PERMOHONAN PEMBEKALAN ITEM BUKAN UBAT LP MARCH 2017 ( UNTUK PENGGUNAAN APRIL & MEI 2017)

BIL ITEM CODE PHIS ITEM BUNGKUSAN KUANTITI DIPES

1 F2200010001.02 Alcohol Swab/Wipes (individual pack) box of 100's 25

2 P1050460001.01 Apron Plastic, Disposable (Large) pack of 100'S 1

3 D2150040001.01 Blood Pressure Cuff, Adult Sz L each

4 D2150040002.00 Blood Pressure Cuff, Adult Sz XL each

5 D2150040004.00 Blood Pressure Cuff, Paediatric each

6 B1200070008.01 Catheter Foley 2 Way Balloon Size 10 Fg.5cc pack of 10's 2

7 B1200070007.01 Catheter Foley 2 Way Balloon Size 12 Fg.30cc pack of 10's 2

8 B1200000004.00 Catheter, Close Suction System, Size 6 pack of 50's 10

9 B1200000003.01 Catheter, Close Suction System, Size 10 pack of 50's 10

10 G1820070001.02 Chinese Paper pack of 15 kg 2

11 N1360040001.01 Chlorhexidine Dressing Sz: 10cm x 10cm (4" x 4") (BACTIGRASS) box of 10's 30

12 G1340070434.00 Condom Free Size pack of 144's 8

13 N1360400002.01 Dressing Retention Rolls (Non Woven, Adhesive) Sz: 10cm x 10m (HYPAFIX) each 20

14 N1360100003.00 Dressing Retention Sheet (Non Woven, Adhesive) Sz: 5cm x 10m (HYPAFIX) each 20

15 D1390010002.00 ECG Electrode, Adult pack of 50's 2

16 D1390130006.00 ECG Electrode, Disposable, Paediatric pack of 50's 1

17 D1490130002.00 ECG Gel/Jelly (Bottle) bottle of 260g 20

18 G1820130034.00 ECG Paper, 50mm x 30m x 16mm (KENZ) pack of 10 roll

19 G1820130039.00 ECG Paper, Fukuda Denshi, Size: 63mm x 30mm x 17mm pack of 10 roll

20 N1840130002.00 Elastic Adhesive Wound Plaster, Size 19mm x 65mm pack of 100's

21 N1480190001.00 Gauze Absorbent 90cm x 100M, White roll 51

22 P1520190001.00 Glove Surgical Sterile, Powder Free, Sz 6 box of 50's 1

23 P1520190002.00 Glove Surgical Sterile, Powder Free, Sz 6.5 box of 50's 3

24 P1520190003.00 Glove Surgical Sterile, Powder Free, Sz 7 box of 50's 1

25 P1520190004.00 Glove Surgical Sterile, Powder Free, Sz 7.5 box of 50's

26 P1520190005.00 Glove Surgical Sterile, Powder Free, Sz 8 box of 50's

27 B1010000001.02 Injection Stopper, Luer-lock fitting male/female (Instopper/Heparin Cap) pack of 100's 1

28 Y1600250002.02 Intubation Stylet 10Fr each 1

29 Y1600250003.02 Intubation Stylet 14Fr each 1

30 Y1030340006.00 Laryngeal Mask Airway, Sterile, Sz: 1.5 each 3

31 Y1030340004.00 Laryngeal Mask Airway, Sterile, Sz: 2 each 3

32 Y1030340001.00 Laryngeal Mask Airway, Sterile, Sz: 3 each 3

33 Y1030340002.00 Laryngeal Mask Airway, Sterile, Sz: 4 each 3

34 N1360340005.01 Low Adherence Absorbent Dressing Sz: 5cm x 5cm (MELOLIN) box of 100's 15
35 N1360340006.01 Low Adherence Absorbent Dressing Sz: 10cm x 10cm (MELOLIN) box of 100's 15

36 P1660550003.00 Mask, Surgical Disposable, 3 ply, Ear Loop pack of 50's 30

37 Y1010370001.01 Mouthpiece for Peak Flow Meter, Disposable, Adult box of 100's

38 Y1010370002.01 Mouthpiece for Peak Flow Meter, Disposable, Peadiatric box of 100's

39 B1160400001.01 Nasal Cannula/Prong Adult each 30

40 B1160400003.00 Nasal Cannula/Prong Paediatric each 30

41 B2170400004.00 Nasogastric Tube Size 8Fg. (Ryles/Feeding Tube) each 10

42 Y1690400001.00 Nebulizer Mask Set, Adult each

43 Y1690400002.00 Nebulizer Mask Set, Paediatric each

44 T1710400010.01 Needle, Intraosseous Infusion, Sz 14G each 2

45 T1710400011.00 Needle, Intraosseous Infusion, Sz 16G each 2

46 T1710000006.01 Needle, Intraosseous Infusion, Sz 18G each 2

47 P1520400003.00 Nitrile Examination Glove, Non Powder, Sz S box 50

48 P1520400004.00 Nitrile Examination Glove, Non Powder, Sz M box 120

49 P1520400005.00 Nitrile Examination Glove, Non Powder, Sz L box 50

50 Y1660370002.01 Oxygen Mask with Tubing (ADULT) each

51 P1660430003.00 Oxygen Mask With Reservoir Bag, Paediatric pack of 50's

52 G1060460040.00 Plain Top Sterilization Paper Bag, Sz: 140x75x250mm CODE D box of 500's 2
53 G1060460105.00 Plain Top Sterilization Paper Bag, Sz: CODE A (9cm x 5cm x 17cm) pack of 1000's 2

54 N1480460010.02 Precut Gauze Plain, Sz 7.5cm x 7.5cm x 32 Ply pack of 100's 30

55 D1960460002.01 Protoscope, Disposable Sz M each

56 G1820550018.00 Sterilization Paper Crepe Green, Size: 1000mm x 1000mm pack of 250's 1

57 N1920000003.01 Surgical Glue Sealant, Ethyl-2 Cyanoacrylate (GLUE STICH MEDICAL) box of 10's

Suture, Absorbable, Catgut Plain, Metric 3 (3/0), 75cm with 24mm 3/8 Cir. Rev. Cut.
58 S2070550052.00 pack of 24's
Needle (CATGUT 3/0)
Suture, Absorbable, Catgut Plain, Metric 2 (4/0), 75cm with 16mm 3/8 Cir. Rev. Cut.
59 S2070550134.00 pack of 12's
Needle (CATGUT 4/0)
Suture, Non Absorbable, Polyamide, Blue, Metric 3(2/0),75cm with 30mm, 3/8
60 S2070550065.01 box of 12's
Cir.Rev.Cut.Needle (DAFILON 2/0)
Suture, Non Absorbable, Monofilament, Polyamide,Size 1 X 75cm Usp 3/0 Needle
61 T2070400008.02 box of 12's 1
(DAFILON 3/0)
Suture, Non Absorbable, Polyamide, Blue, Metric 1.5(4/0), 75cm with 16mm, 3/8
62 S2070550096.01 box of 12's
Cir.Rev.Cut.Needle (DAFILON 4/0)
Suture, Non Absorbable, Monofilament, Polyamide,Size 45cm Usp 5/0 Needle 3/8
63 T2070400009.02 box of 12's
Cir. (DAFILON 5/0)

64 D2140580004.00 Thermometer Probe Cover, Ear box of 200's 7

65 D2140580009.00 Thermometer Probe Cover, Mouth pack of 1000's 2

66 D2150580002.00 Tourniquet, Elastic, Velcro Closure, Sz 14" each

67 N1360580025.01 Transparent Film Dressing Frame Style, 10cm x 12cm (TEGADERM) box of 50's 3

68 G1820610001.00 Ultrasound Density Paper (ULTRASOUND THERMAL PAPER) roll 30

69 D1490610002 Ultrasound Gel, 250ml/ Bottle bottle 20

70 G1010070009.01 Umbilical Cord Clamp each 5

71 G1810610005.00 Underpad, Disposable, 40cm x 60cm box of 300's 24

Wound Care Solution (Oxidized Water, Sodium Hypochlorite, Sodium Chloride)

72 F1950670002.00 bottle 60
500ml/bott

NAMA PEMESAN
UMAH

JAWATAN PEMESAN
PF U44

TARIKH
2/28/2017
 KUANTITI
I DIPESAN
DIBEKALKAN

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SENARAI ITEM BUKAN UBAT LP (NON STANDARD) - ENCIK SHAIPUL

BIL ITEM CODE PHIS ITEM BUNGKUSAN

1 not in phis AED Battery each

2 not in phis AED Savepad each

Blood Pressure Monitor, Digital (OMRON HEM-7120 ) (EXCHANGE BASIS FOR
3 D1970040001.00 each
MERCURY THERMOMETER)
4 D2140100001.01 Dial Thermometer (TFA ) each

5 not in phis Dressing Forcept Curved 12.5cm pack of 10'S

6 D1390130002.00 ECG Clip-on Limb Electrodes each

7 G1410160003.00 Finger Pulse Oximeter each

8 not in phis Forcep Dressing each

9 T1450160026.00 Forcep, Artery, Mosquito Halstead 5" Curved Box Joint each

10 T1450160043.00 Forcep, Artery, Mosquito, Curved, Size 13cm each

11 T1450160040.00 Forcep, Dressing each

12 T1450160016.00 Forcep, Foerster Sponge Holding , Size 7" each

13 G1250190005.00 Gallipot, Stainless Steel, Size: 110ml each

14 G1250190006.00 Gallipot, Stainless Steel, Size: 60ml each

15 G1250190007.00 Gallipot, Stainless Steel, Size: 90ml each

16 G1010000003.01 Hanger for Urine Bag each

17 H1580250016.00 Immobilizer, Splint, Soft Cervical Collar, Sz M each

18 H1580250026.00 Immobilizer, Splint, Soft Cervical Collar, Sz S each

19 S2060250011.00 Inflation Device ( INFLATION BULB) each

20 D2150370001.00 Measuring Tape with Wall Attachment each

21 D2140370001.01 Minimum-Maximum Thermometer (ZEAL) each

22 S2060400008.00 Needle Holder Kilners, Sz 20cm each

23 T1710400005.00 Needle Holder Lawrence Light Weight Fine Jaw 150mm each

24 S2060400005.00 Needle Holder Mayo Hegar, Sz 15cm/6" each

25 not in phis OCCLUDER each

26 D1410550001.01 Patella Hammer each

27 D1490460001.00 Peak Flow Meter, Adult each

28 D1490460002.00 Peak Flow Meter, Child/Paediatric each

29 T1100550015.00 Scalpel Blade Handle No.3 (130mm) each

30 not in phis Scissor Iris each

31 T1910000003.01 Scissors, Counter each

32 not in phis Teale Vulsellum Forceps 3x4 teeth 23cm each

33 D2140580001 Thermometer Clinical Digital (Oral) OMRON MC-245-C1 each

34 G1410460001.00 Professional Medical Torchlight (TORCHPEN) each

35 not in phis Torchlight with Battery (BIG) each

36 G1250580006.00 Tray Instrument, Stainless Steel With Cover, Size: 320 X 260 X 63mm each

37 G1250580011.00 Tray Instrument, Stainless Steel, Size: 11' x 8' x 3/4' each

38 G1250580009.00 Tray Kidney, Stainless Steel, Size: 15cm each

39 G1250580010.00 Tray Kidney, Stainless Steel, Size: 25cm each

40 not in phis Yankauer Suction each

 LAMPIRAN B
KEW.PS-11
No. Permohonan: ..

BORANG PEMOHONAN STOK

Permohonan Pegawai Pelulus

Bil. Kuantiti Kuantiti Baki Kuantiti
Perihal Stok Justifikasi
dipesan Diluluskan Dipesan

1 Dial Thermometer TFA 2 Untuk menggantikan dial termometer yang rosak

Utk.disimpan dlm 2 top loading baru yang diterima drpd QMS,

2 Min-Max thermometer (ZEAL) 3
manakala 1 lagi utk mengantikan yg rosak
Untuk bilik doktor yang bertambah disebabkan perpindahan
3 Patella Hammer 2 klinik
Thermometer Clinical Digital (oral)
4 3 Untuk menggantikan yang rosak.
OMRON MC 245-C1
Professional Medical Torchlight
5 (TORCHPEN) 3 Untuk setiap beg lawatan jururawat

6 Torchlight with battery (BIG) 2 Kelengakapan troli prosedur

Kelulusan:
Permohonan diluluskan / tidak diluluskan*

(Tandatangan Permohon) (Tandatangan Pegawai Pelulus)
Nama : Matron Fauziah Bt Ismail Nama :
Jawatan : Penyelia Jururawat U36 , KK Jelapang Jawatan :
Tarikh : 28/2/2017 Tarikh :
* sila potong yang tidak berkenaan

Kemaskini Rekod: Perakuan Penerimaan:

Stok telah dikeluarkan dan direkod Disahkan bahawa stok yang diluluskan telah diterima.
di Kad Petak No ..

(Tandatangan Pegawai Stor) (Tandatangan Pemohon / Wakil)
Nama : Nama :
Jawatan : Jawatan :
Tarikh : Tarikh :
 LAMPIRAN B
KEW.PS-11
No. Permohonan: ..

BORANG PEMOHONAN STOK

Permohonan Pegawai Pelulus

Bil. Kuantiti Kuantiti Baki Kuantiti
Perihal Stok Justifikasi
dipesan Diluluskan Dipesan

Kuantiti yang sedia ada sikit, dan tidak dapat

1 AED SAVEPAD 1 menampung keperluan harian pesakit
Blood pressure monitor, Digital (OMRON HEM- Utk melengkapkan "self monitoring procedure" dan
2 7120) 5 pemeriksaan kesihatan.

3 Immobilizer splint soft cervical collar sz M 1 Bagi keperluan pesakit remaja

4 Immobilizer splint soft cervical collar sz S 1 bagi keperluan pesakit pediatrik

Needle holder Lawrence Light weight Fine Jaw

5 2 Untuk penggunaan T/S prosedur
150mm

6 Yankauer Suction 10 Untuk melengkapkan set kecemasan

7 Professional medical torchlight (TORCHPEN) 3 Untuk melengkapkan set kecemasan

8 Needle holder Mayo Hegar , Sz 15cm/6' 2 Untuk penggunaan F/B prosedur

Kelulusan:
Permohonan diluluskan / tidak diluluskan*

(Tandatangan Permohon) (Tandatangan Pegawai Pelulus)
Nama : Dr Azlin Yusma Bt MD Yusup Nama :
Jawatan : Pegawai Perubatan UD 54 Jawatan :
Tarikh : 28/2/17 Tarikh :
* sila potong yang tidak berkenaan

Kemaskini Rekod: Perakuan Penerimaan:

Stok telah dikeluarkan dan direkod Disahkan bahawa stok yang diluluskan telah diterima.
di Kad Petak No ..

(Tandatangan Pegawai Stor) (Tandatangan Pemohon / Wakil)
Nama : Nama :
Jawatan : Jawatan :
Tarikh : Tarikh :