Tanggal
NO. NAMA BAHAN MAKANAN SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Lauk hewani
1 Daging sapi Potong 25 75 50 50 50 50 25 75 50 50 75 25 25 75
2 Daging sapi giling kg 1.5 1.5 1.5 1.5 1.5 1.5 1.5 0.5 1.5
3 Ayam negeri potong Potong 65 25 75 50 50 50 75 25 50 25 50 50
4 Ikan tenggiri Kg 1.5 1.5 2 2 1.5 1.5 1.5 1.5 1.5 2 1.5 1.5
5 Telur ayam negeri Butir 50 30 100 40 60 10 40 60 50 30 10 50 20 30 25 25 50 50 50 60
6 Telur puyuh Kg 2 2 2 2 2 2
Lauk nabati
7 Tahu Biji 50 25 50 75 50 50 50 40 30 40 40 50 50 75 50 25 50 50
8 Tempe Keping 15 25 15 25 20 20 30 40 25 25 15 30 30 25 20 30 30 25 20 50
Sayuran
9 Bayam Ikat 10 10 5 10 5 10 5 10
10 Buncis Kg 0.5 0.5 2 0.5 0.5 2 1.5 2 0.5 2 0.5 0.5 1.5
11 Daun Bawang Kg 0.5 0.5 0.5 0.5
12 Daun sop Kg 0.5 0.5
13 Jagung muda Kg 0.5 0.5 0.5 1 0.5 1 0.5 1 1 0.5 1 0.5
14 Kacang panjang Kg 2 1 2 1.5 2 2 2 1.5 1.5 1.5
15 Kentang Kg 3 1.5 1.5 2 4 1 2 1.5 1.5 4 2 3 4 1.5
16 Labu siam Kg 1.5 1.5 1 2 1.5 0.5 1 1
17 Oyong Kg 2 1 2 1 2 2 1
18 Bunga kol Kg 1 1 1 0.5 0.5 1 1 0.5 0.5 1 0.5 0.5 1 1 1
19 Sawi putih Kg 1.5 1.5 1.5 2 2 1.5 1.5 1 1 1
20 Tomat Kg 2 2 2 2
21 Wortel Kg 3 4 2 2 2 4 3 1.5 1.5 3 2 1 1.5 1.5 1 4 4 4 3 3 4 2 2 2
Buah
22 Apel Buah 8 10 5 8 5 8 5 5 8 10 6 5 7 5 3
23 Melon Kg 4.5 4.5 2.5 2.5 1.5 1.5 2.5 2.5 2 2
24 Pear Buah 6 6
25 Semangka Kg 5 6.0 5.0 5.0 5.0 5.0 4.5 4.5 5.0 5.0 5.0 5.0 7.0 7.0 7.0 5.0 4.0 4.0 5.0 5 4 4 5 5
26 Jeruk Buah 10 10 5 10 8 7 10 8 7 12 13 5 6 4 10 5 7
Tanggal
NO. NAMA BAHAN MAKANAN SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Bumbu-bumbu
27 Asam jawa Kg 4
28 Bawang bombay Kg 2 2 2
29 Bawang merah Kg 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1.5 1.5 1.5 1.5
30 Bawang putih Kg 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4
31 Daun salam ikat 5
32 Jahe Kg 1 1 1 1
33 Kemiri Kg
34 Ketumbar bks 5
35 Kunyit Kg 1 1 1 1
36 Lada Kg 0.5
37 Laos Kg 1 1 1 1 1
38 Pala bks 10
39 Serai Kg 0.5 0.5 0.5 0.5
Bahan makanan kering
40 Beras karung 1 1 1 1 1
41 Garam halus Pack 1
42 Tepung roti @ 100 gr bks
43 Gula diabetasol @ 50 sc Ktk
44 Gula diabetasol @ 100 sc Ktk
45 Gula diabetasol @ 200 sc Ktk
46 Gula merah bks 5
47 Gula pasir Kg 2 2 2 3 2 2 2 2 2
48 Kacang hijau Kg 2 2 2 2 2 2 2 2 2 2 2 2
49 Kacang merah Kg
50 Kecap manis @ 600 ml Bks 1 1 1 1 1 1 1 1 1 1 1 1
51 Blue band @ 200 gr bks
52 Minyak goreng @ 1 ltr Ltr 2 2 2 2 2
53 Tepung sagu @ 1 kg Kg 1 1 1 1 1 1 1
54 Santan kelapa instan @ 65 ml Ktk
55 Santan kelapa instan @ 200 ml Ktk 4 4 4 4 4 4 4 4 4 4 2 2
56 Tepung terigu @ 1 kg Kg
57 Teh celup Ktk 2 2 2 2 2 2
58 Biskuit UTD Bks 100 100
Tanggal
NO. NAMA BAHAN MAKANAN SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Susu
59 Susu pediasure @ 850 g Klg
60 Susu entrasol active @ 360 g ktk
61 Susu entrasol gold @ 370 g ktk
62 Susu entrasol gold @ 600 g Ktk 1
63 Susu diabetasol @ 630 g Ktk
64 Susu beruang dus 4 4
65 susu ultra UTD @ 200 ml Ktk
66 Susu Ensure @ 1000 gr klg 1 1 1
67 Susu Peptimune ktk
68 SGM 6 - 12 bln @ 400 gr ktk
69 SGM Explor 1 - 3 th @ 400 gr ktk
70 SGM LLM @ 400 gr ktk 1
71 Susu Nephrisol @185 gr ktk 1 1 1 1 1 1
72 Susu Peptibren @185 gr ktk
73 Susu Hepatosol ktk
Lain-lain
74 Air Isi Ulang galon 7 10 6 9 8 9 6 5 9 8 5 4 7 5 4 6 7 4 6 5 4 5 5 5
75 Snack pasien kotak 50 45 40 40 45 50 45 40 40 50 45 40 40 40 45 40 40 40 40 40 40 40 40 40
76 Bolesa gelas Dus
77 Plastik wrapp gulung 4 4 4 4 2 2 2 4 2 2 2 4
V
NIP .
TOTAL
25 26 27 28 29 30 31
50 50 100 50 950
1.5 14
25 50 50 100 815
2 2 2 2 2 2.5 3 35
50 40 50 50 50 1080
2 2 16
75 25 30 70 100 1150
25 25 20 30 40 35 690
10 10 20 105
2.5 0.5 1.5 1.5 3 23.5
0.5 0.5 3
0.5 0.5 2
1 0.5 0.5 1 11.5
2 1.5 1.5 2 24
3 1.5 2 4 2 3 48
2 1.5 2 1.5 4 21
2 2 2 17
0.5 1 1 1.5 1.5 1.5 19
1.5 1.5 2 19.5
2 2 12
4 4 4 3 1 1 4 82
7 3 10 4 5 5 132
2 2 2 32
4 10 5 5 36
3 4 3 2 3.0 4.0 4.0 145
3 5 5 150
TOTAL
25 26 27 28 29 30 31
5 9
2 2 10
1.5 1.5 1.5 1.5 1.5 1.5 1.5 36.5
0.4 0.5 0.4 0.4 0.4 0.4 0.4 12.5
5
1 5
0
5 5 15
1 5
0.5
1 6
10 20
0.5 2.5
1 1 7
1
0
0
0
0
5 10 20
2 4 4 4 33
2 2 28
0
1 1 1 15
1 1 1 3
4 4 4 22
1 1 9
0
2 2 4 52
2 2 2 6
2 1 2 17
100 100 400
TOTAL
25 26 27 28 29 30 31
0
0
0
1
0
8
240 240
1 4
0
0
0
1
1 7
0
0
5 7 7 8 6 8 6 196
40 35 35 40 40 35 40 1280
0
4 4 4 4 4 56
Petugas gizi