FORM HOSPITAL RECORD REVIEW (HRR) KASUS SUSPEK CRS

(MOHON CEK KELENGKAPAN DATA MELALUI STATUS PASIEN)

NAMA RUMAH SAKIT: …………………………………………………..

KAB/KOTA/PROVINSI: ………………………………………………….
UNIT (POLI/BANGSAL/NICU/PICU/IGD/LAINNYA): ……………………………………..
PERIODE: JANUARI 2021 - AGUSTUS 2021

DIAGNOSIS of Diseases for

NO. KODE ICD 10 Congenital Rubella Syndrome (CRS)
→ ANAK USIA <12 BULAN

10

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KODE ICD-10 KASUS SUSPEK CRS

JUMLAH KASUS TAHUN 2021

(JIKA KASUS BELUM
DIAGNOSIS of Diseases for Congenital Rubella
NO. ICD 10 DILAPORKAN MELALUI WEB
Syndrome (CRS) → ANAK USIA <12 BULAN
CRS MAKA MOHON STATUS
KASUS DISIAPKAN)
1 P35.0 Congenital rubella syndrome

2 Q25.0 Patent ductus arteriosus

Patent ductus Botalli
Persistent ductus arteriosus

3 Q25.6 Stenosis of pulmonary artery

Supravalvular pulmonary stenosis

4 I37.0 Pulmonary valve stenosis

5 I28.28 Other specified diseases of pulmonary vessels

Stenosis of pulmonary vessel

6 Q24.3 Pulmonary infundibular stenosis

8 Q22.1 Congenital pulmonary valve stenosis

9 Q21.1 Atrial septal defect

Coronary sinus defect
Patent or persistent:
- foramen ovale
- ostium secundum defect (type II)
Sinus venosus defect

10 Q21.0 Ventricular septal defect

11 Q12.0 Congenital cataract

12 H35.5 Hereditary retinal dystrophy

Retinopathy pigmentary congenital

13 Q15.0 Congenital glaucoma

Buphthalmos
Glaucoma of newborn
Hydrophthalmos
Keratoglobus, congenital, with glaucoma
Macrocornea with glaucoma
Macrophthalmos in congenital glaucoma
Megalocornea with glaucoma

14 H90.0 Conductive and sensorineural hearing loss

congenital deafness

15 H90.3 Sensorineural hearing loss, bilateral

Sensorineural hearing loss, unilateral with unrestricted

16 H90.4 hearing on the contralateral side

17 H90.5 Sensorineural hearing loss, unspecified

Congenital deafness NOS
Hearing loss: NOS
- central
- neural
- perceptive
- sensory
Sensorineural deafness NOS