1 Aboket 20 5 Pcs Rp 4,500 Rp 22,500 2 Aboket 22 5 Pcs Rp 4,500 Rp 22,500 3 Aboket 24 100 Pcs Rp 4,500 Rp 450,000 4 Aboket 26 100 Pcs Rp 4,500 Rp 450,000 5 Alkohol 1 L 1 Pcs Rp 35,000 Rp 35,000 6 Benang Prolene No 2 5 Pcs Rp 85,000 Rp 425,000 7 Benang Prolene No 3 5 Pcs Rp 85,000 Rp 425,000 8 Benang Prolene No 5 5 Pcs Rp 85,000 Rp 425,000 9 Benang Silk No 3 2 Pcs Rp 8,000 Rp 16,000 10 Combivent 1 Box Rp 188,000 Rp 188,000 11 Dextrose 5% 500ml 20 Pcs Rp 18,000 Rp 360,000 12 Handscoon M 2 Box Rp 85,000 Rp 170,000 13 Handscoon S 3 Box Rp 85,000 Rp 255,000 14 Injek Ranitidin 10 Box Rp 25,000 Rp 250,000 15 Injek Ondansetron 10 Box Rp 25,000 Rp 250,000 16 Injek Neurobion 3 Box Rp 75,000 Rp 225,000 17 Injek Kanamicin 2 Box Rp 150,000 Rp 300,000 18 Injek Ketorolac 3 Box Rp 35,000 Rp 105,000 19 Injek Buscopan 1 Box Rp 60,000 Rp 60,000 20 Infuset 150 Pcs Rp 4,000 Rp 600,000 21 Kassa Steril 5 Box Rp 3,000 Rp 15,000 22 Kassa Rudal 2 Box Rp 75,000 Rp 150,000 23 Lasal 2 Box Rp 47,000 Rp 94,000 24 Needle 23 1 Box Rp 40,000 Rp 40,000 25 Nacl 0.9% 500ml 20 Pcs Rp 10,000 Rp 200,000 26 RL 500ml 80 Pcs Rp 11,000 Rp 880,000 27 Spuit 3 cc 2 Box Rp 55,000 Rp 110,000 29 Salep Genoint 2 Pcs Rp 6,000 Rp 12,000 30 Salep Bioplacenton 1 Pcs Rp 125,000 Rp 125,000 31 Ultrafik 4 Box Rp 23,000 Rp 92,000 Jumlah Rp 6,752,000 FORMULIR PENGAJUAN AMPRAHAN PPI Bulan : Untuk April
No Nama Barang QTY Harga Satuan Jumlah Ket
1 Handscoon M 3 Box Rp 70,000.00 Rp 210,000.00 2 Handscoon S 4 Box Rp 70,000.00 Rp 280,000.00 3 Masker 14 Box Rp 95,000.00 Rp 1,330,000.00 4 Plastik Sampah Medis 40x60 4 Pax Rp 28,000.00 Rp 112,000.00 5 Plastik Sampah Medis 60x100 2 Pax Rp 28,000.00 Rp 56,000.00 6 Bayclin 1 L 3 Botol Rp 20,000.00 Rp 60,000.00 7 Bedak 150 gr 1 Botol Rp 15,000.00 Rp 15,000.00 8 Safety Box 12,5 L 3 Pcs Rp 75,000.00 Rp 225,000.00 9 Safety Box 5 L 8 Pcs Rp 45,000.00 Rp 360,000.00 Jumlah Rp 2,648,000.00 FORMULIR PENGAJUAN AMPRAHAN PERAWAT Bulan : Untuk April
No Nama Barang QTY Harga Satuan Jumlah Ket
1 Kertas A4 3 Rim Rp 39,000 Rp 117,000 2 Termal Paper 4 Pack Rp 4,000 Rp 16,000 3 Pulpen Hitam 1 Pack Rp 12,000 Rp 12,000 4 Pulpen Biru Snowman (Dokter) 1 Pcs Rp 3,000 Rp 3,000 5 Amplop 104 4 Box Rp 8,000 Rp 32,000 6 Binder Klip 107 4 Box Rp 4,000 Rp 16,000 7 Paper Clip 1 Box Rp 2,000 Rp 2,000 8 Isi Tinta Printer Hitam 1 Pcs Rp 20,000 Rp 20,000 9 Isi Tinta Printer Kuning 1 Pcs Rp 20,000 Rp 20,000 10 Isi Tinta Printer Pink 1 Pcs Rp 20,000 Rp 20,000 11 Isi Tinta Printer Biru 1 Pcs Rp 20,000 Rp 20,000 12 Post It Kecil 1 Pcs Rp 8,000 Rp 8,000 13 Isi Kater 1 Box Rp 6,000 Rp 6,000 14 Map Plastik untuk isi bindex 1 Pack Rp 12,000 Rp 12,000 Jumlah Rp 304,000