CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : ZAAL ANAK

TANGGAL : ………………….

PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
2 ASAM TRANEXAMAT 250MG 4
3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
7 PHENITOIN INJ 3
8 SANTAGESIK INJ 3
9 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 EPINEFRIN INJ 3
4 FARGOXIN INJ 1
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 DEXTROSE 10% 2
4 DEXTROSE 5% 2
5 PZ 0,9% 2
6 PZ 100 CC 2
7 RL 2
8 VOLUVEN 2
LACI 3
1 ABB 24 2
2 SELANG O2 BAYI 2
3 SELANG O2 NEONATUS 2
4 SELANG O2 ANAK 2
5 NASAL MASKER ANAK 2
6 SUCTION CATHEHER 6 1
7 SUCTION CATHEHER 8 1
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1

CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : ZAAL INTERNE

TANGGAL : ………………….
PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
2 ASAM TRANEXAMAT 250MG 4
3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
7 HERBESSER INJ 2
8 KETOROLAC INJ 2
9 METHYL PREDNISOLON 125 MG 1
10 PHENITOIN INJ 3
11 SANTAGESIK INJ 3
12 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 DOPAMIN INJ 2
4 EPHEDRIN INJ 2
5 EPINEFRIN INJ 3
6 FARGOXIN INJ 1
7 LIDOCAIN 2% INJ 3
8 VASCON INJ 2
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 MGSO4 20% 3
4 DEXTROSE 10% 2
5 DEXTROSE 5% 2
6 PZ 0,9% 2
7 PZ 100 CC 2
8 RL 2
9 VOLUVEN 2
LACI 3
1 ABB 18 2
2 ABB 20 2
3 ABB 24 2
4 FOLI CATHETER NO 14 2
5 FOLI CATHETER NO 16 2
6 NASAL MASKER DEWASA 2
7 SELANG O2 DEWASA 2
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
NO NAMA OBAT JUMLAH TGL KETERANGAN
KADALUWARSA
DAFTAR RIIL
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1
13 SUCTION CATHEHER 6 1
14 SUCTION CATHEHER 12 1
15 TRANSFUSI SET 1
16 UROBAG 2
 CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : GRIU II

TANGGAL : ………………….

PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
2 ASAM TRANEXAMAT 250MG 4
 3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
7 HERBESSER INJ 2
8 KETOROLAC INJ 2
9 METHYL PREDNISOLON 125 MG 1
10 PHENITOIN INJ 3
11 SANTAGESIK INJ 3
12 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 DOPAMIN INJ 2
4 EPHEDRIN INJ 2
5 EPINEFRIN INJ 3
6 FARGOXIN INJ 1
7 LIDOCAIN 2% INJ 3
8 VASCON INJ 2
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 MGSO4 20% 3
4 DEXTROSE 10% 2
5 DEXTROSE 5% 2
6 PZ 0,9% 2
7 PZ 100 CC 2
8 RL 2
9 VOLUVEN 2
LACI 3
1 ABB 18 2
2 ABB 20 2
3 ABB 24 2
4 FOLI CATHETER NO 14 2
5 FOLI CATHETER NO 16 2
6 NASAL MASKER DEWASA 2
7 SELANG O2 DEWASA 2
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
NO NAMA OBAT JUMLAH TGL KETERANGAN
KADALUWARSA
DAFTAR RIIL
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1
13 SUCTION CATHEHER 6 1
14 SUCTION CATHEHER 12 1
15 TRANSFUSI SET 1
16 UROBAG 2
 CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : GRIU I ATAS

TANGGAL : ………………….

PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
2 ASAM TRANEXAMAT 250MG 4
3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
7 HERBESSER INJ 2
8 KETOROLAC INJ 2
9 METHYL PREDNISOLON 125 MG 1
10 PHENITOIN INJ 3
11 SANTAGESIK INJ 3
12 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 DOPAMIN INJ 2
4 EPHEDRIN INJ 2
5 EPINEFRIN INJ 3
6 FARGOXIN INJ 1
7 LIDOCAIN 2% INJ 3
8 VASCON INJ 2
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 MGSO4 20% 3
4 DEXTROSE 10% 2
5 DEXTROSE 5% 2
6 PZ 0,9% 2
7 PZ 100 CC 2
8 RL 2
9 VOLUVEN 2
LACI 3
1 ABB 18 2
2 ABB 20 2
3 ABB 24 2
4 FOLI CATHETER NO 14 2
5 FOLI CATHETER NO 16 2
6 NASAL MASKER DEWASA 2
7 SELANG O2 DEWASA 2
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
NO NAMA OBAT JUMLAH TGL KETERANGAN
KADALUWARSA
DAFTAR RIIL
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1
13 SUCTION CATHEHER 6 1
14 SUCTION CATHEHER 12 1
15 TRANSFUSI SET 1
16 UROBAG 2
 CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : GRIU I BAWAH

TANGGAL : ………………….

PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
2 ASAM TRANEXAMAT 250MG 4
3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
7 HERBESSER INJ 2
8 KETOROLAC INJ 2
9 METHYL PREDNISOLON 125 MG 1
10 PHENITOIN INJ 3
11 SANTAGESIK INJ 3
12 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 DOPAMIN INJ 2
4 EPHEDRIN INJ 2
5 EPINEFRIN INJ 3
6 FARGOXIN INJ 1
7 LIDOCAIN 2% INJ 3
8 VASCON INJ 2
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 MGSO4 20% 3
4 DEXTROSE 10% 2
5 DEXTROSE 5% 2
6 PZ 0,9% 2
7 PZ 100 CC 2
8 RL 2
9 VOLUVEN 2
LACI 3
1 ABB 18 2
2 ABB 20 2
3 ABB 24 2
4 FOLI CATHETER NO 14 2
5 FOLI CATHETER NO 16 2
6 NASAL MASKER DEWASA 2
7 SELANG O2 DEWASA 2
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
NO NAMA OBAT JUMLAH TGL KETERANGAN
KADALUWARSA
DAFTAR RIIL
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1
13 SUCTION CATHEHER 6 1
14 SUCTION CATHEHER 12 1
15 TRANSFUSI SET 1
16 UROBAG 2
 CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : ZAAL BEDAH

TANGGAL : ………………….

PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
2 ASAM TRANEXAMAT 250MG 4
3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
7 HERBESSER INJ 2
8 KETOROLAC INJ 2
9 METHYL PREDNISOLON 125 MG 1
10 PHENITOIN INJ 3
11 SANTAGESIK INJ 3
12 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 DOPAMIN INJ 2
4 EPHEDRIN INJ 2
5 EPINEFRIN INJ 3
6 FARGOXIN INJ 1
7 LIDOCAIN 2% INJ 3
8 VASCON INJ 2
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 MGSO4 20% 3
4 DEXTROSE 10% 2
5 DEXTROSE 5% 2
6 PZ 0,9% 2
7 PZ 100 CC 2
8 RL 2
9 VOLUVEN 2
LACI 3
1 ABB 18 2
2 ABB 20 2
3 ABB 24 2
4 FOLI CATHETER NO 14 2
5 FOLI CATHETER NO 16 2
6 NASAL MASKER DEWASA 2
7 SELANG O2 DEWASA 2
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
NO NAMA OBAT JUMLAH TGL KETERANGAN
KADALUWARSA
DAFTAR RIIL
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1
13 SUCTION CATHEHER 6 1
14 SUCTION CATHEHER 12 1
15 TRANSFUSI SET 1
16 UROBAG 2
 CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : ICU

TANGGAL : ………………….

PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
2 ASAM TRANEXAMAT 250MG 4
3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
7 HERBESSER INJ 2
8 KETOROLAC INJ 2
9 METHYL PREDNISOLON 125 MG 1
10 PHENITOIN INJ 3
11 SANTAGESIK INJ 3
12 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 DOPAMIN INJ 2
4 EPHEDRIN INJ 2
5 EPINEFRIN INJ 3
6 FARGOXIN INJ 1
7 LIDOCAIN 2% INJ 3
8 VASCON INJ 2
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 MGSO4 20% 3
4 DEXTROSE 10% 2
5 DEXTROSE 5% 2
6 PZ 0,9% 2
7 PZ 100 CC 2
8 RL 2
9 VOLUVEN 2
ELEKTROLIT PEKAT
1 KCL 3
2 MEYLON 3
3 MGSO4 40% 3
LACI 3
1 ABB 18 2
2 ABB 20 2
3 ABB 24 2
4 FOLI CATHETER NO 14 2
5 FOLI CATHETER NO 16 2
6 NASAL MASKER DEWASA 2
NO NAMA OBAT JUMLAH TGL KETERANGAN
KADALUWARSA
DAFTAR RIIL
7 SELANG O2 DEWASA 2
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1
13 SUCTION CATHEHER 6 1
14 SUCTION CATHEHER 12 1
15 TRANSFUSI SET 1
16 UROBAG 2
 CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : ZAAL VK

TANGGAL : ………………….

PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
2 ASAM TRANEXAMAT 250MG 4
3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
7 HERBESSER INJ 2
8 KETOROLAC INJ 2
9 METHYL ERGOMETRIN INJ 5
10 METHYL PREDNISOLON 125 MG 1
11 PHENITOIN INJ 3
12 SANTAGESIK INJ 3
13 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 DOPAMIN INJ 2
4 EPHEDRIN INJ 2
5 EPINEFRIN INJ 3
6 FARGOXIN INJ 1
7 LIDOCAIN 2% INJ 3
8 OXYTOCIN INJ 5
9 VASCON INJ 2
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 MGSO4 20% 3
4 DEXTROSE 10% 2
5 DEXTROSE 5% 2
6 PZ 0,9% 2
7 PZ 100 CC 2
8 RL 2
9 VOLUVEN 2
ELEKTROLIT PEKAT
1 KCL 3
2 MGSO4 40% 3
LACI 3
1 ABB 18 2
2 ABB 20 2
3 ABB 24 2
4 FOLI CATHETER NO 14 2
NO NAMA OBAT JUMLAH TGL KETERANGAN
KADALUWARSA
DAFTAR RIIL
5 FOLI CATHETER NO 16 2
6 NASAL MASKER DEWASA 2
7 SELANG O2 DEWASA 2
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1
13 SUCTION CATHEHER 6 1
14 SUCTION CATHEHER 12 1
15 TRANSFUSI SET 1
16 UROBAG 2

CEKLIS PEMANTAUAN OBAT EMERGENCY

UNIT : PICU-NICU
TANGGAL : ………………….
PETUGAS : ………………….

NO NAMA OBAT JUMLAH TGL KETERANGAN

KADALUWARSA
DAFTAR RIIL
LACI 1
1 AMINOPHYLIN INJ 4
ASAM TRANEXAMAT INJ
2 4
250MG
3 COMBIVENT INJ 1
4 DEXAMETHASON INJ 4
5 DIPHENHYDRAMIN INJ 3
6 FUROSEMID INJ 3
METHYL PREDNISOLON 125
7 1
MG INJ
8 PHENITOIN INJ 3
9 SANTAGESIK INJ 3
10 STESOLID INJ 4
HIGH ALERT
1 ATROPIN SULFAS INJ 5
2 CA GLUKONAS INJ 5
3 DOPAMIN INJ 2
4 EPINEFRIN INJ 3
5 LIDOCAIN 2% INJ 3
LACI 2
1 AQUABIDEST 2
2 D40 % 3
3 DEXTROSE 10% 2
4 DEXTROSE 5% 2
5 PZ 0,9% 2
6 PZ 100 CC 2
7 RL 2
8 VOLUVEN 2
ELEKTROLIT PEKAT
1 KCL 3
2 MEYLON 3
LACI 3
1 ABB 24 2
2 SELANG O2 BAYI 2
3 SELANG O2 NEONATUS 2
4 SELANG O2 ANAK 2
5 NASAL MASKER ANAK 2
6 SUCTION CATHEHER 6 1
7 SUCTION CATHEHER 8 1
8 SPUIT 10 CC 2
9 SPUIT 20 CC 1
10 SPUIT 3 CC 2
11 SPUIT 5 CC 2
12 SPUIT 50 CC 1
13 TRANSFUSI SET 1