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    DISAGREEMENT

    Bambang Udji Djoko Rianto

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    CLINICAL EXAMINATION(CE)

    - !"#i$a%- !i#to&"

    DIAGNOSIS

    'ROGNOSIS

    TERA'

    PENDAHULUAN

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    'RINSI'

    *ob#+&,a#i k%inik b+&+&an ada diagno#i# &ogn

    . t+&ai*b+#a& +&&o& . inkon#i#t+n#i CE m+n/&/nkan k+tan

    *k+t+atan CE d+ngan0 minimi#a#i +&&o& . inkon

    t+n#i

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    *$%ini$a% +1amination (CE)

    - %+bi! b+&+&an da&iada %abo&ato&i/- tajam- kon#i#t+n

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    CE di!a&akan0

    - data "ang di+&%/kan dan "ang tidak- m+ndaatkan data ak/&at dan &+%iab+%- jika tak ak/&at . tak &+%iab+% IN2ONSISTEN

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    Inkon#i#t+n#i CE t+&!ada #am+% "ang #ama0

    - 3 +m+&ik#a int&a-ob#+&,+&

    - 4 3 +m+&ik#a int+&-ob#+&,+&

    CLINICAL DISAGREEMENT

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    BAGAIMANA CLINICAL DISAGREEMENT (CD) TER5A

    37 CD 'ADA 'ATIENT8 ISTORIES

    mi#a%0 - a#i+n ton#i%iti# k&oni# +&%/ o+&a#i- b+&da#a& o+&a#i ada a#i+n %ain

    - m+ng!i%angkan g+ja%a 6 - m+tod+ ba&/ m+m+&baiki a#i+n 6 - a#i+n daat k+mba%i b+&akti,ita# no&m

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    E#tima#i ak/&a#i !a#i% o+&a#i b+&da#a&0

    - !i#to&i+# a#i+n #+$a&a m+n"+%/&/!- kon#i#t+n#i !i#to&i+# "ang didaat- #ki%% ob"+$ti,it"

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    97 CLINICAL DISAGREEMENT 'ADA 'SICAL :INDING

    +m#a II &+tinoati (R) &+tinoati (R)

    N-&ingan #+dang-b+&atm

    R N-&ingan ;< 3= >@ ;9

    N3==

    - ob#+&,+d ag&++m+nt0 ;< ?9 3== @

    a7 int+&-ob#+&,+& ag&++m+nt

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    +mk#n II &+tinoati (R) &+tinoati (R) N-&ingan #+dang-b+&at

    m

    R N-&ingan

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    INDEX CLINICAL AGREEMENT (2A''A)0

    - ob#+&,+d ag&++m+nt- $!an$+ ag&++m+nt- ag&++m+nt +1+$t+d on t!+ ba#i# o $!an$+

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    *C!an$+ ag&++m+nt anta&a 9 +m+&ik#a

    +m+&ik#aan II &+tinoati (R) &+tinoati

    (R)

    N-&ingan#+dang-b+&at

    R N-&ingan => 1 >

    1> 1 ;;99 =>1;;99

    /m%a! >= >=

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    *Ag&++m+nt +1+$t+d on t!+ ba#i# o $!an$+

    +m+&ik#aan II

    &+tinoati (R) &+tinoati(R)

    N-&ingan#+dang-b+&at

    R N-&ingan >@ 1 > ;9 1>

    +m+&ik#aan I

    R #+dang-b+&at >@ 1 ;;9>> ;91;;[email protected]>

    j/m%a! >@3==

    ;93==

    Ag&++m+nt +1+$t+d on t!+ ba#i# o $!an$+ ?9>[email protected]>

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    *ind+1 $%ini$a% di#ag&++m+nt (kaa)

    ag&++m+nt

    = 3==

    Ob#+&,+d ag&++m+nt @

    Ag&++m+nt +1+$t+d ba#+d o$!an$+ ?9>[email protected]>>3

    A$t/a% ag&++m+nt b+"ond $!an$+ @->39

    'ot+ntia% ag&++m+nt b+"ond $!an$ 3== - >3 ;F

    *2aa 9 ;F =>) &+kom+nda#i TE- 93> (>>) tidak TE

    - &+kom+nda#i TE0 FF (;;)

    - &+kom+nda#i TE0 >3 (;;)

    G&/ dokt+& I

    G&/ dokt+& II

    G&/ dokt+& III

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    2+#im/%an $onto!0

    - ag&++m+nt0 ;> - ;

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    >7 CD DALAM UALIT O: MEDICAL CARE

    - +n+%itian B&ook +t a% (3F?)0

    - &+,i+J &+$o&ding- ka#/# UTI T /%k/# d/od+ni . ga#t+

    ag&++m+nt0 3> - >

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    2AUSA CLINICAL DISAGREEMENT

    37 :akto& +m+&ik#a0

    a7 bio%ogi$ ,a&iation in t!+ #+n#+- +ng%i!atan (tajam b/taJa&na)- +nd+nga&an- +ng!id/

    - +ng+$a- #+nt/!an

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    b7 k+$+nd+&/ngan b+&da#a& +nga%aman . b/kan b+&da#a& b/kti

    - diagno#ti$ +&&o&- t!+&a" ina&o&iat+

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    $7 Si#t+m #k+ma k%a#iHka#i diagno#i#0

    3)7 2ak/ tak j+%a# inkon#i#t+n0

    mi#a%0 k%a#iHka#i- t+kanan da&a!- BB #tat/# giKi- kada& g%/ko#a d%%

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    9)7 B+da k&it+&ia diagno#i#

    Mi#a%0 /nt/k diagno#i# +n"akit jant/ng

    - !a&/# ada +&/ba!an mioka&d ('A)- !a&/# ada +&/ba!an +n#imatik (biokimi- !a&/# ada +&/ba!an gamba&an E2G

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    d7 '+&ki&aan #+b+%/mn"a

    - !a&aan m+ndaatkan t+m/an k%ini#

    +7 2+tidak mam/an

    - k+%ainan +ngind+&aan

    - #ki%%- +ng+ta!/an

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    97 :akto& #am+% a#i+n

    a7 ,a&ia#i bio%ogi#0

    - BB- B' nadi o#i#i Jakt/- di+t- #t&+## +1+&$i#+ d%%

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    b7 akibat ++k +n"akit dan +ngobatan m+mb+&ikan0

    - !i#to&" ak/&at dan m+"akinkan- +&/ba!an mani+#ta#i +n"akit#t&ok+ m+m+nga&/!i kom/nika#iobat ana%g+#ik m+m+nga&/!i tanda H

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    $7 ingatan a#i+n #am+%

    - b+&!/b/ngan d+ngan !i#to&" #am+%- k+%/a&ga- &+$o&d#+&/ba!an !i#to&i+#di#ag&++m+nt

    d7 adan"a /nd+&%"ing di#+a#+di#ag&++m+nt m+n+j+m+n

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    ?7 :akto& +m+&ik#aan

    a7 +nga&/! %ingk/ngan t+&!ada +m+&ik#a

    - %ingk/ngan bi#ing m+nggangg/ a/#k/%ta#i a/diom+t&i- #/!/ &/ang t+&%a%/ dingin ana#

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    b7 +&an !/b/nganint+&ak#i +m+&ik#a . a#i

    - #ika +&i%ak/ k+bia#aan

    - m+dia kom/nika#i ba!a#a - &a# - +ndidikan - #tat/# +konomi #o#ia% d%%

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    $7 +ngg/naan a%at diagno#tik "ang tidak t+

    - mi#a%0- ka%ib&a#i "ang tak b+na& a/diom+t+& t+n#im+t+& E2G d#b7

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    CARA MENCEGAH DAN MINIMALISASI CD

    37 S+#/aikan a%at t+mat . %ingk/ngan diagno#ti97 M+n$a&i b/kti k%ini# #+bagai t+m/an k/n$i a7 /%angi +%+m+n +nting +m+&ik#aan k%ini# b7 +n$atatan b/kti t+m/an k%ini#

    $7 konH&ma#i t+m/an k%ini# k/n$i d+ngan t+# " t+atd7 $+k #+$a&a b%ind d+ngan +m+&ik#a %ain

    SIM'ULAN

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    ?7 Lao&an k+#im/%an b+&da#a& b/kti;7 M+ngg/nakan t+knik m+tod+ #+#/ai>7 '+&ki&aan data t+# diagno#tik ka#a& #+$a&a b%in