Transcript

DAFTAR TINDAKANTINDAKAN YANG PERLUINFORMED CONSENT

Sesuai Undang Undang No. 44 tahun 2009 tentang Rumah Sakit, terdapat beberapa tindakan kedokteran dan kedokteran gigi yang wajib diberikan informed consent. Tindakan tersebut yaitu:A. Semua Tindakan Pembedahan dan Tindakan InvasiveB. Semua Tindakan Anestesi & Sedasi (Sedasi Sedang dan Sedasi Dalam) C. Semua Tindakan Pemberian Produk Darah & Komponen DarahC. Semua Tindakan/ PENGOBATAN yang Berisiko Tinggi.

A. Tindakan Pembedahan dan Tindakan Invasive yang memerlukan informed consent antara lain:

NoKSM/ INSTALASI/ UNITTINDAKAN

1KSM BedahSaraf1. Amygdala Hypocampectomy (Epilepsi)

2. Anterior Temporomesial Lobectomi (Epilepsi)

3. Biopsi Saraf Tepi/ Otot

4. Blok Saraf Perifer I

5. Cingulotomy (Psichiatric)

6. Corpus Callosotomi (Epilepsi)

7. Debrimen Rekonstruksi Vulnus Kulit Kepala

8. Dekompresi Saraf Tepi

9. Dekompresi Tulang Durameter

10. Dekortikasi Sinus Frontalis

11. Denervasi Facet

12. DREZ Lession (Pain)

13. Eksisi Ensefalokel/ Mielokel

14. Eksisi Kista Jinak Kulit Kepala

15. Eksisi Osteoma/ Osteositosis

16. Elevasi Kraniotomi Fraktur Impresi,Dengan Robekan

17. Dura

18. Elevasi Kraniotomi Fraktur Impresi Tanpa Robekan

19. Dura

20. Extirpasi Tumor Jinak Saraf Kulit Kepala

NoKSM/ INSTALASI/ UNIT

TINDAKAN

21. Fusi Stabilisasi Corpus Vertebra

22. Graft/ Transposisi Saraf Tepi

23. Hemis ferektomi (Epilepsi)

24. Hemis ferektomi (Epilepsi)

25. Injeksi saraf perifer (dengan radio frekuensi)

26. Injeksi spinal (Pain)

27. Insersi Elektrode Intradural (Epilepsi, Movement, Psikiatrik)

28. Kordotomi Perkutan

29. Kordotomi Servikal Open (Pain)

30. Kordotomi Servikal Perkutan (Pain)

31. Kranioplasti dua sisi

32. Kranioplasti satu sisi

33. Kraniotomi Biopsi otak

34. Laminektomi Eksisi Tumor Spinal

35. Laminoplasti

36. Laminotomi Biopsi Mielum

37. Laminotomi Diskektomi HNP/ Stenosis >1 level

38. Laminotomi Diskektomi HNP/ Stenosis 1 level

39. Lesionectomy (Epilepsi)

40. Lobektomi (Epilepsi)

41. Mesencephalectomy (Pain)

42. Mikrodisekktomi HNP

43. MVD (Microvascular Decompression)

44. Neurektomi/ Neurolise

45. Neuroendoskopi (Otak, Spinal)

46. Neuroplasti

47. Omayadrain

48. Pallidotomi (movement Disorder)

49. Paravertebral Blok Perkutan

50. Pemasangan Traksi Servikal

51. Penjahitan Saraf Tepi

52. Punksi Cairan Otak

53. Reseksi Extra-Temporal (Epilepsi)

54. Revisi VP Shunt

55. Rhizotomi Selektif (Spastisitas)

56. Rhizotomy (Pain)

57. Selective Nerve Root Block

NoKSM/ INSTALASI/ UNITTINDAKAN

58. Selective Thalamotomi (Movement Disorder)

59. Simpatektomi Open (Pain)

60. Simpatektomi Perkutan

61. SLTH

62. Stereotactic Ablative Procedure (Psichiatric)

63. Subthalamotomy (Movement Disorder)

64. Suturektomi Kraniostenosis

65. Thalomotomy (Pain)

66. Transposisi kraniostenosis, dengan orbital advancement

67. Transposisi kraniostenosis, tanpa orbital advancement

68. Trepanasi Cedera Kepala (4jam)

70. Trepanasi CVA Bleeding

71. Trepanasi kelainan Saraf Kranial

72. Trepanasi Kelainan Vascular Otak

73. Trepanasi Tumor Otak

74. VA Shunt

75. VP Shunt Multiple

76. VP Shunt Satu Sisi

No.KSM/ INSTALASI/ UNITTINDAKAN

2KSM BEDAH KEPALA LEHER1. AffArchBarr

2. AffArchBarr dan suspensi maksila

3. Biopsy Insisi onal dengan anastesi lokal

4. Deseksi submandibula

5. Diseksi leher radikal/ radikal neckdissection

6. Eksisi gldsubmandibula

7. Eksisi higroma leher

8. Eksisi kistatiroglosus

9. Eksisi luastumor ganas bibir dengan rekontruksi

10. Flap lokal

11. Eksisi luastumor ganas dengan rekontruksi flap jauh

12. Eksisi luas tumor ganas kulit dengan rekontruksi

13. Flap local

14. Eksisi luas tumor ganas rongga mulut dengan Rekontruksi flap local

15. Eksisi parsial + marsupialisasi Ranula

No.KSM/ INSTALASI/ UINITTINDAKAN

16. Eksisi tumor ganas kulit dengan flap local atau graft

17. Kulit

18. Eksisi tumor ganas kulit dengan flap local jauh

19. Fiksasi interna frakturnasal

20. Fiksasi inter napan-facial

21. Hemiglosektomi

22. Insisi abses dengan anastesi lokal

23. Insisi flegmon dasar mulut

24. Internal Fiksasi fraktur condylusmandibula

25. Internal Fiksasi fraktur maksilofasial 3-4 tempat patahan

26. Internal fiksasi fraktur maksilo fasial 5 tempat patahan atau lebih

27. Laringectomi

No.KSM/ INSTALASI/ UNITTINDAKAN

3BEDAH THT-KL

1. Adenotonsilektomi

2. Anthrostomi+Sinuskopi

3. BLM Simple (Kista,Polip,Nodul,Granulasi)

4. BiopsiTumor

5. Bronkoskopi Rigid

6. BLM Advance (Stenosis, Subjektif/Trakea,Papiloma Laring/ Trakea

7. CaldWellLuc

8. Cochlear Implant/ImplanBaha

9. Dekompresi NervusFasialis

10. DCR

11. Eksisi Ekstostosis

12. Ekstirpasi KistaBranchial

13. Ekstirpasi KistaDuctusTiroglosus

14. Ekstraksi granulasi MAE/Kolesteatosis

15. Ekstraksi Polip

16. Esofagoskopi Rigid&Fleksibel

17. Ethmoidektomi (Intranasal)

18. Ekstraksi Korpus Alienum KavumNasi

19. EkstraksiKorpusAlienumKavumNasiEndoskopi

20. EkstirpasiFistelPre Aurikuler

21. EkstraksiKorpusAlienumMAE

22. EkstirpasiKelenjarSubMandibula

23. EkstirpasiAngiofibromaNasofaring

24. EksplorasiAbsesParafaringeal

No.KSM/ INSTALASI/ UNITTINDAKAN

25. EkstirpasiTumorJinakKepala&Leher(AteromLipoma)

26. Faringotomi

27. FESS

28. FESSAdvance

29. FrontalSinusotomi

30. ForeHeadFlap

31. FrontoEtmoidektomi(Ekstranasal)

32. FOL

33. GlosektomiTotal/Parsial

34. GlosektomiTotal/Hemiglosektomi+RND

35. Hemiglosektomi+SOHND

36. InsisiAbsesLeherDalam

37. InversiGrommet

38. InsisiPerikondritis

39. IrigasiSinusMaksila

40. InsisiAbsesPeritonsil

41. Imunoterapi

42. KonkaReduksi

43. KaustikKonkaInferior

44. Laringektomi

45. Laringektomi+ND

46. LaringoFisur/EksplorasiLaring

47. LigasiA.KarotisEksternal

48. Laringoskopi Rigid

49. Laringoskopi Fleksible

50. Laringoskopi Direkta

51. MaksilektomiTotal+Rekontruksi

52. Mastoidektomi Radikal

53. Mini FESS

54. MyocutaneusFlap(Pectoral Mayor)

55. Myringoplasty/Timpaniplasti

56. Mandibulekromi

57. Neurektomi SarafVidian

58. Osteotomi+Septumkoreksi

59. Rekontruksi Fraktur MaksilaMultiple

60. Rekontruksi Fraktur MaksilaSederhana

61. Rhinoplasti

62. Rinotomi Lateral+Maksilektomi Medial

63. RekontruksiLaringTrakea

64. Reposisi Fraktur OsNasal

65. Reposisi &Fiksasi Fraktur Mandibula

66. Septum Koreksi+Konkotomi

67. Stapedektomi

68. SkinPricleTest

No.KSM/ INSTALASI/ UNITTINDAKAN

69. Tiroidektomi Sub-Total

70. Tonsilektomi/Adenoidektomi

71. Tracheostomi

72. Turbinektomi

73. TiroidektomiTotal+ND

74. Temporal BoneResection

75. TerapiWicarapadaAnak-Anakdandewasa

76. TerapiWicaraTunaLaring

No.KSM/ INTALASI/ UNITTINDAKAN

4KSM Orthopedi DanTraumatologi1. Abdominopelvic amputation

2. Achillotenotomy

3. Adductor tenotomyofhip

4. Advancement oftendon

5. Advancement oftendonof hand

6. Amputationaboveknee

7. Amputationanddisarticulation offinger- general anaesthesia

8. Amputationanddisarticulation offinger local anaesthesia

9. Amputationanddisarticulation ofthumb-general anaesthesia

10. Amputationanddisarticulation offinger- general anaesthesia

11. Amputationanddisarticulation offinger local anaesthesia

12. Amputationanddisarticulation ofthumb-general anaesthesia

13. Amputationanddisarticulation ofthumb-local anaesthesia

14. Amputation of anklethroughmalleoli oftibiaand fibula

15. Amputation oftoe-general anaesthesia

16. Amputation oftoe-localanaesthesia

17. Amputationthroughfoot

18. Amputationthroughforearm

19. Amputationthroughhand,Amputationthrough carpals

20. Amputationthroughhumerus, Upper arm amputation

21. Amputation,not otherwisespecified

22. Anklefusion

23. Applicationof externalfixator device

24. Applicationof externalfixator device,monoplanar system

25. Applicationof externalfixator device,ringsystem

26. Applicationof hybridexternal fixator device

27. Arthrocentesis

28. Arthrodesisof elbow

29. Arthrodesisof hip

30. Arthrodesisofknee

31. Arthrodesisof other specifiedjoints

32. Arthrodesisofshoulder

No.KSM/ INSTALASI/ UNITTINDAKAN

33. Arthrodesisof unspecifiedjoint

34. Arthroplastyofcarpocarpal or carpometacarpal joint withimplant

35. Arthroplastyofcarpocarpal or carpometacarpal joint with out implant

36. Arthroplastyofmetacarpophalangealand interphalangeal jointwithimplant

37. Arthroplastyofmetacarpophalangealand interphalangeal jointwithoutimplant

38. Arthroscopy

39. Arthrotomyfor removal ofprosthesiswithout replacement

40. Aspiration of bursa

41. Aspiration of bursa of hand

42. Aspiration of other softtissue

43. Aspiration of other softtissue ofhand

44. Atlas-axisspinalfusion

45. Biopsyofbone

46. Biopsyofjointstructure

47. Biopsyofspinal cord or spinalmeninges

48. Bone graft

49. Bone marrowor hematopoieticstemcell transplant (all proceduresincludedinthisclass

50. Bunionectomywithsofttissuecorrectionand arthrodesis

51. Bunionectomywithsofttissuecorrectionand osteotomyofthefirstmetatarsal

52. Bursectomy

53. Bursectomyofhand

54. Bursotomy

55. Bursotomyofhand

56. Carporadialfusion

57. Closedreductionof dislocation General anaesthesia

58. Closedreductionof dislocation of ankle

59. Closedreductionof dislocation of elbow

60. Closedreductionof dislocation offoot andtoe- general naesthesia

61. Close dreduction of dislocation of foot and toe-local naesthesia

62. Closedreductionof dislocation of handandfinger- general naesthesia

63. Closedreductionof dislocation of handandfinger- local naesthesia

64. Closedreductionof dislocation of hip

65. Closedreductionof dislocation ofknee

66. Closedreductionof dislocation of other specified sites-general anaesthesia

No.KSM/ INSTALASI/ UNITTINDAKAN

67. Closedreductionof dislocation of other specified sites-local anaesthesia

68. Closedreductionof dislocation of other specified sites-local anaesthesia

69. Closedreductionof dislocation ofshoulder

70. Closedreductionof dislocation ofwrist

71. Closedreductionof dislocation-Localanaesthesia

72. Closedreductionoffracturewithinternalfixation- Carpal andmetacarpal

73. Closedreductionoffracturewithinternalfixation- Femur (Including:MIPO,interlocking nail,TEN)

74. Closedreductionoffracturewithinternalfixation- Humerus(including:Interlockingnail,TEN, MIPO)

75. Closedreductionoffracturewithinternalfixation- Intrarticular Major Bone

76. Closedreductionoffracturewithinternalfixation- Phalang offoot

77. Closedreductionoffracturewithinternalfixation- Phalang offhand

78. Closedreductionoffracturewithinternalfixation- Radiusandulna(MIPO,TEN)

79. Closedreductionoffracturewithinternalfixation- Tarsalandmetatarsal

80. Excisionof bonefor graft

81. Excisionofintervertebral disc

82. Excisionoflesionofmuscle

83. Excisionoflesionofmuscleofhand

84. Excisionoflesionofother softtissue

85. Dorsal anddorsolumbarfusion oftheanterior column,anterior technique

86. Dorsal anddorsolumbarfusion oftheposterior column,posterior technique

87. Excisionof bonefor graft

88. Excisionofintervertebral disc

89. Excisionoflesion ofmuscle

90. Excisionoflesion ofmuscleof hand

91. Excisionoflesion of other softtissue

92. Excisionoflesion oftendonsheath

93. Excisionoflesion oftendonsheath of hand,Ganglionectomyoftendonsheath(wrist)-General anaesthesia

94. Excisionoflesion oftendonsheath of hand, Ganglionectomy of tendons heath (wrist)-Lokal Anestesi

95. Excisionofmuscleor fasciafor graft

96. Excisionofmuscleor fasciaof handfor graft

No.SKM/ INSTALASI/ UNITTINDAKAN

97. Excisionof other lesionofsofttissue of hand

98. Excisionofsemilunar cartilageofknee

99. Excisionoftendonfor graft

100. Excisionoftendonofhandfor graft

101. Excisionor correction ofbunionette,Thatwith osteotomy

102. Excisionor destruction ofintervertebral disc, unspecified

103. Explorationoftendonsheath

104. Explorationoftendonsheathofhand

105. Exploratorythoracotomy

106. Fasciotomy

107. Fasciotomyofhand

108. Finger reattachment

109. Five-in-onerepair ofknee

110. Footreattachment

111. Forearm,wrist, or handreattachment

112. Fusionor refusionof2-3vertebrae

113. Fusionor refusionof4- 8vertebrae

114. Fusionor refusionof9or morevertebrae

115. Graftofmuscleorfascia

116. Hipbearingsurface,ceramic-on-ceramic

117. Hipbearingsurface,ceramic-on-polyethylene,Hip bearingsurface, oxidizedzirconium-on-polyethylene

118. Hipbearingsurface, metal-on-metal

119. Hipbearingsurface, metal-on-polyethylene

120. Implantation ofinternallimblengtheningdevicewith kinetic distraction

121. Implantation of other internal limblengthening device

122. Implantationor replacementof peripheral neurostimulator lead(s)

123. Implantationor replacementofspinal neurostimulator lead(s)

124. Incisionanddrainage ofpalmaror thenar space

125. Injectionof anestheticintoperipheral nervefor analgesia

126. Injectionof anestheticintospinal canalfor analgesia

127. Injectionof destructiveagentintospinal canal

128. Injectionoflocally-actingtherapeuticsubstanceinto other softtissue

129. injection ofsteroid,Subarachnoidperfusion of Refrigeratedsaline

130. Injectionoftherapeuticsubstanceintobursa

131. Injectionoftherapeuticsubstanceintobursaofhand

132. Injectionoftherapeuticsubstanceintojointor ligament

133. Injectionoftherapeuticsubstanceintotendon

134. Injectionoftherapeuticsubstanceintotendon of hand

135. Insertion of bonegrowthstimulator

No.SKM/ INSTALASI/ UNITTINDAKAN

136. Insertion of bonevoidfiller

137. Insertion ofcatheter intospinal canalfor infusionof therapeuticor palliativesubstances, Insertionof catheter intoepidural,subarachnoid, or subdural space ofspinewithintermittentor continuous infusion of drug (with creation of anyreservoir)

138. Insertion ofinterbodyspinalfusiondevice

139. Insertion of other spinal devices

140. Insertion of partial spinal disc prosthesis,cervical

141. Insertion of partial spinal disc prosthesis, lumbosacral

142. Insertion ofrecombinantbone morphogenetic protein

143. Insertion ofspinaldiscprosthesis,not otherwise specified,Replacementofspinaldisc,NOS

144. Insertion ofspinaldiscprosthesis,thoracic

145. insertion ofsternalfixationdevicewithrigidplates

146. Insertion oftotal spinal disc prosthesis,cervical

147. Insertion oftotal spinal disc prosthesis,lumbosacral

148. Insertionor replacementof(cement) spacer

149. Insertionor replacementoffacetreplacement device(s)

150. Insertionor replacementofinterspinousprocess device(s)

151. Insertionor replacementof pedicle-baseddynamic stabilizationdevice(s)

152. Insertionor replacementofskeletal musclestimulator

153. Internalfixationofbonewithoutfracturereduction

154. Interphalangealfusion

155. Interthoracoscapular amputation,Forequarter amputation

156. Intra-operativeneurophysiologicmonitoring Neuromonitoring

157. Intervertebral chemonucleolysis

158. limblengtheningprocedures

159. Limbshorteningprocedures

160. Localexcisionoflesionor tissueof bone

161. Lower legor anklereattachment

162. Lower limbamputation, nototherwisespecified

163. Lumbarandlumbosacralfusionoftheanterior column,anterior technique

164. Lumbarandlumbosacralfusionoftheanterior column,posterior technique

165. Lumbarandlumbosacralfusionoftheposterior column,posterior technique

166. Lysis of adhesionsofhand

167. Lysis of adhesionsofmuscle,tendon,fascia,and bursa

168. Lysis of adhesionsofspinal cordandnerveroots

169. Metacarpocarpalfusion

170. Metacarpophalangeal fusion

No.KMS/ INSTALASI/ UNITTINDAKAN

171. Metatarsophalangealfusion

172. Midtarsalfusion

173. Muscletransfer or transplantation

174. Myotomy

175. Myotomyof hand

176. Neurectasis

177. Openbiopsyofcranial or peripheral nerveorganglion

178. Openbiopsyofsoft tissue

179. Openreductionofdislocationofankle Neglected dislocation

180. Openreductionofdislocationofelbow Fresh dislocation

181. Openreductionofdislocationofhandandfinger-Fresh dislocation

182. Openreductionofdislocationofhip -Fresh dislocation

183. Openreductionofdislocationofhip Neglected dislocation

184. Openreductionofdislocationof knee- Neglected dislocation

185. Openreductionofdislocationof knee-Fresh dislocation

186. Openreductionofdislocationofother specifiedsites

187. Openreductionofdislocationofshoulder-Fresh dislocation

188. Openreductionofdislocationofshoulder-Neglected dislocation

189. Openreductionofdislocationofunspecifiedsite-Fresh dislocation

190. Openreductionofdislocationofunspecifiedsite- Neglected dislocation

191. Openreductionofdislocationofwrist-Fresh dislocation

192. Openreductionoffracturewithinternalfixation- radius andulna-Simplefracture

193. Openreductionof fracturewithinternalfixation- unspecifiedsite(PeriarticularMajorBone)

194. Openreductionof fracturewithinternalfixation-carpals and metacarpals - plate& screws HandNOS-Plate&Screw

195. Openreductionof fracturewithinternalfixation-carpals and metacarpals - plate& screws HandNOS-Plate&Screw

196. Openreductionof fracturewithinternalfixation-carpals and metacarpals - simpleimplants(K-wire) HandNOS-implant sederhana(K-wire)

197. Openreductionof fracturewithinternalfixation-femur Comminutiveor Segmental

198. Openreductionof fracturewithinternalfixation-femur- Simplefracture

199. Open reduction offracturewithinternalfixation- humerus Simplefracture

200. Open reduction offracturewithinternalfixation humerus- Comminutiveor Segmental

No.KSM/ INSTALASI/ UNITTINDAKAN

201. Open reduction offracturewithinternalfixation-phalangesoffoot- simpleimplants(K-wire)

202. Open reduction offracturewithinternalfixation-phalangesoffoot-Plate& Screws

203. Open reduction offracturewithinternalfixation-phalangesof hand- Plate&Screws

204. Open reduction offracturewithinternalfixation-phalangesof hand- simpleimplants

205. Open reduction offracturewithinternalfixation-tarsals andmetatarsals- Plate&Screws

206. Open reduction offracturewithinternalfixation- tarsalsandmetatarsals- simpleimplants

207. Open reduction offracturewithinternalfixation-tibia andfibula Simplefracture

208. Open reduction offracturewithinternalfixation-tibia andfibula-Comminutiveor Segmental

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