RUMKIT TK.II 03.05.

01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL
NO. BARANG SATUAN QTY. YG DIBERI
PENGELUARAN
1 2/1/2015 ST EXAMINASI BOX 5
VERBAN 10 ROLL 30
VERBAN 5 ROLL 100
PLESTER 2X5 ROLL 10
MASKER DISP BOX 6

2 9/1/2015 ST EXAMINASI BOX 5

ALKOHOL 70% FLS 1
STEROBAC FLS 1

3 12/1/2015 STEROBAC FLS 3

ALKOHOL 70% FLS 2
LAFIODIN SOLL FLS 1

4 13/1/2015 STEROBAC FLS 2

JELLY FC FLS 1
LAFIODIN SOLL FLS 1

5 15/1/2015 ST EXAMINASI BOX 5

PLESTER 3X5 ROLL 10
VERBAN 5 ROLL 50
VERBAN 10 ROLL 50
JELLY FC TUBE 2
KERTAS EKG 80X30 ROLL 20

6 19/1/2015 ALKOHOL 70% FLS 2

LAFIODINSOLL FLS 2
HANSCRUB FLS 1

7 20/1/2015 ALKOHOL 70% FLS 2

ST EXAMINASI BOX 10
PLESTER 2X5 ROLL 10
MASKER DISP BOX 4

8 22/1/2015 HANSCRUB FLS 4

LAFIODIN SOLL FLS 1
 9 26/1/2015 KAPAS PUTIH KG 1

10 29/1/2015 ECG PAPER 80X30 ROLL 20

11 3/2/2015 VERBAN 10 CM ROLL 200

ST EXAMINASI BOX 5
MASKER DISP BOX 4

12 6/2/2015 PLESTET 2X5 ROLL 10

13 9/2/2015 ST EXAMINASI BOX 5

14 10/2/2015 STEROBAC FLS 1

15 12/2/2015 ST STERIL NO 7,5 PSG 50

16 13/2/2015 ST EXAMINASI BOX 5

PLESTER 3X5 ROLL 10

17 16/2/2015 ALKOHOL 70% FLS 5

HANSCRUB FLS 2
LAFIODIN SOLL FLS 2

18 18/2/2015 VERBAN 5 ROLL 100

PLESTER 2X5 ROLL 10
ST EXAMINASI BOX 5
DISP ELEKTRODE PACK 2
DISP MASKER BOX 4

19 20/2/2015 ST EXAMINASI BOX 10

20 23/2/2015 KAPAS PUTIH KG 2

PLESTER 3X5 ROLL 10
ALKOHOL 70% FLS 2

21 2/3/2015 LAFIODIN SOLL FLS 2

ALKOHOL 70% FLS 4
HANSCRUB FLS 2

22 3/3/2015 ST EXAMINASI BOX 10

PLESTER 3X5 ROL 10

23 5/3/2015 JELLY FC TUBE 2

24 9/3/2015 PLESTER 2X5 ROL 7
ST EXAMINASI BOX 5
MASKER DISP BOX 4
ECG PAPER 80X30 ROL 10

25 3/3/2015 DISP ELEKTRODE PACK 3

DISP MASKER BOX 2

26 12/3/2015 STEROBAC FLS 2

HANSCRUB FLS 1
ALKOHOL 70% FLS 1

27 16/3/2015 ST EXAMINASI BOX 5

ALKOHOL 70% FLS 3
LAFIODIN SOL FLS 2
PLESTER 2X5 ROL 10

28 19/3/2015 DISP MASKER BOX 5

ST EXAMINASI BOX 4
KERTAS EKG 80X30 ROL 10
PLESTER 3X5 ROL 10
STEROBAC FLS 4
ALKOHOL 70% FLS 1
LAFIODINSOL FLS 1

29 24/3/2015 PLESTER 3X5 ROL 10

VERBAN 5 ROL 100
VERBAN 10 ROL 100
ST 7,5 STERIL PSG 50
ST EXAMINASI BOX 10
FUJI GELL KG 5
FC JELLY TUBE 5
ALKOHOL 70% FLS 2
HANSCRUB FLS 1
STEROBAC FLS 1

30 30/3/2015 ALKOHOL 70% FLS 1

LAFIODIN SOL FLS 1
HANSCRUB FLS 2

31 1/4/2015 STEROBAC FLS 2

ALKOHOL 70% FLS 1
LAFIODINSOL FLS 1

32 2/4/2015 DISP MASKER BOX 6

 ST EXAMINASI BOX 10
PLESTER 3X5 ROL 10
VERBAN 10 ROL 100

33 10/4/2015 DISP MASKER BOX 6

FC JELLY TIBE 5
PLESTER 0,5 ROL 120

34 6/4/2015 STEROBAC FLS 4

ALKOHOL 70% FLS 4
LAFIODIN SOL FLS 2

35 9/4/2015 ALKOHOL 70% FLS 4

HANSCRUB FLS 3
LAFIODINSOL FLS 3

36 13/4/2015 ALKOHOL 70% FLS 4

STEROBAC FLS 2
LAFIODIN SOL FLS 2

37 16/4/2015 STEROBAC FLS 3

ALKOHOL 70% FLS 3
HANSCRUB FLS 2
LAFIODINSOL FLS 1
ST EXAMINASI BOX 20
VERBAN 5 ROL 100
VERBAN 10 ROL 120
PLESTER 0,5 ROL 120
DISP MASKER BOX 6

38 17/4/2015 ALKOHOL 70% FLS 1

HANSCRUB FLS 1
KERTAS EKG 80X30 ROL 10
LAFIODINSOL FLS 2

39 20/4/2015 HANSCRUB FLS 2

40 22/4/2015 PLESTER 3X5 ROL 10

41 24/4/2015 ALKOHOL 70% FLS 2

STEROBAC FLS 2

42 28/4/2015 DISP MASKER BOX 6

ST EXAMINASI BOX 10
EKG PAPER 80X30 ROL 10
 PLESTER 2X5 ROL 10

41 29/4/2015 PLESTER 2X5 ROL 20

KAPAS PITIH KG 2

42 30/4/2015 ALKOHOL 70% FLS 2

HANSCRUB FLS 2
LAFIODIN SOL FLS 2

43 6/5/2015 ALKOHOL 70% FLS 3

LAFIODIN SOL FLS 2
STEROBAC FLS 1
HANSCRUB FLS 1
ST EXAMINASI BOX 10
DISP MASKER BOX 6
PLESTER 3X5 ROL 10
 POLI UGD

HARGA SATUAN HARGA TOTAL

RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 16/1/2015 STEROBAC FLS 6

ALKOHOL 70% FLS 2

2 5/2/2015 TREADMIL PAPER GE PACK 3

DISP ELEKTRODE PACK 10

3 26/2/2015 ECG PAPER 80X30 ROL 85

4 5/3/2015 STEROBAC PACK 4

ECG PAPER 63X30 ROL 10

5 16/3/2015 TREADMIL PAPER GE PACK 2

DISP ELEKTRODE PACK 5
ECG PAPER 80X30 ROL 50
FUJI GELL PROSONIC KG 5
PLESTER 3X5 ROL 1

6 15/4/2015 TREADMIL PAPER GE PACK 2

7 23/4/2015 STEROBAC FLS 7

POLI JANTUNG

HARGA TOTAL
RU
M
Jl.
dr.
UNIT
KI
Dusti
YAN
T
ra
G
FO
No.
MEN
TK
RM
1
GEL
.II
Cima
PE
UAR
hi
NG
KAN
03
Telp:
:
EL
.0
(022
GUD QTY. YG
UA
NO.
)665
ANG TANGGAL BARANG SATUAN HARGA SATUAN
5.
2207
RA
FAR
DIBERI
PENGELUARAN
01
,MASI
N
(0221 29/1/2015 STEROBAC FLS 4
BA
)663
RA ALKOHOL 70% FLS 4
DU
3967
Fax:
NG
ST
(022
)6652
IR 9/4/2015 IV.CATH 20 PCS 10
2170 IV.CATH 22 PCS 10
A,
RL LABU 6
RL 500ML LABU 6
DEXTROSE 5% LABU 6
MASKER DISP BOX 1
ST EXAMINASI BOX 1

3220/4/2015 STEROBAC FLS 1

STEROBAC LTR 1
POLI INTERNE

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL
NO. BARANG SATUAN QTY. YG DIBERI HARGA SATUAN
PENGELUARAN
1 1/1/2015 ST EXAMINASI BOX 2

2 15/1/2015 ST EXAMINASI BOX 2

MASKER DISP BOX 1
PEHACAIN INJ AMP 40
IKADRYL INJ VIAL 3
DISP SPUIT 1CC TB PCS 50
DISP SPUIT 3CC PCS 20
CORTON ACETAT INJ VIAL 2
PHARMAFIX BOX 1
VERBAN 5 ROL 10
VERBAN 10 ROL 10

3 20/2/2015 ST EXAMINASI BOX 3

DISP MASKER BOX 3
DISP SPUIT 1 CC TBC PCS 50
HYPAFIX BOX 2
LIDOCAIN INJ AMP 50
PEHACAIN INJ AMP 60
CORTON ACETAT INJ VIAL 5
IKADRYL INJ VIAL 5
KAPAS PUTIH KG 1

4 18/3/2015 ST EXAMINASI BOX 3

MASKER DISP BOX 3
DISP SPUIT 1CC TBC PCS 100
PHARMAFYX BOX 2
GENYAMICIN EO TUBE 10
LIDOCAIN INJ AMP 100
PEHACAIN INJ AMP 60
CORTON ACETAT INJ VIAL 6
IKADRYL INJ VIAL 5
SAGESTAM CREAM TUBE 20

5 22/4/2015 ST EXAMINASSI BOX 4

DISP MASKER BOX 4
DISP SPUIT 1 CC PCS 50
IKADRYL INJ VIAL 3
KAPAS PUTIH KG 1
POLI KULIT DAN
KELAMIN

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL
NO. BARANG SATUAN QTY. YG DIBERI
PENGELUARAN
1 15/1/2015 ST EXAMINASI BOX 1
MASKER DISP BOX 1

2 24/4/2015 HANSCRUB FLS 2

3 29/4/2015 ALKOHOL 740% FLS 4

LAFIODIN SOL FLS 4
G

POLI JIWA

HARGA SATUAN HARGA TOTAL

RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 15/1/2015 FC JELLY TUBE 4

AQUA BIDEST 500 ML BTL 5
CHLORAETHYL SORAY FLS 1
DARYANTULE LMBR 5
DISP SPUIT 1CC PCS 10
DISP SPUIT 10CC PCS 10
DISP SPUIT 5 CC PCS 20
DISP SPUIT 50 CC PCS 2
HYPAFYX BOX 4
IKAMICETIN SK TUBE 5
MASKER DISP BOX 1
PLESTER 3X5 ROL 3
ST NON 7,5 PSG 5
STNO 7,5 STERIL PSG 20
VERBAN 10 ROL 30
VERBAN 5 ROL 60
HANSAPLAST BOX 1
WATER STERILL 1000 ML LABU 5

2 12/2/2015 STEROBAC FLS 5

3 23/2/2015 ST EXAMINASI BOX 5

4 26/2/2015 VERBAN 5 ROL 60

VERBAN 10 ROL 30
PLESTER 3X5 ROL 5
HANSAPLAST BOX 2
HYPAFIX BOX 5
DISP SPUIT 5 PCS 20
DISP SPUIT 10 PCS 10
DISP SPUIT 50 LP PCS 1
ST EXAMINASI BOX 6
FC JELLY TUBE 6
DARYANTULE LMBR 10
MASKER DISP BOX 1
IKAMICETIN SK TUBE 5
 NACL 500 ML LABU 5
WATER STERIL 1000 ML LABU 5

5 19/3/2015 VERBAN 5 ROL 60

VERBAN 10 ROL 10
PLESTER 3X5 ROL 5
PHARMAFYX BOX 1
DISP SPUIT 5 PCS 20
DISP SPUIT 10 PCS 10
ST EXAMINASI BOX 5
ST 7,5 STREL PSG 24
FC JELLY TUBE 5
DARYANTULE LMBR 5
DISP MASKER BOX 1
CHLORAETHYL SPRAY FLS 1
IKAMICETIN SK TUBE 5
NACL 500 ML LABU 5
ALKOHOL 96% LTR 1
RIVANOL LTR 1
HANSAPLAST ROL 20

6 18/3/2015 STEROBAC FLS 6

HANCRUB LTR 1

7 21/4/205 VERBAN 5 ROL 50

VERBAN 10 ROL 30
PLESTER 3X5 ROL 5
DISP SPUIT 5 PCS 20
DISP SPUIT 10 PCS 10
DISP SPUIT 50 PCS LP 1
ST NO7,5 NON PSG 30
ST EXAMINASI BOX 13
DARYANTULE LMBR 5
WATER STERIL 1000 ML LB 1

8 24/4/2015 IKAMICETIN SK TUBE 5

LAFIODIN SOL LTR 1
RIVANOL LTR 1
HANSAPLAST PCS 100
HYPAFIX BOX 5
FC JELLY TUBE 5
POLI BEDAH

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 3/1/2015 MAKER REBREATING PED PCS 3

DISP SPUIT 1 CC PCS 100

2 22/1/2015 BEROTEC SOLL FLS 2

PYRADOL DROP FLS 10
PARACETAMOL SYR FLS 2
VENTOLIN NEB VIAL 10

3 10/2/2015 ALKOHOL 70% FLS 2

STEROBAC FLS 5

4 27/2/2015 KA EN 1B LABU 7
D5 % LABU 3
NA CL 500 LABU 5
RL LABU 29
IV 24 PCS 26
IV 22 PCS 5
INFUSET MICRO PCS 7
INFUSET MACRO PCS 27
DISP SPUIT 10 PCS 11
DISP SPUIT 5 CC PCS 10
DISP SPUIT 3 CC PCS 95
DISP SPUIT 1 CC PCS 101
PLESTER 3X5 ROL 1
MASKER DISP BOX 1
ST EXAMINASI BOX 2
PPD AMP 10
VERBAN 5 ROL 2
ATROPEN SOL FLS 2
BEROTEX SOL FLS 2
DEXA INJ AMP 5
VIT K INJ AMP 2
AMINOFILIN INJ AMP 5
PCT SYR FLS 1
PCT TAB TAB 10
5 6/3/2015 PPD JUT VIAL 20

6 16/3/2015 ETT NO 3 NKK PCS 1

ETT NO 3,5 NKK PCS 2
ETT NO 4 NKK PCS 2
NGT 6 PCS 2
NGT 8 PCS 2
NGT10 PCS 2
CATETER SUCTION NO 6 PCS 2
CATETER SUCTIN NO 8 PCS 2
CATETER SUCTION NO 12 PCS 2

7 11/5/2015 DISP SPUIT I CC TBC PCS 200

POLI ANAK

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 20/1/2015 UPP 110 Hg ROL 4

ST NO 7,5 STERL PSG 50
ST EXAMINASI BOX 10
PLESTER 3X5 ROL 3
MATA PISAU NO 15 PCS 100
HANSAPLAST BOX 1
FRESCO LIQ 400 ML FLS 2

2 23/2/2015 ST EXAMINASI BOX 10

PLESTER 2X5 ROLL 3
MATA PISAU PCS 100
ST STERIL NO 7,5 PSG 50
RIVANOL FLS 1

3 11/3/2015 UPP 110 Hg ROL 8

4 13/3/2015 ST EXAMINASI BOX 5

MASKER DISP BOX 1
OK PLAST BOX 1

5 16/4/2015 DISP SPUIT 3 CC PCS 30

ST EXAMINASI BOX 10
ST STERL NO 7,5 PSG 10
PLESTER 3X5 ROL 10
MASKER DISP BOX 1
HANSCRUB FLS 2
ALKOHOL 70% FLS 2
POLI OBSGYN

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 13/1/2015 HANSCRUB FLES 1

2 30/1/2015 ST EXAMINASI BOX 3

MASKER DISP BOX 6

3 11/2/2015 BEROTEC 0,1 % FLS 1

4 16/3/2015 BEROTEC SOL 0,1 % FLS 1

5 24/3/2015 STEROBAC FLS 1

6 9/4/2015 DISP MASKER BOX 4

ST EXAMINASI BOX 2

7 6/4/2015 STEROBAC FLS 1

8 28/4/2015 BEROTEC SOL FLS 1

Na CL 500 ML LABU 2
POLI PARU-PARU

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 5/1/2015 FUJU GELL KG 5

2 8/1/2015 ST EXAMINATION BOX 1

MASKER @50 BOX 4

3 2/2/2015 ST EXAMINATION BOX 1

MASKER @50 BOX 3
STEROBAC 400 ML FLS 1

4 20/3/2015 STEROBAC FLS 8

HANSCRUB FLS 1

5 23/3/2015 MASKER DISP BOX 6

POLI FISIOTERAPI

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 9/1/2015 KERTAS EKG ROL 5

KAPAS PUTIH KG 1

2 13/1/2015 AQUABIDEST BTL 11

ALKOHOL 70% FLS 1
Na CL FLS 5

3 16/1/2015 COUTER OPTHALARIC SET 5

4 20/1/2015 MASKER DISP BOX 2

NEEDLE 26 BOX 4
CHLORAETHYL SPARY FLS 2
PHARMAFYX BOX 2
DISP SPUIT 3CC PCS 25
DISP SPUIT 5 CC PCS 25

5 12/2/215 MASKER DISP BOX 2

PEHACAIN INJ AMP 80
LIDOCAIN INJ AMP 400
VERBAN 5 ROL 20
VERBAN 10 ROL 20
XYLOCAIN SPRAY FLS 4
LOMATUEL LMBR 20
KETOKONAZOLE SALF TUBE 30
ST NO 7 STERIL PSG 20
ST NO6,5 STERIL PSG 20
RL LABU 20

6 20/3/2015 MASKER DISP BOX 4

ST EXAMINASI BOX 4
PEHECAIN INJ AMP 40
HIPAFYX BOX 3

7 10/3/2015 ALKOHOL 70% FLS 4

LAFIODIN SOL FLS 1
HANSCRUB FLS 1
 H2O2 3% LTR 1

8 18/3/2015 ALKOHOL 70% FLS 1

9 2//4/2015 ALKOHOL 70% FLS 1

STEROBAC FLS 1
H2O2 3% LTR 1

10 16/4/15 MASKER DISP BOX 2

ST EXAMINASI BOX 4
SPUIT 3CC PCS 100

11 21/4/2015 ST NO 7 STERIL PSG 50

12 24/4/2015 IAKMICETIN SK TUBE 20

AQUABIDEST BTL 11

13 30/4/2015 ALKOHOL 96% LTR 1

14 5/5/2015 ALKOHOL 96% LTR 1

POLI THT

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 15/1/2015 GIPS PUTIH KG 10

GIPS BIRU KG 5
WAX 2
SIKAT POLES HITAM PCS 1
POWER O 2
KAWAT NITI 0,12 UP 2
KAWAT NITI 0,12 LOW 2
SEPTOCAIN 3
JARUM MORITA 12 2
SCANDONEST 3% 2
FUJI 1X 1
FUJI 1 1
HEAT CURE ACRYLUC 1
GIGI FULL RA RB 15
KLAMER 0,7 2
KLAMER 0,8 2
KARET ELASTIS 1/4 10
POLE SUCTION 2
PLESTER 3X5 ROL 2
MASKER DISP BOX 3
GELITAS SPON PCS 10
ST EXAMINASI BOX 17
ST NO 7 NS PSG 50
SPUIT 3CC TERUMO PCS 100
ALKOHOL 70% FLS 4
LAFIODINSOL FLS 1
NaCL 500 LABU 10
HIPOKLORIT PLS 2

2 27/1/2015 ALKOHOL 70% FLS 2

STEROBAC FLS 1
HANSCRUB FLS 1

3 29/1/2015 ALGINATE BKS 3

BOR TULANG 28 MM PCS 20
 SPIRTUS LITER 1
ALKOHOL 70% FLS 4

4 3/2/2015 ALKOHOL 70% FLS 5

5 17/2/2015 ALKOHOL 70% LTR 2

LAFIODIN SOL FLS 2
SPIRTUS TLR 1

6 24/2/2015 SPUIT 3 CC PCS 100

SPUIT 50 CC PCS 20
NEEDLE 19 PCS 100
GELITASPON PCS 10
NaCL 500 LABU 10
INFUSET POLYMED PCS 10
HYPAFIX BOX 1
ST NO 8 NS PSG 40
TOPI DOKTER BOX 1
ST NO 7 STERIL T GLOVE PSG 50
PLESTER 3X5 ROL 2
POT URINE PCS 30
GIGI FUL RA RB SET 15
FUJI 1X SET 1
ENDOMETASON FLS 1
BOOR DIAMOND SET 1
PULL PERYL FLS 1
SEPTOCAIN BOX 1
SCANDONEST 3 % BOX 1
JARUM CITOJECT/MORITA BOX 1
EUGENOL FLS 2
CAVIT G FLS 2
SUPER CEMENT FLS 1
ELITE CEMENT FLS 1
BRAKET SET 5
POWER O SET 1
LIGATURE WIRE ROL 1
SS TABUNG 0,36 1
NITI 0,14 1
ALGINATE 7
GIPS PUTIH KG 10
GIPS BIRU KG 5
KLAMER 0,7 2
KLAMER 0,8 2
LILIN WAX BOX 2
SIKAT POLES HITAM PCS 1
7 17/3/2015 POWER O 1
OPEN COIL PCS 1
BRAKET SET 3
KAWAT NITI 16X16 SET 2
KAWT NITI 16X22 SET 2
GIPS PUTIH KG 10
GIPS BIRU GK 5
KLAMER 0,7 2
KLAMER 0,8 2
SIKAT POLES HITAM PCS 1
LILIN ANCHOR BOX 2
MOLAR BAN LL -20 PCS 21
BOOR 28 MM PCS 20
ALGINATE 5
BOOR EDENTA\DIAMOND SET 4
KARET ELASTIS PACK 10
SEPTOCAIN BOX 2
ACRYLIC HEAT CURTE SET 1
FUJI 1X SET 1
GIGI FULL RA RB SET 15
Na CL 500 ML LABU 20
GELITASPON PCS 10
ST EXAMINASI BOX 15
MASKER DISP BOX 5

8 13/3/2015 ALKOHOL 70% FLS 10

H2O2 35% LTR 1
SPIRTUS LTR 1

9 9/4/2015 SEPTOCAIN BOX 2

JARUN 12 MORITA BOX 2
AKRET ELASTIS PACK 6
BOOR ARKANSAS PCS 6
FETMIN FLES 1
HEAT CURING STELON SET 1
GIGI FULL RA/RB SET 15
KAWAT NITI 0,12 PCS 4
KAWT NITI 16X22 PCS 4
BARKET SET 5
ALGINATE BKS 6
GIPS PUTIH KG 6
GIPS BIRU KG 5
LILIN ANCHOR BOX 1
KLAMER 0,7 M 2
 KLAMER 0,8 M 2
SIKAT POLES HITAM PCS 1
ALKOHOL 70% FLES 11
ALKOHOL 70% LTR 1
LAFIODIN SOL FLS 1

10 15/4/2015 NASSAL CANULU PED PCS 5

NASSAL CANULA ADULT PCS 5
ST EXAMIBNASI BOX 15
ST NO 7 NS PSG 850
ST NO 7,5 NS PSG 50

11 21/4/2015 LAFIODON SOL FLS 2

ALKOHOL 70% FLS 9
H2O2 35% LTR 1

12 6/5/2015 MATA PISAU NO 15 PCS 100

POLI GIGI

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 9/1/2015 CENDO AUGENTONIC TM FLS 5

C XYTROL TM FLS 10
C XYTROL EO FLS 10
C FENICOL EO FLS 10
C MYCOS EO FLS 5
C POLYGRAM FLS 10

2 21/1/2015 HANSRUB FLS 2

SPUIT 3 CC PCS 30
PLESTER 2X5 ROL 2
SPUIT 10 CC PCS 50
SPUIT 5 CC PCS 30
SPUIT 1 CC PCS 100
ST 7,5 STERL PSG 40
ST6,5 STERIL PSG 40
NIFUSET PCS 30
ST NO 7 STERIL PSG 15
KAPAS PUTIH KG 2
MASKER DISP BOX 2

3 23/1/2015 RL 500ML LABU 40

4 6/2/2015 INFUSET POLYMED PCS 40

MASKER DISP BOX 2
TOPI DOKTER BOX 2
ALKOHOL 70% FLS 8

5 10/2/2015 RL WIDATRA LABU 20

TOPI DOKTER BOX 2
INFUSET POLYMED PCS 40
PLESTER 2X5 ROL 5
SPUIT 1CC TBC PCS 100
SPUIT 5 CC TERUMO PCS 100
SPUIT 10 CC TERUMO PCS 100
ST STERIL 6,5 SENSIFLEX PSG 50
 ST STERIL 7 SENSIFLEX PSG 50
ST ATERIL 7,5 SENSIFLEX PSG 50
C POLYGRAM TM FLS 10
CENDOXYTROL TM FLS 10
CENDOXYTROL EO FLS 10
C MYCOS EO FLS 10
GENTAMYCIN TM FLS 10
PANTOCAIN 0,5 TM FLS 10
CENDO FENICOL EO FLS 10
AUGENTONIC TM FLS 10

6 12/2/2015 H2O2 LTR 1

SPURTUS LTR 1

7 174/3/2015 ALKOHOL 70% FLS 9

8 23/3/2015 MASKER DISP BOX 2

SPUIT 1 CC TBC TRM PCS 100

9 10/4/2015 SPUIT 3 CC PCS 30

PLESTER 3X5 ROL 2
SPUIT 5 CC PCS 30
SPUIT 1 CC TBC PCS 100
ST NO 7 STERIL PSG 15
ST NO7,5 STERIL PSG 40
TOPI DOKTER BOX 2
MASKER DISP BOX 2
OPTIXYTROL TM FLS 5
C XYTROL EO FLS 5
C GENTAMYCIN TM FLS 5
C MYCOS FLS 5
RL LABU 30

10 7/4/2015 ALKOHOL 70% FLS 8

11 21/4/2015 C XYTRIL ED FLS 5

C XYTROL EO FLS 5
GARAMYCIN ED FLS 5
DISP DPUIT 3 CC PCS 30
DISP SPUIT 5 PCS 30
DISP SPUIT 1 CC PCS 100
PLESTER 3X5 ROL 2
CENDO MYCOS FLS 5
ST 7,5 STERIL PSG 40
ST 6,5 STERIL PSG 410
ST 7 STERIL PSG 15
RL LABU 30
MASKER DISP BOX 2
INFUSET PCS 15
POLI MATA

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 2/1/2015 STEROBAC FLS 2

2 17/2/2015 MASSKER DISP BOX 1

SPUIT 3CC PCS 5
SPUIT 5 CC PCS 5
SPUIT 1 CC PCS 5
POLI GIZI

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG
NO. BARANG SATUAN HARGA SATUAN
PENGELUARAN DIBERI

1 5/1/2015 ST 7,5 NS PSG 370

2 6/1/2015 SPUIT 3 CC PCS 200

SPUIT 5 CC PCS 200
SPUIT 50 CC PCS 25
MICROPORE ROL 37
HEPARIN INJ VIAL 100
MICROPORE ROL 48
ST 6,5 NS PSG 50
ST 7,5 NS PSG 80
ST 8 NS PSG 50
ST NO 7,5 PSG 100
ST 6,5 STERIL PSG 100
Na CL 1000 ML LABU 150
MASKER DISP BOX 4
SPUIT 20 CC PCS 100

3 13/1/2015 LIDOCAIN INJ AMP 100

HEPERIN INJ VIAL 50

4 15/1/2015 ST NO 6,5 NS PSG 100

ST NO 7 NS PSG 150
ST NO 7,5 NS PSG 150
SPUIT 3 CC PCS 200
SPUIT 5 CC PCS 200
SPUIT 20 CC PCS 100
NASSAL CANULA ADULT PCS 3
Na CL 1000 ML LABU 300
DIALYZER PCS 40
HEPARIN INJ VIAL 100
MASKER DISP BOX 4

5 27/1/2015 HEPARIN INJ VIAL 50

SPUIT 5 CC PCS 200
SPUIT 10 CC PCS 100
 ST NO 8 NS PSG 50
ST NO 6,5 NS PSG 20

6 30/1/2015 DIALYZER PCS 50

BLOOD LINE PCS 320
AV FISTULA 210 SET 200
AV FISTULA 200 SET 650
CONCETRATE ACID GLN 200
BICNAT POWDER ZAK 200
INFUSION SET PCS 300
Na CL 500 LABU 1000

7 2/2/2015 HD SET PCS 400

DIALYZER PCS 40
Na CL 500 ML LABU 1000

8 4/2/2015 HEPARIN INJ VIAL 50

MICROPORE ROL 24
LIDOCAIN INJ AMP 100

9 5/2/2015 ALKOHOL 70% FLS 2

10 10/2/2015 ALKOHOL 70% FLS 4

11 12/2/2015 BICNAT POWDER ZAK 100

BLOODLINE PCS 330
CONCETRATE ACID GLN 100
HEPARIN/INVICLOT VIAL 100
LIDOCAIN INJ AMP 400
Na CL 500 ML LABU 1000

12 20/2/2015 MICHEM FL GLN 3

LIDOCAIN INJ AMP 200
HEPARIN/INVICLOT VIAL 50
MASKER DISP BOX 2

13 27/2/2015 Na CL 500 ML LABU 1000

HEPARIN INJ VIAL 100
INFUSET PCS 675
HD PECK PCS 275

14 3/3/2015 MASKER DISP BOX 2

15 5/3/2015 HD PACK PCS 300

HEPARIN INJ VIAL 100
 BICNAT POWDER ZAK 400
BLOODLINE PCS 480
CONCETRATE ACID GLN 100
AV FISTULA 200 SET 480
AV FISTULS 210 SET 100
INFUSION SET PCS 480
DIALYZER PCS 80
MASKER DISP BOX 10

16 10/3/2015 NaCL 500 ML LABU 1000

HEPARIN INJ VIAL 100
LIDOCAIN INJ AMP 400
ST EXAMINASI BOX 2

17 13/3/2015 STEROBAC FLS 5

18 18/3/2015 Na CL 1000ML LABU 500

MASKER REBREATING ADULT PCS 10
HEPARIN INJ VIAL 100

19 24/3/2015 HEPARIN INJ VIAL 60

20 26/3/2015 MASKER DISP BOX 4

ST 6,5 STERIL PSG 50
ST 7 STERIL PSG 50
ST 7,5 STERIL PSG 50
NASSAL CANULA ADULT PCS 20
Na CL 500 ML LABU 500
BLOODLINE PCS 200
HD SET PCS 375
CONCETRATE ACID GLN 380

21 2/4/2015 BLOODLINE PCS 580

DIALYZER DORA PCS 85
CONCETRATE ACID GLN 280
BICNAT POWDER ZAK 250
AV FISTULA 210 SET 100
AV FISTULA 200 SET 600
INFUSION SET PCS 580
DH PACK PACK 450

22 3/4/2015 Na CL 500 ML LABU 580

HEPARIN /INVICLOT VIAL 150

23 8/4/2015 STEROBAC FLS 1

24 9/4/2015 Na CL 500 ML LABU 1000
HEPARIN INJ VIAL 100
ST NO 7,5 NS PSG 50
ST NO 7,5 NS PSG 50

25 13/4/2015 HEPARIN INJ VIAL 100

EKG 50X30 ROL 2

26 16/4/2015 FC JELLY TUBE 1

27 22/4/2015 ST 7,5 NS PSG 50

ST 7 NS PSG 50
HEPARIN /INVICLOT INJ VIAL 100

28 27/4/2015 NaCL 1000 ML LABU 1000

BLOODLINE FINC PCS 132
PART-A GLN 200
BIBAG BKS 200
HOLLOW FIBER PCS 40
VENOUS FITSULA PCS 200
ST NO 7 NS PSG 50
HEPERIN INJ VIAL 40
ST NO 8 NS PSG 50
ECG PAPER 80X30 ROL 1
MFL RENSE GLN 4
H2O2 35% LTR 4

29 30/4/2015 BICNAT POWDER ZAK 200

CONCETRATE ACID GLN 200
HEPARIN INJ VIAL 100
ST NO 7,5 NS PSG 50
ST 6,5 NS PSG 50
MASKER DISP BOX 4

30 5/5/2015 H2O2 35 % LTR 5

D 40% VIAL 10
LIDOCAIN INJ AMP 400
MICROPORE ROL 10
DEXA INJ AMP 500
HEPARIN /INVICLOT VIAL 100
ST EXAMINASI BOX 2
ST NO 8 NS PSG 10

31 6/5/2015 DIALYZER DORA PCS 90

 BLOODLINE PCS 620
AV FISTULA 210 PCS 110
AV FISTULA 200 PCS 675
CONCETRATE ACID GLN 420
BICNAT POWDER ZAK 420
NaCL 1000 ML LABU 500

32 11/5/2015 ST NO 7 NS PSG 80
ST NO 8 NS PSG 50
ST EXAMINASI BOX 1
MASKER DISP BOX 4
BLOODLINE FMC PCS 68
HEPARIN INJ VIAL 100
HAEMODIALISA

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG HARGA

NO. BARANG SATUAN
PENGELUARAN DIBERI SATUAN

1 13/1/2015 CIDEX OPA GLN 1

CIDEZYME GLN 1

2 16/1/2015 PRECAIN GELL FLS 3

3 20/1/2015 UPC 21 L PAPER SET 2

4 26/1/2015 SPUIT 50 CC PCS 2

5 27/2/2015 CIDEX OPA GLN 1

6 10/3/2015 ST EXAMINASI BOX 2

MASKER DISP BOX 4
PROCAIN GELL POT 2
FC JELLY TUBE 1

7 15/4/2015 PROCAIN GELL POT 1

TOPI OPERASI BOX 1
FC JELLY TUBE 2
FORMALIN CAIR LTR 1
ALKOHOLN70% FLS 1

8 27/4/2015 CIDEX OPA GLN 2

ENDOS COPY

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG HARGA

NO. BARANG SATUAN
PENGELUARAN DIBERI SATUAN

1 19/02/14 KAPORIT KG 30
SODA API POWDER KG 30
PAC KG 30

2 06/6/2014 PAC KG 25
KAPORIT SOL L 30
SODA API SOL L 30

3 15/09/14 STEROBAC FLS 5

KAPORIT SOL L 30
SODA API SOL L 30

4 18/09/14 PAC KG 30

5 10/11/2014 MASKER PCS 100

6 19/01/15 PAC KG 25
KAPORIT SOL L 30
SODA API SOL L 30

7 24/02/15 SARUNG TANGAN EXAMINASI BOX 1

8 08/04/15 SODA API SOL L 30

KAPORIT SOL L 30
PAC KG 25

9 12/5/2015 SARUNG TANGAN EXAMINASI BOX 1

MASKER PCS 50

10 07/05/15 HANSCRUB FLS 1

STEROBAC FLS 1
IPAL

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG HARGA

NO. BARANG SATUAN
PENGELUARAN DIBERI SATUAN

1 13/05/15 STEROBAC FLS 10

INOS

HARGA TOTAL
RUMKIT TK.II 03.05.01 DUSTIRA
Jl. dr. Dustira No. 1 Cimahi
Telp: (022)6652207,(022)6633967 Fax: (022)6652170 ,

FORM PENGELUARAN BARANG

UNIT YANG MENGELUARKAN : GUDANG FARMASI

TANGGAL QTY. YG HARGA

NO. BARANG SATUAN
PENGELUARAN DIBERI SATUAN

1 12/5/2014 ALKOHOL 70% FLS 1

MASKER PCS 50

2 15/07/14 ALKOHOL 70% FLS 1

DISP 3 CC PCS 10

3 01/09/14 SARUNG TANGAN EXAMINASI BOX 1

4 22/12/14 DISP
POLI NEURO

HARGA TOTAL