Evaluasi Resep Dengan Formularium

PEMERINTAH KABUPATEN KUTAI BARAT

UPT PUSKESMAS BESIQ  JLN.SASEN NANE R RT IV KAMPUNG BESIQ KECAMATAN KECAMATAN DAMAI KODE KODE POS 75577

Bulan : November 2018 Tgl

01 November 2018

02 November 2018

0' November 2018

No

1

2

3

Nama

Ny. Ceng Net

Ny. $elli

-n. iyerin

Usia

36 Taun

18 Taun

/ Bulan

1.!bupro"en

200 mg

3#2

2. %re&nison

' mg

3#1

3. C T (

) mg

3#1

). *i+amin C

2'0 mg

2#1

1. %ara,e+amol

'00 mg

3#1

2. %re&nison

' mg

3#1

3. C T (

) mg

3#1

). *i+amin C

2'0 mg

2#1

1. %re&nison

' mg

3#<

2. C T (

) mg

3#<

3. *i+amin C

2'0 mg

3#<

). in ul"a+

20 mg

3#=

4

etap e+ela B-B

100 mg 5 ' ml

3#1

07' mg

3#>

) mg

3#>

2'0 mg

3#>

'. *i+amin B1

100 mg

3#>

1. !bupro"en

100 mg5 ' ml

3#1

2. e#ame+ason

07' mg

3#?

3. C T (

) mg

3#?

). *i+amin C

2'0 mg

3#?

1. -,e+ylsis+ein

200 mg

3#1

2. e#ame+ason

07' mg

3#1

) mg

3#1

2'0 mg

2#1

4

1#1

'00 mg

3#1

2. %re&nison

' mg

3#1

3. C T (

) mg

3#1

). *i+amin C

2'0 mg

2#1

1. !bupro"en

100 mg5 ' ml

3#@

2. %re&nison

' mg

3#>

3. C T (

) mg

3#>

). *i+amin C

2'0 mg

3#>

1. !bupro"en

100 mg5' ml

3#=

'. rali+ 1. !bupro"en

06 November 2018

0/ November 2018

10 November 2018

)

'

6

-n. -&elia

-n. (ariani ristani

Ny. ristna

2. e#ame+ason 171 3. C T ( Taun ). *i+amin C

3 Taun

28 Taun 3. C T ( ). *i+amin C '. *i+. B omples 1. %ara,e+amol

12 November 2018

13 November 2018

/

8

Ny. ena

22 Taun

-n. Revan %a&ila 3 Taun

esesuaian engan ;ormularium

Resep

$a

$a

$a

$a

$a

$a

$a

$a

1' November 2018

9

-n. io emui

3 Taun

2. e#ame+ason

07' mg

3#>

3. C T (

) mg

3#>

2'0 mg

3#>

120 mg5' ml

3#@

2. e#ame+ason

07' mg

3#>

3. C T (

) mg

3#>

). *i+amin C

2'0 mg

3#>

1. -mo#i,ilin

2'0 mg5' ml

3#1

2. %ara,e+amol

120 mg5' ml

3#1

) mg

3#A

). e#ame+ason

07' mg

3#A

'. *i+amin C

2'0 mg

3#A

6. albu+amol

) mg

3#A

1. albu+amol

) mg

3#1

2. e#ame+ason

07' mg

3#1

3. C T (

) mg

3#1

2'0 mg

2#1

). *i+amin C 1.%ara,e+amol 16 November 2018

19 November 2018

26 November 2018

10 -n. -ta

11

-n. $eremia

12 Ny. arolina

11 Bulan

1 Taunn

3/ Taun

3. C T (

). *i+amin C

$a

$a

$a

$a