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LAPORAN BULANAN PELAYANAN KEFARMASIAN DI PUSKESMAS

Nama Puskesmas : ............................................................. Perawatan / Non Perawatan : ....................................


Kabupaten / Kota : ...............................................................................................................................................
Provinsi : ...............................................................................................................................................
Laporan Bulan / Tahun : ......................................................... / tahun .........................................................................

Jenis Pelayanan Resep


No Tanggal Konseling
Rawat Jalan Rawat Inap
(1) (2) (3) (4) (5)

TOTAL

Sadananya, 2015
Yang Melaporkan Mengetahui,
Pengelola Obat Kepala Puskesmas Sadananya

Rd. TITI SARIATI MULYANA, S.Kep


NIP. 19661112 198603 2 003 NIP. 19660320 198603 1 004
AYANAN KEFARMASIAN DI PUSKESMAS

.............. Perawatan / Non Perawatan : ....................................


................................................................................................
................................................................................................
.......... / tahun .........................................................................

Informasi Obat

(6)

Sadananya, 2015

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