CEKLIST KELENGKAPAN DOKUMEN AKREDITASI POKJA ASESMEN PASIEN (AP) NO
MATERI
Elemen Penilaian AP.1 1 Pelaksanaa Pelaksanaan n asesmen asesmen inf!m inf!masi asi "an "an inf!masi inf!masi #an$ %a!&s 'e!se"ia 'e!se"ia &n'&k asien !aa' ina * Pelaksanaa Pelaksanaan n asesmen asesmen inf!masi inf!masi "an inf!masi inf!masi #an$ %a!&s 'e!se"ia 'e!se"ia &n'&k asien !aa' alan
3
Ke'e Ke'en'& n'&an an RS RS 'en'a 'en'an$ n$ inf! inf!mas masii #an$ #an$ "i"k "i"k&me &men'a n'asik sikan an &n'& &n'&k k asesm asesmen en
Elemen Penilaian AP.1.1 5 Pene'aan asesmen le% se6a "isilin klinis 2 Pene'aan 'ena$a kese%a'an #an$ "aa' melak&kan asesmen + Pene'aan minimal asesmen &n'&k asien !aa' ina 8 Pene'aan minimal asesmen &n'&k asien !aa' alan /
Elemen Penilaian AP.1.* , Pelaksanaa Pelaksanaan n asesmen asesmen aal aal asien asien !aa' !aa' ina "an !aa !aa'' alan alan 'e!mas&k9 'e!mas&k9 Ria#a' kese%a'an Peme!iksaan :sik
1
Pelaksanaan asesmen sikl$is
11
Pelaksanaan asesmen ssial eknimi
DOKUMEN PMK *+,-Menkes-Pe!-III-*/ Ke0iakan- 'en'an$ Asesmen Inf!masi Pasien Raa' Jalan "an Raa' Ina Pe"man- 'en'an$ Asesmen Inf!masi Pasien Raa' Jalan "an Raa' Ina Pan"&an- Asesmen inf!masi Pasien Raa' Jalan "an Raa' Ina SPO Asesmen Inf!masi Pasien Raa' Jalan SPO Asesmen Inf!masi Pasien Raa' Ina Ke0i Ke0iaka akan n 'en'a 'en'an$ n$ en&l en&lisa isan n inf!m inf!masi asi ke "alam "alam !ekam !ekam me"is me"is 4asil asesmen a"a !ekam me"is PMK *+,-Menkes-Pe!-III-*/ KMK 'en'an$ s'an"a! !fesi Ke0iakan- 'en'an$ Pela#anan Pela#anan Rekam Me"is (isi asesmen !aa' ina "an !aa' alan) Pe"man- 'en'an$ Pela#anan Rekam Rekam Me"is (isi asesmen !aa' ina "an !aa' alan) Pan"&an- Asesmen Pasien Raa' Jalan Pan"&an- Asesmen Pasien Raa' Ina SPO 'en'an$ Pela#anan Rekam Me"is (isi asesmen !aa' ina "an !aa' alan) 7!m Asesmen asien !aa' ina 7!m Asesmen asien !aa' alan PMK *+,-Menkes-Pe!-III-*/ Ke0iakan- 'en'an$ Pela#anan Pela#anan Rekam Me"is (isi asesmen !aa' ina "an !aa' alan) Ke0iakan- Asesmen Pasien (asesmen aal !aa' ina "an !aa' alan) Pe"man- 'en'an$ Pela#anan Rekam Rekam Me"is (asesmen aal !aa' ina "an !aa' alan) Pan"&an- Asesmen Pasien Raa' Jalan (asesmen aal) Pan"&an- Asesmen Pasien Raa' Ina (asesmen aal) SPO asesmen aal !aa' alan SPO asesmen aal !aa' ina ;&k6 !ekam me"is !aa' alan "an !aa' ina (f!m asesmen aal !aa' alan "an !aa' ina) Pan"&an Asesmen (Psikl$is) SPO Asesmen Psikl$is ;&k6 !ekam me"is Pan"&an Asesmen (ssi
NILAI 2 2
2
1 1
2
KET
1* Pene'aan "ia$nsis 0e!"asa!kan asesmen Elemen Penilaian AP.1.3 13 Pelaksanaan asesmen aal meli&6 !ia#a' kese%a'an= eme!iksaan :sik "an asesmen lain #an$ 'e!"k&men'asi= &n'&k mene'akan ke0&'&%an me"is asien
15
Pelaksanaan asesmen kee!aa'an #an$ 'e!"k&men'asi= &n'&k mene'akan ke0&'&%an kee!aa'an asien= se!'a asesmen lain ses&ai ke0&'&%an asien 12 Pen>a'a'an ke0&'&%an me"is "alam !ekam me"is 1+ Pen>a'a'an ke0&'&%an kee!aa'an "alam !ekam me"is 18 Re$&lasi 'e!kai' sem&a &!aian "i a'as Elemen Penilaian AP.1.3.1 1/ Pelaksanaan asesmen me"is &n'&k asien $aa' "a!&!a'
1,
Pelaksanaan asesmen kee!aa'an &n'&k asien $aa' "a!&!a'
* Un'&k asien #an$ e!asi a"a >a'a'an !in$kas "an "ia$nsis !a<e!asi Elemen Penilaian AP.1.5 *1 Pene'aan ke!an$ka ak'& elaksanaan asesmen a"a sem&a ela#anan ** *3
Pelaksanaan asesmen ses&ai "en$an ke!an$ka ak'& #an$ "i'e'akan !&ma% saki' Pelaksanaan asesmen &lan$ &n'&k asien !aa' ina
Elemen Penilaian AP.1.5.1
;&k6 !ekam me"is SPO Pene'aan Dia$nsis UU N *, 'en'an$ P!ak6k Ke"k'e!an PMK *+,-Menkes-Pe!-III-*/ Ke0iakan- 'en'an$ Pela#anan Rekam Me"is (asesmen !aa' ina "an !aa' alan) Ke0iakan- Asesmen Pasien (asesmen aal !aa' ina "an !aa' alan) Pe"man- 'en'an$ Pela#anan Rekam Me"is (asesmen aal !aa' ina "an !aa' alan) Pan"&an- Asesmen Pasien Raa' Jalan (asesmen aal) Pan"&an- Asesmen Pasien Raa' Ina (asesmen aal) SPO asesmen aal !aa' alan SPO asesmen aal !aa' ina ;&k6 !ekam me"is !aa' alan "an !aa' ina (f!m asesmen aal !aa' alan "an !aa' ina) Ke0iakan- Asesmen asien (kee!aa'an) Pan"&an asesmen kee!aa'an SPO Asesmen (aal) Kee!aa'an ;&k6 !ekam me"is (f!m asesmen aal me"is) ;&k6 !ekam me"is (f!m asesmen aal kee!aa'an)
PMK *+,-Menkes-Pe!-III-*/ Ke0iakan- 'en'an$ Pela#anan Rekam Me"is (asesmen $aa' "a!&!a') Ke0iakan- Asesmen Pasien (asesmen $aa' "a!&!a') Pe"man- 'en'an$ Pela#anan Rekam Me"is (asesmen $aa' "a!&!a') Pan"&an- Asesmen Pasien Gaa' Da!&!a' SPO asesmen asien $aa' "a!&!a' ;&k6 Rekam Me"is Pan"&an- Asesmen Kee!aa'an Gaa' Da!&!a' SPO asesmen kee!aa'an $aa' "a!&!a' ;&k6 !ekam me"is SPO asesmen asien e!asi CITO Ke0iakan Asesmen Pasien SPO asesmen aal !aa' ina (%a!&s 'e!>an'&m ak'&) ;&k6 !ekam me"is Pan"&an Asesmen &lan$ asien !&&kan SPO Asesmen Ulan$ Pasien !&&kan
2
1 2
*5
Pelaksanaan asesmen me"is aal "ilaksanakan "alam *5 am e!'ama seak !aa' ina a'a& le0i% >ea'
*2
Pelaksanaan asesmen kee!aa'an aal "ilaksanakan "alam *5 am e!'ama seak !aa' ina a'a& le0i% >ea'
*+
Pelaksanaan asesmen aal me"is #an$ "ilak&kan se0el&m asien "i !aa' ina= a'a& se0el&m 6n"akan a"a !aa' alan "i !&ma% saki'= #an$ 6"ak 0le% le0i% "a!i 3 %a!i= a'a& !ia#a' me"is 'ela% "ie!0a%a!&i "an eme!iksaan :sik 'ela% "i&lan$i *8 Pelaksanaan en>a'a'an e!&0a%an kn"isi asien #an$ si$ni:kan &n'&k asesmen #an$ "ilak&kan k&!an$ "a!i 3 %a!i= a"a saa' asien mas&k !aa' ina Elemen Penilaian AP.1.2 * / Pe lak sa na an e n>a' a'a n 'em &an "a !i ase sm en a" a !e kam me" is
*, 3
31
Kem&"a%an "alam menem&kan kem0ali %asil asesmen "i !ekam me"is le% me!eka #an$ mem0e!ikan ela#anan kea"a asien Pelaksanaan asesmen me"is #an$ "i>a'a' "alam !ekam me"is "alam ak'& *5 am se'ela% asien "i !aa' ina Pelaksanaan asesmen kee!aa'an #an$ "i>a'a' "alam !ekam me"is "alam ak'& *5 am se'ela% asien "i !aa' ina
Elemen Penilaian AP.12.1 3* Pelaksanaan asesmen me"is se0el&m e!asi 0a$i asien #an$ "i!en>anakan e!asi 33 4asil asesmen me"is "i>a'a' "alam !ekam me"is se0el&m e!asi "im&lai Elemen Penilaian AP.1.+ 35 Pelaksanaan asesmen n&'!isi
32
Pene'a an !i si k n&'!i si nal se0 a$ai %asil asesmen n&'!isi
3+
Pelaksanaan asesmen $i@i &n'&k asien "en$an !isik n&'!isinal
Ke0iakan asesmen asien SPO Asesmen Me"is aal ;&k6 Rekam me"is In"ika'! M&'& Ke0iakan asesmen asien SPO Asesmen Kee!aa'an aal ;&k6 Rekam me"is Ke0iakan asesmen asien SPO Asesmen Ulan$ Pasien !&&kan ;&k6 Rekam me"is
2
Ke0iakan asesmen asien ;&k6 Rekam me"is
Ke0 i aka n a se sm en as ie n SPO Pen>a'a'an inf!masi asesmen ;&k6 Rekam me"is Da?a! f!m&li! !ekam me"is
1
Ke0iakan asesmen asien SPO Asesmen aal (%a!&s a"a ke!an$ka ak'&) ;&k6 Rekam me"is Ke0iakan asesmen asien SPO Asesmen Kee!aa'an (%a!&s a"a ke!an$ka ak'&) ;&k6 Rekam me"is
Pan"&an Asesmen me"is (Asesmen !a<0e"a%) SPO Asesmen !a<0e"a% ;&k6 Rekam me"is (f!m Asesmen !a 0 e"a%) ;&k6 Rekam Me"is (f!m Asesmen !a 0e"a%)
2
Ke0iakan- 'en'an$ asesmen n&'!isi Pe"man- 'en'an$ asesmen n&'!isi Pan"&an asesmen n&'!isi SPO asesmen n&'!isi ;&k6 !ekam me"is (f!m asesmen n&'!isi) Ke0iakan- 'en'an$ asesmen n&'!isi SPO asesmen n&'!isi (%asil asesmen) SPO Kns&l'asi an'a! "isilin-em0e!i as&%an ;&k6 kns&l'asi !ekam me"is (f!m asesmen aal kee!aa'an= f!m kns&l'asi)
1 2
38
Pelaksanaan asesmen f&n$sinal le0i% lan&' le% s'af #an$ kme'en
3/
P!ses sk!inin$ &n'&k menilai ke0&'&%an asesmen f&n$sinal le0i% lan&' se0a$ai 0a$ian "a!i asesmen aal 3, Pelaksanaan kns&l'asi &n'&k asien #an$ meme!l&kan elaksanaan asesmen f&n$sinal ses&ai k!i'e!ia Elemen Penilaian AP.1.8 5 Pelaksanaan asesmen n#e!i
51
Tin"ak lan&' a'as %asil asesmen n#e!i
5*
4asil asesmen n#e!i "i>a'a' "alam !ekam me"is 0ese!'a 6n"ak lan&'n#a
Elemen Penilaian AP.1./ 53 Pene'aan "an elaksanaan asesmen 'am0a%an
55
Pelaksanaan m"i:kasi asesmen &n'&k asien "en$an ke0&'&%an k%&s&s ses&ai "en$an ke0&'&%an asien Elemen Penilaian AP.1., 52 Pelaksanaan asesmen 0a$i asien #an$ akan menin$$al
5+
Pela#anan #an$ "i0e!ikan ses&ai "en$an %asil asesmen
58 4asil asesmen "i>a'a' "alam !ekam me"is Elemen Penilaian AP.1.1 5/ Pelaksanaan !&&kan 0ila 'e!i"en6:kasi a"an#a ke0&'&%an 'am0a%an
Ke0iakan- 'en'an$ asesmen f&n$sinal-a'&% Pe"man- 'en'an$ asesmen f&n$sinal-a'&% Pan"&an asesmen f&n$sinal-a'&% SPO asesmen f&n$sinal-a'&% ("ise!'ai e'&$as #an$ 0e!kme'en) Se!6:ka' kme'ensi-keenan$an klinis ;&k6 !ekam me"is (f!m asesmen aal
1
1
SPO Kns&l'asi ;&k6 !ekam me"is
Ke0iakan- 'en'an$ asesmen n#e!i Pe"man- 'en'an$ asesmen n#e!i Pan"&an asesmen n#e!i SPO asesmen n#e!i ;&k6 !ekam me"is (f!m asesmen n#e!i) Pan"&an manaemen n#e!i SPO Manaemen n#e!i 4asil asesmen "an 6n"ak lan&'n#a "i !ekam me"is (f!m..) Ke0iakan- 'en'an$ asesmen n#e!i ;&k6 !ekam me"is ;&k6 kns&l'asi
1
Ke0iakan- 'en'an$ asesmen asien-&lasi "en$an ke0&'&%an k%&s&s Pe"man- 'en'an$ asesmen asien-&lasi "en$an ke0&'&%an k%&s&s Pan"&an asesmen asien-&lasi "en$an ke0&'&%an k%&s&s SPO asesmen masin$* asien-&lasi ;&k6 !ekam me"is 4asil asesmen "an 6n"ak lan&'n#a "i !ekam me"is
2
2
Ke0iakan- 'en'an$ asesmen asien 'e!minal Pe"man- 'en'an$ asesmen asien 'e!minal Pan"&an asesmen asien 'e!minal SPO asesmen aal asien 'e!minal SPO asesmen &lan$ asien 'e!minal ;&k6 !ekam me"is (f!m asesmen B 'e!minal) SPO Pela#anan PB Ta%a Te!minal 4asil asesmen "an 6n"ak lan&'n#a "i !ekam me"is ;&k6 !ekam me"is (f!m asesmen B 'e!minal)
2
1
Ke0iakan- 'en'an$ asesmen ke0&'&%an k%&s&s
2
asesmen k%&s&s
5, Pen>a'a'an %asil asesmen k%&s&s "i "alam !ekam me"is Elemen Penilaian AP.1.11 2 Pelaksanaan i"en6:kasi asien #an$ saa' em&lan$ann#a "alam kn"isi k!i6s
21
;&k6 !en>ana em&lan$an #an$ "im&lai seak ene!imaan asien !aa' ina Elemen Penilaian AP.* 2* Pelaksanaan asesmen &lan$ &n'&k menen'&kan !esns asien 'e!%a"a en$0a'an 23
25
Pelaksanaan asesmen &lan$ &n'&k e!en>anaan en$0a'an lan&'an a'a& em&lan$an asien
Pelaksanaan asesmen &lan$ "alam in'e!al ses&ai "en$an kn"isi asien "an 0ilamana 'e!a"i e!&0a%an #an$ si$ni:kan a"a kn"isi me!eka= !en>ana as&%an= ke0&'&%an in"ii"&al a'a& ses&ai ke0iakan "an !se"&! !&ma% saki' 22 Pelaksanaan asesmen &lan$ e% "k'e! sek&!an$
Pan"&an asesmen ke0&'&%an k%&s&s SPO asesmen asien ke0&'&%an k%&s&s SPO !&&k asien "en$an ke0&'&%an k%&s&s ;&k6 !ekam me"is (f!m..) 4asil asesmen k%&s&s "an 6n"ak lan&'n#a "i !ekam me"is Ke0iakan- 'en'an$ "is>%a!$e lannin$ PB k!i6s Pe"man- 'en'an$ "is>%a!$e lannin$ PB k!i6s Pan"&an asesmen B ("is>%a!$e lannin$<B k!i6s) SPO 'en'an$ !en>ana em&lan$an asien SPO i"en6:kasi B "$n !en>ana em&lan$an "lm kea"aan k!i6s ;&k6 !ekam me"is 4asil i"en6:kasi "an !en>ana em&lan$an "i !ekam me"is
Pan"&an asesmen &lan$ SPO Asesmen &lan$ (!esn en$0a'an) ;&k6 !ekam me"is Pan"&an asesmen &lan$ SPO Asesmen &lan$ (!en>ana en$0a'an "an em&lan$an B) ;&k6 !ekam me"is Ke0iakan- 'en'an$ in'e!al ak'& asesmen &lan$ Pan"&an asesmen &lan$ SPO Asesmen &lan$ (in'e!al ak'&) ;&k6 !ekam me"is Pan"&an asesmen &lan$ SPO Asesmen &lan$ (le% "k'e!) ;&k6 !ekam me"is Ke0iakan- 'en'an$ asesmen &lan$ asien nn ak&' Pan"&an asesmen &lan$ SPO Asesmen &lan$ (B nn ak&') ;&k6 !ekam me"is ;&k6 !ekam me"is
Ke0iakan- 'en'an$ e'&$as #an$ melak&kan asesmen B "an &lan$ Ke0iakan- 'en'an$ k!e"ensialin$ Pe"man- 'en'an$ asesmen B Pe"man- 'en'an$ k!e"ensialin$ Pan"&an asesmen asien "an asesmen &lan$ Pan"&an k!e"ensialin$ s'af me"is= kee!aa'an= 'ena$a me"is lainn#a SPO Asesmen asien (e'&$as)
1
2
+*
SPO Asesmen &lan$ (e'&$as) Ke0iakan- 'en'an$ e'&$as #an$ melak&kan asesmen B "an &lan$ Ke0iakan- 'en'an$ k!e"ensialin$ Keenan$an klinis SPO Asesmen $aa' "a!&!a' (e'&$as) ;&k6 !ekam me"is SPO Asesmen kee!aa'an aal-&l$ (e'&$as) ;&k6 !ekam me"is Keenan$an klinis
+5
PMK *+,-Menkes-Pe!-III-*/ Ke0iakan- 'en'an$ Pela#anan Rekam Me"is (asesmen 'e!in'e$!asi) Ke0iakan- Asesmen Pasien (asesmen 'e!in'e$!asi) Pe"man- 'en'an$ Pela#anan Rekam Me"is (asesmen 'e!in'e$!asi) Pan"&an Rekam Me"is 'e!in'e$!asi SPO >a'a'an 'e!in'e$!asi ;&k6 !ekam me"is !aa' alan "an !aa' ina N'&len "an A0sensi ssialisasi 'elaa% !ekam me"is
2,
+
Pene'aan 0a%a %an#a me!eka #an$ "ii@inkan "en$an lisensi= ses&ai &n"an$<&n"an$ "an e!a'&!an #an$ 0e!lak&= a'a& se!6:kasi= #an$ "aa' melak&kan asesmen. Pelaksanaan asesmen $aa' "a!&!a' le% e'&$as #an$ kme'en
+1
Pelaksanaan asesmen kee!aa'an le% me!eka #an$ kme'en
Pelaksanaan 0a%a me!eka #an$ kme'en melaksanakan asesmen "an asesmen &lan$ 'e!%a"a asien= "an 'an$$&n$ aa0n#a "i'e'akan se>a!a 'e!'&lis Elemen Penilaian AP.5 +3 Pelaksanaan 0a%a "a'a "an inf!masi asesmen asien "ianalisis "an "iin'e$!asikan
Me!eka #an$ 0e!'an$$&n$ aa0 a'as ela#anan asien "iik&'se!'akan "alam !ses Elemen Penilaian AP.5.1 +2 Ke0&'&%an asien "is&s&n skala !i!i'asn#a 0e!"asa!kan %asil asesmen ++
Pasien "an kel&a!$a "i0e!i inf!masi 'en'an$ %asil "a!i !ses asesmen "an se6a "ia$nsis #an$ 'ela% "i'e'akan aa0ila "ie!l&kan
+8
Pelaksanaan em0e!ian inf!masi kea"a asien "an kel&a!$an#a 'en'an$ !en>ana ela#anan "an en$0a'an= "an "iik&'se!'akan "alam ke&'&san 'en'an$ !i!i'as ke0&'&%an #an$ e!l& "ien&%i Elemen Penilaian AP.2 +/ Pela#anan la0!a'!i&m %a!&s memen&%i s'an"a!= nasinal= &n"an$<&n"an$ "an e!a'&!an. +, Te!se"ia ela#anan la0!a'!i&m #an$ a"ek&a'= 'e!a'&! "an n#aman &n'&k memen&%i ke0&'&%an
8 Pela#anan la0!a'!i&m &n'&k $aa' "a!&!a' 'e!se"ia selama *5 am
Ke0iakan- 'en'an$ !i!i'as ke0&'&%an "a!i %asil asesmen SPO !i!i'as ke0&'&%an "a!i %asil asesmen Ke0iakan- 'en'an$ em0e!ian inf!masi
Pe"man P!ak6k La0!a'!i&m Kese%a'an an$ ;ena!= Dekes= */ Pe"man ela#anan la0!a'!i&m Ke0iakan- ela#anan la0!a'!i&m Pe"man- ela#anan la0!a'!i&m P!$!am Ke!a SPO ela#anan la0!a'!i&m Da?a! inen'a!is la0!a'!i&m (ses&ai s'an"a! nasinal) Ja"al main'enan>e ala' la0!a'!i&m Ke0iakan Pela#anan La0!a'!i&m Ja"al s%i? a$a
2
1
2
1 2
81 Pemili%an ela#anan la0!a'!i&m "il&a! !&ma% saki' 0e!"asa!kan !e&'asi #an$ 0aik "an #an$ memen&%i &n"an$<&n"an$ "an e!a'&!an. 8* Pem0e!i'a%&an kea"a asien 0a%a a"a %&0&n$an an'a!a "k'e! #an$ me!&&k "en$an ela#anan la0!a'!i&m "il&a! !&ma% saki' ( se0a$ai emilik) Elemen Penilaian AP.2.1 83
Pelaksanaan !$!am keselama'an-keamanan la0!a'!i&m #an$ men$a'&! !isik keselama'an #an$ 'ensial "i la0!a'!i&m "an "i a!ea lain #an$ men"aa' ela#anan la0!a'!i&m 85
P!$!am keselama'an-keamanan la0!a'!i&m me!&akan 0a$ian "a!i !$!am manaemen keselama'an - keamanan !&ma% saki'= "an "ila!kan sek&!an$
A"a !e$&lasi"an elaksanaan 'en'an$ enan$anan "an em0&an$an 0a%an 0e!0a%a#a (;3) 8+
88 8/
Pelaksanaan i"en6:kasi !isik keselama'an #an$ "ia0a!kan melal&i !ses #an$ sesi:k "an a'a& a"an#a e!ala'an &n'&k men$&!an$i !isik keselama'an Pelaksanaan !ien'asi &n'&k s'af la0!a'!i&m 'en'an$ !se"&! "an !ak6k keselama'an-keamanan ke!a Pelaksanaan ela6%an &n'&k s'af la0!a'!i&m 'en'an$ !se"&! 0a!& "an en$$&naan 0a%an 0e!0a%a#a (;3) #an$ 0a!&
8, Elemen Penilaian AP.2.* / Pene'aan e'&$as #an$ melaksanakan eme!iksaan la0!a'!i&m= "an s'af
Ke0iakan Pela#anan La0!a'!i&m K!i'e!ia emili%an la0!a' l&a! Pan"&an ela#anan la0!a' l&a! MU "en$an la0!a' SPO inf!masi %&0&n$an "k'e! "en$an l a0!a'!i&m l&a! ;&k6 e"&kasi
2
KMK 53*-Menkes-SK-I-*8 'en'an$ Pe"man Manaemen Kese%a'an "an Keselama'an Ke!a (K3) "i R&ma% Saki' KMK 1/8-Menkes-SK-III-*1 'en'an$ S'an"a! Kese%a'an "an Keselama'an Ke!a "i R&ma% Saki' Pe"man P!ak6k La0!a'!i&m Kese%a'an an$ ;ena!= Dekes= */ P!$!am Ke!a K3RS P!$!am Ke!a la0!a'!i&m Re$is'e! Risik ;&k6 elaksanaan !$!am KMK 53*-Menkes-SK-I-*8 'en'an$ Pe"man Manaemen Kese%a'an "an Keselama'an Ke!a (K3) "i R&ma% Saki' KMK 1/8-Menkes-SK-III-*1 'en'an$ S'an"a! Kese%a'an "an Keselama'an Ke!a "i R&ma% Saki' P!$!am Ke!a KPRS P!$!am Ke!a la0!a'!i&m ;&k6 elaksanaan !$!am La!an Insi"en In'e!nal KPRS Pe"man P!ak6k La0!a'!i&m Kese%a'an an$ ;ena!= Dekes= */ Ke0iakan K3RS 'e!kai' ;3 Pe"man K3RS Pan"&an enan$anan ;3 Pan"&an em0&an$an ;3 SPO 'e!kai' ;3 SPO i"en6:kasi !isik Al&! !ses enan$anan !isik #an$ 'e!i"en6:kasi Pan"&an APD SPO 'e!kai' APD Da?a! Inen'a!is APD ;&k6 !ien'asi K3RS (A0sensi= Ma'e!i= Dk&men'asi)
2
P!$!am ke!a la0!a'!i&m ;&k6 Pelaksanaan Pela6%an ;3 Pelaksanaan ela6%an
KMK 38 'a%&n *8 'en'an$ s'an"a! !fesi a%li 'e%nl$i la0!a'!i&m
2
#an$ men$a!a%kan a'a& mens&e!isi elaksanaan eme!iksaan la0!a'!i&m /1 S'af #an$ melaksanakan eme!iksaan la0!a'!i&m memiliki kme'ensi "an >&k& 0e!en$alaman /*
/3 /5
A"a s'af #an$ kme'en "an >&k& 0e!en$alaman melak&kan in'e!!e'asi %asil 'es (li%a' &$a KPS.5= EP 1). Te!se"ia &mla% s'af #an$ a"ek&a' &n'&k memen&%i ke0&'&%an asien.
S'af #an$ "i'&n&k se0a$ai s&e!is! memiliki kme'ensi (qualifed) "an >&k& 0e!en$alaman. Elemen Penilaian AP.2.3 /2
/+
Pene'aan ak'& selesain#a la!an %asil eme!iksaan. Peman'a&an ke'ea'an ak'& la!an %asil eme!iksaan #an$ &!$en - $aa' "a!&!a'
/8
4asil la0!a'!i&m selesai "alam ke!an$ka ak'& #an$ "i'e'akan &n'&k memen&%i ke0&'&%an asien Elemen Penilaian AP.2.3.1 // Pelaksanaan me'"e kla0!a6f 'e!%a"a em0e!ian %asil #an$ k!i6s "a!i eme!iksaan "ia$ns6k /,
,
Pene'aan nilai am0an$ k!i6s (n!mal) &n'&k se6a eme!iksaan la0!a'!i&m Pelaksanaan ela!an %asil #an$ k!i6s "a!i eme!iksaan "ia$ns6k se0el&m "ise!a%kan
,1 Ke'en'&an 'en'an$ %al<%al #an$ "i>a'a' "i"alam !ekam me"is asien
kese%a'an Pe"man en$!$anisasian la0!a'!i&m (la ke'ena$aan) Se!6:ka' kme'ensi Keenan$an klinis SK Di!ek'&! 'e!kai' ene'aan e'&$as la0!a'!i&m Pe"man en$!$anisasian la0!a'!i&m (la ke'ena$aan) Se!6:ka' kme'ensi Keenan$an klinis KMK 38 'a%&n *8 'en'an$ s'an"a! !fesi a%li 'e%nl$i la0!a'!i&m kese%a'an Pe"man en$!$anisasian la0!a'!i&m (la ke'ena$aan) Se!6:ka' kme'ensi Keenan$an klinis SK Di!ek'&! 'e!kai' ene'aan Keala Ins'alasi La0 Pla Ke'ena$aan In'alasi La0!a'!i&m Pe"man en$!$anisasian la0!a'!i&m (la ke'ena$aan) Se!6:ka' kme'ensi Keenan$an klinis P!$!am m&'& ela#anan la0!a'!i&m Ke0iakan 'en'an$ Pela#anan La0!a'!i&m Pan"&an manaemen in'e!!e'asi %asil La0!a'!i&m SPO in'e!!e'asi %asil mB la0 ("en$an ke!an$ka ak'&) SPO in'e!!e'asi %asil mB la0 CITO ("en$an ke!an$ka ak'&) La!an in"ika'! m&'& P!$!am m&'& ela#anan la0!a'!i&m Ke0iakan 'en'an$ Pela#anan La0!a'!i&m Pan"&an manaemen in'e!!e'asi %asil La0!a'!i&m SPO in'e!!e'asi %asil mB la0 ("en$an ke!an$ka ak'&) ;&k6 la!an in"ika'! m&'& Pan"&an Pela!an %asil k!i6s SPO Pela!an %asil #an$ k!i6s Da?a! %asil #an$ k!i6s Ke0iakan ela#anan la0!a'!i&m Pan"&an Pela!an %asil k!i6s SPO Pela!an %asil #an$ k!i6s Da?a! %asil #an$ k!i6s ;&k6 !ekam me"is SPO Pen>a'a'an 'em&an %asil la0 ;&k6 Rekam me"is
2
2
1
2
1
,*
Pelaksanaan mni'!in$ 'e!%a"a imlemen'asi ke'en'&an #an$ a"a= "an a"an#a !eisi !se"&! 0e!"asa!kan %asil eal&asi Elemen Penilaian AP.2.5 ,3
,5 ,2 ,+ ,8 ,/ ,,
Pelaksanaan !$!am en$ellaan e!ala'an la0!a'!i&m "an 0&k6 elaksanaann#a P!$!am 'e!mas&k !ses seleksi "an en$a"aan ala'. P!$!am 'e!mas&k !ses inen'a!isasi ala' P!$!am 'e!mas&k inseksi "an ala' en$e'esan P!$!am 'e!mas&k kali0!asi "an emeli%a!aan ala' P!$!am 'e!mas&k mni'!in$ "an 6n"ak lan&'
Sem&a 'es= emeli%a!aan "an kali0!asi ala' "i"k&men'asi se>a!a a"ek&a' Elemen Penilaian AP.2.2 1 Pene'aan !ea$ensia esensial "an 0a%an lain
11 Rea$ensia esensial "an 0a%an lain 'e!se"ia= "an a"a !ses &n'&k men#a'akan kaan !ea$en 6"ak 'e!se"ia. 1* Pen#imanan "an "is'!i0&si sem&a !ea$ensia ses&ai e"man "a!i "is'!i0&si a'a& ins'!&ksi a"a kemasann#a 13
15
A"an#a !e$&lasi "an elaksanaann#a= se!'a eal&asi sem&a !ea$ensia a$a! mem0e!ikan %asil #an$ ak&!a' "an !esisi Sem&a !ea$ensia "an la!&'an "i0e!i la0el se>a!a len$ka "an ak&!a'
Elemen Penilaian AP.2.+ 12 A"an#a !se"&! e!min'aan eme!iksaan.
1+
A"an#a !se"&!en$am0ilan "an i"en6:kasi sesimen.
18
A"an#a !se"&! en$i!iman= en#imanan "an en$ae'an sesimen.
La!an Ins'alasi SPO #an$ 'ela% "i!eisi
Pe"man Oe!asinal "an Pemeli%a!aan Pe!ala'an Kese%a'an= Dekes= *1 P!$!am ke!a la0!a'!i&m Pe"man Pela#anan La0!a'!i&m Pan"&an en$ellaan e!ala'an la0!a'!i&m SPO 'e!kai' en$ellaan la0!a'!i&m Da?a! inen'a!is Da?a! main'enan>e e!ala'an la0!a' P!$!am Ke!a P!$!am Ke!a P!$!am Ke!a P!$!am Ke!a P!$!am Ke!a Da?a! main'enan>e "an kali0!asi ala' Ja"al elaksanaan
Ke0iakan... Pe"man ela#anan fa!masi ('en'an$ en$ellaan !ea$ensia) Da?a! !ea$ensia essensial Da?a! !ea$ensia SPO ... Al&! !ses Pan"&an.. SPO... ;&k6 imlemen'asi.. Ke0iakan Pan"&an... SPO eal&asi ;&k6 eal&asi SPO Pela0elan ;&k6 ela0elan Ke0iakan- ela#anan la0!a'!i&m Pe"man- ela#anan la0!a'!i&m Pan"&an ela#anan la0!a'!i&m SPO e!min'aan eme!ikaan SPO en$am0ilan sesimen SPO i"en6:kasi sesimen SPO en$i!iman sesimen SPO en#imanan sesimen
1
1
2
2 1
1/
A"an#a !se"&! ene!imaan "an tracking sesimen.
1,
Sem&a !se"&! "ilaksanakan.
11
P!se"&! "ie!%a6kan &n'&k eme!iksaan #an$ "ilak&kan "i la0!a'!i&m "i l&a! !&ma% saki'. Elemen Penilaian AP.2.8 111 Pene'aan nilai-!en'an$ nilai !&&kan &n'&k se6a eme!iksaan #an$ "ilaksanakan.
11* 113
Ren'an$a'a'an klinis a"a ak'& %asil eme!iksaan "ila!kan. Ren'an$
115 112
Ren'an$
Elemen Penilaian AP.2./ 11+ Pen&n&kan s'af !&ma% saki' #an$ kme'en #an$ melaksanakan en$a!a%an "an en$aasan ela#anan la0!a'!i&m klinis "an la0!a'!i&m lain "i sel&!&% !&ma% saki' 118 Pelaksanaan emeli%a!aan "an en$em0an$an ke'en'&an "an !se"&!= 11/ Pene'aan "an elaksanaan 'an$$&n$ aa0 en$aasan a"minis'!asi 11, 1*
Pene'aan "an elaksanaan 'an$$&n$ aa0 &n'&k mena$a 'e!laksanan#a !$!am kn'!l m&'& Pene'aan "an elaksanaan 'an$$&n$ aa0 &n'&k me!ekmen"asi la0!a'!i&m !&&kan
1*1
Pene'aan "an elaksanaan 'an$$&n$ aa0 &n'&k memni'! "an me!eie sem&a ela#anan la0!a'!i&m "i "alam "an "il&a! la0!a'!i&m Elemen Penilaian AP.2., 1** A"a !$!am kn'!l m&'& &n'&k la0!a'!i&m klinis
1*3
P!$!am 'e!mas&k ali"asi me'"e 'es
SPO en$ae'an sesimen SPO ene!imaan sesimen SPO '!a>kin$ sesimen ;&k6 elaksanaan La!an ins'alasi La!an Insi"en La!an m&'& la0!a' l&a! Da?a! SPO la0!a' l&a! Ke0iakan ela#anan la0!a'!i&m Pe"man ela#anan la0!a'!i&m Pan"&an ela#anan la0!a'!i&m SPO 'e!kai'.. ms$ mB 4asil eme!iksaan la0!a'!i&m SPO 'e!kai'= 'e!>an'&m "i >a'a'an klinis ;&k6 !ekam me"is SPO eme!iksaan l&a! ;&k6 !ekam me"is S'an"a! %asil mB la0 nasinal SPO eal&asi !en'an$ nilai SPO !eisi !en'an$ nilai SK Pen&n&kan Pe"man !$anisasi (UTF)
Pe"man !$anisasi (UTF) La!an ins'alasi Pe"man !$anisasi (UTF) La!an m&'& Pe"man !$anisasi (UTF) ;&k6 !ekmen"asi ;&k6 !aa' Pe"man !$anisasi (UTF) La!an ins'alasi P!$!am Ke!a la0!a'!i&m P!$!am m&'& la0!a'!i&m Pe"man en$en"alian m&'& la0!a'!i&m ;&k6 elaksanaan La!an in"ika'! m&'& P!$!am Ke!a la0!a'!i&m
1
2
1 1
1*5
P!$!am 'e!mas&k s&!eilens %a!ian a'as %asil 'es
1*2
P!$!am 'e!mas&k k!eksi >ea' &n'&k kek&!an$an
1*+
P!$!am 'e!mas&k "k&men'asi %asil "an 6n"akan k!eksi
1*8
Elemen
Pen&n&kan s'af #an$ kme'en #an$ 0e!'an$$&n$aa0 a'as kn'!l m&'& la0!a'!i&m a'a& &n'&k me!eie %asil kn'!l m&'& "a!i s&m0e! l&a! !&ma% saki'
13*
Pen&n&kan s'af #an$ 0e!'an$$&n$aa0 a'a& !an$ kme'en #an$ melak&kan 6n"ak lan&' a'as "asa! %asil kn'!l m&'&
133
La!an 'a%&nan "a'a kn'!l m&'& "a!i la0!a'!i&m l&a! !&ma% saki' "ise!a%kan kea"a iminan &n'&k "i$&nakan "alam memfasili'asi manaemen kn'!ak "an em0a%a!&an kn'!ak.
P!$!am m&'& la0!a'!i&m Pan"&an ali"asi SPO ali"asi ;&k6 elaksanaan P!$!am Ke!a la0!a'!i&m P!$!am m&'& la0!a'!i&m Pan"&an s&!eilans SPO S&!eilan ;&k6 elaksanaan P!$!am Ke!a la0!a'!i&m P!$!am m&'& la0!a'!i&m Pe"man en$en"alian m&'& la0!a'!i&m Pan"&an m&'& la0!a'!i&m SPO K!eksi ;&k6 elaksanaan P!$!am Ke!a la0!a'!i&m P!$!am m&'& la0!a'!i&m Pe"man en$en"alian m&'& la0!a'!i&m Pan"&an m&'& la0!a'!i&m SPO "k&men'asi %asil "an 6n"akan k!eksi ;&k6 elaksanaan ;&k6 elaksanaan
;&k6 PME la0!a'!i&m
2
;&k6 PME la0!a'!i&m
SK ene'aan la0!a'!i&m l&a! MU "en$an la0!a'!i&m l&a!-lain La!an 'en'an$ elaksanaan kn'!l m&'& SK ene'aan s'af Pe"man !$anisasi la0 Keenan$an klinis Se!6:ka' kme'ensi SK ene'aan s'af Pe"man !$anisasi la0 Keenan$an klinis Se!6:ka' kme'ensi La!an 'a%&nan m&'& la0!a'!i&m
Elemen Penilaian AP.2.11 135 Pene'aan nama a%li &n'&k "ia$ns6k sesialis6k
132
A%li "alam 0i"an$ "ia$ns6k sesialis6k "i%&0&n$i 0ila "ie!l&kan.
Elemen Penilaian AP.+ 13+ Pela#anan !a"il$i "an "ia$ns6k imain$ memen&%i s'an"a! nasinal= &n"an$<&n"an$ "an e!a'&!an #an$ 0e!lak&. 138 Pelaksanaan ela#anan !a"il$i "an "ia$ns6k imain$ #an$ a"ek&a'= 'e!a'&!= "an n#aman &n'&k memen&%i ke0&'&%an asien. 13/ Pelaksanaan ela#anan !a"il$i "an "ia$ns6k imain$ &n'&k $aa' "a!&!a' *5 am Elemen Penilaian AP.+.1 13, Pene'aan ela#anan "il&a! !&ma% saki' "iili% 0e!"asa!kan !ekmen"asi "i!ek'&! "an memiliki !ekam eak kine!a #an$ 0aik 'en'an$ 'ea'<ak'& "an memen&%i &n"an$<&n"an$ "an e!a'&!an #an$ 0e!lak&. 15 Pasien "i0e!i 'a%& 'en'an$ %&0&n$an "k'e! #an$ me!&&k "an ela#anan "il&a! !&ma% saki' #an$ "imiliki "k'e! &n'&k ela#anan !a"il$i "an "ia$ns6k imain$ Elemen Penilaian AP.+.* 151 A"a !$!am keamanan !a"iasi #an$ men$a'&! !isik keamanan "an an6siasi 0a%a#a #an$ 0isa 'e!a"i "i "alam a'a& "i l&a! &ni' ke!a 15* P!$!am keamanan me!&akan 0a$ian "a!i !$!am K3 !&ma% saki'= "an "ila!kan sek&!an$
SK ene'aan s'af Pe"man !$anisasi la0 Keenan$an klinis Se!6:ka' kme'ensi SPO 'e!kai'.. ;&k6 elaksanaan KMK 11*-Menkes-SK-II-*/ 'en'an$ S'an"a! Pela#anan Ra"il$i Dia$ns6k "i Sa!ana Pela#anan Kese%a'an Ke0iakan-Pe"man-SPO ela#anan !a"il$i
(1) (1) (1)
MU "en$an ela#anan !a"il$i "i l&a! !&ma% saki'
2
(1) (1) (1) (1) (1)
(1) (1)
Pe"man en$!$anisasian
(1)
SK en&n&kan
(1)
12 121 12*
A"an#a s'af me"is #an$ kme'en "an en$alaman #an$ mema"ai men$in'e!!e'asi %asil eme!iksaan A"an#a s'af #an$ kme'en #an$ mema"ai= meme!i:kasi "an mem0&a' la!an %asil eme!iksaan Te!se"ia s'af "alam &mla% #an$ a"ek&a' (ses&ai la ke'ena$aan) &n'&k memen&%i ke0&'&%an ela#anan asien
A"an#a en&n&kan s'af se0a$ai s&e!is! #an$ kme'en "an 0e!en$alaman #an$ mema"ai. Elemen Penilaian AP.+.5 125 Pene'aan ak'& selesain#a la!an %asil eme!iksaan 122 Eal&asi ke'ea'an ak'& ela!an %asil eme!iksaan kas&s - >i' 12+ 4asil eme!iksaan !a"il$i "an "ia$ns6k imain$ "ila!kan ses&ai ak'& #an$ "i'e'akan &n'&k memen&%i ke0&'&%an asien Elemen Penilaian AP.+.2 128 A"a !$!am "an elaksanaan en$ellaan e!ala'an !a"il$i "an "ia$ns6k imain$ 12/ P!$!am 'e!mas&k emili%an "an en$a"aan e!ala'an 12, P!$!am 'e!mas&k inen'a!isasi e!ala'an 1+ P!$!am 'e!mas&k inseksi "an 'es6n$ e!ala'an 1+1 P!$!am 'e!mas&k kali0!asi "an e!aa'an e!ala'an 1+* P!$!am 'e!mas&k mni'!in$ "an 6n"ak lan&' 1+3 A"a "k&men'asi #an$ a"ek&a' &n'&k sem&a 'es6n$= e!aa'an "an kali0!asi e!ala'an Elemen Penilaian AP.+.+ 1+5 A"an#a ene'aan a!a e!i"ik sem&a e!0ekalan &n'&k menilai ak&!asi "an %asiln#a 1+/ Pelaksanaan em0e!ian la0el &n'&k sem&a e!0ekalan se>a!a len$ka "an ak&!a' Elemen Penilaian AP.+.8 1+, A"an#a iminan &ni' ela#anan !a"il$i "an "ia$ns6k Imain$ #an$ kme'en 18 A"a ke'en'&an 'e!'&lis #an$ "ilaksanakan &n'&k men$em0an$kan= melaksanakan= meme!'a%ankan ela#anan 181 Keala &ni' 0e!'an$$&n$ aa0 &n'&k en$aasan a"minis'!asi= "an "ilaksanakan "en$an 0aik 18* Keala &ni' 0e!'an$$&n$ aa0 &n'&k meme!'a%ankan !$!am kn'!l m&'& "an "ilaksanakan "en$an 0aik
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123
(1)
4asil eme!iksaan !a"il$i Eal&asi ke'ea'an ak'&
(1) (1) (1)
P!$!am &ni' !a"il$i
(1)
4asil mni'!in$ "an eal&asi
(1) (1) (1) (1) (1) (1)
Da?a! e!0ekalan fa!masi &n'&k ela#anan !a"il$i 4asil mni'!in$ "an eal&asi
(1) (1) (1) (1) (1)
SK Keala &ni' !a"il$i
(1)
SK enan$$&n$ aa0 a"minis'!asi ela#anan !a"il$i
(1)
Pe"man-SPO ela#anan !a"il$i
(1)
P!$!am &ni' !a"il$i= 'e!mas&k ke$ia'an m&'&
(1)
183
Keala &ni' 0e!'an$$&n$ aa0 &n'&k mem0e!ikan !ekmen"asi "an mene'akan ela#anan !a"il$i "an "ia$ns6k imain$ "il& a!= "an "ilaksanakan "en$an 0aik 185 Keala &ni' 0e!'an$$&n$ aa0 &n'&k meman'a& "an me!eie sem&a ela#anan !a"il$i "an ela#anan "ia$ns6k imain$ Elemen Penilaian AP.+./ 182 A"a !$!am kn'!l m&'& &n'&k ela#anan !a"il$i "an "ia$ns6k imain$= "an "ilaksanakan 18+ P!$!am kn'!l m&'& 'e!mas&k ali"asi me'"e 'es. 188 P!$!am kn'!l m&'& 'e!mas&k en$aasan %a!ian %asil eme!iksaan imain$. 18/ P!$!am kn'!l m&'& 'e!mas&k e!0aikan >ea' 0ila "i'em&kan kek&!an$an. 18, P!$!am kn'!l m&'& 'e!mas&k en$e'esan !ea$ensia "an la!&'an. 1/ P!$!am kn'!l m&'& 'e!mas&k en"k&men'asian %asil "an lan$ka%< lan$ka% e!0aikan. Elemen Penilaian AP.+., 1/1 A"a ene'aan f!ek&ensi "an 6e "a'a kn'!l m&'& "a!i %asil eme!iksaan !a"il$i"i l&a! !&ma% saki' le% !&ma% saki' 1/* Pen&n&kan s'af #an$ kme'en #an$ 0e!'an$$&n$aa0 a'as kn'!l m&'& %asil eme!iksaan !a"il$i a'a& &n'&k me!eie % asil kn'!l m&'& "a!i s&m0e! l&a! !&ma% saki' 1/3 Pen&n&kan s'af #an$ 0e!'an$$&n$aa0 a'a& !an$ kme'en #an$ melak&kan 6n"ak lan&' a'as "asa! %asil kn'!l m&'& 1/5 La!an 'a%&nan "a'a kn'!l m&'& "a!i la0!a'!i&m l&a! !&ma% saki' "ise!a%kan kea"a iminan &n'&k "i$&nakan "alam memfasili'asi manaemen kn'!ak "an em0a%a!&an kn'!ak. Elemen Penilaian AP.+.1 1/2 A"a "a?a! "k'e! sesialis "alam 0i"an$ "ia$ns6k sesialis6k 1/+ P!se"&! &n'&k men$%&0&n$i "k'e! sesialis 'e!se0&' 0ila "ie!l&kan
4asil eal&asi
(1)
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;&k6 elaksanaan ke$ia'an m&'&
(1) (1) (1) (1) (1) (1)
SK en&n&kan 0ese!'a &!aian '&$asn#a
La!an 'en'an$ elaksanaan kn'!l m&'&
(1)
MU "en$an &ni' !a"il$i l&a!-lain
(1)
SK en&$asan klinis
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