K E M E N T E R I A N K E S E H A T A N R I
DIREKTORAT JENDERAL
( 0 2 1 ) 5 2 9 6 4 8 3 8 Ko t a k P o s 2 0 3 T e l e p o n : ( 0 2 1 ) 5 2 0 1 5 9 0 P '
Berdasarkan
Peraturan Menteri Kes tentang Izin Edar Alat
N OM O R I Z I N E D A R
A L A T K E S E H A T A N
K EM EN K ES RI A K L 11104212328
RITA LEIBINGER Obstetric Ginecology Surgery Instruments
J e n i s P r o d u k
Peralatan Obstetrik dan Ginekologi Peralatan Obstetrik dan Ginekologi Bedah Terlampir
Kantong plastik
RITA LEIBINGER GmbH & CO. KG., Germany Kategori Produk
Sub Kategori Type/Ukuran Kemasan Nama Pabrik Nama Pendaftar Atas dasar lisensi dart
Ketentuan Persetujuan izin edar berlaku sampai dengan 31 Desember 2021.
Wajib menyampaikan laporan berkala setiap 1 (satu) tahun terhadap jenis dan akibat efek samping dart produk yang diedarkan.
Izin edar ini merupakan persetujuan perpanjangan dari nomor pendaftaran, Alat Kesehatan AKL 11104212328 tanggal 20 Juli
Persyaratan 1. Apabila dikemudian hart ada pihak lain yang lebih berhak atas nama keagenan diatas, sesuai dengan ketentuan yang berlaku, pendaftar bersedia melepaskan nama keagenan produk tereebut.
2. Apabila dikemudian hari terdapal kekeliruan, maka persetujuan ini akan ditinjau kembali.
30 Maret 2017 a.n. DjijtaJPdeQderal
Alat Kesehatan dan PKRT
ipya, MKM 199403 2 001
Secretariat Difeklorat Jendsral Kefamaaan dan A ltes: 5214876,521487 V 5214869 tMreklwrt Tats Kalola Obaf PubSk dan Pafaekalan Kesetelan: 5214872 DiraWorat Petayanan Kefarmasian:
DStftWBtPrbiMtf dsn Qistntxsi Kefarmniar . . : 5214873 Dsrektorat Peniiaian Alias dan Pertjekalan Kesehatan Rumah Tangga :5214874 Oiretorat PengawasanAlkes dan Partekalan Kewlatan Rumsh Tangga; 5213601
DIR EKTO R A TJEN D ERA L
KEFARMASIAN DAN ALAT KESEHATAN
1 2 9 5 0
Te l e p o n : ( 0 2 1 ) 5 2 0 1 5 9 0 P e s a w a t 2 0 2 9 F a k s i m i l e : ( 0 2 1 ) 5 2 9 6 4 8 3 8 K o t a k P o s 2 0 3
NOMOR 1ZIN EDAR ALAT KESEHATAN KEMENKES Rl AKL 11104212328
Tanggal, 30 Maret 2017
LAMPIRAN
Kenan
0
s o m i s o o a '
No. Deskrlpsi Tlpe/Kode
1 Scalpel Handle 3L. Angled 10-0234-35
2 Standard Scissor 11,5cm, 81/81, Str 11-0201-11
3 Standard Scissor 13cm, Sh/Bl, Str 11-0203-13
4 Metzanbaum Scissor 15cm, Str 11-0365-15
5 Standard Scissor 14.5cm. Sh/Sh, Str 11-0205-14
6 Standard Scissor 11,5cm, Sh/Bl, Cvd 11-0208-11
-7 . Standard Scissor 20cm, Sh/Bt, Cvd 11-0208-20
■ 8 . Standard Scissor 14.5 cmSh/Sh, Cvd 11-0210-14
9 MAYO scissors 23,0cm, str 11-0271-23
10 Metzanbaum Flno Sdss 20cm BI/BI Cvd 11-0428-20
11 Metzenbaum Fino Scissor 14.5cm, Str 11-0429-14
12 Metzenbaum Flno Scissor 14.5cm Cvd 11-0430-14
13 Iris Fine Operating Scissor 11.5 cm, Flat, str 11-0731-11 14 Iris Fine Operating Scissor 11.5 cm, Flat, cvd 11-0732-11
. 15 Littauer Stitch Scissor 14cm 11-0935-14
16 Iris Scissor 11,5cm, Round , Sir 11-2030-11
17 Sims Scissor 20cm, Cvd 11-3090-20
18 Metzenbaum Scissor 18 cm, Bl/ Bl, Str 11-3100-18
19 5 20
Crafoord Scissor with TC 30cm 11-3215-30
11-3285-14
21 Braun-Stadler Scissors 18cm 11-3285-18
22 Busch Scissor 16cm, Cvd 11-3301-16
23 Strabismus Scissor 11.5cm. BI/BI, Cvd 11-3381-11
24 Mayo Scissor 14.5cm, BI/BI, Str 11-3610-14T
25 Mayo Scissor 14.5cm, BI/BI, Cvd 11-3615-14T
26 Metzenbaum Scissor 20cm, BI/BI, Cvd 11-3660-20T
27 STANDARD Forceps 16cm 12-0201-16
28 Adson Forceps 15cm 12-0269-15
29 Adson-Brown Forceps 12cm, 0.5mm 12-0345-12T
30 Standard Forcep 16cm, 1:2 12-0402-16
31 Coilin-Duval Forceps 20cm, 14mm 12-3225-20
32 Micro-Adson Forceps 12 cm, 1:2 12-3230-12
33 Micro-Adson Forceps 12cm 12-3231-12
34 Hartmann Forcep 10cm, Sir 13-0407-10
35 Micro-Mosquito Forcep 10cm, Str 13-0421-10
36 Spencerwells Forcep 15 cm, Cvd 13-3170-15
37 Rochester-Pean Forcep 20cm, Str 13-3188-20
38 Rochester-Ochsner Forcep 20cm, Str 13-3190-20
39 Adson Forcep 18cm, Str 13-3207-18
40 Adson Forcep 18cm, Half Cvd 13-3208-18
41 Wertheim Vaginal Forcep 25cm 13-3565-25
42 HEANEY Vaginal Clamp 21cm, cvd 13-3585-21
L a m p i r a n 1 d a r i 5 H a l a m a n
Sekretaria! Dlreklorat Jenderal Keiarmasian dan Alices: 5214876.5214871,5214868 DkeWora» Tata fekfe fe at Pub* dsn PabetatoiKesetutan: 5214872 Diretoat Pefeyanan Keiarmasian .5203878
Oirektorat Praduksi dan Distribusi Kefannasran -.5214873 DMtaat PanSaian Alkes dan Pacbdcaian Kasahatan RumaftTangga ; 5214874 DfreUortPaflgawasanMtodMPerbeltataKeselBlanRiaKghlangga:5213601
K E M E N T E R I A N K E S E H A T A N R I
OIREKTORATJENDERAL
J a l a n H . R . R a s u n a S a i d B l o k X- 5 Ka v l i n g 4 - 9 J a k a r t a 1 2 9 5 0
T e l e p o n : ( 0 2 1 ) 5 2 0 1 5 9 0 P e s a w a t 2 0 2 9 F a k s i m i l e : ( 0 2 1 ) 5 2 9 6 4 8 3 8 Ko t a k P o s 2 0 3
3
EO 90012008 FS601003
«nu: « v© SO 900L200*
42QM690
No. Deskripsi Ttpe / Kode
43 HEANEY Vaginal Clamp 19cm cvd 13-3590-19
44 Ball-Socket Towel Fcp 14cm 13-3636-14
45 Gross-Maier Forcep 20 cm, Str 14-0245-20
46 Gross-Maier Forcep 20 cm,Str 14-0323-20
47 Gross-Maier Forcep 25 cm.Str " 14-0323-25 ...
48 Gross-Maier Forcep 25cm, cvd 14-0324-25
49 Ulrich Forcep - 26.5 cm, Str 14-3010-26
50 Ulrich Forcep 26.5cm, Cvd 14-3011-26
51 Bozemann Forcep 26cm, Str 14-3040-26
52 Bozemann Forcep 26cm, Cvd 14-3041-26
53 Bozemann-Douglas 26cm 14-3050-26
54 Foerster Forcep 25cm, Smooth Jaws 14-3055-25
55 Foerster Forcep Serrated 18cm 14-3056-18
56 FOERSTER Forceps 25cm, str 14-3056-25
57 Rampley Forcep 18cm 14-3060-18
58 Rampley Forcep 25 cm. S/J 14-3060-25
59 Langenbeck Retractor 21cm, 30x14mm 15-0394-02
60 Langenbeck Retractor 21cm; 30x16mm 15-0394-03
61 Langenbeck Retractor 21cm, 40x11mm 15-0394-04
62 Langenbeck Retractor 21cm, 50x11mm 15-0394-05
63 DEAVER Retractor 30 cm, 38 mm 15-3080-30
64 Hook Retractor - 16cm, Sharp, 2 Prong 15-3111-16
65 Hook Retractor - 16cm, Sharp, 4 Prong 15-3113-16
66 Desmarres Retractor 16cm, W=14mm 15-3153-16
67 Desmarres Retractor 16cm, W=16mm 15-3154-16
68 Doyen Retractor 28cm, 48x90mm 15-3780-28
69 Doyen Retractor 28cm 48x105mm 15-3781-28
70 Balfour-Baby Retractor 24x20mm, 27mm 15-3805-00
71 Balfour RetractorlOOmm 15-3835-00
72 Mayo-Hegar Needle Holder 14cm »» 20-0491-14
73 Mayo-Hegar Needle Holder 18cm 20-0491-18
74 Mayo-Hegar Needle Holder 20cm 20-0497-20
75 MASSON Needle Holder 27cm 20-3020-27
76 Schmieden Ligature Needle 24cm 20-4140-24
77 Deschamps Ligature Needle, Sh (R) 20-4160-21
78 Lister Bandage Scissor 14cm 21-0266-14
- 79 Lister Bandage Scissor 18cm 21-0266-18
80 Esmarch Bandage Scissor 20cm 21-0306-20
81 ALLIS Forceps 15cm 5x6 30-3071-15
82 Boys-Allis Forcep 15cm, 7:8 30-3075-15
83 Kocher Intestinal Clamp 22cm Str 30-3160-22
84 Sims Rectal Specula 19 cm 30-4035-19
85 Sims Rectal Specula 23.5cm 30-4040-23
86 Kelly Proctoscope D = 22x100 mm 30-4162-00
87 Heywood-Smith Biopsy Forcep 20cm 30-4310-20
88 Heywood-Smlth Biopsy Forcep 21cm 30-4315-21
89 Larry Groove Diractor 18cm 30-4325-18
90 Mathleu Foreign Body Fcp 20cm 31-4065-20
Lampiran 2 dari 5 Halaman Sekretaria! Direktorat Jenderal Ketamasian dan Alkes: 5214876.5214871.5214869
DieWorat Tala KeiolaObalPuMk dan Pefbekatan Kesehatati: 5214872 DifsWorat Pelayanan Kefarmasian: 5203878
Hretaat PrcxMcsi dan Oistribusi Ketamasian : 5214873 DirakMPtn^AlMdanPaitekaanKesriaaiiAraih'bngga : 5214874 Direktorat Pengawasan Ate dan Petbekalan Kesehatan Rumati Tangga: 5213601
K E M E N T E R I A N K E S E H A T A N R I
DIREKTORATJENDERAL
J a l a n H . R . R a s u n a S a i d B l o k X - 5 K a v l i n g 4 - 9 J a k a r t a 1 2 9 5 0
T d e p o n : ( 0 2 1 ) 5 2 0 1 5 9 0 P e s a w a t 2 0 2 9 F a k s i m i l c : ( 0 2 1 ) 5 2 9 6 4 8 3 8 Ko t a k P o s 2 0 3
Dengan kotentuan bahwa izin edar tarsebut hanya beriaku untuk deskripsl dan tipe / kode produk yang tercantum dalam lampiran ini
it Kesehatan dan PKRT
MKM 03 2 001
SekretafetOiretafatJendefa Kefermasian dan Alkes: S214876,5214871,5214869
DiektoratTali Ketta Oh* Puttie dan Psfaaton Kenton: 5214872 Krektorat Produksi dan Dtetrftxjsi Marmesien ; 5214873
ffirektorat Penten Alkes dan Petbekalan Kesehatan Rumah Tangga : 5214874 Direktorat Penga*asan Alkes dan Pwbekalan Kesetiatan Rumali Tangga: 5213601 OfcktoMl Pelaranan Kefamasian: 5203878
No. Deskiipsi Tipe/Kode
187 Smellie Perforator 27cm g ■ _ a. 32-4390-27
188 Winter Ovum Scalp Forcep 29cm, Fig=2 32-4395-29
189 Winter Ovum Scalp Forcep 29cm Fig=3 32-4403-29
190 Winter Ovum Scalp Forcep 29cm, Fig=2 32-4406-29
191 WinterOvum Forcep 29cm Fig=3 32-4407-29
192 Saenger Scalp Forcep 26.5cm 32-4425-26
193 Placenta Forcep 25cm, Fig. 2 32-4441-25
194 Placenta Forcep 25cm, Fig. * 3 . 32-4442-25
195 Placenta Forcep 25cm, Fig. = 4 32-4443-25
196 Placenta Forcep 25cm, Fig. = 5 32-4444-25
197 Braun Decapitating Hook 32.5cm 32-4460-32
198 Gauss 26cm, Scalp Flap Forceps 32-4485-26
199 Graefe Hook - Sharp 34-3295-00
200 Young .lithotomy Forcep 20cm 31-4125-20
• ISO 900X200*
12410013105 Lampiran 5 dari 5 Halaman
DIR EKTO R A TJEN D ERA L
KEFARM ASIAN DAN A LA T KESEHATAN -
Ts l e p o n : ( 0 2 1 ) 5 2 0 1 5 9 0 P s s a wa l 2 0 2 9 F i i k a i m i l s : ( 0 2 1 ) 5 2 9 6 4 8 3 8 K o t t k P o s 2 0 3
Bardasarkan
NOM O RIZ1N EDAR A L A T K E S E H A T A N
KEMENKES RI AKL 1080421233$
RITA LEIBINGER Abdominal Surgery Instruments
Manual gastroenterqtogy-urology surgical instalment and accessories.
Peralatan Gastroenterologi-Urotogi •
....uj*''1 ..i.u v . " * • " .... 1 '
Peralatan Gastroenterologi-Urologi Bedah renampir
Kantong plastik
RITA LEIBINGER GmbH & CO. KG.. Germany
PT. SURYA KHATULISTIWA NUSANTARA, Jakarta Timur Jenis Produk
Kategori Produk Sub Kategori Type/Ukuran
Mama renaanar
Ketentuan Persetujuan izin edar berlakusampal dengan 31 Desember2021.
Wajib menyampaikan laporan berkala seMap 1 (satu) tahun Jenis dan akibat efek samplng dari produk yang diedatkan.
Izin edar Ini merupakan persetujuan perpanjangan dari nomor pendaftaran Alat Kesehatan AKL 10804212330 tanggai 20 Jull
Persyaratan Apabila dlkemudlan harr ada pihak lain yang lebth berhak atas nbma keagenan diatas, sesuai dengan ketentuan yang beriaku, pendaftar bersedia melepaskan nama keagenan produk tersebut.
Apabila dikemudian hari terdapat kekeliruan, maka persetujuan ini akan ditinjau kembali.
Alat Kesehatan dan PKRT
mb MKM
»9403 2 001
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:5214874
;5213601
K E M E N T E R L A N K E S E H A T A N R I
D 1 REKT 0 RAT JENOERAL
J a l a n H J l . R a s u n a S a i d B l o k X - 5 Ka v l i n g 4 - 9 J a k a r t a 1 2 9 5 0
T e l e p o n : ( 0 2 1 ) 5 2 0 1 5 9 0 P e s a w a t 2 0 2 9 F a k s i m i l e : ( 0 2 1 ) 5 2 9 6 4 8 3 8 K o t a k P o s 2 0 3
LAMPIRAN NOMCJR IZIN EDAR
ALAT KESEHATAN irCMCMU'CC 01 A111 A Aftft/tO* W lflIxCMLIMlVCd txl MfvL. 1 uOUWia vJU
Tanggal. 30 Marat 2017
No. Deskripsl Tlpe / Kode
t Duval Tissue Forcep23cm, 25mm 30-3041-23
; 2. Scalpel Handle No.4 10-0201-04
3 Scalpel Handle No.4L Solid Str 10-0205-41
4 Scalpel Handle Standard. Fig. 3 10-0231-03
5 Scalpel Handle No.3L 10-0234-31
6 Scalpel Handle no. 7 16 cm 10-0238-07
-r f : : Standard Scissors 14.5cm, BVBI, Str 11-0201-14
8 Standard Scissors 16.5cm BI/BI, Str 11-0201-16
9 Standard Scissors, bt/sh str. 14,5cm . 11-0203-14 '
10 Standard Scissors 14.5cm,BI/Bi.Cvd 11-0206-14
11 Standard Sdssorel 4.5cm, Sh/BI. Cvd 11-0208-14
12 Mayo Scissor 14cm, BI/BI, Str 11-0271-14
13 Mayo Scissor 15 cm Str 11-0271-15
14 Mayo Scissor 17 cm, BI/BI, Str 11-0271-17
15 Mayo Scissor 14 cm BI/BI, Cvd 11-0272-14
15 Mayo Scissor 16 cm, BI/BI, Cvd 11-0272-15
17 Mayo Scissor 17 on, BI/BI, Cvd 11-0272-17
18 Metzenbaum Scissor 14.5 cm, BI/Bf.Str 11-0351-14
19 Metzenbaum Sdssor 14.5 cm, BVBI, Cvd 11-0356-14
20 Metzenbaum Sdssor 15cm, BI/BI Cvd 11-0366-15
21 Metzenbaum Fine Scissor 18cm, Str 11-0427-18
22 Metzenbaum Fmo Scissor 18cm BVBI Cv 11-0428-18
23 Spencer Scissor 9cm, Normal 11-0925-09
24 Universal Wire Cutter Scissor 12cm 41-0966-12
25 Metzenbaum-Fino Scissor 23 cm Cv 11-1056-23T
26 Metzenbaum-Fmo Scissor 25 cm Cv 11-1056-25T
: ' 27 Metzenbaum-Fino Scissor 16cm, Cvd “ 11-1.058-16T
28 Deaver Scissor 14cm Sh/BI, Str 11-3030-14
29 Deaver Scissor 14cm Sh/BI Cvd 11-3031-14
30 Mayo stale Scissor 15cm BVBI Str 11-3060-15
31 Mayo Stilte Sdssor 15cm BVBi Cv v 11-3065-15
32 Wertheim Sdssor 22.5cm,Cvd 11-3075-22
33 Metzenbaum Sdssor 18cm BVBI, Cvd 11-3105-18
34 Metzenbaum Sdssor 2Bcm, BVBI. Cvd 11-3105-20
35 Metzenbaum Scissor 23 cm, BI/BI 11-3105-23
36 Metzenbaum Scissor 25cm, BI/BI, Cvd 11-3105-25
37 Metzenbaum Scissor 28cm BVBI, Cv 11-3105-28
38 Lexer Sdssor 16 cm, BI/BI, Cvd 11-3136-16
A .
Lamplran 1 dari 5 Halaman
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K E M E N T E R I A N K E S E H A T A N R I
DIREKTORAT JENDERAL
KEFARMASIAN DAN A LAT KESEHATAN
J a l a n H . R . R a s u n a
Te l e p o n ; ( 0 2 1 ) 5 2 0 1 5 9 0 P e s a w a t 2 0 2 9 F a k s i m i l e
S a i d B l o k X - 5 Ka v l i n g 4 - 9 J a k a r t a 1 2 9 5 0
: (021) 52964838 Kotak Pos 203
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R 601003
No. Deskripsi Tipa/Kode
39 Lexer Fino Scissor 16cm, BI/BI, Cvd 11-3145-16
40 Fme Scissor 9cm, Sh/Sh. Flat, Str 11-3350-09
41 MAYO Scissor, strt T C 17 cm bl/bl 11-3610-17T
p i l l ! MAYO scissors curved 17,0 emTC 11-3615-17T
43 Lexer Scissor 16 tan, BI/BI, Cvd, TC 11-3635-16T
~WP-y METZENBAUM scissors 18 cm TC cv 11-3660-18T
45 METZENBAUM Sciss, cvd TC 23cm bl/bl 11-3660-23T
46 Standard Dressing Forcep 13cm Cv 12-0201-13
forceps narrow dress. 14,5 cm 12-0201-14
48 Standard Dressing Forcep 20 cm ; 12-0201-20
49 Standard Dressing Forcep 25cm 12-0201-25
50 Standard Narrow Forcep 14.5cm 12-0221-14
51 Standard Narrow Forcep 18cm 12-0221-18
52 ADSON Forceps, 12 cm, serrated 12-0269-12
53 Adson Forcep 12cm, 0.5mm, TC 12-0351-12T
M ; Standard Forceps 1x2 L 14,5cm, 12-0402-14
55 Standard Tissue Forcep 18cm, 1:2 12-0402-18
56 Standard Tissue Forcep 20 cm, 1:2 12-0402-20
57 Standard Tissue Forcep 25 cm. 1:2 12-0402-25
58 ADSON forceps 1x2 teeth 12 cm 12-0469-12
59 Standard Tissue Forcep 11.5cm 2:3 12-3020-11
60 Standard Tissue Forcep 25cm, 2:3 12-3020*25
61 ALLIS Forceps 19cm 5x6 30-3071-19
62 USA Standard Forcep 14.5cm 12-3035-14
63 USA Standard Forcep 14.5cm 1:2 12-3045-14
64 Stllle Dressing Forcep 15 cm 12-3050-15
85 Waugh Forcep 20cm 1:2 12-3090-20
66 Semken Forcep 12.5cm 12-3095-12
67 Semken Forcep 12.5cm, 1:2 12-3100-12
68 Semken Forceps 15 cm, 1:2 12-3100-15
69 Cushing Forcep 17.5cm Str 12-3115-17
70 CUSHING Forceps 17cm,str, 1:2 12-3120-17
71 Wangensteen Forcep 23cm 12-3180-23
72 Russ-Model Forcep 20cm 12-3195-20
73 Halsted-Mosquito Forceps 10 cm, Str 13-0407-10
74 Halsted-Mosquito Forceps 10 cm, Cvd 13-0408-10
75 HALSTED-Mpsquito Forceps 12,5cm. stif 13-0411-12
76 HALSTED-Mosquito forceps, cvd. 12,5cm 13-0412-12
77 Halsted-Mosquito Fcp 12.5cm, 1 2 , Cvd 13-0415-12
78 MlcrO-Mosquito Forceps 12cm 1:2, Str 13-0422-12
79 Micro-Mosquito Forceps 12 cm, 1:2, Cv 13-0424-12
80 KELLY hemostatic forceps 14 cm, str. 13-0431-14
81 Kelly Forceps 14cm, Cvd 13-0432-14
82 Crile Forceps 14 cm, Cvd 13-0442-14
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Lampirah 2 dari 5 Halaman Srtratarial Dnkteal Jen&rai Ksfarmasian dan ABces .5214878.5214871.5214869
OrateBlTaaKelob QiiatPubBcdan PaiW^anKeseli^n: 5214872 Diretoal Petoyanan Kafamssian:
Direktoral Produks dan Cfetribusi Ktfanntten .5214873 DireidoratPentonABies dan Patetabn Kestatan Rumh Tangga : 5214874 OniiadPi^nsanMes dan PedMaian Kesehatan Runah Tangga: 5213601
K E M E N T E R I A N K E S E H A T A N R I
DIREKTORAT JENDERAL
J a l a n H. R . R a s u n a S a i d B l o k X - S K a v l i n g 4 - 9 J a k a r t a 1 2 9 5 0
Te l e p o n : ( 0 2 1 ) 5 2 0 1 5 9 0 P e s a w a t 2 0 2 9 F a k s h n i l e : ( 0 2 1 ) 5 2 9 6 4 8 3 8 Ko t a k P o s 2 0 3
■M B tso miaow
1
No Deskrips! Tipe/Kode
83 CRILE RANKIN Forceps 16 cm, cvd. 13-0448-16
84 Rochester Pean Forcep 14cm. Sir 13-0511-14
85 Rochester Pean Forcep 20 cm, Str 13-0511-20
86 Rochester Pean Forcep 24cm 13-0511-24
87 Rochester Pean Forcep 14cm, Cvd 13-0512-14
88 ROCHESTER PEAN forceps 16 cm, cvd lu ; 13-0512-16
89 Rochester Pean Forcep 18cm Cvd 13 0512 18
90 ROCHESTER PEAN Forceps 20 cm, cvd 13-0512-20
91 Rochester Ochsner Forcep 14cm, Str 13-0515-14
92 ROCH. OCHSNER Forceps 16 cm, 2x1 13-0515-16
t # s p ROCH. OCHSNER Forceps 20 am, str 2x1 13-0515-20
94 Rochester Ochsner Forcep 26cm, Str 13-0515-26
95 M1XTER-BABY Forcep 18 cm, cvd 13-0520-18
96 Backhaus Towel Forcep 9 cm 13-1016-09
97 Backhaus Towel Forcep 11cm 13-1016-11
98 Backhaus Towel Forcep 13cm 13-1016-13
99 Halsted-Mosquito Forcep, 12cm Str 13-3050-12
100 Halsted-Mosquito Forcep 18cm Str 13-3050-18
101 Halsted-Mosquito Forcep 12 cm, Cvd 13-3051-12
102 Halsted-Mosquito Forcep 12cm, 1:2 Str 13-3052-12
103 Halsted-Mosquito Forcep 18 cm 1:2, Str 13-3052-18
104 Crile Forcep 14 cm 1:2, Str 13-3085-14
105 Crile Forcep 14 cm 1:2, Cv 13-3086-14
106 Kelly Forcep Delicate 14cm Sir 13-3100-14
107 Crile Forcep Delicate 14cm, Str 13-3110-14
108 Pean Forcep 14cm Str 13-3160-14
109 Spencerwells Forcep 18cm Str 13-3169-18
110 Spencerwelis Forcep 12.5cm, Str 13-3173-12
111 Pean Forcep 14.5cm, Str 13-3180-14
112 Kocher Forcep 14cm, 1:2, Str 13-3183-14
113 Kocher Forcep 16 cm, 1:2 Str 13-3183-16
114 Rochester-Pean Forceps 14 cm,Str 13-3186-14
115 Rochester-Ochsner Forcep 16cm, Str 13-3190-16
116 Overholt Forcep 22cm 13-3302-22
117 Overholt-Geissendoerfer Forcep 21cm 13-3310-21
118 Overholt-Geissendoerfer Forcep 27cm 13-3310-27
119 Mixter Forcep 23cm 13-3415-23
120 Guyon Kidney Pedicle Clamp 24cm 13-3465-24
1Z1 Mikulicz Peritoneal Forcep 20cm . 13-3530-20
122 Mikulicz Peritoneal Forcep 20cm 13-3535-20
123 Phaneuf Vaginal Forcep 21cm 1:2 13-3540-21
124 Faure Vaginal Forcep 20 cm 1:2 13-3546-20
125 Wertheim Cullen Forcep, 21.5cm 13-3570-21
126 Moynihan Hysterect Forcep 23cm 13-3575-23
Lampiran 3 dari 5 Halaman Sekratartat OirakloratJeWeralKefarmMian dan ?*«■. 5514876,5214871. S214869
Kfettrafftla KeWa 0tatPub& dan Pertxstetei Kesehatan; 521«72 Direktorai Pelayanan Kefarmasian: 5203878
Qrak^PradiMdanOiEtribusiKefanmMR :5214873
ttretorat Renton Mkes (Jan Perteton Kesetelan Ruroh Tanjga : 5214874 BraBDralPengaws^Aites dan Peitetalan Kesehatan RumaftTangga: 5213601
171 Kelly Retractor 27cm, 190x38mm 15-3405-27
172 Ricard Abdo Retrac (Set) 30cm, 320mm 15-3765-30
173 Gosset Abdominal Retract 63mm, 160mm 15-3800-00
174 Balfour Retract 70x85mm, 35mmx100mm 15-3825-00
175 Haberer General Instrument 30cm, 37/45 15-4030-30
176 Haberer General Instrument 33cm, 30mm 15-4035-33
177 Haberer General Instrument 33cm, 40mm 15-4036-33
178 Probe pg . 1 20cm. 8 16-0209-20
179 Butterfly Grooved Director 14cm 16-0261-14
180 Tobold Cotton Applicator 25cm,Cvd 16-2070-25
181 K-Wire Ruler, 15 cm, mm/inch 17-0519-15
182 FRAZIER Suction Tube, 19 cm, angled 18-0624-07
183 Yankauer Suction Tube 27cm 18-0644-27
184 POOLE aspiration Tube 10mm/30Fr23cm 18-0651-22
185 POOLE aspiration tube 8 mm/23Fr. 23cm 18-0652-22
186 Ochsner Trocar 14 cm, D=4mm 18-3065-14
187 Crile-Wood Needle Holder 15cm 20-0451-15
188 Crile-Wood Needle Holder 18cm 20-0451-18
189 Mayo-Hegar Needle Holder 20cm 20-0491-20
190 Mayo-Hegar Needle Holder 16cm 20-0497-16
191 Mathieu Needle Holder 20 cm 20-0617-20
192 Mathieu Needle Holder 20 cm 20-0637-20
193 Webster Needle Holder 13 cm, TC 20-0731-13T
194 Halsey Needle Holder 13cm, 0.4 mm, TC 20-0738-13T
195 Crile-Wood Needle Holder 15cm TC 20-0739-15T
196 MAYO HEGAR needleholder TC 16 cm 20-0743-16T
197 MAYO HEGAR needleholder TC 18 cm 20-0743-18T
198 Mayo-Hegar Needle Hldr 20cm, 0.5mm TC 20-0743-20T
199 Mayo-Hegar Needle Holder 24cm, 0.5mm 20-0743-24T
200 MAYO HEQAR needleholder TC 26cm 20-0743-26T
Dengan katentuan bahwa izin edar tersebut hanya bertaku untuk deskripsi dan tipe / kode produk yang tercantum dalam lamplran ini
Kesehatan dan PKRT
fta , MKM 199403 2 001
Lamplran 5 dart 5 Halaman Srtraai^OWtbDratJencletalKelamiaaan dan Nkss: 5214876,6214871,5214869
Wreklorat Tab KelolaObat Put® dan Perbakalan Kesehstan: 5214872 Direktorat Pebyanan Kefsmasian: 5203873
D i a c » r t P t t i c W ^ ( l » D i 8 W b u » K e f a m B » ; 5 2 1 4 8 7 3
DkelcloratParilaianAltesdanPabekalafiKeselataiRutnatiTangga :5214S74 Oiretoal Pengawasan Alices dan PMbekaian Kasahatan Rumah Tangga: 5213801
