PURCHASE REQUEST

DEPT. DAY DATE NO. PR BY SYSTEM

NICU/NURSING SENIN Oct, 03th 2022

NO. ITEM NAME SPESIFICATION QTY UNIT PRICE TOTAL

1 Pinset bengkok 3
2
3
4
5
6
7

Sub Total
PPN 11% Rp -
TOTAL Rp -
REASON TO PURCHASE

unit belum punya, permintaan dr. Erik untuk pemasangan umbilical catheter
COMMENT

DELEGATION OF AUTHORITY
User T. Expert Manager Unit Finance Manager Wa. Medis/Non Medis Direktur Operasional Finance Corp SCM

Esti Noviyanti
 DEPT.
NICU/NURSING

NO. ITEM NAME

1 NIV Mask NEONATUS DAN PEDIATRIC
2 head gear accesoris all size
3 helix breathIng circuit
4 circuit bubble cpap
5 nasal prong all size
6 nasal mask all size
7 Baby Flow plus

REASON TO PURCHASE

NIV mask belum ada, permntaan dr. Tartilla, bubble cpap accesoris lebih terfiksasi den
plester /mi
COMMENT

DELEGATION OF AUTHORITY
User T. Expert Manager Unit

Esti Noviyanti
 PURCHASE REQUEST

DAY DATE
selasa Sept, 27th 2022

SPESIFICATION QTY UNIT

dragger @3
drager @3
drager 3
drager 3
drager @3
drager @3
drager 3

Sub Total
PPN 11%
TOTAL

cpap accesoris lebih terfiksasi dengan baik, selama ini pemasangan nasal prong dan topi brawijay
plester /micropore

Finance Manager Wa. Medis/Non Medis Direktur Operasional

 NO. PR BY SYSTEM

PRICE TOTAL

Rp -
Rp -

gan nasal prong dan topi brawijaya di modifikasi oleh

Finance Corp SCM

 PURCHASE REQU

DEPT. DAY
NICU/NURSING TUESDAY

NO. ITEM NAME SPESIFICATION

1 hudson set bubble cpap ascesoris
2
3

REASON TO PURCHASE

nasal prong yang saat ini digunakan tidak efektif dan

COMMENT

DELEGATION OF AUTHORITY
User T. Expert Manager Unit Finance Manager

Esti Noviyanti
PURCHASE REQUEST

DATE NO. PR BY SYSTEM

June, 21th 2022

QTY UNIT PRICE

1 1 520000

Sub Total
PPN 11%
TOTAL

ini digunakan tidak efektif dan efisien, harus ditambal atau fiksasi menggunakan micropore

Wa. Medis/Non Medis Direktur Operasional Finance Corp SCM

BY SYSTEM

TOTAL

Rp -
Rp -

SCM
 DEPT.
NICU/NURSING

NO. ITEM NAME

1 ventilator hfo
2
3

REASON TO PURCHASE
permintaan dokter Eric, pernah minta namun request paper tiak dapat di follow up

COMMENT

DELEGATION OF AUTHORITY
User T. Expert Manager Unit

Esti Noviyanti
 PURCHASE REQUEST

DAY DATE
FRIDAY Sept, 16th 2022

SPESIFICATION QTY UNIT

dragger v600 1 1

Sub Total
PPN 11%
TOTAL

request paper tiak dapat di follow up

Finance Manager Wa. Medis/Non Medis Direktur Operasional

 NO. PR BY SYSTEM

PRICE TOTAL

Rp -
Rp -

Finance Corp SCM

 PURCHASE REQUEST

DEPT. DAY DATE NO. PR BY SYSTEM

ICU/NURSING SELASA 4 Oktober 2022

NO. ITEM NAME SPESIFICATION QTY UNIT PRICE TOTAL

1 MESIN CRRT TAWADA 1 1 Rp.720.000.000,-

Sub Total
PPN 11%
TOTAL
REASON TO PURCHASE
Mesin sdh familliar dengan unit critical, dan sdh direkomendasikan oleh dr Vera Irawani SpAn, KIC
vendor akan melatih semua SDM utk aplikasi dan penggunaan alat CRRT dan bersertifikat

COMMENT

DELEGATION OF AUTHORITY
User T. Expert Manager Unit Finance Manager Wa. Medis/Non Medis Direktur Operasional Finance Corp SCM

Awaludin.R
 PURCHASE REQUEST

DEPT. DAY DATE NO. PR BY SYSTEM

NICU/NURSING Friday Nov 11, 22

NO. ITEM NAME SPESIFICATION QTY UNIT PRICE TOTAL

pinset lancip bengkok
1 instrumen 2
bergerigi

Sub Total
PPN 11%
TOTAL
REASON TO PURCHASE

Permintaan dr. Eric untuk tindfakan pemasangan Umbilical Catheter,

COMMENT

DELEGATION OF AUTHORITY
User T. Expert Manager Unit Finance Manager Wa. Medis/Non Medis Direktur Operasional Finance Corp SCM

Esti
Noviyanti