FORM CHEK LIST AMBULANCE KECIL

NO Nama Obat QTY

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
1 Aserinh (Otsuka) 2
2 Otsu D10 500 (Otsuka) 1
3 Otsu D5 500 (Otsuka) 1
4 Otsu D5 100 (Otsuka) 1
5 Kassa Box
6 Kassa Gulung
7 Ketorolac 1
8 Ondan Sentron 4mg
9 Ephinepirine 2
10 Etason 2
11 Valdimex 1
12 Dexametashone 1
13 Buscopan
14 Scopamin 2
15 Ranitidine 5
16 Neurobat 1
17 Lidocain 5
18 Cateter (Rusch)
19 Cateter 16 ( Rusch) 1
20 Urine Bag (GEA) 1
21 Intravix Makro (Braun) 1
22 Spuit 50cc L. Tengah) 1
23 Cateter 18 (Ruch) 1
24 Spuit 10cc 5
25 Spuit 5cc 2
26 Spuit 3cc 2
27 Spuit 1cc 2
28 Introcan No 20 1
29 Introcan No 22 1
30 Introcan No24
31 Wing nidle 27 (Terumo) 3
32 Transcopix (Konektor) 2
33 Otsu Water 3
34 Alkohol Swab 5
35 Plesterin 6
36 Nasal Kanul Neonatus 1
37 Nasal Sungkup Anak 1
38 NRM (Anak) 1
39 NGT No 14 1
40 NGT No 16 1
41 Wing nidle No 19 1
42 Manitol Infus 1
43 Nasal Kanul Dewasa 1
 FORM CHEK LIST AMBULANCE BESAR

NO Nama Obat QTY

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
1 Tridex 27 B (Sanbe) 1
2 Otsu Water 1
3 Otsu D5 500 cc 1
4 Otsu NS 500 cc 1
5 Introcan no 18 (Braun) 1
6 Introcan no 20 (Braun) 2
7 Introcan no 22 (Braun) 1
8 Introcan no 24 (Braun) 3
9 Surflo No 22 (Terumo) 4
10 Alkohol pad 5
11 Plesterein 7
12 Ngt no 18 1
13 Urine bag 2
14 Cateter no 16 1
15 Cateter no 18 1
16 Kassa gulung 3
17 Oksigen Mask 2
18 Sungkup 1
19 Infus set 1
20 Nassal Dewasa 1
21 Nassal bayi 1