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RUMAH SAKIT UMUM BUNDA THAMRIN Nama : L/P : RUMAH SAKIT UMUM BUNDA THAMRIN Nama : L/P :

Jl. Sei Batang Hari No. 28-30, Medan Sunggal Jl. Sei Batang Hari No. 28-30, Medan Sunggal
Telp. (061) 88813615 – 88813616-88813617 – Tgl Lahir : Telp. (061) 88813615 – 88813616-88813617 – Tgl Lahir :
88813618 No. RM : 88813618 No. RM :
Fax. (061) 80501822 Fax. (061) 80501822

No Nama Alkes Jlh Ket. No Nama Alkes Jlh Ket.


1 Abocath 1 Abocath
2 3 Way 2 3 Way
3 Set infus 3 Set infus
4 Alkohol Swab 4 Alkohol Swab
5 Tegaderm 5 Tegaderm
6 Cairan Infus 6 Cairan Infus
7 NGT 7 NGT
8 Folley Catheter 8 Folley Catheter
9 Urine Bag 9 Urine Bag
10 Suction 10 Suction
11 Spuit 3 ml 11 Spuit 3 ml
12 Spuit 5 ml 12 Spuit 5 ml
13 Spuit 10 ml 13 Spuit 10 ml
14 Spuit 20 ml 14 Spuit 1 ml
15 Spuit 1 ml 15 Neolus
16 Neolus 16 Blood Set
17 Blood Set 17 Handscoon Steril
18 Handscoon Steril 18 Benagn
19 Benang 19 ETT
20 ETT 20 Bactigras
21 Bactigras 21 Pisau Operasi
22 Pisau Operasi 22 Masker Oksigen
Masker Oksigen
Steril Water

Perawat Sirkuler Admin IBS


Perawat Sirkuler Admin IBS

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RUMAH SAKIT UMUM BUNDA THAMRIN RUMAH SAKIT UMUM BUNDA THAMRIN
Jl. Sei Batang Hari No. 28-30, Medan Sunggal Jl. Sei Batang Hari No. 28-30, Medan Sunggal
Telp. (061) 88813615 – 88813616-88813617 – 88813618. Fax. (061) 80501822 Telp. (061) 88813615 – 88813616-88813617 – 88813618. Fax. (061) 80501822

Nama : Jenis Kelamin : L/K Alamat : Nama : Jenis Kelamin : L/K Alamat :
Tgl Lahir : No. RM : Tgl Lahir : No. RM :

Diagnosa : ................................................ Jam Rencana Operasi : ............................... Diagnosa : ................................................ Jam Rencana Operasi : ...............................
Tindakan Operasi : .................................. Dokter Operator Tiba : ................................ Tindakan Operasi : .................................. Dokter Operator Tiba : ................................
Dokter Operator : .................................... ASA/Antibiotik : ........................................... Dokter Operator : .................................... ASA/Antibiotik : ...........................................
Dokter Anastesi : ..................................... Rawat Inap/Site Marking : .......................... Dokter Anastesi : ..................................... Rawat Inap/Site Marking : ...........................
Jam Operasi : ........................................... Pengkajian Anastesi : .................................. Jam Operasi : ........................................... Pengkajian Anastesi : ...................................
Jam Anastesi : .......................................... Jam Anastesi : ..........................................
No Nama Alkes Jlh Ket. No Nama Alkes Jlh Ket.
1 Abocath 1 Abocath
2 3 Way 2 3 Way
3 Set infus 3 Set infus
4 Alkohol Swab 4 Alkohol Swab
5 Tegaderm 5 Tegaderm
6 Cairan Infus 6 Cairan Infus
7 NGT 7 NGT
8 Folley Catheter 8 Folley Catheter
9 Urine Bag 9 Urine Bag
10 Suction 10 Suction
11 Spuit 3 ml 11 Spuit 3 ml
12 Spuit 5 ml 12 Spuit 5 ml
13 Spuit 10 ml 13 Spuit 10 ml
14 Spuit 20 ml 14 Spuit 20 ml
15 Spuit 1 ml 15 Spuit 1 ml
16 Neolus 16 Neolus
17 Blood Set 17 Blood Set
18 Handscoon Steril 18 Handscoon Steril
19 Benang 19 Benang
20 ETT 20 ETT
21 Bactigras 21 Bactigras
22 Pisau Operasi 22 Pisau Operasi
23 Masker Oksigen 23 Masker Oksigen
24 Steril Water 24 Steril Water
Perawat Sirkuler Admin IBS Perawat Sirkuler Admin IBS

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