PR Sipkd

DOKUMEN PELAKSANAAN PERUBAHAN ANGGARAN
NOMOR DPA SKPD
SATUAN KERJA PERANGKAT DAERAH
###
###
#NAME?
Urusan Pemerintahan
: #NAME?
#NAME?
Organisasi
: #NAME?
#NAME?
Program
: #NAME?
#NAME?
Kegiatan
: #NAME?
#NAME?
Lokasi Kegiatan
: #NAME?
Latar belakang perubahan dianggarkan dalam perubahan APBD :
#NAME?
Perubahan Indikator & Tolok Ukur Kinerja Belanja Langsung
Tolok Ukur Kinerja
Indikator
Sebelum Perubahan
Capaian Program
Masukan
Keluaran
Hasil
#NAME?
#NAME?
#NAME?
#NAME?
Setelah Perubahan
#NAME?
#NAME?
#NAME?
#NAME?
Se
#NAME?
Err:509
#NAME?
#NAME?
#NAME?
Rincian Perubahan Anggaran Belanja Langsung Program dan Per Kegiatan Satuan K
Setelah Perubah
Uraian
Rincian Penghitungan
Volume & Satuan
2
6
Kode
Rekening
1
5
BELANJA DAERAH
01
01 02 Honorarium Tim Pengadaan Barang dan Jasa
BELANJA LANGSUNG
BELANJA PEGAWAI
Honorarium PNS
Honor PPK
1orangx2paket
Honor pejabat pengadaan
1orangx2paket
Honor PPHP
1orangx2paket
01 03 Honorarium Tim Pelaksana Kegiatan

HONOR TIM PELAKSANA KEGIATAN
02
02 03 Honor/Upah Kerja
Honorarium Non PNS
Honor upah kerja pendukung sistem IT
2 PAKET
BELANJA BARANG DAN JASA
2orangx3hari
01
Belanja Bahan Pakai Habis
01 01 Belanja Alat Tulis Kantor

Kertas HVS 70 gr
Spidpol Marker
30 rim
10 buah
Amplop putih polosbesar 90
6 dus
Amplop putih polos besar 104
5 dus
Stopmap snailhekter kertas
200 lbr
Stopmap polos plastik
120 lbr
Stopmap polos kertas
5 pak
Odner folio
25 buah
Isi hekter no 10
30 dus
Penghapus tinta
40 dus
Flashdisk 16 gb
6 buah
Bak stampel kecil
12 bh
Spidol whiteboard
24 bh
Spidol board marker
20 bh
Tinta printer black
6 bh
Tinta printer printer warna
6 bh
Tinta stempel
6 btl
CD RW
2 pak
Balpoint
12 pak
Box File
30 pak
Refill tinta printer infusan hitam
4 botol
Refill tinta printer infusan colour
4 botol
Klip paper No 1
11 dus
kl
pembulatan
01 09 Belanja Bahan dan Alat Laboratorium

Mercury (II) Sulfat
btl
HB meter silk isi 25 pc
1 btl
Spirtus 1 liter
1 btl
Stik kolesterol 10 stik
10 pot
HCG test kehamilan 50 pcs
3 bok
Stik gula darah 25 pcs
10 btl
Stik asam urat 25 pcs
10 btl
cairan desinfektan alat lab 1 liter
10 botol
Urine stik 3 parameter 50 pcs
2 btl
Larutan NaCl 0,86 500 ml
5 btl
pembulatan
01 10 Belanja Alat Kedokteran Pakai Habis

ADS 5 ml 20 pcs
5 dus
Bisturi 12 pcs
2 dus
Blood lanset 100 pcs
2 dus
Cut gut cromic 2/0 20 pcs
1 dus
Cut gut crmic 3/0 20 pcs
1 dus
Folley cateter no 18
13 pc
Infus set dewasa
50 pc
Infus set anak
20 pc
Jarum hecting kulit 2 set
24 set
Jarum hecting otot
22 set
Silk 2/0 20 pcs
1 dus
Silk 3/0 20 pcs
1 dus
Spuit 5 ml 100 pcs
3 dus
Spuit 2,5 ml 100 pcs
3 dus
Sopratulle
20 pc
Selang oksigen
3 pc
Urine bag
4 pc
Spuit 10 cc 100 pcs
100 buah
Pembulatan
01 11 Belanja Perlengkapan Medis Pakai Habis

Kapas 250 gr
10 pc
Kassa 16x16 10 pcs
10 dus
Plester 1 inchi x 5m
10 pc
Pot urine kecil
60 pc
Pot dahak
100 pc
Safty box
20 pc
Sarung tangan panjang steril
10 dus
Sarung tangan pendek100 pcs
8 box
Masker N 95
1 box
02
Belanja Bahan/Material
02 04 Belanja Obat-Obatan
Dexamethason 0,5 mg
20,000 btr
Griseovulpin tablet 125 mg
btr
Haloporidol 1,5 mg
btr
Amoxicilin 250 mg
btr
Amoxicillin syrup 120 mg/5 ml
400 btl
Ringer laktat larutan steril
kolf
Paracetamol syrp 120/5 ml
1,000 btl
Kombinasi besi II sulfat 200 mg+ asam folat 0,25mg

Salisil bedak 2% - 50 gr
tab
400 btl
Paracetamol 500 mg
100,000 tab
Amoxicilin 500 mg
100,000 tab
Lidokain inj 2,5 %
350 vial
Simvastatin 10 mg
2,000 tab
Siprofloksasin500mg
tab
Betametason krim 1,5
220 tube
Dimenhidrinat 50 mg
tab
Kodein tab 10 mg
500 tab
Mikonazol kream 2% (nitrat)
150 tube
Vitamin B Complek
10,000 btr
Gentian violet larutan 1% 10 ml

Betason N 2 gr % cream
Eugenol cairan
btl
tube
22 btl
Albendazole
tab
Sefadroksil syrup kering 250mg/ 5 ml
btl
Ibuprofen 400mg
2,400 tab
Kotrimoksazol dewasa 480 mg
5,000 tab
Tetrasiklin HCL 250 mg
4,000 kap
CA Gluconas
Antasi Doen kombinasi 200 mg+Alhidroksida 200mg
Epineprin HCL
amp
4,000 tab
200 vial
Alupurinol 100 mg
3,000 tab
Amlodipin 10 mg
2,400 tab
Nifedipin 10 mg
tab
Ranitidin 150 mg
2,400 tab
Aminopilin 200 mg
Fetamenadion inj 10 mg
Ambroksol tab
tab
500 tab
tab
Ambroksol syrup 15 mg/5 ml
btl
Antalgin 500 mg
tab
Antasid Doen Syrup

Borax gliserin
Gliserin guaikolat syrup
Diazepam 2 mg
200 btl
btl
btl
2,000 tab
Efedrin HCL 25 mg
tab
Fenobarbital 30 mg
tab
fenol gliserol tts telinga
tube
Fetaminadion inj
vial
Gliserin guaikolat 100 mg
tab
Hidrokortison kream 2%
200 tube
Kalsium laktat 500 mg
10,000 tab
Kloramphenikol 250 mg
2,000 kap
Khloramphenikol salep mata
190 tube
Khlorpheniramin maleat4 mg
tab
MgSO4 20 %
vial
Methilergometrin maleat inj 0,125 mg
300 inj
Nistatin tablet 100.000 IU g
600 tab
Obat Batuk Hitam

Oksitetrasiklin HCL salep kulit 3%
Oksitosin inj 10 IU
MetilPrednisolon 5 mg
5,000 tab
Salbutamol 2 mg
4,000 tab
Salep 2-4
200 tube
Serum anti bisa ular
vial
Stesolid supositoria
tube
Tiamin HCL 50 mg
20,000 tab
Ethyl chlorida semprot 100 ml
btl
ETSA
btl
Kalsium hidroksida pasta
btl
Mummifyng pasta
pc
Monoklorkamer Menthol cairan
pc
Temporary stoping flatcher serbuk dan cairan
pc
Acyclofir salep
Acyclofir tablet 40 mg
pembulatan
10,000 tab
tab
tube
3,000 tab
1
Domperidon 10 mg
3,000 tab
Zink tablet dispersibel
2,000 tab
N Asetil sistein 200 mg
2,000 tab
Anti Haemoroid
200 Sup
Omeprazol kap 20 mg
2,000 Kaplet
Asam Mefenamat 500 mg
20,000 tab
Natrium Diklofenak 10 mg
5,000 tab
Kotrimoksazol suspensi 240 mg
300 botol
Metronidazol tablet 500mg
5,000 tab
Furosemid tab 40 mg
3,000 tab
Kaptopril 25 mg
4,000 tab
03
03 06 Belanja Kawat/Faksimili/Internet
Belanja Jasa Kantor
Bayar pulsa internet

paket e Puskesmas + Astinet lite 3 mbps
Biaya pembayaran pulsa astinet
500 vial
5,000 tab
Misoprostol 40 mcg
tube
Pirodeksin HCL 10 mg
Vitaimin c 250 mg
btl
4 bln
1 paket
7 bln
03 12 Belanja Jasa Pelayanan

Jasa Pelayanan Medis (FKTP)
x1orgx12bln
Jasa Pelayanan medis
x1orgx12bln
Jasa Pelayanan Nakes S2 (Bendahara)
x1orgx12bln
Jasa Pelayanan Nakes D3
x10orgx12bln
Jasa Pelayanan Nakes D1 > 10 thn
x3orgx12bln
Jasa Pelayanan Non Nakes < D3
x3orgx12bln
PEMBULATAN
06
Belanja Cetak dan Penggandaan
06 01 Belanja Cetak
Buku KIA Pink
Surat SKS
4 buku
Buku Kohort Ibu
2 buku
Buku Kohort Bayi

Kartu KMS Bayi Biru dan Pink
2 buku
1,000 lbr
Kartu KMS Lansia
300 lbr
Kartu PHBS
500 lbr
Surat SKD
250 buku
4 buku
Kartu Status Ibu hamil
1,385 lbr
Kartu status Pasien
1,000 lbr
Kartu KB
1,500 lbr
06 02 Belanja Penggandaan
Penggandaan laporan
4,200 lbr
penggandaan Program rutin KIA
100 lbr
Penggandaan Pedoman Pengobatan dasar di PKM
500 lbr
Penggandaan formulir Pendataan PHBS
300 lbr
Pembulatan
Penggandaan dokumen pertanggung jawaban keuangan
Jilid Dokumen pertanggung jawaban keuangan
11
11 04 Belanja Makanan dan Minuman Kegiatan
4,000 lbr
30 dok
Belanja Makanan dan Minuman
Snack Konseling Bumil DO ANC ke PKM
6 org
Snack Konseling Bufas DO PNC ke PKM
6 org
snack Konseling Lansia Resti ke PKM
6 org
Snack konseling penderita kusta
6 org
Snack Konseling penderita TBC
5 org
15
Belanja Perjalanan Dinas
15 01 Belanja Perjalanan Dinas Dalam Daerah

Uang harian petugas puskesmas antar kecamatan gol III
x1orgx24bln
Uang harian petugas puskesmas lingkup kecamatan PTT
x1orgxdsx156bln
29
Belanja Jasa Tenaga Ahli/Instruktur/Narasumber
29 01 Belanja Jasa Tenaga Ahli/Instruktur/Narasumber

Honor Tenaga Ahli Pelatihan aplikasi E Puskesmas
10
10 12 Belanja Modal Pengadaan Mesin Absensi
BELANJA MODAL
Belanja Modal Pengadaan Peralatan Kantor
Mesin Absesnsi
2 buah
Biaya instal mesin absensi
2 paket
11
11 07 Belanja Modal Pengadaan Air Conditioner
1orangx4hari
Belanja Modal Pengadaan Perlengkapan Kantor
Pembelian Air Condisiener 1 PK
1 Unit
1 Unit
Biaya Ongkos pemasangan AC
2 unit
11 19 Belanja Modal Pengadaan Papan Nama

Belanja Papan nama
12
12 02 Belanja Modal Pengadaan Komputer/PC
2 buah
Belanja Modal Pengadaan Komputer
komputer PC I 3
2 unit
Honorarium Tim Pengadaan
Honorarium PPK
1 paket
Honorarium tim PP
1 Paket
Honorarium PPHP
1 Paket
12 03 Belanja Modal Pengadaan Komputer Notebook

Laptop IC i5-2450 Ram 2GB,HDD 640GB wind 7 14inc
2 Unit
Honorarium PPK
1orgx1paket
Honorarium PP
1orgx1paket
Honorarium PPHP
1orgx1paket
12 04 Belanja Modal Pengadaan Printer

Pengadaan printer Laser jet
12 10 Belanja Modal Pengadaan Peralatan Jaringan Komputer
2 unit
Acces Point
Kabel UPT cat 6
1 Paket
100 meter
Router
1 Unit
Server
Unit
13
13 01 Belanja Modal Pengadaan Meja Kerja
Belanja Modal Pengadaan Mebeulair
Meja kerja
2 buah
Honorarium PPK
1 Paket
Honorarium PP
1 Paket
Honorarium PPHP
1 paket
13 04 Belanja Modal Pengadaan Kursi Kerja/Kursi Tunggu

Belanja modal kursi tunggu pasien 4 seat
1 unit
13 08 Belanja Modal Pengadaan Sofa

Sofa dengan 3 seeter
1 Buah
Sofa tunggal
1 Buah
Honorarium tim pengadaan
Honorarium PPK
1 Paket
Honorarium PP
1 Paket
Honorarium PPHP
1 Paket
13 09 Belanja Modal Pengadaan Almari Buku, Rak Buku/TV/Kembang

Lemari buku
16
16 03 Belanja Modal Pengadaan Proyektor
1 buah
Belanja Modal Pengadaan Alat-alat Studio
Pengadaan Proyektor Infocus
1 Buah
Pengadaan Layar Proyektor
1 Buah
16 08 Belanja Modal Pengadaan Alat Sound System

Speaker Portabel
19
19 01 Belanja Modal Pengadaan Alat-alat Kedokteran Umum
1 Unit
Belanja Modal Pengadaan Alat-alat Kedokteran
Stetoskop Dewasa
2 bh
Sphygmomanometer dewasa
3 bh
UKS KIT
paket
Tromol sedang
Mortir Obat
1 paket
2 bh
Stand lamp untuk tindakan
1 bh
Lampu Emergency
2 bh
Hecting set
1 set
Bedah minor set
2 set
Termometer dewasa MT-B132F
4 bh
Instrumen troley
bh
Timbangan Dewasa
2 bh
Honorarium PPK
1orangx1paket
Honorarium PP
1orangx1paket
Honorarium PPHP
1orangx1paket
19 02 Belanja Modal Pengadaan Alat-alat Kedokteran Gigi

filling instrumen
set
Cryer
bh
Set tang gigi anterior rahang atas dewasa
1 bh
Set Tang pencabutan dewasa
1 set
handplece straight low speed
1 set
Llight Cure
1 bh
handplece hight speed
bh
Hnorarium PPK
Orang
Honorarium PP
orang
Honorarium PPHP
orang
19 07 Belanja Modal Pengadaan Alat-alat Kedokteran Kebidanan dan Penyakit

Kandungan
Timbangan bayi digital
2 bh
Partus Kit
1 bh
Doplerr SR-100
2 bh
IUD Kit
1 Set
Tempat tidur gynecolog
set
Honorarium PPK
1orangx1paket
Honorarium PP
1orangx1paket
Honorarium PPHP
1orangx1paket
20
Belanja Modal Pengadaan Alat-alat Laboratorium
20 03 Belanja Modal Pengadaan Alat-alat Laboratorium Kimia

HB meter
2 bh
Alat cek kolesterol asam urat dan gula darah
2 set
Jumlah
Rencana Penarikan Dana per Triwulan :
Triwulan I
Rp.
#NAME?
Triwulan II
Rp.
#NAME?
Triwulan III
Rp.
#NAME?
Triwulan IV
Rp.
#NAME?
Jumlah
Rp.
#NAME?
Tim Anggaran Pemerintah Daerah
|
|
No.
Nama
1.
IR. DADANG SOFYAN ISKANDAR,M.Si.
2.
DRS.YAYAT SUPRIATNA,S,B.Sc.F.
3.
MELY KAMELIA, SH.
Jabatan
KABID PEMERINTAHAN DAN PENDAN
KABAG PEMBANGU
KABID ANGGARA
NOMOR DPA SKPD

###
###
Formulir
DPPA-SKPD 2.2.1
#NAME?
Kinerja Belanja Langsung

Target Kinerja
Sebelum Perubahan
Setelah Perubahan
#NAME?
Err:509
#NAME?
#NAME?
#NAME?
Err:509
#NAME?
#NAME?
dan Per Kegiatan Satuan Kerja Perangkat Daerah

Setelah Perubahan
cian Penghitungan
Jumlah (Rp)
Harga Satuan
7
8 = (6 x 7)
Bertambah / (Berkurang)
(Rp)
9=8-5
10
731,640,000
0.00%
731,640,000
0.00%
3,250,000
(50,000)
(1.52%)
2,650,000
(650,000)
(19.70%)
1,750,000
(1,550,000)
(46.97%)
400,000
800,000
(800,000)
(50.00%)
300,000
600,000
(600,000)
(50.00%)
175,000
350,000
(150,000)
(30.00%)
900,000
900,000
900,000
900,000
600,000
600,000
600,000
600,000
600,000
600,000
597,434,000
(14,610,000)
(2.39%)
450,000
100,000
25,468,000
(17,335,000)
(40.50%)
11,406,000
(44,000)
(0.38%)
40,000
1,200,000
(200,000)
(14.29%)
10,000
100,000
(87,500)
(46.67%)
19,000
114,000
12,360
12.16%
17,000
85,000
30,550
56.11%
1,000
200,000
25,000
14.29%
4,500
540,000
120,000
28.57%
82,000
410,000
(565,000)
(57.95%)
25,000
625,000
190,000
43.68%
5,000
150,000
112,500
300.00%
10,000
400,000
154,000
62.60%
150,000
900,000
90,000
11.11%
26,000
312,000
13,200
4.42%
10,000
240,000
(81,750)
(25.41%)
10,000
200,000
75,000
60.00%
136,000
816,000
0.00%
160,000
960,000
0.00%
23,500
141,000
0.00%
166,000
332,000
0.00%
27,000
324,000
25,200
8.43%
34,000
1,020,000
0.00%
265,000
1,060,000
0.00%
300,000
1,200,000
0.00%
7,000
77,000
42,900
125.81%
(460)
(100.00%)
460
4,652,000
2,501,000
(5,768,000)
(55.36%)
(2,501,000)
(100.00%)
669,000
669,000
(1,338,000)
(66.67%)
50,000
50,000
0.00%
125,000
1,250,000
(1,000,000)
(44.44%)
200,000
600,000
(600,000)
(50.00%)
65,000
650,000
0.00%
65,000
650,000
0.00%
7,000
70,000
(98,000)
(58.33%)
231,000
462,000
(231,000)
(33.33%)
50,200
251,000
0.00%
6,430,000
(5,558,000)
(46.36%)
260,000
(368,320)
(58.62%)
52,000
120,000
240,000
(480,000)
(66.67%)
301,000
602,000
(903,000)
(60.00%)
552,000
552,000
(2,210,700)
(80.02%)
774,000
774,000
(774,430)
(50.01%)
29,000
377,000
3,900
1.05%
9,000
450,000
(400,700)
(47.10%)
8,000
160,000
(35,750)
(18.26%)
20,000
480,000
0.00%
20,000
440,000
0.00%
140,000
140,000
0.00%
140,000
140,000
0.00%
150,000
450,000
0.00%
150,000
450,000
0.00%
25,000
500,000
11,000
2.25%
25,000
75,000
0.00%
10,000
40,000
(100,000)
(71.43%)
3,000
300,000
(300,000)
(50.00%)
2,980,000
(5,965,000)
(66.69%)
24,000
240,000
(336,000)
(58.33%)
51,000
510,000
(1,920,000)
(79.01%)
11,000
110,000
(418,000)
(79.17%)
700
42,000
(42,000)
(50.00%)
2,500
250,000
(350,000)
(58.33%)
31,000
620,000
(1,240,000)
(66.67%)
43,500
435,000
(494,000)
(53.18%)
45,500
364,000
(756,000)
(67.50%)
409,000
409,000
(409,000)
(50.00%)
73,502,000
(12,213,000)
(14.25%)
73,502,000
(12,213,000)
(14.25%)
1,020,000
(612,000)
(37.50%)
219
51
(525,600)
(100.00%)
69
(55,200)
(100.00%)
211
(1,519,200)
(100.00%)
2,410
964,000
7,500
3,000
3,000,000
42
83,800
9.52%
(2,700,000)
(100.00%)
(337,598)
(10.11%)
(504,000)
(100.00%)
1,200
480,000
30,000
6.67%
105
10,500,000
8,898,000
555.43%
267
26,700,000
21,804,000
445.34%
990
346,500
145,140
72.08%
170
340,000
(65,600)
(16.17%)
(611,745)
(100.00%)
167,400
91.78%
(124,800)
(100.00%)
(280,000)
(46.67%)
255
1,590
349,800
104
640
320,000
3,800
570,000
(150,000)
(20.83%)
140
1,400,000
(1,168,000)
(45.48%)
2,610
(626,400)
(100.00%)
9,950
(1,194,000)
(100.00%)
20,900
59,792
14.95%
338
459,800
(1,352,000)
(100.00%)
5,895
(707,400)
(100.00%)
150
360,000
2,400
0.67%
175
875,000
(1,807,000)
(67.38%)
187
748,000
(436,000)
(36.82%)
(804,000)
(100.00%)
6,700
75
300,000
(1,500,000)
(83.33%)
3,000
600,000
114,000
23.46%
105
315,000
5,400
1.74%
150
360,000
(432,000)
(54.55%)
(240,000)
(100.00%)
100
150
360,000
(72,000)
(16.67%)
(216,000)
(100.00%)
(360,800)
(47.42%)
(684,000)
(100.00%)
2,880
(691,200)
(100.00%)
148
(3,552,000)
(100.00%)
(569,760)
(54.28%)
(864,000)
(100.00%)
(1,411,200)
(100.00%)
199,200
197.62%
78
(187,200)
(100.00%)
73
(116,800)
(100.00%)
1,580
(189,600)
(100.00%)
1,879
(563,700)
(100.00%)
34
(544,000)
(100.00%)
(686,000)
(52.93%)
90
800
400,000
114
2,400
480,000
3,600
5,880
150
300,000
3,050
610,000
80
800,000
(136,000)
(14.53%)
370
740,000
(1,036,000)
(58.33%)
2,100
399,000
(951,000)
(70.44%)
(483,600)
(100.00%)
31
3,100
(372,000)
(100.00%)
3,100
930,000
712,800
328.18%
860
516,000
416,448
418.32%
1,975
(1,185,000)
(100.00%)
1,834
(484,176)
(100.00%)
2,200
1,100,000
(2,500,000)
(69.44%)
140
700,000
76,000
12.18%
230
1,150,000
598,000
108.33%
98
392,000
156,800
66.67%
3,500
700,000
129,500
22.70%
524,600
(6,295,200)
(100.00%)
26,040
(546,840)
(100.00%)
844,342
73.06%
131,250
(4,331,250)
(100.00%)
248,325
(1,489,950)
(100.00%)
265,200
(1,591,200)
(100.00%)
95,000
(285,000)
(100.00%)
60,000
(360,000)
(100.00%)
95,000
(380,000)
(100.00%)
1,233,900
463.70%
(3,168,000)
(100.00%)
100
150
2,000,000
1,500,000
12,000
7,800
(2,340,000)
(100.00%)
410
1,230,000
(680,400)
(35.62%)
900
900
497
123.33%
150
450,000
450,000
600
1,200,000
1,200,000
500
1,000,000
1,000,000
3,600
720,000
720,000
190
380,000
380,000
125
2,500,000
2,500,000
185
925,000
925,000
2,470
741,000
741,000
130
650,000
650,000
100
300,000
300,000
80
320,000
320,000
450,824,000
9,440,000
2.14%
11,840,000
9,440,000
393.33%
200,000
800,000
(1,600,000)
(66.67%)
2,955,000
2,955,000
2,955,000
1,155,000
8,085,000
8,085,000
438,984,000
0.00%
4,337,921
52,055,052
0.00%
3,330,296
39,963,552
0.00%
2,715,470
32,585,640
0.00%
1,793,235
215,188,200
0.00%
1,508,903
54,320,508
0.00%
1,246,418
44,871,048
0.00%
11,010,000
(502,000)
(4.36%)
9,045,000
(1,102,000)
(10.86%)
12,000
3,000,000
144,000
5.04%
20,000
80,000
(60,000)
(42.86%)
60,000
120,000
0.00%
60,000
120,000
0.00%
1,000
1,000,000
(191,000)
(16.04%)
1,200
360,000
0.00%
800
400,000
(400,000)
(50.00%)
20,000
80,000
(80,000)
(50.00%)
1,000
1,385,000
185,000
15.42%
1,000
1,000,000
(1,500,000)
(60.00%)
1,000
1,500,000
800,000
114.29%
1,965,000
600,000
43.96%
150
630,000
0.00%
150
15,000
0.00%
150
75,000
0.00%
150
45,000
0.00%
150
600,000
300,000
100.00%
20,000
600,000
300,000
100.00%
5,130,000
0.00%
5,130,000
0.00%
15,000
1,080,000
0.00%
15,000
1,080,000
0.00%
15,000
1,080,000
0.00%
15,000
990,000
0.00%
15,000
900,000
0.00%
25,500,000
0.00%
25,500,000
0.00%
250,000
6,000,000
0.00%
125,000
19,500,000
0.00%
6,000,000
6,000,000
6,000,000
6,000,000
6,000,000
6,000,000
130,956,000
14,660,000
12.61%
5,300,000
5,300,000
5,300,000
5,300,000
2,300,000
4,600,000
4,600,000
350,000
700,000
700,000
10,325,000
10,325,000
7,925,000
7,925,000
3,575,000
3,575,000
3,575,000
3,350,000
3,350,000
3,350,000
500,000
1,000,000
1,000,000
2,400,000
2,400,000
2,400,000
2,400,000
42,975,000
14,475,000
50.79%
16,875,000
8,875,000
110.94%
16,000,000
8,000,000
100.00%
1,500,000
1,200,000
8,000,000
400,000
400,000
400,000
300,000
300,000
300,000
175,000
175,000
175,000
18,000,000
0.00%
17,175,000
0.00%
8,587,500
400,000
400,000
0.00%
300,000
300,000
0.00%
125,000
125,000
0.00%
5,000,000
2,500,000
100.00%
5,000,000
2,500,000
100.00%
3,100,000
3,100,000
2,500,000
600,000
600,000
600,000
10,000
1,000,000
1,000,000
1,500,000
1,500,000
1,500,000
32,638,000
32,638,000
10,911,000
10,911,000
10,036,000
10,036,000
5,018,000
400,000
400,000
400,000
300,000
300,000
300,000
175,000
175,000
175,000
4,617,000
4,617,000
4,617,000
4,617,000
12,565,000
12,565,000
6,818,000
6,818,000
6,818,000
4,872,000
4,872,000
4,872,000
4,617,000
400,000
400,000
400,000
300,000
300,000
300,000
175,000
175,000
175,000
4,545,000
4,545,000
4,545,000
4,545,000
8,670,000
8,670,000
5,700,000
5,700,000
4,900,000
4,900,000
4,900,000
800,000
800,000
800,000
2,970,000
2,970,000
2,970,000
2,970,000
28,448,000
(52,848,000)
(65.01%)
12,254,000
(25,420,000)
(67.47%)
415,000
830,000
(2,075,000)
(71.43%)
1,650,000
4,950,000
(3,300,000)
(40.00%)
(9,750,000)
(100.00%)
4,545,000
2,970,000
9,750,000
175,000
175,000
(525,000)
(75.00%)
52,000
104,000
(104,000)
(50.00%)
570,000
570,000
(570,000)
(50.00%)
300,000
600,000
0.00%
450,000
450,000
(900,000)
(66.67%)
1,500,000
3,000,000
0.00%
50,000
200,000
(250,000)
(55.56%)
(7,496,000)
(100.00%)
3,748,000
250,000
500,000
(500,000)
(50.00%)
400,000
400,000
0.00%
300,000
300,000
0.00%
175,000
175,000
50,000
40.00%
5,019,000
(10,303,000)
(67.24%)
3,250,000
(6,500,000)
(100.00%)
901,000
(901,000)
(100.00%)
560,000
560,000
0.00%
418,000
418,000
(418,000)
(50.00%)
541,000
541,000
(541,000)
(50.00%)
3,500,000
3,500,000
0.00%
559,000
(1,118,000)
(100.00%)
400,000
(400,000)
(100.00%)
300,000
(300,000)
(100.00%)
125,000
(125,000)
(100.00%)
11,175,000
(17,125,000)
(60.51%)
925,000
1,850,000
(4,625,000)
(71.43%)
4,000,000
4,000,000
(4,000,000)
(50.00%)
1,000,000
2,000,000
(5,000,000)
(71.43%)
2,500,000
2,500,000
0.00%
3,500,000
(3,500,000)
(100.00%)
400,000
400,000
0.00%
300,000
300,000
0.00%
125,000
125,000
0.00%
2,600,000
(3,900,000)
(60.00%)
2,600,000
(3,900,000)
(60.00%)
650,000
1,300,000
(3,250,000)
(71.43%)
650,000
1,300,000
(650,000)
(33.33%)
0.00%
731,640,000
#NAME?
#NAME?
#NAME?
#NAME?
#NAME?
intah Daerah
Jabatan
EMERINTAHAN DAN PENDANAAN PEMBANGUNAN

KABAG PEMBANGUNAN
KABID ANGGARAN
Tanda Tangan
BELANJA DAERAH
BELANJA LANGSUNG
BELANJA PEGAWAI
Honorarium PNS
Honorarium Tim Pengadaan Barang dan Jasa
Honor PPK
Honor pejabat pengadaan
Honor PPHP
Honorarium Tim Pelaksana Kegiatan

HONOR TIM PELAKSANA KEGIATAN
Honorarium Non PNS

Honor/Upah Kerja
Honor upah kerja pendukung sistem IT
BELANJA BARANG DAN JASA
Belanja Bahan Pakai Habis

Belanja Alat Tulis Kantor
Kertas HVS 70 gr
Spidpol Marker
Amplop putih polosbesar 90
Amplop putih polos besar 104
Stopmap snailhekter kertas
Stopmap polos plastik
Stopmap polos kertas
Odner folio
Isi hekter no 10
Penghapus tinta
Flashdisk 16 gb
Bak stampel kecil
Spidol whiteboard
Spidol board marker
Tinta printer black
Tinta printer printer warna
Tinta stempel
CD RW
Balpoint
Box File
Refill tinta printer infusan hitam
Refill tinta printer infusan colour
Klip paper No 1
pembulatan
Belanja Bahan dan Alat Laboratorium

Mercury (II) Sulfat
HB meter silk isi 25 pc
Spirtus 1 liter
Stik kolesterol 10 stik
HCG test kehamilan 50 pcs
Stik gula darah 25 pcs
Stik asam urat 25 pcs
cairan desinfektan alat lab 1 liter
Urine stik 3 parameter 50 pcs
Larutan NaCl 0,86 500 ml
pembulatan
Belanja Alat Kedokteran Pakai Habis

ADS 5 ml 20 pcs
Bisturi 12 pcs
Blood lanset 100 pcs
Cut gut cromic 2/0 20 pcs
Cut gut crmic 3/0 20 pcs
Folley cateter no 18
Infus set dewasa
Infus set anak
Jarum hecting kulit 2 set
Jarum hecting otot
Silk 2/0 20 pcs
Silk 3/0 20 pcs
Spuit 5 ml 100 pcs
Spuit 2,5 ml 100 pcs
Sopratulle
Selang oksigen
Urine bag
Spuit 10 cc 100 pcs
Pembulatan
Belanja Perlengkapan Medis Pakai Habis

Kapas 250 gr
Kassa 16x16 10 pcs
Plester 1 inchi x 5m
Pot urine kecil
Pot dahak
Safty box
Sarung tangan panjang steril
Sarung tangan pendek100 pcs
Masker N 95
Belanja Bahan/Material
Belanja Obat-Obatan
Dexamethason 0,5 mg
Griseovulpin tablet 125 mg
Haloporidol 1,5 mg
Amoxicilin 250 mg
Amoxicillin syrup 120 mg/5 ml
Ringer laktat larutan steril
Paracetamol droop 120/5 ml
Kombinasi besi II sulfat 200 mg+ asam folat 0,25mg
Salisil bedak 2% - 50 gr
Paracetamol 500 mg
Amoxicilin 500 mg
Lidokain inj 2,5 %

Simvastatin 10 mg
Siprofloksasin500mg
Betametason krim 1,5
Dimenhidrinat 50 mg
Kodein tab 10 mg
Mikonazol kream 2% (nitrat)
Vitamin B Complek
Gentian violet larutan 1% 10 ml
Betason N 2 gr % cream
Eugenol cairan
Albendazole
Sefadroksil syrup kering 250mg/ 5 ml
Ibuprofen 400mg
Kotrimoksazol dewasa 480 mg
Tetrasiklin HCL 250 mg
CA Gluconas
Antasi Doen kombinasi 200 mg+Alhidroksida 200mg
Epineprin HCL
Alupurinol 100 mg
Amlodipin 10 mg
Nifedipin 10 mg
Ranitidin 150 mg
Aminopilin 200 mg
Fetamenadion inj 10 mg
Ambroksol tab
Ambroksol syrup 15 mg/5 ml
Antalgin 500 mg
Antasid Doen Syrup
Borax gliserin
Gliserin guaikolat syrup
Diazepam 2 mg
Efedrin HCL 25 mg
Fenobarbital 30 mg
fenol gliserol tts telinga
Fetaminadion inj
Gliserin guaikolat 100 mg
Hidrokortison kream 2%
Kalsium laktat 500 mg
Kloramphenikol 250 mg
Khloramphenikol salep mata
Khlorpheniramin maleat4 mg
MgSO4 20 %
Methilergometrin maleat inj 0,125 mg
Nistatin tablet 100.000 IU g
Obat Batuk Hitam

Oksitetrasiklin HCL salep kulit 3%
Oksitosin inj 10 IU
Pirodeksin HCL 10 mg
MetilPrednisolon 5 mg
Salbutamol 2 mg
Salep 2-4
Serum anti bisa ular
Stesolid supositoria
Tiamin HCL 50 mg
Ethyl chlorida semprot 100 ml
ETSA
Kalsium hidroksida pasta
Mummifyng pasta
Monoklorkamer Menthol cairan
Temporary stoping flatcher serbuk dan cairan
Vitaimin c 250 mg
Misoprostol 40 mcg
Acyclofir salep
Acyclofir tablet 40 mg
pembulatan
Domperidon 10 mg
Zink tablet dispersibel
N Asetil sistein 200 mg
Anti Haemoroid
Omeprazol kap 20 mg
Asam Mefenamat 500 mg
Natrium Diklofenak 10 mg
Kotrimoksazol suspensi 240 mg
Metronidazol tablet 500mg
Furosemid tab 40 mg
Kaptopril 25 mg
Belanja Jasa Kantor

Belanja Kawat/Faksimili/Internet
Bayar pulsa internet
paket e Puskesmas + Astinet lite 3 mbps
Biaya pembayaran pulsa astinet
Belanja Jasa Pelayanan

Jasa Pelayanan Medis (FKTP)
Jasa Pelayanan medis
Jasa Pelayanan Nakes S2 (Bendahara)
Jasa Pelayanan Nakes D3
Jasa Pelayanan Nakes D1 > 10 thn

Jasa Pelayanan Non Nakes < D3
PEMBULATAN
Belanja Cetak dan Penggandaan

Belanja Cetak
Buku KIA Pink
Surat SKS
Buku Kohort Ibu
Buku Kohort Bayi
Kartu KMS Bayi Biru dan Pink
Kartu KMS Lansia
Kartu PHBS
Surat SKD
Kartu Status Ibu hamil
Kartu status Pasien
Kartu KB
Belanja Penggandaan
Penggandaan laporan
penggandaan Program rutin KIA
Penggandaan Pedoman Pengobatan dasar di PKM
Penggandaan formulir Pendataan PHBS
Pembulatan
Penggandaan dokumen pertanggung jawaban keuangan
Jilid Dokumen pertanggung jawaban keuangan
Belanja Makanan dan Minuman

Belanja Makanan dan Minuman Kegiatan
Snack Konseling Bumil DO ANC ke PKM
Snack Konseling Bufas DO PNC ke PKM
snack Konseling Lansia Resti ke PKM
Snack konseling penderita kusta
Snack Konseling penderita TBC
Belanja Perjalanan Dinas

Belanja Perjalanan Dinas Dalam Daerah
Uang harian petugas puskesmas antar kecamatan gol III
Uang harian petugas puskesmas lingkup kecamatan PTT

Honor Tenaga Ahli Pelatihan aplikasi E Puskesmas
BELANJA MODAL
Belanja Modal Pengadaan Peralatan Kantor

Belanja Modal Pengadaan Mesin Absensi
Mesin Absesnsi
Biaya instal mesin absensi
Belanja Modal Pengadaan Perlengkapan Kantor

Belanja Modal Pengadaan Air Conditioner
Biaya Ongkos pemasangan AC
Belanja Modal Pengadaan Papan Nama

Belanja Papan nama
Belanja Modal Pengadaan Komputer

Belanja Modal Pengadaan Komputer/PC
komputer PC I 3
Honorarium PPK
Honorarium tim PP
Honorarium PPHP
Belanja Modal Pengadaan Komputer Notebook

Laptop IC i5-2450 Ram 2GB,HDD 640GB wind 7 14inc
Honorarium PPK
Honorarium PP
Honorarium PPHP
Belanja Modal Pengadaan Printer

Pengadaan printer Laser jet
Belanja Modal Pengadaan Peralatan Jaringan Komputer
Acces Point
Kabel UPT cat 6
Router
Server
Belanja Modal Pengadaan Mebeulair

Belanja Modal Pengadaan Meja Kerja
Meja kerja
Honorarium PPK
Honorarium PP
Honorarium PPHP
Belanja Modal Pengadaan Kursi Kerja/Kursi Tunggu

Belanja modal kursi tunggu pasien 4 seat
Belanja Modal Pengadaan Sofa

Sofa dengan 3 seeter
Sofa tunggal
Honorarium tim pengadaan
Honorarium PPK
Honorarium PP
Honorarium PPHP
Belanja Modal Pengadaan Almari Buku, Rak Buku/TV/Kembang

Lemari buku
Belanja Modal Pengadaan Alat-alat Studio

Belanja Modal Pengadaan Proyektor
Pengadaan Proyektor Infocus
Pengadaan Layar Proyektor
Belanja Modal Pengadaan Alat Sound System

Speaker Portabel
Belanja Modal Pengadaan Alat-alat Kedokteran

Belanja Modal Pengadaan Alat-alat Kedokteran Umum
Stetoskop Dewasa
Sphygmomanometer dewasa
UKS KIT
Tromol sedang
Mortir Obat
Stand lamp untuk tindakan

Lampu Emergency
Hecting set
Bedah minor set
Termometer dewasa MT-B132F
Instrumen troley
Timbangan Dewasa
Honorarium PPK
Honorarium PP
Honorarium PPHP
Belanja Modal Pengadaan Alat-alat Kedokteran Gigi

filling instrumen
Cryer
Set tang gigi anterior rahang atas dewasa
Set Tang pencabutan dewasa
handplece straight low speed
Llight Cure
handplece hight speed
Hnorarium PPK
Honorarium PP
Honorarium PPHP
Belanja Modal Pengadaan Alat-alat Kedokteran Kebidanan dan Penyakit

Kandungan
Timbangan bayi digital
Partus Kit
Doplerr SR-100
IUD Kit
Tempat tidur gynecolog
Honorarium PPK
Honorarium PP
Honorarium PPHP
Belanja Modal Pengadaan Alat-alat Laboratorium

Belanja Modal Pengadaan Alat-alat Laboratorium Kimia
HB meter
Alat cek kolesterol asam urat dan gula darah
1orangx4paket
400,000
1orangx4paket
300,000
1orangx4paket
125,000
40 rim
35,000
30 buah
6,250
6 dus
16,940
5 dus
10,890
200 lbr
875
120 lbr
3,500
12 pak
81,250
20 buah
21,750
30 dus
1,250
40 dus
6,150
6 buah
135,000
12 bh
24,900
3 lusin
107,250
20 bh
6,250
6 bh
136,000
6 bh
160,000
6 btl
23,500
2 pak
166,000
12 pak
24,900
30 pak
34,000
4 botol
265,000
4 botol
300,000
11 dus
3,100
1 kl
460
1 btl
2,501,000
3 btl
669,000
1 btl
50,000
18 pot
125,000
6 bok
200,000
10 btl
65,000
10 btl
65,000
24 botol
7,000
3 btl
231,000
5 btl
50,200
12 dus
52,360
6 dus
120,000
5 dus
301,000
5 dus
552,540
2 dus
774,215
13 pc
28,700
181 pc
4,700
30 pc
6,525
24 set
20,000
22 set
20,000
1 dus
140,000
1 dus
140,000
3 dus
150,000
3 dus
150,000
20 pc
24,450
3 pc
25,000
4 pc
35,000
200 buah
3,000
24 pc
24,000
48 dus
50,625
48 pc
11,000
120 pc
700
240 pc
2,500
60 pc
31,000
40 dus
23,225
10 box
112,000
2 box
409,000
24,000 btr
68
2,400 btr
219
800 btr
69
7,200 btr
211
360 btl
2,445
360 kolf
7,500
2,321 btl
1,438
12,000 tab
360 btl
42
1,250
18,000 tab
89
18,000 tab
272
240 vial
839
2,400 tab
169
2,399 tab
255
120 tube
1,520
1,200 tab
104
1,200 tab
500
240 tube
3,000
24,000 btr
107
240 btl
2,610
120 tube
9,950
24 btl
16,667
4,000 tab
120 btl
338
5,895
2,400 tab
149
18,000 tab
149
8,000 kap
148
120 amp
6,700
24,000 tab
60 vial
75
8,100
3,600 tab
86
2,400 tab
330
2,400 tab
100
3,600 tab
120
2,400 tab
90
1,200 tab
634
6,000 tab
114
240 btl
24,000 tab
2,880
148
360 btl
2,916
240 btl
3,600
240 btl
5,880
2,400 tab
42
2,400 tab
78
1,600 tab
73
120 tube
1,580
300 vial
1,879
16,000 tab
300 tube
34
4,320
12,000 tab
78
4,800 kap
370
300 tube
4,500
15,600 tab
120 vial
31
3,100
1,200 tab
181
204 tab
488
600 btl
1,975
264 tube
1,834
300 vial
12,000
24,000 tab
26
6,000 tab
92
2,400 tab
98
163 tube
3,500
12 vial
524,600
21 tube
26,040
11,914 tab
97
33 btl
131,250
6 btl
248,325
6 btl
265,200
3 pc
95,000
6 pc
60,000
4 pc
95,000
10 box
26,610
264 tab
12,000
300 tube
7,800
2,388
800
403
x12bln
200,000
x1orgx12bln
4,337,921
x1orgx12bln
3,330,296
x1orgx12bln
2,715,470
x10orgx12bln
1,793,235
x3orgx12bln
1,508,903
x3orgx12bln
1,246,418
238 buku
12,000
7 buku
20,000
2 buku
60,000
2 buku
60,000
1,191 lbr
1,000
300 lbr
1,200
1,000 lbr
800
8 buku
20,000
1,200 lbr
1,000
2,500 lbr
1,000
700 lbr
1,000
4,200 lbr
150
100 lbr
150
500 lbr
150
300 lbr
150
2,000 lbr
150
15 dok
20,000
6 org
15,000
6 org
15,000
6 org
15,000
6 org
15,000
5 org
15,000
x1orgx24bln
250,000
x1orgxdsx156bln
125,000
1 unit
8,000,000
2 Unit
8,587,500
1orgx1paket
400,000
1orgx1paket
300,000
1orgx1paket
125,000
1 unit
2,500,000
7 bh
415,000
5 bh
1,650,000
1 paket
9,750,000
4 paket
175,000
4 bh
52,000
2 bh
570,000
2 bh
300,000
3 set
450,000
2 set
1,500,000
9 bh
50,000
2 bh
3,748,000
4 bh
250,000
1orangx1paket
400,000
1orangx1paket
300,000
1orangx1paket
125,000
2 set
3,250,000
1 bh
901,000
1 bh
560,000
2 set
418,000
2 set
541,000
1 bh
3,500,000
2 bh
559,000
1Orangx1paket
400,000
1orangx1paket
300,000
1orangx1paket
125,000
7 bh
925,000
2 bh
4,000,000
7 bh
1,000,000
1 Set
2,500,000
1 set
3,500,000
1orangx1paket
400,000
1orangx1paket
300,000
1orangx1paket
125,000
7 bh
650,000
3 set
650,000
731,640,000
731,640,000
3,300,000
3,300,000
3,300,000
1,600,000 1orangx2paket
400,000
1,200,000 1orangx2paket
300,000
500,000 1orangx2paket
175,000
612,044,000
2 PAKET
450,000
2orangx3hari
100,000
42,803,000
11,450,000
1,400,000
30 rim
40,000
187,500
10 buah
10,000
101,640
6 dus
19,000
54,450
5 dus
17,000
175,000
200 lbr
1,000
420,000
120 lbr
4,500
975,000
5 pak
82,000
435,000
25 buah
25,000
37,500
30 dus
5,000
246,000
40 dus
10,000
810,000
6 buah
150,000
298,800
12 bh
26,000
321,750
24 bh
10,000
125,000
20 bh
10,000
816,000
6 bh
136,000
960,000
6 bh
160,000
141,000
6 btl
23,500
332,000
2 pak
166,000
298,800
12 pak
27,000
1,020,000
30 pak
34,000
1,060,000
4 botol
265,000
1,200,000
4 botol
300,000
34,100
11 dus
7,000
460
kl
460
2,501,000
btl
2,501,000
2,007,000
1 btl
669,000
50,000
1 btl
50,000
2,250,000
10 pot
125,000
1,200,000
3 bok
200,000
650,000
10 btl
65,000
650,000
10 btl
65,000
168,000
10 botol
693,000
2 btl
231,000
251,000
5 btl
50,200
5 dus
52,000
10,420,000
7,000
11,988,000
628,320
720,000
2 dus
120,000
1,505,000
2 dus
301,000
2,762,700
1 dus
552,000
1,548,430
1 dus
774,000
373,100
13 pc
29,000
850,700
50 pc
9,000
195,750
20 pc
8,000
480,000
24 set
20,000
440,000
22 set
20,000
140,000
1 dus
140,000
140,000
1 dus
140,000
450,000
3 dus
150,000
450,000
3 dus
150,000
489,000
20 pc
25,000
75,000
3 pc
25,000
140,000
4 pc
10,000
600,000
100 buah
3,000
576,000
10 pc
24,000
2,430,000
10 dus
51,000
528,000
10 pc
11,000
84,000
60 pc
700
600,000
100 pc
2,500
1,860,000
20 pc
31,000
8,945,000
929,000
10 dus
43,500
1,120,000
8 box
45,500
818,000
1 box
409,000
85,715,000
85,715,000
1,632,000
20,000 btr
51
525,600
btr
219
55,200
btr
69
1,519,200
btr
211
400 btl
2,410
2,700,000
880,200
kolf
7,500
3,337,598
1,000 btl
3,000
504,000
450,000
tab
400 btl
42
1,200
1,602,000
100,000 tab
105
4,896,000
100,000 tab
267
201,360
350 vial
990
405,600
2,000 tab
170
611,745
tab
182,400
220 tube
124,800
tab
104
600,000
500 tab
640
150 tube
3,800
720,000
2,568,000
626,400
10,000 btr
255
1,590
140
btl
2,610
1,194,000
tube
9,950
400,008
22 btl
20,900
1,352,000
tab
338
707,400
btl
5,895
357,600
2,400 tab
150
2,682,000
5,000 tab
175
1,184,000
4,000 kap
187
804,000
1,800,000
amp
4,000 tab
6,700
75
486,000
200 vial
309,600
3,000 tab
3,000
105
792,000
2,400 tab
150
240,000
tab
100
432,000
2,400 tab
150
216,000
tab
90
760,800
500 tab
800
684,000
tab
114
691,200
btl
2,880
3,552,000
tab
148
1,049,760
200 btl
2,400
btl
3,600
btl
5,880
864,000
1,411,200
100,800
2,000 tab
150
187,200
tab
78
116,800
tab
73
189,600
tube
1,580
563,700
vial
1,879
544,000
tab
34
1,296,000
200 tube
3,050
936,000
10,000 tab
80
1,776,000
2,000 kap
370
1,350,000
190 tube
2,100
483,600
tab
31
372,000
vial
3,100
217,200
300 tab
3,100
99,552
600 tab
860
1,185,000
484,176
3,600,000
btl
1,975
tube
1,834
500 vial
2,200
624,000
5,000 tab
140
552,000
5,000 tab
230
235,200
4,000 tab
98
570,500
200 tube
3,500
6,295,200
vial
524,600
546,840
tube
26,040
1,155,658
20,000 tab
4,331,250
btl
131,250
1,489,950
btl
248,325
1,591,200
btl
265,200
285,000
pc
95,000
360,000
pc
60,000
380,000
pc
95,000
266,100
10,000 tab
3,168,000
100
150
tab
12,000
2,340,000
tube
7,800
1,910,400
3,000 tab
410
900
3,000 tab
150
2,000 tab
600
2,000 tab
500
200 Sup
3,600
403
2,000 Kaplet
190
20,000 tab
125
5,000 tab
185
300 botol
2,470
5,000 tab
130
3,000 tab
100
4,000 tab
80
441,384,000
2,400,000
2,400,000
4 bln
200,000
1 paket
2,955,000
7 bln
1,155,000
52,055,052
x1orgx12bln
4,337,921
39,963,552
x1orgx12bln
3,330,296
32,585,640
x1orgx12bln
2,715,470
215,188,200 x10orgx12bln
1,793,235
438,984,000
54,320,508
x3orgx12bln
1,508,903
44,871,048
x3orgx12bln
1,246,418
11,512,000
10,147,000
2,856,000
250 buku
12,000
140,000
4 buku
20,000
120,000
2 buku
60,000
120,000
2 buku
60,000
1,000 lbr
1,000
360,000
300 lbr
1,200
800,000
500 lbr
800
1,191,000
4 buku
20,000
1,200,000
160,000
1,385 lbr
1,000
2,500,000
1,000 lbr
1,000
700,000
1,500 lbr
1,000
630,000
4,200 lbr
150
15,000
100 lbr
150
75,000
500 lbr
150
45,000
300 lbr
150
300,000
4,000 lbr
150
300,000
30 dok
20,000
1,080,000
6 org
15,000
1,080,000
6 org
15,000
1,080,000
6 org
15,000
990,000
6 org
15,000
900,000
5 org
15,000
x1orgx24bln
250,000
1,365,000
5,130,000
5,130,000
25,500,000
25,500,000
6,000,000
19,500,000x1orgxdsx156bln
125,000
1orangx4hari
1,500,000
2 buah
2,300,000
2 paket
350,000
116,296,000
1 Unit
3,575,000
1 Unit
3,350,000
2 unit
500,000
2 buah
1,200,000
2 unit
8,000,000
28,500,000
8,000,000
8,000,000
1 paket
400,000
1 Paket
300,000
1 Paket
175,000
18,000,000
17,175,000
2 Unit
8,587,500
400,000
1orgx1paket
400,000
300,000
1orgx1paket
300,000
125,000
1orgx1paket
125,000
2,500,000
2,500,000
2 unit
2,500,000
1 Paket
600,000
100 meter
10,000
1 Unit
1,500,000
Unit
2 buah
5,018,000
1 Paket
400,000
1 Paket
300,000
1 paket
175,000
1 unit
4,617,000
1 Buah
6,818,000
1 Buah
4,872,000
1 Paket
400,000
1 Paket
300,000
1 Paket
175,000
1 buah
4,545,000
1 Buah
4,900,000
1 Buah
800,000
1 Unit
2,970,000
81,296,000
37,674,000
2,905,000
2 bh
415,000
8,250,000
3 bh
1,650,000
9,750,000
paket
9,750,000
700,000
1 paket
175,000
208,000
2 bh
52,000
1,140,000
1 bh
570,000
600,000
2 bh
300,000
1,350,000
1 set
450,000
3,000,000
2 set
1,500,000
450,000
4 bh
50,000
7,496,000
bh
3,748,000
1,000,000
2 bh
250,000
400,000
300,000
175,000
15,322,000
6,500,000
set
3,250,000
901,000
bh
901,000
560,000
1 bh
560,000
836,000
1 set
418,000
1,082,000
1 set
541,000
3,500,000
1 bh
3,500,000
1,118,000
bh
559,000
400,000
Orang
400,000
300,000
orang
300,000
125,000
orang
125,000
28,300,000
6,475,000
2 bh
925,000
8,000,000
1 bh
4,000,000
7,000,000
2 bh
1,000,000
2,500,000
1 Set
2,500,000
3,500,000
set
3,500,000
400,000
300,000
125,000
6,500,000
6,500,000
4,550,000
2 bh
650,000
1,950,000
2 set
650,000

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DOKUMEN PELAKSANAAN PERUBAHAN ANGGARAN

NOMOR DPA SKPD

SATUAN KERJA PERANGKAT DAERAH

01 02 Honorarium Tim Pengadaan Barang dan Jasa

Honor pejabat pengadaan

01 03 Honorarium Tim Pelaksana Kegiatan

Honorarium Non PNS

Honor upah kerja pendukung sistem IT

BELANJA BARANG DAN JASA

Belanja Bahan Pakai Habis

01 01 Belanja Alat Tulis Kantor

Amplop putih polosbesar 90

Amplop putih polos besar 104

Stopmap snailhekter kertas

Stopmap polos plastik

Stopmap polos kertas

Bak stampel kecil

Spidol board marker

Tinta printer black

Tinta printer printer warna

Refill tinta printer infusan hitam

Refill tinta printer infusan colour

01 09 Belanja Bahan dan Alat Laboratorium

HB meter silk isi 25 pc

Stik kolesterol 10 stik

HCG test kehamilan 50 pcs

Stik gula darah 25 pcs

Stik asam urat 25 pcs

cairan desinfektan alat lab 1 liter

Urine stik 3 parameter 50 pcs

Larutan NaCl 0,86 500 ml

01 10 Belanja Alat Kedokteran Pakai Habis

Blood lanset 100 pcs

Cut gut cromic 2/0 20 pcs

Cut gut crmic 3/0 20 pcs

Infus set dewasa

Infus set anak

Jarum hecting kulit 2 set

Jarum hecting otot

Silk 2/0 20 pcs

Silk 3/0 20 pcs

Spuit 5 ml 100 pcs

Spuit 2,5 ml 100 pcs

Spuit 10 cc 100 pcs

01 11 Belanja Perlengkapan Medis Pakai Habis

Kassa 16x16 10 pcs

Pot urine kecil

Sarung tangan panjang steril

Sarung tangan pendek100 pcs

Griseovulpin tablet 125 mg

Amoxicillin syrup 120 mg/5 ml

Ringer laktat larutan steril

Paracetamol syrp 120/5 ml

Kombinasi besi II sulfat 200 mg+ asam folat 0,25mg

Lidokain inj 2,5 %

Betametason krim 1,5

Mikonazol kream 2% (nitrat)

Gentian violet larutan 1% 10 ml

Sefadroksil syrup kering 250mg/ 5 ml

Kotrimoksazol dewasa 480 mg

Tetrasiklin HCL 250 mg

Ambroksol syrup 15 mg/5 ml

Antasid Doen Syrup