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  • Form Pio

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    Anonymous ZaWvESK4mF
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    This document is a form from the Baring Public Health Center in Pangkep Regency, South Sulawesi Province, Indonesia for documenting information provided to patients or medical staff about medications. The form collects details about the inquirer, patient information if applicable, the question asked, the type of question, the answer provided, how quickly the answer was given, and the pharmacist who responded. It is used to record inquiries about medication identification, stability, pharmacokinetics, interactions, dosing, pharmacodynamics, price, contraindications, side effects, availability, and more.

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    form pio

    Original Title

    FORM PIO

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    This document is a form from the Baring Public Health Center in Pangkep Regency, South Sulawesi Province, Indonesia for documenting information provided to patients or medical staff about medications. The form collects details about the inquirer, patient information if applicable, the question asked, the type of question, the answer provided, how quickly the answer was given, and the pharmacist who responded. It is used to record inquiries about medication identification, stability, pharmacokinetics, interactions, dosing, pharmacodynamics, price, contraindications, side effects, availability, and more.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views2 pages

    Form Pio

    Uploaded by

    Anonymous ZaWvESK4mF
    This document is a form from the Baring Public Health Center in Pangkep Regency, South Sulawesi Province, Indonesia for documenting information provided to patients or medical staff about medications. The form collects details about the inquirer, patient information if applicable, the question asked, the type of question, the answer provided, how quickly the answer was given, and the pharmacist who responded. It is used to record inquiries about medication identification, stability, pharmacokinetics, interactions, dosing, pharmacodynamics, price, contraindications, side effects, availability, and more.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 2

    PEMERINTAH KABUPATEN PANGKAJENE DAN KEPULAUAN

    DINAS KESEHATAN
    UPT PUSKESMAS BARING
    Jln. Amputtang Desa Baring Kec. Segeri Kab. Pangkep HP 081356859406
    Email: puskesmas_baring@yahoo.co.id Kode POS 90655

    FORM DOKUMENTASI PELAYANAN INFORMASI OBAT

    No. .............Tanggal : ......................... Waktu : ............. Metode :


    Lisan/Tertulis/Telpon)*
    1. Identitas Penanya

    Nama ................................................................. No. Telp. ..........................................


    Status : Pasien / Keluarga Pasien / Petugas Kesehatan
    ( ................................................)*
    2. Data Pasien

    Umur : .......... tahun; Tinggi: .......... cm; Berat : ........... kg; Jenis Kelamin :
    Laki-laki/Perempuan)*
    Kehamilan : Ya ( ........minggu)/Tidak)* Menyusui:
    3. Pertanyaan:
    Uraikan Pertanyaa:
    .............................................................................................................................................
    .............................................................................................................................................
    .........................................................................................................
    Jenis Pertanyaan:

     Identifikasi Obat  Stabilitas  Farmakokinetika

     Interaksi Obat  Dosis  Farmakodinamika

     Harga Obat  Keracunana  Ketersediaan Obat

     Kontra Indikasi  Efek Samping  Lain – lian


    Obat ......................

     Cara Pemakian  Penggunaan


    Terapeutik

    4. Jawaban .............................................................................................................................
    .............................................................................................................................................
    .........................................................................................................................

    5. Penyampaian Jawaban : Segera / Dalam 24 Jam/ Lebih dari 24 jam)*

    6. Apoteker yang menjawab :.....................................................................................


    Tanggal : ............................................. Waktu: ......................................................
    Metode jawaban: Lisan /Tertulis/Telpon)*

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