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RUMAH SAKIT BERSALIN NABASA

JL. SUNGAI RAYA_DALAM N0. 65

OK
RESEP OBAT DAN BAHAN / ALAT ANESTHESI

Ruang Rawat

Kelas

: VIP/l/II/III

Tanggal / Jam

Keterangan

Nama / Umur

Jenis Operasi

: PNS / U / T /ASK
ASK
ASK
:

Jenis Anesthesi

Dokter Operator

Sifat Operasi

: Electif / Cito

Dokter Anesthesi

Alamat / Telp

Gol. Operasi

: K / S / B / KH

NO

Nama Obat / Alkes

Harga

Jumlah

Total

No

Nama Obat / Alkes

Abbocath

41 Spuit inj 1 ml

Adrenalin/amp

42 Spuit inj 3 ml

Aminophyline inj

43 Spuit inj 5 ml

Aquadest 25 ml

44 Spuit inj 10 ml

Catapress inj/amp

45 Spuit inj 20 ml

Cedatron inj 4 mg

46 Succ Choline 100 mg

Dexamethason inj

47 Sulfas Atropin/amp

Dormicum inj 5 mg

48 Syntocinon/amp

Efedrine injeksi/amp

49 Trachirium/25 mg

10 Elektroda

50 Transamin inj 250 mg

11 ET No.

51 Tranfusi Set

12 Fentanyl/amp

52 Urine Bag

13 Haes steril 6 %

53 Asering

14 Halothane/ml

54 Dextrose 5 %

15 Handschoen No.

55 Lidodex

16 Infus Set

56 Bucain Spinal

27 Ivanes/ml

57 Ketamin 1000 mg/vial

18 larum No.

58 Propofol/amp

19 Jarum Spinal

59 Tranus/Atricorium

20 Kalnex inj 250 m

60 KY Gel/tube

21 Kateter Intravena

61 Handyplast/pcs

22 Kateter Urine No.

62 Wing Needle No.23/pcs

23 Lidocaine Plain/amp

63 Tramodol inj/amp

24 Lidodex/amp

64 Ketorolac/amp

25 Marchine Heavy

65 Ranitidine inj/amp

26 Methergin/amp

66 Midazolam 1 mg/cc

27 Morphien 10 m

67 Dobujec inj/amp

28 NaCl 0,9%

68

29 NGT No.

69

30 Nokoba inj/amp

70

31 Pediatric Infus Set

71

32 Pethidine/100 mg

72

33 Primperan inj

73

34 Proinfark

74

35 Prostigmin/amp

75

36 Radin inj/amp

76

37 Recofol/amp

77

38 Remopain 30 mg

78

39 RL

79

40 Sagestam inj 80 mg

80

Harga

Jumlah

PETUGAS APOTIK

DOKTER ANESTHESI

PERAWAT ANESTHESI

( ............. )

(........................... )

(................................ )

Total