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MOH/S/RAN/68.13(HB)
MANUAL FOR DOCUMENTINGDIAGNOSIS IN PER-PD 301
Health Informatics CentrePlanning DivisionMinistry of Health Malaysia
MANUAL FOR DOCUMENTINGDIAGNOSIS IN PER-PD 301
Health Informatics CentrePlanning DivisionMinistry of Health Malaysia
Health Informatics CentrePlanning Division
Ministry of Health Malaysia
MANUAL FOR DOCUMENTING DIAGNOSIS IN PER-PD 301
All rights reserved. No part of this document may be reproduced or trasmitted, in any form or by any means,electronic, photocopying or otherwise without prior written permission from the Ministry of Health, Malaysia
Printed by:D’FA PRINT SDN BERHADNo16, Jalan P10/21, Selaman Light Industrial Park,43650, Bandar Baru Bangi, SelangorT : 03-8926 3808 F : 03-8926 3830www.dfaprint.com
Health Informatics CentrePlanning DivisionMinistry of Health Malaysia
ISBN : 978 - 967 - 0399 - 70 - 6
Date created: October 2012First Edition: January 2013Second Edition: November 2013
Copyright @ Ministry of Health Malaysia 2013
CONTENT
1. INTRODUCTION 5
2. OBJECTIVES 5
3. AREAS TO BE FILLED IN PER-PD 301 (WITH DEFINITION) 5
4. GENERAL INFORMATIONS TO CONSIDER IN DOCUMENTING DIAGNOSIS 7
5. SPECIFIC INFORMATIONS TO CONSIDER IN DOCUMENTING DIAGNOSIS 8A. CERTAIN INFECTIOUS AND PARASITIC DISEASES 8
B. NEOPLASMS 11
C. ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES 13
D. MENTAL AND BEHAVIOURAL DISORDERS 17
E. PREGNANCY, CHILDBIRTH AND THE PUERPERIUM 19
F. CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD 23
G. SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS 25 NOT ELSEWHERE CLASSIFIED
H. INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES 26
I. FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES 31
6. WORKING COMMITTEE ON MANUAL FOR DOCUMENTING DIAGNOSIS IN PER-PD 301 33
5
INTRODUCTION
The aim of this manual is to guide housemen in documenting proper diagnosis. With the availability of this manual as a reference, it is hoped that the error in documenting diagnosis in PER-PD 301 form can be reduced.
OBJECTIVES
• Tointroduceadmission/dischargeform(PER-PD301)• Tofacilitatedoctorsonproperdocumentationofdiagnosis
AREAS TO BE FILLED IN PER-PD 301 (WITH DEFINITION)
MAIN DIAGNOSIS The condition, diagnosed at the end of the episode of health care, primarily responsible for the patient’s need for treatment or investigation
CAUSE OF DEATH All those diseases, morbid conditions or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced any such injuries
UNDERLYING CAUSE The disease or injury which initiated the train of morbid events leading directly to death
6
OTHER DIAGNOSIS A disease that accompanies the main diagnosis and (CO-MORBIDITY) requires treatment and additional care, in addition
to the treatment provided for the condition for which the patient was admitted
COMPLICATION DIAGNOSIS A disease that appears during the episode of care, due to a pre-existing condition or arising as a result of the care received by the patient
EXTERNAL CAUSES OF The circumstances of the accident or violence which INJURY AND POISONING produced the fatal injury
FACTORS INFLUENCING Episode of health care or contact with health HEALTH STATUS AND services are not restricted to the treatment or CONTACT WITH HEALTH investigation of current illness or injury. EpisodesSERVICES may also occur when someone who may not currently be sick requires or receives limited care of services.
7
THE DO’S AND DON’TS IN DOCUMENTING DIAGNOSIS
DO’s• ProperdocumentationofMainDiagnosis• Legiblehandwriting• TodocumentallotherconditionsunderrelevantheadingofOtherDiagnosis• DocumentproceduresintheProcedurecolumn
DONT’S • Donotuseabbreviations• DonotwriteproceduresasMainDiagnosis
GENERAL INFORMATIONS TO CONSIDER IN DOCUMENTING DIAGNOSIS
• Toidentifytheunderlyingcausativeagent(i.e:organism,drugs,chemical,allergens,idiopathic,autoimmune)
• Tospecifysite(anatomicallocalisation)ofinvolvementandside(i.e:Leftor/andright)•Toindicateiftheconditionisacute/sub-acute/chronic,recurrent/persistentormild/moderate/
severe• Tomentioniftheconditioniscongenital/acquired,primary/secondaryorinfantile/juvenile• Tomentionlaboratoryfindingsi.e:Haematological,biopsy,histological(i.e:Sputumpositive/
negative pulmonary tuberculosis)• Tospecifythediagnosisfailingwhichtospecifysymptomsandsignsorreasonforencounter/admission(i.e:AdmittedforbloodtransfusionduetoanaemiawithunderlyingThalassaemia,admittedforchemotherapywithunderlyingbreastcarcinoma,infantofdiabeticmotheradmittedfor observation, baby born before arrival for observation)
A
8
SPECIFIC INFORMATIONS TO CONSIDER IN DOCUMENTING DIAGNOSIS
A. CERTAIN INFECTIOUS AND PARASITIC DISEASES
Maindiagnosis/underlyingcauseshallinclude:
1) General infection • Tospecifythecausativeagent• Tomentioncondition(i.e:Meningitis,acutegastroenteritis)orsite(pulmonarytuberculosis)• Toincludecomplicationwherenecessary(i.e:Cerebralmalaria,rupturespleen,etc)
Other diagnosis• Tomentionantibioticresistanceifpresent(i.e:MRSA,vancomycinresistant,etc)
Example:
Morbidity caseMain diagnosis Example 1
Group A streptococcal (causative agent) septicaemia (condition)
Example 2HIV (causative agent) diseasewith Candidiasis (complication) and Karposi’s sarcoma (complication)
Underlying cause N/A
Other diagnosis(co-morbid)
Hypertension
Other diagnosis Penicillin resistant
Complication N/A
Mainprocedure/surgery Blood culture & sensitivity
A
9
2) Tuberculosis • Tospecifysiteinvolved(i.e:Lung,spine,intestine,etc)• Tomentionmethodofconfirmation(i.e:Smear,cultureorhistology)
Example:
Morbidity caseMain diagnosis Smear positive (method of confirmation) pulmonary (site) tuberculosis
Underlying cause N/A
Other diagnosis(co-morbid)
Non-insulindependentdiabetesmellituswithoutcomplication
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery Sputum for Acid Fast Bacilli (AFB)
Other procedure Chest X-ray
A
10
3) Viral hepatitis• Tospecifyacuteorchronic• Tospecifytypeofvirus(i.e:HepatitisAvirus,hepatitisBvirus,hepatitisCvirusorhepatitisE
virus)• Tomentioncomplicationwithorwithouthepaticcoma.• IfhepatitisBtomentionwithorwithoutdeltaagent(co-infection)
Example: Morbiditycase:Main diagnosis Acute hepatitis B (type of virus)withdeltaagent(co-infection)withhepaticcoma
(complication)
Underlying cause N/A
Other diagnosis(co-morbid)
Hypertension
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery Abdominal ultrasound
11
BB. NEOPLASMS
Maindiagnosis/underlyingcauseshall• Specifyprimaryorsecondarysite• Specifysiteoforganinvolved(i.e:Middlelobeoftherightlung,rightupperquadrantofright
breast)• Specifybehaviour(i.e:Malignantprimary,in-situ,benign,malignantsecondary)• Specifymorphology(i.e:Squamouscellcarcinoma)• Specifymetastasis
Example:
Morbidity caseMain diagnosis Adenocarcinoma (morphology/behaviour) of head of pancreas (site)
metastasis to the liver (metastasis)
Underlying cause Chronic pancreatitis
Other Diagnosis(co-morbid)
Type II diabetes mellitus
Other diagnosis N/A
Complication Cholecystitis
Main procedure/surgery
N/A
12
BMortality case
Cause of death Bronchopneumonia
Underlying cause Adenocarcinoma (morphology/behaviour)oflowerlobeofleftlung(site)withmetastasis to the para-aortic lymph nodes (metastasis)
Other Diagnosis(co-morbid)
Chronic obstructive pulmonary disease
Other diagnosis N/A
Complication Anaemia of chronic disease
Mainprocedure/surgery N/A
13
C
C. ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES
Maindiagnosis/underlyingcauseshallinclude:
1) Endocrine
Disorderofgland:• Tospecifycongenitaloracquired.• Tospecifycondition(i.e:Thyrotoxicosis,hypopituitarism)• Ifthyroidglandinvolved,tospecifywith(diffuse,multinodularorsinglenodular)orwithout
goiter.• Ifconditionisduetodrug-induced,tospecifythenameofdrug.
Ifdiabetesmellitus:• Tospecifythetypei.e:Insulindependant(TypeI,juvenile-onset,etc)ornon-insulindependant
(Type II, adult onset, etc)• Tospecifycomplication(i.e:HyperosmolarHyperglycaemicState(HHS)withcoma,diabetic
ketoacidosis, renal complication, etc)• *Uncontrolled/unstablediabetesmellitusisreferringtoTypeI
14
C
Example:
Morbiditycase:Main diagnosis Type II (type)diabetesmellituswithnephropathy(complication)
Underlying cause N/A
Other diagnosis(co-morbid)
Ischaemic heart disease
Other diagnosis Smear negative pulmonary tuberculosis
Complication N/A
Mainprocedure/surgery N/A
Mortality caseCause of death Streptococcus pneumoniae septicaemia
Underlying cause TypeIIdiabetesmellituswithnephropathy
Other diagnosis (co-morbid) N/A
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery Blood culture & sensitivity
15
C
2)Malnutritionandnutritionaldeficiency• Tospecifycondition(i.e:Kwashiorkor,nutritionalmarasmus,protein-energymalnutrition,etc)• Intheeventofmalnutritiontospecifyseverityofthecondition(i.e:Mild,moderateorsevere)• Tospecifytypeofvitaminormineraldeficiency• Tomentioncomplicationrelatedtonutritionaldeficiency
Example:
Morbidity caseMain diagnosis Example1:
Severe (severity)malnutritionwithmarasmus(condition)
Example2:Thiamine (type)deficiencywithWernicke’sencephalopathy(complication related to deficiency)
Underlying cause N/A
Other diagnosis(co-morbid)
N/A
Other diagnosis Severe dehydration
Complication N/A
16
C
Mortality
Cause of death Severe protein energy malnutritionUnderlying cause N/AOther diagnosis (co-morbid) N/AOther diagnosis N/AComplication N/AMainprocedure/surgery N/A
17
D
D. MENTAL AND BEHAVIOURAL DISORDERS
*There is no issue in documenting diagnosis related to mental and behavioural disorder other than psychoactive substance used/abused
Main diagnosis/underlying cause shall • Indicatethepsychoactivesubstancesused/abused(i.e:Alcohol,opioids,cannabinoids,sedative
or hypnotics, cocaine, tobacco, volatile solvents, hallucinogens, other stimulants)• Mentionthementalandbehaviouraldisordersduetothepsychoactivesubstanceused/abused(i.e:Acuteintoxication,harmfuluse,dependencesyndrome,withdrawalstate,withdrawalstatewithdelirium,psychoticdisorder,amnesicsyndrome,residualandlate-onsetpsychoticdisorder)
• Specifytheseverityofmentalretardation(i.e:Mild,moderate,severe,profound)• Indicatetheextentofbehaviouralimpairment(i.e:Noimpairment,minimalimpairment,significantimpairment)
18
D
Example:
Morbidity CaseMain diagnosis Alcoholic (psychoactive substances used)withdrawalwithdelirium(mental and
behavioural disorder due to the psychoactive substance used/abused)
Underlying cause Alcohol abuse
Other Diagnosis(co-morbid)
N/A
Other diagnosis N/A
Complication Delirium tremens
Mainprocedure/surgery N/A
Main diagnosis Profound (severity)mentalretardationwithsignificantimpairmentofbehaviourrequiringattention(extent of behavioural impairment)
Underlying cause Down’ssyndrome
Other Diagnosis(co-morbid)
N/A
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery N/A
19
E
E. PREGNANCY, CHILDBIRTH AND THE PUERPERIUM
Maindiagnosis/underlyingcauseshallinclude:
1) Pregnancy
• Specifytypesofabortion/miscarriage(i.e:incomplete,complete,inevitable,etc)• Specifythesiteofectopicpregnancy(i.e:Tubal,ovarian,abdominal,etc)• Specifysiteofinfection(i.e:Vaginalcandidiasisinpregnancy,etc)• Specifypregnancy-relatedconditionsandcomplications(i.e:Pregnancy-inducedhypertension,
gestational diabetes mellitus, deep vein thrombosis complicating pregnancy, etc)Example
Morbidity caseMain diagnosis Vaginal candidiasis (site of infection specified) in pregnancy
Underlying cause Insulin dependent gestational diabetes mellitus (pregnancy related condition)
Other Diagnosis(co-morbid)
N/A
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery N/A
20
E
Main diagnosis Ruptured cornual ectopic pregnancy (site of ectopic pregnancy)
Underlying cause N/A
Other Diagnosis (co-morbid)
N/A
Complication Hypovolaemic shock
Mainprocedure/surgery N/A
Mortality case
Cause of death Hypovolaemic shock
Underlying cause Ruptured uterus due to criminal abortion (types of abortion)
Other Diagnosis(co-morbid)
N/A
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery N/A
21
E
2) Delivery and Childbirth
• Specifymethodofdelivery(i.e:Spontaneousvertexdelivery,assistedvacuumdelivery,electivelowersegmentcaesareansection)
• Specifynumberoffetus(i.e:Single,twin,etc)• Relevantcomplicationsduringdelivery
Example:
Morbidity caseMain diagnosis Spontaneous vertex delivery (method of delivery and number of fetus) with3rddegree
perineal laceration (complication during delivery)
Underlying cause N/A
Other Diagnosis(co-morbid)
N/A
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery Examination under anaesthesia and repair
22
E
3) Puerperium
• Specifycomplicationsrelatedtopostpartumperiod(i.e:Postpartumhaemorrhageduetopuerperal sepsis)
Example:
Morbidity caseMain diagnosis Puerperal sepsis (complications related to post partum period)
Underlying cause Retained products of conception
Other Diagnosis(co-morbid)
N/A
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery Evacuation and removal of products of conception
23
F
F. CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD
Maindiagnosis/underlyingcauseshallinclude:• Ifneonataljaundice,mustspecifythecauseofjaundice(i.e:NeonataljaundiceduetoABO
incompatibility)• Ifbabyispremature,tomentionthegestationalageandweight• Ifinjury,toindicatethesiteandeitherduetobirthtraumaorothercauses(pleasespecify)(i.e:Subarachnoidhemorrhageduetobirthinjuryorsubarachnoidhemorrhageduetofallfrom
bed)• Ifbirthasphyxia,tomentiontheAPGARscoreat1minuteand5minute• Ifbabyadmittedforobservationindicatethecondition/suspectedcondition• Toassociatemother’sconditionduringpregnancythataffectthebabywiththereasonfor
admission, treatment or observationExample:
Morbidity caseMain diagnosis Transitory hypoglycemia (baby’s condition)
Underlying cause Infant of diabetic mother (Diabetic mother - mother’s condition)
Other diagnosis (co-morbid) N/A
Other diagnosis N/A
Complication N/A
Mainprocedure/surgery N/A
Otherprocedure/surgery N/A
24
F
Mortality caseCause of death Sepsis due to Staphylococcus aureus infection
Underlying cause Prematureat30weeks,1800grams(baby’s gestational age and weight)
Other diagnosis (co-morbid) N/A
Other diagnosis Neonataljaundiceduetopretermdelivery(cause of jaundice)
Other diagnosis Respiratory distress syndrome
Complication diagnosis N/A
Mainprocedure/surgery N/A
Otherprocedure/surgery N/A
25
G
G. SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS NOT ELSEWHERE CLASSIFIED
ShouldONLYbeusedasmaindiagnosisif:• Casesforwhichnospecificdiagnosiscanbemadeevenafterallthefactsbearingonthecasehavebeeninvestigatedorforanyotherreason(i.e:Facilitynotavailable,patientrefuseforinvestigation, etc)
• Signsorsymptomsexistingatthetimeofinitialencounterthatprovedtobetransientandwhichcausescouldnotbedetermined
• Casesreferredelsewhereforinvestigationortreatmentbeforethediagnosiswasmade.
Example:
Morbidity caseMain diagnosis Pyrexiaofunknownorigin
Underlying cause N/A
Other diagnosis (co-morbid) N/A
Other diagnosis N/A
Complication N/A
External cause N/A
Mainprocedure/surgery N/A
26
H
H. INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES
• The diagnosis pertaining to this topic must specify the external cause1) Injury:
MainDiagnosis/underlyingcauseshallinclude:• Specifytypeofinjury(i.e:Fracture,dislocation,wound,internalorganinjury)• Specifysiteofinjury• If fracture, to mention if open or close• Ifinternalinjuryoccurs,tospecifybluntorpenetratinginjury
Externalcauseofinjuryshallinclude:• Patient’smodeoftransport(i.e:Pedestrian,motorcycle,car,etc)• Patient’srole(i.e:Rider/driverorpassenger)• Mechanismofinjury(i.e:Collisionwithcar,non-collision(skidded,roll-over,etc.),fall,assault,
etc)• Placeofoccurrence(i.e:School,home,road,highway,field,etc)• Activity(i.e:Sports,work,etc)• Intentionoftheevent(i.e:Accidental,self-harm,assault)
27
H
Example:
Morbidity caseMain diagnosis Open fracture (type of injury) mid shaft of right humerus (site of injury)
Other diagnosis Right ulna nerve cut
Other diagnosis Lacerationwoundatscalp
Other diagnosis (co-morbid) Hypertension
Complication diagnosis N/A
External cause Motorcycle rider (patient’s role and mode of transport)incollisionwithcar(mechanism of injury)onhighway(place of occurrence)onthewaytowork(activity)
Mainprocedure/surgery Openreductionandinternalfixationofrighthumerus
Otherprocedure/surgery X-ray of right upper limb
28
H
Mortalitycase:Cause of death Hypovolemic shock due to uncontrolled bleeding
Underlying cause Blunt spleenic rupture (type and site of injury)
Other diagnosis Lacerationwoundatscalp
Other diagnosis Hypertension
Other diagnosis (co-morbid) DiabetesmellitustypeIIwithcataract
External cause Pedestrian (patient’s role and mode of transport) hit by car (mechanism of injury)whilecrossingroad(activity)infrontoftrafficlight(place of occurence)
Mainprocedure/surgery Emergency laparatomy
2)Burn/corrosion:
Main diagnosis shall include- The degree of burn - Specificsiteofburn- Percentage of body surface area
Externalcauseofinjuryshallinclude:- Mechanismofburn(i.e:Thermalorchemical)- Placeofoccurence(i.e:Home,workplace,etc)- Activity(i.e:Cooking,working,etc)- Intentionoftheevent(i.e:Accidental,self-harm,assault,etc)
29
H
Example:
Morbidity caseMain diagnosis 20% (% body surface area) second degree burn (degree of burn)ofchestwall
and bilateral upper limb (specific site of burn)
Other diagnosis(co-morbid) Hypertension
Other diagnosis(co-morbid)
TypeIIdiabetesmellituswithoutcomplication
Complication diagnosis Pseudomonas aeruginosa burnwoundinfection
External cause Accidental (intention of the event) gas tank explosion (mechanism of burn) at home (place of occurence) during cooking (activity)
Mainprocedure/surgery Wound debridement under general anaesthesia
30
H
3) Poisoning
Main diagnosis shall - Specifytypeofpoison(i.e:Drug,chemical,medicament)
Externalcauseofpoisoningshallinclude:- Theintentionofevent(i.e:Accidental,suicide,homicide,adverseeffectintherapeuticuse)- Placeofoccurrence(i.e:Home,workplace,etc)
Example: Morbidity cases
Main diagnosis Pesticide (type of poison) poisoning
Other diagnosis (co-morbid) Acute exacerbation of asthma
Other diagnosis N/A
Complication N/A
External cause Accidental (intention of event) ingestion of pesticide at home (place of occurrence)
Mainprocedure/surgery Gastric lavage
31
I
I. FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES
Maindiagnosis:• Categoriesinthischaptershouldnotbetheprimarymorbidityormortalitydiagnosis• Mentionthereasonforencounterwithhealthcare(i.e:Generalmedicalcheck-up,routineexamination/investigationforspecificcondition,etc)
Episodesofhealthcareorcontactwithhealthservicesarenotrestrictedtotreatmentorinvestigationofcurrentillnessorinjury.Episodesmayalsooccurwhensomeonewhomaynotcurrentlybesickrequiresor receives limited care or services; the details of relevant circumstances should be recorded as the “main condition”.Examplesinclude:
a) Monitoring of previously treated conditionsb) Immunisation c) Contraceptive management, antenatal and postpartum cared) Surveillance of persons at risk because of personal or family historye)Examinationsofhealthypersonseg:forinsuranceoroccupationalreasonsf) Seeking of health-related adviceg)Requestforadvicebypersonswithsocialproblemsh) Consultation on behalf of a third party
32
I
Example:
Morbidity CaseMain diagnosis Adjustmentandmanagementofcardiacpacemaker
(reason for encounter with healthcare)
Underlying cause N/A
Other Diagnosis(co-morbid)
Sick sinus syndrome
Other diagnosis N/A
Complication N/A
FactorsInfluencingHealthStatusandContactwithHealth Services
N/A
MainProcedure/surgery Replacement of pacemaker battery
Main diagnosis Born before arrival for observation (reason for encounter with healthcare)
Underlying cause N/A
Other Diagnosis(co-morbid)
N/A
Other diagnosis N/A
Complication N/A
MainProcedure/surgery N/A
33
6. WORKING COMMITTEE ON MANUAL FOR DOCUMENTING DIAGNOSIS IN PER-PD 301
Dr.RahimahbtMohdAriffinSenior Deputy Director Planning Division
Dr. Md. Khadzir bin Sheikh AhmadDeputy DirectorHealth Informatics Centre (HIC)Planning Division
Dr.MawarbinAyubEmergency and Trauma PhysicianHospital Kuala Lumpur
Dr. Ruhayah bt OmarSenior Principal Assistant DirectorState Health Department, Kelantan
Dr. Mohamad Yurzi bin GhaniDeputy Director (Clinical III)Hospital Sultanah Nur Zahirah, Terengganu
Dr. Nur Shaema DarusAssistant DirectorHealth Informatics Centre (HIC)Planning Division
Dr. Azrulreezal Azannee bin Abdul WahabAssistant DirectorHealth Informatics Centre (HIC)Planning Division
Dr. Charlene Patricia MalukunMedicalOfficerHospital Queen Elizabeth I, Sabah
Mr. Anuar ZainalMedicalRecordOfficerMedical Development Division
Madam Nurul Huda bt RamlanMedicalRecordOfficerHealth Informatics Centre (HIC)Planning Division
34
Madam Fazlina Suriayanti bt FazilMedicalRecordOfficerHealth Informatics Centre (HIC)Planning Division
Mr. Mohamad Uzuman bin Nordin AliMedicalRecordOfficerHospital Sultanah Nur Zahirah, Terengganu
Mr. Azmi bin IbrahimAssistantMedicalRecordOfficerHospital Kuala Lumpur
Madam Normah bt Mohd ShariffAssistantMedicalRecordOfficerHospital Taiping, Perak
Mr. Rosdi bin IbrahimAssistantMedicalRecordOfficerHospitalRajaPerempuanZainabII,Kelantan
Madam Denisa JoilinAssistantMedicalRecordOfficerHospital Wanita dan Kanak-kanak Likas, Sabah
Miss Norlida bt OsmanAssistantMedicalRecordOfficerHospitalTanjungKarang,Selangor
Madam Nurul Adilla bt Mohamed TaibSemantic EngineerMIMOS BHD
Madam Saniah bt MohamedSemantic EngineerMIMOS BHD