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LAMPIRAN I : Permintaan Obat-obatan dan Alkes Klinik Onsite PT.

PDSI
Tanggal

: 04 juni 2015
OBAT-OBATAN DAN ALKES
No
A

Nama Obat dan Alkes


Obat-obatan

Qty

Satuan

Cetirizine

100

Tablet

Ciprofloxacim

100

Tablet

Paratusin

100

Tablet

Dexteem plus

100

Tablet

Spasminal

100

Tablet

Cefixime

100

Tablet

Scopamin

100

Tablet

Cotrimokazole

100

Tablet

Metrodinazole

100

Tablet

10

N-Bethasone

100

Tablet

11
12

Metil Prenidsolone
Ketorolak

100
100

Tablet
Tablet

13

Simpastatin

100

Tablet

14

H202 3%

Liter

15

Fg Troches

100

Tablet

16

Gentamicin Salf

100

Tablet

17

Counterpain

10

PCS

18

Anti Bisa Ular

PCS

Alkes

Bengkok

Unit

Diminta oleh

Diketahui oleh
kabid kep & pen.
medik

Agung.Firmansyah
J. Suwanto, NS,
S.kep, S.pd

Lampiran II
Tanggal

: Permintaan Obat Klinik Onsite


: 21 Mei 2015
No

Nama Obat

Qty

Satuan

NACL OGB 500 ml

10

BOTOL

Glucose 5% (D5)

10

BOTOL

Ringer lactat 500 ml

10

BOTOL

Steril Water 1 L

BOTOL

Dexanta syr

12

BOTOL

Ottopain Ear Drops

PCS

Phaminov Injeksi

10

AMPUL

Ranitidin Injeksi

10

AMPUL

Digoxin 0,25 mg

100

TABLET

10

Stolac Supp

12

TABLET

11

Biodiar Tablet

120

TABLET

12

Amoxicillin 500 mg

100

TABLET

13

Urotractin Kapsul

60

TABLET

14

Becom C tab

100

TABLET

15

Noverty

30

TABLET

16

Fasorbid 5 mg

100

TABLET

17

Cefadroxil 500 mg

100

TABLET

18

Asam Mefenamat 500 mg

100

TABLET

19

Tuzalos

100

TABLET

20

Ketokonazole 200 mg

50

TABLET

21

Ciprofloxacin 500 mg

100

TABLET

22

Cetirizine 10 mg

50

TABLET

23

Meloxicam 7,5 mg

50

TABLET

24

Sanmol 500 mg

100

TABLET

25

New Diatab

100

TABLET

26

Berzymplex tab

100

TABLET

27

Asam Traneksamat 100 mg Inj

10

AMPUL

28

Acyclovir 400 mg

50

TABLET

29

Meloxicam 15 mg

100

TABLET

30

Dulcolax 5 mg Tab

80

TABLET

31

Domperidone Syr

BOTOL

32

Ventolin Inhaler (askes)

PCS

33

Ambroxol 30 mg

100

TABLET

34

Furosemide 40 mg

200

TABLET

35

Ranitidin 150 mg

100

TABLET

36

Omeprazole 20 mg Kaps

30

TABLET

37

Sanadry Exp

BOTOL

38

Hydrocortisone Salep Kulit

PCS

39

Hidroclhorotiazid Tab (HCT)

100

TABLET

40

Ondancentron 4 mg Inj

10

AMPUL

41

Oralit sachet

25

PCS

42

Burnazyn Salf

PCS

43

Ketokonazole Salep Kulit

PCS

44

Hexadol 120 ml

BOTOL

45

Ketricin Orabase 0,1%

BOTOL

46

Scopamin Injeksi

AMPUL

47

Nifedipin 10 mg

100

TABLET

48

Captopril 25 mg

100

TABLET

49

Glimepiride 3 mg

50

TABLET

50

Pronalgess Supp

10

PCS

51

Amlodipin 5 mg

50

TABLET

52

Flunarizin 5 mg

30

TABLET

53

Bisoprolol 5 mg

30

TABLET

54

Lidocain Inj

10

AMPUL

55

Allupurinol 100 mg

100

TABLET

56

Dexamethasone Tab

1000

TABLET

57

Otsu D40 (25 cc)

BOTOL

58

Dexamethasone Inj

10

AMPUL

59

Atropin Sulfas 0.25 Inj

10

AMPUL

60

Tramadol Inj

10

AMPUL

61

Epinefrin Injeksi

10

AMPUL

62

Epsonal

100

TABLET

63

Y.rins

BOTOL

64

Softman

BOTOL

65

Cendolyters

PCS

Diminta oleh

Diketahui oleh
kabid kep & pen.
medik

Agung.Firmansyah
J. Suwanto, NS,
S.kep, S.pd

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