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1111
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Formulir RL 4AFormulir RL 4AFormulir RL 4AFormulir RL 4A
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DATA KEADAAN MORBIDITAS PASIEN RAWAT INAP RUMAH SAKIT
DATA KEADAAN MORBIDITAS PASIEN RAWAT INAP RUMAH SAKIT
DATA KEADAAN MORBIDITAS PASIEN RAWAT INAP RUMAH SAKIT
DATA KEADAAN MORBIDITAS PASIEN RAWAT INAP RUMAH SAKIT
4
5
6
Kode RS: 3302030Kode RS: 3302030Kode RS: 3302030Kode RS: 3302030
7
Nama RS: Tk III 04.06.01/WkNama RS: Tk III 04.06.01/WkNama RS: Tk III 04.06.01/WkNama RS: Tk III 04.06.01/Wk
8
Bulan / Tahun
: Januari / 2026
Ruang / Tahun
: R. ICU / 2020
Ruang / Tahun
: R. KLAS / 2020
Ruang/ Tahun
: R. ANTASENA / 2020
9
10
No. UrutNo. DTDNo.Daftar terperinciGolongan sebab penyakitPasien KeluarNo. UrutNo. DTDNo.Daftar terperinciGolongan sebab penyakitPasien KeluarNo. UrutNo. DTDNo.Daftar terperinciGolongan sebab penyakitPasien KeluarNo. UrutNo. DTDNo.Daftar terperinciGolongan sebab penyakit
11
(Hidup & JmlJml(Hidup & JmlJml(Hidup & JmlJml
12
Jumlah Pasien Hidup dan Mati menurut Golongan & Mati)PasienPasienJumlah Pasien Hidup dan Mati menurut Golongan & Mati)PasienPasienJumlah Pasien Hidup dan Mati menurut Golongan & Mati)PasienPasienJumlah Pasien Hidup dan Mati menurut Golongan
13
Umur & Jenis KelaminMnrt KeluarKeluarUmur & Jenis KelaminMnrt KeluarKeluarUmur & Jenis KelaminMnrt KeluarKeluarUmur & Jenis Kelamin
14
JenisHidupMatiJenisHidupMatiJenisHidupMati
15
Kelamin(23+24)Kelamin(23+24)Kelamin(23+24)
16
0-6 hr7-28hr28hr-<1th1-4th5-14th15-24th25-44th45-64th> 65LKPR0-6 hr7-28hr28hr-<1th1-4th5-14th15-24th25-44th45-64th> 65LKPR0-6 hr7-28hr28hr-<1th1-4th5-14th15-24th25-44th45-64th> 65LKPR0-6 hr7-28hr28hr-<1th1-4th5-14th15-24th25-44th45-64th
17
LPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPLPL
18
12345678910111213141516171819202122232425261234567891011121314151617181920212223242526123456789101112131415161718192021222324252612345678910111213141516171819
19
1001A00Kolera00000000000000000000001001A00Kolera00000000000000000000001001A00Kolera00000000000000000000001001A00Kolera000000000000000
20
2002A01Demam tifoid dan paratifoid000013588123625250121406102002A01Demam tifoid dan paratifoid00000000010000000001102002A01Demam tifoid dan paratifoid0000001012520161321682402002A01Demam tifoid dan paratifoid000000000000000
21
3003A03Sigelosis00000000000000000000003003A03Sigelosis00000000000000000000003003A03Sigelosis00000000000000000000003003A03Sigelosis000000000000000
22
4004'0A06.4Abses hati amuba00000000000000000000004004'0A06.4Abses hati amuba00000000000000000000004004'0A06.4Abses hati amuba00000000000000000000004004'0A06.4Abses hati amuba000000000000000
23
5004.9A06.0 – 3.5-9Amebiasis lainnya00000000000000000000005004.9A06.0 – 3.5-9Amebiasis lainnya00000000000000000000005004.9A06.0 – 3.5-9Amebiasis lainnya00000000000000000000005004.9A06.0 – 3.5-9Amebiasis lainnya000000000000000
24
6005A09Diare & gastroenteritis oleh penyebab Infeksi tertentu (kolitis infeksi)000013557873374115432417306005A09Diare & gastroenteritis oleh penyebab Infeksi tertentu (kolitis infeksi)00000000000000000000006005A09Diare & gastroenteritis oleh penyebab Infeksi tertentu (kolitis infeksi)00000000000000012021306005A09Diare & gastroenteritis oleh penyebab Infeksi tertentu (kolitis infeksi)000000000004000
25
7006A02. A04-A05. A07-A08Penyakit infeksi usus lainnya00000000000000000000007006A02. A04-A05. A07-A08Penyakit infeksi usus lainnya00000000000000000000007006A02. A04-A05. A07-A08Penyakit infeksi usus lainnya00000000000000000000007006A02. A04-A05. A07-A08Penyakit infeksi usus lainnya000000000000000
26
8007.0A15.0Tuberkulosis (TB) paru BTA (+) dengan/tanpa tindakan kuman TB00000000003242554316122718007.0A15.0Tuberkulosis (TB) paru BTA (+) dengan/tanpa tindakan kuman TB00000000000000000000008007.0A15.0Tuberkulosis (TB) paru BTA (+) dengan/tanpa tindakan kuman TB00000000000012131136908007.0A15.0Tuberkulosis (TB) paru BTA (+) dengan/tanpa tindakan kuman TB000000000000100
27
9007.1A15.1-A16.2Tuberkulosis paru lainnya00000000000000010001109007.1A15.1-A16.2Tuberkulosis paru lainnya00000000000000000000009007.1A15.1-A16.2Tuberkulosis paru lainnya00000000000000000000009007.1A15.1-A16.2Tuberkulosis paru lainnya000000000000000
28
10007.9A16.3-9Tuberkulosis alat napas lainnya000000000001000001022010007.9A16.3-9Tuberkulosis alat napas lainnya000000000000000000000010007.9A16.3-9Tuberkulosis alat napas lainnya000000000000000000000010007.9A16.3-9Tuberkulosis alat napas lainnya000000000000000
29
11008.0A17.0Meningitis tuberkulosa000000000000000000000011008.0A17.0Meningitis tuberkulosa000000000000000000000011008.0A17.0Meningitis tuberkulosa000000000000000000000011008.0A17.0Meningitis tuberkulosa000000000000000
30
12008.1A17.1-7Tuberkulosis susunan saraf pusat lainnya000000000000000000000012008.1A17.1-7Tuberkulosis susunan saraf pusat lainnya000000000000000000000012008.1A17.1-7Tuberkulosis susunan saraf pusat lainnya000000000000000000000012008.1A17.1-7Tuberkulosis susunan saraf pusat lainnya000000000000000
31
13008.2A18.0Tuberkulosis tulang dan sensi000000000000000000000013008.2A18.0Tuberkulosis tulang dan sensi000000000000000000000013008.2A18.0Tuberkulosis tulang dan sensi000000000000000000000013008.2A18.0Tuberkulosis tulang dan sensi000000000000000
32
14008.3A18.2Limfadenitis tuberkulosa000000000000000000000014008.3A18.2Limfadenitis tuberkulosa000000000000000000000014008.3A18.2Limfadenitis tuberkulosa000000000000000000000014008.3A18.2Limfadenitis tuberkulosa000000000000000
33
15008.4A19Tuberkulosis milier000000000000200000202015008.4A19Tuberkulosis milier000000000000000000000015008.4A19Tuberkulosis milier000000000000000000000015008.4A19Tuberkulosis milier000000000000000
34
16008.9A18.1.3-8Tuberkulosis lainnya000000000000000000000016008.9A18.1.3-8Tuberkulosis lainnya000000000000000000000016008.9A18.1.3-8Tuberkulosis lainnya000000000000000000000016008.9A18.1.3-8Tuberkulosis lainnya000000000000000
35
17009A20Sampar/Pes000000000000000000000017009A20Sampar/Pes000000000000000000000017009A20Sampar/Pes000000000000000000000017009A20Sampar/Pes000000000000000
36
18010A23Bruselosis000000000000000000000018010A23Bruselosis000000000000000000000018010A23Bruselosis000000000000000000000018010A23Bruselosis000000000000000
37
19011A30Lepra/Kusta000000000000000000000019011A30Lepra/Kusta000000000000000000000019011A30Lepra/Kusta000000000000000000000019011A30Lepra/Kusta000000000000000
38
20012A33Tetanus neonatorum000000000000000000000020012A33Tetanus neonatorum000000000000000000000020012A33Tetanus neonatorum000000000000000000000020012A33Tetanus neonatorum000000000000000
39
21013A34-A35Tetanus lainnya000000000000001000101021013A34-A35Tetanus lainnya000000000000000000000021013A34-A35Tetanus lainnya000000000000000000000021013A34-A35Tetanus lainnya000000000000000
40
22014A36Difteria000000000000000000000022014A36Difteria000000000000000000000022014A36Difteria000000000000000000000022014A36Difteria000000000000000
41
23015A37Pertusis/Batuk rejan000000000000000000000023015A37Pertusis/Batuk rejan000000000000000000000023015A37Pertusis/Batuk rejan000000000000000000000023015A37Pertusis/Batuk rejan000000000000000
42
24016A39Infeksi meningokok000000000000000000000024016A39Infeksi meningokok000000000000000000000024016A39Infeksi meningokok000000000000000000000024016A39Infeksi meningokok000000000000000
43
25017A40-A41Septisemia000000000000000000000025017A40-A41Septisemia000000000000000000000025017A40-A41Septisemia000000000000000000000025017A40-A41Septisemia000000000000000
44
26018.0A22Antrak000000000000000000000026018.0A22Antrak000000000000000000000026018.0A22Antrak000000000000000000000026018.0A22Antrak000000000000000
45
27018.9A21.24-28. A31-32, 38-42-49Penyakit bakteri lainnya0000002001610549522242246027018.9A21.24-28. A31-32, 38-42-49Penyakit bakteri lainnya000000000000000000000027018.9A21.24-28. A31-32, 38-42-49Penyakit bakteri lainnya000000000000000000000027018.9A21.24-28. A31-32, 38-42-49Penyakit bakteri lainnya000000000000103
46
28019A50Sifilis bawaan000000000000000000000028019A50Sifilis bawaan000000000000000000000028019A50Sifilis bawaan000000000000000000000028019A50Sifilis bawaan000000000000000
47
29020A51Sifilis dini000000000000000000000029020A51Sifilis dini000000000000000000000029020A51Sifilis dini000000000000000000000029020A51Sifilis dini000000000000000
48
30021A52-A53Sifilis lainnya000000000000000000000030021A52-A53Sifilis lainnya000000000000000000000030021A52-A53Sifilis lainnya000000000000000000000030021A52-A53Sifilis lainnya000000000000000
49
31022A54Infeksi gonokok000000000000000000000031022A54Infeksi gonokok000000000000000000000031022A54Infeksi gonokok000000000000000000000031022A54Infeksi gonokok000000000000000
50
32023A55-A56Penyakit klamidia yg ditularkan melalui Hubungan seksual000000000000000000000032023A55-A56Penyakit klamidia yg ditularkan melalui Hubungan seksual000000000000000000000032023A55-A56Penyakit klamidia yg ditularkan melalui Hubungan seksual000000000000000000000032023A55-A56Penyakit klamidia yg ditularkan melalui Hubungan seksual000000000000000
51
33024A57-A64Infeksi lainnya yang terutama ditularkan Melalui hubungan seksual000000000000000000000033024A57-A64Infeksi lainnya yang terutama ditularkan Melalui hubungan seksual000000000000000000000033024A57-A64Infeksi lainnya yang terutama ditularkan Melalui hubungan seksual000000000000000000000033024A57-A64Infeksi lainnya yang terutama ditularkan Melalui hubungan seksual000000000000000
52
34025A68Demam bolak balik000000031046343104111829034025A68Demam bolak balik000000000000000000000034025A68Demam bolak balik000000000000000000000034025A68Demam bolak balik000000100000100
53
35026A71Trakoma000000000000000000000035026A71Trakoma000000000000000000000035026A71Trakoma000000000000000000000035026A71Trakoma000000000000000
54
36027A75Demam tifus000000001060020311016723036027A75Demam tifus000000000000000000000036027A75Demam tifus0000000013012321116915036027A75Demam tifus000000000000000
55
37028A80Poliomielitis akut000000000000000000000037028A80Poliomielitis akut000000000000000000000037028A80Poliomielitis akut000000000000000000000037028A80Poliomielitis akut000000000000000
56
38029A82Rabies000000000000000000000038029A82Rabies000000000000000000000038029A82Rabies000000000000000000000038029A82Rabies000000000000000
57
39030A83-A86Ensefalitis virus0000000000430223218917039030A83-A86Ensefalitis virus000000000000000000000039030A83-A86Ensefalitis virus000000000000000000000039030A83-A86Ensefalitis virus000000000000000
58
40031A95Demam kuning000000000000000000000040031A95Demam kuning000000000000000000000040031A95Demam kuning000000000000000000000040031A95Demam kuning000000000000000
59
41032.0A90Demam dengue000000000000130200156041032.0A90Demam dengue000000000000000000000041032.0A90Demam dengue000000000000000000000041032.0A90Demam dengue000000000000000
60
42032.1A91Demam berdarah dengue000000111200100000336042032.1A91Demam berdarah dengue000000000000000000000042032.1A91Demam berdarah dengue000000000000100000101042032.1A91Demam berdarah dengue000000000000000
61
43032.2A92.0Chikungunya000000000000000000000043032.2A92.0Chikungunya000000000000000000000043032.2A92.0Chikungunya000000000000000000000043032.2A92.0Chikungunya000000000000000
62
44032.3A92.1 – A92Demam virus tular nyamuk000000000000000000000044032.3A92.1 – A92Demam virus tular nyamuk000000000000000000000044032.3A92.1 – A92Demam virus tular nyamuk000000000000000000000044032.3A92.1 – A92Demam virus tular nyamuk000000000000000
63
45032.9A93-A94. A96-A99Demam virus dan demam berdarah virus tular Serangga lainnya000000000000000000000045032.9A93-A94. A96-A99Demam virus dan demam berdarah virus tular Serangga lainnya000000000000000000000045032.9A93-A94. A96-A99Demam virus dan demam berdarah virus tular Serangga lainnya000000000000000000000045032.9A93-A94. A96-A99Demam virus dan demam berdarah virus tular Serangga lainnya000000000000000
64
46033B00Infeksi herpesvirus (Herpes simpleks)000000000000000000000046033B00Infeksi herpesvirus (Herpes simpleks)000000000000000000000046033B00Infeksi herpesvirus (Herpes simpleks)000000000000000000000046033B00Infeksi herpesvirus (Herpes simpleks)000000000000000
65
47034B01-B02Varisela (cacar air) dan zoster (herpes zoster)000000000001001000112047034B01-B02Varisela (cacar air) dan zoster (herpes zoster)000000000000000000000047034B01-B02Varisela (cacar air) dan zoster (herpes zoster)000000000000000000000047034B01-B02Varisela (cacar air) dan zoster (herpes zoster)000000000000000
66
48035B05Campak000000000000000000000048035B05Campak000000000000000000000048035B05Campak000000000000000000000048035B05Campak000000000000000
67
49036B06Rubela000000000000000000000049036B06Rubela000000000000000000000049036B06Rubela000000000000000000000049036B06Rubela000000000000000
68
50037B16Hepatitis B akut000000000000000000000050037B16Hepatitis B akut000000000000000000000050037B16Hepatitis B akut000000000000000000000050037B16Hepatitis B akut000000000000000
69
51038.0B15Hepatitis A akut000000000000000000000051038.0B15Hepatitis A akut000000000000000000000051038.0B15Hepatitis A akut000000000000000000000051038.0B15Hepatitis A akut000000000000000
70
52038.1B17.1Hepatitis C akut000000000000000000000052038.1B17.1Hepatitis C akut000000000000000000000052038.1B17.1Hepatitis C akut000000000000000000000052038.1B17.1Hepatitis C akut000000000000000
71
53038.2B17.2Hepatitis E akut000000000000000000000053038.2B17.2Hepatitis E akut000000000000000000000053038.2B17.2Hepatitis E akut000000000000000000000053038.2B17.2Hepatitis E akut000000000000000
72
54038.9B17.0.8 B18-B19Hetitis virus lainnya000000000000000000000054038.9B17.0.8 B18-B19Hetitis virus lainnya000000000000000000000054038.9B17.0.8 B18-B19Hetitis virus lainnya000000000000000000000054038.9B17.0.8 B18-B19Hetitis virus lainnya000000000000000
73
55039B20-B24Penyakit virus gangguan defisiensi imun Pada manusia (HIV)000000000000000000000055039B20-B24Penyakit virus gangguan defisiensi imun Pada manusia (HIV)000000000000000000000055039B20-B24Penyakit virus gangguan defisiensi imun Pada manusia (HIV)000000000000000000000055039B20-B24Penyakit virus gangguan defisiensi imun Pada manusia (HIV)000000000000000
74
56040B26Gondong000000000000000000000056040B26Gondong000000000000000000000056040B26Gondong000000000000000000000056040B26Gondong000000000000000
75
57041A81. A87-A89. B03-B04. B07-B09. B25. B27-B34Penyakit virus lainnya000000000000000000000057041A81. A87-A89. B03-B04. B07-B09. B25. B27-B34Penyakit virus lainnya000000000000000000000057041A81. A87-A89. B03-B04. B07-B09. B25. B27-B34Penyakit virus lainnya000000000000000000000057041A81. A87-A89. B03-B04. B07-B09. B25. B27-B34Penyakit virus lainnya000000000000000
76
58042B35-B49Mikosis000000000000000000000058042B35-B49Mikosis000000000000000000000058042B35-B49Mikosis000000000000000000000058042B35-B49Mikosis000000000000000
77
59043B50.0Malaria cerebral NOS000000000000000000000059043B50.0Malaria cerebral NOS000000000000000000000059043B50.0Malaria cerebral NOS000000000000000000000059043B50.0Malaria cerebral NOS000000000000000
78
60043.0B50.8-9Malaria falciparum000000000000000000000060043.0B50.8-9Malaria falciparum000000000000000000000060043.0B50.8-9Malaria falciparum000000000000000000000060043.0B50.8-9Malaria falciparum000000000000000
79
61043.1B51.0Malaria vivax000000000000000000000061043.1B51.0Malaria vivax000000000000000000000061043.1B51.0Malaria vivax000000000000000000000061043.1B51.0Malaria vivax000000000000000
80
62043.2B51.8-9Malaria vivax lainnya000000000000000000000062043.2B51.8-9Malaria vivax lainnya000000000000000000000062043.2B51.8-9Malaria vivax lainnya000000000000000000000062043.2B51.8-9Malaria vivax lainnya000000000000000
81
63043.3B52.0Malaria malariae000000000000000000000063043.3B52.0Malaria malariae000000000000000000000063043.3B52.0Malaria malariae000000000000000000000063043.3B52.0Malaria malariae000000000000000
82
64043.4B52.8-9Malaria malariae lainnya000000000000000000000064043.4B52.8-9Malaria malariae lainnya000000000000000000000064043.4B52.8-9Malaria malariae lainnya000000000000000000000064043.4B52.8-9Malaria malariae lainnya000000000000000
83
65043.5B53Malaria ovale000000000000000000000065043.5B53Malaria ovale000000000000000000000065043.5B53Malaria ovale000000000000000000000065043.5B53Malaria ovale000000000000000
84
66043.9B54Malaria YTT000000000000000000000066043.9B54Malaria YTT000000000000000000000066043.9B54Malaria YTT000000000000000000000066043.9B54Malaria YTT000000000000000
85
67044B55Lesmaniasis000000000000000000000067044B55Lesmaniasis000000000000000000000067044B55Lesmaniasis000000000000000000000067044B55Lesmaniasis000000000000000
86
68045B56-B57Tripanosomiasis000000000000000000000068045B56-B57Tripanosomiasis000000000000000000000068045B56-B57Tripanosomiasis000000000000000000000068045B56-B57Tripanosomiasis000000000000000
87
69046B65Skistosomiasis (Bilharziasis)000000000000000000000069046B65Skistosomiasis (Bilharziasis)000000000000000000000069046B65Skistosomiasis (Bilharziasis)000000000000000000000069046B65Skistosomiasis (Bilharziasis)000000000000000
88
70047B66Infeksi trematoda lainnya000000000000000000000070047B66Infeksi trematoda lainnya000000000000000000000070047B66Infeksi trematoda lainnya000000000000000000000070047B66Infeksi trematoda lainnya000000000000000
89
71048B67Ekinokokosis000000000000000000000071048B67Ekinokokosis000000000000000000000071048B67Ekinokokosis000000000000000000000071048B67Ekinokokosis000000000000000
90
72049B72Drakunkuliasis000000000000000000000072049B72Drakunkuliasis000000000000000000000072049B72Drakunkuliasis000000000000000000000072049B72Drakunkuliasis000000000000000
91
73050B73Onkosersiasis000000000000000000000073050B73Onkosersiasis000000000000000000000073050B73Onkosersiasis000000000000000000000073050B73Onkosersiasis000000000000000
92
74051B74Filariasis000000000000000000000074051B74Filariasis000000000000000000000074051B74Filariasis000000000000000000000074051B74Filariasis000000000000000
93
75052B76Penyakit cacing tambang000000000000000000000075052B76Penyakit cacing tambang000000000000000000000075052B76Penyakit cacing tambang000000000000000000000075052B76Penyakit cacing tambang000000000000000
94
76053B68-B71, B75, B77-B83Helmitiansis lain000000000000000000000076053B68-B71, B75, B77-B83Helmitiansis lain000000000000000000000076053B68-B71, B75, B77-B83Helmitiansis lain000000000000000000000076053B68-B71, B75, B77-B83Helmitiansis lain000000000000000
95
77054.0B90.9.1Patu/lobus luluh akibat TB000000000000000000000077054.0B90.9.1Patu/lobus luluh akibat TB000000000000000000000077054.0B90.9.1Patu/lobus luluh akibat TB000000000000000000000077054.0B90.9.1Patu/lobus luluh akibat TB000000000000000
96
78054.1B90.9.2Sindrom obstruksi pasca TB000000000000000000000078054.1B90.9.2Sindrom obstruksi pasca TB000000000000000000000078054.1B90.9.2Sindrom obstruksi pasca TB000000000000000000000078054.1B90.9.2Sindrom obstruksi pasca TB000000000000000
97
79054.9B90.0-8Sekuele (gejala sisa) TB lainnya0000000000103122117410179054.9B90.0-8Sekuele (gejala sisa) TB lainnya000000000000000000000079054.9B90.0-8Sekuele (gejala sisa) TB lainnya000000000000000000000079054.9B90.0-8Sekuele (gejala sisa) TB lainnya000000000000000
98
80055B91Sekuele (gejala sisa) poliomielitis000000000000000000000080055B91Sekuele (gejala sisa) poliomielitis000000000000000000000080055B91Sekuele (gejala sisa) poliomielitis000000000000000000000080055B91Sekuele (gejala sisa) poliomielitis000000000000000
99
81056B92Sekuele (gejala sisa) lepra000000000000000000000081056B92Sekuele (gejala sisa) lepra000000000000000000000081056B92Sekuele (gejala sisa) lepra000000000000000000000081056B92Sekuele (gejala sisa) lepra000000000000000
100
82057.0A66Patek (Frambusia)000000000000000000000082057.0A66Patek (Frambusia)000000000000000000000082057.0A66Patek (Frambusia)000000000000000000000082057.0A66Patek (Frambusia)000000000000000