HSAS.CSSD.Borang.

001

HOSPITAL SHAH ALAM

BORANG PENGHANTARAN SET & SUPPLEMENTARY
DARI WAD / KLINIK / UNIT

DATE : _____________________ WARD / CLINIC : _______________

REPLACED

REPLACED
QUANTITY

QUANTITY

QUANTITY

QUANTITY

QUANTITY

QUANTITY
OWING

OWING
ORDER

ORDER
NO PROCEDURE SETS NO DRESSINGS

1. Abdominal tapping set, adult 1. Baby Toilet set

2. Ambulance Set 2. Dressing set
3. Amniocentesis set 3. Dressing set burn
4. Angiogram set 4. Dressing set eye
5. AV fistula set 5. Feeding set
6. Bladder irrigation set 6. Injection set
7. Blood exchange set 7. Post tracheostomy set
8. Bone marrow puncture set 8. Perineal swabbing set (BOWL)
9. Catheterization set 9. Tuberculin set
10. Chest aspiration set 10. Vaginal exam set
11. Delivery set 11. Vaginal douching set
12. Emergency set
14. ENT packing /removal set
13. Episiotomy suturing set AES : CSSD SUPPLEMENTARY
16. Eye irrigation set 1. BC 236 Mayo Needle Holder 6/7”
15. Eye syringing set 2. BC 544 R Mayo STR Scissor 6” B/S
17. Haemorrhoidal ligature set 3. BC 343 Stitch Scissor 6” S/S
18. Hydrotubation set 4. BB 073 R Bark Parker No 3
19. Hystero-salpingogram set 5. BB 084 R Bark Parker No 4
20. Incision and drainage 6. BF 122 R Sponge Holder 9”
21. IV cut down set, adult 7. BH 338 R Spencer Well 8”
22. IV cut down set, child 8. BD 555 R Dissecting Forcep Tooth
23. IV cut down set, infant 9. BD 045 R Dissecting Forcep Non-Tooth
24. Liver biopsy set 10. JG 506 R Kidney Tray 10”
25. Lumbar puncture set 11. BH 145R Crile Artery
27. Pericardial effusion set
26. Peritoneal dialysis set WARD PACKS
28. Pleural biopsy set
29. Pneumothorax set
30. Post anesthetic tray
31. Radiology basic procedure set
32. Toilet & suture set
33. Tracheostomy set, adult
34. Tracheostomy set, child
35. Umbilical catheterization set

Sign : Sign : Sign :

Indent Staff : CSSD Staff : Receiving Staff :

Date : Date : Date :