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FORMULIR PENGEMBALIAN OBAT

TANGGAL :03/06/2017 NAMA :AMRIZAL NO.MR :23-42-71 LANTAI :INSTALASI FARMASI

TGL.EXPIRE PARAF NOMOR SLIP

NO NAMA OBAT JUMLAH
DATE PERAWAT FARMASI APOTIK

1 FURAMIN INJ (NON DOF) 1,00 31/12/2019 IKHWAN BALADI IKHWAN BALADI 10

2 KETESSE 50 MG INJEKSI 6,00 31/12/2019 IKHWAN BALADI IKHWAN BALADI 4

LACEDIM 1 GR INJ (NON
3 1,00 31/12/2019 IKHWAN BALADI IKHWAN BALADI 4
DOF)
ROCER 40 MG INJ (NON
4 1,00 IKHWAN BALADI IKHWAN BALADI 9
DOF)