NO NAMA ALAT MERK KODE

1 TUBBING CLAMP AESCULAP AN 912

2 TUBBING CLAMP AESCULAP AN 913
3 SCALPEL HANDLE NO 3 AESCULAP BB 073 R
4 SCALPEL HANDLE NO 3 AESCULAP BB 075 C
5 SCALPEL HANDLE NO 3 AESCULAP BB 077 R
6 MAYO AESCULAP BC 252 R
7 METZENBAUM AESCULAP BC 265 R
8 MAYO LEXER AESCULAP BC 284 R
9 LISTER AESCULAP BC 979 R
10 TOWEL CLAMPS BACKHAUS AESCULAP BF 431 R
11 TOWEL CLAMPS ROEDER AESCULAP BF 448 R
12 TOWEL CLAMPS AESCULAP BF 460 R
13 HALSTED-MOSQUITO AESCULAP BH 110 R
14 HALSTED-MOSQUITO AESCULAP BH 111 R
15 FRASER KELLY AESCULAP BH 183 R
16 ROCHESTER PEAN AESCULAP BH 442 R
17 ROCHESTER PEAN AESCULAP BH 443 R
18 KOCHER AESCULAP BH 630 R
19 KOCHER AESCULAP BH 631 R
20 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 100 R SD BJ 104 R
21 NEEDLE HOLDER AESCULAP BM 016 R
22 NEEDLE HOLDER AESCULAP BM 063 R
23 NEEDLE HOLDER AESCULAP BM 064 R
24 NEEDLE HOLDER AESCULAP BM 113R
25 RETRACTORS AESCULAP BT 004 R
26 NERVE HOOKS AESCULAP BT 080 R
27 RETRACTORS AESCULAP BT 171 R
28 RETRACTORS AESCULAP BT 253 R
29 RETRACTORS AESCULAP BT 340 R
30 BLOOD SCOOPS AESCULAP BT 780 C
31 UTERIN DILATOR AESCULAP EM 231 R
RETRAC OL 212 R
32 UTERIN DILATOR AESCULAP EM 232 R
33 DE BAKEY AESCULAP FB 402 R
34 DE BAKEY AESCULAP FB 412 R
35 CASTANEDA AESCULAP FB 581 R
36 CASTANEDA AESCULAP FB 592 R
37 CASTANEDA AESCULAP FB 593 R
38 SUCTION FERGRUSSON AESCULAP GF 933 R
39 NERVE HOOKS AESCULAP OF 288 R
40 RETRACTORS AESCULAP OL 212 R
41 SUCTION YANKAUER AESCULAP OM 671 R
42 USG DOPLER PORTABLE
43 LAMPU KEPALA LUXTEC
44 IABP
45 REFRACTOR MAMARIE
46 INJEKTOR PUMP NUCAG
47 CONTAINER INSTRUMENT PEDIATRIC AESCULAP
48 P SIGURIS SEDANG
49 NEIRBEIKEN SEDANG
50 KOM BESAR
51 KOM SEDANG
52 MOSQUITO KECIL
53 DUK CKLEM TAJAM
54 RITE ANGEL KECIL
RITE ANGEL SEDANG
PEAN BENGKOK PANJANG
AORTIC KLEM PANJANG
HAK BEBEK
PINSET ANATOMIS
RETRACTUR MAMAMI
GUNTING FORCES
GASTRO
SPRIDER
IABP
INJEKTOR PUMP
JUMLAH
5
5
2
1
2
1
2
1
1
4
4
5
5
5
2
3
3
3
3
1
2
2
2
1
2
2
2
2
2
2
1

1
4
4
2
2
2
1
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 REVISI PERMINTAAN ALAT BEDAH JANTUNG PEDIATRIC
SMF BEDAH TORAKS KADRIAKS DAN VASKULAR
RSUD ABDUL WAHAB SJAHRASNIE SAMARINDA

NO NAMA ALAT MERK KODE JUMLAH

1 TUBBING CLAMP AESCULAP AN 912 R 5
2 TUBBING CLAMP AESCULAP AN 913 R 5
3 SCALPEL HANDLE NO 3 AESCULAP BB 073 R 2
4 SCALPEL HANDLE NO 3 AESCULAP BB 075 C 1
5 SCALPEL HANDLE NO 3 AESCULAP BB 077 R 2
6 MAYO AESCULAP BC 252 R 1
7 METZENBAUM AESCULAP BC 265 R 2
8 METZENBAUM AESCULAP BC 267 B 1
9 MAYO LEXER AESCULAP BC 284 B 1
10 MAYO LEXER AESCULAP BC 284 R 1
11 NELSON METZENBAUM AESCULAP BC 279 B 1
12 ULTRA DELICATE BLADE 8 MM AESCULAP BC 517 R 1
13 STANDART BLADE SIZA 12 MM AESCULAP BC 523 R 1
14 STANDART BLADE SIZA 12 MM AESCULAP BC 524 R 1
15 STANDART BLADE SIZA 12 MM AESCULAP BC 525 R 1
16 DELICATE BLADE, 10 MM AESCULAP BC 532 R 1
17 DELICATE BLADE, 10 MM AESCULAP BC 534 R 1
18 LISTER AESCULAP BC 979 R 1
19 TOWEL CLAMPS BACKHAUS AESCULAP BF 431 R 4
20 TOWEL CLAMPS ROEDER AESCULAP BF 448 R 4
21 TOWEL CLAMPS AESCULAP BF 460 R 5
22 HALSTED-MOSQUITO AESCULAP BH 110 R 5
23 HALSTED-MOSQUITO AESCULAP BH 111 R 5
24 FRASER KELLY AESCULAP BH 183 R 2
25 ROCHESTER PEAN AESCULAP BH 442 R 3
26 ROCHESTER PEAN AESCULAP BH 443 R 3
27 KOCHER AESCULAP BH 630 R 3
28 KOCHER AESCULAP BH 631 R 3
29 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 100 R 1
30 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 101 R 1
31 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 102 R 1
32 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 103 R 1
33 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 104 R 1
34 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 106 R 1
35 NEEDLE HOLDER AESCULAP BM 015 R 1
36 NEEDLE HOLDER AESCULAP BM 016 R 2
37 NEEDLE HOLDER AESCULAP BM 063 R 2
38 NEEDLE HOLDER AESCULAP BM 064 R 2
39 NEEDLE HOLDER AESCULAP BM 113R 1
NO NAMA ALAT MERK KODE JUMLAH
40 RETRACTORS AESCULAP BT 004 R 2
41 NERVE HOOKS AESCULAP BT 080 R 2
42 RETRACTORS AESCULAP BT 171 R 2
43 VASCULAR BROM VEIN HOOK AESCULAP BT 075 R 2
44 RETRACTORS AESCULAP BT 253 R 2
45 RETRACTORS AESCULAP BT 340 R 2
46 BLOOD SCOOPS AESCULAP BT 780 C 2
47 RETRACTORS AESCULAP BT 560 R 1
48 RETRACTORS AESCULAP BT 561 R 1
49 UTERIN DILATOR AESCULAP EM 231 R 1
50 UTERIN DILATOR AESCULAP EM 232 R 1
51 UTERIN DILATOR AESCULAP EM 233 R 1
52 UTERIN DILATOR AESCULAP EM 234 R 1
53 UTERIN DILATOR AESCULAP EM 235 R 1
54 UTERIN DILATOR AESCULAP EM 236 R 1
55 UTERIN DILATOR AESCULAP EM 237 R 1
56 UTERIN DILATOR AESCULAP EM 238 R 1
57 UTERIN DILATOR AESCULAP EM 239 R 1
58 DE BAKEY AESCULAP FB 395 R 4
59 DE BAKEY AESCULAP FB 402 R 4
60 DE BAKEY AESCULAP FB 412 R 4
61 CASTANEDA AESCULAP FB 581 R 2
62 CASTANEDA AESCULAP FB 582 R 2
63 CASTANEDA AESCULAP FB 590 R 2
64 CASTANEDA AESCULAP FB 591 R 2
65 CASTANEDA AESCULAP FB 592 R 2
66 CASTANEDA AESCULAP FB 593 R 2
67 DE BAKEY AESCULAP FB 482 R 1
68 DE BAKEY AESCULAP FB 481 R 1
69 RETRACTORS SELLOR AESCULAP FB 840 R 1
70 RETRACTORS MORSE AESCULAP FB 845 R 1
71 RETRACTORS MORSE AESCULAP FB 846 R 1
72 VEIN DISSECTOR AESCULAP FC 093 R 1
73 VEIN DISSECTOR AESCULAP FC 094 R 1
74 SCALPEL WEDGE BLADE AESCULAP FD 115 D 1
75 MICRO INSTRUMENT AESCULAP FM 236 R 1
76 MICRO INSTRUMENT AESCULAP FM 276 R 1
77 MICRO INSTRUMENT AESCULAP FM 047 R 1
78 MICRO INSTRUMENT AESCULAP FM 572 R 1
79 SUCTION FERGRUSSON AESCULAP GF 933 R 1
80 NERVE HOOKS AESCULAP OF 288 R 2
81 RETRACTORS AESCULAP OL 212 R 2
82 SUCTION YANKAUER AESCULAP OM 671 R 1
 REVISI PERMINTAAN ALAT BEDAH JANTUNG PEDIATRIC
SMF BEDAH TORAKS KADRIAK DAN VASKULAR
RSUD ABDUL WAHAB SJAHRASNIE SAMARINDA

NO NAMA ALAT MERK KODE JUMLAH

1 TUBBING CLAMP AESCULAP AN 912 R 5
2 TUBBING CLAMP AESCULAP AN 913 R 5
3 SCALPEL HANDLE NO 3 AESCULAP BB 073 R 2
4 SCALPEL HANDLE NO 3 AESCULAP BB 075 C 1
5 SCALPEL HANDLE NO 3 AESCULAP BB 077 R 2
6 MAYO AESCULAP BC 252 R 1
7 METZENBAUM AESCULAP BC 265 R 2
8 METZENBAUM AESCULAP BC 267 B 1
9 MAYO LEXER AESCULAP BC 284 B 1
10 MAYO LEXER AESCULAP BC 284 R 1
11 NELSON METZENBAUM AESCULAP BC 279 B 1
12 ULTRA DELICATE BLADE 8 MM AESCULAP BC 517 R 1
13 STANDART BLADE SIZA 12 MM AESCULAP BC 523 R 1
14 STANDART BLADE SIZA 12 MM AESCULAP BC 524 R 1
15 STANDART BLADE SIZA 12 MM AESCULAP BC 525 R 1
16 DELICATE BLADE, 10 MM AESCULAP BC 532 R 1
17 DELICATE BLADE, 10 MM AESCULAP BC 534 R 1
18 LISTER AESCULAP BC 979 R 1
19 TOWEL CLAMPS BACKHAUS AESCULAP BF 431 R 4
20 TOWEL CLAMPS ROEDER AESCULAP BF 448 R 4
21 TOWEL CLAMPS AESCULAP BF 460 R 5
22 HALSTED-MOSQUITO AESCULAP BH 110 R 5
23 HALSTED-MOSQUITO AESCULAP BH 111 R 5
24 FRASER KELLY AESCULAP BH 183 R 2
25 ROCHESTER PEAN AESCULAP BH 442 R 3
26 ROCHESTER PEAN AESCULAP BH 443 R 3
27 KOCHER AESCULAP BH 630 R 3
28 KOCHER AESCULAP BH 631 R 3
29 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 100 R 1
30 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 101 R 1
31 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 102 R 1
32 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 103 R 1
33 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 104 R 1
34 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 106 R 1
35 NEEDLE HOLDER AESCULAP BM 015 R 1
36 NEEDLE HOLDER AESCULAP BM 016 R 2
37 NEEDLE HOLDER AESCULAP BM 063 R 2
38 NEEDLE HOLDER AESCULAP BM 064 R 2
39 NEEDLE HOLDER AESCULAP BM 113R 1
NO NAMA ALAT MERK KODE JUMLAH
40 RETRACTORS AESCULAP BT 004 R 2
41 NERVE HOOKS AESCULAP BT 080 R 2
42 RETRACTORS AESCULAP BT 171 R 2
43 VASCULAR BROM VEIN HOOK AESCULAP BT 075 R 2
44 RETRACTORS AESCULAP BT 253 R 2
45 RETRACTORS AESCULAP BT 340 R 2
46 BLOOD SCOOPS AESCULAP BT 780 C 2
47 RETRACTORS AESCULAP BT 560 R 1
48 RETRACTORS AESCULAP BT 561 R 1
49 UTERIN DILATOR AESCULAP EM 231 R 1
50 UTERIN DILATOR AESCULAP EM 232 R 1
51 UTERIN DILATOR AESCULAP EM 233 R 1
52 UTERIN DILATOR AESCULAP EM 234 R 1
53 UTERIN DILATOR AESCULAP EM 235 R 1
54 UTERIN DILATOR AESCULAP EM 236 R 1
55 UTERIN DILATOR AESCULAP EM 237 R 1
56 UTERIN DILATOR AESCULAP EM 238 R 1
57 UTERIN DILATOR AESCULAP EM 239 R 1
58 DE BAKEY AESCULAP FB 395 R 4
59 DE BAKEY AESCULAP FB 402 R 4
60 DE BAKEY AESCULAP FB 412 R 4
61 CASTANEDA AESCULAP FB 581 R 2
62 CASTANEDA AESCULAP FB 582 R 2
63 CASTANEDA AESCULAP FB 590 R 2
64 CASTANEDA AESCULAP FB 591 R 2
65 CASTANEDA AESCULAP FB 592 R 2
66 CASTANEDA AESCULAP FB 593 R 2
67 DE BAKEY AESCULAP FB 482 R 1
68 DE BAKEY AESCULAP FB 481 R 1
69 RETRACTORS SELLOR AESCULAP FB 840 R 1
70 RETRACTORS MORSE AESCULAP FB 845 R 1
71 RETRACTORS MORSE AESCULAP FB 846 R 1
72 VEIN DISSECTOR AESCULAP FC 093 R 1
73 VEIN DISSECTOR AESCULAP FC 094 R 1
74 SCALPEL WEDGE BLADE AESCULAP FD 115 D 1
75 MICRO INSTRUMENT AESCULAP FM 236 R 1
76 MICRO INSTRUMENT AESCULAP FM 276 R 1
77 MICRO INSTRUMENT AESCULAP FM 047 R 1
78 MICRO INSTRUMENT AESCULAP FM 572 R 1
79 SUCTION FERGRUSSON AESCULAP GF 933 R 1
80 NERVE HOOKS AESCULAP OF 288 R 2
81 RETRACTORS AESCULAP OL 212 R 2
82 SUCTION YANKAUER AESCULAP OM 671 R 1
81 USG DOPLER PORTABLE 1
NO NAMA ALAT MERK KODE JUMLAH
82 LAMPU KEPALA LUXTEC 1
83 IABP 1
84 REFRACTOR MAMARIE 1
85 INJEKTOR PUMP NUCAG 1
86 CONTAINER INSTRUMENT PEDIATRIC AESCULAP 1
87 P SIGURIS SEDANG 1
88 NEIRBEIKEN SEDANG 1
89 KOM BESAR 1
90 KOM SEDANG 1
91 MOSQUITO KECIL 1
92 DUK CKLEM TAJAM 1
93 RITE ANGEL KECIL 1
94 RITE ANGEL SEDANG 1
95 PEAN BENGKOK PANJANG 1
96 AORTIC KLEM PANJANG 1
97 HAK BEBEK 1
98 PINSET ANATOMIS 1
99 RETRACTUR MAMAMI 1
100 GUNTING FORCES 1
101 GASTRO 1
102 SPRIDER 1
103 IABP 1
104 INJEKTOR PUMP 1

Samarinda, 13 Juli 2015

Ketua SMF Bedah Toraks Kardik dan Vaskular

dr. Ivan Joalsen Mangara Tua, Sp.BTKV

NIP. 1980320 201412 1001
 REVISI PERMINTAAN ALAT BEDAH JANTUNG PEDIATRIC
SMF BEDAH TORAKS KADRIAK DAN VASKULAR
RSUD ABDUL WAHAB SJAHRASNIE SAMARINDA

NO NAMA ALAT MERK KODE JUMLAH

1 TUBBING CLAMP AESCULAP AN 912 R 5

2 TUBBING CLAMP AESCULAP AN 913 R 5

3 SCALPEL HANDLE NO 3 AESCULAP BB 073 R 2

4 SCALPEL HANDLE NO 3 AESCULAP BB 075 C 1

5 SCALPEL HANDLE NO 3 AESCULAP BB 077 R 2

6 MAYO AESCULAP BC 252 R 1

7 METZENBAUM AESCULAP BC 265 R 2

8 METZENBAUM AESCULAP BC 267 B 1

9 MAYO LEXER AESCULAP BC 284 B 1

10 MAYO LEXER AESCULAP BC 284 R 1

11 NELSON METZENBAUM AESCULAP BC 279 B 1

12 ULTRA DELICATE BLADE 8 MM AESCULAP BC 517 R 1

13 STANDART BLADE SIZA 12 MM AESCULAP BC 523 R 1

14 STANDART BLADE SIZA 12 MM AESCULAP BC 524 R 1

15 STANDART BLADE SIZA 12 MM AESCULAP BC 525 R 1

16 DELICATE BLADE, 10 MM AESCULAP BC 532 R 1

17 DELICATE BLADE, 10 MM AESCULAP BC 534 R 1

18 LISTER AESCULAP BC 979 R 1

19 TOWEL CLAMPS BACKHAUS AESCULAP BF 431 R 4

20 TOWEL CLAMPS ROEDER AESCULAP BF 448 R 4

21 TOWEL CLAMPS AESCULAP BF 460 R 5

22 HALSTED-MOSQUITO AESCULAP BH 110 R 5

23 HALSTED-MOSQUITO AESCULAP BH 111 R 5

NO NAMA ALAT MERK KODE JUMLAH

24 FRASER KELLY AESCULAP BH 183 R 2

25 ROCHESTER PEAN AESCULAP BH 442 R 3

26 ROCHESTER PEAN AESCULAP BH 443 R 3

27 KOCHER AESCULAP BH 630 R 3

28 KOCHER AESCULAP BH 631 R 3

29 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 100 R 1

30 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 101 R 1

31 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 102 R 1

32 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 103 R 1

33 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 104 R 1

34 DISSECTING AND LIGATURE FORCEPS (GEMINI) AESCULAP BJ 106 R 1

35 NEEDLE HOLDER AESCULAP BM 015 R 1

36 NEEDLE HOLDER AESCULAP BM 016 R 2

37 NEEDLE HOLDER AESCULAP BM 063 R 2

38 NEEDLE HOLDER AESCULAP BM 064 R 2

39 NEEDLE HOLDER AESCULAP BM 113R 1

40 RETRACTORS AESCULAP BT 004 R 2

41 NERVE HOOKS AESCULAP BT 080 R 2

42 RETRACTORS AESCULAP BT 171 R 2

43 VASCULAR BROM VEIN HOOK AESCULAP BT 075 R 2

44 RETRACTORS AESCULAP BT 253 R 2

45 RETRACTORS AESCULAP BT 340 R 2

46 BLOOD SCOOPS AESCULAP BT 780 C 2

47 RETRACTORS AESCULAP BT 560 R 1

48 RETRACTORS AESCULAP BT 561 R 1

49 UTERIN DILATOR AESCULAP EM 231 R 1

NO NAMA ALAT MERK KODE JUMLAH

50 UTERIN DILATOR AESCULAP EM 232 R 1

51 UTERIN DILATOR AESCULAP EM 233 R 1

52 UTERIN DILATOR AESCULAP EM 234 R 1

53 UTERIN DILATOR AESCULAP EM 235 R 1

54 UTERIN DILATOR AESCULAP EM 236 R 1

55 UTERIN DILATOR AESCULAP EM 237 R 1

56 UTERIN DILATOR AESCULAP EM 238 R 1

57 UTERIN DILATOR AESCULAP EM 239 R 1

58 DE BAKEY AESCULAP FB 395 R 4

59 DE BAKEY AESCULAP FB 402 R 4

60 DE BAKEY AESCULAP FB 412 R 4

61 CASTANEDA AESCULAP FB 581 R 2

62 CASTANEDA AESCULAP FB 582 R 2

63 CASTANEDA AESCULAP FB 590 R 2

64 CASTANEDA AESCULAP FB 591 R 2

65 CASTANEDA AESCULAP FB 592 R 2

66 CASTANEDA AESCULAP FB 593 R 2

67 DE BAKEY AESCULAP FB 482 R 1

68 DE BAKEY AESCULAP FB 481 R 1

69 RETRACTORS SELLOR AESCULAP FB 840 R 1

70 RETRACTORS MORSE AESCULAP FB 845 R 1

71 RETRACTORS MORSE AESCULAP FB 846 R 1

72 VEIN DISSECTOR AESCULAP FC 093 R 1

73 VEIN DISSECTOR AESCULAP FC 094 R 1

74 SCALPEL WEDGE BLADE AESCULAP FD 115 D 1

75 MICRO INSTRUMENT AESCULAP FM 236 R 1

NO NAMA ALAT MERK KODE JUMLAH

76 MICRO INSTRUMENT AESCULAP FM 276 R 1

77 MICRO INSTRUMENT AESCULAP FM 047 R 1

78 MICRO INSTRUMENT AESCULAP FM 572 R 1

79 SUCTION FERGRUSSON AESCULAP GF 933 R 1

80 NERVE HOOKS AESCULAP OF 288 R 2

81 RETRACTORS AESCULAP OL 212 R 2

82 SUCTION YANKAUER AESCULAP OM 671 R 1

Samarinda, 15 September 2016

Ketua SMF Bedah Toraks Kardik dan Vaskular

dr. Ivan Joalsen Mangara Tua, Sp.BTKV

NIP. 1980320 201412 1001