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1. SATUAN KERJA ADALAH NAMA APOTEK, FKTP, FKRTL atau DINKES PROVINSI dan 2. JUMLAH KEBUTUHAN TAHUN 201 ADALAH PEMAKAIAN RATA!RATA PER BULAN &. REN$ANA KEBUTUHAN T AHUN 201 ADALA H REN$ANA KEBUTUHAN 'AN( DIHI ). REN$ANA PEN(ADAAN T AHUN 201 ADALAH REN$ANA OBA T DALAM SATUAN T ". SURA T P EN(ANT AR DAN LAMP IR AN HARUS DI T AND A T AN(ANI OLEH KEP ALA SA *. MOHON UNTUK TIDAK MELAKUKAN PENAMBAHAN MAUPUN PEN(URAN(AN BA RENCANA KEBUTUHAN OBAT PADA F ASILIT AS KES SATUAN KERJA % RSU MITRA SEHAT NO NAMA OBA T 1 2 Ad+ - d -3 4 ta5 10 67 &A untu n8+3 a6 20 64 ) A untu n8+3 a6 2" 64 "A untu 7a3 4 a n 1000 64 * Aa 5-3 + ta5 100 67 Aa 5-3+ ta5 "0 67 # A45+ nda9 -4 3u3 200 67/ " 64 : A45+nda9-4 ta5 )00 67 10 A45u6n 3+u 6 n-6a4 ; <u6an a45u6n= n8 20> 100 64 11 A45u6n 3+u6 n-6a4 ;<u6an a45u6n= n8 20> "0 64 12 A45u6n 3+u 6 n-6a4 ; <u6an a45u6n= n8 2"> 100 64 1& A45u6n 3+u6 n-6a4 ;<u6an a45u6n= n8 2"> 20 64 1) A45u6n 3+u 6 n-6a4 ; <u6an a45u6n= n8 2"> "0 64 1" A45u6n 3+u6 n-6a4 ;<u6an a45u6n= n8 "> 2"0 64 1* A45u6n 3+u 6 n-6a4 ; <u6an a45u6n= n8 "> "0 64 1 A4- un-4 ta5 100 67 1# A4- un -4 ta 5 &00 67 1: A4 a9-4a6 ta5 0,2" 67 20 A4 a9-4 a6 ta 5 0," 67 21 A4 a9-4a6 ta5 1 67 22 A4t+ 4a3 + 3+5 n 8 "0 67/ a4 1"&!S6!EDTMP ;+t<?4+n+da6n+ t+ta6+t<?4+n+ <-3<-n @ a@d= )) 67 $a/Na EDTMP, "!)* 7 3a6au6, dan 1#"0 1#" 65C 3a6au6 1"& + 64

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