STIKER PASIEN

PAKET OK
FARMASI RSUD TG PRIOK

Tanggal Operasi :
Petugas Farmasi yang menyiapkan Set :
Petugas Farmasi yang bertugas di OK :
Nama Dokter Operator :

FORMULIR OK
Rehecting
No. Nama Obat/ Alkes Jumlah Pemakaian
1 APRON 3
2 AQUADEST (WFI) 2
3 Assucril/OPTIME/SAFIL 3/0 CUT 1
4 Assucril/OPTIME/SAFIL/T-VIO 1 TAP 1
5 BISTURI 15 1
6 BISTURI 20 2
7 BOKAL 1
8 CATGUT CHROMIC 2/0USP 1
9 CHLORAMPHENICOL EYE OINT 1
10 DARYANTULE/ SOFRATULE 1
11 DISP SYRINGE 1 CC 1
12 DISP SYRINGE 10 CC 3
13 DISP SYRINGE 20 CC 2
14 DISP SYRINGE 3 CC 2
15 FOLLEY CATETER NO 16 1
16 HARUM PEN 1
17 HARUM PLATE MONO ADULT 1
18 KASSA X-RAY TEBAL 5
19 KETOPROFEN SUPPOSITORIA 2
20 MASKER 6
21 MISOPROSTOL TABLET 3
22 Monosof/ T-Mono 3.0 Cut 1
23 NACL 0.9% 500 ML 1
24 NURSECAP 6
25 PLASTIK BENING UNTUK PLASENTA 2
26 POVIDON IODIN 300 ML 1
27 RL 1
28 SARUNG TANGAN NON STERIL 3
29 SARUNG TANGAN STERIL NO. 6 3
30 SARUNG TANGAN STERIL NO. 6.5 3
31 SARUNG TANGAN STERIL NO. 7 3
32 SARUNG TANGAN STERIL NO. 7.5 3
33 SOEI SILK 2/0 TAPPER 1
34 SUCTION WITH YANKEUR 2
35 TEGADERM WITH PAD 1
36 TRANSOVIX 1
37 UNDERPAD 2
38 URINE BAG 1
39 XYLOCAIN GEL 1

Mengetahui,
Petugas Depo OK

ttd