KEPOLISIAN DAERAH SULAWESI TENGAH

RUMKIT BHAYANGKARA TKT III PALU

Jalan DR. Suharso Lrg. III, No. 2 Palu

DAFTAR PERMINTAAN OBAT / ALKES PERSIAPAN OPERASI

Tanggal :
Nama Pasien :
Nomor RM :
Status Pasien :
Nomor Kartu / SEP :
Ruangan Perawatan :
Diagnosa / Tindakan :
JUMLAH
NO NAMA OBAT / ALKES KETERANGAN
PERMINTAAN TERPAKAI
Abbocath : 16/18/20/22/24/26
Dispo : 1/3/5/10/20/50
ETT No.
LMA No.
Infuset
Bloodset
Spinocan 25/26/27
Canul Oxygen
Gudle No.
Canul Suction No.
Venflon 18/20/22
Bunascan
Ondancentron 4 mg
Ephedrin HCL
Ketamin
Ketorolac 30 mg
Lidocain HCL 2%
Lidocain COMP
Propofol
Prostigmin
Sevoflurane
Isoflurane
Asam Transemat 500 mg
Triway
Epinefrin
Aquadest 25 ml
Atracurium
Atropin Sulfat
Dexametasone
Diazepam
Fentanyl
Pethidine
Midazolam
NaCl 09 %
RL
Mannitol
Gelofusin / Voluven
Kaltrofen Supp
Oxytosin
Methilergometrin
Sambehest
Dextrose 5%
Amiodaron Ampul
Sanmol Infus
Dobutamin Ampul
Norephineprine Ampul
TOTAL
Petugas ANASTESI IBS

(…..............................................)
 KEPOLISIAN DAERAH SULAWESI TENGAH
RUMKIT BHAYANGKARA TKT III PALU
Jalan DR. Suharso Lrg. III, No. 2 Palu

DAFTAR PERMINTAAN OBAT / ALKES PERSIAPAN OPERASI

Tanggal :
Nama Pasien :
Nomor RM :
Status Pasien :
Nomor Kartu / SEP :
Ruangan Perawatan :
Diagnosa / Tindakan :
JUMLAH
NO NAMA OBAT / ALKES KETERANGAN
PERMINTAAN TERPAKAI
Abbocath : 16/18/20/22/24/26
Infuset
Bloodset
Dispo : 1/3/5/10
Dispo : 20/50 (UB), (UK)
Elastis Verban 4" / 6"
Foley Chateter No.
Foley Cath Three Way No
Sofband 4" / 6"
Gypsona 4" / 6"
NGT No.
Slang Suction
Urine Bag
Urogard
T. Vio No.
T. Nylon No.
Silkam No,
Tree Way
Dj Stand No.
Kaltrofen Supp

Asam Traxenamat 250/500 mg

Aquadest 25 ml
Aquadest Irigasi
Ketorolac 30 mg
Lidocain HCL 2%
Lidocain Comp/Pehacain
NaCl
Cuticell/Dariyant Tulle
Spogustin
Bonwax
Surgicell
Marker
Gentamicyn inj
Transofix
Anbacim 1 gr
Sharox 750 mg
Cefotaxim 1 gr
Ceftriaxone 1 gr
Gasrul
Oxytosin
Methylergometrin
Zalt Mata
TOTAL
Petugas BEDAH IBS

(…..............................................)