INSTALASI FARMASI LEMBAR RIWAYAT PENGGUNAAN OBAT DATA PASIEN !"#" !"#" %"&' %"&'() ()
!23 ,")--". ,")--". 3"&67 3"&67 2893 :47; :47;(1 (1 26") 26")-" -") ) ,'<"7 =<" 2'>"?"; =.(1-' OBAT RESEP No.
Nama Generik
* ++++ ++++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ +++ +
,"),")--" -".. /"0' /"0'11
* ++++ ++++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ +++ +
* +++++++++++++++++++++++++ * ++++++ +++++++++ +++++++ +++++++ ++++++ ++++++ ++++++ +++ * ++++ ++++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ ++++ +++ + 2'>"?"; =.(1-'@');4.(1")&' =.(1-'@');4.(1")&' A&B(&'C7"&'D A&B(&'C7"&'D *
!4#41 5"1#"&'
* +++++++++++++++++++++++++
Nama Dagang
Regimen
Sumber Obat
Tgl. Mulai Tgl. Stop
Jml Obat Tersisa
Status Obat Saat Admisi / @ , @ F / @ , @ F / @ , @ F / @ , @ F / @ , @ F / @ , @ F / @ , @ F / @ , @ F
Status Obat Saat Pulang / @ F / @ F / @ F / @ F / @ F / @ F / @ F / @ F
Regimen
Sumber Obat
Tgl. Mulai Tgl. Stop
Jml Obat Tersisa
Status Obat Saat Admisi / @ , @ F / @ , @ F / @ , @ F / @ , @ F / @ , @ F / @ , @ F / @ , @ F
Status Obat Saat Pulang / @ F / @ F / @ F / @ F / @ F / @ F / @ F
E G H I J K L M OBAT NON RESEP (Contoh : produk OTC, herbal, dll.) No.
Nama Generik
Nama Dagang
E G H I J K L Sumber Informasi Obat
8;";6& %"&'() <' 3(<'N". 2(N41< %"&'()@T(.6"1-" %"&'() +++++++++++++ +++++++++++++++ ++ ,(.B * +++++++++++ +++++++++++ =B4;(7 <' .6"1 2893 +++++++++++++ +++++++++++++++ ++ ,(.B * +++++++++++ +++++++++++
Daftar Obat Dibuat Oleh :
=B4;(7(1 * !"#" * !"#" *
/"'))?" A&(O6;7")D * +++++++++++++++++++++ Keterangan
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Catatan
Catatan
