Rab RKPD 2017 Fix

PEMERINTAH KABUPATEN SORONG SELATAN
Rumah Sakit Umum Daerah " Scholoo" Keyen

Alamat : Kampung Keyen Jln. Ayamaru-Teminabuan, Kab. Sororng Selatan
Alamat E-mail : rsudscholookeyen@yahoo.com
USULAN PROGRAM / KEGIATAN MUSREMBANG 2017 KABUPATEN SORONG SELATAN TAHUN 2016
SASARAN/
VOLUME/ LOKASI SUMBER DANA
NO BIDANG/KEGIATAN KET
TUJUAN SATUAN PAGU DANA (Rp) DAU DAK OTSUS APBD PROV
A PENGADAAN ALAT KESEHATAN
1 Oxygent Konsentrat 5 RSUD 204,890,000
2 Amputasi Set 1 RSUD 61,424,493
3 Bed Patien Elektric 1 RSUD 49,794,200
4 Brangkar Dorong dengan Pengaman 2 RSUD 82,629,176
5 Dopler 1 RSUD 23,902,400
6 Endos Copy 1 RSUD 2,572,500,000
7 Examination Lamp (Fleksibel) Err:509 RSUD Err:509
8 Fluid/Solution Warmer 3 RSUD 86,634,000
9 Forcep Biasa (Jangan yg Negel) 2 RSUD 192,438,282
10 Gluco Meter 1 RSUD 453,750
11 Head Lamp Err:509 RSUD Err:509
12 Hecting Set 4 RSUD 36,580,156
13 Korentang 2 RSUD 1,660,646
14 Kuretase Set(Abortus) 2 RSUD 65,182,964
15 Laparascopy + Monitor Err:509 RSUD Err:509
16 Mastektomi Set 1 RSUD 29,547,524
17 Minor Set 4 RSUD 173,645,648
18 Partus Set 1 RSUD 20,740,736
19 Resesitator Bayi 1 RSUD 575,000
20 Suction Pump Dewasa 4 RSUD 120,000,000
E-KATALOG
21 Spirometer 0 RSUD -
22 Standar Infus Beroda 8 RSUD 4,832,000
23 Steteskop Anak 2 RSUD 3,053,200
24 Steteskop Bayi 1 RSUD 1,526,600
25 Steteskop Dewasa 5 RSUD 7,633,000
26 Tensimeter Air Raksa 4 RSUD 26,000,000
27 Tensimeter Digital Dengan Manset Bayi/Anak 2 RSUD 29,680,000
28 Standar Infus Tancap 10 RSUD 4,300,000
29 Timbangan BB Biasa 1 RSUD 2,528,116
30 Timbangan Dewasa W + H 1 RSUD 14,349,760
31 urologi Instrumen Set 1 RSUD 175,431,755
32 CT SCAN 64 SLICE 1 RSUD 12,226,048,000
33 Automated hemoglobin system/hematology analizer 1 RSUD 243,080,000
34 Blood gas analyzer 1 RSUD 221,600,000
35 Coagulation instrumen/peralatan koagulasi 1 RSUD 35,880,600
36 Electrolyte analyzer 1 RSUD 77,452,000
37 Mikropipet ukuran 200-1000 ul 1 RSUD 3,459,000
38 URINE ANALYZER 1 RSUD 90,840,000
39 MICROSCOPE SURGICAL 1 RSUD 992,850,000
40 TENSIMETER DIGITAL DEWASA 2 RSUD 2,810,940
41 Aligator 2 RSUD 160,000
42 Amniotomi Set 2 RSUD 10,000,000
43 Anus Copy 1 RSUD 29,000,000
44 Bak Instrumen Sedang 1 RSUD 11,000,000
45 Bor Elektrik 1 RSUD 461,000
46 Bor Manual 1 RSUD 26,000,000
47 Com Bertutup (Diameter 12 cm) 2 RSUD 300,000
48 Com Besar (Diameter 17 cm) 2 RSUD 191,724,536
49 Embriotomi Set 1 RSUD 95,862,268
50 Gelas ukur 1 Liter (Plastik) 1 RSUD 78,000
51 Instrumen Bedah Vaskuler 1 RSUD 90,000
52 Katarak dan Bedah Refraktif 1 RSUD 1,500,000
53 Klem Ovum 1 RSUD 1,000,000
54 Klisma 5 RSUD 2,500,000
55 Lampu Senter 1 RSUD 7,463,000,000
56 Laringoscope Anak 1 RSUD 22,500,000
57 Meteran 5 RSUD 275,000
58 Nierbeken Besar 3 RSUD 165,000
59 Nierbeken Sedang 1 RSUD 1,500,000
60 Nierbeken Kecil 1 RSUD 1,500,000
61 Pean Bengkok 1 RSUD 52,000,000
62 Pen Light 2 RSUD 300,000
63 Pisau Humvee (STSG) 1 RSUD 3,900,000
64 Pispot Wanita 1 RSUD 7,500,000
65 Pispot BAB 1 RSUD 7,500,000
66 Pispot Pria 1 RSUD 150,000
67 Reflex Hammer 2 RSUD 500,000
68 Sendok Kuret Tajam Set 1 RSUD 350,000
69 Sendok Kuret Tumpel Set 2 RSUD 700,000
70 Spekulum Cocor Bebek Kecil 2 RSUD 400,000
71 Spekulum Cocor Bebek Sedang 1 RSUD 25,000,000
72 Spekulum Sims 2 RSUD 1,400,000
73 Sterilisator Kering 1 RSUD 123,500,000
74 Suction Kuret 1 RSUD 100,000
75 Tempat tidur 1 RSUD 25,000,000
76 Torniket 1 RSUD 22,000,000
77 Tromol Besar (Diameter 17 cm) 1 RSUD 21,000,000
78 USG Anestesi 1 RSUD 3,500,000
79 Vacum Manual (Disposibel) 1 RSUD 3,805,000
80 Waterpas (Pengukur CVC) 1 RSUD 3,805,000
81 Analisa Hb 1 RSUD 3,900,000
82 Autoclave 1 RSUD 3,900,000
83 Automated urinalysis system/urin analizer 7 RSUD 1,050,000
84 Blood bank refrigerator darah siap pakai 4 RSUD 600,000
85 Blood bank refrigerator karantina 2 RSUD 300,000
86 Blood grouping plate 1 RSUD 700,000
87 Blood plasma freezer 3 RSUD 450,000
88 Bunsen 1 RSUD 4,500,000
89 Centrifugal chemistry analyzer for clinical for use/centrifuge kimia klinik 1 RSUD 50,000
90 Cool box dengan fasilitas 2-5 kantong 1 RSUD 55,000
91 Cool box untuk transportasi dengan fasilitas minimal 20 kantong 2 RSUD 3,000,000
92 Hand sealer 4 RSUD 6,000,000
93 Klem 6 RSUD 9,000,000
94 Klem/pean 1 RSUD 40,000
95 LED 1 RSUD 165,615
96 Medical refrigerator 1 RSUD 8,000,000
97 Microbiological incubator 1 RSUD 8,000,000
98 Microscope dinocular 1 RSUD 150,000
99 Microscopes and accessories/Mikroskop 1 RSUD 150,000
100 Mikro balance 1 RSUD 150,000
103 Mikrosentrifus 1 RSUD 16,500,000
104 Mikroskop binokuler 2 RSUD 52,000,000
105 Peti pendingin darah/cool box untuk mobile unit (25 – 50 kantong) 1 RSUD 26,000,000
106 Pinset 1 RSUD 1,200,000
107 Rak slide 1 RSUD 500,000
108 Tempat tidur statis 5 RSUD 200,000
109 Termometer kontrol 3 RSUD 525,000
110 Timbangan darah 1 RSUD 7,500,000
111 Timer 1 RSUD 3,665,250
112 Ultra sentrifuse 1 RSUD 175,000,000
113 UPS 1 RSUD 700,000
114 Central Oxygen Generatorr 1 RSUD 500,000
SubTotal (Harga + PPN 10%) Err:509
B BAHAN MEDIS HABIS PAKAI

1 ALKOHOL 70 %, 1 LITER 300 RSUD 7,417,500
2 ALKOHOL SWABS 300 RSUD 3,450,000
3 AQUA STERIL FOR IRIGASI 1000ML 150 RSUD 1,552,500
4 ARM SLING UK L 50 RSUD 1,500,000
5 ARM SLING UK M 100 RSUD 3,000,000
6 ARM SLING UK S 50 RSUD 1,500,000
7 ASEPTIC GEL 5 LITER 50 RSUD 46,460,000
8 ASEPTIC GEL 500CC DISPENSER 30 RSUD 3,105,000
9 B1STURINO10 500 RSUD 1,725,000
10 BENANG POLYSORB 1 (POLYGLCOLIC ACID ) TAPER 100 RSUD 7,500,000
11 BENANG POLYSORB 2 TAPER 100 RSUD 7,500,000
12 BENANG POLYSORB 2/0 TAPER 150 RSUD 11,250,000
13 BENANG POLYSORB 3/0 TAPER 100 RSUD 7,500,000
14 BENANG VICRYL 4/0 POLYSORB TAPER 100 RSUD 11,600,000
15 BISTURI NO 15 100 RSUD 5,040,000
16 BISTURI NO 19 250 RSUD 862,500
17 BISTURI NO 20 150 RSUD 517,500
18 BISTURI NO 21 500 RSUD 1,725,000
19 BISTURIN0 11 500 RSUD 1,725,000
20 Blue monofilament polyvinylidene floride non absosbable 3.0 ( 3/8 circle 24 mm ) cutting 500 RSUD 1,725,000
21 Blue monofilament polyvinylidene floride non absosbable 4.0 ( 3/8 circle 16 mm ) cutting fineline 150 RSUD 5,250,000
22 CATGUT CHROMIC NO 1 (WITH NEEDLE) TAPER HR 48 150 RSUD 5,250,000
23 CATGUT CHROMIC NO 2 (WITH NEEDLE) TAPER HR 50 100 RSUD 3,406,185
24 CATGUT CHROMIC NO 2/0 (WITH NEEDLE) TAPER HR 37 100 RSUD 3,624,915
25 CATGUT CHROMIC NO 3/0 (WITH NEEDLE) taper HR 26 100 RSUD 2,598,885
26 CATGUT CHROMIC NO 4/0 (WITH NEEDLE) TAPER 150 RSUD 3,898,328
27 CATGUT CHROMIC NO.3 WITH NEEDLE TAPER 100 RSUD 4,179,600
28 Catgut Monofilament natural Absorbable 3.0 ( 1/2 circle 25mm ) tapper 100 RSUD 4,179,600
29 Catgut Monofilament natural Absorbable 3.0 (3/8 circle 16 mm) cutting 100 RSUD 3,650,000
30 catgut monofilament natural absosrbable 1 ( 1/2 circle 64,6 mm) Blunt 100 RSUD 3,650,000
31 catgut monofilament natural absorbable 2.0 ( 1/2 circle 36mm ) cutting 100 RSUD 3,650,000
32 catgut monofilament natural absorbable 2.0 (1/2 circle 35 mm) tapper 100 RSUD 3,650,000
33 catgut monofilament natural absorbable 3.0 ( 1/2 circle 22mm ) tapper 100 RSUD 3,650,000
34 CATGUT PLAIN NO 0 (WITH NEEDLE) TAPER HR 37 100 RSUD 3,650,000
35 CATGUT PLAIN NO 1 (WITH NEEDLE) TAPER HR 37 72 RSUD 2,006,906
36 CATGUT PLAIN NO 2/0 (WITH NEEDLE) TAPER HR 37 72 RSUD 2,189,480
37 CATGUT PLAIN NO 3/0 (WITH NEEDLE) TAPER HR 26 72 RSUD 1,956,647
38 CATGUT PLAIN NO 4/0 (WITH NEEDLE) TAPER 72 RSUD 1,961,615
39 CHATETER SUCTION 6 72 RSUD 2,160,000
40 CHATETER SUCTION NO 10 100 RSUD 404,800
43 CHATETER SUCTION NO. 14 100 RSUD 404,800
46 CHKM DENTAL USE 50 RSUD 202,400
47 CHLORHEXIDIN 4% SOL, 5LITER 20 RSUD 1,500,000
48 COLAR NECK DEWASA L 30 RSUD 28,847,520
49 COLAR NECK PEDIATRIK s 10 RSUD 5,000,000
50 COLAR NECK PEDIATRI M 10 RSUD 5,000,000
51 DERMAFIX ( PLESTER ANTI AIR) UKURAN 10 RSUD 5,000,000
52 DISP 1 CC 100 RSUD 2,000,000
53 DISP 1 CC INSULIN 3,000 RSUD 5,022,000
54 DISP 20 CC 1,000 RSUD 1,540,000
55 DISP 20 CC kateter tip 2,500 RSUD 7,700,000
56 DISP 50 CC (LUBANG PINGGIR) 500 RSUD 1,540,000
57 DISP 50 CC KATETER TIP (LUBANG TENGAH) 500 RSUD 3,927,000
58 DISP10CC 150 RSUD 1,178,100
59 DISP3CC 5,000 RSUD 11,795,000
60 DISP5CC 5,000 RSUD 9,785,000
61 DISPOSIBLE NEEDLE CITOJECT 30G 5,000 RSUD 6,740,000
62 ELASTIC VERBAND 4 INCHI 20 RSUD 2,507,760
63 ELASTIC VERBAND 6 INCHI - RSUD -
64 ELEKTRODA TENS 100 RSUD 4,819,650
65 ENDOMETHASONE septodont 100 RSUD 4,819,650
66 ENDOTRACHEAL TUBE NO 3 5 RSUD 690,000
67 ENDOTRACHEAL TUBE NO 3,5 30 RSUD 2,932,500
68 ENDOTRACHEAL TUBE NO 4 50 RSUD 3,265,350
76 ETSAWP DENTAL 80 RSUD 5,819,760
77 ETT NON KINGKING NO 3,5 80 RSUD 4,308,560
79 ETT NON KINGKING NO 7 30 RSUD 12,375,000
81 ETTNON KINGKING NO 5 30 RSUD 8,839,290
82 EXTENSION TUBE 30 RSUD 12,375,000
83 FOLEY CHATETER NO 16 30 RSUD 1,500,000
86 FOLEY CHATETER NO 8 50 RSUD 632,500
87 FOLEYCHATETERN0 12 50 RSUD 632,500
88 FOLEYCHATETERN0 18 50 RSUD 632,500
89 FOLEYCHATETERNO10 50 RSUD 632,500
90 FOLEYCHATETERNO 14 150 RSUD 1,897,500
91 FOLLY CAT THREE WAY 22 50 RSUD 632,500
92 FOLLY CAT THREE WAY 20 50 RSUD 632,500
93 FORMALIN SOL. 40% 10 RSUD 3,737,500
94 GYPSONA 6 INCHI 10 RSUD 3,737,500
95 GYPSONA4INCHI 100 RSUD 6,000,000
96 H202 (PERHYDROL) 50% 100 RSUD -
97 HAND CALLAR DEWASA 150 RSUD 10,566,150
98 HERNIA MES 200 RSUD 10,560,000
99 I.V CHATETER NO 16 4 RSUD 146,664
100 I.V CHATETER NO 18 10 RSUD 800,000
101 I.V CHATETER NO 20 20 RSUD 1,732,820
102 I.V CHATETER NO 22 250 RSUD 4,440,750
103 I.V CHATETER NO 24 1,000 RSUD 18,113,000
104 I.V CHATETER NO 26 2,000 RSUD 38,000,000
105 INFUSION SET MACRO 1,000 RSUD 17,765,000
106 INFUSION SET MICRO 1,000 RSUD 23,510,000
107 JACKSON-REES SET 500 RSUD 5,633,500
108 JARUM 27 G 2,000 RSUD 28,314,000
109 JARUM CITOJECT N027 G dental use 500 RSUD 4,554,000
110 JARUM SPINAL NO. 25 100 RSUD 4,650,000
111 JARUM SPINAL NO. 26G 250 RSUD 12,500,000
112 JARUM SPNAL 27 30 RSUD 1,200,000
113 JET NEBULIZER MASK PEDIATRIC 10 RSUD 400,000
114 JET NEBULIZER MASKADULT 30 RSUD 1,200,000
115 JOINT FIT ROLL 150 RSUD 4,050,000
116 KANTONG DARAH 350ML ( JGN YANG TRIPEL) 100 RSUD 4,180,000
117 KAPAS 500 GR 100 RSUD 4,180,000
118 KASA ROLL 40 X 80 100 RSUD 5,000,000
119 KASASTERIL 5 RSUD 212,500
120 KERTAS LAKMUS(OBGYN) 150 RSUD 9,780,300
121 KRUKKETIAKL 250 RSUD 14,707,000
122 KRUKKETIAKM 60 RSUD 2,100,000
123 KRUKKETIAKS 150 RSUD 6,930,000
124 L M A (LARINGEAL MASK AIRWAYS) 500 RSUD 25,100,000
125 MASKER OXYGENT DEWASA rebreathing 12 RSUD -
126 MASKER OXYGENT PEDIATRI rebreathing 10 RSUD 411,110
127 MASKER SURGICAL EARLOOP 10 RSUD 357,060
128 MICROBRUSH BONDING APLICATOR 10 RSUD 326,700
129 MOKSA SMOKELES STICK 12 RSUD 633,600
130 MONOPILAMEN POLYGLECAPRONE 25 VIOLET ABSORBABLE 3/0 (3/8,CIRCLE 24 mm ) cutting 12 RSUD 997,920
131 NASAL CANULA 02 DEWASA 150 RSUD 22,425,000
132 NASAL CANULA 02 BAYI 50 RSUD 395,000
133 NASAL CANULA 02 PEDIATRI 20 RSUD 800,000
134 NEEDLE 18 10 RSUD 2,523,140
135 NEEDLE NO. 23 10 RSUD 2,523,440
136 NELATHON CHATETER NO. 10 10 RSUD 2,523,440
137 NELATHON CHATETER NO. 12 20 RSUD 7,333,320
138 NELATHON CHATETER NO.16 5 RSUD 1,625,000
141 ORIGINAL PERFUSSOR 250 RSUD 13,061,250
142 PLESTER HIPAVYX 257 RSUD 13,426,965
143 PLESTER ROLL (LEUKOPLAST 7,5CM X 4,5M) 500 RSUD 14,850,000
144 POLYGYICOLIDE ABSORBABLE 2.0 (1/2 circle 25mm) cutting 30 RSUD 1,800,000
145 POLYGYICOLIDE ABSORBABLE 3.0 (1/2 CIRCLE 25mm) cutting 5 RSUD 1,000,000
146 POLYPREPILEN 2.0 CUTING 150 RSUD 1,575,450
150 PREMILEN 7.0 500 RSUD 700,000
151 SARUNG TANGAN (L) 500 RSUD 700,000
152 SARUNG TANGAN (M) 50 RSUD 480,650
153 SARUNG TANGAN (S) 50 RSUD 480,650
154 SARUNG TANGAN GYNAECOLOG PANJANG 50 RSUD 480,650
155 SARUNG TANGAN NO. 6,5 (STERIL) 50 RSUD 480,650
156 SARUNG TANGAN NO. 7 (STERIL) 50 RSUD 1,275,000
157 SARUNG TANGAN NO. 8 (STERIL) 50 RSUD 7,500,000
158 SARUNG TANGAN NO.7,5 (STERiL) 200 RSUD 36,666,800
159 SHARP CONTAINER 5 LTR 500 RSUD 24,191,000
160 SIDEX (GLUTARLDEIDA) 150 RSUD 6,750,000
161 silk black non absorbable 2.0 (1/2 circle 25 mm ) tapper 150 RSUD 8,250,000
162 silk black non absorbable 3.0 (1/2 circle 25mm ) tapper 150 RSUD 9,675,000
163 silk black non absorbable 3.0 (3/8 circle 16 mm ) cutting 200 RSUD 12,500,000
164 silk black non absorbable 4.0 (1/2 circle 20mm ) tapper 150 RSUD 9,675,000
165 SILK NO 2/0 (WITH NEEDLE) taper HR 26 150 RSUD 9,675,000
166 SILK NO 3/0 (WITH NEEDLE) taper HR 20 36 RSUD 1,980,000
167 SILK NO 4/0 (WITH NEEDLE) Taper HR 20 20,000 RSUD 27,920,000
168 SILK NO 5/0 (WITH NEEDLE) taper 35,000 RSUD 48,860,000
169 SILK NO. 2 WITH NEEDLE cuting 10,000 RSUD 13,960,000
170 SILK NO. 2 WITH NEEDLE taper 100 RSUD 500,000
171 SILK NO. 3 WITH NEEDLE cuting 3,000 RSUD 45,000,000
172 SILK NO. 3 WITH NEEDLE taper 6,000 RSUD 88,302,000
173 SKIN TRAKSI ANAK 2,000 RSUD 28,594,000
174 SKIN TRAKSI DEWASA 10,000 RSUD 143,840,000
175 SOFT BAND 4 INCHI 100 RSUD 6,008,200
176 SOFT BAND 6 INCHI 20 RSUD -
177 SOLDER SLING 300 RSUD 11,400,000
178 SPALAK PANJANG DEWASA UK 100 X 10 CM 300 RSUD 11,400,000
179 SPALAK PANJANG DEWASA UK 100 X 10 CM 300 RSUD 11,400,000
180 SPALAK TANGAN DEWASA 30 X 6 CM 300 RSUD 11,400,000
181 SPOGESTAN 480 RSUD 7,728,000
182 STOMACH TUBE NO 10 480 RSUD 7,516,032
187 STOMACH TUBE NO 3,5 400 RSUD 18,800,000
190 STOMACH TUBE NO 8 60 RSUD -
191 SUMZEHER 200 RSUD 6,214,000
192 SUNGKUP 02 DEWASA 250 RSUD 11,296,250
193 SUNGKUP 02 PEDIATRI 5 RSUD 175,000
194 SURGICRYL (POLYGLYCOLIC ACID) NO.2 60 RSUD 2,100,000
195 THREE WAY 60 RSUD 2,100,000
196 THREE WAY BEREKOR 60 RSUD -
197 TOBAN (PLESTER TRNSPARAN DENGAN IODIUM) 200 RSUD 2,100,000
198 TRANSFUSION SET INFUS 360 RSUD 8,565,120
199 TRANSMISSION JELLY 250 RSUD 5,948,000
200 treated polyester green synthetic non absorbable 1 ( 3/8 circle 31 mm ) j needle 100 RSUD 2,379,200
201 ULTRASONIC GEL 5 LTR 360 RSUD 9,016,920
202 UMBILICAL CORD CLEMP BLUE 360 RSUD 8,565,120
203 UNDERPADS 60X90 200 RSUD 4,758,400
204 URINE BAG 250 RSUD 5,948,000
205 WING NEEDLE N0.23 250 RSUD 5,948,000
206 WING NEEDLE N0.25 250 RSUD 6,760,000
207 WING NEEDLE N0.27 500 RSUD -
208 LOGICATH CVC 2L 12F 20 CM 800 RSUD 24,381,600
211 GOWN DRAPE DISPOSIBLE 750 RSUD 64,829,250
212 DOCK DISPOSIBLE 500 RSUD 7,500,000
213 BETADIN CAIR 500 RSUD 43,217,000
214 KAPSUL 000 1,000 RSUD 23,471,000
215 KAPSUL OO 200 RSUD 7,941,440
216 KAPSUL O 150 RSUD -
217 JARUM AKUPUNTUR 0,25 x 40 mm (dong bang) 15 RSUD 3,604,920
218 JARUM AKUPUNTUR 0,25 x 25 mm (dong bang) 10 RSUD 30,040
219 JARUM AKUPUNTUR 0,25 x 13 mm (dong bang) 3,000 RSUD 18,024,000
220 JELY ULTRASOUND 1,000 RSUD 8,309,000
221 Kapsul 1 10 RSUD 800,000
222 Kapsul 2 10 RSUD 600,000
223 Kapsul 3 10 RSUD 400,000
Sub Total 1,800,048,492
C REAGEN LABORATORIUM
1 Darah Kontrol Mindray 3000 Plus 12 RSUD 10,020,000
2 Diluent Mindray 3000 Plus 24 RSUD 42,120,000
3 Emertion Oil 6 RSUD 4,632,000
4 EZ- Cleanzer (Mindray BJ 3000 Plus) 20 RSUD 17,242,500
5 Giemsa Gram Stain 10 RSUD 15,500,000
6 Kertas Mindray Dan Kimia 72 RSUD 13,500,000
7 M-30P-Prob Cleanser 120 RSUD 9,234,000
8 Methanol 6 RSUD 7,392,000
9 Reagent Gol.Da Anti-A 60 RSUD 8,400,000
10 Reagent Gol.Da Anti- B 60 RSUD 8,400,000
11 Rinse 6 RSUD 10,146,000
12 Lyse Mindray BS 3000 24 RSUD 92,592,000
13 Reagent Gol.Da Anti-D 60 RSUD 9,900,000
14 Turk 1 RSUD 150,000
15 Eosine 2 % 1 RSUD 215,000
16 Eosine Y 1 RSUD 215,000
17 Reagen HE 1 RSUD 200,000
18 Reagent Albumin 5 RSUD 3,107,500
19 Reagent Asam Urat 6 RSUD 9,438,000
20 Reagent Bilirubun T/D 2 RSUD 1,430,000
21 Reagent Cholesterol 12 RSUD 21,120,000
22 Reagent Creatinin 24 RSUD 14,810,400
23 Reagent Glukosa 24 RSUD 17,952,000
24 Reagent SGOT 24 RSUD 40,920,000
25 Reagent SGPT 24 RSUD 40,920,000
26 Reagent Total Protein 2 RSUD 1,540,000
27 Reagent Ureum UV 24 RSUD 45,012,000
28 Serum Control 2 RSUD 7,500,000
29 Sensor Cassette BGA 4 RSUD 1,000,000
30 Solition Pack BGA 4 RSUD 1,000,000
31 Urine Strip 15 RSUD 4,185,000
32 Narkoba Rapid Test 10 RSUD 12,293,000
33 Tabung sentrifuse urine 50 RSUD 135,000
34 Reagen None 1 RSUD 250,000
35 Reagen Pandi 1 RSUD 250,000
36 Rivalta 1 RSUD 3,000,000
37 Sataihelmer Malbin (Cat Urine) 4 RSUD 8,000,000
38 Pregnancy Strip 5 RSUD 1,004,000
39 HbSAg Stick 45 RSUD 20,587,500
40 HCV Stick 11 RSUD 13,750,000
41 HIV Stick 45 RSUD 153,000,000
42 Shipylis Stick 45 RSUD 41,580,000
43 Salmonella Ig M Rapid Test 1 RSUD 1,450,000
44 Anti Dengue Ig G Rapid Test 1 RSUD 1,625,000
45 Bovine albumin 50 RSUD 7,500,000
46 Como test 50 RSUD 7,500,000
47 Cassette CD4 6 RSUD 900,000
48 Control CD4 4 RSUD 600,000
49 Methylen Blue 0,1% 15 RSUD 51,859,500
50 Carbol Fuchsin 0,3% 15 RSUD 1,361,250
51 Blod Lancet 20 RSUD 825,000
52 Blue Tip 24 RSUD 6,960,000
53 Filter Paper Whatman (CT – BT Test) 2 RSUD 2,558,000
54 Kertas Pembersih Lensa Microscope 8 RSUD 1,100,000
55 Object Glass 80 RSUD 2,912,000
56 Tabung Disposible EDTA (ungu) 5,800 RSUD 15,660,000
57 Tabung Disposible Kimia (merah) 4,800 RSUD 12,960,000
58 Tabung Sitros (Biru) 600 RSUD 1,881,000
59 Wright Stain 18 RSUD 12,375,000
60 Yellow Tip 14 RSUD 3,080,000
61 Pot Urine 2,500 RSUD 7,000,000
62 Kartu Gol.Da 6 RSUD 330,000
63 Parafilm (Laboratory Film) 3 RSUD 450,000
64 Tabung Kapiler (Tabung Hematokrit) 2 RSUD 32,428
65 Tabung Sample (plastic) 8 RSUD 11,200,000
Sub Total 865,762,078
D BAHAN MEDIS RADIOLOGI

1 Kertas USG HG Sony 110 200 RSUD 36,000,000
2 KERTAS CTG 130MMX120MM ENDO 20 RSUD 3,800,000
3 Fixer 6 RSUD 5,400,000
4 Developer 6 RSUD 8,100,000
5 Film CR DI-HT FOR DRYPIX 2000 BLUE BASE ukuran 26x36 7 RSUD 42,000,000
6 Film CR DI-HT FOR DRYPIX 2000 BLUE BASE ukuran 35x 43 7 RSUD 57,400,000
7 Fuji Film X-Ray Green Sensitive ukuran 30 x 40 cm 5 RSUD 16,700,000
8 Fuji Film X-Ray Green Sensitive ukuran 35 x 35 cm 5 RSUD 17,800,000
9 Urografin 70% 50 RSUD 10,500,000
10 Iopamirol 50 RSUD 8,300,000
11 BaSO4 10 RSUD 1,500,000
Sub Total 207,500,000
E RUTIN
1 Batterai Besar 115 RSUD 1,518,000
2 Batterai Kecil 189 RSUD 3,638,250
3 Batterai Sedang 6 RSUD 165,000
4 Blanko Laboratorium 5 RSUD 1,375,000
5 Blanko permintaan rawat inap 2 RSUD 550,000
6 Blanko surat rujukan 2 RSUD 550,000
7 Blanko surat sakit 2 RSUD 550,000
8 Buku Folio Besar 155 RSUD 8,525,000
9 Buku Gambar 5 RSUD 27,500
10 Cutter Kecil 28 RSUD 462,000
11 Hekter 85 RSUD 1,244,485
12 Isi Hekter 265 RSUD 1,457,500
13 Isolasi 28 RSUD 308,000
14 Kertas HVS 26 RSUD 1,716,000
15 Kertas Resep 360 RSUD 198,000
16 Lem 184 RSUD 3,306,204
17 Lilin 170 RSUD 3,197,700
18 Map File 150 RSUD 4,125,000
19 Pena 24 RSUD 132,000
20 Penggaris 30 RSUD 439,230
21 Penghapus Papan 31 RSUD 170,500
22 Pensil 2 B 44 RSUD 242,000
23 Pensil Warna (Merah, Biru) 56 RSUD 924,000
24 Rak buku 3 RSUD 5,610,000
25 Rak Sepatu 2 RSUD 3,300,000
26 Spidol Boardmarker 145 RSUD 1,595,000
27 Spidol Permanen 145 RSUD 1,595,000
28 Amplop 3 RSUD 148,500
29 Amplop Foto Ukuran 26 x 36 cm 2,000 RSUD 17,600,000
32 Balpoin Hitam 66 RSUD 326,700
33 Blanko Resep Rawat Inap 2 RSUD 550,000
34 Bolpoint 10 RSUD 49,500
35 Bolpoint Hitam 36 RSUD 178,200
36 Box File 70 RSUD 1,771,000
37 Buku Besar 30 RSUD 1,320,000
38 Buku Expedisi 12 RSUD 105,600
39 Buku Folio Besar 126 RSUD 5,544,000
40 Buku Folio Kecil 63 RSUD 554,400
41 Buku Folio Kecil 6 RSUD 52,800
42 buku folio kecil panjang 42 RSUD 369,600
43 Buku Folio Kecil Pendek 5 RSUD 33,000
44 Buku Folio Ukuran Besar ( Poli Fisio ,Gym, Poli Syaraf ) 5 RSUD 220,000
45 Buku Folio Ukuran Kecil 5 RSUD 44,000
46 Buku Kecil 30 RSUD 264,000
47 buku tulis biasa 34 RSUD 224,400
48 cater & Pisau Cater 12 RSUD 198,000
49 Catrig Hitam 3 RSUD 577,500
50 Catrig Warna 3 RSUD 82,500
51 Clear Holder 10 RSUD 341,000
52 Cutter Besar 4 RSUD 66,000
53 Gunting 2 RSUD 33,000
54 Gunting (ATK) 2 RSUD 55,000
55 Gunting Kertas 3 RSUD 33,000
56 Isolasi 10 RSUD 110,000
57 Jepitan Kertas 12 RSUD 59,400
58 Kabel Roll 2 RSUD 1,530,650
59 kertas A4 2 RSUD 154,000
60 Kertas Caver 3 RSUD 165,000
61 kertas f4 2 RSUD 132,000
62 Kertas Folio F4 5 RSUD 330,000
63 Kertas HVS 2 RSUD 132,000
64 Kertas HVS A4 12 RSUD 1,056,000
65 Kertas HVS F4 24 RSUD 1,584,000
66 kertas HVS ukuran A4 24 RSUD 2,112,000
67 Kertas HVS ukuran F4 36 RSUD 2,376,000
68 Kertas HVS/ Rim 1 RSUD 66,000
69 Kertas NCR 12 RSUD 726,000
70 Kertas Resep Rawat Inap 4 RSUD 1,100,000
71 Klip Kertas Kecil 50 RSUD 247,500
72 klips kertas Besar 50 RSUD 330,000
73 Lem 20 RSUD 33,000
74 Lem Kertas Povinal 20 RSUD 32,208
75 Lembar Observasi 2 RSUD 550,000
76 Lilin 10 RSUD 220,000
77 Map 22 RSUD 121,000
78 Map File 7 RSUD 38,500
79 Map File (Brider) 12 RSUD 66,000
80 Map Folder 106 RSUD 2,915,000
81 Map Kertas 10 RSUD 86,515
82 Map Plastik 43 RSUD 71,565
83 Mistar 22 RSUD 322,102
84 Pelubang kertas 2 RSUD 66,000
85 Pembolong Kertas 6 RSUD 198,000
86 Pemotong Kertas 1 RSUD 266,200
87 Pena 4 RSUD 17,305
88 Pena / Dos 1 RSUD 66,000
89 Pena Farter 40 RSUD 198,000
90 Pena Faster 11 RSUD 54,450
91 Penggaris 15 RSUD 82,500
92 Penggaris 30 cm 10 RSUD 55,000
93 Penggaris ukuran 30 cm 50 RSUD 440,000
94 Pensil 59 RSUD 324,500
95 Pensil 2 B 20 RSUD 110,000
96 Pensil 2b 10 RSUD 55,000
97 Pensil Warna (Merah, Biru) 5 RSUD 82,500
98 Pensil/ Dos 1 RSUD 66,000
99 Resep Umum 20 RSUD 220,000
100 Selotip ukuran besar 2 RSUD 33,000
101 Spidol (merah, hitam, biru, hitam) 12 RSUD 132,000
102 Spidol Board Marker 50 RSUD 550,000
103 Spidol Boardmaker 2 RSUD 15,400
104 Spidol Boardmarker 57 RSUD 438,900
105 Spidol Kecil Hitam 36 RSUD 79,200
106 Spidol Permanen 90 RSUD 990,000
107 Spidol Permanent 60 RSUD 462,000
108 Spidol Permanent 60 RSUD 660,000
109 Spidol Snowan BoardMarker Hitam 64 RSUD 492,800
110 Spidol Snowan Marker Hitam 24 RSUD 264,000
111 Spidol Snowman Boardmarker Hitam 12 RSUD 132,000
112 Tinta Epson 24 RSUD 3,960,000
113 Tinta Print Canon Hitam 18 RSUD 792,000
114 Tinta Print Canon Warna 18 RSUD 792,000
115 Tinta Print Hitam 12 RSUD 528,000
116 Tinta Print Warna 12 RSUD 528,000
117 Tinta Stempel 2 RSUD 154,000
118 TipEx 164 RSUD 2,706,000
Sub Total 145,540,264
F LOGISTIK
1 Alat Pel 80 RSUD 6,600,000
2 Alat Pembersih Kaca 7 RSUD 154,000
3 Anti septic gel 84 RSUD 1,386,000
4 Baby Oil 100ML 24 RSUD 924,000
5 Bay Fresh 364 RSUD 10,010,000
6 Bayclin 471 RSUD 9,325,800
7 Bedak Baby 100 RSUD 1,100,000
8 Cairan Anti Septik 24 RSUD 924,000
9 Clear Pembersih Kaca 255 RSUD 14,025,000
10 Ember Bertutup Besar 34 RSUD 5,610,000
11 Ember bertutup kecil 34 RSUD 2,805,000
12 Ember Bertutup Sedang 4 RSUD 440,000
13 Fortex/ botol 6 RSUD 495,000
14 Gantungan Baju 12 RSUD 330,000
15 Gayung 65 RSUD 715,000
16 Glass Cleaner 17 RSUD 374,000
17 Harpic 12 RSUD 990,000
18 Hibis Scrub 25 RSUD 1,375,000
19 Hit Semprot 307 RSUD 6,922,850
20 Kain Lap / Seka 20 RSUD 440,000
21 Kamfer 208 RSUD 1,144,000
22 Kantong Sampah Besar Ukuran 120 x 180 50 RSUD 16,500,000
23 Kantong Sampah Kecil Ukuran 90 x 90 50 RSUD 3,850,000
24 Kantong Sampah Sedang Ukuran 90 x 180 50 RSUD 11,000,000
25 Karpet 6 RSUD 660,000
26 Keranjang linen kotor 1 RSUD 60,500
27 Kertas Puyer Pres 12 RSUD 726,000
28 Kesek Kaki 49 RSUD 4,042,500
29 Ligent (Pembersih Peralatan Dapur) 1000 ml 8 RSUD 880,000
30 Molto 900ml 106 RSUD 1,749,000
31 Pembersih kaca 130 RSUD 2,860,000
32 Penutup Meja 12 RSUD 2,310,000
33 Perlak Pasien 12 RSUD 2,640,000
34 Plastik Sampah 312 RSUD 12,698,400
35 Plastik Sampah Ukuran 40 x 50 300 RSUD 23,100,000
36 Plastik Sampah Ukuran 60 x 90 200 RSUD 44,000,000
37 Plastik Sampah ukuran 90 x 120 100 RSUD 33,000,000
38 Portex 397 RSUD 32,752,500
39 Rak Jemuran 7 RSUD 4,235,000
40 Rinso 269 RSUD 5,918,000
41 Sabun Batang 162 RSUD 1,782,000
42 Sabun Batang/ batang 6 RSUD 66,000
43 Sabun Cair 153 RSUD 8,415,000
44 Sabun Cuci Mama Lemon 13 RSUD 214,500
45 Sabun Cuci tangan 83 RSUD 1,369,500
46 Sabun Mandi Baby 500 RSUD 5,500,000
47 Sabun Mandi Pasien 101 RSUD 1,111,000
48 sapu 12 RSUD 792,000
49 Sapu Ijuk 31 RSUD 2,046,000
50 Sapu Lantai 29 RSUD 1,914,000
51 Sapu lantai VIP 2 RSUD 132,000
52 Sapu Dinding Ruangan 37 RSUD 7,529,500
53 sapu Lidi 42 RSUD 924,000
54 Sarung bantal pasien 20 RSUD 770,000
55 Selimut 2 RSUD 220,000
56 Selimut Ganti Pasien 25 RSUD 2,750,000
57 Selimut pasien 74 RSUD 8,140,000
58 Semprot Nyamuk 10 RSUD 225,500
59 Sendal Perawat 10 RSUD 275,000
60 Sendok Sampah 4 RSUD 660,000
61 Sendok sampah 4 RSUD 660,000
62 Seprei pasien 10 RSUD 1,980,000
63 Serokan 27 RSUD 594,000
64 Sikat Baju 10 RSUD 110,000
65 Sikat Besar 5 RSUD 110,000
66 Sikat Kamar Mandi 127 RSUD 2,794,000
67 Sikat pakaian 12 RSUD 264,000
68 So Clin Lantai 61 RSUD 2,348,500
69 Sun Cream 12 RSUD 264,000
70 Sunlight 101 RSUD 2,222,000
71 Super pel 488 RSUD 9,125,600
72 Tabung O₂ Besar 5 RSUD 16,500,000
73 Tabung O₂ kecil 2 RSUD 3,300,000
74 Tangkai Pel 14 RSUD 1,155,000
75 Tempat Pakaian Kotor Pasien 12 RSUD 726,000
76 Tempat sampah Untuk CS 18 RSUD 4,950,000
77 Tempat Sampah berpenutup ukuran sedang 1 RSUD 275,000
78 Tempat Sampah Besar 25 RSUD 9,625,000
79 Tempat Sampah Besar dan Penutup 4 RSUD 1,540,000
80 Tempat Sampah Kecil 103 RSUD 22,660,000
81 Tempat sampah kecil bertutup 8 RSUD 1,760,000
82 Tempat Sampah Kecil dan Penutup 8 RSUD 1,760,000
83 Tempat Sampah Pasien bertutup 20 RSUD 5,500,000
84 Tempat Sampah Pasien Tutup Sedang 10 RSUD 2,750,000
85 Tempat Sampah Sedang 50 RSUD 13,750,000
86 Tempat Sampah ukuran sedang dengan penutup 2 RSUD 550,000
87 Tissu Kotak 323 RSUD 3,553,000
88 Tissue Lux 3 RSUD 33,000
89 Tissue Basah 308 RSUD 5,082,000
90 Tissue Kering 72 RSUD 792,000
91 Tissue roll 398 RSUD 3,064,600
92 Tissue Pasien 12 RSUD 198,000
93 Waskom Double 5 RSUD 412,500
94 Waslap Pasien 117 RSUD 3,346,200
95 Waslap Petugas 5 RSUD 143,000
96 Wiper 2 RSUD 77,000
97 Wipol 15 RSUD 577,500
Sub Total 438,459,450
G MEUBELAIR
1 Kipas Angin Err:509 RSUD Err:509
2 Seprei Pasien Err:509 RSUD Err:509
3 Kursi Palstik 1 RSUD 3,850,000
4 Selimut Pasien 7 RSUD 42,000,000
5 Perlak 6 RSUD 60,000,000
6 Kipas Angin Gantung Err:509 RSUD Err:509
7 Kursi Pasien Plastik Err:509 RSUD Err:509
8 Lemari Penyimpanan Barang 2 RSUD 1,600,000
9 Sapu Ruangan 1 RSUD 250,000
10 Lemari Arsip 2 RSUD 200,000
11 Lemari Instrumen 35 RSUD 1,750,000
12 Lampu Emergensi 3 RSUD 300,000
13 AC 1PK 6 RSUD 600,000
14 Kulkas Mini Err:509 RSUD Err:509
15 Dispenser 4 RSUD 6,000,000
16 TV 21" Err:509 RSUD Err:509
17 Kursi Sofa 1 RSUD 50,000,000
18 Taplak Meja Px (Kotak Kecil) 2 RSUD 90,000
19 Exhaused Fan 5 RSUD 375,000
20 Bantal Kepala Err:509 RSUD Err:509
21 Sarung Bantal Kepala 9 RSUD 35,100,000
22 Bantal Guling 600 RSUD 3,000,000
23 Kulkas Err:509 RSUD Err:509
24 Sarung Bantal Guling 12 RSUD 20,400,000
25 Dyspenser set Err:509 RSUD Err:509
26 Jam dinding Err:509 RSUD Err:509
27 Lemari Alat 14 RSUD 14,000,000
28 Parabola 300 RSUD 30,000,000
29 AC 2 PK. 2 RSUD 3,000,000
30 AC 1/2 PK 3 RSUD 450,000
31 PC + Printer 1 RSUD 1,000,000
32 Stavol 500/1000 VOLT 2 RSUD 800,000
33 Kursi Petugas 600 RSUD 3,000,000
34 Meja Konsul Dokter 1 RSUD 300,000
35 Sepatu uk. 44 1 RSUD 250,000
36 Sepatu uk. 39 1 RSUD 100,000
37 Sandal uk. 44 10 RSUD 500,000
38 Sandal uk. 39 10 RSUD 120,000
39 Kaca Mata 1 RSUD 30,000,000
40 Meja Perawat Penjaga 30 RSUD 2,250,000
41 Meja Observasi Pasien 4 RSUD 3,200,000
42 Kursi Kerja Roda 9 RSUD 5,400,000
Sub Total Err:509
H FISIK
1 Pembangunan Gedung Laboratorium 1 RSUD 1,902,427,618.30 DAK
2 Pembangunan Pavilium RSUD 4 RSUD 580,800,000.00
3 Pembangunan Barak Perawat 1 RSUD 1,089,000,000.00
4 Rehab Ringan :
a. Ruang PONEK 1 RSUD 66,000,000.00
b. Ruang Perinatologi 1 RSUD 110,000,000.00
c. Ruang CCSD 1 RSUD 77,000,000.00 DAK
d. Ruang Hemodialisa 1 RSUD 77,000,000.00 DAK
5 Rehabilitasi Kamar Operasi (OK) 1 RSUD 5,000,600,000.00 DAK
6 Sekat ruang isolasi (Interna dan Anak) 1 RSUD 139,194,690.21
7 Pembangunan Aula RSUD 1,200 RSUD -
8 Pembangunan Selasar penghubung R.Rawat bedah dan anak 1 RSUD -
9 Pengadaan Obat-obatan 1 RSUD 2,400,000,000.00 OTSUS
10 Pengadaan SIM RS 1 RSUD 715,000,000.00
11 Pengadaan Mobil Jenazah 2 RSUD 571,736,000.00
12 Perencanaan dan Pegawasan 1 RSUD 523,527,400.00
Sub Total 13,252,285,709
I KEMITRAAN DAN PELATIHAN
1 Penambahan Tenaga :
a. Bersalin 2 Org RSUD 40,800,000
b. Nifas 3 Org RSUD 61,200,000
c. Bedah 1 Org RSUD 20,400,000
d. Lab/UTD 6 Org RSUD 122,400,000
e. Radiologi 2 Org RSUD 40,800,000
f. Tenaga Gizi 2 Org RSUD 40,800,000
2 In House Training
Pelatihan PPGD/ PPGD ON 4 Org RSUD 80,000,000
Pelatihan BTCLS 5 Org RSUD 100,000,000
Pelatihan APN 2 Org RSUD 40,000,000
Pelatihan pijat bayi 2 Org RSUD 40,000,000
Resusitasi bayi 2 Org RSUD 40,000,000
Senam bumil + Nifas 2 Org RSUD 40,000,000
Pelatihan Bidan KB 2 Org RSUD 40,000,000
3 Manajemen Bangsal (KEPALA RUANGAN) 2 Org RSUD 60,000,000

4 Pelatihan Anastesi 1 Org RSUD 30,000,000
5 Pelatihan Bedah 1 Org RSUD 30,000,000
6 Pelatihan ICU 3 Org RSUD 90,000,000
7 Penanganan Pendarahan Persalinan 2 Org RSUD 60,000,000
8 Perawatan luka 1 Org RSUD 30,000,000
9 Perawatan stoma 1 Org RSUD 30,000,000
10 Perinatologi 2 Org RSUD 60,000,000
11 PONEK 2 Org RSUD 60,000,000
12 Pelatihan penyamplingan 2 Org RSUD 60,000,000
13 Pelatihan crossmatcH darah 2 Org RSUD 60,000,000
14 Pelatihan malaria 2 Org RSUD 60,000,000
15 Pelatihan TB 2 Org RSUD 60,000,000
16 Training Manejemen Farmasi 2 Org RSUD 60,000,000
17 Pisiko Tropika 2 Org RSUD 60,000,000
18 Pengobatan Rasional 2 Org RSUD 60,000,000
19 Pelatihan Asuhan Gizi 2 Org RSUD 60,000,000
20 Pelatihan Dietetik Gizi 2 Org RSUD 60,000,000
21 Pelatihan Penanganan Gizi Buruk 2 Org RSUD 60,000,000
22 Manajemen Data & Pelaporan Rumah Sakit 1 Org RSUD 30,000,000
23 Pendidikan & Pelatihan Rekam Medis 1 Org RSUD 30,000,000
24 Pertemuan Persatuan Perekam Medis 1 Org RSUD 30,000,000
25 Pelatihan ATLS bagi Dokter Umum 3 Org RSUD 90,000,000
26 Pelatihan ACLS bagi Dokter Umum 3 Org RSUD 90,000,000
27 Pelatihan HD bagi1 orang dokter Umum dan 1 orang Dokter Spesialis 2 Org RSUD 60,000,000
28 Kegawatdaruratan medik(in house training) 1 Org RSUD 30,000,000
29 ICU(in house training) 1 Org RSUD 30,000,000
30 Pelatihan Penyusunan Clinical Pathway 2 Org RSUD 60,000,000
31 Pelatihan USG bagi Tenaga Medis 4 Org RSUD 120,000,000
32 Pelatihan EKG 2 Org RSUD 60,000,000
33 Pelatihan dokter spesialis 14 Org RSUD 420,000,000
34 Kolegium Obgyn pada TW I 1 Org RSUD 30,000,000
35 Kolegium Penyakit Dalam pada TW II 1 Org RSUD 30,000,000
36 Kolegium Bedah pada TW III 1 Org RSUD 30,000,000
37 Kolegium Anak pada TW IV 1 Org RSUD 30,000,000
38 Audit Medik dan Klinik 1 Org RSUD 30,000,000
39 Manajemen Data & Pelaporan Rumah Sakit 2 Org RSUD 26,000,000
40 Pendidikan & Pelatihan Rekam Medis 1 Org RSUD 13,000,000
41 Pertemuan Persatuan Perekam Medis Seluruh Indonesia 1 Org RSUD 13,000,000
42 Pelatihan Cuci Tangan 1 Org RSUD 15,000,000
43 Pelatihan Pemakaian APD 1 Org RSUD 15,000,000
44 Pelatihan Dekontaminasi 1 Org RSUD 15,000,000
45 Pelatihan Manajemen Linen dan Laundry 1 Org RSUD 15,000,000
46 Pelatihan Manajemen Limbah 1 Org RSUD 15,000,000
47 Pelatihan Penanganan Pasien Infeksius 1 Org RSUD 15,000,000
48 Pelatihan Akupuntur bagi Dokter / Dokter Spesialis 1Org RSUD 20,000,000
49 Pelatihan Khusus Fisioterapis 1 Org RSUD 15,000,000
LIMA PULUH SEMBILAN MILYAR
TEMINABUAN, FEBRUARI 2015
Sub Total TIGA RATUS TIGA PULUH TIGA JUTA DELAPAN RATUS ENAM PULUH LIMA RIBU RUPIAH 3,133,400,000
KEPALA RSUD SCHOLOO KEYEN
KABUPATEN SORONG SELATAN
GRAND TOTAL Err:509
drg. ROSALINE N I.KRIMADI,MPH

NIP.19771120 200212 2 006
EVALUASI PELAKSAANAAN DESK
RAKER RSUD "SCHOLOO" KEYEN
TAHUN 2015
HARI I (Senin, 26 Januari 2015)
Kelengkapan Desk
No Waktu Pelaksanaan Kegiatan
Usulan Kegiatan TOR Gambar, Spesifikasi Surat Pernyataan
1 Desk Ruang.IGD (+) (-) (-) (+)
2 Desk Ruang Bersalin (+) (-) (-) (+)
3 Desk Ruang Nifas (+) (-) (-) (+)
4 Desk Ruang. Interna (+) (-) (-) (+)
5 Desk Ruang.Anak (+) (-) (-) (+)
6 Desk Ruang.Bedah (+) (-) (-) (+)
7 Desk Ruang. OK (+) (-) (-) (+)
8 Desk Ruang ICU (+) (-) (-) (+)
9 Desk Radiologi (+) (-) (-) (+)
HARI II (Selasa, 27 Januari 2015)
Kelengkapan Desk
No Waktu Pelaksanaan Kegiatan
Usulan Kegiatan TOR Gambar, Spesifikasi Surat Pernyataan
1 Desk Komite Medik (+) (-)
2 Desk Komite Keperawatan
3 Desk POKJA VCT-TB-MALARIA (+) (-)
4 Desk Laboratorium (+) (-)
5 Desk Apotik & Gdg.Farmasi (+) (-)
6 Desk Rekam Medik (+) (-)
7 Desk Gizi
8 Desk Loundry dan Kesling
9 Desk IPSRS & Security
10 Desk Rehabilitasi Medik/ Fisioterapi
11 Desk Umum
BLUD RUMAH SAKIT UMUM DAERAH SCHOLOO KEYEN
RENCANA ANGGARAN BIAYA OBAT RSUD SCHOLOO TAHUN 2017
NO NAMA OBAT SATUAN KEMASAN JUMLAH HARGA SATUAN TOTAL

1 ACETOSAL 100MG TAB TAB 100 1,000 140 140,000
2 ACTRAPID VIAL 1000UI IN ml VIAL 1 40 138,000 5,520,000
3 ACYCLOVIR 200MG TAB TAB 100 2,000 476 952,000
4 ACYCLOVIR 400MG TAB TAB 100 1,000 757 757,000
5 ACYCLOVIR salep mata TUBE 25 20 375 7,500
6 AKARBOSE TAB 100 MG TAB 100 5,000 990.0 4,950,000
7 AKARBOSE TAB 50 MG TAB 100 6,000 780.0 4,680,000
8 ALBENDAZOLE TABLET 400mg TAB 400 415 166,000
9 ALLUPURINOL 100MG TAB 100 2,000 100 200,000
10 ALPRAZOLAM 0.25mg TAB 100 3,000 475 1,425,000
11 ALPRAZOLAM 1MG TAB TAB 100 1,000 280.0 280,000
12 AMINOFILIN 200MG TABLET TAB 100 5,000 128 640,000
13 AMINOFILIN INJEKSI VIAL 12 1,000 3,621 3,621,000
14 AMINOFLUID SOLUTION BTL 100 73,920.0 7,392,000
15 AMIODARON 200 MG TAB TAB 3000 1,500.0 4,500,000
16 AMIODARON INJ 150 MG/3ML AMP 150 14,400.0 2,160,000
17 AMIPAREN SOLUTION. BTL 20 400 56,300 22,520,000
18 AMITRYPTILIN 25MG TAB TAB 100 3,600 135 486,000
19 AMLODIPIN TABLET 10mg TAB 30 8,000 391 3,128,000
20 AMLODIPIN TABLET 5mg TAB 30 8,000 218 1,744,000
21 AMOXYCILIN 250MG TAB CAP 120 4,000 317 1,268,000
22 AMOXYCILIN 500MG TAB KAP 100 15,000 356 5,340,000
23 AMOXYCILIN SYRUP 125 MG BTL 50 2,900 4,060 11,774,000
24 AMPICILIN 1G INJEKSI VIAL 10 400 6,441 2,576,400
25 Analog insulin long acting inj 100 UI/ml,BTL 1 80 250,000 20,000,000
26 ANTASIDA SYRUP BTL 50 1,500 2,532 3,798,000
27 ANTASIDA TABLET TAB 1000 5,000 181 905,000
28 ANTI BAKTERI DOEN SALEP KOMBINPOT 240 3,019 724,560
29 ANTI HAEMORHOID SUPP SUP 10 200 3,650.0 730,000
30 ANTI MALARIA DOEN KOMBINASI S TAB 100 500 622 311,000
31 ANTIFUNGI SALEP ( 2-4 ) POT 24 350 2,063 722,050
32 ANTIMIGREN: ERGOTAMIN CAFFEINTAB 100 1000 162 162,000
33 APTIL SOLUTION BTL 1 50 22,686 1,134,300
34 AQUA PRO INJEKSI 20 ML BTL 120 7,200 2,400 17,280,000
35 ASAM ASKORBAT (VIT C ) 250 MG TAB 100 3,000 191 573,000
36 ASAM ASKORBAT 50MG (VITC) TAB 100 114 -
37 ASAM FOLAC 1 mg TAB 100 10000 57 570,000
38 ASAM MEFENAMAT 500MG TAB TAB 100 50,000 139 6,950,000
39 ASAM PIPEMIDAT 400 MG TAB 100 2,000 1,815.0 3,630,000
40 ASAM TRANEXAMAT INJEKSI 500mgAMP 10 1,800 4,000 7,200,000
41 ASERING SOLUTION BTL 20 500 9,000 4,500,000
42 ATRACURIUM INJ AMP 5 150 15,662 2,349,300
43 ATROPINE SO4 0,25MG/ML INJEKSI AMP 20 500 1,518 759,000
44 ATROPINE SO4 TAB 0,5 MG AMP 300 89 26,700
45 ATROPINE SO4 Tetes Mata BTL 1 10 13,500 135,000
46 AZITROMICIN 500 TAB TAB 30 2,000 5,400 10,800,000
47 AZITROMYCIN SYRUP 200mg IN 5ml BTL 50 100 37,500 3,750,000
48 BENZATIN BENZYL PENICILLIN 2.4 JVIA; 10 300 16,080 4,824,000
49 BERAPROSA SODIUM TAB TAB 200 3,600 720,000
50 Fenoterol HBr ih 100 mcg/puf BTL 30 117,500 3,525,000
51 BESI II SO4 TAB. SALUT KOMB. TAB 1000 8,000 49 392,000
52 BETAHISTIN MESILATE 6MG TAB 30 3,000 1,108 3,324,000
53 BETHAMETHASON CR TUBE 10 200 1,865 373,000
54 Bethametason tetes Mata BTL 1 10 25,106 251,060
55 BISOPROLOL 5 MG TAB TAB 50 10,000 909 9,090,000
56 BRICASMA RESPULES 2.5mg IN ml NEB 10 100 6,250 625,000
57 BUPIVACAIN 0,5% + glucosa 8% AMP 150 30,720 4,608,000
58 BUPIVACAIN 0,5% HIPERBARIK AMPAMP 400 32,000 12,800,000
59 CALCIUM LACTATE TABLET TAB 1000 15,000 70 1,050,000
60 CALSIUM CARBONATE TAB500MG TAB 400 489 195,600
61 CALSIUM GLUCONAT INJ AMP 48 96 7,800 748,800
62 CAPTOPRIL 12,5MG TAB TAB 100 10,000 128 1,280,000
63 CAPTOPRIL 25MG TAB TAB 100 60,000 173 10,380,000
64 CARBAMAZEPIN TABLET TAB 100 1,000 296 296,000
65 CATAPRES INJK (KLONIDIN INJ) AMP 5 50 30,600 1,530,000
66 CEFADROXIL 500MG CAPSUL CAP 100 5,000 40 200,000
67 CEFADROXIL SYRUP BTL 30 1,200 6,178 7,413,600
68 CEFIXIME 100MG CAPS CAP 50 25,000 1,010 25,250,000
69 CEFIXIME SYRUP 100MG BTL 50 300 10,500 3,150,000
70 CEFOPERAZONE INJK 1G VIAL 2 300 14,645 4,393,500
71 CEFOTAXIM 1G INJEKSI VIAL 2 4,000 5,394 21,576,000
72 CEFTAZIDIME INJ VIAL 2 200 20,472 4,094,400
73 CEFTRIAXON 1G INJEKSI VIAL 2 5,000 8,955 44,775,000
74 CEFUROXIME INJ 750MG VIAL 100 14,645 1,464,500
75 CETIRIZINE 10MG TAB 30 5,000 211 1,055,000
76 CETIRIZINE SYRUP BTL 50 700 10,500 7,350,000
77 CHLORAMPHENICOL 500MG CAPSUCAP 1000 2,000 350 700,000
78 CHLORAMPHENICOL salep kulit 500 4,750 2,375,000
79 CHLORAMPHENICOL EYE DROPS BTL 24 200 22,210 4,442,000
80 CHLORAMPHENICOL SALEP MATA TUBE 24 580 1,920 1,113,600
81 CHLOROQUIN PO4 250MG TABLET TAB 1000 10,000 126 1,260,000
82 CHLORPENIRAMINA MALEAT ( C T MTAB 100 72,000 101 7,272,000
83 CHLORPROMAZINA 25MG TABLET TAB 1000 3,000 46 138,000
84 CHLORPROMAZINA INJEKSI25MG AMP 25 300 46 13,800
85 CIPROFLOXACIN 500MG TAB TAB 100 10,000 420 4,200,000
86 CIPROFLOXACIN INFUS 2% BTL 10 200 24,457 4,891,400
87 CLINDAMICYN 150MG CAP 50 20,000 451 9,020,000
88 CLINDAMICYN 300MG CAP 50 5,000 842 4,210,000
89 CLOPIDOGREL 75mg TABLET TAB 30 1,500 3,990 5,985,000
90 CODEIN 10MG TAB TAB 2,000 600 1,200,000
91 CODEIN 15MG TAB TAB 100 3,000 1,020.0 3,060,000
92 CODEIN 20MG TAB TAB 100 3,000 1,320.0 3,960,000
93 COMBIVENT INJ AMP 25 1500 5,990 8,985,000
94 COTRIMOXAZOLE 480MG TABLET TAB 100 11,000 199 2,189,000
95 COTRIMOXAZOLE SYRUP BTL 120 600 4,337 2,602,200
96 DANOCLAV TABLET CAP 30 1,980 6,067 12,012,660
97 DARYANTULLE PCS 10 300 19,800 5,940,000
98 DEXAMETHASON INJ AMP 100 2,500 1,897 4,742,500
99 DEXAMETHASON TABLET TAB 100 30,000 107 3,210,000
100 DIAZEPAM 2MG TABLET TAB 100 36,000 54 1,944,000
101 DIAZEPAM 5MG TABLET 100 5,000 195.6 978,000
102 DIAZEPAM INJEKSI AMP 10 1,800 5,016.0 9,028,800
103 DIAZEPAM SUPP 10 MG SUPP 5 100 20,142 2,014,200
104 DIAZEPAM SUPP 5 MG SUP 5 200 13,914 2,782,800
105 DIGOKSIN INJ ( FARGOKSIN) AMP 5 150 26,600 3,990,000
106 DIGOKSIN TAB 0,25MG TABLET TAB 100 10,000 365 3,650,000
107 DILTIAZEM INJ (FARMABEX) AMP 1 100 56,000 5,600,000
108 DILTIAZEM TABLET 30MG TAB 50 500 180 90,000
109 DIMENHIDRINAT 10MG TABLET TAB 100 1,200 125 150,000
110 DIPHENHIDRAMIN INJ AMP 500 1,157 578,500
111 DOBUTAMIN 50mg INJEKSI AMP 5 80 68,607 5,488,560
112 DOPAMIN GIULINI 20 MG/ML AMP 100 11,760 1,176,000
113 DOXICYCLIN CAPSUL 100MG CAP 100 15,000 309 4,635,000
114 BISACODYL 5MG/SUPP SUPP 10 300 4,990 1,497,000
115 ENAKSOPARIN SODIUM 1NJ 20 MG/0AMP 1 50 48,890.0 2,444,500
116 EPHEDRINE 25MG TABLET TAB 100 15,000 62 930,000
117 EPINEFRINE INJEKSI AMP 25 1,000 9,720 9,720,000
118 ERITROPAETIN BETA INJ 2000/IU AMP 100 139,500.0 13,950,000
119 ERITROPAETIN ALFA INJ 2000/IU AMP 100 128,000.0 12,800,000
120 ERYTOMISIN 250MG CAPSUL CAP 100 1,000 600 600,000
121 ERYTOMISIN 500MG TABLET KAP 100 12,000 1,471 17,652,000
122 ERYTROMICIN SYRUP BTL 50 750 9,720 7,290,000
123 ESTROGEN TERKONJUGASI 0,625 MBTL 200 94,925.0 18,985,000
124 ETANOL 70% 100ml BTL 1 1,000 2,875 2,875,000
125 ETHAMBUTOL 500MG TAB TAB 100 1,000 688 688,000
126 EUGENOL SOLUTION 10 20,000.0 200,000
127 FENITHOIN NATR. 100 MG CAP BTL 100 5,000 160 800,000
128 FENITHOIN NATR. INJ AMP 350 22,127 7,744,450
129 FENOFIBRAT 100mg CAPSUL TAB 1,500 1,075 1,612,500
130 FENOL GLISEROL TETES TELINGA BTL 24 72 1,210 87,120
131 FENTANIL INJEKSI im.iv 0.05mg IN mlAMP 10 500 40,697 20,348,500
132 FENTANYL patch 25mcg 100 18,600 1,860,000
133 FLUCONAZOLE 150mg TAB 500 26,400 13,200,000
134 FUROSEMIDE INJ AMP 25 1,000 247 247,000
135 FUROSEMIDE TAB 40 MG TAB 100 10,000 135 1,350,000
136 GEMFIBROZIL 600MG TAB TAB 1,000 815 815,000
137 Gentamisin salep mata 0,3% TUBE 10 200 3,039 607,800
138 GENTAMICYN INJ 40 MG AMP 10 1,600 4,578 7,324,800
139 GENTAMICYN SALEP TUBE 10 2,800 2,459 6,885,200
140 GENTAMICYN TTS MATA 0,3% BTL 10 100 3,933 393,300
141 GENTIAN VIOLET LARUTAN 1 % BTL 200 540 108,000
142 GLIBENCLAMID TAB 5 MG TAB 100 2000 84 168,000
143 GLICERIL GUAICOLAT TAB 100 MG TAB 1000 5,000 33 165,000
144 GLIMEPIRIDE 1MG TAB TAB 50 2,500 318.0 795,000
145 GLIMEPIRIDE 2MG TAB TAB 50 2,000 523 1,046,000
146 GLIMEPIRIDE 3MG TAB TAB 50 500 523 261,500
147 GLIMEPIRIDE 4MG TAB TAB 50 500 516.0 258,000
148 GLISERIL TRINIDRAT INJ AMP 1 40 1,800.0 72,000
149 GLISERIL TRINIDRAT TAB,SUB LINGTAB 100 500 11,900.0 5,950,000
150 GLUKOSA 5% 0.25NS BTL 20 2,000 9,240 18,480,000
151 GLUKOSA 5% 0.5NS 20 1,500 9,240 13,860,000
152 GLUKOSA LARUTAN INFUS 10 %(500BTL 20 200 6,840 1,368,000
153 GLUKOSA LARUTAN INFUS 5 %(500M BTL 20 7,000 6,101 42,707,000
154 GLUKOSA NS BTL 1000 6,800 6,800,000
155 GRISEOFULVIN 125 MG TAB TAB 100 264 -
156 HALOPERIDOL 2MG TAB 100 2,000 138 276,000
157 HALOPERIDOL TABLET 1.5mg TAB 100 1,000 83 83,000
158 HALOTHANE INHALASI BTL 1 3 770,000 2,310,000
159 HEPARIN NAT INJ ( LOW MOLECULAMP 1 100 53,400.0 5,340,000
160 HEPATITIS B IMUNOGLOBIN 100 1,328,000.0 132,800,000
161 HIDRO CHLORTIAZIDE TAB 25 MG TAB 100 5,000 178.0 890,000
162 HIDROCORTISONE KRIM 2,5 % TUBE 25 720 5,775 4,158,000
163 HIDROCORTISONE KRIM 1 % TUBE 300 3,084.0 925,200
164 HIDROXY ETHYL STARCH (HES) BTL 10 500 165,000 82,500,000
165 HUMAN ALBUMIN 20% 100ML BTL 1 100 1,540,000 154,000,000
166 Human tetanus imunoglobulinn injeksi iAMP 5 30 170,000 5,100,000
167 HYOSCINE-N-BUTILBROMIDE 20MG/AMP 10 400 5,400.0 2,160,000
168 IBUPROFEN 200MG TABLET TAB 100 1,000 132 132,000
169 IBUPROFEN 400MG TABLET TAB 100 15,000 189 2,835,000
170 IBUPROFEN SYR 100MG/ML BTL 50 300 4,199 1,259,700
171 IBUPROFEN SYR 200MG/ML BTL 50 200 5,399.0 1,079,800
172 IMPLANON. ETONOGESTREL 20 128,779 2,575,580
173 IPRATROPIUM BROMIDA NEBU 5 500 90,000.0 45,000,000
174 IRBESARTAN 150 MG TAB 30 3000 2,980.0 8,940,000
175 ISONIAZIDE 100MG TABLET TAB 1000 5,000 49 245,000
176 ISONIAZIDE 300MG TABLET TAB 1000 20,000 319 6,380,000
177 ISOSORBID DINITRAT INJ(FARSORBIAMP 10 200 40,920 8,184,000
178 ISOSORBID DINITRATE ( I S D N ) T TAB 100 18,000 117 2,106,000
179 ISOSORBID DINITRATE SUBLINGUALTAB 1000 1,000 107 107,000
180 ISOTIC ADRETOR 0.25% SOL BTL 30 12,000 360,000
181 KAEN 1 B SOLUTION BTL 20 200 9,000 1,800,000
182 KAEN 3 A SOLUTION BTL 20 200 10,000 2,000,000
183 KAEN 3 B SOLUTION BTL 20 140 10,000 1,400,000
184 KAEN MG3 SOLUTION BTL 20 100 11,000 1,100,000
185 Kalium aspartat tab 300 mg TAB 100 1,000 877.0 877,000
186 KALSIUM POLISITERINA SULFANAT TAB 6000 10,140.0 60,840,000
187 KALIUM CLORIDA 600 MG TAB 100 500 1,580.0 790,000
188 KANAMYCIN NJ VIAL 20 400 4,800 1,920,000
189 KANDESARTAN 16 MG TAB 30 2500 5,345 13,362,500
190 KANDESARTAN 8 MG TAB 30 3600 3,720.0 13,392,000
191 Karbogliserin tetes telinga BTL 300 2,450.0 735,000
192 KETOKONAZOLE CR 10G TUBE 10 500 6,681 3,340,500
193 KETOKONAZOLE TAB 200MG TAB 1,500 483 724,500
194 Ketokonazol Scalp Solution BTL 100 33,600 3,360,000
195 KETOPROFEN INJEKSI 100MG AMP 10 300 6,780 2,034,000
196 KETOPROPEN SUPP SUPP 10 250 3,266.0 816,500
197 KETOROLAC INJEKSI 30MG/ML AMP 10 10,800 3,220 34,776,000
198 KLOBAZAM 10mg TAB 100 1,500 1,000 1,500,000
199 KLONIDIN HCL 0,15MG TAB TAB 50 1,000 258 258,000
200 KLOPIDOGREL TAB TAB 30 5,000 1,500 7,500,000
201 KETAMIN INJEKSI 100mg AMP 10 20 132,000 2,640,000
202 KUININ TAB TAB 100 3000 501 1,503,000
203 LACTULOSA SYP BTL 1 500 17,400.0 8,700,000
204 LANSOPRAZOLE CAPS CAP 30 36,000 596 21,456,000
205 LAXADINE EMULSI 60ml BTL 1 300 12,450 3,735,000
206 LEVOFLOXACIN 500MG TAB TAB 30 1,000 633.0 633,000
207 Levofloxacin tetes mata BTL 1 20 15,275 305,500
208 NOREFINEFRIN 8MG/ 8ML) AMP 5 50 64,680 3,234,000
209 LIDOCAIN 2% INJEKSI AMP 100 1,000 1,282 1,282,000
210 LIDOCAIN COMP. INJEKSI(PEHACAINAMP 10 500 2,999 1,499,500
211 LISINOPRIL 10mg TAB 100 1,000 720 720,000
212 LISINOPRIL 5mg TAB 100 1,000 420 420,000
213 HALOPERIDOL INJ 5MG/1ML) AMP 5 50 7,500 375,000
214 LOPERAMIDE TABLET 2,000 107 214,000
215 LORATADINE TAB TAB 100 1,000 185 185,000
216 MAGNESIUM SO4 (MGSO4) INJ 40% BTL 1 240 23,325 5,598,000
217 MAGNESIUM SULFAT 20% AMP . 240 2,800.0 672,000
218 MANNITOL INFUS 20% BTL 10 100 62,000 6,200,000
219 MARTOS SOLUTION BTL 10 200 35,000 7,000,000
220 MEBENDAZOL 500 MG TAB TAB 400 7,650 3,060,000
221 MELOXICAM 7.5mg TAB TAB 1 3,600 1,230 4,428,000
222 MELOXICAM SUPPOSITORIA SYP 300 7,920 2,376,000
223 MEROPENEM 500mg INJEKSI AMP 1 200 80,000.0 16,000,000
224 MEROPENEM INJEKSI 1g AMP 100 88,759 8,875,900
225 METFORMIN 500MG TAB 100 3,000 219 657,000
226 METHYL DOPA 250 TAB TAB 100 1,000 960.0 960,000
227 METHYLERGOMETRIN MALEAT INJEAMP 10 1,000 3,850 3,850,000
228 METHYLPREDNISOLON 125mg INJEKAMP 10 2,000 25,500 51,000,000
229 METHYLPREDNISOLON 16mg TAB 100 5,000 900 4,500,000
230 METHYLPREDNISOLON 500 mg INJEAMP 1 200 11,200 2,240,000
231 METHYLPREDNISOLON TAB 8MG TAB 100 40,000 440 17,600,000
232 METOCLOPRAMIDE INJEKSI AMP 1,000 9,559 9,559,000
233 METOCLOPRAMIDE TABLET 1,000 172 172,000
234 METRONIDAZOLE 250MG TABLET TAB 100 5,000 122.0 610,000
235 METRONIDAZOLE 500MG TAB 100 20,000 265 5,300,000
236 METRONIDAZOLE INFUS BTL 16 6,000 59,148 354,888,000
237 MEYLON INJEKSI BTL 1 100 7,440 744,000
238 MICONAZOLE CREAM TAB 24 240 3,600 864,000
239 MIDAZOLAM INJ 5mg AMP 5 600 10,322.0 6,193,200
240 MORFIN TAB 10mg TAB 300 1,560.0 468,000
241 MORPHIN INJEKSI im.sk.iv 10mg AMP 10 20 12,599 251,980
242 NALOKSON INJK(NALOXONE HCL, NO AMP 30 73,900 2,217,000
243 NATRIUM CHLORIDA SOL. 500ML (0,BTL 20 6,000 5,643 33,858,000
244 NATRIUM DICLOFENAC 25MG TAB 100 5,000 206 1,030,000
245 NATRIUM DICLOFENAC 50MG TAB 100 20,000 271 5,420,000
246 NEUROBION INJ TAB 500 15,000 7,500,000
247 NIFEDIPIN 10MG TABLET TAB 100 18,000 155 2,790,000
248 NIFIDIPIN TAB SR 20 MG TAB 100 500 2,999.0 1,499,500
249 NIKARDIPIN INJ AMP 50 95,700.0 4,785,000
250 NITROKAF FORTE 500 2,171 1,085,500
251 NYSTATIN 100.000IU VAGINAL TABLET 576.0 -
252 NYSTATIN 500.000IU ORAL TABLET 500 720 360,000
253 OBAT BATUK HITAM BTL 50 300 1,716 514,800
254 OFLOXACIN 400MG TAB TAB 50 2,000 883 1,766,000
255 OMEPRAZOLE CAPSUL CAP 30 5,000 261 1,305,000
256 OMEPRAZOLE INJEKSI 40mg IN 10mlAMP 1 1,800 49,000.0 88,200,000
257 ONDANSETRON 4MG TAB 1000 1,090.0 1,090,000
258 ONDANSETRON INJEKSI 4mg IN 2 mlAMP 10 1,000 10,560 10,560,000
259 OTSU KCl 7.46% BTL 1 50 2,460 123,000
260 OXYTETRACYCLIN SALEP MATA 1%TUBE 25 360 2,888 1,039,680
261 OXYTOCIN INJEKSI/INDUXIN AMP 100 1,000 2,750 2,750,000
262 PAN AMIN G SOLUTION BTL 20 1,000 45,000 45,000,000
263 PAPAVERIN HCL TABLET TAB 1000 5,000 119 595,000
264 PARACETAMOL 500MG TABLET TAB 1000 10,000 96.0 960,000
265 PARACETAMOL DROPS BTL 50 500 6,238 3,119,000
266 PARACETAMOL INFUS BTL 10 4,000 49,500 198,000,000
267 PARACETAMOL SYRUP BTL 50 500 1,675 837,500
268 PHENOBARBITAL 30MG TAB TAB 100 3,600 162.0 583,200
269 PHENOBARBITAL INJEKSI TAB 30 720 2,160 1,555,200
270 PHYTOMENADION ( VIT K ) INJ 10 MG AMP 10 1,080 2,398 2,589,840
271 PHYTOMENADION ( VIT K ) TAB 10 TAB 100 1,000 761 761,000
272 PIOGLITAZON 30 MG TAB 1000 5,225.0 5,225,000
273 PIOGLITAZON 15 MG TAB 1000 4,400.0 4,400,000
274 PIRACETAM 1 G INJEKSI BPJS AMP 10 1,800 6,600 11,880,000
275 PIRACETAM INJEKSI 3G/15ML AMP 10 900 20,526 18,473,400
276 PIROXICAM 20MG TABLET TAB 100 1,000 127 127,000
277 PRAVASTATIN TABLET 20mg AMP 100 1,500 2,700 4,050,000
278 PREDNISON TABLET TAB 100 10,000 182 1,820,000
279 PRIMAQUIN TABLET TAB 1000 30,000 211 6,330,000
280 PRIMOLUT N TAB 30 1,000 2,618 2,618,000
281 PROPANOLOL 40MG TABLET TAB 100 1,000 136 136,000
282 PROPANOLOL TABLET 10mg TAB 100 2,500 90 225,000
283 PROPILTIOURASIL 100MG TABLET TAB 10 1,500 432 648,000
284 PROPOFOL INJ AMP 5 500 16,236 8,118,000
285 PROSTIGMIN INJ (NEOSTIGMIN) AMP 5 100 - -
286 PULAREX TABLET TAB 100 5,000 240 1,200,000
287 Budesonid respules / cairan inhaler 0 NEB 5 300 8,900 2,670,000
288 PYRANTEL PAMOATE SYR 125MG BTL 50 240 10,420 2,500,800
289 PYRANTEL TAB 125 MG tab 300 362 108,600
290 PYRAZINAMDE 500MG TABLET TAB 100 5,000 280 1,400,000
291 PYRIDOXIN TABLET (VIT. B 6 ) TAB 1000 43,000 21 903,000
292 RANITIDINE 150MG TABLET TAB 100 30,000 140 4,200,000
293 RANITIDINE INJEKSI AMP 25 9,000 1,680 15,120,000
294 RESPERIDON 1mg TAB TAB 500 1,600.0 800,000
295 RETINOL VIT A 200.000 IU CAP 100 10 551.0 5,510
296 RETINOL VIT A 100.000 IU CAP 100 10 312.0 3,120
297 RIFAMPICIN 300MG CAPSUL TAB 100 7,000 576 4,032,000
298 RIFAMPICIN 450MG TABLET TAB 100 4,000 792 3,168,000
299 RIFAMPICIN 600MG TABLET TAB 100 3,000 1,107 3,321,000
300 RINGER LACTATE SOL 500ML BTL 20 5,000 6,240 31,200,000
301 SALBUTAMOL 2MG TABLET TAB 100 5,000 103 515,000
302 SALBUTAMOL 4MG TAB 100 5,000 117 585,000
303 SALBUTAMOL NEBULESER (VENTOLTAB 25 1800 7,920.0 14,256,000
304 SALYCIL BEDAK bks 1 500 1,450.0 725,000
305 SERETIDE DISCUSS 100mcg 30 12,100 363,000
306 SIMVASTATIN TABLET 10MG TAB 30 44,910 198.0 8,892,180
307 SPIRAMICYN 500MG TABLET TAB 2,500 1,849 4,622,500
308 SPIRONOLAKTON TAB 100 MG TAB 100 3,000 1,100.0 3,300,000
309 SPIRONOLAKTON TAB 25 MG TAB 100 5,000 400 2,000,000
310 STREPTOKINASE INJ AMP 1 10 3,290,000.0 32,900,000
311 STREPTOMICYN SO4 INJEKSI VIAL 100 300 2,280 684,000
312 SUCRALFAT SYP BTL 25 1000 19,500.0 19,500,000
313 SYNARCUS CREAM TUBE 1 10 3,000 30,000
314 TELMISARTAN 40mg TAB TAB 50 2000 3,900.0 7,800,000
315 TEOFILIN 150MG TAB TAB 100 1,500 350.0 525,000
316 TERASOZIN HCL 1 mg TAB TAB 4000 1,900.0 7,600,000
317 TERBUTALIN SO4 TAB 2,5MGTAB TAB 1,000 104.0 104,000
318 THIAMIN 50MG TABLET TAB 100 12,000 45 540,000
319 Asetosal 80 mg TAB 10,800 704 7,603,200
320 TIMOLOL 0,5% TTS MATA BTL 10 100 12,000.0 1,200,000
321 TRAMADOL CAPSUL 50MG CAP 50 7,000 396 2,772,000
322 TRAMADOL INJ AMP 10 2,000 7,682 15,364,000
323 TRIAMSINOLON INJEKSI 50 80,000.0 4,000,000
324 TROPICAMIDE 1% BTL 1 100 36,500.0 3,650,000
325 VALSARAN 80mg TAB TAB 30 4,000 3,510.0 14,040,000
326 VARAPAMIL 80 MG TAB 30 2000 281.0 562,000
327 VITAMIN B COMP. TABLET TAB 100 40,000 123 4,920,000
328 WIDA 2 A BTL 20 200 8,300 1,660,000
329 WIDA HSD 500 9,500 4,750,000
330 WIDA RD BTL 500 6,930 3,465,000
331 YODIUM POVIDON SOL 10% 1LTR BTL 1 500 50,400 25,200,000
332 YODIUM POVIDON SOL 10% 30 ML BTL 1 300 2,590.0 777,000
333 ZINC 20mg TABLET TAB 100 10,000 569 5,690,000
334 ZINK SYP BTL 1 1000 8,880 8,880,000
335 Burnazin Cream 35g TUBE 200 27,650.0 5,530,000
336 Intralipid Infuse 100ml botol 1 40 60,500.0 2,420,000
337 BETADIN BOTOL BTL 400 50,400 20,160,000
2,707,947,850
TERBILANG : DUA MILYAR

SEMBILAN RATUS LIMA PULUH RUPIAH
TEMINABUAN, September 2016

PLT.KEPALA RSUD SCHOLOO KEYEN
dr.FELIX DUWIT,M.Sc,MPH,Sp.PD
NIP.19670812 199712 1 001
139.0 phapros 139,000
138,000.0 ferron 5,520,000
280.0 novell 560,000
400.0 samparindo 400,000
24,750.0 sanbe 495,000
990.0 dexa medica 4,950,000
780.0 dexa medica 4,680,000
415.0 holipharma 166,000
100.0 pertiwi agung 200,000
475.0 dexa medica 1,425,000
280.0 kimia farma 280,000
94.0 erela 470,000
4,587.0 lucas 4,587,000
73,920.0 otsuka 7,392,000
1,500.0 aventis 4,500,000
14,400.0 aventis 2,160,000
56,300.0 otsuka 22,520,000
135.0 indofarma 486,000
391.0 pertiwi agung 3,128,000
243.0 novapharin 972,000
288.0 mersifarma 4,320,000
2,790.0 novapharin 8,091,000
6,120.0 phapros 2,448,000
85,000.0 aventis 6,800,000
2,409.0 novapharin 3,613,500
85.0 erela 425,000
3,019.0 indofarma 724,560
3,650.0 kimia farma 730,000
-
22,686.0 pratapa 1,134,300
2,400.0 ikapharmindo 17,280,000
-
57.0 marin liza 570,000
139.0 promedraharjo 6,950,000
1,815.0 sanbe 3,630,000
-
9,000.0 otsuka 4,500,000
15,662.0 novell 2,349,300
1,620.0 ethica 810,000
89.0 indofarma 26,700
13,500.0 cendo 135,000
5,400.0 kimia farma 10,800,000
37,500.0 soho 3,750,000
16,080.0 phapros 4,824,000
3,600.0 combiphar 720,000
117,500.0 boehringer 3,525,000
-
-
1,824.0 kimia farma 364,800
25,106.0 cendo 251,060
909.0 pratapa 9,090,000
6,250.0 astra zeneca 625,000
30,720.0 dexa medica 4,608,000
32,000.0 astra zeneca 12,800,000
83.0 afifarma 1,245,000
489.0 mersifarma 195,600
7,800.0 ethica 748,800
73.0 phapros 730,000
102.0 phapros 6,120,000
294.0 indofarma 294,000
30,600.0 boehringer 1,530,000
618.0 pharma 3,090,000
5,984.0 holipharma 7,180,800
1,100.0 Hexparn 27,500,000
10,500.0 3,150,000
14,645.0 Hexparn 4,393,500
5,394.0 Hexparn 21,576,000
20,472.0 Hexparn 4,094,400
5,688.0 Hexparn 28,440,000
71,500.0 pratapa 7,150,000
3,960.0 pratapa 2,772,000
4,750.0 ikapharmindo 2,375,000
22,210.0 erela 4,442,000
1,920.0 kimia farma 1,113,600
-
59.0 rama emerald 4,248,000
82.0 phapros 246,000
1,320.0 phapros 396,000
324.0 Hexparn 3,240,000
24,487.0 Hexparn 4,897,400
451.0 indofarma 9,020,000
678.0 indofarma 3,390,000
-
600.0 kimia farma 1,200,000
1,020.0 kimia farma 3,060,000
1,320.0 kimia farma 3,960,000
5,990.0 boehringer 8,985,000
2,590.0 samparindo 1,554,000
-
-
1,897.0 dexa medica 4,742,500
54.0 kimia farma 1,944,000
195.6 indofarma 978,000
5,016.0 indofarma 9,028,800
20,142.0 actavis 2,014,200
13,914.0 actavis 2,782,800
26,600.0 pratapa 3,990,000
119.0 indofarma 1,190,000
56,000.0 pratapa 5,600,000
160.0 dexa medica 80,000
1,265.0 lucas 632,500
31,000.0 ferron 2,480,000
11,760.0 kimia farma 1,176,000
325.0 yarindo 4,875,000
4,990.0 boehringer 1,497,000
48,890.0 aventis 2,444,500
-
9,720.0 phapros 9,720,000
139,500.0 boehringer 13,950,000
128,000.0 kalbe 12,800,000
1,116.0 indofarma 13,392,000
8,495.0 phytokemoagung 6,371,250
94,925.0 sunthi 18,985,000
2,875.0 novapharin 2,875,000
545.0 indofarma 545,000
20,000.0 kimia farma 200,000
160.0 ikapharmindo 800,000
22,127.0 mersifarma 7,744,450
1,075.0 Hexparn 1,612,500
-
40,697.0 kimia farma 20,348,500
183,600.0 kimia farma 18,360,000
26,400.0 kimia farma 13,200,000
2,195.0 indofarma 2,195,000
89.0 samparindo 890,000
815.0 indofarma 815,000
3,039.0 erela 607,800
4,079.0 indofarma 6,526,400
-
3,832.0 indofarma 383,200
-
-
523.0 kimia farma 1,046,000
1,800.0 actavis 72,000
11,900.0 tempo 5,950,000
9,240.0 widatra 18,480,000
9,240.0 widatra 13,860,000
6,840.0 widatra 1,368,000
6,254.0 widatra 43,778,000
6,800.0 widatra 6,800,000
263.0 indofarma -
138.0 mersifarma 276,000
770,000.0 dexa medica 2,310,000
53,400.0 pratapa 5,340,000
1,328,000.0 dipa pharmalab 132,800,000
3,358.0 kimia farma 2,417,760
3,084.0 marin 925,200
33,000.0 frsenius 16,500,000
900,000.0 ikapharmindo 90,000,000
170,000.0 dexa medica 5,100,000
5,400.0 otto 2,160,000
132.0 yarindo 132,000
171.0 novapharin 2,565,000
4,199.0 indofarma 1,259,700
5,399.0 indofarma 1,079,800
-
90,000.0 boehringer 45,000,000
2,980.0 soho 8,940,000
78.0 phytokemoagung 390,000
190.0 phytokemoagung 3,800,000
40,920.0 pratapa 8,184,000
220.0 kimia farma 3,960,000
107.0 indofarma 107,000
-
9,000.0 otsuka 1,800,000
10,000.0 otsuka 2,000,000
10,000.0 otsuka 1,400,000
11,000.0 otsuka 1,100,000
877.0 tempo 877,000
10,140.0 novell 60,840,000
1,580.0 merck 790,000
5,200.0 Hexparn 2,080,000
5,880.0 dexa medica 14,700,000
3,720.0 dexa medica 13,392,000
2,450.0 lucas 735,000
3,083.0 kimia farma 1,541,500
349.0 novapharin 523,500
33,600.0 ikapharmindo 3,360,000
-
3,266.0 kimia farma 816,500
2,799.0 indofarma 30,229,200
1,000.0 dexa medica 1,500,000
3,990.0 soho 19,950,000
132,000.0 guardian 2,640,000
804.0 kimia farma 2,412,000
17,400.0 ikapharmindo 8,700,000
596.0 indofarma 21,456,000
12,450.0 galenium 3,735,000
633.0 promedraharjo 633,000
15,275.0 erela 305,500
64,680.0 kimia farma 3,234,000
1,026.0 phapros 1,026,000
1,635.0 indofarma 817,500
720.0 novell 720,000
420.0 novell 420,000
7,500.0 mersifarma 375,000
107.0 ifars 214,000
3,500.0 otsuka 840,000
2,800.0 otsuka 672,000
62,000.0 finusolprima 6,200,000
35,000.0 otsuka 7,000,000
8,568.0 pfizer 3,427,200
-
-
80,000.0 yarindo 16,000,000
88,759.0 dexa medica 8,875,900
-
960.0 actavis 960,000
3,630.0 ethica 3,630,000
25,500.0 dexa medica 51,000,000
900.0 dexa medica 4,500,000
112,074.0 phapros 22,414,800
440.0 novell 17,600,000
-
109.0 phapros 109,000
122.0 phytokemoagung 610,000
176.0 phytokemoagung 3,520,000
14,400.0 dexa medica 86,400,000
7,440.0 otsuka 744,000
3,600.0 kimia farma 864,000
10,322.0 novell 6,193,200
1,560.0 kimia farma 468,000
12,599.0 kimia farma 251,980
73,900.0 pratapa 2,217,000
5,640.0 widatra 33,840,000
160.0 PT.phapros 800,000
211.0 PT.phapros 4,220,000
-
140.0 dexa medica 2,520,000
2,999.0 bayer 1,499,500
95,700.0 pratapa 4,785,000
-
576.0 phapros -
768.0 phapros 384,000
-
800.0 novell 1,600,000
240.0 novapharin 1,200,000
49,000.0 dexa medica 88,200,000
1,090.0 yarindo 1,090,000
2,700.0 indofarma 2,700,000
2,460.0 otsuka 123,000
-
1,900.0 tunggal idaman 1,900,000
45,000.0 otsuka 45,000,000
-
6,240.0 indofarma 3,120,000
-
1,675.0 novapharin 837,500
162.0 indofarma 583,200
2,160.0 phapros 1,555,200
4,100.0 phapros 4,428,000
761.0 marin liza 761,000
5,225.0 sanbe 5,225,000
4,400.0 takeda 4,400,000
-
-
-
2,700.0 novell 4,050,000
129.0 holipharma 1,290,000
210.0 phapros 6,300,000
2,618.0 bayer 2,618,000
90.0 dexa medica 225,000
383.0 indofarma 574,500
16,236.0 fresenius 8,118,000
-
240.0 zenith 1,200,000
8,900.0 astra zeneca 2,670,000
-
258.0 holipharma 1,290,000
132.0 kimia farma 5,676,000
140.0 erela 4,200,000
1,680.0 phapros 15,120,000
1,600.0 dexa medica 800,000
551.0 lucas 5,510
732.0 indofarma 5,124,000
947.0 indofarma 3,788,000
1,319.0 indofarma 3,957,000
6,240.0 widatra 31,200,000
71.0 yarindo 355,000
7,920.0 glaxo 14,256,000
1,450.0 rama emerald 725,000
121,000.0 glaxo 3,630,000
1,799.0 indofarma 4,497,500
1,100.0 dexa medica 3,300,000
400.0 dexa medica 2,000,000
3,290,000.0 dexa medica 32,900,000
4,380.0 phapros 1,314,000
19,500.0 combiphar 19,500,000
-
3,900.0 boehringer 7,800,000
350.0 kalbe 525,000
1,900.0 abbot 7,600,000
104.0 molex 104,000
-
178.0 mersifarma 1,922,400
12,000.0 pratapa 1,200,000
-
3,000.0 novell 6,000,000
80,000.0 dexa medica 4,000,000
36,500.0 cendo 3,650,000
3,510.0 novartis 14,040,000
122.0 kimia farma 4,880,000
8,300.0 widatra 1,660,000
9,500.0 widatra 4,750,000
6,930.0 widatra 3,465,000
44,434.0 afifarma 22,217,000
2,590.0 afifarma 777,000
569.0 indofarma 5,690,000
8,800.0 meprofarm 8,800,000
27,650.0 darya varya 5,530,000
60,500.0 fresenius 2,420,000
1,946,214,670
Pengadaan Obat-obatan
Pengadaan Bahan medis habis pakai
Pengadaan Bahan Radiologi Habis Pakai
Pengadaan Reagen
Pengadaan oksigen isi ulang
Operasional BBM Ambulance , Genset, Insenerator
Pengadaan logistik
Pengadaan Internet
Operasional program TBC,Kusta dan malaria
Operasional VCT dan IMS
Pengadaan Alat medis & Non medis (DAK)
Pemeliharaan Instalasi air bersih dan perbaikan pipa air
Kalibrasi alat kesehatan
Pengadaan Central Oxygen Generator
Pengadaan Mobil Jenazah (2 Unit) (DAK)
Pengadaan Alat Instalasi Gizi
Pengadaan SIM RS
Pengadaan Mebeleair Rumah Singgah
Pengembangan Ruang CCSD (DAK)
Pengembangan Ruang Perinatologi
Pengembangan Ruang HD (DAK)
Pengembangan Ruang Radiologi (DAK)
Pengembangan Ruang Operasi (DAK)
Pengembangan Ruang Isolasi
Pengembangan Ruang Rekam medik
Pembangunan Aula RSUD
Pengembangan Ruang Laboratorium RS (DAK)
REHBAILITASI BERAT RUANG RAWAT INAP
Pembangunan Bengkel RSUD
Pembangunan Barak Perawat
Rehabilitasi Gedung PONEK
Pembuatan Sumur Bor Tahap II
Landscaping Kompleks Rmh Dokter
INISIASI AKREDITASI
Perencanaan dan Pengawasan
PROGRAM KEMITRAAN PENINGKATAN PELAYANAN

KESEHATAN
Kemitraan pengobatan lanjutan bagi pasien rujukan

Kemitraan Peningkatan Kualitas Dokter dan Paramedis
Kemitraan Tenaga Manajemen
Kemitraan Pelatihan Akreditasi Lanjutan (DAK)
Rapat kerja RSUD Scholoo Kayen
PROGRAM PENINGKATAN PELAYANAN KESEHATAN
MASYARAKAT
Peningkatan Pelayanan Kesehatan Rujukan(Gaji, Insentif )
Pengadaan makan dan minum pasien dan petugas
Honor SPI
Dewan Pengawas
RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

BARANG CETAKAN DAN PENGANDAAN RSUD SCHOLOO KEYEN KAB. SORONG SELATAN
NO URAIAN PROGRAM/ KEGIATAN SATUAN JUMLAH Harga Satuan Harga

A FORMULIR / STATUS REKAM MEDIS
a. Rawat Jalan
1 Formulir Rawat Jalan Halaman 1 Rim 40 500,000 20,000,000
2 Formulir Rawat Jalan Halaman 2 Lanjutan Rim 40 500,000 20,000,000
3 Pembatas Rawat Jalan Rim 40 750,000 30,000,000
3 Daftar Tindakan Medik Pasien Umum Rawat Jalan Rim 20 500,000 10,000,000
b. RAWAT INAP Rim

1 Daftar Tindakan Medik Rawat Inap Rim 20 500,000 10,000,000
2 Ringkasan Masuk & Keluar Rim 2 500,000 1,000,000
3 Surat Persetujuan Tindakan Medik Rim 2 500,000 1,000,000
4 Anamnesa & Pemeriksaan Fisik Rim 6 500,000 3,000,000
5 Intruksi Dokter Rim 20 500,000 10,000,000
6 Catatan Tindakan & Evaluasi Keperawatan Rim 20 500,000 10,000,000
7 Grafik Rim 6 500,000 3,000,000
8 Daftar Obat parenteral Rim 6 500,000 3,000,000
9 Daftar Obat Non Parenteral Rim 6 500,000 3,000,000
10 Resume Keperawatan Rim 20 500,000 10,000,000
11 Pambatas Rawat Inap Rim 10 750,000 7,500,000
12 Formulir Penyimpanan Harta Benda Rim 10 500,000 5,000,000
13 Formilir Second Opinion Rim 6 500,000 3,000,000
14 Formulir Permintaan Privasi Rim 6 500,000 3,000,000
15 Formulir Second Opinion keluar Rim 6 500,000 3,000,000
16 Formulir Persetujuan Umum General Consent Rim 10 500,000 5,000,000
17 Formulir Persetujuan Tindakan Kedokteran Rim 6 500,000 3,000,000
18 Formulir Penolakan Tindakan Kedokteran Rim 6 500,000 3,000,000
19 Formulir Asesment Ulang Nyeri Rim 10 500,000 5,000,000
20 Formulir Pemberian Informasi MBO Rim 4 500,000 2,000,000
21 Formulir Keinginan Pasien Memilih DPJP Rim 4 500,000 2,000,000
22 Formulir Surat Pernyataan Pulang APS Rim 6 500,000 3,000,000
23 Formulir Informasi Tentang anestesi Rim 6 500,000 3,000,000
24 Formulir Permintaan Pelayanan Kerohanian Rim 6 500,000 3,000,000
25 Formulir Pernyataan Jangan Dilakukan Resusitasi Rim 4 500,000 2,000,000
C Form. Operasi
1 Laporan Anestesi 1 Rim 2 500,000 1,000,000
2 Laporan Anestesi 2 Rim 2 500,000 1,000,000
3 Status Anestesi Rim 2 500,000 1,000,000
d. Formulir Umum
1 Surat Rujukan Rim 4 500,000 2,000,000
2 Lembar Laboratorium Rim 60 500,000 30,000,000
3 Laporan Operasi Rim 2 500,000 1,000,000
4 Resume Medis Rawat Jalan Rim 40 500,000 20,000,000
5 Resume Rawat Inap Rim 40 500,000 20,000,000
6 Surat Kontrol Rim 50 500,000 25,000,000
7 Surat Pernyataan Membayar Rim 10 500,000 5,000,000
8 Lembar Konsultasi Dokter Rim 12 500,000 6,000,000
9 Lembar Pemeriksaan Dahak / Sputum Rim 12 500,000 6,000,000
10 Kartu Golongan Darah Rim 2 500,000 1,000,000
11 Lembar Persetujuan Donor Darah Rim 2 500,000 1,000,000
12 Pengantar Rawat Inap Rim 10 500,000 5,000,000
13 Resep Umum Rim 40 500,000 20,000,000
VK
1 Formulir Bagian Kebidanan Rim 10 750,000 7,500,000
2 Formulir Obstetri Ginokologi Nifas Rim 10 750,000 7,500,000
3 Formulir Managemen Asuhn Persalinan Kala II& III Rim 10 750,000 7,500,000
4 Formulir Managemen Asuhn Persalinan Kala IV Rim 10 750,000 7,500,000
5 Formulir Patograf Rim 10 750,000 7,500,000
NIFAS
1 Pengkajian Asuhan Kebidanan Nifas Rim 10 750,000 7,500,000
2 Rencana Asuhan Kebidanan Niifas / Partus Pervaginan Rim 10 750,000 7,500,000
Status Bayi Dari Ruang VK
1 Pengkajian Bayi Rawat Gabung Rim 10 750,000 7,500,000
2 Ringkasan Data Asuhan Pasien Neonatus Rim 10 750,000 7,500,000
3 Pemeriksaan Fisik Bayi Rim 10 750,000 7,500,000
Status Bayi Dari Ruang NIFAS Rim 10 750,000 7,500,000
1 Pelaksanaan Asuhan Kebidanan Neonatus Rawat Gabung Rim 10 750,000 7,500,000
2 Rencana Asuhan Kebidanan Bayi Rawat Gabung Rim 4 200,000 800,000
Formulir tambahan
1 Map Rekam Medis Lembar 1000 5,500 5,500,000
2 Surat Sakit Rim 10 500,000 5,000,000
3 Permintaan Radiologi Rim 2 500,000 1,000,000
4 Jawaban Radiologi Rim 20 200,000 4,000,000
5 Balance Cairan Ruang ICU Rim 4 500,000 2,000,000
6 Status Ruang ICU Rim 4 500,000 2,000,000
7 Fastener Paper Rim 100 dos 2,500 250,000
8 Resep Rawat Inap Ukuran Panjang Rim 4 500,000 2,000,000
Jumlah 444,050,000
PPN 10% 44,405,000
Total 488,455,000
Terbilang : Empat Ratus Delapan Puluh Delapan Juta Enam Ratus Lima Puluh Lima Ribu Rupiah
Teminabuan, Mei 2016
Plt.Direktur RSUD Scholoo Keyen

Kabupaten Sorong Selatan
Nip.19670812 199712 1 001

BAHAN MEDIS HABIS PAKAI (BMHP) RSUD SCHOLOO KEYEN KAB. SORONG SELATAN
NO NAMA ALAT SATUAN VOLUME HARGA JUMLAH
1 ALKOHOL 70 %, 1 LITER BTL 300 24,725 7,417,500
2 ALKOHOL SWABS DOS 300 11,500 3,450,000
3 AQUA STERIL FOR IRIGASI 1000ML BTL 150 10,350 1,552,500
4 ARM SLING UK L PCS 50 30,000 1,500,000
5 ARM SLING UK M PCS 100 30,000 3,000,000
6 ARM SLING UK S PCS 50 30,000 1,500,000
7 ASEPTIC GEL 5 LITER BTL 50 929,200 46,460,000
8 ASEPTIC GEL 500CC DISPENSER BTL 30 103,500 3,105,000
9 B1STURINO10 PCS 500 3,450 1,725,000
10 BENANG POLYSORB 1 (POLYGLCOLIC ACID ) TAPER PCS 100 75,000 7,500,000
11 BENANG POLYSORB 2 TAPER PCS 100 75,000 7,500,000
12 BENANG POLYSORB 2/0 TAPER PCS 150 75,000 11,250,000
13 BENANG POLYSORB 3/0 TAPER PCS 100 75,000 7,500,000
14 BENANG VICRYL 4/0 POLYSORB TAPER PCS 100 116,000 11,600,000
15 BETADIN CAIR BTL 100 50,400 5,040,000
16 BISTURI NO 15 PCS 250 3,450 862,500
17 BISTURI NO 19 PCS 150 3,450 517,500
18 BISTURI NO 20 PCS 500 3,450 1,725,000
19 BISTURI NO 21 PCS 500 3,450 1,725,000
20 BISTURIN0 11 PCS 500 3,450 1,725,000
21 Blue monofilament polyvinylidene floride non absosbable 3.0 ( 3/8 circle 24 mm ) cutting pcs 150 35,000 5,250,000
22 Blue monofilament polyvinylidene floride non absosbable 4.0 ( 3/8 circle 16 mm ) cutting fineline pcs 150 35,000 5,250,000
23 CATGUT CHROMIC NO 1 (WITH NEEDLE) TAPER HR 48 PCS 100 34,062 3,406,185
24 CATGUT CHROMIC NO 2 (WITH NEEDLE) TAPER HR 50 PCS 100 36,249 3,624,915
25 CATGUT CHROMIC NO 2/0 (WITH NEEDLE) TAPER HR 37 PCS 100 25,989 2,598,885
26 CATGUT CHROMIC NO 3/0 (WITH NEEDLE) taper HR 26 PCS 150 25,989 3,898,328
27 CATGUT CHROMIC NO 4/0 (WITH NEEDLE) TAPER PCS 100 41,796 4,179,600
28 CATGUT CHROMIC NO.3 WITH NEEDLE TAPER PCS 100 41,796 4,179,600
29 Catgut Monofilament natural Absorbable 3.0 ( 1/2 circle 25mm ) tapper pcs 100 36,500 3,650,000
30 Catgut Monofilament natural Absorbable 3.0 (3/8 circle 16 mm) cutting pcs 100 36,500 3,650,000
31 catgut monofilament natural absosrbable 1 ( 1/2 circle 64,6 mm) Blunt pcs 100 36,500 3,650,000
32 catgut monofilament natural absorbable 2.0 ( 1/2 circle 36mm ) cutting pcs 100 36,500 3,650,000
33 catgut monofilament natural absorbable 2.0 (1/2 circle 35 mm) tapper pcs 100 36,500 3,650,000
34 catgut monofilament natural absorbable 3.0 ( 1/2 circle 22mm ) tapper pcs 100 36,500 3,650,000
35 CATGUT PLAIN NO 0 (WITH NEEDLE) TAPER HR 37 PCS 72 27,874 2,006,906
36 CATGUT PLAIN NO 1 (WITH NEEDLE) TAPER HR 37 PCS 72 30,409 2,189,480
37 CATGUT PLAIN NO 2/0 (WITH NEEDLE) TAPER HR 37 PCS 72 27,176 1,956,647
38 CATGUT PLAIN NO 3/0 (WITH NEEDLE) TAPER HR 26 PCS 72 27,245 1,961,615
39 CATGUT PLAIN NO 4/0 (WITH NEEDLE) TAPER PCS 72 30,000 2,160,000
40 CHATETER SUCTION 6 PCS 100 4,048 404,800
41 CHATETER SUCTION NO 10 PCS 50 4,048 202,400
44 CHATETER SUCTION NO. 14 PCS 50 4,048 202,400
47 CHKM DENTAL USE PCS 20 75,000 1,500,000
48 CHLORHEXIDIN 4% SOL, 5LITER GEN 30 961,584 28,847,520
49 COLAR NECK DEWASA L PCS 10 500,000 5,000,000
50 COLAR NECK PEDIATRI M PCS 10 500,000 5,000,000
51 COLAR NECK PEDIATRIK s PCS 10 500,000 5,000,000
52 DERMAFIX ( PLESTER ANTI AIR) UKURAN PCS 100 20,000 2,000,000
53 DISP 1 CC PCS 3,000 1,674 5,022,000
54 DISP 1 CC INSULIN 1,000 1,540 1,540,000
55 DISP 20 CC PCS 2,500 3,080 7,700,000
56 DISP 20 CC kateter tip PCS 500 3,080 1,540,000
57 DISP 50 CC (LUBANG PINGGIR) PCS 500 7,854 3,927,000
58 DISP 50 CC KATETER TIP (LUBANG TENGAH) PCS 150 7,854 1,178,100
59 DISP10CC PCS 5,000 2,359 11,795,000
60 DISP3CC PCS 5,000 1,957 9,785,000
61 DISP5CC PCS 5,000 1,348 6,740,000
62 DISPOSIBLE NEEDLE CITOJECT 30G PCS 20 125,388 2,507,760
63 DOCK DISPOSIBLE SET -
64 ELASTIC VERBAND 4 INCHI PCS 100 48,197 4,819,650
65 ELASTIC VERBAND 6 INCHI PCS 100 48,197 4,819,650
66 ELEKTRODA TENS SET 5 138,000 690,000
67 ENDOMETHASONE septodont PCS 30 97,750 2,932,500
68 ENDOTRACHEAL TUBE NO 3 PCS 50 65,307 3,265,350
69 ENDOTRACHEAL TUBE NO 3,5 PCS 50 65,307 3,265,350
78 ETSAWP DENTAL PCS 30 50,000 1,500,000
79 ETT NON KINGKING NO 3,5 PCS 30 412,500 12,375,000
81 ETT NON KINGKING NO 7 PCS 30 294,643 8,839,290
83 ETTNON KINGKING NO 5 PCS 30 50,000 1,500,000
84 EXTENSION TUBE PCS 100 73,334 7,333,400
85 FOLEY CHATETER NO 16 PCS 200 12,650 2,530,000
86 FOLEY CHATETER NO 20 PCS 50 12,650 632,500
89 FOLEYCHATETERN0 12 PCS 50 12,650 632,500
90 FOLEYCHATETERN0 18 PCS 150 12,650 1,897,500
91 FOLEYCHATETERNO 14 PCS 50 12,650 632,500
92 FOLEYCHATETERNO10 PCS 50 12,650 632,500
93 FOLLY CAT THREE WAY 20 PCS 10 373,750 3,737,500
94 FOLLY CAT THREE WAY 22 PCS 10 373,750 3,737,500
95 FORMALIN SOL. 40% BTL 100 60,000 6,000,000
96 GOWN DRAPE DISPOSIBLE SET 100 -
97 GYPSONA 6 INCHI PCS 150 70,441 10,566,150
98 GYPSONA4INCHI PCS 200 52,800 10,560,000
99 H202 (PERHYDROL) 50% PCS 4 36,666 146,664
100 HAND CALLAR DEWASA PCS 10 80,000 800,000
101 HERNIA MES PCS 20 86,641 1,732,820
102 I.V CHATETER NO 16 PCS 250 17,763 4,440,750
103 I.V CHATETER NO 18 PCS 1,000 18,113 18,113,000
107 I.V CHATETER NO 26 PCS 500 11,267 5,633,500
108 INFUSION SET MACRO PCS 2,000 14,157 28,314,000
109 INFUSION SET MICRO PCS 500 9,108 4,554,000
110 JACKSON-REES SET PCS 100 46,500 4,650,000
111 JARUM 27 G PCS 250 50,000 12,500,000
112 JARUM AKUPUNTUR 0,25 x 40 mm (dong bang) BOX 30 40,000 1,200,000
113 JARUM AKUPUNTUR 0,25 x 13 mm (dong bang) BOX 10 40,000 400,000
114 JARUM AKUPUNTUR 0,25 x 25 mm (dong bang) BOX 30 40,000 1,200,000
115 JARUM CITOJECT N027 G dental use PCS 150 27,000 4,050,000
116 JARUM SPINAL NO. 25 PCS 100 41,800 4,180,000
117 JARUM SPINAL NO. 26G PCS 100 41,800 4,180,000
118 JARUM SPNAL 27 PCS 100 50,000 5,000,000
119 JELY ULTRASOUND BTL 5 42,500 212,500
120 JET NEBULIZER MASK PEDIATRIC PCS 150 65,202 9,780,300
121 JET NEBULIZER MASKADULT PCS 250 58,828 14,707,000
122 JOINT FIT ROLL PCS 60 35,000 2,100,000
123 KANTONG DARAH 350ML ( JGN YANG TRIPEL) PCS 150 46,200 6,930,000
124 KAPAS 500 GR PCS 500 50,200 25,100,000
125 KAPSUL 000 BKS 12 -
126 Kapsul 1 10 41,111 411,110
127 Kapsul 2 10 35,706 357,060
128 Kapsul 3 10 32,670 326,700
129 KAPSUL O BKS 12 52,800 633,600
130 KAPSUL OO BKS 12 83,160 997,920
131 KASA ROLL 40 X 80 PCS 150 149,500 22,425,000
132 KASASTERIL PCS 50 7,900 395,000
133 KERTAS LAKMUS(OBGYN) PCS 20 40,000 800,000
134 KRUKKETIAKL PCS 10 252,314 2,523,140
135 KRUKKETIAKM PCS 10 252,344 2,523,440
136 KRUKKETIAKS PCS 10 252,344 2,523,440
137 L M A (LARINGEAL MASK AIRWAYS) PCS 20 366,666 7,333,320
138 LOGICATH CVC 2L 12F 10 CM PCS 5 325,000 1,625,000
141 MASKER OXYGENT DEWASA rebreathing PCS 250 52,245 13,061,250
142 MASKER OXYGENT PEDIATRI rebreathing PCS 257 52,245 13,426,965
143 MASKER SURGICAL EARLOOP PCS 500 29,700 14,850,000
144 MICROBRUSH BONDING APLICATOR PCS 30 60,000 1,800,000
145 MOKSA SMOKELES STICK KOTAK 5 200,000 1,000,000
146 MONOPILAMEN POLYGLECAPRONE 25 VIOLET ABSORBABLE 3/0 (3/8,CIRCLE 24 mm ) cutting pcs 150 10,503 1,575,450
147 NASAL CANULA 02 BAYI 200 11,319 2,263,800
148 NASAL CANULA 02 DEWASA PCS 400 6,600 2,640,000
149 NASAL CANULA 02 PEDIATRI PCS 400 12,500 5,000,000
150 NEEDLE 18 PCS 500 1,400 700,000
151 NEEDLE NO. 23 PCS 500 1,400 700,000
152 NELATHON CHATETER NO. 10 PCS 50 9,613 480,650
153 NELATHON CHATETER NO. 12 PCS 50 9,613 480,650
154 NELATHON CHATETER NO.16 PCS 50 9,613 480,650
155 NELATHON CHATETER NO.18 PCS 50 9,613 480,650
156 NELATHON CHATETER NO.8 PCS 50 25,500 1,275,000
157 ORIGINAL PERFUSSOR PCS 50 150,000 7,500,000
158 PLESTER HIPAVYX ROLL 200 183,334 36,666,800
159 PLESTER ROLL (LEUKOPLAST 7,5CM X 4,5M) ROLL 500 48,382 24,191,000
160 POLYGYICOLIDE ABSORBABLE 2.0 (1/2 circle 25mm) cutting pcs 150 45,000 6,750,000
161 POLYGYICOLIDE ABSORBABLE 3.0 (1/2 CIRCLE 25mm) cutting pcs 150 55,000 8,250,000
162 POLYPREPILEN 2.0 CUTING PCS 150 64,500 9,675,000
166 PREMILEN 7.0 PCS 36 55,000 1,980,000
167 SARUNG TANGAN (L) PCS 20,000 1,396 27,920,000
168 SARUNG TANGAN (M) PCS 35,000 1,396 48,860,000
169 SARUNG TANGAN (S) PCS 10,000 1,396 13,960,000
170 SARUNG TANGAN GYNAECOLOG PANJANG 100 5,000 500,000
171 SARUNG TANGAN NO. 6,5 (STERIL) PCS 3,000 15,000 45,000,000
172 SARUNG TANGAN NO. 7 (STERIL) PCS 6,000 14,717 88,302,000
173 SARUNG TANGAN NO. 8 (STERIL) PCS 2,000 14,297 28,594,000
174 SARUNG TANGAN NO.7,5 (STERiL) PCS 10,000 14,384 143,840,000
175 SHARP CONTAINER 5 LTR PCS 100 60,082 6,008,200
176 SIDEX (GLUTARLDEIDA) JERGEN 20 -
177 silk black non absorbable 2.0 (1/2 circle 25 mm ) tapper pcs 300 38,000 11,400,000
178 silk black non absorbable 3.0 (1/2 circle 25mm ) tapper pcs 300 38,000 11,400,000
179 silk black non absorbable 3.0 (3/8 circle 16 mm ) cutting pcs 300 38,000 11,400,000
180 silk black non absorbable 4.0 (1/2 circle 20mm ) tapper pcs 300 38,000 11,400,000
181 SILK NO 2/0 (WITH NEEDLE) taper HR 26 PCS 480 16,100 7,728,000
182 SILK NO 3/0 (WITH NEEDLE) taper HR 20 PCS 480 15,658 7,516,032
183 SILK NO 4/0 (WITH NEEDLE) Taper HR 20 PCS 500 15,658 7,829,200
184 SILK NO 5/0 (WITH NEEDLE) taper PCS 480 47,047 22,582,560
185 SILK NO. 2 WITH NEEDLE cuting PCS 400 47,000 18,800,000
186 SILK NO. 2 WITH NEEDLE taper PCS 360 47,000 16,920,000
187 SILK NO. 3 WITH NEEDLE cuting PCS 400 47,000 18,800,000
188 SILK NO. 3 WITH NEEDLE taper PCS 360 47,000 16,920,000
189 SKIN TRAKSI ANAK PCS 50 47,000 2,350,000
190 SKIN TRAKSI DEWASA PCS 60 -
191 SOFT BAND 4 INCHI PCS 200 31,070 6,214,000
192 SOFT BAND 6 INCHI PCS 250 45,185 11,296,250
193 SOLDER SLING SET 5 35,000 175,000
194 SPALAK PANJANG DEWASA UK 100 X 10 CM PCS 60 35,000 2,100,000
195 SPALAK PANJANG DEWASA UK 100 X 10 CM PCS 60 35,000 2,100,000
196 SPALAK TANGAN DEWASA 30 X 6 CM PCS 60 -
197 SPOGESTAN PCS 200 10,500 2,100,000
198 STOMACH TUBE NO 10 PCS 360 23,792 8,565,120
203 STOMACH TUBE NO 3,5 PCS 200 23,792 4,758,400
207 SUMZEHER PCS 500 -
208 SUNGKUP 02 DEWASA PCS 800 30,477 24,381,600
209 SUNGKUP 02 PEDIATRI PCS 500 34,830 17,415,000
210 SURGICRYL (POLYGLYCOLIC ACID) NO.2 PCS 300 34,830 10,449,000
211 THREE WAY PCS 750 86,439 64,829,250
212 THREE WAY BEREKOR PCS 500 15,000 7,500,000
213 TOBAN (PLESTER TRNSPARAN DENGAN IODIUM) BUAH 500 86,434 43,217,000
214 TRANSFUSION SET INFUS PCS 1,000 23,471 23,471,000
215 TRANSMISSION JELLY PCS 200 39,707 7,941,440
216 treated polyester green synthetic non absorbable 1 ( 3/8 circle 31 mm ) j needle pcs 150 -
217 ULTRASONIC GEL 5 LTR BTL 15 240,328 3,604,920
218 UMBILICAL CORD CLEMP BLUE BOX 10 3,004 30,040
219 UNDERPADS 60X90 PCS 3,000 6,008 18,024,000
220 URINE BAG PCS 1,000 8,309 8,309,000
221 WING NEEDLE N0.23 PCS 400 2,000 800,000
222 WING NEEDLE N0.25 PCS 300 2,000 600,000
223 WING NEEDLE N0.27 PCS 200 2,000 400,000
Jumlah 1,800,048,492
PPN 10% 180,004,849
Total 1,980,053,341
TERBILANG : SATU MILYAR SEMBILAN RATUS DELAPAN PULUH JUTA LIMA PULUH TIGA RIBU TIGA RATUS EMPAT PULUH SATU RUPIAH
TEMINABUAN, Mei 2016
NIP.19670812 199712 1 001
jayamas
jayamas
widatra
0
0
0
abadinusa
abadinusa
bbraun
0
0
0
0
0
0
bbraun
bbraun
bbraun
bbraun
bbraun
0
0
rajawali
rajawali
rajawali
rajawali
0
0
0
0
0
0
0
0
rajawali
rajawali
rajawali
rajawali
0
megah
megah
megah
megah
megah
megah
megah
0
rajawali
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
megah
megah
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
bio
bio
bio
bio
bio
bio
0
bio
jayamas
jayamas
0
0
0
0
0
0
0
0
0
0
0
0
0
otsuka
otsuka
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ahmadaris
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
0
0
0
0
0
0
0
0
0
0
0
0
0
rajawali
rajawali
rajawali
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Terumo
Terumo
Terumo
Terumo
Terumo
0
Terumo
0
0
0
0
0
0
0
0
rajawali
0
0
0
0
0
0
0
0
Rumah Sakit Umum Daerah Scholoo Keyen
Alamat : Kampung Keyen, Jln. Teminabuan - Ayamaru Kabupaten Sorong Selatan
RENCANA ANGGARAN BIAYA PENGADAAN ALKES NON E-CATALOGUE 2017

No Uraian pekerjaan Satuan Volume Harga Jumlah
1 Aligator Unit 2 80,000 160,000
2 Amniotomi Set Unit 2 5,000,000 10,000,000
3 Analisa Hb Unit 1 29,000,000 29,000,000
4 Anus Copy Unit 1 11,000,000 11,000,000
5 Autoclave Unit 1 461,000 461,000
6 Automated urinalysis system/urin analizer Unit 1 26,000,000 26,000,000
7 Bak Instrumen Sedang Unit 2 150,000 300,000
8 Blood bank refrigerator darah siap pakai Unit 2 95,862,268 191,724,536
9 Blood bank refrigerator karantina Unit 1 95,862,268 95,862,268
10 Blood grouping plate Unit 1 78,000 78,000
11 Blood plasma freezer Unit 1 90,000 90,000
12 Bor Elektrik Unit 1 1,500,000 1,500,000
13 Bor Manual Unit 1 1,000,000 1,000,000
14 Bunsen Unit 5 500,000 2,500,000
15 Central Oxygen Generatorr Unit 1 7,463,000,000 7,463,000,000
16 Centrifugal chemistry analyzer for clinical for use/centrifuge kimia klinik Unit 1 22,500,000 22,500,000
17 Com Bertutup (Diameter 12 cm) Unit 5 55,000 275,000
18 Com Besar (Diameter 17 cm) Unit 3 55,000 165,000
19 Cool box dengan fasilitas 2-5 kantong Unit 1 1,500,000 1,500,000
20 Cool box untuk transportasi dengan fasilitas minimal 20 kantong Unit 1 1,500,000 1,500,000
21 Embriotomi Set Unit 1 52,000,000 52,000,000
22 Gelas ukur 1 Liter (Plastik) Unit 2 150,000 300,000 34,431,683,176
23 Hand sealer Unit 1 3,900,000 3,900,000
24 Instrumen Bedah Vaskuler Unit 1 7,500,000 7,500,000
25 Katarak dan Bedah Refraktif Unit 1 7,500,000 7,500,000
26 Klem Unit 1 150,000 150,000
27 Klem Ovum Unit 2 250,000 500,000
28 Klem/pean Unit 1 350,000 350,000
29 Klisma Unit 2 350,000 700,000
30 Lampu Senter Unit 2 200,000 400,000
31 Laringoscope Anak Unit 1 25,000,000 25,000,000
32 LED Unit 2 700,000 1,400,000
33 Medical refrigerator Unit 1 123,500,000 123,500,000
34 Meteran Unit 1 100,000 100,000
35 Microbiological incubator Unit 1 25,000,000 25,000,000
36 Microscope dinocular Unit 1 22,000,000 22,000,000
37 Microscopes and accessories/Mikroskop Unit 1 21,000,000 21,000,000
38 Mikro balance Unit 1 3,500,000 3,500,000
39 Mikropipet ukuran 50-200 ul Unit 1 3,805,000 3,805,000
40 Mikropipet ukuran 5-50 ul Unit 1 3,805,000 3,805,000
41 Mikrosentrifus Unit 1 3,900,000 3,900,000
42 Mikroskop binokuler Unit 1 3,900,000 3,900,000
43 Nierbeken Besar Unit 7 150,000 1,050,000
44 Nierbeken Kecil Unit 4 150,000 600,000
45 Nierbeken Sedang Unit 2 150,000 300,000
46 Pean Bengkok Unit 1 700,000 700,000
47 Pen Light Unit 3 150,000 450,000
48 Peti pendingin darah/cool box untuk mobile unit (25 – 50 kantong) Unit 1 4,500,000 4,500,000
49 Pinset Unit 1 50,000 50,000
50 Pipetting and diluting system for clinical use/perangkat pipet Unit 1 55,000 55,000
51 Pispot BAB Unit 2 1,500,000 3,000,000
52 Pispot Pria Unit 4 1,500,000 6,000,000
53 Pispot Wanita Unit 6 1,500,000 9,000,000
54 Rak slide Unit 1 40,000 40,000
55 Reflex Hammer Unit 1 165,615 165,615
56 Sendok Kuret Tajam Set Unit 1 8,000,000 8,000,000
57 Sendok Kuret Tumpel Set Unit 1 8,000,000 8,000,000
58 Spekulum Cocor Bebek Kecil Unit 1 150,000 150,000
59 Spekulum Cocor Bebek Sedang Unit 1 150,000 150,000
60 Spekulum Sims Unit 1 150,000 150,000
61 Sterilisator Kering Unit 1 20,000,000 20,000,000
62 STSG Set Unit 1 50,000,000 50,000,000
63 Suction Kuret Unit 1 16,500,000 16,500,000
64 Tempat tidur Unit 2 26,000,000 52,000,000
65 Tempat tidur statis Unit 1 26,000,000 26,000,000
66 Termometer kontrol Unit 1 1,200,000 1,200,000
67 Timbangan darah Unit 1 1,500,000 1,500,000
68 Timer Unit 1 500,000 500,000
69 Torniket Unit 5 40,000 200,000
70 Tromol Besar (Diameter 17 cm) Unit 3 175,000 525,000
71 Ultra sentrifuse Unit 1 7,500,000 7,500,000
72 UPS Unit 1 3,665,250 3,665,250
73 USG Anestesi Unit 1 175,000,000.00 175,000,000
74 Vacum Manual (Disposibel) Unit 1 700,000 700,000
75 Waterpas (Pengukur CVC) Unit 1 500,000 500,000
Jumlah 8,566,976,669
PPN 10% 856,697,667
Total 9,423,674,336
Terbilang : Sembilan Milyar Delapan Ratus Lima PuluhTiga Juta Empat Ratus Sembilan Puluh Sembilan Ribu Rupiah
Teminabuan, Februari 2016
Direktur RSUD Scholoo Keyen

drg.ROSALINE N.I KRIMADI

Nip.19771120 200112 2 006

LOGISTIK RSUD SCHOLOO KEYEN KAB. SORONG SELATAN
NO NAMA ALAT SATUAN VOLUME HARGA PPN 10% JUMLAH
1 Alat Pel set 80 75,000 7,500 6,600,000
2 Alat Pembersih Kaca buah 7 20,000 2,000 154,000
3 Anti septic gel botol 84 15,000 1,500 1,386,000
4 Baby Oil 100ML botol 24 35,000 3,500 924,000
5 Bay Fresh bungkus 364 25,000 2,500 10,010,000
6 Bayclin botol 471 18,000 1,800 9,325,800
7 Bedak Baby botol 100 10,000 1,000 1,100,000
8 Cairan Anti Septik botol 24 35,000 3,500 924,000
9 Clear Pembersih Kaca liter 255 50,000 5,000 14,025,000
10 Ember Bertutup Besar buah 34 150,000 15,000 5,610,000
11 Ember bertutup kecil buah 34 75,000 7,500 2,805,000
12 Ember Bertutup Sedang buah 4 100,000 10,000 440,000
13 Fortex/ botol botol 6 75,000 7,500 495,000
14 Gantungan Baju lusin 12 25,000 2,500 330,000
15 Gayung buah 65 10,000 1,000 715,000
16 Glass Cleaner botol 17 20,000 2,000 374,000
17 Harpic botol 12 75,000 7,500 990,000
18 Hibis Scrub botol 25 50,000 5,000 1,375,000
19 Hit Semprot botol 307 20,500 2,050 6,922,850
20 Kain Lap / Seka pcs 20 20,000 2,000 440,000
21 Kamfer pak 208 5,000 500 1,144,000
22 Kantong Sampah Besar Ukuran 120 x 180 pak 50 300,000 30,000 16,500,000
23 Kantong Sampah Kecil Ukuran 90 x 90 pak 50 70,000 7,000 3,850,000
24 Kantong Sampah Sedang Ukuran 90 x 180 pak 50 200,000 20,000 11,000,000
25 Karpet m2 6 100,000 10,000 660,000
26 Keranjang linen kotor buah 1 55,000 5,500 60,500
27 Kertas Puyer Pres box 12 55,000 5,500 726,000
28 Kesek Kaki pcs 49 75,000 7,500 4,042,500
29 Ligent (Pembersih Peralatan Dapur) 1000 ml liter 8 100,000 10,000 880,000
30 Molto 900ml botol 106 15,000 1,500 1,749,000
31 Pembersih kaca botol 130 20,000 2,000 2,860,000
32 Penutup Meja pcs 12 175,000 17,500 2,310,000
33 Perlak Pasien pcs 12 200,000 20,000 2,640,000
34 Plastik Sampah pak 312 37,000 3,700 12,698,400
35 Plastik Sampah Ukuran 40 x 50 pak 300 70,000 7,000 23,100,000
36 Plastik Sampah Ukuran 60 x 90 pak 200 200,000 20,000 44,000,000
37 Plastik Sampah ukuran 90 x 120 pak 100 300,000 30,000 33,000,000
38 Portex botol 397 75,000 7,500 32,752,500
39 Rak Jemuran buah 7 550,000 55,000 4,235,000
40 Rinso kg 269 20,000 2,000 5,918,000
41 Sabun Batang batang 162 10,000 1,000 1,782,000
42 Sabun Batang/ batang batang 6 10,000 1,000 66,000
43 Sabun Cair untuk Mandi Pasien botol 153 50,000 5,000 8,415,000
44 Sabun Cuci Mama Lemon botol 13 15,000 1,500 214,500
45 Sabun Cuci tangan botol 83 15,000 1,500 1,369,500
46 Sabun Mandi Baby buah 500 10,000 1,000 5,500,000
47 Sabun Mandi Pasien buah 101 10,000 1,000 1,111,000
48 sapu buah 12 60,000 6,000 792,000
49 Sapu Ijuk buah 31 60,000 6,000 2,046,000
50 Sapu Lantai buah 29 60,000 6,000 1,914,000
51 Sapu lantai ruangan buah 2 60,000 6,000 132,000
52 Sapu lawalawa buah 37 185,000 18,500 7,529,500
53 sapu Lidi buah 42 20,000 2,000 924,000
54 Sarung bantal pasien buah 20 35,000 3,500 770,000
55 Selimut buah 2 100,000 10,000 220,000
56 Selimut Ganti Pasien buah 25 100,000 10,000 2,750,000
57 Selimut pasien buah 74 100,000 10,000 8,140,000
58 Semprot Nyamuk buah 10 20,500 2,050 225,500
59 Sendal Perawat pasang 10 25,000 2,500 275,000
60 Sendok Sampah buah 4 150,000 15,000 660,000
62 Seprei pasien buah 10 180,000 18,000 1,980,000
63 Serokan buah 27 20,000 2,000 594,000
64 Sikat Baju buah 10 10,000 1,000 110,000
65 Sikat Besar buah 5 20,000 2,000 110,000
66 Sikat Kamar Mandi buah 127 20,000 2,000 2,794,000
67 Sikat pakaian buah 12 20,000 2,000 264,000
68 So Clin Lantai botol 61 35,000 3,500 2,348,500
69 Sun Cream bungkus 12 20,000 2,000 264,000
70 Sunlight botol 101 20,000 2,000 2,222,000
71 Super pel botol 488 17,000 1,700 9,125,600
72 Tabung O₂ Besar buah 5 3,000,000 300,000 16,500,000
73 Tabung O₂ kecil buah 2 1,500,000 150,000 3,300,000
74 Tangkai Pel batang 14 75,000 7,500 1,155,000
75 Tempat Pakaian Kotor Pasien buah 12 55,000 5,500 726,000
76 Tempat sampah buah 18 250,000 25,000 4,950,000
77 Tempat Sampah berpenutup ukuran sedang buah 1 250,000 25,000 275,000
78 Tempat Sampah Besar buah 25 350,000 35,000 9,625,000
79 Tempat Sampah Besar dan Penutup buah 4 350,000 35,000 1,540,000
80 Tempat Sampah Kecil buah 103 200,000 20,000 22,660,000
81 Tempat sampah kecil bertutup buah 8 200,000 20,000 1,760,000
82 Tempat Sampah Kecil dan Penutup buah 8 200,000 20,000 1,760,000
83 Tempat Sampah Pasien bertutup buah 20 250,000 25,000 5,500,000
84 Tempat Sampah Pasien Tutup Sedang buah 10 250,000 25,000 2,750,000
85 Tempat Sampah Sedang buah 50 250,000 25,000 13,750,000
86 Tempat Sampah ukuran sedang dengan penutup buah 2 250,000 25,000 550,000
87 Tissu Kotak buah 323 10,000 1,000 3,553,000
88 Tissue buah 3 10,000 1,000 33,000
89 Tissue Basah buah 308 15,000 1,500 5,082,000
90 Tissue Kering buah 72 10,000 1,000 792,000
91 Tissue roll roll 398 7,000 700 3,064,600
92 Tisu Basah buah 12 15,000 1,500 198,000
93 Waskom Double buah 5 75,000 7,500 412,500
94 Waslap buah 117 26,000 2,600 3,346,200
95 Waslap Petugas buah 5 26,000 2,600 143,000
96 Wiper buah 2 35,000 3,500 77,000
97 Wipol buah 15 35,000 3,500 577,500
TOTAL 437,799,450
DIBULATKAN 438,500,000
TERBILANG : EMPAT RATUS TIGA PULU DELAPAN LIMA RATUS RIBU RUPIAH
TEMINABUAN, September 2016

NIP.19670812 199712 1 001
RENCANA ANGGARAN BIAYA
PEKERJAAN : OPTIMALISASI JARINGAN AIR BERSIH RSUD SCHOLO KEYEN

LOKASI : KAMPUNG KEYEN TEMINABUAN
TAHUN : 2016
No. URAIAN PEKERJAAN VOLUMESATUAN HARGA SAT.

(Rp)
1 GROUND RESERVOIR
Pembuatan Washout 1.00 unit 20,000,000.00
- Pengadaan dan Pemasangan pip Inlet 1.00 ls 10,000,000.00
2 TOWER
Pengadaan dan Pemasangan Pompa & Ass. 1.00 unit 10,000,000.00
- Pengadaan dan Pemasangan Pipa Inlet & Ass 1.00 ls 25,000,000.00
Pengadaan dan Pemasangan Pipa Inlet & Ass 1.00 ls 5,000,000.00
SUMUR BOR
Pengadaan dan Pemasangan Pompa & Ass. 4.00 unit 25,000,000.00
- Pembuatan IPA Aerasi 1.00 ls 50,000,000.00
Pengadaan dan Pemasangan Pipa Outlet & Ass ke Reservoi 1.00 ls 10,000,000.00
-
4 JARINGAN PELAYANAN KE FASILITAS RS
Pengadaan dan Pemasangan Pipa Induk & Ass Ø 3" PE 400.00 m' 265,000.00
- Pengadaan dan Pemasangan Pipa Sekunder & Ass Ø 2" PE 400.00 m' 250,000.00
Pengadaan dan Pemasangan Pipa Pelayanan & Ass Ø 1/2", 1.00 ls 140,000,000.00
SubTotal
DED dan Supervisi
Administrasi Proyek
Total
PPN 10 %
Total
Dibulatkan
Terbilang :Tujuh ratus enam puluh juta rupiah

NIP.19670812 199712 1 001
CANA ANGGARAN BIAYA
JUMLAH HARGA
(Rp)
20,000,000.00
10,000,000.00
10,000,000.00
25,000,000.00
5,000,000.00
100,000,000.00
50,000,000.00
10,000,000.00
106,000,000.00
100,000,000.00
140,000,000.00
576,000,000.00
57,600,000.00
57,600,000.00
691,200,000.00
69,120,000.00
760,320,000.00
760,000,000.00

NIP.19670812 199712 1 001

CENTRAL OKSIGEN GENERATOR RSUD SCHOLOO KEYEN KAB. SORONG SELATAN
NO NAMA ALAT SATUAN VOLUME HARGA JUMLAH
1 INSTALASI
Ruang Ok Titik 2 33,000,000 66,000,000
Ruang Recovery Titik 1 33,000,000 33,000,000
Ruang ICU Titik 3 33,000,000 99,000,000
Ruang ICU Isolasi Titik 2 33,000,000 66,000,000
Ruang IGD Titik 8 33,000,000 264,000,000
2 OKSIGEN GENERATOR
Main unit unit 1 4,372,000,000 4,372,000,000
3 ONGKOS KIRIM
Ongkir Main Unit Paket 1 150,000,000 150,000,000
Ongkir Pipa dan teknisi Paket 1 350,000,000 350,000,000
TOTAL 5,400,000,000
TERBILANG : LIMA MILYAR EMPAT RATUS JUTA RUPIAH

NIP.19670812 199712 1 001
RENCANA ANGGARAN BIAYA PENGADAAN REAGEN LABORATORIUM HABIS PAKAI TAHUN 2017
No Uraian pekerjaan Satuan Volume Harga Jumlah
1 Darah Kontrol Mindray 3000 Plus Vial ml 12 Rp 835,000 10,020,000
2 Diluent Mindray 3000 Plus Gln/20ltr 24 Rp 1,755,000 42,120,000
3 Emertion Oil Btl/100ml 6 Rp 772,000 4,632,000
4 EZ- Cleanzer (Mindray BJ 3000 Plus) Btl 20 Rp 862,125 17,242,500
5 Giemsa Gram Stain Btl/500ml 10 Rp 1,550,000 15,500,000
6 Kertas Mindray Dan Kimia Roll 72 Rp 187,500 13,500,000
7 M-30P-Prob Cleanser Btl 120 Rp 76,950 9,234,000
8 Methanol Btl/2,5ltr 6 Rp 1,232,000 7,392,000
9 Reagent Gol.Da Anti-A Vial 10ml 60 Rp 140,000 8,400,000
10 Reagent Gol.Da Anti- B Vial 10ml 60 Rp 140,000 8,400,000
11 Rinse Gln/20ltr 6 Rp 1,691,000 10,146,000
12 Lyse Mindray BS 3000 Btl/500ml 24 Rp 3,858,000 92,592,000
13 Reagent Gol.Da Anti-D Vial 10ml 60 Rp 165,000 9,900,000
14 Turk Btl 1 Rp 150,000 150,000
15 Eosine 2 % Btl 1 Rp 215,000 215,000
16 Eosine Y Btl 1 Rp 215,000 215,000
17 Reagen HE Btl 1 Rp 200,000 200,000
18 Reagent Albumin 500ml 5 Rp 621,500 3,107,500
19 Reagent Asam Urat 4 x 100ml 6 Rp 1,573,000 9,438,000
20 Reagent Bilirubun T/D 2 X 100ml 2 Rp 715,000 1,430,000
21 Reagent Cholesterol 4 x 100ml 12 Rp 1,760,000 21,120,000
22 Reagent Creatinin 200ml 24 Rp 617,100 14,810,400
23 Reagent Glukosa 4 x 100ml 24 Rp 748,000 17,952,000
24 Reagent SGOT 20 x 50ml 24 Rp 1,705,000 40,920,000
25 Reagent SGPT 20 x 50ml 24 Rp 1,705,000 40,920,000
26 Reagent Total Protein 1000ml 2 Rp 770,000 1,540,000
27 Reagent Ureum UV 8 x 50ml 24 Rp 1,875,500 45,012,000
28 Serum Control Kotak 20 2 Rp 3,750,000 7,500,000
29 Sensor Cassette BGA Pack 4 Rp 250,000 1,000,000
30 Solition Pack BGA Pack 4 Rp 250,000 1,000,000
31 Urine Strip Btl 15 Rp 279,000 4,185,000
32 Narkoba Rapid Test Box 10 1,229,300 12,293,000
33 Tabung sentrifuse urine Pcs 50 Rp 2,700 135,000
34 Reagen None Btl 1 Rp 250,000 250,000
35 Reagen Pandi Btl 1 Rp 250,000 250,000
36 Rivalta Btl/100ml 1 Rp 3,000,000 3,000,000
37 Sataihelmer Malbin (Cat Urine) Paket 4 2,000,000 8,000,000
38 Pregnancy Strip Box 5 200,800 1,004,000
39 HbSAg Stick Box 50 test 45 Rp 457,500 20,587,500
40 HCV Stick Box 40 test 11 Rp 1,250,000 13,750,000
41 HIV Stick Box 50 test 45 Rp 3,400,000 153,000,000
42 Shipylis Stick Kotak 30 45 Rp 924,000 41,580,000
43 Salmonella Ig M Rapid Test Box 1 Rp 1,450,000 1,450,000
44 Anti Dengue Ig G Rapid Test Box 1 Rp 1,625,000 1,625,000
45 Bovine albumin Box 50 Rp 150,000 7,500,000
46 Como test Box 50 Rp 150,000 7,500,000
47 Cassette CD4 Box @25bh 6 Rp 150,000 900,000
48 Control CD4 Pak 4 Rp 150,000 600,000
49 Methylen Blue 0,1% Btl 100ml 15 3,457,300 51,859,500
50 Carbol Fuchsin 0,3% Btl 15 Rp 90,750 1,361,250
51 Blod Lancet Box 20 Rp 41,250 825,000
52 Blue Tip Box 24 Rp 290,000 6,960,000
53 Filter Paper Whatman (CT – BT Test) Box 2 1,279,000 2,558,000
54 Kertas Pembersih Lensa Microscope Box 8 137,500 1,100,000
55 Object Glass Box 80 36,400 2,912,000
56 Tabung Disposible EDTA (ungu) Btl 5,800 Rp 2,700 15,660,000
57 Tabung Disposible Kimia (merah) btl 4,800 Rp 2,700 12,960,000
58 Tabung Sitros (Biru) Btl 600 3,135 1,881,000
59 Wright Stain Btl 18 Rp 687,500 12,375,000
60 Yellow Tip Sak 14 Rp 220,000 3,080,000
61 Pot Urine Sak 2,500 Rp 2,800 7,000,000
62 Kartu Gol.Da Pak @100 6 Rp 55,000 330,000
63 Parafilm (Laboratory Film) Gulung 3 Rp 150,000 450,000
64 Tabung Kapiler (Tabung Hematokrit) Box @100 2 Rp 16,214 32,428
65 Tabung Sample (plastic) Pak/1000 8 Rp 1,400,000 11,200,000
Jumlah 865,762,078
PPN 10% 86,576,208
Total 952,338,286
Terbilang : Sembilan Ratus Lima Puluh Dua Juta Tiga Ratus Tiga Puluh Delapan Ribu Dua Ratus Rupiah

NIP.19670812 199712 1 001
BUPATEN SORONG SELATAN
UMUM DAERAH SCHOLOO KEYEN
n. Ayamaru-Teminabuan, Kab. Sororng Selatan
: rsudscholookeyen@yahoo.com

MEUBELAIR RSUD SCHOLOO KEYEN KAB. SORONG SELATAN
NO NAMA ALAT SATUAN VOLUME HARGA JUMLAH PPN 10%
1 AC 1/2 PK Unit 1 Rp 3,850,000 Rp 3,850,000 Rp 385,000
2 AC 1PK Unit 7 Rp 6,000,000 Rp 42,000,000 Rp 4,200,000
3 AC 2 PK UNIT 6 Rp 10,000,000 Rp 60,000,000 Rp 6,000,000
4 alat peraga penis buatan buah 2 Rp 800,000 Rp 1,600,000 Rp 160,000
5 alat semprot tanaman unit 1 Rp 250,000 Rp 250,000 Rp 25,000
6 alat siram bunga ( teko) buah 2 Rp 100,000 Rp 200,000 Rp 20,000
7 Bambu buah 35 Rp 50,000 Rp 1,750,000 Rp 175,000
8 Bantal Guling Unit 3 Rp 100,000 Rp 300,000 Rp 30,000
9 Bantal Kepala Unit 6 Rp 100,000 Rp 600,000 Rp 60,000
10 BEDSIDE CABINET UNIT 4 Rp 1,500,000 Rp 6,000,000 Rp 600,000
11 Brosur Tarif Pelayanan Paket 1 Rp 50,000,000 Rp 50,000,000 Rp 5,000,000
12 cangkul buah 2 Rp 45,000 Rp 90,000 Rp 9,000
13 cat warna 5 liter kaleng 5 Rp 75,000 Rp 375,000 Rp 37,500
14 CCTV YANG ADA MEMORI TITIK 9 Rp 3,900,000 Rp 35,100,000 Rp 3,510,000
15 Form Chek List Keselamatan Pasien Lembar 600 Rp 5,000 Rp 3,000,000 Rp 300,000
16 DISPENSER BH 12 Rp 1,700,000 Rp 20,400,000 Rp 2,040,000
17 EXHAUST FAN UNIT 14 Rp 1,000,000 Rp 14,000,000 Rp 1,400,000
18 File Binder Ukuran Sedang Buah 300 Rp 100,000 Rp 30,000,000 Rp 3,000,000
19 FLYER TRAPPER (PENANGKAP LALAT) UNIT 2 Rp 1,500,000 Rp 3,000,000 Rp 300,000
20 gunting tanaman buah 3 Rp 150,000 Rp 450,000 Rp 45,000
21 HARD DISK 500 GB TOSHIBA BH 1 Rp 1,000,000 Rp 1,000,000 Rp 100,000
22 HT (HANDY TALKY) Unit 2 Rp 400,000 Rp 800,000 Rp 80,000
23 Instruksi Pasca Anastesi Lembar 600 Rp 5,000 Rp 3,000,000 Rp 300,000
24 I-phone Unit 1 Rp 300,000 Rp 300,000 Rp 30,000
25 Jam dinding Unit 1 Rp 250,000 Rp 250,000 Rp 25,000
26 Kaca Mata Unit 1 Rp 100,000 Rp 100,000 Rp 10,000
27 kayu 5X10 Batang 10 Rp 50,000 Rp 500,000 Rp 50,000
28 kayu 5x5 Batang 10 Rp 12,000 Rp 120,000 Rp 12,000
29 Kendaraan Operasional (Motor Trial) unit 1 Rp 30,000,000 Rp 30,000,000 Rp 3,000,000
30 KERTAS STIKER U/ PELABELAN OBAT YANG DISIMPAN, HIGH ALERT DAN LASA PCK 30 Rp 75,000 Rp 2,250,000 Rp 225,000
31 Kipas Angin Stan Berdiri Unit 4 Rp 800,000 Rp 3,200,000 Rp 320,000
32 Kipas Angin Gantung Unit 9 Rp 600,000 Rp 5,400,000 Rp 540,000
33 KOMPUTER + PRINTER UNIT 6 Rp 10,000,000 Rp 60,000,000 Rp 6,000,000
34 kondom sutra dos 5 Rp 25,000,000 Rp 125,000,000 Rp 12,500,000
35 kuas besar buah 5 Rp 10,000 Rp 50,000 Rp 5,000
36 kuas sedang buah 5 Rp 7,000 Rp 35,000 Rp 3,500
37 Kulkas Unit 6 Rp 5,750,000 Rp 34,500,000 Rp 3,450,000
38 Kulkas Mini Unit 1 Rp 3,500,000 Rp 3,500,000 Rp 350,000
39 KULKAS OBAT UK. BESAR BH 3 Rp 4,000,000 Rp 12,000,000 Rp 1,200,000
40 Kursi Direksi Buah 2 Rp 1,750,000 Rp 3,500,000 Rp 350,000
41 Kursi Kerja Roda Unit 1 Rp 3,350,000 Rp 3,350,000 Rp 335,000
42 kursi lipat buah 10 Rp 500,000 Rp 5,000,000 Rp 500,000
43 Kursi Plastik Unit 12 Rp 140,000 Rp 1,680,000 Rp 168,000
44 Kursi Petugas Unit 2 Rp 250,000 Rp 500,000 Rp 50,000
45 kursi putar buah 1 Rp 750,000 Rp 750,000 Rp 75,000
46 Kursi Ruang Tunggu Set 5 Rp 5,900,000 Rp 29,500,000 Rp 2,950,000
47 Kursi Sofa Unit 3 Rp 2,800,000 Rp 8,400,000 Rp 840,000
48 KURSI/BANGKU DENGAN SANDARAN/ CHEETOS BH 5 Rp 1,000,000 Rp 5,000,000 Rp 500,000
49 Lampu Emergensi Unit 2 Rp 150,000 Rp 300,000 Rp 30,000
50 Lampu Penerangan Jalan Tiang 1 Rp 2,000,000 Rp 2,000,000 Rp 200,000
51 LAPTOP TOSHIBA CORE I-7 BH 8 Rp 15,000,000 Rp 120,000,000 Rp 12,000,000
52 layar in focus buah 1 Rp 1,000,000 Rp 1,000,000 Rp 100,000
53 Leaflet K3RS Set 200 Rp 5,000 Rp 1,000,000 Rp 100,000
54 Lemari Alat/ Instrument Unit 3 Rp 6,600,000 Rp 19,800,000 Rp 1,980,000
55 LEMARI ALUMINIUM BH 2 Rp 10,000,000 Rp 20,000,000 Rp 2,000,000
56 lemari dokumen besi pintu geser kaca buah 6 Rp 10,000,000 Rp 60,000,000 Rp 6,000,000
57 LEMARI HIGH ALERT ALUMINIUM BER-RAK DAN TERKUNCI UNIT 3 Rp 12,000,000 Rp 36,000,000 Rp 3,600,000
58 LEMARI NARKOTIK UK.80X60X120 BH 2 Rp 4,500,000 Rp 9,000,000 Rp 900,000
59 Lemari Penyimpanan Barang Unit 12 Rp 7,000,000 Rp 84,000,000 Rp 8,400,000
60 LEMARI PENYIMPANAN BERKAS LOKER 12 PINTU BERKUNCI BH 1 Rp 22,100,000 Rp 22,100,000 Rp 2,210,000
61 LEMARI PENYIMPANAN OBAT REKONSILIASI ALUMINIUM UNIT 1 Rp 10,000,000 Rp 10,000,000 Rp 1,000,000
62 Meja 1 Biro Set 1 Rp 3,800,000 Rp 3,800,000 Rp 380,000
63 Meja 1/2 Biro Set 2 Rp 2,650,000 Rp 5,300,000 Rp 530,000
64 MEJA 120X75 CM BH 1 Rp 5,000,000 Rp 5,000,000 Rp 500,000
65 meja kerja/komputer buah 2 Rp 2,000,000 Rp 4,000,000 Rp 400,000
66 Meja Konsul Dokter Unit 5 Rp 900,000 Rp 4,500,000 Rp 450,000
67 Meja Observasi Pasien Unit 3 Rp 4,400,000 Rp 13,200,000 Rp 1,320,000
68 Meja Perawat Penjaga Unit 4 Rp 5,000,000 Rp 20,000,000 Rp 2,000,000
69 MEJA RACIK DAN PEMBUATAN TABLET UNIT 1 Rp 2,000,000 Rp 2,000,000 Rp 200,000
70 MESIN CUCI DENGAN PENGATUR SUHU UNIT 1 Rp 400,000,000 Rp 400,000,000 Rp 40,000,000
71 MESIN PENCETAK BARCODE U/ PASIEN UNIT 1 Rp 10,000,000 Rp 10,000,000 Rp 1,000,000
72 PAPAN INFORMASI KEGIATAN 125X100CM BH 1 Rp 5,350,000 Rp 5,350,000 Rp 535,000
73 Papan Titik Kumpul + Tiang Tiang 4 Rp 2,500,000 Rp 10,000,000 Rp 1,000,000
74 papan white board besar buah 51 Rp 1,000,000 Rp 51,000,000 Rp 5,100,000
75 Parabola Unit 2 Rp 1,200,000 Rp 2,400,000 Rp 240,000
76 parang buah 2 Rp 50,000 Rp 100,000 Rp 10,000
77 pasta gigi anak karton 20 Rp 350,000 Rp 7,000,000 Rp 700,000
78 PEMBUATAN BUKU PEDOMAN PPI EKS 25 Rp 150,000 Rp 3,750,000 Rp 375,000
79 pembuatan leaflet lembar 12000 Rp 10,000 Rp 120,000,000 Rp 12,000,000
80 pembuatan poster buah 15 Rp 15,000 Rp 225,000 Rp 22,500
81 Penandaan Lokasi Operasi Lembar 600 Rp 1,000 Rp 600,000 Rp 60,000
82 PENCETAKAN ASSESMENT GERIATRI EKS 200 Rp 5,000 Rp 1,000,000 Rp 100,000
83 Pencetakan Berkas Rekam Medis Evaluasi Presedasi Anastesi yang 3 Rangkap Lembar 600 Rp 5,000 Rp 3,000,000 Rp 300,000
84 PENCETAKAN KARTU (15 JENIS) MPO EKS 1000 Rp 5,000 Rp 5,000,000 Rp 500,000
85 PENCETAKAN RESEP OBAT YG BARU (RAWAT INAP) EKS 2000 Rp 5,000 Rp 10,000,000 Rp 1,000,000
86 PENCETAKAN RESEP OBAT YG BARU (RAWAT JALAN) EKS 20500 Rp 5,000 Rp 102,500,000 Rp 10,250,000
87 PENCETAKAN STEMPEL VERIFIKASI DPJP BH 21 Rp 300,000 Rp 6,300,000 Rp 630,000
88 PENGADAAN MESIN ETIKET OBAT UNIT 1 Rp 20,000,000 Rp 20,000,000 Rp 2,000,000
89 PENGADAAN MIKROPHONE & SPEAKER UNIT 1 Rp 8,000,000 Rp 8,000,000 Rp 800,000
90 Pengadaan Tabung APAR Buah 17 Rp 2,000,000 Rp 34,000,000 Rp 3,400,000
91 PENGERING PAKAIAN UNIT 1 Rp 133,000,000 Rp 133,000,000 Rp 13,300,000
92 Penggandaan Form Post Anastesi Lembar 600 Rp 5,000 Rp 3,000,000 Rp 300,000
93 Penggandaan Laporan Anastesi Lembar 600 Rp 5,000 Rp 3,000,000 Rp 300,000
94 Penggandaan Laporan Operasi Lembar 600 Rp 5,000 Rp 3,000,000 Rp 300,000
95 Perlak Unit 4 Rp 220,000 Rp 880,000 Rp 88,000
96 PITA LINGKAR LENGAN ATAS BH 10 Rp 5,000 Rp 50,000 Rp 5,000
97 plastik koker besar lembar 300 Rp 10,000 Rp 3,000,000 Rp 300,000
98 plastik koker kecil lembar 300 Rp 5,000 Rp 1,500,000 Rp 150,000
99 plastik koker sedang lembar 300 Rp 7,000 Rp 2,100,000 Rp 210,000
100 PLASTIK SAMPAH HITAM UK.BESAR LBR 7500 Rp 3,000 Rp 22,500,000 Rp 2,250,000
101 PLASTIK SAMPAH KUNING UK. BESAR LBR 7500 Rp 3,000 Rp 22,500,000 Rp 2,250,000
102 Poster K3RS Set 20 Rp 200,000 Rp 4,000,000 Rp 400,000
103 pot bunga besar buah 10 Rp 150,000 Rp 1,500,000 Rp 150,000
104 Pot bunga kecil buah 25 Rp 50,000 Rp 1,250,000 Rp 125,000
105 pot bunga sedang buah 10 Rp 100,000 Rp 1,000,000 Rp 100,000
106 printer+copy+scanner epson buah 5 Rp 3,500,000 Rp 17,500,000 Rp 1,750,000
107 proyektor epson buah 1 Rp 2,000,000 Rp 2,000,000 Rp 200,000
108 RAK OBAT UNTUK GUDANG & APOTEK BERBAHAN ALUMINIUM UNIT 2 Rp 10,000,000 Rp 20,000,000 Rp 2,000,000
109 Rak Sepatu & Sandal Buah 2 Rp 500,000 Rp 1,000,000 Rp 100,000
110 RAM Kasa M 50 Rp 15,000 Rp 750,000 Rp 75,000
111 sabun cuci tangan lifeboy cair botol kecil pencet karton 20 Rp 400,000 Rp 8,000,000 Rp 800,000
112 Sampiran kedap air tiap bed Unit 30 Rp 2,000,000 Rp 60,000,000 Rp 6,000,000
113 Sandal uk. 39 Unit 10 Rp 100,000 Rp 1,000,000 Rp 100,000
114 Sandal uk. 44 Unit 5 Rp 100,000 Rp 500,000 Rp 50,000
115 SAPU PEL BH 60 Rp 300,000 Rp 18,000,000 Rp 1,800,000
116 Sapu Ruangan Unit 1 Rp 100,000 Rp 100,000 Rp 10,000
117 Sarung Bantal Guling Unit 2 Rp 40,000 Rp 80,000 Rp 8,000
118 Sarung Bantal Kepala Unit 6 Rp 40,000 Rp 240,000 Rp 24,000
119 SARUNG TANGAN INDUSTRI PSNG 200 Rp 50,000 Rp 10,000,000 Rp 1,000,000
120 Selimut Pasien Unit 33 Rp 110,000 Rp 3,630,000 Rp 363,000
121 SENDAL TERTUTUP BH 90 Rp 300,000 Rp 27,000,000 Rp 2,700,000
122 seng lembar 20 Rp 100,000 Rp 2,000,000 Rp 200,000
123 Sepatu uk. 39 Unit 5 Rp 200,000 Rp 1,000,000 Rp 100,000
124 Sepatu uk. 44 Unit 5 Rp 200,000 Rp 1,000,000 Rp 100,000
125 Seprei Pasien Unit 4 Rp 300,000 Rp 1,200,000 Rp 120,000
126 Seragam Security Pasang 20 Rp 350,000 Rp 7,000,000 Rp 700,000
127 Seragam Sopir Ambulance Pasang 8 Rp 500,000 Rp 4,000,000 Rp 400,000
128 Sign Ruang Tunggu Buah 1 Rp 300,000 Rp 300,000 Rp 30,000
129 sikat gigi anak karton 10 Rp 200,000 Rp 2,000,000 Rp 200,000
130 SOFTWARE SIM APOTEK DAN GUDANG PCK 1 Rp 400,000,000 Rp 400,000,000 Rp 40,000,000
131 Stavol 500/1000 VOLT Unit 3 Rp 1,200,000 Rp 3,600,000 Rp 360,000
132 TANGGA LIPAT KRISBOW BH 2 Rp 2,200,000 Rp 4,400,000 Rp 440,000
133 Taplak Meja Px (Kotak Kecil) Unit 16 Rp 120,000 Rp 1,920,000 Rp 192,000
134 TELEPON PANASONIC PABX PCS 10 Rp 750,000 Rp 7,500,000 Rp 750,000
135 Televisi 40" + Bracket Set 6 Rp 6,000,000 Rp 36,000,000 Rp 3,600,000
136 TEMPAT SAMPAH MEDIS (PEDAL) UK. SEDANG BH 16 Rp 1,100,000 Rp 17,600,000 Rp 1,760,000
137 TEMPAT SAMPAH NON MEDIS (PEDAL) UK. SEDANG BH 16 Rp 1,100,000 Rp 17,600,000 Rp 1,760,000
138 TROLLEY MAKANAN UNIT 2 Rp 5,200,000 Rp 10,400,000 Rp 1,040,000
139 TROLLEY OBAT UK.BESAR U/ GUDANG BH 2 Rp 2,300,000 Rp 4,600,000 Rp 460,000
140 TROLLEY U/ ANFRAK BH 5 Rp 2,200,000 Rp 11,000,000 Rp 1,100,000
141 UPS UK. SEDANG UNIT 1 Rp 2,000,000 Rp 2,000,000 Rp 200,000
142 VALLET BAHAN KAYU UK. 1X1 BH 50 Rp 300,000 Rp 15,000,000 Rp 1,500,000
143 Warles (merk weston) unit 1 Rp 2,000,000 Rp 2,000,000 Rp 200,000
144 WATER HEATER UNIT 2 Rp 200,000,000 Rp 400,000,000 Rp 40,000,000
145 X-Banner Set 10 Rp 250,000 Rp 2,500,000 Rp 250,000
TOTAL Rp 3,182,575,000
PPN 10% Rp 318,257,500
TOTAL SELURUHNYA Rp 3,500,832,500
TERBILANG : TIGA MILYAR LIMA RATUS JUTA DELAPAN RATUS TIGA PULUH DUA RIBU LIMA RATUS RUPIAH
TEMINABUAN, September 2016 2016

NIP.19670812 199712 1 001

KEMITRAAN DAN PELATIHAN RSUD SCHOLOO KEYEN KAB. SORONG SELATAN
NO NAMA KEGIATAN SATUAN VOLUME HARGA JUMLAH
1 Penambahan Tenaga :
a. Bersalin orang 2 20,400,000 40,800,000
b. Nifas orang 3 20,400,000 61,200,000
c. Bedah orang 1 20,400,000 20,400,000
d. Lab/UTD orang 6 20,400,000 122,400,000
e. Radiologi orang 2 20,400,000 40,800,000
f. Tenaga Gizi orang 2 20,400,000 40,800,000
2 In House Training
Pelatihan PPGD/ PPGD ON Orang 4 20,000,000 80,000,000
Pelatihan BTCLS Orang 5 20,000,000 100,000,000
Pelatihan APN Orang 2 20,000,000 40,000,000
Pelatihan pijat bayi Orang 2 20,000,000 40,000,000
Resusitasi bayi Orang 2 20,000,000 40,000,000
Senam bumil + Nifas Orang 2 20,000,000 40,000,000
Pelatihan Bidan KB Orang 2 20,000,000 40,000,000
-
3 Manajemen Bangsal (KEPALA RUANGAN) Orang 2 30,000,000 60,000,000 →
4 Pelatihan Anastesi Orang 1 30,000,000 30,000,000
5 Pelatihan Bedah Orang 1 30,000,000 30,000,000
6 Pelatihan ICU Orang 3 30,000,000 90,000,000
7 Penanganan Pendarahan Persalinan Orang 2 30,000,000 60,000,000
8 Perawatan luka Orang 1 30,000,000 30,000,000
9 Perawatan stoma Orang 1 30,000,000 30,000,000
10 Perinatologi Orang 2 30,000,000 60,000,000
11 PONEK Orang 2 30,000,000 60,000,000
12 Pelatihan penyamplingan Orang 2 30,000,000 60,000,000
13 Pelatihan crossmatcH darah Orang 2 30,000,000 60,000,000
14 Pelatihan malaria Orang 2 30,000,000 60,000,000
15 Pelatihan TB Orang 2 30,000,000 60,000,000
16 Training Manejemen Farmasi Orang 2 30,000,000 60,000,000
17 Pisiko Tropika Orang 2 30,000,000 60,000,000
18 Pengobatan Rasional Orang 2 30,000,000 60,000,000
19 Pelatihan Asuhan Gizi Orang 2 30,000,000 60,000,000
20 Pelatihan Dietetik Gizi Orang 2 30,000,000 60,000,000
21 Pelatihan Penanganan Gizi Buruk Orang 2 30,000,000 60,000,000
22 Manajemen Data & Pelaporan Rumah Sakit Orang 1 30,000,000 30,000,000
23 Pendidikan & Pelatihan Rekam Medis Orang 1 30,000,000 30,000,000
24 Pertemuan Persatuan Perekam Medis Orang 1 30,000,000 30,000,000
25 Pelatihan ATLS bagi Dokter Umum Orang 3 30,000,000 90,000,000
26 Pelatihan ACLS bagi Dokter Umum Orang 3 30,000,000 90,000,000
Pelatihan HD bagi1 orang dokter Umum dan
27 1 orang Dokter Spesialis Orang 2 30,000,000 60,000,000
28 Kegawatdaruratan medik(in house training) Orang 1 30,000,000 30,000,000
29 ICU (in house training) Orang 1 30,000,000 30,000,000
30 Pelatihan Penyusunan Clinical Pathway Orang 2 30,000,000 60,000,000
31 Pelatihan USG bagi Tenaga Medis Orang 4 30,000,000 120,000,000
32 Pelatihan EKG Orang 2 30,000,000 60,000,000
33 Pelatihan dokter spesialis Orang 14 30,000,000 420,000,000
34 Kolegium Obgyn pada TW I Orang 1 30,000,000 30,000,000
35 Kolegium Penyakit Dalam pada TW II Orang 1 30,000,000 30,000,000
36 Kolegium Bedah pada TW III Orang 1 30,000,000 30,000,000
37 Kolegium Anak pada TW IV Orang 1 30,000,000 30,000,000
38 Audit Medik dan Klinik Orang 1 30,000,000 30,000,000
39 Manajemen Data & Pelaporan Rumah Sakit orang 2 13,000,000 26,000,000
40 Pendidikan & Pelatihan Rekam Medis orang 1 13,000,000 13,000,000
41 Pertemuan Persatuan Perekam Medis Seluruhorang 1 13,000,000 13,000,000
42 Pelatihan Cuci Tangan orang 1 15,000,000 15,000,000
43 Pelatihan Pemakaian APD orang 1 15,000,000 15,000,000
44 Pelatihan Dekontaminasi orang 1 15,000,000 15,000,000
45 Pelatihan Manajemen Linen dan Laundry orang 1 15,000,000 15,000,000
46 Pelatihan Manajemen Limbah orang 1 15,000,000 15,000,000
47 Pelatihan Penanganan Pasien Infeksius orang 1 15,000,000 15,000,000
Pelatihan Akupuntur bagi Dokter / Dokter
48 Spesialis Paket 1 20,000,000 20,000,000
49 Pelatihan Khusus Fisioterapis Paket 1 15,000,000 15,000,000
TOTAL 3,133,400,000.00
DIBULATKAN 3,133,400,000.00
TERBILANG : TIGA MILYAR SERATUS TIGA PULUH TIGA JUTA RUPIAH EMPAT RATUS JUTA RUPIAH

NIP.19670812 199712 1 001
30.000.000
RENCANA ANGGARAN BIAYA HONOR SPI
NO NAMA KEGIATAN SATUAN VOLUME HARGA JUMLAH

1 HONOR Ketua ORANG 12 Rp 3,500,000 Rp 42,000,000
2 HONOR Anggota ORANG 24 Rp 2,500,000 Rp 60,000,000
3 ATK PAKET 1 Rp 2,500,000 Rp 2,500,000
TOTAL Rp 104,500,000
TERBILANG : SERATUS EMPAT JUTA LIMA RATUS RUPIAH

NIP.19670812 199712 1 001
JENIS PELAYANAN BESARAN UANG LEMBUR/JAM (EFEKTIF) Jumlah Jam Lembur Jumlah Pegawai lembur Dana Setahun
2 Rp 3 4 5 6
1 Perawat dan Bidan Cito/operasi Rp 10,000 12 7 Rp 80,640,000
2 Perawat dan Bidan Rp 6,500 12 17 Rp 477,360,000
3 Laboratrium dan UTD Rp 4,500 12 2 Rp 38,880,000
4 Radiologi Rp 4,500 12 1 Rp 19,440,000
5 Farmasi Rp 4,500 12 2 Rp 38,880,000
6 Gizi Rp 4,500 12 1 Rp 19,440,000
7 Rekam Medik Rp 3,500 12 1 Rp 15,120,000
8 Fisioterapi Rp 3,500 6 1 Rp 7,560,000
9 Gymnasium Rp 3,000 6 1 Rp 6,480,000
10 Kesling Rp 3,000 12 1 Rp 12,960,000
11 Cleaning Service Rp 3,000 12 1 Rp 12,960,000
12 Laundry Rp 3,000 12 1 Rp 12,960,000
13 Dapur Rp 3,000 12 1 Rp 12,960,000
14 IPSRS Rp 3,000 12 1 Rp 12,960,000
15 Sopir Rp 3,000 12 1 Rp 12,960,000
16 Kasir Rp 3,000 12 1 Rp 12,960,000
17 Kantor Rp 6,500 4 4 Rp 37,440,000
18 Dokter Umum Rp 21,000 12 2 Rp 181,440,000
19 Dokter Spesialis Rp 250,000 1 15 Rp 1,350,000,000
Rp 831,960,000

NIP.19670812 199712 1 001
USULAN BMHP
RAKER & MUSREN RSUD SCHOLOO KEYEN
NO NAMA USULAN SATUAN VOLUME
1 ALKOHOL 70 %, 1 LITER BTL 500
2 ALKOHOL SWABS DOS 500
3 AQUA STERIL FOR IRIGASI 1000ML BTL 300
4 ARM SLING UK L PCS 100
5 ARM SLING UK M PCS 150
6 ARM SLING UK S PCS 100
7 ASEPTIC GEL 5 LITER BTL 80
8 ASEPTIC GEL 500CC DISPENSER BTL 50
9 B1STURINO10 PCS 1,000
10 BENANG POLYSORB 1 (POLYGLCOLIC ACID ) TAPER PCS 200
11 BENANG POLYSORB 2 TAPER PCS 200
12 BENANG POLYSORB 2/0 TAPER PCS 300
13 BENANG POLYSORB 3/0 TAPER PCS 500
14 BENANG VICRYL 4/0 POLYSORB TAPER PCS 288
15 BISTURI NO 15 PCS 500
16 BISTURI NO 19 PCS 500
17 BISTURI NO 20 PCS 1,000
18 BISTURI NO 21 PCS 1,500
19 BISTURIN0 11 PCS 1,000
20 Blue monofilament polyvinylidene floride non absosbable 3.0 ( 3/8 circle 24 mm ) cutting pcs 360
21 Blue monofilament polyvinylidene floride non absosbable 4.0 ( 3/8 circle 16 mm ) cutting fineline pcs 360
22 CATGUT CHROMIC NO 1 (WITH NEEDLE) TAPER HR 48 PCS 150
23 CATGUT CHROMIC NO 2 (WITH NEEDLE) TAPER HR 50 PCS 150
24 CATGUT CHROMIC NO 2/0 (WITH NEEDLE) TAPER HR 37 PCS 150
25 CATGUT CHROMIC NO 3/0 (WITH NEEDLE) taper HR 26 PCS 300
26 CATGUT CHROMIC NO 4/0 (WITH NEEDLE) TAPER PCS 192
27 CATGUT CHROMIC NO.3 WITH NEEDLE TAPER PCS 288
28 Catgut Monofilament natural Absorbable 3.0 ( 1/2 circle 25mm ) tapper pcs 150
29 Catgut Monofilament natural Absorbable 3.0 (3/8 circle 16 mm) cutting pcs 150
30 catgut monofilament natural absosrbable 1 ( 1/2 circle 64,6 mm) Blunt pcs 150
31 catgut monofilament natural absorbable 2.0 ( 1/2 circle 36mm ) cutting pcs 150
32 catgut monofilament natural absorbable 2.0 (1/2 circle 35 mm) tapper pcs 150
33 catgut monofilament natural absorbable 3.0 ( 1/2 circle 22mm ) tapper pcs 150
34 CATGUT PLAIN NO 0 (WITH NEEDLE) TAPER HR 37 PCS 72
35 CATGUT PLAIN NO 1 (WITH NEEDLE) TAPER HR 37 PCS 72
36 CATGUT PLAIN NO 2/0 (WITH NEEDLE) TAPER HR 37 PCS 72
37 CATGUT PLAIN NO 3/0 (WITH NEEDLE) TAPER HR 26 PCS 72
38 CATGUT PLAIN NO 4/0 (WITH NEEDLE) TAPER PCS 72
39 CHATETER SUCTION 6 PCS 200
40 CHATETER SUCTION NO 10 PCS 100
43 CHATETER SUCTION NO. 14 PCS 100
46 CHKM DENTAL USE PCS 20
47 CHLORHEXIDIN 4% SOL, 5LITER GEN 30
48 COLAR NECK DEWASA L PCS 10
49 COLAR NECK PEDIATRIK s PCS 10
50 COLAR NECK PEDIATRI M PCS 10
51 DERMAFIX ( PLESTER ANTI AIR) UKURAN PCS 300
52 DISP 1 CC PCS 5,000
53 DISP 1 CC INSULIN 2,000
54 DISP 20 CC PCS 4,000
55 DISP 20 CC kateter tip PCS 1,000
56 DISP 50 CC (LUBANG PINGGIR) PCS 800
57 DISP 50 CC KATETER TIP (LUBANG TENGAH) PCS 300
58 DISP10CC PCS 5,000
61 DISPOSIBLE NEEDLE CITOJECT 30G PCS 20
62 ELASTIC VERBAND 4 INCHI PCS 150
63 ELASTIC VERBAND 6 INCHI PCS 150
64 ELEKTRODA TENS SET 5
65 ENDOMETHASONE septodont PCS 30
66 ENDOTRACHEAL TUBE NO 3 PCS 50
67 ENDOTRACHEAL TUBE NO 3,5 PCS 50
76 ETSAWP DENTAL PCS 30
77 ETT NON KINGKING NO 3,5 PCS 30
79 ETT NON KINGKING NO 7 PCS 30
81 ETTNON KINGKING NO 5 PCS 30
82 EXTENSION TUBE PCS 200
83 FOLEY CHATETER NO 16 PCS 400
87 FOLEYCHATETERN0 12 PCS 100
88 FOLEYCHATETERN0 18 PCS 350
89 FOLEYCHATETERNO10 PCS 100
90 FOLEYCHATETERNO 14 PCS 100
91 FOLLY CAT THREE WAY 22 PCS 10
92 FOLLY CAT THREE WAY 20 PCS 10
93 FORMALIN SOL. 40% BTL 200
94 GYPSONA 6 INCHI PCS 300
95 GYPSONA4INCHI PCS 400
96 H202 (PERHYDROL) 50% PCS 4
97 HAND CALLAR DEWASA PCS 10
98 HERNIA MES PCS 20
99 I.V CHATETER NO 16 PCS 500
100 I.V CHATETER NO 18 PCS 2,000
105 INFUSION SET MACRO PCS 4,500
106 INFUSION SET MICRO PCS 700
107 JACKSON-REES SET PCS 100
108 JARUM 27 G PCS 500
109 JARUM CITOJECT N027 G dental use PCS 300
110 JARUM SPINAL NO. 25 PCS 200
111 JARUM SPINAL NO. 26G PCS 200
112 JARUM SPNAL 27 PCS 200
113 JET NEBULIZER MASK PEDIATRIC PCS 360
114 JET NEBULIZER MASKADULT PCS 500
115 JOINT FIT ROLL PCS 60
116 KANTONG DARAH 350ML ( JGN YANG TRIPEL) PCS 300
117 KAPAS 500 GR PCS 1,000
118 KASA ROLL 40 X 80 PCS 350
119 KASASTERIL PCS 100
120 KERTAS LAKMUS(OBGYN) PCS 20
121 KRUKKETIAKL PCS 10
122 KRUKKETIAKM PCS 10
123 KRUKKETIAKS PCS 10
124 L M A (LARINGEAL MASK AIRWAYS) PCS 20
125 MASKER OXYGENT DEWASA rebreathing PCS 900
126 MASKER OXYGENT PEDIATRI rebreathing PCS 500
127 MASKER SURGICAL EARLOOP PCS 1,000
128 MICROBRUSH BONDING APLICATOR PCS 30
129 MOKSA SMOKELES STICK KOTAK 5
130 MONOPILAMEN POLYGLECAPRONE 25 VIOLET ABSORBABLE 3/0 (3/8,CIRCLE 24 mm ) cutting pcs 360
131 NASAL CANULA 02 DEWASA PCS 900
132 NASAL CANULA 02 BAYI 200
133 NASAL CANULA 02 PEDIATRI PCS 400
134 NEEDLE 18 PCS 500
135 NEEDLE NO. 23 PCS 500
136 NELATHON CHATETER NO. 10 PCS 50
137 NELATHON CHATETER NO. 12 PCS 50
138 NELATHON CHATETER NO.16 PCS 50
141 ORIGINAL PERFUSSOR PCS 50
142 PLESTER HIPAVYX ROLL 200
143 PLESTER ROLL (LEUKOPLAST 7,5CM X 4,5M) ROLL 500
144 POLYGYICOLIDE ABSORBABLE 2.0 (1/2 circle 25mm) cutting pcs 150
145 POLYGYICOLIDE ABSORBABLE 3.0 (1/2 CIRCLE 25mm) cutting pcs 150
146 POLYPREPILEN 2.0 CUTING PCS 150
150 PREMILEN 7.0 PCS 36
151 SARUNG TANGAN (L) PCS 20,000
152 SARUNG TANGAN (M) PCS 35,000
153 SARUNG TANGAN (S) PCS 10,000
154 SARUNG TANGAN GYNAECOLOG PANJANG 100
155 SARUNG TANGAN NO. 6,5 (STERIL) PCS 720
156 SARUNG TANGAN NO. 7 (STERIL) PCS 6,000
157 SARUNG TANGAN NO. 8 (STERIL) PCS 1,500
158 SARUNG TANGAN NO.7,5 (STERiL) PCS 6,000
159 SHARP CONTAINER 5 LTR PCS 100
160 SIDEX (GLUTARLDEIDA) JERGEN 20
161 silk black non absorbable 2.0 (1/2 circle 25 mm ) tapper pcs 300
162 silk black non absorbable 3.0 (1/2 circle 25mm ) tapper pcs 300
163 silk black non absorbable 3.0 (3/8 circle 16 mm ) cutting pcs 300
165 SILK NO 2/0 (WITH NEEDLE) taper HR 26 PCS 480
166 SILK NO 3/0 (WITH NEEDLE) taper HR 20 PCS 480
167 SILK NO 4/0 (WITH NEEDLE) Taper HR 20 PCS 500
168 SILK NO 5/0 (WITH NEEDLE) taper PCS 480
169 SILK NO. 2 WITH NEEDLE cuting PCS 400
170 SILK NO. 2 WITH NEEDLE taper PCS 360
172 SILK NO. 3 WITH NEEDLE taper PCS 360
173 SKIN TRAKSI ANAK PCS 50
174 SKIN TRAKSI DEWASA PCS 60
175 SOFT BAND 4 INCHI PCS 200
176 SOFT BAND 6 INCHI PCS 250
177 SOLDER SLING SET 5
178 SPALAK PANJANG DEWASA UK 100 X 10 CM PCS 60
179 SPALAK PANJANG DEWASA UK 100 X 10 CM PCS 60
180 SPALAK TANGAN DEWASA 30 X 6 CM PCS 60
181 SPOGESTAN PCS 200
182 STOMACH TUBE NO 10 PCS 360
187 STOMACH TUBE NO 3,5 PCS 200
191 SUMZEHER PCS 500
192 SUNGKUP 02 DEWASA PCS 800
193 SUNGKUP 02 PEDIATRI PCS 500
194 SURGICRYL (POLYGLYCOLIC ACID) NO.2 PCS 300
195 THREE WAY PCS 750
196 THREE WAY BEREKOR PCS 500
197 TOBAN (PLESTER TRNSPARAN DENGAN IODIUM) BUAH 500
198 TRANSFUSION SET INFUS PCS 2,500
199 TRANSMISSION JELLY PCS 200
200 treated polyester green synthetic non absorbable 1 ( 3/8 circle 31 mm ) j needle pcs 360
201 ULTRASONIC GEL 5 LTR BTL 15
202 UMBILICAL CORD CLEMP BLUE BOX 10
203 UNDERPADS 60X90 PCS 3,000
204 URINE BAG PCS 2,500
205 WING NEEDLE N0.23 PCS 400
208 LOGICATH CVC 2L 12F 20 CM PCS 10
211 GOWN DRAPE DISPOSIBLE SET 100
212 DOCK DISPOSIBLE SET 30
213 BETADIN CAIR BTL 20
214 KAPSUL 000 BKS 12
215 KAPSUL OO BKS 12
216 KAPSUL O BKS 12
217 JARUM AKUPUNTUR 0,25 x 40 mm (dong bang) BOX 30
220 JELY ULTRASOUND BTL 5
221 KAPSUL 1 10
222 KAPSUL 2 10
223 KAPSUL 3 10

dr.FELIX DUWIT,M.Sc,MPH,SP.PD
NIP.19670812 199712 1 001

FISIK RSUD SCHOLOO KEYEN KAB. SORONG SELATAN
NO NAMA ALAT SATUAN VOLUME HARGA PPN 10% JUMLAH
1 Pembangunan Gedung Laboratorium paket 1 1,729,479,653.00 190,242,762 1,902,427,618
2 Pembangunan Pavilium RSUD Unit 4 528,000,000.00 58,080,000 580,800,000
3 Pembangunan Barak Perawat paket 1 990,000,000.00 108,900,000 1,089,000,000
4 Rehab Ringan :
a. Ruang PONEK paket 1 60,000,000 6,600,000 66,000,000
b. Ruang Perinatologi paket 1 100,000,000 11,000,000 110,000,000
c. Ruang CCSD paket 1 70,000,000 7,700,000 77,000,000
d. Ruang Hemodialisa paket 1 70,000,000 7,700,000 77,000,000
5 Rehabilitasi Kamar Operasi (OK) paket 1 4,546,000,000 500,060,000 5,000,600,000
6 Sekat ruang isolasi (Interna dan Anak) M2 105.20 1,202,857.68 13,919,469 139,194,690
7 Pembangunan Aula RSUD (DANA OTSUS) paket 1 - -
8 Pembangunan Selasar penghubung R.Rawat bedah dan anak m2 1 - -
9 Pengadaan Obat-obatan paket 1 2,400,000,000 2,400,000,000
10 Pengadaan SIM RS paket 1 650,000,000 71,500,000 715,000,000
11 Pengadaan Mobil Jenazah Unit 2 285,868,000 571,736,000
12 Perencanaan dan Pegawasan paket 1 475,934,000 52,352,740 523,527,400
1,325,228,571 13,252,285,709
TOTAL 13,252,285,709
TERBILANG : EMPAT BELAS MILYAR RUPIAH DIBULATKAN 14,000,000,000

NIP.19670812 199712 1 001
RENCANA ANGGARAN BIAYA PENGADAAN MEDIS RADIOLOGI TAHUN 2017

NO URAIAN VULUME SATUAN HARGA SATUAN JUMLAH
1 Kertas USG HG Sony 110 200 Roll 180,000 36,000,000
2 KERTAS CTG 130MMX120MM ENDO 20 Roll 190,000 3,800,000
3 Fixer 6 Dos 900,000 5,400,000
4 Developer 6 Dos 1,350,000 8,100,000
5 Film CR DI-HT FOR DRYPIX 2000 BLUE BASE ukuran 26x36 7 Box/100 6,000,000 42,000,000
6 Film CR DI-HT FOR DRYPIX 2000 BLUE BASE ukuran 35x 43 7 Box/100 8,200,000 57,400,000
7 Fuji Film X-Ray Green Sensitive ukuran 30 x 40 cm 5 Box/100 3,340,000 16,700,000
8 Fuji Film X-Ray Green Sensitive ukuran 35 x 35 cm 5 Box/100 3,560,000 17,800,000
9 Urografin 70% 50 Ampul 210,000 10,500,000
10 Iopamirol 50 Flacon 166,000 8,300,000
11 BaSO4 10 Kg 150,000 1,500,000
Jumlah 207,500,000
PPN 10% 20,750,000
Total 228,250,000
Terbilang : Dua Ratus Dua Puluh Delapan Juta Dua Ratus Lima Puluh Ribu Rupiah

NIP.19670812 199712 1 001
BUPATEN SORONG SELATAN
MUM DAERAH SCHOLOO KEYEN
Ayamaru-Teminabuan, Kab. Sororng Selatan
rsudscholookeyen@yahoo.com
dipa pharmalab
DAFTAR OBAT NON E-KATALOG 2017
NO NAMA OBAT SATUAN KEMASAN
1 Akilen tetes telinga BTL
2 AMBROXOL SYRUP BTL 50
3 AMBROXOL TAB TAB 100
4 ALINAMIN INJ AMP
5 ANTI BISA ULAR (KHUSUS ULAR DARI PAPUA) AMP 1
6 ANTI RABIES AMP
7 ASAM SALICIL BASE KG
8 ASAM BORAC KG
9 ASAM TRANEXAMAT TAB 500 MG TAB 100
10 ASAM URSODIOKSIKOLAT TAB
11 ASETAZOMALID TAB TAB
12 ANTALGIN 500MG TAB TAB 100
13 ANTALGIN INJEKSI AMP 100
14 ATS INJ AMP 10
15 BESI II SO4 TAB. SALUT KOMB SYP BTL 1
16 BESI II SO4 TAB. SALUT KOMB SYP DR0P BTL 1
17 BROMHEXIN TABLET TAB 100
18 CHLORAMPHENICOL EAR DROPS TUBE 24
19 CIPROFLOXACIN TETES MATA 0,3% BTL
20 CITICOLIN 125mg INJEKSI AMP 10
21 CITICOLIN 500mg TABLET TAB 30
22 CO- AMOXYCLAV 625MG TAB CAP 30
23 DEXKETOPROFEN TROMETAMOL 25 MG/2ML(KETAMP 5
24 DEXTRAN SOL 70% 500ML BTL 10
25 DOKSAZOSIN MESILAT TAB 1mg TAB 100
26 DULOXETIN INJ AMP
27 EPERISON TAB
28 ETAKRIDINE LAKTATE SOL (RIVANOL) 100ML TAB
29 FENOPER INJ AMP
30 FENOTEROL HBR TAB
31 FLEXON CREAM 20 GR TUBE 1
32 FONDAFARINUX SODIUM AMP 1
33 FUTROLIT INF BTL
34 GABAPENTIn TAB 50
35 GAMEKSAN SOL BTL 1
36 GANSIKLOVIR TAB TAB
37 GLIKUIDON TAB 30 MG TAB 100
38 GLUCOSA 40% SOL 25ML BTL
39 GLUKOSAMIN KONDROITIN TAB TAB
40 GRANISETRON AMP 5
41 HIDROKORTISON INJ AMP 100
42 HYLURONAT ACID INJ AMP
43 HYOSCINE-N-BUTILBROMIDE 10MG TAB 100
44 ITRACONAZOLE 100MG TAB TAB
45 JELLY LUBRICATING 82 GR TUBE
46 KALIUM DIKLOFENAC 50MG TAB 50
47 KALIUM PERMANGANAT (pk) BTL 12
48 KALTROPEN GEL TUBE 1
49 KANDISSTATIN DRP BTL 1
50 KETOPROFEN TABLET 100MG TAB 50
51 KLOMIFEN SITRAT TAB 50MG TAB 30
52 KOLKISIN TAB 500 MG TAB 100
53 LANTOUS AMP
54 LARUTAN PK BTL 24
55 LEVOTIROKSIN TAB TAB
56 LOPAMIROL FLACON
57 MEBENDAZOL 100MG SYRUP SYP 1
58 MECOBALAMIN CAP CAP 100
59 MECOBALAMIN INJ AMP 5
60 MEDIFLEX CREAM 30 GR TUBE 1
61 MESALAZIN TAB TAB
62 METOCLOPRAMIDE SYRUP 5MG/5ML BTL 50
63 METOPROLOL AMP
64 MGSO3 BTL
65 MISOPROSTOL TAB TAB
66 NACL 100 ML INF 0,9 % BTL
67 NACL 3 % BTL
68 NEOMICYN CAPSUL 500MG CAP 50
69 NICARDIPINE 40 MG TAB 100
70 NICARDIPINE HCL 2 MG AMP 10
71 NIMADOPIN TAB TAB
72 NISTATIN SUSP BTL 1
73 NITRAL TABLET 0.5mg
74 NITROFURANOTOIN 50 MG TAB 50
75 NITROGLISERIN AMP
76 NORADRENALIN INJ AMP 5
77 NOVARAPID AMP
78 OKSOFERIN 80 ML BTL 1
79 OKTREOTID INJ AMP 1
80 PANTOCAIN 2% BTL 10
81 PANTOCAIN0,5% BTL 1
82 PANTOPRAZOLE 40MG INJK AMP 1
83 PARACETAMOL SUPP SUPP 10
84 OXYTETRACYCLIN SALEP 3% TUBE 24
85 PELANCAR ASI (LAKTAFIT) TAB
86 PENTHOTAL(theropental) AMP
87 PIRACETAM 400MG CAPSUL CAP 100
88 PIRACETAM TAB 800MG CAP 100
89 PIRODOSTIGMIN INJ AMP
90 PIROXICAM 10MG TABLET TAB 100
91 PROKAIN BENZIN PENICILIN INJ TAB 20
92 RECORONIUM AMP
93 SACARUM LACTIS TAB 100
94 SALAP ICTIOL BTL 24
95 SERUM ANTI RABIES AMP 10
96 SOFT U DERM CREAM TAB
97 SULFACETAMIDA TETES MATA BTL
98 SULTASOLAZIN TAB TAB
99 TUFOSIN INF BTL
100 ULTRASONIC GEL 1 LITER BTL 1
101 UROGRAFIN 70 AMP
102 VECURONIUM AMP
103 VIT B12 50 MG TAB 100
104 VIT B12 INJ AMP 10
105 VITAMIN C INJ AMP
106 ZOLPIDEM 10 MG TAB
107 KSR KALIUM TAB 100
108 SEVOFLORAN CAIR BTL 1
109 ISOPLORAN CAIR BTL
2017
JUMLAH HARGA JUMLAH
250 -
7,200 10,000 -
24,000 159 159 -
1000 -
10 -
30 -
1 -
1 -
10,000 -
3000 -
500 -
5,000 181 -
2,000 1,600 -
100 -
720 -
300 -
5,000 -
240 -
50 -
6,000 -
18,000 -
2,000 -
200 -
1,000 -
4000 3,480.0 pfizer 13,920,000
200 -
1000 -
1000 -
50 -
2000 -
60 -
50 -
200 -
600 -
200 -
1000 -
2000 -
200 -
1000 -
500 -
500 -
500 -
1,000 -
1,500 -
480 -
10,000 -
240 -
60 -
300 -
1,000 -
100 -
2500 -
100 -
240 -
500 -
50 -
300 -
2,000 -
400 -
60 -
300 -
200 -
50 -
30 -
1500 -
20 -
50 -
1,000 -
500 -
50 -
1000 -
400 -
-
2500 -
200 -
100 -
100 -
50 -
60 -
100 -
100 -
300 -
350 -
3,600 -
1000 -
300 -
11,600 -
10,000
100
1,000
300 -
50 -
1500 -
480 -
10 -
300 -
100 -
500 -
300
15
50
100 -
5000 -
1000 -
1000 -
1000 -
1000 #REF!
3
3
Rumah Sakit Umum Daerah Scholoo Keyen
Alamat : Kampung Keyen, Jln. Teminabuan - Ayamaru Kabupaten Sorong Selatan
RENCANA ANGGARAN BIAYA PENGADAAN ALKES E-CATALOGUE 2017

No Uraian pekerjaan Satuan Volume Harga E-Cat Ongkir Jumlah Total Merk
Audiometer Unit - 75,654,000 -
Basic opthalmic instrument Unit 1 39,324,115 39,324,115
Bedah minor set Set 2 86,822,824 86,822,824
Cryosurgical unit and Unit 1 87,681,500 87,681,500
EEG Unit - 364,793,000 -
Examination light/Examination lamp/lampu periksa Unit 2 46,686,297 46,686,297 LID LAMPS
Kursi roda Unit 1 5,058,100 5,058,100
Lampu kepala/head lamp Unit 6 9,100,000 9,100,000 GEA
1 Oxygent Konsentrat Unit 5 34,048,000 6,930,000 40,978,000 204,890,000 NIDEK MEDICAL
2 Amputasi Set Unit 1 58,544,493 2,880,000 61,424,493 61,424,493 RUDOLF
3 Bed Patien Elektric Unit 1 42,594,200 7,200,000 49,794,200 49,794,200 PARAMOUNT
4 Brangkar Dorong dengan Pengaman Unit 2 29,914,588 11,400,000 41,314,588 82,629,176 PARAMOUNT
5 Dopler Unit 1 20,000,000 3,902,400 23,902,400 23,902,400 ZONDAN
6 Endos Copy dan Laparascopy w/ Monitor Unit 1 2,450,000,000 122,500,000 2,572,500,000 2,572,500,000 ENDOCHOICE
8 Fluid/Solution Warmer Unit 3 24,000,000 4,878,000 28,878,000 86,634,000 NUOVA
9 Forcep Biasa (Jangan yg Negel) Unit 2 93,339,141 2,880,000 96,219,141 192,438,282 RUDOLF
10 Gluco Meter Unit 1 453,750 453,750 453,750 ROCHE
12 Hecting Set Unit 4 7,705,039 1,440,000 9,145,039 36,580,156 RUDOLF
13 Korentang Unit 2 555,323 275,000 830,323 1,660,646
14 Kuretase Set(Abortus) Unit 2 29,711,482 2,880,000 32,591,482 65,182,964 RUDOLF
16 Mastektomi Set Unit 1 26,667,524 2,880,000 29,547,524 29,547,524 RUDOLF
17 Minor Set Unit 4 40,531,412 2,880,000 43,411,412 173,645,648 RUDOLF
18 Partus Set Unit 1 17,860,736 2,880,000 20,740,736 20,740,736 RUDOLF
19 Resesitator Bayi Unit 1 460,000 115,000 575,000 575,000 JAYAMAS
20 Suction Pump Dewasa Unit 4 20,800,000 9,200,000 30,000,000 120,000,000 TESENA
21 Spirometer Unit - 30,500,000 8,000,000 38,500,000 - BTL
22 Standar Infus Beroda Unit 8 604,000 604,000 4,832,000 POLY
23 Steteskop Anak Unit 2 1,438,600 88,000 1,526,600 3,053,200
24 Steteskop Bayi Unit 1 1,438,600 88,000 1,526,600 1,526,600
25 Steteskop Dewasa Unit 5 1,438,600 88,000 1,526,600 7,633,000
26 Tensimeter Air Raksa Unit 4 5,000,000 1,500,000 6,500,000 26,000,000 MPM ERKA
27 Tensimeter Digital Dengan Manset Bayi/Anak Unit 2 10,600,000 4,240,000 14,840,000 29,680,000 MPM ERKA
28 Standar Infus Tancap Unit 10 430,000 430,000 4,300,000 POLY
29 Timbangan BB Biasa Unit 1 1,851,316 676,800 2,528,116 2,528,116 SECA
30 Timbangan Dewasa W + H Unit 1 5,149,760 9,200,000 14,349,760 14,349,760 TESENA
31 urologi Instrumen Set Unit 1 171,111,755 4,320,000 175,431,755 175,431,755 RUDOLF
32 CT SCAN 64 SLICE Unit 1 12,161,548,000 64,500,000 12,226,048,000 12,226,048,000 SIEMENS
33 Automated hemoglobin system/hematology analizer Unit 1 233,000,000 10,080,000 243,080,000 243,080,000 SYSMEX
34 Blood gas analyzer Unit 1 220,000,000 1,600,000 221,600,000 221,600,000
35 Coagulation instrumen/peralatan koagulasi Unit 1 24,960,600 10,920,000 35,880,600 35,880,600 MINDRAY
36 Electrolyte analyzer Unit 1 58,352,000 19,100,000 77,452,000 77,452,000 PT.DIATRON PROMEDIKA
37 Mikropipet ukuran 200-1000 ul Unit 1 3,459,000 3,459,000 3,459,000 ABADINUSA
38 URINE ANALYZER Unit 1 75,700,000 15,140,000 90,840,000 90,840,000 JAYAMAS
39 Microscope Surgical Unit 1 992,850,000 992,850,000 992,850,000 CARL ZEISS
40 TENSIMETER DIGITAL DEWASA Unit 2 1,177,470 228,000 1,405,470 2,810,940 MPM ERKA
TOTAL 17,885,953,946
Terbilang : Sembilan Belas Milyar Delapan Ratus Sembilan Puluh Empat Juta Enam Ratus Tiga Puluh Delapan Ribu Tujuh Ratus Dua Puluh Delapan Rupiah
Teminabuan, Februari2016

drg.ROSALINE N.I KRIMADI

Nip.19771120 200112 2 006
RAN BIAYA PENGADAAN ALKES E-CATALOGUE 2017
Penyedia
PT. MULTIGUNA CIPTASENTOSA
PT.MEGA PRATAMA MEDICALINDO

PT. GLOBAL JAYA MEDIKA
PT. GRAHA ISMAYA
PT. PARAMOUNT BED INDONESIA
PT. PARAMOUNT BED INDONESIA
PT MANDIRI JAYA MEDIKA
PT. SURGIKA ALKESINDO
PT. MANDIRI JAYA MEDIKA
PT. GRAHA ISMAYA
PT. ROCHE INDONESIA
PT. GRAHA ISMAYA
PT.ANDINI SARANA
PT. GRAHA ISMAYA
PT. GRAHA ISMAYA
PT. GRAHA ISMAYA
PT. GRAHA ISMAYA
PT. JAYAMAS
PT. TESENA INOVINDO
BTL
PT. POLY JAYA MEDICA

PT. POLY JAYA MEDICA
PT. IDS
PT. TESENA INOVINDO
PT. GRAHA ISMAYA
PT. SIEMENS INDONESIA
PT.SYSMEX INDONESIA
PT.TRANSMEDIC INDINESIA
PT. MINDRAY INDONESIA
PT.DIATRON PROMEDIKA
PT. ABADINUSA
PT. JAYAMAS
PT. ELO KARSA
DAFTAR PERENCANAAN BAHAN MEDIS HABIS PAKAI 2016 INSTALASI FARMASI 2017
NO NAMA BMHP
SATUAN KEMASAN JUM
1 ALKOHOL 70 %, 1 LITER BTL 1 500 21,500

2 ALKOHOL SWABS DOS 500 10,000
3 AQUA STERIL FOR IRIGASI 1000ML BTL 1 300 9,000
4 ARM SLING UK L PCS 1 100 38,000
5 ARM SLING UK M PCS 1 150 38,000
6 ARM SLING UK S PCS 1 100 38,000
7 ASEPTIC GEL 5 LITER BTL 1 80 808,000
8 ASEPTIC GEL 500CC DISPENSER BTL 50 90,000
9 B1STURINO10 PCS 100 1,000 3,000
10 BENANG POLYSORB 1 (POLYGLCOLIC ACID ) TAPER PCS 24 200 100,000
11 BENANG POLYSORB 2 TAPER PCS 24 200 100,000
12 BENANG POLYSORB 2/0 TAPER PCS 36 300 100,000
13 BENANG POLYSORB 3/0 TAPER PCS 36 500 100,000
14 BENANG VICRYL 4/0 POLYSORB TAPER PCS 24 288 100,000
15 BISTURI NO 15 PCS 100 500 3,000
16 BISTURI NO 19 PCS 100 500 3,000
17 BISTURI NO 20 PCS 100 1,000 3,000
18 BISTURI NO 21 PCS 100 1,500 3,000
19 BISTURIN0 11 PCS 100 1,000 3,000
20 Blue monofilament polyvinylidene floride non absosbable 3.0 ( 3/8 circle 24 mm ) cutting pcs 24 360
21 Blue monofilament polyvinylidene floride non absosbable 4.0 ( 3/8 circle 16 mm ) cutting fineline pcs 24 360
22 CATGUT CHROMIC NO 1 (WITH NEEDLE) TAPER HR 48 PCS 48 150 29,619
24 CATGUT CHROMIC NO 2/0 (WITH NEEDLE) TAPER HR 37 PCS 36 150 22,599
25 CATGUT CHROMIC NO 3/0 (WITH NEEDLE) taper HR 26 PCS 36 300 22,599
26 CATGUT CHROMIC NO 4/0 (WITH NEEDLE) TAPER PCS 24 192
27 CATGUT CHROMIC NO.3 WITH NEEDLE TAPER PCS 24 288
28 Catgut Monofilament natural Absorbable 3.0 ( 1/2 circle 25mm ) tapper pcs 24 150
29 Catgut Monofilament natural Absorbable 3.0 (3/8 circle 16 mm) cutting pcs 24 150
30 catgut monofilament natural absosrbable 1 ( 1/2 circle 64,6 mm) Blunt pcs 24 150
31 catgut monofilament natural absorbable 2.0 ( 1/2 circle 36mm ) cutting pcs 24 150
32 catgut monofilament natural absorbable 2.0 (1/2 circle 35 mm) tapper pcs 24 150
33 catgut monofilament natural absorbable 3.0 ( 1/2 circle 22mm ) tapper pcs 24 150
34 CATGUT PLAIN NO 0 (WITH NEEDLE) TAPER HR 37 PCS 24 72 24,238
36 CATGUT PLAIN NO 2/0 (WITH NEEDLE) TAPER HR 37 PCS 24 72 23,631
38 CATGUT PLAIN NO 4/0 (WITH NEEDLE) TAPER PCS 24 72
39 CHATETER SUCTION 6 PCS 1 200 3,520
40 CHATETER SUCTION NO 10 PCS 1 100 3,520
43 CHATETER SUCTION NO. 14 PCS 1 100 3,520
46 CHKM DENTAL USE PCS
47 CHLORHEXIDIN 4% SOL, 5LITER GEN 1 30 836,160
48 COLAR NECK DEWASA L PCS 1 10
49 COLAR NECK PEDIATRIK s PCS 1 10
50 COLARNECKPEDIATRI M PCS 1 10
51 DERMAFIX ( PLESTER ANTI AIR) UKURAN PCS 300
52 DISP 1 CC PCS 50 5,000
53 DISP 1 CC INSULIN 2,000
54 DISP 20 CC PCS 50 4,000
55 DISP 20 CC kateter tip PCS 50 1,000
56 DISP 50 CC (LUBANG PINGGIR) PCS 20 800
57 DISP 50 CC KATETER TIP (LUBANG TENGAH) PCS 20 300
58 DISP10CC PCS 50 5,000
59 DISP3CC PCS 50 20,000
60 DISP5CC PCS 50 15,000
61 DISPOSIBLE NEEDLE CITOJECT 30G PCS
62 ELASTIC VERBAND 4 INCHI PCS 1 150 41,910
64 ELEKTRODA TENS SET 5 120,000
66 ENDOTRACHEAL TUBE NO 3 PCS 1 50 85,000
67 ENDOTRACHEAL TUBE NO 3,5 PCS 1 50 85,000
76 ETSAWP DENTAL PCS
77 ETT NON KINGKING NO 3,5 PCS 1 30 310,000
79 ETT NON KINGKING NO 7 PCS 1 30 310,000
81 ETTNON KINGKING NO 5 PCS 1 30 310,000
82 EXTENSION TUBE PCS 50 200
83 FOLEY CHATETER NO 16 PCS 1 400 11,000
87 FOLEYCHATETERN0 12 PCS 10 100 11,000
89 FOLEYCHATETERNO10 PCS 10 100 11,000
90 FOLEYCHATETERNO 14 100
91 FOLLY CAT THREE WAY 22 PCS 10 10 325,000
93 FORMALIN SOL. 40% BTL 20 200
94 GYPSONA 6 INCHI PCS 1 300
95 GYPSONA4INCHI PCS 1 400
96 H202 (PERHYDROL) 50% PCS 1 4
97 HAND CALLAR DEWASA PCS 1 10
98 HERNIA MES PCS 5 20
99 I.V CHATETER NO 16 PCS 50 500
100 I.V CHATETER NO 18 PCS 50 2,000
105 INFUSION SET MACRO PCS 50 4,500 7,920
106 INFUSION SET MICRO PCS 50 700 7,920
107 JACKSON-REES SET PCS
108 JARUM 27 G PCS 100 500
109 JARUM CITOJECT N027 G dental use PCS
110 JARUM SPINAL NO. 25 PCS 50 200
111 JARUM SPINAL NO. 26G PCS 50 200
112 JARUM SPNAL 27 PCS 50 200
113 JET NEBULIZER MASK PEDIATRIC PCS 1 360
114 JET NEBULIZER MASKADULT PCS 1 500
115 JOINT FIT ROLL PCS 1 60
116 KAIN LINEN STERIL UNTUK PERSALINAN
117 KANTONG DARAH 350ML ( JGN YANG TRIPEL) PCS 1
118 KAPAS 500 GR PCS 1 1,000
119 KASA ROLL 40 X 80 PCS 1 350 130,000
120 KASASTERIL PCS 1 100
122 KRUKKETIAKL PCS 1 10
123 KRUKKETIAKM PCS 1 10
124 KRUKKETIAKS PCS 1 10
125 L M A (LARINGEAL MASK AIRWAYS PCS 1 20
126 MASKER OXYGENT DEWASA rebreathing PCS 1 900
127 MASKER OXYGENT PEDIATRI rebreathing PCS 1 500
128 MASKER SURGICAL EARLOOP PCS 1 1,000 22,000
129 MICROBRUSH BONDING APLICATOR PCS
131 MONOPILAMEN POLYGLECAPRONE 25 VIOLET ABSORBABLE 3/0 (3/8,CIRCLE 24 mm ) cutting pcs 24 360
132 NASAL CANULA 02 DEWASA PCS 1 900
133 NASAL CANULA 02 BAYI 200
134 NASAL CANULA 02 PEDIATRI PCS 1 400
135 NEEDLE 18 PCS 50 500
136 NEEDLE NO. 23 PCS 50 500
137 NELATHON CHATETER NO. 10 PCS 1 50
139 NELATHON CHATETER NO.16 PCS 1 50
143 PLESTER HIPAVYX ROLL 1 200
145 POLYGYICOLIDE ABSORBABLE 2.0 (1/2 circle 25mm) cutting pcs 24
146 POLYGYICOLIDE ABSORBABLE 3.0 (1/2 CIRCLE 25mm) cutting pcs 24
147 POLYPREPILEN 2.0 CUTING PCS 36 200
149 POLYPREPILEN 4.0 CUTING 150
152 SARUNG TANGAN (L) PCS 50 20,000
153 SARUNG TANGAN (M) PCS 50 35,000
154 SARUNG TANGAN (S) PCS 50 10,000
156 SARUNG TANGAN NO. 6,5 (STERIL) PCS 40 720
157 SARUNG TANGAN NO. 7 (STERIL) PCS 40 6,000
159 SARUNG TANGAN NO.7,5 (STERiL) PCS 40 6,000
160 SHARP CONTAINER 5 LTR PCS 1000 100
161 SIDEX (GLUTARLDEIDA) JERGEN 1 20
162 silk black non absorbable 2.0 (1/2 circle 25 mm ) tapper pcs 24
164 silk black non absorbable 3.0 (3/8 circle 16 mm ) cutting pcs 24
166 SILK NO 2/0 (WITH NEEDLE) taper HR 26 PCS 24 480 14,000
168 SILK NO 4/0 (WITH NEEDLE) Taper HR 20 PCS 24 500 13,616
169 SILK NO 5/0 (WITH NEEDLE) taper PCS 24 480
170 SILK NO. 2 WITH NEEDLE cuting PCS 24 400
171 SILK NO. 2 WITH NEEDLE taper PCS 24 360
174 SKIN TRAKSI ANAK PCS 1 50
175 SKIN TRAKSI DEWASA PCS 1 60
176 SOFT BAND 4 INCHI PCS 1 200
179 SPALAK PANJANG DEWASA UK 100 X 10 CM PCS 1 60
181 SPALAK TANGAN DEWAA 30 X 6 CM PCS 1 60
182 SPOGESTAN PCS 200
183 STOMACH TUBE NO 10 PCS 1 360
185 STOMACH TUBE NO 14 PCS 1 100 10,010
188 STOMACH TUBE NO 3,5 PCS 1 200 8,841
192 SUMZEHER PCS
193 SUNGKUP 02 DEWASA PCS 1 800
194 SUNGKUP 02 PEDIATRI PCS 1 500
195 SURGICRYL (POLYGLYCOLIC ACID) NO.2 PCS 1 300
196 THREE WAY PCS 50 750 19,250
197 THREE WAY BEREKOR PCS 50 500 32,160
199 TRANSFUSION SET INFUS PCS 50 2,500
200 TRANSMISSION JELLY PCS 1 200 34,528
201 treated polyester green synthetic non absorbable 1 ( 3/8 circle 31 mm ) j needle pcs 24 360
202 ULTRASONIC GEL 5 LTR BTL 1 15
203 UMBILICAL CORD CLEMP BLUE BOX 50 10 50,000
204 UNDERPADS 60X90 3,000
205 URINE BAG PCS 10 2,500 5,005
206 WING NEEDLE N0.23 PCS 50 400
209 LOGICATH CVC 2L 12F 20 CM PCS 680584 10 680584
210 LOGICATH CVC 2L 12F 10 CM PCS 10 606,486
Jarum akupuntur 0,25 x 40 mm (dong bang) box 30 40,000,000
Jarum akupuntur 0,25 x 25 mm (dong bang) BOX 30 40,000,000
Jarum akupuntur 0,25 x 13 mm (dong bang) BOX 10 40,000,000
Jely ultrasound BTL 5
212 GOWN DRAPE DISPOSIBLE SET 100
213 DOCK DISPOSIBLE SET 30
214 BETADIN CAIR
215 KAPSUL 000 BKS 12
216 KAPSUL OO BKS 12
217 KAPSUL O BKS 12
218 POT SALEP
219 ELEKTRODA
jayamas 24,725 12,362,500
jayamas 11,500 5,750,000
widatra 10,350 3,105,000
43,700 4,370,000
43,700 6,555,000
43,700 4,370,000
abadinusa 929,200 74,336,000
abadinusa 103,500 5,175,000
bbraun 3,450 3,450,000
115,000 23,000,000
115,000 23,000,000
115,000 34,500,000
115,000 57,500,000
115,000 33,120,000
bbraun 3,450 1,725,000
bbraun 3,450 1,725,000
bbraun 3,450 3,450,000
bbraun 3,450 5,175,000
bbraun 3,450 3,450,000
- -
- -
rajawali 34,062 5,109,278
rajawali 36,249 5,437,373
rajawali 25,989 3,898,328
rajawali 25,989 7,796,655
- -
- -
- -
- -
- -
- -
- -
- -
rajawali 27,874 2,006,906
rajawali 30,409 2,189,480
rajawali 27,176 1,956,647
rajawali 27,245 1,961,615
- -
megah 4,048 809,600
megah 4,048 404,800
megah 4,048 404,800
megah 4,048 809,600
megah 4,048 404,800
megah 4,048 404,800
megah 4,048 404,800
- -
rajawali 961,584 28,847,520
- -
- -
- -
- -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
megah 48,197 7,229,475
megah 48,197 7,229,475
138,000 690,000
- -
97,750 4,887,500
97,750 4,887,500
97,750 4,887,500
97,750 4,887,500
97,750 4,887,500
97,750 4,887,500
97,750 7,820,000
97,750 7,820,000
97,750 7,820,000
97,750 7,820,000
- -
356,500 10,695,000
356,500 10,695,000
356,500 10,695,000
356,500 10,695,000
356,500 10,695,000
- -
bio 12,650 5,060,000
bio 12,650 1,265,000
bio 12,650 632,500
bio 12,650 1,265,000
bio 12,650 1,265,000
bio 12,650 4,427,500
bio 12,650 1,265,000
-
jayamas 373,750 3,737,500
jayamas 373,750 3,737,500
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
otsuka 9,108 40,986,000
otsuka 9,108 6,375,600
- -
- -
- -
- - 1000 1000/12
- - 12
- - 83.333333
- -
- -
- -
- -
- -
- -
ahmadaris 149,500 52,325,000
- -
- -
- -
- -
- -
- -
- -
- -
25,300 25,300,000
- -
- -
- -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
50 - -
- -
- -
- -
- -
- -
- -
- -
- -
- PERMINTAAN OK
- -
- -
- -
- -
rajawali 16,100 7,728,000
rajawali 15,658 7,516,032
rajawali 15,658 7,829,200
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
Terumo 11,512 1,151,150
Terumo 11,512 4,144,140
Terumo 11,512 4,144,140
Terumo 10,167 2,033,430
Terumo 10,167 2,541,788
8,855 2,213,750
Terumo 10,167 2,541,788
- -
- -
- -
- -
22,138 16,603,125
36,984 18,492,000
- -
- -
rajawali 39,707 7,941,440
- -
- -
57,500 575,000
- -
5,756 14,389,375
- -
- -
- - 33,568,671
782,672 7,826,716 28,243,619
697,459 6,974,589 61,812,290
681,117 6,811,174
46,000,000
46,000,000
46,000,000
-
- -
- -
- -
- -
- 753,507,124
-
- 800,000,000 788,300,000

RUTIN RSUD SCHOLOO KEYEN KAB. SORONG SELATAN
NO SATUAN VOLUME HARGA PPN 10% JUMLAH
1 Batterai Besar set 115 12,000 1,200 1,518,000
2 Batterai Kecil set 189 17,500 1,750 3,638,250
3 set 6 25,000 2,500 165,000
4 Blanko Laboratorium rim 5 250,000 25,000 1,375,000
5 Blanko permintaan rawat inap rim 2 250,000 25,000 550,000
6 Blanko surat rujukan rim 2 250,000 25,000 550,000
7 Blanko surat sakit rim 2 250,000 25,000 550,000
8 Buku Folio Besar buah 155 50,000 5,000 8,525,000
9 Buku Gambar buah 5 5,000 500 27,500
10 Cutter Kecil buah 28 15,000 1,500 462,000
11 Hekter buah 85 13,310 1,331 1,244,485
12 Isi Hekter pak 265 5,000 500 1,457,500
13 Isolasi roll 28 10,000 1,000 308,000
14 Kertas HVS rim 26 60,000 6,000 1,716,000
15 Kertas Resep lembar 360 500 50 198,000
16 Lem tube 184 16,335 1,634 3,306,204
17 Lilin pak 170 17,100 1,710 3,197,700
18 Map File buah 150 25,000 2,500 4,125,000
19 Pena buah 24 5,000 500 132,000
20 Penggaris buah 30 13,310 1,331 439,230
21 Penghapus Papan buah 31 5,000 500 170,500
22 Pensil 2 B buah 44 5,000 500 242,000
23 Pensil Warna (Merah, Biru) buah 56 15,000 1,500 924,000
24 Rak buku set 3 1,700,000 170,000 5,610,000
25 Rak Sepatu set 2 1,500,000 150,000 3,300,000
26 Spidol Boardmarker buah 145 10,000 1,000 1,595,000
27 Spidol Permanen buah 145 10,000 1,000 1,595,000
28 Amplop dos 3 45,000 4,500 148,500
29 Amplop Foto Ukuran 26 x 36 cm buah 2,000 8,000 800 17,600,000
32 Balpoin Hitam buah 66 4,500 450 326,700
33 Blanko Resep Rawat Inap buah 2 250,000 25,000 550,000
34 Bolpoint buah 10 4,500 450 49,500
35 Bolpoint Hitam buah 36 4,500 450 178,200
36 Box File buah 70 23,000 2,300 1,771,000
37 Buku Besar buah 30 40,000 4,000 1,320,000
38 Buku Expedisi buah 12 8,000 800 105,600
39 Buku Folio Besar buah 126 40,000 4,000 5,544,000
40 Buku Folio Kecil buah 63 8,000 800 554,400
41 Buku Folio Kecil buah 6 8,000 800 52,800
42 buku folio kecil panjang buah 42 8,000 800 369,600
43 Buku Folio Kecil Pendek buah 5 6,000 600 33,000
Buku Folio Ukuran Besar ( Poli Fisio
44 ,Gym, Poli Syaraf ) buah 5 40,000 4,000 220,000
45 Buku Folio Ukuran Kecil buah 5 8,000 800 44,000
46 Buku Kecil buah 30 8,000 800 264,000
47 buku tulis biasa buah 34 6,000 600 224,400
48 cater & Pisau Cater buah 12 15,000 1,500 198,000
49 Catrig Hitam buah 3 175,000 17,500 577,500
50 Catrig Warna buah 3 25,000 2,500 82,500
51 Clear Holder buah 10 31,000 3,100 341,000
53 Cutter Besar buah 4 15,000 1,500 66,000
54 Gunting roll 2 15,000 1,500 33,000
55 Gunting (ATK) dus 2 25,000 2,500 55,000
56 Gunting Kertas buah 3 10,000 1,000 33,000
57 Isolasi dus 10 10,000 1,000 110,000
58 Jepitan Kertas dus 12 4,500 450 59,400
59 Kabel Roll buah 2 695,750 69,575 1,530,650
60 kertas A4 rim 2 70,000 7,000 154,000
61 Kertas Caver pak 3 50,000 5,000 165,000
62 kertas f4 rim 2 60,000 6,000 132,000
63 Kertas Folio F4 rim 5 60,000 6,000 330,000
64 Kertas HVS rim 2 60,000 6,000 132,000
65 Kertas HVS A4 rim 12 80,000 8,000 1,056,000
66 Kertas HVS F4 rim 24 60,000 6,000 1,584,000
67 kertas HVS ukuran A4 rim 24 80,000 8,000 2,112,000
68 Kertas HVS ukuran F4 rim 36 60,000 6,000 2,376,000
69 Kertas HVS/ Rim rim 1 60,000 6,000 66,000
70 Kertas NCR rim 12 55,000 5,500 726,000
71 Kertas Resep Rawat Inap rim 4 250,000 25,000 1,100,000
72 Klip Kertas Kecil dus 50 4,500 450 247,500
73 klips kertas Besar dus 50 6,000 600 330,000
74 Lem buah 20 1,500 150 33,000
75 Lem Kertas Povinal buah 20 1,464 146 32,208
76 Lembar Observasi rim 2 250,000 25,000 550,000
77 Lilin kotak 10 20,000 2,000 220,000
78 Map buah 22 5,000 500 121,000
79 Map File buah 7 5,000 500 38,500
80 Map File (Brider) buah 12 5,000 500 66,000
81 Map Folder buah 106 25,000 2,500 2,915,000
82 Map Kertas buah 10 7,865 787 86,515
83 Map Plastik unit 43 1,513 151 71,565
84 Mistar buah 22 13,310 1,331 322,102
85 Pelubang kertas dos 2 30,000 3,000 66,000
86 Pembolong Kertas buah 6 30,000 3,000 198,000
87 Pemotong Kertas buah 1 242,000 24,200 266,200
88 Pena buah 4 3,933 393 17,305
89 Pena / Dos buah 1 60,000 6,000 66,000
90 Pena Farter buah 40 4,500 450 198,000
91 Pena Faster buah 11 4,500 450 54,450
92 Penggaris buah 15 5,000 500 82,500
93 Penggaris 30 cm buah 10 5,000 500 55,000
94 Penggaris ukuran 30 cm buah 50 8,000 800 440,000
95 Pensil dos 59 5,000 500 324,500
96 Pensil 2 B roll 20 5,000 500 110,000
97 Pensil 2b buah 10 5,000 500 55,000
98 Pensil Warna (Merah, Biru) buah 5 15,000 1,500 82,500
99 Pensil/ Dos buah 1 60,000 6,000 66,000
100 Resep Umum pak 20 10,000 1,000 220,000
101 Selotip ukuran besar buah 2 15,000 1,500 33,000
102 Spidol (merah, hitam, biru, hitam) buah 12 10,000 1,000 132,000
103 Spidol Board Marker buah 50 10,000 1,000 550,000
104 Spidol Boardmaker buah 2 7,000 700 15,400
105 Spidol Boardmarker buah 57 7,000 700 438,900
106 Spidol Kecil Hitam buah 36 2,000 200 79,200
107 Spidol Permanen buah 90 10,000 1,000 990,000
108 Spidol Permanent buah 60 7,000 700 462,000
109 Spidol Permanent buah 60 10,000 1,000 660,000
110 Spidol Snowan BoardMarker Hitam buah 64 7,000 700 492,800
111 Spidol Snowan Marker Hitam dos 24 10,000 1,000 264,000
112 Spidol Snowman Boardmarker Hitam dos 12 10,000 1,000 132,000
113 Tinta Epson botol 24 150,000 15,000 3,960,000
114 Tinta Print Canon Hitam buah 18 40,000 4,000 792,000
115 Tinta Print Canon Warna buah 18 40,000 4,000 792,000
116 Tinta Print Hitam buah 12 40,000 4,000 528,000
117 Tinta Print Warna buah 12 40,000 4,000 528,000
118 Tinta Stempel buah 2 70,000 7,000 154,000
119 TipEx buah 164 15,000 1,500 2,706,000
TOTAL 145,540,264
DIBULATKAN 146,000,000
TERBILANG : SERATUS EMPAT PULUH ENAM JUTA RUPIAH


NIP.19771120 200212 2 006
USULAN KEBUTUHAN ALAT KESEHATAN
RSUD SCHOLOO KEYEN 2017
TOTAL
No NAMA ALAT SATUAN IGD BERSALIN NIFAS INTERNA ANAK BEDAH OK ICU RADIOLOGI LAB UTD
VOLUME
1 OXYGENT KONSENTRAT UNIT 5 2 2 1
2 ALIGATOR UNIT 2 2
3 AMNIOTOMI SET SET 2 2
4 AMPUTASI SET SET 1 1
5 ANUS COPY SET 1 1
6 BAK INSTRUMEN SEDANG UNIT 2 2
7 BED PATIENT ELEKTRIC UNIT 1 1
8 BOR ELEKTRIK SET 1 1
9 BOR MANUAL SET 1 1
10 BRANGKAR DORONG DENGAN PENGAMAN UNIT 2 1 1
11 COM BERTUTUP (DIAMETER 12CM) UNIT 5 3 2
12 COM BESAR (DIAMETER 17CM) BUAH 3 3
13 DOPLER UNIT 1 1
14 EMBRIOTOMI SET SET 1 1
15 ENDOS COPY SET 1 1
16 EXAMINATION LAMP (FLEKSIBEL) UNIT 2 1 1
17 FLUID/SOLUTION WARMER UNIT 1 1
18 FORCEP BIASA ( JANGAN YANG NEGEL) UNIT 2 2
19 GELAS UKUR 1 LITER (PLASTIK) UNIT 2 2
20 GLUCO METER UNIT 1 1
21 HEAD LAMP BUAH 2 2
22 HECTING SET SET 4 4
23 INSTRUMEN BEDAH VASKULER SET 1 1
24 KATARAK DAN BEDAH REFRAKTIF SET 1 1
25 KLEM OVUM UNIT 2 2
26 KLISMA BUAH 2 2
27 KORENTANG BUAH 2 2
28 KURETASE SET SET 2 2
29 LAMPU SENTER BUAH 2 2
30 LAPARASCOPY + MONITOR SET 1 1
31 LARINGOSCOPE ANAK UNIT 1 1
32 MASTEKTOMI SET SET 1 1
33 METERAN BUAH 1 1
34 MINOR SET SET 4 1 1 2
35 NIER BEKEN BESAR SET 7 2 1 2 2
36 NIER BEKEN KECIL SET 2 2
37 NIER BEKEN SEDANG SET 4 2 2
38 OPERATING TABLE UNIT 0
39 PARTUS SET SET 1 1
40 PEAN BENGKOK UNIT 1 1
41 PEN LIGHT BUAH 3 1 2
42 PISAU HUMVEE (STSG) SET 1 1
43 PISPOT (PEREMPUAN) BUAH 6 2 2 2
44 PISPOT BAB UNIT 2 2
45 PISPOT PRIA UNIT 4 2 2
46 REPLEX HAMMER BUAH 1 1
47 RESESITATOR BAYI UNIT 1 1
48 SUCTION PUMP DEWASA UNIT 4 1 1 2
49 SENDOK KURET TAJAM SET SET 1 1
50 SENDOK KURET TUMPUL SET SET 1 1
51 SOLUTION WARMER UNIT 2 1 1
52 SPEKULUM COCOR BEBEK KECIL SET 1 1
53 SPEKULUM COCOR BEBEK SEDANG SET 1 1
54 SPEKULUM SIMS SET 1 1
55 SPIROMETER UNIT 1 1
56 STANDAR INFUS BERODA BUAH 8 2 6
57 STERILISATOR KERING UNIT 1 1
58 STETESKOP ANAK UNIT 2 1 1
59 STETESKOP BAYI UNIT 1 1
60 STETESKOP DEWASA UNIT 5 3 1 1
61 SUCTION KURET SET 1 1
62 Tempat tidur unit 2 2
63 TENSIMETER AIR RAKSA UNIT 4 2 1 1
64 TENSIMETER DIGITAL DDENGAN MANSET BAYI/ANAK UNIT 2 2
65 TERMOMETER AIR RAKSA UNIT 7 2 2 3
66 TERMOMETER DIGITAL UNIT 5 2 3
67 STANDAR INFUS TANCAP UNIT 10 10
68 TIMBANGAN BB BIASA UNIT 1 1
69 TIMBANGAN DEWASA W + H UNIT 1 1
70 TORNIKET UNIT 5 5
71 TROMOL BESAR (DIAMETER 17CM) UNIT 3 3
72 UROLOGI INSTRUMEN SET SET 1 1
73 USG ANASTESI SET 1 1
74 VACUM MANUAL (DISPOSIBLE) SET 1 1
75 WATERPAS (PENGUKUR CVC) BUAH 1 1
76 CT SCAN 64 SLICE SET 1 1
77 Analisa Hb UNIT 1 1
78 Autoclave UNIT 1 1
79 Automated hemoglobin system/hematology analizer UNIT 1 1
80 Automated urinalysis system/urin analizer UNIT 1 1
81 Blood bank refrigerator darah siap pakai UNIT 2 1 1
82 Blood bank refrigerator karantina UNIT 1 1
83 Blood gas analyzer UNIT 1 1
84 Blood grouping plate UNIT 1 1
85 Blood plasma freezer UNIT 1 1
86 Bunsen UNIT 5 5
87 Centrifugal chemistry analyzer for clinical for use/centrifuge kimia UNIT 1 1
88 Coagulation instrumen/peralatan koagulasi UNIT 1 1
89 Cool box dengan fasilitas 2-5 kantong UNIT 1 1
90 Cool box untuk transportasi dengan fasilitas minimal 20 kantong UNIT 1 1
91 Electrolyte analyzer UNIT 1 1
92 Hand sealer UNIT 1 1
93 Kit anti-HIV, HbsAg, anti-HCV UNIT 1 1
94 Kit anti-HIV, HbsAg, Anti-HCV, Anti-Sifilis UNIT 1 1
95 Klem UNIT 1 1
96 Klem/pean UNIT 1 1
97 LED UNIT 2 2
98 Medical refrigerator UNIT 1 1
99 Microbiological incubator UNIT 1 1
100 Microscope dinocular UNIT 1 1
101 Microscopes and accessories/Mikroskop UNIT 1 1
102 Mikro balance UNIT 1 1
103 Mikropipet ukuran 200-1000 ul UNIT 1 1
106 Mikrosentrifus UNIT 1 1
107 Mikroskop binokuler UNIT 1 1
108 Peti pendingin darah/cool box untuk mobile unit (25 – 50 kantong) UNIT 1 1
109 Pinset UNIT 1 1
110 Pipetting and diluting system for clinical use/perangkat pipet UNIT 1 1
111 Platelet agitator dengan inkubator UNIT 1 1
112 Rak slide UNIT 1 1
113 Refrigerated centrifuge UNIT 1 1
114 Refrigerated Centrifuge UNIT 1 1
115 Sterilisator kering UNIT 1 1
116 Tabung reaksi UNIT 1 1
117 Tabung reaksi kaca yang dilapisi silikon atau sekali pakai ukuran UNIT 1 1
118 Tabung reaksi ukuran12x75 mm UNIT 1 1
119 Tempat tidur statis UNIT 1 1
120 Termometer kontrol UNIT 1 1
121 Timbangan darah UNIT 1 1
122 Timer UNIT 1 1
123 Tip biru UNIT 1 1
124 Tip kuning UNIT 1 1
125 Ultra sentrifuse UNIT 1 1
126 UPS UNIT 1 1

NIP.19771120 200212 2 006
USULAN KEGIATAN RUTIN
RAKER & MUSREN RSUD SCHOLOO KEYEN T.A 2017
UNIT PENGUSUL
No Nama Usulan
ANAK BEDAH BERSALIN NIFAS ICU IGD INTERNA CS FARMASI FISIO GIZI LAB LAUNDRY OK RADIO RM Total
1 Batterai Besar 6 6 72 3 6 20 2 115
2 Batterai Kecil 10 6 120 2 10 20 1 20 189
3 Batterai Sedang 2 4 6
4 Blanko Laboratorium 1 1
5 Blanko permintaan rawat inap 2 2
6 Blanko surat rujukan 1 1
7 Blanko surat sakit 1 1
8 Buku Folio Besar 10 120 10 15 155
9 Buku Gambar 5 5
10 Cutter 2 24 2 28
11 Hekter 2 24 3 2 7 38
12 Isi Hekter 5 60 5 5 75
13 Isolasi 2 24 2 28
14 Kertas HVS 1 12 1 12 26
15 Kertas Resep 20 240 40 300
16 Lem 2 24 26
17 Lilin 10 120 10 140
18 Map File 10 120 10 10 150
19 Pena 1 12 10 1 24
20 Penggaris 2 24 2 2 30
21 Penghapus Papan 2 24 3 2 31
22 Pensil 2 B 5 36 3 44
23 Pensil Warna (Merah, Biru) 4 48 4 56
24 Rak buku 3 3
25 Rak Sepatu 2 2
26 Spidol Boardmarker 10 120 5 10 145
27 Spidol Permanen 10 120 5 10 145
28 TipEx 3 36 1 3 43
29 Amplop 3 3
30 Amplop Foto Ukuran 26 x 36 cm 2000 2000
33 Balpoin Hitam 3 15 24 42
34 Blanko Lab 0
35 Blanko Resep Rawat Inap 0
36 Bolpoint 10 10
37 Bolpoint Hitam 36 36
38 Box File 20 5 5 24 6 60
39 Buku Besar 30 30
40 Buku Expedisi 12 12
41 Buku Folio Besar 5 40 6 4 5 10 5 3 12 12 102
42 Buku Folio Kecil 5 40 6 12 63
43 Buku Folio Kecil 6 6
44 buku folio kecil panjang 6 12 18
45 Buku Folio Kecil Pendek 5 5
46 Buku Folio Ukuran Besar ( Poli Fisio ,Gym, Poli Syaraf ) 5 5
47 Buku Folio Ukuran Kecil 5 5
48 Buku Kecil 30 30
49 buku tulis biasa 10 10
50 cater & Pisau Cater 12 12
51 Catrig Hitam 3 3
52 Catrig Warna 3 3
53 Clear Holder 0
54 Cutter 1 1 6 4 12
55 Cutter 2 2 4
56 Fastener 2000 2000
57 Gunting 2 2
58 Gunting (ATK) 2 2
59 Gunting Kertas 3 3
60 Hekter 12 3 4 5 4 2 4 2 2 2 5 45
61 Isi Hekter 5 10 6 10 4 12 50 5 4 36 36 178
62 Isolasi 2 2 3 3 10
63 Jepitan Kertas 12 12
64 Kabel Roll 0
65 kertas A4 0
66 Kertas Caver 3 3
67 kertas f4 0
68 Kertas Folio F4 5 5
69 Kertas HVS 1 1 2
70 Kertas HVS A4 12 12
71 Kertas HVS F4 12 12 24
72 kertas HVS ukuran A4 24 24
73 Kertas HVS ukuran F4 36 36
74 Kertas HVS/ Rim 1 1
75 Kertas NCR 12 12
76 Kertas Resep 20 20 20 60
77 Klip Kertas 50 50
78 klips kertas 0
79 Lem 2 2 3 10 24 2 3 50 96
80 Lem 12 12
81 Lem Kertas Povinal 20 20
82 Lembar Observasi 0
83 Lilin 10 20 30
84 Map 10 12 22
85 Map File 5 2 7
86 Map File (Brider) 12 12
87 Map Folder 6 6 24 60 96
88 Map Kertas 10 10
89 Map Plastik 10 12 6 5 33
90 Mistar 10 10
91 Pelubang kertas 0
92 Pembolong Kertas 3 3 6
93 Pemotong Kertas 1 1
94 Pena 1 3 4
95 Pena / Dos 1 1
96 Pena Farter 40 40
97 Pena Faster 6 2 3 11
98 Penggaris 2 2 5 9
99 Penggaris 30 cm 3 3 6
100 Penggaris ukuran 30 cm 3 2 2 2 9
101 Penggaris/ Mistar 3 3
102 Penghapus Papan 2 2 1 2 3 10
103 Penjepit Kertas 50 50
104 Pensil 12 5 24 6 47
105 Pensil 2 B 1 3 12 4 20
106 Pensil 2b 10 10
107 Pensil Warna (Merah, Biru) 1 4 5
108 Pensil/ Dos 1 1
109 Resep Umum 0
110 Selotip ukuran besar 2 2
111 Spidol (merah, hitam, biru, hitam) 12 12
112 Spidol Board Marker 50 50
113 Spidol Boardmaker 2 2
114 Spidol Boardmarker 5 40 12 57
115 Spidol Kecil Hitam 36 36
116 Spidol Permanen 5 40 12 1 58
117 Spidol Permanent 10 10 20
118 Spidol Permanent 12 12
119 Spidol Snowan BoardMarker Hitam 60 60
120 Spidol Snowan Masker Hitam 60 60
121 Spidol Snowman Boardmarker Hitam 20 20 24 64
122 Spidol Snowman Marker 0
123 Spidol Snowman Marker Hitam 12 12
124 Tinta Epson 24 24
125 Tinta Print Canon Hitam 6 12 18
126 Tinta Print Canon Warna 6 12 18
127 Tinta Print Hitam 12 12
128 Tinta Print Warna 6 6
129 Tinta Stempel 2 2
130 TipEx 5 12 12 12 1 12 12 12 2 12 12 104
131 Type X 5 5
USULAN PENGADAAN MEUBELAIR
UNIT PENGUSUL
No Nama Alat
ANAK BEDAH BERSALIN NIFAS ICU IGD INTERNA OK CS FARMASI FISIOTERAPI GIZI LAB LAUNDRY POLI RM
1 Kipas Angin 1 2
2 Seprei Pasien 4
3 Kursi Palstik 2
4 Selimut Pasien 1 8 24
5 Perlak 4
6 Kipas Angin Gantung 9
7 Kursi Pasien Plastik 10
8 Lemari Penyimpanan Barang 1 1
9 Sapu Ruangan 1
10 Lemari Arsip 1 1
11 Lemari Instrumen 1
12 Lampu Emergensi 2
13 AC 1PK 2 1 1
14 Kulkas Mini 1
15 Dispenser 1
16 TV 21" 2 1 1
17 Kursi Sofa 2 1
18 Taplak Meja Px (Kotak Kecil) 12
19 Exhaused Fan 6 10
20 Bantal Kepala 4 6
21 Sarung Bantal Kepala 6
22 Bantal Guling 6
23 Kulkas 1 1 1
24 Sarung Bantal Guling 6
25 Dyspenser set 2
26 Jam dinding 6 4
27 Lemari Alat 1
28 Parabola 2
29 AC 2PK. 2
30 AC 1/2PK 1
31 PC + Printer 1
32 Stavol 500/1000 VOLT 2 2
33 Kursi Petugas 3
34 Meja Konsul Dokter 1
35 Sepatu uk. 44 5
36 Sepatu uk. 39 5
37 Sandal uk. 44 5
38 Sandal uk. 39 5
39 Kaca Mata 10
40 Meja Perawat Penjaga 1
41 Meja Observasi Pasien 4
42 Kursi Kerja Roda 3


NIP.19771120 200212 2 006
SOPIR Total
3
4
2
33
4
9
10
2
1
2
1
2
4
1
1
4
3
12
16
10
6
6
3
6
2
10
1
2
2
1
1
4
3
1
5
5
5
5
10
1
4
3
USULAN PENGADAAN LOGISTIK
UNIT PENGUSUL
No Nama Usulan
ANAK BEDAH BERSALIN NIFAS ICU IGD INTERNA CS FARMASI FISIO GIZI LAB LAUNDRY OK POKJA VCT RADIO RM POLIK SOPIR Total
1 Alat Pel 4 24 4 30 2 4 4 2 6 2 82
2 Alat Pembersih Kaca 5 2 7
3 Anti septic gel 50 100 24 6 180
4 Baby Oil 12 24 36
5 Baby Shampo 5 5
6 Bay Fresh 10 20 100 20 12 10 24 12 6 12 12 12 12 12 12 286
7 Bayclin 13 20 100 100 60 13 24 25 1 6 24 12 80 15 493
8 Baygon spray 2
9 Bedak Baby 100 100
10 Cairan Anti Septik 50 12 12 74
11 Caladin Lotion 0
12 Caladin Talk 12 12
13 Clear Pembersih Kaca 15 15 50 10 15 150 5 260
14 Ember Bertutup Besar 10 5 1 10 1 10 2 3 42
15 Ember bertutup kecil 10 5 1 10 1 2 3 32
16 Ember Bertutup Sedang 3 1 4
17 Fortex/ botol 20 15 6 41
18 Gantungan Baju 2 10 12
19 Gayung 2 20 2 10 1 12 2 4 53
20 Glass Cleaner 12 5 17
21 Harpic 6 20 12 38
22 Hibis Scrub 5 L 25 25
23 Hit Semprot 15 15 90 20 15 150 5 12 322
24 Kain Lap / Seka 20 20
25 Kamfer 12 12 12 12 150 5 5 208
26 Kantong Sampah Besar Ukuran 120 x 180 50 50
27 Kantong Sampah Kecil Ukuran 90 x 90 50 50
28 Kantong Sampah Sedang Ukuran 90 x 180 50 50
29 Karpet 6 6
30 Keranjang linen kotor 1 1
31 Kertas Puyer Pres 12 12
32 Kesek Kaki 5 4 2 10 2 10 8 6 1 48
33 Klip plastik 12
34 Ligent (Pembersih Peralatan Dapur) 1000 ml 8 8
35 Molto 100 6 106
36 Pembersih kaca 100 6 12 118
37 Penutup Meja 10 2 12
38 Pepsodent Junior 0
39 Perlak Pasien 20 20
40 Plastik Sampah 12 12 12 12 100 12 12 120 10 302
41 Plastik Sampah Ukuran 40 x 50 150 240 150 356 896
42 Plastik Sampah Ukuran 60 x 90 100 390 100 356 946
43 Plastik Sampah ukuran 90 x 120 100 390 490
44 Portex 10 10 10 100 10 150 50 5 6 6 357
45 Rak Jemuran 7 7
46 Rinso 8 20 10 100 12 8 18 12 12 36 236
47 Rinso / kg 1 1
48 Rinso 1 kg 12 12 24
49 Sabun Batang 10 10 24 10 100 8 162
50 Sabun Batang/ batang 6 6
51 Sabun Cair 15 15 36 15 36 6 24 6 12 165
52 Sabun Cuci Mama Lemon 1 12 10 23
53 Sabun Cuci tangan 30 5 24 12 71
54 Sabun Mandi Baby 500 500
55 Sabun Mandi Pasien 100 12 112
56 sapu 2 6 2 10
57 Sapu Ijuk 5 12 5 2 3 4 31
58 Sapu Lantai 2 4 50 56
59 Sapu lantai ruangan 20 2 22
60 Sapu lawalawa 3 12 5 12 2 2 2 1 39
61 sapu Lidi 5 12 1 3 10 2 2 3 2 40
62 Sarung bantal pasien 20 20
63 Selimut 2 2
64 Selimut Ganti Pasien 25 25
65 Selimut pasien 20 20 24 30 94
66 Semprot Nyamuk 10 10
67 Sendal Perawat 15 12 27
68 Sendok Sampah 4 4
69 Sendok sampah 0
70 Seprei pasien 20 10 30
71 Serokan 25 2 27
72 Sikat Baju 10 10
73 Sikat Besar 5 5
74 Sikat Gigi 0
75 Sikat Kamar Mandi 5 12 4 24 50 2 3 6 106
76 Sikat pakaian 12 12
77 So Clin Lantai 25 12 12 49
78 Stella(Pengharum ruangan) 10 10
79 Sun Cream 12 12
80 Sunlight 15 15 20 15 24 12 101
81 Super pel 10 10 40 200 12 10 66 25 12 6 60 12 12 6 12 493
82 Tabung O₂ Besar 1 1
83 Tabung O₂ kecil 1 1
84 Tangkai Pel 2 12 14
85 Tempat Pakaian Kotor Pasien 2 1 3 2 4 12
86 Tempat sampah 3 6 2 11
87 Tempat Sampah berpenutup ukuran sedang 1 1
88 Tempat Sampah Besar 25 25
89 Tempat Sampah Besar dan Penutup 4 4
90 Tempat Sampah Kecil 100 3 103
91 Tempat sampah kecil bertutup 8 8
92 Tempat Sampah Kecil dan Penutup 8 8
93 Tempat Sampah Pasien bertutup 20 20
94 Tempat Sampah Pasien Tutup Sedang 10 10
95 Tempat Sampah Sedang 50 50
96 Tempat Sampah ukuran sedang dNG penutup 1 1
97 Tissu Basah 24 24
98 Tissu Kotak 24 24
99 Tissu Roll 10 12 20 42
100 Tissue 0
101 Tissue Basah 12 12 100 12 100 24 260
102 Tissue Kering 24 24 48
103 Tissue Kotak 12 12 100 50 12 24 50 260
104 Tissue roll 100 100
105 Tisu Basah 12 12
106 Tisu Kotak 12 12
107 Tisu Roll 24 24
108 Tisue Kotak 12 15 27
109 Tisue Roll 100 100
110 Waskom Double 10 5 15
111 Waslap 10 20 12 75 117
112 Waslap Petugas 5 5
113 Wiper 2 2
114 Wipol 15 15
Ukuran 60x90
ukuran 40x50
USULAN REHAB FISIK/BANGUNAN
TOTAL : 58 UNIT
KEGIATAN
No VOLUME SATUAN
1 IGD
TIDAK ADA USULAN
2 BERSALIN
1 KIPAS ANGIN 2 UNIT
2 SEPREI PASIEN 4 UNIT
3 KURSI PLASTIK 2 UNIT
4 SELIMUT PASIEN 1 UNIT
5 PERLAK 4 UNIT
3 NIFAS
1 KIPAS ANGIN GANTUNG 9 UNIT
2 KURSI PASIEN PLASTIK 10 UNIT
3 LEMARI PENYIMPANAN BARANG 1 UNIT
4 SAPU RUANGAN 10 UNIT
5 LEMARI ARSIP 1 UNIT
6 LEMARI INSTRUMEN 1 UNIT
7 LAMPU EMERGENSI 2 UNIT
8 AC 1PK 1 UNIT
9 KULKAS MINI 1 UNIT
10 DISPENSER 1 UNIT
11 TV 21" 1 UNIT
12 KURSI SOFA 1 UNIT
4 INTERNA
1 SELIMUT 24 PAKET
2 TAPLAK MEJA Px (KOTAK KECIL) 12 PAKET
3 EXHAUSED FAN 10 UNIT
4 BANTAL KEPALA 6 UNIT
5 SARUNG BANTAL KEPALA 6 UNIT
6 BANTAL GULING 6 UNIT
7 AC 1 UNIT
8 KULKAS 1 UNIT
9 SARUNG BANTAL GULING 6 UNIT
5 ANAK
TIDAK ADA USULAN
6 BEDAH
1 AC 1 Pk 2 UNIT
2 TV 32 Inc 2 UNIT
3 Sopa 2 UNIT
4 Dyspenser set 2 UNIT
5 Kulkas 1 UNIT
6 Exhespen 6 UNIT
7 Jam dinding 6 UNIT
8 Kipas angin 1 UNIT
9 Lemari Alat 1 UNIT
10 Lemari penyimpanan seprey 1 UNIT
11 Parabola 2 UNIT
7 OK
1 AC 2PK. 2 UNIT
2 AC 1/2PK 1 UNIT
3 JAM DINDING 4 BUAH
4 PC + PRINTER 1 UNIT
5 STAVOL 500/1000 VOLT 2 BUAH
6 KURSI PETUGAS 3 UNIT
7 MEJA KONSUL DOKTER 1 UNIT
8 SEPATU uk. 44 5 PASANG
SEPATUuk. 39 5 PASANG
9 SANDAL uk. 44 5 PASANG
SANDAL uk. 39 5 PASANG
10 KACA MATA 10 BUAH
11 TV 32" 1 UNIT
12 KULKAS 1 UNIT
8 ICU
1 MEJA PERAWAT PENJAGA 1 UNIT
2 MEJA OBSERVASI PASIEN 4 UNIT
3 BANTAL 4 BUAH
4 LEMARI ARSIP 1 UNIT
5 KURSI KERJA RODA 3 UNIT
6 SELIMUT PASIEN BORDIR NAMA RUANGAN 8 BUAH
7 STAVOL 1000 VOLT 2 UNIT
TOTAL : 10 KEGIATAN
KEGIATAN
No
1 IGD
TIDAK ADA
2 BERSALIN
REHAB PONEK
3 NIFAS
REHAB PERINATOLOGI
4 INTERNA
SEKAT RUANG ISOLASI
5 ANAK
SEKAT RUANG ISOLASI
6 BEDAH
TIDAK ADA
7 OK
REHAB RUANG OK
8 ICU
TIDAK ADA
9 LAB
BANGUN BARU
10 IPAL
REHAB
11 HEMODIALISA
REHAB RUANGAN
12 CCSD
REHAB RUANGAN
USULAN SDM
TOTAL : 14 Orang
No UNIT JLH SEKARANG PENAMBAHAN SEHARUSNYA
1 IGD
12 0 14-15
2 BERSALIN
9 2 11-12
3 NIFAS
9 3 11-12
4 INTERNA
12 0 14-15
5 ANAK
13 0 11-12
6 BEDAH
10 1 11-12
7 OK
6 0 6
8 ICU
13 0 13
9 LAB/UTD
8 6 14
10 FARMASI
11 0 11
11 RADIOLOGI
(Tidak Desk) 2 2 4
14
USULAN PERENCANAAN PELATIHAN
KEGIATAN
No TOTAL Satuan IGD BERSALIN NIFAS INTERNA ANAK BEDAH OK ICU KOMED RADIOLOGI LAB UTD FARMASI GIZI RM
1 APN 2 ORANG 2
2 ATLS/ACLS (INHOUSE TRAINING) 1 PAKET 1
3 BCLT/PPGD 4 ORANG 1 1 1 1
4 BTCLS (INHOUSE TRAINING) 5 PAKET 1 1 1 1 1
5 KB 2 ORANG 2
6 MANAJEMEN BANGSAL (KEPALA RUANGAN) 2 ORANG 1 1
7 PELATIHAN ANASTESI 1 ORANG 1
8 PELATIHAN BEDAH 1 ORANG 1
9 PELATIHAN KB 2 ORANG 2
10 PELATIHAN PIJAT BAYI (INHOUSE TRAINING) 2 PAKET 1 1
11 PELATIHAN ICU 3 ORANG 3
12 PENANGANAN PENDARAHAN PERSALINAN 2 ORANG 2
13 Perawatan luka 1 ORANG 1
14 Perawatan stoma 1 ORANG 1
15 PERINATOLOGI 2 ORANG 2
16 PONEK 2 ORANG 2
17 PPGD (INHOUSE TRAINING) 1 PAKET
18 PPGDON 4 ORANG 2 2
19 RESUSITASI BAYI (INHOUSE TRAINING) 2 PAKET 1 1
20 SENAM BUMIL + NIFAS (INHOUSE TRAINING) 1 PAKET 1
21 SENAM IBU NIFAS (INHOUSE TRAINING) 1 PAKET 1
22 Pelatihan penyamplingan 2 ORANG 2
23 Pelatihan crossmatcH darah 2 ORANG 2
24 Pelatihan malaria 2 ORANG 2
25 Pelatihan TB 2 ORANG 2
26 Training Manejemen Farmasi 2 ORANG 2
27 Pisiko Tropika 2 ORANG 2
28 Pengobatan Rasional 2 ORANG 2
29 Pelatihan Asuhan Gizi 2 ORANG 2
30 Pelatihan Dietetik Gizi 2 ORANG 2
31 Pelatihan Penanganan Gizi Buruk 2 ORANG 2
32 Manajemen Data & Pelaporan Rumah Sakit 1 ORANG 1
33 Pendidikan & Pelatihan Rekam Medis 1 ORANG 1
34 Pertemuan Persatuan Perekam Medis 1 ORANG 1
35 Pelatihan ATLS bagi Dokter Umum 3 ORANG 3
36 Pelatihan ACLS bagi Dokter Umum 3 ORANG 3
Pelatihan HD bagi1 orang dokter Umum dan 1 orang Dokter
37 2 ORANG 2
Spesialis
38 Kegawatdaruratan medik(in house training) 1 PAKET 1
39 ICU(in house training) 1 PAKET 1
40 Pelatihan Penyusunan Clinical Pathway 2 ORANG 2
41 Pelatihan USG bagi Tenaga Medis 4 ORANG 4
42 Pelatihan EKG 2 ORANG 2
43 Pelatihan dokter spesialis 14 ORANG 14
44 Kolegium Obgyn pada TW I 1 PAKET 1
45 Kolegium Penyakit Dalam pada TW II 1 PAKET 1
46 Kolegium Bedah pada TW III 1 PAKET 1
47 Kolegium Anak pada TW IV 1 PAKET 1
48 Audit Medik dan Klinik 1 PAKET 1


NIP.19771120 200212 2 006
DATA DUKUNG
USULAN RENCANA KERJA & MUSREN
Nama Peserta Desk : dr. Maria S.D Lumbanraja
Unit : IGD
Jabatan : Kepala Ruangan Grand Total #REF!
No. Telepon :
KEGIATAN SATUAN
No VOLUME SATUAN JUMLAH KETERANGAN LOKASI DATA DUKUNG KEGIATAN (Ada/Tidak)
(Unit Cost)
1 Pengadaan Peralatan Alat Kesehatan
a.
1 MINOR SURGERY SET 1 UNIT
2 BED PATIENT ELEKTRIC 1 UNIT
3 TENSIMETER DIGITAL DDENGAN MANSET BAYI/ANAK 2 UNIT
4 TENSIMETER ANAEROB 2 UNIT
5 STETESKOP REISTER 3 UNIT
d. Kegiatan Pelatihan
1 BTCLS 1 PAKET
2 PPGD 1 PAKET
3 ATLS/ACLS 1 PAKET
4
SubTotal
GRAND TOTAL #REF!
Ka.Bidang Perencanaan Peserta Desk Direktur RSUD Scholoo Keyen
dr. Ade Adrain Sitompul dr. Maria S.D Lumbanraja Drg. ROSALINE N.I KRIMADI, MPH
NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk : LUTFIA RAHMAN
Unit : Ka. Ruangan Bersalin
Jabatan : KA.RUANG
No. Telepon :
KEGIATAN SATUAN DATA DUKUNG KEGIATAN

No VOLUME SATUAN JUMLAH KETERANGAN LOKASI
(Unit Cost) (Ada/Tidak)
I Pengadaan Peralatan dan Alat Kesehatan
Pengadaan Alat Kesehatan
1 TENSIMETER AIR RAKSA 1 UNIT
2 STETESKOP DEWASA 1 UNIT
3 TERMOMETER AIR RAKSA 2 UNIT
4 PARTUS SET 1 SET
5 COM BERTUTUP (DIAMETER 12CM) 3 UNIT
6 TROMOL BESAR (DIAMETER 17CM) 3 UNIT
7 STANDAR INFUS 2 UNIT
8 STERILISATOR KERING 1 UNIT
9 VACUM MANUAL (DISPOSIBLE) 1 SET
10 NIER BEKEN BESAR 2 SET
11 NIER BEKEN SEDANG 2 SET
12 NIER BEKEN KECIL 2 SET
13 FORCEP BIASA ( JANGAN YANG NEGEL) 2 UNIT
15 EMBRIOTOMI SET 1 SET
16 SOLUTION WARMER 1 UNIT
17 PEAN BENGKOK 1 UNIT
18 HEAKTING SET 4 SET
19 AMNIOTOMI SET 2 SET
20 KURETASE SET 2 SET
21 SPEKULUM COCOR BEBEK KECIL 1 SET
22 SPEKULUM COCOR BEBEK SEDANG 1 SET
23 SPEKULUM SIMS 1 SET
24 SENDOK KURET TAJAM SET 1 SET
25 SENDOK KURET TUMPUL SET 1 SET
26 SUCTION KURET 1 SET
27 KLEM OVUM 2 UNIT
28 ALIGATOR 2 UNIT
29 LAMPU SOROT (FLEKSIBEL) 1 UNIT
SubTotal 45
III Pengadaan Kebutuhan Fasilitas Ruangan
1 KIPAS ANGIN 2
2 SEPREI PASIEN 4
3 KURSI PLASTIK 2
4 SELIMUT PASIEN 1
5 PERLAK 4
SubTotal 13
V Kegiatan Pelatihan
1 APN 2
2 PONEK 2
PPGDON 2
3 KB 2
4 SENAM BUMIL + NIFAS (INHOUSE TRAINING) 9
5 PELATIHAN PIJAT BAYI (INHOUSE TRAINING) 9
6 RESUSITASI BAYI BARU LAHIR 2
7 PENANGANAN PENDARAHAN PERSALINAN 2
SubTotal 28
VI Kegiatan Penambahan Tenaga

1 TENAGA SAAT INI 9
2 PENAMBAHAN TENAGA 2
SubTotal 2
Bidang Perencanaan Peserta Desk Direktur RSUD Scholoo Keyen
dr. Ade Adrain Sitompul LUTFIA RAHMAN Drg. ROSALINE N.I KRIMADI, MPH
NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Provinsi
Nama Peserta Desk : SUPIYANTI LAWISA
Unit : Ruangan Nifas
Jabatan : KEPALA RUANGAN NIFAS TOTAL : -
No. Telepon : RSU Jantho
BLUD RSUD dr. H. Yuliddin Aw
KEGIATAN HARGA SATUAN

(Unit Cost)
I Pengadaan Alat Kesehatan -
1 TERMOMETER DOGITAL 2 -
2 TERMOMETER AIR RAKSA 2 -
3 TENSIMETER AIR RAKSA 1 -
4 STETESKOP DEWASA 1 -
5 STETESKOP BAYI 1 -
6 DUPLER 1 -
7 REPLEX HAMMER 1 -
8 LAMPU SINTER 2 -
9 TIMBANGAN DEWASA W + H 1 -
10 FLUID/SOLUTION WARMER 1 -
11 OXIGEN KONSENTRATOR 2 -
12 SACTION PUMP DEWASA 2 -
13 REHAP PERINATOLOGI -
RSUD dr. Fauziah Bireuen
III Pengadaan Kebutuhan Fasilitas Ruangan -
1 KIPAS ANGIN GANTUNG 9 -
2 KURSI PASIEN PLASTIK 10 -
3 LEMARI PENYIMPANAN BARANG 1 -
4 SAPU RUANGAN 10 -
5 LEMARI ARSIP 1 -
6 LEMARI INSTRUMEN 1 -
7 LAMPU EMERGENSI 2 -
8 AC 1PK 1 -
9 KULKAS MINI 1 -
10 DISPENSER 1 -
11 TV 21" 1 -
12 KURSI SOFA 1 -
V Kegiatan Pelatihan -
MANAJEMEN BANGSAL (UNTUK
1 KEPALA RUANGAN)
1 RSUD Dr. RM Djoelham
SENAM IBU NIFAS (INHOUSE

2 TRAINING) 9 RSUD dr. Djasamen Saragih
3 PPGDON 2 RSU DR. F. L. Tobing Sibolga
4 PELATIHAN KB 2 - RSUD Kota Tanjungbalai
5 PYAT BAYI (INHOUSE TRAINING) 9 - RSUD Dr.H.Kumpulan Pane
RESUSITASI BAYI (INHOUSE
6 TRAINING) 9 - RSUD Kota Padangsidempuan
7 PERINATOLOGI 2
Subtotal -
GRAND TOTAL #REF!

VI Kegiatan Penambahan Tenaga -
1 TENAGA SAAT INI 9 RSUD Dr. RM Djoelham
2 PENAMBAHAN TENAGA 3 RSUD dr. Djasamen Saragih
RSUD Dr. Hadrianus Sinaga P

Bidang Perencanaan Peserta Desk Direktur RSUD Scholoo Keyen RSUD Batu Bara
RSUD Sibuhuan
RSUD Gunung Tua
RSUD Kotapinang
dr. Ade Adrain Sitompul SUPIYANTI LAWISA Drg. ROSALINE N.I KRIMADI, MPH RSUD Aek Kanopan
NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Pro
Nama Peserta Desk : ANITA SARI WARDANA Ru
Unit : Ruangan Interna Ka
Jabatan : KEPALA RUAGAN INTERNA TOTAL : - RS
No. Telepon : RS
BL

(Unit Cost)
RS
I Pengadaan Alat Kesehatan RS
1 PISPOT (PEREMPUAN) 2 - RS
2 KLISMA 2 -
3 MINOR SET 1 -
4 NIERBEKEN BESAR 1 -
5 SUCTION DEWASA 1 -
6 02 KONSENTRAT 2 -
7 TIMBANGAN BB BIASA 1 -
8 METERAN 1 -
9 PEN LIGHT 1 -
10 SPIRONOMETER 1 -
11 TIANG INFUS TANCAP 10 -
Subtotal #REF! RS
RS
IV Pengadaan Kebutuhan Fasilitas Ruangan RS
1 SELIMUT 24 - RS
2 TAPLAK MEJA Px (KOTAK KECIL) 12 -
3 EXHAUSED FAN 10 #REF!
4 BANTAL KEPALA 6 -
5 SARUNG BANTAL KEPALA 6 #REF!
6 BANTAL GULING 6
7 AC 1
8 KULKAS 1
9 SARUNG BANTAL GULING 6
10 #REF!
Subtotal #REF! RS
RS
1 BTCLS (INHOUSE TRAINING0 1 PAKET - RS
2 MANAJEMEN BANGSAL (KEPALA RUANGAN) 1 PAKET - RS
3 - RS
VI Kegiatan Penambahan Tenaga

1 TENAGA SAAT INI
2 PENAMBAHAN TENAGA
SubTotal
Subtotal - RS
RS
VII Rehab Tiap Ruangan
1 SEKAT RUANG ISOLASI 1 PAKET -
2 -
Subtotal
GRAND TOTAL RS
RS
RS
Bidang Perencanaan Peserta Desk Direktur RSUD Scholoo Keyen RS
RS
RS
RS
dr. Ade Adrain Sitompul ANITA SARI WARDANA Drg. ROSALINE N.I KRIMADI, MPH RS
NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk :
Unit : RUANG. ANAK
Jabatan :
No. Telepon :
KEGIATAN SATUAN
(Unit Cost)
I Pengadaan Peralatan dan Bahan Kesehatan
a.
1 RESESITATOR BAYI 1
2 STETESKOP ANAK 1
3 OKSIGEN KONSENTRAT 1
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Subtotal
2 Pengadaan Bahan dan Fasilitas Penunjang

Ruangan
b. Pengadaan Kebutuhan Fasilitas Ruangan

c. Pengadaan Bahan Non Medis Habis
d. Kegiatan Pelatihan
PPGD (INHOUSE TRAINING) 1 PAKET
BTCLS (INHOUSE TRAINING) 1 PAKET
dr. Ade Adrain Sitompul 0 Drg. ROSALINE N.I KRIMADI, MPH

NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk : SANTI TANDI
Unit :
Jabatan : KEPALA RUANGAN BEDAH TOTAL : -
No. Telepon :
KEGIATAN HARGA SATUAN DATA DUKUNG KEGIATAN

1 Lampu periksa 1 unit
2 Tempat tidur 2 unit
3 Nurbeken besar 1 unit
4 Nurbeken sedang 1 unit
5 Pispot wanita 2 unit
6 Pispot laki-laki 2 unit
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Subtotal -
II Pengadaan Alat Tulis Kantor

-
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
22 -
23 -
Subtotal
III Pengadaan Kebutuhan Fasilitas

Ruangan
1 AC 1 Pk 2 unit -
2 TV 32 Inc 2 unit -
3 Sopa 2 unit -
4 Dyspenser set 2 unit -
5 Kulkas 1 unit -
6 Exhespen 6 unit -
7 Jam dinding 6 unit -
8 Kipas angin 1 unit -
9 Lemari Alat 1 unit -
10 Lemari penyimpanan seprey 1 unit -
11 Parabola 2 unit -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
22 -
23 -
24 -
25 -
26 -
Subtotal
IV Pengadaan Bahan Non Medis

Habis Pakai -
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
Subtotal -
1 -
2 -
3 -
Subtotal -
VI Kebutuhan Ruangan Kelas I

1 BCLT/PPGD 1 Paket -
2 Perawatan luka 1 Paket -
3 Perawatan stoma 1 Paket -
4 Penambahan petugas 1 orang -
5 -
6 -
7 -
Subtotal
GRAND TOTAL
dr. Ade Adrain Sitompul …………………………………………… Drg. ROSALINE N.I KRIMADI, MPH
NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk : RASDIN
Unit : Ruang OK
Jabatan : PERAWAT ANASTESI TOTAL :
No. Telepon :

No VOLUME JUMLAH KETERANGAN LOKASI
(Unit Cost)
1 LAPARASCOPY + MONITOR 1 SET #VALUE!
2 INSTRUMEN BEDAH VASKULER 1 SET #VALUE!
3 USG ANASTESI 1 SET #VALUE!
4 SUCTION PUMP DEWASA 2 UNIT #VALUE!
5 LARINGOSCOPE ANAK 1 UNIT #VALUE!
6 OPERATING TABLE 1 UNIT #VALUE!
7 TORNIKET 5 UNIT #VALUE!
8 BRANGKAR DORONG DENGAN PENGAMAN 2 UNIT #VALUE!
9 KATARAK DAN BEDAH REFRAKTIF 1 SET #VALUE!
10 AMPUTASI SET 1 SET #VALUE!
11 UROLOGI INSTRUMEN SET 1 SET #VALUE!
12 MASTEKTOMI SET 1 SET #VALUE!
13 MINOR SET 2 SET #VALUE!
14 HEAD LAMP 2 BUAH #VALUE!
15 BOR ELEKTRIK 1 SET #VALUE!
16 BOR MANUAL 1 SET #VALUE!
17 PISAU HUMVEE (STSG) 1 SET #VALUE!
18 ENDOS COPY 1 SET #VALUE!
19 ANUS COPY 1 SET #VALUE!
Subtotal -
III
Pengadaan Kebutuhan Fasilitas Ruangan
1 AC 2PK. 2 UNIT #VALUE!
2 AC 1/2PK 1 UNIT #VALUE!
3 JAM DINDING 4 BUAH #VALUE!
4 PC + PRINTER 1 UNIT #VALUE!
5 STAVOL 500/1000 VOLT 2 BUAH #VALUE!
6 KURSI PETUGAS 3 UNIT #VALUE!
7 MEJA KONSUL DOKTER 1 UNIT #VALUE!
8 SEPATU uk. 44 5 PASANG #VALUE!
SEPATUuk. 39 5 PASANG #VALUE!
9 SANDAL uk. 44 5 PASANG #VALUE!
SANDAL uk. 39 5 PASANG #VALUE!
10 KACA MATA 10 BUAH #VALUE!
11 TV 32" 1 UNIT #VALUE!
12 KULKAS 1 UNIT #VALUE!
Subtotal
V Bangunan Fisik
1 REHAP OK 1 PAKET #VALUE!
Subtotal -
VI Pengembangan SDM
1 PELATIHAN BEDAH 2 ORANG #VALUE!
2 PELATIHAN ANASTESI 1 ORANG #VALUE!
3 BTCLS (INHOUSE TRAINING) 6 ORANG #VALUE!
Subtotal
GRAND TOTAL
dr. Ade Adrain Sitompul RASDIN Drg. ROSALINE N.I KRIMADI, MPH
NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk : REO RIVALDY
Unit :
Jabatan : PERAWAT ICU TOTAL : -
No. Telepon :

No SATUAN JUMLAH KETERANGAN LOKASI DATA DUKUNG KEGIATAN (Ada/Tidak)
(Unit Cost)
VOLUME

1 BAK INSTRUMEN SEDANG 2 UNIT -
2 COM BESAR (DIAMETER 17CM) 2 BUAH -
3 COM KECIL (DIAMETER 12CM) 2 BUAH -
4 KORENTANG 2 BUAH -
5 NIERBEKEN BESAR 2 UNIT -
6 PISPOT BAB 2 UNIT -
7 PISPOT PRIA 2 UNIT -
8 PISPOT WANITA 2 UNIT -
9 STANDAR INFUS BERODA 6 BUAH -
10 GELAS UKUR 1 LITER (PLASTIK) 2 UNIT -
11 PEN LIGTH 2 UNIT -
12 STETESKOP ANAK 1 UNIT -
13 GLUCU METER 1 UNIT -
14 BRANKAR 1 UNIT -
15 WATERPAS (PENGUKUR CVC) 1 BUAH -
16 TERMOMETER DIGITAL 3 UNIT -
17 TERMOMETER AIR RAKSA 3 UNIT -
18 SOLUTION WARMER 1 UNIT -
Subtotal -
III FASILITAS -
1 MEJA PERAWAT PENJAGA 1 UNIT -
2 MEJA OBSERVASI PASIEN 4 UNIT -
3 BANTAL 4 BUAH -
4 LEMARI ARSIP 1 UNIT -
5 KURSI KERJA RODA 3 UNIT -
6 SELIMUT PASIEN BORDIR NAMA RUANGAN 8 BUAH #REF!
7 STAVOL 1000 VOLT 2 UNIT -
Subtotal
VI Pengembangan SDM
1 PELATIHUN ICU 3 ORANG -
2 BTCLS (INHOUSE TRAINING) 12 ORANG -
3 PPGD (INHOUSE TRAINING) 12 ORANG -
Subtotal
GRAND TOTAL
dr. Ade Adrain Sitompul REO RIVALDY Drg. ROSALINE N.I KRIMADI, MPH
NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk :
Unit : Radiologi
Jabatan :
No. Telepon :

I Alat Kesehatan dan Peralatan Radiologi

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
SubTotal
II KEBUTUHAN RUANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
SubTotal
III ATK
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
SubTotal
IV PELATIHAN
1
2
3
4
SubTotal
dr. Ade Adrain Sitompul …………………………… Drg. ROSALINE N.I KRIMADI, MPH
NIP : NIP : NIP : 19771120 200212 2 006
WORKPLAN KOMITE MEDIK TAHUN 2016
OPERASIONAL KOMITE MEDIK

NO KEGIATAN URAIAN VOLUME SATUAN BIAYA (@) TOTAL BIAYA/ TAHUN
I SUB KOMITE KREDENSIAL
Ketua : dr. Natsir Muin, Sp.PD
Anggota : dr. Maria Lumban Raja
Sasaran I : Mendapatkan dan Memastikan Staf Medis yang Profesional dan Akuntabel bagi pelayanan RS
A. Melaksanakan Credentialling bagi tenaga Medis yang bekerja di lingkungan RSUD Schooo Keyen
1. Credentialling Dokter Umum/ Gigi, Dokter PPDS-BK, dan Dokter Spesialis
2. Orientasi Tenaga Medis
B. Melaksanakan Re-Credentialling bagi tenaga Medis yang bekerja di lingkungan RSUD Schooo Keyen
1. Evaluasi Kinerja Tenaga Medis di lingkungan RSUD Scholoo Keyen
Sasaran II : Tersusunnya jenis kewenangan klinis (clinical privilege) bagi setiap staf medis yang melaksanakan pelayanan di RS
A. Pemberian Daftar Kewenangan Klinis ( Clinical Privilage) bagi Tenaga Medis di lingkungan RSUD Scholoo Keyen
1. Pemberian Wewenang Klinis bagi tenaga Medis di RSUD Scholoo Keyen sesuai dengan bagian ilmu yang ditetapkan oleh Kolegium Kedokteran
2. Rekomendasi Penugasan Klinis ( Clinical Appointement) tenaga Medis kepada Direktur RS Scholoo Keyen

II SUB KOMITE MUTU PROFESI 1.Kebutuhan Operasional :
Ketua : dr. Siti Achda Zahiroh, Sp.B a. White Board ukuran 1 meter x 1 meter 1 buah Rp 2,000,000 Rp 2,000,000
Anggota : Sarah Hagia Lestari b. Penghapus White board 1 buah Rp 50,000 Rp 50,000
SASARAN I : Memberikan perlindungan terhadap pasien agar senantiasa mendapatkan pelayanan yang bermutu, dan oleh tenaga medis yang kompeten , etis dan
profesional
2. Peningkatan Kompetensi Tenaga Medik
A. Menyusun Standar Prosedur Operasional di lingkungan RSUD Scholoo Keyen a. Pelatihan ATLS bagi Dokter Umum 3 org Rp 18,000,000 Rp 54,000,000
1. Pembentukan Tim Penyusun SPO b. Pelatihan ACLS bagi Dokter Umum 3 org Rp 18,000,000 Rp 54,000,000
c. Pelatihan HD bagi1 orang dokter Umum
2 org Rp 18,000,000 Rp 36,000,000
2. Pelaksanaan Penyusunan SPO dan 1 orang Dokter Spesialis
d. Inhouse Training :
3. Pengesahan SPO oleh Direktur RSUD Scholoo Keyen A. Kegawatdaruratan medik 1 Paket Rp 10,000,000 Rp 10,000,000
B. ICU 1 Paket Rp 10,000,000 Rp 10,000,000
B. Menyusun Clinical Pathway (CP) yang merupakan konsep pelayanan terpadu yang merangkup setiap langkah yang diberikan kepada pasien berdasarkan Standar e. Pelatihan Penyusunan Clinical Pathway 2 org Rp 18,000,000 Rp 36,000,000
Pelayanan Kedokteran
f. Pelatihan USG bagi Tenaga Medis 4 org Rp 18,000,000 Rp 72,000,000
SASARAN II : Memastikan dan Melaksanakan Pemantauan Kualitas Pelayanan yang dilakukan staf medis melalui Morning Report, Audit Medis, Pelatihan, Pembelajaran
g. Pelatihan EKG 2 org Rp 18,000,000 Rp 36,000,000
yang berkesinambungan, dan Pendampingan Staff Medis
h. Pelatihan Bagi Dokter Spesialis 14 org Rp 18,000,000 Rp 252,000,000
A. Melaksanakan Audit Medis di lingkungan RSUD Scholoo Keyen dalam upaya Evaluasi Mutu Pelayanan Medis yang diberikan kepada pasien . i. Pelaksanaaan Audit (Kolegium)
A. Kolegium Obgyn pada TW I 1 Paket Rp 36,000,000 Rp 36,000,000
B. Kolegium Penyakit Dalam pada
1 Paket Rp 36,000,000 Rp 36,000,000
B.Pelaksanaan Pelatihan/ Pertemuan Ilmiah dan memberikan Rekomendasi Pelatihan bagi Tenaga Medis di lingkungan RSUD Scholoo Keyen TW II
1. Presentasi Materi oleh Dokter PPDS - BK dan Dokter Umum C. Kolegium Bedah pada TW III 1 Paket Rp 36,000,000 Rp 36,000,000
D. Kolegium Anak pada TW IV 1 Paket Rp 36,000,000 Rp 36,000,000
2. Pelatihan : E. Audit Medik dan Klinik 1 Paket Rp 72,000,000 Rp 72,000,000
1. GELS / ATLS / ACLS
2. Pelatihan USG dan EKG
3. Penanggung Jawab ICU
4. Pelatihan Hemodialisa
5. Pelatihan dr. Spesialis
C.Memfasilitasi Proses Pendampingan ( Proctoring) bagi staf Medis yang membutuhkan

1. Pendampingan bagi Staff Medis yang mengalami pengurangan berdasarkan hasil Evaluasi kinerja
D. Pembentukan Komite Etik di RSUD Scholoo Keyen dengan bekerjasama pada RS Rujukan tertinggi di Provinsi Papua Barat
III SUB KOMITE ETIKA DAN DISIPLIN PROFESI
Ketua : dr. Nelce Kambuaya, Sp.Rad
Anggota : Drg. Dixie Sinay
SASARAN I : MELINDUNGI PASIEN DARI PELAYANAN STAF MEDIS YANG TIDAK MEMENUHI SYARAT DAN TIDAK LAYAK UNTUK MELAKUKAN ASUHAN MEDIS
A. Menerapkan Prinsip Profesionalisme Kedokteran dengan memperhatikan kinerja Profesi

1. Penerapan Disiplin Kerja bagi Tenaga Medis ( Jam Kerja, Visite, Tata Cara Konsul)
2. Penerapan Disiplin Perilaku Staf Medis berdasarkan:
a. Pedoman Pelayanan Kedokteran di RS
b. Prosedur Kerja Pelayanan di RS
c. Daftar Kewenangan Klinis Tenaga Medis di RS
d. Kode Etik Kedokteran Indonesia
e. Pedoman Perilaku Profesi dan Pelanggaran Disiplin yang berlaku
f. Standar Prosedur Operasional Asuhan Medis di RS
B. Melakukan Pembinaan Profesionalisme Kedokteran

1. Melaksanakan Pendampingan bagi Tenaga Medis yang terkena sanksi Disiplin Profesi / Etik
2. Sosialisasi, Ceramah, Diskusi tentang Etika dan Disiplin Profesi
SASARAN II : Memberikan rekomendasi atas pertimbangan pengambilan keputusan Etis pada suatu kasus pengobatan di RS
1. Pertemuan Pembahasan kasus ( mengikutsertakan pihak yang kompeten) untuk memberikan pertimbangan keputusan Etis tersebut.
IV KESEKRETARIATAN KOMITE MEDIK Kebutuhan Penunjang Operasional KOMITE
dr. Ade Adrain Sitompul 1. Kursi Pertemuan 20 buah Rp 500,000 Rp 10,000,000
SASARAN I : Terselenggaranya Kontrol dan Evaluasi Program Sub Komite Medik di lingkungan RSUD Scholoo Keyen 2. Slide Proyektor menetap 1 buah Rp 2,000,000 Rp 2,000,000
3. Proyektor menetap 1 buah Rp 2,000,000 Rp 2,000,000
A. Memfasilitasi Proses Pelaksanaan Program Sub-Komite 4. Loudspeaker Dinding (menetap) 1 Unit Rp 3,000,000 Rp 3,000,000
1. Penetapan Desk Job (Tugas Pokok dan Fungsi) Sub Komite Medik di RSUD Scholoo Keyen 5. Komputer Lenovo iCore 3 1 unit Rp 10,000,000 Rp 10,000,000
6. Lemari Buku 1 unit Rp 3,000,000 Rp 3,000,000
2. Koordinasi (Kontrol dan Evaluasi) Program Sub Komite 7.Buku Medis :
a. Sub Komite Kredensial a. Anak 5 buku Rp 300,000 Rp 1,500,000
1. Proses Credentialling b. Kandungan 5 buku Rp 300,000 Rp 1,500,000
2. Proses Re-Credentialling c. Bedah 5 buku Rp 300,000 Rp 1,500,000
3. Penyusunan Kewenangan Klinis dan Rekomendasi Penugasan Klinis d. Penyakit Dalam 5 buku Rp 300,000 Rp 1,500,000
4. Menyampaikan hasil rekomendasi kepada Direktur RSUD Scholo Keyen berdasarkan hasil Evaluasi dari Sub Komite Kredensial e. Kegawatdaruratan Medik 5 buku Rp 300,000 Rp 1,500,000
f. Medik lainnya 10 buku Rp 300,000 Rp 3,000,000
b. Sub Komite Mutu Profesi 8. Printer Canon + Scan 1 UNIT Rp 2,000,000 Rp 2,000,000
1. Penyusunan dan Pengesahan Standar Prosedur Operasional RSUD Scholoo Keyen 9. Meja Kerja 2 Unit Rp 2,000,000 Rp 4,000,000
2.Melaksanakan Kontrol dan Evaluasi Kegiatan Pelatihan/ Pertemuan Ilmiah/ Morning Report yang dilaksanakan oleh Sub Komite Profesi 10. Laptop i-Core 3 1 UNIT Rp 10,000,000 Rp 10,000,000
3. Menyampaikan rekomendasi untuk Mengikuti Pelatihan/ Pertemuan Ilmiah berdasarkan evaluasi dari Sub Komite kepada Pimpinan RSUDScholoo Keyen
c. Sub Komite Etik dan Disiplin Profesi

1. Menyampaikan hasil rekomendasi dari Pertimbangan Etis berdasarkan hasil pertemuan dari Sub Komite Etik dan Disiplin Profesi
2. Evaluasi Proses Kegiatan Pembinaan, dan Disiplin Profesi Tenaga Medis di RSUD Scholoo Keyen
SASARAN II : Terselenggaranya Kegiatan/ Program Sub Komite dengan dukungan Sarana dan Biaya Operasional
1. Tersedianya Sarana untuk mendukung Kegiatan Komite Medik yang dilengkapi dengan :
a. Ruangan Komite Medik
b. Fasiitas Komputer, Printer, ATK
c. Ruang Baca yang dilengkapi dengan Buku Medis dan Akses Internet
2. Memfasilitasi Pembiayaan Operasional Kegiatan Sub Komite
SASARAN III : Terjalinnya Kerjasama yang baik antara Tenaga Medis, dan hubungan yang baik dengan Pimpinan RS ( Mendukung setiap Peraturan dan Kebijakan yang
berlaku, dan membantu Pimpinan terkait dengan Pelayanan di RS)
1. Kegiatan Kesekretariatan Komite Medik lainnya dalam mendukung Pelayanan RS:

b. Pelaksanaan Alur Penerimaan Tenaga Medis di lingkungan RSUD Scholoo Keyen
c. Rekomendasi Kebutuhan Tenaga Medis di lingkungan RSUD Scholoo Keyen ( Dokter Umum, Spesialis)
d. Panitia Penetapan Tarif Pelayanan RSUD Scholoo Keyen
e. Pelaksanaan Akreditasi RSUD Scholoo Keyen
f. Rekomendasi Standar Pelayanan IGD RSUD Scholoo Keyen
2. Kegiatan Kesekretariatan Komite Medik lainnya dalam menjalin kerjasama antara Tenaga Medis :
a. Penetapan Alur dan Tata Cara Konsul kepada dokter Konsulen
b. Rekomendasi Pemberian Jasa Konsultasi, Visite bagi Tenaga Dokter Spesialis dan PPDS-BK
c. Penetapan Tata Cara Perijinan bagi Tenaga Medis yang melaksanakan Ijin, Cuti, dan mengikuti Kegiatan Ilmiah di luar lingkungan RSUD Scholoo Keyen
TOTAL 834,550,000
Ketua Komite Medik Sekretaris Komite Medik
dr. Gomer S Tindi, Sp.OG dr.Ade Adrain Sitompul

DATA DUKUNG
Provinsi
Nama Peserta Desk : SALOMINA MAINOLO.Amd.Keb Rumah Sakit Ibu dan Anak
Unit : KEPERAWATAN Kabupaten
Jabatan : KETUA KOMITE KEPERAWATAN TOTAL : RSU Cut Nyak Dhien Meulaboh
No. Telepon : RSU Jantho
BLUD RSUD dr. H. Yuliddin Away

No VOLUME JUMLAH KETERANGAN LOKASI
RSUD Singkil
I KOMITE KEPERAWATAN - RSU Datu Beru Takengon
A. Pengembangan SDM - RSUD H. Sahudin Kutacane
1 PPGD 59 ORANG BLUD RSUD Idi Kabupaten Aceh Timur
2 BTCLS 40 ORANG
3 PONEK 22 ORANG RS Khusus Rehabilitasi Medik
4 MANAJEMEN BANGSAL 7 ORANG
5 PPGDON 20 ORANG
6 PELATIHAN ICU 9 ORANG
PENANGANANA PENDARAHAN PASKA SALIN (INHOUSE
7 TRAINING) 22 ORANG
PEMASANGAN INPLAN DAN KB POST PLASENTA
8 (INHOUSE TRAINING) 22 ORANG
9 PERAWATAN LUKA (INHOUSE TRAINING) 25 ORANG
RESUSITASI BAYI BARU LAHIR DAN PIJAT BAYI (INHOUSE
10 TRAINING) 30 ORANG
B Sub Komite Peningkatan Mutu - RSUD dr. Fauziah Bireuen

1 RSUD Kab. Pidie
C Fasilitas ( Sarana & Prasarana) -

1 PC + PRINTER 1 UNIT
D Fasilitas Ruangan lainnya:

1 RUANGAN KOMITE KEPERAWATAN 1 UNIT
2 MEUBELAIR 1 PAKET
3
4
5
6
7
8
9
Subtotal - RSUD Tgk Abdullah Syafi'i Beureunuen

GRAND TOTAL - RSUD Kota Tanjungbalai
RSUD Dr.H.Kumpulan Pane
RSUD Kota Padangsidempuan
Bidang Perencanaan Peserta Desk Direktur RSUD Scholoo Keyen RSUD Salak
RSUD Lukas Hilisimaetano
RSUD Doloksanggul
RSUD. Sultan Sulaiman
……………………………………………… SALOMINA MAINOLO.Amd.Keb Drg. ROSALINE N.I KRIMADI, MPH RSUD Dr. Hadrianus Sinaga Pangururan
NIP : NIP : 19740918 200003 2 003 NIP : 19771120 200212 2 006 RSUD Batu Bara
WORKPLAN DAN BIAYA OPERASIONAL PROGRAM TB/HIV/DAN MALARIA 2016
OPERASIONAL VCT/TB/MALARIA
NO AKTIVITAS PROGRAM URAIAN VOLUME SATUAN BIAYA (@) TOTAL BIAYA/ TAHUN
1 SASARAN :MENINGKATKAN FASILITAS LAYANAN KESEHATAN DI RS YANG MEMILIKI SDM YANG BERKUALITAS
MEMILIKI PERALATAN YANG CUKUP DAN MENYEDIAKAN LAYANAN KLINIS TB/ HIV DAN MALARIA YANG
BERKUALITAS.
A.Pengembangan SDM
o Perekrutan Staf pelaksana program o Honor pelaksana program 5 orang/ bln Rp 150,000 Rp 11,250,000
o Pelatihan Internal Staf Medis / Paramedis pemegang program TB/HIV/IMS dan Malaria o Pelatihan Internal tenaga pelaksana program 5 orang/ tahun Rp 4,000,000 Rp 20,000,000
o Persamaan persepsi dalam Implementasi program HIV-TB-IMS dan Malaria dalam pelaksanaan kegiatan pelayanan di o Sosialisasi Implementasi Program
* konsumsi dan fotocopy 3 kali Rp 300,000 Rp 900,000
o Pembahasan Studi kasus o Pertemuan pembahasan kasus yang ditemui
* konsumsi dan fotocopy 3 kali/thn Rp 300,000 Rp 900,000
o In House Training dan mentoring program di RS ( TB 1 kali, HIV 2 kali, IMS 1 kali) o Pelaksanaan In House Training (4 x)
* Honor Narasumber (3 org) 4 kali/thn Rp 1,500,000 Rp 6,000,000
B. Kesiapan Fasilitas dan Pelayanan ( Ruangan TB/HIV/ IMS dan Malaria dan ruang Perawatan yang representative dan
nyaman ) 1.Penyediaan Ruangan penyuluhan dan Konseling
C. KOLABORASI TIM DOTS-IMS-VCT DALAM PENYULUHAN PROGRAM
2. SASARAN : QUALITY CONTROL DAN ALARYM SYSTEM UNTUK MENCEGAH PASIEN LOLOS FOLLOW UP
A. Pengembangan Standard ( SOP ) di RS o Rapat Tim VCT dalam membahas SOP 3 kali Rp 50,000 Rp 150,000
B. Pengembangan Sistem kontrol yang baik untuk program dan pengobatan o Internet Foto Copy dan Penjilidan 1 kali/bln Rp 100,000 Rp 1,200,000
C. Menciptakan metode untuk pencegahan dan melacak pasien lolos follow up o Pendampingan (Proctoring) ke 5 PKM Satelit 5 kali/thn Rp 230,000 Rp 1,150,000
D. Rapat Evaluasi implementasi sistem pencegahan dan pelacakan pasien lolos follow up
E. Melaksanakan Penanganan Managemen Kasus o Konseling ( *Snack dan Air Minum ) 15 kali Rp 50,000 Rp 750,000
o Home Visit (* Transport) 15 kali Rp 100,000 Rp 1,500,000
3. SASARAN : MELAKSANAKAN EVALUASI KEGIATAN DAN SISTEM PELAPORAN YANG EFEKTIF, DAN BERKALA
A. Melaksanakan Rapat Bulanan Tim TB/VCT/ IMS dan Malaria o Rapat Bulanan Tim VCT 15 kali Rp 50,000 Rp 750,000
B. Pelaporan hasil kegiatan kepada KEMENKES dan Dinas Kesehatan Provinsi (IOMS) o Print pelaporan untuk Dinas Kesehatan 15 kali Rp 10,000 Rp 150,000
o Email pelaporan untuk KEMENKES 15 kali Rp 150,000 Rp 2,250,000
4. SASARAN : PENINGKATAN KOMODITAS LOGISTIK (REAGEN DAN OBAT-OBATAN)
A. Pengadaaan Obat ARV di Farmasi RS o Penyediaan obat ARV

B. Pengadaan Reagen di RS o Penyediaan Reagen HIV
5. Kebutuhan Ruangan VCT/TB/Malaria dalam menunjang Pelaksanaan Program KEBUTUHAN RUANGAN

A. White Board Ukuran 1 meter x 1 meter A. White Board Ukuran 1 meter x 1 meter 1 buah Rp 1,000,000 Rp 1,000,000
B. Penghapus White Board B. Penghapus White Board 1 buah Rp 50,000 Rp 50,000
C. Meja Petugas Konseling 1 buah C. Meja Petugas Konseling 1 buah 1 buah Rp 2,500,000 Rp 2,500,000
D. Kursi Pasien 3 buah Merk Chitose D. Kursi Pasien 3 buah Merk Chitose 3 buah Rp 500,000 Rp 1,500,000
E. Kursi Putar untuk Petugas Konseling E. Kursi Putar untuk Petugas Konseling 1 buah Rp 500,000 Rp 500,000
F. Lemari berkas Pasien F. Lemari berkas Pasien 1 buah Rp 3,000,000 Rp 3,000,000
G.Rak Buku G.Rak Buku 1 buah Rp 2,000,000 Rp 2,000,000
H. Exhaust Fan H. Exhaust Fan 2 buah Rp 2,500,000 Rp 5,000,000
TOTAL Rp 65,050,000
Program sudah dilaksanakan
Program yang akan dilaksanakan
Program dilaksanakan 1 kali setahun dalam waktu yang disesuaikan
Biaya Operasional
Besaran biaya operasioanal kegiatan secara keseluruhan adalah Rp 65.050.000,- (Enam Puluh Juta Lima Puluh Ribu Rupiah )
dan terperici dalam kolom Workplan Program.
MENGETAHUI
DIREKTUR RSUD SCHOLOO KEYEN Ketua Tim VCT-TB dan Malaria RSUD Scholoo
drg.ROSALINE N.I KRIMADI, MPH dr.Ade Adrain Sitompul

NIP. 1971120 200212 2 006 NIP. 19861205 201201 1 001
DATA DUKUNG
Nama Peserta Desk : dr.Marlina
Unit : Laboratorium
Jabatan : Koordinator Lab TOTAL :
No. Telepon :

A. PENGADAAN ALAT KESEHATAN
1 Microscope dinocular 1 Unit -
2 Bunsen 5 Unit -
3 Microscopes and accessories/Mikroskop 1 Unit -
4 Automated urinalysis system/urin analizer 1 Unit -
5 Pipetting and diluting system for clinical use/perangkat pipet 1 Unit -
6 Centrifugal chemistry analyzer for clinical for use/centrifuge kimia klinik 1 Unit -
7 LED 2 Unit -
8 Electrolyte analyzer 1 Unit -
9 Analisa Hb 1 Unit -
10 Automated hemoglobin system/hematology analizer 1 Unit -
11 Coagulation instrumen/peralatan koagulasi 1 Unit -
12 Ultra sentrifuse 1 Unit -
13 Autoclave 1 Unit -
14 Mikrosentrifus 1 Unit -
15 Blood storage refrigerator and blood storage frezzer 1 Unit -
16 Sterilisator kering 1 Unit -
17 Rak slide 1 Unit -
18 Microbiological incubator 1 Unit -
19 Blood gas analyzer 1 Unit -
20 Refrigerated centrifuge 1 Unit -
21 Mikro balance 1 Unit -
22 UPS 1 Unit -
-
C HABIS PAKAI
1 Darah Kontrol Mindray 3000 Plus 12 Vial ml Rp 835,000 10,020,000.00
2 Diluent Mindray 3000 Plus 24 Gln/20ltr Rp 1,755,000 42,120,000.00
3 Emertion Oil 6 Btl/100ml Rp 772,000 4,632,000.00
4 EZ- Cleanzer (Mindray BJ 3000 Plus) 20 Btl Rp 862,125 17,242,500.00
5 Giemsa Gram Stain 10 Btl/500ml Rp 1,550,000 15,500,000.00
6 Kertas Mindray Dan Kimia 72 Roll Rp 187,500 13,500,000.00
7 M-30P-Prob Cleanser 120 Btl Rp 76,950 9,234,000.00
8 Methanol 6 Btl/2,5ltr Rp 1,232,000 7,392,000.00
9 Reagent Gol.Da Anti-A 60 Vial 10ml Rp 140,000 8,400,000.00
10 Reagent Gol.Da Anti- B 60 Vial 10ml Rp 140,000 8,400,000.00
11 Rinse 6 Gln/20ltr Rp 1,691,000 10,146,000.00
12 Lyse Mindray BS 3000 24 Btl/500ml Rp 3,858,000 92,592,000.00
13 Reagent Gol.Da Anti-D 60 Vial 10ml Rp 165,000 9,900,000.00
14 Turk 1 Btl -
15 Eosine 2 % 1 Btl -
16 Eosine Y 1 Btl -
17 Reagen HE 1 Btl -
18 Reagent Albumin 5 500ml Rp 621,500 3,107,500.00
19 Reagent Asam Urat 6 4 x 100ml Rp 1,573,000 9,438,000.00
20 Reagent Bilirubun T/D 2 2 X 100ml Rp 715,000 1,430,000.00
21 Reagent Cholesterol 12 4 x 100ml Rp 1,760,000 21,120,000.00
22 Reagent Creatinin 24 200ml Rp 617,100 14,810,400.00
23 Reagent Glukosa 24 4 x 100ml Rp 748,000 17,952,000.00
24 Reagent SGOT 24 20 x 50ml Rp 1,705,000 40,920,000.00
25 Reagent SGPT 24 20 x 50ml Rp 1,705,000 40,920,000.00
26 Reagent Total Protein 2 1000ml Rp 770,000 1,540,000.00
27 Reagent Ureum UV 24 8 x 50ml Rp 1,875,500 45,012,000.00
28 Serum Control 2 Kotak 20 Rp 3,750,000 7,500,000.00
29 Sensor Cassette BGA 4 Pack -
30 Solition Pack BGA 4 Pack -
31 Urine Strip 15 Btl Rp 279,000 4,185,000.00
32 Narkoba Rapid Test 10 Box 1,229,300 12,293,000.00
33 Tabung sentrifuse urine 50 Pcs -
34 Reagen None 1 Btl -
35 Reagen Pandi 1 Btl -
36 Rivalta 1 Btl/100ml -
37 Sataihelmer Malbin (Cat Urine) 4 Paket 2,000,000 8,000,000.00
38 Pregnancy Strip 5 Box 200,800 1,004,000.00
39 HbSAg Stick 45 Box 50 test Rp 457,500 20,587,500.00
40 HCV Stick 11 Box 40 test Rp 1,250,000 13,750,000.00
41 HIV Stick 45 Box 50 test Rp 3,400,000 153,000,000.00
42 Shipylis Stick 45 Kotak 30 Rp 924,000 41,580,000.00
43 Salmonella Ig M Rapid Test 1 Box Rp 1,450,000 1,450,000.00
44 Anti Dengue Ig G Rapid Test 1 Box Rp 1,625,000 1,625,000.00
45 Bovine albumin 50 Box -
46 Como test 50 Box -
47 Cassette CD4 6 Box @25bh -
48 Control CD4 4 Pak -
49 Methylen Blue 0,1% 15 Btl 100ml 3,457,300 51,859,500.00
50 Carbol Fuchsin 0,3% 15 Btl Rp 90,750 1,361,250.00
51 Blod Lancet 20 Box Rp 41,250 825,000.00
52 Blue Tip 24 Box Rp 290,000 6,960,000.00
53 Filter Paper Whatman (CT – BT Test) 2 Box 1,279,000 2,558,000.00
54 Kertas Pembersih Lensa Microscope 8 Box 137,500 1,100,000.00
55 Object Glass 80 Box 36,400 2,912,000.00
56 Tabung Disposible EDTA (ungu) 5,800 Btl Rp 2,700 15,660,000.00
57 Tabung Disposible Kimia (merah) 4,800 btl Rp 2,700 12,960,000.00
58 Tabung Sitros (Biru) 600 Btl 3,135 1,881,000.00
59 Wright Stain 18 Btl Rp 687,500 12,375,000.00
60 Yellow Tip 14 Sak Rp 220,000 3,080,000.00
61 Pot Urine 2,500 Sak Rp 2,800 7,000,000.00
62 Kartu Gol.Da 6 Pak @100 -
63 Parafilm (Laboratory Film) 3 Gulung -
64 Tabung Kapiler (Tabung Hematokrit) 2 Box @100 -
65 Tabung Sample (plastic) 8 Pak/1000 Rp 1,400,000 11,200,000.00
B Pembangunan laboratorium
1 Pembangunan Laboratorium 1 Pkt
C Pengadaan Fasilitas Ruangan

1 AC 2 pk 1 Unit
D SDM -
D3 Analis 4 Org
E Pelatihan
1 Pelatihan penyamplingan 2
2 Pelatihan crossmatcH darah 2
3 Pelatihan malaria 2
4 Pelatihan TB 2

dr. Ade Adrain Sitompul dr.Marlina Drg. ROSALINE N.I KRIMADI, MPH
NIP : NIP : NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk :
Unit : UTD
Jabatan : UTD TOTAL :
No. Telepon :

A. PENGADAAN ALAT KESEHATAN
1 Mikroskop binokuler 1 Unit -
2 Blood bank refrigerator darah siap pakai 1 Unit -
3 Cool box untuk transportasi dengan fasilitas minimal 20 kantong 1 Unit -
4 Tabung reaksi 1 Unit -
5 Kit anti-HIV, HbsAg, Anti-HCV, Anti-Sifilis 1 Unit -
6 Cool box dengan fasilitas 2-5 kantong 1 Unit -
7 Blood bank refrigerator karantina 1 Unit -
8 Blood plasma freezer 1 Unit -
9 Tempat tidur statis 1 Unit -
10 Tabung reaksi ukuran12x75 mm 1 Unit -
11 Termometer kontrol 1 Unit -
12 Timbangan darah 1 Unit -
13 Tabung reaksi kaca yang dilapisi silikon atau sekali pakai ukuran 12x75 mm 1 Unit -
14 Tip biru 1 Unit -
15 Tip kuning 1 Unit -
16 Platelet agitator dengan inkubator 1 Unit -
17 Kit anti-HIV, HbsAg, anti-HCV 1 Unit -
18 Hand sealer 1 Unit -
19 Timer 1 Unit -
20 Mikropipet ukuran 200-1000 ul 1 Unit -
23 Klem 1 Unit
24 Pinset 1 Unit
25 Blood grouping plate 1 Unit
26 Peti pendingin darah/cool box untuk mobile unit (25 – 50 kantong) 1 Unit
27 Refrigerated Centrifuge 1 Unit
28 Medical refrigerator 1 Unit
29 Klem/pean 1 Unit
B PembangunanUTD
1
C Pengadaan Fasilitas Ruangan

1
D SDM -
E Pelatihan
1
2
3
4
dr. Ade Adrain Sitompul 0 Drg. ROSALINE N.I KRIMADI, MPH

NIP : NIP : NIP : 19771120 200212 2 006
DAFTAR PERENCANAAN BAHAN MEDIS HABIS PAKAI 2016 INSTALASI FARMASI 2017
NO NAMA BMHP
SATUAN KEMASAN JUM
1 ALKOHOL 70 %, 1 LITER BTL 1 300 21,500

2 ALKOHOL SWABS DOS 500 10,000
3 AQUA STERIL FOR IRIGASI 1000ML BTL 1 300 9,000
4 ARM SLING UK L PCS 1 100 38,000
5 ARM SLING UK M PCS 1 150 38,000
6 ARM SLING UK S PCS 1 100 38,000
7 ASEPTIC GEL 5 LITER BTL 1 80 808,000
8 ASEPTIC GEL 500CC DISPENSER BTL 1 90,000
9 B1STURINO10 PCS 100 1,000 3,000
10 BENANG POLYSORB 1 (POLYGLCOLIC ACID ) TAPER PCS 24 200
11 BENANG POLYSORB 2 TAPER PCS 24 200
12 BENANG POLYSORB 2/0 TAPER PCS 36 200
13 BENANG POLYSORB 3/0 TAPER PCS 36 500
14 BENANG VICRYL 4/0 POLYSORB TAPER PCS 24 200
16 BISTURI NO 15 PCS 100 500 3,000
17 BISTURI NO 19 PCS 100 500 3,000
18 BISTURI NO 20 PCS 100 1,000 3,000
19 BISTURI NO 21 PCS 100 1,500 3,000
20 BISTURIN0 11 PCS 100 500 3,000
21 Blue monofilament polyvinylidene floride non absosbable 3.0 ( 3/8 circle 24 mm ) cutting pcs 24 360
22 Blue monofilament polyvinylidene floride non absosbable 4.0 ( 3/8 circle 16 mm ) cutting fineline pcs 24 360
25 CATGUT CHROMIC NO 2/0 (WITH NEEDLE) TAPER HR 37 PCS 36 150 22,599
26 CATGUT CHROMIC NO 3/0 (WITH NEEDLE) taper HR 26 PCS 36 150 22,599
27 CATGUT CHROMIC NO 4/0 (WITH NEEDLE) TAPER PCS 24 150
28 CATGUT CHROMIC NO.3 WITH NEEDLE TAPER PCS 24 150
29 Catgut Monofilament natural Absorbable 3.0 ( 1/2 circle 25mm ) tapper pcs 24 150
30 Catgut Monofilament natural Absorbable 3.0 (3/8 circle 16 mm) cutting pcs 24 150
31 catgut monofilament natural absosrbable 1 ( 1/2 circle 64,6 mm) Blunt pcs 24 150
32 catgut monofilament natural absorbable 2.0 ( 1/2 circle 36mm ) cutting pcs 24 150
33 catgut monofilament natural absorbable 2.0 (1/2 circle 35 mm) tapper pcs 24 150
34 catgut monofilament natural absorbable 3.0 ( 1/2 circle 22mm ) tapper pcs 24 150
39 CATGUT PLAIN NO 4/0 (WITH NEEDLE) TAPER PCS 24 72
40 CHATETER SUCTION 6 PCS 1 200 3,520
47 CHKM DENTAL USE PCS
48 CHLORHEXIDIN 4% SOL, 5LITER GEN 1 30 836,160
49 COLAR NECK L PCS 1 10
50 COLAR NECK S PCS 1 10
51 COLAR NECK M PCS 1 10
52 DERMAFIX ( PLESTER ANTI AIR) PCS 300
55 DISP 1 CC PCS 50 5,000
DISP 1 CC (INSULIN) PCS 2,000
56 DISP 20 CC PCS 50 5,000
58 DISP 50 CC (LUBANG PINGGIR) PCS 20 800
59 DISP 50 CC KATETER TIP (LUBANG TENGAH) PCS 20 300
60 DISP10CC PCS 50 5,000
61 DISP3CC PCS 50 20,000
62 DISP5CC PCS 50 15,000
63 DISPOSIBLE NEEDLE CITOJECT 30G PCS
66 ELEKTRODA TENS SET 5 120,000
78 ETSAWP DENTAL PCS
81 ETT NON KINGKING NO 7 PCS 1 30 310,000
83 ETTNON KINGKING NO 5 PCS 1 30 310,000
84 EXTENSION TUBE PCS 50 200
FOLEYCHATETERN0 14 PCS 10 100
91 FOLEYCHATETERNO10 PCS 10 100 11,000
95 FORMALIN SOL. 40% BTL 20 200
98 H202 (PERHYDROL) 50% PCS 1 4
99 HAND CALLAR DEWASA PCS 1 10
100 HERNIA MES PCS 5 20
101 I.V CHATETER NO 16 PCS 50 500
109 INFUSION SET MACRO PCS 50 4,500 7,920
110 INFUSION SET MICRO PCS 50 700 7,920
111 JACKSON-REES SET PCS
112 JARUM 27 G PCS 100 500
113 JARUM CITOJECT N027 G dental use PCS
114 JARUM SPINAL NO. 25 PCS 50 200
115 JARUM SPINAL NO. 26G PCS 50 200
116 JARUM SPNAL 27 PCS 50 200
117 JET NEBULIZER MASK PEDIATRIC PCS 1 360
118 JET NEBULIZER MASKADULT PCS 1 500
119 JOINT FIT ROLL PCS 1 60
122 KAPAS 500 GR PCS 1 1,000
123 KASA ROLL 40 X 80 PCS 1 350 130,000
124 KASASTERIL PCS 1 100
129 L M A (LARINGEAL MASK AIRWAYS PCS 1 20
131 MASKER OXYGENT DEWASA rebreathing PCS 1 900
132 MASKER OXYGENT PEDIATRI rebreathing PCS 1 500
133 MASKER SURGICAL EARLOOP BOX 1 1,000 22,000
134 MICROBRUSH BONDING APLICATOR PCS
136 MONOPILAMEN POLYGLECAPRONE 25 VIOLET ABSORBABLE 3/0 (3/8,CIRCLE 24 mm ) cutting pcs 24 360
137 NASAL CANULA 02 DEWASA PCS 1 900
NASAL CANULA 02 BAYI 200
138 NASAL CANULA 02 PEDIATRI PCS 1 400
139 NEEDLE 18 PCS 50 500
141 NEEDLE NO. 23 PCS 50 500
152 PLESTER HIPAVYX (15X5) ROLL 1 200
163 SARUNG TANGAN (L) PCS 50 20,000
164 SARUNG TANGAN (M) PCS 50 35,000
165 SARUNG TANGAN (S) PCS 50 10,000
167 SARUNG TANGAN NO. 6,5 (STERIL) PCS 40 720
170 SARUNG TANGAN NO.7,5 (STERiL) PCS 40 6,000
171 SHARP CONTAINER 5 LTR PCS 1000 100
172 SIDEX (GLUTARLDEIDA) JERGEN 1 20
179 SILK NO 4/0 (WITH NEEDLE) Taper HR 20 PCS 24 500 13,616
180 SILK NO 5/0 (WITH NEEDLE) taper PCS 24 480
181 SILK NO. 2 WITH NEEDLE cuting PCS 24 400
185 SKIN TRAKSI ANAK PCS 1 50
186 SKIN TRAKSI DEWASA PCS 1 60
192 SPALAK TANGAN DEWASA 30 X 6 CM PCS 1 60
193 SPONGESTAN PCS 200
199 STOMACH TUBE NO 3,5 PCS 1 200 8,841
204 SUNGKUP 02 DEWASA PCS 1 800
205 SUNGKUP 02 PEDIATRI PCS 1 500
206 SURGICRYL (POLYGLYCOLIC ACID) NO.2 PCS 1 300
207 THREE WAY PCS 50 750 19,250
208 THREE WAY BEREKOR PCS 50 500 32,160
210 TRANSFUSION SET INFUS PCS 50 2,500
211 TRANSMISSION JELLY PCS 1 200 34,528
212 treated polyester green synthetic non absorbable 1 ( 3/8 circle 31 mm ) j needle pcs 24 360
213 ULTRASONIC GEL 5 LTR BTL 1 15
214 UMBILICAL CORD CLEMP BLUE BOX 50 10 50,000
215 UNDERPADS 60X90 PCS 3,000
216 URINE BAG PCS 10 2,500 5,005
220 LOGICATH CVC 2L 12F 20 CM PCS 680584 10 680584
GOWN DRAPE DISPOSIBLE PCS 100
JARUM AKUPUNKTUR 0.25 X40 MM (DONG BANG) BOX 30 40,000
Bur fissure silinder besar pendek Kecil (835 009") 25 Pcs
Bur fissure silinder sedang panjang 20 Pcs
Bur fissure silinder kecil pendek 25 Pcs
Bur silinder meruncing panjang 15 Pcs
Bur silinder meruncing pendek Kecil 20 Pcs
Bur Bulat kecil 25 Pcs
Bur Bulat sedang Kecil (BR45) 25 Pcs
Bur Inverted kecil Kecil (805 FG 01 25 pcs
Bur Inverted sedang 25 Pcs
Bur Inverted besar 25 Pcs
Arskansas ujung lancip 25 Pcs
Arkansas bulat 25 Pcs
Lidocaine 2% 1,7ml/
ampul
plastik
citoject,
isi 50
ampul/
pack
Arsen 6,5 gr/Pcs 1 Pcs

C-Bond 10 ml/Botol 3 Botol
Endometason 14 gr/Pcs 1 Pcs
Tambalan sementara 30gr (putih = 2 P4 Pcs
Cresopate 7,5gr /pcs 1 Pcs
Micro aplicator/brush 100Pcs/Box, 4 Box
Calcium hidroksida syringe 3 syringe
Calcium hidroksida padat Padat 1 Btl
Jarum Citoject 30Gx1/2" (0,30x 6 Box
Paper point 15-40 8 Box
45-80 4 Box
Guttap 15-40 1 Box
45-80 1 Box
GIC 2 Pdwr 15gr+ Liqui2 Box
CHKM/ Paramonochlorofenol 20ml/btl 1 Btl
Composite Posterior A3,5 6 Syr
Posterior A3 4 Syr
Tooth Cleaning Tincture 2 Btl
Extra Gel/ Etsa 25ml/Syr 4 Syringe
Kertas artikulasi bentuk oklusal 1 Box
Reamer Ukuran 15-40 6 Set
Ukuran 45-80 6 Set
File Ukuran 5-40 6 Set
Ukuran 45-80 6 Set
Competence Flow/Composite flow Syringe 4 syr
Anestesi topikal Gel Aroma Strowberr2 Pcs
Aroma Jeruk 2 Pcs
Dappen Glass 2 Pcs
celluloid Strip 2 Pack
TKF 1 Btl
Jarum extirpasi 1 Box
Pengukur panjang jarum endo 1 Pcs
spiritus 1 Liter 1 Liter
Tip suction disposible Isi 100/ pack 2 pack
Lampu spiritus 1 Pcs
OBAT E CATALOGUE
NO NAMA OBAT SATUAN KEMASAN JUMLAH HARGA
1 ACETOSAL 100MG TAB TAB 100 1,000
2 ACTRAPID VIAL 1000UI IN ml VIAL 1 40
3 ACYCLOVIR 200MG TAB TAB 100 2,000
4 ACYCLOVIR 400MG TAB TAB 100 1,000
5 ACYCLOVIR salep mata TUBE 25 20
6 AKARBOSE TAB 100 MG TAB 100 5,000
7 AKARBOSE TAB 50 MG TAB 100 6,000
9 ALBENDAZOLE TABLET 400mg TAB 400
11 ALLUPURINOL 100MG TAB 100 2,000
12 ALPRAZOLAM 0.25mg TAB 100 3,000
13 ALPRAZOLAM 1MG TAB TAB 100 1,000
16 AMINOFILIN 200MG TABLET TAB 100 5,000
17 AMINOFILIN INJEKSI VIAL 12 1,000
18 AMINOFLUID SOLUTION BTL 100
19 AMIODARON 200 MG TAB TAB 3000
20 AMIODARON INJ 150 MG/3ML AMP 150
21 AMIPAREN SOLUTION. BTL 20 400
22 AMITRYPTILIN 25MG TAB TAB 100 3,600
23 AMLODIPIN TABLET 10mg TAB 30 8,000
24 AMLODIPIN TABLET 5mg TAB 30 8,000
25 AMOXYCILIN 250MG TAB CAP 120 4,000
26 AMOXYCILIN 500MG TAB KAP 100 15,000
27 AMOXYCILIN SYRUP 125 MG BTL 50 2,900
28 AMPICILIN 1G INJEKSI VIAL 10 400
29 Analog insulin long acting inj 100 UI/ml, vial/cartridge disposible/penfill cartridge BTL 1 80
32 ANTASIDA SYRUP BTL 50 1,500
33 ANTASIDA TABLET TAB 1000 5,000
34 ANTI BAKTERI DOEN SALEP KOMBINASI POT 240
36 ANTI HAEMORHOID SUPP SUP 10 200
37 ANTI MALARIA DOEN KOMBINASI SULFADOXIN TAB 100 500
39 ANTIFUNGI SALEP ( 2-4 ) POT 24 350
40 ANTIMIGREN: ERGOTAMIN CAFFEINE TAB 100 1000
41 APTIL SOLUTION BTL 1 50
42 AQUA PRO INJEKSI 20 ML BTL 120 7,200
45 ASAM ASKORBAT (VIT C ) 250 MG TAB 100 3,000
46 ASAM ASKORBAT 50MG (VITC) TAB 100
48 ASAM FOLAC 1 mg TAB 100 10000
49 ASAM MEFENAMAT 500MG TAB TAB 100 50,000
50 ASAM PIPEMIDAT 400 MG TAB 100 2,000
52 ASAM TRANEXAMAT INJEKSI 500mg AMP 10 1,800
54 ASERING SOLUTION BTL 20 500
56 ATRACURIUM INJ AMP 5 150
57 ATROPINE SO4 0,25MG/ML INJEKSI AMP 20 500
58 ATROPINE SO4 TAB 0,5 MG AMP 300
ATROPINE SO4 Tetes Mata BTL 1 10
60 AZITROMICIN 500 TAB TAB 30 2,000
62 AZITROMYCIN SYRUP 200mg IN 5ml BTL 50 100
63 BENZATIN BENZYL PENICILLIN 2.4 JUTA IU VIA; 10 300
64 BERAPROSA SODIUM TAB TAB 200
65 Fenoterol HBr ih 100 mcg/puf BTL 30
68 BESI II SO4 TAB. SALUT KOMB. TAB 1000 8,000
69 BETAHISTIN MESILATE 6MG TAB 30 3,000
70 BETHAMETHASON CR TUBE 10 200
Bethametason tetes Mata BTL 1 10
71 BISOPROLOL 5 MG TAB TAB 50 10,000
72 BRICASMA RESPULES 2.5mg IN ml NEB 10 100
74 BUPIVACAIN 0,5% + glucosa 8% AMP 150
75 BUPIVACAIN 0,5% HIPERBARIK AMP 4CC AMP 400
77 CALCIUM LACTATE TABLET TAB 1000 15,000
78 CALSIUM CARBONATE TAB500MG TAB 400
79 CALSIUM GLUCONAT INJ AMP 48 96
80 CAPTOPRIL 12,5MG TAB TAB 100 10,000
81 CAPTOPRIL 25MG TAB TAB 100 60,000
82 CARBAMAZEPIN TABLET TAB 100 1,000
83 CATAPRES INJK (KLONIDIN INJ) AMP 5 50
84 CEFADROXIL 500MG CAPSUL CAP 100 5,000
85 CEFADROXIL SYRUP BTL 30 1,200
86 CEFIXIME 100MG CAPS CAP 50 25,000
87 CEFIXIME SYRUP 100MG BTL 50 300
88 CEFOPERAZONE INJK 1G VIAL 2 300
90 CEFOTAXIM 1G INJEKSI VIAL 2 4,000
91 CEFTAZIDIME INJ VIAL 2 200
93 CEFTRIAXON 1G INJEKSI VIAL 2 5,000
94 CEFUROXIME INJ 750MG VIAL 100
95 CETIRIZINE 10MG TAB 30 5,000
96 CETIRIZINE SYRUP BTL 50 700
97 CHLORAMPHENICOL 500MG CAPSUL CAP 1000 2,000
CHLORAMPHENICOL salep kulit 500
CHLORAMPHENICOL EYE DROPS BTL 24 200
99 CHLORAMPHENICOL SALEP MATA TUBE 24 580
100 CHLOROQUIN PO4 250MG TABLET TAB 1000 10,000
101 CHLORPENIRAMINA MALEAT ( C T M ) TAB 100 72,000
102 CHLORPROMAZINA 25MG TABLET TAB 1000 3,000
103 CHLORPROMAZINA INJEKSI25MG AMP 25 300
104 CIPROFLOXACIN 500MG TAB TAB 100 10,000
105 CIPROFLOXACIN INFUS 2% BTL 10 200
109 CLINDAMICYN 150MG CAP 50 20,000
110 CLINDAMICYN 300MG CAP 50 5,000
111 CLOPIDOGREL 75mg TABLET TAB 30 1,500
114 CODEIN 10MG TAB TAB 2,000
115 CODEIN 15MG TAB TAB 100 3,000
116 CODEIN 20MG TAB TAB 100 3,000
117 COMBIVENT INJ AMP 25 1500
118 COTRIMOXAZOLE 480MG TABLET TAB 100 11,000
119 COTRIMOXAZOLE SYRUP BTL 120 600
120 DANOCLAV TABLET CAP 30 1,980
122 DARYANTULLE PCS 10 300
123 DEXAMETHASON INJ AMP 100 2,500
124 DEXAMETHASON TABLET TAB 100 30,000
127 DIAZEPAM 2MG TABLET TAB 100 36,000
128 DIAZEPAM 5MG TABLET 100 5,000
129 DIAZEPAM INJEKSI AMP 10 1,800
130 DIAZEPAM SUPP 10 MG SUPP 5 100
131 DIAZEPAM SUPP 5 MG SUP 5 200
132 DIGOKSIN INJ ( FARGOKSIN) AMP 5 150
133 DIGOKSIN TAB 0,25MG TABLET TAB 100 10,000
134 DILTIAZEM INJ (FARMABEX) AMP 1 100
135 DILTIAZEM TABLET 30MG TAB 50 500
136 DIMENHIDRINAT 10MG TABLET TAB 100 1,200
137 DIPHENHIDRAMIN INJ AMP 500
138 DOBUTAMIN 50mg INJEKSI AMP 5 80
140 DOPAMIN GIULINI 20 MG/ML AMP 100
141 DOXICYCLIN CAPSUL 100MG CAP 100 15,000
142 BISACODYL 5MG/SUPP SUPP 10 300
145 ENAKSOPARIN SODIUM 1NJ 20 MG/0,2 ML AMP 1 50
147 EPHEDRINE 25MG TABLET TAB 100 15,000
148 EPINEFRINE INJEKSI AMP 25 1,000
150 ERITROPAETIN BETA INJ 2000/IU AMP 100
151 ERITROPAETIN ALFA INJ 2000/IU AMP 100
152 ERYTOMISIN 250MG CAPSUL CAP 100 1,000
153 ERYTOMISIN 500MG TABLET KAP 100 12,000
154 ERYTROMICIN SYRUP BTL 50 750
155 ESTROGEN TERKONJUGASI 0,625 MG TA BTL 200
157 ETANOL 70% 100ml BTL 1 1,000
158 ETHAMBUTOL 500MG TAB TAB 100 1,000
159 EUGENOL SOLUTION 10
FENITHOIN NATR. 100 MG CAP BTL 100 5,000
160 FENITHOIN NATR. INJ AMP 350
161 FENOFIBRAT 100mg CAPSUL TAB 1,500
162 FENOL GLISEROL TETES TELINGA BTL 24 72
166 FENTANIL INJEKSI im.iv 0.05mg IN ml AMP 10 500
167 FENTANYL patch 25mcg 100
170 FLUCONAZOLE 150mg TAB 500
173 FUROSEMIDE INJ AMP 25 1,000
174 FUROSEMIDE TAB 40 MG TAB 100 10,000
180 GEMFIBROZIL 600MG TAB TAB 1,000
181 Gentamisin salep mata 0,3% TUBE 10 200
182 GENTAMICYN INJ 40 MG AMP 10 1,600
183 GENTAMICYN SALEP TUBE 10 2,800
184 GENTAMICYN TTS MATA 0,3% BTL 10 100
185 GENTIAN VIOLET LARUTAN 1 % BTL 200
186 GLIBENCLAMID TAB 5 MG TAB 100 2000
187 GLICERIL GUAICOLAT TAB 100 MG TAB 1000 5,000
190 GLIMEPIRIDE 1MG TAB TAB 50 2,500
191 GLIMEPIRIDE 2MG TAB TAB 50 2,000
192 GLIMEPIRIDE 3MG TAB TAB 50 500
193 GLIMEPIRIDE 4MG TAB TAB 50 500
194 GLISERIL TRINIDRAT INJ AMP 1 40
195 GLISERIL TRINIDRAT TAB,SUB LINGUAL TAB 100 500
197 GLUKOSA 5% 0.25NS BTL 20 2,000
198 GLUKOSA 5% 0.5NS 20 1,500
199 GLUKOSA LARUTAN INFUS 10 %(500ML) BTL 20 200
200 GLUKOSA LARUTAN INFUS 5 %(500ML) BTL 20 7,000
201 GLUKOSA NS BTL 1000
204 GRISEOFULVIN 125 MG TAB TAB 100
206 HALOPERIDOL 2MG TAB 100 2,000
208 HALOPERIDOL TABLET 1.5mg TAB 100 1,000
209 HALOTHANE INHALASI BTL 1 3
211 HEPARIN NAT INJ ( LOW MOLECULAR WEIGHT HEPARIN ) AMP 1 100
212 HEPATITIS B IMUNOGLOBIN 100
213 HIDRO CHLORTIAZIDE TAB 25 MG TAB 100 5,000
214 HIDROCORTISONE KRIM 2,5 % TUBE 25 720
HIDROCORTISONE KRIM 1 % TUBE 300
216 HIDROXY ETHYL STARCH (HES) BTL 10 500
218 HUMAN ALBUMIN 20% 100ML BTL 1 100
219 Human tetanus imunoglobulinn injeksi i.m. 250 UI AMP 5 30
222 HYOSCINE-N-BUTILBROMIDE 20MG/ML AMP 10 400
223 IBUPROFEN 200MG TABLET TAB 100 1,000
224 IBUPROFEN 400MG TABLET TAB 100 15,000
225 IBUPROFEN SYR 100MG/ML BTL 50 300
226 IBUPROFEN SYR 200MG/ML BTL 50 200
227 IMPLANON. ETONOGESTREL 20
229 IPRATROPIUM BROMIDA NEBU 5 500
230 IRBESARTAN 150 MG TAB 30 3000
231 ISONIAZIDE 100MG TABLET TAB 1000 5,000
232 ISONIAZIDE 300MG TABLET TAB 1000 20,000
233 ISOSORBID DINITRAT INJ(FARSORBID) AMP 10 200
234 ISOSORBID DINITRATE ( I S D N ) TABLET TAB 100 18,000
235 ISOSORBID DINITRATE SUBLINGUAL 5mg TAB 1000 1,000
236 ISOTIC ADRETOR 0.25% SOL BTL 30
239 KAEN 1 B SOLUTION BTL 20 200
240 KAEN 3 A SOLUTION BTL 20 200
241 KAEN 3 B SOLUTION BTL 20 140 2,015
243 KAEN MG3 SOLUTION BTL 20 100
244 Kalium aspartat tab 300 mg TAB 100 1,000
247 KALSIUM POLISITERINA SULFANAT TAB 6000
249 KALIUM CLORIDA 600 MG TAB 100 500
250 KANAMYCIN NJ VIAL 20 400
251 KANDESARTAN 16 MG TAB 30 2500
252 KANDESARTAN 8 MG TAB 30 3600
255 Karbogliserin tetes telinga BTL 300
256 KETOKONAZOLE CR 10G TUBE 10 500
257 KETOKONAZOLE TAB 200MG TAB 1,500
Ketokonazol Scalp Solution BTL 100
258 KETOPROFEN INJEKSI 100MG AMP 10 300
260 KETOPROPEN SUPP SUPP 10 250
261 KETOROLAC INJEKSI 30MG/ML AMP 10 10,800
263 KLOBAZAM 10mg TAB 100 1,500
265 KLONIDIN HCL 0,15MG TAB TAB 50 1,000
266 KLOPIDOGREL TAB TAB 30 5,000
270 KETAMIN INJEKSI 100mg AMP 10 20
271 KUININ TAB TAB 100 3000
272 LACTULOSA SYP BTL 1 500
273 LANSOPRAZOLE CAPS CAP 30 36,000
276 LAXADINE EMULSI 60ml BTL 1 300
277 LEVOFLOXACIN 500MG TAB TAB 30 1,000
Levofloxacin tetes mata BTL 1 20
278 NOREFINEFRIN 8MG/ 8ML) AMP 5 50
280 LIDOCAIN 2% INJEKSI AMP 100 1,000
281 LIDOCAIN COMP. INJEKSI(PEHACAIN) AMP 10 500
282 LISINOPRIL 10mg TAB 100 1,000
283 LISINOPRIL 5mg TAB 100 1,000
285 HALOPERIDOL INJ 5MG/1ML) AMP 5 50
287 LOPERAMIDE TABLET 2,000
288 LORATADINE TAB TAB 100 1,000
289 MAGNESIUM SO4 (MGSO4) INJ 40% BTL 1 240
290 MAGNESIUM SULFAT 20% AMP . 240
291 MANNITOL INFUS 20% BTL 10 100
292 MARTOS SOLUTION BTL 10 200
293 MEBENDAZOL 500 MG TAB TAB 400
298 MELOXICAM 7.5mg TAB TAB 1 3,600
299 MELOXICAM SUPPOSITORIA SYP 300
300 MEROPENEM 500mg INJEKSI AMP 1 200
301 MEROPENEM INJEKSI 1g AMP 100
303 METFORMIN 500MG TAB 100 3,000
304 METHYL DOPA 250 TAB TAB 100 1,000
305 METHYLERGOMETRIN MALEAT INJEKSI AMP 10 1,000
306 METHYLPREDNISOLON 125mg INJEKSI AMP 10 2,000
307 METHYLPREDNISOLON 16mg TAB 100 5,000
308 METHYLPREDNISOLON 500 mg INJEKSI AMP 1 200
310 METHYLPREDNISOLON TAB 8MG TAB 100 40,000
311 METOCLOPRAMIDE INJEKSI AMP 1,000
313 METOCLOPRAMIDE TABLET 1,000
315 METRONIDAZOLE 250MG TABLET TAB 100 5,000
316 METRONIDAZOLE 500MG TAB 100 20,000
317 METRONIDAZOLE INFUS BTL 16 6,000
318 MEYLON INJEKSI BTL 1 100
320 MICONAZOLE CREAM TAB 24 240
321 MIDAZOLAM INJ 5mg AMP 5 600
324 MORFIN TAB 10mg TAB 300
325 MORPHIN INJEKSI im.sk.iv 10mg AMP 10 20
328 NALOKSON INJK(NALOXONE HCL, NOKOBA 0,4MG/ML) INJK AMP 30
329 NATRIUM CHLORIDA SOL. 500ML (0,9 %) BTL 20 6,000
330 NATRIUM DICLOFENAC 25MG TAB 100 5,000
331 NATRIUM DICLOFENAC 50MG TAB 100 20,000
333 NEUROBION INJ TAB 500
336 NIFEDIPIN 10MG TABLET TAB 100 18,000
337 NIFIDIPIN TAB SR 20 MG TAB 100 500
338 NIKARDIPIN INJ AMP 50
344 NITROKAF FORTE 500
349 NYSTATIN 100.000IU VAGINAL TABLET
350 NYSTATIN 500.000IU ORAL TABLET 500
351 OBAT BATUK HITAM BTL 50 300
352 OFLOXACIN 400MG TAB TAB 50 2,000
355 OMEPRAZOLE CAPSUL CAP 30 5,000
356 OMEPRAZOLE INJEKSI 40mg IN 10ml AMP 1 1,800
357 ONDANSETRON 4MG TAB 1000
359 ONDANSETRON INJEKSI 4mg IN 2 ml AMP 10 1,000
361 OTSU KCl 7.46% BTL 1 50
364 OXYTETRACYCLIN SALEP MATA 1% TUBE 25 360
365 OXYTOCIN INJEKSI/INDUXIN AMP 100 1,000
366 PAN AMIN G SOLUTION BTL 20 1,000
371 PAPAVERIN HCL TABLET TAB 1000 5,000
372 PARACETAMOL 500MG TABLET TAB 1000 10,000
373 PARACETAMOL DROPS BTL 50 500
374 PARACETAMOL INFUS BTL 10 4,000
376 PARACETAMOL SYRUP BTL 50 500
380 PHENOBARBITAL 30MG TAB TAB 100 3,600
381 PHENOBARBITAL INJEKSI TAB 30 720
383 PHYTOMENADION ( VIT K ) INJ 10 MG / 1 ML AMP 10 1,080
384 PHYTOMENADION ( VIT K ) TAB 10 MG TAB 100 1,000
385 PIOGLITAZON 30 MG TAB 1000
386 PIOGLITAZON 15 MG TAB 1000
387 PIRACETAM 1 G INJEKSI BPJS AMP 10 1,800
389 PIRACETAM INJEKSI 3G/15ML AMP 10 900
393 PIROXICAM 20MG TABLET TAB 100 1,000
394 PRAVASTATIN TABLET 20mg AMP 100 1,500
395 PREDNISON TABLET TAB 100 10,000
396 PRIMAQUIN TABLET TAB 1000 30,000
397 PRIMOLUT N TAB 30 1,000
399 PROPANOLOL 40MG TABLET TAB 100 1,000
400 PROPANOLOL TABLET 10mg TAB 100 2,500
401 PROPILTIOURASIL 100MG TABLET TAB 10 1,500
402 PROPOFOL INJ AMP 5 500
404 PROSTIGMIN INJ (NEOSTIGMIN) AMP 5 100
405 PULAREX TABLET TAB 100 5,000
406 Budesonid respules / cairan inhaler 0,25mg/mL NEB 5 300
408 PYRANTEL PAMOATE SYR 125MG BTL 50 240
409 PYRANTEL TAB 125 MG tab 300
410 PYRAZINAMDE 500MG TABLET TAB 100 5,000
411 PYRIDOXIN TABLET (VIT. B 6 ) TAB 1000 43,000
412 RANITIDINE 150MG TABLET TAB 100 30,000
413 RANITIDINE INJEKSI AMP 25 9,000
417 RESPERIDON 1mg TAB TAB 500
418 RETINOL VIT A 200.000 IU CAP 100 10
419 RETINOL VIT A 100.000 IU CAP 100 10
420 RIFAMPICIN 300MG CAPSUL TAB 100 7,000
421 RIFAMPICIN 450MG TABLET TAB 100 4,000
422 RIFAMPICIN 600MG TABLET TAB 100 3,000
423 RINGER LACTATE SOL 500ML BTL 20 5,000
426 SALBUTAMOL 2MG TABLET TAB 100 5,000
427 SALBUTAMOL 4MG TAB 100 5,000
428 SALBUTAMOL NEBULESER (VENTOLIN) TAB 25 1800
430 SALYCIL BEDAK bks 1 500
433 SERETIDE DISCUSS 100mcg 30
435 SIMVASTATIN TABLET 10MG TAB 30 44,910
437 SPIRAMICYN 500MG TABLET TAB 2,500
438 SPIRONOLAKTON TAB 100 MG TAB 100 3,000
439 SPIRONOLAKTON TAB 25 MG TAB 100 5,000
440 STREPTOKINASE INJ AMP 1 10
441 STREPTOMICYN SO4 INJEKSI VIAL 100 300
442 SUCRALFAT SYP BTL 25 1000
448 SYNARCUS CREAM TUBE 1 10
449 TELMISARTAN 40mg TAB TAB 50 2000
450 TEOFILIN 150MG TAB TAB 100 1,500
451 TERASOZIN HCL 1 mg TAB TAB 4000
452 TERBUTALIN SO4 TAB 2,5MGTAB TAB 1,000
453 THIAMIN 50MG TABLET TAB 100 12,000
454 Asetosal 80 mg TAB 10,800
455 TIMOLOL 0,5% TTS MATA BTL 10 100
456 TRAMADOL CAPSUL 50MG CAP 50 7,000
457 TRAMADOL INJ AMP 10 2,000
458 TRIAMSINOLON INJEKSI 50
459 TROPICAMIDE 1% BTL 1 100
463 VALSARAN 80mg TAB TAB 30 4,000
464 VARAPAMIL 80 MG TAB 30 2000
470 VITAMIN B COMP. TABLET TAB 100 40,000
473 WIDA 2 A BTL 20 200
474 WIDA HSD 500
475 WIDA RD BTL 500
476 YODIUM POVIDON SOL 10% 1LTR BTL 1 500
477 YODIUM POVIDON SOL 10% 30 ML BTL 1 300
478 ZINC 20mg TABLET TAB 100 10,000
479 ZINK SYP BTL 1 1000
Burnazin Cream 35g TUBE 200
Intralipid Infuse 100ml botol 1 40
BETADIN BOTOL BTL 400
OBAT NON CATALOGUE

NO NAMA OBAT SATUAN KEMASAN JUMLAH
1 Akilen tetes telinga BTL 250
2 AMBROXOL SYRUP BTL 50 7,200
3 AMBROXOL TAB TAB 100 24,000
4 ALINAMIN INJ AMP 1000
5 ANTI BISA ULAR (KHUSUS ULAR DARI PAPUA) AMP 1 10
6 ANTI RABIES AMP 30
7 ASAM SALICIL BASE KG 1
8 ASAM BORAC KG 1
9 ASAM TRANEXAMAT TAB 500 MG TAB 100 10,000
10 ASAM URSODIOKSIKOLAT TAB 3000
11 ASETAZOMALID TAB TAB 500
12 ANTALGIN 500MG TAB TAB 100 5,000
13 ANTALGIN INJEKSI AMP 100 2,000
14 ATS INJ AMP 10 100
15 BESI II SO4 TAB. SALUT KOMB SYP BTL 1 720
16 BESI II SO4 TAB. SALUT KOMB SYP DR0P BTL 1 300
17 BROMHEXIN TABLET TAB 100 5,000
18 CHLORAMPHENICOL EAR DROPS TUBE 24 240
19 CIPROFLOXACIN TETES MATA 0,3% BTL 50
20 CITICOLIN 125mg INJEKSI AMP 10 6,000
21 CITICOLIN 500mg TABLET TAB 30 18,000
22 CO- AMOXYCLAV 625MG TAB CAP 30 2,000
23 DEXKETOPROFEN TROMETAMOL 25 MG/2ML(KETESE) AMP 5 200
24 DEXTRAN SOL 70% 500ML BTL 10 1,000
25 DOKSAZOSIN MESILAT TAB 1mg TAB 100 4000 pfizer
26 DULOXETIN INJ AMP 200
27 EPERISON TAB 1000
28 ETAKRIDINE LAKTATE SOL (RIVANOL) 100ML TAB 1000
29 FENOPER INJ AMP 50
30 FENOTEROL HBR TAB 2000
31 FLEXON CREAM 20 GR TUBE 1 60
32 FONDAFARINUX SODIUM AMP 1 50
33 FUTROLIT INF BTL 200
34 GABAPENTIn TAB 50 600
35 GAMEKSAN SOL BTL 1 200
36 GANSIKLOVIR TAB TAB 1000
37 GLIKUIDON TAB 30 MG TAB 100 2000
38 GLUCOSA 40% SOL 25ML BTL 200
39 GLUKOSAMIN KONDROITIN TAB TAB 1000
40 GRANISETRON AMP 5 500
41 HIDROKORTISON INJ AMP 100 500
42 HYLURONAT ACID INJ AMP 500
43 HYOSCINE-N-BUTILBROMIDE 10MG TAB 100 1,000
44 ITRACONAZOLE 100MG TAB TAB 1,500
45 JELLY LUBRICATING 82 GR TUBE 480
46 KALIUM DIKLOFENAC 50MG TAB 50 10,000
47 KALIUM PERMANGANAT (pk) BTL 12 240
48 KALTROPEN GEL TUBE 1 60
49 KANDISSTATIN DRP BTL 1 300
50 KETOPROFEN TABLET 100MG TAB 50 1,000
51 KLOMIFEN SITRAT TAB 50MG TAB 30 100
52 KOLKISIN TAB 500 MG TAB 100 2500
53 LANTOUS AMP 100
54 LARUTAN PK BTL 24 240
55 LEVOTIROKSIN TAB TAB 500
56 LOPAMIROL FLACON 50
57 MEBENDAZOL 100MG SYRUP SYP 1 300
58 MECOBALAMIN CAP CAP 100 2,000
59 MECOBALAMIN INJ AMP 5 400
60 MEDIFLEX CREAM 30 GR TUBE 1 60
61 MESALAZIN TAB TAB 300
62 METOCLOPRAMIDE SYRUP 5MG/5ML BTL 50 200
63 METOPROLOL AMP 50
64 MGSO3 BTL 30
65 MISOPROSTOL TAB TAB 1500
66 NACL 100 ML INF 0,9 % BTL 20
67 NACL 3 % BTL 50
68 NEOMICYN CAPSUL 500MG CAP 50 1,000
69 NICARDIPINE 40 MG TAB 100 500
70 NICARDIPINE HCL 2 MG AMP 10 50
71 NIMADOPIN TAB TAB 1000
72 NISTATIN SUSP BTL 1 400
73 NITRAL TABLET 0.5mg
74 NITROFURANOTOIN 50 MG TAB 50 2500
75 NITROGLISERIN AMP 200
76 NORADRENALIN INJ AMP 5 100
77 NOVARAPID AMP 100
78 OKSOFERIN 80 ML BTL 1 50
79 OKTREOTID INJ AMP 1 60
80 PANTOCAIN 2% BTL 10 100
81 PANTOCAIN0,5% BTL 1 100
82 PANTOPRAZOLE 40MG INJK AMP 1 300
83 PARACETAMOL SUPP SUPP 10 350
84 OXYTETRACYCLIN SALEP 3% TUBE 24 3,600
85 PELANCAR ASI (LAKTAFIT) TAB 1000
86 PENTHOTAL(theropental) AMP 300
87 PIRACETAM 400MG CAPSUL CAP 100 11,600
88 PIRACETAM TAB 800MG CAP 100 10,000
89 PIRODOSTIGMIN INJ AMP 100
90 PIROXICAM 10MG TABLET TAB 100 1,000
91 PROKAIN BENZIN PENICILIN INJ TAB 20 300
92 RECORONIUM AMP 50
93 SACARUM LACTIS TAB 100 1500
94 SALAP ICTIOL BTL 24 480
95 SERUM ANTI RABIES AMP 10 10
96 SOFT U DERM CREAM TAB 300
97 SULFACETAMIDA TETES MATA BTL 100
98 SULTASOLAZIN TAB TAB 500
99 TUFOSIN INF BTL 300
100 ULTRASONIC GEL 1 LITER BTL 1 15
101 UROGRAFIN 70 AMP 50
102 VECURONIUM AMP 100
103 VIT B12 50 MG TAB 100 5000
104 VIT B12 INJ AMP 10 1000
105 VITAMIN C INJ AMP 1000
106 ZOLPIDEM 10 MG TAB 1000
107 KSR KALIUM TAB 100 1000
108 SEVOFLORAN CAIR BTL 1 3
109 ISOPLORAN CAIR BTL 3
Pengadaan
III Kebutuhan
Fasilitas
Ruangan
Lemari
Narkotika
1 Ukuran 40 buah
x 80 x 10
cm, Lemari
Dua Pintu 1
2 Blender Oba 1 buah
3 Mesin Pres 1 buah
4 Timbangan An 1 buah
5 Cetakan Kap 1 buah
6 Gelas Ukur 5 1 buah
7 Gelas Ukur 1 1 buah
8 Lumpang Da 10 buah
Bentor Angka 1 buah
Rak Obat 8 buah
9 Kursi 4 buah
10 Kulkas 1 buah
Subtotal
IV Pengadaan Bahan Non Medis Habis pakai

1
2 Sekat Ruang 1 paket
3
4
Subtotal
V Kegiatan Pelatihan Farmasi

1 Training Ma 2 Orang
2 Pisiko Tropi 2 Orang
3 Pengobatan 2 Orang
Subtotal
GRAND TOTAL
jayamas 24,725 7,417,500
jayamas 11,500 5,750,000
widatra 10,350 3,105,000
43,700 4,370,000
43,700 6,555,000
43,700 4,370,000
abadinusa 929,200 74,336,000
abadinusa 103,500 -
bbraun 3,450 3,450,000
- -
- -
- -
- -
- - -
bbraun 3,450 1,725,000
bbraun 3,450 1,725,000
bbraun 3,450 3,450,000
bbraun 3,450 5,175,000
bbraun 3,450 1,725,000
- -
- -
rajawali 34,062 5,109,278
rajawali 36,249 5,437,373
rajawali 25,989 3,898,328
rajawali 25,989 3,898,328
- -
- -
- -
- -
- -
- -
- -
- -
rajawali 27,874 2,006,906
rajawali 30,409 2,189,480
rajawali 27,176 1,956,647
rajawali 27,245 1,961,615
- -
megah 4,048 809,600
megah 4,048 404,800
megah 4,048 404,800
megah 4,048 809,600
megah 4,048 404,800
megah 4,048 404,800
megah 4,048 404,800
- -
rajawali 961,584 28,847,520
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
megah 48,197 7,229,475
megah 48,197 4,819,650
138,000 690,000
- -
97,750 4,887,500
97,750 4,887,500
97,750 4,887,500
97,750 4,887,500
97,750 4,887,500
97,750 4,887,500
97,750 7,820,000
97,750 7,820,000
97,750 7,820,000
97,750 7,820,000
- -
356,500 10,695,000
356,500 10,695,000
356,500 10,695,000
356,500 10,695,000
356,500 10,695,000
- -
bio 12,650 5,060,000
bio 12,650 1,265,000
bio 12,650 632,500
bio 12,650 1,265,000
bio 12,650 1,265,000

bio 12,650 4,427,500
bio 12,650 1,265,000
jayamas 373,750 3,737,500
jayamas 373,750 3,737,500
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
otsuka 9,108 40,986,000
otsuka 9,108 6,375,600
- -
- -
- -
- - 1000 1000/12
- - 12
- - 83.333333
- -
- -
- -
- -
ahmadaris 149,500 52,325,000
- -
- -
- -
- -
- -
25,300 25,300,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- - 400 40
- -
- -
- -
- -
- -
- -
- -
- -
PERMINTAAN OK
rajawali 16,100 7,728,000
rajawali 15,658 7,516,032
rajawali 15,658 7,829,200
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
Terumo 11,512 1,151,150
Terumo 11,512 4,144,140
Terumo 11,512 4,144,140
Terumo 10,167 2,033,430
Terumo 10,167 2,541,788
8,855 2,213,750
Terumo 10,167 2,541,788
- -
- -
- -
22,138 16,603,125
36,984 18,492,000
- -
- -
rajawali 39,707 7,941,440
- -
- -
57,500 575,000
- -
5,756 14,389,375
- -
- -
- - 33,568,671
782,672 7,826,716 28,243,619
697,459 6,974,589 61,812,290
681,117 6,811,174
- -
46,000 1,380,000
46,000 1,380,000
46,000 460,000
564,233,971
800,000,000 788,300,000
HARGA SATUAN
- - 139.0 phapros 139,000
138,000 5,520,000 138,000.0 ferron ###
476 952,000 280.0 novell 560,000
757 757,000 400.0 samparindo 400,000
375 7,500 24,750.0 sanbe 495,000
990.0 4,950,000 990.0 dexa medica ###
780.0 4,680,000 780.0 dexa medica ###
415 166,000 415.0 holipharma 166,000
100 200,000 100.0 pertiwi agung 200,000
475 1,425,000 475.0 dexa medica ###
280.0 280,000 280.0 kimia farma 280,000
128 640,000 94.0 erela 470,000
3,621 3,621,000 4,587.0 lucas ###
73,920.0 7,392,000 73,920.0 otsuka ###
1,500.0 4,500,000 1,500.0 aventis ###
14,400.0 2,160,000 14,400.0 aventis ###
56,300 22,520,000 56,300.0 otsuka ###
135 486,000 135.0 indofarma 486,000
391 3,128,000 391.0 pertiwi agung ###
218 1,744,000 218.0 pertiwi agung ###
317 1,268,000 243.0 novapharin 972,000
356 5,340,000 288.0 mersifarma ###
4,060 11,774,000 2,790.0 novapharin ###
6,441 2,576,400 6,120.0 phapros ###
250,000 20,000,000 85,000.0 aventis ###
2,532 3,798,000 2,409.0 novapharin ###
181 905,000 85.0 erela 425,000
3,019 724,560 3,019.0 indofarma 724,560
3,650.0 730,000 3,650.0 kimia farma 730,000
622 311,000 622.0 kimia farma 311,000
2,063 722,050 -
162 162,000 162.0 kimia farma 162,000
22,686 1,134,300 22,686.0 pratapa ###
2,400 17,280,000 2,400.0 ikapharmindo ###
191 573,000 191.0 kimia farma 573,000
114 - -
57 570,000 57.0 marin liza 570,000
139 6,950,000 139.0 promedraharjo ###
1,815.0 3,630,000 1,815.0 sanbe ###
4,000 7,200,000 -
9,000 4,500,000 9,000.0 otsuka ###
15,662 2,349,300 15,662.0 novell ###
1,518 759,000 1,620.0 ethica 810,000
- - 89.0 indofarma 26,700
13,500 135,000 13,500.0 cendo 135,000
5,400 10,800,000 5,400.0 kimia farma ###
- 37,500.0 soho ###
- 16,080.0 phapros ###
- 3,600.0 combiphar 720,000
117,500 3,525,000 117,500.0 boehringer ###
49 392,000 -
1,108 3,324,000 -
1,865 373,000 1,824.0 kimia farma 364,800
25,106 251,060 25,106.0 cendo 251,060
- 909.0 pratapa ###
6,250 625,000 6,250.0 astra zeneca 625,000
- 30,720.0 dexa medica ###
- 32,000.0 astra zeneca ###
70 1,050,000 83.0 afifarma ###
- 489.0 mersifarma 195,600
7,800 748,800 7,800.0 ethica 748,800
128 1,280,000 73.0 phapros 730,000
173 10,380,000 102.0 phapros ###
296 296,000 294.0 indofarma 294,000
30,600 1,530,000 30,600.0 boehringer ###
40 200,000 618.0 pharma ###
6,178 7,413,600 5,984.0 holipharma ###
1,010 25,250,000 1,100.0 Hexparn ###
10,500 3,150,000 10,500.0 ###
14,645 4,393,500 14,645.0 Hexparn ###
5,394 21,576,000 5,394.0 Hexparn ###
20,472 4,094,400 20,472.0 Hexparn ###
8,955 44,775,000 5,688.0 Hexparn ###
14,645 1,464,500 71,500.0 pratapa ###
211 1,055,000 211.0 pertiwi agung ###
10,500 7,350,000 3,960.0 pratapa ###
350 700,000 299.0 kimia farma 598,000
4,750 2,375,000 4,750.0 ikapharmindo ###
- 22,210.0 erela ###
1,920 1,113,600 1,920.0 kimia farma ###
126 1,260,000 -
101 7,272,000 59.0 rama emerald ###
46 138,000 82.0 phapros 246,000
46 13,800 1,320.0 phapros 396,000
420 4,200,000 324.0 Hexparn ###
24,457 4,891,400 24,487.0 Hexparn ###
451 9,020,000 451.0 indofarma ###
842 4,210,000 678.0 indofarma ###
3,990 5,985,000 -
600 1,200,000 600.0 kimia farma ###
1,020.0 3,060,000 1,020.0 kimia farma ###
1,320.0 3,960,000 1,320.0 kimia farma ###
5,990 8,985,000 5,990.0 boehringer ###
199 2,189,000 166.0 promedraharjo ###
4,337 2,602,200 2,590.0 samparindo ###
6,067 12,012,660 -
19,800 5,940,000 -
1,897 4,742,500 1,897.0 dexa medica ###
107 3,210,000 75.0 promedraharjo ###
54 1,944,000 54.0 kimia farma ###
195.6 978,000 195.6 indofarma 978,000
5,016.0 9,028,800 5,016.0 indofarma ###
20,142 2,014,200 20,142.0 actavis ###
13,914 2,782,800 13,914.0 actavis ###
26,600 3,990,000 26,600.0 pratapa ###
365 3,650,000 119.0 indofarma ###
56,000 5,600,000 56,000.0 pratapa ###
180 90,000 160.0 dexa medica 80,000
125 150,000 125.0 kimia farma 150,000
1,157 578,500 1,265.0 lucas 632,500
68,607 5,488,560 31,000.0 ferron ###
11,760 1,176,000 11,760.0 kimia farma ###
309 4,635,000 325.0 yarindo ###
4,990 1,497,000 4,990.0 boehringer ###
48,890.0 2,444,500 48,890.0 aventis ###
62 930,000 -
9,720 9,720,000 9,720.0 phapros ###
### 13,950,000 139,500.0 boehringer ###
### 12,800,000 128,000.0 kalbe ###
600 600,000 596.0 kimia farma 596,000
1,471 17,652,000 1,116.0 indofarma ###
9,720 7,290,000 8,495.0 phytokemoagun ###
94,925.0 18,985,000 94,925.0 sunthi ###
2,875 2,875,000 2,875.0 novapharin ###
688 688,000 545.0 indofarma 545,000
20,000.0 200,000 20,000.0 kimia farma 200,000
160 800,000 160.0 ikapharmindo 800,000
22,127 7,744,450 22,127.0 mersifarma ###
1,075 1,612,500 1,075.0 Hexparn ###
1,210 87,120 -
40,697 20,348,500 40,697.0 kimia farma ###
18,600 1,860,000 183,600.0 kimia farma ###
26,400 13,200,000 26,400.0 kimia farma ###
247 247,000 2,195.0 indofarma ###
135 1,350,000 89.0 samparindo 890,000
815 815,000 815.0 indofarma 815,000
3,039 607,800 3,039.0 erela 607,800
4,578 7,324,800 4,079.0 indofarma ###
2,459 6,885,200 -
3,933 393,300 3,832.0 indofarma 383,200
540 108,000 -
84 168,000 70.0 indofarma 140,000
33 165,000 -
318.0 795,000 318.0 kimia farma 795,000
523 1,046,000 523.0 kimia farma ###
523 261,500 485.0 kimia farma 242,500
516.0 258,000 516.0 kimia farma 258,000
1,800.0 72,000 1,800.0 actavis 72,000
11,900.0 5,950,000 11,900.0 tempo ###
9,240 18,480,000 9,240.0 widatra ###
9,240 13,860,000 9,240.0 widatra ###
6,840 1,368,000 6,840.0 widatra ###
6,101 42,707,000 6,254.0 widatra ###
6,800 6,800,000 6,800.0 widatra ###
264 - 263.0 indofarma -
138 276,000 138.0 mersifarma 276,000
83 83,000 83.0 indofarma 83,000
770,000 2,310,000 770,000.0 dexa medica ###
53,400.0 5,340,000 53,400.0 pratapa ###
### 132,800,000 1,328,000.0 dipa pharmalab ###
178.0 890,000 178.0 kimia farma 890,000
5,775 4,158,000 3,358.0 kimia farma ###
3,084.0 925,200 3,084.0 marin 925,200
165,000 82,500,000 33,000.0 frsenius ###
### 154,000,000 900,000.0 ikapharmindo ###
170,000 5,100,000 170,000.0 dexa medica ###
5,400.0 2,160,000 5,400.0 otto ###
132 132,000 132.0 yarindo 132,000
189 2,835,000 171.0 novapharin ###
4,199 1,259,700 4,199.0 indofarma ###
5,399.0 1,079,800 5,399.0 indofarma ###
128,779 2,575,580 -
90,000.0 45,000,000 90,000.0 boehringer ###
2,980.0 8,940,000 2,980.0 soho ###
49 245,000 78.0 phytokemoagun 390,000
319 6,380,000 190.0 phytokemoagun ###
40,920 8,184,000 40,920.0 pratapa ###
117 2,106,000 220.0 kimia farma ###
107 107,000 107.0 indofarma 107,000
12,000 360,000 -
9,000 1,800,000 9,000.0 otsuka ###
10,000 2,000,000 10,000.0 otsuka ###
10,000 1,400,000 10,000.0 otsuka ###
11,000 1,100,000 11,000.0 otsuka ###
877.0 877,000 877.0 tempo 877,000
10,140.0 60,840,000 10,140.0 novell ###
1,580.0 790,000 1,580.0 merck 790,000
4,800 1,920,000 5,200.0 Hexparn ###
5,345 13,362,500 5,880.0 dexa medica ###
3,720.0 13,392,000 3,720.0 dexa medica ###
2,450.0 735,000 2,450.0 lucas 735,000
6,681 3,340,500 3,083.0 kimia farma ###
483 724,500 349.0 novapharin 523,500
33,600 3,360,000 33,600.0 ikapharmindo ###
6,780 2,034,000 -
3,266.0 816,500 3,266.0 kimia farma 816,500
3,220 34,776,000 2,799.0 indofarma ###
1,000 1,500,000 1,000.0 dexa medica ###
258 258,000 221.0 kimia farma 221,000
1,500 7,500,000 3,990.0 soho ###
132,000 2,640,000 132,000.0 guardian ###
501 1,503,000 804.0 kimia farma ###
17,400.0 8,700,000 17,400.0 ikapharmindo ###
596 21,456,000 596.0 indofarma ###
12,450 3,735,000 12,450.0 galenium ###
633.0 633,000 633.0 promedraharjo 633,000
15,275 305,500 15,275.0 erela 305,500
64,680 3,234,000 64,680.0 kimia farma ###
1,282 1,282,000 1,026.0 phapros ###
2,999 1,499,500 1,635.0 indofarma 817,500
720 720,000 720.0 novell 720,000
420 420,000 420.0 novell 420,000
7,500 375,000 7,500.0 mersifarma 375,000
107 214,000 107.0 ifars 214,000
185 185,000 185.0 promedraharjo 185,000
23,325 5,598,000 3,500.0 otsuka 840,000
2,800.0 672,000 2,800.0 otsuka 672,000
62,000 6,200,000 62,000.0 finusolprima ###
35,000 7,000,000 35,000.0 otsuka ###
7,650 3,060,000 8,568.0 pfizer ###
1,230 4,428,000 -
7,920 2,376,000 -
80,000.0 16,000,000 80,000.0 yarindo ###
88,759 8,875,900 88,759.0 dexa medica ###
219 657,000 -
960.0 960,000 960.0 actavis 960,000
3,850 3,850,000 3,630.0 ethica ###
25,500 51,000,000 25,500.0 dexa medica ###
900 4,500,000 900.0 dexa medica ###
11,200 2,240,000 112,074.0 phapros ###
440 17,600,000 440.0 novell ###
9,559 9,559,000 -
172 172,000 109.0 phapros 109,000
122.0 610,000 122.0 phytokemoagun 610,000
265 5,300,000 176.0 phytokemoagun ###
59,148 354,888,000 14,400.0 dexa medica ###
7,440 744,000 7,440.0 otsuka 744,000
3,600 864,000 3,600.0 kimia farma 864,000
10,322.0 6,193,200 10,322.0 novell ###
1,560.0 468,000 1,560.0 kimia farma 468,000
12,599 251,980 12,599.0 kimia farma 251,980
73,900 2,217,000 73,900.0 pratapa ###
5,643 33,858,000 5,640.0 widatra ###
206 1,030,000 160.0 PT.phapros 800,000
271 5,420,000 211.0 PT.phapros ###
15,000 7,500,000 -
155 2,790,000 140.0 dexa medica ###
2,999.0 1,499,500 2,999.0 bayer ###
95,700.0 4,785,000 95,700.0 pratapa ###
2,171 1,085,500 -
576.0 - 576.0 phapros -
720 360,000 768.0 phapros 384,000
1,716 514,800 -
883 1,766,000 800.0 novell ###
261 1,305,000 240.0 novapharin ###
49,000.0 88,200,000 49,000.0 dexa medica ###
1,090.0 1,090,000 1,090.0 yarindo ###
10,560 10,560,000 2,700.0 indofarma ###
2,460 123,000 2,460.0 otsuka 123,000
2,888 1,039,680 -
2,750 2,750,000 1,900.0 tunggal idaman ###
45,000 45,000,000 45,000.0 otsuka ###
119 595,000 -
96.0 960,000 96.0 promedraharjo 960,000
6,238 3,119,000 6,240.0 indofarma ###
49,500 198,000,000 -
1,675 837,500 1,675.0 novapharin 837,500
162.0 583,200 162.0 indofarma 583,200
2,160 1,555,200 2,160.0 phapros ###
2,398 2,589,840 4,100.0 phapros ###
761 761,000 761.0 marin liza 761,000
5,225.0 5,225,000 5,225.0 sanbe ###
4,400.0 4,400,000 4,400.0 takeda ###
6,600 11,880,000 -
20,526 18,473,400 -
127 127,000 -
2,700 4,050,000 2,700.0 novell ###
182 1,820,000 129.0 holipharma ###
211 6,330,000 210.0 phapros ###
2,618 2,618,000 2,618.0 bayer ###
136 136,000 130.0 holipharma 130,000
90 225,000 90.0 dexa medica 225,000
432 648,000 383.0 indofarma 574,500
- 16,236.0 fresenius ###
- -
240 1,200,000 240.0 zenith ###
8,900 2,670,000 8,900.0 astra zeneca ###
10,420 2,500,800 -
- 362.0 holipharma 108,600
280 1,400,000 258.0 holipharma ###
21 903,000 132.0 kimia farma ###
140 4,200,000 140.0 erela ###
1,680 15,120,000 1,680.0 phapros ###
1,600.0 800,000 1,600.0 dexa medica 800,000
551.0 5,510 551.0 lucas 5,510
312.0 3,120 312.0 kimia farma 3,120
576 4,032,000 732.0 indofarma ###
792 3,168,000 947.0 indofarma ###
1,107 3,321,000 1,319.0 indofarma ###
6,240 31,200,000 6,240.0 widatra ###
103 515,000 71.0 yarindo 355,000
117 585,000 107.0 kimia farma 535,000
7,920.0 14,256,000 7,920.0 glaxo ###
1,450.0 725,000 1,450.0 rama emerald 725,000
12,100 363,000 121,000.0 glaxo ###
198.0 8,892,180 198.0 pertiwi agung ###
1,849 4,622,500 1,799.0 indofarma ###
1,100.0 3,300,000 1,100.0 dexa medica ###
400 2,000,000 400.0 dexa medica ###
### 32,900,000 3,290,000.0 dexa medica ###
2,280 684,000 4,380.0 phapros ###
19,500.0 19,500,000 19,500.0 combiphar ###
3,000 30,000 -
3,900.0 7,800,000 3,900.0 boehringer ###
350.0 525,000 350.0 kalbe 525,000
1,900.0 7,600,000 1,900.0 abbot ###
104.0 104,000 104.0 molex 104,000
45 540,000 -
704 7,603,200 178.0 mersifarma ###
12,000.0 1,200,000 12,000.0 pratapa ###
396 2,772,000 -
7,682 15,364,000 3,000.0 novell ###
80,000.0 4,000,000 80,000.0 dexa medica ###
36,500.0 3,650,000 36,500.0 cendo ###
3,510.0 14,040,000 3,510.0 novartis ###
281.0 562,000 281.0 kimia farma 562,000
123 4,920,000 122.0 kimia farma ###
8,300 1,660,000 8,300.0 widatra ###
9,500 4,750,000 9,500.0 widatra ###
6,930 3,465,000 6,930.0 widatra ###
50,400 25,200,000 44,434.0 afifarma ###
2,590.0 777,000 2,590.0 afifarma 777,000
569 5,690,000 569.0 indofarma ###
8,880 8,880,000 8,800.0 meprofarm ###
27,650.0 5,530,000 27,650.0 darya varya ###
60,500.0 2,420,000 60,500.0 fresenius ###
50,400 20,160,000
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#REF!
DATA DUKUNG
Nama Peserta Desk : Antonius Moa
Unit : Cleaning Service
Jabatan : Kasi Non Medik/Bendahara Barang
No. Telepon :
KEGIATAN SATUAN
No VOLUME SATUAN
(Unit Cost)
A. KEBUTUHAN
1 Tempat Sampah Besar 25 buah
2 Tempat Sampah Sedang 50 buah
3 Tempat Sampah Kecil 100 buah
4 Kantong Sampah Besar Ukuran 120 x 180 50 pak
5 Kantong Sampah Sedang Ukuran 90 x 180 50 pak
6 Kantong Sampah Kecil Ukuran 90 x 90 50 pak
7 Kain Lap / Seka 20 buah
8 Troly Cleaning Service 10 buah
9 Gerobak Sampah 5 buah
10 Celemek 10 buah
11 Topi Kerja 10 pasang
12 Pakaian Seragam Kerja 40 pasang
13 Spatu Jengle Boot 10 pasang
14 Skop 10 buah
15 Pacul 10 buah
16 Garu-garu Besi 10 buah
B. LOGISTIK
17 Sapu Lantai 25 buah
18 Serok Sampah 25 buah
19 Sapu lawa-lawa 12 buah
20 Alat Pel Lantai 30 buah
21 Sikat Toilet 50 buah
22 Sikat Kamar Mandi 50 buah
23 Alat Pembersih Kaca 5 karton
24 Masker 50 dos
25 Handscoon Besar 50 dos
26 Handscoon On Steril Despesible 50 dos
27 Super Pell 25 karton
28 Soklin Lantai 25 karton
29 sabun Cuci Tangan 5 karton
30 Tisu Roll 24 buah
31 Glass Cleaner 12 karton
32 Harpic 12 buah
33 portex 50 karton
34 Bayclin 25 karton
35 Serok Air / Tolak-tolak Air 25 buah
36 Sapu Lidi 10 buah
37 Garuk-garuk Rumput 10 buah
38 Septi / Jingle Boot 10 pasang
C. A T K
Buku Folio Besar 6 buah
Tip - Ex 12 buah
Spidol Permanent 10 buah
Balpoint Hitam (FASTER) 3 dos
Spidol Snowman Boardmarker Hitam 20 buah
Pensil 12 buah
Hekter 5 buah
Isi Hekter 10 dos
Lem 10 buah
Map Folder 6 buah
Box File 5 buah
Penggaris 30 cm 3 buah
Tambahan Tenaga 6 Orang
Bidang Perencanaan Peserta Desk
……………………………… ……………………………
NIP : NIP :
NG
RJA & MUSREN
EYEN 2015
g TOTAL :
DATA DUKUNG KEGIATAN

JUMLAH KETERANGAN LOKASI
(Ada/Tidak)
…………………… Drg. ROSALINE N.I KRIMADI, MPH

NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk :
Unit : SOPIR
Jabatan : Koordinator
No. Telepon :
KEGIATAN SATUAN
No VOLUME SATUAN
(Unit Cost)
1 Kendaraan Ambulance 2 unit

2 Kendaraan Jenazah 1 unit
3 Service Ringan Kendaraan Setahun 6 kali
4 Tempat Tidur Sopir
5 Kipas Angin
6 Ruangan Tetap
7 Ban Bus Besar 260 Buah
8 Ban Ranger 2 unit
9 Ban Kijang 9 Buah
10 Ban Bus Mini 22 Buah
11 Mesin Gurinda 1 Buah
12 Mesin Bor 1 buah
13 Mesin Las Listrik
14 Sirene Ambulance 4 Buah
15 Kunci Ring Pas 1 Set
16 Kunci Moment 1 Buah
……………………………… ……………………………
NIP : NIP :
UNG
ERJA & MUSREN
KEYEN 2017
TOTAL :

(Ada/Tidak)
………………… Drg. ROSALINE N.I KRIMADI, MPH

NIP : 19771120 200212 2 006
19771120 200212 2 006
DAFTAR KEBUTUHAN BAHAN MAKANAN KERING BAGI PASIEN DAN PEGAWAI
RSUD SCHOOLO KEYEN TAHUN 2017
A. Bahan Makanan Kering
No Jenis Bahan Kering Satuan Penggunaan volume setahun Harga Pasar(Rp) Total Harga Keterangan
perbulan
1 Beras 99,betet@ 25 kg karung 32 384 365,000 140,160,000
2 Beras Ketan hitam kg 2 24 25,000 600,000
3 Biji Slasi btl 4 48 20,000 960,000
4 Biskuit gabin bks 15 180 20,000 3,600,000
5 Cuka Makan Btl 40 480 10,000 4,800,000
6 Cornet Beef @ 340 gr klg 15 180 30,000 5,400,000
7 Daun the celup benderah dos 24 288 6,000 1,728,000
8 Aqua Gelas 220 ml karton 52 624 60,000 37,440,000
9 Aqua Botol 330 ml karton 62 744 80,000 59,520,000
10 Garam halus cap kapal @ 500 gr bks 31 372 5,000 1,860,000
11 Gelas Pop ice gantung 3 36 50,000 1,800,000
12 Gelas es buah gantung 4 48 50,000 2,400,000
13 Gula Merah bh 15 180 25,000 4,500,000
14 Gula Pasir Merk gulaku kg 40 480 60,000 28,800,000
15 Gula Diabetasol dos 2 24 170,000 4,080,000
16 Jagung Manis Kaleng @ 432 gr klg 10 120 35,000 4,200,000
17 Jagung Kaleng Baby @ 425 gr klg 10 120 35,000 4,200,000
18 Jamur Kuping @ 300 gr bks 12 144 25,000 3,600,000
19 Jamur Kaleng Mushrooms klg 10 120 35,000 4,200,000
20 Jamur rumput laut bks 15 180 40,000 7,200,000
21 kacang Tanah kg 10 120 15,000 1,800,000
22 kacang ijo kg 8 96 30,000 2,880,000
23 Kacang Polong klg 10 120 30,000 3,600,000
24 Kawat Gosok bh 12 144 5,000 720,000
25 Kecap Manis @ 620 ml btl 25 300 30,000 9,000,000
26 Kecap Inggris @ 195 ml btl 3 36 35,000 1,260,000
27 Kluwek @ 21 bh bks 4 48 15,000 720,000
28 Kembang Tahu @ 150 gr bks 12 144 30,000 4,320,000
29 Kotak nasi bh 50 600 5,000 3,000,000
30 Krupuk Udang 500 gr bks 4 48 10,000 480,000
31 LPG tabung 12 144 240,000 34,560,000
32 Masako @ 11 gr isi 8/pak pak 6 72 45,000 3,240,000
33 Macaroniku @ 400 gr dos 3 36 35,000 1,260,000
34 Meses Ceres @250 bks 12 144 30,000 4,320,000
35 Mentega Bluband @ 200 gr bks 20 240 15,000 3,600,000
36 Minyak Tanah liter 100 1200 7,000 8,400,000
37 Minyak Sayur @ 900 ml btl 3 36 25,000 900,000
38 Minyak wijen @ 195 ml btl 4 48 30,000 1,440,000
39 Minyak Goreng Bimoli/kunci mas @ 5 ltr gen 30 360 90,000 32,400,000
40 Mika kue A3 bh 1500 18000 1,000 18,000,000
41 Mika Kue A4 bh 8000 96000 1,000 96,000,000
42 Mika nasi bh 50 600 1,000 600,000
43 Mie sedap goreng @ 40 bks karton 8 96 100,000 9,600,000
44 Natade coco @ 1000 gr bks 6 72 30,000 2,160,000
45 Pala @ 5 bh/bks bks 5 60 10,000 600,000
46 Plastik Gula 1 kg bks 2 24 20,000 480,000
47 Plastik Roll 8 cm roll 2 24 20,000 480,000
48 Plastik Strep merah pak 2 24 10,000 240,000
49 Plastik Merah Besar pak 2 24 50,000 1,200,000
50 Plasti Klip ukuran sedang @ 10 bks pak 2 24 50,000 1,200,000
51 Plastik Wraping ukuran besar gulung 2 24 150,000 3,600,000
52 Roti Tawar bks 48 576 20,000 11,520,000
53 Sabun B29 pot 10 120 7,000 840,000
54 Sabun Sunlight @ 800 ml bks 30 360 20,000 7,200,000
55 Saos tiram @ 425 btl 5 60 35,000 2,100,000
56 Sarung Tangan dos 12 144 50,000 7,200,000
57 Sedap mlm @ 100 gr bks 4 48 30,000 1,440,000
58 Sirup ABC @ 580 ml btl 10 120 25,000 3,000,000
59 Soun Cap naga @ 100 gr bks 64 768 7,000 5,376,000
60 Sendok makan Plastik bh 3500 42000 1,000 42,000,000
61 Selai @ 250 gr gls 12 144 35,000 5,040,000
62 Spons Cuci bh 12 144 10,000 1,440,000
63 Susu Dancow saset @ 75 gr isi 10 bgks/gantung gantung 180 2160 35,000 75,600,000
64 Susu SGM 1`,2 ,3 @ 400 gr dos 3 36 75,000 2,700,000
65 Susu pepamin Junior 400 gr dos 4 48 200,000 9,600,000
66 Susu Pregistimin 400 gr dos 4 48 200,000 9,600,000
67 Susu LLM @ 400 gr dos 4 48 65,000 3,120,000
68 Susu Ultra @ 200 ml karton 2 24 120,000 2,880,000
69 Susu Diabetasol @ 600 gr dos 2 24 170,000 4,080,000
70 Tepung beras putih @ 500 gr bks 15 180 15,000 2,700,000
71 Tepung Bumbu mama suka @ 250 gr bks 20 240 15,000 3,600,000
72 Tepung Maizena honig @ 750 gr bks 2 24 30,000 720,000
73 Tissu segi empat bks 10 120 10,000 1,200,000
TOTAL 776,064,000
B. SAYURAN
NO URAIAN SATUAN VOLUME HARGA PASAR Fruktuatif Harga HPS Jumlah Harga
10%
1 Bayam cabut tanpa akar kg 1044 20,000 2,000 22,000 22,968,000
2 Buncis kg 360 35,000 3,500 38,500 13,860,000
3 Bunga kol kg 72 40,000 4,000 44,000 3,168,000
4 Bunga Pepaya ikat 180 10,000 1,000 11,000 1,980,000
5 Daun melinjo ikat 144 10,000 1,000 11,000 1,584,000
6 Daun singkong ikat 756 5,000 500 5,500 4,158,000
7 Daun Kemangi ikat 360 5,000 500 5,500 1,980,000
8 Gambas ikat 72 10,000 1,000 11,000 792,000
9 Gedi ikat 360 15,000 1,500 16,500 5,940,000
10 Jagung Mudah tanpa kulit ikat 144 10,000 1,000 11,000 1,584,000
11 Jantung Pisang bh 108 10,000 1,000 11,000 1,188,000
12 Kacang panjang Mudah ikat 756 10,000 1,000 11,000 8,316,000
13 Kangkung ikat 936 5,000 500 5,500 5,148,000
14 Ketimun tumpuk 288 10,000 1,000 11,000 3,168,000
15 Kentang kg 396 25,000 2,500 27,500 10,890,000
16 Kol puti kg 1080 35,000 3,500 38,500 41,580,000
17 Labu Kuning kg 72 25,000 2,500 27,500 1,980,000
18 Labu siam kg 684 20,000 2,000 22,000 15,048,000
19 Nangka Mudah tanpa kulit tumpuk 252 10,000 1,000 11,000 2,772,000
20 Petatas tumpuk 72 30,000 3,000 33,000 2,376,000
21 Sawi Hijau ikat 1080 10,000 1,000 11,000 11,880,000
22 Sawi Putih kg 108 40,000 4,000 44,000 4,752,000
23 Tauge Kacang hijau tumpuk 864 10,000 1,000 11,000 9,504,000
24 Terong ungu ikat 108 10,000 1,000 11,000 1,188,000
25 Wortel kg 1368 25,000 2,500 27,500 37,620,000
26 Singkong tumpuk 72 20,000 2,000 22,000 1,584,000
27 Sagu tumpuk 108 20,000 2,000 22,000 2,376,000
219,384,000
C . BUMBU -BUMBU
NO URAIAN SAT VOLUME Harga Pasar fruktuatif harga HPS Jumlah Harga
10%
1 Asam Jawa bks 216 40,000 4,000 44,000 9,504,000
2 Barang Merah kg 240 30,000 3,000 33,000 7,920,000
3 Bawang Putih kg 180 30,000 3,000 33,000 5,940,000
4 Biji Pala bks 60 10,000 1,000 11,000 660,000
5 Cabe Rawit kg 72 50,000 5,000 55,000 3,960,000
6 Cabe Merah Besar kg 300 50,000 5,000 55,000 16,500,000
7 Daun Bawang kg 72 35,000 3,500 38,500 2,772,000
8 Daun Jeruk Purut kg 72 35,000 3,500 38,500 2,772,000
9 Daun Kemangi ikat 504 5,000 500 5,500 2,772,000
10 Daun Salam ikat 108 5,000 500 5,500 594,000
11 Daun Seledri ikat 540 5,000 500 5,500 2,970,000
12 Daun Pandan ikat 12 5,000 500 5,500 66,000
13 Daun Pisang gulung 252 10,000 1,000 11,000 2,772,000
14 Jahe Putih kg 36 60,000 6,000 66,000 2,376,000
15 Jintan halus bks 60 20,000 2,000 22,000 1,320,000
16 Kacang Tanah kg 85 30,000 3,000 33,000 2,805,000
17 Kacang Merah kg 180 25,000 2,500 27,500 4,950,000
18 Kayu Manis ikat 12 10,000 1,000 11,000 132,000
19 Kelapa Parut bh 1152 8,000 800 8,800 10,137,600
20 Kemiri kg 60 60,000 6,000 66,000 3,960,000
21 Kencur kg 12 70,000 7,000 77,000 924,000
22 Ketumbar kg 12 30,000 3,000 33,000 396,000
23 Kunyit kg 72 25,000 2,500 27,500 1,980,000
24 Lengkuas kg 180 20,000 2,000 22,000 3,960,000
25 Merica kg 36 60,000 6,000 66,000 2,376,000
26 Sereh ikat 108 10,000 1,000 11,000 1,188,000
27 Tomat Masak kg 560 30,000 3,000 33,000 18,480,000
28 Terasi Udang bks 540 8,000 800 8,800 4,752,000
TOTAL 118,938,600
D . BUAH-BUAHAN
NO URAIAN SAT VOLUME HARGA PASAR Fruktuatif Harga HPS Jumlah Harga (Rp)
10%
1 Apel kg 2160 45,000 4,500 49,500 106,920,000
2 Jeruk Manis kg 2160 15,000 1,500 16,500 35,640,000
3 Pepaya Masak kg 1440 15,000 1,500 16,500 23,760,000
4 Melon kg 720 18,000 1,800 19,800 14,256,000
6 Pisang nona sisir 360 10,000 1,000 11,000 3,960,000
7 Semangka kg 2160 15,000 1,500 16,500 35,640,000
TOTAL 220,176,000
F. SNACK
NO URAIAN SAT VOLUME HARGA PASAR Fruktuatif Harga HPS Jumlah Harga (Rp)
10%
1 Kue Vip/kls 1 bks 150 5,000 500 5,500 825,000
2 Kue Basah Berbagai Rasa Bks 72500 5,000 500 5,500 398,750,000
TOTAL 399,575,000
DAFTAR KEBUTUHAN MAKANAN BAGI PASIEN DAN PEGAWAI RSUD SCHOOLO KEYEN
TAHUN ANGGARAN 2017
E. LAUK-PAUK
NO URAIAN SATUAN VOLUME HARGA PASAR Fruktuatif Harga HPS Jumlah Harga(Rp)
10%
1 Ayam kg 5000 50,000 5000 55,000 275,000,000
2 Udang kg 1300 90,000 9000 99,000 128,700,000
3 Daging Sapi kg 510 120,000 12000 132,000 67,320,000
4 Ikan kembung kg 470 25,000 2500 27,500 12,925,000
5 Ikan ekor kuning kg 580 300,000 30000 330,000 191,400,000
6 Ikan tenggiri tanpa kepala kg 100 120,000 12000 132,000 13,200,000
7 Bakso sapi kg 180 180,000 18000 198,000 35,640,000
8 Telur (16 btr/kg @ 25000) kg 3348 25,000 2500 27,500 92,070,000
9 Tahu (12 bh/kg @ Rp 15000 kg 1644 15,000 1500 16,500 27,126,000
10 Tempe (4 bh/kg @ Rp 20000 kg 336 20,000 2000 22,000 7,392,000
TOTAL 850,773,000
NO GOLONGAN BAHAN MAKANAN BESAR DANA

A BAHAN MAKANAN KERING 776,064,000
E LAUK-PAUK 850,773,000
B SAYURAN 219,384,000
C BUMBU-BUMBU 118,938,600
D BUAH-BUAHAN 220,176,000
F SNACK 399,575,000
TOTAL DANA 2,584,910,600
PPN 10% 258,491,060
2,843,401,660
USULAN KEGIATAN
PERENCANAAN DAN PENGEMBANGAN RSUD SCHOLOO KEYEN TAHUN 2017
Bidang / Unit Pelaksana : Pelayanan Medik / Gizi

Instalasi : RSUD SCHOLOO KEYEN
URAIAN
NO PROGRAM
TUJUAN
/ KEGIATAN
KEGIATAN
DATA
INDIKATOR
PENCAPAIAN AWAL
SATUAN
TAHUN VOLUME
HARGA SATUAN
JUMLAH
1 2 3 4 5 6 7 8 9
PENGADAAN
A PERALATAN DAPUR DAN GIZI
a. Peralatan Gmenunjangkebutuhan alat-alat dapur

1 Alat Ukur Limeningkatkdan gizi tercukupi bh 4 15,000 60,000
2 Timbangankaryawan bh 2 800,000 1,600,000
3 Timbangan Dewasa Dan Alat Ukur Tinggi B bh 1 1,500,000 1,500,000
4 Alat Ukur Lingkar Kepala (Pita Lika) bh 4 15,000 60,000
5 Gelas Ukur ukuran 1 liter bh 2 20,000 40,000
6 Alat Uji Makanan Siap Saji bh 1 2,000,000 2,000,000
b. Peralatan Dapur
1 Gelas Petugas lusin 32 150,000 4,800,000
2 Gelas Pasien lusin 24 150,000 3,600,000
3 Piring Petugas lusin 32 350,000 ###
4 Piring Pasien Kelas (sango) lusin 4 350,000 1,400,000
5 Rantang Susun Petugas stainles Besar set 50 150,000 7,500,000
6 Ompreng makan pasien kelas 3 stainless bh 200 50,000 ###
7 mangko' lauk pasien kelas 1 dan 2 bh 60 30,000 1,800,000
8 Sendok Petugas merk doll lusin 32 80,000 2,560,000
9 Panci Susun 3 Buah (Untuk Pembuatan F75 zet 1 200,000 200,000
10 Panci Lauk (Tempat Saji) zet 1 2,500,000 2,500,000
11 Galon bh 50 80,000 4,000,000
12 Troli Makan dan Penutup bh 2 5,000,000 ###
13 Penyaringan Air Galon/filter air zet 1 ### ###
14 Baki/Nampan Pasien Kelas bh 24 100,000 2,400,000
15 Pisau Potong Sayur bh 12 20,000 240,000
16 Cofee Maker Ukuran Besar bh 2 2,000,000 4,000,000
17 Dandang Pengukus Nasi ukuran 10 liter bh 2 750,000 1,500,000
18 Dandang masak air ukuran 10 liter bh 2 750,000 1,500,000
19 Panci 55 stainless bh 3 200,000 600,000
20 Mangko' sup (bahan kaca) bh 5 200,000 1,000,000
21 Sendok Sup besar bh 2 150,000 300,000
22 Sendok sup sedang bh 2 100,000 200,000
23 Sendok goreng besar bh 5 80,000 400,000
24 Irus bh 5 50,000 250,000
25 Wajan Ukuran Besar bh 3 400,000 1,200,000
26 Wajan ukuran sedang bh 2 200,000 400,000
27 Baskom besar plastik bh 6 150,000 900,000
28 Baskom sedang plastik bh 6 100,000 600,000
29 Kompor hock 32 sumbu bh 2 800,000 1,600,000
30 Kompor gas 2 tungku bh 3 1,000,000 3,000,000
31 Oven hock no.1 bh 2 1,700,000 3,400,000
32 Blender philips 2 gls bh 2 1,000,000 2,000,000
33 Mixer philips bh 2 1,000,000 2,000,000
34 Tabung gas 12 kg bh 6 650,000 3,900,000
35 Rak bumbu bh 2 250,000 500,000
36 Toples tempat bumbu bh 6 50,000 300,000
37 Rak piring kaca bh 2 2,000,000 4,000,000
38 Meja makan set 1 4,000,000 4,000,000
39 Celemek,masker,topi masak set 48 500,000 ###
40 Pakaian kerja pasangan(atas bawah) bh 48 500,000 ###
41 Tupper ware untuk bumbu halus set 1 200,000 200,000
Total ###
USULAN KEGIATAN
URAIAN
NO PROGRAMTUJUAN
/ KEGIATAN
KEGIATAN
INDIKATOR
DATA CAPAIAN AWALSATUAN
TAHUN VOLUME
HARGA SATUAN
JUMLAH
1 2 3 4 5 6 7 8 9
FASILITAS
B RUANGAN PENUNJANG
1 Keset Kaki bh 10 70,000 700,000

2 Tempat Sampah Besar dan Penutup bh 4 300,000 1,200,000
3 Tempat Sampah Kecil dan Penutup bh 8 150,000 1,200,000
4 Penutup Meja Makan bh 2 150,000 300,000
5 Ember Penampung Air Untuk Masak bh 4 300,000 1,200,000
6 Gayung bh 12 50,000 600,000
7 Loyang Besar bh 5 100,000 500,000
8 Loyang Kecil/Sedang bh 10 80,000 800,000
9 Sapu Lidi bh 2 30,000 60,000
10 Keset Kaki Depan Panjang bh 2 100,000 200,000
11 Sapu Ijuk bh 2 50,000 100,000
12 Rak Jemuran Serbet bh 1 200,000 200,000
13 Sikat Kamar Mandi bh 2 50,000 100,000
14 Wiper bh 2 80,000 160,000
15 Sapu Lawa-Lawa bh 2 80,000 160,000
16 AC 1/2 PK bh 2 4,000,000 8,000,000
17 TV 21 Inci Dan Para Bola bh 1 3,000,000 3,000,000
18 Exhaus Van bh 6 2,000,000 ###
19 Kain Pel Dan Tangkai bh 4 50,000 200,000
20 Serbet bh 24 5,000,000 ###
21 Lampu darurat/cas bh 2 300,000 600,000
23 Balon lampu bh 50 50,000 2,500,000
24 Pitting lampu bh 50 25,000 1,250,000
25 Dispenser berdiri bh 3 2,000,000 6,000,000
26 Buku Penuntun Dietetik gizi bh 2 250,000 500,000
27 Buku Penentuan status gizi dewasa bh 2 250,000 500,000
28 Buku Penentuan Status gizi anak bh 2 250,000 500,000
Total ###
USULAN KEGIATAN

URAIAN
NO PROGRAM
TUJUAN
/ KEGIATAN
KEGIATAN
INDIKATOR
TAHUN VOLUME
HARGA SATUAN
JUMLAH
1 2 3 4 5 6 7 8 9
BAHAN
C NON MEDIS HABIS PAKAI
1 Rinso 1 Kg bks 12 25,000 300,000

2 Molto 1 ltr btl 10 30,000 300,000
3 Bayclin 1000 ml btl 12 20,000 240,000
4 Sabun Cair btl 24 20,000 480,000
5 Bayfress btl 12 25,000 300,000
6 Super Pell 1 LTR btl 60 20,000 1,200,000
7 Kamfer Kamar Mandi BKS 5 10,000 50,000
8 Portex 1000 ml btl 5 25,000 125,000
9 Pembersih kaca btl 24 25,000 600,000
10 Tissu Kotak kotak 24 20,000 480,000
11 Semprot Nyamuk btl 24 50,000 1,200,000
12 Plastik Sampah Ukuran 40 x 50 pak 150 100,000 ###
13 Plastik Sampah Ukuran 60 x 90 pak 100 150,000 ###
14 Sabun Cuci Tangan btl 24 50,000 1,200,000
15 Ligent (Pembersih Peralatan Dapur) 1000 m btl 8 100,000 800,000
16 Sarung tangan plastik bks 240 100,000 ###
Total ###
USULAN KEGIATAN

URAIAN
NO PROGRAM
TUJUAN
/ KEGIATAN
KEGIATAN
INDIKATOR
TAHUN VOLUME
HARGA SATUAN
JUMLAH
1 2 3 4 5 6 7 8 9
D ATK
1 Buku Folio Menunjangadministrasi ruangan bh 12 50,000 600,000

2 Buku Folio Kecil Pend lebih baik bh 10 25,000 250,000
3 Buku Folio Kecil Panjang bh 10 20,000 200,000
4 Spidol Permanent bh 10 8,000 80,000
5 Spidol Board Marker bh 48 8,000 384,000
6 Pensil 2b bh 10 5,000 50,000
7 Pena bh 40 5,000 200,000
8 Tip-ex bh 12 5,000 60,000
9 Kertas HVS F4 rim 12 30,000 360,000
10 Lem Kertas Povinal bh 20 7,000 140,000
11 Lakban hitam bh 3 15,000 45,000
11 Isolasi bening bh 3 15,000 45,000
12 Hekter bh 4 25,000 100,000
13 Isi Hekter dos 12 50,000 600,000
14 Jepitan Kertas dos 12 20,000 240,000
15 Tinta Stempel bh 2 20,000 40,000
16 Tinta Print Hitam bh 12 45,000 540,000
17 Tinta Print Warna bh 6 50,000 300,000
18 Penghapus Papan bh 5 20,000 100,000
19 Penggaris Ukuran 30 Cm bh 4 10,000 40,000
20 Map bh 12 5,000 60,000
21 Box file bh 10 50,000 500,000
22 Tempat pena bh 2 20,000 40,000
23 Baterai Kecil Jam Dinding bh 20 15,000 300,000
24 Baterai Remote bh 48 15,000 720,000
Total 5,994,000
USULAN KEGIATAN

URAIAN
NO PROGRAMTUJUAN
/ KEGIATAN
KEGIATAN
INDIKATOR
TAHUN VOLUME JUMLAH
1 2 3 4 5 6 7 8
E PELATIHAN
1 Pelatihan AmeningkatkSDM Gizi Siap Pakai orang 2

2 Pelatihan Dmelaksanakan tugas dan fungsin orang 2
3 Pelatihan Penanganan Gizi Buruk orang 2
DATA DUKUNG
Nama Peserta Desk :
Unit : Loundry
Jabatan :
No. Telepon :
KEGIATAN SATUAN
No VOLUME SATUAN JUMLAH
(Unit Cost)
A. KEBUTUHAN
1 Ember Besar 2 buah
2 Loyang Besar (Karet) 6 buah
3 Sikat Besar 5 buah
4 Sepatu Boot 4 pasang
5 Sarung Tangan Karet 10 pasang
6 Karpet 2 meter
7 Meja 1 meter
8 Kabel Roll 1 buah
9 Seragam Loundry 5 buah
10 Kipas Angin 1 buah
11 Sapu Lidi 3 buah
12 Sapu Ijuk 3 buah
13 Alat Pel 2 buah
14 Alat Pembersih Kaca 2 buah
15 Alat Tolak Air/Serok Air 2 buah
SubTotal
B. Bahan Habis Pakai (Logistik)

1 Rinso 12 karton
2 Molto 6 karton
3 Bayclin 12 karton
4 Super Pell 12 buah
5 Portex/Wipol 6 botol
6 Glass Cleaner 5 botol
SubTotal
C ATK
1 Buku Folio Besar 5 buah
2 Balpoint Hitam 15 buah
3 Pensil 5 buah
4 Tip - Ex 12 buah
5 Penggaris 30 cm 3 buah
6 Hekter 2 buah
7 Isi Hekter 5 dos
8 Lem 3 buah
9 Map Folder 6 buah
10 Spidol Snowman Boardmarker Hitam 20 buah
11 Gunting 2 buah
12 Box File 5 buah
13 Meja 1 buah
14 Kursi 2 buah
SubTotal
……………………………… ……………………………
NIP : NIP :
MUSREN
017
TOTAL :

KETERANGAN LOKASI
(Ada/Tidak)
Drg. ROSALINE N.I KRIMADI, MPH

NIP : 19771120 200212 2 006
DATA DUKUNG
Nama Peserta Desk :
Unit : Poliklinik Fisioterapi
Jabatan : Ka.Ruang TOTAL :
No. Telepon :

I FISIOTERAPI DAN GYM SCHOLOO HEALTH CLUB
Pengembangan SDM
1
2
3
Pengadaan Alat Kesehatan, BMHP dan BNMHP -

Rehabilitasi Medik -
1
2
3
4
5
6
7
8
-
Gymnasium Klub Sehat RSUD Scholoo -
1
2
3
4
5
6
7
-
Bahan Medik Habis Pakai ( Logistik ) -
1 -
2 -
3 -
4 -
5 -
6 -
-
Bahan Non Medik Habis Pakai (Rutin) -
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
-
II FASILITAS / SARANA PRASARANA -
Fasilitas Ruangan (Rutin) 1 -
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
-
Fasilitas Penunjang Ruangan (ATK) -
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
SubTotal -
……………………………… …………………………… Drg. ROSALINE N.I KRIMADI, MPH

NIP : NIP : NIP : 19771120 200212 2 006
USULAN KEGIATAN
PERENCANAAN DAN PENGEMBANGAN RSUD SCHOLOO KEYEN
Bidang / Unit Pelaksana : R. Rekam Medis TAHUN : 2017
Instasi : RSUD Scholoo Keyen
NO URAIAN PROGRAM/ KEGIATAN TUJUAN KEGIATAN INDIKATOR

DATA CAPAIAN AWAL TAHUN
SATUAN VOLUME JUMLAH Harga Satuan Harga KETERANGAN
A FORMULIR / STATUS REKAM MEDIS 1 Rim ( 500 Lembar(Rim )
a. Rawat Jalan
1 Formulir Rawat Jalan Halaman 1 Lembar 20.000 40 Rim Rp. 500.000 Rp. 20.000.000
2 Formulir Rawat Jalan Halaman 2 Lanjutan Lembar 20.000 40 Rim Rp. 500.000 Rp. 20.000.000
3 Pembatas Rawat Jalan Lembar 20.000 40.Rim Rp. 750.000 Rp. 30.000.000
3 Daftar Tindakan Medik Pasien Umum Rawat Jalan Lembar 10.000 20 Rim Rp. 500.000 Rp. 10.000.000
b. RAWAT INAP
1 Daftar Tindakan Medik Rawat Inap Lembar 10.000 20 Rim Rp. 500.000 Rp. 10.000.000
2 Ringkasan Masuk & Keluar Lembar 1.000 2 Rim Rp. 500.000 Rp. 1.000.000
3 Surat Persetujuan Tindakan Medik Lembar 1.000 2 Rim Rp. 500.000 Rp. 1.000.000
4 Anamnesa & Pemeriksaan Fisik Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
5 Intruksi Dokter Lembar 10.000 20 Rim Rp. 500.000 Rp. 10. 000.000
6 Catatan Tindakan & Evaluasi Keperawatan Lembar 10.000 20 Rim Rp. 500.000 Rp. 10. 000.000
7 Grafik Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
8 Daftar Obat parenteral Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
9 Daftar Obat Non Parenteral Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
10 Resume Keperawatan Lembar 10.000 20 Rim Rp. 500.000 Rp. 10.000.000
11 Pambatas Rawat Inap Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
12 Formulir Penyimpanan Harta Benda Lembar 5.000 10 Rim Rp. 500.000 Rp. 5.000.000
13 Formilir Second Opinion Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
14 Formulir Permintaan Privasi Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
15 Formulir Second Opinion keluar Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
16 Formulir Persetujuan Umum General Consent Lembar 5.000 10 Rim Rp. 500.000 Rp. 5.000.000
17 Formulir Persetujuan Tindakan Kedokteran Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
18 Formulir Penolakan Tindakan Kedokteran Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
19 Formulir Asesment Ulang Nyeri Lembar 5.000 10 Rim Rp. 500.000 Rp. 5.000.000
20 Formulir Pemberian Informasi MBO Lembar 2.000 4 Rim Rp. 500.000 Rp. 2.000.000
21 Formulir Keinginan Pasien Memilih DPJP Lembar 2.000 4 Rim Rp. 500.000 Rp. 2.000.000
22 Formulir Surat Pernyataan Pulang APS Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
23 Formulir Informasi Tentang anestesi Lembar 3.000 6 Rim Rp. 500.000 Rp. 3.000.000
24 Formulir Permintaan Pelayanan Kerohanian Lembar 3.000 6 Rim Rp. 500.000 Rp. 2.000.000
25 Formulir Pernyataan Jangan Dilakukan Resusitasi Lembar 2.000 4 Rim Rp. 500.000 Rp. 2.000.000
C Form. Operasi
1 Laporan Anestesi 1 Lembar 1000 2 Rim Rp. 500.000 Rp. 1.000.000
2 Laporan Anestesi 2 Lembar 1000 2 Rim Rp. 500.000 Rp. 1.000.000
3 Status Anestesi Lembar 1000 2 Rim Rp. 500.000 Rp. 1.000.000
d. Formulir Umum
1 Surat Rujukan Lembar 2.000 4 Rim Rp. 500.000 Rp. 2. 000.000
2 Lembar Laboratorium Lembar 30.000 60 Rim Rp. 500.000 Rp. 30.000.000
3 Laporan Operasi Lembar 1.000 2 Rim Rp. 500.000 Rp. 1.000.000
4 Resume Medis Rawat Jalan Lembar 20.000 40 Rim Rp. 500.000 Rp. 20.000.000
5 Resume Rawat Inap Lembar 20.000 40 Rim Rp. 300.000 Rp. 12.000.000 Dicetak 3 Rangkap
6 Surat Kontrol Lembar 25.000 50 Rim Rp. 500.000 Rp. 25. 000.000
7 Surat Pernyataan Membayar Lembar 5.000 10 Rim Rp. 500.000 Rp. 5.000.000
8 Lembar Konsultasi Dokter Lembar 6.000 12 Rim Rp. 500.000 Rp. 6.000.000
9 Lembar Pemeriksaan Dahak / Sputum Lembar 6.000 12 Rim Rp. 500.000 Rp. 6.000.000
10 Kartu Golongan Darah Lembar 1.000 2 Rim Rp. 500.000 Rp. 1. 000.000
11 Lembar Persetujuan Donor Darah Lembar 1.000 2 Rim Rp. 500.000 Rp. 1. 000.000
12 Pengantar Rawat Inap Lembar 5.000 10 Rim Rp. 500.000 Rp. 5.000.000
13 Resep Umum Lembar 20.000 40 Rim Rp. 500.000 Rp. 20.000.000
VK
1 Bagian Kebidanan Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
2 Obstetri Ginokologi Nifas Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
3 Managemen Asuhn Persalinan Kala II& III Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
4 Managemen Asuhn Persalinan Kala IV Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
5 Patograf Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
NIFAS
1 Pengkajian Asuhan Kebidanan Nifas Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
2 Rencana Asuhan Kebidanan Niifas / Partus Pervaginan Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
Status Bayi Dari Ruang VK
1 Pengkajian Bayi Rawat Gabung Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
2 Ringkasan Data Asuhan Pasien Neonatus Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
3 Pemeriksaan Fisik Bayi Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
Status Bayi Dari Ruang NIFAS Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
1 Pelaksanaan Asuhan Kebidanan Neonatus Rawat Gabung Lembar 5.000 10 Rim Rp. 750.000 Rp. 7.500. 000
2 Rencana Asuhan Kebidanan Bayi Rawat Gabung Lembar 2.000 4 Rim Rp. 200.000 Rp. 800.000 dicetak Rangkap 2
Formulit tambahan
1 Map Rekam Medis Lembar 35.000 Rp. 5.500/1 Rp. 210.000.000 Dicetak 2 Warna
2 Surat Sakit Lembar 5.000 10 Rim Rp. 500.000 Rp. 5.000.000
3 Permintaan Radiologi Lembar 1.000 2 Rim Rp. 500.000 Rp. 1. 000.000
4 Jawaban Radiologi Lembar 10.000 20 Rim Rp. 200.000 Rp. 4.000.000 Dicetak Rangkap 4
5 Balance Cairan Ruang ICU Lembar 2.000 4 Rim Rp. 500.000 Rp. 2.000.000
6 Status Ruang ICU Lembar 2.000 4 Rim Rp. 500.000 Rp. 20.000.000
7 Fastener Paper Dos 100 100 Dos Rp. 2.500 Rp. 250.000
8 Resep Rawat Inap Ukuran Panjang Lembar 2.000 4 rim Rp. 500.000 Rp. 2.000.000
9 Pelayanan Gizi
KEBUTUHAN RUANGAN Buah 1

1 Alat Pres Lembar 1.000
2 Plastik Pres Buah 3
3 Stavol Buah 5
5 UPS Buah 8
6 Kursi Buah 12
7 Lemari / Rak Status Rool On Buah 12
8 Air Conditioner ( AC ) Buah 2
9 Loker Untuk Petugas Buah 1
10 Meja ukuran Panjang Buah 3
11 Meja Kerja Buah 1
12 Papan White Board Ukuran Panjang Buah 1
13 papan White Board Ukuran Kecil Buah 10
14 Keranjang U/ Antar Status Dimasing-masing Poliklinik Buah 1
15 Pengeras Suara Buah 2
16 Laptop Buah 2
17 Kasur Petugas Buah 4
18 Bantal Buah 2
19 Sprei Buah 2
20 Kabel Roll Buah 2
21 Tempat Sampah Buah 2
22 Sapu Buah 1
23 Sapu Lawa-lawa Buah 2
24 Kain Pel Lantai Buah 12
25 Super Pel Buah 12
26 Baygon Buah 12
27 Bayfress Buah 12
28 So Clin Lantai Buah 12
29 Tissu Roll Buah 1
30 Televisi Buah 12
31 Sabun Cuci Mama Lemon Buah 1
32 Ember Sedang Buah 2
33 Galon Air Buah 12
34 Flasdisk Buah 1
35 Hardish
36 Pengadaan Seragam Petugas Rekam Medis
37 Mouse Buah 4
38 Ruang Penyimpanan Status In aktif
39 Renovasi Loket Pendaftaran
40 Renovasi Ruang Rekam Medis dijadikan 2 Lantai
ATK
1 Buku Folio Besar Buah 12
2 Buku Folio Kecil Buah 12
3 Buku Expedisi Buah 12
4 Tip-ex Buah 12
5 Spidol Snowan Masker Hitam Buah 60
6 Spidol Snowan BoardMarker Hitam Buah 60
7 Balpoin Hitam Buah 24
8 Pensil Buah 6
9 Hekter dos 12
10 Lem Buah 12
11 Isi Hekter Buah 36
12 Box File Buah 6
13 Map Folder Buah 12
14 Kertas HVS ukuran F4 Buah 36
15 kertas HVS ukuran A4 Buah 24
16 Tinta Epson Buah 24
17 Gunting Kertas Buah 2
18 cater & Pisau Cater Buah 12
19 Pemotong Kertas Buah 1
20 Pembolong Kertas Buah 5
21 Penggaris/ Mistar Buah 5
PELATIHAN
1 Manajemen Data & Pelaporan Rumah Sakit

2 Pendidikan & Pelatihan Rekam Medis
3 Pertemuan Persatuan Perekam Medis
Seluruh Indonesia (Pormiki )
Yang Diadakan Setahun sekali
DATA DUKUNG
USULAN RENCANA KERJA & M
Nama Peserta Desk : Islamudin
Unit : Elektromedik
Jabatan : Koordinator
No. Telepon :
KEGIATAN
No VOLUME SATUAN
A.
1 Ruangan untuk Elektro Medik (Bengkel) 1 Buah
2 Kamar Jaga Untuk Petugas 1 Buah
3 kasur utk petugas 1 Buah
4 Bantal 1 Buah
5 Seprei 2 Buah
6 sarung bantal 2 Buah
7 AC 1 PK 1 Buah
8 Kipas angin 2 Buah
9 Komputer 1 Unit
10 meja Kerja 1 Buah
11 lemari Arsip 2
12 Toilet 1
13 Wastafel 1
14 kursi roda Utk Kerja 4
15 Kompresor sedang 1
16 solder 2
17 Timah 50
18 Kunci Inggris 6
19 Kunci L 2
20 oben 2
21 Tang 2
22 semprot anti karat/WD 24
23 Telepon/I-phone 1
SubTotal
B LOGISTIK
24 Tissue roll 12
25 buku folio besar 24
26 buku folio kecil panjang 24
27 buku tulis biasa 24
28 Tip - Ex 12
29 Spidol Snowman Marker 24
30 Balpoint Hitam 24
31 Pensil 12
32 Hekter 2
33 isi hekter 12
34 Pelubang kertas 2
35 klips kertas 50
36 Lem 50
37 Map folder 10
38 Box File 10
39 handscoon disposible 50
40 Masker 50
41 Kabel Roll 2
42 kertas f4 2
43 kertas A4 2
SubTotal
C. ATK
44 Tempat sampah 2
45 sapu 2
46 sapu lawa - lawa 1
47 pel lantai 2
48 sikat toilet 2
49 Bayfress 12
50 Rinso 1 kg 12
51 so clin lantai 12
52 sabun cuci tangan/hibiscrub 12
SubTotal
D. KEGIATAN PELATIHAN
Pelatihan ElektroMedik Indonesia (IKATEM 1 Orang
……………………………… ……………………………
NIP : NIP :
TA DUKUNG
ANA KERJA & MUSREN
OLOO KEYEN 2015
ik
TOTAL :
SATUAN DATA DUKUNG KEGIATAN

…………… Drg. ROSALINE N.I KRIMADI, MPH

NIP : 19771120 200212 2 006
(Ada/Tidak)
DATA DUKUNG
USULAN RENCANA KERJA & MUS
Nama Peserta Desk : H.Gunawan Rakka, SKM
Unit : TU
Jabatan : Kabag Tu
No. Telepon :
KEGIATAN
No VOLUME SATUAN
A PROGRAM PELAYANAN ADM PERKANTORAN
1 Penyediaan Jasa Komunikasi
2 Penyediaan ATK 1 Paket
3 Penyediaan Barang Cetakan dan Penggandaan 1 Paket
4 Penyediaan Peralatan dan Perlengkapan Kantor 1 Paket
5 Penyediaan Peralatan Rumah Tangga 1 Paket
6 Penyediaan Makan Minum 1 Paket
7 Rapat-rapat Koordinasi dan Konsultasi ke luar daerah 1 Paket
8 Penunjang Pengelola Uang dan Barang 1 Paket
9 Pemeliharaan Komputer RSUD Scholoo Keyen 1 Paket
10 Pemeliharaan kendaraan Dinas 1 Paket
Penyusunan Laporan Capaian Kinerja dan Ikhtisar Realisasi
1
11 Kinerja SKPD Paket
12 Penyusunan Laporan Keuangan Akhir Tahun 1 paket
13 Kemitraan Pelatihan Tenaga Manajemen 10 Orang
14 Sosialisasi dan Pengobatan Masal Penyakit THT 1 Paket
15 Penyusunan Naskah Akademis Standar Pelayanan Kesehatan 1 Paket
16 Akreditasi Rumah sakit 1 Paket
17 Pendampingan Manajemen Rumah Sakit 1 Paket
……………………………… ……………………………
NIP : NIP :
DUKUNG
NA KERJA & MUSREN
LOO KEYEN 2015
TOTAL :
SATUAN
JUMLAH KETERANGAN LOKASI DATA DUKUNG KEGIATAN (Ada/Tidak)
(Unit Cost)
50,000,000
100,000,000.00
150,000,000.00
80,000,000.00
100,000,000.00
1,500,000,000.00
200,000,000.00
40,000,000.00
10,000,000.00
70000000
15,000,000.00
15,000,000.00
200,000,000.00
100,000,000.00
70,000,000.00
300,000,000.00
200,000,000.00

NIP : 19771120 200212 2 006
DATA DUKUNG KEGIATAN (Ada/Tidak)
DATA DUKUNG
USULAN RENCANA KERJA & MUSR
Nama Peserta Desk : Antonius Moa
Unit : IPSRS
Jabatan : Kasi Non Medik/Bendahara Barang
No. Telepon :
KEGIATAN SATUAN
No VOLUME SATUAN
(Unit Cost)
A Pengadaan Pemeliharaan RSUD
Pengadaan Logistik
Pemeliharaan Gedung
a. Tembok
b. Pintu
- Kunci
- Engsel
- Kaca
- Pengecatan
c. Atap
d. Plafon
B RUTIN
Pemeliharaan Instalasi Air
a. Pipa
b. Alat-alat/Kunci Pipa
Pemeliharaan Instalasi
a. Kabel
b. Lampu
c. Terminal
Pemeliharaan Alat Kesehatan ( Kalibrasi)

Pemeliharaan Alkes
……………………………… ……………………………
NIP : NIP :
……………………………… ……………………………
NIP : NIP :
NG
JA & MUSREN
YEN 2015
arang TOTAL :
DATA DUKUNG
KEGIATAN (Ada/Tidak)

NIP : 19771120 200212 2 006
…………………… Drg. ROSALINE N.I KRIMADI, MPH

NIP : 19771120 200212 2 006
DATA DUKUNG
USULAN RENCANA KERJA & MUSR
Nama Peserta Desk : dr.ALEXANDER M. THESIA
Unit : Perencanaan dan Pengembangan
Jabatan : KA. BIDANG
No. Telepon :
KEGIATAN
No VOLUME SATUAN
1 Pembangunan Aula RSUD 1200 m2
2 Pembangunan Pavilium RSUD 4 unit
3 Pembangunan Gedung Laboratorium 448 m2
4 Pembangunan Bengkel RSUD 100 m2
5 Pembangunan Jalan Lingkungan RSUD 1 PAKET
6 Pembangunan Barak Perawat 300 m2
TOTAL
……………………………… ……………………………
NIP : NIP :
DATA DUKUNG
RENCANA KERJA & MUSREN
D SCHOLOO KEYEN 2015
n Pengembangan
TOTAL :
SATUAN DATA DUKUNG KEGIATAN

4,800,000,000.00 4,800,000,000.00
480,000,000.00 1,920,000,000
1,792,000,000.00 1,792,000,000.00
400,000,000.00 400,000,000.00
- -
900,000,000.00 900,000,000.00
9,812,000,000.00

NIP : 19771120 200212 2 006
(Ada/Tidak)
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PEMERINTAH KABUPATEN SORONG SELATAN

Rumah Sakit Umum Daerah " Scholoo" Keyen

SubTotal (Harga + PPN 10%) Err:509

B BAHAN MEDIS HABIS PAKAI

D BAHAN MEDIS RADIOLOGI

Sub Total Err:509

3 Manajemen Bangsal (KEPALA RUANGAN) 2 Org RSUD 60,000,000

GRAND TOTAL Err:509

drg. ROSALINE N I.KRIMADI,MPH

NO NAMA OBAT SATUAN KEMASAN JUMLAH HARGA SATUAN TOTAL

TERBILANG : DUA MILYAR

TEMINABUAN, September 2016

PROGRAM KEMITRAAN PENINGKATAN PELAYANAN

Kemitraan pengobatan lanjutan bagi pasien rujukan

RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

NO URAIAN PROGRAM/ KEGIATAN SATUAN JUMLAH Harga Satuan Harga

b. RAWAT INAP Rim

Teminabuan, Mei 2016

Plt.Direktur RSUD Scholoo Keyen

RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

RENCANA ANGGARAN BIAYA PENGADAAN ALKES NON E-CATALOGUE 2017

Teminabuan, Februari 2016

Direktur RSUD Scholoo Keyen

drg.ROSALINE N.I KRIMADI

RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

TEMINABUAN, September 2016

PEKERJAAN : OPTIMALISASI JARINGAN AIR BERSIH RSUD SCHOLO KEYEN

No. URAIAN PEKERJAAN VOLUMESATUAN HARGA SAT.

TEMINABUAN, Mei 2016

TEMINABUAN, Mei 2016

RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

TERBILANG : LIMA MILYAR EMPAT RATUS JUTA RUPIAH

TEMINABUAN, Mei 2016

TEMINABUAN, Mei 2016

RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

TEMINABUAN, September 2016 2016

RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

TEMINABUAN, Mei 2016

RENCANA ANGGARAN BIAYA HONOR SPI

NO NAMA KEGIATAN SATUAN VOLUME HARGA JUMLAH

TERBILANG : SERATUS EMPAT JUTA LIMA RATUS RUPIAH

TEMINABUAN, Mei 2016

TEMINABUAN, Mei 2016

TEMINABUAN, Mei 2016

PLT.KEPALA RSUD SCHOLOO KEYEN

RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

TEMINABUAN, Mei 2016

RENCANA ANGGARAN BIAYA PENGADAAN MEDIS RADIOLOGI TAHUN 2017

TEMINABUAN, Mei 2016

RENCANA ANGGARAN BIAYA PENGADAAN ALKES E-CATALOGUE 2017

Direktur RSUD Scholoo Keyen

drg.ROSALINE N.I KRIMADI

PT. MULTIGUNA CIPTASENTOSA

PT.MEGA PRATAMA MEDICALINDO

PT.MEGA PRATAMA MEDICALINDO

1 ALKOHOL 70 %, 1 LITER BTL 1 500 21,500

RENCANA ANGGARAN BIAYA (RAB) TAHUN 2017

TEMINABUAN, FEBRUARI 2016

drg. ROSALINE N I.KRIMADI,MPH

TEMINABUAN, FEBRUARI 2016

TEMINABUAN, FEBRUARI 2016

drg. ROSALINE N I.KRIMADI,MPH

TEMINABUAN, FEBRUARI 2016