SATUAN 3
tab tab ampul tab tab vial btl 60 ml tab tab tab btl 60 ml tab tab tab tab tab pot tube supp tab amp tube 5 gram tab amp tab vial vial 5 ml amp 1 ml vial 5 ml vial 5 ml sase tab tube tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab amp tab tab btl 60 ml tab tab amp amp tab tab btl 500 ml botol / 1000 ml tab amp tab btl 60 ml kapsul btl 300 ml tab tab tab amp amp tab btl 30 ml sachet tab ampul tube tab ampul btl 500 ml tab tab btl 10 cc
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab tube tab tab tab tab tab btl tab tab tab tube 15 gr tab tab tab tab tab tab btl 5 ml btl 5 ml btl 60 ml tab tab tab vial btl 10000 ml vial vial tab amp tab tab tab btl 500 ml tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab tab tab btl 100 cc tube 3.5 gr tube 5 gram amp dos dos dos vail btl 60 ml tab tab tab tab btl 300 cc btl 30 ml tab tab tab amp tab tab kap kap btl 500 ml tab ktk 50 gram tab tab btl 60 ml amp tab tab btl 100 ml
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
btl 5 ml tab tab tab tab tab amp kapsul tab tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
1 2 3 4 5 6
Etil Klorida Spray Eugenol Glass Ionomer Cement ART Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Kalsium Hidroksida pasta Semen Seng Fosfat serbuk dan cairan
1 2 3 4 5 6 7 8 9 10 11 12 13 14
IV. Catheter No. 20 IV. Catheter No. 22 IV. Catheter No. 24 Alat Suntik 2,5 ml Alat Suntik 5 ml
Catgut plain / Benang bedah No. 2/0 dengan jarum 24x70 cm/kotak Catgut chromic / Benang bedah No. 3/0 dengan jarum 24x70 cm/kotak Silk (Benang Bedah Sutra) No. 3/0 dengan jarum bedah 5 cm/kotak 12x3x Infus set anak Infus set dewasa Kapas pembalut/absorben 250 gram Kasa pembalut 4 x 3 cm elastic Kasa pembalut 4 x 15 cm elastic Kasa kompres 40/40 steril pcs pcs bungkus rol rol rol
SATUAN 3
rol rol pcs pcs pcs pcs pcs pcs pcs set
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
................................................................. NIP......................................................
................................................................. NIP......................................................
Sumenep, .................................
................................................................. NIP......................................................
SATUAN 3
tab tab ampul tab tab vial btl 60 ml tab tab tab btl 60 ml tab tab tab tab tab pot tube supp tab amp tube 5 gram tab amp tab vial vial 5 ml amp 1 ml vial 5 ml vial 5 ml sase tab tube tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab amp tab tab btl 60 ml tab tab amp amp tab tab btl 500 ml botol / 1000 ml tab amp tab btl 60 ml kapsul btl 300 ml tab tab tab amp amp tab btl 30 ml sachet tab ampul tube tab ampul btl 500 ml tab tab btl 10 cc
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab tube tab tab tab tab tab btl tab tab tab tube 15 gr tab tab tab tab tab tab btl 5 ml btl 5 ml btl 60 ml tab tab tab vial btl 10000 ml vial vial tab amp tab tab tab btl 500 ml tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab tab tab btl 100 cc tube 3.5 gr tube 5 gram amp dos dos dos vail btl 60 ml tab tab tab tab btl 300 cc btl 30 ml tab tab tab amp tab tab kap kap btl 500 ml tab ktk 50 gram tab tab btl 60 ml amp tab tab btl 100 ml
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
btl 5 ml tab tab tab tab tab amp kapsul tab tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
1 2 3 4 5 6
Etil Klorida Spray Eugenol Glass Ionomer Cement ART Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Kalsium Hidroksida pasta Semen Seng Fosfat serbuk dan cairan
1 2 3 4 5 6 7 8 9 10 11 12 13 14
IV. Catheter No. 20 IV. Catheter No. 22 IV. Catheter No. 24 Alat Suntik 2,5 ml Alat Suntik 5 ml Catgut plain / Benang bedah No. 2/0 dengan jarum Catgut chromic / Benang bedah No. 3/0 dengan jarum Infus set anak Infus set dewasa Kapas pembalut/absorben 250 gram Kasa pembalut 4 x 3 cm elastic Kasa pembalut 4 x 15 cm elastic Kasa kompres 40/40 steril
pcs pcs pcs pcs pcs 24x70 cm/kotak 24x70 cm/kotak pcs pcs bungkus rol rol rol
Silk (Benang Bedah Sutra) No. 3/0 dengan jarum bedah 12x3x75 cm/kotak
SATUAN 3
rol rol pcs pcs pcs pcs pcs pcs pcs set
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
................................................................. NIP......................................................
................................................................. NIP......................................................
Sumenep, .................................
................................................................. NIP......................................................
SATUAN 3
tab tab ampul tab tab vial btl 60 ml tab tab tab btl 60 ml tab tab tab tab tab pot tube supp tab amp tube 5 gram tab amp tab vial vial 5 ml amp 1 ml vial 5 ml vial 5 ml sase tab tube tab tab amp tab tab btl 60 ml tab tab amp amp tab tab btl 500 ml botol / 1000 ml tab
PENERIMAAN 5 -
PENGELUARAN 6 -
SATUAN 3
amp tab btl 60 ml kapsul btl 300 ml tab tab tab amp amp tab btl 30 ml sachet tab ampul tube tab ampul btl 500 ml tab tab btl 10 cc tab tube tab tab tab tab tab btl tab tab tab tube 15 gr tab tab tab tab tab tab btl 5 ml btl 5 ml btl 60 ml tab tab tab vial btl 10000 ml vial
PENERIMAAN 5 -
PENGELUARAN 6 -
SATUAN 3
vial tab amp tab tab tab btl 500 ml tab tab tab tab btl 100 cc tube 3.5 gr tube 5 gram amp dos dos dos vail btl 60 ml tab tab tab tab btl 300 cc btl 30 ml tab tab tab amp tab tab kap kap btl 500 ml tab ktk 50 gram tab tab btl 60 ml amp tab tab btl 100 ml btl 5 ml tab tab tab tab
PENERIMAAN 5 -
PENGELUARAN 6 -
SATUAN 3
tab amp kapsul tab tab
PENERIMAAN 5 -
PENGELUARAN 6 -
1 2 3 4 5 6
Etil Klorida Spray Eugenol Glass Ionomer Cement ART Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Kalsium Hidroksida pasta Semen Seng Fosfat serbuk dan cairan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
IV. Catheter No. 20 IV. Catheter No. 22 IV. Catheter No. 24 Alat Suntik 2,5 ml Alat Suntik 5 ml Catgut plain / Benang bedah No. 2/0 dengan jarum Catgut chromic / Benang bedah No. 3/0 dengan jarum Silk (Benang Bedah Sutra) No. 3/0 dengan jarum bedah Infus set anak Infus set dewasa Kapas pembalut/absorben 250 gram Kasa pembalut 4 x 3 cm elastic Kasa pembalut 4 x 15 cm elastic Kasa kompres 40/40 steril Kasa pembalut 2m x 80 cm Plester 5 yards x 2 inc Sarung Tangan No. 7 Sarung Tangan No. 7. 5 Folley catheter No. 16 , 18 Urine bag Otsucath no. 16 Otsucath no. 18 Otsucath no. 20 Jarum jahit no 10,11,12
pcs pcs pcs pcs pcs 24x70 cm/kotak 24x70 cm/kotak 12x3x 5 cm/kotak pcs pcs bungkus rol rol rol rol rol pcs pcs pcs pcs pcs pcs pcs set
................................................................. NIP......................................................
................................................................. NIP......................................................
................................................................. NIP......................................................
................................................................. NIP......................................................
................................................................. NIP......................................................
................................................................. NIP......................................................
................................................................. NIP......................................................
................................................................. NIP......................................................
2 3 Atropin Sulfat inj. Ampul Atropin Sulfat tab. Tablet Dekstromerthorpan Tablet Tablet Dekstromerthorpan Sirup Botol Diazepam 5 mg Tablet Efedrin 25 mg Tablet Epinefrin Inj. Ampul Etakridin larutan 0,1 % Botol Eugenol Botol Fenol Gliserol TT Botol Fitomenadion tab. Tablet Furosemide 40 mg Tablet Garam Oralit Sachet Gliserin Botol Haloperidol 1,5 mg Tablet Haloperidol 5 mg Tablet Hidrochlortiazide 25 mg Tablet STOK AWAL 2012amin Inj. Ampul Klorfeniramin Maleat 4 mg Tablet Klorpromazine 25 mg Tablet Kotrimoksasol 120 mg Tablet Lidokain Inj. Ampul Oksitetrasiklin salep mata 1 % Tube 3,5 gr Mebendasol Tablet Mebendasol sirup Botol Natrium Thio Sulfat Inj. Botol NaCl Botol Nistatin 500.000 IU Tablet Piridoksin tab Tablet Povidon Iodida 300 ml Botol Propanolol 10 mg Tablet Propiltiourasil Tablet Reserpin 0,25 mg Tablet Sulfasetamid Tetes Mata Botol Alat Suntik 1 ml Set Alat Suntik 5 ml Set
................................................................. NIP......................................................
................................................................. NIP......................................................
2 3 Atropin Sulfat inj. Ampul Atropin Sulfat tab. Tablet Dekstromerthorpan Tablet Tablet Dekstromerthorpan Sirup Botol Diazepam 5 mg Tablet Efedrin 25 mg Tablet Epinefrin Inj. Ampul Etakridin larutan 0,1 % Botol Eugenol Botol Fenol Gliserol TT Botol Fitomenadion tab. Tablet Furosemide 40 mg Tablet Garam Oralit Sachet Gliserin Botol Haloperidol 1,5 mg Tablet Haloperidol 5 mg Tablet Hidrochlortiazide 25 mg Tablet STOK AWAL 2012amin Inj. Ampul Klorfeniramin Maleat 4 mg Tablet Klorpromazine 25 mg Tablet Kotrimoksasol 120 mg Tablet Lidokain Inj. Ampul Oksitetrasiklin salep mata 1 % Tube 3,5 gr Mebendasol Tablet Mebendasol sirup Botol Natrium Thio Sulfat Inj. Botol NaCl Botol Nistatin 500.000 IU Tablet Piridoksin tab Tablet Povidon Iodida 300 ml Botol Propanolol 10 mg Tablet Propiltiourasil Tablet Reserpin 0,25 mg Tablet Sulfasetamid Tetes Mata Botol Alat Suntik 1 ml Set Alat Suntik 5 ml Set
................................................................. NIP......................................................
................................................................. NIP......................................................
1 2 ................................................................. NIP......................................................
6 7 ................................................................. NIP......................................................
NAMA OBAT 2
SATUAN 3
Tablet Ampul Tablet Vial Tube Botol Tablet Botol Kaplet Kapsul Botol Botol Ampul Tablet Sachet Botol Botol Tablet Tablet Tablet Tablet Botol Botol Tablet dos dos dos Botol Tube Tablet Tablet Pot Tablet Set Sak Sak
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
DES 15
JUMLAH 16 -
NAMA OBAT 2
SATUAN 3
Rol Sak Set
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
DES 15
JUMLAH 16 -
................................................................. NIP......................................................
................................................................. NIP......................................................
................................................................. NIP......................................................
................................................................. NIP......................................................
NAMA OBAT 2
SATUAN 3
Tablet Ampul Tablet Vial Tube Botol Tablet Botol Kaplet Kapsul Botol Botol Ampul Tablet Sachet Botol Botol Tablet Tablet Tablet Tablet Botol Botol Tablet dos dos dos Botol Tube Tablet Tablet Pot Tablet Set Sak Sak Rol Sak Set
PENERIMAAN 5 -
PENGELUARAN 6 -
................................................................. NIP......................................................
................................................................. NIP......................................................
SATUAN 3
tab tab ampul tab tab vial btl 60 ml tab tab tab btl 60 ml tab tab tab tab tab pot tube supp tab amp tube 5 gram tab amp tab vial vial 5 ml amp 1 ml vial 5 ml vial 5 ml sase tab tube tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
DES 15
SATUAN 3
tab amp tab tab btl 60 ml tab tab amp amp tab tab btl 500 ml botol / 1000 ml tab amp tab btl 60 ml kapsul btl 300 ml tab tab tab amp amp tab btl 30 ml sachet tab ampul tube tab ampul btl 500 ml tab tab btl 10 cc
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
DES 15
SATUAN 3
tab tube tab tab tab tab tab btl tab tab tab tube 15 gr tab tab tab tab tab tab btl 5 ml btl 5 ml btl 60 ml tab tab tab vial btl 10000 ml vial vial tab amp tab tab tab btl 500 ml tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
DES 15
SATUAN 3
tab tab tab btl 100 cc tube 3.5 gr tube 5 gram amp dos dos dos vail btl 60 ml tab tab tab tab btl 300 cc btl 30 ml tab tab tab amp tab tab kap kap btl 500 ml tab ktk 50 gram tab tab btl 60 ml amp tab tab btl 100 ml
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
DES 15
SATUAN 3
btl 5 ml tab tab tab tab tab amp kapsul tab tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
DES 15
1 2 3 4 5 6
Etil Klorida Spray Eugenol Glass Ionomer Cement ART Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Kalsium Hidroksida pasta Semen Seng Fosfat serbuk dan cairan
1 2 3 4 5 6 7 8 9 10 11 12 13 14
IV. Catheter No. 20 IV. Catheter No. 22 IV. Catheter No. 24 Alat Suntik 2,5 ml Alat Suntik 5 ml
Catgut plain / Benang bedah No. 2/0 dengan jarum 24x70 cm/kotak Catgut chromic / Benang bedah No. 3/0 dengan jarum 24x70 cm/kotak Silk (Benang Bedah Sutra) No. 3/0 dengan jarum bedah 12x3x75 cm/kotak Infus set anak Infus set dewasa Kapas pembalut/absorben 250 gram Kasa pembalut 4 x 3 cm elastic Kasa pembalut 4 x 15 cm elastic Kasa kompres 40/40 steril pcs pcs bungkus rol rol rol
SATUAN 3
rol rol pcs pcs pcs pcs pcs pcs pcs set
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENERIMAAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
DES 15
................................................................. NIP......................................................
................................................................. NIP......................................................
SATUAN 3
tab tab ampul tab tab vial btl 60 ml tab tab tab btl 60 ml tab tab tab tab tab pot tube supp tab amp tube 5 gram tab amp tab vial vial 5 ml amp 1 ml vial 5 ml vial 5 ml sase tab tube tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab amp tab tab btl 60 ml tab tab amp amp tab tab btl 500 ml botol / 1000 ml tab amp tab btl 60 ml kapsul btl 300 ml tab tab tab amp amp tab btl 30 ml sachet tab ampul tube tab ampul btl 500 ml tab tab btl 10 cc
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab tube tab tab tab tab tab btl tab tab tab tube 15 gr tab tab tab tab tab tab btl 5 ml btl 5 ml btl 60 ml tab tab tab vial btl 10000 ml vial vial tab amp tab tab tab btl 500 ml tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
tab tab tab btl 100 cc tube 3.5 gr tube 5 gram amp paSTOK AWAL 2012 / dos paSTOK AWAL 2012 / dos paSTOK AWAL 2012 / dos vail btl 60 ml tab tab tab tab btl 300 cc btl 30 ml tab tab tab amp tab tab kap kap btl 500 ml tab ktk 50 gram tab tab btl 60 ml amp tab tab btl 100 ml
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
SATUAN 3
btl 5 ml tab tab tab tab tab amp kapsul tab tab
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
1 2 3 4 5 6
Etil Klorida Spray Eugenol Glass Ionomer Cement ART Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Kalsium Hidroksida pasta Semen Seng Fosfat serbuk dan cairan
1 2 3 4 5 6 7 8 9 10 11 12 13 14
IV. Catheter No. 20 IV. Catheter No. 22 IV. Catheter No. 24 Alat Suntik 2,5 ml Alat Suntik 5 ml Catgut plain / Benang bedah No. 2/0 dengan jarum Catgut chromic / Benang bedah No. 3/0 dengan jarum Infus set anak Infus set dewasa Kapas pembalut/absorben 250 gram Kasa pembalut 4 x 3 cm elastic Kasa pembalut 4 x 15 cm elastic Kasa kompres 40/40 steril
pcs pcs pcs pcs pcs 24x70 cm/kotak 24x70 cm/kotak pcs pcs bungkus rol rol rol
Silk (Benang Bedah Sutra) No. 3/0 dengan jarum bedah 12x3x75 cm/kotak
SATUAN 3
rol rol pcs pcs pcs pcs pcs pcs pcs set
JAN 4
FEB 5
MAR 6
APR 7
MEI 8
JUN 9
PENGELUARAN JUL 10
AGUST 11
SEP 12
OKT 13
NOP 14
................................................................. NIP......................................................
................................................................. NIP......................................................
Sumenep, .................................
................................................................. NIP......................................................
SATUAN 3
tab tab ampul tab tab vial btl 60 ml tab tab tab btl 60 ml tab tab tab tab tab pot tube supp tab amp tube 5 gram tab amp tab vial vial 5 ml amp 1 ml vial 5 ml vial 5 ml sase tab tube tab tab amp tab tab btl 60 ml tab tab amp amp tab tab btl 500 ml botol / 1000 ml tab amp tab btl 60 ml kapsul btl 300 ml tab tab tab amp amp tab
PENERIMAAN 5 -
PENGELUARAN 6 -
SATUAN 3
btl 30 ml sachet tab ampul tube tab ampul btl 500 ml tab tab btl 10 cc tab tube tab tab tab tab tab btl tab tab tab tube 15 gr tab tab tab tab tab tab btl 5 ml btl 5 ml btl 60 ml tab tab tab vial btl 10000 ml vial vial tab amp tab tab tab btl 500 ml tab tab tab tab btl 100 cc tube 3.5 gr tube 5 gram amp dos dos dos vail btl 60 ml tab tab
PENERIMAAN 5 -
PENGELUARAN 6 -
SATUAN 3
tab tab btl 300 cc btl 30 ml tab tab tab amp tab tab kap kap btl 500 ml tab ktk 50 gram tab tab btl 60 ml amp tab tab btl 100 ml btl 5 ml tab tab tab tab tab amp kapsul tab tab
PENERIMAAN 5 -
PENGELUARAN 6 -
1 2 3 4 5 6
Etil Klorida Spray Eugenol Glass Ionomer Cement ART Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Kalsium Hidroksida pasta Semen Seng Fosfat serbuk dan cairan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
IV. Catheter No. 20 IV. Catheter No. 22 IV. Catheter No. 24 Alat Suntik 2,5 ml Alat Suntik 5 ml
Catgut plain / Benang bedah No. 2/0 dengan jarum 24x70 cm/kotak Catgut chromic / Benang bedah No. 3/0 dengan jarum 24x70 cm/kotak Silk (Benang Bedah Sutra) No. 3/0 dengan jarum bedah 12x3x75 cm/kotak Infus set anak Infus set dewasa Kapas pembalut/absorben 250 gram Kasa pembalut 4 x 3 cm elastic Kasa pembalut 4 x 15 cm elastic Kasa kompres 40/40 steril Kasa pembalut 2m x 80 cm Plester 5 yards x 2 inc Sarung Tangan No. 7 Sarung Tangan No. 7. 5 pcs pcs bungkus rol rol rol rol rol pcs pcs
SATUAN 3
pcs pcs pcs pcs pcs set
PENERIMAAN 5 -
PENGELUARAN 6 -
................................................................. NIP......................................................
................................................................. NIP......................................................
1 1 Imulan 2 Methioson 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
................................................................. NIP......................................................
................................................................. NIP......................................................
1 1 Imulan 2 Methioson 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
................................................................. NIP......................................................
................................................................. NIP......................................................
1 1 Imulan 2 Methioson 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 46 47 48 49 50 51 52 53
1 2 3 ................................................................. NIP......................................................
6 7 ................................................................. NIP......................................................