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Ketersedian listrik (24 jamytidak, ada cadangan/tidak) 2. Ketersediaan internet (ya/tidak) SET DAN SKRINING KIT are ‘ALAT YANG TERSEDIA USULANTUMIAR TUMIAWALAT YANG | KONDISIALAT [ALAT YANG Kit Kad [lat ukur tekanan darah [ensimeter a gia) a 2 [rermometer dahi ra 3 Pengukurlingkar pinggang (metine | ry [UNLAH KADER NO. TENIS TENAGA KESEHATAN, TUMIAH, KETERANGAN 1_[ Rader berpendiaikan sampal SMP a z [ainnya TOMUAH KADER TOTAL 248 Mengetahui Kepala Dinas Kesehatan Kabupaten Kubu Raya Wa—— Marlin, S.Pd, Mes SSUPRATMAN. SKM INP. 19660507 198912 1 002 IMP. 19710526 199303 1.006 FORMULIR USULAN ALAT KESEHATAN DAN KONDISI SDM DI PUSKESMAS Provinsi Kalimantan Barat Kabupaten/Kota :Kubu Raya Kecamatan——_: Sungai Raya Kode Puskesmas : 1060203, Puskesmas Sungai Durlan Jenis Perawatan 1} rawat nap 2) non rawatinap a Karakteristik 1) Perkataan, 2) Pedesaan, 3) Terpencl, 4) Sangat Terpencil 2 Keterangan 1. Ketersediaon listrik (24 jam/tidak, ada cadangan/tidak) £1 2. Keterseiaan internet (ya/tidak) ve 3. Juma nakes yang tersdia di puskesmas 69 ASN /52.Non ASN =) Termasuk usulanalat yang dibutubkan untuk kegiatan luar gedung, selain puskesmas pembantu /ALAT KESEHATAN. ove aaro1 Fed ear —| Val soma No NAMA ALAT DI ASPAK. JUMLAH ALATYANG| ‘ALAT YANG ae enseia | (FRFUNGSY/TIPAK | SypurypKaN®) BERFUNGS!) 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E| [Sudip idahlogam / Spatula dah 261 frososoisi6 9 Berfungsi 4 Logam panjang 16,5 cm = 262 [rosso [Sudip/penekan ida Tongue depresser 7 263 [20902046 Syringe Pump i] 364 [uososoioma Tabane Osigen 1 Meterkabi dan 3 eae ae Regulator 263 fiowosone [shinee 6 Mee dn b ees 366 TOOTS [Tabung Sentifus é [Berfonash | 267 [pi7oio1s Habung untuk bls vagina 10 266_|7i707014 ally Counter 5| 269 [21108025 [Tampon tang z [Bertunast a9 [Tang Gigi Anteior dan Premol 270 [10603040 Deena a, Berfunest ao] 271 |106030334ws {Tang Gig Anterior Rahang Atas Dewasa 1 Berfungsi ao 272 {10603033 [Tang Gil Anterior Rehang Bawah Anak 1 Berfunes! x 77 [soso [ang Gigi Molar 3 Rahang Bawah z erunast i 274 [10603035 FTang Gigi Molar Kanan Rahang AtaS + [Berfungst x 275, [10603036 Fang Gigi Molar Kir Raha Aas x Berfungst x 276 |10603081 ae a Mola tabere Fever t |Berfungsi 19) 277 rososse [rang Gig Premolar Rahang Atas z [Bertunest i 276 [10603057 [rang Molar 3 Rahang Aas + Berfungsi 30} 279" [10603047i0d [Tang Molar Rehang Atas Anak 7 [Berfunest ad 7280 [10603042kidi_ [Tang Molar Susu Rehang Atas Anak 1 [Berfunest i oa: [sosox03e i eaiaahaananamiad A bering! aa Je [nosoaeas ne Sar Poveerfoere a er a aS |T06O30Na [Tang Sis Akar Rahang Atos Anak z Berfungst i] 254 [10603043 [Tang Sia Akar Rahang Bawah Anak i Berfungst i 285 0601018 Tangiaikaca mult 2 Berfungs Frempat tidur anak / Pediatric Hospital 226 {20902009 he [Tempat Tidur Priksa dan pall eee [Periengkapannya as [isOTOST [Tensimeter a Berfangs 289 [1801053 [Termometer 1 Berfungst 290 [20901017 [Termometer Anak 3 Berfungs 251 fposo1070 [Termometer Dewara s Berfungst 297 f2oso1011 [Termometer digital 5 Berfungs 293 20801021 [Termometer infant Berfungs 234 {200103 [Termometer kontrol (untuk cooler box) 3 Berfungst 3| 725 [7003056 ang infu 3 Bertungst i 796 200277 Himbangan anal ertungs 297 [10901030 Fimbangan ba 5 [Berfungs x 298 [10901006 [imbangan dewasa z [Berfungst 24] 399 [200778 Himbangan digital (gram) 4 300_[21702053 Himbangen tg a] 301 [10901007 Himbangan Faslen 25 302 [21201066 [ronometerSehiot H [Bertunast 303 [21701015 Hroples Kapas/Kasa Steril z [Berfungsi 304 [10503148 [roriket/Torniquet 22) 305 [10903178 Frorniket Karet = [erfunast 20) 306 [21701018 [romolKasa/ Kain Sten 4 307 [21701014 | Tromol Kasa/kain Steril (125 x 120 mm) 4 208 farmore _ [one aarain ReSOEST 7 ey ‘1 35 TsO [Urine analyzer i Berfunas 310 [21102025 ss 20. 3 Berfungsi 31 |10903156 [Vaccine Carrier] CooTbox 5 Berfungs! 7] 312 |10803155 Waccne Refrigerator 1 Berfungs 313 [31100007 (Vibrator cervical dilators ‘314 [217010125 | Waskom Bengkok i Berfangst 3 315 [21701012¢ |Waskom Cekung. z Berfungs d 316 [71603078 Water Seal Drainage 317 [10102046 Westergren z Berungs 318 [11501050 Ray Film Viewer 319 [1 Sanitarian kit Bertunest 320 [1501023 Femperature logger No JENIS TENAGA KESEHATAN TUMLAH KETERANGAN “L_|Dokter dan/atau doWer spesiais kedokteran keluaga layanan prime SAN 2, PT. 2 Jookter sii JASN 3 [Perawat| 26]ASN 14 NON ASN [Bidan 31]ASN26, NON ASNS fg |TenataFeschatan masyarakat (epidemiolog Kesehatan dan tenaga promosi alasn kesehatan dan mu peril) [Tenaga santas lingkungan ASN, Non ASN 7_|Nutrisionis BIASN A, Non ASN? '8_[Tenaga apoteker dan/atau tenaga toknis kefarmarian Gasn ap 1.asn for Ino [aru GIASN 4 org, Non ASN: Mengetabui, Kepala Dinas Kesehatan Kabupaten Kubu Raya — ae — H. Marian, 5.74 Makes © lara sn ‘up. 19660507 198912 1 002 1710526 198303 1 006

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