Form Kompilasi Peresepan Ranny

FORM-1
FORMULIR PELAPORAN INDIKATOR PERESEPAN ISPA NON PNEUMONIA
Puskesmas : …………………………………………………………..
Kabupaten : ………………………………………………………….. Bulan : …………………………
Provinsi : ………………………………………………………….. Tahun : …………………………
Lama
Jumlah Antibiotik Sesuai Pedoman
Tgl No. Nama Umur Nama Obat Dosis Obat Pemakaian
Item Obat Ya/Tidak Ya/Tidak
(hari)
(1) (2) (3) (4) (5) (6) (7) (8) (9) ( 10 )
a.
b.
1
c.
d.
a.
b.
2
c.
d.
a.
b.
3
c.
d.
a.
b.
4
c.
d.
a.
b.
dst
c.
d.
Total Item Obat A B
N= Rerata Item Obat/ A/N

Lembar Resep
Persentase AB B / N x 100 %
Petugas
……………………………….
NIP.
FORM-2
FORMULIR PELAPORAN INDIKATOR PERESEPAN DIARE NON SPESIFIK
Puskesmas : …………………………………………………………..
Kabupaten : ………………………………………………………….. Bulan : …………………………
Propinsi : ………………………………………………………….. Tahun : …………………………
Lama
Jumlah Antibiotik Sesuai Pedoman
Tgl No. Nama Umur Nama Obat Dosis Pemakaian
Item Obat Ya/Tidak Ya/Tidak
(hari)
(1) (2) (3) (4) (5) (6) (8) (9) ( 10 ) ( 11 )
a.
b.
1
c.
d.
a.
b.
2
c.
d.
a.
b.
3
c.
d.
a.
b.
4
c.
d.
a.
b.
dst
c.
d.
Total Item Obat A B
Rerata Item Obat/
N= A/N
Lembar Resep
Persentase AB B / N x 100 %
Petugas,
............................................
NIP.
FORM-3
FORMULIR PELAPORAN INDIKATOR PERESEPAN MYALGIA
Puskesmas : …………………………………………………………..
Kabupaten : ………………………………………………………….. Bulan : …………………………
Propinsi : ………………………………………………………….. Tahun : …………………………
Lama Sesuai
Jumlah Item Injeksi
Tgl No. Nama Umur Nama Obat Dosis Pemakaian Pedoman
Obat Ya/Tidak
(hari) Ya/Tidak
(1) (2) (3) (4) (5) (6) (8) ( 9) ( 10 ) ( 11 )
a.
b.
1
c.
d.
a.
b.
2
c.
d.
a.
b.
3
c.
d.
a.
b.
4
c.
d.
a.
b.
dst
c.
d.
Total Item Obat A B
N= Rerata A/ N
Persentase Injeksi B / N x 100 %
Petugas,
............................................
NIP.
LAPORAN INDIKATOR PERESEPAN
DI PUSKESMAS MANGKUPALAS
Nama Puskesmas : Puskesmas Mangkupalas Bulan : Agustus
Jenis Puskesmas : Puskesmas Induk Tahun : 2014
Jumlah Apoteker 0
Jumlah AA/D3 Farmasi : 1 orang
Jumlah Dokter : 1 orang
Kabupaten/Kota : Samarinda
Provinsi : Kalimantan Timur
Rerata Item / lembar Resep

% Penggunaan
% Penggunaan % Penggunaan
Antibiotik pada
No Antibiotik pada ISPA Injeksi pada
Diare
Non-Pneumonia Myalgia ISPA Diare Myalgia Rata- rata
Non-Pneumonia
1 0% 6.89% 0% 2.80% 2.41% 2 2.4
Samarinda. 05 September 2014

Petugas,
dr. Riszka Pebriasari

NIP. 198502142010012012
GUNAAN OBAT GENERIK DI PUSKESMAS
PUSKESMAS : MANGKUPALAS
KABUPATEN/KOTA : SAMARINDA
PROVINSI : KALIMANTAN TIMUR
PERIODE : Mei 2013
JUMLAH (TOTAL
NO. BULAN LEMBAR R/ OBAT TOTAL R/ % R/ OBAT RESEP KET.
RESEP OBAT GENERIK SEBULAN)
TOTAL R/
GENERIK TERHADAP
1 2 3 4 5 TOTAL
6=5/4R/ 7 8
1 01/05/2013 106 320 311 97.19% - -
2 02/05/2013 164 496 489 98.59% - -
3 03/05/2013 87 261 258 98.85% - -
4 04/05/2013 73 220 216 98.18% - -
5 05/05/2013 0 0 0 0.00% - -
6 06/05/2013 210 638 630 98.75% - -
7 07/05/2013 141 424 420 99.06% - -
8 08/05/2013 138 414 412 99.52% - -
9 09/05/2013 0 0 0 0.00% - -
10 10/05/2013 61 185 185 100.00% - -
11 11/05/2013 62 188 185 98.40% - -
12 12/05/2013 0 0 0 0.00% - -
13 13/05/2013 124 373 364 97.59% - -
14 14/05/2013 124 372 368 98.92% - -
15 15/05/2013 107 324 318 98.15% - -
16 16/05/2013 219 657 651 99.09% - -
17 17/05/2013 82 246 241 97.97% - -
18 18/05/2013 93 281 278 98.93% - -
19 19/05/2013 0 0 0 0.00% - -
20 20/05/2013 210 631 623 98.73% - -
21 21/05/2013 138 415 411 99.04% - -
22 22/05/2013 120 360 358 99.44% - -
23 23/05/2013 214 644 638 99.07% - -
24 24/05/2013 69 210 207 98.57% - -
25 25/05/2013 0 0 0 0.00% - -
26 26/05/2013 0 0 0 0.00% - -
27 27/05/2013 233 699 695 99.43% - -
28 28/05/2013 149 477 473 99.16% - -
29 29/05/2013 110 330 324 98.18% - -
30 30/05/2013 221 663 660 99.55% - -
31 31/05/2013 63 191 186 97.38% - -
Jumlah 3318 10019 9901 2467.73%
Mengetahui Samarinda, 04 Juni 2013

Plh. Kepala Puskesmas Mangkupalas Pengolah Data
drg. Andi Tenri Awaru Ranny Machjuli

NIP. 197201222002122001 NIP.196907261992031006
Compatibility Report for Form Kompilasi Peresepan.xls
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Minor loss of fidelity # of occurrences
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format available.
PERIODE : Februari 2014
JUMLAH LEMBAR (TOTAL RESEP

NO. BULAN R/ OBAT KET.
RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 ### 102 311 308 99.04% - -
2 ### 0 0 0 0.00% - -
3 ### 207 626 623 99.52% - -
4 ### 148 419 419 100.00% - -
5 ### 134 410 410 100.00% - -
6 ### 182 544 540 99.26% - -
7 ### 72 223 223 100.00% - -
8 ### 102 341 338 99.12% - -
9 ### 0 0 607 0.00% - -
10 ### 203 611 392 64.16% - -
11 ### 134 392 439 111.99% - -
12 ### 147 442 519 117.42% - -
13 ### 175 522 241 46.17% - -
14 ### 82 241 429 178.01% - -
15 ### 145 429 429 100.00% - -
16 ### 0 0 0 0.00% - -
17 ### 183 534 529 99.06% - -
18 ### 137 412 412 100.00% - -
19 ### 176 526 526 100.00% - -
20 ### 99 294 294 100.00% - -
21 ### 76 229 229 100.00% - -
22 ### 102 307 297 96.74% - -
23 ### 0 0 0 0.00% - -
24 ### 184 554 551 99.46% - -
25 ### 100 321 321 100.00% - -
26 ### 134 401 392 97.76% - -
27 ### 55 160 160 100.00% - -
28 ### 65 193 193 100.00% - -
29 - -
30 - -
31 - -
Jumlah 3144 9442 9821 104.01%
Mengetahui Samarinda, 03 Maret 2014

Kepala Puskesmas Mangkupalas Pengolah Data

NIP. 197201222002122001 NIP.196907261992031006
PERIODE : Maret 2014

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 ### 96 286 283 98.95% - -
2 Sunday, March 02, 2014 0 0 0 0.00% - -
3 Monday, March 03, 2014 212 636 631 99.21% - -
4 Tuesday, March 04, 2014 164 496 494 99.60% - -
5 ### 147 440 440 100.00% - -
6 ### 186 554 552 99.64% - -
7 Friday, March 07, 2014 64 191 191 100.00% - -
8 ### 99 295 295 100.00% - -
9 Sunday, March 09, 2014 0 0 0 0.00% - -
10 Monday, March 10, 2014 199 597 595 99.66% - -
11 Tuesday, March 11, 2014 109 319 319 100.00% - -
12 ### 93 279 279 100.00% - -
13 ### 168 304 504 165.79% - -
14 Friday, March 14, 2014 60 185 185 100.00% - -
15 ### 91 273 273 100.00% - -
16 Sunday, March 16, 2014 0 0 0 0.00% - -
17 Monday, March 17, 2014 205 612 609 99.51% - -
18 Tuesday, March 18, 2014 133 399 399 100.00% - -
19 ### 115 344 342 99.42% - -
20 ### 204 612 609 99.51% - -
21 Friday, March 21, 2014 89 267 267 100.00% - -
22 ### 86 258 258 100.00% - -
23 Sunday, March 23, 2014 0 0 0 0.00% - -
24 Monday, March 24, 2014 177 531 528 99.44% - -
25 Tuesday, March 25, 2014 104 314 314 100.00% - -
26 ### 99 296 296 100.00% - -
27 ### 151 457 457 100.00% - -
28 Friday, March 28, 2014 56 168 168 100.00% - -
29 ### 98 294 294 100.00% - -
30 Sunday, March 30, 2014 0 0 0 0.00% - -
31 Monday, March 31, 2014 0 0 0 0.00% - -
Jumlah 3205 9407 9582 101.86%
Mengetahui Samarinda, 01 April 2014

R o s i p i n, SKM Ranny Machjuli

NIP. 1964102019890111005 NIP.196907261992031006
PERIODE : APRIL 2014

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 Tuesday, April 01, 2014 203 605 602 99.50% - -
2 ### 198 592 587 99.16% - -
3 Thursday, April 03, 2014 124 380 380 100.00% - -
4 Friday, April 04, 2014 59 178 178 100.00% - -
5 Saturday, April 05, 2014 74 224 224 100.00% - -
6 Sunday, April 06, 2014 0 0 0 0.00% - -
7 Monday, April 07, 2014 194 579 574 99.14% - -
8 Tuesday, April 08, 2014 75 228 228 100.00% - -
9 ### 0 0 0 0.00% - -
10 Thursday, April 10, 2014 138 415 410 98.80% - -
11 Friday, April 11, 2014 49 149 149 100.00% - -
12 Saturday, April 12, 2014 74 220 220 100.00% - -
13 Sunday, April 13, 2014 0 0 0 0.00% - -
14 Monday, April 14, 2014 208 628 622 99.04% - -
15 Tuesday, April 15, 2014 171 520 518 99.62% - -
16 ### 172 514 514 100.00% - -
17 Thursday, April 17, 2014 137 410 410 100.00% - -
18 Friday, April 18, 2014 0 0 0 0.00% - -
19 Saturday, April 19, 2014 96 284 284 100.00% - -
20 Sunday, April 20, 2014 0 0 0 0.00% - -
21 Monday, April 21, 2014 150 450 450 100.00% - -
22 Tuesday, April 22, 2014 141 424 422 99.53% - -
23 ### 163 487 485 99.59% - -
24 Thursday, April 24, 2014 89 264 264 100.00% - -
25 Friday, April 25, 2014 53 158 158 100.00% - -
26 Saturday, April 26, 2014 102 305 305 100.00% - -
27 Sunday, April 27, 2014 0 0 0 0.00% - -
28 Monday, April 28, 2014 187 548 544 99.27% - -
29 Tuesday, April 29, 2014 180 534 534 100.00% - -
30 ### 91 278 278 100.00% - -
\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\
Jumlah 3128 9374 9340 99.64%
Mengetahui Samarinda, 02 Mei 2014

ROSIPIN, SKM Ranny Machjuli

NIP. 1964102019890111005 NIP.196907261992031006
PERIODE : MEI 2014

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 Thursday, May 01, 2014 0 0 0 0.00% - -
2 Friday, May 02, 2014 74 210 210 100.00% - -
3 Saturday, May 03, 2014 124 370 370 100.00% - -
4 Sunday, May 04, 2014 0 0 0 0.00% - -
5 Monday, May 05, 2014 203 605 605 100.00% - -
6 Tuesday, May 06, 2014 138 410 402 98.05% - -
7 ### 194 585 581 99.32% - -
8 Thursday, May 08, 2014 75 230 230 100.00% - -
9 Friday, May 09, 2014 59 168 168 100.00% - -
10 Saturday, May 10, 2014 138 410 410 100.00% - -
11 Sunday, May 11, 2014 0 0 0 0.00% - -
12 Monday, May 12, 2014 198 560 550 98.21% - -
13 Tuesday, May 13, 2014 74 228 228 100.00% - -
14 ### 208 617 617 100.00% - -
15 Thursday, May 15, 2014 0 0 0 0.00% - -
16 Friday, May 16, 2014 172 517 517 100.00% - -
17 Saturday, May 17, 2014 137 406 406 100.00% - -
18 Sunday, May 18, 2014 0 0 0 0.00% - -
19 Monday, May 19, 2014 96 279 273 97.85% - -
20 Tuesday, May 20, 2014 0 0 0 0.00% - -
21 ### 150 456 455 99.78% - -
22 Thursday, May 22, 2014 141 426 423 99.30% - -
23 Friday, May 23, 2014 163 480 450 93.75% - -
24 Saturday, May 24, 2014 89 265 265 100.00% - -
25 Sunday, May 25, 2014 0 0 0 0.00% - -
26 Monday, May 26, 2014 208 623 617 99.04% - -
27 Tuesday, May 27, 2014 0 0 0 0.00% - -
28 ### 59 175 172 98.29% - -
29 Thursday, May 29, 2014 0 0 0 0.00% - -
30 Friday, May 30, 2014 176 529 518 97.92% - -
31 Saturday, May 31, 2014 177 532 530 99.62% - -
Jumlah 3053 9081 8997 99.07%


NIP. 197201222002122001 NIP.196907261992031006
PERIODE : JUNI 2014

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 Sunday, June 01, 2014 0 0 0 0 - -
2 Monday, June 02, 2014 198 594 594 100.00% - -
3 Tuesday, June 03, 2014 96 288 288 100.00% - -
4 ### 124 372 370 99.46% - -
5 Thursday, June 05, 2014 194 582 579 99.48% - -
6 Friday, June 06, 2014 56 168 168 100.00% - -
7 Saturday, June 07, 2014 59 175 175 100.00% - -
8 Sunday, June 08, 2014 0 0 0 0.00% - -
9 Monday, June 09, 2014 208 620 620 100.00% - -
10 Tuesday, June 10, 2014 95 285 285 100.00% - -
11 ### 74 223 223 100.00% - -
12 Thursday, June 12, 2014 171 510 502 98.43% - -
13 Friday, June 13, 2014 56 168 168 100.00% - -
14 Saturday, June 14, 2014 91 275 275 100.00% - -
15 Sunday, June 15, 2014 0 0 0 0.00% - -
16 Monday, June 16, 2014 172 517 502 97.10% - -
17 Tuesday, June 17, 2014 49 145 145 100.00% - -
18 ### 137 412 412 100.00% - -
19 Thursday, June 19, 2014 115 345 345 100.00% - -
20 Friday, June 20, 2014 64 192 192 100.00% - -
21 Saturday, June 21, 2014 89 265 263 99.25% - -
22 Sunday, June 22, 2014 0 0 0 0.00% - -
23 Monday, June 23, 2014 187 573 573 100.00% - -
24 Tuesday, June 24, 2014 163 489 489 100.00% - -
25 ### 53 159 159 100.00% - -
26 Thursday, June 26, 2014 115 350 350 100.00% - -
27 Friday, June 27, 2014 55 165 165 100.00% - -
28 Saturday, June 28, 2014 99 295 295 100.00% - -
29 Sunday, June 29, 2014 0 0 0 0.00% - -
30 Monday, June 30, 2014 212 641 637 99.38% - -
31
Jumlah 2932 8808 8774 99.61%
Mengetahui Samarinda, 02 Juli 2014

NIP. 197201222002122001 NIP.196907261992031006
LAPORAN PENGGUNAAN OBAT GENERIK
PERIODE : JULI 2014

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 ### 102 311 307 98.71% - -
2 ### 95 287 287 100.00% - -
3 ### 133 387 385 99.48% - -
4 Friday, July 04, 2014 50 148 148 100.00% - -
5 ### 99 298 298 100.00% - -
6 Sunday, July 06, 2014 0 0 0 0.00% - -
7 Monday, July 07, 2014 175 525 521 99.24% - -
8 ### 102 304 304 100.00% - -
9 ### 0 0 0 0.00% - -
10 ### 96 284 284 100.00% - -
11 Friday, July 11, 2014 134 402 400 99.50% - -
12 ### 72 218 218 100.00% - -
13 Sunday, July 13, 2014 0 0 0 0.00% - -
14 Monday, July 14, 2014 151 457 451 98.69% - -
15 ### 145 440 438 99.55% - -
16 ### 82 245 245 100.00% - -
17 ### 138 410 407 99.27% - -
18 Friday, July 18, 2014 64 168 165 98.21% - -
19 ### 65 190 190 100.00% - -
20 Sunday, July 20, 2014 0 0 0 0.00% - -
21 Monday, July 21, 2014 183 549 544 99.09% - -
22 ### 102 306 306 100.00% - -
23 ### 134 400 397 99.25% - -
24 ### 148 440 437 99.32% - -
25 Friday, July 25, 2014 76 220 220 100.00% - -
26 ### 88 265 265 100.00% - -
27 Sunday, July 27, 2014 0 0 0 0.00% - -
28 Monday, July 28, 2014 0 0 0 0.00% - -
29 ### 0 0 0 0.00% - -
30 ### 56 167 167 100.00% - -
31 ### 55 165 165 100.00% - -
Jumlah 2545 7586 7549 99.51%
Mengetahui Samarinda, 04 Agustus 2014
Kepala UPTD. Puskesmas Mangkupalas Pengolah Data

NIP. 197201222002122001 NIP.196907261992031006
PERIODE : Januari 2015

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 ### -
2 Friday, January 02, 2015 -
3 ### -
4 ### -
5 ### -
6 ### -
7 ### -
8 ### -
10 ### -
11 ### -
12 ### -
13 ### -
14 ### -
15 ### -
17 ### -
18 ### -
19 ### -
20 ### -
21 ### -
22 ### -
24 ### -
25 ### -
26 ### -
27 ### -
28 ### -
29 ### -
31 ###
Mengetahui Samarinda, 05 Februari 2015
dr. Deasi Nursanti Natsir, M. Si Ranny Machjuli

NIP. 197512252009112001 NIP.196907261992031006
PERIODE : Februari 2015

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 ### -
2 ### -
3 ### -
4 ### -
5 ### -
6 ### -
7 ### -
8 ### -
9 ### -
10 ### -
11 ### -
12 ### -
13 ### -
14 ### -
15 ### -
16 ### -
17 ### -
18 ### -
19 ### -
20 ### -
21 ### -
22 ### -
23 ### -
24 ### -
25 ### -
26 ### -
27 ### -
28 ### -
Mengetahui Samarinda, 05 Maret 2015

dr. Deasi Nursanti Natsir, M. Si Ranny Machjuli
NIP. 197512252009112001 NIP.196907261992031006
PERIODE : Maret 2015

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 Monday, March 02, 2015 135 540 532 99.00% -
2 Tuesday, March 03, 2015 120 480 473 99.00% -
3 ### 119 416 416 100.00% -
4 ### 129 398 398 100.00% -
5 Friday, March 06, 2015 125 438 412 94.00% -
6 ### 61 240 240 100.00% -
7 Sunday, March 08, 2015 0 0 0 0.00% -
8 Monday, March 09, 2015 127 503 492 98.00% -
9 Tuesday, March 10, 2015 127 495 495 100.00% -
10 ### 130 520 503 97.00% -
11 ### 123 490 481 98.00% -
12 Friday, March 13, 2015 120 472 472 100.00% -
13 ### 69 274 274 100.00% -
14 Sunday, March 15, 2015 0 0 0 0.00% -
15 Monday, March 16, 2015 154 617 602 98.00% -
16 Tuesday, March 17, 2015 129 510 510 100.00% -
17 ### 113 451 423 94.00% -
18 ### 131 329 329 100.00% -
19 Friday, March 20, 2015 91 275 275 100.00% -
20 ### 0 0 0 0.00% -
21 Sunday, March 22, 2015 0 0 0 0.00% -
22 Monday, March 23, 2015 146 445 445 100.00% -
23 Tuesday, March 24, 2015 122 368 368 100.00% -
24 ### 136 419 419 100.00% -
25 ### 132 392 392 100.00% -
26 Friday, March 27, 2015 109 382 382 100.00% -
27 ### 121 369 354 96.00% -
28 Sunday, March 29, 2015 0 0 0 0.00% -
28 Monday, March 30, 2015 134 402 391 97.00% -
28 Tuesday, March 31, 2015 120 372 372 100.00% -
Mengetahui Samarinda, 06 April 2015

Ka. TU Puskesmas Mangkupalas Pengolah Data
Rosipin, SKM Ranny Machjuli

NIP. 196410201989011005 NIP.196907261992031006
PERIODE : April 2015
RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 ### 81 251 251 100.00% -
2 Thursday, April 02, 2015 93 375 375 100.00% -
3 Friday, April 03, 2015 0 0 0 0.00% -
4 Saturday, April 04, 2015 63 192 192 100.00% -
5 Sunday, April 05, 2015 0 0 0 0.00% -
6 Monday, April 06, 2015 144 435 418 96.00% -
7 Tuesday, April 07, 2015 110 332 332 100.00% -
8 ### 105 312 312 100.00% -
9 Thursday, April 09, 2015 94 291 291 100.00% -
10 Friday, April 10, 2015 78 221 215 97.00% -
11 Saturday, April 11, 2015 50 161 152 94.00% -
12 Sunday, April 12, 2015 0 0 0 0.00% -
13 Monday, April 13, 2015 109 330 330 100.00% -
14 Tuesday, April 14, 2015 105 318 301 95.00% -
15 ### 100 310 310 100.00% -
16 Thursday, April 16, 2015 53 159 159 100.00% -
17 Friday, April 17, 2015 56 168 168 100.00% -
18 Saturday, April 18, 2015 55 167 167 100.00% -
19 Sunday, April 19, 2015 0 0 0 0.00% -
20 Monday, April 20, 2015 114 342 338 99.00% -
21 Tuesday, April 21, 2015 19 58 58 100.00% -
22 Saturday, April 07, 1900 98 294 294 100.00% -
23 ### 42 128 128 100.00% -
24 Friday, April 24, 2015 78 239 218 91.00% -
25 Saturday, April 25, 2015 45 135 135 100.00% -
26 Sunday, April 26, 2015 0 0 0 0.00% -
27 Monday, April 27, 2015 132 398 388 100.00% -
28 Tuesday, April 28, 2015 103 315 315 100.00% -
28 ### 72 215 210 98.00% -
28 Thursday, April 30, 2015 108 324 320 99.00% -
Mengetahui Samarinda, 05 Mei 2015

Ka. TU Puskesmas Mangkupalas Pengolah Data

NIP. 196410201989011005 NIP.196907261992031006
PERIODE : Mei 2015

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 Friday, May 01, 2015 -
2 Saturday, May 02, 2015 -
3 Sunday, May 03, 2015 -
4 Monday, May 04, 2015 -
5 Tuesday, May 05, 2015 -
6 ### -
7 Thursday, May 07, 2015 -
8 Friday, May 08, 2015 -
10 Sunday, May 10, 2015 -
11 Monday, May 11, 2015 -
12 Tuesday, May 12, 2015 -
13 ### -
15 Friday, May 15, 2015 -
17 Sunday, May 17, 2015 -
18 Monday, May 18, 2015 -
19 Tuesday, May 19, 2015 -
20 ### -
22 Friday, May 22, 2015 -
24 Sunday, May 24, 2015 -
25 Monday, May 25, 2015 -
26 Tuesday, May 26, 2015 -
27 ### -
28 Friday, May 29, 2015 -

Ka Puskesmas Mangkupalas Pengolah Data
dr. Deasi Nursanti Natsir, M. Si Riska Ariani, S. Farm. Apt

NIP. 197512252009112001 NIP.196907261992031006
PERIODE : Juni 2015

RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 Monday, June 01, 2015 -
2 Tuesday, June 02, 2015 -
3 ### -
4 Thursday, June 04, 2015 -
5 Friday, June 05, 2015 -
6 Saturday, June 06, 2015 -
7 Sunday, June 07, 2015 -
8 Monday, June 08, 2015 -
10 ### -
12 Friday, June 12, 2015 -
14 Sunday, June 14, 2015 -
15 Monday, June 15, 2015 -
17 ### -
19 Friday, June 19, 2015 -
21 Sunday, June 21, 2015 -
22 Monday, June 22, 2015 -
24 ### -
26 Friday, June 26, 2015 -
28 Sunday, June 28, 2015 -
29 Monday, June 29, 2015 -
Mengetahui Samarinda, 03 Juli 2015

Ka Puskesmas Mangkupalas Pengolah Data
dr. Deasi Nursanti Natsir, M. Si Riska Ariani, S. Farm. Apt

NIP. 197512252009112001 NIP.199108122014032004
PERIODE : JANUARI 2014
JUMLAH (TOTAL
NO. BULAN LEMBAR R/ OBAT RESEP KET.
RESEP SEBULAN)
% R/ OBAT
TOTAL R/ GENERIK
TOTAL R/
OBAT TERHADAP
GENERIK TOTAL R/
1 2 3 4 5 6=5/4 7 8
1 ### 0 0 0 0 - -
2 ### 198 582 578 99.31% - -
3 ### 96 291 291 100.00% - -
4 ### 124 368 364 98.91% - -
5 ### 0 0 0 0.00% - -
6 ### 194 584 580 99.32% - -
7 ### 59 175 175 100.00% - -
8 ### 75 221 221 100.00% - -
9 ### 102 315 312 99.05% - -
10 ### 95 286 286 100.00% - -
11 ### 74 220 218 99.09% - -
12 ### 0 0 0 0.00% - -
13 ### 208 630 624 99.05% - -
14 ### 0 0 0 0.00% - -
15 ### 171 514 512 99.61% - -
16 ### 172 520 520 100.00% - -
17 ### 49 147 147 100.00% - -
18 ### 137 408 402 98.53% - -
19 ### 0 0 0 0.00% - -
20 ### 180 514 541 105.25% - -
21 ### 150 452 449 99.34% - -
22 ### 141 430 430 100.00% - -
23 ### 163 479 473 98.75% - -
24 ### 60 192 192 100.00% - -
25 ### 53 162 162 100.00% - -
26 ### 0 0 0 0.00% - -
27 ### 203 601 597 99.33% - -
28 ### 187 566 562 99.29% - -
29 ### 89 267 267 100.00% - -
30 ### 91 270 270 100.00% - -
31 ### 0 0 0 0 - -
Jumlah 3071 9194 9173 99.77%
Mengetahui Samarinda, 04 Februari 2014

Ka TU Puskesmas Mangkupalas Pengolah Data

NIP. 197201222002122002 NIP.196907261992031006

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FORM-1

FORMULIR PELAPORAN INDIKATOR PERESEPAN ISPA NON PNEUMONIA

N= Rerata Item Obat/ A/N

Rerata Item / lembar Resep

1 0% 6.89% 0% 2.80% 2.41% 2 2.4

Samarinda. 05 September 2014

dr. Riszka Pebriasari

Mengetahui Samarinda, 04 Juni 2013

drg. Andi Tenri Awaru Ranny Machjuli

Minor loss of fidelity # of occurrences

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 03 Maret 2014

drg. Andi Tenri Awaru Ranny Machjuli

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 01 April 2014

R o s i p i n, SKM Ranny Machjuli

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 02 Mei 2014

ROSIPIN, SKM Ranny Machjuli

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 02 Juni 2014

drg. Andi Tenri Awaru Ranny Machjuli

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 02 Juli 2014

LAPORAN PENGGUNAAN OBAT GENERIK

JUMLAH LEMBAR (TOTAL RESEP

drg. Andi Tenri Awaru Ranny Machjuli

JUMLAH LEMBAR (TOTAL RESEP

dr. Deasi Nursanti Natsir, M. Si Ranny Machjuli

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 05 Maret 2015

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 06 April 2015

Rosipin, SKM Ranny Machjuli

Mengetahui Samarinda, 05 Mei 2015

Rosipin, SKM Ranny Machjuli

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 05 Juni 2015

dr. Deasi Nursanti Natsir, M. Si Riska Ariani, S. Farm. Apt

JUMLAH LEMBAR (TOTAL RESEP

Mengetahui Samarinda, 03 Juli 2015

dr. Deasi Nursanti Natsir, M. Si Riska Ariani, S. Farm. Apt

Mengetahui Samarinda, 04 Februari 2014

Rosipin, SKM Ranny Machjuli

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