Departement Name : Trauma Center

No RDS NAME QTY RDS

1 Bed examination 5
2 Stretcher - Observation w/ O2 Storage Capacity 1
3 Patient Monitor, 5 Parameters(General) + Bracket 12 " 1
4 Resuscitator bag Adult (Silicone) 1
5 Resuscitator bag Child (Silicone) 1
6 Rescue Pack, Team Code Blue (incl. O2 Mobile Cylinder 500L) 1
7 Baby Scale 1

8 Bedpan + Cover 2
9 ECG 12 Lead 1
10 Emergency trolley (ET) 1
11 Laryngoscope Infant _ RIESTER 1
12 Laryngoscope Mcintosh (Adult+Child) _ RIESTER 1
13 Resuscitator bag Infant (Silicone) 1
14 Defibrillator 1
15 Glucotest machine (KSO) - purchase strips only 1
16 Head Lamp 1
17 Hygrometer 1
18 IV Stand with 4 hooks 1
19 Xray Viewer 2 Film 1
20 Light, Exam, mobile(Roda) 1
21 Mortar and Pestle (Medium) - 13cm 1
22 Nebulizer - Adult/child 1
23 O2, mobile (cylinder) 1000 L + Regulator 3
24 Oximeter Pulse - finger, portable (Adult + Child) - KLINIK 1
25 Pat Slide 1
26 Penlight/ Flash Light 1
27 Pressure Infusor 1
28 Reflex hammer 1
29 Refrigerator - with key 50-60L, 2-9oC 1
30 Scale, Standing (weight + height) - Tulung Agung 1
31 Sphygmomanometer, mobile (Stand model) ANEROID 1
32 Sphygmomanometer,Wall Mounted ANEROID 1
33 Sphygmomanometer Cuff-Pediatric 1
34 Step Stools 1
35 Stethoscope - adult 2
36 Stethoscope - child 1
37 Stethoscope - infant 1
38 Stopwatch 1
39 Thermometer, Digital, Body + Cuff 2
40 Torniquet (Jetpull) 2
41 Trolley - Instrument (Small) 2
42 Urinal, plastic 2
43 Wheel chair (standard) 1
44 Overbed Table 3
45 Jolly Box No. 100 (1 box = 48 unit) 48
46 Jolly Box No. 300 (1 box = 24 unit) 48
47 Thermometer, Refrigerator (incl in ref secific for lab and pharmac 1
48 Diagnostic Set 1
49 O2, mobile (cylinder) 500 L 1
50 Wall Clocks - Digital 1
51 Trash Bin, 10-20 L, Std 8
52 Trash Bin, 10-20 L, High 2
53 Whiteboard 1
54 Bracket - Alcohol Gel 2
55 GIPS REMOVAL 1
56 EMERGENCY TROLLEY INSTRUMENT 1
57 EMERGENCY STICHING SET 1
Departement Name : IPD
NO RDS NAME QTY
1 Bed - manual 2 Crank (incl.bedside locker,overbed table) 10
2 Sphygmomanometer, mobile (Stand model) ANEROID 1
3 Sphygmomanometer Cuff - Pediatric 1
4 Bedpan + Cover 2
5 Bedpan rack with urinal 1
6 Basin Stand, Double (include basin) 1
7 Glucotest machine (KSO) - purchase strips only 1
8 IV Stand with 4 hooks 1
9 Measuring tape 1
10 Oximeter Pulse - finger, portable (Adult + Child) - KLINIK 1
11 Penlight/ Flash Light 1
12 Reflex hammer 1
13 Scale, Standing (weight + height) - Tulung Agung 1
14 Stethoscope - adult 1
15 Stethoscope - child 1
16 Thermometer, Digital, Body + Cuff 1
17 Torniquet (Jetpull) 1
18 Trolley - Dirty Linen (Small) 1
19 Trolley - Dressing 1
20 Trolley - Multipurpose 1
21 Urinal, plastic 2
22 Maatkan 2000 ml 1
23 Trash Bin, 10-20 L, Std 4
24 Trash Bin, 10-20 L, High 1
25 Bracket - Alcohol Gel 1
26 Bracket - Sharp Container (Small) 2
Departement Name : OPD
No RDS NAME QTY
1 Sphygmomanometer Cuff-Pediatric 1
2 Chair, Gynecological - MCU 1
3 Light, Exam, mobile 1
4 Measuring tape 1
5 Trolley - Multipurpose 1
6 INSERTION IUD SET 1
7 USG 4D 1
8 Xray Viewer 1 Film 1
9 Thermometer, Digital, Body + Cuff 1
10 Xray Viewer 2 Film 1
11 Paket Poli Essilor 1
7 Baby Scale 1
13 Penlight/ Flash Light 1
14 Reflex hammer 1
15 Stethoscope - adult 2
16 Stethoscope - Child 1
17 Stethoscope - infant 1
18 Wheel chair (standard) 1
19 Chair, Adjustable Stool 2
20 TV 42" (Proxy) 1
21 TV Bracket Ceiling - 42" 1
22 Wall Clocks 3
23 Trash Bin, 10-20 L, Std 5
24 Trash Bin, 10-20 L, High 3
25 Bracket - Alcohol Gel 1
26 SUTURE REMOVAL SET 2
27 Bracket - Sharp Container (Small) 5
Departement Name : Laboratory
No RDS NAME QTY
1 Chemistry Analyzer - Automated (KSO) 1
2 Cardiac Analyzer (KSO) 1
3 Coagulometer Analyzer (KSO) 1
4 Electrolyte Analyzer (KSO) 1
5 Glucotest machine (KSO) - purchase strips only 2
6 Hematology Analyzer 5 Diff (Auto-Analyzer) (KSO) 1
7 Urine Analyzer(KSO) 1
8 Beaker Glass 100ml 1
9 Beaker Glass 200ml 1
10 Beaker Glass 500ml 1
11 Bottle, Washing 2
12 Bunsen Burner (Micro+Urine) 1
13 Centrifuge Swing Out Rotor (15ml tube, 16 hole ) 1
14 Centrifuge Swing Out Rotor (5ml tube,16 hole) 1
15 Centrifuge, haematrocrit 210 1
16 Cool Box (Small) 2
17 Counting Chamber, Fuchs Rosenthal 1
18 Counting Chamber, Improved Neubauer 1
19 Eye Wash 1
20 Esbach Tube 2
21 ESR Analyzer 1
22 Flammable Storage Cabinet 1
23 Freezer for specimen 75 x 80 x 200 1
24 Funnel, Glass 2
25 Hygrometer 1
26 Loop /Ose cylinder 2
27 Manual Blood Cell Counter (Differential) 1
28 Measuring Cup 1000ml 1
29 Measuring Cup 100ml 1
30 Measuring Cup 10ml 1
31 Measuring Pipette 1 mL 1
32 Measuring Pipette 10 mL 1
33 Measuring Pipette 5 mL 1
34 Micropipette Adjustable 10-100 uL 2
35 Micropipette Adjustable 1-10 uL 2
36 Micropipette Adjustable 200-1000 uL 2
37 Micropipette Adjustable 20-200 uL 2
38 Micropipette Adjustable 5-50 uL 2
39 Micropipette stand 2
40 Microscope for Hema, Urine, Mikro, Bank Darah 1
41 Mixer, Roller 1
42 Mortar and Pestle (Medium) - 13cm 1
43 Pipette Ball, Peleus 1
44 Pipette, Leucocyte 2
45 Pipette,Erithrocyte 2
46 Pippette, volume 25 mL 1
47 Pippette, volume 5 mL 1
48 Pippette, volume 1 mL 1
49 Pippette, volume 10 mL 1
50 Plate Shaker 1
51 Rack, ESR 1
52 Rack, Staining/ Staining tray 2
53 Rack, Urine 3
54 Refrigerator, Pharmaceutical 1
Refrigerator and Freezer 80 x 70 x 175 - Lab Specimen, Reagents,
55 Meds (Mikro - 1, Hematologi & Urine - 1) 1
56 Rotator 1
57 Sifter, Wire 1
58 Slide holder metal 2
59 Staining Jar 12
60 Stopwatch 2
61 Tally Counter 1
62 Test Tube Holder 2
63 Test Tube Rack 2
64 Test Tube Rack (5mL) 6
65 Thermometer, Refrigerator (incl in ref secific for lab and pharmac 1
66 Timer (Digital) 2
67 Trolley - Instrument (Small) 2
68 Vortex 1
69 Forceps 1
70 Wall Clocks 1
71 Trash Bin, 10-20 L, Std 6
Departement Name : LDS
No RDS NAME QTY
1 Baby Crib Trolley 1
2 Bed - for Labor and Delivery - PONEK 1
3 CTG machine 1
4 CTG - Kabel FHR (twin pregnancies) 1
5 Doppler fetus detector 1
6 Infant warmer 1
7 Infant resuscitator set 1
8 Vacuum Extractor + Suction Cup 1
9 DELIVERY SET 1
10 D & C SET 1
11 DELIVERY SUTURE SET 1
Departement Name : OT
No RDS NAME QTY
1 CHALAZION/HORDEOLUM 1
2 Mayo instrument table 1
Departement Name : Ambulance
No RDS NAME QTY
1 Bedpan + Cover 1
2 Torniquet (Jetpull) 1
3 Urinal, plastic 1
4 Thermometer, Digital, Body + Cuff 1
5 Resuscitator bag Adult (Silicone) 1
6 Resuscitator bag Child (Silicone) 1
7 Glucotest machine (KSO) - purchase strips only 1
8 Laryngoscope Mcintosh (Adult+Child) _ RIESTER 1
 9 Laryngoscope Infant _ RIESTER 1
10 O2 Flowmeter + Connector 1
11 Oximeter Pulse - finger, portable (Adult + Child) - KLINIK 1
12 Penlight/ Flash Light 1
13 Sphygmomanometer (Desktop) ANEROID 1
14 Stethoscope - adult 1
15 Stethoscope - child 1
16 Suction Machine (Mobile) 1
17 Toolkit Box 1
Departement Name : Central Pharmacy
NO RDS NAME QTY
1 Basket - Mesh Tray 16x12x6cm (1 box = 12 unit) 50
2 Beaker Glass 100ml 1
3 Beaker Glass 200ml 1
4 Beaker Glass 500ml 1
5 Bottle, Brown, 50ml 1
6 Eye wash 1
7 Funnel, Glass 2
8 Hygrometer 2
9 Jolly Box No. 100 (1 box = 48 unit) 400
10 Jolly Box No. 200 500
11 Jolly Box No. 300 (1 box = 24 unit) 200
12 Jolly Box No. 400 100
13 Measuring Cup 100ml 1
14 Measuring Cup 10ml 2
15 Measuring Cup 20ml 2
16 Measuring Cup 25ml 2
17 Measuring Cup 50ml 1
18 Medicine Pulverizier, Sealing & Packets 1
19 Mortar and Pestle (Large) - 16cm 1
20 Mortar and Pestle (Medium) - 13cm 1
21 Mortar and Pestle (Small) - 10cm 1
22 Refrigerator, Pharmaceutical 1
23 Step Stools 2
24 Timbangan Analitik 1
Thermometer, Refrigerator (incl in ref secific for lab and
25 pharmacy) 1
26 Timer, Amano 2
27 Wall Clocks 2
28 Trash Bin, 10-20 L, Std 7
29 Water Dispenser 1
30 Bracket - Alcohol Gel 1
31 Kotak Obat Mika Besar 0
32 Kotak Obat Mika Kecil 0
Departement Name : Non Clinical Area
No RDS NAME QTY
1 Refrigerator 50 - 60 L, without key 1
2 Safety Box - Night Deposit Box (Cashier) 1
3 Wall Clocks 4
4 Trash Bin, 80 L, Public 2
5 Trash Bin, 10-20 L, Std 8
6 Trash Bin, 10-20 L, High 1
7 Water Dispenser 1
8 Whiteboard 1
9 Bracket - Alcohol Gel 1
10 Cash Box 2
11 Mesin Penghitung Uang - Portable 1
12 Intelligent Money Detector 1
13 Trolley Medical Record 1
14 Mat for Lobby/Main Entrance 2
15 Patient Chair 14
Departement Name : CSSD
No RDS NAME QTY
1 Desktop Sterilizer 22 L 1
2 Hygrometer 1
Departement Name : LINEN
No RDS NAME QTY
HOSPITAL LINEN
1 Sheet (for Bed) 15
2 Sheet (for Cover Blanket) 27
3 Draw Sheet 22
4 Bed Pad / Matras 20
5 Pillow 37
6 Pillow Protector 37
7 Pillow Case 27
8 Bath Mat 25
9 Bath Towel 15
GOWNS QTY
1 Patient Gown Adult, S & M (No Pants) 8
2 Patient Gown Adult, L & XL (No Pants) 8
3 Patient Gown Adult w/ Pants, S & M 1
4 Patient Gown Adult w/ Pants, L & XL 1
5 Patient Gown Pediatric, 3-4 y.o 3
6 Patient Gown Pediatric, 5-6 y.o 3
SCRUBS QTY
1 OT Scrub (Green) S 2
2 OT Scrub (Green) M 2
3 OT Scrub (Green) L 2
4 OT Scrub (Green) XL 2
5 OT Scrub (Green) XXL 2
Departement Name : OTHERS
No RDS NAME QTY
1 Box Container (transparant) - big 1
2
Box Container - big
Dark color, non-transparent, all in 1 color 1
3 Shelf for FMS/CSSD 1
4 Schreider Machine 1
5 HRD Filing cabinet 1
 NO PO QTY PO Realisasi Kekurangan
5 5
PO-20210202-016 1 1
08-001/2023/PO 1 1
PO-20210210-020 2 1
PO-20210210-020 2 1
09-025/2023/PO 1 1
08-010/2023/PO `1 0

PA-20210126-029 5 2
08-001/2023/PO 1 1 -
PA-20210126-026 1 1
09-012/2023/PO 2 1
09-012/2023/PO 2 1
PA-20210126-036 1 1
07-002/2023/PO 1 1
09-006/2023/PO 5
09-012/2023/PO 1 1
PO-20210130-010 7 1
Approval Budget 2 1
PO-20210130-010 1 1
PO-20210127-009 1 1 (-RODA)
PO-20210127-009 3 1
PO-20210210-020 1 1
PO-20210127-005 5 3
PO-10-017-2023 2 0
08-018/2023/PO 1 1
PO-20210130-010 5 1

PO-20210130-010 3 1
CITO SURABAYA 1 1
08-013/2023/PO 2 1
09-012/2023/PO 2 1
09-012/2023/PO 1 1
09-012/2023/PO 3 1
10-005/2023/PO 3 1
07-004/2023/PO 6 2
07-004/2023/PO 4 1
07-004/2023/PO 2 1
PO-20210405-002 3 1
PO-20210301-007 5 2
PO-20210130-010 4 2
PO-20210129-012 4 2
PO-20210129-007 5 2
PO-20210127-009 2 1
08-019/2023/PO 3 3
PO-20210218-005 448 48
PO-20210218-005 dan 09-022/2023/PO(tokopedia)
8/240 8 (-40)
10-020-2023/PO 3 1
09-012/2023/PO 1 1
PO-20210127-005 1 1
PO-20210202-003 1 1
PO-20210215-003 38 8
PO-20210215-003 7 2
 TOKOPEDIA 0 0
PO-20210204-005 6 2
1
09-023/2023/PO 1 1
09-024/2023/PO 1 1

NO PO QTY PO Realisasi Kekurangan

PO-20210202-016 10 10
09-012/2023/PO 2 1
09-012/2023/PO 3 1
PA-20210126-029 5 2
PO-20210129-003 1 1
PO-20210129-012 1
09-006/2023/PO 5 - -
Approval Budget 2 1

PO-10-017-2023 3
PO-20210130-010 5 1
PO-20210130-010 3 1
08-013/2023/PO 2 - -
07-004/2023/PO 6 1
07-004/2023/PO 4 1
PO-20210301-007 5 1
PO-20210130-010 4 1
PROSES PO 1 1
1
CITO SURABAYA 2 1
PO-20210129-007 5 2
PO-20210127-009 1 1
PO-20210215-003 38 4
PO-20210215-003 7 1
PO-20210204-005 6 1
BATAL BATAL BATAL BATAL

NO PO QTY PO Realisasi Kekurangan

09-012/2023/PO 3 1
08-018/2023/PO 1 1 -

CITO SURABAYA 2 1
09-017/2023/PO 1 1
09-014/2023/PO 1 1
08-010/2023/PO 1
PO-20210301-007 5 1
PO-20210130-010 1 1
08-012/2023/PO 1 1
PO-20210218-014 1 1
PO-20210130-010 5 1
PO-20210130-010 3 1
07-004/2023/PO 6 2
07-004/2023/PO 4 1
07-004/2023/PO 2 1
PO-20210127-009 2 1
 PROSES PO 2 2
10-002/2023/PO 1 1
10-002/2023/PO 1 1
PO-20210127-001 12 3
PO-20210215-003 38 5
PO-20210215-003 7 3
PO-20210204-005 6 1
PO-20210210-025 2 1 1
BATAL BATAL BATAL BATAL

NO PO QTY PO Realisasi Kekurangan

09-004/2023 1 1
09-004/2023 1 1
09-005/2023/PO 1 1
09-004/2023 1 1
09-006/2023/PO 5
09-005/2023 1 1
09-004/2023/PO 1 1
PO-20210405-002 2 1
PO-20210405-002 2 1
PO-20210405-002 2 1
10-020/2023/PO 2 2
09-009/2023/PO 1 1
09-009/2023 1 1
09-009/2023 1 1
#N/A #N/A
BELUM ADA PO
09-012/2023/PO 1 1
09-012/2023/PO 1 1
CITO SURABAYA 1 1
10-020/2023 2 2
09-010/2023 1 1
PO-20210129-002 1 1
Ready Grand Mall 1 1
10-020/2023 4 2
PO-20210130-010 7 1

09-013/2023/PO 1 1
09-013/2023/PO 1 1
09-013/2023/PO 1 1
09-013/2023/PO 1 1
09-013/2023/PO 1 1
09-013/2023/PO 1 1
10-020/2023 2 2
10-020/2023 2 2
10-020/2023 2 2
10-020/2023 2 2
10-020/2023 2 2
PO-20210405-002 2 2
PO-20210203-002 1 1
10-020/2023/PO 1 1
PO-20210127-009 3 1
10-020/2023/PO 1 1
09-012/2023/PO 2 2
09-012/2023/PO 2 2
 PO-20210405-002
PO-20210405-002
PO-20210405-002
PO-20210405-002
CITO SURABAYA 1 1
10-020/2023/PO 1 1
CITO SURABAYA 2 2
10-020/2023/PO 3 3
08-020/2023 1 1
PO-20210210-027 1 1
PO-20210217-004 1 1
10-020/2023/PO 1 1
PO-20210129-004 2 2
10-020/2023/PO 12 12
PO-20210405-002 3 2
10-020/2023 1 1
10-020/2023/PO 2 2
PROSES PO 6 6 Lebih 4
PO-20210405-002/PO SUMBER JAYA MEDILAB 3 dan 2 5 kurang 1
10-020-2023/PO 3 1
PO SUMBER JAYA MEDILAB 2 2
PO-20210129-012 4 2
10-020/2023/PO 1 1
09-013/2023/PO 1 1
PO-20210127-001 12 1
PO-20210215-003 38 6

NO PO QTY PO Realisasi Kekurangan

STOK HO STOK HO 1
08-019/2023/PO 1 1
08-014/2023/PO 1 1
08-014/2023/PO 1 1
09-012/2023/PO 1 1
09-008/2023/PO 1 1
09-008/2023/PO 1
09-002/2023/PO 1
09-019/2023/PO 1
09-016/2023/PO 1
09-018/2023/PO 1

NO PO QTY PO Realisasi Kekurangan

PROSES PO 1 1
1 1

NO PO QTY PO Realisasi Kekurangan

PA-20210126-029 5 1
PO-20210130-010 4 1
PO-20210129-007 5 1
PO-20210301-007 5 1
PO-20210210-020 2 1
PO-20210210-020 2 1
09-006/2023/PO 5
09-012/2023/PO 2 1
 09-012/2023/PO 2 1
PO-20210127-004 1 1
PO-10-017-2023 1
PO-20210130-010 5 1
09-012/2023/PO 1 1
07-004/2023/PO 6
07-004/2023/PO 4 1
TIDAK ADA PO
10-005/2023/PO 1 1

NO PO QTY PO Realisasi Kekurangan

Belum ada PO
PO-20210405-002 2 1
PO-20210405-002 2 1
PO-20210405-002 2 1
10-020/2023/PO 1 1
CITO SURABAYA 2 1
10-020/2023 4 2
PO-20210130-010 7 2
PO-20210218-005 448 400
09-022/2023/PO (toko pedia) 500 0
09-022/2023/PO (toko pedia) 240 0
PO-20210218-005 100 100
09-013/2023/PO 2 1
09-013/2023/PO 3 2
09-013/2023/PO 2 2
09-013/2023/PO 2 2
09-013/2023/PO 1 1
PO-20210129-009 1 1
PO-20210127-009 1 1
PO-20210127-009 3 1
PO-20210127-009 1 1
CITO SURABAYA 1 1
10-005/2023/PO 3 1
PO-20210129-010 1 1
10-020-2023/PO 3 1
Belum ada PO
PO-20210127-001 12 2
PO-20210215-003 38 7
PO-20210127-002 2 1
PO-20210204-005 6 1
(-) 0 250
(-) 0 500

NO PO QTY PO Realisasi Kekurangan

09-001/2023/PO 1 1
PO-20210202-002 1 1
PO-20210127-001 12 4
PO-20210210-021 2 2
PO-20210215-003 38 8
PO-20210215-003 7 1
PO-20210127-002 2 1
TOKOPEDIA 0 0
PO-20210204-005 6 1
 10-005/2023/PO 2 2
10-005/2023/PO 1 1
10-005/2023/PO 1 1
PO-20210129-003 1 1
09-026/2023/PO 2 2
PO-20210130-011 / 07-003/2023/PO 3 dan 11 14

NO PO QTY PO Realisasi Kekurangan

PO-20210127-008 1 1
PO-20210130-010 7 1

NO PO QTY PO Realisasi Kekurangan

PO-20210130-004 15 15
PO-20210130-004 27 27
PO-20210130-004 22 22
PO-20210130-004 20 20
PO-20210130-003 37 37
PO-20210130-004 37 37
PO-20210130-004 27 27
PO-20210130-004 25 25
PO-20210130-002 15 15

PO-20210130-004 8 8
PO-20210130-004 8 8
PO-20210130-004 1 1
PO-20210130-004 1 1
PO-20210130-004 3 3
PO-20210130-004 3 3

PO-20210130-004 2 2
PO-20210130-004 2 2
PO-20210130-004 2 2
PO-20210130-004 2 2
PO-20210130-004 2 2

NO PO QTY PO Realisasi Kekurangan

SUMBER ANUGERAH

SUMBER ANUGERAH

10-005/2023/PO 1 1
10-005/2023/PO 1 1
10-005/2023/PO 1 1
Keterangan
On site
On site
On site
On site
On site
On site
BELUM TERIMA DARI INTISUMBER HASIL SEMPURNA, PT

On site
On site
On site
On Site
On Site
On Site
On Site
09-006/2023/PO(MASIH KONFIRMASI PAK SAMUEL) (STOK
KOSONG 1 INDONESIA)
On Site
On Site
On Site
On Site
On Site (- RODA)
On Site
On Site
On Site
Belum Terima dari Vendor PT MEGA PRATAMA MEDICALINDO
On Site
On Site
Stok HO Tidak ada dalam Container 3
On Site
On Site
Belum Di Terima dari PT LABORA MANDIRI INDOPRIMA
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site

Keterangan
On Site
On Site
On Site
On site
On Site
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
09-006/2023/PO(MASIH KONFIRMASI PAK SAMUEL) (STOK
KOSONG 1 INDONESIA)
On Site
Belum ada PO
Belum Terima dari Vendor PT MEGA PRATAMA MEDICALINDO
On Site
On Site
Belum Tiba dari Labora
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
BATAL

Keterangan
On Site
On Site
Belum ada PO
Belum ada PO
On Site
On Site
On Site
Belum Di Terima dari PT INTISUMBER HASIL SEMPURNA GLOBAL
On Site
On Site
On Site
On site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On site (kurang 1 dari boswell)
BATAL

Keterangan
On Site
On Site
On Site
On Site
09-006/2023/PO(MASIH KONFIRMASI PAK SAMUEL) (STOK
KOSONG 1 INDONESIA)
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
Belum dikirim Vendor Sumber Anugerah
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site (-1)
On Site
On Site
On Site
On Site
On Site
On Site
On Site

Keterangan
On Site
On Site
On Site
On Site
On Site
On Site
Belum Terima dari PT BINABAKTI NIAGAPERKASA
Belum Terima dari PT CITRA VITA BUANA (suction cup onsite 3
Nov, Vacum extractor belum onsite)
Belum terima dari boswell
Belum terima dari boswell
Belum terima dari boswell

Keterangan
On Site
On Site

Keterangan
On Site
On Site
On Site
On Site
On Site
On Site
09-006/2023/PO(MASIH KONFIRMASI PAK SAMUEL) (STOK
KOSONG 1 INDONESIA)
On Site
On Site
On Site
Belum Terima dari Vendor PT MEGA PRATAMA MEDICALINDO
On Site
Belum terima dari labora
Belum terima dari PT Anugerah
On Site
TIDAK ADA PO
On Site

Keterangan
Belum di Terima (Tidak ada dalam Container 3)
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
Belum di Terima (Tidak ada dalam Container 3)
Belum di Terima (Tidak ada dalam Container 3)
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site

Keterangan
On Site
On Site
On Site
On Site
On Site
On Site
On Site

On Site
On Site
On Site
On Site
On Site
On Site
On Site

Keterangan
On Site
On Site

Keterangan

On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site

On Site
On Site
On Site
On Site
On Site
On Site

On Site
On Site
On Site
On Site
On Site

Keterangan

On Site
On Site
On Site
Departement Name : Trauma Center
No RDS NAME QTY RDS NO PO QTY PO Realisasi Kekurangan Keterangan
1 Bed examination 5 5 5 On site
2 Stretcher - Observation w/ O2 Storage Capacity 1 PO-20210202-016 1 1 On site
3 Patient Monitor, 5 Parameters(General) + Bracket 12 " 1 08-001/2023/PO 1 1 On site
4 Resuscitator bag Adult (Silicone) 1 PO-20210210-020 2 1 On site
5 Resuscitator bag Child (Silicone) 1 PO-20210210-020 2 1 On site
6 Rescue Pack, Team Code Blue (incl. O2 Mobile Cylinder 500L) 1 09-025/2023/PO 1 1 On site
BELUM TERIMA DARI INTISUMBER HASIL SEMPURNA,
7 Baby Scale 1 08-010/2023/PO `1 0
PT
8 Bedpan + Cover 2 PA-20210126-029 5 2 On site
9 ECG 12 Lead 1 08-001/2023/PO 1 1 - On site
10 Emergency trolley (ET) 1 PA-20210126-026 1 1 On site
11 Laryngoscope Infant _ RIESTER 1 09-012/2023/PO 2 1 On Site
12 Laryngoscope Mcintosh (Adult+Child) _ RIESTER 1 09-012/2023/PO 2 1 On Site
13 Resuscitator bag Infant (Silicone) 1 PA-20210126-036 1 1 On Site
14 Defibrillator 1 07-002/2023/PO 1 1 On Site
09-006/2023/PO(MASIH KONFIRMASI PAK SAMUEL)
15 Glucotest machine (KSO) - purchase strips only 1 09-006/2023/PO 5
(STOK KOSONG 1 INDONESIA)
16 Head Lamp 1 09-012/2023/PO 1 1 On Site
17 Hygrometer 1 PO-20210130-010 7 1 On Site
18 IV Stand with 4 hooks 1 Approval Budget 2 1 On Site
19 Xray Viewer 2 Film 1 PO-20210130-010 1 1 On Site
20 Light, Exam, mobile(Roda) 1 PO-20210127-009 1 1 (-RODA) On Site (- RODA)
21 Mortar and Pestle (Medium) - 13cm 1 PO-20210127-009 3 1 On Site
22 Nebulizer - Adult/child 1 PO-20210210-020 1 1 On Site
23 O2, mobile (cylinder) 1000 L + Regulator 3 PO-20210127-005 5 3 On Site
Belum Terima dari Vendor PT MEGA PRATAMA
24 Oximeter Pulse - finger, portable (Adult + Child) - KLINIK 1 PO-10-017-2023 2 0
MEDICALINDO
25 Pat Slide 1 08-018/2023/PO 1 1 On Site
26 Penlight/ Flash Light 1 PO-20210130-010 5 1 On Site
27 Pressure Infusor 1 Stok HO Tidak ada dalam Container 3
28 Reflex hammer 1 PO-20210130-010 3 1 On Site
29 Refrigerator - with key 50-60L, 2-9oC 1 CITO SURABAYA 1 1 On Site
Belum Di Terima dari PT LABORA MANDIRI
30 Scale, Standing (weight + height) - Tulung Agung 1 08-013/2023/PO 2 1
INDOPRIMA
31 Sphygmomanometer, mobile (Stand model) ANEROID 1 09-012/2023/PO 2 1 On Site
32 Sphygmomanometer,Wall Mounted ANEROID 1 09-012/2023/PO 1 1 On Site
33 Sphygmomanometer Cuff-Pediatric 1 09-012/2023/PO 3 1 On Site
34 Step Stools 1 10-005/2023/PO 3 1 On Site
35 Stethoscope - adult 2 07-004/2023/PO 6 2 On Site
36 Stethoscope - child 1 07-004/2023/PO 4 1 On Site
37 Stethoscope - infant 1 07-004/2023/PO 2 1 On Site
38 Stopwatch 1 PO-20210405-002 3 1 On Site
39 Thermometer, Digital, Body + Cuff 2 PO-20210301-007 5 2 On Site
40 Torniquet (Jetpull) 2 PO-20210130-010 4 2 On Site
41 Trolley - Instrument (Small) 2 PO-20210129-012 4 2 On Site
42 Urinal, plastic 2 PO-20210129-007 5 2 On Site
43 Wheel chair (standard) 1 PO-20210127-009 2 1 On Site
44 Overbed Table 3 08-019/2023/PO 3 3 On Site
45 Jolly Box No. 100 (1 box = 48 unit) 48 PO-20210218-005 448 48 On Site 37 di Gudang
46 Jolly Box No. 300 (1 box = 24 unit) 48 PO-20210218-005 / 09-022/2023/PO(tokopedia) 8/240 8 (-40) On Site 4 di gudang
47 Thermometer, Refrigerator (incl in ref secific for lab and pharmacy) 1 10-020-2023/PO 3 1 On Site
48 Diagnostic Set 1 09-012/2023/PO 1 1 On Site
49 O2, mobile (cylinder) 500 L 1 PO-20210127-005 1 1 On Site
50 Wall Clocks - Digital 1 PO-20210202-003 1 1 On Site
51 Trash Bin, 10-20 L, Std 8 PO-20210215-003 38 8 On Site
52 Trash Bin, 10-20 L, High 2 PO-20210215-003 7 2 On Site
53 Whiteboard 1 TOKOPEDIA 0 0
54 Bracket - Alcohol Gel 2 PO-20210204-005 6 2 On Site
55 EMERGENCY STICHING SET 1 09-024/2023/PO 1 1 belum di terima dari Boswell
56 GIPS REMOVAL 1 09-015/2023/PO 1 belum di terima dari Boswell
57 EMERGENCY TROLLEY INSTRUMENT 1 09-023/2023/PO 1 1 On Site
ED
MAGILL FORCEPS F/ADULTS 1 Onsite
MAGILL FORCEPS F/PED 1 Onsite
MAGILL FORCEPS F/INFANTS 1 Onsite
LISTER BANDAGE SCISSORS 140MM 1 Onsite
Kidney Dish 220X43mm 1 (ED2, ambulance1,IPD3,OPD1,isolasi 1,Lab 2)
Departement Name : IPD
NO RDS NAME QTY NO PO QTY PO Realisasi
1 Bed - manual 2 Crank (incl.bedside locker,overbed table) 10 PO-20210202-016 10 10
2 Sphygmomanometer, mobile (Stand model) ANEROID 1 09-012/2023/PO 2 1
3 Sphygmomanometer Cuff - Pediatric 1 09-012/2023/PO 3 1
4 Bedpan + Cover 2 PA-20210126-029 5 2
5 Bedpan rack with urinal 1 PO-20210129-003 1 1
6 Basin Stand, Double (include basin) 1 PO-20210129-012 1 1
7 Glucotest machine (KSO) - purchase strips only 1 09-006/2023/PO 5 -
8 IV Stand with 4 hooks 1 Approval Budget 2 1
9 Measuring tape 1
10 Oximeter Pulse - finger, portable (Adult + Child) - KLINIK 1 PO-10-017-2023 3
11 Penlight/ Flash Light 1 PO-20210130-010 5 1
12 Reflex hammer 1 PO-20210130-010 3 1
13 Scale, Standing (weight + height) - Tulung Agung 1 08-013/2023/PO 2 -
14 Stethoscope - adult 1 07-004/2023/PO 6 1
15 Stethoscope - child 1 07-004/2023/PO 4 1
16 Thermometer, Digital, Body + Cuff 1 PO-20210301-007 5 1
17 Torniquet (Jetpull) 1 PO-20210130-010 4 1
18 Trolley - Dirty Linen (Small) 1 PROSES PO 1 1
19 Trolley - Dressing 1 1
20 Trolley - Multipurpose 1 CITO SURABAYA 2 1
21 Urinal, plastic 2 PO-20210129-007 5 2
22 Maatkan 2000 ml 1 PO-20210127-009 1 1
23 Trash Bin, 10-20 L, Std 4 PO-20210215-003 38 4
24 Trash Bin, 10-20 L, High 1 PO-20210215-003 7 1
25 Bracket - Alcohol Gel 1 PO-20210204-005 6 1
26 Bracket - Sharp Container (Small) 2 BATAL BATAL BATAL
Kekurangan Keterangan
On Site
On Site
On Site
On site
On Site
On Site
09-006/2023/PO(MASIH KONFIRMASI PAK SAMUEL)
-
(STOK KOSONG 1 INDONESIA)
On Site
Belum ada PO
Belum Terima dari Vendor PT MEGA PRATAMA
MEDICALINDO
On Site
On Site
- Belum Tiba dari Labora
On Site
On Site
On Site
On Site
On Site
On Site
Belum Diterima
On Site
On Site
On Site
On Site
On Site
BATAL BATAL
Departement Name : OPD
No RDS NAME QTY NO PO QTY PO Realisasi Kekurangan
1 Sphygmomanometer Cuff-Pediatric 1 09-012/2023/PO 3 1
2 Chair, Gynecological - MCU 1 08-018/2023/PO 1 1 -
3 Light, Exam, mobile 1
4 Measuring tape 1
5 Trolley - Multipurpose 1 CITO SURABAYA 2 1
6 INSERTION IUD SET 1 09-017/2023/PO 1
7 USG 4D 1 09-014/2023/PO 1 1
8 Xray Viewer 1 Film 1 08-010/2023/PO 1
9 Thermometer, Digital, Body + Cuff 1 PO-20210301-007 5 1
10 Paket Poli Essilor 1 08-012/2023/PO 1 1
11 Baby Scale 1 PO-20210218-014 1 1
12 Penlight/ Flash Light 1 PO-20210130-010 5 1
13 Reflex hammer 1 PO-20210130-010 3 1
14 Stethoscope - adult 2 07-004/2023/PO 6 2
15 Stethoscope - Child 1 07-004/2023/PO 4 1
16 Stethoscope - infant 1 07-004/2023/PO 2 1
17 Wheel chair (standard) 1 PO-20210127-009 2 1
18 Chair, Adjustable Stool 2 PROSES PO 2 2
19 TV 42" (Proxy) 1 10-002/2023/PO 1 1
20 TV Bracket Ceiling - 42" 1 10-002/2023/PO 1 1
21 Wall Clocks 3 PO-20210127-001 12 3
22 Trash Bin, 10-20 L, Std 5 PO-20210215-003 38 5
23 Trash Bin, 10-20 L, High 3 PO-20210215-003 7 3
24 Bracket - Alcohol Gel 1 PO-20210204-005 6 1
25 Bracket - Sharp Container (Small) 5 BATAL BATAL BATAL BATAL
26 SUTURE REMOVAL SET 2 PO-20210210-025 2 1 1
Keterangan
On Site
On Site
Belum ada PO
Belum ada PO
Belum Diterima
Belum terima dari boswell
On Site
Belum Di Terima dari PT INTISUMBER HASIL SEMPURNA
GLOBAL
On Site
On Site
On site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
BATAL
On site (kurang 1 dari boswell)
Departement Name : Laboratory
No RDS NAME QTY NO PO
1 Chemistry Analyzer - Automated (KSO) 1 09-004/2023
2 Cardiac Analyzer (KSO) 1 09-004/2023
3 Coagulometer Analyzer (KSO) 1 09-005/2023/PO
4 Electrolyte Analyzer (KSO) 1 09-004/2023
5 Glucotest machine (KSO) - purchase strips only 2 09-006/2023/PO
6 Hematology Analyzer 5 Diff (Auto-Analyzer) (KSO) 1 09-005/2023
7 Urine Analyzer(KSO) 1 09-004/2023/PO
8 Beaker Glass 100ml 1 PO-20210405-002
9 Beaker Glass 200ml 1 PO-20210405-002
10 Beaker Glass 500ml 1 PO-20210405-002
11 Bottle, Washing 2 10-020/2023/PO
12 Bunsen Burner (Micro+Urine) 1 09-009/2023/PO
13 Centrifuge Swing Out Rotor (15ml tube, 16 hole ) 1 09-009/2023
14 Centrifuge Swing Out Rotor (5ml tube,16 hole) 1 09-009/2023
15 Centrifuge, haematrocrit 210 1 #N/A
16 Cool Box (Small) 2 BELUM ADA PO
17 Counting Chamber, Fuchs Rosenthal 1 09-012/2023/PO
18 Counting Chamber, Improved Neubauer 1 09-012/2023/PO
19 Eye Wash 1 CITO SURABAYA
20 Esbach Tube 2 10-020/2023
21 ESR Analyzer 1 09-010/2023
22 Flammable Storage Cabinet 1 PO-20210129-002
23 Freezer for specimen 75 x 80 x 200 1 Ready Grand Mall
24 Funnel, Glass 2 10-020/2023
25 Hygrometer 1 PO-20210130-010
26 Loop /Ose cylinder 2
27 Manual Blood Cell Counter (Differential) 1
28 Measuring Cup 1000ml 1 09-013/2023/PO
29 Measuring Cup 100ml 1 09-013/2023/PO
30 Measuring Cup 10ml 1 09-013/2023/PO
31 Measuring Pipette 1 mL 1 09-013/2023/PO
32 Measuring Pipette 10 mL 1 09-013/2023/PO
33 Measuring Pipette 5 mL 1 09-013/2023/PO
34 Micropipette Adjustable 10-100 uL 2 10-020/2023
35 Micropipette Adjustable 1-10 uL 2 10-020/2023
36 Micropipette Adjustable 200-1000 uL 2 10-020/2023
37 Micropipette Adjustable 20-200 uL 2 10-020/2023
38 Micropipette Adjustable 5-50 uL 2 10-020/2023
39 Micropipette stand 2 PO-20210405-002
40 Microscope for Hema, Urine, Mikro, Bank Darah 1 PO-20210203-002
41 Mixer, Roller 1 10-020/2023/PO
42 Mortar and Pestle (Medium) - 13cm 1 PO-20210127-009
43 Pipette Ball, Peleus 1 10-020/2023/PO
44 Pipette, Leucocyte 2 09-012/2023/PO
45 Pipette,Erithrocyte 2 09-012/2023/PO
46 Pippette, volume 25 mL 1 PO-20210405-002
47 Pippette, volume 5 mL 1 PO-20210405-002
48 Pippette, volume 1 mL 1 PO-20210405-002
49 Pippette, volume 10 mL 1 PO-20210405-002
50 Plate Shaker 1 CITO SURABAYA
51 Rack, ESR 1 10-020/2023/PO
52 Rack, Staining/ Staining tray 2 CITO SURABAYA
53 Rack, Urine 3 10-020/2023/PO
 54 Refrigerator, Pharmaceutical 1 08-020/2023
55 Refrigerator and Freezer 80 x 70 x 175 - Lab Specimen, 1 PO-20210210-027
56 Rotator 1 PO-20210217-004
57 Sifter, Wire 1 10-020/2023/PO
58 Slide holder metal 2 PO-20210129-004
59 Staining Jar 12 10-020/2023/PO
60 Stopwatch 2 PO-20210405-002
61 Tally Counter 1 10-020/2023
62 Test Tube Holder 2 10-020/2023/PO
63 Test Tube Rack 2 PROSES PO
64 Test Tube Rack (5mL) 6 PO-20210405-002/PO SUMBER JAYA MEDILAB
65 Thermometer, Refrigerator (incl in ref secific for lab an 1 10-020-2023/PO
66 Timer (Digital) 2 PO SUMBER JAYA MEDILAB
67 Trolley - Instrument (Small) 2 PO-20210129-012
68 Vortex 1 10-020/2023/PO
69 Forceps 1 09-013/2023/PO
70 Wall Clocks 1 PO-20210127-001
71 Trash Bin, 10-20 L, Std 6 PO-20210215-003
Kelebihan Lab
Pipette, Leucocyte 2
Pipette,Erithrocyte 2
Test Tube Holder 2
Test Tube Rack 1
Test Tube Rack (5mL) 3
QTY PO Realisasi Kekurangan Keterangan
1 1 On Site
1 1 On Site
1 1 On Site
1 1 On Site
09-006/2023/PO(MASIH KONFIRMASI PAK SAMUEL)
5
(STOK KOSONG 1 INDONESIA)
1 1 On Site
1 1 On Site
2 1 On Site
2 1 On Site
2 1 On Site
2 2 On Site
1 1 On Site
1 1 On Site
1 1 On Site
#N/A On Site
Belum dikirim Vendor Sumber Anugerah
1 1 On Site
1 1 On Site
1 1 On Site
2 2 On Site
1 1 On Site
1 1 On Site
1 1 On Site
4 2 On Site
7 1 On Site
On Site
On Site
1 1 On Site
1 1 On Site
1 1 On Site
1 1 On Site
1 1 On Site
1 1 On Site
2 2 On Site
2 2 On Site
2 2 On Site
2 2 On Site
2 1 On Site
2 2 On Site
1 1 On Site
1 1 On Site
3 1 On Site
1 1 On Site
2 2 On Site
2 2 On Site
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
Belum Terima dari CITO(Tidak Ada Dalam Container 3)
1 1 On Site
1 1 On Site
2 2 On Site
3 3 On Site
 1 1 On Site
1 1 On Site
1 1 On Site
1 1 On Site
2 2 On Site
12 12 On Site
3 2 On Site
1 1 On Site
2 2 On Site
6 6 Lebih 4 On Site
3 dan 2 5 kurang 1 On Site (-1)
3 1 On Site
2 2 On Site
4 2 On Site
1 1 On Site
1 1 On Site
12 1 On Site
38 6 On Site
Departement Name : LDS
No RDS NAME QTY NO PO QTY PO Realisasi
1 Baby Crib Trolley 1 STOK HO STOK HO 1
2 Bed - for Labor and Delivery - PONEK 1 08-019/2023/PO 1 1
3 CTG machine 1 08-014/2023/PO 1 1
4 CTG - Kabel FHR (twin pregnancies) 1 08-014/2023/PO 1 1
5 Doppler fetus detector 1 09-012/2023/PO 1 1
6 Infant warmer 1 09-008/2023/PO 1 1
7 Infant resuscitator set 1 09-008/2023/PO 1

8 Vacuum Extractor + Suction Cup 1 09-002/2023/PO 1

9 DELIVERY SET 1 09-019/2023/PO 1

10 D & C SET 1 09-016/2023/PO 1
11 DELIVERY SUTURE SET 1 09-018/2023/PO 1
Kekurangan Keterangan
On Site
On Site
On Site
On Site
On Site
On Site
Belum Terima dari PT BINABAKTI NIAGAPERKASA

Belum Terima dari PT CITRA VITA BUANA (suction cup

onsite 3 Nov, Vacum extractor belum onsite)

Belum terima dari Boswell

Belum terima dari Boswell
Belum terima dari Boswell
Departement Name : OT
No RDS NAME QTY NO PO QTY PO Realisasi Kekurangan Keterangan
1 CHALAZION/HORDEOLUM 1 1 On Site
2 Mayo instrument table 1 1 On Site
Departement Name : CSSD
No RDS NAME QTY NO PO QTY PO Realisasi Kekurangan Keterangan
1 Desktop Sterilizer 22 L 1 PO-20210127-008 1 1 On Site
2 Hygrometer 1 PO-20210130-010 7 1 On Site
Departement Name : Ambulance
No RDS NAME QTY NO PO QTY PO Realisasi Kekurangan
1 Bedpan + Cover 1 PA-20210126-029 5 1
2 Torniquet (Jetpull) 1 PO-20210130-010 4 1
3 Urinal, plastic 1 PO-20210129-007 5 1
4 Thermometer, Digital, Body + Cuff 1 PO-20210301-007 5 1
5 Resuscitator bag Adult (Silicone) 1 PO-20210210-020 2 1
6 Resuscitator bag Child (Silicone) 1 PO-20210210-020 2 1

7 Glucotest machine (KSO) - purchase strips only 1 09-006/2023/PO 5

8 Laryngoscope Mcintosh (Adult+Child) _ RIESTER 1 09-012/2023/PO 2 1

9 Laryngoscope Infant _ RIESTER 1 09-012/2023/PO 2 1
10 O2 Flowmeter + Connector 1 PO-20210127-004 1 1

11 Oximeter Pulse - finger, portable (Adult + Child) - KLINIK 1 PO-10-017-2023 1

12 Penlight/ Flash Light 1 PO-20210130-010 5 1

13 Sphygmomanometer (Desktop) ANEROID 1 09-012/2023/PO 1
14 Stethoscope - adult 1 07-004/2023/PO 6
15 Stethoscope - child 1 07-004/2023/PO 4 1
16 Suction Machine (Mobile) 1 TIDAK ADA PO
17 Toolkit Box 1 10-005/2023/PO 1 1

MAGILL FORCEPS F/ADULTS 2

MAGILL FORCEPS F/PED 2
MAGILL FORCEPS F/INFANTS 2
LISTER BANDAGE SCISSORS 140MM 2
Kidney Dish 220X43mm 10 (ED1, ambulance1,IPD3,OPD2,Lab 3)
Keterangan
On Site
On Site
On Site
On Site
On Site
On Site

09-006/2023/PO(MASIH KONFIRMASI PAK

SAMUEL) (STOK KOSONG 1 INDONESIA)

On Site
On Site
On Site
Belum Terima dari Vendor PT MEGA
PRATAMA MEDICALINDO
On Site
Belum terima dari Labora
Belum terima dari Anugrah
On Site
TIDAK ADA PO
On Site
Departement Name : Central Pharmacy
NO RDS NAME QTY NO PO QTY PO Realisasi Kekurangan
1 Basket - Mesh Tray 16x12x6cm (1 box = 12 unit) 50 Belum ada PO
2 Beaker Glass 100ml 1 PO-20210405-002 2 1
3 Beaker Glass 200ml 1 PO-20210405-002 2 1
4 Beaker Glass 500ml 1 PO-20210405-002 2 1
5 Bottle, Brown, 50ml 1 10-020/2023/PO 1 1
6 Eye wash 1 CITO SURABAYA 2 1
7 Funnel, Glass 2 10-020/2023 4 2
8 Hygrometer 2 PO-20210130-010 7 2
9 Jolly Box No. 100 (1 box = 48 unit) 400 PO-20210218-005 448 400
10 Jolly Box No. 200 500 09-022/2023/PO (toko pedia) 500 0
11 Jolly Box No. 300 (1 box = 24 unit) 200 09-022/2023/PO (toko pedia) 240 0
12 Jolly Box No. 400 100 PO-20210218-005 100 100
13 Measuring Cup 100ml 1 09-013/2023/PO 2 1
14 Measuring Cup 10ml 2 09-013/2023/PO 3 2
15 Measuring Cup 20ml 2 09-013/2023/PO 2 2
16 Measuring Cup 25ml 2 09-013/2023/PO 2 2
17 Measuring Cup 50ml 1 09-013/2023/PO 1 1
18 Medicine Pulverizier, Sealing & Packets 1 PO-20210129-009 1 1
19 Mortar and Pestle (Large) - 16cm 1 PO-20210127-009 1 1
20 Mortar and Pestle (Medium) - 13cm 1 PO-20210127-009 3 1
21 Mortar and Pestle (Small) - 10cm 1 PO-20210127-009 1 1
22 Refrigerator, Pharmaceutical 1 CITO SURABAYA 1 1
23 Step Stools 2 10-005/2023/PO 3 1
24 Timbangan Analitik 1 PO-20210129-010 1 1
Thermometer, Refrigerator (incl in ref secific for lab
25 10-020-2023/PO 3 1
and pharmacy) 1
26 Timer, Amano 2 Belum ada PO
27 Wall Clocks 2 PO-20210127-001 12 2
28 Trash Bin, 10-20 L, Std 7 PO-20210215-003 38 7
29 Water Dispenser 1 PO-20210127-002 2 1
30 Bracket - Alcohol Gel 1 PO-20210204-005 6 1
31 Kotak Obat Mika Besar 0 (-) 0 250
32 Kotak Obat Mika Kecil 0 (-) 0 500
Keterangan

Belum di Terima (Tidak ada dalam Container 3)

On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
Belum di Terima (Tidak ada dalam Container 3)
Belum di Terima (Tidak ada dalam Container 3)
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site

On Site
On Site
On Site
On Site
On Site
On Site
On Site
On Site
Departement Name : Non Clinical Area
No RDS NAME QTY NO PO QTY PO Realisasi

1 Refrigerator 50 - 60 L, without key 1 09-001/2023/PO 1 1

2 Safety Box - Night Deposit Box (Cashier) 1 PO-20210202-002 1 1
3 Wall Clocks 4 PO-20210127-001 12 4
4 Trash Bin, 80 L, Public 2 PO-20210210-021 2 2
5 Trash Bin, 10-20 L, Std 8 PO-20210215-003 38 8
6 Trash Bin, 10-20 L, High 1 PO-20210215-003 7 1
7 Water Dispenser 1 PO-20210127-002 2 1
8 Whiteboard 1 TOKOPEDIA 0 0
9 Bracket - Alcohol Gel 1 PO-20210204-005 6 1
10 Cash Box 2 10-005/2023/PO 2 2
11 Mesin Penghitung Uang - Portable 1 10-005/2023/PO 1 1
12 Intelligent Money Detector 1 10-005/2023/PO 1 1
13 Trolley Medical Record 1 PO-20210129-003 1 1
14 Mat for Lobby/Main Entrance 2 09-026/2023/PO 2 2
15 Patient Chair 14 PO-20210130-011 / 07-003/2023/PO 3 dan 11 14
Kekurangan Keterangan

On Site
On Site
On Site
On Site
On Site
On Site
On Site

On Site
On Site
On Site
On Site
On Site
On Site
On Site
Departement Name : LINEN
No RDS NAME QTY NO PO QTY PO Realisasi Kekurangan Keterangan Tanggal

HOSPITAL LINEN
1 Sheet (for Bed) 15 PO-20210130-004 15 15 On Site 26-Nov-23
2 Sheet (for Cover Blanket) 27 PO-20210130-004 27 25 On Site 26-Nov-23
3 Draw Sheet 22 PO-20210130-004 22 22 On Site 26-Nov-23
4 Bed Pad / Matras 20 PO-20210130-004 20 20 On Site 26-Nov-23
5 Pillow 37 PO-20210130-003 37 37 On Site 26-Nov-23
6 Pillow Protector 37 PO-20210130-004 37 0 On Site 26-Nov-23
7 Pillow Case 27 PO-20210130-004 27 60 On Site 26-Nov-23
8 Bath Mat 25 PO-20210130-004 25 25 On Site 26-Nov-23
9 Bath Towel 15 PO-20210130-002 15 15 On Site 26-Nov-23
GOWNS QTY
1 Patient Gown Adult, S & M (No Pants) On Site
8 PO-20210130-004 8 8 M:8 26-Nov-23
2 Patient Gown Adult, L & XL (No Pants) 8 PO-20210130-004 8 8 L : 8 On Site 26-Nov-23
3 Patient Gown Adult w/ Pants, S & M On Site
1 PO-20210130-004 1 1 M:1 26-Nov-23
4 Patient Gown Adult w/ Pants, L & XL On Site
1 PO-20210130-004 1 1 L:1 26-Nov-23
5 Patient Gown Pediatric, 3-4 y.o 3 PO-20210130-004 3 3 On Site 26-Nov-23
6 Patient Gown Pediatric, 5-6 y.o 3 PO-20210130-004 3 3 On Site 26-Nov-23
SCRUBS QTY
1 OT Scrub (Green) S 2 PO-20210130-004 2 2 On Site 26-Nov-23
2 OT Scrub (Green) M 2 PO-20210130-004 2 2 On Site 26-Nov-23
3 OT Scrub (Green) L 2 PO-20210130-004 2 2 On Site 26-Nov-23
4 OT Scrub (Green) XL 2 PO-20210130-004 2 2 On Site 26-Nov-23
5 OT Scrub (Green) XXL 2 PO-20210130-004 2 2 On Site 26-Nov-23
CU LINEN Kontrakan Total

0 15
4 20 1
12 10
17 3
37 0
0 0
37 22 1
13 12
15

8
8

1
3
3

2
2
2
2
2