Item Paket Bayi Partus Normal

No Kode Item Nama Alkes Quantity Ceklist

1 SD001849 Cord Clamp 2
2 BP000071 Suction catheter No 8 2
3 SD001527 Mamypoko diapers 30
4 SD001730 Connecting suction 1
5 SD001232 Ansell Sterile Gloves no. 6,5 1
6 SD001233 Ansell Sterile Gloves no. 7 1
7 SD002025 Mucus extractor 1
8 SD000773 Neo K inj 1
9 SD004120 Oxygen nasal neonati 1
10 SD001790 Syringe 1cc 1
11 SD002283 NaCl 0.9% 500 ML 1
12 SD001546 Micropore 0.5" 1
13 SD001940 Tabung EDTA 1
14 SD001941 Tabung Kimia 1
15 SD001878 Water Steril/Aquades 25 ML 1
16 SD001850 Underpad 1
17 SD001245 Alkohol swab 1
18 AS000327 Alkohol 70% 1
19 SD000089 Atropine inj 1
20 SD000389 Ephedrine inj 1
21 SD000391 Epinephrine inj 1
22 SD001791 Syringe 3cc 1
23 SD001792 Syringe 5cc 1
24 SD001788 Syringe 10cc 1
25 BP000072 Suction Catheter No 12 1

Yang menyediakan, Yang menerima,

(nama jelas) (nama jelas)

 Item Paket Ibu Partus Normal

No Kode Item Nama Alkes Quantity Ceklist

1 SD001691 Sensi glove non steril 20
2 SD001245 Alkohol swab 10
3 SD001850 underpad 10
4 SD001232 Ansell Sterile Gloves no. 6,5 5
5 SD001233 Ansell Sterile Gloves no. 7 5
6 SD000633 lidocaine inj 5
7 SD001867 Apron 4
8 SINGLE LINEN litotomi seat/duk steril 3
9 SD003765 diapers adult Dr P 2
10 SD001374 masker 2
11 SD001791 Syringe 3cc 2
12 SD001788 Syringe 10cc 2
13 SD001048 Syntocinon 2
14 SD001890 tampon yoyo 2
15 SD001861 vasofix no 20 2
16 kassa cssd (isi 5) 5
17 SD000123 betadine 30 ml 1
18 SD001968 Chromado chromic 2-0 (923) 1
19 SD002329 foley catheter no 16 1
20 SD004499 bledstop 1
21 SD001546 micropore 0.5" 1
22 SD001680 maternity napkin 1
23 SD001556 Nasal canul adult 1
24 SD003005 RL 500ml 1
25 SD001679 Sangofix 1
26 set partus steril 1
27 SD001764 tegaderm 1623 1
28 SD001860 vasofix no 18 1
29 SD001938 vicryl rapide 2-0 (w9962) 1
30 SD001878 water steril 25ml 1
31 SD000327 dextrose 5% 500ml 1
32 SD2057 gillete goal 1
33 SD002283 NaCl 500ml 1
34 SD001792 Syringe 5cc 1

Yang menyediakan, Yang menerima,

(nama jelas) (nama jelas)
NO KODE ITEM NAMA OBAT NAMA OBAT

1 SD000212 CEFTRIAXONE INJ 1 GR Ceftriaxon 1 gr inj

2 SD000711 METRONIDAZOLE FRES INF 100 MG Metronidazole 500 inf

3 SD004119 POSPARGIN INJ Methergin inj

4 SD001048 SYNTOCINON INJ 10 IU (100'S) Oksitosin/syntosinon inj

6 SD000200 CEFAT CAPS 500 MG Cefat

7 SD000732 MOLOCO-B12 TABLET Moloco tablet

8 SD000900 PROFENID SUPP 100 MG Analgetik supp/Kaltrofen/profenid

9 SD000773 NEO-K INJ 2 MG/ML (PHYTONADION) Neo K inj

10 sd000384 ENGERIX-B INJ 10 MCG/0.5 ML Engerix B inj Pediatric
11 SD000880 POLIO ORAL TRIV V - 1 ML Polio
12 SD001962 FENICOL EYE DROPS 0.25% - 5 ML Cendofenicol tts mata 0.25%

13 SD003077 BUNASCAN SPINAL 0.5% HEAVY Marcain inj

14 AS000332 BPJS PETHIDINE INJ 50MG/1ML Ephedrin inj 50 mg/ml
15 SD000391 EPINEPHRINE INJ 0.1 % - 1 MG/ML Epineprin inj
16 SD000389 EPHEDRIN HCL INJ 50 MG/ML Epineprin inj
17 SD000088 ATROPIN AMP 0.25 MG/ML Atropin inj
18 SD001089 TORASIC INJ 30 MG Torasic inj
19 SD002495 TRAMADOL INJ Tramadol inj
20 SD000365 DUROGESIC 25 MU PATCH Durogesic patch 25 ugr

21 sd000423 FARMADOL INFUS Sanmol infus

22 SD004494 TRANEXID INJEKSI 10 % Kalnex 500 mg inj

23 SD000633 LIDOCAIN INJ 2% KF Lidocain inj
24 SD003201 ONDANCENTRON INJ 8MG Ondansentron inj
25 SD002978 RANITIDINE INJ 50MG/5ML Ranitidin inj

26 SD002902 GELAFUSAL INF 3.5% X 500ML Gelafucin

27 SD000373 ECOSOL NACL INF 0.9% - 500 ML BBRAUN NaCL B Braun
28 SD002282 ECOSOL GLUCOSE 5% 500ML Glucose 5% B Braun
29 SD000960 RINGER LACTAT 500 ML B.BRAUN RL B Braun
30 SD000755 NACL INF 0.9% - 25 ML NaCl 0,9% - 25 ml
31 SD001878 WATER FOR INJECTION 25 ML Water for inj 25 ml
NO CONSUMABLES CONSUMABLES

32 SD001997 VICRYL RAPIDE 2/0 V-34 90 CM W9962 Vicryl 3/0

33 SD002562 VICRYL CTD 1 40MM 1/2 RB (W9431) Vicryl No.1
34 SD001966 CATGUT CHROMIC 2 906T Chromic no. 2
35 SD2038 CATGUT CHROMIC 2/0 HR26 75 CM - 56043/0 Chromic 2/0 B Braun

36 SD001233 Ansell Glove Steril 7 Handschoen 6.5 / 7 / 7.5 / 8

37 SD001789 Terumo Syringe W/ NEEDLE 1ML INS. U-80 Dispo 1cc
38 SD001791 Terumo Syringe W/ NEEDLE 3ML Dispo 3cc
39 SD001792 Terumo Syringe W/ NEEDLE 5ML Dispo 5cc
40 SD001788 Terumo Syringe W/ NEEDLE 10ML Dispo 10cc
41 SD001763 Tegaderm 10 x 25 cm TM1627 Tegaderm T3591
42 SD001764 Tegaderm 1623 Tegaderm pad 1623
43 SD001861 Vasofix Safety G20X1,1/4 Vasofix no. 20
44 SD001583 Norta Foley Catheter 2 Way FR16 Folley Catheter no. 16G
45 SD001858 Urobag - 2000 ml Urine bag 2000ml
46 SD001193 XYLOCAIN JELLY 10 GR Xylocain jelly 10 gr
47 SD001890 HOSPILAB DEEPER BALL MEDIUM (3226H) Kapas ball
48 SD001679 Sangofix ES Blood set
49 SD001343 Discofix C 3-Way Stopcock + Tubing Discofix C 3-Way Stopcock + Tubing
50 SD000029 ALKOHOL 70% - 100 ML (ONEMED) Alkohol 70% 100ml
51 SD001224 3M ECG Electrode Elektroda ECG
52 SD002623 SPINOCAN B-BRAUN 27 G Spinocan needle
53 SD001867 Weldaco Aprons Apron
54 SD001730 Suction connecting funnel Suction connecting funnel
55 SD000124 BETADINE SOL 60 ML Bethadine 60ml
56 SD001245 Alcohol swab Alcohol Swab
57 SD000472 GENTAMICIN EO 3,5 GR(CENDO) Gentamicin cream
58 SD001556 Nasal oxygen adult Canul O2 ibu
Flexicare Suction Catheter with Side Vaccum
59 SD001388 Suction Catheter no.8
Control Size 8 fr
60 SD004120 NASAL OXYGEN NEONATUS Canul O2 bayi
61 SD001399 Gauze Pad 7.5 x 7.5 cm Steril Gauze 7.5 x 7.5
62 SD001401 Gauze Pad X Ray 10 x 10 cm Steril Gauze 10 x 10
63 SD001849 Umbilical Cord Clamp Umbilical cord clem
64 SD001529 Mamy Poko Baby Diapers - NB Diapers Mommy Poko
65 SD003765 DR. P ADULT DIAPERS - M10 Adult Diaper
66 SD001915 WASHLAP 3 WARNA washlap
67 SD001850 Underpad Underpad

Yang menyediakan,

(nama jelas)
 pengganti lain Jml Ceklist

4
2
pengganti pospargin
2
(SD004119)/bledstop(sd004499)
4

10
15

pengganti profenid (sd000900) 2

1
Engerix B inj Pediatric (sd000384) 1
1
1

pengganti Buvanest spinal (sd003022) 1

1
1
1
2
Torasic inj (sd001089) 2
4
1
yang ada skarang farmadol
2
(sd000423)/tamoliv (sd004278)
yang ada skrang tranexid (sd004494) 2
2
2
2

atau widahes (sd2089) 1

3
1
5
2
1

w9962 (sd001997) 1
1
3
 2

10
2
6
5
4
2
2
2
1
1
1
4
1
1
1
3
1
2
2
2
20
1
1

1
3
3
1
10
1
1
untuk OT dan LDS 10

Yang menerima,

(nama jelas)
 Item Complemen Paket
No Nama Item Quantity Ceklist
1 Boneka Teddy Bear 1
2 Buku Bayi 1
3 Set Baju Bayi 2
4 Sertifikat Bayi (foto) 1

Yang menyediakan, Yang menerima,

(nama jelas) (nama jelas)