2014, no.383 10 · 2014, no.383 12 48 dresing forceps unit 1 49 extracting forceps for bayonet unit...

2014, No.383 10

STANDAR PERALATAN KESEHATAN RUMAH SAKIT TINGKAT III

DI LINGKUNGAN KEMHAN DAN TNI

NO. JENIS PERALATAN PADA POKOK PELAYANAN SATUAN JUMLAH KET 1 2 3 4 5 I. PELAYANAN MEDIK UMUM

A. Pelayanan Medik Dasar 1 Diagnostik set Set 1 2 Examination lamp Unit 1 3 Examination table Unit 1 4 Instrument table Unit 1 5 Minor surgery set Set 1 6 Nebulizer Unit 1 7 Sterilisator Unit 1

B. Pelayanan Medik Gigi Mulut 1 Amalgam mixer Unit 1 2 Bedah mulut minor Unit 1 3 Boiling water sterilizer Unit 1 4 Dental cabinet Unit 1 5 Dental Unit: Unit 1 - Air kompresor - Operating stool mobile 6 Dressing drums Unit 1 7 Peralatan standar KG Unit 1 a. Pengawet Gigi 8 Alkohol/spiritus burners all metal Unit 1 9 Alloy mercry dispensor Unit 1

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http://www.djpp.kemenkumham.go.id

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10 Amalgam 1 pluggers double ended Unit 1 11 Amalgam carriers (pistol amalgam) Unit 1 12 Cement pluffers double ended Unit 1 13 Cement spatulas double ended Unit 1 14 Chip blower Unit 1 15 Cotton wool dispensor with springs Unit 1 16 Dappan glass Unit 1 17 Diamond burs assorted Unit 1 18 Dressing tweezers Unit 1 19 Excavatordouble ended Unit 1 20 Exclorers Unit 1 21 Exlirpanon needles assorted Unit 1 22 Finishing instrument Unit 1 23 Lentulo e needles assorted Unit 1 24 Matric band Unit 1 25 Matrix retainer IVORY Unit 1 26 Mixing glass slab Unit 1 27 Mortar & pestle for amalgam Unit 1 28 Mouth mirror Unit 1 29 Petric dish Unit 1 30 Plastic filling instrument double ended Unit 1 31 Reamet assorted Unit 1 32 Scissor Unit 1 33 Silicate spatulas double ended Unit 1 34 Tongue depressor with cotton roll holder Unit 1 35 Water synnge all metal Unit 1 b. Pembersih Karang Gigi 36 Curetalveoli lucas Unit 1 37 Pocket measuring instrument krene Unit 1 38 Scaler Unit 1 39 Scaler abbot Unit 1 40 Scaler blacks Unit 1 41 Scaler bolst Unit 1 42 Scaler call Unit 1 43 Scaler struurridge Unit 1 44 Scaler white Unit 1 c. Untuk Mencabut Gigi 45 Alveololomy files Unit 1 46 Bone rongeurs Unit 1 47 Disposible syringe + jarum Unit 1



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48 Dresing forceps Unit 1 49 Extracting forceps for bayonet Unit 1 50 Extracting forceps for lelt upper molar Unit 1 51 Extracting forceps for lower incisors and

canine Unit 1

52 Extracting forceps for lower molars Unit 1 53 Extracting forceps for lower roots Unit 1 54 Extracting forceps for lower wisdom left Unit 1 55 Extracting forceps for lower wisdom right Unit 1 56 Extracting forceps for right upper molar Unit 1 57 Extracting forceps for upper bicuspid Unit 1 58 Extracting forceps for upper central and

canine Unit 1

59 Extracting forceps for upper laterals Unit 1 60 Extracting forceps for upper root bicuspids Unit 1 61 Extracting forceps for upper root incisors Unit 1 62 Extracting forceps for upper wisdom Unit 1 63 Finger proteclor Unit 1 64 Gauze paver Unit 1 65 Gum scissors bengkok Unit 1 66 Kidney bowls Unit 1 67 Klein’s children forceps for lower incisors Unit 1 68 Klein’s children forceps for lower molar Unit 1 69 Klein’s children forceps for lower roots Unit 1 70 Klein’s children forceps for upper incicors

and canine Unit 1

71 Klein’s children forceps for upper molars Unit 1 72 Klein’s children forceps for upper roots Unit 1 73 Klein’s children forceps for upper roots

(bayonet) Unit 1

74 Needle holder Unit 1 75 Perios teal elevators Unit 1 76 Root elevators (bein) besar Unit 1 77 Root elevators (bein) kecil Unit 1 78 Root elevators apical kanan Unit 1 79 Root elevators apical kiri Unit 1 80 Root elevators cryer kanan Unit 1 81 Root elevators cryer kiri Unit 1 82 Scalpel blades Unit 1 83 Scalpel handles Unit 1 84 Silik suture Unit 1



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85 Sterrilisng lorceps Unit 1 86 Suture needles Unit 1 87 Tissue forceps Unit 1

C. Pelayanan KIA/KB 1 Lampu sorot Unit 1 2 Minor surgery set Set 1 3 Spiculum Set 1 4 Timbangan anak Unit 1 5 USG Unit 1

II. PELAYANAN GAWAT DARURAT 1 Defibrilator Unit 1 2 Anesthesi apparatus Unit 1 3 Balut bidai Set 1 2 x jml.

trauma 4 EKG Unit 1 5 Infusion set Set 1 2xjml.bed 6 Klinik Set Set 1 7 Minor surgery set Set 1 8 Nebulizer Set 1 9 NGT Unit 1 10 Operating Lamp Unit 1 11 Operating table Unit 1 12 Partus Set Set 1 13 Pulse oxymeter Unit 1 14 Sterilisator Unit 1 15 Stetoskop Unit 1 16 Suction pump Unit 1 17 Tabung oksigen Unit 1 18 Tensi meter Unit 1 19 Termometer Unit 1 20 Trolley emergency set: Set 1 - Ambubag dewasa, anak - ETT dewasa, anak - Laringoskop dewasa, anak - Magil forcep - Pipe orofaring (mayo/guedel) - Suction unit - Tabung O2



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- Jarum besar (12-14g) - Collar splint

21 Urine Catheter Set 1

III. PELAYANAN MEDIK SPESIALIS DASAR

A. Pelayanan Penyakit Dalam 1 Alat Cardioverter/DC Shock Unit 1 2 Alat Suction Unit 1 3 Anoskop Rigid (Logam/Plastik) 4 Autoclave table Unit 1 5 Blood Transfusion Set Set 1 6 Botol Wsd Unit 1 7 Bronchoscope Unit 1 8 Cvp Set Set 1 9 Diagnostic set Unit 1 10 EKG 1 Channel Unit 1 11 Ekokardiografi (dengan Sertifikasi) Unit 1 12 Emergency Set Set 1 13 Emergency trolley Unit 1 14 Endotracheal Pipe Unit 1 15 Esofago-Gastroduode Noskopi (dengan

Sertifikasi) Unit 1

16 Examination lamp Unit 1 17 Examination table Unit 1 18 Film Viewer Unit 1 19 Glukometer Unit 1 20 Head Lamp Unit 1 21 Hemodialisi (dengan Sertifikasi) Unit 1 22 Inhalator Unit 1 23 Instrumen trolley Unit 1 24 Jarum Aspirasi Unit 1 25 Jarum Aspirasi Sumsum Tulang (14-16 G) Set 1 26 Jarum Biopsi Set 1 27 Kateter Dialisis Peritoneal Unit 1 28 Kateter Nelaton Unit 1 29 Kateter Vena Sentral Unit 1 30 Kit Anafilasis Unit 1 31 Kit Tes Tempel Kit 1 32 Kit Tes Tusuk Kit 1 33 Kolonoskopi (dengan Sertifikasi) Unit 1



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34 Laringoskop Unit 1 35 Lemari obat/alat Unit 1 36 Mikroskop Unit 1 37 Monitor Jantung Unit 1 38 Mouthpieces Unit 1 39 Nebulizer Unit 1 40 Peakmeter Unit 1 41 Peralatan Biopsi Hati (Jarum Biopsi, dll) Set 1 42 Peralatan Fisioterapi (kerjasama dengan

Unit Rehab Medik) Unit 1

43 Pulse Oximetry Unit 1 44 Pungsi Pleura Set Set 1 45 Pungsi Supra Pubik Set Set 1 46 Reflex hammer Unit 1 47 Rektoskop Unit 1 48 Resuscitation for adult Unit 1 49 Sengstaken Blakemore Tube (Sb Tube) Unit 1 50 Senter Unit 1 51 Sentimeter/Meteran Unit 1 52 Set Bedah Minor Set 1 53 Set Biopsi Ginjal Set 1 54 Spirometri Unit 1 55 Spygmomanometer Unit 1 56 Stetoskop Unit 1 57 Stool fixed height Unit 1 58 Suction for Thorax Unit 1 59 Syringe pump Unit 1 60 Tempat tidur periksa Unit 1 61 Tensimeter Unit 1 62 Timbangan badan/tinggi badan Unit 1 63 TMT (dengan Sertifikasi) Unit 1 64 Tongue spatel Unit 1 65 Trokar Unit 1 66 USG Unit 1

B. Pelayanan Kesehatan Anak a. Klinik Rawat Jalan 1 Alat foto terapi sederhana Unit 1 2 Alat penghisap lendir Unit 1 3 Blue Light Unit 1 4 Cold chain Unit 1



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5 Diagnostic set Set 1 6 EKG Unit 1 7 Emergency cart Unit 1 8 Feeding tubes anak Unit 1 9 Feeding tubes bayi Unit 1 10 Flash light Unit 1 11 Glycerin spuite Unit 1 12 Inkubator bayi sederhana Unit 1 13 Manset tensimeter anak Unit 1 14 Manset tensimeter bayi Unit 1 15 Meja ganti pakaian bayi (baby tafel) Unit 1 16 Meja periksa untuk anak Unit 1 17 Meja resusitasi anak Unit 1 18 Meja resusitasi bayi Unit 1 19 Oxygen set + flowmeter Set 1 20 Paediatric trolley Unit 1 21 Pengukur panjang bayi Unit 1 22 Pipa Schorsten Unit 1 23 Rectal Irigator anak Unit 1 24 Reflex hammer Unit 1 25 Refrigerator Unit 1 26 Respirator Unit 1 27 Set Resusitasi anak dan bayi lengkap

dengan Defibrilator Set 1

28 Sphygmomanometer Unit 1 29 Stetoskop anak Unit 1 30 Stetoskop bayi Unit 1 31 Suction Pump Unit 1 32 Tempat tidur bayi dan anak Unit 1 33 Tensimeter dengan manset untuk anak,

bayi dan dewasa Unit 1

34 Termometer axilla Unit 1 35 Termometer rectal Unit 1 36 Timbangan dan pengukur tinggi bayi dan

anak Unit 1

37 Tongue spatel Unit 1



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b. Perawatan

38 EKG Unit 1 39 Alat penghisap lendir Unit 1 40 Diagnostic Set Set 1 41 Flash light Unit 1 42 Meja Resusitasi Anak Unit 1 43 Meja Resusitasi Bayi Unit 1 44 Meja tindakan dengan radian warmer Unit 1 45 Reflex hammer Unit 1 46 Set Resusitasi Anak Set 1 47 Stetoskop anak Unit 1 48 Stetoskop bayi Unit 1 49 Tempat tidur anak Unit 1 50 Tempat tidur dewasa Unit 1 51 Tensimeter dengan manset untuk anak,

bayi dan dewasa Unit 1

52 Termometer axilla Unit 1 53 Termometer rectal Unit 1 54 Timbangan dan pengukur tinggi bayi dan

anak Unit 1

55 Tongue spatel Unit 1 c. Perinatologi

56 Baby couch Unit 1 57 Baby examination table Unit 1 58 Baby incubator Unit 1 59 Baby resuscitation set Set 1 60 Baby scale Unit 1 61 Examination lamp Unit 1 62 Flash light Unit 1 63 Foto theraphy Unit 1 64 Infant stetoscope Unit 1 65 Infant warmer Unit 1 66 Infusion pump Unit 1 67 Infusion stand Unit 1 68 Intubation set for infant Set 1 69 Scissor for bandage Unit 1 70 Sphygmomanometer Unit 1 71 Sunction pump Unit 1



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72 Termometer axilla Unit 1 73 Termometer rektal Unit 1 74 Tounge spatel Unit 1 75 Transport incubator Unit 1 76 UV room sterilizer Unit 1

C. Pelayanan Bedah 1 Anaesthesi apparatus Unit 1 2 Autoclave table Unit 1 3 Defibrilator Unit 1 4 Electro surgery Unit 1 5 Laser coagulator Unit 1 6 Operating lamp Unit 1 7 Operating table Unit 1 8 Refrigerator Unit 1 9 Respirator Unit 1 10 Suction pump Unit 1 a. Klinik Rawat Jalan

11 Alat bedah minor Unit 1 12 Alat punch biopsi Unit 1 13 Anoskopi Unit 1 14 Autoclave Unit 1 15 Elektrokauter Unit 1 16 Flash light Unit 1 17 Head lamp Unit 1 18 Lampu operasi Unit 1 19 Laringoscope Unit 1 20 Lokal anestesi set Set 1 21 Meja instrument Unit 1 22 Meja periksa Unit 1 23 Minor surgery set/unit Diagnostik dan

treatment Unit 1

24 Resuscitasi set Set 1 25 Resuscitator Unit 1 26 Sigmoidoskopi Unit 1 27 Spekulum hidung Unit 1 28 Stetoskop 1 29 Suction unit Unit 1



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30 Tensimeter 1 31 Tongue Spatel Unit 1 32 Trakeostomi set Set 1 33 Unit diagnostik dan treatment Unit 1 b. Rawat Inap

34 Flash light Unit 1 35 Stetoskop Unit 1 36 Anoskopi Unit 1 37 Meja periksa Unit 1 38 Meja instrument Unit 1 39 Set bedah minor Set 1 40 Unit diagnostik dan terapi Unit 1 41 Tensimeter Unit 1 42 Suction Unit 1 43 Autoclave Unit 1 44 Alat bedah perawatan luka Unit 1

c. Ruang Operasi

45 Alat operasi mayor Unit 1 46 Bedah Kardiotorasik Unit 1 47 Couch examination Unit 1 48 ECG I Channel Unit 1 49 Electrocauter Unit 1 50 Electromedik Unit 1 51 Endotracheal Unit 1 52 Endotracheal tube Unit 1 53 Head lamp Unit 1 54 Head lamp Unit 1 55 Head lamp Unit 1 56 Humby knife Unit 1 57 Lampu operasi Unit 1 58 Lampu operasi Unit 1 59 Laparoskopik set Set 1 60 Laparotomi set I (standar) Set 1 61 Laparatomi set II (ditambah) alat khusus

untuk prosedur tertentu Set 1

62 Laringoscopi Unit 1 63 Maslektomi set Set 1



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64 Meja operasi Unit 1 65 Meja operasi multi prasi Unit 1 66 Nebulizer Unit 1 67 Parotidektomi set Set 1 68 Sphygmomanometer Unit 1 69 Spirometer Unit 1 70 Stool fixed higth Unit 1 71 Suction unit Unit 1 72 Thyroidektomy set Set 1 73 Trakeostomi set Set 1 74 Urologi Unit 1 75 USG Unit 1

D. Pelayanan Kebidanan dan Kandungan 1 Alkohol cotton case Unit 1 2 Anaesthesi apparatus Unit 1 3 Autoclave table Unit 1 4 Baby incubator Unit 1 5 Baby weighing scale Unit 1 6 Badpan untuk orang dewasa Unit 1 7 Benang sutra Unit 1 8 Chromic cat gut Unit 1 9 Cunam fiper Unit 1 10 Cunam naegele Unit 1 11 Dilatator Hegar Unit 1 12 Ekstraktor Vakum Malstrom Unit 1 13 Examination lamp Unit 1 14 Examination table Unit 1 15 Film Viewer Unit 1 16 Foetal monitoring Unit 1 17 Gunting episiotomi Unit 1 18 Gunting lurus (berbagai ukuran) Unit 1 19 Gunting operasi lengkung Unit 1 20 Gunting operasi lurus Unit 1 21 Gunting Siebold Unit 1 22 Gunting tali pusat Unit 1 23 Gunting Verband Unit 1 24 Gynaecological exam table Unit 1 25 Hipodermic needle : 2; 12; 14; 16; 18 Unit 1 26 Hipodermic syringe : 1; 2; 5; 10; 100 cc Unit 1



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27 Infusion pump Unit 1 28 Instrument tray Unit 1 29 Insulin syringe Unit 1 30 Jangka panggul Unit 1 31 Jarum pungsi asites Unit 1 32 Jarum pungsi pleura Unit 1 33 Klem Kocher Unit 1 34 Klem pean Unit 1 35 Kranioklast Unit 1 36 Kuret Uterus tajam No. 1 dan No. 2 Unit 1 37 Kuret Uterus Tumpul Unit 1 38 Lampu operasi Unit 1 39 Lampu trans ilumiarasi Unit 1 40 Meja ginekologik Unit 1 41 Meja operasi Unit 1 42 Meja pemeriksaan obstetrik Unit 1 43 Neonatal resuscitation Unit 1 44 Nierbekken (bengkok) Unit 1 45 Pengait A K D R Unit 1 46 Pengait Braun Unit 1 47 Perforator simspon klem muzeauq Unit 1 48 Pinset anatomi (berbagai ukuran) Unit 1 49 Placenta basin Unit 1 50 Prematur infant Inkubator Unit 1 51 Scale weight Unit 1 52 Sonde Uterus Unit 1 53 Speculum sims Unit 1 54 Spekulum Langenbeck Unit 1 55 Sphygmomanometer Unit 1 56 Spongge holding forceps Unit 1 57 Standar Waskom Unit 1 58 Stetoscope monoaural Laenec Unit 1 59 Stikpan Unit 1 60 Stop watch Unit 1 61 Suction pump Unit 1 62 Tabung Oksigen Unit 1 63 Tampon tang (uterine dressing loceps) Unit 1 64 Tempat tidur partus 65 Tenakulum 66 Test tube kecil dengan rak Unit 1 67 Tubercullini syringe Unit 1 68 Urinemeter Unit 1



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69 Urinoir Unit 1 70 Vacuum extractor Unit 1 71 Waskom Unit 1 a. Penanggulangan Penderita Gawat

Darurat

72 Anaesthesi apparatus Unit 1 73 Bank darah Unit 1 74 Kamar bersalin dengan semua

perlengkapannya termasuk perlengkapan resusitasi bayi

75 Kamar operasi dengan semua perlengkapannya

76 Kamar pulih (recovery room) semua perlengkapannya

77 Patologi: Hb, Leuko, urine, Gula darah dll 78 Radiologi dengan USG Unit 1 79 Sterilisasi Unit 1 b. Klinik Rawat Jalan

80 Doppler Set 1 81 Forceps Biopsy Unit 1 82 Implant kit Set 1 83 IUD kit & Injeksi KB Unit 1 84 Kolposkopi Unit 1 85 Lampu periksa Unit 1 86 Linen Unit 1 87 Meja periksa ginekologi Unit 1 88 Meja periksa kebidanan Unit 1 89 Papsmear kit Set 1 90 Set pemeriksa ginekologi Set 1 91 Stetoskop Unit 1 92 Stetoskop Laenec Unit 1 93 Tensimeter Unit 1 94 Timbangan ibu Unit 1 95 USG Unit 1 c. Kamar Bersalin

96 Cardiotocograph Unit 1



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97 Celemek plastik Unit 1 98 Doek Unit 1 99 Doppler/KTG Unit 1 100 Emergency light Unit 1 101 Forceps Unit 1 102 Gunting tali pusat Unit 1 103 Infus set Set 1 104 Kasa dan kapas Unit 1 105 Klem hemostasis arteri Unit 1 106 Lampu periksa Unit 1 107 Minor surgery instrument set Set 1 108 O2 Set Unit 1 109 Resuscitation for adult Unit 1 110 Resuscitation for infant Unit 1 111 Sarung tangan Unit 1 112 Set AVM/kuretase Set 1 113 Set minor surgery Set 1 114 Set partus Set 1 115 Stand infuse Unit 1 116 Sterilisator Unit 1 117 Stetoskop Unit 1 118 Suction Apparatus Unit 1 119 Tensimeter Unit 1 120 Timbangan bayi Unit 1 121 USG Unit 1 122 Vakum ekstraktor Unit 1

d. Perawatan

123 Tempat tidur ibu Unit 1 124 Tempat tidur bayi Unit 1 125 Tensimeter Unit 1 126 Termometer Unit 1 127 Stetoskop biasa Unit 1 128 Ginekologi Set Set 1 129 Infus set Unit 1 130 Resusitasi Set Set 1 131 Suction pump Unit 1 132 Meja ginekologi Unit 1 133 Instrument table Unit 1 134 O2 Set Set 1



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135 Film Viewer Unit 1 136 Antidecubitus Matras Unit 1 137 Wash basin Unit 1 138 Emergency light Unit 1 139 Lampu periksa 140 Tiang infus 141 Minor surgery set Set 1 142 Catheter Unit 1 143 Nebulizer Unit 1 144 Vena section set Set 1

e. Kamar Bedah

145 Autoclave Unit 1 146 CVP set Set 1 147 Embriotomi set Set 1 148 Emergency light Unit 1 149 Endoskopik videomonitor Unit 1 150 Histerektomi set Set 1 151 Infus set Set 1 152 Inkubator bayi Unit 1 153 Lampu operasi Unit 1 154 Laparoskop diagnostic/sterilisasi set Set 1 155 Laparotomi set Set 1 156 Meja instrument Unit 1 157 Meja operasi Unit 1 158 Monitor Kardiovaskuler Unit 1 159 O2 set Set 1 160 Obstetrik vakum Unit 1 161 Partus set kuret/Abortus set Set 1 162 Peralatan Pemeriksaan rutin: Unit 1

- Darah tepi - Kimia darah - Serologik

163 Radikal set Set 1 164 Resuscitator set Set 1 165 Ring aplikator Unit 1 166 Seksio/Histerektomi set Set 1



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IV. PELAYANAN SPESIALISTIK PENUNJANG MEDIK

A. Pelayanan Anestesiologi Anestesi Umum 1 Anaesthesi machine dengan circle system

dengan O2 dan N2O, dengan vaporizer untuk ether, halothane dan etrane

Unit 1

2 Set Magill system 3 Set waters system 4 Ventilator yang digerakkan dengan O2

tekan atau udara telan, ventilator ini harus dapat dihubungkan dengan mesin anestesi

Unit 1

5 Nasopharingeal airway ukuran dewasa (semua ukuran)

Unit 1

6 Laryngoskop dewasa dengan daun lengkung ukuran 1-4

Unit 1

7 Laryngoskop bayi dengan daun lurus Unit 1 8 Konektor dari tabung oro dan naso trakheal

dengan mesin anesthesi Unit 1

9 Pipa trachea oral/nasal dengan cuff (plain endotracheal tube) no. 2½, 3, 3½, 4, 4½, 5.

Unit 1

10 Pipa trachea spiral no. 5, 5½, 6, 6½, 7, 7½, 8, 8½, 9, 9½.

Unit 1

11 Pipa orotrachea dengan cuff (cuff orotracheal tube) no. 5½, 6, 6½, 7, 7½, 8, 8½, 9, 9½.

Unit 1

12 Pipa nasotrachea dengan cuff no. 5½, 6, 6½, 7, 7½, 8, 8½, 9.

Unit 1

13 Magill forceps ukuran dewasa Unit 1 14 Magill forceps ukuran anak Unit 1 15 Sikat pembersih pipa trachea, ukuran kecil

dan besar Unit 1

16 Infusion stand Unit 1 17 Tensimeter Unit 1 18 Stetoskop Unit 1 19 Timbangan berat badan Unit 1 20 Tabung gas O2 + manometer + flow meter +

humidefier Unit 1



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a. Persiapan Operasi

21 Body weight/high scale Unit 1 22 Double bowel stand Unit 1 23 Infusion stand Unit 1 24 Intubation set Set 1 25 Medicine cabinet Unit 1 26 Medicine trolley Unit 1 27 Oxygen concentrate Unit 1 28 Patient trolley Unit 1 29 Resuscitation set Set 1 30 Scrub-up Unit 1 31 Sphygmomanometer Unit 1 32 Stetoskop Unit 1 33 Suction pump Unit 1 34 Termometer Unit 1 b. Kamar Operasi

35 Anaesthesi Machine Unit 1 36 Anaesthesia Peadiatric set Set 1 37 CVP set Set 1 38 Defibrilator with monitor Unit 1 39 Infusion set Set 1 40 Infusion stand Unit 1 41 Intubation set Set 1 42 Medicine trolley Unit 1 43 Monitor ECG Unit 1 44 Pulse Oxymeter Unit 1 45 Repirator Unit 1 46 Resuscitation set Set 1 47 Sphygmomanometer Unit 1 48 Stetoscope Unit 1 49 Suction pump Unit 1 50 Tabung O2 Unit 1 51 Termometer Unit 1 52 Ventilator Unit 1 c. Pemulihan

53 Defibrilator with monitor Unit 1



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54 Examination Lamp Unit 1 55 ICU bed Unit 1 56 Mobile Sphygmomanometer Unit 1 57 Oxygen apparatus + flowmeter Unit 1 58 Pulse Oxymeter Unit 1 59 Stetoscope Unit 1 60 Suction pump Unit 1

B. Pelayanan Radiologi 1 X-Ray Unit dengan kapasitas minimal

sampai dengan 300 mA Unit 1

2 Generator 100 KV - 150 KV Type transformes 2 buah switch

Unit 1

a. Ruang dokter 3 Spot filming device 4 Meja stationery dengan bucky 5 Overhead tube (berkemampuan 500 mA,

double focus, rotating anode, multi leaves, Light beam collimator) dilengkapi dengan Linear tomography

6 Mobile X-ray, condensor discharge system (100 - 150 KV)

Unit 1

7 Alat mammography 8 Control table 9 Accessories: Set 1 - Vertical cassettestand - Lysholm - Trigator - X-ray marker set - HSG set - Hanger b. Ruang X-ray

10 Kateter Unit 1 11 Nierbekken bengkok Unit 1 12 Korentang Unit 1 13 Pispot/Urinal Unit 1



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14 Lampu pemeriksaan Unit 1 15 Sterilisator Unit 1 16 Tabung O2 Unit 1 17 Resusitator Unit 1 18 Viewing box Unit 1 c. Ruang/Kamar Gelap

19 Tangki developer isi 20 liter Unit 1 20 Safe light Unit 1 21 Interval timer Unit 1 22 Exhaust fan Unit 1 23 Film cutter Unit 1 24 Termometer dinding Unit 1 25 Pass box Unit 1 26 Bak air bersih Unit 1 27 Film dryer Unit 1 d. Proteksi Radiasi

28 Lead apron Unit 1 29 Film bagde Unit 1 30 Screen dengan lead glass ukuran 20 cm x

30 cm Unit 1

31 Lead gloves Unit 1 32 Gonad shield Unit 1 33 Survey meter Unit 1 e. Ruang USG

34 USG Unit 1 35 Transduzer 3,5 - 5 mHz Unit 1 36 Monitor Unit 1 37 Polaroid camera Unit 1 38 ID (numeric alphabhetic) Set 1

C. Pelayanan Rehabilitasi Medik 1 Short wave diatermy + accessories Unit 1 2 Deluxe exercise Bicucle Unit 1 3 Clinical model restorator Unit 1



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4 Ultrasonic generator + mobile stand + accessories

Unit 1

5 Aluminium walking aid/dewasa Unit 1 6 Loddler walkerete Unit 1 7 Grove Crawler Unit 1 8 Infra Red Lamp Unit 1 9 Quadriceps Boot e set complete Unit 1 10 Aluminium Crutches Unit 1 11 Respirometer Unit 1 12 Fore arm crutches Unit 1 13 Quad Cane adult Unit 1 14 Goneometer Unit 1 15 Tumble Form rolls Unit 1 16 Developmental Ball Program Unit 1 17 Cable tensiometer sel with accessories Unit 1 18 Pilar drills vertic black 6 decker Unit 1 19 Router machine Unit 1 20 Oven Unit 1 21 Hand grinder Unit 1 22 Boct finishing Unit 1 23 Vacum machine Unit 1 a. Klinik

24 Biotriger computerized analizer Unit 1 25 Treadmill + evaluasi kapasitas fungsi Unit 1 26 Sortwave A Unit 1 27 Micro Wave Diathermy Unit 1 28 Ultra Sound Theraphy Unit 1 29 Electrical Stimulator Unit 1 30 Paraffin bath Unit 1 31 Ultraviolet Quartz Unit 1 32 Hotpacks & Perculator Unit 1 33 Faradic-Galvanic Theraphy Unit 1 34 Traction unit Unit 1 35 Suspension & Pulley Unit 1 b. Ruang Alat Khusus

36 I V P Unit 1 37 Parallel bars Unit 1 38 T N S Unit 1 39 Ergocycle Unit 1



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40 Rehab timer Unit 1 41 Ankle / wrist Unit 1 42 Tilt table Unit 1 43 Rolley + weights Equipment Unit 1 44 Finger Muscle Theraphy Unit 1 45 Exercise Bicycle Unit 1 46 Wheel chair Unit 1

D. Pelayanan Patologi Klinik a. Laboratorium Patologi Klinik 1 Air Condition Unit 1 2 Bunsen burner Unit 1 3 Cawan petri 900 x 100 mm Unit 1 4 Centrifuges Unit 1 5 Corong 10-15 ml Unit 1 6 Electrolit analyzer Unit 1 7 Erlenmeyer 100 ml Unit 1 8 Erlenmeyer 200 ml Unit 1 9 Fotometer dengan panjang gelombang 340-

600 nm Unit 1

10 Gelas ukur 1000 ml Unit 1 11 Gelas ukur 500 ml Unit 1 12 Inkubator Unit 1 13 Kamar hitung Fuchs Rosenthal Unit 1 14 Kamar hitung improved Neubauer Unit 1 15 Kawat ose Unit 1 16 Labu 250 ml Unit 1 17 Labu 500 ml Unit 1 18 Lemari es no frost Unit 1 19 Meja kursi dan alat administrasi Unit 1 20 Mikroskop binokuler/monokuler Unit 1 21 Oven Unit 1 22 Pipet LED (Westergreen) Unit 1 23 Pipet otomatik 10 ul Unit 1 24 Pipet otomatik 100 ul Unit 1 25 Pipet otomatik 1000 ul Unit 1 26 Pipet otomatik 20 ul Unit 1 27 Pipet otomatik 200 ul Unit 1 28 Pipet otomatik 25 ul Unit 1



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29 Pipet otomatik 250 ul Unit 1 30 Pipet otomatik 50 ul Unit 1 31 Pipet otomatik 500 ul Unit 1 32 Pipet Pasteur Unit 1 33 Pipet Serologi 1ml Unit 1 34 Pipet Volumetrik 10 ml Unit 1 35 Pipet Volumetrik 25 ml Unit 1 36 Pipet Volumetrik 3 ml Unit 1 37 Pipet Volumetrik 5 ml Unit 1 38 Rak pipet + tips Unit 1 39 Rak tabung reaksi Unit 1 40 Rotator VDRL Unit 1 41 Sentrifus mikrohematokrit Unit 1 42 Sterilisator/autoclave kecil Unit 1 43 Stop watch Unit 1 44 Tabung rekasi 10 ml Unit 1 45 Tabung rekasi 20 ml Unit 1 46 Tabung rekasi 3 ml Unit 1 47 Tabung rekasi 5 ml Unit 1 48 Tensimeter Unit 1 49 Termometer 0-150 derajat Unit 1 50 Timbangan/neraca analitik Unit 1 51 Timer Unit 1 52 Water bath Unit 1 b. Laboratorium Kimia Klinik

53 Spectrophotometer Unit 1 54 Centrifuges Unit 1 55 Water Bath Unit 1 56 Densitometer for protein Unit 1 57 Analytical Balance Unit 1 58 PH meter Unit 1 59 Micro Hematocrite centrifuge Unit 1 60 Photo meter Unit 1 61 Water Destilitator Unit 1 62 Precicion Balance Unit 1 c. Laboratorium Hematologi dan Urinalis

67 Microscope Unit 1



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68 Centrifuge Unit 1 69 Centrifuge Haematocrite Unit 1 70 Haemocitometer Unit 1 71 Refractometer Unit 1 72 Water bath Unit 1 73 Laboratory refrigerator Unit 1 74 Glucometer Unit 1 75 Spectrophotometer Unit 1 76 Rotator shaker Unit 1 77 HB meter Unit 1 78 Washing instrument Unit 1 79 Dry Sterilizer Unit 1 80 Oven Unit 1 81 Lab Incubator Unit 1 82 Ultrasonic Cleaner Unit 1 83 Micro Plate reader Unit 1 d. Patologi Forensik

84 Ruang otopsi Unit 1 85 Pendingin mayat Unit 1 86 Ruang pemulasaraan Unit 1 87 Meja otopsi Unit 1 88 Otopsi set Unit 1 89 Peralatan embalming Unit 1

V. PELAYANAN SPESIALISTIK GIGI MULUT

A. Bedah 1 Amalgam set Set 1 2 Cavity Preparation set Set 1 3 Dental Rontgent Unit 1 4 Dental Unit lengkap Unit 1 5 Diagnostic set Set 1 6 Endodonsi set Set 1 7 Inlay indirec set Set 1 8 Light Curing Apparatus Unit 1 9 Oral hygiene set Set 1 10 Penyemenan untuk tumpatan tuang

mahkota/jembatan Unit 1



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11 Preparasi mahkota dan jembatan Unit 1 12 Pulp Tester Unit 1 13 Tambahan sewarna gigi set Set 1

B. Pertumbuhan dan Perkembangan 1 Aktivasi set Set 1 2 Autoclave / Sterilisator Unit 1 3 Cetakan set Set 1 4 Cito Jack Unit 1 5 Elektrolit Segar Unit 1 6 Exsodonsia set Set 1 7 Insersia gigi tiruan set Set 1 8 Orthodonsi piranti cekat Unit 1 9 Ortodonsi piranti coklat Unit 1 10 Panoramic foto Unit 1 11 Peralatan bedah mulut minor set Set 1 12 Peralatan laboratorium teknik dasar Unit 1 13 Sterilisator listrik Unit 1

C. Klinik Gigi dan Mulut Instrumen Besar 1 Dental unit Unit 1 2 Dental Chair Unit 1 3 Operating Stool Unit 1 4 Sterilisator Unit 1 Instrumen Kecil 5 Diagnostic set Set 1 6 Scaler set Set 1 7 Cotton roll holder Unit 1 Dental Material 8 Glass lonomer lengkap Unit 1 9 Composite resin lengkap khusus fissure

sealant Unit 1

D. Pelayanan Medik Gigi Dasar Umum a. Pencabutan Gigi Instrumen Kecil 1 Diagnostik set Set 1



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2 Anestesi lokal set Set 1 3 Exodontia set Set 1 b. Konservasi Instrument besar: 1 Alat Sinar unit 1 Instrumen Kecil: 2 Preparation capitas set Set 1 3 Amalgam set Set 1 4 Tambahan sewarna gigi dengan sinar Unit 1

E. Pelayanan Medik Gigi Dasar Khusus a. Bedah Mulut Sederhana Instrumen besar: 1 Dental Ro standar Unit 1 Instrumen Kecil: 2 Diagnostic set Set 1 3 Set bedah mulut sinar Unit 1 b. Orthodonsi Instrumen Besar 1 Dental Ro standar Unit 1 2 Peralatan lab. teknik gigi dasar Unit 1 Instrumen Kecil 3 Diagnostik set Set 1 4 Set orthodonsi piranti lepas Set 1 5 Set aktivar Set 1 c. Prosthodonsi Instrumen Besar 1 Dental Ro standar Unit 1 2 Alat sinar (light curing) Unit 1 3 Amalgamator Unit 1 4 Peralatan laboratorium teknik gigi dasar Unit 1



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Instrumen Kecil 5 Diagnostik set Set 1 6 Anesthesi lokal set Set 1 7 Set penyemenan Set 1 8 Set preparasi mahkota dan jembatan Set 1 9 Set cetak GTS/GTP dan mahkota/

jembatan Set 1

10 Set insersi GTS/GTP Set 1 d. Konservasi / Endodonsi Instrumen Kecil 1 Diagnostik set Set 1 2 Anesthesi lokal set Set 1 3 Set tambahan sewarna gigi dengan sinar Set 1 4 Set tambahan amalgam Set 1 5 Indirect inlay set Set 1 6 Set penyemenan Set 1

VI. PELAYANAN PENUNJANG KLINIK

A. Pelayanan Perawatan Intensif 1 Alat kateterisasi vena sentral dan

manometernya Unit 1

2 Alat pemantauan untuk tekanan darah non invasif (Non Invasive Blood Pressure), elektrokardiografi, oksimeter nadi, kapnografi, temperatur

Unit 1

3 Alat penghisap (suction) yang setara dengan ruang operasi

Unit 1

4 Alat/sistem pemberian oksigen (nasal canule, simple face mask, non-rebreathing face mask)

Unit 1

5 Beberapa ukuran plester/pita perekat medik

Set 1

6 Berbagai ukuran introducer untuk pipa endrotrakeal dan bougies

Set 1

7 Berbagai ukuran pipa endrotakeal dan konektor

Set 1



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8 Berbagai ukuran pipa orofaring, pipa nasofaring, sungkup laring dan alat bantu jalan nafas lainnya

Set 1

9 Defibrilator jantung dengan kemampuan kardioversi sinkron (synchronised cardioversion) dan pacu jantung eksternal

Unit 1

10 Forsep Magill Unit 1 11 Gunting Unit 1 12 Lampu tindakan Unit 1 13 Peralatan drainase toraks Unit 1 14 Peralatan infus intravena dengan berbagai

ukuran kanul intravena dan berbagai macam infus yang sesuai

Set 1

15 Peraltan portabel untuk transportasi Unit 1 16 Pompa infus dengan pompa syringe Unit 1 17 Balon resusitasi lengkap beserta sungkup

muka dan kantung penampung oksigen (reservoir)

Set 1

18 Laringoskop dengan berbagai ukuran bilahnya

Set 1

19 Syringe untuk mengembangkan balon endrotrakeal dan klem

Unit 1

20 Tempat tidur khsus ICU Unit 1 21 Tournique untuk pemasangan akses vena Unit 1 22 Unit/alat foto rontgen mobile Unit 1 23 Ventilator sederhana Unit 1

B. Pelayanan Darah 1 Blood bank refrigerator Unit 1 2 Plasma freezer Unit 1 3 Blood analyzer system Unit 1 4 Electrolyte analyzer Unit 1

C. Pelayanan Gizi 1 Refrigerator Unit 2 3 Food trolley Unit 2 4 Scale Unit 2



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D. Pelayanan Farmasi 1 Peralatan untuk penyimpanan Unit 1 2 peralatan untuk peracikan obat Unit 1 3 peralatan untuk produksi obat non steril Unit 1 4 Lemari khusus untuk narkotika Unit 1 5 Lemari pendingin dan AC untuk obat yang

termolabil Unit 1

E. Sterilisasi Instrumen 1 Autoclave table Unit 1 2 Autoclave unit Unit 1 3 Container for sterilizer Unit 1 4 Horizontal Sterilizer Unit 1 5 Sterilizer kerosine Unit 1

VII. PELAYANAN KAMAR OPERASI 1 Anaesthesi Apparatus Unit 1 2 Operating lamp Unit 1 3 Operating table Unit 1 4 Electro surgery Unit 1 5 Suction pump Unit 1 6 Respirator Unit 1 7 Defibrilator Unit 1 8 Autoclave table Unit 1 9 Laser coagulator Unit 1 10 Refrigerator Unit 1 11 Infusion pump Unit 1 12 UV sterilizer Unit 1 13 Ultrasound cleaner Unit 1 14 USG Unit 1 15 Mobile operating lamp Unit 1

VIII. PELAYANAN MEDIK SPESIALISTIK LAIN

A. Pelayanan Mata 1 Trial lens dan frame set Set 1 2 Sterilizator



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3 Kaca mata Frenzel Unit 1 4 Optoptypen (Snellen chart) 5. huruf dan E-

chart Unit 1

5 Ishihara colour plate Unit 1 6 Reading chart Unit 1 7 Extractor corpus alienum (magnit) Unit 1 8 Lumbal punksi set 9 Minor surgery for ofthalmology: Set 1 - Chalazion pinset - Gunting halus - Needle holder - Pinset chirurgis - Scalpel - Bengkok - Cilia forceps - Macam-macam cat gut and silk - Eye suture needle 1/2 circle - Forceps Dresing - Sm. Proved modls. - Tenometer schiet - Eye speculum - Currete, Meye hoofer - Razor blade holder - Loupe - Operating Lamp (portable) - Head Lamp a. Klinik

10 Slitlamp Unit 1 11 Lens test set Set 1 12 Flash light and Ruler Unit 1 13 Streak Retenoscopi Unit 1 14 Lensmeter Unit 1 15 Loup Unit 1 16 Tonometer Unit 1 17 Opthalmoscope Unit 1 18 Indirect/Binocular Optalmoscope Unit 1 19 Sterilizer table model Unit 1 20 Buku Ishihara Unit 1 21 Kampimeter Unit 1 22 Microscope binoculair Unit 1 23 Incubator Unit 1



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24 Kartu Snellen Unit 1 25 Kartu Jager Unit 1 26 Placido test Unit 1 27 Dilator Pungtum Unit 1 28 Hertel exophthalmometer Unit 1 29 Lid retractor Unit 1 30 Gunting perban Unit 1 31 Korentang Unit 1 32 Flourescein strips Unit 1 33 Kursi periksa Unit 1 34 Kursi dan meja dokter Unit 1 35 Spatula Kimura Unit 1 36 Gelas obyek dan gelas cover set Set 1 b. Bedah Mata

28 Anesthesia Machine Unit 1 29 Benang 10-0 nylon Set 1 30 Benang 4-0, 6-0, 8-0 silk, aa Set 1 31 Catarac Probe Unit 1 32 Cryotherapy unit Unit 1 33 Dop kaleng Unit 1 34 Duk bolong Unit 1 35 Enukleasi dan Eviserasi set Set 1 36 Flash Light Unit 1 37 Glaukoma set Set 1 38 Gunting perban Unit 1 39 Infuse pump Unit 1 40 Infuse stand Unit 1 41 Instrument table Unit 1 42 Katarak set Set 1 43 Loupe Unit 1 44 Meja Mayo Unit 1 45 Nierbeken Unit 1 46 Operasi minor set Set 1 47 Operating lamp Unit 1 48 Operating microscope Unit 1 49 Operating table Unit 1 50 Oxygen Apparatus + flowmeter Unit 1 51 Retina Probe Unit 1 52 Spons MQA Unit 1 53 Steam Sterilizer Unit 1



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54 Stool Unit 1 55 Tromol 12 inchi Unit 1 56 Tromol 6 inchi Unit 1 57 Tromol 8 inchi Unit 1 58 UV lamp for room sterillization Unit 1 c. Perawatan

56 Loupe Unit 1 57 Tonometer Unit 1 58 Spygmomanometer Unit 1 59 Kartu Snellen Unit 1 60 Flash Light Unit 1 61 Gunting Konjungtiva Unit 1 62 Tromol 12 inchi Unit 1 63 Sarung tangan Unit 1 64 Nierbekken Unit 1 65 Lid retractor Unit 1 66 Korentang Unit 1 67 Trial lens set Set 1 68 Trial frame set Set 1 69 Tempat tidur kamar isolasi Unit 1 70 Tempat tidur pasien Unit 1

B. Pelayanan THT 1 Alat diagniostik THT: Unit 1 - Speculum hidung - Speculum telinga - Kaca larings 2 Garputala Unit 1 3 Bellock Tampon Unit 1 4 Flash Light Unit 1 5 Crocodile forceps Unit 1 6 Balon Mediktzer Unit 1 7 Loupe Unit 1 8 Portable diagnostik Unit 1 9 Head lamp Unit 1 10 Respiration Apparatus Unit 1 11 Anaesthesi Apparatus Unit 1 12 Spygmomanometer Unit 1



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a. Klinik

13 ENT unit Unit 1 14 ENT Diagnostic instrument set Set 1 15 Head light Unit 1 16 Suction pump Unit 1 17 Laryngoscope Unit 1 18 Audiometer Unit 1 b. Kamar Operasi

19 Polypectomy set Set 1 20 Sinus Surgery set Set 1 21 Mastoidectomy set Set 1 22 Tracheotomy set Set 1 23 Tonsiladenoctomy set Set 1 24 Septum correction set Set 1 c. Perawatan

25 Hospital Bed Unit 1 26 Screen bed Unit 1 27 Head light Unit 1 28 ENT examination instrument set Set 1

C. Pelayanan Kulit dan Kelamin a. Ruang Periksa 1 Timbangan badan Unit 1 2 Tensimeter Unit 1 3 Stetoskop Unit 1 4 Loupe Unit 1 5 Tongue spatel Set 1 6 Flash light Buah 1 7 Sterilisator basah Unit 1 b. Kamar Tindakan 8 Meja Operasi Unit 1 9 Meja instrumen Unit 1 10 Almari obat Unit 1



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11 Lampu operasi Unit 1 12 Bangku putar Unit 1 13 Dressing Drum 12’’ Unit 1 14 Dressing Drum 8’’ Unit 1 15 Instrumen bak besar dan kecil Unit 1 16 Container sedang dan kecil Unit 1 17 Mangkok kecil Unit 1 18 Nierbeken besar dan sedang Unit 1 19 Knifehold no.3 dan 4 Unit 1 20 Art clamp Unit 1 21 Mosquito clamp lurus dan bengkok Unit 1 22 Pincet anatomis Unit 1 23 Pincet chirurgis Unit 1 24 Needle holder Unit 1 25 Gunting 12 cm lurus r/t, bekok r/r, kecil/

kecil r/r Unit 1

26 Sonde Unit 1 27 Doek klem Unit 1 28 Skin retraktor Unit 1 c. Kamar Gelap

29 Woodslamp Unit 1 d. Bedah Listrik

30 Cautery unit Unit 1 31 Skincuret Unit 1 32 Pincet anatomis dan Chirurgis Unit 1 33 Commedon Ekstraktor Unit 1 34 Gunting kecil Unit 1 e. Biopsi

35 Punch-set Set 1 36 Gunting kecil Unit 1 37 Sterilisator basah Unit 1



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D. Pelayanan Syaraf a. Klinik Rawat Jalan 1 Oftalmoskop Unit 1 2 Alat tes sensasi Unit 1 3 Stetoskop Unit 1 4 Tensimeter Unit 1 5 Diagnostic set Set 1 6 Flash light Unit 1 7 Garputala Unit 1 8 Termometer Unit 1 9 Tongue spatel Unit 1 10 Lict kaas Unit 1 11 Palu reflex Unit 1 b. Neurodiagnostik

12 Kampimeter Unit 1 13 Visus snellen chart Unit 1 Ishihara

14 Kaca/gelas frenzel Unit 1 15 Oftalmodinamometer Unit 1 16 EEG Unit 1 17 Stabilizer Unit 1 18 EMG Unit 1 c. Tindakan

19 Jarum LP Unit 1 20 Tabung manometer Unit 1 21 Suction/Slijm zuicer Unit 1 22 Tangki O2 Unit 1

E. Pelayanan Jiwa 1 Stetoscop 2 Electro Stimulator Unit 1 3 Defibrilator Unit 1 4 Suction Pump Unit 1 5 Sphygmomanometer Unit 1



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6 Scale Unit 1 7 E C G 1 chanel Unit 1 8 Examination table Unit 1 9 Examination lamp Unit 1 10 Resuscilator Unit 1

MENTERI PERTAHANAN REPUBLIK INDONESIA, PURNOMO YUSGIANTORO


2014, no.383 10 · 2014, no.383 12 48 dresing forceps unit 1 49 extracting forceps for bayonet unit...

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