PERALATAN KESEHATAN PADA RUMAH SAKIT
BERDASARKAN KELAS DAN JENIS PELAYANAN
Peralatan kesehatan yang akan dibahas pada Pedoman Peralatan Kesehatan ini
disusun dengan mengelompokkannya menjadi 11 bagian yaitu :
A. Peralatan Kesehatan pada Pelayanan Medik Umum
B. Peralatan Kesehatan pada Pelayanan Gawat Darurat
C. Peralatan Kesehatan pada Pelayanan Medik Spesialis Dasar
D. Peralatan Kesehatan pada Pelayanan Spesialis Penunjang Medik
E. Peralatan Kesehatan pada Pelayanan Medik Spesialis Lain
F.
Peralatan Kesehatan pada Pelayanan Medik Spesialis Gigi Mulut
G. Peralatan Kesehatan pada Pelayanan Farmasi
H. Peralatan Kesehatan pada Pelayanan Gizi
I.
Peralatan Kesehatan pada Pelayanan Sterilisasi Instrumen
J.
Peralatan Kesehatan pada Pelayanan Unit Transfusi darah (UTD)
Kebutuhan akan jenis dan jumlah peralatan kesehatan pada setiap jenis
pelayanan di rumah sakit dapat dilihat dalam bentuk tabel yang disesuaikan dengan
jenis pelayanannya.
Beberapa hal perlu diketahui bagi perencana dan pengguna dalam upaya
mengoptimalkan daya guna peralatan diantaranya kebutuhan akan pra-instalasi,
kebutuhan jaringan (listrik, air, gas dsb), buku petunjuk pemakaian, buku petunjuk
pemeliharaan/perbaikan, diagram rangkaian (wiring diagram) dan kebutuhan kalibrasi.
Untuk mengetahui hal-hal apa saja yang perlu disiapkan guna optimalisasi peralatan
kesehatan dapat dilihat pada lampiran tersendiri dalam pedoman ini.
Kebutuhan akan persyaratan teknis tersebut mulai dari kebutuhan pra-instalasi
hingga kalibrasi ditandai dengan pemberian tanda + (positif), jika tidak diperlukan
diisikan dengan tanda – (negatif).
PERALATAN KESEHATAN PADA PELAYANAN GAWAT DARURAT
NO
UNIT PELAYANAN
NO
NAMA ALAT
1.
Triage
1
2
3
Patient Stracher
Stethoscope
Tensimeter
2.
Resucitasi
1
Hanging lamp
resucitation crash cart (Emergency
trolley + Defibrilator) (utk RS yg
jumlah pasien < 30 org/hari di igd)
2
3
4
5
6
7
8
9
10
11
12
3.
Observation
1
2
3
Resucitation Bay (sarana resusitasi
lengkap) (utk RS yg jumlah pasien
> 30 org/hari di igd)
Suction pump
Infus Pump
Nebulizer
Portable pulse oximetri
Pneumatic Splint Set
Stethoscope
Tensimeter
Film viewer
syringe pump
Patient Stracher (dgn tiang infus
dan pengaman samping)
Bed side monitor
Suction pump
SPESIFIKASI ALAT
RS kls
A
+
+
+
JUMLAH MINIMAL
RS Kls RS kls
B
C
+
+
+
+
+
+
RS kls
D
+
+
+
-
-
+
+
+
+
-
-
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
4
5
6
7
8
Stethoscope
Sypgmomanometer
resucitation crash cart (Emergency
trolley + Defibrilator)
Infusion pump
syringe pump
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
PERALATAN KESEHATAN PADA PELAYANAN MEDIK SPESIALIS DASAR
1. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS KESEHATAN ANAK
JUMLAH MINIMAL
UNIT PELAYANAN
Klinik (Rawat
Jalan)
NO
1
NAMA ALAT
ECG
SPESIFIKASI ALAT
Technical Specification:
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
3
2
2
1
4
4
3
2
* 3 channel ECG machine : Manual/Auto/Arrhymia Analysis Modes
* Lead: standard 12 leads
* Lead acquisition: 12bit/1000Hzsynchronously 12 leads
* Work modes: MAN/AUTOANALYSIS modes
* Filter: AC Flter : 50Hz / 60Hz – EMG Filter : 25Hz / 45Hz – Anti-Drift Filter :
0.15Hz (Adaptive)
* CMMR: 120dB (with AC filter)
* Input circuit: floating; protection circuit against defibrillator effect
* Sensitivity valve: 20V
* Sensitivity: 51020mm/mV
2
Infant dan baby pediatric resusitation
Neonates, infants and children with a body weight of up to 20 kg,
approx. 4-5 years.
* Max. volume delivered: Approx. 300 ml
* Length x bag diameter with patient valve: 265 mm x 85 mm
* Patient connector: 22/15 mm (ISO)
* Expiratory connector (for PEEP valve connection): 30 mm male (Ambu
specified)
* Dead volume: < 6 ml
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
* Leaks (both ways): Non-measurable
* Inspiratory resistance (with or without oxygen reservoir tube):
At 50 l/min: approx. -0.37 kPa (-3.7 cmH2O)
At 5 l/min: approx. -0.05 kPa (-0.5 cmH2O)
* Pressure-limiting valve: Opening pressure: approx. 4 kPa (40 cmH2O)
Maximum attainable delivery pressure with compliance of 0.01 l/kPa when the
pressure limiting valve is overridden: approx. 11.5 kPa (115 cmH2O).
* Expiratory resistance:
At 50 l/min: approx. 0.45 kPa (4.5 cmH2O)
At 5 l/min: approx. 0.06 kPa (0.6 cmH2O)
* Oxygen reservoir tube: Length: 250 mm, Volume: 100 ml
* Oxygen reservoir bag:
Inspiratory resistance:
With 50 l/min: approx. -0.1 kPa (-1.0 cmH2O)
With 5 l/min.: approx. -0.01 kPa (-0.1 cmH2O)
* Volume: approx. 1500 ml
* Application temperature: -18°C to 50°C (0°F to 122°F)
* Storage temperature: -40°C to 70°C (-40°F to 158°F)
Adults and children with a body weight of more than approx. 15 kg (3
years).
* Maximum provided volume: Approx. 1300 ml
* Length x Diameter (with patient valve): 275 mm x 135 mm
* Weight of the resuscitator with patient valve, (without oxygen reservoir bag
and mask): Approx. 415 g
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
* Maximum frequency of ventilation: Depends on the inspiratory volume used.
The rate of expansion of the bag is sufficiently fast for all frequencies
recommended for practical use.
* Patient connector: 22 /15 mm (ISO)
* Expiration connector: 30 mm male (ISO)
* Inspiration connector: (EN ISO 10651-4) 32 mm female for connection of
Ambu oxygen reservoir bag or ISO refilling valve
* Dead volume: < 5 ml
* Leaks (both ways): Non-measurable
* Inspiratory resistance at 50 l/min: Approx. -0.35 kPa (-3.5 cmH2O)
* The inspiratory resistance of the oxygen reservoir bag at 50 l/min without
supply of oxygen: Approx. -0.1 kPa (-1.0 cmH2O)
Maximum attainable delivery pressure at 0.2 l/kPa: Approx. 10 kPa (100
cmH2O)
* Pressure-limiting system: The elasticity of the outer cover of the baglimits
the airway pressure to approx. 7 kPa (70 cmH2O) when squeezing the bag
normally with one hand, as shown in P.
* Expiratory resistance at 50 l/min: Approx. 0.26 kPa (2.6 cmH2O)
*Volume of the oxygen reservoir bag: Approx. 1500 ml
* Application temperature: -18°C to 50°C (0°F to 122°F)
* Storage temperature: -40°C to 70°C (-40°F to 158°F)
* Parts / Materials:
Inner bag Silicone rubber
Outer cover Silicone rubber
Patient valve housing PSU
O-ring (internal part of patient connector) Silicone rubber
Patientconnector PSU
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
Pressure-limiting valve PSU/stainless steel
Override cap Silicone rubber
Expirations connector Reinforced PP
Cap for manometer port PP/EPDM rubber
3
Infant dan baby pediatric Stetoscope
20
20
10
5
4
Examination lamp
20
20
10
5
5
5
3
2
* Type Reflektor
* Pengaturan Cahaya
: Spherical
: Non Adjustable I Fix
* Durasi pemakaian lampu
dengan masa hidup lampu
: Dapat dihidupkan terus•menerus sesuai
* Interval waktu pemakaian
: Tidak diperlukan
* Temperatur Ruang Operasional : Sesuai dengan Temperatur Ruangan
5
Sypgmomanometer dengan manset
untuk bayi dan anak
* Masa Hidup Lampu
: ± 20.000 Jam
* Color Temperature
: 3000 - 6700k
* illumination Intensity
: 18000 - 22000lx
* Spot Diameter
: 80 - 250 mm
* Maximum error tolerance of + / - 3 mmHg
* 99.99% pure mercury
* Precision glass column Internal diameter 4.2 mm
+ / - 0.2 mm
* Latex bulb with chromium plated release valve
* Precision air release valve, wear-free and with fine regulation
* Microfilter for long life
*Cuff with two-tube latex bladder
* Metal faceplate with easy-to-read scale up to 300 mmHg
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
5
5
3
2
* Mercury lock
* Special seal against mercury contamination
* Large storage compartment for cuff + latex bulb
* Cleaning device for glass column
6
Infant dan baby weighting scale
* Akurasi 0.05kg (0-10Kg)
* Akurasi 0.1 Kg (10-20Kg)
* Ukuran Tray 54.5 x 27cm (P x L)
* Ukuran keseluruhan unit 54.5 x 33.1 x 15.3cm
7
Termometer rectal
20
20
10
5
8
Termometer axial
20
20
20
10
9
Reflex Hammer
5
5
5
3
10
cold chain
* Kulkas Vaksin
1
1
1
1
* Termos Portable
5
5
3
2
11
Vena section set
5
5
3
2
12
Baby Suction pump
3
3
2
2
* Portable Suction Pump
* Vacuum Range 0 to -35 kPa, 0 to -262.5 mm Hg
* Flow Rate 32 lpm
* Vacuum Regulation Needle valve type
* Vacuum Indicator Analogue gauge, Bourdon Tube type
* Indicator Range 0 to –60 kPa, 0 to -450 mm Hg
* Pump Type Twin Piston, Oil Free
* Motor Permanent split capacitor
* Collection Containers 2 x 2 Litre autoclavable, shatterproof, polycarbonate
jars
* Overflow Protection Motor valve / Float valve mechanism
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
B
RS KLS
C
RS KLS
D
13
Oxygen set dan flow meter
* 1500 lt + infant flowmeter dan pediatric flowmeter + trolley
10
10
5
3
14
Nebulizer
* Ultrasonic frequancy
2
2
1
1
50
50
30
20
3
2
2
1
3
2
2
1
20
20
10
5
: 1.7 Mhz ± 10%
* Continuous workong time
: ≥ 4 hours
* Consumed power
: ≤ 50VA
* Maximum capacity of small atomazing cup
: 150 mL
* Maximum capacity of big atomizing cup
: 350 mL
* Maximum atomizing size
: ≥ 4mL/min
* Power supply
* Timing range
min
b. Perawatan Anak
RS KLS
A
15
Tongue spatel (Stainless steel )
1
ECG
: AC 220V ± 10%, 50Hz
: stepless adjustable 0 ~ 60
* Technical Specification
* 3 channel ECG machine
* Manual/Auto/Arrhymia Analysis Modes
* Lead: standard 12 leads
* Lead acquisition: 12bit/1000Hzsynchronously 12 leads
* Work modes: MAN/AUTOANALYSIS modes
* Filter: AC Flter : 50Hz / 60Hz – EMG Filter : 25Hz / 45Hz – Anti-Drift Filter :
0.15Hz (Adaptive)
* CMMR: 120dB (with AC filter)
* Input circuit: floating; protection circuit against defibrillator effect
* Sensitivity valve: 20V
* Sensitivity: 51020mm/mV
2
Emergency Set
3
Examination lamp
* Type Reflektor
* Pengaturan Cahaya
: Spherical
: Non Adjustable I Fix
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
* Durasi pemakaian lampu
dengan masa hidup lampu
: Dapat dihidupkan terus•menerus sesuai
* Interval waktu pemakaian
: Tidak diperlukan
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
10
10
8
5
5
5
3
3
* Temperatur Ruang Operasional : Sesuai dengan Temperatur Ruangan
4
Sypgmomanometer dengan manset
untuk bayi dan anak
* Masa Hidup Lampu
: ± 20.000 Jam
* Color Temperature
: 3000 - 6700k
* illumination Intensity
: 18000 - 22000lx
* Spot Diameter
: 80 - 250 mm
* Maximum error tolerance of + / - 3 mmHg
* 99.99% pure mercury
* Precision glass column Internal diameter 4.2 mm
+ / - 0.2 mm
* Latex bulb with chromium plated release valve
* Precision air release valve, wear-free and with fine regulation
* Microfilter for long life
* Cuff with two-tube latex bladder
* Metal faceplate with easy-to-read scale up to 300 mmHg
* Mercury lock
* Special seal against mercury contamination
* Large storage compartment for cuff + latex bulb
* Cleaning device for glass column
5
Baby Suction pump
* Portable Suction Pump
* Vacuum Range 0 to -35 kPa, 0 to -262.5 mm Hg
* Flow Rate 32 lpm
* Vacuum Regulation Needle valve type
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
* Vacuum Indicator Analogue gauge, Bourdon Tube type
* Indicator Range 0 to –60 kPa, 0 to -450 mm Hg
* Pump Type Twin Piston, Oil Free
* Motor Permanent split capacitor
* Collection Containers 2 x 2 Litre autoclavable, shatterproof, polycarbonate
jars
* Overflow Protection Motor valve / Float valve mechanism
6
Infant dan baby pediatric Stetoscope
20
20
15
10
7
Termometer rectal
20
20
10
5
8
Termometer axial
20
10
10
5
9
Diagnostic Set
4
4
2
2
10
Pediatric Bed
60
50
50
30
10
10
10
5
50
50
30
20
* 3 sets manual crank
* Complete cover side cross bedside rail
* double face castors
* Urin hooks, IV holder
11
Lumbal needle Punction
12
Transfusion set
* tiang infus
* Blood set
* IV Cateter
* Syringe 2,5 ml
* Alkohol swap
13
Micro Hematocrit set
14
Vena section set
10
10
5
5
15
Infusion set
50
40
30
20
16
Nebulizer
5
5
3
2
* Ultrasonic frequancy
: 1.7 Mhz ± 10%
JUMLAH MINIMAL
UNIT PELAYANAN
c. Perinatologi
NO
1
NAMA ALAT
Incubator
SPESIFIKASI ALAT
* Continuous workong time
: ≥ 4 hours
* Consumed power
: ≤ 50VA
* Maximum capacity of small atomazing cup
: 150 mL
* Maximum capacity of big atomizing cup
: 350 mL
* Maximum atomizing size
: ≥ 4mL/min
* Power supply
: AC 220V ± 10%, 50Hz
* Timing range
: stepless adjustable 0 ~ 60
min
* Embedded integrated sensor module and integrated water reservoir in the
shape of drawer.
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
40
40
30
20
5
5
2
2
* Humidity and oxygen concentration display and servo control.
* Optional weighting system and monitor shelf.
* Inclination of bassinet is adjustable.
* X-ray cassette under the bassinet.
* >37℃ temperature setting.
* Failure alarm indication.
* RS-232 connector.
* Adjustable height.
* Bed tilting +/- 10% Trendelenburg and Reverse Trendelenburg, damp
2
Infant Warmer
* Opr temp 10 - 40 C
* Storage temp range -25 to + 60 C
* Operating Humidity Range 0% - 95%
* System control karakteristik
* Microprocessor Base Control System : Self-test function performance at
power on and continuosly
* during normal operation
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
5
5
5
5
RS KLS
C
RS KLS
D
5
2
* Patient Control (servo) Modes : 32o C in increment 0,1o C
* Manual Mode : Indicates manual mode heat selection range from 0 - 100%
in 5% increments
* Temperature variability : less than +/- 0,3o C
* Resolution : +/- 0,1o C
* Probe Intercheageability : +/- 0,1o C
* Probe range : 30oC to 42o C
* Proportional heat control w/ zero voltage switching to minimize radiated and
conducted EMI
* Obsevation light : 100 foor candles at centres of mattress, estimated lamp
life 3000 hours
* Portable Suction Pump
3
Baby Suction pump
* Vacuum Range 0 to -35 kPa, 0 to -262.5 mm Hg
* Flow Rate 32 lpm
* Vacuum Regulation Needle valve type
* Vacuum Indicator Analogue gauge, Bourdon Tube type
* Indicator Range 0 to –60 kPa, 0 to -450 mm Hg
* Pump Type Twin Piston, Oil Free
* Motor Permanent split capacitor
* Collection Containers 2 x 2 Litre autoclavable, shatterproof, polycarbonate
jars
* Overflow Protection Motor valve / Float valve mechanism
4
Infant dan baby weighting scale
* Akurasi 0.05kg (0-10Kg)
* Akurasi 0.1 Kg (10-20Kg)
* Ukuran Tray 54.5 x 27cm (P x L)
* Ukuran keseluruhan unit 54.5 x 33.1 x 15.3cm
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
5
Infant stetoscope
(Sesuai ∑ inkubator)
6
Sypgmomanometer dengan manset
untuk bayi dan anak
* Maximum error tolerance of + / - 3 mmHg
RS KLS
A
(Sesuai ∑
inkubator)
RS KLS
B
(Sesuai ∑
inkubator)
RS KLS
C
(Sesuai ∑
inkubator)
RS KLS
D
(Sesuai ∑
inkubator)
10
10
2
1
* 99.99% pure mercury
* Precision glass column Internal diameter 4.2 mm
+ / - 0.2 mm
* Latex bulb with chromium plated release valve
* Precision air release valve, wear-free and with fine regulation
* Microfilter for long life
* Cuff with two-tube latex bladder
* Metal faceplate with easy-to-read scale up to 300 mmHg
* Mercury lock
* Special seal against mercury contamination
* Large storage compartment for cuff + latex bulb
* Cleaning device for glass column
7
Termometer Rectal
8
Termometer Axial
9
Tongue Spatel
10
Photo Therapy
* Light intensity : Irradiance level at least 30 UW.cm2.nm-1
x
x
x
x
40
40
30
20
x
x
x
x
15
10
5
2
* Wavelength between 430-490nm
* Large surface area to combat extremely high bilirubin levels
* Distance between infant and light source is 1190-1650mm
12
Baby Resusitasion Set
Neonates, infants and children with a body weight of up to 20 kg,
approx. 4-5 years.
15
15
3
2
13
Infusion Pump
- Delivery rate : 0,1 - 1200 ml/h
10
10
10
5
- Vol delivered: 0,0 - 9999 ml/h
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
60
60
40
20
5
5
2
2
5
3
2
1
- Mechanical Accruracy
- Alarms : Air/Occulation/flow error Door/Low batteray
- Power supply : AC/DC
Special functions
- Terdapat lever occulation dan level indicator batteray
- Back up batteray appr 3 jam
- Tubing clamp function
- Memory function : Repeat alarm function
14
Syringe Pump
- Flow rate : 0,1 - 300 ml/h
0,1 - 1200 ml/h
- Display range : 0,1 - 999,9 ml
- Mechanical Accruracy
- Alarms
- Power supply : AC/DC
- Accessories : AC power card
Pole Clamp
Instruction manual
Syringe brand tabel multi Syringe
Multi Syringe
Anti bolus
15
Baby Examination table
16
Examination lamp
* Type Reflektor
* Pengaturan Cahaya
* Durasi pemakaian lampu
dengan masa hidup lampu
: Spherical
: Non Adjustable I Fix
: Dapat dihidupkan terus•menerus sesuai
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
* Interval waktu pemakaian
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
25
25
10
2
: Tidak diperlukan
* Temperatur Ruang Operasional : Sesuai dengan Temperatur Ruangan
* Masa Hidup Lampu
: ± 20.000 Jam
* Color Temperature
: 3000 - 6700k
* illumination Intensity
: 18000 - 22000lx
* Spot Diameter
17
Bed Side Monitor
: 80 - 250 mm
* Parameter : ECG, Respiration, SpO2, NIBP, Press/temp
* Intergrated 15" TFT fkat oabek dusoket w/ SVGA resolution, wideviewing
angle, large numeric
* bed tob bed overview resolution 1024x768 pixel, medical grade monitor
* Build in slot for multi measurement server
* Integrated patient monitor
* 12 lead ECG monitoring withwith electrode using EASI method
* Upgradeble
18
Reflex hammer
x
x
x
x
19
Phono Cardiograph
1
1
1
−
21
Intubation set
6
4
3
2
x
x
x
x
5
5
3
2
* Optima Miller 4 blade for Infant
* Machintosh 4 blade for infant
Laringoskop nomor 00 dan 0
d Ruang Bayi
1
2
Lumbal needle Punction
Incubator
* Air circulation system comforting the baby. The air and baby modes are
controlled by the advanced microcomputer.
* Embedded integrated sensor module and integrated water reservoir in the
shape of drawer.
* Humidity and oxygen concentration display and servo control.
* Optional weighting system and monitor shelf.
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
3
2
2
1
* Inclination of bassinet is adjustable.
* X-ray cassette under the bassinet.
* >37℃ temperature setting.
* Failure alarm indication.
* RS-232 connector.
* Adjustable height.
3
Incubator Transpor
* Closed infant transport incubator
* TI-2000
* Specification:
* Air mode and Baby mode controlled by micro-computer;
* Use AC Power and DC Power alternatively, DC 12V or DC 24V Power on
the ambulance;
* Set temperature, air temperature, baby temperature and internal battery
voltage can be displayed separately;
* Failure alarm indication;
* Double wall Acrylic glass hood with side door so that the bassinet can be
pulled out from it;
* Natural air flow humidity;
* The height of whole unit can be adjusted;
* With Oxygen cylinder and Oxygen supply configuration;
* Observation lamp.
4
Baby Resusitasion Set
Neonates, infants and children with a body weight of up to 20 kg,
approx. 4-5 years.
5
5
2
2
5
Baby Suction pump
* Portable Suction Pump
1
1
1
1
* Vacuum Range 0 to -35 kPa, 0 to -262.5 mm Hg
* Flow Rate 32 lpm
JUMLAH MINIMAL
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
10
10
5
2
x
x
x
x
* Vacuum Regulation Needle valve type
* Vacuum Indicator Analogue gauge, Bourdon Tube type
* Indicator Range 0 to –60 kPa, 0 to -450 mm Hg
* Pump Type Twin Piston, Oil Free
* Motor Permanent split capacitor
* Collection Containers 2 x 2 Litre autoclavable, shatterproof, polycarbonate
jars
* Overflow Protection Motor valve / Float valve mechanism
6
7
Infant Stetoscope
Sypgmomanometer dengan manset
untuk bayi dan anak
* Maximum error tolerance of + / - 3 mmHg
* 99.99% pure mercury
* Precision glass column Internal diameter 4.2 mm
+ / - 0.2 mm
* Latex bulb with chromium plated release valve
* Precision air release valve, wear-free and with fine regulation
* Microfilter for long life
* Cuff with two-tube latex bladder
* Metal faceplate with easy-to-read scale up to 300 mmHg
* Mercury lock
* Special seal against mercury contamination
* Large storage compartment for cuff + latex bulb
* Cleaning device for glass column
8
Termometer rectal
x
x
x
x
9
Termometer axial
10
1
5
2
10
Reflex hammer
x
x
x
x
11
Tongue Spatel
x
x
x
x
JUMLAH MINIMAL
UNIT PELAYANAN
NO
12
NAMA ALAT
Tempat tidur bayi
SPESIFIKASI ALAT
* steel pipe construction
RS KLS
A
RS KLS
B
RS KLS
C
RS KLS
D
40
40
30
20
x
x
x
x
1
1
1
1
* Basket transparant acrylic
* Position normal, trendelenburg, reverse tendelenburg adjustable position
* 2 castor and matress
13
Vena section set
14
Infant Warmer
* Bed tilting +/- 10% Trendelenburg and Reverse Trendelenburg, damp
* Opr temp 10 - 40 C
* Storage temp range -25 to + 60 C
* Operating Humidity Range 0% - 95%
* System control karakteristik
* Microprocessor Base Control System : Self-test function performance at
power on and continuosly during normal operation
* Patient Control (servo) Modes : 32o C in increment 0,1o C
* Manual Mode : Indicates manual mode heat selection range from 0 - 100%
in 5% increments
* Temperature variability : less than +/- 0,3o C
* Resolution : +/- 0,1o C
* Probe Intercheageability : +/- 0,1o C
* Probe range : 30oC to 42o C
* Proportional heat control w/ zero voltage switching to minimize radiated and
conducted EMI
* Observation light : 100 foor candles at centres of mattress, estimated lamp
life 3000 hours
2. PELAYANAN MEDIK SPESIALIS OBSTETRI DAN GINEKOLOGI
Jenis/UNIT
PELAYANAN
Obstetri dan
Ginekologi
a. Klinik ( Rawat Jalan )
NO
1
2
3
4
5
6
7
8
9
NAMA ALAT
Meja Periksa Kebidanan
Meja Periksa Ginekologi
Timbangan Dewasa
Tensimeter
Stetoscope
Doppler
Examination lamp
Gynecologycal Examination set
Pap Smear Kit
9.1 Transformer 23ov Flat Plug
9.2 Clear Head Light W/Foam Rubber
9.3 Spare Electric Bulb 6 Volts For Ac461
9.4 Standard Forceps Serr 200 mm
9.5 Standard Tissue Forceps 1x2 200 mm
9.6 Rochester-Pean Forceps Str 200 mm
9.7 Rochester-Pean Forceps Cvd 200 mm
9.8 Langenbeck Retractoropen 28x10 mm
209 mm
9.9 Langenbeck Retractor 28x14 mm
9.10 Langenbeck Retractor 33x14 mm 210 mm
Spesifikasi alat
RS kls
A
10
4
2
5
5
2
4
4
2
1
1
1
2
2
2
2
1
1
1
JUMLAH
RS Kls
RS kls
B
C
8
4
2
5
5
2
4
4
2
4
2
2
3
3
2
2
3
2
RS kls
D
4
2
2
2
2
2
2
2
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
9.11
9.12
9.13
9.14
9.15
9.16
9.17
9.18
9.19
9.20
9.21
10
Langenbeck Retractor 40x10 mm
Langenbeck Retractor 40x13 mm 210 mm
Grave Vaginal Speculum 75x20 mm
Grave Vaginal Speculum 95x30 mm
Grave Vaginal Speculum 105x33 mm
Sims Vag. Speculum 70x26 mm/75x30 mm
127 mm
Sims Vag. Speculum 75x30 mm / 80x35
mm 153 mm
Sims Vag. Speculum 80x36 mm / 90x40
mm 178 mm
Hegar Dilator Set W/14 Dilators 4-17 mm
Sims Uterine Probegrad Cvd D:4/330 mm
Sims Utrn Probe Grad Cvd Mall D:4/330
mm
Bozemann Forceps Str Serr 261 mm
Kidney Tray Stainless Steel 250 mm
Sterilit Oil Spray 300 ml
Basket Wide Perforation 243x253x56 mm
Bottom For 1/2 Container Height:135 mm
Primeline 1/2 Lid Blue
9.22
9.23
9.24
9.25
9.26
9.27
IUD kit
10.1 Laboratory Dish 0.16 L
10.2 Bozemann Forceps S-Cvd Serr 250mm
10.3 Tenaculum Frcps Delstr1x1250mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
5
3
1
1
4
3
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
10.4
10.5
11
12
13
Kristeller Vag.Spec Set 75x30mm 178mm
Sims Vag. Speculum 70x26 mm / 75x30
mm 127 mm
10.6 Sims Uterine Probegrad Cvd D: 4/330 mm
10.7 Mathieu Foreign Body Forceps 191 mm
10.8 Sterilit Oil Spray 300 ml
Implant Kit
11.1 Bottom For 1/2 Container Height:57 mm
11.2 Basis 1/2 Inner Cover F.Cont.75 mm Silver
11.3 Foerster-Ballengr Spng Fcpserstr180 mm
11.4 Carbon Steel Scalpel Blades #10
11.5 Scalpel Handle #3
11.6 Standard Forceps Serr 145 mm
11.7 Standard Tissue Forceps 1x2 145 mm
11.8 Halsted-Mosquito Forceps Del Cvd125 mm
11.9 Pean Forceps Del Cvd 140 mm
11.10 Mayo-Hegar Needle Holder150 mm
11.11 Baby-Metz Scissors Del Cvd 145 mm
11.12 Surgical Scissors Str S/B145 mm
11.13 Knowles Bandage Scissors 145 mm
11.14 Kidney Tray 170 mm 250 ml
11.15 Laboratory Dish 0.16 L
USG Transvaginal
USG 4 dimensi
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
1
1
1
1
2
2
2
2
2
1
2
-
1
-
1
-
1
1
1
5
1
1
1
2
3
1
1
1
1
1
2
Jenis/UNIT
PELAYANAN
NO
14
15
16
17
18
19
20
21
NAMA ALAT
Spesifikasi alat
USG 3 dimensi
USG 2 dimensi
Colposcopy
Forcep Biopsi
Stetoscope Laenec
Sterilisator portable
Cardiotocography
Minor surgery set
21.1 Scalpel Handle #3
21.2 Surgical Scissors Str S/B145mm
21.3 Mayo-Stille Sciss Bvld-Bld Str 140mm
21.4 Mayo-Stille Sciss Bvld-Bld Cvd 140mm
21.5 Metzenbaum Scissors Cvd180mm
21.6 Tissue Forceps Serr 145mm
21.7 Standard Forceps Serr 145mm
21.8 Standard Forceps Serr 180mm
21.9 Standard Tissue Forceps 1x2 145mm
21.10 Standard Tissue Forceps 1x2 180mm
21.11 Rampley Sponge Forceps Str Serr 180mm
21.12 Backhaus Towel Clamp 90mm
21.13 Halsted-Mosquito Forceps Delstr125mm
21.14 Crile Forceps Cvd 140mm
21.15 Spencer-Wells Forceps Str130mm
Shumacher Biopsy/RngursmTipstr 240 Mm
1
1
1
1
1
1
1
1
1
1
2
4
4
2
6
RS kls
A
1
2
2
2
2
2
2
JUMLAH
RS Kls
RS kls
B
C
1
2
2
2
1
2
2
2
2
1
1
2
2
2
RS kls
D
2
1
1
2
2
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
21.16
21.17
21.18
21.19
21.20
21.21
21.22
21.23
21.24
21.25
22
Kocher-Ochsner Forceps Str 1x2 160mm
Kocher-Ochsner Forceps Str 1x2 185mm
Mayo-Hegar Needle Holder150mm
Mayo-Hegar Needle Holder200mm
Director W/Tongue Str 145mm
Myrtle-Leaf Probe 1.5mm 145mm
Baby-Senn-Miller Rector.Sh.8x7/22x7mm
Farabeuf Rtrctrs25x10/32x12-22x10/28x12
Hook 1-Prong Sharp Sm-Cvd165mm
Langenbeck
Retractoropen28x10mm209mm
21.26 Allis Forceps 4x5 155mm
21.27 Volkmann Bone Curette
#00002.8mm172mm
21.28 Sterilit Oil Spray 300ml
21.29 Basket Wide Perforation 406x253x56mm
21.30 Bottom For 3/4 Container Height:135mm
21.31 Primeline 3/4 Lid Blue
Office Histeroscopy
Diagnostic Hysteroscope Sheath
22.1 Diagnostic Sheath, Diameter 3,7mm, Color
Code White, To Endoscope 2,9mm/
302mm/ 0°
(41.0160a), Working Length 270mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
2
2
1
1
1
1
2
1
2
2
2
1
1
1
1
1
2
1
2
1
1
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
22.2
22.3
22.4
Diagnostic Sheath, Diameter 3,7mm, Color
Code White, To Endoscope 2,9mm/
302mm/30°
(41.0161a), Working Length 270mm
Diagnostic Hysteroscope Sheath, Outer
Diameter In 5,0mm, White,
To Endoscope 2,9mm/302mm/0°
(41.0160a), Working Length 270mm
Diagnostic Hysteroscope Sheath, Outer
Diameter In 5,0mm, White,
To Endoscope 2,9mm/302mm/0°
(41.0161a), Working Length 270mm
Spesifikasi alat
1
1
1
Operative Hysteroscope Sheath
22.5
22.6
22.7
22.8
Operative Sheath, Outer Diameter 5,0mm,
Color Code White, To Endoscope 2,9mm/
302mm/30°
(41.0161a), Working Channel In Charr. 5,
Drop-Shaped
Operative Sheath, Outer Diameter 5,5mm,
Color Code Red, To Endoscope 2,9mm/
302mm/30°
(41.0161a), Workingc Hannel In Charr. 5,
Sheath Form Round
1
1
Endoscope
Endoscope 2,9 X 302mm, Dir. Of View 0°,
Wide Angle, Autoclavable
1
Endoscope 2,9 X 302mm, Dir. Of View 30°,
Wide Angle, Autoclavable
1
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Flexible Instruments 400 Mm
22.9
Forceps, Double Spoon For Biopsy, Double
Action, Flexible,Cutting, 5 Charr, Flexible
22.10 Flexible Scissors, 5 Charr., Length 400 Mm,
Incl. Handle
22.11 Flexible Grasping Forceps, Double Action,
5 Charr., Length 400 Mm
22.12 Biopsy Forceps, Spoon, Serrated, Charr 5,
Working Length 400mm, Flexible
1
1
1
1
Flexible Electrodes
22.13 Flexible Needle Electrode, Monopolar, 5
Charr., 450 Mm,
1
22.14 Flexible Coagulation Electrode, 450 Mm,
Ballshaped, Monopolar, 5 Charr.
1
22.15 Flexible Loop Electrode, Monopolar, Charr
5, Working Length 450mm
1
Monopolar Cable
23
22.16 Monopolar Cable 4mm 3.5 Meters
Cleaning Brush
2
22.17
22.18
22.19
22.20
1
1
1
1
Cleaning Brush 5mm Dia 6/Pkg
Cleaning Brush 10mm Dia
Sterilit Oil Spray 300ml
Sterilit Instrument Oil 50ml
Suction pump
2
2
1
1
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
24
25
26
27
28
29
Utility trolley
Lemari obat kaca
bak Instrument kaca
Tromol kasa
ECG
Nierbekhen
30
31
Kursi Dorong
Standar Infus
Sonde uterus
32
33
34
Tampon Tang
Bak instrument
Spesifikasi alat
Kidney Tray Stainless Steel
250mm
Mayo Galduct Probe Mall
D:5/330mm
Bozemann Forceps S-Cvd Serr
250mm
Mini Container
Bottom F/Mini Container
Height:30mm
Bottom F/Mini Container
Height:30mm
Tutup Mini Container
Mini-Size Lid W/Retention Plate
Blue
Container ukuran 1/2
Bottom For 1/2 Container
Height:90 mm
Bottom For 1/2 Container
Height:120 mm
Bottom For 1/2 Container
RS kls
A
2
2
4
4
2
JUMLAH
RS Kls
RS kls
B
C
2
1
2
1
3
2
3
2
2
1
RS kls
D
1
1
1
2
1
4
3
2
2
2
5
2
4
2
3
2
2
4
3
2
2
5
4
3
2
2
2
2
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
Spesifikasi alat
Height:135 mm
Bottom For 1/2 Container
Height:187 mm
Bottom For 1/2 Container
Height:247 mm
Tutup Container ukuran 1/2
PRIMELINE 1/2 LID BLUE
Container ukuran 3/4
Bottom For 3/4 Container
Height:90 mm
Bottom For 3/4 Container
Height:120 mm
Bottom For 3/4 Container
Height:135 mm
Tutup Container ukuran 3/4
PRIMELINE 3/4 LID BLUE
Container ukuran 1/1
Bottom For 1/1 Container
Height:90 mm
Bottom For 1/1 Container
Height:120 mm
Bottom For 1/1 Container
Height:135 mm
Bottom For 1/1 Container
Height:187mm
Bottom For 1/1 Container
Height:247 mm
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Tutup Container ukuran 1/1
Primeline 1/1 Lid Blue
b. Perawatan
1
2
3
4
5
6
7
8
9
10
11
12
Hospital Bed
Termometer
Examination lamp
Stethoscope
Suction Pump
Infusion set
Infusion pump
Oxygen Set + Flow meter
Recusitation Set
USG 2 dimensi
Autoclave
Minor surgery instrument set
12.1 Scalpel Handle #3
12.2 Surgical Scissors Str S/B145 mm
12.3 Mayo-Stille Sciss Bvld-Bld Str 140 mm
12.4 Mayo-Stille Sciss Bvld-Bld Cvd 140 mm
12.5 Metzenbaum Scissors Cvd180 mm
12.6 Tissue Forceps Serr 145 mm
12.7 Standard Forceps Serr 145 mm
12.8 Standard Forceps Serr 180 mm
12.9 Standard Tissue Forceps 1x2 145 mm
12.10 Standard Tissue Forceps 1x2 180 mm
100
5
4
2
2
1
2
2
4
2
2
2
1
1
1
1
1
1
1
1
1
1
70
5
3
2
2
1
2
2
3
2
1
2
50
5
2
2
2
1
2
2
2
1
1
2
40
5
1
2
2
1
2
2
2
1
1
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
12.11
12.12
12.13
12.14
12.15
12.16
12.17
12.18
12.19
12.20
12.21
12.22
12.23
12.24
12.25
13
14
Rampley Sponge Forceps Str Serr 180 mm
Backhaus Towel Clamp 90 mm
Halsted-Mosquito Forceps Delstr125 mm
Crile Forceps Cvd 140 mm
Spencer-Wells Forceps Str 130 mm
Kocher-Ochsner Forceps Str 1x2 160 mm
Kocher-Ochsner Forceps Str 1x2 185 mm
Mayo-Hegar Needle Holder150 mm
Mayo-Hegar Needle Holder200 mm
Director W/Tongue Str 145 mm
Myrtle-Leaf Probe 1.5mm 145 mm
Baby-Senn-Miller Rector.Sh.8x7/22x7 mm
Farabeuf Rtrctrs 25x10/32x12-22x10/28x12
Hook 1-Prong Sharp Sm-Cvd 165 mm
Langenbeck Retractoropen 28x10 mm
209 mm
12.26 Allis Forceps 4x5 155mm
12.27 Volkmann Bone Curette #00002.8mm
172 mm
12.28 Sterilit Oil Spray 300 ml
12.29 Basket Wide Perforation 406x253x56 mm
12.30 Bottom For 3/4 Container Height:135 mm
12.31 Primeline 3/4 Lid Blue
Antidecubitus Matras
Gynecologycal Examination set
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
2
4
4
2
6
2
2
1
1
1
1
2
1
2
2
2
1
1
1
1
1
1
4
1
4
1
3
1
2
Jenis/UNIT
PELAYANAN
NO
15
16
17
18
19
20
NAMA ALAT
Emergency set
Film viewer
Nebulyzer
Vena section set
18.1 Scalpel Handle #3
18.2 Iris Scissors Str S/S 110mm
18.3 Surgical Scissors Str S/B145mm
18.4 Metzenbaum Scissors Cvd 145mm
18.5 Semken Forceps Del 125mm
18.6 Semken Del.Tissue Forceps 1x2 125 mm
18.7 Rampley Sponge Forceps Str Serr 180 mm
18.8 Backhaus Towel Clamp 90mm
18.9 Halsted-Mosquito Forceps Delstr125 mm
18.10 Halsted-Mosquito Forceps Del Cvd125 mm
18.11 Mayo-Hegar Needle Holder150 mm
18.12 Director W/Tongue Str 145 mm
18.13 Hook 4-Prong Sharp Sm-Cvd 165 mm
18.14 Weitlaner Retractor 2x3t.Sh.105 mm
18.15 Sterilit Oil Spray 300ml
18.16 Basket Wide Perforation 243x253x56 mm
18.17 Bottom For 1/2 Container Height:135 mm
18.18 Primeline 1/2 Lid Blue
Cardiotocograph
Food Troly
Spesifikasi alat
RS kls
A
1
2
4
1
JUMLAH
RS Kls
RS kls
B
C
1
1
2
1
3
2
1
1
RS kls
D
1
1
1
1
1
1
1
1
1
1
1
4
2
2
1
1
2
1
1
1
1
1
1
2
1
2
1
2
1
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
Lemari Obat (Kaca)
Stetoscope
Tensimeter
Lemari Steril
Bak Catheter
Meja Suntik Beroda
Operating Lamp
Manometer
Perkakas
Pinset
Tensimeter
Timbangan Bayi
Instrument trolley
Meja Periksa
Patient monitor
EKG Elektro Photo
Timbangan Dewasa
Sterilisator
Waskom mandi
Anatomische pinset
Chirurgical pinset
42
43
44
Air Viva
Bak instrument
Buli-buli panas
Spesifikasi alat
Standard Forceps Serr 145 mm
Standard Forceps Serr 180mm
Standard Tissue Forceps 1x2
180mm
RS kls
A
2
2
3
2
2
2
5
2
4
5
2
2
2
4
4
2
2
2
10
10
JUMLAH
RS Kls
RS kls
B
C
2
1
2
1
3
2
2
1
2
1
2
1
4
3
2
1
3
2
5
4
2
2
2
2
2
1
4
3
3
2
2
1
2
1
2
1
10
8
10
8
RS kls
D
1
1
2
1
1
1
2
1
1
3
2
1
1
2
1
1
1
1
5
5
10
10
8
5
4
4
2
3
3
2
2
2
1
1
2
1
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
45
46
47
48
Flow meter O2
Gilyserine Spuit
Irigator
Korentang
49
50
Lemari obat kaca
Nierbekhen
51
52
53
Kursi Dorong
Standar Infus
Vena Sectie Set
53.1 Scalpel Handle #3
53.2 Iris Scissors Str S/S 110mm
53.3 Surgical Scissors Str S/B145 mm
53.4 Metzenbaum Scissors Cvd 145 mm
53.5 Semken Forceps Del 125 mm
53.6 Semken Del.Tissue Forceps 1x2 125mm
53.7 Rampley Sponge Forceps Str Serr 180mm
53.8 Backhaus Towel Clamp 90mm
53.9 Halsted-Mosquito Forceps Delstr125mm
53.10 Halsted-Mosquito Forceps Del Cvd125mm
53.11 Mayo-Hegar Needle Holder150mm
53.12 Director W/Tongue Str 145mm
53.13 Hook 4-Prong Sharp Sm-Cvd 165 mm
53.14 Weitlaner Retractor 2x3t.Sh.105 mm
Spesifikasi alat
Cheatle Sterilizing Forceps
280mm
Kidney Tray Stainless Steel
250mm
1
1
1
1
1
1
1
4
2
2
1
1
2
1
RS kls
A
4
10
2
JUMLAH
RS Kls
RS kls
B
C
4
3
10
8
2
1
RS kls
D
2
5
1
5
5
3
2
2
2
2
2
5
4
3
2
2
4
3
2
3
3
2
2
2
2
2
2
Jenis/UNIT
PELAYANAN
NO
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
NAMA ALAT
53.15 Sterilit Oil Spray 300 ml
53.16 Basket Wide Perforation 243x253x56 mm
53.17 Bottom For 1/2 Container Height:135 mm
53.18 Primeline 1/2 Lid Blue
Slim Zuiger elektric
Meja obat
Gelas takar
Tabung O2
Baby incubator
Timbangan Dewasa
Arteri klem
Bed Skreen/sherm
Kom Kompres
Sputum bak
Standar Waskom
Pisfot dewasa
Laser teraphy
UV Lamp
Branchard
Oksigen meter dinding
Suction pump dinding
Traffic Light
Doppler
Microscope labophot
Automatic emergency
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
1
1
1
Crile Forceps Cvd 140mm
Laboratory Dish 2.5 L
2
2
2
2
5
2
10
5
5
5
10
10
2
10
5
5
5
v
3
2
2
2
2
2
2
4
2
8
4
5
5
10
10
2
8
5
5
5
v
2
2
2
1
1
1
1
3
1
5
3
3
4
8
8
1
4
3
4
4
v
2
1
1
1
1
1
1
2
1
4
3
3
4
5
5
1
4
3
3
3
v
2
1
1
Jenis/UNIT
PELAYANAN
c. Kamar Tindakan
Persalinan (VK)
NO
NAMA ALAT
75
76
Box baby
Emergency trolley
1
Delivery instrument set
2
1.1
Standard Forceps Serr 145mm
1.2
Standard Tissue Forceps 1x2 145mm
1.3
Backhaus Towel Clamp 90mm
1.4
Halsted-Mosquito Forceps Delstr125mm
1.5
Mayo-Hegar Needle Holder185mm
1.6
Stadler Episiotomy Scissors145mm
1.7
Sterilit Oil Spray 300ml
Curretage instrument set
2.1
Foerster Sponge Fcps Serr Str 242 mm
2.2
Backhaus Towel Clamp 135 mm
2.3
Mayo Scissors Cvd 155 mm
2.4
Sims Vag. Speculum 70x26 mm/75x30 mm
127 mm
2.5
Sims Vag. Speculum 75x30 mm/ 80x35 mm
153 mm
2.6
Sims Vag. Speculum 80x36 mm/ 90x40mm
178 mm
2.7
Kristeller Vag.Spec Set 75x30mm 178mm
2.8
Sims Uterine Probegrad Cvd D:4/330 mm
2.9
Bozemann Forceps S-Cvd Serr 250 mm
Spesifikasi alat
RS kls
A
5
2
JUMLAH
RS Kls
RS kls
B
C
4
3
2
1
RS kls
D
3
1
5
5
4
4
5
4
3
2
Jenis/UNIT
PELAYANAN
NO
3
NAMA ALAT
2.10 Tenaculum Frcps Delstr1x1250 mm
2.11 Recamier Uter.Curette Sh/Rig.#4 14.0 mm
2.12 Recamier Uter.Curette Sh/Rig.#5 15.0 mm
2.13 Recamier Uter.Curette Sh/Rig.#6 16.5 mm
2.14 Recamier Uter.Curette Sh/Rig.#8 19.5 mm
2.15 Winter Placenta/Ovum Fcps #2cvd292 mm
2.16 Laboratory Dish 0.16 L
2.17 Kidney Tray Stainless Steel 250 mm
2.18 Bottom For 1/2 Container Height:90 mm
2.19 1/2-Size Lid W/Retention Plate Silver
Minor surgery set
3.1
Scalpel Handle #3
3.2
Surgical Scissors Str S/B145 mm
3.3
Mayo Scissors Str 140 mm
3.4
Mayo Scissors Cvd 140 mm
3.5
Metzenbaum Scissors Cvd 180 mm
3.6
Tissue Forceps Serr 145 mm
3.7
Standard Forceps Serr 145 mm
3.8
Standard Forceps Serr 180 mm
3.9
Standard Tissue Forceps 1x2 145 mm
3.10 Standard Tissue Forceps 1x2 180 mm
3.11 Foerster-Ballengr Spng Fcpserstr 180 mm
3.12 Backhaus Towel Clamp 90 mm
3.13 Halsted-Mosquito Forceps Delstr 125 mm
Spesifikasi alat
RS kls
A
2
JUMLAH
RS Kls
RS kls
B
C
2
1
RS kls
D
1
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
3.14
3.15
3.16
3.17
3.18
3.19
3.20
3.21
3.22
3.23
3.24
3.25
4
5
6
7
8
Crile Forceps Cvd 140 mm
Spencer-Wells Forceps Str 130 mm
Kocher-Ochsner Forceps Str 1x2 160 mm
Kocher-Ochsner Forceps Str 1x2 185 mm
Crile-Wood Ndlhldrfine-Serr 150 mm
Crile-Wood Needle Holderhvy-Serr 160 mm
Director W/Tongue Str 145mm
Myrtle-Leaf Probe 2.0mm 145 mm
Senn-Miller Rector.Sh.8x7/18x5.5 mm
Farabeuf Rtrctrs 25x10/32x12-22x10/28x12
Bose Tracheal Lft-Hook165 mm
Langenbeck Retractoropen 28x10 mm
209 mm
3.26 Allis Forceps 4x5 155 mm
3.27 Volkmann Bone Curette #00002.8 mm
172 mm
3.28 Sterilit Oil Spray 300 ml
3.29 Basket Wide Perforation 485x253x56 mm
3.30 Bottom For 1/1 Container Height:135 mm
3.31 Primeline 1/1 Lid Blue
Doppler
Tensimeter
Suction pump
Examination lamp
Timbangan Bayi
2
5
1
5
2
2
4
1
4
2
1
3
1
3
1
1
2
1
3
1
Jenis/UNIT
PELAYANAN
NO
9
10
11
12
13
14
15
16
17
NAMA ALAT
Oxygen Set + Flow meter
Sterilisator
Forceps
11.1
Simpson Obstetrical Forceps305mm
11.2
Simpson Obstetrical Forceps 350 mm
11.3
Kielland Obstetrical Forceps 420 mm
11.4
Piper Obstetrical Fcps F/Breach 445 mm
11.5
Naegele Obstetrical Forceps 355 mm
11.6
Tarnier Obstetrical Forceps 400 mm
11.7
Sterilit Oil Spray 300 ml
11.8
Basket Wide Perforation 243x253x56 mm
11.9
Bottom For 1/2 Container Height:135 mm
11.10 Primeline 1/2 Lid Blue
Vacum Ekstraktor
Cardiotocograph
Stethoscope
Recusitation set
Suction Curetage
sectio caesarian set
17.1
Maier Forceps W/Rcht Cvd265 mm
17.2
Backhaus Towel Clamp 110 mm
17.3
Towel Clamp For Paper Cloths 115 mm
17.4
Scalpel Handle #4
17.5
Tc Metzenbaum Scissors Cvd 200 mm
Spesifikasi alat
RS kls
A
2
2
3
3
2
4
2
2
5
JUMLAH
RS Kls
RS kls
B
C
2
1
2
1
3
2
3
2
4
2
2
4
2
1
2
1
2
3
RS kls
D
1
1
2
2
1
2
1
2
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
17.6
17.7
17.8
17.9
17.10
17.11
17.12
17.13
17.14
17.15
17.16
17.17
17.18
17.19
17.20
17.21
17.22
17.23
17.24
17.25
17.26
17.27
17.28
Tc Nelson-Metz Scissors Cvd 230 mm
Tc Suture Wavecut Scissors Cvd 180 mm
Tc Mayo-Lexer Scissors Cvd 165 mm
Tc Sims Uterine Sciss Cvd B/B 200 mm
Surgical Scissors Str S/B145 mm
Tissue Forceps Serr 145 mm
Tissue Forceps Str 1x2 145 mm
Standard Tissue Forceps 1x2 200 mm
De'bakey Atr.Fcps 2.0mm Str150 mm
De'bakey Atr.Fcps 2.0mm Str 200 mm
Rochester-Ochsner Fcps Str1x2140 mm
Pean Forceps Str 140 mm
Kocher-Ochsner Forceps Str 1x2 200 mm
Rochester-Pean Forceps Str 200 mm
Maier Forceps W/Rcht Str 265 mm
Mikulicz Peritoneum Forceps Cvd.205 mm
Faure Peritoneum Forcepsstrng Cvd
205 mm
Heywood-Smith Forceps 215 mm
Recamier Scoop Fig 1 365 mm
Female Catheter Metal 12fr 159 mm
Tc Crile-Wood Ndl Hldrstrserr 145 mm
Tc Mayo-Hegar Ndl Holderhvyserr205 mm
Tc Hegar Needle Holder Hvy-Serr 205 mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
17.29
17.30
17.31
17.32
18
19
20
21
22
23
Tc Hegar Needle Holder Hvy- Serr245 mm
Roux Retractor3/Set 165 mm
Volkmann Retr6-Prgsemi-S8.5x29222 mm
Haberer Ribbon Retractor 50/40 mm 305
mm
17.33 Fritsch Abdominal Retractor 64x85 mm #5
17.34 Double-Ended Probe 2.0mm 300 mm
17.35 Interior Box F/Bl930
17.36 Needle Case W/7 Sections 150x90x10 mm
17.37 Laboratory Dish 0.16 L
17.38 Laboratory Dish 0.4 L
17.39 Kidney Tray Stainless Steel 250 mm
17.40 Redon Spike Ch.12 Slig.Cvd.Triang.Tip
17.41 Redon Spike Ch.14 Slig.Cvd.Triang.Tip
17.42 Sterilit Oil Spray 300 ml
17.43 Basket Wide Perforation 485x253x56 mm
17.44 Bottom For 1/1 Container Height:135 mm
17.45 Primeline 1/1 Lid Blue
Anesthesi Machine
Infusion pump
Infusion warmer
Auto tranfusion set
Embriotomi set
Spesifikasi alat
Timbangan Bayi
3
2
2
2
2
4
3
1
1
2
2
3
2
1
1
1
1
2
2
1
1
1
1
2
Jenis/UNIT
PELAYANAN
NO
24
25
26
27
NAMA ALAT
Operating Lamp
Utility Troly
Heacting Set
26.1
Foerster-Ballengr Spng Fcpserstr 180 mm
26.2
Surgical Scissors Str S/B145 mm
26.3
Spencer Suture Scissors 90 mm
26.4
Knowles Bandage Scissors 145 mm
26.5
Standard Forceps Serr 145 mm
26.6
Standard Tissue Forceps 1x2 145 mm
26.7
Mayo-Hegar Needle Holder150 mm
26.8
Sut.Needle #G12 Triang.Point Spr.Eye
26.9
Mathieu Ndl Hldrgrip/Rcht Serr 170 mm
26.10 Laboratory Dish 0.16 L
26.11 Kidney Tray 170 mm 250 ml
Alat Partus Set
27.1
Surgical Scissors Str S/B145 mm
27.2
Lister Bandage Scissors Hvy 180 mm
27.3
Standard Forceps Serr 145 mm
27.4
Standard Tissue Forceps 1x2 145 mm
27.5
Foerster Sponge Fcps Serr Str 242 mm
27.6
Hartmann Mosquito Fcsdel Str 100 mm
27.7
Crile Forceps Str 160 mm
27.8
Mayo-Hegar Needle Holder150 mm
27.9
Grave Vaginal Speculum 75x20 mm
Spesifikasi alat
RS kls
A
2
3
4
5
JUMLAH
RS Kls
RS kls
B
C
2
2
2
2
3
2
4
2
RS kls
D
2
2
2
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
28
29
30
31
32
33
27.10 Sims Vag. Speculum 70x26mm/75x30 mm
127 mm
Sims Vag. Speculum 75x30 mm /80x35 mm
27.11 153 mm
27.12 Bozemann-Douglas Fcpss-Cvdserr 260 mm
27.13 Stadler Episiotomy Scissors145 mm
27.14 Umbilical Cord Scissors 105 mm
27.15 Sterilit Oil Spray 300 ml
27.16 Basket Wide Perforation 243x253x56 mm
27.17 Bottom For 1/2 Container Height:135 mm
27.18 Primeline 1/2 Lid Blue
Cardiotocography Unit
Gynecology Examination
Manometer
Alat Pemanas
Stetoscope
Gunting bengkok
34
Pengait IUD
35
Spesifikasi alat
Surgical Scissors Str S/B 145
mm
Iud Removal Hook Saunders
318 mm
Spekulum
Sims Vag. Speculum 70x26
mm / 75x30 mm 127 mm
Sims Vag. Speculum 75x30
mm/ 80x35 mm153 mm
Sims Vag. Speculum 80x36
mm/90x40 mm178 mm
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
2
5
2
2
4
2
4
2
2
3
1
2
1
1
2
1
2
1
1
2
5
4
3
3
2
10
2
8
1
8
1
6
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
36
Tenakulum
37
38
Pinset
Korentang
39
40
41
42
43
44
45
46
47
48
49
50
51
Tromol kasa
Pean bengkok
gagang pisau no. 3
Meja Ginekologi
Lampu ginekolog
Chirurgical pinset
Meja obat
Busi
Himinoplasti
Forceps
Bak instrument
Bak Korentang
Nierbekhen
52
Sonde uterus
53
Sim Utarine Currete Blunt
Spesifikasi alat
Sims Uterine Probegrad Cvd
D:4/330mm
Standard Forceps Serr 145 mm
Cheatle Sterilizing Forceps
280 mm
Pean Forceps Del Cvd 140 mm
Scalpel Handle #3
Standard Tissue Forceps 1x2
145 mm
Naegele Obstetrical Forceps
355 mm
Kidney Tray Stainless Steel
250mm
Sims Uterine Probegrad Cvd
D:4/330mm
Sims Uterine Curette #1 Blunt
255 mm
Sims Uterine Curette #2 Blunt
255 mm
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
5
10
4
8
3
6
2
6
2
5
10
10
4
4
2
4
10
8
3
3
1
3
8
6
2
2
1
2
6
4
2
2
10
2
2
2
8
2
2
2
6
1
1
1
4
1
1
1
2
2
2
2
2
2
1
1
2
1
1
2
5
4
3
2
4
3
2
2
4
4
3
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Sims Uterine Curette #3 Blunt
255 mm
Sims Uterine Curette #4 Blunt
255 mm
Sims Uterine Curette #5 Blunt
255 mm
Sims Uterine Curette #6 B15
mm /255 mm
54
55
Partus instrument set
Pemecah ketuban
56
Sendok kuret
57
Tampon Tang
58
59
60
Metal catheter
Tabung O2
Generator set
Beacham Amniotome 240 mm
Sims Uterine Curette #1 Sharp
255 mm
Sims Uterine Curette #2 Sharp
255 mm
Sims Uterine Curette #3 Sharp
255 mm
Sims Uterine Curette #4 Sharp
255 mm
Sims Uterine Curette #5 Sharp
14 mm/255
Sims Uterine Curette #6 Sharp
255 mm
Bozemann Forceps S-Cvd Serr
250 mm
5
4
4
3
3
2
3
2
2
2
1
1
4
3
2
2
2
4
2
2
3
2
1
2
1
1
2
1
Jenis/UNIT
PELAYANAN
d. Kamar Operasi
Kebidanan
NO
NAMA ALAT
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
Operating table (gynecologi)
4
3
2
2
2
3
4
Operating lamp
Anesthesi Machine
Ventilator dgn probe pengukur suhu inti (core
temperature)
Oxygen Set + Flow meter
Electrosurgical unit
UV lamp for room sterilization
4
4
4
4
3
3
2
2
4
4
3
2
4
3
4
4
3
4
4
4
2
4
4
2
4
3
3
1
3
3
2
3
2
2
1
2
2
2
2
1
5
6
7
8
9
10
11
Vacum pump
Autoclave
Sectio caesarian set
Laparatomy set
11.1
Maier Forceps W/Rcht Cvd 265 mm
11.2
Backhaus Towel Clamp 110 mm
11.3
Towel Clamp For Paper Cloths 115 mm
11.4
Scalpel Handle #4
11.5
Scalpel #4l
11.6
Scalpel Handle #3
11.7
Tc Baby-Metz Scissorsdelcvdb/B145 mm
11.8
Tc Metzenbaum Scissors Del Cvd 180 mm
11.9
Tc Metzenbaum Scissors Cvd 200 mm
11.10 Tc Nelson-Metz Scissors Cvd 230 mm
11.11 Tc Nelson-Metz Sciss Cvd 260 mm
11.12 Tc Nelson-Metz Scissors Del Cvd 280 mm
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
11.13
11.14
11.15
11.16
11.17
11.18
11.19
11.20
11.21
11.22
11.23
11.24
11.25
11.26
11.27
11.28
11.29
11.30
11.31
11.32
11.33
11.34
11.35
11.36
Tc Suture Wavecut Scissors Cvd 180 mm
Tc Suture Sciss W/1 Serr Cvd 230 mm
Tc Mayo-Lexer Scissors Cvd 165 mm
Surgical Scissors Str S/B145 mm
Tissue Forceps Serr 145 mm
Tissue Forceps Str 1x2 145 mm
Dissect.Forceps Med.Wide 1x2t.200 mm
Tissue Forceps 1x2 Teeth 250 mm Med.
De'bakey Atr.Fcps 2.0mm Str150 mm
De'bakey Atr.Fcps 2.0mm Str 200 mm
De'bakey Atr.Fcps 2.0mm Str240 mm
Gerald Tissue Fcps Str 1x2 175 mm
Kocher Forceps Str 1x2 140 mm
Pean Forceps Str 140 mm
Halsted-Mosquito Fcps Delcvd 1x2125 mm
Halsted-Mosquito Forceps Del Cvd 125 mm
Halsted Delicate Forceps Str 185 mm
Halsted-Mosquito Fcpsdelstr1x2185 mm
Kocher-Ochsner Forceps Str 1x2 200 mm
Kocher-Ochsner Forceps Str 1x2240 mm
Maier Forceps W/Rcht Str 265 mm
Mikulicz Peritoneum Forceps Cvd.205 mm
Overholt-Geiss Suture Fcps #3 Cvd229 mm
Overholt Forceps # 1 Cvd 297 mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
11.37
11.38
11.39
11.40
11.41
11.42
11.43
11.44
11.45
11.46
11.47
11.48
11.49
11.50
11.51
11.52
11.53
11.54
11.55
11.56
11.57
11.58
11.59
Overholt-Geiss Suture Fcps#2cvd273 mm
Mixter Suture Forceps Rt-Ang 230 mm
Deschamps Ndlf/Rt-Hndbltlng-Hk215 mm
Koenig Guide Probe 4.5mm195 mm
Tc Crile-Wood Ndl Hldrstrserr 145 mm
Tc Mayo-Hegar Ndl Holderhvyserr205 mm
Tc Wangensteen Needle Hldr Serr275 mm
Tc De'bakey Ndl Holder Del Serr 180 mm
Tc De'bakey Ndl Holder Del Serr 250mm
Roux Retractor3/Set 165mm
Langenbeck Retractor 28x14mm
Langenbeck Retractor 40x10mm
Kocher-Langenbeck Retr 55x11mm 216mm
Volkmann Retr4-Prgsemi-S8.5x19222mm
Fritsch Retractor #4open46x75 mm242 mm
Mikulicz Abdominal Retractor 250 mm
Mikulicz Abdominal Retractor 180x50 mm
Haberer Ribbon Retractor 50/40 mm
305mm
Kirschner Fold-Frame Retractor Complete
Atr.Ovum Forceps Str Sm250 mm
Volkmann Bone Curette #0 5.2mm 172 mm
Nelaton Director W/Tongue Cvd160 mm
Double-Ended Probe 1.5mm 200 mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
12
NAMA ALAT
11.60 Double-Ended Probe 2.0mm 300 mm
11.61 Interior Box F/Bl930
11.62 Needle Case W/7 Sections 150x90x10 mm
11.63 Laboratory Dish 0.16 L
11.64 Laboratory Dish 0.4 L
11.65 Kidney Tray Stainless Steel 250 mm
11.66 Redon Spike Ch.12 Slig.Cvd.Triang.Tip
11.67 Redon Spike Ch.14 Slig.Cvd.Triang.Tip
11.68 Sterilit Oil Spray 300ml
11.69 Basket Wide Perforat.485x253x106 mm
11.70 Bottom For 1/1 Container Height:135 mm
11.71 Primeline 1/1 Lid Blue
Histerectomy set
12.1
Scalpel Handle #3
12.2
Scalpel Handle #4
12.3
Mayo-Harrington Scissors Cvd 230 mm
12.4
Mayo-Stille Sciss Bvld-Bld Str 140 mm
12.5
Mayo-Stille Sciss Bvld-Bld Cvd 170 mm
12.6
Nelson-Metzenbaum Scissors Cvd 253 mm
12.7
Sims Scissors Cvd S/B 200 mm
12.8
Standard Forceps Serr 145 mm
12.9
Standard Forceps Serr 250 mm
12.10 Standard Tissue Forceps 1x2 145 mm
12.11 Standard Tissue Forceps 1x2 200 mm
Spesifikasi alat
RS kls
A
4
JUMLAH
RS Kls
RS kls
B
C
3
2
RS kls
D
1
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
12.12
12.13
12.14
12.15
12.16
12.17
12.18
12.19
12.20
12.21
12.22
12.23
12.24
12.25
12.26
12.27
12.28
12.29
12.30
12.31
12.32
12.33
12.34
Rampley Sponge Forceps Str Serr 250 mm
Backhaus Towel Clamp 90 mm
Halsted-Mosquito Forceps Delstr 125 mm
Halsted-Mosquito Forceps Del Cvd 125 mm
Crile Forceps Cvd 140 mm
Spencer-Wells Forceps Cvd 150 mm
Kocher-Ochsner Forceps Str 1x2 200 mm
Heaney Hyst Forceps Grooved 205 mm
Heaney Hyst Forceps Grooved195 mm
Wertheim-Cullen Clamp Grooved 216 mm
Mayo-Hegar Needle Holder 200 mm
Masson Ndl Hldr Hvy-Serrgroove 265 mm
Abdominal Retractor 48x90 mm Wide
Doyen Abdominal Retractor 48x105 mm
Wide
Ribbon Retractor Mall 330x40 mm
Balfour Abdominal Retractor 200x235 mm
Allis Forceps 4x5 155 mm
Duvacollin Intestinal Forceps195 mm
Doyen Intestinal Forceps Cvd 240 mm
Doyen Retractor 90x45 mm 242 mm
Doyen Retractor 120x45 mm 242 mm
Simon Vaginal Retr 115x26 mm 273 mm
Bozemann Forceps S-Cvd Serr 250 mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
13
NAMA ALAT
12.35 Schroeder Tenaculum Frcpstd 1x1250 mm
12.36 Schroeder Tenaculum Frcpsstr2x2 250 mm
12.37 Doyen Myoma Screw 150 mm
12.38 Sterilit Oil Spray 300 ml
12.39 Basket Wide Perforation 485x253x76 mm
12.40 Bottom For 1/1 Container Height:135 mm
12.41 Primeline 1/1 Lid Blue
Laparoscopy set
Support System For Endoscopy
A
I
Camera System
1
3 Chip Full Hd Camera With Zoom
2
Zoom Coupler C-Mount
3
Iec320 Power Plug And Cord 1m
II
Light Source
1
Axel Xenon Light Source 180w
2
Iec320 Power Plug And Cord 1m
3
Full Hd Light Cable D:4.8mm 2.5m Long
III
Monitor System
1
24" Full Hd Lcd Monitor
2
Foot F/24" Flat Screen Monitor
3
Iec320 Power Plug And Cord 1m
IV
Insufflator
1
Flow40 Insufflator
2
Iec320 Power Plug And Cord 1m
Spesifikasi alat
RS kls
A
2
JUMLAH
RS Kls
RS kls
B
C
2
1
RS kls
D
1
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
3
4
5
6
V
1
2
3
4
5
6
VI
1
2
3
4
5
6
VII
1
VIII
1
2
Co2-Filter Ster 25 Units
Insufflation Tube W/Gas Preheating
High Pressure Tube 1m Us/Din
Cylinder Co 2
Hf Unit
Hf Combi Unit 300w Monop.80w.Bipolar
Iec320 Power Plug And Cord 1m
Doub.Foot Switch 4m Cable
Silicon Neutral Elect.Large 310x160 mm
Silicon Rubber Band W/4 Buttons 1.5 m
Cable F.Silicon Neutral Electrode 3.5 m
Suction & Irrigation
Irrig.Pump Fluid3 Pressure Control
Iec320 Power Plug And Cord 1 m
Tube Fittings Reusable F.Pg050
Fixture For Infusion Stand Fluid 3
Suction/Irrigation Instrument 5mm/330 mm
Lateral Fixtur With Round Tube
Documentation System
Laparoview (Video & Documentation
System)
Trolley System
Endoscopy Trolley Narrow
Mains Cord Orange Euro-Plug
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
3
4
5
B
I
1
2
3
II
1
III
1
2
3
4
5
6
7
8
9
IV
1
Co2 Cylinder Holder
Infusion Bottle Holder
Camera Holding Device
Instrumentation System
Optics
Full Hd Laparoscope 10 mm 0deg 330 mm
Single Scope Tray For Scops Up To
340 mm
Antifogging Soln.Sterile F.Endoscopes
Veress Needle
Veress Insufflation Needle 10 cm
Trocar Systems
Trocar Sleeve 5/110 mm Smooth With Tap
Trocar Pin 5/100 mm W/Triangular Tip
Sealing Unit For 5mm Trocars
Trocar Sleeve 10/110mm Smooth With Tap
Trocar Pin 11/100 mm W/Triangular Tip
Sealing Unit For 10/12 mm Trocars
Sealing Unit F/10/12 mm Trocars
W.Reducer
Disp.Sealing Unit 10/12 mm
Troc.W.Reducer
Reducing Sleeve 10mm To 5 mm
Instruments Scissors
Perit.Sciss Serr 5mm 310 mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
2
3
V
1
2
3
4
5
6
7
8
VI
1
2
3
4
5
6
7
VII
1
2
3
Metzenbaum Scissors 5mm 310 mm
Disp.Sciss.Shaft Metzenbaum
D:5mm/310 mm
Instruments Dissecting & Grasping
Jaw Ins.Grasping & Diss.Fcps D:5/310 mm
Insulated Outer Tube 5/5mm 310 mm
Monopolar Handle With Ratchet
Aggresive Graspers 5mm 310 mm
Tubal Fixation Fcps 5mm 310 mm
Grasp.Fcps 2x4 Teeth 5 mm 310 mm
Claw Grasper 10mm 310 mm
Biopsy Fcps W/Teeth 5mm 310 mm
Instruments Ligating & Suturing
Needle Holder Straight 5 mm 31 cm
Needle Holder Left Curved 5 mm 31 cm
Knot Pusher 5 mm 31 cm
Fascial Port-Closure Instrument
Loop Applier 4.4mm In - 5mm Out
Forceps W/Myoma Screw Po183r
Exploratory Probe 5 mm 400 mm
Instruments Hook & Spatula
Handle F/Monopolar Electrodes 5 mm
Ceramic Electrode Tip J-Hk F/Gk372r
Ceramic Electrode Tip L-Hk F/Gk372r
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
4
VIII
1
2
14
Spesifikasi alat
14.2
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Monopolar Hf Cable 3.5m Long
Instruments Bipolar
Bipolar Metz Scissors 5mm 310 mm
Maryland Gsp.Forceps Fen.5/310 mm Hf
Con.
Bipolar Micro Forceps D:5/310 mm
Bipolar Macro Forceps 5mm 330 mm
Two-Pole Coagulation Cable F/Gn060 3.5
3
4
5
IX
Container System
1
Mis Storage Rack With Basket
2
Bottom For 1/1 Container Height:187 mm
3
Primeline 1/1 Lid Blue
X
Cleaning Brush
1
Cleaning Brush 5mm Dia 6/Pkg
2
Cleaning Brush 10 mm Dia
3
Sterilit Oil Spray 300 ml
4
Sterilit Instrument Oil 50 ml
Histeroscopy set
14.1
RS kls
A
Diagnostic Hysteroscope Sheath
Diagnostic sheath, diameter 5mm, color
code blue, to endoscope 4,0mm/ 302mm/0°
(41.0049a), working length 270mm
Diagnostic sheath, diameter 5mm, color
code blue, to endoscope 4,0mm/
302mm/30°
2
1
1
2
1
1
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
Spesifikasi alat
(41.0055a), working length 270mm
14.3
14.4
14.5
14.6
14.7
14.8
14.9
Diagnostic hysteroscope sheath, outer
diameter in 6,5mm, blue,
to endoscope 4,0mm/302mm/0°
(41.0049a), working length 270mm
Diagnostic hysteroscope sheath, outer
diameter in 6,5mm, blue,
to endoscope 4,0mm/302mm/30°
(41.0055a), working length 270mm
Operative Hysteroscope Sheath
Operative sheath, Outer diameter 6,5mm,
color code blue, to endoscope 4,0mm/
302mm/30°
(41.0055a), working channel in Charr. 5,
drop-shaped
Operative sheath, Outer diameter 8,0mm,
to endoscope 4,0mm/ 302mm/30°
(41.0055a), working channel in Charr. 7
1
1
1
1
Endoscope
Endoscope 4,0 x 302mm, dir. of view 0°,
wide angle, autoclavable
1
Endoscope 4,0 x 302mm, dir. of view 30°,
wide angle, autoclavable
1
Flexible Instruments 400 mm
Forceps, double spoon for biopsy, double
action, flexible,cutting, 5 Charr, flexible
1
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
14.10 Flexible scissors, 5 Charr., length 400 mm,
incl. handle
14.11 Flexible grasping forceps, double action, 5
Charr., length 400 mm
Spesifikasi alat
1
1
14.12 Biopsy forceps, spoon, serrated, Charr 5,
working length 400 mm, flexible
1
14.13 Forceps, double spoon for biopsy, double
action, flexible,cutting,7 Charr., flexible
1
14.14 Flexible scissors, 7 Charr., length 400 mm,
incl. handle
14.15 Scissors, double action jaws, Charr 7,
working length 400 mm
1
1
14.16 Flexible grasping forceps, double action, 7
Charr., length 400 mm
1
14.17 Biopsy forceps, spoon, serrated, Charr 7,
working length 400mm, flexible
1
14.18 Foreign body grasping forceps, stones and
fragments,Charr 7, working length 400 mm,
flexible
1
Flexible Electrodes
14.19 Flexible needle electrode, monopolar, 5
Charr., 450 mm,
1
14.20 Flexible coagulation electrode, 450 mm,
ballshaped, monopolar, 5 Charr.
1
14.21 Flexible loop electrode, monopolar, Charr 5,
working length 450 mm
1
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
15
16
NAMA ALAT
Spesifikasi alat
14.22 Flexible needle electrode, monopolar, 7
Charr., 450 mm,
1
14.23 Flexible coagulation electrode, 450 mm,
ballshaped, monopolar, 7 Charr.
1
14.24 Flexible loop electrode, monopolar, Charr 7,
working length 450mm
1
Monopolar Cable
14.25 Monopolar Cable 4mm 3.5 Meters
2
Cleaning brush
14.26 Cleaning Brush 5mm Dia 6/Pkg
14.27 Cleaning Brush 10 mm Dia
14.28 Sterilit Oil Spray 300 ml
14.29 Sterilit Instrument Oil 50 ml
Electro couter bipolar
15.1
Bipolar Coagulation Unit
15.2
Mains Cord 5m Long
15.3
Bipolar Foot Control
15.4
Two-Pole Coagulation Cable F/Gn060 3.5
15.5
Wire Brushf/Clean Coag Fcps&Electrodes
15.6
Bipolar Coagulation Forceps Str 185 mm
15.7
Bipolar Coagulation Forceps Ang 185 mm
15.8
Precious Metal Forceps160mm 0.7 mm
Electro couter monopolar
16.1
Hf Combi Unit 300w Monop.80w.Bipolar
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
1
1
1
2
2
1
1
2
2
1
1
1
1
1
1
1
1
1
1
1
Jenis/UNIT
PELAYANAN
NO
17
18
NAMA ALAT
16.2
Mains Cord 5m Long
16.3
Vario Dual Foot Switch 4 m Cable
16.4
Silicon Neutral Elect.Large 310x160 mm
16.5
Silicon Rubber Band W/4 Buttons 1.5m
16.6
Cable F.Silicon Neutral Electrode 3.5 m
16.7
Hf-Handle Lg.2 Button 4mm Koax Plug
16.8
Electrode Cable 3.5m Lg.F.Gn207 209
16.9
Electrode Set W/Shaft D:4.0 mm
16.10 Bipol.Diss.Fcps Part Insul.Ang.160 mm
16.11 Two-Pole Coagulation Cable F/Gn060 3.5
16.12 Bipolar Dissection Scissors 230 mm
16.13 Bipolar Cable Aag/Aag Hexagonal
16.14 Wire Brushf/Clean Coag Fcps&Electrodes
16.15 Sterilit Oil Spray 300 ml
Monitor Kardiovaskuler
CVC Set
18.1 Foerster Sponge Fcps Serr Cvd 242 mm
18.2 Tissue Forceps Str 1x2 145 mm
18.3 Tissue Forceps Serr 145 mm
18.4 Scalpel Handle #3
18.5 Surgical Scissors Str B/B 145 mm
18.6 Knowles Bandage Scissors 145 mm
18.7 Crile-Wood Ndlhldrfine-Serr150 mm
18.8 Laboratory Dish 0.16 L
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
1
1
1
1
1
1
1
2
2
2
-
-
Jenis/UNIT
PELAYANAN
NO
19
20
21
22
NAMA ALAT
18.9 Pean Forceps Del Cvd 140 mm
18.10 Kidney Tray 170mm 250ml
18.11 1/2 Basket W/O Stack.Feet 243x253x44 M
Embriotomi set
Endoskopik Videomonitor
Incubator bayi
Micro Surgery set
22.1
Lazar Micro Suture Forceps 0.5mm 155mm
22.2
Lazar Micro Suture Forceps 0.8mm 155mm
22.3
Micro Suture Forceps 0.8mm 185 mm
22.4
Austin Micro Suture Forceps .8 mm140 mm
22.5
Vannas Micro-Scsrcrs/Ser-Hdlcvd 120 mm
22.6
Vannas Micro-Scsrcrs/Ser-Hdlstr 160 mm
22.7
Vannas Micro-Scsrcrs/Ser-Hdlcvd 160 mm
22.8
Millesi Microscrsser-Hdlstrser160 mm
22.9
Barraquer Ndl Hldrw/O Catch Cvd120 mm
22.10 Reill Micro Needle Holder Str 150 mm
22.11 Reill Micro Needle Holder Cvd 150 mm
22.12 Rnd Body Suture Forceps Str.3 mm 120mm
22.13 Rnd Body Suture Forcepsstr0.3 mm150mm
22.14 Yasargil Micro Rasp Cvd Sharp185 mm
22.15 Jacobson Probe W/Ball-Tip185 mm
22.16 Jacobson Vessel Probe & Supporter185mm
22.17 Yasargil Rasp Hvy-Up-Cvd Bayo185 mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
3
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
4
2
4
1
-
1
-
2
1
2
1
1
1
1
1
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
22.18
22.19
22.20
22.21
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
Yasargil Micro Scoop Bayo185 mm
Rack F/12 Micro Surgery Inst
Rack F/7 Micro Surgery Inst
Rack F/7 Bayo Inst Expandable
Operating Lamp
Standar Infus
Standar Waskom
Utility Troly
Operating table bedah
Electric suction pump
Mayo table stand mobile
Ventilator internal
Patient monitor
Meja obat
Perkakas
Ultrasonic cleaner
DC/AC standar
EKG Monitor
Fluid management system
Suction head silicone
Mesin Anestesi
Ligasure USAm
Falley Lab
Hemodinamic monitoring
gagang pisau no. 3
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
1
1
1
4
4
4
2
4
2
1
2
2
2
1
2
2
1
2
v
2
2
2
2
10
4
4
4
2
4
2
1
2
2
2
1
2
2
1
2
v
2
2
2
2
8
2
3
2
1
2
1
1
1
1
1
1
1
1
1
v
1
1
1
1
6
1
2
1
1
1
1
1
1
1
1
1
1
1
v
v
1
1
1
1
4
Jenis/UNIT
PELAYANAN
NO
44
45
46
47
48
NAMA ALAT
Monitor
printer video
Mini viewer
Set jahit
Ring aplikator set
48.1
Veress Insufflation Needle 10cm Luer Lock
48.2
Veress Insufflation Needle 15cm Luer Lock
48.3
Trocar With Pyramidal Tip Hollow Cut
11mm
48.4
Trocar Sleeve W. Silicone Valve +
Insufflation Stop Cock 11mm
Silicon Valve 11 - 12.5mm 1 Pak = 5 Pcs
48.5
48.6
48.7
48.8
Sealing Cap For Trocar Sleeves 1 Pak = 10
Pcs
Silicon Valve 11 - 12.5mm 1 Pak = 5 Pcs
Full Hd Surgical Laparascope Ø11mm,
277mm, W.Channel 6mm 0deg, Wide
Angle
48.9
Valve Adaptor For Operating Instrument
48.10 Valve Body Adaptor For Operating
Instrument
Spesifikasi alat
1
1
1
1
1
10
10
1
1
1
RS kls
A
2
2
2
2
v
JUMLAH
RS Kls
RS kls
B
C
2
1
2
1
2
1
2
1
v
v
RS kls
D
1
1
1
1
v
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
48.11 Flap Valve F/2.55.57mm Trocars 1 Pak =
10 Pcs
48.12 SEALING CAPS DIA 5.5MM 1 PAK = 20
pcs
Spesifikasi alat
10
10
48.13 Schroeder Tenaculum Frcpstd 1x1 250 mm
1
48.14 Ring Applicator, Single Puncture
1
48.15 Cleaning Brush 10mm Dia Length 550 Mm
For Outer Tube Dia 5 - 10 Mm
48.16 1 PAK = 6 Pcs
12
48.17 Sterilit Instrument Oil 50 ml
1
48.18 Loading Device For Ring Applicators
51.0394a
2
48.19 Cone Part For Ring Applicators 51.0394a
2
48.20 Cohen Intra Uterin Probe With One Small
And One Large Cervical Cone
1
48.21 Spare Part Large Cervical Cone For
51.0425a
1
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
Spesifikasi alat
48.22 Spare Part Small Cervical Cone For
51.0425a
1
48.23 20l Insufflator
1
48.24
48.25
48.26
48.27
48.28
48.29
Accessories for Insufflator
High Pressure Tube 1m Us/Din
Silicone Tube No Gas Preheat.
Universal Wrench
Co2 Bottle
Co2-Filter Ster 25 Units
1
1
1
2
50
48.30 Axel Xenon Light Source 180w
1
48.31 Full Hd Lightcable Diam.4.8 Length:250cm
1
48.32 Falope Ring Band
100
48.33 Maryland Gsp.Forceps Fen.5/420mm Hf
Con.
1
48.34 Hand Switch For Adtec Bipolar
1
48.35 1 (One) Set Sterilization Tray Set
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
Jenis/UNIT
PELAYANAN
NO
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
NAMA ALAT
48.36 Disinfection System For Cleaning And
Disinfection Solutions, Consisting Of :
- Soak Basin Bottom Stainles Steel
- Perforated Storage Tray
- Cover For Basin Stainless Steel With
Slide
Kocher
Chirurgical pinset
gunting lurus
Air Viva
Jarum lumbal
Bed side monitor
Lemari obat kaca
Meja Suntik Beroda
Nidle holder
Tromol kasa
Spatel lidah
Pean lurus
Spekulum cocor bebek
Hak langen beck
Speculum Shim
Aligator
Mini Laparotomy set
65.1
Scalpel Handle #3
65.2
Tc Nelson-Metz Scissors Str230 mm
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
1
1
10
10
5
2
2
2
4
4
10
5
5
10
10
4
10
v
5
1
1
8
8
4
2
2
2
3
3
8
4
4
8
8
4
8
v
4
6
6
3
1
1
1
2
2
6
3
2
6
6
2
6
v
3
4
4
2
1
1
1
2
2
4
2
2
4
5
1
4
v
2
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
65.3
65.4
65.5
65.6
65.7
65.8
65.9
65.10
65.11
65.12
65.13
65.14
65.15
65.16
66
67
Tc Nelson-Metz Scissors Cvd 230 mm
Surgical Scissors Str S/B165 mm
Standard Forceps Serr 145 mm
Standard Forceps Serr 200 mm
Standard Tissue Forceps 1x2 145 mm
Foerster Sponge Fcps Serr Str 242 mm
Backhaus-Kocher Twl Clmpw/Scrw135 mm
Halsted-Mosquito Forceps Del Cvd125 mm
Rochester-Pean Forceps Str 185 mm
Rochester-Pean Forceps Cvd 185 mm
Kocher-Ochsner Forceps Str 1x2 160 mm
Tc De'bakey Ndl Holder Del Serr 180 mm
Volkmann Retr4-Prgsharp9x19 mm 222mm
Langenbeck Retractoropen 28x10 mm
209 mm
65.17 Langenbeck Retractor 40x13 mm 210 mm
65.18 Middeldorpf Retr Open 28x28 mm 235 mm
65.19 Bozemann-Douglas Fcpss-Cvdserr 260 mm
65.20 Schroeder Tenaculum Frcpstd 1x1250 mm
65.21 Basket Wide Perforation 406x253x56 mm
65.22 Bottom For 3/4 Container Height:135 mm
65.23 Primeline 3/4 Lid Blue
Laringoscope
Folding Endurance Tester
Spesifikasi alat
RS kls
A
JUMLAH
RS Kls
RS kls
B
C
RS kls
D
1
1
1
1
1
2
4
6
2
2
2
2
1
1
1
1
1
1
1
1
1
2
v
2
v
1
v
1
v
Jenis/UNIT
PELAYANAN
NO
NAMA ALAT
Spesifikasi alat
RS kls
A
10
4
4
2
2
JUMLAH
RS Kls
RS kls
B
C
8
6
3
2
3
2
2
1
2
1
RS kls
D
4
2
2
1
1
68
69
70
71
72
Fenster Klem
Kromatografi Gas
Oksigen meter
Tubing Slip
Bak bengkok
e. ICU Kebidanan
1
2
3
4
5
6
7
8
9
10
11
12
13
Pinset (Pisau Lobang)
Tensimeter
Lampu sorot
Suction pump
Cardiotocography Unit
Instrument trolley
Manometer
Electric bed matras
With T bar Handle
Lambotee Ostiot 24 cm
Halsted Maquito Forceps
Hoke Chisel 17cm
Screw Driver Hexaganol
4
2
2
2
2
2
2
4
2
2
2
2
2
4
2
2
2
2
2
2
4
2
2
2
2
2
-
-
f. IGD Kebidanan
1
2
3
4
5
Stetoscope
Timbangan Dewasa
Tabung O2
Bak Catheter
Lampu Sorot
4
2
2
2
2
3
2
2
2
2
2
1
1
2
1
2
1
1
2
1
Jenis/UNIT
PELAYANAN
NO
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
NAMA ALAT
Pisfot dewasa
Kursi Dorong
Standar infus
Electric Suction pump
Emergency trolley
meja periksa
Manometer
USG 2 Dimensi
Utility trolley
Gynecology examination
USG 4D
Timbangan bayi
Syringe pump
X-ray connect teraphy
Baby bath tube
Meja rontgen
Lemari obat kaca
Sterilisator
Branchard
Spesifikasi alat
RS kls
A
4
2
4
2
2
2
2
1
2
2
1
1
2
2
2
1
1
1
2
JUMLAH
RS Kls
RS kls
B
C
4
2
2
2
4
2
2
1
2
1
2
1
2
1
1
2
1
2
1
1
1
2
1
2
1
2
1
1
1
1
1
1
1
2
2
RS kls
D
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
2
3. PERALATAN KESEHATAN DI PELAYANAN PENYAKIT DALAM
NO
a.
UNIT PELAYANAN
Klinik ( Rawat Jalan )
NO
1
2
3
4
5
6
7
8
9
10
b.
Kamar Tindakan
1
2
3
4
5
6
7
8
9
10
11
NAMA ALAT
SPESIFIKASI ALAT
RS kls A
JUMLAH minimal
RS Kls B
RS kls C
RS kls D
Stetoscope
Tensimeter
Reflek Hammer
Film Viewer
Pen light
Tempat tidur periksa
Timbangan dan pengukur tinggi
badan
Termometer
resucitation crash cart
(Emergency trolley)
Defibrilator
6
6
6
6
6
6
3
3
3
3
3
3
2
2
2
2
2
2
1
1
1
1
1
1
6
3
2
1
6
3
2
1
1
1
1
1
1
1
1
1
Stetoscope
Tensimeter
Reflek Hammer
Film Viewer
Pen light
Tempat tidur periksa
Termometer
Resucitation crash cart
(Emergency trolley)
Defibrilator
Minor surgery set
Lever biopsi set (jarum biopsi
khusus)
4
2
1
2
1
3
2
2
2
1
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
1
2
1
tdk
tdk
NO
UNIT PELAYANAN
NO
12
13
14
NAMA ALAT
Set Aspirasi Sumsum Tulang
Belakang (jarum khusus)
Renal biopsi set (jarum
eklsplorasi, jarum biopsi USG
(tru cut needle)
Rectosigmoidoscopy
15
Colonoscopy
16
17
18
19
20
22
23
24
Suction pump
ECG
Oxygen set + Flowmeter
SB Tube
Spirometri
Anoskop Rigid (Logam atau
Plastik)
Syringe Pump
Trokar
Treadmill
25
Glukometer
26
Bronchoscopy
27
Pulse Oxymetry
21
SPESIFIKASI ALAT
Tube : Insertion-depth markers should be ≤10 cm
apart and accurate to within 1 cm, lapang
pandang > 100 derajat, kedalaman pandangan 575 mm, Tip Deflection Range Up/down 180,
right/left 150
Minimum sample volume <10 µL (preferred),
Measurement Range, 30 to 400 mg/dL,
Hematocrit Range 25 to 60 % (preferred)
Insertion-depth markers should be no more than
10 cm apart and accurate to within 1 cm, Field of
view >90 degrees, Tip Deflection Range Up 180,
down 130
Displays SpO2, pulse rate, pulse strength and/or
signal, low battery, Type LCD, LED, others, SpO2
Range 70-100 %, Accuracy 70-100 ±3 %, Pulse
Rate 30-240, Accuracy ±5
RS kls A
JUMLAH minimal
RS Kls B
RS kls C
RS kls D
2
1
tdk
tdk
2
1
tdk
tdk
2
1
1
1
2
1
tdk
tdk
2
2
2
1
2
1
1
1
1
1
1
1
1
tdk
tdk
1
1
1
tdk
tdk
2
1
1
1
2
2
1
1
1
1
1
1
tdk
1
1
tdk
2
1
1
1
2
1
tdk
tdk
2
1
1
1
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls A
JUMLAH minimal
RS Kls B
RS kls C
RS kls D
Alarms : Audible and visual (High/low SpO2 and
pulse rate,
sensor off, sensor failure, low battery)
Visual only (High/low SpO2 and pulse
rate, sensor
off, low battery)
Battery : Life, hr : 4 intrahospital, 8 interhospital
Rechargeable: Preferred; optional for
handhelds
Recharge time, hr : While on AC
c.
Rawat inap
28
29
30
31
32
33
34
35
Esofago-Gastroduodenoscopy
Nebulyzer
Autoclave
USG Abdomen
USG multi purpose
Echo cardiography
TEE
Bed side monitor
2
2
2
1
1
1
1
1
1
2
3
4
5
6
7
8
9
10
11
Stetoscope
Tensimeter
Reflek Hammer
Film Viewer
Pen light
Tempat tidur (3 kraeng)
Termometer
Emergency trolley
Defibrilator
tindakan Minor set
Suction pump
3
8
4
4
2
6
1
1
1
1
1
1
1
1
tdk
1
1
1
tdk
tdk
tdk
1
3
2
6
4
4
4
3
2
2
2
Sesuai standar RS selama ini
4
4
tdk
1
1
1
tdk
tdk
tdk
1
2
2
2
1
1
2
(resusitasi dan intubasi set)
2
2
4
1
1
4
1
1
3
1
1
2
NO
d.
UNIT PELAYANAN
Hemodialisa
NO
NAMA ALAT
12
13
14
15
16
17
18
19
20
21
22
ECG
Oxygen set + Flowmeter
Syringe Pump
Trokar
Glukometer
Pulse Oxymetry
Nebulyzer
Infusion pump
Matras Dekubitus
Timbangan utk pasien berbaring
bed side monitor
1
Hemodialisa Unit
2
3
4
5
6
7
Suction pump
Sterilisator
Tensimeter
Stethoscope
Water Furi Fication With RO
ETO Sterilizer
SPESIFIKASI ALAT
Temperature alarm limits >41 °C, Transmembrane
pressure Alarm if <0 mmHg, Ultrafiltration removal
rate Accuracy at ±10%, Blood pump range 50-600
mL/min, Disinfection Method Heat or chemical.
Dibutuhkan Blood-leak detector, Air/foam
detector, dan Conductivity. Arterial/venous
pressure : -200/+400 (arterial), -100/+400
(venous)
RS kls A
2
8
8
4
6
6
4
8
4
1
5
JUMLAH minimal
RS Kls B
RS kls C
2
2
6
4
6
4
3
3
4
2
4
4
3
2
6
4
4
2
1
tdk
4
3
RS kls D
1
2
2
2
1
2
1
2
1
tdk
2
10
-
-
2
2
2
2
1
1
-
-
4. PERALATAN KESEHATAN DI PELAYANAN BEDAH
JUMLAH MINIMAL
NO
a.
UNIT PELAYANAN
Klinik (Rawat Jalan)
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
RS kls
B
RS
kls C
RS kls
D
1
Stetoskop
√
√
√
√
2
Tensimeter Non Merkuri
√
√
√
√
3
Head Lamp
√
√
√
√
4
Examination lamp
√
√
√
√
5
Termometer
√
√
√
√
6
Reflex hammer
√
√
√
√
7
Film Viewer 2 slides
√
√
√
√
8
Alat pembuka gips (manual dan elektric)
√
√
√
√
9
Minor Surgery Set
√
√
√
√
9,1
Scalpel Handle #3
2
9,2
Surgical Scissors Str S/B 145 mm
2
9,3
Mayo Scissors Str 140 mm
2
9,4
Mayo Scissors Cvd 140 mm
2
9,5
Metzenbaum Scissors Cvd 180 mm
2
9,6
Tissue Forceps Serr 145 mm
2
9,7
Standard Forceps Serr 145 mm
2
9,8
Standard Forceps Serr 180 mm
2
9,9
Standard Tissue Forceps 1x2 145 mm
2
9.10
Standard Tissue Forceps 1x2 180 mm
2
9.11
Foerster-Ballengr Spng Fcpserstr180 mm
2
9.12
Backhaus Towel Clamp 90 mm
4
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
10
NAMA ALAT
SPESIFIKASI ALAT
9.13
Halsted-Mosquito Forceps Delstr 125 mm
4
9.14
Crile Forceps Cvd 140 mm
2
9.15
Spencer-Wells Forceps Str130 mm
6
9.16
Kocher-Ochsner Forceps Str 1x2 160 mm
2
9.17
Kocher-Ochsner Forceps Str 1x2 185 mm
2
9.18
Crile-Wood Ndlhldrfine-Serr 150 mm
1
9.19
Crile-Wood Needle Holderhvy-Serr160 mm
1
9.20
Director W/Tongue Str 145 mm
2
9.21
Myrtle-Leaf Probe 2.0mm 145 mm
2
9.22
Senn-Miller Rector.Sh.8x7/18x5.5 mm
2
9.23
Farabeuf Rtrctrs25x10/32x12-22x10/28x12
2
9.24
Bose Tracheal Lft-Hook 165 mm
2
9.25
Langenbeck Retractoropen 28x10 mm 209 mm
2
9.26
Allis Forceps 4x5 155 mm
2
9.27
Volkmann Bone Curette #00002.8 mm 172 mm
1
9.28
Sterilit Oil Spray 300 ml
1
9.29
Basket Wide Perforation 485x253x56 mm
1
9.30
Bottom For 1/1 Container Height:135 mm
1
9.31
Primeline 1/1 Lid Blue
Hecting set
1
10.1
Spencer Suture Scissors 90mm
1
10.2
Standard Forceps Serr 145mm
1
10.3
Standard Tissue Forceps 1x2 145mm
1
10.4
Maier Forceps W/Rcht Str 265mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
√
√
JUMLAH MINIMAL
NO
b.
UNIT PELAYANAN
Kamar Tindakan
NO
NAMA ALAT
SPESIFIKASI ALAT
10.5
Sut.Needle #G12 Triang.Point Spr.Eye
1
10.6
Interior Box F/Bl930
1
10.7
Mathieu Ndl Hldrgrip/Rcht Serr170mm
1
11
10.8
Sterilit Oil Spray 300ml
Lokal Anestesi Set
12
Electrocauter
HF Combi Unit 300W Monop.80W.Bipolar
1
12.2
Mains Cord 5m Long
1
12.3
Vario Dual Foot Switch 4m Cable
1
12.4
Silicon Neutral Elect.Large 310X160 mm
1
12.5
Silicon Rubber Band W/4 Buttons 1.5 m
1
12.6
Cable F.Silicon Neutral Electrode 3.5 m
1
12.7
HF-Handle LG.2 Button 4mm Koax Plug
1
12.8
Electrode Cable 3.5m LG.F.GN 207 209
1
12.9
Electrode Set W/SHAFT D:4.0 mm
1
12.10
Bipol.Diss.FCPS Part Insul.ANG.160 mm
1
12.11
Two-Pole Coagulation Cable F/GN060 3.5
1
12.12
Bipolar Dissection Scissors 230 mm
1
12.13
Bipolar Cable AAG/AAG Hexagonal
1
12.14
Wire Brush F/ Clean Coag FCPS & Electrodes
1
12.15 Sterilit Oil Spray 300 ml
Suction Pump
1
Stetoskop
RS kls
B
RS
kls C
RS kls
D
√
√
√
√
√
√
-
-
√
√
√
√
√
√
√
√
1
12.1
13
RS kls
A
1
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
RS kls
B
RS
kls C
RS kls
D
2
Tensimeter Non Merkuri
√
√
√
√
3
Examination Table
√
√
√
√
4
Examination lamp
√
√
√
√
5
Minor Surgery Set
√
√
√
√
6
Circumsisi set
√
√
√
√
7
Electrocauter
√
√
√
√
8
Emergency Set
√
√
√
√
8.1
1/2-Size Wire Basket 50 mm
8.2
Laboratory Dish 0.063 L
8.3
Laboratory Dish 0.16 L
8.4
Foerster-Ballengr Spng Fcp Ser Str180 mm
8.5
Standard Forceps Serr 160 mm
8.6
Standard Tissue Forceps 1X2 160 mm
8.7
Mayo Scissors Str 140 mm
8.8
Mayo Scissors CVD 140 mm
8.9
Kelly Forceps Del CVD 140 mm
8.10
Halsted-Mosquito Forceps Del STR125 mm
8.11
Halsted-Mosquito Forceps Del CVD125 mm
8.12
Allis Forceps 5X6 155 mm
8.13
Lister Sinus Forceps 160 mm
8.14
Mayo-Hegar Needle Holder 150 mm
8.15
Mayo-Hegar Needle Holder 185 mm
8.16
Sterilit Oil Spray 300 ml
8.17
1/2 Basket W/O Stack.Feet 243X253X24 mm
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
8.18
c.
Ruang persiapan
(sblm OP)
d.
Kamar Bedah
SPESIFIKASI ALAT
RS kls
A
RS kls
B
RS
kls C
RS kls
D
Bottom For 1/2 Container Height : 57 mm
9
8.19 Basis 1/2 Inner Cover F.Cont.75 mm Silver
Sterilisator kering
√
√
√
√
1
Stetoskop
√
√
√
√
2
Tensimeter Non Merkuri
√
√
√
√
3
Bed Side Monitor
√
√
√
√
4
Film Viewer 2 slides
√
√
√
√
5
Suction pump
√
√
√
√
6
Oxygen Saturatie
√
√
√
√
1
2
3
11
4
5
6
7
8
9
10
12
13
Operating Table
Mayo table
Operating Lamp Ceiling Type
Examination lamp
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
-
-
ETT, LMA, Nasotracheal, dewasa dan pediatric
Laringoscope set (dewasa dan pediatric)
Fiber Optic
Mesin Anesthesi
Defibrilator
Ventilator Anesthesi
Electro Surgery Unit (ESU)
Autoklaf
Major Surgery Instrument Set utk kepala (Dewasa dan
pediatric)
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
13.1
13.2
13.3
13.4
13.5
13.6
13.7
13.8
Scalpel Handle #3
Scalpel Handle #4
Mayo Scissors Str 170 mm
Mayo Scissors CVD 170 mm
Metzenbaum Scissors CVD 180 mm
Schmieden-Taylor Dura Scissors 155 mm
Adson Forceps Serr 120 mm
Cushing Del Str Forceps 180 mm
1
1
1
1
1
1
2
1
13.9
13.10
Adson tissue fcps fine W/1X2T 120 mm
Tissue Forceps Str 1X2 145 mm
2
1
13.11
Waugh Del.Tissue Forceps 1X2 180 mm
1
13.12
Adson Forceps Bay.Shaped 175 mm
1
13.13
Foerster Sponge Fcps Serr STR 242 mm
1
13.14
Backhaus Towel Clamp 110 mm
8
13.15
Hartmann Mosquito Fcsdel Str 100 mm
8
13.16
Hartmann Mosquito Fcps Del CVD100 mm
8
13.17
Dandy Delicate Forceps CVD140 mm
12
13.18
TC De'bakey Needle Holder Del Serr165 mm
1
13.19
TC Mayo-Hegar Ndl Holder Hvy Serr185 mm
1
13.20
Adson Nerve Hook Sharp
1
13.21
Adson Nerve Hook Blunt
1
13.22
Volkmann Retr 4-Prgsharp 9X19 mm 222 mm
2
13.23
Abdominal Bld.Retractor Maleab.12X200 mm
1
13.24
Weitlaner Retractor 3X4T.BL.165 mm
2
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
13.25
Mollison Retractor Sharp155 mm
1
13.26
1
13.28
Scalpfix Applying Forceps Plastic
Scalpfix Sterile (20 catridge / box @10 pcs scalp
clips)
Removing Forceps For Scalpfix
13.29
Raney Scalp Hemost.Clip Pack Of 25 Pcs.
3
13.30
Raney Apply/Removing Fcps F/FF 002 FF 015 P
3
13.31
Scalp Hemostasis Clip (Self-applying clip @10 pcs)
2
13.32
Yasargil Spring-HK F/Galea Fixation Lrg
3
13.33
Safety Forceps F.Bore Holes
1
13.34
Hudson Drill Brace F/FF 055 R
1
13.35
Hudson Cerebellar Attachment F/FF 055 R
1
13.36
Hudson Burr 9 mm Dia
1
13.37
Hudson Burr 14 mm Dia
1
13.38
Hudson Spherical Burr 16 mm Dia
1
13.39
Hudson Spherical Burr 22 mm Dia
1
13.40
Adson Perforating Burr 15 mm Dia
1
13.41
Mckenzie Twist Drill 13 mm Dia
1
13.42
Cushing Flat Drill 14 mm Dia
1
13.43
Twist Drill 2 mm Dia
1
13.44
Demartel Conductor F/Gigli Saw Flexible 350 mm
2
13.45
Brain Spatula Flat Mall 7&9 mm 178 mm
2
13.46
Brain Spatula Flat Mall 11&13 mm 178 mm
2
13.47
Brain Spatula Flat Mall15 &18 mm 178 mm
2
13.27
5
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
13.48
#1 Penfield Dissector 178 mm
1
13.49
#2 Penfield Dissector 197 mm
1
13.50
#3 Penfield Dissector 197 mm
1
13.51
#4 Penfield Dissector 203 mm
1
13.52
#5 Penfield Dissector 292 mm
1
13.53
Frazier Dura Retractor 130 mm
2
13.54
Yasargil Dissector F/Adult Flex 7 mm
1
13.55
Ventricular Cannula Cushing
1
13.56
Davis Vascular Spatula 245 mm
1
13.57
Rongeur Chushing Ang.Up 3X140 mm
1
13.58
Love-Gruenwald Rongeur Str 3X10 mm135 mm
1
13.59
Gigli Wire Saw Fine6-Wires 400 mm
3
13.60
Hook Handle F/Wire Saws (need to order 2 pcs)
2
13.61
Quervain Elevator 6/195 mm
2
13.62
Raspatory Adson CVD 5 mm
1
13.63
Lambotte Rib Raspatory 5 mm 216 mm
1
13.64
Lambotte Rib Raspatory 10 mm 215 mm
1
13.65
Lambotte Rib Raspatory 15 mm 216 mm
1
13.66
Volkmann Bone Curette #0003.6 mm 172 mm
1
13.67
Kerrison Blk Coated 130 UP 180X2 mm Reg
1
13.68
Kerrison Blk Coated 130 Up 180X3 mm Reg
1
13.69
Kerrison Blk Coated 130 Up 180X4 mm Reg
1
13.70
Jansen Bone Rongeur Str 175 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
13.71
Luer Bone Rongeur Str Oval-Cup180 mm
1
13.72
Frykholm Bone Rongeur 240 mm
1
13.73
Leksell-Stille Bone Rongeur 240 mm
1
13.74
Suction Tube Tapered Teardrop 6FR 205 mm
1
13.75
Suction Tube Tapered Teardrop 8FR 205 mm
1
13.76
Suction Tube Tapered Teardrop 12FR 205 mm
1
13.77
Freer Elevator S/B185 mm
1
13.78
Laboratory Dish 0.16 L
1
13.79
Laboratory Dish 0.4 L
1
13.80
Kidney Tray Stainless Steel 250 mm
1
13.81
1/1 Size Perf Basket 540X253X76 mm
2
13.82
Bottom For 1/1 Container Height:187 mm
1
13.83
Primeline 1/1 Lid Red
1
BOR :
1
2
3
4
Main Console
Microspeed Uni Control Unit W/Cool.Unit
Microspeed Uni Foot Control Two Pedals
Microspeed Uni Motor Cable F/Foot Ctrl.
Mains Cord 5 m Long
1
1
1
1
5
6
7
Irrigation / Tubing Set + Maintenance Oil
Disposable Tube Set F/Micro Motors Ster.
Hi-Line Xs Disp.Spray Nozzle I
Hi-Line Xs Disp.Spray Nozzle I
1
2
2
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
8
9
Hi-Line Xs Disp.Spray Nozzle I
Sterilit Power Systems Oil Spray 300ML
2
2
10
11
12
13
Perforator System
Microspeed Uni Perforator Driver
Cranial Perforator 6/9 mm Hudson Shank
Cranial Perforator 9/12 mm Hudson Shank
Cranial Perforator 12/15 mm Hudson Shank
1
1
1
1
14
15
16
17
18
19
20
21
Craniotome Cutter
Microspeed Uni HI 100 Motor
Hi-Line XS Craniotome Handpiece
Hi-Line XS Fixed Duraguard I
Hi-Line XS Craniotome Cutter I
Hi-Line XS Fixed Duraguard II
Hi-Line XS Craniotome Cutter II
Hi-Line XS Fixed Duraguard III
Hi-Line XS Craniotome Cutter III
1
1
1
3
1
5
1
3
22
23
24
25
26
27
28
29
Saw System
Microspeed Uni Micro 150 Motor
Micro-Line Sagittal Saw Pencil-Shaped
Saw Blade F/GD307 10/13/0.3/0.3 mm
Saw Blade F/GD307 9/13/0.3/0.3 mm
Saw Blade F/GD307 15/5/0.3/0.3 mm
Saw Blade F/GD307 20/5/0.3/0.3 mm
Saw Blade F/GD307 20/12/0.3/0.3 mm
Saw Blade F/GD307 20/16/0.3/0.3 mm
1
1
1
1
1
1
1
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
30
31
14
Saw Blade F/GD307 25/5/0.3/0.3 mm
Saw Blade F/GD307 25/12/0.3/0.3 mm
ECCOS and Trolley
32
Eccos Set F/Microspeed Uni Neurosurgery
33
Eccos Fixation F/GB109/GB110 Etc.
34
Eccos Fixation F/GB 300R-GB308R
35
1/1 Size Perf Basket 485X253X76 mm
36
Primeline 1/1 Lid Blue
37
Bottom For 1/1 Container Height:187mm
38
Mobile stand height-adj.F/Microspeed Uni
Major Surgery Instrument Set utk leher (Dewasa dan
pediatric)
14.1
Maier Forceps W/Rcht CVD 265 mm
14.2
Backhaus Towel Clamp 110 mm
14.3
Towel Clamp For Paper Cloths 115 mm
14.4
scalpel handle #4
14.5
scalpel handle #3
14.6
TC Metzenbaum Scissors Del CVD 180 mm
14.7
TC Metzenbaum Scissors CVD 200 mm
14.8
TC Suture Wavecut Scissors CVD 180 mm
14.9
TC Mayo-Lexer Scissors CVD 165 mm
SPESIFIKASI ALAT
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
-
-
1
1
1
1
3
1
1
1
1
2
6
4
1
1
1
1
1
1
14.10
Surgical Scissors Str S/B145 mm
1
14.11
Tissue Forceps Serr 145 mm
1
14.12
Tissue Forceps Str 1X2 145 mm
2
14.13
Dissect.Forceps Med.Wide 1X2T.180 mm
2
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
14.14
DE'bakey Atr.Fcps 2.0 mm Str 150 mm
2
14.15
Halsted-Mosquito Forceps Del CVD125 mm
4
14.16
Halsted-Mosquito Fcps Del CVD 1X2125 mm
4
14.17
Kocher Forceps Str 1X2 140 mm
2
14.18
Kocher-Ochsner Forceps Str 1X2 200 mm
2
14.19
Baby-Mixter Forceps Heavy-CVD180 mm
2
14.20
Overholt Forceps # 1 CVD 209 mm
2
14.21
Overholt Forceps # 2 CVD 220 mm
2
14.22
Braun Forceps 4X4 155 mm
2
14.23
Babcock Atr.Forceps 160 mm
2
14.24
Allis Atr.Forceps 7.0 mm 200 mm
2
14.25
Deschamps Needle F/RT-Handblunt 210 mm
1
14.26
Deschamps Ndl F/RT-Hndbl Tlng-Hk 215 mm
1
14.27
Payr Hollow Guide Probe 5.0 mm CVD. 225 mm
1
14.28
TC Crile-Wood Ndl Hldr Str Serr 145 mm
1
14.29
TC Mayo-Hegar Ndl Holder Hvy Serr 205 mm
2
14.30
TC De'bakey Ndl Holder Del Serr 180 mm
1
14.31
Volkmann Retr 4-Prg Semi-S 8.5X19222 mm
2
14.32
Roux Retractor 3/Set 165 mm
1
14.33
Kocher Retractor 36X20 mm
2
14.34
Goiter Retractor
1
14.35
Interior Box F/BL930
1
14.36
Needle Case W/7 Sections 150X90X10 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
15
NAMA ALAT
SPESIFIKASI ALAT
14.37
Laboratory Dish 0.16 L
1
14.38
Laboratory Dish 0.4 L
1
14.39
Kidney Tray Stainless Steel 250 MM
1
14.40
Redon Spike Ch.10 Slig.CVD.Triang.Tip
1
14.41
Redon Spike Ch.12 Slig.CVD.Triang.Tip
1
14.42
Kocher Forceps Str 1X2 140 mm
1
14.43
Payr Hollow Guide Probe 5.0 mm CVD.195 mm
1
14.44
Deschamps Needle F/RT-Handblunt 210 MM
1
14.45
Sterilit Oil Spray 300 ml
1
14.46
Basket Wide Perforation 485X253X76 mm
1
14.47
Bottom For 1/1 Container Height:135 mm
1
14.48 Primeline 1/1 Lid Blue
Major Surgery Instrument Set utk thorak dan cardiac Dewasa
1
15.1
Maier Forceps W/Rcht CVD 265 mm
2
15.2
Backhaus Towel Clamp 110 mm
12
15.3
Towel Clamp For Paper Cloths 115 mm
8
15.4
Scalpel Handle #4
2
15.5
Scalpel Handle #3
1
15.6
Scalpel Handel #3L
1
15.7
TC Metzenbaum Scissors Del CVD 180 mm
1
15.8
TC Metzenbaum Scissors CVD 200 mm
1
15.9
TC Nelson-Metz Scissors CVD 230 mm
1
15.10
TC Metzenbaum Scissors Del CVD 230 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
+/-
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
15.11
TC Suture Wavecut Scissors CVD 180 mm
1
15.12
TC Mayo-Lexer Scissors CVD 165 mm
1
15.13
Abdominal Scissors Str B/B180 mm
1
15.14
Surgical Scissors STR S/B 145 mm
1
15.15
Tissue Forceps Serr 145 mm
1
15.16
Tissue Forceps Str 1X2 145 mm
2
15.17
Standard Tissue Forceps 1X2 145 mm
2
15.18
Dissect.Forceps Med.Wide 1X2T.200 mm
2
15.19
Tissue Forceps 1X2 Teeth 250 mm Med.
2
15.20
DE'Bakey Atr.Fcps 2.0 mm STR150 mm
2
15.21
DE'Bakey Atr.Fcps 2.0 mm STR 200 mm
2
15.22
DE'Bakey Atr.Fcps 2.0 mm STR 240 mm
2
15.23
DE'Bakey Atr.Fcps 2.8 mm STR 240 mm
2
15.24
Kocher Forceps Str 1X2 140 mm
6
15.25
Halsted-Mosquito Forceps Del Str125 mm
4
15.26
Halsted-Mosquito Forceps Del CVD125 mm
10
15.27
Crile Forceps CVD 160 mm
6
15.28
Heiss Delicate Forceps Str 200 mm
2
15.29
Sarot Delicate Forceps Str 1 X 2240 mm
2
15.30
Kocher-Ochsner Forceps Str 1X 2260 mm
2
15.31
Maier Forceps W/Rcht Str 265 mm
2
15.32
Mikulicz Peritoneum Forceps CVD.205 mm
4
15.33
Overholt-Geiss Suture Fcps #3 CVD 229 mm
2
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
15.34
Overholt-Geiss Suture Fcps #6 CVD 229 mm
2
15.35
Gemini Clamp Rt-Ang 180 mm
1
15.36
Gemini Clamp Rt-Ang 200 mm
1
15.37
Gemini Clamp Rt-Ang 230 mm
1
15.38
Rumel Suture Forceps Rt-Ang # 5 240 mm
1
15.39
Zenker Suture Forceps SLT- CVD 300 mm
1
15.40
Guyon Atr.Kidney Clamp 230 mm
1
15.41
1
15.42
DE’Bakey Aorta Aneurysm Clmp CVD 95/250 mm
DE’Bakey Aorta Aneurysm Clmp CVD 130/315
mm
15.43
DE'BAKEY CLAMP 60DG 65/100MM 280MM
1
15.44
DE'Bakey Tangential Clmp 1.38 mm-WD 220 mm
1
15.45
DE’Bakey Tangental Clmp 2.48 mm-Wide 265 mm
1
15.46
DE'Bakey Tangental Clmp 54/99/270 mm
1
15.47
DE’Bakey Aorta Anrysm Clmp Hvy-CVD 255 mm
1
15.48
DE'Bakey Aorta Aneurysm Clmp CVD 75/265 mm
1
15.49
Leland-Jones Peripheral Clmp 30 DG 190 mm
1
15.50
De'bakey Atr.Coarct.Clang 15 DG 80/240 mm
1
15.51
Glover Atr.Clamp CVD 215 mm
1
15.52
Allis Atr.Forceps 7.0 mm 200 mm
2
15.53
Collin Atr.Forceps 195 mm
1
15.54
TC Crile-Wood Ndl Hldr Str Serr 145 mm
1
15.55
TC De'bakey Ndl Holder Del Serr 180 mm
1
15.56
TC DE'bakey Ndl Holder Del Serr 250 mm
1
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
15.57
TC Mayo-Hegar Ndl Holder Hvy Serr 205 mm
2
15.58
Durogrip Needleholder F.Sternum-Suture
1
15.59
Reill Cutter F/Wire Close Bone 2/1.6 mm
1
15.60
Kocher Retr 4-Prg Semi-S 16X20222 mm
2
15.61
Roux Retractor 19X22 mm/23X30 mm 145 mm
2
15.62
Langenbeck Retractor 40X10 mm
2
15.63
Kocher Retractor 36X20 mm
2
15.64
Zenker Retractor 60X12 mm 253 mm
2
15.65
Zenker Retractor 75X12 mm 273 mm
2
15.66
Deaver Retractor Fig 3 38 mm 305 mm
1
15.67
Ribbon Retractor Mall 330X50 mm
1
15.68
Ami Sternum Retractor Complet
1
15.69
Cushing Vess.Hook BL. 90° 6/280 mm
1
15.70
Cushing Saddle Hook 22X15 mm 250 mm
1
15.71
Guide F/FB 651 R
1
15.72
Guide Only 6.4 mm F/FB 651 R
1
15.73
Tube Clamp Fluted Mouth 200 mm
6
15.74
De'bakey Suction Cannula D: 3.0 mm 275 mm
1
15.75
Interior Box F/BL 930
1
15.76
Needle Case W/7 Sections 150X90X10 mm
1
15.77
Laboratory Dish 0.16 L
1
15.78
Laboratory Dish 0.4 L
1
15.79
Kidney Tray Stainless Steel 250 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
16
NAMA ALAT
SPESIFIKASI ALAT
15.80
Steel Ruler 300 mm
1
15.81
Redon Spike Ch.12 Strong CVD.Knife Tip
1
15.82
Redon Spike Ch.14 Strong CVD.Knife Tip
1
15.83
Redon Spike Ch.16 Strong CVD.Knife Tip
1
15.84
Sterilit Oil Spray 300 ML
1
15.85
Basket Wide Perforat.485X253X106 mm
1
15.86
Bottom For 1/1 Container Height:135 mm
1
15.87 Primeline 1/1 Lid Blue
Major Surgery Instrument Set utk thorak dan cardiac Baby
1
16.1
16.2
16.3
16.4
16.5
16.6
16.7
16.8
16.9
Maier Forceps W/Rcht CVD 265 mm
Backhaus Towel Clamp 110 mm
Towel Clamp For Paper Cloths 115 mm
Scalpel Handle #4
Scalpel Handle #3
Scalpel Handle RND 155 mm
TC Strabismus Scissors CVD 115 mm
TC Baby-Metz Scissors Del CVD B/B 145 mm
Jameson Tenotomy Sciss Del CVD B/B 150 mm
2
8
6
1
2
1
1
1
1
16.10
Dietrich Vessel Scissors 45DG 180 mm
1
16.11
TC Metzenbaum Scissors Del CVD 180 mm
1
16.12
TC Suture Wavecut Scissors CVD 145 mm
1
16.13
TC Mayo-Lexer Scissors CVD 165 mm
1
16.14
Abdominal Scissors Str B/B180 mm
1
16.15
Surgical Scissors Str S/B145 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
+/-
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
16.16
Tissue Forceps Serr 145 mm
1
16.17
Tissue Forceps Str 1X2 145 mm
2
16.18
DE'Bakey Atr.Fcps 1.5 mm STR150 mm
2
16.19
Micro-Adson Tissue Forceps 1X2 120 mm
2
16.20
Micro-Adson Forceps Serr 120 mm
2
16.21
Gerald Tissue Fcps Str 1X2 175 mm
2
16.22
Gerald Forceps Del Str 175 mm
2
16.23
Micro-Halsted Forceps Del Str125 mm
4
16.24
Micro-Halsted Forceps Del CVD 125 mm
10
16.25
Kocher Forceps Str 1X2 140 mm
2
16.26
Sponge Forceps W/Ratchet CVD.175 mm
2
16.27
Mikulicz Peritoneum Forceps CVD.140 mm
4
16.28
Micro-Adson Suture Forceps CVD 140 mm
1
16.29
Baby-Mixter Forceps CVD 140 mm
1
16.30
Baby-Mixter Forceps Heavy-CVD180 Mm
2
16.31
Gemini Clamp RT-Ang130 mm
1
16.32
Gemini Clamp RT-Ang 180 mm
1
16.33
Cooley Bulldog Clmp Ring-HDL CVD115 mm
1
16.34
Cooley Bulldog Clamp Ring-HDL15DG125 mm
2
16.35
Cooley Bulldog Clmp Ring-HDL 40DG120 mm
2
16.36
Cooley Bulldog Ring-HDL S-CVD120 mm
1
16.37
Cooley Bulldog Ring-Hdl Dbl-CVD 115 mm
1
16.38
Cooley-Beck Pedi Clmp Hvy-CVD 25 mm150 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
16.39
Derra-Cooley Clamp 21 mm 175 mm
1
16.40
Cooley Patent-Ductus Clamp Ang.52/180 mm
1
16.41
Cooley Patnt-Dctus Clmp 60 DG 52 mm170 mm
1
16.42
Cooley Pediatric Clamp 74 mm 185mm
1
16.43
Cooley Atr.Clamp31 mm Jaw 200 mm
1
16.44
Allis Atr.Forceps 6.2 mm 155 mm
2
16.45
TC Ryder Needle Holder Smooth 147 mm
1
16.46
TC DE'Bakey Needle Holder Del Serr165 mm
1
16.47
TC Baby-Crile-Wood Ndl Hldr Serr 150mm
1
16.48
TC Mayo-Hegar Ndl Holder Hvy Serr185 mm
2
16.49
TC Wire Twister SQ-Tip 150. mm
1
16.50
Reill Cutter F/Wire Close Bone 2/1.6 mm
1
16.51
Hook 4-Prong Sharp Sm-CVD 165 mm
2
16.52
Cushing Vein Retractor 10X13 mm 203 mm
2
16.53
Langenbeck Retractor Open 28X10 mm 209 mm
2
16.54
Langenbeck Retractor 40X10 mm
2
16.55
Zenker Retractor 36X8 mm 242 mm
2
16.56
Abdominal Bld.Retractor Maleab.12X200 mm
1
16.57
Abdominal Bld.Retractor Maleab.17X200 mm
1
16.58
Desmarres Retractor 9X12 mm 140 mm
1
16.59
Desmarres Retractor 11X14 mm 140 mm
1
16.60
Langenbeck Green Retractor 16 X6 mm 159 mm
2
16.61
Sm Diss.Wnd Hook/Retractor 235 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
16.62
Struck Infant Rib Spreader Complete
1
16.63
Struck Blades F/FB 853R 10X10 mm
1
16.64
Struck Blades F/FB 853 R 10X15 mm
1
16.65
Struck Blades F/FB 853 R 10X20 mm
1
16.66
Hertzler Abdominal Retractor 20X25 mm
1
16.67
Cushing Vess.Hook BL.90°4/190 mm
1
16.68
Cushing Vess.Hook BL.90°6/190 mm
1
16.69
Desmarres Retractor 9X9mm140 mm
1
16.70
Graefe Nerve/Vessel Hook Med 140 mm
1
16.71
guide F/FB651R
1
16.72
Tubing Clamp X-Hvy Serr 165 mm
6
16.73
DE'Bakey Suction Cannula 5 mm/9 mm 160 mm
1
16.74
Interior Box F/BL930
1
16.75
Needle Case W/7 Sections 150X90X10 mm
1
16.76
Laboratory Dish 0.16 L
1
16.77
Laboratory Dish 0.4 L
1
16.78
Kidney Tray Stainless Steel 250 mm
1
16.79
Steel Ruler 300 mm
1
16.80
Redon Spike Ch.8 Strong CVD.Knife Tip
1
16.81
Redon Spike Ch.10 Strong CVD.Knife Tip
1
16.82
Redon Spike Ch.12 Strong CVD.Knife Tip
1
16.83
Sterilit Oil Spray 300 ml
1
16.84
Basket Wide Perforat.485X253X106 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
16.85
17
SPESIFIKASI ALAT
Bottom For 1/1 Container Height: 135 mm
1
16.86 Primeline 1/1 Lid Blue
Major Surgery Instrument Set utk abdomen Dewasa
1
17.1
17.2
17.3
17.4
17.5
17.6
17.7
17.8
17.9
Maier Forceps W/Rcht CVD 265 mm
Backhaus Towel Clamp 110 mm
Towel Clamp For Paper Cloths 115 mm
Scalpel Handle #4 L
Scalpel Handel #3 L
TC Metzenbaum Scissors CVD 200 mm
TC Nelson-Metz Scissors CVD 230 mm
TC Suture Wavecut Scissors CVD 180 mm
TC Mayo-Lexer Scissors CVD 165 mm
2
4
4
2
1
1
1
1
1
17.10
TC Sims Uterine Sciss CVD B/B 200 mm
1
17.11
TC Wertheim Scissors CVD 230 mm
1
17.12
Surgical Scissors Str S/B145 mm
1
17.13
Tissue Forceps Serr 145 mm
1
17.14
Tissue Forceps Str 1X2 145 mm
2
17.15
Standard Tissue Forceps 1X2 200 mm
2
17.16
Standard Tissue Forceps 1X2 250 mm
2
17.17
DE'Bakey Atr.Fcps 2.0 mm STR150 mm
2
17.18
DE'Bakey Atr.Fcps 2.0 mm STR 200 mm
2
17.19
DE'Bakey Atr.Fcps 2.0 mm STR 240 mm
2
17.20
Gerald Tissue Fcps Str 1X2 175 mm
1
17.21
Rochester-Ochsner Fcps Str 1X2140 mm
6
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
17.22
Pean Forceps Str 140 mm
6
17.23
Kocher-Ochsner Forceps Str 1X2 200 mm
4
17.24
Kocher-Ochsner Forceps Str 1X2240 mm
2
17.25
Wertheim Hysterectomy Forceps CVD.235 mm
4
17.26
Mikulicz Peritoneum Forceps CVD.205 mm
6
17.27
Maier Forceps W/Rcht Str 265 mm
4
17.28
Schroeder Tenaculum Frcp Std 1X1250 mm
2
17.29
Schroeder Tenaculum Fcps Str 3X3 270 mm
1
17.30
Foerster Sponge Fcps Serr Str 242 mm
1
17.31
Overholt-Geiss Suture Fcps #2 CVD 210 mm
2
17.32
Overholt-Geiss Suture Fcps #3 CVD 229 mm
2
17.33
Deschamps Ndl F/RT- Hnd Blt Lng-HK215 mm
1
17.34
Koenig Guide Probe 4.5 mm 195 mm
1
17.35
TC Crile-Wood Ndl Hldr Str Serr 145 mm
1
17.36
TC Mayo-Hegar Ndl Holder Hvy Serr 205 mm
1
17.37
TC Hegar Needle Holder Hvy-Serr 205 mm
1
17.38
TC Hegar Needle Holder Hvy- Serr 245 mm
1
17.39
Roux Retractor 3/Set 165 mm
1
17.40
Volkmann Retr 4-Prg Semi-S 8.5X19222 mm
2
17.41
Kocher Retractor Open 80X60 mm 253 mm
1
17.42
Tuebinger Vaginal Retr 95X20 mm 267 mm
1
17.43
Fritsch Retractor #4 Open 46X75 mm 242 mm
2
17.44
Mikulicz Abdominal Retractor 121X50 mm
2
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
18
NAMA ALAT
SPESIFIKASI ALAT
17.45
Haberer Ribbon Retractor 50/40 mm 305 mm
1
17.46
Double-Ended Probe 2.0 mm 300 mm
1
17.47
Interior Box F/BL 930
1
17.48
Needle Case W/7 Sections 150X90X10 mm
1
17.49
Laboratory Dish 0.16 L
1
17.50
Laboratory Dish 0.4 L
1
17.51
Kidney Tray Stainless Steel 250 mm
1
17.52
Redon Spike Ch.12 Slig.CVD.Triang.Tip
1
17.53
Redon Spike Ch.14 Slig. CVD.Triang.Tip
1
17.54
Sterilit Oil Spray 300 ml
1
17.55
Basket Wide Perforation 485X253X76 mm
1
17.56
Bottom For 1/1 Container Height :135 mm
1
17.57 Primeline 1/1 Lid Blue
Major Surgery Instrument Set utk abdomen pediatric
1
18.1
18.2
18.3
18.4
18.5
18.6
18.7
18.8
18.9
scalpel handle #3
Scalpel Handel #3L
La Grange Scissors Serr 110 mm
TC Metzenbaum Scissors CVD 145 mm
TC Metzenbaum Scissors Del CVD 180 mm
Mayo Scissors Str 140 mm
Mayo Scissors CVD 140 mm
Standard Forceps Serr 160 mm
Semken Forceps Del 150 mm
1
1
2
1
1
1
1
1
2
18.10
Micro-Adson Forceps Serr 120 mm
2
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
18.11
Micro-Adson Tissue Forceps 1X2 120 mm
2
18.12
Standard Tissue Forceps 1X2 145 mm
1
18.13
Semken Del.Tissue Forceps 1X2150 mm
2
18.14
Foerster-Ballengr Spng Fcp Ser Str180 mm
4
18.15
Backhaus Towel Clamp 135 mm
8
18.16
Halsted-Mosquito Forceps Del CVD125 mm
12
18.17
Baby Crile Forceps Del Str 140 mm
4
18.18
Kocher Forceps Del CVD 1X2140 mm
6
18.19
Pean Forceps Str 140 mm
4
18.20
Kocher Forceps Str 1X2 140 mm
4
18.21
Crile-Wood Ndl Hldr Fine-Serr 150 mm
1
18.22
Mayo-Hegar Needle Holder 150 mm
2
18.23
Senn-Miller Rector.SH. 8X7/18X5.5 mm
1
18.24
US-Army Retrac. 26X15/43X15-23X15/40X15
1
18.25
Richardson Retractor Open 47X21 mm 242 mm
2
18.26
Deaver Retractor Fig 000 19 mm 178 mm
2
18.27
Ribbon Retractor Mall 330X30 mm
1
18.28
Collin Abdominal Retractor Bsc.CPL.
1
18.29
Balfour Abdominal Retractor 155X200 mm
1
18.30
Baby-Allis Forceps 4X5 130 mm
4
18.31
Babcock Tissue Forceps 215 mm
2
18.32
Hartmann Atr.Forceps CVD 200 mm
4
18.33
Pool Suction Cannula Charr.21
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
19
NAMA ALAT
SPESIFIKASI ALAT
18.34
Frazier Suctluer-Hub15 FR 5/102 mm Lgth
1
18.35
Basket Wide Perforation 485X253X76 mm
1
18.36
Bottom For 1/1 Container Height: 135 mm
1
18.37 Primeline 1/1 Lid Blue
Major Surgery Instrument Set utk urologi Dewasa
1
19.1
Maier Forceps W/Rcht CVD 265 mm
2
19.2
Backhaus Towel Clamp 110 mm
6
19.3
Towel Clamp For Paper Cloths 115 mm
6
19.4
Scalpel Handle #4
1
19.5
Scalpel Handle #3
1
19.6
Scalpel #4L
1
19.7
Scalpel Handel #3L
1
19.8
TC Metzenbaum Scissors Del CVD 180 mm
1
19.9
TC Metzenbaum Scissors CVD 200 mm
1
19.10
TC Nelson-Metz Scissors CVD 230 mm
1
19.11
TC Nelson-Metz Sciss CVD 260 mm
1
19.12
TC Suture Wavecut Scissors CVD 180 mm
1
19.13
TC Suture Sciss W/1 Serr CVD 230 mm
1
19.14
TC Mayo-Lexer Scissors CVD 165 mm
1
19.15
Potts-Smith Scisslat-Ang 55 DGS/S 180 mm
1
19.16
TC DE'Bakey CV Duct Sciss 22O mm
1
19.17
Surgical Scissors Str S/B 145 mm
1
19.18
Tissue Forceps Serr 145 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
19.19
Tissue Forceps Str 1X2 145 mm
2
19.20
Dissect.Forceps Med.Wide 1X2T. 200 mm
2
19.21
Tissue Forceps 1X2 Teeth 250 mm Med.
2
19.22
DE'Bakey Atr.Fcps 2.0 mm Str 150 mm
2
19.23
DE'Bakey Atr.Fcps 2.0 mm Str 200 mm
2
19.24
DE'Bakey Atr.Fcps 2.0 mm Str 240 mm
2
19.25
Gerald Tissue Fcps Str 1X2 175 mm
1
19.26
Kocher Forceps Str 1X2 140 mm
10
19.27
Halsted-Mosquito Forceps Del CVD 125 mm
10
19.28
Halsted-Mosquito Fcps Del Str 1X2 185 mm
2
19.29
Kocher-Ochsner Forceps Str 1X2 200 mm
2
19.30
Kocher-Ochsner Forceps Str 1X2240 mm
2
19.31
Maier Forceps W/Rcht Str 265 mm
4
19.32
6
19.33
Mikulicz Peritoneum Forceps CVD. 205 mm
OVERHOLT-GEISS SUTURE FCPS #1CVD 210
mm
19.34
Overholt-Geiss Suture Fcps #3 CVD 229 mm
2
19.35
Mixter Suture Forceps RT-Ang 230 mm
2
19.36
Overholt-Geiss Suture Fcps #3 CVD 276 mm
2
19.37
Gemini Clamp Rt-Ang 230 mm
2
19.38
O'Shaugnessy Diss.A.Ligat.Forceps 230 mm
2
19.39
Deschamps Ndlf/Rt-Hnd Blt Lng-Hk 215 mm
1
19.40
Koenig Guide Probe 4.5 mm 195 mm
1
19.41
TC Crile-Wood Ndl Hldr Str Serr 145 mm
1
2
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
19.42
TC Hegar Needle Holder Hvy-Serr 205 mm
2
19.43
TC DE'Bakey Ndl Holder Del Serr 180 mm
1
19.44
TC DE'Bakey Ndl Holder Del Serr 230 mm
1
19.45
TC DE'Bakey Ndl Holder Del Serr 250 mm
1
19.46
TC Stratte Ndl Holder Dbllat-Ang 230 mm
1
19.47
Roux Retractor 3/Set 165 mm
1
19.48
Volkmann Retr4-Prgsemi-S8. 5X19222 mm
2
19.49
Fritsch Retractor #4OPEN 46X75 Mm 242 mm
2
19.50
Mikulicz Abdominal Retractor 121X50 mm
1
19.51
Mikulicz Abdominal Retractor 250 mm
1
19.52
Mikulicz Abdominal Retractor 180X50 mm
1
19.53
haberer ribbon retractor 50/40 mm 305 mm
1
19.54
Caspar Explor.Hook Med-Tip 90 DG 248 mm
1
19.55
Cushing Vein Retractor 10X13 mm 203 mm
1
19.56
Guyon Atr.Kidney Clamp 240 mm
1
19.57
Guyon Atr.Kidney Ped.Clamp 230 mm
1
19.58
1
19.59
DE'Bakey Tangential Clmp 1.38 mm-WD 220 mm
DE’Bakey Tangental Clmp 2.48 mm-Wide 265
mm
19.60
DE'Bakey Tangental Clmp 54/99/270 mm
1
19.61
DE'Bakey Suture Forceps CVD 230 mm
1
19.62
Atr. Ovum Forceps Str Sm 250 mm
1
19.63
Allis Atr.Forceps 8.4 mm 220 mm
2
19.64
Allis Atr.Forceps 8.4 mm 255 mm
2
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
20
NAMA ALAT
SPESIFIKASI ALAT
19.65
Randall Kidney-Stone Frcps Slt-CVD 225 mm
1
19.66
Randall Kidney-Stone Forceps CVD 225 mm
1
19.67
Randall Kidney-Stone Frcps Hvy-CVD 225 mm
1
19.68
Randall Kidney-Stone Fcps Hvy-CVD 190 mm
1
19.69
Probe 2.0 mm 300 mm
1
19.70
Bakes Bile-Duct Dilator 2 mm
1
19.71
Luer Gall Stone Scoop 2.8 mm # 000
1
19.72
Luer Gallstone Scoop 4.3 mm #0
1
19.73
Dbl-Ended Probe Mall 3.5 mm EYES 300 mm
1
19.74
Interior Box F/BL930
1
19.75
Needle Case W/7 Sections 150X90X10 mm
1
19.76
Laboratory Dish 0.16 L
1
19.77
Laboratory Dish 0.4 L
1
19.78
Kidney Tray Stainless Steel 250 mm
1
19.79
Redon Spike Ch.12 Slig.CVD.Triang.Tip
1
19.80
Redon Spike Ch.14 Slig.CVD.Triang.Tip
1
19.81
Sterilit Oil Spray 300 ml
1
19.82
Basket Wide Perforat.485X253X106 mm
1
19.83
Bottom For 1/1 Container Height:135 mm
1
19.84 Primeline 1/1 Lid Blue
Major Surgery Instrument Set utk urologi pediatric
1
20.1
Scalpel Handle #3
2
20.2
Scalpel Handle #7 Enlish NO.5
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
20.3
Iris Scissors Del Str S/S 115 mm
1
20.4
TC Baby-Metz Scissors Del CVD B/B 145 mm
1
20.5
TC Metzenbaum Scissors CVD 145 mm
1
20.6
TC Metzenbaum Scissors CVD 180 mm
1
20.7
Tissue Forceps Serr 160 mm
2
20.8
Tissue Forceps Str 1X2 160 mm
2
20.9
Waugh Del. Tissue Forceps 1X2 180 mm
2
20.10
Sponge Forceps CVD 265 mm
2
20.11
Backhaus Towel Clamp 90 mm
12
20.12
Halsted-Mosquito Forceps Del Str 125 mm
6
20.13
Halsted-Mosquito Fcps Del CVD 1X2 125 mm
6
20.14
Halsted Delicate Forceps STR 185 mm
4
20.15
Pean Forceps Del Str 140 mm
6
20.16
Rochester-Pean Forceps STR 200 mm
4
20.17
Pean Artery Forceps Jaw Spoon Shap. 195 mm
1
20.18
Micro-Adson Suture Forceps CVD 140 mm
2
20.19
Baby-Mixter Forceps CVD 140 mm
2
20.20
Baby-Mixter Forceps Heavy-CVD 180 mm
2
20.21
Baby-Adson Forceps Rt-Ang 180 mm
2
20.22
Overholt-Geiss Suture Fcps #0 CVD 196 mm
2
20.23
Overholt-Geiss Suture Fcps #1 CVD 210 mm
2
20.24
Mikulicz Peritoneum Forceps CVD. 140 mm
6
20.25
Interior Box F/BL 930
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
20.26
Needle Case W/7 Sections 150X90X10 mm
1
20.27
TC Baby-Crile-Wood Ndl Hldr Serr 150 mm
1
20.28
TC DE'Bakey Needle Holder Del Serr 165 mm
1
20.29
TC DE'Bakey Ndl Holder Del Serr 180 mm
1
20.30
TC Mayo-Hegar Ndl Holder Hvy Serr 150 mm
1
20.31
TC Mayo-Hegar Ndl Holder Hvy Serr 205 mm
1
20.32
Rose Retractor 10X12/11X15 mm
2
20.33
Baby-Roux Retractor 135 mm
2
20.34
Roux Retractor 19X22 mm / 23X30 mm 145 mm
2
20.35
Hook 1-Prong Blunt Lrg-CVD 165 mm
2
20.36
Langenbeck Green Retractor 24X6 mm 159 mm
1
20.37
Volkmann Retr 4-Prg Semi-S 8.5X19222 mm
2
20.38
Langenbeck Retractor 40X10 mm
2
20.39
Langenbeck Retractor 63X20 mm
2
20.40
Kocher Retractor 23X8 MM 210 mm
2
20.41
Mikulicz Abdominal Retractor 121 X 50 mm
2
20.42
Fritsch Abdominal Retractor 41X60 mm #3
2
20.43
Tuffier Spatula Mall 17/25 mm
1
20.44
Weitlaner Retractor 2X3T.SH. 105 mm
1
20.45
Guyon Kidney Clamp 235 mm
1
20.46
Stille Kidney Clamp 220 mm
1
20.47
Randall Kidney-Stone Frcps Slt-CVD 225 mm
2
20.48
Tuebinger Vaginal Retr 95X20 mm 267 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
21
NAMA ALAT
SPESIFIKASI ALAT
20.49
Simon Vaginal Retr 115X26 mm 273 mm
1
20.50
DE'Bakey ATR. FCPS 2.0 mm STR 150 mm
2
20.51
DE'Bakey ATR. FCPS 2.0 mm STR 200 mm
2
20.52
Cooley Bulldog Clamp Ring-Hdl 15 DG 125 mm
1
20.53
Cooley Bulldog Ring-Hdl S-CVD 120 mm
1
20.54
Cooley Bulldog Ring-Hdl Dbl-CVD 115 mm
1
20.55
Kidney Tray Stainless Steel 250 mm
2
20.56
Desmarres Retractor 9X9 MM 140 mm
2
20.57
Desmarres Retractor 9X12 MM 140 mm
2
20.58
Basket Wide Perforat. 485X253X106 mm
1
20.59
Bottom For 1/1 Container Height: 135 mm
1
20.60 Primeline 1/1 Lid Blue
Major Surgery Instrument Set utk bedah plastik
1
21.1
21.2
21.3
21.4
21.5
21.6
21.7
21.8
21.9
Gross Forceps W/Rcht CVD 200 mm
Backhaus Towel Clamp 110 mm
Scalpel Handle # 3
Mouth Mirror Hdl. 120 mm
Mouth Mirror Surface D: 22 mm
Explorer Single Ended # 9B
Tissue Forceps Str 1X2 160 mm
Tissue Forceps Str 1X2 145 mm
Tissue Forceps Serr 145 mm
2
10
2
1
1
1
2
2
2
21.10
Tissue Forceps Serr 160 mm
2
21.11
TC Baby-Metz Scissors Del CVD B/B 145 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
-
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
22
NAMA ALAT
SPESIFIKASI ALAT
21.12
TC Mayo-Lexer Scissors CVD 165 mm
1
21.13
TC SCISSORS CVD S/B 145 mm
1
21.14
Kocher-Langenbeck Retr 55X11 mm 216 mm
2
21.15
Volkmann Retr 2-Prong Blunt 8X8 mm 222 mm
2
21.16
Volkmann Retr 4-Prg Blunt 8X19 mm 222 mm
2
21.17
Kocher Retractor 23X8 mm 210 mm
2
21.18
Strandell-Stille Retractor 15X6 mm Blunt
1
21.19
Volkmann Bone Curette # 0 5.2 mm 172 mm
1
21.20
Volkmann Bone Curette # 1 6.8 mm 172 mm
1
21.21
Volkmann Bone Curette # 2 8.5 mm 172 mm
1
21.22
Volkmann Bone Curette # 3 10.0 mm 172 mm
1
21.23
Volkmann Bone Curette # 5 13.0 mm 172 mm
1
21.24
Merian Tooth Tweezer Smooth 150 mm
1
21.25
Sterilit Oil Spray 300 ml
1
21.26
Basket Wide Perforation 406X253X56 mm
1
21.27
Bottom For 3/4 Container Height: 135 mm
1
21.28 Primeline 3/4 Lid Blue
Major Surgery Instrument Set utk vaskuler
1
22.1
Maier Forceps W/Rcht CVD 265 mm
2
22.2
Backhaus Towel Clamp 110 mm
6
22.3
Towel Clamp For Paper Cloths 115 mm
6
22.4
Scalpel Handle # 4
2
22.5
Scalpel Handle # 3
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
-
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
22.6
Jameson Tenotomy Sciss Del CVD B/B 150 mm
1
22.7
TC Iris Scissors CVD S/S 110 mm
1
22.8
Potts-De Martel Scissor S 45 DG S/S 185 mm
1
22.9
TC Baby-Metz Scissors Del CVD B/B 145 mm
1
22.10
TC Metzenbaum Scissors Del CVD 180 mm
1
22.11
TC Metzenbaum Scissors CVD 200 mm
1
22.12
TC Suture Wave Cut Scissors CVD 180 mm
1
22.13
TC Mayo-Lexer Scissors CVD 165 mm
1
22.14
Surgical Scissors STR S/B 145 mm
1
22.15
Tissue Forceps Serr 145 mm
1
22.16
Tissue Forceps Str 1X2 145 mm
2
22.17
Dissect. Forceps Med. Wide 1X2T.200 mm
2
22.18
Ultra-Light Forceps 1.2 mm 150 mm
2
22.19
DE'Bakey Atr.Fcps 2.0 mm STR 150 mm
2
22.20
Ultra-Light Forceps 1.5 mm 200 mm
2
22.21
DE'Bakey Atr. Fcps 2.0 mm STR 200 mm
2
22.22
Kocher Forceps Str 1X2 140 mm
6
22.23
Halsted-Mosquito Forceps Del CVD 125 mm
6
22.24
Kocher-Ochsner Forceps Str 1X2 200 mm
2
22.25
Overholt Forceps # 0 CVD 215 mm
2
22.26
Overholt Forceps # 1 CVD 209 mm
2
22.27
Overholt Forceps # 2 CVD 220 mm
2
22.28
Micro-Adson Suture Forceps CVD 140 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
22.29
Baby-Mixter Forceps Heavy-CVD 180 mm
1
22.30
Gemini Clamp RT-Ang 130 mm
1
22.31
Gemini Clamp RT-Ang 180 mm
1
22.32
TC Baby-Crile-Wood Ndl Hldr Serr 150 mm
1
22.33
TC DE'Bakey Ndl Holder Del Serr 180 mm
1
22.34
TC Mayo-Hegar Ndl Holder Hvy Serr 205 mm
2
22.35
TC Ryder Needle Holder X-Del Serr 155 mm
1
22.36
Hook 4-Prong Sharp SM-CVD 165 mm
2
22.37
Desmarres Retractor 11X14 mm 140 mm
2
22.38
Roux Retractor 3/Set 165 mm
1
22.39
Langenbeck Retractor 28X14 mm
2
22.40
Langenbeck Retractor 40X10 mm
2
22.41
Kocher-Langenbeck Retr 55X11 mm 216 mm
2
22.42
Volkmann Retr 4-Prg Semi-S 8.5X19222 mm
2
22.43
Cushing Vein Retractor 10X13 mm 203 mm
2
22.44
Adson Lamin Retr 5X4 Semi-S 325 mm
1
22.45
Self-Retaining Retr 3X4T. Blunt 240 mm
1
22.46
Adson-Baby Retractor 3X4 Blunt 140 mm
1
22.47
Freer Elevator S/B 185 mm
1
22.48
Vascular Spatula 3 mm Blunt 185 mm
1
22.49
Davis Vascular Spatula 245 mm
1
22.50
Crile Vessel Hook Blunt 90°6/203 mm
1
22.51
Double-Ended Probe 1.5 mm 180 mm
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
22.52
Schmid Irrigating Cannula Malleab.LL.
1
22.53
Atr.Micro Bulldog Clamps 50 mm Str.
2
22.54
Atr .Micro Bulldog Clamps 50 mm Ang.
2
22.55
Atr.Micro Bulldog Clamps 60 mm Str.
2
22.56
Atr.Micro Bulldog Clamps 55 mm Angled
2
22.57
2
22.58
Atr.Micro Bulldog Clamps 55 mm CVD.
DE'Bakey Buld Gx-Act 23 mm JAW CVD 78
mm
22.59
DE'Bakey Buldgx-Act 31 mm Jaw CVD 86 mm
2
22.60
Alpha Vascular Clamp Angled 350 Grams
2
22.61
Alpha Vascular Clamp Slt Curved 350 Gram
2
22.62
Alpha Vascular Clamp Curved 350 Grams
2
22.63
DE'Bakey Peripheral Clamp 60 DG 180 mm
2
22.64
Derra Pediatric Forceps 26 mm 175 mm
1
22.65
Cooley Pediatric Clamp 60 DG 30/160 mm
1
22.66
Allis Atr.Forceps 6.2 mm 155 mm
2
22.67
Pelkmann Forceps CVD Serr 261 mm
1
22.68
Interior Box F/BL 930
1
22.69
Needle Case W/7 Sections 150X90X10 mm
1
22.70
Laboratory Dish 0.16 L
1
22.71
Laboratory Dish 0.4 L
1
22.72
Kidney Tray Stainless Steel 250 mm
1
22.73
redon spike ch.10 Slig.CVD.Triang.Tip
1
22.74
Redon Spike Ch.12 Slig.CVD.Triang.Tip
1
2
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
23
NAMA ALAT
SPESIFIKASI ALAT
22.75
Sterilit Oil Spray 300 ml
1
22.76
Basket Wide Perforat. 485X253X106 mm
1
22.77
Bottom For 1/1 Container Height : 135 mm
1
22.78 Primeline 1/1 Lid Blue
Minimal invasive surgery set
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
+/-
-
-
1
I
I.1
I.2
I.3
I.4
Optics
Laparoscope 10 mm O Deg 330 mm
Laparoscope 5 mm O DEG 310 mm
Double Scope Tray For Scops Up To 340 mm
Antifogging Soln. Sterile F. Endoscopes
1
1
1
1
II
II.1
Veress Needle
Veress Insufflation Needle 10 cm
1
III
III.1
III.2
III.3
III.4
III.5
III.6
III.7
III.8
Trocar Systems
Trocar Sleeve 5/110 mm Smooth With Tap
Trocar Pin Triangular 5/110 mm
Sealing Unit For 5 mm Trocars
Trocar Sleeve 10/110 mm Smooth With Tap
Trocar Pin Triangular 10/110 mm
Sealing Unit For 10/12 mm Trocars
Sealing Unit F/10/12 mm Trocars W. Reducer
Reducing Sleeve 10 mm TO 5 mm
2
2
1
2
2
1
2
1
IV
IV.1
IV.2
IV.3
Instruments Scissors
Hook Scissors 5 mm 310 mm
Metzenbaum Scissors 5 mm 310 mm
Disp.Sciss.Shaft Metzenbaum D: 5 mm /310 mm
1
1
1
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
V
V.1
V.2
V.3
V.4
Instruments Dissecting & Grasping
Maryland Dissector 5 mm 310 mm
Clinching Grasper Fenest 5 mm 310 mm
Atr. Dissecting Fcps 5 mm 310 mm
combination grasping forceps 5/310 mm
1
1
1
1
VI
VI.1
VI.2
VI.3
VI.4
VI.5
VI.6
VI.7
Instruments Ligating & Suturing
Durogrip Needle Holder Str.D: 5/310 mm
Needle Holder Left Curved 5 mm 31 cm
Knot Pusher 5 mm 31 cm
Multif. Clip Appl. Ti-P 10/370 mm F/Ml - Clip
Challenger Ti-P Ml-Ligat.Clips 12 Cartr.
Fascial Port - Closure Instrument
Loop Applier 4.4 mm In – 5 mm Out
1
1
1
1
1
1
1
VII
VII.1
VII.2
VII.3
VII.4
Instruments Hook & Spatula
Handle F/Monopolar Electrodes 5 mm
Ceramic Electrode TIP J-HK F/GK372R
Ceramic Electrode TIP L-HK F/GK372R
Monopolar Hf Cable 3.5 M Long
2
1
1
1
VIII
VIII.1
VIII.2
Instruments Bipolar
Bipolar Metz Scissors 5 mm 310 mm
Bipolar Cable 4 m AAG/Martin AAG FLAT
1
1
IX
IX.1
IX.2
IX.3
Container System
Mis Storage Rack With Basket
Bottom For 1/1 Container Height: 187 mm
Primeline 1/1 Lid Blue
1
1
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
24
NAMA ALAT
SPESIFIKASI ALAT
X
Cleaning brush
X.1
Cleaning Brush 5 mm Dia 6/Pkg
X.2
Cleaning Brush 10 mm Dia
X.3
Sterilit Oil Spray 300 ml
X.4
Sterilit Instrument Oil 50 ml
Mastektomi set
1
1
1
1
24.1
24.2
24.3
24.4
24.5
24.6
24.7
24.8
24.9
Foerster Sponge Fcps Serr Str 242 mm
Backhaus Towel Clamp 135 mm
Scalpel Handle #3
Scalpel Handle #4
TC Mayo Scissors Str 170 mm
TC Mayo Scissors CVD 170 mm
TC Metzenbaum Scissors CVD 145 mm
Surgical Scissors Str S/B 145 mm
Standard Forceps Serr 145 mm
6
12
1
2
1
2
1
2
1
24.10
Standard Forceps Serr 200 mm
1
24.11
Standard Tissue Forceps 1X2 145 mm
1
24.12
Standard Tissue Forceps 1X2 200 mm
1
24.13
Allis Forceps 5X6 155 mm
12
24.14
Halsted-Mosquito Forceps Del CVD 125 mm
12
24.15
Crile Forceps CVD 140 mm
12
24.16
Rochester-Pean Forceps CVD 160 mm
6
24.17
Czerny Retractor 38X22/38X22 mm
6
24.18
Kelly Retractor Open 50X38 mm 261 mm
2
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
√
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
25
26
27
28
29
30
31
32
33
NAMA ALAT
SPESIFIKASI ALAT
24.19
Kelly Retractor Open 64X54 mm 261 mm
2
24.20
US-Army Retrac. 26X15/43X15 - 23X15/40X15
1
24.21
Kocher Retr 4- Prg Semi-S 16X20222 mm
1
24.22
Pool Suction Cannula Charr .30
1
24.23
Mayo-Hegar Needle Holder 150 mm
4
24.24
Sterilit Oil Spray 300 ml
1
24.25
Basket Wide Perforation 485X253X76 mm
1
24.26
Bottom For 1/1 Container Height: 135 mm
1
24.27 Primeline 1/1 Lid Blue
1
Operating Microscope
C-Arm
Infusion pump
Suction pump
Patient Monitor
Patient Stracher
Syringe Pump
Endoscopy THT, Bronchoscopy, gastrocoscopy, colonoscopy
Endoscopy THT, Bronchoscopy, gastrocoscopy, colonoscopy,
ERCP
I
I.1
I.2
I.3
Optics
Arthroscope 4 mm 175 mm Length 0 Degree
Arthroscope 4 mm 175 mm Length 30 Degree
Arthroscope 4 mm 175 mm Length 70 Degree
II
Trocar Systems
1
1
1
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
-
-
√
√
-
-
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
II.1
II.2
II.3
II.4
II.5
II.6
II.7
II.8
II.9
II.10
II.11
II.12
II.13
II.14
II.15
II.16
II.17
II.18
II.19
II.20
II.21
32
Surgical Scissors Str B/B 130 mm
Backhaus Towel Clamp 90 mm
Yankauer Suction Cannula 2.0 mm 285 mm
Suction Cannula Bellucci W/3 Tips
Zoellner Suction Cannula
Discission Knife Thorburn
Thudichum Nasal Speculum #6
Gruenwald – Henke Nasal Cut Fcp Ssm 121 mm
Tilley Ear Tampon Forceps 76 mm Length
Killian Septum Speculum Screw 56X7 mm
Killian Septum Speculum Screw 70X7 mm
Freer Elevator S/B 185 mm
Elevator Hill
Weiblakesley Rongeur Str 3 mm 121 mm
Weil-Blakesley Rng Urup-CVD 3.6 mm 115 mm
Myles Nasal Cutting Forceps 121 mm
Scissors Str. Length Of Shaft 165 mm
Fahlbusch Scissors X-Dellat- CVD 165 mm
Weiblakesley Rongeur Str 3.6 mm 121 mm
Weiblakesley Rongeur Str 4.8 mm 121 mm
Suction Cannula 281.5 mm 248 mm
III
Sterilit
III.1
Sterilit Oil Spray 300 ml
III.2
Sterilit Instrument Oil 50 ml
Cryo surgery
SPESIFIKASI ALAT
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
-
-
-
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
JUMLAH MINIMAL
NO
e.
f.
UNIT PELAYANAN
Recovery Room
Rawat Bedah Umum
NO
NAMA ALAT
33
34
35
36
37
38
39
40
SPESIFIKASI ALAT
RS kls
A
RS kls
B
RS
kls C
RS kls
D
Microwave
Captriton Ultra Sonic Aspiration (CUSA)
Harmonic Scalpel
Caiman Seal and Cutting Device
USG guided
Blood Gas Analyzer
Electrolyte Analyzer
CCTV For Operation
√
√
√
√
√
√
√
√
√
√
√
√
+/-
-
-
1
Bed Side Monitor
√
√
√
√
2
Patient Stracher
√
√
√
√
3
Defibrilator
√
√
√
√
4
Emergency trolley
√
√
√
√
5
Infusion pump
√
√
√
√
6
Suction pump
√
√
√
√
1
Hospital Bed
√
√
√
√
2
Stethoscope
√
√
√
√
3
Brandchard
√
√
√
√
4
Infusion pump
√
√
√
√
5
Examination lamp
√
√
√
√
6
Tensimeter
√
√
√
√
7
Film viewer
√
√
√
√
8
Minor Surgery Instrument Set
√
√
√
√
9
Set Perawatan Luka
√
√
√
√
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
10
NO
UNIT PELAYANAN
a. Klinik (Rawat Jalan)
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
RS kls
B
RS
kls C
RS kls
D
√
√
√
√
Emergency Set
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS kls
RS kls
B
C
RS kls
D
1
Suction Pump
+
+
+
+
2
Minor Surgery Set
+
+
+
+
3
Hecting set
+
+
+
+
4
Alat pembuka gips (manual dan elektric)
+
+
+
+
5
Sphygmomanometer
+
+
6
Stetoscope
+
+
+
+
7
Reflex hammer
+
+
+
+
8
Film Viewer 2 slides
+
+
+
+
9
10
Examination lamp
Electrocauter
+
+
+
+
+
+
-
-








Hf Combi Unit 300w Monop.80w.Bipolar
Mains Cord 5m Long
Vario Dual Foot Switch 4m Cable
Silicon Neutral Elect.Large 310x160mm
Silicon Rubber Band W/4 Buttons 1.5m
Cable F.Silicon Neutral Electrode 3.5m
Hf-Handle Lg.2 Button 4mm Koax Plug
Electrode Cable 3.5m Lg.F.Gn207 209
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT






11
12
b. Kamar Tindakan
c. Ruang persiapan
(sblm OP)
Lokal Anestesi Set
Head Lamp
RS kls
A
JUMLAH MINIMAL
RS kls
RS kls
B
C
RS kls
D
Electrode Set W/Shaft D:4.0mm
Bipol.Diss.Fcps Part Insul.Ang.160mm
Two-Pole Coagulation Cable F/Gn060 3.5
Bipolar Dissection Scissors 230mm
Bipolar Cable Aag/Aag Hexagonal
Wire Brushf/Clean Coag
Fcps&Electrodes
 Clear Head Light W/Foam Rubber
 Spare Electric Bulb 6 Volts For Ac461
 Transformer 23ov Flat Plug
+
+
+
+
+
+
+
+
13
Termometer
+
+
+
+
1
Examination Table
+
+
+
+
2
Examination lamp
+
+
+
+
3
Stethoscope
+
+
+
+
4
Sphygmomanometer
+
+
+
+
5
Minor Surgery Set
+
+
+
+
6
Circumsisi set
+
+
+
+
7
Alat dekontaminasi
+
+
+
+
8
Autoclave portable
+
+
+
+
9
Electrocauter
+
+
+
+
10
Emergency Set
+
+
+
+
1
Bed Side Monitor
+
+
+
+
2
Sphygmomanometer
+
+
+
+
3
Stethoscope
+
+
+
+
NO
UNIT PELAYANAN
d. Kamar Bedah
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
+
JUMLAH MINIMAL
RS kls
RS kls
B
C
+
+
RS kls
D
+
4
Suction pump
5
Oxygen Saturatie
+
+
+
+
6
Film viewer
+
+
+
+
1
Operating Table
+
+
+
+
2
Mayo table
+
+
+
+
3
+
+
+
+
+
+
+
+
5
Operating Lamp Ceiling Type
ETT, LMA, Nasotracheal, dewasa dan
pediatric
Laringoscope set (dewasa dan pediatric)
+
+
+
+
6
fiber optic
+
+
7
Anasthesi Machine
+
+
+
+
8
Defibrilator
+
+
+
+
9
Ventilator Anesthesi
+
+
+
+
10
Electro Surgery Unit (ESU)
+
+
11
Examination lamp
+
+
+
+
12
Autoclave portable
Major Surgery Instrument Set utk kepala
(Dewasa dan pediatric)
Major Surgery Instrument Set utk leher
(Dewasa dan pediatric)
Major Surgery Instrument Set utk thorak
dan cardiac (Dewasa dan pediatric)
Major Surgery Instrument Set utk
abdomen (Dewasa dan pediatric)
Major Surgery Instrument Set utk urologi
(Dewasa dan pediatric)
Major Surgery Instrument Set utk bedah
+
+
+
+
+
+
-
-
+
+
-
-
-
-
-
-
-
-
-
-
4
13
14
15
16
17
18
+
+/-
+
+
+
+
+
-
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS kls
RS kls
B
C
RS kls
D
plastik
19
Major Surgery Instrument Set utk vaskuler
+
-
-
-
20
Minimal invasive surgery set
+
Mastektomi set
+
+/+
+
-
21
22
Operating Microscope
+
+
-
-
23
C-Arm
+
+
24
Infusion pump
+
+
+
+
25
Suction pump
+
+
+
+
26
pasien Monitor
+
+
+
+
27
alat dekontaminasi
+
+
+
+
28
Patient Stracher
+
+
+
+
29
+
+
+
+
+
+
-
-
+
+
-
-
32
Syringe Pump
Endoscopy THT, Bronchoscopy,
gastrocoscopy, colonoscopy
Endoscopy THT, Bronchoscopy,
gastrocoscopy, colonoscopy, ERCP
Cryo surgery
+
-
-
-
33
Microwave
34
Captriton Ultra Sonic Aspiration (CUSA)
+
-
Harmonic Scalpel
+
+
-
35
-
-
36
Caiman Seal and Cutting Device
+
+
-
-
37
USG guided
+
+
-
-
38
Blood Gas Analyzer
+
+
-
-
39
Electrolyte Analyzer
+
+
-
-
40
CCTV For Operation
+
+/-
-
-
30
31
-
NO
UNIT PELAYANAN
e. Recovery Room
f. Rawat Bedah Umum
NO
NAMA ALAT
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS kls
RS kls
B
C
+
+
1
Bed Side Monitor
RS kls
A
+
RS kls
D
+
2
Patient Stracher
+
+
+
+
3
Defibrilator
+
+
+
+
4
Emergency trolley
+
+
+
+
5
Infusion pump
+
+
+
+
6
Suction pump
+
+
+
+
1
Hospital Bed
+
+
+
+
2
Stethoscope
+
+
+
+
3
Brandchard
+
+
+
+
4
Infusion pump
+
+
+
+
5
Examination lamp
+
+
+
+
6
Sypgmomanometer
+
+
+
+
7
Film viewer
+
+
+
+
8
Minor Surgery Instrument Set
+
+
+
+
9
Set Perawatan Luka
+
+
+
+
10
Emergency Set
+
+
+
+
PERALATAN KESEHATAN PADA PELAYANAN MEDIK SPESIALIS LAIN
1. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS NEUROLOGI
UNIT PELAYANAN
a. Rawat Jalan (Klinik)
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS Kls
RS kls
B
C
RS kls
D
1
2
Examination Table
Examination lamp
1
1
1
1
1
1
1
1
3
EMG 4 Channels with Evoked
Potential
2
1
1
1
4
5
6
7
8
9
10
11
12
Brainmaping 32 channels
Ambulatory EEG
Lumbal Set
Tuning for Set
Stethoscope
Sypgmomanometer
Reflex hammer
oftalmoskop
Garpu tala
2
2
40
5
3
3
10
5
5
1
2
40
5
3
3
10
5
5
1
1
20
2
3
3
10
3
5
1
1
20
2
3
3
10
3
5
2. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS BEDAH SARAF
JUMLAH MINIMAL
NO
1
UNIT PELAYANAN
Rawat Jalan
NO
1
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
RS KLS
C
6
2
1
1
1
1
1
1
1
a. Plain Foto
1
1
1
b. Myelografi
1
1
1
Set Pemeriksaan Neurologi
a. Palu Refeks
b. Medical Flash light
c. Opthalmoscope
2
Pemeriksaan penunjang bersama neurologi
a. TCD
b. EEG
Resolusi Data EEG 12 BITS, RATE >200 Hz
c. EMG,Evoke PotensIal, Neurostimulator
3
Fasilitas Neuroradiologi ( bersama radiologi )
c. CT Scan
16 Slices atau lebih
1
64 slices atau lebih ( dipakai bersama cardiologi)
1
1
d. MRI
1.5 Tesla atau lebih
1
1
e. Digital Substraction Angiography suite
3 D Roadmap, monoplanar
1
1
f. Radiologi Nuklir
2
Kamar Tindakan
4
g. SPECT
1
h. PET
1
i. Bone Scanning
1
Alat dan Perlengkapan Dasar
JUMLAH MINIMAL
NO
3
UNIT PELAYANAN
Kamar Operasi
NO
5
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
RS KLS
C
a. Set Punksi Lumbal
3
2
1
b. Set Angkat Jahitan
6
2
1
c. Set Pembersih luka dan ganti pembalut
6
2
d. licght kaas
3
2
e. meja periksa
3
1
b. Meja operasi
3
1
1
c. lampu operasi
3
1
1
d. lampu operasi khusus ( cold light/fiber optic)
2
1
e. Peralatan bius khusus bedah saraf ( mengacu
anestesi )
3
1
1
f. Alat hisap (suction set )
6
2
1
g. Elektrosurgery Unit
3
1
1
h. Set Kraniotomi Dasar
3
1
1
i. Set Laminektomi Dasar
3
1
1
1
Alat dan Perlengkapan Dasar
j. licght kaas
6
3
2
k. C Arm
Digital, dual monitor
2
1
l. Aphron protector x ray
5 kg
8
4
a. CUSA
Micro handpiece, bone currete
1
1
b. Mikroskop Operatif
Microscope operatif bedah saraf
2
1
Alat Penunjang Khusus :
c. Intraoperatif neurofisiology Monitoring
7
1
Alat Operasi Khusus
1
JUMLAH MINIMAL
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS KLS
A
RS KLS
B
b. Set Instrumen Bedah Mikro
2
1
c. Set Instrumen skullbase
1
1
d. Set Instrumen bedah Vaskuler
1
1
e. Set Instrumen Bedah Saraf Fungsional
1
1
f. Set Instrumentasi Bedah Saraf Spinal
1
1
RS KLS
C
a. Kraniotomi Set Elektrik
- Main Unite machine
speed > 70.000 rpm
- Perforator electric
- Kraniotom electric set
- High speed drill set
g. Set Instrumen Bedah Saraf Minimal Invasif
4
Perawatan di ruangan
- Set Bedah Saraf Endoscopi
1
- Set Bedah Saraf Stereotaxy
1
- Set Bedah Saraf Endovascular
1
Alat dan Perlengkapan Dasar
a. Fasilitas perawatan ( tempat tidur dll )
b. Mesin hisap ( suction pump )
6
2
1
c. Alat pemantau tekanan darah (manual)
6
2
1
d. Stetoscope
6
2
1
e. Set Pembersih luka dan ganti pembalut
6
2
1
f. Set Angkat Jahitan
6
2
1
g. Set Punksi Lumbal
6
2
2
3. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS ORTHOPEDI
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS Tipe A
1
PELAYANAN RAWAT JALAN
a. Orthopedi Umum
1
Meja periksa
2
8
Minor Surgery Set
Heacting Set
Film viewer 2 slides
Termometer
Tensimeter
Reflex hammer
Set Perawatan luka
1
Alat diagnostik spesialistik
2
Instrumen pengobatan spesialistik
1
Tempat tidur pasien
2
Oxygen
3
8
Set Perawatan luka
Emergency Set
Termometer
Tensimeter
Reflex hammer
Traksi
9
Minor Surgery Instrumen Set
3
4
5
6
7
b. Orthopedi Sub Spesialistik
PELAYANAN RAWAT INAP
a. Umum
4
5
6
7
b. Orthopedi Spesialistik
RS Tipe B
NO
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS Tipe A
RS Tipe B
+
-
Peralatan disesuaikan dengan kebutuhan
RUANG BEDAH
a. Peralatan Umum :
b. Peralatan Spesialistik :
Disesuaikan dengan kebutuhan
masing-masing spesialis (lihat lampiran)
1
Meja operasi dengan traction table
dan X ray penetrable untuk C Arm
2
Lampu operasi
3
Peralatan anestesi + Monitor Pasien
4
Gas medik
5
Suction
6
Set bedah dasar
7
Meja instrumen
8
DC Shock
9
Diatermi
10
Kontainer linen
11
Kontainer / tromol instrument
1
Micro Surgery (Hand)
+
+
2
Colibri Power Tools Set
+
+
3
Small Fragment Lcp Instrument Set
Large Fragment Lcp & Standard
Instrument Set
+
+
+
+
5
Plate Bending Instrument
+
+
6
General Instrument Bone Surgery
+
+
7
Wire Instrument Set
+
+
8
Mini Instrument Set In Graphic Case
+
+
4
NO
UNIT PELAYANAN
NO
9
10
NAMA ALAT
Arthroscopy System
Instrument Set For Intramedullary
Pins Extraction
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS Tipe A
+
RS Tipe B
+
+
+
11
Damage Screw Set
+
+
12
Torniquet
+
+
13
Amputation Set
+
+
14
Plaster Cast Cutter Set
+
15
Spine Electric Motor
+
+
16
Laminectomy Set
+
17
Spine Endoscopy Instrument
S4 - Thoracolumbar Posterior
Stabilization Instruments
+
19
Lumbar Subcutaneous Retractor
+
20
Caspar Microlumbar Discectomy
+
+
21
Kerrison Set
+
+
22
Cervical Kerisson
+
23
Caspar Cervical Retractor
+
+
24
Anterior Cervical Fusion Set
+
-
18
+
+
-
4. PERALATAN KESEHATAN DI PELAYANAN PSIKIATRI
NO
NAMA ALAT
JUMLAH MINIMAL
SPESIFIKASI ALAT
RS Tipe A
RS Tipe B
12 meja, maksimal 30
kursi
4 meja, maksimal 10 kursi
Rawat Jalan
meja kecil, pemeriksa dan pasien berada di sudut yang berdekatan
(berbentuk segitiga)
1
Examination table
2
3
Stethoscope
2 buah
1 buah
Sphygmomanometer
2 buah
1 buah
4
5
Reflex hammer
1 buah
1 buah
1 buah
1 buah
6
Resucitator
Rawat Inap
1 buah
1 buah
1
Examination table
4 meja, maksimal 10 kursi
1 meja, maksimal 6 kursi
2
3
Stethoscope
1 buah (per bangsal)
1 buah (per bangsal)
Sphygmomanometer
1 buah (per bangsal)
1 buah (per bangsal)
4
5
Reflex hammer
ECT
1 buah (per bangsal)
1 buah
1 buah (per bangsal)
palu pemeriksaan neurologis
suction pump
1 set: ambu bag, laringoskop, tube
meja kecil, pemeriksa dan pasien berada di sudut yang berdekatan
(berbentuk segitiga)
palu pemeriksaan neurologis
ECT dengan monitor untuk tindakan premedikasi
ECT tanpa monitor
-
1 buah
6
EEG 32 channels
1 buah
7
8
Defibrilator
1 buah
1 buah
suction pump
1 buah
1 buah
9
10
ECG 3 channels
1 buah
1 buah
1 buah
1 buah
11
12
Transcranial Magnetic Stimulation
1 buah
-
Deep Brain Stimulation
1 buah
-
13
Biofeedback
1 buah
-
Resucitator
1 set: ambu bag, laringoskop, tube
5. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS THT
UNIT PELAYANAN
a. Rawat Jalan (klinik)
NO
1
NAMA ALAT
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS kls A
RS kls B
RS kls C
RS kls D
Hak serumen
25
15
10
5
2
Luc serumen
25
15
10
5
3
Wattendrager (pembawa kapas)
25
15
10
5
4
Spekulum telinga (macam-macam uk/no)
15
10
5
3
5
Knie pinset
25
15
10
5
6
Tang untuk mengambil benda asing
15
10
5
3
7
lampu spiritus
3
5
5
3
8
Lampu kepala
15
10
5
3
9
Wondspuit
5
5
3
3
10
Suction pump
10
10
7
5
11
Otoscope siegle
25
20
15
3
12
Spekulum hidung
25
20
15
5
13
Garpu tala
2
1
5
5
14
Audio meter
2
1
-
-
15
ABR/BERA (brain Evoke Respon
Audiometer)
2
1
-
-
16
Tymphanometer
2
1
-
-
17
Set irigasi serumen
3
2
2
2
18
Set irigasi sinus
2
2
1
-
19
Lensa Frenzel
1
-
-
-
20
Rinomanometer
1
1
-
-
UNIT PELAYANAN
b. Tindakan Bedah THT
NO
NAMA ALAT
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS kls A
RS kls B
RS kls C
RS kls D
21
Cermin laring
2
4
5
5
22
Cermin Risnoskopi posterior
2
4
5
5
23
Trocar anthrum
3
2
1
-
24
Sinuskop (rigid endoscope)
1
3
1
-
25
Nasofaringoskop (fiber optic)
1
1
-
-
26
Diafanoskop
1
1
-
-
27
Rhinuscope (fiber optic)
1
1
-
-
28
Pharyngoscope (fiber optic)
1
1
-
-
29
Minor surgery set
2
1
1
-
30
Parasintesis set
2
1
1
-
31
Sound proof box
2
1
-
-
32
Ent Diagnostik unit
3
2
1
-
33
Ent trearment
3
2
1
-
34
Tongue spatel
50
40
30
20
35
Sterilisator
2
1
1
1
1
Set bedah minor THT
3
2
1
-
2
Set adenotonsilektomi Sluder & Diseksi
3
2
1
-
3
Set polipektomi
3
2
1
-
4
Set trakeostromi
3
2
1
-
5
Set biopsi nasopharing, tumor hidung
3
2
1
-
6
Mastoidectomy set
2
1
1
-
7
Septum corection set
2
1
1
-
8
Tang Biopsi Nasofaring (menjadi satu
dengan nasofaringoskop-listrik)
4
2
1
-
UNIT PELAYANAN
b. Perawatan THT
NO
NAMA ALAT
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS kls A
RS kls B
RS kls C
RS kls D
9
Biopsi Tang (berbagai macam ukuran dan
jenis)
4
2
1
-
10
Anthrum biopsi tang
4
3
2
-
11
Tonsil anses forceps
4
3
2
-
12
Operating microscope
2
1
1
-
13
Minor Electro Surgery
2
1
1
-
1
ENT Examination set
3
2
1
-
2
Examination lamp
4
3
1
-
3
Sypgmomanometer
5
3
3
3
4
Film viewer
9
5
2
1
5
Suction pump
10
8
5
3
6
Stethoscope
5
5
4
3
6. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS JANTUNG DAN PEMBULUH DARAH
NO
a. Rawat Jalan (Klinik)
1
2
3
4
5
6
7
8
9
10
11
12
Examination Table
Stethoscope
Sypgmomanometer
Film viewer
EKG
Echo cardiography
Treadmill test
MSCT
Trans-Esophageal Echo (TEE)
Duplex Vascular
Pletismografi
Doppler Perifer
8
14
14
5
7
2
2
1
1
1
1
1
2
7
7
2
2
1
1
1
1
1
Minor Surgery Set
3
1
2
3
4
5
Film viewer
Defibrilator
EKG
Oxygen Therapy + Flowmeter
2
1
1
1
1
1
1
6
PCI set (mohon diuraikan secara terinci)
3
1
7
Wire berbagai ukuran
8
Balon kateter berbagai ukuran
9
Stent berbagai ukuran
10
Baterai pacu jantung permanen
b. Kamar tindakan
(Kamar Cath)
NAMA ALAT
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS Kls B
RS kls C
UNIT PELAYANAN
RS kls A
Sesuai Jumlah
Kasus
Sesuai Jumlah
Kasus
Sesuai Jumlah
Kasus
2
-
1
4
4
4
1
1
1
1
-
RS kls D
UNIT PELAYANAN
c. Perawatan
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls A
11
Cathab Angiography
1 Unit
12
Elektrofisiologi set
1 Unit
13
14
Patient monitor
Rotablator
15
Amplatzer
16
17
18
IVUS
FFR
Angiojet
1
Patient monitor
2
Sypgmomanometer
3
Stethoscope
4
Oxygen Therapy + Flowmeter
5
EKG
6
Defibrilator dengan pacing elektroda
7
Temporary cardiac Pacemaker Kit
(mohon diuraikan secara terinci)
8
Infusion pump
9
Syringe pump
10
Simple face mask
1
1
Sesuai Jumlah
Kasus
1
1
1
Sesuai jumlah
bed perawatan
Sesuai jumlah
bed perawatan
Sesuai jumlah
bed perawatan
Sesuai jumlah
bed perawatan
1 Buah/lantai
perawatan
1 Buah/lantai
perawatan
Sesuai jumlah
Pasien
Sesuai jumlah
Pasien
Sesuai jumlah
Pasien
JUMLAH MINIMAL
RS Kls B
RS kls C
1/ 1
-
RS kls D
UNIT PELAYANAN
NO
11
d. ICCU
NAMA ALAT
Rebreathing mask
1
2
Bed side monitor
Defibrilator + External Pacing
3
Swan Ganz
4
11
IABP
Pericard Sintesis Set
Fluoroscopy
EKG
Echo cardiography
Phonocardiography
Ventilator
Holter monitor
12
Cardiac Resuscitation
13
14
15
16
17
18
19
20
21
Cardiac massage unit/ CPR Machine
Cardiac output
Pace maker
Arytmia monitor
Oxator head complete
Sterilization
suction pump
Mobile x-ray
Blood Pressure monitor
5
6
7
8
9
10
SPESIFIKASI ALAT
RS kls A
Sesuai jumlah
Pasien
5
1
Sesuai jumlah
pasien
1
1
1
1
1
3
5
2
1
1
1
5
1
1
1
1
JUMLAH MINIMAL
RS Kls B
RS kls C
RS kls D
7. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS PARU + PERNAPASAN
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls A
Rawat Jalan (Klinik)
Kamar tindakan
Perawatan Paru
1
2
3
4
5
6
7
8
Examination Table
Examination lamp
Stethoscope Dewasa
Stethoscope Anak
Resucitation set
Film viewer
Nebulyzer
Cardiopulmonary Stress Set
9
10
Spirometer
tes Alergen
1
2
3
4
Alat Biopsi Lengkap
Examination lamp
Astograph
Bronchoscopy
5
6
7
8
Thoracoscopy
Suction Thorax
Resucitation set
Film viewer
1
2
Examination lamp
Stethoscope
JUMLAH MINIMAL
RS Kls B
RS kls C
RS kls D
8
8
8
2
1
8
3
1
2
1
5
5
5
2
1
5
2
1
1
1
2
2
2
1
1
2
1
1
1
2
2
2
1
1
2
1
1
1
Besar
Kecil
8
2
1
3
1
1
1
2
1
1
1
5
2
1
2
1
1
1
2
1
1
1
2
1
1
1
1
1
1
-
2
1
1
1
1
1
1
-
Dewasa
4
10
3
8
2
5
2
2
Dewasa
Anak
Intubasi
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
Anak
3
4
5
6
7
Sypgmomanometer
Auto Spirometer
Nebulyzer
Oxygen Concentrat
Film viewer
8
9
10
Resucitation set
Suction Thorax
Pulse Oxymeter
Besar
Kecil
RS kls A
2
6
1
3
2
2
3
3
JUMLAH MINIMAL
RS Kls B
RS kls C
2
1
5
3
1
1
2
1
1
1
1
2
2
3
2
5
4
3
2
RS kls D
1
2
1
1
1
2
1
2
1
8. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS KULIT DAN KELAMIN
UNIT
PELAYANAN
Ruang Periksa
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls A
2
JUMLAH MINIMAL
RS kls
RS kls
B
C
2
2
RS kls
D
2
1
Tensimeter
2
Stetoskop
3
Loupe
tidak tersedia
4
Tongspatel
tidak tersedia
-
-
-
-
5
Senter
tidak tersedia
1
1
1
1
6
Sterilisator Basah
tidak tersedia
1
1
1
-
7
Examination table
tidak tersedia
1
1
1
1
8
Ginecology bed
tidak tersedia
1
1
1
-
Kamar Gelap
1
woodslamp
Burton ultra violet examining light (220 volt, 50/60 Hz. 09 AMPS)
1
1
1
1
Kamar Operasi
1
Examination table
Tipe JC 35-150
3
2
1
1
2
Examination lamp
Tipe 735.22V.50 Hz.125 W
3
2
1
1
3
Mosquito clamp (lurus dan
bengkok)
stainless
25
20
20
5
4
art clamp
stainless
10
10
10
2
5
skin curette
5
3
3
-
6
Electro cauterisasi
Ellman surgitren FFPF
2
2
1
-
7
Comedo extraktor instrument set
Ekstraktor komedo
5
5
5
-
8
Microsurgery with dermatome
2
2
-
-
9
Tensimeter
3
2
1
-
10
Dioda laser surgical
1
1
1
-
2
1
2
2
1
2
2
2
UNIT
PELAYANAN
NO
NAMA ALAT
11
Stetoskop
12
Punch set
13
Peralatan Uji kulit:
SPESIFIKASI ALAT
RS kls A
3
Disposable biopsy punch merk premier @Unipunch, Ø3,4, dan 5
mm
JUMLAH MINIMAL
RS kls
RS kls
B
C
2
1
RS kls
D
1
Tiap
ukuran 20
buah/bln
tiap
ukuran
-
-
Uji tusuk
Stallergen
1/tahun
1/tahun
-
-
Uji tempel
Chemotechnique
1/tahun
1/tahun
-
-
Alat sentrifugasi
Yenaco
1/tahun
1/tahun
-
-
6
4
2
2
1
1
-
-
disposabl
e scalpel
300/bulan
10
5
2
Nirbeken
14
Fototerapi
15
Peralatan Kerokan kulit:
Daavlin 3 series smart touch
Skalpel tumpul
Manicure
sets 777
2
1 botol/
bulan
@7,5cc
1
-
-
-
16
Kantaridin
cantacur
7,5cc/bl
n
7,5cc/bl
n
-
17
Laser CO2
Mixto
-
-
-
18
Peralatan Bedah Skalpel
1
-
-
-
19
Minor surgery set
Esculap, Renz, Yamaco
15
5
5
2
20
Peralatan Bedah Beku
Crydpro maxi, Delasco
1
1
1
-
21
Peralatan Bedah 459nm
1
-
-
-
22
Laser NdYag
1
1
-
-
23
Peralatan Chemical peeling
V-beam candela dg aye shild, gogle operator, gogle pasien
Medlite, Power Output At Tissue ≥1 W, Exposure Time ≥0.1 sec,
Fiber repair Preferred, Laser Cooling System : Internal air cooling
Neostata 20, 35, 50, 70 % ;
2 set/bln
1set/bln
1 set/bln
-
UNIT
PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
TCA 10%, 20%, 35%
TCA 90%
Podofilin tinctura 25%
Gynecolog bed
JUMLAH MINIMAL
RS kls
RS kls
RS kls A
B
C
1 set/bln
1 set/bln 1 set/bln
50
50
100 cc/bln
cc/bln
cc/bln
50
50
100 cc/bln
cc/bln
cc/bln
1
1
1
RS kls
D
-
24
Peralatan Filler
Restilen
1
1
1
-
25
Peralatan Botox
Alergen
1
1
-
-
26
Spekulum
10
10
10
10
27
Sengkelit
10
10
10
10
9. PERALATAN KESEHATAN DI PELAYANAN SPESIALIS MATA
UNIT PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS kls
RS kls
B
C
PELAYANAN KESEHATAN MATA
PRIMER
1
Slit lamp
20
12
6
2
3
4
5
Autorefractometer
3
20
10
3
2
12
3
2
1
6
1
1
10
4
2
2
2
2
2
2
10
10
10
10
1
2
4
5
5
5
1
1
2
3
3
3
10
2
5
5
5
1
3
3
3
1
2
2
+
+
+
6
7
8
9
10
11
12
13
14
15
16
17
18
PELAYANAN KESEHATAN MATA
SEKUNDER
Oftalmoskop direk
Oftalmoskop indirek
Lens Meter
Bingkai uji coba trial lens (trial frame) dan
1 (satu) set lensa uji coba (trial lens set)
Lup Binokuler (lensa pembesar) 3-5
Dioptri
Streak Retinoskopi
Buku Ishihara-kanehara
Snellen test Projector
Basic opthalmik instrumen
Lampu senter
Loup
Tonometer Schiotz
Sterilizer table model
Lensa Gonometri dengan 3 cermin
Set Dilator Punctum
Obat-obatan diagnostik : Midriatikum,
anestesi lokal
RS kls
D
UNIT PELAYANAN
A. Peralatan Diagnostik
NAMA ALAT
1
Lembar optotip snellen yang dilengkapi
clock dial
Lembar kartu tes baca
Bingkai uji coba trial lens (trial frame) dan
1 (satu) set lensa uji coba (trial lens set)
+
+
+
-
+
+
+
-
+
+
+
-
4
5
6
7
8
9
10
11
12
13
14
Buku Ishihara-kanehara
Lensometer
Oftalmoskop direk
Oftalmoskop indirek
Slit lamp
Tonometer Schiotz
Tonometer Aplanasi
Tonometer non contact
Streak retinoscopy
Lensa Gonioskopi dengan 3 cermin
Refrakto Keratometer
+
+
+
+
+
+
-
+
5
+
+
2
2
3
+
3
+
+
2
2
1
+
+
+
+
+
3
+
+
1
1
1
1
Kampimeter Goldman
1
1
1
-
2
3
4
5
6
7
8
9
10
11
Kampimeter Automatic
Biometer A-scan
USG Mata
Retinometer
Fundus Camera + FFA
OCT
Pachymetri
Topografi kornea
Trial Lens Contact (Fitting)
ERG
1
1
1
1
1
1
1
1
1
1
1
1
1
1
-
1
1
1
-
-
2
3
B. Peralatan diagnostik
Pelengkap
SPESIFIKASI ALAT
JUMLAH MINIMAL
RS kls
RS kls
B
C
NO
RS kls
A
RS kls
D
-
-
UNIT PELAYANAN
C. Peralatan Bedah
NO
NAMA ALAT
12
13
14
15
16
17
18
19
20
21
VEP
Synophtofore
Strabismus Diagnostik Set
Hertel Oftalmometer
Spekular Mikroskop
Portable Slit Lamp
Portable Keratometer
Lab. Mikrobiologi Sederhana
Contras Sencitivity Test
Pelly Robson Test
1
Mikroskop Operasi
Mikroskop Operasi dgn Teaching Mirror/
CCTV
Portable Microscope
Set Peralatan Bedah :
 Glaukoma set
 Keratoplasti
 Fakoemulsifikasi set
 Bedah refraktif set
 Strabismus set
 Okuloplasti set
 Orbitotomy lateral set
 DCR set
 Vitreoretinal set :
1. Simple Vitrioretinal surgery
2. Vitrectomy unit
3. Endolaser unit
4. Cryosurgery
2
3
4
SPESIFIKASI ALAT
RS kls
A
1
1
1
1
1
1
1
1
1
1
JUMLAH MINIMAL
RS kls
RS kls
B
C
1
1
1
1
1
-
RS kls
D
-
7
4
2
-
3
2
1
-
5-10
3
1
-
2
2
4
1
1
1
1
1
2
1
2
1
1
-
1
-
1
1
1
1
1
1
-
UNIT PELAYANAN
D. Alat Tindakan Lain
NO
1
2
3
4
NAMA ALAT
Laser Fotocoagulasi retina set
Laser Fotocoagulasi Glaukoma set
YAG Laser set
Lasik set
SPESIFIKASI ALAT
RS kls
A
2
1
1
1
JUMLAH MINIMAL
RS kls
RS kls
B
C
1
1
1
1
-
RS kls
D
-
PELAYANAN KESEHATAN MATA
TERSIER
A. Peralatan Diagnostik
B. Peralatan diagnostik
Pelengkap
1
Slit lamp
20
12
6
-
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Autorefractometer
Oftalmoskop direk
Oftalmoskop indirek
Lensmeter
Trial lens set
Lup Binokuler 3-5 Dioptri
3
20
10
3
10
2
2
2
10
+
+
+
+
+
+
+
+
+
2
12
3
2
4
2
1
2
4
+
+
+
+
+
+
+
+
+
1
6
1
1
2
2
1
1
2
+
+
+
+
+
+
+
+
+
-
Streak retinoscopy
Buku Ishihara-kanehara
Snellen test Projector
Basic Opthalmik instrumen
Lampu senter
Loup
Tonometer Schiotz
Sterilizer table model
Obat diagnostik Midriatikum
Anestesi lokal
Lensa Gonioskopi dengan 3 cermin
Set Dilator Punctum
UNIT PELAYANAN
C. Peralatan Bedah
NO
SPESIFIKASI ALAT
RS kls
A
+
+
+
+
+
JUMLAH MINIMAL
RS kls
RS kls
B
C
+
+
+
+
+
+
+
+
+
+
RS kls
D
-
1
2
3
4
5
Kampimeter
1
2
+
+
+
+
+
+
-
+
+
+
-
4
Mikroskope Operasi
Peralatan Segmen Anterior
Peralatan bedah segmen posterior
sederhana
Peralatan Adneksa dan orbita sederhana
+
+
+
-
1
Katarak dan Bedah Refraktif
+
+
+
-
+
+
-
-
3
D. Peralatan Bedah
spesialistik
NAMA ALAT
2
Keratometer
USG Mata
Worth Four Dot Test
Retinometer
Set Fako-Emulsifikasi
ULTRASOUND SYSTEM
Handpiece type : Piezoelectric
Construction
: Titanium
Weight, g (oz) : ≤145 (5)
Frequency, kHz : 25-55
Pulse mode
: Preferred
Autoclavable
: Preferred
I/A SYSTEM
Pump type
: Peristaltic
Maximum vacuum, mm Hg : 500
I/A handpiece : Port diameters, 0.2-0.5 mm
Autoclavable : Preferred
ANTERIOR VITRECTOMY
Handpiece type : Guillotine
Variable speed : Preferred
OPERATIONAL MODES
Preferred (Irrigation, Ultrasound, I/A, Anterior
capsulotomy, Diathermy, Vitrectomy)
UNIT PELAYANAN
NO
3
4
5
6
7
8
NAMA ALAT
Set Transplantasi Tembus Kornea
Peralatan Refraksi Dan Lensa Kontak
Glaukoma
Peralatan Diagnostik Retina
Infeksi & Imunologi
Strabismus
13
14
PEDIATRIK OFTALMOLOGI
Trial lens set
Trial Frame
Chart Projector
Preferential looking
Lensometer
Streak retinoscopy
Autorefractometer
Slit lamp/ hand held slit lamp
Tonopen
Direct and indirect opthalmoscope
Bleharostat bayi
1 set alat pemeriksaan anel dan probing
(dengan berbagai ukuran)
USG
ERG, VEP
1
2
3
4
REKONSTRUKSI DAN ONKOLOGI
MATA
Hertel
Anel test & sonde
USG
Slit lamp
1
2
3
4
5
6
7
8
9
10
11
12
SPESIFIKASI ALAT
RS kls
A
+
+
+
+
+
+
JUMLAH MINIMAL
RS kls
RS kls
B
C
+
+
+
+
+
+
+
+
+
+
-
RS kls
D
-
+
+
+
+
+
+
+
+
+
+
+
-
-
-
+
-
-
-
+
+
-
-
-
+
+
+
+
-
-
-
UNIT PELAYANAN
NO
5
6
7
8
9
10
11
12
13
14
15
NAMA ALAT
17
18
Pungtum dilatator
Set peralatan bedah plastik
Probe lakrimal
Rounger
Periosteal elevator
Periosteal elevator iga
Boor
Sryker saw
Hak orbita berbagai ukuran
Silicon lacrimal tube
Bahan sintetik untuk rekonstruksi fraktur
Kawat halus atau prolen 3,0 atau plate &
screw
Implan orbita
Endoscope
1
2
3
NEURO OFTALMOLOGI
ERG/NEP
Perimeter Octopus
Hess Screen
16
SPESIFIKASI ALAT
RS kls
A
+
+
+
+
+
+
+
+
+
+
JUMLAH MINIMAL
RS kls
RS kls
B
C
-
RS kls
D
-
+
-
-
-
+
+
-
-
-
+
+
+
-
-
-
10. PERALATAN KESEHATAN PADA PELAYANAN MEDIK SPESIALIS GIGI MULUT
NO
1.
2.
UNIT/JENIS PELAYANAN
NO
NAMA ALAT
1
2
3
4
Alat dasar dokter gigi umum, ditambah
dengan :
Stainless steel crown set
Peraga penyuluhan kesehatan gigi
Tang otrodontic dasar
Alat endodontic dasar
Ilmu Kedokteran Gigi Anak
Prostodonsia
1
2
3
4
5
6
7
Dental X-Ray & Panoramic
Light Curing Apparatus
Amalgamator
Peralatan laboratorium teknik gigi
dasar
- Mikromotor set
- Straight handpiece
- Acrylic trimmer bur
- Stone bur
- Model trimmer
- Dental vibrator
- Mesin poles
- Feltcone
- Brush polisher
- Lampu spiritus
- Lecron
- Pisau wax
Tang Klamer 2 jari
Tang Klamer 3 jari
Periodontal Probe
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS Kls
RS kls
B
C
RS kls
D
+
+/-
-
-
2
4
2
1
3
1
1
2
1
1
1
1
4
4
10
10
2
2
2
5
5
10
10
10
10
10
5
3
3
5
5
1
1
1
3
3
5
5
5
5
5
3
2
2
3
3
1
3
3
3
3
3
2
1
1
2
2
2
3
2
1
1
1
NO
UNIT/JENIS PELAYANAN
NO
RS kls
A
5
5
5
5
JUMLAH MINIMAL
RS Kls
RS kls
B
C
3
2
3
2
3
2
3
2
RS kls
D
1
1
1
1
Crown retractor
Gingival retraction cord packer
Bite fork
Articulator rata-rata
12
Articulator semiadjustable & facebow
4
2
1
-
13
14
Bowl dan spatula
Anasthesi local set
- Citoject
- Conventional syringe
Set Penyemenan
Set preparasi mahkota & jembatan
Set cetak GTS/GTP &
Mahkota/Jembatan
Set Inersi GTS/GTP
Autoclave
Shade Guide
Implant set
15
8
5
2
5
5 box
10
20
3
3 box
7
15
2
2 box
5
10
1
1 box
2
5
20
10
2
10
5
15
5
1
5
2
10
3
1
4
-
5
1
1
2
-
+
+
+
+
+
+
+
+
+
-
+
+
+
+
+
+
+
+
-
17
18
19
20
21
Penyakit Mulut
SPESIFIKASI ALAT
8
9
10
11
15
16
3
NAMA ALAT
1
2
3
4
5
6
7
Tensimeter
Caliper lurus dari stenless
Bur intan :
a. Fissure
b. Tapered
c. Bulat
Dental unit + Dental Stool
Scaler
Probe
Senter Sinar Putih
NO
4
UNIT/JENIS PELAYANAN
Bedah Mulut
NO
NAMA ALAT
8
9
10
11
12
13
14
15
16
17
18
Alat standard pemeriksaan gigi
Mikroskop cahaya
Sterilisator
Alat standar disposable
Object glass
Pewarna methilen blue
Rotary brush
Pumice untuk setelah scalling
Cheek Retractor
Reflektor
Gas chromatography
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Dental unit
Dental X-Ray
Light Curing Apparatus
Pulp Tester
Oral Hygiene Set
Cavity preparation set
Amalgam set
Endodonsy set
Inlay Indirect set
Preparasi mahkota set
Set bedah mulut sinar
Anasthesi local set
Autoclave
Panoramic foto
Cito jack
Operating stool
SPESIFIKASI ALAT
RS kls
A
+
+
+
+
+
+
+
+
+
+
+
JUMLAH MINIMAL
RS Kls
RS kls
B
C
+
+
+
+
+
+
+
+
+
-
RS kls
D
-
NO
5.
UNIT/JENIS PELAYANAN
Orthodonsi
NO
17
Exodonsia set
1
Dental X-Ray
Peralatan laboratorium Teknik Gigi
Dasar
Set orthodensi piranti lepas
Set aktivar
Autoclave
2
3
4
5
6.
Prosthodonsi
NAMA ALAT
1
2
3
4
5
6
7
Dental X-Ray
Light Curing Apparatus
Amalgamator
Peralatan laboratorium Teknik Gigi
Dasar
Anasthesi local set (mohon diuraikan
secara terinci)
Set penyemenan (mohon diuraikan
secara terinci)
Set Preparasi Mahkota & Jembatan
(mohon diuraikan secara terinci)
8
Set cetak GTS/GTP &
Mahkota/Jembatan (mohon diuraikan
secara terinci)
9
Set insersi GTS/GTP (mohon diuraikan
secara terinci)
Autoclave
10
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS Kls
RS kls
B
C
RS kls
D
NO
7.
UNIT/JENIS PELAYANAN
Konservasi
NO
1
2
3
4
5
NAMA ALAT
Anasthesi local set (mohon diuraikan
secara terinci)
Set Tambahan sewarna Gigi dengan
Sinar (mohon diuraikan secara terinci)
Inlay Indirect set (mohon diuraikan
secara terinci)
Set Penyemenan (mohon diuraikan
secara terinci)
Autoclave
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS Kls
RS kls
B
C
RS kls
D
PERALATAN KESEHATAN PADA PELAYANAN SPESIALIS PENUNJANG MEDIK
1. PERALATAN KESEHATAN DI PELAYANAN ANESTESIOLOGI DAN TERAPI INTENSIF
A. ALAT UNTUK PELAYANAN ANESTESI
JUMLAH MINIMAL
NO
I.
JENIS ALAT
NO
NAMA ALAT
SPESIFIKASI / UKURAN
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
1 MESIN/ 3-4 OK
Untuk R.Premedikasi
√
√
√
-
1 MESIN/ 1 OK
√
√
√
-
ALAT UTAMA
TINDAKAN ANESTESI
1.
CIRCUIT SYSTEM
MESIN ANESTESI
A.
MESIN ANESTESI
SEDERHANA
1
2
3
4
Oksigen flusher
5
Sodalime (CO2 absorber)
6
Outlet oksigen Nasal Catheter/Masker
plastik transparant
Corrugated tubing 2 macam dewasa
dan anak2
Safety Device
7
8
B.
MESIN ANESTESI
STANDART
Manuil, tdk ada ventilator, tanpa listrik
Minimal 2 flow meter, 2 gas supply
Oksigen dan Udara/ N2O
Minimal 2 vaporizer (halothane dan
isoflurane), bergantian atau terpasang
2(dua) vaporizer
1
Ventilator. Mode minimal: Volume
Controlled
JUMLAH MINIMAL
NO
JENIS ALAT
NO
NAMA ALAT
SPESIFIKASI / UKURAN
2
3
4
5
6
7
8
9
10
C.
MESIN ANESTESI
CANGGIH
1
2
3
4
5
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
1 buah/ 4 OK (diantara
4 OK, ada 1 buah)
√
√
-
-
Panel monitor : I : E, VT, Resp Rate,
Range Berat Badan 10 kg - >100 kg
Bayi - Dewasa
Gas Supply minimal : 2 macam (2 buah
flow Meter): Oksigen – Udara - (N2O)
Minimal 2 vaporizer (Halothane –
Isoflurane atau Halothane –
Sevoflurane)
Sodalime (CO2 absorber)
Oksigen flusher
Outlet oksigen Nasal Catheter/ Masker
plastik transparant
Corrugated Tubing: 2 macam dewasa
dan anak2
Safety Device
Ventilator. Monitor Screen LCD Mode:
Volume dan Pressure Control
Panel monitor : Mode ventilator, I : E,
VT, MV, Resp Rate, Gas Supply, obat
anestesi
Range Berat Badan 2 kg - >100 kg
Neonatus - Dewasa
Gas Supply : 3 macam (3 buah flow
Meter): Oksigen – Udara - N2O
Minimal 2 vaporizer (Isoflurane –
Sevoflurane dan Halothane/
Sevoflurane)
JUMLAH MINIMAL
NO
JENIS ALAT
NO
NAMA ALAT
SPESIFIKASI / UKURAN
6
Sodalime (CO2 adsorber)
7
Oksigen flusher
8
Outlet oksigen Nasal Catheter/ Masker
plastik transparant
Corrugated Tubing: 2macam dewasa &
anak2
Safety Device
9
10
2.
OPEN SYSTEM
JACKSON REES
II.
PERLENGKAPAN LIFE SUPPORT
Dewasa, Anak dan Neonatus
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
Masing2 1 bh/ 2 OK
√
√
√
-
Adult 1 set/ OK
√
√
√
-
1 bh/ 4 OK
√
√
√
-
TINDAKAN ANESTESI
a. AIRWAY
1
Laryngoscope Set
dewasa Blade No 3 – 4 - 5
anak/ bayi Blade No: 000, 00, 0
Pediatri 1 set/ 4 OK
2
Laryngoscope Mc Coy
dewasa
3
Nasopharyngeal tube
Nomer. 5-6-7
Masing2 nomer 1bh
√
√
√
-
4
5
Oropharyngeal
No unt neonatus sd adult
Masing2 nomer 1bh
√
√
√
-
Masing2 nomer 1bh
√
√
√
-
tube
Endotracheal Tube (ETT)
dewasa Nomer 5 – 6 – 7 - 8
anak/ bayi Nomer. 2 -2.5 -3 -3.5 -4
6
Stylet
Ukuran 2 mm dan 3 mm
Masing2 nomer 1bh
√
√
√
-
7
Magyl forcep
dewasa, anak
Masing2 nomer 1bh
√
√
√
-
8
Mouth spreader
dewasa
1 bh/ 4 OK
√
√
√
-
9
Suction Apparatus
unit
1 Buah/ 1 OK
√
√
√
-
JUMLAH MINIMAL
NO
JENIS ALAT
b. BREATHING
c. CIRCULATION
III.
NO
NAMA ALAT
SPESIFIKASI / UKURAN
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
Masing2 nomer 1bh
√
√
√
-
Masker Anes/ BVM (face
mask)
anak - dewasa Nomer 1 – 2 - 3 – 4 - 5
2
Laryngeal Mask/ LMA
Type Classic nomer 3-4-5
Masing2 nomer 1bh
√
√
√
-
3
4
Bag Valve Mask (BVM)
bayi, anak, dewasa
Masing 1bh/ 2-3 OK
√
√
√
-
Simple Mask (plastik)
dewasa, anak
Masing2 nomer 1bh
√
√
√
-
5
Oksigen Tank Transport
Small Size : 330 liters O2
1 bh/ 2 OK
√
√
√
-
1.
DEFIBRILLATOR
Biphasic
1 unit/ lantai
√
√
√
-
2.
Syringe pump
jelas
Unit/ OK/ Unit Kerja
3 unit
2 unit
1 unit
-
3.
Infusion Pump
jelas
1 unit/ OK/ Unit Kerja
√
√
√
-
4.
Infusion pressure bag
jelas
1 unit/ OK/ Unit Kerja
√
√
√
-
5.
Infuse warmer
jelas
1 unit/ OK/ Unit Kerja
√
√
√
-
6.
Standart infuse
jelas
2 unit/ OK/ Unit Kerja
√
√
√
-
7.
Timbangan darah
jelas
1 unit/ 4 OK
√
√
√
-
a.
MONITOR sederhana
Layar monitor 10 - 12 inch, 2 parameter
1 unit/ 4 OK
Untuk R.Premed
√
√
√
-
1 unit/ 1 OK
√
√
√
-
1
bayi Nomer. 000, 00, 0
MONITOR
TINDAKAN ANESTESI
1.
BEDSIDE MONITOR
b.
MONITOR standart
1
EKG 3 lead
2
Saturasi (SpO2)
Layar monitor 12-14 inch, 4 parameter :
1
Tensi, Nadi (NIBP)
JUMLAH MINIMAL
NO
JENIS ALAT
NO
NAMA ALAT
SPESIFIKASI / UKURAN
2
Saturasi (SpO2)
3
EKG 3 lead
4
Temperatur
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
√
√
-
-
-
-
-
-
-
-
Dapat di upgrade menjadi monitor canggih
c.
MONITOR canggih
Layar monitor 14 inch atau lebih, 5 parameter
:
1 Tensi, Nadi (NIBP)
1 unit/ 3-4 OK
Tipe A: 1 unit/1-2OK
2
Saturasi (SpO2)
Tipe B: 1 unit/ 3-4OK
3
EKG 3 lead
4
Temperatur
5
Capnometer (ETCO2)
6
d.
MONITOR sangat
canggih
Dapat di upgrade menjadi monitor
sangat canggih
Layar monitor, LCD color 14 inch atau lebih,
> 6 parameter :
1
Tensi, Nadi (NIBP)
2
Saturasi (SpO2)
3
EKG 6-12 lead
4
Temperatur
-
-
-
5
Capnometer (ETCO2)
-
-
-
6
Invasive Blood Pressure (ABP)
-
-
-
7
CVP
-
-
-
8
Tampilan layar: NIBP, ABP, Resp,
-
-
-
MAP, SpO2, ETCO2, CVP, PAP
-
-
-
1 unit/ 6 OK
√
JUMLAH MINIMAL
NO
JENIS ALAT
NO
NAMA ALAT
SPESIFIKASI / UKURAN
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
-
.
2.
3.
4.
5.
IV.
MONITOR SATURASI
OKSIGEN
MONITOR END TIDAL
CO2
MONITOR TEKANAN
DARAH
MONITOR FUNGSI
PARU
(pemeriksaan suara
nafas)
PULSE OXYMETER
Portable atau mandiri
1 unit/ 3-4 OK
√
√
√
CAPNOMETER
Portable atau mandiri
1 unit/ 3-4 OK
√
√
√
-
TENSIMETER
a. Electric (otomatis)
1 unit/ 3-4 OK
√
√
√
STETOSCOPE
a.
1 unit/ 3-4 OK
√
√
√
Air Raksa (manual)
-
b.
Precordial Stetoscope
1 unit/ 1 OK
√
√
√
c.
Biaural Stetoscope
1 unit/ 1 OK
√
√
√
-
-
ALAT PENUNJANG
TINDAKAN ANESTESI
1
2
3
4
5
6
Untuk SAB/ Regional
Anestesi/CVC
Untuk Nerve Block/
Regional Anest
Ukur cara manuil VT
mesin anestesi
Untuk vena seksi/
pasang CVP
Untuk operasi2
neonatus/ bayi
Pengahangat untuk
operasi Pediatri atau
operasi lama
SAB- Doek sterile Set
jelas
3 set/ OK
√
√
√
-
Nerve Stimulator
jelas
1 unit
√
√
√
-
Spirometer manuil
jelas
1 unit
√
√
√
-
Hechting-Set
jelas
1 unit/ 4 OK
√
√
√
-
Infant Warmer
jelas
1 unit
√
√
√
-
Warming (and Cooling)
Machine
jelas
1 unit
√
√
-
-
JUMLAH MINIMAL
NO
7
8
9
V.
JENIS ALAT
NO
Untuk Intubasi sulit
atau Airway sulit
Untuk Intubasi sulit
atau Airway sulit
Menilai kedalaman
Anestesi (LOC) Level
of Consiousness
NAMA ALAT
SPESIFIKASI / UKURAN
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
Intubating Laryngeal
Mask Airway Fastrach
Jelas, 1 set isi 3 nomer (3 ukuran)
1 set
√
-
-
-
GlideScope
jelas
1 unit
√
-
-
-
BIS- Bispectral Index
Score
jelas
1 unit/ 4 OK
√
√
-
-
OXYGEN
CONCENTRATOR
jelas
1 unit/ 3 OK
-
-
√
-
ALAT TAMBAHAN
TINDAKAN ANESTESI
1
Sumber oksigen dari
udara bebas
B. ALAT RESUSITASI dan EMERGENCY
JUMLAH MINIMAL
NO
I.
JENIS ALAT
NO
NAMA ALAT
SPESIFIKASI / UKURAN
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
1 mesin/ 2 bed
√
√
√
-
1 mesin/ 4 bed
√
√
√
-
ALAT UTAMA
VENTILATOR
a.
VENTILATOR
STANDART
1
Mode minimal: Volume dan Pressure
Konvensional
b.
VENTILATOR CANGGIH
Ventilator. Panel monitor
2
1
Range Berat Badan 10 kg - >100 kg
Ventilator. Panel monitor LCD
Mode minimal: Volume dan Pressure
2
3
c.
CPAP
Ada mode untuk weaning PS, SIMV,
PSIMV (PSIMV < 15X/menit)
Range Berat Badan < 2 kg sd >100 kg
CPAP
NASAL CPAP (NIV- non invasive ventilation)
II.
√
√
-
-
√
√
√
-
1 buah
√
√
√
-
1 mesin/ 6 bed
PERLENGKAPAN LIFE SUPPORT
RESUSITASI dan EMERGENCY
a.
AIRWAY
1
Laryngoscope Set
dewasa Blade No 3 – 4 - 5
anak/ bayi Blade No: 000, 00, 0
BREATHING
Pediatri 1 set
2
Laryngoscope Mc Coy
dewasa
3
Nomer. 5-6-7
Masing2 nomer 3bh
√
√
√
-
4
Nasopharyngeal tube
Oropharyngeal tube
No unt neonatus sd adult
Masing2 nomer 3 bh
√
√
√
-
5
Endotracheal Tube (ETT)
dewasa Nomer 5 – 6 – 7 - 8
Masing2 nomer 3bh
√
√
√
-
anak/ bayi Nomer 2 -2.5 -3 -3.5 -4
b.
Adult 1 set
6
Stylet
Ukuran 2 mm dan 3 mm
Masing2 nomer 3bh
√
√
√
-
7
Magyl forcep
dewasa dan anak
Masing2 nomer 1bh
√
√
√
-
8
Mouth spreader
dewasa
1 buah
√
√
√
-
9
Suction Apparatus
unit
1 buah/ 2 bed
√
√
√
-
10
Neck collar
unit
1 buah
√
√
√
-
1
Masker Anes/ BVM (face
mask)
anak - dewasa Nomer 1 – 2 - 3 – 4 - 5
Masing2 nomer, 2
buah
√
√
√
-
Laryngeal Mask/ LMA
Type Classic nomer 3-4-5
Masing2 nomer , 1
buah
√
√
√
-
2
bayi Nomer. 000, 00, 0
c.
III.
CIRCULATION
3
Bag Valve Mask (BVM)
bayi, anak dan dewasa
Masing2, 1 buah/ bed
√
√
√
-
4
Simple Mask (plastik)
dewasa dan anak
Masing2, 1 buah/bed
√
√
√
-
5
Jackson Rees
dewasa, anak
Masing2, 1 buah/bed
√
√
√
-
6
Oksigen Tank Transport
Small Size : 330 liters O2
4 buah
√
√
√
-
1
DEFIBRILLATOR
Biphasic
1 unit/ lantai
√
√
√
-
2
Syringe pump
jelas
unit/ bed
3 unit
2 unit
2 unit
-
3
Infusion Pump
jelas
unit/ bed
1 unit
1 unit
1 unit
-
4
Infusion pressure bag
jelas
1 unit/ 2 bed
√
√
√
-
5
Infuse warmer
jelas
1 unit/ 2 bed
√
√
√
-
6
Standart infuse
jelas
2 buah/ 1 bed
√
√
√
-
7
Timbangan darah
jelas
1 unit
√
√
√
-
8
Short spine board
jelas
1 buah
√
√
√
-
9
Long spine board
jelas
1 buah
√
√
√
-
MONITOR standart
Layar monitor 12-14 inch 4 parameteR
1 unit/ 1 bed
√
√
√
-
1 unit/ 3 bed
√
√
√
-
ALAT MONITOR
RESUSITASI dan EMERGENCY
1.
BEDSIDE MONITOR
a.
1
Tensi, Nadi (NIBP)
2
Saturasi (SpO2)
3
EKG 3 lead
4
Temperatur
Dapat di upgrade menjadi monitor canggih
b.
MONITOR canggih
Layar monitor 14 inch atau lebih 5 parameter
1
Tensi, Nadi (NIBP)
2
Saturasi (SpO2)
3
EKG 3 lead
4
Temperatur
5
Capnometer (ETCO2)
Dapat di upgrade menjadi monitor sangat
canggih
2.
3.
4.
5.
III.
MONITOR SATURASI
OKSIGEN
MONITOR END TIDAL
CO2
MONITOR TEKANAN
DARAH
MONITOR FUNGSI
PARU (pemeriksaan
suara nafas)
a.
PULSE OXYMETER
Portable atau mandiri
1 unit
√
√
√
b.
CAPNOMETER
Portable atau mandiri
1 unit
√
√
√
c.
TENSIMETER
a.
Electric (otomatis)
1 unit/ 3 bed
√
√
√
b.
Air Raksa (manual)
1 unit/ 3 bed
√
√
√
-
1 unit/ bed
√
√
√
-
1 unit/ 1 bed
√
√
√
-
1 unit/ 3 bed
√
√
√
-
d.
STETOSCOPE
Biaural Stetoscope
-
ALAT MONITOR
RESUSITASI dan EMERGENCY
1.
BEDSIDE MONITOR
a.
MONITOR standart
Layar monitor 12-14 inch 4 parameteR
1
Tensi, Nadi (NIBP)
2
Saturasi (SpO2)
3
EKG 3 lead
4
Temperatur
Dapat di upgrade menjadi monitor canggih
b.
MONITOR canggih
Layar monitor 14 inch atau lebih, 5 parameter
2.
3.
4.
5.
V
MONITOR SATURASI
OKSIGEN
MONITOR END TIDAL
CO2
PULSE OXYMETER
CAPNOMETER
MONITOR TEKANAN
DARAH
TENSIMETER
MONITOR FUNGSI
PARU (pemeriksaan
suara nafas)
STETOSCOPE
1
Tensi, Nadi (NIBP)
2
Saturasi (SpO2)
3
EKG 3 lead
4
Temperatur
5
Capnometer (ETCO2)
Dapat di upgrade menjadi monitor sangat
canggih
Portable atau mandiri
Portable atau mandiri
√
√
√
1 unit
1 unit
√
√
√
-
a.
Electric (otomatis)
1 unit/ 3 bed
√
√
√
-
b.
Air Raksa (manual)
1 unit/ 3 bed
√
√
√
-
1 unit/ bed
√
√
√
-
Biaural Stetoscope
ALAT CANGGIH
RESUSITASI dan EMERGENCY
1
Alat Analisa Gas Darah
2
Alat Pemeriksa
Hemoglobin
Alat Pemeriksa Gula
Darah
Alat Pemeriksa
Electrolit
Alat Pemeriksa Lactate
Darah
6. Menilai kedalaman
sedasi (LOC) Level of
Consiousness
3
4
5
6
Ada pada 1 alat, contoh
iSTAT
iSTAT
1 unit
√
-
-
-
BIS- Bispectral Index
Score
jelas
1 unit
√
√
-
-
7
8
9
Pemeriksaan canggih
unt Airway
Pengukuran
hemodinamik, penilaian
cardiac output, fungsi/
anatomi jantung/ organ
dalam
Alat dialisis
Bronchoscopy
jelas
ECHOCARDIOGRAPHY
TEE –Trans Esophageal Echocardiography
Khususnya untuk RS dgn fasiltas operasi
TKV
mesin CRRT Continuous
Renal Replacement
Therapy atau HD
Jelas
√
√
1 unit
√
1 unit
√
-
-
-
-
-
-
-
-
C. ALAT PELAYANAN TERAPI INTENSIF
JUMLAH MINIMAL
NO
I.
JENIS ALAT
NO
NAMA ALAT
SPESIFIKASI / UKURAN
JUMLAH
RS kls
A
RS kls
B
RS kls
C
RS kls
D
1 mesin/ 2 bed
√
√
√
-
1 mesin/ 4 bed
√
√
√
-
1 mesin/ 6 bed
√
-
-
-
ALAT UTAMA
VENTILATOR
a.
b.
VENTILATOR
STANDART
Konvensional
VENTILATOR CANGGIH
Ventilator. Panel monitor
1.
2.
Mode minimal: Volume dan Pressure
Range Berat Badan 10 kg - >100 kg
1.
Ventilator. Panel monitor LCD
Mode minimal: Volume dan Pressure
c.
VENTILATOR SANGAT
CANGGIH
2.
Ada mode untuk weaning PS, SIMV,
PSIMV (PSIMV < 15X/menit)
3.
Range Berat Badan < 2 kg sd >100 kg
1.
Ventilator. Panel monitor LCD
Mode: Volume, Pressure, BiPAP dan
2.
HFO (High Frequency Oscillator, untuk
bayi).
3.
4.
d.
Ada mode untuk weaning PS, SIMV,
PSIMV (PSIMV < 15X/menit), NIV
Range Berat Badan < 2 kg sd >100 kg
VENTILATOR BAYI
Dapat diganti dengan Ventilator canggih
e.
II.
CPAP
CPAP
NASAL CPAP (NIV- non invasive ventilation)
1 mesin/ 4 mesin
dewasa
√
√
√
-
1 mesin/ 6 bed
√
√
-
-
√
√
√
-
1 bh
√
√
√
-
PERLENGKAPAN LIFE SUPPORT
PELAYANAN TERAPI INTENSIF
a.
AIRWAY
1.
Laryngoscope Set
dewasa Blade No 3 – 4 - 5
anak/ bayi Blade No: 000, 00, 0
BREATHING
Pediatri 1 set
2.
Laryngoscope Mc Coy
dewasa
3.
Nasopharyngeal tube
Nomer. 5-6-7
Masing2 nomer 3bh
√
√
√
4.
Oropharyngeal
No unt neonatus sd adult
Masing2 nomer 3 bh
√
√
√
5.
Endotracheal Tube (ETT)
Masing2 nomer 3bh
√
√
√
tube
dewasa Nomer 5 – 6 – 7 - 8
anak/ bayi Nomer. 2 -2.5 -3 -3.5 -4
b.
Adult 1 set
-
6.
Stylet
Ukuran 2 mm dan 3 mm
Masing2 nomer 3bh
√
√
√
7.
Magyl forcep
dewasa, anak
Masing2 nomer 1bh
√
√
√
8.
Mouth spreader
dewasa
1 buah
√
√
√
-
9.
Suction Apparatus
unit
1 buah/ 1 bed
√
√
√
-
1.
Masker Anes/ BVM
(face mask)
anak - dewasa Nomer 1 – 2 - 3 – 4 - 5
Masing2 nomer,
2buah
√
√
√
-
Masing2 nomer ,
1buah
√
√
√
bayi Nomer. 000, 00, 0
2.
Laryngeal Mask/ LMA
Type Classic nomer 3-4-5
-
-
CIRCULATION
3.
Bag Valve Mask (BVM)
bayi, anak, dewasa
Masing2, 1 buah/ bed
√
√
√
-
4.
Simple Mask (plastik)
dewasa,anak
Masing2, 1 buah/bed
√
√
√
-
5.
Jackson Rees
dewasa,anak
Masing2, 1 buah/bed
√
√
√
-
6.
Oksigen Tank Transport
Small Size : 330 liters O2
4 buah
√
√
√
-
1.
DEFIBRILLATOR
Biphasic
1 unit/ lantai
√
√
√
-
2.
Syringe pump
jelas
unit/ bed
3 unit
2 unit
2 unit
-
3.
Infusion Pump
jelas
unit/ bed
Infusion pressure bag
jelas
1 unit/ 2 bed
1 unit
√
1 unit
√
-
4.
1 unit
√
5.
Infuse warmer
jelas
1 unit/ 2 bed
√
√
√
-
6.
Standart infuse
jelas
2 buah/ 1 bed
√
√
√
-
7.
Timbangan darah
jelas
1 unit
√
√
√
-
MONITOR standart
Layar monitor 12-14 inch, 4 parameteR
1 unit/ 1 bed
√
√
√
-
1 unit/ 3 bed
√
√
√
-
c.
III.
-
ALAT MONITOR
PELAYANAN TERAPI INTENSIF
1.
BEDSIDE MONITOR
a.
1.
Tensi, Nadi (NIBP)
2.
Saturasi (SpO2)
3.
EKG 3 lead
4.
Temperatur
5.
b.
MONITOR canggih
Dapat di upgrade menjadi monitor
canggih
Layar monitor 14 inch atau lebih, 5 parameter
1.
Tensi, Nadi (NIBP)
2.
Saturasi (SpO2)
3.
EKG 3 lead
4.
Temperatur
5.
Capnometer (ETCO2)
6.
c.
2.
3.
4.
5.
IV.
MONITOR SATURASI
OKSIGEN
MONITOR END TIDAL
CO2
MONITOR TEKANAN
DARAH
MONITOR FUNGSI
PARU (pemeriksaan
suara nafas)
ALAT PENUNJANG
MONITOR sangat
canggih
PULSE OXYMETER
Dapat di upgrade menjadi monitor
sangat canggih
Layar monitor, LCD color 14 inch atau lebih,
> 6 parameter
1.
Tensi, Nadi (NIBP)
2.
Saturasi (SpO2)
3.
EKG 6-12 lead
4.
Temperatur
5.
Capnometer (ETCO2)
6.
Invasive Blood Pressure (ABP)
7.
CVP
8.
Tampilan layar: NIBP, ABP, Resp, MAP,
SpO2, ETCO2, CVP, PAP
1 unit/ 6 bed
√
√
-
-
Portable atau mandiri
1 unit
√
√
√
-
√
√
√
Portable atau mandiri
1 unit
CAPNOMETER
TENSIMETER
STETOSCOPE
-
a.
Electric (otomatis)
1 unit/ 3 bed
√
√
√
-
b.
Air Raksa (manual)
1 unit/ 3 bed
√
√
√
-
1 unit/ bed
√
√
√
-
Biaural Stetoscope
PELAYANAN TERAPI INTENSIF
1.
2.
3
4.
5.
6.
7.
8.
9.
10.
11.
12.
Alat Pemeriksa
Hemoglobin
Alat Pemeriksa Gula
Darah
Alat Analisa Gas
Darah & Elektrolit
Ukur cara manuil VT
mesin anestesi
Untuk vena seksi/
pasang CVP
Untuk tindakan/ pasang
CVC, dll
Menilai kedalaman
obat relaxan
Untuk operasi2
neonatus/ bayi
Warming (and Cooling)
Machine
Untuk Intubasi sulit
atau Airway sulit
Untuk Intubasi sulit
atau Airway sulit
Mesin Bulleau Drain
Hb-meter
jelas
1 unit
√
√
√
Gluco-Stick
jelas
1 unit
√
√
√
Blood Gas Analyzer
Spirometer manuil
Hechting-Set
Doek sterile Set
TOF guard
Infant Warmer
Untuk penghangat dan
Terapi hipotermia
GlideScope
Intubating Laryngeal
Mask Airway Fastrach
V
ALAT CANGGIH PELAYANAN TERAPI INTENSIF
1.
Alat Analisa Gas Darah
2.
Alat Pemeriksa
Hemoglobin
Ada pada 1 alat, contoh
iSTAT
jelas
1 unit
√
√
√
-
jelas
1 unit
√
√
√
-
jelas
1 unit/ 2 bed
√
√
√
-
jelas
1 set/ bed
√
√
√
-
jelas
1 unit
√
√
-
-
jelas
1 unit
√
√
√
-
jelas
1 unit
√
√
-
-
jelas
1 unit
√
√
-
-
Jelas, 1 set isi 3 nomer (3 ukuran)
1 set
√
√
-
-
jelas
1 unit
√
√
√
-
1 unit
√
-
-
-
iSTAT
3.
4.
5.
6.
7.
8.
9.
Alat Pemeriksa Gula
Darah
Alat Pemeriksa
Electrolit
Alat Pemeriksa Lactate
Darah
Menilai kedalaman
sedasi (LOC) Level of
Consiousness
Pemeriksaan canggih
unt Airway
Pengukuran
hemodinamik, penilaian
cardiac output, fungsi/
anatomi jantung/ organ
dalam
Pengukuran
hemodinamik, penilaian
cardiac output, fungsi/
anatomi jantung/
organ dalam
BIS- Bispectral Index
Score
jelas
bronchoscopy
jelas
ECHOCARDIOGRAPHY
TEE –Trans Esophageal Echocardiography
USG Ultra Sonografi
10.
Ukur Cardiac Out put
Vigileo atau PICCO
11.
Ukuran cardiac output
non invasif.
Mengganti fungsi
jantung – paru jangka
panjang
USCOM:Ultrasonic
Cardiac Output Monitor .
ECMO - Extra Corporeal
Membrane Oxygenator
12.
√
√
-
-
√
√
-
-
1 unit
√
-
-
-
Khususnya untuk RS dgn fasiltas operasi
TKV
1. Probe Vascular Golf Stick.
1 unit
√
-
-
-
2.
Probe Thorax
1 unit
√
-
-
-
Probe Abdomen
1 unit
√
-
-
-
1 unit
√
-
-
-
1 unit
3.
Jelas, khusus untuk RS dgn fasiltas operasi
TKV
Jelas, khusus untuk RS dgn fasiltas operasi
TKV
Jelas, khusus untuk RS dgn fasiltas operasi
TKV
1 unit
√
-
-
-
1 unit
√
-
-
-
2. PERALATAN KESEHATAN DI PELAYANAN MIKROBIOLOGI
NO
NAMA ALAT
1
Biosafety cabinet level 2A
2
Biosavety cabinet Level 2B
SPESIFIKASI ALAT
Binokuler, pembesaran 1000x
Dianjurkan menggunakan lensa anti jamur dan kondensor bukan plastik.
Sediaan lampu cadangan
RS kls
A
JUMLAH MINIMAL
RS kls
RS kls
B
C
RS kls
D
3
3
1
-
2
2
-
-
5
4
2
-
3
Mikroskop
4
Mikroskop lapang gelap
1
1
-
-
5
Mikroskop Fluoresen
1
1
-
-
6
Sink dan rak untuk pewarnaan
4
4
2
-
7
Bunsen
Incubator, suhu sd 45 C
Suhu 20-450C
5
4 buah,
@
Volume
200 liter
2
2 buah,
@
volume
120 liter
-
8
5
5 buah,
@
Volume
200 liter
9
Inkubator, suhu sd 45 C
Volume 600 liter, Pintu Kaca tembus pandang
1
-
-
-
10
Incubator, suhu sampai 80-90 C
1 buah,
Volume
200 liter
1 buah,
Volume
200 liter
1 buah,
Volume
120 liter
-
11
Incubator CO2, Volume 80 liter
1
1
-
-
12
Jar anaerob
Model Gas Pack
3
2
-
-
Kapasitas yang besar (600 liter)
5
3
2
-
Kapasitas kapasitas 200 liter
1
1
1
-
Volume 200 liter
1
1
-
-
13
Refrigerator suhu
40C
-200C
14
Freezer
15
Deep Freeze, suhu sd minus 100 C
-
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS kls
RS kls
B
C
RS kls
D
16
Sentrifus
Volume tabung sd 15 ml; kecepatan
Sampai dengan 10.000 rpm
3
2
1
-
17
Refrigerated Centrifuge
Volume tabung sd 15 ml
2
1
-
-
18
Refrigerated Micro-centrifuge
Kapasitas sekitar 20 tabung, volume 1,5 ml.
1
1
-
-
19
Timbangan analitik
Kapasitas menimbang di bawah 1 gram
2
1
1
-
20
Timbangan / Balance untuk Media
Kapasitas sd 1 kilogram
2
2
1
-
21
pH meter
1
1
1
-
22
Mesin PCR
2
1
-
-
23
Perangkat Elektroforesis, horizontal
4
2
-
-
24
Mesin Pembaca produk PCR,
1
1
-
-
25
Vortex
2
2
-
-
26
Inspisator
1
1
-
-
27
Mikropipet
2 set
2 set
-
-
28
Water purifier/Destilator
1
1
1
-
29
Autoklaf
3
2
2
-
30
ELISA reader
1
1
31
Shaking Water bath
1
1
-
-
32
Spectrophotometer
1
1
-
-
33
Inkubator kultur darah otomatik, dengan Optic
Sensing
2
1
-
-
34
Mesin Diagnostik Otomatis Mikrobiologi
1
1
-
-
Satu set
Contoh: GelDoc Machine
Pengatur suhu pada 80-85°C,
kapasitas tergantung beban kerja
Set: di bawah 5 mikroL, 5-20 mikroL, 20-50 mikroL, 50-100 mikroL, 1001000 mikroliter
Destilator tidak menggunakan “metal type”
Sumber air memenuhi persyaratan
Volume 60 liter
Volume air, sekitar 20 liter
kapasitas 120 tabung
-
NO
NAMA ALAT
SPESIFIKASI ALAT
RS kls
A
JUMLAH MINIMAL
RS kls
RS kls
B
C
RS kls
D
35
Mesin Diagnosis M.tuberculosis otomatik
Alat deteksi Mycobacterium dengan kultur media cair
1
1
-
-
36
Shaking Incubator
Volume 120 liter
1
1
-
-
37
Instrumen sterilisasi cairan menggunakan filter
Satu set dengan pompoa
1
1
-
-
38
Alat-alat Gelas:
Tabung Reaksi, Petri Dish, Erlenmeyer, Pipet,
secukup
nya
secukup
nya
secukup
nya
-
3. PERALATAN KESEHATAN DI PELAYANAN PATOLOGI ANATOMI
NO
1
2
UNIT PELAYANAN
Ruang TUP (Ruang pemotongan
jaringan dan pemeriksaan
makroskopik)
Ruang Pemrosesan jaringan
(Histologi)
NO
NAMA ALAT
JUMLAH MINIMAL RS
SPESIFIKASI ALAT
RS kls A
RS kls B
RS kls C
1
Work station / Grossing station
2
1
1
2
Autopsi set
2
2
1
3
Pisau Potong (1 set)
3 set
2 set
1 set
4
Gunting (lurus,bengkok,kecil)
5
3
2
5
Gergaji listrik
1
1
1
6
Pinset, scalpel
5
3
2
7
8
Alat pengukur (penggaris besi)
2
2
1
Alat pengukur berat (timbangan) < 1 kg
2
2
1
9
Alat pengukur berat (timbangan) > 1 kg
2
2
1
10
Loop / kaca pembesar
2
2
1
11
Talenan ( alas memotong jaringan)
4
3
2
1
Automatic Tissue Processing
2
2
1
2
Manual Tissue Processing
1
1
1
3
Automatic Staining Machine
2
2
1
4
Manual Staining
1
1
1
5
6
Embedding Center
Fully motorize rotary microtome + Waterbath
2
3
2
1
2
1
RS kls D
NO
UNIT PELAYANAN
NO
NAMA ALAT
JUMLAH MINIMAL RS
SPESIFIKASI ALAT
RS kls A
3
Ruang Klinik Sitologi
7
Manual Microtome + Waterbath
2
RS kls B
2
RS kls C
1
8
Cryostat
3
2
1
9
10
Hotplate
2
1
Peralatan gelas untuk processing manual
3
30
30
15
11
Timer
5
5
3
12
Microscope Binocular
2
1
1
13
Virtual microscope
1
0
0
14
Lemari asam
2
2
1
15
Ph meter
1
1
1
16
Alkohol meter
1
1
1
1
Tempat tidur pasien
1
1
1
2
Lampu sorot
2
1
1
3
Tempat tidur Gynekologi
1
1
1
4
5
Lampu rontgen
Lemari penyimpanan bahan - bahan FNAB
1
1
1
1
1
1
6
Meja trolly untuk alat
1
1
1
7
Meja kerja
1
1
1
8
Kursi
3
3
3
9
Spekulum (cocor bebek)
10 set
5 set
5 set
10
Autoclave / sterillisator listrik
1
1
1
11
Piston Gun
2
1
1
12
Microscope binocular
1
1
1
RS kls D
NO
4
5
UNIT PELAYANAN
Ruang Pemrosesan cairan
(sitologi)
Ruang Immunohistokimia
NO
NAMA ALAT
JUMLAH MINIMAL RS
SPESIFIKASI ALAT
RS kls A
RS kls B
RS kls C
1
Manual Staining Jar
20
20
10
2
Cyto Centrifuge 1500 rpm
1
1
1
3
Cyto Spin
1
1
0
4
5
Timer
Pipet set (dari kecil sd besar) masing-masing
4
2
4
2
2
2
6
Microscope binocular
3
2
1
7
8
Liquid Base Cytology Manual
1
1
1
Liquid Base Cytology Automatic / machine
1
1
0
9
Vortex
2
1
0
10
Lemari pendingin / kulkas
1
1
1
11
Alkohol meter
1
1
1
12
Hair Dryer
1
1
1
13
Rak Slide
5 set
5 set
3 set
1
Mesin standar automatic pulasan
immunohistokimia
2
2
1
2
Fully motorize rotary microtome + waterbath
2
2
1
3
Hotplate
2
2
1
4
Lemari pendingin 4°C
1
1
1
5
Frezer -20°C
1
1
1
6
Timer
5
5
5
7
Microscope binocular
2
1
1
8
Microscope double head
2
1
1
RS kls D
NO
UNIT PELAYANAN
NO
6
Ruang Imunofluoresensi
1
7
Ruang Patologi Molekuler
1
2
8
Ruang Diagnosa
NAMA ALAT
JUMLAH MINIMAL RS
SPESIFIKASI ALAT
RS kls A
RS kls B
RS kls C
Mikroskop imunofluoresensi lengkap dengan
kamera dan komputer + PC
1
1
1
PCR (RT dan convensional) masing-masing
1
1
0
3
1
0
0
Apparatus Electroforesis
3
gel doc
1
1
4
Ph meter
1
1
0
5
micro balance
1
1
0
1
Microscope binocular
6
5
2
2
3
2
1
3
Microscope double head
five headed microscope+camera
attached+PC
2
1
4
Meja untuk miksroskop
6
5
2
5
Kursi untuk diagnosis
6
5
2
6
Lemari buku (build in)
2
2
1
2
RS kls D
4. PERALATAN KESEHATAN DI PELAYANAN PATOLOGI KLINIK
NO
A
JENIS/
UNIT PELAYANAN
Peralatan Laboratorium
NO
NAMA ALAT
JUMLAH
SPESIFIKASI ALAT
RS kls A
RS Kls B
RS kls C
kls D
1
Biosafety cabinet level 2A
3
2
1
-
2
Fume hood (lemari asam)
1
+
-
-
3
Laminary air flow
1
1
-
-
4
Mikroskop
10
8
4
3
5
Sink dan rak untuk pewarnaan
5
5
4
2
6
Waterbath
37°C
5
3
2
1
7
Refrigerator 2-8°C
200 L
8
6
4
2
8
Cold room
3x3 m
2
1
-
-
9
Freezer -200C
200 L
4
3
2
-
10
Freezer
-800C
100 L
2
1
-
-
11
Sentrifus
1000 g, 15 mL
8
6
4
2
12
Mikrosentrifus
10000 rpm
1
1
1
1
13
Mikropipet
6 set
4 set
2 set
1 set
14
Vortex mixer
5
3
2
1
15
Mikroskop fluoresens
1
1
-
-
16
Stereomicroscope
1
-
-
-
17
Timbangan analitik
2
1
1
1
18
pH meter
2
1
1
1
6
4
2
1
4
2
2
1
19
Inkubator
20
Autoklaf
Binokuler, pembesaran 100, 400 dan 1000x
Antara
20-450C
Ukuran besar dan kecil ?
NO
JENIS/
UNIT PELAYANAN
NO
NAMA ALAT
JUMLAH
SPESIFIKASI ALAT
RS kls A
RS Kls B
RS kls C
kls D
21
Oven
+
+
+
-
22
EIA sistem
2
2
1
-
23
Rotator
2
2
1
-
24
Bunsen
8
6
4
2
25
Fume hood
2
2
1
-
26
Water purifier
1
1
1
-
27
Sitosentrifus
2
2
1
-
28
Spektrofotometer
2
1
1
1
29
Fotometer
-
-
-
1
30
Flowcitometer
1
1
-
-
31
Peralatan Gelas
+
+
+
+
2 (A)
2 (A)
1 (B)
1 (B)
Pipet gondok
Pipet volumetric
Gelas ukur
Tabung erlemeyer
Corong gelas
Tabung reaksi
B
Peralatan khusus
a. Hematologi
1
Hematology analyzer
A. Five parts differential
B. Three parts differential
2
Coagulometer
1
1
1
1
3
Agregometer
1
1
-
-
4
Spektrofotometer
1
1
1
1
5
Flow Cytometri
+
+
UV-VIS
NO
JENIS/
UNIT PELAYANAN
b. Kimia klinik
NO
NAMA ALAT
JUMLAH
SPESIFIKASI ALAT
RS kls A
RS Kls B
RS kls C
kls D
6
Analisa Hb
+
+
-
-
7
LED
+
+
+
+
1
Chemistry analyzer
2
2
1
-
2
Fotometer / spektrofotometer
1
1
1
1
3
Elektroforesis
1
1
-
-
4
Isoelectric focusing system
1
-
-
-
5
Analisa gas darah
+
+
+
-
6
Urine Analyzer
+
+
+
+
5. PERALATAN KESEHATAN DI PELAYANAN RADIOLOGI
NO
1
UNIT
PELAYANAN
Diagnostik
NO
NAMA ALAT
SPESIFIKASI ALAT
RS
Kls.A
5
JUMLAH MINIMAL
RS
RS
Kls.B
Kls.C
2
1
RS
Kls.D
1
1
Film viewer
2
Cassette & Film X-ray semua ukuran
10
5
2
1
3
Film marker
1
1
1
1
4
5
Film dryer
DSA
10
5
3
1
Multi function diagnostic dan therapy, vascular type,
intensifying screen imager 30 -35 inch, road map, land
marking, rotation view (double tube, flat detector),
DICOM 3 compliance
1
-
-
-
Minimal 1,5Tesla. Optional sesuai kebutuhan, DICOM 3
compliance, neuro radiology, oncology, pediatric,
musculosceletal, cardiology, spectroscopy, dilengkapi
dengan work station, injector, metal detector
2
1
-
-
Diatas 64 slice dengan injector. Dilengkapi dengan work
station, dicomp DICOM 3. Printer. Optional sesuai
kebutuhan
2
1
1 (2
slice)
-
2
1
-
-
6
7
8
MRI
CT Multislice
Fluoroskopi
Multipurpose fluoroskopi
High frequency X ray generalor 125 KV
Controle table
Undertable tube/low radiation
Digital system atau compatible computed radiography
(CR)
Ceiling/floor tube support
NO
UNIT
PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS
Kls.A
JUMLAH MINIMAL
RS
RS
Kls.B
Kls.C
RS
Kls.D
Tilting table dan bucky rapid spot film 4 image 2S
Cassette system , Minimal 18 x 24, 24 x30 Maksimal 35
x 35
High image intensifier
TV camera/CCTV. High density resolution
TV monitor 19 inch
9
USG 4D
Multipurpose, color doppler,
Transducer linier dan curve/sektoral 2.5 10
mHz,transducer3D,transducer
3
2
1
1
(USG
portable
)
2
1
-
-
3
2
1
1
transcranial, transrectal/vaginal,
Monitor dan printer USG
10
Analog X-ray Fixed Unit dan atau Digital
Multipurpose radiografi fungsional
Controle table digital atau manual
High tension transformer/generator
X-ray tube dengan kapasitas 40 -150
Meja stationer dengan bucky dan bucky stand
Expose time : 0.01 -1 detik
High X-ray voltage generator 40 -150 KV Generator
11
Mobile x-ray
Punya 2 tuas tangkal tube agar pergerakan dapat
leluasa
Kekuatan 30 -100 KV, minimal 100 mA
Kelengkapan proteksi radiasi : minimal 2
apron,tebal0.25 mm Pb
Beroda, dengan atau tanpa battery
NO
UNIT
PELAYANAN
NO
12
13
14
15
16
17
18
NAMA ALAT
Mammography
SPESIFIKASI ALAT
Digital, stereotactic, system bucky 18 x 24, 24 x 30,
magnification device, compression system (manual atau
motorized), radiation shield. Optional sesuai kebutuhan
(work station/viewer : 5 MP), mammo printer.
CCD System, High Tension Generator (Direct current
rectifying method; X-ray tube focal spot : 0.6 mm x 0.5
mm; tube voltage : 85 kV (57-85 kV); tube current : 12
mA; Exposure time : 12-16 sec (panoramic mode),
inherent filtration : more than 2.5 mm Al-equivalent; Film
size : 150 mm x 300 mm (cephalo mode); power
requirement : AC 100V, 50/60 Hz.
Digital; Focal spot : 0.7 mm x 0.7 mm; tube voltage : 6070 kV; tube current : 4-7 mA; exposure time 0.01 – 3.2
sec; total filtration : 2.0 mmAI; half value layer : 1,5
mmAI
Digital , x-ray generator high frequency, KV range 40 120, mA range 25 -100, exposure time 0.02 -5 sec. II
diameter 20 -35 em, TV monitor min 17 inch, cassette
holder suites 24 x 30, DICOM 3, C-arm free space
rotation, vertical , horizontal
RS
Kls.A
JUMLAH MINIMAL
RS
RS
Kls.B
Kls.C
RS
Kls.D
1
1
-
-
1
1
-
-
1
1
1
-
1
1
-
-
All radiographic examination, cassette all size, out put
power 90 -100 atau 65 70, pixel matrix size good quality,
patient ID, work station , DICOM 3
2
1
-
-
Picture Archiving Communication System'
(PACS)
Server, data storage , viewer, printer, peralatan radiologi
, LAN, internet, bisa/upgraded dihubungkan dengan RIS
(Radiology Integrated System) dan teleradioloqi
1
1
1
1
Peralatan protektif radiasi
Lead apron , tebal 0.25 ·0,5 mm Pb,
5
3
2
1
Digital Panoramic/ Cephalometri
Dental X-ray,
C-arm
Computed Radiography (CR)
Sarung tangan, 0.25 -0.5 mm Pb
Kaca mata Pb, 1 mm Pb
NO
UNIT
PELAYANAN
NO
NAMA ALAT
SPESIFIKASI ALAT
RS
Kls.A
JUMLAH MINIMAL
RS
RS
Kls.B
Kls.C
RS
Kls.D
Pelindung tiroid Pb, 1 mm Pb
Pelindung gonad Pb, 0.25 -0.5 mm Pb
Tabir mobile minimal 200 em (t}x100 cm
19
Perlengkapan proteksi radiasi
Survei meter
Digital Pocket Dosimeter
1
1
1
1
1
1
-
-
1
Sesuai
kebutuh
an
1
1
Sesuai
kebutu
han
1
1
Sesuai
kebutuh
an
1
1
Sesuai
kebutuh
an
1
Film badge/TLD,
20
2
Therapy
Quality Assurance dan Quality Control
Beam alignment test tool , densitometer, sensitometer,
collimator tool, automatic beam analyzer, alat pengukur
suhu dan kelembaban disesuaikan dengan alat
21
Emergency Kit
22
Viewing box
23
Generator set
1
Cobalt Unit
1
-
-
-
2
Brakhitherapy Remote afterloading laju
dosis rendah
1
-
-
-
3
Brakhitherapy Remote afterloading laju
dosis tinggi
1
-
-
-
4
5
6
7
8
9
Simulator
TPS 2D
TPS 3D
TPS 3D, IMRT, SRT, IGRT
Moulding
Dosimetridan survey meter
1
1
1
1
1
1
-
-
-
Double bank, sesuai kebutuhan
NO
3
UNIT
PELAYANAN
Kedokteran
Nuklir
NO
NAMA ALAT
SPESIFIKASI ALAT
RS
Kls.A
1
JUMLAH MINIMAL
RS
RS
Kls.B
Kls.C
-
RS
Kls.D
-
10
Linear accelerator
11
Linac dengan dilengkapi MLC, conformal
terapi, 11 . IIMRT, SRT, lGRT
1
-
-
-
1
2
Kamera gamma
Gamma atau beta counter
1
1
-
-
-
3
ECG synchronizer (automatic synchronizer)
dengan gamma kamera)
1
-
-
-
4
5
6
7
8
9
10
11
12
13
14
15
Nebulizer radioaerosol
Processing box (hot cell)
Treadmill/ergocycle
Alat pengukur radioaktivitas
Alat protekel
Radiasi
Gamma probe
Laminar fume hoods
Alat pemotong jarum
Emergency kit
Alat uji kualitas
Tempat limbah
1
1
1
1
1
1
1
1
1
1
1
1
-
-
-
6. PERALATAN KESEHATAN DI PELAYANAN REHABILITASI MEDIK
NO
1
UNIT PELAYANAN
Rehab Medik
NO
NAMA ALAT
1
Examination Table
2
Examination lamp
3
Stetoscope
TENAGA MEDIS
SPESIFIKASI ALAT
RS KLS
A
JUMLAH MINIMAL
RS KLS RS KLS
B
C
3
3
1
Dokter
6
6
1
Fisioterapi
4
3
1
OT
1
1
1
4
Spygmomanometer
5
Shortwave Diathermy
Fisioterapi
3
1
1
6
Micromave Diathermy
Fisioterapi
3
2
1
7
Ultrasound Therapy
Fisioterapi
2
1
1
8
LF Electro Therapy
9
Faradic-Galvanic Therapy
10
Laser Therapy
Fisioterapi
1
0
0
11
Infrared dan Ultraviolet
Fisioterapi (Infrared)
3
2
1
Fisioterapi(Ultraviolet)
2
1
1
12
Compression Therapy
13
Acupunture Therapy
14
Traction Unit
Fisioterapi
3
2
1
15
Suspention & Pulley Equipment
Fisioterapi(pulley)
2
1
1
OT (suspension walker)
4
2
0
OT(suspension arm sling set)
3
2
0
16
Exercise Equipment
RS KLS
D
NO
UNIT PELAYANAN
NO
17
NAMA ALAT
Treadmill
TENAGA MEDIS
Dokter
SPESIFIKASI ALAT
RS KLS
A
1
JUMLAH MINIMAL
RS KLS RS KLS
B
C
1
0
Fisioterapi
2
1
0
18
Parafin Bath
Fisioterapi
2
1
1
19
Hidro Therapy
Fisioterapi
1
0
0
20
Bath Whirl Pool
Fisioterapi
1
0
0
21
Pulse Erator Unit
22
Isostation For Accurate
23
Lymphatic Physiotherapy
24
25
Finger Muscle Therapy
26
Rowing Machine
Fisioterapi
1
1
0
27
Exercise Bicycle
28
Electro Stimulation & Analgesia
29
Wheel Chair
Fisioterapi
2
2
1
30
Biotrigger Computerize Analizer
31
Ultraviolet quartz
Fisioterapi
2
2
1
32
Hotpacks & Perculator
Fisioterapi
3
3
1
33
IVP
34
Paralell bars
Fisioterapi
2
2
1
OT (besar)
1
1
1
OT (kecil)
1
1
1
Dokter
1
1
0
Fisioterapi
2
2
1
Therapeutical Nerve & Muscle
Stimulation
35
TNS
36
Ergocycle
RS KLS
D
NO
2
3
UNIT PELAYANAN
Psikolog
Fisiotherapy
NO
NAMA ALAT
37
rehab Timer
38
Ankle/Wrist
39
Tilt Table
40
Matras
1
TENAGA MEDIS
OT
Fisioterapi
SPESIFIKASI ALAT
RS KLS
A
2
JUMLAH MINIMAL
RS KLS RS KLS
B
C
2
1
6
6
1
Peralatan Intellegence dan Bakat
1
1
0
2
peralatan kepribadian
1
1
0
3
Perlatan Organis
4
Peralatan Konsultasi dan Terapi
1
Perangkat Olahraga
OT
1
1
0
2
Perangkat Rekreasi
OT
1
1
0
3
Peralatan Ruang Kulit
Meja Kulit
6
6
0
pisau seset kulit
6
0
0
pisau potong kulit
1
0
0
penggaris 100cm
1
1
0
penggaris 60cm
1
1
0
penggaris 30cm
5
5
0
meteran kain
2
2
0
ambleng sepatu
3
3
0
Batu asah
3
3
0
Palu karet
1
1
0
Mesin jahit kain
5
5
0
Mesin jait kulit
2
2
0
set
set
0
Jarum tangan kulit
RS KLS
D
NO
UNIT PELAYANAN
NO
4
5
NAMA ALAT
Peralatan Ruang Kimia
Peralatan Ruang GIP
TENAGA MEDIS
SPESIFIKASI ALAT
RS KLS
A
JUMLAH MINIMAL
RS KLS RS KLS
B
C
Kayu cetakan sepatu 10-43
5
5
0
Alat Pemasang mata ayam
3
3
0
Pelubang kulit cakra
Pelubang kulit (plong)
Kec/bes
6
6
0
6
6
0
Bending iron
2
2
0
Oven thermo plastik
1
1
0
Kompor gas
1
1
0
Timbangan tepung
1
1
0
setrika listrik
1
1
0
Hair dryer
1
1
0
Masker & Kacamata Grinda
3
3
0
Sarung Tangan
5
5
0
Bak Air Panas
1
1
0
gunting seng
2
2
0
Gunting biasa
5
5
0
Test Pen
2
2
0
Lemari Alat/bahan
2
2
0
Pemotong GIP listrik
1
1
0
Pemotong gip (manual)
1
1
0
Oven Pengering gip
1
1
0
Kikir gip bulat
2
2
0
Kikir gip flat
2
2
0
kikir grip 1/2 bulat
2
2
0
Bak penampung air
1
1
0
RS KLS
D
NO
UNIT PELAYANAN
NO
6
NAMA ALAT
Peralatan Ruang kerja Pembuatan
TENAGA MEDIS
SPESIFIKASI ALAT
RS KLS
A
JUMLAH MINIMAL
RS KLS RS KLS
B
C
Jig modifikasi gip
1
1
0
Kamar mandi/WC
1
1
0
Mesin Bor Duduk 13mm
1
1
0
Mesin bubut medium
1
1
0
Mesin bubut small
1
1
0
Jig saw
1
1
0
Seperangkat las listrik
1
1
0
Seperangkat las acetyline
1
1
0
Kompresor angin
1
1
0
Mesin Router (all purpose)
1
1
0
Gurinda poles
3
3
0
Gurinda duduk
1
1
0
Gurinda tangan
1
1
0
Bor tangan
1
1
0
Gunting pemotong plat
1
1
0
Bench saw
1
1
0
Exshauter
1
1
0
Lemari penggantung alat
3
3
0
Paron 25kg
1
1
0
Mesin amplas sepatu
1
1
0
Gergaji besi
2
2
0
Vacum cleaner
1
1
0
Tang gegep
5
5
0
Kunci shock (set)
1
1
0
Kunci ring/pas (set)
1
1
0
RS KLS
D
NO
UNIT PELAYANAN
NO
7
NAMA ALAT
Peralatan Ruang Kerja kayu
TENAGA MEDIS
SPESIFIKASI ALAT
RS KLS
A
JUMLAH MINIMAL
RS KLS RS KLS
B
C
Meja kerja
2
2
0
Kikir kasar bulat kecil besar
1
1
0
Kikir kasar 1/2 bulat
1
1
0
Kikir kasar plat kecil besar
1
1
0
Kikir halus 1/2 bulat
1
1
0
Kikir halus plat kecil
1
1
0
Kikir alumunium
2
2
0
Jangka besi
2
2
0
Drip/center drip
3
3
0
Water pas
1
1
0
Tang biasa
2
2
0
Obeng kembang (-)
1
1
0
Obeng plat (-)
1
1
0
Tang pemotong kawat
2
2
0
Palu konde kecil besar
2
2
0
Kunci inggris kecil besar
2
2
0
Snei komplit
1
1
0
Tap komplit
1
1
0
Tang kakak tua
2
2
0
Pahat besi kecil besar
3
3
0
Tanggem kecil besar
6
6
0
Gergaji kayu potong K/B
3
3
0
Gergaji kayu belah K/B
1
1
0
Penggaris siku besi
3
3
0
Kikir Kayu K/B
2
2
0
RS KLS
D
NO
UNIT PELAYANAN
NO
NAMA ALAT
TENAGA MEDIS
SPESIFIKASI ALAT
RS KLS
A
JUMLAH MINIMAL
RS KLS RS KLS
B
C
Mata bor perseng adjustable
3
3
0
Pahat kayu
2
2
0
Mesin amplas rata
3
3
0
RS KLS
D
PERALATAN KESEHATAN PADA PELAYANAN PENUNJANG KLINIK
1. PERALATAN KESEHATAN PADA PELAYANAN FARMASI
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
NAMA ALAT
Lemari pendingin/ refrigerator
Lemari khusus narkotik
Mortir-stamper/blender obat
mixer
Paket alat pembuat puyer
Precision balance
APD (alat pelindung diri)
Laminar Air Flow (LAF)
Biosafety cabinet
Incenerator
SPESIFIKASI ALAT
RS KLS A
JUMLAH MINIMAL
RS KLS B
RS KLS C
RS KLS D
2. PERALATAN KESEHATAN PADA PELAYANAN GIZI
NO
1.
KEGIATAN
NAMA RUANGAN
KEBUTUHAN PERALATAN
SPESIFIKASI
RS
Kls A
JUMLAH MINIMAL
RS
RS
Kls B
Kls C
RS
Kls D
Asuhan Gizi rawat
inap
a. Kegiatan asuhan
gizi
Alat Ukur tinggi badan dan Berat
badan
Smic ZT 120
45
20
10
5
Alat ukur Lingkar Lengan Atas
Bahan plastik
56
30
10
5
Knee hight (alat ukur tinggi lutut)
Besi
5
5
5
3
Food model
Bahan Resin
8
5
5
3
Skinfold
Besi, tingkat ketelitian 0.01 cm
Digital, dengan penyangga samping kirikanan
12
10
5
3
3
3
2
1
Timbangan Bayi
Alat Ukur Panjang badan Bayi
Multiplex, 1.) Tinggi : 6.5 cm 2.) Lebar : 30
cm 3.) Panjang : 109.7 – 110 cm
3
2
1
1
Bed scale
Kapasitas 500 kg, Berat pasien maksimal
250 kg, Fungsi : TARE, Pre-TARE, HOLD,
BMI, nilai batas, peredam gerakan
4
3
1
1
Bioelectrical Analisys Impedance
Analisa komposisi tubuh (Bioscan 920-II)
2
2
1
1
Chair scale
Pita Ukur Lingkar Pinggang dan
Pinggul
TERA, Auto-HOLD, Automatic swich-off
Bahan Plastik, panjang 150 cm, ketelitian
0.5 cm
2
2
1
1
56
30
10
5
NO
KEGIATAN
b. Kegiatan
pelayanan makanan
NAMA RUANGAN
KEBUTUHAN PERALATAN
SPESIFIKASI
RS
Kls A
JUMLAH MINIMAL
RS
RS
Kls B
Kls C
RS
Kls D
Pantry
Meja Distribusi Makanan
stainlessteel, STPA 15-60, 1500x600x850
mm
2
1
1
1
(untuk 1 pantry)
Rak alat makan
stainlessteel, 4 susun, SPRP 15-50A
1500x500x1600 mm
1
1
1
1
Lemari alat makan
stainlessteel, SCCS 9-60, 900X600X1800
MM
1
1
1
1
alat pemanas
kompor gas portable 2 tungku
1
1
1
1
refrigerator khusus makanan cair
1 pintu, kaca, kapasitas 150 lt, semi auto
defros, low voltage
1
1
1
1
refrigerator
1 pintu, kapasitas 179 lt, semi auto defros,
low voltage
1
1
1
1
1
1
1
1
1
1
1
1
tempat pencucian alat
Food Trolley Sentralisasi
stainlesstell 2 sink
stainlessteel, dengan pemanas, kapasitas
20 trays, 4 roda.
Panjang 9250 mm ,L 640 mm , T 1240 mm
2.
Asuhan Gizi Rawat
jalan
Ruang konseling gizi
Food Trolley Desentralisasi
stainlessteel, dengan pemanas, 4 roda.
Panjang 9250 mm, L 640 mm, T 1240 mm
1
1
1
1
Trolley makanan kelas VIP
stainlessteel, 3 susun, beroda, FST 7-55,
700x555x900 mm
1
1
1
1
Timbangan Makanan
digital, kapasitas 2 kg
1
1
1
1
Blender
Container dari formika, kapasitas 2 liter
2
2
1
1
Alat makan khusus dewasa
Keramik/ Plato stainlees/Plato melamin
SK
SK
SK
SK
Alat makan pasien anak
Keramik/ Plato stainlees/ plato melamin,
SK
SK
SK
SK
Alat Ukur tinggi badan dan Berat
badan (Dewasa dan Anak)
Smic ZT 120
3
3
2
2
NO
3.
KEGIATAN
Penyelenggaraan
Makanan
NAMA RUANGAN
Penerimaan
KEBUTUHAN PERALATAN
RS
Kls A
JUMLAH MINIMAL
RS
RS
Kls B
Kls C
RS
Kls D
Alat ukur Lingkar Lengan Atas
Bahan plastik
3
3
3
2
Food model
Bahan Resin
5
3
3
2
Skinfold
Besi, tingkat ketelitian 0.01 cm
1
1
1
1
Lemari kaca (untuk Food sample)
stainless 2 pintu SWM
1
1
1
1
timbangan lantai
ukuran 100-150 kg
1
1
1
0
timbangan duduk
ukuran 50 kg
1
1
1
1
timbangan digital
ukuran 5 kg
load transfer trolley ukuran 1,2 m x 0.8 m x
0.9 m
1
1
1
1
3
3
1
1
washtafell
Keramik
1
1
1
1
Tempat sampah
besar, plastik, injak, beroda
1
1
1
1
timbangan digital
ukuran 5 kg
1
1
1
1
timbangan duduk
ukuran kapasitas 10-20 kg
1
1
1
1
Pallet
plastik, ukuran 100x200x10cm
Stainless steel, 2 pintu, 600 nlt,
700x850x1970 mm
10
10
5
3
1
1
1
1
2
1
1
1
2
2
1
1
2
2
1
1
trolley barang
Ruang penyimpanan
bahan makanan
kering
SPESIFIKASI
Refrigerator
Tempat sampah
Chiller 4 pintu
besar, plastik, injak, beroda
stainlees AISC 304, kapasitas 1200 l
x140vcm x 850 mm x 1970 mm,
Cooling system blower w/ automatic
defrosting
NO
KEGIATAN
NAMA RUANGAN
KEBUTUHAN PERALATAN
RS
Kls A
JUMLAH MINIMAL
RS
RS
Kls B
Kls C
RS
Kls D
Tangga Lipat
standart, almunium, tinggi 2,5 m
1
1
1
1
Hand lift
Small 2T, 1150 MM, W/Nylon
load transfer trolley ukuran 1,2 m x 0.8 m x
0.9 m
1
1
1
1
2
1
1
1
timbangan lantai
ukuran 100-150 kg
1
1
1
1
Container bertutup
plastik ukuran 80 liter, 120 liter, 200 liter
20/10/'5
15/10/'5
10/'8
10
AC Split
Standart 2 Pk
1
1
1
1
timbangan digital
ukuran 5 kg
2
2
1
1
timbangan duduk
ukuran 50 kg
2
2
1
1
Refrigerator
stainless steel, 2 pintu
1
1
1
1
Tempat sampah
injak, bertutup, beroda
stainlees AISC 304, kapasitas 1200 l
x140vcm x 850 mm x 1970 mm,
2
2
1
1
1
1
1
0
trolley barang
Ruang penyimpanan
bahan makanan segar
SPESIFIKASI
Chiller 4 pintu
Coolyng System blower w/ automatic
defrosting
trolley barang
load transfer trolley ukuran 1,2 m x 0.8 m x
0.9 m
6
4
3
2
timbangan lantai
ukuran 100-150 kg
1
1
1
0
Timbangan duduk
Kapasitas 20-50 kg
1
1
1
1
Container bertutup
plastik ukuran 10 L
15
10
8
5
Container bertutup
plastik ukuran 80 liter, 120 liter, 200 liter
16/10/'5
15
10
5
Freezer cabinet
1 pintu
model 7.0 B, ukuran 3x1,5x2,2 m, volume
7200 L
1
1
1
1
1
1
1
0
Cold room Freezer (Temp -15˚s.d 18˚C)
NO
KEGIATAN
NAMA RUANGAN
Ruangan persiapan
bahan makanan
KEBUTUHAN PERALATAN
RS
Kls A
JUMLAH MINIMAL
RS
RS
Kls B
Kls C
RS
Kls D
Cold room chiller (Temp + 2˚s.d 8˚
C)
model 7.0 B, ukuran 3x1,5x2,2 m, volume
7200 L
3
2
1
1
insectkiller
tanpa lampu UV
4
3
4
2
Timbangan duduk
kapasitas 20-50 kg
1
1
1
1
Timbangan digital
kapasitas 5 kg
1
1
1
1
mesin pemotong daging
meet beat slicer 10'
1
1
1
1
mesin pemotong sayuran
vegetable slicer
bergandeng, stainless, 2 sink table with
Splash back
1
1
1
1
2
2
2
1
penggiling daging
meat grinder, stailess steel
1
1
1
1
mixer
duduk, kue
2
2
1
1
blender
kapasitas 2-5 liter
1
1
1
1
penggiling bumbu
kapasitas 2-5 liter
talenan daging, talenan sayuran, talenan
buah
1
1
1
1
3/4/'4
3/3/'3
2/2/'1
2/2/'1
bak cuci
talenan
Ruang pengolahan
makanan
SPESIFIKASI
food procesor
Multi fungsi, stainless
1
1
1
1
peeler
stainless, Portable Potato Peeler
1
1
1
0
Tempat sampah
besar, plastik, injak, beroda
2
2
1
1
Insect Killer
tanpa lampu UV
Pisau
pisau daging, pisau sayuran, pisau buah
Timbangan
ukuran 5 kg
2
2
1
1
2/5/'5
2/5/'3
2/2/'2
2/2/'1
1
1
1
1
NO
KEGIATAN
NAMA RUANGAN
KEBUTUHAN PERALATAN
SPESIFIKASI
RS
Kls A
JUMLAH MINIMAL
RS
RS
Kls B
Kls C
RS
Kls D
table range 4 tungku, bahan bakar gas,
stainless 800x750x850/910
6
5
4
1
kuali range 2 tungku, bahan bakar gas,
stainless 320x700x850/910
4
3
3
2
frying pan
stainless
2
2
1
1
Gelas ukur
formika
stainless steel,ABM 15-75, ukuran 1500 x
750 x 850/950 mm
5
5
4
3
2
2
2
1
blender
kapasitas 2-5 liter formika
2
2
2
2
Boiling pan
stainless, 100-150 liter, bahan bakar uap
Stainless Steel, kapasitas 80 L, bahan bakar
gas
6
5
5
4
2
2
2
1
oven
oven gas
2
2
2
1
High pressure cooker
stainless
2
2
2
1
Rice cooker
3 susun : elekrik
2
2
1
0
1 susun : Gas
2
2
1
1
cooking range
Bain marrie
Boiling Pan
Pan dadar / ceplok telur
anti lengket
4
3
1
1
double sink heavy
stainless
4
3
1
1
tempat sampah
injak, bertutup, beroda
Stainless Steel, FST 7-55, ukuran 725 x 555
x 900 mm
8
7
4
1
3
3
2
2
Kuali Range
1 tungku
4
4
2
2
Refrigerator
2 pintu
1
1
1
1
Freezer
1 pintu
1
1
1
1
chiller
1 pintu
1
1
1
1
Lemari Alat
stainless, 2 pintu, 4 susun,
3
3
1
1
Trolley
NO
KEGIATAN
NAMA RUANGAN
KEBUTUHAN PERALATAN
Ruang Formula
JUMLAH MINIMAL
RS
RS
Kls B
Kls C
RS
Kls D
stainlees, 4 susun, beroda
4
4
1
1
Lemari Makanan Matang
stainless, 2 susun
1
1
1
1
Mesin Wrapping
plastik wrap food grade, cutter pemanas.
2
2
1
1
Panci set
stainless steel, 1 set panci susun 5
2
2
1
1
Insect Killer
Meja persiapan snack, makanan
cair
cetakan telur
tanpa lampu UV
8
7
2
1
Stainlees 80x75x180 cm,
5
5
1
1
anti lengket
stainless diameter 35cm, diameter 50cm,
diameter 70cm
2
2
1
1
6/6/'6
6/5/'5
6/5/'4
4/3/'2
Plastik, ukuran 80L, 120 L
10
10
7
5
Model NFDT 8- 60 H, 800 x 600 x 1040 mm
10
8
5
5
Model NFDT 8- 60, 800 x 600 x 1040 mm
1
1
1
1
2-5 kg, ketelitian 0.1 kg
1
1
1
1
2
2
1
0
container tertutup
Ruang pencuci dan
penyimpanan alat
RS
Kls A
Rak Alat
Wajan
Ruang distribusi
SPESIFIKASI
Food Trolley makanan dengan
pemanas
Food Trolley makanan tanpa
pemanas
timbangan duduk
mesin pencuci alat
diswashing beserta pemanas dan air dingin
bak pencuci alat
2 bak beserta pemanas dan air dingin
2
2
1
1
lemari
stainless, 2 pintu, 4 susun,
1
1
1
1
rak alat
stainlees, 4 susun, beroda
3
3
1
1
tempat sampah
injak, bertutup, beroda
2
2
2
1
sterilisator
Stainless steel, berisi 3 rak , ukuran 1500 x
500 x 2000 mm
1
1
1
1
NO
KEGIATAN
NAMA RUANGAN
KEBUTUHAN PERALATAN
SPESIFIKASI
RS
Kls A
JUMLAH MINIMAL
RS
RS
Kls B
Kls C
RS
Kls D
tempat sampah
injak, bertutup, beroda, bahan stainless
steel/plastik
2
2
1
1
gelas ukur
formika, kapasitas 1000 ml
4
4
3
1
mixer
kapasitas 2-5 liter
1
1
1
1
blender
bowl formika, kapasitas 2-5 liter
2
2
1
1
kompor gas
kompor gas portable 2 tungku
kuali range 2 tungku, bahan bakar gas,
stainless 320x700x850/910
1
1
1
1
1
1
1
1
tungku
cooking range
table range 4 tungku, bahan bakar gas,
stainless 800x750x850/910
1
1
1
0
Refrigerator
stainless steel 2 pintu
1
1
1
1
Mesin pencuci botol
stainless steel,
stainless steel,ABM 15-75, ukuran 1500 x
750 x 850/950 mm
1
1
1
1
1
1
1
1
Lemari bahan makanan kering
stainless, 2 pintu, 4 susun,
1
1
1
1
Rak botol Susu
stainless, 2 pintu, 4 susun,
stainless steel, 3 susun , ukuran 700x 555x
900 mm
2
2
1
1
3
3
1
1
Bain marrie
Trolley
Trolley
Stainless steel, 2 susun, ukuran 700 x 555 x
900 mm
2
2
1
0
Rak alat
Stainless steel, 4 susun, beroda
2
2
1
1
bak pencuci alat
2 bak beserta pemanas dan air dingin
2
2
1
1
3. PERALATAN KESEHATAN PADA PELAYANAN STERILISASI SENTRAL
NO
NAMA ALAT
JUMLAH MINIMAL
SPESIFIKASI ALAT
KETERANGAN
RS kls A
RS Kls B
RS kls C
RS kls D
Area Kotor
1
Sink
Bak cuci yang cukup lebar dan dalam
4
3
2
2
2
Gun Spray
Suplai air bertekanan melalui selang
dengan bermacam semprotan
digunakan untuk pencucian bagian
dalam lumen
2
1
1
1
3
Ultra Sonik
Alat pembersih dengan prinsip kavitasi
dari gelombang ultra sonik, digunakan
untuk instrumen mikro
2
1
1
1
4
Scope Cleaner
Dihubungkan dengan detergent dan
disinfectant, digunakan untuk pencucian
scope
1
1
0
0
5
Washer Disinfector - Mounted
Alat pembersih dengan prinsip deterjen
dan air bertekanan. Dua pintu,
berkapasitas 8 tray
3
2
0
0
6
Washer Disinfector - Table Top
Alat pembersih dengan prinsip deterjen
dan air bertekanan
0
0
1
1
7
Endoscope washer
Digunakan untuk pencucian endoskop
1
1
0
0
8
Verification Cleaning Monitoring Device
Digunakan untuk monitoring pencucian
di instrument washer
2
1
0
0
NO
NAMA ALAT
JUMLAH MINIMAL
SPESIFIKASI ALAT
KETERANGAN
RS kls A
RS Kls B
RS kls C
RS kls D
9
Drying Cabinet
Lemari pengering instrument dengan
aliran udara steril
2
1
0
0
10
Cart/ Bed Washer Disinfector
Pembersih kereta pengiriman instrumen
atau pembersih tempat tidur
1
0*
0
0
11
Trolly Barang Kotor
Pembawa Instrumen Kotor
10
6
2
1
Area Bersih
1
Meja setting
Meja kerja untuk penataan instrumen
atau linen. Ukuran menyesuaikan
kebutuhan rumah sakit
4
3
2
1
2
Magnifying Glass
Kaca pembesar untuk inspeksi
instrumen. Disertai lampu untuk
memperjelas
2
1
0
0
3
Packing Cutter
Pemotong pengemas instrumen
6
4
2
1
4
Perekat pengemas instrumen
Untuk memberi label pada kemasan yg
disterilkan
4
2
1
1
5
Packing Sealer
Gun Labeler dengan Indikator proses
sterilisasi
4
2
1
1
6
Batch Monitoring Challenge Device
Untuk monitoring sterilisasi per batch
1
1
0
0
7
Hot Air Sterilizer - Oven
Alat sterilisasi dengan menggunakan
udara panas. Ukuran menyesuaikan
kebutuhan rumah sakit.
0
0
1
1
Autoclave - Table top
Alat sterilisasi dengan prinsip uap air
dengan suhu dan tekanan tertentu yang
diletakkan di atas meja, berkapasitas 20
- 30 liter
1
1
1
1
8
*) Kecuali rumah sakit
khusus infeksi
NO
NAMA ALAT
JUMLAH MINIMAL
SPESIFIKASI ALAT
KETERANGAN
RS kls A
RS Kls B
RS kls C
RS kls D
Autoclave - Mounted - Single Door
Alat sterilisasi dengan prinsip uap air
dengan suhu dan tekanan tertentu yang
dipasang secara pasti. Dengan 1
pintu,Kapasitas di RS tipe D antara 300
liter ± 10 %, di RS tipe C antara 450 liter
± 10 %.
0
0
1
1
10
Autoclave - Mounted - Double Door
Alat sterilisasi dengan prinsip uap air
dengan suhu dan tekanan tertentu yang
dipasang secara pasti. Dengan 2
pintu,Kapasitas di RS Tipe B antara 550
liter ± 10 %, sedangkan di RS Tipe A
antara 700 liter ± 10 %
3
2
1
0
11
Sterilisator suhu rendah
3
2
1
0
9
Metode menyesuaikan kebutuhan
rumah sakit:
1. Etilen Oksida
2. LTSF
3. H2O2 / Plasma
4. Ozon
Kapasitas 30 - 250 Liter
12
Inkubator Indikator Biologis
Inkubator dengan suhu yang sesuai
untuk indikator biologis
1
1
0
0
13
Timbangan Kg
Kapasitas 25 Kg
1
1
1
1
14
Trolly Barang Bersih
Pembawa Instrumen Bersih
10
6
2
1
Area Steril
NO
NAMA ALAT
JUMLAH MINIMAL
SPESIFIKASI ALAT
KETERANGAN
RS kls A
RS Kls B
RS kls C
RS kls D
4
3
2
1
1
Rak penyimpanan
Rak penyimpanan dengan banyak
tingkatan untuk menyimpan barang yang
telah disterilkan. Besar rak
menyesuaikan kebutuhan rumah sakit
2
Water Treatment System
Untuk mengolah air yang disupply ke
CSSD
1
1
1
1
3
Thermometer
Alat Pengukur suhu ruangan
3
3
2
2
4
Hygrometer
Alat pengukur kelembaban ruangan
3
3
2
2
5
Barometer
Alat Pengukur tekanan udara
1
1
0
0
6
Trolly Barang Steril
Pembawa Instrumen Steril
10
6
2
1
7
Hepa Filter
Efisiensi 99,8 - 99,9 %
1
1
0
0
Keterangan
1
Kebutuhan ini merupakan usulan sesuai dengan kebutuhan rata-rata tiap kelas rumah sakit
2
Kebutuhan alat tiap rumah sakit tergantung pelayanan masing -masing, baik pelayanan operasi, obsgyn
dan pelayanan perawatan lainnya yang membutuhkan barang steril
4. PERALATAN KESEHATAN PADA PELAYANAN BANK DARAH RUMAH SAKIT
NO
I
JENIS PERALATAN
JUMLAH MINIMAL
SPESIFIKASI ALAT
RS kls A
Paket A Peralatan Utama dan Bahan Habis Pakai
A. Penyimpanan
1. Blood Bank 100 -280 liter (tergantung kebutuhan)
1
2. Medical refrigerator
1
3. Platelet agitator dgn inkubator
1
4. Freezerdengan suhu penyimpanan maksimal -300C (RS tipe
1
A dan B pendidikan)
B. Pemeriksaan pra transfusi
1. Golongan darah ABO dan Rhesuspada resipien dan donor
(metode pemeriksaan cell typing dan serum typing) :
Metode pemeriksaan golongan darah:

Blood grouping plate atau

Tabung reaksi ukuran 12x75mm

Reagen anti ABO dan Rhesus (yg sdh
direkomendasi oleh instansi yang berwenang)
2. Skrining antibodi:

kebutuhan
Sesuai
kebutuhan
Sesuai
kebutuhan
Sel panel kecil
3. Uji silang serasi

Sesuai
Minimal metode Tabung Bovine Albumin:
1
RS Kls B
 Dry incubator
 Serofuge (dengan 2 macam rotor tabung kecil
ukuran 12x75 mm dan besar ukuran 5 ml)
1
1
 Microscope binoculer
 Reagen Bovine Albumin, coombs serum
C. Distribusi

Cool box dgn fasilitas 2-5 kantong

Cool box untuk transportasi dgn fasilitas min. 20
kantong (untuk kebutuhan diluar pengiriman rutin dari
1
Secukupnya
5-10
1
UTD)
Paket
I
B Peralatan Penunjang dan Bahan Habis Pakai
I
Rak
tabung
5 buah
Gunting
2 buah
Pasteur pipette plastik
2 buah
Object glass
3 box
Timer
2 buah
Labu Semprot
4 buah
Baskom stainless steel
4 buah
Jas Laboratorium
Masker sekali pakai
2 x jlh petugas
1 box
Wadah infeksius
1 buah
Termometer pengukur suhu untuk kalibrasi alat rutin
Sesuai
Desinfektan kulit
kebutuhan
Desinfektan peralatan
Secukupnya
Sarung tangan sekali pakai
Secukupnya
NaCl 0,9 %
Sesuai
kebutuhan
Secukupnya
I.
NO
PERSYARATAN MINIMAL PERALATAN DAN BAHAN HABIS PAKAI UTD TINGKAT KABUPATEN/KOTA
JENIS KELENGKAPAN
1.
Perlengkapan seleksi donor
1.1
Peralatan :
Timbangan badan
Beaker glass ukuran 30 ml dan wadah
CuSO4
Tempat kapas Stainlessteel
Termos, wadah untuk menyimpan antisera
Wadah limbah infeksius
Wadah limbah non infeksius
Tensimeter untuk dokter
Bahan Habis Pakai
Blood lancet
1.2
JUMLAH
JUMLAH
Di Gedung
UTD
Mobile Unit
Di Gedung
UTD
Mobile Unit
1 buah
1 buah
1 buah
1 buah
1buah
1buah
1buah
1buah
1
1
1
1
1
1
1
1
1
1
1buah
1buah
1 buah
1 buah
1 buah
1buah
1buah
1 buah
1buah
1 buah
Secukupnya
Secukupnya
buah
buah
buah
buah
buah
Secukupnya
buah
buah
buah
buah
buah
Secukupnya
Pipet kapiler
Desinfektan kulit dgn spray
Kaca obyek sekali pakai
Kapas steril
Ice pack utk reagen termos
Kantong limbah infeksius
Kantong limbah non infeksius
Sabun desinfektan untuk cuci tangan
Secukupnya
1 btl
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1 btl
Secukupnya
1 btl
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1 btl
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Reagensia.
Larutan CuSO4 BJ 1.052
Anti sera anti A, anti B monoklonal
Anti D monoklonal IgM
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
2.
Perlengkapan pengambilan darah
Di Gedung
UTD
Mobile Unit
Di Gedung
UTD
Mobile Unit
2.1
Peralatan :
Tempat tidur statis
Tempat tidur lipat
Tensimeter
Klem / pean
Pinset
Haemoscaleelectric (with mixer function)
Hand sealer
Gunting
Tempat gunting & pean
Tempat pinset
Tempat kassa
Tempat kapas steril
Rak tabung 24 lobang
Electric sealer
Wadah limbah infeksius
Wadah limbah non infeksius
2
2
4
2
2
1
2
2
2
1
2
1
1
1
1
2
2
4
2
2
1
2
2
2
1
2
1
1
1
8 buah
8buah
1 buah
1 buah
16 buah
8 buah
8 buah
4buah
4 buah
8 buah
8 buah
8 buah
4 buah
8 buah
1 buah
8 buah
8 buah
16 buah
8 buah
8 buah
4 buah
4 buah
8 buah
8 buah
8 buah
4 buah
8 buah
-
1.3
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
Tempat limbah padat infeksius (tajam)
2.2
3.
4.
4.1
Bahan Habis Pakai :
Kantong darah 350 ml single, double, triple
Kantong darah pediatric
Sarung tangan ukuran. S,M.L
Desinfektan kulit
Kassa steril
Tabung reaksi dengan tutup ulir untuk
contoh darah
Plester medis
Kantong limbah infeksius
Kantong limbah non infeksius
Desinfektan peralatan
Perlengkapan penyimpanan darah
Blood bank refrigeratorkarantina uk 100L
Blood bank refrigerator darah siap pakai
uk. 100L
Peti pendingin darah / cool box untuk
mobile unit (25 – 50 kantong)
Peti pendingin darah/cool box untuk
ruangan (2 – 5 kantong)
Termometer kontrol
Termometer digital
Perlengkapan Laboratorium Pra
Transfusi
Peralatan :
Serological centrifuge utk tube 12 x 75 mm
Table top centrifuge
Medical refrigerator
Inkubator ( Dry incubator)
1 buah
1 buah
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1 buah
1 buah
4 buah
4 buah
4 buah
4 buah
4 buah
4 buah
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1buah
1buah
1 buah
2 buah
2 buah
5 buah
2 buah
2 buah
1
1
1
1
buah
buah
buah
buah
1
1
1
1
buah
buah
buah
buah
Mikroskop
Tabung reaksi kaca yang dilapisi silikon
atau sekali pakai uk. 12x75mm dan rak
tabungnya
Bloodgrouping plate
Pipet Pasteur uk 1 ml
Adjustable mikropipet uk 5 – 10050ul
Labu semprot
Timer
GelasWadah bilas pipet Pasteur
Gunting
Kaca objek
Ember kecil untuk limbah cair
Wadah limbah infeksius
Wadah limbah non infeksius
4.2
4.3
1 buah
secukupnya
secukupnya
secukupnya
secukupnya
1 buah
2 buah
2 buah
2 buah
Secukupnya
2 buah
Secukupnya
Secukupnya
Bahan Habis Pakai :
Kantong limbah infeksius
Kantong limbah non infeksius
Kertas saring
Tissue
Parafilm
Yellow Tip
Sarung tangan uk S,M,L
Desinfektan instrumen
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1 roll
Secukupnya
Secukupnya
1 botolSecukupnya
Reagensia :
Antisera A, B, D IgM monoklonal@10 ml
Bovine Albumin 22% @ 10 ml
Anti Human Globulin@ 10 ml
Anti D IgG @ 10 ml
Test Sel Standar A, B, O (Dibuat sendiri)
NaCl 0,9 %
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1 buah
1 buah
1 buah
secukupnya
secukupnya
secukupnya
secukupnya
4 buah
4 buah
4 buah
8 buah
4
Secukupnya
secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
roll
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Reagen sel panel untuk skrining allo
antibodi donor
5.
5.1
5.2
Pengolahan Komponen Darah
Peralatan :
Hand Sealer
Electric Sealer
Timbangan darah
Digital Balance
Refrigerated Centrifuge
Plasma Extractor
Klem
Gunting
Freezer -30°C
Blast freezer (pengganti dry ice + Alkohol
96% )
Platelet Incubator & Agitator
Tempat sampah infeksius
Tempat sampah non infeksius
Bahan & alat habis pakai :
Kantong darah ganda, triple
Pipet kapiler
Kapas
Alkohol 70%
Alkohol 96%. Secukupnya.
Dry Ice
Washing bag Secukupnya.
NaCl 0,9%.
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1
1
1
1
1
1
2
2
1
1
2
1
2
2
1
2
4
4
1
1
2
2
1
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
1 buah
1 buah
1 buah
secukupnya
secukupnya
secukupnya
secukupnya
secukupnya
secukupnya
secukupnya
secukupnya
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
buah
secukupnya
secukupnya
secukupnya
secukupnya
secukupnya
secukupnya
secukupnya
6
6.1
6.2
Crito seal
Alumunium ring
Peralatan Laboratorium Pemeriksaan
IMLTD
Metode Rapid Test (untuk jumlah darah
donor <2000 kantong/tahun)
Tabung Reaksi uk.12x75 mm
Rak Tabung reaksi 40 lubang
Metode Elisa (untuk jumlah darah donor
>2000 kantong/tahun )
Alat Elisa set
Tip kuning
Tip biru
Tabung Reaksi uk.12x75 mm
Rak Tabung reaksi 40 lubang
Mikropipet ukuran 5-50 ul
Mikropipet ukuran 50-200 ul
Mikropipet ukuran 200-1000 ul
Dry Incubator
Timer
secukupnya
secukupnya
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1 buah
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1 buah
1 buah
1 buah
1 buah
1 buah
1 buah
Secukupnya
Secukupnya
Secukupnya
Secukupnya
1 buah
1 buah
1 buah
1 buah
1 buah