DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I

SALDO AWAL 01-01-2017 PENAMBAHAN PENGURANGAN SALDO A

No. NAMA SATUAN HARGA NILAI 02-01-17 S.D 30-01-17 02-01-17 S.D 30-01-17
KUANTITAS KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. )
1 2 3 4 5 6 7 8 9 10
1 AMPLOP KABINET BH 450 - BH - BH Rp - -

2 - - 0 - 0 Rp - -

3 - - 0 - 0 Rp - -

4 BLANGKO RINCIAN BIAYA TINDAKAN BUKU 6,500 - BUKU - BUKU Rp - -

5 BUKU PEMANTAUAN PROLANIS PCS 11,000 - PCS - PCS Rp - -

6 BUKU SAKA BHAKTI HUSADA PCS 44,000 - PCS - PCS Rp - -

7 BUKU LOGISTIK IMUNISASI PCS 20,000 - PCS - PCS Rp -

8 BUKU LAPORAN IMUNISASI PCS 15,000 - PCS - PCS Rp -

9 BUKU PEDOMAN PENYULUHAN PCS 12,750 - PCS - PCS Rp -

10 BUKU PEGANGAN KESH CAPENG PCS 10,000 - PCS - PCS Rp -

11 BUKTI PELAYANAN RANAP ( KLEM BPJS) SET 720 - SET - SET Rp -

12 FORMULIR RM RAWAT JALAN PCS 1,115 - PCS - PCS Rp - -

13 FORMULIR CM 2 LBR 175 - LBR - LBR Rp -

14 FORMULIR CM 3 LBR 175 - LBR - LBR Rp -

15 FORMULIR IGD BEDAH LBR 350 - LBR - LBR Rp -

16 FORMULIR RM RANAP NON BEDAH SET 1,500 - SET - SET Rp -

17 FORMULIR PROFIL KESGA 2.2 LBR 270 - LBR - LBR Rp - -

18 KERTAS RESEP RIM 70,000 - RIM - RIM Rp - -

19 KUESIONER SMD MMD SET 1,080 - SET - SET Rp - -

20 MAP FF PCS 2,000 - PCS - PCS Rp - -

21 MAP REKAM MEDIK RANAP PCS 750 - PCS - PCS Rp - -

22 PLASTIK PCS 25,000 - PCS - PCS Rp - -

23 PWS KIA BUKU 35,000 - BUKU - BUKU Rp -

24 PWS ANAK BUKU 40,000 - BUKU - BUKU Rp -

25 STOPMAP DAN FORMULIR KESGA SET 6,500 - SET - SET Rp -

1 2 3 4 5 6 7 8 9 10
26 STOPMAP PLASTIK SAABLON PCS 7,500 - PCS - PCS Rp -

27 Rp -

28 Rp -

JUMLAH - - - - - Rp - -

Cilacap, 31 Januari 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
R PERSEDIAAN

SALDO AKHIR TGL. 30 - 01 - 2017

HARGA NILAI KET
KUANTITAS
SATUAN ( Rp. )
10 11 12 13
BH 450 -

0 - -

0 - -

BUKU 6,500 -

PCS 11,000 -

PCS 44,000 -

PCS 20,000
PCS 15,000
PCS 12,750
PCS 10,000
SET 720
PCS 1,115 -

LBR 175
LBR 175
LBR 350
SET 1,500
LBR 270 -

RIM 70,000 -

SET 1,080 -

PCS 2,000 -

PCS 750 -

PCS 25,000 -

BUKU 35,000 -

BUKU 40,000

SET 6,500
10 11 12 13
PCS 7,500

-
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I

SALDO AWAL 01-02-2017 PENAMBAHAN PENGURANGAN SALDO AKHIR TGL. 27 - 02 - 2017

No. NAMA SATUAN KUANTITA HARGA NILAI 02-02-17 S.D 27-02-17 02-02-17 S.D 27-02-17 HARGA NILAI KET
KUANTITAS
S SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 7 8 9 10 11 12 13
1 AMPLOP KABINET - BH 450 - 300 BH 135,000 BH - 300 BH 450 135,000
2 - - 0 - - 0 - 0 - - 0 - -
3 - - 0 - - 0 - 0 - - 0 - -
4 BLANGKO RINCIAN BIAYA TINDAK - BUKU 6,500 - 20 BUKU 130,000 BUKU - 20 BUKU 6,500 130,000
5 BUKU PEMANTAUAN PROLANIS - PCS 11,000 - - PCS - PCS - - PCS 11,000 -
6 BUKU SAKA BHAKTI HUSADA - PCS 44,000 - - PCS - PCS - - PCS 44,000 -
7 BUKU LOGISTIK IMUNISASI PCS 20,000 - - PCS - PCS - - PCS 20,000 -
8 BUKU LAPORAN IMUNISASI PCS 15,000 - - PCS - PCS - - PCS 15,000 -
9 BUKU PEDOMAN PENYULUHAN PCS 12,750 PCS PCS - PCS 12,750 -
10 BUKU PEGANGAN KESH CAPENG SET 10,000 SET SET - SET 10,000 -
11 BUKTI PELAYANAN RANAP ( KLEM BPJS) PCS 720 PCS PCS - PCS 720 -
12 FORMULIR RM RAWAT JALAN - PCS 1,115 - 2,550 PCS 2,843,250 PCS - 2,550 PCS 1,115 2,843,250
13 FORMULIR CM 2 LBR 175 LBR - LBR - LBR 175 -
14 FORMULIR CM 3 LBR 175 LBR - LBR - LBR 175 -
15 FORMULIR IGD BEDAH LBR 350 LBR - LBR - LBR 350 -
16 FORMULIR RM RANAP NON BEDAH SET 1,500 SET - SET - SET 1,500 -
17 FORMULIR PROFIL KESGA 2.2 - LBR 270 - LBR - LBR - - LBR 270 -
18 KERTAS RESEP - RIM 70,000 - 5 RIM 350,000 RIM - 5 RIM 70,000 350,000
19 KUESIONER SMD MMD - SET 1,080 - SET - SET - - SET 1,080 -
20 MAP FF - PCS 2,000 - 700 PCS 1,400,000 PCS - 700 PCS 2,000 1,400,000
21 MAP REKAM MEDIK RANAP - PCS 750 - PCS - PCS - - PCS 750 -
22 PLASTIK - PCS 25,000 - 10 PCS 250,000 PCS - 10 PCS 25,000 250,000
23 PWS KIA - BUKU 35,000 - BUKU - BUKU - - BUKU 35,000 -
24 PWS ANAK BUKU 40,000 BUKU - BUKU - - BUKU -
25 STOPMAP DAN FORMULIR KESGA SET 6,500 SET - SET - - SET -
26 STOPMAP PLASTIK SAABLON PCS 7,500 PCS - PCS - - PCS -
27 0 0 - 0 - - 0 -
28 0 0 - 0 - - 0 -
JUMLAH - - Rp 5,108,250 - - 5,108,250

Cilacap, 28 Februari 2017

1 2 3 4 5 6 7 8 9 10 11 12 13

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I

SALDO AWAL 01-03-2017 PENAMBAHAN PENGURANGAN SALDO AKHIR TGL. 31 - 03- 2017
No. NAMA SATUAN HARGA NILAI 02-03-17 S.D 31-03-17 02-03-17 S.D 31-03-17 HARGA NILAI KET
KUANTITAS KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 7 8 9 10 11 12 13
1 AMPLOP KABINET 300 BH 450 135,000 BH - - BH - 300 BH 450 135,000

2 - - 0 - - 0 - - 0 - - 0 - -

3 - - 0 - - 0 - - 0 - - 0 - -

4 BLANGKO RINCIAN BIAYA TINDAK 20 BUKU 6,500 - BUKU - BUKU - 20 BUKU 6,500 130,000

5 BUKU PEMANTAUAN PROLANIS - PCS 11,000 - 300 PCS 3,300,000 - PCS - 300 PCS 11,000 3,300,000

6 BUKU SAKA BHAKTI HUSADA - PCS 44,000 - 24 PCS 1,056,000 - PCS - 24 PCS 44,000 1,056,000

7 BUKU LOGISTIK IMUNISASI PCS 20,000 - 15 PCS 300,000 PCS - 15 PCS 20,000 300,000

8 BUKU LAPORAN IMUNISASI PCS 15,000 - 12 PCS 180,000 PCS - 12 PCS 15,000 180,000

9 BUKU PEDOMAN PENYULUHAN PCS 12,750 - PCS - PCS PCS 12,750 -

10 BUKU PEGANGAN KESH CAPENG SET 10,000 - SET - SET SET 10,000 -

11 BUKTI PELAYANAN RANAP ( KLEM BPJS) PCS 720 - PCS - PCS PCS 720 -

12 FORMULIR RM RAWAT JALAN 2,550 PCS 1,115 2,843,250 - PCS - - PCS - 2,550 PCS 1,115 2,843,250

13 FORMULIR CM 2 LBR 175 - LBR - - LBR - - LBR 175 -

14 FORMULIR CM 3 LBR 175 - LBR - - LBR - - LBR 175 -

15 FORMULIR IGD BEDAH LBR 350 - LBR - - LBR - - LBR 350 -

16 FORMULIR RM RANAP NON BEDAH SET 1,500 - SET - - SET - - SET 1,500 -

17 FORMULIR PROFIL KESGA 2.2 - LBR 270 - - LBR - - LBR - - LBR 270 -

18 KERTAS RESEP 5 RIM 70,000 350,000 - RIM - - RIM - 5 RIM 70,000 350,000

19 KUESIONER SMD MMD - SET 1,080 - - SET - - SET - - SET 1,080 -

20 MAP FF 700 PCS 2,000 1,400,000 - PCS - - PCS - 700 PCS 2,000 1,400,000
1 2 3 4 5 6 7 8 9 10 11 12 13
21 MAP REKAM MEDIK RANAP - PCS 750 - - PCS - - PCS - - PCS 750 -

22 PLASTIK 10 PCS 25,000 250,000 - PCS - - PCS - 10 PCS 25,000 250,000

23 PWS KIA - BUKU 35,000 - - BUKU - - BUKU - - BUKU 35,000 -

24 PWS ANAK BUKU 40,000 - BUKU - BUKU - - BUKU 40,000 -

25 STOPMAP DAN FORMULIR KESGA SET 6,500 - SET - SET - SET 6,500 -

26 STOPMAP PLASTIK SAABLON PCS 7,500 - PCS - PCS - PCS 7,500 -

27 0 0 0 0

28 0 0 0 0

JUMLAH

Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I

SALDO AWAL 01-04-2017 PENAMBAHAN PENGURANGAN SALDO AKHIR TGL. 30 - 04- 2017
No. NAMA SATUAN HARGA NILAI 02-04-17 S.D 31-04-17 02-04-17 S.D 31-04-17 HARGA NILAI
KUANTITAS KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 7 8 9 10 11 12
1 AMPLOP KABINET 300 BH 450 135,000 - BH - - BH - 300 BH 450 135,000

2 - - 0 - - - 0 - - 0 - - 0 - -

3 - - 0 - - - 0 - - 0 - - 0 - -

4 BLANGKO RINCIAN BIAYA TINDAKAN 20 BUKU 6,500 130,000 - BUKU - BUKU - 20 BUKU 6,500 130,000

5 BUKU PEMANTAUAN PROLANIS 300 PCS 11,000 3,300,000 - PCS - - PCS - 300 PCS 11,000 3,300,000

6 BUKU SAKA BHAKTI HUSADA 24 PCS 44,000 1,056,000 - PCS - - PCS - 24 PCS 44,000 1,056,000

7 BUKU LOGISTIK IMUNISASI 15 PCS 20,000 300,000 - PCS - PCS - 15 PCS 20,000 300,000

8 BUKU LAPORAN IMUNISASI 12 PCS 15,000 180,000 - PCS - PCS - 12 PCS 15,000 180,000

9 BUKU PEDOMAN PENYULUHAN - PCS 12,750 - 15 PCS 191,250 PCS - 15 PCS 12,750 191,250

10 BUKU PEGANGAN KESH CAPENG - SET 10,000 - 15 SET 150,000 SET - 15 SET 10,000 150,000

11 BUKTI PELAYANAN RANAP ( KLEM BPJS - PCS 720 - 250 PCS 180,000 PCS - 250 PCS 720 180,000

12 FORMULIR RM RAWAT JALAN 2,550 PCS 1,115 2,843,250 - PCS - - PCS - 2,550 PCS 1,115 2,843,250

13 FORMULIR CM 2 - LBR 175 - 400 LBR 70,000 - LBR - 400 LBR 175 70,000

14 FORMULIR CM 3 - LBR 175 - 400 LBR 70,000 - LBR - 400 LBR 175 70,000

15 FORMULIR IGD BEDAH - LBR 350 - 100 LBR 35,000 - LBR - 100 LBR 350 35,000

16 FORMULIR RM RANAP NON BEDAH - SET 1,500 - 1,000 SET 1,500,000 - SET - 1,000 SET 1,500 1,500,000

17 FORMULIR PROFIL KESGA 2.2 - LBR 270 - 500 LBR 135,000 - LBR - 500 LBR 270 135,000

18 KERTAS RESEP 5 RIM 70,000 350,000 - RIM - - RIM - 5 RIM 70,000 350,000

19 KUESIONER SMD MMD - SET 1,080 - 700 SET 756,000 - SET - 700 SET 1,080 756,000

20 MAP FF 700 PCS 2,000 1,400,000 - PCS - - PCS - 700 PCS 2,000 1,400,000

21 MAP REKAM MEDIK RANAP - PCS 750 - 1,000 PCS 750,000 - PCS - 1,000 PCS 750 750,000
1 2 3 4 5 6 7 8 9 10 11 12
22 PLASTIK 10 PCS 25,000 250,000 - PCS - - PCS - 10 PCS 25,000 250,000

23 PWS KIA - BUKU 35,000 - 12 BUKU 420,000 BUKU - 12 BUKU 35,000 420,000

24 PWS ANAK - BUKU 40,000 - 12 BUKU 480,000 BUKU - 12 BUKU 40,000 480,000

25 STOPMAP DAN FORMULIR KESGA - SET 6,500 - 2,000 SET 13,000,000 SET - 2,000 SET 6,500 13,000,000

26 STOPMAP PLASTIK SAABLON - PCS 7,500 - 1,000 PCS 7,500,000 PCS - 1,000 PCS 7,500 7,500,000

27 - - 0 - - - 0 - 0 - - 0 - -

28 - - 0 - - - 0 - 0 - - 0 - -

25 - - 0 - - - 0 - 0 - - 0 - -

JUMLAH 3,936 9,944,250 7,404 Rp 25,237,250 - Rp - 11,340 Rp 35,181,500

Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
DAFTAR PERSEDIAAN

KET

13
13
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I H
A
SALDO AWAL 01-05-2017 PENAMBAHAN
R PENGURANGAN SALDO AKHIR TGL. 31-05-2017
No. NAMA SATUAN NILAI G 30-05-17
02-05-17 S.D 01-12-17 S.D 31-12-17 NILAI KET
HARGA HARGA
KUANTITAS A KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 S 7 8 9 10 11 12 13
A
1 AMPLOP KABINET 300 BH 450 135,000 ### T
- BH - - BH - 300 BH 450 135,000

2 - - 0 - - - ### 0U - - 0 - - 0 - -
A
3 - - 0 - - - ### 0N - - 0 - - 0 - -

4 BLANGKO RINCIAN BIAYA TINDAKAN 20 BUKU 6,500 130,000 - BUKU - - BUKU - 20 BUKU 6,500 130,000

5 BUKU PEMANTAUAN PROLANIS 300 PCS 11,000 3,300,000 ###

- PCS - - PCS - 300 PCS 11,000 3,300,000

6 BUKU SAKA BHAKTI HUSADA 24 PCS 44,000 1,056,000 ###

- PCS - - PCS - 24 PCS 44,000 1,056,000

7 BUKU LOGISTIK IMUNISASI 15 PCS 20,000 300,000 ###

- PCS - - PCS - 15 PCS 20,000 300,000

8 BUKU LAPORAN IMUNISASI 12 PCS 15,000 180,000 ###

- PCS - - PCS - 12 PCS 15,000 180,000
9 BUKU PEDOMAN PENYULUHAN 15 PCS 12,750 191,250 ###
- PCS - - PCS - 15 PCS 12,750 191,250

10 BUKU PEGANGAN KESH CAPENG 15 SET 10,000 150,000 ###

- SET - - SET - 15 SET 10,000 150,000

11 BUKTI PELAYANAN RANAP ( KLEM B 250 PCS 720 180,000 ###

- PCS - - PCS - 250 PCS 720 180,000

12 FORMULIR RM RAWAT JALAN 2,550 PCS 1,115 2,843,250 ###

- PCS - - PCS - 2,550 PCS 1,115 2,843,250

13 FORMULIR CM 2 400 LBR 175 70,000 ###

- LBR - - LBR - 400 LBR 175 70,000

14 FORMULIR CM 3 400 LBR 175 70,000 ###

- LBR - - LBR - 400 LBR 175 70,000

15 FORMULIR IGD BEDAH 100 LBR 350 35,000 ###

- LBR - - LBR - 100 LBR 350 35,000

16 FORMULIR RM RANAP NON BEDAH 1,000 SET 1,500 1,500,000 ###

- SET - - SET - 1,000 SET 1,500 1,500,000

17 FORMULIR PROFIL KESGA 2.2 500 LBR 270 135,000 ###

- LBR - - LBR - 500 LBR 270 135,000

18 KERTAS RESEP 5 RIM 70,000 350,000 ###

- RIM - - RIM - 5 RIM 70,000 350,000

19 KUESIONER SMD MMD 700 SET 1,080 756,000 ###

- SET - - SET - 700 SET 1,080 756,000

20 MAP FF 700 PCS 2,000 1,400,000 ###

- PCS - - PCS - 700 PCS 2,000 1,400,000

21 MAP REKAM MEDIK RANAP 1,000 PCS 750 PCS - PCS 1,000 PCS 750 750,000
22 PLASTIK 10 PCS 25,000 250,000 ###
- PCS - - PCS - 10 PCS 25,000 250,000

23 PWS KIA 12 BUKU 35,000 420,000 ###

- BUKU - - BUKU - 12 BUKU 35,000 420,000
 G
A

1 2 3 4 5 6 S 7 8 9 10 11 12 13
A
24 PWS ANAK 12 BUKU 40,000 480,000 ### T
- BUKU - - BUKU - 12 BUKU 40,000 480,000

STOPMAP DAN FORMULIR KESGA 2,000 SET 6,500 - SET U - SET - 2,000 SET 6,500 13,000,000
A
25 STOPMAP PLASTIK SAABLON 1,000 PCS 7,500 7,500,000 ### N
- PCS - - PCS - 1,000 PCS 7,500 7,500,000

26 - - 0 - - - ###
0 - - 0 - - 0 - -

27 - - 0 - - - ###
0 - - 0 - - 0 - -

- - 0 - 0 0 0

JUMLAH

Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I H
A
SALDO AWAL 01-06-2017 PENAMBAHAN
R PENGURANGAN SALDO AKHIR TGL. 30-06-2017
No. NAMA SATUAN NILAI G 30-06-17
02-06-17 S.D 01-06-17 S.D 31-06-17 NILAI KET
HARGA HARGA
KUANTITAS A KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 S 7 8 9 10 11 12 13
A
1 AMPLOP KABINET 300 dus 450 135,000 ### T
dus - dus - 300 dus 450 135,000

2 - - dus - - ### U
dus - dus - - dus - -
A
3 - - bh - - ### N
bh - bh - - bh - -

4 BLANGKO RINCIAN BIAYA TINDAKAN 20 bh 6,500 130,000 - - 20 6,500 130,000

5 BUKU PEMANTAUAN PROLANIS 300 bh 11,000 3,300,000 ###

bh - bh - 300 bh 11,000 3,300,000

6 BUKU SAKA BHAKTI HUSADA 24 bh 44,000 1,056,000 ###

- bh - - bh - 24 bh 44,000 1,056,000

7 BUKU LOGISTIK IMUNISASI 15 bh 20,000 300,000 ###

bh - bh - 15 bh 20,000 300,000

8 BUKU LAPORAN IMUNISASI 12 bh 15,000 180,000 ###

bh - bh - 12 bh 15,000 180,000

9 BUKU PEDOMAN PENYULUHAN 15 bh 12,750 191,250 ###

bh - bh - 15 bh 12,750 191,250

10 BUKU PEGANGAN KESH CAPENG 15 bh 10,000 150,000 ###

bh - bh - 15 bh 10,000 150,000
11 BUKTI PELAYANAN RANAP ( KLEM BPJS 250 bh 720 180,000 ###
2 bh 24,000 2 bh 24,000 250 bh 720 180,000

12 FORMULIR RM RAWAT JALAN 2,550 bh 1,115 2,843,250 ###

bh - bh - 2,550 bh 1,115 2,843,250

13 FORMULIR CM 2 400 bh 175 70,000 ###

bh - bh - 400 bh 175 70,000

14 FORMULIR CM 3 400 bh 175 70,000 ###

bh - bh - 400 bh 175 70,000

15 FORMULIR IGD BEDAH 100 dosin 350 35,000 ###

dosin - dosin - 100 dosin 350 35,000

16 FORMULIR RM RANAP NON BEDAH 1,000 dosin 1,500 1,500,000 ###

dosin - dosin - 1,000 dosin 1,500 1,500,000

17 FORMULIR PROFIL KESGA 2.2 500 dosin 270 135,000 ###

dosin - dosin - 500 dosin 270 135,000

18 KERTAS RESEP 5 dosin 70,000 350,000 ###

dosin - dosin - 5 dosin 70,000 350,000

19 KUESIONER SMD MMD 700 bh 1,080 756,000 ###

bh - bh - 700 bh 1,080 756,000

20 MAP FF 700 bh 2,000 1,400,000 ###

bh - bh - 700 bh 2,000 1,400,000

21 MAP REKAM MEDIK RANAP 1,000 750 1,000 750 750,000

22 PLASTIK 10 bk 25,000 250,000 bk### - bk - 10 bk 25,000 250,000

23 PWS KIA 12 bh 35,000 420,000 ###

bh - bh - 12 bh 35,000 420,000

24 PWS ANAK 12 bh 40,000 480,000 ###

bh - bh - 12 bh 40,000 480,000
 G
A

1 2 3 4 5 6 S 7 8 9 10 11 12 13
A
25 STOPMAP DAN FORMULIR KESGA 2,000 bh 6,500 ### ### T
bh - bh - 2,000 bh 6,500 13,000,000

26 STOPMAP PLASTIK SAABLON 1,000 bh 7,500 7,500,000 ### U

bh - bh - 1,000 bh 7,500 7,500,000
A
27 - - bh - - ### N
1 bh 5,000 1 bh 5,000 - bh - -

28 - - bh - - ###
bh - bh - - bh - -

JUMLAH ### ### 3 Rp 29,000 3 Rp 29,000 11,340 Rp 35,181,500

Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I H
A
SALDO AWAL 01-07-2017 PENAMBAHAN
R PENGURANGAN SALDO AKHIR TGL. 31-07-2017
No. NAMA SATUAN NILAI G 30-07-17
02-07-17 S.D 02-0-17 S.D 30-07-17 NILAI KET
HARGA HARGA
KUANTITAS A KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 S 7 8 9 10 11 12 13
A
1 AMPLOP KABINET 300 dus 450 135,000 ### T
dus - dus - 300 dus 450 135,000

2 - - dus - - ### U
dus - dus - - dus - -
A
3 - - bh - - ### N
bh - bh - - bh - -

4 BLANGKO RINCIAN BIAYA TI 20 bh 6,500 130,000 - - 20 6,500 130,000

5 BUKU PEMANTAUAN PROLANI 300 bh 11,000 3,300,000 ###

bh - bh - 300 bh 11,000 3,300,000

6 BUKU SAKA BHAKTI HUSADA 24 bh 44,000 1,056,000 ###

bh - bh - 24 bh 44,000 1,056,000

7 BUKU LOGISTIK IMUNISASI 15 bh 20,000 300,000 ###

bh - bh - 15 bh 20,000 300,000

8 BUKU LAPORAN IMUNISASI 12 bh 15,000 180,000 ###

bh - bh - 12 bh 15,000 180,000

9 BUKU PEDOMAN PENYULUHA 15 bh 12,750 191,250 ###

bh - bh - 15 bh 12,750 191,250

10 BUKU PEGANGAN KESH CAP 15 bh 10,000 150,000 ###

bh - bh - 15 bh 10,000 150,000
11 BUKTI PELAYANAN RANAP ( K 250 bh 720 180,000 ###
bh - bh - 250 bh 720 180,000

12 FORMULIR RM RAWAT JALAN 2,550 bh 1,115 2,843,250 ###

bh - bh - 2,550 bh 1,115 2,843,250

13 FORMULIR CM 2 400 bh 175 70,000 ###

bh - bh - 400 bh 175 70,000

14 FORMULIR CM 3 400 bh 175 70,000 ###

bh - bh - 400 bh 175 70,000

15 FORMULIR IGD BEDAH 100 dosin 350 35,000 ###

dosin - dosin - 100 dosin 350 35,000

16 FORMULIR RM RANAP NON B 1,000 dosin 1,500 1,500,000 ###

dosin - dosin - 1,000 dosin 1,500 1,500,000

17 FORMULIR PROFIL KESGA 2. 500 dosin 270 135,000 ###

dosin - dosin - 500 dosin 270 135,000

18 KERTAS RESEP 5 dosin 70,000 350,000 ###

dosin - dosin - 5 dosin 70,000 350,000

19 KUESIONER SMD MMD 700 bh 1,080 756,000 ###

bh - bh - 700 bh 1,080 756,000

20 MAP FF 700 bh 2,000 1,400,000 ###

bh - bh - 700 bh 2,000 1,400,000

21 MAP REKAM MEDIK RANAP 1,000 bh 750 750,000 ###

bh - bh - 1,000 bh 750 750,000

22 PLASTIK 10 bk 25,000 250,000 ###

bh - bk - 10 bk 25,000 250,000

23 PWS KIA 12 bh 35,000 420,000 ###

bh - bh - 12 bh 35,000 420,000

24 PWS ANAK 12 bh 40,000 480,000 ###

bh - bh - 12 bh 40,000 480,000
 G
A

1 2 3 4 5 6 S 7 8 9 10 11 12 13
A
25 STOPMAP DAN FORMULIR KE 2,000 bh 6,500 13,000,000 ### T
bh - bh - 2,000 bh 6,500 13,000,000

26 STOPMAP PLASTIK SAABLON 1,000 bh 7,500 7,500,000 ### U

bh - bh - 1,000 bh 7,500 7,500,000
A
27 - - bh - - ### N
bh - bh - - bh - -

28 - - bh - - ###
bh - bh - - bh - -

JUMLAH 35,181,500 - Rp - - Rp - 11,340 Rp 35,181,500

Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I H
A
SALDO AWAL 01-08-2017 PENAMBAHAN
R PENGURANGAN SALDO AKHIR TGL. 31-08-2017
No. NAMA SATUAN NILAI G 31-08-17
02-08-17 S.D 02-08-17 S.D 31-08-17 NILAI KET
HARGA
KUANTITAS HARGA SATUAN A KUANTITAS
( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 S 7 8 9 10 11 12 13
A
1 AMPLOP KABINET 300 dus 450 135,000 ### T
dus - dus - 300 dus 450 135,000

2 - - dus - - ### U
dus - dus - - dus - -
A
3 - - bh - - ### N
bh - bh - - bh - -

BLANGKO RINCIAN BIAYA TI 20 bh 6,500 130,000 - - 20 6,500 130,000

4 BUKU PEMANTAUAN PROLANI 300 bh 11,000 3,300,000 ###

bh - bh - 300 bh 11,000 3,300,000

5 BUKU SAKA BHAKTI HUSADA 24 bh 44,000 1,056,000 ###

bh - bh - 24 bh 44,000 1,056,000

6 BUKU LOGISTIK IMUNISASI 15 bh 20,000 300,000 ###

bh - bh - 15 bh 20,000 300,000

7 BUKU LAPORAN IMUNISASI 12 bh 15,000 180,000 ###

bh - bh - 12 bh 15,000 180,000

8 BUKU PEDOMAN PENYULUHA 15 bh 12,750 191,250 ###

bh - bh - 15 bh 12,750 191,250

9 BUKU PEGANGAN KESH CAP 15 bh 10,000 150,000 ###

bh - bh - 15 bh 10,000 150,000
10 BUKTI PELAYANAN RANAP ( K 250 bh 720 180,000 ###
bh - bh - 250 bh 720 180,000

11 FORMULIR RM RAWAT JALAN 2,550 bh 1,115 2,843,250 ###

bh - bh - 2,550 bh 1,115 2,843,250

12 FORMULIR CM 2 400 bh 175 70,000 ###

bh - bh - 400 bh 175 70,000

13 FORMULIR CM 3 400 bh 175 70,000 ###

bh - bh - 400 bh 175 70,000

14 FORMULIR IGD BEDAH 100 dosin 350 35,000 ###

dosin - dosin - 100 dosin 350 35,000

15 FORMULIR RM RANAP NON B 1,000 dosin 1,500 1,500,000 ###

dosin - dosin - 1,000 dosin 1,500 1,500,000

16 FORMULIR PROFIL KESGA 2. 500 dosin 270 135,000 ###

dosin - dosin - 500 dosin 270 135,000

17 KERTAS RESEP 5 dosin 70,000 350,000 ###

dosin - dosin - 5 dosin 70,000 350,000

18 KUESIONER SMD MMD 700 bh 1,080 756,000 ###

bh - bh - 700 bh 1,080 756,000

19 MAP FF 700 bh 2,000 1,400,000 ###

bh - bh - 700 bh 2,000 1,400,000

MAP REKAM MEDIK RANAP 1,000 750 750 -

20 PLASTIK 10 bk 25,000 250,000 bk### - bk - 10 bk 25,000 250,000

21 PWS KIA 12 bh 35,000 420,000 ###

bh - bh - 12 bh 35,000 420,000

22 PWS ANAK 12 bh 40,000 480,000 ###

bh - bh - 12 bh 40,000 480,000
 G
A

1 2 3 4 5 6 S 7 8 9 10 11 12 13
A
23 STOPMAP DAN FORMULIR KE 2,000 bh 6,500 ### ### T
bh - bh - 2,000 bh 6,500 13,000,000

24 STOPMAP PLASTIK SAABLON 1,000 bh 7,500 7,500,000 ### U

bh - bh - 1,000 bh 7,500 7,500,000
A
25 - - bh - - ### N
bh - bh - - bh - -

26 - - bh - - ###
bh - bh - - bh - -

JUMLAH ### ### - - - - 10,340 34,431,500

Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I

SALDO AWAL 01-09-2017 PENAMBAHAN PENGURANGAN SALDO AKHIR TGL. 30-09-2017

No. NAMA SATUAN HARGA NILAI 02-09-17 S.D 31-09-17 02-09-17 S.D 31-09-17 HARGA NILAI KET
KUANTITAS KUANTITA KUANTITAS
SATUAN ( Rp. ) ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
S
1 2 3 4 5 6 7 8 9 10 11 12 13
1 AMPLOP KABINET 300 dus 450 135,000 dus - dus - 300 dus 450 135,000

2 - - dus - - dus - dus - - dus - -

3 - - bh - - bh - bh - - bh - -

4 BLANGKO RINCIAN BIAYA TIND 20 bh 6,500 130,000 bh - bh - 20 bh 6,500 130,000

5 BUKU PEMANTAUAN PROLANIS 300 bh 11,000 3,300,000 bh - bh - 300 bh 11,000 3,300,000

6 BUKU SAKA BHAKTI HUSADA 24 bh 44,000 1,056,000 - bh - - bh - 24 bh 44,000 1,056,000

7 BUKU LOGISTIK IMUNISASI 15 bh 20,000 300,000 bh - bh - 15 bh 20,000 300,000

8 BUKU LAPORAN IMUNISASI 12 bh 15,000 180,000 bh - bh - 12 bh 15,000 180,000

9 BUKU PEDOMAN PENYULUHAN 15 bh 12,750 191,250 bh - bh - 15 bh 12,750 191,250

10 BUKU PEGANGAN KESH CAPE 15 bh 10,000 150,000 bh - bh - 15 bh 10,000 150,000

11 BUKTI PELAYANAN RANAP ( KL 250 bh 720 180,000 - bh - - bh - 250 bh 720 180,000

12 FORMULIR RM RAWAT JALAN 2,550 bh 1,115 2,843,250 bh - bh - 2,550 bh 1,115 2,843,250

13 FORMULIR CM 2 400 bh 175 70,000 bh - bh - 400 bh 175 70,000

14 FORMULIR CM 3 400 bh 175 70,000 bh - bh - 400 bh 175 70,000

15 FORMULIR IGD BEDAH 100 dosin 350 35,000 dosi - dosin - 100 dosin 350 35,000

16 FORMULIR RM RANAP NON BE 1,000 dosin 1,500 1,500,000 dosi - dosin - 1,000 dosin 1,500 1,500,000

17 FORMULIR PROFIL KESGA 2.2 500 dosin 270 135,000 dosi - dosin - 500 dosin 270 135,000

18 KERTAS RESEP 5 dosin 70,000 350,000 dosi - dosin - 5 dosin 70,000 350,000

19 KUESIONER SMD MMD 700 bh 1,080 756,000 bh - bh - 700 bh 1,080 756,000

20 MAP FF 700 bh 2,000 1,400,000 bh - bh - 700 bh 2,000 1,400,000

21 MAP REKAM MEDIK RANAP 750 - - - 750

22 PLASTIK 10 bk 25,000 250,000 bk - bk - 10 bk 25,000 250,000

23 PWS KIA 12 bh 35,000 420,000 bh - bh - 12 bh 35,000 420,000

24 PWS ANAK 12 bh 40,000 480,000 bh - bh - 12 bh 40,000 480,000

25 STOPMAP DAN FORMULIR KES 2,000 bh 6,500 ### bh - bh - 2,000 bh 6,500 13,000,000

26 STOPMAP PLASTIK SAABLON 1,000 bh 7,500 7,500,000 bh - bh - 1,000 bh 7,500 7,500,000

1 2 3 4 5 6 7 8 9 10 11 12 13
27 - - bh - - - bh - - bh - - bh - -

28 - - bh - - bh - bh - - bh - -

JUMLAH ### ### - Rp - - Rp - 10,340 Rp 34,431,500

.
Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I

SALDO AWAL 01-10-2017 PENAMBAHAN PENGURANGAN SALDO AKHIR TGL. 31-10-2017

No. NAMA SATUAN HARGA NILAI 02-10-17 S.D 30-10-17 02-10-17 S.D 30-10-17 HARGA NILAI KET
KUANTITAS KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 7 8 9 10 11 12 13
1 AMPLOP KABINET 300 dus 450 135,000 dus - dus - 300 dus 450 135,000

2 - - dus - - dus - dus - - dus - -

3 - - bh - - bh - bh - - bh - -

BLANGKO RINCIAN BIAYA TIND 20 bh 6,500 130,000 - - 20 6,500

4 BUKU PEMANTAUAN PROLANIS 300 bh 11,000 3,300,000 bh - bh - 300 bh 11,000 3,300,000

5 BUKU SAKA BHAKTI HUSADA 24 bh 44,000 1,056,000 bh - bh - 24 bh 44,000 1,056,000

6 BUKU LOGISTIK IMUNISASI 15 bh 20,000 300,000 bh - bh - 15 bh 20,000 300,000

7 BUKU LAPORAN IMUNISASI 12 bh 15,000 180,000 bh - bh - 12 bh 15,000 180,000

8 BUKU PEDOMAN PENYULUHAN 15 bh 12,750 191,250 bh - bh - 15 bh 12,750 191,250

9 BUKU PEGANGAN KESH CAPE 15 bh 10,000 150,000 bh - bh - 15 bh 10,000 150,000

10 BUKTI PELAYANAN RANAP ( KL 250 bh 720 180,000 bh - bh - 250 bh 720 180,000

11 FORMULIR RM RAWAT JALAN 2,550 bh 1,115 2,843,250 bh - bh - 2,550 bh 1,115 2,843,250

12 FORMULIR CM 2 400 bh 175 70,000 bh - bh - 400 bh 175 70,000

13 FORMULIR CM 3 400 bh 175 70,000 bh - bh - 400 bh 175 70,000

14 FORMULIR IGD BEDAH 100 dosin 350 35,000 dosi - dosin - 100 dosin 350 35,000

15 FORMULIR RM RANAP NON BE 1,000 dosin 1,500 1,500,000 dosi - dosin - 1,000 dosin 1,500 1,500,000

16 FORMULIR PROFIL KESGA 2.2 500 dosin 270 135,000 dosi - dosin - 500 dosin 270 135,000

17 KERTAS RESEP 5 dosin 70,000 350,000 dosi - dosin - 5 dosin 70,000 350,000

18 KUESIONER SMD MMD 700 bh 1,080 756,000 bh - bh - 700 bh 1,080 756,000

19 MAP FF 700 bh 2,000 1,400,000 bh - bh - 700 bh 2,000 1,400,000

MAP REKAM MEDIK RANAP - 750 - - - 750

20 PLASTIK 10 bk 25,000 250,000 bk - bk - 10 bk 25,000 250,000

21 PWS KIA 12 bh 35,000 420,000 bh - bh - 12 bh 35,000 420,000

22 PWS ANAK 12 bh 40,000 480,000 bh - bh - 12 bh 40,000 480,000

23 STOPMAP DAN FORMULIR KES 2,000 bh 6,500 13,000,000 bh - bh - 2,000 bh 6,500 13,000,000

24 STOPMAP PLASTIK SAABLON 1,000 bh 7,500 7,500,000 bh - bh - 1,000 bh 7,500 7,500,000

1 2 3 4 5 6 7 8 9 10 11 12 13
25 - - bh - - bh - bh - - bh - -

26 - - bh - - bh - bh - - bh - -

JUMLAH 10,340 34,431,500 - Rp - - Rp - 10,340 Rp 34,301,500

Cilacap, 31 Maret 2017 Cilacap, 31 Oktober 2016

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012

###

12,672
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I

SALDO AWAL 02-11-2017 PENAMBAHAN PENGURANGAN SALDO AKHIR TGL. 30-11-2017

No. NAMA SATUAN HARGA NILAI 02-11-17 S.D 30-11-17 02-11-17 S.D 30-11-17 HARGA NILAI KET
KUANTITAS KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 7 8 9 10 11 12 13
1 AMPLOP KABINET 300 dus 450 135,000 - dus - - dus - 300 dus 450 135,000 -
2 - - dus - - - dus - - dus - - dus - - -
3 - - bh - - - bh - - bh - - bh - - -
BLANGKO RINCIAN BIAYA TIND 20 bh 6,500 130,000 - - - - - - 20 - 6,500 130,000 -
4 BUKU PEMANTAUAN PROLANIS 300 bh 11,000 3,300,000 - bh - - bh - 300 bh 11,000 3,300,000 -
5 BUKU SAKA BHAKTI HUSADA 24 bh 44,000 1,056,000 - bh - - bh - 24 bh 44,000 1,056,000 -
6 BUKU LOGISTIK IMUNISASI 15 bh 20,000 300,000 - bh - - bh - 15 bh 20,000 300,000 -
7 BUKU LAPORAN IMUNISASI 12 bh 15,000 180,000 - bh - - bh - 12 bh 15,000 180,000 -
8 BUKU PEDOMAN PENYULUHAN 15 bh 12,750 191,250 - bh - - bh - 15 bh 12,750 191,250 -
9 BUKU PEGANGAN KESH CAPE 15 bh 10,000 150,000 - bh - - bh - 15 bh 10,000 150,000 -
10 BUKTI PELAYANAN RANAP ( KL 250 bh 720 180,000 - bh - - bh - 250 bh 720 180,000 -
11 FORMULIR RM RAWAT JALAN 2,550 bh 1,115 2,843,250 - bh - - bh - 2,550 bh 1,115 2,843,250 -
12 FORMULIR CM 2 400 bh 175 70,000 - bh - - bh - 400 bh 175 70,000 -
13 FORMULIR CM 3 400 bh 175 70,000 - bh - - bh - 400 bh 175 70,000 -
14 FORMULIR IGD BEDAH 100 dosin 350 35,000 - dosi - - dosin - 100 dosin 350 35,000 -
15 FORMULIR RM RANAP NON BE 1,000 dosin 1,500 1,500,000 - dosi - - dosin - 1,000 dosin 1,500 1,500,000 -
16 FORMULIR PROFIL KESGA 2.2 500 dosin 270 135,000 - dosi - - dosin - 500 dosin 270 135,000 -
17 KERTAS RESEP 5 dosin 70,000 350,000 - dosi - - dosin - 5 dosin 70,000 350,000 -
18 KUESIONER SMD MMD 700 bh 1,080 756,000 - bh - - bh - 700 bh 1,080 756,000 -
19 MAP FF 700 bh 2,000 1,400,000 - bh - - bh - 700 bh 2,000 1,400,000 -
MAP REKAM MEDIK RANAP - - 750 - - - - - - - - - 750 - -
20 PLASTIK 10 bk 25,000 250,000 - bk - - bk - 10 bk 25,000 250,000 -
21 PWS KIA 12 bh 35,000 420,000 - bh - - bh - 12 bh 35,000 420,000 -
22 PWS ANAK 12 bh 40,000 480,000 - bh - - bh - 12 bh 40,000 480,000 -
23 STOPMAP DAN FORMULIR KES 2,000 bh 6,500 13,000,000 - bh - - bh - 2,000 bh 6,500 13,000,000 -
24 STOPMAP PLASTIK SAABLON 1,000 bh 7,500 7,500,000 - bh - - bh - 1,000 bh 7,500 7,500,000 -
1 2 3 4 5 6 7 8 9 10 11 12 13
25 - - bh - - - bh - - bh - - bh - - -
26 - - bh - - - bh - - bh - - bh - - -
JUMLAH 34,431,500 - Rp - - Rp - Rp 34,431,500

.
Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012

12,672
 DAFTAR PERSEDIAAN

JENIS PERSEDIAAN : PERSEDIAAN BAHAN CETAK

DINAS / INSTANSI : UPT PUSKESMAS WANAREJA I

SALDO AWAL 01-12-2017 PENAMBAHAN PENGURANGAN SALDO AKHIR TGL. 31-12-2017

No. NAMA SATUAN HARGA NILAI 01-12-17 S.D 31-12-17 01-12-17 S.D 31-12-17 HARGA NILAI KET
KUANTITAS KUANTITAS
SATUAN ( Rp. ) KUANTITAS ( Rp. ) KUANTITAS ( Rp. ) SATUAN ( Rp. )
1 2 3 4 5 6 7 8 9 10 11 12 13
1 AMPLOP KABINET 300 dus 450 135,000 dus - dus - 300 dus 450 135,000

2 - - dus - - dus - dus - - dus - -

3 - - bh - - bh - bh - - bh - -

4 BLANGKO RINCIAN BIAYA TIND 20 bh 6,500 130,000 - - 20 6,500 130,000

5 BUKU PEMANTAUAN PROLANIS 300 bh 11,000 3,300,000 bh - bh - 300 bh 11,000 3,300,000

6 BUKU SAKA BHAKTI HUSADA 24 bh 44,000 1,056,000 bh - bh - 24 bh 44,000 1,056,000

7 BUKU LOGISTIK IMUNISASI 15 bh 20,000 300,000 bh - bh - 15 bh 20,000 300,000

8 BUKU LAPORAN IMUNISASI 12 bh 15,000 180,000 bh - bh - 12 bh 15,000 180,000

9 BUKU PEDOMAN PENYULUHAN 15 bh 12,750 191,250 bh - bh - 15 bh 12,750 191,250

10 BUKU PEGANGAN KESH CAPE 15 bh 10,000 150,000 bh - bh - 15 bh 10,000 150,000

11 BUKTI PELAYANAN RANAP ( KL 250 bh 720 180,000 bh - bh - 250 bh 720 180,000

12 FORMULIR RM RAWAT JALAN 2,550 bh 1,115 2,843,250 bh - bh - 2,550 bh 1,115 2,843,250

13 FORMULIR CM 2 400 bh 175 70,000 bh - bh - 400 bh 175 70,000

14 FORMULIR CM 3 400 bh 175 70,000 bh - bh - 400 bh 175 70,000

15 FORMULIR IGD BEDAH 100 dosin 350 35,000 dosi - dosin - 100 dosin 350 35,000

16 FORMULIR RM RANAP NON BE 1,000 dosin 1,500 1,500,000 dosi - dosin - 1,000 dosin 1,500 1,500,000

17 FORMULIR PROFIL KESGA 2.2 500 dosin 270 135,000 dosi - dosin - 500 dosin 270 135,000

18 KERTAS RESEP 5 dosin 70,000 350,000 dosi - dosin - 5 dosin 70,000 350,000

19 KUESIONER SMD MMD 700 bh 1,080 756,000 bh - bh - 700 bh 1,080 756,000

20 MAP FF 700 bh 2,000 1,400,000 bh - bh - 700 bh 2,000 1,400,000

21 MAP REKAM MEDIK RANAP - 750 - - 750

22 PLASTIK 10 bk 25,000 250,000 bk - bk - 10 bk 25,000 250,000

23 PWS KIA 12 bh 35,000 420,000 bh - bh - 12 bh 35,000 420,000

24 PWS ANAK 12 bh 40,000 480,000 bh - bh - 12 bh 40,000 480,000

25 STOPMAP DAN FORMULIR KES 2,000 bh 6,500 13,000,000 bh - bh - 2,000 bh 6,500 13,000,000

26 STOPMAP PLASTIK SAABLON 1,000 bh 7,500 7,500,000 bh - bh - 1,000 bh 7,500 7,500,000

1 2 3 4 5 6 7 8 9 10 11 12 13
27 - - bh - - bh - bh - - bh - -

28 - - bh - - bh - bh - - bh - -

JUMLAH 34,431,500 - Rp - - Rp - Rp 34,431,500

Cilacap, 31 Maret 2017

KEPALA UPT PUSKESMAS WANAREJA I PENGELOLA PERSEDIAAN/ INVENTARIS

KABUPATEN CILACAP

Dr.TEGUH WIBOWO WEMI ARIYANTO,AMK

NIP. 19691126 200212 1 002 NIP.19790512 200501 1 012