Dokter 3

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685
Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022
Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla
R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula
Dokter : DR. ANDI EKA PUTRA
1 RJ20220416-0002 16/04/2022 OP20220416-0003 2022041600002 SUCI YOELANDA PUTRI 268,107.0
R/ L BIO SACHET 10.00 SACH 9,800.00 98,000.00 0 1
R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1
R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1
R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1
2 RJ20220416-0005 16/04/2022 OP20220416-0006 2022041600005 RAYSHA ANDINI SIREGAR 353,065.0
R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1
R/ RANIVEL 75MG/5ML SYR 1.00 FLS 80,670.00 80,670.00 0 1
R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1
R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0
R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1
3 RJ20220416-0006 16/04/2022 OP20220416-0005 2022041600006 ALESHA HARMINDA SIREGAR 260,401.0
R/ BUFECT FORTE SYR 1.00 FLS 27,500.00 27,500.00 0 1
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
4 RJ20220418-0001 18/04/2022 OP20220418-0001 2022041800001 NURUL APRILIA 325,181.0
R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1
Total Dokter DR. ANDI EKA PUTRA 1,206,754.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 1 of 140
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685
Laporan Penjualan Resep Rawat Inap Per Dokter

Jenis resep : Rawat Inap


Formula Non Formula
Dokter : DR. BERNARD PARDOMUAN PURBA, SPB
1 RI20220402-0013 02/04/2022 RI20220402-0001 RI20220402-0013 JIMMI PARULIAN SARAGIH 202,821.0
R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1
R/ SPUIT 5 CC (TERUMO) 2.00 PCS 6,300.00 12,600.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1
R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1
R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 110,000.00 220,000.00 1 0

(BPJS)
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
4 RI20220405-0001 05/04/2022 RI20220405-0001 RI20220405-0001 IFHANUDDIN 92,721.0
R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0
R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1
R/ SURFLO NO. 18 (VENFLON) 2.00 PCS 29,200.00 58,400.00 0 1
R/ SET DARAH 1.00 PCS 7,157.00 7,157.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1
R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
8 RI20220412-0014 12/04/2022 RI20220412-0001 RI20220412-0014 INDRA ARIANSYAH 17,507.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ CUTICELL CLASSIC 10 CM X 10 1.00 PCS 11,880.00 11,880.00 0 1

CM
12 RI20220423-0006 23/04/2022 RI20220423-0001 RI20220423-0006 JOICE NETANIA TAMBUNAN 22,680.0
R/ SURFLO NO. 20 VENFLON 1.00 PCS 22,680.00 22,680.00 1 0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
16 RI20220427-0007 27/04/2022 RI20220427-0001 RI20220427-0007 ASTI SETIA PRIHATIN 28,241.0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ NALD 26 (ONEMED) 3.00 PCS 660.00 1,980.00 0 0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ FOLEY CATHETER NO. 16 1.00 PCS 16,500.00 16,500.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ TRAMADOL 50MG/2ML INJ 3.00 AMP 8,002.60 24,007.00 1 0

(OOT)
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
21 RI20220428-0021 28/04/2022 RI20220428-0003 RI20220428-0021 DAHLIA MANURUNG 178,064.0

(BPJS)
R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 2,184.00 6,552.00 1 0
INJ (BPJS)
R/ CITICOLINE 250 MG/2ML 4.00 AMP 22,500.00 90,000.00 0 1
INJEKSI
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

INJ (BPJS)

INJEKSI
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

INJEKSI
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

INJ (BPJS)
(BPJS)
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
27 RJ20220404-0016 04/04/2022 OP20220404-0017 2022040400017 EVI SUSANTI 158,620.0
R/ ARDIUM 500 MG 15.00 TAB 7,700.00 115,500.00 0 1
R/ DULCOLAX 10 MG ADULT SUPP 2.00 SUPP 21,560.00 43,120.00 0 1
28 RJ20220406-0007 06/04/2022 OP20220406-0009 2022040600010 JIMMI PARULIAN SARAGIH 125,472.0
R/ CEFIXIME 100 MG CAP 14.00 CAP 3,233.00 45,262.00 1 0
R/ INBUMIN TAB 250 MG 10.00 TAB 8,021.00 80,210.00 0 1
29 RJ20220411-0013 11/04/2022 OP20220411-0013 2022041100017 JURI SIAGIAN 137,500.0
R/ CITICOLINE 500 MG TAB 15.00 TAB 9,166.67 137,500.00 0 1
30 RJ20220412-0001 12/04/2022 OP20220412-0001 2022041200001 INDRA ARIANSYAH 42,643.0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
31 RJ20220413-0014 13/04/2022 OP20220413-0017 2022041300018 ERNA BR TAMBA 10.0
R/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1
32 RJ20220413-0015 13/04/2022 OP20220413-0018 2022041300019 IFHANUDDIN 10.0
33 RJ20220418-0009 18/04/2022 OP20220418-0014 2022041800009 INDRA ARIANSYAH 2,409.0
R/ VITAMIN B COMPLEX TAB 10.00 TAB 240.90 2,409.00 1 0
34 RJ20220420-0014 20/04/2022 OP20220420-0015 2022042000017 IFHANUDDIN 10.0
35 RJ20220423-0001 23/04/2022 OP20220423-0001 2022042300002 JOICE NETANIA TAMBUNAN 33,780.0
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
36 RJ20220427-0019 27/04/2022 OP20220427-0021 2022042700022 TRIANI 10.0
37 RJ20220427-0020 27/04/2022 OP20220427-0022 2022042700023 JOICE NETANIA TAMBUNAN 10.0
Total Dokter DR. BERNARD PARDOMUAN PURBA, SPB 3,572,461.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DRG. BETTY PASARIBU
1 RJ20220401-0005 01/04/2022 OP20220401-0009 2022040100005 ABIYYU FAIZ ZAKY LUBIS 16,474.0
R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1
2 RJ20220404-0004 04/04/2022 OP20220404-0002 2022040400004 AMELIA S 3,892.0
R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,892.00 3,892.00 0 1
3 RJ20220404-0006 04/04/2022 OP20220404-0009 2022040400006 YASINTA KASIH AKAMAKING 2,200.0
R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0
4 RJ20220404-0018 04/04/2022 OP20220404-0021 2022040400019 ROSMA 85,024.0
R/ BECOM ZET TAB 5.00 TAB 2,888.00 14,440.00 0 0
R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1
5 RJ20220404-0019 04/04/2022 OP20220404-0022 2022040400020 HENDRI RUDIANTO 103,584.0
R/ SPUIT 1 CC TERUMO 2.00 PCS 9,280.00 18,560.00 0 1
6 RJ20220406-0008 06/04/2022 OP20220406-0010 2022040600011 DANIEL TULUS HUTABARAT 4,580.0
R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.00 4,580.00 1 0

KAPLET
7 RJ20220407-0004 07/04/2022 OP20220407-0010 2022040700007 FITRAN SITOMPUL 62,796.0
8 RJ20220408-0006 08/04/2022 OP20220408-0008 2022040800006 ROMAITO HASIBUAN 3,891.0
9 RJ20220408-0009 08/04/2022 OP20220408-0005 2022040800009 PULDIA MAISI 62,796.0
10 RJ20220409-0002 09/04/2022 OP20220409-0006 2022040900002 YOGA NATAN SIMAMORA 3,891.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
11 RJ20220409-0005 09/04/2022 OP20220409-0009 2022040900006 REMY FILIPPINE ASTRADA 3,891.0

LUMBANTOBING
12 RJ20220411-0008 11/04/2022 OP20220411-0006 2022041100009 JIMINA GULTOM 3,891.0
13 RJ20220411-0010 11/04/2022 OP20220411-0009 2022041100012 FITRI RODIATUL HADAWIAH 62,796.0
14 RJ20220411-0014 11/04/2022 OP20220411-0018 2022041100018 DANIEL TULUS HUTABARAT 2,291.0

KAPLET
15 RJ20220413-0005 13/04/2022 OP20220413-0007 2022041300005 JUMALI WIDODO ###
16 RJ20220413-0007 13/04/2022 OP20220413-0007 2022041300007 JUMALI WIDODO 26,343.0
17 RJ20220418-0006 18/04/2022 OP20220418-0008 2022041800006 ABIMANYU PRASETIO 9,424.0
R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1
18 RJ20220418-0010 18/04/2022 OP20220418-0017 2022041800010 ADITYA SAMUEL FRANSISKUS 15,600.0

SINAGA
19 RJ20220418-0012 18/04/2022 OP20220418-0017 2022041800011 ADITYA SAMUEL FRANSISKUS 94,803.0

SINAGA
R/ SANORINE HIJAU 200 ML 1.00 FLS 32,007.00 32,007.00 0 1
20 RJ20220419-0004 19/04/2022 OP20220419-0006 2022041900005 NORITA TOGATOROP 9,424.0

21 RJ20220420-0001 20/04/2022 OP20220420-0005 2022042000002 YASINTA KASIH AKAMAKING 89,139.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
22 RJ20220420-0010 20/04/2022 OP20220420-0013 2022042000012 MULYANA 3,891.0
23 RJ20220422-0005 22/04/2022 OP20220422-0007 2022042200005 NERLAN PASARIBU 2,567.0
R/ IBUPROFEN 400 MG TAB 5.00 TAB 513.50 2,567.00 1 0
24 RJ20220422-0008 22/04/2022 OP20220422-0011 2022042200009 ARNOLDUS TRISNA SINAGA 14,624.0
25 RJ20220425-0008 25/04/2022 OP20220425-0014 2022042500012 SINDY OKTALIA FITRI 5,135.0
26 RJ20220425-0016 25/04/2022 OP20220425-0024 2022042500027 ROBERTH EDUARD 3,891.0
27 RJ20220427-0011 27/04/2022 OP20220427-0013 2022042700011 JEPRI SIAHAAN 14,415.0
28 RJ20220427-0012 27/04/2022 OP20220427-0010 2022042700012 EMLY RISTAWTI 1,937.0

KAPLET
29 RJ20220427-0015 27/04/2022 OP20220427-0015 2022042700015 AIDA RISKIANA NASUTION 1,937.0

KAPLET
30 RJ20220427-0017 27/04/2022 OP20220427-0018 2022042700018 MULYANA 3,891.0
31 RJ20220427-0021 27/04/2022 OP20220427-0023 2022042700024 MAHYARUDIN SALIM 90,270.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
32 RJ20220428-0001 28/04/2022 OP20220428-0002 2022042800001 PULDIA MAISI 90,270.0
33 RJ20220429-0004 29/04/2022 OP20220429-0007 2022042900005 ERICSON MALAU 2,567.0
34 RJ20220429-0005 29/04/2022 OP20220429-0008 2022042900006 ARNOLDUS TRISNA SINAGA 10,400.0
Total Dokter DRG. BETTY PASARIBU 1,004,196.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. IKHSAN, SP.B
1 RI20220405-0006 05/04/2022 RI20220405-0002 RI20220405-0006 MARTODO D. SIMANUNGKALIT 489,697.0
R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1
R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,528.00 22,584.00 1 0
R/ ESOMEPRAZOLE INJ (BPJS) 3.00 VIAL 29,768.00 89,304.00 1 0

KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,528.00 22,584.00 1 0
R/ ANALSIK TAB (PSIKOTROPIKA) 8.00 TAB 1,994.00 15,952.00 0 0
R/ MANITOL 20 % 500 ML INF 1.00 FLS 53,238.00 53,238.00 0 1
6 RI20220407-0005 07/04/2022 RI20220406-0001 RI20220407-0005 ANWAR LUMBAN TORUAN 5,075.0
R/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0

KAPLET
R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ SUNGKUP OKSIGEN DEWASA 1.00 PCS 24,300.00 24,300.00 0 1
R/ CITICOLINE 500 MG TAB 10.00 TAB 9,167.00 91,670.00 0 1
R/ BAQUINOR FORTE 500 MG 10.00 TAB 19,107.00 191,070.00 0 1

KAPLET
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1
R/ CUTICELL CLASSIC 10 CM X 10 2.00 PCS 11,880.00 23,760.00 0 1

CM
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.00 80,909.00 0 1
15 RI20220407-0027 07/04/2022 RI20220407-0003 RI20220407-0027 ANGGELINA PUNGA 17,726.0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

KAPLET
R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

(BPJS)
KAPLET
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

(BPJS)
KAPLET
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

KAPLET
25 RI20220409-0019 09/04/2022 RI20220407-0003 RI20220409-0019 ANGGELINA PUNGA 387.0
R/ PARACETAMOL 500 MG 1.00 KAPLET 387.55 387.00 1 0

KAPLET
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

(BPJS)
KAPLET
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

KAPLET
29 RI20220410-0007 10/04/2022 RI20220406-0001 RI20220410-0007 ANWAR LUMBAN TORUAN 775.0

KAPLET
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

KAPLET
R/ NALD 26 (ONEMED) 2.00 PCS 660.00 1,320.00 0 0
R/ NORAGES INJEKSI 500MG/2ML 2.00 AMP 11,481.00 22,962.00 0 1
32 RI20220411-0007 11/04/2022 RI20220411-0002 RI20220411-0007 NURKHAYLA DOFIANDARI 16,474.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0

KAPLET
R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1

DEWASA

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ VITAMIN B COMPLEX TAB 1.00 TAB 240.90 240.00 1 0
R/ DULCOLAX 10 MG ADULT SUPP 1.00 SUPP 21,560.00 21,560.00 0 1
R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ NORAGES INJEKSI 500MG/2ML 2.00 AMP 11,481.00 22,962.00 0 1
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1
43 RI20220413-0007 13/04/2022 RI20220406-0001 RI20220413-0007 ANWAR LUMBAN TORUAN 627.0

KAPLET
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1

KAPLET
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

KAPLET
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

KAPLET
R/ VITAMIN B6 (PYRIDOXINE) 1.00 TAB 134.55 134.00 1 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ VITAMIN B6 (PYRIDOXINE) 1.00 TAB 134.55 134.00 1 0

TAB

KAPLET

KAPLET
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

KAPLET
R/ VITAMIN B6 (PYRIDOXINE) 10.00 TAB 134.55 1,345.00 1 0

TAB
54 RI20220419-0007 19/04/2022 RI20220419-0002 RI20220419-0007 WESLI RUDIANTO 240,660.0
SIMANJUNTAK
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

SIMANJUNTAK
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

SIMANJUNTAK
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
57 RI20220420-0034 20/04/2022 RI20220420-0002 RI20220420-0034 KURNIAWAN 83,063.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

SIMANJUNTAK
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

(OOT)
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

(OOT)
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

SIMANJUNTAK

(OOT)
R/ RL 500 ML INF 4.00 FLS 8,753.75 35,015.00 0 1
65 RI20220422-0019 22/04/2022 RI20220422-0001 RI20220422-0019 ISMAIL BIN IBRAHIM 55,073.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

(OOT)
69 RI20220423-0020 23/04/2022 RI20220422-0002 RI20220423-0020 NURMINA HUTABARAT 7,156.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ SPUIT 50 ML (WITHOUT 1.00 PCS 42,000.00 42,000.00 0 1

NEEDLE) ONEMED
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ DEXKETOPROFEN 25MG/ML 3.00 AMP 33,792.00 101,376.00 1 0

INJ
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1


(OOT)
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

(OOT)
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

(BPJS)

(OOT)
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

(BPJS)

KAPLET

KAPLET
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

(BPJS)

KAPLET

KAPLET

KAPLET

KAPLET
88 RI20220428-0018 28/04/2022 RI20220428-0001 RI20220428-0018 SILSA 63,222.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
89 RI20220428-0019 28/04/2022 RI20220428-0002 RI20220428-0019 ANISA RAHMA VADIA 54,468.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
91 RI20220429-0010 29/04/2022 RI20220428-0001 RI20220429-0010 SILSA 143,429.0

(OOT)
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ RL 500 ML INF 4.00 FLS 8,753.75 35,015.00 0 1
93 RI20220430-0007 30/04/2022 RI20220428-0001 RI20220430-0007 SILSA 719,496.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

(OOT)
R/ CEFTRIAXONE 1 GR INJ 2.00 VIAL 13,368.00 26,736.00 1 0
94 RJ20220405-0001 05/04/2022 OP20220405-0005 2022040500001 ANDIKA 191,070.0

KAPLET
95 RJ20220416-0004 16/04/2022 OP20220416-0004 2022041600004 ANGGELINA PUNGA 2,409.0
96 RJ20220425-0006 25/04/2022 OP20220425-0009 2022042500010 MUHAMMAD FACHRUL 160,639.0

ERLANGGA

KAPLET
R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0
97 RJ20220427-0007 27/04/2022 OP20220427-0002 2022042700007 ANINDYO FIKRI WIRAPUTRA 132,519.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ BENANG SILK 2/0 CUTTING 1.00 PCS 62,370.00 62,370.00 0 1
R/ BISTURI NO. 11 1.00 PCS 6,049.00 6,049.00 0 1
R/ LIDOCAIN 2% INJ (BPJS) 2.00 AMP 1,800.00 3,600.00 0 1
R/ BENANG BRILON 4/0 CUTTING 1.00 PCS 60,500.00 60,500.00 0 1
98 RJ20220430-0001 30/04/2022 OP20220430-0003 2022043000001 MUHAMMAD FACHRUL 420,481.0

ERLANGGA

KAPLET
Total Dokter DR. IKHSAN, SP.B 9,308,535.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685
Laporan Penjualan Resep Rawat Darurat Per Dokter

Jenis resep : Rawat Darurat


Formula Non Formula
Dokter : DR. DIKA CAHAYA PUTRI
1 RD20220401-0016 01/04/2022 EP20220401-0013 2022040100027 LEGI ZERO PUTRA 297,770.0
R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1
R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1
R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1
2 RD20220401-0017 01/04/2022 EP20220401-0015 2022040100028 ANDI SAPUTRA 255,420.0
R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0
R/ ZOLLOCID CAPS 10.00 CAP ### 126,720.00 0 1
3 RD20220402-0014 02/04/2022 EP20220402-0007 2022040200025 INGGRID 40,838.0
R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00 40,838.00 1 0
AMBROXOL 30 MG TAB 5.00 TAB 285.00 0.00 1 0
KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1
DEXAMETHASON 0,5 MG TAB 5.00 TAB 220.00 0.00 1 0
4 RD20220402-0015 02/04/2022 EP20220402-0008 2022040200026 M.RAVI RAMADANU 36,910.0

KAPLET
5 RD20220402-0016 02/04/2022 EP20220402-0009 2022040200029 ANNA 186.0
R/ CAPTOPRIL 25 MG TAB 1.00 TAB 0.00 186.00 1 0
6 RD20220402-0017 02/04/2022 EP20220402-0009 2022040200030 ANNA 7,157.0
R/ SET DARAH 1.00 PCS 0.00 7,157.00 0 1
7 RD20220402-0018 02/04/2022 EP20220402-0010 2022040200031 RUDI ARDIAN 250,270.0
R/ ASAM TRANEXAMAT 500 MG 10.00 TAB 2,475.00 24,750.00 1 0

TAB
8 RD20220402-0019 02/04/2022 EP20220402-0009 2022040200032 ANNA 42,830.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 0.00 7,420.00 1 0
R/ NATRIUM DIKLOFENAC 50 MG 10.00 TAB 0.00 3,080.00 1 0

TAB

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ CEFIXIME 100 MG CAP 10.00 CAP 0.00 32,330.00 1 0
9 RD20220402-0020 02/04/2022 EP20220402-0009 2022040200033 ANNA 769,793.0
R/ SPALK 8 X 25 X 0.5 ( LENGAN 3.00 PCS 0.00 42,000.00 0 0

ATAS)
R/ SPALK 10 X 60 X 0.5 (SPALK 3.00 PCS 0.00 48,600.00 0 1
LENGAN ATAS )
R/ TENSOCREPE 6 INC (15 CM X 2.00 ROLL 0.00 372,500.00 0 1
4.55 M)
R/ CEFTRIAXONE 1 GR INJ 1.00 VIAL 0.00 13,368.00 1 0
R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 0.00 293,325.00 0 1
10 RD20220402-0021 02/04/2022 EP20220402-0011 2022040200034 TRIONO SIANIPAR 291,200.0
11 RD20220402-0022 02/04/2022 EP20220402-0012 2022040200035 FEDERICO PRATAMA 45,898.0

SITUMORANG
R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 1,000.00 0 1
R/ AMBROXOL 30 MG TAB 4.00 TAB 1.00 285.00 4,060.00 1 0
SALBUTAMOL 2 MG TAB 4.00 TAB 118.00 0.00 1 0
12 RD20220404-0017 04/04/2022 EP20220404-0017 2022040400023 HANS GABRIELO SINAGA 31,044.0
R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 24,544.00 24,544.00 0 1
R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1
13 RD20220405-0001 05/04/2022 EP20220405-0001 2022040500001 ENJELINA TUMANGGOR 25,640.0
R/ PARACETAMOL SYR 60 ML 1.00 FLS 6,840.00 6,840.00 1 0
R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0
R/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1
14 RD20220405-0002 05/04/2022 EP20220405-0002 2022040500002 DINA KAMESWARA 500,571.0
R/ SANADRYL DMP 120 ML SYR 1.00 BTL 28,301.00 28,301.00 0 1

(OOT)
R/ MERTIGO 6 MG TAB 10.00 TAB 4,987.00 49,870.00 0 1
R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1
15 RD20220405-0003 05/04/2022 EP20220405-0003 2022040500003 MARIBET PASARIBU 90,141.0

R/ THROMBOPHOB GEL 1.00 TUBE 68,063.00 68,063.00 0 1
R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 3,818.00 3,818.00 1 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,826.00 18,260.00 1 0
16 RD20220405-0024 05/04/2022 EP20220405-0022 2022040500035 SUPRIYANTI 58,800.0
17 RD20220409-0010 09/04/2022 EP20220409-0008 2022040900015 FRANSISKA IRMANITA DA 110,159.0

SELVI
18 RD20220409-0011 09/04/2022 EP20220409-0008 2022040900016 FRANSISKA IRMANITA DA 110,000.0

SELVI
19 RD20220409-0013 09/04/2022 EP20220409-0010 2022040900018 JULIPER NAPITUPULU 98,670.0
20 RD20220409-0014 09/04/2022 EP20220409-0011 2022040900019 ARIF RAHMANSYAH SIREGAR 196,001.0
R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 481.54 4,815.00 1 0
R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1
R/ COLERGIS TABLET 10.00 TAB 3,666.70 36,667.00 0 1
21 RD20220410-0001 10/04/2022 EP20220410-0002 2022041000002 330,325.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
R/ CORMEGA SOFT CAPS 5.00 CAP 13,200.00 66,000.00 0 1
22 RD20220410-0002 10/04/2022 EP20220410-0003 2022041000003 HERDIANSYAH 21,174.0
R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1
23 RD20220410-0004 10/04/2022 EP20220410-0001 2022041000005 ANGGUN WIJAYA 3,875.0

KAPLET
24 RD20220410-0005 10/04/2022 EP20220410-0005 2022041000006 SELAMAT MUJID 32,455.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ MECOBALAMIN 500 MCG TAB 10.00 TAB 1,200.00 12,000.00 1 0
25 RD20220410-0006 10/04/2022 EP20220410-0006 2022041000007 SABILA NUR ASWANI 574,101.0
26 RD20220414-0001 14/04/2022 EP20220414-0001 2022041400001 ELESTA FARINA SITORUS 118,800.0
R/ VOMETA SYR 60 ML 1.00 FLS 66,000.00 66,000.00 0 1
R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1
27 RD20220414-0002 14/04/2022 EP20220414-0002 2022041400002 RODIAH YOSI 326,999.0
R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1
28 RD20220414-0020 14/04/2022 EP20220414-0015 2022041400024 MARIA GORETI SUE 84,224.0

(BPJS)
29 RD20220415-0001 15/04/2022 EP20220415-0001 2022041500004 KENZIE JONATHAN GINTING 78,650.0
R/ RHINOS NEO DROP (PREK) 1.00 FLS 70,400.00 70,400.00 0 0
R/ AMOXYCILLIN 125 ML SYR 1.00 BTL 8,250.00 8,250.00 1 0
30 RD20220415-0002 15/04/2022 EP20220415-0002 2022041500005 LASDILINA SIAHAAN 65,150.0
R/ BUSCOPAN TAB 10 MG 10.00 TAB 4,397.60 43,976.00 0 1
31 RD20220417-0007 17/04/2022 EP20220417-0006 2022041700012 MUHAMMAD RIDWAN SALEH 61,611.0
R/ OTILON EAR DROP 1.00 FLS 0.00 54,278.00 0 1
R/ RANITIDINE 150 MG TAB 10.00 TAB 0.00 2,750.00 1 0

KAPLET
32 RD20220417-0008 17/04/2022 EP20220417-0007 2022041700013 JUWARDI 463,662.0
R/ SPORETIK 100 MG CAPS 10.00 CAP 27,836.17 278,361.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
33 RD20220417-0009 17/04/2022 EP20220417-0008 2022041700014 AMINULLAH 535,452.0
34 RD20220419-0006 19/04/2022 EP20220419-0005 2022041900012 80,000.0

(BPJS)
35 RD20220419-0007 19/04/2022 EP20220419-0005 2022041900011 ROSMAWATY SINAGA 18,220.0

KAPLET
R/ BETAHISTINE 6 MG TAB 10.00 TAB 1,434.50 14,345.00 1 0
36 RD20220419-0009 19/04/2022 EP20220419-0006 2022041900014 MAHISA RHANI 285,824.0
37 RD20220419-0010 19/04/2022 EP20220419-0007 2022041900015 MANGASI HOTMARTUA 165,000.0

SITUMEANG
38 RD20220419-0011 19/04/2022 EP20220419-0008 2022041900016 SUTIKNO 54,941.0
39 RD20220419-0012 19/04/2022 EP20220419-0009 2022041900017 SUMITRO SIMAMORA 80,000.0

(BPJS)
40 RD20220419-0013 19/04/2022 EP20220419-0010 2022041900018 ROSANTINA HUTABARAT 295,916.0

41 RD20220422-0009 22/04/2022 EP20220422-0006 2022042200013 FISQA SALSABILA 324,896.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
42 RD20220422-0010 22/04/2022 EP20220422-0007 2022042200014 SORIDIN 400,218.0
R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1
R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1
43 RD20220422-0011 22/04/2022 EP20220422-0008 2022042200015 SUTIKNO 58,900.0
44 RD20220422-0012 22/04/2022 EP20220422-0009 2022042200016 AYU FADHILAH UTAMI 65,639.0
R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1
45 RD20220423-0003 23/04/2022 EP20220423-0003 2022042300003 MARNIALA SITUMORANG 82,500.0
46 RD20220423-0004 23/04/2022 EP20220423-0004 2022042300004 MUHAMMAD UBAIDILLAH 544,816.0

MUZAKKI
47 RD20220423-0005 23/04/2022 EP20220423-0005 2022042300009 ANYUN 80,000.0

(BPJS)
48 RD20220423-0007 23/04/2022 EP20220423-0006 2022042300011 SURIANTI SAMOSIR 15,549.0
49 RD20220423-0008 23/04/2022 EP20220423-0007 2022042300012 ANGELINA WAHYUNI 378,855.0

MARGARET OMPUSUNGGU


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
50 RD20220424-0001 24/04/2022 EP20220424-0002 2022042400001 ELI HEDI SURYADI 6,049.0
R/ BISTURI NO. 12 1.00 PCS 6,049.00 6,049.00 0 1
51 RD20220424-0002 24/04/2022 EP20220424-0003 2022042400002 NURKHOLIS 224,694.0
52 RD20220424-0003 24/04/2022 EP20220424-0004 2022042400004 AVRILIA PUTRI SITUMORANG 9,324.0
R/ DOMPERIDON 10 MG TAB 10.00 TAB 544.90 5,449.00 1 0

KAPLET
53 RD20220424-0004 24/04/2022 EP20220424-0005 2022042400005 IMANUEL PURBA 80,000.0

(BPJS)
54 RD20220424-0005 24/04/2022 EP20220424-0005 2022042400006 IMANUEL PURBA 72,488.0
R/ SPASMINAL TABLET 10.00 TAB 1,126.40 11,264.00 0 1
55 RD20220424-0006 24/04/2022 EP20220424-0006 2022042400007 ABDUL RAHIM 47,561.0
R/ CENDO LYTEERS 0,5 ML 1.00 FLS 5,525.00 5,525.00 0 1

MINIDOSE
56 RD20220424-0007 24/04/2022 EP20220 2022042400008 MUHAMMAD ABDI 200,312.0
424-0007
57 RD20220425-0002 25/04/2022 EP20220425-0003 2022042500003 NIJAR EPENDI 185,516.0

58 RD20220425-0003 25/04/2022 EP20220425-0002 2022042500004 LISPIDA ROSTIKA 242,716.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0
59 RD20220425-0004 25/04/2022 EP20220425-0005 2022042500006 SANTA RORIA BANJARNAHOR 158,470.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ IBUPROFEN 400 MG TAB 5.00 TAB 1.00 513.50 4,561.00 1 0
CORTIDEX 0,5 MG TAB 5.00 TAB 398.80 0.00 0 1
60 RD20220425-0006 25/04/2022 EP20220425-0007 2022042500008 TRINO YABES SIANTURI 56,650.0
R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1
61 RD20220425-0007 25/04/2022 EP20220425-0006 2022042500009 FARHAN 87,378.0

TAB
R/ PULMICORT 0.5 MG/ML NEB 2.00 FLS 24,713.45 49,426.00 0 1

(BPJS)
R/ SALBUTAMOL 2 MG TAB 10.00 TAB 117.50 1,175.00 1 0
64 RD20220425-0010 25/04/2022 EP20220425-0009 2022042500012 ATRINA 328,884.0
65 RD20220425-0011 25/04/2022 EP20220425-0011 2022042500013 MARIANTI SIMANGUNSONG 17,612.0

KAPLET

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 962.50 9,625.00 1 0
66 RD20220425-0012 25/04/2022 EP20220425-0010 2022042500014 HIDAYAH PUTRI ANDANI 229,134.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
67 RD20220426-0008 26/04/2022 EP20220426-0002 2022042600015 PUTRI MARSHANDA 167,200.0
68 RD20220426-0009 26/04/2022 EP20220426-0003 2022042600018 LATISHA AZIFA PRENTIKA 8,167.0
R/ PROPYRETIC 80 MG SUPP 1.00 SUPP 8,167.73 8,167.00 0 1

(BPJS)
69 RD20220426-0010 26/04/2022 EP20220426-0003 2022042600019 LATISHA AZIFA PRENTIKA 27,465.0
R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0
70 RD20220426-0011 26/04/2022 EP20220426-0004 2022042600021 TUMBUR PARDEDE 110,000.0
71 RD20220426-0012 26/04/2022 EP20220426-0004 2022042600022 TUMBUR PARDEDE 10,839.0
R/ NEW DIATAB TABLET 10.00 TAB 696.44 6,964.00 0 1

KAPLET
72 RD20220426-0013 26/04/2022 EP20220426-0005 2022042600023 NADILA SABATINA 304,910.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
73 RD20220426-0014 26/04/2022 EP20220426-0006 2022042600024 BOLONTUA MANURUNG 218,623.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0
75 RD20220427-0009 27/04/2022 EP20220427-0008 2022042700015 ALHABSYI IBNU YUSUF 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
76 RD20220427-0011 27/04/2022 EP20220427-0009 2022042700017 ELVA DIANA 272,679.0
77 RD20220427-0012 27/04/2022 EP20220427-0010 2022042700019 SEFRINA SUSANTI SINAGA 98,796.0
78 RD20220427-0013 27/04/2022 EP20220427-0011 2022042700021 SEPTI SUSANTI 294,014.0
79 RD20220427-0015 27/04/2022 EP20220427-0013 2022042700023 TONIS BANJAR NAHOR 343,456.0
80 RD20220427-0016 27/04/2022 EP20220427-0014 2022042700025 SRI PUTRI ANANDA 147,028.0
81 RD20220427-0017 27/04/2022 EP20220427-0015 2022042700026 ARI YOSO 110,036.0

R/ FLAMAR 50 MG TAB 10.00 TAB 2,604.80 26,048.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
82 RD20220428-0005 28/04/2022 EP20220428-0005 2022042800006 SOFIAH SOLEHAH 59,425.0

KAPLET
83 RD20220428-0007 28/04/2022 EP20220428-0007 2022042800009 RUTERISNA MANURUNG 77,174.0
R/ CETIRIZINE 10 MG TAB 10.00 TAB 475.00 4,750.00 1 0
84 RD20220428-0008 28/04/2022 EP20220428-0008 2022042800010 DHONI RAMADHAN 148,804.0
85 RD20220428-0009 28/04/2022 EP20220428-0006 2022042800011 NURBAYA SIBURIAN 12,000.0
R/ MECOBALAMIN 500 MCG TAB 10.00 TAB 1,200.00 12,000.00 1 0
86 RD20220428-0010 28/04/2022 EP20220428-0009 2022042800012 ARIS KASNUR 229,134.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
87 RD20220428-0011 28/04/2022 EP20220428-0011 2022042800013 BONARDO HARORONI 40,087.0

ARMSTRONG SIRAIT
88 RD20220428-0012 28/04/2022 EP20220428-0010 2022042800014 DAHLIA MANURUNG 83,818.0

(BPJS)
89 RD20220428-0013 28/04/2022 EP20220428-0010 2022042800016 DAHLIA MANURUNG 61,371.0
R/ DEXAMETHASON 5MG/1ML INJ 1.00 AMP 3,003.00 3,003.00 1 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

INJEKSI
90 RD20220428-0014 28/04/2022 EP20220428-0012 2022042800020 TRESIA SITUMORANG 254,014.0
91 RD20220428-0015 28/04/2022 EP20220428-0013 2022042800021 AZZAHRA RIYANTO 327,251.0
92 RD20220428-0016 28/04/2022 EP20220428-0014 2022042800022 HARYANTO SUPRYADI 3,875.0

SIMANJUNTAK

KAPLET
93 RD20220428-0017 28/04/2022 EP20220428-0014 2022042800023 HARYANTO SUPRYADI 80,000.0
SIMANJUNTAK

(BPJS)
94 RD20220428-0018 28/04/2022 EP20220428-0016 2022042800024 MENTARI NARARITA 212,720.0
MUNANTO
95 RD20220428-0019 28/04/2022 EP20220428-0015 2022042800025 MITA MELANI 313,854.0
96 RD20220428-0020 28/04/2022 EP20220428-0017 2022042800026 PARDAMEAN TAMBA 167,200.0
97 RD20220428-0021 28/04/2022 EP20220428-0017 2022042800027 PARDAMEAN TAMBA 25,679.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
98 RD20220428-0022 28/04/2022 EP20220428-0018 2022042800028 FARADHITA MEGA DWI 294,014.0

MUSTIKA
99 RD20220429-0015 29/04/2022 EP20220429-0016 2022042900019 ESTER NATHANIA SIRAIT 16,813.0
R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 1.00 100.00 1,000.00 0 1
100 RD20220429-0016 29/04/2022 EP20220429-0016 2022042900020 ESTER NATHANIA SIRAIT 17,600.0
R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1
101 RD20220429-0017 29/04/2022 EP20220429-0017 2022042900021 RYAN RAMADHANI 254,014.0
102 RD20220429-0018 29/04/2022 EP20220429-0019 2022042900022 NIZAM ELDI RIANO 82,812.0
103 RD20220429-0019 29/04/2022 EP20220429-0018 2022042900023 ELVY SUSANTI 404,484.0
104 RD20220429-0020 29/04/2022 EP20220429-0020 2022042900024 IGNASIUS TITUS 110,000.0
R/ DOMPERIDON 10 MG TAB 10.00 TAB 544.90 5,449.00 1 0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
106 RD20220429-0022 29/04/2022 EP20220429-0021 2022042900026 CUT DYLLA ZALMY 6,974.0
R/ ANEMOLAT 1 MG TAB 10.00 TAB 275.00 2,750.00 0 1
107 RJ20220411-0003 11/04/2022 OP20220411-0004 2022041100004 SARMAIDA SILABAN 39,110.0

KAPLET
108 RJ20220411-0006 11/04/2022 OP20220411-0007 2022041100007 YULI PRASTYO 57,376.0

KAPLET
109 RJ20220412-0002 12/04/2022 OP20220412-0002 2022041200004 WISNU SYAHFITRI 340,247.0
R/ SALICYL TALK 60 GR 1.00 POT 7,010.40 7,010.00 0 1
111 RJ20220412-0006 12/04/2022 OP20220412-0007 2022041200009 SYAKILLA LEO ADARA 158,624.0
R/ AMBROXOL 30 MG TAB 5.00 TAB 1.00 285.41 21,766.00 1 0
COLERGIS TABLET 5.00 TAB 3,666.70 0.00 0 1
112 RJ20220420-0002 20/04/2022 OP20220420-0004 2022042000003 RINO AIDIL PUTRA 281,344.0
113 RJ20220420-0005 20/04/2022 OP20220420-0008 2022042000007 RIZKI ARIF 98,255.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
114 RJ20220420-0006 20/04/2022 OP20220420-0009 2022042000008 ALFATIH 196,180.0
R/ AMOXAN 125 MG SYR 1.00 BTL 30,938.00 30,938.00 0 1
R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1
Total Dokter DR. DIKA CAHAYA PUTRI 17,735,985.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. ERIE FAILENGGO
1 RD20220401-0013 01/04/2022 EP20220401-0009 2022040100021 MOSES CHRISTIANO 36,277.0

HARIANJA

(BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
2 RD20220401-0014 01/04/2022 EP20220401-0010 2022040100025 SOBARIN 702,630.0
R/ TROLAC 10 MG TAB 10.00 TAB 7,563.00 75,630.00 0 1
R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,433.00 194,330.00 0 1
3 RD20220401-0015 01/04/2022 EP20220401-0011 2022040100026 DENTO 69,000.0
4 RD20220402-0006 02/04/2022 EP20220402-0003 2022040200008 CHINDY NADEAK 5,140.0
5 RD20220402-0007 02/04/2022 EP20220402-0003 2022040200009 CHINDY NADEAK 5,610.0
R/ BISTURI NO. 22 1.00 PCS 5,610.00 5,610.00 0 1
6 RD20220402-0008 02/04/2022 EP20220402-0004 2022040200012 JIMMI PARULIAN SARAGIH 699,005.0
R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1
7 RD20220402-0009 02/04/2022 EP20220402-0005 2022040200016 SURANTA TARIGAN 2,328.0

KAPLET
8 RD20220402-0010 02/04/2022 EP20220402-0006 2022040200017 IYON PRIADI 293,325.0
9 RD20220402-0011 02/04/2022 EP20220402-0006 2022040200023 IYON PRIADI 164,230.0

10 RD20220402-0012 02/04/2022 EP20220402-0006 2022040200020 IYON PRIADI 113,750.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ TENSOCREPE 4 INC (10 CM X 1.00 ROLL 113,750.00 113,750.00 0 1

4.5 M)
11 RD20220402-0013 02/04/2022 EP20220402-0006 2022040200021 IYON PRIADI 32,330.0
12 RD20220403-0003 03/04/2022 EP20220403-0002 2022040300005 KEYCIA LAMRIA PARDEDE 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
13 RD20220403-0004 03/04/2022 EP20220403-0003 2022040300007 YUNITA PANDIANGAN 12,480.0
14 RD20220404-0003 04/04/2022 EP20220404-0005 2022040400005 MARJAN DAWSIR 177,475.0
15 RD20220404-0004 04/04/2022 EP20220404-0004 2022040400006 ELKANA 582,390.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ LAMETIC 8 MG TAB 5.00 TAB 39,424.00 197,120.00 0 1
16 RD20220404-0005 04/04/2022 EP20220404-0006 2022040400007 RUDI RAHMAD 80,310.0
17 RD20220404-0006 04/04/2022 EP20220404-0007 2022040400008 SUHARNO 85,818.0
R/ BERRY VISION TAB 10.00 TAB 4,435.00 44,350.00 0 1
R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,788.00 36,788.00 0 0

DROP
18 RD20220404-0007 04/04/2022 EP20220404-0009 2022040400010 NURMISNAWATI 11,640.0
19 RD20220404-0008 04/04/2022 EP20220404-0008 2022040400011 MINAR NAPITUPULU 102,755.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ ONDANSETRON 4 MG TAB 6.00 TAB 3,500.00 21,000.00 1 0
20 RD20220404-0009 04/04/2022 EP20220404-0010 2022040400012 RIPALDO SIRAIT 476,310.0
21 RD20220404-0010 04/04/2022 EP20220404-0011 2022040400014 NITISH GUPTA 73,000.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
22 RD20220404-0011 04/04/2022 EP20220404-0012 2022040400016 REYHAN ALFARIZQI SIREGAR 217,966.0
R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1
23 RD20220404-0012 04/04/2022 EP20220404-0013 2022040400015 GIBRAN ALHANAN SIREGAR 217,966.0
R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1
24 RD20220404-0013 04/04/2022 EP20220404-0014 2022040400018 ABDUL HAFIZI 694,015.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1
25 RD20220404-0014 04/04/2022 EP20220404-0011 2022040400019 NITISH GUPTA 869,909.0

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
26 RD20220404-0015 04/04/2022 EP20220404-0015 2022040400020 39,706.0
R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1
27 RD20220404-0016 04/04/2022 EP20220404-0016 2022040400021 628,320.0
28 RD20220405-0012 05/04/2022 EP20220405-0010 2022040500019 JOGI MARIANUS SIHOTANG 73,000.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
29 RD20220405-0013 05/04/2022 EP20220405-0011 2022040500021 UTARI DAHNIA 643,700.0
30 RD20220405-0014 05/04/2022 EP20220405-0013 2022040500022 WHINDY IKA WULANDHARI 506,924.0
R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0
31 RD20220405-0015 05/04/2022 EP20220405-0014 2022040500023 ADRIELLA ELISABETH 331,044.0

AMBARITA
R/ LACTO B SACHET 5.00 SACH 7,080.00 35,400.00 0 1
R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1
R/ VOMETA SYR 60 ML 1.00 FLS 66,000.00 66,000.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
32 RD20220405-0016 05/04/2022 EP20220405-0012 2022040500024 AGUS HENDRA 403,325.0
33 RD20220405-0017 05/04/2022 EP20220405-0012 2022040500025 AGUS HENDRA 152,420.0
R/ KETOROLAC 10 MG TAB 10.00 TAB 3,520.00 35,200.00 1 0
34 RD20220405-0018 05/04/2022 EP20220405-0015 2022040500026 AUDIEA DWI ANGGITA 376,995.0
35 RD20220405-0019 05/04/2022 EP20220405-0016 2022040500028 SRI AYOM 39,420.0
36 RD20220405-0020 05/04/2022 EP20220405-0017 2022040500029 TERESIA UMI 39,420.0
37 RD20220405-0021 05/04/2022 EP20220405-0018 2022040500030 ARTITA PULUNGAN 499,504.0
R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0
38 RD20220405-0022 05/04/2022 EP20220405-0019 2022040500031 IFNIL AMRUL RISKI NASUTION 275,716.0
R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL ### 55,000.00 0 0
39 RD20220405-0023 05/04/2022 EP20220405-0021 2022040500034 FEBRI JHONNATAN NAIBAHO 75,830.0
R/ STESOLID 10 MG/2.5 ML 1.00 TUBE 44,786.00 44,786.00 0 0

RECTAL TUBE
R/ D5 + 1/4 NS 500 ML ( WIDA )
(PSIKOTROPIKA) 1.00 FLS 24,544.00 24,544.00 0 1
40 RD20220407-0003 07/04/2022 EP20220407-0003 2022040700003 ANGGELINA PUNGA 80,000.0

(BPJS)
41 RD20220407-0004 07/04/2022 EP20220407-0004 2022040700006 MUKLIS SIREGAR 307,285.0
R/ METHYLON 4 MG TAB 10.00 TAB 3,162.50 31,625.00 0 1
42 RD20220407-0005 07/04/2022 EP20220407-0004 2022040700007 MUKLIS SIREGAR 103,125.0
R/ METHYLON 125 MG INJ 1.00 VIAL 103,125.00 103,125.00 0 1
43 RD20220407-0006 07/04/2022 EP20220407-0005 2022040700008 DAFFA MUARIF 482,921.0
R/ KETRICIN ORA BASE 0,1% 1.00 TUBE 66,025.00 66,025.00 0 1

CREAM
44 RD20220407-0007 07/04/2022 EP20220407-0006 2022040700009 KASPUL ANWAR 66,025.0

CREAM
45 RD20220407-0008 07/04/2022 EP20220407-0007 2022040700010 FARADHITA MEGA DWI 303,852.0
MUSTIKA
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

46 RD20220407-0009 07/04/2022 EP20220407-0008 2022040700011 DICKY SERFINDO 519,548.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
47 RD20220407-0010 07/04/2022 EP20220407-0010 2022040700012 ARNANDO 134,064.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
48 RD20220407-0011 07/04/2022 EP20220407-0009 2022040700014 MIKAEL BETAWE SILITONGA 36,277.0

(BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
49 RD20220407-0012 07/04/2022 EP20220407-0011 2022040700023 343,661.0
R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0
50 RD20220410-0014 10/04/2022 EP20220410-0012 2022041000017 DAREEN RUMABUTAR 34,074.0
51 RD20220411-0001 11/04/2022 EP20220411-0001 2022041100001 CHARLES JORANGTA S. 80,000.0

SIMANJORANG

(BPJS)
52 RD20220411-0012 11/04/2022 EP20220411-0012 2022041100013 ELVINA SARI BANGUN 91,867.0
R/ FLUNARIZINE 5 MG TAB 3.00 TAB 1,760.00 5,280.00 1 0

53 RD20220412-0001 12/04/2022 EP20220412-0001 2022041200002 AZWAN KURNIAWAN 559,447.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
54 RD20220412-0002 12/04/2022 EP20220412-0002 2022041200003 SHINTA YUNITA PUTRI 192,975.0
55 RD20220412-0003 12/04/2022 EP20220412-0003 2022041200004 TOMMY 4,675.0
56 RD20220415-0003 15/04/2022 EP20220415-0003 2022041500007 MIKE REGULUS YEHOSHUA 91,337.0

DURANDAL WONG

(BPJS)
57 RD20220415-0004 15/04/2022 EP20220415-0004 2022041500008 JANUARYANTI BANJARNAHOR 256,389.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ ESTIN 60 ML SYR 1.00 FLS 73,920.00 73,920.00 0 1
R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1
58 RD20220415-0005 15/04/2022 EP20220415-0005 2022041500009 AHMAD RIYADI SIREGAR 262,456.0
R/ SANORINE HIJAU 200 ML 1.00 FLS 32,007.00 32,007.00 0 1

CREAM
59 RD20220415-0006 15/04/2022 EP20220415-0006 2022041500010 AZWAN KURNIAWAN 7,636.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
60 RD20220415-0012 15/04/2022 EP20220415-0008 2022041500018 MULIA RAHMAD 59,971.0
61 RD20220417-0002 17/04/2022 EP20220417-0002 2022041700002 ARIS SAPRIONO 44,000.0
R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
62 RD20220417-0003
DWS 17/04/2022 EP20220417-0002 2022041700003 ARIS SAPRIONO 97,513.0

(BPJS)
DEWASA
R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1
64 RD20220417-0005 17/04/2022 EP20220417-0004 2022041700007 MARSHA TIMOHTY HASIAN 117,108.0

SIMORANGKIR
65 RD20220417-0006 17/04/2022 EP20220417-0004 2022041700006 MARSHA TIMOHTY HASIAN 23,375.0

SIMORANGKIR
R/ ANITID 50 MG/2ML INJ 1.00 AMP 23,375.00 23,375.00 0 1
67 RD20220418-0004 18/04/2022 EP20220418-0003 2022041800006 MUHAMMAD ARBI 444,204.0
R/ RATIVOL TAB 10.00 TAB 8,096.00 80,960.00 0 1
68 RD20220418-0005 18/04/2022 EP20220418-0004 2022041800008 XAVIER DEVEN SAGOTO 42,144.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

69 RD20220418-0006 18/04/2022 EP20220418-0006 2022041800009 ADIRA MELIKNA 281,441.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1
R/ SINRAL 5 MG TAB 3.00 TAB 6,187.50 18,562.00 0 1
70 RD20220418-0007 18/04/2022 EP20220418-0005 2022041800012 MONIKA SARAS WATI T 607,252.0
71 RD20220418-0008 18/04/2022 EP20220418-0007 2022041800013 JERI AMANDA 607,252.0
72 RD20220418-0009 18/04/2022 EP20220418-0008 2022041800015 SHINTYA RATU ARINA 624,947.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
73 RD20220418-0010 18/04/2022 EP20220418-0008 2022041800016 SHINTYA RATU ARINA 73,000.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
74 RD20220418-0011 18/04/2022 EP20220418-0009 2022041800017 DAHNIAL HUSIN 634,506.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
75 RD20220418-0012 18/04/2022 EP20220418-0010 2022041800018 HERMAN ROZA PUTRA 566,077.0
R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 0.00 70,000.00 0 1
R/ LAMETIC 8 MG TAB 10.00 TAB 0.00 394,240.00 0 1
R/ VOMIZOLE 20 MG TAB 5.00 TAB 0.00 97,162.00 0 1
76 RD20220418-0013 18/04/2022 EP20220418-0011 2022041800019 MUHAMMAD KHALID 625,814.0

KADERUSSYAIKHAN
77 RD20220418-0014 18/04/2022 EP20220418-0012 2022041800020 OBNIEL NICHOLAS MANURUNG 271,677.0
78 RD20220418-0015 18/04/2022 EP20220418-0014 2022041800021 CHRISTIN MEGAWATY 285,949.0

SIREGAR
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
79 RD20220418-0016 18/04/2022 EP20220418-0013 2022041800022 YULIANA TARIHORAN 641,516.0
R/ REMOPAIN INJ AMPUL 1.00 AMP 61,600.00 61,600.00 0 1
R/ RATIVOL TAB 10.00 TAB 8,096.00 80,960.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
80 RD20220418-0017 18/04/2022 EP20220418-0015 2022041800023 DYAN ALFARIZI 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
81 RD20220420-0006 20/04/2022 EP20220420-0003 2022042000008 MYRON NATHANAEL 206,638.0

TAMPUBOLON
R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1
82 RD20220420-0007 20/04/2022 EP20220420-0004 2022042000009 ELKANA 73,000.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
83 RD20220420-0008 20/04/2022 EP20220420-0004 2022042000010 ELKANA 293,060.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
84 RD20220420-0009 20/04/2022 EP20220420-0004 2022042000011 ELKANA 10,800.0
R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1
85 RD20220420-0010 20/04/2022 EP20220420-0005 2022042000012 CICA RAMELIKA 496,865.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
86 RD20220420-0011 20/04/2022 EP20220420-0006 2022042000013 KHUSNAH 831,537.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1
87 RD20220420-0012 20/04/2022 EP20220420-0007 2022042000014 DELVIA ANGGRAINI 863,162.0
88 RD20220421-0012 21/04/2022 EP20220421-0010 2022042100016 MEILI NASTASIA SIMAMORA 308,877.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
89 RD20220421-0013 21/04/2022 EP20220421-0012 2022042100021 HENDRA SANTO KIROYAN 73,000.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
90 RD20220421-0014 21/04/2022 EP20220421-0013 2022042100023 WINNIE YULIARNI 331,805.0
R/ FREGO 5 MG TAB 5.00 TAB 8,448.00 42,240.00 0 0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
91 RD20220421-0015 21/04/2022 EP20220421-0012 2022042100024 HENDRA SANTO KIROYAN 58,438.0
R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
92 RD20220421-0016 21/04/2022 EP20220421-0014 2022042100026 MARDONAL Z 247,352.0
R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1

(PREKURSOR)

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
93 RD20220421-0017 21/04/2022 EP20220421-0015 2022042100027 NICHOLAS SERGIO 47,118.0

SITUMORANG
R/ CETIRIZINE DROP 1.00 FLS 29,518.13 29,518.00 1 0
94 RD20220421-0018 21/04/2022 EP20220421-0017 2022042100028 NATANAEL PANJAITAN 182,024.0
95 RD20220421-0019 21/04/2022 EP20220421-0016 2022042100030 ANTONI 49,665.0
R/ METHYLPREDNISOLONE 125 1.00 VIAL 49,665.00 49,665.00 1 0

MG INJ
96 RD20220421-0020 21/04/2022 EP20220421-0018 2022042100031 DISPEN PANJAITAN 65,587.0
97 RD20220421-0021 21/04/2022 EP20220421-0016 2022042100032 ANTONI 236,854.0
98 RD20220421-0022 21/04/2022 EP20220421-0016 2022042100033 ANTONI 113,750.0
R/ TENSOCREPE 4 INC (10 CM X 1.00 ROLL 113,750.00 113,750.00 0 1

4.5 M)
99 RD20220421-0023 21/04/2022 EP20220421-0019 2022042100035 RINDI ATIKA MARPAUNG 230,779.0

DROP
R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1
100 RD20220423-0001 23/04/2022 EP20220423-0001 2022042300001 JENI RAGIL 391,768.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
101 RD20220423-0002 23/04/2022 EP20220423-0002 2022042300002 SOVIANITA PRATIWI 391,768.0
102 RD20220425-0001 25/04/2022 EP20220425-0001 2022042500001 ANSELMIA MBAY 83,087.0
103 RD20220430-0016 30/04/2022 EP20220430-0016 2022043000020 YASINTA LONA BADHE 73,267.0

DEWASA
R/ SANMOL FORTE TAB 1.00 TAB 467.50 467.00 0 1
105 RD20220430-0018 30/04/2022 EP20220430-0017 2022043000022 NIKOLAUS BRIANUS 17,600.0
106 RJ20220408-0001 08/04/2022 OP20220408-0001 2022040800001 YOGI AMAL PUTRA 318,317.0
107 RJ20220408-0003 08/04/2022 OP20220408-0002 2022040800003 BERIK ESTRADA 159,880.0
R/ CENDO PANTOCAIN 0,5% EYE 1.00 FLS 16,368.75 16,368.00 0 1

DROP
DROP

108 RJ20220408-0005 08/04/2022 OP20220408-0006 2022040800005 MAROMBASTUA 428,727.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0
109 RJ20220408-0007 08/04/2022 OP20220408-0013 2022040800007 LEO MARHASIAN 318,317.0
110 RJ20220408-0008 08/04/2022 OP20220408-0012 2022040800008 RONA AISYAH 217,966.0
R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1
111 RJ20220408-0010 08/04/2022 OP20220408-0011 2022040800010 SRI WAHYUNI 669,330.0
R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1
112 RJ20220408-0011 08/04/2022 OP20220408-0017 2022040800011 HAMDAN 348,113.0

DROP
113 RJ20220409-0001 09/04/2022 OP20220409-0002 2022040900001 DARMADI 192,248.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ CERINI 10 MG TABLET 5.00 TAB 4,716.25 23,581.00 0 1
114 RJ20220413-0002 13/04/2022 OP20220413-0005 2022041300002 KRISMAY ZILFANIA GULTOM 316,108.0
R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1
115 RJ20220413-0006 13/04/2022 OP20220413-0008 2022041300008 YOPI WILYANSEN 221,375.0
R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1
116 RJ20220413-0011 13/04/2022 OP20220413-0015 2022041300014 CARLIE LEONARDO SIMARE 449,070.0

MARE
117 RJ20220413-0013 13/04/2022 OP20220413-0016 2022041300017 LAMBOK SIPAYUNG 98,666.0
R/ ALPRAZOLAM 0,5 MG TAB 2.00 TAB 789.75 1,579.00 0 0

(PSI)
118 RJ20220428-0002 28/04/2022 OP20220428-0003 2022042800002 NURI PURBA 190,096.0

(PREKURSOR)
119 RJ20220429-0001 29/04/2022 OP20220429-0004 2022042900001 ABDUL ROPI 590,325.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
120 RJ20220429-0002 29/04/2022 OP20220429-0005 2022042900003 BRIGHTLY OWENS 1,136,930.0
R/ CORMEGA CAPS BLISTERS 10.00 CAP 16,875.00 168,750.00 0 1
121 RJ20220429-0003 29/04/2022 OP20220429-0006 2022042900004 PENTA MUKTI HERLAMBANG 830,393.0
122 RJ20220429-0006 29/04/2022 OP20220429-0011 2022042900007 NECI PURNAMA SARI 285,207.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
R/ GITAS PLUS TAB 10.00 TAB 8,800.00 88,000.00 0 1
123 RJ20220429-0007 29/04/2022 OP20220429-0012 2022042900008 ROINCAH TOGATOROP 1,041,593.0
R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 ### 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
124 RJ20220429-0008 29/04/2022 OP20220429-0013 2022042900009 TRIWA DESHANA SARAGIH 436,153.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
125 RJ20220429-0009 29/04/2022 OP20220429-0014 2022042900010 CINTA JUMAGAR SIANIAPAR 201,882.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
Total Dokter DR. ERIE FAILENGGO 34,234,732.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR.EKA KURNIATI
1 RD20220406-0003 06/04/2022 EP20220406-0005 2022040600005 ANWAR LUMBAN TORUAN 80,000.0

(BPJS)
2 RD20220406-0005 06/04/2022 EP20220406-0006 2022040600009 FIONA RAMADHANTI WAHONO 116,486.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
3 RD20220406-0006 06/04/2022 EP20220406-0007 2022040600010 SITI HAFSAH 40,000.0
4 RD20220406-0007 06/04/2022 EP20220406-0008 2022040600011 ALI AMRAN 92,430.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ NS 0.9 100 ML (PIGGY BACK) 1.00 FLS 19,430.00 19,430.00 1 0
5 RD20220406-0008 06/04/2022 EP20220406-0008 2022040600012 ALI AMRAN 278,905.0
6 RD20220406-0009 06/04/2022 EP20220406-0009 2022040600013 WARLAN SUHERLAN 22,680.0
R/ ARCAPEC TAB 15.00 TAB 1,512.00 22,680.00 0 1
7 RD20220406-0010 06/04/2022 EP20220406-0012 2022040600019 JENI RAGIL 186.0
8 RD20220406-0011 06/04/2022 EP20220406-0010 2022040600020 NUR MALAIKA ZHAFIRA 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
9 RD20220406-0012 06/04/2022 EP20220406-0011 2022040600021 GILANG YULIYANTO 360,494.0

10 RD20220406-0014 06/04/2022 EP20220406-0012 2022040600022 JENI RAGIL 153,845.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ AMLODIPINE 5 MG TAB 10.00 TAB 1,200.00 12,000.00 1 0
11 RD20220406-0015 06/04/2022 EP20220406-0013 2022040600023 GRACIA YORI 4,680.0
12 RD20220406-0016 06/04/2022 EP20220406-0014 2022040600024 MEGAWATI HUTASOIT 177,046.0
13 RD20220407-0013 07/04/2022 EP20220407-0012 2022040700017 CHARLES SIJABAT 80,000.0

(BPJS)
14 RD20220407-0015 07/04/2022 EP20220407-0013 2022040700021 AERILYN AYU JELITA 35,750.0
R/ LASAL SYR 2 MG/5ML 100 ML 1.00 FLS 35,750.00 35,750.00 0 1
15 RD20220407-0016 07/04/2022 EP20220407-0012 2022040700020 CHARLES SIJABAT 3,875.0

KAPLET
16 RD20220407-0017 07/04/2022 EP20220407-0011 2022040700022 ENDY DWI WISNU WANTONO 73,000.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
17 RD20220408-0001 08/04/2022 EP20220408-0002 2022040800002 MYANTI RONAULY 107,909.0
R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0
18 RD20220408-0028 08/04/2022 EP20220408-0022 2022040800040 META ULKHAIRI 42,227.0
19 RD20220408-0029 08/04/2022 EP20220408-0023 2022040800041 ARIS KASNUR 195,827.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
20 RD20220409-0001 09/04/2022 EP20220409-0001 2022040900001 160,051.0
21 RD20220409-0002 09/04/2022 EP20220409-0002 2022040900003 ADELLA FEBRA ERION 88,753.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

(BPJS)
22 RD20220413-0004 13/04/2022 EP20220413-0004 2022041300007 DINAR SIMBOLON 69,759.0
23 RD20220413-0005 13/04/2022 EP20220413-0005 2022041300008 DEWYNTA MONICA FABRINA 474,225.0

BANGUN
24 RD20220413-0006 13/04/2022 EP20220413-0005 2022041300009 DEWYNTA MONICA FABRINA 11,100.0

BANGUN
R/ ASAM TRANEKSAMAT INJ 1.00 AMP 11,100.00 11,100.00 1 0

500MG/5ML
25 RD20220414-0012 14/04/2022 EP20220414-0008 2022041400016 SALMAN SAGALA 79,079.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
26 RD20220414-0013 14/04/2022 EP20220414-0009 2022041400017 NOVITA ANGLELINA 15,813.0
27 RD20220414-0014 14/04/2022 EP20220414-0010 2022041400018 KHATERIN YOLA GRANTSLICE 3,875.0

SIHOTANG

KAPLET
28 RD20220414-0016 14/04/2022 EP20220414-0011 2022041400021 DANI SAMUEL SINAGA 109,717.0
R/ ARCAPEC TAB 15.00 TAB 1,512.00 22,680.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
29 RD20220414-0017 14/04/2022 EP20220414-0012 2022041400022 RIDELSON JANRIAMAN 228,772.0

MARBUN
30 RD20220414-0018 14/04/2022 EP20220414-0013 2022041500006 TOGAP ORLANDO PARDEDE 18,796.0
31 RD20220415-0007 15/04/2022 EP20220415-0007 2022041500012 TITO NELSON TARIGAN 82,495.0

R/ STESOLID 10 MG/2ML
DWS 1.00 AMP 16,107.60 16,107.00 0 0
INJEKSI (PSIKOTROPIKA)
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ GUEDEL NASAL NO. 5 1.00 PCS 132,812.50 132,812.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ STESOLID 10 MG/2ML 1.00 AMP 16,107.60 16,107.00 0 0

R/ STOMACH TUBE NO. 18 1.00 PCS 38,961.00 38,961.00 0 1
R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
36 RD20220416-0010 16/04/2022 EP20220416-0008 2022041600010 TOMMY 59,927.0
37 RD20220416-0011 16/04/2022 EP20220416-0009 2022041600011 MUHAMMAD ABDI 115,368.0

(OOT)

38 RD20220416-0012 16/04/2022 EP20220416-0010 2022041600012 LASNI MERLINA MANIK 28,301.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

(OOT)
39 RD20220416-0013 16/04/2022 EP20220416-0011 2022041600013 JOSUA GABRIEL STEVEN 24,992.0
SINAGA
40 RD20220416-0014 16/04/2022 EP20220416-0012 2022041600014 BELLA KRISTINA NASRIA 2,854.0

SINAGA
R/ AMBROXOL 30 MG TAB 10.00 TAB 285.41 2,854.00 1 0
41 RD20220416-0015 16/04/2022 EP20220416-0014 2022041600015 PRETTY AGUTINA CHIVA 55,930.0

SINAGA
42 RD20220416-0016 16/04/2022 EP20220416-0013 2022041600016 SAHALA TUA SINAGA 28,301.0

(OOT)
43 RD20220416-0017 16/04/2022 EP20220416-0015 2022041600017 NIJAR EPENDI 263,395.0
44 RD20220416-0018 16/04/2022 EP20220416-0016 2022041600018 ASIYAH 265,272.0
45 RD20220416-0019 16/04/2022 EP20220416-0016 2022041600019 ASIYAH 15,120.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
46 RD20220416-0020 16/04/2022 EP20220416-0017 2022041600020 HASANUDDIN 60,081.0
47 RD20220416-0021 16/04/2022 EP20220416-0018 2022041600021 FADHILLA INAYAH.S 224,014.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
48 RD20220416-0022 16/04/2022 EP20220416-0019 2022041600022 ALDI 95,944.0
R/ ACYCLOVIR 200 MG TAB 15.00 TAB 1,600.00 24,000.00 1 0
R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 1.00 3,818.00 11,973.00 1 0
POT KOSONG 10 ML 1.00 UNT 3,262.50 0.00 0 0
ACYCLOVIR 5 GR CREAM 1.00 TUBE 4,893.00 0.00 1 0
49 RD20220416-0023 16/04/2022 EP20220416-0021 2022041600023 SENIMAN BUULOLO 66,550.0
50 RD20220420-0001 19/04/2022 EP20220419-0013 2022042000001 RIKI HAMDANI 18,415.0
51 RD20220420-0002 19/04/2022 EP20220419-0013 2022042000002 RIKI HAMDANI 2,850.0
52 RD20220420-0003 20/04/2022 EP20220419-0012 2022042000003 RATU SAYYIDAH 81,194.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
53 RD20220421-0001 21/04/2022 EP20220421-0001 2022042100001 ANGGUN RAFLI 268,137.0
54 RD20220422-0001 22/04/2022 EP20220421-0021 2022042200001 MARTUA HUTABARAT 90,626.0

(BPJS)
55 RD20220422-0002 22/04/2022 EP20220421-0021 2022042200002 MARTUA HUTABARAT 3,076.0
R/ ISOSORBID DINITRAT 5 MG 1.00 TAB 161.50 161.00 1 0

R/ ASPILET 80 MG TAB 4.00 TAB 728.80 2,915.00 0 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
56 RD20220428-0004 28/04/2022 EP20220428-0004 2022042800005 BOBI INDRI 425,943.0
R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 0.00 3,818.00 1 0
R/ SPORETIK 200 MG CAPS 10.00 CAP 0.00 411,840.00 0 1
R/ BISTURI NO. 15 1.00 PCS 0.00 5,610.00 0 1
57 RD20220429-0009 29/04/2022 EP20220429-0010 2022042900012 APRILLIA PASKAH ANASTASYA 201,677.0

BR SINURAT
58 RD20220429-0010 29/04/2022 EP20220429-0010 2022042900013 APRILLIA PASKAH ANASTASYA 17,726.0

BR SINURAT
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
59 RD20220429-0011 29/04/2022 EP20220429-0011 2022042900015 M. ARIFIN 500,569.0
60 RD20220429-0012 29/04/2022 EP20220429-0012 2022042900016 MOHAMMAD EDY WIYOSO 297,528.0

TAB
61 RD20220429-0013 29/04/2022 EP20220429-0013 2022042900017 RHIENDA PRESKA 297,528.0

TAB
62 RD20220429-0014 29/04/2022 EP20220429-0015 2022042900018 MUHAMMAD IKHSAN ADHETYA 135,001.0
NUGRAHA
R/ ARCAPEC TAB 15.00 TAB 1,512.00 22,680.00 0 1

63 RD20220430-0003 30/04/2022 EP20220430-0003 2022043000003 GABRIAN GEOFFREY HUTAPEA 45,000.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
64 RD20220430-0004 30/04/2022 EP20220430-0003 2022043000004 GABRIAN GEOFFREY HUTAPEA 90,394.0
R/ ESTIN 60 ML SYR 1.00 FLS 73,920.00 73,920.00 0 1
65 RD20220430-0005 30/04/2022 EP20220430-0004 2022043000005 BOBI INDRI 5,000.0
R/ GENTALEX 5 MG CREAM 1.00 TUBE 0.00 5,000.00 0 1
66 RD20220430-0006 30/04/2022 EP20220430-0005 2022043000006 SHEIVIA AQHILLA 57,616.0

MAHDALENA
67 RD20220430-0007 30/04/2022 EP20220430-0006 2022043000007 15,725.0

MINIDOSE
68 RD20220430-0008 30/04/2022 EP20220430-0007 2022043000008 AMALIA ROSMANDA AZHARI 110,000.0
69 RD20220430-0009 30/04/2022 EP20220430-0010 2022043000012 RAFI TRISTAN INDRASTA 6,668.0
70 RD20220430-0010 30/04/2022 EP20220430-0009 2022043000013 JONI INDARYANTO 85,350.0
71 RJ20220402-0001 02/04/2022 OP20220402-0001 2022040200001 CHINTA NADIRA PUTRI 77,440.0
R/ OPILAX 60 ML SYR 1.00 FLS 77,440.00 77,440.00 0 1
72 RJ20220404-0001 04/04/2022 OP20220404-0001 2022040400001 ALEKS SILITONGA 290,385.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
75 RJ20220404-0005 04/04/2022 OP20220404-0003 2022040400005 ABIGAIL QUEENNARA 235,651.0

HUTABALIAN
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
76 RJ20220404-0008 04/04/2022 OP20220404-0011 2022040400008 PANGERAN HUTAGALUNG 82,742.0
77 RJ20220404-0009 04/04/2022 OP20220404-0012 2022040400010 CHRISTINA RONAULI SIAGIAN 242,390.0
78 RJ20220404-0010 04/04/2022 OP20220404-0012 2022040400009 CHRISTINA RONAULI SIAGIAN 216,800.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
79 RJ20220404-0013 04/04/2022 OP20220404-0014 2022040400015 DIDIT SUSANTO 46,558.0
80 RJ20220404-0014 04/04/2022 OP20220404-0015 2022040400014 MUHAMMAD YUSUF LUBIS 240,515.0

81 RJ20220404-0015 04/04/2022 OP20220404-0016 2022040400016 TOGAP ORLANDO PARDEDE 377,840.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
82 RJ20220405-0011 05/04/2022 OP20220405-0011 2022040500012 MUHAMMAD ANAS SABUR 285,705.0
83 RJ20220425-0002 25/04/2022 OP20220425-0004 2022042500003 FAUZIAH ANUGRAH 201,677.0
84 RJ20220425-0003 25/04/2022 OP20220425-0005 2022042500004 MUHAMMAD HANAFI 17,116.0
R/ CEFADROXYL 500 MG CAPSUL 10.00 CAP 1,050.00 10,500.00 1 0
85 RJ20220425-0009 25/04/2022 OP20220425-0011 2022042500015 TIARA NOVITA SARI 81,221.0

(PREKURSOR)
86 RJ20220425-0011 25/04/2022 OP20220425-0019 2022042500022 M.RAFAL FARUQ AN NUR 61,309.0
87 RJ20220425-0012 25/04/2022 OP20220425-0018 2022042500023 NURKHOLIS 11,050.0

MINIDOSE
88 RJ20220425-0013 25/04/2022 OP20220425-0020 2022042500024 SONDANG HEPRIADI 45,850.0
SIMANJUNTAK
89 RJ20220425-0014 25/04/2022 OP20220425-0021 2022042500025 DESPIANA PITRI 26,596.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
90 RJ20220425-0015 25/04/2022 OP20220425-0022 2022042500026 DIDIT ICHWAN 37,701.0
91 RJ20220426-0001 26/04/2022 OP20220426-0001 2022042600001 RUDI YANTO 60,130.0
93 RJ20220426-0005 26/04/2022 OP20220426-0008 2022042600005 REYHAN KURNIA AKBAR 246,657.0
94 RJ20220426-0006 26/04/2022 OP20220426-0008 2022042600006 REYHAN KURNIA AKBAR 295,680.0
95 RJ20220426-0009 26/04/2022 OP20220426-0012 2022042600012 JUNITA AYU HARDINI 18,796.0
96 RJ20220426-0010 26/04/2022 OP20220426-0013 2022042600013 RIMA AGUSTIN 132,816.0

97 RJ20220426-0012 26/04/2022 OP20220426-0014 2022042600018 NUR HOLISEH 83,070.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
98 RJ20220426-0013 26/04/2022 OP20220426-0015 2022042600019 SUSANA WATI 27,857.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

KAPLET
99 RJ20220426-0015 26/04/2022 OP20220426-0016 2022042600021 DAMASUS CHRISTOHEL 45,850.0
SIHITE
Total Dokter DR.EKA KURNIATI 11,543,522.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. FERRY FHRANS VALENTINUS KARO-KARO
1 RD20220401-0001 01/04/2022 EP20220401-0001 2022040100001 NARA ALETHEIA SASONGKO 17,600.0
2 RD20220401-0002 01/04/2022 EP20220401-0001 2022040100002 NARA ALETHEIA SASONGKO 109,646.0
R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1
R/ KASA STERIL 16 X 16 CM 2.00 KTK 11,880.00 23,760.00 0 1
3 RD20220401-0003 01/04/2022 EP20220401-0002 2022040100004 CHORNALIUS BLEGUR 80,000.0

(BPJS)
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
5 RD20220401-0005 01/04/2022 EP20220401-0003 2022040100005 PUTRI NANDA BR SITEPU 4,590.0

KAPLET
6 RD20220401-0006 01/04/2022 EP20220401-0003 2022040100007 PUTRI NANDA BR SITEPU 10,000.0

500MG/5ML
7 RD20220401-0007 01/04/2022 EP20220401-0005 2022040100008 MUHAMAD ALHAFIZZI 84,480.0
8 RD20220401-0008 01/04/2022 EP20220401-0005 2022040100009 MUHAMAD ALHAFIZZI 316,470.0
R/ INTERZINC SYRUP 1.00 FLS 57,750.00 57,750.00 0 1
9 RD20220401-0009 01/04/2022 EP20220 2022040100010 ANTINIUS SILITONGA 80,000.0

401-0006

(BPJS)
10 RD20220401-0010 01/04/2022 EP20220401-0007 2022040100012 SANDRA AGUSTIN 273,624.0
R/ TRICHODAZOL 500 MG TAB 2.00 TAB 2,337.00 4,674.00 0 1

11 RD20220401-0012 01/04/2022 EP20220401-0006 2022040100020 ANTINIUS SILITONGA 7,800.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

(BPJS)
14 RD20220415-0013 15/04/2022 EP20220415-0009 2022041500019 TIMBUL HENRY PARLAGUTAN 167,200.0
SIHITE

SIHITE

SIHITE
R/ EPINEPHRINE INJ 1.00 AMP 12,160.00 12,160.00 1 0

17 RD20220416-0002
DWS 16/04/2022 EP20220415-0007 2022041600002 935,963.0

INJEKSI
R/ PHENYTOIN 50 MG/ML INJ 10.00 AMP 84,480.00 844,800.00 1 0
R/ SUCTION CATHETHER NO. 16 1.00 PCS 8,712.00 8,712.00 0 1
19 RD20220417-0010 17/04/2022 EP20220417-0009 2022041700015 NIKEN AYU 8,401.0

KAPLET
20 RD20220417-0011 17/04/2022 EP20220417-0010 2022041700017 ELMERIA NAINGGOLAN 2,409.0
21 RD20220417-0012 17/04/2022 EP20220417-0011 2022041700018 MARTHA NADAPDAP 57,200.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
22 RD20220417-0013 17/04/2022 EP20220417-0012 2022041700019 110,000.0
23 RD20220417-0014 17/04/2022 EP20220417-0012 2022041700020 LAILA KUDRIA 64,624.0
24 RD20220418-0001 18/04/2022 EP20220418-0001 2022041800001 ZIO ALFRIANDO SIREGAR 17,600.0
25 RD20220418-0002 18/04/2022 EP20220418-0001 2022041800003 ZIO ALFRIANDO SIREGAR 32,525.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
26 RD20220426-0001 26/04/2022 EP20220425-0019 2022042600002 HAFIZUL FIKRI 257,600.0
R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1

TAB
27 RD20220426-0002 26/04/2022 EP20220425-0015 2022042600013 220,000.0
R/ NICARDIPINE 10 MG INJ 2.00 AMP 110,000.00 220,000.00 1 0
28 RD20220426-0003 26/04/2022 EP20220425-0015 2022042600004 KEHIDUPAN LAIA 27,000.0
R/ HANDSCOEN STERIL NO. 7.5 1.00 PSG 27,000.00 27,000.00 0 1

INJEKSI
30 RD20220426-0005 26/04/2022 EP20220426-0001 2022042600012 PUTRA REZKI PERDHANA 80,000.0

(BPJS)
R/ RECOFOL INJEKSI 1.00 AMP 139,335.00 139,335.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

32 RD20220430-0011 30/04/2022 EP20220430-0012 2022043000015 DAMASUS CHRISTOHEL 92,430.0
SIHITE

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
33 RD20220430-0012 30/04/2022 EP20220430-0012 2022043000016 DAMASUS CHRISTOHEL 90,562.0

SIHITE
34 RD20220430-0013 30/04/2022 EP20220430-0013 2022043000017 NIMROT SILABAN 692,850.0
R/ MEMUCIL 200 MG CAPS 10.00 CAP 4,125.00 41,250.00 0 1
35 RD20220430-0014 30/04/2022 EP20220430-0014 2022043000018 AZKA AZIB 241,773.0
R/ TROLIT SACHET 10.00 SACH 12,674.91 126,749.00 0 1

CREAM
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
36 RD20220430-0015 30/04/2022 EP20220430-0015 2022043000019 KRISTATI OCTALINA GULTOM 93,037.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 1.00 220.00 3,200.00 1 0
Total Dokter DR. FERRY FHRANS VALENTINUS KARO- 4,525,433.0

KARO
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. FELIX VALERIAN HALIM
1 RD20220402-0001 02/04/2022 EP20220402-0001 2022040200001 PONIMAN 10,000.0

500MG/5ML
2 RD20220402-0002 02/04/2022 EP20220402-0002 2022040200002 FERI SIMANJUNTAK 195,313.0
R/ GUEDEL NASAL NO. 5 1.00 PCS 132,813.00 132,813.00 0 1
R/ SUCTION CATHETER NO. 18 1.00 PCS 7,500.00 7,500.00 1 0

500MG/5ML
INJEKSI
3 RD20220402-0003 02/04/2022 EP20220402-0001 2022040200005 PONIMAN 15,080.0

KAPLET

R/ NALD 26 (ONEMED)
DWS 1.00 PCS 660.00 660.00 0 0

(OOT)
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

(BPJS)
7 RD20220403-0002 03/04/2022 EP20220403-0001 2022040300003 ANNEKE FELICIA DAELY 147,169.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

SITUMEANG

9 RD20220407-0002 07/04/2022 EP20220407-0002 2022040700002 BUDAYA 41,696.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
10 RD20220408-0002 08/04/2022 EP20220408-0003 2022040800003 EIG KRISTINA SIHOTANG 80,000.0

(BPJS)
11 RD20220408-0004 08/04/2022 EP20220408-0004 2022040800006 M. WISLY 303,325.0

500MG/5ML
12 RD20220408-0005 08/04/2022 EP20220408-0005 2022040800007 NURMINA HUTABARAT 80,000.0

(BPJS)
13 RD20220408-0006 08/04/2022 EP20220408-0004 2022040800009 M. WISLY 15,083.0

KAPLET
14 RD20220408-0007 08/04/2022 EP20220408-0006 2022040800011 DEFRIT ARFAN 41,696.0
15 RD20220409-0003 09/04/2022 EP20220409-0003 2022040900008 SULAIMAN 474,225.0
16 RD20220409-0004 09/04/2022 EP20220409-0004 2022040900009 PAULUS SINULINGGA 358,545.0

500MG/5ML
R/ BISTURI NO. 22 2.00 PCS 5,610.00 11,220.00 0 1

17 RD20220409-0005
DWS 09/04/2022 EP20220409-0005 2022040900010 VENUS 27,625.0

MINIDOSE
18 RD20220409-0006 09/04/2022 EP20220409-0004 2022040900011 PAULUS SINULINGGA 4,583.0

KAPLET
19 RD20220409-0007 09/04/2022 EP20220409-0006 2022040900012 ILHAM MAULANA 24,713.0
(BPJS)
20 RD20220409-0008 09/04/2022 EP20220409-0006 2022040900013 ILHAM MAULANA 191,018.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ SALBUTAMOL 4 MG TAB 10.00 TAB 161.50 1,615.00 1 0
R/ CEPTIK 30 ML SYRUP 1.00 FLS 144,375.00 144,375.00 0 1
21 RD20220409-0009 09/04/2022 EP20220409-0007 2022040900014 MILAWATI BR TARIGAN 254,340.0
22 RD20220409-0012 09/04/2022 EP20220409-0009 2022040900017 AKIFA NAILA 5,043.0
R/ PARACETAMOL 500 MG 5.00 KAPLET 1.00 387.55 5,043.00 1 0

KAPLET
23 RD20220411-0002 11/04/2022 EP20220411-0001 2022041100002 CHARLES JORANGTA S. 38,589.0

SIMANJORANG
24 RD20220411-0003 11/04/2022 EP20220411-0003 2022041100003 ROTIMAH 3,875.0

KAPLET
25 RD20220412-0004 12/04/2022 EP20220412-0006 2022041200008 VIREN AULIA RAHMA 189,954.0
26 RD20220412-0005 12/04/2022 EP20220412-0009 2022041200009 TULUS POLTAK LUMBAN 80,000.0

TOBING

(BPJS)
27 RD20220412-0006 12/04/2022 EP20220412-0009 2022041200010 TULUS POLTAK LUMBAN 161.0
TOBING

TAB
TOBING

29 RD20220412-0008 12/04/2022 EP20220412-0009 2022041200015 TULUS POLTAK LUMBAN 161.0
TOBING

TAB
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
30 RD20220412-0010 12/04/2022 EP20220412-0011 2022041200017 141,636.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
31 RD20220412-0011 12/04/2022 EP20220412-0010 2022041200018 JONNI HALOMOAN MARPAUNG 141,636.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

TOBING
R/ ATORVASTATIN 20 MG TAB 2.00 TAB 6,166.66 12,333.00 1 0
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
33 RD20220 12/04/2022 EP20220412-0009 2022041200020 TULUS POLTAK LUMBAN 17,919.0

412-0013 TOBING

KAPLET
TOBING
R/ CONDOM CATHETER 1.00 PCS 12,040.00 12,040.00 0 0
36 RD20220412-0016 12/04/2022 EP20220412-0012 2022041200024 JUMALI WIDODO 178,545.0

(BPJS)
38 RD20220412-0019 12/04/2022 EP20220412-0014 2022041200026 MURNIWATI 150,796.0
39 RD20220412-0020 12/04/2022 EP20220412-0013 2022041200027 IBRAHIM KENOBO LANGOUYU 261,662.0
R/ CERINI 10 MG TABLET 10.00 TAB 4,716.25 47,162.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
40 RD20220412-0021 12/04/2022 EP20220412-0017 2022041200028 MONIKA SUSI MARDIANA 364,609.0

GIRSANG
41 RD20220412-0022 12/04/2022 EP20220412-0018 2022041200029 HELDERIKA SILITONGA 356,099.0
42 RD20220412-0023 12/04/2022 EP20220412-0020 2022041200030 MYRON NATHANAEL 178,458.0

TAMPUBOLON

(BPJS)
43 RD20220412-0024 12/04/2022 EP20220412-0019 2022041200031 SUSI SUSANTI 229,811.0
LUMBANTORUAN

(PREKURSOR)
R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,666.66 16,666.00 1 0
CAPSUL
45 RD20220413-0008 13/04/2022 EP20220413-0007 2022041300012 SUTIKNO 590,385.0
46 RD20220413-0009 13/04/2022 EP20220413-0008 2022041300013 MANABUA NABABAN 102,350.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

47 RD20220413-0010 13/04/2022 EP20220413-0007 2022041300014 SUTIKNO 293,325.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

SITUMEANG
49 RD20220413-0012 13/04/2022 EP20220413-0011 2022041300017 ORLANDO SAPUTRA 58,438.0

SIMANJUNTAK

1GR/100 ML
50 RD20220413-0013 13/04/2022 EP20220413-0010 2022041300018 MONIKA SUSI MARDIANA 411,840.0
GIRSANG
51 RD20220413-0014 13/04/2022 EP20220413-0011 2022041300020 ORLANDO SAPUTRA 42,472.0

SIMANJUNTAK
52 RD20220413-0015 13/04/2022 EP20220413-0012 2022041300021 SURYA SAPUTRA 430,799.0

(PREKURSOR)
R/ MYONAL 50 MG TAB 10.00 TAB 10,100.00 101,000.00 0 1
53 RD20220414-0003 14/04/2022 EP20220414-0003 2022041400003 MULIA HASAN 293,270.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
54 RD20220414-0004 14/04/2022 EP20220414-0004 2022041400005 MUHAMMAD ARIFIN 361,140.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

55 RD20220414-0005 14/04/2022 EP20220414-0005 2022041400008 TUMAIDE BR LUMBANBATU 95,375.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

(BPJS)
DEWASA
R/ FUROSEMIDE 10 MG/2 ML INJ 1.00 AMP 4,960.00 4,960.00 1 0
57 RD20220414-0007 14/04/2022 EP20220414-0004 2022041400011 MUHAMMAD ARIFIN 7,000.0
R/ ALLOPURINOL 300 MG TAB 10.00 TAB 700.00 7,000.00 1 0
R/ EXTENSION TUBE 150 CM X 1.00 PCS 62,943.75 62,943.00 0 1

1,5 ML
NEEDLE) ONEMED
R/ FUROSEMIDE 10 MG/2 ML INJ 5.00 AMP 4,960.00 24,800.00 1 0
60 RD20220414-0010 14/04/2022 EP20220414-0006 2022041400014 ERIKA CAHYA SUKMAWATI 199,155.0
61 RD20220414-0011 14/04/2022 EP20220414-0007 2022041400020 25,321.0

KAPLET
R/ COTRIMOXAZOLE 480 MG 20.00 TAB 550.00 11,000.00 1 0

TABLET
62 RD20220416-0004 16/04/2022 EP20220416-0002 2022041600004 PUTRI MINDO 34,894.0
63 RD20220416-0005 16/04/2022 EP20220416-0002 2022041600005 PUTRI MINDO 299,622.0
R/ VAKSIN VERORAB INJ 0.5 ML 1.00 VIAL 299,622.00 299,622.00 0 1
64 RD20220416-0006 16/04/2022 EP20220416-0003 2022041600006 SUTIKNO 314,476.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

SITUMEANG
66 RD20220416-0008 16/04/2022 EP20220416-0005 2022041600008 YULIA GUSTINA 164,884.0
67 RD20220416-0009 16/04/2022 EP20220416-0006 2022041600009 RITA JULIANA KRISTINA 150,123.0

CREAM
68 RD20220418-0027 18/04/2022 EP20220418-0024 2022041800037 MUHAMMAD RONALDO 394,209.0
70 RD20220420-0005 20/04/2022 EP20220420-0002 2022042000006 ANNEKE FELICIA DAELY 248,472.0
R/ BUFECT FORTE SYR 1.00 FLS 27,500.00 27,500.00 0 1
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ THROMBOPHOB GEL 1.00 TUBE 68,063.00 68,063.00 0 1
71 RD20220421-0002 21/04/2022 EP20220421-0002 2022042100003 DELROY VERDYANTO 1,001.0

SIGALINGGING
R/ VITAMIN C XON-CE KAPLET 1.00 KAPLET 1.00 1.00 1,001.00 0 1
72 RD20220421-0003 21/04/2022 EP20220421-0003 2022042100004 HELDERIKA SILITONGA 369,340.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
73 RD20220421-0004 21/04/2022 EP20220421-0005 2022042100005 RUDI ARDIAN 249,860.0
74 RD20220421-0005 21/04/2022 EP20220421-0005 2022042100006 RUDI ARDIAN 92,430.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
75 RD20220421-0006 21/04/2022 EP20220421-0006 2022042100007 ARIF RAHMAN ALI MS 272,046.0
76 RD20220421-0007 21/04/2022 EP20220421-0007 2022042100008 ABDUL AZAM ESKORTA 116,741.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
77 RD20220421-0008 21/04/2022 EP20220421-0009 2022042100013 IBROHIM 182,236.0

(PREKURSOR)

CAPSUL
78 RD20220421-0009 21/04/2022 EP20220421-0008 2022042100010 MAULANA REYHAN AZ-ZIQRA 128,991.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
79 RD20220421-0010 21/04/2022 EP20220421-0004 2022042100014 JERMINA SILALAHI 11,100.0

500MG/5ML

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
81 RD20220422-0003 22/04/2022 EP20220422-0001 2022042200007 INDAH RAHMA FIRTI 97,513.0

DEWASA
(BPJS)
82 RD20220422-0004 22/04/2022 EP20220422-0001 2022042200008 INDAH RAHMA FIRTI 206,999.0
R/ LASAL 4 MG CAPSUL 10.00 CAP 2,200.00 22,000.00 0 0
R/ METHYLPREDNISOLONE 8 MG 10.00 TAB 789.80 7,898.00 1 0

TAB

(PREKURSOR)
CAPSUL
83 RD20220422-0005 22/04/2022 EP20220422-0002 2022042200009 SUYETNO 11,050.0

MINIDOSE
84 RD20220422-0006 22/04/2022 EP20220422-0003 2022042200010 JHON ANDRYANTO SILAEN 376,675.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
85 RD20220422-0007 22/04/2022 EP20220422-0004 2022042200011 IMRON ROSIDI 53,323.0
86 RD20220423-0009 23/04/2022 EP20220423-0008 2022042300013 NURCAH 78,088.0

AYA
TAMBUN
R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00
AN 40,838.00 1 0
R/ IBUPROFEN 60 ML SYR 1.00 FLS 4,725.00 4,725.00 1 0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
87 RD20220423-0010 23/04/2022 EP20220423-0009 2022042300014 NUR HOLISEH 279,460.0

88 RD20220423-0011 23/04/2022 EP20220423-0011 2022042300015 STEVEN ARYA WIJAYA 9,973.0

SAMOSIR

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

(BPJS)
89 RD20220423-0012 23/04/2022 EP20220423-0010 2022042300016 RAHEL SAMOSIR 140,325.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
90 RD20220423-0013 23/04/2022 EP20220423-0011 2022042300017 STEVEN ARYA WIJAYA 163,264.0

SAMOSIR
R/ SANMOL F SYR 60ML 1.00 BTL 37,101.00 37,101.00 0 1
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
91 RD20220423-0015 23/04/2022 EP20220423-0012 2022042300018 PUTRI KIRANTI 448,693.0
R/ MOTADERM 10 GR CREAM 1.00 TUBE 89,375.00 89,375.00 0 1
R/ IBUPROFEN 400 MG TAB 1.00 TAB 513.50 513.00 1 0
92 RD20220423-0016 23/04/2022 EP20220423-0013 2022042300019 NUR AZMI 453,612.0
93 RD20220424-0008 24/04/2022 EP20220424-0009 2022042400012 NOVITA ANGLELINA 72,365.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0
94 RD20220424-0009 24/04/2022 EP20220424-0008 2022042400014 LAZARUS KASAMILALE 11,100.0

500MG/5ML
95 RD20220424-0010 24/04/2022 EP20220424-0010 2022042400019 RAHMAT KRISTIAN 491,577.0
PANGARIBUAN

(PREKURSOR)

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
96 RD20220424-0011 24/04/2022 EP20220424-0011 2022042400020 AYU RISMA ARFIANTI 98,796.0
97 RD20220424-0012 24/04/2022 EP20220424-0012 2022042400021 RAHMAT PRATAMA 5,135.0
98 RD20220427-0001 27/04/2022 EP20220427-0001 2022042700001 JOSUA ADIPUTRA BOY 101,384.0

(BPJS)
R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 481.54 4,815.00 1 0

(BPJS)
102 RD20220427-0006 27/04/2022 EP20220427-0004 2022042700006 BENNY MARSAULI BR 411,675.0
PASARIBU
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
103 RD20220427-0018 27/04/2022 EP20220427-0016 2022042700027 INTAN ISNAWATI 411,675.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
104 RD20220427-0019 27/04/2022 EP20220427-0017 2022042700028 FITRI KARLISA 376,675.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
105 RD20220428-0001 28/04/2022 EP20220428-0001 2022042800001 RISKA WAHYUNI 169,615.0
106 RD20220428-0002 28/04/2022 EP20220428-0002 2022042800003 WILLIAM WILSON SINAGA 116,848.0
107 RD20220428-0003 28/04/2022 EP20220428-0003 2022042800004 LEDRA FREDERICA TANIA 97,056.0

SIAGIAN
R/ ELEKTRODY EKG ANAK 6.00 PCS 13,066.00 78,396.00 0 1

SKINTACT
108 RD20220429-0001 29/04/2022 EP20220429-0002 2022042900011 135,626.0

(BPJS)
INJEKSI
109 RD20220429-0002 29/04/2022 EP20220429-0003 2022042900004 KEVIN ANTONY KASAMILALE 96,124.0

110 RD20220429-0003 29/04/2022 EP20220429-0007 2022042900005 VALENTINO SIRUMAPEA 8,329.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

KAPLET
111 RD20220429-0004 29/04/2022 EP20220429-0006 2022042900006 VINCENT SIRUMAPEA 3,875.0

KAPLET
112 RD20220429-0005 29/04/2022 EP20220429-0005 2022042900007 SITI ROHANI SIAHAAN 5,135.0
113 RD20220429-0006 29/04/2022 EP20220429-0004 2022042900008 ZYLGWYN GYOENZO LUMBAN 1,000.0

SIANTAR
SALBUTAMOL 4 MG TAB 5.00 TAB 161.50 0.00 1 0
114 RD20220429-0007 29/04/2022 EP20220429-0009 2022042900009 MUHAMMAD NUR KM 178,545.0
115 RD20220429-0008 29/04/2022 EP20220429-0008 2022042900010 LEGI ZERO PUTRA 443,689.0
116 RJ20220406-0003 06/04/2022 OP20220406-0006 2022040600003 MUHAMMAD HAIKAL 95,787.0

TAB
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
118 RJ20220406-0006 06/04/2022 OP20220406-0008 2022040600009 HOTMAROJAHAN SARAGIH 14,210.0

KAPLET
119 RJ20220419-0001 19/04/2022 OP20220419-0002 2022041900001 SHINTYA RATU ARINA 2,750.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
120 RJ20220419-0002 19/04/2022 OP20220419-0004 2022041900002 GENKY BERDO KAREL 470,179.0
121 RJ20220419-0005 19/04/2022 OP20220419-0010 2022041900006 WILDA GABRIELSA SIREGAR 456,424.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
122 RJ20220419-0007 19/04/2022 OP20220419-0011 2022041900008 AZALEA ZIVARATUL HUSNA 57,412.0

DROP
123 RJ20220419-0008 19/04/2022 OP20220419-0012 2022041900009 RIDHO KURNIA PRATAMA 261,985.0

(PREKURSOR)
CAPSUL
124 RJ20220419-0009 19/04/2022 OP20220419-0013 2022041900010 NELA AGUSTIANI 490,220.0

CAPSUL
Total Dokter DR. FELIX VALERIAN HALIM 20,115,707.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. GINA ARIANI, SP.PD
1 RI20220401-0001 01/04/2022 RI20220331-0003 RI20220401-0001 SUMITRO SIMAMORA 86,930.0
R/ ELEKTRODY EKG ANAK 5.00 PCS 13,066.00 65,330.00 0 1

SKINTACT
2 RI20220401-0002 01/04/2022 RI20220331-0002 RI20220401-0002 ARDIAN KUKUH MUKTI 24,360.0
WIJAYA
3 RI20220401-0003 01/04/2022 RI20220330-0002 RI20220401-0003 HERI OKTAVIANUS 776.0

KAPLET
4 RI20220401-0004 01/04/2022 RI20220331-0001 RI20220401-0004 ADITYA CHANDRA 456,522.0
R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1
R/ IMUNVIT PLUS KAPLET 1.00 KAPLET 10,935.00 10,935.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

WIJAYA
6 RI20220401-0006 01/04/2022 RI20220330-0002 RI20220401-0006 HERI OKTAVIANUS 125,094.0
R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

(BPJS)
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

KAPLET

TAB
8 RI20220401-0008 01/04/2022 RI20220401-0001 RI20220401-0008 CHORNALIUS BLEGUR 43,827.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RL 500 ML INF 3.00 FLS 8,754.00 26,262.00 0 1
9 RI20220401-0010 01/04/2022 RI20220331-0001 RI20220401-0010 ADITYA CHANDRA 348,885.0
10 RI20220401-0011 01/04/2022 RI20220331-0002 RI202204 ARDIAN KUKUH MUKTI 254.0

01-0011 WIJAYA
R/ NALD 25 (ONEMED) 1.00 PCS 254.00 254.00 0 1
12 RI20220401-0013 01/04/2022 RI20220331-0003 RI20220401-0013 SUMITRO SIMAMORA 729.0
R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0
R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

WIJAYA

KAPLET

(BPJS)

TABLET

KAPLET
(BPJS)

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
18 RI20220402-0006 02/04/2022 RI20220331-0003 RI20220402-0006 SUMITRO SIMAMORA 729.0

WIJAYA
R/ AQUADES 25 ML 75.00 CC 355.00 26,625.00 0 1
R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

WIJAYA

TAB


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1
31 RI20220405-0012 05/04/2022 RI20220405-0003 RI20220405-0012 JOGI MARIANUS SIHOTANG 639,549.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ PANLOC INJ 2.00 VIAL 211,200.00 422,400.00 0 1
R/ MEMUCIL 600 MG 1.00 TAB 11,688.00 11,688.00 0 1

EFFERVESCENT
R/ NALD 25 (ONEMED) 1.00 PCS 254.00 254.00 0 1
R/ EPISAN 100 ML SYR 1.00 FLS 70,541.00 70,541.00 0 1
R/ MEMUCIL 600 MG 1.00 TAB 11,688.00 11,688.00 0 1

EFFERVESCENT
(OOT)
R/ MEMUCIL 600 MG 5.00 TAB 11,688.00 58,440.00 0 1

EFFERVESCENT
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ LANSOPRAZOL 30 MG INJ 1.00 VIAL 126,720.00 126,720.00 1 0
R/ BIOCEF 1 GR INJ 1.00 VIAL 197,120.00 197,120.00 0 1
R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1
R/ LESICHOL 300 MG CAP 3.00 CAP 15,600.00 46,800.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ MEMUCIL 600 MG 1.00 TAB 11,688.00 11,688.00 0 1

EFFERVESCENT

KAPLET
R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1
R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1
R/ MEMUCIL 600 MG 1.00 TAB 11,688.00 11,688.00 0 1

EFFERVESCENT
R/ SANMOL 500 MG TABLET 1.00 TAB 422.00 422.00 0 1
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ BRAXIDIN TABLET 3.00 TAB 1,523.00 4,569.00 0 0

(PSIKOTROPIKA)
R/ IMUNVIT KAPLET 1.00 KAPLET 6,910.00 6,910.00 0 0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
44 RI20220407-0029 07/04/2022 RI20220407-0001 RI20220407-0029 DAVID JULVEN LUMBAN 21,600.0

TORUAN

TORUAN


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

TORUAN

KAPLET
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
51 RI20220409-0005 09/04/2022 RI20220409-0001 RI20220409-0005 ADELLA FEBRA ERION 62,030.0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
54 RI20220409-0013 09/04/2022 RI20220409-0001 RI20220409-0013 ADELLA FEBRA ERION 728.0

R/ RAMIPRIL 5 MG TAB (BPJS) 5.00 TAB 577.27 2,886.00 1 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
57 RI20220409-0020 09/04/2022 RI20220407-0001 RI20220409-0020 DAVID JULVEN LUMBAN 387.0

TORUAN

KAPLET

TORUAN

TORUAN

KAPLET
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

(PSIKOTROPIKA)

KAPLET
64 RI20220412-0016 12/04/2022 RI20220412-0002 RI20220412-0016 DAFFA MUARIF 99,783.0
R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

KAPLET
R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1
R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
68 RI20220413-0005 13/04/2022 RI20220413-0001 RI20220413-0005 DEDI ANTONI 375,325.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ KAPAS 6.00 PCS 302.50 1,815.00 0 1

ALKOHOL
R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ ESTIN 10 MG TAB 1.00 TAB 5,913.60 5,913.00 0 1

(PSIKOTROPIKA)

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ CETIRIZINE 10 MG TAB 2.00 TAB 475.00 950.00 1 0
R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT

(PSIKOTROPIKA)
R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT

KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ PANTOMEX 40 MG/ ML INJ 1.00 VIAL 199,375.00 199,375.00 0 1

(PSIKOTROPIKA)

(PREKURSOR)
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
79 RI20220414-0013 14/04/2022 RI20220412-0002 RI20220414-0013 DAFFA MUARIF 950.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1
R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT
82 RI20220415-0001 15/04/2022 RI20220415-0001 RI20220415-0001 DEWI SARTIKA SILABAN 183,169.0

TABLET
KAPLET
R/ ONDANSETRON 8 MG INJ 2.00 AMP 23,000.00 46,000.00 1 0

(BPJS)
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ FG TROCHES TAB HISAP 4.00 TAB 1,640.00 6,560.00 0 0

(PSIKOTROPIKA)
R/ PANTOMEX 40 MG/ ML INJ 1.00 VIAL 199,375.00 199,375.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

KAPLET
TABLET
(BPJS)

(PREKURSOR)
R/ OPICEF 500 MG KAPSUL 10.00 CAP 14,080.00 140,800.00 0 1

(PSIKOTROPIKA)

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
90 RI20220416-0001 16/04/2022 RI20220416-0002 RI20220416-0001 TITO NELSON TARIGAN 398,292.0

INJEKSI
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ AQUADEST 1000 ML 1.00 FLS 27,113.29 27,113.00 1 0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ THREE WAY STOP CO-CKS 1.00 PCS 31,460.00 31,460.00 0 1
R/ KASA GULUNG KECIL 15 CM 4.00 ROLL 5,167.80 20,671.00 0 1

INJEKSI
R/ ATROPIN SULFAS INJ 1.00 AMP 3,375.00 3,375.00 1 0

R/ SEDACUM INJ 15MG/3ML 9.00 CC 25,911.67 233,205.00 0 0
(PSIKOTROPIKA
R/ ETT SIZE 7.5 RUSCH + BALON 1.00 PCS 84,500.00 84,500.00 1 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ FENTANYL 0.05 MG/ML, 2 ML 4.00 CC 30,250.00 121,000.00 0 0

INJEKSI (NARKOTIKA)
R/ EPHEDRIN HCL INJ (PREK) 1.00 AMP 5,896.40 5,896.00 0 0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ HANDSCOEN STERILE (7.0) 2.00 PCS 10,900.00 21,800.00 1 0
R/ ATRACURIUM BESILATE 50 1.00 AMP 57,750.00 57,750.00 1 0

MG/5 ML INJEKSI

TABLET

KAPLET
R/ DEXTROSE 5% 500 ML INF 2.00 FLS 9,371.60 18,743.00 0 1
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1

500MG/5ML
99 RI20220417-0001 17/04/2022 RI20220417-0001 RI20220417-0001 RAULI 21,600.0

TABLET

KAPLET
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
102 RI20220417-0005 17/04/2022 RI20220417-0002 RI20220417-0005 PATROUW DIRK 7,328.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ ALPRAZOLAM 0,5 MG TAB 1.00 TAB 789.75 789.00 0 0

(PSI)
R/ CODEIN 10 MG TAB 3.00 TAB 924.70 2,774.00 0 0
(NARKOTIKA)
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1
105 RI20220418-0002 18/04/2022 RI20220417-0001 RI20220418-0002 RAULI 28,928.0

(BPJS)
TABLET
(NARKOTIKA)
KAPLET
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

TABLET

(NARKOTIKA)

KAPLET
110 RI20220418-0009 18/04/2022 RI20220417-0001 RI20220418-0009 RAULI 4,569.0

(PSIKOTROPIKA)
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
111 RI20220418-0013 18/04/2022 RI20220417-0001 RI20220418-0013 RAULI 4,303.0
113 RI20220418-0017 18/04/2022 RI20220417-0001 RI20220418-0017 RAULI 2,957.0

(PSIKOTROPIKA)
116 RI20220419-0005 19/04/2022 RI20220417-0001 RI20220419-0005 RAULI 15,233.0

(PSIKOTROPIKA)

(BPJS)
TAB
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
119 RI20220419-0013 19/04/2022 RI20220419-0005 RI20220419-0013 ROSMAWATY SINAGA 48,111.0

KAPLET
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ CURCUMA FCT TAB 1.00 TAB 885.00 885.00 0 1


KAPLET
Kav.
Sungai
Kec. Sagulung
Lekop
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685
Kel.
Sungai
Lekop Laporan Penjualan Resep Rawat Inap Per Dokter


Formula Non Formula
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

(PSIKOTROPIKA)

DEWASA
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

KAPLET

TAB

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
131 RI20220421-0019 21/04/2022 RI20220421-0001 RI20220421-0019 HENDRA SANTO KIROYAN 642,065.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

TABLET

1GR/100 ML
134 RI20220421-0025 21/04/2022 RI20220421-0004 RI20220421-0025 SUMARNI 21,674.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
135 RI20220422-0001 22/04/2022 RI20220421-0001 RI20220422-0001 HENDRA SANTO KIROYAN 387.0

KAPLET

KAPLET

R/ PARAMOL 1GR/100 ML INF 3.00 FLS 96,250.00 288,750.00 0 1
139 RI20220422-0010 22/04/2022 RI20220421-0004 RI20220422-0010 SUMARNI 8,850.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

KAPLET

TABLET
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

KAPLET
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ COTRIMOXAZOLE 480 MG 1.00 TAB 550.00 550.00 1 0

TABLET
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
152 RI20220423-0011 23/04/2022 RI20220421-0001 RI20220423-0011 HENDRA SANTO KIROYAN 1,008,277.0
R/ SANMOL INFUS 3.00 FLS 86,029.00 258,087.00 0 1
154 RI20220423-0013 23/04/2022 RI20220423-0002 RI20220423-0013 ANYUN 124,077.0
R/ DEXKETOPROFEN 25MG/ML 3.00 AMP 33,792.00 101,376.00 1 0

INJ
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
155 RI20220423-0014 23/04/2022 RI20220423-0002 RI20220423-0014 ANYUN 1,770.0

TABLET
158 RI20220424-0007 24/04/2022 RI20220423-0002 RI20220424-0007 ANYUN 32,900.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

(PSIKOTROPIKA)
161 RI20220424-0020 24/04/2022 RI20220424-0001 RI20220424-0020 LAZARUS KASAMILALE 59,561.0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

500MG/5ML
162 RI20220425-0002 25/04/2022 RI20220424-0001 RI20220425-0002 LAZARUS KASAMILALE 50,807.0

500MG/5ML
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
163 RI20220425-0003 25/04/2022 RI20220423-0002 RI20220425-0003 ANYUN 15,414.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
164 RI20220425-0006 25/04/2022 RI20220425-0001 RI20220425-0006 MARIA YANTIMAS 293.0
R/ FUROSEMIDE 40 MG TAB 1.00 TAB 293.50 293.00 1 0
165 RI20220425-0007 25/04/2022 RI20220423-0002 RI20220425-0007 ANYUN 67,680.0

R/ URSODEOXYCHOLIC ACID 250 10.00 CAP 6,237.00 62,370.00 1 0
MG

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
167 RI20220425-0011 25/04/2022 RI20220425-0001 RI20220425-0011 MARIA YANTIMAS 23,918.0
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
169 RI20220426-0005 26/04/2022 RI20220426-0001 RI20220426-0005 PUTRI MARSHANDA 65,700.0

500MG/5ML
171 RI20220426-0011 26/04/2022 RI20220426-0003 RI20220426-0011 TUMBUR PARDEDE 124,292.0

(BPJS)
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

TABLET
172 RI20220426-0012 26/04/2022 RI20220426-0001 RI20220426-0012 PUTRI MARSHANDA 526,090.0

TAB

KAPLET

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

TABLET
(BPJS)
R/ NEW 6.00 TAB 696.44 4,178.00 0 1

DIATAB
177 RI20220428-0002
TABLET 28/04/2022 RI20220426-0003 RI20220428-0002 TUMBUR PARDEDE 31,114.0

TABLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0
R/ NIFEDIPINE 10 MG TAB 1.00 TAB 207.69 207.00 1 0
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ FUROSEMIDE 40 MG TAB 10.00 TAB 293.50 2,935.00 1 0
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
185 RJ20220405-0002 05/04/2022 OP20220405-0004 2022040500002 FELISITAS SEKU 8,491.0
R/ SIMVASTATIN 20 MG TAB 7.00 TAB 1,213.00 8,491.00 1 0
186 RJ20220405-0003 05/04/2022 OP20220405-0004 2022040500003 FELISITAS SEKU 27,899.0
R/ SIMVASTATIN 20 MG TAB 23.00 TAB 1,213.00 27,899.00 1 0
187 RJ20220406-0005 06/04/2022 OP20220406-0005 2022040600007 YASINTA LONA BADHE 7,800.0
188 RJ20220407-0001 07/04/2022 OP20220407-0002 2022040700002 HARIMAN LUMBAN GAOL 5,140.0
189 RJ20220407-0002 07/04/2022 OP20220407-0001 2022040700004 DAVID JULVEN LUMBAN 75,553.0

TORUAN

KAPLET
190 RJ20220407-0003 07/04/2022 OP20220407-0004 2022040700005 LASMA SINAGA 8,655.0
191 RJ20220409-0006 09/04/2022 OP20220409-0007 2022040900007 AGUS BANI 424,634.0
R/ URSODEOXYCHOLIC ACID 250 20.00 CAP 6,237.00 124,740.00 1 0

MG
192 RJ20220411-0011 11/04/2022 OP20220411-0010 2022041100013 PINTOR SIMANGUNSONG 630,515.0
R/ METFORMIN 850 MG TAB 90.00 TAB 600.60 54,054.00 1 0
R/ GLIMEPIRIDE 3 MG TAB 30.00 TAB 2,931.20 87,936.00 1 0
R/ SIMTIN 300 MG CAPSUL 20.00 CAP 14,000.00 280,000.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
193 RJ20220412-0005 12/04/2022 OP20220412-0004 2022041200006 JAUSIN SIMARE MARE 284,773.0
R/ NEUROSANBE 5000 MG TAB 20.00 TAB 3,513.13 70,262.00 0 1
R/ NOVORAPID FLEXPEN 1.00 VIAL 97,636.36 97,636.00 0 1
R/ MEMUCIL 600 MG 10.00 TAB 11,687.50 116,875.00 0 1

EFFERVESCENT
194 RJ20220412-0007 12/04/2022 OP20220412-0006 2022041200010 YOHANES NGAJO 771,722.0
R/ NEUROSANBE 5000 MG TAB 20.00 TAB 3,513.13 70,262.00 0 1
195 RJ20220413-0012 13/04/2022 OP20220413-0014 2022041300016 SARDIONO HUTABARAT 220,000.0
R/ OPIVASK 10 MG TAB 20.00 TAB 11,000.00 220,000.00 0 1
196 RJ20220414-0001 14/04/2022 OP20220414-0001 2022041400001 LASMA SINAGA 8,081.0
197 RJ20220414-0004 14/04/2022 OP20220414-0005 2022041400003 BENNY MARSAULI BR 280,798.0

PASARIBU
R/ MAXTAN 500 MG TABLET 20.00 TAB 1,718.80 34,376.00 1 0
198 RJ20220414-0005 14/04/2022 OP20220414-0006 2022041400004 MARIANUS PEHAN HEWEN 4,040.0
199 RJ20220416-0003 16/04/2022 OP20220416-0002 2022041600003 JOGI MARIANUS SIHOTANG 244,177.0

(PREKURSOR)
200 RJ20220418-0002 18/04/2022 OP20220418-0002 2022041800002 SUDIN 28,690.0
201 RJ20220418-0004 18/04/2022 OP20220418-0009 2022041800004 AMINAH 80,909.0
202 RJ20220418-0005 18/04/2022 OP20220418-0009 2022041800005 AMINAH 80,909.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
203 RJ20220418-0007 18/04/2022 OP20220418-0011 2022041800007 MARIA YANTIMAS 7,702.0
204 RJ20220419-0003 19/04/2022 OP20220419-0003 2022041900004 TUGIMIN 24,616.0
R/ PROPRANOLOL 10 MG TAB 15.00 TAB 1,239.70 18,595.00 1 0

(BPJS)
R/ SPIRONOLACTON 25 MG TAB 15.00 TAB 264.50 3,967.00 1 0
R/ FUROSEMIDE 40 MG TAB 7.00 TAB 293.50 2,054.00 1 0
205 RJ20220419-0006 19/04/2022 OP20220419-0009 2022041900007 PINTOR SIMANGUNSONG 468,000.0
206 RJ20220420-0007 20/04/2022 OP20220420-0001 2022042000009 JEANY RUNTUWEWE 80,909.0
207 RJ20220420-0008 20/04/2022 OP20220420-0001 2022042000010 JEANY RUNTUWEWE 101,209.0
208 RJ20220420-0011 20/04/2022 OP20220420-0011 2022042000013 MUWANTI 8,850.0
209 RJ20220421-0002 21/04/2022 OP20220421-0002 2022042100015 LASMA SINAGA 0.0
R/ RAMIPRIL 10 MG TAB (BPJS) 7.00 TAB 0.00 0.00 1 0
210 RJ20220421-0003 21/04/2022 OP20220421-0002 2022042100014 LASMA SINAGA 0.0
R/ RAMIPRIL 10 MG TAB (BPJS) 23.00 TAB 0.00 0.00 1 0

KAPLET
213 RJ20220421-0015 21/04/2022 OP20220421-0014 2022042100013 KHRISTOPER SITOMPUL 13,750.0
214 RJ20220422-0006 22/04/2022 OP20220422-0004 2022042200007 ANWAR LUMBAN TORUAN 82,927.0

TAB

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
215 RJ20220422-0007 22/04/2022 OP20220422-0004 2022042200008 ANWAR LUMBAN TORUAN 80,909.0
216 RJ20220422-0009 22/04/2022 OP20220422-0013 2022042200011 DEWI SARTIKA SILABAN 74,463.0

TABLET
217 RJ20220422-0010 22/04/2022 OP20220422-0016 2022042300008 LINAWATI LAIA 24,413.0

TAB
R/ PTU 100 MG TAB (BPJS) 7.00 TAB 694.90 4,864.00 1 0
218 RJ20220423-0004 23/04/2022 OP20220423-0006 2022042300005 BUDIONO 34,350.0
219 RJ20220423-0005 23/04/2022 OP20220422-0016 2022042300007 LINAWATI LAIA 15,982.0
R/ PTU 100 MG TAB (BPJS) 23.00 TAB 694.90 15,982.00 1 0
220 RJ20220425-0004 25/04/2022 OP20220425-0002 2022042500005 TRIANI 80,909.0
221 RJ20220425-0005 25/04/2022 OP20220425-0002 2022042500006 TRIANI 161,818.0
222 RJ20220425-0007 25/04/2022 OP20220425-0006 2022042500020 MARIA YANTIMAS 13,708.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

INJ (BPJS)
223 RJ20220425-0010 25/04/2022 OP20220425-0013 2022042500021 LA ODE NASRIN 848,737.0
R/ SIMTIN 300 MG CAPSUL 15.00 CAP 13,062.50 195,937.00 0 1
R/ FENOFIBRATE 300 MG CAPS 30.00 CAP 6,160.00 184,800.00 1 0
224 RJ20220426-0007 26/04/2022 OP20220426-0007 2022042600007 JETTY ROSALINA HUTASOIT 28,220.0

225 RJ20220426-0008 26/04/2022 OP20220426-0007 2022042600008 JETTY ROSALINA HUTASOIT 67,417.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
226 RJ20220426-0014 26/04/2022 OP20220426-0009 2022042600020 SUPOYO 95,063.0

TAB
227 RJ20220427-0016 27/04/2022 OP20220427-0019 2022042700017 NUR HOLISEH 7,012.0
Total Dokter DR. GINA ARIANI, SP.PD 24,304,113.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. HENDRIK, SP.PD
1 RI20220429-0001 29/04/2022 RI20220429-0001 RI20220429-0001 DEDI KOMARUDIN 138,189.0
R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 0 1

INJEKSI
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

Total Dokter DR. HENDRIK, SP.PD 286,876.0
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. SHINLY MEIVINITA GINTING
1 RD20220403-0005 03/04/2022 EP20220403-0004 2022040300008 FRANSISKUS MBAHANG 136,895.0
2 RD20220403-0006 03/04/2022 EP20220403-0005 2022040300009 HALIMAH FITRI BATAMI 236,965.0
R/ FREGO 5 MG TAB 5.00 TAB 8,448.00 42,240.00 0 0
R/ LANAKELOID 10 GR CREAM 1.00 TUBE 128,000.00 128,000.00 0 1
3 RD20220403-0007 03/04/2022 EP20220403-0006 2022040300010 PASYA DENI WIJAYA 268,950.0

SITUMEANG
5 RD20220404-0002 04/04/2022 EP20220404-0003 2022040400004 SRI RAHAYU 167,167.0
6 RD20220405-0004 05/04/2022 EP20220405-0005 2022040500005 MARTODO D. SIMANUNGKALIT 298,935.0
R/ BISTURI NO. 22 1.00 PCS 5,610.00 5,610.00 0 1
7 RD20220405-0005 05/04/2022 EP20220405-0004 2022040500006 MUHARJO 122,690.0
R/ ESTIN 10 MG TAB 10.00 TAB 0.00 59,140.00 0 1
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 0.00 18,800.00 0 1
R/ ARTIMAX KAP 5.00 KAPLET 0.00 44,750.00 0 1
8 RD20220405-0006 05/04/2022 EP20220405-0006 2022040500010 HERUL PUTRA SEWANG 236,313.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Period
e : 01-
April- Jenis resep : Rawat Darurat
2022
s/d
R/30- Nama Item Qty Satuan Harga Jumlah Generik Non Gene
April- Formula Non Formula
2022
9 RD20220405-0007 05/04/2022 EP20220405-0006 2022040500011 HERUL PUTRA SEWANG 293,325.0
10 RD20220405-0008 05/04/2022 EP20220405-0007 2022040500013 RENDY AXINDO SIHOMBING 209,602.0
11 RD20220405-0009 05/04/2022 EP20220405-0005 2022040500014 MARTODO D. SIMANUNGKALIT 3,818.0
12 RD20220405-0010 05/04/2022 EP20220405-0009 2022040500016 ROHANI MAGDALENA 13,750.0

NABABAN
13 RD20220405-0011 05/04/2022 EP20220405-0008 2022040500017 BIMA SAPUTRA SIMANJUNTAK 320,830.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
14 RD20220406-0001 06/04/2022 EP20220406-0001 2022040600001 ENJELINA TUMANGGOR 49,250.0
R/ COMBANTRIN SYR 10 ML 1.00 FLS 19,850.00 19,850.00 0 1
R/ L BIO SACHET 3.00 SACH 9,800.00 29,400.00 0 1
15 RD20220406-0002 06/04/2022 EP20220406-0003 2022040600002 PUTRI RAMADHAN 463,400.0
R/ VENOSMIL GEL 1.00 TUBE 224,000.00 224,000.00 0 1
R/ ANADIUM KAPLET 10.00 KAPLET 11,200.00 112,000.00 0 1
R/ BORAGINOL N SUPP 3.00 SUPP 15,800.00 47,400.00 0 1
16 RD20220408-0009 08/04/2022 EP20220408-0008 2022040800016 DIMAS ARYA PUTRA 30,976.0
R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1
17 RD20220408-0010 08/04/2022 EP20220408-0007 2022040800017 NAZRIEL GALANG PRATAMA 30,976.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
18 RD20220408-0011 08/04/2022 EP20220408-0008 2022040800018 DIMAS ARYA PUTRA 162,106.0
19 RD20220408-0012 08/04/2022 EP20220408-0009 2022040800019 OKTARIANI 123,599.0
R/ TREMENZA TABLET 6.00 TAB 2,000.63 12,003.00 0 1

(PREKURSOR)
20 RD20220408-0013 08/04/2022 EP20220408-0012 2022040800025 DAPOT SIHOMBING 73,563.0
R/ BURNAZIN 35 GR CREAM 1.00 TUBE 73,563.00 73,563.00 0 1
21 RD20220408-0014 08/04/2022 EP20220408-0010 2022040800026 VENNY MALINDRA 137,995.0
22 RD20220408-0016 08/04/2022 EP20220408-0014 2022040800028 DORMAN MARUSAHA GULTOM 151,733.0
23 RD20220408-0017 08/04/2022 EP20220408-0015 2022040800029 ANGELINA KATARINA BUNGA 312,147.0

SOGEN
R/ CLINDAMYCIN 150 MG CAP 10.00 CAP 1,076.20 10,762.00 1 0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
24 RD20220408-0019 08/04/2022 EP20220408-0016 2022040800031 MIKAWANI SARAGIH 48,262.0
25 RD20220408-0020 08/04/2022 EP20220408-0007 2022040800032 NAZRIEL GALANG PRATAMA 24,500.0
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
26 RD20220408-0021 08/04/2022 EP20220408-0016 2022040800033 MIKAWANI SARAGIH 70,400.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
27 RD20220408-0022 08/04/2022 EP20220408-0017 2022040800034 RAMSES SIANTURI 232,272.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
R/ CLINDAMYCIN 150 MG CAP 10.00 CAP 1,076.20 10,762.00 1 0
28 RD20220408-0023 08/04/2022 EP20220408-0018 2022040800035 HAVIKA ADAWIYAH HARAHAP 142,439.0
R/ SANMOL 500 MG TABLET 5.00 TAB 1.00 422.40 13,939.00 0 1
ESTIN 10 MG TAB 2.00 TAB 5,913.60 0.00 0 1
29 RD20220408-0024 08/04/2022 EP20220408-0011 2022040800036 GISSELA BIANCA HUTASOIT 67,007.0
R/ STESOLID 5 MG/2.5 ML 1.00 TUBE 35,963.20 35,963.00 0 0

RECTAL TUBE
R/ D5 + 1/4 NS 500 ML ( WIDA )
(PSIKOTROPIKA) 1.00 FLS 24,544.00 24,544.00 0 1
30 RD20220408-0025 08/04/2022 EP20220408-0020 2022040800037 LELA SURAIDA 146,931.0

(PREKURSOR)
31 RD20220408-0026 08/04/2022 EP20220408-0021 2022040800038 FAWWAZ HAIDAR ISMAIL 239,063.0
R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1
R/ ALCO DROP (PREK) 1.00 FLS 117,563.00 117,563.00 0 1
32 RD20220408-0027 08/04/2022 EP20220408-0019 2022040800039 LUSIA DAMAI YANA MURNI 202,630.0

34 RD20220410-0008 10/04/2022 EP20220410-0008 2022041000012 74,863.0

(BPJS)
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
35 RD20220410-0009 10/04/2022 EP20220410-0009 2022041000010 SAMUEL 22,106.0
36 RD20220410-0010 10/04/2022 EP20220410-0008 2022041000011 MATTEO CHARLES IVANDER 900.0
R/ KERTAS PERKAMEN BERLOGO 9.00 LBR 1.00 100.00 900.00 0 1
37 RD20220410-0011 10/04/2022 EP20220410-0008 2022041000013 MATTEO CHARLES IVANDER 6,500.0
38 RD20220410-0012 10/04/2022 EP20220410-0011 2022041000015 RISNA PULUNGAN 289,630.0
39 RD20220410-0013 10/04/2022 EP20220410-0010 2022041000016 MAESAROH ADI GALIH 324,630.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
40 RD20220411-0004 11/04/2022 EP20220411-0004 2022041100004 RYANTI PASARIBU 253,386.0
41 RD20220411-0005 11/04/2022 EP20220411-0005 2022041100005 RODIAH WAHYUNI SIREGAR 266,434.0
42 RD20220411-0006 11/04/2022 EP20220411-0006 2022041100006 ROSIDAH MUNTE 266,434.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
43 RD20220411-0007 11/04/2022 EP20220411-0007 2022041100007 JONPRIT SIREGAR 77,759.0

DROP
44 RD20220411-0008 11/04/2022 EP20220411-0008 2022041100008 SERLY YANTONO SIBARANI 30,976.0
45 RD20220411-0009 11/04/2022 EP20220411-0008 2022041100009 SERLY YANTONO SIBARANI 407,310.0
46 RD20220411-0010 11/04/2022 EP20220411-0009 2022041100010 RIDWAN 21,964.0
47 RD20220411-0011 11/04/2022 EP20220411-0010 2022041100011 JOKO PAMILI 354,681.0

49 RD20220413-0002
DWS 13/04/2022 EP20220413-0002 2022041300002 DIAN MERY OKTAVIA MANALU 15,687.0

KAPLET
50 RD20220413-0003 13/04/2022 EP20220413-0003 2022041300003 DEDI ANTONI 56,980.0
R/ LODIA 2 MG TABLET 10.00 TAB 0.00 13,750.00 0 1
R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 0.00 30,976.00 0 1
R/ ANTASIDA DOEN SYR 1.00 FLS 0.00 7,800.00 1 0

51 RD20220418-0018 18/04/2022 EP20220418-0016 2022041800026 NURUL KOMARIYAH 335,630.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
52 RD20220418-0019 18/04/2022 EP20220418-0017 2022041800027 MANGIRING LUMBAN RAJA 290,309.0
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1
53 RD20220418-0020 18/04/2022 EP20220418-0018 2022041800030 MUHAMMAD LAIQ 76,750.0
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1
54 RD20220418-0021 18/04/2022 EP20220418-0020 2022041800031 SUSI SARTIKA HUTABARAT 211,200.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
55 RD20220418-0022 18/04/2022 EP20220418-0020 2022041800032 SUSI SARTIKA HUTABARAT 317,254.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
56 RD20220418-0023 18/04/2022 EP20220418-0021 2022041800033 SAHAT PARULIAN SIREGAR 211,200.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
57 RD20220418-0024 18/04/2022 EP20220418-0021 2022041800034 SAHAT PARULIAN SIREGAR 428,000.0
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1
58 RD20220418-0025 18/04/2022 EP20220418-0022 2022041800035 AMIRA RIZKI PUTRI 77,399.0
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1
59 RD20220418-0026 18/04/2022 EP20220418-0023 2022041800036 DICKY SERFINDO 237,925.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ FLUNARIZINE 5 MG TAB 2.00 TAB 1,760.00 3,520.00 1 0
61 RD20220419-0003 19/04/2022 EP20220419-0003 2022041900006 DEO ANGGA NATANAEL 58,438.0

SITANGGANG

1GR/100 ML
900008
R/ AMOXYCILLIN 125 ML SYR 1.00 BTL 8,250.00 8,250.00 1 0
R/ SALBUTAMOL 2 MG TAB 2.00 TAB 1.00 117.50 3,020.00 1 0
PARACETAMOL 500 MG 2.00 KAPLET 387.55 0.00 1 0

KAPLET
AMBROXOL 30 MG TAB 2.00 TAB 285.41 0.00 1 0
64 RD20220425-0013 25/04/2022 EP20220425-0012 2022042500015 IN NIULIPA 97,513.0

DEWASA
(BPJS)
65 RD20220425-0015 25/04/2022 EP20220425-0013 2022042500017 RONALDO FEBRYAN 275,605.0
66 RD20220425-0016 25/04/2022 EP20220425-0014 2022042500018 JONI 143,866.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ GUEDEL NASAL NO. 6/110 1.00 PCS 136,500.00 136,500.00 0 1

INJEKSI
R/ SUCTION CATHETER NO. 18 1.00 PCS 7,500.00 7,500.00 1 0

NEEDLE) ONEMED
R/ EXTENSION TUBE 150 CM X 1.00 PCS 62,943.75 62,943.00 0 1
1,5 ML
R/ NICARDIPINE 10 MG INJ 1.00 AMP 110,000.00 110,000.00 1 0
69 RD20220425-0019 25/04/2022 EP20220425-0016 2022042500023 HASMAULI MANALU 4,675.0
70 RD20220425-0020 25/04/2022 EP20220425-0017 2022042500024 ISHAK SALEH SIREGAR 364,707.0

(PREKURSOR)

72 RD20220425-0022 25/04/2022 EP20220425-0018 2022042500027 CHENG DONGQI 134,000.0
R/ EPHEDRIN HCL INJ (PREK) 1.00 AMP 5,896.40 5,896.00 0 0
R/ ATRACURIUM BESILATE 50 1.00 AMP 57,750.00 57,750.00 1 0

MG/5 ML INJEKSI
R/ SEDACUM INJ 5MG/5ML 5.00 CC 7,333.40 36,667.00 0 0
(PSIKOTROPIKA

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ ETT SIZE 7.5 RUSCH + BALON 1.00 PCS 84,500.00 84,500.00 1 0
R/ FENTANYL 0.05 MG/ML, 2 ML 2.00 CC 30,250.00 60,500.00 0 0

INJEKSI (NARKOTIKA)
74 RD20220426-0015 26/04/2022 EP20220426-0008 2022042600025 MARTINUS TARIGAN 30,976.0
75 RD20220426-0016 26/04/2022 EP20220426-0007 2022042600026 246,510.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

MINIDOSE
76 RD20220426-0017 26/04/2022 EP20220426-0008 2022042600027 MARTINUS TARIGAN 57,254.0
77 RD20220426-0018 26/04/2022 EP20220426-0009 2022042600028 ASHALINA KHANZA RAIQA 61,474.0
78 RD20220426-0019 26/04/2022 EP20220426-0010 2022042600029 AHMAD BUHARI 194,724.0
R/ MYONAL 50 MG TAB 10.00 TAB 10,100.00 101,000.00 0 1
79 RD20220426-0020 26/04/2022 EP20220426-0011 2022042600030 RAPMAIDA SIMARANGKIR 138,438.0

1GR/100 ML
(BPJS)
80 RD20220426-0021 26/04/2022 EP20220426-0011 2022042600031 RAPMAIDA SIMARANGKIR 12,474.0
81 RD20220426-0022 26/04/2022 EP20220426-0012 2022042600034 DEAN EDZHAR 42,144.0
R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 24,544.00 24,544.00 0 1
82 RD20220426-0023 26/04/2022 EP20220426-0012 2022042600036 DEAN EDZHAR 24,544.0
R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 24,544.00 24,544.00 0 1

83 RD20220426-0024 26/04/2022 EP20220426-0013 2022042600037 SHERLINA OCTAVIANI 311,371.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
84 RD20220426-0025 26/04/2022 EP20220426-0014 2022042600038 462,441.0
R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
85 RD20220429-0023 29/04/2022 EP20220429-0022 2022042900027 SHONIA WIDIA PUTRI 28,060.0

KAPLET
86 RD20220429-0024 29/04/2022 EP20220429-0023 2022042900028 MITA MELANI 224,910.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
87 RD20220430-0001 30/04/2022 EP20220430-0001 2022043000001 DENI WILSON PRATAMA 39,726.0

NAPITUPULU
R/ GENTALEX 5 MG CREAM 1.00 TUBE 5,000.00 5,000.00 0 1
88 RD20220430-0002 30/04/2022 EP20220430-0002 2022043000002 SUCIATI 3,080.0

TAB
89 RJ20220401-0001 01/04/2022 OP20220401-0006 2022040100001 WIKY ALEX SANDRA 560,915.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

90 RJ20220401-0003 01/04/2022 OP20220401-0007 2022040100003 HELDERIKA SILITONGA 469,102.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ ESTIN 10 MG TAB 10.00 TAB 5,914.00 59,140.00 0 1
92 RJ20220414-0002 14/04/2022 OP20220414-0002 2022041400002 ANGELO SIANTURI 197,158.0
R/ OTILON EAR DROP 1.00 FLS 54,278.00 54,278.00 0 1
R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1
R/ AMOXAN 500 MG CAPSUL 3.00 CAP 1.00 4,400.00 21,380.00 0 1
ESTIN 10 MG TAB 1.00 TAB 5,913.60 0.00 0 1
SANMOL 500 MG TABLET 3.00 TAB 422.40 0.00 0 1
93 RJ20220414-0007 14/04/2022 OP20220414-0008 2022041400006 EDI SUTIKNO 268,317.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
94 RJ20220414-0008 14/04/2022 OP20220414-0009 2022041400007 RAFI YANDO RAMDAN 355,110.0
95 RJ20220421-0001 21/04/2022 OP20220421-0001 2022042100001 GATOT SUBROTO 322,085.0

(PREKURSOR)
96 RJ20220421-0007 21/04/2022 OP20220421-0007 2022042100005 EDWARD ADIARTO SIAHAAN 89,901.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
97 RJ20220421-0008 21/04/2022 OP20220421-0006 2022042100006 JOSIKA MULIANI 276,144.0
R/ REGIT 10 MG TAB 6.00 TAB 4,200.00 25,200.00 0 1
98 RJ20220421-0010 21/04/2022 OP20220421-0008 2022042100008 BUDAYA 206,560.0
99 RJ20220421-0011 21/04/2022 OP20220421-0010 2022042100009 SYAFRI NALDI 254,438.0

(PREKURSOR)
100 RJ20220421-0012 21/04/2022 OP20220421-0011 2022042100010 WIDI SUHERMAN 195,380.0
101 RJ20220421-0013 21/04/2022 OP20220421-0012 2022042100011 BENNI OKINO 440,357.0

(PREKURSOR)
102 RJ20220421-0014 21/04/2022 OP20220421-0013 2022042100012 DEDI HERWANTO 397,129.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

103 RJ20220422-0003 22/04/2022 OP20220422-0005 2022042200003 ZURANISA AGUSTINI 158,161.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
104 RJ20220423-0002 23/04/2022 OP20220423-0005 2022042300003 WAFA ZOYA AZDKIYA 184,267.0
R/ IMUNOS 60 ML SIRUP 1.00 BTL 63,000.00 63,000.00 0 0

DROP
R/ ESTIN 10 ML DROP 1.00 BTL 84,480.00 84,480.00 0 1
105 RJ20220427-0002 27/04/2022 OP20220427-0003 2022042700002 HARI BUDI SANTOSO 227,844.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
106 RJ20220427-0004 27/04/2022 OP20220427-0005 2022042700004 ZHENG SHANEN 109,455.0
R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1
R/ DIPHENHYDRAMINE HCL INJ 1.00 AMP 2,062.50 2,062.00 1 0

10 MG/ML
R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1
107 RJ20220427-0009 27/04/2022 OP20220427-0012 2022042700009 ANGELO SIANTURI 146,738.0
R/ IMUNOS 60 ML SIRUP 1.00 BTL 63,000.00 ### 0 0
108 RJ20220427-0014 27/04/2022 OP20220427-0017 2022042700014 WILDAN AL GHIFARI 132,412.0
R/ IMUNVIT PLUS SYR 60 ML 1.00 BTL 85,000.00 85,000.00 0 1
109 RJ20220427-0018 27/04/2022 OP20220427-0020 2022042700019 ELKANA 251,675.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

Total Dokter DR. SHINLY MEIVINITA GINTING 19,500,206.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. STEVEN, SP.OG
1 RI20220404-0006 04/04/2022 RI20220404-0001 RI20220404-0006 VIA RAHELIA DAMANIK 57,545.0
R/ RL 500 ML INF 3.00 FLS 8,754.00 26,262.00 0 1
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1
6 RI20220412-0003 12/04/2022 RI20220411-0003 RI20220412-0003 NOPERIDA MANURUNG 136,261.0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

(BPJS)
500MG/5ML

500MG/5ML
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

500MG/5ML
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
11 RI20220419-0009 19/04/2022 RI20220419-0003 RI20220419-0009 EPRIANA SARAGIH 79,321.0
R/ KLEM TALI PUSAT 1.00 PCS 2,772.00 2,772.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ KASA STERIL 16 X 16 CM 1.00 KTK 11,880.00 11,880.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

500MG/5ML
R/ PRONALGES SUPPO 3.00 SUPP 15,500.00 46,500.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

500MG/5ML

KAPLET
17 RJ20220404-0011 04/04/2022 OP20220404-0005 2022040400011 JUWITA ROSITA MALEM 32,062.0
R/ HANDSCOEN STERIL NO. 6.5 1.00 PSG 21,162.00 21,162.00 0 1
18 RJ20220404-0012 04/04/2022 OP20220404-0013 2022040400012 BINTI ASLIKHAH 725,190.0
R/ HI BONE KAPLET 30.00 KAPLET 5,400.00 162,000.00 0 1
R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.00 167,190.00 0 1

19 RJ20220413-0008 13/04/2022 OP20220413-0006 2022041300009 NURHALINA SIREGAR 725,199.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ HI BONE KAPLET 30.00 KAPLET 5,400.00 162,000.00 0 1
20 RJ20220413-0009 13/04/2022 OP20220413-0012 2022041300010 VIA RAHELIA DAMANIK 31,625.0
21 RJ20220420-0004 20/04/2022 OP20220420-0003 2022042000005 NOPERIDA MANURUNG 31,625.0
22 RJ20220427-0013 27/04/2022 OP20220427-0004 2022042700013 AYU FADHILAH UTAMI 167,199.0
Total Dokter DR. STEVEN, SP.OG 2,607,301.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Dokter : DR. YURI SP.A
1 RI20220401-0014 01/04/2022 RI20220401-0002 RI20220401-0014 MOSES CHRISTIANO 220,463.0

HARIANJA
R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1
R/ SAGESTAM 40 MG INJ 1.00 AMP 12,500.00 12,500.00 0 1

HARIANJA
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1

HARIANJA

HARIANJA

HARIANJA

HARIANJA
R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
7 RI20220403-0010 03/04/2022 RI20220403-0001 RI20220403-0010 KEYCIA LAMRIA PARDEDE 275,300.0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

HARIANJA

HARIANJA
R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
11 RI20220404-0007 04/04/2022 RI20220404-0002 RI20220404-0007 HANS GABRIELO SINAGA 85,421.0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ CEFOTAXIME 1 GR INJ 2.00 VIAL 9,355.00 18,710.00 1 0
R/ CEFOTAXIME 1 GR INJ 2.00 VIAL 9,355.00 18,710.00 1 0
R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1
R/ PICYN 750 MG INJ 1.00 VIAL 103,125.00 103,125.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ KERTAS PERKAMEN BERLOGO 15.00 LBR 1.00 100.00 1,500.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
20 RI20220406-0001 06/04/2022 RI20220405-0004 RI20220406-0001 FEBRI JHONNATAN NAIBAHO 215,196.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ SALIN 3 % 500 ML (OTSU) 1.00 FLS 38,828.00 38,828.00 0 1
25 RI20220406-0018 06/04/2022 RI20220406-0002 RI20220406-0018 NUR MALAIKA ZHAFIRA 106,599.0
R/ RANITIDINE 50MG/2ML INJ 1.00 AMP 8,800.00 8,800.00 1 0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
R/ NALD 25 (ONEMED) 1.00 PCS 254.00 254.00 0 1
R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 24,544.00 49,088.00 0 1
R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
31 RI20220407-0030 07/04/2022 RI20220407-0004 RI20220407-0030 MIKAEL BETAWE SILITONGA 298,632.0
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
32 RI20220408-0009 08/04/2022 RI20220407-0004 RI20220408-0009 MIKAEL BETAWE SILITONGA 200,600.0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ COBAZIM 3000MCG 3.00 CAP 14,437.50 43,312.00 0 1

KAPLET
34 RI20220408-0018 08/04/2022 RI20220408-0002 RI20220408-0018 GISSELA BIANCA HUTASOIT 247,605.0

INJ (BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ SAGESTAM 40 MG INJ 1.00 AMP ### 12,500.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

37 RI20220412-0005 12/04/2022 RI20220411-0001 RI20220412-0005 CHRISTIAN YONING GEEM SIM 24,544.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
R/ TROMBUFIT SACHET 3.00 SACH 7,333.33 21,999.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
41 RI20220418-0006 18/04/2022 RI20220418-0001 RI20220418-0006 XAVIER DEVEN SAGOTO 139,134.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

INJ (BPJS)
42 RI20220418-0010 18/04/2022 RI20220418-0002 RI20220418-0010 DYAN ALFARIZI 99,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
43 RI20220418-0014 18/04/2022 RI20220418-0002 RI20220418-0014 DYAN ALFARIZI 861.0
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
45 RI20220419-0006 19/04/2022 RI20220419-0001 RI20220419-0006 DEO ANGGA NATANAEL 265,786.0

SITANGGANG
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
48 RI20220420-0001 20/04/2022 RI20220419-0006 RI20220420-0001 RATU SAYYIDAH 127,272.0

INJ (BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

SITANGGANG
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

SITANGGANG

INJ (BPJS)
54 RI20220420-0020 20/04/2022 RI20220420-0001 RI20220420-0020 EPRIANA SARAGIH BY NY 14,800.0
R/ VAKSIN HB-UNJIJECT 0.5 ML 1.00 SACH 0.00 0.00 0 0

(BAYI/NEONATUS)
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1
R/ DEXAMETHASON 5MG/1ML INJ 1.00 AMP 3,003.00 3,003.00 1 0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula

INJ (BPJS)

INJ (BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
60 RI20220421-0018 21/04/2022 RI20220420-0001 RI20220421-0018 EPRIANA SARAGIH BY NY 1.0
R/ VAKSIN POLIO ORAL 1.00 DOSE 1.00 1.00 0 1

[DINKES ]
62 RI20220426-0007 26/04/2022 RI20220426-0002 RI20220426-0007 DEAN EDZHAR 49,088.0
R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 24,544.00 49,088.00 0 1
R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 0 1
64 RI20220427-0008 27/04/2022 RI20220427-0002 RI20220427-0008 ALHABSYI IBNU YUSUF 199,949.0
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
65 RI20220428-0004 28/04/2022 RI20220427-0002 RI20220428-0004 ALHABSYI IBNU YUSUF 199,088.0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
69 RI20220430-0010 30/04/2022 RI20220430-0001 RI20220430-0010 AMALIA ROSMANDA AZHARI 108,185.0

(BPJS)
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
70 RJ20220406-0001 06/04/2022 OP20220406-0002 2022040600001 SHALYTTA AVICHAYIL DJAGUN 186,280.0
71 RJ20220408-0002 08/04/2022 OP20220408-0007 2022040800002 JOVIAN ALEXSANDER 291,619.0
72 RJ20220411-0001 11/04/2022 OP20220411-0002 2022041100001 ALETHEIA GRACE PAKPAHAN 486,040.0

73 RJ20220411-0002 11/04/2022 OP20220411-0003 2022041100002 ELISKA DEBORA PAKPAHAN 394,877.0

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
R/ INTERLAC SACHET 10.00 SACH 12,825.00 128,250.00 0 1
74 RJ20220411-0004 11/04/2022 OP20220411-0005 2022041100005 CHRISTIAN YONING GEEM SIM 219,120.0
R/ ISPRINOL 60 ML SYR 1.00 FLS 110,000.00 110,000.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1
77 RJ20220413-0003 13/04/2022 OP20220413-0002 2022041300003 MIKAEL BETAWE SILITONGA 15,813.0
78 RJ20220422-0001 22/04/2022 OP20220422-0001 2022042200001 NUR MALAIKA ZHAFIRA 456,203.0

DROP
79 RJ20220425-0001 25/04/2022 OP20220425-0001 2022042500001 NURCAHAYA TAMBUNAN 325,235.0
R/ ISPRINOL 60 ML SYR 1.00 FLS 110,000.00 110,000.00 0 1
80 RJ20220427-0001 27/04/2022 OP20220427-0001 2022042700001 NURCAHAYA TAMBUNAN 292,754.0


Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685



Formula Non Formula
Total Dokter DR. YURI SP.A 10,807,438.0

Grand Total 160,753,259.0

Jumlah
Non Generik
ormula
268,107.00
353,065.00
260,401.00
325,181.00
06,754.00
Jumlah
Non Generik
ormula
202,821.00
995,732.00
886,297.00
92,721.00
0
17,629.00
Jumlah
Non Generik
ormula
8,754.00
1,164.00
17,507.00
8,753.00
36,939.00
11,880.00
22,680.00
45,360.00
8,753.00
17,507.00
28,241.00
24,094.00
0
Jumlah
Non Generik
ormula
33,363.00
17,507.00
32,760.00
178,064.00
37,048.00
67,573.00
211,785.00
0
0
15,055.00
Jumlah
Non Generik
ormula
52,000.00
158,620.00
125,472.00
137,500.00
42,643.00
10.00
10.00
2,409.00
10.00
33,780.00
0
0
Jumlah
Non Generik
ormula
10.00
10.00
72,461.00
Jumlah
Non Generik
ormula
16,474.00
3,892.00
2,200.00
85,024.00
103,584.00
4,580.00
62,796.00
3,891.00
62,796.00
3,891.00
0
Jumlah
Non Generik
ormula
3,891.00
3,891.00
62,796.00
2,291.00
26,343.00
9,424.00
15,600.00
94,803.00
9,424.00
0
89,139.00
Jumlah
Non Generik
ormula
3,891.00
2,567.00
14,624.00
5,135.00
3,891.00
14,415.00
1,937.00
1,937.00
3,891.00
90,270.00
0
0
1
Jumlah
Non Generik
ormula
90,270.00
2,567.00
10,400.00
04,196.00
Jumlah
Non Generik
ormula
489,697.00
1,164.00
29,768.00
499,728.00
53,238.00
5,075.00
20,187.00
452,707.00
0
Jumlah
Non Generik
ormula
24,300.00
301,540.00
19,144.00
23,760.00
19,600.00
87,499.00
17,726.00
7,527.00
7,781.00
0
20,181.00
Jumlah
Non Generik
ormula
81,767.00
17,507.00
17,507.00
15,055.00
98,888.00
18,669.00
387.00
11,888.00
107,423.00
0
1,162.00
Jumlah
Non Generik
ormula
775.00
18,888.00
24,282.00
16,474.00
153,492.00
7,156.00
156,000.00
7,527.00
2,674.00
72,800.00
0
10,150.00
1
Jumlah
Non Generik
ormula
21,800.00
23,375.00
113,413.00
627.00
13,720.00
5,075.00
1,162.00
30,906.00
1,296.00
0
8,186.00
Jumlah
Non Generik
ormula
2,069.00
18,669.00
85,984.00
1,345.00
240,660.00
238,845.00
26,261.00
83,063.00
247,599.00
0
0
Jumlah
Non Generik
ormula
8,000.00
230,091.00
43,329.00
292,357.00
224,363.00
161,689.00
55,073.00
24,500.00
0
0
230,091.00
Jumlah
Non Generik
ormula
8,002.00
7,156.00
42,861.00
36,356.00
17,507.00
40,114.00
358,443.00
257,369.00
0
8,002.00
0
Jumlah
Non Generik
ormula
254,098.00
240,000.00
414,098.00
1,162.00
1,162.00
17,726.00
80,000.00
1,162.00
1,162.00
3,875.00
1,937.00
0
63,222.00
0
Jumlah
Non Generik
ormula
54,468.00
230,091.00
143,429.00
43,878.00
719,496.00
191,070.00
2,409.00
160,639.00
0
0
132,519.00
Jumlah
Non Generik
ormula
420,481.00
08,535.00
Jumlah
Non Generik
ormula
297,770.00
255,420.00
40,838.00
36,910.00
186.00
7,157.00
250,270.00
42,830.00
0
0
Jumlah
Non Generik
ormula
769,793.00
291,200.00
45,898.00
31,044.00
25,640.00
500,571.00
90,141.00
0
0
Jumlah
Non Generik
ormula
58,800.00
110,159.00
110,000.00
98,670.00
196,001.00
330,325.00
21,174.00
3,875.00
32,455.00
0
0
Jumlah
Non Generik
ormula
574,101.00
118,800.00
326,999.00
84,224.00
78,650.00
65,150.00
61,611.00
0
463,662.00
0
Jumlah
Non Generik
ormula
535,452.00
80,000.00
18,220.00
285,824.00
165,000.00
54,941.00
80,000.00
295,916.00
0
324,896.00
0
Jumlah
Non Generik
ormula
400,218.00
58,900.00
65,639.00
82,500.00
544,816.00
80,000.00
15,549.00
378,855.00
0
0
0
Jumlah
Non Generik
ormula
6,049.00
224,694.00
9,324.00
80,000.00
72,488.00
47,561.00
200,312.00
185,516.00
0
242,716.00
0
Jumlah
Non Generik
ormula
158,470.00
56,650.00
87,378.00
49,426.00
148,751.00
328,884.00
17,612.00
0
0
Jumlah
Non Generik
ormula
229,134.00
167,200.00
8,167.00
27,465.00
110,000.00
10,839.00
304,910.00
218,623.00
0
0
23,613.00
Jumlah
Non Generik
ormula
24,544.00
272,679.00
98,796.00
294,014.00
343,456.00
147,028.00
110,036.00
0
0
Jumlah
Non Generik
ormula
59,425.00
77,174.00
148,804.00
12,000.00
229,134.00
40,087.00
83,818.00
61,371.00
0
0
Jumlah
Non Generik
ormula
254,014.00
327,251.00
3,875.00
80,000.00
212,720.00
313,854.00
167,200.00
25,679.00
0
Jumlah
Non Generik
ormula
294,014.00
16,813.00
17,600.00
254,014.00
82,812.00
404,484.00
110,000.00
81,337.00
0
0
Jumlah
Non Generik
ormula
6,974.00
39,110.00
57,376.00
340,247.00
7,010.00
158,624.00
281,344.00
98,255.00
0
Jumlah
Non Generik
ormula
196,180.00
35,985.00
Jumlah
Non Generik
ormula
36,277.00
702,630.00
69,000.00
5,140.00
5,610.00
699,005.00
2,328.00
293,325.00
164,230.00
0
113,750.00
Jumlah
Non Generik
ormula
32,330.00
24,544.00
12,480.00
177,475.00
582,390.00
80,310.00
85,818.00
11,640.00
102,755.00
0
Jumlah
Non Generik
ormula
476,310.00
73,000.00
217,966.00
217,966.00
694,015.00
869,909.00
0
1
0
Jumlah
Non Generik
ormula
39,706.00
628,320.00
73,000.00
643,700.00
506,924.00
331,044.00
0
0
Jumlah
Non Generik
ormula
403,325.00
152,420.00
376,995.00
39,420.00
39,420.00
499,504.00
275,716.00
0
0
0
Jumlah
Non Generik
ormula
75,830.00
80,000.00
307,285.00
103,125.00
482,921.00
66,025.00
303,852.00
0
0
519,548.00
Jumlah
Non Generik
ormula
134,064.00
36,277.00
343,661.00
34,074.00
80,000.00
91,867.00
0
0
559,447.00
Jumlah
Non Generik
ormula
192,975.00
4,675.00
91,337.00
256,389.00
262,456.00
7,636.00
0
Jumlah
Non Generik
ormula
59,971.00
44,000.00
97,513.00
10,626.00
117,108.00
23,375.00
168,303.00
444,204.00
42,144.00
0
281,441.00
Jumlah
Non Generik
ormula
607,252.00
607,252.00
624,947.00
73,000.00
634,506.00
0
0
0
Jumlah
Non Generik
ormula
566,077.00
625,814.00
271,677.00
285,949.00
641,516.00
0
0
0
Jumlah
Non Generik
ormula
24,544.00
206,638.00
73,000.00
293,060.00
10,800.00
496,865.00
831,537.00
0
0
0
Jumlah
Non Generik
ormula
863,162.00
308,877.00
73,000.00
331,805.00
58,438.00
247,352.00
0
0
0
Jumlah
Non Generik
ormula
47,118.00
182,024.00
49,665.00
65,587.00
236,854.00
113,750.00
230,779.00
391,768.00
0
0
0
Jumlah
Non Generik
ormula
391,768.00
83,087.00
73,267.00
61,875.00
17,600.00
318,317.00
159,880.00
0
0
428,727.00
Jumlah
Non Generik
ormula
318,317.00
217,966.00
669,330.00
348,113.00
192,248.00
0
Jumlah
Non Generik
ormula
316,108.00
221,375.00
449,070.00
98,666.00
190,096.00
590,325.00
0
0
Jumlah
Non Generik
ormula
136,930.00
830,393.00
285,207.00
041,593.00
436,153.00
0
0
0
Jumlah
Non Generik
ormula
201,882.00
34,732.00
Jumlah
Non Generik
ormula
80,000.00
116,486.00
40,000.00
92,430.00
278,905.00
22,680.00
186.00
24,544.00
360,494.00
0
153,845.00
Jumlah
Non Generik
ormula
4,680.00
177,046.00
80,000.00
35,750.00
3,875.00
73,000.00
107,909.00
42,227.00
195,827.00
0
0
Jumlah
Non Generik
ormula
160,051.00
88,753.00
69,759.00
474,225.00
11,100.00
79,079.00
15,813.00
3,875.00
109,717.00
0
0
Jumlah
Non Generik
ormula
228,772.00
18,796.00
82,495.00
132,812.00
24,107.00
38,961.00
67,500.00
59,927.00
115,368.00
0
28,301.00
Jumlah
Non Generik
ormula
24,992.00
2,854.00
55,930.00
28,301.00
263,395.00
265,272.00
15,120.00
60,081.00
224,014.00
0
0
0
Jumlah
Non Generik
ormula
95,944.00
66,550.00
18,415.00
2,850.00
81,194.00
268,137.00
90,626.00
3,076.00
0
1
Jumlah
Non Generik
ormula
425,943.00
201,677.00
17,726.00
500,569.00
297,528.00
297,528.00
135,001.00
0
45,000.00
Jumlah
Non Generik
ormula
90,394.00
5,000.00
57,616.00
15,725.00
110,000.00
6,668.00
85,350.00
77,440.00
290,385.00
0
0
Jumlah
Non Generik
ormula
9,200.00
211,200.00
235,651.00
82,742.00
242,390.00
216,800.00
46,558.00
240,515.00
0
377,840.00
Jumlah
Non Generik
ormula
285,705.00
201,677.00
17,116.00
81,221.00
61,309.00
11,050.00
45,850.00
26,596.00
0
0
Jumlah
Non Generik
ormula
37,701.00
60,130.00
275,949.00
246,657.00
295,680.00
18,796.00
132,816.00
0
83,070.00
Jumlah
Non Generik
ormula
27,857.00
45,850.00
43,522.00
Jumlah
Non Generik
ormula
17,600.00
109,646.00
80,000.00
15,120.00
4,590.00
10,000.00
84,480.00
316,470.00
80,000.00
273,624.00
0
0
7,800.00
Jumlah
Non Generik
ormula
26,813.00
11,733.00
167,200.00
7,424.00
66,786.00
935,963.00
8,712.00
8,401.00
2,409.00
57,200.00
0
Jumlah
Non Generik
ormula
110,000.00
64,624.00
17,600.00
32,525.00
257,600.00
220,000.00
27,000.00
66,126.00
80,000.00
147,335.00
0
92,430.00
Jumlah
Non Generik
ormula
90,562.00
692,850.00
241,773.00
93,037.00
25,433.00
Jumlah
Non Generik
ormula
10,000.00
195,313.00
15,080.00
52,663.00
24,500.00
80,000.00
147,169.00
355,958.00
0
41,696.00
0
Jumlah
Non Generik
ormula
80,000.00
303,325.00
80,000.00
15,083.00
41,696.00
474,225.00
358,545.00
27,625.00
4,583.00
24,713.00
0
191,018.00
Jumlah
Non Generik
ormula
254,340.00
5,043.00
38,589.00
3,875.00
189,954.00
80,000.00
161.00
2,915.00
1
161.00
0
Jumlah
Non Generik
ormula
141,636.00
141,636.00
45,696.00
17,919.00
3,875.00
12,040.00
178,545.00
80,000.00
150,796.00
261,662.00
0
0
Jumlah
Non Generik
ormula
364,609.00
356,099.00
178,458.00
229,811.00
9,398.00
590,385.00
102,350.00
0
293,325.00
0
Jumlah
Non Generik
ormula
196,204.00
58,438.00
411,840.00
42,472.00
430,799.00
293,270.00
361,140.00
0
95,375.00
Jumlah
Non Generik
ormula
102,658.00
7,000.00
10,626.00
129,743.00
199,155.00
25,321.00
34,894.00
299,622.00
314,476.00
0
Jumlah
Non Generik
ormula
295,680.00
164,884.00
150,123.00
394,209.00
55,921.00
248,472.00
1,001.00
369,340.00
0
0
0
Jumlah
Non Generik
ormula
249,860.00
92,430.00
272,046.00
116,741.00
182,236.00
128,991.00
11,100.00
100,587.00
0
0
Jumlah
Non Generik
ormula
97,513.00
206,999.00
11,050.00
376,675.00
53,323.00
78,088.00
279,460.00
0
0
9,973.00
Jumlah
Non Generik
ormula
140,325.00
163,264.00
448,693.00
453,612.00
72,365.00
11,100.00
491,577.00
0
0
0
Jumlah
Non Generik
ormula
98,796.00
5,135.00
101,384.00
80,000.00
54,815.00
79,247.00
411,675.00
411,675.00
0
0
0
Jumlah
Non Generik
ormula
376,675.00
169,615.00
116,848.00
97,056.00
135,626.00
96,124.00
0
8,329.00
Jumlah
Non Generik
ormula
3,875.00
5,135.00
1,000.00
178,545.00
443,689.00
95,787.00
394,355.00
14,210.00
2,750.00
0
Jumlah
Non Generik
ormula
470,179.00
456,424.00
57,412.00
261,985.00
490,220.00
15,707.00
Jumlah
Non Generik
ormula
86,930.00
24,360.00
776.00
456,522.00
24,978.00
125,094.00
10,962.00
43,827.00
0
0
Jumlah
Non Generik
ormula
348,885.00
254.00
3,378.00
729.00
7,150.00
24,978.00
105,419.00
6,678.00
116,219.00
0
0
Jumlah
Non Generik
ormula
729.00
26,625.00
10,626.00
144,786.00
5,500.00
178,969.00
20,110.00
8,850.00
21,600.00
5,913.00
3,378.00
25,011.00
0
Jumlah
Non Generik
ormula
25,010.00
639,549.00
39,989.00
611,213.00
17,750.00
46,800.00
0
11,688.00
Jumlah
Non Generik
ormula
18,672.00
9,535.00
21,600.00
386,710.00
11,479.00
58,400.00
88,267.00
21,600.00
21,600.00
0
21,600.00
Jumlah
Non Generik
ormula
33,562.00
613,360.00
13,825.00
8,753.00
62,030.00
7,150.00
17,507.00
728.00
2,886.00
0
Jumlah
Non Generik
ormula
32,400.00
387.00
1,126.00
43,200.00
12,725.00
56,207.00
1,162.00
13,275.00
99,783.00
0
0
Jumlah
Non Generik
ormula
8,753.00
178,862.00
295,680.00
375,325.00
650,141.00
5,913.00
149,355.00
0
0
Jumlah
Non Generik
ormula
10,400.00
24,325.00
12,830.00
23,375.00
638,100.00
355,640.00
114,079.00
950.00
0
73,000.00
Jumlah
Non Generik
ormula
169,375.00
183,169.00
15,055.00
6,560.00
374,991.00
82,262.00
319,985.00
493,453.00
0
Jumlah
Non Generik
ormula
2,655.00
398,292.00
31,460.00
100,265.00
20,671.00
258,340.00
699,666.00
0
0
0
Jumlah
Non Generik
ormula
38,247.00
52,938.00
134,343.00
21,600.00
36,862.00
22,255.00
7,328.00
0
Jumlah
Non Generik
ormula
3,563.00
36,400.00
28,928.00
172,916.00
24,835.00
58,400.00
80,410.00
0
4,569.00
0
Jumlah
Non Generik
ormula
4,303.00
2,869.00
2,957.00
4,303.00
3,379.00
15,233.00
5,500.00
99,287.00
48,111.00
39,131.00
0
0
0
Jumlah
Non Generik
ormula
17,507.00
1,126.00
10,626.00
3,379.00
4,569.00
72,800.00
34,052.00
43,014.00
4,451.00
11,264.00
0
Jumlah
Non Generik
ormula
642,065.00
146,986.00
116,876.00
21,674.00
387.00
35,332.00
591,360.00
288,750.00
0
8,850.00
Jumlah
Non Generik
ormula
6,875.00
12,725.00
81,048.00
22,632.00
168,960.00
2,655.00
48,262.00
1,392.00
17,507.00
12,579.00
527,794.00
0
0
Jumlah
Non Generik
ormula
19,322.00
008,277.00
223,153.00
124,077.00
1,770.00
2,200.00
48,262.00
0
32,900.00
Jumlah
Non Generik
ormula
380,160.00
549,020.00
59,561.00
50,807.00
15,414.00
293.00
67,680.00
0
0
Jumlah
Non Generik
ormula
293.00
23,918.00
15,348.00
65,700.00
98,120.00
124,292.00
526,090.00
1,162.00
17,163.00
0
0
0
Jumlah
Non Generik
ormula
112,241.00
148,964.00
31,114.00
24,387.00
207.00
31,251.00
8,753.00
35,417.00
0
0
2,935.00
Jumlah
Non Generik
ormula
27,127.00
8,491.00
27,899.00
7,800.00
5,140.00
75,553.00
8,655.00
424,634.00
630,515.00
0
0
Jumlah
Non Generik
ormula
284,773.00
771,722.00
220,000.00
8,081.00
280,798.00
4,040.00
244,177.00
28,690.00
80,909.00
80,909.00
0
Jumlah
Non Generik
ormula
7,702.00
24,616.00
468,000.00
80,909.00
101,209.00
8,850.00
0.00
0.00
9,853.00
13,277.00
13,750.00
82,927.00
0
0
Jumlah
Non Generik
ormula
80,909.00
74,463.00
24,413.00
34,350.00
15,982.00
80,909.00
161,818.00
13,708.00
848,737.00
28,220.00
0
67,417.00
Jumlah
Non Generik
ormula
95,063.00
7,012.00
04,113.00
Jumlah
Non Generik
ormula
138,189.00
42,226.00
106,461.00
86,876.00
Jumlah
Non Generik
ormula
136,895.00
236,965.00
268,950.00
196,208.00
167,167.00
298,935.00
122,690.00
236,313.00
0
0
Jumlah
Non Generik
ormula
293,325.00
209,602.00
3,818.00
13,750.00
320,830.00
49,250.00
463,400.00
30,976.00
30,976.00
0
Jumlah
Non Generik
ormula
162,106.00
123,599.00
73,563.00
137,995.00
151,733.00
312,147.00
48,262.00
24,500.00
70,400.00
0
Jumlah
Non Generik
ormula
232,272.00
142,439.00
67,007.00
146,931.00
239,063.00
202,630.00
257,282.00
0
74,863.00
0
Jumlah
Non Generik
ormula
22,106.00
900.00
6,500.00
289,630.00
324,630.00
253,386.00
266,434.00
266,434.00
0
0
0
Jumlah
Non Generik
ormula
77,759.00
30,976.00
407,310.00
21,964.00
354,681.00
44,000.00
15,687.00
56,980.00
0
335,630.00
0
Jumlah
Non Generik
ormula
290,309.00
76,750.00
211,200.00
317,254.00
211,200.00
428,000.00
77,399.00
237,925.00
0
0
Jumlah
Non Generik
ormula
73,781.00
58,438.00
56,650.00
11,270.00
97,513.00
275,605.00
143,866.00
0
0
206,849.00
Jumlah
Non Generik
ormula
214,943.00
4,675.00
364,707.00
106,461.00
134,000.00
399,148.00
0
0
0
Jumlah
Non Generik
ormula
30,976.00
246,510.00
57,254.00
61,474.00
194,724.00
138,438.00
12,474.00
42,144.00
24,544.00
0
311,371.00
Jumlah
Non Generik
ormula
462,441.00
28,060.00
224,910.00
39,726.00
3,080.00
560,915.00
0
469,102.00
Jumlah
Non Generik
ormula
59,140.00
197,158.00
268,317.00
355,110.00
322,085.00
0
0
89,901.00
Jumlah
Non Generik
ormula
276,144.00
206,560.00
254,438.00
195,380.00
440,357.00
397,129.00
0
158,161.00
Jumlah
Non Generik
ormula
184,267.00
227,844.00
109,455.00
146,738.00
132,412.00
251,675.00
0
0
00,206.00
Jumlah
Non Generik
ormula
57,545.00
38,643.00
8,754.00
47,276.00
31,630.00
136,261.00
63,067.00
8,753.00
201,311.00
31,625.00
0
Jumlah
Non Generik
ormula
79,321.00
36,495.00
17,726.00
98,819.00
33,300.00
3,875.00
32,062.00
725,190.00
0
0
725,199.00
Jumlah
Non Generik
ormula
31,625.00
31,625.00
167,199.00
07,301.00
Jumlah
Non Generik
ormula
220,463.00
223,632.00
68,400.00
25,000.00
150,000.00
232,963.00
275,300.00
75,000.00
17,739.00
275,603.00
0
Jumlah
Non Generik
ormula
85,421.00
37,369.00
104,034.00
49,088.00
152,700.00
153,030.00
1,500.00
24,544.00
24,544.00
215,196.00
0
Jumlah
Non Generik
ormula
274,088.00
49,088.00
124,088.00
88,978.00
106,599.00
76,350.00
22,484.00
291,838.00
0
32,790.00
Jumlah
Non Generik
ormula
225,000.00
298,632.00
200,600.00
47,187.00
247,605.00
54,884.00
208,877.00
0
0
24,544.00
Jumlah
Non Generik
ormula
73,632.00
21,999.00
49,088.00
139,134.00
99,544.00
861.00
101,359.00
265,786.00
75,000.00
0
58,400.00
Jumlah
Non Generik
ormula
127,272.00
199,088.00
219,026.00
145,352.00
12,500.00
29,368.00
14,800.00
3,003.00
49,088.00
49,088.00
0
Jumlah
Non Generik
ormula
77,184.00
138,772.00
1.00
352,076.00
49,088.00
176,589.00
199,949.00
199,088.00
0
49,088.00
0
Jumlah
Non Generik
ormula
158,863.00
22,000.00
108,185.00
186,280.00
291,619.00
486,040.00
0
394,877.00
0
Jumlah
Non Generik
ormula
219,120.00
68,069.00
21,999.00
15,813.00
456,203.00
325,235.00
292,754.00
0
0
Jumlah
Non Generik
ormula
07,438.00
53,259.00

Dokter 3

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Dokter 3

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RS SANTA ELISABETH SEI LEKOP

Kav. Sungai Lekop Kel. Sungai Lekop

Laporan Penjualan Resep Rawat Jalan Per Dokter

Jenis resep : Rawat Jalan

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Dokter : DR. ANDI EKA PUTRA

1 RJ20220416-0002 16/04/2022 OP20220416-0003 2022041600002 SUCI YOELANDA PUTRI 268,107.0

R/ L BIO SACHET 10.00 SACH 9,800.00 98,000.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

2 RJ20220416-0005 16/04/2022 OP20220416-0006 2022041600005 RAYSHA ANDINI SIREGAR 353,065.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ RANIVEL 75MG/5ML SYR 1.00 FLS 80,670.00 80,670.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

3 RJ20220416-0006 16/04/2022 OP20220416-0005 2022041600006 ALESHA HARMINDA SIREGAR 260,401.0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ BUFECT FORTE SYR 1.00 FLS 27,500.00 27,500.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

4 RJ20220418-0001 18/04/2022 OP20220418-0001 2022041800001 NURUL APRILIA 325,181.0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

Total Dokter DR. ANDI EKA PUTRA 1,206,754.0

Laporan Penjualan Resep Rawat Inap Per Dokter

Jenis resep : Rawat Inap

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Dokter : DR. BERNARD PARDOMUAN PURBA, SPB

1 RI20220402-0013 02/04/2022 RI20220402-0001 RI20220402-0013 JIMMI PARULIAN SARAGIH 202,821.0

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ SPUIT 5 CC (TERUMO) 2.00 PCS 6,300.00 12,600.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

2 RI20220402-0014 02/04/2022 RI20220402-0001 RI20220402-0014 JIMMI PARULIAN SARAGIH 995,732.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

R/ SPUIT 5 CC (TERUMO) 3.00 PCS 6,300.00 18,900.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 110,000.00 220,000.00 1 0

3 RI20220403-0002 03/04/2022 RI20220402-0001 RI20220403-0002 JIMMI PARULIAN SARAGIH 886,297.0

R/ SPUIT 5 CC (TERUMO) 1.00 PCS 6,300.00 6,300.00 0 1

R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

R/ KAPAS ALKOHOL 4.00 PCS 302.50 1,210.00 0 1

R/ SPUIT 3 CC (TERUMO) 3.00 PCS 5,772.00 17,316.00 1 0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

4 RI20220405-0001 05/04/2022 RI20220405-0001 RI20220405-0001 IFHANUDDIN 92,721.0

R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0

R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1

R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1

R/ SURFLO NO. 18 (VENFLON) 2.00 PCS 29,200.00 58,400.00 0 1

R/ SET DARAH 1.00 PCS 7,157.00 7,157.00 0 1