Tanda Terima Obat Peserta Rujuk Balik

TANDA TERIMA OBAT PESERTA RUJUK BALIK
N0 NAMA OBAT SIGNA DOSIS JUMLAH PARAF PESERTA

NO Nama Pasien Alamat Nama Obat Dosis Signa Jumlah
1 Intan Balee Metformin 500 Mg 2x1 LX
Glimepirid 2 Mg 1x1 xxx
2 Nurhabibah Ranub Dong Metformin 500Mg 2x1 LX
Gliben 2,5 Mg 1x1 XXX
3 M Nazaruddin Mestu Metformin 500Mg 2x1 LX
4 Siti hajir Ujong Tanjong Humulog 10-10-10 IV
Amlodipin 5 Mg 1x1 XXX
5 Nurjannah Ujong Tanjong Humulog 16-0-16 II
6 Ernawati Br Nabiak Langung Metformin 500 Mg 2x1 LX
Glimepirid 2 Mg 1x1 XXX
7 Martini P paya Metformin 500 Mg 2x1 LX
8 Razali sarah Langung Amlodipin 10 Mg 1x1 XXX
Humulog 14-14-14 IV
9 Dewi faulina RPT Amlodipin 5 Mg 1x1 XXX
10 Khairani Fatimah UTD Amlodipin 5 Mg 1x1 XXX
11 Anizar Meurebo Metformin 500 Mg 2x1 LX
12 Nurainal Ujong Drien Metformin 500 Mg 2x1 LX
13 Zuraimi Ujong Drien Metformin 500 Mg 2x1 LX
14 Naimah Mestu Metformin 500 Mg 2x1 LX
15 M Yunan Mestu Amlodipin 5 Mg 1x1 XXX
Metformin 500 Mg 2x1 LX
16 Idris P rayeuk Metformin 500 Mg 2x1 LX
17 Ramlah RPB Metformin 500 Mg 2x1 LX
18 Raisah Balee Amlodipin 5 Mg 1x1 XXX
19 Diana Gunong Kleng Amlodipin 5 Mg 1x1 XXX
20 Muzni Dewifa Meurebo Candesartan 16 Mg 1x1 XXX
21 Darmawati Meurebo Metformin 500 Mg 2x1 LX
Amlodipin 5 Mg XXX
22 Musniadi Abu Pasi Pinang Metformin 500 Mg 2x1 LX
23 Tjut Asnah Mestu Metformin 500 Mg 2x1 LX
24 Meriati Ujong Drien Metformin 500 Mg 2x1 LX
25 Syamsul Bahri Ujong Drien Metformin 500 Mg 2x1 LX
26 Maisar Ujong Drien Amlodipin 5 Mg 1x1 XXX
27 Ibrahim MD G Kleng Metformin 500 Mg 2x1 LX
28 Eva Yulita RPT Berotec I
Ceretiddiskus I
29 Roslami Ujong Drien Novomix 38-0-38 VIII
30 Junaidi Ujong Drien candesartan 8 Mg 1x1 XXX
31 Fadhillah UTD Metformin 500 Mg 2x1 LX
32 Sumiati Ujong Drien Metformin 500 Mg 2x1 LX
33 Norman M yacob Gunong kleng Metformin 500 Mg 2x1 LX
34 Siti Aminah P Paya Metformin 500 Mg 2x1 LX
35 Darmi Pulo Tengoh Amlodipin 5 Mg 1x1 XXX
Humulog 10-10-10 III
36 Maryani Langung Metformin 500 Mg 2x1 LX
37 Wan Aja samani Bukit jaya Metformin 500 Mg 2x1 LX
38 Hanisah Ujong Drien Metformin 500 Mg 2x1 LX
39 Masdawati PCU Metformin 500 Mg 2x1 LX
40 Rohani D Langung Metformin 500 Mg 2x1 LX
41 Betti Nurdiana UTD Amlodipin 5 Mg 1x1 XXX
42 Sumarni Gunong Kleng Metformin 500 Mg 2x1 LX
43 Laila UTD Metformin 500 Mg 2x1 LX
44 Ernidar wati Ujong Drien Metformin 500 Mg 2x1 LX
45 Rosdiana Dewi Pasi Pinang Berotec I
46 Samidan R Dong Novomix 24-0-24 V
47 Nurbaiti Balee Amlodipin 5 Mg 1x1 XXX
48 Faridah Ys RPB Apidra 12-12-12 IV
Levemir 0-0-14 I
49 Rosmiati Ujong Drien Amlodipin 5 Mg 1x1 XXX
50 Nila wati Ujong Drien Metformin 500 Mg 2x1 LX
51 Devi Erniza MRB Ceretiddiskus I
52 Marliana Mestu Metformin 500 Mg 2x1 LX
Gliben 2,5Mg 1x1 XXX
53 Rahmat maulana Ujong Drien Berotec I
54 Azizah Ujong Tanjong Amlodipin 5 Mg 1x1 XXX
55 Nurul Iman Balee Metformin 500 Mg 2x1 LX
56 Rosdiana Ujong Drien Metformin 500 Mg 2x1 LX
57 Nuraini Pasi pinang Metformin 500 Mg 2x1 LX
58 Salwani G Kleng Metformin 500 Mg 2x1 LX
59 Awa Imama Langung Metformin 500 Mg 2x1 LX
60 Buyung Juned Mestu Amlodipin 5 Mg 1x1 XXX
61 Endang Romli P Paya Metformin 500 Mg 2x1 LX
62 Risnawati Ujong Drien Metformin 500 Mg 2x1 LX
Amlodipin 5 mg 1x1 XXX
63 Nurjannah Mestu Novomix 16-0-16 III
64 Mustafa kamal Ujong tanjong Metformin 500 Mg 2x1 LX
65 Maridah Langung Humulog 10-0-0 I
66 Lismawati RPB Amlodipin 5 Mg 1x1 XXX
67 Syafari UTD Metformin 500 Mg 2x1 LX
68 Drs Nawawi Ujong Drien Metformin 500 Mg 2x1 LX
69 Umi salamah RP Timur Metformin 500 Mg 2x1 LX
Gliben 2,5 1x1 XXX
70 T Umar Racidin P paya Metformin 500 Mg 2x1 LX
71 Manah Bukit jaya Metformin 500 Mg 2x1 LX
72 Nurhayati Ujong Drien Metformin 500 Mg 2x1 LX
73 Zainuddin P Rayeuk Novomix 14-0-14 XXX
74 Rismawati P Paya Metformin 500 Mg 2x1 LX
75 Asni Daud Langung Metformin 500 Mg 2x1 LX
76 Salwani G Kleng Amlodipin 5 Mg 1x1 XXX
77 Siti zahara Ujong Tanjong Metformin 500 Mg 2x1 LX
78 Mariani Ujong Drien Berotec I
79 Nurcahya Ranub dong Metformin 500 Mg 2x1 LX
80 Jusmi Arita Ujong Drien Amlodipin 5 Mg 1x1 XXX
81 Husen Us RPB Berotec I
82 Linda Wati P paya Metformin 500 Mg 2x1 LX
83 M Yunus Ys Langung Amlodipin 5 Mg 1x1 XXX
84 Hasan basri R Dong Metformin 500 Mg 2x1 LX
Glikazid 1x1 XXX
85 Mariah Ujong Drien Metformin 500 Mg 2x1 LX
86 Budi Ningsih RPB Amlodipin 5 Mg 1x1 XXX
87 Rahma Dewi Pasi Pinang Metformin 500 Mg 2x1 LX
Gliben 2,5 Mg 1x1x XXX
88 Joko Hadi Mrb Metformin 500 mg 2x1 Lx
89 Asrul Ujong Drien Metformin 500 Mg 2x1 LX
91 Murizal PCU Amlodipin 5 Mg 1x1 XXX
92 Cut Tuti Oktriani MRB Amlodipin 5 Mg 1x1 XXX
93 Sjahiddin R Dong Metformin 500 Mg 2x1 LX
94 Siti aisyah Ujong Tanjong Metformin 500 Mg 2x1 LX
95 Ridla Satrya Mrb Metformin 500 Mg 2x1 LX
96 Samsidar MRb Metformin 500 Mg 2x1 LX
97 Shela Safira MRB Novorapid 10-0-10 I
Levemir 0-0-14 I
98 Mawardi P Paya Gliben 2,5 Mg 1x1 XXX
99 Nurcahya R Dong Metformin 500 Mg 2x1 LX
100 Jurhaida BR Tanjung MRB Metformin 500 Mg 2x1 LX

101 Aisyah MRB Amlodipin 5 Mg 1x1 XXX
102 T raja Idin Ujong Drien Metformin 500 Mg 2x1 LX
103 Yusmaizar G kleng Amlodipin 5 Mg 1x1 XXX
104 Darmawar Pulo Tengoh Metformin 500 Mg 2x1 LX
105 Mahani P A Tunong Amlodipin 5 Mg 1x1 XXX
106 Abdul Manaf P A Baroh Metformin 500 Mg 2x1 LX
107 Fauziah Ujong Tanjong Metformin 500 Mg 2x1 LX
ANDA TERIMA OBAT PESERTA RUJUK BALIK
NAMA PESERTA :
NO KARTU :
TGL PELAYANAN :
DIAGNOSA :
NO TLP/HP :
NO NAMA OBAT SIGNA DOSIS JUMLAH PARAF PESERTA

1
2
3
4
5
6
NAMA PESERTA :
NO KARTU :
TGL PELAYANAN :
DIAGNOSA :
NO TLP/HP :

1
2
3
4
5
6
NAMA PESERTA :
NO KARTU :
TGL PELAYANAN :
DIAGNOSA :
NO TLP/HP :

1
2
3
4
5
6

Tanda Terima Obat Peserta Rujuk Balik

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Tanda Terima Obat Peserta Rujuk Balik

Uploaded by

Copyright:

Available Formats

TANDA TERIMA OBAT PESERTA RUJUK BALIK

N0 NAMA OBAT SIGNA DOSIS JUMLAH PARAF PESERTA

100 Jurhaida BR Tanjung MRB Metformin 500 Mg 2x1 LX

NO NAMA OBAT SIGNA DOSIS JUMLAH PARAF PESERTA