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SURAT PERMINTAAN

Tanggal : 27 Mei 2022


Kode Kegiatan :
Nama Kegiatan :
Kepada Yth.
Kepala Instalasi RSUD Bayung Lencir
Di -
Tempat
Saya yang bertanda tangan di bawah ini :
Nama : Aditiya, Am. Kep
NIP : 19880628 202012 1 001
Jabatan : Ka. Ruangan IBS/OK

Dengan ini mengajukan permintaan Alkes berupa :

NO NAMA BARANG QTY DISTRIBUTOR


1 BOZEMANN UTERINE FORCEPS 26 CM CVD 2 PT. RAJ HEALTH CARE & TRADING
2 FOERSTER COTTON SWAB FORCEPS 25 CM STR 4 PT. RAJ HEALTH CARE & TRADING
3 PEAN (ROCHESTER) ARTERY FORCEPS 18 CM STR 2 PT. RAJ HEALTH CARE & TRADING
4 UTERINE DILATORS SET OF 8 2 PT. RAJ HEALTH CARE & TRADING
5 SIMS UTERINE SOUNDS 32 CM 4 PT. RAJ HEALTH CARE & TRADING
6 SCHROEDER TENACULUM FORCEPS 25 CM 2 PT. RAJ HEALTH CARE & TRADING
7 RECAIMER UTERINE CURRETES 31 CM 7 MM 2 PT. RAJ HEALTH CARE & TRADING
8 RECAIMER UTERINE CURRETES 31 CM 9 MM 2 PT. RAJ HEALTH CARE & TRADING
9 RECAIMER UTERINE CURRETES 31 CM 12 MM 2 PT. RAJ HEALTH CARE & TRADING
10 RECAIMER UTERINE CURRETES 31 CM 16 MM 2 PT. RAJ HEALTH CARE & TRADING
11 RECAIMER UTERINE CURRETES 31 CM 21 MM 2 PT. RAJ HEALTH CARE & TRADING
12 KIDNEY TRAY 200x100x40 MM 2 PT. RAJ HEALTH CARE & TRADING
13 METAL CHATETER 15 CM 2 PT. RAJ HEALTH CARE & TRADING
14 BOX INSTRUMENT 390x200x110 MM 1 PT. RAJ HEALTH CARE & TRADING

Demikian surat permintaan ini saya buat, atas perhatiannya saya ucapkan terimakasih.

Yang Mengajukan Mengetahui


Permintaan Pejabat Pelaksana Teknis Kegiatan

Aditiya, Am. Kep dr. Hedi Mulyadora


NIP. 19880628 202012 1 001 NIP. 19840427 201101 1 005

Mengetahui
Direktur RSUD Bayung Lencir

dr. Diyanti Novitasari, MARS


NIP. 19810313 201001 2 015

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