Dokter 2

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-May-2022 s/d 31-May-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 RJ20220514-0001 14/05/2022 OP20220514-0001 2022051400001 YUSUF AZKA PUTRA 172,876.0
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
2 RJ20220514-0009 14/05/2022 OP20220514-0012 2022051400011 MUHAMMAD HAIKAL 146,670.0
R/ VOMETA SYR 60 ML 1.00 FLS 66,000.00 66,000.00 0 1
R/ RANIVEL 75MG/5ML SYR 1.00 FLS 80,670.00 80,670.00 0 1
3 RJ20220519-0002 19/05/2022 OP20220519-0005 2022051900003 RATNA JULITA 34,243.0
R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1
R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1
4 RJ20220521-0006 21/05/2022 OP20220521-0003 2022052100006 EDELBERTUS IDAMAN BAHY 743,100.0
R/ SAGESTAM 40 MG INJ 6.00 AMP 12,500.00 75,000.00 0 1
R/ PHARMAFIX XL 15 CM X 5 CM / 7,500.00 CM 14.10 105,750.00 0 1

ROLL
R/ HANDSCOEN STERILE 4.00 PSG 18,900.00 75,600.00 0 1
(GAMMEX) NO. 7
R/ KASA GULUNG BESAR 40Y X 2.00 ROLL 243,375.00 486,750.00 0 1
80CM
R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
6 RJ20220530-0005 30/05/2022 OP20220530-0011 2022053000007 MUNDA RAHMA ARIFAH 510,616.0
R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1
R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1
R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1
R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1
R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0
7 RJ20220530-0008 30/05/2022 OP20220530-0013 2022053000010 MARLIYA 180,620.0
R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1
R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0
R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1
R/ RANITIDINE 150 MG TAB 10.00 TAB 275.00 2,750.00 1 0

R/ DOMPERIDON 10 MG TAB 10.00 TAB 544.90 5,449.00 1 0
Print Date:7/14/2022 Print Time: 2:08:00PM Page 1 of 166

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



Formula Non Formula
8 RJ20220530-0010 30/05/2022 OP20220530-0014 2022053000012 BARTOLOMEUS SIMANJORANG 314,476.0
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1
9 RJ20220530-0012 30/05/2022 OP20220530-0017 2022053000014 DERY TANIA WIJAYA 50,066.0
R/ LANSOPRAZOLE 30 MG CAPS 10.00 CAP 2,027.00 20,270.00 1 0
R/ COTRIMOXAZOLE 480 MG 20.00 TAB 550.00 11,000.00 1 0

TABLET
10 RJ20220530-0014 30/05/2022 OP20220530-0019 2022053000016 IMRON ROSIDI 66,625.0
R/ CENDO XITROL 5 ML EYE 1.00 DROP 39,000.00 39,000.00 0 0

DROP
R/ CENDO LYTEERS 0,5 ML 5.00 FLS 5,525.00 27,625.00 0 1
MINIDOSE
11 RJ20220530-0018 30/05/2022 OP20220530-0021 2022053000019 MURNI FITRIYANI 482,437.0
R/ SPUIT 10 CC ( TERUMO ) 1.00 PCS 11,242.00 11,242.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ KAPAS ALKOHOL 1.00 PCS 302.50 302.00 0 1
R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
12 RJ20220530-0019 30/05/2022 OP20220530-0025 2022053000022 ARSYLA RAMADHANI 6,977.0
R/ AMBROXOL 30 MG TAB 5.00 TAB 1.00 285.41 6,977.00 1 0
PARACETAMOL 500 MG 4.00 KAPLET 350.00 0.00 1 0

KAPLET
CETIRIZINE 10 MG TAB 2.00 TAB 475.00 0.00 1 0
DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 0.00 1 0
KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1
13 RJ20220530-0021 30/05/2022 OP20220530-0026 2022053000026 MUHAMMAD KEMAL 654,798.0

R/ WING NEEDLE 25 G (3/4) 1.00 PCS 13,200.00 13,200.00 1 0

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



Formula Non Formula
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1
R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
R/ ASCORBIT ACID 1000 MG/5 ML 1.00 AMP 20,000.00 20,000.00 1 0
INJ
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
Total Dokter DR. ANDI EKA PUTRA 3,367,379.0

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 RI20220501-0005 01/05/2022 RI20220428-0003 RI20220501-0005 DAHLIA MANURUNG 176,572.0
R/ CITICOLINE 500 MG TAB 15.00 TAB 9,166.67 137,500.00 0 1
R/ FLAMAR 50 MG TAB 15.00 TAB 2,604.80 39,072.00 0 1
2 RI20220501-0007 01/05/2022 RI20220427-0001 RI20220501-0007 ASTI SETIA PRIHATIN 39,072.0
3 RI20220501-0008 01/05/2022 RI20220428-0003 RI20220501-0008 DAHLIA MANURUNG 18,200.0
R/ GENTALEX 5 MG CREAM 1.00 TUBE 5,000.00 5,000.00 0 1
4 RI20220511-0008 11/05/2022 RI20220511-0001 RI20220511-0008 DIWE DUHA 84,382.0
R/ SURFLO NO. 18 (VENFLON) 2.00 PCS 29,200.00 58,400.00 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/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ KAPAS ALKOHOL 4.00 PCS 302.50 1,210.00 0 1
5 RI20220511-0011 11/05/2022 RI20220511-0001 RI20220511-0011 DIWE DUHA 5,075.0
R/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0
6 RI20220511-0019 11/05/2022 RI20220511-0001 RI20220511-0019 DIWE DUHA 4,368.0
R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 2,184.00 4,368.00 1 0

INJ (BPJS)
7 RI20220511-0023 11/05/2022 RI20220511-0003 RI20220511-0023 ANGGIAT LAM PATAR 18,826.0
BUTARBUTAR
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
8 RI20220512-0001 12/05/2022 RI20220511-0001 RI20220512-0001 DIWE DUHA 7,156.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

BUTARBUTAR
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ KETOROLAC 30 MG INJ 3.00 AMP 20,047.50 60,142.00 1 0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0
500MG/5ML

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



Formula Non Formula
10 RI20220512-0006 12/05/2022 RI20220512-0001 RI20220512-0006 NUR FAJRI 70,132.0
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/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ SURFLO NO. 20 VENFLON 2.00 PCS 22,680.00 45,360.00 1 0
11 RI20220512-0007 12/05/2022 RI20220511-0001 RI20220512-0007 DIWE DUHA 24,663.0
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
12 RI20220512-0011 12/05/2022 RI20220512-0001 RI20220512-0011 NUR FAJRI 45,360.0
13 RI20220512-0012 12/05/2022 RI20220512-0002 RI20220512-0012 EVA NOVITA NATALIA 45,109.0

SIMANJUNTAK
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
14 RI20220512-0017 12/05/2022 RI20220511-0001 RI20220512-0017 DIWE DUHA 254.0
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
15 RI20220512-0018 12/05/2022 RI20220512-0002 RI20220512-0018 EVA NOVITA NATALIA 254.0

SIMANJUNTAK
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
16 RI20220512-0019 12/05/2022 RI20220512-0001 RI20220512-0019 NUR FAJRI 36,174.0
R/ FOLEY CATHETER NO. 14 1.00 PCS 27,920.46 27,920.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
17 RI20220512-0022 12/05/2022 RI20220512-0004 RI20220512-0022 PRIJON SILITONGA 43,987.0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
18 RI20220512-0023 12/05/2022 RI20220511-0001 RI20220512-0023 DIWE DUHA 31,251.0
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

19 RI20220512-0024 12/05/2022 RI20220512-0001 RI20220512-0024 NUR FAJRI 88,024.0

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

SIMANJUNTAK
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
21 RI20220512-0029 12/05/2022 RI20220511-0001 RI20220512-0029 DIWE DUHA 77,649.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
22 RI20220512-0031 12/05/2022 RI20220511-0001 RI20220512-0031 DIWE DUHA 80,000.0
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)

BUTARBUTAR

500MG/5ML
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
25 RI20220513-0009 13/05/2022 RI20220511-0001 RI20220513-0009 DIWE DUHA 149,307.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

(BPJS)

SIMANJUNTAK
27 RI20220513-0011 13/05/2022 RI20220512-0001 RI20220513-0011 NUR FAJRI 79,464.0


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
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
29 RI20220513-0015 13/05/2022 RI20220511-0001 RI20220513-0015 DIWE DUHA 10,335.0
R/ KASA GULUNG KECIL 15 CM 2.00 ROLL 5,167.80 10,335.00 0 1
30 RI20220513-0019 13/05/2022 RI20220511-0001 RI20220513-0019 DIWE DUHA 51,880.0
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ AQUADES 25 ML 1.00 CC 354.52 354.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ TRAMADOL 50MG/2ML INJ 2.00 AMP 8,002.60 16,005.00 1 0

(OOT)

BUTARBUTAR
R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

BUTARBUTAR

500MG/5ML

(OOT)
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
36 RI20220514-0017 14/05/2022 RI20220512-0001 RI20220514-0017 NUR FAJRI 48,958.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1


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



Formula Non Formula
37 RI202205 14/05/2022 RI20220512-0002 RI20220514-0018 EVA NOVITA NATALIA 40,095.0

14-0018 SIMANJUNTAK
38 RI20220514-0019 14/05/2022 RI20220511-0001 RI20220514-0019 DIWE DUHA 10,335.0

BUTARBUTAR
R/ VITAMIN C XON-CE KAPLET 15.00 KAPLET 1.00 15.00 0 1
R/ NATRIUM DIKLOFENAC 50 MG 15.00 TAB 308.00 4,620.00 1 0

TAB
40 RI20220514-0024 14/05/2022 RI20220511-0001 RI20220514-0024 DIWE DUHA 93,045.0
R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 93,045.36 93,045.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

(OOT)
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

(OOT)
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
R/ DULCOLAX 10 MG ADULT SUPP 1.00 SUPP 21,560.00 21,560.00 0 1

47 RI20220517-0029 17/05/2022 RI20220517-0001 RI20220517-0029 RACHEL PUTRI DUHA 8,753.0

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

KAPLET
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
R/ CUTICELL CLASSIC 10 CM X 10 1.00 PCS 11,880.00 11,880.00 0 1

CM
52 RI20220525-0013 25/05/2022 RI20220525-0002 RI20220525-0013 MARHENTI HARAHAP 137,259.0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ RANITIDINE 50MG/2ML INJ 2.00 AMP 8,800.00 17,600.00 1 0
R/ CEFTRIAXONE 1 GR INJ 2.00 VIAL 13,368.00 26,736.00 1 0
R/ DEXKETOPROFEN 25MG/ML 3.00 AMP 33,792.00 101,376.00 1 0

INJ
R/ SPUIT 5 CC (TERUMO) 5.00 PCS 5,600.00 28,000.00 0 1
R/ CITICOLINE 250 MG/2ML 2.00 AMP 22,500.00 45,000.00 0 1

INJEKSI
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ VITAMIN B COMPLEX TAB 21.00 TAB 240.90 5,058.00 1 0
55 RI20220528-0008 28/05/2022 RI20220528-0003 RI20220528-0008 ENDANG PEMILUT 5,075.0
56 RI20220528-0010 28/05/2022 RI20220528-0002 RI20220528-0010 RINALDI 5,075.0


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



Formula Non Formula
57 RI20220528-0014 28/05/2022 RI20220528-0002 RI20220528-0014 RINALDI 32,500.0
R/ URINE BAG 2.00 PCS 8,000.00 16,000.00 0 1
58 RI20220528-0020 28/05/2022 RI20220528-0002 RI20220528-0020 RINALDI 223,866.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ METRONIDAZOLE 3.00 FLS 68,750.00 206,250.00 1 0

500MG/100ML INFUS
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

500MG/100ML INFUS
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
60 RI20220529-0006 29/05/2022 RI20220528-0002 RI20220529-0006 RINALDI 295,678.0

500MG/100ML INFUS
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

500MG/100ML INFUS
62 RI20220529-0014 29/05/2022 RI20220528-0002 RI20220529-0014 RINALDI 98,120.0
64 RI20220530-0009 30/05/2022 RI20220528-0002 RI20220530-0009 RINALDI 19,600.0
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1

65 RJ20220504-0001 04/05/2022 OP20220504-0004 2022050400001 MARIA YANTIMAS 2,890.0

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



Formula Non Formula
66 RJ20220509-0014 09/05/2022 OP20220509-0014 2022050900018 ASTI SETIA PRIHATIN 131,769.0
67 RJ20220509-0015 09/05/2022 OP20220509-0015 2022050900017 DIWE DUHA 10.0
68 RJ20220509-0016 09/05/2022 OP20220509-0017 2022050900020 DAHLIA MANURUNG 208,899.0
69 RJ20220509-0017 09/05/2022 OP20220509-0016 2022050900021 NUR FAJRI 26,048.0
70 RJ20220511-0018 11/05/2022 OP20220511-0021 2022051100022 MARIA YANTIMAS 12.0
71 RJ20220511-0020 11/05/2022 OP20220511-0025 2022051100025 RACHEL PUTRI DUHA 20,134.0
R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ NALD 26 (TERUMO) 1.00 PCS 4,712.50 4,712.00 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
74 RJ20220518-0015 18/05/2022 OP20220518-0024 2022051800020 MARIA YANTIMAS 17,073.0
75 RJ20220518-0016 18/05/2022 OP20220518-0023 2022051800021 MUHAMAD ALHAFIZZI 50,636.0

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



Formula Non Formula
R/ TRICHODAZOL 500 MG TAB 20.00 TAB 2,337.30 46,746.00 0 1
76 RJ20220518-0017 18/05/2022 OP20220518-0025 2022051800022 CHRISTVANIA LUMBANGAOL 29,412.0
R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0
R/ BUSCOPAN TAB 10 MG 5.00 TAB 4,397.60 21,988.00 0 1
78 RJ20220523-0025 23/05/2022 OP20220523-0029 2022052300035 BARINGIN SITANGGANG 247,000.0
R/ BORAGINOL N SUPP 5.00 SUPP 15,800.00 79,000.00 0 1
R/ ANADIUM KAPLET 15.00 KAPLET 11,200.00 168,000.00 0 1
79 RJ20220523-0026 23/05/2022 OP20220523-0030 2022052300036 NUR FAJRI 6.0
80 RJ20220523-0027 23/05/2022 OP20220523-0031 2022052300037 ANGGIAT LAM PATAR 15.0

BUTARBUTAR
81 RJ20220523-0028 23/05/2022 OP20220523-0032 2022052300038 EVA NOVITA NATALIA 15.0

SIMANJUNTAK
82 RJ20220523-0029 23/05/2022 OP20220523-0033 2022052300039 ENDANG PEMILUT 3,080.0

TAB
83 RJ20220523-0030 23/05/2022 OP20220523-0034 2022052300041 DIWE DUHA 2,409.0
84 RJ20220525-0022 25/05/2022 OP20220525-0030 2022052500029 PRIJON SILITONGA 3,613.0
85 RJ20220525-0023 25/05/2022 OP20220525-0031 2022052500030 MARIA YANTIMAS 10.0

TAB
R/ METRONIDAZOLE 500 MG TAB 10.00 TAB 497.00 4,970.00 1 0

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



Formula Non Formula
R/ INBUMIN TAB 250 MG 10.00 TAB 8,020.83 80,208.00 0 1
89 RJ20220528-0001 28/05/2022 OP20220528-0001 2022052800001 RINALDI 53,972.0
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/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 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/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
91 RJ20220530-0025 30/05/2022 OP20220530-0027 2022053000039 SRI REJEKI 1,750.0

KAPLET
92 RJ20220530-0026 30/05/2022 OP20220530-0028 2022053000034 BARINGIN SITANGGANG 231,000.0
R/ ARDIUM 1000 MG TAB 15.00 TAB 15,400.00 231,000.00 0 1
93 RJ20220530-0027 30/05/2022 OP20220530-0030 2022053000035 EVA NOVITA NATALIA 4,212.0

SIMANJUNTAK

KAPLET
94 RJ20220530-0028 30/05/2022 OP20220530-0031 2022053000036 CHORNALIUS BLEGUR 231,000.0
R/ CITICOLIN 1000 MG TAB 7.00 TAB 16,500.00 115,500.00 1 0
R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

96 RJ20220530-0030 30/05/2022 OP20220530-0033 2022053000038 DIWE DUHA 10.0

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



Formula Non Formula
Total Dokter DR. BERNARD PARDOMUAN PURBA, SPB 6,086,818.0

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



Formula Non Formula
Dokter : DRG. BETTY PASARIBU
1 RJ20220506-0005 06/05/2022 OP20220506-0009 2022050600005 BAYU PRADANA 3,891.0
R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1
2 RJ20220510-0004 10/05/2022 OP20220510-0006 2022051000004 JONATHAN DAWA 16,474.0
R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1
3 RJ20220510-0018 10/05/2022 OP20220510-0017 2022051000022 ARNOLDUS TRISNA SINAGA 17,395.0
R/ PEHACAI 1.00 AMP 3,891.50 3,891.00 0 1

N
R/ SPUIT
INJEKSI1 CC TERUMO 1.00 PCS 9,280.00 9,280.00 0 1
2 ML
4 RJ20220511-0011 11/05/2022 OP20220511-0013 2022051100012 ADOLF LUDWIC W 3,891.0
PANGARIBUAN
5 RJ20220512-0004 12/05/2022 OP20220512-0005 2022051200007 JHON FALBER SIMANIHURUK 7,783.0
6 RJ20220513-0008 13/05/2022 OP20220513-0021 2022051300022 LYEA RESTIKA SARI 52,212.0
R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1
R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1
R/ SPUIT 1 CC TERUMO 2.00 PCS 9,280.00 18,560.00 0 1
8 RJ20220514-0004 14/05/2022 OP20220514-0007 2022051400005 GABRIEL RAYMONDO 50,783.0

SITINJAK
R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.33 4,583.00 1 0

KAPLET
9 RJ20220517-0016 17/05/2022 OP20220517-0017 2022051700018 AL PADJRI PARDEDE 7,766.0

KAPLET
10 RJ20220518-0014 18/05/2022 OP20220518-0021 2022051800017 NILAWATI 48,224.0


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



Formula Non Formula
11 RJ20220518-0018 18/05/2022 OP20220518-0026 2022051800024 ROBERTH EDUARD 3,891.0
12 RJ20220519-0003 19/05/2022 OP20220519-0006 2022051900004 PETRUS ROBERT SANTOSO 23,996.0

SILABAN
13 RJ20220519-0004 19/05/2022 OP20220519-0009 2022051900006 ACHMAD MUJIANTO 139,854.0
14 RJ20220520-0016 20/05/2022 OP20220520-0020 2022052000017 MUHAMMAD ZAINAL NGALA 226,533.0
15 RJ20220521-0001 21/05/2022 OP20220521-0005 2022052100001 NILAWATI 118,014.0
R/ BECOM ZET TAB 10.00 TAB 2,887.50 28,875.00 0 0
16 RJ20220521-0003 21/05/2022 OP20220521-0006 2022052100003 MARYANA TAMBUNAN 29,645.0
17 RJ20220523-0016 23/05/2022 OP20220523-0013 2022052300018 RACHEL GIFANI 20,365.0

KAPLET

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



Formula Non Formula
19 RJ20220524-0011 24/05/2022 OP20220524-0015 2022052400015 ROBI KHAIRUL 94,162.0
20 RJ20220525-0025 25/05/2022 OP20220525-0034 2022052500032 DIDIT ICHWAN 61,395.0
21 RJ20220525-0026 25/05/2022 OP20220525-0035 2022052500033 MUHAMMAD RAFKA HARIS 47,412.0
R/ AMOXAN 125 MG SYR 1.00 BTL 30,938.00 30,938.00 0 1
22 RJ20220525-0027 25/05/2022 OP20220525-0036 2022052500034 GABE IMANUEL MARPAUNG 2,291.0

KAPLET
23 RJ20220527-0008 27/05/2022 OP20220527-0014 2022052700009 FITRIA MUTIKA LIANDA 62,796.0
24 RJ20220530-0015 30/05/2022 OP20220530-0016 2022053000017 BERLIANA MARBUN 103,442.0
25 RJ20220530-0031 30/05/2022 OP20220530-0035 2022053000040 DIDIT ICHWAN 23,121.0
R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 481.54 4,815.00 1 0
R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

26 RJ20220530-0032 30/05/2022 OP20220530-0040 2022053000041 ANIK NOVIYANTI 3,891.0

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



Formula Non Formula
28 RJ20220531-0025 31/05/2022 OP20220531-0002 2022053100026 FRENTRY SIHOMBING 3,891.0
Total Dokter DRG. BETTY PASARIBU 1,310,131.0

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



Formula Non Formula
Dokter : DR. IKHSAN, SP.B
1 RI20220501-0009 01/05/2022 RI20220428-0001 RI20220501-0009 SILSA 4,650.0

KAPLET
2 RI20220508-0015 08/05/2022 RI20220508-0003 RI20220508-0015 RIASI SIGALINGGING 84,878.0
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

(BPJS)
R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
4 RI20220509-0009 09/05/2022 RI20220509-0001 RI20220509-0009 BERLIAN SIMANUNGKALIT 247,599.0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ NALD 26 (TERUMO) 1.00 PCS 4,712.50 4,712.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

(BPJS)
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
9 RI20220510-0021 10/05/2022 RI20220508-0003 RI20220510-0021 RIASI SIGALINGGING 775.0
R/ PARACETAMOL 500 MG 2.00 KAPLET 387.55 775.00 1 0

10 RI20220510-0022 10/05/2022 RI20220510-0002 RI20220510-0022 FIRDO HAPE PURBA 83,063.0

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



Formula Non Formula
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/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1
12 RI20220511-0012 11/05/2022 RI20220510-0002 RI20220511-0012 FIRDO HAPE PURBA 17,616.0
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
13 RI20220511-0015 11/05/2022 RI20220511-0002 RI20220511-0015 SUWARYO 35,601.0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

INJ (BPJS)
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
14 RI20220511-0016 11/05/2022 RI20220511-0002 RI20220511-0016 SUWARYO 57,200.0
R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0
15 RI20220511-0020 11/05/2022 RI20220511-0002 RI20220511-0020 SUWARYO 6,006.0
R/ DEXAMETHASON 5MG/1ML INJ 2.00 AMP 3,003.00 6,006.00 1 0
16 RI20220512-0004 12/05/2022 RI20220511-0002 RI20220512-0004 SUWARYO 43,987.0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
17 RI20220512-0008 12/05/2022 RI20220511-0002 RI20220512-0008 SUWARYO 36,356.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
18 RI20220512-0026 12/05/2022 RI20220511-0002 RI20220512-0026 SUWARYO 3,003.0
19 RI20220513-0001 13/05/2022 RI20220511-0002 RI20220513-0001 SUWARYO 7,543.0

KAPLET
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
20 RI20220513-0002 13/05/2022 RI20220511-0002 RI20220513-0002 SUWARYO 7,527.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
21 RI20220513-0007 13/05/2022 RI20220511-0002 RI20220513-0007 SUWARYO 56,747.0

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



Formula Non Formula
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
22 RI20220513-0018 13/05/2022 RI20220511-0002 RI20220513-0018 SUWARYO 369,360.0
R/ ANBACIM 500 MG KAP 10.00 KAPLET 30,036.00 300,360.00 0 1
23 RI20220517-0036 17/05/2022 RI20220517-0003 RI20220517-0036 AISYAH RAHMADHANI 85,821.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
R/ SANMOL INFUS 1.00 FLS 86,029.00 86,029.00 0 1
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
26 RI20220518-0034 18/05/2022 RI20220518-0007 RI20220518-0034 BAHARDIKA PUTRA JAYA 45,714.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 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

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
30 RI20220523-0008 23/05/2022 RI20220523-0003 RI20220523-0008 ZUL AMRI 83,668.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ SET 1.00 PCS 7,156.80 7,156.00 0 1

DARAH
31 RI20220524-0004 24/05/2022 RI20220523-0003 RI20220524-0004 ZUL AMRI 249,523.0
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
32 RI20220524-0010 24/05/2022 RI20220523-0003 RI20220524-0010 ZUL AMRI 11,100.0

500MG/5ML
33 RI20220524-0011 24/05/2022 RI20220524-0001 RI20220524-0011 DELIMA SILABAN 53,863.0
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
34 RI20220524-0012 24/05/2022 RI20220523-0003 RI20220524-0012 ZUL AMRI 27,127.0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
35 RI20220524-0013 24/05/2022 RI20220523-0003 RI20220524-0013 ZUL AMRI 33,300.0

500MG/5ML
36 RI20220525-0001 25/05/2022 RI20220523-0003 RI20220525-0001 ZUL AMRI 8,753.0
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/ 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/ 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

INJEKSI

(BPJS)

KAPLET
42 RI20220529-0002 29/05/2022 RI20220528-0006 RI20220529-0002 INDARWIDATI 17,507.0
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
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

1GR/100 ML
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

500MG/100ML INFUS
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

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

(BPJS)

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



Formula Non Formula
48 RI20220530-0024 30/05/2022 RI20220530-0003 RI20220530-0024 ADI ERIKARDO SARAGIH 26,261.0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
49 RI20220531-0001 31/05/2022 RI20220530-0002 RI20220531-0001 HARMAUN HARAHAP 16,712.0
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ SUCTION CATHETHER NO. 16 1.00 PCS 8,712.00 8,712.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
52 RI20220531-0008 31/05/2022 RI20220530-0003 RI20220531-0008 ADI ERIKARDO SARAGIH 4,299.0
R/ CURCUMA FCT TAB 3.00 TAB 929.17 2,787.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ TRICHODAZOL INFUS 3.00 FLS 122,788.00 368,364.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

INJ
54 RJ20220507-0001 07/05/2022 OP20220507-0003 2022050700001 MUHAMMAD FACHRUL 273,000.0

ERLANGGA
R/ STAR AG GEL 50 GR 1.00 TUBE 273,000.00 273,000.00 0 1
55 RJ20220511-0001 11/05/2022 OP20220511-0002 2022051100001 ARIS SAPRIONO 97,513.0
R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1

DEWASA
R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 24,713.45 24,713.00 0 1
(BPJS)
56 RJ20220511-0007 11/05/2022 OP20220511-0006 2022051100007 YUSNI SYAFARAH 154,000.0

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



Formula Non Formula
57 RJ20220513-0001 13/05/2022 OP20220513-0001 2022051300002 ANWAR LUMBAN TORUAN 4,576.0
58 RJ20220521-0004 21/05/2022 OP20220521-0002 2022052100004 SUSI SUSANTI 680,251.0
R/ BISTURI NO. 10 1.00 PCS 3,600.00 3,600.00 0 1
R/ LIDOCAIN 2% INJ (BPJS) 2.00 AMP 1,800.00 3,600.00 0 1
R/ COROLENE 4/0 CUTTING 1.00 PCS 151,200.00 151,200.00 0 1
R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,666.66 16,666.00 1 0

CAPSUL
59 RJ20220525-0005 25/05/2022 OP20220525-0004 2022052500005 AISYAH RAHMADHANI 128,000.0
R/ LANAKELOID 10 GR CREAM 1.00 TUBE 128,000.00 128,000.00 0 1
60 RJ20220527-0004 27/05/2022 OP20220527-0008 2022052700004 SUSI SUSANTI 307,372.0
61 RJ20220528-0006 28/05/2022 OP20220528-0007 2022052800011 INDARWIDATI 77,607.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
62 RJ20220530-0006 30/05/2022 OP20220530-0009 2022053000008 EVAN PRASETYA NASUTION 77,000.0
63 RJ20220530-0020 30/05/2022 OP20220530-0006 2022053000024 HARMAUN HARAHAP 103,974.0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

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

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



Formula Non Formula
64 RJ20220530-0024 30/05/2022 OP20220530-0003 2022053000031 ADI ERIKARDO SARAGIH 72,387.0
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/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
65 RJ20220531-0003 31/05/2022 OP20220531-0006 2022053100003 MARTINUS HERENG 77,000.0
66 RJ20220531-0016 31/05/2022 OP20220531-0011 2022053100017 AGUS MANTARI 601,555.0
R/ STAR AG GEL 50 GR 1.00 TUBE 273,000.00 273,000.00 0 1
Total Dokter DR. IKHSAN, SP.B 8,182,761.0

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 RD20220504-0017 04/05/2022 EP20220504-0019 2022050400019 DANI SAMUEL SINAGA 146,902.0
R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1
2 RD20220504-0018 04/05/2022 EP20220504-0020 2022050400020 VERONIKA SIREGAR 98,796.0
R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0
3 RD20220504-0019 04/05/2022 EP20220504-0021 2022050400021 JANUARDI 307,260.0
R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
4 RD20220504-0020 04/05/2022 EP20220504-0022 2022050400022 FINSESIA KOLONG 110,000.0
5 RD20220504-0021 04/05/2022 EP20220504-0023 2022050400026 RUTH MONICA SIHOTANG 315,252.0
R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1
R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1
6 RD20220504-0022 04/05/2022 EP20220504-0024 2022050400027 AMELIA SEPTIA DEVI 209,931.0
7 RD20220504-0023 04/05/2022 EP20220504-0025 2022050400028 ADRIELLA ELISABETH 17,600.0

AMBARITA
R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1
8 RD20220504-0024 04/05/2022 EP20220504-0025 2022050400029 ADRIELLA ELISABETH 69,654.0

AMBARITA
R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

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



Formula Non Formula
9 RD20220504-0025 04/05/2022 EP20220504-0026 2022050400030 HARMIDA LENGU 185.0
R/ CAPTOPRIL 25 MG TAB 1.00 TAB 185.90 185.00 1 0
10 RD20220504-0026 04/05/2022 EP20220504-0026 2022050400031 HARMIDA LENGU 23,299.0
R/ MECOBALAMIN 500 MCG TAB 10.00 TAB 1,200.00 12,000.00 1 0

KAPLET
11 RD20220504-0027 04/05/2022 EP20220504-0027 2022050400032 PANGERAN HUTAGALUNG 79,724.0
R/ COLERGIS 60 ML SYR 1.00 FLS 63,250.00 63,250.00 0 1
12 RD20220504-0028 04/05/2022 EP20220504-0028 2022050400033 HERU EGUERO HUTAGALUNG 6,236.0
R/ SANMOL 500 MG TABLET 5.00 TAB 1.00 422.40 6,236.00 0 1
SIRPLUS TABLET 3.00 BTR 375.00 0.00 1 0
VITAMIN C XON-CE KAPLET 5.00 KAPLET 1.00 0.00 0 1
CORTIDEX 0,5 MG TAB 5.00 TAB 398.80 0.00 0 1
13 RD20220504-0029 04/05/2022 EP20220504-0029 2022050400034 MAULANA REYHAN AZ-ZIQRA 135,269.0
R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1
14 RD20220505-0010 05/05/2022 EP20220505-0008 2022050500017 MOHAMMAD EDY WIYOSO 101,296.0
R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1
15 RD20220505-0011 05/05/2022 EP20220505-0007 2022050500018 SUPOYO 90,626.0
R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

(BPJS)
16 RD20220505-0012 05/05/2022 EP20220505-0007 2022050500019 SUPOYO 3,875.0

KAPLET
17 RD20220505-0013 05/05/2022 EP20220505-0009 2022050500020 IYUT NOVITA SANI SARAGIH 267,475.0


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



Formula Non Formula
R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,825.50 18,255.00 1 0
18 RD20220505-0014 05/05/2022 EP20220505-0010 2022050500021 NEZA ASMIANTI 141,876.0
19 RD20220505-0015 05/05/2022 EP20220505-0011 2022050500022 SUSI SUSANTI 142,115.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
20 RD20220505-0016 05/05/2022 EP20220505-0012 2022050500023 ZULMA ENDRIZAL 378,910.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
21 RD20220506-0014 06/05/2022 EP20220506-0015 2022050600030 RAHMA YUNIARTI ALI 204,644.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
22 RD20220506-0015 06/05/2022 EP20220506-0016 2022050600031 JON KENEDI 229,609.0
23 RD20220506-0016 06/05/2022 EP20220506-0017 2022050600032 ELLA ELYANA 283,575.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

24 RD20220506-0017 06/05/2022 EP20220506-0018 2022050600033 ERIANNI BR SITIO 80,000.0

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



Formula Non Formula

(BPJS)
25 RD20220506-0019 06/05/2022 EP20220506-0019 2022050600039 FITRI RODIATUL HADAWIAH 417,590.0
26 RD20220506-0020 06/05/2022 EP20220506-0020 2022050600040 ANITA 257,350.0
R/ ARCAPEC TAB 5.00 TAB 1,512.00 7,560.00 0 1
27 RD20220507-0015 07/05/2022 EP20220507-0014 2022050700016 SEBASTIAN NAPITUPULU 184,207.0
R/ ACITRAL 120 ML SYR 1.00 FLS 54,313.00 54,313.00 0 1
R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1
28 RD20220509-0001 09/05/2022 EP20220509-0001 2022050900001 MAINUL HASNAEN MAHI 4,583.0

KAPLET
29 RD20220509-0002 09/05/2022 EP20220509-0003 2022050900002 SRI WULANDARI 312,679.0
30 RD20220509-0003 09/05/2022 EP20220509-0006 2022050900006 NARA ALETHEIA SASONGKO 47,412.0
31 RD20220509-0004 09/05/2022 EP20220509-0004 2022050900007 MUHAMAD ALHAFIZZI 443,472.0


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



Formula Non Formula
32 RD20220509-0005 09/05/2022 EP20220509-0005 2022050900008 BERLIAN SIMANUNGKALIT 293,325.0
R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1
33 RD20220509-0006 09/05/2022 EP20220509-0005 2022050900009 BERLIAN SIMANUNGKALIT 81,689.0

KAPLET
34 RD20220509-0010 09/05/2022 EP20220509-0010 2022050900015 TAN LINHUA 12,966.0

KAPLET
R/ METHYLPREDNISOLONE 4 MG 6.00 TAB 594.74 3,568.00 1 0

TAB
35 RD20220509-0020 09/05/2022 EP20220509-0022 2022050900029 CINTA JUMAGAR SIANIAPAR 264,910.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
36 RD20220510-0001 10/05/2022 EP20220510-0001 2022051000001 AGUSTINUS IGOR KAYAMA 89,388.0

MANALU

KAPLET
R/ SPASMINAL TABLET 10.00 TAB 1,126.40 11,264.00 0 1
R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 962.50 9,625.00 1 0
37 RD20220510-0002 10/05/2022 EP20220510-0001 2022051000002 AGUSTINUS IGOR KAYAMA 110,000.0

MANALU
38 RD20220510-0003 10/05/2022 EP20220510-0002 2022051000004 CATHERINE BONITA SIREGAR 130,888.0
R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00 40,838.00 1 0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ IBUPROFEN 60 ML SYR 1.00 FLS 4,725.00 4,725.00 1 0
39 RD20220513-0007 13/05/2022 EP20220513-0006 2022051300010 DINA KAMESWARA 398,322.0


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



Formula Non Formula
40 RD20220513-0008 13/05/2022 EP20220513-0007 2022051300012 ALESHA NAUFALYN ANGGORO 269,099.0
R/ CEPTIK 30 ML SYRUP 1.00 FLS 144,375.00 144,375.00 0 1
41 RD20220513-0009 13/05/2022 EP20220513-0008 2022051300013 MUHAMMAD HAIKAL 49,224.0
R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1
R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0
R/ AMOXAN 125 MG SYR 1.00 BTL 1.00 30,938.00 31,275.00 0 1
SALBUTAMOL 2 MG TAB 1.00 TAB 117.50 0.00 1 0
DEXAMETHASON 0,5 MG TAB 1.00 TAB 220.00 0.00 1 0
44 RD20220513-0012 13/05/2022 EP20220513-0010 2022051300016 JUNITA AYU HARDINI 335,790.0
45 RD20220513-0013 13/05/2022 EP20220513-0012 2022051300017 124,992.0
46 RD20220513-0014 13/05/2022 EP20220513-0011 2022051300019 FATARLANDO SIAHAAN 24,544.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

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



Formula Non Formula
47 RD20220513-0015 13/05/2022 EP20220513-0011 2022051300020 FATARLANDO SIAHAAN 9,973.0
R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1

(BPJS)
R/ TROLAC 10 MG TAB 10.00 TAB 7,562.50 75,625.00 0 1
49 RD20220513-0017 13/05/2022 EP20220513-0014 2022051300023 MARIANA RINA TUKAN 200,992.0

INJ
50 RD20220515-0006 15/05/2022 EP20220515-0005 2022051500010 PEBRIANTO 297,778.0
51 RD20220515-0007 15/05/2022 EP20220515-0006 2022051500011 557,410.0
R/ OSTEOR C 60 GR CREAM 2.00 TUBE 173,250.00 346,500.00 0 1
R/ MYONAL 50 MG TAB 10.00 TAB 10,100.00 101,000.00 0 1
52 RD20220515-0008 15/05/2022 EP20220515-0008 2022051500013 CHRISTINA MANALU 80,000.0

(BPJS)
53 RD20220515-0009 15/05/2022 EP20220515-0009 2022051500014 GOMGOMTUA SITUMORANG 249,667.0
54 RD20220515-0010 15/05/2022 EP20220515-0010 2022051500016 ANCE PAULINA SIBAGARIANG 80,000.0

(BPJS)

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



Formula Non Formula
R/ GELAFUSAL 500 ML INF 1.00 FLS 189,000.00 189,000.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
56 RD20220516-0007 16/05/2022 EP20220516-0006 2022051600009 344,904.0
57 RD20220516-0008 16/05/2022 EP20220516-0008 2022051600010 CHELSEA CINTHYARA 78,204.0

SIPAHUTAR
58 RD20220516-0009 16/05/2022 EP20220516-0009 2022051600011 ZAENAL ABIDIN 161.0
R/ ISOSORBID DINITRAT 5 MG 1.00 TAB 161.50 161.00 1 0

TAB
59 RD20220516-0012 16/05/2022 EP20220516-0010 2022051600015 YASINTA MUEL 3,875.0

KAPLET
60 RD20220517-0015 17/05/2022 EP20220517-0011 2022051700019 RUBI JULIANTO 66,458.0

KAPLET
61 RD20220517-0016 17/05/2022 EP20220517-0013 2022051700023 BUDIARTO 202,217.0
62 RD20220517-0017 17/05/2022 EP20220517-0014 2022051700024 OKTA TIARA ANISA 268,596.0


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



Formula Non Formula
R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
R/ FORMALIN 1000 ML 4,000.00 CC 145.00 580,000.00 0 1
R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1
R/ SET MAKRO 2.00 PCS 13,720.00 27,440.00 0 1
R/ NALD 18 (ONEMED) 2.00 PCS 861.00 1,722.00 1 0
64 RD20220517-0019 17/05/2022 EP20220517-0015 2022051700026 ADIRA MELIKNA 121,910.0
65 RD20220517-0020 17/05/2022 EP20220517-0016 2022051700027 HENISKA EKA VIKTORI ZAI 140,398.0
R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1
R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0
R/ OMEPRA 1.00 VIAL 80,000.00 80,000.00 1 0

ZOLE 40
66 RD20220517-0021
MG INJ 17/05/2022 EP20220517-0017 2022051700028 ERIKA PUTRI AYU SILABAAN 309,630.0
(BPJS)
67 RD20220517-0022 17/05/2022 EP20220517-0018 2022051700029 HELMI 61,176.0
R/ BERRY VISION TAB 5.00 TAB 4,435.20 22,176.00 0 1

DROP
68 RD20220517-0023 17/05/2022 EP20220517-0019 2022051700030 ABIZAR HIBRATUL ASDAQ 125,474.0
R/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1
R/ L BIO SACHET 10.00 SACH 9,800.00 98,000.00 0 1

69 RD20220517-0024 17/05/2022 EP20220517-0020 2022051700031 MUHAMMAD TEGAR PRASSTYO 164,952.0

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



Formula Non Formula
70 RD20220517-0025 17/05/2022 EP20220517-0021 2022051700032 ISKANDAR ZULKARNAIN 124,696.0
R/ SALICYL TALK 60 GR 1.00 POT 7,010.40 7,010.00 0 1
71 RD20220517-0026 17/05/2022 EP20220517-0022 2022051700033 ZULIANI 312,679.0
72 RD20220519-0018 19/05/2022 EP20220519-0020 2022051900023 NAFIL KHAIRIL AL HAFIZ 116,387.0
R/ SANADRYL DMP 120 ML SYR 1.00 BTL 28,301.00 28,301.00 0 1

(OOT)
73 RD20220519-0019 19/05/2022 EP20220519-0021 2022051900026 ARIS KASNUR 293,888.0
74 RD20220519-0020 19/05/2022 EP20220519-0022 2022051900027 KENZO MARSELINO 88,086.0

NAPITUPULUH
75 RD20220519-0022 19/05/2022 EP20220519-0019 2022051900029 AMATUS EDISON 80,000.0

(BPJS)
76 RD20220519-0023 19/05/2022 EP20220519-0023 2022052000001 LISNA SARTIKA 312,679.0

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



Formula Non Formula
77 RD20220520-0001 20/05/2022 EP20220520-0001 2022052000003 SARMAULI SIBORO 138,703.0
R/ PARACETAMOL SYR 60 ML 1.00 FLS 6,840.00 6,840.00 1 0
R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0
R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0
78 RD20220521-0001 21/05/2022 EP20220521-0001 2022052100001 JONNY SIMARMATA 68,499.0

KAPLET
79 RD20220523-0011 23/05/2022 EP20220523-0011 2022052300021 HESRON SEMBIRING 337,261.0
R/ SPORETIK 100 MG CAPS 10.00 CAP 27,836.17 278,361.00 0 1
80 RD20220523-0012 23/05/2022 EP20220523-0012 2022052300022 LASMARIA SIMANJUNTAK 143,792.0

INJ
81 RD20220523-0013 23/05/2022 EP20220523-0013 2022052300023 AMIRA RIZKI PUTRI 83,862.0
83 RD20220523-0015 23/05/2022 EP20220523-0014 2022052300025 IHSAN TEDY HARISON 286,207.0


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



Formula Non Formula
84 RD20220523-0016 23/05/2022 EP20220523-0015 2022052300027 TRINO YABES SIANTURI 81,363.0
R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

(BPJS)
85 RD20220523-0017 23/05/2022 EP20220523-0017 2022052300028 ADMIRAL GILBERT SITORUS 163,144.0
86 RD20220523-0018 23/05/2022 EP20220523-0015 2022052300029 TRINO YABES SIANTURI 139,972.0
R/ SALBUTAMOL 2 MG TAB 5.00 TAB 117.50 587.00 1 0
R/ AMBROXOL 30 MG TAB 5.00 TAB 285.41 1,427.00 1 0
87 RD20220523-0019 23/05/2022 EP20220523-0016 2022052300030 RACHEL DIYANTI PUTRI 247,883.0

SIANTURI
R/ KETRICIN ORA BASE 0,1% 1.00 TUBE 66,025.00 66,025.00 0 1

CREAM
88 RD20220523-0020 23/05/2022 EP20220523-0018 2022052300033 40,104.0
89 RD20220523-0021 23/05/2022 EP20220523-0018 2022052300032 TONIS BANJAR NAHOR 37,812.0
90 RD20220523-0022 23/05/2022 EP20220523-0019 2022052300034 MUNAWAROH 55,200.0
R/ MELOXICAM 7,5 MG TAB 10.00 TAB 1,037.85 10,378.00 1 0

91 RD20220523-0024 23/05/2022 EP20220523-0022 2022052300036 IDARIA AGNES SINAGA 4,224.0

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



Formula Non Formula
92 RD20220523-0026 23/05/2022 EP20220523-0021 2022052300038 ROSANTINA HUTABARAT 293,888.0
93 RD20220524-0012 24/05/2022 EP20220524-0008 2022052400012 JUNITA AYU HARDINI 305,265.0
94 RD20220524-0013 24/05/2022 EP20220524-0009 2022052400013 RONAL TAMPUBOLON 66,161.0

MINIDOSE
95 RD20220524-0014 24/05/2022 EP20220524-0010 2022052400014 MESAHK JUNIOR 6,049.0

HUTAGALUNG
R/ BISTURI NO. 11 1.00 PCS 6,049.00 6,049.00 0 1
96 RD20220524-0015 24/05/2022 EP20220524-0010 2022052400015 MESAHK JUNIOR 45,563.0

HUTAGALUNG
97 RD20220524-0016 24/05/2022 EP20220524-0011 2022052400016 HERMAN ROZA PUTRA 287,799.0
R/ ZOLLOCID CAPS 10.00 CAP 0.00 126,720.00 0 1
R/ VOMETA FT 10 MG TAB 10.00 TAB 0.00 58,665.00 0 1
R/ PROPEPSA 100 ML SYR 1.00 FLS 0.00 83,070.00 0 1
R/ ARCAPEC TAB 10.00 TAB 0.00 15,120.00 0 1
98 RD20220524-0017 24/05/2022 EP20220524-0012 2022052400017 BAYU PRADANA 112,028.0


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



Formula Non Formula
99 RD20220524-0018 24/05/2022 EP20220524-0013 2022052400018 KARLINA HUTABARAT 9,174.0
100 RD20220524-0019 24/05/2022 EP20220524-0014 2022052400019 VICTOR NAPITUPULU 91,264.0

(BPJS)
101 RD20220524-0021 24/05/2022 EP20220524-0015 2022052400020 NANDA SURYA KUSUMA 204,524.0

(OOT)
102 RD20220524-0022 24/05/2022 EP20220524-0016 2022052400021 MELVA AYU TAMPUBOLON 313,854.0
103 RD20220525-0003 25/05/2022 EP20220525-0003 2022052500004 ELISABETH ADRIANA 24,544.0

HASIBUAN
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
104 RD20220525-0004 25/05/2022 EP20220525-0004 2022052500005 PENTA MUKTI HERLAMBANG 354,580.0
105 RD20220525-0005 25/05/2022 EP20220525-0005 2022052500007 MARHENTI HARAHAP 7,527.0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
106 RD20220526-0002 26/05/2022 EP20220526-0002 2022052600004 AZKA SASKARA 48,999.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
107 RD20220526-0003 26/05/2022 EP20220526-0003 2022052600005 HAMDAN 402,087.0


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



Formula Non Formula
108 RD20220526-0004 26/05/2022 EP20220526-0004 2022052600006 NAZMA HAFIZHA HUTASUHUT 120,767.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
109 RD20220526-0005 26/05/2022 EP20220526-0005 2022052600008 GABY YOLANDA OCTAVIANI 82,982.0

SIAHAAN

1GR/100 ML
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
110 RD20220526-0006 26/05/2022 EP20220526-0006 2022052600009 SORIDIN 364,313.0
111 RD20220526-0007 26/05/2022 EP20220526-0007 2022052600012 KASPRONT LUMBAN BATU 12,148.0

KAPLET
112 RD20220526-0008 26/05/2022 EP20220526-0008 2022052600013 MUKHAMMAD ABDUL ADHA 124,696.0
113 RD20220526-0009 26/05/2022 EP20220526-0009 2022052600014 AISYAH NUR RAHMATIKA 126,713.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
114 RD20220527-0004 27/05/2022 EP20220 2022052700004 AYU SETYA NINGSIH 133,298.0

527-0004


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



Formula Non Formula
115 RD20220527-0005 27/05/2022 EP20220527-0005 2022052700005 ROMASI SIAHAAN 25,786.0

(BPJS)
116 RD20220527-0006 27/05/2022 EP20220527-0006 2022052700006 YEYEN PUTRI ANGELA 313,854.0
LEOVANNY
117 RD20220527-0007 27/05/2022 EP20220527-0007 2022052700007 HERDALINA MANURUNG 442,582.0
118 RD20220527-0008 27/05/2022 EP20220527-0009 2022052700008 RIFKA O SIREGAR 240,143.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
R/ BRAXIDIN TABLET 10.00 TAB 1,523.30 15,233.00 0 0

(PSIKOTROPIKA)
119 RD20220527-0009 27/05/2022 EP20220527-0008 2022052700009 RIZAL EPENDI P 240,143.0

(PSIKOTROPIKA)
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
120 RD20220527-0010 27/05/2022 EP20220527-0010 2022052700011 WAHYU BONATAN LUMBAN 9,973.0

RAJA

(BPJS)
RAJA

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

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



Formula Non Formula
R/ GRAPHALAC SYR 1.00 FLS 91,520.00 91,520.00 0 1
122 RD20220527-0013 27/05/2022 EP20220527-0011 2022052700013 TALENTA HUTABARAT 80,000.0

(BPJS)
123 RD20220527-0014 27/05/2022 EP20220527-0012 2022052700015 LAMAIDI 18,796.0
124 RD20220527-0015 27/05/2022 EP20220527-0013 2022052700016 PONTA ADIGUNA 229,134.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
125 RD20220527-0016 27/05/2022 EP20220527-0014 2022052700017 ANDREAS INDRAYADI 193,748.0
126 RD20220528-0004 28/05/2022 EP20220528-0004 2022052800007 MUHAMMAD NASOHA 43,106.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
127 RD20220528-0005 28/05/2022 EP20220528-0005 2022052800008 FENANTIUS MANSE (PASTOR) 438,358.0
128 RD20220528-0007 28/05/2022 EP20220528-0008 2022052800010 KRISTA 167,200.0
129 RD20220528-0008 28/05/2022 EP20220528-0007 2022052800011 ENDRI YENI 73,000.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
130 RD20220528-0009 28/05/2022 EP20220528-0008 2022052800014 KRISTA 46,648.0


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



Formula Non Formula
131 RD20220530-0006 30/05/2022 EP20220530-0005 2022053000010 MYRON NATHANAEL 127,917.0

TAMPUBOLON
R/ RHINOS NEO DROP (PREK) 1.00 FLS 70,400.00 70,400.00 0 0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
132 RD20220530-0007 30/05/2022 EP20220530-0006 2022053000011 BETI LISTITE 266,085.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
133 RD20220530-0008 30/05/2022 EP20220530-0007 2022053000012 ZULMA ENDRIZAL 291,077.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
134 RD20220530-0009 30/05/2022 EP20220530-0008 2022053000013 ARNANDO 255,189.0
135 RD20220530-0010 30/05/2022 EP20220530-0009 2022053000014 VINA NOVISRAMULYA 263,161.0
136 RD20220530-0011 30/05/2022 EP20220530-0010 2022053000015 FITRA RAMADHANI HARAHAP 195,669.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

137 RD20220530-0012 30/05/2022 EP20220530-0011 2022053000016 KRISMAY ZILFANIA GULTOM 156,224.0

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



Formula Non Formula
138 RD20220530-0013 30/05/2022 EP20220530-0012 2022053000017 AYU RISMA ARFIANTI 225,390.0
139 RD20220530-0014 30/05/2022 EP20220530-0013 2022053000018 ELSA SILVERIANI 38,751.0
140 RD20220530-0015 30/05/2022 EP20220530-0015 2022053000019 NUR MALAIKA ZHAFIRA 195,669.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
141 RD20220530-0016 30/05/2022 EP20220530-0014 2022053000020 HASIHOLAN PARDAMEAN 156,756.0

SIMATUPANG
142 RD20220530-0017 30/05/2022 EP20220530-0016 2022053000021 M.RAFAL FARUQ AN NUR 400,964.0
143 RD20220530-0018 30/05/2022 EP20220530-0017 2022053000022 DHONI RAMADHAN 231,097.0

144 RD20220530-0021 30/05/2022 EP20220530-0020 2022053000026 2,894.0

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



Formula Non Formula
R/ KERTAS PERKAMEN BERLOGO 9.00 LBR 100.00 900.00 0 1
145 RD20220531-0008 31/05/2022 EP20220531-0006 2022053100018 MAUREN AFRILLA BAGARIANG 80,000.0

(BPJS)
146 RD20220531-0009 31/05/2022 EP20220531-0007 2022053100016 IRFAN WAHYUDI 270,309.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
147 RD20220531-0010 31/05/2022 EP20220531-0006 2022053100019 MAUREN AFRILLA BAGARIANG 65,199.0
148 RD20220531-0011 31/05/2022 EP20220531-0009 2022053100023 VANIA CASSANDRA 18,562.0
149 RD20220531-0013 31/05/2022 EP20220531-0009 2022053100024 VANIA CASSANDRA 15,595.0
R/ AMBROXOL 30 MG TAB 1.00 TAB 285.41 285.00 1 0
R/ DEXAMETHASON 0,5 MG TAB 1.00 TAB 220.00 220.00 1 0
R/ AMOXYCILLIN 125 ML SYR 1.00 BTL 8,250.00 8,250.00 1 0
150 RD20220531-0014 31/05/2022 EP20220531-0010 2022053100025 RONALDO FEBRYAN 313,854.0
151 RD20220531-0015 31/05/2022 EP20220531-0011 2022053100026 ERIK ISRAIDA 266,085.0

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
152 RD20220531-0016 31/05/2022 EP20220531-0012 2022053100027 EKO SETIAWAN 409,319.0

(PREKURSOR)
153 RD20220531-0017 31/05/2022 EP20220531-0013 2022053100028 MUHAMMAD RONALDO 305,265.0
154 RJ20220512-0001 12/05/2022 OP20220512-0002 2022051200001 RINO EFENDI 80,000.0
155 RJ20220512-0002 12/05/2022 OP20220512-0002 2022051200002 RINO EFENDI 10,000.0
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1
156 RJ20220512-0005 12/05/2022 OP20220512-0008 2022051200005 ALI AMRAN 516,990.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1
157 RJ20220512-0006 12/05/2022 OP20220512-0010 2022051200006 RAHEL HELSI KAROLA 450,809.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1
158 RJ20220518-0004 18/05/2022 OP20220518-0007 2022051800004 SELLY SINAGA 68,346.0


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



Formula Non Formula
159 RJ20220518-0009 18/05/2022 OP20220518-0019 2022051800011 LINDA PUTRI AYU 300,815.0
R/ IBUPROF 10.00 TAB 513.50 5,135.00 1 0

EN 400
160 RJ20220518-0011
MG TAB 18/05/2022 OP20220518-0017 2022051800013 RONY SAPUTRA YEREMIA 685,146.0
WOLO
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
161 RJ20220518-0012 18/05/2022 OP20220518-0020 2022051800015 SYAKILLA LEO ADARA 10,960.0
R/ CORTIDEX 0,5 MG TAB 5.00 TAB 1.00 398.80 3,950.00 0 1
VITAMIN C XON-CE KAPLET 1.00 KAPLET 1.00 0.00 0 1
162 RJ20220518-0013 18/05/2022 OP20220518-0022 2022051800016 LIVIA PUTRI 412,193.0

(OOT)
Total Dokter DR. DIKA CAHAYA PUTRI 29,302,671.0

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



Formula Non Formula
Dokter : DR. ERIE FAILENGGO
1 RD20220501-0001 01/05/2022 EP20220501-0001 2022050100001 RENTA HUTAGALUNG 302,010.0
R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1
R/ SINRAL 5 MG TAB 10.00 TAB 6,187.50 61,875.00 0 1
2 RD20220502-0001 02/05/2022 EP20220502-0001 2022050200001 IHSAN SYAPUTRA 463,157.0
R/ METHYLON 4 MG TAB 10.00 TAB 3,162.50 31,625.00 0 1
R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1
R/ LASAL 2 MG CAPSUL 10.00 CAP 1,718.80 17,188.00 0 1

(BPJS)
4 RD20220502-0003 02/05/2022 EP20220502-0002 2022050200003 EVA NAINGGOLAN 31,885.0

TABLET
5 RD20220502-0004 02/05/2022 EP20220502-0003 2022050200005 MIA PAULYNA 684,172.0
R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1
6 RD20220504-0030 04/05/2022 EP20220504-0030 2022050400036 KASNO 293,325.0
7 RD20220505-0001 05/05/2022 EP20220504-0030 2022050500002 KASNO 11,100.0

500MG/5ML
8 RD20220505-0002 05/05/2022 EP20220504-0030 2022050500003 KASNO 343,063.0
R/ STARXON 1 GR INJ 1.00 VIAL 343,063.00 343,063.00 0 1

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



Formula Non Formula
9 RD20220505-0003 05/05/2022 EP20220505-0001 2022050500004 DEVI HARYANTI SEMBIRING 792,013.0
10 RD20220505-0004 05/05/2022 EP20220505-0002 2022050500005 MAHLIL DAULAY 787,408.0
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
11 RD20220505-0005 05/05/2022 EP20220505-0005 2022050500009 MAISHA TAQQIYAH 8,167.0

(BPJS)
12 RD20220505-0006 05/05/2022 EP20220505-0003 2022050500010 THERESIA FRANSISCA 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
13 RD20220505-0008 05/05/2022 EP20220505-0005 2022050500015 MAISHA TAQQIYAH 22,106.0
R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1
14 RD20220505-0009 05/05/2022 EP20220505-0006 2022050500016 ANTINIUS SILITONGA 4,675.0
15 RD20220506-0003 06/05/2022 EP20220506-0004 2022050600007 ZILHI ZIYATI BR GINTING 956,158.0
R/ CORMEGA CAPS BLISTERS 10.00 CAP 16,875.00 168,750.00 0 1
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
16 RD20220506-0004 06/05/2022 EP20220506-0005 2022050600008 DELIANI HUTAURUK 319,220.0


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



Formula Non Formula
R/ OTILON EAR DROP 1.00 FLS 54,278.00 54,278.00 0 1
R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1
17 RD20220506-0005 06/05/2022 EP20220506-0006 2022050600009 FRENTRY SIHOMBING 4,675.0
18 RD20220506-0006 06/05/2022 EP20220506-0008 2022050600013 RIASI SIGALINGGING 4,675.0
19 RD20220506-0007 06/05/2022 EP20220506-0009 2022050600014 WILIAM MARSELINO 45,550.0
20 RD20220506-0008 06/05/2022 EP20220506-0010 2022050600016 EDELBERTUS IDAMAN BAHY 80,000.0

(BPJS)
21 RD20220506-0009 06/05/2022 EP20220506-0011 2022050600017 REKHA LISMAWATI 549,313.0
SIHOMBING
22 RD20220506-0012 06/05/2022 EP20220506-0014 2022050600027 RATU AURA NINI LIWU 175,719.0
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
23 RD20220506-0013 06/05/2022 EP20220506-0013 2022050600029 IMANUEL CHRISTIAN LIWU 197,637.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
24 RD20220507-0009 07/05/2022 EP20220507-0008 2022050700010 JOGI MARIANUS SIHOTANG 652,281.0


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



Formula Non Formula

(PREKURSOR)
25 RD20220507-0010 07/05/2022 EP20220507-0009 2022050700011 EKA MUNA AFIFAH 427,916.0
26 RD20220507-0011 07/05/2022 EP20220507-0010 2022050700013 HAFIS AZZAM 253,260.0
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
27 RD20220507-0012 07/05/2022 EP20220507-0011 2022050700014 SHANUM ALMAHYRA 112,249.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
28 RD20220507-0013 07/05/2022 EP20220507-0012 2022050700012 HILYA SHANIA 141,986.0
R/ LACTO B SACHET 5.00 SACH 7,080.00 35,400.00 0 1
R/ ESTIN 10 ML DROP 1.00 BTL 84,480.00 84,480.00 0 1
30 RD20220508-0001 08/05/2022 EP20220508-0001 2022050800002 84,480.0

31 RD20220508-0002 08/05/2022 EP20220508-0002 2022050800003 FAUZIAH ANUGRAH 916,793.0

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



Formula Non Formula
R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1
32 RD20220508-0003 08/05/2022 EP20220508-0003 2022050800004 JERI AMANDA 612,666.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
33 RD20220508-0004 08/05/2022 EP20220508-0005 2022050800009 LUKMAN HUTABARAT 80,000.0

(BPJS)
34 RD20220508-0005 08/05/2022 EP20220508-0004 2022050800010 MICHAEL ALFARO SIAHAAN 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
35 RD20220510-0016 10/05/2022 EP20220510-0015 2022051000019 MATTEO CHARLES IVANDER 105,748.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

(BPJS)
36 RD20220510-0017 10/05/2022 EP20220510-0014 2022051000020 ADINDA PUTRI RAMADANIZA 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
37 RD20220511-0001 11/05/2022 EP20220511-0001 2022051100001 JUITA MANIK 4,675.0
38 RD20220511-0002 11/05/2022 EP20220511-0002 2022051100002 EVAN DECO SITUMORANG 17,013.0
R/ KERTAS PERKAMEN BERLOGO 12.00 LBR 1.00 100.00 1,200.00 0 1
39 RD20220511-0003 11/05/2022 EP20220511-0002 2022051100003 EVAN DECO SITUMORANG 9,973.0

(BPJS)
40 RD20220512-0002 12/05/2022 EP20220512-0001 2022051200004 GRACIA JOVANKA RAMOS 33,440.0
SITUMORANG

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



Formula Non Formula
41 RD20220513-0002 13/05/2022 EP20220513-0002 2022051300002 748,963.0
42 RD20220514-0006 14/05/2022 EP20220514-0008 2022051400010 DAMIANUS DALA 142,915.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

DROP
43 RD20220514-0007 14/05/2022 EP20220514-0009 2022051400011 DIMAS CAHYANO 576,018.0
44 RD20220514-0008 14/05/2022 EP20220514-0010 2022051400015 ALAM PARSAULIAN 801,153.0
R/ CORMEGA CAPS BLISTERS 10.00 CAP 16,875.00 ### 0 1
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
45 RD20220514-0009 14/05/2022 EP20220514-0013 2022051400016 ARCHILA MUTIA WAHYUNI 77,939.0

SIHOMBING

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



Formula Non Formula
49 RD20220517-0006 17/05/2022 EP20220517-0004 2022051700009 ELISA NILLA SARI 32,327.0
50 RD20220517-0007 17/05/2022 EP20220517-0005 2022051700010 293,325.0
51 RD20220517-0008 17/05/2022 EP20220517-0006 2022051700012 SERTIKA HARIANJA 523,168.0
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
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
52 RD20220517-0009 17/05/2022 EP20220517-0007 2022051700013 RUDI RAHMAD 354,418.0
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
53 RD20220517-0010 17/05/2022 EP20220517-0005 2022051700014 PUTRA SIMBOLON 11,220.0
R/ BISTURI NO. 22 2.00 PCS 5,610.00 11,220.00 0 1


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



Formula Non Formula
55 RD20220517-0012 17/05/2022 EP20220517-0008 2022051700016 DARMAWAN SINAGA 87,243.0

(PSIKOTROPIKA)
56 RD20220517-0013 17/05/2022 EP20220517-0009 2022051700017 INTRI YULIANI 229,134.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
57 RD20220517-0014 17/05/2022 EP20220517-0010 2022051700018 FIONA RAMADHANTI WAHONO 309,630.0
58 RD20220522-0002 22/05/2022 EP20220522-0003 2022052200002 ZAINAL ABIDIN 301,385.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
59 RD20220523-0001 23/05/2022 EP20220523-0001 2022052300001 AVRILIANA SIHOTANG 9,973.0

(BPJS)
60 RD20220523-0002 23/05/2022 EP20220523-0002 2022052300002 ROMAULI SINAGA 262,560.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

DROP
61 RD20220523-0003 23/05/2022 EP20220523-0003 2022052300004 182,546.0

R/ ESTIN 60 ML SYR 1.00 FLS 73,920.00 73,920.00 0 1

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



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

DROP
62 RD20220523-0004 23/05/2022 EP20220523-0004 2022052300003 RATU AURA NINI LIWU 182,546.0
R/ ESTIN 60 ML SYR 1.00 FLS 73,920.00 73,920.00 0 1

DROP
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
63 RD20220525-0006 25/05/2022 EP20220525-0006 2022052500008 RENDI SABASTIAN 827,346.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
64 RD20220525-0007 25/05/2022 EP20220525-0007 2022052500009 PUTRI INTAN RIZKI 710,083.0
65 RD20220525-0008 25/05/2022 EP20220525-0009 2022052500012 EDWIVO SAUFIAH 966,127.0
66 RD20220525-0009 25/05/2022 EP20220525-0008 2022052500013 VICTOR AMAHORSEYA 302.0
67 RD20220525-0010 25/05/2022 EP20220525-0010 2022052500015 RUSNIATI BUTAR BUTAR 1,059,014.0


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



Formula Non Formula
68 RD20220525-0011 25/05/2022 EP20220525-0011 2022052500016 ANDI KUSWORO 655,214.0

(PREKURSOR)
69 RD20220525-0012 25/05/2022 EP20220525-0012 2022052500017 MARGARETHA INA SABU 297,659.0
BENIKAKAN

(PREKURSOR)
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
R/ PARAMOL 1GR/100 ML INF 1.00 FLS 96,250.00 96,250.00 0 1
R/ ANITID 50 MG/2ML INJ 1.00 AMP 23,375.00 23,375.00 0 1
71 RD20220526-0018 26/05/2022 EP20220526-0017 2022052600023 WIJAYA FIUS SAGALA 81,689.0

KAPLET
72 RD20220527-0001 27/05/2022 EP20220527-0001 2022052700001 CHOIRUDDIN LUBIS 48,262.0
R/ BUSCOPAN 20MG/ML INJ 1.00 AMP 48,262.00 48,262.00 0 1
73 RD20220527-0002 27/05/2022 EP20220527-0001 2022052700002 CHOIRUDDIN LUBIS 24,325.0
74 RD20220527-0003 27/05/2022 EP20220527-0003 2022052700003 MELVA AYU TAMPUBOLON 919,588.0


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



Formula Non Formula
75 RD20220529-0002 29/05/2022 EP20220529-0002 2022052900007 MUNAWAROH 668,910.0
R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1
76 RD20220529-0003 29/05/2022 EP20220529-0003 2022052900004 HARMAUN HARAHAP 1,486,945.0
77 RD20220529-0004 29/05/2022 EP20220529-0004 2022052900005 GABRIEL RAYMONDO 15,225.0

SITINJAK
78 RD20220529-0005 29/05/2022 EP20220529-0002 2022052900006 MUNAWAROH 27,687.0
R/ SIMVASTATIN 10 MG TAB 5.00 TAB 313.45 1,567.00 1 0
R/ FORBETES 500 MG TAB 20.00 TAB 1,306.00 26,120.00 0 1
79 RD20220529-0007 29/05/2022 EP20220529-0006 2022052900011 ASNI DAMANIK 39,000.0

DROP
80 RD20220531-0003 31/05/2022 EP20220531-0003 2022053100006 SONANG MANURUNG 93,013.0
R/ SUNGKUP OKSIGEN DEWASA 1.00 PCS 24,300.00 24,300.00 0 1

(BPJS)
R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0
REBREATHER OXYGEN MASK)
81 RD20220531-0004
DWS 31/05/2022 EP20220531-0003 2022053100009 SONANG MANURUNG 130,961.0

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



Formula Non Formula
R/ STOMACH TUBE NO. 16 1.00 PCS 38,961.00 38,961.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
82 RD20220531-0005 31/05/2022 EP20220531-0003 2022053100010 SONANG MANURUNG 33,992.0
R/ DEXTROSE 10 % INF 500 ML 1.00 FLS 8,366.25 8,366.00 1 0
R/ D 40 25 ML (OTSU) 2.00 FLS 12,813.00 25,626.00 0 1
83 RD20220531-0007 31/05/2022 EP20220531-0005 2022053100014 SHERLINA OCTAVIANI 313,854.0
84 RJ20220511-0002 11/05/2022 OP20220511-0003 2022051100002 RINO EFENDI 882,838.0
85 RJ20220511-0003 11/05/2022 OP20220511-0003 2022051100003 RINO EFENDI 211,200.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
86 RJ20220511-0005 11/05/2022 OP20220511-0007 2022051100005 MAHISA RHANI 268,950.0
R/ REMOPAIN INJ AMPUL 1.00 AMP 57,750.00 57,750.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
87 RJ20220511-0006 11/05/2022 OP20220511-0007 2022051100006 MAHISA RHANI 882,838.0

88 RJ20220511-0013 11/05/2022 OP20220511-0015 2022051100015 ARYA FEBRIANTO ROSSY 200,568.0

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


No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Jumla
Pasien
Formula Non Formula
R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1

DROP
89 RJ20220511-0014 11/05/2022 OP20220511-0016 2022051100016 RAHMA PATIKAWA 268,950.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
90 RJ20220511-0015 11/05/2022 OP20220511-0016 2022051100017 RAHMA PATIKAWA 789,910.0
91 RJ20220520-0001 20/05/2022 OP20220520-0004 2022052000001 WAFA ZOYA AZDKIYA 100,699.0
R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
92 RJ20220520-0007 20/05/2022 OP20220520-0008 2022052000008 FEBRI HARTATI 472,185.0
R/ DIPHENHYDRAMINE HCL INJ 1.00 AMP 2,062.50 2,062.00 1 0

10 MG/ML
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
93 RJ20220520-0010 20/05/2022 OP20220520-0014 2022052000011 WIKY ALEX SANDRA 895,546.0
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

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
94 RJ20220520-0012 20/05/2022 OP20220520-0014 2022052000013 WIKY ALEX SANDRA 31,693.0
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
R/ HANDSCOEN STERILE (7.0) 1.00 PCS 10,900.00 10,900.00 1 0
96 RJ20220520-0014 20/05/2022 OP20220520-0015 2022052000015 EDELBERTUS IDAMAN BAHY 1,208,993.0
R/ NACL 0.9 % 500 ML INF 20.00 FLS 7,527.60 150,552.00 1 0
R/ MASKER KARET 50.00 PCS 3,364.00 168,200.00 0 1
R/ HANDSCOEN NON STERIL S 100.00 PSG 3,532.00 353,200.00 0 1

CM
R/ PHARMAFIX XL 15 CM X 5 CM / 7,500.00 CM 14.10 105,750.00 0 1
ROLL
80CM
97 RJ20220528-0003 28/05/2022 OP20220528-0003 2022052800007 YOSIE ANDRIANI 722,545.0
R/ INPEPSA 100 ML SYR 1.00 FLS 91,520.00 91,520.00 0 1
98 RJ20220528-0004 28/05/2022 OP20220528-0005 2022052800009 MARSHA TIMOHTY HASIAN 113,513.0

SIMORANGKIR

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
99 RJ20220528-0005 28/05/2022 OP20220528-0006 2022052800010 AGUNG APRYA HENDRI 847,855.0

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



Formula Non Formula
Total Dokter DR. ERIE FAILENGGO 33,070,259.0

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



Formula Non Formula
Dokter : DR.EKA KURNIATI
1 RD20220503-0001 03/05/2022 EP20220503-0001 2022050300001 IRMA PASU SITUMORANG 110,000.0
2 RD20220504-0001 04/05/2022 EP20220504-0002 2022050400001 JAINAL TAMPUBOLON 97,051.0

(OOT)
R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0
3 RD20220504-0002 04/05/2022 EP20220504-0003 2022050400002 ALFARIJI 82,101.0
4 RD20220508-0006 08/05/2022 EP20220508-0006 2022050800011 ELFA WANIZA 45,850.0
5 RD20220508-0007 08/05/2022 EP20220508-0007 2022050800012 CRISTIAN ABIGAEL PANJAITAN 17,600.0
6 RD20220509-0007 09/05/2022 EP20220509-0007 2022050900012 SHINDY VALENTINA BR 241,202.0

NAPITUPULU
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
7 RD20220509-0008 09/05/2022 EP20220509-0008 2022050900013 FREADI LUMBAN RAJA 249,028.0
8 RD20220509-0009 09/05/2022 EP20220509-0009 2022050900014 TOMMY WIJAYA MANURUNG 128,212.0


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



Formula Non Formula
9 RD20220509-0011 09/05/2022 EP20220509-0011 2022050900016 ROLAN TOGU PARASIAN 363,043.0
R/ AMLODIPINE 10 MG TAB 10.00 TAB 2,196.47 21,964.00 1 0
10 RD20220509-0012 09/05/2022 EP20220509-0011 2022050900017 ROLAN TOGU PARASIAN 371.0
11 RD20220509-0013 09/05/2022 EP20220509-0014 2022050900021 ILHAM 56,651.0
12 RD20220509-0014 09/05/2022 EP20220509-0015 2022050900022 JOVIAN ALEXSANDER 87,832.0
13 RD20220509-0015 09/05/2022 EP20220509-0016 2022050900023 KHANZA ABIR ADZKIYA 48,999.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
14 RD20220509-0016 09/05/2022 EP20220509-0017 2022050900024 KARISMA TAMBUNAN 244,231.0
15 RD20220509-0017 09/05/2022 EP20220509-0019 2022050900025 DONAL PARLINDUNGAN 85,350.0

NAINGGOLAN
R/ CETIRIZINE 10 MG TAB 6.00 TAB 475.00 2,850.00 1 0
16 RD20220509-0018 09/05/2022 EP20220509-0020 2022050900026 HARI BUDI SANTOSO 365,156.0

(OOT)
17 RD20220509-0019 09/05/2022 EP20220509-0021 2022050900027 MUHAMMAD GILANG 314,476.0
ERLANGGA

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



Formula Non Formula
18 RD20220511-0011 11/05/2022 EP20220511-0010 2022051100017 BLASIUS 98,371.0
19 RD20220511-0012 11/05/2022 EP20220511-0012 2022051100024 DIKA ANDRIANTO 178,040.0

OMPUSUNGGU

(OOT)
R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0
R/ SCABIMITE 10 GR CREAM 2.00 TUBE 56,320.00 112,640.00 0 1
20 RD20220511-0013 11/05/2022 EP20220511-0011 2022051100021 ANGGIAT LAM PATAR 317,793.0

BUTARBUTAR

500MG/5ML
21 RD20220511-0014 11/05/2022 EP20220511-0013 2022051100025 CHARLES SIJABAT 67,014.0
22 RD20220511-0015 11/05/2022 EP20220511-0013 2022051100026 CHARLES SIJABAT 110,000.0
23 RD20220511-0016 11/05/2022 EP20220511-0011 2022051100028 ANGGIAT LAM PATAR 82,500.0

BUTARBUTAR
R/ CEFTAZIDIME 1 GR INJ 1.00 VIAL 82,500.00 82,500.00 1 0
24 RD20220511-0017 11/05/2022 EP20220511-0014 2022051100029 ENDY DWI WISNU WANTONO 41,175.0
25 RD20220511-0018 11/05/2022 EP20220511-0016 2022051100030 SITI ROHANI 99,880.0
R/ TREMENZA TABLET 10.00 TAB 2,000.63 20,006.00 0 1

(PREKURSOR)
26 RD20220511-0019 11/05/2022 EP20220511-0017 2022051100031 ASHALINA KHANZA RAIQA 127,019.0


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



Formula Non Formula
27 RD20220511-0020 11/05/2022 EP20220511-0015 2022051100032 AHMAD BUHARI 295,136.0

(PREKURSOR)
28 RD20220511-0021 11/05/2022 EP20220511-0018 2022051100033 MAYA SANTI 671,548.0
29 RD20220511-0022 11/05/2022 EP20220511-0019 2022051100036 YULI WULANDARI 160,502.0
30 RD20220511-0023 11/05/2022 EP20220511-0020 2022051100037 MUHAMMAD ARSYA 16,474.0

ALDEVARO SOLEMAN
31 RD20220512-0003 12/05/2022 EP20220512-0002 2022051200005 ERIKSON PANGARIBUAN 36,910.0

KAPLET
32 RD20220512-0004 12/05/2022 EP20220512-0002 2022051200006 ERIKSON PANGARIBUAN 293,325.0
33 RD20220512-0005 12/05/2022 EP20220512-0003 2022051200007 HOTLAN SITUMORANG 556,122.0
34 RD20220512-0006 12/05/2022 EP20220512-0004 2022051200008 NURHAFIZIAH HUSNA 168,438.0

1GR/100 ML

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



Formula Non Formula
35 RD20220513-0005 13/05/2022 EP20220513-0005 2022051300006 NGATIYEM 2,196.00
36 RD20220515-0001 15/05/2022 EP20220515-0001 2022051500001 BENNI OKINO 104,683.0
37 RD20220515-0002 15/05/2022 EP20220515-0002 2022051500002 ELRIDA PANGGABEAN 4,675.0
38 RD20220515-0003 15/05/2022 EP20220515-0003 2022051500005 SAIHU MUNIR 83,076.0

(BPJS)
TAB
R/ ASPILET 80 MG TAB 4.00 TAB 728.80 2,915.00 0 0
39 RD20220515-0004 15/05/2022 EP20220515-0003 2022051500008 SAIHU MUNIR 2,670.0

TAB
40 RD20220515-0005 15/05/2022 EP20220515-0004 2022051500009 DISPEN PANJAITAN 43,224.0

DROP
41 RD20220517-0001 17/05/2022 EP20220516-0019 2022051700003 KIKI VERAWATI SITANGGANG 80,000.0

(BPJS)
42 RD20220517-0002 17/05/2022 EP20220517-0001 2022051700004 RANEL ELVANO PANGARIBUAN 161,093.0
43 RD20220517-0003 17/05/2022 EP20220517-0002 2022051700005 GIBRAN GHANI ALKHALID 141,466.0


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



Formula Non Formula
44 RD20220518-0001 17/05/2022 EP20220517-0024 2022051800001 NOBLE HUTASOIT 11,000.0
45 RD20220518-0003 18/05/2022 EP20220518-0003 2022051800005 CHRISTINA BR SURBAKTI 555,203.0
46 RD20220518-0004 18/05/2022 EP20220518-0004 2022051800006 NOBLE HUTASOIT 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
47 RD20220518-0006 18/05/2022 EP20220518-0006 2022051800014 ELISKA DEBORA PAKPAHAN 900.0

KAPLET
48 RD20220519-0001 19/05/2022 EP20220519-0001 2022051900001 GITA ARISADNY PRATIWI 289,930.0
49 RD20220519-0002 19/05/2022 EP20220519-0002 2022051900002 NUWAIRA CARABELLA AZAHRA 32,525.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
50 RD20220522-0006 22/05/2022 EP20220522-0007 2022052200006 ALDI 98,670.0
51 RD20220522-0007 22/05/2022 EP20220522-0009 2022052200008 RANEL ELVANO PANGARIBUAN 134,633.0
52 RD20220522-0008 22/05/2022 EP20220522-0008 2022052200009 HANNAH ANETHA 6,840.0

SIMATUPANG
53 RD20220522-0009 22/05/2022 EP20220522-0010 2022052200011 NETTY MARBUN 22,900.0


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



Formula Non Formula
54 RD20220522-0010 22/05/2022 EP20220522-0011 2022052200012 AYU RISMA ARFIANTI 197,002.0
55 RD20220522-0011 22/05/2022 EP20220522-0012 2022052200013 SISKA KRISTINA SARAGIH 93,514.0
R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 70,875.00 70,875.00 1 0

KAPLET
R/ NEW DIATAB TABLET 15.00 TAB 696.44 10,446.00 0 1
56 RD20220522-0013 22/05/2022 EP20220522-0013 2022052200015 AYLA AFIFAH HARAHAP 113,195.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
57 RD20220522-0014 22/05/2022 EP20220522-0010 2022052200016 NETTY MARBUN 10,626.0
R/ BENANG BRILON 3/0 CUTTING 1.00 PCS 63,800.00 63,800.00 1 0

KAPLET

KAPLET
RAJA

RAJA

RAJA

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



Formula Non Formula

(BPJS)
65 RD20220524-0008 24/05/2022 EP20220524-0003 2022052400008 ABDUL RAHIM 45,850.0
66 RD20220524-0023 24/05/2022 EP20220524-0017 2022052400022 204,868.0
67 RD20220525-0001 25/05/2022 EP20220525-0001 2022052500001 WESTI YURNIZA 238,630.0
68 RD20220525-0002 25/05/2022 EP20220525-0002 2022052500002 ARYA FEBRIANTO ROSSY 120,685.0
R/ EPEXOL TAB 10.00 TAB 1,141.25 11,412.00 0 1
R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 4,000.00 4,000.00 1 0
70 RD20220526-0011 26/05/2022 EP20220526-0011 2022052600016 LEO MARHASIAN 69,476.0

(OOT)
71 RD20220526-0012 26/05/2022 EP20220526-0012 2022052600017 RATNA NGURA 80,375.0
R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1
72 RD20220526-0013 26/05/2022 EP20220526-0013 2022052600018 ROHIM ZAKARIYAH 108,858.0
R/ ESTIN 60 ML SYR 1.00 FLS 73,920.00 73,920.00 0 1


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



Formula Non Formula
73 RD20220526-0014 26/05/2022 EP20220526-0014 2022052600019 ADIL DWI CAESAR 3,500.0

KAPLET
74 RD20220526-0015 26/05/2022 EP20220526-0015 2022052600020 BRIGALDO ERNEST STEVANUS 50,150.0
NABABAN
75 RD20220526-0016 26/05/2022 EP20220526-0015 2022052600021 BRIGALDO ERNEST STEVANUS 95,392.0

NABABAN
76 RD20220526-0017 26/05/2022 EP20220526-0016 2022052600022 JODI CAVIN TANSESE MUNTHE 2,850.0
77 RD20220527-0017 27/05/2022 EP20220527-0015 2022052700018 ANJAR 229,134.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
78 RD20220528-0010 28/05/2022 EP20220528-0009 2022052800017 HASANUDDIN 61,309.0
79 RD20220528-0011 28/05/2022 EP20220528-0010 2022052800018 ARSYAD ROSADI 100,099.0
R/ EPEXOL TAB 10.00 TAB 1,141.25 11,412.00 0 1
80 RD20220528-0012 28/05/2022 EP20220528-0010 2022052800019 ARSYAD ROSADI 79,874.0
81 RD20220528-0013 28/05/2022 EP20220528-0011 2022052800021 MUHAMMAD FAZAR 147,911.0
R/ ESTIN 60 ML SYR 1.00 FLS 73,920.00 73,920.00 0 1
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
82 RD20220528-0014 28/05/2022 EP20220528-0012 2022052800020 CHELSEA DWI NOVITA SARI 84,098.0


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



Formula Non Formula
83 RD20220528-0015 28/05/2022 EP20220528-0013 2022052800022 YAS LEMAN 97,513.0

(BPJS)
DEWASA
84 RD20220529-0008 29/05/2022 EP20220529-0007 2022052900013 CIPTO SUMITRO 1,204.0
85 RD20220529-0010 29/05/2022 EP20220529-0008 2022052900015 MARCHELIUS NANDANA 100,849.0
R/ AMOXYCILLIN 125 ML SYR 1.00 BTL 8,250.00 8,250.00 1 0
86 RD20220529-0011 29/05/2022 EP20220529-0008 2022052900016 MARCHELIUS NANDANA 18,562.0
87 RD20220529-0012 29/05/2022 EP20220529-0009 2022052900017 FIRMAN SUPRAPTO 293,981.0
R/ EPISAN 100 ML SYR 1.00 FLS 70,541.00 70,541.00 0 1
88 RJ20220505-0001 05/05/2022 OP20220505-0001 2022050500001 PARULIANTUA NAIBAHO 108,940.0
89 RJ20220505-0002 05/05/2022 OP20220505-0002 2022050500002 EMILY FIONA GULTOM 41,466.0
90 RJ20220505-0003 05/05/2022 OP20220505-0003 2022050500003 KEVIN HONESTHA GULTOM 20,625.0

91 RJ20220505-0004 05/05/2022 OP20220505-0004 2022050500004 ALIZKA ILLONA GULTOM 79,992.0

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



Formula Non Formula
92 RJ20220505-0005 05/05/2022 OP20220505-0007 2022050500005 ADBREANSYAH EKO WIJAYA 61,309.0
93 RJ20220505-0006 05/05/2022 OP20220505-0008 2022050500006 MAI HOME NAOMI LUMBAN 147,665.0

RAJA

(OOT)
94 RJ20220506-0002 06/05/2022 OP20220506-0003 2022050600002 MULYADI NABABAN 211,200.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
95 RJ20220506-0003 06/05/2022 OP20220506-0003 2022050600003 MULYADI NABABAN 176,098.0
R/ VOMIZOLE 20 MG TAB 5.00 TAB ### 97,162.00 0 1
96 RJ20220506-0004 06/05/2022 OP20220506-0007 2022050600004 KEVIN GINTING 134,550.0
R/ ARCAPEC TAB 15.00 TAB 1,512.00 22,680.00 0 1
97 RJ20220506-0006 06/05/2022 OP20220506-0012 2022050600006 JANUARDI 84,549.0
98 RJ20220507-0003 07/05/2022 OP20220507-0005 2022050700003 ERLANDO TRABANI 174,310.0

SASONGKO
R/ AMOXAN FORTE SYR 1.00 BTL 45,056.00 45,056.00 0 1


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



Formula Non Formula
99 RJ20220507-0004 07/05/2022 OP20220507-0006 2022050700004 NARA ALETHEIA SASONGKO 152,011.0
100 RJ20220510-0001 10/05/2022 OP20220510-0001 2022051000001 ZURANISA AGUSTINI 334,780.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
101 RJ20220510-0002 10/05/2022 OP20220510-0002 2022051000002 LUSIANA PRADA 436,290.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
102 RJ20220510-0008 10/05/2022 OP20220510-0007 2022051000008 GIMSI HUTAGALUNG 204,775.0
103 RJ20220510-0009 10/05/2022 OP20220510-0008 2022051000009 MARDONAL Z 438,221.0
R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
104 RJ20220510-0010 10/05/2022 OP20220510-0010 2022051000010 YOPI WILYANSEN 126,249.0

105 RJ20220510-0017 10/05/2022 OP20220510-0016 2022051000020 RISKA ROSSITA 192,879.0

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



Formula Non Formula
106 RJ20220531-0001 31/05/2022 OP20220531-0003 2022053100001 WIDI SUHERMAN 27,659.0
107 RJ20220531-0002 31/05/2022 OP20220531-0004 2022053100002 DINI RINDA RAJATI 340,390.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ LAMETIC 4 MG INJ 1.00 AMP 42,240.00 42,240.00 0 1
R/ MELOXICAM 7,5 MG TAB 6.00 TAB 1,037.85 6,227.00 1 0
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
110 RJ20220531-0006 31/05/2022 OP20220531-0005 2022053100007 GATOT SUBROTO 233,550.0
R/ LANSOPRAZOL 30 MG INJ 1.00 VIAL 126,720.00 126,720.00 1 0
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1

R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1

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



Formula Non Formula
111 RJ20220531-0007 31/05/2022 OP20220531-0005 2022053100008 GATOT SUBROTO 280,910.0
112 RJ20220531-0010 31/05/2022 OP20220531-0007 2022053100011 AI SUSILAWATI 34,821.0
R/ MOMETASON CREAM 10 GR 1.00 TUBE 30,071.00 30,071.00 1 0
113 RJ20220531-0011 31/05/2022 OP20220531-0008 2022053100012 ENDAH DWI RIYANI 55,275.0
114 RJ20220531-0012 31/05/2022 OP20220531-0008 2022053100013 ENDAH DWI RIYANI 26,701.0

10 MG/ML
115 RJ20220531-0013 31/05/2022 OP20220531-0009 2022053100014 WA HIDJRAH WATI 335,506.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
116 RJ20220531-0014 31/05/2022 OP20220531-0009 2022053100015 WA HIDJRAH WATI 198,375.0

R/ FREGO 5 MG TAB 6.00 TAB 8,448.00 50,688.00 0 0

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



Formula Non Formula
117 RJ20220531-0017 31/05/2022 OP20220531-0013 2022053100018 SHINTYA RATU ARINA 564,482.0
R/ PANLOC INJ 2.00 VIAL 211,200.00 422,400.00 0 1
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
118 RJ20220531-0018 31/05/2022 OP20220531-0013 2022053100019 SHINTYA RATU ARINA 397,417.0
R/ BAQUINOR FORTE 500 MG 10.00 TAB 19,106.55 191,065.00 0 1

KAPLET
119 RJ20220531-0019 31/05/2022 OP20220531-0015 2022053100020 DENISSAH MUHARRAM 97,898.0
R/ FARBION INJ 2.00 AMP 10,000.00 20,000.00 0 1
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
120 RJ20220531-0021 31/05/2022 OP20220531-0015 2022053100022 DENISSAH MUHARRAM 193,700.0
R/ FREGO 5 MG TAB 6.00 TAB 8,448.00 50,688.00 0 0
121 RJ20220531-0022 31/05/2022 OP20220531-0016 2022053100023 DESPIANA PITRI 213,594.0

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/ PLESTERIN 2.00 PCS 1,046.00 2,092.00 0 1
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
Total Dokter DR.EKA KURNIATI 17,172,207.0

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



Formula Non Formula
Dokter : DR. FERRY FHRANS VALENTINUS KARO-KARO
1 RD20220527-0018 27/05/2022 EP20220527-0016 2022052700019 AFINA WAHYUNINGTIYAS 127,490.0
2 RD20220527-0019 27/05/2022 EP20220527-0017 2022052700020 NADYA EKA PUTRI 350,052.0
R/ MEMUCIL 200 MG CAPS 10.00 CAP 4,125.00 41,250.00 0 1
3 RD20220527-0020 27/05/2022 EP20220527-0018 2022052700021 DANIEL SYAHPUTRA 255,070.0
4 RD20220527-0021 27/05/2022 EP20220527-0020 2022052700023 BAYU PRADANA 227,885.0
R/ BETADINE OBAT KUMUR 100 1.00 FLS 25,500.00 25,500.00 0 1

ML
R/ METHYLON 4 MG TAB 5.00 TAB 1.00 3,162.50 16,812.00 0 1
5 RD20220527-0023 27/05/2022 EP20220527-0022 2022052700025 SABINA ARTINDIRANI PUTRI 24,992.0
6 RD20220527-0024 27/05/2022 EP20220527-0023 2022052700027 LYLA ASTRI LATURE 11,733.0

(BPJS)

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

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



Formula Non Formula
8 RD20220527-0026 27/05/2022 EP20220527-0024 2022052700030 BILMA PARLINDUNGAN 101,146.0

SINAGA

SINAGA

SINAGA
R/ BENANG CATGUT CHROM 3/0, 1.00 PCS 73,700.00 73,700.00 0 1

75 CMTAPER
11 RD20220527-0029 27/05/2022 EP20220527-0023 2022052700033 LYLA ASTRI LATURE 9,963.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
Total Dokter DR. FERRY FHRANS VALENTINUS KARO- 1,297,918.0

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


Formula Non Formula
Dokter : DR. FELIX VALERIAN HALIM
1 RD20220501-0010 01/05/2022 EP20220501-0010 2022050100018 SUCIATI 80,000.0

(BPJS)
2 RD20220501-0011 01/05/2022 EP20220501-0011 2022050100019 MUHAMMAD SIDIK 630,462.0

CAPSUL

(PREKURSOR)
3 RD20220501-0012 01/05/2022 EP20220501-0012 2022050100024 IRMA 470,179.0

DEWASA
(BPJS)
R/ SALBUTAMOL 4 MG TAB 10.00 TAB 161.50 1,615.00 1 0

CAPSUL
6 RD20220501-0015 01/05/2022 EP20220501-0014 2022050100027 YASRIL 72,646.0

KAPLET
R/ THROMBOPHOB GEL 1.00 TUBE 68,063.00 68,063.00 0 1
7 RD20220501-0016 01/05/2022 EP20220501-0015 2022050100028 CARLOS SYAPUTRA SIREGAR 9,973.0

(BPJS)
8 RD20220501-0017 01/05/2022 EP20220501-0015 2022050100029 CARLOS SYAPUTRA SIREGAR 93,213.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ COMBANTRIN SYR 10 ML 1.00 FLS 19,850.00 19,850.00 0 1

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



Formula Non Formula
9 RD20220502-0007 02/05/2022 EP20220502-0007 2022050200011 MOHAMMAD EDY WIYOSO 133,900.0
10 RD20220502-0009 02/05/2022 EP20220502-0008 2022050200013 SORTA AFRINA 22,847.0
R/ LORATADINE 10 MG TAB 5.00 TAB 449.70 2,248.00 1 0
11 RD20220503-0010 03/05/2022 EP20220503-0012 2022050300011 NOVITRIANI SINAGA 87,250.0
12 RD20220503-0011 03/05/2022 EP20220503-0013 2022050300013 KATARINA TAMBA 15,628.0
13 RD20220503-0012 03/05/2022 EP20220503-0014 2022050300014 KHODIJA MAULINA 112,517.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
14 RD20220503-0013 03/05/2022 EP20220503-0015 2022050300015 ALFIAN MAULANA 112,517.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
15 RD20220503-0014 03/05/2022 EP20220503-0016 2022050300016 ZEFANY PANJAITAN 45,563.0
16 RD20220503-0015 03/05/2022 EP20220503-0017 2022050300017 FITRI GULTOM 83,875.0

(BPJS)
KAPLET
17 RD20220506-0021 06/05/2022 EP20220506-0021 2022050600044 ZAINUDIN 31,625.0
18 RD20220507-0001 07/05/2022 EP20220507-0001 2022050700001 ASNITA 90,626.0


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



Formula Non Formula

(BPJS)
19 RD20220507-0002 07/05/2022 EP20220507-0001 2022050700002 ASNITA 55,135.0
20 RD20220507-0003 07/05/2022 EP20220507-0002 2022050700003 HOKKOP SIMANJUNTAK 80,000.0

(BPJS)
21 RD20220510-0004 10/05/2022 EP20220510-0003 2022051000005 WAHYU ARISANDI 15,214.0
22 RD20220510-0005 10/05/2022 EP20220510-0004 2022051000006 DODI SIMANJUNTAK 329,609.0
23 RD20220510-0006 10/05/2022 EP20220510-0005 2022051000007 ARYA FEBRIANTO ROSSY 264,325.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
24 RD20220512-0007 12/05/2022 EP20220512-0007 2022051200024 DASITA SEPRIANI 80,000.0

(BPJS)
25 RD20220512-0008 12/05/2022 EP20220512-0007 2022051200025 DASITA SEPRIANI 53,875.0

KAPLET
26 RD20220512-0009 12/05/2022 EP20220512-0008 2022051200026 YOLLANDA JUKASNI 247,195.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
27 RD20220512-0010 12/05/2022 EP20220512-0009 2022051200027 DARMADI 174,884.0
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1


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



Formula Non Formula
28 RD20220512-0011 12/05/2022 EP20220512-0010 2022051200029 MAYYUNI 167,474.0
R/ CERINI 10 MG TABLET 10.00 TAB 4,716.25 47,162.00 0 1
29 RD20220512-0012 12/05/2022 EP20220512-0011 2022051200030 NUWAIRA CARABELLA AZAHRA 152,011.0
30 RD20220512-0013 12/05/2022 EP20220512-0012 2022051200031 DEWI SARTIKA 367,232.0

(PREKURSOR)
31 RD20220512-0014 12/05/2022 EP20220512-0013 2022051200032 ROFIN NONDANG SIANTURI 491,138.0
R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1
32 RD20220512-0015 12/05/2022 EP20220512-0014 2022051200033 BENNI OKINO 261,985.0

(PREKURSOR)

CAPSUL
33 RD20220512-0016 12/05/2022 EP20220512-0015 2022051200034 ABDUL HAFIZI 41,696.0
34 RD20220512-0017 12/05/2022 EP20220512-0016 2022051200035 MUHAMAD ALHAFIZZI 333,340.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1


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



Formula Non Formula

(BPJS)
36 RD20220513-0003 13/05/2022 EP20220513-0003 2022051300003 SIWI GUSTIANI 18,900.0

(GAMMEX) NO. 7
R/ ASAM TRANEXAMAT 500 MG 6.00 TAB 2,475.00 14,850.00 1 0

TAB
38 RD20220514-0001 14/05/2022 EP20220514-0001 2022051400001 TOHIRIN 80,000.0

(BPJS)
39 RD20220514-0004 14/05/2022 EP20220514-0002 2022051400006 PASTOR EMANUEL VENGI 38,499.0
NIVAK
R/ SIMVASTATIN 20 MG TAB 30.00 TAB 1,283.33 38,499.00 1 0
40 RD20220514-0012 14/05/2022 EP20220514-0015 2022051400020 DELVI RIANTI MUSTIKA 5,135.0

HUTAGALUNG
41 RD20220515-0011 15/05/2022 EP20220515-0011 2022051500023 DOBARDO JEREMY 5,135.0

SITUMORANG
42 RD20220516-0001 16/05/2022 EP20220515-0012 2022051600001 YUNUS MARULI TUA 237,169.0
43 RD20220516-0002 16/05/2022 EP20220516-0002 2022051600002 KIKI VERAWATI SITANGGANG 110,000.0
44 RD20220516-0004 16/05/2022 EP20220516-0002 2022051600004 55,135.0
45 RD20220516-0005 16/05/2022 EP20220516-0004 2022051600006 KURNIA FATRIANDA 110,000.0

46 RD20220516-0006 16/05/2022 EP20220516-0005 2022051600007 INTAN KARTIKA 124,497.0

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



Formula Non Formula
47 RD20220518-0005 18/05/2022 EP20220518-0005 2022051800012 461,999.0
48 RD20220519-0003 19/05/2022 EP20220519-0003 2022051900003 NUZRI HAIKAL MATONDANG 108,035.0
49 RD20220519-0004 19/05/2022 EP20220519-0004 2022051900004 FAUZIAH ANUGRAH 195,897.0

(PREKURSOR)

CAPSUL
50 RD20220519-0005 19/05/2022 EP20220519-0005 2022051900005 50,000.0
51 RD20220519-0006 19/05/2022 EP20220519-0006 2022051900006 SAFRIZAL 407,536.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
52 RD20220519-0007 19/05/2022 EP20220519-0007 2022051900007 NIKON OMPUSUNGGU 102,236.0

CAPSUL
(PREKURSOR)


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



Formula Non Formula
54 RD20220520-0003 20/05/2022 EP20220520-0003 2022052000008 NUR AFIAH KAMILAH 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
R/ BISTURI NO. 15 1.00 PCS 5,610.00 5,610.00 0 1
56 RD20220520-0005 20/05/2022 EP20220520-0004 2022052000010 SATRIA SRIKANDI 279,774.0

SIMANUNGKALIT
R/ PROZA KAPLET 10.00 KAPLET 15,974.99 ### 0 1
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
57 RD20220520-0006 20/05/2022 EP20220520-0006 2022052000011 MULIA RAHMAD 181,550.0

CAPSUL
58 RD20220520-0007 20/05/2022 EP20220520-0005 2022052000012 FITRI YANI ZEBUA 68,063.0
R/ THROMBOPHOB GEL 1.00 TUBE 68,063.00 68,063.00 0 1

RAJA

(BPJS)
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
60 RD20220521-0003 21/05/2022 EP20220521-0003 2022052100003 SULTHAN RAFFASA ALFAREZI 206,089.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
61 RD20220521-0004 21/05/2022 EP20220521-0004 2022052100004 KHANZA ABIR ADZKIYA 105,713.0

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

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



Formula Non Formula
62 RD20220521-0005 21/05/2022 EP20220521-0005 2022052100005 RISTIA DESTRI NOVENA 206,089.0

SILABAN
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
63 RD20220521-0006 21/05/2022 EP20220521-0006 2022052100006 NIRWANA SITORUS 110,921.0
64 RD20220521-0007 21/05/2022 EP20220521-0007 2022052100008 LA ALI ORWALA 67,584.0

INJ
R/ TENSOCREPE 4 INC (10 CM X 2.00 ROLL 113,750.00 227,500.00 0 1

4.5 M)
R/ SPALK 10 X 75 X 0.5 (UNTUK 3.00 PCS 13,000.00 39,000.00 0 1
TUNGKAI BAWAH)
67 RD20220521-0010 21/05/2022 EP20220521-0011 2022052100011 RIASI SIGALINGGING 80,000.0

(BPJS)

500MG/5ML
70 RD20220522-0001 22/05/2022 EP20220522-0002 2022052200001 MARDONAL Z 428,129.0
R/ ALLOPURINOL 300 MG TAB 10.00 TAB 700.00 7,000.00 1 0


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



Formula Non Formula
71 RD20220522-0003 22/05/2022 EP20220522-0004 2022052200004 ANTO EFENDI 77,470.0
72 RD20220522-0004 22/05/2022 EP20220522-0004 2022052200003 ANTO EFENDI 110,000.0
73 RD20220522-0005 22/05/2022 EP20220522-0005 2022052200005 MICHAEL PATRICIO PARE 69,654.0
74 RD20220527-0030 27/05/2022 EP20220527-0026 2022052700034 HERI AMINUDDIN 271,889.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
75 RD20220527-0031 27/05/2022 EP20220527-0026 2022052700035 HERI AMINUDDIN 211,200.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
76 RD20220528-0001 27/05/2022 EP20220528-0001 2022052800001 PRADITA ARAFAH 359,209.0
77 RD20220528-0002 28/05/2022 EP20220528-0002 2022052800002 SITI ASIFA SRIULINA 3,500.0

KAPLET
78 RD20220528-0003 28/05/2022 EP20220528-0003 2022052800003 SISNA DIANA 211,200.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
79 RD20220529-0001 29/05/2022 EP20220529-0001 2022052900001 BANGUN HARAHAP 9,589.0
80 RD20220530-0001 30/05/2022 EP20220530-0001 2022053000001 IDA LAIA 78,053.0


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



Formula Non Formula
81 RD20220530-0002 30/05/2022 EP20220530-0001 2022053000002 IDA LAIA 110,000.0
82 RD20220530-0004 30/05/2022 EP20220530-0003 2022053000004 ANGGUN MARAWULENG 279,545.0
83 RJ20220523-0001 23/05/2022 OP20220523-0006 2022052300001 FRISKA PARHUSIP 608,420.0
R/ FLUCONAZOLE 150 MG TAB 20.00 TAB 29,700.40 594,008.00 1 0
R/ MICONAZOLE 10 GR CREAM 2.00 TUBE 4,831.00 9,662.00 1 0
84 RJ20220523-0007 23/05/2022 OP20220523-0010 2022052300007 ADIRA MELIKNA 523,680.0

(PREKURSOR)
85 RJ20220523-0009 23/05/2022 OP20220523-0011 2022052300009 YUSUF AZKA PUTRA 124,819.0
86 RJ20220523-0010 23/05/2022 OP20220523-0012 2022052300012 MAULITA NUR AMANDA 187,465.0

MINIDOSE
CAPSUL
87 RJ20220523-0014 23/05/2022 OP20220523-0019 2022052300016 KEVIN ANJASWANA SILABAN 211,845.0
88 RJ20220523-0018 23/05/2022 OP20220523-0021 2022052300022 YESAYA TARIGAN 271,889.0

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
89 RJ20220523-0019 23/05/2022 OP20220523-0022 2022052300023 KRISTINA ROMAULI SIAHAAN 271,889.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
90 RJ20220523-0021 23/05/2022 OP20220523-0024 2022052300029 JAINAL TAMPUBOLON 484,495.0
R/ MEMUCIL 200 MG CAPS 10.00 CAP 4,125.00 41,250.00 0 1
91 RJ20220524-0004 24/05/2022 OP20220524-0010 2022052400004 EDI SUTIKNO 122,012.0
R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1
R/ NORAGES INJEKSI 500MG/2ML 1.00 AMP 11,481.00 11,481.00 0 1
92 RJ20220524-0005 24/05/2022 OP20220524-0010 2022052400005 EDI SUTIKNO 269,727.0
93 RJ20220525-0001 25/05/2022 OP20220525-0003 2022052500001 SASTRINDU MAWANTI 178,545.0

BR.MANIK
94 RJ20220525-0004 25/05/2022 OP20220525-0007 2022052500004 UTARI DAHNIA 316,189.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

95 RJ20220525-0013 25/05/2022 OP20220525-0022 2022052500019 ANNEKE FELICIA DAELY 48,999.0

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



Formula Non Formula
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
96 RJ20220525-0019 25/05/2022 OP20220525-0028 2022052500025 RINA NATALIA SITORUS 263,439.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
Total Dokter DR. FELIX VALERIAN HALIM 16,743,719.0

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



Formula Non Formula
Dokter : DR. GINA ARIANI, SP.PD
1 RI20220510-0014 10/05/2022 RI20220510-0001 RI20220510-0014 SUPOYO 37,263.0
R/ AQUADEST 1000 ML 1.00 FLS 27,113.29 27,113.00 1 0
2 RI20220510-0024 10/05/2022 RI20220510-0001 RI20220510-0024 SUPOYO 99,658.0
R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 0 1
R/ VITAMIN B6 (PYRIDOXINE) 2.00 TAB 134.55 269.00 1 0

TAB
DEWASA
3 RI20220511-0006 11/05/2022 RI20220510-0001 RI20220511-0006 SUPOYO 123,597.0

(BPJS)
TAB
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0

KAPLET
4 RI20220512-0002 12/05/2022 RI20220511-0004 RI20220512-0002 TOHIRIN 56,250.0
5 RI20220512-0009 12/05/2022 RI20220511-0004 RI20220512-0009 TOHIRIN 77,728.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
6 RI20220512-0015 12/05/2022 RI20220510-0001 RI20220512-0015 SUPOYO 10,636.0
R/ VITAMIN B6 (PYRIDOXINE) 10.00 TAB 134.55 1,345.00 1 0

TAB
7 RI20220512-0020 12/05/2022 RI20220512-0003 RI20220512-0020 NURHAFIZIAH HUSNA 54,173.0

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
9 RI20220512-0027 12/05/2022 RI20220511-0004 RI20220512-0027 TOHIRIN 26,400.0
10 RI20220513-0006 13/05/2022 RI20220511-0004 RI20220513-0006 TOHIRIN 74,978.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ LODIA 2 4.00 TAB 1,375.00 5,500.00 0 1

MG
11 RI20220513-0013
TABLET 13/05/2022 RI20220512-0003 RI20220513-0013 NURHAFIZIAH HUSNA 74,654.0
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

(PSIKOTROPIKA)
R/ PRONALGES SUPPO 1.00 SUPP 15,500.00 15,500.00 0 1
12 RI20220513-0020 13/05/2022 RI20220511-0004 RI20220513-0020 TOHIRIN 49,476.0

(PSIKOTROPIKA)

(PSIKOTROPIKA)
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

(BPJS)
16 RI20220514-0025 14/05/2022 RI20220514-0002 RI20220514-0025 MERINA TIARA 115,377.0

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



Formula Non Formula

KAPLET
(BPJS)
R/ RL 500 ML INF 4.00 FLS 8,753.75 35,015.00 0 1

(BPJS)

(BPJS)
KAPLET

(PSIKOTROPIKA)
KAPLET

KAPLET

(BPJS)
23 RI20220515-0019 15/05/2022 RI20220515-0001 RI20220515-0019 CHRISTINA MANALU 33,855.0

(PSIKOTROPIKA)
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
24 RI20220516-0001 16/05/2022 RI20220515-0002 RI20220516-0001 ANCE PAULINA SIBAGARIANG 564,792.0

KAPLET
R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 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
R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ LEVOFLOXACIN 750 MG INF 2.00 FLS 100,000.00 200,000.00 1 0
R/ THREE WAY STOP CO-CKS 2.00 PCS 31,460.00 62,920.00 0 1

500MG/5ML
R/ SALIN 3 % 500 ML (OTSU) 2.00 FLS 38,828.00 77,656.00 0 1
R/ EXTENSION TUBE 150 CM X 1.00 PCS 62,943.75 62,943.00 0 1

1,5 ML
R/ KSR TAB 2.00 TAB 4,455.00 8,910.00 0 1
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1

1,5 ML
R/ DOBUTAMINE HCL 250 MG/5 2.00 AMP 51,013.00 102,026.00 1 0
ML INJ
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0

R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

KAPLET

(BPJS)

(PSIKOTROPIKA)

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
30 RI20220516-0013 16/05/2022 RI20220516-0001 RI20220516-0013 ZAENAL ABIDIN 44,894.0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
31 RI20220516-0016 16/05/2022 RI20220515-0002 RI20220516-0016 ANCE PAULINA SIBAGARIANG 789.0
R/ ALPRAZOLAM 0,5 MG TAB 1.00 TAB 789.75 789.00 0 0

(PSI)
R/ KSR TAB 2.00 TAB 4,455.00 8,910.00 0 1
R/ LEVOFLOXACIN 750 MG INF 1.00 FLS 100,000.00 100,000.00 1 0

500MG/5ML
33 RI20220516-0020 16/05/2022 RI20220516-0002 RI20220516-0020 ZURAIDA 27,415.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

DEWASA
(BPJS)
R/ FUROSEMIDE 10 MG/2 ML INJ 1.00 AMP 4,960.00 4,960.00 1 0
35 RI20220517-0001 17/05/2022 RI20220516-0003 RI20220517-0001 KIKI VERAWATI SITANGGANG 13,550.0
R/ LEVOFLOXACIN 500MG/100 ML 1.00 FLS 110,000.00 110,000.00 1 0

INF


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



Formula Non Formula

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

(PSIKOTROPIKA
R/ LIDOCAIN 2% INJ (BPJS) 2.00 AMP 1,800.00 3,600.00 0 1

(GAMMEX) NO. 7
R/ ETT SIZE 7,0 RUSCH + BALON 1.00 PCS 27,456.00 27,456.00 0 1
R/ RECOFOL INJEKSI 1.00 AMP 139,335.00 139,335.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ FENTANYL 0.05 MG/ML, 2 ML 2.00 CC 30,250.00 60,500.00 0 0

INJEKSI (NARKOTIKA)
R/ ATRACURIUM BESILATE 50 1.00 AMP 57,750.00 57,750.00 1 0
MG/5 ML INJEKSI

TABLET
42 RI20220517-0012 17/05/2022 RI20220516-0001 RI20220517-0012 ZAENAL ABIDIN 18,414.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ EPHEDRIN HCL INJ (PREK) 1.00 AMP 5,896.40 5,896.00 0 0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

INJ (BPJS)
500MG/5ML

1,5 ML
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/ KCL 7.46% 25 ML 1.00 FLS 11,686.00 11,686.00 0 1
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/ CURCUMA FCT TAB 1.00 TAB 929.17 929.00 0 1
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1
R/ DEXTROSE 5% 500 ML INF 1.00 FLS 9,371.60 9,371.00 0 1

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

500MG/5ML
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ NOREPINEPHRINE 4MG/4ML 1.00 AMP 60,000.00 60,000.00 1 0

INJ (BPJS)
R/ SPUIT 50 ML (WITHOUT 1.00 PCS 42,000.00 42,000.00 0 1
NEEDLE) ONEMED
47 RI20220517-0019 17/05/2022 RI20220516-0002 RI20220517-0019 ZURAIDA 13,192.0

(PSIKOTROPIKA)
R/ KCL 7.46% 25 ML 1.00 FLS 11,686.00 11,686.00 0 1
50 RI20220517-0023 17/05/2022 RI20220516-0002 RI20220517-0023 ZURAIDA 2,200.0

TABLET
51 RI20220517-0024 17/05/2022 RI20220514-0002 RI20220517-0024 MERINA TIARA 929.0
R/ SALIN 3 % 500 ML (OTSU) 1.00 FLS 38,828.00 38,828.00 0 1


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



Formula Non Formula

KAPLET

NEEDLE) ONEMED
R/ METHYLPREDNISOLONE 125 3.00 VIAL 49,665.00 148,995.00 1 0
MG INJ
R/ NOREPINEPHRINE 4MG/4ML 1.00 AMP 60,000.00 60,000.00 1 0
INJ (BPJS)
R/ NALD 18 (ONEMED) 2.00 PCS 861.00 1,722.00 1 0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0

1,5 ML
R/ EPINEPHRINE INJ 2.00 AMP 12,160.00 24,320.00 1 0
R/ MEYLON 25 ML 4.00 FLS 19,430.00 77,720.00 0 1

R/ SUNGKUP OKSIGEN DEWASA
DWS 1.00 PCS 24,300.00 24,300.00 0 1

(BPJS)

TABLET
59 RI20220518-0003 18/05/2022 RI20220518-0001 RI20220518-0003 WILTON PARSORAN LUMBAN 4,569.0
TOBING

(PSIKOTROPIKA)
TOBING

(PSIKOTROPIKA)
61 RI20220518-0014 18/05/2022 RI20220516-0002 RI20220518-0014 ZURAIDA 5,497.0

TABLET

TABLET
(PSIKOTROPIKA)
63 RI20220518-0022 18/05/2022 RI20220516-0002 RI20220518-0022 ZURAIDA 39,863.0

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



Formula Non Formula

TABLET
TOBING
R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0
65 RI20220519-0016 19/05/2022 RI20220519-0001 RI20220519-0016 MANNEN PARSAORAN 128,974.0

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

(BPJS)
66 RI20220520-0001 20/05/2022 RI20220519-0002 RI20220520-0001 AMATUS EDISON 93,903.0
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

(BPJS)
TABLET
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

TABLET
72 RI20220522-0005 22/05/2022 RI20220522-0001 RI20220522-0005 FEBRIN SELLE 110,210.0

TANGGULUNGAN

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



Formula Non Formula

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

KAPLET

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

KAPLET
(BPJS)
74 RI20220523-0002 23/05/2022 RI20220523-0001 RI20220523-0002 RAHMI 918,489.0

500MG/5ML
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
75 RI20220523-0007 23/05/2022 RI20220523-0001 RI20220523-0007 RAHMI 3,003.0
76 RI20220523-0009 23/05/2022 RI20220523-0001 RI20220523-0009 RAHMI 7,156.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
77 RI20220523-0010 23/05/2022 RI20220523-0001 RI20220523-0010 RAHMI 12,727.0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
78 RI20220523-0011 23/05/2022 RI20220523-0001 RI20220523-0011 RAHMI 46,800.0
R/ LESICHOL 300 MG CAP 3.00 CAP 15,600.00 46,800.00 0 1
79 RI20220523-0012 23/05/2022 RI20220523-0001 RI20220523-0012 RAHMI 42,493.0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 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
80 RI20220523-0013 23/05/2022 RI20220523-0001 RI20220523-0013 RAHMI 467,500.0
R/ SIMLEV 750 MG INF 1.00 BOX 467,500.00 467,500.00 0 1
81 RI20220523-0014 23/05/2022 RI20220523-0001 RI20220523-0014 RAHMI 42,000.0

NEEDLE) ONEMED
82 RI20220523-0015 23/05/2022 RI20220523-0001 RI20220523-0015 RAHMI 861.0
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
83 RI20220524-0001 24/05/2022 RI20220523-0001 RI20220524-0001 RAHMI 14,800.0
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1
84 RI20220524-0002 24/05/2022 RI20220523-0001 RI20220524-0002 RAHMI 1,205,581.0
R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1

500MG/5ML
R/ PANLOC INJ 2.00 VIAL 211,200.00 422,400.00 0 1
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

TANGGULUNGAN
86 RI20220524-0007 24/05/2022 RI20220523-0001 RI20220524-0007 RAHMI 141,587.0

NEEDLE) ONEMED
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

87 RI20220524-0008 24/05/2022 RI20220523-0001 RI20220524-0008 RAHMI 67,500.0

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



Formula Non Formula
88 RI20220524-0009 24/05/2022 RI20220523-0001 RI20220524-0009 RAHMI 639,844.0
R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1
89 RI20220524-0014 24/05/2022 RI20220523-0001 RI20220524-0014 RAHMI 247,497.0
R/ SNMC (STRONGER NEO 2.00 AMP 105,000.00 210,000.00 0 0

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

TANGGULUNGAN

(BPJS)
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
91 RI20220525-0003 25/05/2022 RI20220523-0001 RI20220525-0003 RAHMI 1,628,098.0
R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1

500MG/5ML
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
92 RI20220525-0007 25/05/2022 RI20220523-0001 RI20220525-0007 RAHMI 37,203.0

TANGGULUNGAN
(BPJS)
R/ RL 500 ML INF 5.00 FLS 8,753.75 43,768.00 0 1

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



Formula Non Formula
94 RI20220525-0010 25/05/2022 RI20220523-0001 RI20220525-0010 RAHMI 91,520.0
95 RI20220525-0011 25/05/2022 RI20220523-0001 RI20220525-0011 RAHMI 45,180.0
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1
96 RI20220525-0012 25/05/2022 RI20220523-0001 RI20220525-0012 RAHMI 634,651.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
R/ AMINOFUSIN HEPAR 500 ML 1.00 FLS 288,640.00 288,640.00 1 0

INF
R/ MEROPENEM INJEKSI 1 GR 3.00 VIAL 96,250.00 288,750.00 1 0
97 RI20220525-0014 25/05/2022 RI20220523-0001 RI20220525-0014 RAHMI 324,119.0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1
98 RI20220525-0015 25/05/2022 RI20220525-0003 RI20220525-0015 VICTOR AMAHORSEYA 17,507.0
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/ NICARDIPINE 10 MG INJ 1.00 AMP 130,000.00 130,000.00 1 0

1,5 ML
NEEDLE) ONEMED
INJEKSI
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
102 RI20220526-0001 26/05/2022 RI20220525-0004 RI20220526-0001 GRACE HANNA CYNTIA 26,261.0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

TANGGULUNGAN
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
105 RI20220526-0008 26/05/2022 RI20220523-0001 RI20220526-0008 RAHMI 2,347,858.0
R/ PANLOC INJ 2.00 VIAL 211,200.00 422,400.00 0 1
R/ NEO K INJ 2.00 AMP 14,800.34 29,600.00 0 1

INF

MINOPHAGEN C) INJ
R/ MEROPEX 1 GR INJ 2.00 VIAL 529,375.00 1,058,750.00 0 1
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
106 RI20220526-0011 26/05/2022 RI20220523-0001 RI20220526-0011 RAHMI 299,792.0
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
107 RI20220526-0015 26/05/2022 RI20220523-0001 RI20220526-0015 RAHMI 511,888.0

(PREKURSOR)
(OOT)

RS
SANTA
ELISABET
Kec.
H SEISagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685
LEKOP



Formula Non Formula
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
109 RI20220527-0006 27/05/2022 RI20220523-0001 RI20220527-0006 RAHMI 3,129,442.0
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ MEROPEX 1 GR INJ 3.00 VIAL 529,375.00 1,588,125.00 0 1
R/ MEMUCIL 600 MG 1.00 TAB 11,687.50 11,687.00 0 1

EFFERVESCENT

MINOPHAGEN C) INJ
110 RI20220528-0001 28/05/2022 RI20220528-0001 RI20220528-0001 SISNA DIANA 432,089.0
R/ KCL 7.46% 25 ML 2.00 FLS 11,686.00 23,372.00 0 1
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0
R/ KSR TAB 2.00 TAB 4,455.00 8,910.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
112 RI20220528-0011 28/05/2022 RI20220523-0001 RI20220528-0011 RAHMI 183,483.0


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



Formula Non Formula
113 RI20220528-0012 28/05/2022 RI20220523-0001 RI20220528-0012 RAHMI 205,000.0

INF
114 RI20220528-0016 28/05/2022 RI20220528-0005 RI20220528-0016 ENDRI YENI 451,695.0
R/ EPEXOL TAB 11.00 TAB 1,141.25 12,553.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ KCL 7.46% 25 ML 1.00 FLS 11,686.00 11,686.00 0 1
118 RI20220528-0027 28/05/2022 RI20220523-0001 RI20220528-0027 RAHMI 59,136.0
R/ KAEN 4B 500 ML (OTSU) 2.00 FLS 23,100.00 46,200.00 0 1
R/ PANLOC INJ 2.00 VIAL 211,200.00 422,400.00 0 1

KAPLET
R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1

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



Formula Non Formula
R/ PANLOC INJ 3.00 VIAL 211,200.00 633,600.00 0 1
R/ KAEN 4B 500 ML (OTSU) 2.00 FLS 23,100.00 46,200.00 0 1
R/ KSR TAB 2.00 TAB 4,455.00 8,910.00 0 1
R/ KCL 7.46% 25 ML 2.00 FLS 11,686.00 23,372.00 0 1
R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1
122 RI20220529-0012 29/05/2022 RI20220523-0001 RI20220529-0012 RAHMI 509,649.0
R/ KSR TAB 15.00 TAB 4,455.00 66,825.00 0 1
R/ IMUNVIT PLUS KAPLET 10.00 KAPLET 10,935.00 109,350.00 0 1
125 RI20220529-0018 29/05/2022 RI20220529-0001 RI20220529-0018 PATROUW DIRK 17,507.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

127 RI20220530-0014 30/05/2022 RI20220530-0004 RI20220530-0014 BANGUN HARAHAP 295,354.0

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



Formula Non Formula
R/ FUROSEMIDE 40 MG TAB 1.00 TAB 293.50 293.00 1 0
R/ AQUADES 25 ML 750.00 CC 354.52 265,890.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ RAMIPRIL 5 MG TAB (BPJS) 1.00 TAB 577.27 577.00 1 0

KAPLET
R/ SUNGKUP OKSIGEN DEWASA 1.00 PCS 24,300.00 24,300.00 0 1

130 RI20220530-0018
DWS 30/05/2022 RI20220530-0004 RI20220530-0018 BANGUN HARAHAP 49,213.0

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

DEWASA
R/ AQUADEST 1000 ML 1.00 FLS 27,113.29 27,113.00 1 0

NEEDLE) ONEMED
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
135 RI20220531-0002 31/05/2022 RI20220530-0004 RI20220531-0002 BANGUN HARAHAP 929.0


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



Formula Non Formula

KAPLET
R/ RAMIPRIL 5 MG TAB (BPJS) 1.00 TAB 577.27 577.00 1 0
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
139 RI20220531-0012 31/05/2022 RI20220531-0001 RI20220531-0012 ZAKIAH 41,691.0
141 RI20220531-0016 31/05/2022 RI20220530-0004 RI20220531-0016 BANGUN HARAHAP 781.0
R/ ASPILET 80 MG TAB 1.00 TAB 781.40 781.00 0 0
142 RI20220531-0017 31/05/2022 RI20220531-0001 RI20220531-0017 ZAKIAH 83,935.0
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1
143 RI20220531-0019 31/05/2022 RI20220531-0002 RI20220531-0019 SONANG MANURUNG 442,877.0

KAPLET
R/ LEVOFLOXACIN 500MG/100 ML 3.00 FLS 110,000.00 330,000.00 1 0
INF
R/ FLUIMUCIL 100MG/ML AMP 3.00 AMP 10,909.20 32,727.00 0 1
(BPJS)
(BPJS)
R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1

MINOPHAGEN C) INJ
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

DEWASA

INF
150 RJ20220510-0005 10/05/2022 OP20220510-0003 2022051000005 DETY YULIA PUTRI 16,204.0
R/ METOCLOPRAMIDE 10 MG TAB 10.00 TAB 185.90 1,859.00 1 0
151 RJ20220510-0011 10/05/2022 OP20220510-0011 2022051000011 FELISITAS SEKU 11,392.0
152 RJ20220510-0012 10/05/2022 OP20220510-0012 2022051000012 ROSNIATI PANJAITAN 21,939.0
R/ BISOPROLOL 5 MG TAB 7.00 TAB 3,134.27 21,939.00 1 0
153 RJ20220510-0013 10/05/2022 OP20220510-0013 2022051000013 ANDRE HUTAHAEAN 381,454.0

(PSIKOTROPIKA)
154 RJ20220510-0014 10/05/2022 OP20220510-0009 2022051000014 SUPOYO 328,207.0

(BPJS)
DEWASA
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
155 RJ20220510-0015 10/05/2022 OP20220510-0009 2022051000018 SUPOYO 29,200.0
156 RJ20220510-0016 10/05/2022 OP20220510-0015 2022051000019 NENGSI SINAGA 323,184.0
R/ BAQUINOR FORTE 500 MG 6.00 TAB 19,106.55 114,639.00 0 1

KAPLET
158 RJ20220511-0009 11/05/2022 OP20220511-0009 2022051100010 SUPRIADI 40,074.0
R/ RAMIPRIL 5 MG TAB (BPJS) 5.00 TAB 577.27 2,886.00 1 0
159 RJ20220511-0010 11/05/2022 OP20220511-0011 2022051100011 DARIUS PERANGIN ANGIN 320,983.0
160 RJ20220513-0003 13/05/2022 OP20220513-0005 2022051300004 LAURENTIUS BALAMAKIN 22,900.0
161 RJ20220513-0006 13/05/2022 OP20220513-0015 2022051300019 PINTOR SIMANGUNSONG 118,272.0
162 RJ20220514-0008 14/05/2022 OP20220514-0010 2022051400010 ERIANNI BR SITIO 95,580.0
R/ URSODEOXYCHOLIC ACID 250 15.00 CAP 6,237.00 93,555.00 1 0

MG
R/ BICNAT TAB 10.00 TAB 202.50 2,025.00 1 0
163 RJ20220517-0008 17/05/2022 OP20220517-0012 2022051700024 WILTON PARSORAN LUMBAN 8,983.0

TOBING

TOBING
165 RJ20220517-0010 17/05/2022 OP20220517-0013 2022051700010 SUDIN 28,481.0


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



Formula Non Formula
168 RJ20220517-0014 17/05/2022 OP20220517-0014 2022051700017 SUPOYO 96,004.0

TAB

TAB
169 RJ20220517-0015 17/05/2022 OP20220517-0014 2022051700016 SUPOYO 96,139.0

TAB
170 RJ20220518-0005 18/05/2022 OP20220518-0008 2022051800006 AMINAH 93,045.0
171 RJ20220520-0002 20/05/2022 OP20220520-0002 2022052000002 LAURENTIUS BALAMAKIN 34,350.0
172 RJ20220520-0004 20/05/2022 OP20220520-0001 2022052100008 LASMA SINAGA 10,500.0
R/ RAMIPRIL 10 MG TAB (BPJS) 7.00 TAB 1,500.00 10,500.00 1 0
173 RJ20220520-0009 20/05/2022 OP20220520-0012 2022052000010 SARLES SINAGA 274,875.0
R/ MAXTAN 500 MG TABLET 20.00 TAB 1,718.80 34,376.00 1 0
174 RJ20220520-0011 20/05/2022 OP20220520-0013 2022052000012 ROBERTUS BISMA 585,661.0
R/ INTERLAC SACHET 10.00 SACH 12,825.00 128,250.00 0 1
175 RJ20220521-0002 21/05/2022 OP20220521-0004 2022052100002 MERINA TIARA 9,291.0


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



Formula Non Formula
176 RJ20220523-0012 23/05/2022 OP20220523-0004 2022052300013 ANDI PRAJAYA 590,425.0
R/ MEMUCIL 600 MG 7.00 TAB 11,687.50 81,812.00 0 1

EFFERVESCENT
177 RJ20220523-0013 23/05/2022 OP20220523-0008 2022052300015 MARIANUS PEHAN HEWEN 4,040.0
R/ RAMIPRIL 5 MG TAB (BPJS) 7.00 TAB 577.27 4,040.00 1 0
178 RJ20220523-0015 23/05/2022 OP20220523-0009 2022052300017 ANGGUN RAFLI 368,508.0
R/ PLASMINEX 500 MG TAB 10.00 TAB 3,815.68 38,156.00 0 1

TOBING
180 RJ20220523-0022 23/05/2022 OP20220523-0016 2022052300031 LENSIANA MURNI 583,938.0
R/ LEVOFLOXACIN 500 MG TAB 3.00 TAB 1,557.47 4,672.00 1 0
181 RJ20220523-0023 23/05/2022 OP20220523-0023 2022052300032 MARDONAL Z 18,583.0
182 RJ20220524-0003 24/05/2022 OP20220524-0001 2022052400003 LOING PREDI PARULIAN 540,507.0
183 RJ20220524-0006 24/05/2022 OP20220524-0004 2022052400006 CHRISTINA MANALU 9,291.0

184 RJ20220524-0007 24/05/2022 OP20220524-0005 2022052400007 SEMINAR UCI ZAMILI 26,033.0

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



Formula Non Formula
R/ PROPRANOLOL 10 MG TAB 21.00 TAB 1,239.70 26,033.00 1 0

(BPJS)
185 RJ20220524-0008 24/05/2022 OP20220524-0006 2022052400010 SUDIN 13,937.0
186 RJ20220525-0006 25/05/2022 OP20220525-0009 2022052500006 SEMINAR UCI ZAMILI 22,327.0
R/ PTU 100 MG TAB (BPJS) 21.00 TAB 650.00 13,650.00 1 0
R/ PROPRANOLOL 10 MG TAB 7.00 TAB 1,239.70 8,677.00 1 0

(BPJS)
187 RJ20220525-0008 25/05/2022 OP20220525-0005 2022052500016 JEANY RUNTUWEWE 102,028.0
188 RJ20220525-0010 25/05/2022 OP20220525-0012 2022052500018 TRIANI 95,612.0
189 RJ20220525-0014 25/05/2022 OP20220525-0024 2022052500020 AMINAH 93,045.0
190 RJ20220525-0015 25/05/2022 OP20220525-0024 2022052500021 AMINAH 93,045.0
191 RJ20220525-0016 25/05/2022 OP20220525-0021 2022052500022 JETTY ROSALINA HUTASOIT 20,518.0
R/ GLIMEPIRIDE 3 MG TAB 7.00 TAB 2,931.20 20,518.00 1 0
192 RJ20220525-0017 25/05/2022 OP20220525-0021 2022052500023 JETTY ROSALINA HUTASOIT 67,417.0
R/ GLIMEPIRIDE 3 MG TAB 23.00 TAB 2,931.20 67,417.00 1 0
193 RJ20220525-0020 25/05/2022 OP20220525-0027 2022052500026 ELVY SUSANTI 567,197.0
R/ MEMUCIL 600 MG 10.00 TAB 11,687.50 116,875.00 0 1

EFFERVESCENT
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
194 RJ20220527-0009 27/05/2022 OP20220527-0009 2022052700012 SIAME MANAO 130,977.0

MG
195 RJ20220527-0010 27/05/2022 OP20220527-0012 2022052700011 SISNA DIANA 246,552.0

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



Formula Non Formula
196 RJ20220530-0007 30/05/2022 OP20220530-0002 2022053000009 ELVY SUSANTI 455,257.0
R/ MEMUCIL 600 MG 7.00 TAB 11,687.50 81,812.00 0 1

EFFERVESCENT
R/ ESTIN 10 MG TAB 7.00 TAB 5,913.60 41,395.00 0 1
197 RJ20220530-0009 30/05/2022 OP20220530-0010 2022053000011 FEBRIN SELLE 13,200.0

TANGGULUNGAN
198 RJ20220531-0008 31/05/2022 OP20220531-0001 2022053100009 FRIDA MARPAUNG 8,983.0
199 RJ20220531-0009 31/05/2022 OP20220531-0001 2022053100010 FRIDA MARPAUNG 29,516.0
Total Dokter DR. GINA ARIANI, SP.PD 33,218,804.0

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



Formula Non Formula
Dokter : DR. HENDRIK, SP.PD
1 RI20220501-0013 01/05/2022 RI20220501-0003 RI20220501-0013 SUCIATI 34,170.0
2 RI20220501-0014 01/05/2022 RI20220501-0003 RI20220501-0014 SUCIATI 234,887.0
R/ DOBUTAMINE HCL 250 MG/5 3.00 AMP 51,013.00 153,039.00 1 0

ML INJ
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0

NEEDLE) ONEMED
3 RI20220502-0001 02/05/2022 RI20220501-0003 RI20220502-0001 SUCIATI 8,525.0
4 RI20220502-0002 02/05/2022 RI20220501-0003 RI20220502-0002 SUCIATI 7,023.0
R/ UNDER PAD 60 X 90 1.00 PCS 7,023.51 7,023.00 0 1
5 RI20220502-0003 02/05/2022 RI20220501-0003 RI20220502-0003 SUCIATI 10,626.0
6 RI20220502-0004 02/05/2022 RI20220501-0003 RI20220502-0004 SUCIATI 14,047.0
R/ UNDER PAD 60 X 90 2.00 PCS 7,023.51 14,047.00 0 1
7 RI20220502-0005 02/05/2022 RI20220501-0003 RI20220502-0005 SUCIATI 44,000.0

8 RI20220502-0006
DWS 02/05/2022 RI20220501-0003 RI20220502-0006 SUCIATI 23,370.0
9 RI20220502-0009 02/05/2022 RI20220501-0003 RI20220502-0009 SUCIATI 37,488.0
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

10 RI20220502-0010 02/05/2022 RI20220501-0003 RI20220502-0010 SUCIATI 56,412.0

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



Formula Non Formula
R/ ETT SIZE 7,0 RUSCH + BALON 1.00 PCS 27,456.00 27,456.00 0 1
R/ EPINEPHRINE INJ 1.00 AMP 12,160.00 12,160.00 1 0
11 RI20220502-0011 02/05/2022 RI20220501-0003 RI20220502-0011 SUCIATI 149,718.0

R/ SUNGKUP NEBULEZER
ANAK 1.00 PCS 72,800.00 72,800.00 0 1
DEWASA
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ AMIODARON 50 MG/ML INJ 2.00 AMP 8,761.90 17,523.00 1 0
R/ SUCTION CATHETER NO. 18 1.00 PCS 7,500.00 7,500.00 1 0

INJ (BPJS)
12 RI20220504-0003 04/05/2022 RI20220504-0001 RI20220504-0003 FINSESIA KOLONG 198,145.0
R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ

INJEKSI

INJEKSI
15 RI20220505-0002 05/05/2022 RI20220505-0002 RI20220505-0002 ROSNIATI PANJAITAN 47,016.0

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

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

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



Formula Non Formula
R/ NALD 26 (TERUMO) 1.00 PCS 4,712.50 4,712.00 0 1
19 RI20220505-0007 05/05/2022 RI20220504-0001 RI202205 FINSESIA KOLONG 67,500.0

05-0007

INJEKSI

INJ (BPJS)
21 RI20220506-0002 06/05/2022 RI20220506-0002 RI20220506-0002 ANDRE HUTAHAEAN 8,753.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ

INJEKSI

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

(PSIKOTROPIKA)
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

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

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



Formula Non Formula
25 RI20220506-0009 06/05/2022 RI20220506-0003 RI20220506-0009 DETY YULIA PUTRI 25,185.0
26 RI20220506-0010 06/05/2022 RI20220506-0004 RI20220506-0010 SUPRIADI 37,116.0

INJ (BPJS)
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
28 RI20220506-0012 06/05/2022 RI20220506-0005 RI20220506-0012 EDELBERTUS IDAMAN BAHY 130,140.0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ DARYANT TULLE 3.00 PCS 30,071.30 90,213.00 0 1

INJEKSI
31 RI20220506-0015 06/05/2022 RI20220506-0005 RI20220506-0015 EDELBERTUS IDAMAN BAHY 1,500,000.0
R/ OCTALBIN 20 % INF 1.00 FLS 1,500,000.00 1,500,000.00 0 0
32 RI20220506-0016 06/05/2022 RI20220506-0006 RI20220506-0016 ERIANNI BR SITIO 23,370.0

INJEKSI
(PSIKOTROPIKA)
35 RI20220506-0020 06/05/2022 RI20220506-0005 RI20220506-0020 EDELBERTUS IDAMAN BAHY 775.0

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



Formula Non Formula

KAPLET
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
37 RI20220507-0002 07/05/2022 RI20220506-0003 RI20220507-0002 DETY YULIA PUTRI 44,848.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
38 RI20220507-0003 07/05/2022 RI20220506-0004 RI20220507-0003 SUPRIADI 58,237.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

INJ (BPJS)

CM
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
R/ NACL 0.9 % 500 ML INF 4.00 FLS 7,527.60 30,110.00 1 0
R/ METFORMIN 500 MG TAB 10.00 TAB 246.40 2,464.00 1 0


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



Formula Non Formula

MG
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1

MG
R/ ISONIAZID 300 MG TABLET 1.00 TAB 336.00 336.00 1 0

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

CM

500MG/5ML

TABLET


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



Formula Non Formula

MG
53 RI20220508-0010 08/05/2022 RI20220508-0002 RI20220508-0010 LUKMAN HUTABARAT 34,170.0
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
56 RI20220508-0016 08/05/2022 RI20220506-0005 RI20220508-0016 EDELBERTUS IDAMAN BAHY 269.0
R/ ISONIAZID (INH) 300 MG TAB 1.00 TAB 0.01 0.00 1 0

(ARV)
TAB

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

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

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

(ARV)
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/ DARYANT TULLE 1.00 PCS 30,071.30 30,071.00 0 1
R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

MG

CM
R/ NACL 0.9 % 500 ML INF 4.00 FLS 7,527.60 30,110.00 1 0
R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1
69 RI20220510-0008 10/05/2022 RI20220508-0002 RI20220510-0008 LUKMAN HUTABARAT 405.0
R/ BICNAT TAB 2.00 TAB 202.50 405.00 1 0

TAB
TABLET
(ARV)

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

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



Formula Non Formula

INJ (BPJS)
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

CM
R/ NACL 0.9 % 500 ML INF 4.00 FLS 7,527.60 30,110.00 1 0

(ARV)

INJ (BPJS)

TAB
77 RI20220511-0017 11/05/2022 RI20220508-0002 RI20220511-0017 LUKMAN HUTABARAT 5.0
R/ PRIMAQUINE PHOSPHATE 15 1.00 TAB 1.00 1.00 1 0

MG TAB
R/ DHP-FRIMAL TAB 4.00 TAB 1.00 4.00 0 1
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

TAB

TABLET

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

CM
R/ NACL 0.9 % 500 ML INF 4.00 FLS 7,527.60 30,110.00 1 0
R/ PRIMAQUINE PHOSPHATE 15 13.00 TAB 1.00 13.00 1 0

MG TAB
KAPLET
R/ DHP-FRIMAL TAB 8.00 TAB 1.00 8.00 0 1

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

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

(ARV)

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



Formula Non Formula

CM
R/ NACL 0.9 % 500 ML INF 4.00 FLS 7,527.60 30,110.00 1 0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0
R/ TRANSOFIX 2.00 PCS 19,600.00 39,200.00 0 1

CM

1GR/100 ML
R/ AQUADES 25 ML 125.00 CC 354.52 44,315.00 0 1

CM
TABLET

TAB

KAPLET
(ARV)

TABLET
R/ DEVIT 1000 IU 15.00 TAB 2,965.95 44,489.00 0 1

TAB

500MG/5ML
Total Dokter DR. HENDRIK, SP.PD 6,894,655.0

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



Formula Non Formula
Dokter : PERAWAT

80CM
3 RJ20220530-0022 30/05/2022 OP20220530-0024 2022053000028 EDELBERTUS IDAMAN BAHY 1,233,222.0
R/ HANDSCOEN NON STERIL M 50.00 PSG 3,900.00 195,000.00 0 1
R/ MASKER KARET 30.00 PCS 3,364.00 100,920.00 0 1

80CM
R/ NACL 0.9 % 500 ML INF 20.00 FLS 7,527.60 150,552.00 1 0
Total Dokter PERAWAT 2,098,661.0

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



Formula Non Formula
Dokter : DR. SHINLY MEIVINITA GINTING
1 RD20220501-0002 01/05/2022 EP20220501-0002 2022050100002 RIZKI ARIF 190,954.0
R/ ARCAPEC TAB 5.00 TAB 1,512.00 7,560.00 0 1
2 RD20220501-0003 01/05/2022 EP20220501-0003 2022050100003 RIFALDO SIMAMORA 13,907.0

KAPLET
KAPLET
3 RD20220501-0004 01/05/2022 EP20220501-0004 2022050100004 SALSABILA AZZAHRA 61,474.0
4 RD20220501-0005 01/05/2022 EP20220501-0005 2022050100009 JONATAN ROBERKAT 24,544.0

SIMANUNGKALIT
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
5 RD20220501-0006 01/05/2022 EP20220501-0007 2022050100013 HAMDAN 371,651.0
6 RD20220501-0007 01/05/2022 EP20220501-0006 2022050100014 CARISSA FEODORA PRINCESS 24,544.0

SINAGA
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
7 RD20220501-0008 01/05/2022 EP20220501-0008 2022050100015 MEILINDA KRISTIANI SILABAN 107,421.0
R/ CORTIDEX 0,5 MG TAB 4.00 TAB 1.00 398.80 9,621.00 0 1
TREMENZA TABLET 3.00 TAB 2,000.63 0.00 0 1

(PREKURSOR)
8 RD20220501-0009 01/05/2022 EP20220501-0009 2022050100016 RITA ESTERLINA PASARIBU 491,498.0

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



Formula Non Formula

(PREKURSOR)
R/ BURNAZIN 35 GR CREAM 1.00 TUBE 73,563.00 73,563.00 0 1
9 RD20220502-0005 02/05/2022 EP20220502-0005 2022050200007 NOEL ZAIDEN ZAI 52,706.0
10 RD20220502-0006 02/05/2022 EP20220502-0004 2022050200009 RIKKI PRATAMA SIREGAR 95,090.0
11 RD20220503-0002 03/05/2022 EP20220503-0006 2022050300003 ALVARO LUMAYAN ZEBUAH 230,061.0
R/ ALCO DROP (PREK) 1.00 FLS 117,563.00 117,563.00 0 1
R/ AMBROXOL 30 MG TAB 3.00 TAB 1.00 285.41 17,348.00 1 0
AMOXAN 500 MG CAPSUL 3.00 CAP 4,400.00 0.00 0 1
SANMOL 500 MG TABLET 3.00 TAB 422.40 0.00 0 1
12 RD20220503-0003 03/05/2022 EP20220503-0004 2022050300004 JEFRI ZEBUAH 271,383.0
13 RD20220503-0004 03/05/2022 EP20220503-0005 2022050300005 TINCE SITIO 303,811.0

(OOT)

(PREKURSOR)
14 RD20220503-0005 03/05/2022 EP20220503-0008 2022050300006 IVANA YOCELINE SIPAHUTAR 116,474.0

R/ REGIT SYR 1.00 FLS 55,000.00 55,000.00 0 1

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



Formula Non Formula
15 RD20220503-0006 03/05/2022 EP20220503-0009 2022050300007 PERESTROIKA CINTA SILALAHI 0.0
VITAMIN B COMPLEX TAB 2.00 TAB 240.90 0.00 1 0
16 RD20220503-0007 03/05/2022 EP20220503-0003 2022050300008 MAROMBASTUA 337,355.0
R/ BETASON KRIM 5 GR 1.00 TUBE 7,950.00 7,950.00 0 1
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
17 RD20220503-0008 03/05/2022 EP20220503-0010 2022050300009 AHMAD MUMTAZ HUSAIN 112,301.0

SIREGAR

(OOT)
DROP
18 RD20220503-0009 03/05/2022 EP20220503-0011 2022050300010 ADIBA ZAHIRA SALSABILA 112,301.0

SIREGAR

DROP
(OOT)
19 RD20220504-0003 04/05/2022 EP20220504-0005 2022050400004 DESMARNI 236,269.0

KAPLET
20 RD20220504-0004 04/05/2022 EP20220504-0004 2022050400005 FARHAN ADITYA PURBA 37,101.0
21 RD20220504-0005 04/05/2022 EP20220504-0007 2022050400006 MARIA BR SINAMBELA 178,545.0
22 RD20220504-0006 04/05/2022 EP20220504-0008 2022050400007 ADINTA MUDA YUSUF 292,140.0


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



Formula Non Formula
23 RD20220504-0007 04/05/2022 EP20220504-0009 2022050400008 TEUKU BUDIMAN SARI 101,044.0
24 RD20220504-0008 04/05/2022 EP20220504-0010 2022050400009 IRWAN 183,350.0

SIHOMBING
26 RD20220504-0010 04/05/2022 EP20220504-0006 2022050400011 SHEIVIA AQHILLA 100,212.0

MAHDALENA
27 RD20220504-0012 04/05/2022 EP20220504-0014 2022050400014 OBNIEL NICHOLAS MANURUNG 224,552.0

(PREKURSOR)
28 RD20220504-0013 04/05/2022 EP20220504-0015 2022050400015 NOVELINA SELES 236,750.0

LUMBANTORUAN
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
29 RD20220504-0014 04/05/2022 EP20220504-0016 2022050400016 INDAH RAHMA FIRTI 272,949.0
R/ REGIT 10 MG TAB 6.00 TAB 4,200.00 25,200.00 0 1
30 RD20220504-0015 04/05/2022 EP20220504-0017 2022050400017 SRI WULANDARI 178,190.0

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
31 RD20220504-0016 04/05/2022 EP20220504-0018 2022050400018 DOLOROSA MARIA LEBI 71,499.0
32 RD20220505-0017 05/05/2022 EP20220505-0013 2022050500024 ANDRE HUTAHAEAN 128,832.0
33 RD20220506-0001 06/05/2022 EP20220506-0001 2022050600005 AGUSTINUS RENALDY TANI 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
34 RD20220506-0002 06/05/2022 EP20220506-0003 2022050600006 RISMA ULINA PURBA 254,937.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
35 RD20220507-0004 07/05/2022 EP20220507-0003 2022050700005 MURNIWATI 275,200.0
36 RD20220507-0005 07/05/2022 EP20220507-0005 2022050700006 RAHMAD OFDI 293,325.0
37 RD20220507-0006 07/05/2022 EP20220507-0005 2022050700007 RAHMAD OFDI 51,123.0
38 RD20220507-0007 07/05/2022 EP20220507-0006 2022050700008 ANGGA OKTA HARIANTO 217,545.0

DROP
39 RD20220507-0008 07/05/2022 EP20220507-0007 2022050700009 GINA SONIA HUTASOIT 27,600.0

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



Formula Non Formula
40 RD20220510-0007 10/05/2022 EP20220510-0006 2022051000008 BRIGHTLY OWENS 228,415.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
41 RD20220510-0008 10/05/2022 EP20220510-0007 2022051000009 ROLAN TOGU PARASIAN 248,628.0
42 RD20220510-0009 10/05/2022 EP20220510-0008 2022051000010 DESPIANA PITRI 153,485.0
43 RD20220510-0010 10/05/2022 EP20220510-0010 2022051000011 RAFIFAH AFIZA GHANIA 17,600.0
44 RD20220510-0011 10/05/2022 EP20220510-0010 2022051000012 RAFIFAH AFIZA GHANIA 114,274.0
45 RD20220510-0012 10/05/2022 EP20220510-0011 2022051000013 KALAM M ABDILLAH 234,432.0


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



Formula Non Formula
48 RD20220510-0015 10/05/2022 EP20220510-0013 2022051000016 IDA LAIA 94,282.0
49 RD20220511-0004 11/05/2022 EP20220511-0004 2022051100005 KATHARINA ANGEL OKTAVIANI 11,000.0

NAWANG

KAPLET
50 RD20220511-0005 11/05/2022 EP20220511-0006 2022051100008 ARBAIN 137,670.0

DROP
51 RD20220511-0006 11/05/2022 EP20220511-0007 2022051100009 HARTINI.SPD 53,823.0

KAPLET
52 RD20220511-0007 11/05/2022 EP20220511-0005 2022051100011 SUWARYO 47,160.0

INJ
53 RD20220511-0008 11/05/2022 EP20220511-0005 2022051100013 SUWARYO 21,600.0

500MG/5ML
54 RD20220511-0009 11/05/2022 EP20220511-0008 2022051100014 ARIF B BUDIANTO 64,680.0
55 RD20220511-0010 11/05/2022 EP20220511-0009 2022051100016 FITRI AMALIA UTAMA 247,749.0

SIREGAR
56 RD20220514-0002 14/05/2022 EP20220514-0004 2022051400004 HELMI 61,176.0

DROP

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



Formula Non Formula
57 RD20220514-0003 14/05/2022 EP20220514-0003 2022051400005 VRANSISIKUS SITUMEANG 61,176.0

DROP
58 RD20220514-0005 14/05/2022 EP20220514-0006 2022051400007 ESTAURINA GINTING 10,793.0
59 RD20220516-0014 16/05/2022 EP20220516-0011 2022051600018 PUTRA PARDEDE 86,923.0
60 RD20220516-0015 16/05/2022 EP20220516-0012 2022051600019 CANTIKA AZKA RIANDA 238,919.0
R/ ODR 4 MG/5ML SYRUP 60 ML 1.00 BTL 126,500.00 126,500.00 0 0
61 RD20220516-0016 16/05/2022 EP20220516-0013 2022051600020 IKHWAN CIPTADI 338,681.0
62 RD20220516-0017 16/05/2022 EP20220516-0014 2022051600021 LEO PARLUHUTAN SORMIN 186,279.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
63 RD20220516-0018 16/05/2022 EP20220516-0015 2022051600022 IRMA 276,144.0
R/ REGIT 10 MG TAB 6.00 TAB 4,200.00 25,200.00 0 1


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



Formula Non Formula
64 RD20220516-0020 16/05/2022 EP20220516-0016 2022051600023 AFTHAR ALI MAKMUR DAULAT 309,505.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
65 RD20220516-0021 16/05/2022 EP20220516-0017 2022051600024 MUHAMMAD TEGAR PRASSTYO 84,224.0
66 RD20220516-0022 16/05/2022 EP20220516-0018 2022051600028 ZURAIDA 2,750.0
67 RD20220518-0007 18/05/2022 EP20220518-0007 2022051800015 DHONY PUTRA 214,027.0
68 RD20220518-0008 18/05/2022 EP20220518-0008 2022051800016 MUHAMMAD ARRAVI 166,260.0

500MG/5ML
69 RD20220518-0009 18/05/2022 EP20220518-0010 2022051800017 LISDA SIANTURI 196,427.0
R/ VERTIGOSAN 6 MG TAB 10.00 TAB 3,667.84 36,678.00 0 1

DEWASA
(BPJS)
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1


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



Formula Non Formula
72 RD20220518-0012 18/05/2022 EP20220518-0012 2022051800020 ZHARIMAH LUBIS 236,555.0
73 RD20220518-0013 18/05/2022 EP20220518-0013 2022051800021 IREN DIVA SITUMORANG 120,025.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1
75 RD20220518-0015 18/05/2022 EP20220518-0016 2022051800024 RIFKY AL ZAKI NASUTION 155,321.0
ESTIN 10 MG TAB 1.00 TAB 5,913.60 0.00 0 1
76 RD20220518-0017 18/05/2022 EP20220518-0017 2022051800026 APOLINA 24,544.0

RIS
FLORENT
R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 24,544.00
INON 24,544.00 0 1
DYGO
77 RD20220519-0008 19/05/2022 EP20220519-0008 2022051900008 NECI PURNAMA SARI 322,085.0

(PREKURSOR)
78 RD20220519-0009 19/05/2022 EP20220519-0009 2022051900009 ELISA EFRIANA 360,444.0

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
79 RD20220519-0011 19/05/2022 EP20220519-0011 2022051900011 NADILA SABATINA 143,124.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
80 RD20220519-0012 19/05/2022 EP20220519-0012 2022051900012 JAPRI 431,478.0
R/ EPEXOL TAB 10.00 TAB 1,141.25 11,412.00 0 1
81 RD20220519-0013 19/05/2022 EP20220519-0013 2022051900013 BENYAMIN SETIANO 12,831.0

SITUMORANG
82 RD20220519-0014 19/05/2022 EP20220519-0015 2022051900015 OBE HERDIANTO SIMBOLON 334,312.0

(PREKURSOR)
83 RD20220519-0015 19/05/2022 EP20220519-0016 2022051900016 RIKE REFITA SARI 407,554.0
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1
84 RD20220519-0016 19/05/2022 EP20220519-0014 2022051900017 NORITA LIMDRAWATI 6,599.0

KAPLET

R/ REGIT 10 MG TAB 6.00 TAB 4,200.00 25,200.00 0 1

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



Formula Non Formula
86 RD20220519-0021 19/05/2022 EP20220519-0018 2022051900028 MANNEN PARSAORAN 80,000.0

(BPJS)
87 RD20220520-0008 20/05/2022 EP20220520-0007 2022052000013 IAN SABAM KEANU 42,144.0
SIMANJUNTAK
R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 24,544.00 24,544.00 0 1
90 RD20220520-0011 20/05/2022 EP20220520-0010 2022052000018 DERISMANTO MUNTHE 214,295.0
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
91 RD20220520-0012 20/05/2022 EP20220520-0012 2022052000019 RETU FEBRYAN SAPUTRA 575,980.0
92 RD20220520-0013 20/05/2022 EP20220520-0012 2022052000020 RETU FEBRYAN SAPUTRA 30,976.0
R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1
93 RD20220521-0012 21/05/2022 EP20220521-0012 2022052100013 DANKE IBRANI SURI DAL 9,973.0

(BPJS)
94 RD20220521-0013 21/05/2022 EP20220521-0012 2022052100014 DANKE IBRANI SURI DAL 119,601.0


(BPJS)

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



Formula Non Formula
96 RD20220521-0016 21/05/2022 EP20220521-0015 2022052100017 MUHAMMAD AL FARIZY 152,101.0
R/ REGIT SYR 1.00 FLS 55,000.00 55,000.00 0 1
97 RD20220521-0017 21/05/2022 EP20220521-0013 2022052100018 KHODIJA MAULINA 229,674.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ CEFAT 60 ML SYR 1.00 FLS 57,475.00 57,475.00 0 1
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ CEFAT 60 ML SYR 1.00 FLS 57,475.00 57,475.00 0 1
99 RD20220521-0019 21/05/2022 EP20220521-0016 2022052100020 YULIA GUSTINA 516,051.0

(PREKURSOR)
100 RD20220521-0020 21/05/2022 EP20220521-0017 2022052100021 YUSNI SYAFARAH 423,175.0
R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1
R/ VENOSMIL GEL 1.00 TUBE 224,000.00 224,000.00 0 1
101 RD20220521-0021 21/05/2022 EP20220521-0018 2022052100022 SURUNG SIAHAAN 254,291.0
R/ EPEXOL TAB 10.00 TAB 1,141.25 11,412.00 0 1

R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

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



Formula Non Formula
R/ CEFAT 500 MG CAPS 10.00 CAP 14,284.16 142,841.00 0 1
102 RD20220521-0022 21/05/2022 EP20220521-0019 2022052100023 ARIF RAHMANSYAH SIREGAR 110,965.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ REGIT 10 MG TAB 5.00 TAB 1.00 4,200.00 22,000.00 0 1
R/ VERTIGOSAN 6 MG TAB 5.00 TAB 1.00 3,667.84 19,339.00 0 1
103 RD20220523-0005 23/05/2022 EP20220523-0005 2022052300008 HENRI HUTAURUK 71,000.0
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1

DROP
104 RD20220523-0006 23/05/2022 EP20220523-0006 2022052300012 RAHMI 33,300.0

500MG/5ML
105 RD20220523-0007 23/05/2022 EP20220523-0006 2022052300013 RAHMI 22,200.0

500MG/5ML
106 RD20220523-0008 23/05/2022 EP20220523-0008 2022052300016 NAFIS NUR LAILI 24,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
107 RD20220523-0009 23/05/2022 EP20220523-0009 2022052300019 DAHLAN TAMBUNAN 263,685.0
R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1
108 RD20220523-0010 23/05/2022 EP20220523-0010 2022052300020 MUHAMMAD NUR WAHYU 103,499.0

KAPLET
109 RD20220524-0009 24/05/2022 EP20220524-0004 2022052400009 JETTY ROSALINA HUTASOIT 3,875.0

KAPLET
110 RD20220524-0010 24/05/2022 EP20220524-0005 2022052400010 DEWARNI PANGGABEAN 218,694.0

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



Formula Non Formula
R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1
111 RD20220524-0011 24/05/2022 EP20220524-0006 2022052400011 ELESTA FARINA SITORUS 107,800.0
R/ REGIT SYR 1.00 FLS 55,000.00 55,000.00 0 1
MERTIGO 6 MG TAB 6.00 TAB 4,986.75 0.00 0 1
LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 0.00 0 1
113 RD20220525-0015 25/05/2022 EP20220525-0015 2022052500022 LEGRAN A MANIK 60,500.0
114 RD20220525-0016 25/05/2022 EP20220525-0015 2022052500023 LEGRAN A MANIK 74,716.0

KAPLET

TAB
115 RD20220526-0001 26/05/2022 EP20220526-0001 2022052600002 GABBRIEL TIO GABE 63,124.0
R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1
116 RD20220530-0019 30/05/2022 EP20220530-0018 2022053000023 RIPALDO SIRAIT 263,995.0
R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1
117 RD20220531-0001 31/05/2022 EP20220531-0001 2022053100001 REZA HAQQI 2,969.0
118 RD20220531-0002 31/05/2022 EP20220531-0002 2022053100002 ZAKIAH 126,720.0

119 RJ20220509-0001 09/05/2022 OP20220509-0004 2022050900001 SAHAT PARULIAN SIREGAR 395,036.0

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



Formula Non Formula

10 MG/ML
120 RJ20220509-0002 09/05/2022 OP20220509-0002 2022050900004 YANTY NOVITASARI 377,035.0

10 MG/ML
121 RJ20220509-0006 09/05/2022 OP20220509-0007 2022050900007 MAURA ARZEKI MANALU 122,812.0
122 RJ20220509-0011 09/05/2022 OP20220509-0009 2022050900013 JEFRI YANTO HUTASUHUT 153,485.0
123 RJ20220509-0012 09/05/2022 OP20220509-0013 2022050900015 EFFRIZAL 381,720.0

(OOT)
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
124 RJ20220509-0013 09/05/2022 OP20220509-0013 2022050900016 EFFRIZAL 30,976.0
R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1
125 RJ20220513-0004 13/05/2022 OP20220513-0011 2022051300007 POPI ANDARESTA 673,227.0

R/ REGIT 10 MG TAB 5.00 TAB 4,200.00 21,000.00 0 1

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


No. No. Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla
Resep
Formula Non Formula

(PREKURSOR)
126 RJ20220513-0005 13/05/2022 OP20220513-0012 2022051300006 HANDY TRI WIJAYANTO 342,737.0

(PREKURSOR)
R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1
127 RJ20220517-0001 17/05/2022 OP20220517-0002 2022051700001 LUJENG KARTINI 553,918.0
R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1
128 RJ20220517-0003 17/05/2022 OP20220517-0003 2022051700003 FADHIL HAKIM.S 107,066.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ EPEXOL TAB 6.00 TAB 1.00 1,141.25 34,141.00 0 1
ESTIN 10 MG TAB 2.00 TAB 5,913.60 0.00 0 1
SANMOL 500 MG TABLET 3.00 TAB 422.40 0.00 0 1
129 RJ20220517-0004 17/05/2022 OP20220517-0006 2022051700004 RAFIFAH AFIZA GHANIA 116,263.0
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
130 RJ20220517-0005 17/05/2022 OP20220517-0007 2022051700005 SULTHAN RAFFASA ALFAREZI 87,528.0

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

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



Formula Non Formula
R/ MORETIC 15ML DROP 1.00 FLS 37,000.00 37,000.00 0 1
R/ ESTIN 10 MG TAB 1.00 TAB 1.00 5,913.60 18,003.00 0 1
EPERISON 50 MG TAB 1.00 TAB 2,290.00 0.00 1 0
131 RJ20220517-0007 17/05/2022 OP20220517-0008 2022051700008 ROMA ANANDA LUMBANRAJA 86,379.0
R/ MORETIC 15ML DROP 1.00 FLS 37,000.00 37,000.00 0 1
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ EPEXOL TAB 1.00 TAB 1.00 1,141.25 16,854.00 0 1
ESTIN 10 MG TAB 1.00 TAB 5,913.60 0.00 0 1
132 RJ20220517-0013 17/05/2022 OP20220517-0018 2022051700014 ELVANO KENZO ALFARO 147,384.0

(BPJS)
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1
R/ KETRICIN ORA BASE 0,1% 1.00 TUBE 66,025.00 66,025.00 0 1

CREAM
133 RJ20220517-0017 17/05/2022 OP20220517-0020 2022051700020 ELDARINA ROMASTA 410,259.0
R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1

(OOT)
Total Dokter DR. SHINLY MEIVINITA GINTING 23,262,808.0

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



Formula Non Formula
Dokter : DR. STEVEN, SP.OG
1 RI20220514-0023 14/05/2022 RI20220514-0001 RI20220514-0023 AGUSTINA SIMBOLON 89,894.0
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
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
5 RI20220517-0033 17/05/2022 RI20220517-0004 RI20220517-0033 DENNI SERIATI PASARIBU 158,694.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

(GAMMEX) NO. 7
R/ KASA STERIL 16 X 16 CM 1.00 KTK 11,880.00 11,880.00 0 1
R/ KLEM TALI PUSAT 1.00 PCS 2,772.00 2,772.00 0 1
R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
6 RI20220517-0034 17/05/2022 RI20220517-0005 RI20220517-0034 SAWIYAH 150,694.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 0 1


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



Formula Non Formula
7 RI20220517-0035 17/05/2022 RI20220517-0006 RI20220517-0035 RIOMAS SUARTINI SILALAHI 173,061.0
R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 0 1
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1
R/ CEFOTAXIME 1 GR INJ 1.00 VIAL 9,355.00 9,355.00 1 0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
10 RI20220517-0039 17/05/2022 RI20220517-0005 RI20220517-0039 SAWIYAH 7,156.0
R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1
11 RI20220518-0007 18/05/2022 RI20220517-0006 RI20220518-0007 RIOMAS SUARTINI SILALAHI 660.0
R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0
12 RI20220518-0008 18/05/2022 RI20220517-0004 RI20220518-0008 DENNI SERIATI PASARIBU 660.0
R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0
13 RI20220518-0009 18/05/2022 RI20220517-0005 RI20220518-0009 SAWIYAH 660.0
R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0
14 RI20220518-0018 18/05/2022 RI20220517-0005 RI20220518-0018 SAWIYAH 330,355.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1


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



Formula Non Formula

500MG/5ML
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

(OOT)
R/ OXYTOCIN 10 IU/ML INJEKSI 3.00 AMP 3,125.00 9,375.00 1 0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

500MG/5ML
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1
16 RI20220518-0028 18/05/2022 RI20220517-0005 RI20220518-0028 SAWIYAH 23,000.0
R/ AQUADES 25 ML 125.00 CC 354.52 44,315.00 0 1

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

500MG/100ML INFUS

500MG/5ML
19 RI20220519-0013 19/05/2022 RI20220517-0005 RI20220519-0013 SAWIYAH 41,413.0

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



Formula Non Formula
R/ DOPAMET 250 MG TAB 10.00 TAB 2,633.00 26,330.00 0 1
R/ CEFADROXYL 500 MG CAPSUL 10.00 CAP 1,050.00 10,500.00 1 0

KAPLET
20 RJ20220509-0007 09/05/2022 OP20220509-0008 2022050900008 LENNI 795,740.0
R/ HI BONE KAPLET 30.00 KAPLET 5,400.00 162,000.00 0 1
R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.33 167,199.00 0 1
21 RJ20220509-0008 09/05/2022 OP20220509-0012 2022050900009 SRI HARIYATI 80,208.0
22 RJ20220509-0009 09/05/2022 OP20220509-0011 2022050900010 RANI SEVENTINA 167,199.0
23 RJ20220509-0010 09/05/2022 OP20220509-0012 2022050900011 SRI HARIYATI 114,335.0
R/ BIONEMI CAPSUL 10.00 CAP 2,281.50 22,815.00 0 1
24 RJ20220518-0007 18/05/2022 OP20220518-0015 2022051800009 VIA RAHELIA DAMANIK 329,199.0
25 RJ20220520-0003 20/05/2022 OP20220520-0005 2022052000003 NURHALINA SIREGAR 725,199.0
26 RJ20220520-0006 20/05/2022 OP20220520-0010 2022052000007 RINA 687,565.0
R/ UTROGESTAN 200 MG CAPS 16.00 CAP 30,976.00 495,616.00 0 1

TAB
27 RJ20220525-0007 25/05/2022 OP20220525-0014 2022052500007 SAWIYAH 52,312.0
R/ POSTOFIX PU SIZE 10 X 25 CM 1.00 PCS 52,312.50 52,312.00 0 1
28 RJ20220525-0009 25/05/2022 OP20220525-0014 2022052500010 SAWIYAH 2,076.0

R/ NIFEDIPINE 10 MG TAB 10.00 TAB 207.69 2,076.00 1 0

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



Formula Non Formula
29 RJ20220527-0007 27/05/2022 OP20220527-0011 2022052700008 RINI FITRIANI 98,120.0
R/ PROGESTON TAB 10.00 TAB 4,812.00 48,120.00 0 1
Total Dokter DR. STEVEN, SP.OG 4,856,635.0

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



Formula Non Formula
Dokter : DR. YURI SP.A
1 RI20220501-0001 01/05/2022 RI20220430-0001 RI20220501-0001 AMALIA ROSMANDA AZHARI 17,507.0
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1
2 RI20220501-0010 01/05/2022 RI20220501-0001 RI20220501-0010 JONATAN ROBERKAT 861.0

SIMANUNGKALIT
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
3 RI20220501-0011 01/05/2022 RI20220501-0002 RI20220501-0011 CARISSA FEODORA PRINCESS 73,632.0

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

SINAGA
R/ KETOCONAZOLE 10 GR CREAM 1.00 TUBE 7,580.00 7,580.00 1 0

SINAGA
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
6 RI20220501-0016 01/05/2022 RI20220501-0002 RI20220501-0016 CARISSA 49,088.0

FEODOR
A
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00
PRINCES 49,088.00 0 1
S SINAGA
SINAGA
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
8 RI20220502-0008 02/05/2022 RI20220501-0001 RI20220502-0008 JONATAN ROBERKAT 49,088.0

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

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

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

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

SINAGA
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
13 RI20220505-0003 05/05/2022 RI20220505-0001 RI20220505-0003 THERESIA FRANSISCA 242,870.0

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

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



Formula Non Formula
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
15 RI20220506-0001 06/05/2022 RI20220506-0001 RI20220506-0001 AGUSTINUS RENALDY TANI 60,088.0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
17 RI20220506-0006 06/05/2022 RI20220506-0001 RI20220506-0006 AGUSTINUS RENALDY TANI 32,821.0
R/ COBAZIM 1000MCG 1.00 CAP 6,462.50 6,462.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1
19 RI20220508-0011 08/05/2022 RI20220508-0001 RI20220508-0011 MICHAEL ALFARO SIAHAAN 291,814.0
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 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 50.00 CC 354.52 17,726.00 0 1
R/ PICYN 750 MG INJ 2.00 VIAL 103,125.00 206,250.00 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) 1.00 FLS 24,544.00 24,544.00 0 1


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



Formula Non Formula
R/ COBAZIM 1000MCG 3.00 CAP 6,462.50 19,387.00 0 1
23 RI20220510-0025 10/05/2022 RI20220510-0003 RI20220510-0025 ADINDA PUTRI RAMADANIZA 94,034.0
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 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) 3.00 FLS 24,544.00 73,632.00 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) 1.00 FLS 24,544.00 24,544.00 0 1
31 RI20220514-0001 14/05/2022 RI20220513-0001 RI20220514-0001 FATARLANDO SIAHAAN 124,494.0
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0

1GR/100 ML
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ STESOLID 10 MG/2ML 1.00 AMP 16,107.60 16,107.00 0 0
INJEKSI (PSIKOTROPIKA)

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



Formula Non Formula

1GR/100 ML
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ PICYN 750 MG INJ 2.00 VIAL 103,125.00 206,250.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

1GR/100 ML
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

1GR/100 ML
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/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1

1GR/100 ML
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 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
47 RI20220518-0010 18/05/2022 RI20220518-0003 RI20220518-0010 NOBLE HUTASOIT 135,088.0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
49 RI20220518-0015 18/05/2022 RI20220518-0003 RI20220518-0015 NOBLE HUTASOIT 861.0
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0
51 RI20220518-0019 18/05/2022 RI20220518-0006 RI20220518-0019 RIOMAS S SILALAHI BY NY 261,425.0
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1
R/ VAKSIN HB-UNJIJECT 0.5 ML 1.00 SACH 0.00 0.00 0 0


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



Formula Non Formula
52 RI20220518-0024 18/05/2022 RI20220518-0005 RI20220518-0024 DENNI SERIATI PASARIBU BY 907.0

NY

(BAYI/NEONATUS)
53 RI20220518-0026 18/05/2022 RI20220518-0004 RI20220518-0026 SAWIYAH BY NY 54,300.0

(BAYI/NEONATUS)
R/ CENDO FENICOL 1 % SALEP 1.00 FLS 39,500.00 39,500.00 0 0
MATA
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1
R/ FEEDING TUBE 3.5 / 35 CM 1.00 PCS 84,084.00 84,084.00 1 0

(TERUMO)
55 RI20220518-0037 18/05/2022 RI20220518-0008 RI20220518-0037 APOLINARIS FLORENTINON 32,400.0
DYGO
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

DYGO
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ COBAZIM 1000MCG 3.00 CAP 6,462.50 19,387.00 0 1

DYGO

R/ COBAZIM 1000MCG 3.00 CAP 6,462.50 19,387.00 0 1
62 RI20220520-0010 20/05/2022 RI20220520-0001 RI20220520-0010 NUR AFIAH KAMILAH 50,903.0

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
63 RI20220520-0013 20/05/2022 RI20220520-0002 RI20220520-0013 IAN SABAM KEANU 50,903.0

SIMANJUNTAK
R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 24,544.00 49,088.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

SIMANJUNTAK
R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 24,544.00 49,088.00 0 1

SIMANJUNTAK
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

SIMANJUNTAK
R/ D5 + 1/4 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/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1
71 RI20220523-0005 23/05/2022 RI20220523-0002 RI20220523-0005 NAFIS NUR LAILI 121,836.0
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

(BPJS)

R/ NALD 18 (ONEMED) 2.00 PCS 861.00 1,722.00 1 0

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



Formula Non Formula
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
75 RI20220525-0009 25/05/2022 RI20220525-0001 RI20220525-0009 ELISABETH ADRIANA 124,442.0

HASIBUAN
R/ NALD 18 (ONEMED) 2.00 PCS 861.00 1,722.00 1 0
R/ D5 +1/2 NS 500 ML (WIDA) 5.00 FLS 24,544.00 122,720.00 0 1

HASIBUAN
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
78 RI20220526-0010 26/05/2022 RI20220526-0001 RI20220526-0010 GABY YOLANDA OCTAVIANI 314,739.0

SIAHAAN

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

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

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

SIAHAAN

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

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



Formula Non Formula
83 RI20220528-0003 28/05/2022 RI20220528-0004 RI20220528-0003 MUHAMMAD NASOHA 125,903.0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
84 RI20220528-0004 28/05/2022 RI20220527-0001 RI20220528-0004 LYLA ASTRI LATURE 49,088.0
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

HASIBUAN
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

SIAHAAN

INJ (BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1
R/ STESOLID 5 MG/2.5 ML 1.00 TUBE 35,963.20 35,963.00 0 0

RECTAL TUBE
88 RI20220528-0015
(PSIKOTROPIKA) 28/05/2022 RI20220528-0004 RI20220528-0015 MUHAMMAD NASOHA 35,963.0
R/ STESOLID 5 MG/2.5 ML 1.00 TUBE 35,963.20 35,963.00 0 0

RECTAL TUBE
89 RI20220528-0018
(PSIKOTROPIKA) 28/05/2022 RI20220528-0004 RI20220528-0018 MUHAMMAD NASOHA 68,400.0
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

SIAHAAN

INJ (BPJS)
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

1GR/100 ML
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1


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

HASIBUAN
R/ COBAZIM 3000MCG 3.00 CAP 14,437.50 43,312.00 0 1

SIAHAAN
R/ COBAZIM 3000MCG 3.00 CAP 14,437.50 43,312.00 0 1
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
R/ COBAZIM 3000MCG 3.00 CAP 14,437.50 43,312.00 0 1


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

105 RI20220531-0009 31/05/2022 RI20220530-0001 RI20220531-0009 SITI ASIFA SRIULINA 82,495.0
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
106 RJ20220506-0001 06/05/2022 OP20220506-0005 2022050600001 JONATAN ROBERKAT 285,896.0

SIMANUNGKALIT
R/ VAKSIN VAXIGRIP TETRA 0.5 1.00 VIAL 285,896.00 285,896.00 0 1

ML
107 RJ20220509-0003 09/05/2022 OP20220509-0001 2022050900003 AGUSTINUS RENALDY TANI 19,387.0
R/ COBAZIM 1000MCG 3.00 CAP 6,462.50 19,387.00 0 1
108 RJ20220509-0004 09/05/2022 OP20220509-0003 2022050900005 THERESIA FRANSISCA 19,387.0
R/ COBAZIM 1000MCG 3.00 CAP 6,462.50 19,387.00 0 1
109 RJ20220509-0005 09/05/2022 OP20220509-0006 2022050900006 EDWARD ADIARTO SIAHAAN 391,810.0

(BPJS)
R/ ISPRINOL 60 ML SYR 1.00 FLS 110,000.00 110,000.00 0 1

(OOT)
R/ FUSON 5 GR CREAM 1.00 TUBE 1.00 55,000.00 58,262.00 0 1
POT KOSONG 10 ML 1.00 UNT 3,262.50 0.00 0 0
110 RJ20220511-0004 11/05/2022 OP20220511-0004 2022051100004 MICHAEL ALFARO SIAHAAN 128,250.0
R/ INTERLAC SACHET 10.00 SACH 12,825.00 128,250.00 0 1
111 RJ20220518-0002 18/05/2022 OP20220518-0002 2022051800002 EMILY FIONA GULTOM 684,823.0
R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1


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



Formula Non Formula

(BPJS)
R/ ALCO DROP (PREK) 1.00 FLS 117,563.00 117,563.00 0 1
112 RJ20220518-0003 18/05/2022 OP20220518-0003 2022051800003 MARCEL LEVINO HUTABALIAN 611,307.0

(OOT)
(BPJS)
113 RJ20220523-0002 23/05/2022 OP20220523-0002 2022052300002 HANIF AZKA DAMURI 19,387.0
R/ COBAZIM 1000MCG 3.00 CAP 6,462.50 19,387.00 0 1

SIMANUNGKALIT
115 RJ20220523-0004 23/05/2022 OP20220523-0005 2022052300004 ALETHEIA GRACE PAKPAHAN 124,957.0

SIMANUNGKALIT
R/ VAKSIN SYNFLORIX 1.00 VIAL 715,817.00 715,817.00 0 0
117 RJ20220525-0002 25/05/2022 OP20220525-0001 2022052500002 IAN SABAM KEANU 72,325.0

SIMANJUNTAK
R/ COBAZIM 1000MCG 3.00 CAP 6,462.50 19,387.00 0 1
118 RJ20220525-0003 25/05/2022 OP20220525-0002 2022052500003 NOBLE HUTASOIT 0.0
SALBUTAMOL 4 MG TAB 4.00 TAB 161.50 0.00 1 0
119 RJ20220527-0001 27/05/2022 OP20220527-0001 2022052700001 NUR AFIAH KAMILAH 19,387.0
R/ COBAZIM 1000MCG 3.00 CAP 6,462.50 19,387.00 0 1


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



Formula Non Formula
121 RJ20220530-0002 30/05/2022 OP20220530-0005 2022053000002 RADHIKA ADRIAN FAHREZA 358,327.0
R/ MOTADERM 10 GR CREAM 1.00 TUBE 1.00 89,375.00 149,450.00 0 1
POT KOSONG 50 CC 1.00 PCS 5,075.00 0.00 1 0
FUSON 5 GR CREAM 1.00 TUBE 55,000.00 0.00 0 1
122 RJ20220530-0003 30/05/2022 OP20220530-0005 2022053000003 RADHIKA ADRIAN FAHREZA 63,250.0
123 RJ20220530-0017 30/05/2022 OP20220530-0004 2022053000025 SITI ASIFA SRIULINA 133,544.0
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1
Total Dokter DR. YURI SP.A 14,174,195.0

Grand Total 201,039,621.0
Jumlah
Non Generik
ormula
172,876.00
146,670.00
34,243.00
743,100.00
3,875.00
510,616.00
180,620.00
0
0
Jumlah
Non Generik
ormula
314,476.00
50,066.00
66,625.00
482,437.00
6,977.00
654,798.00
0
0
0
Jumlah
Non Generik
ormula
67,379.00
Jumlah
Non Generik
ormula
176,572.00
39,072.00
18,200.00
84,382.00
5,075.00
4,368.00
18,826.00
7,156.00
137,429.00
0
0
Jumlah
Non Generik
ormula
70,132.00
24,663.00
45,360.00
45,109.00
254.00
254.00
36,174.00
43,987.00
31,251.00
0
88,024.00
Jumlah
Non Generik
ormula
88,024.00
77,649.00
80,000.00
5,075.00
112,764.00
149,307.00
61,957.00
79,464.00
0
0
Jumlah
Non Generik
ormula
10,678.00
10,335.00
51,880.00
22,742.00
84,900.00
76,164.00
12,612.00
35,024.00
48,958.00
0
0
Jumlah
Non Generik
ormula
40,095.00
10,335.00
53,125.00
93,045.00
34,419.00
45,802.00
26,261.00
51,238.00
19,600.00
21,560.00
0
8,753.00
Jumlah
Non Generik
ormula
26,261.00
17,507.00
1,162.00
12,741.00
137,259.00
259,767.00
37,385.00
5,075.00
5,075.00
1
Jumlah
Non Generik
ormula
32,500.00
223,866.00
292,616.00
295,678.00
295,678.00
98,120.00
98,120.00
19,600.00
0
2,890.00
0
Jumlah
Non Generik
ormula
131,769.00
10.00
208,899.00
26,048.00
12.00
20,134.00
137,500.00
81,969.00
17,073.00
50,636.00
0
Jumlah
Non Generik
ormula
29,412.00
141,113.00
247,000.00
6.00
15.00
15.00
3,080.00
2,409.00
3,613.00
10.00
8,050.00
0
2,409.00
Jumlah
Non Generik
ormula
112,535.00
53,972.00
68,853.00
1,750.00
231,000.00
4,212.00
231,000.00
122,950.00
0
10.00
Jumlah
Non Generik
ormula
86,818.00
Jumlah
Non Generik
ormula
3,891.00
16,474.00
17,395.00
3,891.00
7,783.00
52,212.00
26,343.00
50,783.00
7,766.00
48,224.00
0
0
Jumlah
Non Generik
ormula
3,891.00
23,996.00
139,854.00
226,533.00
118,014.00
29,645.00
20,365.00
5,828.00
0
0
Jumlah
Non Generik
ormula
94,162.00
61,395.00
47,412.00
2,291.00
62,796.00
103,442.00
23,121.00
0
3,891.00
Jumlah
Non Generik
ormula
104,842.00
3,891.00
10,131.00
Jumlah
Non Generik
ormula
4,650.00
84,878.00
390,091.00
247,599.00
4,712.00
312,016.00
19,019.00
58,400.00
775.00
0
83,063.00
Jumlah
Non Generik
ormula
21,600.00
17,616.00
35,601.00
57,200.00
6,006.00
43,987.00
36,356.00
3,003.00
7,543.00
7,527.00
0
56,747.00
Jumlah
Non Generik
ormula
369,360.00
85,821.00
24,544.00
239,062.00
45,714.00
136,858.00
238,954.00
0
0
0
Jumlah
Non Generik
ormula
240,357.00
83,668.00
249,523.00
11,100.00
53,863.00
27,127.00
33,300.00
8,753.00
33,363.00
0
0
0
Jumlah
Non Generik
ormula
247,708.00
266,338.00
160,000.00
1,050.00
17,507.00
42,226.00
276,786.00
314,132.00
97,507.00
0
0
Jumlah
Non Generik
ormula
103,760.00
26,261.00
16,712.00
7,156.00
14,388.00
4,299.00
552,940.00
273,000.00
97,513.00
154,000.00
0
Jumlah
Non Generik
ormula
4,576.00
680,251.00
128,000.00
307,372.00
77,607.00
77,000.00
103,974.00
0
0
0
Jumlah
Non Generik
ormula
72,387.00
77,000.00
601,555.00
82,761.00
Jumlah
Non Generik
ormula
146,902.00
98,796.00
307,260.00
110,000.00
315,252.00
209,931.00
17,600.00
69,654.00
0
0
Jumlah
Non Generik
ormula
185.00
23,299.00
79,724.00
6,236.00
135,269.00
101,296.00
90,626.00
3,875.00
267,475.00
0
0
0
Jumlah
Non Generik
ormula
141,876.00
142,115.00
378,910.00
204,644.00
229,609.00
283,575.00
0
80,000.00
Jumlah
Non Generik
ormula
417,590.00
257,350.00
184,207.00
4,583.00
312,679.00
47,412.00
443,472.00
0
0
0
Jumlah
Non Generik
ormula
293,325.00
81,689.00
12,966.00
264,910.00
89,388.00
110,000.00
130,888.00
398,322.00
0
Jumlah
Non Generik
ormula
269,099.00
49,224.00
67,750.00
102,749.00
335,790.00
124,992.00
24,544.00
0
Jumlah
Non Generik
ormula
9,973.00
451,513.00
200,992.00
297,778.00
557,410.00
80,000.00
249,667.00
80,000.00
0
Jumlah
Non Generik
ormula
213,500.00
344,904.00
78,204.00
161.00
3,875.00
66,458.00
202,217.00
268,596.00
0
0
0
Jumlah
Non Generik
ormula
792,087.00
121,910.00
140,398.00
309,630.00
61,176.00
125,474.00
0
164,952.00
0
Jumlah
Non Generik
ormula
124,696.00
312,679.00
116,387.00
293,888.00
88,086.00
80,000.00
312,679.00
0
Jumlah
Non Generik
ormula
138,703.00
68,499.00
337,261.00
143,792.00
83,862.00
329,760.00
286,207.00
0
Jumlah
Non Generik
ormula
81,363.00
163,144.00
139,972.00
247,883.00
40,104.00
37,812.00
55,200.00
0
0
4,224.00
Jumlah
Non Generik
ormula
293,888.00
305,265.00
66,161.00
6,049.00
45,563.00
287,799.00
112,028.00
0
0
Jumlah
Non Generik
ormula
9,174.00
91,264.00
204,524.00
313,854.00
24,544.00
354,580.00
7,527.00
48,999.00
402,087.00
0
0
Jumlah
Non Generik
ormula
120,767.00
82,982.00
364,313.00
12,148.00
124,696.00
126,713.00
133,298.00
0
0
0
Jumlah
Non Generik
ormula
25,786.00
313,854.00
442,582.00
240,143.00
240,143.00
9,973.00
341,573.00
0
0
0
Jumlah
Non Generik
ormula
80,000.00
18,796.00
229,134.00
193,748.00
43,106.00
438,358.00
167,200.00
73,000.00
46,648.00
0
0
Jumlah
Non Generik
ormula
127,917.00
266,085.00
291,077.00
255,189.00
263,161.00
195,669.00
0
156,224.00
Jumlah
Non Generik
ormula
225,390.00
38,751.00
195,669.00
156,756.00
400,964.00
231,097.00
0
2,894.00
Jumlah
Non Generik
ormula
80,000.00
270,309.00
65,199.00
18,562.00
15,595.00
313,854.00
266,085.00
0
0
0
Jumlah
Non Generik
ormula
409,319.00
305,265.00
80,000.00
10,000.00
516,990.00
450,809.00
68,346.00
0
0
0
Jumlah
Non Generik
ormula
300,815.00
685,146.00
10,960.00
412,193.00
02,671.00
Jumlah
Non Generik
ormula
302,010.00
463,157.00
24,713.00
31,885.00
684,172.00
293,325.00
11,100.00
343,063.00
0
Jumlah
Non Generik
ormula
792,013.00
787,408.00
8,167.00
24,544.00
22,106.00
4,675.00
956,158.00
319,220.00
0
0
Jumlah
Non Generik
ormula
4,675.00
4,675.00
45,550.00
80,000.00
549,313.00
175,719.00
197,637.00
652,281.00
0
0
0
Jumlah
Non Generik
ormula
427,916.00
253,260.00
112,249.00
141,986.00
714,497.00
84,480.00
0
916,793.00
Jumlah
Non Generik
ormula
612,666.00
80,000.00
24,544.00
105,748.00
24,544.00
4,675.00
17,013.00
9,973.00
0
33,440.00
Jumlah
Non Generik
ormula
748,963.00
142,915.00
576,018.00
801,153.00
77,939.00
620,263.00
0
0
Jumlah
Non Generik
ormula
4,675.00
22,610.00
32,327.00
293,325.00
523,168.00
354,418.00
11,220.00
456,188.00
0
Jumlah
Non Generik
ormula
87,243.00
229,134.00
309,630.00
301,385.00
9,973.00
262,560.00
182,546.00
0
0
Jumlah
Non Generik
ormula
182,546.00
827,346.00
710,083.00
966,127.00
302.00
059,014.00
0
0
0
Jumlah
Non Generik
ormula
655,214.00
297,659.00
144,169.00
81,689.00
48,262.00
24,325.00
919,588.00
0
0
Jumlah
Non Generik
ormula
668,910.00
486,945.00
15,225.00
27,687.00
39,000.00
93,013.00
130,961.00
0
Jumlah
Non Generik
ormula
33,992.00
313,854.00
882,838.00
211,200.00
268,950.00
882,838.00
0
200,568.00
Jumlah
Non Generik
ormula
268,950.00
789,910.00
100,699.00
472,185.00
895,546.00
0
0
0
Jumlah
Non Generik
ormula
31,693.00
57,062.00
208,993.00
722,545.00
113,513.00
0
0
847,855.00
Jumlah
Non Generik
ormula
70,259.00
Jumlah
Non Generik
ormula
110,000.00
97,051.00
82,101.00
45,850.00
17,600.00
241,202.00
249,028.00
128,212.00
0
0
0
Jumlah
Non Generik
ormula
363,043.00
371.00
56,651.00
87,832.00
48,999.00
244,231.00
85,350.00
365,156.00
314,476.00
0
0
Jumlah
Non Generik
ormula
98,371.00
178,040.00
317,793.00
67,014.00
110,000.00
82,500.00
41,175.00
99,880.00
127,019.00
0
0
Jumlah
Non Generik
ormula
295,136.00
671,548.00
160,502.00
16,474.00
36,910.00
293,325.00
556,122.00
168,438.00
0
Jumlah
Non Generik
ormula
104,683.00
4,675.00
83,076.00
2,670.00
43,224.00
80,000.00
161,093.00
141,466.00
0
0
0
Jumlah
Non Generik
ormula
11,000.00
555,203.00
24,544.00
900.00
289,930.00
32,525.00
98,670.00
134,633.00
6,840.00
22,900.00
0
Jumlah
Non Generik
ormula
197,002.00
93,514.00
113,195.00
10,626.00
37,950.00
63,800.00
13,456.00
3,875.00
16,474.00
72,019.00
0
19,946.00
Jumlah
Non Generik
ormula
45,850.00
204,868.00
238,630.00
120,685.00
4,000.00
69,476.00
80,375.00
108,858.00
0
0
0
Jumlah
Non Generik
ormula
3,500.00
50,150.00
95,392.00
2,850.00
229,134.00
61,309.00
100,099.00
79,874.00
147,911.00
84,098.00
0
Jumlah
Non Generik
ormula
97,513.00
1,204.00
100,849.00
18,562.00
293,981.00
108,940.00
41,466.00
20,625.00
0
79,992.00
Jumlah
Non Generik
ormula
61,309.00
147,665.00
211,200.00
176,098.00
134,550.00
84,549.00
174,310.00
0
0
0
Jumlah
Non Generik
ormula
152,011.00
334,780.00
436,290.00
204,775.00
438,221.00
126,249.00
0
192,879.00
0
Jumlah
Non Generik
ormula
27,659.00
340,390.00
226,129.00
10,211.00
233,550.00
0
0
0
Jumlah
Non Generik
ormula
280,910.00
34,821.00
55,275.00
26,701.00
335,506.00
198,375.00
0
1
Jumlah
Non Generik
ormula
564,482.00
397,417.00
97,898.00
193,700.00
213,594.00
0
Jumlah
Non Generik
ormula
265,173.00
5,854.00
72,207.00
Jumlah
Non Generik
ormula
127,490.00
350,052.00
255,070.00
227,885.00
24,992.00
11,733.00
52,087.00
0
0
0
Jumlah
Non Generik
ormula
101,146.00
63,800.00
73,700.00
9,963.00
97,918.00
Jumlah
Non Generik
ormula
80,000.00
630,462.00
470,179.00
97,513.00
100,481.00
72,646.00
9,973.00
93,213.00
0
0
0
Jumlah
Non Generik
ormula
133,900.00
22,847.00
87,250.00
15,628.00
112,517.00
112,517.00
45,563.00
83,875.00
31,625.00
90,626.00
0
Jumlah
Non Generik
ormula
55,135.00
80,000.00
15,214.00
329,609.00
264,325.00
80,000.00
53,875.00
247,195.00
174,884.00
0
0
0
Jumlah
Non Generik
ormula
167,474.00
152,011.00
367,232.00
491,138.00
261,985.00
41,696.00
333,340.00
0
9,973.00
Jumlah
Non Generik
ormula
18,900.00
129,911.00
80,000.00
38,499.00
5,135.00
5,135.00
237,169.00
110,000.00
55,135.00
110,000.00
0
124,497.00
Jumlah
Non Generik
ormula
461,999.00
108,035.00
195,897.00
50,000.00
407,536.00
102,236.00
590,385.00
0
0
Jumlah
Non Generik
ormula
24,544.00
5,610.00
279,774.00
181,550.00
68,063.00
112,152.00
206,089.00
105,713.00
0
0
0
Jumlah
Non Generik
ormula
206,089.00
110,921.00
67,584.00
266,500.00
371,652.00
80,000.00
297,157.00
11,100.00
428,129.00
0
0
0
Jumlah
Non Generik
ormula
77,470.00
110,000.00
69,654.00
271,889.00
211,200.00
359,209.00
3,500.00
211,200.00
9,589.00
78,053.00
0
0
Jumlah
Non Generik
ormula
110,000.00
279,545.00
608,420.00
523,680.00
124,819.00
187,465.00
211,845.00
271,889.00
0
0
0
Jumlah
Non Generik
ormula
271,889.00
484,495.00
122,012.00
269,727.00
178,545.00
316,189.00
0
0
48,999.00
Jumlah
Non Generik
ormula
263,439.00
43,719.00
Jumlah
Non Generik
ormula
37,263.00
99,658.00
123,597.00
56,250.00
77,728.00
10,636.00
54,173.00
0
0
0
Jumlah
Non Generik
ormula
2,787.00
26,400.00
74,978.00
74,654.00
49,476.00
4,569.00
22,983.00
177,507.00
0
115,377.00
0
Jumlah
Non Generik
ormula
1,858.00
35,922.00
160,000.00
149,635.00
19,108.00
83,949.00
33,855.00
564,792.00
0
0
0
Jumlah
Non Generik
ormula
31,460.00
240,857.00
92,812.00
4,569.00
28,894.00
0
0
0
Jumlah
Non Generik
ormula
44,894.00
789.00
124,407.00
27,415.00
102,473.00
13,550.00
110,000.00
9,920.00
4,290.00
0
Jumlah
Non Generik
ormula
23,466.00
361,934.00
40,100.00
18,414.00
8,712.00
5,896.00
35,431.00
491,931.00
0
0
0
Jumlah
Non Generik
ormula
13,192.00
1,523.00
11,686.00
2,200.00
929.00
31,460.00
70,288.00
0
11,154.00
0
Jumlah
Non Generik
ormula
260,244.00
164,983.00
93,013.00
1,100.00
4,569.00
27,681.00
5,497.00
26,233.00
0
39,863.00
0
Jumlah
Non Generik
ormula
4,303.00
128,974.00
93,903.00
111,959.00
22,029.00
8,753.00
57,200.00
68,200.00
0
0
110,210.00
Jumlah
Non Generik
ormula
108,246.00
918,489.00
3,003.00
7,156.00
12,727.00
46,800.00
42,493.00
0
0
Jumlah
Non Generik
ormula
467,500.00
42,000.00
861.00
14,800.00
205,581.00
2,787.00
141,587.00
0
67,500.00
0
Jumlah
Non Generik
ormula
639,844.00
247,497.00
89,682.00
628,098.00
37,203.00
206,555.00
0
0
Jumlah
Non Generik
ormula
91,520.00
45,180.00
634,651.00
324,119.00
17,507.00
449,115.00
0
5,720.00
Jumlah
Non Generik
ormula
10,626.00
26,261.00
13,937.00
8,753.00
347,858.00
299,792.00
511,888.00
0
0
26,261.00
Jumlah
Non Generik
ormula
129,442.00
432,089.00
89,800.00
183,483.00
0
0
0
Jumlah
Non Generik
ormula
205,000.00
451,695.00
10,626.00
19,213.00
46,800.00
59,136.00
46,200.00
648,650.00
0
0
0
Jumlah
Non Generik
ormula
861,107.00
509,649.00
6,589.00
630,393.00
17,507.00
793,406.00
0
0
295,354.00
Jumlah
Non Generik
ormula
24,300.00
53,920.00
49,213.00
72,800.00
68,040.00
27,113.00
33,349.00
929.00
7,150.00
0
8,557.00
Jumlah
Non Generik
ormula
31,511.00
41,691.00
2,787.00
781.00
83,935.00
442,877.00
13,720.00
303,805.00
0
1,858.00
Jumlah
Non Generik
ormula
72,800.00
288,640.00
10,500.00
16,204.00
11,392.00
21,939.00
381,454.00
328,207.00
0
0
Jumlah
Non Generik
ormula
29,200.00
323,184.00
21,939.00
40,074.00
320,983.00
22,900.00
118,272.00
95,580.00
8,983.00
29,516.00
28,481.00
0
0
Jumlah
Non Generik
ormula
8,983.00
29,516.00
96,004.00
96,139.00
93,045.00
34,350.00
10,500.00
274,875.00
585,661.00
9,291.00
0
Jumlah
Non Generik
ormula
590,425.00
4,040.00
368,508.00
10,669.00
583,938.00
18,583.00
540,507.00
9,291.00
0
26,033.00
Jumlah
Non Generik
ormula
13,937.00
22,327.00
102,028.00
95,612.00
93,045.00
93,045.00
20,518.00
67,417.00
567,197.00
130,977.00
0
246,552.00
0
Jumlah
Non Generik
ormula
455,257.00
13,200.00
8,983.00
29,516.00
18,804.00
Jumlah
Non Generik
ormula
34,170.00
234,887.00
8,525.00
7,023.00
10,626.00
14,047.00
44,000.00
23,370.00
37,488.00
0
56,412.00
Jumlah
Non Generik
ormula
149,718.00
198,145.00
90,000.00
101,715.00
47,016.00
58,083.00
8,863.00
0
Jumlah
Non Generik
ormula
4,712.00
67,500.00
2,184.00
8,753.00
288,379.00
64,733.00
454,822.00
0
0
Jumlah
Non Generik
ormula
25,185.00
37,116.00
7,437.00
130,140.00
96,324.00
22,500.00
500,000.00
23,370.00
45,000.00
3,046.00
0
775.00
Jumlah
Non Generik
ormula
43,078.00
44,848.00
58,237.00
35,985.00
178,789.00
106,130.00
15,671.00
0
Jumlah
Non Generik
ormula
7,636.00
12,474.00
66,152.00
12,474.00
1,705.00
148,463.00
98,700.00
1,100.00
32,400.00
46,644.00
0
0
Jumlah
Non Generik
ormula
34,170.00
58,400.00
34,655.00
269.00
1,770.00
16,059.00
12,448.00
38,308.00
86,479.00
0
Jumlah
Non Generik
ormula
42,324.00
15,055.00
21,600.00
21,600.00
71,661.00
97,230.00
84,648.00
405.00
35,584.00
44,936.00
0
0
Jumlah
Non Generik
ormula
2,184.00
10,335.00
7,156.00
178,976.00
35,165.00
5.00
115,779.00
10,335.00
0
Jumlah
Non Generik
ormula
63,400.00
174,007.00
19,771.00
79,594.00
73,137.00
0
0
0
Jumlah
Non Generik
ormula
143,094.00
111,266.00
58,438.00
175,372.00
91,390.00
11,100.00
0
94,655.00
Jumlah
Non Generik
ormula
616,326.00
249,113.00
233,222.00
98,661.00
Jumlah
Non Generik
ormula
190,954.00
13,907.00
61,474.00
24,544.00
371,651.00
24,544.00
107,421.00
0
491,498.00
Jumlah
Non Generik
ormula
52,706.00
95,090.00
230,061.00
271,383.00
303,811.00
116,474.00
0
0
Jumlah
Non Generik
ormula
0.00
337,355.00
112,301.00
112,301.00
236,269.00
37,101.00
178,545.00
292,140.00
0
0
0
Jumlah
Non Generik
ormula
101,044.00
183,350.00
394,476.00
100,212.00
224,552.00
236,750.00
272,949.00
178,190.00
0
0
Jumlah
Non Generik
ormula
71,499.00
128,832.00
24,544.00
254,937.00
275,200.00
293,325.00
51,123.00
217,545.00
27,600.00
0
Jumlah
Non Generik
ormula
228,415.00
248,628.00
153,485.00
17,600.00
114,274.00
234,432.00
3,818.00
373,137.00
0
0
0
Jumlah
Non Generik
ormula
94,282.00
11,000.00
137,670.00
53,823.00
47,160.00
21,600.00
64,680.00
247,749.00
61,176.00
0
1
Jumlah
Non Generik
ormula
61,176.00
10,793.00
86,923.00
238,919.00
338,681.00
186,279.00
276,144.00
0
0
Jumlah
Non Generik
ormula
309,505.00
84,224.00
2,750.00
214,027.00
166,260.00
196,427.00
97,513.00
132,737.00
0
0
0
Jumlah
Non Generik
ormula
236,555.00
120,025.00
490,054.00
155,321.00
24,544.00
322,085.00
360,444.00
0
0
Jumlah
Non Generik
ormula
143,124.00
431,478.00
12,831.00
334,312.00
407,554.00
6,599.00
126,244.00
0
0
0
Jumlah
Non Generik
ormula
80,000.00
42,144.00
16,913.00
88,000.00
214,295.00
575,980.00
30,976.00
9,973.00
119,601.00
74,863.00
0
0
Jumlah
Non Generik
ormula
152,101.00
229,674.00
229,674.00
516,051.00
423,175.00
254,291.00
0
0
0
Jumlah
Non Generik
ormula
110,965.00
71,000.00
33,300.00
22,200.00
24,544.00
263,685.00
103,499.00
3,875.00
218,694.00
0
Jumlah
Non Generik
ormula
107,800.00
283,571.00
60,500.00
74,716.00
63,124.00
263,995.00
2,969.00
126,720.00
0
395,036.00
Jumlah
Non Generik
ormula
377,035.00
122,812.00
153,485.00
381,720.00
30,976.00
673,227.00
0
0
0
Jumlah
Non Generik
ormula
342,737.00
553,918.00
107,066.00
116,263.00
87,528.00
0
Jumlah
Non Generik
ormula
86,379.00
147,384.00
410,259.00
62,808.00
Jumlah
Non Generik
ormula
89,894.00
10,626.00
98,951.00
97,136.00
158,694.00
150,694.00
0
0
0
Jumlah
Non Generik
ormula
173,061.00
7,156.00
7,156.00
7,156.00
660.00
660.00
660.00
330,355.00
0
0
0
Jumlah
Non Generik
ormula
136,684.00
23,000.00
178,441.00
292,285.00
0
41,413.00
Jumlah
Non Generik
ormula
795,740.00
80,208.00
167,199.00
114,335.00
329,199.00
725,199.00
687,565.00
52,312.00
2,076.00
0
Jumlah
Non Generik
ormula
98,120.00
56,635.00
Jumlah
Non Generik
ormula
17,507.00
861.00
73,632.00
7,580.00
17,726.00
49,088.00
49,088.00
49,088.00
73,632.00
73,632.00
49,088.00
49,088.00
242,870.00
0
0
Jumlah
Non Generik
ormula
75,000.00
60,088.00
169,541.00
32,821.00
6,840.00
291,814.00
372,874.00
24,544.00
0
67,065.00
Jumlah
Non Generik
ormula
94,034.00
150,000.00
200,600.00
151,815.00
73,632.00
49,088.00
24,544.00
75,000.00
124,494.00
0
0
Jumlah
Non Generik
ormula
289,658.00
73,632.00
72,019.00
33,726.00
206,210.00
49,088.00
376,611.00
15,813.00
49,088.00
257,526.00
0
0
0
Jumlah
Non Generik
ormula
132,070.00
169,383.00
24,544.00
24,544.00
151,512.00
135,088.00
34,355.00
861.00
50,150.00
261,425.00
0
0
0
Jumlah
Non Generik
ormula
907.00
54,300.00
84,084.00
32,400.00
73,632.00
17,726.00
1,815.00
85,258.00
19,387.00
30,387.00
0
0
50,903.00
Jumlah
Non Generik
ormula
50,903.00
26,359.00
49,088.00
11,000.00
24,544.00
24,544.00
73,632.00
52,938.00
121,836.00
1,722.00
0
Jumlah
Non Generik
ormula
95,631.00
98,554.00
124,442.00
196,688.00
49,088.00
314,739.00
223,632.00
73,632.00
6,552.00
73,632.00
0
Jumlah
Non Generik
ormula
125,903.00
49,088.00
24,544.00
205,640.00
35,963.00
35,963.00
68,400.00
8,753.00
16,107.00
78,091.00
26,261.00
0
522,479.00
Jumlah
Non Generik
ormula
76,657.00
68,400.00
110,550.00
43,312.00
43,312.00
252,773.00
406,157.00
43,312.00
0
150,000.00
0
Jumlah
Non Generik
ormula
216,102.00
82,495.00
285,896.00
19,387.00
19,387.00
391,810.00
128,250.00
684,823.00
0
0
0
Jumlah
Non Generik
ormula
611,307.00
19,387.00
72,019.00
124,957.00
715,817.00
72,325.00
0.00
19,387.00
0
416,128.00
Jumlah
Non Generik
ormula
358,327.00
63,250.00
133,544.00
74,195.00
39,621.00

Dokter 2

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Dokter 2

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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 RJ20220514-0001 14/05/2022 OP20220514-0001 2022051400001 YUSUF AZKA PUTRA 172,876.0

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

2 RJ20220514-0009 14/05/2022 OP20220514-0012 2022051400011 MUHAMMAD HAIKAL 146,670.0

R/ VOMETA SYR 60 ML 1.00 FLS 66,000.00 66,000.00 0 1

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

3 RJ20220519-0002 19/05/2022 OP20220519-0005 2022051900003 RATNA JULITA 34,243.0

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

R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1

4 RJ20220521-0006 21/05/2022 OP20220521-0003 2022052100006 EDELBERTUS IDAMAN BAHY 743,100.0

R/ SAGESTAM 40 MG INJ 6.00 AMP 12,500.00 75,000.00 0 1

R/ PHARMAFIX XL 15 CM X 5 CM / 7,500.00 CM 14.10 105,750.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

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

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0

7 RJ20220530-0008 30/05/2022 OP20220530-0013 2022053000010 MARLIYA 180,620.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0

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

R/ RANITIDINE 150 MG TAB 10.00 TAB 275.00 2,750.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

Print Date:7/14/2022 Print Time: 2:08:00PM Page 1 of 166

Laporan Penjualan Resep Rawat Jalan Per Dokter

Jenis resep : Rawat Jalan

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

8 RJ20220530-0010 30/05/2022 OP20220530-0014 2022053000012 BARTOLOMEUS SIMANJORANG 314,476.0

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

9 RJ20220530-0012 30/05/2022 OP20220530-0017 2022053000014 DERY TANIA WIJAYA 50,066.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ LANSOPRAZOLE 30 MG CAPS 10.00 CAP 2,027.00 20,270.00 1 0

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

R/ CENDO XITROL 5 ML EYE 1.00 DROP 39,000.00 39,000.00 0 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 1.00 PCS 11,242.00 11,242.00 0 1

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

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

R/ KAPAS ALKOHOL 1.00 PCS 302.50 302.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1

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

R/ PLESTERIN 1.00 PCS 1,046.00 1,046.00 0 1

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

12 RJ20220530-0019 30/05/2022 OP20220530-0025 2022053000022 ARSYLA RAMADHANI 6,977.0

R/ AMBROXOL 30 MG TAB 5.00 TAB 1.00 285.41 6,977.00 1 0

PARACETAMOL 500 MG 4.00 KAPLET 350.00 0.00 1 0

DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 0.00 1 0

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

13 RJ20220530-0021 30/05/2022 OP20220530-0026 2022053000026 MUHAMMAD KEMAL 654,798.0

R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

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