DINAS KESEHATAN
PUSKESMAS NGABANG
Jl. Affandi Rani, Jalur II Kecamatan Ngabang Kabupaten Landak
Kode pos 79357
Hari :
Tanggal :
Nama Unit Kerja : Poliklinik Umum/Usila
Difenhidramin Injeksi ( )
Epinefrin Injeksi ( )
Dexamethason Injeksi ( )
Ranitidin Injeksi ( )
Sianokobalamin Injeksi ( )
Alat Suntik 1 ml ( )
Alat Suntik 3 ml ( )
Alat Suntik 5 ml ( )
Etanol ( )
Hipafyx ( )
Kapas ( )
Kassa ( )
Larutan H2O2 ( )
Masker 3 fly ( )
Surgical Gloves ( )
Yodium Povidon ( )
Keterangan :
Petugas
( )
Hari :
Tanggal :
Nama Unit Kerja : Poliklinik KIA/KB
Atropin Injeksi ( )
Difenhidramin Injeksi ( )
Epinefrin Injeksi ( )
Lidokain Injeksi ( )
Aesculap ( )
Alat Suntik 1 ml ( )
Alat Suntik 3 ml ( )
Etanol ( )
Hipafyx ( )
Kapas ( )
Kassa ( )
Masker 3 fly ( )
Surgical Gloves ( )
Ultrasonic Gel ( )
Yodium Povidon ( )
Keterangan :
Petugas
( )
Hari :
Tanggal :
Nama Unit Kerja : Poliklinik Imunisasi
Difenhidramin Injeksi ( )
Epinefrin Injeksi ( )
Alat Suntik 1 ml ( )
Alat Suntik 3 ml ( )
Kapas ( )
Masker 3 fly ( )
Surgical Gloves ( )
Keterangan :
Petugas
( )
Hari :
Tanggal :
Nama Unit Kerja : Poliklinik Gigi
Difenhidramin Injeksi ( )
Epinefrin Injeksi ( )
Lidokain Injeksi ( )
Scandonest 3 % ( )
Absorbent Paper Point ( )
Alat Suntik 3 ml ( )
Albothyl ( )
Alvogil ( )
Blue - red Articulating Paper ( )
Boonding ( )
Calsium Hydroxide/Hydcal ( )
Calxyl ( )
Cotton Roll ( )
Cresophate ( )
Dentine Conditioner ( )
Devitec ( )
Elite Cement Liquid ( )
Etanol ( )
Etching ( )
Etil Klorida Semprot ( )
Eugenol Cairan ( )
Glass Ionomer Cement Anterior ( )
Glass Ionomer Cement Art ( )
Glass Ionomer Cement Posterior ( )
Kapas ( )
Kassa 40 x 80 ( )
Kavit ( )
Ketricin ( )
Masker 3 fly ( )
Micro Brush ( )
Mono Klor Kamfer Mentol Cairan (CHKM) ( )
Needle Citojet ( )
Occo ( )
Paramonoclorofenol ( )
Pulp –X ( )
Retin Composit / Solare ( )
Spons Gelatin Cubicles 1 x 1 x 1 cm ( )
Surgical Gloves ( )
Yodium Povidon ( )
Keterangan :
Petugas
( )
Hari :
Tanggal :
Nama Unit Kerja : Ruang Tindakan Puskesmas Dumai Kota
Atropin Injeksi ( )
Difenhidramin Injeksi ( )
Epinefrin Injeksi ( )
Dexamethason Injeksi ( )
Lidokain Injeksi ( )
Metoclopramid Injeksi ( )
Metilergometrin Injeksi ( )
Oksitosin Injeksi ( )
Ranitidin Injeksi ( )
Sianokobalamin Injeksi ( )
Ventolin Nebulizer ( )
Aesculap ( )
Aqua Bidest ( )
Alat Suntik 1 ml ( )
Alat Suntik 3 ml ( )
Alat Suntik 5 ml ( )
Bioplacenton Jelly ( )
Cat Gut ( )
Etanol ( )
Glukosa Larutan Infus ( )
Hipafyx ( )
Infus Set Anak ( )
Infus Set Dewasa ( )
IV. Catheter ( )
Jarum Jahit Segitiga ( )
Kapas ( )
Kassa ( )
Masker 3 fly ( )
Natrium Klorida Larutan Infus ( )
Proris Suppossitoria ( )
Stessolid Rectal 5 mg ( )
Stessolid Rectal 10 mg ( )
Ringer Laktat Larutan Infus ( )
Silk ( )
Surgical Gloves ( )
Ultrasonic Gel ( )
Yodium Povidon ( )
Keterangan :
Petugas
( )
Hari :
Tanggal :
Nama Unit Kerja : Puskesmas Pembantu Rimba Sekampung
Atropin Injeksi ( )
Difenhidramin Injeksi ( )
Epinefrin Injeksi ( )
Dexamethason Injeksi ( )
Lidokain Injeksi ( )
Metoclopramid Injeksi ( )
Ranitidin Injeksi ( )
Sianokobalamin Injeksi ( )
Aesculap ( )
Aqua Bidest ( )
Alat Suntik 1 ml ( )
Alat Suntik 3 ml ( )
Alat Suntik 5 ml ( )
Bioplacenton Jelly ( )
Cat Gut ( )
Etanol ( )
Glukosa Larutan Infus ( )
Hipafyx ( )
Infus Set Anak ( )
Infus Set Dewasa ( )
IV. Catheter ( )
Jarum Jahit Segitiga ( )
Kapas ( )
Kassa ( )
Masker 3 fly ( )
Natrium Klorida Larutan Infus ( )
Proris Suppossitoria ( )
Ringer Laktat Larutan Infus ( )
Silk ( )
Surgical Gloves ( )
Yodium Povidon ( )
Keterangan :
Petugas
( )
PEMERINTAH KABUPATEN LANDAK
DINAS KESEHATAN
PUSKESMAS NGABANG
Jl. Affandi Rani, Jalur II Kecamatan Ngabang Kabupaten Landak
Kode pos 79357
Hari :
Tanggal :
Nama Unit Kerja : Poskeskel
Atropin Injeksi ( )
Difenhidramin Injeksi ( )
Epinefrin Injeksi ( )
Dexamethason Injeksi ( )
Lidokain Injeksi ( )
Metilergometrin Injeksi ( )
Oksitosin Injeksi ( )
Phytomenadion Injeksi ( )
Sianokobalamin Injeksi ( )
Aesculap ( )
Alat Suntik 1 ml ( )
Alat Suntik 3 ml ( )
Alat Suntik 5 ml ( )
Cat Gut ( )
Etanol ( )
Glukosa Larutan Infus ( )
Hipafyx ( )
Infus Set Dewasa ( )
IV. Catheter ( )
Kapas ( )
Kassa ( )
Masker 3 fly ( )
Natrium Klorida Larutan Infus ( )
Ringer Laktat Larutan Infus ( )
Silk ( )
Surgical Gloves ( )
Yodium Povidon ( )
Keterangan :
Petugas
( )