Paket Operasi 2020

PAKET STT
NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA

1 RECOFOL INJ 1 ampul Rp 131,931
2 TRAMUS INJ 1 ampul Rp 73,604
3 ONDANCENTRONE 4 MG INJ 1 ampul Rp 9,721
4 KETOROLAC 30 MG INJ 1 pcs Rp 16,873
5 ASAM TRANEXAMAT 500 MG INJ 1 ampul Rp 13,888
6 SEDACUM INJ 1 ampul Rp 34,719
7 ETANYL INJ 1 ampul Rp 51,384
8 RANITIDIN IJ 1 ampul Rp 3,245
9 DEXAMETASON INJ 2 ampul Rp 3,033
10 ATROPIN SULFAT (SA) 2 ml Rp 3,472
11 SPINOCAN NO 26/27 1 pcs Rp 65,271

1 ANSEL GAMEX NO 6.5 1 Pcs 29,037.50
2 ANSEL GAMEX NO 7 1 Pcs 29,037.50
3 ANSEL GAMEX NO 7.5 2 Pcs 29,037.50
4 APRON MITRALAB 3 Pcs 4,200.97
5 BISTOURI NO 15 1 Pcs 4,999.50
6 HYPAPIX 5X10 CM 10 Cm 317.75
7 KANCING PENANDA RESIKO KUNIN 1 Pcs 3,106.63
8 KASSA LIPAT (10) 20 1,388.75
9 LOUMATULE/VASELIN SWAB 1 1,145.72
10 MASKER TALI 5 5,346.69
11 SENSI GLOVES 1 1,499.85
12 SPUIT 1 CC 1 8,888.00
13 SPUIT 3 CC 1 6,388.25
14 SPUIT 5 CC 1 7,777.00
15 SPUIT 10 CC 1 10,137.88
16 UNDERPAD 1 6,001.88
17 ALKOHOL 70% 50 94.44
18 POVIDONE 50 129.85
19 INFUS NS-MJB(500 ML) / OGB 1 8,635.25
20 INFUSAN RL 500 ML/SP 1 9,881.49
21 PD SCRUB 5 LT 50 227.76
22 STERILZYM 50 249.98
23 POT OBAT OBAT 50 CM 1 1,333.75
24 T-VIO 3.0 TAPPER 1 129,848.13
25 T-VIO 3.0 CUTTING 1 121,515.63
26 DISP HAND CONTROL PENCIL+CAUTE 1 118,043.75
27 SUREFIT DUAL DISPERSIVE ELECT 4 1 23,331.00
28 Micropore 1 Inch 10 35.64
TOTAL HARGA
Rp 131,931
Rp 73,604
Rp 9,721
Rp 16,873
Rp 13,888
Rp 34,719
Rp 51,384
Rp 3,245
Rp 6,066
Rp 6,944
Rp 65,271
TOTAL HARGA
Rp 29,038
Rp 29,038
Rp 58,075
Rp 12,603
Rp 5,000
Rp 3,178
Rp 3,107
Rp 27,775
Rp 1,146
Rp 26,733
Rp 1,500
Rp 8,888
Rp 6,388
Rp 7,777
Rp 10,138
Rp 6,002
Rp 4,722
Rp 6,493
Rp 8,635
Rp 9,881
Rp 11,388
Rp 12,499
Rp 1,334
Rp 129,848
Rp 121,516
Rp 118,044
Rp 23,331
Rp 356
Rp 1,098,076
PAKET APP


1 ANSEL GAMEX NO 6.5 1 pcs 29,037.50
2 ANSEL GAMEX NO 7 1 pcs 29,037.50
3 ANSEL GA,EX NO 7.5 2 pcs 29,037.50
4 APRON MITRALAB 3 pcs 4,200.97
5 BISTOURI NO 10 1 4,999.50
6 HYPAPIX 10 317.75
7 KANCING PENANDA RESIKO KUNING 1 3,106.63
8 KASSA X-RAY 20 Rp 6,249
9 LOUMATULE 5 1,145.72
12 SPUIT 1 CC 1 8,888.00
13 SPUIT 3 CC 1 6,388.25
14 SPUIT 5 CC 1 7,777.00
15 SPUIT 10 CC 1 10,137.88
16 UNDERPAD 1 6,001.88
17 ALKOHOL 70% 50 94.44
18 POVIDONE 50 129.85
19 INFUS NS-MJB(500 ML) / OGB 1 8,635.25
20 INFUSAN RL 500 ML/SP 1 9,881.49
21 PD SCRUB 5 LT 50 227.76
23 POT OBAT OBAT 50 CM 1 1,333.75
24 T-VIO 3.0 TAPPER 1 129,848.13
25 T-CHROMIC 2.0 TAPPER 1 121,515.63
26 T-SILK 2-0 S25 (GS833)ROUND BODIED 1 73,326.00
26 DISP HAND CONTROL PENCIL+CAUTER TIP CL 1 118,043.75
27 SUREFIT DUAL DISPERSIVE ELECT 410-2200 1 23,331.00
TOTAL HARGA
Rp 131,931
Rp 73,604
Rp 9,721
Rp 16,873
Rp 13,888
Rp 34,719
Rp 51,384
Rp 3,245
Rp 6,066
Rp 6,944
Rp 65,271
TOTAL HARGA
Rp 29,038
Rp 29,038
Rp 58,075
Rp 12,603
Rp 5,000
Rp 3,178
Rp 3,107
Rp 124,988
Rp 5,729
Rp 26,733
Rp 3,000
Rp 8,888
Rp 6,388
Rp 7,777
Rp 10,138
Rp 6,002
Rp 4,722
Rp 6,493
Rp 8,635
Rp 9,881
Rp 11,388
Rp 12,499
Rp 1,334
Rp 129,848
Rp 121,516
Rp 73,326
Rp 118,044
Rp 23,331
Rp 356
Rp 1,274,697
PAKET HERNIA


1 ANSEL GAMEX NO 6.5 1 pcs 29,037.50
2 ANSEL GAMEX NO 7 1 pcs 29,037.50
3 ANSEL GA,EX NO 7.5 2 pcs 29,037.50
4 APRON MITRALAB 3 pcs 4,200.97
5 BISTOURI NO 10 1 pcs 4,999.50
6 HYPAPIX 10 317.75
7 KACING PENANDA RESIKO JATUH 1 3,106.63
8 KASSA X-RAY 20 Rp 6,249
9 LOUMATULE 5 1,145.72
12 SPUIT 3 CC 1 6,388.25
13 SPUIT 5 CC 1 7,777.00
14 SPUIT 10 CC 1 10,137.88
15 UNDERPAD 1 6,001.88
16 ALKOHOL 70% 50 94.44
17 POVIDONE 50 129.85
18 ECOSOL NACL 0.9% 500 ML INF 1 8,635.25
19 ECOSOL RL 500 ML INF 1 9,881.49
20 PD SCRUB 5 LT 50 227.76
22 POT OBAT 1 1,333.75
23 T-VIO 3.0 TAPPER 1 129,848.13
24 T-CHROMIC 2.0 TAPPER 1 121,515.63
25 T-VIO 2.0 CUTTING 1 114,571.88
26 DISP HAND CONTROL PENCIL+CAUTER TIP CL 1 118,043.75
27 SUREFIT DUAL DISPERSIVE ELECT 410-2200 1 23,331.00
TOTAL HARGA
Rp 131,931
Rp 73,604
Rp 9,721
Rp 16,873
Rp 13,888
Rp 34,719
Rp 51,384
Rp 3,245
Rp 6,066
Rp 6,944
Rp 65,271
TOTAL HARGA
Rp 29,038
Rp 29,038
Rp 58,075
Rp 12,603
Rp 5,000
Rp 3,178
Rp 3,107
Rp 124,988
Rp 5,729
Rp 26,733
Rp 3,000
Rp 6,388
Rp 7,777
Rp 10,138
Rp 6,002
Rp 4,722
Rp 6,493
Rp 8,635
Rp 9,881
Rp 11,388
Rp 12,499
Rp 1,334
Rp 129,848
Rp 121,516
Rp 114,572
Rp 118,044
Rp 23,331
Rp 356
Rp 1,307,055
PAKET HEMOROID
NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA TOTAL HARGA

1 RECOFOL INJ 1 ampul Rp 131,931 Rp 131,931
2 TRAMUS INJ 1 ampul Rp 73,604 Rp 73,604
3 ONDANCENTRONE 4 MG INJ 1 ampul Rp 9,721 Rp 9,721
4 KETOROLAC 30 MG INJ 1 pcs Rp 16,873 Rp 16,873
5 ASAM TRANEXAMAT 500 MG INJ 1 ampul Rp 13,888 Rp 13,888
6 SEDACUM INJ 1 ampul Rp 34,719 Rp 34,719
7 ETANYL INJ 1 ampul Rp 51,384 Rp 51,384
8 RANITIDIN IJ 1 ampul Rp 3,245 Rp 3,245
9 DEXAMETASON INJ 2 ampul Rp 3,033 Rp 6,066
10 ATROPIN SULFAT (SA) 2 ml Rp 3,472 Rp 6,944
11 SPINOCAN NO 26/27 1 pcs Rp 65,271 Rp 65,271
NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA TOTAL HARGA

1 ANSEL GAMEX NO 6.5 1 Pcs 29,037.50 Rp 29,038
2 ANSEL GAMEX NO 7 1 Pcs 29,037.50 Rp 29,038
3 ANSEL GAMEX NO 7.5 2 Pcs 29,037.50 Rp 58,075
4 APRON MITRALAB 3 Pcs 4,200.97 Rp 12,603
5 BISTOURI NO 15 1 Pcs 4,999.50 Rp 5,000
6 HYPAPIX 5X10 CM 10 Cm 317.75 Rp 3,178
7 KANCING PENANDA RESIKO KUNING 1 Pcs 3,106.63 Rp 3,107
8 KASSA LIPAT (10) 20 1,388.75 Rp 27,775
9 LOUMATULE/VASELIN SWAB 1 1,145.72 Rp 1,146
10 MASKER TALI 5 Pcs 5,346.69 Rp 26,733
11 SENSI GLOVES 3 Pcs 1,499.85 Rp 4,500
12 SPUIT 1 CC 1 Pcs 8,888.00 Rp 8,888
13 SPUIT 3 CC 1 Pcs 6,388.25 Rp 6,388
14 SPUIT 5 CC 1 Pcs 7,777.00 Rp 7,777
15 SPUIT 10 CC 1 Pcs 10,137.88 Rp 10,138
16 UNDERPAD 1 Pcs 6,001.88 Rp 6,002
17 ALKOHOL 70% 50 94.44 Rp 4,722
18 POVIDONE 50 129.85 Rp 6,493
19 INFUS NS-MJB(500 ML) / OGB 1 8,635.25 Rp 8,635
20 INFUSAN RL 500 ML/SP 1 9,881.49 Rp 9,881
21 PD SCRUB 5 LT 50 227.76 Rp 11,388
22 STERILZYM 50 249.98 Rp 12,499
23 POT OBAT OBAT 50 CM 1 1,333.75 Rp 1,334
25 T-CHROMIC 2.0 TAPPER 1 121,515.63 Rp 121,516
26 DISP HAND CONTROL PENCIL+CAUTER TIP 1 118,043.75 Rp 118,044
27 SUREFIT DUAL DISPERSIVE ELECT 410-2200 1 23,331.00 Rp 23,331
28 Micropore 1 Inch 10 35.64 Rp 356
Rp 971,227
AL HARGA
AL HARGA
SERAH TERIMA PAKET SC
TANGGAL : NAMA DOKTER :

NAMA PASIEN :
Obat & Alkes di Ruang Perawatan

NO NAMA OBAT/ ALKES JML Satuan DISIAPKAN DIPAKAI RETUR KETERANGAN
1 Paket TRANSFUSION SET 1 pcs
2 Ceftriaxone inj 2 VIAL
3 PROTOCIN INJ 1 ampul
4 KETOROLAC 30 MG INJ 3 ampul
5 INFUSAN RL 500 ML/SP 3 fls
6 VASELINE SWAB/LOMMATUL H 10X10 10 cm
7 LEUKOMED T PLUS 10X25CM 1 pcs
8 Sensi Glove "M" 16 pcs
9 SUREPLUS SYRINGE 10ML 1 pcs
10 SUREPLUS SYRINGE 5ML,22G 5 pcs
12 Spuit 1 cc 1 pcs
13 Otsu Water Inj 25 ml 2 fls
14 Foly Catheter Rush no.18 Two Way 1 pcs
15 Urine Bag 1 pcs
16 PISAU CUKUR DOUBLE 1 pcs
17 GELANG DEWASA PINK 1 pcs
18 ECOSOL NACL 0.9% 100 ML 2 fls
19 HYPAFIX 5 x 5 20 cm
20 Micropore 1 Inch 30 cm
21 KERTAS CTG 3 lembar
22 Ansel Gammex 7 /sarung tangan steril donasi 1 pcs
23 METRONIDAZOL 100 ML 3 pcs
Obat & Alkes di Ruang Perawatan / Obat Pulang

NO NAMA OBAT/ ALKES JML Satuan DISIAPKAN DIPAKAI RETUR KETERANGAN
1 Cefadroxille 500 mg 10 tab
2 Asam Mefenamat 500 10 tab
3 KASA STERIL 1 box
FARMASI PRE OP VK
(………………………………………….) (………………………………………….)
NAMA JELAS NAMA JELAS
VK POST OP FARMASI
(………………………………………….) (………………………………………….)
PAKET SC SEPTEMBER 2020
PAKET SC BPJS kelas 1 2 3, UMUM RUJUKAN BIDAN KELAS 3 DAN KRM/ASURANSI
Obat & Alkes OK

NO NAMA OBAT/ ALKES JML Satuan HARGA TOTAL HARGA
1 REGIVEL 4ML AMP 1 ampul Rp 97,213 Rp 97,213
2 ONDANSETRON 4 MG INJ 1 ampul Rp 9,721 Rp 9,721
3 EPHEDRIN HCL INJ 1 ampul Rp 69,438 Rp 69,438
4 Spinocan no.26 /27 1 pcs Rp 65,271 Rp 65,271
5 ASAM TRANEKSAMAT INJ 500 MG 1 ampul Rp 13,888 Rp 13,888
7 METHYLERGOMETRINE MALEATE 0.2MG/ML 1 ampul Rp 4,419 Rp 4,419
8 PROTOCIN INJ 2 ampul Rp 9,999 Rp 19,998
9 Fentanil 0,05 MG/ML INJ 2 ML / ETANYL INJ 1 ampul Rp 51,384 Rp 51,384
10 KETOROLAC 30 MG INJ 1 ampul Rp 16,873 Rp 16,873
11 NEO K 2MG/ML / MEPRO K INJ 1 ampul Rp 17,221 Rp 17,221
1 Ansel Gammex 6,5 2 pcs Rp 29,038 Rp 58,075
2 Ansel Gammex 7 1 pcs Rp 29,038 Rp 29,038
3 Ansel Gammex 7,5 2 pcs Rp 29,038 Rp 58,075
4 Sensi Gloves M 4 pcs Rp 1,500 Rp 5,999
5 Bisturi no.23 1 pcs Rp 5,000 Rp 5,000
6 Gelang Bayi 1 pcs Rp 1,734 Rp 1,734
7 Hypafix 5x10 (di OK) 20 cm Rp 318 Rp 6,355
8 KASA LIPAT (X-RAY) (di OK) 20 pcs Rp 6,249 Rp 124,988
9 KASA LIPAT 40X40 BIASA(OK) 10 pcs 1,893.75 Rp 18,938
10 MASKER TALI 7 pcs Rp 5,347 Rp 37,427
11 APRON MITRALAB 3 pcs Rp 4,201 Rp 12,603
12 Oxigen (di OK) 1 tabung Rp 60,000 Rp 60,000
13 Spuit 1 cc 1 pcs Rp 8,888 Rp 8,888
14 Spuit 3 cc 2 pcs Rp 6,388 Rp 12,777
15 Spuit 5 c 1 pcs Rp 7,777 Rp 7,777
16 Alkohol Swab 1 pcs Rp 556 Rp 556
17 Alkohol 70% 1 L (di OK) 50 ml Rp 94 Rp 4,722
18 PD SCRUB 5 LITER (di OK) 50 ml Rp 228 Rp 11,388
19 POVIDONE IODINE 10% 1 LTR ( di OK) 150 ml Rp 130 Rp 19,478
20 STERILZYME 50 ml 249.98 Rp 12,499
21 UNDERPAD 2 pcs Rp 6,002 Rp 12,004
22 Otsu Water Inj 25 CC 1 fls Rp 8,780 Rp 8,780
23 INFUSAN RL 500 ML/SP 2 fls Rp 9,881 Rp 19,763
24 INFUS NS-MJB(500 ML) 2 fls Rp 8,635 Rp 17,271
25 T-CHROMIC 2-0 C27(CG923)ROUND BODIED 2 pcs Rp 91,658 Rp 183,315
26 T-VIO 2 V122(CL905)HEAY ROUND BODIED 2 pcs Rp 145,819 Rp 291,638
27 T-VIO 3-0 V33 (SL 693)EVERSE CUTTING 1 pcs Rp 104,156 Rp 104,156
28 T-SILK 2-0 S25 (GS833)ROUND BODIED 1 pcs Rp 66,660.00 Rp 66,660
29 Suction Connecting Tube 1 pcs Rp 58,328 Rp 58,328
30 SUCTION CATHETER NO.8 1 pcs Rp 9,721 Rp 9,721
31 Umbilical Cord Damp 1 pcs Rp 4,166 Rp 4,166
32 GELANG RESIKO JATUH (KUNING) 1 pcs Rp 1,894 Rp 1,894
33 VASELINE SWAB/LOMMATUL H 10X10 10 cm Rp 2,600 Rp 25,997
34 SUREFIT DUAL DISPERSIVE ELECT 410-2200 1 KALI Rp 23,331 Rp 23,331
35 DISP HAND CONTROL PENCIL+CAUTER TIP CLE 1 KALI Rp 39,348 Rp 39,348
TOTAL Rp 1,728,109
Obat & Alkes di Ruang Perawatan
1 Paket TRANSFUSION SET 1 pcs Rp 55,550 Rp 55,550
2 Ceftriaxone inj 2 VIAL Rp 23,609 Rp 47,218
3 PROTOCIN INJ 1 ampul Rp 9,999 Rp 9,999
5 INFUSAN RL 500 ML/SP 3 fls Rp 9,881 Rp 29,644
6 VASELINE SWAB/LOMMATUL H 10X10 10 cm Rp 2,600 Rp 25,997
7 LEUKOMED T PLUS 10X25CM 1 pcs Rp 40,440 Rp 40,440
8 Sensi Glove "M" 16 pcs Rp 1,500 Rp 23,998
9 SUREPLUS SYRINGE 10ML 1 pcs Rp 3,819.06 Rp 3,819
10 SUREPLUS SYRINGE 5ML,22G 5 pcs Rp 2,638.63 Rp 13,193
12 Spuit 1 cc 1 pcs Rp 8,888 Rp 8,888
13 Otsu Water Inj 25 ml 2 fls Rp 8,780 Rp 17,559
14 Foly Catheter Rush no.18 Two Way 1 pcs Rp 27,497 Rp 27,497
15 Urine Bag 1 pcs Rp 10,731 Rp 10,731
16 PISAU CUKUR DOUBLE 1 pcs Rp 6,669 Rp 6,669
17 GELANG DEWASA PINK 1 pcs Rp 1,734 Rp 1,734
18 ECOSOL NACL 0.9% 100 ML 2 fls Rp 13,193 Rp 26,386
19 HYPAFIX 5 x 5 20 cm Rp 168 Rp 3,351
20 Micropore 1 Inch 30 cm Rp 36 Rp 1,069
21 KERTAS CTG 3 lembar Rp 5,555 Rp 16,665
22 Ansel Gammex 7 /sarung tangan steril donasi 1 pcs Rp 10,000 Rp 10,000
23 METRONIDAZOL 100 ML 3 pcs 69,437.50 Rp 208,313
TOTAL Rp 641,771
Obat & Alkes di Ruang Perawatan / Obat Pulang

1 Cefadroxille 500 mg 10 tab Rp 1,528 Rp 15,276
2 Asam Mefenamat 500 10 tab Rp 382 Rp 3,819
3 KASA STERIL 1 box Rp 4,668 Rp 4,668
TOTAL Rp 23,764
TOTAL Rp 2,393,643
SERAH TERIMA PAKET STT RANAP

NAMA PASIEN :
NO NAMA OBAT /ALKES RANAP JML Satuan DISIAPKAN DIPAKAI RETUR KETERANGAN
1 SENSI GLOVES 30 Pcs
2 ALKOHOL SWAB 10 Pcs
3 ECOSOL NACL 0.9% 100 ML 4 Pcs
4 SUREPLUS SYRINGE 1ML 1 Pcs
5 SUREPLUS SYRINGE 3ML,23G 12 Pcs
7 MASKER TALI 3 Pcs
8 OTSU WATER INJ 25 ML 3 Pcs
9 HYPAFIX 5 X 10 30 cm
10 Micropore 1 Inch 20 cm
11 PISAU CUKUR DOUBLE 1 pcs
12 PAKET INFUSET 1 PAK
13 INFUSAN RL 500 ML/SP 5 kolf
14 RANITIDINE INJ 4 ampul
15 CEFTRIAXONE 1 GR VIAL 4 vial
TAMBAHAN ALKES RANAP (JIKA

NO JML Satuan DISIAPKAN DIPAKAI RETUR KETERANGAN
GV)
1 LOUMATULE/VASELIN SWAB 10 cm
2 KASA LIPAT BIASA(10) 10 Pcs
3 Sarung tangan steril 1 pcs
4 NS(0,9 SOD CHLO) 1 kolf
5 TRANSOFIXSPCS 1 Pcs
6 HYPAFIX 5 X 10 30 cm
FARMASI PRE OP RANAP
(………………………………………….) (………………………………….)
RANAP POST OP FARMASI
(………………………………………….) (…………………………………….)
SERAH TERIMA PAKET ANESTESI

DIAGNOSA : NAMA PASIEN :
NO NAMA OBAT /ALKES OK JML Satuan DISIAPKAN DIPAKAI RETUR KETERANGAN

ANESTESI SPINAL
1 REGIVEL 4ML AMP 1 ampul
2 ONDANSETRON 4 MG INJ 1 ampul
3 EPHEDRIN HCL INJ 1 ampul
4 Spinocan no.26 /27 1 pcs
5 Fentanil 0,05 MG/ML INJ 2 ML / ETANYL 1 ampul
FARMASI PRE OP OK
(………………………………………….) (………………………………………….)
OK POST OP FARMASI
(………………………………………….) (………………………………………….)
SERAH TERIMA PAKET ANESTESI

DIAGNOSA : NAMA PASIEN :
NO NAMA OBAT /ALKES OK JML Satuan DISIAPKAN DIPAKAI RETUR KETERANGAN

ANESTESI SPINAL
1 REGIVEL 4ML AMP 1 ampul
2 ONDANSETRON 4 MG INJ 1 ampul
3 EPHEDRIN HCL INJ 1 ampul
4 Spinocan no.26 /27 1 pcs
5 Fentanil 0,05 MG/ML INJ 2 ML / ETANYL 1 ampul
FARMASI PRE OP OK
(………………………………………….) (………………………………………….)
OK POST OP FARMASI
(………………………………………….) (………………………………………….)
PAKET STT ANESTESI SPINAL (SEPTEMBER 2020)
NO NAMA OBAT /ALKES OK JUMLAH Satuan HARGA TOTAL HARGA

ANESTESI SPINAL
1 REGIVEL 4ML AMP 1 ampul Rp 97,213 Rp 97,213
3 EPHEDRIN HCL INJ 1 ampul Rp 69,438 Rp 69,438
4 Spinocan no.26 /27 1 pcs Rp 65,271 Rp 65,271
5 Fentanil 0,05 MG/ML INJ 2 ML / ETANYL INJ 1 ampul Rp 51,384 Rp 51,384
ALKES
1 sarung tangan NO 6.5 1 Pcs Rp 10,000 Rp 10,000
2 sarung tangan NO 7 1 Pcs Rp 10,000 Rp 10,000
3 ANSEL GAMEX NO 7.5 2 Pcs Rp 29,038 Rp 58,075
4 APRON MITRALAB 3 Pcs Rp 4,201 Rp 12,603
5 Bisturi no.15 1 Pcs Rp 5,000 Rp 5,000
6 HYPAFIX 5 X 10 10 Cm Rp 318 Rp 3,178
7 GELANG RESIKO JATUH (KUNING) 1 Pcs Rp 1,894 Rp 1,894
8 KASA LIPAT 40X40 BIASA(OK) 20 Pcs Rp 1,894 Rp 37,875
9 LOUMATULE/VASELIN SWAB 10 cm Rp 1,146 Rp 11,457
10 MASKER TALI 5 Pcs Rp 5,347 Rp 26,733
11 SENSI GLOVES 4 Pcs Rp 1,500 Rp 5,999
12 SPUIT 1 CC 1 Pcs Rp 8,888 Rp 8,888
13 SPUIT 3 CC 1 Pcs Rp 6,388 Rp 6,388
14 SPUIT 5 CC 1 Pcs Rp 7,777 Rp 7,777
15 SPUIT 10 CC 1 Pcs Rp 10,138 Rp 10,138
16 UNDERPAD 1 Pcs Rp 6,002 Rp 6,002
17 Alkohol 70% 1 L 50 ml Rp 94 Rp 4,722
18 POVIDONE IODINE 10% 1 LTR 50 ml Rp 130 Rp 6,493
19 NS(0,9 SOD CHLO) 1 kolf Rp 8,635 Rp 8,635
20 INFUSAN RL 500 ML/SP 1 kolf Rp 9,881 Rp 9,881
21 PD SCRUB 5 LITER 50 ml Rp 228 Rp 11,388
22 STERILZYME 50 ml Rp 250 Rp 12,499
23 POT Plastik 50 CC 1 Pcs Rp 1,334 Rp 1,334
24 T-VIO 3.0 TUPPER 1 Pcs Rp 124,988 Rp 124,988
25 T-VIO 3.0 CUTTING 1 Pcs Rp 104,156 Rp 104,156
26 DISP HAND CONTROL PENCIL+CAUTER TIP CL 1 Pcs Rp 39,348 Rp 39,348
27 SUREFIT DUAL DISPERSIVE ELECT 410-2200 1 kali Rp 23,331 Rp 23,331
28 Micropore 1 Inch 10 cm Rp 36 Rp 356
TOTAL OK Rp 879,037
NO NAMA OBAT/ ALKES RANAP JUMLAH Satuan HARGA TOTAL HARGA
2 ALKOHOL SWAB 10 Pcs Rp 556 Rp 5,555
3 ECOSOL NACL 0.9% 100 ML 4 Pcs Rp 13,193 Rp 52,773
4 SUREPLUS SYRINGE 1ML 1 Pcs Rp 2,639 Rp 2,639
5 SUREPLUS SYRINGE 3ML,23G 12 Pcs Rp 2,430 Rp 29,164
8 OTSU WATER INJ 25 ML 3 Pcs Rp 8,780 Rp 26,339
9 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
12 PAKET INFUSET 1 PAK Rp 55,550 Rp 55,550
14 RANITIDINE INJ 4 ampul 3,244.68 Rp 12,979
15 CEFTRIAXONE 1 GR VIAL 4 vial 23,608.75 Rp 94,435
TOTAL RANAP Rp 515,945
NO NAMA OBAT PULANG JUMLAH Satuan HARGA TOTAL HARGA

1 CEFIXIME (200 atau 100 mg) 10 tablet 5,369.82 Rp 53,698
TOTAL OBAT PULANG Rp 57,517
GRAND TOTAL Rp 1,452,500
NO TAMBAHAN ALKES RANAP (JIKA GV) JUMLAH Satuan HARGA TOTAL HARGA
2 KASA LIPAT BIASA(10) 10 Pcs Rp 1,389 Rp 13,888
3 Sarung tangan steril 1 pcs Rp 10,000 Rp 10,000
5 TRANSOFIXSPCS 1 Pcs Rp 9,582 Rp 9,582
6 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
TOTAL GV Rp 63,095
GRAND TOTAL JIKA DENGAN GV Rp 1,515,595
stt : Rp 3.807.800
PAKET STT ANESTESI UMUM (SEPTEMBER 2020)

ANESTESI UMUM
6 ETANYL INJ / FENTANYL INJ 1 ampul Rp 51,384 Rp 51,384
8 ATROPIN SULFAT (SA) 2 pcs Rp 65,271 Rp 130,543
ALKES
6 HYPAFIX 5 X 10 10 Cm Rp 318 Rp 3,178
12 SPUIT 1 CC 1 Pcs Rp 8,888 Rp 8,888
13 SPUIT 3 CC 1 Pcs Rp 6,388 Rp 6,388
14 SPUIT 5 CC 1 Pcs Rp 7,777 Rp 7,777
15 SPUIT 10 CC 1 Pcs Rp 10,138 Rp 10,138
17 Alkohol 70% 1 L 50 ml Rp 94 Rp 4,722
TOTAL OK Rp 1,024,856
9 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533

6 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
TOTAL GV Rp 63,095
stt : Rp 3.807.800
PAKET STT ANESTESI SEDASI (SEPTEMBER 2020)

ANESTESI SEDASI
2 ETANYL INJ/FENTANYL INJ 1 ampul Rp 51,384 Rp 51,384
6 ATROPIN SULFAT (SA) 4 ampul Rp 3,472 Rp 13,888
ALKES
6 HYPAFIX 5 X 10 10 Cm Rp 318 Rp 3,178
12 SPUIT 1 CC 1 Pcs Rp 8,888 Rp 8,888
13 SPUIT 3 CC 1 Pcs Rp 6,388 Rp 6,388
14 SPUIT 5 CC 1 Pcs Rp 7,777 Rp 7,777
15 SPUIT 10 CC 1 Pcs Rp 10,138 Rp 10,138
17 Alkohol 70% 1 L 50 ml Rp 94 Rp 4,722
TOTAL OK Rp 827,654
9 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533

6 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
TOTAL GV Rp 63,095
stt : Rp 3.807.800
PAKET APP


2 ANSEL GAMEX NO 7 1 Pcs Rp 29,038 Rp 29,038
6 HYPAFIX 5 X 10 10 Cm Rp 318 Rp 3,178
8 KASA LIPAT (X-RAY) 20 Pcs Rp 6,249 Rp 124,988
12 SPUIT 1 CC 1 Pcs Rp 8,888 Rp 8,888
13 SPUIT 3 CC 1 Pcs Rp 6,388 Rp 6,388
14 SPUIT 5 CC 1 Pcs Rp 7,777 Rp 7,777
15 SPUIT 10 CC 1 Pcs Rp 10,138 Rp 10,138
17 Alkohol 70% 1 L 50 ml Rp 94 Rp 4,722
24 T-VIO 3.0 TAPPER 1 Pcs Rp 124,988 Rp 124,988
25 T-CHROMIC 2-0 TUPPER 1 Pcs Rp 93,046 Rp 93,046
26 T-SILK 2-0 S25 (GS833)ROUND BODIED 1 Pcs Rp 66,660 Rp 66,660
Rp 1,160,276
9 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
Rp 563,866

Rp 57,517
TOTAL Rp 1,781,660
6 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
Rp 70,039
TOTAL JIKA DENGAN GV Rp 1,851,698

PAKET HERNIA


6 HYPAFIX 5 X 10 10 Cm Rp 318 Rp 3,178
8 KASA LIPAT (X-RAY) 20 Pcs Rp 6,249 Rp 124,988
13 SPUIT 3 CC 1 Pcs Rp 6,388 Rp 6,388
14 SPUIT 5 CC 1 Pcs Rp 7,777 Rp 7,777
15 SPUIT 10 CC 1 Pcs Rp 10,138 Rp 10,138
17 Alkohol 70% 1 L 50 ml Rp 94 Rp 4,722
24 T-VIO 3.0 TAPPER 1 Pcs Rp 124,988 Rp 124,988
30 T-HERNIA MESH 6X11 CM HM30 1 Pcs Rp 211,499 Rp 211,499
Rp 1,400,383
9 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
Rp 433,159

Rp 57,517
TOTAL Rp 1,891,060
6 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
Rp 70,039
TOTAL JIKA DENGAN GV Rp 1,961,098

PAKET HEMOROID

6 HYPAFIX 5 X 10 10 Cm Rp 318 Rp 3,178
11 SPUIT 1 CC 1 Pcs Rp 8,888 Rp 8,888
12 SPUIT 3 CC 1 Pcs Rp 6,388 Rp 6,388
13 SPUIT 5 CC 1 Pcs Rp 7,777 Rp 7,777
14 SPUIT 10 CC 1 Pcs Rp 10,138 Rp 10,138
16 Alkohol 70% 1 L 50 ml Rp 94 Rp 4,722
Rp 862,958
9 HYPAFIX 5 X 10 30 cm Rp 318 Rp 9,533
16 ONDANSETRON 4 MG INJ / RANITIDIN INJ 4 ampul Rp 9,721 Rp 38,885
17 ASAM TRANEKSAMAT INJ 500 MG 6 ampul Rp 13,888 Rp 83,325
18 PK 1 POT Rp 6,000 Rp 6,000
19 FOSEN 133 ML 3 botol Rp 124,988 Rp 374,963
Rp 1,061,180

Rp 57,517
TOTAL Rp 1,981,656
KESIMPULAN
TOTAL SC 2,238,223
TOTAL STT TANPA GV 1,609,275
TOTAL STT DENGAN GV 1,679,313
TOTAL APP TANPA GV 1,781,660
TOTAL APP DENGAN GV 1,851,698
TOTAL HERNIA TANPA GV 1,891,060
TOTAL HEMOROID 1,981,656

Paket Operasi 2020

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PAKET STT

NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA

NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA

NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA

NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA

NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA

NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA

NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA TOTAL HARGA

NO NAMA OBAT/ ALKES JUMLAH Satuan HARGA TOTAL HARGA

TANGGAL : NAMA DOKTER :

Obat & Alkes di Ruang Perawatan

Obat & Alkes di Ruang Perawatan / Obat Pulang

Obat & Alkes OK

Obat & Alkes di Ruang Perawatan / Obat Pulang

TANGGAL : NAMA DOKTER :

TAMBAHAN ALKES RANAP (JIKA

FARMASI PRE OP RANAP

RANAP POST OP FARMASI

TANGGAL : NAMA DOKTER :

NO NAMA OBAT /ALKES OK JML Satuan DISIAPKAN DIPAKAI RETUR KETERANGAN

SERAH TERIMA PAKET ANESTESI

TANGGAL : NAMA DOKTER :

NO NAMA OBAT /ALKES OK JML Satuan DISIAPKAN DIPAKAI RETUR KETERANGAN

NO NAMA OBAT /ALKES OK JUMLAH Satuan HARGA TOTAL HARGA

NO NAMA OBAT PULANG JUMLAH Satuan HARGA TOTAL HARGA

GRAND TOTAL Rp 1,452,500

GRAND TOTAL JIKA DENGAN GV Rp 1,515,595

NO NAMA OBAT /ALKES OK JUMLAH Satuan HARGA TOTAL HARGA

NO NAMA OBAT PULANG JUMLAH Satuan HARGA TOTAL HARGA

GRAND TOTAL Rp 1,598,319

GRAND TOTAL JIKA DENGAN GV Rp 1,661,414

NO NAMA OBAT /ALKES OK JUMLAH Satuan HARGA TOTAL HARGA

NO NAMA OBAT PULANG JUMLAH Satuan HARGA TOTAL HARGA

GRAND TOTAL Rp 1,401,116

GRAND TOTAL JIKA DENGAN GV Rp 1,464,211

NO NAMA OBAT /ALKES OK JUMLAH Satuan HARGA TOTAL HARGA

1 ANSEL GAMEX NO 6.5 1 Pcs Rp 29,038 Rp 29,038

NO NAMA OBAT PULANG JUMLAH Satuan HARGA TOTAL HARGA

TOTAL JIKA DENGAN GV Rp 1,851,698

NO NAMA OBAT /ALKES OK JUMLAH Satuan HARGA TOTAL HARGA

1 ANSEL GAMEX NO 6.5 1 Pcs Rp 29,038 Rp 29,038

NO NAMA OBAT PULANG JUMLAH Satuan HARGA TOTAL HARGA

TOTAL JIKA DENGAN GV Rp 1,961,098

1 ANSEL GAMEX NO 6.5 1 Pcs Rp 29,038 Rp 29,038

NO NAMA OBAT PULANG JUMLAH Satuan HARGA TOTAL HARGA

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