Jl. Jhoni Anwar No. 85, Padang Telp. (0751) 7054785 Nama Apoteker
SIPA No: 123/xxx/xxxx/2014
FR
cap
Lampiran 9. Blanko Salinan Resep
Lampiran 10. Etiket Obat Etiket Pemakaian dalam
No:
APOTEK FARMA
Jl. Jhoni Anwar No.
8 Telp. (0751) 70
Nama Apotek SIPA No: 123/xxx/xNog
:
APOTEK FARMA RECORD
Jl. Jhoni Anwar No. 85, Padang
APOTEK FARMA RECORD
Jl. Jhoni Anwar No. 85, Padang Telp. (0751) 7054785
Nama Apoteker Nama & jumlah obat Na
Nama Pasi SIPA No: 123/xxx/xxxx/2014 Etiket
x sehari Tab
Pemakaian
Sebe
Tidak bole APOTEK FARMA
RECORD
Jl. Jhoni Anwar No. 85, Padang Telp. (0751) 7054785
Nama Apoteker SIPA No: 123/xxx/xxxx/2014
endok Makan Bubur Teh kan
Luar
Lampiran 11. Daftar obat yang dibeli pada tahun pertama
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
RECORD
5, Padang 5478
er xxx/
Tan en
let /
5 Telp. (0751) 7054785
Nama Apoteker 2014 SIPA No: 123/xxx/xxxx/2014
gal Pengerjaan resep Tanggal Pengerjaan resep ma & jumlah obat
Nama Pasien
Kapsul / Bungkus x sehari Tetes / mL
lum / Sesudah makan Sebelum / xSesesudaharih makanS h diulang tanpa resep dokter Kocok Dahulu
Sebelum / Sesudah
No: Tanggal pengerjaan
resep Nama & jumlah obat Nama Pasien Aturan Pakai OBAT LUAR
Nama Pasien
Tanggal Pengerjaan resep
No. Nama Obat Jumlah Satuan
Adalat OROS 30 mg 1 Box
Albothyl 10 ml 10 Btl
Alleron Tablet 1 Btl
A Alletrol 5 Btl
Alkohol 96% 200ml 10 Btl
Alopurinol 100 mg 1 Box
Amdixal 10 mg 1 Box
Aminophylin 200 mg 1 Box
Ambroxol 30 mg 1 Box
Amlodipin 10 mg 1 Box
Amoksisilin Tablet 3 Box
Amoxan Tab 500 mg 3 Box
a Amoxan forte sirup 2 Btl
Ampisilin 500 mg 1 Box
Antalgin 1 Box
Antimo dewasa 1 Box
Antimo anak 1 Box
Asmasolon 1 Box
Aspilets 100 mg 1 Box
No:
Nama & jumlah obat
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
Aspirin 2 Box
Bactrim forte 1 Box
Bactrim tablet 1 Box
Baquinor forte 1 Box
Baycuten N 5 mg 5 Tube
Balsem Balpirik 10 Pot
B Balsem Otot Geliga 10 Pot
Bedak Salisil 10 Ktk
b Bedak herosin 5 Ktk
Bellapheen 1 Box
Benadryl DMP 60 ml 5 Btl
Benocetam 800 mg 1 Box
Benoson N 5gr 10 Tube
Benovit C 1 Box
Beryvission 1 Box
Betadine 5ml 10 Btl
Betadine 15 ml 10 Btl
Betadine Feminime 100 ml 5 Btl
Bioplacenton 10 Tube
Bisolvon 60 ml 10 Btl
Bisolvon 125 ml 10 Btl
Bisolvon tablet 1 Box
Bisoprolol 1 Box
Blopress 16 mg 1 Box
Bodrex 5 Box
Broxal 1 Box
Brainvit syrup 5 Btl
Buscopan 1 Box
Caladine Powder 60 g 5 Btl
Caladine 60 ml lotion 5 Btl
Canesten 5 g 5 Tube
Captopril 12,5 mg 2 Box
Captopril 25 mg 1 Box
Captopril 50 mg 1 Box
Carpiaton 100 mg 1 Box
Cendo astenof 2 Btl
Cendo vital 1 Box
Cendo Vitanorm 1 Box
C Cendo vitrolenta MD 1 Box
Cendo Tropin 5 Fls
Carvit 5 Fls
Clarastil 5 Fls
Cefixim syr 10 Btl
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
1 1 1 1 1 1
Cefixim 100 mg 1 Box
Catapres 0,15 mg 1 Box
Cedocard 10 mg 1 Box
Cefila 1 Box
Cendo catarlent 2 Btl
C Cendo dexaton 3 Btl
Cendo lyteers 2 Btl
C Cendo xitrol 3 Btl
Cerebrovit 1 Box
Cerebrovit x-cel 1 Box
Cobazym 1000 1 Box
Codein 20 mg 2 Btl
Combantrin 250 1 Box
Curcuma 5 Btl
Damaben tablet 1 Box
Damaben solutio 60 ml 6 Btl
Decolgen 1 Box
Diapet 1 Box
Digoxin Sandoz 3 Box
d Domperidone 10 mg 1 Box
Dorzol 1 Box
D – reth 1 Box
Dulcolax Suppos Adult 2 Box
Dulcolax Suppos Children 2 Box
Dulcolax Tablet 1 Box
Dumin 500 mg 2 Box
Dumin Syrup 60 ml 10 Btl
Dumocalcin 500 mg 1 Box
Dumoxin 100 mg 1 Box
Disflatyl 1 Box
Erlamycetin tetes mata 2 Btl
Erymed 20 g 5 Tube
Erysanbe 250 mg 1 Box
Erysanbe 500 mg 1 Box
Erythromycin 250 mg 1 Box
Erythromicyn 500 mg 1 Box
Etambutol 250 mg 1 Box
00. Etambutol 500 mg 1 Box
01. Extra joss sachet 10 Sachet
02. Fargoxin 1 Box
03. Farmabes 1 Box
04. Farmadral 1 Box
05. Farsorbid 10 mg 1 Box
106.
107.
108.
109.
g 110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.
141.
142.
143.
144.
145.
146.
147.
148.
149.
150.
151.
Feminax Forneuro
Furosemid 40 mg Gentamycin Giflox md Glaoplus md
Glucophage 500 mg Glukometer
Hapsen HCT 25 mg Hemaviton action Hemaviton skin nutrient Hemobion
Handscoon berbagai ukuran Handscoon steril
Homoclomin Homatro Imodium 2 mg Incidal OD Inderal 10 mg INH, 300 mg Inhipras Inotrop Inoxin 400 mg Insto, 10 ml Kapas Kasa
Kemicetin 15 g Kalpanax 5g Komix
Konimag tablet Konimag 7 ml Koyo
KSR Lasal 4 mg Letonal 25 mg Letonal 100 mg Lexotan 1,5 mg Lexotan 3 mg Lipitor 10 mg Masker Mebendazol Melanox , 15g Minyak Gosok
Minyak K.pth Cap Lang 30 ml Minyak K. Pth Cap Lang 60 ml
1 Box
1 Box
1 Box
2 Btl
3 Box
1 Box
5 Box
2 Unit
1 Box
1 Btl
20 Strip 10 Strip
1 Box
1 Ktk
1 Pack
1 Box
5 Fls
1 Box
1 Box
1 Box
1 Box
1 Box
2 Box
1 Box
10 Btl
12 Ikat
10 Ikat
15 Tube
15 Tube
2 Ktk
10 Strip
1 Box
1 Ktk
1 Btl
1 Box
1 Box
1 Box
1 Box
1 Box
1 Box
2 Ktk
1 Box
10 Tube
10 Btl
20 Btl
12 Btl
152.
153.
M 154.
155.
156.
157.
158.
159.
160.
161.
162.
163.
164.
165.
166.
167.
168.
169.
170.
171.
172.
173.
N 174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
195.
196.
Minyak Telon 30 ml Minyak Telon 60 ml Micardis
Microgynon
Mucopect tablet 30 mg Multivitaplex Myonal
Mylanta 150 ml Mylanta 360 ml Mylanta tablet Natur E Neciblok tablet Neoentrostop Neosanmag Neuralgin RX Neurobion Neurocet 1200 Neurodex Neurosanbe Normafit Norvask Nutriflam Obimin AF Ocu- V Odace Oralit
Omega 3 plus Omeprazol cap OMZ
Optimax for-g Osteocal Panadol Paracetamol Paracetamol Syrup Paramex
Persantin 25 mg Pharmaton Phaproxin Phenilbutazon Phenitoin cap Pil KB
Piracetam 1200 Plester
Poldan mig Polydex Md
10 12 1 1 1 2 1 12 12 5 2 1 1 1 1 1 1 1 1 5 2 2 4 5 1 100
5 2 2 1 2 5 2 20
1 1 1 1 1 1 2 2 1 1 1
Btl Btl Box Box Box Btl Box Btl Btl Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Bks Btl Box Box Box Box Box Box Btl Box Box Box Box Btl Box Box Box Ktk Box Box
197.
198.
199.
200.
201.
202.
203.
204.
205.
206.
207.
208.
209.
210.
211.
212.
213.
214.
215.
216.
217.
218.
219.
220.
221.
222.
223.
224.
225.
226.
227.
228.
229.
230.
231.
232.
233.
234.
T 235.
236.
237.
238.
239.
240.
241.
242.
Ponstan 500 mg Posop Md Procold Promaag Perkamen Proinfrak
Proris Sirup forte Provitat plus Plester HandyPlast Primperan Tab 10 mg Propanolol Ranitidin Retaphil SR Retivit Retop
Reco tetes mata Rifampisin 450 mg Rohto 10 ml Rivanol 100 ml Sagestam cream Sanexon 16 mg Salbutamol 2 mg Sanaflu
Sangobion syr Sangobion kapsul Scott's Emulsion Sedrofen 500 mg Silopect syrup Simvastatin 10mg Stesolid 2mg Stimuno 50 mg Stolax suppositoria Supradyn
Susu Lactamil Susu prenagen Tensivask Tensimeter Thermometer
Tetracycline 500 mg Tebokan special Theravask
Thiamfenicol 500 mg Tramal Tripanzim Troches Unalium
1 2 1 1 10000
1 5 1 4 1 1 2 1 1 1 2 5 12
5 10
1 2 1 1 1 5 1 3 2 1 1 1 3 10 10 3 2 5 5 1 2 3 1 3 1 1
Box Box Box Box Lbr Box
Btl Box Box Box Box Box Box Box Box Btl Box
Btl Btl Tube
Box Btl Box Box Box Btl Box
Btl Box Box Box Box Tube
Ktk Ktk Box Unit Unit Box Box Box Box Box Box Box Box
Box 1
Box 243.
244.
245.
246.
24V7.alisan 248.
249.
250.
251.
252.
253.
254.
255.
256.
257.
258.
259.
260.
261.
262.
263.
264.
265.
266.
267.
268.
269.
270.
271.
272.
273.
274.
275. Zevit C
1 Xilon 16 mg
Btl 12
Woods Pepermint child 120 ml
Btl 12
Woods Antitusif 100 ml
Btl 12
Woods Eksp 100 ml
Btl 2
Voltaren suspense 20 g
Box 1
Voltaren 50 mg
Btl 1
Vitamin K
Btl 1
Vitamin B12
Btl 1
Vitamin B6
Btl 1
Vitamin B1
Pot 12
Vicks Vaporub 40 g
Pot 12
Vicks Vaporub 10 g
Btl 12
Vicks formula 44 120 ml
Btl 12
Vicks formula 44 60 ml
Btl 12
Vicks formula 44 30 ml
Btl 12
Vicks anak formula 44 60 ml
Btl 12
Vicks anak formula 44 30 ml
Box 2
Vitrolenta Md
Btl 5
Vitaplex
Btl 10
Vitacur Syrup
Box 3
Vitacimin
Box 1
Vibramicyn
Box 1
Viadoxin 100 mg
Btl 5
Visine drop
Box 2
Velosef 500 mg
Box 1
Vascuprax 200 mg
Box 1
Vascuprax 100 mg
Box 3
Valisanbe 5 mg
Box 3
Valisanbe 2 mg
Box 2
Urica
Box 3
Urdafalk
Box 1
Urbason 4 mg