SO FLOOR STOCK OBAT DAN AKLES IGD

Diperiksa tanggal :

JUMLAH
NO NAMA OBAT SATUAN AKTUAL STOCK
SEHARUSNYA
1 Abocath No. 18 Pcs 5
2 Abocath No. 20 Pcs 5
3 Abocath No. 22 Pcs 5
4 Abocath No. 24 Pcs 5
5 Abocath No. 26 Pcs 5
6 Amlodipin 5 mg Tablet 5
7 Asetosal 100 mg Tablet 3
8 As. Traneksamat 250 mg Injeksi Ampul 2
9 Asering 500ml Kolf 3
10 Betahistine 6 mg Tablet 5
11 Bisolvon Solution 50ml Botol 1
12 Blood Set Pcs 1
13 Captopril 25 mg Tablet 5
14 Catgut Pcs 2
15 Clopidogrel Bisulfate 75 mg Tablet 5
16 Combivent Pcs 5
17 D 5% 500ml Kolf 1
18 D 10% 500ml Kolf 1
19 Diphenhidramine Injeksi Ampul 2
20 Dobutamin 250 mg Injeksi Ampul 2
21 Dexamethasone 5 mg/ml Injeksi Ampul 2
22 Discofix triway Pcs 2
23 Elektroda Pcs 10
24 Folley Cateter 14 Pcs 1
25 Folley Cateter 16 Pcs 1
26 Folley Cateter 18 Pcs 1
27 Handscoon Steril no. 7 Pcs 3
28 Hyocine Injeksi Ampul 2
29 Infus set Makro Pcs 5
30 Infus Set Mikro Pcs 5
31 Isosorbite Dinitrate 5 mg Tablet 5
32 KA-EN 3B Kolf 2
33 Kassa Steril Box 5
34 Ketorolac 30mg Injeksi Ampul 5
35 Lidokain HCL 2% Injeksi Ampul 5
36 NaCl 0,9% 100 ml Kolf 2
37 NaCl 0,9% 500ml Kolf 5
38 Nasal canul anak Pcs 3
39 Nasal canul dewasa Pcs 3
40 Nebulizer mask anak Pcs 1
41 Nebulizer mask dewasa Pcs 1
42 NGT No. 5 Pcs 1
43 NGT No. 12 Pcs 1
44 Nifedipine 10 mg Tablet 5
45 NRM Anak Pcs 1
46 NRM Dewasa Pcs 1
47 Ondansetron 4 mg Injeksi Ampul 5
48 Omeprazole 40 mg Injeksi Vial 5
49 Paracetamol 500 mg Tablet 5
50 Phytomenadione Injeksi Ampul 2
51 Prosogan (Lansoprazol ) Injeksi Vial 2
52 Ranitidin 25mg Injeksi Ampul 5
53 Ringer Laktat 500ml Kolf 5
54 Silk 3.0 Pcs 5
55 Spuit 1cc Pcs 2
56 Spuit 3cc Pcs 10
57 Spuit 5cc Pcs 5
58 Spuit 10cc Pcs 5
59 Spuit 20cc Pcs 2
60 Spuit 50cc Pcs 2
61 Suction Catheter No. 8 Pcs 1
62 Suction Catheter No. 10 Pcs 1
63 Suction Catheter No. 12 Pcs 1
64 Suction Catheter No. 14 Pcs 1
65 Suction Catheter No. 16 Pcs 1
66 Suction Catheter No. 18 Pcs 1
67 Underpad Pcs 5
68 Urine bag 2000 ml Pcs 1
69 Water For Injection 25ml Kolf 5
70 Wing Needle No. 25 Pcs 5
71 Wing Needle No. 27 Pcs 5
72 Xylocain gel Pcs 2

Unit Farmasi Penanggung Jawab Unit

(……………………………………………) (……………………………………….
GD

KETERANGAN
enanggung Jawab Unit

…………………………………..)
 Januari 2019 Februari 2019
No. Nama Alkes Satuan Jumlah Tidak Tidak
Sesuai Sesuai
Sesuai Sesuai
1 Abocath No.18 pcs 5
2 Abocath No.22 pcs 5
3 Abocath No.24 pcs 5
4 Abocath No.26 pcs 5
5 Alkohol Swab pcs Amprahan
6 Folley Catheter No.10 pcs 1
7 Folley Catheter No.12 pcs 1
8 Folley Catheter No.14 pcs 1
9 Folley Catheter No.18 pcs 1
10 Folley Catheter No.20 pcs 1
11 Folley Catheter No.22 pcs 1
12 Folley Catheter No.24 pcs 1
13 Folley Catheter No.6 pcs 1
14 Folley Catheter No.8 pcs 1
15 Handscoon Steril No.7 pcs 2
16 Infus Set Makro pcs 5
17 Infus Set Mikro pcs 5
18 Kassa Steril pcs Amprahan
19 Micropore 1 inch pcs Amprahan
20 Micropore 1/2 inch pcs Amprahan
21 Nasal Cannula Anak pcs 5
22 Nasal Cannula Dewasa pcs 5
23 Non Rebreathing Mask Anak pcs 2
24 Non Rebreathing Mask Dewasa pcs 2
25 Pot urine 100mL pcs Amprahan
26 Rebreathing Mask Anak pcs 1
27 Rebreathing Mask Dewasa pcs 1
28 Spuit 10cc pcs 10
29 Spuit 1cc pcs 10
30 Spuit 2.5cc pcs 10
31 Spuit 20cc pcs 10
32 Spuit 3cc pcs 10
33 Spuit 50cc pcs 10
34 Spuit 5cc pcs 10
35 Threeway pcs 5
36 Underpad pcs Amprahan
37 Urine Bag pcs 5
38 Water For Injection 25mL pcs 5
39 Wing Needle No.25 pcs 5
40 Wing Needle No.27 pcs 5
41 Xylocain Gel pcs 2
Tanggal Supervisi
Paraf Apoteker
Paraf PJ Unit

Tindak Lanjut Supervisi

 DAFTAR FLOOR STOCK ALKES UNIT RAWAT INAP LANTAI 4

Maret 2019 April 2019 Mei 2019 Juni 2019 Juli 2019
Tidak Tidak Tidak Tidak
Sesuai Sesuai Sesuai Sesuai Sesuai
Sesuai Sesuai Sesuai Sesuai
LANTAI 4

Juli 2019 Agustus 2019 September 2019 Oktober 2019 November 2019
Tidak Tidak Tidak Tidak Tidak
Sesuai Sesuai Sesuai Sesuai
Sesuai Sesuai Sesuai Sesuai Sesuai
 Desember 2019
Tidak
Sesuai
Sesuai
 Januari 2019 Februari 2019
No. Nama Alkes Satuan Jumlah Tidak Tidak
Sesuai Sesuai
Sesuai Sesuai
1 Abocath No.18 pcs 3
2 Abocath No.20 pcs 3
3 Abocath No.22 pcs 3
4 Abocath No.24 pcs 3
5 Assucryl 2/0 pcs 1
6 Blood Set pcs 1
7 Chromic Catgut 3/0 pcs 5
8 Condom pcs 6
9 Folley Catheter No.14 pcs 1
10 Folley Catheter No.16 pcs 1
11 Folley Catheter No.18 pcs 1
12 Folley Catheter No.24 pcs 1
13 Folley Catheter No.8 pcs 2
14 Glukosa 5% 500mL pcs 3
15 Handscoon Ginekologi pcs 1
16 Handscoon Steril No.7 pcs 3
17 Infus Set Makro pcs 1
18 Infus Set Mikro pcs 1
19 IUD Cooper T pcs 3
20 Myomergin Injection pcs 1
21 NaCl 0.9% 500mL pcs 3
22 Nasal Cannula Bayi pcs 3
23 Nasal Cannula Dewasa pcs 1
24 Ringer Laktat 500mL pcs 3
25 Silk 3/0 pcs 1
26 Spuit 10cc pcs 1
27 Spuit 1cc pcs 3
28 Spuit 20cc pcs 3
29 Spuit 3cc pcs 3
30 Spuit 5cc pcs 3
31 Syntocinon Injection pcs 5
32 Umbilical pcs 2
33 Underpad pcs 5
34 Urine Bag pcs 3
35 Vaginal Spekulum disp pcs 5
36 Water For Injection 25mL pcs 3
37 Xylocain Gel pcs 3
Tanggal Supervisi
Paraf Apoteker
Paraf PJ Unit

Tindak Lanjut Supervisi

 DAFTAR FLOOR STOCK ALKES UNIT VK

Maret 2019 April 2019 Mei 2019 Juni 2019 Juli 2019
Tidak Tidak Tidak Tidak
Sesuai Sesuai Sesuai Sesuai Sesuai
Sesuai Sesuai Sesuai Sesuai
Juli 2019 Agustus 2019 September 2019 Oktober 2019 November 2019
Tidak Tidak Tidak Tidak Tidak
Sesuai Sesuai Sesuai Sesuai
Sesuai Sesuai Sesuai Sesuai Sesuai
 Desember 2019
Tidak
Sesuai
Sesuai
 LIST SHOCK ANAFILAKTIK EMERGENCY

STOK STOK
NO. NAMA OBAT NAMA SEDIAAN
MINIMAL SAAT INI
A Laci 1
1 Suction Catheter Nomor 6 1
Nomor 8 1
Nomor 10 1
Nomor 12 1
Nomor 14 1
Nomor 16 1
Nomor 18 1
B Laci 2

C Laci 3
1 IV Catheter/Venflon/Abocath Abocath 20G/32mm 3
Abocath 24G/19mm 3
2 Atropine Atropine 0,25mg Injeksi 10
3 Dexamethasone Dexamethasone 5 mg Injeksi 10
4 Diphenhydramine HCl Diphenhydramine HCl 10 mg/mL inj 2
5 Epineprine Epineprine 1mg Injeksi 10
6 Infus Set Makro 2
Mikro 2
7 Infus NaCl 0,9% 500 mL 2
8 Ringer Laktat Ringer Laktat 500ml 1
9 Spuit Spuit 1cc 3
Spuit 3cc 3
Spuit 5cc 5
Spuit 10cc 3
D Laci 4
1 Urine bag Urine Bag 2000mL 1
MERGENCY

STOK SUDAH TERISI

ED KETERANGAN
TERPAKAI (YA/TIDAK)
 LIST TROLLEY EMERGENCY LANTAI 4

STOK
NO. NAMA SEDIAAN SATUAN ED NO.
TERSEDIA
A LACI 1 5
1 Amiadaron 200mg Tablet 2 Apr-21
2 Aminophylline 24mg/mL Injeksi 3 Mar-20
3 Asam Traneksamat 500mg/mL Injeksi 3 May-22 6
4 Aptor (Acetyl Salicylic Acid 100mg Tablet 6 Jul-23
Oct-20
5 Atropine 0.25mg/mL Injeksi 5 7
Feb-20
6 Calcii Gluconas 100mg/mL Injeksi 3 Jun-19
7 Clopidogrel Bisulfate 75mg Tablet 5 Jan-20
8 Dexamethasone 5mg/mL Injeksi 5 Feb-20
9 Diphenhydramine HCl 10mg/mL Injeksi 5 Dec-19
10 Dobutamin HCl 50mg/mL Injeksi 3 Feb-20
11 Dopamin 200mg/mL Injeksi 2 Aug-19
12 Epineprine 1mg/mL Injeksi 5 Jun-20 8
Jul-19
13 Furosemide 10mg/mL Injeksi 5
Jun-19
14 Isosorbite Dinitrate 5mg Tablet 5 Aug-19
15 IV Catheter/Venflon/Abocath no.18 Pcs 5 Jul-21
IV Catheter/Venflon/Abocath no.20 Pcs 5 Aug-22
IV Catheter/Venflon/Abocath no.22 Pcs 5 May-23
IV Catheter/Venflon/Abocath no.24 Pcs 5 May-23
IV Catheter/Venflon/Abocath no.26 Pcs 4 Feb-22 9
16 Salbutamol (Ventolin 2.5mg) Flacon 2 Feb-21
17 Stesolid Rectaltube 5mg/2.5mg Rektal 1 Sep-19
Stesolid Rectaltube 10mg/2.5mg Rektal 1 Jun-19
B LACI 2 10
1 Aqua Gel Sterile 82gr Tube 1 Aug-19
2 D 10% 500mL Flacon 2 Apr-19 11
3 NaCl 0.9% 100mL Kolf 1 Sep-20
NaCl 0.9% 500mL Kolf 2 Mar-22
4 KCl 7.64% 25mL Flacon 2 Apr-20
5 MgSO4 40% 25mL Flacon 1 Apr-20
6 Natrium Bikarbonat (Meylon 8.4%) Flacon 1 Aug-20
7 Nasal Canula Anak Pcs 1 Mar-22
Mar-22
Nasal Canula Dewasa Pcs 2 12
Aug-22
Nasal Canula Bayi Pcs 1 Mar-23
8 Non Rebreathing Mask Anak Pcs 1 Mei-21
Non Rebreathing Mask Dewasa Pcs 1 Mar-22
9 Ringer Laktat 500mL Kolf 1 Jun-19
10 Rebreathing Mask Anak Pcs 2 May-20
Rebreathing Mask Dewasa Pcs 2 Mar-21
C LACI 3 13
1 Endo Tracheal Tube (ETT) no.3 Pcs 1 Jul-21 14
Endo Tracheal Tube (ETT) no.3.5 Pcs 1 Jul-21
Endo Tracheal Tube (ETT) no.4 Pcs 1 Nov-19
Endo Tracheal Tube (ETT) no.4.5 Pcs 1 Mar-21
Endo Tracheal Tube (ETT) no.5 Pcs 1 Jun-20
Endo Tracheal Tube (ETT) no.5.5 Pcs 1 Nov-19
Endo Tracheal Tube (ETT) no.6 Pcs 1 Sep-22
Endo Tracheal Tube (ETT) no.6.5 Pcs 1 Mar-19
Endo Tracheal Tube (ETT) no.7 Pcs 1 Sep-22
Endo Tracheal Tube (ETT) no.8 Pcs 1 Aug-21
2 Extention Tube Pcs 1
3 Feeding Tube/NGT no.3.5 Pcs 0 Kosong
Feeding Tube/NGT no.5 Pcs 1 Oct-21
Feeding Tube/NGT no.8 Pcs 1 Oct-21
Feeding Tube/NGT no.10 Pcs 1 Dec-22
Feeding Tube/NGT no.12 Pcs 1 Dec-20
Feeding Tube/NGT no.14 Pcs 1 Dec-20
Feeding Tube/NGT no.18 Pcs 1 Dec-21
4 Folley Catheter no.6 Pcs 1 May-20
Folley Catheter no.8 Pcs 1 Aug-22
Folley Catheter no.10 Pcs 1 Feb-22
Folley Catheter no.12 Pcs 1 Apr-21
Folley Catheter no.14 Pcs 1 Mei-22
Folley Catheter no.16 Pcs 1 Apr-23
Folley Catheter no.18 Pcs 1 Mei-20
Folley Catheter no.20 Pcs 1 Oct-21
Folley Catheter no.22 Pcs 1 Apr-21
Folley Catheter no.24 Pcs 1 Aug-21
Y LANTAI 4

STOK
NAMA SEDIAAN SATUAN ED
TERSEDIA
Handscoon Sterile no.6 Pairs 2 Jul-20
Handscoon Sterile no.7 Pairs 2 Jul-20
Handscoon Sterile no.7.5 Pairs 2 Oct-20
Infus Set Makro Pcs 2 Oct-20
Infus Set Mikro Pcs 2 Oct-19
Oropharingeal (Guedal) no.00 Pcs 1 Jun-21

Oropharingeal (Guedal) no.0 Pcs 1 Sep-23

Oropharingeal (Guedal) no.01 Pcs 1 Jun-19
Oropharingeal (Guedal) no.02 Pcs 1 Jan-23
Oropharingeal (Guedal) no.03 Pcs 1 Mar-23
Oropharingeal (Guedal) no.04 Pcs 1 Jan-23
Oropharingeal (Guedal) no.05 Pcs 1 Mar-22
Laryngeal Mas Silicon no.1 Pcs 0 Kosong

Laryngeal Mas Silicon no.1.5 Pcs 0 Kosong

Laryngeal Mas Silicon no.2 Pcs 0 Kosong

Laryngeal Mas Silicon no.2.5 Pcs 0 Kosong
Laryngeal Mas Silicon no.3 Pcs 0 Kosong
Laryngeal Mas Silicon no.4 Pcs 0 Kosong
Laryngeal Mas Silicon no.5 Pcs 0 Kosong
Nasopharyngeal Airway no.6 Pcs 0 Kosong
Nasopharyngeal Airway no.7 Pcs 0 Kosong
Nasopharyngeal Airway no.8 Pcs 0 Kosong
Nasopharyngeal Airway no.9 Pcs 0 Kosong
Oxygen Mask Anak Pcs 0 Kosong
Oxygen Mask Dewasa Pcs 0 Kosong
Spuit 1cc Pcs 5 Nov-19
Spuit 3cc Pcs 5 Nov-20
Spuit 5cc Pcs 5 Nov-20
Spuit 10cc Pcs 3 Dec-22
Spuit 20cc Pcs 3 Jan-22
Spuit 50cc Pcs 0 Kosong
Spuit 50cc Catheter Tip Pcs 1 Dec-22

Suction Catheter no.6 Pcs 0 Kosong

Suction Catheter no.8 Pcs 1 Mar-23
Suction Catheter no.10 Pcs 1 Jul-20
Suction Catheter no.12 Pcs 1 Mar-19
Suction Catheter no.14 Pcs 1 Apr-21
Suction Catheter no.16 Pcs 1 Jul-21
Suction Catheter no.18 Pcs 1 Apr-21
Threeway Stopcock Pcs 1 Aug-19
Urine Bag 2000mL Pcs 1 Apr-22
 LIST TROLLEY EMERGENCY LANTAI 5

STOK
NO. NAMA SEDIAAN SATUAN ED NO.
TERSEDIA
A LACI 1 D
1 Amiadaron 200mg Tablet 2 Apr-21 1
2 Aminophylline 24mg/mL Injeksi 3 Mar-20
3 Asam Traneksamat 250mg/mL Injeksi 2 May-22
4 Aptor (Acetyl Salicylic Acid 100mg Tablet 6 Jul-23 2
5 Atropine 0.25mg/mL Injeksi 5 Oct-20
6 Calcii Gluconas 100mg/mL Injeksi 3 Jun-19 3
7 Clopidogrel Bisulfate 75mg Tablet 5 Jan-20
8 Dexamethasone 5mg/mL Injeksi 5 Feb-20
9 Diphenhydramine HCl 10mg/mL Injeksi 5 Dec-19
Mar-19
10 Injeksi 3
Dobutamin HCl 50mg/mL & 250mg Feb-20
Aug-19
11 Injeksi 2
Dopamin 200mg/mL Jan-20
Jun-19
12 Injeksi 5
Epineprine 1mg/mL Jun-20
Jul-19
13 Injeksi 5 4
Furosemide 10mg/mL Jun-19
14 Isosorbite Dinitrate 5mg Tablet 5 Aug-19
15 Salbutamol (Ventolin 2.5mg) Flacon 2 Feb-21
16 Stesolid Rectaltube 5mg/2.5mg Rektal 1 Sep-19
Stesolid Rectaltube 10mg/2.5mg Rektal 1 Jun-19
B LACI 2
1 IV Catheter/Venflon/Abocath no.18 Pcs 5 Jul-21
IV Catheter/Venflon/Abocath no.20 Pcs 5 Aug-22 5
IV Catheter/Venflon/Abocath no.22 Pcs 5 May-23
IV Catheter/Venflon/Abocath no.24 Pcs 5 May-23
IV Catheter/Venflon/Abocath no.26 Pcs 5 Feb-22 6
2 Spuit 1cc Pcs 5 Nov-19
Spuit 3cc Pcs 5 Sep-20
Spuit 5cc Pcs 5 Nov-20
Spuit 10cc Pcs 3 Mar-23 7
Jan-22
Pcs
Spuit 20cc 3 Oct-22
Spuit 50cc Pcs 1 Aug-21 8
Spuit 50cc Catheter Tip Pcs 1 Dec-22
C LACI 3 9
1 Endo Tracheal Tube (ETT) no.3 Pcs 0 Kosong
Endo Tracheal Tube (ETT) no.3.5 Pcs 1 Jul-21 10
Endo Tracheal Tube (ETT) no.4 Pcs 1 Nov-19
Endo Tracheal Tube (ETT) no.4.5 Pcs 1 Mar-21
Endo Tracheal Tube (ETT) no.5 Pcs 1 Jun-20
Endo Tracheal Tube (ETT) no.5.5 Pcs 1 Nov-19
Endo Tracheal Tube (ETT) no.6 Pcs 1 Sep-22
Endo Tracheal Tube (ETT) no.6.5 Pcs 1 Mar-19
Endo Tracheal Tube (ETT) no.7 Pcs 1 Sep-22 11
Endo Tracheal Tube (ETT) no.8 Pcs 1 Aug-21 12
2 Extention Tube Pcs 1 E
3 Feeding Tube/NGT no.3.5 Pcs 0 Kosong 1
Feeding Tube/NGT no.5 Pcs 1 Oct-22 2
Feeding Tube/NGT no.8 Pcs 1 Oct-21 3
Feeding Tube/NGT no.10 Pcs 1 Dec-22
Feeding Tube/NGT no.12 Pcs 1 Dec-20 4
Feeding Tube/NGT no.14 Pcs 0 Kosong 5
Feeding Tube/NGT no.18 Pcs 1 Dec-21 6
4 Folley Catheter no.6 Pcs 1 May-20 7
Folley Catheter no.8 Pcs 1 Aug-22
Folley Catheter no.10 Pcs 1 Feb-22
Folley Catheter no.12 Pcs 1 Apr-21
Folley Catheter no.14 Pcs 1 Mei-22
Folley Catheter no.16 Pcs 1 Apr-23
Folley Catheter no.18 Pcs 1 Mei-20
Folley Catheter no.20 Pcs 1 Oct-21
Folley Catheter no.22 Pcs 1 Apr-21
Folley Catheter no.24 Pcs 1 Aug-21
CY LANTAI 5

STOK
NAMA SEDIAAN SATUAN ED
TERSEDIA
LACI 4
Handscoon Sterile no.6 Pairs 2 Jul-20
Handscoon Sterile no.7 Pairs 2 Jul-20
Handscoon Sterile no.7.5 Pairs 2 Oct-20
Infus Set Makro Pcs 2 Apr-23
Infus Set Mikro Pcs 2 Oct-19
Oropharingeal (Guedal) no.00 Pcs 1 Jun-21
Oropharingeal (Guedal) no.0 Pcs 1 Sep-23
Oropharingeal (Guedal) no.01 Pcs 1 Jun-19
Oropharingeal (Guedal) no.02 Pcs 1 Jan-23

Pcs Mar-23
Oropharingeal (Guedal) no.03 1
Pcs 1 Jan-23
Oropharingeal (Guedal) no.04
Pcs Mar-22
Oropharingeal (Guedal) no.05 1
Pcs Kosong
Laryngeal Mas Silicon no.1 0
Laryngeal Mas Silicon no.1.5 Pcs 0 Kosong
Laryngeal Mas Silicon no.2 Pcs 0 Kosong
Laryngeal Mas Silicon no.2.5 Pcs 0 Kosong
Laryngeal Mas Silicon no.3 Pcs 0 Kosong
Laryngeal Mas Silicon no.4 Pcs 0 Kosong
Laryngeal Mas Silicon no.5 Pcs 0 Kosong
Nasal Canula Anak Pcs 1 Mar-22
Nasal Canula Dewasa Pcs 2 Aug-22
Nasal Canula Bayi Pcs 1 Mar-23
Nasopharyngeal Airway no.6 Pcs 0 Kosong
Nasopharyngeal Airway no.7 Pcs 0 Kosong
Nasopharyngeal Airway no.8 Pcs 0 Kosong
Nasopharyngeal Airway no.9 Pcs 0 Kosong
Non Rebreathing Mask Anak Pcs 1 Feb-22
Pcs Mar-22
Non Rebreathing Mask Dewasa 1
Rebreathing Mask Anak Pcs 0 Kosong
Rebreathing Mask Dewasa Pcs 2 Mar-21
Oxygen Mask Anak Pcs 0 Kosong
Oxygen Mask Dewasa Pcs 0 Kosong
Suction Catheter no.6 Pcs 1 Mar-19
Suction Catheter no.8 Pcs 1 Mar-23
Suction Catheter no.10 Pcs 1 Jul-20
Suction Catheter no.12 Pcs 1 Mar-19
Suction Catheter no.14 Pcs 1 Apr-21
Suction Catheter no.16 Pcs 1 Jul-21
Suction Catheter no.18 Pcs 1 Apr-21
Threeway Stopcock Pcs 1 Aug-19
Urine Bag 2000mL Pcs 1 Apr-22
LACI 5
Aqua Gel Sterile 82gr Tube 1 Aug-19
D 10% 500mL Flacon 2 Apr-19
NaCl 0.9% 100mL Kolf 1 Sep-20
NaCl 0.9% 500mL Kolf 2 Mar-22
KCl 7.64% 25mL Flacon 2 Apr-20
MgSO4 40% 25mL Flacon 1 Apr-20
Natrium Bikarbonat (Meylon 8.4%) Flacon 1 Aug-20
Ringer Laktat 500mL Kolf 1 Jun-19
 LIST TROLLEY EMERGENCY LANTAI IGD

STOK
NO. NAMA SEDIAAN SATUAN ED NO.
TERSEDIA
A LACI 1 5
1 Amiadaron 200mg Tablet 2 Apr-21
2 Aminophylline 24mg/mL Injeksi 3 Mar-20
3 Asam Traneksamat 250mg/5mL Injeksi 3 May-22 6
Asam Traneksamat 100mg/mL Injeksi 2 May-22
4 Aptor (Acetyl Salicylic Acid 100mg Tablet 6 Jul-23 7
5 Atropine 0.25mg/mL Injeksi 5 Oct-20
6 Calcii Gluconas 100mg/mL Injeksi 3 Jun-19
7 Clopidogrel Bisulfate 75mg Tablet 5 Jan-20
8 Dexamethasone 5mg/mL Injeksi 5 May-20
9 Diphenhydramine HCl 10mg/mL Injeksi 5 Dec-19
10 Dobutamin HCl 50mg/mL Injeksi 3 Feb-20
11 Dopamin 200mg/mL Injeksi 2 Aug-19 8
12 Epineprine 1mg/mL Injeksi 5 Jun-20
Jul-19
13 Injeksi 5
Furosemide 10mg/mL Jun-19
14 Isosorbite Dinitrate 5mg Tablet 5 Aug-19
15 IV Catheter/Venflon/Abocath no.18 Pcs 3 Jul-21
IV Catheter/Venflon/Abocath no.20 Pcs 3 Aug-22
IV Catheter/Venflon/Abocath no.22 Pcs 3 May-23
IV Catheter/Venflon/Abocath no.24 Pcs 3 May-23 9
IV Catheter/Venflon/Abocath no.26 Pcs 6 Feb-22
16 Salbutamol (Ventolin 2.5mg) Flacon 2 Feb-21
17 Stesolid Rectaltube 5mg/2.5mg Rektal 1 Sep-19
Stesolid Rectaltube 10mg/2.5mg Rektal 1 Jun-19 10
B LACI 2
1 Aqua Gel Sterile 82gr Tube 1 Aug-19 11
2 D 10% 500mL Flacon 2 Apr-19
3 NaCl 0.9% 100mL Kolf 1 Sep-20
NaCl 0.9% 500mL Kolf 2 Mar-22
4 KCl 7.64% 25mL Flacon 2 Apr-20
5 MgSO4 40% 25mL Flacon 1 Apr-20
6 Natrium Bikarbonat (Meylon 8.4%) Flacon 1 Aug-20
7 Nasal Canula Anak Pcs 1 Mar-22 12
Mar-22
Pcs 2
Nasal Canula Dewasa Aug-22
Nasal Canula Bayi Pcs 1 Mar-23
8 Non Rebreathing Mask Anak Pcs 1 Mei-21
Non Rebreathing Mask Dewasa Pcs 1 Mar-22
9 Ringer Laktat 500mL Kolf 1 Jun-19
10 Rebreathing Mask Anak Pcs 2 May-20
Rebreathing Mask Dewasa Pcs 2 Mar-21 13
C LACI 3 14
1 Endo Tracheal Tube (ETT) no.3 Pcs 1 Jul-21
Endo Tracheal Tube (ETT) no.3.5 Pcs 1 Jul-21
Endo Tracheal Tube (ETT) no.4 Pcs 1 Nov-19
Endo Tracheal Tube (ETT) no.4.5 Pcs 1 Mar-21
Endo Tracheal Tube (ETT) no.5 Pcs 1 Jun-20
Endo Tracheal Tube (ETT) no.5.5 Pcs 1 Nov-19
Endo Tracheal Tube (ETT) no.6 Pcs 1 Sep-22
Endo Tracheal Tube (ETT) no.6.5 Pcs 1 Mar-19
 Endo Tracheal Tube (ETT) no.7 Pcs 1 Sep-22
Endo Tracheal Tube (ETT) no.8 Pcs 1 Aug-21
2 Extention Tube Pcs 1
3 Feeding Tube/NGT no.3.5 Pcs 0 Kosong
Feeding Tube/NGT no.5 Pcs 2 Oct-22
Feeding Tube/NGT no.8 Pcs 2 Oct-21
Feeding Tube/NGT no.10 Pcs 2 Dec-22
Feeding Tube/NGT no.12 Pcs 2 Dec-20
Feeding Tube/NGT no.14 Pcs 2 Dec-20
Feeding Tube/NGT no.18 Pcs 2 Dec-21
4 Folley Catheter no.6 Pcs 1 May-20
Folley Catheter no.8 Pcs 1 Aug-22
Folley Catheter no.10 Pcs 1 Feb-22
Folley Catheter no.12 Pcs 1 Apr-21
Folley Catheter no.14 Pcs 1 Mei-22
Folley Catheter no.16 Pcs 1 Apr-23
Folley Catheter no.18 Pcs 1 Mei-20
Folley Catheter no.20 Pcs 1 Oct-21
Folley Catheter no.22 Pcs 1 Apr-21
Folley Catheter no.24 Pcs 1 Aug-21
Y LANTAI IGD

STOK
NAMA SEDIAAN SATUAN ED
TERSEDIA
Handscoon Sterile no.6 Pairs 2 Jul-20
Handscoon Sterile no.7 Pairs 2 Jul-20
Handscoon Sterile no.7.5 Pairs 2 Oct-20
Infus Set Makro Pcs 2 Dec-22
Infus Set Mikro Pcs 2 Oct-19
Oropharingeal (Guedal) no.00 Pcs 1 Jun-21
Oropharingeal (Guedal) no.0 Pcs 1 Sep-23
Oropharingeal (Guedal) no.01 Pcs 1 Jun-19
Oropharingeal (Guedal) no.02 Pcs 1 Jan-23
Oropharingeal (Guedal) no.03 Pcs 1 Mar-23
Oropharingeal (Guedal) no.04 Pcs 1 Jan-23
Oropharingeal (Guedal) no.05 Pcs 1 Mar-22
Laryngeal Mas Silicon no.1 Pcs 0 Kosong
Laryngeal Mas Silicon no.1.5 Pcs 0 Kosong

Pcs 0 Kosong
Laryngeal Mas Silicon no.2
Laryngeal Mas Silicon no.2.5 Pcs 0 Kosong
Laryngeal Mas Silicon no.3 Pcs 0 Kosong
Laryngeal Mas Silicon no.4 Pcs 0 Kosong
Laryngeal Mas Silicon no.5 Pcs 0 Kosong
Nasopharyngeal Airway no.6 Pcs 0 Kosong
Nasopharyngeal Airway no.7 Pcs 0 Kosong
Nasopharyngeal Airway no.8 Pcs 0 Kosong
Nasopharyngeal Airway no.9 Pcs 0 Kosong
Oxygen Mask Anak Pcs 0 Kosong
Oxygen Mask Dewasa Pcs 0 Kosong
Spuit 1cc Pcs 5 Nov-19
Spuit 3cc Pcs 5 Nov-20
Spuit 5cc Pcs 5 Nov-20
Spuit 10cc Pcs 3 Dec-22
Spuit 20cc Pcs 3 Jan-22
Spuit 50cc Pcs 0 Kosong
Spuit 50cc Catheter Tip Pcs 1 Dec-22
Suction Catheter no.6 Pcs 1 Mar-19

Pcs Mar-23
Suction Catheter no.8 1
Suction Catheter no.10 Pcs 1 Jul-20
Suction Catheter no.12 Pcs 1 Mar-19
Suction Catheter no.14 Pcs 1 Apr-21
Suction Catheter no.16 Pcs 1 Jul-21
Suction Catheter no.18 Pcs 1 Apr-21
Threeway Stopcock Pcs 1 Aug-19
Urine Bag 2000mL Pcs 1 Apr-22
 FORM PEMAKAIAN TROLI EMERGENCY

No. Tanggal Troli No.Seri Kunci Nama yang Tanda Tangan Nama Obat yang Terpakai Jumlah Keterangan (Farmasi) No.Seri Kunci Nama yang Tanda Tangan
Terbuka Terbuka Membuka Pembuka Menutup Farmasi

10

11

12

13

14

15

16

17

18

19

20
 LIST TAS GADAR 2019

STOK Check
NO. NAMA SEDIAAN SATUAN ED NO.
TERSEDIA list
1 Aptor (Acetyl Salicylic Acid 100mg Tablet 2 Jul-23 19
2 Atropine 0.25mg/mL Injeksi 1 Oct-20
3 Clopidogrel Bisulfate 75mg Tablet 5 Jan-20
4 Dexamethasone 5mg/mL Injeksi 1 Feb-20 20
5 Diphenhydramine HCl 10mg/mL Injeksi 1 Dec-19
6 Epineprine 1mg/mL Injeksi 5 Jun-20 21
7 Isosorbite Dinitrate 5mg Tablet 5 Aug-19
8 IV Catheter/Venflon/Abocath no.18 Pcs 2 Jul-21
IV Catheter/Venflon/Abocath no.20 Pcs 2 Aug-22
IV Catheter/Venflon/Abocath no.22 Pcs 2 Mar-23
IV Catheter/Venflon/Abocath no.24 Pcs 2 May-23
IV Catheter/Venflon/Abocath no.26 Pcs 2 Feb-22
9 D 10% 500mL Flacon 1 Apr-19 22
10 NaCl 0.9% 100mL Kolf 1 Nov-21
NaCl 0.9% 500mL Kolf 1 Mar-22
11 Nasal Canula Anak Pcs 2 Mar-22
Nasal Canula Dewasa Pcs 2 Aug-22
12 Non Rebreathing Mask Anak Pcs 1 Feb-22
Non Rebreathing Mask Dewasa Pcs 1 Nov-22
13 Ringer Laktat 500mL Kolf 1 Jun-19 23
14 Rebreathing Mask Anak Pcs 1 May-20
Rebreathing Mask Dewasa Pcs 1 Mar-21
15 Endo Tracheal Tube (ETT) no.3 Pcs 1 Sep-23
Endo Tracheal Tube (ETT) no.3.5 Pcs 1 Feb-23 24
Endo Tracheal Tube (ETT) no.4 Pcs 1 Sep-22
Endo Tracheal Tube (ETT) no.4.5 Pcs 1 Dec-21 25
Endo Tracheal Tube (ETT) no.5 Pcs 1 Feb-23
Endo Tracheal Tube (ETT) no.5.5 Pcs 1 Feb-23
Endo Tracheal Tube (ETT) no.6 Pcs 1 Sep-22
Endo Tracheal Tube (ETT) no.6.5 Pcs 1 Dec-21
Endo Tracheal Tube (ETT) no.7 Pcs 1 Jun-23
Endo Tracheal Tube (ETT) no.8 Pcs 1 Aug-21
16 Extention Tube Pcs 2 Mar-23 26
17 Feeding Tube/NGT no.3.5 Pcs 0 Kosong
Feeding Tube/NGT no.5 Pcs 1 Oct-22
Feeding Tube/NGT no.8 Pcs 1 Oct-21
Feeding Tube/NGT no.10 Levin Pcs 1 Dec-22
Feeding Tube/NGT no.12 Ryles Pcs 1 Jan-21
 Feeding Tube/NGT no.14 Pcs 0 Kosong
Feeding Tube/NGT no.16 Levin Pcs 1 Jul-23 27
Feeding Tube/NGT no.18 Levin Pcs 1 Dec-22 28
18 Folley Catheter no.6 Pcs 1 Aug-22 29
Folley Catheter no.8 Pcs 1 Aug-22
Folley Catheter no.10 Pcs 1 Feb-22
Folley Catheter no.12 Pcs 1 Feb-22
Folley Catheter no.14 Pcs 1 May-22
Folley Catheter no.16 Pcs 1 Apr-23
Folley Catheter no.18 Pcs 1 Jan-21
Folley Catheter no.20 Pcs 1 Oct-21
Folley Catheter no.22 Pcs 1 Apr-21
Folley Catheter no.24 Pcs 1 May-21
DAR 2019

STOK Check
NAMA SEDIAAN SATUAN ED
TERSEDIA list
Handscoon Sterile no.6 Pairs 1 Jul-20
Handscoon Sterile no.7 Pairs 1 Jul-20
Handscoon Sterile no.7.5 Pairs 1 Oct-20
Infus Set Makro Pcs 2 Oct-20
Infus Set Mikro Pcs 2 Nov-19
Oropharingeal (Guedal) no.00 Pcs 1 Sep-23
Oropharingeal (Guedal) no.0 Pcs 1 Sep-23
Oropharingeal (Guedal) no.01 Pcs 1 Jun-19
Oropharingeal (Guedal) no.02 Pcs 1 Jan-23
Oropharingeal (Guedal) no.03 Pcs 1 Aug-23
Oropharingeal (Guedal) no.04 Pcs 1 Jan-23
Oropharingeal (Guedal) no.05 Pcs 1 Mar-22
Laryngeal Mas Silicon no.1 Pcs 0 Kosong
Laryngeal Mas Silicon no.1.5 Pcs 0 Kosong
Laryngeal Mas Silicon no.2 Pcs 0 Kosong
Laryngeal Mas Silicon no.2.5 Pcs 0 Kosong
Laryngeal Mas Silicon no.3 Pcs 0 Kosong
Laryngeal Mas Silicon no.4 Pcs 0 Kosong
Laryngeal Mas Silicon no.5 Pcs 0 Kosong
Nasopharyngeal Airway no.6 Pcs 0 Kosong
Nasopharyngeal Airway no.7 Pcs 0 Kosong
Nasopharyngeal Airway no.8 Pcs 0 Kosong
Nasopharyngeal Airway no.9 Pcs 0 Kosong
Oxygen Mask Anak Pcs 0 Kosong
Oxygen Mask Dewasa Pcs 1 Jan-23
Spuit 1cc Pcs 2 Nov-19
Spuit 3cc Pcs 5 Sep-20
Spuit 5cc Pcs 2 Sep-20
Spuit 10cc Pcs 3 Mar-23
Spuit 20cc Pcs 1 Jan-22
Spuit 50cc Pcs 1 Aug-21
Spuit 50cc Catheter Tip Pcs 1 Dec-22
Suction Catheter no.6 Pcs 1 Mar-19
Suction Catheter no.8 Pcs 1 Mar-23
Suction Catheter no.10 Pcs 1 Jul-20
Suction Catheter no.12 Pcs 1 Mar-19
Suction Catheter no.14 Pcs 1 Apr-21
Suction Catheter no.16 Pcs 1 Jul-21
Suction Catheter no.18 Pcs 1 Apr-21
Discofix 3 Way Pcs 1 Aug-19
Urine Bag 2000mL Pcs 1 Aug-22
Micropore Kecil Pcs 1 -
Micropore Besar Pcs 1 -
 LIST ALKES AMBULANCE HIACE

STOK
NO. NAMA SEDIAAN SATUAN ED Check list
TERSEDIA
1 IV Catheter/Venflon/Abocath no.18 Pcs 1 Jul-21
IV Catheter/Venflon/Abocath no.20 Pcs 1 Aug-22
IV Catheter/Venflon/Abocath no.22 Pcs 1 Mar-23
IV Catheter/Venflon/Abocath no.24 Pcs 1 May-23
IV Catheter/Venflon/Abocath no.26 Pcs 1 Feb-22
2 Spuit 1cc Pcs 1 Nov-19
Spuit 3cc Pcs 1 Sep-20
Spuit 5cc Pcs 1 Sep-20
3 NaCl 0.9% 500mL Kolf 3 Jul-23
4 Ringer Laktat 500mL Kolf 3 May-23
5 Asering 500mL Kolf 3 Sep-20
6 D 5% 500mL Kolf 3 Mar-20
7 Infus Set Makro Pcs 2 Oct-20
Infus Set Mikro Pcs 2 Nov-19
8 Water For Injection Flacon 2 Jan-19
Nasal Canula Bayi Pcs 1 Mar-23
9 Nasal Canula Anak Pcs 1 Mar-22
Nasal Canula Dewasa Pcs 1 Aug-22
10 Rebreathing Mask Anak Pcs 1 May-20
Rebreathing Mask Dewasa Pcs 0 Kosong
11 Non Rebreathing Mask Anak Pcs 1 Feb-22
Non Rebreathing Mask Dewasa Pcs 1 Nov-22
13 Endo Tracheal Tube (ETT) no.6.5 Pcs 1 Dec-21
14 Endo Tracheal Tube (ETT) no.7 Pcs 1 Nov-22
Endo Tracheal Tube (ETT) no.7.5 Pcs 1 Sep-22
Kassa Steril Pcs 1 Feb-22
Mitela Pcs 0 Kosong
Elastis Perban 7.5 cm x 4.55 mm Pcs 1 Apr-23
Xylocain Gel Pcs 1 May-20
Handscoon Non Steril Ukuran L Pcs 1 Apr-23
Handscoon Steril No.7 Pcs 2 Jul-20
Masker Tali Pcs 1 Nov-22
Betadine Botol 1 Oct-20
Alkohol Swab Pcs 1 Oct-20
Micropore 1/2 inch Pcs 1 -
16 Urine Bag Pcs 1 Aug-22
17 Bagging Set Pcs 0 Kosong
Suction Catheter No.6 Pcs 0 Kosong
Suction Catheter No.14 Pcs 1 Apr-21
Guedel No.004 Pcs 1 Jan-23
Oxygen Dewasa Pcs 1 Oct-22
Nebulizer Dewasa Pcs 1 Nov-22
Nebulizer Anak Pcs 1 Jan-23
 List Obat High Alert Trolley Emergency List Obat High A

No. Nama Obat Satuan Jumlah No.

1 Atropin Sulfat 0.25mg/mL Ampul 5 1
2 Calcii Gluconas 100mg/mL Ampul 3 2
3 Dopamin (Cetadop) 200mg/5mL Ampul 2 3
4 Dobutamin 50mg/mL Ampul 3 4
5 Epineprine 1mg/mL (ada di kulkas) Ampul 5 5
6 KCl 7.46% 25mL Flacon 2 6
7 MgSO4 40% 25mL Flacon 1 7
8 Natrium Bikarbonat (Meylon 8.4%) 25mL Flacon 1 8

List Obat High Alert Trolley Emergency List Obat High A

No. Nama Obat Satuan Jumlah No.

1 Atropin Sulfat 0.25mg/mL Ampul 5 1
2 Calcii Gluconas 100mg/mL Ampul 3 2
3 Dopamin (Cetadop) 200mg/5mL Ampul 2 3
4 Dobutamin 50mg/mL Ampul 3 4
5 Epineprine 1mg/mL (ada di kulkas) Ampul 5 5
6 KCl 7.46% 25mL Flacon 2 6
7 MgSO4 40% 25mL Flacon 1 7
8 Natrium Bikarbonat (Meylon 8.4%) 25mL Flacon 1 8

List Obat High Alert Trolley Emergency List Obat High A

No. Nama Obat Satuan Jumlah No.

1 Atropin Sulfat 0.25mg/mL Ampul 5 1
2 Calcii Gluconas 100mg/mL Ampul 3 2
3 Dopamin (Cetadop) 200mg/5mL Ampul 2 3
4 Dobutamin 50mg/mL Ampul 3 4
5 Epineprine 1mg/mL (ada di kulkas) Ampul 5 5
6 KCl 7.46% 25mL Flacon 2 6
7 MgSO4 40% 25mL Flacon 1 7
8 Natrium Bikarbonat (Meylon 8.4%) 25mL Flacon 1 8
 List Obat High Alert Trolley Emergency

Nama Obat Satuan Jumlah

Atropin Sulfat 0.25mg/mL Ampul 5
Calcii Gluconas 100mg/mL Ampul 3
Dopamin (Cetadop) 200mg/5mL Ampul 2
Dobutamin 50mg/mL Ampul 3
Epineprine 1mg/mL (ada di kulkas) Ampul 5
KCl 7.46% 25mL Flacon 2
MgSO4 40% 25mL Flacon 1
Natrium Bikarbonat (Meylon 8.4%) 25mL Flacon 1

List Obat High Alert Trolley Emergency

Nama Obat Satuan Jumlah

Atropin Sulfat 0.25mg/mL Ampul 5
Calcii Gluconas 100mg/mL Ampul 3
Dopamin (Cetadop) 200mg/5mL Ampul 2
Dobutamin 50mg/mL Ampul 3
Epineprine 1mg/mL (ada di kulkas) Ampul 5
KCl 7.46% 25mL Flacon 2
MgSO4 40% 25mL Flacon 1
Natrium Bikarbonat (Meylon 8.4%) 25mL Flacon 1

List Obat High Alert Trolley Emergency

Nama Obat Satuan Jumlah

Atropin Sulfat 0.25mg/mL Ampul 5
Calcii Gluconas 100mg/mL Ampul 3
Dopamin (Cetadop) 200mg/5mL Ampul 2
Dobutamin 50mg/mL Ampul 3
Epineprine 1mg/mL (ada di kulkas) Ampul 5
KCl 7.46% 25mL Flacon 2
MgSO4 40% 25mL Flacon 1
Natrium Bikarbonat (Meylon 8.4%) 25mL Flacon 1