Sor Visor Sen Ys T. FAMED CALIBRATION |x “ALIBRATION & TESTING OF MEDICAL EQUIPMENT SERTIFIKAT PENGUJIAN Testing Certificate No. Sertifikat 003075 Certificate Number IDENTITAS ALAT IDENTIFICATION DEVICE Nama Alat ULTRASONOGRAPHY Device Name Merk SIEMENS, Brand ‘Type/Model ACUSON X300 Type / Modet Nomor Seri 348710 Serial Number IDENTITAS PEMILIK IDENTITY OF THE OWNER ‘Nama Pemilik RUMAH SAKIT LIRA MEDIKA Name Of The Owner Alamat JL. Syech Quro No. 14 Address Palumbonsari ~ Karawang, Sertifikat ini terdiri dari: 5 Halaman This certificate consists of > 5 Pages Diterbitkan tanggal ——_: 08 JANUARI 2019 Published date A Famed Calibration ( ee npn see AT snot Nae Manajer Teknik Technical Manager J. Radar AURI Ruko Pondok Cibubur Blok E No. 1} Cimanggis ~ Dé Tap: (O21) BT3OATO/ Fa, (021) 87753185, fiSEVESVEGVES. € PT. FAMED CALIBRATION CALIBRATION & TESTING OF MEDICAL EQUIPMENT 4, Radar AURI Ruko Pondok Cibubur Blok E No. 11 Cimanggis — Depok 16452 Telp.: (021 ) 8730470 / Fax. (021 ) 7753159, E-mail: famedicalibration2016@email com SERTIFIKAT PENGUJIAN TESTING CERTIFICATE ume 003075 ‘Felangean Lal ~ Customer Tocaion —_R, POLI OBYGN GEDUNG A ‘Retugas Penguiia RUMAH SAKIT LIRA MEDIKA, Calibration Office HENDRA RUSDIATMA $ “Tanggal Penguilan: | Calibration Dawe 26 DESEMBER 2018 ‘Alamat Pelanggan | Berlaku Sampai Dengan: Customer address Valid until 26 DESEMBER 2019 1 ech Quo No. a : cies emai va Desh 7 Pare Sip nan ree ee oes ‘Keterangan Alai : i ~ Inset deserpton ‘Reference procedure Nama : ULTRASONOGRAPHY Name L. ECRI474-20081015-01 Merk, : SIEMENS. 2. KAN Guide On The Evaluation and Bend Expression of Uncertainty in Measurement, KAN-G-01, 2016, Peraturan Menteri Kesehatan RI No.S4 Tahun 201s | ‘Ast ibrasi / Pengufian vang Digunakan : Calibration / Testing standart used No.| instrument Standard _| _ Brand / Type’ Serial Number Traceabiluy “Ulirsonography Phantom | CIRS 7 0S4GS/ D-8655-4 ‘Thermohygrometer BNO /HIC-2/ THFCOO2A fF | Alat Standar ‘Merk Tipe NoSeri Terfelasur erent nae a ren ae erent retae ono Be ans ketenex WE € PT. FAMED CALIBRATION CALIBRATION & TESTING OF MEDICAL EQUIPMENT. we, Radar AURI Ruko Pondok Cibubur Blok E No. 11 Cimanggis — Depok 16452 Telp_: (021 ) 8730470 / Fax. (021 ) 87753159, E-mail: famedcalibration2016@ gmail.com Kondisi Lin Eironnent Conditonsy Tae royce | flambaban (sro 30 7a | i dan Fungsi tot Pan al Kondisi Fungi | Physical Can ition {| HASIL PENGUJIAN TESTING RESULTS ‘A. Jenis Probe Conveks Tee, | Pambscian || Retidakpasian’ | Ponyimpangan | | Parameter | Alat”” | Koreksi | Pengukuran | Malina! 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FAMED CALIBRATION CALIBRATION & TESTING OF MEDICAL EQUIPMENT € wD 1 Rl AU Ralo una ur hE 11 Cina De 1652 ‘Tebp. : (021 ) 8730470 / Fax. (021 ) 87753159, E-mail: famedealibration20|6@gmail.com A on ] etidapasin” | Penyimpangan S pene | Pet Des | Se |S 1 sata} Le) | ijnkan . 7a j Gru? “est : ; : (3 Lomi | __7 - = ( Tp eay [a] | =) | atest [apnea [a [a [ote (Saks, [céemioem [ei [a 0.010 45% dep bem [= [= Stash 6m) | =| = ‘Avecioic [81] a [oon “db | i Gaysaie $4 —T = a = 45% 6a Figperecios_[-81_[ =a) ao Note: + Pemibacaan nls lat diambil dar rate-ratacnam pengukuran| =/ ‘The instrument reading taken from the average Value of sx measurements )) + Nilai sebenarnya adalah Pembacaan Alat (PA) dtambah koreksi Corrections are added othe reading for abtaining true reading Ketidakpastian yang diberikan dalam sertfka ini menggunakan tingkat kepercaynan 95%, dengan faktorcakupan k= 2 ‘Uncercanties given inthis cerificae using with 95% confidence level with a coverage factor of k=2 ~ Berdasarkan hasil Pemeriksaan dan Pengukuran, maka alat ii dinyatakan Laik Pakai/ Tidak Lik Pakai* Based on the results of checks and measurements, then the tool i expressed Feasibility Wear / Not easily Hear.*, ~ Ultrasonography Laik Paka karena tidak melobihi Nisi Penyimpangan yang Diijinkan Ultrasonography Eligible 1 Use because i's not exceeds the Allowable Deviation Value Laboratorium Pengujian “Manajer Tek ‘Technical Manager SSipeaese |__003075 een Pesan: et Het th rn hed cn a wen pronto Pee le nl t done ena dst abrasin Eran soe ato C — Se EE SE DOE SESE RE)