Form Lidian Obat

TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
6 Amitriptilin 25 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
9 Amoxsisilin Forte sir
10 Amoxsisilin sirup
11 Amoxsisilin 250 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
18 Asam VIT C 250 mg
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
31 Captopril 12,5 mg
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
35 Chloramfenicol cap
36 Chloramfenicol sirup
37 Cimetidin 200
38 Ciprofloxacin 500 mg
39 Cloram Salep Mata
40 Cloram Tetes Telinga
41 CloramTetes Mata
42 CODEIN 10 MG
43 Cotrimoxsasol 480
44 Cotrimoxsasol sirup
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
55 Eritromisin 500 mg
56 Eritromisin sirup
57 Farnormin
58 Farsifen sirup
59 Fe
60 Fenobarbital 30 mg
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
74 Hidrokortison krim
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
79 Ketokonasol cream
80 Kotrimoksazol forte
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
84 Metformint 850 mg
85 Metoklopramid 10 mg
86 Metronidazol 250 mg
88 Mikonazol krim
89 Natrium Bikar 500 mg
90 Natrium diklo 25 mg
91 Natrium Diklo 50 mg
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
96 Oksitetra Salep kulit
97 Oksitetra salep mata
98 Omeprazol 20 mg
99 Parasetamol 500 mg
100 Parasetamol DROP
101 Parasetamol sirup
102 Piroksikam 20 mg
103 Prednison 5 mg
104 Pularex
105 Ranitidin 150 mg
106 Salbutamol 2 mg
107 Salep 2-4
108 Salisil Bedak 2 %
109 Scabimite salep
110 setirizin sirup
111 Simvastatin 10 mg
113 Sulfa tetes mata
114 Tetrasiklin kapsul
115 Trifluoperazin 5 mg
116 Triheksifenidil 2 mg
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
124 Zink sirup /zircum
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0 R/3 = 0 BPJS = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0 JAMKESDA = 0
R/5 = 0 0 R/5 = 0 0
0 0

29 30 31 32 33 resep 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53
NO NAMA
obat G NG
0 0 1 Albendazol 400 mg
0 0 2 Allupurinol 100
0 0 4 Ambroksol 30 mg
0 0 5 Aminofilin 200 mg
0 0 6 Amitriptilin 25 mg
0 0 7 Amlodipin 10 mg
0 0 9 Amoxsisilin Forte sir
0 0 10 Amoxsisilin sirup
0 0 11 Amoxsisilin 250 mg
0 0 13 Antalgin
0 0 14 Antasida
0 0 15 Antasida SIRUP
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 18 Asam VIT C 250 mg
0 0 20 Asam Folat
0 0 21 Asam Mefenamat
0 0 22 Asetosal 100 mg
0 0 24 Asiklovir 200 mg
0 0 26 Asiklovir krim
0 0 27 Aspilet tablet
0 0 28 Bacitrasin salep
0 0 29 Betametason krim
0 0 30 Calcium AD
0 0 31 Captopril 12,5 mg
0 0 32 Captopril 25 mg
0 0 34 Carmazepin
0 0 35 Chloramfenicol cap
0 0 36 Chloramfenicol sirup
0 0 37 Cimetidin 200
0 0 38 Ciprofloxacin 500 mg
0 0 39 Cloram Salep Mata
0 0 40 Cloram Tetes Telinga
0 0 41 CloramTetes Mata
0 0 42 CODEIN 10 MG
0 0 43 Cotrimoxsasol 480
0 0 44 Cotrimoxsasol sirup
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 49 Diazepam 2 mg
0 0 50 Digoksin
0 0 51 Dimenhidrinat
0 0 52 Domperidon sirup
0 0 53 Efedrin 25 mg
0 0 54 Ekstrak Belladon
0 0 55 Eritromisin 500 mg
0 0 56 Eritromisin sirup
0 0 57 Farnormin
0 0 58 Farsifen sirup
0 0 59 Fe
0 0 60 Fenobarbital 30 mg
0 0 61 Fenol Gliserol
0 0 62 Furosemid 40 mg
0 0 63 Garam Oralit
0 0 64 Gentamisin salep
0 0 65 Gentian Violet
0 0 66 GG 100 mg
0 0 67 Glibenklamid5 mg
0 0 68 Glimepirid 2 mg
0 0 69 GLIMEPIRID 1 MG
0 0 70 Griseofulvin
0 0 71 Guanistrep sirup
0 0 72 Haloperidol 5 mg
0 0 73 HCT 25 mg
0 0 74 Hidrokortison krim
0 0 75 Ibuprofen 200 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 79 Ketokonasol cream
0 0 80 Kotrimoksazol forte
0 0 81 Laxamex
0 0 82 Loratadin 10 mg
0 0 83 Metformin 500 mg
0 0 84 Metformint 850 mg
0 0 85 Metoklopramid 10 mg
0 0 86 Metronidazol 250 mg
0 0 88 Mikonazol krim
0 0 89 Natrium Bikar 500 mg
0 0 90 Natrium diklo 25 mg
0 0 91 Natrium Diklo 50 mg
0 0 92 Neurovit- E
0 0 93 Nifedipin10 mg
0 0 94 Novabion tablet
0 0 95 OBH Sirup
0 0 96 Oksitetra Salep kulit
0 0 97 Oksitetra salep mata
0 0 98 Omeprazol 20 mg
0 0 99 Parasetamol 500 mg
0 0 100 Parasetamol DROP
0 0 101 Parasetamol sirup
0 0 102 Piroksikam 20 mg
0 0 103 Prednison 5 mg
0 0 104 Pularex
0 0 105 Ranitidin 150 mg
0 0 106 Salbutamol 2 mg
0 0 107 Salep 2-4
0 0 108 Salisil Bedak 2 %
0 0 109 Scabimite salep
0 0 110 setirizin sirup
0 0 111 Simvastatin 10 mg
0 0 113 Sulfa tetes mata
0 0 114 Tetrasiklin kapsul
0 0 115 Trifluoperazin 5 mg
0 0 116 Triheksifenidil 2 mg
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 124 Zink sirup /zircum
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

54 55 56 57 58 59 60 61 62 63 64 65 66 resep 67 68 69 70 71 72 73 74 75 76 77 78
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0 R/1 = 0 BAYAR = 0

SUBSIDI = 0 R/2 = 0 SUBSIDI = 0
BPJS = 0 R/3 = 0 BPJS = 0
JAMKESDA = 0 R/4 = 0 JAMKESDA = 0
0 R/5 = 0 0
0

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 resep 100 101 102 103

NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1
R/2 = 0 SUBSIDI = 0 R/2
R/3 = 0 BPJS = 0 R/3
R/4 = 0 JAMKESDA = 0 R/4
R/5 = 0 0 R/5
0

104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 resep
obat G NG
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
= 0 BAYAR = 0 R/1 = 0 BAYAR = 0
= 0 SUBSIDI = 0 R/2 = 0 SUBSIDI = 0
= 0 BPJS = 0 R/3 = 0 BPJS = 0
= 0 JAMKESDA = 0 R/4 = 0 JAMKESDA = 0
= 0 0 R/5 = 0 0
0 0
N0 NAMA UMUR ALAMAT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/4 = 0 JAMKESDA = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin Forte sir
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Chloramfenicol sirup
Cimetidin 200
Ciprofloxacin 500 mg
Cloram Salep Mata
Cloram Tetes Telinga
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium Bikar 500 mg
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Oksitetra Salep kulit
Oksitetra salep mata
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
Triheksifenidil 2 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
TANGGAL :
1 2 3 4 5 6 7 8 9 10 11 12
NO NAMA
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

32 33 resep 34 35 36 37 38 39 40
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
R/1 = 0
R/2 = 0
R/3 = 0
R/4 = 0
R/5 = 0
0
41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
BPJS = 0 R/3 = 0 BPJS = 0
0 R/5 = 0 0
0

60 61 62 63 64 65 66 resep 67 68
NO NAMA
obat G NG
0 0 13 Antalgin
0 0 14 Antasida
0 0 16 Antifungi
0 0 17 Antihemoroid
0 0 20 Asam Folat
0 0 30 Calcium AD
0 0 34 Carmazepin
0 0 42 CODEIN 10 MG
0 0 45 CPZ 100
0 0 46 CPZ 25 mg
0 0 47 CTM 4 mg
0 0 48 Deksametason
0 0 50 Digoksin
0 0 57 Farnormin
0 0 59 Fe
0 0 63 Garam Oralit
0 0 66 GG 100 mg
0 0 70 Griseofulvin
0 0 73 HCT 25 mg
0 0 77 ISDN 5 mg
0 0 78 Kalk 500 mg
0 0 81 Laxamex
0 0 92 Neurovit- E
0 0 95 OBH Sirup
0 0 104 Pularex
0 0 107 Salep 2-4
0 0 117 VIT B 12
0 0 118 Vitamin B1
0 0 119 Vitamin B6
0 0 120 Vitamin BC
0 0 121 Vitamin K
0 0 122 Zinc drop
0 0 123 Zinc tablet
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0 R/1 = 0
R/2 = 0 SUBSIDI = 0 R/2 = 0
R/3 = 0 BPJS = 0 R/3 = 0
R/4 = 0 JAMKESDA = 0 R/4 = 0
R/5 = 0 0 R/5 = 0
0 0

88 89 90 91 92 93 94 95 96 97 98 99 resep
NO
obat G NG
0 0 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0 101
0 0 102
0 0 103
0 0 104
0 0 105
0 0 106
0 0 107
0 0 108
0 0 109
0 0 110
0 0 111
0 0 112
0 0 113
0 0 114
0 0 115
0 0 116
0 0 117
0 0 118
0 0 119
0 0 120
0 0 121
0 0 122
0 0 123
0 0 124
0 0 126
0 0 127
0 0 128
0 0 129
0 0 130
0 0 131
0 0 132
0 0 133
0 0 134
0 0 135
0 0 136
0 0 137
0 0 138
0 0 139
0 0 140
0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAYAR = 0
SUBSIDI = 0
BPJS = 0
JAMKESDA = 0
0
100 101 102 103 104 105 106 107 108 109 110 111 112
NAMA
Albendazol 400 mg
Allupurinol 100
Allupurinol 300
Ambroksol 30 mg
Aminofilin 200 mg
Amitriptilin 25 mg
Amlodipin 10 mg
Amlodipin 5 mg
Amoxsisilin sirup
Amoxsisilin 250 mg
Amoxsisilin 500 mg
Antalgin
Antasida
Antasida SIRUP
Antifungi
Antihemoroid
Asam VIT C 250 mg
Asam VIT C 50 mg
Asam Folat
Asam Mefenamat
Asetosal 100 mg
Asetosal 500 mg
Asiklovir 200 mg
Asiklovir 400 mg
Asiklovir krim
Aspilet tablet
Bacitrasin salep
Betametason krim
Calcium AD
Captopril 12,5 mg
Captopril 25 mg
Captopril 50 mg
Carmazepin
Chloramfenicol cap
Cimetidin 200
Cloram Salep Mata
CloramTetes Mata
CODEIN 10 MG
Cotrimoxsasol 480
Cotrimoxsasol sirup
CPZ 100
CPZ 25 mg
CTM 4 mg
Deksametason
Diazepam 2 mg
Digoksin
Dimenhidrinat
Domperidon sirup
Efedrin 25 mg
Ekstrak Belladon
Eritromisin 500 mg
Eritromisin sirup
Farnormin
Farsifen sirup
Fe
Fenobarbital 30 mg
Fenol Gliserol
Furosemid 40 mg
Garam Oralit
Gentamisin salep
Gentian Violet
GG 100 mg
Glibenklamid5 mg
Glimepirid 2 mg
GLIMEPIRID 1 MG
Griseofulvin
Guanistrep sirup
Haloperidol 5 mg
HCT 25 mg
Hidrokortison krim
Ibuprofen 200 mg
Ibuprofen 400 mg
ISDN 5 mg
Kalk 500 mg
Ketokonasol cream
Kotrimoksazol forte
Laxamex
Loratadin 10 mg
Metformin 500 mg
Metformint 850 mg
Metoklopramid 10 mg
Metronidazol 250 mg
Metronidazol 500 mg
Mikonazol krim
Natrium diklo 25 mg
Natrium Diklo 50 mg
Neurovit- E
Nifedipin10 mg
Novabion tablet
OBH Sirup
Omeprazol 20 mg
Parasetamol 500 mg
Parasetamol DROP
Parasetamol sirup
Piroksikam 20 mg
Prednison 5 mg
Pularex
Ranitidin 150 mg
Salbutamol 2 mg
Salep 2-4
Salisil Bedak 2 %
Scabimite salep
setirizin sirup
Simvastatin 10 mg
Simvastatin 20 mg
Sulfa tetes mata
Tetrasiklin kapsul
Trifluoperazin 5 mg
VIT B 12
Vitamin B1
Vitamin B6
Vitamin BC
Vitamin K
Zinc drop
Zinc tablet
Zink sirup /zircum
0 0 0 0 0 0 0 0 0 0 0 0 0
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL :
R/1 = 0 BAYAR = 0
R/2 = 0 SUBSIDI = 0
R/3 = 0 BPJS = 0
R/5 = 0 0
0
132 resep N0 NAMA
obat G NG 1
0 0 2
0 0 3
0 0 4
0 0 5
0 0 6
0 0 7
0 0 8
0 0 9
0 0 10
0 0 11
0 0 12
0 0 13
0 0 14
0 0 15
0 0 16
0 0 17
0 0 18
0 0 19
0 0 20
0 0 21
0 0 22
0 0 23
0 0 24
0 0 25
0 0 26
0 0 27
0 0 28
0 0 29
0 0 30
0 0 31
0 0 32
0 0 33
0 0 34
0 0 35
0 0 36
0 0 37
0 0 38
0 0 39
0 0 40
0 0 41
0 0 42
0 0 43
0 0 44
0 0 45
0 0 46
0 0 47
0 0 48
0 0 49
0 0 50
0 0 51
0 0 52
0 0 53
0 0 54
0 0 55
0 0 56
0 0 57
0 0 58
0 0 59
0 0 60
0 0 61
0 0 62
0 0 63
0 0 64
0 0 65
0 0 66
0 0 67
0 0 68
0 0 69
0 0 70
0 0 71
0 0 72
0 0 73
0 0 74
0 0 75
0 0 76
0 0 77
0 0 78
0 0 79
0 0 80
0 0 81
0 0 82
0 0 83
0 0 84
0 0 85
0 0 86
0 0 87
0 0 88
0 0 89
0 0 90
0 0 91
0 0 92
0 0 93
0 0 94
0 0 95
0 0 96
0 0 97
0 0 98
0 0 99
0 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
UMUR ALAMAT
REGISTER OBAT
BULAN :
SISA TANGGAL
PERSEDI
NO NAMA BULAN TERIMA
AAN
LALU 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 Albendazol 400 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Allupurinol 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Allupurinol 300 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Ambroksol 30 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Aminofilin 200 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Amitriptilin 25 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Amlodipin 10 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Amlodipin 5 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Amoxsisilin Forte sir 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Amoxsisilin sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Amoxsisilin 250 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Amoxsisilin 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Antalgin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Antasida 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Antasida SIRUP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Antifungi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Antihemoroid 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Asam VIT C 250 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Asam VIT C 50 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Asam Folat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Asam Mefenamat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Asetosal 100 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Asetosal 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Asiklovir 200 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Asiklovir 400 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Asiklovir krim 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Aspilet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Bacitrasin salep 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Betametason krim 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Calcium AD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Captopril 12,5 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Captopril 25 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Captopril 50 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Carmazepin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 Chloramfenicol cap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Chloramfenicol sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Cimetidin 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Ciprofloxacin 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Cloram Salep Mata 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Cloram Tetes Telinga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 CloramTetes Mata 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 CODEIN 10 MG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Cotrimoxsasol 480 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Cotrimoxsasol sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 CPZ 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 CPZ 25 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
47 CTM 4 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Deksametason 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Diazepam 2 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Digoksin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Dimenhidrinat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Domperidon sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Efedrin 25 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Ekstrak Belladon 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Eritromisin 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Eritromisin sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Farnormin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Farsifen sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Fe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Fenobarbital 30 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Fenol Gliserol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Furosemid 40 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Garam Oralit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Gentamisin salep 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Gentian Violet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 GG 100 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Glibenklamid5 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
68 Glimepirid 2 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 GLIMEPIRID 1 MG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Griseofulvin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Guanistrep sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Haloperidol 5 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 HCT 25 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Hidrokortison krim 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Ibuprofen 200 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
76 Ibuprofen 400 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 ISDN 5 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Kalk 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
79 Ketokonasol cream 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Kotrimoksazol forte 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
81 Laxamex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
82 Loratadin 10 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
83 Metformin 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
84 Metformint 850 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
85 Metoklopramid 10 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
86 Metronidazol 250 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
87 Metronidazol 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
88 Mikonazol krim 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Natrium Bikar 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
90 Natrium diklo 25 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91 Natrium Diklo 50 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
92 Neurovit- E 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
93 Nifedipin10 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
94 Novabion tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
95 OBH Sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Oksitetra Salep kulit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Oksitetra salep mata 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
98 Omeprazol 20 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
99 Parasetamol 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100 Parasetamol DROP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
101 Parasetamol sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
102 Piroksikam 20 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
103 Prednison 5 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
104 Pularex 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
105 Ranitidin 150 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
106 Salbutamol 2 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Salep 2-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
108 Salisil Bedak 2 % 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
109 Scabimite salep 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 setirizin sirup 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
111 Simvastatin 10 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
112 Simvastatin 20 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
113 Sulfa tetes mata 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Tetrasiklin kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
115 Trifluoperazin 5 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Triheksifenidil 2 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
117 VIT B 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
118 Vitamin B1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
119 Vitamin B6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
120 Vitamin BC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Vitamin K 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
122 Zinc drop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
123 Zinc tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
124 Zink sirup /zircum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
126 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
128 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
131 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
132 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
133 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
134 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
135 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
136 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
137 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
138 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
140 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

PUSTU SISA
KELUAR
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
PENERIMAAN OBAT
BULAN :
TANGGAL
NO NAMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 Albendazol 400 mg
2 Allupurinol 100
3 Allupurinol 300
4 Ambroksol 30 mg
5 Aminofilin 200 mg
7 Amlodipin 10 mg
8 Amlodipin 5 mg
13 Antalgin
14 Antasida
15 Antasida SIRUP
16 Antifungi
17 Antihemoroid
19 Asam VIT C 50 mg
20 Asam Folat
21 Asam Mefenamat
22 Asetosal 100 mg
23 Asetosal 500 mg
24 Asiklovir 200 mg
25 Asiklovir 400 mg
26 Asiklovir krim
27 Aspilet tablet
28 Bacitrasin salep
29 Betametason krim
30 Calcium AD
32 Captopril 25 mg
33 Captopril 50 mg
34 Carmazepin
37 Cimetidin 200
41 CloramTetes Mata
42 CODEIN 10 MG
45 CPZ 100
46 CPZ 25 mg
47 CTM 4 mg
48 Deksametason
49 Diazepam 2 mg
50 Digoksin
51 Dimenhidrinat
52 Domperidon sirup
53 Efedrin 25 mg
54 Ekstrak Belladon
57 Farnormin
58 Farsifen sirup
59 Fe
61 Fenol Gliserol
62 Furosemid 40 mg
63 Garam Oralit
64 Gentamisin salep
65 Gentian Violet
66 GG 100 mg
67 Glibenklamid5 mg
68 Glimepirid 2 mg
69 GLIMEPIRID 1 MG
70 Griseofulvin
71 Guanistrep sirup
72 Haloperidol 5 mg
73 HCT 25 mg
75 Ibuprofen 200 mg
76 Ibuprofen 400 mg
77 ISDN 5 mg
78 Kalk 500 mg
81 Laxamex
82 Loratadin 10 mg
83 Metformin 500 mg
88 Mikonazol krim
92 Neurovit- E
93 Nifedipin10 mg
94 Novabion tablet
95 OBH Sirup
98 Omeprazol 20 mg
103 Prednison 5 mg
104 Pularex
106 Salbutamol 2 mg
107 Salep 2-4
109 Scabimite salep
110 setirizin sirup
117 VIT B 12
118 Vitamin B1
119 Vitamin B6
120 Vitamin BC
121 Vitamin K
122 Zinc drop
123 Zinc tablet
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
obat
19 20 21 22
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH KUNJUNGAN PUSKES
BULAN :
TANGGAL 1 2 3 4 5 6 7 8 9
1 BAYAR 0 0 0 0 0 0 0 0 0
2 SUBSIDI 0 0 0 0 0 0 0 0 0
3 BPJS 0 0 0 0 0 0 0 0 0
4 JAMKESDA 0 0 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0
1 NON GENERIK 0 0 0 0 0 0 0 0 0
2 GENERIK 0 0 0 0 0 0 0 0 0
3 R/1 - 3 0 0 0 0 0 0 0 0 0
4 R/3 - 6 0 0 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0
UNGAN PUSKESMAS CAMPUREJO
10 11 12 13 14 15 16 17 18 19 20 21 22
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH
0
0
0
0
0
0
0
0
0
0

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TANGGAL :

BAYAR = 0 R/1 = 0 BAYAR = 0

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 resep 100 101 102 103

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