Tanggal

RS / Klinik
Tagihan

PHI PPG
Produk Deskripsi Harga HNA Terkirim kembali Terpakai
Kode Kode
211-1604 A30075 1.6mm x 4mm Auto-Drive ™ Screw Rp 410,850 0
211-1605 A30076 1.6mm x 5mm Auto-Drive ™ Screw Rp 410,850 14 14
211-1606 A30077 1.6mm x 6mm Auto-Drive ™ Screw Rp 410,850 11 11
211-1608 A30084 1.6mm x 8mm Auto-Drive ™ Screw Rp 410,850 7 7
218-0038 A30006 10 Hole straight plate 1.6mm Rp 1,287,000 2 2
220-0002 Drill 1.3mm 0
220-0086 Screwdriver 1.6mm 1 1
0
211-2004 A30088 2.0mm x 4mm Auto-Drive ™ Screw Rp 410,850 5 5
211-2005 A30083 2.0mm x 5mm Auto-Drive ™ Screw Rp 410,850 10 10
211-2006 A30079 2.0mm x 6mm Auto-Drive ™ Screw Rp 410,850 6 6
211-2008 A30078 2.0mm x 8mm Auto-Drive ™ Screw Rp 410,850 8 8
202-2010 A30080 2.0mm X 10mm Screw Rp 386,100 4 4
202-2012 A30082 2.0mm X 12mm Screw Rp 386,100 6 6
210-0032 A30007 10 Hole straight plate (2.0mm) Rp 2,759,625 2 2

210-0034 A30012 16 Hole straight plate (2.0mm) Rp 3,613,500 1 1

210-1032 A30031 Mini 8 Hole straight plate (2.0mm) , Rp 2,475,000 0
210-1036 A30023 Mini 16 Hole straight plate (2.0mm) , Rp 4,318,875 1 1
209-2008 2.0mm X 8mm Screw Quick fix 4 4
220-0021 Screwdriver 2.0/2.4mm 1 1
320-1415 Drill 1.5mm 1 1
0
206-2405 A30099 2.4mm X 5mm Screw 0
206-2406 A30103 2.4mm X 6mm Screw 0
206-2408 A30092 2.4mm X 8mm Screw 0
206-2410 A30096 2.4mm X 10mm Screw 2 2
206-2412 A30090 2.4mm X 12mm Screw 0
206-2414 A30098 2.4mm X 14mm Screw 0
220-0019 A30434 Taperlock screwdriver body 1 1
220-0024 A30435 Right angle plate bender 0
220-0027 A30436 Small grasping forceps 1 1
220-0028 Plate cutter 1 1
220-0049 Plate bending forceps 1 1
220-0574 A30439 3 Prong bender, 1.2mm & 1.6mm plates 1 1
220-0077 A30455 Rigid mini plate cutter 1 1
220-0566 A30474 2.0mm/2.4mm Fracture plate bending plier 1 1
220-0567 A30475 2.0/2.4mm Fracture plate bending plier 0
220-0572 Depth Gauge 1 1
220-1000 A31685 Drill Charge Rp 500,000 1 1

Dikirim tanggal :
Dikembalikan Tanggal :
Diterima Oleh :
 Tgl Pengiriman
RS / Klinik / Dr
No. Cek List / RDO
FORM CEK LIST ALAT - OPERASI
Part No JUMLAH JUMLAH SELISIH
No. KODE PRODUK Part No PPG Keterangan
PPG (REG) DIANTAR DIAMBIL TERPAKAI

PLATE & SCREW (IMPLANT)

1.6
1 211-1604 A30075 1.6MMX4MM AT-DRV SCRW 211-1604 12
2 211-1605 A30076 1.6MMX5MM AT-DRV SCRW 211-1605 9
3 211-1606 A30077 1.6MMX6MM AT-DRV SCRW 211-1606 10
4 211-1608 A30084 1.6MMX8MM AT-DRV SCRW 211-1608 10
5 218-0038 A30006 10 HL STR PLT 1.6MM 218-0038 3
6 220-0086 A30426 1.6MM SCWDVR SHFTLNGMNL 220-0086 1
7 220-0302 A30459 1.3MM PLDRLSTEOPWR 12MM 220-0302 1
8 212-0080 A30016 ORBITAL PLT 212-0080 1
2.0
1 211-2004 A30088 2.0MMX4MM AT-DRV SCRW 211-2004 10
2 211-2005 A30083 2.0MMX5MM AT-DRV SCRW 211-2005 10
3 211-2006 A30079 2.0MMX6MM AT-DRV SCRW 211-2006 10
4 211-2008 A30078 2.0MMX8MM AT-DRV SCRW 211-2008 8
5 202-2010 A30080 2.0MMX10MM SCRW 202-2010 8
6 202-2012 A30082 2.0MMX12MM SCRW 202-2012 8
7 202-2014 A30087 2.0MM X 14MM SCRW 202-2014 6
8 210-0032 A30007 10 HL STR PLT 2.0MM 210-0032 2
9 210-0034 A30012 16 HL STR PLT 210-0034 2
10 210-1032 A30031 MINI 8 HL STR PLT 1.0MM 210-1032 2
11 210-1036 A30023 MINI 16HL STR PLT 1.0MM 210-1036 1
12 220-0021 A30421 2.0/2.4MM SCWDVR SHFMNL 220-0021 1
13 220-0303 A30460 PLT DRLMNSW1.6MM1:1MNDB 220-0303 1
14 209-2011 A30362 2.0x11mmMMFADrvScrwQckF 209-2011 4
15 206-2410 A30096 2.4MM X 10MM SCRW 206-2410 2
INSTRUMENT #N/A
1 220-0019 A30434 TAPERLOCK SCRWDRVR BODY 220-0019 1
2 220-0024 A30435 RIGHT ANGLE PLT BENDER 220-0024 1
3 220-0574 A30439 3PRNG BNDR,1.2&1.6MMPLT 220-0574 -
4 220-0049 A30438 PLT BENDING FORCEPS 220-0049 1
5 220-0028 A30437 PLT CUTTER 220-0028 -
6 220-0027 A30436 SMALL GRASPING FORCEPS 220-0027 1
7 220-0566 A30474 2.0/2.4MMFRCTRPLBNDGPLR 220-0566 1
8 220-0077 A30455 RGD MINI PLT CUTTER 220-0077 1
9 220-0567 A30475 2.0/2.4MMFRCTRPLBNDGPLR 220-0567 1
10 220-0055 A30449 SHORT POINTED CANNULA 220-0055 -
11 220-0058 A30451 CHEEK RETRACTOR 220-0058 -
12 220-0570 A30476 DRLGD2.0MMLCKGPLTBLNTCA 220-0570 -
13 220-0571 A30477 2.0MM LCKNG DRLGUIDEMDL 220-0571 -
+ #N/A
1 207-0121 A30810 ARCHBAR SPLINT W-HOOKS 207-0121 1
2 207-0120R3M A30486 24 GA. STNLS STL WR 207-0120R3M 1

Ö Diberi tanda kolom dibawah ini bila SESUAI Barang dikirim, Barang diambil,
Pengirim Diterima Diserahkan
X Diberi tanda kolom dibawah ini bila TIDAK SESUAI Diambil oleh (LO)
(LO) oleh oleh
* Barang telah dicek sesuai dengan Pesanan
* Barang diterima dalam kondisi baik, tidak cacat/ tidak rusak
* Cara penggunaan Bur Strong telah ditunjukkan oleh Log Off PHI dan berfungsi dengan baik
* Barang steril pack dan tidak boleh di autoclave harus dipisah dari tray agar tidak rusak