Rumah Sakit Umum dr. H.

KOESNADI
BONDOWOSO Check List Pemeliharaan Alat Elektromedik

Periode :
Ruang :

Tanggal
No Nama Alat Merk/Type Serial Number

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Dibuat Disetujui
List Pemeliharaan Alat Elektromedik

Tanggal

23 24 25 26 27 28 29 30 31

Diketahui
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Juli 2019
RUANGAN : Pav. Seruni

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Baby Incubator GE/Ohmeda HDEQ50062
2 Baby Incubator GE/Ohmeda HDEQ50061
3 Baby Incubator GE/Ohmeda HDEQ50048
4 Baby Incubator GE/Ohmeda HDEQ50049
5 Baby Incubator GE/Ohmeda HDEQ50080
6 Baby Incubator GE/Ohmeda HDEQ50082
7 Baby Incubator GE/Ohmeda HDEQ50063
8 Baby Incubator GE/Ohmeda HDEQ50047
9 Baby Incubator GE/Ohmeda HDEQ50060
10 Baby Incubator GE/Ohmeda HDEQ50084
11 Baby Incubator Babylife/Medicor CEV00053
12 Baby Incubator
13 Baby Incubator Transport Airborne 750i EA229
14 Vein Viewer de konight medlys 60170974265
15 Pototerapi
16 Pototerapi Fanem TAM 062027
17 Pototerapi Lullaby SDW08470214PA
18 CPAP SLE1000 PB0400869
19 CPAP WILAMed WFEJFJBKIJC
20 CPAP WILAMed N8180721028B
21 CPAP WILAMed WFEJFZFZG
22 CPAP WILAMed WFEJFJBKIZH
23 CPAP WILAMed WFEJFJBKIJG
24 Suction Pump Ardo, senator 30 320197
25 Suction Pump Ardo, senator 1720155
26 Nebulizer Omron 20140300704UF
27 Nebulizer U3002-S S172821
28 Resusitator Neopuff 13091000333
29 Resusitator
30 Resusitator
31 Resusitator
32 Oximetri Trusat FCC12180054SA
33 Oximetri Trusat FCC12180077SA
34 Oximetri Trusat FCC12190086SA
35 Oxymetri Schiller HPA17H0173
36 Oxymetri Schiller HPA17L0030
37 Oxymetri Schiller HPA17H0170
38 Oxymetri Schiller HPA17H0119
39 Oxymetri Schiller HPA17H0166
40 Oxymetri Schiller HPA17H0171
41 Syringe Pump Terumo TE 332 1102000015
42 Syringe Pump Terumo TE 332 1002000037
43 Syringe Pump Terumo TE 331 9010043
44 Syringe Pump B Broun, Perfusor compact S 83831
45 Syringe Pump B Broun, Perfusor compact S 111880
46 Syringe Pump B Broun, Perfusor compact S -
47 Syringe Pump B Broun, Perfusor compact S 111865
48 Syringe Pump Mindray SK SK80101724
49 Infant Warmer Lullaby SF812231289PA
50 Infant Warmer Lullaby SF813442459PA
51 Infant Warmer Lullaby SF813302322PA
52 Infant Warmer Lullaby SF813442460PA
53 Infant Warmer Axion/Uon-03F TY9444-173-07530936
54 Infus Pump Terumo TE 172 9090088
55 Pasien Monitor Philips Suresign VM6 US42794331
56 Pasien Monitor Philips Suresign VM6 US42974336
57 Timbangan bayi Seca 5334082109680
58 Timbangan bayi Seca 5334083109803
59 Timbangan bayi Seca 533401111787
60 Timbangan bayi Seca 5334083109807
61 Timbangan bayi Seca 5334226117698
62 Oxy Mixer
63 Oksigen concentrator Braun Crystal 5-8-2 17000139
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Juli 2019
RUANGAN : Pav. Mawar

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Patient Monitor Dixion Strom 05/02/1703/0776
2 Patient Monitor Meditec/M777 KF160707023
3 Elektrocardiograph Cardioline ar 2100 4581202
4 USG Mindray DP20 6R71003828
5 NST/CTG Philip, Avalon FM 20 DE53029926
6 Nebulizer Omron NE-C900 20171200474UF
7 Nebulizer Omron NE-C900 20160800044UF
8 Timbangan Bayi Laica PPO-202022
9 Infant Warmer Axion UON-05F TY94444-173-
07530936-2009
10 Syringe pump Bbraun Perfusor Compact S 114645
11 Syringe pump Bbraun Perfusor Compact S 111871
12 Syringe pump Bbraun Perfusor Compact S 114650
13 Syringe pump Mindray SK - II 70102526
14 Doppler Pocket Bistos BT-200 BAB B50948
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Juli 2019
RUANGAN : Ponek

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Lampu tindakan Dyna DNA 100 R -
2 Lampu tindakan Dyna DNA 100 R -
3 Doppler Toitu FD 390 9421W12
4 Doppler Toitu FD 390 9719F42
5 Suction Pump ARDO 1720173
6 Suction Pump ARDO 1720165
7 Suction Pump ARDO 1720174
8 Infant Warmer Lullaby SF813442458PA
9 Infant Warmer GE/Ohmeda HCCN50222
10 Timbangan bayi Seca -
11 Patient Monitor Meditec England, M777 KF160707028
12 Patient Monitor Philip Intelivue MP20
13 Patient Monitor
14 Baby Incubator Medicor, Babylife CEV00052
15 USG
16 Fetal Monitor Wallach F3 460957M18802590
010
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Juli 2019
RUANGAN : Pav. Melati

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Suction Pump Ardo, senator 1720162
2 Suction Pump Dixion Vacus 7305 70618052942
3 Suction Pump Dixion Vacus 7305 70618052896
4 Suction Pump Dixion Vacus 7305 70618052943
5 Nebulizer U-3002-S S172747
6 Nebulizer Omron NEC 900 20160800073UF
7 Nebulizer Omron NEC 901 20171200419UF
8 Timbangan Bayi Misaki -
9 Timbangan Bayi Elitech TM01177A1110
10 Patient Monitor Dixion 05/02/1703/0796
11 Patient Monitor Dixion 05/02/1703/0780
12 Patient Monitor Infinium Omni III A17083101161
13 Patient Monitor Dixion 05/02/1703/0774
14 Syringe Pump Terumo TE 332 1102000012
15 Syringe Pump Terumo TE 332 1208000121
16 Syringe Pump Mindray SK 500-II 80101826
17 Syringe Pump B Broun, Perfusor 83847
18 Infuse Pump Terumo TE 172 090400013
19 Infuse Pump Terumo TE 172 13030000073
20 Infuse Pump B Braun Infusomat Space P 92024
21 Elektrocardiograph Cardioline ar 2100 5381209
22 Oxymetri Bionics, BPM200 1251L5100
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Juli 2019
RUANGAN : PICU

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Ventilator Wilamed Intensa YRZR013
2 Suction Pump Dixion Vacus 7305 70618052943
3 Suction Pump Dixion Vacus 7305 70618052945
4 Infuse Pump Mindray SK-600 II SK90105141
5 Infuse Pump Mindray SK-600 II SK90105080
6 Infuse Pump B Braun Infusomat Space P 92024
7 Syringe Pump Mindray Sk-500 II SK80101826
8 Baby Incubator Baby Life CEV 00054
9 CPAP WILAMed 75185092
10 Patient Monitor Infinium Omni III A17083101161
11 Patient Monitor Dixion 05/02/1703/0780
12 Patient Monitor Dixion 05/02/1703/0772
13 Patient Monitor Dixion 05/02/1703/0779
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Agustus 2019
RUANGAN : Pav. Teratai

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Suction Pump Ardo, Senator 1120529
2 Suction Pump Ardo, Senator 1720168
3 Nebulizer Omron 20141100603 UF
4 Nebulizer Omron 20140300258
5 Tensimeter digital ABN,DM500 151006218
6 Tensimeter digital Erkameter 125 164100604
7 Tensimeter digital Erkameter 125 164100560
8 Patient Monitor Philip US42794333
9 Patient Monitor Philip US42794332
10 Patient Monitor Philip US42794339
11 Patient Monitor Dixion 05/02/1703/0790
12 Patient Monitor Dixion 05/02/1703/0783
13 Elektrocardiograph GE MAC 800 SJ415330951WA
14 Infuse Pump B Broun 920421
15 Infuse Pump B Broun 449978
16 Syringe Pump Fresenius Kabi 018094/22800061
17 Syringe Pump Fresenius Kabi 018094/22800017
18 Syringe Pump B Broun 83895
19 Syringe Pump B Broun Infusomat space 449978
20 Syringe Pump Mindray, SK-500 70102547
21 Syringe Pump Mindray, SK-500 70102556
22 Syringe Pump Mindray, SK-500 II SK80101819
23 Syringe Pump Mindray, SK-500 II SK80101729
24 Syringe Pump Mindray, SK-500 II SK80101817
25 Defibrilator Axion D251650030
26 Oxymetri Solaris
27 Oxymetri Solaris NTA15060235
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Agustus 2019
RUANGAN : Pav. Bougenvile

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Tensimeter Raksa Trimed BPM161BKN
2 Tensimeter Digital Omron HEM-9210T 202004000784F
3 Nebulizer Parimaster 21A10
4 Syringe Pump Mindray SK500II SK90507714
5 Oximetry Solaris
6 Syringe Pump Fresenius Kabi 22800013
7 Syringe Pump B Braun 111864
8 Syringe Pump B Bround, Compac S 114644
9 Syringe Pump B Bround, Compac S 114653
10 Elektrocardiograph GE MAC 800 SJ415330949WA
11 Tensimeter Digital Omron HBP-1100 01019882LF
12 Termometer Digital Omron MC-720
13 Nebulizer U-3002-S S172745
14 Suction Pump Ardo Senator 1720164
15 Suction Pump Ardo Senator 1720159
16 Tensimeter digital Omron HBP 1100 01019886LF
17 Termometer digital Omron MC-720
18 Termometer digital Omron MC-720
19 Syringe Pump B Bround, Compac S 114652
20 Termometer digital Omron MC-721
21 Nebulizer U-3002-S S172780
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Agustus 2019
RUANGAN : Pav. Dahlia

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Patient Monitor Philips US42794341
2 Patient Monitor Philips US42794335
3 Patient Monitor Dixion Strom 5900-04 50217030797
4 Infuse Pump B Bround 92029
5 Syringe Pump Fresenius Kabi 018094/22742136
6 Syringe Pump Fresenius Kabi 018094/22800018
7 Syringe Pump Fresenius Kabi 018094/22800010
8 Syringe Pump Fresenius Kabi 018094/22800016
9 Syringe Pump Mindray SK-500 70102676
10 Tensimeter digital ERKA 164100631
11 Tensimeter digital Omron HBP-1100 0109889LF
12 Defibrilator Primedik, Metrax 73943000247
13 Defibrilator Axion DKI-N-11 D291770169
14 Elektrocardiograph GE MAC 800 SJ415421171WA
15 Oximetri Solaris NT1A180080242
16 Nebulizer Omron , NEC 900
17 Nebulizer U-3002-S S172827
18 Suction Pump serenity, DF 500 9052436
19 Suction Pump serenity, DF 500 9052438
20 Suction Pump Ardo Senator 1720176
21 Termometer Digital Microlife AG 9443 FRIDLI
22 Tensimeter Raksa Trimed Exacta BPM 161 BKA
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Agustus 2019
RUANGAN : Pav. Anggrek

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Suction Pump Uni-M, TSA 40 D -
2 Suction Pump Ardo, Senator 1720166
3 Nebulizer Omron 20140300308UF
4 Nebulizer Omron 20141100604UF
5 Nebulizer Omron 20160800075UF
6 Nebulizer Omron 20160800085UF
7 Nebulizer U-3002-S S172746
8 Tensimeter digital BPM ERKA 164100523
9 Tensimeter Digital Omron HBP 1100 01019885LF
10 Elektrocardiograph GE MAC800 SJ415431211WA
11 Syringe Pump B Broun 83778
12 Syringe Pump Terumo TE 332 9120000050
13 Syringe Pump Mindray SK 500 II SK90507709
14 Infus Pump B Braun Infustomat P 92028
15 Infus Pump Mindray SK 600 II SK90511536T
16 Defibrilator Primedik, Metrax 73943000244
17 Defibrilator Axion D291750074
18 Oxymetri Solaris NT1A15060243
19 Oxymetri Solaris NT1A15060235
20 Oksigen Concentrat Braun Crystal 17100177
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Agustus 2019
RUANGAN : Pav. Rengganis

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Elektrocardiograph Axion EK 3TC CO51610300
2 Elektrocardiograph Dixion 1012Exp 11318020398
3 Tensimeter raksa Riester 14460014
4 Infus Pump B Braun Infusomat Space P 460105
5 Infus Pump B Braun Infusomat Space P 460101
6 Infus Pump Terumo TE 112 07020232
7 Nebulizer Omron NEC29 20140800606UF
8 Nebulizer Omron 20140300703UF
9 Syringe Pump Fresenius Kabi 1809422800008
10 Syringe Pump Terumo TE 331 6110235
11 Syringe Pump Terumo TE332 912000054
12 Syringe Pump B Braun, Infusomat Space P 406105
13 Syringe Pump Frensius Kabi Injectomat 180942280009
14 Syringe Pump Mindray SK500 II SK80101768
15 Syringe Pump Mindray SK500 II SK80101752
16 Syringe Pump Mindray SK500 II SK 90 507706
17 Syringe Pump B Braun Infustomat Space P 460101
18 Suction Pump Ardo, Senator 1720154
19 Suction Pump Ardo, Senator 1720171
20 Temperature digital Omron SEM-1
21 Temperature digital Omron MC-720
22 Oximetri Bionet Oxygwave 02Q8ꬾ4ꬾꬾꬾ77
23 Oximetri Schiller Argus OXM C HPA17H0168
24 Timbangan berat badan
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : September 2019
RUANGAN : ICU

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Syringe Pump Fresenius Kabi 22742182
2 Syringe Pump Fresenius Kabi 22742162
3 Syringe Pump Fresenius Kabi 22800019
4 Syringe Pump Fresenius Kabi 22742168
5 Syringe Pump Fresenius Kabi 22740933
6 Syringe Pump Fresenius Kabi 22742169
7 Syringe Pump Fresenius Kabi 22800015
8 Syringe Pump Fresenius Kabi 22742157
9 Syringe Pump Fresenius Kabi 22740931
10 Syringe Pump Fresenius Kabi 22740914
11 Syringe Pump B Bround, Perfusor compac s83848
12 Syringe Pump B Bround, Infusomat space P460111
13 Syringe Pump Terumo, TE 331 07060326
14 Syringe Pump Terumo, TE 331 08060017
15 Syringe Pump Mindray SK 500 II SK90507764
16 Syringe Pump Mindray SK 500 II 70102521
17 Syringe Pump Mindray SK 500 II SK80101736
18 Syringe Pump Mindray SK 500 II SK80101728
19 Syringe Pump Mindray SK 500 II SK80101770
20 Syringe Pump Mindray SK 500 II SK90507716
21 Syringe Pump Mindray SK 500 II SK90507725
22 Syringe Pump Mindray SK 500 II 70102514
23 Syringe Pump Mindray SK 500 II SK90507746
24 Syringe Pump Mindray SK 500 II SK90507779
25 Syringe Pump Mindray SK 500 II 70102608
26 Syringe Pump Mindray SK 500 II 70102609
27 Syringe Pump Mindray SK 500 II SK80101784
28 Infuse Pump Terumo TE-112 7020232
29 Infuse Pump B Bround, Infusomat Space P449979
30 Infuse Pump B Bround, Infusomat Space P449977
31 Infuse Pump B Bround, Infusomat Space P460111
32 Infuse Pump B Bround, Infusomat Space P92038
33 Infuse Pump Fresenius Kabi, Optima PT 22869710
34 Ventilator Raphael 15610
35 Ventilator Raphael Hamilton 15611
36 Ventilator Drager, Savina 300 ASFL-0037
37 Ventilator Wilamed Intensa intensayuyy004
38 Ventilator Transport Newportmed HT 70 NI4HT721217552
39 Patient Monitor Philips Suresign VM6 US42794299
40 Patient Monitor Philips Suresign VM6 US42794283
41 Patient Monitor Philips Suresign VM6 US42794279
42 Patient Monitor Philips Suresign VM6 US42794288
43 Patient Monitor Philips Suresign VM6 US42794278
44 Patient Monitor Philips Suresign VM6 US42794294
45 Patient Monitor Philips Suresign VM6 US42794295
46 Patient Monitor Philips Intelivue MP20 DE72870628
47 Patient Monitor Dixion Strom 5900-04 50217030793
48 Patient Monitor Philips Suresign VM6 US42794280
49 Nebulizer Omron NE-C900 20160800042UF
50 Nebulizer Omron NE-C28 20081100535UF
51 Nebulizer Omron NE-C29 20140300306UF
52 Nebulizer Schulte U-3002-S S172779
53 Defibrilator Axion DK1-N-11 D291750070
54 Defibrilator Axion DK1-N-11 D291750067
55 Defibrilator Primedik Metrax 73943001574
56 Suction Pump Ardo Senator 1720156
57 Suction Pump Ardo Senator 1720167
58 Suction Pump Ardo Senator 1720173
59 Suction Pump Ardo Senator 1720156
60 Suction Pump Dixion Vacus7305 070618052934
61 Suction Pump Shin Ei, Minic S 1306069U
62 Ultrasonograph Mindray DP 20 26377317
63 Laryngoscope Storz C-Max OQ18419
64 Tensimeter aneroid ABN mobile 00495680
65 Blood warmer Barkey S line 2906968
66 Central Monitor
67 Central Monitor
68 Blanked warmer Smiths Medical Equator S102B07718
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : September 2019
RUANGAN : ICCU

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Pasien Monitor Philips, Suresign VM6 US42794285
2 Pasien Monitor Philips, Suresign VM6 US42794284
3 Pasien Monitor Philips, Suresign VM6 US42794289
4 Pasien Monitor Philips, Suresign VM6 US42794296
5 Pasien Monitor Philips, Suresign VM6 US42794282
6 Pasien Monitor Philips, Suresign VM7 US42794297
7 Pasien Monitor Philips, Suresign VM6 US42794290
8 Pasien Monitor Dixion, Stom 5900-04 05/02/1703/0777
9 Pasien Monitor Dixion, Stom 5900-04 05/02/1703/0792
10 Pasien Monitor Dixion Strom 5600-02 05/02/1703/0784
11 Pasien Monitor Dixion Strom 5600-02 05/02/1703/0794
12 Pasien Monitor Dixion Strom 5600-02 05/02/1703/0556
13 Syringe Pump B Braun, Perfusor Compac S 111859
14 Syringe Pump B Braun, Perfusor Compac S 111860
15 Syringe Pump B Braun, Perfusor Compac S 111888
16 Syringe Pump B Braun, Perfusor Compac S 111872
17 Syringe Pump Fresenius Kabi Injectomat A 22742161
18 Syringe Pump Fresenius Kabi Injectomat A 22742145
19 Syringe Pump Fresenius Kabi Injectomat A 22742151
20 Syringe Pump Fresenius Kabi Injectomat A 23107316
21 Syringe Pump Fresenius Kabi Injectomat A 22742142
22 Syringe Pump Fresenius Kabi Injectomat A 23107317
23 Syringe Pump Fresenius Kabi Injectomat A 23742181
24 Syringe Pump Fresenius Kabi Injectomat A 23742163
25 Syringe Pump Fresenius Kabi Injectomat A 23742141
26 Syringe Pump Fresenius Kabi Injectomat A 23742118
27 Syringe Pump SK 500 II 70102556
28 Syringe Pump SK 500 II SK90507737
29 Syringe Pump SK 500 II SK90507715
30 Syringe Pump SK 500 II SK90507778
31 Syringe Pump SK 500 II SK90507712
32 Syringe Pump SK 500 II SK80101812
33 Syringe Pump B Braun Infusomat Space P 449983
34 Syringe Pump B Braun Infusomat Space P 449981
35 Syringe Pump B Braun Infusomat Space P 449974
36 Syringe Pump B Braun Infusomat Space P 449984
37 Syringe Pump B Braun Infusomat Space P 449976
38 Syringe Pump B Braun Infusomat Space P 449982
39 Syringe Pump B Braun Infusomat Space P 449980
40 Syringe Pump B Braun Infusomat Space P 449975
41 Infuse Pump SK 600 II SK90105167
42 Infuse Pump B Braun Infusomat Space P 449983
43 Infuse Pump B Braun Infusomat Space P 449976
44 Infuse Pump B Braun Infusomat Space P 449979
45 Infuse Pump B Braun Infusomat Space P 449980
46 Infuse Pump B Braun Infusomat Space P 449984
47 Infuse Pump B Braun Infusomat Space P 517554
48 Infuse Pump B Braun Infusomat Space P 449983
49 Infuse Pump B Braun Infusomat Space P 449981
50 Infuse Pump Terumo TE-172 1703000118
51 Infuse Pump Terumo TE-172 1703000115
52 Infuse Pump Terumo TE-172 170300120
53 Infuse Pump Terumo TE-172 170300119
54 Elektrocardiograph GE MAC 800 S1415421170WA
55 Elektrocardiograph GE MAC 800 S1415421167WA
56 Echocardiograph GE Logic e S1719017
57 Suction Pump Ardo, Senator 1720157
58 Suction Pump Ardo, Senator 1720170
59 Nebulizer Omron,NEC900 20160800087UF
60 Nebulizer Omron,NEC900 20160800076UF
61 Tensimeter Aneroid ABN, Stand 00441525
62 Tensimeter Aneroid ABN, Stand 00495923
63 Defibrilator Axion,DKI-N-11 D251660049
64 Defibrilator Axion,DKI-N-11 D251660048
65 Defibrilator Axion D291780215
66 Defibrilator Axion D291750065
67 Tensimeter Digital ABN DM-499 151006563
68 Tensimeter Digital ABN DM-500 151006562
69 Oxymetri Schiller HPA17L0031
70 Oxymetri Schiller HPA17H0172
71 Oxymetri Schiller HPA17H0174
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : September 2019
RUANGAN : IBS

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Mesin Anaestesi Penlon, Prima SP SP120226
2 Mesin Anaestesi Penlon, Prima SP SP120222
3 Patient Monitor Philips, Sure sign VM6 US42794337
4 Patient Monitor Meditec M777 KF160707027
5 Microscope Mata Pecho CV9000 90164
6 Syringe Pump Fresenius Kabi, Agilia 018094/22800012
7 Syringe Pump Fresenius Kabi, Agilia 018094/22800014
8 Syringe Pump Fresenius Kabi, Agilia 018094/22800020
9 Oximetri Trusat SCC12180056SA
10 Oximetri Solaris NT 1A NT1A15080236
11 Oximetri Chamcare A006A0509
12 Infant warmer Sanrito
13 Infant warmer Lullaby SF813432449PA
14 Suction Pump Ardo, Senator 30 1720175
15 Suction Pump ATMOS C451 200003508
16 Suction Pump ATMOS C451
17 Ventilator Penlon AVS 900 AV9100322
18 Ventilator Penlon AVS 900 AV9100324
19 Defibrilator Axion DKI-N-II D291750069
20 Infuse Pump Atom P-600 1368809
21 Cassete Autoclave Scicon Statim 5000S 140717K00009
22 Timbangan Bayi Seca 334 5334075122402
23 Film Viewer Tesena TSN 014-S 682000000517
24 Meja Operasi Famed SU-03.0 1003/00227
25 ESU Zerone Zeus -400 A03BPBM0692
26 Mesin Anaestesi Drager, Fabius plus USHH-0006
27 Patient Monitor Philips, Sure sign VM6 US42794338
28 Anastesi Vaporizer Drager Vapor 2000 ASHK-0165
29 Anastesi Vaporizer Drager Vapor 2000 ASHK-0693
30 Lampu Operasi Skytron, Aurora
31 Lampu Operasi Aeomed
32 ESU Zerone Zeus -400 A03BPBM0698
33 Meja Operasi Tesena TSN 014-S 681000000517
34 Patient Monitor Philips, Sure sign VM6 US42794293
35 Suction Pump Dixion Vacus 7305 070618052948
36 Film Viewer Skytron, EZ slide 20182-0180
37 Patient Monitor Philips, Sure sign VM6 US42794337
38 Elektrosurgery Unit Zeus 400 Z40A14010020
39 Lampu Operasi Skytron, Aurora 03514081/21201710
0351
40 Mesin Anaestesi Drager Fabius Plus ASLD-0103
41 Laringoscope Storz C-Max UT9679
42 Suction Pump Dixion Vacus 7305 070618052946
43 Film Viewer
44 Anastesi Vaporizer Drager Vapor 2000 ASLE-0484
45 Anastesi Vaporizer Drager Vapor 2000 ASLC-1020
46 Meja Operasi Uzumcu OM6N 18121107235
47 Bedside Monitor Philips, Sure sign VM6 US42794292
48 Lampu Operasi Skytron, Aurora 03273615/21201709
3615
49 Suction Pump Ardo, Senator 30 1720169
50 Mesin Anaestesi Drager Fabius plus ASLD-0096
51 ESU Covider Forcetriod T7B48738EX
52 Anastesi Vaporizer Drager Vapor 2000 ASLC-1017
53 Anastesi Vaporizer Drager Vapor 2000 ASLE-0367
54 Mikroskop mata Leica F40
55 Ventilator Ulco 4032
56 Mesin Anaestesi Penlon, sigma delta 4019
57 Elektrosurgery Unit Zepone Zeus 400 AO3BPBM0695
58 Suction Pump ATMOS Record 55 170040890
59 Oximetri Shin-Ei Tof dream 1401005
60 Anastesi Vaporizer Penlon, Sigma Delta D0803287
61 Anastesi Vaporizer Penlon, Sigma Delta D08100702
62 Lampu Operasi Aeomed
63 Patient Monitor Dixion Strom 5900-04 050217030788
64 Patient Monitor Philips, Sure sign VM6 US42794291
65 Patient Monitor Philips, Sure sign VM6 US42794298
66 Patient Monitor Meditec M777 KF160707019
67 Patient Monitor AnalogicMEd AM1000
68 Patient Monitor Dixion Storm
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : September 2019
RUANGAN : IGD

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Patient Monitor Philip G40 CN44000308
2 Patient Monitor Philip G40 CN44000309
3 Patient Monitor Philip G40 CN44000343
4 Patient Monitor Dixion, stom 5900-04 05/02/1703/0800
5 Patient Monitor Dixion, stom 5900-04 05/02/1703/0781
6 Patient Monitor Dixion, stom 5900-04 05/02/1703/0782
7 Patient Monitor Dixion, stom 5900-04 05/02/1703/0786
8 Patient Monitor Dixion, stom 5900-04 05/02/1703/0787
9 Patient Monitor Dixion, stom 5900-04 05/02/1703/0789
10 Patient Monitor Dixion, stom 5600-03 05/02/1711/1031
11 Patient Monitor Dixion, stom 5600-03 05/02/1711/1032
12 Patient Monitor Dixion, stom 5600-03 05/02/1711/1033
13 Patient Monitor Dixion, stom 5600-03 05/02/1711/1034
14 Patient Monitor Heilmed XM 261836-
M19612860024
15 Patient Monitor Heilmed XM 261836-
M19612860080
16 Patient Monitor Heilmed XM 261836-
M19612860092
17 Patient Monitor Heilmed XM 261836-
M19612860096
18 Patient Monitor Heilmed XM 261836-
M19612860068
261836-
19 Patient Monitor Heilmed XM
M19612860046
261836-
20 Patient Monitor Heilmed XM M19612860004
261836-
21 Patient Monitor Heilmed XM M19612860057
22 Patient Monitor Mindray MEC 1200 CC-92107700
23 Patient Monitor Meditec M777
24 Patient Monitor Dixion, stom 5900-04 05/02/1703/0775
25 Tensimeter aneroid ABN 00495296
26 Defibrilator Mediana 144315110077
27 Defibrilator Axion-DKI-N-11 D291750073
28 Defibrilator Zoll AEDPRO (21)AA14J033719
29 Infant warmer GE Ohmeda HCCQ50093
30 Incubator Transport Airborne 750i EA226
31 Elektrocardiograph GE MAC 800 SJ415421162WA
32 Elektrocardiograph Friedtroen W1900580011
33 Syringe Pump Fresenius Kabi Injectomat A 22800005
34 Syringe Pump Fresenius Kabi Injectomat A 22800007
35 Syringe Pump Fresenius Kabi Injectomat A 22800006
36 Timbangan Bayi Laica PPO2020202
37 Timbangan Badan Tesena TSN 9806 -
38 Nebulizer Schulte U-3002-S S172748
39 Nebulizer Schulte U-3002-S S172784
40 Central Monitor
41 Vein Viewer
42 Laringoscope Storz C-Max VT 9749
Berch told Chromophare
43 Lampu operasi 7330180510318
E520
44 Lampu tindakan Onemed OLP2 -
45 Lampu tindakan Lampara -
46 Lampu tindakan Rinsa Saturno 10610
47 Lampu tindakan Dyna DNA 100 R -
48 Suction Pump Ardo Senator 1720172
49 Suction Pump Ardo Senator 1720165
50 Suction Pump Dixion vacus 7305 07/06/1805/2925
51 Suction Pump Dixion vacus 7305 07/06/1805/3002
52 Suction Pump Dixion vacus 7305 07/06/1805/2947
53 Suction Pump Dixion vacus 7305 07/06/1805/2941
54 Suction Pump Dixion vacus 7305 07/06/1805/2988
55 Suction Pump Dixion vacus 7305 07/06/1805/2933
56 Suction Pump Dixion vacus 7305 07/06/1805/2940
57 Suction Pump Dixion vacus 7305 07/06/1805/2946
58 Suction Pump Dixion vacus 7305 07/06/1805/2936
59 Suction Pump Dixion vacus 7305 07/06/1805/2937
60 Suction Pump Dixion vacus 7305 07/06/1805/2938
61 Suction Pump Dixion vacus 7305 07/06/1805/2939
62 Suction Pump Dixion vacus 7305 07/06/1805/2944
63 Suction Pump Dixion vacus 7305 07/06/1805/2957
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Oktober 2019
RUANGAN : Laboratorium

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Centrifuge Hettich EBA 21 005632-04-00
2 Centrifuge Hettich EBA 280 000185704
3 Centrifuge Hettich EBA 281 000197704
4 Centrifuge PLC-05 1707364
5 Microscop Nicon YS100 535159
6 Microtom Olympus LX31 20948
7 Hematologi Analizer Mytic 22 200210-000-636
8 Hematologi Analizer Sismex XN-450 11218
9 Hematologi Analizer Mindray BC3200
10 Autoanalizer Selectra E 67289
11 Autoanalizer PRO XL 168395
12 Elektrolit Analizer Nova 5 N05CO3110
13 Elektrolit Analizer Spotcem SE1520 10803006
14 Potometer Vital Microlab 300 16-43056
15 Potometer ERBA Chem-7 9952
16 Potometer ERBA Chem-7 8035
17 Imunologi Analizer Biomerieu
18 Imunologi Analizer Tosoh-AIA360 27868604
19 Lab. Incubator Elektromag, M6040BP
20 Refrigerator Trimed
21 Refrigerator Trimed
22 Centrifuge PLC Series 1605748
23 Incubator Biologi Bio Rad 2001324
24 Imunologi Analizer Vidas IVD5206658
25 Bloodbank Helmier 2011214
26 Mikroskop Olympus CX41 7F40836
27 Refrigerator GEA 7F48502
28 Refrigerator Frimed
29 Refrigerator Frimed
30 Mikroskop Olympus CX41RF 7D465416
31 Sterilisator Basah Gemmy SA 232X
32 Sterilisator Basah Gemmy SA 232X
33 Sterilisator kering WTC Binder CHR C112-0014
Thermo Scientific 1300
34 Biosafety Cabinet
Series A2
 Identifikasi kuman dan tes
35 Phoenix 100 PX2972
kepekaan antibiotik
36 Intubasi kultur darah BD Bactex FX40 FF1999
37 Mixer Forte mixer 1305735
38 Clinic pet Hamilton 25 μL
39 Colonicon Biotech 101660
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Oktober 2019
RUANGAN : HD

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Patient Monitor OMNI III Infinium OMNI3-1203-52224-
A
2 Tensimeter Digital Omron HBP 1100 01019881LF
3 Tensimeter Digital Omron HBP 1101 01019883LF

0
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Oktober 2019
RUANGAN : Radiologi

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Floroscopy X ray Italray
2 X Ray Villa 84M590
3 Dental X ray Panoramic 1130736
4 X Ray Mammography Viola
5 CT Scan Philips Ingenuity core 140504
6 Injector
7 USG GE Logiq E9
8 USG GE Logic F5 612193WXO
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Oktober 2019
RUANGAN : CSSD

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Autoclave SHINVA 2015C738
2 Autoclave Matacana SC500 E-25170
3 Autoclave AMARO500
4 Low Temp sterilisator Crystal 120M
5 Washer Laser Stelco/DS61012 1706310J1120
6 Washer Laser Stelco/DS61012 1706310J1121
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Patologi

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
8340060307MM008
1 Mikroskope Laica, DM750
5/01/12
8340060307MM007
2 Mikroskope Laica, DM750 7/01/12
3 Mikroskope Olympus CX21FS1 0J84519
4 Mikroskope Olympus X41 7D46728
5 Centrifuge H-C-8 -
6 Neraca analitik O haus, Pioneer B402200176
7 Cytocentrifuge Slide stainer Aerospray Pro 7151 7151100179
8 Waterbath Laica 10255-03-12
9 Coolplate Laica -
10 Microtom Laica RM2245 2997/10/2012
11 Tissue Embedding Laica EG 1150 H 895210/2012
12 Tissue Processor Laica 1020 -
13 Mikropipet
14 Hotplate Laica 5/12/8177
15 Shaker Rotator H-MSR -
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Rehab

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Elektrostimulator (TEN) ASTAR Aries AMS -040312
2 Elektrostimulator (TEN) ASTAR Aries AMS -130812
3 Elektrostimulator (TEN) BTL5000 038008008717
4 Elektrostimulator (TEN) BTL5000 038008010021
5 Elektrostimulator (TEN) Physiomed VocaStim VSM-1513404
6 Ultrasound BTL5000 Series 038008009753
7 Ultrasound BTL5000 Series 038008009923
8 Timbangan Badan Onemed AMS 130812
9 Laser terapi BTL
10 Parafin bath Ncare NP-70
11 Parafin bath
12 Traksi
13 Lamp IR
14 Lamp IR Philip
15 Oximetri Solaris NT1A 15060230
16 Micro Wave Diathermy BTL 6000 Microwave 250 .018B00227
17 Short Wav Diathermy BTL 6000 Shortwave 400 '01300B002677
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Kandungan

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 USG GE, Voluson P6 324367SU2
2 Timbangan badan
3 Tensimeter digital Erkameter 125 164100629
4 Doppler Toitu FD 390 9421W13
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Jantung

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Electrocardiograph GE Mac800 SJ415421172WA
2 Treadmil GE T21100 2153416275A
3 Echocardiograph GE Logic P6 55011
4 Tensimeter Digital Tensoval 8194047
5 Oximetri Bionet Oxy9wave 02Q478
6 e-bike / sepeda GE Case 11318020392
7 Tensimeter digital Omron HBP-1100 01019884LF
8 Elektrocardiograph Dixion ECG 1012EXP D291770170
9 Tensimeter Aneroid ABN 00495858
10 Tensimeter Aneroid ABN 00495081
11 Defibrilator Axion DK1-N-11 -
12 Timbangan badan GEA ZT-120 -
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Gigi

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Tensimeter Riester
2 Dental Unit Andini Fortuna 1904012017
3 Dental Unit Andini Fortuna 1904012018
4 Dental Unit Andini Fortuna 1904012019
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Mata

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Tensimeter Digital ERKA 164100627
2 Sterilisator kering Memmert C1120014
3 Slit Lamp Shin Nippon/SL-203 520380502792
4 Autoprojector Takaci CP30 0394617
5 Autorefraktometer Nidek ARK-1S 631165
6 Echoscan Usg mata Nidek US-4000 41518
7 Lampu tindakan Everlight TLA-100H -
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli THT

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Suction Pump Thomas Medi Pump 11328L 70300005752
2 Tensimeter ABN 209038
3 Endoscopi telinga Chammed extreme xvs3 xvs31710905
4 Light source Medicon Visiomed 918981
5 Timbangan bayi Gea -
6 Suction pump Thomas 070300005752
7 Suction pump Thomas 1132GL 100300006401
8 Head worn light Bistos BT410 ECD70156
9 Audiometer Interacoustic AD 226 125018
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Syaraf

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 USG Logiq e S1703008
2 Timbangan badan Smic ZT-120 -
3 Tensimeter digital ERKA 125 164100514
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Bedah

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Lampu tindakan LID HTI -
2 Tensimeter aneroid Onemed 1675746
3 Lampu tindakan Mentor me 1-01 -
4 Tensimeter aneroid Onemed 1664636
5 Timbangan badan Onemed -
6
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Nopember 2019
RUANGAN : Poli Dalam

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Elektrocardiograph Cardioline ar 2100 05381204
2 Tensimeter digital Omron HBP-1100 01019887LF
3 Tensimeter digital Omron, Hem 720 20101107183LF
4 USG Mindray, DP20 6R71003830
5 Timbangan badan Onemed OD 205 -
6 Tensimeter digital Omron HBP-1100 01019890LF
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Desember 2019
RUANGAN : Poli Paru

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Suction Pump Olympus 21510563
2 Suction Pump Serenity DF-500 9048819
3 Bronco Endoscopy Olympus CV-170 7544284
4 Nebulizer Omron NEC29 20140300701UF
5 Nebulizer Omron NEC29 20140800605UF
6 Nebulizer Schulte U-3002-S S 172783
7 Tensimeter Riester 1110480045
8 Tensimeter Aneroid ABN 004955057
9 Spirometri Sciller SP-1 54008406
10 Spirometri
11 Suction Pump Serenity DF 500 9048019
12 Oximetri Acare AH-MX 6R-71003829
13 Pasien Monitor Dixion Strom 05/02/1703/0791
14 USG Mobile Mindray DP-20 VQ08516
15 Lampu tindakan Kawe SE-20-018
16 Bronchoscopy Stroz TP-100
17 Bronchoscopy
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Desember 2019
RUANGAN : Poli Kulit

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 ESU ITC 100
2 Lampu Tindakan Onemes OLP 2
3 Lampu diagnostik kulit Wood lamp WOO9230
4 Room UV Mentor MUV 01
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Desember 2019
RUANGAN : Poli Anak

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Timbangan Badan ZT-120
2 Timbangan Bayi Tanita
3 Temperature Digital Omron Microlife 9/28/2018
4 Tensimeter Raksa ABN
5 Tensimeter Aneroid ABN 20140401311UF
6 Nebulizer Omron Compec NEC-29
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Desember 2019
RUANGAN : Poli Umum

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Tensimeter Aneroid ABN 00495814
2 Timbangan badan Onemed OD025
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Desember 2019
RUANGAN : Cathlab

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Pasien Monitor BLT Anyview A8 A027E000898
260511K1720006000
2 Pasien Monitor Elite V8
2
3 Pasien Monitor Dixion Strom 5900-04 05/02/1703/0785
4 Pasien Monitor Dixion Strom 5900-05 05/02/1703/0770
Eurocolumbus/ Euroampli
5 C Arm
Alien 9
6 Suction Pump Ardo Senator 1720163
7 Tensimeter Aneroid ABN Mobile 00495659
8 Defibrilator Philips Heartstart MRX
9 Defibrilator Axion, DKI-N-II D291340052
10 Syringe Pump Bbraun Perfusor Compact S 111859
11 Syringe Pump Bbraun Perfusor Compact S 111868
12 Syringe Pump Bbraun Perfusor Compact S 111882
13 Syringe Pump Bbraun Perfusor Compact S 111889
14 Syringe Pump Frensenius Kabi Injectomat 22742164
15 Tensimeter digital Omron HBP-1100 01019888LF
16 Tensimeter digital Elitech
17 Electrocardiograph Medset Padsy W1700100010
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Desember 2019
RUANGAN : Kemoterapi

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Infuse Pump Mindray SK-600 II SK90511553T
2 Infuse Pump Mindray SK-600 II SK90511548T
3 Infuse Pump Mindray SK-600 II SK90511557T
4 Infuse Pump Mindray SK-600 II SK90511519T
5 Infuse Pump Mindray SK-600 II SK90105105T
6 Infuse Pump Mindray SK-600 II SK90511535T
7 Infuse Pump Mindray SK-600 II SK90511538T
8 Infuse Pump Mindray SK-600 II SK90511533T
9 Tensimeter Raksa Trimed BPM161BKN
10 Pulse Oxymetri Acare AH-MX
11 Timbangan Badan Onemed
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Juni 2019
RUANGAN : Poli Paru

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Suction Pump Olympus 21510563
2 Suction Pump Serenity DF-500 9048819
3 Bronco Endoscopy Olympus CV-170 7544284
4 Nebulizer Omron NEC29 20140300701UF
5 Nebulizer Omron NEC29 20140800605UF
6 Nebulizer Schulte U-3002-S S 172783
7 Tensimeter Riester 1110480045
8 Tensimeter Aneroid ABN 004955057
9 Spirometri Sciller SP-1 54008406
10 Spirometri
11 Suction Pump Serenity DF 500 9048019
12 Oximetri Acare AH-MX 6R-71003829
13 Pasien Monitor Dixion Strom 05/02/1703/0791
14 USG Mobile Mindray DP-20 VQ08516
15 Lampu tindakan Kawe SE-20-018
16 Bronchoscopy Stroz TP-100
17 Bronchoscopy

Bondowoso, 31 Juni 2019

Mengetahui,
Ka. Instalasi Pemeliharaan Sarana

MISTUR,SH
NIP. 19671214 198903 1 004
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Juni 2019
RUANGAN : Poli Kulit

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 ESU ITC 100
2 Lampu Tindakan Onemes OLP 2
3 Lampu diagnostik kulit Wood lamp WOO9230
4 Room UV Mentor MUV 01

Bondowoso, 30 Juni 2019

Mengetahui,
Ka. Instalasi Pemeliharaan Sarana

MISTUR,SH
NIP. 19671214 198903 1 004
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeliharaan Alat Elektromedik
PERIODE : Juni 2019
RUANGAN : Poli Anak

Tanggal
NO NAMA ALAT MERK/TYPE NO SERI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Timbangan Badan ZT-120
2 Timbangan Bayi Tanita
3 Temperature Digital Omron Microlife 9/28/2018
4 Tensimeter Raksa ABN
5 Tensimeter Aneroid ABN 20140401311UF
6 Nebulizer Omron Compec NEC-29

Bondowoso, 31 Juni 2019

Mengetahui,
Ka. Instalasi Pemeliharaan Sarana

MISTUR,SH
NIP. 19671214 198903 1 004
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeli
PERIODE : Juni 2019
RUANGAN : Poli Umum

NO NAMA ALAT MERK/TYPE NO SERI

1 2 3 4 5 6 7 8 9
1 Tensimeter Aneroid ABN 00495814
2 Timbangan badan Onemed OD025
klis Pemeliharaan Alat Elektromedik

Tanggal
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Bondowoso, 31 Juni 2019

Mengetahui,
Ka. Instalasi Pemeliharaan Sarana

MISTUR,SH
NIP. 19671214 198903 1 004
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeli
PERIODE : Juni 2019
RUANGAN : Cathlab

NO NAMA ALAT MERK/TYPE NO SERI

1 2 3 4 5 6 7 8 9
1 Pasien Monitor BLT Anyview A8 A027E000898
260511K1720006000
2 Pasien Monitor Elite V8 2
3 Pasien Monitor Dixion Strom 5900-04 05/02/1703/0785
4 Pasien Monitor Dixion Strom 5900-05 05/02/1703/0770
5 C Arm Eurocolumbus/ Euroampli
Alien 9
6 Suction Pump Ardo Senator 1720163
7 Tensimeter Aneroid ABN Mobile 00495659
8 Defibrilator Philips Heartstart MRX
9 Defibrilator Axion, DKI-N-II D291340052
10 Syringe Pump Bbraun Perfusor Compact S 111859
11 Syringe Pump Bbraun Perfusor Compact S 111868
12 Syringe Pump Bbraun Perfusor Compact S 111882
13 Syringe Pump Bbraun Perfusor Compact S 111889
14 Syringe Pump Frensenius Kabi Injectomat 22742164
15 Tensimeter digital Omron HBP-1100 01019888LF
16 Tensimeter digital Elitech
17 Electrocardiograph Medset Padsy W1700100010
klis Pemeliharaan Alat Elektromedik

Tanggal
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Bondowoso, 31 Juni 2019

Mengetahui,
Ka. Instalasi Pemeliharaan Sarana

MISTUR,SH
NIP. 19671214 198903 1 004
 Rumah Sakit Umum dr. H. KOESNADI
BONDOWOSO Ceklis Pemeli
PERIODE : Juni 2019
RUANGAN : Kemoterapi

NO NAMA ALAT MERK/TYPE NO SERI

1 2 3 4 5 6 7 8 9
1 Infuse Pump Mindray SK-600 II SK90511553T
2 Infuse Pump Mindray SK-600 II SK90511548T
3 Infuse Pump Mindray SK-600 II SK90511557T
4 Infuse Pump Mindray SK-600 II SK90511519T
5 Infuse Pump Mindray SK-600 II SK90105105T
6 Infuse Pump Mindray SK-600 II SK90511535T
7 Infuse Pump Mindray SK-600 II SK90511538T
8 Infuse Pump Mindray SK-600 II SK90511533T
9 Tensimeter Raksa Trimed BPM161BKN
10 Pulse Oxymetri Acare AH-MX
11 Timbangan Badan Onemed
klis Pemeliharaan Alat Elektromedik

Tanggal
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Bondowoso, 31 Juni 2019

Mengetahui,
Ka. Instalasi Pemeliharaan Sarana

MISTUR,SH
NIP. 19671214 198903 1 004