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  • Form Obat Yang Dibawa Dari Rumah

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    RSU Lirboyo
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    1. The document is a form for recording medications that patients bring from outside the hospital. 2. It collects information such as the patient's name, date of birth, age, doctor, medications brought including name, dose, route, amount remaining, and whether the medication will be continued or discontinued in the hospital. 3. Signatures are required from the person receiving and handing off the medications.

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    4

    Original Title

    FORM OBAT YANG DIBAWA DARI RUMAH

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    1. The document is a form for recording medications that patients bring from outside the hospital. 2. It collects information such as the patient's name, date of birth, age, doctor, medications brought including name, dose, route, amount remaining, and whether the medication will be continued or discontinued in the hospital. 3. Signatures are required from the person receiving and handing off the medications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views1 page

    Form Obat Yang Dibawa Dari Rumah

    Uploaded by

    RSU Lirboyo
    1. The document is a form for recording medications that patients bring from outside the hospital. 2. It collects information such as the patient's name, date of birth, age, doctor, medications brought including name, dose, route, amount remaining, and whether the medication will be continued or discontinued in the hospital. 3. Signatures are required from the person receiving and handing off the medications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    CM

    …………………….

    No. CM No. Register


    Nama Pasien (L/P*)
    Tanggal Lahir Umur
    FORMULIR OBAT YANG DIBAWA PASIEN DARI LUAR
    Dokter
    Ruangan
    Tanggal Masuk Jam Masuk
    Jmlh Obat Obat Dilanjutkan (L) / Diterima oleh Diserahkan oleh
    No. Nama Obat Dosis Rute Keterangan
    Sisa Tidak Dilanjutkan (T) (Nama & Paraf) (Nama & Paraf)

    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    Keterangan diisi dengan : Tanda tangan dan nama jelas
    1 Resep dokter
    2 Obat dibeli sendiri
    3 Obat herbal/fitofarmaka
    4 Traditional Chinese Medicine (TCM) ( ________________________________ )
    Dokter Penanggung Jawab Pasien

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