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BORANG PERMOHONAN UNTUK PEMBELIAN UNIT PEMBELIAN DAN PERBEKALAN HOAPITAL RIPAS A.

Untuk di Isikan oleh : Nama Pemohon: Bahagian: (ENT) Jawatan: Tel. Ext: Specialist ORL Surgeon & Head 5303 / 5304; mobile: 8841192 Dr. Pramod Kumar Garg Department of Otorhinolaryngology

B. Keterangan barang / Perkhidmatan yang dipohonkan:

NAME OF ITEM: NASOPHARYNGOSCOPE WITH LIGHT SOURCE


Bil 1 Keterangan barang Portable Rhino-laryngo Fiberscope (Adult) Fully portable battery operated fiberscope. Can also be used with conventional halogen light source and video system if required. Incorporating two rechargeable long life miniature light sources - while one is used, other can be recharged. Provides large and bright high resolution image and good illumination Field of view 85 ; Distal end outer diameter f 3.4mm; Working length 300mm; angulation range - up/down 130 Both fiberscope and light source fully waterproof and can be fully immersed for cleaning and disinfecting. Battery life indicator
Adult Rhino-laryngo Fiberscope Fully waterproof fiberscope can be immersed for cleaning and

Kuanti ti 1

sterilization. Field of view 85 degree Distal end outer diameter 3.4mm Working length - 300mm 130 degree up/down angulation Complete with Light Guide Fiberoptic Cable

Pediatric Fiber-optic Rhino-Laryngoscope Fully waterproof fiberscope can be immersed for cleaning and sterilization. Field of view 85 degree Distal end outer diameter 1.8 mm Working length - 300mm 130 degree up/down angulation Complete with Light Guide Fiberoptic Cable Portable Light source: Compact, light and portable light source Halogen bulb with mirror Compatible with Olympus Rhino-Laryngoscope Adopter for use with Karl Storz endoscope

(sila lampirkan specifikasi / catalog yang lengkap sekiranya ruang tidak mencukupi) C. Pengesahan Ketua Bahagian / Unit OTORHINOLARYNGOLOGY (ENT) Nama Ketua Bahagian / Unit Kumar Garg Tandatangan oleh Ketua Bahagian / Unit dan tarikh Dr. Pramod

-----------------------------------Untuk diisikan oleh Bahagian Kewangan, Pembelian dan Perbekalan, Hospital RIPAS Pegawai Perbekalan, sila ambil tindakan sepert berikut: Sila dapatkan sebutharga Sila gunakan peruntukan Hubungi pengguna untuk keterangan lanjut Pembelian dibawah $2,000.00

Keluarlan PO

(..) Pen. Pengarah Kewangan, Pembelian dan Perbekalan

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