Yayasan Karya Kesehatan Santo Vincentius

RUMAH SAKIT SANTO VINCENTIUS

Jl. P. Diponegoro No. 05 Singkawang 79123
Telp : (0562) 631008, 636768, Fax. (0562) 633881 e-mail: s_vincentius@yahoo.com

FORMULIR PENILAIAN SAMPEL ALAT KESEHATAN

1. Nama alat : Septalkan desinfectan cleaner + Septalkan Wipes

2. Asal : PT. Global Dispomedika (GDM)

3. Harga : Rp. 285.500,- + Rp. 245.000,-

4. Jumlah : 1 botol (750 ml) + 1 Pack (100 pic)

5. Keadaan alat :

( ) baik dan bisa digunakan

( ) baik tapi tidak bisa digunakan

6. Dibandingkan dengan alat yang dimiliki dan digunakan di rumah sakit:

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7. Usul dan rekomendasi :

( ) diadakan karena sangat diperlukan di RSSV

( ) tidak perlu diadakan di RSSV

( ) boleh dipertimbangkan diadakan di RSSV

( ) boleh menggantikan produk yang dipakai di RSSV

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Singkawang, .............................................
Kepala Ruangan ......................................./ Penilai

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