Stoke Offnam 2018

PEMERINTAH KABUPATEN GARUT
DINAS KESEHATAN
UPT PUSKESMAS SINDANGRATU
Jl Raya Bungbulang KM 65 Pakenjeng-Garut
e.mail : puskesmasdtpsindangratu@gmail.com
BERITA ACARA STOK OPNAME

GUDANG UPT PUSKESMAS SINDANGRATU PER 31 Desember 2018
Pada Hari Ini Senin Tanggal Tiga Puluh Satu Bulan Desember Tahun dua ribu delapan belas telah dilakukan
pemeriksaan fisik barang-barang yang ada di gudang UPT Puskesmas Sindangratu.
Persedian barang tesebut terdiri dari :
Persediaan Alat Tulis Kantor Sebesar Rp 5,893,500

Persediaan Bahan Laboratoium Sebesar Rp 2,243,000
Bahan Medis Habis Pakai Sebesar Rp 3,380,100
Persediaan Barang Gizi Sebesar Rp 67,000
Persediaan BHP Ruangan dan Oksigen Sebesar Rp 280,000
Persediaan Alat dan Bahan Kebersihan Sebesar Rp 92,000
Jumlah Total Rp 11,955,600
Adapun secara detail persediaan tersebut terlampir.

Demikian Berita Acara Stock Opname ini dibuat untuk digunakan sebagaimana mestinya
Sindangratu,
Pejabat Penerima Hasil Pekerjaan Petugas Pengelola Stock
Dede Hidayat Gina Sonia

NIP. 19680803 200901 1 003
Mengetahui
Kepala BLUD UPT Puskesmas Sindangratu Pejabat Teknis UPT Puskesmas Sind
A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.Ip

NIP.19660211 198803 1 004 NIP.19680824 198903 2 004
T
ATU
t
Desember 2018
u delapan belas telah dilakukan

ngratu.
31 Desember 2018
Petugas Pengelola Stock
Gina Sonia
bat Teknis UPT Puskesmas Sindangratu
Dedeh Sopaenah, S.Ip

NIP.19680824 198903 2 004
DINAS KESEHATAN

Persediaan Alat Tulis Kantor
Pada Hari Ini Senin Tanggal Tiga Puluh Satu Bulan Desember Tahun dua ribu delapan belas telah dilakukan pemer
barang-barang yang ada di gudang UPT Puskesmas Sindangratu.
PENGADAAN
NO URAIAN UKURAN BANYAKNYA HARGA SATUAN
1 Kertas F4 40 RIM 40,000

2 Kertas A4 37 RIM 38,000
3 Tinta Hitam 3 BTL 90,000
4 Tinta Warna 9 BTL 95,000
5 Pensil 7 BUAH 2,000
6 Klip Besar 2 BOK 24,000
7 Map Plastik 9 PAK 23,000
8 Kertas Thermal 8 45,000
9 Tinta Serbuk Photocopy 1 114,500
10 Klip Kecil 1 BOK 16,000
11 Paku Heckter 3 bok 26,000
12 Map Kertas 10 PAK 17,000
13 Tinta Printer 6 Warna 6 BTOL 105,000
14 Map Folder 5 25,000
Jumlah Total
Sindangratu,

NIP. 19680803 200901 1 003
Mengetahui
Kepala BLUD UPT Puskesmas Sindangratu Pejabat Teknis UPT Puskesmas S
A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.I

NIP.19660211 198803 1 004 NIP.19680824 198903 2
EMERINTAH KABUPATEN GARUT
DINAS KESEHATAN
T PUSKESMAS SINDANGRATU
Raya Bungbulang KM 65 Pakenjeng-Garut

Persediaan Alat Tulis Kantor
Bulan Desember Tahun dua ribu delapan belas telah dilakukan pemeriksaan fisik
esmas Sindangratu.
PENGADAAN
TOTAL HARGA
1,600,000
1,406,000
270,000
855,000
14,000
48,000
207,000
360,000
114,500
16,000
78,000
170,000
630,000
125,000
Rp 5,893,500
31 Desember 2018
Petugas Pengelola Stock
Gina Sonia
Pejabat Teknis UPT Puskesmas Sindangratu
Dedeh Sopaenah, S.Ip

NIP.19680824 198903 2 004
DINAS KESEHATAN

Persediaan Bahan Laboratoium
Pada Hari Ini Senin Tanggal Tiga Puluh Satu Bulan Desember Tahun dua ribu delapan belas telah dilakukan pemeriksaan
fisik barang-barang yang ada di gudang UPT Puskesmas Sindangratu.
NO URAIAN UKURAN BANYAKNYA SATUAN
1 GOT IFCC 20X5ml ML 1 130,500

2 GPT IFCC 20X5ml Buah 1 130,500
3 Reagen Sysmex Paket 1 1,752,000
4 STIK Kolestro BOK 1 115,000
5 STIK Asam Urat Bok 1 115,000
Jumlah Total
Sindangratu,

NIP. 19680803 200901 1 003
Mengetahui
Pejabat Teknis UPT Puskesmas

Kepala BLUD UPT Puskesmas Sindangratu
Sindangratu

NIP.19660211 198803 1 004 NIP.19680824 198903 2 004
s telah dilakukan pemeriksaan
TOTAL HARGA
130,500
130,500
1,752,000
115,000
115,000
Rp 2,243,000
31 Desember 2018
tugas Pengelola Stock
Gina Sonia
at Teknis UPT Puskesmas

Sindangratu
deh Sopaenah, S.Ip

19680824 198903 2 004
DINAS KESEHATAN

Bahan Medis Habis Pakai
Pada Hari Ini Senin Tanggal Tiga Puluh Satu Bulan Desember Tahun dua ribu delapan belas telah dilakukan pemeriksaan fis
barang-barang yang ada di gudang UPT Puskesmas Sindangratu.
1 HandSok Bok 1 67,000

2 Kantong kresek kecil Buah 6 7,000
3 Umbilical Klaim Buah 207 6,270
4 Pembalut Hidropil DRC 250 gr Buah 40 29,000
5 Aqua Gel 82 gr Buah 10 52,000
6 Kasa Steril Dus 16 8,200
7 Betadine BTOL 1 57,000
8 Kasa Gulung 1 105,000
Jumlah Total
Sindangratu,

NIP. 19680803 200901 1 003
Mengetahui

Pejabat Teknis UPT Puskesmas Sindangr

NIP.19660211 198803 1 004 NIP.19680824 198903 2 004
s telah dilakukan pemeriksaan fisik
TOTAL HARGA
67,000
42,000
1,297,890
1,160,000
520,000
131,200
57,000
105,000
Rp 3,380,100
31 Desember 2018
etugas Pengelola Stock
Gina Sonia
knis UPT Puskesmas Sindangratu
edeh Sopaenah, S.Ip

P.19680824 198903 2 004
DINAS KESEHATAN

Persediaan Barang Gizi
1 Telor kg 1 22,000
2 masako bks 2 500
3 Beras Kg 2 12,000
4 Worte Kg 1.0 13,000
5 tempe bks 1 7,000
Jumlah Total
Sindangratu,

NIP. 19680803 200901 1 003
Mengetahui

Sindangratu

NIP.19660211 198803 1 004 NIP.19680824 198903 2 004
TOTAL HARGA
22,000
1,000
24,000
13,000
7,000
Rp 67,000
31 Desember 2018
Gina Sonia

Sindangratu
deh Sopaenah, S.Ip

19680824 198903 2 004
DINAS KESEHATAN

Persediaan BHP Ruangan dan Oksigen
1 Pengisian tabung O2 Kecil tabung 1 40,000

2 Pemgisian tabung O2 Besar tabung 3 80,000
Jumlah Total
Sindangratu,

NIP. 19680803 200901 1 003
Mengetahui

Sindangratu

NIP.19660211 198803 1 004 NIP.19680824 198903 2 004
TOTAL HARGA
40,000
240,000
Rp 280,000
31 Desember 2018
Gina Sonia

Sindangratu
deh Sopaenah, S.Ip

19680824 198903 2 004
DINAS KESEHATAN

Persediaan Alat dan Bahan Kebersihan
1 DETERGEN BKS 1 44,000

2 PENGHARUM RUANGAN BKS 1 20,000
3 Pewangi bks 1 28,000
Jumlah Total
Sindangratu,

NIP. 19680803 200901 1 003
Mengetahui
Kepala BLUD UPT Puskesmas Sindangratu Sindangratu

NIP.19660211 198803 1 004 NIP.19680824 198903 2 004
TOTAL HARGA
44,000
20,000
28,000
Rp 92,000
31 Agustus 2018
Gina Sonia
Sindangratu
deh Sopaenah, S.Ip

19680824 198903 2 004
Penerimaan Barang Persediaan Ta
Saldo Per 31 Desember 2017
2018
No Nama Barang Satuan
Harga
Vol Jumlah Vol
Satuan
A Bahan Habis Pakai
Alat Tulis Kantor
1 F4 70 Office Rim 5 40,000 200,000 95
2 A4 70 Office Rim 0 38,000 0 90
3 F4 Karton Rim 2 60,000 120,000 20
4 Tinta Epson Hitam L120 Buah 0 90,000 0 20
5 Tinta Epson Hitam L800 Buah 0 145,000 0 10
6 Tinta Epson Biru Buah 0 95,000 0 20
7 Tinta Epson Kuning Buah 0 95,000 0 20
8 Tinta Epson Merah Buah 0 95,000 0 20
9 Tinta Serbuk Buah 1 50,000 50,000 2
10 Buku Kwarto Besar 200 Buah 0 16,000 0 9
11 Buku Folio Besar 200 Buah 0 32,000 0 10
12 Buku Folio 100 L Buku 0 17,000 0 5
13 Buku Folio 300 L Buku 0 75,000 0 5
14 Ballpoint Snowman v5 Buah 0 6,000 0
15 Ballpoint Tizo Biru Buah 0 4,000 0
16 Ballpoint Buah 0 3,000 0
17 Ballpoint Buah 0 2,000 0 24
18 Spidol Snowman Permanen Buah 0 7,000 0 36
19 Spidol Snowman Permanen Buah 0 9,000 0 -
1
20 Spidol Snowman White Board Buah 0 8,000 0 36
21 Pensil 2B Staedler Buah 0 8,000 0 -
22 Guntng Besar Buah 0 30,000 0 1
23 Penghapus Pensil Buah 0 2,500 0 12
24 Isi Hekter Besar 24/6 Pak 0 75,000 0 10
25 Isi Hekter Kecil 10 Pak 0 26,000 0 10
26 Cutter L500 Buah 0 17,000 0 10
27 Isi Cutter L500 Buah 0 6,000 0 20
28 Plastik Mika Jilid Pak 0 1,500 0 20
29 Klip Besar Pak 0 24,000 0 20
30 Map Plastik Pak 0 23,000 0 30
31 Ketas Thermal Buah 0 45,000 0 30
32 Tinta Serbuk Photocopy Buah 0 114,500 0 4
33 Klip Kecil No.3 Pak 0 16,000 0 20
34 Map Kertas Biasa Pak 0 17,000 0 25
35 Tinta Printer Botol Besar Botol 0 105,000 0 10
36 Map Folder Buah 0 25,000 0 10
37 Materai 3000 Buah 0 3,000 0 500
38 Materai 6000 Buah 0 6,000 0 150
39 Amplop Pak 0 25,000 0 5
Alat Listrik dan elektrik
1 paku kabel buah 0 0 0 2
2 plafon saklar listrik buah - - - 1
3 bohlam buah - - - 2
4 Batre Energzer max Pak - - - 1
5 ABC R-6 Biru Pak - - - 1
6 ABC LR-06 AA Pak - - - 1
7 Stoket T Buah - - - 1
8 LED panasonic 9 w Buah - - - 5
9 LED panasonic 18 w Buah - - - 5
10 LED Philip 15 w Buah - - - 5
11 Lampu emergency 15 w Buah - - - 3
12 Stop kontak 4 tabung Buah - - - 0
13 Batu batre mix Buah - - - 1
14 Batu batre ABC Buah - - - 4
15 Batu ABC lr A4 Buah - - - 1
16 Batu ABC lr 06 Buah - - - 4
17 Batu batre eperdin Buah - - - 1
18 LED 12 w Buah - - - 1
19 LED Neon Buah - - - 1
20 Emergency hanok Buah - - - 3
21 LED philip 5 w Buah - - - 5
2
22 LED philip 6,5 w Buah - - - 3
23 LED philip 10,5 Buah - - - 2
24 LED philip 19 w Buah - - - 5
25 philip esensial 18 w Buah - - - 2
26 Philip tornado 24 w Buah - - - 8
27 Philip tornado 20 w Buah - - - 2
28 Philip pijar 40 + 60 w Buah - - - 8
29 NCB Buah - - - 5
30 Stop kontak Buah - - - 2
31 Batre Mix Buah - - - 2
32 Kabel NYN Meter - - - 10
33 NCB broco Buah - - - 10
34 Tutup NCB Buah - - - 1
35 Batre ABC Buah - - - 1
36 Batre ABC lr 03 Buah - - - 1
37 Kabel Buah - - - 1
38 Plapon Buah - - - 1
39 Piting Buah - - - 1
40 Saklar Buah - - - 1
41 Sekrup Buah - - - 2
42 Batu ABC Alkalin Buah - - - 20
43 Batu Energenzer Buah - - - 20
Peralatan kebersihan dan bahan
pembersih
1 Tempat Sampah injak Buah 73,590 3
2 Baby Bath Viola SL Buah 66,343 3
3 Gayung hati Besar Buah 10,035 1
4 Ember Buah 30,663 4
5 Pengki Buah 16,725 6
6 Sapu rayung Kecil Buah 23,973 -
7 Sapu Rayung Sedang Buah 26,760 3
8 Nagoya Pel Biru Buah 23,415 -
9 Yosika Kanebo Tabung SR Buah 18,955 2
10 Kesed Indah K Buah 10,035 6
11 Plastik Pak - 10
12 Molto Botol - 1
13 Tissue Pak - 2
14 Bayclin Botol - 2
15 Rinso Kg - 1
16 Pewangi Soklin Botol - 1
17 Soklin Pemutih Botol - 15
18 Daia Kg - 1
19 Kesed Wellcome Kain Buah 23,973 -
20 Alfa TIS 700 Pak - 2
21 Tempat Cucian Buah - 1
22 Boom 400 Grm Buah - 2
23 Alfa C.PRG LMN Buah - 2
24 Wipol Pine Botol - 1
25 Sedotan Flexi Buah - 1
26 Bayclin 500 ML Botol - 3
27 Stella Buah - 1
28 Paseo Tis 250 S Pak - 1
29 Kantong Kresek 30 cm Pak - 1
30 Tissue Pak - 6
31 Hand shoap Pak - 2
32 Karbol Sereh Liter - 8
33 Detol HW sensitif Botol - 5
34 Tissue Tesa Pcs - 15
36 Paseo Pak - 3
3 37 Rinso Sacset Sct - 1

38 Tiseu Pak - 4
39 Sunligth Botol - 1
41 Sunligth Botol - 2
42 Glade M PRS Pcs - 2
43 Tisue alfa Pak - 4
44 Karbol Botol - 1
45 Ron-up Botol - 1
46 Cling Botol - 4
47 Wipol Botol - 2
48 Repil Hand shoap Pcs - 4
49 Detergen 900 grm Pcs - 5
50 Mama lemon Botol - 3
51 Kamper sub boll Buah - 5
52 Hand shoap Botol - 2
53 Stela gantung Pcs - 10
54 Tisue Paseo Pak - 10
55 Kresek 30 panda Pak - 2
56 Kresek 24 tulip Pak - 2
57 Sabut Stainles Buah - 3
58 Kanebo Buah - 6
59 Sapu Plastik Buah - 3
60 Lap Pel Dragon Buah - 6
61 Kamoceng Buah - 3
62 Sikat Wc Lion Star Buah - 4
63 Sikat Klining Buah - 5
64 Spon Politek Buah - 3
65 Alfa Tisue Pak - 3
66 Bayclin 500 ML Botol - 4
67 Harpic org Botol - 2
68 Harpic tact Botol - 1
69 Sos sereh Botol - 2
70 Sos apel 800 ml Botol - 8
71 Tempat sampah tertutup Buah - 1
72 Sikat panjang Buah - 1
73 DETERGEN Botol 1 44,000 44,000 2
74 PENGHARUM RUANGAN Pcs 1 20,000 20,000 2
75 Pewangi Pcs 2 28,000 56,000 3
Barang cetakan (formulir/ blanko)
1 Rincian Biaya Perawatan BUKU 15

2 Rincian BMHP Swasta BUKU 35
3 Rincian Biaya Ambulance BUKU 20
4 Rekam Medik UGD SET 400
5 Rincian BMHP Dinkes BUKU 13
6 Form Hasil Pemeriksaan Lab BUKU 12
7 Form Hasil Pemeriksaan Urine BUKU 12
8 Belangko Hasil Pemeriksaan BUKU 12
9 Daftar Pemeriksaan Lab BUKU 12
10 Daftar Rincian Biaya Lab BUKU 17
11 Rincian Biaya Lab BUKU 17
12 Surat Keterangan Sakit BUKU 40
13 Surat Rujukan Umum BUKU 18
14 Surat Keterangan Di Rawat BUKU 20
15 Surat Keterangan Buta Warna BUKU 20
16 Ekspedisi Surat BUKU 11
17 Rekam medis Poned SET 400
18 Kartu Kunjungan KB LEMBAR 1,000
19 Buku Register KIA BUKU 5
20 Buku Register Bayi Poned BUKU 5
21 Buku Register Poned BUKU 5
22 Surat Perintah Rawat Inap BUKU 40
23 Lembar Persetujuan KB BUKU 40
24 Kwitansi JKN BUKU -
25 Rekapitulasi Obat Bulanan BUKU 11
26 Rekapitulasi Obat Harian BUKU 13
27 Penerimaan Obat BUKU 9
28 Lembar Persetujuan Anc Dan BUKU 20
29 Kartu Rekam Medik ( Umum) LEMBAR 11,000
30 Kartu Kunjungan (Umum) LEMBAR 5,000
31 Harian Pasien BUKU -
32 Map Rekam Medik Buah 1,000
33 Inform Concent LEMBAR 11,000
34 Amplop Rekam Medik Buah -
35 Rincian Biaya KIA BUKU -
36 Rincian Biaya PONED BUKU -
37 Kohor Ibu BUKU 10
38 Kohor Bayi BUKU 10
39 Sistem Informasi posyandu (SI BUKU 62
40 SKDN BUKU 62
41 Leaflet Buah 100
42 Buku Agenda BUKU 50
B. REKAPITULASI OBAT
43 BUKU 12
BULANAN
B. LAPORAN DISTRIBUSI
44 OBAT KE PUSTU, BP, BUKU 5
POLINDES
45 B. HASIL PEMERIKSAAN BUKU 30
B. HASIL PEMERIKSAAN
46 BUKU 30
URINE
47 B. HASIL PEMERIKSAAN BUKU 30
KARTU KUNJUNGAN
48 LEMBAR 500
VAKSIN HPR
KARTU IDENTITAS
49 LEMBAR 500
PENDERITA
50 KARTU PESERTA KB LEMBAR 500
RINCIAN BIAYA
51 PENGGUNAAN BMHP & BUKU 20
OBAT SWASTA
RINCIAN BIAYA
52 BUKU 20
AMBULANCE
53 KWITANSI BUKU 20
54 BUKTI PELAYANAN JKN BUKU 20
4
55 SURAT PERINTAH RANAP BUKU 20
LEMBAR PERSETUJUAN
4 56 (INFORMED CONSENT) BUKU 20
PELAYANAN KB
LEMBAR PERSETUJUAN
57 (INFORMED CONSENT) BUKU 20
PEMERIKSAAN ANC & PNC
LEMBAR PERSETUJUAN
58 (INFORMED CONSENT) BUKU 10
PEMERIKSAAN USG
59 KETERANGAN LAHIR BUKU 20
PEMAKAIAN OBAT PADA
60 BUKU 5
RESEP
61 PENERIMAAN OBAT BUKU 5
62 RESEP BUKU 20
LAPORAN KEUANGAN
63 BUKU 5
OBAT SWASTA
RINCIAN BIAYA
64 BUKU 10
LABORATORIUM
REGISTER TBC UNIT
65 PELAYANAN KESEHATAN BUKU 10
(UPK)
RINCIAN BIAYA
66 BUKU 10
LABORATORIUM
KARTU PENGOBATAN
67 LEMBAR 200
PASIEN TB (TB.01)
FORMULIR PERMOHONAN
68 PEMERIKSAAN BUKU 10
BAKTERIOLOGIS TB
LAPORAN BULANAN
69 BUKU 20
PUSKESMAS
LAPORAN BULANAN
PELAYANAN
70 BUKU 20
LABORATORIUM
PUSKESMAS
RINCIAN TARIF PELAYANAN

71 BUKU 20
DI RUANG UGD
RINCIAN BIAYA
72 BUKU 20
PERAWATAN
REKAPITULASI PENDERITA
73 BUKU 20
GIGITAN HPR
SURAT LAPORAN
74 BUKU 20
PEMAKAIAN VAR
75 RINCIAN BIAYA BP GIGI BUKU 20
LAPORAN BULANAN TB
76 BUKU 20
PARU
77 KARTU BAYI BUKU 10
78 PARTOGRAF BUKU 10
79 KARTU IBU BUKU 10
80 BUKU REGISTER KIA BUKU 10
81 BUKU REGISTER PONED BUKU 10
BUKU REGISTER BAYI
82 BUKU 10
PONED
PERNYATAAN
PERSETUJUAN
83 BUKU 20
PERAWATAN & TINDAKAN
MEDIK
BUKU REGISTER
84 KUNJUNGAN PASIEN BP BUKU 500
GIGI
ASUHAN KEPERAWATAN /
85 BUKU 5
KEBIDANAN
BUKU REGISTER
86 KUNJUNGAN RANAP BUKU 5
TAHUN 2019
BUKU REGISTER
87 KUNJUNGAN UGD TAHUN BUKU 5
2019
BUKU REGISTER
88 KUNJUNGAN PELAYANAN BUKU 5
UMUM TAHUN 2019
BUKU REGISTER
KUNJUNGAN
89 BUKU 5
LABORATORIUM TAHUN
2019
pengisian tabung gas

1 Pengisian tabung O2 kecil tabung 2 40,000 80,000 40
5
2 Pengisian tabung O2 kecil tabung 0 60,000 0 0
3 Pengisian tabung O2 besar tabung 2 80,000 160,000 50
Bahan Pangan/ gizi
1 Beras Kg 12,000 321
2 Garam (Kecil) Bks 2,000 7
3 Kecap Btl 14,500 7
4 Merica Bks 500 80
5 Wortel Kg 13,508 18
6 Kentang Kg 13,469 20
7 Buncis Kg 12,133 20
8 Daging Ayam Kg 29,011 40
9 Bawang merah Kg 37,333 18
10 Bawang putih Kg 27,368 18
11 Tomat Kg 7,000 20
6
12 Bayam Kg 2,000 9
13 Brokoli Kg 23,202 29
14 Daging sapi Kg 109,375 19
15 Ati sapi Kg 90,000 22
16 Ikan Kg 30,000 43
17 Telor Kg 22,000 70
18 Tempe Bks 7,000 15
19 Tahu Bks 9,107 7
20 Melon Kg 8,000 9
21 Minyak Bks 28,667 40
22 Baso Bks 10,000 10
23 Abon Bks 15,000 10
Bahan Medis habis pakai
1 HandSok Buah 16
2 Kantong kresek kecil Buah 206
3 Umbilical Klaim Buah 207
4 Pembalut Hidropil DRC 250 Buah 50
5 Aqua Gel 82 gr Dus 15
6 Kasa Steril Buah 18
7 Betadine Buah 5
8 Kasa Gulung Liter 6
9 USG Gel Galon 4 Lt Liter 5
10 Safeqlove Latex L Dus 2
11 Inflo 26 G Buah 100
12 Alkohol One Swab Dus 98
13 Hematology Callibrator SCS-1 Dus 1
14 Kresek putih Pak 2
15 Kresek putih Pak 29
16 Pehacain Box 5
17 Abothyl Botol 4
18 Masker Earloop Dus 2
7
19 Steraket no 26 Buah 20
20 Kromik 3.0 Buah 39
21 Kasa steril Pak 12
22 Sony USG Paper UPP-110 Hg Rol 2
23 Kresek no 40 Pak 1
24 Articulating paper Pak 1
25 Micro brush Pak 1
26 Seluloid strip Pak 1
27 Suction Ejektor Pak 1
28 Topical Gel Botol 1
29 Root cannal K-File 21 mm Pak 1
30 Root cannal K-File 31 mm Pak 1
31 Septocain Pak 1
32 Komposit A3 Tube 1
33 Etching Buah 1
34 Bonding Buah 1
35 Fluor gel Botol 1
36 P60 Komposit Tube 1
37 Reagen stik HB isi 25 Tube 10
B Bahan Material
1 Bahan baku bangunan
2 bahan / bibit tanaman
3 bibit ternak
4 bahan obat obatan
Bahan kimia / laboratorium
1 GOT IFCC 20X5ml Liter 68
2 GPT IFCC 20X5ml ML 1343
3 Reagen Sysmex ML 61
4 STIK Kolestro Buah 3
5 STIK Asam Urat Buah - - - 201
5 6 Cellpack 20 L Liter - - - 20
7 Sromatolyzer 500 ML ML - - - 1,000
8 Tabung Edta Buah - - - 500
9 Tabung Vakum Plain 3 ML Buah - - - 200
10 IGG/ IGM Typoid Buah - - - 20
11 Strip HbsAg Buah - - - 50
12 Stik Urine 10 Parameter Buah - - - 300
C Barang lainnya
1 Barang untuk dijual
Barang yang akan diserahkan kepada

2
masyarakat
Penerimaan Barang Persediaan Tahun Pengeluaran Barang Persediaan Tahun
Saldo Per 31 Agustus Tahun 2018
2018 2018
Harga Satuan Jumlah Vol Harga Satuan Jumlah Vol Harga Satuan Jumlah
40,000 3,800,000 60 40,000 2,400,000 40 40,000 1,600,000

38,000 3,420,000 53 38,000 2,014,000 37 38,000 1,406,000
60,000 1,200,000 22 60,000 1,320,000 - 60,000 0
90,000 1,800,000 17 90,000 1,530,000 3 90,000 270,000
145,000 1,450,000 10 145,000 1,450,000 - 145,000 0
95,000 1,900,000 17 95,000 1,615,000 3 95,000 285,000
95,000 1,900,000 17 95,000 1,615,000 3 95,000 285,000
95,000 1,900,000 17 95,000 1,615,000 3 95,000 285,000
50,000 100,000 3 50,000 150,000 - 50,000 0
16,000 144,000 9 16,000 144,000 - 16,000 0
32,000 320,000 10 32,000 320,000 - 32,000 0
17,000 85,000 5 17,000 85,000 - 17,000 0
75,000 375,000 5 75,000 375,000 - 75,000 0
6,000 - - 6,000 - - 6,000 0
4,000 - - 4,000 - - 4,000 0
3,000 - - 3,000 - - 3,000 0
2,000 48,000 17 2,000 34,000 7 2,000 14,000
7,000 252,000 36 7,000 252,000 - 7,000 0
9,000 - - 9,000 - - 9,000 0
8,000 288,000 36 8,000 288,000 - 8,000 0
8,000 - - 8,000 - - 8,000 0
30,000 30,000 1 30,000 30,000 - 30,000 0
2,500 30,000 12 2,500 30,000 - 2,500 0
75,000 750,000 10 75,000 750,000 - 75,000 0
26,000 260,000 7 26,000 182,000 3 26,000 78,000
17,000 170,000 10 17,000 170,000 - 17,000 0
6,000 120,000 20 6,000 120,000 - 6,000 0
1,500 30,000 20 1,500 30,000 - 1,500 0
24,000 480,000 18 24,000 432,000 2 24,000 48,000
23,000 690,000 21 23,000 483,000 9 23,000 207,000
45,000 1,350,000 22 45,000 990,000 8 45,000 360,000
114,500 458,000 3 114,500 343,500 1 114,500 114,500
16,000 320,000 19 16,000 304,000 1 16,000 16,000
17,000 425,000 15 17,000 255,000 10 17,000 170,000
105,000 1,050,000 4 105,000 420,000 6 105,000 630,000
25,000 250,000 5 25,000 125,000 5 25,000 125,000
3,000 1,500,000 500 3,000 1,500,000 - 3,000 0
6,000 900,000 150 6,000 900,000 - 6,000 0
25,000 125,000 5 25,000 125,000 -
- - -
5,000 10,000 2 5,000 20,000 - 5,000
25,000 25,000 1 25,000 25,000 - 25,000
8,000 16,000 2 8,000 16,000 - 8,000
29,500 29,500 1 29,500 29,500 - 29,500
11,200 11,200 1 11,200 11,200 - 11,200
31,800 31,800 1 31,800 31,800 - 31,800
25,000 25,000 1 25,000 25,000 - 25,000
33,000 330,000 5 33,000 165,000 - 33,000
67,000 670,000 5 67,000 335,000 - 67,000
35,000 175,000 2 35,000 70,000 - 35,000
50,000 150,000 - 50,000 - - 50,000
25,000 - - 25,000 - - 25,000
12,200 12,200 1 12,200 12,200 - 12,200
7,375 29,500 4 7,375 29,500 - 7,375
25,900 25,900 1 25,900 25,900 - 25,900
6,125 24,500 4 6,125 24,500 - 6,125
7,200 7,200 1 7,200 7,200 - 7,200
15,000 15,000 1 15,000 15,000 - 15,000
25,000 25,000 1 25,000 25,000 - 25,000
120,030 360,090 3 120,030 360,090 - 120,030
35,000 175,000 2 35,000 70,000 - 35,000
40,000 120,000 3 40,000 120,000 - 40,000
55,000 110,000 2 55,000 110,000 - 55,000
90,000 450,000 5 90,000 450,000 - 90,000
38,000 76,000 2 38,000 76,000 - 38,000
55,000 440,000 8 55,000 440,000 - 55,000
45,000 90,000 2 45,000 90,000 - 45,000
10,000 80,000 2 10,000 20,000 - 10,000
9,000 45,000 5 9,000 45,000 - 9,000
10,000 20,000 2 10,000 20,000 - 10,000
15,000 30,000 2 15,000 30,000 - 15,000
10,000 100,000 10 10,000 100,000 - 10,000
4,500 45,000 10 4,500 45,000 - 4,500
5,000 5,000 1 5,000 5,000 - 5,000
25,500 25,500 1 25,500 25,500 - 25,500
27,500 27,500 1 27,500 27,500 - 27,500
25,000 25,000 1 25,000 25,000 - 25,000
5,000 5,000 1 5,000 5,000 - 5,000
8,500 8,500 1 8,500 8,500 - 8,500
5,000 5,000 1 5,000 5,000 - 5,000
10,000 20,000 2 10,000 20,000 - 10,000
5,750 115,000 - 5,750 - - 5,750
30,000 600,000 - 30,000 - - 30,000
75,000 225,000 3 73,590 225,000 - 73,590

50,000 150,000 3 66,343 150,000 - 66,343
10,035 44,000 1 10,035 44,000 - 10,035
13,500 54,000 4 30,663 54,000 - 30,663
15,000 90,000 6 16,725 90,000 - 16,725
- - - 23,973 - - 23,973
25,000 75,000 3 26,760 75,000 - 26,760
- - - 23,415 - - 23,415
20,000 40,000 2 20,000 40,000 - 18,955
15,000 90,000 3 10,035 90,000 - 10,035
4,000 40,000 10 4,000 40,000 - 4,000
13,000 13,000 1 13,000 13,000 - 13,000
11,900 23,800 2 11,900 23,800 - 11,900
9,000 18,000 2 9,000 18,000 - 9,000
11,900 11,900 1 11,900 11,900 - 11,900
12,000 12,000 1 12,000 12,000 - 12,000
5,000 75,000 15 5,000 75,000 - 5,000
18,000 18,000 1 18,000 18,000 - 18,000
23,973 - - 23,973 - 3 23,973
28,900 57,800 2 28,900 57,800 - 28,900
45,000 45,000 1 45,000 45,000 - 45,000
5,200 10,400 2 5,200 10,400 - 5,200
9,900 19,800 2 9,900 19,800 - 9,900
12,900 12,900 1 12,900 12,900 - 12,900
5,500 5,500 1 5,500 5,500 - 5,500
8,500 25,500 3 8,500 25,500 - 8,500
34,900 34,900 1 34,900 34,900 - 34,900
10,000 10,000 1 10,000 10,000 - 10,000
11,000 11,000 1 11,000 11,000 - 11,000
12,000 72,000 6 12,000 72,000 - 12,000
17,000 34,000 2 17,000 34,000 - 17,000
23,125 185,000 8 23,125 185,000 - 23,125
19,800 99,000 5 19,800 99,000 - 19,800
5,500 82,500 15 5,500 82,500 - 5,500
9,600 9,600 1 9,600 9,600 - 9,600
12,000 36,000 3 12,000 36,000 - 12,000
1,000 1,000 1 1,000 1,000 - 1,000
13,000 52,000 4 13,000 52,000 - 13,000
14,000 14,000 1 14,000 14,000 - 14,000
25,500 25,500 1 25,500 25,500 - 25,500
19,900 39,800 2 19,900 39,800 - 19,900
15,050 30,100 2 15,050 30,100 - 15,050
9,900 39,600 4 9,900 39,600 - 9,900
24,500 24,500 1 24,500 24,500 - 24,500
85,000 85,000 1 85,000 85,000 - 85,000
8,000 32,000 4 8,000 32,000 8,000
6,000 12,000 2 6,000 12,000 6,000
10,000 40,000 4 10,000 40,000 10,000
15,400 77,000 5 15,400 77,000 15,400
14,000 42,000 3 14,000 42,000 14,000
16,000 80,000 5 16,000 80,000 16,000
16,000 32,000 2 16,000 32,000 16,000
10,000 100,000 10 10,000 100,000 10,000
8,500 85,000 10 8,500 85,000 8,500
8,000 16,000 2 8,000 16,000 8,000
11,500 23,000 2 11,500 23,000 11,500
5,000 15,000 3 5,000 15,000 5,000
19,000 114,000 6 19,000 114,000 19,000
25,000 75,000 3 25,000 75,000 25,000
42,500 255,000 6 42,500 255,000 42,500
10,000 30,000 3 10,000 30,000 10,000
17,500 70,000 4 17,500 70,000 17,500
5,000 25,000 5 5,000 25,000 5,000
2,500 7,500 3 2,500 7,500 2,500
19,900 59,700 3 19,900 59,700 19,900
8,300 33,200 4 8,300 33,200 8,300
19,000 38,000 2 19,000 38,000 19,000
19,200 19,200 1 19,200 19,200 19,200
9,900 19,800 2 9,900 19,800 9,900
7,900 63,200 8 7,900 63,200 7,900
45,000 45,000 1 45,000 45,000 45,000
20,000 20,000 1 20,000 20,000 20,000
44,000 88,000 2 44,000 82,500 1 44,000 44,000
20,000 40,000 2 20,000 15,000 1 20,000 20,000
28,000 84,000 4 28,000 40,000 1 28,000 28,000
21,873 328,095 15 21,873 328,095 - 21,873

10,937 382,778 35 10,937 382,778 - 10,937
10,937 218,730 20 10,937 218,730 - 10,937
6,332 2,532,600 400 6,332 2,532,600 - 6,332
21,873 284,349 13 21,873 284,349 - 21,873
9,498 113,973 12 9,498 113,973 - 9,498
9,498 113,973 12 9,498 113,973 - 9,498
9,498 113,973 12 9,498 113,973 - 9,498
9,498 113,973 12 9,498 113,973 - 9,498
21,873 371,841 17 21,873 371,841 - 21,873
21,873 371,841 17 21,873 371,841 - 21,873
10,937 437,460 40 10,937 437,460 10,937
10,937 196,857 18 10,937 196,857 10,937
10,937 218,730 20 10,937 218,730 10,937
10,937 218,730 20 10,937 218,730 10,937
10,937 120,302 11 10,937 120,302 - 10,937
6,332 2,532,600 400 6,332 2,532,600 - 6,332
345 344,500 1000 345 344,500 - 345
31,659 158,293 5 31,659 158,293 - 31,659
31,659 158,293 5 31,659 158,293 - 31,659
31,659 158,293 5 31,659 158,293 - 31,659
10,937 437,460 40 10,937 437,460 - 10,937
10,937 437,460 40 10,937 437,460 - 10,937
10,937 - - 10,937 - - 10,937
43,747 481,217 11 43,747 481,217 - 43,747
25,327 329,251 13 25,327 329,251 - 25,327
25,327 227,943 9 25,327 227,943 - 25,327
10,937 218,730 20 10,937 218,730 - 10,937
180 1,980,000 11000 180 1,980,000 - 345
200 1,000,000 5000 200 1,000,000 - 86
- - - - - - 25,327
1,500 1,500,000 1000 1,500 1,500,000 - 1,500
233 2,567,290 11000 233 2,567,290 - 233
- - - - - - 2,878
- - - - - - 21,873
- - - - - - 21,873
124,400 1,244,000 10 124,400 1,244,000 - 124,400
124,400 1,244,000 10 124,400 1,244,000 - 124,400
31,200 1,934,400 62 31,200 1,934,400 - 31,200
25,000 1,550,000 62 25,000 1,550,000 - 25,000
6,300 630,000 100 6,300 630,000 - 6,300
65,600 3,280,000 50 65,600 3,280,000 - 21,873
49,500 594,000 12 49,500 594,000 - 49,500
31,500 157,500 5 31,500 157,500 - 31,500
7,650 229,500 30 7,650 229,500 - 7,650
7,650 229,500 30 7,650 229,500 - 7,650
7,650 229,500 30 7,650 229,500 - 7,650
400 200,000 500 400 200,000 - 400
630 315,000 500 630 315,000 - 630
495 247,500 500 495 247,500 - 495
12,150 243,000 20 12,150 243,000 - 12,150
12,150 243,000 20 12,150 243,000 - 12,150
12,150 243,000 20 12,150 243,000 - 12,150

12,150 243,000 20 12,150 243,000 - 12,150
12,150 243,000 20 12,150 243,000 - 12,150
12,150 243,000 20 12,150 243,000 - 12,150
12,150 243,000 20 12,150 243,000 - 12,150
15,750 157,500 10 15,750 157,500 - 15,750
12,150 243,000 20 12,150 243,000 - 12,150
31,500 157,500 5 31,500 157,500 - 31,500
31,500 157,500 5 31,500 157,500 - 31,500

5,500 110,000 20 5,500 110,000 - 5,500
31,500 157,500 5 31,500 157,500 - 31,500
24,500 245,000 10 24,500 245,000 - 24,500
48,600 486,000 10 48,600 486,000 - 48,600
24,750 247,500 10 24,750 247,500 - 24,750
1,500 300,000 200 1,500 300,000 - 1,500
31,500 315,000 10 31,500 315,000 - 31,500
24,550 491,000 20 24,550 491,000 - 24,550
24,550 491,000 20 24,550 491,000 - 24,550
24,550 491,000 20 24,550 491,000 - 24,550
24,550 491,000 20 24,550 491,000 - 24,550
24,550 491,000 20 24,550 491,000 - 24,550
24,550 491,000 20 24,550 491,000 - 24,550
24,550 491,000 20 24,550 491,000 - 24,550
24,550 491,000 20 24,550 491,000 - 24,550
31,500 315,000 10 31,500 315,000 - 31,500

31,500 315,000 10 31,500 315,000 - 31,500
38,000 380,000 10 38,000 380,000 - 38,000
40,500 405,000 10 40,500 405,000 - 40,500
40,500 405,000 10 40,500 405,000 - 40,500
40,500 405,000 10 40,500 405,000 - 40,500
31,500 630,000 20 31,500 630,000 - 31,500
9,000 4,500,000 500 9,000 4,500,000 100 9,000
31,500 157,500 5 31,500 157,500 - 31,500
40,500 202,500 5 40,500 202,500 - 40,500
40,500 202,500 5 40,500 202,500 - 40,500
40,500 202,500 5 40,500 202,500 - 40,500
40,500 202,500 5 40,500 202,500 - 40,500
- - - -
40,000 1,600,000 41 40,000 1,640,000 1 40,000 40,000
6,000 0 0 60,000 0 0 60,000 0
80,000 4,000,000 50 80,000 4,000,000 2 80,000 160,000
- - - -
12,000 3,852,000 319 12,000 3,828,000 2 12,000 24,000
2,000 14,000 7 2,000 14,000 0 2,000 0
14,500 101,500 7 14,500 101,500 0 14,500 0
500 40,000 78 500 39,000 2 500 1,000
13,000 234,000 17 13,000 221,000 1 13,000 13,000
13,469 269,380 20 13,469 269,380 0 13,469 0
12,133 242,660 20 12,133 242,660 0 12,133 0
29,011 1,160,440 40 29,011 1,160,440 0 29,011 0
37,333 671,994 18 37,333 671,994 0 37,333 0
27,368 492,624 18 27,368 492,624 0 27,368 0
7,000 140,000 20 7,000 140,000 0 7,000 0
2,000 18,000 9 2,000 18,000 0 2,000 0
23,202 672,858 29 23,202 672,858 0 23,202 0
109,375 2,078,125 19 109,375 2,078,125 0 109,375 0
90,000 1,980,000 22 90,000 1,980,000 0 90,000 0
30,000 1,290,000 43 30,000 1,290,000 0 30,000 0
22,000 1,540,000 69 22,000 1,518,000 1 22,000 22,000
7,000 105,000 14 7,000 98,000 1 7,000 7,000
9,107 63,749 7 9,107 63,749 0 9,107 0
8,000 72,000 9 8,000 72,000 0 8,000 0
28,667 1,146,680 40 28,667 1,146,680 0 28,667 0
10,000 100,000 10 10,000 100,000 0 10,000 0
15,000 150,000 10 15,000 150,000 0 15,000 0
67,000 1,072,000 15 67,000 1,005,000 1 16,909 16,909

7,000 1,442,000 200 7,000 1,400,000 6 1,339 8,034
6,270 1,297,890 0 6,270 0 207 24,059 4,980,213
29,000 1,450,000 10 29,000 290,000 40 5,000 200,000
52,000 780,000 5 52,000 260,000 10 25,000 250,000
8,200 147,600 2 8,200 16,400 16 20,000 320,000
57,000 285,000 4 57,000 228,000 1 20,000 20,000
105,000 630,000 5 105,000 525,000 1 30,000 30,000
39,000 195,000 5 39,000 195,000 - 39,000 -
55,000 110,000 2 55,000 110,000 - 55,000 -
8,677 867,700 100 8,677 867,700 - 8,677 -
18,000 1,764,000 98 18,000 1,764,000 - 18,000 -
1,942,600 1,942,600 1 1,942,600 1,942,600 - 1,942,600 -
15,000 30,000 2 15,000 30,000 - 15,000 -
6,000 174,000 29 6,000 174,000 - 6,000 -
65,000 325,000 5 65,000 325,000 - 65,000 -
55,000 220,000 4 55,000 220,000 - 55,000 -
30,000 60,000 2 30,000 60,000 - 30,000 -
8,500 170,000 20 8,500 170,000 - 8,500 -
9,000 351,000 39 9,000 351,000 - 9,000 -
8,000 96,000 12 8,000 96,000 - 8,000 -
238,000 476,000 2 238,000 476,000 - 238,000 -
37,500 37,500 1 37,500 37,500 - 37,500 -
66,000 66,000 1 66,000 66,000 - 66,000 -
69,000 69,000 1 69,000 69,000 - 69,000 -
136,000 136,000 1 136,000 136,000 - 136,000 -
65,000 65,000 1 65,000 65,000 - 65,000 -
245,000 245,000 1 245,000 245,000 - 245,000 -
65,000 65,000 1 65,000 65,000 - 65,000 -
65,000 65,000 1 65,000 65,000 - 65,000 -
985,000 985,000 1 985,000 985,000 - 985,000 -
245,000 245,000 1 245,000 245,000 - 245,000 -
95,000 95,000 1 95,000 95,000 - 95,000 -
167,000 167,000 1 167,000 167,000 - 167,000 -
78,000 78,000 1 78,000 78,000 - 78,000 -
645,000 645,000 1 645,000 645,000 - 645,000 -
461,910 4,619,100 10 461,910 4,619,100 - 461,910 -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
130,500 8,874,000 67 130,500 8,743,500 1 130,500 130,500
130,500 175,261,500 1,342 130,500 175,131,000 1 130,500 130,500
1,752,000 106,872,000 60 1,752,000 105,120,000 1 1,752,000 1,752,000
115,000 345,000 2 115,000 230,000 1 115,000 115,000
115,000 23,115,000 200 115,000 23,000,000 1 115,000 115,000
88,440 1,768,800 20 88,440 1,768,800 88,440
2,343 2,343,000 1000 2,343 2,343,000 2,343
1,925 962,500 500 1,925 962,500 1,925
748 149,600 200 748 149,600 748
4,180 83,600 20 4,180 83,600 4,180
7,150 357,500 50 7,150 357,500 7,150
1,089 326,700 300 1,089 326,700 1,089
- - - -
- - - -
- - - -
3,380,100

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BERITA ACARA STOK OPNAME

Persedian barang tesebut terdiri dari :

Persediaan Alat Tulis Kantor Sebesar Rp 5,893,500

Adapun secara detail persediaan tersebut terlampir.

Dede Hidayat Gina Sonia

A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.Ip

u delapan belas telah dilakukan

bat Teknis UPT Puskesmas Sindangratu

Dedeh Sopaenah, S.Ip

BERITA ACARA STOK OPNAME

1 Kertas F4 40 RIM 40,000

Dede Hidayat Gina Sonia

Kepala BLUD UPT Puskesmas Sindangratu Pejabat Teknis UPT Puskesmas S

A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.I

BERITA ACARA STOK OPNAME

Pejabat Teknis UPT Puskesmas Sindangratu

Dedeh Sopaenah, S.Ip

BERITA ACARA STOK OPNAME

NO URAIAN UKURAN BANYAKNYA SATUAN

1 GOT IFCC 20X5ml ML 1 130,500

Dede Hidayat Gina Sonia

Pejabat Teknis UPT Puskesmas

A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.Ip

at Teknis UPT Puskesmas

deh Sopaenah, S.Ip

BERITA ACARA STOK OPNAME

NO URAIAN UKURAN BANYAKNYA SATUAN

1 HandSok Bok 1 67,000

Dede Hidayat Gina Sonia

Kepala BLUD UPT Puskesmas Sindangratu

A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.Ip

knis UPT Puskesmas Sindangratu

edeh Sopaenah, S.Ip

BERITA ACARA STOK OPNAME

NO URAIAN UKURAN BANYAKNYA SATUAN

Dede Hidayat Gina Sonia

Pejabat Teknis UPT Puskesmas

A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.Ip

at Teknis UPT Puskesmas

deh Sopaenah, S.Ip

BERITA ACARA STOK OPNAME

NO URAIAN UKURAN BANYAKNYA SATUAN

1 Pengisian tabung O2 Kecil tabung 1 40,000

Dede Hidayat Gina Sonia

Pejabat Teknis UPT Puskesmas

A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.Ip

at Teknis UPT Puskesmas

deh Sopaenah, S.Ip

BERITA ACARA STOK OPNAME

NO URAIAN UKURAN BANYAKNYA SATUAN

1 DETERGEN BKS 1 44,000

Dede Hidayat Gina Sonia

Kepala BLUD UPT Puskesmas Sindangratu Sindangratu

A Nurjaman D, S.Kep, Ners, M.Mkes Dedeh Sopaenah, S.Ip

deh Sopaenah, S.Ip

3 37 Rinso Sacset Sct - 1

Barang cetakan (formulir/ blanko)

1 Rincian Biaya Perawatan BUKU 15

RINCIAN TARIF PELAYANAN

pengisian tabung gas

Barang yang akan diserahkan kepada

40,000 3,800,000 60 40,000 2,400,000 40 40,000 1,600,000

75,000 225,000 3 73,590 225,000 - 73,590