DETASEMEN KESEHATAN WILAYAH 12.04.

02
RUMAH SAKIT TK.IV 12.07.03

LAMPIRAN
BERITA ACARA STOK OPNAME BARANG PERSEDIAAN
SUB SATKER RUMKIT TK.IV 12.07.03
NOMOR : BA / 17 / VII / 2022
NILAI
DATA FISIK GUDANG SELISIH
S/D 31 DES 2020
KODE
URAIAN SATUAN KET
BARANG
JUMLAH RUPIAH JUMLAH RP SATUAN (4:3) RUPIAH (5X6) JUMLAH (3-5) RUPIAH (4-7)

1 2 3 4 5 6 7 8 9 10
OBAT CAIR(PERSEDIAAN LAINNYA) Rp -
Gentian Violet Pcs 9 Rp - 0 Rp - Rp - 9 0
Betadine 1L Botol 5 Rp - 0 Rp - Rp - 5 0
Chloramfecort-H Tube 7 Rp - 0 Rp - Rp - 7 0
Amiodaron Inj Ampul 10 Rp - 0 Rp - Rp - 10 0
Anbacin Inj Ampul 8 Rp - 0 Rp - Rp - 8 0
Sevoflurane Botol 2 Rp - 0 Rp - Rp - 2 0
Brainact 500mg Inj Ampul 6 Rp - 0 Rp - Rp - 6 0
Ketamin Inj Vial 2 Rp - 0 Rp - Rp - 2 0
D 40% Inf Botol 19 Rp - 0 Rp - Rp - 19 0
Alkohol 95% Medika 1L Botol 3 Rp - 0 Rp - Rp - 3 0
H2O2 Botol 10 Rp - 0 Rp - Rp - 10 0
Vitamin C 200mg Inj Ampul 506 Rp - 0 Rp - Rp - 506 0
Ventolin Inhaler Pcs 6 Rp - 0 Rp - Rp - 6 0
Ondansetron 4mg Inj Dus 3 Rp - 0 Rp - Rp - 3 0
Pehacain Inj Box 23 Rp - 0 Rp - Rp - 23 0

1 2 3 4 5 6 7 8 9 10
OBAT PADAT(PERSEDIAAN LAINNYA) Rp -
Atorvastatin 20mg Box 5 Rp - 0 Rp - Rp - 5 0
 Fluconazole Box 5 Rp - 0 Rp - Rp - 5 0
Candesartan 16mg Box 6 Rp - 0 Rp - Rp - 6 0
Acarbose 100mg Box 12 Rp - 0 Rp - Rp - 12 0
Clindamycin 150mg Box 9 Rp - 0 Rp - Rp - 9 0
Urdafalk Box 8 Rp - 0 Rp - Rp - 8 0
Irbesartan Box 5 Rp - 0 Rp - Rp - 5 0
Framycetin Sulfate Box 30 Rp - 0 Rp - Rp - 30 0
Hydroxyqhloroquine Sulfate 200mg Dus 37 Rp - 0 Rp - Rp - 37 0
Oralit Box 14 Rp - 0 Rp - Rp - 14 0

1 2 3 4 5 6 7 8 9 10
BHP Rp -
Urgotule Box 10 Rp - 0 Rp - Rp - 10 0
Abocath No.24 Box 2 Rp - 0 Rp - Rp - 2 0
Masker KN 95 Box 4 Rp - 0 Rp - Rp - 4 0
Nurse Cap Box 3 Rp - 0 Rp - Rp - 3 0
Handscoon Steril Uk.8 Pcs 13 Rp - 0 Rp - Rp - 13 0
Handscoon Non Steril Uk.M Box 6 Rp - 0 Rp - Rp - 6 0
Vaseline Swab Box 10 Rp - 0 Rp - Rp - 10 0
ETT Non King No.7 Pcs 3 Rp - 0 Rp - Rp - 3 0
ETT Non King No.3,5 Rusch Pcs 4 Rp - 0 Rp - Rp - 4 0
Fleximed Jackson Rees For Pediatric 1L Pcs 12 Rp - 0 Rp - Rp - 12 0
Incubation Stylet Bayi Pcs 11 Rp - 0 Rp - Rp - 11 0
Fleximed Anethesia Mask Smal Size 01 Pcs 7 Rp - 0 Rp - Rp - 7 0
KOO Anethesia Mask Size 02 Pcs 5 Rp - 0 Rp - Rp - 5 0
Bisturi No.11 Pcs 7 Rp - 0 Rp - Rp - 7 0
Suction Catheter Size 10 Pcs 6 Rp - 0 Rp - Rp - 6 0
Incubation Stylet 6Fs Pcs 5 Rp - 0 Rp - Rp - 5 0
Catgut Chromic 3.0 Box 6 Rp - 0 Rp - Rp - 6 0
ARM Sling S Onemed Box 1 Rp - 0 Rp - Rp - 1 0
Jarum Kulit No.16 Box 2 Rp - 0 Rp - Rp - 2 0
Jarum Kulit No.10 Box 2 Rp - 0 Rp - Rp - 2 0
Masker O2 NRM Pcs 13 Rp - 0 Rp - Rp - 13 0

Operator SAKTI, Apoteker,

Prianto, A.Md.Kep Anna Oktaviyani, S.Farm.,Apt

ASN NIP. 198901202010121006 Sukwan

Mengetahui
Kepala Rumah Sakit Tk.IV 12.07.03,

dr.Abdul Aziz Mubarok,Sp.PD

Kapten Ckm NRP 11080087390680
opr_344383_198901202010121006
 NOMO NILAI
R : BA / URAIAN
S/D 30 JUNI 2020
01 / I / JUMLAH JUMLAH RUPIAH
2021
Jumlah 153,733,155

Keterangan:
1. Persediaan senilai Rp. 0,- dalam kondisi rusak.
2. Persediaan senilai Rp. 0,- dalam kondisi usang.
Disetujui tanggal : Kuasa Pengguna Barang,
Komandan Denkesyah 12 04 01 Sintang
M. Hadi Mulyono,S. Kep, M.Kes Letnan Kolonel Ckm NRP
11950009951271

Keterangan: 76,409,760
1.
Persediaan
senilai Rp.
0,- dalam
kondisi
rusak.
2.
Persediaan
senilai Rp.
0,- dalam
kondisi
usang.
Disetujui
tanggal :
Kuasa
Pengguna
Barang,
Komandan
Denkesyah
12 04 01
Sintang
M. Hadi
Mulyono,S.
Kep, M.Kes
Letnan
Kolonel
Ckm NRP
1195000995
1271

759,000
1,039,500
10,179,000
760,000
4,592,000
570,000
 988,000
195,500
897,000
1,203,500
918,000
1,067,520
864,000
2,775,000
6,926,500
1,059,000
1,120,000
2,656,500
5,999,980
2,969,520
2,316,000
1,481,000
4,332,000
2,110,500
2,163,600
1,018,500
840,000
1,026,200
2,107,500
304,200
3,766,770
3,766,770
3,637,200
165,538,601
3,651,200
10,000
115,320
1,721,265
341,700
829,600
668,710
1,911,000
926,100
2,508,000
5,115,000
3,684,000
5,838,000
684,000
577,500
2,863,000
913,500
840,000
495,000
855,000
1,111,500
5,504,000
3,283,000
72,000
2,033,500
1,060,500
907,500
 330,000
474,000
480,000
88,000
1,140,000
2,400,000
607,500
1,610,000
3,036,000
1,309,000
2,810,600
855,600
3,895,000
4,235,000
2,511,040
370,500
4,587,000
1,205,290
328,800
1,015,200
2,079,000
1,577,000
2,433,500
435,000
1,865,800
126,000
1,698,300
7,965,000
5,610,000
649,800
1,553,250
543,600
973,500
1,560,000
2,509,000
5,230,000
992,380
1,973,400
5,581,450
3,735,000
2,702,000
1,832,386
2,300,000
2,520,000
563,200
637,000
1,085,000
767,200
486,000
1,649,200
2,590,800
2,017,500
192,500
1,341,900
560,250
 747,300
2,479,950
504,000
1,773,600
2,391,600
1,362,060
493,000
2,124,450
1,251,900
266,400
10,658,249
231,000
1,798,000
140,400
1,644,225
1,382,320
28,000
784,000
1,564,500
485,000
590,134
856,920
1,153,750
7,297,520

5,817,020
1,480,500
36,280,662
1,031,412
6,876,000
6,976,000
3,594,600
1,547,160
277,965
508,200
1,395,100
3,934,350
3,934,350
3,934,350
176,550
1,464,625
45 630,000 45

Total 296,184,792

Sersan Dua NRP. 31010255530980

Kepala Kesdam XII/Tanjungpura,

dr. Noerjanto Rahardjo,Sp.PD.FINASIM
Kolonel Ckm NRP. 32994
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00

- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
 - 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00

- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00

- 0 00
- 0 00

- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
- 0 00
### 630,000 00

Sersan Dua NRP. 31000256041279