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Monitoring Stok Obat Emergency

This document is a form for monitoring emergency medicine supplies at a community health center in Pontianak City over a month. It lists 14 types of medicines including atropine sulfate injection, diazepam injection, dexamethasone injection, and others. For each medicine, the form tracks the stock quantity, usage, expiration date and needed follow up actions over 31 days. The responsible staff signs off at the bottom.

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Zexion Oz
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86 views3 pages

Monitoring Stok Obat Emergency

This document is a form for monitoring emergency medicine supplies at a community health center in Pontianak City over a month. It lists 14 types of medicines including atropine sulfate injection, diazepam injection, dexamethasone injection, and others. For each medicine, the form tracks the stock quantity, usage, expiration date and needed follow up actions over 31 days. The responsible staff signs off at the bottom.

Uploaded by

Zexion Oz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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MONITORING OBAT EMERGENCY

UPTD PUSKESMAS KECAMATAN PONTIANAK KOTA

BULAN :
TAHUN :
RUANG :

TANGGAL
NO. NAMA OBAT/SEDIAAN SAT 1 2 3 4 5 6 7 8 9 10 11 12
M K S M K S M K S M K S M K S M K S M K S M K S M K S M K S M K S M K S
1 ATROPIN SULFAT INJ AMP
2 DIAZEPAM INJ. 5MG/ML AMP
2ML

3 DEXAMETASON INJ. AMP


5MG/ML 1ML

4 DIFENHIDRAMIN HCl INJ. AMP


10MG/ML 1 ML
5 DEXTROSE INFUSE 5% BTL

6 EPINEFRIN (ADRENALIN) AMP


INJ. 0,1%
7 LIDOCAIN COMP. INJ AMP
8 LIDOCAIN NON ADRENALIN AMP
INJ.
9 MgSO4 INJ. IV 20% 25ML VIAL
10 METHERGIN INJ. AMP
11 RINGER LAKTAT INF. BTL
12 STESOLID 5MG/ML 2,5ML TUBE
13 SYNTOCYNON INJ. AMP
14 SALBUTAMOL NEBULE VIAL
TANGGAL
NO. NAMA OBAT/SEDIAAN SAT 13 14 15 16 17 18 19 20 21 22 23 24
M K S M K S M K S M K S M K S M K S M K S M K S M K S M K S M K S M K S
1 ATROPIN SULFAT INJ AMP
2 DIAZEPAM INJ. 5MG/ML AMP
2ML
3 5MG/ML 1ML INJ.
DEXAMETASON AMP
4 DIFENHIDRAMIN HCl INJ. AMP
10MG/ML 1 ML
5 DEXTROSE INFUSE 5% BTL
6 EPINEFRIN (ADRENALIN) AMP
INJ. 0,1%
7 LIDOCAIN COMP. INJ AMP
8 LIDOCAIN NON ADRENALIN AMP
INJ.
9 MgSO4 INJ. IV 20% 25ML VIAL
10 METHERGIN INJ. AMP
11 RINGER LAKTAT INF. BTL
12 STESOLID 5MG/ML 2,5ML TUBE
13 SYNTOCYNON INJ. AMP
14 SALBUTAMOL NEBULE VIAL

TANGGAL
NO. NAMA OBAT/SEDIAAN SAT 25 26 27 28 29 30 31
M K S M K S M K S M K S M K S M K S M K S
1 ATROPIN SULFAT INJ AMP
2 DIAZEPAM INJ. 5MG/ML AMP PENANGGUNG JAWAB RUANGAN
2ML
3 DEXAMETASON INJ. AMP
5MG/ML 1ML HCl INJ.
DIFENHIDRAMIN
4 10MG/ML 1 ML AMP
5 DEXTROSE INFUSE 5% BTL
6 EPINEFRIN (ADRENALIN) AMP
INJ. 0,1%
7 LIDOCAIN COMP. INJ AMP
8 LIDOCAIN NON ADRENALIN AMP ( …………………………………………….. )
INJ.
9 MgSO4 INJ. IV 20% 25ML VIAL
10 METHERGIN INJ. AMP
11 RINGER LAKTAT INF. BTL
12 STESOLID 5MG/ML 2,5ML TUBE
13 SYNTOCYNON INJ. AMP
14 SALBUTAMOL NEBULE VIAL
FORMULIR MONITORING OBAT EMERGENCY
UPTD PUSKESMAS KECAMATAN PONTIANAK KOTA

BULAN :
TAHUN :
RUANG :

JUMLAH JUMLAH TANGGAL


NO. NAMA OBAT STOK PEMAKAI EXP. DATE TINDAK LANJUT
OBAT -AN

1 ATROPIN SULFAT INJ

2 DIAZEPAM INJ. 5MG/ML 2ML

3 DEXAMETASON INJ. 5MG/ML 1ML

4 DIFENHIDRAMIN HCl INJ. 10MG/ML


1 ML

5 DEXTROSE INFUSE 5%

6 EPINEFRIN (ADRENALIN) INJ. 0,1%

7 LIDOCAIN COMP. INJ

8 LIDOCAIN NON ADRENALIN INJ.

9 MgSO4 INJ. IV 20% 25ML

10 METHERGIN INJ.

11 RINGER LAKTAT INF.

12 STESOLID 5MG/ML 2,5ML

13 SYNTOCYNON INJ.

14 SALBUTAMOL NEBULE

PENANGGUNG JAWAB RUANGAN

(………………………………………………..)

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