FORM AUDIT INSTALASI RADIOLOGI

RSI SULTAN AGUNG BANJARBARU

FEBRUARI 2024

1. Audit Film X-Ray Codonic Radiologi

No Bahan Penyimpanan Label Kadaluarsa Fisik Persediaan Tanggal Petugas

1 Film Small v v 8.2027 v 100

2 Film Medium v v 10.2027 v 100

v v 4.2029 v 100
3 Film Large

2. Audit Media Kontras Radiologi

No Bahan Penyimpanan Label Kadaluarsa Fisik Persediaan Tanggal Petugas

1 Iopamiro 370/50 ml v v 3.2028 v 10

v v 3.2028 v 12
2 Iopamiro 370/100 ml

3 Barium Sulfat BASO4 v v Apr.2026 v 4

v v 7.2025 v 8
4 Urografin 76%

3. Audit Perbekalan Pelayanan Radiologi

Fisi
No Bahan Penyimpanan Label Kadaluarsa Persediaan Tanggal Petugas
k
1 Spirite v v 13.6.2024 v 8

2 Gel USG v v Aug.2025 v 17

3 Handrub v v 10.2025 v 11

4 Masker Kn 95 - - - - 0

5 Masker Bedah v v - v 100

6 Masker N95 v v 4.4.2026 v 20

7 Sarung Tangan Non Steril v v 13.8.2028 v 6

8 Nacl 25 Ml v v 10.Nov.2025 v 12

9 Nacl 100 Ml v v 12.Dec.2025 v 8

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 v v Feb.2026 v 10
10 Betadine 60 Ml

11 Kasa Lipat v v Sep.2027 v 4

12 Plesterin Bulat v v Feb.2026 v 55

13 Alkohol Swab v v 5.2028 v 127

14 Paper Film USG v v - v 10

15 Dermafix S IV v v Sep.2026 v 46

16 Kasa Gulung/Pembalut v v - v 10

17 Aquades / Water Injection v v 21.Nov.2025 v 30

18 Selang Injector v v 10.2025 v 16

19 Katerer Tip 50 Ml v v 1.8.2027 v 12

20 Venflon No 22 v v 1.12.2026 v 5
v v 1.6.2026 v 3
21 Venflon No 24

22 Venflon No 20 v v 1.9.2027 v 2

23 Venflon No 18 v v 1.1.2027 v 10

24 Selang 3 Way v v Apr.2028 v 7

25 Syringe 1 Ml v v 31.3.2028 v 14

26 Syringe 3 cc v v 30.4.2028 v 13

27 Syringe 5 Ml v v 31.10.2026 v 13

28 Syringe 10 Ml v v 30.6.2028 v 17

29 Syringe 20 Ml v v 31.10.2026 v 17

30 Syringe 50 Ml v v 11.2026 v 6
- - - - 0
31 Syringe 60 Ml

32 Syringe Injector 200 Ml v v 15.06.2026 v 6

33 Spekulum Disposible Uk S v v 12.2026 v 3

34 Spekulum Disposible Uk L v v Dec.2025 v 2

35 Folley Kateter No 20 v v 19.4.2026 v 8

36 Folley Kateter No 22 v v 19.4.2026 v 4

37 Folley Kateter No 8 v v 19.4.2026 v 12

38 Urine Bag v v Nov.2028 v 8

39 Sarung Tangan Steril v v 24.8.2028 v 10

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40 Transofix v v 1.1.2028 v 5

41 Abocat v v 30.4.2028 v 10

42 Lubricating Jelly v v Okt.2026 v 5

43 CD v v - v 550

44 DVD v v - v 350

45 Amplop CD/DVD v v - v 700

46 Amplop Small v v - v 300

47 Amplop Medium v v - v 200

48 Amplop Large v v - v 500

49 Map USG v v - v 400

50 Kertas Logo Expertise - - - 0

Form Permintaan - - - 0
51
Radiologi

Banjarbaru,
Mengetahui
Penanggung Jawab Instalasi Radiologi PJ. Logistik

Mohammad Fadhil, A.Md. Rad Selvia Ratu Ernila, A.Md.Rad

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