FORMAT PEMBERIAN OBAT ORAL

NAMA : NO. REG :

UMUR : RUANGAN:
NAMA OBAT TGL
Terima
Frek
Pagi Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Sore Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Malam Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Ekstra
Sisa
NAMA OBAT TGL
Terima
Frek
Pagi Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Sore Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Malam Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Ekstra
Sisa
NAMA OBAT TGL
Terima
Frek
Pagi Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

24
 Sisa
Sore Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Malam Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Ekstra
Sisa
NAMA OBAT TGL
Terima
Frek
Pagi Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Sore Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Malam Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf Jam Pf

Sisa
Ekstra
Sisa

Keterangan:

1. Tidak ada persediaan (TAP)

2. Pasien tidak mau minum
3. Obat dihentikan
4. Pasien tidak diperbolehkan minum obat

25