KERANGKA ACUAN KERJA

( KAK )

PENGADAAN ALAT KESEHATAN UMUM

DINAS KESEHATAN KABUPATEN KEDIRI

BERSUMBER DANA KAPITASI JKN
TAHUN ANGGARAN 2016

KERANGKA ACUAN KERJA

PENGADAAN ALAT KESEHATAN UMUM DALAM RANGKA PEMENUHAN
KEBUTUHAN PELAYANAN PUSKESMAS TAHUN ANGGARAN 2016
BLUD-UPTD PUSKESMAS

I.

LATAR BELAKANG
Berdasarkan Keputusan Bupati No. 188.45/298/418.32/2015 tanggal 16 Juni 2015
tentang 37 UPTD Puskesmas di Kabupaten Kediri telah ditetapkan sebagai UPTD
Puskesmas yang menerapkan PPK-BLUD dengan status penuh, oleh karena itu demi
kelancaran

pelaksanaan

penerapan

PPK-BLUD

UPTD

Puskesmas

Semen

perlu

menyediakan barang alat kesehatan umum. Selain pelaksanaan UPTD Puskesmas Semen
telah ditetapkan menjadi BLUD, dalam rangka meningkatkan pelayanan dan pendekatan
pelayanan kepada masyarakat serta didukung pelaksanaan program JKN Puskesmas
Semen selain memberikan layanan rawat jalan juga akan memberikan layanan rawat inap.
Harapan UPTD Puskesmas Semen dengan pemenuhan alat kesehatan umum dapat
memberikan pelayanan sesuai standart. Sehubungan dengan hal tersebut diatas, untuk
menunjang kelancaran pelaksanaan pelayanan diperlukan penyediaan barang modal alat
kesehatan umum dengan rincian sebagaimana terlampir.
II.

MAKSUD DAN TUJUAN

1. Maksud kegiatan adalah salah satu penunjang pelaksanaan pelayanan rawat jalan dan
rawat inap di BLUD-UPTD Puskesmas Semen.
2. Tujuan kegiatan adalah tersedianya barang modal alat kesehatan umum.

III.

REFERENSI HUKUM
1. Peraturan Menteri Kesehatan Republik Indonesia Nomor 75 Tahun 2014 tentang
Puskesmas
2. Keputusan Bupati No. 188.45/298/418.32/2015 tanggal 16 Juni 2015 tentang 37 UPTD
Puskesmas di Kabupaten Kediri telah ditetapkan sebagai UPTD Puskesmas yang
menerapkan PPK-BLUD dengan status penuh

IV.

LOKASI KEGIATAN
Lokasi kegiatan bertempat di UPTD Puskesmas Semen Jl. Argowilis 127 Semen Kabupaten
Kediri

V.

SUMBER DANA
Sumber dana berasal dari dana Kapitasi JKN UPTD Puskesmas Semen Kabupaten Kediri
tahun 2016 pada DPA JKN, sebagai berikut :
Program
: Peningkatan mutu pelayanan kesehatan pada BLUD (1.02.01.39)
Kegiatan
: Pelayanan dan Pendukung Pelayanan (1.02.01.39.01)
Belanja
: Barang modal alat kesehatan umum (39.01.5.2.2.34.01)
Nilai
: Rp. 388.552.973,- (tiga ratus delapan puluh delapan juta lima ratus
lima puluh dua ribu sembilan ratus tujuh puluh tiga rupiah)
Untuk tahap pertama Puskesmas belanja sejumlah Rp. 219.224.070,(dua ratus sembilan belas juta dua ratus dua puluh empat ribu tujuh
puluh rupiah) sesuai dengan kebutuhan UPTD Puskesmas Semen.

VI.

IDENTITAS PROYEK
Nama PPK
: AHSIN USMAN,S.Sos.,MM
NIP
: 19691012 198910 1 001
Pangkat / Golongan : Pembina/ IV A
Alamat
: Dinas Kesehatan Kabupaten Kediri, Jl. Pamenang No. 1 C Kediri
Nama Pengadaan
: Barang modal alat kesehatan umum
Nama SKPD
: UPTD Puskesmas Semen Dinas Kesehatan Kabupaten Kediri

VII. JANGKA WAKTU

Jangka waktu penyelesaian adalah 60 (enam puluh hari) hari kalender ; tanggal 25 Juli s/d
23 September 2016
VIII. HAL-HAL LAIN
a.

Produksi dalam Negeri :

Semua jenis pengadaan sarana dan prasarana berdasarkan KAK ini harus dilakukan di
dalam wilayah Negara Republik Indonesia kecuali ditetapkan lain dengan pertimbangan
keterbatasan kompetensi dalam negeri.

b. Untuk pengadaan barang modal alat kesehatan sebelum dilakukan penyerahan

terlebih dahulu dilakukan pengecekan dan uji fungsi untuk kebenaran dan
pengoperasian alat tersebut.
c. Harga sudah termasuk pajak-pajak.
d. Denda: Terhadap setiap hari keterlambatan penyelesaian pekerjaan Penyedia Jasa
akan dikenakan Denda Keterlambatan sebesar 1/1000 (satu per seribu) dari Nilai
Kontrak atau bagian tertentu dari Nilai Kontrak sebelum PPN sesuai dengan
persyaratan dan ketentuan Kontrak.

Kediri, 18 Juli 2016

Mengetahui
Kuasa Pengguna Anggaran

Pejabat Pelaksana Teknis

Kegiatan

UPTD Puskesmas Semen

dr. RINI HIDAYAT

dr. NIQKO BAYU PRAKARSA

NIP.19760628 20101 2 006

NIP.19871118 201502 1 002

SPESIFIKASI TEHNIS
PENGADAAN BARANG MODAL ALAT KESEHATAN UMUM
BERSUMBER DANA JKN
TAHUN 2016
No
1

JENIS BARANG

VOLU
ME

SATUA
N

KET

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MAK bedside cabinet 73032

Construction
Consist of
Table Top
Accessories
Castor
Coating

Made of steel sheet with phosphate coating,

assembled with MIG/MAG welding process.
One Drawer, dimension : (L)475x(W)375x(H)100 mm.
Cupboard, with one self and shoe compartment,
under cupboard with ventilation on the backside.
Made of ABS plastic with injection molding process.
Towel Hanger, made of stainless steel rod (6.3 mm).
Door & Drawer handle, made of ABS plastic with injection
molding process.
Four 2 swivel castors.
Epoxy powder coating finish

Max. Load
50 Kg.
Net Weight (approx.)
30.5 Kg.
Dimension(approx.)
(L)455 x (W)495 x (H)990mm
Warranty
3 year
Kode prod
73032
MAK Mattress adult type 31813
3

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Construction:

Made of Natural rubber has the advantage

for the patient
who lies on the bed for long time.
And this is cool natural
reaction for the skin of the patient.
Additional chemical reaction of the
mattress is called anti-bacteriostatic
that will kill the bacteria instantly.
Dimension(approx.)
(L)2000 x (W)900 x (H)100mm
Warranty
3 year
Kode prod
31813
MAK wheel chair ST. ST 31303
Construction

Made of stainless steel pipe (25.4mm),

assembled with TIG welding process.
Back Support & Seat
Made of foam and covered by imitation leather.
Armrest & footrest
Made of nylon plastic (injection molding process).
Wheel
The front wheel two 8" castors, and the main
wheel two 24" rubber wheel with non air tube
tire and plastic rim.
Equipped with
Lock position, and Wheel Chair can be folded easily
to reduce the storing place.
Max. Load
120kg.
Net Weight (approx.)
17 Kg.
Dimension (approx.)
(L)950 x (W)625 x (H)890 mm.
Warranty
3 year
Kode prod
31303
MAK examination table 34105
Construction
Mattress
Back Raise
Max. Load
Dimension(approx.)
Warranty
Kode prod

MAK instrument cabinet 32901

Construction
Section
Door
Coating
Max. Load
Net Weight (approx.)
Dimension (approx.)
Warranty
Kode prod

Made of stainless steel tube (square profile,

size 25x25mm; 25x50mm). Assembled with TIG
welding process.
Made of multiplex wood (thickness 12mm) and
covered with foam imitation leather upholstery
with 50 mm thick foam padding.
Adjustable by rack mechanism, with single
hand operated.
150 Kg.
(L)1865 x (W) 620 x (H) 755 mm (overall)
3 year
34105

Made of steel sheet with phosphate coating

(thickness 1 mm). Assembled with MIG
welding process.
Four adjustable shelves.
Two doors with full transparent glass 5 mm
equipped with lock and key.
Epoxy powder coating finish.
25 kg. (each shelf).
68 Kg.
(L)900 x (W)460 x (H)1750 mm
3 year
32901

MAK instrum trolley 35101

Construction
Upper shelf

Lower shelf
Handle
Castor
Max. Load

Made of stainless steel sheet (thickness 1mm)

and assembled with TIG welding process.
Made of stainless steel sheet (thickness 1mm)
with list on each side and equipped a drawer
(dimension : (L)375 x (W)290 x (H)65mm)
underneath the shelf.
Made of stainless steel sheet (thickness 1mm)
with list on each side.
Made of stainless steel pipe ( 16mm)
Four 2" castor with the bumper overhead each castor
(made of plastic by injection molding process).
25 Kg. (each shelf)

Net Weight (approx.)

Dimension (approx.)
Warranty
Kode prod

15 Kg.
(L)630 x (W)470 x (H)835 mm
3 year
35101

MAK foot step 34152

Construction:
Made of steel pipe (26 mm) assembled with MIG welding process.
Steps:
Two steps made of steel sheet (thickness 1 mm) with list on
each side which made of stainless steel sheet (8% Ni, thickness 0.8 mm) .
Painting : Epoxy powder coating finish.
Max. Load : 150 kg
Dimension (approx.) : (L)400 x (W)400 x (H)435mm
Warranty :3 year
Code prod :34152
MAK Waiting chair 31320
Construction : The frame is made of steel pipe (27mm). Assembled with
MIG welding process
Main Frame : Made of square mild steel pipe (40x60mm).
Backrest and Seat : Made of mild steel sheet (thickness 1.2mm), perforated.
Seat Mattress (Not Included) :
Made of soft foam : 10mm with durable convenient cover.
Painting : Epoxy powder coating finish
Detail : Consist of 4 seats
Max. Load : 400 Kg.
Dimension (approx.) : (L)2150 x (W)550 x (H)740mm
Warranty :3 year
Code prod :31320

MAK infus stand 36101

INFUSE STAND
MAK / PT. MEGA ANDALAN KALASAN
INFUSE STAND MOBILE / 36101
INDONESIA
INDONESIA
AKD 10903900512
300 888 1803
93 / 42 / EEC
IEC Compliance :
ISO 9001-2008 04.100.032054
ISO 13485-2012 44.221.06.341820-001
ISO 14001-2004 08.104.0021
OHSAS 18001-2007 05101.2008.0087.E5
INDONESIA, EURO, ASIA
Upper Stand Made of stainless steel pipe (16mm), two hooks made of
stainless steel rod (6.3mm), assembled with TIG welding
process. Adjustable height with locking screw.
Lower Stand Made of steel pipe (25.4mm) and the pedestal is made of
steel
sheet (thickness 2.8mm), assembled with MIG/MAG welding
process.
Coating Epoxy powder coating finish
Castor Three 2" swivel castors
Max. Load 3 Kg. (each hook).
Net Weight (approx.) 5 Kg.
Dimension (approx.) (L)400 x (W)320 x (H) 1300 - 2100 mm
3 Year
FUNCTION ROOM ACCESSORIES
CODE PROD. 36101

10

TESENA X- ray film viewer single films / tsn 014 s

Fluorescent Lam p (standard) :
Pow er : AC 220 V / 50 Hz / App. 20 W
Lamp : 1 x 20 W Fluorescent Lamp
Dimension : Appr. 40 W x 14 D x 55 H cm
Body : Steel sheet painted w ith epoxy pow der coating

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Weight : Appr. 7 Kg
Garansi : 1 (satu) tahun
Spare Part : 5 (lim a) tahun
11

12

TESENA halogen examination lamp / tsn 015 fhc

HALOGEN (standard)
Pow er Supply : AC 220 V , 50 Hz, 50 Watt
Light Intensity : Appr. 18.000 Lux
Adjustable stand : Appr. 120-170 cm ,w ith flexible arm
Bulb : Halogen bulb, 12 V, 50 Watt
Base : Plastic or Heavy alumunium casting alloy (by request)
Castors : 5 castors 2"
Dimension : Appr. 60 x 120 H cm
Weight : Appr. 12 Kg
Garansi : 1 (satu) tahun
Spare Part : 5 (lim a) tahun
GE Mac I
Instrument type
Microprocessor augmented automatic electrocardiograph; 10-leadwire, 12-lead
simultaneous acquisition with
programmable lead configuration.
Signal Processing
Acquisition 12-leads simultaneous ECG acquisition
Digital sampling rate 2,000 samples/second/channel
Acquisition mode 10 seconds of simultaneous and sequential ECG recording
ECG Measurements Supports measurement with Marquette* 12SL ECG
Analysis Program
(optional feature)
ECG Interpretation Supports adult interpretation with Marquette 12SL ECG
Analysis Program
(optional feature)
ECG analysis frequency 500 samples/second/channel
Dynamic range AC Differential 5 mV, DC offset 300 mV
Resolution 4.88 V/LSB @ 500 sps
Frequency response 3 dB @ 0.01 to 150 Hz
Low cut off frequency 0.01 Hz, 0.02 Hz, 0.16 Hz or 0.32 Hz
High cut off frequency 150 Hz, 40 Hz or 20 Hz if muscle filter is enabled
Operating modes Automatic ECG (12-lead data), rhythm/manual (real-time data)
Common mode rejection >100 dB (with AC filter enabled)
Input impedence >10 M @ 10 Hz, defibrillator protected
Patient leakage <10 A in normal condition and <50 A in single fault condition
Lead fail indication Disconnected lead detection. Each single electrode is
monitored except N/right leg
Heart rate meter 30 to 300 BPM 10% or 5 BPM, whichever is greater. Heart
rates outside
30 to 300 BPM will not be displayed.
Start up time 7 seconds
Software standard
Resting ECG mode Records and prints 12-lead resting ECGs with 10 second
duration as a standard feature
Language support English
Software option
Measurement Supports measurement with Marquette 12SL ECG Analysis
Program;
List of measurements printed.
a. Vent. Rate b. P duration c. PR interval d. RR Interval
e. QRS duration f. QT/QTc g. P-R-T axes
Interpretation Supports Interpretation with Marquette 12SL ECG Analysis
Program.
Display
Display type 2x16 alphanumeric display with adjustable contrast
Display data Operating mode, heart rate, print formats/lead display, speed, gain,
muscle filter,
AC filter and configuration menu
Keyboard
Type Membrane keyboard with tactile feedback
Accessories
ECG Electrodes Value reusable IEC/AHA limb clamps and bulb electrodes (user
selectable)
ECG Cable Fixed Value fixed 10-lead patient cable IEC/AHA (user selectable)
Power Supply External medical grade power supply
Paper 58 mm standard roll paper (with 1 ch); 80 mm standard roll paper, 80 mm
standard
Z-fold paper (with 3 ch)
Gel Electrode cream 250 ML/TUBE
Pediatric electrodes Pediatric electrodes and universal clip (optional)
Printer option
Thermal printer (58 mm) for 1 channel option

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Thermal printer (80 mm) for 3 channel option

Printer specification
Technology Thermal dot array print head
Speed 5, 25, & 50 mm/s
Number of traces 1 channel rhythm (for 1 channel option), 3 channel rhythm (for
3 channel option)
Sensitivity/gain 2.5, 5, 10, 20 mm/mV
Speed accuracy 5%
Amplitude 5%
Resolution Horizontal 40 dots/mm @ 25 mm/s, 8 dots/mm vertical
Paper type Thermal roll (for 1 channel and 3 channel options), Z fold (for 3
channel option)
Paper size - Z fold Sheet width 80 mm, length 90 mm, 280 sheets/pack roll
paper length 15.7 mm
(for 3 channel option)
Print format
Thermal printer (58 mm) (for 1 channel option) 1-lead simultaneous; 1-lead
sequential; 1-lead rhythm report format with selectable lead
Thermal printer (80 mm) (for 3 channel option)
3-lead simultaneous (short and long format), 3 lead Sequential (with and without
rhythm), 3-lead rhythm report format with selectable lead sequence, 1-lead
rhythm
report format with selectable lead (configurable)
Lead sequence Standard and Cabrera
Electrical
Power Supply External ACDC adaptor
External ACDC adaptor specifications
Input voltage 100 to 240 VAC 10 %
Input current Maximum 0.5A @ 90 VAC, 0.3A @ 240 VAC
Operating frequency 50 to 60Hz (3Hz)
Output voltage 12V 5%
Battery specifications
Battery Type Replaceable/rechargeable, lithium ion
Battery capacity 7.2V typical, 2.25 AH 10%
250 continuous ECGs in sequential 1-lead report format at 25 mm/s and 10
mm/mV;
Minimum 120 minutes of continuous rhythm print at 25 mm/S and 10 mm/mV
250 continuous ECGs in simultaneous 3-lead report format at 25 mm/s and 10
mm/
mV (if 3 channel option enabled); Minimum 120 minutes continuous rhythm print
at
25 mm/S and 10 mm/mV
Battery charge time Approximately 3 hours from total discharge
Standard Configuration
Basic unit for 1 channel Main unit 1 channel with standard accessories
Basic unit for 3 channel Main unit 3 channel with standard accessories
Option I Measurement
Option II Measurement and Interpretation
Physical specification
Height Approximately 85 mm
Width Approximately 275 mm
Depth Approximately 215 mm
Weight Approximately 1.2 Kg including battery and paper
Environmental specification
Temperature
Operating 5 to 40C
Transport/storage -15C to 50C
Humidity
Operating 25% to 95% RH non-condensing
Transport /storage 25% to 95% RH non-condensing
Pressure
Operating 710 to 1060 hPA
Transport /storage 500 to 1060 hPA
Safety & Regulatory
MDD Class II a
IEC 60601-1
IEC 60601-1-2
IEC 60601-1-4
IEC 60601-2-25
IEC 60601-2-51
IEC 60601-1-6
UL 60601-1
CAN/CSA C22.2 No.601.1-M90
ANSI/AAMI EC-11
ANSI/AAMI EC-13

13

ABN DM 500 Desk Model

Pressure Indication Range : 20-280 mmHg
Accuracy of Cuff Pressure Display : 3 mmHg
Operating Environtment C, 85% relative humidity or below
Storage Environment - C, 85% relative humidity or below
Electrical Savety : Internally powered instrument, type BF equipment
Power Source : 2 AA Batteries
Voltage : DC 3V
Power Consumption : 0.5 W (max)
Turn off device by pressing "on/off Button"
Size : 122.7 x 310.5 x 86.3 mm, closed
Weight : Approximately 780 g, not including batteries
Applicable arm circumference of the standard cuff : 25.4 to 40.6 cm
Optional small size cuff
(for arms 17 to 25 cm) and Large size cuff (for arms 32 to 42 cm) available
Include Instruction Manual Book

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Berat Satuan : 2 Kg
14

15

ABN Classic Stetoscope

ABN Classic Stethoscope Chestpiece :
Adult : SS-021-xx - Terbuat dari bahan Stainless Steel dengan Grafir
Child : SS-025-xx - ABN Print Logo Diaphragm
Infant : SS-023-xx - Soft PVC non chill ring dan non chill bell ring
- Diameter membrane : - Dewasa 48 mm, dengan bell ring : 36 mm
- Anak 36 mm, dengan bell ring : 28 mm
- Bayi 28 mm, dengan bell ring : 24 mm
Y-tubing :
- Terbuat dari campuran Soft PVC dan Polyurethane
- Panjang Y-tubing +/- 65 cm
- Panjang total stethoscope 78,5 cm
Binaural :
- Double inner spring binaural
- Terbuat dari Stainless Steel
Carton Box :
- Deluxe folding box uk. 16.5 x 33.0 x 5.5 cm
- UV finishing
Spare Part :
- 2 pasang soft eartips
- 1 buah membrane with ABN Print Logo
- Spare part Dikemas dalam hard case plastik berbentuk kotak deluxe.
Ukuran :
- Tersedia dalam pilihan ukuran Adult, Child dan Infant
Warna Pilihan :
Adult : Black, Grey, Burgundy, Light Blue, Pink, Hunter Green, Navy Blue,
Royal Blue
Child : Black, Grey, Light Blue, Pink
Infant : Black, Grey, Light Blue, Pink
ABN Tensimeter berdiri

1.Faceplate: 15.3 x 15.3 cm, tanpa PIN STOP.

2.Arah Faceplate : Dapat diputar secara horizontal sesuai arah user
3.Kelengkapan : Box tempat penyimpanan manset/ cuff with latex
bladder, selang
spiral yang bisa dipanjangkan hingga 2.5 m, metal connector, Latex Bulb
ABN
dengan valve Deluxe Assembly
5.Penempatan : Di trolley berroda (mobile type).

Berat Satuan : 7 Kg
16

Sterilisator elitec

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18

Timbangan badan berdiri

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Kode : ZT 120 Jenis : Timbangan dan alat ukur tinggi badan

Tipe : Standard
Kondisi : Baru
Max Berat : 120 kg
Rentang Pengukuran Tinggi: 70-190 cm
Berat Kotor : 16 kg
Berat Bersih : 14 kg
Dimensi : 91 cm x 34 cm x 29 cm
Berat Pengiriman : 15 kg (pembagi 6000) / 23 kg (pembagi 4000)

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echnical Specifications
Imaging technology
Custom digital high definition cameras for patented multi-spectral
imaging for all patients;
DeepVu ultrasound for imaging deeper veins, if needed.
Connectivity Bluetooth, Wifi, 3G wireless. USB 2/3 for virtually limitless
accessories: barcode
scanner, wireless keyboard/mouse, printer/scanner, bedside
telemedicine/telenursing
connectivity.
Audio
Dual speakers for 2-way communications.
Storage/Memory
1 GB storage, up to 32 GB memory to easily document procedures via
images or video.
Power
Battery unit worn on belt keeps Glasses lightweight.
Overall size
3 x 8 x 2
Weight (without battery pack)
11 oz.

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Mengetahui
Kuasa Pengguna Anggaran

Kediri, 18 Juli 2016

Pejabat Pelaksana Teknis Kegiatan

UPTD Puskesmas Semen

dr. RINI HIDAYAT

dr. NIQKO BAYU PRAKARSA

NIP.19760628 20101 2 006

NIP.19871118 201502 1 002

HARGA PERKIRAAN SENDIRI ( HPS )

PENGADAAN BARANG MODAL ALAT KESEHATAN UMUM
BERSUMBER DANA KAPITASI JKN
TAHUN 2016
No
1

JENIS BARANG

VOLU
ME

SATUA
N

HARGA

MAK bedside cabinet 73032

8.979.651

3
buah
Construction
Made of steel sheet with phosphate coating,
assembled with MIG/MAG welding process.
Consist of
One Drawer, dimension : (L)475x(W)375x(H)100 mm.
Cupboard, with one self and shoe compartment,
under cupboard with ventilation on the backside.
Table Top
Made of ABS plastic with injection molding process.
Accessories
Towel Hanger, made of stainless steel rod (6.3 mm).
Door & Drawer handle, made of ABS plastic with injection
molding process.
Castor
Four 2 swivel castors.
Coating
Epoxy powder coating finish
Max. Load
50 Kg.
Net Weight (approx.)
30.5 Kg.
Dimension(approx.)
(L)455 x (W)495 x (H)990mm
Warranty
3 year
Kode prod
73032
MAK Mattress adult type 31813
3
buah
Construction:
Made of Natural rubber has the advantage
for the patient
who lies on the bed for long time.
And this is cool natural
reaction for the skin of the patient.
Additional chemical reaction of the
mattress is called anti-bacteriostatic
that will kill the bacteria instantly.
Dimension(approx.)
(L)2000 x (W)900 x (H)100mm
Warranty
3 year
Kode prod
31813
MAK wheel chair ST. ST 31303
2
buah
Construction
Made of stainless steel pipe (25.4mm),
assembled with TIG welding process.
Back Support & Seat
Made of foam and covered by imitation leather.
Armrest & footrest
Made of nylon plastic (injection molding process).
Wheel
The front wheel two 8" castors, and the main
wheel two 24" rubber wheel with non air tube
tire and plastic rim.
Equipped with
Lock position, and Wheel Chair can be folded easily
to reduce the storing place.
Max. Load
120kg.
Net Weight (approx.)
17 Kg.
Dimension (approx.)
(L)950 x (W)625 x (H)890 mm.
Warranty
3 year
Kode prod
31303
MAK examination table 34105
2
buah
Construction
Made of stainless steel tube (square profile,
size 25x25mm; 25x50mm). Assembled with TIG
welding process.
Mattress
Made of multiplex wood (thickness 12mm) and
covered with foam imitation leather upholstery
with 50 mm thick foam padding.
Back Raise
Adjustable by rack mechanism, with single
hand operated.
Max. Load
150 Kg.
Dimension(approx.)
(L)1865 x (W) 620 x (H) 755 mm (overall)
Warranty
3 year
Kode prod
34105

2.993.217

9.636.699
3.212.233

5.256.200
2.628.100

11.096.800
5.548.400

MAK instrument cabinet 32901

Construction
Section

JUMLAH

5
Made of steel sheet with phosphate coating
(thickness 1 mm). Assembled with MIG
welding process.
Four adjustable shelves.

25.916.500
buah

5.183.300

Door
Coating
Max. Load
Net Weight (approx.)
Dimension (approx.)
Warranty
Kode prod
6

MAK instrum trolley 35101

Construction
Upper shelf

Lower shelf
Handle
Castor
Max. Load
Net Weight (approx.)
Dimension (approx.)
Warranty
Kode prod

Two doors with full transparent glass 5 mm

equipped with lock and key.
Epoxy powder coating finish.
25 kg. (each shelf).
68 Kg.
(L)900 x (W)460 x (H)1750 mm
3 year
32901
31.684.100
5
buah
Made of stainless steel sheet (thickness 1mm)
and assembled with TIG welding process.
Made of stainless steel sheet (thickness 1mm)
with list on each side and equipped a drawer
(dimension : (L)375 x (W)290 x (H)65mm)
underneath the shelf.
Made of stainless steel sheet (thickness 1mm)
with list on each side.
Made of stainless steel pipe ( 16mm)
Four 2" castor with the bumper overhead each castor
(made of plastic by injection molding process).
25 Kg. (each shelf)
15 Kg.
(L)630 x (W)470 x (H)835 mm
3 year
35101

MAK foot step 34152

Construction:
Made of steel pipe (26 mm) assembled with MIG
welding process.
Steps:
Two steps made of steel sheet (thickness 1 mm) with list on
each side which made of stainless steel sheet (8% Ni,
thickness 0.8 mm) . Painting : Epoxy powder coating finish.
Max. Load : 150 kg
Dimension (approx.) : (L)400 x (W)400 x (H)435mm
Warranty :3 year
Code prod :34152
MAK Waiting chair 31320
Construction : The frame is made of steel pipe (27mm).
Assembled with
MIG welding process
Main Frame : Made of square mild steel pipe (40x60mm).
Backrest and Seat : Made of mild steel sheet (thickness
1.2mm), perforated.
Seat Mattress (Not Included) :
Made of soft foam : 10mm with durable convenient
cover.
Painting : Epoxy powder coating finish
Detail : Consist of 4 seats
Max. Load : 400 Kg.
Dimension (approx.) : (L)2150 x (W)550 x (H)740mm
Warranty :3 year
Code prod :31320

MAK infus stand 36101

INFUSE STAND
MAK / PT. MEGA ANDALAN KALASAN
INFUSE STAND MOBILE / 36101
INDONESIA
INDONESIA
AKD 10903900512
300 888 1803
93 / 42 / EEC
IEC Compliance :
ISO 9001-2008 04.100.032054
ISO 13485-2012 44.221.06.341820-001
ISO 14001-2004 08.104.0021

4.526.300

5.621.000
7

buah

803.000

buah

4.818.000

38.544.000

1.168.000
buah

5.840.000

OHSAS 18001-2007 05101.2008.0087.E5

INDONESIA, EURO, ASIA
Upper Stand Made of stainless steel pipe (16mm), two
hooks made of
stainless steel rod (6.3mm), assembled with TIG
welding
process. Adjustable height with locking screw.
Lower Stand Made of steel pipe (25.4mm) and the
pedestal is made of steel
sheet (thickness 2.8mm), assembled with MIG/MAG
welding
process.
Coating Epoxy powder coating finish
Castor Three 2" swivel castors
Max. Load 3 Kg. (each hook).
Net Weight (approx.) 5 Kg.
Dimension (approx.) (L)400 x (W)320 x (H) 1300 - 2100
mm
3 Year
FUNCTION ROOM ACCESSORIES
CODE PROD. 36101
10

11

12

TESENA X- ray film viewer single films / tsn 014 s

Fluorescent Lam p (standard) :
Pow er : AC 220 V / 50 Hz / App. 20 W
Lamp : 1 x 20 W Fluorescent Lamp
Dimension : Appr. 40 W x 14 D x 55 H cm
Body : Steel sheet painted w ith epoxy pow der coating
Weight : Appr. 7 Kg
Garansi : 1 (satu) tahun
Spare Part : 5 (lim a) tahun
TESENA halogen examination lamp / tsn 015 fhc
HALOGEN (standard)
Pow er Supply : AC 220 V , 50 Hz, 50 Watt
Light Intensity : Appr. 18.000 Lux
Adjustable stand : Appr. 120-170 cm ,w ith flexible arm
Bulb : Halogen bulb, 12 V, 50 Watt
Base : Plastic or Heavy alumunium casting alloy (by request)
Castors : 5 castors 2"
Dimension : Appr. 60 x 120 H cm
Weight : Appr. 12 Kg
Garansi : 1 (satu) tahun
Spare Part : 5 (lim a) tahun
GE Mac I
Instrument type
Microprocessor augmented automatic electrocardiograph; 10leadwire, 12-lead simultaneous acquisition with
programmable lead configuration.
Signal Processing
Acquisition 12-leads simultaneous ECG acquisition
Digital sampling rate 2,000 samples/second/channel
Acquisition mode 10 seconds of simultaneous and sequential
ECG recording
ECG Measurements Supports measurement with Marquette*
12SL ECG Analysis Program
(optional feature)
ECG Interpretation Supports adult interpretation with Marquette
12SL ECG Analysis Program
(optional feature)
ECG analysis frequency 500 samples/second/channel
Dynamic range AC Differential 5 mV, DC offset 300 mV
Resolution 4.88 V/LSB @ 500 sps
Frequency response 3 dB @ 0.01 to 150 Hz
Low cut off frequency 0.01 Hz, 0.02 Hz, 0.16 Hz or 0.32 Hz
High cut off frequency 150 Hz, 40 Hz or 20 Hz if muscle filter is
enabled
Operating modes Automatic ECG (12-lead data),
rhythm/manual (real-time data)
Common mode rejection >100 dB (with AC filter enabled)
Input impedence >10 M @ 10 Hz, defibrillator protected
Patient leakage <10 A in normal condition and <50 A in
single fault condition
Lead fail indication Disconnected lead detection. Each single

2.800.000
1

buah

2.800.000

buah
2

buah

4.651.000

9.302.400

12.000.000

12.000.000

electrode is monitored except N/right leg

Heart rate meter 30 to 300 BPM 10% or 5 BPM, whichever is
greater. Heart rates outside
30 to 300 BPM will not be displayed.
Start up time 7 seconds
Software standard
Resting ECG mode Records and prints 12-lead resting ECGs
with 10 second duration as a standard feature
Language support English
Software option
Measurement Supports measurement with Marquette 12SL
ECG Analysis Program;
List of measurements printed.
a. Vent. Rate b. P duration c. PR interval d. RR Interval
e. QRS duration f. QT/QTc g. P-R-T axes
Interpretation Supports Interpretation with Marquette 12SL
ECG Analysis Program.
Display
Display type 2x16 alphanumeric display with adjustable
contrast
Display data Operating mode, heart rate, print formats/lead
display, speed, gain, muscle filter,
AC filter and configuration menu
Keyboard
Type Membrane keyboard with tactile feedback
Accessories
ECG Electrodes Value reusable IEC/AHA limb clamps and bulb
electrodes (user selectable)
ECG Cable Fixed Value fixed 10-lead patient cable IEC/AHA
(user selectable)
Power Supply External medical grade power supply
Paper 58 mm standard roll paper (with 1 ch); 80 mm standard
roll paper, 80 mm standard
Z-fold paper (with 3 ch)
Gel Electrode cream 250 ML/TUBE
Pediatric electrodes Pediatric electrodes and universal clip
(optional)
Printer option
Thermal printer (58 mm) for 1 channel option
Thermal printer (80 mm) for 3 channel option
Printer specification
Technology Thermal dot array print head
Speed 5, 25, & 50 mm/s
Number of traces 1 channel rhythm (for 1 channel option), 3
channel rhythm (for 3 channel option)
Sensitivity/gain 2.5, 5, 10, 20 mm/mV
Speed accuracy 5%
Amplitude 5%
Resolution Horizontal 40 dots/mm @ 25 mm/s, 8 dots/mm
vertical
Paper type Thermal roll (for 1 channel and 3 channel options),
Z fold (for 3 channel option)
Paper size - Z fold Sheet width 80 mm, length 90 mm, 280
sheets/pack roll paper length 15.7 mm
(for 3 channel option)
Print format
Thermal printer (58 mm) (for 1 channel option) 1-lead
simultaneous; 1-lead sequential; 1-lead rhythm report format
with selectable lead
Thermal printer (80 mm) (for 3 channel option)
3-lead simultaneous (short and long format), 3 lead Sequential
(with and without
rhythm), 3-lead rhythm report format with selectable lead
sequence, 1-lead rhythm
report format with selectable lead (configurable)
Lead sequence Standard and Cabrera
Electrical
Power Supply External ACDC adaptor
External ACDC adaptor specifications
Input voltage 100 to 240 VAC 10 %
Input current Maximum 0.5A @ 90 VAC, 0.3A @ 240 VAC
Operating frequency 50 to 60Hz (3Hz)
Output voltage 12V 5%
Battery specifications
Battery Type Replaceable/rechargeable, lithium ion
Battery capacity 7.2V typical, 2.25 AH 10%
250 continuous ECGs in sequential 1-lead report format at 25
mm/s and 10 mm/mV;
Minimum 120 minutes of continuous rhythm print at 25 mm/S

13

and 10 mm/mV
250 continuous ECGs in simultaneous 3-lead report format at
25 mm/s and 10 mm/
mV (if 3 channel option enabled); Minimum 120 minutes
continuous rhythm print at
25 mm/S and 10 mm/mV
Battery charge time Approximately 3 hours from total discharge
Standard Configuration
Basic unit for 1 channel Main unit 1 channel with standard
accessories
Basic unit for 3 channel Main unit 3 channel with standard
accessories
Option I Measurement
Option II Measurement and Interpretation
Physical specification
Height Approximately 85 mm
Width Approximately 275 mm
Depth Approximately 215 mm
Weight Approximately 1.2 Kg including battery and paper
Environmental specification
Temperature
Operating 5 to 40C
Transport/storage -15C to 50C
Humidity
Operating 25% to 95% RH non-condensing
Transport /storage 25% to 95% RH non-condensing
Pressure
Operating 710 to 1060 hPA
Transport /storage 500 to 1060 hPA
Safety & Regulatory
MDD Class II a
IEC 60601-1
IEC 60601-1-2
IEC 60601-1-4
IEC 60601-2-25
IEC 60601-2-51
IEC 60601-1-6
UL 60601-1
CAN/CSA C22.2 No.601.1-M90
ANSI/AAMI EC-11
ANSI/AAMI EC-13
ABN DM 500 Desk Model
Pressure Indication Range : 20-280 mmHg
7
Accuracy of Cuff Pressure Display : 3 mmHg
Operating Environtment C, 85% relative humidity or below
Storage Environment - C, 85% relative humidity or below
Electrical Savety : Internally powered instrument, type BF equipment
Power Source : 2 AA Batteries
Voltage : DC 3V
Power Consumption : 0.5 W (max)
Turn off device by pressing "on/off Button"
Size : 122.7 x 310.5 x 86.3 mm, closed
Weight : Approximately 780 g, not including batteries
Applicable arm circumference of the standard cuff : 25.4 to 40.6 cm
Optional small size cuff
(for arms 17 to 25 cm) and Large size cuff (for arms 32 to 42 cm) available
Include Instruction Manual Book

1.230.000

8.610.000

buah

Berat Satuan : 2 Kg
14

ABN Classic Stetoscope

ABN Classic Stethoscope Chestpiece :
Adult : SS-021-xx - Terbuat dari bahan Stainless Steel dengan
Grafir
Child : SS-025-xx - ABN Print Logo Diaphragm
Infant : SS-023-xx - Soft PVC non chill ring dan non chill bell
ring
- Diameter membrane : - Dewasa 48 mm, dengan bell ring : 36
mm
- Anak 36 mm, dengan bell ring : 28 mm
- Bayi 28 mm, dengan bell ring : 24 mm
Y-tubing :
- Terbuat dari campuran Soft PVC dan Polyurethane
- Panjang Y-tubing +/- 65 cm
- Panjang total stethoscope 78,5 cm
Binaural :
- Double inner spring binaural
- Terbuat dari Stainless Steel
Carton Box :

1.800.000
8

buah

225.000

15

- Deluxe folding box uk. 16.5 x 33.0 x 5.5 cm

- UV finishing
Spare Part :
- 2 pasang soft eartips
- 1 buah membrane with ABN Print Logo
- Spare part Dikemas dalam hard case plastik berbentuk kotak
deluxe.
Ukuran :
- Tersedia dalam pilihan ukuran Adult, Child dan Infant
Warna Pilihan :
Adult : Black, Grey, Burgundy, Light Blue, Pink, Hunter Green,
Navy Blue,
Royal Blue
Child : Black, Grey, Light Blue, Pink
Infant : Black, Grey, Light Blue, Pink
ABN Tensimeter berdiri

1.Faceplate: 15.3 x 15.3 cm, tanpa PIN STOP.

2.Arah Faceplate : Dapat diputar secara horizontal
sesuai arah user
3.Kelengkapan : Box tempat penyimpanan manset/ cuff
with latex bladder, selang
spiral yang bisa dipanjangkan hingga 2.5 m, metal
connector, Latex Bulb ABN
dengan valve Deluxe Assembly
5.Penempatan : Di trolley berroda (mobile type).

8.525.000
5

buah

buah

Kode : ZT 120 Jenis : Timbangan dan alat ukur tinggi badan

Tipe : Standard
Kondisi : Baru
Max Berat : 120 kg
Rentang Pengukuran Tinggi: 70-190 cm
Berat Kotor : 16 kg
Berat Bersih : 14 kg
Dimensi : 91 cm x 34 cm x 29 cm
Berat Pengiriman : 15 kg (pembagi 6000) / 23 kg (pembagi
4000)

buah

Kacamata Evena

1.705.000

Berat Satuan : 7 Kg
16

17

18

Sterilisator elitec

Timbangan badan berdiri

echnical Specifications
Imaging technology
Custom digital high definition cameras for patented multispectral imaging for all patients;

buah

1.600.000

3.200.000

1.602.930

6.411.720

8.000.000

24.000.000

DeepVu ultrasound for imaging deeper veins, if

needed.
Connectivity Bluetooth, Wifi, 3G wireless. USB 2/3 for
virtually limitless accessories: barcode
scanner, wireless keyboard/mouse, printer/scanner,
bedside telemedicine/telenursing
connectivity.
Audio
Dual speakers for 2-way communications.
Storage/Memory
1 GB storage, up to 32 GB memory to easily document
procedures via images or video.
Power
Battery unit worn on belt keeps Glasses lightweight.
Overall size
3 x 8 x 2
Weight (without battery pack)
11 oz.

219.224.0
70
JUMLAH (Harga sudah termasuk pajak)

Mengetahui

Kediri, 18 Juli 2016

Kuasa Pengguna Anggaran

Pejabat Pembuat Komitmen

UPTD Puskesmas Semen

dr. RINI HIDAYAT

AHSIN USMAN, S.Sos. MM

NIP.19760628 20101 2 006

NIP.19691012 198910 1 001

RENCANA ANGGARAN BELANJA ( RAB )

PENGADAAN BARANG MODAL ALAT KESEHATAN UMUM
BERSUMBER DANA KAPITASI JKN
TAHUN 2016
No
1

JENIS BARANG

VOLU
ME

SATUA
N

HARGA

MAK bedside cabinet 73032

8.979.651

3
buah
Construction
Made of steel sheet with phosphate coating,
assembled with MIG/MAG welding process.
Consist of
One Drawer, dimension : (L)475x(W)375x(H)100 mm.
Cupboard, with one self and shoe compartment,
under cupboard with ventilation on the backside.
Table Top
Made of ABS plastic with injection molding process.
Accessories
Towel Hanger, made of stainless steel rod (6.3 mm).
Door & Drawer handle, made of ABS plastic with injection
molding process.
Castor
Four 2 swivel castors.
Coating
Epoxy powder coating finish
Max. Load
50 Kg.
Net Weight (approx.)
30.5 Kg.
Dimension(approx.)
(L)455 x (W)495 x (H)990mm
Warranty
3 year
Kode prod
73032
MAK Mattress adult type 31813
3
buah
Construction:
Made of Natural rubber has the advantage
for the patient
who lies on the bed for long time.
And this is cool natural
reaction for the skin of the patient.
Additional chemical reaction of the
mattress is called anti-bacteriostatic
that will kill the bacteria instantly.
Dimension(approx.)
(L)2000 x (W)900 x (H)100mm
Warranty
3 year
Kode prod
31813
MAK wheel chair ST. ST 31303
2
buah
Construction
Made of stainless steel pipe (25.4mm),
assembled with TIG welding process.
Back Support & Seat
Made of foam and covered by imitation leather.
Armrest & footrest
Made of nylon plastic (injection molding process).
Wheel
The front wheel two 8" castors, and the main
wheel two 24" rubber wheel with non air tube
tire and plastic rim.
Equipped with
Lock position, and Wheel Chair can be folded easily
to reduce the storing place.
Max. Load
120kg.
Net Weight (approx.)
17 Kg.
Dimension (approx.)
(L)950 x (W)625 x (H)890 mm.
Warranty
3 year
Kode prod
31303
MAK examination table 34105
2
buah
Construction
Made of stainless steel tube (square profile,
size 25x25mm; 25x50mm). Assembled with TIG
welding process.
Mattress
Made of multiplex wood (thickness 12mm) and
covered with foam imitation leather upholstery
with 50 mm thick foam padding.
Back Raise
Adjustable by rack mechanism, with single
hand operated.
Max. Load
150 Kg.
Dimension(approx.)
(L)1865 x (W) 620 x (H) 755 mm (overall)
Warranty
3 year
Kode prod
34105

2.993.217

9.636.699
3.212.233

5.256.200
2.628.100

11.096.800
5.548.400

MAK instrument cabinet 32901

Construction
Section

JUMLAH

5
Made of steel sheet with phosphate coating
(thickness 1 mm). Assembled with MIG
welding process.
Four adjustable shelves.

25.916.500
buah

5.183.300

Door
Coating
Max. Load
Net Weight (approx.)
Dimension (approx.)
Warranty
Kode prod
6

MAK instrum trolley 35101

Construction
Upper shelf

Lower shelf
Handle
Castor
Max. Load
Net Weight (approx.)
Dimension (approx.)
Warranty
Kode prod

Two doors with full transparent glass 5 mm

equipped with lock and key.
Epoxy powder coating finish.
25 kg. (each shelf).
68 Kg.
(L)900 x (W)460 x (H)1750 mm
3 year
32901
31.684.100
5
buah
Made of stainless steel sheet (thickness 1mm)
and assembled with TIG welding process.
Made of stainless steel sheet (thickness 1mm)
with list on each side and equipped a drawer
(dimension : (L)375 x (W)290 x (H)65mm)
underneath the shelf.
Made of stainless steel sheet (thickness 1mm)
with list on each side.
Made of stainless steel pipe ( 16mm)
Four 2" castor with the bumper overhead each castor
(made of plastic by injection molding process).
25 Kg. (each shelf)
15 Kg.
(L)630 x (W)470 x (H)835 mm
3 year
35101

MAK foot step 34152

Construction:
Made of steel pipe (26 mm) assembled with MIG
welding process.
Steps:
Two steps made of steel sheet (thickness 1 mm) with list on
each side which made of stainless steel sheet (8% Ni,
thickness 0.8 mm) . Painting : Epoxy powder coating finish.
Max. Load : 150 kg
Dimension (approx.) : (L)400 x (W)400 x (H)435mm
Warranty :3 year
Code prod :34152
MAK Waiting chair 31320
Construction : The frame is made of steel pipe (27mm).
Assembled with
MIG welding process
Main Frame : Made of square mild steel pipe (40x60mm).
Backrest and Seat : Made of mild steel sheet (thickness
1.2mm), perforated.
Seat Mattress (Not Included) :
Made of soft foam : 10mm with durable convenient
cover.
Painting : Epoxy powder coating finish
Detail : Consist of 4 seats
Max. Load : 400 Kg.
Dimension (approx.) : (L)2150 x (W)550 x (H)740mm
Warranty :3 year
Code prod :31320

MAK infus stand 36101

INFUSE STAND
MAK / PT. MEGA ANDALAN KALASAN
INFUSE STAND MOBILE / 36101
INDONESIA
INDONESIA
AKD 10903900512
300 888 1803
93 / 42 / EEC
IEC Compliance :
ISO 9001-2008 04.100.032054
ISO 13485-2012 44.221.06.341820-001
ISO 14001-2004 08.104.0021

4.526.300

5.621.000
7

buah

803.000

buah

4.818.000

38.544.000

1.168.000
buah

5.840.000

OHSAS 18001-2007 05101.2008.0087.E5

INDONESIA, EURO, ASIA
Upper Stand Made of stainless steel pipe (16mm), two
hooks made of
stainless steel rod (6.3mm), assembled with TIG
welding
process. Adjustable height with locking screw.
Lower Stand Made of steel pipe (25.4mm) and the
pedestal is made of steel
sheet (thickness 2.8mm), assembled with MIG/MAG
welding
process.
Coating Epoxy powder coating finish
Castor Three 2" swivel castors
Max. Load 3 Kg. (each hook).
Net Weight (approx.) 5 Kg.
Dimension (approx.) (L)400 x (W)320 x (H) 1300 - 2100
mm
3 Year
FUNCTION ROOM ACCESSORIES
CODE PROD. 36101
10

11

12

TESENA X- ray film viewer single films / tsn 014 s

Fluorescent Lam p (standard) :
Pow er : AC 220 V / 50 Hz / App. 20 W
Lamp : 1 x 20 W Fluorescent Lamp
Dimension : Appr. 40 W x 14 D x 55 H cm
Body : Steel sheet painted w ith epoxy pow der coating
Weight : Appr. 7 Kg
Garansi : 1 (satu) tahun
Spare Part : 5 (lim a) tahun
TESENA halogen examination lamp / tsn 015 fhc
HALOGEN (standard)
Pow er Supply : AC 220 V , 50 Hz, 50 Watt
Light Intensity : Appr. 18.000 Lux
Adjustable stand : Appr. 120-170 cm ,w ith flexible arm
Bulb : Halogen bulb, 12 V, 50 Watt
Base : Plastic or Heavy alumunium casting alloy (by request)
Castors : 5 castors 2"
Dimension : Appr. 60 x 120 H cm
Weight : Appr. 12 Kg
Garansi : 1 (satu) tahun
Spare Part : 5 (lim a) tahun
GE Mac I
Instrument type
Microprocessor augmented automatic electrocardiograph; 10leadwire, 12-lead simultaneous acquisition with
programmable lead configuration.
Signal Processing
Acquisition 12-leads simultaneous ECG acquisition
Digital sampling rate 2,000 samples/second/channel
Acquisition mode 10 seconds of simultaneous and sequential
ECG recording
ECG Measurements Supports measurement with Marquette*
12SL ECG Analysis Program
(optional feature)
ECG Interpretation Supports adult interpretation with Marquette
12SL ECG Analysis Program
(optional feature)
ECG analysis frequency 500 samples/second/channel
Dynamic range AC Differential 5 mV, DC offset 300 mV
Resolution 4.88 V/LSB @ 500 sps
Frequency response 3 dB @ 0.01 to 150 Hz
Low cut off frequency 0.01 Hz, 0.02 Hz, 0.16 Hz or 0.32 Hz
High cut off frequency 150 Hz, 40 Hz or 20 Hz if muscle filter is
enabled
Operating modes Automatic ECG (12-lead data),
rhythm/manual (real-time data)
Common mode rejection >100 dB (with AC filter enabled)
Input impedence >10 M @ 10 Hz, defibrillator protected
Patient leakage <10 A in normal condition and <50 A in
single fault condition
Lead fail indication Disconnected lead detection. Each single

2.800.000
1

buah

2.800.000

buah
2

buah

4.651.000

9.302.400

12.000.000

12.000.000

electrode is monitored except N/right leg

Heart rate meter 30 to 300 BPM 10% or 5 BPM, whichever is
greater. Heart rates outside
30 to 300 BPM will not be displayed.
Start up time 7 seconds
Software standard
Resting ECG mode Records and prints 12-lead resting ECGs
with 10 second duration as a standard feature
Language support English
Software option
Measurement Supports measurement with Marquette 12SL
ECG Analysis Program;
List of measurements printed.
a. Vent. Rate b. P duration c. PR interval d. RR Interval
e. QRS duration f. QT/QTc g. P-R-T axes
Interpretation Supports Interpretation with Marquette 12SL
ECG Analysis Program.
Display
Display type 2x16 alphanumeric display with adjustable
contrast
Display data Operating mode, heart rate, print formats/lead
display, speed, gain, muscle filter,
AC filter and configuration menu
Keyboard
Type Membrane keyboard with tactile feedback
Accessories
ECG Electrodes Value reusable IEC/AHA limb clamps and bulb
electrodes (user selectable)
ECG Cable Fixed Value fixed 10-lead patient cable IEC/AHA
(user selectable)
Power Supply External medical grade power supply
Paper 58 mm standard roll paper (with 1 ch); 80 mm standard
roll paper, 80 mm standard
Z-fold paper (with 3 ch)
Gel Electrode cream 250 ML/TUBE
Pediatric electrodes Pediatric electrodes and universal clip
(optional)
Printer option
Thermal printer (58 mm) for 1 channel option
Thermal printer (80 mm) for 3 channel option
Printer specification
Technology Thermal dot array print head
Speed 5, 25, & 50 mm/s
Number of traces 1 channel rhythm (for 1 channel option), 3
channel rhythm (for 3 channel option)
Sensitivity/gain 2.5, 5, 10, 20 mm/mV
Speed accuracy 5%
Amplitude 5%
Resolution Horizontal 40 dots/mm @ 25 mm/s, 8 dots/mm
vertical
Paper type Thermal roll (for 1 channel and 3 channel options),
Z fold (for 3 channel option)
Paper size - Z fold Sheet width 80 mm, length 90 mm, 280
sheets/pack roll paper length 15.7 mm
(for 3 channel option)
Print format
Thermal printer (58 mm) (for 1 channel option) 1-lead
simultaneous; 1-lead sequential; 1-lead rhythm report format
with selectable lead
Thermal printer (80 mm) (for 3 channel option)
3-lead simultaneous (short and long format), 3 lead Sequential
(with and without
rhythm), 3-lead rhythm report format with selectable lead
sequence, 1-lead rhythm
report format with selectable lead (configurable)
Lead sequence Standard and Cabrera
Electrical
Power Supply External ACDC adaptor
External ACDC adaptor specifications
Input voltage 100 to 240 VAC 10 %
Input current Maximum 0.5A @ 90 VAC, 0.3A @ 240 VAC
Operating frequency 50 to 60Hz (3Hz)
Output voltage 12V 5%
Battery specifications
Battery Type Replaceable/rechargeable, lithium ion
Battery capacity 7.2V typical, 2.25 AH 10%
250 continuous ECGs in sequential 1-lead report format at 25
mm/s and 10 mm/mV;
Minimum 120 minutes of continuous rhythm print at 25 mm/S

13

and 10 mm/mV
250 continuous ECGs in simultaneous 3-lead report format at
25 mm/s and 10 mm/
mV (if 3 channel option enabled); Minimum 120 minutes
continuous rhythm print at
25 mm/S and 10 mm/mV
Battery charge time Approximately 3 hours from total discharge
Standard Configuration
Basic unit for 1 channel Main unit 1 channel with standard
accessories
Basic unit for 3 channel Main unit 3 channel with standard
accessories
Option I Measurement
Option II Measurement and Interpretation
Physical specification
Height Approximately 85 mm
Width Approximately 275 mm
Depth Approximately 215 mm
Weight Approximately 1.2 Kg including battery and paper
Environmental specification
Temperature
Operating 5 to 40C
Transport/storage -15C to 50C
Humidity
Operating 25% to 95% RH non-condensing
Transport /storage 25% to 95% RH non-condensing
Pressure
Operating 710 to 1060 hPA
Transport /storage 500 to 1060 hPA
Safety & Regulatory
MDD Class II a
IEC 60601-1
IEC 60601-1-2
IEC 60601-1-4
IEC 60601-2-25
IEC 60601-2-51
IEC 60601-1-6
UL 60601-1
CAN/CSA C22.2 No.601.1-M90
ANSI/AAMI EC-11
ANSI/AAMI EC-13
ABN DM 500 Desk Model
Pressure Indication Range : 20-280 mmHg
7
Accuracy of Cuff Pressure Display : 3 mmHg
Operating Environtment C, 85% relative humidity or below
Storage Environment - C, 85% relative humidity or below
Electrical Savety : Internally powered instrument, type BF equipment
Power Source : 2 AA Batteries
Voltage : DC 3V
Power Consumption : 0.5 W (max)
Turn off device by pressing "on/off Button"
Size : 122.7 x 310.5 x 86.3 mm, closed
Weight : Approximately 780 g, not including batteries
Applicable arm circumference of the standard cuff : 25.4 to 40.6 cm
Optional small size cuff
(for arms 17 to 25 cm) and Large size cuff (for arms 32 to 42 cm) available
Include Instruction Manual Book

1.230.000

8.610.000

buah

Berat Satuan : 2 Kg
14

ABN Classic Stetoscope

ABN Classic Stethoscope Chestpiece :
Adult : SS-021-xx - Terbuat dari bahan Stainless Steel dengan
Grafir
Child : SS-025-xx - ABN Print Logo Diaphragm
Infant : SS-023-xx - Soft PVC non chill ring dan non chill bell
ring
- Diameter membrane : - Dewasa 48 mm, dengan bell ring : 36
mm
- Anak 36 mm, dengan bell ring : 28 mm
- Bayi 28 mm, dengan bell ring : 24 mm
Y-tubing :
- Terbuat dari campuran Soft PVC dan Polyurethane
- Panjang Y-tubing +/- 65 cm
- Panjang total stethoscope 78,5 cm
Binaural :
- Double inner spring binaural
- Terbuat dari Stainless Steel
Carton Box :

1.800.000
8

buah

225.000

15

- Deluxe folding box uk. 16.5 x 33.0 x 5.5 cm

- UV finishing
Spare Part :
- 2 pasang soft eartips
- 1 buah membrane with ABN Print Logo
- Spare part Dikemas dalam hard case plastik berbentuk kotak
deluxe.
Ukuran :
- Tersedia dalam pilihan ukuran Adult, Child dan Infant
Warna Pilihan :
Adult : Black, Grey, Burgundy, Light Blue, Pink, Hunter Green,
Navy Blue,
Royal Blue
Child : Black, Grey, Light Blue, Pink
Infant : Black, Grey, Light Blue, Pink
ABN Tensimeter berdiri

1.Faceplate: 15.3 x 15.3 cm, tanpa PIN STOP.

2.Arah Faceplate : Dapat diputar secara horizontal
sesuai arah user
3.Kelengkapan : Box tempat penyimpanan manset/ cuff
with latex bladder, selang
spiral yang bisa dipanjangkan hingga 2.5 m, metal
connector, Latex Bulb ABN
dengan valve Deluxe Assembly
5.Penempatan : Di trolley berroda (mobile type).

8.525.000
5

buah

buah

Kode : ZT 120 Jenis : Timbangan dan alat ukur tinggi badan

Tipe : Standard
Kondisi : Baru
Max Berat : 120 kg
Rentang Pengukuran Tinggi: 70-190 cm
Berat Kotor : 16 kg
Berat Bersih : 14 kg
Dimensi : 91 cm x 34 cm x 29 cm
Berat Pengiriman : 15 kg (pembagi 6000) / 23 kg (pembagi
4000)

buah

Kacamata Evena

1.705.000

Berat Satuan : 7 Kg
16

17

18

Sterilisator elitec

Timbangan badan berdiri

echnical Specifications
Imaging technology
Custom digital high definition cameras for patented multispectral imaging for all patients;

buah

1.600.000

3.200.000

1.602.930

6.411.720

8.000.000

24.000.000

DeepVu ultrasound for imaging deeper veins, if

needed.
Connectivity Bluetooth, Wifi, 3G wireless. USB 2/3 for
virtually limitless accessories: barcode
scanner, wireless keyboard/mouse, printer/scanner,
bedside telemedicine/telenursing
connectivity.
Audio
Dual speakers for 2-way communications.
Storage/Memory
1 GB storage, up to 32 GB memory to easily document
procedures via images or video.
Power
Battery unit worn on belt keeps Glasses lightweight.
Overall size
3 x 8 x 2
Weight (without battery pack)
11 oz.

Mengetahui
Kuasa Pengguna Anggaran

Kediri, 18 Juli 2016

Pejabat Pelaksana Teknis Kegiatan

UPTD Puskesmas Semen

dr. RINI HIDAYAT

dr. NIQKO BAYU PRAKARSA

NIP.19760628 20101 2 006

NIP.19871118 201502 1 002