R/ Cefixime 200mg No.

X
2 dd 1

Omeperazol No. X
3 dd 1

Dexamethason No. X
2 dd 1

Ketorolac No. No. XV

3 dd 1

Paracetamol No. XV
3 dd 1

Mecobalamin No. X
2 dd 1
Bahasa Latin:

SKRINING ADMINISTRATIF
Persyaratan administrasi meliputi:
a. Nama, umur, jenis kelamin dan berat badan pasien.
b. Nama, dan paraf dokter.
c. Tanggal resep.
d. Ruangan/unit asal resep.

JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ

No : Tgl :
Pro :

Bungkus/Tablet/Kapsul/
…………XSehari…………
Sendok Takar……….ml

………….Sebelum/Saat/Sesudah Makan

Nama Obat : ED:

Jmlh :
JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ

COPY RESEP
Dari Dokter : Tgl Copy Resep :
No Resep :
Tgl Resep :
Nama Pasien :
Umur :

R/ Meptin 13 mcg
Triamcinolon 1.5 mg
Cetirizine 2.5 mg
M.f pulv dtd no XIV
S 2 dd pulv 1

R/ Pct syr no I fls

S 4 dd 6 ml

R/ Elkana syr no I
S 1 dd 1 cth

R/ Erdostein syr no I
S 3 dd 65 mg

P.C.C
Cap apotek