LIST TINDAKAN CATHLAB APRIL 2019

TINDAKAN
NO NAMA TANGGAL KELAS
PAC PCI
1 RUDY 1-Apr-19 1 1
2 NURHAYATI 1-Apr-19 1 3
3 WALTER SINAGA 1-Apr-19 1 1
4 NURDIAH 1-Apr-19 1 1
5 KRISBIANTO 1-Apr-19 1 2
6 JUNIFAH 1-Apr-19 1 1
7 NUR ALI 2-Apr-19 1 3
8 JOHANSYAH 2-Apr-19 1 1
9 PURWANTO 2-Apr-19 1 1
10 ARDI SALIM 2-Apr-19 1 3
11 ELVI ISKANDAR 2-Apr-19 1 VIP
12 NURHAYATI R 3-Apr-19 1 1
13 SUPRIHATIN 3-Apr-19 1 VIP
14 ZAINAL ABIDIN 4-Apr-19 1 3
15 HJ LATIFAH 4-Apr-19 1 1
16 MASRIAH 4-Apr-19 1 2
17 AMIN SUHADI 4-Apr-19 1 1 VIP
18 SITI ROMLAH 5-Apr-19 1 1
19 REYINLIUS PAPANG 5-Apr-19 1 1
20 ALIMAH 5-Apr-19 1 3
21 MAHLI 5-Apr-19 1 2
22 SUGIANTO 5-Apr-19 1 2
23 KARTINAH 5-Apr-19 1 1
24 SUGITO 5-Apr-19 1 1
25 ARI TAMAEN 6-Apr-19 1 2
26 SARWANI DJAMRI 6-Apr-19 1 1
27 KARMEN HUTAHEAN 6-Apr-19 1 2
28 RIRIN WULANDARI 6-Apr-19 1 SUITE
29 AMIR HAMZAH 7-Apr-19 1 3
30 ESTINA SIMAMORA 8-Apr-19 1 1
31 SARAH IDARMAS 8-Apr-19 1 1
32 NENGKO 8-Apr-19 1 3
33 ROSITA 8-Apr-19 1 2
34 SYAIFUL BAHRI 8-Apr-19 1 1
35 TITI RASMAH 9-Apr-19 1 1
36 MARIA TOYANG 9-Apr-19 1 3
37 HUSMIASIH 9-Apr-19 1 2
38 MOCHTAR 9-Apr-19 1 1
39 USMAN 9-Apr-19 1 2
40 SUPRAPTI KWAN W 10-Apr-19 1 2
41 MAWARDAH 10-Apr-19 1 3
42 ACHMADSYAH 10-Apr-19 1 2
43 SYAMSUL 10-Apr-19 1 VIP
44 YUDIANTO (O8-051965) 10-Apr-19 1 1
45 HARIYANTO 10-Apr-19 1 1
46 YUDIANTO (3-4-1948) 11-Apr-19 1 1
47 NORSIAH 11-Apr-19 1 2
48 SITI FATIMAH 11-Apr-19 1 1
49 MIHAMMAD SALENG 12-Apr-19 1 3
50 HERY SULISDIANTO 13-Apr-19 1 1
51 MASNI 13-Apr-19 1 3
52 RUSLI 13-Apr-19 1 2
53 YORI JUNIARTI 13-Apr-19 1 1
54 PONIMAN 13-Apr-19 1 1
55 NIKMAH 15-Apr-19 1 3
56 EDIANSYAH 15-Apr-19 1 SUITE
57 TAHIR 15-Apr-19 1 2
58 CHAYALUDDIN D 15-Apr-19 1 1
59 GEBY TINEKE 15-Apr-19 1 2
60 DIAN W UTAMI 16-Apr-19 1 3
61 ACHMAD 16-Apr-19 1 2
62 TRIONO JATOR 16-Apr-19 1 1
63 ELFA SARI 16-Apr-19 1 VIP
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
45 19
PENANGGUNG

BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
UP V
BPJS
PLN
BPJS
BPJS
BPJS
PHM
BPJS
BPJS
BPJS
KPC
INHEALTH
BPJS
BPJS
BPJS
BPJS
BPJS
PHKT
BPJS POBA (TANPA STENT)
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS FAIL PCI
PAMA
BPJS
BPJS
 KPC
SCHLUMBERGER
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
PHKT
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
PETROSEA
Pemakaian ABHP : TN RUDY
Tanggungan : BPJS
No.Reg : R031919071
Tindakan : PAC 1
Tanggal : 1-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY NURHAYATI
Tanggungan : BPJS
No.Reg : R031919073
Tindakan : PAC 1
Tanggal : 1-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : HJ JUNIFAR
Tanggungan : BPJS
No.Reg : R031919072
Tindakan : PAC 1
Tanggal : 1-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN WALTER SINAGA
Tanggungan : BPJS
No.Reg : R041900115
Tindakan : PCI 1
Tanggal : 1-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 CATETER CLS 6FR 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA SION BLUE 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 2.5X12 REVASS 1 PCS KSO
40 STENT DES COMBO 2.5X18 MM REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1810659
LOT FA1708500
Pemakaian ABHP : NY NURDIAH
Tanggungan : BPJS
No.Reg : R041900194
Tindakan : PCI 1
Tanggal : 1-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 CATETER CLS 6FR 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA SION BLUE 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.0X15 REVASS 1 PCS KSO
40 STENT DES COMBO 3.0X15 MM REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1809644
LOT FA1710543
Pemakaian ABHP : TN KRISBIANTO
Tanggungan : BPJS
No.Reg : R041900166
Tindakan : PAC 1
Tanggal : 1-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN NUR ALI
Tanggungan : BPJS
No.Reg : R041900986
Tindakan : PAC 3
Tanggal : 2-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN JOHANSYAH
Tanggungan : BPJS
No.Reg : R041900946
Tindakan : PAC 1
Tanggal : 2-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN PURWANTO
Tanggungan : BPJS
No.Reg : R041901102
Tindakan : PCI 1
Tanggal : 2-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 CATETER CLS 6FR 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA VERSATURN 2 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 2.75X15 REVASS 1 PCS KSO
40 STENT DES ALEX 2.75X22 MM BALTON 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1810587
LOT 1310918
Pemakaian ABHP : ARDI SALIM
Tanggungan : BPJS
No.Reg : R041901071
Tindakan : PCI 3
Tanggal : 2-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 6FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA VERSATURN 2 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 2.5X15 REVASS 1 PCS KSO
40 STENT DES ALEX 2.5X18 MM BALTON 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
LOT 201706011
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1809712
LOT 0580119
Pemakaian ABHP : TN ELVI ISKANDAR
Tanggungan : PERTAMINA RU V
No.Reg : R041901404
Tindakan : PAC VIP
Tanggal : 2-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 Guide wire J CURVE BALTON 1 PCS KSO
22 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY NURHAYATI
Tanggungan : BPJS
No.Reg : R041901808
Tindakan : PCI 1
Tanggal : 3-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 5 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat FEMORAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 CATH DIAGNOSTIK JR & JL BALTON 6FR 1/1 PCS KSO
22 GUIDING CATH PCI ORIEN 6FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA VERSATURN 2 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 2.75X12 REVASS 1 PCS KSO
40 STENT DES COMBO 2.75X33 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE

REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1809713
LOT FA1809531
Pemakaian ABHP : NY SUPRIHATIN
Tanggungan : PLN
No.Reg : R041901767
Tindakan : PAC VIP
Tanggal : 3-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire J CURVE BALTON 1 PCS KSO
21 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN ZAINAL A
Tanggungan : BPJS
No.Reg : R041901888
Tindakan : PAC 3
Tanggal : 4-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATETER TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY HJ LATIFAH
Tanggungan : BPJS
No.Reg : R041902182
Tindakan : PCI 1
Tanggal : 4-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.0X12 REVASS 1 PCS KSO
40 STENT DES ALEX 3.0X12 MM BALTON 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
LOT 201810003
REUSE
REUSE
REUSE

REUSE

LOT 181012
REUSE
REUSE
LOT FA1809712
LOT 1250918
Pemakaian ABHP : NY MASRIAH
Tanggungan : BPJS
No.Reg : R041901997
Tindakan : PAC 2 (FAIL PCI)
Tanggal : 4-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 5 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat FEMORAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 GUIDING CATH PCI CLS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 ANGIOGRAPHIC NEEDLE NO 18 BALTON 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : AMIN SUHADI
Tanggungan : PHM
No.Reg : R041902385
Tindakan : PAC DAN PCI VIP
Tanggal : 4-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH TERUMO 2 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.0X12 REVASS 1 PCS KSO
40 STENT DES COMBO 3.0X13 MM REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

LOT 201810003
REUSE
REUSE
REUSE

REUSE

LOT 181012
REUSE

LOT FA1808693
LOT FA1811614
Pemakaian ABHP : NY SITI ROMLAH
Tanggungan : BPJS
No.Reg : R041902992
Tindakan : PAC 2
Tanggal : 5-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 SURFLO NO 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN REYINLIUS PAPPING
Tanggungan : BPJS
No.Reg : R041902974
Tindakan : PAC 1
Tanggal : 5-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 CATH DIAGNOSTIK JL 5FR PERFORMA MERIT 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 SURFLO NO 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE

REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY ALIMAH
Tanggungan : BPJS
No.Reg : R041902977
Tindakan : PAC 3
Tanggal : 5-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 CATH DIAGNOSTIK JL 5FR PERFORMA MERIT 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 SURFLO NO 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE

REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN MALILI
Tanggungan : RELLIANCE
No.Reg : R041903420
Tindakan : PAC 2
Tanggal : 5-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN SUGIANTO
Tanggungan : INHEALTH
No.Reg : R031919105
Tindakan : PAC 2
Tanggal : 5-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY KARTINAH
Tanggungan : BPJS
No.Reg : R041903362
Tindakan : PCI 1
Tanggal : 5-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 2.0X18 REVASS 1 PCS KSO
40 STENT DES ALEX 2.25X29 MM BALTON 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1702659
LOT 0580119
Pemakaian ABHP : TN SUGITO
Tanggungan : BPJS
No.Reg : R041903029
Tindakan : PCI 1
Tanggal : 5-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.5X15 REVASS 1 PCS KSO
40 STENT DES COMBO 3.0X18 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1809508
LOT FA1710625
Pemakaian ABHP : TN ARI TAMAEN
Tanggungan : BPJS
No.Reg : R041903805
Tindakan : PAC 2
Tanggal : 6-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN SARWANI DJAMRI
Tanggungan : BPJS
No.Reg : R041903857
Tindakan : PAC 1
Tanggal : 6-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN KARMEN HUTAHAEN
Tanggungan : BPJS
No.Reg : R041903858
Tindakan : PAC 3
Tanggal : 6-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY RIRIN WULANDARI
Tanggungan : PHKT
No.Reg : R041903856
Tindakan : PAC SUITE
Tanggal : 6-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS TERUMO 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
Pemakaian ABHP : AMIR HAMZAH
Tanggungan : BPJS
No.Reg : R041904087
Tindakan : POBA 3 (DIKURANG HARGA STENT BPJS)
Tanggal : 7-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA PILOT 50 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 4.0X15 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

LOT 8090571
REUSE
REUSE
LOT FA1809651
Pemakaian ABHP : NY ESTINA SIMAMORA
Tanggungan : BPJS
No.Reg : R041904164
Tindakan : PAC 1
Tanggal : 8-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY SARAH IDARMAS
Tanggungan : BPJS
No.Reg : R041904177
Tindakan : PAC 1
Tanggal : 8-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN NENGKO
Tanggungan : BPJS
No.Reg : R041904751
Tindakan : PCI 3
Tanggal : 8-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 2.0X15 REVASS 1 PCS KSO
40 STENT DES ALEX PLUS 2.75X38 BALTON 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1701571
LOT 0700119
Pemakaian ABHP : NY ROSITA
Tanggungan : BPJS
No.Reg : R041904389
Tindakan : PCI 2
Tanggal : 8-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.0X12 REVASS 1 PCS KSO
40 STENT DES COMBO PLUS 3.0X18 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1808693
LOT FA1811616
Pemakaian ABHP : TN SYAIFUL BAHRI
Tanggungan : BPJS
No.Reg : R041904566
Tindakan : PCI 1
Tanggal : 8-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 2 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.0X12 REVASS 1 PCS KSO
40 STENT DES COMBO PLUS 3.0X13 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

LOT FA181012
REUSE
REUSE
LOT FA1810660
LOT FA1811614
Pemakaian ABHP : NY TITI RASMAH
Tanggungan : BPJS
No.Reg : R041905261
Tindakan : PAC 1
Tanggal : 9-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY MARIA TOYANG
Tanggungan : BPJS
No.Reg : R041905266
Tindakan : PAC 3
Tanggal : 9-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 3 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY HUSMIASIH
Tanggungan : BPJS
No.Reg : R041905522
Tindakan : PCI 2
Tanggal : 9-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 4.0X12 REVASS 1 PCS KSO
40 STENT DES COMBO PLUS 3.0X33 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

LOT FA181012
REUSE
REUSE
LOT FA1809650
LOT FA1712535
Pemakaian ABHP : TN MOCHTAR
Tanggungan : BPJS
No.Reg : R041905670
Tindakan : FAIL PCI 1
Tanggal : 9-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN 5FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

LOT FA181012
REUSE
REUSE
Pemakaian ABHP : TN USMAN
Tanggungan : PAMA
No.Reg : R041905929
Tindakan : PAC 2
Tanggal : 9-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 CATH JL 4.0 5FR ALVISION 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 SURFLO NO 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY SUPRAPTI KWAN WILLIAM
Tanggungan : BPJS
No.Reg : R041906129
Tindakan : PAC 2
Tanggal : 10-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY MAWARDAH
Tanggungan : BPJS
No.Reg : R041906146
Tindakan : PAC 3
Tanggal : 10-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 6 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Sheat FEMORAL 6FR BALTON 1 PCS KSO
21 Guide wire INQIWIRE SUNMED 1 PCS KSO
22 CATH TIG 5FR RUBYLINE 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS TERUMO 1 PCS KSO
31 Video DVD 1 PCS KSO
32 SURFLO NO 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 40 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
Pemakaian ABHP : TN ACHMADSYAH
Tanggungan : KPC
No.Reg : R041906479
Tindakan : PAC 2
Tanggal : 10-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN SYAMSUL
Tanggungan : SCHLUMBERGER
No.Reg : R041906416
Tindakan : PAC VIP
Tanggal : 10-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
35 WIRE PCI RUNTHROUGH NS FLOOPY TERUMO 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE

REUSE

LOT 181012
Pemakaian ABHP : TN YUDIANTO (08-05-1965)
Tanggungan : BPJS
No.Reg : R041906324
Tindakan : PCI 1
Tanggal : 10-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN JL 4.0 6FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 1.0X10 REVASS 1 PCS KSO
40 STENT DES ALEX 3.0X15 BALTON 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
LOT 201810007
REUSE
REUSE
REUSE

REUSE

LOT FA181012
REUSE
REUSE
LOT FA1809537
LOT 0700119
Pemakaian ABHP : TN HARIYANTO
Tanggungan : BPJS
No.Reg : R041906216
Tindakan : PAC 1
Tanggal : 10-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN YUDIANTO (03-04-1948)
Tanggungan : BPJS
No.Reg : R041907059
Tindakan : PCI 1
Tanggal : 11-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN JL 4.0 6FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.5X15 REVASS 1 PCS KSO
40 STENT DES COMBO 3.5X18 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1809508
LOT FA1809534
Pemakaian ABHP : NY NORSIAH
Tanggungan : BPJS
No.Reg : R041907059
Tindakan : PCI 1
Tanggal : 11-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN JL 4.0 6FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 2.5X15 REVASS 1 PCS KSO
40 STENT DES ALEX 2.75X22 BALTON 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1809712
LOT 1310918
Pemakaian ABHP : NY HJ SITI FATIMAH
Tanggungan : BPJS
No.Reg : R041907192
Tindakan : PAC 1
Tanggal : 11-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 6 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS OMNIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Sheat FEMORAL 6FR BALTON 1 PCS KSO
21 Guide wire INQIWIRE SUNMED 1 PCS KSO
22 CATH PERFORMA JR 6FR MERIT 1 PCS KSO
23 CATH PERFORMA JL 6FR MERIT 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
25 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
26 MANIFOLD REVASS 1 PCS KSO
27 ALKOHOL SWAB (PASTIK) 2 PCS KSO
28 GLOVE NON STERIL (REMEDI) 8 PCS KSO
29 BLOOD SET INFUS 1 PCS KSO
30 MACRO SET INFUS 1 PCS KSO
31 TR BANDS TERUMO 1 PCS KSO
32 Video DVD 1 PCS KSO
33 SURFLO NO 18 TERUMO 1 PCS KSO
34 GILLETE GOAL 0 PCS KSO
35 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
36 PLESTER/LEUCOFIX 40 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN MUHAMMAD SALENG
Tanggungan : BPJS
No.Reg : R041907828
Tindakan : PAC 3
Tanggal : 12-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS SCANLUX 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN HERY SULISTIYANTO
Tanggungan : BPJS
No.Reg : R041908667
Tindakan : PAC 1
Tanggal : 13-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS SCANLUX 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY MASNI
Tanggungan : BPJS
No.Reg : R041908670
Tindakan : PAC 3
Tanggal : 13-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS SCANLUX 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN RUSLI
Tanggungan : BPJS
No.Reg : R041908677
Tindakan : PAC 2
Tanggal : 13-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS SCANLUX 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY YORI JUNIARTI
Tanggungan : BPJS
No.Reg : R041908687
Tindakan : PAC 1
Tanggal : 13-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS SCANLUX 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN PONIMAN
Tanggungan : BPJS
No.Reg : R041908704
Tindakan : PAC 1
Tanggal : 13-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS SCANLUX 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : NY NIKMAH
Tanggungan : BPJS
No.Reg : R041909079
Tindakan : PAC 3
Tanggal : 15-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE

REUSE
REUSE
REUSE

REUSE
Pemakaian ABHP : TN EDIANSYAH
Tanggungan : PHKT
No.Reg : R041909581
Tindakan : PAC SUITE
Tanggal : 15-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
35 CATH DIAGNOSTIK PERFORMA JR 3.5 5FR MERIT 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE

REUSE

LOT I1332822
Pemakaian ABHP : TN TAHIR
Tanggungan : BPJS
No.Reg : R041909242
Tindakan : PCI 2
Tanggal : 15-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN XB 3.5 6FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.5X15 REVASS 1 PCS KSO
40 STENT DES COMBO 3.0X15 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1811678
LOT FA1811615
Pemakaian ABHP : TN CHAYALUDDIN DAUD
Tanggungan : BPJS
No.Reg : R041909380
Tindakan : PCI 1
Tanggal : 15-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 2 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN XB 3.5 6FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.0X15 REVASS 1 PCS KSO
40 STENT DES ALEX Plus 3.0X29 BALTON 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1810549
LOT 0700119
Pemakaian ABHP : NY GEBY TINEKE SUATAN
Tanggungan : BPJS
No.Reg : R041909416
Tindakan : PCI 2
Tanggal : 15-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1 BOTOL KSO
9 MASKER TIE ON 5 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 6FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE 1 PCS KSO
21 GUIDING CATH PCI ORIEN XB 3.5 6FR REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
24 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
25 MANIFOLD REVASS 1 PCS KSO
26 ALKOHOL SWAB (PASTIK) 2 PCS KSO
27 GLOVE NON STERIL (REMEDI) 8 PCS KSO
28 BLOOD SET INFUS 1 PCS KSO
29 MACRO SET INFUS 1 PCS KSO
30 TR BANDS SUNMED 1 PCS KSO
31 Video DVD 1 PCS KSO
32 Surflo No 18 TERUMO 1 PCS KSO
33 GILLETE GOAL 0 PCS KSO
34 STERIL BLADE SCALPEL NO 11 AESCULAP 1 PCS KSO
35 PLESTER/LEUCOFIX 20 CM KSO
36 WIRE PTCA RUNTHROUGH FLOOPY TERUMO 1 PCS KSO
37 BASIC INDEFLATOR BALTON 1 PCS KSO
38 ACCESSORIES KIT REVASS 1 PCS KSO
39 BALOON NC SAPPHIRE 3.5X18 REVASS 1 PCS KSO
40 STENT DES COMBO 3.5X13 REVASS 1 PCS KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE
REUSE
REUSE
REUSE
REUSE

REUSE

REUSE
REUSE
REUSE
LOT FA1810677
LOT FA1809604
Pemakaian ABHP : NY DIAN W UTAMI
Tanggungan : BPJS
No.Reg : R041910212
Tindakan : PAC 3
Tanggal : 16-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE

REUSE
Pemakaian ABHP : TN ACHMAD S
Tanggungan : BPJS
No.Reg : R041910229
Tindakan : PAC 2
Tanggal : 16-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 1 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 1 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE

REUSE
Pemakaian ABHP : TN TRIONO JATOR
Tanggungan : BPJS
No.Reg : R041910241
Tindakan : PAC 1
Tanggal : 16-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE

REUSE
Pemakaian ABHP : NY ELFA SARI
Tanggungan : PETROSEA
No.Reg : R041910641
Tindakan : PAC VIP
Tanggal : 16-Apr-19

NO ALKES DAN OBAT JUMLAH KETERANGAN

1 ALKOHOL 70% 20 ML KSO
2 BETHADINE SOL 20 ML KSO
3 NACL 0.9% 1 KOLF KSO
4 DEXTROSE 5% 0 KOLF KSO
5 HEPARIN 1 CC KSO
6 LIDOCAIN 1 AMPUL KSO
7 INJ. CEDOCARD/NTG 1 CC KSO
8 KONTRAS VISIPAGUE 1/2 BOTOL KSO
9 MASKER TIE ON 4 PCS KSO
10 TOPI OPERASI 2 PCS KSO
11 PLASTIK PENUTUP 1 PCS KSO
12 KASA 7X7 10 PCS KSO
13 GLOVE STERIL GAMMEX 6.5 2 PAIR KSO
14 GLOVE STERIL GAMMEX 7.0 0 PAIR KSO
15 DISP. SYRINGE 1CC 1 PCS KSO
16 DISP. SYRINGE 3CC 1 PCS KSO
17 DISP. SYRINGE 5CC 1 PCS KSO
18 DISP. SYRINGE 10CC 2 PCS KSO
19 Sheat TRANSRADIAL 5FR BALTON 1 PCS KSO
20 Guide wire INQIWIRE SUNMED 1 PCS KSO
21 CATH TIG 5FR RUBYLINE 1 PCS KSO
22 HIGH PRESSURE TUBING HPET 120CM REVASS 1 PCS KSO
23 HIGH PRESSURE TUBING HPET 60CM REVASS 1 PCS KSO
24 MANIFOLD REVASS 1 PCS KSO
25 ALKOHOL SWAB (PASTIK) 2 PCS KSO
26 GLOVE NON STERIL (REMEDI) 8 PCS KSO
27 BLOOD SET INFUS 1 PCS KSO
28 MACRO SET INFUS 1 PCS KSO
29 TR BANDS SUNMED 1 PCS KSO
30 Video DVD 1 PCS KSO
31 SURFLO NO 18 TERUMO 1 PCS KSO
32 GILLETE GOAL 0 PCS KSO
33 STERIL BLADE SCALPEL NO 11 AESCULAP 0 PCS KSO
34 PLESTER/LEUCOFIX 20 CM KSO
VISIPAGUE 320MG/100ML
OMNIPAGUE 350MG/100ML
SCANLUX 300MG/100ML
KETERANGAN

REUSE