LAPORAN KHUSUS PENGGUNAAN CODIPRONT CUM.Expect.

CAP (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

RESEP PASIEN DOKTE

NO. NAMA SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT NAMA
R/ PENYERAHAN
1 Codipront cum exp.cap Kapsul 1 6/5/2017 10 HASAN RAJAL FURQON
2 Codipront cum exp.cap Kapsul 2 6/9/2017 10 ANITA RAJAL LUTHFI
3 Codipront cum exp.cap Kapsul 3 6/21/2017 10 HELLI S RAJAL SUSILO
TOTAL 30

Samarinda, 03 Juli 2017

Pembuat laporan Penanggung Jawab Stok

Rizki Amalia, Amd., Far Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat J

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt

NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
RUTIN)

BULAN : JUNI
TAHUN : 2017
DOKTER

ALAMAT SPESIALISASI

RSU-AWS JANTUNG
RSU-AWS SARAF
RSU-AWS SARAF

wab Stok

Amd., Far

masi Rawat Jalan

M.Si, Apt
0903 2 003
 RESEP PASIEN
NAMA
NO. SEDIAAN JADI SATUAN NO JMLH
TANGGAL NAMA ALAMAT
R/ PENYERAHAN
115 " " 115 16.06.2017 10 NURJANNAH RAJAL
116 " " 116 16.06.2017 15 SUPU KARIN RAJAL
117 " " 117 16.06.2017 15 WAHYU TAMAM RAJAL
118 " " 118 16.06.2017 10 SITI RUKIYAH RAJAL
119 " " 119 16.06.2017 15 RUKAYAH RAJAL
120 " " 120 16.06.2017 10 NURSITA T RAJAL
121 " " 121 16.06.2017 10 ABDUL JEBAR RAJAL
122 " " 122 16.06.2017 5 SURYADI RAJAL
123 " " 123 16.06.2017 12 RUSNELI RAJAL
124 " " 124 16.06.2017 5 SURYATI RAJAL
125 " " 125 16.06.2017 10 SANGKALA RAJAL
126 " " 126 19.06.2017 5 ASMURAN RAJAL
127 " " 127 19.06.2017 10 A. A. ANOM RAJAL
128 " " 128 19.06.2017 10 DEDDY ALPIAN RAJAL
129 " " 129 19.06.2017 15 BERNADETA SONG RAJAL
130 " " 130 19.06.2017 10 TAPPE PIETER SUNDUN RAJAL
131 " " 131 19.06.2017 15 VIVI SUSANTI RAJAL
132 " " 132 19.06.2017 10 RATNA RAJAL
133 " " 133 19.06.2017 10 ENCE IRWAN RAJAL
134 " " 134 19.06.2017 10 EMY LINARSINI RAJAL
135 " " 135 20.06.2017 10 UMMI RAJAL
136 " " 136 20.06.2017 10 USMAN RAJAL
137 " " 137 20.06.2017 10 MUHTAR RAJAL
138 " " 138 20.06.2017 15 SUNAN LAWAI RAJAL
139 " " 139 20.06.2017 15 ELVIDAWATI RAJAL
140 " " 140 20.06.2017 15 SIRTO RAJAL
141 " " 141 20.06.2017 15 NIKO MOHAMMAD H RAJAL
142 " " 142 20.06.2017 10 M. ASIKIN NUR RAJAL
143 " " 143 21.06.2017 15 ANSORIYANTO RAJAL
144 " " 144 21.06.2017 10 FATIMAH RAJAL
145 " " 145 21.06.2017 15 DORIANNA S RAJAL
146 " " 146 21.06.2017 10 NOOR RAHMAN RAJAL
147 " " 147 21.06.2017 15 DINI NOVITA RAJAL
148 " " 148 21.06.2017 10 TRULY PANUH RAJAL
149 " " 149 21.06.2017 10 BEDDU WAHE RAJAL
150 " " 150 21.06.2017 10 MUSTAPA RAJAL
151 " " 151 21.06.2017 15 UDIN RAJAL
152 " " 152 21.06.2017 10 BERTHA RAJAL
153 " " 153 21.06.2017 10 DIN UCAU RAJAL
154 " " 154 21.06.2017 10 JUNAIDI RAJAL
155 " " 155 22.06.2017 10 SURANTO RAJAL
156 " " 156 22.06.2017 10 SIGIT DWI F RAJAL
157 " " 157 22.06.2017 10 AMAN RAJAL
158 " " 158 22.06.2017 10 BASO TURUN BUA RAJAL
159 " " 159 22.06.2017 10 HERLINA PANGLOLI RAJAL
 RESEP PASIEN
NAMA
NO. SEDIAAN JADI SATUAN NO JMLH
TANGGAL NAMA ALAMAT
R/ PENYERAHAN
160 " " 160 22.06.2017 7 A. A. ANOM RAJAL
161 " " 161 22.06.2017 10 BAYU ADI RAJAL
162 " " 162 22.06.2017 10 ARTONO RAJAL
163 " " 163 22.06.2017 10 ERHAMSYAH RAJAL
164 " " 164 22.06.2017 15 MUNAWARAH RAJAL
165 " " 165 22.06.2017 10 SITI AISYAH RAJAL
166 " " 166 22.06.2017 10 ANDRI RIZKI RAJAL
TOTAL 2089

Samarinda, 03 Juli 2017

Pembuat laporan Penanggung Jaw

Rizki Amalia, Amd., Far Nia Patmawati,

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farm

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.

NIP : 19640412 199203 2 010 NIP : 19780602 20
 DOKTER

NAMA ALAMAT SPESIALISASI

EVA RSU-AWS THT

MARWAN RSU-AWS PARU
MARWAN RSU-AWS PARU
SELVIANTI RSU-AWS THT
MARWAN RSU-AWS PARU
EVA RSU-AWS THT
EVA RSU-AWS THT
SINTA RSU-AWS P. DALAM
DJOEN RSU-AWS JANTUNG
KUNTJORO RSU-AWS P. DALAM
MARWAN RSU-AWS PARU
KUNTJORO RSU-AWS HD
SIZIGIA RSU-AWS HD
SELVIANTI RSU-AWS THT
SELVIANTI RSU-AWS THT
YANTI RSU-AWS PARU
ANITA RSU-AWS P. DALAM
YANTI RSU-AWS P. DALAM
ZAINAL RSU-AWS ONKOLOGI
YANTI RSU-AWS PARU
SIZIGIA RSU-AWS HD
YANTI RSU-AWS PARU
SIZIGIA RSU-AWS HD
RAHMAWATI RSU-AWS THT
RAHMAWATI RSU-AWS THT
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
SOEHARTONO RSU-AWS THT
KUNTJORO RSU-AWS P. DALAM
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
SIZIGIA RSU-AWS HD
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
YANTI RSU-AWS PARU
 DOKTER

NAMA ALAMAT SPESIALISASI

SIZIGIA RSU-AWS HD
MORIKO RSU-AWS THT
SIZIGIA RSU-AWS HD
SIZIGIA RSU-AWS HD
YULIANA RSU-AWS P. DALAM
SIZIGIA RSU-AWS HD
YANTI RSU-AWS PARU

Samarinda, 03 Juli 2017

Penanggung Jawab Stok

Nia Patmawati, Amd., Far

Mengetahui,
Penanggung Jawab Farmasi Rawat Jalan

Yuniastuti., S.Si.,M.Si, Apt

NIP : 19780602 200903 2 003
 LAPORAN KHUSUS PENGGUNAAN CODEIN 15 MG TAB (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

RESEP PASIEN DOKT

NAMA
NO. SEDIAAN JADI SATUAN TANGGAL JMLH
NO R/ NAMA ALAMAT NAMA
PENYERAHAN
1 Codein 15 Mg Tablet 1 02.06.2017 10 VIVI SOERYA T RAJAL MANGALINDUNG
2 " " 2 06.06.2017 10 ERNY ELLYAWATI RAJAL RAHMAWATI
3 " " 3 06.06.2017 10 ROSILAWATI RAJAL RAHMAWATI
4 " " 4 06.06.2017 10 PUSPAWATI RAJAL RAHMAWATI
5 " " 5 07.06.2017 7.5 DIRLY APRILIANO RAJAL SOEHARTONO
6 " " 6 20.06.2017 10 ASNAN RAJAL RAHMAWATI
7 " " 7 21.06.2017 15 RUSNELIWANTI RAJAL SOEHARTONO
TOTAL 72.5

Samarinda, 03 Juli 2017

Pembuat laporan Penanggung Jawab Stok

Rizki Amalia, Amd., Far Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat J

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt

NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
NAAN CODEIN 15 MG TAB (RUTIN)

BULAN : JUNI
TAHUN : 2017
DOKTER
ALAMAT SPESIALISASI
RSU-AWS B. UMUM
RSU-AWS THT
RSU-AWS THT
RSU-AWS THT
RSU-AWS THT
RSU-AWS THT
RSU-AWS THT

nda, 03 Juli 2017

Penanggung Jawab Stok

Nia Patmawati, Amd., Far

engetahui,
Penanggung Jawab Farmasi Rawat Jalan

Yuniastuti., S.Si.,M.Si, Apt

NIP : 19780602 200903 2 003
 LAPORAN KHUSUS PENGGUNAAN CODEIN 20 MG TAB (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

RESEP PASIEN DOKT

NO. NAMAJADI
SEDIAAN SATUAN JMLH
NO R/ TANGGAL NAMA ALAMAT NAMA
PENYERAHAN
1 Codein 20 Mg Tablet 1 06.06.2017 10 DANDI H RAJAL LUTHFI
2 " " 2 07.06.2017 10 HJ. ARPAH RAJAL SUSILO
3 " " 3 12.06.2017 10 MUHASIP RAJAL SUSILO
4 " " 4 12.06.2017 10 M. ARSYAD HK RAJAL SUSILO
5 " " 5 12.06.2017 10 JAINAL WAHAB RAJAL SUSILO
6 " " 6 12.06.2017 10 LASIAH RAJAL SUSILO
7 " " 7 12.06.2017 10 ROHANI RAJAL SUSILO
8 " " 8 12.06.2017 10 SURIANSYAH RAJAL SUSILO
9 " " 9 12.06.2017 10 SITI KHOMSIYAH RAJAL SUSILO
10 " " 10 12.06.2017 10 MUNGKEN RAJAL SUSILO
11 " " 11 13.06.2017 10 TANSIR I RAJAL SUSILO
12 " " 12 14.06.2017 30 ENNI SELLI RAJAL SUSILO
13 " " 13 19.06.2017 10 NURUL HUDA RAJAL SUSILO
14 " " 14 19.06.2017 10 MUHASIP RAJAL SUSILO
15 " " 15 19.06.2017 10 TUTIK HANDAYANI RAJAL SUSILO
16 " " 16 19.06.2017 10 FUAD ABDULLAH RAJAL SUSILO
17 " " 17 21.06.2017 10 MIMI MARIANI RAJAL SUSILO
18 " " 18 21.06.2017 10 WARSITO S RAJAL SUSILO
19 " " 19 21.06.2017 10 BENI KUNCORO RAJAL SUSILO
20 " " 20 21.06.2017 10 JUMRAH RAJAL SUSILO
21 " " 21 21.06.2017 10 KUSNADI RAJAL SUSILO
22 " " 22 21.06.2017 30 ENNI SELLI RAJAL SUSILO
23 " " 23 21.06.2017 10 SUYANTO RAJAL SUSILO
24 " " 24 21.06.2017 10 SUPRIYATI RAJAL SUSILO
25 " " 25 21.06.2017 10 HJ. LAILA RAJAL SUSILO
TOTAL 290

Samarinda, 03 Juli 2017

Pembuat laporan Penanggung Jawab Stok

Rizki Amalia, Amd., Far Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat
 RESEP PASIEN DOKT
NO. NAMAJADI
SEDIAAN SATUAN JMLH
NO R/ TANGGAL NAMA ALAMAT NAMA
PENYERAHAN
Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt
NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
GUNAAN CODEIN 20 MG TAB (RUTIN)

BULAN : JUNI
TAHUN : 2017
DOKTER

ALAMAT SPESIALISASI

RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF
RSU-AWS SARAF

arinda, 03 Juli 2017

Penanggung Jawab Stok

Nia Patmawati, Amd., Far

Mengetahui,
Penanggung Jawab Farmasi Rawat Jalan
 DOKTER

ALAMAT SPESIALISASI

Yuniastuti., S.Si.,M.Si, Apt

NIP : 19780602 200903 2 003
 LAPORAN KHUSUS PENGGUNAAN MST 10 MG (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

RESEP PASIEN DOK

NAMA
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT NAMA
R/ PENYERAHAN
1 MST 10 Mg Tablet 1 05.06.2017 5 SRI WAHYUNI RAJAL RUDY
2 " " 2 05.06.2017 10 PATIMASANG RAJAL ANDRIANSYAH
3 " " 3 05.06.2017 10 SITTI RAJAL ARIF
4 " " 4 05.06.2017 7 HANA RAYHANI RAJAL ZAINAL A.
5 " " 5 05.06.2017 5 SHERLY RAJAL RUDY
6 " " 6 06.06.2017 5 SUMADJI RAJAL FRITZ
7 " " 7 07.06.2017 6 ENDANG RAJAL ERWIN G.
8 " " 8 09.06.2017 5 EMY LINASARI RAJAL ZAINAL A.
9 " " 9 12.06.2017 5 SHERLY RAJAL ZAINAL A.
10 " " 10 13.06.2017 10 ZAINI GUNAWAN RAJAL DJOEN
11 " " 11 14.06.2017 10 SAIMAH RAJAL ANDRIANSYAH
12 " " 12 14.06.2017 10 RINI RAHAYU RAJAL ZAINAL A.
13 " " 13 14.06.2017 10 UMIK HANIFAH RAJAL ANDRIANSYAH
14 " " 14 14.06.2017 5 SRI WAHYUNI RAJAL ZAINAL A.
15 " " 15 16.06.2017 20 HANA RAYHANI RAJAL RUDY
16 " " 16 19.06.2017 10 ENDANG RAJAL GUSTI
17 " " 17 19.06.2017 10 MARAKUP RAJAL FURQON
18 " " 18 19.06.2017 10 JUMA'AH AKBAR RAJAL GUSTI
19 " " 19 21.06.2017 10 MISTININGSIH RAJAL MARIHOT
20 " " 20 21.06.2017 10 NELLY TRESNAWATI RAJAL MARIHOT
21 " " 21 21.06.2017 10 SITI RUKAYAH RAJAL RAHMAWATI
22 " " 22 22.06.2017 10 NANA RAJAL ANDI SATYA
TOTAL 193

Samarinda, 03 Juli 2017

Pembuat laporan Penanggung Jawab Stok

Rizki Amalia, Amd., Far Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat Ja

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt

 RESEP PASIEN DOK
NAMA
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT NAMA
R/ PENYERAHAN
NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
NGGUNAAN MST 10 MG (RUTIN)

BULAN : JUNI
TAHUN : 2017
DOKTER
ALAMAT SPESIALISASI

RSU-AWS ONKOLOGI
RSU-AWS KANDUNGAN
RSU-AWS B. TORAKS
RSU-AWS ONKOLOGI
RSU-AWS ONKOLOGI
RSU-AWS B. UMUM
RSU-AWS KANDUNGAN
RSU-AWS ONKOLOGI
RSU-AWS ONKOLOGI
RSU-AWS JANTUNG
RSU-AWS KANDUNGAN
RSU-AWS ONKOLOGI
RSU-AWS KANDUNGAN
RSU-AWS ONKOLOGI
RSU-AWS ONKOLOGI
RSU-AWS KANDUNGAN
RSU-AWS JANTUNG
RSU-AWS KANDUNGAN
RSU-AWS KANDUNGAN
RSU-AWS KANDUNGAN
RSU-AWS THT
RSU-AWS KANDUNGAN

inda, 03 Juli 2017

Penanggung Jawab Stok

Nia Patmawati, Amd., Far

Mengetahui,
Penanggung Jawab Farmasi Rawat Jalan

Yuniastuti., S.Si.,M.Si, Apt

 DOKTER
ALAMAT SPESIALISASI

NIP : 19780602 200903 2 003

 LAPORAN KHUSUS PENGGUNAAN MST 15 MG TAB (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

RESEP PASIEN DOKTER

NAMA
NO. SATUAN NO TANGGAL JMLH
SEDIAAN JADI NAMA ALAMAT NAMA
R/ PENYERAHAN
1 MST 15 mg Tablet 1 02.06.2017 10 VIVI SOERYA T RAJAL MANGALINDUNG
2 " " 2 05.06.2017 10 WAWAN KRISTANTO RAJAL CARTA
3 " " 3 06.06.2017 10 NAPSIAH RAJAL LUTHFI
4 " " 4 12.06.2017 10 WAWAN KRISTANTO RAJAL CARTA
5 " " 5 13.06.2017 10 NAPSIAH RAJAL LUTHFI
6 " " 6 19.06.2017 10 WAWAN KRISTANTO RAJAL CARTA
7 " " 7 19.06.2017 10 NAPSIAH RAJAL SUSILO
8 " " 8 22.06.2017 10 NAPSIAH RAJAL ASWAD
TOTAL 80

Samarinda, 03 Juli 2017

Pembuat laporan Penanggung Jawab Stok

Rizki Amalia, Amd., Far Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat Jal

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt

NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
NGGUNAAN MST 15 MG TAB (RUTIN)

BULAN : JUNI
TAHUN : 2017
DOKTER
ALAMAT SPESIALISASI

RSU-AWS B. UMUM
RSU-AWS P. DALAM
RSU-AWS SARAF
RSU-AWS P. DALAM
RSU-AWS SARAF
RSU-AWS P. DALAM
RSU-AWS SARAF
RSU-AWS SARAF

marinda, 03 Juli 2017

Penanggung Jawab Stok

Nia Patmawati, Amd., Far

Mengetahui,
Penanggung Jawab Farmasi Rawat Jalan

Yuniastuti., S.Si.,M.Si, Apt

NIP : 19780602 200903 2 003
 LAPORAN KHUSUS PENGGUNAAN DUROGESIC PATCH 25 µG (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

RESEP PASIEN DOKTE

NAMA SEDIAAN
NO. SATUAN TANGGAL JMLH
JADI NO R/ NAMA ALAMAT NAMA
PENYERAHAN
1 Durogesic 25 µg Patch 1 08.06.2017 1 TAUFIK ALAMSYAH RAJAL RIDMAWAN
2 " Patch 2 09.06.2017 1 TAUFIK ALAMSYAH RAJAL RIDMAWAN
TOTAL 2

Samarinda, 03 Juli 2017

Pembuat laporan Penanggung Jawab Stok

Rizki Amalia, Amd., Far Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat J

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt

NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
GUNAAN DUROGESIC PATCH 25 µG (RUTIN)

BULAN : JUNI
TAHUN : 2017
DOKTER

ALAMAT SPESIALISASI

AWS PARU
AWS PARU

amarinda, 03 Juli 2017

Penanggung Jawab Stok

Nia Patmawati, Amd., Far

Mengetahui,
Penanggung Jawab Farmasi Rawat Jalan

Yuniastuti., S.Si.,M.Si, Apt

NIP : 19780602 200903 2 003
 LAPORAN KHUSUS PENGGUNAAN DUROGESIC PATCH 12,5µG (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

RESEP PASIEN DOKTER

NO. NAMA SEDIAAN JADI SATUAN TANGGAL JMLH
NO R/ NAMA ALAMAT NAMA
PENYERAHAN
1 Durogesic 12,5 µg Patch 1 21.06.2017 2 MUJIONOKO RAJAL YANTI
TOTAL 2

Samarinda, 03 Juli 2017

Pembuat laporan Penanggung Jawab Stok

Rizki Amalia, Amd., Far Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat Jal

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt

NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
AAN DUROGESIC PATCH 12,5µG (RUTIN)

BULAN : JUNI
TAHUN : 2017
DOKTER

ALAMAT SPESIALISASI

AWS PARU

inda, 03 Juli 2017

Penanggung Jawab Stok

Nia Patmawati, Amd., Far

Mengetahui,
Penanggung Jawab Farmasi Rawat Jalan

Yuniastuti., S.Si.,M.Si, Apt

NIP : 19780602 200903 2 003
 LAPORAN KHUSUS PENGGUNAAN CODIPRONT CAP (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR
BULAN
TAHUN
NAMA RESEP PASIEN DOKTER
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT NAMA ALAMAT
R/ PENYERAHAN
1 CODIPRONT CAP " 1 31.03.2017 3 RIZKY H RAJAL MORIKO RSU-AWS
TOTAL 3

Pembuat laporan Samarinda, 03 April 2017

Nia Patmawati, Amd., Far Dayang Bella Risky Wanda, Amd

Mengetahui,
Koord. Depo Farmasi Jalan Ka. Instalasi Farmasi RSUD A W S

Yuniastuti., S.Si.,M.Si, Apt Dra. Hj.Linawati., Apt

NIP : 19780602 200903 2 003 NIP : 19640412 199203 2 01
 : MARET
: 2017
TER
SPESIALISASI

THT

il 2017

da, Amd., Far

D A W Syahranie

, Apt
03 2 010
 LAPORAN KHUSUS PENGGUNAAN MORFIN INJEKSI (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

NAMA RESEP PASIEN DOKT

NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT NAMA
R/ PENYERAHAN
1 Morfin Inj. Ampul
2 " "
3 " "
4 " "
5 " "
6 " "
7 " "
8 " "
9 " "
10 " "
TOTAL 0

Samarinda, 28 No
Mengetahui,
Ka.IFRS AWS,

Dra. Hj.Linawati.,
NIP : 19640412 1
)

BULAN :
TAHUN : 2013
DOKTER
SPESIA-
ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS

inda, 28 November 2013

etahui,
S AWS,

.Linawati., Apt
9640412 199203 2 010
 LAPORAN KHUSUS PENGGUNAAN PETHIDIN INJEKSI (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

NAMA RESEP PASIEN

NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
1 Pethidin Inj Ampul
2 " "
3 " "
4 " "
5 " "
6 " "
7 " "
TOTAL 0
EKSI (RUTIN)

BULAN :
TAHUN : 2013
DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS

Samarinda, 15 Maret 2013

Mengetahui,
Ka.IFRS AWS,

Dra. Hj.Linawati., Apt

NIP : 19640412 199203 2 010
 LAPORAN KHUSUS PENGGUNAAN FENTANYL 2 ml INJ (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

NAMA RESEP PASIEN

NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
1 Fentanyl 2 ml Ampul
2 " "
3 " "
4 " "
5 " "
6 " "
7 " "
8 " "
9 " "
10 " "
11 " "
12 " "
13 " "
14 " "
15 " "
16 " "
17 " "
18 " "
19 " "
20 " "
21 " "
22 " "
23 " "
24 " "
25 " "
26 " "
27 " "
28 " "
29 " "
30 " "
31 " "
32 " "
33 " "
34 " "
35 " "
36 " "
37 " "
38 " "
39 " "
40 " "
41 " "
42 " "
43 " "
44 " "
45 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
46 " "
47 " "
48 " "
49 " "
50 " "
51 " "
52 " "
53 " "
54 " "
55 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
56 " "
57 " "
58 " "
59 " "
60 " "
61 " "
62 " "
63 " "
64 " "
65 " "
66 " "
67 " "
68 " "
69 " "
70 " "
71 " "
72 " "
73 " "
74 " "
75 " "
76 " "
77 " "
78 " "
79 " "
80 " "
81 " "
82 " "
83 " "
84 " "
85 " "
86 " "
87 " "
88 " "
89 " "
90 " "
91 " "
92 " "
93 " "
94 " "
95 " "
96 " "
97 " "
98 " "
99 " "
100 " "
101 " "
102 " "
103 " "
104 " "
105 " "
106 " "
107 " "
108 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
109 " "
110 " "
111 " "
112 " "
113 " "
114 " "
115 " "
116 " "
117 " "
118 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
119 " "
120 " "
121 " "
122 " "
123 " "
124 " "
125 " "
126 " "
127 " "
128 " "
129 " "
130 " "
131 " "
132 " "
133 " "
134 " "
135 " "
136 " "
137 " "
138 " "
139 " "
140 " "
141 " "
142 " "
143 " "
144 " "
145 " "
146 " "
147 " "
148 " "
149 " "
150 " "
151 " "
152 " "
153 " "
154 " "
155 " "
156 " "
157 " "
158 " "
159 " "
160 " "
161 " "
162 " "
163 " "
164 " "
165 " "
166 " "
167 " "
168 " "
169 " "
170 " "
171 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
172 " "
173 " "
174 " "
175 " "
176 " "
177 " "
178 " "
179 " "
180 " "
181 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
182 " "
183 " "
184 " "
185 " "
186 " "
187 " "
188 " "
189 " "
190 " "
191 " "
192 " "
193 " "
194 " "
195 " "
196 " "
197 " "
198 " "
199 " "
200 " "
201 " "
202 " "
203 " "
204 " "
205 " "
206 " "
207 " "
208 " "
209 " "
210 " "
211 " "
212 " "
213 " "
214 " "
215 " "
216 " "
217 " "
218 " "
219 " "
220 " "
221 " "
222 " "
223 " "
224 " "
225 " "
226 " "
227 " "
228 " "
229 " "
230 " "
231 " "
232 " "
233 " "
234 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
235 " "
236 " "
237 " "
238 " "
239 " "
240 " "
241 " "
242 " "
243 " "
244 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
245 " "
246 " "
247 " "
248 " "
249 " "
250 " "
251 " "
252 " "
253 " "
254 " "
255 " "
256 " "
257 " "
258 " "
259 " "
260 " "
261 " "
262 " "
263 " "
264 " "
265 " "
266 " "
267 " "
268 " "
269 " "
270 " "
271 " "
272 " "
273 " "
274 " "
275 " "
276 " "
277 " "
278 " "
279 " "
280 " "
281 " "
282 " "
283 " "
284 " "
285 " "
286 " "
287 " "
288 " "
289 " "
290 " "
291 " "
292 " "
293 " "
294 " "
295 " "
296 " "
297 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
298 " "
299 " "
300 " "
301 " "
302 " "
303 " "
304 " "
305 " "
306 " "
307 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
308 " "
309 " "
310 " "
311 " "
312 " "
313 " "
314 " "
315 " "
316 " "
317 " "
318 " "
319 " "
320 " "
321 " "
322 " "
323 " "
324 " "
325 " "
326 " "
327 " "
328 " "
329 " "
330 " "
331 " "
332 " "
333 " "
334 " "
335 " "
336 " "
337 " "
338 " "
339 " "
340 " "
341 " "
342 " "
343 " "
344 " "
345 " "
346 " "
347 " "
348 " "
349 " "
350 " "
351 " "
352 " "
353 " "
354 " "
355 " "
356 " "
357 " "
358 " "
359 " "
360 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
361 " "
362 " "
363 " "
364 " "
365 " "
366 " "
367 " "
368 " "
369 " "
370 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
371 " "
372 " "
373 " "
374 " "
375 " "
376 " "
377 " "
378 " "
379 " "
380 " "
381 " "
382 " "
383 " "
384 " "
385 " "
386 " "
TOTAL -

Samarinda, 28 No
Mengetahui,
Ka.IFRS AWS,

Dra. Hj.Linawati.,
NIP : 19640412 1
RUTIN)

BULAN :
TAHUN : 2013
DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS

nda, 28 November 2013

ahui,
AWS,

Linawati., Apt
640412 199203 2 010
 LAPORAN KHUSUS PENGGUNAAN CODIPRONT SYR .(RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

NAMA RESEP PASIEN DOKTE

NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT NAMA
R/ PENYERAHAN
1 Codipront Syr Botol 1 03.05.2017 1 AMAT RAJAL FURQON
TOTAL 1

Samarinda, 02 Juni 2017

Pembuat laporan Penanggung Jawab Stok

Febrina Chairiani Nia Patmawati, Amd., Far

GGUNAAN CODIPRONT SYR .(RUTIN)

BULAN : MEI
TAHUN : 2017
DOKTER
SPESIA-
ALAMAT
LISASI
AWS JANTUNG

rinda, 02 Juni 2017

Penanggung Jawab Stok

Nia Patmawati, Amd., Far

 LAPORAN KHUSUS PENGGUNAAN CODIPRONT CUM.EXP.SYR (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

NAMA RESEP PASIEN DOK

NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT NAMA
R/ PENYERAHAN
1 Codipront Cum Exp Syr Botol 1 RAJAL
2 " " 2 RAJAL
TOTAL 0

Pembuat laporan, Samarinda, 03 FEBRUARI 2017

NIA PATMAWATI DEWI NURHAYATI

IN)

BULAN : JANUARI
TAHUN : 2017
DOKTER
SPESIA-
ALAMAT
LISASI
RSU-AWS
RSU-AWS

2017
 LAPORAN KHUSUS PENGGUNAAN DUROGESIC 12.5 mcg/h INJ (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

NAMA RESEP PASIEN

NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
1 Durogesic 12,5 mcg/h Inj. Ampul 1 RAJAL
2 " "
3 " "
4 " "
5 " "
6 " "
7 " "
8 " "
9 " "
10 " "
11 " "
TOTAL 0
cg/h INJ (RUTIN)

BULAN :
TAHUN : 2013
DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS

Samarinda, 28 November 2013

Mengetahui,
Ka.IFRS AWS,

Dra. Hj.Linawati., Apt

NIP : 19640412 199203 2 010
 LAPORAN KHUSUS PENGGUNAAN FENTANYL 10 ml INJ (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

NAMA RESEP PASIEN

NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN

TOTAL

Penyusun Laporan

Yusniati, S.Si,Apt
NIP : 19650810 199803 2004
0 ml INJ (RUTIN)

BULAN
TAHUN : 2012
DOKTER
SPESIA-
NAMA ALAMAT
LISASI

Samarinda, 18 Februari 2013

Mengetahui,
Ka.IFRS AWS,

Dra. Hj.Linawati., Apt

NIP : 19640412 199203 2 010
 LAPORAN KHUSUS PENGGUNAAN CLOPEDINE INJ (RUTIN)

NAMA RUMAH SAKIT : RSUD A. WAHAB SJAHRANIE

ALAMAT : JL. PALANG MERAH INDONESIA
TELEPON : (0541) 742055, 742056. Ext 206
KAB./KODYA : SAMARINDA - KALIMANTAN TIMUR

NAMA RESEP PASIEN

NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
1 Clopedine Inj. Ampul
2 " "
3 " "
4 " "
5 " "
6 " "
7 " "
8 " "
9 " "
10 " "
11 " "
12
13 " "
14 " "
15 " "
16 " "
17 " "
18 " "
19 " "
20 " "
21 " "
22 " "
23 " "
24 " "
25 " "
26 " "
27 " "
28 " "
29 " "
30 " "
31 " "
32 " "
33 " "
34 " "
35 " "
36 " "
37 " "
38 " "
39 " "
40 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
41 " "
42 " "
43 " "
44 " "
45 " "
46 " "
47 " "
48 " "
49 " "
50 " "
51 " "
52 " "
53 " "
54 " "
55 " "
 NAMA RESEP PASIEN
NO. SEDIAAN JADI SATUAN NO TANGGAL JMLH
NAMA ALAMAT
R/ PENYERAHAN
56 " "
57 " "
58 " "
59 " "
60 " "
61 " "
62 " "
63 " "
64 " "
65 " "
66 " "
67 " "
68 " "
69 " "
70 " "
71 " "
72 " "
73 " "
74 " "
75 " "
76 " "
77 " "
78 " "
79 " "
80 " "
81 " "
81 " "
81 " "
81 " "
81 " "
81 " "
81 " "
81 " "
TOTAL 0
(RUTIN)

BULAN :
TAHUN : 2013
DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
 DOKTER
SPESIA-
NAMA ALAMAT
LISASI
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS
RSU-AWS

Samarinda, 28 November 2013

Mengetahui,
Ka.IFRS AWS,

Dra. Hj.Linawati., Apt

NIP : 19640412 199203 2 010