Nama :.......................................................................... Nama :..........................................................................
Obat :....................................................................mg Obat :....................................................................mg dalam...........................................................ml dalam...........................................................ml Rute P. :........................................................................... Rute P. :........................................................................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu kadaluarsa :.........................jam.................. Tgl & waktu kadaluarsa :.........................jam.................. Penyimpanan :............................................................... Penyimpanan :...............................................................
Nama :.......................................................................... Nama :..........................................................................
No. MR :...................................Ruang:............................ No. MR :...................................Ruang:............................ Obat :....................................................................mg Obat :....................................................................mg dalam...........................................................ml dalam...........................................................ml Rute P. :........................................................................... Rute P. :........................................................................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu kadaluarsa :.........................jam.................. Tgl & waktu kadaluarsa :.........................jam.................. Penyimpanan :............................................................... Penyimpanan :...............................................................
Nama :.......................................................................... Nama :..........................................................................
No. MR :...................................Ruang:............................ No. MR :...................................Ruang:............................ Obat :....................................................................mg Obat :....................................................................mg dalam...........................................................ml dalam...........................................................ml Rute P. :........................................................................... Rute P. :........................................................................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu kadaluarsa :.........................jam.................. Tgl & waktu kadaluarsa :.........................jam.................. Penyimpanan :............................................................... Penyimpanan :...............................................................
Nama :.......................................................................... Nama :..........................................................................
No. MR :...................................Ruang:............................ No. MR :...................................Ruang:............................ Obat :....................................................................mg Obat :....................................................................mg dalam...........................................................ml dalam...........................................................ml Rute P. :........................................................................... Rute P. :........................................................................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu kadaluarsa :.........................jam.................. Tgl & waktu kadaluarsa :.........................jam.................. Penyimpanan :............................................................... Penyimpanan :...............................................................
Nama :.......................................................................... Nama :..........................................................................
No. MR :...................................Ruang:............................ No. MR :...................................Ruang:............................ Obat :....................................................................mg Obat :....................................................................mg dalam...........................................................ml dalam...........................................................ml Rute P. :........................................................................... Rute P. :........................................................................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu penyiapan :.........................jam................... Tgl & waktu kadaluarsa :.........................jam.................. Tgl & waktu kadaluarsa :.........................jam.................. Penyimpanan :............................................................... Penyimpanan :...............................................................