LAPORAN PENERIMAAN DAN PEMAKA

KABUPATEN BR
PUSKESMAS SITA
TAHUN 201
SATUAN HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN
1 2 3 4 5

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592
14 EDTA 10 % Botol 100 ml botol 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904
18 Hayem Botol 100 ml botol 268,604
19 turk Botol 100 ml botol 99,347
20 Rees Ecker Botol 100 ml botol 121,424
21 Aquades Botol 1000 ml botol 20,070
22 widal O Botol 5 ml botol 134,915
23 widal H Botol 5 ml botol 134,915
24 Xylol Botol 100 ml botol 204,212
25 Emersi oil Botol 100 ml botol 864,683
26 Golongan Darah botol 10 x 4 botol 345,650
27 HCG Urine box 50 test box 107,040
28 HbsAg Rapid test box 50 test box 557,500
29 Malaria rapid test box 25 test box 724,750
30 RF test kit 5 ml kit 312,200
31 Urin test 10 parameter tube 100 test tube 334,500
32 Urin test 3 parameter tube 100 test tube 167,250
33 Kartu Golda box 100 lb box 55,750
34 Micropor inc box 24 gulung box 267,600
35 Termal rol 5,7 rol Rol rol 10,592
36 Glukosa stik on call box 25 test box 167,250
37 Glukosa stik easy tooch box 25 test box 167,250
38 Uris acid east tooch box 25 test box 278,750
39 Cholesterol easy tooc box 10 test box 223,000
40 Hb stik Quick cek box 50 test box 858,550
41 Kertas Lensa buah 50 shet buah 33,450
42 Lancet box 100 buah box 39,025
43 Kertas Saring box 100 lembar box 18,955
44 Diluent ST box 2 liter box 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000
47 Hematology Cleaner botol 100 ml botol 390,250
48 Preci control multi botol 5 ml botol 390,250
49 Card mellet box Box box 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800
51 Paket reagen melet box paket box 9,700,500
52 Eosin btl 100 ml btl 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000
54 WIDAL H Botol 5 ml botol 132,000
55 WIDAL O Botol 5 ml botol 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750
57 HCL 100 ML Botol 100 ml botol 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825
64 Biliirubin 2x100ml Box Box 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075
67 Hemoglobin Kit Kit 1,322,167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
ENERIMAAN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
PUSKESMAS SITANGGAL
TAHUN 2016
HARGA SISA AWAL PENERIMAAN PEMAKAIAN
SATUAN VOLUME HARGA VOLUME HARGA VOLUME HARGA
6 7 8 9 10 11 12

1,944,000 - - - - -
1,962,400 - - - - -
826,200 - - - - -
834,020 - - - - -
681,753 - - - - -
688,067 - - - - -
2,006,407 - - - - -
2,806,650 - - - - -
2,833,215 - - - - -
4,131,000 - - - - -
4,170,100 - - - - -
643,729 - - - - -
647,592 - - - - -
283,322 2 566,643 - - 1 283,322
121,424 4 485,694 - - 4 485,694
224,450 - - - - -
115,904 - - - - -
268,604 1 268,604 - - - -
99,347 1 99,347 - - - -
121,424 4 485,694 - - 4 485,694
20,070 7 140,490 - - 7 140,490
134,915 9 1,214,235 - - 9 1,214,235
134,915 9 1,214,235 - - 8 1,079,320
204,212 1 204,212 - - - -
864,683 1 864,683 - - 1 864,683
345,650 5 1,728,250 - - 5 1,728,250
107,040 2 214,080 - - 1 107,040
557,500 1 557,500 - - - -
724,750 1 724,750 - - - -
312,200 1 312,200 - - - -
334,500 1 334,500 - - - -
167,250 5 836,250 - - 3 501,750
55,750 8 446,000 - - 8 446,000
267,600 2 535,200 - - 1 267,600
10,592 - - - - -
167,250 10 1,672,500 - - 9 1,505,250
167,250 10 1,672,500 - - 9 1,505,250
278,750 8 2,230,000 - - 8 2,230,000
223,000 12 2,676,000 - - 12 2,676,000
858,550 2 1,717,100 - - 2 1,717,100
 33,450 7 234,150 - - - -
39,025 7 273,175 - - 7 273,175
18,955 - - - - -
1,784,000 - - - - -
1,092,700 - - - - -
892,000 - - - - -
390,250 - - - - -
390,250 - - - - -
3,122,000 - - - - -
802,800 - - - - -
9,700,500 - - - - -
217,425 - - - - -
50,000 - 1 50,000 1 50,000
132,000 - - - - -
132,000 - - - - -
156,750 - 1 156,750 - -
41,250 - 12 495,000 2 82,500
70,000 - - - - -
70,000 - 1 70,000 - -
25,000 - 2 50,000 - -
110,000 - 1 110,000 - -
20,000 - 3 60,000 - -
1,287,825 - - - - -
797,225 - - - - -
1,753,895 - - - - -
1901075 - 0 - 0 -
1322167 - 0 - 0 -
121.00 21,707,991 21 991,750 102 17,643,352

Sitanggal, Januari 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
 SISA AKHIR
VOLUME HARGA
13 14

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1 283,322
- -
- -
- -
1 268,604
1 99,347
- -
- -
- -
1 134,915
1 204,212
- -
- -
1 107,040
1 557,500
1 724,750
1 312,200
1 334,500
2 334,500
- -
1 267,600
- -
1 167,250
1 167,250
- -
- -
- -
 7 234,150
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1 156,750
10 412,500
- -
1 70,000
2 50,000
1 110,000
3 60,000
- -
- -
- -
- -
- -
40 5,056,389

Laboratorium

............................
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : JANUARI 2
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
ULAN : JANUARI 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
2 566,643 - - - 2
4 485,694 - - 1 121,424 3
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
4 485,694 - - 1 121,424 3
7 140,490 - - 1 20,070 6
9 1,214,235 - - 1 134,915 8
9 1,214,235 - - 1 134,915 8
1 204,212 - - - - 1
1 864,683 - - - 1
5 1,728,250 - - 1 345,650 4
2 214,080 - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
5 836,250 - - 1 167,250 4
8 446,000 - - 2 111,500 6
2 535,200 - - 1 267,600 1
- - - - - -
10 1,672,500 - - - 10
10 1,672,500 - - 2 334,500 8
 8 2,230,000 - - 1 278,750 7
12 2,676,000 - - 3 669,000 9
2 1,717,100 - - - 2
7 234,150 - - - - 7
7 273,175 - - 2 78,050 5
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
121.00 21,707,991 18 2,785,047 103

Sitanggal, Februari 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
566,643
364,271
-
-
268,604
99,347
364,271
120,420
1,079,320
1,079,320
204,212
864,683
1,382,600
214,080
557,500
724,750
312,200
334,500
669,000
334,500
267,600
-
1,672,500
1,338,000
 1,951,250
2,007,000
1,717,100
234,150
195,125
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
18,922,944
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : FEBRUARI
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
ULAN : FEBRUARI 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
2 566,643 - - 1 283,322 1
3 364,271 - - - 3
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - 1
3 364,271 - - - 3
6 120,420 - - - 6
8 1,079,320 - - 1 134,915 7
8 1,079,320 - - 1 134,915 7
1 204,212 - - - - 1
1 864,683 - - 1 864,683 -
4 1,382,600 - - - 4
2 214,080 - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
4 669,000 - - - 4
6 334,500 - - 3 167,250 3
1 267,600 - - - 1
- - - - - -
10 1,672,500 - - - 10
8 1,338,000 - - 4 669,000 4
 7 1,951,250 - - 2 557,500 5
9 2,007,000 - - 4 892,000 5
2 1,717,100 - - 2 1,717,100 -
7 234,150 - - - - 7
5 195,125 - - 3 117,075 2
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
103.00 18,922,944 22 5,537,759 81

Sitanggal, Maret 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
364,271
-
-
268,604
99,347
364,271
120,420
944,405
944,405
204,212
-
1,382,600
214,080
557,500
724,750
312,200
334,500
669,000
167,250
267,600
-
1,672,500
669,000
 1,393,750
1,115,000
-
234,150
78,050
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
13,385,185
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : MARET 20
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
BULAN : MARET 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
1 283,322 - - - 1
3 364,271 - - 1 121,424 2
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
3 364,271 - - 1 121,424 2
6 120,420 - - 1 20,070 5
7 944,405 - - 1 134,915 6
7 944,405 - - 2 269,830 5
1 204,212 - - - - 1
- - - - -
4 1,382,600 - - 1 345,650 3
2 214,080 - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
4 669,000 - - 1 167,250 3
3 167,250 - - 1 55,750 2
1 267,600 - - - 1
- - - - - -
10 1,672,500 - - - 10
4 669,000 - - 3 501,750 1
 5 1,393,750 - - 2 557,500 3
5 1,115,000 - - 3 669,000 2
- - - - -
7 234,150 - - - - 7
2 78,050 - - 1 39,025 1
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
81.00 13,385,185 18 3,003,587 63

Sitanggal, April 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
242,847
-
-
268,604
99,347
242,847
100,350
809,490
674,575
204,212
-
1,036,950
214,080
557,500
724,750
312,200
334,500
501,750
111,500
267,600
-
1,672,500
167,250
 836,250
446,000
-
234,150
39,025
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
10,381,598
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : APRIL 20
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
BULAN : APRIL 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
1 283,322 - - - 1
2 242,847 - - 1 121,424 1
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
2 242,847 - - 1 121,424 1
5 100,350 - - 1 20,070 4
6 809,490 - - 2 269,830 4
5 674,575 - - 2 269,830 3
1 204,212 - - - - 1
- - - - -
3 1,036,950 - - 1 345,650 2
2 214,080 - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
3 501,750 - - - 3
2 111,500 - - 1 55,750 1
1 267,600 - - - 1
- - - - - -
10 1,672,500 - - - 10
1 167,250 - - - 1
 3 836,250 - - 2 557,500 1
2 446,000 - - 2 446,000 -
- - - - -
7 234,150 - - - - 7
1 39,025 - - 1 39,025 -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
63.00 10,381,598 14 2,246,502 49

Sitanggal, Mei 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
121,424
-
-
268,604
99,347
121,424
80,280
539,660
404,745
204,212
-
691,300
214,080
557,500
724,750
312,200
334,500
501,750
55,750
267,600
-
1,672,500
167,250
 278,750
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
8,135,096
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : MEI 201
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
BULAN : MEI 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
1 283,322 - - - 1
1 121,424 - - 1 121,424 -
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
1 121,424 - - 1 121,424 -
4 80,280 - - - 4
4 539,660 - - 1 134,915 3
3 404,745 - - 2 269,830 1
1 204,212 - - - - 1
- - - - -
2 691,300 - - - 2
2 214,080 - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
3 501,750 - - - 3
1 55,750 - - 1 55,750 -
1 267,600 - - - 1
- - - - - -
10 1,672,500 - - - 10
1 167,250 - - - 1
 1 278,750 - - 1 278,750 -
- - - -
- - - - -
7 234,150 - - - - 7
- - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
49.00 8,135,096 7 982,092 42

Sitanggal, Juni 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
80,280
404,745
134,915
204,212
-
691,300
214,080
557,500
724,750
312,200
334,500
501,750
-
267,600
-
1,672,500
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
7,153,004
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN :JUNI 201
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
BULAN :JUNI 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
- - - - - -
0 - - - - - -
1 283,322 - - - - 1
0 - - - - - -
0 - - - - - -
0 - - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
0 - - - - - -
4 80,280 - - - - 4
3 404,745 - - - - 3
1 134,915 - - - - 1
1 204,212 - - - - 1
0 - - - - - -
2 691,300 - - - - 2
2 214,080 - - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
3 501,750 - - - - 3
0 - - - - - -
1 267,600 - - - - 1
0 - - - - - -
10 1,672,500 - - - - 10
1 167,250 - - - - 1
 0 - - - - - -
- - - - - -
0 - - - - - -
7 234,150 - - - - 7
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
42.00 7,153,004 - - 42

Sitanggal, Juli 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
80,280
404,745
134,915
204,212
-
691,300
214,080
557,500
724,750
312,200
334,500
501,750
-
267,600
-
1,672,500
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
7,153,004
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : JULI 201
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
BULAN : JULI 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
1 283,322 - - - - 1
- - - - - -
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
- - - - - -
4 80,280 - - - - 4
3 404,745 - - 1 134,915 2
1 134,915 - - - - 1
1 204,212 - - - - 1
- - - - - -
2 691,300 - - - - 2
2 214,080 - - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
3 501,750 - - 1 167,250 2
- - - - - -
1 267,600 - - - 1
- - - - - -
10 1,672,500 - - - - 10
1 167,250 - - - - 1
 - - - - - -
- - - - - -
- - - - - -
7 234,150 - - - - 7
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
42.00 7,153,004 2 302,165 40

Sitanggal, Agustus 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
80,280
269,830
134,915
204,212
-
691,300
214,080
557,500
724,750
312,200
334,500
334,500
-
267,600
-
1,672,500
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
6,850,839
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : AGU STUS 2
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
ULAN : AGU STUS 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
1 283,322 - - - - 1
- - - - - -
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
- - - - - -
4 80,280 - - 2 40,140 2
2 269,830 - - 1 134,915 1
1 134,915 - - - - 1
1 204,212 - - - - 1
- - - - - -
2 691,300 - - 1 345,650 1
2 214,080 - - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
2 334,500 - - - 2
- - - - - -
1 267,600 - - - 1
- - - - - -
10 1,672,500 - - - - 10
1 167,250 - - - - 1
 - - - - - -
- - - - - -
- - - - - -
7 234,150 - - - - 7
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- 1 50,000 - - 1
- - - - -
- - - - -
- 1 156,750 - - 1
- 7 288,750 - - 7
- - - - -
- 1 70,000 - - 1
- 2 50,000 - - 2
- 1 110,000 - - 1
- 3 60,000 - - 3
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
40.00 6,850,839 16 785,500 4 520,705 52

Sitanggal, September 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
40,140
134,915
134,915
204,212
-
345,650
214,080
557,500
724,750
312,200
334,500
334,500
-
267,600
-
1,672,500
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
50,000
-
-
156,750
288,750
-
70,000
50,000
110,000
60,000
-
-
-
-
-
7,115,634
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : SEPTEMBER
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
LAN : SEPTEMBER 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
1 283,322 - - - - 1
- - - - - -
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
- - - - - -
2 40,140 - - 2 40,140 -
1 134,915 - - 1 134,915 -
1 134,915 - - - - 1
1 204,212 - - - - 1
- - - - - -
1 345,650 - - 1 345,650 -
2 214,080 - - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
2 334,500 - - - 2
- - - - - -
1 267,600 - - - 1
- - - - - -
10 1,672,500 - - - - 10
1 167,250 - - - - 1
 - - - - - -
- - - - - -
- - - - - -
7 234,150 - - - - 7
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1 50,000 - - - - 1
- - - - - -
- - - - - -
1 156,750 - - - - 1
7 288,750 - - 1 41,250 6
- - - - - -
1 70,000 - - - - 1
2 50,000 - - - - 2
1 110,000 - - - - 1
3 60,000 - - - - 3
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
52.00 7,115,634 5 561,955 47

Sitanggal, Oktober 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
-
-
134,915
204,212
-
-
214,080
557,500
724,750
312,200
334,500
334,500
-
267,600
-
1,672,500
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
50,000
-
-
156,750
247,500
-
70,000
50,000
110,000
60,000
-
-
-
-
-
6,553,679
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : OKTOBER
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
ULAN : OKTOBER 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
1 283,322 - - - - 1
- - - - - -
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
- - - - - -
- - - - -
- - - - -
1 134,915 - - - - 1
1 204,212 - - - - 1
- - - - - -
- - - - -
2 214,080 - - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
2 334,500 - - - 2
- - - - - -
1 267,600 - - - 1
- - - - - -
10 1,672,500 - - 3 501,750 7
1 167,250 - - - - 1
 - - - - - -
- - - - - -
- - - - - -
7 234,150 - - - - 7
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1 50,000 - - - - 1
- - - - - -
- - - - - -
1 156,750 - - - - 1
6 247,500 5 206,250 1 41,250 10
- - - - - -
1 70,000 - - - - 1
2 50,000 - - - - 2
1 110,000 - - - - 1
3 60,000 - - - - 3
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
47.00 6,553,679 5 206,250 4 543,000 48

Sitanggal, November 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
-
-
134,915
204,212
-
-
214,080
557,500
724,750
312,200
334,500
334,500
-
267,600
-
1,170,750
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
50,000
-
-
156,750
412,500
-
70,000
50,000
110,000
60,000
-
-
-
-
-
6,216,929
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : NOVEMBER
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
LAN : NOVEMBER 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
- - - - -
0 - - - - - -
1 283,322 - - - - 1
0 - - - - - -
0 - - - - - -
0 - - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
0 - - - - - -
0 - - - - -
0 - - - - -
1 134,915 - - - - 1
1 204,212 - - - - 1
0 - - - - - -
0 - - - - -
2 214,080 - - - - 2
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
2 334,500 - - - 2
0 - - - - - -
1 267,600 - - - 1
0 - - - - - -
7 1,170,750 - - 3 501,750 4
1 167,250 - - - - 1
 0 - - - - - -
0 - - - - - -
0 - - - - - -
7 234,150 - - - - 7
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
1 50,000 - - - - 1
0 - - - - - -
0 - - - - - -
1 156,750 - - - - 1
10 412,500 - - 10
0 - - - - - -
1 70,000 - - - - 1
2 50,000 - - - - 2
1 110,000 - - - - 1
3 60,000 - - - - 3
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
48.00 6,216,929 3 501,750 45

Sitanggal, Desember 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
-
-
134,915
204,212
-
-
214,080
557,500
724,750
312,200
334,500
334,500
-
267,600
-
669,000
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
50,000
-
-
156,750
412,500
-
70,000
50,000
110,000
60,000
-
-
-
-
-
5,715,179
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : DESEMBER
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
LAN : DESEMBER 2016
SISA AWAL PENERIMAAN PEMAKAIAN SISA AKHIR
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
1 283,322 - - - - 1
- - - - - -
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
- - - - - -
- - - - -
- - - - -
1 134,915 - - - - 1
1 204,212 - - - - 1
- - - - - -
- - - - -
2 214,080 - - 1 107,040 1
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
2 334,500 - - - 2
- - - - - -
1 267,600 - - - 1
- - - - - -
4 669,000 - - 3 501,750 1
1 167,250 - - - - 1
 - - - - - -
- - - - - -
- - - - - -
7 234,150 - - - - 7
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
1 50,000 - - 1 50,000 -
- - - - - -
- - - - - -
1 156,750 - - - - 1
10 412,500 - - 10
- - - - - -
1 70,000 - - - - 1
2 50,000 - - - - 2
1 110,000 - - - - 1
3 60,000 - - - - 3
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
45.00 5,715,179 5 658,790 40

Sitanggal, Januari 2016

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
-
-
134,915
204,212
-
-
107,040
557,500
724,750
312,200
334,500
334,500
-
267,600
-
167,250
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
-
-
-
156,750
412,500
-
70,000
50,000
110,000
60,000
-
-
-
-
-
5,056,389
 LAPORAN PENERIMAAN DAN PEMAKAIA
KABUPATEN BREB
PUSKESMAS SITANG
BULAN : DESEMBER
SATUAN HARGA HARGA
NO NAMA REAGEN KEMASAN
KEMASAN KEMASAN SATUAN
1 2 3 4 5 6

BAHAN KIMIA/ REAGEN

1 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,944,000 1,944,000
2 Choles ENZ CLR 4x100 ml Kit 4x100 ml Kit 1,962,400 1,962,400
3 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 826,200 826,200
4 Glucose God PAP 4x100 ml Kit 4x100 ml Kit 834,020 834,020
5 Creatin Photo CLR 200 ml Kit 200 ml Kit 681,753 681,753
6 Creatin Photo CLR 200 ml Kit 200 ml Kit 688,067 688,067
7 GOT IFCC 8x50 ml Kit 8x50 ml Kit 2,006,407 2,006,407
8 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,806,650 2,806,650
9 Triglycerides 4x100 ml Kit 4x100 ml Kit 2,833,215 2,833,215
10 HDL Cholesterol 80 ml Kit 80 ml Kit 4,131,000 4,131,000
11 HDL Cholesterol 80 ml Kit 80 ml Kit 4,170,100 4,170,100
12 Urea Enzy 2x100 ml Kit 2x100 ml Kit 643,729 643,729
13 Urea Enzy 2x100 ml Kit 2x100 ml Kit 647,592 647,592
14 EDTA 10 % Botol 100 ml botol 283,322 283,322
15 HCL 0,1 N Botol 100 ml botol 121,424 121,424
16 Natrium Citrat 3,8 % Botol 500 ml botol 224,450 224,450
17 Hb Cyanmet Botol 500 ml botol 115,904 115,904
18 Hayem Botol 100 ml botol 268,604 268,604
19 turk Botol 100 ml botol 99,347 99,347
20 Rees Ecker Botol 100 ml botol 121,424 121,424
21 Aquades Botol 1000 ml botol 20,070 20,070
22 widal O Botol 5 ml botol 134,915 134,915
23 widal H Botol 5 ml botol 134,915 134,915
24 Xylol Botol 100 ml botol 204,212 204,212
25 Emersi oil Botol 100 ml botol 864,683 864,683
26 Golongan Darah botol 10 x 4 botol 345,650 345,650
27 HCG Urine box 50 test box 107,040 107,040
28 HbsAg Rapid test box 50 test box 557,500 557,500
29 Malaria rapid test box 25 test box 724,750 724,750
30 RF test kit 5 ml kit 312,200 312,200
31 Urin test 10 parameter tube 100 test tube 334,500 334,500
32 Urin test 3 parameter tube 100 test tube 167,250 167,250
33 Kartu Golda box 100 lb box 55,750 55,750
34 Micropor inc box 24 gulung box 267,600 267,600
35 Termal rol 5,7 rol Rol rol 10,592 10,592
36 Glukosa stik on call box 25 test box 167,250 167,250
37 Glukosa stik easy tooch box 25 test box 167,250 167,250
38 Uris acid east tooch box 25 test box 278,750 278,750
39 Cholesterol easy tooc box 10 test box 223,000 223,000
40 Hb stik Quick cek box 50 test box 858,550 858,550
41 Kertas Lensa buah 50 shet buah 33,450 33,450
42 Lancet box 100 buah box 39,025 39,025
43 Kertas Saring box 100 lembar box 18,955 18,955
44 Diluent ST box 2 liter box 1,784,000 1,784,000
45 Lyser WH botol 500 ml botol 1,092,700 1,092,700
46 Kontrol norm R&D kit 2,5 ml kit 892,000 892,000
47 Hematology Cleaner botol 100 ml botol 390,250 390,250
48 Preci control multi botol 5 ml botol 390,250 390,250
49 Card mellet box Box box 3,122,000 3,122,000
50 Control hematologi melet botol 1.5 botol 802,800 802,800
51 Paket reagen melet box paket box 9,700,500 9,700,500
52 Eosin btl 100 ml btl 217,425 217,425
53 OBJECK GLASS MERAH Box 72 pcs Box 50,000 50,000
54 WIDAL H Botol 5 ml botol 132,000 132,000
55 WIDAL O Botol 5 ml botol 132,000 132,000
56 EDTA 100 ML Botol 100 ml botol 156,750 156,750
57 HCL 100 ML Botol 100 ml botol 41,250 41,250
58 COVER GLASS 22X22 Box 50 pcs Box 70,000 70,000
59 NEEDLE 26 Box 100 pcs Box 70,000 70,000
60 ALKOHOL SWAB Box 100 pcs Box 25,000 25,000
61 TES KEHAMILAN Box 50 pcs Box 110,000 110,000
62 MICROPORE 1/2 INCI Box 1 Gulung Box 20,000 20,000
63 Glucose God PAP kit 4x1000mL kit 1,287,825 1,287,825
64 Biliirubin 2x100ml Box Box 797,225 797,225
65 Uric Acid 4x 100 ml Kit kit 1,753,895 1,753,895
66 SG Pt 1/2 kit Kit kit 1901075 1901075
67 Hemoglobin Kit Kit 1,322,167 1322167
JUMLAH

Kepala Puskesmas
SITANGGAL

Prawoto, SKM.S.Kep.M.Kes
NIP. 19710310 199001 1 001
AN DAN PEMAKAIAN REAGEN PUSKESMAS
KABUPATEN BREBES
USKESMAS SITANGGAL
LAN : DESEMBER 2016
SISA AWAL 15 PENERIMAAN PEMAKAIAN SISA AKHIR 16
VOLUME HARGA VOLUME HARGA VOLUME HARGA VOLUME
7 8 9 10 11 12 13

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
- - - - - -
2 566,643 - - 1 283,322 1
4 485,694 - - 4 485,694 -
- - - - - -
- - - - - -
1 268,604 - - - - 1
1 99,347 - - - - 1
4 485,694 - - 4 485,694 -
7 140,490 - - 7 140,490 -
9 1,214,235 - - 9 1,214,235 -
9 1,214,235 - - 8 1,079,320 1
1 204,212 - - - - 1
1 864,683 - - 1 864,683 -
5 1,728,250 - - 5 1,728,250 -
2 214,080 - - 1 107,040 1
1 557,500 - - - - 1
1 724,750 - - - - 1
1 312,200 - - - - 1
1 334,500 - - - - 1
5 836,250 - - 3 501,750 2
8 446,000 - - 8 446,000 -
2 535,200 - - 1 267,600 1
- - - - - -
10 1,672,500 - - 9 1,505,250 1
10 1,672,500 - - 9 1,505,250 1
 8 2,230,000 - - 8 2,230,000 -
12 2,676,000 - - 12 2,676,000 -
2 1,717,100 - - 2 1,717,100 -
7 234,150 - - - - 7
7 273,175 - - 7 273,175 -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
0 - - - - - -
1 50,000 - - 1 50,000 -
0 - - - - - -
0 - - - - - -
1 156,750 - - - - 1
12 495,000 - - 2 82,500 10
0 - - - - - -
1 70,000 - - - - 1
2 50,000 - - - - 2
1 110,000 - - - - 1
3 60,000 - - - - 3
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - - -
0 - - - - -
142.00 22,699,741 102 17,643,352 40

Sitanggal, Januari 2017

Petugas Pengelola Laboratorium
Puskesmas Sitanggal

Sri Indah Setyawati

NIP. ...................................................
SISA AKHIR 16
HARGA
14

-
-
-
-
-
-
-
-
-
-
-
-
-
283,322
-
-
-
268,604
99,347
-
-
-
134,915
204,212
-
-
107,040
557,500
724,750
312,200
334,500
334,500
-
267,600
-
167,250
167,250
 -
-
-
234,150
-
-
-
-
-
-
-
-
-
-
-
-
-
-
156,750
412,500
-
70,000
50,000
110,000
60,000
-
-
-
-
-
5,056,389