SURAT I(IN PRAKTEK DOKTER RST TK I) SINGARA(A

NO NAMA /OKE5 (PE(IALI( NO. (IP 0E5AK%I5 (IP 7AM P5AKEK

1 dr. A"du %aris /rake-(+.O 44,='',=/(>II=/ikes=2,13 ??? ,'.,,>14.3,

2 dr. *ede /armayasa (a+utra-(+.An 44,='!.=/(>I=/ikes=2,14 ??? ,'.,,>14.,,

3 dr. Ketut Putra (edana-(+.O* 44,=2!.$=/(>II=/ikes=2,1! ,' 7uni 2,1$ 13.,,>1$.,,

4 dr. 0agiadnya-(+.0 44,=2!.!=/(>I=/ikes=2,1! 12 Agustus 2,1' 13.,,>1$.,,

NO NAMA /OKE5 <M<M NO. (IP 0E5AK%I5 (IP 7AM P5AKEK

1 dr. Luh Putu (uartini Kusumaati 44,=4,)1=/< I=/inkes=2,11 3, Okto"er 2,1$ Menyusaikan 8ada 8

2 dr. *ede Prasada 44,=2).&=/<>II=/ikes=2,12 31 Okto"er 2,1$ ,'.,,>1!.,,

3 dr. 5e9inda A9isantia 44,='4.2=/<>I=/ikes=2,1! 13 7uni 2,1) >

NO NAMA /OKE5 *I*I NO. (IP 0E5AK%I5 (IP 7AM P5AKEK

1 drg. Primandita Nugraha 44,=1,$.3=/*>I=/ikes=2,1! 13 /esem"er 2,1$ >

5( K I: NI A/ (ingara8a

5( K I: NI A/ (ingara8a

5( K I: NI A/ (ingara8a

5( K I: NI A/ (ingara8a

5( K I: NI A/ (ingara8a

5( K I: NI A/ (ingara8a

5( K I: NI A/ (ingara8a

5( K I: NI A/ (ingara8a

EMPA P5AKEK (E(<AI

(IP

EMPA P5AKEK (E(<AI

(IP

EMPA P5AKEK (E(<AI

(IP

R2$P$( SD

Rekredesialig 3*

NO SDM NO&SIP BERAKHIRSIP

I& DOKTER UMUM

* dr. De;a =ede Sida $rdhaa 53/8/SPD.3/2es/2PP9//+*5 GGG

+ dr. Putu Dia Purama Sari 53/*4+/SP.D.6+/2es/2PPT/,/+*3 +8 $gustus +*> 3 dr.  ade Ded% 2usa;a1 S.2ed 53/*+0/D.40/2es/2PPT/?/+*+ 3 Ae!ruari +*8

4 dr. Suri%oo 53/*43/SP.D.63/2es/2PPT/,/+*3 *3 Ae!ruari +*8

5 dr. (i ade ?ia Sep:ai 53/**/SP.D.+0/2es/2PPT/?/+*5 ++ ei +*0 6 dr. Putu 9uliai @idiasari1 S.2ed 53/*+4/D.44/2es/2PPT/?/+*+ 3 Ae!ruari +*8 8 dr.  @a%a Suaa1 .2es 53/4*/SPD.0/2es/2PPT/?/+*5 GGG

> dr.  =us: $u Lakshmi Damaa: 53/40/SP.D.*4/2es/2TTP/?/+*3 GGG

0 dr. da a%u Putu Raga Diatari 53/3+/SP.D.0/2es/2TTP//+*4 0 Ae!ruari +*8 * dr.  Putu $gus Sur%a;a 53/*5/SP.D.+4/2es/2ppT/,/+*4 + ei +*>

II& DOKTER GIGI

* drg. (i Putu $ri 2umalasai 53/*>*/SPD.44/2es/2PPT/,/+*5 +4 aret +*0 + drg.  =us: $%u ade D;i Resturii 53/*3/d.5/2es/2PPT/?/+*+ GGG

III& PELA%ANAN MEDIK SPESIALIS DASAR III&A& PEN%AKIT DALAM

* dr. =ede Sukra;a1 .'iomed1Sp.PD 53/>/SPD.++/2es/2TTP/?/+*5 +* desem!er +*0 + dr. (egah Susup $ra;a1Sp.PD 53/4*/SP.D.*/2es/2PPT//+*3 GGG

3 dr. (i Luh ta:k Sri;ah%ui1Sp.PD 53/4/SPD.>/2es/2TTP/?/+*5 *0 ei +*>

III&B& KESEHATAN ANAK

* dr. R%aa "arlist%a:1Sp.$ 53/*0/D.55/2es/2PPT/,/+** GGG

+ dr. (i Putu Sucita @ah%u De;i1 .Sc1Sp.$ +3/06/D.+3/2es/2TTP//+*+ *4 Desem!er +*6

III&C& BEDAH

* dr.  =us: 'agus =ita Triarta1Sp.' 53/+8/D.**/2es/2TTP/?/+** GGG

+ dr.  ade Liggih $r%aa1Sp.' 53/***/D.58/2es/2TTP/,/+** oda%1 $pril **1 +*6

III&D& OBSTETRI DAN GINEKOLOGI

+ dr.  2etut Rai @i;a (egara1Sp.&= 53/*83/D.83/2es/2PPT/,/+*+ Suda%1 $pril *01 +*5

I)& PELA%ANAN MEDIK SPESIALIS PENUN(ANG I)&A& ANESTESIOLOGI

* dr.  =ede ka $ri @ira;a1Sp.$ 53/**/D.+4/2ep/2PPT//+*+ +> Ae!ruari +*8

I)&B& RADIOLOGI

* dr. (%oma Sat%a1Sp.Rad 53/*86/D.86/2es/2PPT/,/+*+ 4 uli +*8

)&C& PATOLOGI KLINIK

* dr. 2etut merta dra;a:1Sp.P2 53/*54/SPD.3>/2es/2PPT/?/+*5 oda%1 $pril **1 +*6

)I& DOKTER GIGI SPESIALIS

)II& PELA%ANAN MEDIK LAINN%A

* dr.  =us: Putu $rdaa1Sp.S 53/*85/D.85/2es/2PPT/,/+*+ *3 (opem!er +*6 + dr. (i ade Tirta Sai;ai1Sp.T"T-2L 53/3/SP.D.8/2es/2PPT//+*4 *0 Ae!ruari +*0 3 dr.  gus: (gurah $om Suprad%aa1Sp. Surat Tugas) 44/4+880/'PP GGG

4 dr. De;a =ede Satria $m!ara Putra1.'iomed1Sp.&t 53/3/SPD.38/2es/2PPT/?/+*5 3 ui ++

)III& TENAGA KEFARMASIAN

* @id% Tri Reto Sari1S.Aarm.$pt 53/*45+/9akes.Dikes/?/+*5 GGG

+ (i Putu 9uliasih1S.Aarm.$pt 53/+0>5/9akes.Dikes/,/+*5 * ui ++ 3 (i ade $%u Pra:;i Praa 53/+>>/9akes.Dikes/?/+*5 *5 $gustus +*0 4 2adek $ri Puspa%a:.1 $.d.Aarm 53/+33>/9akes.Dikes/,/+*5 Arida%1 $pril 51 +*0 5 (i ade $%u Puspita Sari 53/+>6/9akes. Dikes/?/+*5 > ei +*0

I*& TENAGA KEPERA+ATAN

* (s.  Putu &las arta;a1S.2ep 53/*0>/S2.P.56/2es/2PPT/,/+*5 *3 aret ++ + (i ade "aria:i 53/*08/S2.P.55/2es/2PPT/,/+*5 *4 aret ++ 3 =utsi $%u Putu Dia Aera%a:1$.d12ep 53/*04/S2.P.5+/2es/2PPT/,/+*5 ++ $gustus ++ 4 $ris Lipa%a:1$.d12ep. 53/*03/S2.P.5*/2es/2PPT/,/+*5 Arida%1 $pril 31 ++ 5 $ggraei Tri a%a Sari1$.d12ep 53/*0+/S2.P.5/2es/2PPT/,/+*5 * aret +*0 6 Ria Pura;a:1$.d12ep 53/*0*/S2.P.40/2es/2PPT/,/+*5 *> ei ++ 8 l% Raha%u SaHtri1$md12ep 53/*0/S2.P.4>/2es/2PPT/,/+*5 5 mei +*> > (i 2etut Sri @idiai1$.d12ep 53/*06/S2.P.54/2es/2PPT/,/+*5 *8 Desem!er ++ 0 (i Luh made @ir%ai1$.d12ep 53/*05/S2.P.53/2es/2PPT/,/+*5 *6 Desem!er ++ * Diaa Sari1$.d12ep 53/*>0/S2.P.48/2es/2PPT/,/+*5 +3 aret ++ ** (s.Aema $rgadiata1S.2ep 53/8+/S2.P.+6/2es/2PPT/?/+*5 GGG

*+ (s. Putu $rdia 2ariata1S.2ep 53/8*/S2.P.+5/2es/2PPT/?/+*5 *5 Ae!ruari +*8 *3 (s. (i @a%a Sri Raha%ui Utami1 S.2ep 53/6>/S2.P.++/2es/2PPT/?/+*5 5 uli ++ *4 Dei Susi%a:1S.2ep.(s 53/>8/S2.P.+>/2es/2PPT/?/+*5 + $gustus ++ *5 (o7iaa sari (ugroho1S.2ep.(s 53/>6/S2.P.+8/2es/2PPT/?/+*5 GGG

*6 da 'agus 2ade 2uria Saputra1S.2ep.(s 53/0+/S2.P.2es/2PPT/?/+*5 ** $gustus ++ *8  Putu 9oga Semadhi1S.2ep.(s 53/>0/S2.P.3/2es/2PPT/?/+*5 ** Ae!ruari ++ *> (i Luh Dia eiliatariasih1S.2ep.(s 53/*/S2/P.35/2es/2PPT/?/+*5 *0 ei +*8 *0 (s. 2ade D;i $d%aa1S.2ep 53/8/S2.P.+4/2es/2PPT/?/+*5 +0 Desem!er ++ + (s.  ade $r%sta Sur%a;a1S.2ep 53/*3/S2.P.*/2es/2PPT//+*5 Saturda%1 $pril +51 ++ +* Putu $gus $di Pratama1S.2ep.(ers. 53/*4/S2.P.4/2es/2PPT/?/+*5 * aret ++ ++ 9uli $dri @ia%a1S.2ep.(s 53/>>/S2.P.+0/2es/2PPT/?/+*5 3 uli ++ +3 (i ade $%u ra 2usuma De;i1$.d.2ep 53/*6/S2.P.3/2es/2PPT/?/+*+ +6 ei +*8 +4 (i (%oma Suari:1$.d.2ep 53/63/S2.P.*8/2es/2PPT/?/+*5 +4 ui ++ +5  2omag =ede @ira%a =ua $rtha1$.d.2ep 53/6+/S2.P.*6/ 2es/2PPT/?/+*5 GGG +6 (i Putu Dia Utari1$.d.2ep 53/0/S2.P.3*/2es/2PPT/?/+*5 GGG

+8 (i 2etut Ratasih1 $.d12ep 53/+*/S2.P.+/2es/2PPT//+*5 * $gustus ++ +> (ue @ahida1$.d12ep 53/00/S2.P.34/2es/2PPT/?/+*5 Arida%1 $pril +41 ++

+0 Suparto1 SST 53/*3/S2.P$.3/2es/2PPT//+*4 3* Desem!er +*8

*& TENAGA KEBIDANAN

* Putu 'udiar:i1$.d.2e! 53/*43/S2.'.40/2es/2PPT/?/+*5 * auari +*3 + (i ade Umie "ardai1$.d12ed 53/03/S2.'/*8/2es/2PPT/?/+*5 + auari +*0 3 (i 2omag Sri da%a:1$.d.2e! 53/*4+/S2.'.4>/2es/2PPT/?/+*5 +6 aret +*8 4 (i ade (ia D;i 2arlie1$.d.2e! 53/*4>/S2.'.5*/2es/2PPT/?/+*5 *3 $gustus +*0 5 Putu $%u $stri Puspita1$md.2e! 53/*4/S2.'.4>/2es/2PPT/?/+*+ Suda%1 $pril 31 +*8 6 2aria $Brilia1$.d.2e! 53/*48/S2.'.5/2es/2PPT/?/+*5 Arida%1 $pril +41 ++ 8 (i 2adek Sriari aha%oi1$.d.2e! 53/*4*/S2.'.48/2es/2PPT/?/+*5 3 ui +*8 > (i Putu ega Sari De;i 446/*8>/9akes.Dikes +* Ae!ruari +*6 0 Putu $%u Sari De;i1$.d.2e! 53/*30/S2.'.48/2es/2PPT/?/+*+ Suda%1 $pril 31 +*8 * @i;it @idhiarsa:1 $md.2e! 53/*+/S2.'.3/2es/2PPT//+*5 *4 Ae!ruari +*> ** #hrist% Raha%u De;i .$md.2e! 53/*/S2.'.*/2es/2PPT//+*5 GGG

STR Proses Pera;at $estesi

SU 'U(D$

$gustus +*6

(AM PRAKTEK

KESESUAIAN (UMLAH DENGAN PMK ,- TAHUN ./01

Se2arusn3a Ken3a$aan Kesesuaian

RSU 'uda

0 0 Sesuai

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RSU 'uda

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ARS Umum 'uda _{+ Tidak Sesuai}

ARS Umum 'uda ARS Umum 'uda

*+ Cmiimal 3 Tidak Sesuai

ARS Umum 'uda ARS Umum 'uda

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R2$P$( SD

Rekredesialig 3*

NO SDM NO&SIP BERAKHIRSIP

I& DOKTER UMUM

* dr. De;a Putu ka uli $tara 53/*/SPD.*/2es/2PPT//+*6 + Desem!er ++ + dr. Putu Dia Purama Sari 53/*4+/SP.D.6+/2es/2PPT/,/+*3 +8 $gustus +*> 3 dr.  ade Ded% 2usa;a1 S.2ed 53/*+0/D.40/2es/2PPT/?/+*+ 3 Ae!ruari +*8

4 dr. Suri%oo 53/*43/SP.D.63/2es/2PPT/,/+*3 *3 Ae!ruari +*8

5 dr. (i ade ?ia Sep:ai 53/**/SP.D.+0/2es/2PPT/?/+*5 ++ ei +*0 6 dr.  =us: $u Lakshmi Damaa: 53/40/SP.D.*4/2es/2TTP/?/+*3 GGG

8 dr. da a%u Putu Raga Diatari 53/3+/SP.D.0/2es/2TTP//+*4 0 Ae!ruari +*8 > dr.  Putu $gus Sur%a;a 53/*5/SP.D.+4/2es/2ppT/,/+*4 + ei +*>

II& DOKTER GIGI

* drg. (i Putu $ri 2umalasai 53/*>*/SPD.44/2es/2PPT/,/+*5 +4 aret +*0 + drg.  =us: $%u ade D;i Resturii 53/*3/d.5/2es/2PPT/?/+*+ GGG

III& PELA%ANAN MEDIK SPESIALIS DASAR III&A& PEN%AKIT DALAM

* dr. =ede Sukra;a1 .'iomed1Sp.PD 53/>/SPD.++/2es/2TTP/?/+*5 +* Desem!er +*0 + dr. (egah Susup $ra;a1Sp.PD 53/4*/SP.D.*/2es/2PPT//+*3 GGG

3 dr. (i Luh ta:k Sri;ah%ui1Sp.PD 53/4/SPD.>/2es/2TTP/?/+*5 *0 ei +*>

III&B& KESEHATAN ANAK

* dr. R%aa "arlist%a:1Sp.$ 53/*0/D.55/2es/2PPT/,/+** GGG

+ dr. (i Putu Sucita @ah%u De;i1 .Sc1Sp.$ +3/06/D.+3/2es/2TTP//+*+ *4 Desem!er +*6

III&C& BEDAH

* dr.  =us: 'agus =ita Triarta1Sp.' 53/*+8/D.48/2es/2TTP/?/+*+ GGG + dr.  ade Liggih $r%aa1Sp.' 53/+8/SP.D.+/2es/2PPT/?/+*6 GGG

III&D& OBSTETRI DAN GINEKOLOGI

* dr.  =de ade Saraa1Sp.&= 53/*84/D.84/2es/2PPT/,/+*+ GGG

+ dr.  2etut Rai @i;a (egara1Sp.&= 53/46/SPD.*3/2es/2PPT/?/+*5 Suda%1 $pril *01 ++

I)&A& ANESTESIOLOGI

* dr.  =ede ka $ri @ira;a1Sp.$ 53/**/D.+4/2ep/2PPT//+*+ +> Ae!ruari +*8

I)&B& RADIOLOGI

* dr. (%oma Sat%a1Sp.Rad 53/*86/D.86/2es/2PPT/,/+*+ 4 ui +*8

)&C& PATOLOGI KLINIK

* dr. 2etut merta dra;a:1Sp.P2 53/+36/SP.D.+5/2es/kppt/7/+*6 +5 auari ++*

)I& DOKTER GIGI SPESIALIS

)II& PELA%ANAN MEDIK LAINN%A

* dr.  =us: Putu $rdaa1Sp.S 53/*85/D.85/2es/2PPT/,/+*+ *3 (opem!er +*6 + dr. (i ade Tirta Sai;ai1Sp.T"T-2L 53/3/SP.D.8/2es/2PPT//+*4 *0 Ae!ruari +*0 3 dr.  gus: (gurah $om Suprad%aa1Sp. Surat Tugas) 44/4+880/'PP GGG

4 dr. De;a =ede Satria $m!ara Putra1.'iomed1Sp.&t 53/3/SPD.38/2es/2PPT/?/+*5 3 ui ++

)III& TENAGA KEFARMASIAN

* @id% Tri Reto Sari1S.Aarm.$pt 53/*45+/9akes.Dikes/?/+*5 GGG

+ (i Putu 9uliasih1S.Aarm.$pt 53/+0>5/9akes.Dikes/,/+*5 * ui ++ 3 (i ade $%u Pra:;i Praa 53/+>>/9akes.Dikes/?/+*5 *5 $gustus +*0 4 2adek $ri Puspa%a:.1 $.d.Aarm 53/+33>/9akes.Dikes/,/+*5 Arida%1 $pril 51 +*0 5 (i ade $%u Puspita Sari 53/+>6/9akes. Dikes/?/+*5 > ei +*0

I*& TENAGA KEPERA+ATAN

* (s.  Putu &las arta;a1S.2ep 53/*0>/S2.P.56/2es/2PPT/,/+*5 *3 aret ++ + (i ade "aria:i 53/*08/S2.P.55/2es/2PPT/,/+*5 *4 aret ++ 3 =utsi $%u Putu Dia Aera%a:1$.d12ep 53/*04/S2.P.5+/2es/2PPT/,/+*5 ++ $gustus ++ 4 $ris Lipa%a:1$.d12ep. 53/*03/S2.P.5*/2es/2PPT/,/+*5 Arida%1 $pril 31 ++ 5 $ggraei Tri a%a Sari1$.d12ep 53/*0+/S2.P.5/2es/2PPT/,/+*5 * aret +*0 6 Ria Pura;a:1$.d12ep 53/*0*/S2.P.40/2es/2PPT/,/+*5 *> ei ++ 8 l% Raha%u SaHtri1$md12ep 53/*0/S2.P.4>/2es/2PPT/,/+*5 5 mei +*> > (i 2etut Sri @idiai1$.d12ep 53/*06/S2.P.54/2es/2PPT/,/+*5 *8 Desem!er ++ 0 (i Luh made @ir%ai1$.d12ep 53/*05/S2.P.53/2es/2PPT/,/+*5 *6 Desem!er ++ * Diaa Sari1$.d12ep 53/*>0/S2.P.48/2es/2PPT/,/+*5 +3 aret ++ ** (s.Aema $rgadiata1S.2ep 53/8+/S2.P.+6/2es/2PPT/?/+*5 GGG

*+ (s. Putu $rdia 2ariata1S.2ep 53/8*/S2.P.+5/2es/2PPT/?/+*5 *5 Ae!ruari +*8 *3 (s. (i @a%a Sri Raha%ui Utami1 S.2ep 53/6>/S2.P.++/2es/2PPT/?/+*5 5 uli ++

*4 Dei Susi%a:1S.2ep.(s 53/>8/S2.P.+>/2es/2PPT/?/+*5 + $gustus ++ *5 (o7iaa sari (ugroho1S.2ep.(s 53/>6/S2.P.+8/2es/2PPT/?/+*5 GGG

*6 da 'agus 2ade 2uria Saputra1S.2ep.(s 53/0+/S2.P.2es/2PPT/?/+*5 ** $gustus ++ *8  Putu 9oga Semadhi1S.2ep.(s 53/>0/S2.P.3/2es/2PPT/?/+*5 ** Ae!ruari ++ *> (i Luh Dia eiliatariasih1S.2ep.(s 53/*/S2/P.35/2es/2PPT/?/+*5 *0 ei +*8 *0 (s. 2ade D;i $d%aa1S.2ep 53/8/S2.P.+4/2es/2PPT/?/+*5 +0 Desem!er ++ + (s.  ade $r%sta Sur%a;a1S.2ep 53/*3/S2.P.*/2es/2PPT//+*5 Saturda%1 $pril +51 ++ +* Putu $gus $di Pratama1S.2ep.(ers. 53/*4/S2.P.4/2es/2PPT/?/+*5 * aret ++ ++ 9uli $dri @ia%a1S.2ep.(s 53/>>/S2.P.+0/2es/2PPT/?/+*5 3 uli ++ +3 (i ade $%u ra 2usuma De;i1$.d.2ep 53/*6/S2.P.3/2es/2PPT/?/+*+ +6 ei +*8 +4 (i (%oma Suari:1$.d.2ep 53/63/S2.P.*8/2es/2PPT/?/+*5 +4 ui ++ +5  2omag =ede @ira%a =ua $rtha1$.d.2ep 53/6+/S2.P.*6/ 2es/2PPT/?/+*5 GGG +6 (i Putu Dia Utari1$.d.2ep 53/0/S2.P.3*/2es/2PPT/?/+*5 GGG

+8 (i 2etut Ratasih1 $.d12ep 53/+*/S2.P.+/2es/2PPT//+*5 * $gustus ++ +> (ue @ahida1$.d12ep 53/00/S2.P.34/2es/2PPT/?/+*5 Arida%1 $pril +41 ++

+0 Suparto1 SST 53/*3/S2.P$.3/2es/2PPT//+*4 3* Desem!er +*8

*& TENAGA KEBIDANAN

* Putu 'udiar:i1$.d.2e! 53/*43/S2.'.40/2es/2PPT/?/+*5 * auari +*3 + (i ade Umie "ardai1$.d12ed 53/03/S2.'/*8/2es/2PPT/?/+*5 + auari +*0 3 (i 2omag Sri da%a:1$.d.2e! 53/*4+/S2.'.4>/2es/2PPT/?/+*5 +6 aret +*8 4 (i ade (ia D;i 2arlie1$.d.2e! 53/*4>/S2.'.5*/2es/2PPT/?/+*5 *3 $gustus +*0 5 Putu $%u $stri Puspita1$md.2e! 53/*4/S2.'.4>/2es/2PPT/?/+*+ Suda%1 $pril 31 +*8 6 2aria $Brilia1$.d.2e! 53/*48/S2.'.5/2es/2PPT/?/+*5 Arida%1 $pril +41 ++ 8 (i 2adek Sriari aha%oi1$.d.2e! 53/*4*/S2.'.48/2es/2PPT/?/+*5 3 ui +*8 > (i Putu ega Sari De;i 446/*8>/9akes.Dikes +* Ae!ruari +*6 0 Putu $%u Sari De;i1$.d.2e! 53/*30/S2.'.48/2es/2PPT/?/+*+ Suda%1 $pril 31 +*8 * @i;it @idhiarsa:1 $md.2e! 53/*+/S2.'.3/2es/2PPT//+*5 *4 Ae!ruari +*> ** #hrist% Raha%u De;i .$md.2e! 53/*/S2.'.*/2es/2PPT//+*5 GGG

STR Proses Pera;at $estesi

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