Nama pasien : Alamat : Nama pasien : Alamat :

No RM : Tanggal : No RM : Tanggal :

NO NAMA BHP JUMLAH KETERANGAN NO NAMA BHP JUMLAH KETERANGAN

1. Umbilical cord 1. Umbilical cord
2. Gelang bayi pink/biru 2. Gelang bayi pink/biru
3. Injeksi vitamin K 3. Injeksi vitamin K
4. Handscoon No 6,5 / 7 / 7,5 / 8 4. Handscoon No 6,5 / 7 / 7,5 / 8
5. Suction No 6 / 8 / 10 / 12 / 14 5. Suction No 6 / 8 / 10 / 12 / 14
6. Nasal Canule Bayi 6. Nasal Canule Bayi
7. Spuit 1cc / 3cc / 5cc / 10 cc 7. Spuit 1cc / 3cc / 5cc / 10 cc
8. Kassa steril 8. Kassa steril
9. Iv catheter no 26 9. Iv catheter no 26
10. Infus set pump terumo 10. Infus set pump terumo
11. Epinefrin 11. Epinefrin
12. Feeding tube no 3,5 / 5 100cm / 5 40 cm/ 8 12. Feeding tube no 3,5 / 5 100cm / 5 40 cm/ 8
100cm/ 8 40 cm 100cm/ 8 40 cm
13. Three Way 13. Three Way
14. Infus D10% 14. Infus D10%
15. Nacl 25 cc / 100 cc 15. Nacl 25 cc / 100 cc
17. Perfusor 17. Perfusor
18. Endotracheal Tube no 2,5 / 3 / 3,5 / 4 18. Endotracheal Tube no 2,5 / 3 / 3,5 / 4
19. 19.
20. 20.