163 hiosina butilbromida tab 10 mg 400 3,000

164 human insulin long acting 150 300

165 human insulin mix insulin 100 -

166 human insulin short acting 150 300

167 human tetanus imunoglobulin inj 250 UI (i.m.) 300

168 human tetanus imunoglobulin inj 500 UI (i.m.)

169 ibuprofen sir 100 mg/5 mL 750 200

170 ibuprofen tab 400 mg 30,000 5,000

171 imidapril tab 5 mg 100 3,000

172 ipratropium bromida ih padat 20 mg -

173 ipratropium bromida nebulizer 0,025% 400

174 irbesartan tab 150 mg 500 5,000

175 isoniazid tab 100 mg -

176 isoniazid tab 300 mg 500 -

177 isosorbid dinitrat inj 10 mg/10 mL (i.v.) 50 200

178 isosorbid dinitrat tab 5 mg 1,000 5,000

179 kalium aspartat tab 300 mg 250 2,000

180 kalium klorida tab siap larut 300 mg -

181 kalium klorida tab 600 mg 1,000 7,000

182 kalsium glukonat inj 100 mg/mL 75 75

183 kalsium glukonat inj 100 mg/mL

184 kalsium hidroksida bubuk, pasta 10 -

185 kalsium karbonat tab 500 mg 1,500 5,000

186 kalsium laktat (kalk) tab 500 mg 3,000 2,000

187 kandesartan tab 16 mg 750 3,000

188 kandesartan tab 8 mg 750 3,000

189 kaptopril tab 12,5 mg 500 5,000

190 kaptopril tab 25 mg 2,000 7,000

191 kaptopril tab 50 mg 250 -

192 karbamazepin tab 200 mg 2,000 10,000

193 karbogliserin tts telinga 10 % 150 150

194 ketokonazol tab 200 mg 500 5,000

195 ketokonazol krim 2% 5 gr 250 250

196 ketoprofen sup 100 mg 1,940 300

197 ketorolak inj 30 mg/mL 600 600

198 klindamisin kaps 150 mg 500 3,000

199 klindamisin kaps 300 mg 500 3,000

200 klobazam tab 10 mg 250 5,000

201 klomifen sitrat tab 50 mg 100 -

202 klonidin tab 0,15 mg 500 3,000

203 klopidogrel tab 75 mg 1,000 7,000

204 kloral hidrat lar 25 -

205 kloramfenikol tts mata 1% 250 250

206 kloramfenikol kaps 500 mg 500 -

207 kloramfenikol salep kulit 2% 250 250

208 kloramfenikol salep mata 1% 250 -

209 kloramfenikol susp 125 mg/5 mL 250 250

210 klorfeniramin (CTM) tab 4 mg 2,000 5,000

211 klorfenol kamfer mentol (CHKM) 3 -

212 klorpromazin inj 25 mg/mL (i.m.) -

213 klorpromazin inj 5 mg/mL (i.m.) -

214 klorpromazin inj 5 mg/mL (i.m.)

215 klorpromazin tab 25 mg 100 -

216 klorpromazin tab sal 100 mg 250 -

217 kodein tab 10 mg 2,500 -

218 kolekalsiferol (vitamin D3) kaps lunak 0,25 mcg 3,000 -

219 kolekalsiferol (vitamin D3) kaps lunak 0,5 mcg

220 koloid HES BM 130 000 lar inf 6% 250

221 500 7,000

222 200 -

223 kombinasi : ergotamin 1 mg + kafein 50 mg 500 5,000

224 5,000 5,000

225 2,000

226 kombinasi : ipratropium bromida 0,5 mg + salbutamol 2,5 mg Solution 0,025% 300

227 200 -

228 kombinasi : medroksi progesteron asetat + estradiol sipionat inj depot 25 mg + 5 mg 500 -

229 500

230 250 5,000

231 komposit resin 100 -

232 1,000 5,000

233 250 250

234 kuinin inj 25% (i.v.) 25 25

235 kuinin tab 200 mg 500 500

236 kuinin tab 222 mg -

237 laktulosa sir 3,335 g/5 mL 100 100

238 lansoprazol inj 30 mg/mL 100 200

239 lansoprazol kaps 30 mg 500 10000

240 levofloksasin inf 5 mg/mL 100 100

241 levofloksasin tab 500 mg 250 1,500

242 levonorgestrel implan 2 rods, 75 mg (3-4 tahun) 30 -

243 levotiroksin tab 100 mcg 750 1,000

244 lidokain cairan semprot 10% 25 -

245 lidokain gel 2% 100 300

246 lidokain HCl 2% + epinefrin 1 : 80.000 inj 2 mL 500 10,000

247 lidokain inj 100 mg, vial (i.v.) -

248 lidokain inj 2% (HCl) 500 -

249 lidokain inj 2% (infiltr/p.v.) 4,500 -

250 lidokain pasta 5% (HCl) 100 -

251 lisinopril tab 10 mg 200 3,000

252 lisinopril tab 5 mg 250 7,000

253 loperamid tab 2 mg 250 5,000

254 lorazepam tab 1 mg 100 500

255 magnesium sulfat inj 40% 50 200

256 manitol lar infus 20% 50 5,000

257 mecobalamin 500 mg -

258 medroksi progesteron asetat inj depo 150 mg 500 -

259 medroksi progesteron asetat tab 5 mg -

260 meloxicam 7,5mg 3,000 10,000

261 Meloxicam 15mg 10,000

262 metformin tab 500 mg 15,000 10,000

263 metilergometrin inj 0,2 mg/mL 100 200

264 metilergometrin tab salut 0,125 mg 400 1,000

265 metilprednisolon inj 125 mg/vial 100 100

266 metilprednisolon tab 16 mg -

267 metilprednisolon tab 4 mg 2,000 2,000

268 metilprednisolon tab 4 mg 2,000

269 metoklopramid inj 5 mg/mL 100 200

kombinasi : benserazid 25 mg + levodopa 100 mg tab kombinasi : desogestrel 150 mcg + etinilestradiol 30 mcg kombinasi : ferro sulfat 200 mg + asam folat 0,25 mg kombinasi : ferro sulfat 200 mg + asam folat 0,25 mg, tab salut

kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg kombinasi: ipratropium Br 0,5 mg + Salbutamol 2,5 mg, Nebules kombinasi: kaolin 550 mg + pektin 20 mg

kotrimoksazol 480 mg kotrimoksazol susp 240 mg

270 metoklopramid sir 5 mg/5 mL 100 -

271 metoklopramid tab 5 mg 250 5,000

272 metronidazol lar inf 5 mg/mL 100 200

273 metronidazol lar infus 5 mg/mL 250

274 metronidazol ovula 500 mg 250 -

275 metronidazol tab 500 mg 3,000 5,000

276 metronidazol tab 500 mg 5,000

277 mikonazol krim 2% 250 250

278 Misoprostol 0.2 mg -

279 nalokson inj 0,4 mg/mL -

280 n-asetil sistein ih 100 mg/mL -

281 n-asetil sistein kaps 200 mg 1,000 3,000

282 natrium bikarbonat inj 8,4% (i.v.) 100 100

283 natrium diklofenak tab 25 mg 1,250 15,000

284 natrium diklofenak tab 50 mg 3,750 15,000

285 natrium fusidat krim 20 mg/g 50 -

286 natrium tiosulfat inj 25% (i.v.) -

287 nifedipin kaps 10 mg 500 -

288 nifedipin tab SR 30 mg 25,000

289 nikotinamid tab 100 mg -

290 nikotinamid tab 20 mg -

291 nikotinamid tab 5 mg 3,000 -

292 nistatin susp 100.000 UI/mL 250 300

293 nistatin susp 100.000 UI/mL 50

294 nistatin tab salut 500.000 UI 250 1,000

295 norepinefrin inj 1 mg/mL 50 100

296 Norestisteron 5mg -

297 ofloksasin tts telinga 3% 250 100

298 oksimetazolin tts hidung 0,025% 50 50

299 oksimetazolin tts hidung 0,050% -

300 oksitetrasiklin HCl inj 50 mg/mL (i.m.) -

301 oksitosin inj 10 UI/mL 250 500

302 olopatadin tts mata 0,1% 100 -

303 omeprazol inj 40 mg/10 mL 100 -

304 omeprazol kaps 20 mg 1,000 10,000

305 ondansetron inj 2 mg/mL 250 5,000

306 ondansetron tab 4 mg 500 5,000

307 ondansetron tab 8 mg 500 5,000

308 parasetamol drips (infus) 1000 mg/100 mL -

309 parasetamol sir 120 mg/5 mL 750 3,000

310 Parasetamol supp 500

311 parasetamol tab 500 mg 30,000 30,000

312 parasetamol tts 60 mg/0,6 mL 375 1,000

313 perak nitrat lar 20% 50 -

314 perak sulfadiazin krim 1% 50 -

315 permetrin krim 5 % 50 100

316 piracetam inj 3 gr 100 300

317 piracetam tab 800 mg 500 10,000

318 piracetam 1200mg 10,000

319 pirantel pamoat susp 125 mg/5 mL 150 200

320 pirantel pamoat tab scored 125 mg 300 5,000

321 pirazinamid tab 500 mg 500 -

322 piridoksin (vitamin B6) inj 100 mg/mL -

323 piridoksin (vitamin B6) tab 10 mg 3,000 5,000

324 piridoksin (vitamin B6) tab 25 mg -

325 polietilen glikol 100 50

326 polikresulen lar 100

327 povidon iodin lar 100 mg/mL 1 liter 10,000 700

328 prednison tab 5 mg 1,000 5,000

329 Pregabalin 7,000

330 probenesid tab 500 mg -

331 propiltiourasil tab 100 mg 1,500 8,000

332 propranolol tab 10 mg 200 5,000

333 propranolol tab 10 mg 550

334 propranolol tab 10 mg 500

335 propranolol tab 40 mg 550 7,000

336 ramipril tab 2,5 mg 300 7,000

337 ramipril tab 5 mg 300 7,000

338 ranitidin inj 25 mg/mL 100 7,000

339 ranitidin tab 150 mg 1,000 20,000

340 retinol (vitamin A) kaps lunak 100.000 UI -

341 retinol (vitamin A) kaps lunak 200.000 UI -

342 rifampisin kaps 300 mg 500 pasien -

343 rifampisin kaps 450 mg -

344 risperidon tab sal 2 mg 250 3,000

345 salbutamol cairan ih 0,1%

346 salbutamol lar ih 0,5 %

347 salbutamol nebules vial 2,5 mg 500 1,500

348 salbutamol serb ih 200 mcg/kaps + rotahaler

349 salbutamol tab 2 mg 2,000 7,000

350 salbutamol tab 4 mg 7,000

351 sefadroksil kaps 500 mg 2,000 25,000

352 sefadroksil sir kering 125 mg/5 mL 500 500

353 sefaleksin kaps 500 mg -

354 sefepim serb inj 1000 mg/vial 500

355 sefiksim sir 100 mg/5 mL 150 200

356 sefiksim tab 100 mg 500 3,000

357 sefotaksim serb inj 1.000 mg/vial 1,500 7,000

358 seftazidim serb inj 1.000 mg/vial 200 200

359 seftriakson serb inj 1.000 mg/vial 1,500 7,000

360 seftriakson serb inj 750 mg/vial -

361 seftriakson tab sal 500 mg -

362 serum anti bisa ular inj 5

363 serum antirabies inj 200 UI/mL 5

364 serum antitetanus (A.T.S)inj 1500 UI/amp (i.m.) 500

365 serum antitetanus (A.T.S)inj inj 10.000 UI/vial (i.m /i.v.)

366 serum antitetanus (A.T.S)inj inj 20.000 UI/vial (i.m /i.v.)

367 setirizin tab 10 mg 1,000 10,000

368 setirizin sir 5 mg/5 mL 300 300

369 sianokobalamin (vitamin B12) inj 500 mcg/mL 500 5,000

370 sianokobalamin (vitamin B12) tab 50 mcg 20,000 10,000

371 sianokobalamin (vitamin B12) tab 50 mcg 3,000

372 simvastatin tab sal 10 mg 500 5,000

373 siprofloksasin inf 2 mg/mL 100 200

374 siprofloksasin tab scored 500 mg 2,000 25,000

375 spironolakton tab 25 mg 5,000 7,000

376 streptomisin serb inj 1000 mg/vial 50

377 sukralfat susp 500 mg/5 mL 100 300

378 sukralfat tab 500 mg 500 3,000

379 teofilin tab 150 mg 1,500 5,000

380 terazosin HCl tab 1 mg 500 3,000

381 terbutalin tab 2,5 mg 1,000 3,000

382 testosteron inj 250 mg/mL -

383 tetanus toxoid inj 100 100

384 tetrakain tts mata 0,5% 20 100

385 tetrasiklin kaps 250 mg 500 5,000

386 tetrasiklin kaps 500 mg 500 -

387 tiamazol tab 5 mg 750 3,000

388 tiamin (vitamin B1) tab 50 mg 3,000 7,000

389 tramadol inj 50 mg/mL 600 5,000

390 triamsinolon asetonid nasal spray 55 mcg/puff 50 50

391 triheksifenidil tab 2 mg 500 10,000

392 vaksin BCG inj

393 vaksin campak inj

394 vaksin jerap difteri tetanus pertusis (DTP) inj

395 vaksin jerap difteri tetanus (DT) inj

396 vaksin jerap tetanus (tetanus adsorbed toxoid) inj

397 vaksin kombinasi DPT + hepatitis B inj

398 vaksin polio cairan steril 10 dosis

399 vaksin polio drops 10 dosis

400 vaksin rabies serb inj + bososter

401 valproat sir 250 mg/5 mL 30 100

402 valproat tab SR 250 mg 1,500 3,000

403 valproat tab SR 500 mg 3,000

404 valsartan tab 80 mg 500 5,000

405 verapamil tab 80 mg 500 3,000

406 verapamil tab 80 mg 250

407 vitamin B kompleks tab 3,000 15,000

408 warfarin tab 1 mg 7,000

409 zinc sir 20 mg/5 mL 250 500

410 zinc tab disp 20 mg 500 5,000

411 zinc sir 10 mg/mL 500 300

Laxadin syrup 60ml 500 klorampenicol tts telinga 300 bismecon gel 500 Glukosa 40% 500 RL

NaCl

glukosa 5%

Glukosa 10%

Gentamisin SK 300 hemafort

No Nama Obat/AlkesJumlah

APBD DAK BPJS

1 Spuit 1cc IFRS 1,624 10,000 2 Spuit 3cc IFRS 1,824 15,000 3 Spuit 5 cc IFRS 1,424 10,000 4 Spuit 10cc IFRS 624 - 5 Spuit 20cc IFRS 624 - 6 Spuit 50cc IFRS 624 - 7 Infus set Anak IFRS 1,624 5,000 8 Infus set Dewasa IFRS 1,224 5,000 9 Transfusion set IFRS 1,224 50 10 NGT No.5 IFRS 1,224 100 11 NGT No. 8 IFRS 824 200 12 NGT No. 10 IFRS 824 200 13 NGT No. 12 IFRS 824 100 14 NGT No. 16 IFRS 824 200 15 NGT No 18 IFRS 824 200 16 IV. Chateter No. 16 IFRS 1,024 500 17 IV. Catheter No. 18 IFRS 824 500 18 IV. Catheter No. 20 IFRS 824 3,000 19 IV. Catheter No. 22 IFRS 824 3,000 20 IV. Catheter No. 24 IFRS 824 5,000 21 IV. catheter No. 26 IFRS 824 1,000 22 Handscoon steril (No. 6, 7, 8 ) IFRS 3,228 20,000 23 Handscoon non steril (ear loop, tie on) IFRS 3,228 20,000 24 Folley Catheter No. 12 IFRS 1,224 200 25 Folley catheter No. 16 IFRS 1,224 200 26 Folley Catheter No. 18 IFRS 1,224 200 27 Kapas Pembalut IFRS - 300 28 Kassa hidrofi luk. 36x40cm IFRS 1,628 1,000 29 Kassa hidrofil uk. 2x80 cm IFRS 1,628 1,000 30 Kassa hidrofil uk. 4x15 cm IFRS 1,628 5,000 31 Kassa hidrofil uk. 3x4cm IFRS 1,628 5,000 32 Kassa steril uk. 16x16cm IFRS 1,628 5,000 33 Catqut Plain No. 2/0 IFRS 636 200 34 Catqut Plain No. 3/0 IFRS 636 200 35 CatqutCromic No. 2/0 IFRS 636 200 36 CatqutCromic No. 3/0 IFRS 636 200 37 CatqutCromic No. 4/0 IFRS 636 50 38 Silk No. 2/0 IFRS 636 100 39 Silk No. 3/0 IFRS 636 300 40 Urine bag IFRS 824 200 41 Plester IFRS 824 30,000 42 Alkohol Swab IFRS 824 5,000 43 Glass Ukur 100mL IFRS - 5 44 Antiseptic surgical hand scrub IFRS 150 200 45 IV. Dressing IFRS - 100 46 catheter Gel IFRS 150 - 47 plester ZnO IFRS - - 48 Plester Elastis (Elastis Perban) IFRS 200 10 49 Plester Sutera IFRS 200 - 50 Plester Rayon IFRS 200 - 51 Plester Plastik IFRS 200 - 52 Plester Plastik Waterprof IFRS 200 100 53 Suction chateter IFRS 140 200 54 wing needle IFRS 464 500 55 Nald IFRS 1,600 500 56 Scalpel Blade IFRS 624 2 57 Sofratulle Dr. Desi 624 - 58 Kondom Cateter Dr. Desi - 500 59 Kertas EKG dr. Ismail 20 100 60 Cat gut Plain Caset dr. Ismail 20 3 61 Cat gut Cromic Caset dr. Ismail 20 3 62 Larutann Clorin 500 ml drg. Arie 360 200 63 Currasponge drg. Arie 360 200 64 Paper plate drg. Arie 100 50 65 Matrik Strip drg. Arie 100 50 66 Spuit Insulin IFRS 100 2,000 67 Nald Insulin IFRS 1,500 5,000 68 Antiseptik Clorhexidine 500 ml IFRS 650 300 69 Cangkang Kapsul (0, 00, 000) IFRS 1000,1000,1000 70 Pot Salep IFRS 500 71 Masker IFRS 10,000 72 Pulverizer IFRS 5,000 73 Sealing Equitment IFRS 1 74 Plastik Spoon IFRS 2 75 Medicine Pocket / Kertas Perkamen IFRS 1,000 76 Aquadest IFRS - 77 Gelang Identitas (pink, biru muda, orange, merah) IFRS 1000,1000,1000,1000 78 Apron Kebidanan 10 79 Under Pad Kebidanan 100 80 USG Gel Kebidanan 20 81 Handscoon Panjang Kebidanan 100 82 Handscoon Rumah Tangga Kebidanan 100 83 Umbilical Cord Klem Steril Nylon Kebidanan 100

Jumlah berdasarkan

KOMITE MEDIK

Perencanaan Jumlah

kebutuhan 18 Bulan

84 Film Rontgen uk. 24x30 Rontgen85 Film Rontgen uk. 30x40 Rontgen86 Larutan Fixer dan Developer Rontgen87 Tissue LAB 150 gulung 88 Tempat limbah infeksius padat LAB 12 89 Tempat limbah infeksius cair LAB 12 90 Larutan Steril ( Bayclin/Lisol) LAB 12 91 Antiseptic Hand srubs LAB 12 92 Vacutainer Vacum EDTA LAB 12 93 Vacutainer Vacum Plain LAB 800 94 Thermal Paper LAB 15 rol 95 Blue Tip LAB 10,000 96 Yellow Tip LAB 10,000 97 Sputum cup LAB 500 98 Faeces cup LAB 500 99 Urine cup LAB 500 100 Glukosa Strip LAB 1,000 101 Hemoglobin strip LAB 500 102 Narkoba Test 5 parameter LAB 500 103 Urine strip LAB 500 104 Spirtus LAB 5 105 Diluent 10L LAB 6 106 Lyse 960ml LAB 4 107 Cleaner 960ml LAB 12 108 Blood Kontrol/calibrator LAB 4 109 Serum Kontrol (Kimia Darah) LAB 4 110 Reagen Ureum LAB 4 111 Reagen Kreatinin LAB 4 112 Reagen Asam Urat LAB 4 113 Reagen Kholesterol LAB 3 114 Reagen Triglyserida LAB 3 115 Reagen HDL Kholesterol LAB 3 116 Reagen Bilirubin T/D LAB 2 117 Reagen SGOT/AST LAB 4 118 Reagen SGPT/ALT LAB 4 119 Reagen Glukosa LAB 4 120 Reagen Total Protein LAB 2 121 Reagen Albumin LAB 2 122 Reagen Gamma GT LAB 2 123 Reagen Alkali Phosphate LAB 2 124 Reagen Dengue IgG/IgM LAB 50 125 Reagen HbsAg Test LAB 10 126 Reagen Widal O LAB 4 127 Reagen Widal AO LAB 4 128 Reagen Widal BO LAB 4 129 Reagen Widal CO LAB 4 130 Reagen Widal H LAB 4 131 Reagen Widal AH LAB 4 132 Reagen Widal BH LAB 4 133 Reagen Widal CH LAB 4 134 Reagent HCG Test strip (test Kehamilan) LAB 100 135 Reagen Golongan Darah Anti - A LAB 2 136 Reagen Golongan Darah Anti - B LAB 2 137 Reagen Golongan Darah Anti - AB LAB 2 138 Reagen Golongan Darah Anti - O LAB 2 139 Reagen Eosin 2% btl @100ml LAB 2 140 Reagen Giemsa LAB 2 141 Reagen Buffer giemsa LAB 5 142 Reagen Lar.Karbol Fuchsin LAB 5 143 Reagen Lar. Metilen Blue LAB 5 144 Reagen Alkohol Asam LAB 5 145 Reagen Gentian Violet LAB 5 146 Reagen Metanol LAB 5 147 Reagen Hcl 0,1 N LAB 3

1 Ambroxol syr 15mg/ml 2,000

2 Ambroxol tab 30mg 15,000

3 asam fusidat krim 3% 5,000

4 asam salisilat salep 5% 50 50

5 asam traneksamat tab 500 mg 4,000 7,000

6 betahistin 3,000 10,000

7 bisakodil tab sal 5 mg 200 5,000

8 citicholine inj 250 mg 250 500

9 citicholine inj 500 mg 250 500

10 citicholine tab 500 mg 500 10,000

11 coal tar lar 5 % 50 50

12 diazepam tab 5 mg 500 1,000

13 epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) 200 200

14 ergotamin tab 1 mg 500 3,000

15 etil klorida semprot 100 mL 20 100

16 fenobarbital tab 30 mg 500 5,000

17 ferro sulfat tab salut 300 mg 1,500 3,000

18 glucosamin 500mg 750 5,000

19 hidroklorotiazid tab 25 mg 2,000 2,000

20 kalsium karbonat tab 500 mg 1,500 5,000

21 kloramfenikol tts mata 1% 250 250

DS. 10 x 10 21,298

1 rondo @ 5 amp 60,000 1 rondo @ 5 amp 120,000 3 strip @ 10 tab 198,000

No Nama Obat/Alkes

1 Vacutainer Vacum EDTA LAB 12 2 Vacutainer Vacum Plain LAB 800 3 Thermal Paper LAB 15 rol 4 Blue Tip LAB 10,000 5 Yellow Tip LAB 10,000 6 Sputum cup LAB 500 7 Faeces cup LAB 500 8 Urine cup LAB 500 9 Glukosa Strip LAB 1,000 10 Hemoglobin strip LAB 500 11 Narkoba Test 5 parameter LAB 500 12 Urine strip LAB 500 13 Spirtus LAB 5 14 Diluent 10L LAB 6 15 Lyse 960ml LAB 4 16 Cleaner 960ml LAB 12 17 Blood Kontrol/calibrator LAB 4 18 Serum Kontrol (Kimia Darah) LAB 4 19 Reagen Ureum LAB 4 20 Reagen Kreatinin LAB 4 21 Reagen Asam Urat LAB 4 22 Reagen Kholesterol LAB 3 23 Reagen Triglyserida LAB 3 24 Reagen HDL Kholesterol LAB 3 25 Reagen Bilirubin T/D LAB 2 26 Reagen SGOT/AST LAB 4 27 Reagen SGPT/ALT LAB 4 28 Reagen Glukosa LAB 4 29 Reagen Total Protein LAB 2 30 Reagen Albumin LAB 2 31 Reagen Gamma GT LAB 2 32 Reagen Alkali Phosphate LAB 2 33 Reagen Dengue IgG/IgM LAB 50 34 Reagen HbsAg Test LAB 10 35 Reagen Widal O LAB 4 36 Reagen Widal AO LAB 4 37 Reagen Widal BO LAB 4 38 Reagen Widal CO LAB 4 39 Reagen Widal H LAB 4 40 Reagen Widal AH LAB 4 41 Reagen Widal BH LAB 4 42 Reagen Widal CH LAB 4 43 Reagent HCG Test strip (test Kehamilan) LAB 100 44 Reagen Golongan Darah Anti - A LAB 2

Jumlah berdasarkan

KOMITE MEDIK

Perencanaan Jumlah

kebutuhan 18 Bulan

45 Reagen Golongan Darah Anti - B LAB 2 46 Reagen Golongan Darah Anti - AB LAB 2 47 Reagen Golongan Darah Anti - O LAB 2 48 Reagen Eosin 2% btl @100ml LAB 2 49 Reagen Giemsa LAB 2 50 Reagen Buffer giemsa LAB 5 51 Reagen Lar.Karbol Fuchsin LAB 5 52 Reagen Lar. Metilen Blue LAB 5 53 Reagen Alkohol Asam LAB 5 54 Reagen Gentian Violet LAB 5 55 Reagen Metanol LAB 5 56 Reagen Hcl 0,1 N LAB 3

Jumlah

APBD DAK BPJS

DAFTAR OBAT-OBATAN DAN BAHAN MEDIS HABIS PAKAI

YANG MENGALAMI KEKOSONGAN

No. Nama Obat Keterangan1 Alopurinol tab 100 mg

2 Ambroxol syr 15mg/ml

3 Amlodipin tab 10 mg

4 Amlodipin tab 5 mg

5 Antasida susp

67 Asam Traneksamat tab 500 mg

8 Asiklovir krim 5%

9 Citicholine inj 250 mg10 Citicholine inj 500 mg11 Citicholine tab 500 mg12 Diazepam lar rektal 5 mg/2,5 mL

13 Diazepam tab 5 mg

14 Fitomenadion (vitamin K 1) inj 2 mg/mL (i.m.)

15 Human Tetanus Imunoglobulin inj 250 UI (i.m.)

16 Karbamazepin tab 200 mg

17 Kloramphenicol Tetes Telinga

18 Kodein tab 10 mg

19 Lidokain HCl 2% + epinefrin 1 : 80.000 inj 2 mL

20 Lidokain inj 2% (HCl)

21 Oksitosin inj 10 UI/mL

22 Ondansetron inj 2 mg/mL

23 Parasetamol tts 60 mg/0,6 mL

24 Phenitoin Kapsul 100 mg

25 Pehavral

26 Ranitidin inj 25 mg/mL

27 Salbutamol tab 2 mg

28 Sefotaksim serb inj 1.000 mg/vial

29 Seftriakson serb inj 1.000 mg/vial

30 Trihexylphenidil tab 2 mg

31 Meloxicam 15 mg32 Metformin tab 500 mg

Bahan Medis Habis Pakai33 Spuit 1cc

34 Spuit 3cc

35 Spuit 5 cc

36 IV. Catheter No. 22

37 IV. Catheter No. 24

38 IV. Catheter No. 26

39 Plester

40 Etanol 70% 1 liter (Alkohol)

41 Infus set Anak

42 Infus set Dewasa

43 Kasa Hydrophil 40 x 80 cm

44 Surgical Gloves Non Steril

45 Surgical Mask

Indralaya, 08 September 2015

Direktur RSUD Kab. Ogan Ilir,

drg. Hj. Irma Novianty, M. Kes

NIP. 196811151999032003

Antihemoroid Supp Kombinasi