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No. No.

Ref SJP No Ka PST PISA Nama


1 0089R00203150000093 0001475880906 P SITI KHODIJAH
2 0089R00203150000025 0001814825046 P Ny. Revolena
3 0089R00203150000043 0001785645551 A WIRANTO ARIES MUNANDAR
4 0089R00203150000524 0001269419354 I Ny. Halimah
5
6 0089R00203150000573 0001797302801 P DAHLIA
7 0089R00203150000589 0001814825046 P Ny. Revolena
8 0089R00203150000674 0001813848849 P Ny. Lili Helni
9 0089R00203150000804 0001504890988 P Tn. B. Saurama Sinaga
10 0089R00203150001080 0000171792494 P IRAWAN SAYYID LUBTY
11 0089R00203150001168 0000030231472 P ZAINAL HAMZAH ADIT
12 0089R00203150001369 0000030113594 P ASMIATI
13 0089R00203150001458 0001809532697 P Yeyen Alsadip
14 0089R00203150001593 0001826907737 P Ny. Nurina
15 0089R00203150001590 0001816054648 P Ny. Sutarmi
16 0089R00203150002163 0001829725828 P Sarikun
17 0089R00203150002186 0000030257278 P TEDI ASMUNI
18 0089R00203150002072 0001809532697 P Yeyen Alsadip
19 0089R00203150002084 0001826314547 P Tn. Adam
20 0089R00203150002076 0001829227509 P A Hamid
21 0089R00203150002234 0000030260801 I LUCI
22
23 0089R00203150002348 0000030010408 P ANWAR
24 0089R00203150002363 0000171792494 P IRAWAN SAYYID LUBTY
25 0089R00203150002014 0001808451347 A Agit Prayoga
26 0089R00203150002505 0000030276955 P MARDIANA
27 0089R00203150002522 0001284445462 P Hartini
28 0089R00203150002548 0000030125597 P HUSNAWATI
29
30 0089R00203150002494 0001799577371 P Nurhawa
31
32
33 0089R00203150002627 0000167071678 P SYILVIA MIRANDA YUSHAIRANI
34
35 0089R00203150002876 0001829725828 P Sarikun
No Resep Tgl Yan By.Tag. Resep By.Ver. Resep R/
00001 02/03/2015 107.100,00 0,00 N
00002 02/03/2015 107.100,00 0,00 N
00003 02/03/2015 53.504,00 0,00 N
00008 06/03/2015 4.073,00 0,00 N
N
00010 06/03/2015 107.100,00 0,00 N
00004 09/03/2015 107.100,00 0,00 N
00005 09/03/2015 107.100,00 0,00 N
00007 10/03/2015 107.100,00 0,00 N
00006 12/03/2015 107.100,00 0,00 N
00009 13/03/2015 107.100,00 0,00 N
00011 16/03/2015 107.100,00 0,00 N
00012 17/03/2015 53.504,00 0,00 N
00014 18/03/2015 107.100,00 0,00 N
00015 18/03/2015 107.100,00 0,00 N
00022 23/03/2015 107.100,00 0,00 N
00023 23/03/2015 107.100,00 0,00 N
00016 24/03/2015 53.504,00 0,00 N
00017 24/03/2015 107.100,00 0,00 N
00018 24/03/2015 107.100,00 0,00 N
00019 25/03/2015 8.796,00 0,00 N
N
00020 26/03/2015 107.100,00 0,00 N
00021 26/03/2015 107.100,00 0,00 N
00023 26/03/2015 5.555,00 0,00 N
00024 27/03/2015 2.345,00 0,00 N
00025 28/03/2015 107.100,00 0,00 N
00026 28/03/2015 21.334,00 0,00 N
N
00027 28/03/2015 23.169,00 0,00 N
N
N
00028 30/03/2015 15.809,00 0,00 N
N
00029 30/03/2015 107.100,00 0,00 N
Nama Obat Jml Aju Jml Setuju Diajukan Disetujui
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Depakene 250 mg/5 ml 1,00 0 53.504,00 0
Furosemide 40 mg 4,00 0 481,28 0
Asam Asetil Salisilat (Asetosa 100 mg 23,00 0 3.591,68 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Depakene 250 mg/5 ml 1,00 0 53.504,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Depakene 250 mg/5 ml 1,00 0 53.504,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Metformin 850 mg 16,00 0 4.392,96 0
Glimepiride 4 mg 8,00 0 4.403,20 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Phenytoin 100 mg 31,00 0 5.555,20 0
Metformin 500 mg 16,00 0 2.344,96 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0
Spironolacton 25 mg 4,00 0 1.638,40 0
Bisoprolol 5 mg 23,00 0 19.695,36 0
Glimepiride 2 mg 23,00 0 12.835,84 0
Asam Asetil Salisilat (Asetosa 100 mg 23,00 0 3.591,68 0
Metformin 500 mg 46,00 0 6.741,76 0
Carbamazepine 200 mg 23,00 0 7.566,08 0
Phenytoin 100 mg 46,00 0 8.243,20 0
Lantus Solostar Pen 100 IU/ml 1,00 0 107.100,00 0