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DOC : BHCC/YM/IGD/FR-

15/01-00

CEK LIST AMBULANCE


TANGGAL
NAMA ALAT / OBAT JUMLAH KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Perban Balut 1 gulung
Kassa Steril 1 kotak
Kapas / Alkohol swab 1 kotak
Plester 1 pcs
Alkohol 70% 1 botol
Cairan Infus Nacl 0,9% 1 botol
Sarung Tangan Steril 1 psg
Betadine 1 botol
Sarung Tangan On 1 box
Spuit 10 cc 5 pcs
Bag valve mask 1 pcs
Nasal kanul 1 pcs
Simple Mask 1 pcs
Rebreathing Mask 1 pcs
Non Rebreathing Mask 1 pcs
Infus set 5 pcs
IV Catheter 5 pcs
Tensimeter 1 pcs
Spuit 3cc 5 pcs
Stetoscope 1 pcs
Poley Catheter 1 pcs
Urine Bag 1 pcs
Tourniket 2 pcs
Perban Gulung 1 gulung
Mitela 5 pcs
Elastik Perban 1 pcs
Tabung oksigen (portable1 pcs
Regulator / Flowmeter ok1 pcs
Spalk / bidai 5 pcs
Scoope strecher 1 pcs
Urinal / pispot 1 pcs
Neirbeken 1 pcs
Masker 1 box
Selimut 1 pcs
DOC : BHCC/YM/IGD/FR-
15/02-00

CEK LIST OBAT - OBATAN AMBULANCE


TANGGAL KET
NAMA OBAT JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19###
###
###
###24###26###28 29 30 31
Adrenlin / Epinepri 2
Sulfat Atropin 0,2 2
Kalmetason 2
Buscopan 2
Dextrose 40% 2
Lasik 2
Aminophiline 2
Cylocard 100 mg 2
Lidocain 2% 2
Diazepam 2
Valium 10 mg 2
ISDN 2
DOC : BHCC/YM/IGD/FR-
15/01-00

CEK LIST AMBULANCE


TANGGAL
NAMA ALAT / OBAT JUMLAH KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Regulator / Flowmeter o 1 pcs


Spalk / bidai 5 pcs
Scoope strecher 1 pcs
Urinal / pispot 1 pcs
Neirbeken 1 pcs
Masker 1 box
Selimut 1 pcs

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