Form Permintaan BMHP Lab [PDF]

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PERMINTAAN BMHP LABORATORIUM UPT PUSKESMAS SEMESTER : I (SATU) NO



NAMA / MERK BARANG



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Blue tip Bood lancet Cover glass Drabkin Edta 10% cair Kartu golongan darah Kertas lensa Lampu Bunsen Larutan Eosin 2% Larutan Giemsa Larutan Hayem Larutan HCL 0,1 Larutan KOH 10% Larutan Natrium sitrat 3.8 Larutan Rees Ecker Larutan Turk Metylen blue Oil emersi Plestrin bulat standar Pot sputum 7cm X 5Cm PP test Rapid Test Dengue antibody Rapid Test Dengue NS1 Rapid Test HBSAG 25 strip Rapid Test HBSAG strip 25 test Rapid Test HBSAG strip 50 test Rapid Test Syphilis Ultra Rapid tes strip Reagen Golongan darah Reagen Kimia Albumin Reagen Kimia Cholestrol 5x100ml Reagen Kimia Cholestrol 5x25ml Reagen Kimia Creatine 4X50ml Reagen Kimia Glucose 5 x 100ml Reagen Kimia Glucose 5X100ml Reagen Kimia SGOT - 3X 50ml Reagen Kimia Trigliserida 4 X 50ml Reagen Kimia Ureum 2 X 125ml Reagen Kimia Uric Acid 2 X 50ml Slide Spiritus Stick B - HB Microcuvvete 201 Stick Cholestrol - Easy Touch Stick Glucose - Easy Touch Stick HB - ET Stick HB - quick check Stick Hb stik - easy touch Stick Uric Acid - Easy Touch Urinalisa strip 10P Urinalisa strip 3P Widal Test



TAHUN : 2017 JUMLAH SATUAN Pack Box Box Botol Box Pack Box Buah Botol Botol Botol Botol Botol Botol Botol Botol Botol Botol Box Pcs Box Box Box Box Box Box Box Set Box Box Box Box Box Box Box Box Box Box Box Botol Box Box Box Box Box Box Box Box Box Box



HARGA Jumlah Harga SATUAN 150,000 0 31,250 0 20,000 0 39,000 0 78,000 0 28,500 0 27,500 0 25,000 0 290,000 0 187,500 0 26,000 0 13,000 0 19,000 0 20,000 0 32,500 0 13,000 0 32,312 0 320,000 0 31,500 0 2,750 0 71,500 0 1,875,000 0 2,375,000 0 495,000 0 495,000 0 750,000 0 681,250 0 270,000 0 1,031,250 0 2,475,000 0 2,420,000 0 848,375 0 1,028,500 0 1,028,500 0 1,597,200 0 2,227,500 0 1,980,000 0 998,250 0 11,880 0 16,000 0 1,117,188 0 181,250 0 106,250 0 175,000 0 550,000 0 175,000 0 112,500 0 226,500 0 81,250 0 500,000 0



51 Yellow tip



Mengetahui Kepala UPT. Puskesmas



Pack



150,000



0 0



Koordinator Labora



Koordinator Laboratorium