RUMAH SAKIT ANUGERAH BUNDA KHATULISTIWA

Graha Bunda
Jl. Ahmad Yani Pontianak Kalimantan Barat 78124 Indonesia
Tel p. : (0561) 581818 (Hunting) Hp. : 0852 4992 2000 Fax. : (0561)584100
Website : www.rsabk.co.id Email : rsabk.ptk@gmail.com
Owner : PT. Anugerah Bunda Khatulistiwa

1. Tanggal : / /
2. Nama : +

3. No. RM :
4. Tanggal Lahir/Umur : / Tahun
No Nama Bahan No Nama Obat
A Unit Harga Jumlah B Unit Harga Jumlah
Alat Kesehatan / BMHP Alat Obat / BMHP
1 Benang Slik No. 1 Aspilet Tablet
2 Benang Cutgat No. 2 Antrain
3 Bisturi No 3 Aminophilin
4 Chest Pace Ecg 4 Betadine 15 ml
5 Comporming / Elastomull 5 Bisolvon Drop
6 Endotracheal Tube No. 6 Cedocard 5 Mg Tablet
7 Extension Tube Purfusior 7 Dipenhidramin
8 Feeding Tube No. 8 Duvadilan / Proterin
9 Foley Catheter No. 9 Dobutamin / Inotrop
10 Handschone Non Steril 10 Dopamin / Indop
11 Handschone Steril No. 11 Epinephrin
12 Hypafik / Transpore 12 Farbivent / Combivent
13 Gypsona 13 Flixotide / Pulmicort
14 Leukosan Strip 14 Lasacom / Velutin
15 Opsite No. 15 Indexon
16 Infus Transfusi Set Tipe Y 16 Invomit
17 Iv Catheter No. 17 Kaltrofen Supositoria
18 Kapas E.Care 18 Kalnex / Plasminex
19 Kasa Steril ( Lembar ) 19 Lasix
20 Infus Set Adult 20 Lasarcom
21 Leukocrepe 15 Cm X 4,5 M 21 Lidocain / Pehacain
22 Masker 22 Onetik 8 mg
23 Masker NRM Bayi / Anak / Dewasa 23 Pamol Suppo 125 mg
24 Nasal Canula Bayi / Anak / Dewasa 24 Pamol Suppo 250 mg
25 Perfusor 25 Propyretic Suppo 80 mg
26 Pempers Dewasa ( OK IGD ) 26 Propyretic Suppo 160 mg
27 Infus Set Pediatrik 27 Propyretic Suppo 240 mg
28 Soffban Synthetic Besar / Kecil 28 Remopain 30 mg
29 IV 3000’ 29 Stesolid Rectal 5 mg
30 Spuit 1cc 30 Stesolid Rectal 10 mg
31 Spuit 3cc 31 Sanmol Infus 1000 mg
32 Spuit 5cc 32 Sulfas Atropin (SA)
33 Spuit 10cc 33 Vascon
34 Spuit 20cc
35 Spuit 50cc No Nama Bahan
D Unit Harga Jumlah
36 Stomach Tube No. Cairan Infus/ BMHP
37 Sufratule zalf / daryantulle / Cuticell 1 Aquadest 1000 cc / Otsu water
38 Surplug 2 Dextrose 10 % Sanbe 500 cc
39 Three Way / Stop Coch 3 Dextrose 5 % Sanbe 500 cc
40 Urine Bag 4 Dextrose 5 % Sanbe 100 cc / 250cc
41 Underpad Solamed 5 Dextrose ½ NS Sanbe 500 cc
42 Xylocaine Jelly 6 Dextrose ¼ NS Sanbe 500 cc
7 Futrolit
8 Haes – Steril / Sanbe Hes
No Nama Bahan 9 Nacl Sanbe 500 cc
C Unit Harga Jumlah
Alkes Logistik / BMHP 10 Nacl Sanbe 100 cc / 250 cc
1 Oksigen 0-2 l/m (jam) 11 Otsu I aquadest 25 ml
2 Oksigen 2-4 l/m (jam) 12 Otsu I Nacl 25 ml
3 Oksigen 4-6 l/m (jam) 13 Otsu MgSo4 25 ml
4 Oksigen 6-8 l/m (jam) 14 Otsu D40 25 ml
5 Oksigen 8-10 l/m (jam) 15 Otsu KCL 25 ml
6 Pisau cukur 16 Ring As
7 Klip Rawat Inap Kuning / Merah 17 Ringer Lactat Sanbe

NO PEMAKAIAN ALAT-ALAT MEDIS Unit Harga Jumlah

 RUMAH SAKIT ANUGERAH BUNDA KHATULISTIWA
Graha Bunda
Jl. Ahmad Yani Pontianak Kalimantan Barat 78124 Indonesia
Tel p. : (0561) 581818 (Hunting) Hp. : 0852 4992 2000 Fax. : (0561)584100
Website : www.rsabk.co.id Email : rsabk.ptk@gmail.com
Owner : PT. Anugerah Bunda Khatulistiwa

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