LEMBAR MONITORING KOTAK EMERGENSI TAHUN 2023

BLUD UPTD PUSKESMAS ABELI

No. Kotak : 5
UNIT : POLI UMUM
BULAN KETER
No. Batch/
NO. Nama Obat Satuan Jumlah ED ANGA
Lot JAN FEB MAR APR MEI JUN JUL AGS SEP OKT NOV DES N
1 Deksamethason 5 mg/ml inj Ampul 3 563370612 May-25
2 Difenhidramin Inj Ampul 3 563420163 Jun-24
3 Epinefrin 0.1% inj Ampul 2 463440122 Oct-24
4 Phytomenadion Inj (Vit K) Ampul 3 664780122 Mar-25
5 Atropin Sulfat Ampul 3 9621M0358A Dec-24
6 Spuit 1 cc Unit 5 231014 Mar-28
7 Spuit 3 cc Unit 5 23030101 Jan-27
8 Spuit 5 cc Unit 3 175401
9 Alcohol Swab Sachet 10 200406212 Jun-27

Penerima Pengelola Obat,

Dilla Zulfa Rif'atul M., S.Farm., Apt

( ) NIP. 199303182019032002
 UNIT : UGD Kotak : 1 UNIT : Rawat Inap Kotak : 3
NO. Nama Obat Satuan Jumlah No. Batch/ Lot ED NO. Nama Obat Satuan Jumlah No. Batch/ Lot ED NO.

1 Deksamethason 5 mg/ml inAmpul 3 563370612 May-25 1 Deksamethason 5 mg/ml inAmpul 3 563370612 May-25 1

2 Difenhidramin Inj Ampul 3 563420163 Jun-24 2 Difenhidramin Inj Ampul 3 563420163 Jun-24 2

3 Atropin Sulfat Ampul 5 9621M0358A Dec-24 3 Atropin Sulfat Ampul 5 9621M0358A Dec-24 3

4 Epinefrin Inj Ampul 4 463440122 Oct-24 4 Epinefrin Inj Ampul 2 463440122 Oct-24 4

5 Phytomenadion Inj (Vit K) Ampul 3 664780122 Mar-25 5 Phytomenadion Inj (Vit K) Ampul 3 664780122 Mar-25 5

6 MgSO4 40% Botol 3 B98L51A Dec-23 6 MgSO4 40% Botol 3 B98L51A Dec-23 6

7 Spuit 1 cc Unit 5 231014 Mar-28 7 Spuit 1 cc Unit 5 231014 Mar-28 7

8 Spuit 3 cc Unit 5 23030101 Jan-27 8 Spuit 3 cc Unit 5 23030101 Jan-27 8

9 Spuit 5 cc Unit 3 175401 9 Spuit 5 cc Unit 3 175401 9

10 Infus set makro Unit 1 23B01L1J Jan-28 10 Infus set makro Unit 1 23B01L1J Jan-28

11 Infus set mikro Unit 1 20200625 May-25 11 Infus set mikro Unit 1 20200625 May-25

12 Alcohol Swab Sachet 10 200406212 Jun-27 12 Alcohol Swab Sachet 10 200406212 Jun-27

UNIT : PONED Kotak : 2 UNIT : Poli Gigi Kotak : 4

No. Batch/
NO. Nama Obat Satuan Jumlah ED NO. Nama Obat Satuan Jumlah No. Batch/ Lot ED
Lot

1 Deksamethason 5 mg/ml inAmpul 3 563370612 May-25 1 Deksamethason 5 mg/ml inAmpul 3 563370612 May-25

2 Difenhidramin Inj Ampul 3 563420163 Jun-24 2 Difenhidramin Inj Ampul 3 563420163 Jun-24

3 Atropin Sulfat Ampul 5 9621M0358A Dec-24 3 Atropin Sulfat Ampul 3 9621M0358A Dec-24

4 Phytomenadion Inj (Vit K) Ampul 3 664780122 Mar-25 4 Phytomenadion Inj (Vit K) Ampul 3 664780122 Mar-25

5 Epinefrin Inj Ampul 2 463440122 Oct-24 5 Epinefrin Inj Ampul 1 463440122 Oct-24

6 MgSO4 40% Botol 3 B98L51A Dec-23 6 Spuit 1 cc Unit 5 231014 Mar-28

7 Spuit 1 cc Unit 5 231014 Mar-28 7 Spuit 3 cc Unit 5 23030101 Jan-27

8 Spuit 3 cc Unit 5 23030101 Jan-27 8 Spuit 5 cc Unit 3 175401

9 Spuit 5 cc Unit 3 175401 9 Alcohol Swab Sachet 10 200406212 Jun-27

10 Infus set makro Unit 1 23B01L1J Jan-28

11 Infus set mikro Unit 1 20200625 May-25

12 Alcohol Swab Sachet 10 200406212 Jun-27

UNIT : Poli Umum Kotak : 5
No. Batch/
Nama Obat Satuan Jumlah ED
Lot

Deksamethason 5 mg/ml inj Ampul 3 563370612 May-25

Difenhidramin Inj Ampul 3 563420163 Jun-24

Atropin Sulfat Ampul 3 9621M0358A Dec-24

Epinefrin Injeksi Ampul 1 463440122 Oct-24

Phytomenadion Inj (Vit K) Ampul 3 664780122 Mar-25

Spuit 1 cc Unit 5 231014 Mar-28

Spuit 3 cc Unit 5 23030101 Jan-27

Spuit 5 cc Unit 3 175401

Alcohol Swab Sachet 10 200406212 Jun-27

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 LEMBAR MONITORING KOTAK EMERGENSI TAHUN 2023
BLUD UPTD PUSKESMAS ABELI

No. Kotak : 5
UNIT : Poli Umum Bulan :
Tanggal
NO. Nama Obat Satuan Juml No. Batch/ Lot ED KE
ah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 T
Deksametha
1 son 5 mg/ml Ampul 3 563370612 May-25
inj

Difenhidram
2 in Inj Ampul 3 563420163 Jun-24

Epinefrin
3 0.1% inj Ampul 2 463440122 Oct-24

Phytomenad
4 ion Inj (Vit Ampul 3 664780122 Mar-25
K)

Atropin
5 Sulfat Ampul 3 9621M0358A Dec-24

6 Spuit 1 cc Unit 5 231014 Mar-28

7 Spuit 3 cc Unit 5 23030101 Jan-27
8 Spuit 5 cc Unit 3 175401
Alcohol
9 Swab Sachet 10 200406212
Jun-27

Penerima Pengelola Obat,

Dilla Zulfa Rif'atul M., S.Farm., Apt

( ) NIP. 199303182019032002