Laporan Evaluasi Alkes

LABORATORIUM
BLUD PUSKESMAS KECAMATAN MENTENG

Jl. Pegangsaan Barat No.14
JAKARTA PUSAT, Telp : 31935836-3103439 Fax : 3190496
LAPORAN EVALUASI ALKES LABORATORIUM TAH
PERIODE : JANUARI
JUMLAH
STOK AWAL JUMLAH STOK
STOK
NAMA MERK UNIT SATUAN BULAN TERPAKAI
NO JENIS BARANG DITERIMA
DAGANG TERKECIL BULAN INI
A B C
Spuit 1.0 ml
1 Terumo Box, 100 pcs 5 0 3
2 Spuit 3.0 / 2.5 ml Terumo Box, 100 pcs 7 0 7
3 Spuit 5.0 ml Terumo Box, 100 pcs 1 0 0
4 Wing needle 27 g x ½ ‘’ Terumo Box, 100 pcs 0 0 0
5 Swab Alkohol AC Swabs Box, 100 pcs 20 0 20
6 Masker Sensi Mask Box, 100 pcs 0 0 0
7 Sarung Tangan Maxter Box, 100 pcs 0 0 0
8 Objek Glass - Box, 72 slide 46 0 2
9 Deck Glass Box, 50 slide 8 0 0
10 Vacutainer Needle BD Box, 50 pcs 0 0 0
11 Vacutainer EDTA BD Box, 100 pcs 0 34 7
12 Vacutainer Plain BD Box, 100 pcs 17 0 17

13 Blue Tip Nesco Pak, 500 pcs 23 0 1
14 Yellow Tip Nesco Pak, 500 pcs 5 0 3
15 Cup Sample Vial - Pak, 1000 pcs 1 0 0
16 Cup Sample Tutup Ulir - Pak, 250 pcs 1 0 1
17 Cup sample 0,5 ml (alat

Indiko)
- Pak, 1000 pcs 1 6 0
18 Kartu Golongan Darah - Pak, 100 lembar 10 0 5
19 Micropore 1/2 inch Nextcare Box, 24 pcs 0 0 0
20 Korek Api - Pak, 10 kotak 0 0 0
21 Kertas Lensa - Pak, 100 lembar 1 0 0
22 pH Indikator - Pak, 2 0 0
23 Pipet Tetes - Pak, 100 pcs 3 0 0
24 Tencell cuvettes Thermo, Scientific Pak, 10 x 18 pcs 2 6 1
25 Cup - Kit, 50 test 0 0 0
26 Lidi sate - Pak 2 0 0
27 Tusuk gigi - Pak, 100 batang 0 0 0
28 Safety Box Limbah Jarum - Pcs 20 20 20
29 Plastik Kuning - Pcs 0 0 0
30 Sediplast - Set, 100 pcs 2 0 0
31 Tissue - Pak, 200 lembar 5 6 5
32 Kassa - Pak 2 0 0
33 Kapas - Gulung 1 0 0
34 Pot urin _ Kontainer 1 0 0
35 Pot Dahak - Kontainer 0 0 0
36 Bluecapps centrifuge tubes Pak, 25 tube 0 0 0
37 Micropore 1/2 inch 3M Box, 24 pcs 11 0 0
38 Vacutainer Needle BD Box, 100 pcs 40 0 16
39 Autoclix lancet One Med 0 0 0
40 Lancet One Med 28 0 14
41 Botol semprot Plastik 4 0 0
42 Slide Mikroskop untuk

sedimen urine
SY, slide Plastik 3 0 0
43 Lancet Single One Touch Box, @ 200 pcs 4 0 2
44 Box Objek Glass Orange pcs 1 0 0
45 Torniquet dewasa pcs 7 0 0
46 Pot faeces bening tutup ulir + sendok pcs 27 0 27
Warna kuning, merah,

47 Dispenser Cotton Roll putih
pcs 2 0 0
48 Cotton Roll pak 47 0 0
49 Kertas Lakmus Kertas pak 0 0 0
50 Kertas saring Kertas pak 0 0 0
51 Torniquet anak _ pcs 6 0 6
52 Alkohol Swab Deschoderm pack 6 0 2
53 Masker Aximed pack 22 0 0
54 Handscoon Aximed pack , 100 pcs 4 0 4

55 Micropore 1 inch Nextcare 0 0 0
56 Micropore 2 inchi Nextcare 0 0 0
57 Plastik Putih (obat) 8 0 2
58 Plastik Klip (10x7) pack @100 lbr 10 0 3
59 Plastik klip (10x15) pack @100 lbr 7 0 4
60 Tabung Urine SY Urine @100 pcs 21 0 2
61 Plastik Bening Kiloan 4 0 0
62 Plestern 43 0 0
63 Tempat Dahak Steril pack @20 btl 2 0 0
64 Handscoon COSMO MED 0 30 6
65 Wing needle 23 g x ½ ‘’ Box Box,100 pcs 0 17 0
66 Wing needle 25 g x ½ ‘’ Box Box,100 pcs 0 16 0
67 Media Amis Swab pcs

ORIUM
AMATAN MENTENG
Barat No.14
836-3103439 Fax : 31904965
ABORATORIUM TAHUN 2018
KADALUWARSA
DALAM KURUN
JUMLAH WAKTU 1-3 BULAN
STOK JUMLAH
KADALUWA SISA STOK KEBUTUHAN PERMINTAAN Expired Date
RSA/ AKHIR BULAN UNTUK 3 JUML UNTUK 3
AH LOT
RUSAK / INI BULAN ED
BULAN
HILANG
BULAN INI
D E = (A+B)-(C+D) F = (3X C) G H = (CX3)-E I
0 2 9
0 0 21
0 1 0
0 0 0
0 0 60
0 0 0
0 0 0
0 44 6
0 8 0
0 0 0
0 27 21
0 0 51
0 22 3
0 2 9
0 1 0
0 0 3
0 7 0
0 5 15
0 0 0
0 0 0
0 1 0
0 2 0
0 3 0
0 7 3
0 0 0
0 2 0
0 0 0
0 20 60
0 0 0
0 2 0
0 6 15
0 2 0
0 1 0
0 1 0
0 0 0
0 0 0
0 11 0
0 24 48
0 0 0
0 14 42
0 4 0
0 3 0
0 2 6
0 1 0
0 7 0
0 0 81
0 2 0
0 47 0
0 0 0
0 0 0
0 0 18
0 4 6
0 22 0
0 0 12
0 0 0
0 0 0
0 6 6
0 7 9
0 3 12
0 19 6
0 4 0
0 43 0
0 2 0
0 24 18
0 17 0
0 16 0
LABORATORIUM
LAPORAN EVALUASI ALKES LABORATORIUM TAHUN
PERIODE : FEBRUARI
JUMLAH
JUMLAH STOK
STOK JUMLAH STOK KADALUWAR
NAMA MERK UNIT SATUAN AWAL STOK TERPAKAI
BULAN DITERIMA BULAN SA/HILANG
NO JENIS BARANG RUSAK /
DAGANG TERKECIL
INI
BULAN INI
A B C D
1 Spuit 1.0 ml Terumo Box, 100 pcs 2 4 0 0
2 Spuit 3.0 / 2.5 ml Terumo Box, 100 pcs 0 2 0 0
3 Spuit 5.0 ml Terumo Box, 100 pcs 1 0 0 0
4 Wing needle 27 g x ½ ‘’ Terumo Box, 100 pcs 0 0 0 0
5 Swab Alkohol AC Swabs Box, 100 pcs 0 0 0 0
6 Masker Sensi Mask Box, 100 pcs 0 0 0 0
7 Sarung Tangan Maxter Box, 100 pcs 0 0 0 0
8 Objek Glass - Box, 72 slide 44 0 4 0
9 Deck Glass Box, 50 slide 8 0 0 0
10 Vacutainer Needle BD Box, 50 pcs 0 0 0 0
11 Vacutainer EDTA BD Box, 100 pcs 27 0 6 0
12 Vacutainer Plain BD Box, 100 pcs 0 0 0 0
13 Blue Tip Nesco Pak, 500 pcs 22 0 0 0

14 Yellow Tip Nesco Pak, 500 pcs 2 0 0 0
15 Cup Sample Vial - Pak, 1000 pcs 1 0 0 0
16 Cup Sample Tutup Ulir - Pak, 250 pcs 0 0 0 0
17 Cup sample 0,5 ml

(alat Indiko)
- Pak, 1000 pcs 7 0 0 0
18 Kartu Golongan Darah -

Pak, 100
lembar
5 0 2 0
19 Micropore 1/2 inch Nextcare Box, 24 pcs 0 0 0 0
20 Korek Api - Pak, 10 kotak 0 0 0 0
Pak, 100
21 Kertas Lensa -
lembar
1 0 0 0
22 pH Indikator - Pak, 2 0 0 0
23 Pipet Tetes - Pak, 100 pcs 3 0 0 0
Pak, 10 x 18
24 Tencell cuvettes Thermo, Scientific
pcs
7 0 2 0
25 Cup - Kit, 50 test 0 0 0 0
26 Lidi sate - Pak 2 0 0 0
Pak, 100
27 Tusuk gigi -
batang
0 0 0 0
28 Safety
Jarum
Box Limbah
- Pcs 20 0 5 0
29 Plastik Kuning - Pcs 0 0 0 0
30 Sediplast - Set, 100 pcs 2 0 0 0
Pak, 200
31 Tissue -
lembar
6 0 4 0
32 Kassa - Pak 2 0 0 0
33 Kapas - Gulung 1 0 0 0
34 Pot urin _ Kontainer 1 0 0 0
35 Pot Dahak - Kontainer 0 0 0 0
36 Bluecapps centrifuge tubes Pak, 25 tube 0 0 0 0
37 Micropore 1/2 inch 3M Box, 24 pcs 11 0 11 0
38 Vacutainer Needle BD Box, 100 pcs 24 0 10 0
39 Autoclix lancet One Med 0 0 0 0
40 Lancet One Med 14 0 7 0
41 Botol semprot Plastik 4 0 0 0

sedimen urine
SY, slide Plastik 3 0 0 0
43 Lancet Single One Touch Box, @ 200 pcs 2 0 1 0
44 Box Objek Glass Orange pcs 1 0 0 0
45 Torniquet dewasa pcs 7 0 1 0
46 Pot faeces bening tutup ulir + sendok pcs 0 0 0 0

pcs 2 0 0 0
48 Cotton Roll pak 47 0 1 0
49 Kertas Lakmus Kertas pak 0 0 0 0
50 Kertas saring Kertas pak 0 0 0 0
51 Torniquet anak _ pcs 0 0 0 0
52 Alkohol Swab Deschoderm pack 4 0 4 0
53 Masker Aximed pack 22 0 20 0

54 Handscoon Aximed pack , 100 pcs 0 0 0 0
55 Micropore 1 inch Nextcare 0 0 0 0
56 Micropore 2 inchi Nextcare 0 0 0 0
57 Plastik Putih (obat) 6 0 0 0
58 Plastik Klip (10x7) pack @100 lbr 7 0 0 0
59 Plastik klip (10x15) pack @100 lbr 3 0 0 0
60 Tabung Urine SY Urine @100 pcs 19 0 2 0
61 Plastik Bening Kiloan 4 0 0 0
62 Plestern 43 0 0 0
63 Tempat Dahak Steril pack @20 btl 2 0 0 0
64 Handscoon COSMO MED 24 0 0 0
65 Wing needle 23 g x ½ ‘’ Box Box,100 pcs 17 0 0 0
66 Wing needle 25 g x ½ ‘’ Box Box,100 pcs 16 0 0 0
67 Media Amis Swab pcs 0
68 Masker Jilbab GP Care, Pack Pack @50 pcs
69 Handscoon Box Box, 100 pcs 0 30 10 0
70 Alkohol Swab Box Box, 200 pcs 0 100 36 0

M
TAN MENTENG
No.14
03439 Fax : 31904965
RATORIUM TAHUN 2018
KADALUWARSA
DALAM KURUN JUMLAH
SISA STOK KEBUTUHA WAKTU 1-3 BULAN PERMINTAAN Expired
AKHIR BULAN N UNTUK 3 UNTUK 3 Date
INI BULAN JUMLAH LOT ED BULAN
E = (A+B)-(C+D) F = (3X C) G H = (CX3)-E I
6 0 -6
2 0 -2
1 0 -1
0 0 0
0 0 0
0 0 0
0 0 0
40 12 -28
8 0 -8
0 0 0
21 18 -3
0 0 0
22 0 -22
2 0 -2
1 0 -1
0 0 0
7 0 -7
3 6 3
0 0 0
0 0 0
1 0 -1
2 0 -2
3 0 -3
5 6 1
0 0 0
2 0 -2
0 0 0
15 15 0
0 0 0
2 0 -2
2 12 10
2 0 -2
1 0 -1
1 0 -1
0 0 0
0 0 0
0 33 33
14 30 16
0 0 0
7 21 14
4 0 -4
3 0 -3
1 3 2
1 0 -1
6 3 -3
0 0 0
2 0 -2
46 3 -43
0 0 0
0 0 0
0 0 0
0 12 12
2 60 58
0 0 0
0 0 0
0 0 0
6 0 -6
7 0 -7
3 0 -3
17 6 -11
4 0 -4
43 0 -43
2 0 -2
24 0 -24
17 0 -17
16 0 -16
0 0 0
20
64
LABORATORIUM
LAPORAN EVALUASI ALKES LABORATORIUM TAHUN 2018
PERIODE : MARET
KADALUWARSA DALAM
KURUN WAKTU 1-3 BULAN KE
JUMLAH JUMLAH STOK

STOK JUMLAH STOK STOK KADALUWARSA/ SISA STOK AKHIR BULAN KEBUTUHAN
AWAL UNTUK 3
NAMA MERK DAGANG UNIT SATUAN DITERIMA TERPAKAI RUSAK / HILANG INI
NO JENIS BARANG BULAN BULAN JUMLAH LOT ED
TERKECIL BULAN INI BULAN INI
A B C D E = (A+B)-(C+D) F = (3X C) G
Spuit 1.0 ml
1 Terumo Box, 100 pcs 6 0 3 0 3 9
2 Spuit 3.0 / 2.5 ml Terumo Box, 100 pcs 2 0 2 0 0 6
3 Spuit 5.0 ml Terumo Box, 100 pcs 1 0 0 0 1 0
4 Wing needle 27 g x ½ ‘’ Terumo Box, 100 pcs 0 0 0 0 0 0
5 Swab Alkohol AC Swabs Box, 100 pcs 0 0 0 0 0 0
6 Masker Sensi Mask Box, 100 pcs 0 0 0 0 0 0
7 Sarung Tangan Maxter Box, 100 pcs 0 0 0 0 0 0
8 Objek Glass - Box, 72 slide 40 0 2 0 38 6

9 Deck Glass Box, 50 slide 8 0 0 0 8 0
10 Vacutainer Needle BD Box, 50 pcs 0 0 0 0 0 0
11 Vacutainer EDTA BD Box, 100 pcs 21 0 8 0 13 24
12 Vacutainer Plain BD Box, 100 pcs 0 0 0 0 0 0
13 Blue Tip Nesco Pak, 500 pcs 22 0 2 0 20 6
14 Yellow Tip Nesco Pak, 500 pcs 2 0 2 0 0 6
15 Cup Sample Vial - Pak, 1000 pcs 1 0 1 0 0 3
16 Cup Sample Tutup Ulir - Pak, 250 pcs 0 0 0 0 0 0
Cup sample 0,5 ml (alat

17 Indiko)
- Pak, 1000 pcs 7 0 1 0 6 3
Kartu Golongan Darah

18 - Pak, 100 lembar 3 0 1 0 2 3
19 Micropore 1/2 inch Nextcare Box, 24 pcs 0 0 0 0 0 0
20 Korek Api - Pak, 10 kotak 0 0 0 0 0 0
21 Kertas Lensa - Pak, 100 lembar 1 0 1 0 0 3
22 pH Indikator - Pak, 2 0 2 0 0 6
23 Pipet Tetes - Pak, 100 pcs 3 0 3 0 0 9
Pak, 10 x 18
24 Tencell cuvettes Thermo, Scientific
pcs
5 0 1 0 4 3
25 Cup - Kit, 50 test 0 0 0 0 0 0
26 Lidi sate - Pak 2 0 2 0 0 6

27 Tusuk gigi - Pak, 100 batang 0 0 0 0 0 0
28 Safety Box Limbah Jarum - Pcs 15 0 2 0 13 6
29 Plastik Kuning - Pcs 0 0 0 0 0 0
30 Sediplast - Set, 100 pcs 2 0 0 0 2 0
31 Tissue - Pak, 200 lembar 2 0 2 0 0 6
32 Kassa - Pak 2 0 2 0 0 6
33 Kapas - Gulung 1 0 1 0 0 3
34 Pot urin _ Kontainer 1 0 1 0 0 3
35 Pot Dahak - Kontainer 0 1 1 0 0 3
36 Bluecapps centrifuge tubes Pak, 25 tube 0 0 0 0 0 0
37 Micropore 1/2 inch 3M Box, 24 pcs 0 0 0 0 0 0
38 Vacutainer Needle BD Box, 100 pcs 14 0 7 0 7 21
39 Autoclix lancet One Med 0 0 0 0 0 0
40 Lancet One Med 7 0 2 0 5 6
41 Botol semprot Plastik 4 0 0 0 4 0
Slide Mikroskop untuk

42 sedimen urine SY, slide Plastik 3 0 1 0 2 3
43 Lancet Single One Touch Box, @ 200 pcs 1 0 1 0 0 3
44 Box Objek Glass Orange pcs 1 0 1 0 0 3

45 Torniquet dewasa pcs 6 0 1 0 5 3
46 Pot faeces bening tutup ulir + sendok pcs 0 0 0 0 0 0
47 Dispenser Cotton Roll Warna kuning, merah, putih pcs 2 0 0 0 2 0
48 Cotton Roll pak 46 0 1 0 45 3
49 Kertas Lakmus Kertas pak 0 0 0 0 0 0
50 Kertas saring Kertas pak 0 0 0 0 0 0
51 Torniquet anak _ pcs 0 0 0 0 0 0
52 Alkohol Swab Deschoderm pack 0 0 0 0 0 0
53 Masker Aximed pack 2 0 2 0 0 6
54 Handscoon Aximed pack , 100 pcs 0 0 0 0 0 0
55 Micropore 1 inch Nextcare 0 0 0 0 0 0
56 Micropore 2 inchi Nextcare 0 0 0 0 0 0
57 Plastik Putih (obat) 6 0 6 0 0 18
58 Plastik Klip (10x7) pack @100 lbr 7 0 1 0 6 3
59 Plastik klip (10x15) pack @100 lbr 3 0 0 0 3 0
60 Tabung Urine SY Urine @100 pcs 17 0 2 0 15 6
61 Plastik Bening Kiloan 4 0 0 0 4 0

62 Plestern 43 0 1 0 42 3
63 Tempat Dahak Steril pack @20 btl 2 0 0 0 2 0
64 Handscoon COSMO MED 24 0 5 0 19 15
65 Wing needle 23 g x ½ ‘’ Box Box,100 pcs 17 0 1 0 16 3
66 Wing needle 25 g x ½ ‘’ Box Box,100 pcs 16 0 2 0 14 6
67 Media Amis Swab pcs 0 0 0
68 Masker Jilbab GP Care, Pack Pack @50 pcs 0
69 Handscoon Box Box, 100 pcs 20 0 12 0 8
70 Alkohol Swab Box Box, 200 pcs 64 0 24 0 40
71 One Ject Uk. 0.05 ml : 27 G X 3/8 0
72 Pot Dahak (Uk.Sedang) 0
73 Micro Tube EDTA Pack pack, 50 pcs 0 10 1 0 9 3

IUM
MATAN MENTENG
at No.14
-3103439 Fax : 31904965
ORATORIUM TAHUN 2018
JUMLAH
PERMINTAAN Expired Date
UNTUK 3
BULAN
H = (CX3)-E I
-1
-32
-8
11
-14
-3
-1
6
0
-7
-2
14
-4
3
-2
-2
-42
18
-3
-3
-9
-4
-39
-2
-4
-13
-8
-6 2019/04
LABORATORIUM
BLUD PUSKESMAS KECAMAT
Jl. Pegangsaan Barat N
JAKARTA PUSAT, Telp : 31935836-310
LAPORAN EVALUASI ALKES LABOR
PERIODE : APRIL
STOK
AWAL JUMLAH STOK
NAMA MERK DAGANG UNIT SATUAN DITERIMA
NO JENIS BARANG BULAN
TERKECIL
A B
1 Spuit 1.0 ml Terumo Box, 100 pcs 3
2 Spuit 3.0 / 2.5 ml Terumo Box, 100 pcs 0
3 Spuit 5.0 ml Terumo Box, 100 pcs 1
4 Wing needle 27 g x ½ ‘’ Terumo Box, 100 pcs 0
5 Swab Alkohol AC Swabs Box, 100 pcs 0
6 Masker Sensi Mask Box, 100 pcs 0
7 Sarung Tangan Maxter Box, 100 pcs 0
8 Objek Glass - Box, 72 slide 38
9 Deck Glass Box, 50 slide 8
10 Vacutainer Needle BD Box, 50 pcs 0
11 Vacutainer EDTA BD Box, 100 pcs 13
12 Vacutainer Plain BD Box, 100 pcs 0

13 Blue Tip Nesco Pak, 500 pcs 20
14 Yellow Tip Nesco Pak, 500 pcs 0
15 Cup Sample Vial - Pak, 1000 pcs 0
16 Cup Sample Tutup Ulir - Pak, 250 pcs 0
17 Cup sample 0,5 ml (alat Indiko) - Pak, 1000 pcs 6
18 Kartu Golongan Darah - Pak, 100 lembar 2
19 Micropore 1/2 inch Nextcare Box, 24 pcs 0
20 Korek Api - Pak, 10 kotak 0
21 Kertas Lensa - Pak, 100 lembar 0
22 pH Indikator - Pak, 0
23 Pipet Tetes - Pak, 100 pcs 0
24 Tencell cuvettes Thermo, Scientific Pak, 10 x 18 pcs 4
25 Cup - Kit, 50 test 0
26 Lidi sate - Pak 0
27 Tusuk gigi - Pak, 100 batang 0
28 Safety Box Limbah Jarum - Pcs 13
29 Plastik Kuning - Pcs 0
30 Sediplast - Set, 100 pcs 2
31 Tissue - Pak, 200 lembar 0
32 Kassa - Pak 0
33 Kapas - Gulung 0
34 Pot urin _ Kontainer 0
35 Pot Dahak - Kontainer 0
36 Bluecapps centrifuge tubes Pak, 25 tube 0
37 Micropore 1/2 inch 3M Box, 24 pcs 0
38 Vacutainer Needle BD Box, 100 pcs 7
39 Autoclix lancet One Med 0
40 Lancet One Med 5
41 Botol semprot Plastik 4
42 Slide
urine
Mikroskop untuk sedimen
SY, slide Plastik 2
43 Lancet Single One Touch Box, @ 200 pcs 0
44 Box Objek Glass Orange pcs 0
45 Torniquet dewasa pcs 5
46 Pot faeces bening tutup ulir + sendok pcs 0

pcs 2
48 Cotton Roll pak 45
49 Kertas Lakmus Kertas pak 0
50 Kertas saring Kertas pak 0
51 Torniquet anak _ pcs 0
52 Alkohol Swab Deschoderm pack 0

53 Masker Aximed pack 0
54 Handscoon Aximed pack , 100 pcs 0
55 Micropore 1 inch Nextcare 0
56 Micropore 2 inchi Nextcare 0
57 Plastik Putih (obat) 0
58 Plastik Klip (10x7) pack @100 lbr 6
59 Plastik klip (10x15) pack @100 lbr 3
60 Tabung Urine SY Urine @100 pcs 15
61 Plastik Bening Kiloan 4
62 Plestern 42
63 Tempat Dahak Steril pack @20 btl 2
64 Handscoon COSMO MED 19
65 Wing needle 23 g x ½ ‘’ Box Box,100 pcs 16
66 Wing needle 25 g x ½ ‘’ Box Box,100 pcs 14
67 Media Amis Swab pcs 0
68 Masker Jilbab GP Care, Pack Pack @50 pcs 0
69 Handscoon Box Box, 100 pcs 8
70 Alkohol Swab Box Box, 200 pcs 40
71 One Ject Uk. 0.05 ml : 27 G X 3/8 PCS 0
72 Pot Dahak (Uk.Sedang) 0

73 Micro Tube EDTA Pack pack, 50 pcs 9
LABORATORIUM
UD PUSKESMAS KECAMATAN MENTENG
TA PUSAT, Telp : 31935836-3103439 Fax : 31904965
ALUASI ALKES LABORATORIUM TAHUN 2018
KADALUWARSA DALAM
JUMLAH STOK
JUMLAH STOK KADALUWARSA/ SISA STOK AKHIR KEBUTUHAN
TERPAKAI RUSAK / HILANG BULAN INI UNTUK 3 BULAN JUMLAH LOT ED
BULAN INI BULAN INI
C D E = (A+B)-(C+D) F = (3X C) G
JUMLAH
PERMINTAAN Expired Date
UNTUK 3
BULAN
H = (CX3)-E I
LABORATORIUM
PERIODE : Mei
KADALU SISA STOK KEBUTUH
STOK JUMLAH STOK
NAMA UNIT WARSA/ AKHIR AN
JENIS AWAL STOK TERPAKAI RUSAK / BULAN
NO MERK SATUAN UNTUK 3
BARANG DAGANG TERKECIL BULAN DITERIMA BULAN HILANG INI BULAN
Spuit 1.0 A B C D E = (A+B)-(C+D)
F = (3X C)
ml Box, 100
1 Terumo
pcs
Spuit 3.0 / Box, 100
2 2.5 ml
Terumo
pcs
Spuit 5.0 Box, 100
3 ml
Terumo
pcs
Wing
Box, 100
4 needle 27 Terumo
pcs
g x ½ ‘’
Swab Box, 100
5 Alkohol
AC Swabs
pcs
Sensi Box, 100
6 Masker
Mask pcs
Sarung Box, 100
7 Tangan
Maxter
pcs
Objek Box, 72
8 Glass
-
slide
Deck Box, 50
9 Glass slide
Vacutainer Box, 50
10 Needle
BD
pcs
Vacutainer Box, 100
11 EDTA
BD
pcs
Vacutainer Box, 100
12 Plain
BD
pcs
Pak, 500
13 Blue Tip Nesco
pcs
Yellow Tip Pak, 500
14 Nesco
pcs
Cup
Sample Pak, 1000
15 Vial
-
pcs
Cup
Pak, 250
16 Sample -
pcs
Tutup Ulir
Cup
sample 0,5
Pak, 1000
17 ml (alat -
pcs
Indiko)
Kartu
Golongan Pak, 100
18 Darah
-
lembar
Micropore Box, 24
19 1/2 inch
Nextcare
pcs
Pak, 10
20 Korek Api -
kotak
Kertas Pak, 100
21 Lensa
-
lembar
pH
22 Indikator
- Pak,
Pipet Tetes Pak, 100

23 -
pcs
Tencell Thermo, Pak, 10 x
24 cuvettes Scientific 18 pcs
25 Cup - Kit, 50 test
26 Lidi sate - Pak
Tusuk gigi Pak, 100
27 -
batang
Safety Box
28 Limbah - Pcs
Jarum
Plastik
29 Kuning
- Pcs
Set, 100
30 Sediplast -
pcs
Pak, 200
31 Tissue -
lembar
32 Kassa - Pak
33 Kapas - Gulung
34 Pot urin _ Kontainer
35 Pot Dahak- Kontainer
36 Bluecapps centrifugePak, 25 tube
Micropore Box, 24
37 1/2 inch
3M pcs
Vacutainer Box, 100
38 Needle
BD pcs
Autoclix
39 lancet
One Med
40 Lancet One Med

Botol
41 semprot
Plastik
Slide
Mikroskop
42 untuk SY, slide Plastik
sedimen
urine
Lancet Box, @
43 Single
One Touch200 pcs
Box Objek
44 Glass
Orange pcs
Torniquet
45 dewasa
pcs
Pot faeces tutup ulir +

46 bening sendok
pcs
Warna
Dispenser kuning,
47 Cotton Roll merah,
pcs
putih
48 Cotton Roll pak
Kertas
49 Lakmus
Kertas pak
Kertas
50 saring
Kertas pak
Torniquet
51 anak
_ pcs
Alkohol
52 Swab
Deschode pack
53 Masker Aximed pack
Handscoo pack , 100
54 n
Aximed pcs
Micropore
55 1 inch
Nextcare
Micropore
56 2 inchi
Nextcare
Plastik
57 Putih
(obat)
Plastik Klip
58 (10x7)
pack @100 lbr
Plastik klip
59 (10x15)
pack @100 lbr
Tabung
60 Urine
SY Urine @100 pcs
Plastik
61 Bening
Kiloan
62 Plestern
Tempat
63 Dahak pack @20 btl
Steril
Handscoo
64 n
COSMO MED
Wing
65 needle 23 Box Box,100 pcs
g x ½ ‘’
Wing
66 needle 25 Box Box,100 pcs
g x ½ ‘’
67 Media Amipcs
Masker GP Care, Pack @50
68 Jilbab Pack pcs
Handscoo Box, 100
69 n
Box
pcs
Alkohol Box, 200
70 Swab
Box
pcs
Uk. 0.05
71 One Ject ml : 27 G X PCS
3/8
Pot Dahak
72 (Uk.Sedan
g)
73 Micro TubePack pack, 50 pcs
ENTENG
Fax : 31904965
RIUM TAHUN 2018
KADALUWARSA DALAM JUMLAH

KURUN WAKTU 1-3 BULAN KE PERMINTAA Expired
JUMLAH LOT ED N UNTUK 3 Date
BULAN
G H = (CX3)-E I
LABORATORIUM
LAPORAN EVALUASI ALKES LABORATORIUM TA
PERIODE : Agustus
KADALU
STOK JUMLAH STOK WARSA/
NAMA MERK UNIT SATUAN AWAL STOK TERPAKAI
BULAN DITERIMA BULAN RUSAK
NO JENIS BARANG /
DAGANG TERKECIL HILANG
A B C D
1 Spuit 1.0 ml Terumo Box, 100 pcs
2 Spuit 3.0 / 2.5 ml Terumo Box, 100 pcs
4 Wing needle 27 g x ½ ‘’ Terumo Box, 100 pcs
5 Swab Alkohol AC Swabs Box, 100 pcs
6 Masker Sensi Mask Box, 100 pcs
7 Sarung Tangan Maxter Box, 100 pcs
8 Objek Glass - Box, 72 slide
9 Deck Glass Box, 50 slide
10 Vacutainer Needle BD Box, 50 pcs
11 Vacutainer EDTA BD Box, 100 pcs
12 Vacutainer Plain BD Box, 100 pcs
13 Blue Tip Nesco Pak, 500 pcs
14 Yellow Tip Nesco Pak, 500 pcs
15 Cup Sample Vial - Pak, 1000 pcs
16 Cup Sample Tutup Ulir - Pak, 250 pcs
17 Cup sample 0,5 ml (alat Indiko) - Pak, 1000 pcs
18 Kartu Golongan Darah - Pak, 100 lembar

19 Micropore 1/2 inch Nextcare Box, 24 pcs
20 Korek Api - Pak, 10 kotak
21 Kertas Lensa - Pak, 100 lembar
22 pH Indikator - Pak,
23 Pipet Tetes - Pak, 100 pcs
24 Tencell cuvettes Thermo, Scientific Pak, 10 x 18 pcs
26 Lidi sate - Pak
27 Tusuk gigi - Pak, 100 batang
28 Safety Box Limbah Jarum - Pcs
29 Plastik Kuning - Pcs
30 Sediplast - Set, 100 pcs
31 Tissue - Pak, 200 lembar
32 Kassa - Pak
33 Kapas - Gulung
35 Pot Dahak - Kontainer
36 Bluecapps centrifuge tubes Pak, 25 tube
37 Micropore 1/2 inch 3M Box, 24 pcs
39 Autoclix lancet One Med
40 Lancet One Med
41 Botol semprot Plastik
42 Slide
urine
Mikroskop untuk sedimen
SY, slide Plastik
43 Lancet Single One Touch Box, @ 200 pcs
44 Box Objek Glass Orange pcs
45 Torniquet dewasa pcs
46 Pot faeces bening tutup ulir + sendok pcs

pcs
48 Cotton Roll pak
49 Kertas Lakmus Kertas pak
50 Kertas saring Kertas pak
51 Torniquet anak _ pcs
52 Alkohol Swab Deschoderm pack
54 Handscoon Aximed pack , 100 pcs
55 Micropore 1 inch Nextcare
56 Micropore 2 inchi Nextcare
57 Plastik Putih (obat)
58 Plastik Klip (10x7) pack @100 lbr
59 Plastik klip (10x15) pack @100 lbr
60 Tabung Urine SY Urine @100 pcs
61 Plastik Bening Kiloan
62 Plestern
63 Tempat Dahak Steril pack @20 btl
64 Handscoon COSMO MED
65 Wing needle 23 g x ½ ‘’ Box Box,100 pcs

69 Handscoon Box Box, 100 pcs
70 Alkohol Swab Box Box, 200 pcs
71 One Ject Uk. 0.05 ml : 27 G X 3/8 PCS
72 Pot Dahak (Uk.Sedang)
73 Micro Tube EDTA Pack pack, 50 pcs

BORATORIUM
AS KECAMATAN MENTENG
ngsaan Barat No.14
: 31935836-3103439 Fax : 31904965
KES LABORATORIUM TAHUN 2018
KEBUTUH KADALUWARSA DALAM JUMLAH

SISA STOK AKHIR AN KURUN WAKTU 1-3 PERMINTAA Expired
BULAN INI UNTUK 3 JUMLAH LOT ED N UNTUK 3 Date
BULAN
E = (A+B)-(C+D) F = (3X C) G H BULAN
= (CX3)-E I
PERIODE : September
KADALU
STOK JUMLAH STOK
STOK TERPAKAI RUSAK / SISABULAN
UNIT WARSA/ STOK AKHIR
JENIS NAMA MERK AWAL
NO SATUAN INI
BARANG DAGANG BULAN DITERIMA BULAN HILANG
TERKECIL A B C D E = (A+B)-(C+D)
Spuit 1.0 ml
1 Terumo Box, 100 pcs
Spuit 3.0 / 2.5

2 ml
Terumo Box, 100 pcs
Wing needle
4 27 g x ½ ‘’
Terumo Box, 100 pcs
10 Vacutainer
Needle
BD Box, 50 pcs
11 Vacutainer
EDTA
BD Box, 100 pcs
12 Vacutainer
Plain
BD Box, 100 pcs
15 Cup
Vial
Sample
- Pak, 1000 pcs
16 Cup Sample
Tutup Ulir
- Pak, 250 pcs
Cup sample
17 0,5 ml (alat - Pak, 1000 pcs
Indiko)
Kartu
Golongan Pak, 100
18 Darah
-
lembar
19 Micropore
inch
1/2
Nextcare Box, 24 pcs

Pak, 100
21 Kertas Lensa - lembar
24 Tencell
cuvettes
Thermo,
Scientific
Pak, 10 x 18
pcs
26 Lidi sate - Pak
Pak, 100
27 Tusuk gigi -
batang
28 Safety Box
Limbah Jarum
- Pcs

Pak, 200
31 Tissue -
lembar
32 Kassa - Pak
33 Kapas - Gulung
Bluecapps
36 centrifuge Pak, 25 tube
tubes
37 Micropore
inch
1/2
3M Box, 24 pcs
38 Vacutainer
Needle
BD Box, 100 pcs
40 Lancet One Med
Slide
42 Mikroskop
untuk sedimen
SY, slide Plastik
urine
Box, @ 200
43 Lancet Single One Touch pcs
44 Box Objek
Glass
Orange pcs
45 Torniquet
dewasa
pcs
46 Pot faeces
bening
tutup ulir +
sendok
pcs
47 Dispenser
Cotton Roll
Warna kuning,
merah, putih
pcs
48 Cotton Roll pak


pack , 100
54 Handscoon Aximed pcs
55 Micropore
inch
1
Nextcare
56 Micropore
inchi
2
Nextcare
57 Plastik
(obat)
Putih
58 Plastik
(10x7)
Klip
pack @100 lbr
59 Plastik
(10x15)
klip
pack @100 lbr
60 Tabung Urine SY Urine @100 pcs
61 Plastik
Kiloan
Bening
62 Plestern
63 Tempat
Steril
Dahak
pack @20 btl
Wing needle
65 23 g x ½ ‘’
Box Box,100 pcs
66 Wing needle
25 g x ½ ‘’
Box Box,100 pcs
67 Media Amis pcs

Swab
68 Masker Jilbab GP Care, Pack Pack
pcs
@50

Uk. 0.05 ml :
71 One Ject 27 G X 3/8
PCS
72 Pot Dahak
(Uk.Sedang)
73 Micro Tube Pack pack, 50 pcs

EDTA
4
39 Fax : 31904965
TORIUM TAHUN 2018

AN KURUN WAKTU 1-3 BULAN KE PERMINTAA Expired
UNTUK 3 JUMLAH LOT ED N UNTUK 3 Date
BULAN BULAN
F = (3X C) G H = (CX3)-E I
PERIODE : OKTOBER
JUMLAH
STOK
JUMLAH KADALU SISA STOK
STOK JUMLAH STOK WARSA/ AKHIR
JENIS NAMA MERK UNIT SATUAN AWAL STOK TERPAKAI RUSAK / BULAN
NO BULAN DITERIMA BULAN HILANG
BARANG DAGANG TERKECIL INI
INI BULAN
INI
A B C D E = (A+B)-(C+D)
Spuit 1.0 ml
1 Terumo Box, 100 pcs
2 Spuit
ml
3.0 / 2.5
Terumo Box, 100 pcs
4 Wing needle 27
g x ½ ‘’
Terumo Box, 100 pcs
10 Vacutainer
Needle
BD Box, 50 pcs
11 Vacutainer
EDTA
BD Box, 100 pcs
12 Vacutainer
Plain
BD Box, 100 pcs
15 Cup
Vial
Sample
- Pak, 1000 pcs
16 Cup Sample
Tutup Ulir
- Pak, 250 pcs
Cup sample 0,5

17 ml (alat Indiko) - Pak, 1000 pcs
Kartu Golongan
18 Darah - Pak, 100 lembar
19 Micropore
inch
1/2
24 Tencell
cuvettes
Thermo, Scientific Pak, 10 x 18 pcs
26 Lidi sate - Pak

28 Safety Box
Limbah Jarum
- Pcs
32 Kassa - Pak
33 Kapas - Gulung
Bluecapps
tubes
37 Micropore
inch
1/2
3M Box, 24 pcs
38 Vacutainer
Needle
BD Box, 100 pcs
40 Lancet One Med
Slide Mikroskop
42 untuk sedimen SY, slide Plastik
urine

44 Box Objek
Glass
Orange pcs
45 Torniquet
dewasa
pcs
46 Pot faeces
bening
tutup ulir + sendok pcs
47 Dispenser
Cotton Roll
Warna kuning,
merah, putih
pcs
48 Cotton Roll pak
55 Micropore
inch
1
Nextcare
56 Micropore
inchi
2
Nextcare
57 Plastik
(obat)
Putih
58 Plastik
(10x7)
Klip
pack @100 lbr
59 Plastik
(10x15)
klip
pack @100 lbr
60 Tabung Urine SY Urine @100
pcs
61 Plastik
Kiloan
Bening
62 Plestern
63 Tempat
Steril
Dahak
pack @20 btl
65 Wing needle 23
g x ½ ‘’
Box Box,100 pcs
66 Wing needle 25
g x ½ ‘’
Box Box,100 pcs
67 Media Amis
Swab pcs
Uk. 0.05 ml : 27 G X
71 One Ject 3/8
PCS
72 Pot Dahak
(Uk.Sedang)

EDTA
9 Fax : 31904965
KADALUWARSA DALAM
KEBUTUH JUMLAH
AN PERMINTAA Expired
BULAN BULAN
F = (3X C) G H = (CX3)-E I
LABORATORIUM
PERIODE : OKTOBER
KADALU
STOK JUMLAH STOK SISA STOK
WARSA/
NAMA MERK UNIT SATUAN AWAL STOK TERPAKAI RUSAK / AKHIR BULAN
NO JENIS BARANG DAGANG BULAN DITERIMA BULAN HILANG INI
TERKECIL
A B C D E = (A+B)-(C+D)
4 Wing needle 27
g x ½ ‘’
Terumo Box, 100 pcs
10 Vacutainer
Needle
BD Box, 50 pcs
16 Cup Sample
Tutup Ulir
- Pak, 250 pcs
Cup sample 0,5
17 ml (alat Indiko) - Pak, 1000 pcs
Kartu Golongan
18 Darah - Pak, 100 lembar
19 Micropore
inch
1/2

24 Tencell cuvettes Thermo,

Scientific
Pak, 10 x 18 pcs
26 Lidi sate - Pak
28 Safety Box
Limbah Jarum
- Pcs
32 Kassa - Pak
33 Kapas - Gulung

Bluecapps
tubes
37 Micropore
inch
1/2
3M Box, 24 pcs
38 Vacutainer
Needle
BD Box, 100 pcs
40 Lancet One Med

Slide Mikroskop
42 untuk sedimen SY, slide Plastik
urine
45 Torniquet
dewasa
pcs
46 Pot faeces
bening
tutup ulir +
sendok
pcs
47 Dispenser
Cotton Roll
Warna kuning,
merah, putih
pcs
48 Cotton Roll pak
56 Micropore
inchi
2
Nextcare
57 Plastik
(obat)
Putih
58 Plastik
(10x7)
Klip
pack @100 lbr
59 Plastik
(10x15)
klip
pack @100 lbr
60 Tabung Urine SY Urine

@100 pcs
61 Plastik
Kiloan
Bening
62 Plestern
63 Tempat
Steril
Dahak
pack @20 btl
65 Wing needle 23
g x ½ ‘’
Box Box,100 pcs
66 Wing needle 25
g x ½ ‘’
Box Box,100 pcs
67 Media Amis pcs

Swab
Uk. 0.05 ml : 27
71 One Ject G X 3/8
PCS
72 Pot Dahak
(Uk.Sedang)
EDTA
ENTENG
Fax : 31904965

AN KURUN WAKTU 1-3 PERMINTAA Expired
BULAN BULAN
F = (3X C) G H = (CX3)-E I
LABORATORIUM
PERIODE : OKTOBER
KADALU
STOK JUMLAH STOK
STOK TERPAKAI RUSAK / SISABULAN
WARSA/ STOK AKHIR
NAMA MERK UNIT SATUAN AWAL
NO JENIS BARANG INI
DAGANG TERKECIL BULAN DITERIMA BULAN HILANG
A B C D E = (A+B)-(C+D)
4 Wing needle 27 g x ½ ‘’ Terumo Box, 100 pcs
16 Cup Sample Tutup Ulir - Pak, 250 pcs
17 Cup sample 0,5 ml (alat

Indiko)
- Pak, 1000 pcs
18 Kartu Golongan Darah - Pak, 100 lembar
19 Micropore 1/2 inch Nextcare Box, 24 pcs

24 Tencell cuvettes Thermo, Scientific Pak, 10 x 18 pcs
26 Lidi sate - Pak
28 Safety Box Limbah Jarum - Pcs
32 Kassa - Pak
33 Kapas - Gulung
36 Bluecapps centrifuge Pak, 25 tube

tubes
37 Micropore 1/2 inch 3M Box, 24 pcs
40 Lancet One Med

sedimen urine
SY, slide Plastik

45 Torniquet dewasa pcs
46 Pot faeces bening tutup ulir + sendok pcs
Warna kuning,
47 Dispenser Cotton Roll merah, putih
pcs
48 Cotton Roll pak
56 Micropore 2 inchi Nextcare
57 Plastik Putih (obat)
58 Plastik Klip (10x7) pack @100 lbr
59 Plastik klip (10x15) pack @100 lbr
60 Tabung Urine SY Urine @100

pcs
61 Plastik Bening Kiloan
62 Plestern
63 Tempat Dahak Steril pack @20 btl

Uk. 0.05 ml : 27 G
71 One Ject X 3/8
PCS
72 Pot Dahak (Uk.Sedang)
73 Micro Tube EDTA Pack pack, 50 pcs

TORIUM
CAMATAN MENTENG
Barat No.14
5836-3103439 Fax : 31904965

AN KURUN WAKTU 1-3 BULAN KE PERMINTAAN Expired
UNTUK 3 JUMLAH LOT ED UNTUK 3 Date
BULAN BULAN
F = (3X C) G H = (CX3)-E I

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LABORATORIUM

BLUD PUSKESMAS KECAMATAN MENTENG

LAPORAN EVALUASI ALKES LABORATORIUM TAH

2 Spuit 3.0 / 2.5 ml Terumo Box, 100 pcs 7 0 7

3 Spuit 5.0 ml Terumo Box, 100 pcs 1 0 0

4 Wing needle 27 g x ½ ‘’ Terumo Box, 100 pcs 0 0 0

5 Swab Alkohol AC Swabs Box, 100 pcs 20 0 20

6 Masker Sensi Mask Box, 100 pcs 0 0 0

7 Sarung Tangan Maxter Box, 100 pcs 0 0 0

8 Objek Glass - Box, 72 slide 46 0 2

9 Deck Glass Box, 50 slide 8 0 0

10 Vacutainer Needle BD Box, 50 pcs 0 0 0

11 Vacutainer EDTA BD Box, 100 pcs 0 34 7

12 Vacutainer Plain BD Box, 100 pcs 17 0 17

14 Yellow Tip Nesco Pak, 500 pcs 5 0 3

15 Cup Sample Vial - Pak, 1000 pcs 1 0 0

16 Cup Sample Tutup Ulir - Pak, 250 pcs 1 0 1

17 Cup sample 0,5 ml (alat

18 Kartu Golongan Darah - Pak, 100 lembar 10 0 5

19 Micropore 1/2 inch Nextcare Box, 24 pcs 0 0 0

20 Korek Api - Pak, 10 kotak 0 0 0

21 Kertas Lensa - Pak, 100 lembar 1 0 0

23 Pipet Tetes - Pak, 100 pcs 3 0 0

24 Tencell cuvettes Thermo, Scientific Pak, 10 x 18 pcs 2 6 1

25 Cup - Kit, 50 test 0 0 0

26 Lidi sate - Pak 2 0 0

27 Tusuk gigi - Pak, 100 batang 0 0 0

28 Safety Box Limbah Jarum - Pcs 20 20 20

29 Plastik Kuning - Pcs 0 0 0

30 Sediplast - Set, 100 pcs 2 0 0

31 Tissue - Pak, 200 lembar 5 6 5

35 Pot Dahak - Kontainer 0 0 0

36 Bluecapps centrifuge tubes Pak, 25 tube 0 0 0

37 Micropore 1/2 inch 3M Box, 24 pcs 11 0 0

38 Vacutainer Needle BD Box, 100 pcs 40 0 16

39 Autoclix lancet One Med 0 0 0

40 Lancet One Med 28 0 14

41 Botol semprot Plastik 4 0 0

42 Slide Mikroskop untuk

43 Lancet Single One Touch Box, @ 200 pcs 4 0 2

44 Box Objek Glass Orange pcs 1 0 0

45 Torniquet dewasa pcs 7 0 0

46 Pot faeces bening tutup ulir + sendok pcs 27 0 27

Warna kuning, merah,

48 Cotton Roll pak 47 0 0

49 Kertas Lakmus Kertas pak 0 0 0

50 Kertas saring Kertas pak 0 0 0

51 Torniquet anak _ pcs 6 0 6

52 Alkohol Swab Deschoderm pack 6 0 2

53 Masker Aximed pack 22 0 0

54 Handscoon Aximed pack , 100 pcs 4 0 4

56 Micropore 2 inchi Nextcare 0 0 0

57 Plastik Putih (obat) 8 0 2

58 Plastik Klip (10x7) pack @100 lbr 10 0 3

59 Plastik klip (10x15) pack @100 lbr 7 0 4

60 Tabung Urine SY Urine @100 pcs 21 0 2

61 Plastik Bening Kiloan 4 0 0

63 Tempat Dahak Steril pack @20 btl 2 0 0

64 Handscoon COSMO MED 0 30 6

65 Wing needle 23 g x ½ ‘’ Box Box,100 pcs 0 17 0

66 Wing needle 25 g x ½ ‘’ Box Box,100 pcs 0 16 0

67 Media Amis Swab pcs

ABORATORIUM TAHUN 2018