Formulir B

FORMULIR HARIAN
PASIEN BARU

Unit:R. Neonaty Bulan:Mei Tahun:2019

No Tanggal Nama J.Kelamin Umur Med.Rec Dokter Tindakan
1 01-05-19 By.Rianti Siagian Pr 1hari 02.16.90 Rosmauliana
2 By.Reni Priska Pr 1hari 02.17.14 Hj.Susanti
3 By.Resti Manurung LK 1hari 02.17.16 Hj.Susanti
4 02-05-19 By.Tiarma Pr 1hari 02.17.33 Rosmauliana
5 By.Helentina Lk 1hari 02.17.40 Rosmauliana
6 By.Ulfa Yulanda Pr 1hari 02.17.41 Rosmauliana
7 By.Fera junita 1 Pr 1hari 02.17.18 Hj.Susanti
8 By.Fera junita 2 Lk 1hari 02.17.19 Hj.Susanti IVL
9 M.Faris Supyan Lk 1hari 02.17.17 Hj.Susanti IVL
10 By.Mesnawati Pr 1hari 02.17.49 Rosmauliana
11 03-05-19 By.Marta Ventina Lk 1hari 02.17.63 Hj.Susanti
12 By.Mega Suryani Pr 1hari 02.17.64 Hj.Susanti
13 By.Patma Lk 1hari 02.17.72 Hj.Susanti
14 By.Sukin Lk 1hari 02.17.74 Hj.Susanti
15 By.Ananda Lk 1hari 02.17.52 Rosmauliana IVL
16 By.Nurmawati Lk 18hari 02.17.66 Rosmauliana IVL
17 04-05-19 By.Emma Rosita Pr 1hari 02.17.84 Rosmauliana
18 By.Ambriana Pr 1hari 02.17.95 Hj.Susanti IVL
19 05-05-19 By.Sri Devi Nainggolan Lk 1hari 02.18.02 Rosmauliana
20 By.Nur Hafni Sinaga Pr 1hari 02.18.06 Rosmauliana
21 06-05-19 By.Muliati Lk 1hari 02.18.33 Hj.Susanti
22 By.Dora Sinta Purba Pr 1hari 02.18.34 Hj.Susanti
23 By.Elridha Pr 1hari 02.18.35 Hj.Susanti
24 By.Astaria Pasaribu Pr 1hari 02.18.37 Hj.Susanti
25 By.Agustina Pr 1hari 02.18.40 Hj.Susanti
26 By.Erlin Fitriana Pr 1hari 02.18.36 Hj.Susanti
27 07-05-19 By.Debora Lk 1hari 02.18.51 Hj.Susanti
28 By.Novita Sari Pr 1hari 02.18.73 Rosmauliana
29 By.Hanna Lk 1hari 02.18.74 Rosmauliana
30 By.Mariana Lk 1hari 02.18.75 Rosmauliana
31 By.Romauli Lk 1hari 02.18.71 Rosmauliana
32 By.Veronika Dewi Pr 7hari 02.18.83 Rosmauliana IVL
33 08-05-19 By.Riska Sitanggang Lk 1hari 02.18.96 Hj.Susanti
34 By.Linda Saragih Lk 1hari 02.18.97 Hj.Susanti
35 By.Fitri Lk 1hari 02.18.98 Hj.Susanti
36 By.Ajriel Syahputra Lk 3minggu 02.18.84 Hj.Susanti
37 By.Novita Perawati Pr 1hari 02.18.99 Hj.Susanti
38 By.Ana Maya Sari Pr 1hari 02.19.08 Hj.Susanti
39 09-05-19 By.Putridiah Lk 1hari 02.19.10 Hj.Susanti
40 By.Indrayani Pr 1hari 02.19.24 Rosmauliana
41 By.Eva debora Lk 1hari 02.19.27 Rosmauliana
42 10-05-19 By.Kristina Julyanti Pr 1hari 02.19.45 Hj.Susanti
43 By.Lestari Oktavina Pr 1hari 02.19.51 Hj.Susanti
44 By.Sri lestari Lk 1hari 02.19.44 Hj.Susanti
45 11-05-19 By.Melin Pr 1hari 02.19.55 Rosmauliana
46 By.Novi Ani Ariska Lk 1hari 02.19.68 Rosmauliana
47 By.Siti Aisyah Pr 1hari 02.19.69 Rosmauliana
48 12-05-19 By.Erni Vania Lk 1hari 02.19.79 Rosmauliana
49 By.Rudiana Pr 1hari 02.19.84 Hj.Susanti
50 13-05-19 By.Sutriwanti Pr 1hari 02.20.08 Rosmauliana
51 By.Tantri Sari Pr 1hari 02.20.09 Rosmauliana
52 By.Rahmadani 1 Lk 1hari 02.20.10 Rosmauliana
53 By.Rahmadani 2 Lk 1hari 02.20.11 Rosmauliana
54 By.Fadhilah Sinaga Pr 1hari 02.20.14 Rosmauliana
55 By.Demina Pr 1hari 02.20.17 Rosmauliana
56 By.Poniarti Pr 1hari 02.20.20 Rosmauliana
57 By.Tien Sianturi Pr 1hari 02.20.23 Rosmauliana
58 14-05-19 By.Masma Pr 1hari 02.20.41 Hj.Susanti
59 By.Habibah Lk 1hari 02.20.46 Hj.Susanti
60 By.Nila Lk 1hari 02.00.44 Hj.Susanti
61 By.Sukma Wulandari Lk 1hari 02.20.48 Hj.Susanti
62 By.Susanti Purwani Lk 1hari 02.20.47 Hj.Susanti
63 15-05-19 By.Sri Andani Pr 1hari 02.20.86 Rosmauliana
64 By.Rika Saragih Lk 1hari 02.20.72 Rosmauliana
65 By.Ummu Hani Pr 1hari 02.20.73 Rosmauliana
66 16-05-19 By.Pasu Andriani Pr 1hari 02.20.79 Rosmauliana
67 By.Maya Sari Arnol Lk 1hari 02.20.92 Hj.Susanti
68 By.Eriana Purba Lk 1hari 02.20.97 Hj.Susanti
69 18-05-19 By.Anes Fandiara Lk 1hari 02.21.28 Hj.Susanti
70 By.Putri Suryani Lk 1hari 02.21.29 Hj.Susanti
71 19-05-19 By.Yusniar Ningsih Pr 1hari 02.21.38 Rosmauliana
72 By.Lasmaini Lk 1hari 02.21.41 Rosmauliana
73 20-05-19 By.Vina Silviya 1 Lk 1hari 02.21.56 Hj.Susanti
74 By.Vina Silviya 2 Pr 1hari 02.21.57 Hj.Susanti
75 By.Kasiani Pr 1hari 02.21.60 Hj.Susanti
76 By.Sri Wahyuni Lk 1hari 02.21.63 Hj.Susanti
77 21-05-19 By.Titik Azanul Lk 1hari 02.21.88 Rosmauliana
78 By.Arti Murti Larasati Lk 1hari 02.21.95 Rosmauliana
79 22-05-19 By.Chotimah dewi Lk 1hari 02.21.97 Rosmauliana
80 By.Nurhabibah LK 1hari 02.22.05 Hj.Susanti
81 By.Cristina gultom Pr 1hari 02.22.14 Hj.Susanti
82 23-05-19 By.Nanda Febriani Pr 1hari 02.22.24 Rosmauliana
83 By.Meri Feronika Pr 1hari 02.22.33 Rosmauliana
84 24-05-19 By.Sherly Melinton Pr 1hari 02.22.43 Hj.Susanti
85 25-05-19 By.Rotua Simorangkir Pr 1hari 02.22.53 Hj.Susanti
86 By.Iin Fermiyati LK 1hari 02.22.54 Hj.Susanti
87 26-05-19 B y.Ria Anggelina Lk 1hari 02.22.66 Rosmauliana
88 By.Wasripah Pr 1hari 02.22.71 Hj.Susanti
89 By.Irna Junita Pr 1hari 02.22.72 Hj.Susanti
90 By.Isva rohana Lk 1hari 02.22.76 Hj.Susanti
91 27-05-19 By.Sukarni Pr 1hari 02.22.97 Rosmauliana
92 By.Tetti Lk 1hari 02.23.01 Rosmauliana
93 By.Rina Imelda Pr 1hari 02.23.02 Rosmauliana
94 By.Mustika Lk 1hari 02.23.03 Rosmauliana
95 By.Ira Fitri Andini Lk 1hari 02.23.04 Rosmauliana
96 28-05-19 By.Juita Bangun Lk 1hari 02.23.21 Hj.Susanti
97 By.Nining Rahayu Lk 1hari 02.23.22 Hj.Susanti
98 By.Nurul Bahria Lk 1hari 02.23.25 Hj.Susanti
99 29-05-19 By.Sri Wahyuni Lk 1hari 02.23.47 Rosmauliana
100 30-05-19 By.Zumiaty Pr 1hari 02.23.64 Hj.Susanti
101 31-05-19 By.Sri Wahyuni Lk 1hari 02.23.67 Hj.Susanti
102 By.Erni Dwitya Pr 1hari 02.23.79 Rosmauliana
103 By.Novita Purnama Lk 1hari 02.23.80 Rosmauliana
104 By.Mestiani Lk 1hari 02.23.81 Rosmauliana
 Formulir C
Formulir harian data pemakaian peralatan medis
Unit:R.Neonaty Bulan:Mei Tahun:2019
No Tanggal Nama Pemakaian Alat Kultur Antibiotika Ket
ETT IVL CVL UC
1 01-05-19 By.Fera Junita 2 √ Kalfoxim 500 1/4flc
2 By.M.Faris Supyan √ Cefotaxim 125mg
3 02-05-19 By.Fera Junita 2 √ Kalfoxim 500 1/4flc
4 By.M.Faris Supyan √ Cefotaxim 125mg
5 By.Ananda √ Cefotaxim 100mg
6 03-05-19 By.Nurmawati √ Cefotaxim 100mg
By.Juliani √ Cefotaxim 125mg
7 By.Fera Junita 2 √ Kalfoxim 500 1/4flc
8 By.Marta Ventina √ Cefotaxim 125mg
9 By.Ananda √ Cefotaxim 100mg
10 04-05-19 By.Fera Junita 2 √ Kalfoxim 500 1/4amp
11 By.Juliani √ Cefotaxim 125mg
12 By.Nurmawati √ Cefotaxim 100mg
13 By.Ananda √ Cefotaxim 100mg
14 By.Marta ventina √ Cefotaxim 125mg
15 By.Ambriana √ Kalfoxim 500mg 1/4flc
16 05-05-19 By.Fera 2 √ Kalfoxim 500 1/4amp
17 By.Nurmawati √ Cefotaxim 100mg
18 By.Marta Ventina √ Cefotaxim 125mg
19 By.Ambriana √ Kalfoxim 500mg 1/4flc
20 06-05-19 By.Ambriana √ Kalfoxim 500 1/4flc
21 07-05-19 By.Ambriana √ Kalfoxim 500 1/4flc
22 By.Veronika Dewi √ Cefotaxim 170mg
23 14-05-19 By.Sukma √ Cefotaxim 100mg
24 15-05-19 By.Sukma √ Cefotaxim 100mg
25 20-05-19 By.Lenni Manik √ Kalfoxim 500 1/4flc
26 21-05-19 By.Lenni Manik √ Kalfoxim 500 1/4flc
27 22-05-19 By.Santi √ Cefotaxim 125mg
28 23-05-19 By.santi √ Cefotaxim 125mg
29 24-05-19 By.Santi √ Cefotaxim 125mg
30 25-05-19 By.Santi √ Cefotaxim 125mg
31 By.Ristiani √ Cefotaxim 100mg
32 26-05-19 By.Ristiani √ Cefotaxim 125mg
33 27-05-19 By.Ristiani √ Cefotaxim 125mg
34 By.Faujiah √ Cefotaxim 100mg
35 28-05-19 By.Ristiani √ Cefotaxim 125mg
36 By.Faujiah √ Cefotaxim 100mg
37 29-05-19 By.Ristiani √ Cefotaxim 125mg
38 By.Faujiah √ Cefotaxim 100mg
39 By.Sundari √ Kalfoxim 150mg
40 30-05-19 By.Ristiani √ Cefotaxim 125mg
41 By.Faujiah √ Cefotaxim 100mg
42 BY.Sundari √ Kalfoxim 150mg
43 31-05-19 By.Faujiah √ Cefotaxim 100mg
44 By.Sundari √ Kalfoxim 150mg