RS SANTA ELISABETH SEI LEKOP

Kav. Sungai Lekop Kel. Sungai Lekop

Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. ANDI EKA PUTRA

1 RJ20220416-0002 16/04/2022 OP20220416-0003 2022041600002 SUCI YOELANDA PUTRI 268,107.0

R/ L BIO SACHET 10.00 SACH 9,800.00 98,000.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

2 RJ20220416-0005 16/04/2022 OP20220416-0006 2022041600005 RAYSHA ANDINI SIREGAR 353,065.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ RANIVEL 75MG/5ML SYR 1.00 FLS 80,670.00 80,670.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

3 RJ20220416-0006 16/04/2022 OP20220416-0005 2022041600006 ALESHA HARMINDA SIREGAR 260,401.0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ BUFECT FORTE SYR 1.00 FLS 27,500.00 27,500.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

4 RJ20220418-0001 18/04/2022 OP20220418-0001 2022041800001 NURUL APRILIA 325,181.0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

Total Dokter DR. ANDI EKA PUTRA 1,206,754.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 1 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. BERNARD PARDOMUAN PURBA, SPB

1 RI20220402-0013 02/04/2022 RI20220402-0001 RI20220402-0013 JIMMI PARULIAN SARAGIH 202,821.0

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ SPUIT 5 CC (TERUMO) 2.00 PCS 6,300.00 12,600.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

2 RI20220402-0014 02/04/2022 RI20220402-0001 RI20220402-0014 JIMMI PARULIAN SARAGIH 995,732.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

R/ SPUIT 5 CC (TERUMO) 3.00 PCS 6,300.00 18,900.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 110,000.00 220,000.00 1 0

3 RI20220403-0002 03/04/2022 RI20220402-0001 RI20220403-0002 JIMMI PARULIAN SARAGIH 886,297.0

R/ SPUIT 5 CC (TERUMO) 1.00 PCS 6,300.00 6,300.00 0 1

R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

R/ KAPAS ALKOHOL 4.00 PCS 302.50 1,210.00 0 1

R/ SPUIT 3 CC (TERUMO) 3.00 PCS 5,772.00 17,316.00 1 0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

4 RI20220405-0001 05/04/2022 RI20220405-0001 RI20220405-0001 IFHANUDDIN 92,721.0

R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0

R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1

R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1

R/ SURFLO NO. 18 (VENFLON) 2.00 PCS 29,200.00 58,400.00 0 1

R/ SET DARAH 1.00 PCS 7,157.00 7,157.00 0 1

5 RI20220405-0009 05/04/2022 RI20220405-0001 RI20220405-0009 IFHANUDDIN 17,629.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 2 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1

6 RI20220405-0018 05/04/2022 RI20220405-0001 RI20220405-0018 IFHANUDDIN 8,754.0

R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1

7 RI20220406-0007 06/04/2022 RI20220405-0001 RI20220406-0007 IFHANUDDIN 1,164.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
8 RI20220412-0014 12/04/2022 RI20220412-0001 RI20220412-0014 INDRA ARIANSYAH 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

9 RI20220412-0019 12/04/2022 RI20220412-0001 RI20220412-0019 INDRA ARIANSYAH 8,753.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

10 RI20220413-0008 13/04/2022 RI20220412-0001 RI20220413-0008 INDRA ARIANSYAH 36,939.0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

11 RI20220414-0008 14/04/2022 RI20220412-0001 RI20220414-0008 INDRA ARIANSYAH 11,880.0

R/ CUTICELL CLASSIC 10 CM X 10 1.00 PCS 11,880.00 11,880.00 0 1

CM
12 RI20220423-0006 23/04/2022 RI20220423-0001 RI20220423-0006 JOICE NETANIA TAMBUNAN 22,680.0

R/ SURFLO NO. 20 VENFLON 1.00 PCS 22,680.00 22,680.00 1 0

13 RI20220423-0007 23/04/2022 RI20220423-0001 RI20220423-0007 JOICE NETANIA TAMBUNAN 45,360.0

R/ SURFLO NO. 20 VENFLON 2.00 PCS 22,680.00 45,360.00 1 0

14 RI20220423-0016 23/04/2022 RI20220423-0001 RI20220423-0016 JOICE NETANIA TAMBUNAN 8,753.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

15 RI20220424-0008 24/04/2022 RI20220423-0001 RI20220424-0008 JOICE NETANIA TAMBUNAN 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

16 RI20220427-0007 27/04/2022 RI20220427-0001 RI20220427-0007 ASTI SETIA PRIHATIN 28,241.0

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ NALD 26 (ONEMED) 3.00 PCS 660.00 1,980.00 0 0

17 RI20220428-0005 28/04/2022 RI20220427-0001 RI20220428-0005 ASTI SETIA PRIHATIN 24,094.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 3 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

18 RI20220428-0008 28/04/2022 RI20220427-0001 RI20220428-0008 ASTI SETIA PRIHATIN 33,363.0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ FOLEY CATHETER NO. 16 1.00 PCS 16,500.00 16,500.00 0 1

19 RI20220428-0011 28/04/2022 RI20220427-0001 RI20220428-0011 ASTI SETIA PRIHATIN 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

20 RI20220428-0014 28/04/2022 RI20220427-0001 RI20220428-0014 ASTI SETIA PRIHATIN 32,760.0

R/ TRAMADOL 50MG/2ML INJ 3.00 AMP 8,002.60 24,007.00 1 0

(OOT)
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

21 RI20220428-0021 28/04/2022 RI20220428-0003 RI20220428-0021 DAHLIA MANURUNG 178,064.0

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 2,184.00 6,552.00 1 0
INJ (BPJS)
R/ CITICOLINE 250 MG/2ML 4.00 AMP 22,500.00 90,000.00 0 1
INJEKSI
22 RI20220429-0003 29/04/2022 RI20220427-0001 RI20220429-0003 ASTI SETIA PRIHATIN 37,048.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

23 RI20220429-0004 29/04/2022 RI20220428-0003 RI20220429-0004 DAHLIA MANURUNG 67,573.0

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 2,184.00 4,368.00 1 0

INJ (BPJS)
R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ CITICOLINE 250 MG/2ML 2.00 AMP 22,500.00 45,000.00 0 1

INJEKSI
R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

24 RI20220430-0004 30/04/2022 RI20220428-0003 RI20220430-0004 DAHLIA MANURUNG 211,785.0

R/ CITICOLINE 250 MG/2ML 4.00 AMP 22,500.00 90,000.00 0 1

INJEKSI
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 2,184.00 6,552.00 1 0

INJ (BPJS)
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0
(BPJS)
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

25 RI20220430-0009 30/04/2022 RI20220428-0003 RI20220430-0009 DAHLIA MANURUNG 15,055.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 4 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

26 RI20220430-0012 30/04/2022 RI20220428-0003 RI20220430-0012 DAHLIA MANURUNG 52,000.0

R/ SPUIT 3 CC (TERUMO) 10.00 PCS 5,200.00 52,000.00 1 0

27 RJ20220404-0016 04/04/2022 OP20220404-0017 2022040400017 EVI SUSANTI 158,620.0

R/ ARDIUM 500 MG 15.00 TAB 7,700.00 115,500.00 0 1

R/ DULCOLAX 10 MG ADULT SUPP 2.00 SUPP 21,560.00 43,120.00 0 1

28 RJ20220406-0007 06/04/2022 OP20220406-0009 2022040600010 JIMMI PARULIAN SARAGIH 125,472.0

R/ CEFIXIME 100 MG CAP 14.00 CAP 3,233.00 45,262.00 1 0

R/ INBUMIN TAB 250 MG 10.00 TAB 8,021.00 80,210.00 0 1

29 RJ20220411-0013 11/04/2022 OP20220411-0013 2022041100017 JURI SIAGIAN 137,500.0

R/ CITICOLINE 500 MG TAB 15.00 TAB 9,166.67 137,500.00 0 1

30 RJ20220412-0001 12/04/2022 OP20220412-0001 2022041200001 INDRA ARIANSYAH 42,643.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1

31 RJ20220413-0014 13/04/2022 OP20220413-0017 2022041300018 ERNA BR TAMBA 10.0

R/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1

32 RJ20220413-0015 13/04/2022 OP20220413-0018 2022041300019 IFHANUDDIN 10.0

R/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1

33 RJ20220418-0009 18/04/2022 OP20220418-0014 2022041800009 INDRA ARIANSYAH 2,409.0

R/ VITAMIN B COMPLEX TAB 10.00 TAB 240.90 2,409.00 1 0

34 RJ20220420-0014 20/04/2022 OP20220420-0015 2022042000017 IFHANUDDIN 10.0

R/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1

35 RJ20220423-0001 23/04/2022 OP20220423-0001 2022042300002 JOICE NETANIA TAMBUNAN 33,780.0

R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 5 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

36 RJ20220427-0019 27/04/2022 OP20220427-0021 2022042700022 TRIANI 10.0

R/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1

37 RJ20220427-0020 27/04/2022 OP20220427-0022 2022042700023 JOICE NETANIA TAMBUNAN 10.0

R/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1

Total Dokter DR. BERNARD PARDOMUAN PURBA, SPB 3,572,461.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 6 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DRG. BETTY PASARIBU

1 RJ20220401-0005 01/04/2022 OP20220401-0009 2022040100005 ABIYYU FAIZ ZAKY LUBIS 16,474.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

2 RJ20220404-0004 04/04/2022 OP20220404-0002 2022040400004 AMELIA S 3,892.0

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,892.00 3,892.00 0 1

3 RJ20220404-0006 04/04/2022 OP20220404-0009 2022040400006 YASINTA KASIH AKAMAKING 2,200.0

R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

4 RJ20220404-0018 04/04/2022 OP20220404-0021 2022040400019 ROSMA 85,024.0

R/ PEHACAIN INJEKSI 2 ML 2.00 AMP 3,892.00 7,784.00 0 1

R/ BECOM ZET TAB 5.00 TAB 2,888.00 14,440.00 0 0

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

5 RJ20220404-0019 04/04/2022 OP20220404-0022 2022040400020 HENDRI RUDIANTO 103,584.0

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

R/ PEHACAIN INJEKSI 2 ML 2.00 AMP 3,892.00 7,784.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

R/ BECOM ZET TAB 5.00 TAB 2,888.00 14,440.00 0 0

R/ SPUIT 1 CC TERUMO 2.00 PCS 9,280.00 18,560.00 0 1

6 RJ20220406-0008 06/04/2022 OP20220406-0010 2022040600011 DANIEL TULUS HUTABARAT 4,580.0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.00 4,580.00 1 0

KAPLET
7 RJ20220407-0004 07/04/2022 OP20220407-0010 2022040700007 FITRAN SITOMPUL 62,796.0

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

8 RJ20220408-0006 08/04/2022 OP20220408-0008 2022040800006 ROMAITO HASIBUAN 3,891.0

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

9 RJ20220408-0009 08/04/2022 OP20220408-0005 2022040800009 PULDIA MAISI 62,796.0

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

10 RJ20220409-0002 09/04/2022 OP20220409-0006 2022040900002 YOGA NATAN SIMAMORA 3,891.0

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 7 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

11 RJ20220409-0005 09/04/2022 OP20220409-0009 2022040900006 REMY FILIPPINE ASTRADA 3,891.0

LUMBANTOBING

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

12 RJ20220411-0008 11/04/2022 OP20220411-0006 2022041100009 JIMINA GULTOM 3,891.0

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

13 RJ20220411-0010 11/04/2022 OP20220411-0009 2022041100012 FITRI RODIATUL HADAWIAH 62,796.0

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

14 RJ20220411-0014 11/04/2022 OP20220411-0018 2022041100018 DANIEL TULUS HUTABARAT 2,291.0

R/ ASAM MEFENAMAT 500 MG 5.00 KAPLET 458.33 2,291.00 1 0

KAPLET
15 RJ20220413-0005 13/04/2022 OP20220413-0007 2022041300005 JUMALI WIDODO ###

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ BECOM ZET TAB 10.00 TAB 2,887.50 28,875.00 0 0

16 RJ20220413-0007 13/04/2022 OP20220413-0007 2022041300007 JUMALI WIDODO 26,343.0

R/ SPUIT 1 CC TERUMO 2.00 PCS 9,280.00 18,560.00 0 1

R/ PEHACAIN INJEKSI 2 ML 2.00 AMP 3,891.50 7,783.00 0 1

17 RJ20220418-0006 18/04/2022 OP20220418-0008 2022041800006 ABIMANYU PRASETIO 9,424.0

R/ SPUIT 3 CC (TERUMO) 1.00 PCS 5,200.00 5,200.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

18 RJ20220418-0010 18/04/2022 OP20220418-0017 2022041800010 ADITYA SAMUEL FRANSISKUS 15,600.0

SINAGA

R/ SPUIT 3 CC (TERUMO) 3.00 PCS 5,200.00 15,600.00 1 0

19 RJ20220418-0012 18/04/2022 OP20220418-0017 2022041800011 ADITYA SAMUEL FRANSISKUS 94,803.0

SINAGA

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ SANORINE HIJAU 200 ML 1.00 FLS 32,007.00 32,007.00 0 1

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

20 RJ20220419-0004 19/04/2022 OP20220419-0006 2022041900005 NORITA TOGATOROP 9,424.0

R/ SPUIT 3 CC (TERUMO) 1.00 PCS 5,200.00 5,200.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

21 RJ20220420-0001 20/04/2022 OP20220420-0005 2022042000002 YASINTA KASIH AKAMAKING 89,139.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 8 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ SPUIT 1 CC TERUMO 2.00 PCS 9,280.00 18,560.00 0 1

R/ PEHACAIN INJEKSI 2 ML 2.00 AMP 3,891.50 7,783.00 0 1

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

22 RJ20220420-0010 20/04/2022 OP20220420-0013 2022042000012 MULYANA 3,891.0

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

23 RJ20220422-0005 22/04/2022 OP20220422-0007 2022042200005 NERLAN PASARIBU 2,567.0

R/ IBUPROFEN 400 MG TAB 5.00 TAB 513.50 2,567.00 1 0

24 RJ20220422-0008 22/04/2022 OP20220422-0011 2022042200009 ARNOLDUS TRISNA SINAGA 14,624.0

R/ SPUIT 3 CC (TERUMO) 2.00 PCS 5,200.00 10,400.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

25 RJ20220425-0008 25/04/2022 OP20220425-0014 2022042500012 SINDY OKTALIA FITRI 5,135.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

26 RJ20220425-0016 25/04/2022 OP20220425-0024 2022042500027 ROBERTH EDUARD 3,891.0

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

27 RJ20220427-0011 27/04/2022 OP20220427-0013 2022042700011 JEPRI SIAHAAN 14,415.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ SPUIT 1 CC TERUMO 1.00 PCS 9,280.00 9,280.00 0 1

28 RJ20220427-0012 27/04/2022 OP20220427-0010 2022042700012 EMLY RISTAWTI 1,937.0

R/ PARACETAMOL 500 MG 5.00 KAPLET 387.55 1,937.00 1 0

KAPLET
29 RJ20220427-0015 27/04/2022 OP20220427-0015 2022042700015 AIDA RISKIANA NASUTION 1,937.0

R/ PARACETAMOL 500 MG 5.00 KAPLET 387.55 1,937.00 1 0

KAPLET
30 RJ20220427-0017 27/04/2022 OP20220427-0018 2022042700018 MULYANA 3,891.0

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

31 RJ20220427-0021 27/04/2022 OP20220427-0023 2022042700024 MAHYARUDIN SALIM 90,270.0

R/ SPUIT 1 CC TERUMO 1.00 PCS 9,280.00 9,280.00 0 1

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

R/ BECOM ZET TAB 10.00 TAB 2,887.50 28,875.00 0 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 9 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

32 RJ20220428-0001 28/04/2022 OP20220428-0002 2022042800001 PULDIA MAISI 90,270.0

R/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

R/ SPUIT 1 CC TERUMO 1.00 PCS 9,280.00 9,280.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,891.50 3,891.00 0 1

R/ BECOM ZET TAB 10.00 TAB 2,887.50 28,875.00 0 0

33 RJ20220429-0004 29/04/2022 OP20220429-0007 2022042900005 ERICSON MALAU 2,567.0

R/ IBUPROFEN 400 MG TAB 5.00 TAB 513.50 2,567.00 1 0

34 RJ20220429-0005 29/04/2022 OP20220429-0008 2022042900006 ARNOLDUS TRISNA SINAGA 10,400.0

R/ SPUIT 3 CC (TERUMO) 2.00 PCS 5,200.00 10,400.00 1 0

Total Dokter DRG. BETTY PASARIBU 1,004,196.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 10 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. IKHSAN, SP.B

1 RI20220405-0006 05/04/2022 RI20220405-0002 RI20220405-0006 MARTODO D. SIMANUNGKALIT 489,697.0

R/ SPUIT 3 CC (TERUMO) 3.00 PCS 4,600.00 13,800.00 1 0

R/ KAPAS ALKOHOL 7.00 PCS 303.00 2,121.00 0 1

R/ SPUIT 5 CC (TERUMO) 3.00 PCS 5,600.00 16,800.00 0 1

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,528.00 22,584.00 1 0

R/ ESOMEPRAZOLE INJ (BPJS) 3.00 VIAL 29,768.00 89,304.00 1 0

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

2 RI20220405-0010 05/04/2022 RI20220405-0002 RI20220405-0010 MARTODO D. SIMANUNGKALIT 1,164.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
3 RI20220405-0014 05/04/2022 RI20220405-0002 RI20220405-0014 MARTODO D. SIMANUNGKALIT 29,768.0

R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 29,768.00 29,768.00 1 0

4 RI20220406-0008 06/04/2022 RI20220405-0002 RI20220406-0008 MARTODO D. SIMANUNGKALIT 499,728.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,528.00 22,584.00 1 0

R/ ESOMEPRAZOLE INJ (BPJS) 3.00 VIAL 29,768.00 89,304.00 1 0

R/ ANALSIK TAB (PSIKOTROPIKA) 8.00 TAB 1,994.00 15,952.00 0 0

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

R/ SPUIT 3 CC (TERUMO) 3.00 PCS 5,200.00 15,600.00 1 0

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ SPUIT 5 CC (TERUMO) 2.00 PCS 5,600.00 11,200.00 0 1

5 RI20220406-0011 06/04/2022 RI20220405-0002 RI20220406-0011 MARTODO D. SIMANUNGKALIT 53,238.0

R/ MANITOL 20 % 500 ML INF 1.00 FLS 53,238.00 53,238.00 0 1

6 RI20220407-0005 07/04/2022 RI20220406-0001 RI20220407-0005 ANWAR LUMBAN TORUAN 5,075.0

R/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0

7 RI20220407-0009 07/04/2022 RI20220406-0001 RI20220407-0009 ANWAR LUMBAN TORUAN 20,187.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1

8 RI20220407-0011 07/04/2022 RI20220405-0002 RI20220407-0011 MARTODO D. SIMANUNGKALIT 452,707.0

R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 11 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ESOMEPRAZOLE INJ (BPJS) 3.00 VIAL 29,768.00 89,304.00 1 0

R/ SPUIT 5 CC (TERUMO) 3.00 PCS 5,600.00 16,800.00 0 1

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ TROLAC 30 MG/ML INJ 3.00 AMP 41,250.00 123,750.00 0 1

9 RI20220407-0012 07/04/2022 RI20220406-0001 RI20220407-0012 ANWAR LUMBAN TORUAN 24,300.0

R/ SUNGKUP OKSIGEN DEWASA 1.00 PCS 24,300.00 24,300.00 0 1

10 RI20220407-0015 07/04/2022 RI20220405-0002 RI20220407-0015 MARTODO D. SIMANUNGKALIT 301,540.0

R/ CITICOLINE 500 MG TAB 10.00 TAB 9,167.00 91,670.00 0 1

R/ BAQUINOR FORTE 500 MG 10.00 TAB 19,107.00 191,070.00 0 1

KAPLET
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

11 RI20220407-0016 07/04/2022 RI20220406-0001 RI20220407-0016 ANWAR LUMBAN TORUAN 19,144.0

R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1

12 RI20220407-0017 07/04/2022 RI20220406-0001 RI20220407-0017 ANWAR LUMBAN TORUAN 23,760.0

R/ CUTICELL CLASSIC 10 CM X 10 2.00 PCS 11,880.00 23,760.00 0 1

CM
13 RI20220407-0018 07/04/2022 RI20220406-0001 RI20220407-0018 ANWAR LUMBAN TORUAN 19,600.0

R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1

14 RI20220407-0020 07/04/2022 RI20220406-0001 RI20220407-0020 ANWAR LUMBAN TORUAN 87,499.0

R/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.00 80,909.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

15 RI20220407-0027 07/04/2022 RI20220407-0003 RI20220407-0027 ANGGELINA PUNGA 17,726.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

16 RI20220408-0001 08/04/2022 RI20220406-0001 RI20220408-0001 ANWAR LUMBAN TORUAN 7,527.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0

17 RI20220408-0004 08/04/2022 RI20220406-0001 RI20220408-0004 ANWAR LUMBAN TORUAN 7,781.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0

R/ NALD 25 (ONEMED) 1.00 PCS 254.10 254.00 0 1

18 RI20220408-0007 08/04/2022 RI20220406-0001 RI20220408-0007 ANWAR LUMBAN TORUAN 20,181.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 12 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
19 RI20220408-0010 08/04/2022 RI20220407-0003 RI20220408-0010 ANGGELINA PUNGA 81,767.0

R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0
KAPLET
20 RI20220409-0003 09/04/2022 RI20220407-0003 RI20220409-0003 ANGGELINA PUNGA 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

21 RI20220409-0004 09/04/2022 RI20220406-0001 RI20220409-0004 ANWAR LUMBAN TORUAN 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

22 RI20220409-0007 09/04/2022 RI20220406-0001 RI20220409-0007 ANWAR LUMBAN TORUAN 15,055.0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

23 RI20220409-0010 09/04/2022 RI20220407-0003 RI20220409-0010 ANGGELINA PUNGA 98,888.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0
KAPLET
24 RI20220409-0011 09/04/2022 RI20220406-0001 RI20220409-0011 ANWAR LUMBAN TORUAN 18,669.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
25 RI20220409-0019 09/04/2022 RI20220407-0003 RI20220409-0019 ANGGELINA PUNGA 387.0

R/ PARACETAMOL 500 MG 1.00 KAPLET 387.55 387.00 1 0

KAPLET
26 RI20220409-0021 09/04/2022 RI20220406-0001 RI20220409-0021 ANWAR LUMBAN TORUAN 11,888.0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

27 RI20220410-0003 10/04/2022 RI20220407-0003 RI20220410-0003 ANGGELINA PUNGA 107,423.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0
KAPLET
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1
28 RI20220410-0004 10/04/2022 RI20220406-0001 RI20220410-0004 ANWAR LUMBAN TORUAN 1,162.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 13 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
29 RI20220410-0007 10/04/2022 RI20220406-0001 RI20220410-0007 ANWAR LUMBAN TORUAN 775.0

R/ PARACETAMOL 500 MG 2.00 KAPLET 387.55 775.00 1 0

KAPLET
30 RI20220411-0003 11/04/2022 RI20220406-0001 RI20220411-0003 ANWAR LUMBAN TORUAN 18,888.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
31 RI20220411-0006 11/04/2022 RI20220406-0001 RI20220411-0006 ANWAR LUMBAN TORUAN 24,282.0

R/ NALD 26 (ONEMED) 2.00 PCS 660.00 1,320.00 0 0

R/ NORAGES INJEKSI 500MG/2ML 2.00 AMP 11,481.00 22,962.00 0 1

32 RI20220411-0007 11/04/2022 RI20220411-0002 RI20220411-0007 NURKHAYLA DOFIANDARI 16,474.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

33 RI20220411-0008 11/04/2022 RI20220411-0002 RI20220411-0008 NURKHAYLA DOFIANDARI 153,492.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

R/ SURFLO NO. 22 VENFLON 3.00 PCS 29,200.00 87,600.00 1 0

R/ SURFLO NO. 20 VENFLON 2.00 PCS 22,680.00 45,360.00 1 0

34 RI20220411-0009 11/04/2022 RI20220411-0002 RI20220411-0009 NURKHAYLA DOFIANDARI 7,156.0

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

35 RI20220412-0001 11/04/2022 RI20220411-0002 RI20220412-0001 NURKHAYLA DOFIANDARI 156,000.0

R/ SURFLO NO. 24 VENFLON 2.00 PCS 34,200.00 68,400.00 0 1

R/ SURFLO NO. 22 VENFLON 3.00 PCS 29,200.00 87,600.00 1 0

36 RI20220412-0002 12/04/2022 RI20220406-0001 RI20220412-0002 ANWAR LUMBAN TORUAN 7,527.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0

37 RI20220412-0006 12/04/2022 RI20220406-0001 RI20220412-0006 ANWAR LUMBAN TORUAN 2,674.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

38 RI20220412-0009 12/04/2022 RI20220406-0001 RI20220412-0009 ANWAR LUMBAN TORUAN 72,800.0

R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1

DEWASA
39 RI20220412-0011 12/04/2022 RI20220406-0001 RI20220412-0011 ANWAR LUMBAN TORUAN 10,150.0

R/ NALD NOVORAPID 32G 2.00 PCS 5,075.00 10,150.00 0 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 14 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

40 RI20220412-0013 12/04/2022 RI20220406-0001 RI20220412-0013 ANWAR LUMBAN TORUAN 21,800.0

R/ VITAMIN B COMPLEX TAB 1.00 TAB 240.90 240.00 1 0

R/ DULCOLAX 10 MG ADULT SUPP 1.00 SUPP 21,560.00 21,560.00 0 1

41 RI20220412-0020 12/04/2022 RI20220406-0001 RI20220412-0020 ANWAR LUMBAN TORUAN 23,375.0

R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT
42 RI20220413-0002 13/04/2022 RI20220406-0001 RI20220413-0002 ANWAR LUMBAN TORUAN 113,413.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ NORAGES INJEKSI 500MG/2ML 2.00 AMP 11,481.00 22,962.00 0 1

R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

R/ SURFLO NO. 22 VENFLON 2.00 PCS 29,200.00 58,400.00 1 0

R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1

43 RI20220413-0007 13/04/2022 RI20220406-0001 RI20220413-0007 ANWAR LUMBAN TORUAN 627.0

R/ PARACETAMOL 500 MG 1.00 KAPLET 387.55 387.00 1 0

KAPLET
R/ VITAMIN B COMPLEX TAB 1.00 TAB 240.90 240.00 1 0

44 RI20220413-0013 13/04/2022 RI20220406-0001 RI20220413-0013 ANWAR LUMBAN TORUAN 13,720.0

R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1

45 RI20220413-0016 13/04/2022 RI20220406-0001 RI20220413-0016 ANWAR LUMBAN TORUAN 5,075.0

R/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0

46 RI20220414-0002 14/04/2022 RI20220406-0001 RI20220414-0002 ANWAR LUMBAN TORUAN 1,162.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
47 RI20220414-0006 14/04/2022 RI20220406-0001 RI20220414-0006 ANWAR LUMBAN TORUAN 30,906.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ VITAMIN B COMPLEX TAB 1.00 TAB 240.90 240.00 1 0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

48 RI20220415-0006 15/04/2022 RI20220406-0001 RI20220415-0006 ANWAR LUMBAN TORUAN 1,296.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ VITAMIN B6 (PYRIDOXINE) 1.00 TAB 134.55 134.00 1 0
49 RI20220416-0007 16/04/2022 RI20220406-0001 RI20220416-0007 ANWAR LUMBAN TORUAN 8,186.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 15 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ VITAMIN B6 (PYRIDOXINE) 1.00 TAB 134.55 134.00 1 0

TAB
R/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
50 RI20220416-0015 16/04/2022 RI20220406-0001 RI20220416-0015 ANWAR LUMBAN TORUAN 2,069.0

R/ KAPAS ALKOHOL 3.00 PCS 302.50 907.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
51 RI20220417-0003 17/04/2022 RI20220406-0001 RI20220417-0003 ANWAR LUMBAN TORUAN 18,669.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
52 RI20220417-0008 17/04/2022 RI20220406-0001 RI20220417-0008 ANWAR LUMBAN TORUAN 85,984.0

R/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.09 80,909.00 0 1

53 RI20220418-0008 18/04/2022 RI20220406-0001 RI20220418-0008 ANWAR LUMBAN TORUAN 1,345.0

R/ VITAMIN B6 (PYRIDOXINE) 10.00 TAB 134.55 1,345.00 1 0

TAB
54 RI20220419-0007 19/04/2022 RI20220419-0002 RI20220419-0007 WESLI RUDIANTO 240,660.0
SIMANJUNTAK

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

55 RI20220420-0005 20/04/2022 RI20220419-0002 RI20220420-0005 WESLI RUDIANTO 238,845.0

SIMANJUNTAK

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

56 RI20220420-0033 20/04/2022 RI20220419-0002 RI20220420-0033 WESLI RUDIANTO 26,261.0

SIMANJUNTAK

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

57 RI20220420-0034 20/04/2022 RI20220420-0002 RI20220420-0034 KURNIAWAN 83,063.0

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

R/ SURFLO NO. 18 (VENFLON) 2.00 PCS 29,200.00 58,400.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

58 RI20220421-0002 21/04/2022 RI20220419-0002 RI20220421-0002 WESLI RUDIANTO 247,599.0

SIMANJUNTAK
R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 16 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

59 RI20220421-0006 21/04/2022 RI20220420-0002 RI20220421-0006 KURNIAWAN 8,000.0

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

60 RI20220421-0010 21/04/2022 RI20220420-0002 RI20220421-0010 KURNIAWAN 230,091.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

61 RI20220421-0015 21/04/2022 RI20220420-0002 RI20220421-0015 KURNIAWAN 43,329.0

R/ TRAMADOL 50MG/2ML INJ 3.00 AMP 8,002.60 24,007.00 1 0

(OOT)
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

62 RI20220422-0002 22/04/2022 RI20220420-0002 RI20220422-0002 KURNIAWAN 292,357.0

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

R/ TRAMADOL 50MG/2ML INJ 3.00 AMP 8,002.60 24,007.00 1 0

(OOT)
R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

63 RI20220422-0003 22/04/2022 RI20220419-0002 RI20220422-0003 WESLI RUDIANTO 224,363.0

SIMANJUNTAK

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

64 RI20220422-0013 22/04/2022 RI20220420-0002 RI20220422-0013 KURNIAWAN 161,689.0

R/ TRAMADOL 50MG/2ML INJ 2.00 AMP 8,002.60 16,005.00 1 0

(OOT)
R/ RL 500 ML INF 4.00 FLS 8,753.75 35,015.00 0 1

R/ ANBACIM 1 GR INJ 1.00 VIAL 110,669.00 110,669.00 0 1

65 RI20220422-0019 22/04/2022 RI20220422-0001 RI20220422-0019 ISMAIL BIN IBRAHIM 55,073.0

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

R/ KAPAS ALKOHOL 4.00 PCS 302.50 1,210.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ SURFLO NO. 18 (VENFLON) 1.00 PCS 29,200.00 29,200.00 0 1

66 RI20220423-0005 23/04/2022 RI20220422-0001 RI20220423-0005 ISMAIL BIN IBRAHIM 24,500.0

R/ FOLEY CATHETER NO. 16 1.00 PCS 16,500.00 16,500.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

67 RI20220423-0010 23/04/2022 RI20220422-0001 RI20220423-0010 ISMAIL BIN IBRAHIM 230,091.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 17 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

68 RI20220423-0015 23/04/2022 RI20220422-0001 RI20220423-0015 ISMAIL BIN IBRAHIM 8,002.0

R/ TRAMADOL 50MG/2ML INJ 1.00 AMP 8,002.60 8,002.00 1 0

(OOT)
69 RI20220423-0020 23/04/2022 RI20220422-0002 RI20220423-0020 NURMINA HUTABARAT 7,156.0

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

70 RI20220423-0021 23/04/2022 RI20220422-0002 RI20220423-0021 NURMINA HUTABARAT 42,861.0

R/ SPUIT 50 ML (WITHOUT 1.00 PCS 42,000.00 42,000.00 0 1

NEEDLE) ONEMED
R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0

71 RI20220424-0001 24/04/2022 RI20220422-0002 RI20220424-0001 NURMINA HUTABARAT 36,356.0

R/ SURFLO NO. 18 (VENFLON) 1.00 PCS 29,200.00 29,200.00 0 1

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

72 RI20220424-0002 24/04/2022 RI20220422-0002 RI20220424-0002 NURMINA HUTABARAT 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

73 RI20220424-0003 24/04/2022 RI20220422-0002 RI20220424-0003 NURMINA HUTABARAT 40,114.0

R/ FOLEY CATHETER NO. 18 1.00 PCS 14,388.00 14,388.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

74 RI20220424-0005 24/04/2022 RI20220422-0001 RI20220424-0005 ISMAIL BIN IBRAHIM 358,443.0

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

R/ DEXKETOPROFEN 25MG/ML 3.00 AMP 33,792.00 101,376.00 1 0

INJ
R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

75 RI20220424-0006 24/04/2022 RI20220422-0002 RI20220424-0006 NURMINA HUTABARAT 257,369.0

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ KAPAS ALKOHOL 3.00 PCS 302.50 907.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

76 RI20220424-0009 24/04/2022 RI20220422-0001 RI20220424-0009 ISMAIL BIN IBRAHIM 8,002.0

R/ TRAMADOL 50MG/2ML INJ 1.00 AMP 8,002.60 8,002.00 1 0

(OOT)
Print Date:7/14/2022 Print Time: 2:09:07PM Page 18 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

77 RI20220424-0011 24/04/2022 RI20220422-0002 RI20220424-0011 NURMINA HUTABARAT 254,098.0

R/ TRAMADOL 50MG/2ML INJ 3.00 AMP 8,002.60 24,007.00 1 0

(OOT)
R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

78 RI20220424-0016 24/04/2022 RI20220422-0002 RI20220424-0016 NURMINA HUTABARAT 240,000.0

R/ OMEPRAZOLE 40 MG INJ 3.00 VIAL 80,000.00 240,000.00 1 0

(BPJS)
79 RI20220425-0004 25/04/2022 RI20220422-0002 RI20220425-0004 NURMINA HUTABARAT 414,098.0

R/ TRAMADOL 50MG/2ML INJ 3.00 AMP 8,002.60 24,007.00 1 0

(OOT)
R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 80,000.00 160,000.00 1 0

(BPJS)
80 RI20220425-0005 25/04/2022 RI20220422-0002 RI20220425-0005 NURMINA HUTABARAT 1,162.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
81 RI20220425-0010 25/04/2022 RI20220422-0002 RI20220425-0010 NURMINA HUTABARAT 1,162.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
82 RI20220425-0012 25/04/2022 RI20220422-0002 RI20220425-0012 NURMINA HUTABARAT 17,726.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

83 RI20220426-0001 26/04/2022 RI20220422-0002 RI20220426-0001 NURMINA HUTABARAT 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
84 RI20220426-0006 26/04/2022 RI20220422-0002 RI20220426-0006 NURMINA HUTABARAT 1,162.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
85 RI20220426-0008 26/04/2022 RI20220422-0002 RI20220426-0008 NURMINA HUTABARAT 1,162.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
86 RI20220427-0001 27/04/2022 RI20220422-0002 RI20220427-0001 NURMINA HUTABARAT 3,875.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
87 RI20220427-0002 27/04/2022 RI20220422-0002 RI20220427-0002 NURMINA HUTABARAT 1,937.0

R/ PARACETAMOL 500 MG 5.00 KAPLET 387.55 1,937.00 1 0

KAPLET
88 RI20220428-0018 28/04/2022 RI20220428-0001 RI20220428-0018 SILSA 63,222.0

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 19 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ SURFLO NO. 18 (VENFLON) 1.00 PCS 29,200.00 29,200.00 0 1

89 RI20220428-0019 28/04/2022 RI20220428-0002 RI20220428-0019 ANISA RAHMA VADIA 54,468.0

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

R/ SURFLO NO. 18 (VENFLON) 1.00 PCS 29,200.00 29,200.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

90 RI20220429-0009 29/04/2022 RI20220428-0002 RI20220429-0009 ANISA RAHMA VADIA 230,091.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

91 RI20220429-0010 29/04/2022 RI20220428-0001 RI20220429-0010 SILSA 143,429.0

R/ TRAMADOL 50MG/2ML INJ 3.00 AMP 8,002.60 24,007.00 1 0

(OOT)
R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

R/ ANBACIM 1 GR INJ 1.00 VIAL 110,669.00 110,669.00 0 1

92 RI20220429-0016 29/04/2022 RI20220428-0002 RI20220429-0016 ANISA RAHMA VADIA 43,878.0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ RL 500 ML INF 4.00 FLS 8,753.75 35,015.00 0 1

93 RI20220430-0007 30/04/2022 RI20220428-0001 RI20220430-0007 SILSA 719,496.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

R/ TRAMADOL 50MG/2ML INJ 3.00 AMP 8,002.60 24,007.00 1 0

(OOT)
R/ OMEPRAZOLE 40 MG INJ 6.00 VIAL 110,000.00 660,000.00 1 0

R/ CEFTRIAXONE 1 GR INJ 2.00 VIAL 13,368.00 26,736.00 1 0

94 RJ20220405-0001 05/04/2022 OP20220405-0005 2022040500001 ANDIKA 191,070.0

R/ BAQUINOR FORTE 500 MG 10.00 TAB 19,107.00 191,070.00 0 1

KAPLET
95 RJ20220416-0004 16/04/2022 OP20220416-0004 2022041600004 ANGGELINA PUNGA 2,409.0

R/ VITAMIN B COMPLEX TAB 10.00 TAB 240.90 2,409.00 1 0

96 RJ20220425-0006 25/04/2022 OP20220425-0009 2022042500010 MUHAMMAD FACHRUL 160,639.0

ERLANGGA

R/ BAQUINOR FORTE 500 MG 6.00 TAB 19,106.55 114,639.00 0 1

KAPLET
R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0

97 RJ20220427-0007 27/04/2022 OP20220427-0002 2022042700007 ANINDYO FIKRI WIRAPUTRA 132,519.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 20 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ BENANG SILK 2/0 CUTTING 1.00 PCS 62,370.00 62,370.00 0 1

R/ BISTURI NO. 11 1.00 PCS 6,049.00 6,049.00 0 1

R/ LIDOCAIN 2% INJ (BPJS) 2.00 AMP 1,800.00 3,600.00 0 1

R/ BENANG BRILON 4/0 CUTTING 1.00 PCS 60,500.00 60,500.00 0 1

98 RJ20220430-0001 30/04/2022 OP20220430-0003 2022043000001 MUHAMMAD FACHRUL 420,481.0

ERLANGGA

R/ BAQUINOR FORTE 500 MG 10.00 TAB 19,106.55 191,065.00 0 1

KAPLET
R/ INBUMIN TAB 250 MG 20.00 TAB 8,020.83 160,416.00 0 1

R/ DEXKETOPROFEN 25 MG TAB 15.00 TAB 4,600.00 69,000.00 1 0

Total Dokter DR. IKHSAN, SP.B 9,308,535.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 21 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. DIKA CAHAYA PUTRI

1 RD20220401-0016 01/04/2022 EP20220401-0013 2022040100027 LEGI ZERO PUTRA 297,770.0

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.00 4,220.00 0 1

2 RD20220401-0017 01/04/2022 EP20220401-0015 2022040100028 ANDI SAPUTRA 255,420.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.00 4,220.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP ### 126,720.00 0 1

3 RD20220402-0014 02/04/2022 EP20220402-0007 2022040200025 INGGRID 40,838.0

R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00 40,838.00 1 0

AMBROXOL 30 MG TAB 5.00 TAB 285.00 0.00 1 0

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

DEXAMETHASON 0,5 MG TAB 5.00 TAB 220.00 0.00 1 0

4 RD20220402-0015 02/04/2022 EP20220402-0008 2022040200026 M.RAVI RAMADANU 36,910.0

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,233.00 32,330.00 1 0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.00 4,580.00 1 0

KAPLET
5 RD20220402-0016 02/04/2022 EP20220402-0009 2022040200029 ANNA 186.0

R/ CAPTOPRIL 25 MG TAB 1.00 TAB 0.00 186.00 1 0

6 RD20220402-0017 02/04/2022 EP20220402-0009 2022040200030 ANNA 7,157.0

R/ SET DARAH 1.00 PCS 0.00 7,157.00 0 1

7 RD20220402-0018 02/04/2022 EP20220402-0010 2022040200031 RUDI ARDIAN 250,270.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ ASAM TRANEXAMAT 500 MG 10.00 TAB 2,475.00 24,750.00 1 0

TAB
R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

8 RD20220402-0019 02/04/2022 EP20220402-0009 2022040200032 ANNA 42,830.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 0.00 7,420.00 1 0

R/ NATRIUM DIKLOFENAC 50 MG 10.00 TAB 0.00 3,080.00 1 0

TAB

Print Date:7/14/2022 Print Time: 2:09:07PM Page 22 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ CEFIXIME 100 MG CAP 10.00 CAP 0.00 32,330.00 1 0

9 RD20220402-0020 02/04/2022 EP20220402-0009 2022040200033 ANNA 769,793.0

R/ SPALK 8 X 25 X 0.5 ( LENGAN 3.00 PCS 0.00 42,000.00 0 0

ATAS)
R/ SPALK 10 X 60 X 0.5 (SPALK 3.00 PCS 0.00 48,600.00 0 1
LENGAN ATAS )
R/ TENSOCREPE 6 INC (15 CM X 2.00 ROLL 0.00 372,500.00 0 1
4.55 M)
R/ CEFTRIAXONE 1 GR INJ 1.00 VIAL 0.00 13,368.00 1 0

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 0.00 293,325.00 0 1

10 RD20220402-0021 02/04/2022 EP20220402-0011 2022040200034 TRIONO SIANIPAR 291,200.0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

11 RD20220402-0022 02/04/2022 EP20220402-0012 2022040200035 FEDERICO PRATAMA 45,898.0

SITUMORANG

R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00 40,838.00 1 0

R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 1,000.00 0 1

R/ AMBROXOL 30 MG TAB 4.00 TAB 1.00 285.00 4,060.00 1 0

SALBUTAMOL 2 MG TAB 4.00 TAB 118.00 0.00 1 0

DEXAMETHASON 0,5 MG TAB 4.00 TAB 220.00 0.00 1 0

12 RD20220404-0017 04/04/2022 EP20220404-0017 2022040400023 HANS GABRIELO SINAGA 31,044.0

R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 24,544.00 24,544.00 0 1

R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

13 RD20220405-0001 05/04/2022 EP20220405-0001 2022040500001 ENJELINA TUMANGGOR 25,640.0

R/ PARACETAMOL SYR 60 ML 1.00 FLS 6,840.00 6,840.00 1 0

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

R/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1

14 RD20220405-0002 05/04/2022 EP20220405-0002 2022040500002 DINA KAMESWARA 500,571.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 28,301.00 28,301.00 0 1

(OOT)
R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,987.00 49,870.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

15 RD20220405-0003 05/04/2022 EP20220405-0003 2022040500003 MARIBET PASARIBU 90,141.0

R/ THROMBOPHOB GEL 1.00 TUBE 68,063.00 68,063.00 0 1

R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 3,818.00 3,818.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 23 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,826.00 18,260.00 1 0

16 RD20220405-0024 05/04/2022 EP20220405-0022 2022040500035 SUPRIYANTI 58,800.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

17 RD20220409-0010 09/04/2022 EP20220409-0008 2022040900015 FRANSISKA IRMANITA DA 110,159.0

SELVI

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,825.50 18,255.00 1 0

18 RD20220409-0011 09/04/2022 EP20220409-0008 2022040900016 FRANSISKA IRMANITA DA 110,000.0

SELVI

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

19 RD20220409-0013 09/04/2022 EP20220409-0010 2022040900018 JULIPER NAPITUPULU 98,670.0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

20 RD20220409-0014 09/04/2022 EP20220409-0011 2022040900019 ARIF RAHMANSYAH SIREGAR 196,001.0

R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 481.54 4,815.00 1 0

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,666.70 36,667.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

21 RD20220410-0001 10/04/2022 EP20220410-0002 2022041000002 330,325.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ CORMEGA SOFT CAPS 5.00 CAP 13,200.00 66,000.00 0 1

22 RD20220410-0002 10/04/2022 EP20220410-0003 2022041000003 HERDIANSYAH 21,174.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

23 RD20220410-0004 10/04/2022 EP20220410-0001 2022041000005 ANGGUN WIJAYA 3,875.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
24 RD20220410-0005 10/04/2022 EP20220410-0005 2022041000006 SELAMAT MUJID 32,455.0
R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,825.50 18,255.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 24 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ MECOBALAMIN 500 MCG TAB 10.00 TAB 1,200.00 12,000.00 1 0

25 RD20220410-0006 10/04/2022 EP20220410-0006 2022041000007 SABILA NUR ASWANI 574,101.0

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

26 RD20220414-0001 14/04/2022 EP20220414-0001 2022041400001 ELESTA FARINA SITORUS 118,800.0

R/ VOMETA SYR 60 ML 1.00 FLS 66,000.00 66,000.00 0 1

R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

27 RD20220414-0002 14/04/2022 EP20220414-0002 2022041400002 RODIAH YOSI 326,999.0

R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

28 RD20220414-0020 14/04/2022 EP20220414-0015 2022041400024 MARIA GORETI SUE 84,224.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
29 RD20220415-0001 15/04/2022 EP20220415-0001 2022041500004 KENZIE JONATHAN GINTING 78,650.0

R/ RHINOS NEO DROP (PREK) 1.00 FLS 70,400.00 70,400.00 0 0

R/ AMOXYCILLIN 125 ML SYR 1.00 BTL 8,250.00 8,250.00 1 0

30 RD20220415-0002 15/04/2022 EP20220415-0002 2022041500005 LASDILINA SIAHAAN 65,150.0

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ BUSCOPAN TAB 10 MG 10.00 TAB 4,397.60 43,976.00 0 1

31 RD20220417-0007 17/04/2022 EP20220417-0006 2022041700012 MUHAMMAD RIDWAN SALEH 61,611.0

R/ OTILON EAR DROP 1.00 FLS 0.00 54,278.00 0 1

R/ RANITIDINE 150 MG TAB 10.00 TAB 0.00 2,750.00 1 0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 0.00 4,583.00 1 0

KAPLET
32 RD20220417-0008 17/04/2022 EP20220417-0007 2022041700013 JUWARDI 463,662.0

R/ SPORETIK 100 MG CAPS 10.00 CAP 27,836.17 278,361.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 25 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

33 RD20220417-0009 17/04/2022 EP20220417-0008 2022041700014 AMINULLAH 535,452.0

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1

R/ SPORETIK 100 MG CAPS 10.00 CAP 27,836.17 278,361.00 0 1

34 RD20220419-0006 19/04/2022 EP20220419-0005 2022041900012 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
35 RD20220419-0007 19/04/2022 EP20220419-0005 2022041900011 ROSMAWATY SINAGA 18,220.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
R/ BETAHISTINE 6 MG TAB 10.00 TAB 1,434.50 14,345.00 1 0

36 RD20220419-0009 19/04/2022 EP20220419-0006 2022041900014 MAHISA RHANI 285,824.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

37 RD20220419-0010 19/04/2022 EP20220419-0007 2022041900015 MANGASI HOTMARTUA 165,000.0

SITUMEANG

R/ BENOSON G 10 GR CREAM 2.00 TUBE 82,500.00 165,000.00 0 1

38 RD20220419-0011 19/04/2022 EP20220419-0008 2022041900016 SUTIKNO 54,941.0

R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 3,818.00 3,818.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0

39 RD20220419-0012 19/04/2022 EP20220419-0009 2022041900017 SUMITRO SIMAMORA 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
40 RD20220419-0013 19/04/2022 EP20220419-0010 2022041900018 ROSANTINA HUTABARAT 295,916.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

41 RD20220422-0009 22/04/2022 EP20220422-0006 2022042200013 FISQA SALSABILA 324,896.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 26 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

42 RD20220422-0010 22/04/2022 EP20220422-0007 2022042200014 SORIDIN 400,218.0

R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,825.50 18,255.00 1 0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1

43 RD20220422-0011 22/04/2022 EP20220422-0008 2022042200015 SUTIKNO 58,900.0

R/ INBUMIN TAB 250 MG 5.00 TAB 8,020.83 40,104.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

44 RD20220422-0012 22/04/2022 EP20220422-0009 2022042200016 AYU FADHILAH UTAMI 65,639.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ RANITIDINE 150 MG TAB 10.00 TAB 275.00 2,750.00 1 0

45 RD20220423-0003 23/04/2022 EP20220423-0003 2022042300003 MARNIALA SITUMORANG 82,500.0

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

46 RD20220423-0004 23/04/2022 EP20220423-0004 2022042300004 MUHAMMAD UBAIDILLAH 544,816.0

MUZAKKI

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

R/ LANFIX 100 MG KAPSUL 15.00 TAB 29,568.00 443,520.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

47 RD20220423-0005 23/04/2022 EP20220423-0005 2022042300009 ANYUN 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
48 RD20220423-0007 23/04/2022 EP20220423-0006 2022042300011 SURIANTI SAMOSIR 15,549.0

R/ VITAMIN B COMPLEX TAB 5.00 TAB 240.90 1,204.00 1 0

R/ BETAHISTINE 6 MG TAB 10.00 TAB 1,434.50 14,345.00 1 0

49 RD20220423-0008 23/04/2022 EP20220423-0007 2022042300012 ANGELINA WAHYUNI 378,855.0

MARGARET OMPUSUNGGU

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 27 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

50 RD20220424-0001 24/04/2022 EP20220424-0002 2022042400001 ELI HEDI SURYADI 6,049.0

R/ BISTURI NO. 12 1.00 PCS 6,049.00 6,049.00 0 1

51 RD20220424-0002 24/04/2022 EP20220424-0003 2022042400002 NURKHOLIS 224,694.0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

52 RD20220424-0003 24/04/2022 EP20220424-0004 2022042400004 AVRILIA PUTRI SITUMORANG 9,324.0

R/ DOMPERIDON 10 MG TAB 10.00 TAB 544.90 5,449.00 1 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
53 RD20220424-0004 24/04/2022 EP20220424-0005 2022042400005 IMANUEL PURBA 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
54 RD20220424-0005 24/04/2022 EP20220424-0005 2022042400006 IMANUEL PURBA 72,488.0

R/ SPASMINAL TABLET 10.00 TAB 1,126.40 11,264.00 0 1

R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

55 RD20220424-0006 24/04/2022 EP20220424-0006 2022042400007 ABDUL RAHIM 47,561.0

R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ CENDO LYTEERS 0,5 ML 1.00 FLS 5,525.00 5,525.00 0 1

MINIDOSE
56 RD20220424-0007 24/04/2022 EP20220 2022042400008 MUHAMMAD ABDI 200,312.0
424-0007

R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

57 RD20220425-0002 25/04/2022 EP20220425-0003 2022042500003 NIJAR EPENDI 185,516.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

58 RD20220425-0003 25/04/2022 EP20220425-0002 2022042500004 LISPIDA ROSTIKA 242,716.0

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 28 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

59 RD20220425-0004 25/04/2022 EP20220425-0005 2022042500006 SANTA RORIA BANJARNAHOR 158,470.0

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 1,000.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ IBUPROFEN 400 MG TAB 5.00 TAB 1.00 513.50 4,561.00 1 0

CORTIDEX 0,5 MG TAB 5.00 TAB 398.80 0.00 0 1

60 RD20220425-0006 25/04/2022 EP20220425-0007 2022042500008 TRINO YABES SIANTURI 56,650.0

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

61 RD20220425-0007 25/04/2022 EP20220425-0006 2022042500009 FARHAN 87,378.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ VITAMIN B COMPLEX TAB 5.00 TAB 240.90 1,204.00 1 0

R/ ASAM TRANEXAMAT 500 MG 10.00 TAB 2,475.00 24,750.00 1 0

TAB
62 RD20220425-0008 25/04/2022 EP20220425-0007 2022042500010 TRINO YABES SIANTURI 49,426.0

R/ PULMICORT 0.5 MG/ML NEB 2.00 FLS 24,713.45 49,426.00 0 1

(BPJS)
63 RD20220425-0009 25/04/2022 EP20220425-0007 2022042500011 TRINO YABES SIANTURI 148,751.0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

R/ SALBUTAMOL 2 MG TAB 10.00 TAB 117.50 1,175.00 1 0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

64 RD20220425-0010 25/04/2022 EP20220425-0009 2022042500012 ATRINA 328,884.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

65 RD20220425-0011 25/04/2022 EP20220425-0011 2022042500013 MARIANTI SIMANGUNSONG 17,612.0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.33 4,583.00 1 0
KAPLET
R/ VITAMIN B COMPLEX TAB 5.00 TAB 240.90 1,204.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 29 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 962.50 9,625.00 1 0

R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

66 RD20220425-0012 25/04/2022 EP20220425-0010 2022042500014 HIDAYAH PUTRI ANDANI 229,134.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

67 RD20220426-0008 26/04/2022 EP20220426-0002 2022042600015 PUTRI MARSHANDA 167,200.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

68 RD20220426-0009 26/04/2022 EP20220426-0003 2022042600018 LATISHA AZIFA PRENTIKA 8,167.0

R/ PROPYRETIC 80 MG SUPP 1.00 SUPP 8,167.73 8,167.00 0 1

(BPJS)
69 RD20220426-0010 26/04/2022 EP20220426-0003 2022042600019 LATISHA AZIFA PRENTIKA 27,465.0

R/ PARACETAMOL SYR 60 ML 1.00 FLS 6,840.00 6,840.00 1 0

R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0

70 RD20220426-0011 26/04/2022 EP20220426-0004 2022042600021 TUMBUR PARDEDE 110,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

71 RD20220426-0012 26/04/2022 EP20220426-0004 2022042600022 TUMBUR PARDEDE 10,839.0

R/ NEW DIATAB TABLET 10.00 TAB 696.44 6,964.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
72 RD20220426-0013 26/04/2022 EP20220426-0005 2022042600023 NADILA SABATINA 304,910.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

73 RD20220426-0014 26/04/2022 EP20220426-0006 2022042600024 BOLONTUA MANURUNG 218,623.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

74 RD20220427-0008 27/04/2022 EP20220427-0007 2022042700013 ELESTA FARINA SITORUS 23,613.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 30 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

75 RD20220427-0009 27/04/2022 EP20220427-0008 2022042700015 ALHABSYI IBNU YUSUF 24,544.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

76 RD20220427-0011 27/04/2022 EP20220427-0009 2022042700017 ELVA DIANA 272,679.0

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

77 RD20220427-0012 27/04/2022 EP20220427-0010 2022042700019 SEFRINA SUSANTI SINAGA 98,796.0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

78 RD20220427-0013 27/04/2022 EP20220427-0011 2022042700021 SEPTI SUSANTI 294,014.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

79 RD20220427-0015 27/04/2022 EP20220427-0013 2022042700023 TONIS BANJAR NAHOR 343,456.0

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

80 RD20220427-0016 27/04/2022 EP20220427-0014 2022042700025 SRI PUTRI ANANDA 147,028.0

R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

81 RD20220427-0017 27/04/2022 EP20220427-0015 2022042700026 ARI YOSO 110,036.0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1

R/ FLAMAR 50 MG TAB 10.00 TAB 2,604.80 26,048.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 31 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

82 RD20220428-0005 28/04/2022 EP20220428-0005 2022042800006 SOFIAH SOLEHAH 59,425.0

R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

R/ RANITIDINE 150 MG TAB 10.00 TAB 275.00 2,750.00 1 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
83 RD20220428-0007 28/04/2022 EP20220428-0007 2022042800009 RUTERISNA MANURUNG 77,174.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ CETIRIZINE 10 MG TAB 10.00 TAB 475.00 4,750.00 1 0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

84 RD20220428-0008 28/04/2022 EP20220428-0008 2022042800010 DHONI RAMADHAN 148,804.0

R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1

R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

85 RD20220428-0009 28/04/2022 EP20220428-0006 2022042800011 NURBAYA SIBURIAN 12,000.0

R/ MECOBALAMIN 500 MCG TAB 10.00 TAB 1,200.00 12,000.00 1 0

86 RD20220428-0010 28/04/2022 EP20220428-0009 2022042800012 ARIS KASNUR 229,134.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

87 RD20220428-0011 28/04/2022 EP20220428-0011 2022042800013 BONARDO HARORONI 40,087.0

ARMSTRONG SIRAIT

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

88 RD20220428-0012 28/04/2022 EP20220428-0010 2022042800014 DAHLIA MANURUNG 83,818.0

R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 3,818.00 3,818.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
89 RD20220428-0013 28/04/2022 EP20220428-0010 2022042800016 DAHLIA MANURUNG 61,371.0
R/ DEXAMETHASON 5MG/1ML INJ 1.00 AMP 3,003.00 3,003.00 1 0

R/ CEFTRIAXONE 1 GR INJ 1.00 VIAL 13,368.00 13,368.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 32 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ CITICOLINE 250 MG/2ML 2.00 AMP 22,500.00 45,000.00 0 1

INJEKSI
90 RD20220428-0014 28/04/2022 EP20220428-0012 2022042800020 TRESIA SITUMORANG 254,014.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

91 RD20220428-0015 28/04/2022 EP20220428-0013 2022042800021 AZZAHRA RIYANTO 327,251.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

92 RD20220428-0016 28/04/2022 EP20220428-0014 2022042800022 HARYANTO SUPRYADI 3,875.0

SIMANJUNTAK

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
93 RD20220428-0017 28/04/2022 EP20220428-0014 2022042800023 HARYANTO SUPRYADI 80,000.0
SIMANJUNTAK

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
94 RD20220428-0018 28/04/2022 EP20220428-0016 2022042800024 MENTARI NARARITA 212,720.0
MUNANTO

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0

95 RD20220428-0019 28/04/2022 EP20220428-0015 2022042800025 MITA MELANI 313,854.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

96 RD20220428-0020 28/04/2022 EP20220428-0017 2022042800026 PARDAMEAN TAMBA 167,200.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

97 RD20220428-0021 28/04/2022 EP20220428-0017 2022042800027 PARDAMEAN TAMBA 25,679.0

R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,825.50 18,255.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 33 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

98 RD20220428-0022 28/04/2022 EP20220428-0018 2022042800028 FARADHITA MEGA DWI 294,014.0

MUSTIKA

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

99 RD20220429-0015 29/04/2022 EP20220429-0016 2022042900019 ESTER NATHANIA SIRAIT 16,813.0

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 1.00 100.00 1,000.00 0 1

100 RD20220429-0016 29/04/2022 EP20220429-0016 2022042900020 ESTER NATHANIA SIRAIT 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

101 RD20220429-0017 29/04/2022 EP20220429-0017 2022042900021 RYAN RAMADHANI 254,014.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

102 RD20220429-0018 29/04/2022 EP20220429-0019 2022042900022 NIZAM ELDI RIANO 82,812.0

R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1

R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1

103 RD20220429-0019 29/04/2022 EP20220429-0018 2022042900023 ELVY SUSANTI 404,484.0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1

R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0

104 RD20220429-0020 29/04/2022 EP20220429-0020 2022042900024 IGNASIUS TITUS 110,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

105 RD20220429-0021 29/04/2022 EP20220429-0020 2022042900025 IGNASIUS TITUS 81,337.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ DOMPERIDON 10 MG TAB 10.00 TAB 544.90 5,449.00 1 0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ SPASMINAL TABLET 10.00 TAB 1,126.40 11,264.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 34 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

106 RD20220429-0022 29/04/2022 EP20220429-0021 2022042900026 CUT DYLLA ZALMY 6,974.0

R/ ANEMOLAT 1 MG TAB 10.00 TAB 275.00 2,750.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

107 RJ20220411-0003 11/04/2022 OP20220411-0004 2022041100004 SARMAIDA SILABAN 39,110.0

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.33 4,583.00 1 0

KAPLET
R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

108 RJ20220411-0006 11/04/2022 OP20220411-0007 2022041100007 YULI PRASTYO 57,376.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
109 RJ20220412-0002 12/04/2022 OP20220412-0002 2022041200004 WISNU SYAHFITRI 340,247.0

R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

110 RJ20220412-0003 12/04/2022 OP20220412-0002 2022041200003 WISNU SYAHFITRI 7,010.0

R/ SALICYL TALK 60 GR 1.00 POT 7,010.40 7,010.00 0 1

111 RJ20220412-0006 12/04/2022 OP20220412-0007 2022041200009 SYAKILLA LEO ADARA 158,624.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ AMBROXOL 30 MG TAB 5.00 TAB 1.00 285.41 21,766.00 1 0

COLERGIS TABLET 5.00 TAB 3,666.70 0.00 0 1

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

112 RJ20220420-0002 20/04/2022 OP20220420-0004 2022042000003 RINO AIDIL PUTRA 281,344.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

113 RJ20220420-0005 20/04/2022 OP20220420-0008 2022042000007 RIZKI ARIF 98,255.0

R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,825.50 18,255.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 35 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

114 RJ20220420-0006 20/04/2022 OP20220420-0009 2022042000008 ALFATIH 196,180.0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

R/ AMOXAN 125 MG SYR 1.00 BTL 30,938.00 30,938.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

Total Dokter DR. DIKA CAHAYA PUTRI 17,735,985.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 36 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. ERIE FAILENGGO

1 RD20220401-0013 01/04/2022 EP20220401-0009 2022040100021 MOSES CHRISTIANO 36,277.0

HARIANJA

R/ PROPYRETIC 240 MG SUPP 1.00 SUPP 11,733.00 11,733.00 0 1

(BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

2 RD20220401-0014 01/04/2022 EP20220401-0010 2022040100025 SOBARIN 702,630.0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

R/ TROLAC 10 MG TAB 10.00 TAB 7,563.00 75,630.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,433.00 194,330.00 0 1

3 RD20220401-0015 01/04/2022 EP20220401-0011 2022040100026 DENTO 69,000.0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,233.00 32,330.00 1 0

4 RD20220402-0006 02/04/2022 EP20220402-0003 2022040200008 CHINDY NADEAK 5,140.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

5 RD20220402-0007 02/04/2022 EP20220402-0003 2022040200009 CHINDY NADEAK 5,610.0

R/ BISTURI NO. 22 1.00 PCS 5,610.00 5,610.00 0 1

6 RD20220402-0008 02/04/2022 EP20220402-0004 2022040200012 JIMMI PARULIAN SARAGIH 699,005.0

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

R/ BIOXON INJ 1 GR 1.00 VIAL 295,680.00 295,680.00 0 1

7 RD20220402-0009 02/04/2022 EP20220402-0005 2022040200016 SURANTA TARIGAN 2,328.0

R/ PARACETAMOL 500 MG 6.00 KAPLET 388.00 2,328.00 1 0

KAPLET
8 RD20220402-0010 02/04/2022 EP20220402-0006 2022040200017 IYON PRIADI 293,325.0

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

9 RD20220402-0011 02/04/2022 EP20220402-0006 2022040200023 IYON PRIADI 164,230.0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.00 3,710.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ TROLAC 10 MG TAB 10.00 TAB 7,563.00 75,630.00 0 1

R/ INBUMIN TAB 250 MG 10.00 TAB 8,021.00 80,210.00 0 1

10 RD20220402-0012 02/04/2022 EP20220402-0006 2022040200020 IYON PRIADI 113,750.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 37 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ TENSOCREPE 4 INC (10 CM X 1.00 ROLL 113,750.00 113,750.00 0 1

4.5 M)
11 RD20220402-0013 02/04/2022 EP20220402-0006 2022040200021 IYON PRIADI 32,330.0

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,233.00 32,330.00 1 0

12 RD20220403-0003 03/04/2022 EP20220403-0002 2022040300005 KEYCIA LAMRIA PARDEDE 24,544.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

13 RD20220403-0004 03/04/2022 EP20220403-0003 2022040300007 YUNITA PANDIANGAN 12,480.0

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

14 RD20220404-0003 04/04/2022 EP20220404-0005 2022040400005 MARJAN DAWSIR 177,475.0

R/ TROLAC 10 MG TAB 10.00 TAB 7,563.00 75,630.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

15 RD20220404-0004 04/04/2022 EP20220404-0004 2022040400006 ELKANA 582,390.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,975.00 159,750.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ LAMETIC 8 MG TAB 5.00 TAB 39,424.00 197,120.00 0 1

16 RD20220404-0005 04/04/2022 EP20220404-0006 2022040400007 RUDI RAHMAD 80,310.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ TROLAC 10 MG TAB 10.00 TAB 7,563.00 75,630.00 0 1

17 RD20220404-0006 04/04/2022 EP20220404-0007 2022040400008 SUHARNO 85,818.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ BERRY VISION TAB 10.00 TAB 4,435.00 44,350.00 0 1

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,788.00 36,788.00 0 0

DROP
18 RD20220404-0007 04/04/2022 EP20220404-0009 2022040400010 NURMISNAWATI 11,640.0

R/ NEW DIATAB TABLET 10.00 TAB 696.00 6,960.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

19 RD20220404-0008 04/04/2022 EP20220404-0008 2022040400011 MINAR NAPITUPULU 102,755.0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.00 3,710.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 38 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ CEFIXIME 100 MG CAP 5.00 CAP 3,233.00 16,165.00 1 0

R/ ONDANSETRON 4 MG TAB 6.00 TAB 3,500.00 21,000.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

20 RD20220404-0009 04/04/2022 EP20220404-0010 2022040400012 RIPALDO SIRAIT 476,310.0

R/ TROLAC 10 MG TAB 10.00 TAB 7,563.00 75,630.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

21 RD20220404-0010 04/04/2022 EP20220404-0011 2022040400014 NITISH GUPTA 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

22 RD20220404-0011 04/04/2022 EP20220404-0012 2022040400016 REYHAN ALFARIZQI SIREGAR 217,966.0

R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

23 RD20220404-0012 04/04/2022 EP20220404-0013 2022040400015 GIBRAN ALHANAN SIREGAR 217,966.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1

24 RD20220404-0013 04/04/2022 EP20220404-0014 2022040400018 ABDUL HAFIZI 694,015.0

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,433.00 194,330.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

25 RD20220404-0014 04/04/2022 EP20220404-0011 2022040400019 NITISH GUPTA 869,909.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ CORMEGA SOFT CAPS 20.00 CAP 13,200.00 264,000.00 0 1

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 39 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

26 RD20220404-0015 04/04/2022 EP20220404-0015 2022040400020 39,706.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

27 RD20220404-0016 04/04/2022 EP20220404-0016 2022040400021 628,320.0

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SPASMINAL TABLET 10.00 TAB 1,126.00 11,260.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

28 RD20220405-0012 05/04/2022 EP20220405-0010 2022040500019 JOGI MARIANUS SIHOTANG 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

29 RD20220405-0013 05/04/2022 EP20220405-0011 2022040500021 UTARI DAHNIA 643,700.0

R/ LAMETIC 8 MG TAB 5.00 TAB 39,424.00 197,120.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,975.00 159,750.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ TROLAC 10 MG TAB 10.00 TAB 7,563.00 75,630.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

30 RD20220405-0014 05/04/2022 EP20220405-0013 2022040500022 WHINDY IKA WULANDHARI 506,924.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,975.00 159,750.00 0 1

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

R/ TROLAC 10 MG TAB 10.00 TAB 7,563.00 75,630.00 0 1

31 RD20220405-0015 05/04/2022 EP20220405-0014 2022040500023 ADRIELLA ELISABETH 331,044.0

AMBARITA

R/ RANIVEL 75MG/5ML SYR 1.00 FLS 80,670.00 80,670.00 0 1

R/ LACTO B SACHET 5.00 SACH 7,080.00 35,400.00 0 1

R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1

R/ VOMETA SYR 60 ML 1.00 FLS 66,000.00 66,000.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 40 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

32 RD20220405-0016 05/04/2022 EP20220405-0012 2022040500024 AGUS HENDRA 403,325.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

33 RD20220405-0017 05/04/2022 EP20220405-0012 2022040500025 AGUS HENDRA 152,420.0

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,233.00 32,330.00 1 0

R/ INBUMIN TAB 250 MG 10.00 TAB 8,021.00 80,210.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ KETOROLAC 10 MG TAB 10.00 TAB 3,520.00 35,200.00 1 0

34 RD20220405-0018 05/04/2022 EP20220405-0015 2022040500026 AUDIEA DWI ANGGITA 376,995.0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

35 RD20220405-0019 05/04/2022 EP20220405-0016 2022040500028 SRI AYOM 39,420.0

R/ RANITIDINE 150 MG TAB 10.00 TAB 275.00 2,750.00 1 0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

36 RD20220405-0020 05/04/2022 EP20220405-0017 2022040500029 TERESIA UMI 39,420.0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ RANITIDINE 150 MG TAB 10.00 TAB 275.00 2,750.00 1 0

37 RD20220405-0021 05/04/2022 EP20220405-0018 2022040500030 ARTITA PULUNGAN 499,504.0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,433.00 194,330.00 0 1

38 RD20220405-0022 05/04/2022 EP20220405-0019 2022040500031 IFNIL AMRUL RISKI NASUTION 275,716.0

R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 41 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL ### 55,000.00 0 0

39 RD20220405-0023 05/04/2022 EP20220405-0021 2022040500034 FEBRI JHONNATAN NAIBAHO 75,830.0

R/ STESOLID 10 MG/2.5 ML 1.00 TUBE 44,786.00 44,786.00 0 0

RECTAL TUBE
R/ D5 + 1/4 NS 500 ML ( WIDA )
(PSIKOTROPIKA) 1.00 FLS 24,544.00 24,544.00 0 1

R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

40 RD20220407-0003 07/04/2022 EP20220407-0003 2022040700003 ANGGELINA PUNGA 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
41 RD20220407-0004 07/04/2022 EP20220407-0004 2022040700006 MUKLIS SIREGAR 307,285.0

R/ TROLAC 10 MG TAB 10.00 TAB 7,562.50 75,625.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ METHYLON 4 MG TAB 10.00 TAB 3,162.50 31,625.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

42 RD20220407-0005 07/04/2022 EP20220407-0004 2022040700007 MUKLIS SIREGAR 103,125.0

R/ METHYLON 125 MG INJ 1.00 VIAL 103,125.00 103,125.00 0 1

43 RD20220407-0006 07/04/2022 EP20220407-0005 2022040700008 DAFFA MUARIF 482,921.0

R/ COLERGIS TABLET 10.00 TAB 3,666.70 36,667.00 0 1

R/ KETRICIN ORA BASE 0,1% 1.00 TUBE 66,025.00 66,025.00 0 1

CREAM
R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

44 RD20220407-0007 07/04/2022 EP20220407-0006 2022040700009 KASPUL ANWAR 66,025.0

R/ KETRICIN ORA BASE 0,1% 1.00 TUBE 66,025.00 66,025.00 0 1

CREAM
45 RD20220407-0008 07/04/2022 EP20220407-0007 2022040700010 FARADHITA MEGA DWI 303,852.0
MUSTIKA

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

46 RD20220407-0009 07/04/2022 EP20220407-0008 2022040700011 DICKY SERFINDO 519,548.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 42 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ TROLAC 10 MG TAB 10.00 TAB 7,562.50 75,625.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ INBUMIN TAB 250 MG 10.00 TAB 8,020.83 80,208.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

47 RD20220407-0010 07/04/2022 EP20220407-0010 2022040700012 ARNANDO 134,064.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ VOMETA FT 10 MG TAB 5.00 TAB 5,866.50 29,332.00 0 1

48 RD20220407-0011 07/04/2022 EP20220407-0009 2022040700014 MIKAEL BETAWE SILITONGA 36,277.0

R/ PROPYRETIC 240 MG SUPP 1.00 SUPP 11,733.00 11,733.00 0 1

(BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

49 RD20220407-0012 07/04/2022 EP20220407-0011 2022040700023 343,661.0

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

50 RD20220410-0014 10/04/2022 EP20220410-0012 2022041000017 DAREEN RUMABUTAR 34,074.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

51 RD20220411-0001 11/04/2022 EP20220411-0001 2022041100001 CHARLES JORANGTA S. 80,000.0

SIMANJORANG

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
52 RD20220411-0012 11/04/2022 EP20220411-0012 2022041100013 ELVINA SARI BANGUN 91,867.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ FLUNARIZINE 5 MG TAB 3.00 TAB 1,760.00 5,280.00 1 0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.40 3,712.00 1 0

R/ ONDANSETRON 4 MG TAB 6.00 TAB 3,500.00 21,000.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

53 RD20220412-0001 12/04/2022 EP20220412-0001 2022041200002 AZWAN KURNIAWAN 559,447.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 43 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

R/ KETOROLAC 10 MG TAB 10.00 TAB 3,520.00 35,200.00 1 0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.40 3,712.00 1 0

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

R/ INBUMIN TAB 250 MG 10.00 TAB 8,020.83 80,208.00 0 1

54 RD20220412-0002 12/04/2022 EP20220412-0002 2022041200003 SHINTA YUNITA PUTRI 192,975.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ SPASMINAL TABLET 10.00 TAB 1,126.40 11,264.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

55 RD20220412-0003 12/04/2022 EP20220412-0003 2022041200004 TOMMY 4,675.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

56 RD20220415-0003 15/04/2022 EP20220415-0003 2022041500007 MIKE REGULUS YEHOSHUA 91,337.0

DURANDAL WONG

R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 24,713.45 24,713.00 0 1

(BPJS)
R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

57 RD20220415-0004 15/04/2022 EP20220415-0004 2022041500008 JANUARYANTI BANJARNAHOR 256,389.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ RANIVEL 75MG/5ML SYR 1.00 FLS 80,670.00 80,670.00 0 1

R/ ESTIN 60 ML SYR 1.00 FLS 73,920.00 73,920.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

58 RD20220415-0005 15/04/2022 EP20220415-0005 2022041500009 AHMAD RIYADI SIREGAR 262,456.0

R/ SANORINE HIJAU 200 ML 1.00 FLS 32,007.00 32,007.00 0 1

R/ KETRICIN ORA BASE 0,1% 1.00 TUBE 66,025.00 66,025.00 0 1

CREAM
R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

59 RD20220415-0006 15/04/2022 EP20220415-0006 2022041500010 AZWAN KURNIAWAN 7,636.0

R/ GENTAMICIN 5 GR CREAM 2.00 TUBE 3,818.00 7,636.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 44 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

60 RD20220415-0012 15/04/2022 EP20220415-0008 2022041500018 MULIA RAHMAD 59,971.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

61 RD20220417-0002 17/04/2022 EP20220417-0002 2022041700002 ARIS SAPRIONO 44,000.0

R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
62 RD20220417-0003
DWS 17/04/2022 EP20220417-0002 2022041700003 ARIS SAPRIONO 97,513.0

R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 24,713.45 24,713.00 0 1

(BPJS)
R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1
DEWASA
63 RD20220417-0004 17/04/2022 EP20220417-0002 2022041700004 ARIS SAPRIONO 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

64 RD20220417-0005 17/04/2022 EP20220417-0004 2022041700007 MARSHA TIMOHTY HASIAN 117,108.0

SIMORANGKIR

R/ RANIVEL 75MG/5ML SYR 1.00 FLS 80,670.00 80,670.00 0 1

R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

65 RD20220417-0006 17/04/2022 EP20220417-0004 2022041700006 MARSHA TIMOHTY HASIAN 23,375.0

SIMORANGKIR

R/ ANITID 50 MG/2ML INJ 1.00 AMP 23,375.00 23,375.00 0 1

66 RD20220418-0003 18/04/2022 EP20220418-0002 2022041800004 MARNIALA SITUMORANG 168,303.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ CEFIXIME 200 MG CAP 10.00 CAP 6,187.50 61,875.00 1 0

R/ INBUMIN TAB 250 MG 10.00 TAB 8,020.83 80,208.00 0 1

67 RD20220418-0004 18/04/2022 EP20220418-0003 2022041800006 MUHAMMAD ARBI 444,204.0

R/ SPORETIK 100 MG CAPS 10.00 CAP 27,836.17 278,361.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ INBUMIN TAB 250 MG 10.00 TAB 8,020.83 80,208.00 0 1

R/ RATIVOL TAB 10.00 TAB 8,096.00 80,960.00 0 1

68 RD20220418-0005 18/04/2022 EP20220418-0004 2022041800008 XAVIER DEVEN SAGOTO 42,144.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

69 RD20220418-0006 18/04/2022 EP20220418-0006 2022041800009 ADIRA MELIKNA 281,441.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 45 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1

R/ SINRAL 5 MG TAB 3.00 TAB 6,187.50 18,562.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

70 RD20220418-0007 18/04/2022 EP20220418-0005 2022041800012 MONIKA SARAS WATI T 607,252.0

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

71 RD20220418-0008 18/04/2022 EP20220418-0007 2022041800013 JERI AMANDA 607,252.0

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

72 RD20220418-0009 18/04/2022 EP20220418-0008 2022041800015 SHINTYA RATU ARINA 624,947.0

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

73 RD20220418-0010 18/04/2022 EP20220418-0008 2022041800016 SHINTYA RATU ARINA 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

74 RD20220418-0011 18/04/2022 EP20220418-0009 2022041800017 DAHNIAL HUSIN 634,506.0

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 46 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ SINRAL 5 MG TAB 3.00 TAB 6,187.50 18,562.00 0 1

75 RD20220418-0012 18/04/2022 EP20220418-0010 2022041800018 HERMAN ROZA PUTRA 566,077.0

R/ SANMOL FORTE TAB 10.00 TAB 0.00 4,675.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 0.00 70,000.00 0 1

R/ LAMETIC 8 MG TAB 10.00 TAB 0.00 394,240.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 0.00 97,162.00 0 1

76 RD20220418-0013 18/04/2022 EP20220418-0011 2022041800019 MUHAMMAD KHALID 625,814.0

KADERUSSYAIKHAN

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

R/ SINRAL 5 MG TAB 3.00 TAB 6,187.50 18,562.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

77 RD20220418-0014 18/04/2022 EP20220418-0012 2022041800020 OBNIEL NICHOLAS MANURUNG 271,677.0

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

78 RD20220418-0015 18/04/2022 EP20220418-0014 2022041800021 CHRISTIN MEGAWATY 285,949.0

SIREGAR

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SINRAL 5 MG TAB 5.00 TAB 6,187.50 30,937.00 0 1

79 RD20220418-0016 18/04/2022 EP20220418-0013 2022041800022 YULIANA TARIHORAN 641,516.0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.40 3,712.00 1 0

R/ REMOPAIN INJ AMPUL 1.00 AMP 61,600.00 61,600.00 0 1

R/ RATIVOL TAB 10.00 TAB 8,096.00 80,960.00 0 1

R/ INBUMIN TAB 250 MG 10.00 TAB 8,020.83 80,208.00 0 1

R/ SPORETIK 100 MG CAPS 10.00 CAP 27,836.17 278,361.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 47 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

80 RD20220418-0017 18/04/2022 EP20220418-0015 2022041800023 DYAN ALFARIZI 24,544.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

81 RD20220420-0006 20/04/2022 EP20220420-0003 2022042000008 MYRON NATHANAEL 206,638.0

TAMPUBOLON

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1

R/ LACTO B SACHET 1.00 SACH 7,080.00 7,080.00 0 1

R/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1

82 RD20220420-0007 20/04/2022 EP20220420-0004 2022042000009 ELKANA 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

83 RD20220420-0008 20/04/2022 EP20220420-0004 2022042000010 ELKANA 293,060.0

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

84 RD20220420-0009 20/04/2022 EP20220420-0004 2022042000011 ELKANA 10,800.0

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

85 RD20220420-0010 20/04/2022 EP20220420-0005 2022042000012 CICA RAMELIKA 496,865.0

R/ SINRAL 5 MG TAB 5.00 TAB 6,187.50 30,937.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

86 RD20220420-0011 20/04/2022 EP20220420-0006 2022042000013 KHUSNAH 831,537.0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ TROLAC 10 MG TAB 10.00 TAB 7,562.50 75,625.00 0 1

R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 48 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

87 RD20220420-0012 20/04/2022 EP20220420-0007 2022042000014 DELVIA ANGGRAINI 863,162.0

R/ TROLAC 10 MG TAB 10.00 TAB 7,562.50 75,625.00 0 1

R/ METHYLON 4 MG TAB 10.00 TAB 3,162.50 31,625.00 0 1

R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1

R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

88 RD20220421-0012 21/04/2022 EP20220421-0010 2022042100016 MEILI NASTASIA SIMAMORA 308,877.0

R/ SINRAL 5 MG TAB 5.00 TAB 6,187.50 30,937.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

89 RD20220421-0013 21/04/2022 EP20220421-0012 2022042100021 HENDRA SANTO KIROYAN 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

90 RD20220421-0014 21/04/2022 EP20220421-0013 2022042100023 WINNIE YULIARNI 331,805.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ FREGO 5 MG TAB 5.00 TAB 8,448.00 42,240.00 0 0

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

91 RD20220421-0015 21/04/2022 EP20220421-0012 2022042100024 HENDRA SANTO KIROYAN 58,438.0

R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
92 RD20220421-0016 21/04/2022 EP20220421-0014 2022042100026 MARDONAL Z 247,352.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1
(PREKURSOR)
R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 49 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

93 RD20220421-0017 21/04/2022 EP20220421-0015 2022042100027 NICHOLAS SERGIO 47,118.0

SITUMORANG

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

R/ CETIRIZINE DROP 1.00 FLS 29,518.13 29,518.00 1 0

94 RD20220421-0018 21/04/2022 EP20220421-0017 2022042100028 NATANAEL PANJAITAN 182,024.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

95 RD20220421-0019 21/04/2022 EP20220421-0016 2022042100030 ANTONI 49,665.0

R/ METHYLPREDNISOLONE 125 1.00 VIAL 49,665.00 49,665.00 1 0

MG INJ
96 RD20220421-0020 21/04/2022 EP20220421-0018 2022042100031 DISPEN PANJAITAN 65,587.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.40 3,712.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

97 RD20220421-0021 21/04/2022 EP20220421-0016 2022042100032 ANTONI 236,854.0

R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1

R/ INBUMIN TAB 250 MG 5.00 TAB 8,020.83 40,104.00 0 1

R/ METHYLON 4 MG TAB 10.00 TAB 3,162.50 31,625.00 0 1

R/ TROLAC 10 MG TAB 10.00 TAB 7,562.50 75,625.00 0 1

98 RD20220421-0022 21/04/2022 EP20220421-0016 2022042100033 ANTONI 113,750.0

R/ TENSOCREPE 4 INC (10 CM X 1.00 ROLL 113,750.00 113,750.00 0 1

4.5 M)
99 RD20220421-0023 21/04/2022 EP20220421-0019 2022042100035 RINDI ATIKA MARPAUNG 230,779.0

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,787.50 36,787.00 0 0

DROP
R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1

100 RD20220423-0001 23/04/2022 EP20220423-0001 2022042300001 JENI RAGIL 391,768.0

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 50 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

101 RD20220423-0002 23/04/2022 EP20220423-0002 2022042300002 SOVIANITA PRATIWI 391,768.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

102 RD20220425-0001 25/04/2022 EP20220425-0001 2022042500001 ANSELMIA MBAY 83,087.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ ONDANSETRON 4 MG TAB 5.00 TAB 3,500.00 17,500.00 1 0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.40 3,712.00 1 0

103 RD20220430-0016 30/04/2022 EP20220430-0016 2022043000020 YASINTA LONA BADHE 73,267.0

R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1

DEWASA
R/ SANMOL FORTE TAB 1.00 TAB 467.50 467.00 0 1

104 RD20220430-0017 30/04/2022 EP20220430-0016 2022043000021 YASINTA LONA BADHE 61,875.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

105 RD20220430-0018 30/04/2022 EP20220430-0017 2022043000022 NIKOLAUS BRIANUS 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

106 RJ20220408-0001 08/04/2022 OP20220408-0001 2022040800001 YOGI AMAL PUTRA 318,317.0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

107 RJ20220408-0003 08/04/2022 OP20220408-0002 2022040800003 BERIK ESTRADA 159,880.0

R/ CENDO PANTOCAIN 0,5% EYE 1.00 FLS 16,368.75 16,368.00 0 1

DROP
R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,787.50 36,787.00 0 0
DROP
R/ BERRY VISION TAB 5.00 TAB 4,435.20 22,176.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

108 RJ20220408-0005 08/04/2022 OP20220408-0006 2022040800005 MAROMBASTUA 428,727.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 51 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ VOMETA FT 10 MG TAB 6.00 TAB 5,866.50 35,199.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

109 RJ20220408-0007 08/04/2022 OP20220408-0013 2022040800007 LEO MARHASIAN 318,317.0

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

110 RJ20220408-0008 08/04/2022 OP20220408-0012 2022040800008 RONA AISYAH 217,966.0

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

111 RJ20220408-0010 08/04/2022 OP20220408-0011 2022040800010 SRI WAHYUNI 669,330.0

R/ VOMETA FT 10 MG TAB 6.00 TAB 5,866.50 35,199.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

112 RJ20220408-0011 08/04/2022 OP20220408-0017 2022040800011 HAMDAN 348,113.0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ BERRY VISION TAB 10.00 TAB 4,435.20 44,352.00 0 1

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,787.50 36,787.00 0 0

DROP
R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ TROLAC 10 MG TAB 5.00 TAB 7,562.50 37,812.00 0 1

113 RJ20220409-0001 09/04/2022 OP20220409-0002 2022040900001 DARMADI 192,248.0

R/ COLERGIS TABLET 10.00 TAB 3,666.70 36,667.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 52 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ CERINI 10 MG TABLET 5.00 TAB 4,716.25 23,581.00 0 1

114 RJ20220413-0002 13/04/2022 OP20220413-0005 2022041300002 KRISMAY ZILFANIA GULTOM 316,108.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1

115 RJ20220413-0006 13/04/2022 OP20220413-0008 2022041300008 YOPI WILYANSEN 221,375.0

R/ KETOROLAC 10 MG TAB 10.00 TAB 3,520.00 35,200.00 1 0

R/ METHYLON 4 MG TAB 10.00 TAB 3,162.50 31,625.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1

116 RJ20220413-0011 13/04/2022 OP20220413-0015 2022041300014 CARLIE LEONARDO SIMARE 449,070.0

MARE

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

117 RJ20220413-0013 13/04/2022 OP20220413-0016 2022041300017 LAMBOK SIPAYUNG 98,666.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ ONDANSETRON 4 MG TAB 9.00 TAB 3,500.00 31,500.00 1 0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.40 3,712.00 1 0

R/ ALPRAZOLAM 0,5 MG TAB 2.00 TAB 789.75 1,579.00 0 0

(PSI)
R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

118 RJ20220428-0002 28/04/2022 OP20220428-0003 2022042800002 NURI PURBA 190,096.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ ONDANSETRON 4 MG TAB 6.00 TAB 3,500.00 21,000.00 1 0

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ RHINOS SR KAPSUL 6.00 CAP 8,043.50 48,261.00 0 1

(PREKURSOR)
119 RJ20220429-0001 29/04/2022 OP20220429-0004 2022042900001 ABDUL ROPI 590,325.0
R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 53 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

120 RJ20220429-0002 29/04/2022 OP20220429-0005 2022042900003 BRIGHTLY OWENS 1,136,930.0

R/ TROLAC 10 MG TAB 10.00 TAB 7,562.50 75,625.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,781.25 37,812.00 0 1

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

R/ CORMEGA CAPS BLISTERS 10.00 CAP 16,875.00 168,750.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1

121 RJ20220429-0003 29/04/2022 OP20220429-0006 2022042900004 PENTA MUKTI HERLAMBANG 830,393.0

R/ SINRAL 5 MG TAB 10.00 TAB 6,187.50 61,875.00 0 1

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 394,240.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

122 RJ20220429-0006 29/04/2022 OP20220429-0011 2022042900007 NECI PURNAMA SARI 285,207.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ GITAS PLUS TAB 10.00 TAB 8,800.00 88,000.00 0 1

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

123 RJ20220429-0007 29/04/2022 OP20220429-0012 2022042900008 ROINCAH TOGATOROP 1,041,593.0

R/ LAMETIC 8 MG TAB 10.00 TAB 39,424.00 ### 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ SINRAL 5 MG TAB 10.00 TAB 6,187.50 61,875.00 0 1

124 RJ20220429-0008 29/04/2022 OP20220429-0013 2022042900009 TRIWA DESHANA SARAGIH 436,153.0

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 54 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ SINRAL 5 MG TAB 10.00 TAB 6,187.50 61,875.00 0 1

125 RJ20220429-0009 29/04/2022 OP20220429-0014 2022042900010 CINTA JUMAGAR SIANIAPAR 201,882.0

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

Total Dokter DR. ERIE FAILENGGO 34,234,732.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 55 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR.EKA KURNIATI

1 RD20220406-0003 06/04/2022 EP20220406-0005 2022040600005 ANWAR LUMBAN TORUAN 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
2 RD20220406-0005 06/04/2022 EP20220406-0006 2022040600009 FIONA RAMADHANTI WAHONO 116,486.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ ZOLLOCID CAPS 3.00 CAP 12,672.00 38,016.00 0 1

3 RD20220406-0006 06/04/2022 EP20220406-0007 2022040600010 SITI HAFSAH 40,000.0

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

4 RD20220406-0007 06/04/2022 EP20220406-0008 2022040600011 ALI AMRAN 92,430.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ NS 0.9 100 ML (PIGGY BACK) 1.00 FLS 19,430.00 19,430.00 1 0

5 RD20220406-0008 06/04/2022 EP20220406-0008 2022040600012 ALI AMRAN 278,905.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

6 RD20220406-0009 06/04/2022 EP20220406-0009 2022040600013 WARLAN SUHERLAN 22,680.0

R/ ARCAPEC TAB 15.00 TAB 1,512.00 22,680.00 0 1

7 RD20220406-0010 06/04/2022 EP20220406-0012 2022040600019 JENI RAGIL 186.0

R/ CAPTOPRIL 25 MG TAB 1.00 TAB 186.00 186.00 1 0

8 RD20220406-0011 06/04/2022 EP20220406-0010 2022040600020 NUR MALAIKA ZHAFIRA 24,544.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

9 RD20220406-0012 06/04/2022 EP20220406-0011 2022040600021 GILANG YULIYANTO 360,494.0

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

10 RD20220406-0014 06/04/2022 EP20220406-0012 2022040600022 JENI RAGIL 153,845.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 56 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ AMLODIPINE 5 MG TAB 10.00 TAB 1,200.00 12,000.00 1 0

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

11 RD20220406-0015 06/04/2022 EP20220406-0013 2022040600023 GRACIA YORI 4,680.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

12 RD20220406-0016 06/04/2022 EP20220406-0014 2022040600024 MEGAWATI HUTASOIT 177,046.0

R/ ZOLLOCID CAPS 3.00 CAP 12,672.00 38,016.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,987.00 49,870.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

13 RD20220407-0013 07/04/2022 EP20220407-0012 2022040700017 CHARLES SIJABAT 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
14 RD20220407-0015 07/04/2022 EP20220407-0013 2022040700021 AERILYN AYU JELITA 35,750.0

R/ LASAL SYR 2 MG/5ML 100 ML 1.00 FLS 35,750.00 35,750.00 0 1

15 RD20220407-0016 07/04/2022 EP20220407-0012 2022040700020 CHARLES SIJABAT 3,875.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
16 RD20220407-0017 07/04/2022 EP20220407-0011 2022040700022 ENDY DWI WISNU WANTONO 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

17 RD20220408-0001 08/04/2022 EP20220408-0002 2022040800002 MYANTI RONAULY 107,909.0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

18 RD20220408-0028 08/04/2022 EP20220408-0022 2022040800040 META ULKHAIRI 42,227.0

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ OMEPRAZOLE 20 MG CAP 3.00 CAP 742.40 2,227.00 1 0

19 RD20220408-0029 08/04/2022 EP20220408-0023 2022040800041 ARIS KASNUR 195,827.0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 57 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

20 RD20220409-0001 09/04/2022 EP20220409-0001 2022040900001 160,051.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

21 RD20220409-0002 09/04/2022 EP20220409-0002 2022040900003 ADELLA FEBRA ERION 88,753.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
22 RD20220413-0004 13/04/2022 EP20220413-0004 2022041300007 DINAR SIMBOLON 69,759.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

23 RD20220413-0005 13/04/2022 EP20220413-0005 2022041300008 DEWYNTA MONICA FABRINA 474,225.0

BANGUN

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

24 RD20220413-0006 13/04/2022 EP20220413-0005 2022041300009 DEWYNTA MONICA FABRINA 11,100.0

BANGUN

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 11,100.00 11,100.00 1 0

500MG/5ML
25 RD20220414-0012 14/04/2022 EP20220414-0008 2022041400016 SALMAN SAGALA 79,079.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

26 RD20220414-0013 14/04/2022 EP20220414-0009 2022041400017 NOVITA ANGLELINA 15,813.0

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

27 RD20220414-0014 14/04/2022 EP20220414-0010 2022041400018 KHATERIN YOLA GRANTSLICE 3,875.0

SIHOTANG

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
28 RD20220414-0016 14/04/2022 EP20220414-0011 2022041400021 DANI SAMUEL SINAGA 109,717.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ ARCAPEC TAB 15.00 TAB 1,512.00 22,680.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 58 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

29 RD20220414-0017 14/04/2022 EP20220414-0012 2022041400022 RIDELSON JANRIAMAN 228,772.0

MARBUN

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

30 RD20220414-0018 14/04/2022 EP20220414-0013 2022041500006 TOGAP ORLANDO PARDEDE 18,796.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

31 RD20220415-0007 15/04/2022 EP20220415-0007 2022041500012 TITO NELSON TARIGAN 82,495.0

R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
R/ STESOLID 10 MG/2ML
DWS 1.00 AMP 16,107.60 16,107.00 0 0
INJEKSI (PSIKOTROPIKA)
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ FOLEY CATHETER NO. 18 1.00 PCS 14,388.00 14,388.00 0 1

32 RD20220415-0008 15/04/2022 EP20220415-0007 2022041500013 TITO NELSON TARIGAN 132,812.0

R/ GUEDEL NASAL NO. 5 1.00 PCS 132,812.50 132,812.00 0 1

33 RD20220415-0009 15/04/2022 EP20220415-0007 2022041500014 TITO NELSON TARIGAN 24,107.0

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ STESOLID 10 MG/2ML 1.00 AMP 16,107.60 16,107.00 0 0

INJEKSI (PSIKOTROPIKA)
34 RD20220415-0010 15/04/2022 EP20220415-0007 2022041500016 TITO NELSON TARIGAN 38,961.0

R/ STOMACH TUBE NO. 18 1.00 PCS 38,961.00 38,961.00 0 1

35 RD20220415-0011 15/04/2022 EP20220415-0007 2022041500017 TITO NELSON TARIGAN 67,500.0

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
36 RD20220416-0010 16/04/2022 EP20220416-0008 2022041600010 TOMMY 59,927.0

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0

R/ DEXKETOPROFEN 25 MG TAB 6.00 TAB 4,600.00 27,600.00 1 0

37 RD20220416-0011 16/04/2022 EP20220416-0009 2022041600011 MUHAMMAD ABDI 115,368.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 28,301.00 28,301.00 0 1

(OOT)
R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ CORTIDEX 0,5 MG TAB 6.00 TAB 398.80 2,392.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

38 RD20220416-0012 16/04/2022 EP20220416-0010 2022041600012 LASNI MERLINA MANIK 28,301.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 59 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 28,301.00 28,301.00 0 1

(OOT)
39 RD20220416-0013 16/04/2022 EP20220416-0011 2022041600013 JOSUA GABRIEL STEVEN 24,992.0
SINAGA

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

40 RD20220416-0014 16/04/2022 EP20220416-0012 2022041600014 BELLA KRISTINA NASRIA 2,854.0

SINAGA

R/ AMBROXOL 30 MG TAB 10.00 TAB 285.41 2,854.00 1 0

41 RD20220416-0015 16/04/2022 EP20220416-0014 2022041600015 PRETTY AGUTINA CHIVA 55,930.0

SINAGA

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ AMOXAN 125 MG SYR 1.00 BTL 30,938.00 30,938.00 0 1

42 RD20220416-0016 16/04/2022 EP20220416-0013 2022041600016 SAHALA TUA SINAGA 28,301.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 28,301.00 28,301.00 0 1

(OOT)
43 RD20220416-0017 16/04/2022 EP20220416-0015 2022041600017 NIJAR EPENDI 263,395.0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ SANMOL 500 MG TABLET 6.00 TAB 422.40 2,534.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ AMLODIPINE 10 MG TAB 10.00 TAB 2,196.47 21,964.00 1 0

44 RD20220416-0018 16/04/2022 EP20220416-0016 2022041600018 ASIYAH 265,272.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

45 RD20220416-0019 16/04/2022 EP20220416-0016 2022041600019 ASIYAH 15,120.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

46 RD20220416-0020 16/04/2022 EP20220416-0017 2022041600020 HASANUDDIN 60,081.0

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ COLERGIS TABLET 5.00 TAB 3,781.25 18,906.00 0 1

47 RD20220416-0021 16/04/2022 EP20220416-0018 2022041600021 FADHILLA INAYAH.S 224,014.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ ORALIT SACHET 10.00 SACH 515.00 5,150.00 0 1

R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1

R/ LACTO B SACHET 6.00 SACH 7,080.00 42,480.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 60 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1

48 RD20220416-0022 16/04/2022 EP20220416-0019 2022041600022 ALDI 95,944.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ ACYCLOVIR 200 MG TAB 15.00 TAB 1,600.00 24,000.00 1 0

R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 1.00 3,818.00 11,973.00 1 0

POT KOSONG 10 ML 1.00 UNT 3,262.50 0.00 0 0

ACYCLOVIR 5 GR CREAM 1.00 TUBE 4,893.00 0.00 1 0

49 RD20220416-0023 16/04/2022 EP20220416-0021 2022041600023 SENIMAN BUULOLO 66,550.0

R/ CEFIXIME 200 MG CAP 10.00 CAP 6,187.50 61,875.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

50 RD20220420-0001 19/04/2022 EP20220419-0013 2022042000001 RIKI HAMDANI 18,415.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ EPERISON 50 MG TAB 6.00 TAB 2,290.00 13,740.00 1 0

51 RD20220420-0002 19/04/2022 EP20220419-0013 2022042000002 RIKI HAMDANI 2,850.0

R/ CETIRIZINE 10 MG TAB 6.00 TAB 475.00 2,850.00 1 0

52 RD20220420-0003 20/04/2022 EP20220419-0012 2022042000003 RATU SAYYIDAH 81,194.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

53 RD20220421-0001 21/04/2022 EP20220421-0001 2022042100001 ANGGUN RAFLI 268,137.0

R/ VOMETA FT 10 MG TAB 6.00 TAB 5,866.50 35,199.00 0 1

R/ LAPRAZ 30 MG CAP 6.00 CAP 16,472.50 98,835.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 92,928.00 92,928.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

54 RD20220422-0001 22/04/2022 EP20220421-0021 2022042200001 MARTUA HUTABARAT 90,626.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

55 RD20220422-0002 22/04/2022 EP20220421-0021 2022042200002 MARTUA HUTABARAT 3,076.0

R/ ISOSORBID DINITRAT 5 MG 1.00 TAB 161.50 161.00 1 0

R/ ASPILET 80 MG TAB 4.00 TAB 728.80 2,915.00 0 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 61 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

56 RD20220428-0004 28/04/2022 EP20220428-0004 2022042800005 BOBI INDRI 425,943.0

R/ SANMOL FORTE TAB 10.00 TAB 0.00 4,675.00 0 1

R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 0.00 3,818.00 1 0

R/ SPORETIK 200 MG CAPS 10.00 CAP 0.00 411,840.00 0 1

R/ BISTURI NO. 15 1.00 PCS 0.00 5,610.00 0 1

57 RD20220429-0009 29/04/2022 EP20220429-0010 2022042900012 APRILLIA PASKAH ANASTASYA 201,677.0

BR SINURAT

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

58 RD20220429-0010 29/04/2022 EP20220429-0010 2022042900013 APRILLIA PASKAH ANASTASYA 17,726.0

BR SINURAT

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

59 RD20220429-0011 29/04/2022 EP20220429-0011 2022042900015 M. ARIFIN 500,569.0

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

R/ COLERGIS TABLET 6.00 TAB 3,781.25 22,687.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

60 RD20220429-0012 29/04/2022 EP20220429-0012 2022042900016 MOHAMMAD EDY WIYOSO 297,528.0

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ NATRIUM DIKLOFENAC 50 MG 6.00 TAB 308.00 1,848.00 1 0

TAB
61 RD20220429-0013 29/04/2022 EP20220429-0013 2022042900017 RHIENDA PRESKA 297,528.0

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ NATRIUM DIKLOFENAC 50 MG 6.00 TAB 308.00 1,848.00 1 0

TAB
62 RD20220429-0014 29/04/2022 EP20220429-0015 2022042900018 MUHAMMAD IKHSAN ADHETYA 135,001.0
NUGRAHA

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ ORALIT SACHET 10.00 SACH 515.00 5,150.00 0 1

R/ ARCAPEC TAB 15.00 TAB 1,512.00 22,680.00 0 1

63 RD20220430-0003 30/04/2022 EP20220430-0003 2022043000003 GABRIAN GEOFFREY HUTAPEA 45,000.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 62 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1

64 RD20220430-0004 30/04/2022 EP20220430-0003 2022043000004 GABRIAN GEOFFREY HUTAPEA 90,394.0

R/ ESTIN 60 ML SYR 1.00 FLS 73,920.00 73,920.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

65 RD20220430-0005 30/04/2022 EP20220430-0004 2022043000005 BOBI INDRI 5,000.0

R/ GENTALEX 5 MG CREAM 1.00 TUBE 0.00 5,000.00 0 1

66 RD20220430-0006 30/04/2022 EP20220430-0005 2022043000006 SHEIVIA AQHILLA 57,616.0

MAHDALENA

R/ ORALIT SACHET 10.00 SACH 515.00 5,150.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1

67 RD20220430-0007 30/04/2022 EP20220430-0006 2022043000007 15,725.0

R/ CENDO LYTEERS 0,5 ML 2.00 FLS 5,525.00 11,050.00 0 1

MINIDOSE
R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

68 RD20220430-0008 30/04/2022 EP20220430-0007 2022043000008 AMALIA ROSMANDA AZHARI 110,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

69 RD20220430-0009 30/04/2022 EP20220430-0010 2022043000012 RAFI TRISTAN INDRASTA 6,668.0

R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 3,818.00 3,818.00 1 0

R/ CETIRIZINE 10 MG TAB 6.00 TAB 475.00 2,850.00 1 0

70 RD20220430-0010 30/04/2022 EP20220430-0009 2022043000013 JONI INDARYANTO 85,350.0

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

R/ CETIRIZINE 10 MG TAB 6.00 TAB 475.00 2,850.00 1 0

71 RJ20220402-0001 02/04/2022 OP20220402-0001 2022040200001 CHINTA NADIRA PUTRI 77,440.0

R/ OPILAX 60 ML SYR 1.00 FLS 77,440.00 77,440.00 0 1

72 RJ20220404-0001 04/04/2022 OP20220404-0001 2022040400001 ALEKS SILITONGA 290,385.0

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,987.00 49,870.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 63 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

73 RJ20220404-0002 04/04/2022 OP20220404-0001 2022040400002 ALEKS SILITONGA 9,200.0

R/ SPUIT 3 CC (TERUMO) 2.00 PCS 4,600.00 9,200.00 1 0

74 RJ20220404-0003 04/04/2022 OP20220404-0001 2022040400003 ALEKS SILITONGA 211,200.0

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

75 RJ20220404-0005 04/04/2022 OP20220404-0003 2022040400005 ABIGAIL QUEENNARA 235,651.0

HUTABALIAN

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

76 RJ20220404-0008 04/04/2022 OP20220404-0011 2022040400008 PANGERAN HUTAGALUNG 82,742.0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

77 RJ20220404-0009 04/04/2022 OP20220404-0012 2022040400010 CHRISTINA RONAULI SIAGIAN 242,390.0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,987.00 49,870.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

78 RJ20220404-0010 04/04/2022 OP20220404-0012 2022040400009 CHRISTINA RONAULI SIAGIAN 216,800.0

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ SPUIT 5 CC (TERUMO) 1.00 PCS 5,600.00 5,600.00 0 1

79 RJ20220404-0013 04/04/2022 OP20220404-0014 2022040400015 DIDIT SUSANTO 46,558.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ METHYLON 4 MG TAB 6.00 TAB 3,163.00 18,978.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

80 RJ20220404-0014 04/04/2022 OP20220404-0015 2022040400014 MUHAMMAD YUSUF LUBIS 240,515.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

81 RJ20220404-0015 04/04/2022 OP20220404-0016 2022040400016 TOGAP ORLANDO PARDEDE 377,840.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 64 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

82 RJ20220405-0011 05/04/2022 OP20220405-0011 2022040500012 MUHAMMAD ANAS SABUR 285,705.0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,987.00 49,870.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

83 RJ20220425-0002 25/04/2022 OP20220425-0004 2022042500003 FAUZIAH ANUGRAH 201,677.0

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

84 RJ20220425-0003 25/04/2022 OP20220425-0005 2022042500004 MUHAMMAD HANAFI 17,116.0

R/ CEFADROXYL 500 MG CAPSUL 10.00 CAP 1,050.00 10,500.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ CORTIDEX 0,5 MG TAB 6.00 TAB 398.80 2,392.00 0 1

85 RJ20220425-0009 25/04/2022 OP20220425-0011 2022042500015 TIARA NOVITA SARI 81,221.0

R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1

R/ RHINOS SR KAPSUL 2.00 CAP 8,043.50 16,087.00 0 1

(PREKURSOR)
R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

86 RJ20220425-0011 25/04/2022 OP20220425-0019 2022042500022 M.RAFAL FARUQ AN NUR 61,309.0

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

87 RJ20220425-0012 25/04/2022 OP20220425-0018 2022042500023 NURKHOLIS 11,050.0

R/ CENDO LYTEERS 0,5 ML 2.00 FLS 5,525.00 11,050.00 0 1

MINIDOSE
88 RJ20220425-0013 25/04/2022 OP20220425-0020 2022042500024 SONDANG HEPRIADI 45,850.0
SIMANJUNTAK

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

89 RJ20220425-0014 25/04/2022 OP20220425-0021 2022042500025 DESPIANA PITRI 26,596.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 65 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

90 RJ20220425-0015 25/04/2022 OP20220425-0022 2022042500026 DIDIT ICHWAN 37,701.0

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ CEFADROXYL 500 MG CAPSUL 10.00 CAP 1,050.00 10,500.00 1 0

R/ CORTIDEX 0,5 MG TAB 6.00 TAB 398.80 2,392.00 0 1

91 RJ20220426-0001 26/04/2022 OP20220426-0001 2022042600001 RUDI YANTO 60,130.0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,825.50 18,255.00 1 0

R/ METHYLON 4 MG TAB 6.00 TAB 3,162.50 18,975.00 0 1

92 RJ20220426-0002 26/04/2022 OP20220426-0003 2022042600002 WISNU SYAHFITRI 275,949.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,432.50 97,162.00 0 1

93 RJ20220426-0005 26/04/2022 OP20220426-0008 2022042600005 REYHAN KURNIA AKBAR 246,657.0

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

R/ COLERGIS TABLET 5.00 TAB 3,781.25 18,906.00 0 1

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

94 RJ20220426-0006 26/04/2022 OP20220426-0008 2022042600006 REYHAN KURNIA AKBAR 295,680.0

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

95 RJ20220426-0009 26/04/2022 OP20220426-0012 2022042600012 JUNITA AYU HARDINI 18,796.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

96 RJ20220426-0010 26/04/2022 OP20220426-0013 2022042600013 RIMA AGUSTIN 132,816.0

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,866.50 58,665.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 28,301.00 28,301.00 0 1

97 RJ20220426-0012 26/04/2022 OP20220426-0014 2022042600018 NUR HOLISEH 83,070.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 66 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

98 RJ20220426-0013 26/04/2022 OP20220426-0015 2022042600019 SUSANA WATI 27,857.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.40 3,712.00 1 0

R/ ORALIT SACHET 10.00 SACH 515.00 5,150.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
99 RJ20220426-0015 26/04/2022 OP20220426-0016 2022042600021 DAMASUS CHRISTOHEL 45,850.0
SIHITE

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

Total Dokter DR.EKA KURNIATI 11,543,522.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 67 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. FERRY FHRANS VALENTINUS KARO-KARO

1 RD20220401-0001 01/04/2022 EP20220401-0001 2022040100001 NARA ALETHEIA SASONGKO 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

2 RD20220401-0002 01/04/2022 EP20220401-0001 2022040100002 NARA ALETHEIA SASONGKO 109,646.0

R/ SANMOL 60 ML SYR 2.00 FLS 16,474.00 32,948.00 0 1

R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

R/ KASA STERIL 16 X 16 CM 2.00 KTK 11,880.00 23,760.00 0 1

3 RD20220401-0003 01/04/2022 EP20220401-0002 2022040100004 CHORNALIUS BLEGUR 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
4 RD20220401-0004 01/04/2022 EP20220401-0002 2022040100003 CHORNALIUS BLEGUR 15,120.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

5 RD20220401-0005 01/04/2022 EP20220401-0003 2022040100005 PUTRI NANDA BR SITEPU 4,590.0

R/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.00 4,580.00 1 0

KAPLET
6 RD20220401-0006 01/04/2022 EP20220401-0003 2022040100007 PUTRI NANDA BR SITEPU 10,000.0

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 10,000.00 10,000.00 1 0

500MG/5ML
7 RD20220401-0007 01/04/2022 EP20220401-0005 2022040100008 MUHAMAD ALHAFIZZI 84,480.0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

8 RD20220401-0008 01/04/2022 EP20220401-0005 2022040100009 MUHAMAD ALHAFIZZI 316,470.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ INTERZINC SYRUP 1.00 FLS 57,750.00 57,750.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

9 RD20220401-0009 01/04/2022 EP20220 2022040100010 ANTINIUS SILITONGA 80,000.0

401-0006

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
10 RD20220401-0010 01/04/2022 EP20220401-0007 2022040100012 SANDRA AGUSTIN 273,624.0

R/ TRICHODAZOL 500 MG TAB 2.00 TAB 2,337.00 4,674.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ INTERZINC SYRUP 1.00 FLS 57,750.00 57,750.00 0 1

11 RD20220401-0012 01/04/2022 EP20220401-0006 2022040100020 ANTINIUS SILITONGA 7,800.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 68 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

12 RD20220403-0008 03/04/2022 EP20220403-0007 2022040300011 MIKAEL BETAWE SILITONGA 26,813.0

R/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

13 RD20220403-0009 03/04/2022 EP20220403-0007 2022040300012 MIKAEL BETAWE SILITONGA 11,733.0

R/ PROPYRETIC 240 MG SUPP 1.00 SUPP 11,733.00 11,733.00 0 1

(BPJS)
14 RD20220415-0013 15/04/2022 EP20220415-0009 2022041500019 TIMBUL HENRY PARLAGUTAN 167,200.0
SIHITE

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

15 RD20220415-0014 15/04/2022 EP20220415-0009 2022041500020 TIMBUL HENRY PARLAGUTAN 7,424.0

SIHITE

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

16 RD20220416-0001 16/04/2022 EP20220416-0001 2022041600001 TIMBUL HENRY PARLAGUTAN 66,786.0

SIHITE

R/ EPINEPHRINE INJ 1.00 AMP 12,160.00 12,160.00 1 0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
17 RD20220416-0002
DWS 16/04/2022 EP20220415-0007 2022041600002 935,963.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

R/ NS 0.9 100 ML (PIGGY BACK) 1.00 FLS 19,430.00 19,430.00 1 0

R/ STESOLID 10 MG/2ML 1.00 AMP 16,107.60 16,107.00 0 0

INJEKSI (PSIKOTROPIKA)
R/ CITICOLINE 250 MG/2ML 2.00 AMP 22,500.00 45,000.00 0 1
INJEKSI
R/ PHENYTOIN 50 MG/ML INJ 10.00 AMP 84,480.00 844,800.00 1 0

18 RD20220416-0003 16/04/2022 EP20220415-0007 2022041600003 TITO NELSON TARIGAN 8,712.0

R/ SUCTION CATHETHER NO. 16 1.00 PCS 8,712.00 8,712.00 0 1

19 RD20220417-0010 17/04/2022 EP20220417-0009 2022041700015 NIKEN AYU 8,401.0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.33 4,583.00 1 0

KAPLET
R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 3,818.00 3,818.00 1 0

20 RD20220417-0011 17/04/2022 EP20220417-0010 2022041700017 ELMERIA NAINGGOLAN 2,409.0

R/ VITAMIN B COMPLEX TAB 10.00 TAB 240.90 2,409.00 1 0

21 RD20220417-0012 17/04/2022 EP20220417-0011 2022041700018 MARTHA NADAPDAP 57,200.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 69 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

22 RD20220417-0013 17/04/2022 EP20220417-0012 2022041700019 110,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 110,000.00 110,000.00 1 0

23 RD20220417-0014 17/04/2022 EP20220417-0012 2022041700020 LAILA KUDRIA 64,624.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

24 RD20220418-0001 18/04/2022 EP20220418-0001 2022041800001 ZIO ALFRIANDO SIREGAR 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

25 RD20220418-0002 18/04/2022 EP20220418-0001 2022041800003 ZIO ALFRIANDO SIREGAR 32,525.0

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

26 RD20220426-0001 26/04/2022 EP20220425-0019 2022042600002 HAFIZUL FIKRI 257,600.0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1

R/ NATRIUM DIKLOFENAC 50 MG 10.00 TAB 308.00 3,080.00 1 0

TAB
27 RD20220426-0002 26/04/2022 EP20220425-0015 2022042600013 220,000.0

R/ NICARDIPINE 10 MG INJ 2.00 AMP 110,000.00 220,000.00 1 0

28 RD20220426-0003 26/04/2022 EP20220425-0015 2022042600004 KEHIDUPAN LAIA 27,000.0

R/ HANDSCOEN STERIL NO. 7.5 1.00 PSG 27,000.00 27,000.00 0 1

29 RD20220426-0004 26/04/2022 EP20220425-0015 2022042600008 KEHIDUPAN LAIA 66,126.0

R/ CITICOLINE 250 MG/2ML 2.00 AMP 22,500.00 45,000.00 0 1

INJEKSI
R/ SUCTION CATHETHER NO. 14 1.00 PCS 10,500.00 10,500.00 0 1

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

30 RD20220426-0005 26/04/2022 EP20220426-0001 2022042600012 PUTRA REZKI PERDHANA 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
31 RD20220426-0006 26/04/2022 EP20220425-0015 2022042600009 KEHIDUPAN LAIA 147,335.0

R/ RECOFOL INJEKSI 1.00 AMP 139,335.00 139,335.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

32 RD20220430-0011 30/04/2022 EP20220430-0012 2022043000015 DAMASUS CHRISTOHEL 92,430.0
SIHITE

Print Date:7/14/2022 Print Time: 2:09:07PM Page 70 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ NS 0.9 100 ML (PIGGY BACK) 1.00 FLS 19,430.00 19,430.00 1 0

33 RD20220430-0012 30/04/2022 EP20220430-0012 2022043000016 DAMASUS CHRISTOHEL 90,562.0

SIHITE

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

34 RD20220430-0013 30/04/2022 EP20220430-0013 2022043000017 NIMROT SILABAN 692,850.0

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1

R/ MEMUCIL 200 MG CAPS 10.00 CAP 4,125.00 41,250.00 0 1

35 RD20220430-0014 30/04/2022 EP20220430-0014 2022043000018 AZKA AZIB 241,773.0

R/ TROLIT SACHET 10.00 SACH 12,674.91 126,749.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ KETRICIN ORA BASE 0,1% 1.00 TUBE 66,025.00 66,025.00 0 1

CREAM
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

36 RD20220430-0015 30/04/2022 EP20220430-0015 2022043000019 KRISTATI OCTALINA GULTOM 93,037.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00 40,838.00 1 0

R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 1.00 220.00 3,200.00 1 0

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

Total Dokter DR. FERRY FHRANS VALENTINUS KARO- 4,525,433.0

KARO
Print Date:7/14/2022 Print Time: 2:09:07PM Page 71 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. FELIX VALERIAN HALIM

1 RD20220402-0001 02/04/2022 EP20220402-0001 2022040200001 PONIMAN 10,000.0

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 10,000.00 10,000.00 1 0

500MG/5ML
2 RD20220402-0002 02/04/2022 EP20220402-0002 2022040200002 FERI SIMANJUNTAK 195,313.0

R/ GUEDEL NASAL NO. 5 1.00 PCS 132,813.00 132,813.00 0 1

R/ SUCTION CATHETER NO. 18 1.00 PCS 7,500.00 7,500.00 1 0

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 10,000.00 10,000.00 1 0

500MG/5ML
R/ CITICOLINE 250 MG/2ML 2.00 AMP 22,500.00 45,000.00 0 1
INJEKSI
3 RD20220402-0003 02/04/2022 EP20220402-0001 2022040200005 PONIMAN 15,080.0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.00 4,580.00 1 0

KAPLET
R/ CEFADROXYL 500 MG CAPSUL 10.00 CAP 1,050.00 10,500.00 1 0

4 RD20220402-0004 02/04/2022 EP20220402-0002 2022040200006 FERI SIMANJUNTAK 52,663.0

R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
R/ NALD 26 (ONEMED)
DWS 1.00 PCS 660.00 660.00 0 0

R/ TRAMADOL 50MG/2ML INJ 1.00 AMP 8,003.00 8,003.00 1 0

(OOT)
5 RD20220402-0005 02/04/2022 EP20220402-0002 2022040200007 FERI SIMANJUNTAK 24,500.0

R/ FOLEY CATHETER NO. 16 1.00 PCS 16,500.00 16,500.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

6 RD20220403-0001 02/04/2022 EP20220402-0013 2022040300002 YASINTA LONA BADHE 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
7 RD20220403-0002 03/04/2022 EP20220403-0001 2022040300003 ANNEKE FELICIA DAELY 147,169.0

R/ ONDANSETRON 4 MG TAB 5.00 TAB 3,500.00 17,500.00 1 0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ RANIVEL 75MG/5ML SYR 1.00 FLS 80,670.00 80,670.00 0 1

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

8 RD20220407-0001 07/04/2022 EP20220407-0001 2022040700001 MANGASI HOTMARTUA 355,958.0

SITUMEANG

R/ PROZA KAPLET 10.00 KAPLET 15,975.00 159,750.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

9 RD20220407-0002 07/04/2022 EP20220407-0002 2022040700002 BUDAYA 41,696.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 72 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

10 RD20220408-0002 08/04/2022 EP20220408-0003 2022040800003 EIG KRISTINA SIHOTANG 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
11 RD20220408-0004 08/04/2022 EP20220408-0004 2022040800006 M. WISLY 303,325.0

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 10,000.00 10,000.00 1 0

500MG/5ML
12 RD20220408-0005 08/04/2022 EP20220408-0005 2022040800007 NURMINA HUTABARAT 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
13 RD20220408-0006 08/04/2022 EP20220408-0004 2022040800009 M. WISLY 15,083.0

R/ CEFADROXYL 500 MG CAPSUL 10.00 CAP 1,050.00 10,500.00 1 0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.33 4,583.00 1 0

KAPLET
14 RD20220408-0007 08/04/2022 EP20220408-0006 2022040800011 DEFRIT ARFAN 41,696.0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

15 RD20220409-0003 09/04/2022 EP20220409-0003 2022040900008 SULAIMAN 474,225.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

16 RD20220409-0004 09/04/2022 EP20220409-0004 2022040900009 PAULUS SINULINGGA 358,545.0

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 10,000.00 10,000.00 1 0

500MG/5ML
R/ BISTURI NO. 22 2.00 PCS 5,610.00 11,220.00 0 1

R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
17 RD20220409-0005
DWS 09/04/2022 EP20220409-0005 2022040900010 VENUS 27,625.0

R/ CENDO LYTEERS 0,5 ML 5.00 FLS 5,525.00 27,625.00 0 1

MINIDOSE
18 RD20220409-0006 09/04/2022 EP20220409-0004 2022040900011 PAULUS SINULINGGA 4,583.0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.33 4,583.00 1 0

KAPLET
19 RD20220409-0007 09/04/2022 EP20220409-0006 2022040900012 ILHAM MAULANA 24,713.0
R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 24,713.45 24,713.00 0 1
(BPJS)
20 RD20220409-0008 09/04/2022 EP20220409-0006 2022040900013 ILHAM MAULANA 191,018.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 73 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ METHYLON 4 MG TAB 5.00 TAB 3,162.50 15,812.00 0 1

R/ SALBUTAMOL 4 MG TAB 10.00 TAB 161.50 1,615.00 1 0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ CEPTIK 30 ML SYRUP 1.00 FLS 144,375.00 144,375.00 0 1

21 RD20220409-0009 09/04/2022 EP20220409-0007 2022040900014 MILAWATI BR TARIGAN 254,340.0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

22 RD20220409-0012 09/04/2022 EP20220409-0009 2022040900017 AKIFA NAILA 5,043.0

R/ PARACETAMOL 500 MG 5.00 KAPLET 1.00 387.55 5,043.00 1 0

KAPLET
KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

DEXAMETHASON 0,5 MG TAB 5.00 TAB 220.00 0.00 1 0

23 RD20220411-0002 11/04/2022 EP20220411-0001 2022041100002 CHARLES JORANGTA S. 38,589.0

SIMANJORANG

R/ NEW DIATAB TABLET 10.00 TAB 696.44 6,964.00 0 1

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,162.50 31,625.00 1 0

24 RD20220411-0003 11/04/2022 EP20220411-0003 2022041100003 ROTIMAH 3,875.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
25 RD20220412-0004 12/04/2022 EP20220412-0006 2022041200008 VIREN AULIA RAHMA 189,954.0

R/ SANMOL 500 MG TABLET 5.00 TAB 422.40 2,112.00 0 1

R/ ONDANSETRON 4 MG TAB 6.00 TAB 3,500.00 21,000.00 1 0

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,472.50 82,362.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

26 RD20220412-0005 12/04/2022 EP20220412-0009 2022041200009 TULUS POLTAK LUMBAN 80,000.0

TOBING

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
27 RD20220412-0006 12/04/2022 EP20220412-0009 2022041200010 TULUS POLTAK LUMBAN 161.0
TOBING

R/ ISOSORBID DINITRAT 5 MG 1.00 TAB 161.50 161.00 1 0

TAB
28 RD20220412-0007 12/04/2022 EP20220412-0009 2022041200014 TULUS POLTAK LUMBAN 2,915.0
TOBING

R/ ASPILET 80 MG TAB 4.00 TAB 728.80 2,915.00 0 0

29 RD20220412-0008 12/04/2022 EP20220412-0009 2022041200015 TULUS POLTAK LUMBAN 161.0
TOBING

R/ ISOSORBID DINITRAT 5 MG 1.00 TAB 161.50 161.00 1 0

TAB
Print Date:7/14/2022 Print Time: 2:09:07PM Page 74 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

30 RD20220412-0010 12/04/2022 EP20220412-0011 2022041200017 141,636.0

R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

31 RD20220412-0011 12/04/2022 EP20220412-0010 2022041200018 JONNI HALOMOAN MARPAUNG 141,636.0

R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

32 RD20220412-0012 12/04/2022 EP20220412-0009 2022041200019 TULUS POLTAK LUMBAN 45,696.0

TOBING

R/ ATORVASTATIN 20 MG TAB 2.00 TAB 6,166.66 12,333.00 1 0

R/ FOLEY CATHETER NO. 16 1.00 PCS 16,500.00 16,500.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

33 RD20220 12/04/2022 EP20220412-0009 2022041200020 TULUS POLTAK LUMBAN 17,919.0

412-0013 TOBING

R/ FOLEY CATHETER NO. 12 1.00 PCS 17,919.09 17,919.00 0 1

34 RD20220412-0014 12/04/2022 EP20220412-0015 2022041200023 AMALIA ROSMANDA AZHARI 3,875.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
35 RD20220412-0015 12/04/2022 EP20220412-0009 2022041200022 TULUS POLTAK LUMBAN 12,040.0
TOBING

R/ CONDOM CATHETER 1.00 PCS 12,040.00 12,040.00 0 0

36 RD20220412-0016 12/04/2022 EP20220412-0012 2022041200024 JUMALI WIDODO 178,545.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

37 RD20220412-0017 12/04/2022 EP20220412-0015 2022041200025 AMALIA ROSMANDA AZHARI 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
38 RD20220412-0019 12/04/2022 EP20220412-0014 2022041200026 MURNIWATI 150,796.0

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

39 RD20220412-0020 12/04/2022 EP20220412-0013 2022041200027 IBRAHIM KENOBO LANGOUYU 261,662.0

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.25 47,162.00 0 1

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 75 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

40 RD20220412-0021 12/04/2022 EP20220412-0017 2022041200028 MONIKA SUSI MARDIANA 364,609.0

GIRSANG

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

41 RD20220412-0022 12/04/2022 EP20220412-0018 2022041200029 HELDERIKA SILITONGA 356,099.0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,162.50 31,625.00 1 0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

42 RD20220412-0023 12/04/2022 EP20220412-0020 2022041200030 MYRON NATHANAEL 178,458.0

TAMPUBOLON

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1

(BPJS)
43 RD20220412-0024 12/04/2022 EP20220412-0019 2022041200031 SUSI SUSANTI 229,811.0
LUMBANTORUAN

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ RHINOS SR KAPSUL 6.00 CAP 8,043.50 48,261.00 0 1

(PREKURSOR)
R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,666.66 16,666.00 1 0
CAPSUL
R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

44 RD20220413-0007 13/04/2022 EP20220413-0006 2022041300011 TOGAP ORLANDO PARDEDE 9,398.0

R/ MEFINAL 500 MG KAPLET 5.00 KAPLET 1,879.68 9,398.00 0 1

45 RD20220413-0008 13/04/2022 EP20220413-0007 2022041300012 SUTIKNO 590,385.0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ SPORETIK 200 MG CAPS 10.00 CAP 41,184.00 411,840.00 0 1

46 RD20220413-0009 13/04/2022 EP20220413-0008 2022041300013 MANABUA NABABAN 102,350.0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

47 RD20220413-0010 13/04/2022 EP20220413-0007 2022041300014 SUTIKNO 293,325.0

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 76 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

48 RD20220413-0011 13/04/2022 EP20220413-0009 2022041300015 MANGASI HOTMARTUA 196,204.0

SITUMEANG

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

49 RD20220413-0012 13/04/2022 EP20220413-0011 2022041300017 ORLANDO SAPUTRA 58,438.0

SIMANJUNTAK

R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
50 RD20220413-0013 13/04/2022 EP20220413-0010 2022041300018 MONIKA SUSI MARDIANA 411,840.0
GIRSANG

R/ SPORETIK 200 MG CAPS 10.00 CAP 41,184.00 411,840.00 0 1

51 RD20220413-0014 13/04/2022 EP20220413-0011 2022041300020 ORLANDO SAPUTRA 42,472.0

SIMANJUNTAK

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ BECOM ZET TAB 5.00 TAB 2,887.50 14,437.00 0 0

52 RD20220413-0015 13/04/2022 EP20220413-0012 2022041300021 SURYA SAPUTRA 430,799.0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ MYONAL 50 MG TAB 10.00 TAB 10,100.00 101,000.00 0 1

53 RD20220414-0003 14/04/2022 EP20220414-0003 2022041400003 MULIA HASAN 293,270.0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 962.50 9,625.00 1 0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ LODIA 2 MG TABLET 4.00 TAB 1,375.00 5,500.00 0 1

54 RD20220414-0004 14/04/2022 EP20220414-0004 2022041400005 MUHAMMAD ARIFIN 361,140.0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

55 RD20220414-0005 14/04/2022 EP20220414-0005 2022041400008 TUMAIDE BR LUMBANBATU 95,375.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 77 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ FOLEY CATHETER NO. 16 1.00 PCS 16,500.00 16,500.00 0 1

R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 70,875.00 70,875.00 1 0

56 RD20220414-0006 14/04/2022 EP20220414-0005 2022041400010 TUMAIDE BR LUMBANBATU 102,658.0

R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 24,713.45 24,713.00 0 1

(BPJS)
R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1
DEWASA
R/ FUROSEMIDE 10 MG/2 ML INJ 1.00 AMP 4,960.00 4,960.00 1 0

R/ CAPTOPRIL 25 MG TAB 1.00 TAB 185.90 185.00 1 0

57 RD20220414-0007 14/04/2022 EP20220414-0004 2022041400011 MUHAMMAD ARIFIN 7,000.0

R/ ALLOPURINOL 300 MG TAB 10.00 TAB 700.00 7,000.00 1 0

58 RD20220414-0008 14/04/2022 EP20220414-0005 2022041400012 TUMAIDE BR LUMBANBATU 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

59 RD20220414-0009 14/04/2022 EP20220414-0005 2022041400013 TUMAIDE BR LUMBANBATU 129,743.0

R/ EXTENSION TUBE 150 CM X 1.00 PCS 62,943.75 62,943.00 0 1

1,5 ML
R/ SPUIT 50 ML (WITHOUT 1.00 PCS 42,000.00 42,000.00 0 1
NEEDLE) ONEMED
R/ FUROSEMIDE 10 MG/2 ML INJ 5.00 AMP 4,960.00 24,800.00 1 0

60 RD20220414-0010 14/04/2022 EP20220414-0006 2022041400014 ERIKA CAHYA SUKMAWATI 199,155.0

R/ EPERISON 50 MG TAB 9.00 TAB 2,290.00 20,610.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

61 RD20220414-0011 14/04/2022 EP20220414-0007 2022041400020 25,321.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
R/ NEW DIATAB TABLET 15.00 TAB 696.44 10,446.00 0 1

R/ COTRIMOXAZOLE 480 MG 20.00 TAB 550.00 11,000.00 1 0

TABLET
62 RD20220416-0004 16/04/2022 EP20220416-0002 2022041600004 PUTRI MINDO 34,894.0

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0

R/ IBUPROFEN 400 MG TAB 5.00 TAB 513.50 2,567.00 1 0

63 RD20220416-0005 16/04/2022 EP20220416-0002 2022041600005 PUTRI MINDO 299,622.0

R/ VAKSIN VERORAB INJ 0.5 ML 1.00 VIAL 299,622.00 299,622.00 0 1

64 RD20220416-0006 16/04/2022 EP20220416-0003 2022041600006 SUTIKNO 314,476.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 78 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

65 RD20220416-0007 16/04/2022 EP20220416-0004 2022041600007 MANGASI HOTMARTUA 295,680.0

SITUMEANG

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

66 RD20220416-0008 16/04/2022 EP20220416-0005 2022041600008 YULIA GUSTINA 164,884.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

67 RD20220416-0009 16/04/2022 EP20220416-0006 2022041600009 RITA JULIANA KRISTINA 150,123.0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ KETRICIN ORA BASE 0,1% 1.00 TUBE 66,025.00 66,025.00 0 1

CREAM
R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

68 RD20220418-0027 18/04/2022 EP20220418-0024 2022041800037 MUHAMMAD RONALDO 394,209.0

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

69 RD20220420-0004 20/04/2022 EP20220420-0001 2022042000004 MARNIALA SITUMORANG 55,921.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ CEFIXIME 200 MG CAP 6.00 CAP 6,187.50 37,125.00 1 0

70 RD20220420-0005 20/04/2022 EP20220420-0002 2022042000006 ANNEKE FELICIA DAELY 248,472.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ BUFECT FORTE SYR 1.00 FLS 27,500.00 27,500.00 0 1

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ THROMBOPHOB GEL 1.00 TUBE 68,063.00 68,063.00 0 1

71 RD20220421-0002 21/04/2022 EP20220421-0002 2022042100003 DELROY VERDYANTO 1,001.0

SIGALINGGING

R/ VITAMIN C XON-CE KAPLET 1.00 KAPLET 1.00 1.00 1,001.00 0 1

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

72 RD20220421-0003 21/04/2022 EP20220421-0003 2022042100004 HELDERIKA SILITONGA 369,340.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 79 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

73 RD20220421-0004 21/04/2022 EP20220421-0005 2022042100005 RUDI ARDIAN 249,860.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,472.50 164,725.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

74 RD20220421-0005 21/04/2022 EP20220421-0005 2022042100006 RUDI ARDIAN 92,430.0

R/ NS 0.9 100 ML (PIGGY BACK) 1.00 FLS 19,430.00 19,430.00 1 0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

75 RD20220421-0006 21/04/2022 EP20220421-0006 2022042100007 ARIF RAHMAN ALI MS 272,046.0

R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

76 RD20220421-0007 21/04/2022 EP20220421-0007 2022042100008 ABDUL AZAM ESKORTA 116,741.0

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

77 RD20220421-0008 21/04/2022 EP20220421-0009 2022042100013 IBROHIM 182,236.0

R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,666.66 16,666.00 1 0

CAPSUL
R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

78 RD20220421-0009 21/04/2022 EP20220421-0008 2022042100010 MAULANA REYHAN AZ-ZIQRA 128,991.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

79 RD20220421-0010 21/04/2022 EP20220421-0004 2022042100014 JERMINA SILALAHI 11,100.0

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 11,100.00 11,100.00 1 0

500MG/5ML
80 RD20220421-0011 21/04/2022 EP20220421-0011 2022042100015 IGNASIUS TITUS 100,587.0
R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 80 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.40 3,712.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

81 RD20220422-0003 22/04/2022 EP20220422-0001 2022042200007 INDAH RAHMA FIRTI 97,513.0

R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1

DEWASA
R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 24,713.45 24,713.00 0 1
(BPJS)
82 RD20220422-0004 22/04/2022 EP20220422-0001 2022042200008 INDAH RAHMA FIRTI 206,999.0

R/ LASAL 4 MG CAPSUL 10.00 CAP 2,200.00 22,000.00 0 0

R/ METHYLPREDNISOLONE 8 MG 10.00 TAB 789.80 7,898.00 1 0

TAB
R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,666.66 16,666.00 1 0
CAPSUL
83 RD20220422-0005 22/04/2022 EP20220422-0002 2022042200009 SUYETNO 11,050.0

R/ CENDO LYTEERS 0,5 ML 2.00 FLS 5,525.00 11,050.00 0 1

MINIDOSE
84 RD20220422-0006 22/04/2022 EP20220422-0003 2022042200010 JHON ANDRYANTO SILAEN 376,675.0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

85 RD20220422-0007 22/04/2022 EP20220422-0004 2022042200011 IMRON ROSIDI 53,323.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ CEFIXIME 100 MG CAP 10.00 CAP 3,232.72 32,327.00 1 0

R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

86 RD20220423-0009 23/04/2022 EP20220423-0008 2022042300013 NURCAH 78,088.0

AYA
TAMBUN
R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00
AN 40,838.00 1 0

R/ IBUPROFEN 60 ML SYR 1.00 FLS 4,725.00 4,725.00 1 0

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

87 RD20220423-0010 23/04/2022 EP20220423-0009 2022042300014 NUR HOLISEH 279,460.0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

88 RD20220423-0011 23/04/2022 EP20220423-0011 2022042300015 STEVEN ARYA WIJAYA 9,973.0

SAMOSIR

Print Date:7/14/2022 Print Time: 2:09:07PM Page 81 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1

(BPJS)
89 RD20220423-0012 23/04/2022 EP20220423-0010 2022042300016 RAHEL SAMOSIR 140,325.0

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

90 RD20220423-0013 23/04/2022 EP20220423-0011 2022042300017 STEVEN ARYA WIJAYA 163,264.0

SAMOSIR

R/ SANMOL F SYR 60ML 1.00 BTL 37,101.00 37,101.00 0 1

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00 40,838.00 1 0

91 RD20220423-0015 23/04/2022 EP20220423-0012 2022042300018 PUTRI KIRANTI 448,693.0

R/ MOTADERM 10 GR CREAM 1.00 TUBE 89,375.00 89,375.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ IBUPROFEN 400 MG TAB 1.00 TAB 513.50 513.00 1 0

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

92 RD20220423-0016 23/04/2022 EP20220423-0013 2022042300019 NUR AZMI 453,612.0

R/ LANFIX 100 MG KAPSUL 12.00 TAB 29,568.00 354,816.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

93 RD20220424-0008 24/04/2022 EP20220424-0009 2022042400012 NOVITA ANGLELINA 72,365.0

R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0

R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0

R/ PARACETAMOL SYR 60 ML 1.00 FLS 6,840.00 6,840.00 1 0

94 RD20220424-0009 24/04/2022 EP20220424-0008 2022042400014 LAZARUS KASAMILALE 11,100.0

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 11,100.00 11,100.00 1 0

500MG/5ML
95 RD20220424-0010 24/04/2022 EP20220424-0010 2022042400019 RAHMAT KRISTIAN 491,577.0
PANGARIBUAN

R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,666.66 16,666.00 1 0
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 82 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

96 RD20220424-0011 24/04/2022 EP20220424-0011 2022042400020 AYU RISMA ARFIANTI 98,796.0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

97 RD20220424-0012 24/04/2022 EP20220424-0012 2022042400021 RAHMAT PRATAMA 5,135.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

98 RD20220427-0001 27/04/2022 EP20220427-0001 2022042700001 JOSUA ADIPUTRA BOY 101,384.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,162.50 31,625.00 1 0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

99 RD20220427-0002 27/04/2022 EP20220427-0002 2022042700003 RAHMAT PRATAMA 80,000.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
100 RD20220427-0003 27/04/2022 EP20220427-0002 2022042700004 RAHMAT PRATAMA 54,815.0

R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 481.54 4,815.00 1 0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 5,000.00 50,000.00 1 0

101 RD20220427-0004 27/04/2022 EP20220427-0003 2022042700005 ELESTA FARINA SITORUS 79,247.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1

(BPJS)
102 RD20220427-0006 27/04/2022 EP20220427-0004 2022042700006 BENNY MARSAULI BR 411,675.0
PASARIBU

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

103 RD20220427-0018 27/04/2022 EP20220427-0016 2022042700027 INTAN ISNAWATI 411,675.0

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 83 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

104 RD20220427-0019 27/04/2022 EP20220427-0017 2022042700028 FITRI KARLISA 376,675.0

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

105 RD20220428-0001 28/04/2022 EP20220428-0001 2022042800001 RISKA WAHYUNI 169,615.0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

106 RD20220428-0002 28/04/2022 EP20220428-0002 2022042800003 WILLIAM WILSON SINAGA 116,848.0

R/ IBUPROFEN 400 MG TAB 12.00 TAB 513.50 6,162.00 1 0

R/ BECOM ZET TAB 5.00 TAB 2,887.50 14,437.00 0 0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,162.50 31,625.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

107 RD20220428-0003 28/04/2022 EP20220428-0003 2022042800004 LEDRA FREDERICA TANIA 97,056.0

SIAGIAN

R/ EPINEPHRINE INJ 1.00 AMP 12,160.00 12,160.00 1 0

R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

R/ ELEKTRODY EKG ANAK 6.00 PCS 13,066.00 78,396.00 0 1

SKINTACT
108 RD20220429-0001 29/04/2022 EP20220429-0002 2022042900011 135,626.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ CITICOLINE 250 MG/2ML 2.00 AMP 22,500.00 45,000.00 0 1
INJEKSI
R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

109 RD20220429-0002 29/04/2022 EP20220429-0003 2022042900004 KEVIN ANTONY KASAMILALE 96,124.0

R/ ONDANSETRON 4 MG TAB 9.00 TAB 3,500.00 31,500.00 1 0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.40 7,424.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

110 RD20220429-0003 29/04/2022 EP20220429-0007 2022042900005 VALENTINO SIRUMAPEA 8,329.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 84 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.40 4,454.00 1 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
111 RD20220429-0004 29/04/2022 EP20220429-0006 2022042900006 VINCENT SIRUMAPEA 3,875.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
112 RD20220429-0005 29/04/2022 EP20220429-0005 2022042900007 SITI ROHANI SIAHAAN 5,135.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

113 RD20220429-0006 29/04/2022 EP20220429-0004 2022042900008 ZYLGWYN GYOENZO LUMBAN 1,000.0

SIANTAR

R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 1,000.00 0 1

SALBUTAMOL 4 MG TAB 5.00 TAB 161.50 0.00 1 0

114 RD20220429-0007 29/04/2022 EP20220429-0009 2022042900009 MUHAMMAD NUR KM 178,545.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

115 RD20220429-0008 29/04/2022 EP20220429-0008 2022042900010 LEGI ZERO PUTRA 443,689.0

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

116 RJ20220406-0003 06/04/2022 OP20220406-0006 2022040600003 MUHAMMAD HAIKAL 95,787.0

R/ CEFIXIME DRY 30 ML SYR 1.00 BTL 40,838.00 40,838.00 1 0

R/ METHYLPREDNISOLONE 4 MG 10.00 TAB 595.00 5,950.00 1 0

TAB
R/ ELKANA SYR 1.00 FLS 32,525.00 32,525.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

117 RJ20220406-0004 06/04/2022 OP20220406-0007 2022040600006 TOGAP ORLANDO PARDEDE 394,355.0

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,975.00 79,875.00 0 1

118 RJ20220406-0006 06/04/2022 OP20220406-0008 2022040600009 HOTMAROJAHAN SARAGIH 14,210.0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.00 4,580.00 1 0

KAPLET
R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 963.00 9,630.00 1 0

119 RJ20220419-0001 19/04/2022 OP20220419-0002 2022041900001 SHINTYA RATU ARINA 2,750.0

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 85 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

120 RJ20220419-0002 19/04/2022 OP20220419-0004 2022041900002 GENKY BERDO KAREL 470,179.0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,162.50 31,625.00 1 0

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

121 RJ20220419-0005 19/04/2022 OP20220419-0010 2022041900006 WILDA GABRIELSA SIREGAR 456,424.0

R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

122 RJ20220419-0007 19/04/2022 OP20220419-0011 2022041900008 AZALEA ZIVARATUL HUSNA 57,412.0

R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,787.50 36,787.00 0 0

DROP
123 RJ20220419-0008 19/04/2022 OP20220419-0012 2022041900009 RIDHO KURNIA PRATAMA 261,985.0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,666.66 16,666.00 1 0
CAPSUL
R/ IBUPROFEN 400 MG TAB 10.00 TAB 513.50 5,135.00 1 0

124 RJ20220419-0009 19/04/2022 OP20220419-0013 2022041900010 NELA AGUSTIANI 490,220.0

R/ ONDANSETRON 4 MG TAB 10.00 TAB 3,500.00 35,000.00 1 0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,666.66 16,666.00 1 0

CAPSUL
R/ VOMIZOLE 20 MG TAB 10.00 TAB 19,432.50 194,325.00 0 1

Total Dokter DR. FELIX VALERIAN HALIM 20,115,707.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 86 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. GINA ARIANI, SP.PD

1 RI20220401-0001 01/04/2022 RI20220331-0003 RI20220401-0001 SUMITRO SIMAMORA 86,930.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ ELEKTRODY EKG ANAK 5.00 PCS 13,066.00 65,330.00 0 1

SKINTACT
2 RI20220401-0002 01/04/2022 RI20220331-0002 RI20220401-0002 ARDIAN KUKUH MUKTI 24,360.0
WIJAYA

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

3 RI20220401-0003 01/04/2022 RI20220330-0002 RI20220401-0003 HERI OKTAVIANUS 776.0

R/ PARACETAMOL 500 MG 2.00 KAPLET 388.00 776.00 1 0

KAPLET
4 RI20220401-0004 01/04/2022 RI20220331-0001 RI20220401-0004 ADITYA CHANDRA 456,522.0

R/ SANMOL 500 MG TABLET 3.00 TAB 422.00 1,266.00 0 1

R/ SPUIT 5 CC (TERUMO) 3.00 PCS 5,600.00 16,800.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ MERTIGO 6 MG TAB 3.00 TAB 4,987.00 14,961.00 0 1

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

R/ IMUNVIT PLUS KAPLET 1.00 KAPLET 10,935.00 10,935.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

5 RI20220401-0005 01/04/2022 RI20220331-0002 RI20220401-0005 ARDIAN KUKUH MUKTI 24,978.0

WIJAYA

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ SPASMINAL TABLET 3.00 TAB 1,126.00 3,378.00 0 1

6 RI20220401-0006 01/04/2022 RI20220330-0002 RI20220401-0006 HERI OKTAVIANUS 125,094.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
7 RI20220401-0007 01/04/2022 RI20220331-0003 RI20220401-0007 SUMITRO SIMAMORA 10,962.0

R/ ISOSORBID DINITRAT 5 MG 1.00 TAB 162.00 162.00 1 0

TAB
R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

8 RI20220401-0008 01/04/2022 RI20220401-0001 RI20220401-0008 CHORNALIUS BLEGUR 43,827.0

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 87 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ RL 500 ML INF 3.00 FLS 8,754.00 26,262.00 0 1

R/ LODIA 2 MG TABLET 6.00 TAB 1,375.00 8,250.00 0 1

9 RI20220401-0010 01/04/2022 RI20220331-0001 RI20220401-0010 ADITYA CHANDRA 348,885.0

R/ IMUNVIT PLUS KAPLET 10.00 KAPLET 10,935.00 109,350.00 0 1

R/ MERTIGO 6 MG TAB 15.00 TAB 4,987.00 74,805.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

10 RI20220401-0011 01/04/2022 RI20220331-0002 RI202204 ARDIAN KUKUH MUKTI 254.0

01-0011 WIJAYA

R/ NALD 25 (ONEMED) 1.00 PCS 254.00 254.00 0 1

11 RI20220401-0012 01/04/2022 RI20220401-0001 RI20220401-0012 CHORNALIUS BLEGUR 3,378.0

R/ SPASMINAL TABLET 3.00 TAB 1,126.00 3,378.00 0 1

12 RI20220401-0013 01/04/2022 RI20220331-0003 RI20220401-0013 SUMITRO SIMAMORA 729.0

R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

13 RI20220401-0015 01/04/2022 RI20220331-0003 RI20220401-0015 SUMITRO SIMAMORA 7,150.0

R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

14 RI20220402-0002 02/04/2022 RI20220331-0002 RI20220402-0002 ARDIAN KUKUH MUKTI 24,978.0

WIJAYA

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ SPASMINAL TABLET 3.00 TAB 1,126.00 3,378.00 0 1

15 RI20220402-0003 02/04/2022 RI20220330-0002 RI20220402-0003 HERI OKTAVIANUS 105,419.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
16 RI20220402-0004 02/04/2022 RI20220401-0001 RI20220402-0004 CHORNALIUS BLEGUR 6,678.0

R/ SPASMINAL TABLET 3.00 TAB 1,126.00 3,378.00 0 1

R/ COTRIMOXAZOLE 480 MG 6.00 TAB 550.00 3,300.00 1 0

TABLET
17 RI20220402-0005 02/04/2022 RI20220330-0002 RI20220402-0005 HERI OKTAVIANUS 116,219.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0
(BPJS)

Print Date:7/14/2022 Print Time: 2:09:07PM Page 88 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

18 RI20220402-0006 02/04/2022 RI20220331-0003 RI20220402-0006 SUMITRO SIMAMORA 729.0

R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

19 RI20220402-0008 02/04/2022 RI20220331-0002 RI20220402-0008 ARDIAN KUKUH MUKTI 26,625.0

WIJAYA

R/ AQUADES 25 ML 75.00 CC 355.00 26,625.00 0 1

20 RI20220402-0009 02/04/2022 RI20220331-0003 RI20220402-0009 SUMITRO SIMAMORA 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

21 RI20220402-0011 02/04/2022 RI20220401-0001 RI20220402-0011 CHORNALIUS BLEGUR 144,786.0

R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1

22 RI20220402-0017 02/04/2022 RI20220401-0001 RI20220402-0017 CHORNALIUS BLEGUR 5,500.0

R/ LODIA 2 MG TABLET 4.00 TAB 1,375.00 5,500.00 0 1

23 RI20220403-0001 03/04/2022 RI20220401-0001 RI20220403-0001 CHORNALIUS BLEGUR 178,969.0

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1

24 RI20220403-0004 03/04/2022 RI20220331-0002 RI20220403-0004 ARDIAN KUKUH MUKTI 20,110.0

WIJAYA

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

R/ SPASMINAL TABLET 10.00 TAB 1,126.00 11,260.00 0 1

25 RI20220403-0005 03/04/2022 RI20220330-0002 RI20220403-0005 HERI OKTAVIANUS 8,850.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

26 RI20220403-0006 03/04/2022 RI20220330-0002 RI20220403-0006 HERI OKTAVIANUS 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

27 RI20220403-0007 03/04/2022 RI20220331-0003 RI20220403-0007 SUMITRO SIMAMORA 5,913.0

R/ ASPILET 80 MG TAB 7.00 TAB 729.00 5,103.00 0 0

R/ ISOSORBID DINITRAT 5 MG 5.00 TAB 162.00 810.00 1 0

TAB
28 RI20220403-0008 03/04/2022 RI20220401-0001 RI20220403-0008 CHORNALIUS BLEGUR 3,378.0

R/ SPASMINAL TABLET 3.00 TAB 1,126.00 3,378.00 0 1

29 RI20220404-0004 04/04/2022 RI20220401-0001 RI20220404-0004 CHORNALIUS BLEGUR 25,011.0

R/ SPASMINAL TABLET 3.00 TAB 1,126.00 3,378.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 89 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1

R/ LODIA 2 MG TABLET 3.00 TAB 1,375.00 4,125.00 0 1

30 RI20220404-0005 04/04/2022 RI20220401-0001 RI20220404-0005 CHORNALIUS BLEGUR 25,010.0

R/ SPASMINAL TABLET 10.00 TAB 1,126.00 11,260.00 0 1

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

31 RI20220405-0012 05/04/2022 RI20220405-0003 RI20220405-0012 JOGI MARIANUS SIHOTANG 639,549.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 422.00 1,266.00 0 1

R/ SPUIT 5 CC (TERUMO) 5.00 PCS 5,600.00 28,000.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ PANLOC INJ 2.00 VIAL 211,200.00 422,400.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 11,688.00 11,688.00 0 1

EFFERVESCENT
R/ NALD 25 (ONEMED) 1.00 PCS 254.00 254.00 0 1

R/ EPISAN 100 ML SYR 1.00 FLS 70,541.00 70,541.00 0 1

32 RI20220405-0013 05/04/2022 RI20220405-0003 RI20220405-0013 JOGI MARIANUS SIHOTANG 39,989.0

R/ MEMUCIL 600 MG 1.00 TAB 11,688.00 11,688.00 0 1

EFFERVESCENT
R/ SANADRYL DMP 120 ML SYR 1.00 BTL 28,301.00 28,301.00 0 1
(OOT)
33 RI20220406-0002 06/04/2022 RI20220405-0003 RI20220406-0002 JOGI MARIANUS SIHOTANG 611,213.0

R/ LODIA 2 MG TABLET 5.00 TAB 1,375.00 6,875.00 0 1

R/ MEMUCIL 600 MG 5.00 TAB 11,688.00 58,440.00 0 1

EFFERVESCENT
R/ SPUIT 10 CC ( TERUMO ) 1.00 PCS 11,242.00 11,242.00 0 1

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

R/ SURFLO NO. 22 VENFLON 2.00 PCS 29,200.00 58,400.00 1 0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ LANSOPRAZOL 30 MG INJ 1.00 VIAL 126,720.00 126,720.00 1 0

R/ EPISAN 100 ML SYR 1.00 FLS 70,541.00 70,541.00 0 1

R/ BIOCEF 1 GR INJ 1.00 VIAL 197,120.00 197,120.00 0 1

34 RI20220406-0010 06/04/2022 RI20220405-0003 RI20220406-0010 JOGI MARIANUS SIHOTANG 17,750.0

R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1

35 RI20220406-0013 06/04/2022 RI20220405-0003 RI20220406-0013 JOGI MARIANUS SIHOTANG 46,800.0

R/ LESICHOL 300 MG CAP 3.00 CAP 15,600.00 46,800.00 0 1

36 RI20220406-0015 06/04/2022 RI20220405-0003 RI20220406-0015 JOGI MARIANUS SIHOTANG 11,688.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 90 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ MEMUCIL 600 MG 1.00 TAB 11,688.00 11,688.00 0 1

EFFERVESCENT
37 RI20220406-0016 06/04/2022 RI20220406-0001 RI20220406-0016 ANWAR LUMBAN TORUAN 18,672.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1

38 RI20220406-0017 06/04/2022 RI20220406-0001 RI20220406-0017 ANWAR LUMBAN TORUAN 9,535.0

R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

39 RI20220407-0004 07/04/2022 RI20220405-0003 RI20220407-0004 JOGI MARIANUS SIHOTANG 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

40 RI20220407-0010 07/04/2022 RI20220405-0003 RI20220407-0010 JOGI MARIANUS SIHOTANG 386,710.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 11,688.00 11,688.00 0 1

EFFERVESCENT
R/ SANMOL 500 MG TABLET 1.00 TAB 422.00 422.00 0 1

R/ SPUIT 5 CC (TERUMO) 2.00 PCS 5,600.00 11,200.00 0 1

R/ LESICHOL 300 MG CAP 3.00 CAP 15,600.00 46,800.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

41 RI20220407-0021 07/04/2022 RI20220405-0003 RI20220407-0021 JOGI MARIANUS SIHOTANG 11,479.0

R/ BRAXIDIN TABLET 3.00 TAB 1,523.00 4,569.00 0 0

(PSIKOTROPIKA)
R/ IMUNVIT KAPLET 1.00 KAPLET 6,910.00 6,910.00 0 0

42 RI20220407-0026 07/04/2022 RI20220405-0003 RI20220407-0026 JOGI MARIANUS SIHOTANG 58,400.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 29,200.00 58,400.00 1 0

43 RI20220407-0028 07/04/2022 RI20220405-0003 RI20220407-0028 JOGI MARIANUS SIHOTANG 88,267.0

R/ EPISAN 100 ML SYR 1.00 FLS 70,541.00 70,541.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

44 RI20220407-0029 07/04/2022 RI20220407-0001 RI20220407-0029 DAVID JULVEN LUMBAN 21,600.0

TORUAN

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

45 RI20220408-0002 08/04/2022 RI20220407-0001 RI20220408-0002 DAVID JULVEN LUMBAN 21,600.0

TORUAN

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

46 RI20220408-0003 08/04/2022 RI20220405-0003 RI20220408-0003 JOGI MARIANUS SIHOTANG 21,600.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 91 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

47 RI20220408-0008 08/04/2022 RI20220407-0001 RI20220408-0008 DAVID JULVEN LUMBAN 33,562.0

TORUAN

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

48 RI20220408-0013 08/04/2022 RI20220405-0003 RI20220408-0013 JOGI MARIANUS SIHOTANG 613,360.0

R/ EPISAN 100 ML SYR 1.00 FLS 70,541.00 70,541.00 0 1

R/ LESICHOL 300 MG CAP 15.00 CAP 15,600.00 234,000.00 0 1

R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ IMUNVIT PLUS KAPLET 5.00 KAPLET 10,935.00 54,675.00 0 1

49 RI20220408-0016 08/04/2022 RI20220408-0001 RI20220408-0016 NURMINA HUTABARAT 13,825.0

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

50 RI20220409-0002 09/04/2022 RI20220408-0001 RI20220409-0002 NURMINA HUTABARAT 8,753.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

51 RI20220409-0005 09/04/2022 RI20220409-0001 RI20220409-0005 ADELLA FEBRA ERION 62,030.0

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ LODIA 2 MG TABLET 4.00 TAB 1,375.00 5,500.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

52 RI20220409-0006 09/04/2022 RI20220409-0001 RI20220409-0006 ADELLA FEBRA ERION 7,150.0

R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

53 RI20220409-0012 09/04/2022 RI20220408-0001 RI20220409-0012 NURMINA HUTABARAT 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

54 RI20220409-0013 09/04/2022 RI20220409-0001 RI20220409-0013 ADELLA FEBRA ERION 728.0

R/ ASPILET 80 MG TAB 1.00 TAB 728.80 728.00 0 0

55 RI20220409-0016 09/04/2022 RI20220408-0001 RI20220409-0016 NURMINA HUTABARAT 2,886.0

R/ RAMIPRIL 5 MG TAB (BPJS) 5.00 TAB 577.27 2,886.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 92 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

56 RI20220409-0018 09/04/2022 RI20220409-0001 RI20220409-0018 ADELLA FEBRA ERION 32,400.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

57 RI20220409-0020 09/04/2022 RI20220407-0001 RI20220409-0020 DAVID JULVEN LUMBAN 387.0

TORUAN

R/ PARACETAMOL 500 MG 1.00 KAPLET 387.55 387.00 1 0

KAPLET
58 RI20220409-0022 09/04/2022 RI20220409-0001 RI20220409-0022 ADELLA FEBRA ERION 1,126.0

R/ SPASMINAL TABLET 1.00 TAB 1,126.40 1,126.00 0 1

59 RI20220410-0001 10/04/2022 RI20220407-0001 RI20220410-0001 DAVID JULVEN LUMBAN 43,200.0

TORUAN

R/ ASERING 500 ML INF 4.00 FLS 10,800.00 43,200.00 0 1

60 RI20220410-0002 10/04/2022 RI20220407-0001 RI20220410-0002 DAVID JULVEN LUMBAN 12,725.0

TORUAN

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
61 RI20220410-0005 10/04/2022 RI20220409-0001 RI20220410-0005 ADELLA FEBRA ERION 56,207.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

R/ BRAXIDIN TABLET 3.00 TAB 1,523.30 4,569.00 0 0

(PSIKOTROPIKA)
62 RI20220410-0006 10/04/2022 RI20220409-0001 RI20220410-0006 ADELLA FEBRA ERION 1,162.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
63 RI20220411-0004 11/04/2022 RI20220409-0001 RI20220411-0004 ADELLA FEBRA ERION 13,275.0

R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

64 RI20220412-0016 12/04/2022 RI20220412-0002 RI20220412-0016 DAFFA MUARIF 99,783.0

R/ NALD 26 (ONEMED) 1.00 PCS 660.00 660.00 0 0

R/ CEFTRIAXONE 1 GR INJ 2.00 VIAL 13,368.00 26,736.00 1 0

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 93 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

65 RI20220412-0018 12/04/2022 RI20220412-0002 RI20220412-0018 DAFFA MUARIF 8,753.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

66 RI20220413-0001 13/04/2022 RI20220412-0002 RI20220413-0001 DAFFA MUARIF 178,862.0

R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1

R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT
R/ METHYLON 4 MG TAB 3.00 TAB 3,162.50 9,487.00 0 1

67 RI20220413-0003 13/04/2022 RI20220412-0002 RI20220413-0003 DAFFA MUARIF 295,680.0

R/ LAMETIC 4 MG INJ 2.00 AMP 42,240.00 84,480.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

68 RI20220413-0005 13/04/2022 RI20220413-0001 RI20220413-0005 DEDI ANTONI 375,325.0

R/ BUSCOPAN TAB 10 MG 3.00 TAB 4,397.60 13,192.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ LODIA 2 MG TABLET 6.00 TAB 1,375.00 8,250.00 0 1

R/ IMUNVIT PLUS KAPLET 1.00 KAPLET 10,935.00 10,935.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ SPUIT 5 CC (TERUMO) 1.00 PCS 5,600.00 5,600.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

69 RI20220413-0006 13/04/2022 RI20220412-0002 RI20220413-0006 DAFFA MUARIF 650,141.0

R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1

R/ KAPAS 6.00 PCS 302.50 1,815.00 0 1

ALKOHOL
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 422.40 1,267.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

70 RI20220413-0010 13/04/2022 RI20220412-0002 RI20220413-0010 DAFFA MUARIF 5,913.0

R/ ESTIN 10 MG TAB 1.00 TAB 5,913.60 5,913.00 0 1

71 RI20220413-0011 13/04/2022 RI20220413-0001 RI20220413-0011 DEDI ANTONI 149,355.0

R/ BRAXIDIN TABLET 3.00 TAB 1,523.30 4,569.00 0 0
(PSIKOTROPIKA)
R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 94 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

72 RI20220413-0014 13/04/2022 RI20220412-0002 RI20220413-0014 DAFFA MUARIF 10,400.0

R/ SPUIT 3 CC (TERUMO) 2.00 PCS 5,200.00 10,400.00 1 0

73 RI20220414-0001 14/04/2022 RI20220412-0002 RI20220414-0001 DAFFA MUARIF 24,325.0

R/ CETIRIZINE 10 MG TAB 2.00 TAB 475.00 950.00 1 0

R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT
74 RI20220414-0003 14/04/2022 RI20220413-0001 RI20220414-0003 DEDI ANTONI 12,830.0

R/ IMUNVIT KAPLET 1.00 KAPLET 6,910.31 6,910.00 0 0

R/ BRAXIDIN TABLET 1.00 TAB 1,523.30 1,523.00 0 0

(PSIKOTROPIKA)
R/ BUSCOPAN TAB 10 MG 1.00 TAB 4,397.60 4,397.00 0 1

75 RI20220414-0004 14/04/2022 RI20220413-0001 RI20220414-0004 DEDI ANTONI 23,375.0

R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT
76 RI20220414-0007 14/04/2022 RI20220412-0002 RI20220414-0007 DAFFA MUARIF 638,100.0

R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1

R/ CETIRIZINE 10 MG TAB 1.00 TAB 475.00 475.00 1 0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

77 RI20220414-0010 14/04/2022 RI20220413-0001 RI20220414-0010 DEDI ANTONI 355,640.0

R/ PANTOMEX 40 MG/ ML INJ 1.00 VIAL 199,375.00 199,375.00 0 1

R/ BRAXIDIN TABLET 3.00 TAB 1,523.30 4,569.00 0 0

(PSIKOTROPIKA)
R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1

R/ IMUNVIT KAPLET 1.00 KAPLET 6,910.31 6,910.00 0 0

78 RI20220414-0011 14/04/2022 RI20220412-0002 RI20220414-0011 DAFFA MUARIF 114,079.0

R/ RHINOS SR KAPSUL 2.00 CAP 8,043.50 16,087.00 0 1

(PREKURSOR)
R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

79 RI20220414-0013 14/04/2022 RI20220412-0002 RI20220414-0013 DAFFA MUARIF 950.0

R/ CETIRIZINE 10 MG TAB 2.00 TAB 475.00 950.00 1 0

80 RI20220414-0014 14/04/2022 RI20220412-0002 RI20220414-0014 DAFFA MUARIF 73,000.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 95 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

81 RI20220414-0015 14/04/2022 RI20220412-0002 RI20220414-0015 DAFFA MUARIF 169,375.0

R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1

R/ MEMUCIL 600 MG 2.00 TAB 11,687.50 23,375.00 0 1

EFFERVESCENT
82 RI20220415-0001 15/04/2022 RI20220415-0001 RI20220415-0001 DEWI SARTIKA SILABAN 183,169.0

R/ COTRIMOXAZOLE 480 MG 2.00 TAB 550.00 1,100.00 1 0

TABLET
R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0
KAPLET
R/ ONDANSETRON 8 MG INJ 2.00 AMP 23,000.00 46,000.00 1 0

R/ ASERING 500 ML INF 5.00 FLS 10,800.00 54,000.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ KAPAS ALKOHOL 3.00 PCS 302.50 907.00 0 1

83 RI20220415-0002 15/04/2022 RI20220412-0002 RI20220415-0002 DAFFA MUARIF 15,055.0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

84 RI20220415-0003 15/04/2022 RI20220412-0002 RI20220415-0003 DAFFA MUARIF 6,560.0

R/ FG TROCHES TAB HISAP 4.00 TAB 1,640.00 6,560.00 0 0

85 RI20220415-0004 15/04/2022 RI20220413-0001 RI20220415-0004 DEDI ANTONI 374,991.0

R/ BRAXIDIN TABLET 3.00 TAB 1,523.30 4,569.00 0 0

(PSIKOTROPIKA)
R/ PANTOMEX 40 MG/ ML INJ 1.00 VIAL 199,375.00 199,375.00 0 1

R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

86 RI20220415-0005 15/04/2022 RI20220415-0001 RI20220415-0005 DEWI SARTIKA SILABAN 82,262.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ COTRIMOXAZOLE 480 MG 2.00 TAB 550.00 1,100.00 1 0
TABLET
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0
(BPJS)
87 RI20220415-0007 15/04/2022 RI20220412-0002 RI20220415-0007 DAFFA MUARIF 319,985.0

R/ FG TROCHES TAB HISAP 10.00 TAB 1,640.00 16,400.00 0 0

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,043.50 80,435.00 0 1

(PREKURSOR)
R/ OPICEF 500 MG KAPSUL 10.00 CAP 14,080.00 140,800.00 0 1

88 RI20220415-0008 15/04/2022 RI20220413-0001 RI20220415-0008 DEDI ANTONI 493,453.0

R/ BRAXIDIN TABLET 10.00 TAB 1,523.30 15,233.00 0 0
(PSIKOTROPIKA)

Print Date:7/14/2022 Print Time: 2:09:07PM Page 96 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ GITAS PLUS TAB 10.00 TAB 8,800.00 88,000.00 0 1

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ IMUNVIT PLUS KAPLET 10.00 KAPLET 10,935.00 109,350.00 0 1

R/ GASTROLAN CAPS 10.00 CAP 19,712.00 197,120.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

89 RI20220415-0009 15/04/2022 RI20220415-0001 RI20220415-0009 DEWI SARTIKA SILABAN 2,655.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

90 RI20220416-0001 16/04/2022 RI20220416-0002 RI20220416-0001 TITO NELSON TARIGAN 398,292.0

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

R/ SUCTION CATHETHER NO. 16 1.00 PCS 8,712.00 8,712.00 0 1

R/ CITICOLINE 250 MG/2ML 3.00 AMP 22,500.00 67,500.00 0 1

INJEKSI
R/ PHENYTOIN 50 MG/ML INJ 3.00 AMP 84,480.00 253,440.00 1 0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

R/ AQUADEST 1000 ML 1.00 FLS 27,113.29 27,113.00 1 0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

91 RI20220416-0002 16/04/2022 RI20220416-0002 RI20220416-0002 TITO NELSON TARIGAN 31,460.0

R/ THREE WAY STOP CO-CKS 1.00 PCS 31,460.00 31,460.00 0 1

92 RI20220416-0003 16/04/2022 RI20220416-0002 RI20220416-0003 TITO NELSON TARIGAN 100,265.0

R/ SURFLO NO. 18 (VENFLON) 1.00 PCS 29,200.00 29,200.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

R/ SURFLO NO. 20 VENFLON 3.00 PCS 22,680.00 68,040.00 1 0

93 RI20220416-0004 16/04/2022 RI20220416-0002 RI20220416-0004 TITO NELSON TARIGAN 20,671.0

R/ KASA GULUNG KECIL 15 CM 4.00 ROLL 5,167.80 20,671.00 0 1

94 RI20220416-0005 16/04/2022 RI20220416-0002 RI20220416-0005 TITO NELSON TARIGAN 258,340.0

R/ PHENYTOIN 50 MG/ML INJ 1.00 AMP 84,480.00 84,480.00 1 0

R/ NS 0.9 100 ML (PIGGY BACK) 2.00 FLS 19,430.00 38,860.00 1 0

R/ CITICOLINE 250 MG/2ML 6.00 AMP 22,500.00 135,000.00 0 1

INJEKSI
95 RI20220416-0006 16/04/2022 RI20220416-0002 RI20220416-0006 TITO NELSON TARIGAN 699,666.0

R/ ATROPIN SULFAS INJ 1.00 AMP 3,375.00 3,375.00 1 0

R/ SEDACUM INJ 15MG/3ML 9.00 CC 25,911.67 233,205.00 0 0
(PSIKOTROPIKA
R/ ETT SIZE 7.5 RUSCH + BALON 1.00 PCS 84,500.00 84,500.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 97 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ LIDOCAIN 2% INJ (BPJS) 2.00 AMP 1,459.90 2,919.00 0 1

R/ FENTANYL 0.05 MG/ML, 2 ML 4.00 CC 30,250.00 121,000.00 0 0

INJEKSI (NARKOTIKA)
R/ EPHEDRIN HCL INJ (PREK) 1.00 AMP 5,896.40 5,896.00 0 0

R/ RECOFOL INJEKSI 1.00 AMP 139,335.00 139,335.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ EPINEPHRINE INJ 1.00 AMP 12,160.00 12,160.00 1 0

R/ HANDSCOEN STERILE (7.0) 2.00 PCS 10,900.00 21,800.00 1 0

R/ ATRACURIUM BESILATE 50 1.00 AMP 57,750.00 57,750.00 1 0

MG/5 ML INJEKSI
96 RI20220416-0008 16/04/2022 RI20220415-0001 RI20220416-0008 DEWI SARTIKA SILABAN 38,247.0

R/ COTRIMOXAZOLE 480 MG 2.00 TAB 550.00 1,100.00 1 0

TABLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
97 RI20220416-0009 16/04/2022 RI20220415-0001 RI20220416-0009 DEWI SARTIKA SILABAN 52,938.0

R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

98 RI20220416-0010 16/04/2022 RI20220416-0002 RI20220416-0010 TITO NELSON TARIGAN 134,343.0

R/ DEXTROSE 5% 500 ML INF 2.00 FLS 9,371.60 18,743.00 0 1

R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0

500MG/5ML
R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1
(CATHETER TIP) TERUMO
99 RI20220417-0001 17/04/2022 RI20220417-0001 RI20220417-0001 RAULI 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

100 RI20220417-0002 17/04/2022 RI20220415-0001 RI20220417-0002 DEWI SARTIKA SILABAN 36,862.0

R/ COTRIMOXAZOLE 480 MG 6.00 TAB 550.00 3,300.00 1 0

TABLET
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
101 RI20220417-0004 17/04/2022 RI20220415-0001 RI20220417-0004 DEWI SARTIKA SILABAN 22,255.0

R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

102 RI20220417-0005 17/04/2022 RI20220417-0002 RI20220417-0005 PATROUW DIRK 7,328.0

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 98 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0

103 RI20220417-0007 17/04/2022 RI20220415-0001 RI20220417-0007 DEWI SARTIKA SILABAN 3,563.0

R/ ALPRAZOLAM 0,5 MG TAB 1.00 TAB 789.75 789.00 0 0

(PSI)
R/ CODEIN 10 MG TAB 3.00 TAB 924.70 2,774.00 0 0
(NARKOTIKA)
104 RI20220418-0001 18/04/2022 RI20220417-0002 RI20220418-0001 PATROUW DIRK 36,400.0

R/ SURFLO NO. 20 VENFLON 1.00 PCS 22,680.00 22,680.00 1 0

R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1

105 RI20220418-0002 18/04/2022 RI20220417-0001 RI20220418-0002 RAULI 28,928.0

R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

106 RI20220418-0003 18/04/2022 RI20220415-0001 RI20220418-0003 DEWI SARTIKA SILABAN 172,916.0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 80,000.00 160,000.00 1 0

(BPJS)
R/ COTRIMOXAZOLE 480 MG 6.00 TAB 550.00 3,300.00 1 0
TABLET
R/ CODEIN 10 MG TAB 3.00 TAB 924.70 2,774.00 0 0
(NARKOTIKA)
R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0
KAPLET
R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

107 RI20220418-0004 18/04/2022 RI20220417-0002 RI20220418-0004 PATROUW DIRK 24,835.0

R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

108 RI20220418-0005 18/04/2022 RI20220415-0001 RI20220418-0005 DEWI SARTIKA SILABAN 58,400.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 29,200.00 58,400.00 1 0

109 RI20220418-0007 18/04/2022 RI20220415-0001 RI20220418-0007 DEWI SARTIKA SILABAN 80,410.0

R/ COTRIMOXAZOLE 480 MG 10.00 TAB 550.00 5,500.00 1 0

TABLET
R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

R/ CODEIN 10 MG TAB 10.00 TAB 924.70 9,247.00 0 0

(NARKOTIKA)
R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
110 RI20220418-0009 18/04/2022 RI20220417-0001 RI20220418-0009 RAULI 4,569.0

R/ BRAXIDIN TABLET 3.00 TAB 1,523.30 4,569.00 0 0

(PSIKOTROPIKA)
Print Date:7/14/2022 Print Time: 2:09:07PM Page 99 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

111 RI20220418-0013 18/04/2022 RI20220417-0001 RI20220418-0013 RAULI 4,303.0

R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0

112 RI20220418-0016 18/04/2022 RI20220417-0002 RI20220418-0016 PATROUW DIRK 2,869.0

R/ BETAHISTINE 6 MG TAB 2.00 TAB 1,434.50 2,869.00 1 0

113 RI20220418-0017 18/04/2022 RI20220417-0001 RI20220418-0017 RAULI 2,957.0

R/ BETAHISTINE 6 MG TAB 1.00 TAB 1,434.50 1,434.00 1 0

R/ BRAXIDIN TABLET 1.00 TAB 1,523.30 1,523.00 0 0

(PSIKOTROPIKA)
114 RI20220419-0003 19/04/2022 RI20220417-0002 RI20220419-0003 PATROUW DIRK 4,303.0

R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0

115 RI20220419-0004 19/04/2022 RI20220417-0002 RI20220419-0004 PATROUW DIRK 3,379.0

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

116 RI20220419-0005 19/04/2022 RI20220417-0001 RI20220419-0005 RAULI 15,233.0

R/ BRAXIDIN TABLET 10.00 TAB 1,523.30 15,233.00 0 0

(PSIKOTROPIKA)
117 RI20220419-0008 19/04/2022 RI20220417-0002 RI20220419-0008 PATROUW DIRK 5,500.0

R/ LODIA 2 MG TABLET 4.00 TAB 1,375.00 5,500.00 0 1

118 RI20220419-0011 19/04/2022 RI20220419-0004 RI20220419-0011 SUMITRO SIMAMORA 99,287.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ ISOSORBID DINITRAT 5 MG 2.00 TAB 161.50 323.00 1 0
TAB
R/ ASPILET 80 MG TAB 2.00 TAB 728.80 1,457.00 0 0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

119 RI20220419-0013 19/04/2022 RI20220419-0005 RI20220419-0013 ROSMAWATY SINAGA 48,111.0

R/ PARACETAMOL 500 MG 2.00 KAPLET 387.55 775.00 1 0

KAPLET
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0

120 RI20220420-0003 20/04/2022 RI20220419-0005 RI20220420-0003 ROSMAWATY SINAGA 39,131.0

R/ CURCUMA FCT TAB 1.00 TAB 885.00 885.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
Print Date:7/14/2022 Print Time: 2:09:07PM Page 100 of 140
RS SANTA ELISABETH SEI LEKOP
Kav.
Sungai
Kec. Sagulung
Lekop
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685
Kel.
Sungai
Lekop Laporan Penjualan Resep Rawat Inap Per Dokter
Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ BETAHISTINE 6 MG TAB 2.00 TAB 1,434.50 2,869.00 1 0

121 RI20220420-0004 20/04/2022 RI20220419-0004 RI20220420-0004 SUMITRO SIMAMORA 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

122 RI20220420-0013 20/04/2022 RI20220417-0002 RI20220420-0013 PATROUW DIRK 1,126.0

R/ SPASMINAL TABLET 1.00 TAB 1,126.40 1,126.00 0 1

123 RI20220420-0014 20/04/2022 RI20220417-0002 RI20220420-0014 PATROUW DIRK 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

124 RI20220420-0016 20/04/2022 RI20220419-0005 RI20220420-0016 ROSMAWATY SINAGA 3,379.0

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

125 RI20220420-0018 20/04/2022 RI20220419-0005 RI20220420-0018 ROSMAWATY SINAGA 4,569.0

R/ BRAXIDIN TABLET 3.00 TAB 1,523.30 4,569.00 0 0

(PSIKOTROPIKA)
126 RI20220420-0019 20/04/2022 RI20220417-0002 RI20220420-0019 PATROUW DIRK 72,800.0

R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1

DEWASA
127 RI20220421-0003 21/04/2022 RI20220417-0002 RI20220421-0003 PATROUW DIRK 34,052.0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

128 RI20220421-0004 21/04/2022 RI20220419-0005 RI20220421-0004 ROSMAWATY SINAGA 43,014.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ BETAHISTINE 6 MG TAB 3.00 TAB 1,434.50 4,303.00 1 0

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

129 RI20220421-0016 21/04/2022 RI20220419-0004 RI20220421-0016 SUMITRO SIMAMORA 4,451.0

R/ ASPILET 80 MG TAB 5.00 TAB 728.80 3,644.00 0 0

R/ ISOSORBID DINITRAT 5 MG 5.00 TAB 161.50 807.00 1 0

TAB
130 RI20220421-0017 21/04/2022 RI20220417-0002 RI20220421-0017 PATROUW DIRK 11,264.0
R/ SPASMINAL TABLET 10.00 TAB 1,126.40 11,264.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 101 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

131 RI20220421-0019 21/04/2022 RI20220421-0001 RI20220421-0019 HENDRA SANTO KIROYAN 642,065.0

R/ IMUNVIT KAPLET 3.00 KAPLET 6,910.31 20,730.00 0 0

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

R/ LODIA 2 MG TABLET 6.00 TAB 1,375.00 8,250.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ SPUIT 5 CC (TERUMO) 4.00 PCS 5,600.00 22,400.00 0 1

R/ BUSCOPAN TAB 10 MG 3.00 TAB 4,397.60 13,192.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

132 RI20220421-0020 21/04/2022 RI20220421-0001 RI20220421-0020 HENDRA SANTO KIROYAN 146,986.0

R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1

R/ COTRIMOXAZOLE 480 MG 4.00 TAB 550.00 2,200.00 1 0

TABLET
133 RI20220421-0022 21/04/2022 RI20220421-0001 RI20220421-0022 HENDRA SANTO KIROYAN 116,876.0

R/ PARACETAMOL INFUS 2.00 FLS 58,438.00 116,876.00 1 0

1GR/100 ML
134 RI20220421-0025 21/04/2022 RI20220421-0004 RI20220421-0025 SUMARNI 21,674.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

135 RI20220422-0001 22/04/2022 RI20220421-0001 RI20220422-0001 HENDRA SANTO KIROYAN 387.0

R/ PARACETAMOL 500 MG 1.00 KAPLET 387.55 387.00 1 0

KAPLET
136 RI20220422-0005 22/04/2022 RI20220419-0005 RI20220422-0005 ROSMAWATY SINAGA 35,332.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

137 RI20220422-0008 22/04/2022 RI20220421-0001 RI20220422-0008 HENDRA SANTO KIROYAN 591,360.0

R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1

138 RI20220422-0009 22/04/2022 RI20220421-0001 RI20220422-0009 HENDRA SANTO KIROYAN 288,750.0

R/ PARAMOL 1GR/100 ML INF 3.00 FLS 96,250.00 288,750.00 0 1

139 RI20220422-0010 22/04/2022 RI20220421-0004 RI20220422-0010 SUMARNI 8,850.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 102 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

140 RI20220422-0011 22/04/2022 RI20220421-0001 RI20220422-0011 HENDRA SANTO KIROYAN 6,875.0

R/ LODIA 2 MG TABLET 5.00 TAB 1,375.00 6,875.00 0 1

141 RI20220422-0012 22/04/2022 RI20220419-0005 RI20220422-0012 ROSMAWATY SINAGA 12,725.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
142 RI20220422-0015 22/04/2022 RI20220421-0001 RI20220422-0015 HENDRA SANTO KIROYAN 81,048.0

R/ LAMETIC 8 MG TAB 2.00 TAB 39,424.00 78,848.00 0 1

R/ COTRIMOXAZOLE 480 MG 4.00 TAB 550.00 2,200.00 1 0

TABLET
143 RI20220422-0016 22/04/2022 RI20220421-0001 RI20220422-0016 HENDRA SANTO KIROYAN 22,632.0

R/ NEW DIATAB TABLET 2.00 TAB 696.44 1,392.00 0 1

R/ LACTO B SACHET 3.00 SACH 7,080.00 21,240.00 0 1

144 RI20220422-0017 22/04/2022 RI20220421-0001 RI20220422-0017 HENDRA SANTO KIROYAN 168,960.0

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

145 RI20220422-0018 22/04/2022 RI20220421-0001 RI20220422-0018 HENDRA SANTO KIROYAN 2,655.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

146 RI20220422-0020 22/04/2022 RI20220421-0001 RI20220422-0020 HENDRA SANTO KIROYAN 48,262.0

R/ BUSCOPAN 20MG/ML INJ 1.00 AMP 48,262.00 48,262.00 0 1

147 RI20220422-0021 22/04/2022 RI20220421-0001 RI20220422-0021 HENDRA SANTO KIROYAN 1,392.0

R/ NEW DIATAB TABLET 2.00 TAB 696.44 1,392.00 0 1

148 RI20220423-0001 23/04/2022 RI20220422-0002 RI20220423-0001 NURMINA HUTABARAT 17,507.0

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

149 RI20220423-0002 23/04/2022 RI20220421-0001 RI20220423-0002 HENDRA SANTO KIROYAN 12,579.0

R/ NEW DIATAB TABLET 2.00 TAB 696.44 1,392.00 0 1

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

R/ PARACETAMOL 500 MG 1.00 KAPLET 387.55 387.00 1 0

KAPLET
150 RI20220423-0003 23/04/2022 RI20220421-0001 RI20220423-0003 HENDRA SANTO KIROYAN 527,794.0
R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 103 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ COTRIMOXAZOLE 480 MG 1.00 TAB 550.00 550.00 1 0

TABLET
R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ BUSCOPAN TAB 10 MG 1.00 TAB 4,397.60 4,397.00 0 1

R/ LODIA 2 MG TABLET 3.00 TAB 1,375.00 4,125.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

151 RI20220423-0004 23/04/2022 RI20220422-0002 RI20220423-0004 NURMINA HUTABARAT 19,322.0

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

152 RI20220423-0011 23/04/2022 RI20220421-0001 RI20220423-0011 HENDRA SANTO KIROYAN 1,008,277.0

R/ SANMOL INFUS 3.00 FLS 86,029.00 258,087.00 0 1

R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1

R/ BIOXON INJ 1 GR 2.00 VIAL 295,680.00 591,360.00 0 1

R/ NEW DIATAB TABLET 10.00 TAB 696.44 6,964.00 0 1

R/ LACTO B SACHET 1.00 SACH 7,080.00 7,080.00 0 1

153 RI20220423-0012 23/04/2022 RI20220422-0002 RI20220423-0012 NURMINA HUTABARAT 223,153.0

R/ ANBACIM 1 GR INJ 2.00 VIAL 110,669.00 221,338.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

154 RI20220423-0013 23/04/2022 RI20220423-0002 RI20220423-0013 ANYUN 124,077.0

R/ DEXKETOPROFEN 25MG/ML 3.00 AMP 33,792.00 101,376.00 1 0

INJ
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

155 RI20220423-0014 23/04/2022 RI20220423-0002 RI20220423-0014 ANYUN 1,770.0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

156 RI20220423-0018 23/04/2022 RI20220421-0001 RI20220423-0018 HENDRA SANTO KIROYAN 2,200.0

R/ COTRIMOXAZOLE 480 MG 4.00 TAB 550.00 2,200.00 1 0

TABLET
157 RI20220424-0004 24/04/2022 RI20220421-0001 RI20220424-0004 HENDRA SANTO KIROYAN 48,262.0
R/ BUSCOPAN 20MG/ML INJ 1.00 AMP 48,262.00 48,262.00 0 1

158 RI20220424-0007 24/04/2022 RI20220423-0002 RI20220424-0007 ANYUN 32,900.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 104 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

159 RI20220424-0014 24/04/2022 RI20220421-0001 RI20220424-0014 HENDRA SANTO KIROYAN 380,160.0

R/ BIOXON INJ 1 GR 1.00 VIAL 295,680.00 295,680.00 0 1

R/ LAMETIC 8 MG INJ 1.00 AMP 84,480.00 84,480.00 0 1

160 RI20220424-0015 24/04/2022 RI20220421-0001 RI20220424-0015 HENDRA SANTO KIROYAN 549,020.0

R/ GASTROLAN CAPS 14.00 CAP 19,712.00 275,968.00 0 1

R/ LACTO B SACHET 13.00 SACH 7,080.00 92,040.00 0 1

R/ BUSCOPAN TAB 10 MG 10.00 TAB 4,397.60 43,976.00 0 1

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ BRAXIDIN TABLET 20.00 TAB 1,523.30 30,466.00 0 0

(PSIKOTROPIKA)
R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ NEW DIATAB TABLET 14.00 TAB 696.44 9,750.00 0 1

161 RI20220424-0020 24/04/2022 RI20220424-0001 RI20220424-0020 LAZARUS KASAMILALE 59,561.0

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0

500MG/5ML
162 RI20220425-0002 25/04/2022 RI20220424-0001 RI20220425-0002 LAZARUS KASAMILALE 50,807.0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0

500MG/5ML
R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

163 RI20220425-0003 25/04/2022 RI20220423-0002 RI20220425-0003 ANYUN 15,414.0

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

164 RI20220425-0006 25/04/2022 RI20220425-0001 RI20220425-0006 MARIA YANTIMAS 293.0

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 293.50 293.00 1 0

165 RI20220425-0007 25/04/2022 RI20220423-0002 RI20220425-0007 ANYUN 67,680.0

R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

R/ URSODEOXYCHOLIC ACID 250 10.00 CAP 6,237.00 62,370.00 1 0
MG

Print Date:7/14/2022 Print Time: 2:09:07PM Page 105 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

166 RI20220425-0008 25/04/2022 RI20220425-0001 RI20220425-0008 MARIA YANTIMAS 293.0

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 293.50 293.00 1 0

167 RI20220425-0011 25/04/2022 RI20220425-0001 RI20220425-0011 MARIA YANTIMAS 23,918.0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

168 RI20220426-0002 26/04/2022 RI20220425-0001 RI20220426-0002 MARIA YANTIMAS 15,348.0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 293.50 293.00 1 0

169 RI20220426-0005 26/04/2022 RI20220426-0001 RI20220426-0005 PUTRI MARSHANDA 65,700.0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0

500MG/5ML
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

170 RI20220426-0010 26/04/2022 RI20220425-0001 RI20220426-0010 MARIA YANTIMAS 98,120.0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 93,045.36 93,045.00 0 1

R/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0

171 RI20220426-0011 26/04/2022 RI20220426-0003 RI20220426-0011 TUMBUR PARDEDE 124,292.0

R/ LODIA 2 MG TABLET 6.00 TAB 1,375.00 8,250.00 0 1

R/ SPASMINAL TABLET 3.00 TAB 1,126.40 3,379.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ COTRIMOXAZOLE 480 MG 4.00 TAB 550.00 2,200.00 1 0

TABLET
R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

172 RI20220426-0012 26/04/2022 RI20220426-0001 RI20220426-0012 PUTRI MARSHANDA 526,090.0

R/ GASTROLAN CAPS 20.00 CAP 19,712.00 394,240.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ ASAM TRANEXAMAT 500 MG 20.00 TAB 2,475.00 49,500.00 1 0

TAB
173 RI20220426-0013 26/04/2022 RI20220426-0003 RI20220426-0013 TUMBUR PARDEDE 1,162.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 387.55 1,162.00 1 0

KAPLET
174 RI20220427-0003 27/04/2022 RI20220425-0001 RI20220427-0003 MARIA YANTIMAS 17,163.0

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 293.50 293.00 1 0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 7,527.60 15,055.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 106 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

175 RI20220427-0004 27/04/2022 RI20220426-0003 RI20220427-0004 TUMBUR PARDEDE 112,241.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ LODIA 2 MG TABLET 4.00 TAB 1,375.00 5,500.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ COTRIMOXAZOLE 480 MG 4.00 TAB 550.00 2,200.00 1 0

TABLET
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0
(BPJS)
R/ SPASMINAL TABLET 1.00 TAB 1,126.40 1,126.00 0 1

176 RI20220427-0006 27/04/2022 RI20220426-0003 RI20220427-0006 TUMBUR PARDEDE 148,964.0

R/ BUSCOPAN 20MG/ML INJ 3.00 AMP 48,262.00 144,786.00 0 1

R/ NEW 6.00 TAB 696.44 4,178.00 0 1

DIATAB
177 RI20220428-0002
TABLET 28/04/2022 RI20220426-0003 RI20220428-0002 TUMBUR PARDEDE 31,114.0

R/ COTRIMOXAZOLE 480 MG 20.00 TAB 550.00 11,000.00 1 0

TABLET
R/ SPASMINAL TABLET 10.00 TAB 1,126.40 11,264.00 0 1

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

178 RI20220428-0003 28/04/2022 RI20220425-0001 RI20220428-0003 MARIA YANTIMAS 24,387.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 7,527.60 22,582.00 1 0

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 293.50 293.00 1 0

179 RI20220428-0006 28/04/2022 RI20220425-0001 RI20220428-0006 MARIA YANTIMAS 207.0

R/ NIFEDIPINE 10 MG TAB 1.00 TAB 207.69 207.00 1 0

180 RI20220428-0007 28/04/2022 RI20220425-0001 RI20220428-0007 MARIA YANTIMAS 31,251.0

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ FOLEY CATHETER NO. 18 1.00 PCS 14,388.00 14,388.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

181 RI20220428-0013 28/04/2022 RI20220425-0001 RI20220428-0013 MARIA YANTIMAS 8,753.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

182 RI20220429-0005 29/04/2022 RI20220425-0001 RI20220429-0005 MARIA YANTIMAS 35,417.0

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 293.50 293.00 1 0

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

183 RI20220430-0002 30/04/2022 RI20220425-0001 RI20220430-0002 MARIA YANTIMAS 2,935.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 107 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ FUROSEMIDE 40 MG TAB 10.00 TAB 293.50 2,935.00 1 0

184 RI20220430-0003 30/04/2022 RI20220425-0001 RI20220430-0003 MARIA YANTIMAS 27,127.0

R/ TRANSOFIX 1.00 PCS 19,600.00 19,600.00 0 1

R/ NACL 0.9 % 500 ML INF 1.00 FLS 7,527.60 7,527.00 1 0

185 RJ20220405-0002 05/04/2022 OP20220405-0004 2022040500002 FELISITAS SEKU 8,491.0

R/ SIMVASTATIN 20 MG TAB 7.00 TAB 1,213.00 8,491.00 1 0

186 RJ20220405-0003 05/04/2022 OP20220405-0004 2022040500003 FELISITAS SEKU 27,899.0

R/ SIMVASTATIN 20 MG TAB 23.00 TAB 1,213.00 27,899.00 1 0

187 RJ20220406-0005 06/04/2022 OP20220406-0005 2022040600007 YASINTA LONA BADHE 7,800.0

R/ ANTASIDA DOEN SYR 1.00 FLS 7,800.00 7,800.00 1 0

188 RJ20220407-0001 07/04/2022 OP20220407-0002 2022040700002 HARIMAN LUMBAN GAOL 5,140.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

189 RJ20220407-0002 07/04/2022 OP20220407-0001 2022040700004 DAVID JULVEN LUMBAN 75,553.0

TORUAN

R/ SURFLO NO. 20 VENFLON 1.00 PCS 22,680.00 22,680.00 1 0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0

KAPLET
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ SURFLO NO. 22 VENFLON 1.00 PCS 29,200.00 29,200.00 1 0

190 RJ20220407-0003 07/04/2022 OP20220407-0004 2022040700005 LASMA SINAGA 8,655.0

R/ RAMIPRIL 5 MG TAB (BPJS) 15.00 TAB 577.00 8,655.00 1 0

191 RJ20220409-0006 09/04/2022 OP20220409-0007 2022040900007 AGUS BANI 424,634.0

R/ AMLODIPINE 10 MG TAB 30.00 TAB 2,196.47 65,894.00 1 0

R/ URSODEOXYCHOLIC ACID 250 20.00 CAP 6,237.00 124,740.00 1 0

MG
R/ LESICHOL 300 MG CAP 15.00 CAP 15,600.00 234,000.00 0 1

192 RJ20220411-0011 11/04/2022 OP20220411-0010 2022041100013 PINTOR SIMANGUNSONG 630,515.0

R/ METFORMIN 850 MG TAB 90.00 TAB 600.60 54,054.00 1 0

R/ GLIMEPIRIDE 3 MG TAB 30.00 TAB 2,931.20 87,936.00 1 0

R/ SIMTIN 300 MG CAPSUL 20.00 CAP 14,000.00 280,000.00 0 1

R/ GASTROLAN CAPS 7.00 CAP 19,712.00 137,984.00 0 1

R/ EPISAN 100 ML SYR 1.00 FLS 70,541.00 70,541.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 108 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

193 RJ20220412-0005 12/04/2022 OP20220412-0004 2022041200006 JAUSIN SIMARE MARE 284,773.0

R/ NEUROSANBE 5000 MG TAB 20.00 TAB 3,513.13 70,262.00 0 1

R/ NOVORAPID FLEXPEN 1.00 VIAL 97,636.36 97,636.00 0 1

R/ MEMUCIL 600 MG 10.00 TAB 11,687.50 116,875.00 0 1

EFFERVESCENT
194 RJ20220412-0007 12/04/2022 OP20220412-0006 2022041200010 YOHANES NGAJO 771,722.0

R/ LANFIX 100 MG KAPSUL 20.00 TAB 29,568.00 591,360.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

R/ FLAMAR 50 MG TAB 15.00 TAB 1,850.00 27,750.00 0 1

R/ NEUROSANBE 5000 MG TAB 20.00 TAB 3,513.13 70,262.00 0 1

195 RJ20220413-0012 13/04/2022 OP20220413-0014 2022041300016 SARDIONO HUTABARAT 220,000.0

R/ OPIVASK 10 MG TAB 20.00 TAB 11,000.00 220,000.00 0 1

196 RJ20220414-0001 14/04/2022 OP20220414-0001 2022041400001 LASMA SINAGA 8,081.0

R/ RAMIPRIL 5 MG TAB (BPJS) 14.00 TAB 577.27 8,081.00 1 0

197 RJ20220414-0004 14/04/2022 OP20220414-0005 2022041400003 BENNY MARSAULI BR 280,798.0

PASARIBU

R/ MAXTAN 500 MG TABLET 20.00 TAB 1,718.80 34,376.00 1 0

R/ EPERISON 50 MG TAB 20.00 TAB 2,290.00 45,800.00 1 0

R/ GASTROLAN CAPS 6.00 CAP 19,712.00 118,272.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 8,235.00 82,350.00 0 1

198 RJ20220414-0005 14/04/2022 OP20220414-0006 2022041400004 MARIANUS PEHAN HEWEN 4,040.0

R/ RAMIPRIL 5 MG TAB (BPJS) 7.00 TAB 577.27 4,040.00 1 0

199 RJ20220416-0003 16/04/2022 OP20220416-0002 2022041600003 JOGI MARIANUS SIHOTANG 244,177.0

R/ RHINOS SR KAPSUL 15.00 CAP 8,043.50 120,652.00 0 1

(PREKURSOR)
R/ PROVITAL PLUS CAPS 15.00 CAP 8,235.00 123,525.00 0 1

200 RJ20220418-0002 18/04/2022 OP20220418-0002 2022041800002 SUDIN 28,690.0

R/ BETAHISTINE 6 MG TAB 20.00 TAB 1,434.50 28,690.00 1 0

201 RJ20220418-0004 18/04/2022 OP20220418-0009 2022041800004 AMINAH 80,909.0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.09 80,909.00 0 1

202 RJ20220418-0005 18/04/2022 OP20220418-0009 2022041800005 AMINAH 80,909.0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.09 80,909.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 109 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

203 RJ20220418-0007 18/04/2022 OP20220418-0011 2022041800007 MARIA YANTIMAS 7,702.0

R/ IBUPROFEN 400 MG TAB 15.00 TAB 513.50 7,702.00 1 0

204 RJ20220419-0003 19/04/2022 OP20220419-0003 2022041900004 TUGIMIN 24,616.0

R/ PROPRANOLOL 10 MG TAB 15.00 TAB 1,239.70 18,595.00 1 0

(BPJS)
R/ SPIRONOLACTON 25 MG TAB 15.00 TAB 264.50 3,967.00 1 0

R/ FUROSEMIDE 40 MG TAB 7.00 TAB 293.50 2,054.00 1 0

205 RJ20220419-0006 19/04/2022 OP20220419-0009 2022041900007 PINTOR SIMANGUNSONG 468,000.0

R/ LESICHOL 300 MG CAP 30.00 CAP 15,600.00 468,000.00 0 1

206 RJ20220420-0007 20/04/2022 OP20220420-0001 2022042000009 JEANY RUNTUWEWE 80,909.0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.09 80,909.00 0 1

207 RJ20220420-0008 20/04/2022 OP20220420-0001 2022042000010 JEANY RUNTUWEWE 101,209.0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.09 80,909.00 0 1

R/ NALD NOVORAPID 32G 4.00 PCS 5,075.00 20,300.00 0 0

208 RJ20220420-0011 20/04/2022 OP20220420-0011 2022042000013 MUWANTI 8,850.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

209 RJ20220421-0002 21/04/2022 OP20220421-0002 2022042100015 LASMA SINAGA 0.0

R/ RAMIPRIL 10 MG TAB (BPJS) 7.00 TAB 0.00 0.00 1 0

210 RJ20220421-0003 21/04/2022 OP20220421-0002 2022042100014 LASMA SINAGA 0.0

R/ RAMIPRIL 10 MG TAB (BPJS) 23.00 TAB 0.00 0.00 1 0

211 RJ20220421-0004 21/04/2022 OP20220421-0003 2022042100002 MARIANUS PEHAN HEWEN 9,853.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 387.55 5,813.00 1 0

KAPLET
R/ RAMIPRIL 5 MG TAB (BPJS) 7.00 TAB 577.27 4,040.00 1 0

212 RJ20220421-0005 21/04/2022 OP20220421-0003 2022042100003 MARIANUS PEHAN HEWEN 13,277.0

R/ RAMIPRIL 5 MG TAB (BPJS) 23.00 TAB 577.27 13,277.00 1 0

213 RJ20220421-0015 21/04/2022 OP20220421-0014 2022042100013 KHRISTOPER SITOMPUL 13,750.0

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

214 RJ20220422-0006 22/04/2022 OP20220422-0004 2022042200007 ANWAR LUMBAN TORUAN 82,927.0

R/ VITAMIN B6 (PYRIDOXINE) 15.00 TAB 134.55 2,018.00 1 0
TAB
R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.09 80,909.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 110 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

215 RJ20220422-0007 22/04/2022 OP20220422-0004 2022042200008 ANWAR LUMBAN TORUAN 80,909.0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.09 80,909.00 0 1

216 RJ20220422-0009 22/04/2022 OP20220422-0013 2022042200011 DEWI SARTIKA SILABAN 74,463.0

R/ COTRIMOXAZOLE 480 MG 15.00 TAB 550.00 8,250.00 1 0

TABLET
R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

217 RJ20220422-0010 22/04/2022 OP20220422-0016 2022042300008 LINAWATI LAIA 24,413.0

R/ METHYLPREDNISOLONE 8 MG 15.00 TAB 789.80 11,847.00 1 0

TAB
R/ IBUPROFEN 400 MG TAB 15.00 TAB 513.50 7,702.00 1 0

R/ PTU 100 MG TAB (BPJS) 7.00 TAB 694.90 4,864.00 1 0

218 RJ20220423-0004 23/04/2022 OP20220423-0006 2022042300005 BUDIONO 34,350.0

R/ EPERISON 50 MG TAB 15.00 TAB 2,290.00 34,350.00 1 0

219 RJ20220423-0005 23/04/2022 OP20220422-0016 2022042300007 LINAWATI LAIA 15,982.0

R/ PTU 100 MG TAB (BPJS) 23.00 TAB 694.90 15,982.00 1 0

220 RJ20220425-0004 25/04/2022 OP20220425-0002 2022042500005 TRIANI 80,909.0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 80,909.09 80,909.00 0 1

221 RJ20220425-0005 25/04/2022 OP20220425-0002 2022042500006 TRIANI 161,818.0

R/ LEVEMIR FLEXPEN (BPJS) 2.00 VIAL 80,909.09 161,818.00 0 1

222 RJ20220425-0007 25/04/2022 OP20220425-0006 2022042500020 MARIA YANTIMAS 13,708.0

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 2,184.00 6,552.00 1 0

INJ (BPJS)
223 RJ20220425-0010 25/04/2022 OP20220425-0013 2022042500021 LA ODE NASRIN 848,737.0

R/ LESICHOL 300 MG CAP 30.00 CAP 15,600.00 468,000.00 0 1

R/ SIMTIN 300 MG CAPSUL 15.00 CAP 13,062.50 195,937.00 0 1

R/ FENOFIBRATE 300 MG CAPS 30.00 CAP 6,160.00 184,800.00 1 0

224 RJ20220426-0007 26/04/2022 OP20220426-0007 2022042600007 JETTY ROSALINA HUTASOIT 28,220.0

R/ GLIMEPIRIDE 3 MG TAB 7.00 TAB 2,931.20 20,518.00 1 0

R/ IBUPROFEN 400 MG TAB 15.00 TAB 513.50 7,702.00 1 0

225 RJ20220426-0008 26/04/2022 OP20220426-0007 2022042600008 JETTY ROSALINA HUTASOIT 67,417.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 111 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ GLIMEPIRIDE 3 MG TAB 23.00 TAB 2,931.20 67,417.00 1 0

226 RJ20220426-0014 26/04/2022 OP20220426-0009 2022042600020 SUPOYO 95,063.0

R/ LEVEMIR FLEXPEN (BPJS) 1.00 VIAL 93,045.36 93,045.00 0 1

R/ VITAMIN B6 (PYRIDOXINE) 15.00 TAB 134.55 2,018.00 1 0

TAB
227 RJ20220427-0016 27/04/2022 OP20220427-0019 2022042700017 NUR HOLISEH 7,012.0

R/ SANMOL FORTE TAB 15.00 TAB 467.50 7,012.00 0 1

Total Dokter DR. GINA ARIANI, SP.PD 24,304,113.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 112 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. HENDRIK, SP.PD

1 RI20220429-0001 29/04/2022 RI20220429-0001 RI20220429-0001 DEDI KOMARUDIN 138,189.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 0 1

R/ CITICOLINE 250 MG/2ML 4.00 AMP 22,500.00 90,000.00 0 1

INJEKSI
2 RI20220429-0002 29/04/2022 RI20220429-0001 RI20220429-0002 DEDI KOMARUDIN 42,226.0

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ FOLEY CATHETER NO. 16 1.00 PCS 16,500.00 16,500.00 0 1

3 RI20220429-0007 29/04/2022 RI20220429-0001 RI20220429-0007 DEDI KOMARUDIN 106,461.0

R/ STOMACH TUBE NO. 16 1.00 PCS 38,961.00 38,961.00 0 1

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
Total Dokter DR. HENDRIK, SP.PD 286,876.0
Print Date:7/14/2022 Print Time: 2:09:07PM Page 113 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. SHINLY MEIVINITA GINTING

1 RD20220403-0005 03/04/2022 EP20220403-0004 2022040300008 FRANSISKUS MBAHANG 136,895.0

R/ PROZA KAPLET 5.00 KAPLET 15,975.00 79,875.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.00 4,220.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

2 RD20220403-0006 03/04/2022 EP20220403-0005 2022040300009 HALIMAH FITRI BATAMI 236,965.0

R/ FREGO 5 MG TAB 5.00 TAB 8,448.00 42,240.00 0 0

R/ LANAKELOID 10 GR CREAM 1.00 TUBE 128,000.00 128,000.00 0 1

R/ PROZA KAPLET 3.00 KAPLET 15,975.00 47,925.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

3 RD20220403-0007 03/04/2022 EP20220403-0006 2022040300010 PASYA DENI WIJAYA 268,950.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ INPEPSA 100 ML SYR 1.00 FLS 84,480.00 84,480.00 0 1

R/ INTERZINC SYRUP 1.00 FLS 57,750.00 57,750.00 0 1

4 RD20220404-0001 04/04/2022 EP20220404-0001 2022040400002 MANGASI HOTMARTUA 196,208.0

SITUMEANG

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

5 RD20220404-0002 04/04/2022 EP20220404-0003 2022040400004 SRI RAHAYU 167,167.0

R/ PROZA KAPLET 5.00 KAPLET 15,975.00 79,875.00 0 1

R/ SPASMINAL TABLET 10.00 TAB 1,126.00 11,260.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

6 RD20220405-0004 05/04/2022 EP20220405-0005 2022040500005 MARTODO D. SIMANUNGKALIT 298,935.0

R/ BISTURI NO. 22 1.00 PCS 5,610.00 5,610.00 0 1

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

7 RD20220405-0005 05/04/2022 EP20220405-0004 2022040500006 MUHARJO 122,690.0

R/ ESTIN 10 MG TAB 10.00 TAB 0.00 59,140.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 0.00 18,800.00 0 1

R/ ARTIMAX KAP 5.00 KAPLET 0.00 44,750.00 0 1

8 RD20220405-0006 05/04/2022 EP20220405-0006 2022040500010 HERUL PUTRA SEWANG 236,313.0

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 114 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Period
e : 01-
April- Jenis resep : Rawat Darurat
2022
No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla
s/d
R/30- Nama Item Qty Satuan Harga Jumlah Generik Non Gene
April- Formula Non Formula
2022
R/ INBUMIN TAB 250 MG 5.00 TAB 8,021.00 40,105.00 0 1

9 RD20220405-0007 05/04/2022 EP20220405-0006 2022040500011 HERUL PUTRA SEWANG 293,325.0

R/ TETAGAM INJEKSI (VAKSIN) 1.00 VIAL 293,325.00 293,325.00 0 1

10 RD20220405-0008 05/04/2022 EP20220405-0007 2022040500013 RENDY AXINDO SIHOMBING 209,602.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ DEXKETOPROFEN 25 MG TAB 6.00 TAB 4,600.00 27,600.00 1 0

11 RD20220405-0009 05/04/2022 EP20220405-0005 2022040500014 MARTODO D. SIMANUNGKALIT 3,818.0

R/ GENTAMICIN 5 GR CREAM 1.00 TUBE 3,818.00 3,818.00 1 0

12 RD20220405-0010 05/04/2022 EP20220405-0009 2022040500016 ROHANI MAGDALENA 13,750.0

NABABAN

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

13 RD20220405-0011 05/04/2022 EP20220405-0008 2022040500017 BIMA SAPUTRA SIMANJUNTAK 320,830.0

R/ PROZA KAPLET 10.00 KAPLET 15,975.00 159,750.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.00 4,220.00 0 1

14 RD20220406-0001 06/04/2022 EP20220406-0001 2022040600001 ENJELINA TUMANGGOR 49,250.0

R/ COMBANTRIN SYR 10 ML 1.00 FLS 19,850.00 19,850.00 0 1

R/ L BIO SACHET 3.00 SACH 9,800.00 29,400.00 0 1

15 RD20220406-0002 06/04/2022 EP20220406-0003 2022040600002 PUTRI RAMADHAN 463,400.0

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ VENOSMIL GEL 1.00 TUBE 224,000.00 224,000.00 0 1

R/ ANADIUM KAPLET 10.00 KAPLET 11,200.00 112,000.00 0 1

R/ BORAGINOL N SUPP 3.00 SUPP 15,800.00 47,400.00 0 1

16 RD20220408-0009 08/04/2022 EP20220408-0008 2022040800016 DIMAS ARYA PUTRA 30,976.0

R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1

17 RD20220408-0010 08/04/2022 EP20220408-0007 2022040800017 NAZRIEL GALANG PRATAMA 30,976.0

R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 115 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

18 RD20220408-0011 08/04/2022 EP20220408-0008 2022040800018 DIMAS ARYA PUTRA 162,106.0

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ ARTIMAX KAP 5.00 KAPLET 8,950.00 44,750.00 0 1

19 RD20220408-0012 08/04/2022 EP20220408-0009 2022040800019 OKTARIANI 123,599.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,000.63 12,003.00 0 1

(PREKURSOR)
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ GLUTAFIT CAPSUL 5.00 CAP 8,000.00 40,000.00 1 0

20 RD20220408-0013 08/04/2022 EP20220408-0012 2022040800025 DAPOT SIHOMBING 73,563.0

R/ BURNAZIN 35 GR CREAM 1.00 TUBE 73,563.00 73,563.00 0 1

21 RD20220408-0014 08/04/2022 EP20220408-0010 2022040800026 VENNY MALINDRA 137,995.0

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

22 RD20220408-0016 08/04/2022 EP20220408-0014 2022040800028 DORMAN MARUSAHA GULTOM 151,733.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

23 RD20220408-0017 08/04/2022 EP20220408-0015 2022040800029 ANGELINA KATARINA BUNGA 312,147.0

SOGEN

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

R/ CLINDAMYCIN 150 MG CAP 10.00 CAP 1,076.20 10,762.00 1 0

R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

24 RD20220408-0019 08/04/2022 EP20220408-0016 2022040800031 MIKAWANI SARAGIH 48,262.0

R/ BUSCOPAN 20MG/ML INJ 1.00 AMP 48,262.00 48,262.00 0 1

25 RD20220408-0020 08/04/2022 EP20220408-0007 2022040800032 NAZRIEL GALANG PRATAMA 24,500.0

R/ FOLEY CATHETER NO. 16 1.00 PCS 16,500.00 16,500.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

26 RD20220408-0021 08/04/2022 EP20220408-0016 2022040800033 MIKAWANI SARAGIH 70,400.0

R/ SPASMINAL TABLET 10.00 TAB 1,126.40 11,264.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 116 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ GASTROLAN CAPS 3.00 CAP 19,712.00 59,136.00 0 1

27 RD20220408-0022 08/04/2022 EP20220408-0017 2022040800034 RAMSES SIANTURI 232,272.0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

R/ CLINDAMYCIN 150 MG CAP 10.00 CAP 1,076.20 10,762.00 1 0

28 RD20220408-0023 08/04/2022 EP20220408-0018 2022040800035 HAVIKA ADAWIYAH HARAHAP 142,439.0

R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1

R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 1,000.00 0 1

R/ BENOSON G 10 GR CREAM 1.00 TUBE 82,500.00 82,500.00 0 1

R/ SANMOL 500 MG TABLET 5.00 TAB 1.00 422.40 13,939.00 0 1

ESTIN 10 MG TAB 2.00 TAB 5,913.60 0.00 0 1

29 RD20220408-0024 08/04/2022 EP20220408-0011 2022040800036 GISSELA BIANCA HUTASOIT 67,007.0

R/ STESOLID 5 MG/2.5 ML 1.00 TUBE 35,963.20 35,963.00 0 0

RECTAL TUBE
R/ D5 + 1/4 NS 500 ML ( WIDA )
(PSIKOTROPIKA) 1.00 FLS 24,544.00 24,544.00 0 1

R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

30 RD20220408-0025 08/04/2022 EP20220408-0020 2022040800037 LELA SURAIDA 146,931.0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ RHINOS SR KAPSUL 6.00 CAP 8,043.50 48,261.00 0 1

(PREKURSOR)
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

31 RD20220408-0026 08/04/2022 EP20220408-0021 2022040800038 FAWWAZ HAIDAR ISMAIL 239,063.0

R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1

R/ ALCO DROP (PREK) 1.00 FLS 117,563.00 117,563.00 0 1

32 RD20220408-0027 08/04/2022 EP20220408-0019 2022040800039 LUSIA DAMAI YANA MURNI 202,630.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ ONDANSETRON 4 MG TAB 6.00 TAB 3,500.00 21,000.00 1 0

33 RD20220410-0007 10/04/2022 EP20220410-0007 2022041000008 TOGAP ORLANDO PARDEDE 257,282.0

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

34 RD20220410-0008 10/04/2022 EP20220410-0008 2022041000012 74,863.0

R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 24,713.45 24,713.00 0 1

(BPJS)
Print Date:7/14/2022 Print Time: 2:09:07PM Page 117 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

35 RD20220410-0009 10/04/2022 EP20220410-0009 2022041000010 SAMUEL 22,106.0

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

36 RD20220410-0010 10/04/2022 EP20220410-0008 2022041000011 MATTEO CHARLES IVANDER 900.0

R/ KERTAS PERKAMEN BERLOGO 9.00 LBR 1.00 100.00 900.00 0 1

37 RD20220410-0011 10/04/2022 EP20220410-0008 2022041000013 MATTEO CHARLES IVANDER 6,500.0

R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

38 RD20220410-0012 10/04/2022 EP20220410-0011 2022041000015 RISNA PULUNGAN 289,630.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ FLAMAR 50 MG TAB 10.00 TAB 1,850.00 18,500.00 0 1

39 RD20220410-0013 10/04/2022 EP20220410-0010 2022041000016 MAESAROH ADI GALIH 324,630.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 398.80 3,988.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

40 RD20220411-0004 11/04/2022 EP20220411-0004 2022041100004 RYANTI PASARIBU 253,386.0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1

R/ BUSCOPAN TAB 10 MG 10.00 TAB 4,397.60 43,976.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

41 RD20220411-0005 11/04/2022 EP20220411-0005 2022041100005 RODIAH WAHYUNI SIREGAR 266,434.0

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ GITAS PLUS TAB 10.00 TAB 8,800.00 88,000.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

42 RD20220411-0006 11/04/2022 EP20220411-0006 2022041100006 ROSIDAH MUNTE 266,434.0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ GITAS PLUS TAB 10.00 TAB 8,800.00 88,000.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 118 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

43 RD20220411-0007 11/04/2022 EP20220411-0007 2022041100007 JONPRIT SIREGAR 77,759.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,787.50 36,787.00 0 0

DROP
R/ BERRY VISION TAB 5.00 TAB 4,435.20 22,176.00 0 1

44 RD20220411-0008 11/04/2022 EP20220411-0008 2022041100008 SERLY YANTONO SIBARANI 30,976.0

R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1

45 RD20220411-0009 11/04/2022 EP20220411-0008 2022041100009 SERLY YANTONO SIBARANI 407,310.0

R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0

R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1

46 RD20220411-0010 11/04/2022 EP20220411-0009 2022041100010 RIDWAN 21,964.0

R/ AMLODIPINE 10 MG TAB 10.00 TAB 2,196.47 21,964.00 1 0

47 RD20220411-0011 11/04/2022 EP20220411-0010 2022041100011 JOKO PAMILI 354,681.0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ OSTEOR C 60 GR CREAM 1.00 TUBE 173,250.00 173,250.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

48 RD20220413-0001 13/04/2022 EP20220413-0001 2022041300001 ARIS SAPRIONO 44,000.0

R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
49 RD20220413-0002
DWS 13/04/2022 EP20220413-0002 2022041300002 DIAN MERY OKTAVIA MANALU 15,687.0

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ PARACETAMOL 500 MG 5.00 KAPLET 387.55 1,937.00 1 0

KAPLET
50 RD20220413-0003 13/04/2022 EP20220413-0003 2022041300003 DEDI ANTONI 56,980.0

R/ LODIA 2 MG TABLET 10.00 TAB 0.00 13,750.00 0 1

R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 0.00 30,976.00 0 1

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 0.00 4,454.00 1 0

R/ ANTASIDA DOEN SYR 1.00 FLS 0.00 7,800.00 1 0

51 RD20220418-0018 18/04/2022 EP20220418-0016 2022041800026 NURUL KOMARIYAH 335,630.0

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 119 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

52 RD20220418-0019 18/04/2022 EP20220418-0017 2022041800027 MANGIRING LUMBAN RAJA 290,309.0

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1

53 RD20220418-0020 18/04/2022 EP20220418-0018 2022041800030 MUHAMMAD LAIQ 76,750.0

R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1

R/ ARTIMAX KAP 5.00 KAPLET 8,950.00 44,750.00 0 1

54 RD20220418-0021 18/04/2022 EP20220418-0020 2022041800031 SUSI SARTIKA HUTABARAT 211,200.0

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

55 RD20220418-0022 18/04/2022 EP20220418-0020 2022041800032 SUSI SARTIKA HUTABARAT 317,254.0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

56 RD20220418-0023 18/04/2022 EP20220418-0021 2022041800033 SAHAT PARULIAN SIREGAR 211,200.0

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

57 RD20220418-0024 18/04/2022 EP20220418-0021 2022041800034 SAHAT PARULIAN SIREGAR 428,000.0

R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

58 RD20220418-0025 18/04/2022 EP20220418-0022 2022041800035 AMIRA RIZKI PUTRI 77,399.0

R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

59 RD20220418-0026 18/04/2022 EP20220418-0023 2022041800036 DICKY SERFINDO 237,925.0

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 120 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

60 RD20220419-0002 19/04/2022 EP20220419-0002 2022041900002 CHORNALIUS BLEGUR 73,781.0

R/ FLUNARIZINE 5 MG TAB 2.00 TAB 1,760.00 3,520.00 1 0

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.40 4,454.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ BETAHISTINE 6 MG TAB 6.00 TAB 1,434.50 8,607.00 1 0

61 RD20220419-0003 19/04/2022 EP20220419-0003 2022041900006 DEO ANGGA NATANAEL 58,438.0

SITANGGANG

R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
62 RD20220419-0004 19/04/2022 EP20220419-0004 2022041 RATU SAYYIDAH 56,650.0
900008

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

63 RD20220419-0005 19/04/2022 EP20220419-0004 2022041900009 RATU SAYYIDAH 11,270.0

R/ AMOXYCILLIN 125 ML SYR 1.00 BTL 8,250.00 8,250.00 1 0

R/ SALBUTAMOL 2 MG TAB 2.00 TAB 1.00 117.50 3,020.00 1 0

PARACETAMOL 500 MG 2.00 KAPLET 387.55 0.00 1 0

KAPLET
KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

DEXAMETHASON 0,5 MG TAB 2.00 TAB 220.00 0.00 1 0

AMBROXOL 30 MG TAB 2.00 TAB 285.41 0.00 1 0

64 RD20220425-0013 25/04/2022 EP20220425-0012 2022042500015 IN NIULIPA 97,513.0

R/ SUNGKUP NEBULEZER 1.00 PCS 72,800.00 72,800.00 0 1

DEWASA
R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 24,713.45 24,713.00 0 1
(BPJS)
65 RD20220425-0015 25/04/2022 EP20220425-0013 2022042500017 RONALDO FEBRYAN 275,605.0

R/ GITAS PLUS TAB 6.00 TAB 8,800.00 52,800.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

66 RD20220425-0016 25/04/2022 EP20220425-0014 2022042500018 JONI 143,866.0

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

67 RD20220425-0017 25/04/2022 EP20220425-0015 2022042500020 KEHIDUPAN LAIA 206,849.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 121 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ CAPTOPRIL 25 MG TAB 1.00 TAB 185.90 185.00 1 0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

R/ GUEDEL NASAL NO. 6/110 1.00 PCS 136,500.00 136,500.00 0 1

R/ CITICOLINE 250 MG/2ML 1.00 AMP 22,500.00 22,500.00 0 1

INJEKSI
R/ FOLEY CATHETER NO. 18 1.00 PCS 14,388.00 14,388.00 0 1

R/ SUCTION CATHETER NO. 18 1.00 PCS 7,500.00 7,500.00 1 0

68 RD20220425-0018 25/04/2022 EP20220425-0015 2022042500022 KEHIDUPAN LAIA 214,943.0

R/ SPUIT 50 ML (WITHOUT 1.00 PCS 42,000.00 42,000.00 0 1

NEEDLE) ONEMED
R/ EXTENSION TUBE 150 CM X 1.00 PCS 62,943.75 62,943.00 0 1
1,5 ML
R/ NICARDIPINE 10 MG INJ 1.00 AMP 110,000.00 110,000.00 1 0

69 RD20220425-0019 25/04/2022 EP20220425-0016 2022042500023 HASMAULI MANALU 4,675.0

R/ SANMOL FORTE TAB 10.00 TAB 467.50 4,675.00 0 1

70 RD20220425-0020 25/04/2022 EP20220425-0017 2022042500024 ISHAK SALEH SIREGAR 364,707.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,000.63 12,003.00 0 1

(PREKURSOR)
R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

71 RD20220425-0021 25/04/2022 EP20220425-0015 2022042500026 KEHIDUPAN LAIA 106,461.0

R/ STOMACH TUBE NO. 18 1.00 PCS 38,961.00 38,961.00 0 1

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
72 RD20220425-0022 25/04/2022 EP20220425-0018 2022042500027 CHENG DONGQI 134,000.0

R/ DEXKETOPROFEN 25 MG TAB 10.00 TAB 4,600.00 46,000.00 1 0

R/ GITAS PLUS TAB 10.00 TAB 8,800.00 88,000.00 0 1

73 RD20220425-0023 25/04/2022 EP20220425-0015 2022042600014 KEHIDUPAN LAIA 399,148.0

R/ RECOFOL INJEKSI 1.00 AMP 139,335.00 139,335.00 0 1

R/ EPHEDRIN HCL INJ (PREK) 1.00 AMP 5,896.40 5,896.00 0 0

R/ ATRACURIUM BESILATE 50 1.00 AMP 57,750.00 57,750.00 1 0

MG/5 ML INJEKSI
R/ SEDACUM INJ 5MG/5ML 5.00 CC 7,333.40 36,667.00 0 0
(PSIKOTROPIKA
R/ LIDOCAIN 2% INJ (BPJS) 2.00 AMP 1,800.00 3,600.00 0 1

R/ HANDSCOEN STERILE (7.0) 1.00 PCS 10,900.00 10,900.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 122 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ETT SIZE 7.5 RUSCH + BALON 1.00 PCS 84,500.00 84,500.00 1 0

R/ FENTANYL 0.05 MG/ML, 2 ML 2.00 CC 30,250.00 60,500.00 0 0

INJEKSI (NARKOTIKA)
74 RD20220426-0015 26/04/2022 EP20220426-0008 2022042600025 MARTINUS TARIGAN 30,976.0

R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1

75 RD20220426-0016 26/04/2022 EP20220426-0007 2022042600026 246,510.0

R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ CENDO LYTEERS 0,5 ML 5.00 FLS 5,525.00 27,625.00 0 1

MINIDOSE
76 RD20220426-0017 26/04/2022 EP20220426-0008 2022042600027 MARTINUS TARIGAN 57,254.0

R/ GITAS PLUS TAB 6.00 TAB 8,800.00 52,800.00 0 1

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.40 4,454.00 1 0

77 RD20220426-0018 26/04/2022 EP20220426-0009 2022042600028 ASHALINA KHANZA RAIQA 61,474.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ APIALYS 100 ML SYR 1.00 BTL 45,000.00 45,000.00 0 1

78 RD20220426-0019 26/04/2022 EP20220426-0010 2022042600029 AHMAD BUHARI 194,724.0

R/ MYONAL 50 MG TAB 10.00 TAB 10,100.00 101,000.00 0 1

R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

79 RD20220426-0020 26/04/2022 EP20220426-0011 2022042600030 RAPMAIDA SIMARANGKIR 138,438.0

R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0
(BPJS)
80 RD20220426-0021 26/04/2022 EP20220426-0011 2022042600031 RAPMAIDA SIMARANGKIR 12,474.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ LODIA 2 MG TABLET 6.00 TAB 1,375.00 8,250.00 0 1

81 RD20220426-0022 26/04/2022 EP20220426-0012 2022042600034 DEAN EDZHAR 42,144.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 24,544.00 24,544.00 0 1

82 RD20220426-0023 26/04/2022 EP20220426-0012 2022042600036 DEAN EDZHAR 24,544.0

R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 24,544.00 24,544.00 0 1

83 RD20220426-0024 26/04/2022 EP20220426-0013 2022042600037 SHERLINA OCTAVIANI 311,371.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 123 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Darurat Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Darurat

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ MERTIGO 6 MG TAB 10.00 TAB 4,986.75 49,867.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

84 RD20220426-0025 26/04/2022 EP20220426-0014 2022042600038 462,441.0

R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1

R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ TISON 4 MG TAB 10.00 TAB 3,200.00 32,000.00 0 1

R/ ESTIN 10 MG TAB 10.00 TAB 5,913.60 59,136.00 0 1

85 RD20220429-0023 29/04/2022 EP20220429-0022 2022042900027 SHONIA WIDIA PUTRI 28,060.0

R/ FG TROCHES TAB HISAP 6.00 TAB 1,640.00 9,840.00 0 0

R/ BETAHISTINE 6 MG TAB 10.00 TAB 1,434.50 14,345.00 1 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
86 RD20220429-0024 29/04/2022 EP20220429-0023 2022042900028 MITA MELANI 224,910.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

87 RD20220430-0001 30/04/2022 EP20220430-0001 2022043000001 DENI WILSON PRATAMA 39,726.0

NAPITUPULU

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ GENTALEX 5 MG CREAM 1.00 TUBE 5,000.00 5,000.00 0 1

R/ FLAMAR 50 MG TAB 10.00 TAB 2,604.80 26,048.00 0 1

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.40 4,454.00 1 0

88 RD20220430-0002 30/04/2022 EP20220430-0002 2022043000002 SUCIATI 3,080.0

R/ NATRIUM DIKLOFENAC 50 MG 10.00 TAB 308.00 3,080.00 1 0

TAB
89 RJ20220401-0001 01/04/2022 OP20220401-0006 2022040100001 WIKY ALEX SANDRA 560,915.0

R/ ZOLLOCID CAPS 10.00 CAP 12,672.00 126,720.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,975.00 79,875.00 0 1

R/ TROLAC 30 MG/ML INJ 1.00 AMP 41,250.00 41,250.00 0 1

90 RJ20220401-0003 01/04/2022 OP20220401-0007 2022040100003 HELDERIKA SILITONGA 469,102.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 124 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,880.00 18,800.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ GLUTAFIT CAPSUL 10.00 CAP 8,000.00 80,000.00 1 0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

91 RJ20220401-0004 01/04/2022 OP20220401-0008 2022040100004 TOGAP ORLANDO PARDEDE 59,140.0

R/ ESTIN 10 MG TAB 10.00 TAB 5,914.00 59,140.00 0 1

92 RJ20220414-0002 14/04/2022 OP20220414-0002 2022041400002 ANGELO SIANTURI 197,158.0

R/ OTILON EAR DROP 1.00 FLS 54,278.00 54,278.00 0 1

R/ PROZA SYR 1.00 FLS 121,500.00 121,500.00 0 1

R/ AMOXAN 500 MG CAPSUL 3.00 CAP 1.00 4,400.00 21,380.00 0 1

ESTIN 10 MG TAB 1.00 TAB 5,913.60 0.00 0 1

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

SANMOL 500 MG TABLET 3.00 TAB 422.40 0.00 0 1

93 RJ20220414-0007 14/04/2022 OP20220414-0008 2022041400006 EDI SUTIKNO 268,317.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ SINRAL 5 MG TAB 5.00 TAB 6,187.50 30,937.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

94 RJ20220414-0008 14/04/2022 OP20220414-0009 2022041400007 RAFI YANDO RAMDAN 355,110.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ LANPEPSA 500MG/5ML SYR 1.00 FLS 70,000.00 70,000.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ RATINAL 25 MG/2 ML INJ 1.00 AMP 30,976.00 30,976.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

95 RJ20220421-0001 21/04/2022 OP20220421-0001 2022042100001 GATOT SUBROTO 322,085.0

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,000.63 12,003.00 0 1

(PREKURSOR)
R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

96 RJ20220421-0007 21/04/2022 OP20220421-0007 2022042100005 EDWARD ADIARTO SIAHAAN 89,901.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 125 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ SANMOL F SYR 60ML 1.00 BTL 37,101.00 37,101.00 0 1

97 RJ20220421-0008 21/04/2022 OP20220421-0006 2022042100006 JOSIKA MULIANI 276,144.0

R/ GITAS PLUS TAB 10.00 TAB 8,800.00 88,000.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ REGIT 10 MG TAB 6.00 TAB 4,200.00 25,200.00 0 1

98 RJ20220421-0010 21/04/2022 OP20220421-0008 2022042100008 BUDAYA 206,560.0

R/ ARTIMAX KAP 10.00 KAPLET 8,950.00 89,500.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ FLAMAR 50 MG TAB 10.00 TAB 1,850.00 18,500.00 0 1

99 RJ20220421-0011 21/04/2022 OP20220421-0010 2022042100009 SYAFRI NALDI 254,438.0

R/ SANMOL 500 MG TABLET 10.00 TAB 422.40 4,224.00 0 1

R/ TREMENZA TABLET 10.00 TAB 2,000.63 20,006.00 0 1

(PREKURSOR)
R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

100 RJ20220421-0012 21/04/2022 OP20220421-0011 2022042100010 WIDI SUHERMAN 195,380.0

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

101 RJ20220421-0013 21/04/2022 OP20220421-0012 2022042100011 BENNI OKINO 440,357.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,000.63 12,003.00 0 1

(PREKURSOR)
R/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

102 RJ20220421-0014 21/04/2022 OP20220421-0013 2022042100012 DEDI HERWANTO 397,129.0

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 15,974.99 159,749.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

103 RJ20220422-0003 22/04/2022 OP20220422-0005 2022042200003 ZURANISA AGUSTINI 158,161.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 126 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,879.68 18,796.00 0 1

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

104 RJ20220423-0002 23/04/2022 OP20220423-0005 2022042300003 WAFA ZOYA AZDKIYA 184,267.0

R/ IMUNOS 60 ML SIRUP 1.00 BTL 63,000.00 63,000.00 0 0

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,787.50 36,787.00 0 0

DROP
R/ ESTIN 10 ML DROP 1.00 BTL 84,480.00 84,480.00 0 1

105 RJ20220427-0002 27/04/2022 OP20220427-0003 2022042700002 HARI BUDI SANTOSO 227,844.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ PROZA KAPLET 5.00 KAPLET 15,974.99 79,874.00 0 1

R/ REGIT 10 MG TAB 10.00 TAB 4,200.00 42,000.00 0 1

106 RJ20220427-0004 27/04/2022 OP20220427-0005 2022042700004 ZHENG SHANEN 109,455.0

R/ ESTIN 10 MG TAB 5.00 TAB 5,913.60 29,568.00 0 1

R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

R/ DIPHENHYDRAMINE HCL INJ 1.00 AMP 2,062.50 2,062.00 1 0

10 MG/ML
R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1

107 RJ20220427-0009 27/04/2022 OP20220427-0012 2022042700009 ANGELO SIANTURI 146,738.0

R/ AMOXAN 125 MG SYR 1.00 BTL 30,938.00 30,938.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ IMUNOS 60 ML SIRUP 1.00 BTL 63,000.00 ### 0 0

108 RJ20220427-0014 27/04/2022 OP20220427-0017 2022042700014 WILDAN AL GHIFARI 132,412.0

R/ IMUNVIT PLUS SYR 60 ML 1.00 BTL 85,000.00 85,000.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ AMOXAN 125 MG SYR 1.00 BTL 30,938.00 30,938.00 0 1

109 RJ20220427-0018 27/04/2022 OP20220427-0020 2022042700019 ELKANA 251,675.0

R/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ ARCAPEC TAB 10.00 TAB 1,512.00 15,120.00 0 1

R/ GASTROLAN CAPS 5.00 CAP 19,712.00 98,560.00 0 1

R/ LODIA 2 MG TABLET 10.00 TAB 1,375.00 13,750.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 8,235.00 41,175.00 0 1

Total Dokter DR. SHINLY MEIVINITA GINTING 19,500,206.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 127 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. STEVEN, SP.OG

1 RI20220404-0006 04/04/2022 RI20220404-0001 RI20220404-0006 VIA RAHELIA DAMANIK 57,545.0

R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ RL 500 ML INF 3.00 FLS 8,754.00 26,262.00 0 1

R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 29,768.00 29,768.00 1 0

2 RI20220405-0003 05/04/2022 RI20220404-0001 RI20220405-0003 VIA RAHELIA DAMANIK 38,643.0

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 29,768.00 29,768.00 1 0

3 RI20220405-0015 05/04/2022 RI20220404-0001 RI20220405-0015 VIA RAHELIA DAMANIK 8,754.0

R/ RL 500 ML INF 1.00 FLS 8,754.00 8,754.00 0 1

4 RI20220406-0003 06/04/2022 RI20220404-0001 RI20220406-0003 VIA RAHELIA DAMANIK 47,276.0

R/ RL 500 ML INF 2.00 FLS 8,754.00 17,508.00 0 1

R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 29,768.00 29,768.00 1 0

5 RI20220407-0006 07/04/2022 RI20220404-0001 RI20220407-0006 VIA RAHELIA DAMANIK 31,630.0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,163.00 31,630.00 1 0

6 RI20220412-0003 12/04/2022 RI20220411-0003 RI20220412-0003 NOPERIDA MANURUNG 136,261.0

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ ASAM TRANEKSAMAT INJ 3.00 AMP 10,000.00 30,000.00 1 0
500MG/5ML
7 RI20220412-0007 12/04/2022 RI20220411-0003 RI20220412-0007 NOPERIDA MANURUNG 63,067.0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0

500MG/5ML
R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 29,767.50 29,767.00 1 0

8 RI20220412-0017 12/04/2022 RI20220411-0003 RI20220412-0017 NOPERIDA MANURUNG 8,753.0

R/ RL 500 ML INF 1.00 FLS 8,753.75 8,753.00 0 1

9 RI20220413-0015 13/04/2022 RI20220411-0003 RI20220413-0015 NOPERIDA MANURUNG 201,311.0

R/ ESOMEPRAZOLE INJ (BPJS) 2.00 VIAL 70,875.00 141,750.00 1 0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0

500MG/5ML
R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

10 RI20220414-0009 14/04/2022 RI20220411-0003 RI20220414-0009 NOPERIDA MANURUNG 31,625.0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,162.50 31,625.00 1 0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 128 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

11 RI20220419-0009 19/04/2022 RI20220419-0003 RI20220419-0009 EPRIANA SARAGIH 79,321.0

R/ KAPAS ALKOHOL 10.00 PCS 302.50 3,025.00 0 1

R/ KLEM TALI PUSAT 1.00 PCS 2,772.00 2,772.00 0 1

R/ SET DARAH 1.00 PCS 7,156.80 7,156.00 0 1

R/ HANDSCOEN STERILE (7.0) 1.00 PCS 10,900.00 10,900.00 1 0

R/ SURFLO NO. 18 (VENFLON) 1.00 PCS 29,200.00 29,200.00 0 1

R/ FOLEY CATHETER NO. 18 1.00 PCS 14,388.00 14,388.00 0 1

R/ KASA STERIL 16 X 16 CM 1.00 KTK 11,880.00 11,880.00 0 1

12 RI20220419-0010 19/04/2022 RI20220419-0003 RI20220419-0010 EPRIANA SARAGIH 36,495.0

R/ SUCTION CATHETHER NO. 8 1.00 PCS 10,125.00 10,125.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

13 RI20220420-0008 20/04/2022 RI20220419-0003 RI20220420-0008 EPRIANA SARAGIH 17,726.0

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

14 RI20220420-0012 20/04/2022 RI20220419-0003 RI20220420-0012 EPRIANA SARAGIH 98,819.0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0

500MG/5ML
R/ PRONALGES SUPPO 3.00 SUPP 15,500.00 46,500.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

15 RI20220420-0025 20/04/2022 RI20220419-0003 RI20220420-0025 EPRIANA SARAGIH 33,300.0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 11,100.00 33,300.00 1 0

500MG/5ML
16 RI20220421-0014 21/04/2022 RI20220419-0003 RI20220421-0014 EPRIANA SARAGIH 3,875.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
17 RJ20220404-0011 04/04/2022 OP20220404-0005 2022040400011 JUWITA ROSITA MALEM 32,062.0

R/ HANDSCOEN STERILE (7.0) 1.00 PCS 10,900.00 10,900.00 1 0

R/ HANDSCOEN STERIL NO. 6.5 1.00 PSG 21,162.00 21,162.00 0 1

18 RJ20220404-0012 04/04/2022 OP20220404-0013 2022040400012 BINTI ASLIKHAH 725,190.0

R/ HI BONE KAPLET 30.00 KAPLET 5,400.00 162,000.00 0 1

R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.00 167,190.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

19 RJ20220413-0008 13/04/2022 OP20220413-0006 2022041300009 NURHALINA SIREGAR 725,199.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 129 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.33 167,199.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

R/ HI BONE KAPLET 30.00 KAPLET 5,400.00 162,000.00 0 1

20 RJ20220413-0009 13/04/2022 OP20220413-0012 2022041300010 VIA RAHELIA DAMANIK 31,625.0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,162.50 31,625.00 1 0

21 RJ20220420-0004 20/04/2022 OP20220420-0003 2022042000005 NOPERIDA MANURUNG 31,625.0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,162.50 31,625.00 1 0

22 RJ20220427-0013 27/04/2022 OP20220427-0004 2022042700013 AYU FADHILAH UTAMI 167,199.0

R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.33 167,199.00 0 1

Total Dokter DR. STEVEN, SP.OG 2,607,301.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 130 of 140
RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

Dokter : DR. YURI SP.A

1 RI20220401-0014 01/04/2022 RI20220401-0002 RI20220401-0014 MOSES CHRISTIANO 220,463.0

HARIANJA

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

R/ SAGESTAM 40 MG INJ 1.00 AMP 12,500.00 12,500.00 0 1

2 RI20220402-0001 02/04/2022 RI20220401-0002 RI20220402-0001 MOSES CHRISTIANO 223,632.0

HARIANJA

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

3 RI20220402-0010 02/04/2022 RI20220401-0002 RI20220402-0010 MOSES CHRISTIANO 68,400.0

HARIANJA

R/ SURFLO NO. 24 VENFLON 2.00 PCS 34,200.00 68,400.00 0 1

4 RI20220402-0012 02/04/2022 RI20220401-0002 RI20220402-0012 MOSES CHRISTIANO 25,000.0

HARIANJA

R/ SAGESTAM 40 MG INJ 2.00 AMP 12,500.00 25,000.00 0 1

5 RI20220402-0016 02/04/2022 RI20220401-0002 RI20220402-0016 MOSES CHRISTIANO 150,000.0

HARIANJA

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

6 RI20220403-0003 03/04/2022 RI20220401-0002 RI20220403-0003 MOSES CHRISTIANO 232,963.0

HARIANJA

R/ AQUADES 25 ML 25.00 CC 355.00 8,875.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ SAGESTAM 40 MG INJ 2.00 AMP 12,500.00 25,000.00 0 1

7 RI20220403-0010 03/04/2022 RI20220403-0001 RI20220403-0010 KEYCIA LAMRIA PARDEDE 275,300.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

R/ KAPAS ALKOHOL 4.00 PCS 303.00 1,212.00 0 1

8 RI20220404-0001 04/04/2022 RI20220401-0002 RI20220404-0001 MOSES CHRISTIANO 75,000.0

HARIANJA

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

9 RI20220404-0002 04/04/2022 RI20220401-0002 RI20220404-0002 MOSES CHRISTIANO 17,739.0

HARIANJA

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

10 RI20220404-0003 04/04/2022 RI20220403-0001 RI20220404-0003 KEYCIA LAMRIA PARDEDE 275,603.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 131 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

11 RI20220404-0007 04/04/2022 RI20220404-0002 RI20220404-0007 HANS GABRIELO SINAGA 85,421.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ STESOLID 10 MG/2ML 1.00 AMP 16,108.00 16,108.00 0 0

INJEKSI (PSIKOTROPIKA)
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ CEFOTAXIME 1 GR INJ 2.00 VIAL 9,355.00 18,710.00 1 0

12 RI20220405-0002 05/04/2022 RI20220404-0002 RI20220405-0002 HANS GABRIELO SINAGA 37,369.0

R/ CEFOTAXIME 1 GR INJ 2.00 VIAL 9,355.00 18,710.00 1 0

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1

13 RI20220405-0004 05/04/2022 RI20220403-0001 RI20220405-0004 KEYCIA LAMRIA PARDEDE 104,034.0

R/ PICYN 750 MG INJ 1.00 VIAL 103,125.00 103,125.00 0 1

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

14 RI20220405-0005 05/04/2022 RI20220404-0002 RI20220405-0005 HANS GABRIELO SINAGA 49,088.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

15 RI20220405-0007 05/04/2022 RI20220404-0002 RI20220405-0007 HANS GABRIELO SINAGA 152,700.0

R/ SURFLO NO. 26 (VENFLON) 2.00 PCS 42,150.00 84,300.00 0 1

R/ SURFLO NO. 24 VENFLON 2.00 PCS 34,200.00 68,400.00 0 1

16 RI20220405-0008 05/04/2022 RI20220403-0001 RI20220405-0008 KEYCIA LAMRIA PARDEDE 153,030.0

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

17 RI20220405-0011 05/04/2022 RI20220404-0002 RI20220405-0011 HANS GABRIELO SINAGA 1,500.0

R/ KERTAS PERKAMEN BERLOGO 15.00 LBR 1.00 100.00 1,500.00 0 1

18 RI20220405-0016 05/04/2022 RI20220403-0001 RI20220405-0016 KEYCIA LAMRIA PARDEDE 24,544.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

19 RI20220405-0017 05/04/2022 RI20220404-0002 RI20220405-0017 HANS GABRIELO SINAGA 24,544.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

20 RI20220406-0001 06/04/2022 RI20220405-0004 RI20220406-0001 FEBRI JHONNATAN NAIBAHO 215,196.0

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 132 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ STESOLID 10 MG/2ML 1.00 AMP 16,108.00 16,108.00 0 0

INJEKSI (PSIKOTROPIKA)
21 RI20220406-0004 06/04/2022 RI20220403-0001 RI20220406-0004 KEYCIA LAMRIA PARDEDE 274,088.0

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

22 RI20220406-0005 06/04/2022 RI20220404-0002 RI20220406-0005 HANS GABRIELO SINAGA 49,088.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

23 RI20220406-0006 06/04/2022 RI20220405-0004 RI20220406-0006 FEBRI JHONNATAN NAIBAHO 124,088.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

24 RI20220406-0009 06/04/2022 RI20220404-0002 RI20220406-0009 HANS GABRIELO SINAGA 88,978.0

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

R/ SALIN 3 % 500 ML (OTSU) 1.00 FLS 38,828.00 38,828.00 0 1

25 RI20220406-0018 06/04/2022 RI20220406-0002 RI20220406-0018 NUR MALAIKA ZHAFIRA 106,599.0

R/ RANITIDINE 50MG/2ML INJ 1.00 AMP 8,800.00 8,800.00 1 0

R/ SPUIT 3 CC (TERUMO) 3.00 PCS 5,200.00 15,600.00 1 0

R/ SPUIT 5 CC (TERUMO) 3.00 PCS 5,600.00 16,800.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

R/ ONDANSETRON 4 MG INJ 1.00 AMP 6,875.00 6,875.00 1 0

R/ SPUIT 10 CC ( TERUMO ) 3.00 PCS 11,242.00 33,726.00 0 1

R/ NALD 25 (ONEMED) 1.00 PCS 254.00 254.00 0 1

26 RI20220407-0001 07/04/2022 RI20220405-0004 RI20220407-0001 FEBRI JHONNATAN NAIBAHO 76,350.0

R/ SURFLO NO. 26 (VENFLON) 1.00 PCS 42,150.00 42,150.00 0 1

R/ SURFLO NO. 24 VENFLON 1.00 PCS 34,200.00 34,200.00 0 1

27 RI20220407-0003 07/04/2022 RI20220406-0002 RI20220407-0003 NUR MALAIKA ZHAFIRA 22,484.0

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

28 RI20220407-0007 07/04/2022 RI20220405-0004 RI20220407-0007 FEBRI JHONNATAN NAIBAHO 291,838.0

R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 24,544.00 49,088.00 0 1

R/ AQUADES 25 ML 50.00 CC 355.00 17,750.00 0 1

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

29 RI20220407-0008 07/04/2022 RI20220406-0002 RI20220407-0008 NUR MALAIKA ZHAFIRA 32,790.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 133 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ RANITIDINE 50MG/2ML INJ 1.00 AMP 8,800.00 8,800.00 1 0

R/ SPUIT 3 CC (TERUMO) 3.00 PCS 5,200.00 15,600.00 1 0

R/ ONDANSETRON 4 MG INJ 1.00 AMP 6,875.00 6,875.00 1 0

30 RI20220407-0014 07/04/2022 RI20220403-0001 RI20220407-0014 KEYCIA LAMRIA PARDEDE 225,000.0

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

31 RI20220407-0030 07/04/2022 RI20220407-0004 RI20220407-0030 MIKAEL BETAWE SILITONGA 298,632.0

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1

32 RI20220408-0009 08/04/2022 RI20220407-0004 RI20220408-0009 MIKAEL BETAWE SILITONGA 200,600.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ KAPAS ALKOHOL 5.00 PCS 302.50 1,512.00 0 1

33 RI20220408-0011 08/04/2022 RI20220403-0001 RI20220408-0011 KEYCIA LAMRIA PARDEDE 47,187.0

R/ COBAZIM 3000MCG 3.00 CAP 14,437.50 43,312.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 387.55 3,875.00 1 0

KAPLET
34 RI20220408-0018 08/04/2022 RI20220408-0002 RI20220408-0018 GISSELA BIANCA HUTASOIT 247,605.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 2,184.00 2,184.00 1 0

INJ (BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ STESOLID 10 MG/2ML 1.00 AMP 16,107.60 16,107.00 0 0

INJEKSI (PSIKOTROPIKA)
R/ SAGESTAM 40 MG INJ 1.00 AMP ### 12,500.00 0 1

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

35 RI20220408-0019 08/04/2022 RI20220406-0002 RI20220408-0019 NUR MALAIKA ZHAFIRA 54,884.0

R/ SPUIT 5 CC (TERUMO) 3.00 PCS 5,600.00 16,800.00 0 1

R/ SPUIT 3 CC (TERUMO) 3.00 PCS 5,200.00 15,600.00 1 0

R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

36 RI20220409-0009 09/04/2022 RI20220406-0002 RI20220409-0009 NUR MALAIKA ZHAFIRA 208,877.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

37 RI20220412-0005 12/04/2022 RI20220411-0001 RI20220412-0005 CHRISTIAN YONING GEEM SIM 24,544.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 134 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

38 RI20220412-0008 12/04/2022 RI20220411-0001 RI20220412-0008 CHRISTIAN YONING GEEM SIM 73,632.0

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 24,544.00 73,632.00 0 1

39 RI20220412-0012 12/04/2022 RI20220411-0001 RI20220412-0012 CHRISTIAN YONING GEEM SIM 21,999.0

R/ TROMBUFIT SACHET 3.00 SACH 7,333.33 21,999.00 0 1

40 RI20220413-0009 13/04/2022 RI20220411-0001 RI20220413-0009 CHRISTIAN YONING GEEM SIM 49,088.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

41 RI20220418-0006 18/04/2022 RI20220418-0001 RI20220418-0006 XAVIER DEVEN SAGOTO 139,134.0

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 2,184.00 4,368.00 1 0

INJ (BPJS)
R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

42 RI20220418-0010 18/04/2022 RI20220418-0002 RI20220418-0010 DYAN ALFARIZI 99,544.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

43 RI20220418-0014 18/04/2022 RI20220418-0002 RI20220418-0014 DYAN ALFARIZI 861.0

R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0

44 RI20220419-0001 19/04/2022 RI20220418-0002 RI20220419-0001 DYAN ALFARIZI 101,359.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

45 RI20220419-0006 19/04/2022 RI20220419-0001 RI20220419-0006 DEO ANGGA NATANAEL 265,786.0

SITANGGANG

R/ RANITIDINE 50MG/2ML INJ 3.00 AMP 8,800.00 26,400.00 1 0

R/ RL 500 ML INF 3.00 FLS 8,753.75 26,261.00 0 1

R/ PARAMOL 1GR/100 ML INF 2.00 FLS 96,250.00 192,500.00 0 1

R/ ONDANSETRON 4 MG INJ 3.00 AMP 6,875.00 20,625.00 1 0

46 RI20220419-0012 19/04/2022 RI20220418-0002 RI20220419-0012 DYAN ALFARIZI 75,000.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

47 RI20220419-0014 19/04/2022 RI20220418-0002 RI20220419-0014 DYAN ALFARIZI 58,400.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 135 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ SURFLO NO. 22 VENFLON 2.00 PCS 29,200.00 58,400.00 1 0

48 RI20220420-0001 20/04/2022 RI20220419-0006 RI20220420-0001 RATU SAYYIDAH 127,272.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 2,184.00 2,184.00 1 0

INJ (BPJS)
R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 1,000.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

49 RI20220420-0006 20/04/2022 RI20220418-0002 RI20220420-0006 DYAN ALFARIZI 199,088.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

50 RI20220420-0007 20/04/2022 RI20220419-0001 RI20220420-0007 DEO ANGGA NATANAEL 219,026.0

SITANGGANG

R/ AQUADES 25 ML 50.00 CC 354.52 17,726.00 0 1

R/ PARAMOL 1GR/100 ML INF 2.00 FLS 96,250.00 192,500.00 0 1

R/ RANITIDINE 50MG/2ML INJ 1.00 AMP 8,800.00 8,800.00 1 0

51 RI20220420-0009 20/04/2022 RI20220419-0001 RI20220420-0009 DEO ANGGA NATANAEL 145,352.0

SITANGGANG

R/ TROMBUFIT SACHET 10.00 SACH 7,333.33 73,333.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

52 RI20220420-0010 20/04/2022 RI20220419-0006 RI20220420-0010 RATU SAYYIDAH 12,500.0

R/ SAGESTAM 40 MG INJ 1.00 AMP 12,500.00 12,500.00 0 1

53 RI20220420-0011 20/04/2022 RI20220418-0002 RI20220420-0011 DYAN ALFARIZI 29,368.0

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 2,184.00 4,368.00 1 0

INJ (BPJS)
R/ SAGESTAM 40 MG INJ 2.00 AMP 12,500.00 25,000.00 0 1

54 RI20220420-0020 20/04/2022 RI20220420-0001 RI20220420-0020 EPRIANA SARAGIH BY NY 14,800.0

R/ VAKSIN HB-UNJIJECT 0.5 ML 1.00 SACH 0.00 0.00 0 0

(BAYI/NEONATUS)
R/ NEO K INJ 1.00 AMP 14,800.34 14,800.00 0 1

55 RI20220420-0026 20/04/2022 RI20220419-0006 RI20220420-0026 RATU SAYYIDAH 3,003.0

R/ DEXAMETHASON 5MG/1ML INJ 1.00 AMP 3,003.00 3,003.00 1 0

56 RI20220420-0031 20/04/2022 RI20220419-0006 RI20220420-0031 RATU SAYYIDAH 49,088.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

57 RI20220420-0032 20/04/2022 RI20220418-0002 RI20220420-0032 DYAN ALFARIZI 49,088.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 136 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

58 RI20220421-0005 21/04/2022 RI20220419-0006 RI20220421-0005 RATU SAYYIDAH 77,184.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 2,184.00 2,184.00 1 0

INJ (BPJS)
R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

59 RI20220421-0007 21/04/2022 RI20220418-0002 RI20220421-0007 DYAN ALFARIZI 138,772.0

R/ SAGESTAM 40 MG INJ 1.00 AMP 12,500.00 12,500.00 0 1

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 2,184.00 2,184.00 1 0

INJ (BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

60 RI20220421-0018 21/04/2022 RI20220420-0001 RI20220421-0018 EPRIANA SARAGIH BY NY 1.0

R/ VAKSIN POLIO ORAL 1.00 DOSE 1.00 1.00 0 1

[DINKES ]
61 RI20220422-0007 22/04/2022 RI20220419-0006 RI20220422-0007 RATU SAYYIDAH 352,076.0

R/ ALCO DROP (PREK) 1.00 FLS 117,563.00 117,563.00 0 1

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

R/ AMOXAN 125 MG SYR 1.00 BTL 30,938.00 30,938.00 0 1

R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

62 RI20220426-0007 26/04/2022 RI20220426-0002 RI20220426-0007 DEAN EDZHAR 49,088.0

R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 24,544.00 49,088.00 0 1

63 RI20220427-0005 27/04/2022 RI20220426-0002 RI20220427-0005 DEAN EDZHAR 176,589.0

R/ AQUADES 25 ML 75.00 CC 354.52 26,589.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

64 RI20220427-0008 27/04/2022 RI20220427-0002 RI20220427-0008 ALHABSYI IBNU YUSUF 199,949.0

R/ NALD 18 (ONEMED) 1.00 PCS 861.00 861.00 1 0

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

65 RI20220428-0004 28/04/2022 RI20220427-0002 RI20220428-0004 ALHABSYI IBNU YUSUF 199,088.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

66 RI20220428-0009 28/04/2022 RI20220426-0002 RI20220428-0009 DEAN EDZHAR 49,088.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 24,544.00 49,088.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 137 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Inap Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Inap

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

67 RI20220428-0010 28/04/2022 RI20220426-0002 RI20220428-0010 DEAN EDZHAR 158,863.0

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

68 RI20220428-0016 28/04/2022 RI20220426-0002 RI20220428-0016 DEAN EDZHAR 22,000.0

R/ ZINC SIRUP 20 MG/5ML 2.00 FLS 11,000.00 22,000.00 0 1

69 RI20220430-0010 30/04/2022 RI20220430-0001 RI20220430-0010 AMALIA ROSMANDA AZHARI 108,185.0

R/ KAPAS ALKOHOL 6.00 PCS 302.50 1,815.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 80,000.00 80,000.00 1 0

(BPJS)
R/ AQUADES 25 ML 25.00 CC 354.52 8,863.00 0 1

R/ RL 500 ML INF 2.00 FLS 8,753.75 17,507.00 0 1

70 RJ20220406-0001 06/04/2022 OP20220406-0002 2022040600001 SHALYTTA AVICHAYIL DJAGUN 186,280.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

R/ AMOXAN 125 MG SYR 1.00 BTL 30,938.00 30,938.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 55,000.00 55,000.00 0 0

71 RJ20220408-0002 08/04/2022 OP20220408-0007 2022040800002 JOVIAN ALEXSANDER 291,619.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 24,992.00 24,992.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

72 RJ20220411-0001 11/04/2022 OP20220411-0002 2022041100001 ALETHEIA GRACE PAKPAHAN 486,040.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

R/ ALCO DROP (PREK) 1.00 FLS 117,563.00 117,563.00 0 1

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

73 RJ20220411-0002 11/04/2022 OP20220411-0003 2022041100002 ELISKA DEBORA PAKPAHAN 394,877.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,474.00 16,474.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 138 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ INTERZINC SYRUP 1.00 FLS 57,750.00 57,750.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ INTERLAC SACHET 10.00 SACH 12,825.00 128,250.00 0 1

74 RJ20220411-0004 11/04/2022 OP20220411-0005 2022041100005 CHRISTIAN YONING GEEM SIM 219,120.0

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ ISPRINOL 60 ML SYR 1.00 FLS 110,000.00 110,000.00 0 1

R/ SANMOL F SYR 60ML 1.00 BTL 37,101.00 37,101.00 0 1

75 RJ20220411-0005 11/04/2022 OP20220411-0005 2022041100006 CHRISTIAN YONING GEEM SIM 68,069.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 24,544.00 24,544.00 0 1

R/ SURFLO NO. 22 VENFLON 1.00 PCS 29,200.00 29,200.00 1 0

R/ KAPAS ALKOHOL 2.00 PCS 302.50 605.00 0 1

R/ SET MAKRO 1.00 PCS 13,720.00 13,720.00 0 1

76 RJ20220411-0009 11/04/2022 OP20220411-0005 2022041100011 CHRISTIAN YONING GEEM SIM 21,999.0

R/ TROMBUFIT SACHET 3.00 SACH 7,333.33 21,999.00 0 1

77 RJ20220413-0003 13/04/2022 OP20220413-0002 2022041300003 MIKAEL BETAWE SILITONGA 15,813.0

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

78 RJ20220422-0001 22/04/2022 OP20220422-0001 2022042200001 NUR MALAIKA ZHAFIRA 456,203.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ ALCO DROP (PREK) 1.00 FLS 117,563.00 117,563.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,787.50 36,787.00 0 0

DROP
79 RJ20220425-0001 25/04/2022 OP20220425-0001 2022042500001 NURCAHAYA TAMBUNAN 325,235.0

R/ ISPRINOL 60 ML SYR 1.00 FLS 110,000.00 110,000.00 0 1

R/ SANMOL F SYR 60ML 1.00 BTL 37,101.00 37,101.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 57,750.00 57,750.00 0 1

80 RJ20220427-0001 27/04/2022 OP20220427-0001 2022042700001 NURCAHAYA TAMBUNAN 292,754.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 120,384.00 120,384.00 0 1

R/ SANMOL F SYR 60ML 1.00 BTL 37,101.00 37,101.00 0 1

Print Date:7/14/2022 Print Time: 2:09:07PM Page 139 of 140

RS SANTA ELISABETH SEI LEKOP
Kav. Sungai Lekop Kel. Sungai Lekop
Kec. Sagulung
Telp : (0778) 3850 332, 3850 268, 0812 7048 6685

Laporan Penjualan Resep Rawat Jalan Per Dokter

Periode : 01-April-2022 s/d 30-April-2022

Jenis resep : Rawat Jalan

No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla

R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene

Formula Non Formula

R/ ELKANA CL SYR 1.00 FLS 72,019.00 72,019.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 63,250.00 63,250.00 0 1

Total Dokter DR. YURI SP.A 10,807,438.0

Grand Total 160,753,259.0

Print Date:7/14/2022 Print Time: 2:09:07PM Page 140 of 140

 Jumlah

Non Generik
ormula

268,107.00

353,065.00

260,401.00

325,181.00

06,754.00
 Jumlah

Non Generik
ormula

202,821.00

995,732.00

886,297.00

92,721.00

0
17,629.00
 Jumlah

Non Generik
ormula

8,754.00

1,164.00

17,507.00

8,753.00

36,939.00

11,880.00

22,680.00

45,360.00

8,753.00

17,507.00

28,241.00

24,094.00
0
 Jumlah

Non Generik
ormula

33,363.00

17,507.00

32,760.00

178,064.00

37,048.00

67,573.00

211,785.00

0
 0

15,055.00
 Jumlah

Non Generik
ormula

52,000.00

158,620.00

125,472.00

137,500.00

42,643.00

10.00

10.00

2,409.00

10.00

33,780.00

0
0
 Jumlah

Non Generik
ormula

10.00

10.00

72,461.00
 Jumlah

Non Generik
ormula

16,474.00

3,892.00

2,200.00

85,024.00

103,584.00

4,580.00

62,796.00

3,891.00

62,796.00

3,891.00
0
 Jumlah

Non Generik
ormula

3,891.00

3,891.00

62,796.00

2,291.00

26,343.00

9,424.00

15,600.00

94,803.00

9,424.00

0
89,139.00
 Jumlah

Non Generik
ormula

3,891.00

2,567.00

14,624.00

5,135.00

3,891.00

14,415.00

1,937.00

1,937.00

3,891.00

90,270.00

0
0

1
 Jumlah

Non Generik
ormula

90,270.00

2,567.00

10,400.00

04,196.00
 Jumlah

Non Generik
ormula

489,697.00

1,164.00

29,768.00

499,728.00

53,238.00

5,075.00

20,187.00

452,707.00
0
 Jumlah

Non Generik
ormula

24,300.00

301,540.00

19,144.00

23,760.00

19,600.00

87,499.00

17,726.00

7,527.00

7,781.00

0
20,181.00
 Jumlah

Non Generik
ormula

81,767.00

17,507.00

17,507.00

15,055.00

98,888.00

18,669.00

387.00

11,888.00

107,423.00

0
1,162.00
 Jumlah

Non Generik
ormula

775.00

18,888.00

24,282.00

16,474.00

153,492.00

7,156.00

156,000.00

7,527.00

2,674.00

72,800.00

0
10,150.00

1
 Jumlah

Non Generik
ormula

21,800.00

23,375.00

113,413.00

627.00

13,720.00

5,075.00

1,162.00

30,906.00

1,296.00

0
8,186.00
 Jumlah

Non Generik
ormula

2,069.00

18,669.00

85,984.00

1,345.00

240,660.00

238,845.00

26,261.00

83,063.00

247,599.00
0

0
 Jumlah

Non Generik
ormula

8,000.00

230,091.00

43,329.00

292,357.00

224,363.00

161,689.00

55,073.00

24,500.00

0
 0

230,091.00
 Jumlah

Non Generik
ormula

8,002.00

7,156.00

42,861.00

36,356.00

17,507.00

40,114.00

358,443.00

257,369.00

0
8,002.00

0
 Jumlah

Non Generik
ormula

254,098.00

240,000.00

414,098.00

1,162.00

1,162.00

17,726.00

80,000.00

1,162.00

1,162.00

3,875.00

1,937.00

0
63,222.00

0
 Jumlah

Non Generik
ormula

54,468.00

230,091.00

143,429.00

43,878.00

719,496.00

191,070.00

2,409.00

160,639.00

0
 0

132,519.00
 Jumlah

Non Generik
ormula

420,481.00

08,535.00
 Jumlah

Non Generik
ormula

297,770.00

255,420.00

40,838.00

36,910.00

186.00

7,157.00

250,270.00

42,830.00
0

0
 Jumlah

Non Generik
ormula

769,793.00

291,200.00

45,898.00

31,044.00

25,640.00

500,571.00

90,141.00
0

0
 Jumlah

Non Generik
ormula

58,800.00

110,159.00

110,000.00

98,670.00

196,001.00

330,325.00

21,174.00

3,875.00

32,455.00
0

0
 Jumlah

Non Generik
ormula

574,101.00

118,800.00

326,999.00

84,224.00

78,650.00

65,150.00

61,611.00

0
463,662.00

0
 Jumlah

Non Generik
ormula

535,452.00

80,000.00

18,220.00

285,824.00

165,000.00

54,941.00

80,000.00

295,916.00

0
324,896.00

0
 Jumlah

Non Generik
ormula

400,218.00

58,900.00

65,639.00

82,500.00

544,816.00

80,000.00

15,549.00

378,855.00

0
0

0
 Jumlah

Non Generik
ormula

6,049.00

224,694.00

9,324.00

80,000.00

72,488.00

47,561.00

200,312.00

185,516.00

0
242,716.00

0
 Jumlah

Non Generik
ormula

158,470.00

56,650.00

87,378.00

49,426.00

148,751.00

328,884.00

17,612.00
0

0
 Jumlah

Non Generik
ormula

229,134.00

167,200.00

8,167.00

27,465.00

110,000.00

10,839.00

304,910.00

218,623.00

0
 0

23,613.00
 Jumlah

Non Generik
ormula

24,544.00

272,679.00

98,796.00

294,014.00

343,456.00

147,028.00

110,036.00

0
0
 Jumlah

Non Generik
ormula

59,425.00

77,174.00

148,804.00

12,000.00

229,134.00

40,087.00

83,818.00

61,371.00
0

0
 Jumlah

Non Generik
ormula

254,014.00

327,251.00

3,875.00

80,000.00

212,720.00

313,854.00

167,200.00

25,679.00
0
 Jumlah

Non Generik
ormula

294,014.00

16,813.00

17,600.00

254,014.00

82,812.00

404,484.00

110,000.00

81,337.00

0
0
 Jumlah

Non Generik
ormula

6,974.00

39,110.00

57,376.00

340,247.00

7,010.00

158,624.00

281,344.00

98,255.00
0
 Jumlah

Non Generik
ormula

196,180.00

35,985.00
 Jumlah

Non Generik
ormula

36,277.00

702,630.00

69,000.00

5,140.00

5,610.00

699,005.00

2,328.00

293,325.00

164,230.00

0
113,750.00
 Jumlah

Non Generik
ormula

32,330.00

24,544.00

12,480.00

177,475.00

582,390.00

80,310.00

85,818.00

11,640.00

102,755.00
0
 Jumlah

Non Generik
ormula

476,310.00

73,000.00

217,966.00

217,966.00

694,015.00

869,909.00

0
1

0
 Jumlah

Non Generik
ormula

39,706.00

628,320.00

73,000.00

643,700.00

506,924.00

331,044.00

0
0
 Jumlah

Non Generik
ormula

403,325.00

152,420.00

376,995.00

39,420.00

39,420.00

499,504.00

275,716.00

0
0

0
 Jumlah

Non Generik
ormula

75,830.00

80,000.00

307,285.00

103,125.00

482,921.00

66,025.00

303,852.00

0
 0

519,548.00
 Jumlah

Non Generik
ormula

134,064.00

36,277.00

343,661.00

34,074.00

80,000.00

91,867.00

0
 0

559,447.00
 Jumlah

Non Generik
ormula

192,975.00

4,675.00

91,337.00

256,389.00

262,456.00

7,636.00
0
 Jumlah

Non Generik
ormula

59,971.00

44,000.00

97,513.00

10,626.00

117,108.00

23,375.00

168,303.00

444,204.00

42,144.00

0
281,441.00
 Jumlah

Non Generik
ormula

607,252.00

607,252.00

624,947.00

73,000.00

634,506.00

0
0

0
 Jumlah

Non Generik
ormula

566,077.00

625,814.00

271,677.00

285,949.00

641,516.00

0
0

0
 Jumlah

Non Generik
ormula

24,544.00

206,638.00

73,000.00

293,060.00

10,800.00

496,865.00

831,537.00

0
0

0
 Jumlah

Non Generik
ormula

863,162.00

308,877.00

73,000.00

331,805.00

58,438.00

247,352.00

0
0

0
 Jumlah

Non Generik
ormula

47,118.00

182,024.00

49,665.00

65,587.00

236,854.00

113,750.00

230,779.00

391,768.00

0
0

0
 Jumlah

Non Generik
ormula

391,768.00

83,087.00

73,267.00

61,875.00

17,600.00

318,317.00

159,880.00

0
 0

428,727.00
 Jumlah

Non Generik
ormula

318,317.00

217,966.00

669,330.00

348,113.00

192,248.00
0
 Jumlah

Non Generik
ormula

316,108.00

221,375.00

449,070.00

98,666.00

190,096.00

590,325.00
0

0
 Jumlah

Non Generik
ormula

136,930.00

830,393.00

285,207.00

041,593.00

436,153.00

0
0

0
 Jumlah

Non Generik
ormula

201,882.00

34,732.00
 Jumlah

Non Generik
ormula

80,000.00

116,486.00

40,000.00

92,430.00

278,905.00

22,680.00

186.00

24,544.00

360,494.00

0
153,845.00
 Jumlah

Non Generik
ormula

4,680.00

177,046.00

80,000.00

35,750.00

3,875.00

73,000.00

107,909.00

42,227.00

195,827.00

0
0
 Jumlah

Non Generik
ormula

160,051.00

88,753.00

69,759.00

474,225.00

11,100.00

79,079.00

15,813.00

3,875.00

109,717.00

0
0
 Jumlah

Non Generik
ormula

228,772.00

18,796.00

82,495.00

132,812.00

24,107.00

38,961.00

67,500.00

59,927.00

115,368.00

0
28,301.00
 Jumlah

Non Generik
ormula

24,992.00

2,854.00

55,930.00

28,301.00

263,395.00

265,272.00

15,120.00

60,081.00

224,014.00

0
0

0
 Jumlah

Non Generik
ormula

95,944.00

66,550.00

18,415.00

2,850.00

81,194.00

268,137.00

90,626.00

3,076.00

0
1
 Jumlah

Non Generik
ormula

425,943.00

201,677.00

17,726.00

500,569.00

297,528.00

297,528.00

135,001.00

0
45,000.00
 Jumlah

Non Generik
ormula

90,394.00

5,000.00

57,616.00

15,725.00

110,000.00

6,668.00

85,350.00

77,440.00

290,385.00

0
0
 Jumlah

Non Generik
ormula

9,200.00

211,200.00

235,651.00

82,742.00

242,390.00

216,800.00

46,558.00

240,515.00

0
377,840.00
 Jumlah

Non Generik
ormula

285,705.00

201,677.00

17,116.00

81,221.00

61,309.00

11,050.00

45,850.00

26,596.00
0

0
 Jumlah

Non Generik
ormula

37,701.00

60,130.00

275,949.00

246,657.00

295,680.00

18,796.00

132,816.00

0
83,070.00
 Jumlah

Non Generik
ormula

27,857.00

45,850.00

43,522.00
 Jumlah

Non Generik
ormula

17,600.00

109,646.00

80,000.00

15,120.00

4,590.00

10,000.00

84,480.00

316,470.00

80,000.00

273,624.00

0
 0

7,800.00
 Jumlah

Non Generik
ormula

26,813.00

11,733.00

167,200.00

7,424.00

66,786.00

935,963.00

8,712.00

8,401.00

2,409.00

57,200.00
0
 Jumlah

Non Generik
ormula

110,000.00

64,624.00

17,600.00

32,525.00

257,600.00

220,000.00

27,000.00

66,126.00

80,000.00

147,335.00

0
92,430.00
 Jumlah

Non Generik
ormula

90,562.00

692,850.00

241,773.00

93,037.00

25,433.00
 Jumlah

Non Generik
ormula

10,000.00

195,313.00

15,080.00

52,663.00

24,500.00

80,000.00

147,169.00

355,958.00

0
41,696.00

0
 Jumlah

Non Generik
ormula

80,000.00

303,325.00

80,000.00

15,083.00

41,696.00

474,225.00

358,545.00

27,625.00

4,583.00

24,713.00
 0

191,018.00
 Jumlah

Non Generik
ormula

254,340.00

5,043.00

38,589.00

3,875.00

189,954.00

80,000.00

161.00

2,915.00

1
161.00

0
 Jumlah

Non Generik
ormula

141,636.00

141,636.00

45,696.00

17,919.00

3,875.00

12,040.00

178,545.00

80,000.00

150,796.00

261,662.00

0
0
 Jumlah

Non Generik
ormula

364,609.00

356,099.00

178,458.00

229,811.00

9,398.00

590,385.00

102,350.00

0
293,325.00

0
 Jumlah

Non Generik
ormula

196,204.00

58,438.00

411,840.00

42,472.00

430,799.00

293,270.00

361,140.00

0
95,375.00
 Jumlah

Non Generik
ormula

102,658.00

7,000.00

10,626.00

129,743.00

199,155.00

25,321.00

34,894.00

299,622.00

314,476.00
0
 Jumlah

Non Generik
ormula

295,680.00

164,884.00

150,123.00

394,209.00

55,921.00

248,472.00

1,001.00

369,340.00

0
0

0
 Jumlah

Non Generik
ormula

249,860.00

92,430.00

272,046.00

116,741.00

182,236.00

128,991.00

11,100.00

100,587.00
0

0
 Jumlah

Non Generik
ormula

97,513.00

206,999.00

11,050.00

376,675.00

53,323.00

78,088.00

279,460.00

0
 0

9,973.00
 Jumlah

Non Generik
ormula

140,325.00

163,264.00

448,693.00

453,612.00

72,365.00

11,100.00

491,577.00

0
0

0
 Jumlah

Non Generik
ormula

98,796.00

5,135.00

101,384.00

80,000.00

54,815.00

79,247.00

411,675.00

411,675.00

0
0

0
 Jumlah

Non Generik
ormula

376,675.00

169,615.00

116,848.00

97,056.00

135,626.00

96,124.00

0
8,329.00
 Jumlah

Non Generik
ormula

3,875.00

5,135.00

1,000.00

178,545.00

443,689.00

95,787.00

394,355.00

14,210.00

2,750.00
0
 Jumlah

Non Generik
ormula

470,179.00

456,424.00

57,412.00

261,985.00

490,220.00

15,707.00
 Jumlah

Non Generik
ormula

86,930.00

24,360.00

776.00

456,522.00

24,978.00

125,094.00

10,962.00

43,827.00
0

0
 Jumlah

Non Generik
ormula

348,885.00

254.00

3,378.00

729.00

7,150.00

24,978.00

105,419.00

6,678.00

116,219.00

0
0
 Jumlah

Non Generik
ormula

729.00

26,625.00

10,626.00

144,786.00

5,500.00

178,969.00

20,110.00

8,850.00

21,600.00

5,913.00

3,378.00

25,011.00
0
 Jumlah

Non Generik
ormula

25,010.00

639,549.00

39,989.00

611,213.00

17,750.00

46,800.00

0
11,688.00
 Jumlah

Non Generik
ormula

18,672.00

9,535.00

21,600.00

386,710.00

11,479.00

58,400.00

88,267.00

21,600.00

21,600.00

0
21,600.00
 Jumlah

Non Generik
ormula

33,562.00

613,360.00

13,825.00

8,753.00

62,030.00

7,150.00

17,507.00

728.00

2,886.00
0
 Jumlah

Non Generik
ormula

32,400.00

387.00

1,126.00

43,200.00

12,725.00

56,207.00

1,162.00

13,275.00

99,783.00

0
0
 Jumlah

Non Generik
ormula

8,753.00

178,862.00

295,680.00

375,325.00

650,141.00

5,913.00

149,355.00
0

0
 Jumlah

Non Generik
ormula

10,400.00

24,325.00

12,830.00

23,375.00

638,100.00

355,640.00

114,079.00

950.00
 0

73,000.00
 Jumlah

Non Generik
ormula

169,375.00

183,169.00

15,055.00

6,560.00

374,991.00

82,262.00

319,985.00

493,453.00
0
 Jumlah

Non Generik
ormula

2,655.00

398,292.00

31,460.00

100,265.00

20,671.00

258,340.00

699,666.00

0
0

0
 Jumlah

Non Generik
ormula

38,247.00

52,938.00

134,343.00

21,600.00

36,862.00

22,255.00

7,328.00
0
 Jumlah

Non Generik
ormula

3,563.00

36,400.00

28,928.00

172,916.00

24,835.00

58,400.00

80,410.00

0
4,569.00

0
 Jumlah

Non Generik
ormula

4,303.00

2,869.00

2,957.00

4,303.00

3,379.00

15,233.00

5,500.00

99,287.00

48,111.00

39,131.00

0
0

0
 Jumlah

Non Generik
ormula

17,507.00

1,126.00

10,626.00

3,379.00

4,569.00

72,800.00

34,052.00

43,014.00

4,451.00

11,264.00
0
 Jumlah

Non Generik
ormula

642,065.00

146,986.00

116,876.00

21,674.00

387.00

35,332.00

591,360.00

288,750.00
 0

8,850.00
 Jumlah

Non Generik
ormula

6,875.00

12,725.00

81,048.00

22,632.00

168,960.00

2,655.00

48,262.00

1,392.00

17,507.00

12,579.00

527,794.00
0

0
 Jumlah

Non Generik
ormula

19,322.00

008,277.00

223,153.00

124,077.00

1,770.00

2,200.00

48,262.00
 0

32,900.00
 Jumlah

Non Generik
ormula

380,160.00

549,020.00

59,561.00

50,807.00

15,414.00

293.00

67,680.00

0
0
 Jumlah

Non Generik
ormula

293.00

23,918.00

15,348.00

65,700.00

98,120.00

124,292.00

526,090.00

1,162.00

17,163.00

0
0

0
 Jumlah

Non Generik
ormula

112,241.00

148,964.00

31,114.00

24,387.00

207.00

31,251.00

8,753.00

35,417.00

0
 0

2,935.00
 Jumlah

Non Generik
ormula

27,127.00

8,491.00

27,899.00

7,800.00

5,140.00

75,553.00

8,655.00

424,634.00

630,515.00

0
0
 Jumlah

Non Generik
ormula

284,773.00

771,722.00

220,000.00

8,081.00

280,798.00

4,040.00

244,177.00

28,690.00

80,909.00

80,909.00
0
 Jumlah

Non Generik
ormula

7,702.00

24,616.00

468,000.00

80,909.00

101,209.00

8,850.00

0.00

0.00

9,853.00

13,277.00

13,750.00

82,927.00
0

0
 Jumlah

Non Generik
ormula

80,909.00

74,463.00

24,413.00

34,350.00

15,982.00

80,909.00

161,818.00

13,708.00

848,737.00

28,220.00

0
67,417.00
 Jumlah

Non Generik
ormula

95,063.00

7,012.00

04,113.00
 Jumlah

Non Generik
ormula

138,189.00

42,226.00

106,461.00

86,876.00
 Jumlah

Non Generik
ormula

136,895.00

236,965.00

268,950.00

196,208.00

167,167.00

298,935.00

122,690.00

236,313.00
0

0
 Jumlah

Non Generik
ormula

293,325.00

209,602.00

3,818.00

13,750.00

320,830.00

49,250.00

463,400.00

30,976.00

30,976.00
0
 Jumlah

Non Generik
ormula

162,106.00

123,599.00

73,563.00

137,995.00

151,733.00

312,147.00

48,262.00

24,500.00

70,400.00
0
 Jumlah

Non Generik
ormula

232,272.00

142,439.00

67,007.00

146,931.00

239,063.00

202,630.00

257,282.00

0
74,863.00

0
 Jumlah

Non Generik
ormula

22,106.00

900.00

6,500.00

289,630.00

324,630.00

253,386.00

266,434.00

266,434.00

0
0

0
 Jumlah

Non Generik
ormula

77,759.00

30,976.00

407,310.00

21,964.00

354,681.00

44,000.00

15,687.00

56,980.00

0
335,630.00

0
 Jumlah

Non Generik
ormula

290,309.00

76,750.00

211,200.00

317,254.00

211,200.00

428,000.00

77,399.00

237,925.00
0

0
 Jumlah

Non Generik
ormula

73,781.00

58,438.00

56,650.00

11,270.00

97,513.00

275,605.00

143,866.00

0
 0

206,849.00
 Jumlah

Non Generik
ormula

214,943.00

4,675.00

364,707.00

106,461.00

134,000.00

399,148.00

0
0

0
 Jumlah

Non Generik
ormula

30,976.00

246,510.00

57,254.00

61,474.00

194,724.00

138,438.00

12,474.00

42,144.00

24,544.00

0
311,371.00
 Jumlah

Non Generik
ormula

462,441.00

28,060.00

224,910.00

39,726.00

3,080.00

560,915.00

0
469,102.00
 Jumlah

Non Generik
ormula

59,140.00

197,158.00

268,317.00

355,110.00

322,085.00

0
 0

89,901.00
 Jumlah

Non Generik
ormula

276,144.00

206,560.00

254,438.00

195,380.00

440,357.00

397,129.00

0
158,161.00
 Jumlah

Non Generik
ormula

184,267.00

227,844.00

109,455.00

146,738.00

132,412.00

251,675.00

0
 0

00,206.00
 Jumlah

Non Generik
ormula

57,545.00

38,643.00

8,754.00

47,276.00

31,630.00

136,261.00

63,067.00

8,753.00

201,311.00

31,625.00
0
 Jumlah

Non Generik
ormula

79,321.00

36,495.00

17,726.00

98,819.00

33,300.00

3,875.00

32,062.00

725,190.00

0
 0

725,199.00
 Jumlah

Non Generik
ormula

31,625.00

31,625.00

167,199.00

07,301.00
 Jumlah

Non Generik
ormula

220,463.00

223,632.00

68,400.00

25,000.00

150,000.00

232,963.00

275,300.00

75,000.00

17,739.00

275,603.00
0
 Jumlah

Non Generik
ormula

85,421.00

37,369.00

104,034.00

49,088.00

152,700.00

153,030.00

1,500.00

24,544.00

24,544.00

215,196.00
0
 Jumlah

Non Generik
ormula

274,088.00

49,088.00

124,088.00

88,978.00

106,599.00

76,350.00

22,484.00

291,838.00

0
32,790.00
 Jumlah

Non Generik
ormula

225,000.00

298,632.00

200,600.00

47,187.00

247,605.00

54,884.00

208,877.00

0
 0

24,544.00
 Jumlah

Non Generik
ormula

73,632.00

21,999.00

49,088.00

139,134.00

99,544.00

861.00

101,359.00

265,786.00

75,000.00

0
58,400.00
 Jumlah

Non Generik
ormula

127,272.00

199,088.00

219,026.00

145,352.00

12,500.00

29,368.00

14,800.00

3,003.00

49,088.00

49,088.00
0
 Jumlah

Non Generik
ormula

77,184.00

138,772.00

1.00

352,076.00

49,088.00

176,589.00

199,949.00

199,088.00

0
49,088.00

0
 Jumlah

Non Generik
ormula

158,863.00

22,000.00

108,185.00

186,280.00

291,619.00

486,040.00

0
394,877.00

0
 Jumlah

Non Generik
ormula

219,120.00

68,069.00

21,999.00

15,813.00

456,203.00

325,235.00

292,754.00
0

0
 Jumlah

Non Generik
ormula

07,438.00
53,259.00