Rapb Rs. Meilia 2022 - Luna - Perina

ANGGARAN RUTIN UMUM & MEDIS
TAHUN 2022
KELAS III
No Kode Barang Nama Barang Satuan Harga
TW 1 TW 2 TW 3 TW 4 TW 1
Total QTY Total Anggaran
QTY Jumlah QTY Jumlah QTY Jumlah QTY Jumlah QTY
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - - - - - -
Bendera Merah Putih 1,5 X
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
Facial Tissue Hard Pack
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
4 RTK DISPOSIBLE UNTUK Pcs 475 - - - - - -
PASIEN
Hand Towel Multifold Nee
5 PRT05044 PCS 7,892 22 173,621 23 181,513 22 173,621 22 173,621 89 702,378 22
Sleeve Pack
Jumbo Roll Tissue Eco
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 - - - - - -
Kantong Plastik Obat Hd
8 PRT2833 PCS 251 111 27,809 112 28,060 111 27,809 112 28,060 446 111,739 112
( Kresek ) 15 X 33 Cm
Kantong Plastik Putih Besar
9 PRT2835 PAK 12,527 - - - - - -
No.35
Kantong Plastik Putih Kecil
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
12 PRT05129 Kardus (Magnum) PCS 8,161 - - - - - -
13 PRT2842 Karet Gelang PAK 4,906 - - - - - -
14 PRT2711 Karung PCS 1,566 - - - - - -
Label Obat 11 x 15 cm (1
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
Label Obat 6,7 x 10,5 cm 1
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
19 PRT2824 Plastik 60 X 100 Cm PAK 18,268 1 18,268 - - - 1 18,268
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 2 18,268 2 18,268 2 18,268 2 18,268 8 73,073 2
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 - - - - - -
24 PRT2823 Plastik 40 X 60 Cm PAK 18,268 - - - - - -
26 PRT06505 Plastik Klip 25 X 16 PCS 354 - - - - - -
Anggaran Rs. Meilia 2022

284
Rutin Umum Medis
27 PRT2828 Plastik Klip Obat 10 X 15 PCS 152 - - - - - -
29 PRT2827 Plastik Klip Obat 8,7 X 13 PCS 123 - - - - - -
Plastik Sampah Hd (Kuning)
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
32 PRT06273 Pupuk Tanaman KRG 26,098 - - - - - -
Sabun Colek Ekonomi 215
33 PRT05532 PCS 1,973 - - - - - -
Gr
Sabun Cuci Botol Refil
34 PRT2755 PCS 17,485 - - - - - -
400Ml
Sabun Cuci Piring Cea
35 PRT2753 BTL 12,292 3 36,876 - - - 3 36,876
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 5 46,845 - - - 5 46,845
Sabun Mandi Cair Nuvo
37 PRT05269 PCS 12,135 5 60,677 - - - 5 60,677
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 4 70,985 - 4 70,985 - 8 141,970
40 RTK Sandal Swallow Pasang 11,388 - - - - - -
Sarung tangan panjang
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 4 41,756 - - - 4 41,756
Semprotan Cairan Anti
44 PRT12733 BTL 26,098 - - - - - -
Embun
45 PRT07308 Senter Besar PCS 26,098 1 26,098 - - - 1 26,098
46 PRT2769 Senter Kecil PCS 15,659 - - - - - -
47 Sepatu bot 237,250 - - - - - -
48 PRT2795 Shampo Kit PCS 11,639 - - - - - -
49 PRT2771 Sikat Baju Eterna (Naga) PCS 7,568 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 1 22,861 - 2 45,723 - 3 68,584
51 PRT06122 Stella All In One PCS 9,152 - - - - - -
52 PRT2742 Stella Matic Alat PCS 65,374 - - - - - -
53 PRT06123 Stella Matic Refill PCS 26,506 - - - - - -
54 PRT07436 Tali Bendera PCS 208,780 - - - - - -
55 PRT06106 Tali Rapia Besar ROL 15,659 - - - - - -
56 Tempat Payung Pcs 284,700 - - - - - -
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 - - - - - - 99

58 PRT10344 Umbul Umbul PCS 260,975 - - - - - -
Grand Total RTK 544,065 227,842 336,407 219,950 1,328,264

285
Rutin Umum Medis
PAKET WELLCOME
1 PRT04734 Handuk Rs Meilia PCS 20,900 - - - - - -
2 PRT2858 Pasta Gigi + Sikat PCS 1,829 - - - - - -
3 PRT12199 Pasta Gigi Athena PCS 6,766 - - - - - -
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
6 PRT04768 Tas Spunbond Rs. Meilia PCS 7,472 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
Grand Total Paket Wellcome - - - - -
UMUM NON MEDIS

1 PRT13647 Access Point Wifi Unit 1,879,020 1 1,879,020 - - - 1 1,879,020
Adult Thermal Band 7022
2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
4 PRT09402 Alas Kaki / Sendal Nicu Pasang 94,900 - - - - - -
5 PRT09243 Batang Pengaduk Unit 18,980 - - - - - -
6 PRT07097 Bel Pasien Dan Colokan Unit 1,409,265 - - - - - -
7 PRT07517 Blender Obat Unit 1,879,020 - - - - - -
8 PRT05862 Botol Semprot Unit 94,900 1 94,900 - - - 1 94,900
9 PRT2681 Box Container 150 Liter PCS 237,250 - - - - - -
11 PRT11186 Box Container Cb-10 Liter PCS 47,450 - - - - - -
13 non medis Box Coutener 50 liter 142,350 - - - - - -
Box KECIL untuk antar
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 2 474,500 - - - 2 474,500
17 PRT2848 Gelang Pasien Anak Blue PCS 846 - - - - - -
18 PRT2849 Gelang Pasien Anak Pink PCS 846 - - - - - -
Gorden Plastik Kamar
19 237,250 - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 - - - - - - 1
21 PRT10770 Handy Talky Unit 939,510 - - - - - -
Infant Thermal Adhesive
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

286
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
SEAL (Kabel Ties Farmasi)
25 PRT10231 Jam Dinding Unit 237,250 4 949,000 - - - 4 949,000

26 PRT06799 Kacamata Pelindung (Pcs) pcs 47,450 - - - - - -
27 PRT2723 Kanebo Pcs 66,430 - - - - - -
28 PRT10487 Keranjang Farmasi (Besar) PCS 28,470 - - - - - -
29 PRT07526 Keranjang Farmasi (Kecil) PCS 9,490 - - - - - -

30 PRT09844 Keset Lobby PCS 1,565,850 - - - - - -
31 PRT3294 Keset Toilet Pcs 94,900 - - - - - -
32 PRT09562 Kotak Obat Kecil Udd Pcs 56,940 - - - - - -
33 PRT09563 Kotak Plastik Besar Udd Pcs 75,920 - - - - - -
34 PRT07180 Kursi Kantor Unit 759,200 - - - - - -
35 PRT10277 Kursi Merah Pcs 379,600 - - - - - -
36 PRT11766 Kursi Pasien Pcs 759,200 - - - - - -
37 PRT09561 Kursi Tindakan Bulat Unit 1,879,020 - - - - - -
38 PRT10795 Label " Alergi" Merah PCS 711 90 64,002 90 64,002 90 64,002 90 64,002 360 256,009 113
39 PRT10795 Label " Dnr" PCS 711 49 34,846 - - - 49 34,846
40 PRT09271 Label "Fall Risk" Yellow PCS 711 40 28,445 40 28,445 40 28,445 40 28,445 160 113,782 96
41 PRT13409 Laci 2 Susun plastik Pcs 75,920 - - - - - -
42 PRT13409 Laci 3 Susun Ukuran Besar Pcs 142,350 - - - - - -
43 PRT13409 Laci 5 Susun Ukuran Kecil Pcs 237,250 - - - - - -

Laci Hasil Lab Alfabet (26
44 949,000 - - - - - -
kotak, Customized)
45 PRT10976 Laci Map Gantung Unit 759,200 - - - - - -
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
47 PRT11661 Lemari Narkotika Unit 2,348,775 - - - - - -
48 PRT08661 Lidah Puyer PCS 75,920 - - - - - -
49 PRT04869 Meja Kerja Unit 1,409,265 - - - - - - 1
50 Meja Snack 2,372,500 - - - - - -
51 PRT13472 Mesin Hitung Uang Unit 1,409,265 - - - - - -
52 PRT12463 Microphone Wireless Unit 474,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Pemanggilan Nomor Antrian
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -
Pengambilan Nomor Antrian

287
Rutin Umum Medis
Mini Pc Untuk Tampilan
55 PRT13182 Unit 2,348,775 - - - - - -
Ketersediaan Tempat Tidur
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 - 2 949,000 - - 2 949,000
58 Rak piring dan gelas 474,500 - - - - - -
59 PRT13409 Rak Susun 5 Tingkat Unit 142,350 - - - - - -
60 Rel Gorden Kamar Mandi 47,450 - - - - - -
Sendal untuk tindakan
61 non medis Pasang 949,000 - - - - - -
operasi
62 PRT10202 Sepatu Anti Air pasang 237,250 - - - - - -
63 PRT06787 Sepatu Treadmill PASANG 521,950 - - - - - -
Speaker untuk TAT/Critical
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 - - - - - -
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 1 94,900 - - - 1 94,900
67 Telepon Portabel 949,000 - - - - - -
68 Tempat linen tertutup 474,500 - - - - - -
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - - - - - -

Tempat Sabun Cuci Tangan
70 18,980 1 18,980 - - - 1 18,980 1
Plastik
71 Tempat Sabun Stainless 237,250 - - - - - -
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 - - - - - -
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 - - - - - -
74 PRT10957 Tempat Tissue Hand Towel pcs 142,350 - - - - - -

Tempat Tisuue Roll Dinding
75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
77 PRT09396 Wastafel Unit 939,510 - - - - - -
78 Website 2,847,000 - - - - - -
79 PRT11929 White Board Besar Pcs 1,409,265 - - - - - -
Grand Total Umum Non Medis 3,638,593 1,041,448 92,448 92,448 4,864,936
UMUM MEDIS
1 Alat Press Racikan SCI Pcs 2,411,409 - - - - - -
2 PRT13608 Ambubag Anak Unt 2,799,550 - - - - - -

288
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
4 PRT13190 Ambubag Dewasa Unt 2,799,550 - - - - - -
5 Bak instrumen sedang 189,800 1 189,800 - - - 1 189,800
6 PRT08714 Bak Spuit Pcs 56,940 1 56,940 - - - 1 56,940
7 Beker Glass 250 ml Pcs 118,625 - - - - - -
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 - - - - - -
10 PRT13652 Bengkok Besar Unit 237,250 2 474,500 - - - 2 474,500
11 PRT06170 Buli-Buli Panas Unit 56,940 - - - - - -
12 Corong Kaca 100mm Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -
16 extractor corpus buah 474,500 - - - - - -
17 Forcep Frontal ( Jerapah ) 949,000 - - - - - -
18 PRT11704 Gelas Ukur 10 Ml Pcs 47,450 - - - - - -

19 PRT10651 Gelas Ukur 100 Ml Unit 56,940 - - - - - -
20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 1 94,900 - - - 1 94,900
21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
24 PRT10613 Gunting Aff Heacting Kecil Unt 2,348,775 1 2,348,775 - - - 1 2,348,775
25 PRT10616 Gunting Benang Unt 2,348,775 - - - - - -
26 Gunting jaringan 1,138,800 - - - - - -
27 PRT06786 Gunting Kasa buah 379,600 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 1 71,175 - - - 1 71,175
30 PRT10386 Kotak Obat (Akrilik) Pcs 23,725 - - - - - -
Lampu Blue Ligh Tl 250
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 1 284,700 - - - 1 284,700
33 Lampu Laringoscope 284,700 - - - - - -

34 LAMPU SOROT 1,898,000 - - - - - -
manset dewasa tensimeter
35 Pcs 664,300 - - - - - -
stand manual
36 PRT06316 Manset Monitor Anak PCS 664,300 - - - - - -
37 PRT10294 Manset Monitor Bayi PCS 711,750 - - - - - -

289
Rutin Umum Medis
38 PRT06315 Manset Monitor Dewasa PCS 949,000 - - - - - -
39 PRT06317 Manset Monitor Jumbo PCS 1,043,900 - - - - - -
40 manset tensi anak 711,750 - - - - - -
41 PRT10939 Meteran Badan buah 18,980 - - - - - -
42 PRT06333 Nebulazer Omron Ne-C29 Unt 1,423,500 - - - - - -
43 PRT08142 Over Bed Table Set 1,423,500 - - - - - -

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 2 664,300 - - - 2 664,300
46 Pinset Cirurgis 332,150 1 332,150 - - - 1 332,150
47 Pinset Couter ukuran 20 Cm 569,400 - - - - - -
48 PRT11756 Pinset Panjang Unit 332,150 - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - - - - - -
50 PRT09314 Regulator Oksigen Portable Unit 284,700 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 1 332,150 - - - 1 332,150
Stetoskop
Sarung Tangan Panjang
52 PRT2762 ( Buat Cssd ) Bahan Busa buah 142,350 - - - - - -
Tebal
53 Sendal tertutup 664,300 - - - - - -
54 PRT06567 Speculum ( S) Unt 2,348,775 - - - - - -
Sterilization Packaging Reel
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
57 PRT06791 Stetoscope Litman Anak Bh 1,660,750 - - - - - -
58 PRT07438 Stetoscope Litman Bayi Bh 1,898,000 - - - - - -
Stetoscope Litman Classic Ii
59 PRT06709 Unt 1,518,400 - - - - - -
Duos
60 T conector oksigen dinding 1,898,000 - - - - - -
61 PRT13517 Tempat Laringoscope Unt 284,700 - - - - - -

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
(Thermometer Kulkas)
63 PRT11123 Thermometer Non Contact Pcs 901,550 1 901,550 - - - 1 901,550
64 PRT09242 Thermometer Ruangan Pcs 189,800 - - - - - -
Three Way Connector ( T
65 PRT12582 Unt 1,898,000 2 3,796,000 - - - 2 3,796,000
Conector)
66 PRT06708 Tiang Infus Unt 949,000 - - - - - -
67 PRT09957 Timbangan Digital Pcs 1,186,250 - - - - - -

290
Rutin Umum Medis
Timbangan Digital Dan
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
70 PRT06883 Timer Digital Unit 94,900 - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 1 284,700 - - - 1 284,700
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 9,831,640 - - - 9,831,640
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
3 PRT04868 Amplop Coklat Kabinet PCS 136 - - - - - -
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - - 1
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 1 17,746 1 17,746 1 17,746 1 17,746 4 70,985 1
( Zamens )
Bak Stampel No.1 Merk :
6 PRT2966 PCS 7,307 1 7,307 - - - 1 7,307
Joyko (Zamens)
7 PRT06232 Batu Baterai L/R 1130 PCS 4,176 - - - - - -
8 PRT2978 Batu Baterey 23 A (Zamens) PCS 8,351 - - - - - -

Batu Baterey Calculator
9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
10 PRT2982 Batu Baterey GP 27 A PCS 8,351 - - - - - -
11 PRT2976 Batu Baterey Lr-41 PCS 3,132 - - - - - -
Batu Baterey Sedang
12 PRT2974 PCS 28,185 2 56,371 - - - 2 56,371
Energizer
13 ATK Batu Batre LR-54 PCS 9,490 - - - - - -
Batu Battrey Aaa Alkaline
14 PRT13178 PCS 5,741 1 5,741 2 11,483 2 11,483 2 11,483 7 40,190 2
( Zamens )
Batu Battrey Aaa Panasonic
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
Batu Battrey Abc Aa Biru
16 PRT04545 PCS 1,983 - - - - - - 2
( Zamens )
Batu Battrey Alkaline Aa
17 PRT04546 PCS 4,959 3 14,876 - 2 9,917 - 5 24,793 1
( Isi 2 ) ( Zamens )
Batu Battrey Besar Abc Biru
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
Batu Battrey Cr-2032
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

291
Rutin Umum Medis
Batu Battrey Energizer
20 PRT04548 PCS 38,520 - - - - - -
Kotak 9 V ( Zamens )
21 PRT2977 Batu Battrey Lr-44 PCS 3,132 - - - - - -
22 PRT2981 Batu Battrey Maxell Cr-1616 PCS 3,132 - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 1 3,132 - - - 1 3,132

Binder Clips No.155
24 PRT04725 Dus 5,220 1 5,220 - - - 1 5,220
( Zamens )
25 PRT2987 Binder Clips No.200 Dus 10,439 - - - - - -
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
Bolpoint 4 Warna Top
27 PRT04553 PCS 7,307 1 7,307 1 7,307 1 7,307 1 7,307 4 29,229 1
Unique ( Zamens )
Bolpoint Meja / Stand
28 PRT04717 PCS 6,785 2 13,571 - - - 2 13,571
( Zamens )
Bolpoint Standar Ae-7
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 3 4,384 4 5,846 4 5,846 4 5,846 15 21,922 4
Box File Bantex 4011
31 PRT04554 PCS 27,141 - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
Double Folio ( Zamens )
34 PRT3005 Buku Telepon PCS 26,098 1 26,098 - - - 1 26,098
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 1 5,741 1 5,741 1 5,741 - 3 17,224 1
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 4 41,756 - - - 4 41,756
Buku Tulis Kwarto ( Zamens
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 15 46,976 - - - 15 46,976
( Zamens )
Bussines File Kuning
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 - - - - - -
42 PRT3007 Bussines File Warna Merah PCS 3,132 - - - - - -
43 PRT06441 Casing Cd Oval PCS 1,775 - - - - - -

Catridge Remanu Faktur 05
44 PRT04992 UNT 260,975 - - - - - -
A

292
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
49 PRT06061 Catridge Remanufaktur 12 A UNT 260,975 - - - - - -
Catridge Remanufaktur
50 PRT04689 UNT 365,365 - - - - - -
3428
Catridge Remanufaktur Ce
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
Cd Label Sticker Hvs
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - - - - - -
Copy Safe Bantex A4 5220
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
Copy Safe Bantex F4 5221
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)
60 PRT04581 Cover Mika A4 ( Zamens ) PCS 224 - - - - - -
61 PRT04562 Cutter A-300 ( Zamens ) PCS 5,220 - - - - - -

62 PRT3022 Cutter Besar L-500 PCS 11,483 - - - - - -
63 PRT3023 Devider Bantex 6050 PAK 8,873 - - - - - -
Dispenser Tape Kecil
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
Dispenser Tape Lion No:50
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
Double Tape 2 In ( Zamens
67 PRT04564 ROL 5,220 - - - - - -
)
68 PRT3027 Double Tape Sedang 1 Inc ROL 8,351 - - - - - -
69 PRT12321 Dvd R 16 X Sony PCS 2,923 - - - - - -

293
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
71 PRT3034 Elevated Tray Susun 3 PCS 76,205 - - - - - -
72 PRT11165 Flashdisk 32 Gb BH 140,927 - - - - - -
73 PRT3035 Frame Id Card Clear PCS 2,088 - - - - - -
GANTUNGAN ID CARD
74 PRT07476 YOYO DAN LOGO MEILIA PCS 4,384 - - - - - -
(MIKA)
75 PRT3037 Gantungan Kunci PCS 438 - - - - - -
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 1 9,395 - - - 1 9,395
(Zamens)
78 PRT04565 Gunting Kecil ( Zamens ) PCS 6,263 1 6,263 - - - 1 6,263
Isi Cutter Besar L-150
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 1 626 - - - 1 626
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 3 9,395 - - - 3 9,395
Isi Staples Kecil No.10 Max
82 PRT04802 PAK 1,827 - - - - - -
( Zamens )
Isi Staples T-3 Jumbo 10
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
Kalkulator 12 Digit Casio
84 PRT05506 PCS 101,258 1 101,258 - - - 1 101,258
( Zamens )
Kalkulator Besar Casio Gx-
85 PRT3050 PCS 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 3 1,096 - - - 3 1,096
Kartu ID CARD - Polos
87 PRT3057 PCS 2,088 - - - - - -
Putih
88 PRT3477 Kartu Nama 1 Muka BOX 26,098 - - - - - -
Kartu Rfid 125Khz With
89 PRT07474 PCS 2,088 - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 2 58,458 - - - 2 58,458
Kertas A4 70 Gr Naga
91 PRT04572 RIM 39,146 4 156,585 4 156,585 4 156,585 4 156,585 16 626,340 3
( Zamens )
Kertas A4 70 Gr Warna
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
93 PRT3060 Kertas Buffalo LEMBAR 522 - - - - - -
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
Kertas Concord A4 Putih
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

294
Rutin Umum Medis
Kertas Folio 70 Gr Putih
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
98 PRT06594 Kertas Glossy 180 Gr LBR 1,305 - - - - - -
99 PRT3078 Kertas Sampul Coklat LBR 2,088 - - - - - -
100 PRT06336 Kertas Thermal ROL 14,406 - - - - - -
101 PRT3088 Kwitansi Kecil PCS 1,566 - - - - - -
Label Barcode + Ribbon
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )
Label Semicoated Uk. 10X5

103 PRT11970 ROL 100,214 - - - - - -
Cm Core 1" (1500 Pcs)
Label Thermal Transfer 60

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)
Label Thermal Transfer Uk.

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)
Label Tom & Jerry 103

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
111 ATK Label Tom & Jerry No.113 LBR - - - - - -
664
112 PRT04860 Label Tom & Jerry No.119 LBR 418 - - - - - -
114 ATK Label Tom & Jerry No.98 LBR 949 - - - - - -

Lakban Bening Daimaru
115 PRT04575 ROL 12,527 1 12,527 - - - 1 12,527
( Zamens )
Lakban Coklat Daimaru
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 1 7,307 - - - 1 7,307
( Zamens )
118 PRT3096 Lakban Hitam 1,5 “ ROL 10,439 - - - - - -
119 PRT3097 Lakban Kertas 1” Nashwa ROL 6,263 - - - - - -
120 PRT05706 Lem Fox BTL 13,571 - - - - - -
121 PRT3101 Lem Power Glue PCS 3,132 - - - - - -

295
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 2 12,527 3 18,790 3 18,790 3 18,790 11 68,897 3
123 PRT3105 Map Bening Daichi A4 PCS 2,349 - - - - - -
Map Bening Daichi A4
124 PRT07117 PCS 2,175 - - - - - -
Merah
Map Gantung Bantex Hijau
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
128 PRT3114 Mica Cover A4 PCS 224 - - - - - -
Namebadge Multy No.101 (
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 2 37,580 - - - 2 37,580
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 - - - - - -
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
Papan Jalan / Clip Board
134 PRT3131 PCS 8,948 1 8,948 - - - 1 8,948
Lokal
Papan Tulis / White Board
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
Paper Clips No.3 ( Zamens
136 PRT04582 PAK 1,253 3 3,758 - - - 3 3,758
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 - - - - - -
138 PRT06231 Pembatas Besi PCS 10,961 - - - - - -

139 PRT3136 Pembolong Besar PCS 46,976 - - - - - -
Pembolong Kecil No.30
140 PRT04584 PCS 9,395 1 9,395 - - - 1 9,395
( Zamens )
Penggaris Besi 30 Cm
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
Penghapus Pensil Kecil
142 PRT04808 PCS 1,566 1 1,566 - - - 1 1,566
Steadler ( Zamens )
143 PRT3142 Penghapus White Board PCS 6,263 - - - - - -
Pensil Stadler 2B
144 PRT04585 PCS 3,262 2 6,524 - - - 2 6,524
( Zamens )
145 PRT13512 Pin Code Blue Rs. Meilia PCS 5,220 - - - - - -
Plastik Gol.Darah 6.5 X 9.5
146 PRT3150 PCS 141 - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 - - - - - -
Plastik Pln / Kartu Kontrol
148 PRT3151 PCS 731 - - - - - -
17 X 22

296
Rutin Umum Medis
149 PRT06233 Post It 7.6 X 7.6 Mm PCS 9,395 - - - - - -
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 3 25,054 - - - 3 25,054
151 PRT3157 Pushpin Pack 3,132 - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 1 1,566 - - - 1 1,566
Rautan Pensil / Meja
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
Refil Toner Hp Cb 540A
154 PRT3160 PCS 208,780 - - - - - -
Black
155 PRT06688 Ribbon Award Wax 00069 ROL 26,098 - - - - - -
Ribbon Fargo Black DTC
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
157 PRT07449 Ribbon Wax Ressin ROL 37,580 - - - - - -
158 PRT07482 Ribbon Zxp3 Black UNT 255,756 - - - - - -
Ribon Fargo Color Dtc 1250
159 PRT11156 PCS 664,300 - - - - - -
E
160 PRT2770 Scotlite / Stiker MTR 73,073 - - - - - -
161 PRT04591 Selotip 1/2 X 10 ( Zamens ) PCS 1,044 - - - - - -
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 2 5,220 - 3 7,829 - 5 13,049
163 PRT06918 Sign Here PCS 20,878 - - - - - -
164 PRT04805 Snelhekter Acco ( Zamens ) PAK 9,395 - - - - - -

Spidol Artline 70 Hitam
165 PRT04593 PCS 7,307 1 7,307 - - - 1 7,307
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 2 11,308 - - - 2 11,308
Snowman Hitam ( Zamens )
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 - - - - - -

Staples Alat Kenko Hd-10
169 PRT04596 PCS 31,317 1 31,317 - - - 1 31,317
( Zamens )
170 PRT3178 Staples Besar Max Hd 50 PCS 52,195 - - - - - -
171 PRT11319 Stempel Administrasi Rs PCS 41,756 - - - - - -
172 PRT06332 Stempel Dokter PCS 41,756 - - - - - -
173 PRT09328 Stempel Film PCS 31,317 - - - - - -
174 ATK Stempel IGD dan bantalan PCS 41,756 - - - - - -
175 PRT08141 Stempel Legalisir PCS 83,512 - - - - - -
176 PRT06229 Stempel Lunas PCS 31,317 - - - - - -
177 PRT13600 Stempel Penunggu Pasien PCS 41,756 - - - - - -

297
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
179 PRT06240 STEMPEL RS MEILIA PCS 41,756 - - - - - -
180 ATK Stempel serah terima 41,756 1 41,756 - - - 1 41,756
181 ATK Stempel TBAK 41,756 1 41,756 - - - 1 41,756
182 ATK Stempel Verifikasi 41,756 1 41,756 - - - 1 41,756
183 PRT05505 Tempat Pensil Meja PCS 10,439 - - - - - -
184 PRT11577 Tinta Epson 003 Black PCS 83,512 - - - - - -
185 PRT11578 Tinta Epson 003 Cyan PCS 83,512 - - - - - -
186 PRT11579 Tinta Epson 003 Magenta PCS 83,512 - - - - - -
187 PRT11580 Tinta Epson 003 Yellow PCS 83,512 - - - - - -
188 PRT05767 Tinta Epson 70 Ml Biru PCS 140,927 - - - - - -
Tinta Epson 70 Ml Light
189 PRT10189 PCS 140,927 - - - - - -
Cyan
190 PRT10190 Tinta Epson 70 Ml Magenta PCS 140,927 - - - - - -
191 PRT09057 Tinta Epson 70Ml Black PCS 140,927 - - - - - -

192 PRT09056 Tinta Epson 70Ml Yellow PCS 140,927 - - - - - -
193 ATK Tinta epson LM 70 ml pink 140,927 - - - - - -
194 PRT12388 Tinta Epson T664 Black PCS 83,512 - - - - - -
195 PRT12385 Tinta Epson T664 Cyan PCS 83,512 - - - - - -
196 PRT12386 Tinta Epson T664 Magenta PCS 83,512 - - - - - -
197 PRT12387 Tinta Epson T664 Yellow PCS 83,512 - - - - - -

198 PRT3210 Tinta Metal Lion Hitam PCS 31,317 - - - - - -
Tinta Refil Botol Untuk
199 PRT05605 BTL 36,537 - - - - - -
Epson Black( Zamens )
200 PRT05765 BTL 46,976 - - - - - -
Epson Warna( Zamens )
Tinta Stampel Pyramid Biru
201 PRT04810 BTL 7,307 1 7,307 - - - 1 7,307 1
( Zamens ) Ranap
Tinta Stampel Pyramid

202 PRT04601 BTL 7,307 - - - - - -
Hijau ( Zamens ) Keuangan
203 PRT07008 Tinta Stempel Dokter 5 Ml PCS 23,725 - - - - - -

Tip-X Kenko Botol ( Zamens
204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 913,781 223,499 241,245 217,758 1,596,283
LINEN
1 Alas Meja Operasi 60X200Cm 144,300 - - - - - -
2 Apron PVC 68,250 7 477,750 - - - 7 477,750

298
Rutin Umum Medis
3 Bad Mate 54,600 21 1,146,600 - - - 21 1,146,600
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
6 PRT3229 Baju+celana MCU 143,000 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 14 1,365,000 - - - 14 1,365,000
9 Bantal VVIP 227,500 - - - - - -
10 Barakscort Perlak 68,250 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 14 1,365,000 - - - 14 1,365,000
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
16 Duk Lubang Bulat M 60 X 90 Cm (Csr) 96,200 - - - - - -
17 Duk Lubang Mediana 205 X 325 419,250 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
21 Duk Persegi 125 X 125 Cm (Csr) 146,250 - - - - - -
22 DUK S ( Bungkus Istrumen) 96,200 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
25 Hacinco Dan Celana ( L ) 187,200 - - - - - -
26 Hacinco Dan Celana ( M ) 187,200 - - - - - -
27 Hacinco Dan Celana ( Xl ) 187,200 - - - - - -
28 Hacinco Dan Celana ( Xxxxxl / 5 L) 191,750 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
34 Ikat Kaki/Tangan (All Size) 49,400 - - - - - -
35 Jas Operasi 358,150 - - - - - -
36 Jas Operasi Standard/ Cotton Soil Releas 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
38 Kimono + Celana Jumbo 162,500 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

299
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 7 900,900 - - - 7 900,900
44 Pembungkus Instrument 2 P-M (Double) 154,050 - - - - - -
45 Pembungkus Instrument 21 P-L Double 198,250 - - - - - -
46 Pembungkus Instrument 21 P-S Double 6 87,750 - - - - - -
47 Penutup Inkubator 113,750 - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
51 Perlak Meja Operasi 280 X 120 156,000 - - - - - -
52 Perlak pemasangan infus 32,500 7 227,500 - - - 7 227,500
53 Perlak tempat tidur 130,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 4 312,000 - - - 4 312,000
56 Rompi Kegiatan 166,260 - - - - - -
57 Sarung bantal bayi 22,750 - - - - - -
58 Sarung Bantal Perlak Pvc 50 X 70 84,500 - - - - - -
59 Sarung bantal VPC 63,500 - - - - - -
60 Sarung Batal 41,750 28 1,169,000 - - - 28 1,169,000
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
65 Sarung Meja Mayo 60X80 104,000 - - - - - -
66 Sarung Standar Meja Mayo 75 X 140 125,450 - - - - - -
67 Sarung tangan bayi 9,750 - - - - - -
68 Selimut Polar 113,750 14 1,592,500 - - - 14 1,592,500
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 28 3,931,200 - - - 28 3,931,200
71 Seprei Inkubator (Karet) 48,750 - - - - - -
72 Stike Laken 57,000 28 1,596,000 - - - 28 1,596,000
73 Tali Pengikat Kamar Bedah 65,000 - - - - - -
74 Taplak Meja 97,500 - - - - - -
75 Taplak Meja Makan Pcs 48,750 - - - - - -
76 Topi bayi 29,250 - - - - - -
77 Topi Pasien Ok All Size 45,500 - - - - - -
78 Topi Tali All Size 47,450 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 7 386,750 - - - 7 386,750

300
Rutin Umum Medis
Grand Total Linen 14,470,200 - - - 14,470,200
LAUNDRY
1 PRT04655 Ec - Chlorine KG 39,227 - - - - - -
2 PRT04658 Ec - Emulsifier LTR 31,381 - - - - - -
3 PRT04660 Ec - Oxy Bleach Liquid LTR 20,519 - - - - - -
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
5 PRT04652 Ec - Softener LTR 19,599 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
7 PRT04654 Ec - Super Alkali KG 22,933 - - - - - -
8 PRT04653 Ec - Super Detergen KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
Grand Total Laundry - - - - -
AIR
MINUM
1 PRT11059 Air Minum Aqua Galon GLN 19,853 - - - - - -
2 PRT08421 Air Minum Oasis Botol 330 M KRT 31,347 - - - - - -
4 PRT2656 Air Minum Oasis Galon GLN 12,539 30 376,159 30 376,159 30 376,159 32 401,236 122 1,529,713 27
5 PRT09445 Air Minum Oasis Gelas 240 KRT 21,943 - - - - - -
Grand Total Air Minum 376,159 376,159 376,159 401,236 1,529,713
CETAKAN
Amplop Coklat Dokumen
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
Amplop Coklat Kecil Logo
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
Amplop Coklat Sedang
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi
4 PRT3413 Amplop Hasil Laboratorium PAK 42,300 - - - - - -
5 PRT3414 Amplop Pt.Kes PAK 56,400 - - - - - -

Amplop Radiologi Besar
6 PRT3410 PCS 9,400 - - - - - -
Warna
Amplop Radiologi Hasil
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
Amplop Rs Meilia ( Hitam
8 PRT3412 PAK 27,260 - - - - - -
Putih )
9 PRT3411 Amplop Rs Meilia ( Warna ) PAK 56,400 - - - - - -
10 cetakan Asesmen awal anak RIM 65,800 - - - - - -

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

301
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
14 cetakan Asesmen awal kebidanan RIM 65,800 - - - - - -
asesmen awal keperatan
15 cetakan RIM 65,800 1 65,800 - - - 1 65,800 1
dewasa
16 cetakan Asesmen awal medis anak RIM 65,800 - - 1 65,800 - 1 65,800
Asesmen awal medis
17 cetakan RIM 65,800 1 65,800 - - - 1 65,800
dewasa
18 cetakan Asesmen Neonatus RIM 65,800 - - - - - -
Asesmen Ulang Nyeri Dan
19 PRT11806 RIM 65,800 1 65,800 - - - 1 65,800
Intervensi
20 cetakan Assesmen pra anestesi RIM 65,800 - - - - - -
21 cetakan Assesmen pra bedah RIM 65,800 - - - - - -
22 PRT3512 Assesment Awal Gizi RIM 61,100 - - - - - -
23 PRT3574 Assesment Pasien Terminal RIM 61,100 - - - - - -

Assesment Pemasangan
24 PRT3580 RIM 65,800 1 65,800 - - - 1 65,800
Restrain
Bicycle / Treadmill Exercise
25 PRT3417 RIM 51,700 - - - - - -
Test Report
Blanko Permintaan Darah
26 PRT3418 BK 77,550 2 155,100 - - - 2 155,100
Pmi
Blanko Surat Keterangan
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
28 PRT06822 Buku Catatan Medik Anak BK 32,900 - - - - - -
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
30 PRT12721 Catatan Anestesi / Sedasi LEMBAR 752 - - - - - -
Catatan Perkembangan
31 PRT11810 RIM 65,800 4 263,200 3 197,400 4 263,200 3 197,400 14 921,200 2
Pasien Terintegrasi
32 PRT3436 Catatan Persalinan LBR 1,034 - - - - - -
33 PRT3447 Copy Resep BK 5,170 - - - - - -
Daftar Pemakaian Alat/Obat

34 PRT10560 BK 15,040 - - - - - -
Di Inst. Ko Lembar 1

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

302
Rutin Umum Medis
Daftar Pemberian Obat
37 PRT12075 RIM 61,100 1 61,100 - 1 61,100 - 2 122,200 1
Pasien (New)
Data Kesehatan Peserta
38 PRT3451 BK 23,500 - - - - - -
Mcu
Data Umum Pre Dan Post
39 PRT3450 RIM 51,700 - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - - - -
Echocardiography / Doppler
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 1 61,100 - - - 1 61,100
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 1 61,100 - - - 1 61,100
44 Form Indikasi Masuk Imc RIM 61,100 1 61,100 - - - 1 61,100
Form Pelayanan Medis
45 PRT3459 RIM 31,020 - - - - - -
Rawat Jalan 1/2 Folio
46 Form Pencatatan Dpjp RIM 61,100 1 61,100 - 1 61,100 - 2 122,200
47 PRT3458 Form Permintaan Barang BK 8,460 - - - - - -
Form Retur Obat Pelayanan
48 PRT3461 BK 9,915 - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 1 7,520 - - - 1 7,520
50 PRT06087 Form Work Order BK 8,460 - - - - - -
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 1 65,800 - 1 65,800 - 2 131,600 1
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
Formulir Linen Laundry
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 1 61,100 - - - 1 61,100
56 cetakan Formulir NEWSS RIM 65,800 - - - - - -
Formulir Pemakaian Alat
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
Formulir Terintegrasi
58 PRT11807 Edukasi Pasien Dan RIM 65,800 1 65,800 - 1 65,800 - 2 131,600 1
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
Implementasi Dan Evaluasi
60 PRT3466 RIM 65,800 3 197,400 - 3 197,400 - 6 394,800 2
Keperawatan
61 PRT05616 Indikasi Sectio Caesaria RIM 51,700 - - - - - -
62 PRT05732 Jasa Dokter BK 7,755 26 201,630 26 201,630 25 193,875 26 201,630 103 798,765 13
63 PRT3472 Kardeks Rawat Inap RIM 51,700 1 51,700 - - - 1 51,700 1

303
Rutin Umum Medis
64 PRT3474 Kartu Dental Status LBR 1,128 - - - - - -
65 PRT3475 Kartu Kontrol LBR 564 - - - - - -
66 PRT3478 Kartu Pasien PCS 2,350 - - - - - -
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Gd.Farmasi ( Merah )
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Gd.Farmasi ( Putih )
Kartu Stock Obat/Alkes
69 PRT05777 Kecil Hijau ( Tunas Karya LBR 362 - - - - - -
Grafika )
Kertas 1/2 Folio 70 Gr Logo
70 PRT04486 RIM 28,200 - - - - - -
Tengah
Kertas A4 70 Gr Logo
71 PRT04485 RIM 51,700 - - - - - -
Tengah
72 PRT06141 Kertas Puyer KRT 1,649,230 - - - - - -
73 PRT3484 Keterangan Medis BK 15,040 - - - - - -
74 PRT3483 Keterangan Pasien RIM 51,700 3 155,100 - 3 155,100 - 6 310,200 3
75 PRT3485 Klinik Mata RIM 56,400 - - - - - -
Komunikasi Informasi
76 PRT3535 Edukasi Harian RIM 61,100 1 61,100 - 1 61,100 - 2 122,200 1
(Penyampaian Informasi)
Kop Surat 4 Warna A4 “Rs
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
Kop Surat Folio “Rs Meilia”,
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
79 PRT3490 Kop Surat Mcu RIM 117,500 - - - - - -
80 PRT3491 Kop Surat Pt.Kes RIM 51,700 - - - - - -
Label Bank Darah Gol : A
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
Label Bank Darah Gol : Ab (
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Label Bank Darah Gol : B
83 PRT07569 ( Warna Merah PCS 329 - - - - - -
Jambu/Pink )
Label Bank Darah Gol : O
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
85 PRT3504 Laboratorium Cito ½ Folio BK 8,145 - - - - - -
Laporan Kejadian Code
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
87 PRT3506 Laporan Pembedahan RIM 65,800 - - - - - -
88 PRT3507 Leaflet Diet Pasien LBR 3,102 - - - - - -
89 PRT3509 Lembar Disposisi RIM 51,700 1 51,700 - - - 1 51,700
90 PRT3510 Lembar Konsultasi RIM 65,800 1 65,800 - - - 1 65,800

304
Rutin Umum Medis
Map Hasil Pemeriksaan
91 PRT3516 Usg,Ecg,Treadmil,Endosco PCS 2,585 - - - - - -
py,Ec
92 cetakan MAP KHUSUS GERIATRI 470 - - - - - -

Map Pasien Tanpa Logo
93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )
94 PRT3513 Map Rm / Rekam Medik PCS 2,585 - - - - - -
95 PRT3514 Map Rs Meilia Ukuran Folio PCS 2,820 - - - - - -
96 PRT12246 Medical Report BK 15,040 - - - - - -

97 PRT12724 Monitor Harian RIM 65,800 1 65,800 - - - 1 65,800
Monitoring Gizi (Monitoring
98 PRT3511 Catatan Asupan Makanan RIM 61,100 - - - - - -
Pasien)
Observasi Cairan Masuk
99 PRT12725 RIM 65,800 - 2 131,600 1 65,800 2 131,600 5 329,000 2
Dan Keluar
Pemeriksaan Bayi Baru
100 PRT3520 BK 16,920 - - - - - -
Lahir
Pemeriksaan Phisik Mcu
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 3 183,300 3 183,300 3 183,300 3 183,300 12 733,200 1
103 PRT3526 Pengajuan Pembedahan RIM 61,100 - - - - - -
104 PRT3527 Pengawasan Infus RIM 51,700 - - - - - -
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - - - - - - 1
Sakit Lain (Diambulance)
Pengkajian Dan Intervensi

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 - - - - - -
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 1 61,100 - 1 61,100 - 2 122,200
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - -
Kedokteran
Penolakan Tindakan Medis
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - - - - - -
112 PRT3536 Perincian Biaya Igd BK 12,690 - - - - - -
113 PRT3537 Perincian Biaya Rajal BK 12,925 - - - - - -

305
Rutin Umum Medis
Permintaan Konsultasi
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 - - - - - -
Permintaan Pemeriksaan
116 PRT3541 Histopatologi Parafin Dan RIM 51,700 - - - - - -
Potong Beku
117 PRT3542 BK 15,040 1 15,040 - - - 1 15,040 1
Laboratorium
118 PRT3543 BK 15,040 1 15,040 - - - 1 15,040
Radiologi
119 PRT11816 Permintaan Privasi RIM 62,040 - - - - - -
Pernyataan Pemberian Ket.
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
Persetujuan tindakan
121 cetakan RIM 65,800 - - - - - -
anestesi
122 cetakan Persetujuan tindakan bedah RIM 65,800 - - - - - -
Persetujuan Tindakan
123 PRT11814 RIM 61,100 1 61,100 - - - 1 61,100 1
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
125 PRT3546 Persetujuan Transfusi RIM 61,100 - - - - - -
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 3 45,120 3 45,120 3 45,120 3 45,120 12 180,480 2
128 PRT06086 Pesanan Pulang Neonatus BK 15,040 - - - - - -
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 1 61,100 - 1 61,100 - 2 122,200 1
130 PRT11493 Rekonsiliasi Obat RIM 61,100 - - - - - -
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Keperawatan Perioperatif
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
133 PRT3554 Resep Kaca Mata BK 5,640 - - - - - -
134 PRT3555 Resep Rawat Jalan BK 8,272 12 99,264 12 99,264 12 99,264 12 99,264 48 397,056 12
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - 1 51,700 - 1 51,700 1
( New )
137 cetakan Rincian Biaya Operasi RIM 65,800 - - - - - -
Rincian Biaya Rawat Inap,
138 PRT3558 BK 8,178 5 40,890 5 40,890 5 40,890 5 40,890 20 163,560 3
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 1 51,700 - 1 51,700 - 2 103,400 1
Keluar Pasien Rawat Inap

306
Rutin Umum Medis
Riwayat Penyakit Dan
140 PRT3560 RIM 65,800 - - - - - -
Pemeriksaan THT ( Hal. 1 )

141 PRT3561 RIM 61,100 - - - - - -
142 PRT12271 Screening Pasien Covid RIM 61,100 - - - - - -

143 PRT3563 Sensus Harian Pasien Igd RIM 53,956 - - - - - -
Sensus Harian Pasien
144 PRT3564 BK 23,030 1 23,030 - - - 1 23,030 1
Rawat Inap
Sticker Tempat Sampah
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis
146 PRT09389 Sticker Transparan Apar A3 PCS 18,800 - - - - - -
147 PRT06962 Sticker Transparan Hd PCS 517 - - - - - -
Stiker High Alert Lingkaran

148 PRT06936 (Kecil) Bhn Stiker Kromo PCS 188 - - - - - -
Diameter 1Cm Cetak 1/0

(Sedang) Bahan Stiker
149 PRT06341 PCS 282 - - - - - -
Kromo Diameter 1,5Cm
Cetak 1/0
Stiker High Alert Persegi
150 PRT06506 PCS 940 - - - - - -
Panjang
151 cetakan STIKER LABEL GERIATRI 65,800 - - - - - -
152 PRT11089 Stiker Lasa Kuning PCS 94 - - - - - -

153 PRT3583 Surat Keterangan BK 7,238 1 7,238 - - - 1 7,238 1
154 PRT3584 Surat Keterangan Kematian BK 5,640 - - - - - -
155 PRT06575 Surat Keterangan Mata BK 5,640 - - - - - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 1 5,687 - - - 1 5,687 1
157 PRT3586 Surat Keterangan Sehat BK 5,170 - - - - - -
158 PRT3587 Surat Masuk Perawatan BK 5,170 - - - - - -
Surat Pengantar Rujuk
159 PRT11608 RIM 61,100 - - - - - -
Pasien
Surat Perintah Lembur ( 2
160 PRT3589 BK 8,460 - - - - - -
Ply )
Surat Perny. Pulang Atas
161 PRT3590 RIM 61,100 1 61,100 - - - 1 61,100
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -
Penolakan Rawat Inap

307
Rutin Umum Medis
Surat Pernyataan Alih
163 PRT3592 RIM 61,100 1 61,100 - - - 1 61,100
Rawat
Surat Persetujuan Biaya
164 PRT3593 RIM 61,100 - - - - - - 1
Tindakan/Pengobatan A4
165 PRT12729 Surgical Safety Checklist RIM 61,100 - - - - - -
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 - - - - - -
167 PRT3597 Tanda Terima Barang BK 7,520 - - - - - -
168 PRT3596 Tanda Terima Dokumen BK 7,520 - - - - - -
Tape/Etiket Obat Luar ( Biru
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
Tape/Etiket Obat Luar
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
Tata Tertib Pasien Rawat
172 PRT3580 BK 21,973 - - - - - -
Inap
Transfer Pasien Antar
173 RIM 61,100 1 61,100 - - - 1 61,100
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 2,890,359 899,204 1,850,249 899,204 6,539,016
Grand Total Biaya Rutin Umum dan Medis 32,664,798 2,768,151 2,896,508 1,830,595 40,160,053

308
Rutin Umum Medis
TAHUN 2022
HESTIA
KELAS III (UMUM)
Jumlah QTY Jumlah QTY Jumlah QTY Jumlah QTY Jumlah
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - 1 15,439 - - 1 15,439 -
2 PRT08294 PCS 260,975 - - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - - -
(Tissue Kotak)
GELAS MINUM
4 RTK DISPOSIBLE UNTUK Pcs 475 - - - - - - -
PASIEN
5 PRT05044 PCS 7,892 173,621 23 181,513 22 173,621 22 173,621 89 702,378 -
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 - - - - - - -
8 PRT2833 PCS 251 28,060 112 28,060 112 28,060 112 28,060 448 112,240 112 28,060
9 PRT2835 PAK 12,527 - - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - - -
No.24
12 PRT05129 Kardus (Magnum) PCS 8,161 - - - - - - -
13 PRT2842 Karet Gelang PAK 4,906 - - - - - - -
14 PRT2711 Karung PCS 1,566 - - - - - - -
15 RTK PCS 160 - - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - - -
19 PRT2824 Plastik 60 X 100 Cm PAK 18,268 - - 1 18,268 - 1 18,268 -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - - -
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 18,268 2 18,268 2 18,268 2 18,268 8 73,073 5 45,671
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 - - - - - - -
24 PRT2823 Plastik 40 X 60 Cm PAK 18,268 - - - - - - -
26 PRT06505 Plastik Klip 25 X 16 PCS 354 - - - - - - -

309
Rutin Umum Medis
27 PRT2828 Plastik Klip Obat 10 X 15 PCS 152 - - - - - - -
29 PRT2827 Plastik Klip Obat 8,7 X 13 PCS 123 - - - - - - -
30 PRT06826 PAK 83,512 - - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - - -
32 PRT06273 Pupuk Tanaman KRG 26,098 - - - - - - -
33 PRT05532 PCS 1,973 - - - - - - -
Gr
34 PRT2755 PCS 17,485 - 3 52,456 - - 3 52,456 -
400Ml
35 PRT2753 BTL 12,292 - - 3 36,876 - 3 36,876 -
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - 5 46,845 - - 5 46,845 -
37 PRT05269 PCS 12,135 - 6 72,812 - - 6 72,812 -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 - 4 70,985 - 4 70,985 8 141,970 4 70,985
40 RTK Sandal Swallow Pasang 11,388 - - - - - - -
41 47,450 - - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 - - - - - - -
44 PRT12733 BTL 26,098 - - - - - - -
Embun
45 PRT07308 Senter Besar PCS 26,098 - - - - - - -
46 PRT2769 Senter Kecil PCS 15,659 - - - - - - -
47 Sepatu bot 237,250 - - - - - - -
48 PRT2795 Shampo Kit PCS 11,639 - - - - - - -
49 PRT2771 Sikat Baju Eterna (Naga) PCS 7,568 - - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 - 2 45,723 - 2 45,723 4 91,446 1 22,861
51 PRT06122 Stella All In One PCS 9,152 - - - - - - -
52 PRT2742 Stella Matic Alat PCS 65,374 - - - - - - -
53 PRT06123 Stella Matic Refill PCS 26,506 - - - - - - -
54 PRT07436 Tali Bendera PCS 208,780 - - - - - - -
55 PRT06106 Tali Rapia Besar ROL 15,659 - - - - - - -
56 Tempat Payung Pcs 284,700 - - - - - - -
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 169,591 98 167,878 99 169,591 98 167,878 394 674,938 -
58 PRT10344 Umbul Umbul PCS 260,975 - - - - - - -
Grand Total RTK 389,541 699,980 444,685 504,536 2,038,741 167,577

310
Rutin Umum Medis
PAKET WELLCOME
1 PRT04734 Handuk Rs Meilia PCS 20,900 - - - - - - -
2 PRT2858 Pasta Gigi + Sikat PCS 1,829 - - - - - - -
3 PRT12199 Pasta Gigi Athena PCS 6,766 - - - - - - -
4 PRT2856 Sabun PCS 1,045 - - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - - -
6 PRT04768 Tas Spunbond Rs. Meilia PCS 7,472 - - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - - -
Grand Total Paket Wellcome - - - - - -
UMUM NON MEDIS

1 PRT13647 Access Point Wifi Unit 1,879,020 - - - - - - -
2 PRT08247 PCS 1,636 - - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - - -
Pdm 13
4 PRT09402 Alas Kaki / Sendal Nicu Pasang 94,900 - - - - - - -
5 PRT09243 Batang Pengaduk Unit 18,980 - - - - - - -
6 PRT07097 Bel Pasien Dan Colokan Unit 1,409,265 - - - - - - -
7 PRT07517 Blender Obat Unit 1,879,020 - - - - - - -
8 PRT05862 Botol Semprot Unit 94,900 - - - - - - -
9 PRT2681 Box Container 150 Liter PCS 237,250 - - - - - - -
11 PRT11186 Box Container Cb-10 Liter PCS 47,450 - - - - - - -
13 non medis Box Coutener 50 liter 142,350 - - - - - - -
14 non medis Pcs 189,800 - - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - - -
17 PRT2848 Gelang Pasien Anak Blue PCS 846 - - - - - - -
18 PRT2849 Gelang Pasien Anak Pink PCS 846 - - - - - - -
19 237,250 - - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 47,450 - - - 1 47,450 -
21 PRT10770 Handy Talky Unit 939,510 - - - - - - -
22 PRT08249 PCS 2,923 - - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - - -
Band 7702-49-Pdl

311
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - 1 237,250 - - 1 237,250 -

26 PRT06799 Kacamata Pelindung (Pcs) pcs 47,450 - - - - - - -
27 PRT2723 Kanebo Pcs 66,430 - - - - - - -
28 PRT10487 Keranjang Farmasi (Besar) PCS 28,470 - - - - - - -
29 PRT07526 Keranjang Farmasi (Kecil) PCS 9,490 - - - - - - -

30 PRT09844 Keset Lobby PCS 1,565,850 - - - - - - -
31 PRT3294 Keset Toilet Pcs 94,900 - - - - - - -
32 PRT09562 Kotak Obat Kecil Udd Pcs 56,940 - - - - - - -
33 PRT09563 Kotak Plastik Besar Udd Pcs 75,920 - - - - - - -
34 PRT07180 Kursi Kantor Unit 759,200 - - - - - - -
35 PRT10277 Kursi Merah Pcs 379,600 - - - - - - -
36 PRT11766 Kursi Pasien Pcs 759,200 - - - - - - -
37 PRT09561 Kursi Tindakan Bulat Unit 1,879,020 - - - - - - -
38 PRT10795 Label " Alergi" Merah PCS 711 80,358 - - - 113 80,358 -
39 PRT10795 Label " Dnr" PCS 711 - - - - - - -
40 PRT09271 Label "Fall Risk" Yellow PCS 711 68,269 96 68,269 96 68,269 96 68,269 384 273,076 20 14,223
41 PRT13409 Laci 2 Susun plastik Pcs 75,920 - - - - - - -
42 PRT13409 Laci 3 Susun Ukuran Besar Pcs 142,350 - - - - - - -
43 PRT13409 Laci 5 Susun Ukuran Kecil Pcs 237,250 - - - - - - -

44 949,000 - - - - - - -
kotak, Customized)
45 PRT10976 Laci Map Gantung Unit 759,200 - - - - - - -
46 PRT10976 Lampu Uv PCS 189,800 - - - - - - -
47 PRT11661 Lemari Narkotika Unit 2,348,775 - - - - - - -
48 PRT08661 Lidah Puyer PCS 75,920 - - - - - - -
49 PRT04869 Meja Kerja Unit 1,409,265 1,409,265 - - - 1 1,409,265 -
50 Meja Snack 2,372,500 - - - - - - -
51 PRT13472 Mesin Hitung Uang Unit 1,409,265 - - - - - - -
52 PRT12463 Microphone Wireless Unit 474,500 - - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - - -

312
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 - - - - - - -
58 Rak piring dan gelas 474,500 - - - - - - -
59 PRT13409 Rak Susun 5 Tingkat Unit 142,350 - - - - - - -
60 Rel Gorden Kamar Mandi 47,450 - - - - - - -
61 non medis Pasang 949,000 - - - - - - -
operasi
62 PRT10202 Sepatu Anti Air pasang 237,250 - - - - - - -
63 PRT06787 Sepatu Treadmill PASANG 521,950 - - - - - - -
64 949,000 - - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 - - - - - - -
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 - - - - - - -
67 Telepon Portabel 949,000 - - - - - - -
68 Tempat linen tertutup 474,500 - - - - - - -
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - - - - - - -

70 18,980 18,980 - - - 1 18,980 1 18,980
Plastik
71 Tempat Sabun Stainless 237,250 - - - - - - -
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 - - - - - - -
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 - - - - - - -
74 PRT10957 Tempat Tissue Hand Towel pcs 142,350 - - - - - - -

75 PRT10957 Unit 237,250 - - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - - -
77 PRT09396 Wastafel Unit 939,510 - - - - - - -
78 Website 2,847,000 - - - - - - -
79 PRT11929 White Board Besar Pcs 1,409,265 - - - - - - -
Grand Total Umum Non Medis 1,624,322 305,519 68,269 68,269 2,066,380 33,203
UMUM MEDIS
1 Alat Press Racikan SCI Pcs 2,411,409 - - - - - - -
2 PRT13608 Ambubag Anak Unt 2,799,550 - - - - - - -

313
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - - -
4 PRT13190 Ambubag Dewasa Unt 2,799,550 - - - - - - -
5 Bak instrumen sedang 189,800 - - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - - -
7 Beker Glass 250 ml Pcs 118,625 - - - - - - -
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 - - - - - - -
10 PRT13652 Bengkok Besar Unit 237,250 - - - - - - -
11 PRT06170 Buli-Buli Panas Unit 56,940 - - - - - - -
12 Corong Kaca 100mm Pcs 56,940 - - - - - - -
14 Cutiing Loop 1,423,500 - - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - - -
16 extractor corpus buah 474,500 - - - - - - -
17 Forcep Frontal ( Jerapah ) 949,000 - - - - - - -
18 PRT11704 Gelas Ukur 10 Ml Pcs 47,450 - - - - - - -

19 PRT10651 Gelas Ukur 100 Ml Unit 56,940 - - - - - - -
21 Gelas Ukur 30ml Pcs 37,960 - - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - - -
24 PRT10613 Gunting Aff Heacting Kecil Unt 2,348,775 - - - - - - -
25 PRT10616 Gunting Benang Unt 2,348,775 - - - - - - -
26 Gunting jaringan 1,138,800 - - - - - - -
27 PRT06786 Gunting Kasa buah 379,600 - - - - - - -
28 Gunting verban 711,750 - - - - - - -
29 kom kecil 71,175 - - - - - - -
30 PRT10386 Kotak Obat (Akrilik) Pcs 23,725 - - - - - - -
31 PRT09490 Unit 237,250 - - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - - - - - - -
33 Lampu Laringoscope 284,700 - - - - - - -

34 LAMPU SOROT 1,898,000 - - - - - - -
35 Pcs 664,300 - - - - - - -
stand manual
36 PRT06316 Manset Monitor Anak PCS 664,300 - - - - - - -
37 PRT10294 Manset Monitor Bayi PCS 711,750 - - - - - - -

314
Rutin Umum Medis
38 PRT06315 Manset Monitor Dewasa PCS 949,000 - - - - - - -
39 PRT06317 Manset Monitor Jumbo PCS 1,043,900 - - - - - - -
40 manset tensi anak 711,750 - - - - - - -
41 PRT10939 Meteran Badan buah 18,980 - - - - - - -
42 PRT06333 Nebulazer Omron Ne-C29 Unt 1,423,500 - - - - - - -
43 PRT08142 Over Bed Table Set 1,423,500 - - - - - - -

44 PRT06713 Penlight PCS 284,700 - - - - - - -
45 pinset anatomis 332,150 - - - - - - -
46 Pinset Cirurgis 332,150 - - - - - - -
47 Pinset Couter ukuran 20 Cm 569,400 - - - - - - -
48 PRT11756 Pinset Panjang Unit 332,150 - - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - - - - - - -
50 PRT09314 Regulator Oksigen Portable Unit 284,700 - - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - - -
Stetoskop
52 PRT2762 ( Buat Cssd ) Bahan Busa buah 142,350 - - - - - - -
Tebal
53 Sendal tertutup 664,300 - - - - - - -
54 PRT06567 Speculum ( S) Unt 2,348,775 - - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - - -
(Flat) 15Cmx200M
57 PRT06791 Stetoscope Litman Anak Bh 1,660,750 - - - - - - -
58 PRT07438 Stetoscope Litman Bayi Bh 1,898,000 - - - - - - -
59 PRT06709 Unt 1,518,400 - - - - - - -
Duos
60 T conector oksigen dinding 1,898,000 - - - - - - -
61 PRT13517 Tempat Laringoscope Unt 284,700 - - - - - - -

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 - - - - - - -
64 PRT09242 Thermometer Ruangan Pcs 189,800 - - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - - -
Conector)
66 PRT06708 Tiang Infus Unt 949,000 - - - - - - -
67 PRT09957 Timbangan Digital Pcs 1,186,250 - - - - - - -

315
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - - -
70 PRT06883 Timer Digital Unit 94,900 - - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 - - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - 1 284,700 - - 1 284,700 -
73 Trolly Barang 1,423,500 - - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - - -
Grand Total Umum Medis - 284,700 - - 284,700 -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - - -
( Zamens )
3 PRT04868 Amplop Coklat Kabinet PCS 136 - - - - - - -
Amplop Royal No.110
4 PRT04713 PAK 14,615 14,615 - - - 1 14,615 1 14,615
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 17,746 1 17,746 1 17,746 1 17,746 4 70,985 1 17,746
( Zamens )
6 PRT2966 PCS 7,307 - - - - - - -
Joyko (Zamens)
7 PRT06232 Batu Baterai L/R 1130 PCS 4,176 - - - - - - -
8 PRT2978 Batu Baterey 23 A (Zamens) PCS 8,351 - - - - - - -

9 ATK PCS 9,490 - - - - - - -
Citizen CE (MELLY)
10 PRT2982 Batu Baterey GP 27 A PCS 8,351 - - - - - - -
11 PRT2976 Batu Baterey Lr-41 PCS 3,132 - - - - - - -
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - - 2 56,371
Energizer
13 ATK Batu Batre LR-54 PCS 9,490 - - - - - - -
14 PRT13178 PCS 5,741 11,483 2 11,483 2 11,483 2 11,483 8 45,932 4 22,966
( Zamens )
15 PRT04547 PCS 3,654 - - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 3,967 2 3,967 2 3,967 2 3,967 8 15,867 -
( Zamens )
17 PRT04546 PCS 4,959 4,959 1 4,959 1 4,959 1 4,959 4 19,834 1 4,959
18 PRT04715 PCS 5,220 - - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - - -
( Zamens )

316
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - - -
21 PRT2977 Batu Battrey Lr-44 PCS 3,132 - - - - - - -
22 PRT2981 Batu Battrey Maxell Cr-1616 PCS 3,132 - - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 - 1 3,132 - - 1 3,132 -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - - -
( Zamens )
25 PRT2987 Binder Clips No.200 Dus 10,439 - - - - - - -
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 7,307 1 7,307 1 7,307 1 7,307 4 29,229 1 7,307
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 5,846 4 5,846 4 5,846 4 5,846 16 23,383 2 2,923
31 PRT04554 PCS 27,141 - - - - - - 2 54,283
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - - -
34 PRT3005 Buku Telepon PCS 26,098 - - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 - - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 5,741 1 5,741 - 1 5,741 3 17,224 1 5,741
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - 2 20,878 - - 2 20,878 -
38 PRT04557 PCS 5,741 - - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - 15 46,976 - - 15 46,976 -
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 - - - - - - -
42 PRT3007 Bussines File Warna Merah PCS 3,132 - - - - - - -
43 PRT06441 Casing Cd Oval PCS 1,775 - - - - - - -

44 PRT04992 UNT 260,975 - - - - - - -
A

317
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - - -
A
49 PRT06061 Catridge Remanufaktur 12 A UNT 260,975 - - - - - - -
50 PRT04689 UNT 365,365 - - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - - - - - - -
58 PRT3020 PCS 3,132 - - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - - - - - -
(Zamens)
60 PRT04581 Cover Mika A4 ( Zamens ) PCS 224 - - - - - - -
61 PRT04562 Cutter A-300 ( Zamens ) PCS 5,220 - - - - - - -

62 PRT3022 Cutter Besar L-500 PCS 11,483 - - - - - - -
63 PRT3023 Devider Bantex 6050 PAK 8,873 - - - - - - -
64 PRT04800 PCS 10,439 - - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - - -
)
68 PRT3027 Double Tape Sedang 1 Inc ROL 8,351 - - - - - - -
69 PRT12321 Dvd R 16 X Sony PCS 2,923 - - - - - - -

318
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - - -
( Zamens )
71 PRT3034 Elevated Tray Susun 3 PCS 76,205 - - - - - - -
72 PRT11165 Flashdisk 32 Gb BH 140,927 - - - - - - -
73 PRT3035 Frame Id Card Clear PCS 2,088 - - - - - - -
GANTUNGAN ID CARD
74 PRT07476 YOYO DAN LOGO MEILIA PCS 4,384 - - - - - - -
(MIKA)
75 PRT3037 Gantungan Kunci PCS 438 - - - - - - -
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - - -
(Zamens)
78 PRT04565 Gunting Kecil ( Zamens ) PCS 6,263 - - - - - - -
79 PRT04566 PCS 1,044 - - - - - - -
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 - - - - - - -
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - 3 9,395 - - 3 9,395 -
82 PRT04802 PAK 1,827 - - - - - - -
( Zamens )
83 PRT05503 BOX 12,527 - - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 - 3 1,096 - - 3 1,096 -
87 PRT3057 PCS 2,088 - - - - - - -
Putih
88 PRT3477 Kartu Nama 1 Muka BOX 26,098 - - - - - - -
89 PRT07474 PCS 2,088 - - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 - - - - - - -
91 PRT04572 RIM 39,146 117,439 4 156,585 3 117,439 3 117,439 13 508,901 3 117,439
( Zamens )
92 PRT04719 RIM 50,107 - - - - - - -
Kuning ( Zamens )
93 PRT3060 Kertas Buffalo LEMBAR 522 - - - - - - -
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - - -
( Zamens )

319
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - - -
Naga ( Zamens )
98 PRT06594 Kertas Glossy 180 Gr LBR 1,305 - - - - - - -
99 PRT3078 Kertas Sampul Coklat LBR 2,088 - - - - - - -
100 PRT06336 Kertas Thermal ROL 14,406 - - - - - - -
101 PRT3088 Kwitansi Kecil PCS 1,566 - - - - - - -
102 PRT10201 ROL 39,146 - - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - - -

104 PRT04624 ROL 67,332 - - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - - -
Merah (Zamens)
111 ATK Label Tom & Jerry No.113 LBR - - - - - - -
664
112 PRT04860 Label Tom & Jerry No.119 LBR 418 - - - - - - -
114 ATK Label Tom & Jerry No.98 LBR 949 - - - - - - -

115 PRT04575 ROL 12,527 - - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - - -
( Zamens )
118 PRT3096 Lakban Hitam 1,5 “ ROL 10,439 - - - - - - -
119 PRT3097 Lakban Kertas 1” Nashwa ROL 6,263 - - - - - - -
120 PRT05706 Lem Fox BTL 13,571 - - - - - - -
121 PRT3101 Lem Power Glue PCS 3,132 - - - - - - -

320
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 18,790 3 18,790 3 18,790 3 18,790 12 75,161 2 12,527
123 PRT3105 Map Bening Daichi A4 PCS 2,349 - - - - - - -
124 PRT07117 PCS 2,175 - - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - - -
Kuning
128 PRT3114 Mica Cover A4 PCS 224 - - - - - - -
129 PRT04603 DOS 36,537 - - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - 2 37,580 - - 2 37,580 -
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 - - - - - - -
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - 1 8,948 - - 1 8,948 -
Lokal
135 PRT11929 PCS 234,878 - - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - 1 1,253 - - 1 1,253 -
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 - - - - - - -
138 PRT06231 Pembatas Besi PCS 10,961 - - - - - - -

139 PRT3136 Pembolong Besar PCS 46,976 - - - - - - -
140 PRT04584 PCS 9,395 - - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - 1 1,566 - - 1 1,566 -
Steadler ( Zamens )
143 PRT3142 Penghapus White Board PCS 6,263 - - - - - - -
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - - -
( Zamens )
145 PRT13512 Pin Code Blue Rs. Meilia PCS 5,220 - - - - - - -
146 PRT3150 PCS 141 - - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 - - - - - - -
148 PRT3151 PCS 731 - - - - - - -
17 X 22

321
Rutin Umum Medis
149 PRT06233 Post It 7.6 X 7.6 Mm PCS 9,395 - - - - - - -
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 - 3 25,054 - - 3 25,054 -
151 PRT3157 Pushpin Pack 3,132 - - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 - - - - - - -
153 PRT11061 PCS 62,634 - - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - - -
Black
155 PRT06688 Ribbon Award Wax 00069 ROL 26,098 - - - - - - -
156 PRT07364 PCS 284,700 - - - - - - -
1250 E (045102)
157 PRT07449 Ribbon Wax Ressin ROL 37,580 - - - - - - -
158 PRT07482 Ribbon Zxp3 Black UNT 255,756 - - - - - - -
159 PRT11156 PCS 664,300 - - - - - - -
E
160 PRT2770 Scotlite / Stiker MTR 73,073 - - - - - - -
161 PRT04591 Selotip 1/2 X 10 ( Zamens ) PCS 1,044 - - - - - - -
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 - 2 5,220 - - 2 5,220 -
163 PRT06918 Sign Here PCS 20,878 - - - - - - -
164 PRT04805 Snelhekter Acco ( Zamens ) PAK 9,395 - - - - - - -

165 PRT04593 PCS 7,307 - - - - - - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - 1 5,654 - - 1 5,654 -
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 - - - - - - -

169 PRT04596 PCS 31,317 - - - - - - -
( Zamens )
170 PRT3178 Staples Besar Max Hd 50 PCS 52,195 - - - - - - -
171 PRT11319 Stempel Administrasi Rs PCS 41,756 - - - - - - -
172 PRT06332 Stempel Dokter PCS 41,756 - - - - - - -
173 PRT09328 Stempel Film PCS 31,317 - - - - - - -
174 ATK Stempel IGD dan bantalan PCS 41,756 - - - - - - -
175 PRT08141 Stempel Legalisir PCS 83,512 - - - - - - -
176 PRT06229 Stempel Lunas PCS 31,317 - - - - - - -
177 PRT13600 Stempel Penunggu Pasien PCS 41,756 - - - - - - -

322
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - - -
EMPAT SAUDARA
179 PRT06240 STEMPEL RS MEILIA PCS 41,756 - - - - - - -
180 ATK Stempel serah terima 41,756 - - - - - - -
181 ATK Stempel TBAK 41,756 - - - - - - -
182 ATK Stempel Verifikasi 41,756 - - - - - - -
183 PRT05505 Tempat Pensil Meja PCS 10,439 - - - - - - -
184 PRT11577 Tinta Epson 003 Black PCS 83,512 - - - - - - -
185 PRT11578 Tinta Epson 003 Cyan PCS 83,512 - - - - - - -
186 PRT11579 Tinta Epson 003 Magenta PCS 83,512 - - - - - - -
187 PRT11580 Tinta Epson 003 Yellow PCS 83,512 - - - - - - -
188 PRT05767 Tinta Epson 70 Ml Biru PCS 140,927 - - - - - - -
189 PRT10189 PCS 140,927 - - - - - - -
Cyan
190 PRT10190 Tinta Epson 70 Ml Magenta PCS 140,927 - - - - - - -
191 PRT09057 Tinta Epson 70Ml Black PCS 140,927 - - - - - - -

192 PRT09056 Tinta Epson 70Ml Yellow PCS 140,927 - - - - - - -
193 ATK Tinta epson LM 70 ml pink 140,927 - - - - - - -
194 PRT12388 Tinta Epson T664 Black PCS 83,512 - - - - - - -
195 PRT12385 Tinta Epson T664 Cyan PCS 83,512 - - - - - - -
196 PRT12386 Tinta Epson T664 Magenta PCS 83,512 - - - - - - -
197 PRT12387 Tinta Epson T664 Yellow PCS 83,512 - - - - - - -

198 PRT3210 Tinta Metal Lion Hitam PCS 31,317 - - - - - - -
199 PRT05605 BTL 36,537 - - - - - - -
200 PRT05765 BTL 46,976 - - - - - - -
201 PRT04810 BTL 7,307 7,307 - - - 1 7,307 1 7,307
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - - -
203 PRT07008 Tinta Stempel Dokter 5 Ml PCS 23,725 - - - - - - -

204 PRT04602 BH 4,176 - - - - - - -
)
Grand Total ATK 215,200 399,174 187,537 193,278 995,189 324,183
LINEN
1 Alas Meja Operasi 60X200Cm 144,300 - - - - - - -
2 Apron PVC 68,250 - - - - - - 6 409,500

323
Rutin Umum Medis
3 Bad Mate 54,600 - - - - - - 18 982,800
4 Baju Bayi 22,750 - - - - - - -
5 Baju pasien OK 131,300 - - - - - - -
6 PRT3229 Baju+celana MCU 143,000 - - - - - - -
7 bantal bayi 32,500 - - - - - - -
8 Bantal Biasa 97,500 - - - - - - 12 1,170,000
9 Bantal VVIP 227,500 - - - - - - -
10 Barakscort Perlak 68,250 - - - - - - -
11 Bed Cover Anak 276,250 - - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - - -
13 Bed Pad 97,500 - - - - - - 12 1,170,000
14 Bedong Bayi 32,500 - - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - -
16 Duk Lubang Bulat M 60 X 90 Cm (Csr) 96,200 - - - - - - -
17 Duk Lubang Mediana 205 X 325 419,250 - - - - - - -
18 Duk M 96,200 - - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - - -
21 Duk Persegi 125 X 125 Cm (Csr) 146,250 - - - - - - -
22 DUK S ( Bungkus Istrumen) 96,200 - - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - -
24 Hacinco 5L 162,500 - - - - - - -
25 Hacinco Dan Celana ( L ) 187,200 - - - - - - -
26 Hacinco Dan Celana ( M ) 187,200 - - - - - - -
27 Hacinco Dan Celana ( Xl ) 187,200 - - - - - - -
28 Hacinco Dan Celana ( Xxxxxl / 5 L) 191,750 - - - - - - -
29 Hacinco L 130,000 - - - - - - -
30 Hacinco M 130,000 - - - - - - -
31 Hacinco XL 130,000 - - - - - - -
32 Handuk Bayi 97,500 - - - - - - -
33 Handuk dewasa 97,500 - - - - - - -
34 Ikat Kaki/Tangan (All Size) 49,400 - - - - - - -
35 Jas Operasi 358,150 - - - - - - -
36 Jas Operasi Standard/ Cotton Soil Releas 358,150 - - - - - - -
37 Kerudung OK 29,250 - - - - - - -
38 Kimono + Celana Jumbo 162,500 - - - - - - -
39 Kimono + Celana L 162,500 - - - - - - -
40 Kimono + Celana M 162,500 - - - - - - -
41 Kimono + Celana S 162,500 - - - - - - -

324
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - - -
43 OPG 128,700 - - - - - - 6 772,200
44 Pembungkus Instrument 2 P-M (Double) 154,050 - - - - - - -
45 Pembungkus Instrument 21 P-L Double 198,250 - - - - - - -
46 Pembungkus Instrument 21 P-S Double 6 87,750 - - - - - - -
47 Penutup Inkubator 113,750 - - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - - -
49 Perlak bayi 48,750 - - - - - - -
50 Perlak full bed 78,000 - - - - - - -
51 Perlak Meja Operasi 280 X 120 156,000 - - - - - - -
52 Perlak pemasangan infus 32,500 - - - - - - -
53 Perlak tempat tidur 130,000 - - - - - - -
54 Popok bayi 22,750 - - - - - - -
55 Restrain 78,000 - - - - - - 3 234,000
56 Rompi Kegiatan 166,260 - - - - - - -
57 Sarung bantal bayi 22,750 - - - - - - -
58 Sarung Bantal Perlak Pvc 50 X 70 84,500 - - - - - - -
59 Sarung bantal VPC 63,500 - - - - - - -
60 Sarung Batal 41,750 - - - - - - 24 1,002,000
61 Sarung C-Arm 175,500 - - - - - - -
62 Sarung Couter 55,250 - - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - -
64 Sarung Meja mayo 104,000 - - - - - - -
65 Sarung Meja Mayo 60X80 104,000 - - - - - - -
66 Sarung Standar Meja Mayo 75 X 140 125,450 - - - - - - -
67 Sarung tangan bayi 9,750 - - - - - - -
68 Selimut Polar 113,750 - - - - - - 12 1,365,000
69 Sepre Rajal 113,750 - - - - - - -
70 Seprei 140,400 - - - - - - 24 3,369,600
71 Seprei Inkubator (Karet) 48,750 - - - - - - -
72 Stike Laken 57,000 - - - - - - 24 1,368,000
73 Tali Pengikat Kamar Bedah 65,000 - - - - - - -
74 Taplak Meja 97,500 - - - - - - -
75 Taplak Meja Makan Pcs 48,750 - - - - - - -
76 Topi bayi 29,250 - - - - - - -
77 Topi Pasien Ok All Size 45,500 - - - - - - -
78 Topi Tali All Size 47,450 - - - - - - -
79 Topi Tali OK 47,450 - - - - - - -
80 Zeil 55,250 - - - - - - 6 331,500

325
Rutin Umum Medis
Grand Total Linen - - - - - 12,174,600
LAUNDRY
1 PRT04655 Ec - Chlorine KG 39,227 - - - - - - -
2 PRT04658 Ec - Emulsifier LTR 31,381 - - - - - - -
3 PRT04660 Ec - Oxy Bleach Liquid LTR 20,519 - - - - - - -
4 PRT04659 Ec - Pine LTR 24,140 - - - - - - -
5 PRT04652 Ec - Softener LTR 19,599 - - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - - -
7 PRT04654 Ec - Super Alkali KG 22,933 - - - - - - -
8 PRT04653 Ec - Super Detergen KG 24,140 - - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - - -
Grand Total Laundry - - - - - -
AIR
MINUM
1 PRT11059 Air Minum Aqua Galon GLN 19,853 - - - - - - -
2 PRT08421 Air Minum Oasis Botol 330 M KRT 31,347 - - - - - - -
4 PRT2656 Air Minum Oasis Galon GLN 12,539 338,543 27 338,543 27 338,543 27 338,543 108 1,354,172 20 250,773
5 PRT09445 Air Minum Oasis Gelas 240 KRT 21,943 - - - - - - -
Grand Total Air Minum 338,543 338,543 338,543 338,543 1,354,172 250,773
CETAKAN
1 PRT08389 PCS 1,241 - - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - - -
Instalasi Radiologi
4 PRT3413 Amplop Hasil Laboratorium PAK 42,300 - - - - - - -
5 PRT3414 Amplop Pt.Kes PAK 56,400 - - - - - - -

6 PRT3410 PCS 9,400 - - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - - -
Putih )
9 PRT3411 Amplop Rs Meilia ( Warna ) PAK 56,400 - - - - - - -
10 cetakan Asesmen awal anak RIM 65,800 - - - - - - -

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - - -
Darurat Hal 1-2

326
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - - -
Darurat Hal 5-6
14 cetakan Asesmen awal kebidanan RIM 65,800 - - - - - - -
15 cetakan RIM 65,800 65,800 - - - 1 65,800 1 65,800
dewasa
16 cetakan Asesmen awal medis anak RIM 65,800 - - - - - - -
Asesmen awal medis
17 cetakan RIM 65,800 - - - 1 65,800 1 65,800 -
dewasa
18 cetakan Asesmen Neonatus RIM 65,800 - - - - - - -
19 PRT11806 RIM 65,800 - - - - - - -
Intervensi
20 cetakan Assesmen pra anestesi RIM 65,800 - - - - - - -
21 cetakan Assesmen pra bedah RIM 65,800 - - - - - - -
22 PRT3512 Assesment Awal Gizi RIM 61,100 - - - - - - -
23 PRT3574 Assesment Pasien Terminal RIM 61,100 - - - - - - -

24 PRT3580 RIM 65,800 - - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - - -
Test Report
26 PRT3418 BK 77,550 - 2 155,100 - - 2 155,100 -
Pmi
27 PRT3419 LBR 940 - - - - - - -
Lahir ( Skl )
28 PRT06822 Buku Catatan Medik Anak BK 32,900 - - - - - - -
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - - -
Hemodialisa
30 PRT12721 Catatan Anestesi / Sedasi LEMBAR 752 - - - - - - -
31 PRT11810 RIM 65,800 131,600 2 131,600 2 131,600 2 131,600 8 526,400 1 65,800
Pasien Terintegrasi
32 PRT3436 Catatan Persalinan LBR 1,034 - - - - - - -
33 PRT3447 Copy Resep BK 5,170 - - - - - - -

34 PRT10560 BK 15,040 - - - - - - -

35 PRT10561 BK 15,040 - - - - - - -

36 PRT10562 BK 15,040 - - - - - - -

327
Rutin Umum Medis
37 PRT12075 RIM 61,100 61,100 - 1 61,100 - 2 122,200 -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - - - - 1 61,100
41 PRT3453 RIM 51,700 - - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - - -
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 - - - - - - -
44 Form Indikasi Masuk Imc RIM 61,100 - - - - - - -
45 PRT3459 RIM 31,020 - - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - 1 61,100 - - 1 61,100 -
47 PRT3458 Form Permintaan Barang BK 8,460 - - - - - - -
48 PRT3461 BK 9,915 - - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - 1 7,520 - - 1 7,520 1 7,520
50 PRT06087 Form Work Order BK 8,460 - - - - - - -
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 65,800 - 1 65,800 - 2 131,600 1 65,800
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - 1 61,100 - - 1 61,100 -
56 cetakan Formulir NEWSS RIM 65,800 - - - - - - -
57 PRT12723 RIM 61,100 - - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 65,800 - - - 1 65,800 1 65,800
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 131,600 - 2 131,600 2 131,600 6 394,800 2 131,600
Keperawatan
61 PRT05616 Indikasi Sectio Caesaria RIM 51,700 - - - - - - -
62 PRT05732 Jasa Dokter BK 7,755 100,815 13 100,815 13 100,815 13 100,815 52 403,260 7 54,285
63 PRT3472 Kardeks Rawat Inap RIM 51,700 51,700 - - - 1 51,700 1 51,700

328
Rutin Umum Medis
64 PRT3474 Kartu Dental Status LBR 1,128 - - - - - - -
65 PRT3475 Kartu Kontrol LBR 564 - - - - - - -
66 PRT3478 Kartu Pasien PCS 2,350 - - - - - - -
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - - -
69 PRT05777 Kecil Hijau ( Tunas Karya LBR 362 - - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - - -
Tengah
72 PRT06141 Kertas Puyer KRT 1,649,230 - - - - - - -
73 PRT3484 Keterangan Medis BK 15,040 - - - - - - 1 15,040
74 PRT3483 Keterangan Pasien RIM 51,700 155,100 - 3 155,100 - 6 310,200 3 155,100
75 PRT3485 Klinik Mata RIM 56,400 - - - - - - -
76 PRT3535 Edukasi Harian RIM 61,100 61,100 - 1 61,100 - 2 122,200 -
77 PRT3488 RIM 98,230 - - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - - -
Hitam-Putih
79 PRT3490 Kop Surat Mcu RIM 117,500 - - - - - - -
80 PRT3491 Kop Surat Pt.Kes RIM 51,700 - - - - - - -
81 PRT07568 PCS 329 - - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - - -
Warna Putih )
83 PRT07569 ( Warna Merah PCS 329 - - - - - - -
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - - -
( Warna Biru )
85 PRT3504 Laboratorium Cito ½ Folio BK 8,145 - - - - - - -
86 PRT11605 RIM 65,800 - - - - - - -
Blue Rs Meilia
87 PRT3506 Laporan Pembedahan RIM 65,800 - - - - - - -
88 PRT3507 Leaflet Diet Pasien LBR 3,102 - - - - - - -
89 PRT3509 Lembar Disposisi RIM 51,700 - - - - - - -
90 PRT3510 Lembar Konsultasi RIM 65,800 - 1 65,800 - - 1 65,800 1 65,800

329
Rutin Umum Medis
91 PRT3516 Usg,Ecg,Treadmil,Endosco PCS 2,585 - - - - - - -
py,Ec
92 cetakan MAP KHUSUS GERIATRI 470 - - - - - - -

93 PRT3517 PCS 19,439 - - - - - - -
( Warna Kuning )
94 PRT3513 Map Rm / Rekam Medik PCS 2,585 - - - - - - -
95 PRT3514 Map Rs Meilia Ukuran Folio PCS 2,820 - - - - - - -
96 PRT12246 Medical Report BK 15,040 - - - - - - -

97 PRT12724 Monitor Harian RIM 65,800 - - - - - - -
98 PRT3511 Catatan Asupan Makanan RIM 61,100 - - - - - - -
Pasien)
99 PRT12725 RIM 65,800 131,600 2 131,600 2 131,600 2 131,600 8 526,400 1 65,800
Dan Keluar
100 PRT3520 BK 16,920 - - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 -
103 PRT3526 Pengajuan Pembedahan RIM 61,100 - - - - - - -
104 PRT3527 Pengawasan Infus RIM 51,700 - - - - - - -
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 61,100 - - - 1 61,100 -

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 - - - - - - -
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - 1 61,100 - - 1 61,100 -
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - 1 61,100 - - 1 61,100 1 61,100
Kedokteran
110 PRT3534 RIM 61,100 - - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - - - - - - -
112 PRT3536 Perincian Biaya Igd BK 12,690 - - - - - - -
113 PRT3537 Perincian Biaya Rajal BK 12,925 - - - - - - -

330
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - - -
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 - - - - - - -
116 PRT3541 Histopatologi Parafin Dan RIM 51,700 - - - - - - -
Potong Beku
117 PRT3542 BK 15,040 15,040 - - - 1 15,040 -
Laboratorium
118 PRT3543 BK 15,040 - - - - - - -
Radiologi
119 PRT11816 Permintaan Privasi RIM 62,040 - - - - - - -
120 PRT3544 RIM 51,700 - - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - - -
anestesi
122 cetakan Persetujuan tindakan bedah RIM 65,800 - - - - - - -
123 PRT11814 RIM 61,100 61,100 - 1 61,100 - 2 122,200 1 61,100
Kedokteran
124 PRT3545 RIM 61,100 - - - - - - -
Medis
125 PRT3546 Persetujuan Transfusi RIM 61,100 - - - - - - -
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 30,080 2 30,080 2 30,080 2 30,080 8 120,320 2 30,080
128 PRT06086 Pesanan Pulang Neonatus BK 15,040 - - - - - - -
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 61,100 - - - 1 61,100 1 61,100
130 PRT11493 Rekonsiliasi Obat RIM 61,100 - - - - - - -
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - - -
Pembedahan
133 PRT3554 Resep Kaca Mata BK 5,640 - - - - - - -
134 PRT3555 Resep Rawat Jalan BK 8,272 99,264 12 99,264 12 99,264 12 99,264 48 397,056 12 99,264
135 PRT3556 Resume BK 9,915 - - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 51,700 - - - 1 51,700 1 51,700
( New )
137 cetakan Rincian Biaya Operasi RIM 65,800 - - - - - - -
138 PRT3558 BK 8,178 24,534 3 24,534 3 24,534 3 24,534 12 98,136 -
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 51,700 - 1 51,700 - 2 103,400 1 51,700

331
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - - -

141 PRT3561 RIM 61,100 - - - - - - -
142 PRT12271 Screening Pasien Covid RIM 61,100 - - - - - - -

143 PRT3563 Sensus Harian Pasien Igd RIM 53,956 - - - - - - -
144 PRT3564 BK 23,030 23,030 - - - 1 23,030 1 23,030
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - - -
Medis & Non Medis
146 PRT09389 Sticker Transparan Apar A3 PCS 18,800 - - - - - - -
147 PRT06962 Sticker Transparan Hd PCS 517 - - - - - - -

148 PRT06936 (Kecil) Bhn Stiker Kromo PCS 188 - - - - - - -

149 PRT06341 PCS 282 - - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - - -
Panjang
151 cetakan STIKER LABEL GERIATRI 65,800 - - - - - - -
152 PRT11089 Stiker Lasa Kuning PCS 94 - - - - - - -

153 PRT3583 Surat Keterangan BK 7,238 7,238 - - - 1 7,238 1 7,238
154 PRT3584 Surat Keterangan Kematian BK 5,640 - 1 5,640 - 1 5,640 2 11,280 -
155 PRT06575 Surat Keterangan Mata BK 5,640 - - - - - - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 5,687 - - - 1 5,687 1 5,687
157 PRT3586 Surat Keterangan Sehat BK 5,170 - - - - - - -
158 PRT3587 Surat Masuk Perawatan BK 5,170 - - - - - - -
159 PRT11608 RIM 61,100 - - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - - -

332
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - - -
Rawat
164 PRT3593 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 -
165 PRT12729 Surgical Safety Checklist RIM 61,100 - - - - - - -
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 - - - - - - -
167 PRT3597 Tanda Terima Barang BK 7,520 - - - - - - -
168 PRT3596 Tanda Terima Dokumen BK 7,520 - - - - - - -
169 PRT3574 PCS 47 - - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - - -
Inap
173 RIM 61,100 - - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - - -
Grand Total Cetakan 1,635,788 1,118,553 1,227,593 843,133 4,825,067 1,323,144
Grand Total Biaya Rutin Umum dan Medis 4,203,394 3,146,469 2,266,626 1,947,759 11,564,249 14,273,480

333
Rutin Umum Medis
TAHUN 2022
KELAS II
TW 2 TW 3 TW 4 TW 1
QTY Jumlah QTY Jumlah QTY Jumlah QTY Jumlah
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - 1 15,439 - 1 15,439 -
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 - - - - - -
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 112 28,060 112 28,060 112 28,060 448 112,240 111 27,809
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 4 36,537 5 45,671 4 36,537 18 164,414 4 36,537

334
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - 1 17,485 - 1 17,485 -
400Ml
35 PRT2753 BTL 12,292 - - 3 36,876 3 36,876 -
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - 5 46,845 - 5 46,845 -
37 PRT05269 PCS 12,135 - 6 72,812 - 6 72,812 -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 - - - 4 70,985 -
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 - - - - - -
44 PRT12733 BTL 26,098 - - - - - -
Embun
45 PRT07308 Senter Besar PCS 26,098 - - - - - -
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 1 22,861 1 22,861 1 22,861 4 91,446 -
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 - - - - - -

Grand Total RTK 87,458 249,174 124,334 628,543 64,346

335
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

1 PRT13647 Access Point Wifi Unit 1,879,020 - - - - - -
2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
8 PRT05862 Botol Semprot Unit 94,900 - - - - - -
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 - - - - - 1 47,450
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

336
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - 1 237,250 - 1 237,250 -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 - - - - - -
39 PRT10795 Label " Dnr" PCS 711 - - - - - -
40 PRT09271 Label "Fall Risk" Yellow PCS 711 20 14,223 20 14,223 20 14,223 80 56,891 15 10,667

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
49 PRT04869 Meja Kerja Unit 1,409,265 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

337
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 - - - - - -
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 2 94,900 - - 2 94,900 2 94,900
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 - - - - - -

70 18,980 - 1 18,980 - 2 37,960 1 18,980
Plastik

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 109,123 270,453 14,223 427,001 171,997
UMUM MEDIS

338
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
3 Ambubag bayi Unt 2,799,550 - - - - - -
5 Bak instrumen sedang 189,800 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
10 PRT13652 Bengkok Besar Unit 237,250 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
24 PRT10613 Gunting Aff Heacting Kecil Unt 2,348,775 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - - - - - -

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

339
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1

44 PRT06713 Penlight PCS 284,700 - - - - - 1 284,700
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
57 PRT06791 Stetoscope Litman Anak Bh 1,660,750 - - - - - 1 1,660,750
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - 1 1,898,000
Conector)

340
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - - - 1 284,700
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis - - - - 4,128,150
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - 1 14,615 1 14,615
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 1 17,746 1 17,746 1 17,746 4 70,985 1 17,746
( Zamens )
6 PRT2966 PCS 7,307 - - - - - 1 7,307
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - 2 56,371 -
Energizer
14 PRT13178 PCS 5,741 4 22,966 4 22,966 4 22,966 16 91,863 2 11,483
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 1 4,959 1 4,959 1 4,959 4 19,834 3 14,876
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

341
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
20 PRT04548 PCS 38,520 - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 - 1 3,132 - 1 3,132 1 3,132

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 1 7,307 1 7,307 1 7,307 4 29,229 1 7,307
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 2 2,923 2 2,923 2 2,923 8 11,692 1 1,461
31 PRT04554 PCS 27,141 - - - 2 54,283 -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
34 PRT3005 Buku Telepon PCS 26,098 - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 - 1 5,741 - 2 11,483 1 5,741
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - - - - - -
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )

44 PRT04992 UNT 260,975 - - - - - -
A

342
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

343
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
78 PRT04565 Gunting Kecil ( Zamens ) PCS 6,263 - - - - - -
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 - - - - - -
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - - - - - -
82 PRT04802 PAK 1,827 - - - - - -
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 - - - - - -
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 - - - - - -
91 PRT04572 RIM 39,146 3 117,439 3 117,439 3 117,439 12 469,755 3 117,439
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

344
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - 1 7,307
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

345
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 2 12,527 2 12,527 2 12,527 8 50,107 2 12,527
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - 2 37,580 - 2 37,580 -
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - 1 8,948 - 1 8,948 -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - 1 1,253 - 1 1,253 1 1,253
)

140 PRT04584 PCS 9,395 - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

346
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 - 3 25,054 - 3 25,054 -
151 PRT3157 Pushpin Pack 3,132 - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 - - 2 5,220 2 5,220 2 5,220
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - 1 7,307
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - 1 5,654 - 1 5,654 -

169 PRT04596 PCS 31,317 - - - - - -
( Zamens )

347
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
180 ATK Stempel serah terima 41,756 - - - - - -
181 ATK Stempel TBAK 41,756 - - - - - -
182 ATK Stempel Verifikasi 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - - - 1 7,307 1 7,307
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 185,866 273,228 191,086 974,363 242,028
LINEN
2 Apron PVC 68,250 - - - 6 409,500 -

348
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
3 Bad Mate 54,600 - - - 18 982,800 -
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - 12 1,170,000 -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - 12 1,170,000 -
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

349
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - 6 772,200 -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
52 Perlak pemasangan infus 32,500 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - - 3 234,000 -
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 - - - 24 1,002,000 -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 - - - 12 1,365,000 -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - 24 3,369,600 -
72 Stike Laken 57,000 - - - 24 1,368,000 -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - 6 331,500 -

350
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
Grand Total Linen - - - 12,174,600 -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 20 250,773 20 250,773 20 250,773 80 1,003,091 15 188,080
Grand Total Air Minum 250,773 250,773 250,773 1,003,091 188,080
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

351
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - 1 65,800 -
dewasa
16 cetakan Asesmen awal medis anak RIM 65,800 - - - - - -
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 1 77,550 - - 1 77,550 -
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 - 1 65,800 - 2 131,600 1 65,800
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

352
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
37 PRT12075 RIM 61,100 - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - 1 61,100 -
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 - - - - - -
44 Form Indikasi Masuk Imc RIM 61,100 - - - - - -
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - - 1 61,100 1 61,100 -
48 PRT3461 BK 9,915 - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - 1 7,520 - 2 15,040 -
50 PRT06087 Form Work Order BK 8,460 1 8,460 - - 1 8,460 1 8,460
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - - - 1 65,800 -

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - - 1 61,100 1 61,100 -
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - - - 1 65,800 -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 2 131,600 2 131,600 2 131,600 8 526,400 1 65,800
Keperawatan
62 PRT05732 Jasa Dokter BK 7,755 7 54,285 7 54,285 7 54,285 28 217,140 4 31,020
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - - - 1 51,700 1 51,700

353
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - - - 1 15,040 -
74 PRT3483 Keterangan Pasien RIM 51,700 - 3 155,100 1 51,700 7 361,900 3 155,100
76 PRT3535 Edukasi Harian RIM 61,100 1 61,100 - 1 61,100 2 122,200 1 61,100
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
89 PRT3509 Lembar Disposisi RIM 51,700 - - - - - -
90 PRT3510 Lembar Konsultasi RIM 65,800 1 65,800 - 1 65,800 3 197,400 -

354
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

97 PRT12724 Monitor Harian RIM 65,800 - - - - - -
Pasien)
99 PRT12725 RIM 65,800 2 131,600 1 65,800 2 131,600 6 394,800 1 65,800
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - - - - - -
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - - - - - -

Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - - 1 61,100 1 61,100 -
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - 1 61,100 -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - - - - - 1 61,100

355
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - 1 15,040
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
119 PRT11816 Permintaan Privasi RIM 62,040 - - - - - 1 62,040
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - 1 61,100 -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 2 30,080 2 30,080 2 30,080 8 120,320 1 15,040
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - - - 1 61,100 -

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 12 99,264 12 99,264 12 99,264 48 397,056 12 99,264
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - 1 51,700 1 51,700
( New )
138 PRT3558 BK 8,178 - 7 57,246 - 7 57,246 -
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - 1 51,700 -

356
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 - - - 1 23,030 -
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 - - - 1 7,238 -

156 PRT3585 Surat Keterangan Rawat BK 5,687 - - - 1 5,687 -
159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - 1 61,100
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

357
Rutin Umum Medis
TW 2 TW 3 TW 4 TW 1
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 659,739 666,695 808,729 3,458,307 870,064

358
Rutin Umum Medis
TAHUN 2022
KELAS II
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 - - - - - 23 181,513 23
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 111 27,809 111 27,809 112 28,060 445 111,489 112 28,060 112
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -

359
Rutin Umum Medis
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - 1 17,485 1 17,485 -
400Ml
35 PRT2753 BTL 12,292 3 36,876 - - 3 36,876 -
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - - 5 46,845 5 46,845 -
37 PRT05269 PCS 12,135 - - 6 72,812 6 72,812 -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 - 4 70,985 - 4 70,985 -
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 1 22,861 - 1 22,861 2 45,723 5 114,307 5

Grand Total RTK 124,083 144,465 224,600 557,495 360,417

360
Rutin Umum Medis
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - - 2
19 237,250 - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 - - - 1 47,450 -
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

361
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - - - - - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

39 PRT10795 Label " Dnr" PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

362
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 - - - 2 94,900 - 1

70 18,980 - 1 18,980 - 2 37,960 1 18,980
Plastik

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
UMUM MEDIS

363
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - 1 56,940
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 - - - - - - 12
10 PRT13652 Bengkok Besar Unit 237,250 - - - - - 2 474,500
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - 2 1,328,600 2
stand manual

364
Rutin Umum Medis

44 PRT06713 Penlight PCS 284,700 - - - 1 284,700 -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - - - - - 2 664,300

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - 1 332,150
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
57 PRT06791 Stetoscope Litman Anak Bh 1,660,750 - - - 1 1,660,750 -
59 PRT06709 Unt 1,518,400 - - - - - 1 1,518,400
Duos
60 T conector oksigen dinding 1,898,000 - - - - - 2 3,796,000

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 - - - - - 1 901,550
65 PRT12582 Unt 1,898,000 - - - 1 1,898,000 1 1,898,000
Conector)

365
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - 1 284,700 -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - 2 2,818,530
Grand Total Umum Medis - - - 4,128,150 13,788,970
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - 1 14,615 -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 1 17,746 1 17,746 1 17,746 4 70,985 2 35,493 2
( Zamens )
6 PRT2966 PCS 7,307 - - - 1 7,307 -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 2 11,483 2 11,483 - 6 34,449 4 22,966 4
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 3 14,876 3 14,876 3 14,876 12 59,502 5 24,793 5
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

366
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 - - - 1 3,132 - 1

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 - 1 7,307 - 2 14,615 2 14,615 2
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 - - - 1 5,741 - 2
( Zamens )
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )

44 PRT04992 UNT 260,975 - - - - - -
A

367
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - - - - - 1 11,483
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

368
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
82 PRT04802 PAK 1,827 - - - - - -
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 3 117,439 3 117,439 3 117,439 12 469,755 5 195,731 5
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

369
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - 1 7,307 -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

370
Rutin Umum Medis
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - - 2 37,580 2 37,580 1 18,790
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - 1 8,948 1 8,948 - 1
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - 1 1,253 3 3,758
)

140 PRT04584 PCS 9,395 - - - - - 1 9,395
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - 1 1,566 - 1 1,566 -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

371
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 - - 3 25,054 3 25,054 3 25,054
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 - 2 5,220 - 4 10,439 - 2
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - 1 7,307 - 2
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - 1 5,654 1 5,654 - 1

169 PRT04596 PCS 31,317 - - - - - -
( Zamens )

372
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - 1 41,756
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - 1 7,307 - 2 14,615 - 1
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 175,532 196,932 241,284 855,776 428,469
LINEN
2 Apron PVC 68,250 - - - - - -

373
Rutin Umum Medis
3 Bad Mate 54,600 - - - - - 27 1,474,200
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - 18 1,755,000
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - 12 1,170,000
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

374
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - 9 1,158,300
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - - - - 4 312,000
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 - - - - - 36 1,503,000
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 - - - - - 18 2,047,500
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - 36 5,054,400
72 Stike Laken 57,000 - - - - - 36 2,052,000
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - 9 497,250

375
Rutin Umum Medis
Grand Total Linen - - - - 17,023,650
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 15 188,080 15 188,080 15 188,080 60 752,318 55 689,625 55
Grand Total Air Minum 188,080 188,080 188,080 752,318 689,625
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )
10 cetakan Asesmen awal anak RIM 65,800 - - - - - 1 65,800

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

376
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - - 1
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - 1 65,800 - 1 65,800 1 65,800
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi
20 cetakan Assesmen pra anestesi RIM 65,800 - - - - - 1 65,800
21 cetakan Assesmen pra bedah RIM 65,800 - - - - - - 1
23 PRT3574 Assesment Pasien Terminal RIM 61,100 - - - - - - 1

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - - - - 2 155,100 3
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 - 1 65,800 - 2 131,600 3 197,400 3
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

377
Rutin Umum Medis
37 PRT12075 RIM 61,100 - - - - - 1 61,100
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - - - 1 61,100
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - - - - - 1 61,100 1
48 PRT3461 BK 9,915 - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 1 7,520 - - 1 7,520 1 7,520
50 PRT06087 Form Work Order BK 8,460 - - - 1 8,460 - 1
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 1 65,800 - - 1 65,800 1 65,800
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - - - - - 1 61,100
56 cetakan Formulir NEWSS RIM 65,800 - - - - - - 1
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - 1 65,800 - 1 65,800 1 65,800
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 - - - 1 65,800 4 263,200 4
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - - - 1 51,700 1 51,700

378
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 1 15,040 - - 1 15,040 1 15,040
74 PRT3483 Keterangan Pasien RIM 51,700 3 155,100 3 155,100 3 155,100 12 620,400 3 155,100 3
76 PRT3535 Edukasi Harian RIM 61,100 - - - 1 61,100 1 61,100 1
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - 1 65,800 - 1 65,800 1 65,800 1

379
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - 1 65,800 - 2 131,600 4 263,200 4
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - - - - - 2 122,200 2
103 PRT3526 Pengajuan Pembedahan RIM 61,100 - - - - - 1 61,100
Pengawasan Pasien

Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - - - - - - 1
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 1 61,100 - - 1 61,100 - 1
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - - - 1 61,100 -

380
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - 1 15,040 1 15,040
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
119 PRT11816 Permintaan Privasi RIM 62,040 - - - 1 62,040 -
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - 1 61,100 - 1 61,100 1 61,100 2
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 1 61,100 - - 1 61,100 1 61,100
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - 1 51,700 1 51,700
( New )
138 PRT3558 BK 8,178 - - - - - 9 73,602 9
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 1 51,700 - - 1 51,700 1 51,700

381
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 - - 2 46,060 2 46,060 1 23,030
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 - - 2 14,476 2 14,476 1 7,238
154 PRT3584 Surat Keterangan Kematian BK 5,640 - - - - - 1 5,640

156 PRT3585 Surat Keterangan Rawat BK 5,687 - - 2 11,374 2 11,374 1 5,687
159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - 1 61,100 -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

382
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 562,684 690,524 372,334 2,495,606 2,763,130

383
Rutin Umum Medis
TAHUN 2022
GAEA
KELAS I ISOLASI
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - 1 15,439 - 1 15,439 - -
2 PRT08294 PCS 260,975 - - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 181,513 23 181,513 23 181,513 92 726,053 22 173,621 23 181,513
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 - - - - - - -
8 PRT2833 PCS 251 28,060 112 28,060 112 28,060 448 112,240 112 28,060 112 28,060
9 PRT2835 PAK 12,527 - - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - - -
15 RTK PCS 160 - - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - - -

384
Rutin Umum Medis
30 PRT06826 PAK 83,512 - - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - - -
33 PRT05532 PCS 1,973 - - - - - - -
Gr
34 PRT2755 PCS 17,485 - 3 52,456 - 3 52,456 - -
400Ml
35 PRT2753 BTL 12,292 - - - - - - -
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - 5 46,845 - 5 46,845 - -
37 PRT05269 PCS 12,135 - 6 72,812 - 6 72,812 - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 - - 4 70,985 4 70,985 - -
41 47,450 - - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 - - - - - - -
44 PRT12733 BTL 26,098 - - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 114,307 5 114,307 5 114,307 20 457,228 1 22,861 -
51 PRT06122 Stella All In One PCS 9,152 - 4 36,607 - 4 36,607 - -
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 - - - - - - -

Grand Total RTK 360,417 584,577 431,402 1,736,813 261,079 246,110

385
Rutin Umum Medis
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - - -
16 PRT12904 Ember pcs 237,250 474,500 - - 2 474,500 - -
19 237,250 - - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 - - - - - - -
22 PRT08249 PCS 2,923 - - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - - -
Band 7702-49-Pdl

386
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - 4 949,000 - 4 949,000 1 237,250 -

27 PRT2723 Kanebo Pcs 66,430 - - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 - - - - - - -
39 PRT10795 Label " Dnr" PCS 711 - - - - - - -

44 949,000 - - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - - -
49 PRT04869 Meja Kerja Unit 1,409,265 - - - - - - -
50 Meja Snack 2,372,500 - - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - - -

387
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - - -

61 non medis Pasang 949,000 - - - - - - -
operasi
64 949,000 - - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 47,450 - - 1 47,450 1 47,450 -
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - - - - - - -

70 18,980 - 1 18,980 - 2 37,960 1 18,980 -
Plastik

75 PRT10957 Unit 237,250 - - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - - -
78 Website 2,847,000 - - - - - - -
Grand Total Umum Non Medis 571,730 1,017,760 49,780 1,708,028 321,458 17,778
UMUM MEDIS

388
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - 1 56,940 1 56,940 -
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 2,277,600 - - 12 2,277,600 - -
10 PRT13652 Bengkok Besar Unit 237,250 - - - 2 474,500 - -
14 Cutiing Loop 1,423,500 - - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - - -
28 Gunting verban 711,750 - - - - - - -
29 kom kecil 71,175 - - - - - - -
31 PRT09490 Unit 237,250 - - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - - -
35 Pcs 664,300 1,328,600 2 1,328,600 2 1,328,600 8 5,314,400 - -
stand manual

389
Rutin Umum Medis

44 PRT06713 Penlight PCS 284,700 - - - - - - -
45 pinset anatomis 332,150 - - - - - - -
46 Pinset Cirurgis 332,150 - - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - - - 2 664,300 - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - 1 332,150 - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - 1 1,518,400 - -
Duos
60 T conector oksigen dinding 1,898,000 - - - 2 3,796,000 - -

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 - - - 1 901,550 - -
65 PRT12582 Unt 1,898,000 - - - 1 1,898,000 - -
Conector)

390
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - - - - -
73 Trolly Barang 1,423,500 - - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - 2 2,818,530 - -
Grand Total Umum Medis 3,606,200 1,328,600 1,328,600 20,052,370 56,940 -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - 1 14,615 -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 35,493 2 35,493 2 35,493 8 141,970 1 17,746 1 17,746
( Zamens )
6 PRT2966 PCS 7,307 - - - - - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - 2 56,371 - 2 56,371 - -
Energizer
14 PRT13178 PCS 5,741 22,966 4 22,966 4 22,966 16 91,863 2 11,483 2 11,483
( Zamens )
15 PRT04547 PCS 3,654 - - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 24,793 5 24,793 5 24,793 20 99,171 3 14,876 2 9,917
18 PRT04715 PCS 5,220 - - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - - -
( Zamens )

391
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 3,132 - - 1 3,132 - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 14,615 2 14,615 2 14,615 8 58,458 1 7,307 -
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 - - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 11,483 - - 2 11,483 - 1 5,741
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - - - - - - -
38 PRT04557 PCS 5,741 - - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - - -
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 - 20 62,634 - 20 62,634 - -

44 PRT04992 UNT 260,975 - - - - - - -
A

392
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - - - - - -
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - - - 1 11,483 - -
63 PRT3023 Devider Bantex 6050 PAK 8,873 - - - - - - -
64 PRT04800 PCS 10,439 - - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - - -
)

393
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - - -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - 3 9,395 - 3 9,395 - -
82 PRT04802 PAK 1,827 - - - - - - -
( Zamens )
83 PRT05503 BOX 12,527 - - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - 1 101,258 - 1 101,258 - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 - 3 1,096 - 3 1,096 - -
87 PRT3057 PCS 2,088 - - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - - -
Numbering
91 PRT04572 RIM 39,146 195,731 5 195,731 5 195,731 20 782,925 1 39,146 2 78,293
( Zamens )
92 PRT04719 RIM 50,107 - - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - - -
( Zamens )

394
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - - -

104 PRT04624 ROL 67,332 - - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - - -

395
Rutin Umum Medis
124 PRT07117 PCS 2,175 - - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - - - 1 18,790 - 1 18,790
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 - - - - - - -
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 8,948 - - 1 8,948 1 8,948 -
Lokal
135 PRT11929 PCS 234,878 - - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - 3 3,758 - 2 2,505
)

140 PRT04584 PCS 9,395 - - - 1 9,395 - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - 1 1,566 1 1,566 - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - - -
17 X 22

396
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 - 3 25,054 - 6 50,107 - 3 25,054
151 PRT3157 Pushpin Pack 3,132 - - - - - - -
153 PRT11061 PCS 62,634 - - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 5,220 - 2 5,220 4 10,439 2 5,220 -
163 PRT06918 Sign Here PCS 20,878 - - - - - - -

165 PRT04593 PCS 7,307 14,615 - - 2 14,615 - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 5,654 - - 1 5,654 - -

169 PRT04596 PCS 31,317 - - - - - 1 31,317 -
( Zamens )

397
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - 1 41,756 - -
189 PRT10189 PCS 140,927 - - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - - -
200 PRT05765 BTL 46,976 - - - - - - -
201 PRT04810 BTL 7,307 7,307 - 1 7,307 2 14,615 1 7,307 -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - - -

204 PRT04602 BH 4,176 - - - - - - -
)
Grand Total ATK 374,590 574,041 332,326 1,709,425 173,414 184,979
LINEN
2 Apron PVC 68,250 - - - - - - -

398
Rutin Umum Medis
3 Bad Mate 54,600 - - - 27 1,474,200 6 327,600 -
4 Baju Bayi 22,750 - - - - - - -
5 Baju pasien OK 131,300 - - - - - - -
7 bantal bayi 32,500 - - - - - - -
8 Bantal Biasa 97,500 - - - 18 1,755,000 4 390,000 -
9 Bantal VVIP 227,500 - - - - - - -
11 Bed Cover Anak 276,250 - - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - - -
13 Bed Pad 97,500 - - - 12 1,170,000 4 390,000 -
14 Bedong Bayi 32,500 - - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - -
18 Duk M 96,200 - - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - -
24 Hacinco 5L 162,500 - - - - - - -
29 Hacinco L 130,000 - - - - - - -
30 Hacinco M 130,000 - - - - - - -
31 Hacinco XL 130,000 - - - - - - -
32 Handuk Bayi 97,500 - - - - - - -
33 Handuk dewasa 97,500 - - - - - - -
35 Jas Operasi 358,150 - - - - - - -
37 Kerudung OK 29,250 - - - - - - -
39 Kimono + Celana L 162,500 - - - - - - -
40 Kimono + Celana M 162,500 - - - - - - -
41 Kimono + Celana S 162,500 - - - - - - -

399
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - - -
43 OPG 128,700 - - - 9 1,158,300 2 257,400 -
48 Perlak 1/2 bed 65,000 - - - - - - -
49 Perlak bayi 48,750 - - - - - - -
50 Perlak full bed 78,000 - - - - - - -
54 Popok bayi 22,750 - - - - - - -
55 Restrain 78,000 - - - 4 312,000 1 78,000 -
56 Rompi Kegiatan 166,260 - - - - - - -
60 Sarung Batal 41,750 - - - 36 1,503,000 8 334,000 -
61 Sarung C-Arm 175,500 - - - - - - -
62 Sarung Couter 55,250 - - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - -
64 Sarung Meja mayo 104,000 - - - - - - -
68 Selimut Polar 113,750 - - - 18 2,047,500 4 455,000 -
69 Sepre Rajal 113,750 - - - - - - -
70 Seprei 140,400 - - - 36 5,054,400 8 1,123,200 -
72 Stike Laken 57,000 - - - 36 2,052,000 8 456,000 -
74 Taplak Meja 97,500 - - - - - - -
76 Topi bayi 29,250 - - - - - - -
79 Topi Tali OK 47,450 - - - - - - -
80 Zeil 55,250 - - - 9 497,250 4 221,000 -

400
Rutin Umum Medis
Grand Total Linen - - - 17,023,650 4,032,200 -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 689,625 55 689,625 55 689,625 220 2,758,499 20 250,773 20 250,773
Grand Total Air Minum 689,625 689,625 689,625 2,758,499 250,773 250,773
CETAKAN
1 PRT08389 PCS 1,241 - - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - - -
Putih )
10 cetakan Asesmen awal anak RIM 65,800 - - - 1 65,800 - -

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - - -
Darurat Hal 1-2

401
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 65,800 - - 1 65,800 1 65,800 -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - 1 65,800 - 1 65,800
dewasa
19 PRT11806 RIM 65,800 - - - - - - -
Intervensi
20 cetakan Assesmen pra anestesi RIM 65,800 - - - 1 65,800 - -
21 cetakan Assesmen pra bedah RIM 65,800 65,800 - - 1 65,800 - -
23 PRT3574 Assesment Pasien Terminal RIM 61,100 61,100 - - 1 61,100 - -

24 PRT3580 RIM 65,800 - - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - - -
Test Report
26 PRT3418 BK 77,550 232,650 2 155,100 3 232,650 10 775,500 1 77,550 -
Pmi
27 PRT3419 LBR 940 - - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 197,400 3 197,400 3 197,400 12 789,600 1 65,800 -
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - - -

34 PRT10560 BK 15,040 - - - - - - -

35 PRT10561 BK 15,040 - - - - - - -

36 PRT10562 BK 15,040 - - - - - - -

402
Rutin Umum Medis
37 PRT12075 RIM 61,100 - 1 61,100 1 61,100 3 183,300 1 61,100 -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - 1 61,100 - -
41 PRT3453 RIM 51,700 - - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 61,100 - 1 61,100 3 183,300 - -
48 PRT3461 BK 9,915 - - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - - 1 7,520 2 15,040 - 1 7,520
50 PRT06087 Form Work Order BK 8,460 8,460 - - 1 8,460 - 1 8,460
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - 1 65,800 - 2 131,600 1 65,800 1 65,800
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - - - 1 61,100 - -
56 cetakan Formulir NEWSS RIM 65,800 65,800 - - 1 65,800 - -
57 PRT12723 RIM 61,100 - - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - 1 65,800 - 2 131,600 1 65,800 -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 263,200 4 263,200 4 263,200 16 1,052,800 1 65,800 -
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - 1 51,700 1 51,700 3 155,100 1 51,700 -

403
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - - - 1 15,040 1 15,040 -
74 PRT3483 Keterangan Pasien RIM 51,700 155,100 3 155,100 3 155,100 12 620,400 3 155,100 3 155,100
76 PRT3535 Edukasi Harian RIM 61,100 61,100 1 61,100 1 61,100 4 244,400 1 61,100 -
77 PRT3488 RIM 98,230 - - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 65,800 1 65,800 2 131,600 5 329,000 1 65,800 -

404
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 263,200 4 263,200 4 263,200 16 1,052,800 1 65,800 -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 122,200 2 122,200 2 122,200 8 488,800 1 61,100 -
103 PRT3526 Pengajuan Pembedahan RIM 61,100 - 1 61,100 - 2 122,200 - -
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - - - - - - -

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 - 1 65,800 - 1 65,800 - -
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 61,100 - 1 61,100 2 122,200 - -
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 61,100 - - 1 61,100 - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - - -
( A4 )

405
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - 1 15,040 - 2 30,080 - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - - -
anestesi
123 PRT11814 RIM 61,100 122,200 1 61,100 2 122,200 6 366,600 1 61,100 -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - - -
Perawatan
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - 1 61,100 - 2 122,200 1 61,100 -
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - 1 51,700 1 51,700 3 155,100 1 51,700 -
( New )
138 PRT3558 BK 8,178 73,602 9 73,602 9 73,602 36 294,408 1 8,178 1 8,178
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - 1 51,700 - 1 51,700

406
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - - -

141 PRT3561 RIM 61,100 - - - - - - -

144 PRT3564 BK 23,030 - - - 1 23,030 1 23,030 -
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 - - - 1 7,238 1 7,238 -
154 PRT3584 Surat Keterangan Kematian BK 5,640 - 1 5,640 - 2 11,280 - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 - - - 1 5,687 1 5,687 -
159 PRT11608 RIM 61,100 - - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - - -

407
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - - -
169 PRT3574 PCS 47 - - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - - -
Inap
173 RIM 61,100 - - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - - -
Grand Total Cetakan 2,422,145 2,338,015 2,331,905 9,855,195 1,291,137 492,372

408
Rutin Umum Medis
TAHUN 2022
ISOLASI KELAS III

TW 3 TW 4 TW 1 TW 2
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - 1 15,439 1 15,439 - -
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - 5 13,165 5 13,165
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 22 173,621 22 173,621 89 702,378 5 39,459 5 39,459
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 - - - - 1 7,777 1 7,777
8 PRT2833 PCS 251 112 28,060 112 28,060 448 112,240 30 7,516 30 7,516
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -

409
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - 1 17,485 1 17,485
400Ml
35 PRT2753 BTL 12,292 - 3 36,876 3 36,876 - -
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - 5 46,845 5 46,845 1 9,369 1 9,369
37 PRT05269 PCS 12,135 - 6 72,812 6 72,812 1 12,135 1 12,135
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 - 4 70,985 4 70,985 - 1 17,746
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 1 22,861 - 2 45,723 - 1 22,861
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 - - - - 5 8,565 5 8,565

Grand Total RTK 261,079 481,175 1,249,444 124,607 165,214

410
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
8 PRT05862 Botol Semprot Unit 94,900 - - - - - 1 94,900
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 - - - - - -
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

411
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - - 1 237,250 - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 - - - - 2 1,422 2 1,422
39 PRT10795 Label " Dnr" PCS 711 - - - - - -
40 PRT09271 Label "Fall Risk" Yellow PCS 711 25 17,778 25 17,778 100 71,114 15 10,667 15 10,667

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

412
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 - - 1 47,450 - 1 47,450

70 18,980 1 18,980 - 2 37,960 - -
Plastik
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 - - - - - 1 142,350

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
UMUM MEDIS

413
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - 1 56,940 - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

414
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

415
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 2 94,900 - 2 94,900 - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 94,900 - 151,840 - -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - 1 14,615 - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 1 17,746 1 17,746 4 70,985 - -
( Zamens )
6 PRT2966 PCS 7,307 - - - - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 2 11,483 2 11,483 8 45,932 - 1 5,741
( Zamens )
15 PRT04547 PCS 3,654 - - - - - 1 3,654
( Zamens )
16 PRT04545 PCS 1,983 - - - - - 1 1,983
( Zamens )
17 PRT04546 PCS 4,959 3 14,876 2 9,917 10 49,585 - 1 4,959
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

416
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
20 PRT04548 PCS 38,520 - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 1 7,307 - 2 14,615 1 7,307 1 7,307
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 - - - - 1 27,141 1 27,141
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 - - - - - 1 2,088

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 - 1 5,741 2 11,483 1 5,741 1 5,741
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - - - - 1 10,439 1 10,439
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - 1 3,132
( Zamens )
40 PRT05172 PCS 3,132 - - - - - 1 3,132
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 - - - - - 1 3,132
42 PRT3007 Bussines File Warna Merah PCS 3,132 - - - - - 1 3,132

44 PRT04992 UNT 260,975 - - - - - -
A

417
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - - - - 1 26,098 -
58 PRT3020 PCS 3,132 - - - - 3 9,395 3 9,395
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

63 PRT3023 Devider Bantex 6050 PAK 8,873 - - - - - 1 8,873
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

418
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - - - - - 1 3,132
82 PRT04802 PAK 1,827 - - - - - 1 1,827
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 1 39,146 2 78,293 6 234,878 1 39,146 1 39,146
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

419
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

420
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 2 12,527 2 12,527 8 50,107 - 1 6,263
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - - 1 18,790 - -
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 - - - - - 1 27,141
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - 1 8,948 - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - 2 2,505 - 1 1,253
)

140 PRT04584 PCS 9,395 - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - 1 3,262 1 3,262
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

421
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 - - 3 25,054 - 1 8,351
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 - - 2 5,220 1 2,610 1 2,610
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 1 5,654 - 1 5,654 - -

169 PRT04596 PCS 31,317 - - 1 31,317 - -
( Zamens )

422
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - - 1 7,307 - -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 111,662 138,630 608,685 132,601 194,296
LINEN
2 Apron PVC 68,250 - - - - - -

423
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
3 Bad Mate 54,600 - - 6 327,600 - -
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - 4 390,000 - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - 4 390,000 - -
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

424
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - 2 257,400 - -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - 1 78,000 - -
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 - - 8 334,000 - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 - - 4 455,000 - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - 8 1,123,200 - -
72 Stike Laken 57,000 - - 8 456,000 - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - 4 221,000 - -

425
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
Grand Total Linen - - 4,032,200 - -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 20 250,773 20 250,773 80 1,003,091 5 62,693 5 62,693
Grand Total Air Minum 250,773 250,773 1,003,091 62,693 62,693
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

426
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - 1 65,800 - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - 1 65,800 - -
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - 1 77,550 - 1 77,550
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 - - 1 65,800 1 65,800 1 65,800
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

427
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
37 PRT12075 RIM 61,100 - - 1 61,100 - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 1 61,100 - 1 61,100 - -
47 PRT3458 Form Permintaan Barang BK 8,460 - - - - 1 8,460 -
48 PRT3461 BK 9,915 - - - - - 1 9,915
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - - 1 7,520 - -
50 PRT06087 Form Work Order BK 8,460 - - 1 8,460 - -
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 1 65,800 1 65,800 4 263,200 - -
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 1 61,100 - 1 61,100 - -
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - - 1 65,800 - -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 1 65,800 - 2 131,600 - -
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - - 1 51,700 - -

428
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - - 1 15,040 - -
74 PRT3483 Keterangan Pasien RIM 51,700 3 155,100 3 155,100 12 620,400 - -
76 PRT3535 Edukasi Harian RIM 61,100 - - 1 61,100 - -
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - - 1 65,800 - -

429
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 1 65,800 - 2 131,600 - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - - 1 61,100 - -
Pengawasan Pasien

Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 1 61,100 - 1 61,100 - -
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

430
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - 1 61,100 - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 1 15,040 - 3 45,120 - 1 15,040
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - - 1 61,100 - -

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - 1 51,700 - -
( New )
138 PRT3558 BK 8,178 1 8,178 1 8,178 4 32,712 - 1 8,178
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - 1 51,700 - -

431
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 1 23,030 - 2 46,060 1 23,030 1 23,030
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 1 7,238 - 2 14,476 - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 1 5,687 - 2 11,374 - -
159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

432
Rutin Umum Medis
TW 3 TW 4 TW 1 TW 2
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 709,747 343,852 2,837,108 113,317 215,540
Grand Total Biaya Rutin Umum dan Medis 1,464,919 1,232,208 10,276,141 445,308 934,533

433
Rutin Umum Medis
TAHUN 2022
KELAS III KELAS II

RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 10 26,330 10 26,330 30 78,991 5 13,165 5 13,165 10
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 18 142,054 18 142,054 46 363,027 5 39,459 5 39,459 18
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 2 15,554 3 23,331 7 54,439 1 7,777 1 7,777 2
8 PRT2833 PCS 251 30 7,516 30 7,516 120 30,064 30 7,516 30 7,516 30
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -

434
Rutin Umum Medis
30 PRT06826 PAK 83,512 1 83,512 - 1 83,512 - - 1
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 1 17,485 1 17,485 4 69,941 1 17,485 1 17,485 1
400Ml
35 PRT2753 BTL 12,292 1 12,292 1 12,292 2 24,584 - - 1
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 2 18,738 2 18,738 6 56,214 1 9,369 1 9,369 2
37 PRT05269 PCS 12,135 3 36,406 3 36,406 8 97,083 1 12,135 1 12,135 3
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 2 35,493 2 35,493 5 88,732 - 1 17,746 2
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 1 10,439 1 10,439 2 20,878 - - 1
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 1 22,861 1 22,861 3 68,584 - 1 22,861 1
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 24 41,113 25 42,826 59 101,069 5 8,565 5 8,565 24
Grand Total RTK 488,062 423,174 1,201,057 124,607 165,214

435
Rutin Umum Medis
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
8 PRT05862 Botol Semprot Unit 94,900 - - 1 94,900 - 1 94,900
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

436
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - 1 237,250 1 237,250 - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

39 PRT10795 Label " Dnr" PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

437
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 1 47,450 1 47,450 3 142,350 - 1 47,450 1
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - - - - - - 1

70 18,980 - - - - - -
Plastik
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 - 1 142,350 2 284,700 - 1 142,350

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
UMUM MEDIS

438
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

439
Rutin Umum Medis

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - 1 332,150 -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

440
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis - - - 332,150 -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 1 17,746 1 17,746 2 35,493 - - 1
( Zamens )
6 PRT2966 PCS 7,307 - - - - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 2 11,483 2 11,483 5 28,707 - 1 5,741 2
( Zamens )
15 PRT04547 PCS 3,654 2 7,307 2 7,307 5 18,268 - 1 3,654 2
( Zamens )
16 PRT04545 PCS 1,983 2 3,967 2 3,967 5 9,917 - 1 1,983 2
( Zamens )
17 PRT04546 PCS 4,959 1 4,959 1 4,959 3 14,876 - 1 4,959 1
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

441
Rutin Umum Medis
20 PRT04548 PCS 38,520 - 1 38,520 1 38,520 - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 1 7,307 1 7,307 4 29,229 1 7,307 1 7,307 1
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 1 27,141 1 27,141 4 108,566 1 27,141 1 27,141 1
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 1 2,088 1 2,088 3 6,263 - 1 2,088 1
Buku Tulis Expedisi
36 PRT04558 PCS 5,741 1 5,741 1 5,741 4 22,966 1 5,741 1 5,741 1
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 1 10,439 1 10,439 4 41,756 1 10,439 1 10,439 1
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 2 6,263 2 6,263 5 15,659 - 1 3,132 2
( Zamens )
40 PRT05172 PCS 3,132 2 6,263 2 6,263 5 15,659 - 1 3,132 2
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 2 6,263 2 6,263 5 15,659 - 1 3,132 2
42 PRT3007 Bussines File Warna Merah PCS 3,132 2 6,263 2 6,263 5 15,659 - 1 3,132 2

44 PRT04992 UNT 260,975 - - - - - -
A

442
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - - 1 26,098 1 26,098 -
58 PRT3020 PCS 3,132 10 31,317 11 34,449 27 84,556 3 9,395 3 9,395 10
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - - - - - 1 11,483
63 PRT3023 Devider Bantex 6050 PAK 8,873 1 8,873 1 8,873 3 26,619 - 1 8,873 1
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - - 1
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - 1 3,654 1 3,654 - - 1
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

443
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - - 1 3,132 - 1 3,132
82 PRT04802 PAK 1,827 2 3,654 2 3,654 5 9,134 - 1 1,827 2
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 1 39,146 1 39,146 4 156,585 1 39,146 1 39,146 1
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

444
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 1 7,307 - 1 7,307 - - 1
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

445
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 1 6,263 1 6,263 3 18,790 - 1 6,263 1
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 1 18,790 1 18,790 2 37,580 - - 1
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 2 54,283 2 54,283 5 135,707 - 1 27,141 2
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - 1 8,948 1 8,948 - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 1 1,253 1 1,253 3 3,758 - 1 1,253 1
)

140 PRT04584 PCS 9,395 - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - 1 1,566 1 1,566 - - 1
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 1 3,262 1 3,262 4 13,049 1 3,262 1 3,262 2
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

446
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 1 8,351 1 8,351 3 25,054 - 1 8,351 1
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 1 2,610 2 5,220 5 13,049 1 2,610 1 2,610 2
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 1 7,307 - 1 7,307 - - 1
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - - 1

169 PRT04596 PCS 31,317 - - - - 1 31,317 -
( Zamens )

447
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 1 7,307 1 7,307 2 14,615 - - 1
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 324,418 368,232 1,019,547 163,918 205,779
LINEN
2 Apron PVC 68,250 - - - - - -

448
Rutin Umum Medis
3 Bad Mate 54,600 - - - - - -
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - -
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

449
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - - - - -
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 - - - - - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 - - - - - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - -
72 Stike Laken 57,000 - - - - - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - -

450
Rutin Umum Medis
Grand Total Linen - - - - -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

451
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - 1 65,800
Intervensi
22 PRT3512 Assesment Awal Gizi RIM 61,100 - - - - - - 1

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 1 77,550 1 77,550 3 232,650 - 1 77,550 1
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 1 65,800 1 65,800 4 263,200 1 65,800 1 65,800 2
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

452
Rutin Umum Medis
37 PRT12075 RIM 61,100 - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - - - - - -
47 PRT3458 Form Permintaan Barang BK 8,460 - - 1 8,460 1 8,460 -
48 PRT3461 BK 9,915 - - 1 9,915 - 1 9,915
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - - - - - -
50 PRT06087 Form Work Order BK 8,460 1 8,460 - 1 8,460 - - 1
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - - - - - -

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - - - - - -
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - - - - - -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 1 65,800 1 65,800 2 131,600 - - 1
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - - - - - -

453
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
74 PRT3483 Keterangan Pasien RIM 51,700 - - - - - -
76 PRT3535 Edukasi Harian RIM 61,100 - - - - - -
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - - - - - -

454
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
Pengawasan Pasien

Anak
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

455
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - - - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 1 15,040 1 15,040 3 45,120 - 1 15,040 1
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - - - - - -

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - - - -
( New )
138 PRT3558 BK 8,178 1 8,178 1 8,178 3 24,534 - 1 8,178 1
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

456
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 4 92,120 3 69,090 9 207,270 1 23,030 1 23,030 4
Rawat Inap
145 PRT10086 PCS 2,350 1 2,350 1 2,350 2 4,700 - - 1
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 - - - - - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 - 1 5,687 1 5,687 - -
159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

457
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 399,406 373,603 1,101,866 113,317 281,340
Grand Total Biaya Rutin Umum dan Medis 1,427,390 1,760,825 4,568,055 808,775 1,011,816

458
Rutin Umum Medis
TAHUN 2022
LUNA
KELAS II Kelas 1/Standar
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - - - - - - -
2 PRT08294 PCS 260,975 - - - - - - -
2,25 M
3 PRT2843 PCS 2,633 26,330 10 26,330 30 78,991 5 13,165 5 13,165 10 26,330
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 142,054 18 142,054 46 363,027 5 39,459 5 39,459 18 142,054
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 15,554 3 23,331 7 54,439 1 7,777 1 7,777 2 15,554
8 PRT2833 PCS 251 7,516 30 7,516 120 30,064 30 7,516 30 7,516 30 7,516
9 PRT2835 PAK 12,527 - - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - - -
15 RTK PCS 160 - - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - - -

459
Rutin Umum Medis
30 PRT06826 PAK 83,512 83,512 - 1 83,512 - - 1 83,512
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - - -
33 PRT05532 PCS 1,973 - - - - - - -
Gr
34 PRT2755 PCS 17,485 17,485 1 17,485 4 69,941 1 17,485 1 17,485 1 17,485
400Ml
35 PRT2753 BTL 12,292 12,292 1 12,292 2 24,584 - - 1 12,292
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 18,738 2 18,738 6 56,214 1 9,369 1 9,369 2 18,738
37 PRT05269 PCS 12,135 36,406 3 36,406 8 97,083 1 12,135 1 12,135 3 36,406
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 35,493 2 35,493 5 88,732 - 1 17,746 2 35,493
41 47,450 - - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 10,439 1 10,439 2 20,878 - - 1 10,439
44 PRT12733 BTL 26,098 - - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 22,861 1 22,861 3 68,584 - 1 22,861 1 22,861
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 41,113 25 42,826 59 101,069 5 8,565 5 8,565 24 41,113
Grand Total RTK 488,062 423,174 1,201,057 124,607 165,214 488,062

460
Rutin Umum Medis
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - - -
Pdm 13
8 PRT05862 Botol Semprot Unit 94,900 - - 1 94,900 - 1 94,900 -
14 non medis Pcs 189,800 - - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - - -
19 237,250 - - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - - -
Band 7702-49-Pdl

461
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - 1 237,250 1 237,250 - - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 7,111 11 7,822 25 17,778 2 1,422 2 1,422 10 7,111
39 PRT10795 Label " Dnr" PCS 711 - - - - - - -

44 949,000 - - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - - -
50 Meja Snack 2,372,500 - - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - - -

462
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - - -

61 non medis Pasang 949,000 - - - - - - -
operasi
64 949,000 - - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 47,450 1 47,450 3 142,350 - 1 47,450 1 47,450
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 142,350 - 1 142,350 - - 1 142,350
70 18,980 - - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 - - - - 1 237,250 - -
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 - 1 142,350 2 284,700 - 1 142,350 1 142,350

75 PRT10957 Unit 237,250 - - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - - -
78 Website 2,847,000 - - - - - - -
Grand Total Umum Non Medis 232,468 470,429 1,011,776 249,339 296,789 374,818
UMUM MEDIS

463
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - - -
14 Cutiing Loop 1,423,500 - - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - - -

20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 - 1 94,900 1 94,900 - - -
21 Gelas Ukur 30ml Pcs 37,960 - - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - - -
28 Gunting verban 711,750 - - - - - - -
29 kom kecil 71,175 - - - - - - -
31 PRT09490 Unit 237,250 - - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - - -
35 Pcs 664,300 - - - - - - -
stand manual

464
Rutin Umum Medis

44 PRT06713 Penlight PCS 284,700 - - - - - - -
45 pinset anatomis 332,150 - - - - - - -
46 Pinset Cirurgis 332,150 - - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - - - - - 1 332,150 -

Ring dan Membran
51 PRT10617 pcs 332,150 - - 1 332,150 1 332,150 - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - - -
Conector)

465
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - - - - 1 284,700
73 Trolly Barang 1,423,500 - - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - - -
Grand Total Umum Medis - 94,900 427,050 332,150 332,150 284,700
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 17,746 1 17,746 2 35,493 - - 1 17,746
( Zamens )
6 PRT2966 PCS 7,307 - - - - 1 7,307 - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - - -
Energizer
14 PRT13178 PCS 5,741 11,483 2 11,483 5 28,707 - 1 5,741 2 11,483
( Zamens )
15 PRT04547 PCS 3,654 7,307 2 7,307 5 18,268 - 1 3,654 2 7,307
( Zamens )
16 PRT04545 PCS 1,983 3,967 2 3,967 5 9,917 - 1 1,983 2 3,967
( Zamens )
17 PRT04546 PCS 4,959 4,959 1 4,959 3 14,876 - 1 4,959 1 4,959
18 PRT04715 PCS 5,220 - - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - - -
( Zamens )

466
Rutin Umum Medis
20 PRT04548 PCS 38,520 - 1 38,520 1 38,520 - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 7,307 1 7,307 4 29,229 1 7,307 1 7,307 1 7,307
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 27,141 1 27,141 4 108,566 1 27,141 1 27,141 1 27,141
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 2,088 1 2,088 3 6,263 - 1 2,088 1 2,088
Buku Tulis Expedisi
36 PRT04558 PCS 5,741 5,741 1 5,741 4 22,966 1 5,741 1 5,741 1 5,741
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 10,439 1 10,439 4 41,756 1 10,439 1 10,439 1 10,439
38 PRT04557 PCS 5,741 - - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 6,263 2 6,263 5 15,659 - 1 3,132 2 6,263
( Zamens )
40 PRT05172 PCS 3,132 6,263 2 6,263 5 15,659 - 1 3,132 2 6,263
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 6,263 2 6,263 5 15,659 - 1 3,132 2 6,263
42 PRT3007 Bussines File Warna Merah PCS 3,132 6,263 2 6,263 5 15,659 - 1 3,132 2 6,263

44 PRT04992 UNT 260,975 - - - - - - -
A

467
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - - 1 26,098 1 26,098 - -
58 PRT3020 PCS 3,132 31,317 11 34,449 27 84,556 3 9,395 3 9,395 10 31,317
(Zamens)
59 PRT11126 PCS 1,566 - - - - - - -
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - - 1 11,483 - 1 11,483 -
63 PRT3023 Devider Bantex 6050 PAK 8,873 8,873 1 8,873 3 26,619 - 1 8,873 1 8,873
64 PRT04800 PCS 10,439 - - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 18,790 - 1 18,790 - - 1 18,790
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 3,654 1 3,654 2 7,307 - - 1 3,654
( Zamens )
67 PRT04564 ROL 5,220 - - - - - - -
)

468
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - 1 9,395 1 9,395 - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - 1 1,044 -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - - 1 3,132 - 1 3,132 -
82 PRT04802 PAK 1,827 3,654 2 3,654 5 9,134 - 1 1,827 2 3,654
( Zamens )
83 PRT05503 BOX 12,527 - - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 - - - - - - -
87 PRT3057 PCS 2,088 - - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - - -
Numbering
91 PRT04572 RIM 39,146 39,146 1 39,146 4 156,585 1 39,146 1 39,146 1 39,146
( Zamens )
92 PRT04719 RIM 50,107 - - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - - -
( Zamens )

469
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - - -

104 PRT04624 ROL 67,332 - - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 7,307 - 1 7,307 - - 1 7,307
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - - -
121 PRT3101 Lem Power Glue PCS 3,132 - - - - - - 1 3,132

470
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 6,263 1 6,263 3 18,790 - 1 6,263 1 6,263
124 PRT07117 PCS 2,175 - - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 18,790 1 18,790 2 37,580 - - 1 18,790
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 54,283 2 54,283 5 135,707 - 1 27,141 2 54,283
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - 1 8,948 1 8,948 - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - - -
(120X80)
136 PRT04582 PAK 1,253 1,253 1 1,253 3 3,758 - 1 1,253 1 1,253
)

140 PRT04584 PCS 9,395 - - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 1,566 1 1,566 2 3,132 - - 1 1,566
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 6,524 2 6,524 6 19,573 1 3,262 1 3,262 2 6,524
( Zamens )
146 PRT3150 PCS 141 - - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - - -
17 X 22

471
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 8,351 1 8,351 3 25,054 - 1 8,351 1 8,351
151 PRT3157 Pushpin Pack 3,132 - - - - - - -
153 PRT11061 PCS 62,634 - - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 5,220 3 7,829 7 18,268 1 2,610 1 2,610 2 5,220
163 PRT06918 Sign Here PCS 20,878 - - - - - - -

165 PRT04593 PCS 7,307 7,307 1 7,307 2 14,615 - - 1 7,307
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 5,654 1 5,654 2 11,308 - - 1 5,654

169 PRT04596 PCS 31,317 - - 1 31,317 1 31,317 - -
( Zamens )

472
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - - -
189 PRT10189 PCS 140,927 - - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - - -
200 PRT05765 BTL 46,976 - - - - - - -
201 PRT04810 BTL 7,307 7,307 1 7,307 2 14,615 - - 1 7,307
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - - -

204 PRT04602 BH 4,176 - - - - - - -
)
Grand Total ATK 361,415 397,922 1,129,034 171,226 206,823 364,547
LINEN
2 Apron PVC 68,250 - - - - - - -

473
Rutin Umum Medis
3 Bad Mate 54,600 - - - - - - -
4 Baju Bayi 22,750 - - - - - - -
5 Baju pasien OK 131,300 - - - - - - -
7 bantal bayi 32,500 - - - - - - -
8 Bantal Biasa 97,500 - - - - - - -
9 Bantal VVIP 227,500 - - - - - - -
11 Bed Cover Anak 276,250 - - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - - -
13 Bed Pad 97,500 - - - - - - -
14 Bedong Bayi 32,500 - - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - -
18 Duk M 96,200 - - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - -
24 Hacinco 5L 162,500 - - - - - - -
29 Hacinco L 130,000 - - - - - - -
30 Hacinco M 130,000 - - - - - - -
31 Hacinco XL 130,000 - - - - - - -
32 Handuk Bayi 97,500 - - - - - - -
33 Handuk dewasa 97,500 - - - - - - -
35 Jas Operasi 358,150 - - - - - - -
37 Kerudung OK 29,250 - - - - - - -
39 Kimono + Celana L 162,500 - - - - - - -
40 Kimono + Celana M 162,500 - - - - - - -
41 Kimono + Celana S 162,500 - - - - - - -

474
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - - -
43 OPG 128,700 - - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - - -
49 Perlak bayi 48,750 - - - - - - -
50 Perlak full bed 78,000 - - - - - - -
54 Popok bayi 22,750 - - - - - - -
55 Restrain 78,000 - - - - - - -
56 Rompi Kegiatan 166,260 - - - - - - -
60 Sarung Batal 41,750 - - - - - - -
61 Sarung C-Arm 175,500 - - - - - - -
62 Sarung Couter 55,250 - - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - -
64 Sarung Meja mayo 104,000 - - - - - - -
68 Selimut Polar 113,750 - - - - - - -
69 Sepre Rajal 113,750 - - - - - - -
70 Seprei 140,400 - - - - - - -
72 Stike Laken 57,000 - - - - - - -
74 Taplak Meja 97,500 - - - - - - -
76 Topi bayi 29,250 - - - - - - -
79 Topi Tali OK 47,450 - - - - - - -
80 Zeil 55,250 - - - - - - -

475
Rutin Umum Medis
Grand Total Linen - - - - - -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 125,386 10 125,386 30 376,159 5 62,693 5 62,693 10 125,386
Grand Total Air Minum 125,386 125,386 376,159 62,693 62,693 125,386
CETAKAN
1 PRT08389 PCS 1,241 - - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - - -
Darurat Hal 1-2

476
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - 1 65,800 - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - 1 65,800 - 1 65,800 -
Intervensi
22 PRT3512 Assesment Awal Gizi RIM 61,100 61,100 - 1 61,100 - - 1 61,100

24 PRT3580 RIM 65,800 - - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - - -
Test Report
26 PRT3418 BK 77,550 77,550 1 77,550 3 232,650 - 1 77,550 1 77,550
Pmi
27 PRT3419 LBR 940 - - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 131,600 2 131,600 6 394,800 1 65,800 1 65,800 2 131,600
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - - -

34 PRT10560 BK 15,040 - - - - - - -

35 PRT10561 BK 15,040 - - - - - - -

36 PRT10562 BK 15,040 - - - - - - -

477
Rutin Umum Medis
37 PRT12075 RIM 61,100 - - - - - 1 61,100 -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - - - - -
41 PRT3453 RIM 51,700 - - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - - - - - - 1 61,100
47 PRT3458 Form Permintaan Barang BK 8,460 - - 1 8,460 1 8,460 - -
48 PRT3461 BK 9,915 - - 1 9,915 - 1 9,915 -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - - - - - - -
50 PRT06087 Form Work Order BK 8,460 8,460 - 1 8,460 - - 1 8,460
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - - - - 1 65,800 - -

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - - - - - - -
57 PRT12723 RIM 61,100 - - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - - - - - 1 65,800 -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 65,800 1 65,800 2 131,600 - - 1 65,800
Keperawatan
61 PRT05616 Indikasi Sectio Caesaria RIM 51,700 - - - - - - 1 51,700
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - - - - - - -

478
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - - - - 1 15,040 - -
74 PRT3483 Keterangan Pasien RIM 51,700 - - - - - - -
76 PRT3535 Edukasi Harian RIM 61,100 - - - - - 1 61,100 -
77 PRT3488 RIM 98,230 - - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - - - - - - -

479
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - - -
( Warna Kuning )

97 PRT12724 Monitor Harian RIM 65,800 - - - - - - 1 65,800
Pasien)
99 PRT12725 RIM 65,800 - - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - - - - 1 61,100 - -
104 PRT3527 Pengawasan Infus RIM 51,700 - - - - - 1 51,700 -
Pengawasan Pasien

Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - - - - - - 1 61,100
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - - -
( A4 )

480
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - 1 15,040 1 15,040 - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - - 1 61,100 - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 15,040 1 15,040 3 45,120 - 1 15,040 1 15,040
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - - - - - 1 61,100 -

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - - - - 1 51,700
( New )
138 PRT3558 BK 8,178 8,178 1 8,178 3 24,534 - 1 8,178 1 8,178
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - - -

481
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - - -

141 PRT3561 RIM 61,100 - - - - - - -

144 PRT3564 BK 23,030 92,120 3 69,090 9 207,270 1 23,030 1 23,030 4 92,120
Rawat Inap
145 PRT10086 PCS 2,350 2,350 1 2,350 2 4,700 - - 1 2,350
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 - - - - - - -
154 PRT3584 Surat Keterangan Kematian BK 5,640 - - - - - - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 - 1 5,687 1 5,687 - - -
159 PRT11608 RIM 61,100 - - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - - -

482
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - 1 61,100 - -
169 PRT3574 PCS 47 - - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - - -
Inap
173 RIM 61,100 - - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - - -
Grand Total Cetakan 526,306 454,443 1,375,406 443,257 582,140 817,706

483
Rutin Umum Medis
TAHUN 2022
LUNA
Kelas 1/Standar Deluxe
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 10 26,330 30 78,991 5 13,165 5 13,165 10 26,330 10
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 18 142,054 46 363,027 5 39,459 5 39,459 18 142,054 18
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 30 7,516 120 30,064 30 7,516 30 7,516 30 7,516 30
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -

484
Rutin Umum Medis
30 PRT06826 PAK 83,512 - 1 83,512 - - 1 83,512 1
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 1 17,485 4 69,941 1 17,485 1 17,485 1 17,485 1
400Ml
35 PRT2753 BTL 12,292 1 12,292 2 24,584 - - 1 12,292 1
( Botol )
37 PRT05269 PCS 12,135 3 36,406 8 97,083 1 12,135 1 12,135 3 36,406 1
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 2 35,493 5 88,732 - 1 17,746 2 35,493 2
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 1 10,439 2 20,878 - - 1 10,439 1
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 1 22,861 3 68,584 - 1 22,861 1 22,861 1
Grand Total RTK 423,174 1,201,057 124,607 165,214 488,062

485
Rutin Umum Medis
PAKET WELLCOME
1 PRT04734 Handuk Rs Meilia PCS 20,900 - - - - - - - - - -
2 PRT2858 Pasta Gigi + Sikat PCS 1,829 - - - 12 21,945 12 21,945 12 21,945 12
3 PRT12199 Pasta Gigi Athena PCS 6,766 - - - 12 81,197 12 81,197 12 81,197 12
4 PRT2856 Sabun PCS 1,045 - - - - - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - 12 58,311 12 58,311 12 58,311 12
6 PRT04768 Tas Spunbond Rs. Meilia PCS 7,472 - - - 12 89,661 12 89,661 12 89,661 12
7 PRT05527 Washlap PCS 3,658 - - - 24 87,780 24 87,780 24 87,780 24
Grand Total Paket Wellcome - - 338,894 338,894 338,894
UMUM NON MEDIS

1 PRT13647 Access Point Wifi Unit 1,879,020 - - - - - - 1
2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
8 PRT05862 Botol Semprot Unit 94,900 - 1 94,900 - - -
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

486
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 1 237,250 1 237,250 - - - 1

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

39 PRT10795 Label " Dnr" PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

487
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 - - - - - - 1
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 1 47,450 3 142,350 - 1 47,450 1 47,450 1
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - 1 142,350 - - 1 142,350

70 18,980 - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 - 1 237,250 1 237,250 - -
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 1 142,350 3 427,050 - 1 142,350 1 142,350 1

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 470,429 1,391,376 249,339 201,889 374,818
UMUM MEDIS

488
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
11 PRT06170 Buli-Buli Panas Unit 56,940 - - - - - - 1
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 1 94,900 1 94,900 - - - 1
21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

489
Rutin Umum Medis
38 PRT06315 Manset Monitor Dewasa PCS 949,000 - - - - - - 1

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - 1 332,150 - 1 332,150 -

Ring dan Membran
51 PRT10617 pcs 332,150 - 1 332,150 1 332,150 - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - - 1
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - - 1
63 PRT11123 Thermometer Non Contact Pcs 901,550 - - - - - - 1
64 PRT09242 Thermometer Ruangan Pcs 189,800 - - - - - - 1
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)
66 PRT06708 Tiang Infus Unt 949,000 - - - - - - 1
67 PRT09957 Timbangan Digital Pcs 1,186,250 - - - - - - 1

490
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - 1 284,700 - - 1 284,700
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 94,900 1,043,900 332,150 332,150 284,700
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 1 14,615 1 14,615 - - - 1
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 1 17,746 2 35,493 - - 1 17,746 1
( Zamens )
6 PRT2966 PCS 7,307 - 1 7,307 1 7,307 - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 2 11,483 5 28,707 - 1 5,741 2 11,483 2
( Zamens )
15 PRT04547 PCS 3,654 2 7,307 5 18,268 - 1 3,654 2 7,307 2
( Zamens )
16 PRT04545 PCS 1,983 2 3,967 5 9,917 - 1 1,983 2 3,967 2
( Zamens )
17 PRT04546 PCS 4,959 1 4,959 3 14,876 - 1 4,959 1 4,959 1
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

491
Rutin Umum Medis
20 PRT04548 PCS 38,520 1 38,520 1 38,520 - - - 2

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 1 7,307 4 29,229 1 7,307 1 7,307 1 7,307 1
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 1 27,141 4 108,566 1 27,141 1 27,141 1 27,141 1
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 1 2,088 3 6,263 - 1 2,088 1 2,088 1
Buku Tulis Expedisi
36 PRT04558 PCS 5,741 1 5,741 4 22,966 1 5,741 1 5,741 1 5,741 1
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 1 10,439 4 41,756 1 10,439 1 10,439 1 10,439 1
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 2 6,263 5 15,659 - 1 3,132 2 6,263 2
( Zamens )
40 PRT05172 PCS 3,132 2 6,263 5 15,659 - 1 3,132 2 6,263 2
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 2 6,263 5 15,659 - 1 3,132 2 6,263 2
42 PRT3007 Bussines File Warna Merah PCS 3,132 2 6,263 5 15,659 - 1 3,132 2 6,263 2

44 PRT04992 UNT 260,975 - - - - - -
A

492
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - 1 26,098 1 26,098 - -
58 PRT3020 PCS 3,132 11 34,449 27 84,556 3 9,395 3 9,395 10 31,317 11
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - 1 11,483 - 1 11,483 -
63 PRT3023 Devider Bantex 6050 PAK 8,873 1 8,873 3 26,619 - 1 8,873 1 8,873 1
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - 1 18,790 - - 1 18,790
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 1 3,654 2 7,307 - - 1 3,654 1
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

493
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 1 9,395 1 9,395 - - - 1
(Zamens)
79 PRT04566 PCS 1,044 - 1 1,044 - 1 1,044 -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - 1 3,132 - 1 3,132 -
82 PRT04802 PAK 1,827 2 3,654 5 9,134 - 1 1,827 2 3,654 2
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 1 39,146 4 156,585 1 39,146 1 39,146 1 39,146 1
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

494
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - 1 7,307 - - 1 7,307
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -
121 PRT3101 Lem Power Glue PCS 3,132 - 1 3,132 - - 1 3,132

495
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 1 6,263 3 18,790 - 1 6,263 1 6,263 1
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 1 18,790 2 37,580 - - 1 18,790 1
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 2 54,283 5 135,707 - 1 27,141 2 54,283 2
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 1 8,948 1 8,948 - - - 1
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 1 1,253 3 3,758 - 1 1,253 1 1,253 1
)

139 PRT3136 Pembolong Besar PCS 46,976 - - - - - - 1
140 PRT04584 PCS 9,395 - - - - - - 1
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 1 1,566 2 3,132 - - 1 1,566 1
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 2 6,524 6 19,573 1 3,262 1 3,262 2 6,524 2
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

496
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 1 8,351 3 25,054 - 1 8,351 1 8,351 1
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - - 1
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 1 7,307 2 14,615 - - 1 7,307 1
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 1 5,654 2 11,308 - - 1 5,654 1

169 PRT04596 PCS 31,317 - 1 31,317 1 31,317 - -
( Zamens )
170 PRT3178 Staples Besar Max Hd 50 PCS 52,195 - - - - - - 1

497
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
180 ATK Stempel serah terima 41,756 - - - - - - 1
181 ATK Stempel TBAK 41,756 - - - - - - 1
182 ATK Stempel Verifikasi 41,756 - - - - - - 1
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 1 7,307 2 14,615 - - 1 7,307 1
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 412,536 1,155,131 171,226 206,823 364,547
LINEN
2 Apron PVC 68,250 - - - - - -

498
Rutin Umum Medis
3 Bad Mate 54,600 - - - - - -
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - -
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

499
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - - - - -
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 - - - - - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 - - - - - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - -
72 Stike Laken 57,000 - - - - - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - -

500
Rutin Umum Medis
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )
10 cetakan Asesmen awal anak RIM 65,800 1 65,800 1 65,800 - - - 1

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

501
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
14 cetakan Asesmen awal kebidanan RIM 65,800 - - - - - - 1
15 cetakan RIM 65,800 - 1 65,800 1 65,800 - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - - 1
dewasa
19 PRT11806 RIM 65,800 - 1 65,800 - 1 65,800 -
Intervensi
22 PRT3512 Assesment Awal Gizi RIM 61,100 - 1 61,100 - - 1 61,100

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 1 77,550 3 232,650 - 1 77,550 1 77,550 1
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 2 131,600 6 394,800 1 65,800 1 65,800 2 131,600 2
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

502
Rutin Umum Medis
37 PRT12075 RIM 61,100 - 1 61,100 - 1 61,100 -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - - 1
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - - - - 1
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 - - - - - - 1
44 Form Indikasi Masuk Imc RIM 61,100 - - - - - - 1
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - 1 61,100 - - 1 61,100
47 PRT3458 Form Permintaan Barang BK 8,460 - 1 8,460 1 8,460 - -
48 PRT3461 BK 9,915 - 1 9,915 - 1 9,915 -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 1 7,520 1 7,520 - - - 1
50 PRT06087 Form Work Order BK 8,460 - 1 8,460 - - 1 8,460
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - 1 65,800 1 65,800 - -

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - - - - - - 1
56 cetakan Formulir NEWSS RIM 65,800 - - - - - - 1
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - 1 65,800 - 1 65,800 -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 1 65,800 2 131,600 - - 1 65,800 1
Keperawatan
61 PRT05616 Indikasi Sectio Caesaria RIM 51,700 - 1 51,700 - - 1 51,700
63 PRT3472 Kardeks Rawat Inap RIM 51,700 1 51,700 1 51,700 - - - 1

503
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - 1 15,040 1 15,040 - -
76 PRT3535 Edukasi Harian RIM 61,100 - 1 61,100 - 1 61,100 -
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - - - - - - 1

504
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

97 PRT12724 Monitor Harian RIM 65,800 - 1 65,800 - - 1 65,800
Pasien)
99 PRT12725 RIM 65,800 1 65,800 1 65,800 - - - 1
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - 1 61,100 1 61,100 - -
103 PRT3526 Pengajuan Pembedahan RIM 61,100 - - - - - - 1
104 PRT3527 Pengawasan Infus RIM 51,700 - 1 51,700 - 1 51,700 -
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - - - - - - 1

Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - 1 61,100 - - 1 61,100
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - - 1
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - - - - - - 1

505
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - -
Laboratorium
118 PRT3543 BK 15,040 1 15,040 1 15,040 - - -
Radiologi
119 PRT11816 Permintaan Privasi RIM 62,040 - - - - - - 1
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - 1 61,100 1 61,100 - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 1 15,040 3 45,120 - 1 15,040 1 15,040 1
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - 1 61,100 - 1 61,100 -

130 PRT11493 Rekonsiliasi Obat RIM 61,100 - - - - - - 1
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - 1 51,700 - - 1 51,700
( New )
138 PRT3558 BK 8,178 1 8,178 3 24,534 - 1 8,178 1 8,178 1
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 1 51,700 1 51,700 - - - 1

506
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 3 69,090 9 207,270 1 23,030 1 23,030 4 92,120 3
Rawat Inap
145 PRT10086 PCS 2,350 1 2,350 2 4,700 - - 1 2,350 1
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

154 PRT3584 Surat Keterangan Kematian BK 5,640 - - - - - - 1

156 PRT3585 Surat Keterangan Rawat BK 5,687 1 5,687 1 5,687 - - - 1
159 PRT11608 RIM 61,100 - - - - - - 1
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - - 1
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - - 1

507
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - 1 61,100 1 61,100 - -
167 PRT3597 Tanda Terima Barang BK 7,520 - - - - - - 1
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - - 1
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 696,963 2,540,066 443,257 582,140 817,706

508
Rutin Umum Medis
TAHUN 2022
PERINA 1
Deluxe
Jumlah QTY Jumlah QTY Jumlah QTY Jumlah QTY
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 26,330 30 78,991 - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 142,054 46 363,027 10 78,919 10 78,919 10 78,919 10
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 23,331 7 54,439 - - -
8 PRT2833 PCS 251 7,516 120 30,064 100 25,054 100 25,054 100 25,054 100
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 27,402 7 63,939 - - -

509
Rutin Umum Medis
30 PRT06826 PAK 83,512 83,512 2 167,024 1 83,512 - 1 83,512
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 17,485 4 69,941 3 52,456 3 52,456 3 52,456 3
400Ml
35 PRT2753 BTL 12,292 12,292 2 24,584 - - -
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 18,738 6 56,214 - - -
37 PRT05269 PCS 12,135 12,135 6 72,812 - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 35,493 5 88,732 - - -
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 10,439 2 20,878 - - -
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 22,861 3 68,584 - - -
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 42,826 59 101,069 - - -

Grand Total RTK 482,415 1,260,298 239,940 156,428 239,940

510
Rutin Umum Medis
PAKET WELLCOME
2 PRT2858 Pasta Gigi + Sikat PCS 1,829 21,945 48 87,780 - - -
3 PRT12199 Pasta Gigi Athena PCS 6,766 81,197 48 324,786 - - -
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 58,311 48 233,244 - - -
6 PRT04768 Tas Spunbond Rs. Meilia PCS 7,472 89,661 48 358,644 - - -
7 PRT05527 Washlap PCS 3,658 87,780 96 351,120 - - -
Grand Total Paket Wellcome 338,894 1,355,574 - - -
UMUM NON MEDIS

1 PRT13647 Access Point Wifi Unit 1,879,020 1,879,020 1 1,879,020 - - -
2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
4 PRT09402 Alas Kaki / Sendal Nicu Pasang 94,900 - - - 2 189,800 - 2 189,800
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
17 PRT2848 Gelang Pasien Anak Blue PCS 846 - - - 35 29,595 35 29,595 35 29,595 35
18 PRT2849 Gelang Pasien Anak Pink PCS 846 - - - 60 50,734 60 50,734 60 50,734 60
19 237,250 - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 47,450 1 47,450 - - -
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

511
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 237,250 1 237,250 1 237,250 - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 7,822 25 17,778 - - -
39 PRT10795 Label " Dnr" PCS 711 - - - - - -
40 PRT09271 Label "Fall Risk" Yellow PCS 711 35,557 130 92,448 100 71,114 100 71,114 100 71,114 100

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

512
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 474,500 1 474,500 1 474,500 - -
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 47,450 3 142,350 1 47,450 - -
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - 1 142,350 1 142,350 - -

70 18,980 - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 - 1 237,250 2 474,500 - -
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 142,350 3 427,050 - - -

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 2,871,399 3,697,446 1,717,292 151,442 341,242
UMUM MEDIS

513
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
11 PRT06170 Buli-Buli Panas Unit 56,940 56,940 1 56,940 - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 94,900 1 94,900 1 94,900 - -
21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - - - 1 284,700 - -

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

514
Rutin Umum Medis
38 PRT06315 Manset Monitor Dewasa PCS 949,000 949,000 1 949,000 - - -
41 PRT10939 Meteran Badan buah 18,980 - - - 1 18,980 - 1 18,980

44 PRT06713 Penlight PCS 284,700 - - - 1 284,700 - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - 1 332,150 - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - 1 332,150 1 332,150 - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
58 PRT07438 Stetoscope Litman Bayi Bh 1,898,000 - - - 1 1,898,000 - -
59 PRT06709 Unt 1,518,400 1,518,400 1 1,518,400 - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 189,800 1 189,800 - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 901,550 1 901,550 1 901,550 - -
64 PRT09242 Thermometer Ruangan Pcs 189,800 189,800 1 189,800 - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)
66 PRT06708 Tiang Infus Unt 949,000 949,000 1 949,000 - - -
67 PRT09957 Timbangan Digital Pcs 1,186,250 1,186,250 1 1,186,250 - - -

515
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 - - - 1 284,700 - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - 1 284,700 - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 6,035,640 6,984,640 4,099,680 - 18,980
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 14,615 1 14,615 1 14,615 - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 17,746 2 35,493 1 17,746 2 35,493 1 17,746 1
( Zamens )
6 PRT2966 PCS 7,307 - 1 7,307 1 7,307 - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 11,483 5 28,707 4 22,966 4 22,966 4 22,966 4
( Zamens )
15 PRT04547 PCS 3,654 7,307 5 18,268 - - -
( Zamens )
16 PRT04545 PCS 1,983 3,967 5 9,917 3 5,950 3 5,950 3 5,950 3
( Zamens )
17 PRT04546 PCS 4,959 4,959 3 14,876 - - -
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

516
Rutin Umum Medis
20 PRT04548 PCS 38,520 77,040 2 77,040 - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 7,307 4 29,229 2 14,615 2 14,615 2 14,615 2
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 2,923 6 8,769 6 8,769 6 8,769 6 8,769 6
31 PRT04554 PCS 27,141 27,141 4 108,566 1 27,141 1 27,141 1 27,141 1
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 2,088 3 6,263 2 4,176 2 4,176 2 4,176 2
Buku Tulis Expedisi
36 PRT04558 PCS 5,741 5,741 4 22,966 3 17,224 3 17,224 3 17,224 3
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 10,439 4 41,756 2 20,878 2 20,878 2 20,878 2
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 6,263 5 15,659 2 6,263 2 6,263 2 6,263 2
( Zamens )
40 PRT05172 PCS 3,132 6,263 5 15,659 2 6,263 2 6,263 2 6,263 2
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 6,263 5 15,659 2 6,263 2 6,263 2 6,263 2
42 PRT3007 Bussines File Warna Merah PCS 3,132 6,263 5 15,659 2 6,263 2 6,263 2 6,263 2

44 PRT04992 UNT 260,975 - - - - - -
A

517
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - 1 26,098 1 26,098 - -
58 PRT3020 PCS 3,132 34,449 27 84,556 5 15,659 5 15,659 5 15,659 5
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - 1 11,483 - - -
63 PRT3023 Devider Bantex 6050 PAK 8,873 8,873 3 26,619 2 17,746 2 17,746 2 17,746 2
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - 1 18,790 - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 3,654 2 7,307 - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

518
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 9,395 1 9,395 1 9,395 - -
(Zamens)
79 PRT04566 PCS 1,044 - 1 1,044 2 2,088 2 2,088 2 2,088 2
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 - - - 1 626 1 626 1 626 1
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - 1 3,132 1 3,132 1 3,132 1 3,132 1
82 PRT04802 PAK 1,827 3,654 5 9,134 3 5,480 3 5,480 3 5,480 3
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 39,146 4 156,585 2 78,293 2 78,293 2 78,293 2
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

519
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - 1 7,307 - - -
( Zamens )
118 PRT3096 Lakban Hitam 1,5 “ ROL 10,439 - - - 1 10,439 - 1 10,439
120 PRT05706 Lem Fox BTL 13,571 - - - - - -
121 PRT3101 Lem Power Glue PCS 3,132 - 1 3,132 - - -

520
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 6,263 3 18,790 1 6,263 - 1 6,263
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 18,790 2 37,580 1 18,790 1 18,790 1 18,790 1
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 54,283 5 135,707 1 27,141 1 27,141 1 27,141 1
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 8,948 1 8,948 2 17,895 - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 1,253 3 3,758 - - -
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 - - - 1 3,654 - 1 3,654

139 PRT3136 Pembolong Besar PCS 46,976 46,976 1 46,976 - - -
140 PRT04584 PCS 9,395 9,395 1 9,395 1 9,395 - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 1,566 2 3,132 1 1,566 - 1 1,566
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 6,524 6 19,573 1 3,262 1 3,262 1 3,262 1
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

521
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 8,351 3 25,054 2 16,702 2 16,702 2 16,702 2
151 PRT3157 Pushpin Pack 3,132 - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 - - - 1 1,566 - -
153 PRT11061 PCS 62,634 62,634 1 62,634 - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 7,829 7 18,268 3 7,829 3 7,829 3 7,829 3
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 7,307 2 14,615 2 14,615 - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 5,654 2 11,308 2 11,308 1 5,654 1 5,654 2

169 PRT04596 PCS 31,317 - 1 31,317 1 31,317 - -
( Zamens )
170 PRT3178 Staples Besar Max Hd 50 PCS 52,195 52,195 1 52,195 - - -

522
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
180 ATK Stempel serah terima 41,756 41,756 1 41,756 - - -
181 ATK Stempel TBAK 41,756 41,756 1 41,756 - - -
182 ATK Stempel Verifikasi 41,756 41,756 1 41,756 - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 7,307 2 14,615 3 21,922 3 21,922 3 21,922 3
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 747,524 1,490,119 548,621 406,590 410,765
LINEN
2 Apron PVC 68,250 - - - - - -

523
Rutin Umum Medis
3 Bad Mate 54,600 - - - - - -
4 Baju Bayi 22,750 - - - 36 819,000 - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - 5 162,500 - -
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - -
14 Bedong Bayi 32,500 - - - 36 1,170,000 - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - 15 1,462,500 - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

524
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - 2 97,500 - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - 36 819,000 - -
55 Restrain 78,000 - - - - - -
56 Rompi Kegiatan 166,260 - - - - - - -
57 Sarung bantal bayi 22,750 - - - 36 819,000 - -
60 Sarung Batal 41,750 - - - - - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - 36 351,000 - -
64 Sarung Meja mayo 104,000 - - - - - -
67 Sarung tangan bayi 9,750 - - - 36 351,000 - -
68 Selimut Polar 113,750 - - - - - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - -
71 Seprei Inkubator (Karet) 48,750 - - - 10 487,500 - -
72 Stike Laken 57,000 - - - - - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - 36 1,053,000 - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - -

525
Rutin Umum Medis
Grand Total Linen - - 7,592,000 - -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 125,386 30 376,159 20 250,773 20 250,773 20 250,773 20
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )
10 cetakan Asesmen awal anak RIM 65,800 65,800 1 65,800 - - -

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

526
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
14 cetakan Asesmen awal kebidanan RIM 65,800 65,800 1 65,800 - - -
15 cetakan RIM 65,800 - 1 65,800 - - -
dewasa
16 cetakan Asesmen awal medis anak RIM 65,800 - - - 1 65,800 - -
Asesmen awal medis
17 cetakan RIM 65,800 65,800 1 65,800 - - -
dewasa
18 cetakan Asesmen Neonatus RIM 65,800 - - - 1 65,800 - -
19 PRT11806 RIM 65,800 - 1 65,800 - - -
Intervensi
22 PRT3512 Assesment Awal Gizi RIM 61,100 - 1 61,100 - - -

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 77,550 3 232,650 - - -
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
28 PRT06822 Buku Catatan Medik Anak BK 32,900 - - - 100 3,290,000 100 3,290,000 100 3,290,000 100
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 131,600 6 394,800 2 131,600 1 65,800 1 65,800 1
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

527
Rutin Umum Medis
37 PRT12075 RIM 61,100 - 1 61,100 - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 51,700 1 51,700 - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 61,100 1 61,100 - - -
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 61,100 1 61,100 - - -
44 Form Indikasi Masuk Imc RIM 61,100 61,100 1 61,100 - - -
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - 1 61,100 1 61,100 - -
47 PRT3458 Form Permintaan Barang BK 8,460 - 1 8,460 1 8,460 1 8,460 1 8,460 1
48 PRT3461 BK 9,915 - 1 9,915 - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 7,520 1 7,520 - - -
50 PRT06087 Form Work Order BK 8,460 - 1 8,460 1 8,460 - 1 8,460
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - 1 65,800 1 65,800 - -

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 61,100 1 61,100 1 61,100 - -
56 cetakan Formulir NEWSS RIM 65,800 65,800 1 65,800 1 65,800 - -
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - 1 65,800 1 65,800 - -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 65,800 2 131,600 1 65,800 1 65,800 1 65,800 1
Keperawatan
61 PRT05616 Indikasi Sectio Caesaria RIM 51,700 - 1 51,700 - - -
62 PRT05732 Jasa Dokter BK 7,755 31,020 10 77,550 6 46,530 6 46,530 6 46,530 6
63 PRT3472 Kardeks Rawat Inap RIM 51,700 51,700 1 51,700 1 51,700 - -

528
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - 1 15,040 1 15,040 - -
76 PRT3535 Edukasi Harian RIM 61,100 - 1 61,100 1 61,100 - -
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 65,800 1 65,800 1 65,800 - -

529
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

97 PRT12724 Monitor Harian RIM 65,800 - 1 65,800 1 65,800 - -
Pasien)
99 PRT12725 RIM 65,800 65,800 1 65,800 1 65,800 - -
Dan Keluar
100 PRT3520 BK 16,920 - - - 2 33,840 2 33,840 2 33,840 2
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
103 PRT3526 Pengajuan Pembedahan RIM 61,100 61,100 1 61,100 - - -
104 PRT3527 Pengawasan Infus RIM 51,700 - 1 51,700 - - -
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 61,100 1 61,100 - - -

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 - - - 1 65,800 - -
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - 1 61,100 - - -
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 61,100 1 61,100 - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 61,100 1 61,100 - - -

530
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 - - - 1 11,503 1 11,503 1 11,503 1
Potong Beku
117 PRT3542 BK 15,040 - - - 1 15,040 1 15,040 1 15,040 1
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
119 PRT11816 Permintaan Privasi RIM 62,040 62,040 1 62,040 - - -
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - 1 61,100 - - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 15,040 3 45,120 - - -
128 PRT06086 Pesanan Pulang Neonatus BK 15,040 - - - 2 30,080 2 30,080 2 30,080 2
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - 1 61,100 - - -

130 PRT11493 Rekonsiliasi Obat RIM 61,100 61,100 1 61,100 - - -
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 33,088 10 82,720 5 41,360 5 41,360 5 41,360 5
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - 1 51,700 1 51,700 - -
( New )
138 PRT3558 BK 8,178 8,178 3 24,534 2 16,356 2 16,356 2 16,356 2
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 51,700 1 51,700 1 51,700 - -

531
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 69,090 9 207,270 2 46,060 2 46,060 2 46,060 2
Rawat Inap
145 PRT10086 PCS 2,350 2,350 2 4,700 - 2 4,700 - 2
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

154 PRT3584 Surat Keterangan Kematian BK 5,640 5,640 1 5,640 - - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 5,687 1 5,687 - - -
158 PRT3587 Surat Masuk Perawatan BK 5,170 - - - 2 10,340 2 10,340 2 10,340 2
159 PRT11608 RIM 61,100 61,100 1 61,100 - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 61,100 1 61,100 - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 61,100 1 61,100 - - -

532
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - 1 61,100 - - -
167 PRT3597 Tanda Terima Barang BK 7,520 7,520 1 7,520 - 1 7,520 -
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 61,100 1 61,100 - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 1,866,323 3,709,426 4,762,169 3,693,389 3,689,629

533
Rutin Umum Medis
TAHUN 2022
PERINA 1
Isolasi Covid
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - - - 1 15,439 - -
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 78,919 40 315,675 33 260,432 34 268,324 33 260,432 33
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 - - - 4 31,108 4 31,108 4 31,108 4
8 PRT2833 PCS 251 25,054 400 100,214 30 7,516 30 7,516 30 7,516 30
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - 1 12,109 - 1 12,109
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 - - - 3 27,402 3 27,402 3 27,402 3
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 - - - 1 9,134 1 9,134 3 27,402 2

534
Rutin Umum Medis
30 PRT06826 PAK 83,512 - 2 167,024 - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 52,456 12 209,824 - - -
400Ml
35 PRT2753 BTL 12,292 - - - 1 12,292 1 12,292 1 12,292 1
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - - - 1 9,369 1 9,369 1 9,369 1
37 PRT05269 PCS 12,135 - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 - - - 1 17,746 1 17,746 3 53,239 2
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 - - - 1 10,439 - 1 10,439
44 PRT12733 BTL 26,098 - - - 1 26,098 1 26,098 2 52,195 2
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 - - - 1 22,861 - 1 22,861 1

Grand Total RTK 156,428 792,738 461,947 408,990 526,366

535
Rutin Umum Medis
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
4 PRT09402 Alas Kaki / Sendal Nicu Pasang 94,900 - 4 379,600 - - -
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
17 PRT2848 Gelang Pasien Anak Blue PCS 846 29,595 140 118,378 - - -
18 PRT2849 Gelang Pasien Anak Pink PCS 846 50,734 240 202,934 - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

536
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - 1 237,250 1 237,250 - -

26 PRT06799 Kacamata Pelindung (Pcs) pcs 47,450 - - - 1 47,450 1 47,450 1 47,450 1
27 PRT2723 Kanebo Pcs 66,430 - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 - - - 10 7,111 10 7,111 10 7,111 10
39 PRT10795 Label " Dnr" PCS 711 - - - 4 2,845 4 2,845 4 2,845 4

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

537
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 - 1 474,500 - - -
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 - 1 47,450 1 47,450 1 47,450 1 47,450 1
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - 1 142,350 1 142,350 - -

70 18,980 - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 - 2 474,500 - - -

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 151,442 2,361,417 505,790 126,190 126,190
UMUM MEDIS

538
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 - 1 94,900 - - -
21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - 1 284,700 - - -

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

539
Rutin Umum Medis
41 PRT10939 Meteran Badan buah 18,980 - 2 37,960 - - -

44 PRT06713 Penlight PCS 284,700 - 1 284,700 - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - 1 332,150 - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
58 PRT07438 Stetoscope Litman Bayi Bh 1,898,000 - 1 1,898,000 - - -
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 - 1 901,550 - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

540
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 - 1 284,700 - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis - 4,118,660 - - -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - 1 14,615 - - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 17,746 5 88,732 1 17,746 - 1 17,746 1
( Zamens )
6 PRT2966 PCS 7,307 - 1 7,307 - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - 1 28,185 1 28,185 2 56,371 2
Energizer
14 PRT13178 PCS 5,741 22,966 16 91,863 9 51,673 8 45,932 8 45,932 9
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 5,950 12 23,801 5 9,917 4 7,934 5 9,917 4
( Zamens )
17 PRT04546 PCS 4,959 - - - 5 24,793 4 19,834 5 24,793 4
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

541
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 - - - 1 3,132 - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - 1 5,220 - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 14,615 8 58,458 4 29,229 3 21,922 4 29,229 3
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 27,141 4 108,566 1 27,141 1 27,141 1 27,141 1
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 4,176 8 16,702 - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 17,224 12 68,897 2 11,483 2 11,483 1 5,741 2
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 20,878 8 83,512 1 10,439 1 10,439 1 10,439
38 PRT04557 PCS 5,741 - - - 1 5,741 - 1 5,741 1
)
Bussines File Hijau
39 PRT04559 PCS 3,132 6,263 8 25,054 1 3,132 2 6,263 1 3,132 2
( Zamens )
40 PRT05172 PCS 3,132 6,263 8 25,054 1 3,132 1 3,132 1 3,132 1
( Zamens )

44 PRT04992 UNT 260,975 - - - - - -
A

542
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - 1 26,098 - - -
58 PRT3020 PCS 3,132 15,659 20 62,634 2 6,263 2 6,263 2 6,263 2
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

543
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - 1 9,395 - - 1 9,395
(Zamens)
79 PRT04566 PCS 1,044 2,088 8 8,351 - - 1 1,044
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 626 4 2,505 - - -
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 3,132 4 12,527 1 3,132 1 3,132 1 3,132
82 PRT04802 PAK 1,827 5,480 12 21,922 3 5,480 3 5,480 3 5,480 3
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 - - - 3 1,096 3 1,096 3 1,096 3
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 - - - - - 1 29,229
91 PRT04572 RIM 39,146 78,293 8 313,170 3 117,439 3 117,439 3 117,439 3
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

544
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - 1 12,527 - 1
( Zamens )
116 PRT04576 ROL 12,527 - - - - 1 12,527 - 1
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - 1 7,307 - 1
( Zamens )
118 PRT3096 Lakban Hitam 1,5 “ ROL 10,439 - 2 20,878 - - -
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

545
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 - 2 12,527 4 25,054 3 18,790 4 25,054 3
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 18,790 4 75,161 1 18,790 1 18,790 1 18,790 1
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - 2 17,895 - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - -
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 - 2 7,307 - - -

139 PRT3136 Pembolong Besar PCS 46,976 - - - 1 46,976 - -
140 PRT04584 PCS 9,395 - 1 9,395 - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - 2 3,132 1 1,566 - 1 1,566
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 3,262 4 13,049 1 3,262 1 3,262 1 3,262 1
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 - - - 3 2,505 3 2,505 3 2,505 3
148 PRT3151 PCS 731 - - - - - -
17 X 22

546
Rutin Umum Medis
151 PRT3157 Pushpin Pack 3,132 - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 - 1 1,566 - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - 2 14,615 1 7,307 1 7,307 1 7,307 1
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 11,308 6 33,923 1 5,654 - 1 5,654
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 - - - 1 4,176 - 1 4,176

169 PRT04596 PCS 31,317 - 1 31,317 - - -
( Zamens )

547
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
180 ATK Stempel serah terima 41,756 - - - 1 41,756 - -
181 ATK Stempel TBAK 41,756 - - - 1 41,756 - -
182 ATK Stempel Verifikasi 41,756 - - - 1 41,756 - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 21,922 12 87,688 1 7,307 1 7,307 1 7,307 1
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 394,497 1,760,474 675,707 504,961 551,483
LINEN
2 Apron PVC 68,250 - - - - - -

548
Rutin Umum Medis
3 Bad Mate 54,600 - - - 21 1,146,600 - -
4 Baju Bayi 22,750 - 36 819,000 - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - 5 162,500 - - -
8 Bantal Biasa 97,500 - - - 13 1,267,500 - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - 13 1,267,500 - -
14 Bedong Bayi 32,500 - 36 1,170,000 - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - 15 1,462,500 - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

549
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - 2 97,500 - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - 36 819,000 - - -
55 Restrain 78,000 - - - 4 312,000 - -
56 Rompi Kegiatan 166,260 - - - - - -
57 Sarung bantal bayi 22,750 - 36 819,000 - - -
60 Sarung Batal 41,750 - - - 28 1,169,000 - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - 36 351,000 - - -
64 Sarung Meja mayo 104,000 - - - - - -
67 Sarung tangan bayi 9,750 - 36 351,000 - - -
68 Selimut Polar 113,750 - - - 13 1,478,750 - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - 28 3,931,200 - -
71 Seprei Inkubator (Karet) 48,750 - 10 487,500 - - -
72 Stike Laken 57,000 - - - 28 1,596,000 - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - 36 1,053,000 - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - 13 718,250 - -

550
Rutin Umum Medis
Grand Total Linen - 7,592,000 12,886,800 - -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 250,773 80 1,003,091 30 376,159 30 376,159 30 376,159 30
Grand Total Air Minum 250,773 1,003,091 376,159 376,159 376,159
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

551
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - 1 65,800 - -
dewasa
16 cetakan Asesmen awal medis anak RIM 65,800 - 1 65,800 - - -
Asesmen awal medis
17 cetakan RIM 65,800 - - - 1 65,800 - -
dewasa
18 cetakan Asesmen Neonatus RIM 65,800 - 1 65,800 - - -
19 PRT11806 RIM 65,800 - - - 1 65,800 - -
Intervensi
23 PRT3574 Assesment Pasien Terminal RIM 61,100 - - - 1 61,100 - -

24 PRT3580 RIM 65,800 - - - 1 65,800 - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - - 1 77,550 1 77,550 1 77,550 1
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
28 PRT06822 Buku Catatan Medik Anak BK 32,900 3,290,000 400 13,160,000 - - -
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 65,800 5 329,000 1 65,800 2 131,600 1 65,800 2
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

552
Rutin Umum Medis
37 PRT12075 RIM 61,100 - - - 1 61,100 1 61,100 1 61,100 1
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - 1 61,100 - -
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - 1 61,100 - -
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 - - - 1 61,100 - -
44 Form Indikasi Masuk Imc RIM 61,100 - - - 1 61,100 - -
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - 1 61,100 1 61,100 - -
47 PRT3458 Form Permintaan Barang BK 8,460 8,460 4 33,840 1 8,460 1 8,460 1 8,460 1
48 PRT3461 BK 9,915 - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - - - 1 7,520 1 7,520 1 7,520 1
50 PRT06087 Form Work Order BK 8,460 - 2 16,920 1 8,460 1 8,460 1 8,460 1
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - 1 65,800 1 65,800 1 65,800 1 65,800
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - 1 61,100 1 61,100 - -
56 cetakan Formulir NEWSS RIM 65,800 - 1 65,800 1 65,800 - 1 65,800 1
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - 1 65,800 1 65,800 1 65,800 1 65,800
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 65,800 4 263,200 1 65,800 2 131,600 1 65,800 2
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - 1 51,700 1 51,700 - -

553
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - 1 15,040 1 15,040 1 15,040 1 15,040
76 PRT3535 Edukasi Harian RIM 61,100 - 1 61,100 1 61,100 1 61,100 1 61,100
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - 1 65,800 1 65,800 1 65,800 1 65,800

554
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

97 PRT12724 Monitor Harian RIM 65,800 - 1 65,800 - - -
Pasien)
99 PRT12725 RIM 65,800 - 1 65,800 1 65,800 1 65,800 1 65,800 1
Dan Keluar
100 PRT3520 BK 16,920 33,840 8 135,360 - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - - - 1 61,100 - -

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 - 1 65,800 1 65,800 - -
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - - - 1 61,100 - 1 61,100
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - 1 61,100 1 61,100 1 61,100 1
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - - - 1 61,100 - -

555
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 11,503 4 46,013 1 11,503 1 11,503 1 11,503
Potong Beku
117 PRT3542 BK 15,040 15,040 4 60,160 1 15,040 1 15,040 1 15,040
Laboratorium
118 PRT3543 BK 15,040 - - - 1 15,040 - 1 15,040
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - 1 61,100 1 61,100 1 61,100 1
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 - - - 1 15,040 1 15,040 1 15,040 1
128 PRT06086 Pesanan Pulang Neonatus BK 15,040 30,080 8 120,320 - - -
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - - - 1 61,100 1 61,100 1 61,100
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - 1 51,700 - 1 51,700 -
( New )
138 PRT3558 BK 8,178 16,356 8 65,424 2 16,356 2 16,356 2 16,356 2
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - 1 51,700 - 1 51,700 -

556
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 46,060 8 184,240 2 46,060 3 69,090 2 46,060 3
Rawat Inap
145 PRT10086 PCS 2,350 4,700 4 9,400 - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 - - - 1 7,238 1 7,238 1 7,238 1
154 PRT3584 Surat Keterangan Kematian BK 5,640 - - - 1 5,640 1 5,640 1 5,640 1

156 PRT3585 Surat Keterangan Rawat BK 5,687 - - - 1 5,687 1 5,687 1 5,687 1
158 PRT3587 Surat Masuk Perawatan BK 5,170 10,340 8 41,360 - - -
159 PRT11608 RIM 61,100 - - - 1 61,100 - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - 1 61,100 - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - 1 61,100 - -

557
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - 1 61,100 - -
Rawat
164 PRT3593 RIM 61,100 - - - 1 61,100 1 61,100 1 61,100 1
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 - - - 60 93,060 60 93,060 60 93,060 60
167 PRT3597 Tanda Terima Barang BK 7,520 - 1 7,520 1 7,520 - 1 7,520
168 PRT3596 Tanda Terima Dokumen BK 7,520 - - - 1 7,520 - 1 7,520
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - 1 61,100 - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -

558
Rutin Umum Medis
TAHUN 2022
VENUS
Isolasi Covid ICU Covid Ventilator
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - 1 15,439 1 15,439 - - -
2 PRT08294 PCS 260,975 - - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 260,432 133 1,049,621 33 260,432 34 268,324 33 260,432 33 260,432
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 7,516 120 30,064 30 7,516 30 7,516 30 7,516 30 7,516
9 PRT2835 PAK 12,527 - - - - - - -
No.35
10 PRT2837 PAK 12,109 - 2 24,218 1 12,109 - - -
No.17
11 PRT2836 PAK 12,527 - - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - - -
15 RTK PCS 160 - - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - - -
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 18,268 7 63,939 1 9,134 1 9,134 3 27,402 2 18,268

559
Rutin Umum Medis
30 PRT06826 PAK 83,512 - - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - - -
33 PRT05532 PCS 1,973 - - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - - -
400Ml
35 PRT2753 BTL 12,292 12,292 4 49,168 1 12,292 1 12,292 1 12,292 1 12,292
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 9,369 4 37,476 1 9,369 1 9,369 1 9,369 1 9,369
37 PRT05269 PCS 12,135 - - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 35,493 7 124,224 1 17,746 1 17,746 3 53,239 2 35,493
41 47,450 - - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 - 2 20,878 1 10,439 - - -
44 PRT12733 BTL 26,098 52,195 6 156,585 1 26,098 1 26,098 2 52,195 2 52,195
Embun
47 Sepatu bot 237,250 - - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 22,861 3 68,584 1 22,861 - 1 22,861 1 22,861

Grand Total RTK 476,937 1,874,239 461,947 408,990 503,817 476,937

560
Rutin Umum Medis
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - - -
19 237,250 - - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - - -
Band 7702-49-Pdl

561
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - 1 237,250 1 237,250 - - -

26 PRT06799 Kacamata Pelindung (Pcs) pcs 47,450 47,450 4 189,800 1 47,450 1 47,450 1 47,450 1 47,450
27 PRT2723 Kanebo Pcs 66,430 - - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 7,111 40 28,445 10 7,111 10 7,111 10 7,111 10 7,111
39 PRT10795 Label " Dnr" PCS 711 2,845 16 11,378 4 2,845 4 2,845 4 2,845 4 2,845

44 949,000 - - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - - -
50 Meja Snack 2,372,500 - - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - - -

562
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - - -

61 non medis Pasang 949,000 - - - - - - -
operasi
64 949,000 - - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 47,450 4 189,800 1 47,450 1 47,450 1 47,450 1 47,450
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - 1 142,350 1 142,350 - - -

70 18,980 - - - - - - -
Plastik

75 PRT10957 Unit 237,250 - - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - - -
78 Website 2,847,000 - - - - - - -
Grand Total Umum Non Medis 126,190 884,360 505,790 126,190 126,190 126,190
UMUM MEDIS

563
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - - -
14 Cutiing Loop 1,423,500 - - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - - -
28 Gunting verban 711,750 - - - - - - -
29 kom kecil 71,175 - - - - - - -
31 PRT09490 Unit 237,250 - - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - - -
35 Pcs 664,300 - - - - - - -
stand manual

564
Rutin Umum Medis

44 PRT06713 Penlight PCS 284,700 - - - - - - -
45 pinset anatomis 332,150 - - - - - - -
46 Pinset Cirurgis 332,150 - - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - - -
Conector)

565
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - - - - -
73 Trolly Barang 1,423,500 - - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - - -
Grand Total Umum Medis - - - - - -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 17,746 3 53,239 1 17,746 - 1 17,746 1 17,746
( Zamens )
6 PRT2966 PCS 7,307 - - - - - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 56,371 6 169,112 1 28,185 1 28,185 2 56,371 2 56,371
Energizer
14 PRT13178 PCS 5,741 51,673 34 195,209 8 45,932 7 40,190 8 45,932 8 45,932
( Zamens )
15 PRT04547 PCS 3,654 - - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 7,934 18 35,701 4 7,934 3 5,950 4 7,934 4 7,934
( Zamens )
17 PRT04546 PCS 4,959 19,834 18 89,253 4 19,834 3 14,876 4 19,834 4 19,834
18 PRT04715 PCS 5,220 - - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - - -
( Zamens )

566
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 - 1 3,132 - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - 1 5,220 - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 21,922 14 102,302 1 7,307 1 7,307 3 21,922 2 14,615
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 27,141 4 108,566 - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 11,483 7 40,190 1 5,741 1 5,741 1 5,741 1 5,741
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - 3 31,317 - - - -
38 PRT04557 PCS 5,741 5,741 3 17,224 1 5,741 - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 6,263 6 18,790 1 3,132 - 1 3,132 1 3,132
( Zamens )
40 PRT05172 PCS 3,132 3,132 4 12,527 1 3,132 - 1 3,132 -
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 3,132 4 12,527 1 3,132 - 1 3,132 -
42 PRT3007 Bussines File Warna Merah PCS 3,132 3,132 4 12,527 1 3,132 - 1 3,132 -

44 PRT04992 UNT 260,975 - - - - - - -
A

567
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - - -
Champion
58 PRT3020 PCS 3,132 6,263 8 25,054 1 3,132 1 3,132 1 3,132 1 3,132
(Zamens)
59 PRT11126 PCS 1,566 - - - - - - -
(Zamens)

63 PRT3023 Devider Bantex 6050 PAK 8,873 8,873 4 35,493 1 8,873 - - -
64 PRT04800 PCS 10,439 - - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - - -
)

568
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - 1 9,395 - - - -
(Zamens)
79 PRT04566 PCS 1,044 - 1 1,044 - - - -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - 3 9,395 - - - -
82 PRT04802 PAK 1,827 5,480 12 21,922 1 1,827 1 1,827 1 1,827 1 1,827
( Zamens )
83 PRT05503 BOX 12,527 - - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 1,096 12 4,384 1 365 1 365 1 365 1 365
87 PRT3057 PCS 2,088 - - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 - 1 29,229 - - - -
91 PRT04572 RIM 39,146 117,439 12 469,755 1 39,146 1 39,146 1 39,146 1 39,146
( Zamens )
92 PRT04719 RIM 50,107 - - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - - -
( Zamens )

569
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - - -

104 PRT04624 ROL 67,332 - - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 12,527 2 25,054 - - - -
( Zamens )
116 PRT04576 ROL 12,527 12,527 2 25,054 - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 7,307 2 14,615 - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - - -

570
Rutin Umum Medis
124 PRT07117 PCS 2,175 - - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 18,790 4 75,161 1 18,790 - - -
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 54,283 6 162,848 1 27,141 - 1 27,141 1 27,141
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - - -
)

139 PRT3136 Pembolong Besar PCS 46,976 - 1 46,976 - - - -
140 PRT04584 PCS 9,395 - - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - 2 3,132 - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 3,262 4 13,049 - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 2,505 12 10,021 1 835 1 835 1 835 1 835
148 PRT3151 PCS 731 - - - - - - -
17 X 22

571
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 16,702 6 50,107 1 8,351 - 1 8,351 1 8,351
151 PRT3157 Pushpin Pack 3,132 - - - - - - -
153 PRT11061 PCS 62,634 - - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 2,610 4 10,439 1 2,610 - - -
163 PRT06918 Sign Here PCS 20,878 - - - - - - -

165 PRT04593 PCS 7,307 7,307 4 29,229 1 7,307 - - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - 2 11,308 - - - -
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 - 2 8,351 - - - -

169 PRT04596 PCS 31,317 - - - - - - -
( Zamens )

572
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - - -
EMPAT SAUDARA
180 ATK Stempel serah terima 41,756 - 1 41,756 - - - -
181 ATK Stempel TBAK 41,756 - 1 41,756 - - - -
182 ATK Stempel Verifikasi 41,756 - 1 41,756 - - - -
189 PRT10189 PCS 140,927 - - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - - -
200 PRT05765 BTL 46,976 - - - - - - -
201 PRT04810 BTL 7,307 7,307 4 29,229 - - - -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - - -

204 PRT04602 BH 4,176 - - - - - - -
)
Grand Total ATK 548,804 2,280,955 284,358 162,587 297,825 274,859
LINEN
2 Apron PVC 68,250 - - - - - - -

573
Rutin Umum Medis
3 Bad Mate 54,600 - 21 1,146,600 - - - -
4 Baju Bayi 22,750 - - - - - - -
5 Baju pasien OK 131,300 - - - - - - -
7 bantal bayi 32,500 - - - - - - -
8 Bantal Biasa 97,500 - 13 1,267,500 - - - -
9 Bantal VVIP 227,500 - - - - - - -
11 Bed Cover Anak 276,250 - - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - - -
13 Bed Pad 97,500 - 13 1,267,500 - - - -
14 Bedong Bayi 32,500 - - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - -
18 Duk M 96,200 - - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - -
24 Hacinco 5L 162,500 - - - - - - -
29 Hacinco L 130,000 - - - - - - -
30 Hacinco M 130,000 - - - - - - -
31 Hacinco XL 130,000 - - - - - - -
32 Handuk Bayi 97,500 - - - - - - -
33 Handuk dewasa 97,500 - - - - - - -
35 Jas Operasi 358,150 - - - - - - -
37 Kerudung OK 29,250 - - - - - - -
39 Kimono + Celana L 162,500 - - - - - - -
40 Kimono + Celana M 162,500 - - - - - - -
41 Kimono + Celana S 162,500 - - - - - - -

574
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - - -
43 OPG 128,700 - - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - - -
49 Perlak bayi 48,750 - - - - - - -
50 Perlak full bed 78,000 - - - - - - -
54 Popok bayi 22,750 - - - - - - -
55 Restrain 78,000 - 4 312,000 - - - -
56 Rompi Kegiatan 166,260 - - - - - - -
60 Sarung Batal 41,750 - 28 1,169,000 - - - -
61 Sarung C-Arm 175,500 - - - - - - -
62 Sarung Couter 55,250 - - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - -
64 Sarung Meja mayo 104,000 - - - - - - -
68 Selimut Polar 113,750 - 13 1,478,750 - - - -
69 Sepre Rajal 113,750 - - - - - - -
70 Seprei 140,400 - 28 3,931,200 - - - -
72 Stike Laken 57,000 - 28 1,596,000 - - - -
74 Taplak Meja 97,500 - - - - - - -
76 Topi bayi 29,250 - - - - - - -
79 Topi Tali OK 47,450 - - - - - - -
80 Zeil 55,250 - 13 718,250 - - - -

575
Rutin Umum Medis
Grand Total Linen - 12,886,800 - - - -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 376,159 120 1,504,636 30 376,159 30 376,159 30 376,159 30 376,159
Grand Total Air Minum 376,159 1,504,636 376,159 376,159 376,159 376,159
CETAKAN
1 PRT08389 PCS 1,241 - - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - - -
Darurat Hal 1-2

576
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - 1 65,800 - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - 1 65,800 - - - -
dewasa
19 PRT11806 RIM 65,800 - 1 65,800 - - - -
Intervensi
23 PRT3574 Assesment Pasien Terminal RIM 61,100 - 1 61,100 - - - -

24 PRT3580 RIM 65,800 - 1 65,800 - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - - -
Test Report
26 PRT3418 BK 77,550 77,550 4 310,200 1 77,550 - 1 77,550 -
Pmi
27 PRT3419 LBR 940 - - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 131,600 6 394,800 1 65,800 - 1 65,800 1 65,800
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - - -

34 PRT10560 BK 15,040 - - - - - - -

35 PRT10561 BK 15,040 - - - - - - -

36 PRT10562 BK 15,040 - - - - - - -

577
Rutin Umum Medis
37 PRT12075 RIM 61,100 61,100 4 244,400 - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - 1 61,100 - - - -
41 PRT3453 RIM 51,700 - - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - 1 61,100 - - - -
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 - 1 61,100 - - - -
44 Form Indikasi Masuk Imc RIM 61,100 - 1 61,100 - - - -
45 PRT3459 RIM 31,020 - - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - 1 61,100 - - - -
47 PRT3458 Form Permintaan Barang BK 8,460 8,460 4 33,840 - - - -
48 PRT3461 BK 9,915 - - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 7,520 4 30,080 - - - -
50 PRT06087 Form Work Order BK 8,460 8,460 4 33,840 - - - -
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - 3 197,400 - - - -

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - 1 61,100 - - - -
56 cetakan Formulir NEWSS RIM 65,800 65,800 3 197,400 - - - -
57 PRT12723 RIM 61,100 - - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - 3 197,400 - - - -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 131,600 6 394,800 1 65,800 - 1 65,800 1 65,800
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - 1 51,700 - - - -

578
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - 3 45,120 - - - -
76 PRT3535 Edukasi Harian RIM 61,100 - 3 183,300 - - - -
77 PRT3488 RIM 98,230 - - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - 3 197,400 - - - -

579
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 65,800 4 263,200 - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - 1 61,100 - - - -
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - 1 61,100 - - - -

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 - 1 65,800 - - - -
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - 2 122,200 - - - -
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 61,100 4 244,400 1 61,100 - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - 1 61,100 - - - -

580
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - - -
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 - 3 34,510 - - - -
Potong Beku
117 PRT3542 BK 15,040 - 3 45,120 - - - -
Laboratorium
118 PRT3543 BK 15,040 - 2 30,080 - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - - -
anestesi
123 PRT11814 RIM 61,100 61,100 4 244,400 - - - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 15,040 4 60,160 1 15,040 - 1 15,040 -
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - 3 183,300 - - - -

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - 1 51,700 - - - -
( New )
138 PRT3558 BK 8,178 16,356 8 65,424 1 8,178 1 8,178 1 8,178 1 8,178
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - 1 51,700 - - - -

581
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - - -

141 PRT3561 RIM 61,100 - - - - - - -

144 PRT3564 BK 23,030 69,090 10 230,300 1 23,030 1 23,030 2 46,060 1 23,030
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 7,238 4 28,952 - - - -
154 PRT3584 Surat Keterangan Kematian BK 5,640 5,640 4 22,560 - - - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 5,687 4 22,748 1 5,687 - 1 5,687 -
159 PRT11608 RIM 61,100 - 1 61,100 - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - - -
Ply )
161 PRT3590 RIM 61,100 - 1 61,100 - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - 1 61,100 - - - -

582
Rutin Umum Medis
163 PRT3592 RIM 61,100 - 1 61,100 - - - -
Rawat
164 PRT3593 RIM 61,100 61,100 4 244,400 - - - -
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 93,060 240 372,240 60 93,060 60 93,060 60 93,060 60 93,060
167 PRT3597 Tanda Terima Barang BK 7,520 - 2 15,040 - - - -
168 PRT3596 Tanda Terima Dokumen BK 7,520 - 2 15,040 - - - -
169 PRT3574 PCS 47 - - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - - -
Inap
173 RIM 61,100 - 1 61,100 - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - - -
Grand Total Cetakan 1,064,456 6,565,818 526,400 211,641 480,575 359,268

583
Rutin Umum Medis
TAHUN 2022
VENUS
ICU Covid Ventilator ICU Covid Non Ventilator
TW 1 TW 2 TW 3 TW 4
Total QTY Total Anggaran Total QTY
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 1 15,439 1 15,439 - - - 1
2 PRT08294 PCS 260,975 - - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 133 1,049,621 33 260,432 34 268,324 33 260,432 34 268,324 134
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 120 30,064 30 7,516 30 7,516 30 7,516 30 7,516 120
9 PRT2835 PAK 12,527 - - - - - - -
No.35
10 PRT2837 PAK 12,109 1 12,109 1 12,109 - - - 1
No.17
11 PRT2836 PAK 12,527 - - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - - -
15 RTK PCS 160 - - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - - -
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 7 63,939 3 27,402 4 36,537 3 27,402 4 36,537 14

584
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
30 PRT06826 PAK 83,512 - - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - - -
33 PRT05532 PCS 1,973 - - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - - -
400Ml
35 PRT2753 BTL 12,292 4 49,168 2 24,584 2 24,584 2 24,584 2 24,584 8
( Botol )
37 PRT05269 PCS 12,135 - - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 7 124,224 3 53,239 4 70,985 3 53,239 4 70,985 14
41 47,450 - - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 1 10,439 1 10,439 - - - 1
44 PRT12733 BTL 26,098 6 156,585 3 78,293 3 78,293 3 78,293 3 78,293 12
Embun
45 PRT07308 Senter Besar PCS 26,098 - - - 1 26,098 - - 1
46 PRT2769 Senter Kecil PCS 15,659 - - - 1 15,659 - - 1
47 Sepatu bot 237,250 - - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 3 68,584 2 45,723 1 22,861 2 45,723 1 22,861 6

Grand Total RTK 1,851,691 638,705 654,384 600,717 612,628

585
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - - -
Pdm 13
8 PRT05862 Botol Semprot Unit 94,900 - - 1 94,900 1 94,900 1 94,900 - 3
14 non medis Pcs 189,800 - - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - - -
19 237,250 - - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 - - 1 47,450 - 1 47,450 - 2
22 PRT08249 PCS 2,923 - - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - - -
Band 7702-49-Pdl

586
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 1 237,250 1 237,250 - 1 237,250 1 237,250 3

26 PRT06799 Kacamata Pelindung (Pcs) pcs 47,450 4 189,800 3 142,350 3 142,350 3 142,350 3 142,350 12
27 PRT2723 Kanebo Pcs 66,430 - - - - - - -

39 PRT10795 Label " Dnr" PCS 711 16 11,378 4 2,845 5 3,556 4 2,845 5 3,556 18

44 949,000 - - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - - -
50 Meja Snack 2,372,500 - - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - - -

587
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
55 PRT13182 Unit 2,348,775 - - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 - - - 1 474,500 - - 1
61 non medis Pasang 949,000 - - - - - - -
operasi
64 949,000 - - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 4 189,800 2 94,900 2 94,900 2 94,900 2 94,900 8
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 - - - 1 94,900 - - 1
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 1 142,350 1 142,350 1 142,350 1 142,350 1 142,350 4
70 18,980 - - - - - - -
Plastik

75 PRT10957 Unit 237,250 - - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - - -
78 Website 2,847,000 - - - - - - -
Grand Total Umum Non Medis 884,360 790,490 1,075,901 790,490 648,851
UMUM MEDIS

588
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
3 Ambubag bayi Unt 2,799,550 - - - - - - -
4 PRT13190 Ambubag Dewasa Unt 2,799,550 - - 1 2,799,550 - - - 1
6 PRT08714 Bak Spuit Pcs 56,940 - - 1 56,940 - - - 1
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 - - 1 189,800 - - - 1
14 Cutiing Loop 1,423,500 - - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - - -
28 Gunting verban 711,750 - - - - - - -
29 kom kecil 71,175 - - - - - - -
31 PRT09490 Unit 237,250 - - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - - 1 284,700 - - - 1

34 LAMPU SOROT 1,898,000 - - - - - - -
35 Pcs 664,300 - - - - - - -
stand manual

589
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
38 PRT06315 Manset Monitor Dewasa PCS 949,000 - - 1 949,000 - 1 949,000 - 2

44 PRT06713 Penlight PCS 284,700 - - - 1 284,700 - - 1
45 pinset anatomis 332,150 - - - - - - -
46 Pinset Cirurgis 332,150 - - - - - - -
48 PRT11756 Pinset Panjang Unit 332,150 - - - 1 332,150 - - 1

Ring dan Membran
51 PRT10617 pcs 332,150 - - - 1 332,150 - - 1
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - - -
Conector)

590
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
68 PRT06529 Unt 6,263,400 - - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - 1 284,700 - - 1
73 Trolly Barang 1,423,500 - - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - - -
Grand Total Umum Medis - 4,279,990 1,233,700 949,000 -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - 1 14,615 - 1 14,615 - 2
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 3 53,239 2 35,493 1 17,746 2 35,493 1 17,746 6
( Zamens )
6 PRT2966 PCS 7,307 - - 1 7,307 - - - 1
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 6 169,112 3 84,556 3 84,556 3 84,556 3 84,556 12
Energizer
14 PRT13178 PCS 5,741 31 177,985 8 45,932 7 40,190 8 45,932 8 45,932 31
( Zamens )
15 PRT04547 PCS 3,654 - - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 15 29,751 4 7,934 3 5,950 4 7,934 4 7,934 15
( Zamens )
17 PRT04546 PCS 4,959 15 74,378 4 19,834 3 14,876 4 19,834 4 19,834 15
18 PRT04715 PCS 5,220 - - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - - -
( Zamens )

591
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
20 PRT04548 PCS 38,520 - - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 7 51,151 1 7,307 1 7,307 3 21,922 2 14,615 7
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 - - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 4 22,966 1 5,741 1 5,741 1 5,741 1 5,741 4
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - - - - - - -
38 PRT04557 PCS 5,741 1 5,741 1 5,741 - - - 1
)
Bussines File Hijau
39 PRT04559 PCS 3,132 3 9,395 1 3,132 - 1 3,132 1 3,132 3
( Zamens )
40 PRT05172 PCS 3,132 2 6,263 1 3,132 - 1 3,132 - 2
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 2 6,263 1 3,132 - 1 3,132 - 2
42 PRT3007 Bussines File Warna Merah PCS 3,132 2 6,263 1 3,132 - 1 3,132 - 2

44 PRT04992 UNT 260,975 - - - - - - -
A

592
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
45 PRT04765 UNT 182,683 - - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - - -
Champion
58 PRT3020 PCS 3,132 4 12,527 1 3,132 1 3,132 1 3,132 1 3,132 4
(Zamens)
59 PRT11126 PCS 1,566 - - - - - - -
(Zamens)

63 PRT3023 Devider Bantex 6050 PAK 8,873 1 8,873 1 8,873 - - - 1
64 PRT04800 PCS 10,439 - - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - - -
)

593
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - - -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - - - - - - -
82 PRT04802 PAK 1,827 4 7,307 1 1,827 1 1,827 1 1,827 1 1,827 4
( Zamens )
83 PRT05503 BOX 12,527 - - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 4 1,461 1 365 1 365 1 365 1 365 4
87 PRT3057 PCS 2,088 - - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - - -
Numbering
91 PRT04572 RIM 39,146 4 156,585 1 39,146 1 39,146 1 39,146 1 39,146 4
( Zamens )
92 PRT04719 RIM 50,107 - - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - - -
( Zamens )

594
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
97 PRT04806 RIM 43,322 - - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - - -

104 PRT04624 ROL 67,332 - - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - - -

595
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
124 PRT07117 PCS 2,175 - - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 1 18,790 1 18,790 - - - 1
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 3 81,424 1 27,141 - 1 27,141 1 27,141 3
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - - -
)

140 PRT04584 PCS 9,395 - - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 4 3,340 1 835 1 835 1 835 1 835 4
148 PRT3151 PCS 731 - - - - - - -
17 X 22

596
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 3 25,054 1 8,351 - 1 8,351 1 8,351 3
151 PRT3157 Pushpin Pack 3,132 - - - - - - -
153 PRT11061 PCS 62,634 - - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 1 2,610 1 2,610 - - - 1
163 PRT06918 Sign Here PCS 20,878 - - - - - - -

165 PRT04593 PCS 7,307 1 7,307 1 7,307 - - - 1
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - - -

169 PRT04596 PCS 31,317 - - - - - - -
( Zamens )

597
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - - -
189 PRT10189 PCS 140,927 - - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - - -
200 PRT05765 BTL 46,976 - - - - - - -
201 PRT04810 BTL 7,307 - - - - - - -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - - -

204 PRT04602 BH 4,176 - - - - - - -
)
Grand Total ATK 1,019,629 380,397 236,704 358,371 303,044
LINEN
2 Apron PVC 68,250 - - - - - - -

598
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
3 Bad Mate 54,600 - - - - - - -
4 Baju Bayi 22,750 - - - - - - -
5 Baju pasien OK 131,300 - - - - - - -
7 bantal bayi 32,500 - - - - - - -
8 Bantal Biasa 97,500 - - - - - - -
9 Bantal VVIP 227,500 - - - - - - -
11 Bed Cover Anak 276,250 - - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - - -
13 Bed Pad 97,500 - - - - - - -
14 Bedong Bayi 32,500 - - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - -
18 Duk M 96,200 - - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - -
24 Hacinco 5L 162,500 - - - - - - -
29 Hacinco L 130,000 - - - - - - -
30 Hacinco M 130,000 - - - - - - -
31 Hacinco XL 130,000 - - - - - - -
32 Handuk Bayi 97,500 - - - - - - -
33 Handuk dewasa 97,500 - - - - - - -
35 Jas Operasi 358,150 - - - - - - -
37 Kerudung OK 29,250 - - - - - - -
39 Kimono + Celana L 162,500 - - - - - - -
40 Kimono + Celana M 162,500 - - - - - - -
41 Kimono + Celana S 162,500 - - - - - - -

599
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
42 Kimono + Celana XL 162,500 - - - - - - -
43 OPG 128,700 - - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - - -
49 Perlak bayi 48,750 - - - - - - -
50 Perlak full bed 78,000 - - - - - - -
54 Popok bayi 22,750 - - - - - - -
55 Restrain 78,000 - - - - - - -
56 Rompi Kegiatan 166,260 - - - - - - -
60 Sarung Batal 41,750 - - - - - - -
61 Sarung C-Arm 175,500 - - - - - - -
62 Sarung Couter 55,250 - - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - -
64 Sarung Meja mayo 104,000 - - - - - - -
68 Selimut Polar 113,750 - - - - - - -
69 Sepre Rajal 113,750 - - - - - - -
70 Seprei 140,400 - - - - - - -
72 Stike Laken 57,000 - - - - - - -
74 Taplak Meja 97,500 - - - - - - -
76 Topi bayi 29,250 - - - - - - -
79 Topi Tali OK 47,450 - - - - - - -
80 Zeil 55,250 - - - - - - -

600
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 120 1,504,636 30 376,159 30 376,159 30 376,159 30 376,159 120
Grand Total Air Minum 1,504,636 376,159 376,159 376,159 376,159
CETAKAN
1 PRT08389 PCS 1,241 - - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - - -
Darurat Hal 1-2

601
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - - -
Intervensi

24 PRT3580 RIM 65,800 - - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - - -
Test Report
26 PRT3418 BK 77,550 2 155,100 1 77,550 - 1 77,550 - 2
Pmi
27 PRT3419 LBR 940 - - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 3 197,400 1 65,800 - 1 65,800 1 65,800 3
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - - -

34 PRT10560 BK 15,040 - - - - - - -

35 PRT10561 BK 15,040 - - - - - - -

36 PRT10562 BK 15,040 - - - - - - -

602
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
37 PRT12075 RIM 61,100 - - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - - - - -
41 PRT3453 RIM 51,700 - - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - - - - - - -
48 PRT3461 BK 9,915 - - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - - - - - - -
50 PRT06087 Form Work Order BK 8,460 - - - - - - -
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - - - - - - -

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - - - - - - -
57 PRT12723 RIM 61,100 - - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - - - - - - -
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 3 197,400 1 65,800 - 1 65,800 1 65,800 3
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - - - - - - -

603
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - - - - - - -
76 PRT3535 Edukasi Harian RIM 61,100 - - - - - - -
77 PRT3488 RIM 98,230 - - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - - - - - - -

604
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
py,Ec

93 PRT3517 PCS 19,439 - - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - - - - - - -
Pengawasan Pasien

Anak
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 1 61,100 1 61,100 - - - 1
Kedokteran
110 PRT3534 RIM 61,100 - - - - - - -
( A4 )

605
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
114 PRT3539 RIM 51,700 - - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - - - - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 2 30,080 1 15,040 - 1 15,040 - 2
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - - - - - - -

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - - - - -
( New )
138 PRT3558 BK 8,178 4 32,712 1 8,178 1 8,178 1 8,178 1 8,178 4
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - - -

606
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
140 PRT3560 RIM 65,800 - - - - - - -

141 PRT3561 RIM 61,100 - - - - - - -

144 PRT3564 BK 23,030 5 115,150 1 23,030 1 23,030 2 46,060 1 23,030 5
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 - - - - - - -
154 PRT3584 Surat Keterangan Kematian BK 5,640 - - - - - - -

156 PRT3585 Surat Keterangan Rawat BK 5,687 2 11,374 1 5,687 - 1 5,687 - 2
159 PRT11608 RIM 61,100 - - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - - -

607
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
163 PRT3592 RIM 61,100 - - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - - -
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 240 372,240 60 93,060 60 93,060 60 93,060 60 93,060 240
169 PRT3574 PCS 47 - - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - - -
Inap
173 RIM 61,100 - - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - - -
Grand Total Cetakan 1,577,884 526,400 211,641 480,575 359,268

608
Rutin Umum Medis
TAHUN 2022
ICU Covid Non Ventilator STANDARD UMUM

TW 1 TW 2 TW 3 TW 4
Total Anggaran Total QTY
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 15,439 - - - - -
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - 75 197,476 75 197,476 75 197,476 75 197,476 300
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 1,057,512 30 236,757 30 236,757 30 236,757 30 236,757 120
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 155,541 4 31,108 4 31,108 4 31,108 4 31,108 16
8 PRT2833 PCS 251 30,064 90 22,548 90 22,548 90 22,548 90 22,548 360
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 12,109 - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 146,146 10 91,341 10 91,341 10 91,341 10 91,341 40
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 127,878 1 9,134 - - - 1

609
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - 1 17,485 1 17,485 1 17,485 1 17,485 4
400Ml
35 PRT2753 BTL 12,292 98,335 1 12,292 - - - 1
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 112,428 - - - - -
37 PRT05269 PCS 12,135 - 2 24,271 2 24,271 2 24,271 2 24,271 8
(450Ml)
38 PRT07518 Sabut PCS 3,132 - 1 3,132 - 1 3,132 - 2
39 PRT11090 Safety Box 5 Liter PCS 17,746 248,448 1 17,746 1 17,746 1 17,746 1 17,746 4
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 10,439 - 1 10,439 - - 1
44 PRT12733 BTL 26,098 313,170 - - - - -
Embun
45 PRT07308 Senter Besar PCS 26,098 26,098 - - - - -
46 PRT2769 Senter Kecil PCS 15,659 15,659 - - - - -
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 137,168 1 22,861 1 22,861 1 22,861 1 22,861 4

Grand Total RTK 2,506,435 686,152 672,033 664,726 661,594

610
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - 85 88,825 85 88,825 85 88,825 85 88,825 340
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
Grand Total Paket Wellcome - 88,825 88,825 88,825 88,825
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
8 PRT05862 Botol Semprot Unit 94,900 284,700 1 94,900 - - - 1
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - 1 237,250 - - - 1
19 237,250 - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 94,900 1 47,450 - - - 1
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

611
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 711,750 - 1 237,250 - - 1

26 PRT06799 Kacamata Pelindung (Pcs) pcs 47,450 569,400 - - - - -
27 PRT2723 Kanebo Pcs 66,430 - - - - - -

36 PRT11766 Kursi Pasien Pcs 759,200 - 4 3,036,800 - - - 4
38 PRT10795 Label " Alergi" Merah PCS 711 28,445 50 35,557 - 50 35,557 - 100
39 PRT10795 Label " Dnr" PCS 711 12,800 40 28,445 - - - 40
40 PRT09271 Label "Fall Risk" Yellow PCS 711 85,336 50 35,557 - 50 35,557 - 100

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

612
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 474,500 - - 1 474,500 - 1
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 379,600 2 94,900 - - - 2
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 94,900 - - - - -
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 569,400 4 569,400 - - - 4

70 18,980 - - - - - -
Plastik

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 3,305,732 4,180,259 237,250 545,614 -
UMUM MEDIS
2 PRT13608 Ambubag Anak Unt 2,799,550 - - 1 2,799,550 - - 1

613
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
3 Ambubag bayi Unt 2,799,550 - - - - - -
4 PRT13190 Ambubag Dewasa Unt 2,799,550 2,799,550 - - - - -
5 Bak instrumen sedang 189,800 - 3 569,400 - - - 3
6 PRT08714 Bak Spuit Pcs 56,940 56,940 1 56,940 - - - 1
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 189,800 1 189,800 - - - 1
10 PRT13652 Bengkok Besar Unit 237,250 - 1 237,250 - - - 1
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
24 PRT10613 Gunting Aff Heacting Kecil Unt 2,348,775 - 1 2,348,775 - - - 1
27 PRT06786 Gunting Kasa buah 379,600 - 1 379,600 - - - 1
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - 3 213,525 - - - 3
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 284,700 - - - - -

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

614
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
38 PRT06315 Manset Monitor Dewasa PCS 949,000 1,898,000 - - 1 949,000 - 1
40 manset tensi anak 711,750 - 1 711,750 - - - 1

44 PRT06713 Penlight PCS 284,700 284,700 1 284,700 - - - 1
45 pinset anatomis 332,150 - 4 1,328,600 - - - 4
46 Pinset Cirurgis 332,150 - 1 332,150 - - - 1
48 PRT11756 Pinset Panjang Unit 332,150 332,150 - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - 1 332,150 - - - 1

Ring dan Membran
51 PRT10617 pcs 332,150 332,150 - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
57 PRT06791 Stetoscope Litman Anak Bh 1,660,750 - 1 1,660,750 - - - 1
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

615
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 - - 1 284,700 - - 1
72 PRT04699 Tourniquete Dewasa buah 284,700 284,700 - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 6,462,690 8,645,390 3,084,250 949,000 -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 29,229 1 14,615 - - - 1
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 106,478 1 17,746 2 35,493 1 17,746 2 35,493 6
( Zamens )
6 PRT2966 PCS 7,307 7,307 1 7,307 - - - 1
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 338,224 2 56,371 - - - 2
Energizer
14 PRT13178 PCS 5,741 177,985 10 57,415 10 57,415 10 57,415 10 57,415 40
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 29,751 - - - - -
( Zamens )
17 PRT04546 PCS 4,959 74,378 6 29,751 6 29,751 6 29,751 6 29,751 24
18 PRT04715 PCS 5,220 - 2 10,439 - 2 10,439 - 4
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

616
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
20 PRT04548 PCS 38,520 - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 51,151 2 14,615 2 14,615 2 14,615 2 14,615 8
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 37,998 10 14,615 - 10 14,615 - 20
31 PRT04554 PCS 27,141 - - 1 27,141 - - 1
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 - 1 2,088 1 2,088 - - 2

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 22,966 2 11,483 3 17,224 3 17,224 3 17,224 11
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - 1 10,439 1 10,439 1 10,439 1 10,439 4
38 PRT04557 PCS 5,741 5,741 1 5,741 - - - 1
)
Bussines File Hijau
39 PRT04559 PCS 3,132 9,395 6 18,790 - - - 6
( Zamens )
40 PRT05172 PCS 3,132 6,263 6 18,790 - - - 6
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 6,263 6 18,790 - - - 6
42 PRT3007 Bussines File Warna Merah PCS 3,132 6,263 - - - - -

44 PRT04992 UNT 260,975 - - - - - -
A

617
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - 1 26,098 - - - 1
58 PRT3020 PCS 3,132 12,527 2 6,263 2 6,263 2 6,263 2 6,263 8
(Zamens)
59 PRT11126 PCS 1,566 - 10 15,659 - - - 10
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - 1 11,483 - - - 1
63 PRT3023 Devider Bantex 6050 PAK 8,873 8,873 1 8,873 1 8,873 - - 2
64 PRT04800 PCS 10,439 - 1 10,439 - - - 1
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

618
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
71 PRT3034 Elevated Tray Susun 3 PCS 76,205 - 1 76,205 - - - 1
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - 1 9,395 - - - 1
(Zamens)
79 PRT04566 PCS 1,044 - 5 5,220 - - - 5
( Zamens )
82 PRT04802 PAK 1,827 7,307 2 3,654 2 3,654 2 3,654 2 3,654 8
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - 1 140,927 - - - 1
14
86 PRT3053 Karbon ( Zamens ) PCS 365 1,461 4 1,461 - - - 4
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 156,585 2 78,293 2 78,293 2 78,293 2 78,293 8
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

619
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - 1 7,307 - - - 1
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

620
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 43,844 2 12,527 2 12,527 2 12,527 2 12,527 8
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 18,790 1 18,790 - - - 1
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - 1 8,948 - - - 1
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - -
)

140 PRT04584 PCS 9,395 - 1 9,395 - - - 1
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - 1 1,566 - 1 1,566 - 2
Steadler ( Zamens )
143 PRT3142 Penghapus White Board PCS 6,263 - 1 6,263 - - - 1
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - 2 6,524 - 2 6,524 - 4
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 3,340 - - - - -
148 PRT3151 PCS 731 - - - - - -
17 X 22

621
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 25,054 - 2 16,702 - 1 8,351 3
151 PRT3157 Pushpin Pack 3,132 - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 - 1 1,566 - - - 1
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 7,307 2 14,615 - - - 2
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - 2 11,308 - 2 11,308 - 4

169 PRT04596 PCS 31,317 - 1 31,317 - - - 1
( Zamens )

622
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
180 ATK Stempel serah terima 41,756 - 1 41,756 - - - 1
181 ATK Stempel TBAK 41,756 - 1 41,756 - - - 1
182 ATK Stempel Verifikasi 41,756 - 1 41,756 - - - 1
183 PRT05505 Tempat Pensil Meja PCS 10,439 - 1 10,439 - - - 1
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - 2 14,615 - 1 7,307 - 3
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 1,278,517 1,040,302 377,370 356,577 330,916
LINEN
2 Apron PVC 68,250 - 3 204,750 - - - - 3

623
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
3 Bad Mate 54,600 - 18 982,800 - - - - 18
4 Baju Bayi 22,750 - - - - - - -
5 Baju pasien OK 131,300 - - - - - - -
7 bantal bayi 32,500 - - - - - - -
8 Bantal Biasa 97,500 - 12 1,170,000 - - - - 12
9 Bantal VVIP 227,500 - - - - - - -
11 Bed Cover Anak 276,250 - - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - - -
13 Bed Pad 97,500 - 12 1,170,000 - - - - 12
14 Bedong Bayi 32,500 - - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - -
18 Duk M 96,200 - - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - -
24 Hacinco 5L 162,500 - - - - - - -
29 Hacinco L 130,000 - - - - - - -
30 Hacinco M 130,000 - - - - - - -
31 Hacinco XL 130,000 - - - - - - -
32 Handuk Bayi 97,500 - - - - - - -
33 Handuk dewasa 97,500 - - - - - - -
35 Jas Operasi 358,150 - - - - - - -
37 Kerudung OK 29,250 - - - - - - -
39 Kimono + Celana L 162,500 - - - - - - -
40 Kimono + Celana M 162,500 - - - - - - -
41 Kimono + Celana S 162,500 - - - - - - -

624
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
42 Kimono + Celana XL 162,500 - - - - - - -
43 OPG 128,700 - 6 772,200 - - - - 6
48 Perlak 1/2 bed 65,000 - - - - - - -
49 Perlak bayi 48,750 - - - - - - -
50 Perlak full bed 78,000 - - - - - - -
54 Popok bayi 22,750 - - - - - - -
55 Restrain 78,000 - 3 234,000 - - - - 3
56 Rompi Kegiatan 166,260 - - - - - - -
60 Sarung Batal 41,750 - 24 1,002,000 - - - - 24
61 Sarung C-Arm 175,500 - - - - - - -
62 Sarung Couter 55,250 - - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - -
64 Sarung Meja mayo 104,000 - - - - - - -
68 Selimut Polar 113,750 - 12 1,365,000 - - - - 12
69 Sepre Rajal 113,750 - - - - - - -
70 Seprei 140,400 - 24 3,369,600 - - - - 24
72 Stike Laken 57,000 - 24 1,368,000 - - - - 24
74 Taplak Meja 97,500 - - - - - - -
76 Topi bayi 29,250 - - - - - - -
79 Topi Tali OK 47,450 - - - - - - -
80 Zeil 55,250 - 12 663,000 - - - - 12

625
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Grand Total Linen - 12,301,350 - - -
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 1,504,636 20 250,773 20 250,773 20 250,773 20 250,773 80
Grand Total Air Minum 1,504,636 250,773 250,773 250,773 250,773
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

626
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - 1 65,800 - - - 1
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - 1 65,800 - - - 1
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 155,100 1 77,550 1 77,550 1 77,550 1 77,550 4
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 197,400 2 131,600 2 131,600 2 131,600 2 131,600 8
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

627
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
37 PRT12075 RIM 61,100 - 1 61,100 - - - 1
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - 1 51,700 - - - 1
Operasi
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
47 PRT3458 Form Permintaan Barang BK 8,460 - 1 8,460 - 1 8,460 - 2
48 PRT3461 BK 9,915 - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - 1 7,520 - 1 7,520 1 7,520 3
50 PRT06087 Form Work Order BK 8,460 - 1 8,460 - 1 8,460 - 2
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - 1 65,800 - 1 65,800 - 2

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 - 1 61,100 - - - 1
56 cetakan Formulir NEWSS RIM 65,800 - 1 65,800 - - - 1
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - 1 65,800 - 1 65,800 - 2
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 197,400 1 65,800 1 65,800 1 65,800 1 65,800 4
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - 1 51,700 - - - 1

628
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 - 1 15,040 - 1 15,040 - 2
76 PRT3535 Edukasi Harian RIM 61,100 - 1 61,100 - - - 1
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 - 1 65,800 - - - 1

629
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - 1 65,800 1 65,800 1 65,800 2 131,600 5
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - 1 61,100 - - - 1
Pengawasan Pasien

Anak
Dewasa
108 PRT11809 Resiko Jatuh Pada Pasien RIM 65,800 - 1 65,800 - - - 1
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 61,100 1 61,100 - 1 61,100 - 2
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

630
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 - 1 11,503 - - - 1
Potong Beku
117 PRT3542 BK 15,040 - 1 15,040 - - - 1
Laboratorium
118 PRT3543 BK 15,040 - 1 15,040 - - - 1
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - 1 61,100 - - - 1
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 30,080 3 45,120 3 45,120 3 45,120 3 45,120 12
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - 1 61,100 - - - 1

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - 1 51,700 - - - 1
( New )
138 PRT3558 BK 8,178 32,712 1 8,178 - 1 8,178 - 2
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - 1 51,700 - - - 1

631
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 115,150 2 46,060 2 46,060 2 46,060 2 46,060 8
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 - 3 21,714 3 21,714 3 21,714 3 21,714 12
154 PRT3584 Surat Keterangan Kematian BK 5,640 - 1 5,640 - - - 1

156 PRT3585 Surat Keterangan Rawat BK 5,687 11,374 3 17,061 - 3 17,061 3 17,061 9
159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - 1 61,100 - - - 1
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - 1 61,100 - - - 1

632
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - 1 61,100 - - - 1
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 372,240 - - - - -
167 PRT3597 Tanda Terima Barang BK 7,520 - 2 15,040 - - - 2
168 PRT3596 Tanda Terima Dokumen BK 7,520 - - 1 7,520 - - 1
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - 1 61,100 - - - 1
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 1,577,884 2,119,688 660,726 910,625 743,587

633
Rutin Umum Medis
TAHUN 2022
ILYTHIA
STANDARD UMUM DELUXE
TW 1 TW 2 TW 3 TW 4
Total Anggaran Total QTY Total Anggaran
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 - - - - - - -
2 PRT08294 PCS 260,975 - - - - - - -
2,25 M
3 PRT2843 PCS 2,633 789,906 150 394,953 150 394,953 150 394,953 150 394,953 600 1,579,811
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 947,026 30 236,757 30 236,757 30 236,757 30 236,757 120 947,026
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 90,193 220 55,118 220 55,118 220 55,118 220 55,118 880 220,472
9 PRT2835 PAK 12,527 - - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - - -
15 RTK PCS 160 - - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - - -
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 9,134 - 1 9,134 - - 1 9,134

634
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
30 PRT06826 PAK 83,512 - 1 83,512 1 83,512 1 83,512 1 83,512 4 334,048
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - - -
33 PRT05532 PCS 1,973 - - - - - - -
Gr
34 PRT2755 PCS 17,485 69,941 1 17,485 1 17,485 1 17,485 1 17,485 4 69,941
400Ml
35 PRT2753 BTL 12,292 12,292 - - 1 12,292 - 1 12,292
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - - - - - - -
37 PRT05269 PCS 12,135 97,083 3 36,406 3 36,406 3 36,406 3 36,406 12 145,624
(450Ml)
38 PRT07518 Sabut PCS 3,132 6,263 1 3,132 - - - 1 3,132
39 PRT11090 Safety Box 5 Liter PCS 17,746 70,985 4 70,985 4 70,985 4 70,985 4 70,985 16 283,941
41 47,450 - - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 10,439 - - 1 10,439 - 1 10,439
44 PRT12733 BTL 26,098 - - - - - - -
Embun
45 PRT07308 Senter Besar PCS 26,098 - 1 26,098 - - - 1 26,098
47 Sepatu bot 237,250 - - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 91,446 2 45,723 2 45,723 2 45,723 2 45,723 8 182,891
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 - 216 370,017 216 370,017 216 370,017 216 370,017 864 1,480,066
Grand Total RTK 2,684,506 1,470,411 1,450,316 1,463,913 1,441,182 5,825,821

635
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
PAKET WELLCOME
2 PRT2858 Pasta Gigi + Sikat PCS 1,829 - 125 228,594 125 228,594 125 228,594 125 228,594 500 914,375
3 PRT12199 Pasta Gigi Athena PCS 6,766 - 125 845,797 125 845,797 125 845,797 125 845,797 500 3,383,188
4 PRT2856 Sabun PCS 1,045 355,300 85 88,825 85 88,825 85 88,825 85 88,825 340 355,300
5 PRT2855 Sandal PCS 4,859 - 125 607,406 125 607,406 125 607,406 125 607,406 500 2,429,625
6 PRT04768 Tas Spunbond Rs. Meilia PCS 7,472 - 125 933,969 125 933,969 125 933,969 125 933,969 500 3,735,875
7 PRT05527 Washlap PCS 3,658 - 250 914,375 250 914,375 250 914,375 250 914,375 1,000 3,657,500
Grand Total Paket Wellcome 355,300 3,618,966 3,618,966 3,618,966 3,618,966 14,475,863
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - - -
Pdm 13
8 PRT05862 Botol Semprot Unit 94,900 94,900 - 1 94,900 - - 1 94,900
14 non medis Pcs 189,800 - - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - - -
16 PRT12904 Ember pcs 237,250 237,250 1 237,250 - - - 1 237,250
19 237,250 - - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 47,450 - - - - - -
22 PRT08249 PCS 2,923 - - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - - -
Band 7702-49-Pdl

636
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 237,250 - 1 237,250 - - 1 237,250

27 PRT2723 Kanebo Pcs 66,430 - - - - - - -

36 PRT11766 Kursi Pasien Pcs 759,200 3,036,800 - - - - - -
37 PRT09561 Kursi Tindakan Bulat Unit 1,879,020 - 1 1,879,020 - - - 1 1,879,020
38 PRT10795 Label " Alergi" Merah PCS 711 71,114 100 71,114 - 100 71,114 - 200 142,227
39 PRT10795 Label " Dnr" PCS 711 28,445 - 40 28,445 - - 40 28,445
40 PRT09271 Label "Fall Risk" Yellow PCS 711 71,114 100 71,114 - - - 100 71,114

44 949,000 - - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - - -
50 Meja Snack 2,372,500 - - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - - -

637
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
55 PRT13182 Unit 2,348,775 - - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 474,500 - - - - - -
61 non medis Pasang 949,000 - - - - - - -
operasi
64 949,000 - - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 94,900 2 94,900 - - - 2 94,900
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 - 1 94,900 - - - 1 94,900
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 569,400 3 427,050 - - - 3 427,050
70 18,980 - - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 - 2 474,500 - - - 2 474,500
74 PRT10957 Tempat Tissue Hand Towel pcs 142,350 - 1 142,350 - - - 1 142,350

75 PRT10957 Unit 237,250 - - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - - -
78 Website 2,847,000 - - - - - - -
Grand Total Umum Non Medis 4,963,123 3,492,197 360,595 71,114 - 3,923,906
UMUM MEDIS
2 PRT13608 Ambubag Anak Unt 2,799,550 2,799,550 - - - - - -

638
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
3 Ambubag bayi Unt 2,799,550 - - - - - - -
4 PRT13190 Ambubag Dewasa Unt 2,799,550 - 1 2,799,550 - - - 1 2,799,550
5 Bak instrumen sedang 189,800 569,400 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 56,940 2 113,880 - - - 2 113,880
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 189,800 2 379,600 - - - 2 379,600
10 PRT13652 Bengkok Besar Unit 237,250 237,250 1 237,250 - - - 1 237,250
14 Cutiing Loop 1,423,500 - - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - - -

20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 - 1 94,900 - - - 1 94,900
21 Gelas Ukur 30ml Pcs 37,960 - - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - - -
24 PRT10613 Gunting Aff Heacting Kecil Unt 2,348,775 2,348,775 - - - - - -
27 PRT06786 Gunting Kasa buah 379,600 379,600 - - - - - -
28 Gunting verban 711,750 - - - - - - -
29 kom kecil 71,175 213,525 - - - - - -
31 PRT09490 Unit 237,250 - - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - - 1 284,700 - - 1 284,700

34 LAMPU SOROT 1,898,000 - - - - - - -
35 Pcs 664,300 - - - - - - -
stand manual
36 PRT06316 Manset Monitor Anak PCS 664,300 - 1 664,300 - - - 1 664,300

639
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
38 PRT06315 Manset Monitor Dewasa PCS 949,000 949,000 1 949,000 - - - 1 949,000
40 manset tensi anak 711,750 711,750 - - - - - -

44 PRT06713 Penlight PCS 284,700 284,700 - - - - - -
45 pinset anatomis 332,150 1,328,600 - - - - - -
46 Pinset Cirurgis 332,150 332,150 - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 332,150 1 332,150 - - - 1 332,150

Ring dan Membran
51 PRT10617 pcs 332,150 - 1 332,150 - - - 1 332,150
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - - -
(Flat) 15Cmx200M
57 PRT06791 Stetoscope Litman Anak Bh 1,660,750 1,660,750 - - - - - -
59 PRT06709 Unt 1,518,400 - - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 - 1 901,550 - - - 1 901,550
65 PRT12582 Unt 1,898,000 - - - - - - -
Conector)
67 PRT09957 Timbangan Digital Pcs 1,186,250 - 1 1,186,250 - - - 1 1,186,250

640
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
68 PRT06529 Unt 6,263,400 - - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 284,700 - - - - - -
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - 1 284,700 - 1 284,700
73 Trolly Barang 1,423,500 - - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - - -
Grand Total Umum Medis 12,678,640 7,990,580 284,700 284,700 - 8,559,980
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 14,615 1 14,615 - - - 1 14,615
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 106,478 1 17,746 2 35,493 1 17,746 2 35,493 6 106,478
( Zamens )
6 PRT2966 PCS 7,307 7,307 1 7,307 - - - 1 7,307
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 56,371 2 56,371 2 56,371 - - 4 112,741
Energizer
14 PRT13178 PCS 5,741 229,658 20 114,829 20 114,829 20 114,829 20 114,829 80 459,316
( Zamens )
15 PRT04547 PCS 3,654 - - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 119,005 12 59,502 12 59,502 12 59,502 12 59,502 48 238,009
18 PRT04715 PCS 5,220 20,878 - 2 10,439 - 2 10,439 4 20,878
( Zamens )
19 PRT04716 PCS 3,654 - - - - - - -
( Zamens )

641
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
20 PRT04548 PCS 38,520 - - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 58,458 2 14,615 2 14,615 2 14,615 2 14,615 8 58,458
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 27,141 - 1 27,141 - - 1 27,141
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - - -
34 PRT3005 Buku Telepon PCS 26,098 - 1 26,098 - - - 1 26,098
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 4,176 - - 1 2,088 1 2,088 2 4,176
Buku Tulis Expedisi
36 PRT04558 PCS 5,741 63,156 2 11,483 3 17,224 3 17,224 3 17,224 11 63,156
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 41,756 2 20,878 2 20,878 2 20,878 2 20,878 8 83,512
38 PRT04557 PCS 5,741 5,741 1 5,741 - 1 5,741 - 2 11,483
)
Bussines File Hijau
39 PRT04559 PCS 3,132 18,790 6 18,790 - - - 6 18,790
( Zamens )
40 PRT05172 PCS 3,132 18,790 6 18,790 - - - 6 18,790
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 18,790 6 18,790 - - - 6 18,790

44 PRT04992 UNT 260,975 - - - - - - -
A

642
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
45 PRT04765 UNT 182,683 - - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 26,098 - - - - - -
58 PRT3020 PCS 3,132 25,054 2 6,263 2 6,263 - - 4 12,527
(Zamens)
59 PRT11126 PCS 1,566 15,659 - 10 15,659 - - 10 15,659
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 11,483 - - - - - -
63 PRT3023 Devider Bantex 6050 PAK 8,873 17,746 1 8,873 1 8,873 - - 2 17,746
64 PRT04800 PCS 10,439 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - - -
)

643
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - - -
( Zamens )
71 PRT3034 Elevated Tray Susun 3 PCS 76,205 76,205 - - - - - -
72 PRT11165 Flashdisk 32 Gb BH 140,927 - 1 140,927 - - - 1 140,927
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 5,220 - - - - - -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - - - - - - -
82 PRT04802 PAK 1,827 14,615 3 5,480 2 3,654 3 5,480 2 3,654 10 18,268
( Zamens )
83 PRT05503 BOX 12,527 - - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 1,461 6 2,192 - - - 6 2,192
87 PRT3057 PCS 2,088 - - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - - -
Numbering
91 PRT04572 RIM 39,146 313,170 2 78,293 2 78,293 2 78,293 2 78,293 8 313,170
( Zamens )
92 PRT04719 RIM 50,107 - - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - - -
( Zamens )

644
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
97 PRT04806 RIM 43,322 - - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - - -

104 PRT04624 ROL 67,332 - - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - 1 12,527 - - - 1 12,527
( Zamens )
116 PRT04576 ROL 12,527 - 1 12,527 - - - 1 12,527
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 7,307 - 1 7,307 - - 1 7,307
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - - -

645
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
124 PRT07117 PCS 2,175 - - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 18,790 - 1 18,790 1 18,790 - 2 37,580
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 217,131 4 108,566 4 108,566 4 108,566 4 108,566 16 434,262
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 8,948 - 1 8,948 - - 1 8,948
Lokal
135 PRT11929 PCS 234,878 - - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - - -
)

139 PRT3136 Pembolong Besar PCS 46,976 - 1 46,976 - - - 1 46,976
140 PRT04584 PCS 9,395 9,395 - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - 1 5,220 - - - 1 5,220
(Zamens)
142 PRT04808 PCS 1,566 3,132 - 1 1,566 - 1 1,566 2 3,132
Steadler ( Zamens )
143 PRT3142 Penghapus White Board PCS 6,263 6,263 - - - - - -
Pensil Stadler 2B
144 PRT04585 PCS 3,262 13,049 2 6,524 - - - 2 6,524
( Zamens )
146 PRT3150 PCS 141 - - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - - -
17 X 22

646
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 25,054 1 8,351 1 8,351 1 8,351 1 8,351 4 33,405
151 PRT3157 Pushpin Pack 3,132 - - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 1,566 - - - - - -
153 PRT11061 PCS 62,634 - - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 10,439 1 2,610 1 2,610 1 2,610 1 2,610 4 10,439
163 PRT06918 Sign Here PCS 20,878 - - - - - - -

165 PRT04593 PCS 7,307 14,615 - 2 14,615 - - 2 14,615
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 22,615 - - - 2 11,308 2 11,308

169 PRT04596 PCS 31,317 31,317 - 1 31,317 - - 1 31,317
( Zamens )
170 PRT3178 Staples Besar Max Hd 50 PCS 52,195 - 1 52,195 - - - 1 52,195

647
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - - -
EMPAT SAUDARA
180 ATK Stempel serah terima 41,756 41,756 - - - - - -
181 ATK Stempel TBAK 41,756 41,756 - - - - - -
182 ATK Stempel Verifikasi 41,756 41,756 - - - - - -
183 PRT05505 Tempat Pensil Meja PCS 10,439 10,439 - - - - - -
189 PRT10189 PCS 140,927 - - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - - -
200 PRT05765 BTL 46,976 - - - - - - -
201 PRT04810 BTL 7,307 21,922 2 14,615 - 2 14,615 - 4 29,229
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - - -

204 PRT04602 BH 4,176 - - - - - - -
)
Grand Total ATK 2,105,166 943,790 697,400 515,426 515,511 2,672,127
LINEN
1 Alas Meja Operasi 60X200Cm 144,300 - - - - - - - -
2 Apron PVC 68,250 204,750 3 204,750 - - - - 3 204,750

648
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
3 Bad Mate 54,600 982,800 39 2,129,400 - - - - 39 2,129,400
4 Baju Bayi 22,750 - - - - - - - -
5 Baju pasien OK 131,300 - - - - - - - -
6 PRT3229 Baju+celana MCU 143,000 - - - - - - - -
7 bantal bayi 32,500 - - - - - - - -
8 Bantal Biasa 97,500 1,170,000 26 2,535,000 - - - - 26 2,535,000
9 Bantal VVIP 227,500 - - - - - - - -
10 Barakscort Perlak 68,250 - - - - - - - -
11 Bed Cover Anak 276,250 - - - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - - - -
13 Bed Pad 97,500 1,170,000 26 2,535,000 - - - - 26 2,535,000
14 Bedong Bayi 32,500 - - - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - - -
16 Duk Lubang Bulat M 60 X 90 Cm (Csr) 96,200 - - - - - - - -
17 Duk Lubang Mediana 205 X 325 419,250 - - - - - - - -
18 Duk M 96,200 - - - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - - - -
21 Duk Persegi 125 X 125 Cm (Csr) 146,250 - - - - - - - -
22 DUK S ( Bungkus Istrumen) 96,200 - - - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - - -
24 Hacinco 5L 162,500 - - - - - - - -
25 Hacinco Dan Celana ( L ) 187,200 - - - - - - - -
26 Hacinco Dan Celana ( M ) 187,200 - - - - - - - -
27 Hacinco Dan Celana ( Xl ) 187,200 - - - - - - - -
28 Hacinco Dan Celana ( Xxxxxl / 5 L) 191,750 - - - - - - - -
29 Hacinco L 130,000 - - - - - - - -
30 Hacinco M 130,000 - - - - - - - -
31 Hacinco XL 130,000 - - - - - - - -
32 Handuk Bayi 97,500 - - - - - - - -
33 Handuk dewasa 97,500 - - - - - - - -
34 Ikat Kaki/Tangan (All Size) 49,400 - - - - - - - -
35 Jas Operasi 358,150 - - - - - - - -
36 Jas Operasi Standard/ Cotton Soil Releas 358,150 - - - - - - - -
37 Kerudung OK 29,250 - - - - - - - -
38 Kimono + Celana Jumbo 162,500 - - - - - - - -
39 Kimono + Celana L 162,500 - - - - - - - -
40 Kimono + Celana M 162,500 - - - - - - - -
41 Kimono + Celana S 162,500 - - - - - - - -

649
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
42 Kimono + Celana XL 162,500 - - - - - - - -
43 OPG 128,700 772,200 13 1,673,100 - - - - 13 1,673,100
44 Pembungkus Instrument 2 P-M (Double) 154,050 - - - - - - - -
45 Pembungkus Instrument 21 P-L Double 198,250 - - - - - - - -
46 Pembungkus Instrument 21 P-S Double 6 87,750 - - - - - - - -
47 Penutup Inkubator 113,750 - - - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - - - -
49 Perlak bayi 48,750 - - - - - - - -
50 Perlak full bed 78,000 - - - - - - - -
51 Perlak Meja Operasi 280 X 120 156,000 - - - - - - - -
52 Perlak pemasangan infus 32,500 - - - - - - - -
53 Perlak tempat tidur 130,000 - - - - - - - -
54 Popok bayi 22,750 - - - - - - - -
55 Restrain 78,000 234,000 6 468,000 - - - - 6 468,000
56 Rompi Kegiatan 166,260 - - - - - - - -
57 Sarung bantal bayi 22,750 - - - - - - - -
58 Sarung Bantal Perlak Pvc 50 X 70 84,500 - - - - - - - -
59 Sarung bantal VPC 63,500 - - - - - - - -
60 Sarung Batal 41,750 1,002,000 52 2,171,000 - - - - 52 2,171,000
61 Sarung C-Arm 175,500 - - - - - - - -
62 Sarung Couter 55,250 - - - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - - -
64 Sarung Meja mayo 104,000 - - - - - - - -
65 Sarung Meja Mayo 60X80 104,000 - - - - - - - -
66 Sarung Standar Meja Mayo 75 X 140 125,450 - - - - - - - -
67 Sarung tangan bayi 9,750 - - - - - - - -
68 Selimut Polar 113,750 1,365,000 26 2,957,500 - - - - 26 2,957,500
69 Sepre Rajal 113,750 - - - - - - - -
70 Seprei 140,400 3,369,600 52 7,300,800 - - - - 52 7,300,800
71 Seprei Inkubator (Karet) 48,750 - - - - - - - -
72 Stike Laken 57,000 1,368,000 52 2,964,000 - - - - 52 2,964,000
73 Tali Pengikat Kamar Bedah 65,000 - - - - - - - -
74 Taplak Meja 97,500 - - - - - - - -
75 Taplak Meja Makan Pcs 48,750 - - - - - - - -
76 Topi bayi 29,250 - - - - - - - -
77 Topi Pasien Ok All Size 45,500 - - - - - - - -
78 Topi Tali All Size 47,450 - - - - - - - -
79 Topi Tali OK 47,450 - - - - - - - -
80 Zeil 55,250 663,000 26 1,436,500 - - - - 26 1,436,500

650
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Grand Total Linen 12,301,350 26,375,050 - - - 26,375,050
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 1,003,091 60 752,318 60 752,318 60 752,318 60 752,318 240 3,009,272
Grand Total Air Minum 1,003,091 752,318 752,318 752,318 752,318 3,009,272
CETAKAN
1 PRT08389 PCS 1,241 - - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - - -
Putih )
10 cetakan Asesmen awal anak RIM 65,800 - - - - 1 65,800 1 65,800

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - - -
Darurat Hal 1-2

651
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 65,800 1 65,800 1 65,800 1 65,800 - 3 197,400
dewasa
16 cetakan Asesmen awal medis anak RIM 65,800 - 1 65,800 - - - 1 65,800
Asesmen awal medis
17 cetakan RIM 65,800 65,800 - 1 65,800 - 1 65,800 2 131,600
dewasa
19 PRT11806 RIM 65,800 - 1 65,800 - - - 1 65,800
Intervensi
23 PRT3574 Assesment Pasien Terminal RIM 61,100 - - 1 61,100 - - 1 61,100

24 PRT3580 RIM 65,800 - 1 65,800 - - - 1 65,800
Restrain
25 PRT3417 RIM 51,700 - - - - - - -
Test Report
26 PRT3418 BK 77,550 310,200 1 77,550 1 77,550 1 77,550 1 77,550 4 310,200
Pmi
27 PRT3419 LBR 940 - - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 526,400 2 131,600 2 131,600 2 131,600 2 131,600 8 526,400
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - - -

34 PRT10560 BK 15,040 - - - - - - -

35 PRT10561 BK 15,040 - - - - - - -

36 PRT10562 BK 15,040 - - - - - - -

652
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
37 PRT12075 RIM 61,100 61,100 1 61,100 - 1 61,100 - 2 122,200
Pasien (New)
38 PRT3451 BK 23,500 - - - - - - -
Mcu
39 PRT3450 RIM 51,700 51,700 1 51,700 - - - 1 51,700
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - 1 61,100 - - 1 61,100
41 PRT3453 RIM 51,700 - - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - - -
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 - 1 61,100 - - - 1 61,100
44 Form Indikasi Masuk Imc RIM 61,100 - 1 61,100 - - - 1 61,100
45 PRT3459 RIM 31,020 - - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - 1 61,100 1 61,100 - 1 61,100 3 183,300
47 PRT3458 Form Permintaan Barang BK 8,460 16,920 - - - - - -
48 PRT3461 BK 9,915 - - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 22,560 2 15,040 2 15,040 2 15,040 2 15,040 8 60,160
50 PRT06087 Form Work Order BK 8,460 16,920 1 8,460 1 8,460 1 8,460 1 8,460 4 33,840
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 131,600 1 65,800 - 1 65,800 1 65,800 3 197,400
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 61,100 2 122,200 - - - 2 122,200
56 cetakan Formulir NEWSS RIM 65,800 65,800 2 131,600 - - - 2 131,600
57 PRT12723 RIM 61,100 - - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 131,600 1 65,800 1 65,800 - 1 65,800 3 197,400
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 263,200 4 263,200 3 197,400 4 263,200 3 197,400 14 921,200
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 51,700 1 51,700 - 1 51,700 - 2 103,400

653
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 30,080 1 15,040 - 1 15,040 - 2 30,080
76 PRT3535 Edukasi Harian RIM 61,100 61,100 1 61,100 - 1 61,100 - 2 122,200
77 PRT3488 RIM 98,230 - - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - 1 65,800 - - - 1 65,800
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 65,800 - 1 65,800 - 1 65,800 2 131,600

654
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
py,Ec

93 PRT3517 PCS 19,439 - - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 329,000 4 263,200 3 197,400 4 263,200 3 197,400 14 921,200
Dan Keluar
100 PRT3520 BK 16,920 - - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 61,100 1 61,100 - 1 61,100 - 2 122,200
103 PRT3526 Pengajuan Pembedahan RIM 61,100 - 1 61,100 - - - 1 61,100
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - 1 61,100 - - - 1 61,100

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 - 1 65,800 - - - 1 65,800
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - 1 61,100 - - - 1 61,100
Dewasa
108 PRT11809 Resiko Jatuh Pada Pasien RIM 65,800 65,800 - - - - - -
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 122,200 1 61,100 - 1 61,100 - 2 122,200
Kedokteran
110 PRT3534 RIM 61,100 - - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - 1 61,100 - - - 1 61,100

655
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
114 PRT3539 RIM 51,700 - 1 51,700 - - - 1 51,700
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 11,503 - - - - - -
Potong Beku
117 PRT3542 BK 15,040 15,040 1 15,040 - 1 15,040 - 2 30,080
Laboratorium
118 PRT3543 BK 15,040 15,040 1 15,040 - 1 15,040 - 2 30,080
Radiologi
119 PRT11816 Permintaan Privasi RIM 62,040 - 1 62,040 - - - 1 62,040
120 PRT3544 RIM 51,700 - - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - - -
anestesi
123 PRT11814 RIM 61,100 61,100 1 61,100 - 1 61,100 - 2 122,200
Kedokteran
124 PRT3545 RIM 61,100 - - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - - -
Perawatan
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 1 61,100 4 244,400
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 363,968 35 289,520 35 289,520 35 289,520 35 289,520 140 1,158,080
135 PRT3556 Resume BK 9,915 - - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 51,700 1 51,700 - 1 51,700 - 2 103,400
( New )
138 PRT3558 BK 8,178 16,356 2 16,356 1 8,178 2 16,356 1 8,178 6 49,068
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 51,700 1 51,700 - 1 51,700 - 2 103,400

656
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
140 PRT3560 RIM 65,800 - - - - - - -

141 PRT3561 RIM 61,100 - - - - - - -

144 PRT3564 BK 23,030 184,240 2 46,060 2 46,060 2 46,060 2 46,060 8 184,240
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 86,856 4 28,952 4 28,952 4 28,952 4 28,952 16 115,808
154 PRT3584 Surat Keterangan Kematian BK 5,640 5,640 1 5,640 - - - 1 5,640

156 PRT3585 Surat Keterangan Rawat BK 5,687 51,183 6 34,122 6 34,122 6 34,122 6 34,122 24 136,488
159 PRT11608 RIM 61,100 - 1 61,100 - - - 1 61,100
Pasien
160 PRT3589 BK 8,460 - - - - - - -
Ply )
161 PRT3590 RIM 61,100 61,100 - 1 61,100 - - 1 61,100
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 61,100 - 1 61,100 - - 1 61,100

657
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
163 PRT3592 RIM 61,100 - 1 61,100 - - - 1 61,100
Rawat
164 PRT3593 RIM 61,100 61,100 1 61,100 - 1 61,100 1 61,100 3 183,300
167 PRT3597 Tanda Terima Barang BK 7,520 15,040 - - - - - -
168 PRT3596 Tanda Terima Dokumen BK 7,520 7,520 - - - - - -
169 PRT3574 PCS 47 - - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - - -
Inap
173 RIM 61,100 61,100 1 61,100 - - - 1 61,100
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - - -
Grand Total Cetakan 4,434,626 3,717,700 2,017,522 2,287,020 1,900,022 9,922,264

658
Rutin Umum Medis
TAHUN 2022
ILYTHIA
ISOLASI
TW 1 TW 2 TW 3 TW 4
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 25 65,825 25 65,825 25 65,825 25 65,825 100 263,302
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 15 118,378 30 236,757 30 236,757 30 236,757 105 828,648
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 1 7,777 1 7,777 1 7,777 1 7,777 4 31,108
8 PRT2833 PCS 251 30 7,516 30 7,516 30 7,516 30 7,516 120 30,064
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 - - 1 9,134 - 1 9,134

659
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
30 PRT06826 PAK 83,512 1 83,512 - 1 83,512 - 2 167,024
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 1 17,485 1 17,485 1 17,485 1 17,485 4 69,941
400Ml
35 PRT2753 BTL 12,292 - - - - - -
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - - - - - -
37 PRT05269 PCS 12,135 1 12,135 1 12,135 1 12,135 1 12,135 4 48,541
(450Ml)
38 PRT07518 Sabut PCS 3,132 1 3,132 - - - 1 3,132
39 PRT11090 Safety Box 5 Liter PCS 17,746 1 17,746 1 17,746 1 17,746 1 17,746 4 70,985
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 1 22,861 - - - 1 22,861
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 50 85,652 50 85,652 50 85,652 50 85,652 200 342,608
Grand Total RTK 533,362 542,235 634,881 542,235 2,252,714

660
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
PAKET WELLCOME
2 PRT2858 Pasta Gigi + Sikat PCS 1,829 125 228,594 125 228,594 125 228,594 125 228,594 500 914,375
3 PRT12199 Pasta Gigi Athena PCS 6,766 125 845,797 125 845,797 125 845,797 125 845,797 500 3,383,188
4 PRT2856 Sabun PCS 1,045 80 83,600 80 83,600 80 83,600 80 83,600 320 334,400
5 PRT2855 Sandal PCS 4,859 125 607,406 125 607,406 125 607,406 125 607,406 500 2,429,625
6 PRT04768 Tas Spunbond Rs. Meilia PCS 7,472 125 933,969 125 933,969 125 933,969 125 933,969 500 3,735,875
7 PRT05527 Washlap PCS 3,658 250 914,375 250 914,375 250 914,375 250 914,375 1,000 3,657,500
Grand Total Paket Wellcome 3,613,741 3,613,741 3,613,741 3,613,741 14,454,963
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

661
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - - - 1 237,250 1 237,250

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 50 35,557 - - - 50 35,557
39 PRT10795 Label " Dnr" PCS 711 20 14,223 - - - 20 14,223
40 PRT09271 Label "Fall Risk" Yellow PCS 711 50 35,557 - - - 50 35,557

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

662
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 1 47,450 - - - 1 47,450
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 1 142,350 - - - 1 142,350

70 18,980 - - - - - -
Plastik

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 275,136 - - 237,250 512,386
UMUM MEDIS

663
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

664
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 1 332,150 - - - 1 332,150

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

665
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 332,150 - - - 332,150
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 1 17,746 1 17,746 1 17,746 1 17,746 4 70,985
( Zamens )
6 PRT2966 PCS 7,307 - - - - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 6 34,449 6 34,449 6 34,449 6 34,449 24 137,795
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 6 29,751 6 29,751 6 29,751 6 29,751 24 119,005
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

666
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
20 PRT04548 PCS 38,520 - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 1 7,307 - 1 7,307 - 2 14,615
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 1 2,088 - - - 1 2,088

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 1 5,741 - - - 1 5,741
( Zamens )
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )

44 PRT04992 UNT 260,975 - - - - - -
A

667
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - 10 15,659 - 10 15,659
(Zamens)

64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

668
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
82 PRT04802 PAK 1,827 1 1,827 - 1 1,827 - 2 3,654
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 1 39,146 1 39,146 1 39,146 1 39,146 4 156,585
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

669
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

670
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 2 12,527 2 12,527 2 12,527 2 12,527 8 50,107
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - - 1 18,790 - 1 18,790
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - -
)

140 PRT04584 PCS 9,395 - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

671
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 2 16,702 - - - 2 16,702
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 1 2,610 - - - 1 2,610
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - -

169 PRT04596 PCS 31,317 - - - - - -
( Zamens )

672
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 1 7,307 - - - 1 7,307
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 180,125 136,542 180,125 136,542 633,334
LINEN
1 Alas Meja Operasi 60X200Cm 144,300 - - - - - - - - - -
2 Apron PVC 68,250 - - - - - - - - - -

673
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
3 Bad Mate 54,600 - - - - - - - - - -
4 Baju Bayi 22,750 - - - - - - - - - -
5 Baju pasien OK 131,300 - - - - - - - - - -
6 PRT3229 Baju+celana MCU 143,000 - - - - - - - - - -
7 bantal bayi 32,500 - - - - - - - - - -
8 Bantal Biasa 97,500 - - - - - - - - - -
9 Bantal VVIP 227,500 - - - - - - - - - -
10 Barakscort Perlak 68,250 - - - - - - - - - -
11 Bed Cover Anak 276,250 - - - - - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - - - - - -
13 Bed Pad 97,500 - - - - - - - - - -
14 Bedong Bayi 32,500 - - - - - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - - - - -
16 Duk Lubang Bulat M 60 X 90 Cm (Csr) 96,200 - - - - - - - - - -
17 Duk Lubang Mediana 205 X 325 419,250 - - - - - - - - - -
18 Duk M 96,200 - - - - - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - - - - - -
21 Duk Persegi 125 X 125 Cm (Csr) 146,250 - - - - - - - - - -
22 DUK S ( Bungkus Istrumen) 96,200 - - - - - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - - - - - -
24 Hacinco 5L 162,500 - - - - - - - - - -
25 Hacinco Dan Celana ( L ) 187,200 - - - - - - - - - -
26 Hacinco Dan Celana ( M ) 187,200 - - - - - - - - - -
27 Hacinco Dan Celana ( Xl ) 187,200 - - - - - - - - - -
28 Hacinco Dan Celana ( Xxxxxl / 5 L) 191,750 - - - - - - - - - -
29 Hacinco L 130,000 - - - - - - - - - -
30 Hacinco M 130,000 - - - - - - - - - -
31 Hacinco XL 130,000 - - - - - - - - - -
32 Handuk Bayi 97,500 - - - - - - - - - -
33 Handuk dewasa 97,500 - - - - - - - - - -
34 Ikat Kaki/Tangan (All Size) 49,400 - - - - - - - - - -
35 Jas Operasi 358,150 - - - - - - - - - -
36 Jas Operasi Standard/ Cotton Soil Releas 358,150 - - - - - - - - - -
37 Kerudung OK 29,250 - - - - - - - - - -
38 Kimono + Celana Jumbo 162,500 - - - - - - - - - -
39 Kimono + Celana L 162,500 - - - - - - - - - -
40 Kimono + Celana M 162,500 - - - - - - - - - -
41 Kimono + Celana S 162,500 - - - - - - - - - -

674
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
42 Kimono + Celana XL 162,500 - - - - - - - - - -
43 OPG 128,700 - - - - - - - - - -
44 Pembungkus Instrument 2 P-M (Double) 154,050 - - - - - - - - - -
45 Pembungkus Instrument 21 P-L Double 198,250 - - - - - - - - - -
46 Pembungkus Instrument 21 P-S Double 6 87,750 - - - - - - - - - -
47 Penutup Inkubator 113,750 - - - - - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - - - - - -
49 Perlak bayi 48,750 - - - - - - - - - -
50 Perlak full bed 78,000 - - - - - - - - - -
51 Perlak Meja Operasi 280 X 120 156,000 - - - - - - - - - -
52 Perlak pemasangan infus 32,500 - - - - - - - - - -
53 Perlak tempat tidur 130,000 - - - - - - - - - -
54 Popok bayi 22,750 - - - - - - - - - -
55 Restrain 78,000 - - - - - - - - - -
56 Rompi Kegiatan 166,260 - - - - - - - - - -
57 Sarung bantal bayi 22,750 - - - - - - - - - -
58 Sarung Bantal Perlak Pvc 50 X 70 84,500 - - - - - - - - - -
59 Sarung bantal VPC 63,500 - - - - - - - - - -
60 Sarung Batal 41,750 - - - - - - - - - -
61 Sarung C-Arm 175,500 - - - - - - - - - -
62 Sarung Couter 55,250 - - - - - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - - - - -
64 Sarung Meja mayo 104,000 - - - - - - - - - -
65 Sarung Meja Mayo 60X80 104,000 - - - - - - - - - -
66 Sarung Standar Meja Mayo 75 X 140 125,450 - - - - - - - - - -
67 Sarung tangan bayi 9,750 - - - - - - - - - -
68 Selimut Polar 113,750 - - - - - - - - - -
69 Sepre Rajal 113,750 - - - - - - - - - -
70 Seprei 140,400 - - - - - - - - - -
71 Seprei Inkubator (Karet) 48,750 - - - - - - - - - -
72 Stike Laken 57,000 - - - - - - - - - -
73 Tali Pengikat Kamar Bedah 65,000 - - - - - - - - - -
74 Taplak Meja 97,500 - - - - - - - - - -
75 Taplak Meja Makan Pcs 48,750 - - - - - - - - - -
76 Topi bayi 29,250 - - - - - - - - - -
77 Topi Pasien Ok All Size 45,500 - - - - - - - - - -
78 Topi Tali All Size 47,450 - - - - - - - - - -
79 Topi Tali OK 47,450 - - - - - - - - - -
80 Zeil 55,250 - - - - - - - - - -

675
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 6 75,232 6 75,232 6 75,232 6 75,232 24 300,927
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

676
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 1 65,800 - - - 1 65,800
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - 1 65,800 1 65,800
dewasa
19 PRT11806 RIM 65,800 1 65,800 - - - 1 65,800
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 1 77,550 1 77,550 1 77,550 1 77,550 4 310,200
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 2 131,600 2 131,600 2 131,600 2 131,600 8 526,400
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

677
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
37 PRT12075 RIM 61,100 1 61,100 - - - 1 61,100
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - 1 61,100 - 1 61,100
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 1 61,100 - - - 1 61,100
48 PRT3461 BK 9,915 - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 1 7,520 - - - 1 7,520
50 PRT06087 Form Work Order BK 8,460 1 8,460 - 1 8,460 - 2 16,920
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 1 65,800 1 65,800 1 65,800 - 3 197,400
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 1 61,100 - - - 1 61,100
56 cetakan Formulir NEWSS RIM 65,800 1 65,800 - - - 1 65,800
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 1 65,800 - - - 1 65,800
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 1 65,800 - 1 65,800 - 2 131,600
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 1 51,700 - - - 1 51,700

678
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 1 15,040 - - - 1 15,040
76 PRT3535 Edukasi Harian RIM 61,100 1 61,100 - - - 1 61,100
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia
90 PRT3510 Lembar Konsultasi RIM 65,800 1 65,800 - - - 1 65,800

679
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 1 65,800 - - - 1 65,800
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 1 61,100 - - - 1 61,100
Pengawasan Pasien

Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 1 61,100 - - - 1 61,100
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 1 61,100 - - - 1 61,100
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

680
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 1 15,040 - - - 1 15,040
Laboratorium
118 PRT3543 BK 15,040 - 1 15,040 - - 1 15,040
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 1 61,100 - - - 1 61,100
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 1 15,040 - 1 15,040 - 2 30,080
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 1 61,100 - - - 1 61,100

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 1 51,700 - - - 1 51,700
( New )
138 PRT3558 BK 8,178 2 16,356 2 16,356 2 16,356 2 16,356 8 65,424
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 1 51,700 - - - 1 51,700

681
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 2 46,060 - - - 2 46,060
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 2 14,476 2 14,476 2 14,476 2 14,476 8 57,904

156 PRT3585 Surat Keterangan Rawat BK 5,687 1 5,687 1 5,687 1 5,687 - 3 17,061
159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

682
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 1 61,100 - - - 1 61,100
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 1,709,437 390,617 525,977 369,890 2,995,921

683
Rutin Umum Medis
TAHUN 2022
APRODITE
VVIP
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 1 15,439 - - - 1 15,439 1
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 125 329,127 125 329,127 125 329,127 125 329,127 500 1,316,509 275
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 30 236,757 30 236,757 30 236,757 30 236,757 120 947,026 60
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 125 31,317 125 31,317 125 31,317 125 31,317 500 125,268 125
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -

684
Rutin Umum Medis
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - -
400Ml
35 PRT2753 BTL 12,292 3 36,876 3 36,876 3 36,876 3 36,876 12 147,503 3
( Botol )
37 PRT05269 PCS 12,135 3 36,406 3 36,406 3 36,406 3 36,406 12 145,624 3
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 5 88,732 5 88,732 5 88,732 5 88,732 20 354,926 5
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 1 10,439 - - 1 10,439 2 20,878 1
44 PRT12733 BTL 26,098 - - - - - -
Embun
45 PRT07308 Senter Besar PCS 26,098 1 26,098 - - - 1 26,098
46 PRT2769 Senter Kecil PCS 15,659 1 15,659 - - - 1 15,659
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 3 68,584 3 68,584 3 68,584 3 68,584 12 274,337 3
Grand Total RTK 1,277,709 1,210,075 1,210,075 1,220,514 4,918,371

685
Rutin Umum Medis
PAKET WELLCOME
1 PRT04734 Handuk Rs Meilia PCS 20,900 80 1,672,000 80 1,672,000 80 1,672,000 80 1,672,000 320 6,688,000 156
2 PRT2858 Pasta Gigi + Sikat PCS 1,829 80 146,300 80 146,300 80 146,300 80 146,300 320 585,200 156
4 PRT2856 Sabun PCS 1,045 80 83,600 80 83,600 80 83,600 80 83,600 320 334,400 156
5 PRT2855 Sandal PCS 4,859 80 388,740 80 388,740 80 388,740 80 388,740 320 1,554,960 156
6 PRT04768 Tas Spunbond Rs. Meilia PCS 7,472 80 597,740 80 597,740 80 597,740 80 597,740 320 2,390,960 156
7 PRT05527 Washlap PCS 3,658 160 585,200 160 585,200 160 585,200 160 585,200 640 2,340,800 312
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
10 PRT2675 Box Container 70 Liter PCS 94,900 1 94,900 - - - 1 94,900
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 1 237,250 - - - 1 237,250
19 237,250 5 1,186,250 5 1,186,250 5 1,186,250 5 1,186,250 20 4,745,000
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 1 47,450 - - - 1 47,450 1
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

686
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 13 3,084,250 - - - 13 3,084,250 8

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

39 PRT10795 Label " Dnr" PCS 711 50 35,557 - - - 50 35,557 50

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

687
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 6 2,847,000 - - - 6 2,847,000
60 Rel Gorden Kamar Mandi 47,450 1 47,450 2 94,900 1 47,450 1 47,450 5 237,250
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 1 47,450 1 47,450 1 47,450 1 47,450 4 189,800 2
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 1 94,900 - - - 1 94,900
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 13 1,850,550 - - - 13 1,850,550 8

70 18,980 - - - - - -
Plastik
71 Tempat Sabun Stainless 237,250 5 1,186,250 5 1,186,250 5 1,186,250 5 1,186,250 20 4,745,000
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 5 1,186,250 - 5 1,186,250 - 10 2,372,500 5
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 10 1,423,500 - - - 10 1,423,500 10

75 PRT10957 Unit 237,250 12 2,847,000 - - - 12 2,847,000 8
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 16,294,232 2,593,075 3,731,875 2,545,625 25,164,807
UMUM MEDIS

688
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 2 113,880 - - - 2 113,880 2
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 2 379,600 - - - 2 379,600 2
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 1 284,700 - - - 1 284,700

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual
36 PRT06316 Manset Monitor Anak PCS 664,300 1 664,300 1 664,300 - - 2 1,328,600

689
Rutin Umum Medis

44 PRT06713 Penlight PCS 284,700 1 284,700 - - - 1 284,700
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - - - - - - 2
50 PRT09314 Regulator Oksigen Portable Unit 284,700 1 284,700 - - - 1 284,700

Ring dan Membran
51 PRT10617 pcs 332,150 1 332,150 - - - 1 332,150 1
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 1 1,518,400 - - - 1 1,518,400
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 1 901,550 - - - 1 901,550
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

690
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 4,763,980 664,300 - - 5,428,280
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - - - - - -
( Zamens )
3 PRT04868 Amplop Coklat Kabinet PCS 136 - - - - - - - - - -
Amplop Royal No.110
4 PRT04713 PAK 14,615 1 14,615 - - - 1 14,615 1
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 1 17,746 2 35,493 1 17,746 2 35,493 6 106,478 3
( Zamens )
6 PRT2966 PCS 7,307 1 7,307 - - - - - - 1 7,307 1
Joyko (Zamens)
7 PRT06232 Batu Baterai L/R 1130 PCS 4,176 - - - - - - - - - -
8 PRT2978 Batu Baterey 23 A (Zamens) PCS 8,351 - - - - - - - - - -

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
10 PRT2982 Batu Baterey GP 27 A PCS 8,351 - - - - - - - - - -
11 PRT2976 Batu Baterey Lr-41 PCS 3,132 - - - - - - - - - -
Batu Baterey Sedang
12 PRT2974 PCS 28,185 6 169,112 6 169,112 6 169,112 6 169,112 24 676,447 6
Energizer
14 PRT13178 PCS 5,741 20 114,829 20 114,829 20 114,829 20 114,829 80 459,316 22
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 12 59,502 12 59,502 12 59,502 12 59,502 48 238,009 21
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

691
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 - - - - - - 1

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - - 1
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 1 7,307 1 7,307 1 7,307 1 7,307 4 29,229 8
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 - - - - - - 2
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 4 22,966 4 22,966 4 22,966 4 22,966 16 91,863 4
( Zamens )
38 PRT04557 PCS 5,741 - - - - - - 2
)
Bussines File Hijau
39 PRT04559 PCS 3,132 10 31,317 10 31,317 10 31,317 10 31,317 40 125,268 10
( Zamens )
40 PRT05172 PCS 3,132 5 15,659 5 15,659 5 15,659 5 15,659 20 62,634 5
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 5 15,659 5 15,659 5 15,659 5 15,659 20 62,634 5
42 PRT3007 Bussines File Warna Merah PCS 3,132 5 15,659 5 15,659 5 15,659 5 15,659 20 62,634 5

44 PRT04992 UNT 260,975 - - - - - -
A

692
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 - - - - - - 1
58 PRT3020 PCS 3,132 5 15,659 5 15,659 5 15,659 5 15,659 20 62,634 5
(Zamens)
59 PRT11126 PCS 1,566 5 7,829 5 7,829 5 7,829 5 7,829 20 31,317 5
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - - - - - - 1
63 PRT3023 Devider Bantex 6050 PAK 8,873 1 8,873 1 8,873 1 8,873 1 8,873 4 35,493 1
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 1 3,654 - - - 1 3,654
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

693
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
78 PRT04565 Gunting Kecil ( Zamens ) PCS 6,263 1 6,263 - - - 1 6,263
79 PRT04566 PCS 1,044 1 1,044 - - - 1 1,044 1
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 5 3,132 - - - 5 3,132
82 PRT04802 PAK 1,827 2 3,654 2 3,654 2 3,654 2 3,654 8 14,615 4
( Zamens )
83 PRT05503 BOX 12,527 1 12,527 - - - 1 12,527
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 3 1,096 3 1,096 3 1,096 3 1,096 12 4,384 3
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 1 29,229 - - - 1 29,229 1
91 PRT04572 RIM 39,146 4 156,585 4 156,585 4 156,585 4 156,585 16 626,340 4
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

694
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 1 12,527 - - - 1 12,527 1
( Zamens )
116 PRT04576 ROL 12,527 1 12,527 - - - 1 12,527 1
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 1 7,307 - - - 1 7,307
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

695
Rutin Umum Medis
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 5 93,951 5 93,951 5 93,951 5 93,951 20 375,804 5
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 5 135,707 5 135,707 5 135,707 5 135,707 20 542,828 5
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 2 17,895 - - - 2 17,895
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 3 3,758 - - - 3 3,758 3
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 3 10,961 - - - 3 10,961 3

139 PRT3136 Pembolong Besar PCS 46,976 - - - - - - 1
140 PRT04584 PCS 9,395 1 9,395 - - - 1 9,395
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 1 1,566 - - - 1 1,566
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 - - - - - - 10
148 PRT3151 PCS 731 - - - - - -
17 X 22

696
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 6 50,107 6 50,107 6 50,107 6 50,107 24 200,429 6
151 PRT3157 Pushpin Pack 3,132 - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 1 1,566 - - - 1 1,566
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 1 7,307 - - - 1 7,307
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 2 11,308 - 2 11,308 - 4 22,615

169 PRT04596 PCS 31,317 - - - - - - 1
( Zamens )

697
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
180 ATK Stempel serah terima 41,756 1 41,756 - - - 1 41,756
181 ATK Stempel TBAK 41,756 1 41,756 - - - 1 41,756
182 ATK Stempel Verifikasi 41,756 1 41,756 - - - 1 41,756
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 2 14,615 2 14,615 2 14,615 2 14,615 8 58,458 2
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - - - - - -
203 PRT07008 Tinta Stempel Dokter 5 Ml PCS 23,725 - - - - - - - - - -

204 PRT04602 BH 4,176 - - - - - - - - - -
)
Grand Total ATK 1,290,182 1,008,773 1,002,334 1,008,773 4,310,061
LINEN
2 Apron PVC 68,250 6 409,500 - - - 6 409,500 4

698
Rutin Umum Medis
3 Bad Mate 54,600 18 982,800 - - - 18 982,800 12
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 12 2,730,000 - - - 12 2,730,000 8
11 Bed Cover Anak 276,250 5 1,381,250 - - - 5 1,381,250 2
12 Bed Cover Dewasa 276,250 7 1,933,750 - - - 7 1,933,750 6
13 Bed Pad 97,500 12 1,170,000 - - - 12 1,170,000 8
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
38 Kimono + Celana Jumbo 162,500 3 487,500 - - - 3 487,500 3
39 Kimono + Celana L 162,500 7 1,137,500 - - - 7 1,137,500 5
40 Kimono + Celana M 162,500 6 975,000 - - - 6 975,000 6
41 Kimono + Celana S 162,500 3 487,500 - - - 3 487,500 3

699
Rutin Umum Medis
42 Kimono + Celana XL 162,500 7 1,137,500 - - - 7 1,137,500 5
43 OPG 128,700 7 900,900 - - - 7 900,900 8
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 3 234,000 - - - 3 234,000 2
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 24 1,002,000 - - - 24 1,002,000 16
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 12 1,365,000 - - - 12 1,365,000 8
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 24 3,369,600 - - - 24 3,369,600 16
72 Stike Laken 57,000 24 1,368,000 - - - 24 1,368,000 16
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 12 663,000 - - - 12 663,000 8

700
Rutin Umum Medis
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 65 815,011 65 815,011 65 815,011 65 815,011 260 3,260,045 135
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )
10 cetakan Asesmen awal anak RIM 65,800 - - 1 65,800 - 1 65,800

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

701
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 1 65,800 - - - 1 65,800 1
dewasa
16 cetakan Asesmen awal medis anak RIM 65,800 - - - - - - 1
Asesmen awal medis
17 cetakan RIM 65,800 1 65,800 - - - 1 65,800 2
dewasa
19 PRT11806 RIM 65,800 1 65,800 - - - 1 65,800
Intervensi
23 PRT3574 Assesment Pasien Terminal RIM 61,100 1 61,100 - - - 1 61,100

24 PRT3580 RIM 65,800 1 65,800 - - - 1 65,800
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 1 77,550 1 77,550 1 77,550 1 77,550 4 310,200 1
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 2 131,600 1 65,800 2 131,600 1 65,800 6 394,800 5
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

702
Rutin Umum Medis
37 PRT12075 RIM 61,100 - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 1 51,700 - - - 1 51,700
Operasi
40 PRT11812 Discharge Planing RIM 61,100 1 61,100 - - - 1 61,100 1
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 1 61,100 - - - 1 61,100
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 1 61,100 - - - 1 61,100
44 Form Indikasi Masuk Imc RIM 61,100 1 61,100 - - - 1 61,100
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 1 61,100 - 1 61,100 - 2 122,200 1
47 PRT3458 Form Permintaan Barang BK 8,460 1 8,460 2 16,920 1 8,460 2 16,920 6 50,760 1
48 PRT3461 BK 9,915 - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 1 7,520 1 7,520 1 7,520 1 7,520 4 30,080 4
50 PRT06087 Form Work Order BK 8,460 1 8,460 1 8,460 1 8,460 1 8,460 4 33,840 1
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 1 65,800 - 1 65,800 - 2 131,600 1
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 1 61,100 - - - 1 61,100 2
56 cetakan Formulir NEWSS RIM 65,800 1 65,800 - - - 1 65,800 2
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 1 65,800 - 1 65,800 - 2 131,600
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 1 65,800 1 65,800 1 65,800 1 65,800 4 263,200 3
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 1 51,700 - 1 51,700 - 2 103,400 1

703
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 10 5,499 - - - 10 5,499 10
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 1 15,040 - 1 15,040 - 2 30,080 1
74 PRT3483 Keterangan Pasien RIM 51,700 2 103,400 2 103,400 2 103,400 2 103,400 8 413,600 4
76 PRT3535 Edukasi Harian RIM 61,100 1 61,100 - 1 61,100 - 2 122,200 2
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 1 65,800 - - - 1 65,800
Blue Rs Meilia
88 PRT3507 Leaflet Diet Pasien LBR 3,102 90 279,180 90 279,180 90 279,180 90 279,180 360 1,116,720 100
90 PRT3510 Lembar Konsultasi RIM 65,800 1 65,800 - - - 1 65,800 1

704
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 1 65,800 1 65,800 1 65,800 2 131,600 5 329,000 3
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 1 61,100 - 1 61,100 - 2 122,200 1
103 PRT3526 Pengajuan Pembedahan RIM 61,100 1 61,100 - - - 1 61,100
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 1 61,100 - - - 1 61,100

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 1 65,800 - - - 1 65,800
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 - 1 61,100 - - 1 61,100 1
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 1 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 1 61,100 - - - 1 61,100

705
Rutin Umum Medis
114 PRT3539 RIM 51,700 1 51,700 - - - 1 51,700
Sitologi
116 PRT3541 Histopatologi Parafin Dan RIM 51,700 1 51,700 - - - 1 51,700
Potong Beku
117 PRT3542 BK 15,040 1 15,040 - - 1 15,040 2 30,080
Laboratorium
118 PRT3543 BK 15,040 1 15,040 - - - 1 15,040 1
Radiologi
119 PRT11816 Permintaan Privasi RIM 62,040 1 62,040 - - - 1 62,040
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 1 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 1 61,100 - 1 61,100 - 2 122,200 1
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 1 51,700 - 1 51,700 - 2 103,400 1
( New )
138 PRT3558 BK 8,178 3 24,534 3 24,534 3 24,534 3 24,534 12 98,136 8
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 1 51,700 - 1 51,700 - 2 103,400 1

706
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -
142 PRT12271 Screening Pasien Covid RIM 61,100 1 61,100 - - - 1 61,100

144 PRT3564 BK 23,030 2 46,060 2 46,060 2 46,060 2 46,060 8 184,240 2
Rawat Inap
145 PRT10086 PCS 2,350 10 23,500 - - - 10 23,500
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 3 21,714 3 21,714 3 21,714 3 21,714 12 86,856 3
154 PRT3584 Surat Keterangan Kematian BK 5,640 1 5,640 - - - 1 5,640

156 PRT3585 Surat Keterangan Rawat BK 5,687 2 11,374 2 11,374 2 11,374 2 11,374 8 45,496 4
159 PRT11608 RIM 61,100 1 61,100 - - - 1 61,100
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 1 61,100 - - - 1 61,100
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

707
Rutin Umum Medis
163 PRT3592 RIM 61,100 1 61,100 - - - 1 61,100
Rawat
164 PRT3593 RIM 61,100 1 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
167 PRT3597 Tanda Terima Barang BK 7,520 1 7,520 1 7,520 1 7,520 1 7,520 4 30,080
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 1 61,100 - - - 1 61,100
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -

708
Rutin Umum Medis
TAHUN 2022
APRODITE
VIP
RTK
1 PRT06832 Bayclin Reguler LTR 15,439 15,439 - - - 1 15,439
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 724,080 275 724,080 275 724,080 275 724,080 1,100 2,896,320
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 473,513 60 473,513 60 473,513 60 473,513 240 1,894,052
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 77,771 10 77,771 10 77,771 10 77,771 40 311,082
8 PRT2833 PCS 251 31,317 125 31,317 125 31,317 125 31,317 500 125,268
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 118,744 13 118,744 13 118,744 13 118,744 52 474,975

709
Rutin Umum Medis
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - -
400Ml
35 PRT2753 BTL 12,292 36,876 3 36,876 3 36,876 3 36,876 12 147,503
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 93,690 10 93,690 10 93,690 10 93,690 40 374,760
37 PRT05269 PCS 12,135 36,406 3 36,406 3 36,406 3 36,406 12 145,624
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 88,732 5 88,732 5 88,732 5 88,732 20 354,926
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 10,439 - - 1 10,439 2 20,878
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 68,584 3 68,584 3 68,584 3 68,584 12 274,337
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 599,564 350 599,564 350 599,564 350 599,564 1,400 2,398,256
Grand Total RTK 2,375,154 2,349,276 2,349,276 2,359,715 9,433,421

710
Rutin Umum Medis
PAKET WELLCOME
1 PRT04734 Handuk Rs Meilia PCS 20,900 3,260,400 156 3,260,400 156 3,260,400 156 3,260,400 624 13,041,600
2 PRT2858 Pasta Gigi + Sikat PCS 1,829 285,285 156 285,285 156 285,285 156 285,285 624 1,141,140
4 PRT2856 Sabun PCS 1,045 163,020 156 163,020 156 163,020 156 163,020 624 652,080
5 PRT2855 Sandal PCS 4,859 758,043 156 758,043 156 758,043 156 758,043 624 3,032,172
6 PRT04768 Tas Spunbond Rs. Meilia PCS 7,472 1,165,593 156 1,165,593 156 1,165,593 156 1,165,593 624 4,662,372
7 PRT05527 Washlap PCS 3,658 1,141,140 312 1,141,140 312 1,141,140 312 1,141,140 1,248 4,564,560
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 47,450 - - - 1 47,450
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

711
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 1,898,000 - - - 8 1,898,000

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

38 PRT10795 Label " Alergi" Merah PCS 711 35,557 50 35,557 50 35,557 50 35,557 200 142,227
39 PRT10795 Label " Dnr" PCS 711 35,557 - - - 50 35,557
40 PRT09271 Label "Fall Risk" Yellow PCS 711 46,224 65 46,224 65 46,224 65 46,224 260 184,895

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

712
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 - 6 2,847,000 - - 6 2,847,000
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
65 PRT2780 Spillkit (Blood Spill Pack) PAK 47,450 94,900 2 94,900 2 94,900 2 94,900 8 379,600
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 1,138,800 - - - 8 1,138,800

70 18,980 - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 1,186,250 - 5 1,186,250 - 10 2,372,500
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 1,423,500 - - - 10 1,423,500

75 PRT10957 Unit 237,250 1,898,000 - - - 8 1,898,000
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 7,804,237 3,023,681 1,362,931 176,681 12,367,529
UMUM MEDIS

713
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 113,880 - - - 2 113,880
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 379,600 - - - 2 379,600
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

714
Rutin Umum Medis

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 664,300 - - - 2 664,300

Ring dan Membran
51 PRT10617 pcs 332,150 332,150 - - - 1 332,150
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 - 1 901,550 - - 1 901,550
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

715
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 1,489,930 901,550 - - 2,391,480
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 14,615 - - - 1 14,615
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 53,239 2 35,493 3 53,239 2 35,493 10 177,463
( Zamens )
6 PRT2966 PCS 7,307 7,307 - - - 1 7,307
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 169,112 6 169,112 6 169,112 6 169,112 24 676,447
Energizer
14 PRT13178 PCS 5,741 126,312 22 126,312 22 126,312 22 126,312 88 505,248
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 104,129 21 104,129 21 104,129 21 104,129 84 416,516
18 PRT04715 PCS 5,220 - 10 52,195 - - 10 52,195
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

716
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - -
23 PRT2984 Binder Clips No.107 Dus 3,132 3,132 - - - 1 3,132

Binder Clips No.155
24 PRT04725 Dus 5,220 5,220 - - - 1 5,220
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 58,458 8 58,458 8 58,458 8 58,458 32 233,834
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 14,615 10 14,615 10 14,615 10 14,615 40 58,458
31 PRT04554 PCS 27,141 54,283 - - - 2 54,283
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 22,966 4 22,966 4 22,966 4 22,966 16 91,863
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - 4 41,756 - - 4 41,756
38 PRT04557 PCS 5,741 11,483 - - - 2 11,483
)
Bussines File Hijau
39 PRT04559 PCS 3,132 31,317 10 31,317 10 31,317 10 31,317 40 125,268
( Zamens )
40 PRT05172 PCS 3,132 15,659 5 15,659 5 15,659 5 15,659 20 62,634
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 15,659 5 15,659 5 15,659 5 15,659 20 62,634
42 PRT3007 Bussines File Warna Merah PCS 3,132 15,659 5 15,659 5 15,659 5 15,659 20 62,634

44 PRT04992 UNT 260,975 - - - - - -
A

717
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
57 PRT3015 Clear Holder Isi 40 PCS 26,098 26,098 - - - 1 26,098
58 PRT3020 PCS 3,132 15,659 5 15,659 5 15,659 5 15,659 20 62,634
(Zamens)
59 PRT11126 PCS 1,566 7,829 5 7,829 5 7,829 5 7,829 20 31,317
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 11,483 - - - 1 11,483
63 PRT3023 Devider Bantex 6050 PAK 8,873 8,873 1 8,873 1 8,873 1 8,873 4 35,493
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

718
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 1,044 - - - 1 1,044
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 - 3 1,879 - - 3 1,879
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - 3 9,395 - - 3 9,395
82 PRT04802 PAK 1,827 7,307 4 7,307 4 7,307 4 7,307 16 29,229
( Zamens )
83 PRT05503 BOX 12,527 - 1 12,527 - - 1 12,527
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 1,096 3 1,096 3 1,096 3 1,096 12 4,384
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 29,229 - - - 1 29,229
91 PRT04572 RIM 39,146 156,585 4 156,585 4 156,585 4 156,585 16 626,340
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

719
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 12,527 - - - 1 12,527
( Zamens )
116 PRT04576 ROL 12,527 12,527 - - - 1 12,527
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - 1 7,307 - - 1 7,307
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

720
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 31,317 5 31,317 5 31,317 5 31,317 20 125,268
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 93,951 5 93,951 5 93,951 5 93,951 20 375,804
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 135,707 5 135,707 5 135,707 5 135,707 20 542,828
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - 2 17,895 - - 2 17,895
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 3,758 - - - 3 3,758
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 10,961 - - - 3 10,961

139 PRT3136 Pembolong Besar PCS 46,976 46,976 - - - 1 46,976
140 PRT04584 PCS 9,395 - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - 1 1,566 - - 1 1,566
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 8,351 - - - 10 8,351
148 PRT3151 PCS 731 - - - - - -
17 X 22

721
Rutin Umum Medis
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 50,107 6 50,107 6 50,107 6 50,107 24 200,429
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 7,829 3 7,829 3 7,829 3 7,829 12 31,317
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - 2 14,615 - - 2 14,615
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - 2 11,308 - 2 11,308 4 22,615

169 PRT04596 PCS 31,317 31,317 - - - 1 31,317
( Zamens )
170 PRT3178 Staples Besar Max Hd 50 PCS 52,195 52,195 - - - 1 52,195

722
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 14,615 - - - 2 14,615
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 1,500,502 1,296,080 1,143,384 1,136,945 5,076,910
LINEN
2 Apron PVC 68,250 273,000 - - - 4 273,000

723
Rutin Umum Medis
3 Bad Mate 54,600 655,200 - - - 12 655,200
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 1,820,000 - - - 8 1,820,000
11 Bed Cover Anak 276,250 552,500 - - - 2 552,500
12 Bed Cover Dewasa 276,250 1,657,500 - - - 6 1,657,500
13 Bed Pad 97,500 780,000 - - - 8 780,000
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
38 Kimono + Celana Jumbo 162,500 487,500 - - - 3 487,500
39 Kimono + Celana L 162,500 812,500 - - - 5 812,500
40 Kimono + Celana M 162,500 975,000 - - - 6 975,000
41 Kimono + Celana S 162,500 487,500 - - - 3 487,500

724
Rutin Umum Medis
42 Kimono + Celana XL 162,500 812,500 - - - 5 812,500
43 OPG 128,700 1,029,600 - - - 8 1,029,600
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 156,000 - - - 2 156,000
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 668,000 - - - 16 668,000
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 910,000 - - - 8 910,000
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 2,246,400 - - - 16 2,246,400
72 Stike Laken 57,000 912,000 - - - 16 912,000
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 442,000 - - - 8 442,000

725
Rutin Umum Medis
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 1,692,716 135 1,692,716 135 1,692,716 135 1,692,716 540 6,770,862
Grand Total Air Minum 1,692,716 1,692,716 1,692,716 1,692,716 6,770,862
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )
10 cetakan Asesmen awal anak RIM 65,800 - 1 65,800 - - 1 65,800

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

726
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 65,800 - 1 65,800 - 2 131,600
dewasa
16 cetakan Asesmen awal medis anak RIM 65,800 65,800 - - - 1 65,800
Asesmen awal medis
17 cetakan RIM 65,800 131,600 - - - 2 131,600
dewasa
19 PRT11806 RIM 65,800 - 1 65,800 - - 1 65,800
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 77,550 1 77,550 1 77,550 1 77,550 4 310,200
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 329,000 4 263,200 5 329,000 4 263,200 18 1,184,400
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

727
Rutin Umum Medis
37 PRT12075 RIM 61,100 - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
40 PRT11812 Discharge Planing RIM 61,100 61,100 - - - 1 61,100
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 61,100 - - - 1 61,100
47 PRT3458 Form Permintaan Barang BK 8,460 8,460 2 16,920 1 8,460 2 16,920 6 50,760
48 PRT3461 BK 9,915 - - - - - -
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 30,080 4 30,080 4 30,080 4 30,080 16 120,320
50 PRT06087 Form Work Order BK 8,460 8,460 1 8,460 1 8,460 1 8,460 4 33,840
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 65,800 - 1 65,800 - 2 131,600
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
55 cetakan Formulir MPP RIM 61,100 122,200 - - - 2 122,200
56 cetakan Formulir NEWSS RIM 65,800 131,600 - - - 2 131,600
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
58 PRT11807 Edukasi Pasien Dan RIM 65,800 - 1 65,800 - 1 65,800 2 131,600
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 197,400 3 197,400 3 197,400 3 197,400 12 789,600
Keperawatan
62 PRT05732 Jasa Dokter BK 7,755 178,365 23 178,365 23 178,365 23 178,365 92 713,460
63 PRT3472 Kardeks Rawat Inap RIM 51,700 51,700 - 1 51,700 - 2 103,400

728
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 5,499 - - - 10 5,499
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
73 PRT3484 Keterangan Medis BK 15,040 15,040 1 15,040 1 15,040 1 15,040 4 60,160
74 PRT3483 Keterangan Pasien RIM 51,700 206,800 4 206,800 4 206,800 4 206,800 16 827,200
76 PRT3535 Edukasi Harian RIM 61,100 122,200 1 61,100 2 122,200 1 61,100 6 366,600
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - 1 65,800 - - 1 65,800
Blue Rs Meilia
88 PRT3507 Leaflet Diet Pasien LBR 3,102 310,200 100 310,200 100 310,200 100 310,200 400 1,240,800
90 PRT3510 Lembar Konsultasi RIM 65,800 65,800 - 1 65,800 - 2 131,600

729
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 197,400 2 131,600 3 197,400 3 197,400 11 723,800
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
Pengawasan Pasien

Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 61,100 - - - 1 61,100
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

730
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - 1 15,040 - - 1 15,040
Laboratorium
118 PRT3543 BK 15,040 15,040 - - - 1 15,040
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 75,200 4 60,160 5 75,200 4 60,160 18 270,720
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 61,100 2 122,200 1 61,100 2 122,200 6 366,600
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 248,160 30 248,160 30 248,160 30 248,160 120 992,640
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 51,700 1 51,700 1 51,700 1 51,700 4 206,800
( New )
138 PRT3558 BK 8,178 65,424 8 65,424 8 65,424 8 65,424 32 261,696
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 51,700 - 1 51,700 - 2 103,400

731
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 46,060 2 46,060 2 46,060 2 46,060 8 184,240
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

153 PRT3583 Surat Keterangan BK 7,238 21,714 3 21,714 3 21,714 3 21,714 12 86,856
154 PRT3584 Surat Keterangan Kematian BK 5,640 - 1 5,640 - - 1 5,640

156 PRT3585 Surat Keterangan Rawat BK 5,687 22,748 4 22,748 4 22,748 4 22,748 16 90,992
159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

732
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
167 PRT3597 Tanda Terima Barang BK 7,520 - 1 7,520 - - 1 7,520
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -

733
Rutin Umum Medis
TAHUN 2022
SUITE
TW 1 TW 2 TW 3 TW 4 .....
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 - - - - - -
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 - - - - - -
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 - - - - - -

734
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - -
400Ml
35 PRT2753 BTL 12,292 - - - - - -
( Botol )
37 PRT05269 PCS 12,135 - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 - - - - - -
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 - - - - - -

Grand Total RTK - - - - -

735
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

736
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

39 PRT10795 Label " Dnr" PCS 711 - - - - - -
40 PRT09271 Label "Fall Risk" Yellow PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

737
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert

70 18,980 - - - - - -
Plastik

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis - - - - -
UMUM MEDIS

738
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

739
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

740
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis - - - - -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 - - - - - -
( Zamens )
6 PRT2966 PCS 7,307 - - - - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 - - - - - -
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 - - - - - -
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

741
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
20 PRT04548 PCS 38,520 - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 - - - - - -
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 - - - - - -
31 PRT04554 PCS 27,141 - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 - - - - - -
( Zamens )
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )

44 PRT04992 UNT 260,975 - - - - - -
A

742
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

743
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
82 PRT04802 PAK 1,827 - - - - - -
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 - - - - - -
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

744
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

745
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 - - - - - -
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - - - - - -
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - -
)

140 PRT04584 PCS 9,395 - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

746
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 - - - - - -
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - -

169 PRT04596 PCS 31,317 - - - - - -
( Zamens )

747
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - - - - - -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK - - - - -
LINEN
2 Apron PVC 68,250 - - - - - -

748
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
3 Bad Mate 54,600 - - - - - -
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - -
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

749
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - - - - -
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 - - - - - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 - - - - - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - -
72 Stike Laken 57,000 - - - - - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - -

750
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 - - - - - -
Grand Total Air Minum - - - - -
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

751
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - - - - -
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 - - - - - -
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

752
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
37 PRT12075 RIM 61,100 - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
48 PRT3461 BK 9,915 - - - - - -
Farmasi

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 - - - - - -
Keperawatan
62 PRT05732 Jasa Dokter BK 7,755 - - - - - -

753
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia

754
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
Pengawasan Pasien

Anak
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

755
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - - - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 - - - - - -

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 - - - - - -
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - - - -
( New )
138 PRT3558 BK 8,178 - - - - - -
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

756
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 - - - - - -
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang


156 PRT3585 Surat Keterangan Rawat BK 5,687 - - - - - -
159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

757
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan - - - - -
Grand Total Biaya Rutin Umum dan Medis - - - - -

758
Rutin Umum Medis
TAHUN 2022
KEGIATAN
..... ...... ..... .... TW 1
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 - - - - - - 60
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 - - - - - - 6
8 PRT2833 PCS 251 - - - - - - 150
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - - 9
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 - - - - - - 3

759
Rutin Umum Medis
..... ...... ..... .... TW 1
30 PRT06826 PAK 83,512 - - - - - - 1
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - -
400Ml
35 PRT2753 BTL 12,292 - - - - - - 6
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 - - - - - - 6
37 PRT05269 PCS 12,135 - - - - - - 9
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - - 4
39 PRT11090 Safety Box 5 Liter PCS 17,746 - - - - - - 6
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 - - - - - - 3
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 - - - - - - 6


760
Rutin Umum Medis
..... ...... ..... .... TW 1
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - - 2
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

761
Rutin Umum Medis
..... ...... ..... .... TW 1
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - - - - - - 2

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

31 PRT3294 Keset Toilet Pcs 94,900 - - - - - - 1
35 PRT10277 Kursi Merah Pcs 379,600 - - - - - - 2
38 PRT10795 Label " Alergi" Merah PCS 711 - - - - - - 90
39 PRT10795 Label " Dnr" PCS 711 - - - - - - 90
40 PRT09271 Label "Fall Risk" Yellow PCS 711 - - - - - - 90

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

762
Rutin Umum Medis
..... ...... ..... .... TW 1
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 - - - - - - 2
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - - - - - - 1

70 18,980 - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 - - - - - - 2
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 - - - - - - 2

75 PRT10957 Unit 237,250 - - - - - - 2
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
UMUM MEDIS

763
Rutin Umum Medis
..... ...... ..... .... TW 1
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - - 1
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 - - - - - - 2
10 PRT13652 Bengkok Besar Unit 237,250 - - - - - - 2
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 - - - - - - 1
21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - - - - - - 1

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

764
Rutin Umum Medis
..... ...... ..... .... TW 1

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 - - - - - - 1
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

765
Rutin Umum Medis
..... ...... ..... .... TW 1
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - - 3
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 - - - - - - 3
( Zamens )
6 PRT2966 PCS 7,307 - - - - - - 1
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - - 9
Energizer
14 PRT13178 PCS 5,741 - - - - - - 3
( Zamens )
15 PRT04547 PCS 3,654 - - - - - - 9
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 - - - - - -
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - - 3
( Zamens )

766
Rutin Umum Medis
..... ...... ..... .... TW 1
20 PRT04548 PCS 38,520 - - - - - -
21 PRT2977 Batu Battrey Lr-44 PCS 3,132 - - - - - - 3

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - - 1
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - - 1
( ZAMENS )
27 PRT04553 PCS 7,307 - - - - - - 12
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - - 3
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 - - - - - - 24
31 PRT04554 PCS 27,141 - - - - - - 3
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - - 1
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 - - - - - - 6

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 - - - - - - 9
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - - - - - - 9
38 PRT04557 PCS 5,741 - - - - - - 9
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - - 9
( Zamens )
40 PRT05172 PCS 3,132 - - - - - - 9
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 - - - - - - 9
42 PRT3007 Bussines File Warna Merah PCS 3,132 - - - - - - 9

44 PRT04992 UNT 260,975 - - - - - -
A

767
Rutin Umum Medis
..... ...... ..... .... TW 1
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - - 30
(Zamens)
59 PRT11126 PCS 1,566 - - - - - - 30
(Zamens)
61 PRT04562 Cutter A-300 ( Zamens ) PCS 5,220 - - - - - - 1

63 PRT3023 Devider Bantex 6050 PAK 8,873 - - - - - - 3
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)
68 PRT3027 Double Tape Sedang 1 Inc ROL 8,351 - - - - - - 2

768
Rutin Umum Medis
..... ...... ..... .... TW 1
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
72 PRT11165 Flashdisk 32 Gb BH 140,927 - - - - - - 1
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - - 1
(Zamens)
79 PRT04566 PCS 1,044 - - - - - - 3
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 - - - - - - 3
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - - - - - - 1
82 PRT04802 PAK 1,827 - - - - - - 1
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 - - - - - - 12
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 - - - - - - 4
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - - 2
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

769
Rutin Umum Medis
..... ...... ..... .... TW 1
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - - 24
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - - 1
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

770
Rutin Umum Medis
..... ...... ..... .... TW 1
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 - - - - - - 3
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - - - - - - 3
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 - - - - - - 6
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - - 1
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - -
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 - - - - - - 1

140 PRT04584 PCS 9,395 - - - - - - 1
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - - 1
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 - - - - - - 6
148 PRT3151 PCS 731 - - - - - -
17 X 22

771
Rutin Umum Medis
..... ...... ..... .... TW 1
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 - - - - - - 3
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
161 PRT04591 Selotip 1/2 X 10 ( Zamens ) PCS 1,044 - - - - - - 9
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - - 3
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - - 3
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 - - - - - - 3

169 PRT04596 PCS 31,317 - - - - - -
( Zamens )

772
Rutin Umum Medis
..... ...... ..... .... TW 1
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - - - - - - 1
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
LINEN
2 Apron PVC 68,250 - - - - - - 5

773
Rutin Umum Medis
..... ...... ..... .... TW 1
3 Bad Mate 54,600 - - - - - - 9
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - - 5
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - - 5
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

774
Rutin Umum Medis
..... ...... ..... .... TW 1
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - - 7
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - - - - - 5
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 - - - - - - 12
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 - - - - - - 5
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - - 12
72 Stike Laken 57,000 - - - - - - 12
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - - 5

775
Rutin Umum Medis
..... ...... ..... .... TW 1
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 - - - - - - 20
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

776
Rutin Umum Medis
..... ...... ..... .... TW 1
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - - 1
Intervensi
23 PRT3574 Assesment Pasien Terminal RIM 61,100 - - - - - - 1

24 PRT3580 RIM 65,800 - - - - - - 1
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - - - - - 3
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 - - - - - - 6
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

777
Rutin Umum Medis
..... ...... ..... .... TW 1
37 PRT12075 RIM 61,100 - - - - - - 1
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - - 1
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - - - - - - 3
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - - 3
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 - - - - - - 1
44 Form Indikasi Masuk Imc RIM 61,100 - - - - - - 1
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 - - - - - - 2
47 PRT3458 Form Permintaan Barang BK 8,460 - - - - - - 1
48 PRT3461 BK 9,915 - - - - - - 1
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 - - - - - - 1
50 PRT06087 Form Work Order BK 8,460 - - - - - - 3
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - - - - - - 6

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - - 1
Ultrasonografi
60 PRT3466 RIM 65,800 - - - - - - 9
Keperawatan
62 PRT05732 Jasa Dokter BK 7,755 - - - - - - 24

778
Rutin Umum Medis
..... ...... ..... .... TW 1
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
76 PRT3535 Edukasi Harian RIM 61,100 - - - - - - 12
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - - 3
Blue Rs Meilia
87 PRT3506 Laporan Pembedahan RIM 65,800 - - - - - - 1
89 PRT3509 Lembar Disposisi RIM 51,700 - - - - - - 1
90 PRT3510 Lembar Konsultasi RIM 65,800 - - - - - - 3

779
Rutin Umum Medis
..... ...... ..... .... TW 1
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - - - - - - 3
Pengawasan Pasien

Anak
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - - 1
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

780
Rutin Umum Medis
..... ...... ..... .... TW 1
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 - - - - - - 3
Potong Beku
117 PRT3542 BK 15,040 - - - - - - 3
Laboratorium
118 PRT3543 BK 15,040 - - - - - - 3
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - - - - 6
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 - - - - - - 3
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 - - - - - - 4

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 - - - - - - 36
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - - - - 1
( New )
138 PRT3558 BK 8,178 - - - - - - 24
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

781
Rutin Umum Medis
..... ...... ..... .... TW 1
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 - - - - - - 10
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - - 60
Panjang


156 PRT3585 Surat Keterangan Rawat BK 5,687 - - - - - - 1
159 PRT11608 RIM 61,100 - - - - - - 1
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - - 1
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

782
Rutin Umum Medis
..... ...... ..... .... TW 1
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - - 3
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 - - - - - - 300
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - - 2
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -

783
Rutin Umum Medis
TAHUN 2022
ICU
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 473,513 60 473,513 60 473,513 60 473,513 240 1,894,052 90
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 46,662 6 46,662 6 46,662 6 46,662 24 186,649 6
8 PRT2833 PCS 251 37,580 150 37,580 150 37,580 150 37,580 600 150,322 300
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 82,207 9 82,207 9 82,207 9 82,207 36 328,829 12
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 27,402 3 27,402 3 27,402 3 27,402 12 109,610 6

784
Rutin Umum Medis
30 PRT06826 PAK 83,512 83,512 1 83,512 1 83,512 1 83,512 4 334,048 1
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - -
400Ml
35 PRT2753 BTL 12,292 73,752 6 73,752 6 73,752 6 73,752 24 295,006 9
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 56,214 6 56,214 6 56,214 6 56,214 24 224,856 9
37 PRT05269 PCS 12,135 109,218 9 109,218 9 109,218 9 109,218 36 436,872 12
(450Ml)
38 PRT07518 Sabut PCS 3,132 12,527 4 12,527 4 12,527 4 12,527 16 50,107 4
39 PRT11090 Safety Box 5 Liter PCS 17,746 106,478 6 106,478 6 106,478 6 106,478 24 425,911 9
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 31,317 3 31,317 3 31,317 3 31,317 12 125,268 3
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 137,168 6 137,168 6 137,168 6 137,168 24 548,674 9
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 20,556 12 20,556 12 20,556 12 20,556 48 82,226 18
Grand Total RTK 1,298,107 1,298,107 1,298,107 1,298,107 5,192,430

785
Rutin Umum Medis
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 474,500 - 2 474,500 - 4 949,000 2
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

786
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 474,500 - 2 474,500 - 4 949,000 2

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

31 PRT3294 Keset Toilet Pcs 94,900 94,900 1 94,900 1 94,900 1 94,900 4 379,600 1
35 PRT10277 Kursi Merah Pcs 379,600 759,200 - 2 759,200 - 4 1,518,400 2
38 PRT10795 Label " Alergi" Merah PCS 711 64,002 90 64,002 90 64,002 90 64,002 360 256,009 120
39 PRT10795 Label " Dnr" PCS 711 64,002 90 64,002 90 64,002 90 64,002 360 256,009 120

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

787
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 474,500 - 1 474,500 - 2 949,000 1
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 189,800 - 2 189,800 - 4 379,600 2
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 142,350 - - - 1 142,350

70 18,980 - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 474,500 - 2 474,500 - 4 949,000 2
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 284,700 - 2 284,700 - 4 569,400 2

75 PRT10957 Unit 237,250 474,500 - 2 474,500 - 4 949,000 2
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 4,035,457 286,907 3,893,107 286,907 8,502,377
UMUM MEDIS
2 PRT13608 Ambubag Anak Unt 2,799,550 - 1 2,799,550 - - 1 2,799,550

788
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 - - - - - -
4 PRT13190 Ambubag Dewasa Unt 2,799,550 - 2 5,599,100 - - 2 5,599,100
6 PRT08714 Bak Spuit Pcs 56,940 56,940 - - - 1 56,940
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 379,600 - - - 2 379,600
10 PRT13652 Bengkok Besar Unit 237,250 474,500 - - - 2 474,500
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 94,900 - - - 1 94,900
21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 284,700 - - - 1 284,700

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual
36 PRT06316 Manset Monitor Anak PCS 664,300 - 2 1,328,600 - - 2 1,328,600
37 PRT10294 Manset Monitor Bayi PCS 711,750 - 1 711,750 - - 1 711,750

789
Rutin Umum Medis
38 PRT06315 Manset Monitor Dewasa PCS 949,000 - 5 4,745,000 - - 5 4,745,000
39 PRT06317 Manset Monitor Jumbo PCS 1,043,900 - 2 2,087,800 - - 2 2,087,800
42 PRT06333 Nebulazer Omron Ne-C29 Unt 1,423,500 - - 1 1,423,500 - 1 1,423,500

44 PRT06713 Penlight PCS 284,700 - 1 284,700 - - 1 284,700
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -
50 PRT09314 Regulator Oksigen Portable Unit 284,700 - - 1 284,700 - 1 284,700

Ring dan Membran
51 PRT10617 pcs 332,150 - - 3 996,450 - 3 996,450
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos
61 PRT13517 Tempat Laringoscope Unt 284,700 - - 3 854,100 - 3 854,100

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 901,550 - - - 1 901,550 1
65 PRT12582 Unt 1,898,000 - - - - - - 1
Conector)
66 PRT06708 Tiang Infus Unt 949,000 - - 4 3,796,000 - 4 3,796,000

790
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 - 1 284,700 - - 1 284,700
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - 1 1,409,265 - - 1 1,409,265
Grand Total Umum Medis 2,192,190 19,535,165 7,354,750 - 29,082,105
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 43,844 3 43,844 3 43,844 3 43,844 12 175,375 6
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 53,239 3 53,239 3 53,239 3 53,239 12 212,956 6
( Zamens )
6 PRT2966 PCS 7,307 7,307 - - - 1 7,307
Joyko (Zamens)
7 PRT06232 Batu Baterai L/R 1130 PCS 4,176 - 4 16,702 - - 4 16,702

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 253,668 9 253,668 9 253,668 9 253,668 36 1,014,671 6
Energizer
14 PRT13178 PCS 5,741 17,224 3 17,224 3 17,224 3 17,224 12 68,897 3
( Zamens )
15 PRT04547 PCS 3,654 32,883 9 32,883 9 32,883 9 32,883 36 131,531 9
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 - - - - - -
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 10,961 3 10,961 3 10,961 3 10,961 12 43,844 3
( Zamens )

791
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - -
21 PRT2977 Batu Battrey Lr-44 PCS 3,132 9,395 3 9,395 3 9,395 3 9,395 12 37,580 3
23 PRT2984 Binder Clips No.107 Dus 3,132 3,132 1 3,132 1 3,132 1 3,132 4 12,527 1
Binder Clips No.155
24 PRT04725 Dus 5,220 5,220 1 5,220 1 5,220 1 5,220 4 20,878 1
( Zamens )
25 PRT2987 Binder Clips No.200 Dus 10,439 10,439 1 10,439 1 10,439 1 10,439 4 41,756 1
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 12,527 1 12,527 1 12,527 1 12,527 4 50,107 1
( ZAMENS )
27 PRT04553 PCS 7,307 87,688 12 87,688 12 87,688 12 87,688 48 350,750 18
Unique ( Zamens )
28 PRT04717 PCS 6,785 20,356 3 20,356 3 20,356 3 20,356 12 81,424 5
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 81,424 3 81,424 3 81,424 3 81,424 12 325,697 3
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 28,185 - 1 28,185 - 2 56,371 1
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 12,527 6 12,527 6 12,527 6 12,527 24 50,107 9
Buku Tulis Expedisi
36 PRT04558 PCS 5,741 51,673 9 51,673 9 51,673 9 51,673 36 206,692 12
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 93,951 9 93,951 9 93,951 9 93,951 36 375,804 12
38 PRT04557 PCS 5,741 51,673 9 51,673 9 51,673 9 51,673 36 206,692 12
)
Bussines File Hijau
39 PRT04559 PCS 3,132 28,185 9 28,185 9 28,185 9 28,185 36 112,741 12
( Zamens )
40 PRT05172 PCS 3,132 28,185 9 28,185 9 28,185 9 28,185 36 112,741 12
( Zamens )

44 PRT04992 UNT 260,975 - - - - - -
A

792
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 93,951 30 93,951 30 93,951 30 93,951 120 375,804 30
(Zamens)
59 PRT11126 PCS 1,566 46,976 30 46,976 30 46,976 30 46,976 120 187,902 30
(Zamens)
61 PRT04562 Cutter A-300 ( Zamens ) PCS 5,220 5,220 - - - 1 5,220

62 PRT3022 Cutter Besar L-500 PCS 11,483 - 1 11,483 - - 1 11,483 1
64 PRT04800 PCS 10,439 - 1 10,439 - - 1 10,439
( Zamens )
65 PRT3024 PCS 18,790 - 1 18,790 - - 1 18,790
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)
68 PRT3027 Double Tape Sedang 1 Inc ROL 8,351 16,702 2 16,702 2 16,702 2 16,702 8 66,810 2

793
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
71 PRT3034 Elevated Tray Susun 3 PCS 76,205 - 1 76,205 - - 1 76,205
72 PRT11165 Flashdisk 32 Gb BH 140,927 140,927 - - - 1 140,927
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 9,395 - 1 9,395 - 2 18,790 1
(Zamens)
78 PRT04565 Gunting Kecil ( Zamens ) PCS 6,263 - 1 6,263 - 1 6,263 2 12,527
79 PRT04566 PCS 1,044 3,132 3 3,132 3 3,132 3 3,132 12 12,527 3
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 1,879 3 1,879 3 1,879 3 1,879 12 7,516 3
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 3,132 1 3,132 1 3,132 1 3,132 4 12,527 1
82 PRT04802 PAK 1,827 1,827 1 1,827 1 1,827 1 1,827 4 7,307 2
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - 1 140,927 - - 1 140,927
14
86 PRT3053 Karbon ( Zamens ) PCS 365 4,384 12 4,384 12 4,384 12 4,384 48 17,538 6
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 - 1 29,229 - - 1 29,229
91 PRT04572 RIM 39,146 156,585 3 117,439 4 156,585 3 117,439 14 548,048 6
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 52,195 - 2 52,195 - 4 104,390 2
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

794
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 12,527 24 12,527 24 12,527 24 12,527 96 50,107 36
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 12,527 1 12,527 1 12,527 1 12,527 4 50,107 1
( Zamens )
116 PRT04576 ROL 12,527 - 1 12,527 - - 1 12,527
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - 1 7,307 - - 1 7,307
( Zamens )
118 PRT3096 Lakban Hitam 1,5 “ ROL 10,439 - 1 10,439 - - 1 10,439
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

795
Rutin Umum Medis
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 18,790 3 18,790 3 18,790 3 18,790 12 75,161 6
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 56,371 3 56,371 3 56,371 3 56,371 12 225,482 3
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 8,948 1 8,948 1 8,948 1 8,948 4 35,791 1
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - 2 2,505 - - 2 2,505
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 3,654 - - - 1 3,654

139 PRT3136 Pembolong Besar PCS 46,976 - 1 46,976 - - 1 46,976
140 PRT04584 PCS 9,395 9,395 - - - 1 9,395 1
( Zamens )
141 PRT3143 PCS 5,220 - - 1 5,220 - 1 5,220
(Zamens)
142 PRT04808 PCS 1,566 - 2 3,132 - - 2 3,132
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 3,262 1 3,262 1 3,262 1 3,262 4 13,049 1
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 5,011 6 5,011 6 5,011 6 5,011 24 20,043 9
148 PRT3151 PCS 731 - - - - - -
17 X 22

796
Rutin Umum Medis
151 PRT3157 Pushpin Pack 3,132 - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 - 1 1,566 - - 1 1,566
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 21,922 3 21,922 3 21,922 3 21,922 12 87,688 3
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 16,961 3 16,961 3 16,961 3 16,961 12 67,845 3
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 12,527 - - - 3 12,527

169 PRT04596 PCS 31,317 - 1 31,317 - - 1 31,317
( Zamens )
170 PRT3178 Staples Besar Max Hd 50 PCS 52,195 52,195 - - - 1 52,195

797
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 7,307 1 7,307 1 7,307 1 7,307 4 29,229 1
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 2,036,747 2,102,409 1,810,743 1,682,865 7,632,765
LINEN
2 Apron PVC 68,250 341,250 - - - 5 341,250 8

798
Rutin Umum Medis
3 Bad Mate 54,600 491,400 - - - 9 491,400 12
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 487,500 - - - 5 487,500 8
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 487,500 - - - 5 487,500 8
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

799
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 900,900 - - - 7 900,900 8
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 390,000 - - - 5 390,000 4
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 501,000 - - - 12 501,000 16
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 568,750 - - - 5 568,750 8
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 1,684,800 - - - 12 1,684,800 16
72 Stike Laken 57,000 684,000 - - - 12 684,000 16
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 276,250 - - - 5 276,250 8

800
Rutin Umum Medis
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 250,773 20 250,773 20 250,773 20 250,773 80 1,003,091 40
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

801
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 65,800 1 65,800 1 65,800 1 65,800 4 263,200 1
Intervensi
23 PRT3574 Assesment Pasien Terminal RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
24 PRT3580 RIM 65,800 65,800 1 65,800 1 65,800 1 65,800 4 263,200 1
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 232,650 3 232,650 3 232,650 3 232,650 12 930,600 3
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 394,800 6 394,800 6 394,800 6 394,800 24 1,579,200 9
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

802
Rutin Umum Medis
37 PRT12075 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 51,700 - 1 51,700 - 2 103,400 1
Operasi
40 PRT11812 Discharge Planing RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200 3
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200 3
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
44 Form Indikasi Masuk Imc RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 122,200 2 122,200 2 122,200 2 122,200 8 488,800 3
47 PRT3458 Form Permintaan Barang BK 8,460 8,460 - - - 1 8,460
48 PRT3461 BK 9,915 9,915 1 9,915 1 9,915 1 9,915 4 39,660 1
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 7,520 1 7,520 1 7,520 1 7,520 4 30,080 1
50 PRT06087 Form Work Order BK 8,460 25,380 3 25,380 3 25,380 3 25,380 12 101,520 3
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 394,800 6 394,800 6 394,800 6 394,800 24 1,579,200 9
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 17,578 1 17,578 1 17,578 1 17,578 4 70,312 1
Ultrasonografi
60 PRT3466 RIM 65,800 592,200 9 592,200 9 592,200 9 592,200 36 2,368,800 12
Keperawatan

803
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
76 PRT3535 Edukasi Harian RIM 61,100 733,200 12 733,200 12 733,200 12 733,200 48 2,932,800 16
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 197,400 3 197,400 3 197,400 3 197,400 12 789,600 2
Blue Rs Meilia
87 PRT3506 Laporan Pembedahan RIM 65,800 65,800 1 65,800 1 65,800 1 65,800 4 263,200 1
89 PRT3509 Lembar Disposisi RIM 51,700 51,700 1 51,700 1 51,700 1 51,700 4 206,800 1
90 PRT3510 Lembar Konsultasi RIM 65,800 197,400 3 197,400 3 197,400 3 197,400 12 789,600 3

804
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200 3
103 PRT3526 Pengajuan Pembedahan RIM 61,100 - 1 61,100 - 1 61,100 2 122,200 1
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - 1 61,100 - - 1 61,100

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 197,400 3 197,400 3 197,400 3 197,400 12 789,600 3
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 366,600 6 366,600 6 366,600 6 366,600 24 1,466,400 9
Dewasa
108 PRT11809 Resiko Jatuh Pada Pasien RIM 65,800 197,400 3 197,400 3 197,400 3 197,400 12 789,600 3
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - 1 61,100 - - 1 61,100

805
Rutin Umum Medis
114 PRT3539 RIM 51,700 - 1 51,700 - - 1 51,700
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 34,510 3 34,510 3 34,510 3 34,510 12 138,039 3
Potong Beku
117 PRT3542 BK 15,040 45,120 3 45,120 3 45,120 3 45,120 12 180,480 3
Laboratorium
118 PRT3543 BK 15,040 45,120 3 45,120 3 45,120 3 45,120 12 180,480 3
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 366,600 6 366,600 6 366,600 6 366,600 24 1,466,400 9
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 45,120 3 45,120 3 45,120 3 45,120 12 180,480 5
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 244,400 4 244,400 4 244,400 4 244,400 16 977,600 8
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 297,792 36 297,792 36 297,792 36 297,792 144 1,191,168 42
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 51,700 1 51,700 1 51,700 1 51,700 4 206,800 1
( New )
138 PRT3558 BK 8,178 196,272 24 196,272 24 196,272 24 196,272 96 785,088 36
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

806
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 230,300 10 230,300 10 230,300 10 230,300 40 921,200 10
Rawat Inap
145 PRT10086 PCS 2,350 - 20 47,000 - - 20 47,000
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 56,400 - - - 60 56,400
Panjang

154 PRT3584 Surat Keterangan Kematian BK 5,640 - 3 16,920 3 16,920 3 16,920 9 50,760 2

156 PRT3585 Surat Keterangan Rawat BK 5,687 5,687 1 5,687 1 5,687 1 5,687 4 22,748 1
159 PRT11608 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400 1
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

807
Rutin Umum Medis
163 PRT3592 RIM 61,100 - 1 61,100 - - 1 61,100
Rawat
164 PRT3593 RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200 3
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 465,300 300 465,300 300 465,300 300 465,300 1,200 1,861,200 600
167 PRT3597 Tanda Terima Barang BK 7,520 7,520 1 7,520 1 7,520 1 7,520 4 30,080 1
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 122,200 1 61,100 2 122,200 1 61,100 6 366,600 3
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -

808
Rutin Umum Medis
TAHUN 2022
IMC
TW 1 TW 2 TW 3 TW 4 .....
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 710,270 90 710,270 90 710,270 90 710,270 360 2,841,078
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 75,161 300 75,161 300 75,161 300 75,161 1,200 300,643
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 109,610 12 109,610 12 109,610 12 109,610 48 438,438
21 PRT2815 Plastik ½ Kg ( 12 X 25 ) PAK 9,134 54,805 6 54,805 6 54,805 6 54,805 24 219,219

809
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
30 PRT06826 PAK 83,512 83,512 1 83,512 1 83,512 1 83,512 4 334,048
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - -
400Ml
35 PRT2753 BTL 12,292 110,627 9 110,627 9 110,627 9 110,627 36 442,509
( Botol )
36 PRT10961 Sabun Mandi Cair Lifebuoy PCS 9,369 84,321 9 84,321 9 84,321 9 84,321 36 337,284
37 PRT05269 PCS 12,135 145,624 12 145,624 12 145,624 12 145,624 48 582,496
(450Ml)
38 PRT07518 Sabut PCS 3,132 12,527 4 12,527 4 12,527 4 12,527 16 50,107
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
43 PRT05862 Semprotan Botol BH 10,439 31,317 3 31,317 3 31,317 3 31,317 12 125,268
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 205,753 9 205,753 9 205,753 9 205,753 36 823,011
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 30,835 18 30,835 18 30,835 18 30,835 72 123,339
Grand Total RTK 1,860,739 1,860,739 1,860,739 1,860,739 7,442,957

810
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 474,500 - 2 474,500 - 4 949,000
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

811
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 474,500 - 2 474,500 - 4 949,000

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

31 PRT3294 Keset Toilet Pcs 94,900 94,900 1 94,900 1 94,900 1 94,900 4 379,600
35 PRT10277 Kursi Merah Pcs 379,600 759,200 - 2 759,200 - 4 1,518,400
38 PRT10795 Label " Alergi" Merah PCS 711 85,336 120 85,336 120 85,336 120 85,336 480 341,345
39 PRT10795 Label " Dnr" PCS 711 85,336 120 85,336 120 85,336 120 85,336 480 341,345
40 PRT09271 Label "Fall Risk" Yellow PCS 711 85,336 120 85,336 120 85,336 120 85,336 480 341,345

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

812
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 474,500 - 1 474,500 - 2 949,000
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
66 PRT11705 Stamper Besar dan Mortir PCS 94,900 189,800 - 2 189,800 - 4 379,600
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - - 1 142,350 - 1 142,350

70 18,980 - - - - - -
Plastik
72 PRT2786 Tempat Sampah Injak besar PCS 237,250 474,500 - 2 474,500 - 4 949,000
73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 284,700 - 2 284,700 - 4 569,400

75 PRT10957 Unit 237,250 474,500 - 2 474,500 - 4 949,000
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
UMUM MEDIS
2 PRT13608 Ambubag Anak Unt 2,799,550 - 1 2,799,550 - - 1 2,799,550

813
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
3 Ambubag bayi Unt 2,799,550 - - - - - -
4 PRT13190 Ambubag Dewasa Unt 2,799,550 - 1 2,799,550 - - 1 2,799,550
6 PRT08714 Bak Spuit Pcs 56,940 - - 1 56,940 - 1 56,940
9 PRT06795 Bengkok ( Nierbiekken ) Unit 189,800 - - 2 379,600 - 2 379,600
10 PRT13652 Bengkok Besar Unit 237,250 - - 2 474,500 - 2 474,500
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

20 PRT06609 Gelas Ukur 1000 Ml Unit 94,900 - - 1 94,900 - 1 94,900
21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - - 1 284,700 - 1 284,700

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual
36 PRT06316 Manset Monitor Anak PCS 664,300 - 2 1,328,600 - - 2 1,328,600
37 PRT10294 Manset Monitor Bayi PCS 711,750 - 1 711,750 - - 1 711,750

814
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
38 PRT06315 Manset Monitor Dewasa PCS 949,000 - 8 7,592,000 - - 8 7,592,000
39 PRT06317 Manset Monitor Jumbo PCS 1,043,900 - 2 2,087,800 - - 2 2,087,800

44 PRT06713 Penlight PCS 284,700 - 1 284,700 - - 1 284,700
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -
50 PRT09314 Regulator Oksigen Portable Unit 284,700 - - 1 284,700 - 1 284,700

Ring dan Membran
51 PRT10617 pcs 332,150 - - 2 664,300 - 2 664,300
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos
61 PRT13517 Tempat Laringoscope Unt 284,700 - - 2 569,400 - 2 569,400

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
63 PRT11123 Thermometer Non Contact Pcs 901,550 901,550 - - - 1 901,550
65 PRT12582 Unt 1,898,000 1,898,000 - - - 1 1,898,000
Conector)
66 PRT06708 Tiang Infus Unt 949,000 - - 6 5,694,000 - 6 5,694,000

815
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - 1 1,409,265 - - 1 1,409,265
Grand Total Umum Medis 2,799,550 19,582,615 8,503,040 - 30,885,205
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 87,688 6 87,688 6 87,688 6 87,688 24 350,750
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 106,478 6 106,478 6 106,478 6 106,478 24 425,911
( Zamens )
6 PRT2966 PCS 7,307 - - 1 7,307 - 1 7,307
Joyko (Zamens)
7 PRT06232 Batu Baterai L/R 1130 PCS 4,176 - 4 16,702 - - 4 16,702

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 169,112 6 169,112 6 169,112 6 169,112 24 676,447
Energizer
14 PRT13178 PCS 5,741 17,224 3 17,224 3 17,224 3 17,224 12 68,897
( Zamens )
15 PRT04547 PCS 3,654 32,883 9 32,883 9 32,883 9 32,883 36 131,531
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 - - - - - -
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 10,961 3 10,961 3 10,961 3 10,961 12 43,844
( Zamens )

816
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
20 PRT04548 PCS 38,520 - - - - - -
21 PRT2977 Batu Battrey Lr-44 PCS 3,132 9,395 3 9,395 3 9,395 3 9,395 12 37,580
23 PRT2984 Binder Clips No.107 Dus 3,132 3,132 1 3,132 1 3,132 1 3,132 4 12,527
Binder Clips No.155
24 PRT04725 Dus 5,220 5,220 1 5,220 1 5,220 1 5,220 4 20,878
( Zamens )
25 PRT2987 Binder Clips No.200 Dus 10,439 10,439 1 10,439 1 10,439 1 10,439 4 41,756
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 12,527 1 12,527 1 12,527 1 12,527 4 50,107
( ZAMENS )
27 PRT04553 PCS 7,307 131,531 18 131,531 18 131,531 18 131,531 72 526,126
Unique ( Zamens )
28 PRT04717 PCS 6,785 33,927 5 33,927 5 33,927 5 33,927 20 135,707
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 81,424 3 81,424 3 81,424 3 81,424 12 325,697
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 28,185 - 1 28,185 - 2 56,371
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 18,790 9 18,790 9 18,790 9 18,790 36 75,161
Buku Tulis Expedisi
36 PRT04558 PCS 5,741 68,897 12 68,897 12 68,897 12 68,897 48 275,590
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 125,268 12 125,268 12 125,268 12 125,268 48 501,072
38 PRT04557 PCS 5,741 68,897 12 68,897 12 68,897 12 68,897 48 275,590
)
Bussines File Hijau
39 PRT04559 PCS 3,132 37,580 12 37,580 12 37,580 12 37,580 48 150,322
( Zamens )
40 PRT05172 PCS 3,132 37,580 12 37,580 12 37,580 12 37,580 48 150,322
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 37,580 12 37,580 12 37,580 12 37,580 48 150,322
42 PRT3007 Bussines File Warna Merah PCS 3,132 37,580 12 37,580 12 37,580 12 37,580 48 150,322

44 PRT04992 UNT 260,975 - - - - - -
A

817
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 93,951 30 93,951 30 93,951 30 93,951 120 375,804
(Zamens)
59 PRT11126 PCS 1,566 46,976 30 46,976 30 46,976 30 46,976 120 187,902
(Zamens)
61 PRT04562 Cutter A-300 ( Zamens ) PCS 5,220 - - 1 5,220 - 1 5,220

62 PRT3022 Cutter Besar L-500 PCS 11,483 11,483 - - - 1 11,483
63 PRT3023 Devider Bantex 6050 PAK 8,873 26,619 3 26,619 3 26,619 3 26,619 12 106,478
64 PRT04800 PCS 10,439 - 1 10,439 - - 1 10,439
( Zamens )
65 PRT3024 PCS 18,790 - 1 18,790 - - 1 18,790
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)
68 PRT3027 Double Tape Sedang 1 Inc ROL 8,351 16,702 2 16,702 2 16,702 2 16,702 8 66,810

818
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
71 PRT3034 Elevated Tray Susun 3 PCS 76,205 - 1 76,205 - - 1 76,205
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 9,395 - 1 9,395 - 2 18,790
(Zamens)
78 PRT04565 Gunting Kecil ( Zamens ) PCS 6,263 - 1 6,263 - 1 6,263 2 12,527
79 PRT04566 PCS 1,044 3,132 3 3,132 3 3,132 3 3,132 12 12,527
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 1,879 3 1,879 3 1,879 3 1,879 12 7,516
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 3,132 1 3,132 1 3,132 1 3,132 4 12,527
82 PRT04802 PAK 1,827 3,654 2 3,654 2 3,654 2 3,654 8 14,615
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - 1 101,258 - - 1 101,258
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 2,192 6 2,192 6 2,192 6 2,192 24 8,769
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
90 PRT3056 Kartu Stock Besar PAK 29,229 - 1 29,229 - - 1 29,229
91 PRT04572 RIM 39,146 234,878 6 234,878 6 234,878 6 234,878 24 939,510
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 52,195 - 2 52,195 - 4 104,390
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

819
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 18,790 36 18,790 36 18,790 36 18,790 144 75,161
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 12,527 1 12,527 1 12,527 1 12,527 4 50,107
( Zamens )
116 PRT04576 ROL 12,527 - 1 12,527 - - 1 12,527
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - 1 7,307 - - 1 7,307
( Zamens )
118 PRT3096 Lakban Hitam 1,5 “ ROL 10,439 - 1 10,439 - - 1 10,439
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

820
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 56,371 3 56,371 3 56,371 3 56,371 12 225,482
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 325,697 12 325,697 12 325,697 12 325,697 48 1,302,787
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 8,948 1 8,948 1 8,948 1 8,948 4 35,791
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - 2 2,505 - - 2 2,505
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 - 1 3,654 - - 1 3,654

139 PRT3136 Pembolong Besar PCS 46,976 - 1 46,976 - - 1 46,976
140 PRT04584 PCS 9,395 9,395 - - - 1 9,395
( Zamens )
141 PRT3143 PCS 5,220 - - 1 5,220 - 1 5,220
(Zamens)
142 PRT04808 PCS 1,566 - 2 3,132 - - 2 3,132
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 3,262 1 3,262 1 3,262 1 3,262 4 13,049
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
147 PRT06509 Plastik Laminating PCS 835 7,516 9 7,516 9 7,516 9 7,516 36 30,064
148 PRT3151 PCS 731 - - - - - -
17 X 22

821
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
150 PRT04589 Post-It Pronto ( Zamens ) PCS 8,351 50,107 6 50,107 6 50,107 6 50,107 24 200,429
151 PRT3157 Pushpin Pack 3,132 - - - - - -
152 PRT05760 Rautan Pensil (Zamens) PCS 1,566 - 1 1,566 - - 1 1,566
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
161 PRT04591 Selotip 1/2 X 10 ( Zamens ) PCS 1,044 12,527 12 12,527 12 12,527 12 12,527 48 50,107
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 21,922 3 21,922 3 21,922 3 21,922 12 87,688
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 16,961 3 16,961 3 16,961 3 16,961 12 67,845
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 - - 3 12,527 - 3 12,527

169 PRT04596 PCS 31,317 - 1 31,317 - - 1 31,317
( Zamens )
170 PRT3178 Staples Besar Max Hd 50 PCS 52,195 - 1 52,195 - - 1 52,195

822
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 7,307 1 7,307 1 7,307 1 7,307 4 29,229
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 2,320,010 2,639,861 2,329,405 2,215,620 9,504,895
LINEN
2 Apron PVC 68,250 546,000 - - - 8 546,000

823
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
3 Bad Mate 54,600 655,200 - - - 12 655,200
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 780,000 - - - 8 780,000
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 780,000 - - - 8 780,000
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

824
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 1,029,600 - - - 8 1,029,600
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 312,000 - - - 4 312,000
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 668,000 - - - 16 668,000
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 910,000 - - - 8 910,000
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 2,246,400 - - - 16 2,246,400
72 Stike Laken 57,000 912,000 - - - 16 912,000
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 442,000 - - - 8 442,000

825
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 501,545 40 501,545 40 501,545 40 501,545 160 2,006,181
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

826
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 65,800 1 65,800 1 65,800 1 65,800 4 263,200
Intervensi
23 PRT3574 Assesment Pasien Terminal RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
24 PRT3580 RIM 65,800 65,800 1 65,800 1 65,800 1 65,800 4 263,200
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 232,650 3 232,650 3 232,650 3 232,650 12 930,600
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 592,200 9 592,200 9 592,200 9 592,200 36 2,368,800
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

827
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
37 PRT12075 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 51,700 - 1 51,700 - 2 103,400
Operasi
40 PRT11812 Discharge Planing RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200
Resuscitation )
43 Form Indikasi Masuk Icu RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
44 Form Indikasi Masuk Imc RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
45 PRT3459 RIM 31,020 - - - - - -
46 Form Pencatatan Dpjp RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200
47 PRT3458 Form Permintaan Barang BK 8,460 - 1 8,460 - - 1 8,460
48 PRT3461 BK 9,915 9,915 1 9,915 1 9,915 1 9,915 4 39,660
Farmasi
49 PRT3457 Form Spj Ambulance BK 7,520 7,520 1 7,520 1 7,520 1 7,520 4 30,080
50 PRT06087 Form Work Order BK 8,460 25,380 3 25,380 3 25,380 3 25,380 12 101,520
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 592,200 9 592,200 9 592,200 9 592,200 36 2,368,800
Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 17,578 1 17,578 1 17,578 1 17,578 4 70,312
Ultrasonografi
60 PRT3466 RIM 65,800 789,600 12 789,600 12 789,600 12 789,600 48 3,158,400
Keperawatan

828
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
76 PRT3535 Edukasi Harian RIM 61,100 977,600 16 977,600 16 977,600 16 977,600 64 3,910,400
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 131,600 2 131,600 2 131,600 2 131,600 8 526,400
Blue Rs Meilia
87 PRT3506 Laporan Pembedahan RIM 65,800 65,800 1 65,800 1 65,800 1 65,800 4 263,200
89 PRT3509 Lembar Disposisi RIM 51,700 51,700 1 51,700 1 51,700 1 51,700 4 206,800
90 PRT3510 Lembar Konsultasi RIM 65,800 197,400 3 197,400 3 197,400 3 197,400 12 789,600

829
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200
103 PRT3526 Pengajuan Pembedahan RIM 61,100 61,100 - 1 61,100 - 2 122,200
Pengawasan Pasien
105 PRT11606 Transfer / Rujuk Ke Rumah RIM 61,100 - - 1 61,100 - 1 61,100

106 PRT11808 Resiko Jatuh Pada Pasien RIM 65,800 197,400 3 197,400 3 197,400 3 197,400 12 789,600
Anak
107 PRT11811 Resiko Jatuh Pada Pasien RIM 61,100 549,900 9 549,900 9 549,900 9 549,900 36 2,199,600
Dewasa
108 PRT11809 Resiko Jatuh Pada Pasien RIM 65,800 197,400 3 197,400 3 197,400 3 197,400 12 789,600
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )
111 PRT11813 Penundaan Pelayanan RIM 61,100 - - 1 61,100 - 1 61,100

830
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
114 PRT3539 RIM 51,700 - - 1 51,700 - 1 51,700
Sitologi
115 PRT3540 Permintaan Obat/Alkes BK 11,503 34,510 3 34,510 3 34,510 3 34,510 12 138,039
Potong Beku
117 PRT3542 BK 15,040 45,120 3 45,120 3 45,120 3 45,120 12 180,480
Laboratorium
118 PRT3543 BK 15,040 45,120 3 45,120 3 45,120 3 45,120 12 180,480
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 549,900 9 549,900 9 549,900 9 549,900 36 2,199,600
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
127 PRT3548 Pesanan Pulang BK 15,040 75,200 5 75,200 5 75,200 5 75,200 20 300,800
129 PRT3551 Profil Pengobatan Pasien RIM 61,100 488,800 8 488,800 8 488,800 8 488,800 32 1,955,200
Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 347,424 42 347,424 42 347,424 42 347,424 168 1,389,696
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 51,700 1 51,700 1 51,700 1 51,700 4 206,800
( New )
138 PRT3558 BK 8,178 294,408 36 294,408 36 294,408 36 294,408 144 1,177,632
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

831
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 230,300 10 230,300 10 230,300 10 230,300 40 921,200
Rawat Inap
145 PRT10086 PCS 2,350 - 32 75,200 - - 32 75,200
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang

154 PRT3584 Surat Keterangan Kematian BK 5,640 11,280 2 11,280 2 11,280 2 11,280 8 45,120

156 PRT3585 Surat Keterangan Rawat BK 5,687 5,687 1 5,687 1 5,687 1 5,687 4 22,748
159 PRT11608 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 61,100 1 61,100 1 61,100 1 61,100 4 244,400
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

832
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
163 PRT3592 RIM 61,100 - 1 61,100 - - 1 61,100
Rawat
164 PRT3593 RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 930,600 600 930,600 600 930,600 600 930,600 2,400 3,722,400
167 PRT3597 Tanda Terima Barang BK 7,520 7,520 1 7,520 1 7,520 1 7,520 4 30,080
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 183,300 3 183,300 3 183,300 3 183,300 12 733,200
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -

833
Rutin Umum Medis
TAHUN 2022
KEGIATAN INTENSIVE
..... ...... ..... .... TW 1
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - - 5
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 - - - - - - 15
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 - - - - - -
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - - 1

834
Rutin Umum Medis
..... ...... ..... .... TW 1
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - - 1
400Ml
35 PRT2753 BTL 12,292 - - - - - - 1
( Botol )
37 PRT05269 PCS 12,135 - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 - - - - - - 1


835
Rutin Umum Medis
..... ...... ..... .... TW 1
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
4 PRT09402 Alas Kaki / Sendal Nicu Pasang 94,900 - - - - - - 4
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

836
Rutin Umum Medis
..... ...... ..... .... TW 1
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

39 PRT10795 Label " Dnr" PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

837
Rutin Umum Medis
..... ...... ..... .... TW 1
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert

70 18,980 - - - - - -
Plastik

75 PRT10957 Unit 237,250 - - - - - - 5
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
UMUM MEDIS

838
Rutin Umum Medis
..... ...... ..... .... TW 1
3 Ambubag bayi Unt 2,799,550 - - - - - - 1
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - - 4
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

839
Rutin Umum Medis
..... ...... ..... .... TW 1
41 PRT10939 Meteran Badan buah 18,980 - - - - - - 1

44 PRT06713 Penlight PCS 284,700 - - - - - - 1
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

840
Rutin Umum Medis
..... ...... ..... .... TW 1
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 - - - - - -
( Zamens )
6 PRT2966 PCS 7,307 - - - - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 - - - - - - 4
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - -
( Zamens )
17 PRT04546 PCS 4,959 - - - - - -
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

841
Rutin Umum Medis
..... ...... ..... .... TW 1
20 PRT04548 PCS 38,520 - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 - - - - - - 1
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 - - - - - - 3
31 PRT04554 PCS 27,141 - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 - - - - - - 1
( Zamens )
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )

44 PRT04992 UNT 260,975 - - - - - -
A

842
Rutin Umum Medis
..... ...... ..... .... TW 1
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

63 PRT3023 Devider Bantex 6050 PAK 8,873 - - - - - - 4
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

843
Rutin Umum Medis
..... ...... ..... .... TW 1
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
82 PRT04802 PAK 1,827 - - - - - -
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 - - - - - - 1
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

844
Rutin Umum Medis
..... ...... ..... .... TW 1
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664
112 PRT04860 Label Tom & Jerry No.119 LBR 418 - - - - - - 5

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

845
Rutin Umum Medis
..... ...... ..... .... TW 1
122 PRT04721 Lem Stik 15 Gr ( Zamens ) PCS 6,263 - - - - - - 1
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - - - - - - 1
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - -
)

140 PRT04584 PCS 9,395 - - - - - - 1
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

846
Rutin Umum Medis
..... ...... ..... .... TW 1
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - -

169 PRT04596 PCS 31,317 - - - - - -
( Zamens )

847
Rutin Umum Medis
..... ...... ..... .... TW 1
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - - - - - -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
LINEN
2 Apron PVC 68,250 - - - - - -

848
Rutin Umum Medis
..... ...... ..... .... TW 1
3 Bad Mate 54,600 - - - - - -
4 Baju Bayi 22,750 - - - - - - 12
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - - 5
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - -
14 Bedong Bayi 32,500 - - - - - - 12
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - - 9
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

849
Rutin Umum Medis
..... ...... ..... .... TW 1
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - - 5
47 Penutup Inkubator 113,750 - - - - - - 10
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - - 5
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - - 12
55 Restrain 78,000 - - - - - -
56 Rompi Kegiatan 166,260 - - - - - -
57 Sarung bantal bayi 22,750 - - - - - - 12
60 Sarung Batal 41,750 - - - - - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - - 12
64 Sarung Meja mayo 104,000 - - - - - -
67 Sarung tangan bayi 9,750 - - - - - - 12
68 Selimut Polar 113,750 - - - - - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - -
71 Seprei Inkubator (Karet) 48,750 - - - - - - 10
72 Stike Laken 57,000 - - - - - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - - 12
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - -

850
Rutin Umum Medis
..... ...... ..... .... TW 1
LAUNDRY
1 PRT04655 Ec - Chlorine KG 39,227 - - - - - - 1
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
5 PRT04652 Ec - Softener LTR 19,599 - - - - - - 1
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
8 PRT04653 Ec - Super Detergen KG 24,140 - - - - - - 1
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

851
Rutin Umum Medis
..... ...... ..... .... TW 1
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - - - - -
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 - - - - - -
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

852
Rutin Umum Medis
..... ...... ..... .... TW 1
37 PRT12075 RIM 61,100 - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - - 1
Operasi
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
48 PRT3461 BK 9,915 - - - - - -
Farmasi
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - - - - - - 1

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 - - - - - -
Keperawatan

853
Rutin Umum Medis
..... ...... ..... .... TW 1
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - - 1
Tengah
76 PRT3535 Edukasi Harian RIM 61,100 - - - - - - 1
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia

854
Rutin Umum Medis
..... ...... ..... .... TW 1
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
Pengawasan Pasien

Anak
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

855
Rutin Umum Medis
..... ...... ..... .... TW 1
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - - - - 1
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 - - - - - - 2
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - - - -
( New )
138 PRT3558 BK 8,178 - - - - - - 1
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

856
Rutin Umum Medis
..... ...... ..... .... TW 1
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 - - - - - - 1
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - - 4
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang


159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

857
Rutin Umum Medis
..... ...... ..... .... TW 1
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 - - - - - - 38
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -

858
Rutin Umum Medis
TAHUN 2022
NICU
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 13,165 - 5 13,165 - 10 26,330
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 118,378 16 126,270 12 94,703 15 118,378 58 457,729 24
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 - 1 7,777 - 1 7,777 2 15,554 1
8 PRT2833 PCS 251 - - - - - -
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 9,134 1 9,134 1 9,134 1 9,134 4 36,537
25 PRT2821 Plastik 5 Kg ( 30 X 45 ) PAK 15,659 - 1 15,659 - - 1 15,659

859
Rutin Umum Medis
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 17,485 1 17,485 1 17,485 1 17,485 4 69,941 2
400Ml
35 PRT2753 BTL 12,292 12,292 - 1 12,292 1 12,292 3 36,876 1
( Botol )
37 PRT05269 PCS 12,135 - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 22,861 - 1 22,861 - 2 45,723
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 6,852 4 6,852 4 6,852 4 6,852 16 27,409 4
Grand Total RTK 200,168 183,177 176,493 171,919 731,757

860
Rutin Umum Medis
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
4 PRT09402 Alas Kaki / Sendal Nicu Pasang 94,900 379,600 - - - 4 379,600
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

861
Rutin Umum Medis
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

31 PRT3294 Keset Toilet Pcs 94,900 - 1 94,900 - - 1 94,900
39 PRT10795 Label " Dnr" PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

862
Rutin Umum Medis
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

57 PRT11530 Pesawat Telepon Unit 474,500 474,500 - - - 1 474,500
61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - 1 142,350 - - 1 142,350 1

70 18,980 - - - - - -
Plastik

75 PRT10957 Unit 237,250 1,186,250 5 1,186,250 5 1,186,250 - 15 3,558,750 5
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 2,040,350 1,423,500 1,186,250 - 4,650,100
UMUM MEDIS

863
Rutin Umum Medis
3 Ambubag bayi Unt 2,799,550 2,799,550 - - - 1 2,799,550
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 949,000 - 4 949,000 - 8 1,898,000 4
Watt
32 PRT06797 Lampu Buat Laringoscope buah 284,700 - 1 284,700 - - 1 284,700

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

864
Rutin Umum Medis
41 PRT10939 Meteran Badan buah 18,980 18,980 - - - 1 18,980

44 PRT06713 Penlight PCS 284,700 284,700 - - - - 1 284,700
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

865
Rutin Umum Medis
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 4,052,230 569,400 949,000 - 5,570,630
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - 1 14,615 - 1 14,615
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 - 1 17,746 - 1 17,746 2 35,493
( Zamens )
6 PRT2966 PCS 7,307 - - - - - - 1
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 22,966 4 22,966 4 22,966 - 12 68,897
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - 2 3,967 - 2 3,967
( Zamens )
17 PRT04546 PCS 4,959 - 2 9,917 - - 2 9,917 2
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

866
Rutin Umum Medis
20 PRT04548 PCS 38,520 - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 7,307 - 1 7,307 - 2 14,615
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 - 1 2,088 - - 1 2,088

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 5,741 - - - 1 5,741
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - - 1 10,439 - 1 10,439
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 - 3 9,395 - 2 6,263 5 15,659

44 PRT04992 UNT 260,975 - - - - - -
A

867
Rutin Umum Medis
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - - - - - 10
(Zamens)
61 PRT04562 Cutter A-300 ( Zamens ) PCS 5,220 - - - - - - 1

63 PRT3023 Devider Bantex 6050 PAK 8,873 35,493 - 4 35,493 - 8 70,985 5
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - 1 3,654 - - 1 3,654
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

868
Rutin Umum Medis
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
81 PRT3047 Isi Staples Besar M-3 PAK 3,132 - - 1 3,132 - 1 3,132
82 PRT04802 PAK 1,827 - - - - - -
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 39,146 1 39,146 - 1 39,146 3 117,439 1
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

869
Rutin Umum Medis
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664
112 PRT04860 Label Tom & Jerry No.119 LBR 418 2,088 5 2,088 - 5 2,088 15 6,263
113 PRT11609 Label Tom & Jerry No.129 LBR 438 - - - - - - 5

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

870
Rutin Umum Medis
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 18,790 - - - 1 18,790 1
( Zamens )
132 PRT3128 Odner Insert 8523 Foliio PCS 27,141 - - 2 54,283 - 2 54,283
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - - 1
)
137 PRT04583 Paper Clips No.5 ( Zamens ) PAK 3,654 - 1 3,654 - - 1 3,654

140 PRT04584 PCS 9,395 9,395 - - - 1 9,395
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - - 1
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

871
Rutin Umum Medis
149 PRT06233 Post It 7.6 X 7.6 Mm PCS 9,395 - - - 1 9,395 1 9,395
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
161 PRT04591 Selotip 1/2 X 10 ( Zamens ) PCS 1,044 - - - - - - 1
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - -
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 - - - - - - 1

169 PRT04596 PCS 31,317 - - - - - -
( Zamens )

872
Rutin Umum Medis
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - - - - - -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 151,574 122,763 162,848 85,287 522,472
LINEN
2 Apron PVC 68,250 - - - - - -

873
Rutin Umum Medis
3 Bad Mate 54,600 - - - - - -
4 Baju Bayi 22,750 273,000 - - - 12 273,000
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 162,500 - - - 5 162,500
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - -
14 Bedong Bayi 32,500 390,000 - - - 12 390,000
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 877,500 - - - 9 877,500
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

874
Rutin Umum Medis
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 643,500 - - - 5 643,500
47 Penutup Inkubator 113,750 1,137,500 - - - 10 1,137,500
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 243,750 - - - 5 243,750
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 273,000 - - - 12 273,000
55 Restrain 78,000 - - - - - -
56 Rompi Kegiatan 166,260 - - - - - -
57 Sarung bantal bayi 22,750 273,000 - - - 12 273,000
60 Sarung Batal 41,750 - - - - - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 117,000 - - - 12 117,000
64 Sarung Meja mayo 104,000 - - - - - -
67 Sarung tangan bayi 9,750 117,000 - - - 12 117,000
68 Selimut Polar 113,750 - - - - - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - -
71 Seprei Inkubator (Karet) 48,750 487,500 - - - 10 487,500
72 Stike Laken 57,000 - - - - - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 351,000 - - - 12 351,000
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - -

875
Rutin Umum Medis
LAUNDRY
1 PRT04655 Ec - Chlorine KG 39,227 39,227 1 39,227 1 39,227 1 39,227 4 156,907
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
5 PRT04652 Ec - Softener LTR 19,599 19,599 1 19,599 1 19,599 1 19,599 4 78,396 1
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
8 PRT04653 Ec - Super Detergen KG 24,140 24,140 2 48,279 1 24,140 2 48,279 6 144,837 1
9 PRT10927 Parfum LTR 34,485 - - - - - -
Grand Total Laundry 82,965 107,105 82,965 107,105 380,140
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 100,309 7 87,770 7 87,770 7 87,770 29 363,620 7
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

876
Rutin Umum Medis
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - - - - -
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 - 1 65,800 - - 1 65,800 1
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

877
Rutin Umum Medis
37 PRT12075 RIM 61,100 - - 1 61,100 - 1 61,100
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 51,700 - - - 1 51,700
Operasi
40 PRT11812 Discharge Planing RIM 61,100 - 1 61,100 - - 1 61,100
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
48 PRT3461 BK 9,915 - - - - - -
Farmasi
50 PRT06087 Form Work Order BK 8,460 - 1 8,460 - - 1 8,460
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 65,800 - - - 1 65,800

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 - - - - - -
Keperawatan

878
Rutin Umum Medis
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
69 PRT05777 Kecil Hijau ( Tunas Karya LBR 362 - - - - - - 5
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 51,700 1 51,700 1 51,700 1 51,700 4 206,800 1
Tengah
76 PRT3535 Edukasi Harian RIM 61,100 61,100 - - - 1 61,100
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia

879
Rutin Umum Medis
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

97 PRT12724 Monitor Harian RIM 65,800 - - - - - - 1
Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - 1 16,920 - - 1 16,920
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
102 PRT12726 Penempelan Copy Resep RIM 61,100 - - 1 61,100 - 1 61,100
Pengawasan Pasien

Anak
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

880
Rutin Umum Medis
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 61,100 - - - 1 61,100
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
125 PRT3546 Persetujuan Transfusi RIM 61,100 - - 1 61,100 - 1 61,100
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
128 PRT06086 Pesanan Pulang Neonatus BK 15,040 - - - - - - 2

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
135 PRT3556 Resume BK 9,915 - - - - - - 1
Resume Keperawatan
136 PRT3557 RIM 51,700 - 1 51,700 - - 1 51,700
( New )
138 PRT3558 BK 8,178 8,178 1 8,178 1 8,178 1 8,178 4 32,712 1
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

881
Rutin Umum Medis
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 23,030 1 23,030 1 23,030 1 23,030 4 92,120 1
Rawat Inap
145 PRT10086 PCS 2,350 9,400 - 2 4,700 - 6 14,100
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang


159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

882
Rutin Umum Medis
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
166 PRT12542 Tabel Icu Flow Sit LBR 1,551 58,938 38 58,938 38 58,938 38 58,938 152 235,752
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 423,000 443,680 361,900 173,900 1,402,480
Grand Total Biaya Rutin Umum dan Medis 12,396,847 2,937,395 3,007,227 625,981 18,967,449

883
Rutin Umum Medis
TAHUN 2022
PERINA 2
TW 1 TW 2 TW 3 TW 4 .....
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - 5 13,165 - - 5 13,165
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 189,405 23 181,513 26 205,189 25 197,297 98 773,405
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 7,777 - 1 7,777 - 2 15,554
8 PRT2833 PCS 251 - - - - - -
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -

884
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
27 PRT2828 Plastik Klip Obat 10 X 15 PCS 152 - 1 152 - - 1 152
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 34,971 1 17,485 2 34,971 1 17,485 6 104,912
400Ml
35 PRT2753 BTL 12,292 12,292 1 12,292 1 12,292 1 12,292 4 49,168
( Botol )
37 PRT05269 PCS 12,135 - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
41 47,450 - - - - - -
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - -
Young
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - -
50 PRT06124 Stella Aerosol 400Ml BTL 22,861 - 1 22,861 - 1 22,861 2 45,723
57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 6,852 4 6,852 4 6,852 - 12 20,556
Grand Total RTK 251,297 254,321 267,081 249,936 1,022,634

885
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

886
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

35 PRT10277 Kursi Merah Pcs 379,600 - 1 379,600 - - 1 379,600
39 PRT10795 Label " Dnr" PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

887
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

61 non medis Pasang 949,000 - - - - - -
operasi
64 949,000 - - - - - -
Value Allert
69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 142,350 - - - - 1 142,350

70 18,980 - - - - - -
Plastik

75 PRT10957 Unit 237,250 1,186,250 - 5 1,186,250 5 1,186,250 15 3,558,750
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
Grand Total Umum Non Medis 1,328,600 379,600 1,186,250 1,186,250 4,080,700
UMUM MEDIS

888
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - -
15 ELIS KLAMP 1,613,300 - - - - - -

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
28 Gunting verban 711,750 - - - - - -
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 949,000 - 5 1,186,250 - 9 2,135,250
Watt

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual

889
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
Tebal
53 Sendal tertutup 664,300 - - - - - -
55 PRT11092 PAK 1,741,852 - - - - - -
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - -
(Flat) 15Cmx200M
58 PRT07438 Stetoscope Litman Bayi Bh 1,898,000 - 1 1,898,000 - - 1 1,898,000
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)

890
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
Grand Total Umum Medis 949,000 1,898,000 1,186,250 - 4,033,250
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - 1 14,615 - 1 14,615
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 - 1 17,746 - - 1 17,746
( Zamens )
6 PRT2966 PCS 7,307 7,307 - 1 7,307 - 2 14,615
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 - 4 22,966 - 4 22,966 8 45,932
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - 2 3,967 - - 2 3,967
( Zamens )
17 PRT04546 PCS 4,959 9,917 - 2 9,917 - 4 19,834
18 PRT04715 PCS 5,220 - - - - - -
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

891
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
20 PRT04548 PCS 38,520 - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 - 1 7,307 - 1 7,307 2 14,615
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - -
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
31 PRT04554 PCS 27,141 - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 - - - - - -
( Zamens )
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 - 2 6,263 - 2 6,263 4 12,527

44 PRT04992 UNT 260,975 - - - - - -
A

892
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 15,659 - - - 10 15,659
(Zamens)
61 PRT04562 Cutter A-300 ( Zamens ) PCS 5,220 5,220 - - - 1 5,220

63 PRT3023 Devider Bantex 6050 PAK 8,873 44,366 5 44,366 - 5 44,366 15 133,097
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - 1 3,654 - 1 3,654
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

893
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - -
(Zamens)
79 PRT04566 PCS 1,044 - - - - - -
( Zamens )
80 PRT05761 Isi Cutter Kecil (Zamens) PCS 626 - 1 626 - - 1 626
82 PRT04802 PAK 1,827 - - 1 1,827 - 1 1,827
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - -
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
86 PRT3053 Karbon ( Zamens ) PCS 365 731 2 731 2 731 2 731 8 2,923
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 39,146 1 39,146 1 39,146 1 39,146 4 156,585
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

894
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664
113 PRT11609 Label Tom & Jerry No.129 LBR 438 2,192 - 5 2,192 - 10 4,384

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

895
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 18,790 - - - 1 18,790
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 1,253 - 1 1,253 - 2 2,505
)

140 PRT04584 PCS 9,395 - - - - - -
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 1,566 - 1 1,566 - 2 3,132
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

896
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
161 PRT04591 Selotip 1/2 X 10 ( Zamens ) PCS 1,044 1,044 - - - 1 1,044
162 PRT04590 Selotip 1/2 X 72 ( Zamens ) PCS 2,610 - - 1 2,610 - 1 2,610
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - -
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - -
168 PRT04595 Stabilo Warna ( Zamens ) PCS 4,176 4,176 - 1 4,176 - 2 8,351
169 PRT04596 PCS 31,317 - - - - - -
( Zamens )

897
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
189 PRT10189 PCS 140,927 - - - - - -
Cyan


199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - - - - - -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
Grand Total ATK 155,750 147,503 94,838 125,164 523,255
LINEN
2 Apron PVC 68,250 - - - - - -

898
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
3 Bad Mate 54,600 - - - - - -
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - -
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 - - - - - -
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - -
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - -
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - -
20 Duk Pandestill 205 X 325 419,250 - - - - - -
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
35 Jas Operasi 358,150 - - - - - -
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

899
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - -
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - - - - -
56 Rompi Kegiatan 166,260 - - - - - -
60 Sarung Batal 41,750 - - - - - -
61 Sarung C-Arm 175,500 - - - - - -
62 Sarung Couter 55,250 - - - - - -
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
68 Selimut Polar 113,750 - - - - - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - -
72 Stike Laken 57,000 - - - - - -
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - -

900
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
LAUNDRY
1 PRT04655 Ec - Chlorine KG 39,227 - 1 39,227 - - 1 39,227
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
5 PRT04652 Ec - Softener LTR 19,599 19,599 1 19,599 1 19,599 1 19,599 4 78,396
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
8 PRT04653 Ec - Super Detergen KG 24,140 24,140 1 24,140 1 24,140 1 24,140 4 96,558
9 PRT10927 Parfum LTR 34,485 - - - - - -
Grand Total Laundry 43,738 82,965 43,738 43,738 214,181
AIR
MINUM
4 PRT2656 Air Minum Oasis Galon GLN 12,539 87,770 7 87,770 7 87,770 8 100,309 29 363,620
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

901
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - - - - -
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
31 PRT11810 RIM 65,800 65,800 - - - 1 65,800
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

902
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
37 PRT12075 RIM 61,100 - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
48 PRT3461 BK 9,915 - - - - - -
Farmasi
50 PRT06087 Form Work Order BK 8,460 - - 1 8,460 - 1 8,460
51 PRT12722 Formulir Hand Over Pasien RIM 65,800 - 1 65,800 - - 1 65,800

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
57 PRT12723 RIM 61,100 - - - - - -
Dan Kassa
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 - - - - - -
Keperawatan
63 PRT3472 Kardeks Rawat Inap RIM 51,700 - 1 51,700 - - 1 51,700

903
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
69 PRT05777 Kecil Hijau ( Tunas Karya LBR 362 1,810 - 5 1,810 - 10 3,619
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 51,700 1 51,700 1 51,700 1 51,700 4 206,800
Tengah
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia

904
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

97 PRT12724 Monitor Harian RIM 65,800 65,800 - 1 65,800 - 2 131,600
Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - 1 16,920 1 16,920
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
Pengawasan Pasien

Anak
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

905
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - - - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan
128 PRT06086 Pesanan Pulang Neonatus BK 15,040 30,080 - 2 30,080 - 4 60,160

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - -
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - -
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 8,272 - 1 8,272 - 2 16,544
135 PRT3556 Resume BK 9,915 9,915 - - - 1 9,915
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - - - -
( New )
138 PRT3558 BK 8,178 8,178 1 8,178 1 8,178 1 8,178 4 32,712
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

906
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 23,030 1 23,030 1 23,030 1 23,030 4 92,120
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang


159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

907
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -
Grand Total Cetakan 280,095 215,918 212,840 115,338 824,190

908
Rutin Umum Medis
TAHUN 2022
KEGIATAN NICU
..... ...... ..... .... TW 1
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 - - - - - - 30
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
7 PRT05529 Kamper Swallow Gantung PCS 7,777 - - - - - - 3
8 PRT2833 PCS 251 - - - - - -
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 - - - - - - 3

909
Rutin Umum Medis
..... ...... ..... .... TW 1
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - -
400Ml
35 PRT2753 BTL 12,292 - - - - - - 8
( Botol )
37 PRT05269 PCS 12,135 - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
39 PRT11090 Safety Box 5 Liter PCS 17,746 - - - - - - 3
40 RTK Sandal Swallow Pasang 11,388 - - - - - - 10
41 47,450 - - - - - - 4
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 - - - - - - 3
Young
43 PRT05862 Semprotan Botol BH 10,439 - - - - - - 3
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 - - - - - - 4
55 PRT06106 Tali Rapia Besar ROL 15,659 - - - - - - 2


910
Rutin Umum Medis
..... ...... ..... .... TW 1
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
13 non medis Box Coutener 50 liter 142,350 - - - - - - 2
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

911
Rutin Umum Medis
..... ...... ..... .... TW 1
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 - - - - - - 7

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

39 PRT10795 Label " Dnr" PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

912
Rutin Umum Medis
..... ...... ..... .... TW 1
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

58 Rak piring dan gelas 474,500 - - - - - - 1
59 PRT13409 Rak Susun 5 Tingkat Unit 142,350 - - - - - - 2
61 non medis Pasang 949,000 - - - - - - 12
operasi
64 949,000 - - - - - -
Value Allert
68 Tempat linen tertutup 474,500 - - - - - - 1

70 18,980 - - - - - -
Plastik

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
UMUM MEDIS

913
Rutin Umum Medis
..... ...... ..... .... TW 1
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 - - - - - - 1
15 ELIS KLAMP 1,613,300 - - - - - -
17 Forcep Frontal ( Jerapah ) 949,000 - - - - - - 2

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
24 PRT10613 Gunting Aff Heacting Kecil Unt 2,348,775 - - - - - - 2
25 PRT10616 Gunting Benang Unt 2,348,775 - - - - - - 4
26 Gunting jaringan 1,138,800 - - - - - - 6
27 PRT06786 Gunting Kasa buah 379,600 - - - - - - 2
28 Gunting verban 711,750 - - - - - - 4
29 kom kecil 71,175 - - - - - -
31 PRT09490 Unit 237,250 - - - - - -
Watt
33 Lampu Laringoscope 284,700 - - - - - - 6

34 LAMPU SOROT 1,898,000 - - - - - -
35 Pcs 664,300 - - - - - -
stand manual
37 PRT10294 Manset Monitor Bayi PCS 711,750 - - - - - - 2

914
Rutin Umum Medis
..... ...... ..... .... TW 1
38 PRT06315 Manset Monitor Dewasa PCS 949,000 - - - - - - 4
39 PRT06317 Manset Monitor Jumbo PCS 1,043,900 - - - - - - 2

44 PRT06713 Penlight PCS 284,700 - - - - - -
45 pinset anatomis 332,150 - - - - - -
46 Pinset Cirurgis 332,150 - - - - - -

4
49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - - - - - - 6
50 PRT09314 Regulator Oksigen Portable Unit 284,700 - - - - - - 1

Ring dan Membran
51 PRT10617 pcs 332,150 - - - - - -
Stetoskop
52 PRT2762 ( Buat Cssd ) Bahan Busa buah 142,350 - - - - - - 6
Tebal
53 Sendal tertutup 664,300 - - - - - - 4
55 PRT11092 PAK 1,741,852 - - - - - - 2
(Flat) 10Cmx200M
56 PRT11240 PAK 2,552,513 - - - - - - 1
(Flat) 15Cmx200M
59 PRT06709 Unt 1,518,400 - - - - - -
Duos

Thermo Hygro Htc 2
62 PRT09625 Pcs 189,800 - - - - - -
64 PRT09242 Thermometer Ruangan Pcs 189,800 - - - - - - 2
65 PRT12582 Unt 1,898,000 - - - - - -
Conector)
66 PRT06708 Tiang Infus Unt 949,000 - - - - - - 8

915
Rutin Umum Medis
..... ...... ..... .... TW 1
68 PRT06529 Unt 6,263,400 - - - - - -
Tinggi Badan Manual
69 PRT06040 Timer Unit 47,450 - - - - - -
71 PRT09431 Tourniquete Anak buah 284,700 - - - - - - 2
72 PRT04699 Tourniquete Dewasa buah 284,700 - - - - - - 2
73 Trolly Barang 1,423,500 - - - - - -
74 PRT09636 Urinal Unt 1,409,265 - - - - - -
ALAT TULIS KANTOR

1 PRT06495 Acrylic A4 PCS 52,195 - - - - - -
Amplop Coklat Folio
2 PRT05606 PCS 365 - - - - - -
( Zamens )
Amplop Royal No.110
4 PRT04713 PAK 14,615 - - - - - -
( Zamens )
Amplop Royal No.90
5 PRT04542 PAK 17,746 - - - - - -
( Zamens )
6 PRT2966 PCS 7,307 - - - - - -
Joyko (Zamens)

9 ATK PCS 9,490 - - - - - -
Citizen CE (MELLY)
Batu Baterey Sedang
12 PRT2974 PCS 28,185 - - - - - -
Energizer
14 PRT13178 PCS 5,741 - - - - - - 10
( Zamens )
15 PRT04547 PCS 3,654 - - - - - -
( Zamens )
16 PRT04545 PCS 1,983 - - - - - - 5
( Zamens )
17 PRT04546 PCS 4,959 - - - - - -
18 PRT04715 PCS 5,220 - - - - - - 6
( Zamens )
19 PRT04716 PCS 3,654 - - - - - -
( Zamens )

916
Rutin Umum Medis
..... ...... ..... .... TW 1
20 PRT04548 PCS 38,520 - - - - - -

Binder Clips No.155
24 PRT04725 Dus 5,220 - - - - - -
( Zamens )
BINDER CLIPS NO.260
26 PRT04550 Dus 12,527 - - - - - -
( ZAMENS )
27 PRT04553 PCS 7,307 - - - - - -
Unique ( Zamens )
28 PRT04717 PCS 6,785 - - - - - - 9
( Zamens )
29 PRT04552 PCS 1,461 - - - - - -
Merah ( Zamens )
30 PRT2991 Bolpoint Standar R3 PCS 1,461 - - - - - -
31 PRT04554 PCS 27,141 - - - - - -
Warna 15 ( Zamens )
Buku Kwitansi Mini
32 PRT04574 PCS 1,044 - - - - - -
( Zamens )
Buku Register Besar
33 PRT04555 PCS 28,185 - - - - - -
35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 - - - - - - 2

Buku Tulis Expedisi
36 PRT04558 PCS 5,741 - - - - - - 2
( Zamens )
37 PRT04556 Buku Tulis Folio ( Zamens ) PCS 10,439 - - - - - - 11
38 PRT04557 PCS 5,741 - - - - - -
)
Bussines File Hijau
39 PRT04559 PCS 3,132 - - - - - -
( Zamens )
40 PRT05172 PCS 3,132 - - - - - -
( Zamens )
41 PRT3006 Bussines File Warna Biru PCS 3,132 - - - - - - 3

44 PRT04992 UNT 260,975 - - - - - -
A

917
Rutin Umum Medis
..... ...... ..... .... TW 1
45 PRT04765 UNT 182,683 - - - - - -
A
46 PRT05137 UNT 260,975 - - - - - -
A
47 PRT09267 UNT 365,365 - - - - - -
A
48 PRT04463 UNT 182,683 - - - - - -
A
49 PRT06061 Catridge Remanufaktur 12 A UNT 260,975 - - - - - - 1
50 PRT04689 UNT 365,365 - - - - - -
3428
52 PRT12170 UNT 208,780 - - - - - -
310 (Black)
53 PRT12211 UNT 208,780 - - - - - -
311 (Cyan)
54 PRT12212 UNT 208,780 - - - - - -
312 (Yellow)
55 PRT11988 UNT 208,780 - - - - - -
313 (Magenta/Merah)
56 PRT09872 PAK 17,224 - - - - - -
Champion
58 PRT3020 PCS 3,132 - - - - - -
(Zamens)
59 PRT11126 PCS 1,566 - - - - - -
(Zamens)

62 PRT3022 Cutter Besar L-500 PCS 11,483 - - - - - - 1
64 PRT04800 PCS 10,439 - - - - - -
( Zamens )
65 PRT3024 PCS 18,790 - - - - - -
(Zamens)
Double Tape 1/2 In
66 PRT04606 ROL 3,654 - - - - - -
( Zamens )
67 PRT04564 ROL 5,220 - - - - - -
)

918
Rutin Umum Medis
..... ...... ..... .... TW 1
Dvd Rw Verbatim
70 PRT04798 PCS 17,746 - - - - - -
( Zamens )
GANTUNGAN ID CARD
(MIKA)
Gantungan Penunggu
76 PRT07027 PCS 2,088 - - - - - -
Pasien Warna Hijau
Gunting Besar Kenko
77 PRT05049 PCS 9,395 - - - - - - 1
(Zamens)
79 PRT04566 PCS 1,044 - - - - - - 20
( Zamens )
82 PRT04802 PAK 1,827 - - - - - - 4
( Zamens )
83 PRT05503 BOX 12,527 - - - - - -
Mb ( Zamens )
84 PRT05506 PCS 101,258 - - - - - - 1
( Zamens )
85 PRT3050 PCS 140,927 - - - - - -
14
87 PRT3057 PCS 2,088 - - - - - -
Putih
89 PRT07474 PCS 2,088 - - - - - -
Numbering
91 PRT04572 RIM 39,146 - - - - - - 3
( Zamens )
92 PRT04719 RIM 50,107 - - - - - -
Kuning ( Zamens )
Kertas Buram A4
94 PRT04569 RIM 26,098 - - - - - -
( Zamens )
95 PRT05634 RIM 99,171 - - - - - -
( Zamens )
Kertas Fax 210 X 30
96 PRT04571 ROL 17,746 - - - - - -
( Zamens )

919
Rutin Umum Medis
..... ...... ..... .... TW 1
97 PRT04806 RIM 43,322 - - - - - -
Naga ( Zamens )
98 PRT06594 Kertas Glossy 180 Gr LBR 1,305 - - - - - - 60
102 PRT10201 ROL 39,146 - - - - - -
10,2 X 4,8 ( Isi 500 Pcs )

103 PRT11970 ROL 100,214 - - - - - -

104 PRT04624 ROL 67,332 - - - - - -
X 40
105 PRT07524 ROL 68,897 - - - - - -
X 40 (Warna Biru)

106 PRT11366 ROL 51,673 - - - - - -
40X30 Core 1" (1500 Pcs)

107 PRT07409 ROL 90,819 - - - - - -
70X30 Core 1" (1500 Pcs)

108 PRT06043 LBR 522 - - - - - -
(Zamens)
109 PRT12520 LBR 1,253 - - - - - -
Hijau (Zamens)
110 PRT12433 LBR 1,253 - - - - - -
Merah (Zamens)
664

115 PRT04575 ROL 12,527 - - - - - -
( Zamens )
116 PRT04576 ROL 12,527 - - - - - -
( Zamens )
Lakban Hitam 1 In
117 PRT04578 ROL 7,307 - - - - - -
( Zamens )
120 PRT05706 Lem Fox BTL 13,571 - - - - - -

920
Rutin Umum Medis
..... ...... ..... .... TW 1
124 PRT07117 PCS 2,175 - - - - - -
Merah
125 PRT06075 PCS 8,769 - - - - - -
Muda
126 PRT3110 PCS 8,769 - - - - - -
Tua
Map Gantung Bantex
127 PRT3109 PCS 8,769 - - - - - -
Kuning
129 PRT04603 DOS 36,537 - - - - - -
Zamens )
130 PRT10559 Nota / Bon PCS 2,088 - - - - - -
Odner Folio Bindex
131 PRT3122 PCS 18,790 - - - - - -
( Zamens )
Odner Kwitansi Gema
133 PRT3127 PCS 15,137 - - - - - -
( Zamens )
134 PRT3131 PCS 8,948 - - - - - -
Lokal
135 PRT11929 PCS 234,878 - - - - - -
(120X80)
136 PRT04582 PAK 1,253 - - - - - -
)

140 PRT04584 PCS 9,395 - - - - - - 2
( Zamens )
141 PRT3143 PCS 5,220 - - - - - -
(Zamens)
142 PRT04808 PCS 1,566 - - - - - -
Steadler ( Zamens )
Pensil Stadler 2B
144 PRT04585 PCS 3,262 - - - - - -
( Zamens )
146 PRT3150 PCS 141 - - - - - -
– 0.13
148 PRT3151 PCS 731 - - - - - -
17 X 22

921
Rutin Umum Medis
..... ...... ..... .... TW 1
151 PRT3157 Pushpin Pack 3,132 - - - - - -
153 PRT11061 PCS 62,634 - - - - - -
(Zamens)
154 PRT3160 PCS 208,780 - - - - - -
Black
156 PRT07364 PCS 284,700 - - - - - -
1250 E (045102)
159 PRT11156 PCS 664,300 - - - - - -
E
163 PRT06918 Sign Here PCS 20,878 - - - - - -

165 PRT04593 PCS 7,307 - - - - - - 8
( Zamens )
Spidol Kecil Hitam
166 PRT05608 BH 835 - - - - - -
(Zamens)
Spidol White Board

167 PRT04594 PCS 5,654 - - - - - - 15

169 PRT04596 PCS 31,317 - - - - - - 3
( Zamens )

922
Rutin Umum Medis
..... ...... ..... .... TW 1
STEMPEL PT KARYA
178 PRT11560 PCS 62,634 - - - - - -
EMPAT SAUDARA
181 ATK Stempel TBAK 41,756 - - - - - -
188 PRT05767 Tinta Epson 70 Ml Biru PCS 140,927 - - - - - - 1
189 PRT10189 PCS 140,927 - - - - - - 1
Cyan
190 PRT10190 Tinta Epson 70 Ml Magenta PCS 140,927 - - - - - - 1
191 PRT09057 Tinta Epson 70Ml Black PCS 140,927 - - - - - - 1

192 PRT09056 Tinta Epson 70Ml Yellow PCS 140,927 - - - - - - 1
193 ATK Tinta epson LM 70 ml pink 140,927 - - - - - - 1

199 PRT05605 BTL 36,537 - - - - - -
200 PRT05765 BTL 46,976 - - - - - -
201 PRT04810 BTL 7,307 - - - - - -
( Zamens ) Ranap

202 PRT04601 BTL 7,307 - - - - - -

204 PRT04602 BH 4,176 - - - - - -
)
LINEN
1 Alas Meja Operasi 60X200Cm 144,300 - - - - - - 100
2 Apron PVC 68,250 - - - - - -

923
Rutin Umum Medis
..... ...... ..... .... TW 1
3 Bad Mate 54,600 - - - - - -
4 Baju Bayi 22,750 - - - - - -
5 Baju pasien OK 131,300 - - - - - - 56
7 bantal bayi 32,500 - - - - - -
8 Bantal Biasa 97,500 - - - - - -
9 Bantal VVIP 227,500 - - - - - -
10 Barakscort Perlak 68,250 - - - - - - 60
11 Bed Cover Anak 276,250 - - - - - -
12 Bed Cover Dewasa 276,250 - - - - - -
13 Bed Pad 97,500 - - - - - -
14 Bedong Bayi 32,500 - - - - - -
15 Duk L 90 X 125 Cm 141,700 - - - - - - 50
16 Duk Lubang Bulat M 60 X 90 Cm (Csr) 96,200 - - - - - - 50
17 Duk Lubang Mediana 205 X 325 419,250 - - - - - - 30
18 Duk M 96,200 - - - - - -
19 Duk M 60 X 90 Cm (Csr) 93,600 - - - - - - 50
20 Duk Pandestill 205 X 325 419,250 - - - - - - 30
21 Duk Persegi 125 X 125 Cm (Csr) 146,250 - - - - - - 50
23 GORDEN PASIEN 3,800,000 - - - - - -
24 Hacinco 5L 162,500 - - - - - -
25 Hacinco Dan Celana ( L ) 187,200 - - - - - - 75
26 Hacinco Dan Celana ( M ) 187,200 - - - - - - 50
27 Hacinco Dan Celana ( Xl ) 187,200 - - - - - - 75
28 Hacinco Dan Celana ( Xxxxxl / 5 L) 191,750 - - - - - - 20
29 Hacinco L 130,000 - - - - - -
30 Hacinco M 130,000 - - - - - -
31 Hacinco XL 130,000 - - - - - -
32 Handuk Bayi 97,500 - - - - - -
33 Handuk dewasa 97,500 - - - - - -
34 Ikat Kaki/Tangan (All Size) 49,400 - - - - - - 20
35 Jas Operasi 358,150 - - - - - -
36 Jas Operasi Standard/ Cotton Soil Releas 358,150 - - - - - - 100
37 Kerudung OK 29,250 - - - - - -
39 Kimono + Celana L 162,500 - - - - - -
40 Kimono + Celana M 162,500 - - - - - -
41 Kimono + Celana S 162,500 - - - - - -

924
Rutin Umum Medis
..... ...... ..... .... TW 1
42 Kimono + Celana XL 162,500 - - - - - -
43 OPG 128,700 - - - - - -
44 Pembungkus Instrument 2 P-M (Double) 154,050 - - - - - - 30
45 Pembungkus Instrument 21 P-L Double 198,250 - - - - - - 50
46 Pembungkus Instrument 21 P-S Double 6 87,750 - - - - - - 20
48 Perlak 1/2 bed 65,000 - - - - - -
49 Perlak bayi 48,750 - - - - - -
50 Perlak full bed 78,000 - - - - - -
51 Perlak Meja Operasi 280 X 120 156,000 - - - - - - 40
54 Popok bayi 22,750 - - - - - -
55 Restrain 78,000 - - - - - -
56 Rompi Kegiatan 166,260 - - - - - -
58 Sarung Bantal Perlak Pvc 50 X 70 84,500 - - - - - - 20
60 Sarung Batal 41,750 - - - - - -
61 Sarung C-Arm 175,500 - - - - - - 25
62 Sarung Couter 55,250 - - - - - - 40
63 Sarung kaki bayi 9,750 - - - - - -
64 Sarung Meja mayo 104,000 - - - - - -
65 Sarung Meja Mayo 60X80 104,000 - - - - - - 40
66 Sarung Standar Meja Mayo 75 X 140 125,450 - - - - - - 40
68 Selimut Polar 113,750 - - - - - -
69 Sepre Rajal 113,750 - - - - - -
70 Seprei 140,400 - - - - - -
72 Stike Laken 57,000 - - - - - -
73 Tali Pengikat Kamar Bedah 65,000 - - - - - - 20
74 Taplak Meja 97,500 - - - - - -
76 Topi bayi 29,250 - - - - - -
77 Topi Pasien Ok All Size 45,500 - - - - - - 56
78 Topi Tali All Size 47,450 - - - - - - 100
79 Topi Tali OK 47,450 - - - - - -
80 Zeil 55,250 - - - - - -

925
Rutin Umum Medis
..... ...... ..... .... TW 1
LAUNDRY
4 PRT04659 Ec - Pine LTR 24,140 - - - - - -
6 PRT04657 Ec - Sour KG 24,140 - - - - - -
9 PRT10927 Parfum LTR 34,485 - - - - - -
AIR
MINUM
CETAKAN
1 PRT08389 PCS 1,241 - - - - - -
(28 X 38 Cm)
2 PRT3406 PCS 620 - - - - - -
Rs.Meilia
3 PRT3407 PCS 1,410 - - - - - -
Instalasi Radiologi

6 PRT3410 PCS 9,400 - - - - - -
Warna
7 PRT3409 PAK 42,300 - - - - - -
Pemeriksaan
8 PRT3412 PAK 27,260 - - - - - -
Putih )

Asesmen Awal Gawat
11 PRT11607 RIM 65,800 - - - - - -
Darurat Hal 1-2

926
Rutin Umum Medis
..... ...... ..... .... TW 1
Asesmen Awal Gawat
12 PRT11612 RIM 65,800 - - - - - -
Darurat Hal 3-4
Asesmen Awal Gawat
13 PRT11613 RIM 65,800 - - - - - -
Darurat Hal 5-6
15 cetakan RIM 65,800 - - - - - -
dewasa
Asesmen awal medis
17 cetakan RIM 65,800 - - - - - -
dewasa
19 PRT11806 RIM 65,800 - - - - - -
Intervensi
20 cetakan Assesmen pra anestesi RIM 65,800 - - - - - - 1
21 cetakan Assesmen pra bedah RIM 65,800 - - - - - - 1

24 PRT3580 RIM 65,800 - - - - - -
Restrain
25 PRT3417 RIM 51,700 - - - - - -
Test Report
26 PRT3418 BK 77,550 - - - - - -
Pmi
27 PRT3419 LBR 940 - - - - - -
Lahir ( Skl )
Buku Data Pasien
29 PRT06991 BK 4,738 - - - - - -
Hemodialisa
30 PRT12721 Catatan Anestesi / Sedasi LEMBAR 752 - - - - - - 450
31 PRT11810 RIM 65,800 - - - - - - 1
Pasien Terintegrasi
33 PRT3447 Copy Resep BK 5,170 - - - - - -

34 PRT10560 BK 15,040 - - - - - -

35 PRT10561 BK 15,040 - - - - - -

36 PRT10562 BK 15,040 - - - - - -

927
Rutin Umum Medis
..... ...... ..... .... TW 1
37 PRT12075 RIM 61,100 - - - - - -
Pasien (New)
38 PRT3451 BK 23,500 - - - - - -
Mcu
39 PRT3450 RIM 51,700 - - - - - -
Operasi
41 PRT3453 RIM 51,700 - - - - - -
Echo Report
Form Dnr ( Do Not
42 PRT3573 RIM 61,100 - - - - - -
Resuscitation )
45 PRT3459 RIM 31,020 - - - - - -
48 PRT3461 BK 9,915 - - - - - -
Farmasi

Formulir Kesehatan
52 PRT3462 BK 8,178 - - - - - -
Karyawan Ncr 2Ply
53 PRT3463 BK 8,145 - - - - - -
( Model : 1 ) Ranap
54 PRT3464 BK 8,145 - - - - - -
( Model : 2 ) Ok
57 PRT12723 RIM 61,100 - - - - - - 1
Dan Kassa
Keluarga
Hasil Pemeriksaan
59 PRT10680 BK 17,578 - - - - - -
Ultrasonografi
60 PRT3466 RIM 65,800 - - - - - -
Keperawatan

928
Rutin Umum Medis
..... ...... ..... .... TW 1
Kartu Stock Alkes
67 PRT3481 LBR 550 - - - - - -
Kartu Stock Obat
68 PRT3480 LBR 550 - - - - - -
Grafika )
70 PRT04486 RIM 28,200 - - - - - -
Tengah
71 PRT04485 RIM 51,700 - - - - - -
Tengah
77 PRT3488 RIM 98,230 - - - - - -
Meilia”
78 PRT3489 RIM 51,700 - - - - - -
Hitam-Putih
81 PRT07568 PCS 329 - - - - - -
( Warna Kuning )
82 PRT07571 PCS 329 - - - - - -
Warna Putih )
Jambu/Pink )
84 PRT07570 PCS 329 - - - - - -
( Warna Biru )
86 PRT11605 RIM 65,800 - - - - - -
Blue Rs Meilia

929
Rutin Umum Medis
..... ...... ..... .... TW 1
91 PRT3516 Usg,Ecg,Treadmil,Endosco PCS 2,585 - - - - - - 50
py,Ec

93 PRT3517 PCS 19,439 - - - - - -
( Warna Kuning )

Pasien)
99 PRT12725 RIM 65,800 - - - - - -
Dan Keluar
100 PRT3520 BK 16,920 - - - - - -
Lahir
101 PRT3521 LBR 486 - - - - - -
( Hal 1 & 2 )
Pengawasan Pasien

Anak
Dewasa
Geriatri
Penolakan Tindakan
109 PRT11815 RIM 61,100 - - - - - -
Kedokteran
110 PRT3534 RIM 61,100 - - - - - -
( A4 )

930
Rutin Umum Medis
..... ...... ..... .... TW 1
114 PRT3539 RIM 51,700 - - - - - -
Sitologi
Potong Beku
117 PRT3542 BK 15,040 - - - - - -
Laboratorium
118 PRT3543 BK 15,040 - - - - - -
Radiologi
120 PRT3544 RIM 51,700 - - - - - -
Kepada Pihak Ke-3
121 cetakan RIM 65,800 - - - - - -
anestesi
123 PRT11814 RIM 61,100 - - - - - -
Kedokteran
124 PRT3545 RIM 61,100 - - - - - -
Medis
Persetujuan Untuk
126 PRT3547 BK 15,656 - - - - - -
Perawatan

Rencana Asuhan
131 PRT12727 RIM 65,800 - - - - - - 1
Rencana Pasca
132 PRT12728 RIM 61,100 - - - - - - 1
Pembedahan
134 PRT3555 Resep Rawat Jalan BK 8,272 - - - - - -
135 PRT3556 Resume BK 9,915 - - - - - -
Resume Keperawatan
136 PRT3557 RIM 51,700 - - - - - -
( New )
138 PRT3558 BK 8,178 - - - - - -
Uk ½ Folio
Ringkasan Masuk Dan
139 PRT3559 RIM 51,700 - - - - - -

931
Rutin Umum Medis
..... ...... ..... .... TW 1
140 PRT3560 RIM 65,800 - - - - - -

141 PRT3561 RIM 61,100 - - - - - -

144 PRT3564 BK 23,030 - - - - - -
Rawat Inap
145 PRT10086 PCS 2,350 - - - - - -
Medis & Non Medis


149 PRT06341 PCS 282 - - - - - -
Cetak 1/0
150 PRT06506 PCS 940 - - - - - -
Panjang


159 PRT11608 RIM 61,100 - - - - - -
Pasien
160 PRT3589 BK 8,460 - - - - - -
Ply )
161 PRT3590 RIM 61,100 - - - - - -
Permintaan Sendiri
Surat Pernyataan
162 PRT3591 RIM 61,100 - - - - - -

932
Rutin Umum Medis
..... ...... ..... .... TW 1
163 PRT3592 RIM 61,100 - - - - - -
Rawat
164 PRT3593 RIM 61,100 - - - - - -
165 PRT12729 Surgical Safety Checklist RIM 61,100 - - - - - - 1
169 PRT3574 PCS 47 - - - - - -
) Drop Besar
170 PRT3573 PCS 47 - - - - - -
) Drop Kecil
171 PRT3571 PAK 47 - - - - - -
(Putih) Drop Kecil
172 PRT3580 BK 21,973 - - - - - -
Inap
173 RIM 61,100 - - - - - -
Ruangan
174 PRT11604 Triase RIM 129,250 - - - - - -

933
Rutin Umum Medis
TAHUN 2022
KAMAR BEDAH
TW 1 TW 2 TW 3 TW 4 .....
RTK
2 PRT08294 PCS 260,975 - - - - - -
2,25 M
3 PRT2843 PCS 2,633 - - - - - -
(Tissue Kotak)
GELAS MINUM
PASIEN
5 PRT05044 PCS 7,892 236,757 30 236,757 30 236,757 30 236,757 120 947,026
Sleeve Pack
6 PRT05045 ROL 15,085 - - - - - -
Value 16 In 1
8 PRT2833 PCS 251 - - - - - -
9 PRT2835 PAK 12,527 - - - - - -
No.35
10 PRT2837 PAK 12,109 - - - - - -
No.17
11 PRT2836 PAK 12,527 - - - - - -
No.24
14 PRT2711 Karung PCS 1,566 - - - - - -
15 RTK PCS 160 - - - - - -
Box
Label= Obat
8.00017
Pcs)
x 22,5 cm (1
16 RTK PCS 356 - - - - - -
Box = 3.600 Pcs)
17 RTK PCS 64 - - - - - -
Box = 20.000 Pcs
18 RTK Payung Pcs 47,450 - - - - - -
20 PRT2817 Plastik ¼ ( 10 X 20 ) PAK 9,134 - - - - - -
22 PRT2818 Plastik 1 Kg ( 15 X 30 ) PAK 9,134 27,402 3 27,402 3 27,402 3 27,402 12 109,610
23 PRT2819 Plastik 2 Kg ( 20 X 35 ) PAK 18,268 54,805 3 54,805 3 54,805 3 54,805 12 219,219
25 PRT2821 Plastik 5 Kg ( 30 X 45 ) PAK 15,659 15,659 - - - 1 15,659

934
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
30 PRT06826 PAK 83,512 - - - - - -
60X100
31 PRT09092 Pot Bunga PCS 31,317 - - - - - -
33 PRT05532 PCS 1,973 - - - - - -
Gr
34 PRT2755 PCS 17,485 - - - - - -
400Ml
35 PRT2753 BTL 12,292 98,335 8 98,335 8 98,335 8 98,335 32 393,342
( Botol )
37 PRT05269 PCS 12,135 - - - - - -
(450Ml)
38 PRT07518 Sabut PCS 3,132 - - - - - -
40 RTK Sandal Swallow Pasang 11,388 113,880 10 113,880 10 113,880 10 113,880 40 455,520
41 47,450 189,800 - - - 4 189,800
karet
Sarung Tangan Young
42 PRT2762 PSG 43,322 129,966 3 129,966 3 129,966 3 129,966 12 519,862
Young
43 PRT05862 Semprotan Botol BH 10,439 31,317 3 31,317 3 31,317 3 31,317 12 125,268
44 PRT12733 BTL 26,098 - - - - - -
Embun
47 Sepatu bot 237,250 949,000 - - - 4 949,000
55 PRT06106 Tali Rapia Besar ROL 15,659 31,317 2 31,317 2 31,317 2 31,317 8 125,268

Grand Total RTK 1,954,807 800,349 800,349 800,349 4,355,853

935
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
PAKET WELLCOME
4 PRT2856 Sabun PCS 1,045 - - - - - -
5 PRT2855 Sandal PCS 4,859 - - - - - -
7 PRT05527 Washlap PCS 3,658 - - - - - -
UMUM NON MEDIS

2 PRT08247 PCS 1,636 - - - - - -
Pdm 12
3 PRT08248 PCS 1,636 - - - - - -
Pdm 13
13 non medis Box Coutener 50 liter 142,350 284,700 - 2 284,700 - 4 569,400
14 non medis Pcs 189,800 - - - - - -
sampel DARAH KE LAB
15 Dispenser 2,562,300 - - - - - -
16 PRT12904 Ember pcs 237,250 - - - - - -
19 237,250 - - - - - -
Mandi
20 PRT13379 Gunting Pemotong Obat PCS 47,450 47,450 1 47,450 1 47,450 1 47,450 4 189,800
22 PRT08249 PCS 2,923 - - - - - -
Band 7701-49-Pdl
23 PRT08250 PCS 2,923 - - - - - -
Band 7702-49-Pdl

936
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
INTERLOCK SECURITY
24 PRT11243 pcs 5,694 - - - - - -
25 PRT10231 Jam Dinding Unit 237,250 1,660,750 - - - 7 1,660,750

27 PRT2723 Kanebo Pcs 66,430 - - - - - -

39 PRT10795 Label " Dnr" PCS 711 - - - - - -

44 949,000 - - - - - -
kotak, Customized)
46 PRT10976 Lampu Uv PCS 189,800 - - - - - -
50 Meja Snack 2,372,500 - - - - - -
Mini Pc Untuk Mesin

53 PRT13182 Unit 2,348,775 - - - - - -
Mini Pc Untuk Mesin

54 PRT13182 Unit 2,348,775 - - - - - -

937
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
55 PRT13182 Unit 2,348,775 - - - - - -
56 PRT13454 Monitor Unit 1,644,143 - - - - - -

58 Rak piring dan gelas 474,500 474,500 - - - 1 474,500
59 PRT13409 Rak Susun 5 Tingkat Unit 142,350 284,700 - 2 284,700 - 4 569,400
61 non medis Pasang 949,000 11,388,000 - 12 11,388,000 - 24 22,776,000
operasi
64 949,000 - - - - - -
Value Allert
68 Tempat linen tertutup 474,500 474,500 - - - 1 474,500

70 18,980 - - - - - -
Plastik

75 PRT10957 Unit 237,250 - - - - - -
Kamar Mandi
76 UPS buat CCTV PCS 1,423,500 - - - - - -
78 Website 2,847,000 - - - - - -
UMUM MEDIS

938
Rutin Umum Medis
TW 1 TW 2 TW 3 TW 4 .....
3 Ambubag bayi Unt 2,799,550 - - - - - -
6 PRT08714 Bak Spuit Pcs 56,940 - - - - - -
14 Cutiing Loop 1,423,500 1,423,500 1 1,423,500 1 1,423,500 1 1,423,500 4 5,694,000
15 ELIS KLAMP 1,613,300 - - - - - -
17 Forcep Frontal ( Jerapah ) 949,000 1,898,000 - - - 2 1,898,000

21 Gelas Ukur 30ml Pcs 37,960 - - - - - -
23 Gelas Ukur 50ml Pcs 47,450 - - - - - -
24 PRT10613 Gunting Aff Heacting Kecil Unt 2,348,775 4,697,550 - 2 4,697,550 - 4 9,395,100
25 PRT10616 Gunting Benang Unt 2,348,775 9,395,100 -

Rapb Rs. Meilia 2022 - Luna - Perina

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Rapb Rs. Meilia 2022 - Luna - Perina

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ANGGARAN RUTIN UMUM & MEDIS

Anggaran Rs. Meilia 2022

55 PRT06106 Tali Rapia Besar ROL 15,659 - - - - - -

56 Tempat Payung Pcs 284,700 - - - - - -

57 PRT06314 Tissue Roll Kw I Polos PCS 1,713 - - - - - - 99

Anggaran Rs. Meilia 2022

UMUM NON MEDIS

Anggaran Rs. Meilia 2022

25 PRT10231 Jam Dinding Unit 237,250 4 949,000 - - - 4 949,000

28 PRT10487 Keranjang Farmasi (Besar) PCS 28,470 - - - - - -

29 PRT07526 Keranjang Farmasi (Kecil) PCS 9,490 - - - - - -

42 PRT13409 Laci 3 Susun Ukuran Besar Pcs 142,350 - - - - - -

43 PRT13409 Laci 5 Susun Ukuran Kecil Pcs 237,250 - - - - - -

Mini Pc Untuk Mesin

Mini Pc Untuk Mesin

Anggaran Rs. Meilia 2022

56 PRT13454 Monitor Unit 1,644,143 - - - - - -

67 Telepon Portabel 949,000 - - - - - -

68 Tempat linen tertutup 474,500 - - - - - -

69 PRT12988 Tempat Sabun Cuci Tangan Pcs 142,350 - - - - - -

73 PRT07084 Tempat Sampah Injak kecil PCS 142,350 - - - - - -

74 PRT10957 Tempat Tissue Hand Towel pcs 142,350 - - - - - -

Anggaran Rs. Meilia 2022

17 Forcep Frontal ( Jerapah ) 949,000 - - - - - -

18 PRT11704 Gelas Ukur 10 Ml Pcs 47,450 - - - - - -

33 Lampu Laringoscope 284,700 - - - - - -

Anggaran Rs. Meilia 2022

42 PRT06333 Nebulazer Omron Ne-C29 Unt 1,423,500 - - - - - -

43 PRT08142 Over Bed Table Set 1,423,500 - - - - - -

47 Pinset Couter ukuran 20 Cm 569,400 - - - - - -

48 PRT11756 Pinset Panjang Unit 332,150 - - - - - -

49 PRT06174 Regulator Oksigen Dinding Unit 332,150 - - - - - -

50 PRT09314 Regulator Oksigen Portable Unit 284,700 - - - - - -

61 PRT13517 Tempat Laringoscope Unt 284,700 - - - - - -

Anggaran Rs. Meilia 2022

ALAT TULIS KANTOR

8 PRT2978 Batu Baterey 23 A (Zamens) PCS 8,351 - - - - - -

Anggaran Rs. Meilia 2022

22 PRT2981 Batu Battrey Maxell Cr-1616 PCS 3,132 - - - - - -

23 PRT2984 Binder Clips No.107 Dus 3,132 1 3,132 - - - 1 3,132

35 PRT05607 Buku Tulis Biasa ( Zamens ) PCS 2,088 - - - - - -

42 PRT3007 Bussines File Warna Merah PCS 3,132 - - - - - -

43 PRT06441 Casing Cd Oval PCS 1,775 - - - - - -

Anggaran Rs. Meilia 2022

61 PRT04562 Cutter A-300 ( Zamens ) PCS 5,220 - - - - - -

69 PRT12321 Dvd R 16 X Sony PCS 2,923 - - - - - -

Anggaran Rs. Meilia 2022

Anggaran Rs. Meilia 2022

Label Semicoated Uk. 10X5

Label Thermal Transfer 60

Label Thermal Transfer Uk.

Label Thermal Transfer Uk.

Label Tom & Jerry 103

113 PRT11609 Label Tom & Jerry No.129 LBR 438 - - - - - -

114 ATK Label Tom & Jerry No.98 LBR 949 - - - - - -

Anggaran Rs. Meilia 2022

138 PRT06231 Pembatas Besi PCS 10,961 - - - - - -

Anggaran Rs. Meilia 2022

161 PRT04591 Selotip 1/2 X 10 ( Zamens ) PCS 1,044 - - - - - -

163 PRT06918 Sign Here PCS 20,878 - - - - - -

164 PRT04805 Snelhekter Acco ( Zamens ) PAK 9,395 - - - - - -

Spidol White Board