LAPORAN PENGGUNAAN OBAT KHUSUS

LAPORAN KHUSUS PENGGUNN PSIKOTROPIKA: ALPAZOLAM 1 MG,ALPAZORAM 5 MG.
ALPAZORAM O,25 MG,AMITRIPTILIN,CLOBAZAM,DIAZEPAM,KLORPROMAZIN 100 MG

HALOPERIDOL 5 MG, HALOPERIDOL INJ, RISPERIDONE 1 MG, TRIHEXIPENIDIL 2 MG
nama puskesmas Betung Kota
No. Izin puskesmas Bulan : September
No. Izin puskesmas Tahun :2017
Alamat Jl. Penghulu ali Basir Lingk. II Kel.Rimba Asam
Resep Pasien Dokter

NO Nama Sediaan Satuan Tanggal Tanggal Jumlah Ket
Nama Alamat Nama Spesialisasi
Permintaan Penyerahan
1 2 3 4 5 6 7 8 9 10 11
Haloperiodol Tab 9/1/2017 9/1/2017 30 Agus Kel.Rimba Asam dr.Een

9/4/2017 9/4/2017 30 Alfian Kel.Betung dr.Een
9/4/2017 9/4/2017 30 Innallah Kel.Betung dr.Een
9/4/2017 9/4/2017 30 Novi DS.bukit dr.Een
9/5/2017 9/5/2017 30 Agus Kel.Rimba Asam dr.Een
9/6/2017 9/6/2017 60 M.Puji DS.Srikembang dr.Een
9/7/2017 9/7/2017 30 Sukri DS.Srikembang dr.Een
9/14/2017 9/14/2017 30 Innallah Kel.Betung dr.Een
9/14/2017 9/14/2017 30 Novi DS.bukit dr.Een
9/15/2017 9/15/2017 30 Sukri DS.Srikembang dr.Een
9/19/2017 9/19/2017 60 Nilawat DS.Srikembang dr.Een
9/22/2017 9/22/2017 30 Ari Anggara Desa Lubuk Karet dr.Een
Total 420
2 THP Tab 9/4/2017 9/4/2017 30 Ari anggara Desa Lubuk Karet dr.Een
9/5/2017 9/5/2017 30 Pono Desa Sri Kembang dr.Een
9/6/2017 9/6/2017 30 Andi Desa Bukit dr.Een
9/12/2017 9/12/2017 30 Marsai Kel.Betung dr.Een
9/13/2017 9/13/2017 30 Andi M Kel.Betung dr.Een
9/22/2017 9/22/2017 30 Noviani Desa Bukit dr.Een
9/22/2017 9/22/2017 30 Pono Desa Sri Kembang dr.Een
9/25/2017 9/25/2017 30 Irawan Desa Lubuk Karet dr.Een
9/25/2017 9/25/2017 30 M.Puji Desa Sri Kembang dr.Een
9/25/2017 9/25/2017 30 Alfian Kel.Betung dr.Een
Total 300
3 Risperidon Tab 9/1/2017 9/1/2017 60 Noviani Ds.bukit dr.Een

9/5/2017 9/5/2017 30 Megawat Kel.Betung dr.Een
9/6/2017 9/6/2017 30 Agus Kel.Betung dr.Een
9/7/2017 9/7/2017 20 Andi Kel.Betung dr.Een
Total 140
4 Clobazam Tab 01/09 2017 01/09 2017 15 Efendi Kel.Betung dr.Een

9/6/2017 9/6/2017 30 Kudus Kel.Betung dr.Een
Total 45
5 Merlopam Tab 9/1/2017 9/1/2017 10 Nazarudin Desa Lubuk Karet dr.Een

9/26/2017 9/26/2017 10 Nilawat Desa Sri kembang dr.Een
9/26/2017 9/26/2017 25 Efendi Desa Lubuk Karet dr.Een
Total 45
6 Devacode Syrup 9/6/2017 9/6/2017 2 Btl Akbar Desa Lubuk Karet dr.Een
Total 2 btl
### Inj.Haldol Injeksi 9/6/2017 9/6/2017 I ampl Innallah Kel.Betung dr.Een

9/15/2017 9/15/2017 I ampl Sukri Ds.Srikembang dr.Een
9/22/2017 9/22/2017 I ampl Nilawat Ds.Srikembang dr.Een
9/22/2017 9/22/2017 I ampl Agus Ds.Srikembang dr.Een
Total 4 ampl
Betung, September 2017
Pemegang Program jiwa
SUCI ROHANI AM.kep

NIP.198301252014082002
Nama Rumah Sakit : RSUD Sekayu
No. Izin RS :-
No. Izin Khusus :-
Alamat : Jl. Kol. Wahid Udin Lk.I Kayu Ara Sekayu. Telp: 0714-321130
Pemasukan Jumlah Pengeluaran

No Nama Sediaan Satuan Persediaan Keseluruhan Untuk
Tanggal Dari Jumlah
(4+7) Pembuatan/ R Lain-lain
1 2 3 4 5 6 7 8 9 10
1 Pethidin 50 mg Ampul 30 0 0 0 30 - -
2 Codein 10 mg Tablet 577 0 0 0 577 - -
3 Fentanyl 10 mg Ampul 0 0 0 0 0 - -
4 Morfin 10 mg Ampul 0 21-1-2014 KF 200 200 - -
5 Coditam Tablet - - - - - - -
6 MST 15 mg Tablet 612 0 0 0 612 - -
7 MST 10 mg Tablet 37 0 0 0 37 - -
LAPORAN KHUSUS PENGGUNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST
Nama Rumah Sakit : RSUD Sekayu N-16
No. Izin RS : Bulan : Januari
No. Izin Khusus : Tahun : 2014
Resep Jumlah Pasien Dokter

No Nama Sediaan Satuan Tanggal Tanggal Nama Alamat Nama Spesialisasi
1 2 3 4 5 6 7 8 9 10
1 Petdin inj 1/4/2014 1/4/2014 1 Afzalur Rahman Sekayu dr Ropi SpTHT

1/6/2014 1/6/2014 1 Rosadi Bukit Indah dr. Dahlan SpB
1/6/2014 1/6/2014 1 Rendi Rimba Asam dr. Dahlan SpB
1/6/2014 1/6/2014 1 Reni Apriza Muara Teladan dr. Dahlan SpB
1/6/2014 1/6/2014 1 Evi Sekayu dr. Taufik SpOG
1/6/2014 1/6/2014 1 Suryani Sekayu dr. Taufik SpOG
1/6/2014 1/6/2014 1 Lelawat Sekayu dr. Taufik Sp0G
1/7/2014 07/101/2014 1 Sisiana Sereka dr. Taufik SpOG
1/9/2014 1/9/2014 1 Sumiyat Panca Tunggal dr. Taufik SpOG
1/10/2014 1/10/2014 1 Hartat Lembah Buli dr. Taufik SpOG
1/10/2014 1/10/2014 1 Asnawi Ngulak dr. Febryanto SpB
1/10/2014 1/10/2014 1 Zulkarnaen Balai Agung dr. Febryanto SpB
1/13/2014 1/13/2014 1 Yusuf Mangun Jaya dr. Dahlan SpB
1/13/2014 1/13/2014 1 Hayat Bayat dr. Taufik SpOG
1/16/2014 1/16/2014 1 Maharani Pandang Dulan dr. Taufik SpOG
1/16/2014 1/16/2014 1 Fauziah Serasan Jaya dr. Taufik SpoG
1/16/2014 1/16/2014 1 Rahayu Sekayu dr. Febryanto SpB
1/16/2014 1/16/2014 1 M. Rizki Ngulak dr. Febryanto SpB
1/16/2014 1/16/2014 1 Manansyah Marga Mulyo dr. Taufik SpOG
1/16/2014 1/16/2014 1 Sutopo Sungi Selabu dr. Dahlan SpB
1/16/2014 1/16/2014 1 Eka Nila Keluang dr. Taufik SpoG
1/16/2014 1/16/2014 1 Nurhat Ulak Paceh dr. Dahlan SpB
1/17/2014 1/17/2014 1 Rukaya Balai Agung dr. Taufik SpoG
1/18/2014 1/18/2014 1 Paidi Bayung Lincir dr. Febryanto SpOG
1/19/2014 1/19/2014 1 Sit Aritha Gajah Mat dr. Taufik SpOG
1/20/2013 1/20/2014 1 Homsia Sekayu dr. Febryanto SpB
1/20/2014 1/20/2014 1 Ida Jirak dr. Febryanto SpB
1/21/2014 1/21/2014 1 Ardi Padang Bulan dr. Febryanto SpB
1/21/2014 1/21/2014 1 Agus Sekayu dr. Promadika SpOT
1/22/2014 1/22/2014 1 Pujiat Suka damai dr. Febryanto SpB
Jumlah 30
3 MST 10 mg Tab 12/1/2014 12/1/2014 2 M.Apil Sekayu dr. Mega dalam

25/1/2014 25/1/2014 20 Nuraidah Sekayu Ropi THT
27/1/2014 27/1/2014 10 Zainab Sekayu Rosidi Dalam
28/1/2014 28/1/2014 2 Suparni Sekayu Rosidi Dalam
29/1/2014 29/1/2014 2 Sudani Sekayu Rosidi Dalam
Jumlah 36
3 MST 15 mg Tab 12/1/2014 12/1/2014 4 Ngatni Sekayu Mega dalam
20/1/2014 20/1/2014 2 Rusdan Sekayu Kabul jantung
21/1/2014 21/1/2014 2 Rusdan Sekayu Kabul jantung
22/1/2014 22/1/2014 3 M.Adil Sekayu Kabul jantung
25/1/2014 25/1/2014 3 Rokyah Sekayu Rosidi dalam
30/1/2014 30/1/2014 4 Dalamat Sekayu Rosidi dalam
Jumlah 18
4 Codein 10 mg Tab 22/1/2014 22/1/2014 6 Abu bakar Sekayu Dr. Kabul. SpJp Jantung
23/1/2014 23/1/2014 20 Widari Sekayu Dr. Kabul. SpJp Jantung
23/1/2014 23/1/2014 15 Wahab Sekayu Dr. Kabul. SpJp Jantung
23/1/2014 23/1/2014 10 Tarmizi Sekayu Dr. Kabul. SpJp Jantung
23/1/2014 23/1/2014 10 F.Ramli Sekayu Dr. Kabul. SpJp Jantung
24/1/2014 24/1/2014 10 Numi Bt Masril Sekayu Dr. Kabul. SpJp Jantung
24/1/2014 24/1/2014 10 Zainiyah Sekayu Dr. Kabul. SpJp Jantung
25/1/2014 25/1/2014 10 Mariana Sekayu Dr. Kabul. SpJp Jantung
29/1/2014 29/1/2014 20 Rosyidah Serasan Jaya Dr. Kabul. SpJp Jantung
29/1/2014 29/1/2014 15 Zuraidah Ds II Toman Sekayu Dr. Kabul. SpJp Jantung
30/1/2014 30/1/2014 15 Murni Kertayu Dr. Kabul. SpJp Jantung
Jumlah 141
Sekayu, 08 Februari 2014

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
SIPA : 843/247/SIPA/DINKES/I/2012
N-16
Bulan : Januari
Tahun : 2014
engeluaran Persediaan
Akhir Bulan Ket
Jumlah
(8-11)
11 12 13
30 0
141 436 -
- - -
- 200 -
- - -
18 594 -
36 1 -

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
Ket
11
No. Izin RS :-
No. Izin Khusus :-

Tanggal Dari Jumlah
1 2 3 4 5 6 7 8 9 10
1 Pethidin 50 mg Ampul 0 0 0 0 0 - -
2 Codein 10 mg Tablet 436 0 0 0 436 - -
3 Fentanyl 10 mg Ampul 0 0 0 0 0 - -
4 Morfin 10 mg Ampul 200 0 0 0 200 - -
5 Coditam Tablet - - - - - - -
6 MST 15 mg Tablet 594 0 0 0 594 - -
7 MST 10 mg Tablet 1 0 0 0 1 - -
No. Izin RS : Bulan : Februari

1 2 3 4 5 6 7 8 9 10
3 MST 15 mg Tab 1/2/2014 1/2/2014 4 Palamat Sekayu dr.Fera

3/2/2014 3/2/2014 10 Zainab Sekayu dr.Fera
5/2/2014 5/2/2014 2 Rozani Sekayu dr. Rosyidi
6/2/2014 6/2/2014 2 Rozani Sekayu dr. Rosyidi
11/2/2014 11/2/2014 3 Ansori Sekayu dr.Kabul.Sp.Jp
13-2-2014 13-2-2014 2 Sarnubi Sekayu dr.Kabul.Sp.Jp
15-2-2014 15-2-2014 12 Jawarna Sekayu dr. Rosyidi
18-2-2014 18-2-2014 3 Sahuna Sekayu dr.Kabul.Sp.Jp
20-2-2014 20-2-2014 3 Mariyani Sekayu dr.Kabul.Sp.Jp
20-2-2014 20-2-2014 3 sahuna Sekayu dr.Kabul.Sp.Jp
Jumlah 50
4 Codein 10 mg Tab 3/2/2014 3/2/2014 5 Pura Bt Medar (59 Thn) sekayu dr.Kabul.Sp.Jp
3/2/2014 3/2/2014 21 Seta budi (54 thn) sekayu dr. Henry
3/2/2014 3/2/2014 15 A Sani (59 thn) sekayu dr. Henry
6/2/2014 6/2/2014 10 Yunita Sari (18 Thn) sekayu dr. Fary
7/2/2014 7/2/2014 21 Odem (69 thn) sekayu dr. Henry
7/2/2014 7/2/2014 21 Neli (35 thn) sekayu dr. Henry
8/2/2014 8/2/2014 14 Bany (66 thn) sekayu dr. Henry
8/2/2014 8/2/2014 10 dr. Hasanudin.Sp.M sekayu dr. Fary
8/2/2014 8/2/2014 12 Asmedy (34 thn) sekayu dr. Henry
10/2/2014 10/2/2014 21 Maimanah (49 thn) sekayu dr. Henry
10/2/2014 10/2/2014 21 Jhon Kenedy (29 thn) sekayu dr. Henry
10/2/2014 10/2/2014 21 Alimin bin Gunyn(58 thn) sekayu dr. Ahmad Hifni
10/2/2014 10/2/2014 14 Gunadi bin A sekayu dr. Henry
10/2/2014 10/2/2014 15 Yunaini sekayu dr.Kabul.Sp.Jp
11/2/2014 11/2/2014 21 Zainuning Bt H sekayu dr. Henry
11/2/2014 11/2/2014 14 Rusmaning (65 thn) sekayu dr. Henry
11/2/2014 11/2/2014 21 Rusmalayani (46 thn) sekayu dr. Henry
12/2/2014 12/2/2014 10 M. Ali (Medang) sekayu dr.Kabul.Sp.Jp
12/2/2014 12/2/2014 10 Anang bt Nanak sekayu dr.Kabul.Sp.Jp
12/2/2014 12/2/2014 21 Hasiah (74 thn) sekayu dr. Henry
12/2/2014 12/2/2014 21 Rokiah (55 thn) sekayu dr. Henry
12/2/2014 12/2/2014 3 Ramalus sekayu dr. Henry
12/2/2014 12/2/2014 12 Alimin bin Goni (58 thn) sekayu dr. Ahmad Hifni
13-2-2014 13-2-2014 15 Hosibah (74 thn) sekayu dr.Kabul.Sp.Jp
13-2-2014 13-2-2014 10 Murni sekayu dr.Kabul.Sp.Jp
13-2-2014 13-2-2014 3 Ramalus sekayu dr Nursaenah
13-2-2014 13-2-2014 15 Rosydah (42 thn) sekayu dr.Kabul.Sp.Jp
14-2-2014 14-2-2014 15 Syali sekayu dr.Kabul.Sp.Jp
14-2-2014 14-2-2014 21 Sartut sekayu dr. Henry
15-2-2014 15-2-2014 3 Widari (30thn) sekayu dr. Deni Harapan
436
Jumlah 872
Sekayu, 08 Maret 2014

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
N-16
Bulan : Februari
Tahun : 2014
engeluaran Persediaan
Akhir Bulan Ket
Jumlah
(8-11)
11 12 13
0 0
436 0 -
0 0 -
0 200 -
- - -
50 544 -
1 1 -

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
Ket
11
No. Izin RS :- Bulan : Januari
No. Izin Khusus :- Tahun : 2015
Pemasukan Jumlah Pengeluaran Persediaan

No Nama Sediaan Satuan Persediaan Keseluruhan Untuk Akhir Bulan Ket
Tanggal Dari Jumlah Jumlah
(4+7) Pembuatan/ R Lain-lain (8-11)
1 2 3 4 5 6 7 8 9 10 13
1 Clopedin (Pethidin) Ampul 794 - - - 794 0 - 0 794 -
2 Codein 10 mg Tablet 0 - - - 0 0 - 0 0 -
3 Fentanyl 0,05 MG/ML 2 ML Ampul 480 - - - 480 151 - 151 329 -
4 Morfin 10 mg Ampul 146 - - - 146 8 - 8 138 -
5 Coditam Tablet 0 - - - 0 0 - 0 0 -
6 MST 15 mg Tablet 519 - - - 519 1 - 1 518 -
7 MST 10 mg Tablet 287 - - - 287 4 - 4 283 -

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001

No Nama Sediaan Satuan Tanggal Tanggal Nama Alamat Nama Spesialisasi Ket
1 2 3 4 5 6 7 8 9 10 11
1 MST 10 mg Tab 1/13/2015 1/13/2015 2 rusli damai sekayu dr.Tora.

1/16/2015 1/16/2015 2 ahdan sekayu dr.Tora.
Jumlah 4
2 MST 15 mg Tab 1/12/2015 1/12/2015 1 supardi karta jaya dr. Hikamtar
Jumlah 1
3 Morpin Inj Tab 1/9/2015 1 winda bailangu dr. Dian Kesumarini.SpAn

1/9/2015 1 sit aisyah tanjung keputren dr. Dian Kesumarini.SpAn
1/10/2015 1 sudar sungai keruh dr. Dian Kesumarini.SpAn
1/15/2015 1 yent babt toman dr. Dian Kesumarini.SpAn
1/28/2015 1 eka sekayu dr. Dian Kesumarini.SpAn
1/28/2015 1 sumardi keluang dr. Dian Kesumarini.SpAn
1/29/2015 1 susi susant keluang dr. Dian Kesumarini.SpAn
1/29/2015 1 krisna tanjung bulan dr. Dian Kesumarini.SpAn
Jumlah 8
4 Fentanil Tab 1/1/2015 1/1/2015 1 indah kasmaran dr. Dian Kesumarini.SpAn

1/1/2015 1/1/2015 1 sumarni lais dr. Dian Kesumarini.SpAn
1/2/2015 1/2/2015 1 iis sumarni sekayu dr. Dian Kesumarini.SpAn
1/3/2015 1/3/2015 1 Rodatul janah sekayu dr. Dian Kesumarini.SpAn
1/3/2015 1/3/2015 1 Mulyana sekayu dr. Dian Kesumarini.SpAn
1/5/2015 1/5/2015 1 Jamaludin sekayu dr. Dian Kesumarini.SpAn
1/5/2015 1/5/2015 1 Marlina sekayu dr. Dian Kesumarini.SpAn
1/5/2015 1/5/2015 1 Sri sekayu dr. Dian Kesumarini.SpAn
1/7/2015 1/7/2015 1 Nauval sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 ST. Aisah sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 2 Heri sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 Dede sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 Sri Hanafiah sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 Apriyadi sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 St. Istmah tegal mulya dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Lajmi suka jaya dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Jimi Saputra bangun rejo dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Ardion sekayu dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Sumirah babat supat dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Tut sekayu dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 2 Peni sekayu dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Tri ulak paceh dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Nirwana sekayu dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Akbar sumber rizki dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 Ruspidah rantau kasih dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 Pahria sekayu dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 Met sekayu dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 Asri sekayu dr.Oyon.SPB
1/10/2015 1/10/2015 1 Yahadi sindang marga dr.Oyon.SPB
1/10/2015 1/10/2015 1 irmayasari sekayu dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 wulan lais dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 desi sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 dion sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 mazaini sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 nurlela bintale dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 nurlia sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 sit aisyah sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 letu sidang marga dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 winda sungai lilin dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 emilda babt toman dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 dewi trans dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 saripah sungai lilin dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 melia tebing bulan dr.Taufik Firdaus.SPOG
1/12/2015 1/12/2015 1 memori sekayu dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 3 krisna sekayu dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 karina sekayu dr.Taufik Firdaus.SPOG
1/12/2015 1/12/2015 2 koirul tebing bulan dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 leli sangga desa dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 2 neni tebing bulan dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 mita ulak bacang dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 2 nanik sekayu dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 yuliana sekayu dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 fitriani sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 ferdian sekayu dr.Taufik Firdaus.SPOG
1/13/2015 1/13/2015 1 amiza sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 asini sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 2 triasi sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 arisa sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 herniwat jirak dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 ernawat sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 noni sekayu dr. Dian Kesumarini.SpAn
1/14/2015 1/14/2015 1 intan sungai lilin dr. Dian Kesumarini.SpAn
1/14/2015 1/14/2015 1 masito sekayu dr. Dian Kesumarini.SpAn
1/14/2015 1/14/2015 2 yuni sarah babt toman dr. Dian Kesumarini.SpAn
1/15/2015 1/15/2015 1 hosiah sekayu dr. Dian Kesumarini.SpAn
1/15/2015 1/15/2015 1 janah keluang dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 hayat jirak dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 rusik sekayu dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 jamalia sekayu dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 elisa sekayu dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 winda sekayu dr.Taufik Firdaus.SPOG
1/17/2015 1/17/2015 1 dimas sekayu dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 sudarni mangun jaya dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 leni karang waru dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 rita zahara sekayu dr.Taufik Firdaus.SPOG
1/19/2015 1/19/2015 1 tantan jirak dr. Dian Kesumarini.SpAn
1/19/2015 1/19/2015 1 reni macan sakt dr. Dian Kesumarini.SpAn
1/19/2015 1/19/2015 1 sri yunita sekayu dr. Dian Kesumarini.SpAn
1/19/2015 1/19/2015 1 rima sekayu dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 wagio plakat tnggi dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 widiyawaty babt toman dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 yunita epil dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 yayu sekayu dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 lerdi sekayu dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 hendri sekayu dr. Dian Kesumarini.SpAn
1/21/2015 1/21/2015 2 sri pujiat tungkkal jaya dr. Dian Kesumarini.SpAn
1/21/2015 1/21/2015 1 iis dahlia ulak pandan dr. Dian Kesumarini.SpAn
1/21/2015 1/21/2015 1 masdalena sekayu dr. Dian Kesumarini.SpAn
1/22/2015 1/22/2015 1 abdullah baba toman dr. Dian Kesumarini.SpAn
1/22/2015 1/22/2015 1 ratna dewi sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 mardiat sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 asiah sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 ainun sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 apriant mulyo asih dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 senang sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 fitria sekayu dr. Dian Kesumarini.SpAn
1/24/2015 1/24/2015 1 tnii teluk kijing dr.Taufik Firdaus.SPOG
1/24/2015 1/24/2015 1 Semi keluang dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 eva sekayu dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 yayan jirak dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 asima sekayu dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 kamas sekayu dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 trimurt sekayu dr. Dian Kesumarini.SpAn
1/26/2015 1/26/2015 1 sumardi keluang dr. Dian Kesumarini.SpAn
1/26/2015 1/26/2015 1 nurjani plkat tnggi dr. Dian Kesumarini.SpAn
1/27/2015 1/27/2015 1 elita sekayu dr. Dian Kesumarini.SpAn
1/27/2015 1/27/2015 1 sit salama sekayu dr. Dian Kesumarini.SpAn
1/27/2015 1/27/2015 1 rusmini sekayu dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 sujina dusun waihandar dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 emina ulak paceh dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 emorsi bailangu dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 musri kartajaya dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 eka bandar jaya dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 rosidin sungai batang dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 mustka keluang dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 aziza dusun kasmaran dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 winarni sungai batang dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 atka sekayu dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 verawat babat toman dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 wayan bukit slabu dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 abu bakar simpang sari dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 susi susant sekayu dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 rahmat keluang dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 1 puspa sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 2 karnadi sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 1 heniwat sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 1 nurmala sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 2 okta rizki sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 1 supriatn sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 1 linawat sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 1 putri sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 1 rani sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 3 leo candra yangjung agung dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 3 abdullah sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 1 nurbait sunggai angit dr. Dian Kesumarini.SpAn
Jumlah 151
Sekayu, 8 Januari 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
794
0
480
146
0
519
287
No. Izin RS :-
No. Izin Khusus :-

1 2 3 4 5 6 7 8 9 10
1 Clopedin (Pethidin) Ampul 794 - - - 794 3 - 3
2 Codein 10 mg Tablet 0 - - - 0 0 - 0
3 Fentanyl 0,05 MG/ML 2 ML Ampul 329 - - - 329 117 - 117
4 Morfin 10 mg Ampul 138 - - - 138 4 - 4
5 Coditam Tablet 0 - - - 0 0 - 0
6 MST 15 mg Tablet 518 - - - 518 0 - 0
7 MST 10 mg Tablet 283 - - - 283 0 - 0
Sekayu, 8 Maret 2
Penanggung Jaw
Dra. Hanifdar, Ap
Nip. 19670730 19970
SIPA : 843/247/SIPA/DIN

1 2 3 4 5 6 7 8 9 10 11
1 Petdin Ampul 2/9/2015 2/9/2015 1 Sutana Desa Sri Mulyo dr. Dian Kesumarini.SpAn
2/9/2015 2/9/2015 1 Irma Suryani Bumi Kencana dr. Dian Kesumarini.SpAn
2/9/2015 2/9/2015 1 Yuni Kurnia Epil dr. Dian Kesumarini.SpAn
Jumlah 3
3 Morpin Inj Ampul 2/9/2015 2/9/2015 1 Dewi Ustari Betung dr. Dian Kesumarini.SpAn
2/23/2015 2/23/2015 1 Edi Herman Ulak Paceh dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 2 Edi Herman Ulak Paceh dr. Dian Kesumarini.SpAn
Jumlah 4
4 Fentanil Ampul 2/1/2015 2/1/2015 1 linawat Ulak Paceh dr. Dian Kesumarini.SpAn
2/1/2015 2/1/2015 1 Dwi Y Sekayu dr. Dian Kesumarini.SpAn
2/3/2015 2/3/2015 1 Yunita Destari muara teladan dr. Dian Kesumarini.SpAn
2/3/2015 2/3/2015 1 Bet Bt Miskur sungai angit dr. Dian Kesumarini.SpAn
2/3/2015 2/3/2015 1 Atka Bt sidik sungai angit dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Rusmiwat rantau kroya dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Retno S sungai lilin dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Fitriani bangun sari dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Mariya karya maju dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Sudira rejosari dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Karunia plakat tnggi dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Lasmi serasan jaya dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Sant VBS dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Rini andriani serasan jaya dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 2 Zaidin karang waru dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 iin ds. Napal dr. Dian Kesumarini.SpAn
2/4/2015 2/4/2015 1 Mulyanan Rimbah Ukur dr. Dian Kesumarini.SpAn
2/5/2015 2/5/2015 1 andre Teluk Kijing dr. Dian Kesumarini.SpAn
2/5/2015 2/5/2015 1 komaria Rantau panjang dr. Dian Kesumarini.SpAn
2/5/2015 2/5/2015 1 sainem pulo gadung dr. Dian Kesumarini.SpAn
2/5/2015 2/5/2015 1 eka wat dr. Dian Kesumarini.SpAn
2/5/2015 2/5/2015 1 wirawat Tanjung agung Brt dr. Dian Kesumarini.SpAn
2/6/2015 2/6/2015 1 aimar Randik dr. Dian Kesumarini.SpAn
2/6/2015 2/6/2015 1 giono jirak dr. Dian Kesumarini.SpAn
2/6/2015 2/6/2015 1 edison Purwosari dr. Dian Kesumarini.SpAn
2/6/2015 2/6/2015 1 edison purwosari dr. Dian Kesumarini.SpAn
2/6/2015 2/6/2015 1 giyono jirak dr. Dian Kesumarini.SpAn
2/6/2015 2/6/2015 1 yaman cinta karya dr. Dian Kesumarini.SpAn
2/7/2015 2/7/2015 1 juwarni sungai lilin dr. Dian Kesumarini.SpAn
2/9/2015 2/9/2015 1 sit aminah Tenggulang baru dr. Dian Kesumarini.SpAn
2/9/2015 2/9/2015 1 sukarno asmara kodim dr. Dian Kesumarini.SpAn
2/9/2015 2/9/2015 1 masdalena T.A.T dr. Dian Kesumarini.SpAn
2/9/2015 2/9/2015 1 rokiya Kertayu dr. Dian Kesumarini.SpAn
2/10/2015 2/10/2015 1 seriyana Pangkalan Tungkal dr. Dian Kesumarini.SpAn
2/10/2015 2/10/2015 1 nari Gajah Mat dr. Dian Kesumarini.SpAn
2/10/2015 2/10/2015 1 abdullah Danau ulak lia dr. Dian Kesumarini.SpAn
2/10/2015 2/10/2015 1 indrawat lubuk buah dr. Dian Kesumarini.SpAn
2/10/2015 2/10/2015 1 komarindang VBS dr. Dian Kesumarini.SpAn
2/10/2015 2/10/2015 1 komarindang VBS dr. Dian Kesumarini.SpAn
2/11/2015 2/11/2015 1 dewi Sekayu dr. Dian Kesumarini.SpAn
2/11/2015 2/11/2015 1 m.sarwan Mangsang dr. Dian Kesumarini.SpAn
2/11/2015 2/11/2015 1 yuniat Macan Sakt dr. Dian Kesumarini.SpAn
2/11/2015 2/11/2015 1 refile R. Keroyah dr. Dian Kesumarini.SpAn
2/11/2015 2/11/2015 1 sukat Bero Jaya Timur dr. Dian Kesumarini.SpAn
2/11/2015 2/11/2015 1 indosenang Tg Karang dr. Dian Kesumarini.SpAn
2/11/2015 2/11/2015 1 risalah sialang Agung dr. Dian Kesumarini.SpAn
2/11/2015 2/11/2015 1 sumarni Sekayu dr. Dian Kesumarini.SpAn
2/12/2015 2/12/2015 1 herlina Ngulak I dr. Dian Kesumarini.SpAn
2/12/2015 2/12/2015 1 dianasari Lumpatan dr. Dian Kesumarini.SpAn
2/12/2015 2/12/2015 1 armila Sukarami dr. Dian Kesumarini.SpAn
2/12/2015 2/12/2015 1 desi puspita Air Puth Ulu dr. Dian Kesumarini.SpAn
2/13/2015 2/13/2015 1 inim Letang dr. Dian Kesumarini.SpAn
2/13/2015 2/13/2015 1 komaria Rantau Panjang dr. Dian Kesumarini.SpAn
2/13/2015 2/13/2015 1 hayana Prabu Menang dr. Dian Kesumarini.SpAn
2/13/2015 2/13/2015 1 lina Tempirai Utara dr. Dian Kesumarini.SpAn
2/14/2015 2/14/2015 1 made Bandar Tenggulang dr. Dian Kesumarini.SpAn
2/15/2015 2/15/2015 1 ismigat Sungai Medak dr. Dian Kesumarini.SpAn
2/16/2015 2/16/2015 1 saharudin Teluk Kijing dr. Dian Kesumarini.SpAn
2/16/2015 2/16/2015 1 arkoni Balai Ahung dr. Dian Kesumarini.SpAn
2/16/2015 2/16/2015 1 sila bumi kencana dr. Dian Kesumarini.SpAn
2/16/2015 2/16/2015 1 saipul Tanah abang dr. Dian Kesumarini.SpAn
2/16/2015 2/16/2015 1 rudi hartono Mekar sari dr. Dian Kesumarini.SpAn
2/17/2015 2/17/2015 1 rasmini Lk.III. Kayu ara dr. Dian Kesumarini.SpAn
2/17/2015 2/17/2015 1 asropi Sumber Jaya dr. Dian Kesumarini.SpAn
2/17/2015 2/17/2015 2 megaria Gajah Mat dr. Dian Kesumarini.SpAn
2/18/2015 2/18/2015 1 husnaini Keluang dr. Dian Kesumarini.SpAn
2/18/2015 2/18/2015 1 sugiart Sungai Lilin dr. Dian Kesumarini.SpAn
2/18/2015 2/18/2015 1 pebriansyah Lumpatan II dr. Dian Kesumarini.SpAn
2/18/2015 2/18/2015 1 sundari Rantau Kasih dr. Dian Kesumarini.SpAn
2/18/2015 2/18/2015 1 kasma Kemang dr. Dian Kesumarini.SpAn
2/19/2015 2/19/2015 1 sant Tl Leban dr. Dian Kesumarini.SpAn
2/20/2015 2/20/2015 1 roidah sungai angit dr. Dian Kesumarini.SpAn
2/20/2015 2/20/2015 1 ibat suthat Dusun Lama dr. Dian Kesumarini.SpAn
2/20/2015 2/20/2015 1 rini komilah Sungai lilin dr. Dian Kesumarini.SpAn
2/20/2015 2/20/2015 1 siswo bupiarso warga mulyo dr. Dian Kesumarini.SpAn
2/20/2015 2/20/2015 1 pinto sungai angit dr. Dian Kesumarini.SpAn
2/20/2015 2/20/2015 1 ernawat C5 dr. Dian Kesumarini.SpAn
2/20/2015 2/20/2015 1 eva gustna serasan jaya dr. Dian Kesumarini.SpAn
2/21/2015 2/21/2015 1 parda Sekayu dr. Dian Kesumarini.SpAn
2/21/2015 2/21/2015 1 piki sutowo mangun jaya dr. Dian Kesumarini.SpAn
2/21/2015 2/21/2015 1 vera laila kayu ara dr. Dian Kesumarini.SpAn
2/21/2015 2/21/2015 1 novi sukarami dr. Dian Kesumarini.SpAn
2/21/2015 2/21/2015 1 rika sari bayung lincir dr. Dian Kesumarini.SpAn
2/21/2015 2/21/2015 1 ebit akbar pagar kaya dr. Dian Kesumarini.SpAn
2/23/2015 2/23/2015 1 susrilaini babat dr. Dian Kesumarini.SpAn
2/23/2015 2/23/2015 1 suherman mekar jaya dr. Dian Kesumarini.SpAn
2/23/2015 2/23/2015 1 diki soak baru dr. Dian Kesumarini.SpAn
2/23/2015 2/23/2015 1 leni ds. Sri gunung dr. Dian Kesumarini.SpAn
2/23/2015 2/23/2015 1 arma leni sekayu dr. Dian Kesumarini.SpAn
2/23/2015 2/23/2015 1 zainabah sukarami dr. Dian Kesumarini.SpAn
2/23/2015 2/23/2015 1 elita septn petaling dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 1 arpiani tlk Kijing dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 1 pariem sekayu dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 1 azizah rantau panajang dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 1 yuhadi sidang marga dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 1 sudila sukarami dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 1 maharani danau cala dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 1 ali lk.7 Sekayu dr. Dian Kesumarini.SpAn
2/24/2015 2/24/2015 1 yuliana bailangu dr. Dian Kesumarini.SpAn
2/25/2015 2/25/2015 1 suratn keluang dr. Dian Kesumarini.SpAn
2/26/2015 2/26/2015 1 edi yansa Teluk Kijing dr. Dian Kesumarini.SpAn
2/26/2015 2/26/2015 1 nining kertajaya dr. Dian Kesumarini.SpAn
2/26/2015 2/26/2015 1 mulyana air puth ilir dr. Dian Kesumarini.SpAn
2/27/2015 2/27/2015 1 sit sekayu dr. Dian Kesumarini.SpAn
2/27/2015 2/27/2015 1 erlinda sukarami dr. Dian Kesumarini.SpAn
2/27/2015 2/27/2015 1 tresnawat tenggulang jaya dr. Dian Kesumarini.SpAn
2/27/2015 2/27/2015 1 yuliana kertajaya dr. Dian Kesumarini.SpAn
2/27/2015 2/27/2015 1 lilis hartat lumpatan dr. Dian Kesumarini.SpAn
2/27/2015 2/27/2015 1 rosita sekayu dr. Dian Kesumarini.SpAn
2/27/2015 2/27/2015 1 leni maryana bayung lincir dr. Dian Kesumarini.SpAn
2/27/2015 2/27/2015 1 ruslan bailangu dr. Dian Kesumarini.SpAn
2/28/2015 2/28/2015 1 yogi R suka damai dr. Dian Kesumarini.SpAn
2/28/2015 2/28/2015 1 Randa sikarami dr. Dian Kesumarini.SpAn
2/28/2015 2/28/2015 1 agustn bandar jaya dr. Dian Kesumarini.SpAn
2/28/2015 2/28/2015 1 heni gustna Ngulak I dr. Dian Kesumarini.SpAn
Jumlah 117

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
N-16
Bulan : Februari
Tahun : 2015
Persediaan
Akhir Bulan Ket
(8-11)
13
791 - 791
0 - 0
212 - 212
134 - 134
0 - 0
518 - 518
283 - 283
0
0

Penanggung Jawab
Dra. Hanifdar, Apt

p. 19670730 199703 2 001
843/247/SIPA/DINKES/I/2012
No. Izin RS :-
No. Izin Khusus :-

1 2 3 4 5 6 7 8 9 10
1 Clopedin (Pethidin) Ampul 791 - - - 791 4 4
2 Codein 10 mg Tablet 0 - - - 0 0 0
3 Fentanyl 0,05 MG/ML 2 ML Ampul 212 - - - 212 128 128
4 Morfin 10 mg Ampul 134 - - - 134 12 12
5 Coditam Tablet 0 - - - 0 0 0
6 MST 15 mg Tablet 518 - - - 518 0 0
7 MST 10 mg Tablet 283 - - - 283 0 0
Sekayu, 8 April 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS : Bulan : Maret

1 2 3 4 5 6 7 8 9 10 11
1 Petdin Ampul 3/9/2015 3/9/2015 1 Nora sekayu dr. Dian Kesumarini.SpAn

3/9/2015 3/9/2015 1 Mahadi simpang bayat dr. Dian Kesumarini.SpAn
3/9/2015 3/9/2015 1 Firdaus sekayu dr. Dian Kesumarini.SpAn
3/10/2015 3/10/2015 1 Endah Astut plakat tnggi dr. Dian Kesumarini.SpAn
3 Morpin Inj Ampul 3/7/2015 3/7/2015 3 Edi Herman ulak paceh dr. Dian Kesumarini.SpAn
3/8/2015 3/8/2015 3 Edi Herman ulak paceh dr. Dian Kesumarini.SpAn
3/10/2015 3/10/2015 3 Edi Herman ulak paceh dr. Dian Kesumarini.SpAn
3/25/2015 3/25/2015 1 dasinah Balai agung dr. Dian Kesumarini.SpAn
3/30/2015 3/30/2015 2 linda sekayu dr. Dian Kesumarini.SpAn
Jumlah 12
4 Fentanil Ampul 3/1/2015 3/1/2015 1 Novi Efriant Sekayu dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Ernawat mangun jaya dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Ayu P Sekayu dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Nurhasanah Sekayu dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Dempi Susant Bumi ayu dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Egi Via epil dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Susi susant gajah mat dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Nyayu Maimunah Sekayu dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Muria Sekayu dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Suman jirak dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Dini babat dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Debi Sekayu dr. Dian Kesumarini.SpAn
3/2/2015 3/2/2015 1 Mastura tebing bulan dr. Dian Kesumarini.SpAn
3/3/2015 3/3/2015 1 Pangki gajah mat dr. Dian Kesumarini.SpAn
3/4/2015 3/4/2015 1 Roilah keban dr. Dian Kesumarini.SpAn
3/4/2015 3/4/2015 1 Lusiana lais dr. Dian Kesumarini.SpAn
3/4/2015 3/4/2015 1 Yuyun Sekayu dr. Dian Kesumarini.SpAn
3/4/2015 3/4/2015 1 Samsudin jirak dr. Dian Kesumarini.SpAn
3/4/2015 3/4/2015 1 Irma ulak paceh dr. Dian Kesumarini.SpAn
3/4/2015 3/4/2015 1 Purnawan bintale dr. Dian Kesumarini.SpAn
3/5/2015 3/5/2015 1 Arina bangun sari dr. Dian Kesumarini.SpAn
3/5/2015 3/5/2015 1 Johansyah Sekayu dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 Malasari sungai lilin dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 supartni bintale dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 winda nurjayant Sekayu dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 asmari epil dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 novita sari Sekayu dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 zely septa Sekayu dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 bambang Sekayu dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 sutomo sukalali dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 edi herman ulak paceh dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 rosilah soak baru dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 diat toman dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 sant ttana mangun jaya dr. Dian Kesumarini.SpAn
3/6/2015 3/6/2015 1 rat ratha sungai keruh dr. Dian Kesumarini.SpAn
3/7/2015 3/7/2015 1 irwansyah epil dr. Dian Kesumarini.SpAn
3/7/2015 3/7/2015 1 ttn R sungai lilin dr. Dian Kesumarini.SpAn
3/7/2015 3/7/2015 1 Yuli Bt Ernawat sungai batang dr. Dian Kesumarini.SpAn
3/7/2015 3/7/2015 1 Asmawat rantau panjang dr. Dian Kesumarini.SpAn
3/8/2015 3/8/2015 1 supita lubuk tampul dr. Dian Kesumarini.SpAn
3/8/2015 3/8/2015 1 sarina petaling dr. Dian Kesumarini.SpAn
3/9/2015 3/9/2015 2 kadim ngunang dr. Dian Kesumarini.SpAn
3/9/2015 3/9/2015 1 romlah keluang dr. Dian Kesumarini.SpAn
3/10/2015 3/10/2015 1 ida R ulak teberau dr. Dian Kesumarini.SpAn
3/10/2015 3/10/2015 1 Nurdila sekayu dr. Dian Kesumarini.SpAn
3/10/2015 3/10/2015 1 Yeni ulak teberau dr. Dian Kesumarini.SpAn
3/11/2015 3/11/2015 1 lupita sari bukit selabu dr. Dian Kesumarini.SpAn
3/11/2015 3/11/2015 1 zulfa kayuara dr. Dian Kesumarini.SpAn
3/12/2015 3/12/2015 1 fitri ningsih serasan jaya dr. Dian Kesumarini.SpAn
3/12/2015 3/12/2015 1 sari anggini muara teladan dr. Dian Kesumarini.SpAn
3/13/2015 3/13/2015 1 rohat gajah mat dr. Dian Kesumarini.SpAn
3/13/2015 3/13/2015 1 hertut sekayu dr. Dian Kesumarini.SpAn
3/13/2015 3/13/2015 1 derry damant Sekayu dr. Dian Kesumarini.SpAn
3/13/2015 3/13/2015 1 zainah supat dr. Dian Kesumarini.SpAn
3/16/2015 3/16/2015 1 masla deswat ngulak dr. Dian Kesumarini.SpAn
3/16/2015 3/16/2015 2 arniyant teluk kijing dr. Dian Kesumarini.SpAn
3/16/2015 3/16/2015 1 edi herman ulak paceh dr. Dian Kesumarini.SpAn
3/16/2015 3/16/2015 1 neni pratwi epil dr. Dian Kesumarini.SpAn
3/16/2015 3/16/2015 1 erlina danau cala dr. Dian Kesumarini.SpAn
3/16/2015 3/16/2015 1 tara bayung lincir dr. Dian Kesumarini.SpAn
3/16/2015 3/16/2015 1 diana lisna rantau panjang dr. Dian Kesumarini.SpAn
3/16/2015 3/16/2015 1 andriansyah peninggalan dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 maya rumantr babat toman dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 zulfa riyant sekayu dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 sit julaiha epil dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 nova lais dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 zainudin tanjung kerang dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 Arwina karang waru dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 abu bakar sekayu dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 edwar sekayu dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 yuliana ulak paceh dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 marisiani bukit sejahtera dr. Dian Kesumarini.SpAn
3/17/2015 3/17/2015 1 helen danau cala dr. Dian Kesumarini.SpAn
3/18/2015 3/18/2015 1 eva hariyant kayuara dr. Dian Kesumarini.SpAn
3/18/2015 3/18/2015 1 rinda teluk kijing dr. Dian Kesumarini.SpAn
3/18/2015 3/18/2015 1 hijra sekayu dr. Dian Kesumarini.SpAn
3/18/2015 3/18/2015 1 irawat sekayu dr. Dian Kesumarini.SpAn
3/19/2015 3/19/2015 1 ttk lestari Sungai batang dr. Dian Kesumarini.SpAn
3/19/2015 3/19/2015 1 verawat lumpatan dr. Dian Kesumarini.SpAn
3/19/2015 3/19/2015 1 sinta novita sekayu dr. Dian Kesumarini.SpAn
3/19/2015 3/19/2015 1 maya sari jirak dr. Dian Kesumarini.SpAn
3/19/2015 3/19/2015 1 jurnita peninggalan dr. Dian Kesumarini.SpAn
3/20/2015 3/20/2015 1 nurlaila sekayu dr. Dian Kesumarini.SpAn
3/20/2015 3/20/2015 1 suprapt sidorejo dr. Dian Kesumarini.SpAn
3/23/2015 3/23/2015 2 sulastri sekayu dr. Dian Kesumarini.SpAn
3/23/2015 3/23/2015 1 erlinawat ulak teberau dr. Dian Kesumarini.SpAn
3/23/2015 3/23/2015 1 net nurmawat Sekayu dr. Dian Kesumarini.SpAn
3/23/2015 3/23/2015 1 M. Nabil sekayu dr. Dian Kesumarini.SpAn
3/23/2015 3/23/2015 1 net nurmawat sekayu dr. Dian Kesumarini.SpAn
3/23/2015 3/23/2015 1 Dasito jirak dr. Dian Kesumarini.SpAn
3/24/2015 3/24/2015 1 Liza lismayat muara teladan dr. Dian Kesumarini.SpAn
3/24/2015 3/24/2015 1 Holipa Ds.II Pagar kaya dr. Dian Kesumarini.SpAn
3/24/2015 3/24/2015 1 zalmah Sekayu dr. Dian Kesumarini.SpAn
3/24/2015 3/24/2015 1 susilawat Teluk kijing dr. Dian Kesumarini.SpAn
3/24/2015 3/24/2015 1 zakiya Rantau kasih dr. Dian Kesumarini.SpAn
3/25/2015 3/25/2015 1 irma sari karang ringin dr. Dian Kesumarini.SpAn
3/25/2015 3/25/2015 1 dasinah sekayu dr. Dian Kesumarini.SpAn
3/25/2015 3/25/2015 1 umari rantau kroya dr. Dian Kesumarini.SpAn
3/25/2015 3/25/2015 1 pemilia kerta jaya dr. Dian Kesumarini.SpAn
3/25/2015 3/25/2015 1 zubaidah sungai angit dr. Dian Kesumarini.SpAn
3/26/2015 3/26/2015 1 sri indriana sekayu dr. Dian Kesumarini.SpAn
3/26/2015 3/26/2015 1 romsuria simpang tungkal dr. Dian Kesumarini.SpAn
3/26/2015 3/26/2015 1 inna ds. Lais utara dr. Dian Kesumarini.SpAn
3/26/2015 3/26/2015 1 malkana desa pagar kaya dr. Dian Kesumarini.SpAn
3/26/2015 3/26/2015 1 kurniasih mekar jaya dr. Dian Kesumarini.SpAn
3/26/2015 3/26/2015 1 sri marlina bailangu dr. Dian Kesumarini.SpAn
3/26/2015 3/26/2015 1 kurniasih mekar jaya dr. Dian Kesumarini.SpAn
3/26/2015 3/26/2015 1 murtningsih rukun rahayu dr. Dian Kesumarini.SpAn
3/27/2015 3/27/2015 1 trisca serasan jaya dr. Dian Kesumarini.SpAn
3/27/2015 3/27/2015 1 rosalina lumpatan dr. Dian Kesumarini.SpAn
3/27/2015 3/27/2015 1 holila VBS Sekayu dr. Dian Kesumarini.SpAn
3/27/2015 3/27/2015 1 hartat peninggalan dr. Dian Kesumarini.SpAn
3/27/2015 3/27/2015 1 risca sari perum PT Pinago dr. Dian Kesumarini.SpAn
3/27/2015 3/27/2015 1 vina andriant tanding marga dr. Dian Kesumarini.SpAn
3/27/2015 3/27/2015 1 nurchotmah sungai lilin dr. Dian Kesumarini.SpAn
3/27/2015 3/27/2015 1 yusmeli babat toman dr. Dian Kesumarini.SpAn
3/30/2015 3/30/2015 1 emi artka sukarami dr. Dian Kesumarini.SpAn
3/30/2015 3/30/2015 1 susilawaty kerta jaya dr. Dian Kesumarini.SpAn
3/30/2015 3/30/2015 1 arin wahyuni petaling dr. Dian Kesumarini.SpAn
3/31/2015 3/31/2015 1 nurjanah bailangu dr. Dian Kesumarini.SpAn
3/31/2015 3/31/2015 1 yelita marna dusun bangan dr. Dian Kesumarini.SpAn
3/31/2015 3/31/2015 1 dewi widi cinta karya dr. Dian Kesumarini.SpAn
3/31/2015 3/31/2015 1 sit fatmah keluang dr. Dian Kesumarini.SpAn
3/31/2015 3/31/2015 1 pipi herlini sumber rezeki dr. Dian Kesumarini.SpAn
Jumlah 128

Penanggung Jawab
Dra. Hanifdar, Apt
Nip. 19670730 199703 2 001
N-16
Bulan : Maret
Tahun : 2015
Persediaan
Akhir Bulan Ket
(8-11)
13
787 - 787
0 - 0
84 - 84
122 - 122
0 - 0
518 - 518
283 - 283

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
PA : 843/247/SIPA/DINKES/I/2012
No. Izin RS :-
No. Izin Khusus :-

1 2 3 4 5 6 7 8 9 10
3 Fentanyl 0,05 MG/ML 2 ML Ampul 84 14-4-2015, 28-4-2015 Kimia Farma 400 484 197 197
4 Morfin 10 mg Ampul 122 - - - 122 4 4
6 MST 15 mg Tablet 518 - - - 518 10 10
7 MST 10 mg Tablet 283 - - - 283 20 20
Sekayu, 8 Mei 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2
SIPA : 843/247/SIPA/DINK
No. Izin RS : Bulan : April

1 2 3 4 5 6 7 8 9 10 11
1 Petdin Ampul 4/9/2015 4/9/2015 2 maimunah sekayu dr. Dian Kesumarini.SpAn

4/9/2015 4/9/2015 1 resmaini sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 aini sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 2 sutkah sekayu dr. Asdi.Sppd
4/9/2015 4/9/2015 1 tten S sekayu dr. Asdi.Sppd
4/9/2015 4/9/2015 2 tten S sekayu dr. Asdi.Sppd
4/9/2015 4/9/2015 1 sukarno sekayu dr. Asdi.Sppd
4/9/2015 4/9/2015 1 syamsiah sekayu dr. Dian Kesumarini.SpAn
11
2 Morpin Inj Ampul 4/3/2015 4/3/2015 3 Linda Sekayu dr. Dian Kesumarini.SpAn
4/3/2015 4/3/2015 1 Efendi sekayu dr. Dian Kesumarini.SpAn
Jumlah 4
3 Fentanil Ampul 4/1/2015 4/1/2015 4 Asmadi Sekayu dr. Dian Kesumarini.SpAn

4/1/2015 4/1/2015 2 asmadi Sekayu dr. Dian Kesumarini.SpAn
4/1/2015 4/1/2015 1 reni Sekayu dr. Dian Kesumarini.SpAn
4/1/2015 4/1/2015 1 Akal Sekayu dr. Dian Kesumarini.SpAn
4/2/2015 4/2/2015 2 Asmadi Sekayu dr. Dian Kesumarini.SpAn
4/2/2015 4/2/2015 1 ulil afidah Sekayu dr. Dian Kesumarini.SpAn
4/2/2015 4/2/2015 1 murni Sekayu dr. Dian Kesumarini.SpAn
4/2/2015 4/2/2015 1 sit nurwaliyah Sekayu dr. Dian Kesumarini.SpAn
4/3/2015 4/3/2015 1 mariani Sekayu dr. Dian Kesumarini.SpAn
4/3/2015 4/3/2015 2 ayu aprilia Sekayu dr. Dian Kesumarini.SpAn
4/3/2015 4/3/2015 2 sri lestari Sekayu dr. Dian Kesumarini.SpAn
4/3/2015 4/3/2015 2 asnita Sekayu dr. Dian Kesumarini.SpAn
4/4/2015 4/4/2015 1 elyawat Sekayu dr. Dian Kesumarini.SpAn
4/4/2015 4/4/2015 2 zainuba Sekayu dr. Dian Kesumarini.SpAn
4/4/2015 4/4/2015 2 eni yant Sekayu dr. Dian Kesumarini.SpAn
4/4/2015 4/4/2015 2 endang Sekayu dr. Dian Kesumarini.SpAn
4/5/2015 4/5/2015 1 suzana Sekayu dr. Dian Kesumarini.SpAn
4/5/2015 4/5/2015 1 aan nuraini Sekayu dr. Dian Kesumarini.SpAn
4/6/2015 4/6/2015 1 perawat Sekayu dr. Dian Kesumarini.SpAn
4/6/2015 4/6/2015 1 imas putri Sekayu dr. Dian Kesumarini.SpAn
4/6/2015 4/6/2015 1 edi candra Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 1 suryat Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 2 wakiah Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 1 bobi Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 1 robiyanto Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 1 lusi Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 1 asni Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 1 darmi Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 1 serlita Sekayu dr. Dian Kesumarini.SpAn
4/7/2015 4/7/2015 1 iin Sekayu dr. Dian Kesumarini.SpAn
4/8/2015 4/8/2015 1 sarminah Sekayu dr. Dian Kesumarini.SpAn
4/8/2015 4/8/2015 1 uya Sekayu dr. Dian Kesumarini.SpAn
4/8/2015 4/8/2015 1 sri sulastri Sekayu dr. Dian Kesumarini.SpAn
4/8/2015 4/8/2015 1 anisa Sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 arni jaya Sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 sinta Sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 nursani Sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 mimi mirawat Sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 susi susant Sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 kaminem Sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 dika Sekayu dr. Dian Kesumarini.SpAn
4/9/2015 4/9/2015 1 helmi Sekayu dr. Dian Kesumarini.SpAn
4/10/2015 4/10/2015 1 yuliant Sekayu dr. Dian Kesumarini.SpAn
4/10/2015 4/10/2015 1 komala sari Sekayu dr. Dian Kesumarini.SpAn
4/10/2015 4/10/2015 1 komala sari Sekayu dr. Dian Kesumarini.SpAn
4/10/2015 4/10/2015 1 ratna dewi Sekayu dr. Dian Kesumarini.SpAn
4/11/2015 4/11/2015 2 linda Sekayu dr. Dian Kesumarini.SpAn
4/11/2015 4/11/2015 1 repi Sekayu dr. Dian Kesumarini.SpAn
4/11/2015 4/11/2015 1 lia Sekayu dr. Dian Kesumarini.SpAn
4/11/2015 4/11/2015 1 alifna Sekayu dr. Dian Kesumarini.SpAn
4/11/2015 4/11/2015 1 marlita Sekayu dr. Dian Kesumarini.SpAn
4/12/2015 4/12/2015 1 rahaya Sekayu dr. Dian Kesumarini.SpAn
4/12/2015 4/12/2015 1 nuraini Sekayu dr. Dian Kesumarini.SpAn
4/13/2015 4/13/2015 1 leni fitriani Sekayu dr. Dian Kesumarini.SpAn
4/13/2015 4/13/2015 1 rusmiat Sekayu dr. Dian Kesumarini.SpAn
4/13/2015 4/13/2015 1 iswat Sekayu dr. Dian Kesumarini.SpAn
4/13/2015 4/13/2015 1 alfan Sekayu dr. Dian Kesumarini.SpAn
4/13/2015 4/13/2015 1 dwi Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 mariatun Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 yusnani Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 tri widart Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 bela umbari Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 zainabun Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 ani epiyant Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 yatni Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 rini Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 sri bidini Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 1 rusmi hasan Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 susi yant Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 pepi Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 rina Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 evi andriani Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 emilda Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 dewi murni Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 sriwat Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 pani usman Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 malis Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 mustka Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 yuliana Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 balkia Sekayu dr. Dian Kesumarini.SpAn
4/15/2015 4/15/2015 1 ramilah Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 1 marlina Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 1 suhartut Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 1 melisa Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 1 ira yuliant Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 1 diva galih Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 1 mai saroh Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 1 linda Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 1 desi Sekayu dr. Dian Kesumarini.SpAn
4/16/2015 4/16/2015 2 artna Sekayu dr. Dian Kesumarini.SpAn
4/17/2015 4/17/2015 1 pahmi idris Sekayu dr. Dian Kesumarini.SpAn
4/17/2015 4/17/2015 1 mariani Sekayu dr. Dian Kesumarini.SpAn
4/18/2015 4/18/2015 1 della Sekayu dr. Dian Kesumarini.SpAn
4/18/2015 4/18/2015 1 nalni Sekayu dr. Dian Kesumarini.SpAn
4/20/2015 4/20/2015 1 muis Sekayu dr. Dian Kesumarini.SpAn
4/20/2015 4/20/2015 1 samsul Sekayu dr. Dian Kesumarini.SpAn
4/20/2015 4/20/2015 1 monalisa Sekayu dr. Dian Kesumarini.SpAn
4/20/2015 4/20/2015 1 rat Sekayu dr. Dian Kesumarini.SpAn
4/20/2015 4/20/2015 1 sopian Sekayu dr. Dian Kesumarini.SpAn
4/20/2015 4/20/2015 1 anita Sekayu dr. Dian Kesumarini.SpAn
4/20/2015 4/20/2015 1 nurhayat Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 mardalena Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 rosita Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 yuna lestari Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 ahmad syarifulla Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 makmubah Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 tugini Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 fatmah yat Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 rina Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 susant Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 1 sit aisyahah Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 2 suwart Sekayu dr. Dian Kesumarini.SpAn
4/21/2015 4/21/2015 2 sunari Sekayu dr. Dian Kesumarini.SpAn
4/22/2015 4/22/2015 1 umi soleha Sekayu dr. Dian Kesumarini.SpAn
4/22/2015 4/22/2015 1 mariem Sekayu dr. Dian Kesumarini.SpAn
4/22/2015 4/22/2015 1 hata Sekayu dr. Dian Kesumarini.SpAn
4/22/2015 4/22/2015 1 rosidin Sekayu dr. Dian Kesumarini.SpAn
4/22/2015 4/22/2015 1 m. Azka Sekayu dr. Dian Kesumarini.SpAn
4/22/2015 4/22/2015 1 sit romlah Sekayu dr. Dian Kesumarini.SpAn
4/22/2015 4/22/2015 1 syamsuri Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 rendra Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 mala Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 rusmini Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 nuraini Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 rita Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 landri Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 yusuf Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 minart Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 tumira Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 junaida Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 herawat Sekayu dr. Dian Kesumarini.SpAn
4/23/2015 4/23/2015 1 wiji Sekayu dr. Dian Kesumarini.SpAn
4/24/2015 4/24/2015 1 amna Sekayu dr. Dian Kesumarini.SpAn
4/24/2015 4/24/2015 1 agustna Sekayu dr. Dian Kesumarini.SpAn
4/24/2015 4/24/2015 1 rico Sekayu dr. Dian Kesumarini.SpAn
4/24/2015 4/24/2015 1 sinta melat Sekayu dr. Dian Kesumarini.SpAn
4/24/2015 4/24/2015 1 rusdi usman Sekayu dr. Dian Kesumarini.SpAn
4/24/2015 4/24/2015 1 ardianto Sekayu dr. Dian Kesumarini.SpAn
4/25/2014 4/25/2014 1 bahidin Sekayu dr. Dian Kesumarini.SpAn
4/25/2014 4/25/2014 1 herman sawran Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 agus salim Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 kartka Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 rika Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 eka purnama Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 M. Ridho Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 dewi Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 karyat Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 adi putra Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 dwi lestari Sekayu dr. Dian Kesumarini.SpAn
4/28/2015 4/28/2015 1 daryanto Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 mustaro Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 nurainun Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 masinah Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 ulian sari Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 rahmi Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 masttn Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 karmila Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 sri lidia Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 octa Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 puspita Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 eva susant Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 1 f juliani Sekayu dr. Dian Kesumarini.SpAn
4/30/2015 4/30/2015 1 emawat Sekayu dr. Dian Kesumarini.SpAn
4/30/2015 4/30/2015 1 bayu Sekayu dr. Dian Kesumarini.SpAn
4/30/2015 4/30/2015 1 rosiana Sekayu dr. Dian Kesumarini.SpAn
4/30/2015 4/30/2015 1 marzuku Sekayu dr. Dian Kesumarini.SpAn
4/30/2015 4/30/2015 1 heni irawan Sekayu dr. Dian Kesumarini.SpAn
Jumlah 197
4 MST 10 mg tab 4/8/2015 4/1/2015 1 Idon bin Amron Sekayu dr. Dian Kesumarini.SpAn
4/11/2015 4/11/2015 2 Sugini bt surat Sekayu dr. Dian Kesumarini.SpAn
4/14/2015 4/14/2015 2 hasan basri Sekayu dr. Dian Kesumarini.SpAn
4/17/2015 4/17/2015 2 romlah Sekayu dr. Dian Kesumarini.SpAn
4/29/2015 4/29/2015 10 zaipen Sekayu dr. Dian Kesumarini.SpAn
Jumlah 20
5 MST 15 mg tab 4/29/2015 4/29/2015 10 Otb Sekayu dr. Rosidi. SPpd
Jumlah 10
Sekayu, 8 Mei 2015

Penanggung Jawab
Dra. Hanifdar, Apt
Nip. 19670730 199703 2 001
N-16
Bulan : April
Tahun : 2015
Persediaan
Akhir Bulan Ket
(8-11)
13
776 - 776
0 - 0
287 - 287
118 - 118
0 - 0
508 - 508
263 - 263
0
0
Sekayu, 8 Mei 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
LAPORAN KHUSUS PENGGUNAAN PSIKOTROPIKA
Gudang November R.Inap November
No Nama Obat Satuan Keluar Masuk

Sisa Awal Masuk dari Sisa Awal
Total Sisa dari Total Keluar
November Distributor November Gudang
R.jalan R.Inap total
1 Clopedin (Pethidin) Ampul 800
2 Codein 10 mg Tablet 0
3 Fentanyl 0,05 MG/ML 2 ML Ampul 535
4 Morfin 10 mg Ampul 170
5 Coditam Tablet 0
6 MST 15 mg Tablet 420
7 MST 10 mg Tablet 180
8
30
Sekayu,................................. Sekayu,.............................
Pelapor. Gudang Farmasi Pelapor Farmasi R,Inap
Anton Pranoto.Amf Tent Rosita.S.Farm.Apt

LAPORAN KHUSUS PENGGUNAAN Narkotika
Gudang Desember R.Inap Desember
No Nama Obat Satuan Sisa Awal Masuk dari Keluar Sisa Awal Masuk
Desember Distributor Desember Gudang
R.jalan R.Inap total
1 Clopedin (Pethidin) Ampul 800 20 20 780 5 20 25 11
2 Codein 10 mg Tablet 0 0 0 0 0
3 Fentanyl 0,05 MG/ML 2 ML Ampul 535 80 80 455 15 80 95 70
4 Morfin 10 mg Ampul 170 30 30 140 9 30 39 33
5 Coditam Tablet 0 0 0 0 0
6 MST 15 mg Tablet 420 60 60 360 133 133 19
7 MST 10 mg Tablet 180 0 180 94 94 28
8 0 0 0
30
Sekayu,.................................
Pelapor Farmasi R,Inap
Tent Rosita.S.Farm.Apt

Gudang Februari R.Inap Februari
Sisa Awal Masuk dari Sisa Awal
Februari Distributor R.jalan R.Inap total Februari Gudang
1 Clopedin (Pethidin) Ampul 780 780 0 780 14 14
2 Codein 10 mg Tablet 0 0 0 0 0 0
3 Fentanyl 0,05 MG/ML 2 ML Ampul 455 455 0 455 25 25
4 Morfin 10 mg Ampul 140 140 0 140 6 6
5 Coditam Tablet 0 0 0 0 0 0
6 MST 15 mg Tablet 360 360 0 360 114 114
7 MST 10 mg Tablet 180 180 0 180 66 66
8 0 0 0 0 0 0
30
Sekayu,.................................
Gudang Maret R.Inap Maret
Masuk dari Sisa Awal
Stock Awal Stock Gudang Total Sisa dari Total Keluar
Distributor R.jalan R.Inap total Desember Gudang
1 Clopedin (Pethidin) Ampul 794 780 780 780 14 14 3
2 Codein 10 mg Tablet 0 0 0 0 0 0
3 Fentanyl 0,05 MG/ML 2 ML Ampul 329 325 325 135 190 190 4 135 139 117
4 Morfin 10 mg Ampul 138 110 110 110 110 28 28 4
6 MST 15 mg Tablet 518 360 360 360 113 113
7 MST 10 mg Tablet 283 180 180 180 62 62
0
30
Sekayu,.................................
Gudang April R.Inap April
Distributor R.jalan R.Inap total Desember Gudang
1 Clopedin (Pethidin) Ampul 780 780 780 0 780 11 11 4
2 Codein 10 mg Tablet 0 0 0 0 0 0 0
4 Morfin 10 mg Ampul 110 110 110 0 110 24 24 12
5 Coditam Tablet 0 0 0 0 0 0 0
6 MST 15 mg Tablet 360 360 360 0 360 113 113
7 MST 10 mg Tablet 180 180 180 0 180 62 62
0 0 0 0
30
Sekayu,.................................

Gudang Mei R.Inap Mei
Distributor R.jalan R.Inap total April Gudang
1 Clopedin (Pethidin) Ampul 780 780 780 20 20 760 7 20 27 11
3 Fentanyl 0,05 MG/ML 2 ML Ampul 65 65 400 465 205 205 260 19 205 224 197
4 Morfin 10 mg Ampul 110 110 110 0 110 12 12 4
6 MST 15 mg Tablet 360 360 360 0 360 113 113 0
7 MST 10 mg Tablet 180 180 180 0 180 62 62 20
0 0 0 0 0 0 0
30
Sekayu,.................................
Gudang Mei R.Inap Mei
Distributor R.jalan R.Inap total April Gudang
4 Morfin 10 mg Ampul 110 110 110 0 110 12 12 4
6 MST 15 mg Tablet 360 360 360 0 360 113 113 0
7 MST 10 mg Tablet 180 180 180 0 180 62 62 20
0 0 0 0 0 0 0
30
Sekayu,.................................
Gudang Juni R.Inap Juni
Distributor R.jalan R.Inap total Mei Gudang
4 Morfin 10 mg Ampul 118 110 110 110 8 8 1
6 MST 15 mg Tablet 508 360 360 360 103 0 0 0
7 MST 10 mg Tablet 263 180 180 60 60 120 42 60 102 54
Sekayu,.................................
Gudang Juli R.Inap Juli
Distributor R.jalan R.Inap total juni Gudang
2 Codein 10 mg Tablet 0 0 0 0
4 Morfin 10 mg Ampul 117 110 110 10 10 100 7 10 17 14
5 Coditam Tablet 0 0 0
6 MST 15 mg Tablet 498 360 360 360 103 103 12
7 MST 10 mg Tablet 190 120 120 60 60 120 0 48 60 108 97
Sekayu,.................................
Gudang Agustus R.Inap Agustus
Distributor R.jalan R.Inap total juli Gudang
1 Clopedin (Pethidin) Ampul 771 760 760 760 11 9
4 Morfin 10 mg Ampul 103 100 100 20 20 80 3 20 23 3
5 Coditam Tablet 0 0 0 0
6 MST 15 mg Tablet 476 360 360 60 60 300 91 60 151 97
7 MST 10 mg Tablet 24 0 0 0 11 11
sekayu,.....................................
pelapor Gudang Farmasi
Gani Alba, Amf

Gudang September R.Inap September
Distributor R.jalan R.Inap total agustus Gudang
4 Morfin 10 mg Ampul 100 80 0 0 20
6 MST 15 mg Tablet 369 300 300 60 120 180 120 54 120 174 108
7 MST 10 mg Tablet 0 0 360 360 60 0 60 300 0
sekayu,.....................................
Gani Alba, Amf

Gudang September R.Inap Oktober
Distributor R.jalan R.Inap total september Gudang
4 Morfin 10 mg Ampul 100 80 0 80 20 20 1
6 MST 15 mg Tablet 369 300 300 60 120 180 120 54 120 174 108
7 MST 10 mg Tablet 0 0 360 360 60 0 60 300 0
sekayu,.....................................
Gani Alba, Amf

Gudang September R.Inap Oktober
Distributor R.jalan R.Inap total september Gudang
4 Morfin 10 mg Ampul 99 80 80 80 19 19 3
6 MST 15 mg Tablet 211 120 120 120 66 66 20
7 MST 10 mg Tablet 360 300 0 300 0 60 60 240 0 60 60 16
sekayu,.....................................
Gani Alba, Amf

R.Jalan November
Masuk
Sisa Awal
Sisa dari Total Keluar Sisa
November Gudang
5 0
0 1
15 0
9 0
0 0
133 0
94 56
Sekayu,................................. Sekayu,.................................
Pelapor Farmasi R,Inap Pelapor Farmasi R.Jalan
Tent Rosita.S.Farm.Apt Fatmawat.Amf

R.Jalan Desember
Total
Masuk Tota Keluar + Sisa Jumlah
Sisa Awal Keluar
Desember Gudang
1 2 (2-1)
14 0 0 0 11 805 794
0 1 1 1 0 1 1 0
25 0 0 0 70 550 480
6 0 0 0 33 179 146
0 0 0 0 0 0 0
114 0 60 60 15 45 34 553 519
66 56 56 15 41 43 330 287
0 0 0 0 0 0
0 0 0
........................... Sekayu,.................................
Farmasi R,Inap Pelapor Farmasi R.Jalan
ita.S.Farm.Apt Fatmawat.Amf
R.Jalan Februari Total

Sisa Awal Keluar
Februari 1 2 (2-1)
Gudang
14 0 0 0 0 794 794
0 0 0 0 0 0 0
25 0 0 0 151 480 329
6 0 0 0 8 146 138
0 0 0 0 0 0 0
114 45 45 45 1 519 518
66 41 41 41 4 287 283
0 0 0 0 0 0
0 0 0
........................... Sekayu,.................................
R.Jalan Maret Total
Sisa Awal Keluar
Desember 1 2 (2-1)
Gudang
11 0 0 0 3 794 791
0 0 0 0 0 0 0
22 0 0 0 117 329 212
24 0 0 0 4 138 134
0 0 0 0 0 0 0
113 45 45 45 0 518 518
62 41 41 41 0 283 283
0 0 0
........................... Sekayu,.................................
R.Jalan April Total Tota Keluar + Sisa Jumlah
Sisa Awal Msk Keluar
Sisa Total Keluar Sisa
Desember gudang 1 2 (2-1)
7 0 0 4 791 787 3153
0 0 0 0 0 0 0
19 0 0 128 212 84 1326
12 0 0 12 134 122 512
0 0 0 0 0 0 0
113 45 45 45 0 518 518 1824
62 41 41 41 0 283 283 947
0 0
0 0 0 0
........................... Sekayu,.................................
ita.S.Farm.Apt Yulis Afriani
R.Jalan Mei Total Tota Keluar + Sisa Jumlah

16 0 0 11 787 776 3221
0 0 0 0 0 0 0
27 0 0 197 484 287 2337
8 0 0 4 122 118 476
0 0 0 0 0 0 0
113 45 45 10 35 10 518 508 1824
42 41 41 20 283 263 947
0 0 0
0 0 0 0
........................... Sekayu,.................................

R.Jalan Mei Total Tota Keluar + Sisa Jumlah
16 0 0 11 787 776 3221
0 0 0 0 0 0 0
27 0 0 197 484 287 2337
8 0 0 4 122 118 476
0 0 0 0 0 0 0
113 45 45 10 35 10 518 508 1824
42 41 41 20 283 263 947
0 0 0
0 0 0 0
........................... Sekayu,.................................

R.Jalan Juni Total Tota Keluar + Sisa Jumlah
Mei gudang 1 2 (2-1)
14 0 2 776 774
0 0 0 0 0
9 0 138 287 149
7 0 1 118 117
0 0 0 0 0
103 45 45 10 35 10 508 498
48 41 41 19 22 73 263 190
........................... Sekayu,.................................

R.Jalan Juli Total Tota Keluar + Sisa Jumlah
juni gudang 1 2 (2-1)
11 3 774 771
0 0 0
15 124 149 25
3 14 117 103
0 0 0
91 35 35 10 25 22 498 476
11 22 60 82 69 13 166 190 24
........................... Sekayu,.................................

R.Jalan Agustus Total Tota Keluar + Sisa Jumlah
juli gudang 1 2 (2-1)
2 9 771 762
0 0 0 0
14 131 265 134
20 3 103 100
0 0 0 0
54 25 25 10 15 107 476 369
0 13 13 13 0 24 24 0
Sekayu,................................. Sekayu,.................................
Tent Rosita.S.Farm.Apt Yulis Afriani

R.Jalan September Total Tota Keluar + Sisa Jumlah
agustus gudang 1 2 (2-1)
20
0
17
0
66 15 60 75 50 25
0 0 60 60 0 60
Sekayu,................................. Sekayu,.................................
R.Jalan Oktober Total Tota Keluar + Sisa Jumlah

september gudang 1 2 (2-1)
20 22 782 760
0
17 277 474 197
19 1 100 99
0
66 15 60 75 50 25 338 549 211
0 0 60 60 0 60 0 360 360
Sekayu,................................. Sekayu,.................................
R.Jalan Oktober Total Tota Keluar + Sisa Jumlah

september gudang 1 2 (2-1)
18 2 760 758
0
12 175 197 22
16 3 99 96
0
46 25 0 25 10 15 30 211 181
44 0 60 60 0 60 16 360 344
Sekayu,................................. Sekayu,.................................

No. Izin RS :-
No. Izin Khusus :-

Tanggal Dari Jumlah
1 2 3 4 5 6 7 8 9 10
1 Clopedin (Pethidin) Ampul 794 - - - 794 0 -
2 Codein 10 mg Tablet 0 - - - 0 0 -
3 Fentanyl 0,05 MG/ML 2 ML Ampul 480 - - - 480 151 -
4 Morfin 10 mg Ampul 146 - - - 146 8 -
5 Coditam Tablet 0 - - - 0 0 -
6 MST 15 mg Tablet 519 - - - 519 1 -
7 MST 10 mg Tablet 287 - - - 287 4 -

Tanggal Dari Jumlah
1 2 3 4 5 6 7 8 9 10
1 Clopedin (Pethidin) Ampul 794 - - - 794 3 -
2 Codein 10 mg Tablet 0 - - - 0 0 -
3 Fentanyl 0,05 MG/ML 2 ML Ampul 329 - - - 329 117 -
4 Morfin 10 mg Ampul 138 - - - 138 4 -
5 Coditam Tablet 0 - - - 0 0 -
6 MST 15 mg Tablet 518 - - - 518 0 -
7 MST 10 mg Tablet 283 - - - 283 0 -

1 2 3 4 5 6 7 8 9 10
1 MST 10 mg Tab 1/13/2015 1/13/2015 2 rusli damai sekayu dr.Tora.

1/16/2015 1/16/2015 2 ahdan sekayu dr.Tora.
Jumlah 4
2 MST 15 mg Tab 1/12/2015 1/12/2015 1 supardi karta jaya dr. Hikamtar
Jumlah 1
3 Morpin Inj Tab 1/9/2015 1 winda bailangu dr. Dian Kesumarini.SpAn
1/9/2015 1 sit aisyah tanjung keputren dr. Dian Kesumarini.SpAn
1/10/2015 1 sudar sungai keruh dr. Dian Kesumarini.SpAn
1/15/2015 1 yent babt toman dr. Dian Kesumarini.SpAn
1/28/2015 1 eka sekayu dr. Dian Kesumarini.SpAn
1/28/2015 1 sumardi keluang dr. Dian Kesumarini.SpAn
1/29/2015 1 susi susant keluang dr. Dian Kesumarini.SpAn
1/29/2015 1 krisna tanjung bulan dr. Dian Kesumarini.SpAn
Jumlah 8
4 Fentanil Tab 1/1/2015 1/1/2015 1 indah kasmaran dr. Dian Kesumarini.SpAn

1/1/2015 1/1/2015 1 sumarni lais dr. Dian Kesumarini.SpAn
1/2/2015 1/2/2015 1 iis sumarni sekayu dr. Dian Kesumarini.SpAn
1/3/2015 1/3/2015 1 Rodatul janah sekayu dr. Dian Kesumarini.SpAn
1/3/2015 1/3/2015 1 Mulyana sekayu dr. Dian Kesumarini.SpAn
1/5/2015 1/5/2015 1 Jamaludin sekayu dr. Dian Kesumarini.SpAn
1/5/2015 1/5/2015 1 Marlina sekayu dr. Dian Kesumarini.SpAn
1/5/2015 1/5/2015 1 Sri sekayu dr. Dian Kesumarini.SpAn
1/7/2015 1/7/2015 1 Nauval sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 ST. Aisah sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 2 Heri sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 Dede sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 Sri Hanafiah sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 Apriyadi sekayu dr. Dian Kesumarini.SpAn
1/8/2015 1/8/2015 1 St. Istmah tegal mulya dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Lajmi suka jaya dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Jimi Saputra bangun rejo dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Ardion sekayu dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Sumirah babat supat dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Tut sekayu dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 2 Peni sekayu dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Tri ulak paceh dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Nirwana sekayu dr. Dian Kesumarini.SpAn
1/9/2015 1/9/2015 1 Akbar sumber rizki dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 Ruspidah rantau kasih dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 Pahria sekayu dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 Met sekayu dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 Asri sekayu dr.Oyon.SPB
1/10/2015 1/10/2015 1 Yahadi sindang marga dr.Oyon.SPB
1/10/2015 1/10/2015 1 irmayasari sekayu dr. Dian Kesumarini.SpAn
1/10/2015 1/10/2015 1 wulan lais dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 dion sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 mazaini sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 nurlela bintale dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 nurlia sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 sit aisyah sekayu dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 letu sidang marga dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 winda sungai lilin dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 emilda babt toman dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 dewi trans dr. Dian Kesumarini.SpAn
1/11/2015 1/11/2015 1 saripah sungai lilin dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 melia tebing bulan dr.Taufik Firdaus.SPOG
1/12/2015 1/12/2015 1 memori sekayu dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 3 krisna sekayu dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 karina sekayu dr.Taufik Firdaus.SPOG
1/12/2015 1/12/2015 2 koirul tebing bulan dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 leli sangga desa dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 2 neni tebing bulan dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 mita ulak bacang dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 2 nanik sekayu dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 yuliana sekayu dr. Dian Kesumarini.SpAn
1/12/2015 1/12/2015 1 fitriani sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 ferdian sekayu dr.Taufik Firdaus.SPOG
1/13/2015 1/13/2015 1 amiza sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 asini sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 2 triasi sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 arisa sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 herniwat jirak dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 ernawat sekayu dr. Dian Kesumarini.SpAn
1/13/2015 1/13/2015 1 noni sekayu dr. Dian Kesumarini.SpAn
1/14/2015 1/14/2015 1 intan sungai lilin dr. Dian Kesumarini.SpAn
1/14/2015 1/14/2015 1 masito sekayu dr. Dian Kesumarini.SpAn
1/14/2015 1/14/2015 2 yuni sarah babt toman dr. Dian Kesumarini.SpAn
1/15/2015 1/15/2015 1 hosiah sekayu dr. Dian Kesumarini.SpAn
1/15/2015 1/15/2015 1 janah keluang dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 hayat jirak dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 rusik sekayu dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 jamalia sekayu dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 elisa sekayu dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 winda sekayu dr.Taufik Firdaus.SPOG
1/17/2015 1/17/2015 1 dimas sekayu dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 sudarni mangun jaya dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 leni karang waru dr. Dian Kesumarini.SpAn
1/17/2015 1/17/2015 1 rita zahara sekayu dr.Taufik Firdaus.SPOG
1/19/2015 1/19/2015 1 tantan jirak dr. Dian Kesumarini.SpAn
1/19/2015 1/19/2015 1 reni macan sakt dr. Dian Kesumarini.SpAn
1/19/2015 1/19/2015 1 sri yunita sekayu dr. Dian Kesumarini.SpAn
1/19/2015 1/19/2015 1 rima sekayu dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 wagio plakat tnggi dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 widiyawaty babt toman dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 yunita epil dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 yayu sekayu dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 lerdi sekayu dr. Dian Kesumarini.SpAn
1/20/2015 1/20/2015 1 hendri sekayu dr. Dian Kesumarini.SpAn
1/21/2015 1/21/2015 2 sri pujiat tungkkal jaya dr. Dian Kesumarini.SpAn
1/21/2015 1/21/2015 1 iis dahlia ulak pandan dr. Dian Kesumarini.SpAn
1/21/2015 1/21/2015 1 masdalena sekayu dr. Dian Kesumarini.SpAn
1/22/2015 1/22/2015 1 abdullah baba toman dr. Dian Kesumarini.SpAn
1/22/2015 1/22/2015 1 ratna dewi sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 mardiat sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 asiah sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 ainun sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 apriant mulyo asih dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 senang sekayu dr. Dian Kesumarini.SpAn
1/23/2015 1/23/2015 1 fitria sekayu dr. Dian Kesumarini.SpAn
1/24/2015 1/24/2015 1 tnii teluk kijing dr.Taufik Firdaus.SPOG
1/24/2015 1/24/2015 1 Semi keluang dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 eva sekayu dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 yayan jirak dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 asima sekayu dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 kamas sekayu dr. Dian Kesumarini.SpAn
1/25/2015 1/25/2015 1 trimurt sekayu dr. Dian Kesumarini.SpAn
1/26/2015 1/26/2015 1 sumardi keluang dr. Dian Kesumarini.SpAn
1/26/2015 1/26/2015 1 nurjani plkat tnggi dr. Dian Kesumarini.SpAn
1/27/2015 1/27/2015 1 elita sekayu dr. Dian Kesumarini.SpAn
1/27/2015 1/27/2015 1 sit salama sekayu dr. Dian Kesumarini.SpAn
1/27/2015 1/27/2015 1 rusmini sekayu dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 sujina dusun waihandar dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 emina ulak paceh dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 emorsi bailangu dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 musri kartajaya dr. Dian Kesumarini.SpAn
1/28/2015 1/28/2015 1 eka bandar jaya dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 rosidin sungai batang dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 mustka keluang dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 aziza dusun kasmaran dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 winarni sungai batang dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 atka sekayu dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 verawat babat toman dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 wayan bukit slabu dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 abu bakar simpang sari dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 susi susant sekayu dr. Dian Kesumarini.SpAn
1/29/2015 1/29/2015 1 rahmat keluang dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 1 puspa sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 2 karnadi sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 1 heniwat sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 1 nurmala sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 2 okta rizki sekayu dr. Dian Kesumarini.SpAn
1/30/2015 1/30/2015 1 supriatn sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 1 linawat sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 1 putri sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 1 rani sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 3 leo candra yangjung agung dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 3 abdullah sekayu dr. Dian Kesumarini.SpAn
1/31/2015 1/31/2015 1 nurbait sunggai angit dr. Dian Kesumarini.SpAn
Jumlah 151
Sekayu, 8 Januari 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
N-16
Bulan : Januari
Tahun : 2014
uaran Persediaan
Akhir Bulan Ket
Jumlah
(8-11)
13
0 794 - 794 794
0 0 - 0 0
151 329 - 480 329
8 138 - 146 138
0 0 - 0 0
1 518 - 519 518
4 283 - 287 283
0 0
0 0
uaran Persediaan
Akhir Bulan Ket
Jumlah
(8-11)
13
3 791 - 791
0 0 - 0
117 212 - 212
4 134 - 135
0 0 - 0
0 518 - 563
0 283 - 324
Ket
11
No. Izin RS :-
No. Izin Khusus :-

1 2 3 4 5 6 7 8 9 10 11
4 Morfin 10 mg Ampul 118 - - - 118 1 1
6 MST 15 mg Tablet 508 - - - 508 0 0
7 MST 10 mg Tablet 263 - - - 263 73 73
Sekayu, Juli 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS : Bulan : Mei
Resep Pasien Dokter

No Nama Sediaan Satuan Tanggal Tanggal Jumlah Ket
1 2 3 4 5 6 7 8 9 10 11
1 MST 10 mg Tab 5/11/2015 5/11/2015 8 Syarifudin Sekayu dr. Fary

5/13/2015 5/13/2015 3 Sri Suriat Sungai Angit dr. Taufik SpOG
5/20/2015 5/20/2015 2 Jarmi Mekar Jaya dr. Rosyidi SpPd
5/21/2015 5/21/2015 3 Jarmi Mekar Jaya dr. Rosyidi SppD
5/21/2015 5/21/2015 2 Sarmin Balai Agung dr. Tora
5/21/2015 5/21/2015 5 Amer hamzah Tebing Bulang dr. Rosyidi SpPd
5/22/2015 5/22/2015 2 Jarmi Mekar Jaya dr. Asdi SppD
5/27/2015 5/27/2015 2 Rosi Mangun Jaya dr. Rosyidi SpPd
5/28/2015 5/28/2015 2 M. Sobri Bailangu dr. Tora
5/28/2015 5/28/2015 3 Yuliana Sindang dr.Taufik SpOG
5/28/2015 5/28/2015 2 Rosi Mangun Jaya dr.Rosyidi SpPd
5/28/2015 5/28/2015 14 Otb Tegal Mulyo dr. Asdi SpPd
5/29/2015 5/29/2015 3 Sobri Bailangu dr. Asdi SpPd
5/29/2015 5/29/2015 3 Yuliana Sindang dr. Taufik SpOG
5/29/2015 5/29/2015 2 Rosi Mangun Jaya dr. Asdi SpPd
5/31/2015 5/31/2015 2 Amrina Mangun Jaya dr. Herianto
5/31/2015 5/31/2015 2 Sobri Bailangu dr.Herianto
5/31/2015 5/31/2015 2 ZIZI Sekayu dr.Tora
5/31/2015 5/31/2015 2 Rosi Mangun Jaya dr.Asdi SpPd
5/31/2015 5/31/2015 4 Amrina Mangun Jaya dr. Asdi SpPd
5/31/2015 5/31/2015 2 ZIZI Sekayu dr. Herianto
5/31/2015 5/31/2015 3 Sobri Bailangu dr.Asdi SpPd
Jumlah 73
2 Fentanyl inj 5/1/2015 5/1/2015 1 Hendriani Lais dr. Dian SpAn

5/2/2015 5/2/2015 1 Martna Lingga Sari dr. Dian SpAn
5/3/2015 5/3/2015 1 Eka Sidomulyo dr. Dian SpAn
5/3/2015 5/3/2015 1 Prida Sidomulyo dr. Dian SpAn
5/4/2015 5/4/2015 1 Marlina Talang Ulin dr. Dian SpAn
5/4/2015 5/4/2015 1 Tembel Sungai Keruh dr. Dian SpAn
5/4/2015 5/4/2015 1 Dewi Oktasari Randik dr. Dian SpAn
5/4/2015 5/4/2015 1 Nurhasanah Lais dr. Dian SpAn
5/4/2015 5/4/2015 1 Lensi Teluk Kijing dr. Dian SpAn
5/4/2015 5/4/2015 1 Nanda Epil dr. Dian SpAn
5/4/2015 5/4/2015 1 Neta Simpang Marga dr. Dian SpAn
5/4/2015 5/4/2015 1 Helmiat Sungai Lilin dr. Dian SpAn
5/5/2015 5/5/2015 1 Silvia Agung selatan dr. Dian SpAn
5/5/2015 5/5/2015 1 Sepriat Sekayu dr. Dian SpAn
5/5/2015 5/5/2015 1 Mimin Lumpatan dr. Dian SpAn
5/5/2015 5/5/2015 1 Sami Sekayu dr. Dian SpAn
5/5/2015 5/5/2015 1 Susana Sekayu dr. Dian SpAn
5/5/2015 5/5/2015 1 Sakiya Jirak dr. Dian SpAn
5/5/2015 5/5/2015 1 Kasamah Sungai Lilin dr. Dian SpAn
5/5/2015 5/5/2015 1 Tukimin Sungai Lilin dr. Dian SpAn
5/5/2015 5/5/2015 1 Puji Sungai Lilin dr. Dian SpAn
5/5/2015 5/5/2015 1 Yant Babat Toman dr. Dian SpAn
5/6/2015 5/6/2015 1 haris Srigunung dr. Dian SpAn
5/6/2015 5/6/2015 1 Isman Plakat tnggi dr. Dian SpAn
5/6/2015 5/6/2015 1 Sit Zahara rantau Panjang dr. Dian SpAn
5/6/2015 5/6/2015 1 Sumart Keluang dr. Dian SpAn
5/6/2015 5/6/2015 1 Sit Babat Toman dr. Dian SpAn
5/6/2015 5/6/2015 1 Ria Baru Jaya dr. Dian SpAn
5/7/2015 5/7/2015 1 Diana Lumpatan dr. Dian SpAn
5/7/2015 5/7/2015 1 Nurlela Sekayu dr. Dian SpAn
5/7/2015 5/7/2015 1 Marisa Sekayu dr. Dian SpAn
5/7/2015 5/7/2015 1 Firman Kayuara dr. Dian SpAn
5/7/2015 5/7/2015 1 Marisa Sekayu dr. Dian SpAn
5/7/2015 5/7/2015 1 Sumarni Simpang Tungkal dr. Dian SpAn
5/7/2015 5/7/2015 1 Nurhasanah Babat Toman dr. Dian SpAn
5/7/2015 5/7/2015 1 Susi Lestari Soak dr. Dian SpAn
5/7/2015 5/7/2015 1 Sutah Sungai Lilin dr. Dian SpAn
5/8/2015 5/8/2015 1 Menuk Sekayu dr. Dian SpAn
5/8/2015 5/8/2015 1 Abdi Darma Sekayu dr. Dian SpAn
5/8/2015 5/8/2015 1 Leni marlina Bailangu dr. Dian SpAn
5/8/2015 5/8/2015 1 Darma Bandar Jaya dr. Dian SpAn
5/8/2015 5/8/2015 1 Rupini Pinang banjar dr. Dian SpAn
5/8/2015 5/8/2015 1 Srimanik Tebing bulang dr. Dian SpAn
5/8/2015 5/8/2015 1 Ishak Sukajaya dr. Dian SpAn
5/9/2015 5/9/2015 1 Lindawat Babat Toman dr. Dian SpAn
5/9/2015 5/9/2015 1 Emilia Payaraman dr. Dian SpAn
5/10/2015 5/10/2015 1 Kartni Lais dr. Dian SpAn
5/11/2015 5/11/2015 1 Najmi Rantau Kasih dr. Dian SpAn
5/11/2015 5/11/2015 1 Tani Sari Mekar Jaya dr. Dian SpAn
5/11/2015 5/11/2015 1 Jon Sanga Desa dr. Dian SpAn
5/11/2015 5/11/2015 1 Fajar Sungai Lilin dr. Dian SpAn
5/11/2015 5/11/2015 1 Pidiawat Sri Damai dr. Dian SpAn
5/12/2015 5/12/2015 1 yusant Kayuara dr. Dian SpAn
5/12/2015 5/12/2015 1 Eva Sungai Lilin dr. Dian SpAn
5/12/2015 5/12/2015 1 Tatk MBI dr. Dian SpAn
5/12/2015 5/12/2015 1 Norce Tebing bulang dr. Dian SpAn
5/12/2015 5/12/2015 1 Sumarni Sekayu dr. Dian SpAn
5/12/2015 5/12/2015 1 Nurhasanah Balai Agung dr. Dian SpAn
5/12/2015 5/12/2015 1 Sri Suart Sungai Angit dr. Dian SpAn
5/12/2015 5/12/2015 1 Endang Balai Agung dr. Dian SpAn
5/12/2015 5/12/2015 1 Kurniat Karang Agung dr. Dian SpAn
5/12/2015 5/12/2015 1 Eko saputra sukarami dr. Dian SpAn
5/12/2015 5/12/2015 1 Manuya Ngulak dr. Dian SpAn
5/12/2015 5/12/2015 1 Diana Gajahmat dr. Dian SpAn
5/13/2015 5/13/2015 1 Linda suaimi Lumpatan dr. Dian SpAn
5/13/2015 5/13/2015 1 Isra Sekayu dr. Dian SpAn
5/13/2015 5/13/2015 1 Desi Lubuk dr. Dian SpAn
5/13/2015 5/13/2015 1 Masniani Tungkal dr. Dian SpAn
5/14/2015 5/14/2015 1 Roiha Lumpatan dr. Dian SpAn
5/15/2015 5/15/2015 1 Sri Sungai Lilin dr. Dian SpAn
5/16/2015 5/16/2015 1 Yuliant Babat Toman dr. Dian SpAn
5/16/2015 5/16/2015 1 Miswa Rantau Kasih dr. Dian SpAn
5/18/2015 5/18/2015 1 Susant Tebing bulang dr. Dian SpAn
5/18/2015 5/18/2015 1 Nirma Rantau Panjang dr. Dian SpAn
5/18/2015 5/18/2015 1 Danisa Mangun Jaya dr. Dian SpAn
5/18/2015 5/18/2015 1 Riki rantau Panjang dr. Dian SpAn
5/18/2015 5/18/2015 1 Murdani Ngulak dr. Dian SpAn
5/18/2015 5/18/2015 1 Sudarsi WargaMulia dr. Dian SpAn
5/18/2015 5/18/2015 1 Wiji R Air Puth dr. Dian SpAn
5/18/2015 5/18/2015 1 Risnawat Plakat tnggi dr. Dian SpAn
5/19/2015 5/19/2015 1 Rini Plakat tnggi dr. Dian SpAn
5/19/2015 19/5/1015 1 Mutmainah Gajahmat dr. Dian SpAn
5/19/2015 5/19/2015 1 Aswadi Teluk Kijing dr. Dian SpAn
5/19/2015 19/5/1016 1 Triwulandari Lais dr. Dian SpAn
5/19/2015 5/19/2015 1 Rini Eka Sekayu dr. Dian SpAn
5/19/2015 19/5/1017 1 Andriani Sekayu dr. Dian SpAn
5/19/2015 5/19/2015 1 Nopera Plakat tnggi dr. Dian SpAn
5/19/2015 19/5/1018 1 Yurnita Peninggalan dr. Dian SpAn
5/19/2015 5/19/2015 1 Fauziah Mangun Jaya dr. Dian SpAn
5/19/2015 19/5/1015 1 Kasmujen Sungai Lilin dr. Dian SpAn
5/19/2015 5/19/2015 1 Yant Jirak dr. Dian SpAn
5/19/2015 19/5/1016 1 Hety Muara Teladan dr. Dian SpAn
5/20/2015 5/20/2015 1 Sulastri Peninggalan dr. Dian SpAn
5/20/2015 5/20/2015 1 Yurnita Soak Baru dr. Dian SpAn
5/20/2015 5/20/2015 1 Harwant Sekayu dr. Dian SpAn
5/20/2015 5/20/2015 1 Saris Plakat tnggi dr. Dian SpAn
5/20/2015 5/20/2015 1 Juita Keluang dr. Dian SpAn
5/20/2015 5/20/2015 1 Dana Sekayu dr. Dian SpAn
5/20/2015 5/20/2015 1 Sulastri Kayuara dr. Dian SpAn
5/22/2015 5/22/2015 1 Sit Rokaya Sekayu dr. Dian SpAn
5/22/2015 5/22/2015 1 Lasima Bukit selabu dr. Dian SpAn
5/22/2015 5/22/2015 1 Yurnalika Muara Teladan dr. Dian SpAn
5/25/2015 5/25/2015 1 Yuliana Bailangu dr. Dian SpAn
5/25/2015 5/25/2015 1 Herawat Sekayu dr. Dian SpAn
5/25/2015 5/25/2015 1 Mariani Sungai Lilin dr. Dian SpAn
5/25/2015 5/25/2015 1 Kartna Sekayu dr. Dian SpAn
5/25/2015 5/25/2015 1 Kutzaipah Panca Tunggal dr. Dian SpAn
5/25/2015 5/25/2015 1 dewi P Teluk Kijing dr. Dian SpAn
5/25/2015 5/25/2015 1 Dewi Plakat tnggi dr. Dian SpAn
5/25/2015 5/25/2015 1 Srimulyani Sungai Lilin dr. Dian SpAn
5/25/2015 5/25/2015 1 Matjain Babat Toman dr. Dian SpAn
5/25/2015 5/25/2015 1 Sutni Babat Toman dr. Dian SpAn
5/25/2015 5/25/2015 1 Heldiana Ulak pace dr. Dian SpAn
5/25/2015 5/25/2015 1 Devi A Lumpatan dr. Dian SpAn
5/26/2015 5/26/2015 1 Dempi Air Puth dr. Dian SpAn
5/26/2015 5/26/2015 1 Meri Ngulak dr. Dian SpAn
5/26/2015 5/26/2015 1 Sukri Lais dr. Dian SpAn
5/26/2015 5/26/2015 1 Zubaidah Peninggalan dr. Dian SpAn
5/26/2015 5/26/2015 1 Heldiana Babat Toman dr. Dian SpAn
5/26/2015 5/26/2015 1 Fina Oktarina Tanah abang dr. Dian SpAn
5/26/2015 5/26/2015 1 yurnaim Epil dr. Dian SpAn
5/26/2015 5/26/2015 1 Lili Plakat tnggi dr. Dian SpAn
5/27/2015 5/27/2015 1 Sukmawat Macan Sakt dr. Dian SpAn
5/27/2015 5/27/2015 1 Jepri Bailangu dr. Dian SpAn
5/27/2015 5/27/2015 1 wiwin Bailangu dr. Dian SpAn
5/27/2015 5/27/2015 1 Radipan Sekayu dr. Dian SpAn
5/27/2015 5/27/2015 1 Rosmiat Plakat tnggi dr. Dian SpAn
5/27/2015 5/27/2015 1 Ponira Plakat tnggi dr. Dian SpAn
5/27/2015 5/27/2015 1 Lasinem Plakat tnggi dr. Dian SpAn
5/27/2015 5/27/2015 1 Oktariani Karang Ringin dr. Dian SpAn
5/27/2015 5/27/2015 1 Sant Sekayu dr. Dian SpAn
5/27/2015 5/27/2015 1 Kiki Napal dr. Dian SpAn
5/27/2015 5/27/2015 1 Nurkomala Lumpatan dr. Dian SpAn
5/27/2015 5/27/2015 1 Ruli Teluk Kijing dr. Dian SpAn
5/29/2015 5/29/2015 1 Tulus Srimulya dr. Dian SpAn
5/30/2015 5/30/2015 1 Irma Suryani Sukarami dr. Dian SpAn
5/30/2015 5/30/2015 1 Ira Sekayu dr. Dian SpAn
5/31/2015 5/31/2015 1 Asmawat Tanjung Agung dr. Dian SpAn
JUMLAH 138
3 Morfin inj 5/5/2015 5/5/2015 1 Herlina Tanah Abang dr. Fathi
JUMLAH 1
4 Pethidin inj 5/15/2015 5/15/2015 1 Rita Sekayu dr. Dian SpAn

5/16/2015 5/16/2015 1 Sukma Sekayu dr. Dian SpAn
JUMLAH 2
Sekayu, Juli 2015

Penanggung Jawab
Dra. Hanifdar, Apt
Nip. 19670730 199703 2 001
N-16
Bulan : Mei
Tahun : 2015
Persediaan
Akhir Bulan Ket
(8-11)
12 13
774 -
0 -
149 -
117 -
0 -
508 -
190 -
Sekayu, Juli 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-

1 2 3 4 5 6 7 8 9 10 11
4 Morfin 10 mg Ampul 117 - - - 117 14 14
6 MST 15 mg Tablet 508 - - - 508 22 22
7 MST 10 mg Tablet 190 - - - 190 166 166
Sekayu, Juli 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS : Bulan : Juni
Resep Pasien Dokter

1 2 3 4 5 6 7 8 9 10 11
1 MST 10 mg Tab 6/4/2015 6/4/2015 2 Huzaibah Lumpatan dr.Dian SpAn

6/4/2015 6/4/2015 14 Otb Tegal Mulyo dr.Asdi SpPd
6/5/2015 6/5/2015 3 Huzaibah Lumpatan dr.Asdi SpPd
6/7/2015 6/7/2015 3 Huzaibah Lumpatan dr.Herianto
6/8/2015 6/8/2016 1 Hulik Lumpatan dr.Taufik SpOG
6/9/2015 6/9/2015 10 Heni Sekayu dr.Taufik SpOG
6/10/2015 6/10/2015 2 Husni Teluk Kijing dr.oyon SpB
6/10/2015 6/10/2015 10 Retno Kayuare dr.Taufik SpoG
6/11/2015 6/11/2015 10 Heriani Sekayu dr.Taufik SpOG
6/11/2015 6/11/2015 2 Rusni Teluk Kijing dr.Dian SpAn
6/11/2015 6/11/2015 10 Tasa Nasuton Bailangu dr. Syarifudin SpAn
6/13/2015 6/13/2015 10 Heni Sekayu dr.Taufik SpOG
6/14/2015 6/14/2015 3 Kumini Sekayu dr. Taufik SpOG
6/17/2015 6/17/2015 10 M. Sobri Sekayu dr. Syarifudin SpPd
6/20/2015 6/20/2015 3 Yamsa Teluk Kijing dr. Syarifudin SpPd
6/20/2015 6/20/2015 10 Rusna Wat Sekayu dr. Syarifudin SpPd
6/21/2015 6/21/2015 3 M. Yamin Teluk Kijing dr. Herianto
6/24/2015 6/24/2015 15 Isnawat Peninggalan dr. Rosyidi SpPd
6/25/2015 6/25/2015 10 Novita anggraini Sekayu dr.Taufik SpOG
6/28/2015 6/28/2015 3 Maimunah Sekayu dr. Herianto
6/29/2015 6/29/2015 7 Yamsa Teluk Kijing dr.Rosyidi SpPd
6/29/2015 6/29/2015 2 Yamin Sekayu dr.Herianto
6/29/2015 6/29/2015 2 Wast Sekayu dr.Herianto
6/29/2015 6/29/2015 3 Sahril Sekayu dr.Herianto
6/29/2015 6/29/2015 3 Maimunah Sekayu dr.Rosyidi SpPd
6/29/2015 6/29/2015 2 Hasan Sekayu dr.Rosyidi SpPd
6/29/2015 6/29/2015 10 Rozak Sekayu dr.Rosyidi SpPd
6/30/2015 6/30/2015 2 Yamin Sekayu dr.Herianto
6/30/2015 6/30/2015 1 Wast Sekayu dr.Herianto
Jumlah 166
2 Fentanyl inj 6/1/2015 6/1/2015 2 Romasari Sekayu dr. Dian SpAn

6/2/2015 6/2/2016 1 Nurlaila Sekayu dr. Dian SpAn
6/2/2015 6/2/2015 2 Rath Sekayu dr. Dian SpAn
6/2/2015 6/2/2015 1 Nazirah Sekayu dr. Dian SpAn
6/2/2015 6/2/2015 1 M.Fajri Sekayu dr. Dian SpAn
6/3/2015 6/3/2015 1 Susilawat Sekayu dr. Dian SpAn
6/3/2015 6/3/2015 1 Dewi sartka Sekayu dr. Dian SpAn
6/3/2015 6/3/2015 1 Sri Rezeki Sekayu dr. Dian SpAn
6/3/2015 6/3/2015 1 Wart Sekayu dr. Dian SpAn
6/3/2015 6/3/2015 1 Hasiah Sekayu dr. Dian SpAn
6/3/2015 6/3/2015 1 Lusiana Sekayu dr. Dian SpAn
6/4/2015 6/4/2015 1 Huzaibah Sekayu dr. Dian SpAn
6/4/2015 6/4/2015 1 Ernawat Sekayu dr. Dian SpAn
6/4/2015 6/4/2015 1 Farida Sekayu dr. Dian SpAn
6/4/2015 6/4/2015 1 Ita lastut Sekayu dr. Dian SpAn
6/4/2015 6/4/2015 1 Suri Sekayu dr. Dian SpAn
6/4/2015 6/4/2015 1 Bahuning Sekayu dr. Dian SpAn
6/4/2015 6/4/2015 1 Anita Sekayu dr. Dian SpAn
6/4/2015 6/4/2015 1 Emida Sanga desa dr. Dian SpAn
6/4/2015 6/4/2015 1 Ramadastn Bailangu dr. Dian SpAn
6/4/2015 6/4/2015 1 Elizabet Karangwangu dr. Dian SpAn
6/6/2015 6/6/2015 1 Rosita gajah mat dr. Dian SpAn
6/6/2015 6/6/2015 1 Rath Babat Toman dr. Dian SpAn
6/6/2015 6/6/2015 1 Ramadastn Bailangu dr. Dian SpAn
6/8/2015 6/8/2015 1 Suryani Sekayu dr. Dian SpAn
6/8/2015 6/8/2015 1 Ica Mangun jaya dr. Dian SpAn
6/9/2015 6/9/2015 1 Susilawat MuaraPunjung dr. Dian SpAn
6/9/2015 6/9/2015 1 Yulita Sekayu dr. Dian SpAn
6/10/2015 6/10/2015 1 Doni Bailangu dr. Dian SpAn
6/10/2015 6/10/2015 1 Yulia Sekayu dr. Dian SpAn
6/10/2015 6/10/2015 1 Kurnia Sekayu dr. Dian SpAn
6/11/2015 6/11/2015 1 Et Sekayu dr. Dian SpAn
6/11/2015 6/11/2015 1 Sarmidi Babat Toman dr. Dian SpAn
6/11/2015 6/11/2015 1 Sulastri Sekayu dr. Dian SpAn
6/12/2015 6/12/2015 1 Sumi Sekayu dr. Dian SpAn
6/15/2015 6/15/2015 1 Heni Sekayu dr. Dian SpAn
6/15/2015 6/15/2015 1 Rohila LubukPadi dr. Dian SpAn
6/16/2015 6/16/2015 1 Evi Sekayu dr. Dian SpAn
6/16/2015 6/16/2015 1 Dava Adita Sekayu dr. Dian SpAn
6/17/2015 6/17/2015 1 Martalina Ulakpace dr. Dian SpAn
6/18/2015 6/18/2015 1 Antoni LubukPadi dr. Dian SpAn
6/18/2015 6/18/2015 1 Muryat SungaiLilin dr. Dian SpAn
6/18/2015 6/18/2015 1 Reni Ayu Teladan dr. Dian SpAn
6/18/2015 6/18/2015 1 Retno Sekayu dr. Dian SpAn
6/18/2015 6/18/2015 1 Rusmala Sekayu dr. Dian SpAn
6/18/2015 6/18/2015 1 Sumiat Sekayu dr. Dian SpAn
6/18/2015 6/18/2015 1 Muryat SungaiLilin dr. Dian SpAn
6/18/2015 6/18/2015 1 Samitri Sekayu dr. Dian SpAn
6/18/2015 6/18/2015 1 Ariyant Bailangu dr. Dian SpAn
6/19/2015 6/19/2015 1 Eva Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Kutut Gagan kamputen dr. Dian SpAn
6/19/2015 6/19/2015 1 Alpino Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Salabiah Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Fitriani Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Wasiah Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Sri Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Sunarsi Betung dr. Dian SpAn
6/19/2015 6/19/2015 1 Sarinah SungaiLilin dr. Dian SpAn
6/19/2015 6/19/2015 1 Eva susant Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Destri Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Tika Sekayu dr. Dian SpAn
6/19/2015 6/19/2015 1 Neneng Sekayu dr. Dian SpAn
6/20/2015 6/20/2015 1 Aswad Babat Toman dr. Dian SpAn
6/20/2015 6/20/2015 1 Fatma Bailangu dr. Dian SpAn
6/20/2015 6/20/2015 1 Inda Bailangu dr. Dian SpAn
6/20/2015 6/20/2015 1 Endang Sekayu dr. Dian SpAn
6/20/2015 6/20/2015 1 Eki Sekayu dr. Dian SpAn
6/20/2015 6/20/2015 1 Uci Okta Keluang dr. Dian SpAn
6/20/2015 6/20/2015 1 Tutk Ngulak dr. Dian SpAn
6/21/2015 6/21/2015 1 Heri Sekayu dr. Dian SpAn
6/21/2015 6/21/2015 1 Wasniah Sekayu dr. Dian SpAn
6/21/2015 6/21/2015 1 Yuni Sekayu dr. Dian SpAn
6/21/2015 6/21/2015 1 Deni Sekayu dr. Dian SpAn
6/21/2015 6/21/2015 1 Pardin SungaiLilin dr. Dian SpAn
6/22/2015 6/22/2015 1 Suraidah Karyamaju dr. Dian SpAn
6/22/2015 6/22/2015 1 Rohilah Ngulak dr. Dian SpAn
6/22/2015 6/22/2015 1 Febriansyah SungaiLilin dr. Dian SpAn
6/22/2015 6/22/2015 1 Sit Aminah Sekayu dr. Dian SpAn
6/22/2015 6/22/2015 1 Asni Tanjung Karang dr. Dian SpAn
6/22/2015 6/22/2015 1 Winart Babat dr. Dian SpAn
6/22/2015 6/22/2015 1 Salik Jembatan Baru dr. Dian SpAn
6/22/2015 6/22/2015 1 Agustna Ngulak dr. Dian SpAn
6/22/2015 6/22/2015 1 Dwi Babat Toman dr. Dian SpAn
6/23/2015 6/23/2015 1 Kardiant Cinta Damai dr. Dian SpAn
6/23/2015 6/23/2015 1 Dwi Ropi Sekayu dr. Dian SpAn
6/23/2015 6/23/2015 1 Marnawat Bailangu dr. Dian SpAn
6/23/2015 6/23/2015 1 Sunarsi Purwosari dr. Dian SpAn
6/23/2015 6/23/2015 1 Sunarya Sekayu dr. Dian SpAn
6/23/2015 6/23/2015 1 Sit Muntoha Sekayu dr. Dian SpAn
6/23/2015 6/23/2015 1 Marsini Rejodadi dr. Dian SpAn
6/23/2015 6/23/2015 1 Rohani Mangun jaya dr. Dian SpAn
6/24/2015 6/24/2015 1 Fitriani Sekayu dr. Dian SpAn
6/24/2015 6/24/2015 1 Mudaladi Sekayu dr. Dian SpAn
6/24/2015 6/24/2015 1 Megawat Sekayu dr. Dian SpAn
6/24/2015 6/24/2015 1 Asnani Jirak dr. Dian SpAn
6/24/2015 6/24/2015 1 Wiwin Lubuk Teberau dr. Dian SpAn
6/24/2015 6/24/2015 1 Sahmin Sanga desa dr. Dian SpAn
6/24/2015 6/24/2015 1 Nurlaila Sekayu dr. Dian SpAn
6/25/2015 6/25/2015 1 Romiah Sekayu dr. Dian SpAn
6/25/2015 6/25/2015 1 Depi Tanjung Agung dr. Dian SpAn
6/25/2015 6/25/2015 1 Amir Hamzah Sekayu dr. Dian SpAn
6/25/2015 6/25/2015 1 Mardini Sekayu dr. Dian SpAn
6/25/2015 6/25/2015 1 Romaiyana Sekayu dr. Dian SpAn
6/26/2015 6/26/2015 1 Heni Sekayu dr. Dian SpAn
6/26/2015 6/26/2015 1 Reihan Sekayu dr. Dian SpAn
6/26/2015 6/26/2015 1 Agung BumiAyu dr. Dian SpAn
6/26/2015 6/26/2015 1 Sukarian SungaiLilin dr. Dian SpAn
6/26/2015 6/26/2015 1 Amir Hamzah Sekayu dr. Dian SpAn
6/26/2015 6/26/2015 1 Yuniani Sekayu dr. Dian SpAn
6/27/2015 6/27/2015 1 Kartni Teluk dr. Dian SpAn
6/27/2015 6/27/2015 1 Rusdi Keluang dr. Dian SpAn
6/29/2015 6/29/2015 1 Zastra Bailangu dr. Dian SpAn
6/29/2015 6/29/2015 1 Umi Sukadamai dr. Dian SpAn
6/29/2015 6/29/2015 1 Elisa Srigunung dr. Dian SpAn
6/29/2015 6/29/2015 1 Nani Bailangu dr. Dian SpAn
6/29/2015 6/29/2015 1 Erni Bailangu dr. Dian SpAn
6/29/2015 6/29/2015 1 Anita Bailangu dr. Dian SpAn
6/29/2015 6/29/2015 1 Sak ari Sekayu dr. Dian SpAn
6/29/2015 6/29/2015 1 Dedi Sekayu dr. Dian SpAn
6/29/2015 6/29/2015 1 Nurton Sekayu dr. Dian SpAn
6/29/2015 6/29/2015 1 Yuli Sekayu dr. Dian SpAn
6/29/2015 6/29/2015 1 Rini Sekayu dr. Dian SpAn
JUMLAH 124
3 Morfin inj 6/25/2015 6/25/2015 1 Hamzah Ulak paceh dr.Citra

6/26/2015 6/26/2015 1 Hamzah Ulak paceh dr. Dian SpAn
6/28/2015 6/28/2015 3 Hamzah Ulak paceh dr.Fahri
6/29/2015 6/29/2015 3 Hamzah Ulak paceh dr. Oyon SpB
JUMLAH 14
4 Pethidin inj 6/6/2015 6/6/2015 2 Hulik Sekayu dr. Asdi SpPd

6/17/2015 6/17/2015 1 Suratmi Air Puth Ulu dr. Dian SpAn
JUMLAH 3
5 MST 15 Tab 6/17/2015 6/17/2015 10 Rohat Sekayu dr.Saripudin SppD

6/19/2015 6/19/2015 3 Ibrahim Betung dr.Saripudin SppD
6/27/2015 6/27/2015 6 Herman Sekayu dr.Saripudin SppD
6/27/2015 6/27/2015 3 Maimunah Sekayu dr.Saripudin SppD
JUMLAH 22
Sekayu, Juli 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
N-16
Bulan : Juni
Tahun : 2015
Persediaan
Akhir Bulan Ket
(8-11)
12 13
771 -
0 -
25 -
103 -
0 -
486 -
24 -
Sekayu, Juli 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-

1 2 3 4 5 6 7 8 9 10 11
3 Fentanyl 0,05 MG/ML 2 ML Ampul 25 - - 250 275 131 131
4 Morfin 10 mg Ampul 103 - - - 103 3 3
6 MST 15 mg Tablet 486 - - - 486 107 107
7 MST 10 mg Tablet 24 - - - 24 24 24
Sekayu, September 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS : Bulan : Juli
Resep Pasien Dokter

1 2 3 4 5 6 7 8 9 10 11
1 MST 10 mg Tab 7/5/2015 7/5/2015 2 Hermanto Tanjung Raya dr.Herianto

7/6/2015 7/6/2015 2 Fatmah Teladan dr.Rosyidi SpPD
7/6/2015 7/6/2015 3 Amri Tanjung Marga dr.Asdi SpPD
7/7/2015 7/7/2015 2 Hermanto Tanjung Raya dr.Rosyidi SpPD
7/10/2015 7/10/2015 2 Amri Tanjung Marga dr.Asi SpPD
7/30/2015 7/30/2015 13 Rusnaini Muara Punjang dr. Dwi SpPD
Jumlah 24
2 Fentanyl inj 7/2/2015 7/2/2015 1 Hamzah Ulakpaceh dr. Dian SpAn

7/2/2015 7/2/2015 1 Sit Sunart Rejosari dr. Dian SpAn
7/2/2015 7/2/2015 1 Herawat Teluk Kijing dr. Dian SpAn
7/2/2015 7/2/2015 1 Ade Nopiza Bayung lincir dr. Dian SpAn
7/2/2015 7/2/2015 1 Sit Aisah Lumpatan dr. Dian SpAn
7/2/2015 7/2/2015 1 Akurmiat Praja dr. Dian SpAn
7/2/2015 7/2/2015 1 Herlina Sungai Keruh dr. Dian SpAn
7/2/2015 7/2/2015 1 Lesi Sekayu dr. Dian SpAn
7/2/2015 7/2/2015 1 Lindawat Mangunjaya dr. Dian SpAn
7/2/2015 7/2/2015 1 Epasusant Soak baru dr. Dian SpAn
7/2/2015 7/2/2015 1 Ansori Sekayu dr. Dian SpAn
7/2/2015 7/2/2015 1 Reza Sekayu dr. Dian SpAn
7/2/2015 7/2/2015 1 Ade kusuma Sekayu dr. Dian SpAn
7/2/2015 7/2/2015 1 Yesi Widiastut Sekayu dr. Dian SpAn
7/3/2015 7/3/2015 2 Hamzah Ulakpaceh dr. Dian SpAn
7/3/2015 7/3/2015 1 Sit Aisah Lumpatan dr. Dian SpAn
7/5/2015 7/5/2015 1 Maryani Sungai Batang dr. Dian SpAn
7/6/2015 7/6/2015 1 Marhan Jirak dr. Dian SpAn
7/6/2015 1/5/1900 1 Rima Sungai Lilin dr. Dian SpAn
7/6/2015 7/6/2015 1 Saparia Keluang dr. Dian SpAn
7/6/2015 7/6/2015 1 Maryat Epil dr. Dian SpAn
7/6/2015 7/6/2015 1 Hendra Talang Simpang dr. Dian SpAn
7/6/2015 7/6/2015 1 iswedi ulak tebrau dr. Dian SpAn
7/6/2015 7/6/2015 1 garet perum kodim dr. Dian SpAn
7/6/2015 7/6/2015 1 Masyito simpang gardu dr. Dian SpAn
7/7/2015 7/7/2015 1 Husnul epil dr. Dian SpAn
7/7/2015 7/72015 1 Nurlita Ulakpaceh dr. Dian SpAn
7/7/2015 7/7/2015 1 Zupani Mangunjaya dr. Dian SpAn
7/8/2015 7/8/2015 1 Marko Sungai Lilin dr. Dian SpAn
7/9/2015 7/9/2015 1 Nurlela Sekayu dr. Dian SpAn
7/9/2015 7/9/2015 1 Sahlendang Tanjung Agung dr. Dian SpAn
7/9/2015 7/9/2015 1 Alam Perumnas dr. Dian SpAn
7/9/2015 7/9/2015 1 Alrita Ulakpaceh dr. Dian SpAn
7/9/2015 7/9/2015 1 Heldiana Ulakpaceh dr. Dian SpAn
7/9/2015 7/9/2015 1 Tamrin Palembang dr. Dian SpAn
7/9/2015 7/9/2015 1 Enzi Sekayu dr. Dian SpAn
7/9/2015 7/9/2015 1 Yeyen Rantau Kasih dr. Dian SpAn
7/10/2015 7/10/2015 1 Arjuna Babat Supat dr. Dian SpAn
7/10/2015 7/10/2015 1 Marlina Karanganyar dr. Dian SpAn
7/10/2015 7/10/2015 1 Sit Zuhaira Sungai Keruh dr. Dian SpAn
7/10/2015 7/10/2015 1 Sopian Rantau Kasih dr. Dian SpAn
7/10/2015 7/10/2015 1 Fitrianingsih Plakat Tinggi dr. Dian SpAn
7/10/2015 7/10/2015 1 Nurma Plakat Tinggi dr. Dian SpAn
7/10/2015 7/10/2015 1 M.Tanzi Sekayu dr. Dian SpAn
7/10/2015 7/10/2015 1 Simuria Kertayu dr. Dian SpAn
7/10/2015 7/10/2015 1 Fariasi Sungai Keruh dr. Dian SpAn
7/10/2015 7/10/2015 1 Abdul Malik Sungai Lilin dr. Dian SpAn
7/10/2015 7/10/2015 1 M.Sumari Keluang dr. Dian SpAn
7/10/2015 7/10/2015 1 Helena Lawang wetan dr. Dian SpAn
7/10/2015 7/10/2015 1 Mardiana Lumpatan dr. Dian SpAn
7/11/2015 7/11/2015 2 Nurmania Sekayu dr. Dian SpAn
7/11/2015 7/11/2015 1 Sumarni Keluang dr. Dian SpAn
7/11/2015 7/11/2015 1 Erna Karang Agung dr. Dian SpAn
7/12/2015 7/12/2015 1 Sumiat Kayuara dr. Dian SpAn
7/12/2015 7/12/2015 1 Lukman Lumpatan dr. Dian SpAn
7/12/2015 7/12/2015 1 Sukinah Keluang dr. Dian SpAn
7/13/2015 7/13/2015 1 Suciramadani Sungaimedang dr. Dian SpAn
7/13/2015 7/13/2015 1 Koilon Sumber agung dr. Dian SpAn
7/13/2015 7/13/2015 1 DewiKinasih Lumpatan dr. Dian SpAn
7/13/2015 7/13/2015 1 Arwani Sangadesa dr. Dian SpAn
7/14/2015 7/14/2015 1 Samani Keluang dr. Dian SpAn
7/14/2015 7/14/2015 1 Zubaidah Sukarami dr. Dian SpAn
7/14/2015 7/14/2015 1 Mulyari Babat Supat dr. Dian SpAn
7/14/2015 7/14/2015 1 Sobri GMP dr. Dian SpAn
7/14/2015 7/14/2015 1 Kirant TanahAbang dr. Dian SpAn
7/14/2015 7/14/2015 1 Irma Keluang dr. Dian SpAn
7/14/2015 7/14/2015 1 Liza Sekayu dr. Dian SpAn
7/14/2015 7/14/2015 1 Sarni Sungai Lilin dr. Dian SpAn
7/14/2015 7/14/2015 1 Muladi Batang Hari Leko dr. Dian SpAn
7/14/2015 7/14/2015 1 Epa Sit Babat Toman dr. Dian SpAn
7/14/2015 7/14/2015 1 Leni Sungai Lilin dr. Dian SpAn
7/19/2015 7/19/2015 1 Irma Sukadamai dr. Dian SpAn
7/20/2015 7/20/2015 1 Leni Marlina Purwosari dr. Dian SpAn
7/21/2015 7/21/2015 1 Emir Lumpatan dr. Dian SpAn
7/22/2015 7/22/2015 1 Rosi Pandang Dulang dr. Dian SpAn
7/22/2015 7/22/2015 1 Emiyat Sungai Lilin dr. Dian SpAn
7/22/2015 7/22/2015 1 Waliya Lais dr. Dian SpAn
7/22/2015 7/22/2015 1 Jupri Sekayu dr. Dian SpAn
7/23/2015 7/23/2015 1 Wardi Filiph dr. Dian SpAn
7/23/2015 7/23/2015 1 Haikal Jirak dr. Dian SpAn
7/23/2015 7/23/2015 1 Alikasim Sekayu dr. Dian SpAn
7/23/2015 7/23/2015 1 Meriyadi Babat Supat dr. Dian SpAn
7/23/2015 7/23/2015 1 Roi Gatri dr. Dian SpAn
7/23/2015 7/23/2015 1 Eka Sekayu dr. Dian SpAn
7/23/2015 7/23/2015 1 sarjut Plakat Tinggi dr. Dian SpAn
7/23/2015 7/23/2015 1 Karni Plakat Tinggi dr. Dian SpAn
7/23/2015 7/23/2015 1 Arli Rantai Kroya dr. Dian SpAn
7/23/2015 7/23/2015 1 Susi Sekayu dr. Dian SpAn
7/24/2015 7/24/2015 1 Eka Babat Supat dr. Dian SpAn
7/24/2015 7/24/2015 1 enaliya Sekayu dr. Dian SpAn
7/24/2015 7/24/2015 1 Iskandar Ulak pace dr. Dian SpAn
7/24/2015 7/24/2015 1 Iyen Sungai Lilin dr. Dian SpAn
7/24/2015 7/24/2015 1 Nevi Mangunjaya dr. Dian SpAn
7/24/2015 7/24/2015 1 Titn Keluang dr. Dian SpAn
7/25/2015 7/25/2015 1 Kandar Air balui dr. Dian SpAn
7/26/2015 7/26/2015 1 Mislun Sekayu dr. Dian SpAn
7/26/2015 7/26/2015 1 Vera Danau cala dr. Dian SpAn
7/27/2015 7/27/2015 1 Meni Sekayu dr. Dian SpAn
7/27/2015 7/27/2015 1 Epi Sekayu dr. Dian SpAn
7/27/2015 7/27/2015 2 Yeni Lumpatan dr. Dian SpAn
7/27/2015 7/27/2015 1 Yepi Teluk Kijing dr. Dian SpAn
7/27/2015 7/27/2015 1 Iin Marlina Ngulak dr. Dian SpAn
7/27/2015 7/27/2015 1 Sit Jirak dr. Dian SpAn
7/27/2015 7/27/2015 1 Yoni GMP dr. Dian SpAn
7/28/2015 7/28/2015 1 Hendri Kotabaru dr. Dian SpAn
7/28/2015 7/28/2015 1 Kartni Sangadesa dr. Dian SpAn
7/28/2015 7/28/2015 1 Zuraidi Sekayu dr. Dian SpAn
7/28/2015 7/28/2015 1 Kasliawan Plakat Tinggi dr. Dian SpAn
7/28/2015 7/28/2015 1 Aji Sekayu dr. Dian SpAn
7/28/2015 7/28/2015 1 Ambrina Sekayu dr. Dian SpAn
7/28/2015 7/28/2015 1 Kartni Sangadesa dr. Dian SpAn
7/29/2015 7/29/2015 1 Jumiat Toman dr. Dian SpAn
7/29/2015 7/29/2015 1 Tiur Lumpatan dr. Dian SpAn
7/29/2015 7/29/2015 1 Misna Betung dr. Dian SpAn
7/29/2015 7/29/2015 1 Ana Sekayu dr. Dian SpAn
7/30/2015 7/30/2015 1 Lisa Kramat Jaya dr. Dian SpAn
7/30/2015 7/30/2015 1 Suryani epil dr. Dian SpAn
7/30/2015 7/30/2015 1 Prayoga Sekayu dr. Dian SpAn
7/30/2015 7/30/2015 1 Napsah Toman dr. Dian SpAn
7/31/2015 7/31/2015 1 Hisparul Berlian makmur dr. Dian SpAn
7/31/2015 7/31/2015 1 Parida Lumpatan dr. Dian SpAn
7/31/2015 7/31/2015 1 Alijul Sekayu dr. Dian SpAn
7/31/2015 7/31/2015 1 Jiril Sekayu dr. Dian SpAn
7/31/2015 7/31/2015 1 Aprilia Sekayu dr. Dian SpAn
7/31/2015 7/31/2015 1 Sulastri Talang duku dr. Dian SpAn
7/31/2015 7/31/2015 1 Sri Utami Tanjung Kaputren dr. Dian SpAn
7/31/2015 7/31/2015 1 Juniart Mangunjaya dr. Dian SpAn
7/31/2015 7/31/2015 1 Iin Jirak dr. Dian SpAn
JUMLAH 131
3 Morfin inj 7/2/2015 7/2/2015 2 Sit Aisah Sekayu dr.Perdi

7/3/2015 7/3/2015 1 Sit Aisah Sekayu dr. Dian SpAn
dr.Fahri
dr. Dian SpAn
dr. Oyon SpB
dr. Dian SpAn
JUMLAH 3
4 Pethidin inj 7/4/2015 7/4/2015 1 Hermanto Tanjung Raya dr. Syarifudin SpPd
7/12/2015 7/12/2015 1 Mia Bandar Jaya dr. Dian SpAn
7/13/2015 7/13/2015 1 eka Plakat Tinggi dr. Dian SpAn
7/13/2015 7/13/2015 1 Sri Balai Agung dr. Dian SpAn
7/13/2015 7/13/2015 1 Sit Musliha Babat Toman dr. Dian SpAn
7/13/2015 7/13/2015 1 Heni Lumpatan dr. Dian SpAn
7/13/2015 7/13/2015 1 Emis Sekayu dr. Dian SpAn
7/14/2015 7/14/2015 1 Nurmania Sekayu dr. Dian SpAn
7/25/2015 7/25/2015 1 Sriyant Sungai Lilin dr. Dian SpAn
JUMLAH 9
5 MST 15 Tab 7/1/2015 7/1/2015 10 M.Sobri Sekayu dr.Saripudin SppD

7/9/2015 7/9/2015 2 Mandi Karta Sekayu dr. Rosyidi SppD
7/9/2015 7/9/2015 10 Hermanto Tanjung Raja dr. Asdi SppD
7/9/2015 7/9/2015 2 Kamarudin Tanjung Raja dr.Saripudin SppD
7/8/2015 7/8/2015 3 Hermanto Tanjung Raja dr. Asdi SppD
7/9/2015 7/9/2015 2 Fatmah Sekayu dr. Rosyidi SppD
7/9/2015 7/9/2015 2 Hermanto Tanjung Raja dr.Saripudin SppD
7/10/2015 7/10/2015 3 Syafir Sekayu dr.Saripudin SppD
7/10/2015 7/10/2015 3 Adi Air Puth dr.Saripudin SppD
7/10/2015 7/10/2015 2 Mandi Karta Sekayu dr.Herianto SppD
7/10/2015 7/10/2015 2 Asiah Sekayu dr. Asdi SppD
7/11/2015 7/11/2015 2 Asiah Sekayu dr. Asdi SppD
7/11/2015 7/11/2015 10 Mandi Karta Sekayu dr.Herianto SppD
7/12/2015 7/12/2015 1 Eliya Sekayu dr. Herianto SppD
7/12/2015 7/12/2015 1 Amri Pali dr.Herianto SppD
7/12/2015 7/12/2015 2 Mastur Babat Supat dr. Herianto SppD
7/13/2015 7/13/2015 3 Yamin Sekayu dr. Rosyidi SppD
7/13/2015 7/13/2015 2 Mastur Babat Supat dr. Rosyidi SppD
7/13/2015 7/13/2015 1 Amri Sekayu dr. Rosyidi SppD
7/14/2015 7/14/2015 7 Asiah Sekayu dr. Rosyidi SppD
7/14/2015 7/14/2015 3 Samin Tanding marga dr. Rosyidi SppD
7/14/2015 7/14/2015 3 Yamin Jirak dr. Rosyidi SppD
7/15/2015 7/15/2015 3 Yamin Jirak dr. Rosyidi SppD
7/15/2015 7/15/2015 2 Sri wahyuni Sekayu dr. Herianto
7/15/2015 7/15/2015 5 Sumiat Sekayu dr. Taufik spOg
7/15/2015 7/15/2015 2 Samin Sekayu dr. Herianto
7/16/2015 7/16/2015 2 Misnawat Sekayu dr. Taufik spOg
7/16/2015 7/16/2015 2 Sri wahyuni Sekayu dr. Herianto
7/16/2015 7/16/2015 4 Samin Sekayu dr. Herianto
7/24/2015 7/24/2015 3 Abdul Manan Sekayu dr. Saripudin SppD
7/25/2015 7/25/2015 2 Kamarudin Sekayu dr.Herianto
7/25/2015 7/25/2015 2 Dedi Sekayu dr.Adrian spJP
7/31/2015 7/31/2015 2 Misnawat Sekayu dr. Taufik spOg
JUMLAH 107

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
N-16
Bulan : Juli
Tahun : 2015
Persediaan
Akhir Bulan Ket
(8-11)
12 13
762 -
0 -
134 -
100 -
0 -
369 -
0 -

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS :- Bulan : Agustus
No. Izin Khusus :- Tahun : 2015

No Nama Sediaan Satuan Persediaan Keseluruhan Untuk Akhir Bulan Ket
1 2 3 4 5 6 7 8 9 10 11 12 13
1 Clopedin (Pethidin) Ampul 762 - - - 762 2 2 760 -
2 Codein 10 mg Tablet 0 - - - 0 -
3 Fentanyl 0,05 MG/ML 2 ML Ampul 134 8/28/2015 KF 200 334 137 137 197 -
4 Morfin 10 mg Ampul 100 - - - 100 1 1 99 -
5 Coditam Tablet 0 - - - 0 -
6 MST 15 mg Tablet 369 - - - 369 158 158 211 -
7 MST 10 mg Tablet 0 8/28/2015 KF 360 360 0 0 360 -

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS : Bulan : Agustus
Resep Pasien Dokter

1 2 3 4 5 6 7 8 9 10 11
1 Fentanyl inj 8/1/2015 8/1/2015 1 Sonia Gajah Mat dr. Dian SpAn
8/3/2015 8/3/2015 1 Sumi Sekayu dr. Dian SpAn
8/4/2015 8/4/2015 1 Susilawat sekayu dr. Dian SpAn
8/4/2015 8/4/2015 1 Rodiah Lawang wetan dr. Dian SpAn
8/4/2015 8/4/2015 1 Linda Jirak dr. Dian SpAn
8/4/2015 8/4/2015 1 Hermanto sekayu dr. Dian SpAn
8/4/2015 8/4/2015 1 Patri Sekayu dr. Dian SpAn
8/4/2015 8/4/2015 1 Det Sekayu dr. Dian SpAn
8/4/2015 8/4/2015 1 Rusmani sekayu dr. Dian SpAn
8/5/2015 8/5/2015 1 Tri Sekayu dr. Dian SpAn
8/5/2015 8/5/2015 1 Leni Sekayu dr. Dian SpAn
8/5/2015 8/5/2015 1 Rosadi sekayu dr. Dian SpAn
8/5/2015 8/5/2015 1 Linda Sekayu dr. Dian SpAn
8/5/2015 8/5/2015 1 Nurzanah Sekayu dr. Dian SpAn
8/6/2015 8/6/2015 1 Insani Sekayu dr. Dian SpAn
8/6/2015 8/6/2015 1 Sri Air puth dr. Dian SpAn
8/6/2015 8/6/2015 1 Nurma Sekayu dr. Dian SpAn
8/6/2015 8/6/2015 1 Ari pratama Teluk kijing dr. Dian SpAn
8/6/2015 8/6/2015 1 Rizal Rantau Sialang dr. Dian SpAn
8/7/2015 8/7/2015 1 Lismala Danau cala dr. Dian SpAn
8/7/2015 8/7/2015 1 Dina Kelaung dr. Dian SpAn
8/7/2015 8/7/2015 1 Alhan Karang Ringin dr. Dian SpAn
8/7/2015 8/7/2015 1 Efriyant Mekar Sari dr. Dian SpAn
8/7/2015 8/7/2015 1 Lani Sekayu dr. Dian SpAn
8/7/2015 8/7/2015 1 Samart Sekayu dr. Dian SpAn
8/7/2015 8/7/2015 1 Padilah Bukit Indah dr. Dian SpAn
8/7/2015 8/7/2015 1 Tukimo Sungai Lilin dr. Dian SpAn
8/7/2015 8/7/2015 1 Irmawat Sekayu dr. Dian SpAn
8/7/2015 8/7/2015 1 Nurlela Ngulak dr. Dian SpAn
8/7/2015 8/7/2015 1 Anita Sukamaju dr. Dian SpAn
8/7/2015 8/7/2015 1 Samiatun Sungai batang dr. Dian SpAn
8/7/2015 8/7/2015 1 Raka Sungai Waru dr. Dian SpAn
8/7/2015 8/7/2015 1 Salim Sekayu dr. Dian SpAn
8/8/2015 8/8/2015 1 Andika Sekayu dr. Dian SpAn
8/8/2015 8/8/2015 1 Zainur pagar ayu dr. Dian SpAn
8/8/2015 8/8/2015 1 Oktarina Sekayu dr. Dian SpAn
8/8/2015 8/8/2015 1 Tri Agung Babat dr. Dian SpAn
8/8/2015 8/8/2015 1 Sulmi Sungai Lilin dr. Dian SpAn
8/8/2015 8/8/2015 1 Syamsudin Pandan dulang dr. Dian SpAn
8/8/2015 8/8/2015 1 Rusmita Ngulak dr. Dian SpAn
8/9/2015 8/9/2015 1 Neli Babat Supat dr. Dian SpAn
8/10/2015 8/10/2015 1 Nena Babat Toman dr. Dian SpAn
8/10/2015 8/10/2015 1 Trio Rantau Kasih dr. Dian SpAn
8/10/2015 8/10/2015 1 Maharni Sekayu dr. Dian SpAn
8/10/2015 8/10/2015 1 Ani Sungai lilin dr. Dian SpAn
8/10/2015 8/10/2015 1 Kordani Tanjung dr. Dian SpAn
8/10/2015 8/10/2015 1 Juairiah sekayu dr. Dian SpAn
8/10/2015 8/10/2015 1 Neli Otanza Sekayu dr. Dian SpAn
8/11/2015 8/11/2015 1 Hamdan Sekayu dr. Dian SpAn
8/11/2015 8/11/2015 1 Nuraini Sekayu dr. Dian SpAn
8/11/2015 8/11/2015 1 Riska Sekayu dr. Dian SpAn
8/11/2015 8/11/2015 1 Arpani Sekayu dr. Dian SpAn
8/12/2015 8/12/2015 1 Lusi sekayu dr. Dian SpAn
8/12/2015 8/12/2015 1 Apriani Babat Toman dr. Dian SpAn
8/12/2015 8/12/2015 1 Rina Soak Baru dr. Dian SpAn
8/12/2015 8/12/2015 1 Muryani Mangun Jaya dr. Dian SpAn
8/12/2015 8/12/2015 1 Leni Mangun Jaya dr. Dian SpAn
8/12/2015 8/12/2015 1 Candra Mangun Jaya dr. Dian SpAn
8/13/2015 8/13/2015 1 Nurima Sungai Lilin dr. Dian SpAn
8/13/2015 8/13/2015 1 Tent H Mangun Jaya dr. Dian SpAn
8/13/2015 8/13/2015 1 Heryana Sekayu dr. Dian SpAn
8/13/2015 8/13/2015 1 Royani sekayu dr. Dian SpAn
8/13/2015 8/13/2015 1 Yabani Sekayu dr. Dian SpAn
8/13/2015 8/13/2015 1 Marlina Sekayu dr. Dian SpAn
8/13/2015 8/13/2015 1 M. Ainul Sekayu dr. Dian SpAn
8/15/2015 8/15/2015 1 Risnida Mangun Jaya dr. Dian SpAn
8/15/2015 8/15/2015 1 Endang Sekayu dr. Dian SpAn
8/15/2015 8/15/2015 1 Nabil Sekayu dr. Dian SpAn
8/16/2015 8/16/2015 1 Intan Sari Teluk kijing dr. Dian SpAn
8/17/2015 8/17/2015 1 Sulis Sekayu dr. Dian SpAn
8/17/2015 8/17/2015 1 Murni Sungai Lilin dr. Dian SpAn
8/18/2015 8/18/2015 1 Meli plakat tnggi dr. Dian SpAn
8/18/2015 8/18/2015 1 petalina sekayu dr. Dian SpAn
8/18/2015 8/18/2015 1 fitri Sekayu dr. Dian SpAn
8/19/2015 8/19/2015 1 Ngatni keluang dr. Dian SpAn
8/19/2015 8/19/2015 1 Mariana Sanga Desa dr. Dian SpAn
8/19/2015 8/19/2015 1 Fitririani Simpang dr. Dian SpAn
8/19/2015 8/19/2015 1 Sant Teluk kijing dr. Dian SpAn
8/19/2015 8/19/2015 1 Leni Lumpatan dr. Dian SpAn
8/20/2015 8/20/2015 1 Pipin Rantau Panjang dr. Dian SpAn
8/20/2015 8/20/2015 1 Irzan plakat tnggi dr. Dian SpAn
8/20/2015 8/20/2015 1 Cerrysa Letang dr. Dian SpAn
8/20/2015 8/20/2015 1 Denis Sukamaju dr. Dian SpAn
8/20/2015 8/20/2015 1 Sit sungai lilin dr. Dian SpAn
8/20/2015 8/20/2015 1 Nazarudin Teluk kijing dr. Dian SpAn
8/20/2015 20/8/20215 1 Herlina Teladan dr. Dian SpAn
8/20/2015 8/20/2015 1 Wahyuni Sekayu dr. Dian SpAn
8/20/2015 8/20/2015 1 Wahyu sungai lilin dr. Dian SpAn
8/21/2015 8/21/2015 1 Jhon Sekayu dr. Dian SpAn
8/21/2015 8/21/2015 1 Warsito Teladan dr. Dian SpAn
8/21/2015 8/21/2015 1 Leni Sekayu dr. Dian SpAn
8/21/2015 8/21/2015 1 Sutant Sekayu dr. Dian SpAn
8/21/2015 8/21/2015 1 Nazarudin Tanjung dr. Dian SpAn
8/22/2105 8/22/2015 1 Amrit Babat Supat dr. Dian SpAn
8/22/2015 8/22/2105 1 Pet pali dr. Dian SpAn
8/23/2015 8/23/2015 1 Desi Bintale dr. Dian SpAn
8/24/2015 8/24/2015 1 Kohar Ngulak dr. Dian SpAn
8/24/2015 8/24/2015 1 Subandi Mangun Jaya dr. Dian SpAn
8/24/2015 8/24/2015 1 Sismita Muara Teladan dr. Dian SpAn
8/24/2015 8/24/2015 1 Lusiana Jirak dr. Dian SpAn
8/25/2015 8/25/2015 1 Desi Rantau dulang dr. Dian SpAn
8/25/2015 8/25/2015 1 Fitri Rantau Panjang dr. Dian SpAn
8/26/2015 8/26/2015 1 Rony Tungkal Jaya dr. Dian SpAn
8/26/2015 8/26/2015 1 Ika Babat Toman dr. Dian SpAn
8/26/2015 8/26/2015 1 Arma Sekayu dr. Dian SpAn
8/26/2015 8/26/2015 1 Lisdamayant Sekayu dr. Dian SpAn
8/27/2015 8/27/2015 1 Suanda Sekayu dr. Dian SpAn
8/27/2015 8/27/2015 1 Iskardi karang Anyar dr. Dian SpAn
8/27/2015 8/27/2015 1 Fenry Sekayu dr. Dian SpAn
8/27/2015 8/27/2015 1 Et Kusendang Kerta Jaya dr. Dian SpAn
8/27/2015 8/27/2015 1 Paramita Rantau Sialang dr. Dian SpAn
8/27/2015 8/27/2015 1 Endang sekayu dr. Dian SpAn
8/27/2015 8/27/2015 1 Suilani Sungai Lilin dr. Dian SpAn
8/27/2015 8/27/2015 1 Ahmad Sekayu dr. Dian SpAn
8/27/2015 8/27/2015 1 Wat Batang Hari dr. Dian SpAn
8/28/2015 8/28/2018 1 Kirom Sukamaju dr. Dian SpAn
8/28/2015 8/28/2015 1 Sarnubi Bumi Ayu dr. Dian SpAn
8/28/2015 8/28/2015 1 Delhi Mangun Jaya dr. Dian SpAn
8/28/2015 8/28/2015 1 Syamsul Lais dr. Dian SpAn
8/29/2015 8/29/2015 1 Verawat Sekayu dr. Dian SpAn
8/29/2015 8/29/2015 1 Emy Gajah Mat dr. Dian SpAn
8/29/2015 8/29/2015 1 Rosmeli Sekayu dr. Dian SpAn
8/29/2015 8/29/2015 1 Paijan keluang dr. Dian SpAn
8/29/2015 8/29/2015 1 Tatk Babat Toman dr. Dian SpAn
8/29/2015 8/29/2015 1 Hiyana Tanah Abang dr. Dian SpAn
8/29/2015 8/29/2015 1 Nila Jirak dr. Dian SpAn
8/31/2015 8/31/2015 1 Mirna Sungai Lilin dr. Dian SpAn
8/31/2015 8/31/2015 1 Hikmah plakat tnggi dr. Dian SpAn
8/31/2015 8/31/2015 1 Nursilah Sekayu dr. Dian SpAn
8/31/2015 8/31/2015 1 Syarnubi Sekayu dr. Dian SpAn
8/31/2015 8/31/2015 1 Kohar Sekayu dr. Dian SpAn
8/31/2015 8/31/2015 1 Damini Sekayu dr. Dian SpAn
8/31/2015 8/31/2015 1 Ramayana sekayu dr. Dian SpAn
8/31/2015 8/31/2015 1 Rina Sekayu dr. Dian SpAn
8/31/2015 8/31/2015 1 Rian Sekayu dr. Dian SpAn
8/31/2015 8/31/2015 2 Jumi plakat tnggi dr. Dian SpAn
137
3 Morfin inj 8/31/2015 8/31/2015 1 Alpina Babat Toman dr.Dian SpAn
JUMLAH 1
4 Pethidin inj 8/12/2015 8/12/2015 1 Vita Bukit Selabu dr. Dian SpAn
8/12/2015 8/12/2015 1 Putri Kertayu dr. Dian SpAn
JUMLAH 2
5 MST 15 inj 8/1/2015 8/1/2015 5 Misnawat Sekayu dr.Taufik SpOG
8/8/2015 8/8/2015 3 Joyo Sekayu dr. Afif
8/9/2015 8/9/2015 3 Joyo Sekayu dr. Saripudin SppD
8/10/2015 8/10/2015 2 Joyo Sekayu dr.Saripudin SppD
8/10/2015 8/10/2015 3 H. Tinggal Sungai Lilin dr. Asdi SppD
8/10/2015 8/10/2015 3 Yusri Sungai Lilin dr. Rosyidi SppD
8/11/2015 8/11/2015 2 Mirlaina Sungai Lilin dr.Saripudin SppD
8/11/2015 8/11/2015 3 H. Tinggal Sungai Lilin dr. Rosyidi SppD
8/12/2015 8/12/2015 2 Arida Sekayu dr.Syarifudin SppD
8/12/2015 8/12/2015 2 Mirlaina Sekayu dr.Syarifudin SppD
8/13/2015 8/13/2015 2 Fatmah Sekayu dr.Asdi SppD
8/13/2015 8/13/2015 2 Mirlaina Sekayu dr. Asdi SppD
8/14/2015 8/14/2015 3 Yusri Sekayu dr. Syarifudin SppD
8/14/2015 8/14/2015 1 Surip Supat dr.Irham SppD
8/15/2015 8/15/2015 2 Abidin Langkat dr. Irham SppD
8/15/2015 8/15/2015 2 Fatmah Sekayu dr.Afif
8/16/2015 8/16/2015 3 Yusri Sekayu dr. Syarifudin SppD
8/17/2015 8/17/2015 3 Yusri Sekayu dr. Afif
8/18/2015 8/18/2015 5 yusri Sekayu dr. Rosyidi SppD
8/19/2015 8/19/2015 2 Yusri Sekayu dr. Rosyidi SppD
8/19/2015 8/19/2015 2 Fatmah Sekayu dr. Syarifudin SppD
8/19/2015 8/19/2015 3 Mungkim Sekayu dr. Syarifudin SppD
8/20/2015 8/20/2015 2 Yusri Sekayu dr. Rosyidi SppD
8/20/2015 8/20/2015 2 Mungkim Sekayu dr. Syarifudin SppD
8/21/2015 8/21/2015 2 Hendri Sekayu dr. Oyon SpB
8/22/2015 8/22/2015 4 Mahfudin Sekayu dr. Syarifudin SppD
8/22/2015 8/22/2015 10 Hendri Sekayu dr. Dony SpB
8/22/2015 8/22/2015 1 Rusli Sekayu dr. Syarifudin SpPD
8/23/2015 8/23/2015 2 Rusli Sekayu dr. Afif
8/23/2015 8/23/2015 3 Fatmah Sekayu dr. Asdi
8/29/2015 8/29/2015 3 Fatmah Sekayu dr. Saripudin SppD
8/30/2015 8/30/2015 3 Fatmah Sekayu dr. Afif
8/31/2015 8/31/2105 2 fatmah Sekayu dr. Rosyidi SppD
JUMLAH 108

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-
Pemasukan
No Nama Sediaan Satuan Persediaan
Tanggal Dari
1 2 3 1/3/1900 5 6
1 Clopedin (Pethidin) Ampul - -
2 Codein 10 mg Tablet - -
3 Fentanyl 0,05 MG/ML 2 ML Ampul
4 Morfin 10 mg Ampul - -
5 Coditam Tablet - -
6 MST 15 mg Tablet - -
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MORPHIN, PETHIDIN, FENTANY

No. Izin RS :
No. Izin Khusus :
Resep
No Nama Sediaan Satuan Tanggal Tanggal Jumlah
1 2 3 1/3/1900 5 6
1 Fentanyl inj 1/9/2015 1/9/2015 1

1/9/2015 1/9/2015 1
1/9/2015 1/9/2015 1
1/9/2015 1/9/2015 1
1/9/2015 1/9/2015 1
1/9/2015 1/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 2
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 2
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
2/9/2015 2/9/2015 1
11/9/2015 11/9/2015 1
11/9/2015 11/9/2015 1
11/9/2015 11/9/2015 1
11/9/2015 11/9/2015 1
11/9/2015 11/9/2015 1
12/9/2015 12/10/2015 1
09/13/2015 09/13/2016 1
09/14/2015 09/14/2016 1
09/14/2015 09/14/2016 1
09/14/2015 09/14/2016 1
09/14/2015 09/14/2016 4
09/14/2015 09/14/2016 1
09/14/2015 09/14/2016 1
09/14/2015 09/14/2016 1
09/14/2015 09/14/2016 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/15/2015 09/15/2015 1
09/16/2015 09/16/2015 1
09/16/2015 09/16/2015 1
09/16/2015 09/16/2015 1
09/16/2015 09/16/2015 1
09/16/2015 09/16/2015 1
09/16/2015 09/16/2015 1
09/17/2015 09/17/2015 1
09/17/2015 09/17/2015 1
09/17/2015 09/17/2015 1
09/17/2015 09/17/2015 1
09/17/2015 09/17/2015 1
09/17/2015 09/17/2015 1
09/17/2015 09/17/2015 1
09/17/2015 09/17/2015 1
09/17/2015 09/17/2015 1
09/18/2015 09/18/2015 1
09/18/2015 09/18/2015 1
09/18/2015 09/18/2015 1
09/18/2015 09/18/2015 1
09/18/2015 09/18/2015 1
09/19/2015 09/19/2015 1
09/19/2015 09/19/2015 1
09/20/2015 09/20/2016 2
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/21/2015 09/21/2015 1
09/22/2015 09/22/2015 1
09/22/2015 09/22/2015 1
09/22/2015 09/22/2015 1
09/22/2015 09/22/2015 1
09/22/2015 09/22/2015 1
09/22/2015 09/22/2015 1
09/22/2015 09/22/2015 1
09/23/2015 09/23/2015 1
09/23/2015 09/23/2016 1
09/23/2015 09/23/2015 1
09/24/2015 09/24/2016 1
09/25/2015 09/25/2015 1
09/25/2015 09/25/2015 1
09/25/2015 09/25/2015 1
09/26/2015 09/26/2015 1
09/26/2015 09/26/2015 1
09/26/2015 09/26/2015 1
09/26/2015 09/26/2015 1
09/27/2015 09/27/2015 1
09/27/2015 09/27/2015 1
09/27/2015 09/27/2015 1
09/28/2015 09/28/2015 5
09/28/2015 09/28/2015 1
09/28/2015 09/28/2015 1
09/28/2015 09/28/2015 1
09/28/2015 09/28/2015 1
09/28/2015 09/28/2015 1
09/28/2015 09/28/2015 1
09/28/2015 09/28/2015 1
09/28/2015 09/28/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/29/2015 09/29/2015 1
09/30/2015 09/30/2015 1
09/30/2015 09/30/2015 1
09/30/2015 09/30/2015 1
09/30/2015 09/30/2015 1
09/30/2015 09/30/2015 1
09/30/2015 09/30/2015 1
09/30/2015 09/30/2015 1
JUMLAH 175
3 Morfin inj 11/9/2015 11/10/2015 1

09/15/2015 09/15/2016 2
JUMLAH 3
4 Pethidin inj 09/18/2015 09/18/2016 2
JUMLAH 2
5 MST 15 inj 7/9/2015 7/9/2015 3

8/9/2015 8/9/2015 2
8/9/2015 8/9/2015 2
11/9/2015 11/9/2015 3
11/9/2015 11/9/2015 7
09/18/2015 09/18/2016 3
JUMLAH 20
6 MST 10 inj 8/9/2015 8/9/2015 3

9/9/2015 9/9/2015 3
10/9/2015 10/9/2015 3
09/24/2015 09/24/2016 1
09/29/2015 09/29/2016 6
JUMLAH 16
N-16
Bulan : September
Tahun : 2015
p: 0714-321130

Keseluruhan Untuk Akhir Bulan Ket
Jumlah Jumlah
7 8 9 10 11 12 13
- -
- -
-
- -
- -
- -
-

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : September
Tahun : 2015
p: 0714-321130
Pasien Dokter
Ket
7 8 9 10 11
Ardila Sukarami dr. Dian SpAn

Septa Lais dr. Dian SpAn
Tumiyah PT. MBI dr. Dian SpAn
Isnaniar Babat Toman dr. Dian SpAn
Noe Evil dr. Dian SpAn
Maryat Babat Toman dr. Dian SpAn
Sarnubi ds. Ulak tebrau dr. Dian SpAn
Senen Tj. Kerang dr. Dian SpAn
Irma Yant Sekayu dr. Dian SpAn
Oktarina Gatri dr. Dian SpAn
Damai Yant Sekayu dr. Dian SpAn
Rusidah Sanga Desa dr. Dian SpAn
Yuliana Desa Keban dr. Dian SpAn
Pipit Kertayu dr. Dian SpAn
Ika Gatri dr. Dian SpAn
Hermawat Teluk kijing dr. Dian SpAn
Cicah Kayuara dr. Dian SpAn
Ardiansyah Keluang dr. Dian SpAn
Suharto Langkap dr. Dian SpAn
Hidayani Sungai lilin dr. Dian SpAn
Rusdiana Toman dr. Dian SpAn
Mardani Berang JM dr. Dian SpAn
Tri Wahyuni Sungai lilin dr. Dian SpAn
Novi Sekayu dr. Dian SpAn
Juairiah Keluang dr. Dian SpAn
Candra Sukarami dr. Dian SpAn
Sit Mirawat Plakat tnggi dr. Dian SpAn
Sri Mulyana Babat Toman dr. Dian SpAn
Tina Sungai lilin dr. Dian SpAn
Rosmala Keluang dr. Dian SpAn
Herlina Sri Gunung dr. Dian SpAn
Mely Mangun Jaya dr. Meili SpAn
Kiki Kayuara dr. Meili SpAn
Paigawat Karang Waru dr. Meili SpAn
Sumarto Damai baru dr. Meili SpAn
Maryat Sungai Batang dr. Meili SpAn
Sri Antni Suka Makmur dr. Meili SpAn
Dodi Indrawan Teluk kijing dr. Meili SpAn
Sukini Jirak dr. Meili SpAn
Eria. C Tebing Bulang dr. Meili SpAn
Amir Paisal Lumpatan dr. Meili SpAn
Rohana Karang Anyar dr. Meili SpAn
Saropah Cinta Damai dr. Dian SpAn
Rikwan Soak Baru dr. Dian SpAn
Fitria Lais dr. Dian SpAn
Oktariani Sukarami dr. Dian SpAn
Ismail Desa Langkap dr. Dian SpAn
Neni Deashi Bailangu Timur dr. Dian SpAn
Ofina Cinta Karya dr. Dian SpAn
Nureliyat Pelangkat Tinggi dr. Dian SpAn
Jamila Lumpatan dr. Dian SpAn
Umi Kalsum Ngulak 1 dr. Dian SpAn
Virma.s Soak Baru dr. Dian SpAn
Tarpiah Serasan Jaya dr. Dian SpAn
Rio Ngulak 2 dr. Dian SpAn
Sindah Wat Perumahan IBI SpAn
Asmawat Karta jaya dr. Dian SpAn
Nawi Karlina Balai Agung dr. Dian SpAn
Desi Ratna Sari Rukun rahayu dr. Dian SpAn
Rosiana Rantau Sialang dr. Dian SpAn
Dessy Oktaria Griya Randik dr. Dian SpAn
Juriah Sekayu dr. Dian SpAn
Masla Ngulak dr. Dian SpAn
Zainudin Sekayu dr. Dian SpAn
Necis Sumber Rezeki dr. Dian SpAn
M.nur Samsudin Keluang dr. Dian SpAn
Maisa Simpang Tungkal dr. Dian SpAn
Royani Lumpatan dr. Dian SpAn
Herlina Sungai keruh dr. Dian SpAn
Sinart Bailangu Timur dr. Dian SpAn
Weni Keluang dr. Dian SpAn
Arcir Kasmaran dr. Meili SpAn
Ida Eliza Sungai lilin dr. Meili SpAn
Sumarno loka Jaya dr. Meili SpAn
M.nur loka Jaya dr. Meili SpAn
Sutripto Lingkar JM dr. Meili SpAn
Leni Kartka Keluang dr. Meili SpAn
Sumijah Jirak dr. Meili SpAn
Evi Muara Teladan dr. Meili SpAn
Kartka Sari Sekayu dr. Meili SpAn
Sawani Keluang dr. Meili SpAn
Yatno Pelangkat Tinggi dr. Meili SpAn
juriah Sukarami dr. Meili SpAn
Puspita Kayuara dr. Meili SpAn
Muslim Dawas dr. Meili SpAn
Hodijah Bumi Ayu dr. Meili SpAn
M. Nur Syamsudin Muara Teladan dr. Meili SpAn
Ainiyatul Pangkalan Bulian dr. Meili SpAn
Zainudin Karang Waru dr. Dian SpAn
Desi Muara Teladan dr. Dian SpAn
Maryat Sekayu dr. Dian SpAn
Ragi Irwandi Peninggalan 1 dr. Dian SpAn
Yulia Witantri Baru jaya 1 dr. Dian SpAn
Yuliant Panda Dulang dr. Dian SpAn
Yesi Tanjung Agung dr. Dian SpAn
Marina Karang Anyar dr. Dian SpAn
Ernanik Jirak dr. Dian SpAn
Lusiana Sekayu dr. Dian SpAn
Marlina Keluang dr. Dian SpAn
Abadih Sekayu dr. Dian SpAn
Ponim Sungai medak dr. Dian SpAn
Jauhir Gajah Muda dr. Dian SpAn
Marsiana Potensi Guna dr. Dian SpAn
Anisa Kayuara dr. Dian SpAn
Abah Serasan Jaya dr. Dian SpAn
Christna Sungai lilin dr. Meili SpAn
Mardianah Ulpa Jaya dr. Meili SpAn
Rudi Sungai lilin dr. Meili SpAn
Vina Tanah Abang dr. Meili SpAn
Rosita Tanjung Kerang dr. Meili SpAn
Rusnaini Tebing Bulang dr. Meili SpAn
Abadi Komplek Nsc dr. Meili SpAn
Japari Desa Kasmaran dr. Meili SpAn
Zainab Gria Randik dr. Meili SpAn
Nani Komplek UBS dr. Meili SpAn
Noviana Rantau Pandan dr. Meili SpAn
Maimuna Sugi Waras dr. Meili SpAn
Asmanah Babat Toman dr. Meili SpAn
Juriwat Sukarami dr. Meili SpAn
Triwarni Lais dr. Meili SpAn
Tiran Suka Damai dr. Meili SpAn
Kalimin Sungai lilin dr. Meili SpAn
Faturrahman Sekayu dr. Meili SpAn
Fitri Puspasari Balai Agung dr. Meili SpAn
Nuraida Lumpatan dr. Meili SpAn
Lasmawat Lalan dr. Meili SpAn
Desi Sungai lilin dr. Meili SpAn
Alawi Sekayu dr. Dian SpAn
Dani Prasetyanto Sekayu dr. Edi
Yuli Arimbi Sungai lilin dr. Dian SpAn
Mariana Balai Agung dr. Dian SpAn
Rani Sungai lilin dr. Dian SpAn
Emi Oktaria Keluang dr. Dian SpAn
Indrayani Keluang dr. Dian SpAn
Zanzabila Gajah Muda dr. Dian SpAn
Lima Suryani Rimba Ukur dr. Dian SpAn
Kusmiah Bayung Lincir dr. Dian SpAn
Reni Astut Sungai lilin dr. Meili SpAn
Sri Surya Sekayu dr. Meili SpAn
Mustka Beruge dr. Meili SpAn
Yeni Inpres Penjara dr. Meili SpAn
Hodijah Keban 1 dr. Wiyah
Rima Sugi Waras dr. Meili SpAn
Awaro Lais dr. Meili SpAn
Rasipan Balai Agung dr. Meili SpAn
Tri Yulia Perumahan IBI dr. Meili SpAn
Meilinda Sekayu dr. Meili SpAn
Sundari Kasmaran dr. Meili SpAn
Dedek Impres Kampung Sekate dr. Meili SpAn
Putri Sekayu dr. Meili SpAn
Mursila Rantau Kasih dr. Meili SpAn
Rohiba Prumnas dr. Meili SpAn
Sandi KBN II dr. Meili SpAn
Evi Oktalina Babat dr. Meili SpAn
Rosipan Sekayu dr. Meili SpAn
Rohman Kebun Asri dr. Meili SpAn
Hanif Jirak dr. Meili SpAn
Rohayani Rimba Asam dr. Meili SpAn
Cucu Cipta Praja dr. Meili SpAn
Tarsini Balai Agung dr. Meili SpAn
Sanaria Berlian Makmur dr. Meili SpAn
Eni Mangun Jaya dr. Meili SpAn
Dina Maryana Sekayu dr. Meili SpAn
Rosimah Jirak dr. Meili SpAn
Rusdianah Selarai dr. Meili SpAn
Fitria Lais dr.Dian SpAn

M. Nur Keluang dr. Meili SpAn
Habudin Sekayu dr. Asdi
Hamidun Sekayu dr. Oyon SpB

Joko Sekayu dr. Oyon SpB
Joko Suganto Sungai Medak dr. Oyon SpB
Hamidun Sekayu dr. Donny SpB
Hamidun Muara Teladan dr. Sit
Karomah Keban 2 dr. Syarifudin SppD

Hamidun Sekayu dr. Donny SpB
Umar Sekayu dr. Fathy
Mariana Bailangu Timur dr. Taufik SpOG

Penanggung Jawab
Dra. Hanifdar, Apt
Nip. 19670730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-
Pemasukan
Nama Sediaan Satuan Persediaan
Tanggal
1 2 3 1/3/1900 5
1 Clopedin (Pethidin) Ampul -
2 Codein 10 mg Tablet -
3 Fentanyl 0,05 MG/M Ampul
4 Morfin 10 mg Ampul -
5 Coditam Tablet -
6 MST 15 mg Tablet -
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MORPHIN, PETHI

No. Izin RS :
No. Izin Khusus :
Resep
No Nama Sediaan Satuan Tanggal Tanggal
1 2 3 1/3/1900 5
1 Fentanyl inj 10/1/2015 10/1/2015

10/1/2015 10/1/2015
10/1/2015 10/1/2015
10/1/2015 10/1/2015
10/1/2015 10/1/2015
10/1/2015 10/1/2015
10/2/2015 10/2/2015
10/2/2015 10/2/2015
10/3/2015 10/3/2015
10/3/2015 10/3/2015
10/3/2015 10/3/2015
10/3/2015 10/3/2015
10/4/2015 10/4/2015
10/4/2015 10/4/2015
10/5/2015 10/5/2015
10/5/2015 10/5/2015
10/5/2015 10/5/2015
10/5/2015 10/5/2015
10/5/2015 10/5/2015
10/5/2015 10/5/2015
10/5/2015 10/5/2015
10/5/2015 10/5/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/13/2015 10/13/2015
10/13/2015 10/13/2015
10/13/2015 10/13/2015
10/13/2015 10/13/2015
10/13/2015 10/13/2015
10/13/2015 10/13/2015
10/13/2015 10/13/2015
10/13/2015 10/13/2015
10/13/2015 10/13/2015
10/14/2015 10/14/2015
10/14/2015 10/14/2015
10/14/2015 10/14/2015
10/14/2015 10/14/2015
10/14/2015 10/14/2015
10/14/2015 10/14/2015
10/15/2015 10/15/2015
10/15/2015 10/15/2015
10/15/2015 10/15/2015
10/15/2015 10/15/2015
10/16/2015 10/16/2015
10/16/2015 10/16/2015
10/16/2015 10/16/2015
10/16/2015 10/16/2015
10/17/2015 10/17/2015
10/17/2015 10/17/2015
10/19/2015 10/19/2015
10/19/2015 10/19/2015
10/19/2015 10/19/2015
10/19/2015 10/19/2015
10/19/2015 10/19/2015
10/19/2015 10/19/2015
10/19/2015 10/19/2015
10/19/2015 10/19/2015
10/19/2015 10/19/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/20/2015 10/20/2015
10/21/2015 10/21/2015
10/21/2015 10/21/2015
10/21/2015 10/21/2015
10/21/2015 10/21/2015
10/21/2015 10/21/2015
10/21/2015 10/21/2015
10/21/2015 10/21/2015
10/21/2015 10/21/2015
10/21/2015 10/21/2015
10/22/2015 10/22/2015
10/22/2015 10/22/2015
10/22/2015 10/22/2015
10/22/2015 10/22/2015
10/22/2015 10/22/2015
10/22/2015 10/22/2015
10/23/2015 10/23/2015
10/23/2015 10/23/2015
10/23/2015 10/23/2015
10/23/2015 10/23/2015
10/23/2015 10/23/2015
10/23/2015 10/23/2015
10/23/2015 10/23/2015
10/24/2015 10/24/2015
10/25/2015 10/25/2015
10/25/2015 10/25/2015
10/25/2015 10/25/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/26/2015 10/26/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/30/2015 10/30/2015
10/30/2015 10/30/2015
10/30/2015 10/30/2015
10/30/2015 10/30/2015
10/31/2015 10/31/2015
Jumlah
2 Morfin Inj 10/13/2015 10/13/2015

10/15/2015 10/15/2015
Jumlah
3 Petdin Inj 10/6/2015 10/6/2015

10/6/2015 10/6/2015
10/6/2015 10/6/2015
10/6/2015 10/6/2015
10/6/2015 10/6/2015
10/6/2015 10/6/2015
10/6/2015 10/6/2015
10/7/2015 10/7/2015
10/7/2015 10/7/2015
10/8/2015 10/8/2015
10/9/2015 10/9/2015
10/10/2015 10/10/2015
10/10/2015 10/10/2015
10/10/2015 10/10/2015
10/24/2015 10/24/2015
10/24/2015 10/24/2015
10/31/2015 10/31/2015
10/31/2015 10/31/2015
Jumlah
4 Mst 15 mg Tab 10/5/2015 10/5/2015

10/5/2015 10/5/2015
10/6/2015 10/6/2015
10/7/2015 10/7/2015
10/7/2015 10/7/2015
10/8/2015 10/8/2015
10/10/2015 10/10/2015
10/11/2015 10/11/2015
10/15/2015 10/15/2015
10/16/2015 10/16/2015
10/17/2015 10/17/2015
10/21/2015 10/21/2015
10/22/2015 10/22/2015
10/22/2015 10/22/2015
10/23/2015 10/23/2015
10/24/2015 10/24/2015
10/26/2015 10/26/2015
10/27/2015 10/27/2015
10/29/2015 10/29/2015
10/30/2015 10/30/2015
Jumlah
Mst 10 mg Tab 10/9/2015 10/9/2015

10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/12/2015 10/12/2015
10/13/2015 10/13/2015
10/20/2015 10/20/2015
10/21/2015 10/20/2015
10/21/2015 10/21/2015
10/22/2015 10/22/2015
10/24/2015 10/24/2015
10/26/2015 10/26/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/27/2015 10/27/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/28/2015 10/28/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/29/2015 10/29/2015
10/30/2015 10/30/2015
10/30/2015 10/30/2015
10/31/2015 10/31/2015
10/31/2015 10/31/2015
10/31/2015 10/31/2015
Jumlah
Keseluruhan Untuk
Dari Jumlah Jumlah
6 7 8 9 10 11
- -
- -
- -
- -
- -
Sekayu, Oktober 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
AAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : Oktober
Tahun : 2015
Pasien Dokter
Jumlah Ket
6 7 8 9 10 11
1 Sri Lestari Babat Toman dr.Dian SpAn

1 Sit Susilawat Tebing Bulang dr.Dian SpAn
1 Yet Oktasari Sanga Desa dr.Dian SpAn
1 Fajri Ridho Tanjung Kerang dr.Dian SpAn
1 Sukarmin Lais dr.Dian SpAn
1 Ahmad Plakat Tinggi dr.Dian SpAn
1 Rodiah Kayuara dr.Dian SpAn
1 Rodiah Kayuara dr.Riri
1 Sulastri Sungai Lilin dr.Dian spAn
1 Alya Tanjung Kerang dr.Dian SpAn
1 Maya Soak Baru dr.Dian SpAn
1 Susant Sanga Desa dr.Dian SpAn
1 Lamsona Suka Damai dr.Dian SpAn
1 Cica Keban II dr.Dian SpAn
1 Leni Marlina Sugi Waras dr.Meili SpAn
1 Dian Atma Pertwi Sekayu dr.Meili SpAn
1 Alpa Edison Soak Baru dr.Meili SpAn
1 Parira Sekayu dr.Riri
1 Herlita Tiase dr.Meili SpAn
1 Zubaidah Kertajaya dr.Meili SpAn
1 Harjono Simpang Tungkal dr.Meili SpAn
1 Rusmaleni Sungai Angit dr.Meili SpAn
1 Suandi Tanjung Kerang dr.Meili SpAn
1 Jamaat Semedan dr.Meili SpAn
1 Alfarizi Sungai Keruh dr.Meili SpAn
1 Azizah Kayuara dr.Meili SpAn
1 Arpawan Muara Teladan dr.Meili SpAn
1 Marisa Sekaya dr.Meili SpAn
2 A. Rifai Ngunang dr.Meili SpAn
1 Nita Serasan Jaya dr.Meili SpAn
1 sukmawat Rantau Panjang dr.Meili SpAn
1 M.Toha Epil dr.Meili SpAn
1 Nurlaila Keluang dr.Meili SpAn
1 Nurdiana Lais dr.Meili SpAn
1 Yudistra Sekayu dr.Meili SpAn
1 Fitriani Sungai Lilin dr.Meili SpAn
1 Holba Lais dr.Meili SpAn
1 Ermawat Lumpatan dr.Meili SpAn
1 Nurhadi Lais dr.Meili SpAn
1 Sri Darmawat Bukit Jaya Sp III dr.Meili SpAn
1 Elsa Soak Baru dr.Meili SpAn
1 Italia Sungai Batang dr.Meili SpAn
1 Mardi Keluang dr.Meili SpAn
1 Rahmawat Kayuara dr.Meili SpAn
1 Winart Sungai Lilin dr.Dian spAn
1 Rita Susant Lumpatan dr.Meili SpAn
1 Minar Ulak Teberau dr.Dian SpAn
1 Rensi Noviant Serasan Jaya dr.Dian SpAn
1 lindawat Sekayu dr.Dian SpAn
1 Amrullah Lumpatan dr.Dian SpAn
1 Kuwat Hidayat Berlian Makmur dr. Dian SpAn
1 Musripah Balai Agung dr.Dian SpAn
1 Tika Lais dr.Dian SpAn
1 Rusadi Keluang dr.Dian SpAn
1 Sabtu Sanga Desa dr.Dian SpAn
1 Rozak Lumpatan dr.Dian SpAn
1 Sri Diah Sekayu dr.Dian SpAn
1 Sukini Kayuara dr.Dian SpAn
1 Susant Keluang dr.Dian SpAn
1 Maslimin Gmp. Sekayu dr.Dian SpAn
1 Ujang Efendi Berlian Makmur dr.Meili SpAn
1 Candra Lawang Wetan dr.Meili SpAn
1 Rusli Tanjung Kerang dr.Meili SpAn
1 M.lekat Ds.Terusan dr.Meili SpAn
1 Rolis Lais dr.Meili SpAn
1 Dinda Sekayu dr.Meili SpAn
1 Jhon Kenedy Lais dr.Meili spAn
1 Ujang Berlian Makmur dr.Meili SpAn
1 Ngatni Plakat Tinggi dr.Meili SpAn
1 Ariel Sugi Waras dr.Meili SpAn
1 Rusmawat Plakat Tinggi dr.Meili SpAn
1 Diana Putri Lumpatan dr.Meili SpAn
1 Mardalena Perumnas dr.Meili SpAn
1 Wal Azim Tempirai Utara dr.Meili SpAn
1 Muslih Sungai Lilin dr.Meili SpAn
1 Saudun Rampak Terusan dr.Meili SpAn
1 Salikun Rampak Terusan dr.Meili SpAn
1 Malik Rampak Terusan dr.Meili SpAn
1 Nilawat Babat Supat dr.Meili SpAn
1 Nopi Sanga Desa dr.Meili SpAn
1 Tatk Lumpatan dr.Meili SpAn
1 Rohimin Babat Toman dr.Meili SpAn
1 Ali Kasim Komplek Dc dr.Meili SpAn
2 Helmi Ds.Terusan dr.Meili SpAn
1 Syarpai Lais dr.Meili SpAn
1 Eva Lumpatan dr.Meili SpAn
1 Rumiatun Plakat Tinggi dr.Meili SpAn
1 Nesi Babat dr.Meili SpAn
1 Arjun Purwosari dr.Meili SpAn
1 Wawan Keban II dr.Meili SpAn
1 Warsiah Randik dr.Meili SpAn
1 Sri Yuniar Sungai Lilin dr.Meili SpAn
1 Angga Suka Maju dr.Meili SpAn
1 Rizky Sumber Agung dr.Meili SpAn
1 Diana Keluang dr.Dian SpAn
1 Dwi Bangun Sari dr.Dian SpAn
1 H.Sabtu Sanga Desa dr.Dian SpAn
1 Hendra Sungai Lilin dr.Dian SpAn
1 Izza Tulayani Plakat Tinggi dr.Dian SpAn
1 Malik Ds.Terusan dr.Dian SpAn
1 Rodiah Plakat Tinggi dr.Dian SpAn
1 Wal Azim Tempirai Utara dr.Dian SpAn
1 Salikun Rampak Terusan dr.Dian SpAn
1 Salidun Rampak Terusan dr.Dian SpAn
1 Lekat Rampak Terusan dr.Dian SpAn
1 wayma Sekayu dr.Dian SpAn
1 Intan Sekayu dr.Dian SpAn
1 Suryat Sungai Lilin dr.Dian SpAn
1 Pupud Novel Praja Permai dr.Dian spAn
1 Intan Wahyu Ningsih Keluang dr.Dian spAn
1 Ista Babat Toman dr.Meili SpAn
1 Marzuki Karang Ringin II dr.Meili SpAn
1 Maryam Ds.letang dr.Meili SpAn
1 Helmi Ds.Terusan dr.Meili SpAn
1 Jhon Kenedy Tanjung Agung dr.Meili SpAn
1 Evi Susant Lumpatan dr.Meili SpAn
1 Lekat Sanga Desa dr.Meili SpAn
1 laily Praja Permai dr.Meili SpAn
1 Husaini Kayuara dr.Meili SpAn
1 Said Sungai Angit dr.Meili SpAn
1 Marlina Teluk Kijing I dr.Meili SpAn
1 wiwik Tungkal Ilir dr.Meili SpAn
1 Sumiyat Suka Damai dr.Meili SpAn
1 Dadang Kayuara dr.Meili SpAn
1 Diding Plakat Tinggi dr.Meili SpAn
1 Suaji Sekayu dr.Meili SpAn
1 Hasidin Lais dr.Meili SpAn
1 Ratna Sari Epil dr.Meili SpAn
1 Rafa Cinta Karya dr.Meili SpAn
1 Sunar Lent Agung Timur dr.Meili SpAn
1 Nasip Lais dr.Meili SpAn
1 Evi Sungai Lilin dr.Meili SpAn
1 Nur Azima Jirak dr.Meili SpAn
1 Wulan Sungai Lilin dr.Meili SpAn
1 Epan Sereka dr.Meili SpAn
1 Yant Tanjung Raya dr.Meili SpAn
1 Heriyansyah Teluk Kijing I dr.Meili SpAn
1 Azka Batang Hari leko dr.Meili SpAn
1 Taufik Keluang dr.Meili SpAn
1 Tufatun Keluang dr.Meili SpAn
3 M.Januar Balai Agung dr.Nora
1 Kiki Babat Supat dr.Dian SpAn
1 Desi Sinta Mangun Jaya dr.Dian SpAn
1 Ahnaf Keluang dr.Dian SpAn
1 Ani Rimba Asam dr.Dian SpAn
1 Murfi Randik dr.Dian spAn
1 Saeh Lumpatan dr.Dian SpAn
1 Lilis Ariska Bandar Jaya dr.Dian SpAn
1 Maizah Lumpatan dr.Dian SpAn
1 Lamitun Sanga Desa dr.Dian SpAn
1 sukmawat Ngulak dr.Dian SpAn
1 Jack Lumpatan dr.Dian SpAn
1 Salikun Ds.Terusan dr.Dian SpAn
1 Anggi Lestari Beruge dr.Dian SpAn
158
1 Huzairin Balai Agung dr.Tiar

1 Huzairin Balai Agung dr.Syarifuddin SppD
1 Abdul Rahman Sukarami dr.Meili SpAn

1 Muh.Sinin Danau Cala dr.Meili SpAn
1 Suhaida Rantau Kasih dr.Meili SpAn
1 Ayu Ningsih Balai Agung dr.Meili SpAn
1 Sit Maryam Sekayu dr.Meili SpAn
1 Ambia Petaling dr.Meili SpAn
1 Ida Laila Lumpatan dr.Meili SpAn
1 Khoiriyah Keluang dr.Meili SpAn
1 Asmawat Bukit Selabu dr.Meili SpAn
1 Nuryah Karang Ringin dr.Dian SpAn
1 Yuli Bumi Ayu dr.Dian SpAn
1 Wiji Plakat Tinggi .dr.Dian SpAn
2 Sukantak Bukit Selabu dr.Asdi SppD
1 Ningmas Tanjung Agung dr.Dian SpAn
1 Cendawat Babat Toman dr.Dian SpAn
1 Astut Babat Toman dr.Dian SpAn
1 Hanan Keban I dr.Dian SpAn
1 Agustan Sungai Batang dr.Dian SpAn
19
2 Hamidun Muara Teladan dr.Oyon SpB

3 Sukantak Bukit Selabu dr.Oyon SpB
3 Hamidun Muara Teladan dr.Rosidi SppD
3 Hamidun Muara Teladan dr.Tiar
2 Hamidun Muara Teladan dr.Wiyah
3 Hamidun Muara Teladan dr.Dony SpB
3 Hamidun Muara Teladan dr.Dony SpB
3 Hamidun Muara Teladan dr.Nora
3 Malik Sekayu dr.Oyon SpB
2 Jayusman Sekayu dr.Dony SpB
3 Malik Sekayu dr.Dony SpB
3 Malik Sekayu dr.Dony SpB
3 Malik Sekayu dr.Nora
3 M.Lekat Ds.Terusan dr.Oyon SpB
3 M.Lekat Ds.Terusan DR.Oyon SpB
3 M.Lekat Ds.Terusan dr.Dony SpB
3 M.Salikun Ds.Terusan dr.Dony SpB
56
2 Hamidun Muara Teladan dr.Ferdy

4 Ningmas Sekayu dr.Taufik SpoG
4 Ropida Sekayu dr.Taufik SpoG
6 Cendra Lelah Lawang Wetan dr.Taufik SpoG
6 Cendra Lelah Lawang Wetan dr.Taufik SpoG
4 Jayusman Keluang dr. Lita
2 M.Malik Sekayu dr.Oyon SpB
3 Malik Sekayu dr.Oyon SpB
3 Salikun Sekayu dr.Oyon SpB
3 Jon Kenedi Gardu Harapan dr. Nora
3 M.Lekat Ds.Terusan dr.Citra
3 Salikun Ds.Terusan dr.Citra
3 Helmi Ds.Terusan dr.Oyon SpB
3 Jon Kenedi Gardu Harapan dr.Oyon SpB
3 Helmi Ds.Terusan dr.Nora
6 Jon Kenedi Gardu Harapan dr.Nora
3 Salikun Sekayu dr.Dian SpAn
4 Jon Kenedi Gardu Harapan dr.Dian SpAn
3 M.Lekat Ds.Terusan dr.Dony SpB
3 Jon Kenedi Gardu Harapan dr.Citra
3 Helmi Ds.Terusan dr.Citra
3 Salikun Ds.Terusan dr.Oyon
98

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
INKES/I/2012
No. Izin RS :-
No. Izin Khusus :-
Pemasukan
Tanggal Dari
1 2 3 1/3/1900 5 6
1 Clopedin (Pethidin) Ampul - -
2 Codein 10 mg Tablet - -
3 Fentanyl 0,05 MG/ML 2 Ampul
4 Morfin 10 mg Ampul - -
5 Coditam Tablet - -
6 MST 15 mg Tablet - -
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MORPHIN, PETHIDIN, FEN

No. Izin RS :
No. Izin Khusus :
Resep
1 2 3 1/3/1900 5 6
1 Fenthanyl Inj 12/1/2015 12/1/2015 1

12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/1/2015 12/1/2015 1
12/2/2015 12/2/2015 1
12/2/2015 12/2/2015 1
12/2/2015 12/2/2015 1
12/2/2015 12/2/2015 1
12/2/2015 12/2/2015 1
12/2/2015 12/2/2015 1
12/2/2015 12/2/2015 1
12/2/2015 12/2/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/3/2015 12/3/2015 1
12/4/2015 12/4/2015 1
12/4/2015 12/4/2015 1
12/4/2015 12/4/2015 1
12/4/2015 12/4/2015 1
12/4/2015 12/4/2015 1
12/4/2015 12/4/2015 1
12/4/2015 12/4/2015 1
12/4/2015 12/4/2015 1
12/5/2015 12/5/2015 1
12/6/2015 12/6/2015 1
12/6/2015 12/6/2015 1
12/6/2015 12/6/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/7/2015 12/7/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/8/2015 12/8/2015 1
12/10/2015 12/10/2015 1
12/10/2015 12/10/2015 1
12/10/2015 12/10/2015 1
12/10/2015 12/10/2015 1
12/10/2015 12/10/2015 1
12/10/2015 12/10/2015 1
12/10/2015 12/10/2015 1
12/11/2015 12/11/2015 1
12/11/2015 12/11/2015 1
12/11/2015 12/11/2015 1
12/11/2015 12/11/2015 1
12/12/2015 12/12/2015 1
12/12/2015 12/12/2015 1
12/13/2015 12/13/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/14/2015 12/14/2015 1
12/15/2015 12/15/2015 1
12/15/2015 12/15/2015 1
12/15/2015 12/15/2015 1
12/15/2015 12/15/2015 1
12/15/2015 12/15/2015 1
12/15/2015 12/15/2015 1
12/15/2015 12/15/2015 1
12/15/2015 12/15/2015 1
12/15/2015 12/15/2015 1
12/16/2015 12/16/2015 1
12/16/2015 12/16/2015 1
12/16/2015 12/16/2015 1
12/16/2015 12/16/2015 1
12/16/2015 12/16/2015 1
12/16/2015 12/16/2015 1
12/16/2015 12/16/2015 1
12/16/2015 12/16/2015 1
12/17/2015 12/17/2015 1
12/18/2015 12/18/2015 1
12/18/2015 12/18/2015 1
12/18/2015 12/18/2015 1
12/18/2015 12/18/2015 1
12/18/2015 12/18/2015 1
12/19/2015 12/19/2015 1
12/20/2015 12/20/2015 1
12/20/2015 12/20/2015 1
12/21/2015 12/21/2015 2
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/21/2015 12/21/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/22/2015 12/22/2015 1
12/23/2015 12/23/2015 1
12/23/2015 12/23/2015 1
12/23/2015 12/23/2015 1
12/23/2015 12/23/2015 1
12/23/2015 12/23/2015 1
12/23/2015 12/23/2015 1
12/23/2015 12/23/2015 1
12/24/2015 12/24/2015 1
12/24/2015 12/24/2015 1
12/24/2015 12/24/2015 1
12/25/2015 12/25/2015 1
12/25/2015 12/25/2015 1
12/25/2015 12/25/2015 1
12/26/2015 12/26/2015 1
12/26/2015 12/26/2015 1
12/26/2015 12/26/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/28/2015 12/28/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/29/2015 12/29/2015 1
12/30/2015 12/30/2015 1
12/30/2015 12/30/2015 1
12/30/2015 12/30/2015 1
12/30/2015 12/30/2015 1
12/30/2015 12/30/2015 1
12/31/2015 12/31/2015 1
12/31/2015 12/31/2015 1
12/31/2015 12/31/2015 1
Jumlah 222
2 Petdin Inj 12/5/2015 12/5/2015 2

12/5/2015 12/5/2015 1
12/22/2015 12/22/2015 1
12/28/2015 12/28/2015 1
Jumlah 5
3 Mst 15 mg Tab 12/8/2015 12/8/2015 2

12/9/2015 12/9/2015 10
12/10/2015 12/10/2015 2
12/10/2015 12/10/2015 5
12/10/2015 12/10/2015 3
12/11/2015 12/11/2015 2
12/17/2015 12/17/2015 2
12/18/2015 12/18/2015 2
12/19/2015 12/19/2015 2
12/20/2015 12/20/2015 2
12/20/2015 12/20/2015 2
12/21/2015 12/21/2015 3
12/22/2015 12/22/2015 2
12/23/2015 12/23/2015 3
12/23/2015 12/23/2015 3
12/30/2015 12/30/2015 3
12/30/2015 12/30/2015 3
12/31/2015 12/31/2015 3
Jumlah 54
4 Mst 10 mg Tab 12/1/2015 12/1/2015 2

12/2/2015 12/2/2015 10
12/2/2015 12/2/2015 2
12/3/2015 12/3/2015 2
12/4/2015 12/4/2015 2
12/4/2015 12/4/2015 3
12/4/2015 12/4/2015 2
12/4/2015 12/4/2015 2
12/4/2015 12/4/2015 2
12/5/2015 12/5/2015 3
12/5/2015 12/5/2015 2
12/5/2015 12/5/2015 3
12/6/2015 12/6/2015 2
12/6/2015 12/6/2015 2
12/7/2015 12/7/2015 2
12/8/2015 12/8/2015 3
12/9/2015 12/9/2015 8
Jumlah 52
Keseluruhan Untuk
Jumlah Jumlah
7 8 9 10 11
-
-
-
-
-
Sekayu, Desember 2015

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
AN MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : Desember
Tahun : 2015
Pasien Dokter
Ket
7 8 9 10 11
Martalena Sekayu dr.Meili SpAn

Meta Sekayu dr.Meili SpAn
Oktarina Teluk dr.Meili SpAn
Fet Ds. Terusan dr.Meili SpAn
M.Rizki Sekayu dr.Meili SpAn
Abdul Hadi Sekayu dr.Meili SpAn
Jumarniansi Tanah Abang dr.Meili SpAn
Asiana Talang Piase dr.Meili SpAn
Elon Ruslan Sumber Harum dr.Meili SpAn
Rahmat Babat Supat dr.Meili SpAn
Liza Gajah Mat dr.Meili SpAn
Sit Qomaryatu Babat Toman dr.Meili SpAn
Devi Seftiani Pagar Kasa dr.Meili SpAn
Basuni Rantau Koroya dr.Meili SpAn
Suanini Sukalali, Sungai Keruh dr.Meili SpAn
Sri Suhaini Bailangu Timur dr.Meili SpAn
Lendi Pardede Sanga Desa dr.Meili SpAn
Asmadi Babat Supat dr.Meili SpAn
Nazana Teluk dr.Meili SpAn
Ayu Wulandari Lais dr.Meili SpAn
Suroto Tungkal Jaya dr.Meili SpAn
Nurmansyah Sungai Keruh dr.Meili SpAn
Deni Kadin Sukarami dr.Meili SpAn
Pegi Melat Sukma Danau Cala dr.Dian SpAn
Suryat Ulak Paceh dr.Dian SpAn
Otong Keramat Jaya dr.Dian SpAn
Samsiah Lais dr.Dian SpAn
Aida Lumpatan dr.Dian SpAn
Nopriyant Sungai Lilin dr.Dian SpAn
Anita Agung utara dr.Dian SpAn
Susi Marhani Serasan Jaya dr.Dian SpAn
Yusnani Rantau Panjang dr.Dian SpAn
Keluang Sekayu dr.Dian SpAn
Naimatun Karya Maju dr.Dian SpAn
Dastrican Lawang Wetan dr.Dian SpAn
Rika Febriani Bukit Selabu dr.Dian SpAn
Lidia Sukajadi dr.Dian SpAn
Dendra Mangun Jaya dr.Dian SpAn
Kornia Lumpatan dr.Dian SpAn
Triwat Sidorejo. Keluang dr. Nora
Meta Tebing Bulang dr.Dian SpAn
Sartka Suluk Danau dr.Meili SpAn
Net KBN.I dr.Meili SpAn
Rosdani T.Tenggulang dr.Meili SpAn
Suratmi Keluang dr.Meili SpAn
Anita Lubuk dr.Meili SpAn
Nur Imama Sungai Lilin dr.Meili SpAn
Ismail Sekayu dr.Meili SpAn
Yeni Lais dr.Meili SpAn
Ainun Cipta Praja.Blok G dr.Meili SpAn
Aqeila Ds.I Lumpatan II dr.Meili SpAn
Gunarso Teluk Kijing dr.Meili SpAn
Suryadi Sungai Keruh dr.Meili SpAn
Wage Babat Toman dr.Meili SpAn
Mala Sungai Keruh dr.Meili SpAn
Yusnet Lais dr.Meili SpAn
Wawan Kasmaran dr.Meili SpAn
Slaminan Plakat Tinggi dr.Meili SpAn
Sunaryo Sungai Lilin dr.Meili SpAn
Azmawat Ulak Paceh dr.Meili SpAn
Pasha Albhodi Talang Piase dr.Meili SpAn
Nasrullah Kayuara dr.Meili SpAn
Net Hendriyani Sekayu dr.Meili SpAn
Sumiana Babat Toman dr.Meili SpAn
Zainal Tanah Abang dr.Meili SpAn
Devi Yantka Muara Tanjung dr.Meili SpAn
Yuliana Sekayu dr.Meili SpAn
Heni Gajah Mat dr.Meili SpAn
Hery Yansyah Sekayu dr.Meili SpAn
Lita Dawas Keluang dr.Meili SpAn
Topi Yant Sungai Keruh dr.Dian SpAn
Asnawat Rantau Panjang dr.Dian SpAn
Leni Marlina Sungai Lilin dr.Dian SpAn
Andika Sanga Desa dr.Dian SpAn
Melat Simpang Sari dr.Dian SpAn
Arida Lumpatan dr.Dian SpAn
Net Sekayu dr.Dian SpAn
Erna Keluang dr.Dian SpAn
Martono Keluang dr.Dian SpAn
Darlina Babat Toman dr.Dian SpAn
Hotmah Sungai Lilin dr.Dian SpAn
Eliyani Purwosari dr.Dian SpAn
Fitriani Soak Baru dr. Riri
Rendi Mangun Jaya dr. Dian SpAn
Ika Kayuara dr.Meili SpAn
Tyos Keluang dr.Meili SpAn
Syahudin Danau Cala dr. Meili SpAn
Suparlan Plakat Tinggi dr.Meili SpAn
Maturidi Sekayu dr.Meili SpAn
Hendra Bayung Lincir dr. Meili SpAn
Algifari Abdullah Plakat Tinggi dr.Meili SpAn
Elia Nopitasari Sungai Lilin dr.Meili SpAn
Suud Sekayu dr. Meili SpAn
Sit Marlita Karang Waru dr.Meili SpAn
Destri Pagar Kaya dr.Meili SpAn
Feri Aidil Babat Toman dr. Meili SpAn
Tat Kayuara dr.Meili SpAn
Nurlela Penuduan Darat dr.Meili SpAn
Sasmita Sidomula Sp.I dr. Meili SpAn
Eka Triasih Keluang dr.Meili SpAn
Titk Sekayu dr.Meili SpAn
Paijah Plakat Tinggi dr.Meili SpAn
Nasehat Sekayu dr.Meili SpAn
Niartul Ulya Sungai Lilin dr.Meili SpAn
M. Chazrul Sekayu dr.Meili SpAn
Ide I Tut Ulak Paceh dr.Meili SpAn
Yeni Karang Waru dr.Meili SpAn
Sumarsih Sekayu dr.Meili SpAn
Hosiah Lumpatan dr.Meili SpAn
Agung Teluk Kijing dr.Meili SpAn
Sulaiman Serasan Jaya dr.Meili SpAn
Nirwana Praja Mukt dr.Meili SpAn
Rusmala Balai Agung dr. Dian SpAn
Endras Sungai Lilin dr. Dian SpAn
Endang Sungai Lilin dr. Dian SpAn
Romayant Teladan dr. Dian SpAn
Eka Pertwi Keluang dr. Dian SpAn
Susilawat Karang Ringin dr. Dian SpAn
Ibnu Khotab Bandar Jaya dr. Dian SpAn
Nirwat Sungai Lilin dr. Dian SpAn
Rosita Mangun Jaya dr. Dian SpAn
Kartni Tanjung Agung Utara dr. Meili SpAn
Yeni Ds. Ngant dr.Dian SpAn
Jaleha Babat Supat dr.Meili SpAn
Maimunah Lais dr.Meili SpAn
Yeyen Lais dr.Meili SpAn
Indiart Epil dr.Meili SpAn
Haldafi Inpres Penjara dr.Meili SpAn
M. Idi Sugi Waras dr.Meili SpAn
Devi PT. MBI dr.Meili SpAn
Endah Sungai Lilin dr.Meili SpAn
Evi Sekayu dr.Meili SpAn
Dafa Tungkal Jaya dr.Meili SpAn
Mudiara Batang Hari Leko dr.Meili SpAn
Agustna Serasan Jaya dr.Meili SpAn
Tukiyah Peninggalan dr.Meili SpAn
Aldi Sungai Keruh dr.Meili SpAn
Intan Soak Baru dr.Meili SpAn
Samen Karya Maju dr.Meili SpAn
Ari Suseno Serasan Jaya dr.Meili SpAn
Lydia Ds. Dawas dr.Meili SpAn
Yayi Sekayu dr.Meili SpAn
Asmanah Sekayu dr.Meili SpAn
Miranda Babat Toman dr.Meili SpAn
Erni Lumpatan dr.Meili SpAn
Eva Soak Baru dr.Meili SpAn
Iin Keluang dr.Meili SpAn
Vingkan Tebing Bulang dr.Meili SpAn
Lindawat Sekayu dr.Meili SpAn
Ulil Amin Plakat Tinggi dr.Meili SpAn
Yant Lais dr.Meili SpAn
Dimas Tanjung Agung dr.Meili SpAn
Fardan Plakat Tinggi dr.Meili SpAn
Pria Wansa Lumpatan dr.Meili SpAn
Sit Dwi Narsi Sanga Desa dr.Meili SpAn
Zukro Teluk Kijing dr.Meili SpAn
Rizki Serasan Jaya dr.Meili SpAn
Dennis Jirak dr.Meili SpAn
Kirom Babat Toman dr.Meili SpAn
Haisun Kasmaran dr.Meili SpAn
Suharjo Tungkal Jaya dr.Meili SpAn
Gufta Serasan Jaya dr.Meili SpAn
Levi Diana Serasan Jaya dr.Meili SpAn
Poniran Bayung Lincir dr.Meili SpAn
Okta Serasan Jaya dr.Meili SpAn
Irwan Lais dr.Meili SpAn
Dzaki Sekayu dr.Meili SpAn
Romaidah Lalan dr.Meili SpAn
Rusli Lais dr.Meili SpAn
Abdul Mukt Lawang Wetan dr.Meili SpAn
Nurhidayat Sekayu dr.Meili SpAn
Leni Marlina Cinta Karya dr.Meili SpAn
Net Junart Sungai Lilin dr.Dian SpAn
Dian Khareni Sungai Medak dr.Dian SpAn
Lim Noviant Sekayu dr.Dian SpAn
Sit Plakat Tinggi dr.Dian SpAn
Dahlia Teluk Kijing dr.Dian SpAn
Ruth Jumi Bumi Kencana dr.Dian SpAn
Bebi.K Babat Supat dr.Dian SpAn
Endang Susant Keluang dr.Dian SpAn
Rita Hardiyant Sungai Lilin dr.Dian SpAn
Usmita Sanga Desa dr. Meili SpAn
Eva Suka Maju dr.Meili SpAn
Sari Meliyana Teluk dr.Meili SpAn
Miskia Tungkal Jaya dr.Edi SpAn
Heri Sungai Medak dr.Meili SpAn
Rafli Sekayu dr.Meili SpAn
Sumiyat Babat Toman dr.Meili SpAn
Reasi Sungai Keruh dr.Meili SpAn
Romario Bailangu Timur dr.Meili SpAn
Ahmad Sabirin Griya Randik dr.Meili SpAn
Kartana Sungai Lilin dr.Meili SpAn
Suart Babat Toman dr.Meili SpAn
Tiara Keluang dr.Meili SpAn
Heri Lumpatan dr.Meili SpAn
Hengki Tornando Betung dr.Meili SpAn
Feni Lumpatan dr.Meili SpAn
Octrifiani Sekayu dr.Meili SpAn
Deslinah Babat Toman dr.Meili SpAn
Hafidz Zida Villa Bukit Sejahtera dr.Meili SpAn
Nuryana Tungkal Jaya dr.Meili SpAn
Abel Sekayu dr.Meili SpAn
Abdul Aziz Sekayu dr.Meili SpAn
Evan Lais dr.Meili SpAn
Amina Gajah Mat dr.Meili SpAn
Sunarno Simpang Sari dr.Meili SpAn
Desvi Perumnas dr.Meili SpAn
Dinda Epil dr.Meili SpAn
Angga Akbar Serasan Jaya dr.Meili SpAn
Siliyah Sungai Keruh dr.Meili SpAn
Mahmuda Babat dr.Meili SpAn
Holiyatul Keluang dr.Meili SpAn
Darmansyah Ds. Tempirai Induk dr.Meili SpAn
Deni Sekayu dr.Meili SpAn
Mustka Sekayu dr.Meili SpAn
Susanto Sekayu dr.Meili SpAn
Binart Bayung Lincir dr.Meili SpAn
Uripah Plakat Tinggi dr.Dian SpAn
Dina Ariska Babat dr.Dian SpAn
Mia Oktakiani Kayuara dr.Dian SpAn
Ermilawat Mangun Jaya dr.Dian SpAn
Desi Lk.III Serma Basri dr.Dian SpAn

Diana Mangun Jaya dr.Dian SpAn
Yant Yuhana Lais dr.Meili SpAn
Heri Sungai Medak dr.Meili SpAn
Wawan Sekayu dr.Oyon SpB

Herlina Sekayu dr.Rosidi SppD
Wawan Hermanto Sekayu dr.Dony SpB
Devi Yantka Sekayu dr.Taufik SpoG
Nopasari Ds.Vanai dr.Syarifuddin SppD
Tarpidi Sekayu dr.Dony SpB
Yudi Palembang dr.Dony SpB
Yudi Patriyogi Tanjung Lubuk dr.Rosidi SppD
Yudi Patriyogi Tanjung Lubuk dr.Nora
Masrizal Sungai Lilin dr.Edi
Yudi Tanjung Beringin dr.Wiyah
Masrizal Sungai Lilin dr.Rosidi SppD
Masrizal Sungai Lilin dr.Rosidi SppD
Asmanah Sekayu dr.Rosidi SppD
Asmanah Sekayu dr.Taufik SpoG
Dwi Balai Agung dr.Taufik SpoG
Abu Kasim Tungkal Jaya dr.syarifuddin SppD
Abu Kasim Tungkal Jaya dr.Syarifuddin SppD
Hayat Sekayu dr.Syafriyadi SppD

Hukmi Betung dr.Syarifuddin SppD
Hayat Sekayu dr.Syarifuddin SppD
Ali Kasim Komplek Dc dr.Asdi SppD
Kemal Tebing Bulang dr.Doni SpB
Ali Kasim Komplek Dc dr.Syarifuddin SppD
Ebit Sugara Babat Toman dr.Doni SpB
Lendi Sekayu dr.Doni SpB
Syamsu Deni Babat Toman dr.Doni SpB
Ali Kasim Komplek Dc dr.Syarifuddin SppD
A.Manan Sekayu dr.Asdi SppD
Sri Suhartni Sekayu dr.Taufik SpoG
Kemal Tebing Bulang dr.Aci
Abdul Manan Ds.Dawas Keluang dr.Aci
Wawan Hermanto Sekayu dr.Oyon SpB
Ali Kasim Komplek Dc dr.Rosidi SppD
Ali Kasim Serasan Jaya dr.Rosidi SppD
Sekayu, Desember 2015
Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-
Pemasuk
Tanggal
1 2 3 1/3/1900 5
5 Coditam Tablet -
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MORPHIN, P

No. Izin RS :
No. Izin Khusus :
Resep
1 2 3 1/3/1900 5
1 Fenthanyl Inj 1/3/2016 1/3/2016

1/4/2016 1/4/2016
1/4/2016 1/4/2016
1/4/2016 1/4/2016
1/4/2016 1/4/2016
1/4/2016 1/4/2016
1/4/2016 1/4/2016
1/4/2016 1/4/2016
1/4/2016 1/4/2016
1/4/2016 1/4/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/5/2016 1/5/2016
1/6/2016 1/6/2016
1/6/2016 1/6/2016
1/6/2016 1/6/2016
1/6/2016 1/6/2016
1/6/2016 1/6/2016
1/6/2016 1/6/2016
1/6/2016 1/6/2016
1/7/2016 1/7/2016
1/7/2016 1/7/2016
1/7/2016 1/7/2016
1/7/2016 1/7/2016
1/7/2016 1/7/2016
1/7/2016 1/7/2016
1/9/2016 1/9/2016
1/11/2016 1/11/2016
1/11/2016 1/11/2016
1/11/2016 1/11/2016
1/11/2016 1/11/2016
1/11/2016 1/11/2016
1/11/2016 1/11/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/12/2016 1/12/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/13/2016 1/13/2016
1/14/2016 1/14/2016
1/14/2016 1/14/2016
1/14/2016 1/14/2016
1/14/2016 1/14/2016
1/14/2016 1/14/2016
1/14/2016 1/14/2016
1/14/2016 1/14/2016
1/15/2016 1/15/2016
1/16/2016 1/16/2016
1/16/2016 1/16/2016
1/16/2016 1/16/2016
1/16/2016 1/16/2016
1/16/2016 1/16/2016
1/17/2016 1/17/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/18/2016 1/18/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/19/2016 1/19/2016
1/20/2016 1/20/2016
1/20/2016 1/20/2016
1/20/2016 1/20/2016
1/20/2016 1/20/2016
1/20/2016 1/20/2016
1/20/2016 1/20/2016
1/20/2016 1/20/2016
1/21/2016 1/21/2016
1/21/2016 1/21/2016
1/21/2016 1/21/2016
1/21/2016 1/21/2016
1/21/2016 1/21/2016
1/21/2016 1/21/2016
1/22/2016 1/22/2016
1/22/2016 1/22/2016
1/22/2016 1/22/2016
1/22/2016 1/22/2016
1/22/2016 1/22/2016
1/22/2016 1/22/2016
1/23/2016 1/23/2016
1/23/2016 1/23/2016
1/23/2016 1/23/2016
1/24/2016 1/24/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/25/2016 1/25/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/26/2016 1/26/2016
1/27/2016 1/27/2016
1/27/2016 1/27/2016
1/27/2016 1/27/2016
1/27/2016 1/27/2016
1/27/2016 1/27/2016
1/28/2016 1/28/2016
1/28/2016 1/28/2016
1/28/2016 1/28/2016
1/29/2016 1/29/2016
1/29/2016 1/29/2016
1/29/2016 1/29/2016
1/29/2016 1/29/2016
1/29/2016 1/29/2016
1/29/2016 1/29/2016
1/29/2016 1/29/2016
1/30/2016 1/30/2016
1/30/2016 1/30/2016
1/30/2016 1/30/2016
1/31/2016 1/31/2016
1/31/2016 1/31/2016
1/31/2016 1/31/2016
Jumlah
2 Petdin Inj 1/13/2016 1/13/2016

1/17/2016 1/17/2016
1/20/2016 1/20/2016
1/25/2016 1/25/2016
1/27/2016 1/27/2016
1/27/2016 1/27/2016
1/27/2016 1/27/2016
1/31/2016 1/31/2016
Jumlah
3 Mst 15 mg Tab 1/4/2016 1/4/2016

1/4/2016 1/4/2016
1/8/2016 1/8/2016
1/9/2016 1/9/2016
Jumlah
4 Mst 10 mg Tab 1/12/2016 1/12/2016

1/13/2016 1/13/2016
1/16/2016 1/16/2016
1/22/2016 1/22/2016
1/24/2016 1/24/2016
1/26/2016 1/26/2016
1/28/2016 1/28/2016
1/28/2016 1/28/2016
1/29/2016 1/29/2016
1/30/2016 1/30/2016
Jumlah
0714-321130

Keseluruhan Untuk
Dari Jumlah
6 7 8 9 10
- -
- -
- -
- -
- -
Sekayu, Januari 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
GGUNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : Januari
Tahun : 2016
0714-321130
Pasien Dokter
Jumlah
6 7 8 9 10
1 Nita Eliyani Keluang dr.Dian SpAn

1 Marlina Sekayu dr.Meili SpAn
1 Yuseli Bandar Jaya dr.Meili SpAn
1 Al. Muluk Sekayu dr.Meili SpAn
1 Rita Susant Babat Rimba Jaya dr.Meili SpAn
1 Mutamam Sekayu dr.Meili SpAn
1 Rosadah Balai Agung dr.Meili SpAn
1 Rianto Lais dr.Meili SpAn
1 Mariana Tebing Bulang dr.Meili SpAn
1 Holipa Karta Jaya dr.Meili SpAn
1 Rizki Gajah Mat dr.Meili SpAn
1 Vivi Sri Gunung dr.Meili SpAn
1 Sit Khodijah Sekayu dr.Meili SpAn
1 Hasan Babat Toman dr.Meili SpAn
1 Evi Sekayu dr.Meili SpAn
1 Rusmala Dewi Keluang dr.Meili SpAn
1 Vica Adelia Lumpatan dr.Meili SpAn
1 Achmadi Rimba Ukur dr.Meili SpAn
1 Erlina Keluang dr.Meili SpAn
1 Kartni Ngulak dr.Meili SpAn
1 Kartni Tanjung Agung Timur dr.Meili SpAn
1 Suraida Danau Cala dr.Meili SpAn
1 Jus Kerta Jaya dr.Meili SpAn
1 Zainur Sekayu dr.Meili SpAn
1 Heni Sungai Lilin dr.Meili SpAn
1 Kurniawat Lubuk Buah dr.Meili SpAn
1 Nurmala Yant Bayung Lencir dr.Meili SpAn
1 Sukri Bukit Indah dr.Meili SpAn
1 Mahderi Tungkal Jaya dr.Meili SpAn
1 Rodia Tanjung Barat dr.Meili SpAn
1 Italia Sanga Desa dr.Meili SpAn
1 Roiyah Sungai Lilin dr.Meili SpAn
1 Hartni Tungkal Jaya dr.Meili SpAn
1 Surami Suka Damai Baru dr.Meili SpAn
1 Hasrul Balai Agung dr.Meili SpAn
1 Yan Fitriyusufiana Balai Agung dr.Meili SpAn
1 Puri Sungai Lilin dr.Meili SpAn
1 Rent Kayuara dr.Meili SpAn
1 Eka Sekayu dr.Meili SpAn
1 Sant Plakat Tinggi dr.Meili SpAn
1 Indra Muara Teladan dr.Meili SpAn
1 Sutwi Simpang Sari dr.Meili SpAn
1 Eka Asmawat Plakat Tinggi dr.Meili SpAn
1 Desi Gajah Mat dr.Meili SpAn
1 Sifa Sungai Lilin dr.Meili SpAn
1 Koyiman Karta Maju dr.Meili SpAn
1 Sri Mulyant Keluang dr.Meili SpAn
1 Windari Plakat Tinggi dr.Meili SpAn
1 Mardianah Kayuara dr.Meili SpAn
1 Marzuki Serasan Sekate dr.Meili SpAn
1 Renilawat Kayuara dr.Meili SpAn
1 Dahlia Ds.Terusan dr.Meili SpAn
1 Rodiah Ds.Toman dr.Meili SpAn
1 Manan Gajah Mat dr.Meili SpAn
1 Darmansyah Tempirai Induk dr.Meili SpAn
1 Faysyabilla Sekayu dr.Meili SpAn
1 Lin Agustn Teluk Kijing dr.Meili SpAn
1 Reni Betung dr.Meili SpAn
1 Rosidah Teladan dr.Meili SpAn
1 Sami Limbah Ukur dr.Meili SpAn
1 Rusdi Gajah Mat dr.Meili SpAn
1 Nurjanah Sungai Lilin dr.Meili SpAn
1 Asmanah Terusan dr.Meili SpAn
1 Bumi Yarmi Sungai Angit dr.Meili SpAn
1 Idham Ngulak I dr.Dian SpAn
1 Idaria Teluk Kijing dr.Dian SpAn
1 Heri Plakat Tinggi dr.Dian SpAn
1 Nurlela Sukarami dr.Dian SpAn
1 Purnama Sukajaya dr.Dian SpAn
1 Baijuri Karang Anyar dr.Dian SpAn
1 Nefi Safari Sekayu dr.Dian SpAn
1 Net Safari Serasan Jaya dr.Dian SpAn
1 Julio Dwi Kurniawan Balai Agung dr.Dian SpAn
1 Tomi Kayuara dr.Dian SpAn
1 Fitriana Sekayu dr.Dian SpAn
1 Toni Randik dr.Dian SpAn
1 Umi Barokah Kertayu dr.Dian SpAn
1 Khosiah Kayuara dr.Dian SpAn
1 Leni M Komp.GMP dr.Dian SpAn
1 Nursada Ds. Bonat dr.Meili SpAn
1 Eva Diant Lumpatan dr.Meili SpAn
1 Yosi Ds. Sukamaju dr.Meili SpAn
1 Seli Baru Jayadr dr.Meili SpAn
1 Zainab Bintago dr.Meili SpAn
1 Fajar Bailangu dr.Meili SpAn
1 Arya Plakat Tinggi dr.Meili SpAn
1 Mihertla Bailangu Timur dr.Meili SpAn
1 Tasosi Kayuara dr.Meili SpAn
1 Ayurina Sekayu dr.Meili SpAn
1 Mika Bailangu dr.Meili SpAn
1 Syamsina Ds. Tanjung Agung dr.Meili SpAn
1 Ratna Keluang dr.Meili SpAn
1 Eli Ds.Teluk dr.Meili SpAn
1 Selamat Plakat Tinggi dr.Meili SpAn
1 Ila Susant Prumnas dr.Meili SpAn
1 Erlina Palembang dr.Meili SpAn
1 Rita Kayuara dr.Meili SpAn
1 Romli Ds.Ngunang dr.Meili SpAn
1 Novri Beringin dr.Meili SpAn
1 Hayat Babat Supat dr.Meili SpAn
1 Eni Bandar Jaya dr.Meili SpAn
1 Andika Sido Rahayu dr.Meili SpAn
1 Youvi Sekayu dr.Meili SpAn
1 Homsya Bumi Ayu dr.Meili SpAn
1 Ita Sungai Lilin dr.Meili SpAn
1 Lydia Sereka dr.Meili SpAn
1 Edo Babat Supat dr.Meili SpAn
1 Ruminah Sungai Lilin dr.Meili SpAn
1 Holidi Plakat Tinggi dr.Meili SpAn
1 Maimun Karang Ringin dr.Meili SpAn
1 Zaim Sekayu dr.Meili SpAn
1 Aagil Babat Toman dr.Meili SpAn
1 Sit Yulita Cinta Karya dr.Meili SpAn
1 Winarsi Bayung Lencir dr.Dian SpAn
1 Kovi Trans C3 dr.Dian SpAn
1 Sukemi Ds. Teladan dr.Dian SpAn
1 Indah M. Jaya dr.Dian SpAn
1 Sulaiman Tanah Abang dr.Dian SpAn
1 Purwanto Sungai Lilin dr.Dian SpAn
1 Halimah Sungai Lilin dr.Dian SpAn
1 Rosdalena Babat Toman dr.Dian SpAn
1 Endang Astut Sungai Lilin dr.Dian SpAn
1 Armila Babat Toman dr.Dian SpAn
1 Asmari Babat Toman dr.Dian SpAn
1 Wat Lais dr.Dian SpAn
1 Lisa Ds. Sugiwaras dr.Dian SpAn
1 Alya Lubuk Buah dr.Dian SpAn
1 Rozali Selarai dr.Dian SpAn
1 Kusen Lais dr.Dian SpAn
1 Maryani Sungai Lilin dr.Meili SpAn
1 Suwart Sungai Lilin dr.Meili SpAn
1 Chrisky Triana Komp PT. Pinago dr.Meili SpAn
1 Murdimah Sungai Dua dr.Meili SpAn
1 Dimas Serasan Jaya dr.Meili SpAn
1 Supratman Ds.Sialang Agung dr.Meili SpAn
1 Dita Kayuara dr.Meili SpAn
1 Mustofa Kayuara dr.Meili SpAn
1 Fatmawat Serasan Jaya dr.Meili SpAn
1 Fitriant Babat Supat dr.Meili SpAn
1 Nurlita Ds. Epil dr.Meili SpAn
1 Mad. Darus Lawang Wetan dr.Meili SpAn
1 Mariam Sekayu dr.Meili SpAn
1 Husni Thamrin Simpang Randik dr.Meili SpAn
1 Sit Rahayu Babat Toman dr.Meili SpAn
1 Marbela Tebing Bulang dr.Meili SpAn
1 Suhaini Ngulak dr.Meili SpAn
1 Gita Ria Balai Agung dr.Meili SpAn
1 Sumarni Lawang Wetan dr.Meili SpAn
1 Desiana Sari Sukarami dr.Meili SpAn
1 Rinto Ds. Toman dr.Meili SpAn
1 Wartni Sungai Lilin dr.Meili SpAn
1 Fitri Maskuri Lais dr.Meili SpAn
1 Sandra Sekayu dr.Meili SpAn
1 Herani Lawang Wetan dr.Meili SpAn
1 Umi Kalsum Lawang Wetan dr.Meili SpAn
1 Kartni Muara Teladan dr.Meili SpAn
1 Angga Balai Agung dr.Meili SpAn
1 Hardianto Sungai Keruh dr.Meili SpAn
1 Edi Balai Agung dr.Meili SpAn
1 Sukesi Sungai Lilin dr.Meili SpAn
1 Cici Kartni Ds. Bailangu dr. Dian SpAn
1 Eka Ds. Sugi Raya dr. Meili SpAn
1 Sit Khodijah Sekayu dr. Dian SpAn
1 Sumiat Tanjung Agung dr. Dian SpAn
1 Epin Suryani Epil dr. Dian SpAn
1 Surani Tanah Abang dr. Dian SpAn
1 Emilia Sekayu dr. Dian SpAn
1 Heri Yuliani Balai Agung dr. Dian SpAn
1 Holipah Gajah Mat dr. Dian SpAn
1 Twiyah Kertajaya dr. Dian SpAn
1 Ernawat Keluang dr. Dian SpAn
1 Ika Margiyat Tegal Mulyo dr. Dian SpAn
1 Anidi Gardu Harapan dr. Dian SpAn
1 Marlina Rimba Ukur dr. Dian SpAn
1 Triono Tanjung Raya dr. Dian SpAn
1 Liza Hartat Sekayu dr. Dian SpAn
1 Elsa Sundari Teladan dr. Dian SpAn
1 Zubaidah Plakat Tinggi dr. Dian SpAn
178
1 Lin Agustn Teluk Kijing dr.Meili SpAn

1 Ria.A Babat Toman dr.Meili SpAn
2 Ruminah Sungai Lilin dr.Meili SpAn
1 Rehan Kayuara dr.Meili SpAn
1 Murdimah Sekayu dr .Riri
1 Dina Ariska Babat Toman dr.Dian SpAn
1 Kartna Plakat Tinggi dr.Dian SpAn
1 Fitri Angraini Seberang JM dr.Dian SpAn
10 Padilah Kayuara dr. Rosidi SppD

3 Abu Kasim Sekayu dr. Rosidi SppD
3 Nachola Sekayu dr.Syarifuddin SppD
3 Nachola Sekayu dr.Syarifuddin SppD
19
10 Desi Apriana Gajah Mat dr.Taufik SpoG

10 Mardiana Kayuara dr.Rosidi SppD
2 Fauzan Sekayu dr.Edi
10 Ruminah Sungai Lilin dr.Taufik SpoG
2 Padilah Sekayu dr.Edi
10 Sawiyah Sekayu dr.Taufik SpoG
10 Sawiyah Mendir Jaya dr.Taufik SpoG
10 Umi Kalsum Karang Anyar dr.Taufik SpoG
2 Rono Siderejo dr.Salahudin
3 Nurwahid Sekayu dr.Edi
69

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
42400 1/31/2016 1 Liza Hartat Sekayu
42400 1/31/2016 1 Elsa Sundari Teladan
42400 1/31/2016 1 Zubaidah Plakat Tinggi
eluaran
Jumlah
11

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
lan : Januari
Ket
11
j
dr. Dian SpAn
dr. Dian SpAn
dr. Dian SpAn
No. Izin RS :-
No. Izin Khusus :-

No. Izin RS :-
No. Izin Khusus :-
Pemasukan
Tanggal
1 2 3 1/3/1900 5
5 Coditam Tablet -
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MORPHIN, P

No. Izin RS :
No. Izin Khusus :
Resep
1 2 3 1/3/1900 5
1 Fenthanyl Inj 2/1/2016 2/1/2016

2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/1/2016 2/1/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/2/2016 2/2/2016
2/3/2016 2/3/2016
2/3/2016 2/3/2016
2/3/2016 2/3/2016
2/3/2016 2/3/2016
2/3/2016 2/3/2016
2/3/2016 2/3/2016
2/3/2016 2/3/2016
2/3/2016 2/3/2016
2/3/2016 2/3/2016
2/4/2016 2/4/2016
2/4/2016 2/4/2016
2/4/2016 2/4/2016
2/4/2016 2/4/2016
2/4/2016 2/4/2016
2/5/2016 2/5/2016
2/6/2016 2/6/2016
2/6/2016 2/6/2016
2/7/2016 2/7/2016
2/7/2016 2/7/2016
2/7/2016 2/7/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/10/2016 2/10/2016
2/11/2016 2/11/2016
2/11/2016 2/11/2016
2/11/2016 2/11/2016
2/11/2016 2/11/2016
2/11/2016 2/11/2016
2/11/2016 2/11/2016
2/11/2016 2/11/2016
2/12/2016 2/12/2016
2/12/2016 2/12/2016
2/12/2016 2/12/2016
2/13/2016 2/13/2016
2/13/2016 2/13/2016
2/13/2016 2/13/2016
2/13/2016 2/13/2016
2/13/2016 2/13/2016
2/13/2016 2/13/2016
2/13/2016 2/13/2016
2/13/2016 2/13/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/15/2016 2/15/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/19/2016 2/19/2016
2/19/2016 2/19/2016
2/19/2016 2/19/2016
2/19/2016 2/19/2016
2/19/2016 2/19/2016
2/19/2016 2/19/2016
2/19/2016 2/19/2016
2/19/2016 2/19/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/20/2016 2/20/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/25/2016 2/25/2016
2/26/2016 2/26/2016
2/26/2016 2/26/2016
2/26/2016 2/26/2016
2/26/2016 2/26/2016
2/26/2016 2/26/2016
2/28/2016 2/28/2016
Jumlah
2 Petdin Inj 2/4/2016 2/4/2016

2/4/2016 2/4/2016
2/19/2016 2/19/2016
2/25/2016 2/25/2016
2/29/2016 2/29/2016
Jumlah
3 Mst 15 mg Tab 2/16/2016 2/16/2016

2/16/2016 2/16/2016
2/22/2016 2/22/2016
Jumlah
4 Mst 10 mg 2/2/2016 2/2/2016
2/5/2016 2/5/2016
2/6/2016 2/6/2016
2/6/2016 2/6/2016
2/8/2016 2/8/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/9/2016 2/9/2016
2/15/2016 2/15/2016
2/16/2016 2/16/2016
2/16/2016 2/16/2016
2/17/2016 2/17/2016
2/17/2016 2/17/2016
2/18/2016 2/18/2016
2/18/2016 2/18/2016
2/18/2016 2/18/2016
2/19/2016 2/19/2016
2/20/2016 2/20/2016
2/21/2016 2/21/2016
2/22/2016 2/22/2016
2/23/2016 2/23/2016
23//02/2016 2/23/2016
2/24/2016 2/24/2016
2/24/2016 2/24/2016
2/25/2016 2/25/2016
2/26/2016 2/26/2016
2/27/2016 2/27/2016
2/29/2016 2/29/2016
Jumlah
Ara Sekayu. Telp: 0714-321130
0714-321130

Keseluruhan Untuk
Dari Jumlah Jumlah
6 7 8 9 10 11
- -
- -
- -
- -
- -
Sekayu, Februari 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
GUNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : Februari
Tahun : 2016
0714-321130
Pasien Dokter
Jumlah Ket
6 7 8 9 10 11
1 Rizqi Batang Hari leko dr.Meili SpAn

1 M.Rifki Plakat Tinggi dr.Meili SpAn
1 Andeka Tanah Abang dr.Meili SpAn
1 Wero Babat Supat dr.Meili SpAn
1 Musa Lawang Wetan dr.Meili SpAn
1 Deni Lumpatan dr.Meili SpAn
1 Berita Tempirai Selatan dr.Meili SpAn
1 Ahmad Sungai Batang dr.Meili SpAn
1 Desi Sekayu dr.Meili SpAn
1 Mariono Plakat Tinggi dr.Meili SpAn
1 Deni Babat Supat dr.Meili SpAn
1 Eliza Ngant dr.Meili SpAn
1 Lestari Keluang dr.Meili SpAn
1 Evi Babat Toman dr.Meili SpAn
1 Rimelda Sekayu dr.Meili SpAn
1 Fitriani Ds.I Ulak Kembang dr.Meili SpAn
1 Husmir Tanding Marga dr.Meili SpAn
1 Elsa Sekayu dr.Meili SpAn
1 Galih Babat Toman dr.Meili SpAn
1 Sangkut Sekayu dr.Meili SpAn
1 Mulyadi Bukit Sejahtera dr.Meili SpAn
1 Mat Sani Babat Banyuasin dr.Meili SpAn
1 Junaidi Sekayu dr.Meili SpAn
1 Apria Sungai Lilin dr.Meili SpAn
1 Nurhasanah Bayung Lencir dr.Meili SpAn
1 Sulastri Plakat Tinggi dr.Meili SpAn
1 Novi Yurisa Plakat Tinggi dr.Meili SpAn
1 Miskinem Plakat Tinggi dr.Meili SpAn
1 Novi Teluk Kijing dr.Meili SpAn
1 Reki Danau Cala dr.Meili SpAn
1 Melyantka Sekayu dr.Meili SpAn
1 Syahroni Babat Supat dr.Meili SpAn
1 Symartut Muara Teladan dr.Meili SpAn
1 Umiyat Babat Toman dr.Meili SpAn
1 Sriyah Plakat Tinggi dr.Meili SpAn
1 Rizki Sagitri Randik dr.Dian SpAn
1 Caswita Wijaya Karang Agung dr.Dian SpAn
1 Embun Soni Kp.I Supat dr.Dian SpAn
1 Mayuna Rantau Karya dr.Dian SpAn
1 Desi Keluang dr.Dian SpAn
1 Paiga Juniarni Sekayu dr.Dian SpAn
1 Agus Sungai Lilin dr.Dian SpAn
1 Kurniawan Keluang dr.Dian SpAn
1 Linda Labu Pali dr.Yunika
1 Titn Ds.Saud dr.Dian SpAn
1 Marlina Ulak Embacang dr.Dian SpAn
1 Yuli Yani Kayuara dr.Meili SpAn
1 Mardiana Plakat Tinggi dr.Meili SpAn
1 Trisna Mekar Jaya dr.Meili SpAn
1 Hajiah Kasmaran dr.Meili SpAn
1 Dian Maya Sari Sungai Keruh dr.Meili SpAn
1 Saryadi Sungai Lilin dr.Meili SpAn
1 Muhajirin Bailangu dr.Meili SpAn
1 Maryama Lumpatan dr.Meili SpAn
1 Paryono Batang Hari leko dr.Meili SpAn
1 Levi Letnan H.Nur dr.Meili SpAn
1 Edi Ulak Paceh dr.Meili SpAn
1 Ruminah Kasmaran dr.Meili SpAn
1 Taryart Cinta Karya dr.Meili SpAn
1 Kasmabot Teluk Kijing dr.Meili SpAn
1 Tomi Sido Mulyo dr.Meili SpAn
1 Cik Mat Plakat Tinggi dr.Meili SpAn
1 Juni Mayasari Teladan dr.Meili SpAn
1 Agus Supriyamto Karang Tanding dr.Meili SpAn
1 Yeni Mangun Jaya dr.Meili SpAn
1 Primayana Rantau Kasih dr.Meili SpAn
1 Yetti Memori Lais dr.Dian SpAn
1 Bet Eliana Sekayu dr.Dian SpAn
1 Maryam Sungai Medak dr.Dian SpAn
1 Sumiat Randik dr.Dian SpAn
1 Jumiatun Mekar Jaya dr.Dian SpAn
1 Yant Sungai Lilin dr.Dian SpAn
1 Devi .S Babat Toman dr.Dian SpAn
1 Angga Bailangu dr.Dian SpAn
1 Kartna Bangun Sari dr.Dian SpAn
1 Nova Firmansyah Muara Teladan dr.Dian SpAn
1 Temuk Keluang dr.Dian SpAn
1 Muthia .R Lawang Wetan dr.Dian SpAn
1 Sobri Selarai dr.Dian SpAn
1 Sit Hawa Lais dr.Dian SpAn
1 Puri Damayant Sungai Lilin dr.Dian SpAn
1 Twi Yant Kertajaya dr.Dian SpAn
1 Era Yunita Tanjung Kerang dr.Dian SpAn
1 Rusnidart Babat Toman dr.Dian SpAn
1 Forziza Ngulak dr.Dian SpAn
1 Darnaji Air Tenggulang dr.Ferdi
1 Rita Epil dr.Meili SpAn
1 Irmawat Sukarami dr.Meili SpAn
1 Kasmila Ds. Alendis dr.Meili SpAn
2 Susilawat Sukarami dr.Meili SpAn
1 Gofar Sekayu dr.Meili SpAn
1 Endang Sekayu dr.Meili SpAn
1 Feriyadi Serasan Jaya dr.Meili SpAn
1 Purnama Kayuara dr.Meili SpAn
1 Haris Sukarami dr.Meili SpAn
1 Wahyu Gajah Mat dr.Meili SpAn
1 Otong Ds.Karang Jaya dr.Meili SpAn
1 Fauzan Babat Jaya dr.Meili SpAn
1 Asep Rantau Keroya dr.Meili SpAn
1 Emilia Lingkar JM dr.Meili SpAn
1 Lestari Sungai Keruh dr.Meili SpAn
1 Aji Sugiwaras dr.Meili SpAn
1 Ratona Tungkal Jaya dr.Meili SpAn
1 Sit Aminah Lawang Wetan dr.Meili SpAn
1 Glen Malpino Lais dr.Meili SpAn
1 Sulaiman Plakat Tinggi dr.Meili SpAn
1 Hamaya Sekayu dr.Meili SpAn
1 Asmadi Babat Supat dr.Meili SpAn
1 Sit Rohila Sekayu dr.Meili SpAn
1 Ikash Bailangu Timur dr.Meili SpAn
1 Ruslah Keluang dr.Meili SpAn
3 Darmaji Babat Supat dr.Meili SpAn
1 Tut Randik dr.Meili SpAn
1 Hartat Lais dr.Meili SpAn
1 Mardiawat Babat Supat dr.Meili SpAn
1 Slamet Keluang dr.Meili SpAn
1 Nazuro Karang Ringin dr.Meili SpAn
1 Linda Yani Air Puth Ulu dr.Meili SpAn
1 Usmi Diana Tanjung Agung selatan dr.Meili SpAn
1 Gust Rafael Lumpatan dr.Meili SpAn
1 Minarni Sukarami dr.Meili SpAn
1 Fitri Villa Bukit Sejahtera dr.Dian SpAn
1 Endang Sumber Agung dr.Dian SpAn
1 Jehan Saputra Keluang dr.Dian SpAn
1 Reni Yant Kayuara dr.Dian SpAn
1 Jehan Saputra Keluang dr.Dian SpAn
1 Elmis Sekayu dr.Dian SpAn
1 Farha Babat Toman dr.Dian SpAn
1 Meili Keluang dr.Dian SpAn
1 Nadia Sapitri Tanah Abang dr.Dian SpAn
1 Rita Lumpatan. II dr.Dian SpAn
1 Rubiyat Sanga Desa dr.Dian SpAn
1 Alamsyah Sekayu dr.Dian SpAn
1 Meli Angga Putri Keluang dr.Dian SpAn
1 Irma Sari Sekayu dr.Dian SpAn
1 Yuniar IBI dr.Dian SpAn
1 Martna Ngulak dr.Dian SpAn
1 Elisa Tanjung Agung dr.Dian SpAn
1 Yesi Wulandari Balai Agung dr.Dian SpAn
1 Desi Serasan Jaya dr.Dian SpAn
1 Saida Kertayu dr.Dian SpAn
1 Jefri Sungai Batang dr.Dian SpAn
1 Luspa Diana Lumpatan dr.Dian SpAn
1 Serli Selviyani Tanjung Agung selatan dr.Dian SpAn
1 Kalisna Sekayu dr.Dian SpAn
1 Nanang Boy Tangga Buntung dr.Edi
1 Suryana Plakat Tinggi dr.Meili SpAn
1 Ratna Bukit Selabu dr.Meili SpAn
1 Tasum Ngant dr.Meili SpAn
1 Rafiqo Tungkal Jaya dr.Meili SpAn
1 Irul Baru Jaya dr.Meili SpAn
1 Ali Maskuro Muara Teladan dr.Meili SpAn
1 Ary Supriandi Bundaran LK.7 dr.Meili SpAn
1 Komaria Sungai Keruh dr.Meili SpAn
1 Rudi Ds.Tanah Lembak dr.Meili SpAn
1 Sri Nurhayat Selarai dr.Meili SpAn
1 Sariyah Sungai Lilin dr.Meili SpAn
1 Sri Astut Sungai Lilin dr.Meili SpAn
1 Maryam Keluang dr.Meili SpAn
1 Agnesia Babat Toman dr.Meili SpAn
1 Saryuh PT. Gatri dr.Meili SpAn
1 Supra Ds.Langkap dr.Meili SpAn
1 Hidupi Sanga Desa dr.Meili SpAn
1 Dewi GPI. III dr.Meili SpAn
1 Agunadi Kasmaran dr.Meili SpAn
1 lilik Keluang dr.Meili SpAn
1 Rendi Sekayu dr.Meili SpAn
1 Zulfa Sumber Rezeki dr.Meili SpAn
1 Juanda Ulak Teberau dr.Meili SpAn
1 Sumarni Batang Hari leko dr.Meili SpAn
1 Sit Marlia Sungai Lilin dr.Meili SpAn
1 Joni Darwin Kayuara dr.Meili SpAn
1 Ardianah Ulak Paceh Jaya dr.Meili SpAn
1 Atk Ds.Teladan dr.Dian SpAn
1 Efri Ngulak. I dr.Dian SpAn
1 Miswanto Sungai Lilin dr.Dian SpAn
1 Ratna Sari Susant Prumnas dr.Dian SpAn
1 Fitri Sungai Angit dr.Dian SpAn
1 Amelok Sungai Lilin dr.Dian SpAn
1 Dina Fitriyat Sekayu dr.Dian SpAn
183
1 Nurleli Balai Agung dr.Dian SpAn

1 Yunita Lais dr.Dian SpAn
1 La Carita Air Balui dr.Dian SpAn
1 Kartni Selarai dr.Dian SpAn
1 Endahria Astut Balai Agung dr.Meili SpAn
2 Pini Ds.Mekar Jaya dr.Rosidi SppD

2 Ismail Ds.Pengaturan dr.Rosidi SppD
2 Heman PT.Pinago dr.Damai
6
15 Umi Kalsum Sekayu dr.Taufik SpoG
3 Supardik Kerta Jaya dr.Syariffudin SppD
3 Supardik Kerta Jaya dr.A. Syaukat
2 Hasanudin Sekayu dr.Riri
3 Supardik Kerta Jaya dr.Salahudin SppD
3 Ningim Sekayu dr.Rosidi SppD
2 Sukart Sekayu dr.Ali
2 Herman Sekayu dr.Ali
2 Sakdiah Sekayu dr.Rosidi SppD
15 Sadiah Sekayu dr.Rosidi SppD
2 Azhari Muara Teladan dr.Rosidi SppD
3 Endang Herawat Soak Baru dr.Taufik SpoG
10 Ilaihi Sekayu dr.Asdi SppD
6 Tutk Sekayu dr.Asdi SppD
2 Azhari Muara Teladan dr.Syariffudin SppD
2 Azhari Muara Teladan dr.Syariffudin SppD
2 Azhari Muara Teladan dr.Robiatul
2 Herman Rantau Keroya dr.Yurika
2 Herman Rantau Keroya dr.Rosidi SppD
2 Alex Perumnas dr.Rosidi SppD
6 Alex Perumnas dr.Rosidi SppD
1 Kenoki Bayung Lencir dr.Syariffudin SppD
2 Kenokilase Bayung Lencir dr.Rosidi SppD
105
Sekayu, Februari 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
Persediaan
Akhir Bulan Ket
(8-11)
12 13
u, Februari 2016
nggung Jawab
Hanifdar, Apt
0730 199703 2 001
7/SIPA/DINKES/I/2012
No. Izin RS :-
No. Izin Khusus :-

No. Izin RS :-
No. Izin Khusus :-
Pemasukan
Tanggal
1 2 3 1/3/1900 5
5 Coditam Tablet -
7 MST 10 mg Tablet
8 Duragesic 25 MG Patches
9 Duragesic 12,5 MG Patches
LAPORAN KHUSUS PENGGUNAAN MORPHIN,

No. Izin RS :
No. Izin Khusus :
Resep
1 2 3 1/3/1900 5
1 Fenthanyl 6/1/2016 6/1/2016

6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/1/2016 6/1/2016
6/2/2016 6/2/2016
6/2/2016 6/2/2016
6/2/2016 6/2/2016
6/2/2016 6/2/2016
6/4/2016 6/4/2016
6/4/2016 6/4/2016
6/5/2016 6/5/2016
6/5/2016 6/5/2016
6/5/2016 6/5/2016
6/6/2016 6/6/2016
6/6/2016 6/6/2016
6/6/2016 6/6/2016
6/6/2016 6/6/2016
6/7/2016 6/7/2016
6/7/2016 6/7/2016
6/7/2016 6/7/2016
6/7/2016 6/7/2016
6/7/2016 6/7/2016
6/7/2016 6/7/2016
6/8/2016 6/8/2016
6/8/2016 6/8/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/10/2016 6/10/2016
6/10/2016 6/10/2016
6/10/2016 6/10/2016
6/10/2016 6/10/2016
6/10/2016 6/10/2016
6/11/2016 6/11/2016
6/11/2016 6/11/2016
6/11/2016 6/11/2016
6/13/2016 6/13/2016
6/13/2016 6/13/2016
6/13/2016 6/13/2016
6/13/2016 6/13/2016
6/13/2016 6/13/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/14/2016 6/14/2016
6/15/2016 6/15/2016
6/15/2016 6/15/2016
6/15/2016 6/15/2016
6/15/2016 6/15/2016
6/15/2016 6/15/2016
6/15/2016 6/15/2016
6/15/2016 6/15/2016
6/15/2016 6/15/2016
6/16/2016 6/16/2016
6/16/2016 6/16/2016
6/16/2016 6/16/2016
6/16/2016 6/16/2016
6/16/2016 6/16/2016
6/16/2016 6/16/2016
6/16/2016 6/16/2016
6/17/2016 6/17/2016
6/17/2016 6/17/2016
6/17/2016 6/17/2016
6/17/2016 6/17/2016
6/17/2016 6/17/2016
6/17/2016 6/17/2016
6/17/2016 6/17/2016
6/17/2016 6/17/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/20/2016 6/20/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/21/2016 6/21/2016
6/22/2016 6/22/2016
6/22/2016 6/22/2016
6/22/2016 6/22/2016
6/22/2016 6/22/2016
6/22/2016 6/22/2016
6/22/2016 6/22/2016
6/22/2016 6/22/2016
6/23/2016 6/23/2016
6/23/2016 6/23/2016
6/23/2016 6/23/2016
6/23/2016 6/23/2016
6/24/2016 6/24/2016
6/24/2016 6/24/2016
6/24/2016 6/24/2016
6/25/2016 6/25/2016
6/25/2016 6/25/2016
6/27/2016 6/27/2016
6/27/2016 6/27/2016
6/27/2016 6/27/2016
6/27/2016 6/27/2016
6/27/2016 6/27/2016
6/27/2016 6/27/2016
6/27/2016 6/27/2016
6/28/2016 6/28/2016
6/28/2016 6/28/2016
6/28/2016 6/28/2016
6/28/2016 6/28/2016
6/28/2016 6/28/2016
6/28/2016 6/28/2016
6/28/2016 6/28/2016
6/28/2016 6/28/2016
6/29/2016 6/29/2016
6/29/2016 6/29/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
6/30/2016 6/30/2016
Jumlah
2 Petdin Inj 6/2/2016 6/2/2016

6/3/2016 6/3/2016
6/3/2016 6/3/2016
6/4/2016 6/4/2016
6/5/2016 6/5/2016
6/15/2016 6/15/2016
6/27/2016 6/27/2016
6/27/2016 6/27/2016
6/27/2016 6/27/2016
6/28/2016 6/28/2016
6/28/2016 6/28/2016
Jumlah
3 Morfin Inj 6/8/2016 6/8/2016
Jumlah
4 Mst 15 mg Tab 6/15/2016 6/15/2016
Jumlah
5 Mst 10 mg Tab 6/3/2016 6/3/2016

6/5/2016 6/5/2016
6/5/2016 6/5/2016
6/6/2016 6/6/2016
6/6/2016 6/6/2016
6/7/2016 6/7/2016
6/8/2016 6/8/2016
6/9/2016 6/9/2016
6/9/2016 6/9/2016
6/10/2016 6/10/2016
6/10/2016 6/10/2016
6/11/2016 6/11/2016
6/12/2016 6/12/2016
6/13/2016 6/13/2016
6/14/2016 6/14/2016
6/17/2016 6/17/2016
6/21/2016 6/21/2016
6/23/2016 6/23/2016
6/23/2016 6/23/2016
6/24/2016 6/24/2016
Jumlah
6 Duragesic 25 mg Patch 6/13/2016 6/13/2016

6/14/2016 6/14/2016
6/21/2016 6/21/2016
Jumlah

6/28/2016 6/28/2016
Jumlah
p: 0714-321130

Keseluruhan Untuk
Dari Jumlah
6 7 8 9 10
- -
- -
- -
- -
- -
Nip. 19670730 199703 2 0

SIPA : 843/247/SIPA/DINKES
US PENGGUNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : Juni
Tahun : 2016
p: 0714-321130
Pasien Dokter
Jumlah
6 7 8 9 10
1 Susant Ds.IV Pandulung dr.Meili SpAn

1 Oka Sungai Angit dr.Meili SpAn
1 Meli Teluk Kijing dr.Meili SpAn
1 Wani Jln. Mangkubumi No.37 dr.Meili SpAn
1 M.Taufik Griya Randik dr.Meili SpAn
1 Istqomah Sungai Dua dr.Meili SpAn
1 Tut Plakat Tinggi dr.Meili SpAn
1 Asniyant Sungai Lilin dr.Meili SpAn
1 Dita Adila Petaling dr.Dian SpAn
1 Nalarat Jirak dr.Dian SpAn
1 Rina Serasan Jaya dr.Dian SpAn
1 Dodi Syaputra Kerta Jaya dr.Dian SpAn
1 Satui Marja Mulyo dr.Dian SpAn
1 Surianto Sungai Lilin dr.Ali
2 Purwadi Babat Toman dr.Damai
1 Mustka Bumi Ayu dr.Dian SpAn
1 Rani Keluang dr.Dian SpAn
1 Nurlaila Babat Toman dr.Dian SpAn
1 Hendri Simpang Gardu dr.Edi
1 Paradila Betung dr.Meili SpAn
1 Jumina Teluk dr.Meili SpAn
1 Nasrul Plakat Tinggi dr.Meili SpAn
1 Nasrul Plakat Tinggi dr.Meili SpAn
1 Ningsih Arisandi Jln. Merdeka Kp.VI dr. Dian SpAn
1 Mey Hartat Balai Agung dr.Meili SpAn
1 Mia Soak Baru dr.Meili SpAn
1 Hadi Bayung Lencir dr.Meili SpAn
1 Elya Sari Serasan Jaya dr.Meili SpAn
1 Tina Perumahan GPI dr.Meili SpAn
1 Ahmad Satrio Plakat Tinggi dr.Meili SpAn
1 Martni Simpang Peninggalan dr.Meili SpAn
1 Sinart Plakat Tinggi dr.Dian SpAn
1 Anafisiah Balai Agung dr.Dian SpAn
1 Sit Nawiyah Sungai Lilin dr.Dian SpAn
1 Emalia Kertayu dr.Ali
1 Romlah Sungai Lilin dr.Meili SpAn
1 Idris Langkap dr.Dian SpAn
1 Zuhari Mangun Jaya dr.Dian SpAn
1 Evi Moriska Mangun Jaya dr.Dian SpAn
1 Nasrul Jln. Guntur Jambi dr.Dian SpAn
1 Susi Susant Kerta Jaya dr.Dian SpAn
1 Vaulina Teluk Kijing dr.Dian SpAn
1 Rohana Perumahan GPI dr.Dian SpAn
1 Suryani Bailangu dr.Dian SpAn
1 Reyhan Asrama Kodim dr.Dian SpAn
1 Tri Handayani Komplek. Praja Permai dr.Dian SpAn
1 Nasiyah Pinang Banjar dr.Dian SpAn
1 Sit Sukarami dr.Dian SpAn
1 Zulailah Kerta Jaya dr.Dian SpAn
1 Sri Hartat Babat Supat dr.Dian SpAn
1 Dima Liliana Keluang dr.Dian SpAn
1 Ipada Susila Karangin. II dr.Dian SpAn
1 Siswanto Sumber Agung dr.Meili SpAn
1 Nartk Kayuara dr.Meili SpAn
1 Rafina Keluang dr.Meili SpAn
1 Milawat Ds. Biru Jaya dr.Meili SpAn
1 Hendriyadi Simpang IV. Teladan dr.Meili SpAn
1 Sri Hartat Plakat Tinggi dr.Meili SpAn
1 Marleni Bailangu dr.Meili SpAn
1 M. Bayu Balai Agung dr.Meili SpAn
1 Adi Sekayu dr.Meili SpAn
1 Jelly Gajah Mat dr.Meili SpAn
1 M.Fatahullah Sungai Keruh dr.Meili SpAn
1 Det Betung dr.Meili SpAn
1 Suherni Bayung Lencir dr.Meili SpAn
1 Iliyah Sekayu dr.Meili SpAn
1 Sit Malika Babat Toman dr.Meili SpAn
1 Yuliana Praja Permai dr.Meili SpAn
1 Lilis Simpang Gardu dr.Meili SpAn
1 Ilmayant Sindang Marga dr.Meili SpAn
1 Citra Jln. Letnan Munandar dr.Meili SpAn
1 Sit Hawa Karang Waru dr.Meili SpAn
1 Hendriadi Batang Agung dr.Meili SpAn
1 Homsia Ngunang dr.Meili SpAn
1 Fitri Babat Toman dr.Dian SpAn
1 Latfa Bandar Jaya dr.Dian SpAn
1 Sumini Berlian Makmur dr.Dian SpAn
1 Fitri Babat Toman dr.Meili SpAn
1 Suarni Pagar Kaye dr.Dian SpAn
1 Novi Muara Teladan dr.Dian SpAn
1 Susant Bayung Lencir dr.Dian SpAn
1 Hulfaiza Sanga Desa dr.Dian SpAn
1 Winda Ds. II. Supat dr.Dian SpAn
1 Rospita Sitnjay Tungkal Jaya dr.Dian SpAn
1 Ratna Dewi Ulak Paceh dr.Dian SpAn
1 Muhammad Rizal Sumber Agung dr.Dian SpAn
1 F itri Ningsih Serasan Jaya dr.Dian SpAn
1 Rumini GPI dr.Dian SpAn
1 Suhartni Babat Toman dr.Dian SpAn
1 Sit Fatonah Mulyo Rejo dr.Dian SpAn
1 Karmila Bailangu dr.Dian SpAn
1 Sit Fatonah Mulyo Rejo dr.Dian SpAn
1 Yosi Reneldi Sugi Waras dr.Dian SpAn
1 Fitri Serasan Jaya dr.Dian SpAn
1 Herda Sekayu dr.Dian SpAn
1 Komariyat Epil dr.Wiyah
1 Sumiat Serasan Jaya dr.Meili SpAn
1 Desi Lia Anggraini Babat Toman dr.Meili SpAn
1 Elda Babat Toman dr.Meili SpAn
1 M.Sirojudin dr.Meili SpAn
1 Arlendi Kasmaran dr.Meili SpAn
1 Latf Babat Toman dr.Meili SpAn
1 Weny Novitari Lais dr.Meili SpAn
1 Sit Aminah Sukamaju dr.Meili SpAn
1 Rina Kertayu dr.Meili SpAn
1 Fitriani Perumnas dr.Meili SpAn
1 Rahmalina Balai Agung dr.Meili SpAn
1 Dewi. A Keluang dr.Meili SpAn
1 Armiana Teluk Kijing dr.Meili SpAn
1 Ulandri Sekayu dr.Meili SpAn
1 Mariat Sido Rahayu dr.Meili SpAn
1 Estu Serasan Jaya dr.Meili SpAn
1 Sri Maryat Teladan dr.Meili SpAn
1 Saryanto Mangun Jaya dr.Meili SpAn
1 Sumarni Babat Toman dr.Meili SpAn
1 Ida Laila Rantau Kasih dr.Meili SpAn
1 Sinta Wat Sungai Lilin dr.Meili SpAn
1 Arsan Ulak Paceh dr.Meili SpAn
1 Hent Sido Mulyo dr.Meili SpAn
1 Sit Maisaroh Mulyo Asih dr.Meili SpAn
1 Eriawat Kampung Sekate dr.Meili SpAn
1 Ida Royani Seta Jaya dr.Meili SpAn
1 Yat Kurniawat Seta Jaya dr.Meili SpAn
1 Fahriyat Lumpatan dr.Meili SpAn
1 Dian Triana Balai Agung dr.Dian SpAn
1 Hafifitria Babat Supat dr.Dian SpAn
1 Nurulkhot Suka Damai dr.Dian SpAn
1 Moh.Rhaca Sungai Lilin dr.Dian SpAn
1 Elsa Babat Banyuasin dr.Dian SpAn
1 Maria Teluk Kijing dr.Dian SpAn
1 Samsudin Ngunang dr.Edi
1 Neli.S Sanga Desa dr.Dian SpAn
1 Feriadi Babat Toman dr.Dian SpAn
1 Eeny Jirak dr.Meili SpAn
1 Alamsyah Teluk Kijing dr.Meili SpAn
1 Suharno Balai Agung dr.Meili SpAn
1 Maisuri Sungai Lilin dr.Meili SpAn
1 Asnimar Sungai Lilin dr.Meili SpAn
1 Eli Babat Supat dr.Meili SpAn
1 Eeng Jirak dr.Meili SpAn
1 Asmita Karang Ringin dr.Meili SpAn
1 Zulaila Kerta Jaya dr.Meili SpAn
1 Mariani Sekayu dr.Meili SpAn
1 Nia Sanga Desa dr.Meili SpAn
1 Raditya Sukarami dr.Meili SpAn
1 Sella Ds.IV Teladan dr.Meili SpAn
1 Khodijah Randik dr.Meili SpAn
1 Aidit Tanah Abang dr.Meili
1 Sit Nur Aliatun Mulyo Asih dr.Meili SpAn
1 Sumiart Sri Mulya Sei Angit dr.Meili SpAn
1 Yunani Sungai Medak dr.Dian SpAn
1 Novita Sari Muara Punjung dr.Dian SpAn
1 Romaini Sungai Batang dr.Dian SpAn
1 Nova Sako Suban dr.Dian SpAn
1 Mardiana Sumber Rezeki dr.Dian SpAn
1 Kartni Sungai Lilin dr.Dian SpAn
1 Nurhidayat Sumber Rezeki dr.Dian SpAn
1 Narowi Petaling dr.Dian SpAn
1 Kiat Praja Mukt dr.Dian SpAn
1 Novi Rimba Ukur dr.Dian SpAn
1 Safitri Sungai Lilin dr.Dian SpAn
162
1 Melat Griya Randik dr.Dian SpAn

1 Ria Sindang Marga dr.Dian SpAn
1 Susi Susant Sungai Lilin dr.Dian SpAn
1 Surianto Sungai Lilin dr.Wiyah
1 Hendriadi Balai Agung dr.Meili SpAn
1 Aini Petaling dr.Meili SpAn
1 Erma Ds.I Babat dr.Meili SpAn
1 Rent Mangun Jaya dr.Meili SpAn
1 Septana Tanjung Kerang dr.Meili SpAn
1 Yulia Supriatn Sinar Jaya dr.Meili SpAn
11
3 Dailani Serasan Jaya dr.Irham
2 Feriadi Babat Toman dr.Oyon SpB
3 Surianto Sungai Lilin dr. Asdi SppD

2 Hendri Betung dr.Damai
3 Surianto Sungai Lilin dr.Rosidi SppD
3 Hendri Betung dr.Rosidi SppD
2 Surianto Sungai Lilin dr.Rosidi SppD
2 Poniman Tungkal Jaya dr.Rosidi SppD
3 M.Yusuf Bumi Kencana dr.Rosidi SppD
3 Sit Sholihatun Bumi Kencana dr.Asdi SppD
3 Emilia Bayung Lencir dr.Asdi SppD
3 Emilia Bayung Lencir dr.Damai
3 Emilia Bayung Lencir dr.Syaphri SppD
3 Emilia Bayung Lencir dr.Rosidi SppD
2 Feriadi Lk III.Babat dr.Yurika
2 Hermanto Plakat Tinggi dr.Rosidi SppD
2 Basir Balai Agung dr.Ali
49
1 Hendriyadi Sekayu dr.Meili SpAn

1 Rusmi Muara Teladan dr.Oyon SpB
1 Mariawat Sido Rahayu dr.Meili SpAn
1 Citra Sekayu dr.Meili SpAn

1 Sanik Plakat Tinggi dr.Oyon SpB
Sekayu, Juni 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
Pengeluaran
Jumlah
11
Sekayu, Juni 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
Ket
11
ayu, Juni 2016
anggung Jawab
a. Hanifdar, Apt
70730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-

No. Izin RS :-
No. Izin Khusus :-
Pemasukan
Tanggal
1 2 3 1/3/1900 5
3 Fentanyl 0,05 MG/ML 2 M Ampul
5 Coditam Tablet -
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN M

No. Izin RS :
No. Izin Khusus :
Resep
1 2 3 1/3/1900 5
1 Fenthanyl 7/1/2016 7/1/2016

7/1/2016 7/1/2016
7/1/2016 7/1/2016
7/1/2016 7/1/2016
7/1/2016 7/1/2016
7/1/2016 7/1/2016
7/2/2016 7/2/2016
7/3/2016 7/3/2016
7/3/2016 7/3/2016
7/4/2016 7/4/2016
7/4/2016 7/4/2016
7/4/2016 7/4/2016
7/5/2016 7/5/2016
7/5/2016 7/5/2016
7/6/2016 7/6/2016
7/6/2016 7/6/2016
7/7/2016 7/7/2016
7/7/2016 7/7/2016
7/8/2016 7/8/2016
7/8/2016 7/8/2016
7/8/2016 7/8/2016
7/9/2016 7/9/2016
7/9/2016 7/9/2016
7/11/2016 7/11/2016
7/11/2016 7/11/2016
7/11/2016 7/11/2016
7/11/2016 7/11/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
13/07/2016 13/07/2016
13/07/2016 13/07/2016
13/07/2016 13/07/2016
13/07/2016 13/07/2016
13/07/2016 13/07/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/14/2016 7/14/2016
7/15/2016 7/15/2016
7/15/2016 7/15/2016
7/15/2016 7/15/2016
7/15/2016 7/15/2016
7/15/2016 7/15/2016
7/15/2016 7/15/2016
7/15/2016 7/15/2016
7/15/2016 7/15/2016
7/15/2016 7/15/2016
7/16/2016 7/16/2016
7/18/2016 7/18/2016
7/18/2016 7/18/2016
7/18/2016 7/18/2016
7/18/2016 7/18/2016
7/18/2016 7/18/2016
7/18/2016 7/18/2016
7/19/2016 7/19/2016
7/19/2016 7/19/2016
7/19/2016 7/19/2016
7/19/2016 7/19/2016
7/19/2016 7/19/2016
7/20/2016 7/20/2016
7/20/2016 7/20/2016
7/20/2016 7/20/2016
7/20/2016 7/20/2016
7/20/2016 7/20/2016
7/20/2016 7/20/2016
7/21/2016 7/21/2016
7/21/2016 7/21/2016
7/21/2016 7/21/2016
7/21/2016 7/21/2016
7/21/2016 7/21/2016
7/21/2016 7/21/2016
7/21/2016 7/21/2016
7/22/2016 7/22/2016
7/22/2016 7/22/2016
7/22/2016 7/22/2016
7/22/2016 7/22/2016
7/22/2016 7/22/2016
7/22/2016 7/22/2016
7/23/2016 7/23/2016
7/23/2016 7/23/2016
7/23/2016 7/23/2016
7/24/2016 7/24/2016
7/24/2016 7/24/2016
7/25/2016 7/25/2016
7/25/2016 7/25/2016
7/25/2016 7/25/2016
7/25/2016 7/25/2016
7/25/2016 7/25/2016
7/25/2016 7/25/2016
7/26/2016 7/26/2016
7/26/2016 7/26/2016
7/26/2016 7/26/2016
7/26/2016 7/26/2016
7/26/2016 7/26/2016
7/27/2016 7/27/2016
7/27/2016 7/27/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/28/2016 7/28/2016
7/29/2016 7/29/2016
7/29/2016 7/29/2016
7/29/2016 7/29/2016
7/30/2016 7/30/2016
7/30/2016 7/30/2016
7/30/2016 7/30/2016
7/31/2016 7/31/2016
7/31/2016 7/31/2016
7/31/2016 7/31/2016
Jumlah
2 Petdin Inj 7/2/2016 7/2/2016

7/2/2016 7/2/2016
7/4/2016 7/4/2016
7/4/2016 7/4/2016
7/15/2016 7/15/2016
7/25/2016 7/25/2016
7/25/2016 7/25/2016
7/26/2016 7/26/2016
7/27/2016 7/27/2016
7/27/2016 7/27/2016
Jumlah
3 Morfin Inj 7/27/2016 7/27/2016

7/28/2016 7/28/2016
7/29/2016 7/29/2016
Jumlah
4 Mst 10 mg Tab 7/10/2016 7/10/2016

7/11/2016 7/11/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
7/12/2016 7/12/2016
7/18/2016 7/18/2016
7/19/2016 7/19/2016
7/20/2016 7/20/2016
7/20/2016 7/20/2016
Jumlah

7/22/2016 7/22/2016
7/26/2016 7/26/2016
Jumlah

7/28/2016 7/28/2016
Jumlah
u Ara Sekayu. Telp: 0714-321130
714-321130

Keseluruhan Untuk
Dari Jumlah
(4+7) Pembuatan/ R
6 7 8 9
- -
- -
- -
- -
- -
USUS PENGGUNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST
714-321130
Pasien Dokter
Jumlah
Nama Alamat Nama
6 7 8 9
1 Saris Darlina Praja Permai dr. Dian

1 Tariyem Kampung Sekate dr. Dian
1 Eka Apriani Ulak Teberau dr. Dian
1 Satni Balai Agung dr. Dian
1 Rusdaini Tanah Abang dr. Dian
1 Titn Kayuara dr. Dian
1 Novi Mekarsari dr. Dian
1 Saopi Tanjung Piase dr. Dian
1 Yusiana Kayuara dr. Dian
1 Nurlaila Ulak Teberau dr.Meili
1 Mistna Bukit Sejahtera dr.Meili
1 Mustka Epil dr.Meili
1 Wiwin Sukajaya dr.Meili
1 Yuli Danau Cala dr.Meili
1 Fitri Epil dr.Meili
1 Satriana Balai Agung dr.Meili
1 Helda Lais dr. Dian
1 Murt Talang Piase dr. Dian
1 Herlina Ulak Embacang dr. Dian
1 Arnita Babat Toman dr. Dian
1 Anita Bandar Jaya dr. Dian
1 Rohani Bukit Indah dr. Dian
1 Rita Ngulak dr. Dian
1 Yant Keluang dr.Meili
1 Kasmiyat Kayuara dr. Meili
1 Sutejo Serasan Damai dr. Meili
1 Arsi Talang Akar dr. Meili
1 Masum Jirak dr. Meili
1 Warmi Air Puth Ulu dr. Meili
1 Syamsuri Sugi Waras dr. Meili
1 Maruf Babat Supat dr. Meili
1 Zunaidi Ds. Layan dr. Meili
1 Lisa Banjar Tempirai dr. Meili
1 Rusli Jirak dr. Meili
1 Mida Lumpatan II dr. Meili
1 Eka Lesmana Lais dr. Meili
1 Evi Bailangu dr. Meili
1 Ainah Babat Toman dr. Meili
1 Ahmad Amirudin Keluang dr.Dian
1 Tarma Sungai Lilin dr.A.Syaukat
1 Tri Murtri Babat Toman dr.Dian
1 Hartat Sekayu dr.Dian
1 Melly Prumnas dr.Dian
1 Revan Bayung Lencir dr.Dian
1 Devinca Teluk Kijing dr.Dian
1 Yuli Suhest Sungai Lilin dr.Dian
1 Mawardah Sungai Lilin dr.Dian
1 Dicky Agustn Sungai Lilin dr.Dian
1 Badrun Ulak Teberau dr.Dian
1 Dedi Ulak Teberau dr.Dian
1 Joko Ulak Teberau dr.Dian
1 Rani Lumpatan dr.Dian
1 Indriani Jln.Kol .Wahid Udin dr.Dian
1 Et Hartat Jln.Merdeka dr.Dian
1 Ernawat Jembatan Gantung dr.Dian
1 Kartka Sari Sri Gunung dr.Dian
1 Yunita Sari Sungai Lilin dr.Dian
1 Aman Lumpatan dr.Dian
1 Abdul Serasan Jaya dr.Dian
1 Ningsih Babat Supat dr.Dian
1 Luluk Keluang dr.Dian
1 Zakaria Teluk Kemang dr.Dian
1 Maryat Panca Tunggal dr.Dian
1 Ana Larasat GPI dr.Dian
1 Reni Karlinda Balai Agung dr.Dian
1 Riska Ulak Teberau dr.Meili
1 Rokima Lalan dr.Meili
1 Nurbait Sekayu dr.Meili
1 Nia Lumpatan dr.Meili
1 Nurdin Sumber Rezeki dr.Meili
4 Syeh Rozali Rantau Kasih dr.Ali
1 Iis Dahlia Lumpatan dr.Meili
1 Rokiyah Soak Baru dr.Meili
1 Hendra Soak Baru dr.Meili
1 Yant Praja Permai dr.Meili
1 Esi Lusiana Balai Agung dr.Meili
1 Rosita Keluang dr.Meili
1 Warsiah Sekayu dr.Meili
1 Reni Muara Teladan dr.Meili
1 Susilawat GMP II dr.Meili
1 Royani Ac Milan dr.Meili
1 Rizki Amelia Ngulak dr.Dian
1 Ret Herlina Lais dr.Dian
1 Yoga Plakat Tinggi dr.Dian
1 Sapri Sungai Lilin dr.Dian
1 Desta Sungai Lilin dr.Dian
2 Heriant Kayuara dr.Dian
1 Mega Sari Babat Supat dr.Dian
1 Karsito Lais dr.Dian
1 Agus Lais dr.Dian
1 Parman Keluang dr.Dian
1 Rosta Muara Enim dr.Dian
1 Desi Air Puth Ilir dr.Dian
1 Ruslan Sidorejo dr.Dian
1 Suraya Bumi Ayu dr.Dian
1 Halima Petaling dr.Dian
1 Netti Babat Supat dr.Dian
1 Suwart Keluang dr.Meili
1 Denyana Sungai Lilin dr.Dian
1 Candra Danau Cala dr.Meili
1 Khoirina Serasan Jaya dr.Meili
1 Irwansyah Epil dr.Meili
1 Imron Sekayu dr.Meili
1 Sit Rukim Keluang dr.Meili
1 Kiat Lalan dr.Meili
1 Umila Epil dr.Meili
1 Sulastri Serasan Jaya dr.Meili
1 Sarotn Plakat Tinggi dr.Meili
1 Usman Lais dr.Meili
1 Warna Sukalali dr.Meili
1 Suhaida Sungai Lilin dr.Meili
1 Nitra Bukit Selabu dr.Meili
1 Yeni Serasan Jaya dr.Meili
1 Nesi Teluk Kijing dr.Dian
1 Rima Muara Teladan dr.Dian
1 Khoirul Ds. Ngant dr.Dian
1 Sadi Lalan dr.Dian
1 Liliyana Sukarami dr.Dian
1 Pintor Tungkal Jaya dr.Dian
1 Yatna Sungai Lilin dr.Dian
1 Pera Muliana Ulak Paceh Jaya dr.Dian
1 M.Soleh Selarai dr.Dian
1 Giyant Sukajaya dr.Dian
1 Saudi Epil dr.Dian
1 Fira Rian Bailangu Barat dr.Dian
1 Emilia Sidorayu dr.Dian
1 Andes Rantau Sialang dr.Dian
1 Akendra Bailangu Barat dr.Dian
1 Putri Ramadani Jln. Merdeka Lk.III dr.Dian
1 Salinudin Balai Agung dr.Dian
1 Widia Ningsih Kasmaran dr.Dian
1 Jumiyem Keluang dr.Dian
1 Sit Nuraeni Sekayu dr.Dian
1 Jumiyat Sungai Lilin dr.Dian
138
1 Randika Sukarami dr.Dian

1 Putri Adha Kayuara dr.Dian
1 Evi Animoni Keluang dr.Meili
1 Susmawat Simpang Tungkal dr.Meili
1 Heliya Seta Jaya dr.Dian
1 Saliman Berajaya Timur dr.Meili
1 Ano Suherman Keluang dr.Meili
1 Tri Keluang dr.Meili
1 Nita Sekayu dr.Meili
1 Agus Sekayu dr.Meili
10
2 Ismail Tungkal Jaya dr.Damai

1 Alwani Sekayu dr.Hikmatar
2 Ismail Tungkal Jaya dr.Dian
2 Supardik Sungai Keruh dr.Irham

2 Supardik Sungai Keruh dr.Rosidi
2 Sastu Sekayu dr.Rosidi
2 Supardik Sungai Keruh dr.Rosidi
20 Manaf Pemda Laut dr.Rosidi
2 Rizal Sri Mulyo dr.A.Syaukat
3 Rizal Sri Mulyo dr.Rosidi
3 Rohimin Lumpatan dr.Rosidi
3 Rohimin Lumpatan dr.Rosidi
44
1 Yuzar Teluk Kijing dr.Oyon

1 Desi Komalasari Air Puth dr.Dian
1 Ririn Babat Toman dr.Meili
1 Tiara Agustn Serasan Jaya dr.Dian

1 Ismail Sukarami dr.Dian
2
Pengeluaran
Untuk
Jumlah
Lain-lain
10 11
Sekayu, Juli 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
N-16
Bulan : Juli
Tahun : 2016
Dokter
Ket
Spesialisasi
10 11
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SppD
SppD
SppD
SppD
SppD
SppD
SppD
SppD
SppD
SpB
SpAn
SpAn
SpAn
SpAn
Sekayu, Juli 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-
Alamat : Jl. Kol. Wahid Udin Lk.I Kayu Ara Sekayu. Telp: 0714

No. Izin RS :-
No. Izin Khusus :-
Pemasukan
Tanggal
1 2 3 1/3/1900 5
5 Coditam Tablet -
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MORPHIN, PET

No. Izin RS :
No. Izin Khusus :
Resep
1 2 3 1/3/1900 5
1 Fenthanyl Inj 10/1/2016 10/1/2016

10/1/2016 10/1/2016
10/1/2016 10/1/2016
10/1/2016 10/1/2016
10/1/2016 10/1/2016
10/2/2016 10/2/2016
10/2/2016 10/2/2016
10/2/2016 10/2/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/3/2016 10/3/2016
10/4/2016 10/4/2016
10/4/2016 10/4/2016
10/4/2016 10/4/2016
10/4/2016 10/4/2016
10/4/2016 10/4/2016
10/4/2016 10/4/2016
10/4/2016 10/4/2016
10/5/2016 10/5/2016
10/5/2016 10/5/2016
10/5/2016 10/5/2016
10/5/2016 10/5/2016
10/5/2016 10/5/2016
10/5/2016 10/5/2016
10/5/2016 10/5/2016
10/5/2016 10/5/2016
10/6/2016 10/6/2016
10/6/2016 10/6/2016
10/6/2016 10/6/2016
10/6/2016 10/6/2016
10/6/2016 10/6/2016
10/6/2016 10/6/2016
10/6/2016 10/6/2016
10/7/2016 10/7/2016
10/7/2016 10/7/2016
10/7/2016 10/7/2016
10/7/2016 10/7/2016
10/7/2016 10/7/2016
10/8/2016 10/8/2016
10/8/2016 10/8/2016
10/8/2016 10/8/2016
10/9/2016 10/9/2016
10/10/2016 10/10/2016
10/10/2016 10/10/2016
10/10/2016 10/10/2016
10/10/2016 10/10/2016
10/10/2016 10/10/2016
10/10/2016 10/10/2016
10/10/2016 10/10/2016
10/10/2016 10/10/2016
10/11/2016 10/11/2016
10/11/2016 10/11/2016
10/11/2016 10/11/2016
10/11/2016 10/11/2016
10/11/2016 10/11/2016
10/11/2016 10/11/2016
10/11/2016 10/11/2016
10/11/2016 10/11/2016
10/11/2016 10/11/2016
10/12/2016 10/12/2016
10/12/2016 10/12/2016
10/12/2016 10/12/2016
10/12/2016 10/12/2016
10/12/2016 10/12/2016
10/12/2016 10/12/2016
10/12/2016 10/12/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/13/2016 10/13/2016
10/14/2016 10/14/2016
10/14/2016 10/14/2016
10/14/2016 10/14/2016
10/14/2016 10/14/2016
10/14/2016 10/14/2016
10/15/2016 10/15/2016
10/15/2016 10/15/2016
10/17/2016 10/17/2016
10/17/2016 10/17/2016
10/17/2016 10/17/2016
10/17/2016 10/17/2016
10/17/2016 10/17/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/18/2016 10/18/2016
10/19/2016 10/19/2016
10/19/2016 10/19/2016
10/19/2016 10/19/2016
10/19/2016 10/19/2016
10/19/2016 10/19/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/20/2016 10/20/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/21/2016 10/21/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/24/2016 10/24/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/25/2016 10/25/2016
10/26/2016 10/26/2016
10/26/2016 10/26/2016
10/26/2016 10/26/2016
10/26/2016 10/26/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/27/2016 10/27/2016
10/28/2016 10/28/2016
10/28/2016 10/28/2016
10/28/2016 10/28/2016
10/28/2016 10/28/2016
10/29/2016 10/29/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
10/31/2016 10/31/2016
Jumlah
2 Morfin Inj 10/14/2016 10/14/2016

10/15/2016 10/15/2016
Jumlah
3 Mst 10 mg Tab 10/3/2016 10/3/2016

10/4/2016 10/4/2016
10/5/2016 10/5/2016
10/6/2016 10/6/2016
10/19/2016 10/19/2016
10/20/2016 10/20/2016
10/22/2016 10/22/2016
10/26/2016 10/26/2016
10/27/2016 10/27/2016
Jumlah

10/20/2016 10/20/2016
10/24/2016 10/24/2016
10/25/2016 10/25/2016
Jumlah

10/12/2016 10/12/2016
10/14/2016 10/14/2016
10/19/2016 10/19/2016
Jumlah
yu Ara Sekayu. Telp: 0714-321130
Telp: 0714-321130

Keseluruhan Untuk
Dari Jumlah Jumlah
6 7 8 9 10 11
- -
- -
- -
- -
- -

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
UNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : Oktober
Tahun : 2016
Telp: 0714-321130
Pasien Dokter
Jumlah Ket
o Alamat Nama Spesialisasi
6 7 8 9 10 11
1 Komala Lumpatan dr.Dian SpAn

1 Umar Sekayu dr. Irham
1 Fitriani Rantau Kasih dr.Dian SpAn
1 Umi Hanif Keluang dr.Dian SpAn
1 Fitriani Rantau Kasih dr.Dian SpAn
2 Novita Sari Plakat Tinggi dr.Dian SpAn
1 Maryana Babat Toman dr.Dian SpAn
1 Suratmi Keluang dr.Dian SpAn
1 Emayana Rantau Sialang dr.Meili SpAn
1 Noviah Panca Tunggal dr.Meili SpAn
1 Sri Pramazita Babat Toman dr.Meili SpAn
1 Rofiant Sungai Lilin dr.Meili SpAn
1 Sit Holifa Soak Baru dr.Meili SpAn
1 Oftadila Bailangu dr.Meili SpAn
1 Dimas Pangkalan Tungkal dr.Meili SpAn
1 Tri Endang Gajah Mat dr.Meili SpAn
1 Imran Sekayu dr.Meili SpAn
1 Azhari Sekayu dr.Meili SpAn
1 Ratna Ulak Lia dr.Meili SppD
1 Leni Kertayu dr.Meili SpAn
1 Jamani Margo Mulyo dr.Meili SpAn
1 Imran Komplek GMP dr.Meili SpAn
1 Sulastri Jln .Merdeka Lk. IV dr.Meili SpAn
1 Hasan Babat Toman dr.Meili SpAn
1 Jamari Margo Mulyo dr.Meili SpAn
1 Ratna Dewi Margo Mulyo dr.Meili SpAn
1 Jumiat KUB Tran dr.Meili SpAn
1 Pet Teluk Kijing II dr.Meili SpAn
1 Yesi Muara Punjung dr.Meili SpAn
1 Oyen Sumber Harum dr.Meili SpAn
1 Imelda Babat Toman dr.Meili SpAn
1 Harditriyani Babat Toman dr.Meili SpAn
1 Mawarda Epil dr.Meili SpAn
1 Herawat Teluk Kijing dr.Meili SpAn
1 Julia Babat Supat dr.Meili SpAn
1 Rosi Teluk Kijing dr.Meili SpAn
1 Eni Kertayu dr.Meili SpAn
1 Merge Diana Jirak dr.Meili SpAn
1 Rubayuni Petaling dr.Dian SpAn
1 Artka Lumpatan dr.Dian SpAn
1 Arum rum Plakat Tinggi dr.Dian SpAn
1 Sit Madriky Bailangu dr.Dian SpAn
1 Roibah Sungai Lilin dr.Dian SpAn
1 Dian Maya Kayuara dr.Dian SpAn
1 Ana Hermawah Sungai Lilin dr.Dian SpAn
1 Asmawat Jln. Kol Wahid UdIN dr.Dian SpAn
1 Melat Griya Randik dr.Dian SpAn
1 Agus Suka Damai dr.Dian SpAn
1 Nizul Awan Lumba Jaya dr.Dian SpAn
1 Hasan Babat Toman dr.Dian SpAn
1 Suwaji Sungai Lilin dr.Dian SpAn
1 Fauzi Kemang dr.Dian SpAn
1 Ririn Kayuara dr.Dian SpAn
1 Herlina Tanjung Utara dr.Dian SpAn
1 Susilawat Bailangu Timur dr.Dian SpAn
1 Idoh Sungai Lilin dr.Dian SpAn
1 Susanto Ds. IV Dawas dr.Meili SpAn
1 Susanto Ds. IV Dawas dr.Meili SpAn
1 Nirwani Epil dr.Meili SpAn
1 Nilawat Sanga Desa dr.Meili SpAn
1 Okta Sanga Desa dr.Meili SpAn
1 Eva Keban dr.Meili SpAn
1 Mardiyat Keluang dr.Meili SpAn
1 Icha Tharina Lumpatan dr.Meili SpAn
1 Yat Karang Tanding dr.Meili SpAn
1 Diana Plakat Tinggi dr.Meili SpAn
1 Kiki Mangun Jaya dr.Meili SpAn
1 Suryant Babat Supat dr.Meili SpAn
1 Sukira Sekayu dr.Meili SpAn
2 Asbawat Muara Teladan dr.Meili SpAn
1 Rismawat Perumnas dr.Meili SpAn
1 Sandi Pratama Sekayu dr.Meili SpAn
1 Asbawat Muara Teladan dr.Meili SpAn
1 Yusrizal Soak Baru dr.Meili SpAn
1 Rika Rahim Plakat Tinggi dr.Meili SpAn
1 Fitriani Sumber Agung dr.Meili SpAn
1 Tatk Hartat Seberang JM dr.Meili SpAn
1 Eni Kalsum Ds. Bukit Pangkuasan dr.Meili SpAn
1 Eva Kayuara dr.Meili SpAn
1 Ratna Muara Teladan dr.Meili SpAn
1 Depitri Tebing Bulang dr.Dian SpAn
1 Maryamah Lumpatan . II dr.Dian SpAn
1 Ramai Yant KPS. Masjid Jamik A.nur dr.Dian SpAn
1 Nurjanah Tanjung Indah dr.Dian SpAn
1 Depitri Tebing Bulang dr.Dian SpAn
1 Net Herawat Ngulak dr.Dian SpAn
1 Aldiansyah Babat Banyuasin dr.Dian SpAn
1 Lim Amelia Ds. Mulyo Asih dr.Dian SpAn
1 Dedi Mandala Babat Toman dr.Dian SpAn
1 Etk Ds. Seta Jaya dr.Dian SpAn
1 Ago Sumarno Sungai Lilin dr.Dian SpAn
1 Alon Bailangu dr.Dian SpAn
1 Andeka Komp.Bukit Sejahtera dr.Dian SpAn
1 Mirnawat Babat Supat dr.Dian SpAn
1 Juarsa Gajah Muda dr.Dian SpAn
1 Putri Laleta Ulak Paceh dr.Dian SpAn
1 Lis Fuliyani Sumber Agung dr.Dian SpAn
1 Amirah Sungai Lilin dr.Dian SpAn
1 Lukis Ds. Bagan dr.Meili SpAn
1 Bakrim Lumpatan dr.Meili SpAn
2 Sugiman Rukun Rahayu dr.Meili SpAn
2 Perawat Lais dr.Meili SpAn
1 Cinta Ds. Toman dr.Meili SpAn
1 Erik Bandar Jaya dr.Meili SpAn
1 Sahrini Bayung Lencir dr.Meili SpAn
1 Sumira Babat Toman dr.Meili SpAn
1 Anggi Teluk Kijing dr.Meili
1 Amriadi Sekayu dr.Meili SpAn
1 Komara Serasan Jaya dr.Meili SpAn
1 Mastur Mangun Jaya dr.Meili SpAn
1 Rusmini Sungai Batang dr.Meili SpAn
1 Leni Marlina Plakat Tinggi dr.Meili SpAn
1 Eka Terusan dr.Meili SpAn
1 Mila Gastri PT. Pinago Utama dr.Meili SpAn
1 Elpina Komp. PBK dr.Meili SpAn
1 Rini Sungai Lilin dr.Wiyah
1 Nurhayat Sekayu dr.Meili SpAn
1 Mustarin Tanjung Kerang dr.Meili SpAn
1 Sujiah Keluang dr.Meili SpAn
1 Edo Rihila Mekar Jadi dr.Meili SpAn
1 Sumarni Ds.II Jirak dr.Meili SpAn
1 M. Fajri Kom. Perum Gatri dr.Meili SpAn
1 Mursal Lais dr.Dian SpAn
1 Nurhayat Bailangu dr.Meili SpAn
1 Elis Karya Maju dr.Dian SpAn
1 Lubis Lumpatan dr.Edi
2 Moch.Safi Bumi Kencana dr.Meili SpAn
1 Arma Babat Toman dr.Dian SpAn
1 Destriyosa Sekayu dr.Dian SpAn
1 Dika Sungai Lilin dr.Dian SpAn
1 Mumok Plakat Tinggi dr.Dian SpAn
1 Sumarni Sungai Lilin dr.Dian SpAn
1 Taufik Peninggalan dr.Dian SpAn
1 Casmuri Sungai Lilin dr.Dian SpAn
1 Zupriandi Sungai Lilin dr.Dian SpAn
1 Anisa Sanga Desa dr.Dian SpAn
2 Darmawi Sungai Lilin dr.Dian SpAn
1 Satmin Sungai Lilin dr.Dian SpAn
1 Ceflani Yuniart Petaling dr.Dian SpAn
1 Ita Castut Sungai Lilin dr.Dian SpAn
1 Husnia Randik dr.Dian SpAn
1 Ratna Dewi Sekayu dr.Dian SpAn
1 Sinta Bailangu dr.Dian SpAn
1 Andini Muara Teladan dr.Dian SpAn
1 Dodi Sekayu dr.Dian SpAn
1 Cik mat Balai Agung dr.Dian SpAn
1 Bagas Griya Randik dr.Dian SpAn
1 Fatmah Karang Ringin dr.Dian SpAn
1 Alkoni Sekayu dr.Dian SpAn
1 Mettarida Sekayu dr.Dian SpAn
1 Mentari Tebing Bulang dr.Meili SpAn
1 Sit Fatmah Balai Agung dr.Meili SpAn
1 Saminem Simpang Sari dr.Meili SpAn
1 Nur Aseva Sukarami dr.Meili SpAn
1 Ermala Jirak dr.Meili SpAn
1 Halim Lumpatan dr.Meili SpAn
1 Wawa Talang Jawa dr.Meili SpAn
1 Samsiah Ulak Paceh Jaya dr.Meili SpAn
1 Syamsiah Ulak Paceh Jaya dr.Meili SpAn
1 Nadia Balai Agung dr.Meili SpAn
1 Mukriyadi Tanjung Keputran dr.Meili SpAn
1 Pras Hadi Danau Cala dr.Meili SpAn
1 Martni Petaling dr.Meili SpAn
1 Anita Anggraini Muara Teladan dr.Meili SpAn
1 Rahayu Air Puth Ulu dr.Meili SpAn
1 Soleha Sungai Lilin dr.Meili SpAn
1 Sri Sartka Babat Toman dr.Meili SpAn
1 Sely Kayuara dr.Meili SpAn
1 Desy Perumahan DPRD dr.Meili SpAn
1 Khoidir Karang Ringin dr.Meili SpAn
1 Juli Anggara Muara Teladan dr.Meili SpAn
1 Damila Epil dr.Meili SpAn
1 Kartni Kayuara dr.Meili SpAn
1 Riansyah Talang Piase dr.Meili SpAn
1 Resmawat Plakat Tinggi dr.Meili SpAn
1 Eltni Kasmaran dr.Meili SpAn
1 Euis Ulak Paceh Jaya dr.Meili SpAn
1 Julianto SukaJaya dr.Meili SpAn
1 Gunawan Tegal Mulyo dr.Meili SpAn
1 Yowanda Dewi Sungai Lilin dr.Meili SpAn
1 Yant PT.MBI dr.Meili SpAn
1 Sutarsi Talang Leban dr.Meili SpAn
1 Indraliah Babat Supat dr.Meili SpAn
1 Wat Mentayan dr.Dian SpAn
1 Sari Ngunang dr.Dian SpAn
1 Akrul Teluk Kijing dr.Dian SpAn
1 Thamrin Lapas dr.Dian SpAn
1 Rohima Sungai Lilin dr.Dian SpAn
1 Mukt Sungai Lilin dr.Dian SpAn
1 Komara Sungai Lilin dr.Dian SpAn
1 Yuliani Pasar Inpres Sekayu dr.Dian SpAn
1 Akhmad Nurcholis Sungai Lilin dr.Dian SpAn
1 Yuli Praja Mukt dr.Dian SpAn
1 Bambang Irawan Ngulak dr.Dian SpAn
1 Leni Marlina Keluang dr.Dian SpAn
1 Dora Nopariant Rantau Sialang dr.Dian SpAn
1 Rudi Sungai Lilin dr.Dian SpAn
1 Suliami Keluang dr.Dian SpAn
1 Ronia Sukalan dr.Meili SpAn
1 Alpian Soak Baru dr.Meili SpAn
1 Ahmad Yani Sekayu dr.Meili SpAn
1 Diansyah Babat Toman dr.Meili SpAn
1 Budi Rimba Ukur dr.Meili SpAn
1 Halisan Sukarami dr.Meili SpAn
1 Mardiana Balai Agung dr.Meili SpAn
1 Ramon Karang Waru dr.Meili SpAn
1 Sri Suryat TP.Baru dr.Meili SpAn
1 Deni Suryadi Epil dr.Meili SpAn
1 Partni Keluang dr.Meili SpAn
1 Heri Kurniawan Lubuk Buah dr.Meili SpAn
1 Meisiana Rantau Sialang dr.Meili SpAn
217
3 Nimi Hariani Serasan Jaya dr.Rosidi SppD

2 Nimi Hariani Serasan Jaya dr.Damai
2 Junar Mulyo Rejo dr.Rosidi SppD

2 Junar Mulyo Rejo dr.Yurika
2 Cek Wan Lumpatan dr.Rosidi SppD
3 Cek Wan Lumpatan dr.Rosidi SppD
10 Cek Wan Lumpatan dr. Syarifudin SppD
2 Jamilah Teluk Kijing dr.Meili SpAn
1 Jamilah Teluk Kijing dr. Hasnawi
27
1 Susanto Ds.Dawas dr.Meili SpAn

1 Mursal Lais dr.Dian SpAn
1 Andika Sekayu dr.Oyon SpB
1 Melat Komp. Randik dr.Dian SpAn

1 Sujiah Keluang dr.Meili SpAn
4

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 00
yu, Oktober 2016
nanggung Jawab
a. Hanifdar, Apt
70730 199703 2 001
Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
IPA : 843/247/SIPA/DINKES/I/2012
No. Izin RS :-
No. Izin Khusus :-
Alamat : Jl. Kol. Wahid Udin Lk.I Kayu Ara Sekayu. T

No. Izin RS :-
No. Izin Khusus :-
1 2 3 1/3/1900
1 Clopedin (Pethidin) Ampul
2 Codein 10 mg Tablet
3 Fentanyl 0,05 MG/ML 2 M Ampul
4 Morfin 10 mg Ampul
5 Coditam Tablet
6 MST 15 mg Tablet
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MO

No. Izin RS :
No. Izin Khusus :
Resep
No Nama Sediaan Satuan Tanggal
Permintaan
1 2 3 1/3/1900
1 Fenthanyl 8/1/2016
8/1/2016
8/1/2016
8/1/2016
8/1/2016
8/1/2016
8/2/2016
8/2/2016
8/2/2016
8/2/2016
8/2/2016
8/2/2016
8/2/2016
8/2/2016
8/3/2016
8/3/2016
8/3/2016
8/3/2016
8/3/2016
8/3/2016
8/3/2016
8/3/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/4/2016
8/5/2016
8/5/2016
8/5/2016
8/5/2016
8/5/2016
8/5/2016
8/5/2016
8/5/2016
8/7/2016
8/7/2016
8/7/2016
8/7/2016
8/8/2016
8/9/2016
8/9/2016
8/9/2016
8/9/2016
8/10/2016
8/10/2016
8/10/2016
8/11/2016
8/11/2016
8/11/2016
8/11/2016
8/11/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/12/2016
8/13/2016
8/13/2016
8/14/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/15/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/16/2016
8/17/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/18/2016
8/19/2016
8/19/2016
8/19/2016
8/19/2016
8/19/2016
8/19/2016
8/20/2016
8/20/2016
8/20/2016
8/20/2016
8/21/2016
8/22/2016
8/22/2016
8/22/2016
8/22/2016
8/22/2016
8/22/2016
8/22/2016
8/23/2016
8/23/2016
8/23/2016
8/23/2016
8/23/2016
8/23/2016
8/23/2016
8/23/2016
8/23/2016
8/24/2016
8/24/2016
8/24/2016
8/24/2016
8/24/2016
8/25/2016
8/25/2016
8/25/2016
8/25/2016
8/25/2016
8/25/2016
8/25/2016
8/25/2016
8/25/2016
8/26/2016
8/26/2016
8/26/2016
8/26/2016
8/27/2016
8/28/2016
8/28/2016
8/29/2016
8/29/2016
8/29/2016
8/29/2016
8/29/2016
8/29/2016
8/30/2016
8/30/2016
8/30/2016
8/30/2016
8/30/2016
8/31/2016
8/31/2016
8/31/2016
8/31/2016
8/31/2016
8/31/2016
Jumlah
2 Morfin Inj 8/12/2016

8/18/2016
Jumlah
3 Mst 10 mg Tab 8/15/2016

8/15/2016
8/16/2016
8/20/2016
8/30/2016
8/30/2016
8/31/2016
Jumlah
4 Duragesic 25 mg Patch 8/8/2016

8/8/2016
8/8/2016
Jumlah

8/16/2016
8/17/2016
8/18/2016
8/19/2016
8/19/2016
8/20/2016
8/23/2016
8/29/2016
8/30/2016
Jumlah
l. Wahid Udin Lk.I Kayu Ara Sekayu. Telp: 0714-321130

Keseluruhan Untuk
Tanggal Dari Jumlah
(4+7) Pembuatan/ R
5 6 7 8 9
- - -
- - -
- - -
- - -
- - -
ORAN KHUSUS PENGGUNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST
Resep Pasien Dokter

Tanggal Jumlah
Nama Alamat Nama
Penyerahan
5 6 7 8 9
8/1/2016 1 Rath Purnamasari Babat Toman dr. Meili

8/1/2016 1 Purwat Tanjung Kerang dr. Meili
8/1/2016 1 Novita Sari Kerta Jaya dr. Meili
8/1/2016 1 Jhon Heri Bailangu dr. Meili
8/1/2016 1 Isra Sungai Lilin dr. Meili
8/1/2016 1 Sri Sumarni Keluang dr. Meili
8/2/2016 1 Suparmi Plakat Tinggi dr. Meili
8/2/2016 1 Fatmah Jln. Kol Wahid Udin dr. Meili
8/2/2016 1 Pajria Tanjung Kerang dr. Meili
8/2/2016 1 Yeni Petaling dr. Meili
8/2/2016 1 Anita Tanjung Agung Selatan dr. Meili
8/2/2016 1 Yuli Perumnas dr. Meili
8/2/2016 1 Ida Laila Pali dr. Meili
8/2/2016 1 Zumedi Petaling dr. Meili
8/3/2016 1 Nurimah Suka Maju dr. Meili
8/3/2016 1 Yuliant Ulak Paceh dr. Meili
8/3/2016 1 Rosdiana Soak Baru dr.Dian
8/3/2016 1 Evi Ngulak dr.Meili
8/3/2016 1 Dimas Teluk Kijing dr.Dian
8/3/2016 1 Kuswijiart Serasan Jaya dr.Dian
8/3/2016 1 Rosdiana Sekayu dr.Meili
8/3/2016 1 Husnadi Sukarami dr.Hikmah Tiar
8/4/2016 1 Putri Plakat Tinggi dr.Dian
8/4/2016 2 M. Dahlan Rantau Panjang dr.Meili
8/4/2016 1 Fitriani Sungai Lilin dr.Dian
8/4/2016 1 Masitoh Lumpatan dr.Dian
8/4/2016 1 Andika Sekayu dr.Dian
8/4/2016 1 Muflif Lumpatan dr.Dian
8/4/2016 1 Saleh Durian Daun dr.Dian
8/4/2016 1 Febriansyah Teluk Kijing dr.Dian
8/4/2016 1 Ratna Lumpatan dr.Dian
8/4/2016 1 Lamiran Plakat Tinggi dr.Dian
8/4/2016 1 Saskia Sungai Lilin dr.Dian
8/4/2016 1 Nurliat Sungai Lilin dr.Dian
8/4/2016 1 Leni Bayung Lencir dr.Dian
8/4/2016 1 Neli yani Babat Supat dr.Dian
8/5/2016 1 Karlena Lawang Wetan dr.Dian
8/5/2016 1 Tridasari Sidorejo dr.Dian
8/5/2016 1 Kamsul Mekar Jaya dr.Dian
8/5/2016 1 Hasan Bayung Lencir dr.Dian
8/5/2016 1 Latef Soak Baru dr.Dian
8/5/2016 1 Hasan Ds. Mangsang dr.Dian
8/5/2016 1 Bostomi Karang Ringin I dr.Dian
8/5/2016 1 Holina Plakat Tinggi dr.Dian
8/7/2016 1 Sri Sutami Balai Agung dr.Dian
8/7/2016 1 Riza Sungai Lilin dr.Dian
8/7/2016 1 Robiyatun Cipta Praja dr.Dian
8/7/2016 1 Tri wulan Jln. Merdeka Lk .II dr.Dian
8/8/2016 1 Wiji Tegal Mulyo dr.Dian
8/9/2016 1 Samiha Wat Babat Banyuasin dr.Meili
8/9/2016 1 Dina Sundari Sungai Lilin dr.Meili
8/9/2016 1 Suaiba Jln.Merdeka Lk.III dr.Meili
8/9/2016 1 Yurningsih Tanjung Bali dr.Meili
8/10/2016 1 Ariadi Randik dr.Meili
8/10/2016 1 Nurlaila Plakat Tinggi dr.Dian
8/10/2016 1 Novi Parlina Teluk Kijing dr.Dian
8/11/2016 1 Carina Kayuara dr.Dian
8/11/2016 1 Eka Agustni Begi Mulyo dr.Dian
8/11/2016 1 Ist Keluang dr.Dian
8/11/2016 1 Lili Akitri Suka Damai dr.Dian
8/11/2016 1 Paida Jirak dr.Dian
8/12/2016 1 Dahlia Bailangu Timur dr.Dian
8/12/2016 1 Mest Sohat Mendis Jaya dr.Dian
8/12/2016 1 Dian Lumpatan dr.Dian
8/12/2016 1 Sit Komaria Babat Toman dr.Dian
8/12/2016 1 Yoni Tungkal Jaya dr.Dian
8/12/2016 1 List Yani Teluk Kijing dr.Dian
8/12/2016 1 Dewi Lumpatan dr.Dian
8/12/2016 1 Aries Pinago Utama dr.Dian
8/12/2016 1 Afrianto Tebing Bulang dr.Dian
8/12/2016 1 Wat Tebing Bulang dr.Dian
8/12/2016 1 Sugianto Sekayu dr.Dian
8/12/2016 1 Untung Sungai Lilin dr.Dian
8/12/2016 1 Jana Tanding Marga dr.Dian
8/13/2016 1 Jelita Praja Permai dr.Dian
8/13/2016 1 Wida Tungkal Jaya dr.Riri
8/14/2016 1 Pitri Yant Batang Hari Leko dr.Dian
8/15/2016 1 Mat Mainah Keluang dr.Meili
8/15/2016 1 Desi Maya Tina Plakat Tinggi dr.Meili
8/15/2016 1 Irma Damayant Ulak Paceh Jaya dr.Meili
8/15/2016 1 Poniran Babat Supat dr.Meili
8/15/2016 1 Abu Bakar Keluang dr.Meili
8/15/2016 1 Aziz Babat Toman dr.Meili
8/15/2016 1 Lorenza Rantau Sialang dr.Meili
8/15/2016 1 Supardi Tebing Bulang dr.Meili
8/15/2016 1 Hamzah Kertayu dr.Meili
8/15/2016 1 Naziro Petaling dr.Meili
8/15/2016 1 Romli Batang Hari Leko dr.Meili
8/15/2016 1 Titn Tanjung Agung dr.Meili
8/15/2016 1 Nahison Kemang dr.Meili
8/15/2016 1 Leni Marlina Babat Supat dr.Meili
8/16/2016 1 Mala Babat Toman dr.Meili
8/16/2016 1 Wanda Lk.VII Sekayu dr.Meili
8/16/2016 1 Sumiat Sri Gunung dr.Meili
8/16/2016 1 Misrukia Sugiwaras dr.Meili
8/16/2016 1 Rita Soak Baru dr.Meili
8/16/2016 1 Mentawat Lais dr.Meili
8/16/2016 1 Ernawat Praja Permai dr.Meili
8/16/2016 1 Ratna Dewi Sukarami dr.Meili
8/16/2016 1 Hanie Apriani Sekayu dr.Meili
8/16/2016 1 Yudi Kasmaran dr.Meili
8/16/2016 1 Silawat Serasan Jaya dr.Meili
8/16/2016 1 Eltni Kasmaran dr.Meili
8/17/2016 1 Ulfazila Sukarami dr.Meili
8/18/2016 1 Yunita Ds. Telang Bulang dr.Dian
8/18/2016 1 Sri Rezeki Praja Permai dr.Dian
8/18/2016 1 Diandra Sungai Lilin dr.Dian
8/18/2016 1 Lukman Lumba Jaya dr.Dian
8/18/2016 1 Khaidar Sungai Lilin dr.Dian
8/18/2016 1 Sugeng Supat Barat dr.Dian
8/18/2016 1 Mulyani Rantau Kasih dr.Dian
8/18/2016 1 Paiman Sungai Lilin dr.Dian
8/18/2016 1 Roi Khatul Sungai Lilin dr.Dian
8/18/2016 1 Apidine Sungai Lilin dr.Dian
8/18/2016 1 Enem Babat Supat dr.Dian
8/18/2016 1 Listono Sumber Rezeki dr.Dian
8/18/2016 1 Ernawat Babat Banyuasin dr.Dian
8/18/2016 1 Martni Babat Toman dr.Dian
8/19/2016 1 Susant Sanga Desa dr.Dian
8/19/2016 1 Susant Efendi Babat Toman dr.Dian
8/19/2016 1 Juwar Bukit Selabu dr.Dian
8/19/2016 1 Rumia Sungai Lilin dr.Dian
8/19/2016 1 Robin Sungai Lilin dr.Dian
8/19/2016 1 Ummi Sungai Lilin dr.Dian
8/20/2016 1 Nuraini Betung dr.Dian
8/20/2016 1 Kristnawat Kayuara dr.Dian
8/20/2016 1 Lini Sekayu dr.Dian
8/20/2016 1 Erta Bailangu dr.Dian
8/21/2016 1 Muslikah Gpi. III dr.Dian
8/22/2016 1 Ardeta Mangun Jaya dr.Meili
8/22/2016 1 Mirwan Talang Piase dr.Meili
8/22/2016 1 Melat Lais dr.Meili
8/22/2016 2 Richi Serasan Jaya dr.Meili
8/22/2016 2 Mujiat Sekayu dr.Meili
8/22/2016 2 Melat Lais dr.Meili
8/22/2016 2 Suparmi Mekar Jaya dr.Meili
8/23/2016 1 Yuliana Air Puth dr.Meili
8/23/2016 1 Herlina Kertayu dr.Meili
8/23/2016 1 Dwi Ramaningsih Griya Randik dr.Meili
8/23/2016 1 Ruli Babat Toman dr.Meili
8/23/2016 1 Heriawan Batang Hari Leko dr.Meili
8/23/2016 1 Hadid Balai Agung dr.Meili
8/23/2016 1 Asna Net Lumpatan dr.Meili
8/23/2016 2 Eri Alfiando Tanah Abang dr.Meili
8/23/2016 1 Sunyaki Rimba Ukur dr.Meili
8/24/2016 1 M.Rizki Keluang dr.Meili
8/24/2016 1 Mulyani Mangun Jaya dr.Dian
8/24/2016 1 Kasmirah Keluang dr.Dian
8/24/2016 1 Ita Sei Lilin dr.Dian
8/24/2016 1 Indah Lumpatan dr.Dian
8/25/2016 1 Nurhidayah Prumnas dr.Dian
8/25/2016 1 Wahyu Plakat Tinggi dr.Dian
8/25/2016 1 Eva Plakat Tinggi dr.Dian
8/25/2016 1 Yesri Ariska Ds.Dawas dr.Dian
8/25/2016 1 Ika Ds.Jirak dr.Dian
8/25/2016 1 Nurdin Jln.Seberang JM dr.Dian
8/25/2016 1 Kailani Ulak Paceh dr.Dian
8/25/2016 1 Lukmi Sekayu dr.Dian
8/25/2016 1 Maryat Penukal Utara dr.Dian
8/26/2016 1 Kartna Gpi dr.Dian
8/26/2016 1 Asmawat Muara Teladan dr.Dian
8/26/2016 1 Hasyim Lk. I Babat dr.Dian
8/26/2016 1 Sirkum Bumi Kencana dr.Dian
8/27/2016 1 Desi Purnamasari Peninggalan dr.Dian
8/28/2016 1 Damaihuri Lumpatan dr.Meili
8/28/2016 1 Ima Lumpatan dr.Meili
8/29/2016 1 Suhermin Babat Supat dr.Meili
8/29/2016 1 Hazal Serasan Jaya dr.Meili
8/29/2016 1 Nurhayat Philip dr.Meili
8/29/2016 1 Fitriyani Plakat Tinggi dr.Meili
8/29/2016 1 Musa Serasan Jaya dr.Meili
8/29/2016 1 Ilia Wat Lumpatan dr.Meili
8/30/2016 1 Suci Keluang dr.Meili
8/30/2016 1 Ribuana Lumpatan dr.Meili
8/30/2016 1 Herayani Batang Hari Leko dr.Meili
8/30/2016 1 Ima Lumpatan dr.Meili
8/30/2016 1 Heri Bailangu dr.Meili
8/31/2016 1 Ngatmiah Sungai Lilin dr.Meili
8/31/2016 1 Devi Erlila Lk II. Sekayu dr.Meili
8/31/2016 1 Abdul Malik Ulak Paceh dr.Meili
8/31/2016 1 Mistri Sungai Lilin dr.Meili
8/31/2016 1 Juwita Teluk Kijing dr.Meili
8/31/2016 1 Lis Diana Lumpatan dr.Meili
189
8/12/2016 1 Busmedi Kertajaya dr.Wiyah

8/18/2016 2 Yudi Santoso Babat Toman dr.Yurika
8/15/2016 3 Sunoto Yakum Jaya dr.Syaukat

8/15/2016 2 Yafet Laila Sekayu dr.Rosidi
8/16/2016 3 Sunoto Yakum Jaya dr.Wiyah
8/20/2016 10 Yafet Laila Sekayu dr.Syarifudin
8/30/2016 2 Nurhayat Epil dr.Rosidi
8/30/2016 2 Hasum Bailangu dr.Rosidi
8/31/2016 2 Nurhayat Epil dr.Rosidi
24
8/8/2016 1 Yuliazwar Perumnas dr.Meili

8/8/2016 1 Edi Rizal Batang Hari Leko dr.Oyon
8/8/2016 1 Surniwat Sekayu dr.Oyon
8/16/2016 1 Yafet Sekayu dr.Rosidi

8/16/2016 1 Hanie Apriani Tanah Abang dr.Meili
8/17/2016 1 Yafet Laila Sekayu dr.Irham
8/18/2016 2 Sri Rizki Praja Permai dr.Dian
8/19/2016 1 Yafet Laila Sekayu dr.Dian
8/19/2016 1 Sundiat Ds.III Supat dr.Dian
8/20/2016 1 Lini Media Sekayu dr.Dian
8/23/2016 1 Supratman Bukit Sejahtera dr.Meili
8/29/2016 1 Imron Suri Sekayu dr.Rosidi
8/30/2016 1 Azhari Muara Punjung dr.Meili
11
Pengeluaran
Untuk
Jumlah
Lain-lain
10 11
Sekayu, Agustus 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
N-16
Bulan : Agustus
Tahun : 2016
Dokter
Ket
Spesialisasi
10 11
SpAn
SpAn
SpAn
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SppD
SppD
SppD
SppD
SpAn
SpB
SpB
SppD
SpAn
SpAn
SpAn
SpAn
SpAn
SpAn
SppD
SpAn

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-
Alamat : Jl. Kol. Wahid Udin Lk.I Kayu Ara Sekayu. Telp

No. Izin RS :-
No. Izin Khusus :-
1 2 3 1/3/1900
1 Clopedin (Pethidin) Ampul
2 Codein 10 mg Tablet
4 Morfin 10 mg Ampul
5 Coditam Tablet
6 MST 15 mg Tablet
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MORPHIN, PET

No. Izin RS :
No. Izin Khusus :
Resep
No Nama Sediaan Satuan Tanggal
Permintaan
1 2 3 1/3/1900
1 Fenthanyl Inj 9/1/2016

9/1/2016
9/1/2016
9/1/2016
9/1/2016
9/1/2016
9/1/2016
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9/21/2016
9/21/2016
9/22/2016
9/22/2016
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9/22/2016
9/22/2016
9/22/2016
9/22/2016
9/23/2016
9/23/2016
9/23/2016
9/23/2016
9/23/2016
9/24/2016
9/25/2016
9/25/2016
9/26/2016
9/26/2016
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9/27/2016
9/27/2016
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9/30/2016
9/30/2016
9/30/2016
9/30/2016
9/30/2016
9/30/2016
9/30/2016
9/30/2016
Jumlah
2 Petdin Inj 9/23/2016

9/23/2016
Jumlah

9/15/2016
9/22/2016
9/28/2016
Jumlah

9/8/2016
9/8/2016
9/15/2016
9/15/2016
9/16/2016
9/22/2016
Jumlah
Wahid Udin Lk.I Kayu Ara Sekayu. Telp: 0714-321130

Keseluruhan Untuk
Tanggal Dari Jumlah
5 6 7 8 9 10
- - -
- - -
- - -
- - -
- - -

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2
SIPA : 843/247/SIPA/DINKE
US PENGGUNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : September
Tahun : 2016
Resep Pasien Dokter

Tanggal Jumlah
Penyerahan
5 6 7 8 9 10
9/1/2016 1 Salma Sungai Lilin dr.Dian SpAn

9/1/2016 1 Leni Marlina Sungai Lilin dr.Dian SpAn
9/1/2016 1 Rika Lumpatan dr.Dian SpAn
9/1/2016 1 Metalia Kayuara dr.Dian SpAn
9/1/2016 1 Holmah Rantau Panjang dr.Dian SpAn
9/1/2016 1 Suryana Sungai Lilin dr.Dian SpAn
9/1/2016 1 Khoirul Sungai Lilin dr.Dian SpAn
9/1/2016 1 Faisol Mulya Asi dr.Dian SpAn
9/1/2016 1 Khusnul Khotmah Sungai Lilin dr.Dian SpAn
9/1/2016 1 Indah Andani Bailangu Timur dr.Dian SpAn
9/2/2016 1 Muslim Sungai Lilin dr.Dian SpAn
9/2/2016 1 Ani Plakat Tinggi dr.Dian SpAn
9/2/2016 1 Want Sumber Rezeki dr.Dian SpAn
9/2/2016 1 Sumiat Bumi Kencana dr.Dian SpAn
9/2/2016 1 Sazili Piase Berang dr.Dian SpAn
9/2/2016 1 Halimah Rantau Panjang dr.Dian SpAn
9/2/2016 1 Anita Danau Cala dr.Dian SpAn
9/2/2016 1 Ekis Irawat Sungai Lilin dr.Dian SpAn
9/5/2016 1 M.Amri Serasan Jaya dr.Rosidi SppD
9/5/2016 1 Marlina Ramba Rampok dr.Meili SpAn
9/5/2016 1 Rukmini Lawang Wetan dr.Meili SpAn
9/5/2016 1 Larni Ulak Paceh dr.Meili SpAn
9/5/2016 1 Evi Hariyana Sindang Marga dr.Meili SpAn
9/5/2016 1 Fauzi Epil dr.Meili SpAn
9/5/2016 1 Mawar Sungai Keruh dr.Meili SpAn
9/5/2016 1 Sugiat Sungai Lilin dr.Meili SpAn
9/5/2016 1 Suharni Sungai Lilin dr.Meili SpAn
9/5/2016 1 Murt Handayani Tanah Abang dr.Meili SpAn
9/5/2016 1 Sugiart Sungai Lilin dr.Meili SpAn
9/5/2016 1 Balkolni Teluk Kijing dr.Meili SpAn
9/6/2016 1 Istpada Jln.Kol Burlian dr.Meili SpAn
9/6/2016 1 Leni Marlina Sungai Dua dr.Meili SpAn
9/6/2016 1 Nurlaila Lingkar Randik dr.Meili SpAn
9/6/2016 1 Romiat Muara Teladan dr.Meili SpAn
9/7/2016 1 Konida Selarai dr.Meili SpAn
9/7/2016 1 Zulfitri Gpi dr.Meili SpAn
9/7/2016 1 Azirawat Ds. Panca Tunggal dr.Meili SpAn
9/7/2016 1 Zurina Ds. Babat Supat dr.Meili SpAn
9/7/2016 1 Tri Ricanto Jln. Wahid Udin Lk III dr.Meili SpAn
9/7/2016 1 Lasna Ds.III JM. Gantung dr. Dian SpAn
9/7/2016 1 Yunita Ds. Epil dr. Dian SpAn
9/7/2016 1 Tri Putri Pebriyant Jln. Muara Teladan dr. Dian SpAn
9/7/2016 1 Suhaiba Jln. Pal II.Pinago dr. Dian SpAn
9/8/2016 2 Syafei Epil dr. Dian SpAn
9/8/2016 1 Suhek Lais Utara dr. Dian SpAn
9/8/2016 1 Yurnika Sungai Lilin dr. Dian SpAn
9/8/2016 1 Nuraini Tanah Agung dr. Dian SpAn
9/8/2016 1 Eliana Ds. Simpang Babat dr. Dian SpAn
9/8/2016 1 Indah Babat Supat dr. Dian SpAn
9/8/2016 1 Yeyen Lumpatan dr. Dian SpAn
9/8/2016 1 Yuda GPI. III dr.Dian SpAn
9/8/2016 1 Eliana Simpang Bayat dr. Dian SpAn
9/8/2016 2 Tukimo Sungai Lilin dr. Dian SpAn
9/8/2016 1 Gusnawat Babat Supat dr. Dian SpAn
9/9/2016 1 Heni Serasan Jaya dr. Dian SpAn
9/9/2016 1 Rosita Tanjung Bali dr. Dian SpAn
9/9/2016 1 Yohan Ds. II Serekah dr. Dian SpAn
9/10/2016 1 Faiz Jln. Merdeka dr. Dian SpAn
9/11/2016 1 Andini yolanda Tanah Abang dr. Dian SpAn
9/11/2016 1 Tri Winarsi Sri Gunung dr. Dian SpAn
9/12/2016 1 Arpitayani Muara Teladan dr.Meili SpAn
9/13/2016 1 Cahyat Sei Lilin dr.Meili SpAn
9/13/2016 1 Afatar Karang Anyar dr.Meili SpAn
9/13/2016 1 Cik Wan Jln. Balai Agung dr.Meili SpAn
9/13/2016 1 Maryadi Suka Damai Baru dr.Meili SpAn
9/13/2016 1 Mujiono Sumber Agung dr.Meili SpAn
9/13/2016 1 Fitri Penukal Utara dr.Meili SpAn
9/13/2016 1 Dewi Sartka Rukun Rahayu dr.Meili SpAn
9/13/2016 1 Suryasin Ds.Air Puth Ulu dr.Meili SpAn
9/13/2016 1 Bakri Ds III. Keramat Jaya dr.Meili SpAn
9/13/2016 1 Yeni Sako Suban dr.Meili SpAn
9/14/2016 1 Deviana Danau Cala dr.Meili SpAn
9/14/2016 1 Sulastri Rantau Sialang dr.Meili SpAn
9/14/2016 1 Holna Jln. Merdeka Lk II dr.Meili SpAn
9/14/2016 1 Ramon Ds. II Karang Waru dr.Meili SpAn
9/14/2016 1 Usnawat Plakat Tinggi dr.Meili SpAn
9/14/2016 1 M.Rozi Ds.II Muara Teladan dr.Meili SpAn
9/14/2016 1 Adeng Purwosari dr.Meili SpAn
9/14/2016 1 Nurhayat Kayuara dr.Meili SpAn
9/14/2016 1 Iin Mulaina Ds. III Jirak dr.Meili SpAn
9/14/2016 1 Lisa Umami Lais dr.Meili SpAn
9/15/2016 1 Bintu Fransiska Perumnas dr.Dian SpAn
9/15/2016 1 Fitri Teluk Kijing dr.Dian SpAn
9/15/2016 1 Sanatum Kayuara dr. Irham
9/15/2016 1 Rusdi Sungai Lilin dr.Dian SpAn
9/15/2016 1 Suprodi Sungai Lilin dr.Dian SpAn
9/15/2016 1 Istkhoma Sri Gunung dr.Dian SpAn
9/15/2016 1 Marlina Sungai Lilin dr.Dian SpAn
9/15/2016 1 Rosdoyant Keluang dr.Dian SpAn
9/15/2016 1 Chelvie Octavia Sekayu dr.Dian SpAn
9/15/2016 1 Een Rohaeni Wulan Jadi dr.Dian SpAn
9/15/2016 1 Herlita Lais dr.Dian SpAn
9/15/2016 1 Sit Inam Tanding Marga dr.Dian SpAn
9/15/2016 1 Erna Serasan Jaya dr.Dian SpAn
9/16/2016 1 Dest Sungai Batang dr.Dian SpAn
9/16/2016 1 Pai Langkap dr.Dian SpAn
9/16/2016 1 Cica Lais dr.Dian SpAn
9/16/2016 1 Sit Sungai Keruh dr.Dian SpAn
9/16/2016 1 Manisa Sekayu dr.Dian SpAn
9/16/2016 1 Musirah Bayung Lencir dr.Dian SpAn
9/16/2016 1 Minarni Soak Baru dr.Dian SpAn
9/16/2016 1 Syawitri Raihani Lumpatan dr.Dian SpAn
9/16/2016 1 Nurlela Serasan Jaya dr.Dian SpAn
9/17/2016 1 Julia Sari Keluang dr.Dian SpAn
9/17/2016 1 Misnawat Bailangu Barat dr.Dian SpAn
9/17/2016 1 Amri Peltu Yusuf Ulak dr.Salahudin
9/17/2016 1 Nasriat Sekayu dr.Dian SpAn
9/17/2016 1 Sumiat Serasan Jaya dr.Dian SpAn
9/19/2016 1 Ernita Ula Paceh Jaya dr.Meili SpAn
9/19/2016 1 Munir Jln. Merdeka Lk. VII dr.Meili SpAn
9/19/2016 1 Zumrotul Babat Toman dr.Meili SpAn
9/19/2016 1 Meli Agustni Keluang dr.Meili SpAn
9/19/2016 1 Sit Yansyah Sungai Lilin dr.Meili SpAn
9/19/2016 1 Fent Haryant Batang Hari Leko dr.Meili SpAn
9/20/2016 1 Farida Bailangu Timur dr.Meili SpAn
9/20/2016 1 Husdatul Lais dr.Meili SpAn
9/20/2016 1 Dwi Astari Babat Supat dr.Meili SpAn
9/20/2016 1 Maryam Petaling dr.Meili SpAn
9/20/2016 1 Sumarni Air Puth Ulu dr.Meili SpAn
9/20/2016 1 Rizki Babat Supat dr.Meili SpAn
9/20/2016 1 Ernaini Talang Jawa dr.Meili SpAn
9/20/2016 1 Puput Lumpatan dr.Meili SpAn
9/20/2016 1 Deby Triyana praja Permai dr.Meili SpAn
9/20/2016 1 Titn Kayuara dr.Meili SpAn
9/21/2016 1 Subairun Karang Ringin dr.Meili SpAn
9/21/2016 1 Roni Lais dr.Meili SpAn
9/21/2016 1 Tugiyem Plakat Tinggi dr.Meili SpAn
9/21/2016 1 Satmah Jirak dr.Meili SpAn
9/21/2016 1 Iza'mala Gajah Mat dr.Meili SpAn
9/21/2016 1 Yulia Jln.Lingkar Sekayu dr.Meili SpAn
9/21/2016 1 Heny Serasan Jaya dr.Meili SpAn
9/21/2016 1 Milayani Gajah Mat dr.Meili SpAn
9/21/2016 1 Darmus Air Balui dr.Meili SpAn
9/22/2016 1 Nani Muara Teladan dr.Dian SpAn
9/22/2016 1 Yeni Babat Toman dr.Dian SpAn
9/22/2016 1 Dedi Mangun Jaya dr.Dian SpAn
9/22/2016 1 Yunus Petaling dr.Dian SpAn
9/22/2016 1 Nurmada Gpi dr.Dian SpAn
9/22/2016 1 Abidin Lais dr.Dian SpAn
9/22/2016 1 Wita Serasan Jaya dr.Dian SpAn
9/22/2016 1 Lekat Kertajaya dr.Dian SpAn
9/22/2016 1 Armin Teluk Kijing dr.Dian SpAn
9/22/2016 1 Andriani PT.MBI dr.Dian SpAn
9/23/2016 1 Sulastri Ula Paceh Jaya dr.Dian SpAn
9/23/2016 1 Divieka Lingga Sari dr.Dian SpAn
9/23/2016 1 Marianah Kp.I Sekayu dr.Dian SpAn
9/23/2016 1 Nurmiana Petaling dr.Dian SpAn
9/23/2016 1 Fadila Danau Cala dr.Dian SpAn
9/24/2016 2 Zulkopli Jln.Merdeka Lk. VII dr.Dian SpAn
9/25/2016 1 Rustam Jirak dr.Dian SpAn
9/25/2016 1 Sit Halimah Talang Jawa dr.Dian SpAn
9/26/2016 1 Liah Tebing Bulang dr.Meili SpAn
9/26/2016 1 Abdullah Danau Cala dr.Meili SpAn
9/26/2016 1 Elvin Bailangu dr.Meili SpAn
9/26/2016 1 Tiara Napal dr.Meili SpAn
9/27/2016 1 Omi Fitri Tanah Abang dr.Meili SpAn
9/27/2016 1 Rosidah Ulak Teberau dr.Meili SpAn
9/27/2016 1 Asanudin Sungai Lilin dr.Meili SpAn
9/27/2016 1 Ratna Lilis Bayung Lencir dr.Meili SpAn
9/27/2016 1 Litka Petaling dr.Meili SpAn
9/27/2016 1 Hermala Sekayu dr.Meili SpAn
9/27/2016 2 Asanudin Sungai Lilin dr.Meili SpAn
9/27/2016 1 Erlina Lais dr.Meili SpAn
9/27/2016 1 Irma Susant Sanga Desa dr.Meili SpAn
9/28/2016 1 Parmini Tungkal Jaya dr.Meili SpAn
9/28/2016 1 Rahmi Jln.Kol Wahid Udin dr.Meili SpAn
9/28/2016 2 Yeni Liono Sako Suban dr.Meili SpAn
9/28/2016 1 Sri Maryat Epil dr.Meili SpAn
9/28/2016 1 Lidia Wat Kayuara dr.Meili SpAn
9/28/2016 1 Siska Rantau Kroya dr.Meili SpAn
9/28/2016 1 Hartono Sekayu dr. Syaukat
9/29/2016 1 Ismail Sp .IV dr.Dian SpAn
9/29/2016 1 Fitri Erlinda Perumnas dr.Dian SpAn
9/29/2016 2 M.Jepri Komplek Dc dr.Dian SpAn
9/29/2016 1 Cici Wat Air Puth Ulu dr.Dian SpAn
9/29/2016 1 Kart Panca Tunggal dr.Dian SpAn
9/29/2016 1 Fitri Balai Agung dr.Dian SpAn
9/29/2016 1 Dwi Hasanah Epil dr.Dian SpAn
9/29/2016 1 Esta Pangkalan Tungkal dr.Dian SpAn
9/29/2016 1 Yulia Babat Banyuasin dr.Dian SpAn
9/30/2016 2 Jawiya Tebing Bulang dr.Dian SpAn
9/30/2016 2 Trisca Jln. H.Nur dr.Dian SpAn
9/30/2016 2 Nanang Sekayu dr.Dian SpAn
9/30/2016 2 Wahyudin Jln.Tembus Randik dr.Dian SpAn
9/30/2016 2 Nurlaila Jln.Lingkar Randik dr.Dian SpAn
9/30/2016 1 Atka Lumpatan dr.Dian SpAn
9/30/2016 1 Yusneli Air Itam dr.Dian SpAn
9/30/2016 1 Eka Keluang dr.Dian SpAn
199
9/23/2016 1 Kurniawan Ds. I Dawas dr.Dian SpAn

9/23/2016 1 Sudirman Tanjung Karang dr.Dian SpAn
2
9/15/2016 1 Gunawan Jambi dr.Dian SpAn

9/15/2016 1 Sit Inam Tanding Marga dr.Dian SpAn
9/22/2016 1 Erna Serasan Jaya dr.Dian SpAn
42641 1 Yeni Liono Sako Suban dr.Meili SpAn
9/6/2016 1 Sugiart Sekayu dr.Oyon SpB

9/8/2016 1 Amri Lk.VII Sekayu dr.Rosidi SppD
9/8/2016 2 Nuraini Tanjung Agung dr.Dian SpAn
9/15/2016 1 Amri Serasan Jaya dr.Rosidi SppD
9/15/2016 1 Ginta Fransica Perumnas dr.Dian SpAn
9/16/2016 1 Mast Sehat Bayung Lencir dr.Dian SpAn
9/22/2016 1 Supardi Sei Lilin dr.Dian SpAn

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 0
ngeluaran
Jumlah
11

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
Bulan : September
Tahun : 2016
Ket
11
Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
No. Izin RS :-
No. Izin Khusus :-

No. Izin RS :-
No. Izin Khusus :-
Pemasukan
Tanggal
1 2 3 1/3/1900 5
5 Coditam Tablet -
7 MST 10 mg Tablet
LAPORAN KHUSUS PENGGUNAAN MORPHIN, PE

No. Izin RS :
No. Izin Khusus :
Resep
1 2 3 1/3/1900 5
1 Fenthanyl 11/1/2016 11/1/2016

11/1/2016 11/1/2016
11/1/2016 11/1/2016
11/1/2016 11/1/2016
11/1/2016 11/1/2016
11/1/2016 11/1/2016
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11/2/2016 11/2/2016
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11/3/2016 11/3/2016
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11/3/2016 11/3/2016
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11/3/2016 11/3/2016
11/4/2016 11/4/2016
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11/4/2016 11/4/2016
11/5/2016 11/5/2016
11/7/2016 11/7/2016
11/7/2016 11/7/2016
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11/7/2016 11/7/2016
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11/24/2016 11/24/2016
11/24/2016 11/24/2016
11/24/2016 11/24/2016
11/24/2016 11/24/2016
11/24/2016 11/24/2016
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11/24/2016 11/24/2016
11/24/2016 11/24/2016
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11/25/2016 11/25/2016
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11/25/2016 11/25/2016
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11/26/2016 11/26/2016
11/26/2016 11/26/2016
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11/27/2016 11/27/2016
11/28/2016 11/28/2016
11/28/2016 11/28/2016
11/28/2016 11/28/2016
11/28/2016 11/28/2016
11/28/2016 11/28/2016
11/28/2016 11/28/2016
11/28/2016 11/28/2016
11/28/2016 11/28/2016
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11/29/2016 11/29/2016
11/29/2016 11/29/2016
11/29/2016 11/29/2016
11/29/2016 11/29/2016
11/29/2016 11/29/2016
11/29/2016 11/29/2016
11/29/2016 11/29/2016
11/30/2016 11/30/2016
11/30/2016 11/30/2016
11/30/2016 11/30/2016
11/30/2016 11/30/2016
Jumlah
2 Petdin Inj 11/3/2016 11/3/2016

11/18/2016 11/18/2016
Jumlah
3 Mst 15 mg Tab 11/1/2016 11/1/2016

11/5/2016 11/5/2016
11/9/2016 11/9/2016
11/10/2016 11/10/2016
11/11/2016 11/11/2016
19/11/2016 19/11/2016
Jumlah
4 Mst 10 mg Tab 11/5/2016 11/5/2016

11/16/2016 11/16/2016
11/21/2016 11/21/2016
11/22/2016 11/22/2016
11/22/2016 11/22/2016
11/24/2016 11/24/2016
11/29/2016 11/29/2016
11/30/2016 11/30/2016
Jumlah

11/9/2016 11/9/2016
11/12/2016 11/12/2016
11/14/2016 11/14/2016

11/15/2016 11/15/2016
11/18/2016 11/18/2016
11/22/2016 11/22/2016
Jumlah
k.I Kayu Ara Sekayu. Telp: 0714-321130
yu. Telp: 0714-321130

Keseluruhan Untuk
Dari Jumlah
6 7 8 9 10
- -
- -
- -
- -
- -
Sekayu, Nopember 20
Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2
SIPA : 843/247/SIPA/DINK
SUS PENGGUNAAN MORPHIN, PETHIDIN, FENTANYL, Codein, MST

N-16
Bulan : Nopember
Tahun : 2016
yu. Telp: 0714-321130
Pasien Dokter
Jumlah
o Alamat Nama Spesialisasi
6 7 8 9 10
1 Romasari GMP dr.Meili SpAn

1 Devi Agustna Soak Baru dr.Meili SpAn
1 Halisan Sukarami dr.Meili SpAn
1 Ceman Komp Lapas dr.Meili SpAn
1 Pardia Tebing Bulang dr.Meili SpAn
1 Yunita Epil dr.Meili SpAn
1 Sit Zulaika Keluang dr.Meili SpAn
1 Sulastri Sareka dr.Meili SpAn
2 Imran Mekar Jaya dr.Meili SpAn
2 Arpan Babat Supat dr.Meili SpAn
1 Nurlaila Talang Piase dr.Meili SpAn
1 Menta Wat Petaling dr.Meili SpAn
1 Suharno Bukit Selabu dr.Meili SpAn
1 Sri Lestari Sukarami dr.Meili SpAn
1 Sri Manik Tebing Bulang dr.Meili SpAn
1 Sidar Erma Lubuk Rimpui dr.Meili SpAn
2 Selvi anawat Babat Banyuasin dr.Meili SpAn
1 Yunus Talang Leban dr.Meili SpAn
1 Eni Juita Petaling dr.Meili SppD
1 Rusnita Sungai Keruh dr.Meili SpAn
1 Winda Lalan dr.Meili SpAn
1 Sit Rokhayatun Ulak Paceh dr.Meili SpAn
1 Eka Purnasari Ulak Paceh dr.Meili SpAn
1 Meyni Ulak Paceh dr.Dian SpAn
1 Irfan Sungai Lilin dr.Dian SpAn
1 Anita Lawang Duren dr.Dian SpAn
1 Ana Serasan Jaya dr.Dian SpAn
1 M.Hadi Siregar Tungkal Jaya dr.Dian SpAn
1 Sit Rohaya Karang Agung Ulu dr.Dian SpAn
1 Sasmita Karang Ringin dr.Dian SpAn
1 Yuli Komp. GMP dr.Dian SpAn
1 Nurhayat Lumpatan dr.Dian SpAn
1 Apung Pasar Lama dr.Dian SpAn
1 Lia Babat Supat dr.Dian SpAn
1 Sudianto Tanjung Utara dr.Dian SpAn
1 Zairi Griya Randik dr.Dian SpAn
1 Sudi Muliono Sungai Lilin dr.Dian SpAn
1 Yaumila Randik dr.Dian SpAn
1 Witta Bayung Lencir dr.Dian SpAn
1 Rahmi Bukit Sejahtera dr.Dian SpAn
1 Irawat Keluang dr.Dian SpAn
1 Rat Lestari Jirak dr.Dian SpAn
1 Ayu Agustna Soak Baru dr.Meili SpAn
1 Noriza Karya Maju dr.Meili SpAn
1 Hanipan Rantau Panjang dr.Meili SpAn
1 Enok Keluang dr.Meili SpAn
1 Krisna Randik dr.Meili SpAn
1 Parida Tebing Bulang dr.Meili SpAn
1 Zumadi Babat Supat dr.Meili SpAn
1 Sasi Bailangu dr.Meili SpAn
1 Sarnoto Sungai Medak dr.Meili SpAn
1 Sant Sungai Medak dr.Meili SpAn
1 Isa Rantau Sialang dr.Meili SpAn
1 Ina Yant Ds.Pengaturan dr.Meili SpAn
1 Nuraini Serasan Jaya dr.Meili SpAn
1 Kurniasiah Soak Baru dr.Meili SpAn
1 Nyoman Air Balui dr.Meili SpAn
1 Mahiyah Gajah Mat dr.Meili SpAn
1 Diva Galih Keluang dr.Meili SpAn
1 Jamilah Keluang dr.Meili SpAn
1 Alimin Sekayu dr.Meili SpAn
1 Menta Wat Petaling dr.Meili SpAn
1 Mamat Keluang dr.Meili SpAn
1 Romita Sekayu dr.Meili SpAn
1 Leka Gajah Muda dr.Meili SpAn
2 Eliya Ulak Paceh dr.Taufik SpoG
2 Hermawat Pali dr.Meili SpAn
2 Lis Sugianto Sekayu dr.Meili SpAn
2 Wairah Sukadamai dr.Meili SpAn
1 Umi Ismiatun Bandar Jaya dr.Meili SpAn
1 Dwi Apriani Randik dr.Dian SpAn
1 Yamini Plakat Tinggi dr.Dian SpAn
1 Ayu Rahayu Sekayu dr.Dian SpAn
1 Zalina SP2 dr.Dian SpAn
2 Maisaro Gajah Mat dr.Dian SpAn
1 Dedi Maradona Sungai Lilin dr.Dian SpAn
1 Malah Tungkal Jaya dr.Dian SpAn
1 Yulihat Tungkal Jaya dr.Dian SpAn
1 Kartka Tebing Bulang dr.Dian SpAn
1 Mahani Sungai Lilin dr.Dian SpAn
1 Desi Putri Utami Muara Teladan dr.Dian SpAn
1 Darsono Keluang dr.Dian SpAn
1 Herlina Epil dr.Dian SpAn
1 Suhairo Lais dr.Dian SpAn
1 Suryani Tungkal Jaya dr.Dian SpAn
1 M.Afandi Tungkal Jaya dr.Dian SpAn
1 Yuyun Harmoni Purwosari dr.Dian SpAn
1 Leni Marlina Ngulak dr.Dian SpAn
1 Herlina Epil dr.Dian SpAn
1 Fitri Claudia Kertayu dr.Dian SpAn
1 Ripana Teluk Kijing dr.Dian SpAn
1 Ahmad Kurniawan Sungai Lilin dr.Dian SpAn
1 Sumin Keluang dr.Dian SpAn
1 Marni Sungai Batang dr.Dian SpAn
1 Ardiansyah Soak Baru dr.Dian SpAn
1 Ratna Juwita Babat Supat dr.Dian SpAn
1 Indra Lawang Wetan dr.Dian SpAn
1 Rumna Mangsang dr.Dian SpAn
1 Sarningsih Jirak dr.Meili SpAn
1 Melinda Keluang dr.Dian SpAn
1 Emilia Kayuara dr.Meili SpAn
1 Sit Aisyah Balai Agung dr.Meili SpAn
2 M.Bustam Tengaro dr.Meili SpAn
1 M.Aming Lais dr.Meili SpAn
1 Komaria Nant dr.Meili SpAn
1 Nurmala Epil dr.Meili SpAn
1 Rita Zila Bandar Jaya dr.Meili SpAn
1 Sudiria Tanjung Kerang dr.Meili SpAn
1 Fuji Kartka Karang Ringin dr.Meili SpAn
1 Faria Mekar Jaya dr.Meili SpAn
1 Maimuna Lumpatan dr.Meili SpAn
1 Ayunub Keban II dr.Meili SpAn
1 Kartni Komp Gatri dr.Meili SpAn
2 Tarsok Tebing Bulang dr.Meili SpAn
1 Windu Widiart Sekayu dr.Meili SpAn
1 Aska Serasan Jaya dr.Meili SpAn
1 Nurhayat Sukarami dr.Meili SpAn
1 Ilham Sukarami dr.Meili SpAn
1 Intan Pamulang dr.Meili SpAn
1 Sugeng Keluang dr.Meili SpAn
2 Mustopa Plakat Tinggi dr.Meili SpAn
2 Maulana Jirak dr.Meili SpAn
1 Susi Susant Epil dr.Meili SpAn
1 Ahmad Ramadhan Bayung Lencir dr.Meili SpAn
1 Sumini Sungai Lilin dr.Meili SpAn
2 Sumini Sungai Lilin dr.Meili SpAn
1 Susant Gajah Mat dr.Dian SpAn
1 Anita Tanjung Agung Barat dr.Meili SpAn
1 Citra Marni Sugi Waras dr.Dian SpAn
1 Marten Andres Rantau Panjang dr.Dian SpAn
1 Helen Saparingga Tebing Bulang dr.Dian SpAn
1 M.Tukiman Sungai Lilin dr.Dian SpAn
2 Imas Karyat Keluang dr.Meili SpAn
1 Ida Royani Sungai Lilin dr.Meili SpAn
1 Hamron Tanjung Agung dr.Meili SpAn
1 Jhon Heri Lais dr.Meili SpAn
1 Ruslina Bumi Ayu dr.Meili SpAn
1 Anita Sekayu dr.Meili SpAn
1 Wiwin Tauladan dr.Meili SpAn
2 Eliya Ulak Paceh dr.Riri
1 Mad Seri Balai Agung dr.Dian SpAn
1 Ester Sungai Lilin dr.Dian SpAn
1 Afif Anggara Balai Agung dr.Dian SpAn
1 Yulia Artka Sungai Lilin dr.Dian SpAn
2 Rusmayana Serasan Jaya dr.Dian SpAn
1 Reli Apriyani Meji Mulyo dr.Meili SpAn
1 Siere Fendi Jirak dr.Meili SpAn
1 Samsuri Kayuara dr.Meili SpAn
1 Asni Sungai Keruh dr.Meili SpAn
1 Katni Simpang Sari dr.Meili SpAn
1 Ramasari Ngulak dr.Meili SpAn
1 Syayut Talang Piase dr.Meili SpAn
1 Irsandi Balai Agung dr.Meili SpAn
1 Dino Ds.III Toman dr.Meili SpAn
1 Asmawat Keluang dr.Meili SpAn
1 Ika Afriyana Tanjung Agung Selatan dr.Meili SpAn
1 Tri Muryat Rimba Ukur dr.Meili SpAn
1 Erika Sungai Keruh dr.Meili SpAn
1 Mistono B.V Teran dr.Meili SpAn
1 Yuliza Sekayu dr.Meili SpAn
1 Nani Kurnia Muara Teladan dr.Meili SpAn
1 Nopri Babat Toman dr.Meili SpAn
2 Salimin Plakat Tinggi dr.Meili SpAn
2 Veri Wijaya Kayuara dr.Meili SpAn
1 Sri Sunart Penukal Utara dr.Meili SpAn
1 Nur Silawat Jln. Inpres Penjara dr.Meili SpAn
2 Elsa Sungai Lilin dr.Meili SpAn
2 Reniat Muara Teladan dr.Meili SpAn
1 Rusmala Dewi Plakat Tinggi dr.Meili SpAn
1 Untung Sungai Lilin dr.Meili SpAn
2 Umar Balai Agung dr.Meili SpAn
1 Syarifudin Gajah Mat dr.Meili SpAn
2 Herlia Peninggalan dr.Meili SpAn
1 Jhon Kenedi Soak Baru dr.Meili SpAn
1 Nurhadi Keluang dr.Meili SpAn
1 Kemin Sekayu dr.Meili SpAn
1 Rusmala Dewi Lawang Wetan dr.Meili SpAn
1 Suwandi Sungai Lilin dr.Meili SpAn
1 Hamim Sandes dr.Meili SpAn
1 Anouriyant Jln.Kol Wahid Udin dr.Meili SpAn
2 Tuharjo Keluang dr.Meili SpAn
1 Purnawirawan Tanjung Agung Utara dr.Meili SpAn
1 Zulhikmah Lk. VII Sekayu dr.Meili SpAn
2 Mahisar Kertajaya dr.Meili SpAn
2 Yusri Keluang dr.Meili SpAn
1 Minarni Sanga Desa dr.Meili SpAn
1 Ayu Lumpatan dr.Meili SpAn
3 Kailani Balai Agung dr.Damai
1 Sarino Bandar Jaya dr.Meili SpAn
1 Yuni Balai Agung dr.Meili SpAn
2 Rahaya Sungai Keruh dr.Meili SpAn
1 Wiwit Setasari Sungai Lilin dr.Meili SpAn
1 Uyendi Sopiya Simpang Gardu dr.Meili SpAn
1 Tira Tungkal Jaya dr.Meili SpAn
1 Titn Lumpatan dr.Meili SpAn
1 Sudart Rantau Kasih dr.Meili SpAn
1 Ainum Lais dr.Meili SpAn
1 Pasita Penukal Utara dr.Meili SpAn
1 Sri Plasih Keluang dr.Meili SpAn
1 Sarmidi Sungai Keruh dr.Meili SpAn
1 M. Risfaldo Keluang dr.Meili SpAn
1 Fauziah Jirak dr.Meili SpAn
1 Margo Rahayu Sungai Lilin dr.Meili SpAn
1 Yunia Kayuara dr.Meili SpAn
1 Yant Ulak Paceh dr.Meili SpAn
1 Wendi Komplek Dc dr.Meili SpAn
1 Kopli Simpang Tungkal Jaya dr.Meili SpAn
1 Hosirun Sanga Desa dr.Meili SpAn
1 Sutyem Gajah Mat dr.Meili SpAn
1 Ambur Plakat Tinggi dr.Meili SpAn
1 Tri Puji Febriyant Muara Teladan dr.Meili SpAn
1 Khairi Plakat Tinggi dr.Meili SpAn
1 Saipul Kertajaya dr.Meili SpAn
2 Faka Keramat Jaya dr.Meili SpAn
1 Laseman Bukit Pangkuasan dr.Meili SpAn
1 Junaida Komp. Dc dr.Meili SpAn
1 Sari Mavica Sungai Lilin dr.Meili SpAn
246
1 Eka Purnamasari Sekayu dr.Dian SpAn

1 Farida Serasan Jaya dr.Dian SpAn

3 Subakir Plakat Tinggi dr.Syarifuddin SppD
2 Eliya Ulak Paceh dr.Meili SpAn
2 Eliya Ulak Paceh dr.Riri
3 Eliya Ulak Paceh dr.Syarifuddin SppD
3 Matsani Babat Supat dr.Syarifuddin SppD
15
3 Subakir Marga Mulyo dr.Salahudin

3 Matsani Babat Supat dr.Rosidi SppD
3 Mustopa Sungai Keruh dr.Syapri SppD
15 Matsani Babat Banyuasin dr.Rosidi SppD
3 Emri Mahmud Rantau Keroya dr.Syapri SppD
2 Emri Mahmud Rantau Keroya dr.Rosidi SppD
41
1 Mamat Keluang dr.Meili SpAn

1 Umi Islamiatun Sekayu dr.Meili SpAn
1 Rumna Ds. Mangsang dr.Meili SpAn
1 Rustam Tersaro dr.Meili SpAn
1 Bambang Ngulak dr.Oyon SpB

1 Windu Sekayu dr.Meili SpAn
1 Farida Serasan Jaya dr.Dian SpAn
1 Wiwin Sekayu dr.Oyon SpB
4
aran
Jumlah
11
Sekayu, Nopember 2016

Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
Ket
11
Sekayu, Nopember 2016
Penanggung Jawab
Dra. Hanifdar, Apt

Nip. 19670730 199703 2 001
LAPORAN KHUSUS PENGGUNAAN PSIKOTROPIKA : ALPRAZOLAM 1 MG, ALPRAZOLAM 5 MG, ALPRAZOLAM 0,25 MG, AMITRIPTILIN, CLOBAZAM,DIAZEPAM,KLORPROM
HALOPERIDOL 5MG,HALOPERIDOL INJ,RISPERIDONE 1 MG, TRIHEXIPENIDIL 2MG
Nama Puskesmas :
No. Izin Puskesmas :-
Alamat :
Resep Pasien Dokter

Nama Alamat Nama
1 2 3 1/3/1900 5 6 7 8 9
DIAZEPAM,KLORPROMAZIN 100 MG
N-16
Bulan : JANUARI
Tahun : 2017
kter
Ket
Spesialisasi
10 11
Pangkalan Balai, Januari 2017
Penanggung Jawab
Nip
LAPORAN KHUSUS PENGGUNAAN PSIKOTRO
TAHUN : 2
Nama Puskesmas :
Alamat
Persediaan
Nama Sediaan Satuan
Akhir Desember Masuk
2016 Gudang
1 2 3 1/3/1900
1
2
3
4
5
6
7
8
9
LAPORAN KHUSUS PENGGUNAAN PSIKOTROPIKA : ALPRAZOLAM 1 MG, ALPRAZOLAM 5 MG, A

HALOPERIDOL 5MG,HALOPERIDOL INJ,RISPERIDON
Nama Puskesmas :
Alamat :
Resep
No Nama Obat Satuan Tanggal
Permintaan
1 2 3 1/3/1900
US PENGGUNAAN PSIKOTROPIKA DI PUSKESMAS KAB. BANYUASIN
TAHUN : 2017
Bulan :
Tahun :

Keseluruhan Untuk
Tanggal Dari Jumlah
(4+7) Pembuatan/ R Lain-lain Jumlah
5 6 7 8 9 10 11

Yang Menyerahkan
Nip
M 1 MG, ALPRAZOLAM 5 MG, ALPRAZOLAM 0,25 MG, AMITRIPTILIN, CLOBAZAM,DIAZEPAM,KLORPROMAZIN 100 MG

HALOPERIDOL INJ,RISPERIDONE 1 MG, TRIHEXIPENIDIL 2MG
N-16
Bulan : JANUARI
Tahun : 2017
Jumlah Pasien Dokter

Tanggal Nama Alamat Nama Spesialisasi
Penyerahan
5 6 7 8 9 10
Pangkalan Balai, Jan
Penanggung Jaw
Nip
Persediaan
Akhir bulan
Ket
Akhir Bulan
( 8-11 )
12 13
n Balai, Januari 2017

ng Menyerahkan
N 100 MG
Bulan : JANUARI
Tahun : 2017
Spesialisasi Ket
11
Penanggung Jawab
Nip

LAPORAN PENGGUNAAN OBAT KHUSUS

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LAPORAN PENGGUNAAN OBAT KHUSUS

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LAPORAN KHUSUS PENGGUNN PSIKOTROPIKA: ALPAZOLAM 1 MG,ALPAZORAM 5 MG.

ALPAZORAM O,25 MG,AMITRIPTILIN,CLOBAZAM,DIAZEPAM,KLORPROMAZIN 100 MG

Resep Pasien Dokter

Haloperiodol Tab 9/1/2017 9/1/2017 30 Agus Kel.Rimba Asam dr.Een

3 Risperidon Tab 9/1/2017 9/1/2017 60 Noviani Ds.bukit dr.Een

4 Clobazam Tab 01/09 2017 01/09 2017 15 Efendi Kel.Betung dr.Een

5 Merlopam Tab 9/1/2017 9/1/2017 10 Nazarudin Desa Lubuk Karet dr.Een

### Inj.Haldol Injeksi 9/6/2017 9/6/2017 I ampl Innallah Kel.Betung dr.Een

SUCI ROHANI AM.kep

Pemasukan Jumlah Pengeluaran

Resep Jumlah Pasien Dokter

1 Petdin inj 1/4/2014 1/4/2014 1 Afzalur Rahman Sekayu dr Ropi SpTHT

3 MST 10 mg Tab 12/1/2014 12/1/2014 2 M.Apil Sekayu dr. Mega dalam

Sekayu, 08 Februari 2014

Dra. Hanifdar, Apt

Sekayu, 3 Februari 2014

Dra. Hanifdar, Apt

Pemasukan Jumlah Pengeluaran

Resep Jumlah Pasien Dokter

3 MST 15 mg Tab 1/2/2014 1/2/2014 4 Palamat Sekayu dr.Fera

Sekayu, 08 Maret 2014

Dra. Hanifdar, Apt

Sekayu, 3 Maret 2014

Dra. Hanifdar, Apt

Pemasukan Jumlah Pengeluaran Persediaan

Sekayu, 8 Februari 2015

Dra. Hanifdar, Apt

Resep Jumlah Pasien Dokter

1 MST 10 mg Tab 1/13/2015 1/13/2015 2 rusli damai sekayu dr.Tora.

2 MST 15 mg Tab 1/12/2015 1/12/2015 1 supardi karta jaya dr. Hikamtar

3 Morpin Inj Tab 1/9/2015 1 winda bailangu dr. Dian Kesumarini.SpAn

4 Fentanil Tab 1/1/2015 1/1/2015 1 indah kasmaran dr. Dian Kesumarini.SpAn

Sekayu, 8 Januari 2015

Dra. Hanifdar, Apt

Pemasukan Jumlah Pengeluaran

Resep Jumlah Pasien Dokter

Sekayu, 8 Maret 2015

Dra. Hanifdar, Apt

Sekayu, 8 Maret 2015

Dra. Hanifdar, Apt

Pemasukan Jumlah Pengeluaran

Sekayu, 8 April 2015

Dra. Hanifdar, Apt

Resep Jumlah Pasien Dokter

1 Petdin Ampul 3/9/2015 3/9/2015 1 Nora sekayu dr. Dian Kesumarini.SpAn

Sekayu, 8 April 2015

Sekayu, 8 April 2015

Dra. Hanifdar, Apt

Pemasukan Jumlah Pengeluaran

Sekayu, 8 Mei 2015

Dra. Hanifdar, Apt

Resep Jumlah Pasien Dokter

1 Petdin Ampul 4/9/2015 4/9/2015 2 maimunah sekayu dr. Dian Kesumarini.SpAn

3 Fentanil Ampul 4/1/2015 4/1/2015 4 Asmadi Sekayu dr. Dian Kesumarini.SpAn

5 MST 15 mg tab 4/29/2015 4/29/2015 10 Otb Sekayu dr. Rosidi. SPpd

Sekayu, 8 Mei 2015

Sekayu, 8 Mei 2015

Dra. Hanifdar, Apt

No Nama Obat Satuan Keluar Masuk

Anton Pranoto.Amf Tent Rosita.S.Farm.Apt

LAPORAN KHUSUS PENGGUNAAN Narkotika

LAPORAN KHUSUS PENGGUNAAN Narkotika

Gani Alba, Amf