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Tgl & waktu kadaluarsa :.........................jam.................. Tgl & waktu kadaluarsa :.........................jam..................
Penyimpanan :............................................................... Penyimpanan :...............................................................

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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 :...............................................................

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