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CERTIFICATE OF INSTALLATION

This is cerify, that the Hospital / Institution accepted the following equipment confirmation yhe

completion of installation :

EQUIPMENT :

No

.

DESCRIPTION Model Serial No.

1. VENTILATOR MEK MV 2000 SU 2 MV 2000 NA I EO 1!0

2. "U"LE CPOP OSTEC 1!0#$1022%1&0#0'000(

'. PASIEN MONITOR )ONCARE $000C *0!1!000#& V' CCE

&. PASIEN MONITOR )ONCARE $000C *0!1!00!&0 V' CCE

!. PASIEN MONITOR )ONCARE $000C *0!1!00!&! V' CCE(. PASIEN MONITOR )ONCARE $000C *0!1!00!&' V' CCE

$. KOMPRESOR VA 0& TC 1'1'1

TC 1'12+

Has been installed on,

Hospital / institution : RSIA !"R#ATA $%&'A

Address : () $RI*("&' +ATA#S &o- +"TA!A&* .+A)$AR0

!hone :

'ate of Installation : 12 &3"#$"R 4512

'uration of 6arranty : 14 month from thr date of installation

o,-ial % I/,iio/ PT. PERMANA PUTRA MANDIRI

Authorised Representati7e Authorised Representati7e

. 0 . 0

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SERTIFIKAT KALI"RASI

 

IDENTITAS ALAT

Naa Ala Mer3 Pa4ri3 Ti-e Noor ,eri No. Seri5i3a

"ed Side

Mo/ior

)o/e6are PM7$000C *0!1!00!&'V'CC

E

KSI 1!100'+1

"ed Side

Mo/ior

)o/e6are PM7$000C *0!1!000#&V'CC

E

KSI 1!100'+0

"ed Side

Mo/ior

)o/e6are PM7$000C *0!1!00!&0V'CC' KSI 1!100'##

"ed Side

Mo/ior

)o/e6are PM7$000C *0!1!00!&!V'CC' KSI 1!100'#+

IDENTITAS PEMILIK 

Naa : RSIA. PERMATA "UNDA

Alaa : *l. "ri89e/d Kaa,o No.$ Kea-a/8 Kalia/a/ "ara

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PT. KALMED SE*ATERA INDONESIA

ASIL KALI"RASI

Naa Order : A70'(

Noor Seri5i3a : KSI 1!100'+1

Naa Ala : "ed Side Mo/ior

Mer3 Pa4ri3 : )o/e6are

Ti-e : PM7$000C

Noor Seri : *0!1!00!&'V'CCE

Re/a/8 U3r : 7

Te-a Kali4ra,i : Ra/8 La4 Keli,ri3a/ KSI

Ta/88al Kali4ra,i : 01 O3o4er 201!

I +ondisi )ing8ungan

1 Suhu : . 49259 0 ;<

4 +elembaban : . 2=-24>0 ?RH

II !eralatan Standar +alibrasi

1 3ital Signs Simulator mer8 @lu8e tipe prosim 9 &o Seri : 4>-2551

4 Sp4 @unctional Tester mer8 @lu8e tipe Spot )ight &o Seri : 4>-2551

= Thermohygrometer mer8 'e88o tipe >94 &o Seri : 1=559-=9

9 "lectrical Safety Analyer mer8 @lu8e tipe "SA >14 &o Seri : 4>-2541

 

III +etelusuran !eralatan Standar +alibrasi1 3ital Signs Simulator : $!@+ (a8arta

4 Sp4 @unctional Tester : @lu8e $iomedical

= Themohygrometer : !T #utuagung )estari

9 "lectrical Safety Analyer : $!@+ (a8arta

 

I3 +ondisi @isi8 'an @ungsi Alat

1 +ondisi @isi8 : $ai8  

4 @ungsi Alat : $ai8  

3 !engamatan !engu8uran 8eselamatan )istri8 

No PARAMETER AM"AN; "ATAS TERUKUR  

1 #ain 3oltage 44515?3 4194BA

4 !rotecti7e "art Resistance C54D 51-2 D

= Insulation Resistance E4 # D ) # D

9 "arth )ea8age

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!olarity &o "arth

PT. KALMED SE*ATERA INDONESIA

= #en8es/!"R/I3/1GGF

 Delivered follow PERMENKES No. 363. Menes!PER!"#!$%%& and 

!rosedur !enguJian / +alibrasi Alat +esehatan 'epatrtemen +esehatan RI, Tahun 45510

 Prosedure 'estin( ! Cali)ration of Medical Equipment R" Departement *ealt+, -$

3iii +eterangan / Remar8s

1 Hasil +etida8pastian pengu8uran mempunyai ting8at 8epercayaan G2? dengan fa8torca8upan .+0K4

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'+e result of measurement uncertaint/ +as a confidence level 0C12 of %4 wit+ a covera(e

 factor 0K25-

4 &ilai sebenarnya K &ilai !embacaan Alat L &ilai +ore8si

'rue #alue 5 Equipment Readin( #alue Correction #alue

= Hasil +alibrasi tertelusur 8e sistemsatuan internasional .SI0

Cali)ration result are tracea)le to t+e international unit s/stem9 Alat di8alibrasi menurut metode +SI=41, dengan "