| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | AA | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Audit Tool (Total Sampling) | ||||||||||||||||||||||||||
2 | |||||||||||||||||||||||||||
3 | |||||||||||||||||||||||||||
4 | FORM AUDIT KEPATUHAN REMINDER H-30 MNT | ||||||||||||||||||||||||||
5 | |||||||||||||||||||||||||||
6 | Ruang | : LT. 1 | |||||||||||||||||||||||||
7 | Bulan | : SEPTEMBER 2026 | |||||||||||||||||||||||||
8 | |||||||||||||||||||||||||||
9 | No | Nama DPJP | KSM | Tanggal Dan Jam Jadwal Praktik | Tanggal dan Jam Dihubungi oleh Perawat (30 menit sebelum jadwal praktik) | Nama Petugas | Kepatuhan Perawat Dalam Reminder 30 menit sebelum jadwal praktik | ||||||||||||||||||||
10 | Ya | Tidak | |||||||||||||||||||||||||
11 | 1 | dr. Anditta Syifarahmah, Sp.M | MATA | 01-09-2026 Jam 12:30-15:30 | 01-09-2026 Jam 11:45 | ALFIN | 1 | 0 | Verifikasi Kepala Ruang | Tanggal | |||||||||||||||||
12 | 2 | dr. Maharani, Sp.M | MATA | CUTI | CUTI | ALFIN | 1 | 0 | |||||||||||||||||||
13 | 3 | dr. Liana Ekowati, Sp.M | MATA | 01-09-2026 Jam 07:30-11:30 | 01-09-2026 Jam 07:00 | ALFIN | 1 | 0 | |||||||||||||||||||
14 | 4 | dr. Trilaksana Nugroho, Sp.M | MATA | 01-09-2026 Jam 12:30-15:30 | 01-09-2026 11:50 | ALFIN | 1 | 0 | Analisa dan Masalah | 1. sesuai | |||||||||||||||||
15 | 5 | dr. A. Rizal Fanany, Sp.M | MATA | 01-09-2026 Jam 07:30-11:30 | 01-09-2026 7:00 | ALFIN | 1 | 0 | 2. | ||||||||||||||||||
16 | 6 | dr. Dina Novita, Sp.M | MATA | 01-09-2026 Jam 07:30-11:30 | 01-09-2026 7:00 | ALFIN | 1 | 0 | 3. | ||||||||||||||||||
17 | 7 | dr.Farokah,Sp.THHT-KL | THT | Selasa 01-09-2026 Jam 07:30-11:30 | Selasa 01-09-2026 Jam 07:00 | NILA | 1 | 0 | dst. | ||||||||||||||||||
18 | 8 | dr. Muyasssaroh,Sp.THT(K) | THT | Selasa 01-09-2026 Jam 07:30-11:30 | Selasa 01-09-2026 Jam 07:01 | NILA | 1 | 0 | |||||||||||||||||||
19 | 9 | dr. Hendro Purnomo,Sp.T.H.T.B.K.L | THT | Selasa 01-09-2026 Jam 07:30-11:30 | Selasa 01-09-2026 Jam 07:02 | NILA | 1 | 0 | |||||||||||||||||||
20 | 10 | dr. Zulfikar Naftali,Sp.THT-KL | THT | Selasa 01-09-2026 Jam 12:30-15:30 | Selasa 01-09-2026 Jam 12:00 | NILA | 1 | 0 | |||||||||||||||||||
21 | 11 | dr. Nourma Wahyu Andriani,Sp.T.H.T.K.L | THT | Selasa 01-09-2026 Jam 12:30-15:31 | Selasa 01-09-2026 Jam 12:00 | NILA | 1 | 0 | Rencana dan Tindak Lanjut | 1. | |||||||||||||||||
22 | 12 | dr.Dian Yusnita,Sp.THT-KL | THT | Selasa 01-09-2026 Jam 12:30-15:32 | Selasa 01-09-2026 Jam 12:00 | NILA | 1 | 0 | 2. | ||||||||||||||||||
23 | 13 | dr. Carissa Sp.DV. | KULIT & KELAMIN | Selasa 01-09-2026 Jam 07:30-11:30 | CUTI , delegasi ke dr Holy Ametati | Yuyun | 0 | 0 | 3. | ||||||||||||||||||
24 | 14 | dr. Holy Ametati, Sp.DVE, FINSDV, FAADV | KULIT & KELAMIN | Selasa 01-09-2026 Jam 12:30-15:30 | 01-09-2026 Jam 07:30 | Yuyun | 1 | 0 | dst. | ||||||||||||||||||
25 | 15 | dr. Natalia Dewi Wardani, Sp. Kj | PSIKIATRI | Selasa 01-09-2026 Jam 07:30-11:30 | 01-09-2026 Jam 06:45 | Rochma | 1 | 0 | |||||||||||||||||||
26 | 16 | dr. Rachmawati, Sp.Kj | PSIKIATRI | Selasa 01-09-2026 Jam 12:30-15:30 | 01-09-2026 Jam 11:49 | Rochma | 1 | 0 | |||||||||||||||||||
27 | 17 | dr. Soesmeyka Savitri, Sp.kj | PSIKIATRI | CUTI | CUTI, Delegasi ke dr Mahesa | Rochma | 1 | 0 | |||||||||||||||||||
28 | 18 | dr. Mahesa Permana Kardis, Sp.kj | PSIKIATRI | Rabu 02-09-2026 Jam 07:30-15:30 | 02-09-2026 Jam 06:48 | Rochma | 1 | 0 | |||||||||||||||||||
29 | 19 | dr. Pujo Widodo,Sp.THT | THT | Rabu 02-09-2026 JAM 07.30-11.30 | Rabu 02-09-2026 JAM 07.00 | NILA | 1 | 0 | |||||||||||||||||||
30 | 20 | dr. Anna Mailasari Kusuma Dewi,Sp.THT | THT | Rabu 02-09-2026 JAM 07.30-11.30 | Rabu 02-09-2026 JAM 07.00 | NILA | 1 | 0 | |||||||||||||||||||
31 | 21 | dr. Afrina Yanti,Sp.THT-KL | THT | Rabu 02-09-2026 JAM 07.30-11.30 | Rabu 02-09-2026 JAM 07.00 | NILA | 1 | 0 | |||||||||||||||||||
32 | 22 | dr. Desy Iriani,Sp.THT-KL | THT | Rabu 02-09-2026 JAM 12:30-15:30 | Rabu 02-09-2026 JAM 12:00 | NILA | 1 | 0 | |||||||||||||||||||
33 | 23 | dr. Liana Ekowati, Sp.M (K) | MATA | 02-09-2026 Jam 12:30-15:30 | 02-09-2026 Jam | ALFIN | 1 | 0 | |||||||||||||||||||
34 | 24 | dr. A. Rizal Fanany, Sp.M (K) | MATA | 02-09-2026 Jam 07:30-11:30 | 02-09-2026 Jam | ALFIN | 1 | 0 | |||||||||||||||||||
35 | 25 | dr. Riski Prihatningtias, Sp.M (K) | MATA | CUTI PIT | CUTI PIT | ALFIN | 1 | 0 | |||||||||||||||||||
36 | 26 | dr. Fatimah Dyah N.A, Sp.M(K)., MARS | MATA | 02-09-2026 Jam 07:30-11:30 | 02-09-2026 Jam | ALFIN | 1 | 0 | |||||||||||||||||||
37 | 27 | dr. Arief Wildan, Sp.M(K) | MATA | CUTI PIT | CUTI PIT | ALFIN | 1 | 0 | |||||||||||||||||||
38 | 28 | dr. Nugraha Adiyasa, Sp.M | MATA | 02-09-2026 Jam 07:30-11:30 | 02-09-2026 Jam | ALFIN | 1 | 0 | |||||||||||||||||||
39 | 29 | dr. Denti Puspasari, Sp.M(K) | MATA | 02-09-2026 Jam 12:30-15:30 | 02-09-2026 Jam | ALFIN | 1 | 0 | |||||||||||||||||||
40 | 30 | drg. Feni Norma Zunita, M.Kes.Sp.Ort | GIGI DAN MULUT | Selasa 1-09-2026 JAM 12.30-15.30 | Selasa 1-09-2026 JAM 11:57 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
41 | 31 | drg. Resta Diamawati, Sp.KG | GIGI DAN MULUT | Selasa 1-09-2026 JAM 07.30-11.30 | Selasa 1-09-2026 JAM 06:55 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
42 | 32 | drg.Yunnie Adiesty, Sp.KG | GIGI DAN MULUT | Selasa 1-09-2026 JAM 12.30-15.30 | Selasa 1-09-2026 JAM 11:56 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
43 | 33 | drg. Devi Farida U,Sp.BM | GIGI DAN MULUT | Selasa 1-09-2026 JAM 12.30-15.30 | Selasa 1-09-2026 JAM 11:57 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
44 | 34 | drg. Etis Duhita Rahayuningtyas, Sp. PM | GIGI DAN MULUT | Selasa 1-09-2026 JAM 12.30-15.30 | Selasa 1-09-2026 JAM 11:57 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
45 | 35 | drg. Windriyatna | GIGI DAN MULUT | Selasa 1-09-2026 JAM 12.30-15.30 | Selasa 1-09-2026 JAM 11:59 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
46 | 36 | drg. Rendy Sumali,Sp.Perio | GIGI DAN MULUT | Selasa 1-09-2026 JAM 07.30-11.30 | Selasa 1-09-2026 JAM 06:56 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
47 | 37 | drg.Ahmad Saptadi,Sp.BM | GIGI DAN MULUT | Selasa 1-09-2026 JAM 07.30-11.30 | Selasa 1-09-2026 JAM 06: 58 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
48 | 38 | drg.Diah Ajeng Purbaningru, Sp.KGA | GIGI DAN MULUT | Selasa 1-09-2026 JAM 07.30-11.30 | Selasa 1-09-2026 JAM 06:58 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
49 | 39 | drg. Budi Wibowo, Sp.Ort | GIGI DAN MULUT | Rabu 02-09-2026 JAM 07.30-11.30 | Rabu 02-09-2026 JAM cuti | SUWARJOKO | 1 | 0 | |||||||||||||||||||
50 | 40 | drg. Devi Farida U,Sp.BM | GIGI DAN MULUT | Rabu 02-09-2026 JAM 07.30-11.30 | Rabu 02-09-2026 JAM 06:49 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
51 | 41 | drg. Etis Duhita Rahayuningtyas, Sp. PM | GIGI DAN MULUT | Rabu 02-09-2026 JAM 12.30-15.30 | Rabu 02-09-2026 JAM 11:55 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
52 | 42 | drg. Feni Norma Zunita, M.Kes.Sp.Ort | GIGI DAN MULUT | Rabu 02-09-2026 JAM 12.30-15.30 | Rabu 02-09-2026 JAM 11:55 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
53 | 43 | drg. Resta Diamawati, Sp.KG | GIGI DAN MULUT | Rabu 02-09-2026 JAM 07.30-15.30 | Rabu 02-09-2026 JAM 06:54 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
54 | 44 | drg. Windriyatna | GIGI DAN MULUT | Rabu 02-09-2026 JAM 07.30-11.30 | Rabu 02-09-2026 JAM 06:54 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
55 | 45 | drg.Diah Ajeng Purbaningru, Sp.KGA | GIGI DAN MULUT | Rabu 02-09-2026 JAM 07.30-11.30 | Rabu 02-09-2026 JAM 06:53 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
56 | 46 | drg.Ahmad Saptadi,Sp.BM | GIGI DAN MULUT | Rabu 02-09-2026 JAM 12.30-15.30 | Rabu 02-09-2026 JAM 11:46 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
57 | 47 | dr. Carissa Sp.DV. | KULIT & KELAMIN | Rabu 03-09-2026 Jam 07:30-11:30 | Cuti , delegasi ke dr Yoseph Rahmat | Yuyun | 0 | 0 | |||||||||||||||||||
58 | 48 | dr. Yosep Ferdinand Rahmat Sugianto , Sp.DVE, Subsp.DAI, FINSDV, FAADV | KULIT & KELAMIN | Rabu 03-09-2026 Jam 11:30-15:30 | 03-09-2026 Jam 07:00 | Yuyun | 1 | 0 | |||||||||||||||||||
59 | 49 | dr. Rery Budiarti,Sp.THT-KL | THT | Kamis, 03-09-2026 Jam 07:30-11:30 | Kamis, 03-09-2026 Jam 07:00 | NILA | 1 | 0 | |||||||||||||||||||
60 | 50 | dr. Muyasssaroh,Sp.THT(K) | THT | Kamis, 03-09-2026 Jam 07:30-11:30 | Kamis, 03-09-2026 Jam 07:00 | NILA | 1 | 0 | |||||||||||||||||||
61 | 51 | dr. Dian Yusnita, Sp.THT-KL | THT | Kamis, 03-09-2026 Jam 07:30-11:30 | Kamis, 03-09-2026 Jam 07:00 | NILA | 1 | 0 | |||||||||||||||||||
62 | 52 | dr. Farokah, Sp.THT-KL | THT | Kamis, 03-09-2026 Jam 12:30-15:30 | Kamis, 03-09-2026 Jam 12:00 | NILA | 1 | 0 | |||||||||||||||||||
63 | 53 | dr. Dian Ayu Ruspita,Sp.THT-KL | THT | Kamis, 03-09-2026 Jam 12:30-15:30 | Kamis, 03-09-2026 Jam 12:00 | NILA | 1 | 0 | |||||||||||||||||||
64 | 54 | dr. Mahesa Permana Kardis, Sp.kj | PSIKIATRI | Kamis, 03-09-2026 Jam 07:30-11:30 | Kamis, 03-09-2026 Jam 06:53 | Rochma | 1 | 0 | |||||||||||||||||||
65 | 55 | dr. Rachmawati, Sp.Kj | PSIKIATRI | Kamis, 03-09-2026 Jam 12:30-15:30 | Kamis, 03-09-2026 Jam 11:45 | Rochma | 1 | 0 | |||||||||||||||||||
66 | 56 | dr. Widyastuti, Sp.DVE, FINSDV, FAADV | KULIT & KELAMIN | Kamis 03-09-2026 Jam 07:30-11:30 | 03-09-2026 Jam 07:00 | Yuyun | 1 | 0 | |||||||||||||||||||
67 | 57 | dr. Yosep Ferdinand Rahmat Sugianto , Sp.DVE, Subsp.DAI, FINSDV, FAADV | KULIT & KELAMIN | Kamis 03-09-2026 Jam 11:30-15:30 | Cuti , delegasi ke dr Widyastuti | Yuyun | 0 | 0 | |||||||||||||||||||
68 | 58 | drg.Yunnie Adiesty, Sp.KG | GIGI DAN MULUT | Kamis 03-09-2026 11.30-15.30 | 03/09/2026 11:00:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
69 | 59 | drg. Etis Duhita Rahayuningtyas, Sp. PM | GIGI DAN MULUT | Kamis 03-09-2026 07.30-11.30 | 03/09/2026 6:57 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
70 | 60 | drg. Windriyatna | GIGI DAN MULUT | Kamis 03-09-2026 07.30-11.30 | 03/09/2026 6:56:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
71 | 61 | drg. Feni Norma Zunita, M.Kes.Sp.Ort | GIGI DAN MULUT | Kamis 03-09-2026 07.30-11.30 | 03-09-2026 11:57:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
72 | 62 | drg. Gustantyo Wahyu Wibowo, Sp KG | GIGI DAN MULUT | Kamis03-09-2026 07.30-11.30 | 03/09/2026 6:58 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
73 | 63 | drg. Rendy Sumali,Sp.Perio | GIGI DAN MULUT | Kamis 03-09-2026 12.30-15.30 | 003-09-2026 11:57:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
74 | 64 | drg. M. Reza Pahlevi,Sp.BM | GIGI DAN MULUT | Kamis 03-09-2026 07.30-11.30 | 03/09/2026 6:56 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
75 | 65 | drg. Devi Farida U,Sp.BM | GIGI DAN MULUT | Kamis 03-09-2026 12.30-15.30 | 03/09/2026 11:58 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
76 | 66 | drg.Diah Ajeng Purbaningru, Sp.KGA | GIGI DAN MULUT | Kamis 03-09-2026 12.30-15.30 | 03/09/2026 11:59:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
77 | 67 | dr. Rachmawati, Sp.Kj | PSIKIATRI | Jum'at 04-09-2026 07:30-11:30 | Jum'at 04-09-2026 06:49 | Rochma | 1 | 0 | |||||||||||||||||||
78 | 68 | dr. Natalia Dewi Wardani, Sp. Kj | PSIKIATRI | CUTI | CUTI,delegasi dr. Rachmawati | Rochma | 1 | 0 | |||||||||||||||||||
79 | 69 | dr. Hendro Purnomo, Sp,T.H.T.B.K.L | THT | Jum'at 07-09-2026 Jam 07:30-11:30 | Jum'at 07-09-2026 Jam 07:00 | NILA | 1 | 0 | |||||||||||||||||||
80 | 70 | dr. Desy Iriani,Sp.THT-KL | THT | Jum'at 07-09-2026 Jam 07:30-11:30 | Jum'at 07-09-2026 Jam 07:00 | NILA | 1 | 0 | |||||||||||||||||||
81 | 71 | dr. Nourma Wahyu,Sp.THT | THT | Jum'at 07-09-2026 Jam 07:30-11:30 | Jum'at 07-09-2026 Jam 07:00 | NILA | 1 | 0 | |||||||||||||||||||
82 | 72 | dr. Afrina Yanti, Sp.THT-KL | THT | Jum'at 07-09-2026 Jam 12:30-15:30 | Jum'at 07-09-2026 Jam 12:00 | NILA | 1 | 0 | |||||||||||||||||||
83 | 73 | dr. Holy Ametati, Sp.DVE, FINSDV, FAADV | KULIT & KELAMIN | Jumat 04-09-2026 Jam 07:30-11:30 | 04-09-2026 Jam 07:00 | Yuyun | 1 | 0 | |||||||||||||||||||
84 | 74 | dr. Renni Yuniati, Sp.DVE, FINSDV, FAADV, MH | KULIT & KELAMIN | Jumat 04-09-2026 Jam 12:30-15:30 | CUTI , delegasi kepada dr Holy | Yuyun | 0 | 0 | |||||||||||||||||||
85 | 75 | drg. Feni Norma Zunita, M.Kes.Sp.Ort | GIGI DAN MULUT | Jum'at 04-09- 2026 12.30-15.30 | 04-09- 2026 11:59:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
86 | 76 | drg. Resta Diamawati, Sp.KG | GIGI DAN MULUT | Jum'at 04-09- 2026 07.30-11.30 | 04-09- 2026 cuti | SUWARJOKO | 1 | 0 | |||||||||||||||||||
87 | 77 | drg. Windriyatna | GIGI DAN MULUT | Jum'at 04-09- 2026 07.30-11.30 | 04-09- 2026 6:59:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
88 | 78 | drg. Etis Duhita Rahayuningtyas, Sp. PM | GIGI DAN MULUT | Jum'at 04-09- 2026 12.30-15.30 | 04-09- 2026 11:58:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
89 | 79 | drg.Diah Ajeng Purbaningru, Sp.KGA | GIGI DAN MULUT | Jumat 04-09- 2026 12.30-15.30 | 04-09- 2026 11:59:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
90 | 80 | drg.Yunnie Adiesty, Sp.KG | GIGI DAN MULUT | Jumat 04-09- 2026 12.30-15.30 | 04-09- 2026 11:59:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
91 | 81 | drg.Ahmad Saptadi,Sp.BM | GIGI DAN MULUT | Jumat04-09- 2026 12.30-15.30 | 04-09- 2026 11:57:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
92 | 82 | drg. M. Reza Pahlevi,Sp.BM | GIGI DAN MULUT | Jumat 04-09- 2026 07.30-11.30 | 04-09- 2026 cuti | SUWARJOKO | 1 | 0 | |||||||||||||||||||
93 | 83 | drg. M. Reza Pahlevi,Sp.BM | GIGI DAN MULUT | 7-09-2026 JAM 12:30-15:30 | 7-09-2026 JAM 11:58 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
94 | 84 | drg.Yunnie Adiesty, Sp.KG | GIGI DAN MULUT | 7-09-2026 12.30-15.30 | 07/09/2026 11:57 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
95 | 85 | drg. Devi Farida U,Sp.BM | GIGI DAN MULUT | 7-09-2026 07.30-11.30 | 07/09/2026 6:59:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
96 | 86 | drg. Feni Norma Zunita, M.Kes.Sp.Ort | GIGI DAN MULUT | 7-09-2026 07.30-11.30 | 07/09/2026 6:58:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
97 | 87 | drg. Gustantyo Wahyu Wibowo, Sp KG | GIGI DAN MULUT | 7-09-2026 07.30-11.30 | 07/09/2026 11:59 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
98 | 88 | drg.Diah Ajeng Purbaningru, Sp.KGA | GIGI DAN MULUT | 7-09-2026 12.30-15.30 | 07-09-2026 11:58:00 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
99 | 89 | drg. Etis Duhita Rahayuningtyas, Sp. PM | GIGI DAN MULUT | 7-09-2026 07.30-11.30 | 07/09/2026 6:57 | SUWARJOKO | 1 | 0 | |||||||||||||||||||
100 | 90 | drg. Rendy Sumali,Sp.Perio | GIGI DAN MULUT | 7-09-2026 12.30-15.30 | 07/09/2026 11:59 | SUWARJOKO | 1 | 0 | |||||||||||||||||||