Monitoring Stok Obat Emergency [PDF]

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MONITORING OBAT EMERGENCY UPTD PUSKESMAS KECAMATAN PONTIANAK KOTA BULAN : TAHUN : RUANG :



TANGGAL NO.



NAMA OBAT/SEDIAAN



SAT M



1 ATROPIN SULFAT INJ INJ. 5MG/ML 2 DIAZEPAM 2ML



AMP



INJ. 3 DEXAMETASON 5MG/ML 1ML



AMP



HCl INJ. 4 DIFENHIDRAMIN 10MG/ML 1 ML



AMP



5 DEXTROSE INFUSE 5%



BTL



(ADRENALIN) 6 EPINEFRIN INJ. 0,1%



AMP



7 LIDOCAIN COMP. INJ NON ADRENALIN 8 LIDOCAIN INJ. 9 MgSO4 INJ. IV 20% 25ML 10 METHERGIN INJ. 11 RINGER LAKTAT INF. 12 STESOLID 5MG/ML 2,5ML 13 SYNTOCYNON INJ. 14 SALBUTAMOL NEBULE



AMP



AMP AMP VIAL AMP BTL TUBE AMP VIAL



1 K



S



M



2 K



S



M



3 K



S



M



4 K



S



M



5 K



S



M



6 K



S



M



7 K



S



M



8 K



S



M



9 K



S



10 M K



S



11 M K



S



12 M K



S



TANGGAL NO.



NAMA OBAT/SEDIAAN



1 ATROPIN SULFAT INJ INJ. 5MG/ML 2 DIAZEPAM 2ML DEXAMETASON 3 5MG/ML 1ML INJ. HCl INJ. 4 DIFENHIDRAMIN 10MG/ML 1 ML 5 DEXTROSE INFUSE 5% (ADRENALIN) 6 EPINEFRIN INJ. 0,1% 7 LIDOCAIN COMP. INJ 8 LIDOCAIN NON ADRENALIN INJ. 9 MgSO4 INJ. IV 20% 25ML 10 METHERGIN INJ. 11 RINGER LAKTAT INF. 12 STESOLID 5MG/ML 2,5ML 13 SYNTOCYNON INJ. 14 SALBUTAMOL NEBULE



NO.



NAMA OBAT/SEDIAAN



1 ATROPIN SULFAT INJ INJ. 5MG/ML 2 DIAZEPAM 2ML INJ. 3 DEXAMETASON 5MG/ML 1ML HCl INJ. DIFENHIDRAMIN 4 10MG/ML 1 ML 5 DEXTROSE INFUSE 5% (ADRENALIN) 6 EPINEFRIN INJ. 0,1% 7 LIDOCAIN COMP. INJ NON ADRENALIN 8 LIDOCAIN INJ. 9 MgSO4 INJ. IV 20% 25ML 10 METHERGIN INJ. 11 RINGER LAKTAT INF. 12 STESOLID 5MG/ML 2,5ML 13 SYNTOCYNON INJ. 14 SALBUTAMOL NEBULE



SAT



13 M K



S



14 M K



S



26 M K



S



15 M K



S



27 M K



S



16 M K



S



17 M K



S



TANGGAL 28 M K S



29 M K



S



18 M K



S



30 M K



S



19 M K



S



S



31 M K



S



20 M K



S



21 M K



S



22 M K



S



23 M K



S



AMP AMP AMP AMP BTL AMP AMP AMP VIAL AMP BTL TUBE AMP VIAL



SAT AMP AMP AMP AMP BTL AMP AMP AMP VIAL AMP BTL TUBE AMP VIAL



25 M K



PENANGGUNG JAWAB RUANGAN



(



……………………………………………..



)



24 M K



S



FORMULIR MONITORING OBAT EMERGENCY UPTD PUSKESMAS KECAMATAN PONTIANAK KOTA BULAN TAHUN RUANG



NO.



: : :



NAMA OBAT



1 ATROPIN SULFAT INJ 2 DIAZEPAM INJ. 5MG/ML 2ML 3 DEXAMETASON INJ. 5MG/ML 1ML HCl INJ. 10MG/ML 4 DIFENHIDRAMIN 1 ML 5 DEXTROSE INFUSE 5% 6 EPINEFRIN (ADRENALIN) INJ. 0,1% 7 LIDOCAIN COMP. INJ 8 LIDOCAIN NON ADRENALIN INJ. 9 MgSO4 INJ. IV 20% 25ML 10 METHERGIN INJ. 11 RINGER LAKTAT INF. 12 STESOLID 5MG/ML 2,5ML 13 SYNTOCYNON INJ. 14 SALBUTAMOL NEBULE



PENANGGUNG JAWAB RUANGAN



(………………………………………………..)



JUMLAH JUMLAH TANGGAL STOK PEMAKAI EXP. DATE OBAT -AN



TINDAK LANJUT