RENCANA KERJA ANGGARAN

Pengkajian Keperawatan Pasien Tahap Terminal RM 5 E Hal 1/2 Pengkajian Keperawatan Pasien Hemodialisa RM 5 F Hal 1/4 Pengkajian Keperawatan Pasien Hemodialisa RM 5 F Hal 3/4

Permintaan Konsul Jawaban Konsul RM 12 A (RM 059-Page I) Asesmen Ulang Tanda - tanda & Ulang Nyeri RM 8 F Hal 1/2 Pengkajian Keperawatan Pasien Ranap Usia 14 Tahun RM 5 G Hal 1/4 Pengkajian Keperawatan Pasien Ranap Usia 14 Tahun RM 5 G Hal 3/4

Satuan Tarif/Harga 5 5.1 5.1.02 2,158,721,435 5.1.02.01 5.1.02.01.01 188,023,000 375 BUNGKUS 20,000 7,500,000 540 KOTAK 32,000 17,280,000 752 BUNGKUS 5,000 3,760,000 752 BUNGKUS 25,000 18,800,000 556 BUNGKUS 15,000 8,340,000 375 KG 35,000 13,125,000 40 BUAH 25,000 1,000,000 500 BUNGKUS 15,000 7,500,000 33,850 BUAH 3,000 101,550,000 11,280 BUAH 600 6,768,000 100 KOTAK 20,000 2,000,000 10 KG 40,000 400,000 5.1.02.01.01.0010 129,500,000 148 Tabung 875,000 129,500,000 5.1.02.01.01.0043 1,841,198,435 8,766 kg 13,110 114,922,260 500 kotak 3,729 1,864,500 1,504 kg 15,952 23,991,808 735 kotak 11,495 8,448,825 30,000 butir 1,499 44,970,000 752 kotak 67,276 50,591,552 40 kotak 76,433 3,057,320 26 kotak 186,000 4,836,000 120 bungkus 261,250 31,350,000 1,000 sachet 18,295 18,295,000 6 kg 143,629 861,774 1,500 kg 14,520 21,780,000 3,000 kg 36,300 108,900,000 375 kg 36,300 13,612,500 800 kg 135,600 108,480,000 565 kg 118,650 67,037,250 7,500 kg 55,000 412,500,000 150 kg 35,000 5,250,000 150 kg 35,000 5,250,000 1,503 buah 7,910 11,888,730 940 kg 9,200 8,648,000 500 kg 43,700 21,850,000 730 kg 48,345 35,291,850 270 kg 58,520 15,800,400 470 kg 8,050 3,783,500 3,200 batang 2,200 7,040,000 12,532 potong 1,243 15,577,276 600 kg 7,840 4,704,000 11,300 buah 1,130 12,769,000 200 buah 22,000 4,400,000 3,759 kg 16,950 63,715,050 750 kg 4,500 3,375,000 1,000 sisir 19,550 19,550,000 816 kg 19,550 15,952,800 PISANG BARANGAN BUAH PIR LABU KUNING SEMANGKA MERAH @ 5KG/BUAH SEMANGKA KUNING@3KG TAHU OYONG / GAMBAS LABU JIPANG BAWANG PUTIH (KUPAS) DAUN SOP / PREI TEMPE TOMAT CABE MERAH BAWANG MERAH (KUPAS) BAKSO AYAM SOSIS AYAM KELAPA DAGING SAPI ( HAS ) DAGING SAPI (SOP) IKAN LAUT SEGAR MINYAK GORENG KEMASAN DAGING AYAM NUGGET AYAM SUSU BUBUK BLENDERA @1,25 KG SUSU ENSURE VANILLA MINYAK / CORN OIL TROPICANA SLIM 1 LITER/KG SUSU BUBUK ISOCAL 400 GR SUSU BUBUK SGM GAIN 100 400 GR SUSU SKIM TROPICANA SLIM 1000 GR GULA PUTIH TEPUNG MAIZENA 100 GR TELUR AYAM Belanja Bahan Makan Pokok Pasien [-] Belanja Kebutuhan Makan Minum Pasien BERAS IR 64 BUBUK TEH BENDERA 50 GR Belanja Bahan-Isi Tabung Gas [#] Belanja Pengisian Tabung Gas [-] Belanja Pengisian Tabung Gas ELPIJI GAS ELPIJI 50 KG / TABUNG PEMANTIK API GELAS CUP PLASTIK ( 1 bungkus isi 50 buah) KOTAK NASI KOMPLIT KOTAK STREOFOM SARUNG TANGAN DISPOSABLE KARET GELANG SUNLIGHT 400 ml (refil) PLASTIK WRAF Uk. 300 mm x 30 m TISSUE MAKAN PLASTIK PULUT UKURAN KECIL SENDOK MAKAN PLASTIK PLASTIK UKURAN 1/4 KG Belanja Barang Pakai Habis [-] Belanja BHP Instalasi Gizi BELANJA DAERAH BELANJA OPERASI Belanja Barang dan Jasa Belanja Barang Kode Rekening Uraian Rincian Perhitungan jumlah Volume Masukan Dana yang dibutuhkan Rp 65,000,000,000 Keluaran terlaksananya Operasional RS 1 tahun RENCANA KERJA ANGGARAN (RKA) BLUD 2022 Indikator Tolak Ukur Kinerja Target Kinerja Capaian Program Hasil - -

750 kg 33,900 25,425,000 600 kg 19,210 11,526,000 750 kg 49,500 37,125,000 12 kg 50,000 600,000 988 kg 16,950 16,746,600 56,700 buah 3,025 171,517,500 5,840 buah 8,349 48,758,160 100 sachet 8,470 847,000 513 kg 4,600 2,359,800 260 kg 6,900 1,794,000 742 kg 14,520 10,773,840 1,150 kg 9,040 10,396,000 1,500 ikat 3,450 5,175,000 2,570 ikat 1,150 2,955,500 500 kg 8,050 4,025,000 700 kg 8,050 5,635,000 125 kg 28,250 3,531,250 520 kg 4,600 2,392,000 550 kg 9,200 5,060,000 180 kg 13,800 2,484,000 210 kg 27,120 5,695,200 180 kg 45,200 8,136,000 12 kg 22,000 264,000 290 kg 9,040 2,621,600 400 kg 9,040 3,616,000 50 kg 2,825 141,250 290 kg 9,040 2,621,600 275 kg 9,200 2,530,000 275 kg 11,300 3,107,500 275 kg 28,250 7,768,750 275 kg 9,040 2,486,000 275 kg 25,990 7,147,250 275 kg 10,350 2,846,250 275 kg 10,170 2,796,750 275 kg 16,950 4,661,250 275 kg 12,000 3,300,000 275 kg 16,950 4,661,250 8 kg 112,932 903,456 60 kg 24,200 1,452,000 75 kg 26,620 1,996,500 375 botol 20,000 7,500,000 375 bungkus 20,000 7,500,000 650 sachet 1,210 786,500 39 kg 59,840 2,333,760 123 kg 80,500 9,901,500 2,000 butir 509 1,018,000 170 kg 54,240 9,220,800 129 kg 20,700 2,670,300 30 kg 56,500 1,695,000 13 kg 155,375 2,019,875 30 kg 55,000 1,650,000 6 kg 80,000 480,000 150 kg 12,100 1,815,000 1,027 ikat 18,645 19,148,415 40 buah 9,944 397,760 200 kg 6,780 1,356,000 26 kg 27,830 723,580 8 kg 41,745 333,960 62 kg 40,250 2,495,500 3 kg 63,250 189,750 3 kg 150,000 450,000 5 kg 45,000 225,000 7 kg 80,000 560,000 2 kg 180,000 360,000 25 buah 6,215 155,375 60 kg 45,200 2,712,000 37 kg 10,000 370,000 37 kg 34,182 1,264,734 100 kg 24,860 2,486,000 100 kg 9,944 994,400 1,410 buah 1,130 1,593,300 1,000 sachet 1,243 1,243,000 1,100 bungkus 14,690 16,159,000 KENCUR 10 kg 18,645 186,450 JERUK NIPIS ROYCO GARAM HALUS UK.500GR/BUNGKUS GULA MERAH JAHE LENGKUAS SODA KUE BAWANG GORENG MASAK KERUPUK KAYU MANIS PALA BULAT CENGKEH KEMIRI KAPULAGA BUNGA LAWANG JAGUNG MANIS ASAM POTONG ASAM JAWA TEPUNG TERIGU DAUN - DAUNAN ( SERE,D.JERUK,D.KUNYIT,D.SALAM ) BELACAN / TERASI BUBUK MERICA BUBUK KUNYIT BUBUK JINTAN CUMI - CUMI CABE IJO BUBUK KETUMBAR CABE RAWIT UDANG SEGAR TELUR PUYUH SAOS TOMAT KECAP MANIS REFIL KECAP MANIS SACHET IKAN TERI NASI KACANG TANAH UDANG KECEPE MELON ( JUS ) GUAVA ( JUS ) BUAH NAGA (JUS ) TERONG BELANDA ( JUS ) TIMUN ( JUS ) BELIMBING (JUS) JERUK PERAS ( JUS ) MARKISA ( JUS ) WORTEL ( JUS ) KOL BROKOLI TOMAT ( JUS ) MAKARONI BUNGA KOL BUNCIS MELINJO JANTEN ERCIS SELADA TIMUN SAWI IJO KANGKUNG TAUGE KACANG PANJANG KENTANG (KUPAS) WORTEL BAYAM BLUEBAND SACHET SAWI PUTIH SAWI PAHIT BUAH NAGA KUE SNACK PASIEN ( UNTUK SMUA KELAS ) KUE SNACK PASIEN ( UNTUK KELAS S.VIP / SR ) APEL FUJI SUNKIST ANGGUR JERUK MANIS

37 kg 22,600 836,200 75 botol 8,000 600,000 400 bungkus 8,000 3,200,000 550 ikat 1,500 825,000 40 kg 10,000 400,000 40 kg 50,000 2,000,000 37 botol 15,000 555,000 25 bungkus 102,545 2,563,625 BAWANG BOMBAY KALDU BLOK (1 BOTOL ISI 20 BLOK) SWEETENER TROPICANA SLIM ISI 150 SACHET/BUNGKUS SAOS SACHET @ 1 BUNGKUS ISI 25 SACHET KEMANGI KUCAI TAUCO CUKA

Buah pir Jeruk manis Semangka merah @ 5kg/buah Semangka kuning@3kg Pisang barangan Oyong / Gambas Labu jipang Labu kuning Daun sop / prei Tempe Tahu Cabe merah Bawang merah (kupas) Bawang putih (kupas) Sosis ayam Kelapa Tomat Daging sapi (sop) Ikan laut segar Bakso ayam Daging ayam Nugget ayam Daging sapi ( has ) Susu Ensure vanilla Minyak / corn oil tropicana slim 1 liter/kg Minyak goreng kemasan Susu bubuk SGM GAIN 100 400 gr Susu skim tropicana slim 1000 gr Susu Bubuk Blendera @1,25 kg Tepung maizena 100 gr Telur ayam Susu bubuk isocal 400 gr Beras IR 64 Bubuk teh bendera 50 gr Gula putih

Tauco Royco Garam halus uk.500gr/bungkus Kencur Jahe Lengkuas Jeruk nipis Bawang goreng masak Kerupuk Gula merah Pala bulat Cengkeh Soda kue Kapulaga Bunga lawang Kayu manis Asam potong Asam jawa Kemiri Daun - daunan ( sere,d.jeruk,d.kunyit,d.salam ) Belacan / terasi Jagung manis Bubuk kunyit Bubuk Jintan Tepung terigu Cabe ijo Bubuk ketumbar Bubuk merica Udang segar Telur puyuh Cumi - cumi Kecap manis refil Kecap manis sachet Cabe rawit Kacang tanah Udang kecepe Saos tomat Guava ( Jus ) Buah naga (jus ) Ikan teri nasi Timun ( jus ) Belimbing (jus) Melon ( jus ) Markisa ( jus ) Wortel ( jus ) Terong belanda ( jus ) Brokoli Tomat ( jus ) Jeruk peras ( jus ) Bunga kol Buncis Kol Janten Ercis Makaroni Timun Sawi ijo Melinjo Tauge Kacang panjang Selada Wortel Bayam Kangkung Sawi putih Sawi pahit Kentang (Kupas) Kue snack pasien ( untuk smua kelas ) Kue snack pasien ( untuk kelas S.Vip / SR ) Blueband sachet Sunkist Anggur Buah Naga Apel fuji

Kaldu Blok (1 botol isi 20 blok) Sweetener tropicana slim isi 150 sachet/bungkus Kemangi Kucai Bawang Bombay Cuka Saos Sachet @ 1 bungkus isi 25 sachet

Satuan Tarif/Harga 5 5.1 5.1.02 5.1.02.01 5.1.02.01.01.0038 12,781,992,685 8,898,277,878 8,000 TABLET 22,300 178,400,000 100,000 TABLET 130 13,000,000 40,000 KAPSUL 507 20,280,000 1,000 AMPUL 9,200 9,200,000 1 BOX 4,460,000 4,460,000 1,200 TABLET 429 514,800 120 TUBE 2,260 271,200 60,001 TABLET 3,986 239,163,986 10,000 TABLET 66 660,000 50,000 TABLET 850 42,500,000 30,000 TABLET 600 18,000,000 6,000 KAPSUL 5,500 33,000,000 100 AMPUL 12,067 1,206,700 6,000 TABLET 200 1,200,000 6,000 TABLET 400 2,400,000 60,000 TABLET 1,397 83,820,000 80,000 TABLET 643 51,440,000 15,000 TABLET 78 1,170,000 30,000 TABLET 99 2,970,000 3,000 BOTOL 3,988 11,964,000 5,000 TABLET 229 1,142,550 3,000 VIAL 29,700 89,100,000 1,000 AMPUL 2,704 2,704,000 500 BAG 69,364 34,682,000 50 BOTOL 79,500 3,975,000 50 BOTOL 51,190 2,559,500 500 BOTOL 44,100 22,050,000 300 AMPUL 9,570 2,871,000 50,000 TABLET 168 8,400,000 100,000 TABLET 131 13,100,000 50,000 TABLET 86 4,300,000 200 BOTOL 3,498 699,600 20,000 TABLET 211 4,220,000 400 VIAL 8,988 3,595,200 8,000 BOTOL 1,725 13,800,000 10,001 TABLET 60 600,060 700 SUPP 3,250 2,275,000 5,000 PEN 89,500 447,500,000 15,000 FLS 2,500 37,500,000 3,000 TABLET 6,888 20,664,000 1,800 SIRING 225,290 405,522,000 200 TABLET 44,800 8,960,000 80,000 TABLET 157 12,560,000 300 TUBE 6,277 1,883,100 60,000 TABLET 150 9,000,000 8,000 TABLET 1,870 14,960,000 10,000 AMPUL 1,880 18,800,000 100 BOTOL 9,680 968,000 8,000 TABLET 615 4,920,000 8,000 TABLET 400 3,200,000 8,000 TABLET 500 4,000,000 600 AMPUL 8,978 5,386,800 4,000 AMPUL 1,718 6,872,000 400 AMPUL 170,500 68,200,000 100 FLS 115,400 11,540,000 6,000 TABLET 11,330 67,980,000 ATROPIN SULFAT INJ ATS (BIOSAT 1,5 IU ) AVAMYS AVODART/DUTASTERIDE 0,5 MG ASAM TRANEKSAMAT INJ 100 MG/ML ASERING ATIVAN 2 MG/LORAZEPAM 2 MG ATORVASTATIN 10 MG ATORVASTATIN 20 MG ATRACURIUM/NOTRIXUM/TRAMUS ARIXTRA INJ 2,5 MG/0,5 ML AROMASIN TAB 25 MG ASAM ASKORBAT 50 MG TAB/VIT C ASAM FUSIDAT KRIM 20MG/FUCILEX CREAM ASAM MEFENAMAT 500 MG ASAM TRANEKSAMAT 500 MG TABLET ANTASIDA DOEN SUSPENSI ANTASIDA DOEN TABLET ANTIHEMOROID SUPP APIDRA SOLOSTAR AQUA PRO INJEKSI 25 ML ARICEPT EVASS 10 MG AMITRIPTILIN TAB 25 MG AMLODIPIN 10 MG TAB AMLODIPIN 5 MG TAB AMOKSISILIN 125 MG/5 ML SYRUP AMOKSISILIN 500 MG AMPICILLIN 1 GR INJEKSI AMINOFILIN INJ 24 MG/ML AMINOFLUID 500 ml / BFLUID AMINOHEPAR AMINOFUSIN L 600 AMINOSTERIL INFANT 6% AMIODARONE INJ 150 MG ALPENTIN 300 MG / GABAPENTIN 300 MG ALPRAZOLAM 0,5 MG TAB ALPRAZOLAM TAB 1 MG AMBROXOL SYRUP AMBROXOL TABLET AMIKASIN INJ 250 MG/ML AKARBOSE 50 MG ALBUMINO/CHANNA ALINAMIN INJEKSI/FURAMIN ALLOPURINOL 100 MG ALLOPURINOL 300 MG ALPENTIN 100 MG ACTILYSE 50 MG ACYCLOVIR 200 MG TAB ACYCLOVIR CREAM ADALAT OROS 30 MG AFOLAT (ASAM FOLAT) TAB 0,4 MG AKARBOSE 100 MG Belanja Obat-obatan Lainnya [-] Belanja BHP Obat ABILIFY DISCMELT 10 MG / ARIPRIPAZOLE ACETOSAL TAB/MINIASPI 80 MG ACETYLCYSTEIN 200 MG ACETYLCYSTEIN INJEKSI BELANJA DAERAH BELANJA OPERASI Belanja Barang dan Jasa Belanja Barang Hasil - - Kode Rekening Uraian Rincian Perhitungan jumlah Volume Masukan Dana yang dibutuhkan Rp 65,000,000,000 Keluaran terlaksananya Operasional RS 1 tahun RENCANA KERJA ANGGARAN (RKA) BLUD 2022 Indikator Tolak Ukur Kinerja Target Kinerja Capaian Program

15,000 TABLET 1,300 19,500,000 200 TUBE 1,540 308,000 100 FLS 86,930 8,693,000 100 TUBE 43,318 4,331,800 20,000 TABLET 121 2,420,000 10,001 TABLET 72 720,072 5,000 TABLET 500 2,500,000 80,000 TABLET 200 16,000,000 20 VIAL 382,875 7,657,500 4,800 TABLET 8,404 40,339,200 1,000 AMPUL 30,000 30,000,000 300 TUBE 18,557 5,567,100 2,000 TABLET 1,050 2,100,000 100 AMPUL 5,778 577,800 500 AMPUL 5,987 2,993,500 10,000 TABLET 100 1,000,000 20,000 TABLET 200 4,000,000 84 TABLET 11,100 932,400 30,000 KAPSUL 388 11,640,000 300 BOTOL 3,914 1,174,200 50 VIAL 6,323 316,150 15,000 TABLET 387 5,805,000 30,000 TABLET 749 22,470,000 700 BOTOL 4,947 3,462,900 400 VIAL 7,888 3,155,200 200 VIAL 8,313 1,662,600 6,000 VIAL 3,188 19,128,000 2,000 VIAL 6,597 13,194,000 30,000 VIAL 2,850 85,500,000 400 TABLET 7,915 3,166,000 500 BOTOL 2,702 1,351,000 30,000 TABLET 188 5,640,000 50 STRIP 31,128 1,556,400 100 STRIP 22,506 2,250,600 100 STRIP 18,030 1,803,000 50 STRIP 17,500 875,000 50 STRIP 18,080 904,000 500 STRIP 18,080 9,040,000 100 STRIP 36,361 3,636,100 100 STRIP 40,595 4,059,500 300 STRIP 24,936 7,480,800 300 AMPUL 3,397 1,019,100 500 KAPSUL 1,174 587,000 30 TUBE 3,431 102,930 2,000 TABLET 190 380,000 30,000 TABLET 250 7,500,000 2,000 BOTOL 7,715 15,430,000 6,000 AMPUL 5,455 32,730,000 6,000 TABLET 2,500 15,000,000 8,000 TABLET 473 3,784,000 30,000 TABLET 600 18,000,000 500 TABLET 649 324,500 2,000 FLS 5,005 10,010,000 45,000 TABLET 569 25,605,000 15,000 TABLET 3,097 46,455,000 6,000 TABLET 652 3,912,000 300 BOTOL 2,100 630,000 8,000 TABLET 240 1,920,000 600 TABLET 15,550 9,330,000 5,000 TABLET 100 500,000 4,000 BOTOL 9,500 38,000,000 30,000 TABLET 575 17,250,000 600 FLS 10,460 6,276,000 1,200 FLS 10,405 12,486,000 30,000 TABLET 136 4,080,000 9,000 AMPUL 968 8,712,000 800 BOTOL 12,123 9,698,400 15,000 TABLET 2,950 44,250,000 30,000 TABLET 1,421 42,630,000 800 TUBE 9,000 7,200,000 2,000 FLS 7,000 14,000,000 600 AMPUL 1,545 927,000 8,000 TABLET 100 800,000 4,000 TABLET 150 600,000 DEPAKOTE ER 500 MG SR DEXOCORT/DESOXIMETASON 0,25 KRIM DEXTROSE 40% 25 ML DIAZEPAM 10 MG/2 ML DIAZEPAM TAB 2 MG DIAZEPAM TAB 5 MG D5 1/2 NS D5 1/4NS DEKSAMETASON 0,5 MG TAB DEKSAMETASON INJ 5 MG/ML DEPAKENE SYRUP/SODIUM VALPROATE 250 DEPAKOTE ER 250 MG SR COTRIMOXAZOLE SYRUP COTRIMOXAZOLE TABLET CRIPSA (BROMOKRIPTIN) CTM TAB 4 MG CURCUMA SIRUP CURCUMA TABLET CODEIN TAB 10 MG COLCHICINE TABLET COMBIVENT 2,5 MG NEBULLES CONCOR 2.5 MG / BISOPROLOL 2,5 MG CONCOR 10 MG CORSANEURON TABLET CHLORPROMAZINE 100 MG (CPZ) CIPROFLOXACIN 500 MG CIPROFLOXACIN INFUS CITICOLIN INJEKSI CITICOLIN TABLET/PUSPALIN CLOZAPINE 25 MG CENDO MYDRIATIL 1% CENDO TIMOL 0,5% CENDO XYTROL CETADOP 200 MG (DOPAMIN INJ) CHLORAMEX 500 MG (KLORAMFENIKOL KAP) CHLORAMFENICOL 1% SALEP MATA CENDO AUGENTONIC CENDO CATARLENT CENDO CARPINE CENDO FENICOL CENDO FLOXA CENDO LYTEERS CEFOTAKSIM 1000 MG CEFTAZIDIM 1000 MG CEFTRIAXON 1000 MG CELLCEPT/KAMYFET TABLET CETIRIZIN SIRUP 5 MG/5 ML CETIRIZIN TABLET 10 MG CEFAZOLIN INJ 1 G CEFIKSIM 100 MG TABLET CEFIKSIM 200 MG TABLET CEFIKSIM 100 MG/5 ML SIRUP CEFOPERAZONE 1 GR CEFOPERAZONE SULBACTAM CA GLUCONAS INJ CAPTOPRIL 25 MG CARBAMAZEPIN 200 MG CASODEX 50 MG CEFADROKSIL 500 MG TABLET CEFADROKSIL SIRUP 125 MG/ML BLEOCIN 15 MG/ML BRILINTA 90 MG BUPIVACAIN SPINAL HEAVY BURNAZIN/SULFADIAZINE SILVER BUSCOVAN/HYOCIN N-BUTIL BROMID 10 MG/SCOPMA TABLET BUSCOVAN/HYOCIN N-BUTIL BROMID 20 MG /SCOPAMIN INJEKSI BEROTEC MDI BETADINE SALEP 20 GR BETAHISTIN MESYLATE 6 MG BICNAT BISAKODIL TABLET 5 MG BISOPROLOL 5 MG AZITROMYCIN 500 MG BETAMETASONE 0,1% CREAM

100 AMPUL 825 82,500 100 TABLET 18,800 1,880,000 5,000 TABLET 95 475,000 30,000 TABLET 135 4,050,000 200 BOTOL 245,000 49,000,000 500 VIAL 8,497 4,248,500 2,000 TABLET 289 578,000 50,000 TABLET 75 3,750,000 500 BOTOL 9,756 4,878,000 2,000 TABLET 4,900 9,800,000 300 SUPP 5,085 1,525,500 800 SUPP 4,325 3,460,000 300 BOTOL 49,790 14,937,000 1,000 AMPUL 6,486 6,486,000 20,000 TABLET 922 18,440,000 1,000 AMPUL 1,590 1,590,000 100 BOTOL 6,786 678,600 3,000 TABLET 862 2,586,000 8,000 TABLET 684 5,472,000 3,000 TABLET 975 2,925,000 80 AMPUL 23,000 1,840,000 10 VIAL 163,700 1,637,000 8,000 TABLET 300 2,400,000 35,000 KAPSUL 923 32,305,000 1,200 AMPUL 3,567 4,280,400 3,000 TABLET 473 1,419,000 3,000 TABLET 573 1,719,000 2,501 AMPUL 37,000 92,537,000 1,000 SUPP 1,998 1,998,000 300 FLS 14,738 4,421,400 500 FLS 14,126 7,063,000 2,500 TABLET 2,400 6,000,000 5,000 TABLET 3,072 15,360,000 4,000 TABLET 1,500 6,000,000 1,000 TABLET 1,210 1,210,000 2,000 AMPUL 14,520 29,040,000 500 AMPUL 36,300 18,150,000 1,200 AMPUL 9,889 11,866,800 100 TABLET 1,345 134,500 10,000 AMPUL 923 9,230,000 70,000 TABLET 224 15,680,000 4,500 TABLET 1,647 7,411,500 100 SACCET 6,050 605,000 2,000 SACCET 280 560,000 1,000 TABLET 388 388,000 1,000 TABLET 847 847,000 1,500 TUBE 2,670 4,005,000 6,000 AMPUL 3,355 20,130,000 200 TUBE 2,800 560,000 100 FLS 4,720 472,000 5,000 TABLET 2,082 10,410,000 50,000 TABLET 199 9,950,000 10,000 TABLET 1,000 10,000,000 30,000 TABLET 93 2,790,000 20,000 TABLET 228 4,560,000 40,000 TABLET 143 5,720,000 5,000 TABLET 297 1,485,000 3,000 BOTOL 7,200 21,600,000 3,000 BOTOL 6,627 19,881,000 100 BOTOL 50,407 5,040,700 3,000 TABLET 49 147,000 2,000 TABLET 54 108,000 2,000 TABLET 7,860 15,720,000 10,000 TABLET 4,356 43,560,000 10,000 TABLET 148 1,480,000 3,000 AMPUL 80,000 240,000,000 20 TUBE 2,750 55,000 50 TUBE 2,325 116,250 1,000 PEN 112,000 112,000,000 2,000 PEN 112,000 224,000,000 500 BOTOL 8,925 4,462,500 1,000 TABLET 580 580,000 2,000 TABLET 980 1,960,000 30 TUBE 151,200 4,536,000 HYTROZ 2 MG IALUSET PLUS HIDROKORTISON 1% KRIM HIDROKORTISON 2,5% KRIM HUMALOG MIX 25 KWIKPEN HUMALOG MIX 50 KWIKPEN HUSTAB SYRUP HYTROZ 1 MG HALOPERIDOL 0,5 MG HALOPERIDOL 5 MG HARNAL D 0,2 MG HARNAL OCAS 0,4 MG TABLET HCT TAB 25 MG HEMAPO 3000-ERITROPOETIN 3000 UI/ML GLIMEPIRIDE 2 MG GLIMEPIRIDE 3 MG GLIMEPIRIDE 4 MG GLUKOSA 10 % GLUKOSA 5% H2O2 50 % GENTAMISIN SALEP MATA/GENOIN 0,3 % GENTAMISIN TETES MATA 0,3% GERMISEP 2,5 GR GLIKLAZID 80 MG/GLUCODEX GLIKUIDON 30 MG TAB GLIMEPIRIDE 1MG GARAM INGGRIS GARAM ORALIT GEMFIBROZIL 300 MG TAB GEMFIBROZIL 600 MG TAB GENTAMISIN 0,1 % SK GENTAMISIN 40 MG/ML INJ FORTANEST 15 MG/ 3ML FRESOFOL 1% FRIDEP 50 MG (SERTRALIN TAB) FUROSEMID 10 MG INJEKSI FUROSEMID 40 MG TAB GALVUS TABLET FLUCONAZOLE INFUS FLUOKSETIN 10 MG / KALXETIN FLUOKSETIN 20 MG / KALXETIN FLUNARIZIN FORMALIN TAB FORTANEST 5 MG/ 1ML FENITOIN 50 MG/ML INJ FENOFIBRAT 100 MG FENOFIBRAT 300 MG FENTANIL INJ 2 ML FETIK SUP/ KETOPROFEN SUP/SUPRAFENID FLIXOTIDE NEBULES ETHAMBUTOL TABLET 500 MG EUTHYROX 100 MCG FARGOXIN 0,25 MG INJ FARMABES 25 MG (DILTIAZEM INJ) FARSORBID 10 MG (ISDN 10 MG) FENITOIN 100 MG KAPSUL/KUTOIN KAPSUL EAS PFRIMER / RENXAMIN EFEDRIN INJ 50MG/ML EPERISON/MYONEP TABLET EPINEFRIN INJ 1 MG/ML ERITROMISIN SIRUP ERITROMISIN TABLET 500 MG DOKSISIKLIN 100 MG DOMPERIDON 10 MG TAB DOMPERIDON SYRUP DORNER / BERAPROST DULCOLAX SUPP 5 MG INFANT DULCOLAX SUPP ADULT 10 MG DIFENHIDRAMIN INJ 10 MG/ML DIFLUCAN 50 MG DIGOKSIN 0,25 MG DILTIAZEM TAB 30 MG DIPEPTIVEN INFUS DOBUTAMIN INJ/INOTROP

500 BOTOL 3,296 1,648,000 8,000 TABLET 346 2,768,000 2,000 TABLET 250 500,000 40 BOTOL 69,600 2,784,000 200 BOTOL 38,819 7,763,800 20,000 TABLET 75 1,500,000 20,000 TABLET 150 3,000,000 50 BOTOL 78,600 3,930,000 3,000 AMPUL 46,635 139,905,000 1,200 TABLET 424 508,800 1,200 TABLET 749 898,800 100,000 TABLET 150 15,000,000 100 BOTOL 12,700 1,270,000 50 BOTOL 10,250 512,500 100 FLS 10,350 1,035,000 600 FLS 11,500 6,900,000 400 BAG 256,000 102,400,000 7,000 TABLET 208 1,453,410 50,000 TABLET 319 15,950,000 100,000 TABLET 212 21,200,000 3,000 TABLET 1,235 3,705,000 100 VIAL 14,788 1,478,800 600 TUBE 2,289 1,373,400 3,000 TABLET 260 780,000 5,000 TABLET 2,176 10,880,000 30,000 AMPUL 880 26,400,000 5,000 TABLET 761 3,805,000 10,000 TABLET 522 5,220,000 8,000 TABLET 384 3,072,000 30,000 TABLET 1,182 35,460,000 4,000 TABLET 1,842 7,368,000 1,000 SACCET 3,593 3,593,000 1,000 BOTOL 5,190 5,190,000 50,000 KAPSUL 278 13,900,000 3,000 PEN 89,000 267,000,000 100 BOTOL 8,470 847,000 1,000 PEN 89,000 89,000,000 10,000 BOTOL 8,713 87,130,000 10,000 TABLET 373 3,730,000 30,000 TABLET 904 27,120,000 3,000 AMPUL 891 2,673,000 3,000 AMPUL 847 2,541,000 5,000 TABLET 77 385,000 5,000 TABLET 121 605,000 400 SYRINGE 90,660 36,264,000 400 SYRINGE 125,325 50,130,000 600 BOTOL 26,960 16,176,000 50 VIAL 965,594 48,279,700 10,000 TABLET 520 5,200,000 300 AMPUL 1,916 574,800 20,000 TABLET 351 7,020,000 1,000 TABLET 460 460,000 500 FLS 6,245 3,122,500 500 VIAL 16,359 8,179,500 3,000 VIAL 27,435 82,305,000 2,600 TABLET 7,850 20,410,000 10,000 AMPUL 2,960 29,600,000 100,000 TABLET 77 7,700,000 20,000 TABLET 159 3,180,000 1,000 AMPUL 1,023 1,023,000 3,000 TABLET 214 642,000 6,000 VIAL 10,912 65,472,000 60,000 TABLET 102 6,120,000 10,000 TABLET 413 4,130,000 5,000 TABLET 117 585,000 1,200 TABLET 943 1,131,600 6,000 BOTOL 5,885 35,310,000 10,000 TABLET 267 2,670,000 500 BOTOL 3,765 1,882,500 500 AMPUL 6,750 3,375,000 500 AMPUL 4,444 2,222,000 300 TUBE 1,900 570,000 500 TABLET 5,143 2,571,500 500 AMPUL 29,900 14,950,000 MIDAZOLAM INJEKSI MIKONAZOL KRIM 2% MISOPROSTOL TABLET MORFIN INJEKSI METOKLOPRAMID 10 MG METOTREKSAT /RHEU-TREX 2,5 MG METRONIDAZOL INFUS METRONIDAZOL KAPTAB 500 MG METRONIDAZOL SYRUP MEYLON 25 ML METFORMIN HCL 850 MG METILERGOMETRIN INJEKSI METILERGOMETRIN TABLET METILPREDNISOLON INJ 125 MG INJEKSI METILPREDNISOLON TAB 4 MG METILPREDNISOLON TAB 8 MG MEPTIN INHALATION INJ MEROPENEM SER INJ 500 MG MEROPENEM SERB INJ 1000 MG MESTINONE METAMIZOLE SODIUM INJEKSI/NOVALGIN METFORMIN HCL 500 MG MANNITOL 20% 500 ML MANTOUX TEST/ TUBERCULIN PPDRT MECOBALAMIN 500 MG/ OXICOBAL MECOBALAMIN INJEKSI MELOXICAM 15 MG MELOXICAM 7,5 MG LIDOKAIN INJ 2% LIDOKAIN INJ 2% + EPINEFRIN LOPERAMID TAB 2 MG LORATADIN TAB 10 MG LOVENOX 0,4 SYRINGE LOVENOX 0,6 SYRINGE LANTUS SOLOSTAR LAXADINE SYRUP LEVEMIR FLEXPEN LEVOFLOKSASIN 5 MG/ML INFUS LEVOFLOKSASIN TAB 500 MG LEVOPAR TABLET/LEPARSON TAB KLOBAZAM TAB 10 MG KLOPIDOGREL TAB 75 MG KSR LACTO B/ L BIO LAKTULOSA SIRUP/EXTRALAC SIRUP LANSOPRAZOL KAP 30 MG KETOKONAZOL KRIM 2% KETOKONAZOL TABLET 200 MG KETOROLAC TABLET KETOROLAK INJ 30 MG/ML KLINDAMISIN 150 MG KLINDAMISIN 300 MG KABIVEN FERIPHERAL INF KALSIUM LAKTAT 500 MG KANDESARTAN TAB 16 MG KANDESARTAN TAB 8 MG KENDARON TAB KETAMIN 100 MG/ML / IVANES IRBESARTAN 300 MG ISDN 5 MG/ISOSORBIDE DINITTAT ISOTIC ADRETOR 0,25% ISOTIC ADRETOR 0,5% KA EN 1B INFUS KA EN 3B INFUS ILIADIN SPRAY 0,05% INH 100 MG TAB/ISONIAZID INH 300 MG TAB/ISONIAZID INTRALIPID 20% 100 ML INVICLOT/HEPARIN 5000 UI/ML IRBESARTAN 150 MG IBUPROFEN 100 MG/5 ML SUSPENSI IBUPROFEN 400 MG TAB IBUPROFEN TAB 200 MG ILIADIN DROPS 0,025%

700 TABLET 16,000 11,200,000 1,000 VIAL 44,597 44,597,000 10 TUBE 30,000 300,000 20,000 TABLET 115 2,300,000 30,000 TABLET 108 3,240,000 1,000 BOTOL 6,906 6,906,000 1,000 FLS 6,764 6,764,000 40,000 BOTOL 6,900 276,000,000 300 AMPUL 87,731 26,319,300 200 BOTOL 112,710 22,542,000 250 BOTOL 47,498 11,874,500 1,000 AMPUL 12,276 12,276,000 10,000 TABLET 675 6,750,000 1,000 TABLET 118 118,000 500 AMPUL 7,872 3,936,000 10,000 TABLET 1,415 14,150,000 20,000 TABLET 2,530 50,600,000 100,000 TABLET 1,640 164,000,000 1,000 AMPUL 6,298 6,298,000 500 TABLET 1,499 749,500 5,000 TABLET 1,077 5,385,000 1,000 PEN 112,000 112,000,000 1,000 PEN 89,500 89,500,000 2,000 AMPUL 70,785 141,570,000 500 BOTOL 11,750 5,875,000 10 FLS 131,250 1,312,500 1,000 BOTOL 3,812 3,812,000 500 TABLET 567 283,500 6,000 VIAL 5,346 32,076,000 60,000 KAPSUL 129 7,740,000 5,000 TABLET 270 1,350,000 500 TABLET 275 137,500 40,000 AMPUL 873 34,920,000 2,000 TABLET 4,000 8,000,000 2,000 TABLET 713 1,426,000 30 BOTOL 19,000 570,000 30 TABLET 3,569 107,070 6,000 TABLET 2,600 15,600,000 60 FLS 40,575 2,434,500 600 AMPUL 3,760 2,256,000 600 AMPUL 4,290 2,574,000 1,000 FLS 30,335 30,335,000 1,000 FLS 3,472 3,472,000 2,000 AMPUL 1,126 2,252,000 20 BOTOL 35,200 704,000 100 BOTOL 5,113 511,300 6,000 BOTOL 11,263 67,578,000 1,200 BOTOL 1,160 1,392,000 120,000 TABLET 254 30,480,000 500 AMPUL 13,300 6,650,000 30,000 TABLET 182 5,460,000 8,000 TABLET 243 1,944,000 250 BOTOL 445,000 111,250,000 100 BOTOL 905,000 90,500,000 150 BOTOL 1,590,000 238,500,000 50 BOTOL 794,000 39,700,000 35 BOTOL 940,000 32,900,000 600 TABLET 5,900 3,540,000 10,000 TABLET 71 710,000 5,000 TABLET 59 295,000 1,000 TABLET 82 82,000 3,000 AMPUL 7,050 21,150,000 2,000 TABLET 405 810,000 250 FLS 10,478 2,619,500 500 TABLET 317 158,500 8,000 TABLET 710 5,680,000 20,000 TABLET 146 2,920,000 80,000 TABLET 85 6,800,000 60,000 AMPUL 858 51,480,000 2,000 SYRINGE 80,000 160,000,000 15,000 TABLET 1,170 17,550,000 2,000 TABLET 837 1,674,200 6,000 TABLET 934 5,604,000 1,000 TABLET 1,233 1,233,000 RANITIDINE INJ 50 MG/ML RENOGEN 3000 IU RETAPHYL SR STRIP RIFAMPISIN TAB 300 MG RIFAMPISIN TAB 450 MG RIFAMPISIN TAB 600 MG PTU 100 MG PULMICORT RESPULES 0,25 MG/ML PYRANTEL 125 TABLET RAMIPRIL 10 MG TAB RAMIPRIL 5 MG TAB RANITIDIN TAB 150 MG PLASBUMIN 5 % 50 ML PLETAAL XR 100 MG/ CILOSTAZOLE PREDNISON KAP 5 MG PROPANOLOL TAB 10 MG PROPANOLOL TAB 40 MG PROSTIGMIN INJ 0,5 MG PHENOBARBITAL 20 MG TAB PIRAZINAMID 500 MG TABLET PLASBUMIN 20% 50 ML PLASBUMIN 20% 100 ML PLASBUMIN 25 % 100 ML PLASBUMIN 25 % 50 ML PANTOCAIN 0,5 % PARACETAMOL DROP PARACETAMOL INFUS PARACETAMOL SYRUP PARACETAMOL 500 MG TABLET PETHIDINE HCL INJEKSI 50 MG/2 ML OTOPAIN EAR DROP OTSU MGSO4 20% OTSU MGSO4 40% OTSU SALIN 3 % OTSU-KCL 7,46%/KLARIUM CLORIDA 25 ML OXYTOCIN INJ 10 IU/100,S ONDANSETRON 4 MG/2ML ONZAPIN 10 MG ONZAPIN 5 MG OPTIFLOX 0,5 %/LEVOFLOXASIN TM ORIXAL 500 MG / KLARITROMISIN 500 MG OSCAL 0,5 MG TABLET / CALCITROL OBH SYRUP OFLOXACIN 400 MG OMEPRAZOL INJ 40MG/10ML OMEPRAZOL KAP 20 MG ONDANSENTRON TAB 4 MG ONDANSENTRON TAB 8 MG NOTISIL 2 MG/SIMARC NOVOMIX FLEXPEN 100 UI/ML NOVORAPID FLEXPEN 100 UI/ML NTG /DBL GLICERYL TRINITRATE 50 MG/10 ML NYSTATIN DROP/CANDISTATIN/ENYSTIN OBUCORT SWINGHALER NIKARDIPIN INJ 10 MG NITRAL-GLISERIL TRINITRAT 0,5 MG NITROKAF FORTE 5 MG NITROKAF RETARD 2,5 MG NOREPINEPHRINE INJ NOSTHYRA 5 MG/NORELUT NAROPIN 7,5 MG/ML NASACORT AQ 55 MCG/PUFF NEPHOSTERIL 250 ML NEO K INJEKSI NEW ANTIDES 600 MG NIFEDIPIN 10 MG MUPIROCIN CREAM NA DIKLOFENAK TAB 25 MG NA DIKLOFENAK TAB 50 MG NaCl 0,9% 1000 ML NaCl 0,9% 100 ML NaCl 0,9% 500 ML MORFIN TAB 10 MG / MST CONTINUS 10 MOXIFLOXACIN 400 MG INFUS

5,000 TABLET 123 615,000 10,000 TABLET 123 1,230,000 5,000 TABLET 259 1,295,000 60,000 BOTOL 7,703 462,180,000 1,000 PEN 112,000 112,000,000 2,000 AMPUL 27,998 55,996,000 200 BOTOL 4,069 813,800 10,000 TABLET 50 500,000 7,000 TABLET 65 455,000 8,000 TABLET 3,750 30,000,000 50 AMPUL 58,000 2,900,000 1,200 TABLET 13,400 16,080,000 3,000 TABLET 6,814 20,442,000 1,500 TABLET 7,787 11,680,500 200 BOTOL 59,000 11,800,000 350 BOTOL 111,850 39,147,500 300 BOTOL 137,492 41,247,600 100 BOTOL 965,250 96,525,000 5,000 TABLET 78 390,000 1,000 AMPUL 1,700 1,700,000 4,500 TABLET 5,406 24,327,000 6,000 TABLET 68 408,000 20,000 TABLET 150 3,000,000 200 BOTOL 39,600 7,920,000 500 TUBE 6,190 3,095,000 300 AMPUL 1,762 528,600 100 BOX 445,000 44,500,000 16,000 TABLET 530 8,480,000 50,000 TABLET 200 10,000,000 100 BOTOL 47,495 4,749,500 600 SUPP 17,488 10,492,800 600 SUPP 12,001 7,200,600 200 VIAL 5,808 1,161,600 6,000 BOTOL 5,970 35,820,000 6,000 TABLET 222 1,332,000 300 BOTOL 135,577 40,673,100 5,000 TABLET 238 1,190,000 500 BOTOL 35,000 17,500,000 100 BOTOL 400,000 40,000,000 100 BOX 195,500 19,550,000 10,000 TABLET 1,169 11,690,000 6,000 TABLET 143 858,000 30,000 TABLET 163 4,890,000 2,000 TABLET 13,500 27,000,000 1,400 TABLET 1,634 2,287,600 10,000 TABLET 1,679 16,790,000 5,000 TABLET 748 3,740,000 5,000 TABLET 397 1,985,000 50 VIAL 140,290 7,014,500 8,000 FLS 3,636 29,088,000 500 AMPUL 1,452 726,000 1,000 TABLET 781 781,000 25,000 TABLET 112 2,800,000 700 BOTOL 18,000 12,600,000 600 BOTOL 16,100 9,660,000 5,000 FLS/1 L 10,220 51,100,000 800 TABLET 24,330 19,464,000 100 AMPUL 73,040 7,304,000 5 BOTOL 95,660 478,300 15,000 TABLET 253 3,795,000 500 BOTOL 5,308 2,654,000 3,883,714,807 900 PCS 11,605 10,444,500 6,000 PCS 1,950 11,700,000 100 PCS 7,744 774,400 100 PCS 7,744 774,400 3,000 PCS 7,744 23,232,000 7,000 PCS 7,744 54,208,000 5,000 PCS 7,744 38,720,000 4,000 PCS 7,744 30,976,000 500 BOTOL 27,373 13,686,500 50 GLN 500,532 25,026,600 1,000 BOX 13,900 13,900,000 ALKOHOL 96% @ 20 LITER ALKOHOL SWAB ABOCAT NO 16 ABOCAT NO 18 ABOCAT NO 20 ABOCAT NO 22 ABOCAT NO 24 ALKOHOL 70% @ 1 LITER ZINC SULFAT SYRUP/60 ML [-] Belanja BHP Alat Kesehatan 3 WAY ANAK 3 WAY DEWASA ABOCAT NO 14 WIDA RS 500 ML WIDA WI 1000 ML/AQUA 1L XARELTO 20 MG XYLOCAIN 2% PDF INJEKSI XYLOCAIN 10% SPRAY ZINC 20 MG VANCOMYCIN INJEKSI VENTOLIN NEBULES VIT K INJ VIT K TAB 10 MG VITAMIN B KOMPLEKS VOLUVEN INFUS/VOLULYTE TRIHEKSIFENIDIL 2 MG TABLET ULTIBRO TABLET URINTER 400 MG URSODEOXYCHOLIC ACID 250 MG VALSARTAN 160 MG/VALESCO 160 MG VALSARTAN 80 MG / VALESCO 80 MG TABLET TAMBAH DARAH / SF TARIVID OTIC 3%/ ALKILEN TERRELL 250 ML/ISOFLURAN TETAGAM INJEKSI THYROZOL 10 MG TIAMIN (VIT B1) 50 MG STESOLID SUPP 10 MG STESOLID SUPP 5 MG STREPTOMISIN 1000 MG/ML SUKRALFAT SYRUP SUKRALFAT TABLET/ULSIDEX SYMBBICORT TURBUHALER 160/4,5 MCG SOFT U DERM- UREA CREAM 10 % SOTATIC/METOCLOPRAMIDE INJEKSI SPIRIVA RESPIMAT 2,5 MCG SPIRONOLAKTON 100 MG SPIRONOLAKTON 25 MG STESOLID SYRUP SIANOKOBALAMIN (VIT B12) 500 MCG SIBITAL INJ SIFROL ER 0,375 TABLET SIMVASTATIN 10 MG SIMVASTATIN 20 MG SMOFLIPID 20% 100 ML SEREQUEL XR 300 MG SEREQUEL XR 400 MG SERETIDE 50 MCG SERETIDE 250 MCG SERETIDE 500 MCG SEVORANE 250 ML SALBUTAMOL SIRUP SALBUTAMOL TAB 2 MG SALBUTAMOL TAB 4 MG SANDEPRIL 50 MG SANDOSTATIN / OCTREOTIDE INJEKSI SEREQUEL XR 200 MG RISPERIDON 1 MG RISPERIDON 2 MG RISPERIDON 3 MG RL INFUS RYZODEG INSULIN ROCURONIUM INJ 5 ML/ ROCULAX

10,000 PCS 2,625 26,250,000 300 TUBE 29,550 8,865,000 600 BOTOL 31,000 18,600,000 50 PCS 18,500 925,000 50 PCS 18,500 925,000 50 PCS 18,500 925,000 300 SET 72,558 21,767,400 250 PCS 67,000 16,750,000 150 PCS 67,000 10,050,000 150 PCS 67,000 10,050,000 1,500 PCS 3,600 5,400,000 100 PCS 45,187 4,518,700 5 BOX 1,043,000 5,215,000 50 PCS 1,519,674 75,983,700 100 PCS 375,000 37,500,000 30 PCS 1,667,000 50,010,000 400 PCS 7,440 2,976,000 72 PCS 71,610 5,155,920 72 PCS 68,750 4,950,000 24 PCS 98,450 2,362,800 144 PCS 67,320 9,694,080 720 PCS 64,240 46,252,800 144 PCS 62,040 8,933,760 240 PCS 59,290 14,229,600 300 PCS 44,000 13,200,000 30 PCS 212,395 6,371,850 30 PCS 212,395 6,371,850 400 PCS 24,000 9,600,000 200 PCS 5,800 1,160,000 200 PCS 5,800 1,160,000 200 PCS 5,800 1,160,000 5,000 PCS 7,700 38,500,000 1 PCS 3,245,000 3,245,000 150 PCS 730,162 109,524,300 50 PCS 935,072 46,753,600 20 PCS 426,112 8,522,240 20 PCS 660,018 13,200,360 100 PCS 597,883 59,788,300 20 PCS 708,070 14,161,400 48 PCS 325,429 15,620,592 300 PCS 13,200 3,960,000 80 PCS 478,049 38,243,920 24 BOX/10 400,000 9,600,000 500 PCS 6,875 3,437,500 5 BOX 5,738,000 28,690,000 50 PCS 213,790 10,689,500 2 BOX 2,613,278 5,226,556 2 BOX 1,228,983 2,457,966 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 400 PCS 23,100 9,240,000 400 PCS 23,100 9,240,000 100 PCS 23,100 2,310,000 30 PCS 86,240 2,587,200 30 PCS 86,240 2,587,200 30 PCS 86,240 2,587,200 5 PCS 2,256,000 11,280,000 100 BOX/100 161,665 16,166,500 800 ROLL 102,500 82,000,000 600 ROLL 148,000 88,800,000 200 ROLL 15,730 3,146,000 200 ROLL 19,910 3,982,000 200 ROLL 29,810 5,962,000 30 PCS 54,450 1,633,500 20 PCS 54,450 1,089,000 100 PCS 54,450 5,445,000 100 PCS 60,000 6,000,000 FOLY CATH 3WAY NO 20 FOLY CATH 3WAY NO 22 FOLY CATH 3WAY NO 24 FOLY CATH NO 6 FILM IV DRESS 67P FIXOMUL 5X10 FIXOMUL 5X15 FM CREPE 3 INC FM CREPE 4 INC FM CREPE 6 INC ETT 7,5 ETT 8 ETT NONKINGKING 6,5 ETT NONKINGKING 7 ETT NONKINGKING 7,5 EVD ETT 4,5 ETT 5 ETT 5,5 ETT 6 ETT 6,5 ETT 7 ETHIBOND W 4843 ETHILON 10/0 U-7003 ETT 2,5 ETT 3 ETT 3,5 ETT 4 DERMAFIX DJ STENT SET ECG PAPER ECOPLAC MIX ELEFIX / PASTA EEG EPIDURAL CATETER/ PERIFIX 400 CVC 3LUMEN NO 12 CVC NO 4 CVC NO 5 CVC NO 7 CVC TRIO V720/CERTOFIX DAFILON 10/0 2XDLM 6S CONDOM CATH S CONDOM CATH M CONDOM CATH L CUTICEL 10x10 CUTTING LOOP CVC 2LUMEN NO 12/CERTOFIX CATGUT PLAIN 3/0 CUTTING CATGUT PLAIN 3/0 TAPER CATHEJELL/ AQUATOUCH LUBRICANT CLOSED SUCTION NO 12 CLOSED SUCTION NO 14 COLOSTOMY BAG BROS SIKAT OPERASI (SCRUBBRUSH) CATGUT CROMIC 1 TAPER CATGUT CROMIC 2 TAPER CATGUT CROMIC 2 CUTTING CATGUT PLAIN 2/0 CUTTING CATGUT PLAIN 2/0 TAPER BLOOD TRANSFUSION SET BONE WAX BONGROS 5CC BREATHING CIRCUIT WITH CHAMBER BREATING CIRCUIT VENTILATOR BREATHING CIRCUIT CPAP ARM SLING M ARM SLING L BACTERI FILTER/TERMOVEN HEPA BAJU OPERASI STERIL UKURAN L BAJU OPERASI STERIL UKURAN LL BAJU OPERASI STERIL UKURAN XL APRON PLASTIK AQUA GEL 82/ MY JELLY AQUA PACK/HYDROX ARM SLING S

100 PCS 56,000 5,600,000 100 PCS 55,500 5,550,000 100 PCS 16,800 1,680,000 100 PCS 16,800 1,680,000 1,500 PCS 16,800 25,200,000 1,500 PCS 16,800 25,200,000 30 PCS 19,690 590,700 20 PCS 19,690 393,800 100 PCS 1,210 121,000 100 PCS 1,210 121,000 50 BOX/250 27,500 1,375,000 90 PCS 14,000 1,260,000 10 PCS 14,000 140,000 50 GALON 869,700 43,485,000 200 FLS 82,900 16,580,000 3,000 BOX 94,500 283,500,000 2,000 PCS 48,000 96,000,000 50 PCS 420,000 21,000,000 300 PCS 42,900 12,870,000 12,000 PCS 3,500 42,000,000 1,200 PCS 3,500 4,200,000 1,200 PCS 21,264 25,516,800 200 BUNGKUS 27,280 5,456,000 1,500 LEMBAR 1,860 2,790,000 10 ROLL 400,000 4,000,000 100 PCS 71,827 7,182,700 200 ROLL 43,400 8,680,000 60 BOX/6 233,906 14,034,360 2,500 BOX 40,000 100,000,000 100 PCS 18,788 1,878,800 800 PCS 18,788 15,030,400 1,500 PCS 18,788 28,182,000 10 PCS 205,462 2,054,620 240 PCS 108,900 26,136,000 96 PCS 143,947 13,818,912 5,000 PCS 1,695 8,475,000 300 PCS 358 107,400 300 PCS 358 107,400 100 PCS 358 35,800 500 PCS 358 179,000 3,000 PCS 358 1,074,000 100 PCS 358 35,800 30 PCS 370,000 11,100,000 20 PCS 197,281 3,945,620 60 PCS 7,656 459,360 60 PCS 7,656 459,360 60 PCS 7,656 459,360 60 PCS 7,656 459,360 100 PCS 7,656 765,600 300 PCS 7,744 2,323,200 300 PCS 7,744 2,323,200 200 PCS 7,744 1,548,800 150 PCS 7,744 1,161,600 500 PCS 7,744 3,872,000 1,200 PCS 7,744 9,292,800 1,200 PCS 7,744 9,292,800 120 PCS 55,330 6,639,600 420 PCS 47,960 20,143,200 360 PCS 47,960 17,265,600 80 GLN/5L 420,000 33,600,000 30 PCS 90,032 2,700,960 30 PCS 130,310 3,909,300 1 BOX 2,683,233 2,683,233 1 BOX 3,678,687 3,678,687 2,000 ROLL/400 1,898 3,796,000 2,000 ROLL/400 1,898 3,796,000 800 PCS 20,160 16,128,000 1,500 PCS 37,843 56,764,500 100 PCS 3,125 312,500 6 BOX/100 250,113 1,500,678 6 BOX/100 250,113 1,500,678 12 BOX/100 250,113 3,001,356 6 BOX/100 250,113 1,500,678 12 BOX/100 250,113 3,001,356 PIPET TETES KACA PISAU OPERASI NO 10 PISAU OPERASI NO 11 PISAU OPERASI NO 15 PISAU OPERASI NO 20 PISAU OPERASI NO 22 PDS II 5/0 - Z1013H PDS II 6/0 - Z-432H PERBAN 5 CM PERBAN 10 CM PERPUSOR SYRINGE WHITE PERPUSOR TUBING WHITE NYLON 2/0 TS 19 NYLON 3/0 TS 19 NYLON 4/0 TS 19 ONE SCRUB OPSITE 45X28 OPSITE 55X45 NGT NO 8 100 CM NGT NO 10 NGT NO 12 NGT NO 14 NGT NO 16 NGT NO 18 NGT NO 3,5 NGT NO 4 NGT NO 5 40 CM NGT NO 5 100 CM NGT NO 6 NGT NO 8 40 CM NALD NO 24 NALD NO 25 NALD NO 26 NALD NO 27 NC PAP BREATHING CIRCUIT NEONATAL REM POLYHESIVE MEDIFIX MANOMETER MONOCRYL 4/0 MPC 426 MONOSYN 4/0 DS 19 NALD BD NO 31X5 NALD NO 18 NALD NO 23 LEUKOPLAST 7,5 CM x 4,5 LYOSTYPT 5X6CM MASKER BEDAH MASKER NON REBREATHING BAYI MASKER NON REBREATHING ANAK MASKER NON REBREATHING DEWASA INFUS SET PAED STERA (ANAK) INTRAFIX SAFESET (INFUSET PUMP) KAPAS 500 GR KERTAS EKG KERTAS USG SONY LAMINARIA HAND RUB 500 CC HANDSCOON/ SARUNG TANGAN NONSTERIL HARUM PEN / ELECROSURGICAL PEN HARUM PLATE CABLE MONOPOLAR HARUM PLATE NON CABLE INFUS SET ADULT STERA GELANG BAYI BIRU GELANG BAYI PINK GELANG PASIEN ISI 250 PCS GUDEL 100 MM ADULT GUDEL 60 MM ANAK H2O2 50% FOLY CATH NO 12 FOLY CATH NO 14 FOLY CATH NO 16 FOLY CATH NO 18 FOLY CATH NO 20 FOLY CATH NO 24 FOLY CATH NO 8 FOLY CATH NO 10

120 ROLL 11,700 1,404,000 150 ROLL 15,100 2,265,000 100 ROLL 20,300 2,030,000 100 ROLL 15,400 1,540,000 150 ROLL 22,100 3,315,000 150 ROLL 28,900 4,335,000 48 PCS 82,170 3,944,160 48 PCS 76,540 3,673,920 48 PCS 80,190 3,849,120 48 PCS 76,450 3,669,600 48 PCS 190,850 9,160,800 600 LITER 80,000 48,000,000 1,200 PCS 2,200 2,640,000 1,200 PCS 2,200 2,640,000 30 PCS 224,070 6,722,100 2 BOX/36 2,042,731 4,085,462 4 BOX/36 1,472,358 5,889,432 4 BOX/36 1,270,551 5,082,203 2 BOX/36 6,384,235 12,768,470 100 PCS 6,490 649,000 100 PCS 6,491 649,100 100 PCS 6,490 649,000 100 PCS 6,490 649,000 2 PCS 403,520 807,040 800 PCS 88,660 70,928,000 400 PCS 84,150 33,660,000 400 PCS 86,350 34,540,000 60 PCS 80,960 4,857,600 100 PSG 34,694 3,469,400 300 PSG 34,694 10,408,200 200 PSG 34,694 6,938,800 100 PSG 34,694 3,469,400 100 PCS 19,470 1,947,000 200 PCS 19,470 3,894,000 300 PCS 5,500 1,650,000 200 PCS 5,500 1,100,000 2,000 PCS 5,500 11,000,000 1,500 PCS 21,798 32,697,000 600 PCS 40,370 24,222,000 900 PCS 46,200 41,580,000 780 PCS 46,750 36,465,000 720 PCS 43,120 31,046,400 60 PCS 45,210 2,712,600 10 PCS 2,085,500 20,855,000 500 PCS 16,000 8,000,000 5 BOX 3,789,000 18,945,000 1,000 PCS 1,905 1,905,000 6,000 PCS 3,217 19,302,000 10 BOX 667,000 6,670,000 300 PCS 29,549 8,864,700 1,500 PCS 30,550 45,825,000 500 PCS 30,550 15,275,000 5,000 PCS 650 3,250,000 60,000 PCS 779 46,740,000 25,000 PCS 968 24,200,000 15,000 PCS 1,200 18,000,000 4,000 PCS 1,500 6,000,000 1,000 PCS 4,049 4,049,000 1,000 PCS 3,400 3,400,000 2,000 PCS 6,702 13,404,000 500 PCS 17,589 8,794,500 10 BOTOL 561,042 5,610,420 50 BOX/100 360,000 18,000,000 60 PCS 39,455 2,367,300 60 PCS 39,455 2,367,300 60 PCS 39,455 2,367,300 300 BAG/10 41,624 12,487,200 50 PCS 4,345 217,250 100 PCS 4,345 434,500 100 PCS 4,345 434,500 200 PCS 4,345 869,000 300 PCS 4,345 1,303,500 200 PCS 4,345 869,000 300 PSG 5,332 1,599,600 SUCTION CATH NO 16 SURGI GLOVE STERIL 6 SOFTPAD SUCTION CATH NO 6 SUCTION CATH NO 8 SUCTION CATH NO 10 SUCTION CATH NO 12 SUCTION CATH NO 14 SPUIT 100 CC STABIMET STIK KGD STYLET TRACH TUBE BAYI STYLET TRACH TUBE ANAK STYLET TRACH TUBE DEWASA SPUIT 5 CC SPUIT 10 CC SPUIT 20 CC ECCENTRIC SPUIT 30 CC SPUIT 50 CC ECCENTRIC SPUIT 50 CC CATHIP SODA LIME SPINOCAN NO 23 SPINOCAN NO 25 SPINOCAN NO 27 SPUIT 1 CC SPUIT 3 CC SILK BLACK 4/0 TAPPER SIRCUIT NCPAP SLE SKIN MARKER REGULAR TIP SKIN PREPARATION GEL/SKINPURE SKINTEK FOAM/ELEKTRODA ANAK SKINTEK FOAM/ELEKTRODA DEWASA SELANG NASAL O2 DEWASA SELANG SUCTION / MASS SUCTION SILK BLACK 2/0 CUTTING SILK BLACK 2/0 TAPPER SILK BLACK 3/0 TAPPER SILK BLACK 3/0 CUTTING SARUNG TANGAN PANJANG NO 7,5 SARUNG TANGAN PANJANG NO 8 SELANG NEBULIZER ANAK SELANG NEBULIZER DEWASA SELANG NASAL O2 ANAK SELANG NASAL O2 BAYI SAFIL 1 HR / T-VIO / PGA 1 SAFIL 2/0 HR / T-VIO / PGA 2/0 SAFIL 3/0 HR / T-VIO / PGA 3/0 SAFIL 4/0 HR / T-VIO / PGA 4/0 SARUNG TANGAN PANJANG NO 6,5 SARUNG TANGAN PANJANG NO 7 PROLENE 7/0 EP 8735 H RECTAL TUBE NO 20 RECTAL TUBE NO 22 RECTAL TUBE NO 28 RECTAL TUBE NO 32 RING PERSARIUM NO 7,5 POT PLASTIK 100CC POT PLASTIK 50CC PREMILEN MESH 5X10 PROLENE 2/0 8685 H PROLENE 5/0 W 8006T PROLENE 6/0 8606 G POLYPROPYLANE 2/0 TS 27 POLYPROPYLANE 4/0 TS 19 POLYPROPYLANE 3/0 TS 19 POLYPROPYLANE 5/0 CUTTING POLYPROPYLANE 7/0 TAPPER POPIDONE IODINE 1000CC/ECODIN POLIBAN 3 INC POLIBAN 4 INC POLIBAN 6 INC POLIGYP 3 INC POLIGYP 4 INC POLIGYP 6 INC

5,000 PSG 5,332 26,660,000 8,000 PSG 5,332 42,656,000 12,000 PSG 5,332 63,984,000 1,200 PSG 5,332 6,398,400 80 PCS 55,500 4,440,000 100 BOX/10 60,500 6,050,000 12 BOX/10 3,490,174 41,882,088 200 ROLL 152,637 30,527,400 200 ROLL 197,329 39,465,800 10 PCS 302,500 3,025,000 10 PCS 302,500 3,025,000 5 BOX 127,600 638,000 5 BOX 112,640 563,200 100 BOX/100 70,400 7,040,000 100 BOX/100 39,500 3,950,000 5 PCS 3,369,786 16,848,930 5 PCS 142,500 712,500 5 PCS 142,500 712,500 5 PCS 142,500 712,500 5 PCS 142,500 712,500 500 PCS 149,490 74,745,000 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 50 PCS 37,000 1,850,000 50 PCS 37,000 1,850,000 8 PCS 5,120,000 40,960,000 50 PCS 36,872 1,843,600 50 PCS 36,872 1,843,600 50 PCS 31,716 1,585,800 50 PCS 32,090 1,604,500 30 PCS 44,801 1,344,030 80 PCS 112,695 9,015,600 4,000 PCS 7,626 30,504,000 5,000 PCS 4,700 23,500,000 10 GLN/5L 322,000 3,220,000 2 BOX/36 3,296,375 6,592,750 2 BOX/36 4,004,215 8,008,430 10 BOX/36 3,378,477 33,784,770 10 BOX/36 3,860,651 38,606,510 10 BOX/36 2,945,315 29,453,150 6 PCS 2,900,000 17,400,000 6 PCS 2,900,000 17,400,000 10 PCS 82,000 820,000 10 PCS 82,000 820,000 VICRYL 4/0 VCP 392 H VICRYL 4/0 VCP 310 VP SHUNT MED PRESSURE ANAK VP SHUNT MED PRESSURE DEWASA WOUND DRAIN 200 ML NO 10 WOUND DRAIN 200 ML NO 12 UNDER PAD URINE BAG USG GEL ONEMED VICRYL 1/0 VCP 359 VICRYL 2/0 VCP 602 H VICRYL 3/0 VCP 316 UMBLICAL CATH NO 2,5 UMBLICAL CATH NO 3,5 UMBLICAL CATH NO 4 UMBLICAL CATH NO 5 UMBLICAL CATH NO 8 UMBLICAL CORD THORARIC TROCAT NO 24 THORARIC TROCAT NO 28 THORARIC TROCAT NO 32 TUTUP MATA BAYI GEA SIZE M TUTUP MATA BAYI GEA SIZE S ULTRA FAST FIX TRACHEOSTOMY NO 6 TRACHEOSTOMY NO 7 TRACHEOSTOMY 7,5 TRACHEOSTOMY 8 TRIPLE LUMEN OCTOPUS THORARIC TROCAT NO 16 T.TUBE / T. DRINE NO 5 TENSOPLAST STK ADULT TENSOPLAST STK PAED TOPI DOKTER TOPI PERAWAT TOPI WILAMED NEONATAL BONNET SUREFIT/GROUNDING CABLE SURGICAL MASKER VISOR B24 SURGICEL FIBLIAR 5X10 SYNCERA ELECTOFIX 10X10 SYNCERA ELECTOFIX 15X10 T.TUBE / T. DRINE NO 3 SURGI GLOVE STERIL 6,5 SURGI GLOVE STERIL 7 SURGI GLOVE STERIL 7,5 SURGI GLOVE STERIL 8

5,226,556.00

radiologi laboratorium HD CSSD

Satuan Tarif/Harga 5 5.1 5.1.02 5.1.02.01 5.1.02.01.01 5.1.02.01.01.0026 467,605,593 100 Kotak 52,202 5,220,200 50 Bungkus 45,938 2,296,900 2,000 Lembar 4,802 9,604,000 2,000 Lembar 4,802 9,604,000 700 Lembar 4,802 3,361,400 100 Blok 49,592 4,959,200 10 Bks 2,610 26,100 1,000 Lembar 2,000 2,000,000 10 Blok 55,000 550,000 1,000 Lembar 1,096 1,096,000 100 Blok 7,000 700,000 200 Blok 53,768 10,753,600 20 Blok 26,883 537,660 50 Blok 22,000 1,100,000 20 Blok 125,000 2,500,000 40 Blok 49,070 1,962,800 40 Blok 37,324 1,492,960 20 Blok 41,761 835,220 400 Blok 23,751 9,500,400 50 Blok 22,000 1,100,000 30 Blok 50,000 1,500,000 10 Blok 41,761 417,610 10 Blok 26,000 260,000 20 Blok 49,592 991,840 60 Blok 49,592 2,975,520 70 Kotak 275,000 19,250,000 50 Kotak 275,000 13,750,000 50 Kotak 275,000 13,750,000 60 Blok 112,000 6,720,000 3,000 Rim 156 468,000 4,000 Lbr 3,000 12,000,000 300 Lbr 1,500 450,000 500 Lbr 1,500 750,000 200 Lbr 1,000 200,000 200 Lbr 2,000 400,000 200 Lbr 2,000 400,000 14 Rim 350,000 4,830,000 5 Rim 620,000 3,100,000 4 Rim 350,000 1,400,000 5 Rim 137,814 689,070 50 Blok 26,883 1,344,150 50 Blok 26,883 1,344,150 50 Blok 47,504 2,375,200 12,000 Lbr 2,088 25,056,000 300 Blok 49,592 14,877,600 50 Lbr 292 14,600 2,000 Lbr 573 1,146,000 500 Lbr 1,566 783,000 600 Lbr 4,000 2,400,000 600 Lbr 4,000 2,400,000 150 Blok 47,504 7,125,600 20 Blok 47,504 950,080 30 Blok 47,504 1,425,120 20 Blok 47,504 950,080 60 Blok 10,440 626,400 SURAT KETERANGAN SAKIT SURAT KETERANGAN DOKTER SURAT PENGANTAR SURAT KETERANGAN MENINGGAL STELLING CARD GUDANG FARMASI STIKER OBAT LASA SEDANG SURAT KETERANGAN KELAHIRAN LK MAP STATUS RESEP STELLING CARD KARTU STOK HIJAU KARTU STOK MERAH KERTAS MERAH SURAT KETERANGAN KELAHIRAN PR SURAT KETERANGAN PROTOKOL TERAPI LAPORAN HARIAN RAJAL PRIBADI LAPORAN PELAYANAN RAWAT JALAN POLI BPJS LAPORAN KEGIATAN PELAYANAN DI POLIKLINIK RSHM PEMANTAUAN ICU/ CETAK OBSERVASI ICU PEMANTAUAN ICU/KERTAS PICU NICU LAPORAN ANASTESI KARTU STOK BIRU HVS BERKOP WARNA KARTU BEROBAT KECIL KARTU IGD GELANG PASIEN ANAK-ANAK GELANG PASIEN DEWASA LAKI-LAKI GELANG PASIEN DEWASA WANITA BON CATATAN LINEN BON PERBAIKAN BARANG BUKTI PELAYANAN RAJAL BPJS KARTU PEMERIKSAAN USG OBGYN REPORT KARTU PEMELIHARAAN ALAT KESEHATAN BUKU CETAK DISPOSISI SURAT FORMULIR PELAYANAN INFORMASI OBAT FORMULIR SELESAI KEPANITERAAN KLINIK DAFTAR TINDAKAN HD TRAVELLING DIALISIS DAFTAR PEMAKAIAN OKSIGEN BLANGKO SP (SURAT PESANAN) BLANGKO FOTO BLANGKO LABORATORIUM FORMULIR PERMINTAAN PEMERIKSAAN PATOLOGI BLANGKO PA BLANKO ECHO KERTAS BC WARNA HIJAU DOUBLE BLANGKO EEG BLANGKO EKG Belanja Barang Habis Pakai Belanja Alat/Bahan untuk Kegiatan Kantor- Bahan Cetak [-] Barang Cetakan AMPLOP BERKOP BLANGKO PMI FAAL HATI BLANGKO PEMERIKSAAN LABORATORIUM AMPLOP SCANNING BIRU UK 37X57 ASESMEN PRA OPERASI AMPLOP COKLAT EEG AMPLOP DINAS AMPLOP RADIOLOGI UK 24X30 AMPLOP RADIOLOGI UK 37X47 Masukan Dana yang dibutuhkan Rp 65,000,000,000 Keluaran terlaksananya Operasional RS 1 tahun RENCANA KERJA ANGGARAN (RKA) BLUD 2022 Indikator Tolak Ukur Kinerja Target Kinerja Capaian Program Hasil - - Kode Rekening Uraian Rincian Perhitungan jumlah Volume BELANJA DAERAH BELANJA OPERASI Belanja Barang dan Jasa Belanja Barang

30 Blok 24,535 736,050 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 50 Blok 49,592 2,479,600 20 Blok 49,592 991,840 100 Blok 49,592 4,959,200 60 Blok 49,592 2,975,520 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 100 Blok 49,592 4,959,200 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 10 Blok 49,592 495,920 10 Blok 49,592 495,920 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 20 Blok 49,592 991,840 20 Blok 49,592 991,840 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 5 Blok 49,592 247,960 20 Blok 49,592 991,840 5 Rim 49,592 247,960 300 Blok 49,592 14,877,600 20 Blok 49,592 991,840 50 Blok 49,592 2,479,600 10 Blok 49,592 495,920 30 Blok 49,592 1,487,760 60 Blok 49,592 2,975,520 30 Blok 49,592 1,487,760 30 Blok 49,592 1,492,719 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 60 Blok 49,592 2,975,520 20 Blok 49,592 991,840 50 Blok 49,592 2,479,600 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 20 Blok 49,592 991,840 20 Blok 49,592 991,840 20 Blok 49,592 991,840 10 Blok 49,592 495,920 10 Blok 49,592 495,920 4 Blok 49,592 198,368 2 Blok 49,592 99,184 4 Blok 49,592 198,368 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 20 Blok 49,592 991,840 10 Blok 49,592 495,920 NYERI AKUT FORM RM 009 1 32 NYERI KRONIS FORM RM 009 1 33 HIPER TERMIA FORM RM 09 1 20 CEMAS FORM RM 009. 1. 04 GANGGUAN ELIMINASI DIARE FORM RM 009 1 08 GANGGUAN ELIMINASI KONSTIPASI FORM RM 009 1 09 GANGGUAN ELIMINASI URINE FORM RM 009 1 10 GANGGUAN INTEGRITAS KULIT HIPOTERMI FORM RM 009 1 21 INTOLERANSI AKTIFITAS FORM 009 1 23 MUAL FORM RM 009 1 30 PINDAH ANTAR RUANGAN RM 035 HAL 1/3 PINDAH ANTAR RUANGAN RM 035 HAL 3/3 BERSIHAN JALAN NAFAS TIDAK EFEKTIF FORM RM 009.1.03 TINDAKAN HARIAN KEBIDANAN RM 9B HAL 1/10 TINDAKAN HARIAN KEBIDANAN RM 9B HAL 3/10 TINDAKAN HARIAN KEBIDANAN RM 9B HAL 9/10 PERMINTAAN KONSUL JAWABAN KONSUL RM 12 A (RM 059-PAGE I) TRANSFER PASIEN DARI IGD ANTAR RUANGAN RM 12 B HAL 1/2 CATATAN VITAL SIGN RM 025.1 HAL 1/2 ASUHAN KEBIDANAN RM 9 C DAFTAR PEMBERIAN TERAFI RM 10 B HAL 1/2 RM 9 E HAL 5/10 PELAKSANAAN PENCEGAHAN PASIEN JATUH RM 11 B TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 9/10 ASSESEMEN AWAL MEDIS HEMODIALISIS TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 1/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 3/10 EDUKASI PASIEN DAN KELUARGA TERINTEGRASI RM 7 E HAL 3/4 CATATAN INTAKE DAN OUT PUT RM 8 D (RM 025) ASESMEN ULANG TANDA - TANDA & ULANG NYERI RM 8 F HAL 1/2 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 3/6 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 5/6 PENGKAJIAN AWAL KEBIDANAN BAYI BARU LAHIR RM 5 I HAL 1/2 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 5/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 7/10 KOMUNIKASI S BAR RM 7 C KOMUNIKASI EDUKASI HARIAN RM 7 D EDUKASI PASIEN DAN KELUARGA TERINTEGRASI RM 7 E HAL 1/4 SITE MARKING (PENANDAAN OPERASI) RM 6 B LAPORAN PEMBEDAHAN / LAPORAN OPERASI RM 6 A HAL 1/2 CATATAN PERKEMBANGAN PASIEN TERINTEGRASI RM 7 A HAL 1/2 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 1/6 PENGKAJIAN KEPERAWATAN PASIEN TAHAP TERMINAL RM 5 E HAL 1/2 PENGKAJIAN KEPERAWATAN PASIEN HEMODIALISA RM 5 F HAL 1/4 PENGKAJIAN KEPERAWATAN PASIEN HEMODIALISA RM 5 F HAL 3/4 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 5/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 7/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 9/10 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 3/6 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 5/6 PENGKAJIAN AWAL MEDIS THT RANAP RM 4 G HAL 1/3 PENGKAJIAN KEPERAWATAN PASIEN RANAP USIA 14 TAHUN RM 5 G HAL 1/4 PENGKAJIAN KEPERAWATAN PASIEN RANAP USIA 14 TAHUN RM 5 G HAL 3/4 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 5/6 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 1/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 3/10 PENGKAJIAN AWAL MEDIS THT RANAP RM 4 G HAL 3/3 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 1/6 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 3/6 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 1/6 PENGKAJIAN MEDIS THT RAJAL RM 3 F HAL 1/4 PENGKAJIAN MEDIS THT RAJAL RM 3 F HAL 3/4 PENGKAJIAN MEDIS IGD RM 4 A HAL 1/4 PENGKAJIAN AWAL KEPERAWATAN RAJAL RM 3 B HAL 1/2 PENGKAJIAN AWAL MEDIS NEUROLOGI RAJAL RM 3 E HAL 1/3 PENGKAJIAN AWAL MEDIS NEUROLOGI RAJAL RM 3 E HAL 3/3 PENGKAJIAN MEDIS IGD RM 4 A HAL 3/4 PENGKAJIAN AWAL MEDIS RANAP RM 4 B HAL1/2 RESUME KEPERAWATAN PASIEN PULANG RANAP RM 2+E RENCANA PEMULANGAN PASIEN 2 F HAL 1/2 PENGKAJIAN AWAL MEDIS RAJAL RM 3A HAL 1/2 SURAT REKOMENDASI DPJP RESUME KLINIS RAJAL RM 2 A RESUME MEDIS RANAP RM 2 B HAL 1/2 (RM 002)

10 Blok 49,592 495,920 2,500 Blok 49,592 123,980,000 20 Blok 49,592 991,840 10 Blok 49,592 495,920 10 Blok 26,101 261,010 50 Blok 31,500 1,575,000 2 Blok 49,592 99,184 50 Blok 132,000 6,600,000 30 Blok 47,504 1,425,120 30 Blok 26,883 806,490 287,669,000.00 200 Buah 1,000 200,000 1,000 Buah 1,300 1,300,000 100 Botol 60,000 6,000,000 500 Botol 60,000 30,000,000 100 Botol 45,000 4,500,000 30 Buah 11,000 330,000 50 Botol 42,988 2,149,400 20 Buah 14,300 286,000 100 Buah 100,000 10,000,000 20 Helai 80,000 1,600,000 400 Botol 60,000 24,000,000 6 Kg 30,000 180,000 400 Helai 57,500 23,000,000 7 Botol 21,000 147,000 10 Buah 50,000 500,000 25 Buah 16,250 406,250 24 Buah 17,000 408,000 120 Buah 13,000 1,560,000 400 Bungkus 40,150 16,060,000 700 Kg 20,800 14,560,000 700 Kg 28,600 20,020,000 100 Kg 46,200 4,620,000 100 Kg 31,110 3,111,000 100 Kg 16,500 1,650,000 100 Kg 7,800 780,000 100 Kg 6,500 650,000 100 Kg 9,100 910,000 800 Saset 25,740 20,592,000 350 Batang 1,000 350,000 100 Botol 140,000 14,000,000 250 Buah 7,000 1,750,000 12 Buah 33,800 405,600 45 Pasang 40,000 1,800,000 100 Buah 62,500 6,250,000 30 Buah 60,000 1,800,000 50 Pasang 18,750 937,500 25 Pasang 12,650 316,250 7 Pasang 220,000 1,540,000 200 Buah 60,000 12,000,000 300 Bungkus 25,000 7,500,000 1,000 Kotak 19,500 19,500,000 500 Botol 60,000 30,000,000 470,978,050.00 1,000 Kotak 26,000 26,000,000 200 Kotak 85,000 17,000,000 140 Kotak 44,000 6,160,000 140 Kotak 32,800 4,592,000 120 Bungkus 2,610 313,200 50 Buah 36,000 1,800,000 50 Buah 30,500 1,525,000 144 Buah 258,000 37,152,000 61 Buah 21,300 1,299,300 750 Buah 13,900 10,425,000 1,000 Buah 16,500 16,500,000 80 Buah 16,500 1,320,000 80 Buah 40,000 3,200,000 120 Kotak 7,800 936,000 120 Kotak 3,900 468,000 500 Buah 31,000 15,500,000 300 Buah 80,600 24,180,000 50 Buah 16,500 825,000 BINDER KLIP BESAR BINDER KLIP KECIL BUKU BESAR FOLIO BUKU EXPEDISI DOKUMEN PAPER ISI 100 BATRE PETAK 9 VOLT BALPOINT CAIR BALPOINT MERAH BATRAI REMOT AMPLOP COKLAT UK HVS BALPOINT HITAM BALPOINT BIRU SERBET KAIN KOTAK SUNLIGHT / MAMA LEMON TISSU KOTAK BATRAI JAM BATRAI SEDANG ANAK HEKTER BESAR AMPLOP BESAR PUTIH AMPLOP KECIL PUTIH WIPOL [-] BARANG ALAT TULIS KANTOR (ATK) ANAK HEKTER KECIL SEPATU BOAT SANDAL SAPU PLASTIK SAPU KECIL U MOBIL SABUN DETTOL CAIR SABUN MANDI LIFEBUOY SAMPO MOBIL PLASTIK KUNING 90X100 PLASTIK 1/4 /KG PLASTIK 1/2 KG SARUNG TANGAN KARET SARUNG TANGAN KAIN PLASTIK OBAT KLIP UK17X11 RINSO / DAIA SABUN BATANGAN PLASTIK 1 KG PLASTIK OBAT KLIP UK 12X8 PLASTIK OBAT KLIP UK 15X10 PLASTIK HITAM 90X100 KIT BLACK SEMIR PEWANGI GANTUNG UNTUK MOBIL PINGWIN STELLA GANTUNG/PEWANGI GANTUNG KARET GELANG KESET KAKI HANDUK KIT BLACK SEMPROT MAGIC BESAR BAYGON SEMPROT BAYCLIN BAYFRES PISAU SILET CUKUR GAGANG PLASTIK ASOY PUTIH JAM DINDING KANEBO UNTUK MOBIL KARBOL BRUS HITAM FORCE MAGIC PEMBUNUH SERANGGA GUNTING BESAR BOTOL POT OBAT BOTOL TETES TELINGA PERINCIAN BIAYA SURAT MASUK PERAWATAN TIKET JASA DOKTER POLA NAFAS TIDAK EFEKTIF FORM RM 009 1 42 RESIKO ASPIKSIA FORM RM 009 1 43 RESIKO CEDERA JATUH FORM RM 009 1 46 [-] BARANG RUMAH TANGGA RESIKO TIDAK STABIL KADAR GULA DARAH CETAK AMPRAHAN FARMASI NCR R3 FOLIO KERTAS PICU - PICU PERUBAHAN NUTRISI LEBIH DARI KEBUTUHAN RM 009 1 41

150 Buah 42,000 6,300,000 30 Buah 175,000 5,250,000 250 Buah 20,250 5,062,500 50 Buah 60,000 3,000,000 1,000 Rim 49,270 49,270,000 1,000 Rim 43,000 43,000,000 3 Bungkus 575,000 1,725,000 2 Rol 4,687,500 9,375,000 500 Buah 750 375,000 1 Bungkus 90,000 90,000 100 Kotak 21,792 2,179,200 20 Buah 500,000 10,000,000 70 Kotak 9,100 637,000 200 Kotak 5,200 1,040,000 10 Kotak 400,000 4,000,000 25 Kotak 442,600 11,065,000 75 Buah 35,000 2,625,000 100 Buah 19,500 1,950,000 150 Buah 46,150 6,922,500 2,000 Buah 2,500 5,000,000 300 Buah 63,000 18,900,000 30 Buah 350,000 10,500,000 24 Buah 3,600 86,400 240 Buah 20,000 4,800,000 30 Kotak 45,500 1,365,000 5 Rol 40,000 200,000 300 Lembar 1,650 495,000 45 Buah 35,100 1,579,500 150 Buah 11,500 1,725,000 150 Buah 30,500 4,575,000 150 Buah 23,000 3,450,000 900 Buah 13,000 11,700,000 450 Buah 15,600 7,020,000 40 Buah 3,900 156,000 2 Buah 153,400 306,800 300 Buah 7,500 2,250,000 250 Botol 105,447 26,361,750 100 Botol 105,447 10,544,700 100 Botol 105,447 10,544,700 100 Botol 105,447 10,544,700 10 Botol 300,000 3,000,000 100 Botol 14,059 1,405,900 100 Buah 14,059 1,405,900 TINTA PRINTER CANNON TINTA STEMPEL OTOMATIS BIRU TINTA STEMPEL OTOMATIS HIJAU TINTA PRINTER KUNING EPOSN TINTA PRINTER MERAH EPSON TINTA PRINTER BIRU EPSON SLASIBAN COKLAT PITA TIK KALKULATOR PLASTIK KARTU INVENTARIS ROL BESI SLASIBAN BENING BESAR SLASIBAN HITAM BESAR SPIDOL PERMANENT SPIDOL WHITE BOARD STIP PINSIL 2B STEMPEL TANGGAL TINTA PRINT LABEL FARMASI TINTA PRINTER HITAM EPSON PINSIL 2 B PISAU CUTTER PITA PRINTER LX 310 KLIP ATOM SEDANG KERTAS CF 9 1/2 X 11 R3 KERTAS CF 9 1/2 X 11 R3 F MAP KERTAS MAP TULANG PLASTIK MOUSE COMPUTER WAYAR LES LEM POVINAL LETTER FILE 401 LETTER FILE 403 KLIP ATOM BESAR KABEL JARINGAN KERTAS PRINT ETIKET FARMASI KERTAS FILM GLOSSY HVS F4 HVS A4 JEK IRJ KABEL JARIGAN KERTAS PRINT THERMAL 80X80 KEYBOARD COMPUTER WAYAR LES FLASDISK 32 GB HEKTER SEDANG HEKTER BESAR FILE BOX