PARTUS SET 3

No Nama Obat Satuan Jumlah

1 ALKOHOL SWAB PCS 4
2 CHROMIC CATGUT 2/0 HRG 50 PCS 2
3 FOLLEY CATHETER NO. 18 PCS 1
4 HANDSCONE 6.5 PCS 1
5 HANDSCONE 7 PCS 1
6 HANDSCONE 7,5 PCS 1
7 INFUS SET DEWASA PCS 1
8 IV. CATHETER NO. 18 PCS 1
9 IV. CATHETER NO. 20 PCS 1
10 NASAL CANUL DEWASA PCS 1
11 SPUIT 1 ML PCS 1
12 SPUIT 3ML PCS 3
13 SUCTION CATHETER NO. 10 PCS 1
14 UMBILICAL CORD PCS 2
15 UNDERPAD PCS 2
16 CHLORAMPHENICOL EYE OINT TUBE 1
17 LIDOCAIN INJ. Ampul 2
18 METHERGIN INJ. Ampul 5
19 MISOPROSTOL TABLET Tablet 5
20 OKSITOSIN INJ. Ampul 5
21 RINGER LACTATE Kolf 1
22 VITAMIN K 2 MG INJ. Ampul 1
 EMERGENCY KIT PERINA

No Nama Obat SATUAN

1 Alkohol Swab
2 ETT No 3,0 CUFF
3 ETT No 3,5 CUFF
4 ETT No 4,5 CUFF
5 ETT No 5,0 CUFF
6 Handscoon Steril No 6,5
7 Handscoon Steril No 7
8 Micropore 2 Inch
9 Stomach Tube / Feeding Tube / NGT No 8 (40 cm)
10 Spuit 10 CC
11 Spuit 20 CC
12 Spuit 50 CC
13 Suction Cath No 10
14 Suction Cath No 6
15 Suction Cath No 8
16 Duoderma Extrathin
17 Guedel 00 (50 mm)
18 ETT No 4 CUFF
19 Stomach Tube / Feeding Tube / NGT No 8 (100 cm)
20 ETT No 5,5 CUFF
21 Spuit 1 CC
22 ETT No 3,0 UNCUFF
23 ETT No 3,5 UNCUFF
24 ETT No 4,0 UNCUFF
25 ETT No 2,5 UNCUFF
26 Profix 5 x 5
27 Mandrin 2,0 mm
28 Threeway
29 Guedel 0 (60 mm)
30 Spuit 3 CC
31 Suction Cath No 8
32 ETT No 4,0 CUFF
33 ETT No 2,0 CUFF
34 Extension Tube 100 cm
35 Surgical Blade No 22 / Bisturi no 22
36 Dobutamine 50 mg/ml Inj Ampul
37 WFI 20 ml Ampul
38 Ephineprin Inj Ampul
Ephineprin Inj Ampul
39 Atropin Sulfas Inj Ampul
GENCY KIT PERINA

NO BATCH ED Jumlah Restock Terpakai

9
1
1
1
1
1
1
1
1
2
2
2
2
2
2
1
1
1
1
1
2
1
1
1
1
1
1
1
1
2
2
1
1
1
1
4310396A Feb-24 1
0720860 Jul-24 2
36344003-1 Aug-23 1
9621I0268A Sep-23 2
9621G0175A Jul-24 2
 PARTUS SET 3
No Nama Obat Satuan Jumlah
1 ALKOHOL SWAB PCS 4
2 CHROMIC CATGUT 2/0 HSRG 38 PCS 2
3 FOLLEY CATHETER NO. 18 PCS 1
4 HANDSCONE 6.5 PCS 1
5 HANDSCONE 7 PCS 1
6 HANDSCONE 7,5 PCS 1
7 INFUS SET DEWASA PCS 1
8 IV. CATHETER NO. 18 PCS 1
9 IV. CATHETER NO. 20 PCS 1
10 NASAL CANUL DEWASA PCS 1
11 SPUIT 1 ML PCS 1
12 SPUIT 3ML PCS 3
13 SUCTION CATHETER NO. 10 PCS 1
14 UMBILICAL CORD PCS 2
15 UNDERPAD PCS 2
16 CHLORAMPHENICOL EYE OINT TUBE 1
17 LIDOCAIN INJ. Ampul 2
18 METHERGIN INJ. Ampul 5
19 MISOPROSTOL TABLET Tablet 5
20 OKSITOSIN INJ. Ampul 5
21 RINGER LACTATE Kolf 1
22 VITAMIN K 2 MG INJ. Ampul 1
 ANAFILAKTIK SYOK POLI BEDAH
No Nama Barang Satuan Lot/Batch Expired Date Jumlah Terpakai Restock
1 Atropin Sulfas Inj Ampul 9621I0270A Oct-24 5
2 Alkohol Swab Pcs GM2101002 Jan-26 5
3 Dexametasone Inj Ampul 46337112 Sep-24 3
4 Diphenhidramin Injeksi Ampul 46342025-2 Dec-23 1
5 D5% 500 ml Kolf A96L51A Dec-23 1
6 Ephineprine Inj Ampul 9621I0268A Sep-23 2
7 Infus Set Macro Pcs 22A20L1J 31-Dec-26 1
8 Infus Set Micro Pcs 19A25K8891 01-Jan-24 1
9 IV Catheter No 18 Pcs 181017H Sep-23 1
10 IV Catheter No 20 Pcs 22A1806J Dec-26 1
11 IV Catheter No 22 Pcs 22A1906J Dec-26 1
12 IV Catheter No 24 Pcs 21E1806J Apr-26 1
13 IV Catheter No 26 Pcs 3346521N Nov-26 1
14 NaCl 0,9% 500 ml Kolf A89L51A 20-Dec-23 1
15 Ringer Laktat Kolf 500602 May-23 1
16 Spuit 1 ml Pcs 1110 Nov-26 2
17 Spuit 3 ml Pcs 22F2308J May-27 3

Jakarta, 2022
Yang Menerima Yang Menyerahkan

(…...........................................) (…...........................................)
 ANAFILAKTIK SYOK OK
No Nama Barang Satuan Lot/Batch Expired Date Jumlah
1 Atropin Sulfas Inj Ampul 9621I0270A Oct-24 5
2 Alkohol Swab Pcs 07/SDP/18 Sep-23 5
3 Dexametasone Inj Ampul 46337112 Sep-24 3
4 Diphenhidramin Injeksi Ampul 46342025-2 Dec-23 1
5 D5% 500 ml Kolf D10312 Apr-23 1
6 Ephineprine Inj Ampul 9621I0268A Sep-23 2
7 Infus Set Macro Pcs 22A20L1J 31-Dec-26 1
8 Infus Set Micro Pcs 19A25K8891 01-Jan-24 1
9 IV Catheter No 18 Pcs 181017H Sep-23 1
10 IV Catheter No 20 Pcs 21J1706J Sep-26 1
11 IV Catheter No 22 Pcs 22A1906J Dec-26 1
12 IV Catheter No 24 Pcs 20200428 Mar-25 1
13 IV Catheter No 26 Pcs 3346521N Nov-26 1
14 NaCl 0,9% 500 ml Kolf A86B52A 17-Feb-24 1
15 Ringer Laktat Kolf 500602 May-23 1
16 Spuit 1 ml Pcs 8072188 Jun-26 2
17 Spuit 3 ml Pcs 4062188 May-26 3
 MEDICAL SUPPLY BOX GIGI

No Nama Barang Satuan Jumlah

1 Pehacain Injeksi Ampul 20

2 Lidocain Injeksi Ampul 30