7/21/2019 paket IW_Anak-1.ods

http://slidepdf.com/reader/full/paket-iwanak-1ods 1/2

fle:///var/www/apps/conversion/tmp/scratch_5/296700664.ods

Instalasi Farmasi

RS.Jantung & Pembuluh Darah Harapan Kita

 Nama Tgl.Masuk : ...........................

 No.MR Tgl. Keluar : …………………

 No.Kunjungan Jaminan : ...........................

 No. No. Item Nama Barang Diberi Dipakai Sisa Ket

Kelompok Obat

!"##$ "

% !"##!$ Otsu Ns %& Ml "

" !"#"!" OTSu Na'l ## Ml

 No. No. Item Nama Barang Diberi Dipakai Sisa Ket

Kelompok (lkes

!#)$ (lko*ol S+ab #

% !##$! ,la-e ,onne'tor " !/$ ,one'ting Tube No.! 0uroplast

) !### Disp S1ringe ,' &

& !###! Disp S1ringe %2& ,' 10

!###$ Disp S1ringe & ,' &

! !###/ Disp S1ringe # ,' &

$ !### Disp S1ringe %# ,' "

/ !## Disp S1ringe &# ,' "

# !##"% Disp. Nee3le No. $ %

!"!# 0'g 0le'tro3e 4e3iatri' Sil-ertra'e "

% !"! 5ee3ing Buret

" !##! 5ee3ing Tube 5r & Jms ) !##$ 5ee3ing Tube 5r $ Jms

& !%"& 6lo-e 7ate8 20

!##% I- ,at*eter No %) 3

! !#%// 7inear Bag 9it*out Soli3i1ing (gent ;

$ !)! Manometer 7ine ,ss %

/ !#&"

%# !##) Mi'ro3rip Jms

% !&$  Nebuli<er 4e3iatri' Salterlabs

%% !&/ O81gen Suppl1 Tubing Salterlabs

%" !$! Su'tion ,at* No. =ospite'* %

%) !$$ Su'tion ,at* No.$ =ospite'* %

%& !##! Tega3erm %%

% !##& T*ree 9a1 Berbuntut

%! !"/" T*ree 9a1 Stop'o'k )%) B3 Biasa

%$ !#$& >as'o sarung tangan no. 2&

%/ !#$ >as'o sarung tangan no. !2#

Petugas Ruangan Petugas Farmasi

(......................... (.........................

4embuat paket :

4eng*itung sisa paket :

P!K"# I.$ !%!K 

  '''''''''..

  '''''''''..

 

'''''''''..

Otsu 9i %&Ml ?!/#!$ @

Me3itape 12 In'* Jms; "## A

7/21/2019 paket IW_Anak-1.ods

http://slidepdf.com/reader/full/paket-iwanak-1ods 2/2

fle:///var/www/apps/conversion/tmp/scratch_5/296700664.ods

mohon untuk selalu mencantumkan stiker pasien !!! 

Instalasi Farmasi

RS.Jantung & Pembuluh Darah Harapan Kita

 Nama Tgl.Masuk : ...........................

 No.MR Tgl. Keluar : …………………

 No.Kunjungan Jaminan : ...........................

 No. No. Item Nama Barang Diberi Dipakai Sisa Ket

Kelompok Obat

" !"##!& "

) !"##!% Otsu Ns %& Ml "

" !"#"!" Otsu Na'l ## ''

 No. No. Item Nama Barang Diberi Dipakai Sisa Ket

Kelompok (lkes

"# !#$%%2! (lko*ol S+ab #" !#$"/2& ,la-e ,onne'tor

"% !#$&2) ,one'ting Tube No.! 0uroplast

"" !#$!"2" Disp S1ringe ,' &

") !#$/#2 Disp S1ringe %2& ,' #

"& !#/#! Disp S1ringe & ,' &

" !#/%"2$ Disp S1ringe # ,' &

"! !#/)#2! Disp S1ringe %# ,' "

"$ !#/&!2 Disp S1ringe &# ,' "

"/ !#/!)2) Disp. Nee3le No. $ %

)# !#//2" 0'g 0le'tro3e 4e3iatri' Sil-ertra'e "

) !##$2 5ee3ing Buret )% !#%& 5ee3ing Tube 5r & Jms

)" !#)2$ 5ee3ing Tube 5r $ Jms

)) !#&$2! 6lo-e 7ate8 )#

)& !#!&2 I- ,at*eter No %) &

) !#/%2) 7inear Bag 9it*out Soli3i1ing (gent ;

)! !#/2" Manometer 7ine ,ss &

)$ !%2

)/ !)" Mi'ro3rip Jms

&# !&/2$  Nebuli<er 4e3iatri' Salterlabs

& !!2! O81gen Suppl1 Tubing Salterlabs

&% !/"2 Su'tion ,at* No. =ospite'* &

&" !%#2) Su'tion ,at* No.$ =ospite'* %

&) !%%!2" Tega3erm %" "

&& !%))2 T*ree 9a1 Berbuntut "

& !% T*ree 9a1 Stop'o'k )%) B3 Biasa %

&! !%!!2$ >as'o sarung tangan no. 2&

&$ !%/)2! >as'o sarung tangan no. !

I- ,at*eter No %% "

  Bloo3 Set

  Inus Set

Petugas Ruangan Petugas Farmasi

(......................... (.........................

4embuat paket :

4eng*itung sisa paket :

P!K"# I.$ !%!K 

  '''''''''..

 

'''''''''..

  '''''''''..

Otsu 9i %&Ml ?!/#!$ @

Me3itape 12 In'* Jms; "## A