PEMERINTAH KABUPATEN CIAMIS

DINAS KESEHATAN
UPTD KESEHATAN PUSKESMAS CIEURIH
Jalan Cieurih Nomor. 05 Kecamatan Cipaku Tlp. (0265 ) 2798101 CIAMIS
Kode Pos 46252

DAFTAR PENERIMAAN ALAT KESEHATAN SEMENTARA NON DTP

PUSKESMAS CIEURIH TAHUN 2014
Nomor : /288/PKM/2014

NO NAMA ALAT KESEHATAN JUMLAH BARANG TANGGAL PARAF

A. POLIKLINIK UMUM
1 Medical equipment cabinet 1 06-01-2015
2 Examination table 1 06-01-2015
3 Valero Cuff for pediatric 1 06-01-2015
4 Reflex hammer 1 17-01-2015
5 Stopwatch 1 17-01-2015
6 Snellen chart 1 06-01-2015
7 Stethoscope 1 17-01-2015
8 Tongue spatle,SS 16,5 CM 1 06-01-2015
9 Mercury sphygmomanometer 1 06-01-2015
10 Aneroid sphygmomanometer 1 17-01-2015
11 Clinical Thermometer 1 17-01-2015
12 Medical height and weight scale for adult 1 06-01-2015
13 Standard operating scissor,curved sharp/blunt 1 06-01-2015
14 Standard operating scissor,straight sharp/sharp 1 06-01-2015
15 Standard operating scissor,straight sharp/blunt 1 06-01-2015
16 Standard operating scissor,straight blunt/blunt 1 06-01-2015
17 Bandage scissors (lister) 1 06-01-2015
18 Forseps,curved,16 cm 1 06-01-2015
19 Forseps,curved,18 cm 1 06-01-2015
20 Forseps,straight,14 cm 1 06-01-2015
21 Forseps,straight,16 cm 1 06-01-2015
22 Forseps,straight,18 cm 1 06-01-2015
23 Nald holder 14 CM 1 06-01-2015
24 Nald holder 18 CM 1 06-01-2015
25 Forceps,sponge holding (foerster) 1 06-01-2015
26 Forceps,dissecting,14,5 cm 1 06-01-2015
27 Forceps,dissecting,18 cm 1 06-01-2015
28 Forceps,dissecting,14,5 cm 1 06-01-2015
29 Forceps,tissue,14,5 cm 1 06-01-2015
30 Forceps,tissue,18 cm 1 06-01-2015
31 Flashlight 1 06-01-2015
32 Eletrical sterilizer 2 shelves 1 17-01-2015
33 Tray (covered) for sterile intrument Small 1 06-01-2015
34 Tray (covered) for sterile intrument Medium 1 06-01-2015
35 Tray (covered) for sterile intrument Large 1 06-01-2015
36 Tray (swalowed) for sterile intrument 1 06-01-2015
37 Examination Lamp 1 17-01-2015
38 Iodine cup 1 17-01-2015
39 Nierbekken medium 1 17-01-2015
40 Nierbekken large 1 17-01-2015
41 Infusion stand 1 17-01-2015
42 Oxygen cylinder 2 mᵌ complete set 1 17-01-2015
43 Cotton Holder 1 06-01-2015
44 Dressing drum 125 mm x 120 mm (medium) 1 17-01-2015
45 Ultrasonic nebulizer 1 17-01-2015
NO NAMA ALAT KESEHATAN JUMLAH BARANG TANGGAL PARAF
46 Xray film viewer 1 17-01-2015
47 Trial lens set ECG 1 17-01-2015
48 Gerlad Tissue Forceps 1 17-01-2015
49 Head Lamp 1 06-01-2015
50 Head mirror 1 17-01-2015
51 Scalpel blade 1 17-01-2015
52 Scalpel handle 1 17-01-2015
53 Tonometer 1 17-01-2015
54 Rubber torniquete 1 17-01-2015
B. KLINIK GIGI
1 Dental unit 1 17-01-2015
2 Low Speed Diamond Bur Assorted 1 06-01-2015
3 Low Speed Contra Angle Hand Piece 1 06-01-2015
4 Excavator double-ended (large) 1 06-01-2015
5 Mouth mirror no. 4 1 06-01-2015
6 Tongue spatel,SS 12 CM 1 06-01-2015
7 Cryer mesial 1 06-01-2015
8 Cryer destal 1 06-01-2015
9 Tooth pincet 1 06-01-2015
10 Scaler,standard,Cresent Shaped (siekle) 1 06-01-2015
11 Scaler,standard,bent right (chisel/distal) 1 06-01-2015
12 Scaler,standard,bent left (chisel/distal) 1 06-01-2015
13 Scaler,standard,(hock) 1 06-01-2015
14 Forceps,extraction,Upper roots 1 06-01-2015
15 Forceps,extraction,children,lower roots 1 06-01-2015
16 Forceps,extraction,lipper roots of incisors 1 06-01-2015
17 Forceps,extraction,children,upper molars 1 06-01-2015
18 Forceps,extraction,right,upper molars 1 06-01-2015
19 Forceps,extraction,I",upper molars 1 06-01-2015
20 Forceps,extraction,children,lower molars 1 06-01-2015
21 Forceps,extraction,lower molars 1 06-01-2015
22 Forceps,extraction,lower biscuspids and canines 1 06-01-2015
23 Forceps,extraction,upper center and canines 1 06-01-2015
24 Forceps,extraction,lower incisors and canines 1 06-01-2015
25 Electrical sterilizer 1 06-01-2015
26 Nierbekken medium 1 06-01-2015
27 Forceps,sponge holding (foester) 1 06-01-2015
28 Paediatric Phantom Tooth Set 1 06-01-2015
29 Cement Spatula 1 06-01-2015
30 Cement Stopper 1 06-01-2015
31 Curved Mosquito Hemastatic 1 06-01-2015
32 Curved Non Irish Forceps 1 06-01-2015
33 Dental Sonde 1 06-01-2015
34 Dental Sonde Half Moon 1 06-01-2015
35 Double Ended Applier and Carver 1 06-01-2015
36 Excavator double-ended (large) 1 06-01-2015
37 Excavator double-ended (small) 1 06-01-2015
38 Extracting Forceps Lower Root Either Side 1 06-01-2015
39 Hoe Stainless Steel 1 06-01-2015
40 Mouth Mirror + Handle 1 06-01-2015
41 Mouth Mirror No 5 1 06-01-2015
42 Matrix holder 1 06-01-2015
43 Tablet crusher 1 06-01-2015
44 Spatula,for silicate 1 06-01-2015
45 Spatula (plastik) 1 06-01-2015
46 Spoon excavator large 1 06-01-2015
47 Spoon excavator medium 1 06-01-2015
48 Spoon excavator small 1 06-01-2015
49 Dappen Glass 1 06-01-2015
NO NAMA ALAT KESEHATAN JUMLAH BARANG TANGGAL PARAF
50 Tweezer Dressing 1 06-01-2015
51 Bein-Small-Straight 1 06-01-2015

C. KB
1 Gynecology examination table 1 06-01-2015
2 IUD Inserted 1 06-01-2015
3 IUD hook 1 06-01-2015
4 Scissors,surgical,standard,straight 1 06-01-2015
5 Forceps,tissue,14,5 cm 1 06-01-2015
6 Forceps,tissue,18 cm 1 06-01-2015
7 Tray (swalow) for sterile instrument 1 06-01-2015
8 Dressing drum 125 mm x 120 mm (medium) 1 06-01-2015
9 Dressing drum 150 mm x 150 mm (large) 1 06-01-2015
10 Nierbekken medium 1 06-01-2015
11 Grave vaginal speculum S,M,L 1 06-01-2015
12 Haemostatik forceps 12 cm,halstead-mosquito,curved,with teath 1x2 1 06-01-2015
13 Haemostatik forceps 12 cm,halstead-mosquito,Staight,with teath 1x2 1 06-01-2015
14 Haemostatik forceps 12 cm,halstead-Straight,without teath 1 06-01-2015
15 Forceps,implant holder 1 06-01-2015
16 IUD Kit : 1 06-01-2015
Tenaculum 4 pcs 1 06-01-2015
Forceps,uterine 1 06-01-2015
Forceps,penster 1 06-01-2015
Speculum S,M,L 1 06-01-2015
Tray (swalow) for sterile instrument 1 06-01-2015
Excavator 1 06-01-2015
Aligotor forceps 1 06-01-2015

D. PARTUS SET
1 Scissors,Episiotomy,braun stadler, 14,5 cm 1 06-01-2015
2 Scissors,umbilical cord 13 cm 1 06-01-2015
3 Scissors, bandage 1 06-01-2015
4 Forceps,kocher 1 06-01-2015
5 Haemostatic forceps, 14 cm,Kocher 1 06-01-2015
6 Forceps,uterine dressing (bozemann) 25 cm 1 06-01-2015
7 Needle holder, 18 cm, mayo-hegar 1 06-01-2015
8 Forceps,holding+standard 1 06-01-2015
9 Forceps,dissecting,14,5 cm 1 06-01-2015
10 Forceps,dissecting,18 cm 1 06-01-2015
11 Forceps,tissue 14,5 cm 1 06-01-2015
12 Forceps,tissue 18 cm 1 06-01-2015
13 Tray (swalow) for sterile instrument 1 06-01-2015
14 Tray (covered) 1 06-01-2015
15 Nierbekken 1 06-01-2015
16 Mercury sphygmomanometer 1 06-01-2015
17 Stethoscope 1 06-01-2015
18 Cylinder for sterile forceps 1 06-01-2015
19 Drum foer sterile instrument 22 cm 1 06-01-2015
20 Drum foer sterile instrument 27 cm 1 06-01-2015
21 Baby weight scale 1 06-01-2015
22 Medical height and weight scale for adult 1 17-01-2015
23 Reflex hammer 1 06-01-2015

E. LABORATORIUM
1 Centrifuge 8 place 1 17-01-2015
2 Test Tube Rack ( 40 place ) 1 17-01-2015
3 Urine Analyzer 1 06-01-2015
4 Binocular Miscroscope 1 06-01-2015
NO NAMA ALAT KESEHATAN JUMLAH BARANG TANGGAL PARAF
F. GIZI
1 Beam eye level weight scale 1 06-01-2015
2 Microtoise 1 06-01-2015
3 Length Board 1 06-01-2015
4 Upper arm meassurement deviee ( LILA ) 1 06-01-2015

G.POLI KIA
1 Examination Lamp 1 04-02-2015
2 Pervimeter Obtetrik Untuk Pengukuran Panggul 1 04-02-2015
3 Spekulum Vagina (Cocor Bebek)Besar,Sedang,Kecil 1 04-02-2015
4 Speculum (Sims) 3 ukuran 1 04-02-2015
5 Stetoscope Duplek 1 04-02-2015
6 Stetoscope janin 1 04-02-2015
7 Sudip Lidah,logam,12 cm 1 04-02-2015
8 Tensimeter,Air Raksa 1 04-02-2015
9 Termometer Klinis 1 04-02-2015
10 Timbangan Bayi 1 04-02-2015
11 Timbangan Dewasa + tinggi badan 1 04-02-2015
12 Pita Pengukur lila 1 04-02-2015
13 Gunting Bedah Standar,Lurus 1 04-02-2015
14 Gunting Pembalut (Lister) 1 04-02-2015
15 Klem Arteri,Lurus (Kelly) 1 04-02-2015
16 Klem Tampon Uterus,25 cm (Bozeman) 1 04-02-2015
17 Klem / Penjepit Porsio, 25 Cm (Schroder) 1 04-02-2015
18 Korentang, Lengkung,Penjepit Alat Steril,23 Cm (Cheattle) 1 04-02-2015
19 Korentang,Penjepit Sponge (Foerster) 1 04-02-2015
20 Sonde Uterus/Penduga 1 04-02-2015
21 Sterilisator Listrik dua pintu 1 04-02-2015
22 Baki Logam Tempat Alat Steril 1 04-02-2015
23 Tromol 31 Cm 1 04-02-2015
24 Nierbeken Bengkok Sedang 1 04-02-2015
25 Nierbeken Bengkok Besar 1 04-02-2015
26 Doppler 1 04-02-2015
27 Resusitasi For Adult 1 04-02-2015
28 Resusitasi For Infant 1 04-02-2015

Yang Menerima Yang Menyerahkan

Tanda Tangan : .................................. Tanda Tangan : ..................................

Nama : MAMAN.S.kep,Ners Nama : MAMAN.S.kep,Ners
NIP /NRPTT : 19650801 198911 1 002 NIP /NRPTT : 19650801 198911 1 002
Pangkat golongan : Penata III/C Pangkat golongan : Penata III/C

Mengetahui
Kepala UPTD Kesehatan Puskesmas Cieurih

HAMLAN. SKM.,MM
NIP.19670808 198901 1 002
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
UPTD KESEHATAN PUSKESMAS CIEURIH
Jalan Cieurih Nomor. 05 Kecamatan Cipaku Tlp. (0265 ) 2798101 CIAMIS
Kode Pos 46252
==================================================================================

DAFTAR PENERIMAAN ALAT KESEHATAN PUSKESMAS PEMBANTU DESA CIPAKU

DINAS KESEHATAN KABUPATEN CIAMIS TAHUN 2014
Nomor : /288/PKM/2015

JUMLAH
NO NAMA ALAT KESEHATAN TANGGAL
BARANG
1 Medical Equipment Cabinet 1 31 - 12 - 2014
2 Stethoscope 1 31 - 12 - 2014
3 Tongue Spatle,SS 12 CM 1 31 - 12 - 2014
4 Mercury Sphygmomanometer 1 31 - 12 - 2014
5 Medical Height and Weight Scale for Adult 1 31 - 12 - 2014
6 Standard operating scissors,curved sharp/sharp 2 31 - 12 - 2014
7 Standard operating scissors,curved sharp/blunt 2 31 - 12 - 2014
8 Standard operating scissors,curved blunt/blunt 2 31 - 12 - 2014
9 Standard operating scissors,curved straight sharp/sharp 2 31 - 12 - 2014
10 Standard operating scissors,straight sharp/blunt 2 31 - 12 - 2014
11 Standard operating scissors,straight blunt/blunt 2 31 - 12 - 2014
12 Bandage scissor (lister) 2 31 - 12 - 2014
13 Scissor,Ligature stick 2 31 - 12 - 2014
14 Forceps,curved,14 cm 2 31 - 12 - 2014
15 Forceps,straight,14 cm 2 31 - 12 - 2014
16 Nald horder,14 cm 2 31 - 12 - 2014
17 Forceps,sponge,holding (foerster) 1 31 - 12 - 2014
18 Forceps,dissecting,14,5 cm 2 31 - 12 - 2014
19 Forceps,dissecting,18 cm 1 31 - 12 - 2014
20 Flashlight 1 31 - 03 - 2015

Cieurih, Tanggal 31 Maret 2015

Yang Menerima Yang Menyerahkan

Tanda Tangan : .................................. Tanda Tangan : ..................................

Nama : NANI SURYANI,AM.Keb Nama : ENGKOS KOSMARA,Amd.Kep

NIP /NRPTT : 19711003 199103 2 004 NIP /NRPTT : 19740525 201409 1 001

Pangkat golongan : Penata III/D Pangkat golongan : Pengatur II/C

Mengetahui
Kepala UPTD Kesehatan Puskesmas Cieurih

KIRMAN KARWENDJA,S.Kep.,Ners
NIP.19611218 198410 1 001
IPAKU

PARAF

...................

KOSMARA,Amd.Kep

5 201409 1 001
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
UPTD KESEHATAN PUSKESMAS CIEURIH
Jalan Cieurih Nomor. 05 Kecamatan Cipaku Tlp. (0265 ) 2798101 CIAMIS
Kode Pos 46252
==================================================================================

DAFTAR PENERIMAAN ALAT KESEHATAN POSKESDES DESA BANGBAYANG

DINAS KESEHATAN KABUPATEN CIAMIS TAHUN 2014
Nomor : /288/PKM/2014

NO NAMA ALAT KESEHATAN JUMLAH BARANG TANGGAL PARAF

1 Scissor,surgical,standard,curved 1 16 - 01 - 2015
2 Scissor,surgical,standard,staight 1 16 - 01 - 2015
3 Bandage scissor (lister) 1 16 - 01 - 2015
4 Forseps,dissecting 1 16 - 01 - 2015
5 Dressing forceps 1 16 - 01 - 2015
6 Amniotome hook 1 16 - 01 - 2015
7 Standard forceps 1 16 - 01 - 2015
8 Adult weight scale 1 06 - 01 - 2015
9 Medical equioment storage bag 1 06 - 01 - 2015

Cieurih, Tanggal 31 Desember 2014

Yang Menerima Yang Menyerahkan

Tanda Tangan : ............................... Tanda Tangan : ..................................

Nama : IRMA KUSMAWATI Nama : MAMAN.S.kep,Ners

NIP /NRPTT : 10.4.047.12036 NIP /NRPTT : 19650801 198911 1 002

Pangkat golongan : .............................. Pangkat golongan : Penata III/C

Mengetahui
Kepala UPTD Kesehatan Puskesmas Cieurih

HAMLAN. SKM.,MM
NIP.19670808 198901 1 002
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
UPTD KESEHATAN PUSKESMAS CIEURIH
Jalan Cieurih Nomor. 05 Kecamatan Cipaku Tlp. (0265 ) 2798101 CIAMIS
Kode Pos 46252
==================================================================================

DAFTAR PENERIMAAN ALAT KESEHATAN POSKESDES DESA GEREBA

DINAS KESEHATAN KABUPATEN CIAMIS TAHUN 2014
Nomor : /288/PKM/2014

NO NAMA ALAT KESEHATAN JUMLAH BARANG TANGGAL PARAF

1 Scissor,surgical,standard,curved 1 16 - 01 - 2015
2 Scissor,surgical,standard,staight 1 16 - 01 - 2015
3 Bandage scissor (lister) 1 16 - 01 - 2015
4 Forseps,dissecting 1 16 - 01 - 2015
5 Dressing forceps 1 16 - 01 - 2015
6 Amniotome hook 1 16 - 01 - 2015
7 Standard forceps 1 16 - 01 - 2015
8 Adult weight scale 1 06 - 01 - 2015
9 Medical equioment storage bag 1 06 - 01 - 2015

Cieurih, Tanggal 31 Desember 2014

Yang Menerima Yang Menyerahkan

Tanda Tangan : ............................... Tanda Tangan : ..................................

Nama : GITA EKAPUTRA R Nama : MAMAN.S.kep,Ners
NIP /NRPTT : 10.4.048.4095 NIP /NRPTT : 19650801 198911 1 002

Pangkat golongan : .............................. Pangkat golongan : Penata III/C

Mengetahui
Kepala UPTD Kesehatan Puskesmas Cieurih

HAMLAN. SKM.,MM
NIP.19670808 198901 1 002
 PEMERINTAH KABUPATEN CIAMIS
DINAS KESEHATAN
UPTD KESEHATAN PUSKESMAS CIEURIH
Jalan Cieurih Nomor. 05 Kecamatan Cipaku Tlp. (0265 ) 2798101 CIAMIS
Kode Pos 46252
==================================================================================

DAFTAR PENERIMAAN ALAT KESEHATAN POSKESDES DESA CIAKAR

DINAS KESEHATAN KABUPATEN CIAMIS TAHUN 2014
Nomor : /288/PKM/2014

NO NAMA ALAT KESEHATAN JUMLAH BARANG TANGGAL PARAF

1 Scissor,surgical,standard,curved 1 16 - 01 - 2015
2 Scissor,surgical,standard,staight 1 16 - 01 - 2015
3 Bandage scissor (lister) 1 16 - 01 - 2015
4 Forseps,dissecting 1 16 - 01 - 2015
5 Dressing forceps 1 16 - 01 - 2015
6 Amniotome hook 1 16 - 01 - 2015
7 Standard forceps 1 16 - 01 - 2015
8 Adult weight scale 1 06 - 01 - 2015
9 Medical equioment storage bag 1 06 - 01 - 2015

Cieurih, Tanggal 31 Desember 2014

Yang Menerima Yang Menyerahkan

Tanda Tangan : ............................... Tanda Tangan : ..................................

Nama : VIRA NURHANDAYANI Nama : MAMAN.S.kep,Ners

NIP /NRPTT 10.4.047.12016 NIP /NRPTT : 19650801 198911 1 002

Pangkat golongan : .............................. Pangkat golongan : Penata III/C

Mengetahui
Kepala UPTD Kesehatan Puskesmas Cieurih

HAMLAN. SKM.,MM
NIP.19670808 198901 1 002