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Dokumen ini memberikan informasi tentang persyaratan pendaftaran di loket puskesmas, daftar rumah sakit rujukan yang bekerja sama dengan puskesmas, hak dan kewajiban pasien. Persyaratan pendaftaran meliputi KK/KTP dan kartu BPJS untuk peserta. Daftar rumah sakit rujukan berisi 9 rumah sakit beserta alamatnya. Hak pasien mencakup mendapat penjelasan medis dan menolak tindakan, se

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LOKET PENDAFTARAN
PERSYARATAN
LAMA BARU
1. KK ATAU KTP 1. KK ATAU KTP
2. KARTU BPJS/KIS 2. KARTU BPJS/KIS
(BAGI PESERTA) (BAGI PESERTA)
3. KARTU KUNJUNGAN

DAFTAR RUMAH SAKIT RUJUKAN YANG
TELAH MELAKUKAN PERJANJIAN
KERJASAMA DENGAN UPTD PUSKESMAS
TAROKAN KABUPATEN KEDIRI
NO RUMAH SAKIT ALAMAT
1 RSKK PARE KAB
KEDIRI
JL. PAHLAWAN
KUSUMA BANGSA
NO 1 CANGKRING
PELEM PARE KEDIRI
64123
2 RSUD
GAMBIRAN
JL. KAPTEN
TENDEAN NO 116
PAKUNDEN
PESANTREN KOTA
KEDIRI 64133
3 RS DARMA
HUSADA
JL. VETERAN N0 48
MOJOROTO KOTA
KEDIRI 64114
4 RS AHMAD
DAHLAN
JL GATOT SUBROTO
N0 84 MRICAN,
MOJOROTO KOTA
KEDIRI 64112

5 RSU AURA
SYIFA
JL. JOYOBOYONO
42 DLOPO NGASEM
KAB. KEDIRI 64183
6 RS BAPTIS JL. BRIGJEND POL.
IBH PRANOTO NO 17
BANGSAL
PESANTREN KOTA
KEDIRI 64131
7 RSUD SIMPANG
LIMA GUMUL
JL. GALUH
CANDRAKIRANA
TUGUREJO KEC.
NGASEM KAB
KEDIRI 64182
8 RS DKT KEDIRI JL. MAYJEND
SUNGKONO NO 44
SEMAMPIR KOTA
KEDIRI 64129
9 RS
BHAYANGKARA
JL. KOMBES POLISI
HIDAYAT NO 17
KOTA KEDIRI

HAK DAN KEWAJIBAN PASIEN
KEWAJIBAN PASIEN :
1. MENDAPATKAN PENJELASAN
SECARA LENGKAP TENTANG
TINDAKAN MEDIS
2. MEMINTA PENDAPAT DOKTER
ATAU DOKTER GIGI LAIN
3. MENDAPATKAN PELAYANAN
SESUAI DENGAN KEBUTUHAN
MEDIS
4. MENOLAK TINDAKAN MEDIS
5. MENDAPATKAN ISI REKAM MEDIS

HAK PASIEN :
1. MEMBERIKAN INFORMASI YANG
LENGKAP DAN JUJUR TENTANG
MASALAH KESEHATNNYA
2. MEMATUHI NASEHAT DARI
DOKTER ATAU DOKTER GIGI
3. MEMATUHI KETENTUAN YANG
BERLAKU DI SARANA PELAYAN
KESEHATAN
4. MEMBERIKAN IMBALAN JASA
ATAS PELAYANAN YANG
DITERIMA
(UU no 29 tahun 2004 tentang praktek kedokteran)

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BANNER OMBUDSMAN.docx

1. LOKET PENDAFTARAN PERSYARATAN LAMA BARU 1. KK ATAU KTP 1. KK ATAU KTP 2. KARTU BPJS/KIS 2. KARTU BPJS/KIS (BAGI PESERTA) (BAGI PESERTA) 3. KARTU KUNJUNGAN

2. DAFTAR RUMAH SAKIT RUJUKAN YANG TELAH MELAKUKAN PERJANJIAN KERJASAMA DENGAN UPTD PUSKESMAS TAROKAN KABUPATEN KEDIRI NO RUMAH SAKIT ALAMAT 1 RSKK PARE KAB KEDIRI JL. PAHLAWAN KUSUMA BANGSA NO 1 CANGKRING PELEM PARE KEDIRI 64123 2 RSUD GAMBIRAN JL. KAPTEN TENDEAN NO 116 PAKUNDEN PESANTREN KOTA KEDIRI 64133 3 RS DARMA HUSADA JL. VETERAN N0 48 MOJOROTO KOTA KEDIRI 64114 4 RS AHMAD DAHLAN JL GATOT SUBROTO N0 84 MRICAN, MOJOROTO KOTA KEDIRI 64112

3. 5 RSU AURA SYIFA JL. JOYOBOYONO 42 DLOPO NGASEM KAB. KEDIRI 64183 6 RS BAPTIS JL. BRIGJEND POL. IBH PRANOTO NO 17 BANGSAL PESANTREN KOTA KEDIRI 64131 7 RSUD SIMPANG LIMA GUMUL JL. GALUH CANDRAKIRANA TUGUREJO KEC. NGASEM KAB KEDIRI 64182 8 RS DKT KEDIRI JL. MAYJEND SUNGKONO NO 44 SEMAMPIR KOTA KEDIRI 64129 9 RS BHAYANGKARA JL. KOMBES POLISI HIDAYAT NO 17 KOTA KEDIRI

4. HAK DAN KEWAJIBAN PASIEN KEWAJIBAN PASIEN : 1. MENDAPATKAN PENJELASAN SECARA LENGKAP TENTANG TINDAKAN MEDIS 2. MEMINTA PENDAPAT DOKTER ATAU DOKTER GIGI LAIN 3. MENDAPATKAN PELAYANAN SESUAI DENGAN KEBUTUHAN MEDIS 4. MENOLAK TINDAKAN MEDIS 5. MENDAPATKAN ISI REKAM MEDIS

5. HAK PASIEN : 1. MEMBERIKAN INFORMASI YANG LENGKAP DAN JUJUR TENTANG MASALAH KESEHATNNYA 2. MEMATUHI NASEHAT DARI DOKTER ATAU DOKTER GIGI 3. MEMATUHI KETENTUAN YANG BERLAKU DI SARANA PELAYAN KESEHATAN 4. MEMBERIKAN IMBALAN JASA ATAS PELAYANAN YANG DITERIMA (UU no 29 tahun 2004 tentang praktek kedokteran)

BANNER OMBUDSMAN.docx

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BANNER OMBUDSMAN.docx