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  • 5pemerintah Kota Lubuklinggau Form Permintaan Obat Unit: Dinas Kesehatan Puskesmas Perumnas

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    firma nelis emi
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    This document is a request form from a health center to replenish medical supplies. It contains a list of 32 medicines and their current stock levels, requested quantities, and units of measure. It also includes a request for 4 consumable items like hand soap, medical tape, prescription paper, and plastic bags. The form must be fulfilled by the next day and is signed by the head of the health center and two nurses.

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    PERMINTAAN OBAT DESEMBER KE-1

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    This document is a request form from a health center to replenish medical supplies. It contains a list of 32 medicines and their current stock levels, requested quantities, and units of measure. It also includes a request for 4 consumable items like hand soap, medical tape, prescription paper, and plastic bags. The form must be fulfilled by the next day and is signed by the head of the health center and two nurses.

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    © All Rights Reserved
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    14 views2 pages

    5pemerintah Kota Lubuklinggau Form Permintaan Obat Unit: Dinas Kesehatan Puskesmas Perumnas

    Uploaded by

    firma nelis emi
    This document is a request form from a health center to replenish medical supplies. It contains a list of 32 medicines and their current stock levels, requested quantities, and units of measure. It also includes a request for 4 consumable items like hand soap, medical tape, prescription paper, and plastic bags. The form must be fulfilled by the next day and is signed by the head of the health center and two nurses.

    Copyright:

    © All Rights Reserved
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    of 2

    5PEMERINTAH KOTA LUBUKLINGGAU FORM PERMINTAAN OBAT UNIT

    DINAS KESEHATAN No. :


    PUSKESMAS PERUMNAS Hari/ Tanggal :Rabu, 01-12-2021
    Tanggal Harus Diterima :Kamis,02-12-2021

    No Nama Obat Sisa Akhir Permintaan Pemberian Satuan


    1. Ambroxol HCL 30 mg - 1000 Tablet
    2. Ambroxol Syrup 30 mg/5 ml - 50 Botol
    3. Amlodipin 5 mg 90 200 Tablet
    4. Amlodipin 10 mg - 200 Tablet
    5. Amoxicillin 500 mg 350 1000 Tablet
    6. Amoxicillin Syrup kering 125 mg/5 ml - 50 Botol
    7. Antasida DOEN 110 500 Tablet
    8. Attapulgit (Akita 110 100 Tablet
    9. Bedak Salisilk Serbuk 2 % - 5 Kotak
    10. Cefadroxil 500 mg 210 500 Tablet
    11. Cefadroxil Syrup 11 30 Botol
    12. Ciprofloxacin 500 mg 80 500 Tablet
    13. Citirizine 10 mg - 1000 Tablet
    14. Cetirizine sirup 5 mg/5 ml - 30 Botol
    15. Gentamisin Salep Kulit 2 30 Tube
    16. Gentamisin Tetes Mata 1 30 Tube
    17. Gentian Violet - 10 Botol
    18. Glyceryl Guaiacolate ( GG ) 10 mg - 1000 Tablet
    19. Ketokonazol 200 mg 40 200 Tablet
    20. Ketokonazol krim 2 % 2 20 Tablet
    21. Klorfeniramin Maleat ( CTM ) 4 mg 200 1000 Tablet
    22. Lansoprazol 30 mg - 300 Tablet
    23. Loratadin 10 mg 80 500 Tablet
    24. Nystatin 500.000 iu - 300 Tablet
    25. Omeprazole 20 mg 40 50 Tablet
    26. Paracetamol Drop 100 mg/ml - 20 Botol
    27. Paracetamol Syrup 120 mg/ 5 ml - 50 Botol
    28. Paracetamol 500mg - 1000 Tablet
    29. Perak Sulfadiazin Krim 1% - 5 Tube
    30. Tetagram Human Tetanus 250 ui - 10 Syringe
    31. Vitamin B Complek - 500 Tablet
    32. Vitamin C (asam askorbat) 50 mg - 1000 Tablet
    BARANG HABIS PAKAI
    1. Handscoon M 17 1 Kotak Kotak
    2. Kasa Hidrofile 40 yard x 80 cm - 1 Roll Roll
    3. Kertas obat racik - 1000 Lembar
    4. Plastik kantong obat - 4 pack Pack
    Yang Membuat Permintaan Pimpinan BLUD PKM Perumnas

    Firma Nelis Emi, S.Kep, Ners Hamila, SKM


    NIP. 197509302006042005 NIP. 197306181993012002

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