CEKLIST INVENTARIS HARIAN ELEKTROMEDIK ANESTESI

TANGGAL
NO. NAMA BARANG ∑ MERK Keterangan
1 2 3 4 5 6 7 8 9 10
Infant/Pediatrik 1 Ambu
1 Resusitator Puritan
Adult 2
Drager
Am 2 SN.00000980 1
2 Blood Warmer Elltec
Am 2 SN.00000974 1
1 Matrix
Pediatrik
1 Welch Alyn
2 Riester
3 Laringoscope Adult 2 Foreger Folding
2 Mac Riester
Glide Scope
1 Glide Scope
SN. AN153080
1 Riester
No. 0
2 Matrix
1 Foreger Folding
1 Riester
No. 1 1 Matrix
1 Aika
1 Welch Alyn
1 Foreger Folding
4 Blade 1 Riester
No. 2
1 Aika
2 Mac Riester
1 Foreger Folding
No. 3 2 Riester
2 Mac Riester
1 Riester
No. 4 1 Aika
2 Mac Riester
 5 Sphygmomanometer SN. 030271 1 Nova Riester
Model TEC - 5521K
6 Defibrillator 1 Nihon Kohden
SN. 09303
1 Shin el
7 Humidifier
5 Allied Healthcare

TANGGAL
NO. NAMA BARANG ∑ MERK Keterangan
1 2 3 4 5 6 7 8 9 10
Infant :
L1A25992 1 Littman
Pediatrik :
K8X29383 1 Littman
Adult :
8 Stetoscope 18X72768 1
110M78659 1
Littman
18X51318 1
18X51311 1
Classic II 1
Riester
Riester Duplex 2
9 Doppler SN. 9031 Q 266728 1 Yamamoto Giken
Neonatus 1
Infant 1
10 Face Mask Toddler 3
Small 2
Meduim Adult 5
Pediatrik :
An. 380 3
11 Magil Aesculap
Adult :
An. 381 4
Small 9 Tayoma 003
12 Kidney Basin Medium 7 Tayoma 006
Large 11 Tayoma 034
13 Infuse Pump SN. 56252 1 B-Braun
 Type : STC 527
Terumo
SN. 95020038 1
Type : 8713030
14 Syringe Pump SN. 68641 1
SN. 68616 1 B-Braun
SN. 91186 1
SN. 95425 1
Kaki 4 6
15 Standar Infus Kaki 3 3
Urologi 1

TANGGAL
NO. NAMA BARANG ∑ MERK Keterangan
1 2 3 4 5 6 7 8 9 10
Type : Prima SP 2
SN. SP 20908 06 1
Penlon
Analisa Gas :
SN. AVS0908 69 1
16 Mesin Anestesi Type : Siesta iTS
SN. AM 5156517 1 Dameca
SN. AM 5156512 1
Type : Fabius
Drager
SN. ARYA-0043 1
Type : iMEC 12
SN. EV-8A040563 1
ECG EV6201 1 Mindray
Pulse O2 014489 1
Type : iMEC 12
SN. EV-8A040562 1
ECG EV6201 1 Mindray
Pulse O2 314488 1
Type : Bene View T5 IPX1
SN. CM-62147784 1
EGC EV6201 1
Mindray
17 Monitor
 Pulse O2 1 Mindray Rusak
17 Monitor
Bene View T1 IPX2
1
SN. FB-62012869
Type : Bene View T5 IPX1
SN. CM-62147785 1
ECG EV6201 1
Pulse O2 1 Mindray Rusak
Bene View T1 IPX2
1
SN. FB-62012870
Type : SP M5
SN. CM-97107741 1 Penlon ECG Rusak
Type : IntelliVue MX700
SN. ASDF-0074 1 Philips Pulse O2 Rusak
2 Hill-Room
18 Brankar + Tiang Infus 1 GEA
3 Paramount Bed
19 Patslide 1

TANGGAL
NO. NAMA BARANG ∑ MERK Keterangan
1 2 3 4 5 6 7 8 9 10
Type : Portable Vario
SN. 1081071 1
SN. 1080117 1 Medela
20 Suction SN. 1178727 1
Type : Puritan
Regulator Portable 1
Puritan Bennet
Regulator Central 3
SN. 180004283 1 Thermamed
21 Warm Blanked
SN. CI 0506 J158 1 Warm Touch
2 SM Sammora
22 Penlight
2 Energizer
23 Test Lung 1
24 Trolley Emergency 1 Metro Life
25 Tourniquet 5
26 Tabung O2 Kecil 1
27 Tempat tidur + Tiang 425 4 Hill Room
28 Dura Cuf
 PERMOHONAN CUTI

Bulan :

Tanggal
No. Nama
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 SUCIPTO
2 LILY PRATIWI
3 OLIVIA ELINA
4 MARSINDAK E.S
5 NIDYA TRI
6 ITOH NURJANAH
7 AVIN ELVINDO
8 HARSYA LOKITA
9 DEDEN AJI
10 YUZMAN SKD
11 SITI ARKHANI
12 WELNY A. PANGGESO
13 OKTAVIANA GEBY
14 SRI KURNIWATI
15 KRISTOFORUS ENGA
16 TRI MEYFITRIATY

ANESTESI

17 DEWI ARITA
18 PRISKA DIANNY
19 NURUBAY WIJAYANTI
20 SANTI EVI A.P
21 FAUZI PAHRESA
22 SAMUEL PRATAMA
23
24
Ket
 KEGIATAN ROTASI PERAWAT KAMAR BEDAH

KEGIATAN
NO TGL IDENTITAS PASIEN DIAGNOSA TINDAKAN PARAF
INST SIRK ANEST RR
 UPDATE DATA ELEKTROMEDIK ANESTESI 2019
OT MAYAPADA HOSPITAL TANGERANG

NO. NAMA BARANG ∑ MERK KETERANGA

Infant/Pediatrik 1 Ambu
1 Resusitator Puritan
Adult 2
Drager
Am 2 SN.00000980 1
2 Blood Warmer Elltec
Am 2 SN.00000974 1
1 Matrix
Pediatrik
1 Welch Alyn
2 Riester
3 Laringoscope Adult 2 Foreger Folding
2 Mac Riester
Glide Scope
1 Glide Scope
SN. AN153080
1 Riester
No. 0
2 Matrix
1 Foreger Folding
1 Riester
No. 1 1 Matrix
1 Aika
1 Welch Alyn
1 Foreger Folding
4 Blade 1 Riester
No. 2
1 Aika
2 Mac Riester
1 Foreger Folding
No. 3 2 Riester
2 Mac Riester
1 Riester
No. 4 1 Aika
2 Mac Riester
5 Sphygmomanometer SN. 030271 1 Nova Riester
Model TEC - 5521K
6 Defibrillator 1 Nihon Kohden
SN. 09303
1 Shin el
7 Humidifier
5 Allied Healthcare
Infant :
L1A25992 1 Littman
Pediatrik :
K8X29383 1 Littman
Adult :
8 Stetoscope
8 Stetoscope 18X72768 1
110M78659 1
Littman
18X51318 1
18X51311 1
Classic II 1
Riester
Riester Duplex 2
9 Doppler SN. 9031 Q 266728 1 Yamamoto Giken
Neonatus 1
Infant 1
10 Face Mask Toddler 3
Small 2
Meduim Adult 5
Pediatrik :
An. 380 3
11 Magil Aesculap
Adult :
An. 381 4
Small 9 Tayoma 003
12 Kidney Basin Medium 7 Tayoma 006
Large 11 Tayoma 034
13 Infuse Pump SN. 56252 1 B-Braun
Type : STC 527
Terumo
SN. 95020038 1
Type : 8713030
14 Syringe Pump SN. 68641 1
SN. 68616 1 B-Braun

SN. 91186 1
SN. 95425 1
Kaki 4 6
15 Standar Infus Kaki 3 3
Urologi 1
Type : Prima SP 2
SN. SP 20908 06 1
Penlon
Analisa Gas :

SN. AVS0908 69 1
Type : Siesta iTS

SN. AM 5156517 1 Dameca

SN. AM 5156512 1
Type : Fabius
Drager
SN. ARYA-0043 1
16 Mesin Anestesi Type : Carestation 650
1
SN. SM718060042MA
Analisa Gas : GE Diterima tgl 27 febr
Model : G1500242
1
SN. 091052368
Type : Carestation 650
1
SN. SM719210031MA
GE Diterima tgl 1 agus
 Analisa Gas : GE Diterima tgl 1 agus

Model : G1500242
1
SN. 091078860
Sevo :
SN. D0808 0559 1
SN. D1002 304 1 Penlon

Iso :
SN. D0908 0159 1
Sevo :
SN. D0912 0621 1
SN. D0912 0636 1
Dameca Sigma Delta
Iso :
SN. D0712 0134 1
SN. D0812 0286 1
17 Vaporizer
Sevo :
SN. ARYA-0992 1
Drager Vapor 2000
Iso :
SN. ARYA-0435 1
Type : TEC 7
Sevo :
SN. BEJX00796 1
SN. BEJX02050 1 Datex-Ohmed

Iso :
SN. BEGW02476 1
SN. BEGX00407 1
Type : iMEC 12
SN. EV-8A040563 1
ECG EV6201 1 Mindray
Pulse O2 014489 1
Type : iMEC 12
SN. EV-8A040562 1
ECG EV6201 1 Mindray
Pulse O2 314488 1
Type : Bene View T5 IPX1
SN. CM-62147784 1
EGC EV6201 1
Pulse O2 1 Mindray
18 Monitor
Bene View T1 IPX2
1
SN. FB-62012869
Type : Bene View T5 IPX1
SN. CM-62147785 1
ECG EV6201 1
Pulse O2 1 Mindray
Bene View T1 IPX2
1
SN. FB-62012870
 Type : SP M5
SN. CM-97107741 1 Penlon
Type : IntelliVue MX700
SN. ASDF-0074 1 Philips
2 Hill-Room
19 Brankar + Tiang Infus 1 GEA
3 Paramount Bed
20 Patslide 1
Type : Portable Vario
SN. 1081071 1
SN. 1080117 1 Medela
21 Suction SN. 1178727 1
Type : Puritan
Regulator Portable 1
Puritan Bennet
Regulator Central 3
SN. 180004283 1 Thermamed
22 Warm Blanked
SN. CI 0506 J158 1 Warm Touch
2 SM Sammora
23 Penlight
2 Energizer
24 Test Lung 1
25 Trolley Emergency 1 Metro Life
26 Tourniquet 5
27 Tabung O2 Kecil 1
28 Tempat tidur + Tiang 425 4 Hill Room
Large Adult :
CM 1204 1
Adult :
CM 1203 6
29 Dura Cuff Mindray
Child :
CM 1202 2
Infant :
CM 1201 1
KETERANGAN
Diterima tgl 27 februari 2019

Diterima tgl 1 agustus 2019

Diterima tgl 1 agustus 2019
 CEKLIST HARIAN ELEKTROMEDIK ANESTESI
OT MAYAPADA HOSPITAL TANGERANG

BULAN :
TANGGAL
NO. NAMA BARANG ∑ MERK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Infant/Pediatrik 1 Ambu
1 Resusitator Puritan
Adult 2
Drager
Am 2 SN.00000980 1
2 Blood Warmer Elltec
Am 2 SN.00000974 1
1 Matrix
Pediatrik
1 Welch Alyn
2 Riester
3 Laringoscope Adult 2 Foreger Folding
2 Mac Riester
Glide Scope
1 Glide Scope
SN. AN153080
1 Riester
No. 0
2 Matrix
1 Foreger Folding
1 Riester
No. 1 1 Matrix
1 Aika
1 Welch Alyn
1 Foreger Folding
4 Blade 1 Riester
No. 2
1 Aika
2 Mac Riester
1 Foreger Folding
No. 3 2 Riester
2 Mac Riester
1 Riester
No. 4 1 Aika
2 Mac Riester
5 Sphygmomanometer SN. 030271 1 Nova Riester
 Model TEC - 5521K
6 Defibrillator 1 Nihon Kohden
SN. 09303
1 Shin el
7 Humidifier
5 Allied Healthcare
Infant :
L1A25992 1 Littman
Pediatrik :
K8X29383 1 Littman
Adult :
8 Stetoscope 18X72768 1
110M78659 1
Littman
18X51318 1
18X51311 1
Classic II 1
Riester
Riester Duplex 2
9 Doppler SN. 9031 Q 266728 1 Yamamoto Giken
Neonatus 1
Infant 1
10 Face Mask Toddler 3
Small 2
Meduim Adult 5
Pediatrik :
An. 380 3
11 Magil Aesculap
Adult :
An. 381 4
Small 9 Tayoma 003
12 Kidney Basin Medium 7 Tayoma 006
Large 11 Tayoma 034
13 Infuse Pump SN. 56252 1 B-Braun
Type : STC 527
Terumo
SN. 95020038 1
Type : 8713030
14 Syringe Pump SN. 68641 1
SN. 68616 1 B-Braun

SN. 91186 1
SN. 95425 1
 Kaki 4 6
15 Standar Infus Kaki 3 3
Urologi 1
Type : Prima SP 2
SN. SP 20908 06 1
Penlon
Analisa Gas :

SN. AVS0908 69 1
Type : Siesta iTS

SN. AM 5156517 1 Dameca

SN. AM 5156512 1
Type : Fabius
Drager
SN. ARYA-0043 1
16 Mesin Anestesi Type : Carestation 650
1
SN. SM718060042MA
Analisa Gas : GE

Model : G1500242
1
SN. 091052368
Type : Carestation 650
1
SN. SM719210031MA
Analisa Gas : GE

Model : G1500242
1
SN. 091078860
Sevo :
SN. D0808 0559 1
SN. D1002 304 1 Penlon

Iso :
SN. D0908 0159 1
Sevo :
SN. D0912 0621 1
SN. D0912 0636 1
Dameca Sigma Delta
Iso :
SN. D0712 0134 1
SN. D0812 0286 1
17 Vaporizer
Sevo :
SN. ARYA-0992 1
Drager Vapor 2000
Iso :
 Drager Vapor 2000

SN. ARYA-0435 1
Type : TEC 7

Sevo :
SN. BEJX00796 1
SN. BEJX02050 1 Datex-Ohmed

Iso :
SN. BEGW02476 1
SN. BEGX00407 1
Type : iMEC 12
SN. EV-8A040563 1
ECG EV6201 1 Mindray
Pulse O2 014489 1
Type : iMEC 12
SN. EV-8A040562 1
ECG EV6201 1 Mindray
Pulse O2 314488 1
Type : Bene View T5 IPX1
SN. CM-62147784 1
EGC EV6201 1
Pulse O2 1 Mindray
18 Monitor
Bene View T1 IPX2
1
SN. FB-62012869
Type : Bene View T5 IPX1
SN. CM-62147785 1
ECG EV6201 1
Pulse O2 1 Mindray

Bene View T1 IPX2

1
SN. FB-62012870
Type : SP M5
SN. CM-97107741 1 Penlon
Type : IntelliVue MX700
SN. ASDF-0074 1 Philips
2 Hill-Room
19 Brankar + Tiang Infus 1 GEA
3 Paramount Bed
20 Patslide 1
 Type : Portable Vario
SN. 1081071 1
SN. 1080117 1 Medela
21 Suction SN. 1178727 1
Type : Puritan
Regulator Portable 1
Puritan Bennet
Regulator Central 3
SN. 180004283 1 Thermamed
22 Warm Blanked
SN. CI 0506 J158 1 Warm Touch
2 SM Sammora
23 Penlight
2 Energizer
24 Test Lung 1
25 Trolley Emergency 1 Metro Life
26 Tourniquet 5
27 Tabung O2 Kecil 1
28 Tempat tidur + Tiang 425 4 Hill Room
Large Adult :
CM 1204 1
Adult :
CM 1203 6
29 Dura Cuf Mindray
Child :
CM 1202 2
Infant :
CM 1201 1

NOTE :
21 22 23 24 25 26 27 28 29 30 31