - 1 -
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5 4 - 221 17
- - -
- 4 1 33 1
2 - - 5 4
- - -
- 1 - 5 2
- - - 3 2
2 1 - 8 5
- - - 4 4
1 - - 20 18
- - - - -
- - -
- 2 1 19 3
- 4 - 28 -
1 - - 12 1
- 18 1 32 3
1 1 - 2 1
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1 12 6 39 14
- 1 1 49 14
- 3 - 29 2
- - - 10 1
- 1 - 12 1
6 4 1 271 39
- - -
- 2 1 19 3
- 4 - 28 -
1 - - 12 1
- 18 1 32 3
1 1 - 2 1
- - - 1 -
1 12 6 39 14
6 4 1 271 39
- - -
124 304 11 1,379 172
195 389 107 1,347 402
- - -
1 27 - 529 17
2 1 1 56 19
- 119 - 927 2
- - -
- 319 2 1,736 6
- 284 3 1,464 3
- - -
13 293 9 1,177 56
- 175 - 509 5
- - -
- 16 - 77 2
- 15 - 57 -
- - -
7 12 2 136 37
- - -
- 4 2 20 10
- 2 1 5 2
- - -
10 4 4 36 28
6 4 4 16 15
- - -
1 150 1 1,088 15
7 112 - 583 14
- - -
4 116 - 362 30
2 105 - 415 5
- - -
4 116 - 362 30
2 105 - 415 5
- - -
4 116 - 362 30
- 14 1 85 7
- - -
4 116 - 362 30
- 2 - 11 -
- - -
4 116 - 362 30
1 115 1 560 6
- - -
4 116 - 362 30
- 230 2 990 25
- 3 - 24 6
- - -
4 116 - 362 30
1 104 2 556 7
- - -
4 116 - 362 30
3 2 - 78 21
- 93 4 467 4
- - -
3 15 1 1,230 22
- 27 1 390 2
1 - - 60 6
- - - 3 -
- - - 2 1
2 110 2 123 8
4 72 4 321 25
- - -
1 30 - 180 19
2 14 1 73 11
2 2 - 12 3
9 35 - 193 20
- - -
1 30 - 180 19
16 186 2 1,101 27
9 35 - 193 20
- - -
- - - - -
- - - - -
- - - - -
- - - - -
- 5 - 86 -
- - - - -
- - - - -
- - -
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- - - - -
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- 3 3 6 3
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- - - - -
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- 2 2 9 2
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1 3 - 22 3
- - -
- 2 2 9 2
- 2 - 12 -
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1 3 - 22 3
2 - - 4 2
1 - - 1 1
- - -
- 1 - 3 -
- 1 1 5 1
1 - - 1 1
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- 7 1 16 1
- 2 - 2 -
- 2 1 7 1
- 2 - 3 -
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- - - 1 1
- - - - -
2 1 1 3 3
- 7 3 17 5
- - -
- - - 1 -
- - - 2 -
- - -
- - - 1 -
- - - 2 -
- - - 2 1
- - - 2 1
- - -
5 348 1 1,625 35
- - -
72 90 66 457 362
106 45 43 258 231
18 33 32 79 74
35 21 16 70 61
77 10 10 169 160
76 29 28 225 206
14 38 20 187 90
- - -
48 101 29 300 131

35 97 18 430 76
74 293 46 644 168
43 90 46 489 242
65 23 20 228 175
26 393 42 745 98
- - -
48 101 29 300 131

35 97 18 430 76
74 293 46 644 168
19 8 7 90 67
- - -
653 477 167 6,240 3,351
817 1,710 261 6,013 2,743

- - -
360 3,297 432 35,182 3,141
675 13,888 527 88,446 4,102

- - -
- - - 9 -
2 10 5 28 12
5 41 7 149 19
- - -
2 - - 11 6
8 - - 11 9
- - - 1 -
3 1 1 7 6
- - - 7 2
2 - - 3 2
- 207 - 212 1
- 1 - 1 -
- - -
- - - 3 -
- - - 2 2
- - - 1 1
- 2 - 2 -
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- 1 1 1 1
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5 15 - 34 10
- - -
3 - - 10 6
- - - 9 1
1 - - 1 1
- - - 2 1
2 3 - 10 5
- - -
6 45 1 2,089 45
8 1,012 9 3,886 109
5 9 2 267 15
2 5 2 116 19
- 1 - 87 -
11 17 3 649 73
6 476 1 3,561 58
1 - - 6 1
- - - 39 3
4 32 4 432 13
- - -
- 34 9 178 18
- 369 - 1,431 10
- - - 2 -
1 5 - 40 1
- 3 1 150 10
- - -
27 28 7 121 45
8 - - 36 8
1 - - 3 2
4 2 2 7 7
- - - 1 1
6 1 1 8 7
7 2 1 14 10
63 65 14 218 105
- - -
1 7 3 87 26
115 36 9 286 177
5 - - 5 5
- - - 1 1
4 20 2 211 8
- - -
19 268 13 893 41
- 289 - 901 1
- 3 2 18 8
- - - 1 -
2 2 - 160 6
18 498 10 1,614 72
- 2 - 28 -
- - -
33 556 18 3,159 143
14 4 2 603 109
1 2,549 5 5,957 13
23 8 3 70 50
- 2 - 3 -
38 192 15 916 112
123 7,843 49 51,879 434
- - -
14 8 7 117 98
27 60 18 471 79
- - -
45 327 60 1,080 237
6 171 16 1,130 70
- - -
9 30 14 296 67
1 18 1 79 4
- - -
13 48 39 110 69
- 1 - 17 7
- - -
3 13 2 85 52
9 22 13 94 57
- - -
17 1,159 10 7,077 94
1 105 - 1,470 4
9 10 2 186 17
3 5 1 187 16
12 65 3 522 28
22 30 14 151 90
6 5 4 18 15
3 48 3 237 18
11 1,542 27 3,978 115
- 11 3 192 6
- 4 1 83 2
- - - - -
- 5 1 58 3
2 15 3 291 9
- 1 - 1 -
- - -
21 8 2 172 81
1 17 - 66 10
21 4 3 854 382
43 2 2 102 63
36 126 73 669 286

- - -
1 3 - 19 8
- 1 - 7 1
- - -
582 411 401 2,592 2,389

31 73 56 585 478
- - -
582 411 401 2,592 2,389

52 164 120 653 490
- - -
582 411 401 2,592 2,389

4 59 16 99 34
- - -
582 411 401 2,592 2,389

9 83 32 232 127
- - -
76 97 86 275 243
- - - 1 1
- - -
38 273 16 1,205 121
1 18 1 195 12
17 9 7 62 36
1 12 2 58 7
7 42 4 216 30
75 264 27 1,292 188
1 4 - 16 6
1 6 - 21 3
3 1 1 47 4
- 4 1 22 10
- - - 6 2
- 4 4 11 7
2 3 1 13 4
- - -
12 47 12 226 52
13 390 34 2,244 148
- - -
9 29 4 225 53
9 14 2 65 26
10 24 11 143 42
46 197 54 1,408 364

53 239 47 845 244
32 87 16 269 147
14 470 15 1,600 96
4 10 6 29 14
1 3 - 16 6
- - - 1 -
3 3 1 13 6
- - -
52 40,989 133 163,812 672
- - -
155 500 131 2,452 681
30 74 23 265 113
44 74 11 390 144
67 296 92 798 252

- - -
16 35 16 95 41
- 1 - 23 1
6 4 4 21 16
19 8 4 50 29
13 34 15 175 75
11 54 17 417 98
34 56 19 205 103
- - - 4 1
13 34 11 141 49
2 10 4 17 8
- 1 1 14 10
18 37 13 221 80
- - -
- 16,406 1 74,817 12
- - -
7 789 5 6,036 26
- 417 - 2,858 3
1 1 1 217 2
7 1,522 12 15,535 67
4 6 2 63 16
2 311 1 321 5
18 108 14 245 67
- - -
54 286 20 1,321 185
1 6 - 469 4
15 3 2 169 24
82 298 22 2,001 252
31 14 8 99 76
135 103 69 484 356
16 12 7 77 64
1 2 2 15 10
5 10 3 37 26
- - -
2 7 2 81 12
- 17 1 229 5
- 1 1 7 7
10 5 4 32 28
- - -
- 634 1 5,333 1
- 390 - 6,628 2
1 70 - 3,964 3
- 408 2 2,773 5
- 7,263 3 23,198 7
3 1,749 8 4,514 16
- 6,368 9 16,941 22
1 1,490 - 11,786 3
- 1,760 1 4,162 4
- - -
1 8 - 29 11
- 1 - 8 2
1 2 1 7 4
- 1 - 10 3
- - - 1 -
12 5 3 48 27
10 16 9 51 31
1 3 3 8 6
1 2 - 9 4
- - - 13 7
- 2 - 2 -
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- - - 1 -
1 2 - 3 1
- - - 4 -
- - - - -
- - - - -
2 - - 3 3
- 4 4 11 10
5 9 6 41 27
1 - - 246 42
1 - - 65 7
- 1 1 29 15
- - - 8 4
- - - 3 2
- - - 1 -
- - - - -
- - - - -
2 - - 11 6
23 26 14 145 65
142 68 46 400 253
- 1 - 1 -
- - - 1 1
4 6 5 17 15
37 136 96 461 224
- - -
87 316 27 1,315 275
18 7 2 475 38
6 46 1 205 10
1 1 - 23 5
- - - 139 131
- 2 - 11 1
2 1 1 9 4
- - - 5 -
1 - - 12 4
21 1 1 53 44
93 193 41 990 350
23 371 15 1,853 97
4 5 3 36 23
13 15 6 68 43
3 4 4 32 28
1 1 - 13 10
249 38 24 774 448
- - -
4 30 2 148 16
- 1 1 17 5
- - -
4 30 2 148 16
1 3 - 15 3
6 32 3 818 32
- 266 1 790 12
- - - - -
220 388 10 2,801 455
- - -
12 9 6 42 25
- 52 5 102 6
- - -
229 1,733 69 7,510 992
220 388 10 2,801 455
42 8 5 335 139
40 29 25 374 270
16 2,732 32 8,069 164
- - -
9 349 4 2,102 22
4 61 5 424 17
1 523 10 1,749 23
23 165 27 312 95
2 13 3 65 7
- - -
58 190 9 405 94
169 86 12 852 218

- - -
46 721 17 14,612 165
4 538 5 10,130 23
- 4 - 43 1
238 972 199 1,945 745
22 206 8 3,278 75
86 18,621 46 48,327 446
519 6,737 527 34,501 2,290
15 13 7 148 47
- - -
- 3 - 5 1
- 3 1 3 1
- - -
- 21 1 93 12
- 16 - 70 -
2 2 - 17 9
- - -
11 209 21 1,083 145
4 41 2 308 11
5 28 14 77 41
- 4 2 49 8
6 14 6 85 32
4 34 8 143 42
1 80 4 426 15
39 438 45 1,649 215

7 2 1 29 17
1 18 1 195 12
2 7 7 16 14
- - - 4 2
1 4 2 9 6
2 5 5 16 11
- - - 1 -
- 1 1 2 2
1 57 7 245 19
- - -
11 209 21 1,083 145
4 41 2 308 11
5 28 14 77 41
- 4 2 49 8
6 14 6 85 32
4 34 8 143 42
1 80 4 426 15
39 438 45 1,649 215

- - -
4 17 5 1,274 51
- 67 3 341 4
3 6 4 398 25
1 214 - 711 3
- - -
4 17 5 1,274 51
- 1 - 13 3
- - -
17 563 20 2,359 122

- 108 - 824 -
11 121 7 1,354 74
52 1,069 45 4,449 235
- - -
14 29 16 198 52
- 2 - 14 -
- 2 2 8 5
1 2 1 18 6
29 41 18 192 87
- - -
- 12 - 34 1
- - -
11 172 10 4,413 77
- 18 - 1,182 6
- 17 - 60 1
- - - 8 -
- - - 8 1
- 106 - 111 -
1 6 1 199 7
- - - 10 -
- - - 13 -
- 5 2 161 9
17 341 3 1,933 47
- 23 2 186 39
- 1 - 40 2
- - - 8 5
1 - - 17 15
1 - - 32 31
- - - 7 -
1 - - 5 4
- 1 - 20 1
8 40 6 249 24
- - -
4 2 - 9 6
- 4 2 8 2
- 5 1 5 1
1 1 1 35 3
- - -
4 2 - 9 6
- 7 - 25 -
5 - - 8 8
4 2 1 80 23
- - - - -
9 116 1 1,294 12
- 2 - 10 1
- - -
15 258 10 1,152 129
3 22 1 425 10
11 65 12 1,027 64
5 723 3 3,431 24
- - -
1 1 - 37 1
- 2 - 17 7
- - -
3 252 2 2,242 24
- 324 - 4,339 1
- 1 - 34 -
- - - 18 1
- - - - -
- 1 - 11 1
4 944 5 1,701 29
- - - - -
6 13 - 194 16
- - - 13 -
- - - 1 -
- - - 1 -
- 29 - 33 -
- 16 5 40 8
14 29 2 165 30
- - - - -
- - -
4 9 2 45 17
2 4 1 51 11
- 1 1 1 1
- 1 - 1 -
- - - - -
- - - 2 2
1 2 - 4 2
1 - - 10 1
3 6 - 31 11
- - - - -
- - - 2 -
- - - - -
- 2 - 2 -
- - -
- - - - -
- - - 5 -
- - -
6 13 9 57 46
13 3 3 46 40
- - - - -
- - - 2 -
1 2 2 8 6
6 3 3 69 52
4 17 5 1,274 51
- 67 3 341 4
3 6 4 398 25
1 214 - 711 3
1 - - 7 1
- - - 1 1
- - - - -
- - -
1 3 - 9 1
- 5 1 12 2
- - - - -
- 1 - 1 -
- - - 1 -
2 18 - 45 5
- - -
- - - 7 -
1 3 - 29 1
- - - 1 -
- 2 2 2 2
- 42 - 175 -
- - - - -
- - - 1 -
- - -
11 33 20 114 85
2 7 4 23 14
1 2 1 3 2
- 2 2 2 2
- - - 1 1
- - - 1 -
- - -
12 4 2 86 41
- 1 - 3 -
- - -
49 209 20 1,775 186
10 1,048 15 3,494 66
17 8 8 159 37
41 65 35 495 163
- - - - -
- - - - -
- - -
49 209 20 1,775 186
10 1,048 15 3,494 66
17 8 8 159 37
41 65 35 495 163
- - - - -
- - - - -
- - -
17 16 8 85 49
- - -
17 16 8 85 49
- - -
1 57 7 245 19
2 - - 9 3
- - - 11 3
6 7 5 19 15
4 22 5 84 19
- - -
1 2 2 9 5
2 - - 4 3
1 1 - 5 3
2 5 5 18 12
- - -
10 5 2 163 33
2 57 3 194 18
3 1 1 29 13
- 1 1 1 1
2 - - 44 2
- - -
10 5 2 163 33
2 57 3 194 18
3 1 1 29 13
- 1 1 1 1
2 - - 44 2
1 - - 3 2
12 29 - 83 31
1 - - 18 7
- - -
10 5 2 163 33
- 2 - 23 -
1 - - 3 3
- - - 4 2
- 1 1 1 1
2 - - 44 2
- - -
1 3 3 36 13
6 13 7 45 22
4 6 6 17 15
- 17 15 21 17
5 12 11 42 32
1 - - 4 4
5 7 5 80 63
30 10 6 57 44
- - -
- - - - -
- 1 - 4 1
- - - - -
- - -
1 86 1 746 7
15 341 2 5,263 24
3 - - 57 4
1 - - 102 1
14 302 14 1,189 33
3 5 5 28 25
26 26 24 208 134
- - -
- 1 - 4 -
- 1 - 3 -
- - -
- 1 - 4 -
- 1 - 2 -
9 20 4 81 31
2 4 - 22 6
- - -
- - - 2 1
- - -
9 18 12 84 51
11 60 2 346 42
- - -
25 715 17 5,245 86
- 1 - 135 2
- - -
3 270 14 2,299 114

4 47 11 635 81
14 221 12 1,493 116
54 1,053 44 3,424 206
349 1,024 48 4,323 644
24 21 8 930 62
- - - - -
- - -
30 15 12 283 81
9 75 15 468 39
93 28 26 215 187
- - -
- 100 - 148 -
- - - 19 -
- - - 2 -
- - - 422 -
- 1 1 639 1
- - - 29 -
- - - - -
1 - - 48 1
3 1,112 25 3,317 59
4 19 6 721 18
3 509 8 2,683 53
1 5 - 50 2
10 83 3 355 27
- - -
5 42 27 140 99
- 1 - 16 5
1 8 7 22 18
11 22 14 119 73
- - -
- 2 2 17 8
- - - 5 2
- - -
2 52 9 121 21
- 3 - 32 -
1 4 - 14 2
- - - - -
- - - 1 -
- - - - -
- - - 3 -
- 2 2 2 2
- 2 - 4 -
- - - 3 3
- - - - -
- - - - -
- - - - -
1 - - 4 1
- 1 - 11 -
- - - 4 -
- - - 1 -
- - - - -
- - - - -
- - - - -
- 2 - 44 5
1 10 - 29 8
2 1 - 10 2
- - - - -
- - - - -
- - - 2 -
- - - - -
- 5 - 12 3
- - - 10 -
- 2 - 4 -
1 30 8 89 14
- 2 1 5 1
- - - - -
- - - - -
- - - - -
- 2 1 103 4
- 8 - 38 5
- 2 - 13 1
- - - 7 2
- - - - -
- - - - -
- - - - -
1 1 - 6 1
3 - - 46 8
- - - 7 -
- 1 - 1 -
- - - 1 -
- - - - -
- - - - -
- - -
- 2 - 7 -
- - - 2 -
- - - - -
- 1 - 6 -
- - - 1 -
- 1 - 8 -
- 1 - 4 2
- - - 1 -
- - - - -
- - - - -
- - - - -
- - - - -
2 4 - 143 11
2 - - 192 2
- 7 3 155 15
1 211 - 1,454 4
- - -
1 12 1 28 4
- 12 - 56 1
- - -
- 4 - 6 -
1 5 - 9 1
- - - - -
- - - 2 -
- 3 2 3 2
- - -
- - - 2 -
- - - - -
- 2 - 9 -
- - - 1 -
1 10 - 469 6
- 6 - 7 -
- - -
- - - - -
- - - - -
- - - - -
- - - - -
1 10 - 469 6
- - -
4 - - 19 4
2 1 - 6 5
4 - - 59 4
- - - 11 9
- 2 - 3 -
ICD 10 tanpa titik
Z271
Z272
Z273
E10
E109
E11
E119
E44
E440
E441
E46
E640
E661
E791
F512
G442
G443
G444
J156
K21
K219
N10
N12
O268
O269
T291
T292
T295
T296
X78
X79
ICD 10 tanpa titik
Need for immunization against diphtheria-tetanus-pertussis, combined [DTP]
Need for immunization against diphtheria-tetanus-pertussis with typhoid-paratyphoid [DTP + TAB]
Need for immunization against diphtheria-tetanus-pertussis with poliomyelitis [DTP + polio]
Insulin-dependent diabetes mellitus
Insulin-dependent diabetes mellitus without complications
Non-insulin-dependent diabetes mellitus
Non-insulin-dependent diabetes mellitus without complications
Protein-energy malnutrition of moderate and mild degree
Moderate protein-energy malnutrition
Mild protein-energy malnutrition
Unspecified protein-energy malnutrition
Sequelae of protein-energy malnutrition
Drug-induced obesity
Lesch-Nyhan syndrome
Nonorganic disorder of the sleep-wake schedule
Tension-type headache
Chronic post-traumatic headache
Drug-induced headache, not elsewhere classified
Pneumonia due to other aerobic Gram-negative bacteria
Gastro-oesophageal reflux disease
Gastro-oesophageal reflux disease without oesophagitis
Acute tubulo-interstitial nephritis
Tubulo-interstitial nephritis, not specified as acute or chronic
Other specified pregnancy-related conditions
Pregnancy-related condition, unspecified
Burns of multiple regions, no more than first-degree burns mentioned
Burns of multiple regions, no more than second-degree burns mentioned
Corrosions of multiple regions, no more than first-degree corrosions mentioned
Corrosions of multiple regions, no more than second-degree corrosions mentioned
Intentional self-harm by sharp object
Intentional self-harm by blunt object
Skrofuloderma
Pertusis
Erisipelas
Sifilis stadium 1 dan 2
Diabetes melitus tipe 1
Defisiensi vitamin
Defisiensi mineral
Dermatitis numularis
Salpingitis
Mabuk perjalanan
Keracunan makanan
Kekerasan tajam
Kekerasan tumpul

Lampiran BA Peer Review KC Madiun Juli 2019

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Lampiran BA Peer Review KC Madiun Juli 2019

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LAMPIRAN BERITA ACARA

HASIL FOCUS GROUP DISCUSSION PEER REVIEW DIAGNOSA NON SPESIALISTIK

Disentri basiler, disentri amuba (A06-Amoebiasis)

(A06.0-Acute amoebic dysentery) KMK 514 √

(A03.0-Shigellosis due to Shigella dysenteriae)

(A03.1-Shigellosis due to Shigella flexneri)

(A03.2-Shigellosis due to Shigella boydii)

Gastroenteritis (termasuk kolera, (A09-Other gastroenteritis and colitis of

(A09.0-Other and unspecified gastroenteritis KMK 514 √

(A08.4-Viral intestinal infection, unspecified)

(A08.5-Other specified intestinal infections)

(A02-Other salmonella infections)

Tuberkulosis paru tanpa (A15-Respiratory tuberculosis, bacteriologically

(A15.0-Tuberculosis of lung, confirmed by KMK 514 √

(A15.1-Tuberculosis of lung, confirmed by

(A15.7-Primary respiratory tuberculosis,

(A15.8-Other respiratory tuberculosis,

(A15.9-Respiratory tuberculosis unspecified,

(A16.1-Tuberculosis of lung, bacteriological

(A16.2-Tuberculosis of lung, without mention

(A16.7-Primary respiratory tuberculosis

(A16.8-Other respiratory tuberculosis, without

(A16.9-Respiratory tuberculosis unspecified,

Skrofuloderma (A18-Tuberculosis of other organs)

Leptospirosis (tanpa komplikasi) (A27- Leptospirosis)

(A27.8-Other forms of leptospirosis)

Lepra (A30-Leprosy [Hansen disease]) √

Tetanus (A35-Other tetanus) KMK 514

8 (Z27.1-Need for immunization against √

(Z27.2-Need for immunization against

(Z27.3-Need for immunization against

Pertusis (A37-Whooping cough)

Erisipelas (A46-Erysipelas) KMK 514 √

Sifilis stadium 1 dan 2 (A51-Early syphilis) KMK 514

Sindrom duh (discharge) genital (A54-Gonococcal infection) √

(A54.0-Gonococcal infection of lower

(A64-Unspecified sexually transmitted disease)

Gonore (A54-Gonococcal infection) √

(A64-Unspecified sexually transmitted disease)

Demam dengue, DHF (A90-Dengue fever [classical dengue])

Herpes simpleks tanpa komplikasi (B00-Herpesviral [herpes simplex] infections) √

(B00.9-Herpesviral infection, unspecified) KMK 514 √

Varisela tanpa komplikasi (B01-Varicella [chickenpox]) √

Herpes zoster tanpa komplikasi (B02-Zoster [herpes zoster]) √

Morbili tanpa komplikasi (B05-Measles) √

19 Veruka vulgaris (B07-Viral warts) KMK 514

(B08-Other viral infections characterized by

Hepatitis A (B15-Acute hepatitis A) KMK 514 √

Tinea kapitis (B35-Dermatophytosis) KMK 514 √

Tinea barbe (B35-Dermatophytosis) √

Tinea unguium (B35-Dermatophytosis) √

Tinea manus (B35-Dermatophytosis) √

Tinea pedis (B35-Dermatophytosis) √

Tinea korporis (B35-Dermatophytosis) √

Tinea kruris (B35-Dermatophytosis) √

Tinea fasialis (B35-Dermatophytosis) √

Pitiriasis versikolor (B36-Other superficial mycoses) √

Kandidosis mukokutan ringan (B37-Candidal stomatitis) √

Kandidiasis mulut (B37-Candidiasis) √

Skistosomiasis (B65-Schistosomiasis [bilharziasis])

(B65.0-Schistosomiasis due to Schistosoma KMK 514

(B65.1-Schistosomiasis due to Schistosoma

(B65.2-Schistosomiasis due to Schistosoma