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-February-2022 s/d 28-February-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. ANDI EKA PUTRA

1 RD20220203-0001 03/02/2022 EP20220203-0001 2022020300001 MUHAMMAD AVATAR 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

2 RD20220203-0002 03/02/2022 EP20220203-0001 2022020300002 MUHAMMAD AVATAR 295,888.0

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ ISPRINOL 60 ML SYR 1.00 FLS 110,000.00 110,000.00 0 1

R/ PROZA SYR 1.00 FLS 117,000.00 117,000.00 0 1

3 RD20220203-0003 03/02/2022 EP20220203-0002 2022020300003 KEVIN ANJASWANA SILABAN 143,945.0

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,473.00 82,365.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

4 RD20220216-0034 16/02/2022 EP20220216-0033 2022021600057 RUTH MONICA SIHOTANG 194,435.0

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

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,473.00 82,365.00 0 1

5 RD20220216-0035 16/02/2022 EP20220216-0034 2022021600058 SABINA ARTINDIRANI PUTRI 70,400.0

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

6 RD20220217-0002 17/02/2022 EP20220217-0002 2022021700002 M.NUR ALIF ADI TRIANSYAH 8,165.0

R/ PARACETAMOL 500 MG 4.00 KAPLET 185.00 740.00 1 0

KAPLET
R/ AMBROXOL 30 MG TAB 5.00 TAB 285.00 1,425.00 1 0

R/ CETIRIZINE 10 MG TAB 5.00 TAB 1,000.00 5,000.00 1 0

R/ KERTAS PERKAMEN BERLOGO 10.00 LBR 1.00 100.00 1,000.00 0 1

7 RD20220217-0003 17/02/2022 EP20220217-0003 2022021700005 NOPASARI SILITONGA 183,110.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

8 RD20220217-0004 17/02/2022 EP20220217-0005 2022021700007 22,653.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 1 of 190

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-February-2022 s/d 28-February-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/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

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

9 RD20220217-0005 17/02/2022 EP20220217-0006 2022021700010 IMAM NAWAWI 58,048.0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

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

R/ RANITIDINE 150 MG TAB 10.00 TAB 200.00 2,000.00 1 0

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
10 RD20220217-0006 17/02/2022 EP20220217-0009 2022021700027 26,010.0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

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

11 RD20220217-0007 17/02/2022 EP20220217-0007 2022021700019 JEFRI ROLLI RICHARDO 58,898.0

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ AMBROXOL 30 MG TAB 10.00 TAB 285.00 2,850.00 1 0

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

12 RD20220217-0030 17/02/2022 EP20220217-0007 2022021700065 JEFRI ROLLI RICHARDO 10,800.0

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

Total Dokter DR. ANDI EKA PUTRA 1,089,952.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 2 of 190
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-February-2022 s/d 28-February-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. BERNARD PARDOMUAN PURBA, SPB

1 RJ20220202-0008 02/02/2022 OP20220202-0014 2022020200014 BREMA S.P TUMANGGOR 1,500.0

R/ VITAMIN B COMPLEX TAB 10.00 TAB 150.00 1,500.00 1 0

2 RJ20220202-0009 02/02/2022 OP20220202-0015 2022020200015 SUMAIRI 3,350.0

R/ VITAMIN B COMPLEX TAB 10.00 TAB 150.00 1,500.00 1 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
3 RJ20220204-0002 04/02/2022 OP20220204-0006 2022020400003 ERNI PURBA 1,500.0

R/ VITAMIN B COMPLEX TAB 10.00 TAB 150.00 1,500.00 1 0

Total Dokter DR. BERNARD PARDOMUAN PURBA, SPB 6,350.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 3 of 190
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-February-2022 s/d 28-February-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 RJ20220202-0002 02/02/2022 OP20220202-0004 2022020200004 ARING LAILIL MUKHAROMAH 66,960.0

R/ SPUIT 3 CC (TERUMO) 1.00 PCS 4,600.00 4,600.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,836.00 18,360.00 0 1

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

2 RJ20220202-0005 02/02/2022 OP20220202-0013 2022020200011 ASEP RAFQI SULAIMAN 18,360.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,836.00 18,360.00 0 1

3 RJ20220203-0005 03/02/2022 OP20220203-0007 2022020300007 DICKY LAKSAMANA 5,810.0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 239.00 2,390.00 1 0

KAPLET
R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 342.00 3,420.00 1 0

4 RJ20220203-0006 03/02/2022 OP20220203-0007 2022020300008 DICKY LAKSAMANA 3,892.0

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

5 RJ20220203-0007 03/02/2022 OP20220203-0009 2022020300009 ROINCAH TOGATOROP 91,804.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,836.00 18,360.00 0 1

R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

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

6 RJ20220204-0003 04/02/2022 OP20220204-0007 2022020400004 DONDA WEDIA ASTUTI SILALA 71,392.0

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
R/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,892.00 3,892.00 0 1

7 RJ20220207-0005 07/02/2022 OP20220207-0011 2022020700008 RAME PASARIBU 20,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

8 RJ20220208-0001 08/02/2022 OP20220208-0003 2022020800003 KHAIRUL NIZAM 20,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

9 RJ20220208-0005 08/02/2022 OP20220208-0005 2022020800007 ARING LAILIL MUKHAROMAH 13,880.0

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

R/ SPUIT 3 CC (TERUMO) 1.00 PCS 4,600.00 4,600.00 1 0

10 RJ20220209-0006 09/02/2022 OP20220209-0012 2022020900008 SIPORA 66,390.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 4 of 190

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-February-2022 s/d 28-February-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/ AMOXAN 500 MG CAPSUL 10.00 CAP 4,400.00 44,000.00 0 1

11 RJ20220210-0002 10/02/2022 OP20220210-0004 2022021000003 AE SRIUTAMI 18,644.0

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

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

R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 342.00 3,420.00 1 0

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

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

KAPLET
12 RJ20220211-0004 11/02/2022 OP20220211-0006 2022021100004 DEDI HERWANTO 64,190.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

13 RJ20220216-0012 16/02/2022 OP20220216-0014 2022021600016 IBROHIM 42,360.0

R/ CLINDAMYCIN 300 MG CAP 10.00 CAP 1,818.00 18,180.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

14 RJ20220216-0013 16/02/2022 OP20220216-0015 2022021600017 HIROSIMA SIHOMBING 13,880.0

R/ SPUIT 3 CC (TERUMO) 1.00 PCS 4,600.00 4,600.00 1 0

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

15 RJ20220221-0012 21/02/2022 OP20220221-0016 2022022100013 SARILAN HARAHAP 9,960.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 482.00 4,820.00 1 0

16 RJ20220222-0001 22/02/2022 OP20220222-0002 2022022200001 MALA FITRI YANTI 3,892.0

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

17 RJ20220222-0006 22/02/2022 OP20220222-0005 2022022200006 ZENI SILVIA 70,282.0

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

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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

18 RJ20220222-0007 22/02/2022 OP20220222-0006 2022022200007 MULIA RAHMAD 64,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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

19 RJ20220223-0006 23/02/2022 OP20220223-0006 2022022300007 WANDEDI 3,892.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 5 of 190

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-February-2022 s/d 28-February-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/ PEHACAIN INJEKSI 2 ML 1.00 AMP 3,892.00 3,892.00 0 1

20 RJ20220225-0011 25/02/2022 OP20220225-0014 2022022500014 SARILAN HARAHAP 4,820.0

R/ AMOXICILLIN 500 MG KAPLET 10.00 KAPLET 482.00 4,820.00 1 0

21 RJ20220225-0012 25/02/2022 OP20220225-0014 2022022500015 SARILAN HARAHAP 3,892.0

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

Total Dokter DRG. BETTY PASARIBU 678,870.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 6 of 190

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-February-2022 s/d 28-February-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 RI20220202-0019 02/02/2022 RI20220202-0002 RI20220202-0019 SUMUANG EFENDI SIMAMORA 18,460.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

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

2 RI20220202-0021 02/02/2022 RI20220202-0002 RI20220202-0021 SUMUANG EFENDI SIMAMORA 59,617.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

3 RI20220202-0027 02/02/2022 RI20220202-0002 RI20220202-0027 SUMUANG EFENDI SIMAMORA 27.0

R/ BICNAT TAB 3.00 TAB 9.00 27.00 1 0

4 RI20220202-0029 02/02/2022 RI20220202-0002 RI20220202-0029 SUMUANG EFENDI SIMAMORA 4,960.0

R/ FUROSEMIDE 10 MG/2 ML INJ 1.00 AMP 4,960.00 4,960.00 1 0

5 RI20220202-0031 02/02/2022 RI20220202-0002 RI20220202-0031 SUMUANG EFENDI SIMAMORA 14,048.0

R/ UNDER PAD 60 X 90 2.00 PCS 7,024.00 14,048.00 0 1

6 RI20220202-0033 02/02/2022 RI20220202-0002 RI20220202-0033 SUMUANG EFENDI SIMAMORA 7,357.0

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

R/ ANEMOLAT 1 MG TAB 1.00 TAB 200.00 200.00 0 1

7 RI20220203-0002 03/02/2022 RI20220202-0002 RI20220203-0002 SUMUANG EFENDI SIMAMORA 2,451.0

R/ SPASMINAL TABLET 3.00 TAB 817.00 2,451.00 0 1

8 RI20220203-0003 03/02/2022 RI20220202-0004 RI20220203-0003 MULIAN 69,712.0

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

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

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

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

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

9 RI20220203-0004 03/02/2022 RI20220202-0002 RI20220203-0004 SUMUANG EFENDI SIMAMORA 37,929.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

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

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

10 RI20220203-0014 03/02/2022 RI20220202-0002 RI20220203-0014 SUMUANG EFENDI SIMAMORA 331,645.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 7 of 190

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-February-2022 s/d 28-February-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/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ FOLEY CATHETER NO. 16 1.00 PCS 24,975.00 24,975.00 0 1

R/ FUROSEMIDE 10 MG/2 ML INJ 2.00 AMP 4,960.00 9,920.00 1 0

R/ MEROPENEM INJEKSI 1 GR 3.00 VIAL 96,250.00 288,750.00 1 0

11 RI20220203-0015 03/02/2022 RI20220202-0004 RI20220203-0015 MULIAN 47,758.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

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

12 RI20220203-0018 03/02/2022 RI20220202-0002 RI20220203-0018 SUMUANG EFENDI SIMAMORA 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

13 RI20220203-0019 03/02/2022 RI20220202-0002 RI20220203-0019 SUMUANG EFENDI SIMAMORA 7,150.0

R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

14 RI20220203-0021 03/02/2022 RI20220202-0002 RI20220203-0021 SUMUANG EFENDI SIMAMORA 17,800.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

15 RI20220203-0024 03/02/2022 RI20220202-0002 RI20220203-0024 SUMUANG EFENDI SIMAMORA 213,705.0

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

R/ AQUADEST 1000 ML 1.00 FLS 32,134.00 32,134.00 1 0

R/ FUROSEMIDE 10 MG/2 ML INJ 5.00 AMP 4,960.00 24,800.00 1 0

R/ SPUIT 50 ML (WITHOUT 1.00 PCS 37,206.00 37,206.00 0 1

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

R/ THREE WAY STOP CO-CKS 1.00 PCS 31,460.00 31,460.00 0 1

R/ EXTENSION TUBE 150 CM X 1.00 PCS 62,944.00 62,944.00 0 1

1,5 ML
16 RI20220203-0025 03/02/2022 RI20220202-0002 RI20220203-0025 SUMUANG EFENDI SIMAMORA 25,019.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

R/ KCL 7.46% 25 ML 1.00 FLS 11,686.00 11,686.00 0 1

17 RI20220204-0001 04/02/2022 RI20220202-0002 RI20220204-0001 SUMUANG EFENDI SIMAMORA 137,890.0

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

DEWASA
R/ ACETYLCYSTEIN 200 MG 6.00 CAP 1,485.00 8,910.00 1 0
CAPSUL
R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 7,890.00 7,890.00 0 1
(BPJS)
R/ ELEKTRODA 3M RED DOT 2239 3.00 PCS 1,430.00 4,290.00 0 1
R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0
REBREATHER OXYGEN MASK)
18 RI20220204-0004
DWS 04/02/2022 RI20220202-0002 RI20220204-0004 SUMUANG EFENDI SIMAMORA 352,515.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 8 of 190

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-February-2022 s/d 28-February-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

Generik
Formula Non Formula

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

R/ MEROPENEM INJEKSI 1 GR 3.00 VIAL 96,250.00 288,750.00 1 0

R/ SPASMINAL TABLET 3.00 TAB 817.00 2,451.00 0 1

R/ AQUADES 25 ML 125.00 CC 356.00 44,500.00 0 1

R/ BISOPROLOL 5 MG TAB 1.00 TAB 3,134.00 3,134.00 1 0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ FUROSEMIDE 10 MG/2 ML INJ 1.00 AMP 4,960.00 4,960.00 1 0

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

19 RI20220204-0011 04/02/2022 RI20220202-0004 RI20220204-0011 MULIAN 46,000.0

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

20 RI20220204-0014 04/02/2022 RI20220204-0001 RI20220204-0014 MUHAMAD ZAENAL ARIFIN 20,852.0

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

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

21 RI20220204-0015 04/02/2022 RI20220202-0002 RI20220204-0015 SUMUANG EFENDI SIMAMORA 1,714.0

R/ RAMIPRIL 5 MG TAB (BPJS) 2.00 TAB 857.00 1,714.00 1 0

22 RI20220204-0016 04/02/2022 RI20220202-0002 RI20220204-0016 SUMUANG EFENDI SIMAMORA 1,200.0

R/ ANEMOLAT 1 MG TAB 6.00 TAB 200.00 1,200.00 0 1

23 RI20220204-0019 04/02/2022 RI20220202-0002 RI20220204-0019 SUMUANG EFENDI SIMAMORA 25,661.0

R/ FUROSEMIDE 10 MG/2 ML INJ 5.00 AMP 4,960.00 24,800.00 1 0

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

24 RI20220205-0010 05/02/2022 RI20220204-0001 RI20220205-0010 MUHAMAD ZAENAL ARIFIN 968,093.0

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

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

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

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

R/ STARXON 1 GR INJ 2.00 VIAL 326,563.00 653,126.00 0 1

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

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

25 RI20220205-0014 05/02/2022 RI20220204-0001 RI20220205-0014 MUHAMAD ZAENAL ARIFIN 326,563.0

R/ STARXON 1 GR INJ 1.00 VIAL 326,563.00 326,563.00 0 1

26 RI20220206-0004 06/02/2022 RI20220204-0001 RI20220206-0004 MUHAMAD ZAENAL ARIFIN 92,000.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 9 of 190

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-February-2022 s/d 28-February-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/ DEXKETOPROFEN 25 MG TAB 20.00 TAB 4,600.00 92,000.00 1 0

27 RI20220206-0014 06/02/2022 RI20220206-0003 RI20220206-0014 REZA HAQQI 80,107.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

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

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

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

28 RI20220206-0016 06/02/2022 RI20220206-0003 RI20220206-0016 REZA HAQQI 7,157.0

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

29 RI20220207-0010 07/02/2022 RI20220206-0003 RI20220207-0010 REZA HAQQI 171,156.0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

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

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 8,085.00 24,255.00 1 0

500MG/5ML
30 RI20220207-0013 07/02/2022 RI20220207-0001 RI20220207-0013 MULIANTA SITEPU 204,132.0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 8,085.00 24,255.00 1 0

500MG/5ML
R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0
(BPJS)
R/ ANADIUM KAPLET 2.00 KAPLET 11,172.00 22,344.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

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

31 RI20220207-0017 07/02/2022 RI20220207-0002 RI20220207-0017 FATMAWATI 473,004.0

R/ DEXTROSE 5% 500 ML INF 1.00 FLS 21,040.00 21,040.00 0 1

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

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

R/ MEROPENEM INJEKSI 1 GR 3.00 VIAL 96,250.00 288,750.00 1 0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
32 RI20220207-0019 07/02/2022 RI20220206-0003 RI20220207-0019 REZA HAQQI 8,085.0

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 8,085.00 8,085.00 1 0

500MG/5ML
33 RI20220207-0022 07/02/2022 RI20220207-0002 RI20220207-0022 FATMAWATI 21,040.0
R/ DEXTROSE 5% 500 ML INF 1.00 FLS 21,040.00 21,040.00 0 1

34 RI20220208-0001 08/02/2022 RI20220207-0002 RI20220208-0001 FATMAWATI 5,075.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 10 of 190

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-February-2022 s/d 28-February-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/ NALD NOVORAPID 32G 1.00 PCS 5,075.00 5,075.00 0 0

35 RI20220208-0004 08/02/2022 RI20220207-0002 RI20220208-0004 FATMAWATI 415,470.0

R/ MEROPENEM INJEKSI 1 GR 3.00 VIAL 96,250.00 288,750.00 1 0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
36 RI20220208-0006 08/02/2022 RI20220207-0001 RI20220208-0006 MULIANTA SITEPU 176,790.0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ ANADIUM KAPLET 1.00 KAPLET 11,172.00 11,172.00 0 1

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 8,085.00 8,085.00 1 0

500MG/5ML
R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

37 RI20220208-0009 08/02/2022 RI20220206-0003 RI20220208-0009 REZA HAQQI 177,675.0

R/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ ASAM TRANEKSAMAT INJ 3.00 AMP 8,085.00 24,255.00 1 0
500MG/5ML
38 RI20220208-0012 08/02/2022 RI20220206-0003 RI20220208-0012 REZA HAQQI 67,500.0

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
39 RI20220208-0014 08/02/2022 RI20220207-0002 RI20220208-0014 FATMAWATI 434,136.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ MEROPENEM INJEKSI 1 GR 3.00 VIAL 96,250.00 288,750.00 1 0

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

40 RI20220208-0024 08/02/2022 RI20220207-0002 RI20220208-0024 FATMAWATI 24,360.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

41 RI20220208-0028 08/02/2022 RI20220207-0002 RI20220208-0028 FATMAWATI 19,532.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

42 RI20220208-0029 08/02/2022 RI20220207-0001 RI20220208-0029 MULIANTA SITEPU 19,532.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

43 RI20220209-0008 09/02/2022 RI20220207-0002 RI20220209-0008 FATMAWATI 442,170.0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

R/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

R/ MEROPENEM INJEKSI 1 GR 3.00 VIAL 96,250.00 288,750.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 11 of 190

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-February-2022 s/d 28-February-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

44 RI20220209-0010 09/02/2022 RI20220206-0003 RI20220209-0010 REZA HAQQI 152,490.0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 8,085.00 24,255.00 1 0

500MG/5ML
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
45 RI20220209-0018 09/02/2022 RI20220207-0001 RI20220209-0018 MULIANTA SITEPU 555.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
46 RI20220209-0029 09/02/2022 RI20220207-0002 RI20220209-0029 FATMAWATI 282,738.0

R/ OMEPRAZOLE 40 MG INJ 4.00 VIAL 63,360.00 253,440.00 1 0

(BPJS)
R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

47 RI20220209-0030 09/02/2022 RI20220207-0002 RI20220209-0030 FATMAWATI 5,075.0

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

48 RI20220209-0043 09/02/2022 RI20220207-0002 RI20220209-0043 FATMAWATI 253,440.0

R/ OMEPRAZOLE 40 MG INJ 4.00 VIAL 63,360.00 253,440.00 1 0

(BPJS)
49 RI20220210-0005 10/02/2022 RI20220207-0002 RI20220210-0005 FATMAWATI 7,024.0

R/ UNDER PAD 60 X 90 1.00 PCS 7,024.00 7,024.00 0 1

50 RI20220210-0010 10/02/2022 RI20220207-0001 RI20220210-0010 MULIANTA SITEPU 54,137.0

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

R/ FOLEY CATHETER NO. 16 1.00 PCS 24,975.00 24,975.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 1.00 PSG 21,162.00 21,162.00 0 1

51 RI20220210-0011 10/02/2022 RI20220207-0002 RI20220210-0011 FATMAWATI 318,048.0

R/ MEROPENEM INJEKSI 1 GR 3.00 VIAL 96,250.00 288,750.00 1 0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

52 RI20220210-0019 10/02/2022 RI20220210-0001 RI20220210-0019 LISNA SITORUS 126,529.0

R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

R/ HANDSCOEN STERIL NO. 6.0 1.00 PSG 27,000.00 27,000.00 0 1

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

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

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

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

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 12 of 190

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-February-2022 s/d 28-February-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

53 RI20220210-0020 10/02/2022 RI20220206-0003 RI20220210-0020 REZA HAQQI 46,813.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

R/ CUTICELL CLASSIC 10 CM X 10 2.00 PCS 16,740.00 33,480.00 0 1

CM
54 RI20220210-0022 10/02/2022 RI20220207-0002 RI20220210-0022 FATMAWATI 79,972.0

R/ SAGESTAM 40 MG INJ 4.00 AMP 19,993.00 79,972.00 0 1

55 RI20220210-0023 10/02/2022 RI20220207-0002 RI20220210-0023 FATMAWATI 7,024.0

R/ UNDER PAD 60 X 90 1.00 PCS 7,024.00 7,024.00 0 1

56 RI20220210-0024 10/02/2022 RI20220210-0001 RI20220210-0024 LISNA SITORUS 102,510.0

R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
57 RI20220210-0031 10/02/2022 RI20220207-0002 RI20220210-0031 FATMAWATI 555.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
58 RI20220210-0032 10/02/2022 RI20220207-0002 RI20220210-0032 FATMAWATI 91,059.0

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

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

59 RI20220210-0033 10/02/2022 RI20220207-0001 RI20220210-0033 MULIANTA SITEPU 154,286.0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

60 RI20220210-0039 10/02/2022 RI20220207-0001 RI20220210-0039 MULIANTA SITEPU 15,400.0

R/ ARDIUM 500 MG 2.00 TAB 7,700.00 15,400.00 0 1

61 RI20220210-0041 10/02/2022 RI20220210-0002 RI20220210-0041 RIYANDRE PRATAMA 86,604.0

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

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

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

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

62 RI20220211-0003 11/02/2022 RI20220210-0001 RI20220211-0003 LISNA SITORUS 157,533.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 13 of 190

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-February-2022 s/d 28-February-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/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

63 RI20220211-0004 11/02/2022 RI20220207-0001 RI20220211-0004 MULIANTA SITEPU 170,111.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

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

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ ANADIUM KAPLET 2.00 KAPLET 11,172.00 22,344.00 0 1

64 RI20220211-0009 11/02/2022 RI20220207-0002 RI20220211-0009 FATMAWATI 70,315.0

R/ KASA GULUNG KECIL 15 CM 2.00 ROLL 5,168.00 10,336.00 0 1

R/ SAGESTAM 40 MG INJ 3.00 AMP 19,993.00 59,979.00 0 1

65 RI20220211-0012 11/02/2022 RI20220210-0002 RI20220211-0012 RIYANDRE PRATAMA 136,486.0

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
66 RI20220211-0016 11/02/2022 RI20220211-0002 RI20220211-0016 ARTOTONG 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

67 RI20220211-0020 11/02/2022 RI20220211-0002 RI20220211-0020 ARTOTONG 7,150.0

R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

68 RI20220211-0021 11/02/2022 RI20220207-0002 RI20220211-0021 FATMAWATI 1,850.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
69 RI20220211-0028 11/02/2022 RI20220211-0002 RI20220211-0028 ARTOTONG 44,000.0

R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
70 RI20220211-0030
DWS 11/02/2022 RI20220211-0002 RI20220211-0030 ARTOTONG 69,500.0

R/ MANITOL 20 % 500 ML INF 1.00 FLS 69,500.00 69,500.00 0 1

71 RI20220211-0031 11/02/2022 RI20220211-0002 RI20220211-0031 ARTOTONG 16,006.0

R/ TRAMADOL 50MG/2ML INJ 2.00 AMP 8,003.00 16,006.00 1 0

(OOT)
72 RI20220211-0032 11/02/2022 RI20220211-0002 RI20220211-0032 ARTOTONG 39,999.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

73 RI20220212-0002 12/02/2022 RI20220211-0002 RI20220212-0002 ARTOTONG 309,280.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ TONG SPATEL 2.00 PCS 644.00 1,288.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 14 of 190

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-February-2022 s/d 28-February-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/ CITICOLINE 250 MG/2ML 4.00 AMP 30,938.00 123,752.00 0 1

INJEKSI
R/ TRAMADOL 50MG/2ML INJ 2.00 AMP 8,003.00 16,006.00 1 0
(OOT)
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
74 RI20220212-0008 12/02/2022 RI20220207-0001 RI20220212-0008 MULIANTA SITEPU 56,000.0

R/ ANADIUM KAPLET 5.00 KAPLET 11,200.00 56,000.00 0 1

75 RI20220213-0008 13/02/2022 RI20220211-0002 RI20220213-0008 ARTOTONG 305,040.0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ CITICOLINE 250 MG/2ML 3.00 AMP 30,938.00 92,814.00 0 1
INJEKSI
R/ MANITOL 20 % 500 ML INF 1.00 FLS 69,500.00 69,500.00 0 1

R/ TRAMADOL 50MG/2ML INJ 2.00 AMP 8,003.00 16,006.00 1 0

(OOT)
76 RI20220213-0010 13/02/2022 RI20220211-0002 RI20220213-0010 ARTOTONG ###

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

77 RI20220213-0018 13/02/2022 RI20220211-0002 RI20220213-0018 ARTOTONG 61,876.0

R/ CITICOLINE 250 MG/2ML 2.00 AMP 30,938.00 61,876.00 0 1

INJEKSI
78 RI20220214-0002 14/02/2022 RI20220211-0002 RI20220214-0002 ARTOTONG 61,876.0

R/ CITICOLINE 250 MG/2ML 2.00 AMP 30,938.00 61,876.00 0 1

INJEKSI
79 RI20220214-0006 14/02/2022 RI20220211-0002 RI20220214-0006 ARTOTONG 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

80 RI20220214-0021 14/02/2022 RI20220211-0002 RI20220214-0021 ARTOTONG 187,143.0

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

R/ CITICOLINE 250 MG/2ML 6.00 AMP 30,938.00 185,628.00 0 1

INJEKSI
81 RI20220214-0035 14/02/2022 RI20220211-0002 RI20220214-0035 ARTOTONG 39,999.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

82 RI20220214-0038 14/02/2022 RI20220211-0002 RI20220214-0038 ARTOTONG 861.0

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

83 RI20220215-0009 15/02/2022 RI20220211-0002 RI20220215-0009 ARTOTONG 137,505.0

R/ CITICOLINE 500 MG TAB 15.00 TAB 9,167.00 137,505.00 0 1

84 RI20220215-0019 15/02/2022 RI20220215-0002 RI20220215-0019 JEPRI PARULIAN SIHOMBING 110,799.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 15 of 190

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-February-2022 s/d 28-February-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/ SET DARAH 1.00 PCS 7,157.00 7,157.00 0 1

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

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

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

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

85 RI20220216-0003 16/02/2022 RI20220215-0002 RI20220216-0003 JEPRI PARULIAN SIHOMBING 31,288.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

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

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

86 RI20220216-0012 16/02/2022 RI20220215-0002 RI20220216-0012 JEPRI PARULIAN SIHOMBING 49,575.0

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 10,000.00 30,000.00 1 0

500MG/5ML
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

87 RI20220216-0023 16/02/2022 RI20220216-0003 RI20220216-0023 GUSTAM RIKYANTO 165,872.0

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

R/ CITICOLINE 250 MG/2ML 4.00 AMP 30,938.00 123,752.00 0 1

INJEKSI
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

88 RI20220216-0024 16/02/2022 RI20220216-0003 RI20220216-0024 GUSTAM RIKYANTO 660.0

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

89 RI20220217-0006 17/02/2022 RI20220216-0003 RI20220217-0006 GUSTAM RIKYANTO 134,328.0

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

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ CITICOLINE 250 MG/2ML 3.00 AMP 30,938.00 92,814.00 0 1

INJEKSI
90 RI20220217-0011 17/02/2022 RI20220216-0003 RI20220217-0011 GUSTAM RIKYANTO 88,200.0

R/ MANITOL 20 % 500 ML INF 1.00 FLS 88,200.00 88,200.00 0 1

91 RI20220218-0003 18/02/2022 RI20220216-0003 RI20220218-0003 GUSTAM RIKYANTO 134,328.0

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

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ CITICOLINE 250 MG/2ML 3.00 AMP 30,938.00 92,814.00 0 1

INJEKSI
92 RI20220218-0014 18/02/2022 RI20220216-0003 RI20220218-0014 GUSTAM RIKYANTO 137,505.0

R/ CITICOLINE 500 MG TAB 15.00 TAB 9,167.00 137,505.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 16 of 190

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-February-2022 s/d 28-February-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

93 RI20220218-0027 18/02/2022 RI20220218-0002 RI20220218-0027 PUSPA DEWI 25,771.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

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

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

94 RI20220219-0015 19/02/2022 RI20220218-0002 RI20220219-0015 PUSPA DEWI 47,738.0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ UNDER PAD 60 X 90 3.00 PCS 7,024.00 21,072.00 0 1

95 RI20220219-0016 19/02/2022 RI20220218-0002 RI20220219-0016 PUSPA DEWI 128,538.0

R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
96 RI20220220-0007 20/02/2022 RI20220218-0002 RI20220220-0007 PUSPA DEWI 111,622.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

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

KAPLET
R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

97 RI20220220-0026 20/02/2022 RI20220218-0002 RI20220220-0026 PUSPA DEWI 29,298.0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

98 RI20220221-0028 21/02/2022 RI20220218-0002 RI20220221-0028 PUSPA DEWI 198,715.0

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

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

R/ SAGESTAM 40 MG INJ 5.00 AMP 19,993.00 99,965.00 0 1

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

99 RI20220221-0033 21/02/2022 RI20220221-0001 RI20220221-0033 NODES SETIYAWAN 40,827.0

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

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

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

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

100 RI20220221-0043 21/02/2022 RI20220221-0001 RI20220221-0043 NODES SETIYAWAN 1,813.0

R/ NALD 23 (ONEMED) 1.00 PCS 1,813.00 1,813.00 0 1

101 RI20220221-0046 21/02/2022 RI20220221-0003 RI20220221-0046 MIKO TSABET 76,232.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 17 of 190

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-February-2022 s/d 28-February-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. 18 (VENFLON) 2.00 PCS 29,200.00 58,400.00 0 1

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

102 RI20220222-0009 22/02/2022 RI20220221-0001 RI20220222-0009 NODES SETIYAWAN 31,288.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

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

103 RI20220222-0010 22/02/2022 RI20220221-0003 RI20220222-0010 MIKO TSABET 71,937.0

R/ FOLEY CATHETER NO. 16 1.00 PCS 24,975.00 24,975.00 0 1

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 1.00 PSG 21,162.00 21,162.00 0 1

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

104 RI20220222-0021 22/02/2022 RI20220221-0001 RI20220222-0021 NODES SETIYAWAN 157,836.0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

105 RI20220222-0029 22/02/2022 RI20220221-0003 RI20220222-0029 MIKO TSABET 28,432.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

106 RI20220222-0032 22/02/2022 RI20220221-0003 RI20220222-0032 MIKO TSABET 13,613.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ NALD 26 (TERUMO) 1.00 PCS 4,713.00 4,713.00 0 1

107 RI20220223-0007 23/02/2022 RI20220221-0001 RI20220223-0007 NODES SETIYAWAN 388.0

R/ PARACETAMOL 500 MG 1.00 KAPLET 388.00 388.00 1 0

KAPLET
108 RI20220223-0008 23/02/2022 RI20220221-0001 RI20220223-0008 NODES SETIYAWAN 113,488.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
109 RI20220223-0034 23/02/2022 RI20220221-0001 RI20220223-0034 NODES SETIYAWAN 63,360.0
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)

Print Date:7/14/2022 Print Time: 2:11:10PM Page 18 of 190

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-February-2022 s/d 28-February-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

110 RI20220224-0019 24/02/2022 RI20220224-0001 RI20220224-0019 MULIANTA SITEPU 176,018.0

R/ ASAM TRANEKSAMAT INJ 2.00 AMP 10,000.00 20,000.00 1 0

500MG/5ML
R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
111 RI20220224-0020 24/02/2022 RI20220224-0001 RI20220224-0020 MULIANTA SITEPU 1,129,492.0

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

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

R/ RESFAR 25 ML 2.00 FLS 280,192.00 560,384.00 0 1

R/ ZEMINDO 60 ML SYR 2.00 BTL 52,800.00 105,600.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 3.00 PCS 11,242.00 33,726.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,667.00 5,001.00 1 0

CAPSUL
112 RI20220225-0004 25/02/2022 RI20220224-0001 RI20220225-0004 MULIANTA SITEPU 50,418.0

R/ ACETYLCYSTEIN 200 MG 2.00 CAP 1,667.00 3,334.00 1 0

CAPSUL
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

113 RI20220225-0006 25/02/2022 RI20220224-0001 RI20220225-0006 MULIANTA SITEPU 20,909.0

R/ ASAM TRANEKSAMAT INJ 2.00 AMP 10,000.00 20,000.00 1 0

500MG/5ML
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

114 RI20220225-0007 25/02/2022 RI20220224-0001 RI20220225-0007 MULIANTA SITEPU 8,900.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

115 RI20220226-0002 26/02/2022 RI20220224-0001 RI20220226-0002 MULIANTA SITEPU 78,361.0

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 10,000.00 10,000.00 1 0

500MG/5ML
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,667.00 5,001.00 1 0
CAPSUL
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

116 RI20220226-0009 26/02/2022 RI20220224-0001 RI20220226-0009 MULIANTA SITEPU 444,611.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 10,000.00 30,000.00 1 0
500MG/5ML
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 19 of 190

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-February-2022 s/d 28-February-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 13,333.00 26,666.00 1 0

R/ HANDSCOEN STERILE 3.00 PSG 18,900.00 56,700.00 0 1

(GAMMEX) NO. 7
R/ HANDSCOEN STERIL NO. 6.5 3.00 PSG 21,162.00 63,486.00 0 1

R/ FAVIKAL 200 MG TABLET 6.00 TAB 21,120.00 126,720.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,667.00 5,001.00 1 0

CAPSUL
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
117 RI20220227-0001 27/02/2022 RI20220224-0001 RI20220227-0001 MULIANTA SITEPU 1,667.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,667.00 1,667.00 1 0

CAPSUL
118 RI20220227-0009 27/02/2022 RI20220224-0001 RI20220227-0009 MULIANTA SITEPU 1,001,141.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ DEVIT 1000 IU 6.00 TAB 2,600.00 15,600.00 0 1

R/ ASAM TRANEKSAMAT INJ 2.00 AMP 10,000.00 20,000.00 1 0

500MG/5ML
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,667.00 5,001.00 1 0
CAPSUL
R/ ASERING 500 ML INF 5.00 FLS 10,800.00 54,000.00 0 1

R/ FAVIKAL 200 MG TABLET 18.00 TAB 21,120.00 380,160.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ NACL 0.9 % 500 ML INF 5.00 FLS 13,333.00 66,665.00 1 0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
119 RI20220227-0014 27/02/2022 RI20220224-0001 RI20220227-0014 MULIANTA SITEPU 280,192.0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

120 RI20220227-0016 27/02/2022 RI20220224-0001 RI20220227-0016 MULIANTA SITEPU 280,192.0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

121 RI20220228-0001 28/02/2022 RI20220224-0001 RI20220228-0001 MULIANTA SITEPU 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
122 RI20220228-0002 28/02/2022 RI20220224-0001 RI20220228-0002 MULIANTA SITEPU 382,241.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ FAVIKAL 200 MG TABLET 6.00 TAB 21,120.00 126,720.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 20 of 190

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-February-2022 s/d 28-February-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/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 10,000.00 30,000.00 1 0

500MG/5ML
123 RI20220228-0012 28/02/2022 RI20220224-0001 RI20220228-0012 MULIANTA SITEPU 21,340.0

R/ ACETYLCYSTEIN 200 MG 5.00 CAP 1,667.00 8,335.00 1 0

CAPSUL
R/ DEVIT 1000 IU 5.00 TAB 2,600.00 13,000.00 0 1

R/ VITAMIN C XON-CE KAPLET 5.00 KAPLET 1.00 5.00 0 1

124 RJ20220202-0001 02/02/2022 OP20220202-0002 2022020200002 HARIANTI 2,250.0

R/ VITAMIN B COMPLEX TAB 15.00 TAB 150.00 2,250.00 1 0

125 RJ20220202-0004 02/02/2022 OP20220202-0008 2022020200007 SUMUANG EFENDI SIMAMORA 39,999.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

126 RJ20220202-0007 02/02/2022 OP20220202-0008 2022020200013 SUMUANG EFENDI SIMAMORA 60,552.0

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

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

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

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

127 RJ20220203-0001 03/02/2022 OP20220203-0002 2022020300002 ULAN PRAWATI 69,000.0

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

128 RJ20220203-0003 03/02/2022 OP20220203-0006 2022020300005 MUHAMAD ZAENAL ARIFIN 69,000.0

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

129 RJ20220204-0001 04/02/2022 OP20220204-0001 2022020400001 DAMIANUS BEWAT 69,000.0

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

130 RJ20220207-0006 07/02/2022 OP20220207-0007 2022020700009 ROHANA BUTAR- BUTAR 139,805.0

R/ DEXKETO 15.00 TAB 4,600.00 69,000.00 1 0

PROFEN
R/ CEFIXIME
25 MG 200 MG CAP 10.00 CAP 6,188.00 61,880.00 1 0
TAB
R/ METHYLPREDNISOLONE 4 MG 15.00 TAB 595.00 8,925.00 1 0
TAB
131 RJ20220207-0010 07/02/2022 OP20220207-0016 2022020700015 PANAHATTAN NAPITUPULU 87,000.0

R/ MECOBALAMIN 500 MCG TAB 15.00 TAB 1,200.00 18,000.00 1 0

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

132 RJ20220207-0013 07/02/2022 OP20220207-0019 2022020700020 DAMIANUS BEWAT 45,855.0

R/ LEVOFLOXACIN 500 MG TAB 10.00 TAB 1,557.00 15,570.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 21 of 190

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-February-2022 s/d 28-February-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 15.00 KAPLET 2,019.00 30,285.00 0 1

133 RJ20220210-0001 10/02/2022 OP20220210-0001 2022021000002 LISNA SITORUS 118,973.0

R/ FOLEY CATHETER NO. 16 1.00 PCS 24,975.00 24,975.00 0 1

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

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

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

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

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

134 RJ20220211-0003 11/02/2022 OP20220211-0005 2022021100003 ARTOTONG 319,645.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

R/ OMEPRAZOLE 40 MG INJ 2.00 VIAL 63,360.00 126,720.00 1 0

(BPJS)
R/ TRAMADOL 50MG/2ML INJ 2.00 AMP 8,003.00 16,006.00 1 0
(OOT)
R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

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

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

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

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

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

R/ CITICOLINE 250 MG/2ML 3.00 AMP 30,938.00 92,814.00 0 1

INJEKSI
135 RJ20220212-0002 12/02/2022 OP20220212-0006 2022021200004 GITHA PAKPAHAN 8,925.0

R/ METHYLPREDNISOLONE 4 MG 15.00 TAB 595.00 8,925.00 1 0

TAB
136 RJ20220214-0006 14/02/2022 OP20220214-0008 2022021400006 REZA HAQQI 1,850.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
137 RJ20220214-0008 14/02/2022 OP20220214-0009 2022021400009 FATMAWATI 2,775.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 185.00 2,775.00 1 0

KAPLET
138 RJ20220215-0003 15/02/2022 OP20220215-0005 2022021500003 LISNA SITORUS 4,576.0

R/ GENTALEX 5 MG CREAM 1.00 TUBE 4,576.00 4,576.00 0 1

139 RJ20220216-0010 16/02/2022 OP20220216-0012 2022021600011 FAHRI ALDIANO 1,850.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
140 RJ20220218-0003 18/02/2022 OP20220218-0006 2022021800004 DAMIANUS BEWAT 84,570.0
R/ DEXKETOPROFEN 25 MG TAB 15.00 TAB 4,600.00 69,000.00 1 0

R/ LEVOFLOXACIN 500 MG TAB 10.00 TAB 1,557.00 15,570.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 22 of 190

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-February-2022 s/d 28-February-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

141 RJ20220218-0005 18/02/2022 OP20220218-0009 2022021800006 RIYANDRE PRATAMA 69,000.0

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

142 RJ20220219-0001 19/02/2022 OP20220219-0002 2022021900002 MUHAMAD ZAENAL ARIFIN 294,570.0

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

R/ STAR AG GEL 50 GR 1.00 TUBE 210,000.00 210,000.00 0 1

R/ LEVOFLOXACIN 500 MG TAB 10.00 TAB 1,557.00 15,570.00 1 0

143 RJ20220219-0002 19/02/2022 OP20220219-0003 2022021900003 ARTOTONG 137,505.0

R/ CITICOLINE 500 MG TAB 15.00 TAB 9,167.00 137,505.00 0 1

144 RJ20220221-0002 21/02/2022 OP20220221-0001 2022022100002 GUSTAM RIKYANTO 5,820.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 388.00 5,820.00 1 0

KAPLET
145 RJ20220221-0004 21/02/2022 OP20220221-0005 2022022100004 MULIANTA SITEPU 69,000.0

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

146 RJ20220221-0005 21/02/2022 OP20220221-0010 2022022100005 RIYANDRE PRATAMA 27,600.0

R/ DEXKETOPROFEN 25 MG TAB 6.00 TAB 4,600.00 27,600.00 1 0

147 RJ20220222-0002 22/02/2022 OP20220222-0001 2022022200002 MUHAMAD ZAENAL ARIFIN 84,570.0

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

R/ LEVOFLOXACIN 500 MG TAB 10.00 TAB 1,557.00 15,570.00 1 0

148 RJ20220223-0003 23/02/2022 OP20220223-0002 2022022300004 EKSA MERIYATI PURBA 204,443.0

R/ BURNAZIN 35 GR CREAM 1.00 TUBE 73,563.00 73,563.00 0 1

R/ CEFIXIME 200 MG CAP 10.00 CAP 6,188.00 61,880.00 1 0

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

149 RJ20220224-0002 24/02/2022 OP20220224-0002 2022022400002 RIYANDRE PRATAMA 4,576.0

R/ GENTALEX 5 MG CREAM 1.00 TUBE 4,576.00 4,576.00 0 1

150 RJ20220226-0001 26/02/2022 OP20220226-0001 2022022600001 NODES SETIYAWAN 5,825.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 388.00 5,820.00 1 0

KAPLET
R/ VITAMIN C XON-CE KAPLET 5.00 KAPLET 1.00 5.00 0 1

Total Dokter DR. IKHSAN, SP.B 17,244,341.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 23 of 190
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-February-2022 s/d 28-February-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 RD20220214-0001 14/02/2022 EP20220214-0001 2022021400001 NOVIA RAMADHANI 92,520.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

2 RD20220214-0002 14/02/2022 EP20220214-0003 2022021400007 DESI ERNAWATI 119,300.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 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/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
3 RD20220214-0003 14/02/2022 EP20220214-0004 2022021400009 NURUL APRILIA 206,470.0

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

4 RD20220214-0004 14/02/2022 EP20220214-0002 2022021400010 RIKI RICARDO YUNUS 245,800.0

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

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

5 RD20220214-0005 14/02/2022 EP20220214-0005 2022021400011 MANGIRING GULTOM 204,410.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

6 RD20220214-0006 14/02/2022 EP20220214-0007 2022021400013 JUMALI WIDODO 253,000.0

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

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

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

7 RD20220214-0007 14/02/2022 EP20220214-0009 2022021400015 HASTONI 41,468.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,788.00 36,788.00 0 0

DROP

Print Date:7/14/2022 Print Time: 2:11:10PM Page 24 of 190

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-February-2022 s/d 28-February-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

8 RD20220214-0008 14/02/2022 EP20220214-0010 2022021400016 SAHAT PARULIAN SIREGAR 249,435.0

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

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

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ ORALIT SACHET 10.00 SACH 515.00 5,150.00 0 1

9 RD20220214-0010 14/02/2022 EP20220214-0013 2022021400023 LALU MUH SATRIA BUDI 1,850.0

PRATAMA

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
10 RD20220214-0011 14/02/2022 EP20220214-0012 2022021400027 NANDA ADITIA PRIMA DEWI 26,950.0
ARIFIN

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
11 RD20220214-0012 14/02/2022 EP20220214-0012 2022021400028 NANDA ADITIA PRIMA DEWI 239,382.0
ARIFIN

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ FREGO 5 MG TAB 10.00 TAB 8,448.00 84,480.00 0 0

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

12 RD20220214-0013 14/02/2022 EP20220214-0006 2022021400029 RAHMA YUNIARTI ALI 132,528.0

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

13 RD20220214-0014 14/02/2022 EP20220214-0011 2022021400030 OBE HERDIANTO SIMBOLON 125,200.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

14 RD20220214-0015 14/02/2022 EP20220214-0015 2022021400031 HALIMAH FITRI BATAMI 152,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

15 RD20220214-0016 14/02/2022 EP20220214-0016 2022021400032 RAHEL HELSI KAROLA 93,538.0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 25 of 190

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-February-2022 s/d 28-February-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 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

16 RD20220214-0017 14/02/2022 EP20220214-0018 2022021400033 CHRISTIN MEGAWATY 142,250.0

SIREGAR

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
17 RD20220214-0019 14/02/2022 EP20220214-0020 2022021400035 WIKY ALEX SANDRA 228,990.0

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 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

18 RD20220214-0020 14/02/2022 EP20220214-0019 2022021400036 NUR ANDINI SYAFITRI 20,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

19 RD20220214-0023 14/02/2022 EP20220214-0021 2022021400045 RANA AFRILIA PUTRI 339,285.0

R/ FREGO 5 MG TAB 2.00 TAB 8,448.00 16,896.00 0 0

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 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 468.00 4,680.00 0 1

20 RD20220215-0025 15/02/2022 EP20220215-0022 2022021500027 PUTRI AYU SIHITE 242,870.0

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

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

21 RD20220215-0026 15/02/2022 EP20220215-0023 2022021500028 TOMMY WIJAYA MANURUNG 197,768.0

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

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

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

22 RD20220215-0027 15/02/2022 EP20220215-0024 2022021500030 DAME SIHOTANG 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)

Print Date:7/14/2022 Print Time: 2:11:10PM Page 26 of 190

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-February-2022 s/d 28-February-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

23 RD20220215-0028 15/02/2022 EP20220215-0024 2022021500031 DAME SIHOTANG 1,850.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
24 RD20220215-0029 15/02/2022 EP20220215-0025 2022021500032 RONALDO FEBRYAN 190,740.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

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

25 RD20220215-0030 15/02/2022 EP20220215-0026 2022021500033 TRI SARA NAINGGOLAN 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
26 RD20220215-0031 15/02/2022 EP20220215-0026 2022021500034 TRI SARA NAINGGOLAN 61,900.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ AMBROXOL 30 MG TAB 10.00 TAB 285.00 2,850.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

27 RD20220215-0032 15/02/2022 EP20220215-0028 2022021500035 KINTAN HANNAN ASRAWI 159,800.0

DARMA

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

28 RD20220215-0033 15/02/2022 EP20220215-0027 2022021500038 ANDI SAPUTRA 64,020.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

29 RD20220215-0034 15/02/2022 EP20220215-0029 2022021500039 FUTRI SIHOMBING 190,740.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

30 RD20220215-0035 15/02/2022 EP20220215-0031 2022021500043 AGAM ABDILAH HASIBUAN 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 27 of 190

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-February-2022 s/d 28-February-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

31 RD20220215-0036 15/02/2022 EP20220215-0031 2022021500044 AGAM ABDILAH HASIBUAN 15,813.0

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

32 RD20220 15/02/2022 EP20220215-0030 2022021500045 RYAN RAMADHANI 138,938.0

215-0037

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 591.00 5,910.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

33 RD20220215-0038 15/02/2022 EP20220215-0033 2022021500047 KHANZA ABIR ADZKIYA 66,000.0

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

34 RD20220215-0039 15/02/2022 EP20220215-0034 2022021500048 JOVIAN ALEXSANDER 82,088.0

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

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

35 RD20220215-0041 15/02/2022 EP20220215-0035 2022021500056 NELLY RYANTY PAKPAHAN 7,940.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ RANITIDINE 150 MG TAB 10.00 TAB 200.00 2,000.00 1 0

R/ METOCLOPRAMIDE 10 MG TAB 10.00 TAB 186.00 1,860.00 1 0

36 RD20220215-0042 15/02/2022 EP20220215-0036 2022021500057 ZEFRI SIMANJUNTAK 224,910.0

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

37 RD20220215-0043 15/02/2022 EP20220215-0037 2022021500058 AMIRA RIZKI PUTRI 58,438.0

R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
38 RD20220215-0044 15/02/2022 EP20220215-0040 2022021500059 DINA MUSTIKA ROHMAH 69,760.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

39 RD20220215-0045 15/02/2022 EP20220215-0040 2022021500060 DINA MUSTIKA ROHMAH 136,360.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 28 of 190

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-February-2022 s/d 28-February-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 RD20220215-0046 15/02/2022 EP20220215-0042 2022021500063 M.RIZKI NANDA 27,180.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

R/ VITAMIN B COMPLEX TAB 10.00 TAB 150.00 1,500.00 1 0

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

41 RD20220215-0047 15/02/2022 EP20220215-0038 2022021500065 SHEIVIA AQHILLA 95,838.0

MAHDALENA

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

42 RD20220215-0048 15/02/2022 EP20220215-0039 2022021500064 IRMA SITEPU 211,449.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ FLUNARIZINE 5 MG TAB 5.00 TAB 1,760.00 8,800.00 1 0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

43 RD20220215-0049 15/02/2022 EP20220215-0042 2022021500066 M.RIZKI NANDA 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

44 RD20220216-0021 16/02/2022 EP20220216-0021 2022021600036 AHMAD RIADI LUBIS 95,300.0

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

R/ INBUMIN TAB 250 MG 5.00 TAB 8,556.00 42,780.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

45 RD20220216-0022 16/02/2022 EP20220216-0020 2022021600037 OGENDO NAIBAHO 73,430.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ NEW DIATAB TABLET 10.00 TAB 696.00 6,960.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

46 RD20220216-0023 16/02/2022 EP20220216-0022 2022021600038 NUR OKTAPIANI 39,670.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

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

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

47 RD20220216-0024 16/02/2022 EP20220216-0023 2022021600039 RIZKO HENDRAWAN 14,050.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0
KAPLET

Print Date:7/14/2022 Print Time: 2:11:10PM Page 29 of 190

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-February-2022 s/d 28-February-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/ CETIRIZINE 10 MG TAB 10.00 TAB 1,000.00 10,000.00 1 0

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

48 RD20220216-0025 16/02/2022 EP20220216-0025 2022021600042 DIANA SUMIATI 188,900.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

49 RD20220216-0026 16/02/2022 EP20220216-0024 2022021600043 GUSTAM RIKYANTO 105,876.0

R/ CITICOLINE 250 MG/2ML 2.00 AMP 30,938.00 61,876.00 0 1

INJEKSI
R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0
REBREATHER OXYGEN MASK)
50 RD20220216-0027
DWS 16/02/2022 EP20220216-0026 2022021600047 CHRISTINA RONAULI SIAGIAN 150,020.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

51 RD20220216-0028 16/02/2022 EP20220216-0027 2022021600048 MIFTA WAHYU PUTRI 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
52 RD20220216-0029 16/02/2022 EP20220216-0029 2022021600050 MARIA MAGDALENA HENUKH 31,000.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

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

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
53 RD20220216-0030 16/02/2022 EP20220216-0031 2022021600051 SUPRIYANTI 77,690.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

54 RD20220216-0031 16/02/2022 EP20220216-0030 2022021600052 SAUT P PANGARIBUAN 361,250.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

55 RD20220216-0032 16/02/2022 EP20220216-0030 2022021600053 SAUT P PANGARIBUAN 10,000.0

R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1

56 RD20220216-0033 16/02/2022 EP20220216-0032 2022021600056 MONIKA SARAS WATI T 206,470.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 30 of 190

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-February-2022 s/d 28-February-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

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

57 RD20220218-0001 18/02/2022 EP20220218-0001 2022021800001 IDA LAIA 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
58 RD20220218-0002 18/02/2022 EP20220218-0001 2022021800004 IDA LAIA 20,170.0

R/ SPASMINAL TABLET 10.00 TAB 817.00 8,170.00 0 1

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

59 RD20220218-0003 18/02/2022 EP20220218-0002 2022021800003 MARTUA SIBURIAN 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

60 RD20220218-0004 18/02/2022 EP20220218-0002 2022021800005 MARTUA SIBURIAN 12,000.0

R/ SUPRAFENID SUPP 1.00 SUPP 12,000.00 12,000.00 0 1

61 RD20220218-0006 18/02/2022 EP20220218-0004 2022021800012 WESLEY ARMANDO NABABAN 0.0

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

62 RD20220218-0009 18/02/2022 EP20220218-0003 2022021800017 RANI LESTARI MANURUNG 388.0

R/ PARACETAMOL 500 MG 1.00 KAPLET 388.00 388.00 1 0

KAPLET
63 RD20220220-0001 20/02/2022 EP20220220-0001 2022022000001 ZHANG KAILI 138,080.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ INBUMIN TAB 250 MG 10.00 TAB 8,556.00 85,560.00 0 1

64 RD20220221-0001 21/02/2022 EP20220221-0001 2022022100003 RISKI WAHYUDI SIKUMBANG 75,528.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

65 RD20220223-0002 23/02/2022 EP20220223-0002 2022022300003 ADITIA 297,460.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 31 of 190

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-February-2022 s/d 28-February-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

66 RD20220223-0003 23/02/2022 EP20220223-0004 2022022300004 TRI APRILLENY 253,870.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

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

67 RD20220223-0004 23/02/2022 EP20220223-0003 2022022300005 FIONA OKTAVIANI 107,700.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

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

68 RD20220223-0005 23/02/2022 EP20220223-0005 2022022300007 YUNI LUKITO KARYA 7,340.0

R/ VITAMIN B COMPLEX TAB 10.00 TAB 150.00 1,500.00 1 0

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

KAPLET
R/ GLIBENCLAMIDE 5 MG TAB 10.00 TAB 126.00 1,260.00 1 0

69 RD20220223-0006 23/02/2022 EP20220223-0005 2022022300008 YUNI LUKITO KARYA 5,168.0

R/ KASA GULUNG KECIL 15 CM 1.00 ROLL 5,168.00 5,168.00 0 1

70 RD20220223-0007 23/02/2022 EP20220223-0007 2022022300009 TRESIA SITUMORANG 44,680.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

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

71 RD20220223-0008 23/02/2022 EP20220223-0006 2022022300010 YUYUN PARIDA YANTI 146,000.0

R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1

72 RD20220223-0009 23/02/2022 EP20220223-0006 2022022300011 YUYUN PARIDA YANTI 114,690.0

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

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

73 RD20220223-0010 23/02/2022 EP20220223-0008 2022022300014 DEWI KRISTINA BR SINAGA 29,890.0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

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

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
74 RD20220223-0011 23/02/2022 EP20220223-0009 2022022300017 LISPIDA ROSTIKA 112,198.0

R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 32 of 190

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-February-2022 s/d 28-February-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 23,788.00 23,788.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

75 RD20220223-0012 23/02/2022 EP20220223-0010 2022022300020 DEWI SARTIKA SITINJAK 281,020.0

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

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

76 RD20220224-0012 24/02/2022 EP20220224-0010 2022022400025 GIBRAN GHANI ALKHALID 110,276.0

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

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

77 RD20220224-0013 24/02/2022 EP20220224-0011 2022022400027 PANUTURAN SAMOSIR 115,360.0

R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

78 RD20220224-0014 24/02/2022 EP20220224-0012 2022022400029 DIKI PRATAMA PUTRA 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
79 RD20220224-0015 24/02/2022 EP20220224-0013 2022022400037 KHATERIN YOLA GRANTSLICE 11,990.0
SIHOTANG

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

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

R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 591.00 5,910.00 1 0

80 RD20220224-0016 24/02/2022 EP20220224-0014 2022022400038 SHINDY VALENTINA BR 88,410.0

NAPITUPULU

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 33 of 190

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-February-2022 s/d 28-February-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/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

81 RD20220224-0017 24/02/2022 EP20220224-0015 2022022400039 RAUZATUN NURAKFAL 88,410.0

R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

82 RD20220224-0018 24/02/2022 EP20220224-0017 2022022400042 MARIA DASILVA PIRE 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

83 RD20220224-0019 24/02/2022 EP20220224-0016 2022022400043 M.ADI MULIA 42,740.0

R/ AMBROXOL 30 MG TAB 10.00 TAB 285.00 2,850.00 1 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
R/ CETIRIZINE 10 MG TAB 10.00 TAB 1,000.00 10,000.00 1 0

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

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

84 RD20220224-0020 24/02/2022 EP20220224-0017 2022022400044 MARIA DASILVA PIRE ###

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

85 RD20220224-0021 24/02/2022 EP20220224-0018 2022022400045 RENTANIA SEFTARITA 6,640.0

PANJAITAN

R/ VITAMIN B COMPLEX TAB 10.00 TAB 150.00 1,500.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

86 RD20220224-0022 24/02/2022 EP20220224-0019 2022022400046 MAHAMPUKATON GALANG 9,330.0

HAKIK

R/ DOMPERIDON 10 MG TAB 10.00 TAB 545.00 5,450.00 1 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
87 RD20220224-0023 24/02/2022 EP20220224-0019 2022022400047 MAHAMPUKATON GALANG 63,360.0
HAKIK

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
88 RD20220224-0024 24/02/2022 EP20220224-0020 2022022400049 RIA RINDI SARI 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
89 RD20220225-0021 25/02/2022 EP20220225-0025 2022022500044 HERMANSYAH 3,880.0
R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0
KAPLET

Print Date:7/14/2022 Print Time: 2:11:10PM Page 34 of 190

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-February-2022 s/d 28-February-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

90 RD20220226-0001 26/02/2022 EP20220226-0001 2022022600001 ABID RAFFASYAH PRANAJA 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

91 RD20220226-0003 26/02/2022 EP20220226-0002 2022022600004 TIOLINAR SIRUMAPEA 68,680.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,667.00 16,670.00 1 0

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

R/ DEVIT 1000 IU 20.00 TAB 2,600.00 52,000.00 0 1

92 RD20220227-0010 27/02/2022 EP20220227-0004 2022022700012 ANGGUN MARAWULENG 131,208.0

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

R/ TREMENZA TABLET 10.00 TAB 2,001.00 20,010.00 0 1

(PREKURSOR)
R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

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

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

93 RD20220227-0011 27/02/2022 EP20220227-0005 2022022700013 ENDAH DWI RIYANI 288,660.0

R/ MERTIGO 6 MG TAB 10.00 TAB 4,987.00 49,870.00 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 5,800.00 29,000.00 0 1

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

94 RD20220227-0012 27/02/2022 EP20220227-0006 2022022700014 DIAZ JOSHUA SIMAMORA 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

95 RD20220227-0013 27/02/2022 EP20220227-0006 2022022700015 DIAZ JOSHUA SIMAMORA 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

96 RD20220227-0015 27/02/2022 EP20220227-0006 2022022700017 DIAZ JOSHUA SIMAMORA 0.0

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

97 RD20220227-0016 27/02/2022 EP20220227-0007 2022022700018 RITA 13,990.0

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

R/ RANITIDINE 150 MG TAB 10.00 TAB 200.00 2,000.00 1 0

R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 591.00 5,910.00 1 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
 Total Dokter DR. DIKA CAHAYA PUTRI 9,884,820.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 35 of 190

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-February-2022 s/d 28-February-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 RD20220202-0003 02/02/2022 EP20220202-0003 2022020200003 ROZI KURNIA MARTA 521,318.0

R/ FREGO 5 MG TAB 5.00 TAB 8,448.00 42,240.00 0 0

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

R/ BETAHISTINE 6 MG TAB 10.00 TAB 881.00 8,810.00 1 0

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ MELOXICAM 7,5 MG TAB 6.00 TAB 1,038.00 6,228.00 1 0

2 RD20220202-0005 02/02/2022 EP20220202-0006 2022020200008 PUTRI PRATIWI 251,085.0

R/ VOMETA FT 10 MG TAB 5.00 TAB 5,867.00 29,335.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

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

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ FREGO 5 MG TAB 5.00 TAB 8,448.00 42,240.00 0 0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

3 RD20220202-0006 02/02/2022 EP20220202-0004 2022020200009 SITI MAIMUNAH RAMBE 313,634.0

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 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 5,800.00 29,000.00 0 1

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/ AMLODIPINE 5 MG TAB 15.00 TAB 1,047.00 15,705.00 1 0

4 RD20220202-0007 02/02/2022 EP20220202-0007 2022020200010 ABDI SANTOSO 78,658.0

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.00 3,710.00 1 0

R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1

R/ METHYLPREDNISOLONE 4 MG 10.00 TAB 595.00 5,950.00 1 0

TAB
R/ BRAXIDIN TABLET 2.00 TAB 14,094.00 28,188.00 0 0
(PSIKOTROPIKA)
R/ KETOPROFEN 100 MG TAB 10.00 TAB 1,826.00 18,260.00 1 0

5 RD20220202-0008 02/02/2022 EP20220202-0010 2022020200013 MUHAMMAD IKHSAN ADHETYA 73,000.0

NUGRAHA

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

6 RD20220202-0009 02/02/2022 EP20220202-0010 2022020200014 MUHAMMAD IKHSAN ADHETYA 191,290.0
NUGRAHA

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 36 of 190

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-February-2022 s/d 28-February-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/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

7 RD20220202-0010 02/02/2022 EP20220202-0009 2022020200015 LISA 448,924.0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

8 RD20220202-0011 02/02/2022 EP20220202-0011 2022020200016 NERLY SIHOMBING 10,956.0

R/ KETOPROFEN 100 MG TAB 6.00 TAB 1,826.00 10,956.00 1 0

9 RD20220202-0012 02/02/2022 EP20220202-0013 2022020200017 YUNI MANULLANG 114,735.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

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/ 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

10 RD20220205-0005 05/02/2022 EP20220205-0005 2022020500009 ALMA FAUZIAH 72,270.0

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

R/ PARACETAMOL 500 MG 6.00 KAPLET 185.00 1,110.00 1 0

KAPLET
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)
11 RD20220205-0006 05/02/2022 EP20220205-0006 2022020500010 ROIDA SIHOTANG 8,910.0

R/ PARACETAMOL 500 MG 6.00 KAPLET 185.00 1,110.00 1 0

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

12 RD20220209-0004 09/02/2022 EP20220209-0002 2022020900004 OLIDI 85,016.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ LANSOPRAZOLE 30 MG CAPS 6.00 CAP 1,689.00 10,134.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ ONDANSETRON 4 MG TAB 6.00 TAB 2,167.00 13,002.00 1 0

13 RD20220209-0006 09/02/2022 EP20220209-0004 2022020900011 RAYA SIHOMBING 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)
Print Date:7/14/2022 Print Time: 2:11:10PM Page 37 of 190
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-February-2022 s/d 28-February-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

14 RD20220209-0007 09/02/2022 EP20220209-0005 2022020900012 N.SAUT PARHITEAN 122,470.0

PAKPAHAN

R/ INBUMIN TAB 250 MG 10.00 TAB 8,556.00 85,560.00 0 1

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

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

15 RD20220209-0008 09/02/2022 EP20220209-0006 2022020900013 SARI KRISTIANI JULIETA BR 268,929.0

SIANTURI

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

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

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

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

16 RD20220209-0009 09/02/2022 EP20220209-0007 2022020900014 SIAME MANAO 10,080.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ CETIRIZINE 10 MG TAB 6.00 TAB 1,000.00 6,000.00 1 0

17 RD20220209-0010 09/02/2022 EP20220209-0009 2022020900017 DIMAS ALDI PRATAMA 326,563.0

R/ STARXON 1 GR INJ 1.00 VIAL 326,563.00 326,563.00 0 1

18 RD20220209-0011 09/02/2022 EP20220209-0009 2022020900018 DIMAS ALDI PRATAMA 7,813.0

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

KAPLET
R/ CEFIXIME 100 MG CAP 1.00 CAP 3,233.00 3,233.00 1 0

19 RD20220209-0013 09/02/2022 EP20220209-0003 2022020900023 CLARA OLIVIA SINAGA 50,625.0

R/ ARMSLING SIZE M 1.00 PCS 50,625.00 50,625.00 0 1

20 RD20220210-0002 10/02/2022 EP20220210-0002 2022021000003 NADIA ZAHRA AMRI 179,872.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.00 4,452.00 1 0

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

21 RD20220210-0003 10/02/2022 EP20220210-0006 2022021000006 WISNU SYAHFITRI 200,218.0

R/ ORALIT SACHET 10.00 SACH 515.00 5,150.00 0 1

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

R/ VOMIZOLE 20 MG TAB 6.00 TAB 19,433.00 116,598.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 38 of 190

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-February-2022 s/d 28-February-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/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

22 RD20220210-0004 10/02/2022 EP20220210-0007 2022021000007 NANDA SURYA KUSUMA 160,038.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ PROZA SYR 1.00 FLS 117,000.00 117,000.00 0 1

23 RD20220210-0005 10/02/2022 EP20220210-0005 2022021000008 ENDAH DWI RIYANI 60,630.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

24 RD20220210-0006 10/02/2022 EP20220210-0008 2022021000011 MUTIA ANGRAINI 67,180.0

R/ CETIRIZINE 10 MG TAB 5.00 TAB 1,000.00 5,000.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

25 RD20220210-0007 10/02/2022 EP20220210-0009 2022021000012 CHELSEA DWI NOVITA SARI 8,900.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

26 RD20220210-0008 10/02/2022 EP20220210-0009 2022021000013 CHELSEA DWI NOVITA SARI 190,070.0

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

27 RD20220210-0009 10/02/2022 EP20220210-0010 2022021000015 PUTRI EISYA L SIMANJUNTAK 238,780.0

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

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

28 RD20220210-0010 10/02/2022 EP20220210-0013 2022021000019 PUTRI KIRANTI 8,900.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

29 RD20220210-0011 10/02/2022 EP20220210-0011 2022021000020 RAFI YANDO RAMDAN 8,900.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

30 RD20220210-0012 10/02/2022 EP20220210-0012 2022021000021 PUTRI APRILLIYANI 231,062.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 39 of 190

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-February-2022 s/d 28-February-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/ CORTIDEX 0,5 MG TAB 6.00 TAB 399.00 2,394.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ VOMIZOLE 20 MG TAB 6.00 TAB 19,433.00 116,598.00 0 1

31 RD20220210-0013 10/02/2022 EP20220210-0013 2022021000022 PUTRI KIRANTI 208,948.0

R/ VOMIZOLE 20 MG TAB 6.00 TAB 19,433.00 116,598.00 0 1

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/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

32 RD20220210-0014 10/02/2022 EP20220210-0011 2022021000023 RAFI YANDO RAMDAN 244,020.0

R/ COLERGIS TABLET 6.00 TAB 3,667.00 22,002.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ VOMIZOLE 20 MG TAB 6.00 TAB 19,433.00 116,598.00 0 1

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

33 RD20220210-0016 10/02/2022 EP20220210-0016 2022021000025 PANGERAN HUTAGALUNG 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

34 RD20220210-0017 10/02/2022 EP20220210-0016 2022021000026 PANGERAN HUTAGALUNG 134,888.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

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

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

35 RD20220212-0001 12/02/2022 EP20220212-0002 2022021200001 NADA SUHALLAH 116,352.0

R/ COLERGIS TABLET 6.00 TAB 3,667.00 22,002.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ RANITIDINE 150 MG TAB 10.00 TAB 200.00 2,000.00 1 0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

36 RD20220212-0002 12/02/2022 EP20220212-0001 2022021200002 N.SAUT PARHITEAN 148,920.0

PAKPAHAN

R/ INBUMIN TAB 250 MG 10.00 TAB 8,556.00 85,560.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

37 RD20220212-0003 12/02/2022 EP20220212-0005 2022021200005 ERZON 377,240.0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 40 of 190

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-February-2022 s/d 28-February-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 26,950.00 26,950.00 0 1

(OOT)
R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1
(PREKURSOR)
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/ KETOPROFEN 100 MG TAB 10.00 TAB 1,826.00 18,260.00 1 0

38 RD20220212-0004 12/02/2022 EP20220212-0004 2022021200006 MUHAMMAD HUSEIN 20,500.0

HERWANTO

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

39 RD20220213-0006 13/02/2022 EP20220213-0004 2022021300009 RISKA ROSSITA 494,734.0

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

40 RD20220213-0007 13/02/2022 EP20220213-0005 2022021300010 INDRI ULANDARI 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

41 RD20220213-0008 13/02/2022 EP20220213-0005 2022021300011 INDRI ULANDARI 284,890.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ VOMETA FT 10 MG TAB 5.00 TAB 5,867.00 29,335.00 0 1

R/ FREGO 5 MG TAB 5.00 TAB 8,448.00 42,240.00 0 0

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

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

42 RD20220213-0009 13/02/2022 EP20220213-0006 2022021300012 ANGGELINUS ARYANTO 83,732.0

R/ PROVITAL PLUS CAPS 3.00 CAP 5,800.00 17,400.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.00 4,452.00 1 0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

43 RD20220213-0010 13/02/2022 EP20220213-0007 2022021300014 NURIA RITONGA 46,694.0

R/ CERINI 10 MG TABLET 1.00 TAB 4,716.00 4,716.00 0 1

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,788.00 36,788.00 0 0

R/ MELOXICAM 7,5 MG TAB 5.00 TAB 1,038.00 5,190.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 41 of 190

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-February-2022 s/d 28-February-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

44 RD20220213-0011 13/02/2022 EP20220213-0008 2022021300019 MEYSTAVIA BERTA WAHYU 508,591.0

RENGGANIS

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ FREGO 5 MG TAB 2.00 TAB 8,448.00 16,896.00 0 0

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

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

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

45 RD20220213-0012 13/02/2022 EP20220213-0008 2022021300018 MEYSTAVIA BERTA WAHYU 73,000.0

RENGGANIS

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

46 RD20220213-0013 13/02/2022 EP20220213-0010 2022021300021 SAHURI 36,910.0

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

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

47 RD20220213-0015 13/02/2022 EP20220213-0012 2022021300027 MARIA GISELA NONA 34,220.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

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

48 RD20220213-0019 13/02/2022 EP20220213-0013 2022021300039 SILVIA MAHESTI 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

49 RD20220214-0021 14/02/2022 EP20220214-0022 2022021400043 CHAIRUL AZMI 199,654.0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
50 RD20220214-0022 14/02/2022 EP20220214-0023 2022021400044 NUR ASIYAH HASIBUAN 237,013.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ FREGO 5 MG TAB 2.00 TAB 8,448.00 16,896.00 0 0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

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

R/ VOMETA FT 10 MG TAB 6.00 TAB 5,867.00 35,202.00 0 1

51 RD20220214-0024 14/02/2022 EP20220214-0024 2022021400046 SURUNG SIAHAAN 29,570.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.00 3,710.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 42 of 190

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-February-2022 s/d 28-February-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/ FLUNARIZINE 5 MG TAB 2.00 TAB 1,760.00 3,520.00 1 0

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

52 RD20220214-0025 14/02/2022 EP20220214-0025 2022021400047 MUHAMMAD ABIDZAR 44,773.0

ALGIFARI

R/ INBUMIN TAB 250 MG 3.00 TAB 8,556.00 25,668.00 0 1

R/ CEFIXIME 100 MG CAP 5.00 CAP 3,233.00 16,165.00 1 0

R/ SANMOL 500 MG TABLET 5.00 TAB 408.00 2,040.00 0 1

R/ KERTAS PERKAMEN BERLOGO 9.00 LBR 1.00 100.00 900.00 0 1

53 RD20220214-0026 14/02/2022 EP20220214-0026 2022021400049 RUSMARIANA SITUMORANG 232,446.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ VOMETA FT 10 MG TAB 6.00 TAB 5,867.00 35,202.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

54 RD20220214-0027 14/02/2022 EP20220214-0027 2022021400050 NOVIATI 184,569.0

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

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

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
55 RD20220214-0028 14/02/2022 EP20220214-0028 2022021400053 HAMBALI MURDANI 619,360.0

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

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 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/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

56 RD20220214-0029 14/02/2022 EP20220214-0029 2022021400054 AGUS NOVITA 580,805.0

R/ FREGO 5 MG TAB 5.00 TAB 8,448.00 42,240.00 0 0

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

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

R/ VOMETA FT 10 MG TAB 5.00 TAB 5,867.00 29,335.00 0 1

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 43 of 190

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-February-2022 s/d 28-February-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

57 RD20220214-0030 14/02/2022 EP20220214-0030 2022021400055 BOY HARPIT AKROMA 61,600.0

R/ REMOPAIN INJ AMPUL 1.00 AMP 61,600.00 61,600.00 0 1

58 RD20220214-0031 14/02/2022 EP20220214-0030 2022021400057 BOY HARPIT AKROMA 183,455.0

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

R/ FLUNARIZINE 5 MG TAB 3.00 TAB 1,760.00 5,280.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

59 RD20220214-0032 14/02/2022 EP20220214-0031 2022021400058 CARINIH 172,500.0

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

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

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

60 RD20220214-0033 14/02/2022 EP20220214-0032 2022021400059 MAYA SANTI 127,910.0

R/ ALPRAZOLAM 0,5 MG TAB 3.00 TAB 790.00 2,370.00 0 0

(PSI)
R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

61 RD20220214-0034 14/02/2022 EP20220214-0033 2022021400060 AURELIA TASHA TAMPUBOLON 80,670.0

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

62 RD20220214-0035 14/02/2022 EP20220214-0034 2022021400061 CHRISTYANTO MANULLANG 135,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

63 RD20220215-0050 15/02/2022 EP20220215-0041 2022021500068 SRI UTAMI 114,700.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

64 RD20220215-0051 15/02/2022 EP20220215-0044 2022021500069 BENNY NABABAN 164,836.0

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 44 of 190

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-February-2022 s/d 28-February-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/ FREGO 5 MG TAB 2.00 TAB 8,448.00 16,896.00 0 0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

65 RD20220215-0052 15/02/2022 EP20220215-0043 2022021500074 DELFINORA PASARIBU 484,950.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

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

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ CODEIN 10 MG TAB 10.00 TAB 925.00 9,250.00 0 0

(NARKOTIKA)
66 RD20220216-0001 16/02/2022 EP20220216-0001 2022021600002 SWARNADWIPA NOVANDIKA 508,010.0
PUTRA GIRSANG

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
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/ LANFIX 100 MG KAPSUL 10.00 TAB 29,568.00 295,680.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

67 RD20220218-0007 18/02/2022 EP20220218-0005 2022021800015 LINEKER EFRAIM NIXON 371,948.0

SILALAHI

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

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

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

68 RD20220218-0008 18/02/2022 EP20220218-0006 2022021800016 ROIS IGREYA BARUS 218,450.0

R/ INBUMIN TAB 250 MG 5.00 TAB 8,556.00 42,780.00 0 1

R/ LANAKELOID 10 GR CREAM 1.00 TUBE 121,000.00 121,000.00 0 1

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

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

69 RD20220218-0010 18/02/2022 EP20220218-0007 2022021800018 LISTEN SIMANJUNTAK 143,000.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 45 of 190

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-February-2022 s/d 28-February-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/ PARAMOL 1GR/100 ML INF 1.00 FLS 70,000.00 70,000.00 0 1

70 RD20220218-0011 18/02/2022 EP20220218-0007 2022021800019 LISTEN SIMANJUNTAK 8,390.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ OMEPRAZOLE 20 MG CAP 5.00 CAP 742.00 3,710.00 1 0

71 RD20220218-0012 18/02/2022 EP20220218-0008 2022021800021 NECI PURNAMA SARI 148,540.0

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

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

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

72 RD20220218-0013 18/02/2022 EP20220218-0011 2022021800027 SARWONO 127,189.0

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

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

73 RD20220218-0014 18/02/2022 EP20220218-0010 2022021800028 KRISTINA ROMAULI SIAHAAN 522,024.0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 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 468.00 4,680.00 0 1

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

74 RD20220218-0015 18/02/2022 EP20220218-0012 2022021800029 MUHAMMAD ILHAM SADIQ 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

75 RD20220218-0016 18/02/2022 EP20220218-0012 2022021800030 MUHAMMAD ILHAM SADIQ 184,689.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 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

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

76 RD20220218-0017 18/02/2022 EP20220218-0009 2022021800034 PUSPA DEWI 68,750.0

R/ METRONIDAZOLE 1.00 FLS 68,750.00 68,750.00 1 0
500MG/100ML INFUS
77 RD20220218-0018 18/02/2022 EP20220218-0013 2022021800035 SESONIA KESYALIANI 117,280.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 46 of 190

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-February-2022 s/d 28-February-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/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0

R/ METHYLPREDNISOLONE 4 MG 10.00 TAB 595.00 5,950.00 1 0

TAB
R/ VITAMIN C XON-CE KAPLET 5.00 KAPLET 1.00 5.00 0 1

R/ DEVIT 1000 IU 5.00 TAB 2,600.00 13,000.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 ### 0 1

(PREKURSOR)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ RANITIDINE 150 MG TAB 6.00 TAB 200.00 1,200.00 1 0

78 RD20220218-0019 18/02/2022 EP20220218-0014 2022021800040 PETRO BERLIN SIMANJUNTAK 107,760.0

R/ BECOM C KAPLET 3.00 KAPLET 2,166.00 6,498.00 0 1

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.00 4,452.00 1 0

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

R/ EPERISON 50 MG TAB 6.00 TAB 2,290.00 13,740.00 1 0

79 RD20220219-0004 19/02/2022 EP20220219-0006 2022021900011 SAFRIZAL 293,325.0

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

80 RD20220219-0005 19/02/2022 EP20220219-0006 2022021900013 SAFRIZAL 140,230.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ INBUMIN TAB 250 MG 10.00 TAB 8,556.00 85,560.00 0 1

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

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

81 RD20220219-0006 19/02/2022 EP20220219-0005 2022021900015 SHYALOMI LETHISIA KHEREN 20,500.0

MANURUNG

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

82 RD20220219-0007 19/02/2022 EP20220219-0007 2022021900016 RINDI ATIKA MARPAUNG 73,000.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

83 RD20220219-0008 19/02/2022 EP20220219-0007 2022021900017 RINDI ATIKA MARPAUNG 253,651.0

R/ COLERGIS TABLET 6.00 TAB 3,667.00 22,002.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

84 RD20220219-0009 19/02/2022 EP20220219-0008 2022021900018 BERLIANA SIREGAR 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
Print Date:7/14/2022 Print Time: 2:11:10PM Page 47 of 190
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-February-2022 s/d 28-February-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

85 RD20220219-0010 19/02/2022 EP20220219-0009 2022021900020 EDWARD RONANDO 2,448.0

TAMBUNAN

R/ SANMOL 500 MG TABLET 6.00 TAB 408.00 2,448.00 0 1

86 RD20220219-0011 19/02/2022 EP20220219-0011 2022021900023 MUTIARA IMANI GUSTI 285,979.0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

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

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

87 RD20220219-0012 19/02/2022 EP20220219-0011 2022021900021 MUTIARA IMANI GUSTI 211,200.0

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

88 RD20220219-0013 19/02/2022 EP20220219-0012 2022021900024 RIANTO H MARPAUNG 211,200.0

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

89 RD20220219-0014 19/02/2022 EP20220219-0010 2022021900030 220,049.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROVITAL PLUS CAPS 3.00 CAP 5,800.00 17,400.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

90 RD20220219-0015 19/02/2022 EP20220219-0010 2022021900027 DICKY ARDIANSYAH 211,200.0

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

91 RD20220219-0016 19/02/2022 EP20220219-0013 2022021900029 RISKA WAHYUNI 10,830.0

R/ BECOM C KAPLET 5.00 KAPLET 2,166.00 10,830.00 0 1

92 RD20220219-0017 19/02/2022 EP20220219-0012 2022021900032 RIANTO H MARPAUNG 169,932.0

R/ BECOM C KAPLET 5.00 KAPLET 2,166.00 10,830.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

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

93 RD20220220-0011 20/02/2022 EP20220220-0011 2022022000030 TRY OCTAVANIA YANDRI 540,594.0

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 48 of 190

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-February-2022 s/d 28-February-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 5.00 CAP 8,000.00 40,000.00 1 0

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

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

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

94 RD20220220-0012 20/02/2022 EP20220220-0012 2022022000031 BINTA MINA BR SEMBIRING 191,700.0

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

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
95 RD20220220-0013 20/02/2022 EP20220220-0013 2022022000032 NURHALINA SIREGAR 282,575.0

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

96 RD20220220-0014 20/02/2022 EP20220220-0013 2022022000033 NURHALINA SIREGAR 61,600.0

R/ REMOPAIN INJ AMPUL 1.00 AMP 61,600.00 61,600.00 0 1

97 RD20220220-0015 20/02/2022 EP20220220-0014 2022022000034 MUHAMMAD SYAFIQ AL FATIH 83,530.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 61,600.00 61,600.00 0 1

R/ SALICYL TALK 60 GR 1.00 POT 5,842.00 5,842.00 0 1

98 RD20220220-0016 20/02/2022 EP20220220-0015 2022022000035 WALID MARZUQI SARUMPAET 20,500.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

99 RD20220220-0017 20/02/2022 EP20220220-0016 2022022000038 LEO MARHASIAN 61,600.0

R/ REMOPAIN INJ AMPUL 1.00 AMP 61,600.00 61,600.00 0 1

100 RD20220220-0018 20/02/2022 EP20220220-0016 2022022000039 LEO MARHASIAN 456,138.0

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

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 49 of 190

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-February-2022 s/d 28-February-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

101 RD20220220-0019 20/02/2022 EP20220220-0017 2022022000040 SRI WAHYUNI 61,600.0

R/ REMOPAIN INJ AMPUL 1.00 AMP 61,600.00 61,600.00 0 1

102 RD20220220-0020 20/02/2022 EP20220220-0017 2022022000041 SRI WAHYUNI 539,254.0

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

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

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

103 RD20220221-0033 21/02/2022 EP20220221-0031 2022022100076 BAKRI 217,800.0

R/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

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

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ COLERGIS TABLET 6.00 TAB 3,667.00 22,002.00 0 1

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

104 RD20220222-0001 22/02/2022 EP20220222-0001 2022022200003 IDHAM SYAFRIL 540,884.0

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 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

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

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

105 RD20220224-0002 24/02/2022 EP20220224-0002 2022022400007 ANDRI HADI SURYA 356,685.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

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

106 RD20220224-0003 24/02/2022 EP20220224-0003 2022022400008 INDAH MARTIANA PUTRI 272,585.0

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 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 FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 50 of 190

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-February-2022 s/d 28-February-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

107 RD20220224-0004 24/02/2022 EP20220224-0002 2022022400010 ANDRI HADI SURYA 449,280.0

R/ INBUMIN TAB 250 MG 10.00 TAB 8,556.00 85,560.00 0 1

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

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

108 RD20220224-0005 24/02/2022 EP20220224-0004 2022022400011 BOLONTUA MANURUNG 378,968.0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ SANMOL FORTE TAB 15.00 TAB 468.00 7,020.00 0 1

R/ EPEXOL TAB 10.00 TAB 1,141.00 11,410.00 0 1

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

109 RD20220224-0006 24/02/2022 EP20220224-0005 2022022400012 MULIANTA SITEPU 226,406.0

R/ SPONGOSTAN STANDART 1.00 PCS 226,406.00 226,406.00 0 1

110 RD20220224-0007 24/02/2022 EP20220224-0006 2022022400013 ZARA AFDHILLA SANDENA 326,319.0

PUTRI

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

R/ BRAXIDIN TABLET 2.00 TAB 1,523.00 3,046.00 0 0

(PSIKOTROPIKA)
R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ FREGO 5 MG TAB 6.00 TAB 8,448.00 50,688.00 0 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

111 RD20220224-0008 24/02/2022 EP20220224-0009 2022022400019 BUNYAMIN 259,550.0

R/ TREMENZA 60 ML SYR (PREK) 2.00 FLS 28,188.00 56,376.00 0 1

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/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

112 RD20220224-0009 24/02/2022 EP20220224-0005 2022022400022 MULIANTA SITEPU 80,000.0

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

(BPJS)
113 RD20220224-0010 24/02/2022 EP20220224-0007 2022022400023 4,685.0
R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ VITAMIN C XON-CE KAPLET 5.00 KAPLET 1.00 5.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 51 of 190

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-February-2022 s/d 28-February-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

114 RD20220224-0011 24/02/2022 EP20220224-0008 2022022400024 45,868.0

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ DEVIT 1000 IU 5.00 TAB 2,600.00 13,000.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

115 RD20220225-0014 25/02/2022 EP20220225-0017 2022022500031 ZARA AFDHILLA SANDENA 73,000.0

PUTRI

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

116 RD20220225-0015 25/02/2022 EP20220225-0017 2022022500034 ZARA AFDHILLA SANDENA 336,989.0

PUTRI

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ TREMENZA TABLET 10.00 TAB 2,001.00 20,010.00 0 1

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

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

117 RD20220225-0018 25/02/2022 EP20220225-0022 2022022500040 ANI SARI SUSANTI 401,719.0

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ GLUTAFIT CAPSUL 20.00 CAP 8,000.00 160,000.00 1 0

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

118 RD20220225-0019 25/02/2022 EP20220225-0023 2022022500041 DANI SAMUEL SINAGA 344,915.0

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

R/ GLUTAFIT CAPSUL 20.00 CAP 8,000.00 160,000.00 1 0

119 RD20220225-0020 25/02/2022 EP20220225-0024 2022022500042 WESLEY ARMANDO NABABAN 15,813.0

R/ DOMPERIDON 60 ML SYR 1.00 FLS 15,813.00 15,813.00 1 0

120 RD20220227-0004 27/02/2022 EP20220227-0001 2022022700004 LEO SIMANJUNTAK 22,146.0

R/ CEFIXIME 100 MG CAP 6.00 CAP 3,233.00 19,398.00 1 0

R/ ASAM MEFENAMAT 500 MG 6.00 KAPLET 458.00 2,748.00 1 0

121 RD20220227-0005 27/02/2022 EP20220227-0002 2022022700006 YANCE MAURICE MANURUNG 19,840.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 52 of 190

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-February-2022 s/d 28-February-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/ FUROSEMIDE 10 MG/2 ML INJ 4.00 AMP 4,960.00 19,840.00 1 0

122 RD20220227-0006 27/02/2022 EP20220227-0002 2022022700007 169,903.0

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

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

R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
123 RD20220227-0007 27/02/2022 EP20220227-0002 2022022700008 YANCE MAURICE MANURUNG 62,944.0

R/ EXTENSION TUBE 150 CM X 1.00 PCS 62,944.00 62,944.00 0 1

1,5 ML
124 RD20220227-0008 27/02/2022 EP20220227-0003 2022022700010 ASHIFAN FAUZI SITORUS 302,308.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ PROZA SYR 1.00 FLS 117,000.00 117,000.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

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

R/ COLERGIS 60 ML SYR 1.00 FLS 61,600.00 61,600.00 0 1

125 RD20220227-0009 27/02/2022 EP20220227-0003 2022022700011 ASHIFAN FAUZI SITORUS 35,200.0

R/ PAMOL 125 MG SUPP 2.00 SUPP 17,600.00 35,200.00 0 1

126 RD20220228-0001 28/02/2022 EP20220228-0001 2022022800002 TERESIA AYULINA TIVANY 20,500.0

SIALLAGAN

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

Total Dokter DR. ERIE FAILENGGO 22,972,384.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 53 of 190
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-February-2022 s/d 28-February-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 RD20220201-0007 01/02/2022 EP20220201-0005 2022020100011 ADE NOVIT SYAHPUTRA 292,600.0

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

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

R/ CEFIXIME 200 MG CAP 10.00 CAP 6,188.00 61,880.00 1 0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

2 RD20220201-0008 01/02/2022 EP20220201-0005 2022020100012 ADE NOVIT SYAHPUTRA 77,350.0

R/ TENSOCREPE 3 INC (7.5 CM X 1.00 ROLL 77,350.00 77,350.00 0 1

4.55 M)
3 RD20220202-0013 02/02/2022 EP20220202-0014 2022020200018 GIMSI HUTAGALUNG 267,790.0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 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

4 RD20220202-0014 02/02/2022 EP20220202-0015 2022020200019 DICKY SERFINDO 215,590.0

R/ PROVITAL PLUS CAPS 1.00 CAP 5,800.00 5,800.00 0 1

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

5 RD20220202-0015 02/02/2022 EP20220202-0016 2022020200020 SUYETNO 421,335.0

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

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

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

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

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

6 RD20220202-0016 02/02/2022 EP20220202-0018 2022020200022 ARING LAILIL MUKHAROMAH 450,380.0

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

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

R/ BETAHISTINE 6 MG TAB 10.00 TAB 881.00 8,810.00 1 0

R/ FLUNARIZINE 5 MG TAB 10.00 TAB 1,760.00 17,600.00 1 0

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

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

7 RD20220202-0017 02/02/2022 EP20220202-0020 2022020200023 CHINTA NADIRA PUTRI 72,934.0

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 54 of 190

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-February-2022 s/d 28-February-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 EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

8 RD20220202-0018 02/02/2022 EP20220202-0019 2022020200024 JONI 195,620.0

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

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

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

9 RD20220202-0019 02/02/2022 EP20220202-0021 2022020200025 RIANTO H MARPAUNG 219,700.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

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

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

10 RD20220207-0017 07/02/2022 EP20220207-0015 2022020700023 RUDI YANTO 209,790.0

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

11 RD20220207-0018 07/02/2022 EP20220207-0016 2022020700024 ELKANA 275,924.0

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

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

12 RD20220207-0019 07/02/2022 EP20220207-0017 2022020700025 RUDI ARIYANTO 61,990.0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

13 RD20220207-0020 07/02/2022 EP20220207-0018 2022020700026 FLOWERIDA SITANGGANG 267,790.0

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/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

14 RD20220207-0021 07/02/2022 EP20220207-0019 2022020700028 DANIEL CLYNTON SILAEN 371,900.0

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

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

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

R/ CALCIUM LACTATE 500 MG 10.00 TAB 303.00 3,030.00 1 0

TABLET
R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

15 RD20220207-0022 07/02/2022 EP20220207-0020 2022020700029 RUDIANA 333,790.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 55 of 190

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-February-2022 s/d 28-February-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 10.00 CAP 5,800.00 58,000.00 0 1

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

16 RD20220215-0011 15/02/2022 EP20220215-0011 2022021500013 DEWARNI PANGGABEAN 113,418.0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ METHYLON 4 MG TAB 10.00 TAB 3,163.00 31,630.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

17 RD20220215-0012 15/02/2022 EP20220215-0012 2022021500015 NADIA PUTRI PALGA 108,300.0

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

R/ BETAMETASON 5 GR CREAM 1.00 TUBE 3,140.00 3,140.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

18 RD20220215-0013 15/02/2022 EP20220215-0013 2022021500014 SOHMA KUDADIRI 62,080.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

19 RD20220215-0014 15/02/2022 EP20220215-0014 2022021500016 AHMAD RIDHO AFRICANO 85,868.0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

20 RD20220215-0015 15/02/2022 EP20220215-0015 2022021500017 MARLAN MANALU 98,800.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ AMLODIPINE 10 MG TAB 10.00 TAB 2,196.00 21,960.00 1 0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

21 RD20220215-0016 15/02/2022 EP20220215-0017 2022021500018 ARYA DZAKI PERDANA 77,275.0

R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1

R/ SAN-B PLEX P DROP 1.00 FLS 25,575.00 25,575.00 0 1

22 RD20220215-0017 15/02/2022 EP20220215-0016 2022021500019 ESLINA SIMAMORA 70,000.0

R/ PARAMOL 1GR/100 ML INF 1.00 FLS 70,000.00 70,000.00 0 1

23 RD20220215-0018 15/02/2022 EP20220215-0016 2022021500020 ESLINA SIMAMORA 274,916.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 56 of 190

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-February-2022 s/d 28-February-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 10.00 CAP 5,800.00 58,000.00 0 1

R/ BRAXIDIN TABLET 2.00 TAB 1,523.00 3,046.00 0 0

(PSIKOTROPIKA)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

24 RD20220215-0019 15/02/2022 EP20220215-0017 2022021500021 ARYA DZAKI PERDANA 52,800.0

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

25 RD20220215-0020 15/02/2022 EP20220215-0018 2022021500022 ADISTY DIANE ROLIS 84,913.0

R/ CETIRIZINE 10 MG TAB 10.00 TAB 1,000.00 10,000.00 1 0

R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

26 RD20220215-0021 15/02/2022 EP20220215-0019 2022021500023 DENISSAH MUHARRAM 93,710.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ METHYLON 4 MG TAB 10.00 TAB 3,163.00 31,630.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

27 RD20220215-0023 15/02/2022 EP20220215-0020 2022021500051 168,822.0

R/ BUSCOPAN 20MG/ML INJ 1.00 AMP 48,262.00 48,262.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

28 RD20220215-0024 15/02/2022 EP20220215-0021 2022021500026 MARIA BR SINAMBELA 104,480.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ METHYLON 4 MG TAB 10.00 TAB 3,163.00 31,630.00 0 1

29 RD20220215-0040 15/02/2022 EP20220215-0020 2022021500053 HOKKOP SIMANJUNTAK 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
Total Dokter DR. FERRY FHRANS VALENTINUS KARO- 5,193,225.0
KARO
Print Date:7/14/2022 Print Time: 2:11:10PM Page 57 of 190
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-February-2022 s/d 28-February-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 RD20220203-0004 03/02/2022 EP20220203-0003 2022020300004 NUR SYARIFAH 443,470.0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

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

2 RD20220203-0005 03/02/2022 EP20220203-0004 2022020300005 WANTU HOTMAN SIHOMBING 37,540.0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,163.00 31,630.00 1 0

R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 591.00 5,910.00 1 0

3 RD20220203-0006 03/02/2022 EP20220203-0004 2022020300006 WANTU HOTMAN SIHOMBING 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
4 RD20220203-0007 03/02/2022 EP20220203-0005 2022020300008 ANISA PUTRI 327,470.0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

R/ ONDANSETRON 4 MG TAB 10.00 TAB 2,167.00 21,670.00 1 0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

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

5 RD20220203-0008 03/02/2022 EP20220203-0007 2022020300009 NUR ASIYAH HASIBUAN 146,445.0

R/ ORALIT SACHET 5.00 SACH 515.00 2,575.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

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

6 RD20220203-0009 03/02/2022 EP20220203-0008 2022020300010 SIMONE NATANEL NABABAN 105,678.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

7 RD20220203-0010 03/02/2022 EP20220203-0009 2022020300011 RIVALDO ELDEST 18,360.0

HAMONANGAN PURBA

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,836.00 18,360.00 0 1

8 RD20220203-0011 03/02/2022 EP20220203-0010 2022020300012 SAMUEL KEVIN SIAHAAN 41,260.0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 58 of 190

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-February-2022 s/d 28-February-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 1,836.00 18,360.00 0 1

9 RD20220203-0012 03/02/2022 EP20220203-0011 2022020300013 NURHIKMAH SARI 307,380.0

MATONDANG

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ ONDANSETRON 4 MG TAB 10.00 TAB 2,167.00 21,670.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

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

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

10 RD20220204-0001 04/02/2022 EP20220204-0001 2022020400001 SUDARNO 39,296.0

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

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 239.00 2,390.00 1 0

KAPLET
R/ GENTALEX 5 MG CREAM 1.00 TUBE 4,576.00 4,576.00 0 1

11 RD20220204-0002 04/02/2022 EP20220204-0003 2022020400003 NUWAIRA CARABELLA AZAHRA 96,939.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

12 RD20220204-0003 04/02/2022 EP20220204-0004 2022020400007 NATALIA NOPRIANTI BR 80,000.0

TARIGAN

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

13 RD20220207-0023 07/02/2022 EP20220207-0022 2022020700033 MUHAMMAD SIDIK 203,210.0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

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

14 RD20220208-0002 08/02/2022 EP20220207-0021 2022020800002 NOVRIATI SIMANUNGKALIT 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
15 RD20220208-0017 08/02/2022 EP20220208-0016 2022020800029 WYLIA DHARMA FITRI 392,240.0

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

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ CEFIXIME 200 MG CAP 10.00 CAP 6,188.00 61,880.00 1 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0
CAPSUL
R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,163.00 31,630.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 59 of 190

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-February-2022 s/d 28-February-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

16 RD20220208-0018 08/02/2022 EP20220208-0017 2022020800030 JIMMY SM NABABAN 6,600.0

R/ COTRIMOXAZOLE 480 MG 12.00 TAB 550.00 6,600.00 1 0

TABLET
17 RD20220209-0001 09/02/2022 EP20220209-0001 2022020900002 BERLIAN HUTAPEA 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
18 RD20220209-0002 09/02/2022 EP20220209-0001 2022020900003 11,340.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ DOMPERIDON 10 MG TAB 10.00 TAB 545.00 5,450.00 1 0

R/ VITAMIN B COMPLEX TAB 5.00 TAB 150.00 750.00 1 0

19 RD20220211-0003 11/02/2022 EP20220211-0003 2022021100007 KRISTIAN KERANS 89,516.0

R/ STESOLID 10 MG/2ML 1.00 AMP 16,108.00 16,108.00 0 0

INJEKSI (PSIKOTROPIKA)
R/ SELANG O2 ANAK 1.00 PCS 6,500.00 6,500.00 0 1

R/ STESOLID 5 MG/2.5 ML 2.00 TUBE 33,454.00 66,908.00 0 0

RECTAL TUBE
20 RD20220211-0004
(PSIKOTROPIKA) 11/02/2022 EP20220 2022021100008 YELVIDA 119,080.0
211-0004

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

21 RD20220211-0005 11/02/2022 EP20220211-0005 2022021100009 NURFITRI WITA NURFIQ 315,870.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

22 RD20220211-0006 11/02/2022 EP20220211-0004 2022021100011 YELVIDA 167,190.0

R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.00 167,190.00 0 1

23 RD20220211-0007 11/02/2022 EP20220211-0003 2022021100012 KRISTIAN KERANS 20,500.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

24 RD20220211-0008 11/02/2022 EP20220211-0006 2022021100015 EKA JERNITA LUMBAN 164,082.0

TORUAN

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ VOMIZOLE 20 MG TAB 6.00 TAB 19,433.00 116,598.00 0 1

R/ CORTIDEX 0,5 MG TAB 6.00 TAB 399.00 2,394.00 0 1

R/ EPEXOL TAB 10.00 TAB 1,141.00 11,410.00 0 1

25 RD20220211-0009 11/02/2022 EP20220211-0007 2022021100020 MUHAMMAD HASAN 20,500.0

 HERWANTO

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 60 of 190

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-February-2022 s/d 28-February-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

26 RD20220211-0010 11/02/2022 EP20220211-0012 2022021100029 TEE MENG SUN 138,610.0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1
(PREKURSOR)
27 RD20220211-0012 11/02/2022 EP20220211-0011 2022021100031 NAURA SYAKIRA ARSYIDINATA 20,500.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

28 RD20220211-0013 11/02/2022 EP20220211-0013 2022021100032 AZZAHRA RIYANTO 382,990.0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

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

29 RD20220212-0016 12/02/2022 EP20220212-0017 2022021200026 AURELIA TASHA TAMPUBOLON 30,473.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1

(BPJS)
30 RD20220212-0017 12/02/2022 EP20220212-0017 2022021200028 AURELIA TASHA TAMPUBOLON 247,862.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

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

R/ KAPAS ALKOHOL 4.00 PCS 303.00 1,212.00 0 1

R/ PICYN 750 MG INJ 2.00 VIAL 103,125.00 206,250.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

31 RD20220213-0001 13/02/2022 EP20220213-0001 2022021300001 MARIA GISELA NONA 121,508.0

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

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

32 RD20220213-0004 13/02/2022 EP20220213-0003 2022021300004 YOSAN VRNANDA TOGATOROP 11,733.0

R/ PROPYRETIC 240 MG SUPP 1.00 SUPP 11,733.00 11,733.00 0 1

(BPJS)
33 RD20220213-0021 13/02/2022 EP20220213-0018 2022021300046 RINALDO PURBA 63,215.0

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 61 of 190

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-February-2022 s/d 28-February-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/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
34 RD20220214-0036 14/02/2022 EP20220214-0035 2022021400062 ROSANTINA HUTABARAT 272,930.0

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

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

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

35 RD20220215-0001 15/02/2022 EP20220215-0001 2022021500001 NADYA EKA PUTRI 101,090.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

36 RD20220215-0002 15/02/2022 EP20220215-0002 2022021500002 ELKANA 395,992.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

R/ ONDANSETRON 4 MG TAB 6.00 TAB 2,167.00 13,002.00 1 0

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

37 RD20220215-0003 15/02/2022 EP20220215-0003 2022021500004 LISPIDA ROSTIKA 167,910.0

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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

38 RD20220215-0004 15/02/2022 EP20220215-0004 2022021500005 ROMARTA HALOHO 77,990.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

39 RD20220215-0005 15/02/2022 EP20220215-0005 2022021500006 RICKY ZAMUSTI 86,090.0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ METHYLPREDNISOLONE 8 MG 10.00 TAB 790.00 7,900.00 1 0

TAB
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1
40 RD20220215-0006 15/02/2022 EP20220215-0006 2022021500007 MUHAMMAD KEMAL 327,470.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 62 of 190

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-February-2022 s/d 28-February-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/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ ONDANSETRON 4 MG TAB 10.00 TAB 2,167.00 21,670.00 1 0

41 RD20220215-0007 15/02/2022 EP20220215-0007 2022021500008 RASHYA ALFAIZI 76,588.0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

42 RD20220215-0008 15/02/2022 EP20220215-0008 2022021500009 INDRIANI 153,520.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
43 RD20220215-0009 15/02/2022 EP20220215-0009 2022021500010 APRILLIA PASKAH ANASTASYA 78,190.0
BR SINURAT

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

44 RD20220215-0010 15/02/2022 EP20220215-0010 2022021500011 HENDRI RUDIANTO 64,168.0

R/ IBUPROFEN 400 MG TAB 12.00 TAB 514.00 6,168.00 1 0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

45 RD20220217-0031 17/02/2022 EP20220217-0031 2022021700068 ALFREDO SINAGA 143,810.0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
46 RD20220217-0032 17/02/2022 EP20220217-0030 2022021700069 NUR ASIYAH HASIBUAN 310,940.0

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

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

47 RD20220217-0033 17/02/2022 EP20220217-0032 2022021700071 ABDUL ROPI 305,800.0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

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

48 RD20220217-0034 17/02/2022 EP20220217-0029 2022021700074 ESLINA SIMAMORA 121,530.0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
Print Date:7/14/2022 Print Time: 2:11:10PM Page 63 of 190
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-February-2022 s/d 28-February-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/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

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

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
49 RD20220217-0035 17/02/2022 EP20220217-0033 2022021700075 M IQBAL 63,140.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

50 RD20220217-0036 17/02/2022 EP20220217-0034 2022021700078 DESPIANA PITRI 175,440.0

R/ METHYLON 4 MG TAB 10.00 TAB 3,163.00 31,630.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

51 RD20220217-0037 17/02/2022 EP20220217-0035 2022021700079 NOVIANTY NDURU 176,468.0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ IBUPROFEN 400 MG TAB 12.00 TAB 514.00 6,168.00 1 0

R/ METHYLON 4 MG TAB 10.00 TAB 3,163.00 31,630.00 0 1

52 RD20220217-0038 17/02/2022 EP20220217-0036 2022021700080 ELFIRITA SIMATUPANG 78,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

53 RD20220217-0039 17/02/2022 EP20220217-0037 2022021700082 KAYANA YUMNA MUMTAZAH 97,763.0

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

54 RD20220217-0040 17/02/2022 EP20220217-0038 2022021700084 NORLELA 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
55 RD20220217-0041 17/02/2022 EP20220217-0039 2022021700089 RIA RISVIANA 100,660.0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
56 RD20220217-0042 17/02/2022 EP20220217-0038 2022021700090 NORLELA 86,940.0
R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0
KAPLET

Print Date:7/14/2022 Print Time: 2:11:10PM Page 64 of 190

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-February-2022 s/d 28-February-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/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ CETIRIZINE 10 MG TAB 10.00 TAB 1,000.00 10,000.00 1 0

R/ AMBROXOL 30 MG TAB 10.00 TAB 285.00 2,850.00 1 0

R/ DEVIT 1000 IU 5.00 TAB 2,600.00 13,000.00 0 1

57 RD20220218-0041 18/02/2022 EP20220218-0035 2022021800070 ROFINA PAKU 52,540.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ RANITIDINE 150 MG TAB 10.00 TAB 200.00 2,000.00 1 0

R/ CETIRIZINE 10 MG TAB 10.00 TAB 1,000.00 10,000.00 1 0

R/ AMBROXOL 30 MG TAB 10.00 TAB 285.00 2,850.00 1 0

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

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

58 RD20220219-0001 19/02/2022 EP20220219-0001 2022021900004 GITA MARISKA BR TARIGAN 145,858.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ IBUPROFEN 400 MG TAB 12.00 TAB 514.00 6,168.00 1 0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,163.00 31,630.00 1 0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ CETIRIZINE 10 MG TAB 10.00 TAB 1,000.00 10,000.00 1 0

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

59 RD20220219-0002 19/02/2022 EP20220219-0002 2022021900008 NURUL APRILIA 289,410.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ ONDANSETRON 4 MG TAB 10.00 TAB 2,167.00 21,670.00 1 0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

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

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

60 RD20220219-0003 19/02/2022 EP20220219-0003 2022021900009 JAN PARUNTUNGAN RONO 88,350.0

HUTABARAT

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 65 of 190

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-February-2022 s/d 28-February-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/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

61 RD20220220-0003 20/02/2022 EP20220220-0003 2022022000007 NOVI NOVRI YENTI 148,320.0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
62 RD20220220-0004 20/02/2022 EP20220220-0005 2022022000009 ANGGUN RIDONA 20,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

63 RD20220220-0005 20/02/2022 EP20220220-0004 2022022000010 ANI HUTAHAYAN 65,876.0

R/ D 40 25 ML (OTSU) 2.00 FLS 12,813.00 25,626.00 0 1

R/ DEXTROSE 10 % INF 500 ML 1.00 FLS 7,275.00 7,275.00 1 0

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

R/ FOLEY CATHETER NO. 16 1.00 PCS 24,975.00 24,975.00 0 1

64 RD20220220-0006 20/02/2022 EP20220220-0006 2022022000013 YUNI LUKITO KARYA 315,870.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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

65 RD20220220-0007 20/02/2022 EP20220220-0008 2022022000019 HALIMATUS SAKINAH 377,470.0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

66 RD20220220-0008 20/02/2022 EP20220220-0007 2022022000020 FANOTONA YUBILA DAELI 155,540.0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1
67 RD20220220-0009 20/02/2022 EP20220220-0009 2022022000025 ADE CANDRA PUTRA 4,580.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 66 of 190

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-February-2022 s/d 28-February-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/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.00 4,580.00 1 0

KAPLET
68 RD20220220-0010 20/02/2022 EP20220220-0010 2022022000029 NOVELINA SELES 155,540.0
LUMBANTORUAN

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1
(PREKURSOR)
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

69 RD20220221-0002 21/02/2022 EP20220221-0002 2022022100006 ANGELICA DEBORA 155,540.0

SIMANJUTAK

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

70 RD20220221-0003 21/02/2022 EP20220221-0004 2022022100009 SARWONO 100,660.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1
(PREKURSOR)
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

71 RD20220221-0006 21/02/2022 EP20220221-0006 2022022100013 DELIMA PUTRI MARBUN 217,903.0

R/ WING NEEDLE 25 G (3/4) 1.00 PCS 2,973.00 2,973.00 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/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

72 RD20220221-0007 21/02/2022 EP20220221-0005 2022022100014 TIOLINAR SIRUMAPEA 46,000.0

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

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

73 RD20220221-0008 21/02/2022 EP20220221-0008 2022022100020 WELTINA MARPAUNG 28,880.0

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

74 RD20220221-0009 21/02/2022 EP20220221-0009 2022022100022 RODIAH YOSI 110,111.0

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ RHINOS SR KAPSUL 4.00 CAP 8,067.00 32,268.00 0 1

(PREKURSOR)

Print Date:7/14/2022 Print Time: 2:11:10PM Page 67 of 190

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-February-2022 s/d 28-February-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/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ WING NEEDLE 25 G (3/4) 1.00 PCS 2,973.00 2,973.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

75 RD20220221-0010 21/02/2022 EP20220221-0007 2022022100027 SUGIONO 107,485.0

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

R/ RHINOS SR KAPSUL 5.00 CAP 8,067.00 40,335.00 0 1

(PREKURSOR)
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
76 RD20220221-0011 21/02/2022 EP20220221-0012 2022022100033 NUR ASIYAH HASIBUAN 294,933.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

R/ WING NEEDLE 25 G (3/4) 1.00 PCS 2,973.00 2,973.00 1 0

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ DEVIT 1000 IU 12.00 TAB 2,600.00 31,200.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

77 RD20220221-0012 21/02/2022 EP20220221-0014 2022022100034 BLASIUS 20,190.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

78 RD20220221-0013 21/02/2022 EP20220221-0013 2022022100035 SURYA DARMA LATURE 125,003.0

R/ WING NEEDLE 25 G (3/4) 1.00 PCS 2,973.00 2,973.00 1 0

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

79 RD20220221-0014 21/02/2022 EP20220221-0016 2022022100038 SUHERMAN 5,140.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

80 RD20220221-0015 21/02/2022 EP20220221-0015 2022022100040 JANWAR CANDRA SINUKABAN 80,603.0

R/ METHYLPREDNISOLONE 8 MG 10.00 TAB 790.00 7,900.00 1 0

TAB
R/ WING NEEDLE 25 G (3/4) 1.00 PCS 2,973.00 2,973.00 1 0
R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0
CAPSUL
R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 68 of 190

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-February-2022 s/d 28-February-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/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

81 RD20220222-0002 22/02/2022 EP20220222-0002 2022022200006 295,275.0

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

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,163.00 31,630.00 1 0

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

R/ ACETYLCYSTEIN 200 MG 15.00 CAP 1,485.00 22,275.00 1 0

CAPSUL
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

82 RD20220222-0003 22/02/2022 EP20220222-0004 2022022200007 BAMBANG JUWITO 212,570.0

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

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

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,163.00 31,630.00 1 0

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

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

83 RD20220222-0004 22/02/2022 EP20220222-0005 2022022200009 PESMAWATI 154,575.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ ACETYLCYSTEIN 200 MG 15.00 CAP 1,485.00 22,275.00 1 0

CAPSUL
R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

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

84 RD20220222-0005 22/02/2022 EP20220222-0007 2022022200011 FARID ASNGARI 315,870.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

85 RD20220222-0006 22/02/2022 EP20220222-0006 2022022200012 RIZKI AFRIANATA 51,820.0

R/ METHYLON 4 MG TAB 10.00 TAB 3,163.00 31,630.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

86 RD20220222-0007 22/02/2022 EP20220222-0003 2022022200014 VERAWATI LUMBAN TOBING 175,859.0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ ACETYLCYSTEIN 200 MG 15.00 CAP 1,485.00 22,275.00 1 0

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

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ CERINI 10 MG TABLET 9.00 TAB 4,716.00 42,444.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 69 of 190

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-February-2022 s/d 28-February-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

87 RD20220222-0008 22/02/2022 EP20220222-0008 2022022200015 OBNIEL NICHOLAS MANURUNG 100,190.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

88 RD20220222-0009 22/02/2022 EP20220222-0010 2022022200016 BAYU SUKMA 85,140.0

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

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

89 RD20220222-0010 22/02/2022 EP20220222-0011 2022022200017 YAN ARDIMAN 28,040.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

90 RD20220222-0011 22/02/2022 EP20220222-0012 2022022200019 FEBY ERDINA 197,870.0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

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

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
R/ CETIRIZINE 10 MG TAB 10.00 TAB 1,000.00 10,000.00 1 0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ CEFIXIME 200 MG CAP 10.00 CAP 6,188.00 61,880.00 1 0

91 RD20220222-0012 22/02/2022 EP20220222-0013 2022022200020 IRFAN FADIL MAHENDRA 39,500.0

R/ CENDO FENICOL 1 % SALEP 1.00 FLS 39,500.00 39,500.00 0 0

MATA
92 RD20220222-0013 22/02/2022 EP20220222-0014 2022022200021 SHINTIA ELISRA 95,140.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ CETIRIZINE 10 MG TAB 10.00 TAB 1,000.00 10,000.00 1 0

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

93 RD20220222-0014 22/02/2022 EP20220222-0015 2022022200022 JOHANES 323,770.0

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

R/ METHYLPREDNISOLONE 8 MG 10.00 TAB 790.00 7,900.00 1 0

TAB
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

94 RD20220222-0015 22/02/2022 EP20220222-0016 2022022200023 PERMATA SUCI 85,140.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

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

95 RD20220223-0018 23/02/2022 EP20220223-0016 2022022300032 ELVINA SARI BANGUN 10.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 70 of 190

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-February-2022 s/d 28-February-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

96 RD20220224-0001 24/02/2022 EP20220224-0001 2022022400004 189,178.0

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

CAPSUL
97 RD20220225-0001 25/02/2022 EP20220225-0001 2022022500003 DEVI HARYANTI SEMBIRING 387,358.0

R/ METHYLON 4 MG TAB 10.00 TAB 3,163.00 31,630.00 0 1

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,667.00 16,670.00 1 0

CAPSUL
98 RD20220226-0010 26/02/2022 EP20220226-0010 2022022600017 CHYNTIA PARHUSIP 3,880.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
99 RD20220226-0011 26/02/2022 EP20220226-0009 2022022600018 MUHAMMAD RONALDO 190,998.0

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,667.00 16,670.00 1 0

CAPSUL
R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

100 RD20220226-0012 26/02/2022 EP20220226-0011 2022022600019 SAHAT PARULIAN SIREGAR 462,870.0

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ PROPEPSA 100 ML SYR 2.00 FLS 83,070.00 166,140.00 0 1

R/ LAPRAZ 30 MG CAP 10.00 CAP 16,473.00 164,730.00 0 1

101 RD20220226-0013 26/02/2022 EP20220226-0012 2022022600020 YULIA GUSTINA 120,140.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

102 RD20220226-0014 26/02/2022 EP20220225-0002 2022022600031 SESONIA KESYALIANI 3,880.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0
KAPLET

Print Date:7/14/2022 Print Time: 2:11:10PM Page 71 of 190

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-February-2022 s/d 28-February-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

103 RD20220226-0015 26/02/2022 EP20220226-0013 2022022600022 SHINTA YUNITA PUTRI 136,810.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,667.00 16,670.00 1 0

CAPSUL
R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

104 RD20220226-0016 26/02/2022 EP20220226-0016 2022022600023 NOVITA ANGLELINA 35,715.0

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

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

105 RD20220226-0017 26/02/2022 EP20220226-0016 2022022600024 NOVITA ANGLELINA 9,973.0

R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1

(BPJS)
106 RD20220226-0018 26/02/2022 EP20220226-0015 2022022600025 RISNA PULUNGAN 119,080.0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

107 RD20220226-0019 26/02/2022 EP20220226-0014 2022022600026 ALI AMRAN 197,070.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ CEFIXIME 200 MG CAP 10.00 CAP 6,188.00 61,880.00 1 0

108 RD20220226-0020 26/02/2022 EP20220226-0017 2022022600027 KINTAN HANNAN ASRAWI 128,040.0

DARMA

R/ METHYLPREDNISOLONE 8 MG 10.00 TAB 790.00 7,900.00 1 0

TAB
R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

109 RD20220226-0021 26/02/2022 EP20220226-0018 2022022600028 DENTO 36,910.0

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

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

110 RD20220226-0022 26/02/2022 EP20220226-0019 2022022600032 ELISABETH EVI 141,860.0

R/ ONDANSETRON 8 MG TAB 10.00 TAB 3,163.00 31,630.00 1 0

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
R/ LANSOPRAZOLE 30 MG CAPS 10.00 CAP 2,027.00 20,270.00 1 0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

111 RD20220227-0017 27/02/2022 EP20220227-0008 2022022700019 DIESEL SIMANJUNTAK 4,580.0

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 458.00 4,580.00 1 0
KAPLET
Print Date:7/14/2022 Print Time: 2:11:10PM Page 72 of 190
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-February-2022 s/d 28-February-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

112 RD20220227-0019 27/02/2022 EP20220 2022022700024 DIAZ JOSHUA SIMAMORA 20,500.0

227-0009

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

113 RD20220227-0020 27/02/2022 EP20220227-0011 2022022700025 TOMMY WIJAYA MANURUNG 315,870.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

114 RD20220227-0021 27/02/2022 EP20220227-0011 2022022700026 TOMMY WIJAYA MANURUNG 4,576.0

R/ GENTALEX 5 MG CREAM 1.00 TUBE 4,576.00 4,576.00 0 1

115 RD20220228-0002 28/02/2022 EP20220228-0002 2022022800004 JESSICA ORLEE SIRAIT 105,463.0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

116 RD20220228-0003 28/02/2022 EP20220228-0005 2022022800007 LENA MARTATI 3,880.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
117 RD20220228-0004 28/02/2022 EP20220228-0004 2022022800008 GRASELLA SESILIA SIMAMORA 20,500.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

118 RD20220228-0005 28/02/2022 EP20220228-0007 2022022800009 FADHILLA INAYAH.S 250,113.0

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

R/ COLERGIS 60 ML SYR 1.00 FLS 61,600.00 61,600.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

119 RD20220228-0006 28/02/2022 EP20220228-0006 2022022800011 FADHIL HAKIM.S 250,113.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

R/ COLERGIS 60 ML SYR 1.00 FLS 61,600.00 61,600.00 0 1

120 RD20220228-0007 28/02/2022 EP20220228-0008 2022022800012 SARDIMA HARAHAP 70,700.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

R/ BECOM ZET TAB 10.00 TAB 2,888.00 28,880.00 0 0

R/ TREMENZA TABLET 10.00 TAB 2,001.00 20,010.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,667.00 16,670.00 1 0
CAPSUL

Print Date:7/14/2022 Print Time: 2:11:10PM Page 73 of 190

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-February-2022 s/d 28-February-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

121 RD20220228-0008 28/02/2022 EP20220228-0003 2022022800014 WENDELINUS LIAN HEWEN 2,460.0

R/ METFORMIN 500 MG TAB 10.00 TAB 246.00 2,460.00 1 0

122 RD20220228-0011 28/02/2022 EP20220228-0003 2022022800017 WENDELINUS LIAN HEWEN 134,420.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ MEFINAL 500 MG KAPLET 6.00 KAPLET 2,019.00 12,114.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

123 RI20220204-0018 04/02/2022 RI20220204-0002 RI20220204-0018 NATALIA NOPRIANTI BR 66,510.0

TARIGAN

R/ URSODEOXYCHOLIC ACID 250 3.00 CAP 6,237.00 18,711.00 1 0

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

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

124 RI20220205-0003 05/02/2022 RI20220204-0002 RI20220205-0003 NATALIA NOPRIANTI BR 58,710.0

TARIGAN

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ URSODEOXYCHOLIC ACID 250 3.00 CAP 6,237.00 18,711.00 1 0

MG
125 RI20220207-0024 07/02/2022 RI20220207-0004 RI20220207-0024 NOVRIATI SIMANUNGKALIT 305,970.0

R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ OMEPRAZOLE 40 MG INJ 3.00 VIAL 63,360.00 190,080.00 1 0

(BPJS)
126 RI20220208-0003 08/02/2022 RI20220207-0004 RI20220208-0003 NOVRIATI SIMANUNGKALIT 251,715.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ ASERING 500 ML INF 5.00 FLS 37,560.00 187,800.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
Total Dokter DR. FELIX VALERIAN HALIM 17,189,519.0
Print Date:7/14/2022 Print Time: 2:11:10PM Page 74 of 190
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-February-2022 s/d 28-February-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 RI20220201-0006 01/02/2022 RI20220131-0002 RI20220201-0006 YULIANA MELI 116,850.0

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

R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

2 RI20220201-0009 01/02/2022 RI20220129-0002 RI20220201-0009 TINJAU SINUKABAN 1,310.0

R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

R/ BICNAT TAB 3.00 TAB 9.00 27.00 1 0

3 RI20220201-0012 01/02/2022 RI20220131-0002 RI20220201-0012 YULIANA MELI 8,100.0

R/ KSR TAB 2.00 TAB 4,050.00 8,100.00 0 1

4 RI20220202-0002 02/02/2022 RI20220129-0002 RI20220202-0002 TINJAU SINUKABAN 12,180.0

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

5 RI20220202-0004 02/02/2022 RI20220129-0002 RI20220202-0004 TINJAU SINUKABAN 17,800.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

6 RI20220202-0006 02/02/2022 RI20220129-0002 RI20220202-0006 TINJAU SINUKABAN 102,215.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ SALIN 3 % 500 ML (OTSU) 1.00 FLS 38,828.00 38,828.00 0 1

R/ BICNAT TAB 3.00 TAB 9.00 27.00 1 0

7 RI20220202-0007 02/02/2022 RI20220131-0002 RI20220202-0007 YULIANA MELI 41,568.0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

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

R/ KSR TAB 2.00 TAB 4,050.00 8,100.00 0 1

8 RI20220202-0011 02/02/2022 RI20220131-0002 RI20220202-0011 YULIANA MELI 150,240.0

R/ ASERING 500 ML INF 4.00 FLS 37,560.00 150,240.00 0 1

9 RI20220202-0018 02/02/2022 RI20220202-0001 RI20220202-0018 JOHAN WIBOWO 548,071.0

PANGARIBUAN

R/ SPUIT 10 CC ( TERUMO ) 3.00 PCS 11,242.00 33,726.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ LAMETIC 4 MG INJ 2.00 AMP 42,240.00 84,480.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 75 of 190

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-February-2022 s/d 28-February-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/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ MERTIGO 6 MG TAB 3.00 TAB 4,987.00 14,961.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

10 RI20220202-0020 02/02/2022 RI20220129-0002 RI20220202-0020 TINJAU SINUKABAN 64,643.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

11 RI20220202-0025 02/02/2022 RI20220202-0001 RI20220202-0025 JOHAN WIBOWO 101,902.0

PANGARIBUAN

R/ RHINOS SR KAPSUL 2.00 CAP 8,067.00 16,134.00 0 1

(PREKURSOR)
R/ SPUIT 5 CC (TERUMO) 4.00 PCS 5,600.00 22,400.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 4.00 PCS 11,242.00 44,968.00 0 1

R/ SPUIT 3 CC (TERUMO) 4.00 PCS 4,600.00 18,400.00 1 0

12 RI20220202-0032 02/02/2022 RI20220202-0001 RI20220202-0032 JOHAN WIBOWO 38,056.0

PANGARIBUAN

R/ CORTIDEX 0,5 MG TAB 4.00 TAB 399.00 1,596.00 0 1

R/ ZOLLOCID CAPS 1.00 CAP 12,672.00 12,672.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

13 RI20220202-0034 02/02/2022 RI20220131-0002 RI20220202-0034 YULIANA MELI 885.0

R/ CURCUMA FCT TAB 1.00 TAB 885.00 885.00 0 1

14 RI20220203-0010 03/02/2022 RI20220129-0002 RI20220203-0010 TINJAU SINUKABAN 92,760.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

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

15 RI20220203-0012 03/02/2022 RI20220202-0001 RI20220203-0012 JOHAN WIBOWO 521,157.0

PANGARIBUAN

R/ KAPAS ALKOHOL 4.00 PCS 303.00 1,212.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

R/ LAMETIC 8 MG INJ 1.00 AMP 84,480.00 84,480.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ MERTIGO 6 MG TAB 3.00 TAB 4,987.00 14,961.00 0 1

R/ SPUIT 5 CC (TERUMO) 4.00 PCS 5,600.00 22,400.00 0 1

16 RI20220203-0016 03/02/2022 RI20220131-0002 RI20220203-0016 YULIANA MELI 7,160.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0
KAPLET
R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 76 of 190

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-February-2022 s/d 28-February-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

17 RI20220203-0017 03/02/2022 RI20220129-0002 RI20220203-0017 TINJAU SINUKABAN 185.0

R/ PARACETAMOL 500 MG 1.00 KAPLET 185.00 185.00 1 0

KAPLET
18 RI20220203-0029 03/02/2022 RI20220202-0001 RI20220203-0029 JOHAN WIBOWO 90,283.0
PANGARIBUAN

R/ MERTIGO 6 MG TAB 1.00 TAB 4,987.00 4,987.00 0 1

R/ LAMETIC 8 MG INJ 1.00 AMP 84,480.00 84,480.00 0 1

R/ SANMOL 500 MG TABLET 2.00 TAB 408.00 816.00 0 1

19 RI20220204-0003 04/02/2022 RI20220202-0001 RI20220204-0003 JOHAN WIBOWO 658,660.0

PANGARIBUAN

R/ MERTIGO 6 MG TAB 3.00 TAB 4,987.00 14,961.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ ASERING 500 ML INF 5.00 FLS 37,560.00 187,800.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

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

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

20 RI20220204-0021 04/02/2022 RI20220202-0001 RI20220204-0021 JOHAN WIBOWO 1,000.0

PANGARIBUAN

R/ CETIRIZINE 10 MG TAB 1.00 TAB 1,000.00 1,000.00 1 0

21 RI20220205-0004 05/02/2022 RI20220202-0001 RI20220205-0004 JOHAN WIBOWO 582,025.0

PANGARIBUAN

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

R/ MERTIGO 6 MG TAB 3.00 TAB 4,987.00 14,961.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

22 RI20220205-0011 05/02/2022 RI20220202-0001 RI20220205-0011 JOHAN WIBOWO 23,788.0

PANGARIBUAN

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

23 RI20220205-0012 05/02/2022 RI20220204-0002 RI20220205-0012 NATALIA NOPRIANTI BR 7,800.0

TARIGAN

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

24 RI20220205-0013 05/02/2022 RI20220202-0001 RI20220205-0013 JOHAN WIBOWO 98,900.0

PANGARIBUAN

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 77 of 190

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-February-2022 s/d 28-February-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

25 RI20220206-0001 06/02/2022 RI20220204-0002 RI20220206-0001 NATALIA NOPRIANTI BR 45,377.0

TARIGAN

R/ URSODEOXYCHOLIC ACID 250 3.00 CAP 6,237.00 18,711.00 1 0

MG
R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

26 RI20220206-0005 06/02/2022 RI20220202-0001 RI20220206-0005 JOHAN WIBOWO 846,946.0

PANGARIBUAN

R/ ASERING 500 ML INF 4.00 FLS 37,560.00 150,240.00 0 1

R/ RHINOS SR KAPSUL 3.00 CAP 8,067.00 24,201.00 0 1

(PREKURSOR)
R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ MERTIGO 6 MG TAB 3.00 TAB 4,987.00 14,961.00 0 1

R/ SPUIT 3 CC (TERUMO) 5.00 PCS 4,600.00 23,000.00 1 0

R/ LAMETIC 8 MG INJ 4.00 AMP 84,480.00 337,920.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

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

27 RI20220206-0007 06/02/2022 RI20220206-0001 RI20220206-0007 ROIDA SIHOTANG 37,098.0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

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

28 RI20220206-0011 06/02/2022 RI20220204-0002 RI20220206-0011 NATALIA NOPRIANTI BR 6,519.0

TARIGAN

R/ TRICHODAZOL 500 MG TAB 3.00 TAB 2,173.00 6,519.00 0 1

29 RI20220206-0012 06/02/2022 RI20220204-0002 RI20220206-0012 NATALIA NOPRIANTI BR 7,800.0

TARIGAN

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

30 RI20220206-0013 06/02/2022 RI20220202-0001 RI20220206-0013 JOHAN WIBOWO 77,440.0

PANGARIBUAN

R/ OPILAX 60 ML SYR 1.00 FLS 77,440.00 77,440.00 0 1

31 RI20220206-0020 06/02/2022 RI20220204-0002 RI20220206-0020 NATALIA NOPRIANTI BR 44,500.0

TARIGAN

R/ AQUADES 25 ML 125.00 CC 356.00 44,500.00 0 1

32 RI20220207-0001 07/02/2022 RI20220206-0001 RI20220207-0001 ROIDA SIHOTANG 19,532.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

33 RI20220207-0002 07/02/2022 RI20220202-0001 RI20220207-0002 JOHAN WIBOWO 45,360.0

PANGARIBUAN

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

34 RI20220207-0003 07/02/2022 RI20220204-0002 RI20220207-0003 NATALIA NOPRIANTI BR 83,029.0

 TARIGAN

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 78 of 190

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-February-2022 s/d 28-February-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/ TRICHODAZOL 500 MG TAB 3.00 TAB 2,173.00 6,519.00 0 1

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ URSODEOXYCHOLIC ACID 250 3.00 CAP 6,237.00 18,711.00 1 0

MG
35 RI20220207-0004 07/02/2022 RI20220206-0001 RI20220207-0004 ROIDA SIHOTANG 38,198.0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

36 RI20220207-0006 07/02/2022 RI20220202-0001 RI20220207-0006 JOHAN WIBOWO 547,495.0

PANGARIBUAN

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ ASERING 500 ML INF 2.00 FLS 37,560.00 75,120.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ MERTIGO 6 MG TAB 3.00 TAB 4,987.00 14,961.00 0 1

37 RI20220207-0009 07/02/2022 RI20220202-0001 RI20220207-0009 JOHAN WIBOWO 259,223.0

PANGARIBUAN

R/ LAPRAZ 30 MG CAP 5.00 CAP 16,473.00 82,365.00 0 1

R/ IMUNVIT KAPLET 7.00 KAPLET 10,000.00 70,000.00 0 0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

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

38 RI20220207-0011 07/02/2022 RI20220204-0002 RI20220207-0011 NATALIA NOPRIANTI BR 8,970.0

TARIGAN

R/ SPASMINAL TABLET 3.00 TAB 817.00 2,451.00 0 1

R/ TRICHODAZOL 500 MG TAB 3.00 TAB 2,173.00 6,519.00 0 1

39 RI20220207-0012 07/02/2022 RI202202 RI20220207-0012 INNA 152,822.0

07-0003

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 3,003.00 6,006.00 1 0

INJ (BPJS)
R/ SET DARAH 1.00 PCS 7,157.00 7,157.00 0 1

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

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ COTRIMOXAZOLE 480 MG 3.00 TAB 550.00 1,650.00 1 0
TABLET
R/ SURFLO NO. 20 VENFLON 1.00 PCS 22,680.00 22,680.00 1 0

R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 79 of 190

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-February-2022 s/d 28-February-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 RI20220207-0015 07/02/2022 RI20220207-0003 RI20220207-0015 INNA 1,770.0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

41 RI20220207-0021 07/02/2022 RI20220207-0003 RI20220207-0021 INNA 13,333.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

42 RI20220208-0002 08/02/2022 RI20220207-0003 RI20220208-0002 INNA 7,157.0

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

43 RI20220208-0005 08/02/2022 RI20220207-0003 RI20220208-0005 INNA 50,882.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
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/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
44 RI20220208-0007 08/02/2022 RI20220208-0001 RI20220208-0007 ANDIKA PUTRA 556,420.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

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

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ PROVITAL PLUS CAPS 3.00 CAP 5,800.00 17,400.00 0 1

R/ MERTIGO 6 MG TAB 3.00 TAB 4,987.00 14,961.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

45 RI20220208-0008 08/02/2022 RI20220207-0005 RI20220208-0008 ARI SAPUTRA RAMBE 96,505.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ ASERING 500 ML INF 2.00 FLS 37,560.00 75,120.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
46 RI20220208-0010 08/02/2022 RI20220204-0002 RI20220208-0010 NATALIA NOPRIANTI BR 65,628.0
TARIGAN

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ SPASMINAL TABLET 3.00 TAB 817.00 2,451.00 0 1

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ URSODEOXYCHOLIC ACID 250 3.00 CAP 6,237.00 18,711.00 1 0

MG
Print Date:7/14/2022 Print Time: 2:11:10PM Page 80 of 190
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-February-2022 s/d 28-February-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

47 RI20220208-0015 08/02/2022 RI20220207-0005 RI20220208-0015 ARI SAPUTRA RAMBE 1,770.0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

48 RI20220208-0018 08/02/2022 RI20220208-0002 RI20220208-0018 POLMAN MANALU 29,597.0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ KAPAS ALKOHOL 2.00 PCS 303.00 606.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
49 RI20220208-0020 08/02/2022 RI20220208-0002 RI20220208-0020 POLMAN MANALU 17,800.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

50 RI20220208-0021 08/02/2022 RI20220207-0003 RI20220208-0021 INNA 29,700.0

R/ FLUCONAZOLE 150 MG TAB 1.00 TAB 29,700.00 29,700.00 1 0

51 RI20220208-0023 08/02/2022 RI20220208-0001 RI20220208-0023 ANDIKA PUTRA 25,344.0

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

52 RI20220208-0026 08/02/2022 RI20220207-0004 RI20220208-0026 NOVRIATI SIMANUNGKALIT 885.0

R/ CURCUMA FCT TAB 1.00 TAB 885.00 885.00 0 1

53 RI20220208-0030 08/02/2022 RI20220207-0004 RI20220208-0030 NOVRIATI SIMANUNGKALIT 75,120.0

R/ ASERING 500 ML INF 2.00 FLS 37,560.00 75,120.00 0 1

54 RI20220208-0031 08/02/2022 RI20220208-0001 RI20220208-0031 ANDIKA PUTRA 13,435.0

R/ MERTIGO 6 MG TAB 1.00 TAB 4,987.00 4,987.00 0 1

R/ FREGO 5 MG TAB 1.00 TAB 8,448.00 8,448.00 0 0

55 RI20220209-0001 09/02/2022 RI20220208-0003 RI20220209-0001 CHRISTOPER HP SITANGGANG 98,441.0

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
56 RI20220209-0003 09/02/2022 RI20220207-0004 RI20220209-0003 NOVRIATI SIMANUNGKALIT 112,680.0
R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 81 of 190

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-February-2022 s/d 28-February-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

57 RI20220209-0004 09/02/2022 RI20220208-0003 RI20220209-0004 CHRISTOPER HP SITANGGANG 51,734.0

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

R/ AQUADEST 1000 ML 1.00 FLS 32,134.00 32,134.00 1 0

58 RI20220209-0006 09/02/2022 RI20220208-0003 RI20220209-0006 CHRISTOPER HP SITANGGANG 84,648.0

R/ HANDSCOEN STERIL NO. 6.5 4.00 PSG 21,162.00 84,648.00 0 1

59 RI20220209-0007 09/02/2022 RI20220204-0002 RI20220209-0007 NATALIA NOPRIANTI BR 61,161.0

TARIGAN

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ URSODEOXYCHOLIC ACID 250 3.00 CAP 6,237.00 18,711.00 1 0

MG
R/ SPASMINAL TABLET 3.00 TAB 817.00 2,451.00 0 1

60 RI20220209-0009 09/02/2022 RI20220207-0004 RI20220209-0009 NOVRIATI SIMANUNGKALIT 227,685.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ ASERING 500 ML INF 6.00 FLS 37,560.00 225,360.00 0 1

61 RI20220209-0011 09/02/2022 RI20220207-0003 RI20220209-0011 INNA 13,333.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

62 RI20220209-0012 09/02/2022 RI20220208-0002 RI20220209-0012 POLMAN MANALU 61,187.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

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

R/ OMEPRAZOLE 20 MG CAP 1.00 CAP 742.00 742.00 1 0

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/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
63 RI20220209-0013 09/02/2022 RI20220207-0003 RI20220209-0013 INNA 37,580.0

R/ FLUCONAZOLE 150 MG TAB 1.00 TAB 29,700.00 29,700.00 1 0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0
KAPLET
R/ COTRIMOXAZOLE 480 MG 2.00 TAB 550.00 1,100.00 1 0
TABLET
64 RI20220209-0014 09/02/2022 RI20220208-0003 RI20220209-0014 CHRISTOPER HP SITANGGANG 29,298.0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

65 RI20220209-0015 09/02/2022 RI20220208-0002 RI20220209-0015 POLMAN MANALU 39,999.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 82 of 190

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-February-2022 s/d 28-February-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 3.00 FLS 13,333.00 39,999.00 1 0

66 RI20220209-0020 09/02/2022 RI20220204-0002 RI20220209-0020 NATALIA NOPRIANTI BR 349,167.0

TARIGAN

R/ SPUIT 50 ML (WITHOUT 1.00 PCS 37,206.00 37,206.00 0 1

NEEDLE) ONEMED
R/ HANDSCOEN STERIL NO. 6.0 1.00 PSG 27,000.00 27,000.00 0 1

R/ AMINOFUSIN HEPAR 500 ML 1.00 FLS 246,000.00 246,000.00 1 0

INF
R/ STOMACH TUBE NO. 16 1.00 PCS 38,961.00 38,961.00 0 1

67 RI20220209-0021 09/02/2022 RI20220209-0001 RI20220209-0021 RAYA SIHOMBING 94,428.0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
68 RI20220209-0022 09/02/2022 RI20220204-0002 RI20220209-0022 NATALIA NOPRIANTI BR 133,975.0
TARIGAN

R/ STOMACH TUBE NO. 16 1.00 PCS 38,961.00 38,961.00 0 1

R/ IBUPROFEN 400 MG TAB 1.00 TAB 514.00 514.00 1 0

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
R/ HANDSCOEN STERIL NO. 6.0 1.00 PSG 27,000.00 27,000.00 0 1

69 RI20220209-0023 09/02/2022 RI20220208-0002 RI20220209-0023 POLMAN MANALU 9,533.0

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

70 RI20220209-0024 09/02/2022 RI20220204-0002 RI20220209-0024 NATALIA NOPRIANTI BR 19,600.0

TARIGAN

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

71 RI20220209-0025 09/02/2022 RI20220208-0001 RI20220209-0025 ANDIKA PUTRA 2,451.0

R/ SPASMINAL TABLET 3.00 TAB 817.00 2,451.00 0 1

72 RI20220209-0027 09/02/2022 RI20220207-0005 RI20220209-0027 ARI SAPUTRA RAMBE 2,140.0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ PARACETAMOL 500 MG 2.00 KAPLET 185.00 370.00 1 0

KAPLET
73 RI20220209-0028 09/02/2022 RI20220208-0001 RI20220209-0028 ANDIKA PUTRA 84,480.0

R/ LAMETIC 8 MG INJ 1.00 AMP 84,480.00 84,480.00 0 1

74 RI20220209-0031 09/02/2022 RI20220207-0003 RI20220209-0031 INNA 675.0

R/ VITAMIN B6 (PYRIDOXINE) 5.00 TAB 135.00 675.00 1 0
TAB

Print Date:7/14/2022 Print Time: 2:11:10PM Page 83 of 190

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-February-2022 s/d 28-February-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

75 RI20220209-0033 09/02/2022 RI20220209-0002 RI20220209-0033 EKA ROSIANA 102,916.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

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

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ CODEIN 10 MG TAB 3.00 TAB 925.00 2,775.00 0 0
(NARKOTIKA)
R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

76 RI20220209-0035 09/02/2022 RI20220208-0003 RI20220209-0035 CHRISTOPER HP SITANGGANG 337,920.0

R/ FAVIKAL 200 MG TABLET 16.00 TAB 21,120.00 337,920.00 0 1

77 RI20220209-0041 09/02/2022 RI20220208-0001 RI20220209-0041 ANDIKA PUTRA 5,804.0

R/ MERTIGO 6 MG TAB 1.00 TAB 4,987.00 4,987.00 0 1

R/ SPASMINAL TABLET 1.00 TAB 817.00 817.00 0 1

78 RI20220209-0042 09/02/2022 RI20220207-0004 RI20220209-0042 NOVRIATI SIMANUNGKALIT 112,680.0

R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

79 RI20220210-0002 10/02/2022 RI20220208-0001 RI20220210-0002 ANDIKA PUTRA 33,600.0

R/ SPUIT 5 CC (TERUMO) 6.00 PCS 5,600.00 33,600.00 0 1

80 RI20220210-0003 10/02/2022 RI20220208-0002 RI20220210-0003 POLMAN MANALU 42,324.0

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

81 RI20220210-0004 10/02/2022 RI20220208-0003 RI20220210-0004 CHRISTOPER HP SITANGGANG 42,324.0

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

82 RI20220210-0006 10/02/2022 RI20220207-0003 RI20220210-0006 INNA 685.0

R/ COTRIMOXAZOLE 480 MG 1.00 TAB 550.00 550.00 1 0

TABLET
R/ VITAMIN B6 (PYRIDOXINE) 1.00 TAB 135.00 135.00 1 0
TAB
83 RI20220210-0007 10/02/2022 RI20220208-0003 RI20220210-0007 CHRISTOPER HP SITANGGANG 1,485.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
84 RI20220210-0008 10/02/2022 RI20220208-0002 RI20220210-0008 POLMAN MANALU 13,333.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

85 RI20220210-0009 10/02/2022 RI20220208-0003 RI20220210-0009 CHRISTOPER HP SITANGGANG 73,126.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)
R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 84 of 190

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-February-2022 s/d 28-February-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

86 RI20220210-0012 10/02/2022 RI20220204-0002 RI20220210-0012 NATALIA NOPRIANTI BR 41,514.0

TARIGAN

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

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

87 RI20220210-0013 10/02/2022 RI20220209-0001 RI20220210-0013 RAYA SIHOMBING 142,835.0

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)
R/ RL 500 ML INF 5.00 FLS 9,766.00 48,830.00 0 1

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

88 RI20220210-0014 10/02/2022 RI20220208-0002 RI20220210-0014 POLMAN MANALU 97,278.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

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

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
89 RI20220210-0015 10/02/2022 RI20220208-0003 RI20220210-0015 CHRISTOPER HP SITANGGANG 233,921.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0
KAPLET
R/ FAVIKAL 200 MG TABLET 6.00 TAB 21,120.00 126,720.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

90 RI20220210-0016 10/02/2022 RI20220207-0004 RI20220210-0016 NOVRIATI SIMANUNGKALIT 205,065.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 85 of 190

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-February-2022 s/d 28-February-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
91 RI20220210-0017 10/02/2022 RI20220207-0003 RI20220210-0017 INNA 48,284.0

R/ VITAMIN B6 (PYRIDOXINE) 3.00 TAB 135.00 405.00 1 0

TAB
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ COTRIMOXAZOLE 480 MG 2.00 TAB 550.00 1,100.00 1 0

TABLET
R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0
KAPLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

92 RI20220210-0018 10/02/2022 RI20220209-0002 RI20220210-0018 EKA ROSIANA 106,689.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ CODEIN 10 MG TAB 3.00 TAB 925.00 2,775.00 0 0
(NARKOTIKA)
93 RI20220210-0025 10/02/2022 RI20220208-0003 RI20220210-0025 CHRISTOPER HP SITANGGANG 198,486.0

R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1

R/ HANDSCOEN STERIL NO. 6.0 3.00 PSG 27,000.00 81,000.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 3.00 PSG 21,162.00 63,486.00 0 1

94 RI20220210-0026 10/02/2022 RI20220208-0002 RI20220210-0026 POLMAN MANALU 198,486.0

R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1

R/ HANDSCOEN STERIL NO. 6.0 3.00 PSG 27,000.00 81,000.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 3.00 PSG 21,162.00 63,486.00 0 1

95 RI20220210-0027 10/02/2022 RI20220208-0001 RI20220210-0027 ANDIKA PUTRA 338,968.0

R/ MERTIGO 6 MG TAB 15.00 TAB 4,987.00 74,805.00 0 1

R/ IMUNVIT KAPLET 7.00 KAPLET 10,000.00 70,000.00 0 0

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

R/ SPASMINAL TABLET 15.00 TAB 817.00 12,255.00 0 1

R/ LAPRAZ 30 MG CAP 6.00 CAP 16,473.00 98,838.00 0 1

96 RI20220210-0028 10/02/2022 RI20220207-0003 RI20220210-0028 INNA 29,700.0

R/ FLUCONAZOLE 150 MG TAB 1.00 TAB 29,700.00 29,700.00 1 0

97 RI20220210-0029 10/02/2022 RI20220204-0002 RI20220210-0029 NATALIA NOPRIANTI BR 25,195.0

TARIGAN

R/ SPASMINAL TABLET 10.00 TAB 817.00 8,170.00 0 1

R/ DOMPERIDON 10 MG TAB 15.00 TAB 545.00 8,175.00 1 0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 86 of 190

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-February-2022 s/d 28-February-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

98 RI20220210-0030 10/02/2022 RI20220207-0005 RI20220210-0030 ARI SAPUTRA RAMBE 8,850.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

99 RI20220210-0035 10/02/2022 RI20220209-0002 RI20220210-0035 EKA ROSIANA 4,050.0

R/ KSR TAB 1.00 TAB 4,050.00 4,050.00 0 1

100 RI20220210-0036 10/02/2022 RI20220208-0002 RI20220210-0036 POLMAN MANALU 168,960.0

R/ FAVIKAL 200 MG TABLET 8.00 TAB 21,120.00 168,960.00 0 1

101 RI20220210-0037 10/02/2022 RI20220207-0003 RI20220210-0037 INNA 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

102 RI20220210-0038 10/02/2022 RI20220207-0003 RI20220210-0038 INNA 2,025.0

R/ VITAMIN B6 (PYRIDOXINE) 15.00 TAB 135.00 2,025.00 1 0

TAB
103 RI20220210-0042 10/02/2022 RI20220207-0003 RI20220210-0042 INNA 13,720.0

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

104 RI20220210-0043 10/02/2022 RI20220208-0003 RI20220210-0043 CHRISTOPER HP SITANGGANG 126,720.0

R/ FAVIKAL 200 MG TABLET 6.00 TAB 21,120.00 126,720.00 0 1

105 RI20220211-0002 11/02/2022 RI20220208-0002 RI20220211-0002 POLMAN MANALU 63,360.0

R/ FAVIKAL 200 MG TABLET 3.00 TAB 21,120.00 63,360.00 0 1

106 RI20220211-0005 11/02/2022 RI20220209-0001 RI20220211-0005 RAYA SIHOMBING 96,498.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

107 RI20220211-0006 11/02/2022 RI20220208-0003 RI20220211-0006 CHRISTOPER HP SITANGGANG 265,813.0

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

R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ FAVIKAL 200 MG TABLET 6.00 TAB 21,120.00 126,720.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
Print Date:7/14/2022 Print Time: 2:11:10PM Page 87 of 190
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-February-2022 s/d 28-February-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/ AZITHROMYCIN 500 MG 2.00 KAPLET 6,930.00 13,860.00 1 0

KAPLET
108 RI20220211-0007 11/02/2022 RI20220208-0002 RI20220211-0007 POLMAN MANALU 150,950.0

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ FAVIKAL 200 MG TABLET 6.00 TAB 21,120.00 126,720.00 0 1

109 RI20220211-0008 11/02/2022 RI20220207-0003 RI20220211-0008 INNA 38,894.0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ VITAMIN B6 (PYRIDOXINE) 3.00 TAB 135.00 405.00 1 0

TAB
R/ COTRIMOXAZOLE 480 MG 2.00 TAB 550.00 1,100.00 1 0
TABLET
R/ FLUCONAZOLE 150 MG TAB 1.00 TAB 29,700.00 29,700.00 1 0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
110 RI20220211-0010 11/02/2022 RI20220208-0003 RI20220211-0010 CHRISTOPER HP SITANGGANG 162,000.0

R/ HANDSCOEN STERIL NO. 6.0 6.00 PSG 27,000.00 162,000.00 0 1

111 RI20220211-0011 11/02/2022 RI20220208-0002 RI20220211-0011 POLMAN MANALU 162,000.0

R/ HANDSCOEN STERIL NO. 6.0 6.00 PSG 27,000.00 162,000.00 0 1

112 RI20220211-0013 11/02/2022 RI20220207-0004 RI20220211-0013 NOVRIATI SIMANUNGKALIT 8,085.0

R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

R/ PARACETAMOL 500 MG 15.00 KAPLET 185.00 2,775.00 1 0

KAPLET
113 RI20220211-0015 11/02/2022 RI20220207-0003 RI20220211-0015 INNA 83,088.0

R/ COTRIMOXAZOLE 480 MG 6.00 TAB 550.00 3,300.00 1 0

TABLET
R/ ACETYLCYSTEIN 200 MG 9.00 CAP 1,485.00 13,365.00 1 0
CAPSUL
R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

R/ DOMPERIDON 10 MG TAB 15.00 TAB 545.00 8,175.00 1 0

114 RI20220211-0025 11/02/2022 RI20220208-0003 RI20220211-0025 CHRISTOPER HP SITANGGANG 4,455.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
115 RI20220211-0029 11/02/2022 RI20220208-0002 RI20220211-0029 POLMAN MANALU 1,200.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 88 of 190

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-February-2022 s/d 28-February-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/ AMLODIPINE 5 MG TAB 1.00 TAB 1,200.00 1,200.00 1 0

116 RI20220212-0001 12/02/2022 RI20220208-0002 RI20220212-0001 POLMAN MANALU 21,252.0

R/ SELANG O2 DEWASA 2.00 PCS 10,626.00 21,252.00 0 1

117 RI20220212-0012 12/02/2022 RI20220209-0001 RI20220212-0012 RAYA SIHOMBING 8,850.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

118 RI20220212-0013 12/02/2022 RI20220208-0003 RI20220212-0013 CHRISTOPER HP SITANGGANG 331,833.0

R/ FAVIPIRAVIR 200 MG TABLET 9.00 TAB 24,300.00 218,700.00 1 0

R/ ACETYLCYSTEIN 200 MG 20.00 CAP 1,485.00 29,700.00 1 0

CAPSUL
R/ DEVIT 1000 IU 6.00 TAB 2,600.00 15,600.00 0 1

R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.00 4,452.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ VITAMIN C XON-CE KAPLET 21.00 KAPLET 1.00 21.00 0 1

119 RI20220212-0014 12/02/2022 RI20220208-0002 RI20220212-0014 POLMAN MANALU 444,522.0

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

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

R/ VITAMIN C XON-CE KAPLET 22.00 KAPLET 1.00 22.00 0 1

R/ ACETYLCYSTEIN 200 MG 20.00 CAP 1,485.00 29,700.00 1 0

CAPSUL
R/ FAVIPIRAVIR 200 MG TABLET 15.00 TAB 24,300.00 364,500.00 1 0

120 RI20220212-0020 12/02/2022 RI20220212-0002 RI20220212-0020 ANANDA DAME SIHOMBING 136,610.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ LEVOFLOXACIN 500MG/100 ML 1.00 FLS 110,000.00 110,000.00 1 0
INF
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
121 RI20220213-0007 13/02/2022 RI20220212-0002 RI20220213-0007 ANANDA DAME SIHOMBING 254,440.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0
CAPSUL
R/ LEVOFLOXACIN 500MG/100 ML 2.00 FLS 110,000.00 220,000.00 1 0
INF
122 RI20220213-0012 13/02/2022 RI20220212-0002 RI20220213-0012 ANANDA DAME SIHOMBING 17,800.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

123 RI20220213-0017 13/02/2022 RI20220213-0002 RI20220213-0017 SILVIA MAHESTI 225,786.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 89 of 190

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-February-2022 s/d 28-February-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/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ LAMETIC 8 MG INJ 2.00 AMP 84,480.00 168,960.00 0 1

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

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

124 RI20220213-0021 13/02/2022 RI20220213-0003 RI20220213-0021 NADA SUHALLAH 47,664.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
125 RI20220213-0022 13/02/2022 RI20220213-0004 RI20220213-0022 ASIMA FLORENTINA MANIK 888,394.0

R/ FAVIPIRAVIR 200 MG TABLET 8.00 TAB 24,300.00 194,400.00 1 0

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ RESFAR 25 ML 2.00 FLS 280,192.00 560,384.00 0 1

R/ LEVOFLOXACIN 500MG/100 ML 1.00 FLS 110,000.00 110,000.00 1 0

INF
R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0
KAPLET
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

126 RI20220213-0023 13/02/2022 RI20220213-0004 RI20220213-0023 ASIMA FLORENTINA MANIK 21,040.0

R/ DEXTROSE 5% 500 ML INF 1.00 FLS 21,040.00 21,040.00 0 1

127 RI20220214-0001 14/02/2022 RI20220213-0004 RI20220214-0001 ASIMA FLORENTINA MANIK 16,134.0

R/ RHINOS SR KAPSUL 2.00 CAP 8,067.00 16,134.00 0 1

(PREKURSOR)
128 RI20220214-0010 14/02/2022 RI20220213-0005 RI20220214-0010 RINALDO PURBA 32,715.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

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

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

129 RI20220214-0012 14/02/2022 RI20220213-0002 RI20220214-0012 SILVIA MAHESTI 21,952.0

R/ SANMOL 500 MG TABLET 2.00 TAB 408.00 816.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 90 of 190

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-February-2022 s/d 28-February-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

130 RI20220214-0013 14/02/2022 RI20220213-0004 RI20220214-0013 ASIMA FLORENTINA MANIK 700,228.0

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

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
R/ FAVIPIRAVIR 200 MG TABLET 11.00 TAB 24,300.00 267,300.00 1 0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

R/ LEVOFLOXACIN 500MG/100 ML 1.00 FLS 110,000.00 110,000.00 1 0

INF
R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

131 RI20220214-0014 14/02/2022 RI20220212-0002 RI20220214-0014 ANANDA DAME SIHOMBING 27,822.0

R/ KAPAS ALKOHOL 4.00 PCS 303.00 1,212.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
132 RI20220214-0019 14/02/2022 RI20220213-0003 RI20220214-0019 NADA SUHALLAH 48,573.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
133 RI20220214-0024 14/02/2022 RI20220213-0005 RI20220214-0024 RINALDO PURBA 44,500.0

R/ AQUADES 25 ML 125.00 CC 356.00 44,500.00 0 1

134 RI20220214-0026 14/02/2022 RI20220212-0002 RI20220214-0026 ANANDA DAME SIHOMBING 26,003.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

135 RI20220214-0027 14/02/2022 RI20220213-0003 RI20220214-0027 NADA SUHALLAH 2,603.0

R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

136 RI20220214-0029 14/02/2022 RI20220213-0004 RI20220214-0029 ASIMA FLORENTINA MANIK 83,070.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 91 of 190

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-February-2022 s/d 28-February-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

137 RI20220214-0032 14/02/2022 RI20220213-0004 RI20220214-0032 ASIMA FLORENTINA MANIK 122,448.0

R/ HANDSCOEN STERILE 2.00 PSG 18,900.00 37,800.00 0 1

(GAMMEX) NO. 7
R/ HANDSCOEN STERIL NO. 6.5 4.00 PSG 21,162.00 84,648.00 0 1

138 RI20220214-0033 14/02/2022 RI20220213-0004 RI20220214-0033 ASIMA FLORENTINA MANIK 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

139 RI20220214-0034 14/02/2022 RI20220213-0004 RI20220214-0034 ASIMA FLORENTINA MANIK 13,720.0

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

140 RI20220214-0036 14/02/2022 RI20220212-0002 RI20220214-0036 ANANDA DAME SIHOMBING 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

141 RI20220214-0037 14/02/2022 RI20220213-0005 RI20220214-0037 RINALDO PURBA 10,800.0

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 ### 0 1

142 RI20220214-0039 14/02/2022 RI20220213-0004 RI20220214-0039 ASIMA FLORENTINA MANIK 1,485.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
143 RI20220214-0040 14/02/2022 RI20220213-0004 RI20220214-0040 ASIMA FLORENTINA MANIK 20,134.0

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

144 RI20220214-0041 14/02/2022 RI20220213-0004 RI20220214-0041 ASIMA FLORENTINA MANIK 22,484.0

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

145 RI20220215-0001 15/02/2022 RI20220213-0004 RI20220215-0001 ASIMA FLORENTINA MANIK 488,472.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ NS 0.9 100 ML (PIGGY BACK) 1.00 FLS 19,430.00 19,430.00 1 0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

R/ DEVIT 1000 IU 2.00 TAB 2,600.00 5,200.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

146 RI20220215-0002 15/02/2022 RI20220212-0002 RI20220215-0002 ANANDA DAME SIHOMBING 16,772.0

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
R/ VITAMIN C XON-CE KAPLET 2.00 KAPLET 1.00 2.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 92 of 190

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-February-2022 s/d 28-February-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

147 RI20220215-0003 15/02/2022 RI20220213-0004 RI20220215-0003 ASIMA FLORENTINA MANIK 42,324.0

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

148 RI20220215-0006 15/02/2022 RI20220213-0003 RI20220215-0006 NADA SUHALLAH 104,732.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

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

149 RI20220215-0007 15/02/2022 RI20220213-0002 RI20220215-0007 SILVIA MAHESTI 52,697.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

R/ VITAMIN C XON-CE KAPLET 2.00 KAPLET 1.00 2.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

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

150 RI20220215-0008 15/02/2022 RI20220213-0005 RI20220215-0008 RINALDO PURBA 97,818.0

R/ ASERING 500 ML INF 6.00 FLS 10,800.00 64,800.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0
KAPLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

151 RI20220215-0011 15/02/2022 RI20220213-0002 RI20220215-0011 SILVIA MAHESTI 677,818.0

R/ NALD 23 (ONEMED) 2.00 PCS 1,813.00 3,626.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ DEVIT 1000 IU 2.00 TAB 2,600.00 5,200.00 0 1

R/ ACETYLCISTEINE 200MG/VIAL 1.00 VIAL 280,192.00 280,192.00 1 0

152 RI20220215-0012 15/02/2022 RI20220213-0003 RI20220215-0012 NADA SUHALLAH 675,218.0

R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 93 of 190

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-February-2022 s/d 28-February-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/ ACETYLCISTEINE 200MG/VIAL 1.00 VIAL 280,192.00 280,192.00 1 0

R/ NALD 23 (ONEMED) 2.00 PCS 1,813.00 3,626.00 0 1

153 RI20220215-0013 15/02/2022 RI20220212-0002 RI20220215-0013 ANANDA DAME SIHOMBING 5,430.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ CODEIN 10 MG TAB 3.00 TAB 925.00 2,775.00 0 0

(NARKOTIKA)
154 RI20220215-0015 15/02/2022 RI20220213-0003 RI20220215-0015 NADA SUHALLAH 145,800.0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

155 RI20220215-0016 15/02/2022 RI20220213-0002 RI20220215-0016 SILVIA MAHESTI 145,800.0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

156 RI20220215-0017 15/02/2022 RI20220212-0002 RI20220215-0017 ANANDA DAME SIHOMBING 24,200.0

R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

157 RI20220215-0018 15/02/2022 RI20220215-0003 RI20220215-0018 HOKKOP SIMANJUNTAK 52,855.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

158 RI20220216-0001 16/02/2022 RI20220215-0005 RI20220216-0001 RINA NUR SAFRIDA 406,094.0

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

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ IMUNVIT KAPLET 1.00 KAPLET 10,000.00 10,000.00 0 0

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

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

159 RI20220216-0002 16/02/2022 RI20220215-0004 RI20220216-0002 AMIRA RIZKI PUTRI 247,101.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ PARACETAMOL INFUS 3.00 FLS 58,438.00 175,314.00 1 0

1GR/100 ML
R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0
KAPLET
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 94 of 190

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-February-2022 s/d 28-February-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

160 RI20220216-0004 16/02/2022 RI20220215-0004 RI20220216-0004 AMIRA RIZKI PUTRI 162,730.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ PARACETAMOL INFUS 2.00 FLS 58,438.00 116,876.00 1 0
1GR/100 ML
R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0
KAPLET
R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

161 RI20220216-0005 16/02/2022 RI20220213-0003 RI20220216-0005 NADA SUHALLAH 482,974.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

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

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

162 RI20220216-0006 16/02/2022 RI20220212-0002 RI20220216-0006 ANANDA DAME SIHOMBING 73,042.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ CODEIN 10 MG TAB 3.00 TAB 925.00 2,775.00 0 0

(NARKOTIKA)
R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0
KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ ONDANSETRON 8 MG INJ 2.00 AMP 10,000.00 20,000.00 1 0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

163 RI20220216-0007 16/02/2022 RI20220213-0002 RI20220216-0007 SILVIA MAHESTI 476,533.0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ ACETYLCISTEINE 200MG/VIAL 1.00 VIAL 280,192.00 280,192.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

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

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 95 of 190

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-February-2022 s/d 28-February-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

164 RI20220216-0008 16/02/2022 RI20220213-0004 RI20220216-0008 ASIMA FLORENTINA MANIK 144,486.0

R/ HANDSCOEN STERIL NO. 7.5 3.00 PSG 27,000.00 81,000.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 3.00 PSG 21,162.00 63,486.00 0 1

165 RI20220216-0009 16/02/2022 RI20220215-0004 RI20220216-0009 AMIRA RIZKI PUTRI 42,324.0

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

166 RI20220216-0010 16/02/2022 RI20220215-0003 RI20220216-0010 HOKKOP SIMANJUNTAK 33,915.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

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

167 RI20220216-0011 16/02/2022 RI20220213-0005 RI20220216-0011 RINALDO PURBA 66,570.0

R/ ASERING 500 ML INF 6.00 FLS 10,800.00 64,800.00 0 1

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

168 RI20220216-0013 16/02/2022 RI20220215-0005 RI20220216-0013 RINA NUR SAFRIDA 634,979.0

R/ IMUNVIT PLUS KAPLET 1.00 KAPLET 13,500.00 13,500.00 0 1

R/ PANLOC INJ 2.00 VIAL 211,200.00 422,400.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 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/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

169 RI20220216-0014 16/02/2022 RI20220215-0003 RI20220216-0014 HOKKOP SIMANJUNTAK 13,275.0

R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

170 RI20220216-0015 16/02/2022 RI20220216-0001 RI20220216-0015 WANRA HUTAPEA 66,468.0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

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

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ LODIA 2 MG TABLET 3.00 TAB 1,375.00 4,125.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

171 RI20220216-0018 16/02/2022 RI20220213-0004 RI20220216-0018 ASIMA FLORENTINA MANIK 437,556.0

R/ DEVIT 1000 IU 21.00 TAB 2,600.00 54,600.00 0 1

R/ PARACETAMOL 500 MG 15.00 KAPLET 185.00 2,775.00 1 0
KAPLET
R/ FAVIKAL 200 MG TABLET 18.00 TAB 21,120.00 380,160.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 96 of 190

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-February-2022 s/d 28-February-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/ VITAMIN C XON-CE KAPLET 21.00 KAPLET 1.00 21.00 0 1

172 RI20220216-0019 16/02/2022 RI20220212-0002 RI20220216-0019 ANANDA DAME SIHOMBING 27,150.0

R/ CODEIN 10 MG TAB 15.00 TAB 925.00 13,875.00 0 0

(NARKOTIKA)
R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

173 RI20220216-0022 16/02/2022 RI20220213-0002 RI20220216-0022 SILVIA MAHESTI 14,000.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
174 RI20220216-0025 16/02/2022 RI20220213-0005 RI20220216-0025 RINALDO PURBA 10,160.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
R/ SET DARAH 1.00 PCS 7,157.00 7,157.00 0 1

175 RI20220216-0026 16/02/2022 RI20220213-0005 RI20220216-0026 RINALDO PURBA 30,000.0

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 10,000.00 30,000.00 1 0

500MG/5ML
176 RI20220216-0027 16/02/2022 RI20220213-0005 RI20220216-0027 RINALDO PURBA 52,377.0

R/ NEO K INJ 3.00 AMP 17,459.00 52,377.00 0 1

177 RI20220216-0028 16/02/2022 RI20220215-0004 RI20220216-0028 AMIRA RIZKI PUTRI 6,930.0

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
178 RI20220216-0031 16/02/2022 RI20220213-0005 RI20220216-0031 RINALDO PURBA 555.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
179 RI20220216-0033 16/02/2022 RI20220216-0004 RI20220216-0033 MIFTA WAHYU PUTRI 25,770.0

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/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

180 RI20220217-0001 17/02/2022 RI20220216-0001 RI20220217-0001 WANRA HUTAPEA 19,532.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

181 RI20220217-0002 17/02/2022 RI20220215-0004 RI20220217-0002 AMIRA RIZKI PUTRI 59,187.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

182 RI20220217-0003 17/02/2022 RI20220213-0005 RI20220217-0003 RINALDO PURBA 118,617.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 97 of 190

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-February-2022 s/d 28-February-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/ NEO K INJ 3.00 AMP 17,459.00 52,377.00 0 1

R/ ASAM TRANEKSAMAT INJ 3.00 AMP 10,000.00 30,000.00 1 0

500MG/5ML
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

183 RI20220217-0004 17/02/2022 RI20220213-0002 RI20220217-0004 SILVIA MAHESTI 490,533.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

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

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

184 RI20220217-0005 17/02/2022 RI20220215-0005 RI20220217-0005 RINA NUR SAFRIDA 413,388.0

R/ IMUNVIT PLUS KAPLET 1.00 KAPLET 13,500.00 13,500.00 0 1

R/ PANLOC INJ 1.00 VIAL 211,200.00 211,200.00 0 1

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

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

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ VIVENA INJ 2.00 VIAL 73,000.00 146,000.00 0 1

R/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

185 RI20220217-0007 ### RI20220216-0004 RI20220217-0007 MIFTA WAHYU PUTRI 36,570.0

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

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

186 RI20220217-0008 17/02/2022 RI20220216-0001 RI20220217-0008 WANRA HUTAPEA 67,843.0

R/ LODIA 2 MG TABLET 4.00 TAB 1,375.00 5,500.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0
INJ
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 98 of 190

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-February-2022 s/d 28-February-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

187 RI20220217-0010 17/02/2022 RI20220213-0003 RI20220217-0010 NADA SUHALLAH 491,913.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

188 RI20220217-0013 17/02/2022 RI20220216-0004 RI20220217-0013 MIFTA WAHYU PUTRI 29,784.0

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
189 RI20220217-0014 17/02/2022 RI20220216-0001 RI20220217-0014 WANRA HUTAPEA 555.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
190 RI20220217-0015 17/02/2022 RI20220215-0004 RI20220217-0015 AMIRA RIZKI PUTRI 52,800.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

191 RI20220217-0016 17/02/2022 RI20220213-0003 RI20220217-0016 NADA SUHALLAH 52,800.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

192 RI20220217-0018 17/02/2022 RI20220217-0001 RI20220217-0018 MARIA ANA LIPAT 217,379.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ PARACETAMOL INFUS 3.00 FLS 58,438.00 175,314.00 1 0

1GR/100 ML
R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ KAPAS ALKOHOL 4.00 PCS 303.00 1,212.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

193 RI20220217-0019 17/02/2022 RI20220217-0003 RI20220217-0019 ANA MARIANA 162,741.0

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
R/ ONDANSETRON 8 MG INJ 2.00 AMP 10,000.00 20,000.00 1 0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

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

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1
EFFERVESCENT
R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 99 of 190

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-February-2022 s/d 28-February-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/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

R/ PROVITAL PLUS CAPS 1.00 CAP 5,800.00 5,800.00 0 1

194 RI20220217-0020 17/02/2022 RI20220217-0001 RI20220217-0020 MARIA ANA LIPAT 14,760.0

R/ SPUIT 3 CC (TERUMO) 1.00 PCS 4,600.00 4,600.00 1 0

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

R/ DEXAMETHASON 5MG/1ML INJ 1.00 AMP 3,003.00 3,003.00 1 0

195 RI20220217-0021 17/02/2022 RI20220217-0001 RI20220217-0021 MARIA ANA LIPAT 13,333.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

196 RI20220217-0022 17/02/2022 RI20220217-0004 RI20220217-0022 JEFRI ROLLI RICHARDO 62,967.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ONDANSETRON 8 MG INJ 1.00 AMP 10,000.00 10,000.00 1 0

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

KAPLET
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ PROVITAL PLUS CAPS 2.00 CAP 5,800.00 11,600.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

197 RI20220217-0023 17/02/2022 RI20220217-0003 RI20220217-0023 ANA MARIANA 105,810.0

R/ HANDSCOEN STERIL NO. 6.5 5.00 PSG 21,162.00 105,810.00 0 1

198 RI20220217-0025 17/02/2022 RI20220217-0003 RI20220217-0025 ANA MARIANA 31,286.0

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

R/ KCL 7.46% 25 ML 1.00 FLS 11,686.00 11,686.00 0 1

199 RI20220218-0001 18/02/2022 RI20220217-0003 RI20220218-0001 ANA MARIANA 10,000.0

R/ ONDANSETRON 8 MG INJ 1.00 AMP 10,000.00 10,000.00 1 0

200 RI20220218-0002 18/02/2022 RI20220213-0002 RI20220218-0002 SILVIA MAHESTI 13,741.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

R/ SANMOL 500 MG TABLET 1.00 TAB 408.00 408.00 0 1

201 RI20220218-0004 18/02/2022 RI20220213-0002 RI20220218-0004 SILVIA MAHESTI 228,141.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 100 of 190

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-February-2022 s/d 28-February-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/ SANMOL 500 MG TABLET 3.00 TAB 408.00 1,224.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

202 RI20220218-0005 18/02/2022 RI20220216-0001 RI20220218-0005 WANRA HUTAPEA 63,507.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

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

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0
KAPLET
203 RI20220218-0007 18/02/2022 RI20220215-0004 RI20220218-0007 AMIRA RIZKI PUTRI 735,249.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

204 RI20220218-0008 18/02/2022 RI20220213-0003 RI20220218-0008 NADA SUHALLAH 67,136.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

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

KAPLET
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

205 RI20220218-0009 18/02/2022 RI20220217-0003 RI20220218-0009 ANA MARIANA 61,008.0

R/ PROVITAL PLUS CAPS 1.00 CAP 5,800.00 5,800.00 0 1

R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ SIMVASTATIN 10 MG TAB 1.00 TAB 480.00 480.00 1 0
206 RI20220218-0010 18/02/2022 RI20220215-0005 RI20220218-0010 RINA NUR SAFRIDA 21,600.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 101 of 190

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-February-2022 s/d 28-February-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

207 RI20220218-0011 18/02/2022 RI20220217-0004 RI20220218-0011 JEFRI ROLLI RICHARDO 61,867.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

KAPLET
R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ PROVITAL PLUS CAPS 2.00 CAP 5,800.00 11,600.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

208 RI20220218-0012 18/02/2022 RI20220217-0002 RI20220218-0012 FRENTRY SIHOMBING 50,219.0

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/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
209 RI20220218-0013 18/02/2022 RI20220217-0001 RI20220218-0013 MARIA ANA LIPAT 25,190.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

210 RI20220218-0015 18/02/2022 RI20220218-0001 RI20220218-0015 RANI LESTARI MANURUNG 273,815.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 4.00 PSG 21,162.00 84,648.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0
KAPLET
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ HANDSCOEN STERIL NO. 7.5 3.00 PSG 27,000.00 81,000.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

211 RI20220218-0016 18/02/2022 RI20220213-0005 RI20220218-0016 RINALDO PURBA 8,850.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

212 RI20220218-0017 18/02/2022 RI20220216-0004 RI20220218-0017 MIFTA WAHYU PUTRI 8,250.0

R/ LODIA 2 MG TABLET 6.00 TAB 1,375.00 8,250.00 0 1

213 RI20220218-0018 18/02/2022 RI20220215-0005 RI20220218-0018 RINA NUR SAFRIDA 130,210.0

R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 102 of 190

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-February-2022 s/d 28-February-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/ ZOLLOCID CAPS 5.00 CAP 12,672.00 63,360.00 0 1

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

214 RI20220218-0021 18/02/2022 RI20220216-0004 RI20220218-0021 MIFTA WAHYU PUTRI 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

215 RI20220218-0023 18/02/2022 RI20220213-0003 RI20220218-0023 NADA SUHALLAH 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

216 RI20220218-0024 18/02/2022 RI20220215-0004 RI20220218-0024 AMIRA RIZKI PUTRI 6,930.0

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
217 RI20220218-0025 18/02/2022 RI20220217-0002 RI20220218-0025 FRENTRY SIHOMBING 7,803.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

218 RI20220218-0026 18/02/2022 RI20220217-0004 RI20220218-0026 JEFRI ROLLI RICHARDO 57,200.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

219 RI20220218-0028 18/02/2022 RI20220217-0001 RI20220218-0028 MARIA ANA LIPAT 21,803.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

220 RI20220218-0030 18/02/2022 RI20220217-0003 RI20220218-0030 ANA MARIANA 7,803.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

221 RI20220218-0032 18/02/2022 RI20220218-0001 RI20220218-0032 RANI LESTARI MANURUNG 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

222 RI20220218-0033 18/02/2022 RI20220216-0004 RI20220218-0033 MIFTA WAHYU PUTRI 885.0

R/ CURCUMA FCT TAB 1.00 TAB 885.00 885.00 0 1

223 RI20220218-0035 18/02/2022 RI20220218-0004 RI20220218-0035 ANCUS PARULIAN SILALAHI 293,843.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ PARACETAMOL INFUS 2.00 FLS 58,438.00 116,876.00 1 0

1GR/100 ML
R/ SPUIT 5 CC (TERUMO) 5.00 PCS 5,600.00 28,000.00 0 1

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 103 of 190

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-February-2022 s/d 28-February-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/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ ONDANSETRON 8 MG INJ 3.00 AMP 10,000.00 30,000.00 1 0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

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

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

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

KAPLET
224 RI20220219-0002 19/02/2022 RI20220217-0004 RI20220219-0002 JEFRI ROLLI RICHARDO 878,452.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

R/ LEVOFLOXACIN 750 MG INF 1.00 FLS 100,000.00 100,000.00 1 0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0
KAPLET
R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

225 RI20220219-0003 19/02/2022 RI20220217-0001 RI20220219-0003 MARIA ANA LIPAT 13,720.0

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

226 RI20220219-0004 19/02/2022 RI20220217-0002 RI20220219-0004 FRENTRY SIHOMBING 1,158,644.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ LEVOFLOXACIN 750 MG INF 1.00 FLS 100,000.00 100,000.00 1 0

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

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

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

KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ RESFAR 25 ML 2.00 FLS 280,192.00 560,384.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

227 RI20220219-0005 19/02/2022 RI20220217-0001 RI20220219-0005 MARIA ANA LIPAT 1,124,545.0

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 104 of 190

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-February-2022 s/d 28-February-2022

Jenis
resep :
No. No. Resep Tgl. Resep No. Reg No. Bukti Nama Pasien Jumla
Rawat
Inap
R/ Nama Item Qty Satuan Harga Jumlah Generik Non Gene
Formula Non Formula

R/ RESFAR 25 ML 2.00 FLS 280,192.00 560,384.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

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

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

228 RI20220219-0006 19/02/2022 RI20220215-0004 RI20220219-0006 AMIRA RIZKI PUTRI 591,048.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

229 RI20220219-0007 19/02/2022 RI20220218-0004 RI20220219-0007 ANCUS PARULIAN SILALAHI 56,882.0

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/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
230 RI20220219-0009 19/02/2022 RI20220213-0003 RI20220219-0009 NADA SUHALLAH 171,422.0

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

KAPLET
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

231 RI20220219-0011 19/02/2022 RI20220213-0002 RI20220219-0011 SILVIA MAHESTI 167,603.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 105 of 190

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-February-2022 s/d 28-February-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 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

232 RI20220219-0012 19/02/2022 RI20220218-0001 RI20220219-0012 RANI LESTARI MANURUNG 161,051.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

KAPLET
R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

233 RI20220219-0013 19/02/2022 RI20220216-0001 RI20220219-0013 WANRA HUTAPEA 62,901.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

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

KAPLET
234 RI20220219-0014 19/02/2022 RI20220216-0004 RI20220219-0014 MIFTA WAHYU PUTRI 66,003.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

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

KAPLET
235 RI20220219-0017 19/02/2022 RI20220217-0003 RI20220219-0017 ANA MARIANA 736,053.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ SIMVASTATIN 10 MG TAB 1.00 TAB 480.00 480.00 1 0

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ KSR TAB 1.00 TAB 4,050.00 4,050.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 106 of 190

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-February-2022 s/d 28-February-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

236 RI20220219-0018 19/02/2022 RI20220219-0001 RI20220219-0018 TARULI SINAGA 110,467.0

R/ ASERING 500 ML INF 4.00 FLS 10,800.00 43,200.00 0 1

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

KAPLET
R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ LODIA 2 MG TABLET 4.00 TAB 1,375.00 5,500.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

237 RI20220219-0019 19/02/2022 RI20220217-0003 RI20220219-0019 ANA MARIANA 81,364.0

R/ NOVORAPID FLEXPEN 1.00 VIAL 81,364.00 81,364.00 0 1

238 RI20220219-0021 19/02/2022 RI20220216-0004 RI20220219-0021 MIFTA WAHYU PUTRI 2,451.0

R/ SPASMINAL TABLET 3.00 TAB 817.00 2,451.00 0 1

239 RI20220219-0022 19/02/2022 RI20220218-0001 RI20220219-0022 RANI LESTARI MANURUNG 52,800.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

240 RI20220219-0023 19/02/2022 RI20220217-0003 RI20220219-0023 ANA MARIANA 5,075.0

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

241 RI20220219-0027 19/02/2022 RI20220217-0004 RI20220219-0027 JEFRI ROLLI RICHARDO 254,524.0

R/ FAVIPIRAVIR 200 MG TABLET 8.00 TAB 24,300.00 194,400.00 1 0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

242 RI20220219-0028 19/02/2022 RI20220217-0002 RI20220219-0028 FRENTRY SIHOMBING 217,800.0

R/ LEVOFLOXACIN 750 MG INF 2.00 FLS 100,000.00 200,000.00 1 0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

243 RI20220219-0029 19/02/2022 RI20220217-0001 RI20220219-0029 MARIA ANA LIPAT 550.0

R/ ANEMOLAT 1 MG TAB 2.00 TAB 275.00 550.00 0 1

244 RI20220219-0032 19/02/2022 RI20220219-0005 RI20220219-0032 WANSI SITUMORANG 36,855.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

245 RI20220219-0034 19/02/2022 RI20220215-0004 RI20220219-0034 AMIRA RIZKI PUTRI 13,720.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 107 of 190

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-February-2022 s/d 28-February-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

246 RI20220219-0035 19/02/2022 RI20220218-0004 RI20220219-0035 ANCUS PARULIAN SILALAHI 501,258.0

R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ FAVIPIRAVIR 200 MG TABLET 8.00 TAB 24,300.00 194,400.00 1 0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

247 RI20220219-0036 19/02/2022 RI20220215-0004 RI20220219-0036 AMIRA RIZKI PUTRI 72,900.0

R/ FAVIPIRAVIR 200 MG TABLET 3.00 TAB 24,300.00 72,900.00 1 0

248 RI20220219-0037 19/02/2022 RI20220217-0001 RI20220219-0037 MARIA ANA LIPAT 194,400.0

R/ FAVIPIRAVIR 200 MG TABLET 8.00 TAB 24,300.00 194,400.00 1 0

249 RI20220219-0038 19/02/2022 RI20220217-0002 RI20220219-0038 FRENTRY SIHOMBING 194,400.0

R/ FAVIPIRAVIR 200 MG TABLET 8.00 TAB 24,300.00 194,400.00 1 0

250 RI20220219-0039 19/02/2022 RI20220217-0003 RI20220219-0039 ANA MARIANA 194,400.0

R/ FAVIPIRAVIR 200 MG TABLET 8.00 TAB 24,300.00 194,400.00 1 0

251 RI20220220-0002 20/02/2022 RI20220216-0001 RI20220220-0002 WANRA HUTAPEA 19,532.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

252 RI20220220-0003 20/02/2022 RI20220217-0001 RI20220220-0003 MARIA ANA LIPAT 34,860.0

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

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

253 RI20220220-0005 20/02/2022 RI20220216-0001 RI20220220-0005 WANRA HUTAPEA 660.0

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

254 RI20220220-0006 20/02/2022 RI20220219-0003 RI20220220-0006 ERIKSON SIMORANGKIR 5,373.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
R/ METHYLPREDNISOLONE 8 MG 3.00 TAB 790.00 2,370.00 1 0
TAB
255 RI20220220-0008 20/02/2022 RI20220219-0003 RI20220220-0008 ERIKSON SIMORANGKIR 39,999.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

256 RI20220220-0010 20/02/2022 RI20220216-0001 RI20220220-0010 WANRA HUTAPEA 80,658.0

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
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/ RL 500 ML INF 4.00 FLS 9,766.00 39,064.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 108 of 190

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-February-2022 s/d 28-February-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

257 RI20220220-0011 20/02/2022 RI20220219-0005 RI20220220-0011 WANSI SITUMORANG 42,294.0

R/ NALD 23 (ONEMED) 3.00 PCS 1,813.00 5,439.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

258 RI20220220-0014 20/02/2022 RI20220219-0001 RI20220220-0014 TARULI SINAGA 44,397.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

KAPLET
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

259 RI20220220-0017 20/02/2022 RI20220218-0004 RI20220220-0017 ANCUS PARULIAN SILALAHI 652,112.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

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

KAPLET
R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ LEVOFLOXACIN 750 MG INF 1.00 FLS 100,000.00 100,000.00 1 0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

260 RI20220220-0018 20/02/2022 RI20220215-0004 RI20220220-0018 AMIRA RIZKI PUTRI 516,594.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

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

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

261 RI20220220-0019 20/02/2022 RI20220217-0001 RI20220220-0019 MARIA ANA LIPAT 288,877.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 109 of 190

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-February-2022 s/d 28-February-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/ ANEMOLAT 1 MG TAB 1.00 TAB 275.00 275.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ HANDSCOEN STERIL NO. 7.5 3.00 PSG 27,000.00 81,000.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
262 RI20220220-0020 20/02/2022 RI20220217-0003 RI20220220-0020 ANA MARIANA 691,228.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ RESFAR 25 ML 2.00 FLS 280,192.00 560,384.00 0 1

R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1

R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

263 RI20220220-0021 20/02/2022 RI20220217-0002 RI20220220-0021 FRENTRY SIHOMBING 892,635.0

R/ RESFAR 25 ML 2.00 FLS 280,192.00 560,384.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ LEVOFLOXACIN 750 MG INF 1.00 FLS 100,000.00 100,000.00 1 0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

KAPLET
R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

264 RI20220220-0022 20/02/2022 RI20220217-0004 RI20220220-0022 JEFRI ROLLI RICHARDO 453,284.0

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

KAPLET
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ LEVOFLOXACIN 750 MG INF 1.00 FLS 100,000.00 100,000.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 110 of 190

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-February-2022 s/d 28-February-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 50.00 CC 356.00 17,800.00 0 1

R/ ONDANSETRON 8 MG TAB 2.00 TAB 3,163.00 6,326.00 1 0

265 RI20220220-0023 20/02/2022 RI20220218-0001 RI20220220-0023 RANI LESTARI MANURUNG 136,527.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

KAPLET
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

266 RI20220220-0024 20/02/2022 RI20220213-0003 RI20220220-0024 NADA SUHALLAH 535,352.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

KAPLET
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
267 RI20220220-0025 20/02/2022 RI20220213-0002 RI20220220-0025 SILVIA MAHESTI 21,803.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
268 RI20220220-0030 20/02/2022 RI20220216-0001 RI20220220-0030 WANRA HUTAPEA 12,730.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

269 RI20220220-0031 20/02/2022 RI20220216-0004 RI20220220-0031 MIFTA WAHYU PUTRI 26,480.0

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

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0

KAPLET
270 RI20220220-0034 20/02/2022 RI20220217-0004 RI20220220-0034 JEFRI ROLLI RICHARDO 14,000.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
Print Date:7/14/2022 Print Time: 2:11:10PM Page 111 of 190
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-February-2022 s/d 28-February-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

271 RI20220220-0035 20/02/2022 RI20220220-0001 RI20220220-0035 ANI HUTAHAYAN 122,170.0

R/ DEXTROSE 10 % INF 500 ML 1.00 FLS 7,275.00 7,275.00 1 0

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1
EFFERVESCENT
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ RAMIPRIL 5 MG TAB (BPJS) 1.00 TAB 857.00 857.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

272 RI20220220-0036 20/02/2022 RI20220220-0001 RI20220220-0036 ANI HUTAHAYAN 25,626.0

R/ D 40 25 ML (OTSU) 2.00 FLS 12,813.00 25,626.00 0 1

273 RI20220220-0041 20/02/2022 RI20220217-0003 RI20220220-0041 ANA MARIANA 8,100.0

R/ KSR TAB 2.00 TAB 4,050.00 8,100.00 0 1

274 RI20220220-0043 20/02/2022 RI20220220-0001 RI20220220-0043 ANI HUTAHAYAN 42,080.0

R/ DEXTROSE 5% 500 ML INF 2.00 FLS 21,040.00 42,080.00 0 1

275 RI20220220-0044 20/02/2022 RI20220219-0001 RI20220220-0044 TARULI SINAGA 6,664.0

R/ LODIA 2 MG TABLET 4.00 TAB 1,375.00 5,500.00 0 1

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

KAPLET
276 RI20220220-0045 20/02/2022 RI20220219-0003 RI20220220-0045 ERIKSON SIMORANGKIR 3,003.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
277 RI20220221-0001 21/02/2022 RI20220219-0001 RI20220221-0001 TARULI SINAGA 2,750.0

R/ LODIA 2 MG TABLET 2.00 TAB 1,375.00 2,750.00 0 1

278 RI20220221-0002 21/02/2022 RI20220217-0004 RI20220221-0002 JEFRI ROLLI RICHARDO 34,860.0

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

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

279 RI20220221-0003 21/02/2022 RI20220219-0003 RI20220221-0003 ERIKSON SIMORANGKIR 13,720.0

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

280 RI20220221-0004 21/02/2022 RI20220219-0001 RI20220221-0004 TARULI SINAGA 9,876.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 112 of 190

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-February-2022 s/d 28-February-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 388.00 1,164.00 1 0

KAPLET
281 RI20220221-0006 21/02/2022 RI20220219-0003 RI20220221-0006 ERIKSON SIMORANGKIR 39,999.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

282 RI20220221-0007 21/02/2022 RI20220218-0004 RI20220221-0007 ANCUS PARULIAN SILALAHI 243,179.0

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

KAPLET
R/ FAVIPIRAVIR 200 MG TABLET 9.00 TAB 24,300.00 218,700.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
283 RI20220221-0008 21/02/2022 RI20220218-0004 RI20220221-0008 ANCUS PARULIAN SILALAHI 32,400.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

284 RI20220221-0012 21/02/2022 RI20220215-0004 RI20220221-0012 AMIRA RIZKI PUTRI 165,003.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 2.00 TAB 2,600.00 5,200.00 0 1

285 RI20220221-0013 21/02/2022 RI20220217-0001 RI20220221-0013 MARIA ANA LIPAT 574,302.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ANEMOLAT 1 MG TAB 1.00 TAB 275.00 275.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 9.00 TAB 24,300.00 218,700.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ NACL 0.9 % 500 ML INF 4.00 FLS 13,333.00 53,332.00 1 0

286 RI20220221-0014 21/02/2022 RI20220217-0003 RI20220221-0014 ANA MARIANA 496,247.0

R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

R/ VITAMIN C XON-CE KAPLET 2.00 KAPLET 1.00 2.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ NACL 0.9 % 500 ML INF 4.00 FLS 13,333.00 53,332.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 113 of 190

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-February-2022 s/d 28-February-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

287 RI20220221-0015 21/02/2022 RI20220217-0002 RI20220221-0015 FRENTRY SIHOMBING 355,327.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ NACL 0.9 % 500 ML INF 4.00 FLS 13,333.00 53,332.00 1 0

288 RI20220221-0016 21/02/2022 RI20220217-0004 RI20220221-0016 JEFRI ROLLI RICHARDO 561,299.0

R/ NACL 0.9 % 500 ML INF 4.00 FLS 13,333.00 53,332.00 1 0

R/ FAVIPIRAVIR 200 MG TABLET 9.00 TAB 24,300.00 218,700.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ PARACETAMOL 500 MG 1.00 KAPLET 388.00 388.00 1 0

KAPLET
R/ CURCUMA FCT TAB 1.00 TAB 885.00 885.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ VITAMIN C XON-CE KAPLET 2.00 KAPLET 1.00 2.00 0 1

289 RI20220221-0017 21/02/2022 RI20220218-0001 RI20220221-0017 RANI LESTARI MANURUNG 809,560.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ NACL 0.9 % 500 ML INF 4.00 FLS 13,333.00 53,332.00 1 0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

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

KAPLET
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

290 RI20220221-0018 21/02/2022 RI20220213-0003 RI20220221-0018 NADA SUHALLAH 83,782.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)
R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0
KAPLET
R/ DEVIT 1000 IU 1.00 TAB 2,600.00 2,600.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

291 RI20220221-0019 21/02/2022 RI20220220-0001 RI20220221-0019 ANI HUTAHAYAN 103,238.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 114 of 190

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-February-2022 s/d 28-February-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/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ DEXTROSE 10 % INF 500 ML 1.00 FLS 7,275.00 7,275.00 1 0

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

292 RI20220221-0020 21/02/2022 RI20220213-0002 RI20220221-0020 SILVIA MAHESTI 21,803.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
293 RI20220221-0021 21/02/2022 RI20220219-0001 RI20220221-0021 TARULI SINAGA 708,991.0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

294 RI20220221-0022 21/02/2022 RI20220218-0004 RI20220221-0022 ANCUS PARULIAN SILALAHI 24,360.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

295 RI20220221-0024 21/02/2022 RI20220220-0001 RI20220221-0024 ANI HUTAHAYAN 77,486.0

R/ HANDSCOEN STERIL NO. 6.5 3.00 PSG 21,162.00 63,486.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
296 RI20220221-0025 21/02/2022 RI20220219-0001 RI20220221-0025 TARULI SINAGA 77,486.0

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ HANDSCOEN STERIL NO. 6.5 3.00 PSG 21,162.00 63,486.00 0 1

297 RI20220221-0026 21/02/2022 RI20220220-0001 RI20220221-0026 ANI HUTAHAYAN 56,700.0

R/ HANDSCOEN STERILE 3.00 PSG 18,900.00 56,700.00 0 1

(GAMMEX) NO. 7
298 RI20220221-0027 21/02/2022 RI20220219-0005 RI20220221-0027 WANSI SITUMORANG 14,670.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 388.00 5,820.00 1 0

KAPLET
R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

299 RI20220221-0030 21/02/2022 RI20220217-0003 RI20220221-0030 ANA MARIANA 15,900.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ KSR TAB 2.00 TAB 4,050.00 8,100.00 0 1

300 RI20220221-0036 21/02/2022 RI20220219-0003 RI20220221-0036 ERIKSON SIMORANGKIR 3,003.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0
INJ (BPJS)
Print Date:7/14/2022 Print Time: 2:11:10PM Page 115 of 190
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-February-2022 s/d 28-February-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

301 RI20220221-0037 21/02/2022 RI20220213-0002 RI20220221-0037 SILVIA MAHESTI 68,010.0

R/ MEMUCIL 600 MG 3.00 TAB 14,000.00 42,000.00 0 1

EFFERVESCENT
R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

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

302 RI20220221-0038 21/02/2022 RI20220218-0004 RI20220221-0038 ANCUS PARULIAN SILALAHI 84,585.0

R/ WING NEEDLE 25 G (3/4) 5.00 PCS 2,973.00 14,865.00 1 0

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

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

303 RI20220221-0039 21/02/2022 RI20220218-0001 RI20220221-0039 RANI LESTARI MANURUNG 69,720.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

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

304 RI20220221-0041 21/02/2022 RI20220219-0003 RI20220221-0041 ERIKSON SIMORANGKIR 20,490.0

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

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

305 RI20220221-0042 21/02/2022 RI20220220-0001 RI20220221-0042 ANI HUTAHAYAN 42,080.0

R/ DEXTROSE 5% 500 ML INF 2.00 FLS 21,040.00 42,080.00 0 1

306 RI20220221-0044 21/02/2022 RI20220220-0001 RI20220221-0044 ANI HUTAHAYAN 21,040.0

R/ DEXTROSE 5% 500 ML INF 1.00 FLS 21,040.00 21,040.00 0 1

307 RI20220221-0045 21/02/2022 RI20220217-0003 RI20220221-0045 ANA MARIANA 4,050.0

R/ KSR TAB 1.00 TAB 4,050.00 4,050.00 0 1

308 RI20220222-0002 22/02/2022 RI20220221-0004 RI20220222-0002 SULAIMAN 26,939.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

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

KAPLET
R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

R/ FUROSEMIDE 10 MG/2 ML INJ 1.00 AMP 4,960.00 4,960.00 1 0

309 RI20220222-0007 22/02/2022 RI20220221-0004 RI20220222-0007 SULAIMAN 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
310 RI20220222-0008 22/02/2022 RI20220221-0004 RI20220222-0008 SULAIMAN 13,993.0
R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 116 of 190

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-February-2022 s/d 28-February-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

311 RI20220222-0011 22/02/2022 RI20220221-0004 RI20220222-0011 SULAIMAN 18,688.0

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

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

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

KAPLET
R/ FUROSEMIDE 10 MG/2 ML INJ 1.00 AMP 4,960.00 4,960.00 1 0

312 RI20220222-0014 22/02/2022 RI20220215-0004 RI20220222-0014 AMIRA RIZKI PUTRI 186,502.0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
R/ VITAMIN C XON-CE KAPLET 2.00 KAPLET 1.00 2.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

313 RI20220222-0015 22/02/2022 RI20220217-0003 RI20220222-0015 ANA MARIANA 207,266.0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
R/ NACL 0.9 % 500 ML INF 2.00 FLS 13,333.00 26,666.00 1 0

R/ KSR TAB 2.00 TAB 4,050.00 8,100.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

314 RI20220222-0017 22/02/2022 RI20220221-0004 RI20220222-0017 SULAIMAN 50,188.0

R/ AQUADE 25.00 CC 356.00 8,900.00 0 1

S 25 ML
R/ FOLEY CATHETER NO. 18 1.00 PCS 14,388.00 14,388.00 0 1

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

315 RI20220222-0018 22/02/2022 RI20220218-0004 RI20220222-0018 ANCUS PARULIAN SILALAHI 509,373.0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

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

KAPLET
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

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

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1
R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1
(GAMMEX) NO. 7
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 117 of 190

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-February-2022 s/d 28-February-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

316 RI20220222-0019 22/02/2022 RI20220220-0001 RI20220222-0019 ANI HUTAHAYAN 801,426.0

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

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

R/ RAMIPRIL 5 MG TAB (BPJS) 1.00 TAB 857.00 857.00 1 0

R/ FAVIPIRAVIR 200 MG TABLET 16.00 TAB 24,300.00 388,800.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

317 RI20220222-0022 22/02/2022 RI20220217-0002 RI20220222-0022 FRENTRY SIHOMBING 45,370.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

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

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

KAPLET
R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1
(GAMMEX) NO. 7
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

318 RI20220222-0023 22/02/2022 RI20220217-0004 RI20220222-0023 JEFRI ROLLI RICHARDO 42,715.0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

319 RI20220222-0024 22/02/2022 RI20220217-0001 RI20220222-0024 MARIA ANA LIPAT 172,778.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ANEMOLAT 1 MG TAB 1.00 TAB 275.00 275.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
320 RI20220222-0025 22/02/2022 RI20220213-0003 RI20220222-0025 NADA SUHALLAH 31,264.0
R/ PARACETAMOL 500 MG 3.00 KAPLET 388.00 1,164.00 1 0
KAPLET

Print Date:7/14/2022 Print Time: 2:11:10PM Page 118 of 190

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-February-2022 s/d 28-February-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/ OMEPRAZOLE 20 MG CAP 1.00 CAP 742.00 742.00 1 0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

321 RI20220222-0026 22/02/2022 RI20220218-0001 RI20220222-0026 RANI LESTARI MANURUNG 442,633.0

R/ FAVIPIRAVIR 200 MG TABLET 2.00 TAB 24,300.00 48,600.00 1 0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

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

KAPLET
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

322 RI20220222-0027 22/02/2022 RI20220219-0001 RI20220222-0027 TARULI SINAGA 476,473.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 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/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

323 RI20220222-0028 22/02/2022 RI20220219-0003 RI20220222-0028 ERIKSON SIMORANGKIR 10,225.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

R/ ANEMOLAT 1 MG TAB 5.00 TAB 275.00 1,375.00 0 1

324 RI20220222-0030 22/02/2022 RI20220221-0004 RI20220222-0030 SULAIMAN 125,361.0

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1
(GAMMEX) NO. 7
R/ STOMACH TUBE NO. 16 1.00 PCS 38,961.00 38,961.00 0 1

325 RI20220222-0031 22/02/2022 RI20220221-0004 RI20220222-0031 SULAIMAN 2,655.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

326 RI20220222-0034 22/02/2022 RI20220217-0001 RI20220222-0034 MARIA ANA LIPAT 46,380.0

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 119 of 190

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-February-2022 s/d 28-February-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. 24 VENFLON 1.00 PCS 34,200.00 34,200.00 0 1

327 RI20220222-0036 22/02/2022 RI20220215-0004 RI20220222-0036 AMIRA RIZKI PUTRI 6,930.0

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
328 RI20220222-0037 22/02/2022 RI20220217-0003 RI20220222-0037 ANA MARIANA 8,942.0

R/ AZITHROMYCIN 500 MG 1.00 KAPLET 6,930.00 6,930.00 1 0

KAPLET
R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

329 RI20220222-0038 22/02/2022 RI20220217-0004 RI20220222-0038 JEFRI ROLLI RICHARDO 100,000.0

R/ LEVOFLOXACIN 750 MG INF 1.00 FLS 100,000.00 100,000.00 1 0

330 RI20220222-0039 22/02/2022 RI20220217-0002 RI20220222-0039 FRENTRY SIHOMBING 100,000.0

R/ LEVOFLOXACIN 750 MG INF 1.00 FLS 100,000.00 100,000.00 1 0

331 RI20220222-0040 22/02/2022 RI20220221-0004 RI20220222-0040 SULAIMAN 20,790.0

R/ AZITHROMYCIN 500 MG 3.00 KAPLET 6,930.00 20,790.00 1 0

KAPLET
332 RI20220222-0041 22/02/2022 RI20220218-0001 RI20220222-0041 RANI LESTARI MANURUNG 1,000.0

R/ CETIRIZINE 10 MG TAB 1.00 TAB 1,000.00 1,000.00 1 0

333 RI20220222-0042 22/02/2022 RI20220217-0001 RI20220222-0042 MARIA ANA LIPAT 1,485.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
334 RI20220222-0044 22/02/2022 RI20220217-0003 RI20220222-0044 ANA MARIANA 1,485.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
335 RI20220222-0045 22/02/2022 RI20220217-0002 RI20220222-0045 FRENTRY SIHOMBING 1,485.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
336 RI20220222-0046 22/02/2022 RI20220213-0003 RI20220222-0046 NADA SUHALLAH 1,485.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
337 RI20220222-0047 22/02/2022 RI20220221-0004 RI20220222-0047 SULAIMAN 885.0

R/ CURCUMA FCT TAB 1.00 TAB 885.00 885.00 0 1

338 RI20220223-0001 23/02/2022 RI20220221-0004 RI20220223-0001 SULAIMAN 12,786.0

R/ KAPAS ALKOHOL 2.00 PCS 303.00 606.00 0 1

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 120 of 190

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-February-2022 s/d 28-February-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

339 RI20220223-0009 23/02/2022 RI20220215-0004 RI20220223-0009 AMIRA RIZKI PUTRI 62,088.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

340 RI20220223-0010 23/02/2022 RI20220221-0004 RI20220223-0010 SULAIMAN 8,132.0

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

KAPLET
R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

341 RI20220223-0011 23/02/2022 RI20220217-0003 RI20220223-0011 ANA MARIANA 257,474.0

R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ SIMVASTATIN 20 MG TAB 1.00 TAB 1,283.00 1,283.00 1 0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
R/ KSR TAB 1.00 TAB 4,050.00 4,050.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

342 RI20220223-0012 23/02/2022 RI20220218-0004 RI20220223-0012 ANCUS PARULIAN SILALAHI 209,052.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

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

KAPLET
R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

343 RI20220223-0014 23/02/2022 RI20220220-0001 RI20220223-0014 ANI HUTAHAYAN 303,461.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

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

R/ HANDSCOEN STERIL NO. 6.5 3.00 PSG 21,162.00 63,486.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ HANDSCOEN STERIL NO. 7.5 3.00 PSG 27,000.00 81,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 121 of 190

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-February-2022 s/d 28-February-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/ RAMIPRIL 5 MG TAB (BPJS) 1.00 TAB 857.00 857.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

344 RI20220223-0016 23/02/2022 RI20220217-0002 RI20220223-0016 FRENTRY SIHOMBING 306,546.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

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

KAPLET
345 RI20220223-0017 23/02/2022 RI20220217-0004 RI20220223-0017 JEFRI ROLLI RICHARDO 156,252.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

KAPLET
R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0
CAPSUL
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

346 RI20220223-0018 23/02/2022 RI20220217-0001 RI20220223-0018 MARIA ANA LIPAT 251,687.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ ANEMOLAT 1 MG TAB 1.00 TAB 275.00 275.00 0 1

R/ HANDSCOEN STERIL NO. 7.5 2.00 PSG 27,000.00 54,000.00 0 1

347 RI20220223-0020 23/02/2022 RI20220213-0003 RI20220223-0020 NADA SUHALLAH 13,107.0

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

KAPLET
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 122 of 190

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-February-2022 s/d 28-February-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

348 RI20220223-0021 23/02/2022 RI20220218-0001 RI20220223-0021 RANI LESTARI MANURUNG 354,852.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

KAPLET
R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

349 RI20220223-0022 23/02/2022 RI20220219-0001 RI20220223-0022 TARULI SINAGA 252,921.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

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

KAPLET
350 RI20220223-0024 23/02/2022 RI20220220-0001 RI20220223-0024 ANI HUTAHAYAN 544,901.0

R/ FAVIPIRAVIR 200 MG TABLET 21.00 TAB 24,300.00 510,300.00 1 0

R/ DEVIT 1000 IU 7.00 TAB 2,600.00 18,200.00 0 1

R/ RAMIPRIL 5 MG TAB (BPJS) 7.00 TAB 857.00 5,999.00 1 0

R/ VITAMIN C XON-CE KAPLET 7.00 KAPLET 1.00 7.00 0 1

R/ ACETYLCYSTEIN 200 MG 7.00 CAP 1,485.00 10,395.00 1 0

CAPSUL
351 RI20220223-0026 23/02/2022 RI20220217-0001 RI20220223-0026 MARIA ANA LIPAT 62,665.0

R/ VITAMIN C XON-CE KAPLET 15.00 KAPLET 1.00 15.00 0 1

R/ DEVIT 1000 IU 15.00 TAB 2,600.00 39,000.00 0 1

R/ ANEMOLAT 1 MG TAB 5.00 TAB 275.00 1,375.00 0 1

R/ ACETYLCYSTEIN 200 MG 15.00 CAP 1,485.00 22,275.00 1 0

CAPSUL
352 RI20220223-0027 23/02/2022 RI20220217-0003 RI20220223-0027 ANA MARIANA 71,350.0

R/ VITAMIN C XON-CE KAPLET 15.00 KAPLET 1.00 15.00 0 1

R/ ASPILET 80 MG TAB 5.00 TAB 729.00 3,645.00 0 0

R/ DEVIT 1000 IU 15.00 TAB 2,600.00 39,000.00 0 1

R/ SIMVASTATIN 20 MG TAB 5.00 TAB 1,283.00 6,415.00 1 0

R/ ACETYLCYSTEIN 200 MG 15.00 CAP 1,485.00 22,275.00 1 0

CAPSUL

Print Date:7/14/2022 Print Time: 2:11:10PM Page 123 of 190

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-February-2022 s/d 28-February-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

353 RI20220223-0029 23/02/2022 RI20220215-0004 RI20220223-0029 AMIRA RIZKI PUTRI 4,850.0

R/ CETIRIZINE 10 MG TAB 3.00 TAB 1,000.00 3,000.00 1 0

R/ CODEIN 10 MG TAB 2.00 TAB 925.00 1,850.00 0 0

(NARKOTIKA)
354 RI20220224-0001 24/02/2022 RI20220215-0004 RI20220224-0001 AMIRA RIZKI PUTRI 12,258.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

355 RI20220224-0003 24/02/2022 RI20220219-0001 RI20220224-0003 TARULI SINAGA 13,422.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

KAPLET
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
356 RI20220224-0005 24/02/2022 RI20220218-0004 RI20220224-0005 ANCUS PARULIAN SILALAHI 81,867.0

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

KAPLET
R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 3.00 TAB 24,300.00 72,900.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

357 RI20220224-0006 24/02/2022 RI20220217-0002 RI20220224-0006 FRENTRY SIHOMBING 16,077.0

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

KAPLET
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0
CAPSUL
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

358 RI20220224-0007 24/02/2022 RI20220217-0004 RI20220224-0007 JEFRI ROLLI RICHARDO 13,422.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

KAPLET
359 RI20220224-0008 24/02/2022 RI20220218-0001 RI20220224-0008 RANI LESTARI MANURUNG 12,258.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
Print Date:7/14/2022 Print Time: 2:11:10PM Page 124 of 190
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-February-2022 s/d 28-February-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

360 RI20220224-0009 24/02/2022 RI20220213-0003 RI20220224-0009 NADA SUHALLAH 12,258.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

361 RI20220224-0012 24/02/2022 RI20220218-0004 RI20220224-0012 ANCUS PARULIAN SILALAHI 144,615.0

R/ DEVIT 1000 IU 15.00 TAB 2,600.00 39,000.00 0 1

R/ VITAMIN C XON-CE KAPLET 15.00 KAPLET 1.00 15.00 0 1

R/ ZEMINDO 60 ML SYR 2.00 BTL 52,800.00 105,600.00 0 1

362 RI20220224-0013 24/02/2022 RI20220215-0004 RI20220224-0013 AMIRA RIZKI PUTRI 181,809.0

R/ VITAMIN C XON-CE KAPLET 9.00 KAPLET 1.00 9.00 0 1

R/ ZEMINDO 60 ML SYR 3.00 BTL 52,800.00 158,400.00 0 1

R/ DEVIT 1000 IU 9.00 TAB 2,600.00 23,400.00 0 1

363 RI20220224-0014 24/02/2022 RI20220213-0003 RI20220224-0014 NADA SUHALLAH 129,009.0

R/ DEVIT 1000 IU 9.00 TAB 2,600.00 23,400.00 0 1

R/ VITAMIN C XON-CE KAPLET 9.00 KAPLET 1.00 9.00 0 1

R/ ZEMINDO 60 ML SYR 2.00 BTL 52,800.00 105,600.00 0 1

364 RI20220224-0015 24/02/2022 RI20220218-0001 RI20220224-0015 RANI LESTARI MANURUNG 145,800.0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

365 RI20220224-0016 24/02/2022 RI20220219-0001 RI20220224-0016 TARULI SINAGA 145,800.0

R/ FAVIPIRAVIR 200 MG TABLET 6.00 TAB 24,300.00 145,800.00 1 0

366 RI20220224-0018 24/02/2022 RI20220217-0002 RI20220224-0018 FRENTRY SIHOMBING 4,455.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
367 RI20220225-0001 25/02/2022 RI20220224-0002 RI20220225-0001 RIA RINDI SARI 310,366.0

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/ SPUIT 10 CC ( TERUMO ) 3.00 PCS 11,242.00 33,726.00 0 1

R/ METOCLOPRAMIDE 5 MG/ML 3.00 AMP 9,625.00 28,875.00 1 0

INJ
R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,667.00 5,001.00 1 0
CAPSUL
R/ ZEMINDO 60 ML SYR 2.00 BTL 52,800.00 105,600.00 0 1
R/ SUCRALFATE SYR 100 ML 2.00 FLS 57,200.00 114,400.00 1 0

368 RI20220225-0002 25/02/2022 RI20220219-0001 RI20220225-0002 TARULI SINAGA 81,864.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 125 of 190

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-February-2022 s/d 28-February-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/ FAVIPIRAVIR 200 MG TABLET 3.00 TAB 24,300.00 72,900.00 1 0

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

KAPLET
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

369 RI20220225-0005 25/02/2022 RI20220224-0002 RI20220225-0005 RIA RINDI SARI 81,779.0

R/ HANDSCOEN STERILE 2.00 PSG 18,900.00 37,800.00 0 1

(GAMMEX) NO. 7
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

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

KAPLET
R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

370 RI20220225-0008 25/02/2022 RI20220218-0001 RI20220225-0008 RANI LESTARI MANURUNG 160,500.0

R/ PROVITAL PLUS CAPS 6.00 CAP 5,800.00 34,800.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 3.00 TAB 24,300.00 72,900.00 1 0

371 RI20220225-0009 25/02/2022 RI20220217-0004 RI20220225-0009 JEFRI ROLLI RICHARDO 87,600.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ PROVITAL PLUS CAPS 6.00 CAP 5,800.00 34,800.00 0 1

372 RI20220225-0010 25/02/2022 RI20220217-0002 RI20220225-0010 FRENTRY SIHOMBING 87,600.0

R/ PROVITAL PLUS CAPS 6.00 CAP 5,800.00 34,800.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

373 RI20220225-0012 25/02/2022 RI20220224-0002 RI20220225-0012 RIA RINDI SARI 7,803.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

374 RI20220225-0013 25/02/2022 RI20220225-0001 RI20220225-0013 YANUARI 7,150.0

R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

375 RI20220225-0014 25/02/2022 RI20220225-0001 RI20220225-0014 YANUARI 54,625.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ CURCUMA FCT TAB 5.00 TAB 885.00 4,425.00 0 1

376 RI20220225-0015 25/02/2022 RI20220225-0001 RI20220225-0015 YANUARI 20,533.0

R/ PRONALGES SUPPO 1.00 SUPP 20,533.00 20,533.00 0 1

377 RI20220225-0017 25/02/2022 RI20220225-0002 RI20220225-0017 FENTY LISTIJAWATI 424,762.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 126 of 190

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-February-2022 s/d 28-February-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/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ ISOSORBID DINITRAT 5 MG 1.00 TAB 162.00 162.00 1 0

TAB
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ FAVIPIRAVIR 200 MG TABLET 12.00 TAB 24,300.00 291,600.00 1 0

R/ ASCORBIT ACID 1000 MG/5 ML 2.00 AMP 20,000.00 40,000.00 1 0

INJ
378 RI20220225-0018 25/02/2022 RI20220225-0001 RI20220225-0018 YANUARI 51,150.0

R/ SUNGKUP O2(NON- 1.00 PCS 44,000.00 44,000.00 1 0

REBREATHER OXYGEN MASK)
R/ ELEKTRODA 3M RED DOT 2239
DWS 5.00 PCS 1,430.00 7,150.00 0 1

379 RI20220225-0019 25/02/2022 RI20220225-0001 RI20220225-0019 YANUARI 614,524.0

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
R/ GELAFUSAL 500 ML INF 2.00 FLS 175,000.00 350,000.00 0 1

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

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

R/ SPUIT 50 ML (WITHOUT 1.00 PCS 37,206.00 37,206.00 0 1

NEEDLE) ONEMED
R/ EXTENSION TUBE 150 CM X 1.00 PCS 62,944.00 62,944.00 0 1
1,5 ML
R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

R/ NOREPINEPHRINE 4MG/4ML 1.00 AMP 37,500.00 37,500.00 1 0

INJ (BPJS)
R/ THREE WAY STOP CO-CKS 1.00 PCS 31,460.00 31,460.00 0 1

380 RI20220226-0001 26/02/2022 RI20220225-0001 RI20220226-0001 YANUARI 32,400.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

381 RI20220226-0003 26/02/2022 RI20220224-0002 RI20220226-0003 RIA RINDI SARI 5,001.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,667.00 5,001.00 1 0

CAPSUL
382 RI20220226-0004 26/02/2022 RI20220225-0001 RI20220226-0004 YANUARI 62,417.0

R/ AQUADES 25 ML 3.00 CC 356.00 1,068.00 0 1

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/ STOMACH TUBE NO. 16 1.00 PCS 38,961.00 38,961.00 0 1

383 RI20220226-0005 26/02/2022 RI20220225-0001 RI20220226-0005 YANUARI 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

384 RI20220226-0006 26/02/2022 RI20220225-0001 RI20220226-0006 YANUARI 67,500.0

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
Print Date:7/14/2022 Print Time: 2:11:10PM Page 127 of 190
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-February-2022 s/d 28-February-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

385 RI20220226-0007 26/02/2022 RI20220225-0001 RI20220226-0007 YANUARI 31,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 10,000.00 10,000.00 1 0

500MG/5ML
386 RI20220226-0008 26/02/2022 RI20220225-0002 RI20220226-0008 FENTY LISTIJAWATI 196,120.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ASCORBIT ACID 1000 MG/5 ML 2.00 AMP 20,000.00 40,000.00 1 0

INJ
R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ FAVIKAL 200 MG TABLET 6.00 TAB 21,120.00 126,720.00 0 1

387 RI20220226-0010 26/02/2022 RI20220224-0002 RI20220226-0010 RIA RINDI SARI 9,318.0

R/ VITAMIN C XON-CE KAPLET 3.00 KAPLET 1.00 3.00 0 1

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

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

388 RI20220226-0011 26/02/2022 RI20220225-0001 RI20220226-0011 YANUARI 854,147.0

R/ GUEDEL NASAL NO. 5 1.00 PCS 132,813.00 132,813.00 0 1

R/ RECOFOL INJEKSI 1.00 AMP 139,335.00 139,335.00 0 1

R/ EPINEPHRINE INJ 1.00 AMP 12,160.00 12,160.00 1 0

R/ HANDSCOEN STERILE 2.00 PSG 18,900.00 37,800.00 0 1

(GAMMEX) NO. 7
R/ URINE BAG 1.00 PCS 8,000.00 8,000.00 0 1

R/ STOMACH TUBE NO. 18 1.00 PCS 38,961.00 38,961.00 0 1

R/ EPHEDRIN HCL INJ (PREK) 2.00 AMP 5,896.00 11,792.00 0 0

R/ D 40 25 ML (OTSU) 4.00 FLS 12,813.00 51,252.00 0 1

R/ DEXTROSE 10 % INF 500 ML 1.00 FLS 7,275.00 7,275.00 1 0

R/ SPUIT 50 ML SONDE 1.00 PCS 67,500.00 67,500.00 0 1

(CATHETER TIP) TERUMO
R/ NALD 18 ( TERUMO) 2.00 PCS 4,568.00 9,136.00 0 1

R/ ATRACURIUM BESILATE 50 2.00 AMP 57,750.00 115,500.00 1 0

MG/5 ML INJEKSI
R/ FOLEY CATHETER NO. 16 1.00 PCS 24,975.00 24,975.00 0 1

R/ SEDACUM INJ 15MG/3ML 3.00 CC 25,912.00 77,736.00 0 0

(PSIKOTROPIKA
R/ ETT SIZE 7.5 RUSCH + BALON 1.00 PCS 84,500.00 84,500.00 1 0

R/ SUCTION CATHETHER NO. 16 1.00 PCS 8,712.00 8,712.00 0 1

R/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

389 RI20220226-0012 26/02/2022 RI20220225-0001 RI20220226-0012 YANUARI 7,150.0

R/ ELEKTRODA 3M RED DOT 2239 5.00 PCS 1,430.00 7,150.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 128 of 190

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-February-2022 s/d 28-February-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

390 RI20220226-0013 26/02/2022 RI20220225-0001 RI20220226-0013 YANUARI 128,130.0

R/ D 40 25 ML (OTSU) 10.00 FLS 12,813.00 128,130.00 0 1

391 RI20220226-0014 26/02/2022 RI20220219-0001 RI20220226-0014 TARULI SINAGA 120,315.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ IMUNVIT PLUS KAPLET 5.00 KAPLET 13,500.00 67,500.00 0 1

R/ VITAMIN C XON-CE KAPLET 15.00 KAPLET 1.00 15.00 0 1

392 RI20220226-0015 26/02/2022 RI20220225-0002 RI20220226-0015 FENTY LISTIJAWATI 294.0

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 294.00 294.00 1 0

393 RI20220226-0017 26/02/2022 RI20220225-0002 RI20220226-0017 FENTY LISTIJAWATI 21,040.0

R/ DEXTROSE 5% 500 ML INF 1.00 FLS 21,040.00 21,040.00 0 1

394 RI20220226-0022 26/02/2022 RI20220225-0002 RI20220226-0022 FENTY LISTIJAWATI 12,180.0

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

395 RI20220227-0003 27/02/2022 RI20220224-0002 RI20220227-0003 RIA RINDI SARI 1,667.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,667.00 1,667.00 1 0

CAPSUL
396 RI20220227-0004 27/02/2022 RI20220225-0002 RI20220227-0004 FENTY LISTIJAWATI 48,555.0

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

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

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

397 RI20220227-0006 27/02/2022 RI20220227-0001 RI20220227-0006 YANCE MAURICE MANURUNG 97,972.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,667.00 5,001.00 1 0

CAPSUL
R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

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

R/ FUROSEMIDE 10 MG/2 ML INJ 3.00 AMP 4,960.00 14,880.00 1 0

R/ ASPILET 80 MG TAB 1.00 TAB 729.00 729.00 0 0

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

398 RI20220227-0008 27/02/2022 RI20220227-0001 RI20220227-0008 YANCE MAURICE MANURUNG 19,729.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ BICNAT TAB 3.00 TAB 203.00 609.00 1 0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 129 of 190

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-February-2022 s/d 28-February-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

399 RI20220227-0010 27/02/2022 RI20220225-0002 RI20220227-0010 FENTY LISTIJAWATI 319,574.0

R/ ASCORBIT ACID 1000 MG/5 ML 2.00 AMP 20,000.00 40,000.00 1 0

INJ
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ASERING 500 ML INF 5.00 FLS 10,800.00 54,000.00 0 1

R/ DEXTROSE 5% 500 ML INF 1.00 FLS 21,040.00 21,040.00 0 1

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 294.00 294.00 1 0

R/ FAVIKAL 6.00 TAB 21,120.00 126,720.00 0 1

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

400 RI20220227-0011 27/02/2022 RI20220224-0002 RI20220227-0011 RIA RINDI SARI 912,631.0

R/ NACL 0.9 % 500 ML INF 6.00 FLS 13,333.00 79,998.00 1 0

R/ TRANSOFIX 2.00 PCS 19,600.00 39,200.00 0 1

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

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,667.00 5,001.00 1 0

CAPSUL
R/ FAVIKAL 200 MG TABLET 16.00 TAB 21,120.00 337,920.00 0 1

R/ ASCORBIT ACID 1000 MG/5 ML 2.00 AMP 20,000.00 40,000.00 1 0

INJ
401 RI20220227-0013 27/02/2022 RI20220227-0001 RI20220227-0013 YANCE MAURICE MANURUNG 52,927.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ BICNAT TAB 3.00 TAB 203.00 609.00 1 0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

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

R/ ASPILET 80 MG TAB 2.00 TAB 729.00 1,458.00 0 0

402 RI20220227-0017 27/02/2022 RI20220225-0002 RI20220227-0017 FENTY LISTIJAWATI 52,800.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

403 RI20220228-0003 28/02/2022 RI20220224-0002 RI20220228-0003 RIA RINDI SARI 327,992.0

R/ ASCORBIT ACID 1000 MG/5 ML 2.00 AMP 20,000.00 40,000.00 1 0

INJ
R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 130 of 190

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-February-2022 s/d 28-February-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

404 RI20220228-0007 28/02/2022 RI20220225-0002 RI20220228-0007 FENTY LISTIJAWATI 372,298.0

R/ HANDSCOEN STERIL NO. 6.0 2.00 PSG 27,000.00 54,000.00 0 1

R/ HANDSCOEN STERILE 2.00 PSG 18,900.00 37,800.00 0 1

(GAMMEX) NO. 7
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ FAVIKAL 200 MG TABLET 6.00 TAB 21,120.00 126,720.00 0 1

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
R/ HANDSCOEN STERIL NO. 6.5 2.00 PSG 21,162.00 42,324.00 0 1

R/ FUROSEMIDE 40 MG TAB 1.00 TAB 294.00 294.00 1 0

R/ ASCORBIT ACID 1000 MG/5 ML 2.00 AMP 20,000.00 40,000.00 1 0

INJ
405 RI20220228-0008 28/02/2022 RI20220225-0002 RI20220228-0008 FENTY LISTIJAWATI 23,788.0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

406 RJ20220202-0003 02/02/2022 OP20220202-0001 2022020200006 LAURENTIUS BALAMAKIN 2,775.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 185.00 2,775.00 1 0

KAPLET
407 RJ20220202-0006 02/02/2022 OP20220202-0012 2022020200012 MEGAWATI SIMANJUNTAK 368,356.0

R/ LAPRAZ 30 MG CAP 7.00 CAP 16,473.00 115,311.00 0 1

R/ OPILAX 60 ML SYR 1.00 FLS 77,440.00 77,440.00 0 1

R/ IMUNVIT KAPLET 7.00 KAPLET 10,000.00 70,000.00 0 0

R/ FLUNARIZINE 5 MG TAB 10.00 TAB 1,760.00 17,600.00 1 0

R/ VOMETA FT 10 MG TAB 15.00 TAB 5,867.00 88,005.00 0 1

408 RJ20220203-0002 03/02/2022 OP20220203-0001 2022020300003 MEGAWATI SIMANJUNTAK 185,010.0

R/ ATORVASTATIN 20 MG TAB 30.00 TAB 6,167.00 185,010.00 1 0

409 RJ20220203-0004 03/02/2022 OP20220203-0003 2022020300006 MEI RANDA PAKPAHAN 8,085.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 185.00 2,775.00 1 0

KAPLET
R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

410 RJ20220205-0001 05/02/2022 OP20220205-0005 2022020500002 ALLFIL REZKY ANDRIAL 15,975.0

R/ DOMPERIDON 10 MG TAB 15.00 TAB 545.00 8,175.00 1 0

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

411 RJ20220207-0011 07/02/2022 OP20220207-0017 2022020700018 NELLY SITINJAK 76,434.0

R/ ACETYLCYSTEIN 200 MG 15.00 CAP 1,485.00 22,275.00 1 0

CAPSUL
R/ CORTIDEX 0,5 MG TAB 15.00 TAB 399.00 5,985.00 0 1
R/ BECOM C KAPLET 7.00 KAPLET 2,166.00 15,162.00 0 1

R/ CERINI 10 MG TABLET 7.00 TAB 4,716.00 33,012.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 131 of 190

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-February-2022 s/d 28-February-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

412 RJ20220207-0014 07/02/2022 OP20220207-0018 2022020700023 IWAN SUMARNA 7,329.0

R/ AMLODIPINE 5 MG TAB 7.00 TAB 1,047.00 7,329.00 1 0

413 RJ20220208-0002 08/02/2022 OP20220208-0002 2022020800004 HENDRA 5,140.0

R/ IBUPROFEN 400 MG TAB 10.00 TAB 514.00 5,140.00 1 0

414 RJ20220208-0004 08/02/2022 OP20220208-0001 2022020800006 NURMA PARHUSIP 13,275.0

R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

415 RJ20220209-0003 09/02/2022 OP20220209-0005 2022020900003 LAURENTIUS BALAMAKIN 13,275.0

R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

416 RJ20220209-0007 09/02/2022 OP20220209-0006 2022020900009 TAMBA TUA SIHOMBING 40,035.0

R/ ACETYLCYSTEIN 200 MG 21.00 CAP 1,485.00 31,185.00 1 0

CAPSUL
R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

417 RJ20220210-0003 10/02/2022 OP20220210-0005 2022021000004 JOHAN WIBOWO 70,000.0

PANGARIBUAN

R/ IMUNVIT KAPLET 7.00 KAPLET 10,000.00 70,000.00 0 0

418 RJ20220212-0003 12/02/2022 OP20220212-0002 2022021200005 YESAYA ZAI 47,650.0

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

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

R/ ACETYLCYSTEIN 200 MG 15.00 CAP 1,485.00 22,275.00 1 0

CAPSUL
R/ PARACETAMOL 500 MG 15.00 KAPLET 185.00 2,775.00 1 0
KAPLET
419 RJ20220212-0004 12/02/2022 OP20220212-0007 2022021200006 ERNAWATI MANIK 17,020.0

R/ SPASMINAL TABLET 10.00 TAB 817.00 8,170.00 0 1

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

420 RJ20220214-0001 14/02/2022 OP20220214-0002 2022021400001 AMINAH 91,059.0

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

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

421 RJ20220214-0002 14/02/2022 OP20220214-0003 2022021400002 NOVRIATI SIMANUNGKALIT 8,850.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

422 RJ20220214-0003 14/02/2022 OP20220214-0002 2022021400003 AMINAH 497,424.0

R/ LEVEMIR FLEXPEN (BPJS) 2.00 VIAL 80,909.00 161,818.00 0 1

R/ NOVORAPID FLEXPEN 4.00 VIAL 81,364.00 325,456.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 132 of 190

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-February-2022 s/d 28-February-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/ NALD NOVORAPID 32G 2.00 PCS 5,075.00 10,150.00 0 0

423 RJ20220214-0004 14/02/2022 OP20220214-0005 2022021400004 NURLELA 8,981.0

R/ SIMVASTATIN 20 MG TAB 7.00 TAB 1,283.00 8,981.00 1 0

424 RJ20220214-0009 14/02/2022 OP20220214-0010 2022021400012 ANDIKA PUTRA 507,340.0

R/ MERTIGO 6 MG TAB 15.00 TAB 4,987.00 74,805.00 0 1

R/ ALPRAZOLAM 0,5 MG TAB 3.00 TAB 790.00 2,370.00 0 0

(PSI)
R/ IMUNVIT KAPLET 10.00 KAPLET 10,000.00 100,000.00 0 0

R/ LAPRAZ 30 MG CAP 15.00 CAP 16,473.00 247,095.00 0 1

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

425 RJ20220214-0010 14/02/2022 OP20220214-0007 2022021400011 ERNAWATI MANIK 7,160.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

426 RJ20220214-0011 14/02/2022 OP20220214-0011 2022021400013 ROIDA SIHOTANG 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 80,909.00 80,909.00 0 1

427 RJ20220216-0006 16/02/2022 OP20220216-0005 2022021600006 TAHI RIANTO HENRIK PURBA 115,500.0

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

428 RJ20220216-0008 16/02/2022 OP20220216-0007 2022021600012 NURLIANA BUTARBUTAR 4,650.0

R/ CLONIDINE 0.15 MG TAB 15.00 TAB 310.00 4,650.00 1 0

429 RJ20220216-0009 16/02/2022 OP20220216-0008 2022021600010 MUSA SILABAN 16,975.0

R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

R/ PARACETAMOL 500 MG 20.00 KAPLET 185.00 3,700.00 1 0

KAPLET
430 RJ20220216-0011 16/02/2022 OP20220216-0011 2022021600014 NESRY PURBA 2,058.0

R/ FUROSEMIDE 40 MG TAB 7.00 TAB 294.00 2,058.00 1 0

431 RJ20220217-0001 17/02/2022 OP20220217-0001 2022021700001 LAURENTIUS BALAMAKIN 13,275.0

R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

432 RJ20220217-0002 17/02/2022 OP20220217-0002 2022021700003 SUDIN 8,175.0

R/ DOMPERIDON 10 MG TAB 15.00 TAB 545.00 8,175.00 1 0

433 RJ20220217-0003 17/02/2022 OP20220217-0003 2022021700006 INNA 61,188.0

R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 133 of 190

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-February-2022 s/d 28-February-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/ COTRIMOXAZOLE 480 MG 15.00 TAB 550.00 8,250.00 1 0

TABLET
434 RJ20220217-0005 17/02/2022 OP20220217-0006 2022021700008 SEPTRIDA DAMANIK 591,885.0

R/ LAPRAZ 30 MG CAP 15.00 CAP 16,473.00 247,095.00 0 1

R/ IMUNVIT PLUS KAPLET 10.00 KAPLET 13,500.00 135,000.00 0 1

R/ FREGO 5 MG TAB 15.00 TAB 8,448.00 126,720.00 0 0

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

435 RJ20220217-0006 17/02/2022 OP20220217-0007 2022021700011 FURI NINGSIH 1,850.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
436 RJ20220218-0002 18/02/2022 OP20220218-0002 2022021800003 MULLER SITORUS 54,781.0

R/ SIMVASTATIN 20 MG TAB 7.00 TAB 1,283.00 8,981.00 1 0

R/ EPERISON 50 MG TAB 20.00 TAB 2,290.00 45,800.00 1 0

437 RJ20220219-0003 19/02/2022 OP20220219-0004 2022021900005 ABDUL ROPI 233,481.0

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

R/ LAPRAZ 30 MG CAP 7.00 CAP 16,473.00 115,311.00 0 1

R/ SPASMINAL TABLET 15.00 TAB 817.00 12,255.00 0 1

R/ BRAXIDIN TABLET 15.00 TAB 1,523.00 22,845.00 0 0

(PSIKOTROPIKA)
438 RJ20220219-0004 19/02/2022 OP20220219-0001 2022021900008 ERIKSON SIMORANGKIR 74,051.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
R/ SET DARAH 1.00 PCS 7,157.00 7,157.00 0 1

R/ KAPAS ALKOHOL 4.00 PCS 303.00 1,212.00 0 1

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

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

439 RJ20220221-0001 21/02/2022 OP20220221-0006 2022022100001 ERNAWATI MANIK 5,310.0

R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

440 RJ20220221-0003 21/02/2022 OP20220221-0007 2022022100003 TRIHENMOI SINAGA 236,551.0

R/ LAPRAZ 30 MG CAP 7.00 CAP 16,473.00 115,311.00 0 1

R/ BRAXIDIN TABLET 20.00 TAB 1,523.00 30,460.00 0 0

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

R/ IBUPROFEN 400 MG TAB 15.00 TAB 514.00 7,710.00 1 0

441 RJ20220221-0010 21/02/2022 OP20220221-0014 2022022100010 NURLELA 5,310.0

R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 134 of 190

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-February-2022 s/d 28-February-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

442 RJ20220222-0003 22/02/2022 OP20220222-0003 2022022200003 HERI KUSTIANTO 388,712.0

R/ IMUNVIT PLUS KAPLET 7.00 KAPLET 13,500.00 94,500.00 0 1

R/ GASTROLAN CAPS 7.00 CAP 18,226.00 127,582.00 0 1

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

R/ OPILAX 60 ML SYR 1.00 FLS 77,440.00 77,440.00 0 1

R/ SANMOL 500 MG TABLET 15.00 TAB 408.00 6,120.00 0 1

443 RJ20220222-0004 22/02/2022 OP20220222-0004 2022022200004 DINAR RISNAWATI 16,142.0

R/ ASPILET 80 MG TAB 7.00 TAB 729.00 5,103.00 0 0

R/ FUROSEMIDE 40 MG TAB 7.00 TAB 294.00 2,058.00 1 0

R/ SIMVASTATIN 20 MG TAB 7.00 TAB 1,283.00 8,981.00 1 0

444 RJ20220222-0005 22/02/2022 OP20220222-0004 2022022200005 DINAR RISNAWATI 53,038.0

R/ SIMVASTATIN 20 MG TAB 23.00 TAB 1,283.00 29,509.00 1 0

R/ FUROSEMIDE 40 MG TAB 23.00 TAB 294.00 6,762.00 1 0

R/ ASPILET 80 MG TAB 23.00 TAB 729.00 16,767.00 0 0

445 RJ20220223-0004 23/02/2022 OP20220223-0005 2022022300005 NESRY PURBA 8,850.0

R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

446 RJ20220223-0007 23/02/2022 OP20220223-0007 2022022300008 HOKKOP SIMANJUNTAK 5,820.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 388.00 5,820.00 1 0

KAPLET
447 RJ20220223-0008 23/02/2022 OP20220223-0008 2022022300009 TAHI RIANTO HENRIK PURBA 13,275.0

R/ CURCUMA FCT TAB 15.00 TAB 885.00 13,275.00 0 1

448 RJ20220223-0009 23/02/2022 OP20220223-0010 2022022300010 MUSA SILABAN 71,220.0

R/ URSODEOXYCHOLIC ACID 250 10.00 CAP 6,237.00 62,370.00 1 0

MG
R/ CURCUMA FCT TAB 10.00 TAB 885.00 8,850.00 0 1

449 RJ20220223-0010 23/02/2022 OP20220223-0003 2022030200022 NURLIANA BUTARBUTAR 8,996.0

R/ VITAMIN C XON-CE KAPLET 15.00 KAPLET 1.00 15.00 0 1

R/ SIMVASTATIN 20 MG TAB 7.00 TAB 1,283.00 8,981.00 1 0

450 RJ20220223-0011 23/02/2022 OP20220223-0003 2022030200021 NURLIANA BUTARBUTAR 29,509.0

R/ SIMVASTATIN 20 MG TAB 23.00 TAB 1,283.00 29,509.00 1 0

451 RJ20220223-0012 23/02/2022 OP20220223-0011 2022022300013 RIZKI AFRIANATA 190,180.0

R/ MAXTAN 500 MG TABLET 20.00 TAB 1,784.00 35,680.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 135 of 190

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-February-2022 s/d 28-February-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/ IMUNVIT PLUS KAPLET 7.00 KAPLET 13,500.00 94,500.00 0 1

R/ KOLKISIN 0.5 MG TABLET 15.00 TAB 4,000.00 60,000.00 1 0

452 RJ20220223-0013 23/02/2022 OP20220223-0013 2022022300014 HERMINA BR SIBARANI 5,820.0

R/ PARACETAMOL 500 MG 15.00 KAPLET 388.00 5,820.00 1 0

KAPLET
453 RJ20220224-0003 24/02/2022 OP20220224-0003 2022022400003 FURI NINGSIH 106,575.0

R/ IBUPROFEN 400 MG TAB 15.00 TAB 514.00 7,710.00 1 0

R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

R/ URSODEOXYCHOLIC ACID 250 15.00 CAP 6,237.00 93,555.00 1 0

MG
454 RJ20220224-0004 24/02/2022 OP20220224-0004 2022022400008 ALFONSUS PARHUSIP 108,405.0

R/ SANMOL 500 MG TABLET 15.00 TAB 408.00 6,120.00 0 1

R/ IMUNVIT PLUS KAPLET 7.00 KAPLET 13,500.00 94,500.00 0 1

R/ LEVOFLOXACIN 500 MG TAB 5.00 TAB 1,557.00 7,785.00 1 0

455 RJ20220225-0007 25/02/2022 OP20220225-0009 2022022500008 JAN SIRAIT 13,020.0

R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

R/ IBUPROFEN 400 MG TAB 15.00 TAB 514.00 7,710.00 1 0

456 RJ20220225-0008 25/02/2022 OP20220225-0012 2022022500009 ERIKSON SIMORANGKIR 1,925.0

R/ ANEMOLAT 1 MG TAB 7.00 TAB 275.00 1,925.00 0 1

457 RJ20220225-0010 25/02/2022 OP20220225-0010 2022022500013 MULLER SITORUS 65,220.0

R/ SIMVASTATIN 20 MG TAB 5.00 TAB 1,283.00 6,415.00 1 0

R/ ZEMINDO 60 ML SYR 1.00 BTL ### 52,800.00 0 1

R/ VITAMIN C XON-CE KAPLET 5.00 KAPLET 1.00 5.00 0 1

R/ AMLODIPINE 5 MG TAB 5.00 TAB 1,200.00 6,000.00 1 0

458 RJ20220226-0002 26/02/2022 OP20220226-0004 2022022600002 RINALDO PURBA 5,310.0

R/ CURCUMA FCT TAB 6.00 TAB 885.00 5,310.00 0 1

Total Dokter DR. GINA ARIANI, SP.PD 60,538,562.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 136 of 190
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-February-2022 s/d 28-February-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 RD20220201-0003 01/02/2022 EP20220201-0003 2022020100004 MUHAMMAD YUSUF LUBIS 204,966.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ CERINI 10 MG TABLET 6.00 TAB 4,716.00 28,296.00 0 1

2 RD20220201-0004 01/02/2022 EP20220201-0002 2022020100005 TEGAR TRI ATMAJA 20,500.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

3 RD20220201-0005 01/02/2022 EP20220201-0004 2022020100007 SERTA NURCAHAYA 8,158.0

HUTAURUK

R/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 193.00 1,930.00 1 0

R/ MELOXICAM 7,5 MG TAB 6.00 TAB 1,038.00 6,228.00 1 0

4 RD20220203-0013 03/02/2022 EP20220203-0012 2022020300015 ROHANA BUTAR- BUTAR 272,516.0

R/ MEFINAL 500 MG KAPLET 5.00 KAPLET 1,836.00 9,180.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ SANMOL 500 MG TABLET 5.00 TAB 408.00 2,040.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ BUSCOPAN TAB 10 MG 6.00 TAB 4,398.00 26,388.00 0 1

5 RD20220203-0014 03/02/2022 EP20220203-0013 2022020300016 BETTY PAKPAHAN 4,741.0

R/ CIPROFLOXACINE 500 MG TAB 6.00 TAB 591.00 3,546.00 1 0

R/ ASAM MEFENAMAT 500 MG 5.00 KAPLET 239.00 1,195.00 1 0

KAPLET
6 RD20220203-0015 03/02/2022 EP20220203-0014 2022020300017 ANDI KUSWORO 291,788.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

7 RD20220203-0016 03/02/2022 EP20220203-0015 2022020300018 ADITYA CHANDRA 208,744.0

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/ VOMETA FT 10 MG TAB 6.00 TAB 5,867.00 35,202.00 0 1

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

8 RD20220203-0017 03/02/2022 EP20220203-0016 2022020300019 GRACELESA AMORA SITORUS 47,105.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 137 of 190

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-February-2022 s/d 28-February-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/ 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 23,005.00 23,005.00 0 1

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

9 RD20220203-0018 03/02/2022 EP20220203-0017 2022020300021 HASIAN SIMATUPANG 178,530.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,836.00 18,360.00 0 1

10 RD20220203-0019 03/02/2022 EP20220203-0018 2022020300022 PITRA PRATAMA GURUSINGA 11,242.0

R/ SANMOL 500 MG TABLET 9.00 TAB 1.00 408.00 11,242.00 0 1

METHYLPREDNISOLONE 4 MG 6.00 TAB 595.00 0.00 1 0

TAB
KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

CETIRIZINE 10 MG TAB 3.00 TAB 1,000.00 0.00 1 0

11 RD20220203-0020 03/02/2022 EP20220203-0019 2022020300023 ANDIKA PUTRA 266,472.0

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

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

12 RD20220204-0004 04/02/2022 EP20220204-0005 2022020400011 INNA 4,020.0

R/ DOMPERIDON 10 MG TAB 6.00 TAB 545.00 3,270.00 1 0

R/ VITAMIN B COMPLEX TAB 5.00 TAB 150.00 750.00 1 0

13 RD20220204-0005 04/02/2022 EP20220204-0006 2022020400012 BETI LISTITE 205,520.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,836.00 18,360.00 0 1

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

14 RD20220204-0006 04/02/2022 EP20220204-0006 2022020400013 BETI LISTITE 82,500.0

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

15 RD20220204-0007 04/02/2022 EP20220204-0007 2022020400014 KAILA PEPAYOSA HUTASOIT 32,274.0

R/ D5 + 1/4 NS 500 ML ( WIDA ) 1.00 FLS 23,005.00 23,005.00 0 1

R/ PROPYRETIC 80 MG SUPP 1.00 SUPP 9,269.00 9,269.00 0 1
(BPJS)
16 RD20220204-0008 04/02/2022 EP20220204-0009 2022020400016 REVA ARAFAH FADILAH PUTRI 120,002.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 138 of 190

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-February-2022 s/d 28-February-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/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ SANMOL 500 MG TABLET 14.00 TAB 408.00 5,712.00 0 1

17 RD20220204-0009 04/02/2022 EP20220204-0008 2022020400019 WARSONO 24,940.0

R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1

R/ ASAM MEFENAMAT 500 MG 10.00 KAPLET 239.00 2,390.00 1 0

KAPLET
18 RD20220204-0010 04/02/2022 EP20220204-0010 2022020400020 ROSMAWATI NAPITUPULU 2,600.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ VITAMIN B COMPLEX TAB 5.00 TAB 150.00 750.00 1 0

19 RD20220204-0011 04/02/2022 EP20220204-0011 2022020400021 CHRISTIN MEGAWATY 92,773.0

SIREGAR

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 1,836.00 18,360.00 0 1

R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

20 RD20220204-0012 04/02/2022 EP20220204-0012 2022020400022 SITI HARYANTI 255,910.0

R/ BENOSON M 5 GR CREAM 2.00 TUBE 75,625.00 151,250.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

21 RD20220204-0013 04/02/2022 EP20220204-0013 2022020400023 KAMIL 29,619.0

R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0

R/ DEXAMETHASON 0,5 MG TAB 6.00 TAB 193.00 1,158.00 1 0

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

22 RD20220204-0014 04/02/2022 EP20220204-0014 2022020400024 HAMDANI PRABOWO 87,474.0

R/ CEFIXIME 100 MG CAP 6.00 CAP 3,233.00 19,398.00 1 0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ DOMPERIDON 10 MG TAB 6.00 TAB 545.00 3,270.00 1 0

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
23 RD20220205-0001 05/02/2022 EP20220205-0001 2022020500001 ARNOLD TAMBA 401,402.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

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

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 139 of 190

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-February-2022 s/d 28-February-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/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

24 RD20220205-0002 05/02/2022 EP20220205-0002 2022020500003 CHRISTIANO P TAMBUNAN 1,850.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
25 RD20220206-0005 06/02/2022 EP20220206-0006 2022020600009 NUR AFIKA 13,190.0

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

KAPLET
R/ BETAHISTINE 6 MG TAB 6.00 TAB 1,435.00 8,610.00 1 0

26 RD20220206-0006 06/02/2022 EP20220206-0007 2022020600010 ISMAIL 36,788.0

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,788.00 36,788.00 0 0

DROP
27 RD20220206-0007 06/02/2022 EP20220206-0008 2022020600011 AULIA RAHMA DANI 18,420.0
TAMBUNAN

R/ ASAM TRANEXAMAT 500 MG 6.00 TAB 2,475.00 14,850.00 1 0

TAB
R/ METHYLPREDNISOLONE 4 MG 6.00 TAB 595.00 3,570.00 1 0
TAB
28 RD20220206-0008 06/02/2022 EP20220206-0009 2022020600014 WITA SUKMA 140,170.0

R/ CORMEGA SOFT CAPS 10.00 CAP 13,200.00 132,000.00 0 1

R/ SPASMINAL TABLET 10.00 TAB 817.00 8,170.00 0 1

29 RD20220206-0009 06/02/2022 EP20220206-0012 2022020600016 YOGI ALEXSANDER 21,493.0

PARDAMEAN PAKPAHAN

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

KAPLET
R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1

30 RD20220206-0010 06/02/2022 EP20220206-0011 2022020600017 TAMARA GERALDIN AGUSTINA 4,580.0

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

KAPLET
31 RD20220206-0011 06/02/2022 EP20220206-0010 2022020600018 N.SAUT PARHITEAN 60,500.0
PAKPAHAN

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

32 RD20220206-0012 06/02/2022 EP20220206-0010 2022020600019 N.SAUT PARHITEAN 66,112.0

PAKPAHAN

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

TAB
R/ OMEPRAZOLE 20 MG CAP 6.00 CAP 742.00 4,452.00 1 0

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

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

33 RD20220206-0013 06/02/2022 EP20220206-0013 2022020600021 PITRA PRATAMA GURUSINGA 20,500.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

34 RD20220208-0003 08/02/2022 EP20220208-0003 2022020800005 YUDISTIRA 131,014.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 140 of 190

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-February-2022 s/d 28-February-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/ CALCIUM LACTATE 500 MG 10.00 TAB 303.00 3,030.00 1 0

TABLET
R/ MEFINAL 500 MG KAPLET 6.00 KAPLET 2,019.00 12,114.00 0 1

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

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

35 RD20220208-0005 08/02/2022 EP20220208-0005 2022020800010 ROLAN TOGU PARASIAN 158,978.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

36 RD20220208-0006 08/02/2022 EP20220208-0006 2022020800011 MAYANG RISTALENTA 267,290.0

HARIANJA

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

37 RD20220209-0012 09/02/2022 EP20220209-0011 2022020900020 SHANIA ALI AGATHA 323,438.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

38 RD20220209-0014 09/02/2022 EP20220209-0013 2022020900026 ANGELICA DEBORA 234,432.0

SIMANJUTAK

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

39 RD20220209-0015 09/02/2022 EP20220209-0014 2022020900028 BONIFASIUS SIHOTANG 117,153.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1

R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

40 RD20220209-0016 09/02/2022 EP20220209-0015 2022020900030 JANWAR CANDRA SINUKABAN 394,680.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)

Print Date:7/14/2022 Print Time: 2:11:10PM Page 141 of 190

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-February-2022 s/d 28-February-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/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ AMLODIPINE 5 MG TAB 10.00 TAB 1,047.00 10,470.00 1 0

41 RD20220210-0015 10/02/2022 EP20220210-0015 2022021000024 JUANDA PANGARIBUAN 208,292.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 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 5,800.00 29,000.00 0 1

42 RD20220210-0018 10/02/2022 EP20220210-0017 2022021000029 DIDIT SUSANTO 271,076.0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

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

R/ TREMENZA TABLET 10.00 TAB 2,001.00 20,010.00 0 1

(PREKURSOR)
R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

43 RD20220210-0019 10/02/2022 EP20220210-0018 2022021000031 PUTRI MARINA SINAGA 28,461.0

R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
44 RD20220210-0020 10/02/2022 EP20220210-0020 2022021000032 NOVIA LISTINA RAHAYU 41,368.0

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

KAPLET
R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,788.00 36,788.00 0 0
DROP
45 RD20220210-0021 10/02/2022 EP20220210-0021 2022021000036 NOFRIMA DAKESMI 243,504.0

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

R/ TREMENZA TABLET 2.00 TAB 2,001.00 4,002.00 0 1

(PREKURSOR)
R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

46 RD20220210-0022 10/02/2022 EP20220210-0022 2022021000034 ERWIN SITORUS 217,405.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

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

R/ SPASMINAL TABLET 10.00 TAB 817.00 8,170.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

47 RD20220210-0023 10/02/2022 EP20220210-0019 2022021000035 YOHANES BAPTISTA SALLE 127,194.0

 LADO PURAB

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 142 of 190

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-February-2022 s/d 28-February-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/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

R/ OTILON EAR DROP 1.00 FLS 53,006.00 53,006.00 0 1

R/ AMBROXOL 30 MG TAB 3.00 TAB 1.00 160.00 40,500.00 1 0

TREMENZA TABLET 20.00 TAB 2,001.00 0.00 0 1

(PREKURSOR)
48 RD20220210-0024 10/02/2022 EP20220210-0023 2022021000037 RUDI YANTO 119,122.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

49 RD20220210-0025 10/02/2022 EP20220210-0024 2022021000038 TETTI ARIANI BUTAR-BUTAR 1,850.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
50 RD20220210-0026 10/02/2022 EP20220210-0025 2022021000039 BERSIUS SITANGGANG 13,710.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ METHYLPREDNISOLONE 4 MG 10.00 TAB 595.00 5,950.00 1 0
TAB
R/ CIPROFLOXACINE 500 MG TAB 10.00 TAB 591.00 5,910.00 1 0

51 RD20220211-0002 11/02/2022 EP20220211-0002 2022021100002 MAHISA RHANI 164,082.0

R/ CORTIDEX 0,5 MG TAB 6.00 TAB 399.00 2,394.00 0 1

R/ EPEXOL TAB 10.00 TAB 1,141.00 11,410.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ VOMIZOLE 20 MG TAB 6.00 TAB 19,433.00 116,598.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

52 RD20220211-0015 11/02/2022 EP20220211-0016 2022021100035 JONI ARESKI 32,489.0

R/ MEFINAL 500 MG KAPLET 6.00 KAPLET 2,019.00 12,114.00 0 1

R/ CENDO LYTEERS 0,5 ML 1.00 FLS 5,525.00 5,525.00 0 1

MINIDOSE
R/ ASAM TRANEXAMAT 500 MG 6.00 TAB 2,475.00 14,850.00 1 0
TAB
53 RD20220211-0016 11/02/2022 EP20220211-0015 2022021100036 CIHTRA AGUSTINA GULTOM 153,315.0

R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

54 RD20220211-0017 11/02/2022 EP20220211-0017 2022021100037 NAUFAL ZAKY RAMADHAN 213,186.0

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

R/ SANMOL F SYR 60ML 1.00 BTL 36,186.00 36,186.00 0 1

R/ PROZA SYR 1.00 FLS 117,000.00 117,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 143 of 190

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-February-2022 s/d 28-February-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/ L BIO SACHET 5.00 SACH 9,800.00 49,000.00 0 1

55 RD20220211-0018 11/02/2022 EP20220211-0018 2022021100038 ELVIRA OKTAVIANI 393,220.0

R/ VENOSMIL GEL 1.00 TUBE 224,000.00 224,000.00 0 1

R/ ANADIUM KAPLET 10.00 KAPLET 11,172.00 111,720.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

56 RD20220211-0019 11/02/2022 EP20220211-0019 2022021100039 LISNA SARTIKA 210,032.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 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 408.00 4,080.00 0 1

57 RD20220211-0020 11/02/2022 EP20220211-0020 2022021100041 NIKE PEBRINA 196,272.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

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/ SPASMINAL TABLET 10.00 TAB 817.00 8,170.00 0 1

58 RD20220211-0021 11/02/2022 EP20220211-0021 2022021100043 MUHAMMAD ABIDZAR 89,773.0

ALGIFARI

R/ KERTAS PERKAMEN BERLOGO 9.00 LBR 100.00 900.00 0 1

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

R/ CEFIXIME 100 MG CAP 5.00 CAP 1.00 3,233.00 43,873.00 1 0

INBUMIN TAB 250 MG 3.00 TAB 8,556.00 0.00 0 1

SANMOL 500 MG TABLET 5.00 TAB 408.00 0.00 0 1

59 RD20220211-0022 11/02/2022 EP20220211-0022 2022021100044 SHERINA SYAHPUTRI BR 278,182.0

GINTING

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

60 RD20220211-0023 11/02/2022 EP20220211-0023 2022021100045 DIDIT ICHWAN 176,932.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 144 of 190

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-February-2022 s/d 28-February-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

61 RD20220211-0024 11/02/2022 EP20220211-0024 2022021100046 RUTINA SORMIN 284,178.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

62 RD20220211-0025 11/02/2022 EP20220211-0025 2022021100047 YAHYA SYAPUTRA 148,150.0

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

R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1

R/ CENDO LYTEERS 0,5 ML 1.00 FLS 5,525.00 5,525.00 0 1

MINIDOSE
R/ CENDO FENICOL 1 % SALEP 1.00 FLS 39,500.00 39,500.00 0 0
MATA
63 RD20220211-0026 11/02/2022 EP20220211-0026 2022021100048 DAFFA MUARIF 234,432.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

64 RD20220211-0027 11/02/2022 EP20220211-0027 2022021100050 JHON RENALDO MANURUNG 58,438.0

R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
65 RD20220212-0006 12/02/2022 EP20220212-0007 2022021200012 PERA AGNESCIA 174,232.0

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

66 RD20220212-0007 12/02/2022 EP20220212-0008 2022021200013 DEDY KOKO ARJUNA 10,100.0

SITUMORANG

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ LODIA 2 MG TABLET 6.00 TAB 1,375.00 8,250.00 0 1

67 RD20220212-0008 12/02/2022 EP20220212-0009 2022021200014 NELLY RYANTY PAKPAHAN 104,740.0

R/ ONDANSETRON 4 MG TAB 10.00 TAB 2,167.00 21,670.00 1 0

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

68 RD20220212-0009 12/02/2022 EP20220212-0010 2022021200015 APRIANI 221,470.0

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 145 of 190

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-February-2022 s/d 28-February-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 26,950.00 26,950.00 0 1

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

69 RD20220212-0010 12/02/2022 EP20220212-0011 2022021200016 AFDHAL HABIB SIREGAR 168,296.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ CERINI 10 MG TABLET 6.00 TAB 4,716.00 28,296.00 0 1

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

70 RD20220212-0011 12/02/2022 EP20220212-0013 2022021200018 CATHERINE BONITA SIREGAR 194,440.0

R/ PROZA SYR 1.00 FLS 117,000.00 117,000.00 0 1

R/ OPILAX 60 ML SYR 1.00 FLS 77,440.00 77,440.00 0 1

71 RD20220212-0012 12/02/2022 EP20220212-0014 2022021200019 SEJAHTERA 23,650.0

R/ VITAMIN B COMPLEX TAB 5.00 TAB 150.00 750.00 1 0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

72 RD20220212-0014 12/02/2022 EP20220212-0015 2022021200022 SARILAN HARAHAP 35,733.0

R/ BETAHISTINE 6 MG TAB 6.00 TAB 1,435.00 8,610.00 1 0

R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0

R/ AMLODIPINE 5 MG TAB 5.00 TAB 1,200.00 6,000.00 1 0

R/ CETIRIZINE 10 MG TAB 6.00 TAB 1,000.00 6,000.00 1 0

R/ ASAM MEFENAMAT 500 MG 6.00 KAPLET 458.00 2,748.00 1 0

KAPLET
73 RD20220212-0015 12/02/2022 EP20220212-0016 2022021200024 MARIA GISELA NONA 92,061.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

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

R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1

(BPJS)
74 RD20220213-0014 13/02/2022 EP20220213-0014 2022021300026 NAIFA CAHYA DEWI 56,320.0

R/ SCABIMITE 10 GR CREAM 1.00 TUBE 56,320.00 56,320.00 0 1

75 RD20220213-0016 13/02/2022 EP20220213-0015 2022021300029 NADA SUHALLAH 23,486.0

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

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

76 RD20220213-0017 13/02/2022 EP20220213-0016 2022021300037 ASIMA FLORENTINA MANIK 23,486.0

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

R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 146 of 190

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-February-2022 s/d 28-February-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

77 RD20220213-0018 13/02/2022 EP20220213-0016 2022021300038 ASIMA FLORENTINA MANIK 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

78 RD20220213-0020 13/02/2022 EP20220213-0015 2022021300040 NADA SUHALLAH 10,626.0

R/ SELANG O2 DEWASA 1.00 PCS 10,626.00 10,626.00 0 1

79 RD20220216-0002 16/02/2022 EP20220216-0002 2022021600006 RINA NATALIA SITORUS 101,036.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1
(OOT)
R/ PROVITAL PLUS CAPS 10.00 CAP 5,800.00 58,000.00 0 1

80 RD20220216-0003 16/02/2022 EP20220216-0004 2022021600007 MARIA ANTONIA 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

81 RD20220216-0004 16/02/2022 EP20220216-0005 2022021600009 WANRA HUTAPEA 58,438.0

R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
82 RD20220216-0005 16/02/2022 EP20220216-0003 2022021600014 SRI WULANDARI 65,220.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

83 RD20220216-0006 16/02/2022 EP20220216-0004 2022021600015 MARIA ANTONIA 132,012.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

84 RD20220216-0007 16/02/2022 EP20220216-0006 2022021600016 YESLINDA BR KARO 68,874.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

85 RD20220216-0008 16/02/2022 EP20220216-0007 2022021600017 ZURANISA AGUSTINI 148,122.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 147 of 190

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-February-2022 s/d 28-February-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 5,800.00 29,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

86 RD20220216-0010 16/02/2022 EP20220216-0008 2022021600020 LAMAIDI 119,122.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

87 RD20220216-0011 16/02/2022 EP20220216-0011 2022021600021 ALIDE TAMBA 70,350.0

R/ CORTIDEX 0,5 MG TAB 6.00 TAB 399.00 2,394.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1
(PREKURSOR)
88 RD20220216-0012 16/02/2022 EP20220216-0012 2022021600022 MARLAN MANALU 101,000.0

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

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

89 RD20220216-0013 16/02/2022 EP20220216-0009 2022021600023 WILDA GABRIELSA SIREGAR 129,212.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

90 RD20220216-0014 16/02/2022 EP20220216-0013 2022021600026 LUSIYANTI SIHOMBING 56,496.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ EPEXOL TAB 10.00 TAB 1,141.00 11,410.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

91 RD20220216-0015 16/02/2022 EP20220216-0015 2022021600029 BILQIS ULFAIRA 270,878.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ PULMICORT 0.5 MG/ML NEB 1.00 FLS 7,890.00 7,890.00 0 1

(BPJS)
R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)

Print Date:7/14/2022 Print Time: 2:11:10PM Page 148 of 190

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-February-2022 s/d 28-February-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

R/ PROZA SYR 1.00 FLS 117,000.00 117,000.00 0 1

92 RD20220216-0016 16/02/2022 EP20220216-0014 2022021600028 MECHTILDIS NOVELIA AURA 20,500.0

LADDY

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

93 RD20220216-0017 16/02/2022 EP20220216-0016 2022021600032 JUANDA RIZKI 295,148.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
94 RD20220216-0018 16/02/2022 EP20220216-0017 2022021600033 XAVIER ALI IMRAN 9,269.0

R/ PROPYRETIC 80 MG SUPP 1.00 SUPP 9,269.00 9,269.00 0 1

(BPJS)
95 RD20220216-0019 16/02/2022 EP20220216-0018 2022021600034 ROMARTA HALOHO 72,978.0

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

R/ MEFINAL 10.00 KAPLET 2,019.00 20,190.00 0 1

500 MG
R/ EPEXOL
KAPLET SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

96 RD20220216-0020 16/02/2022 EP20220216-0019 2022021600035 AHMAD YANI 206,470.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

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

97 RD20220217-0008 17/02/2022 EP20220217-0010 2022021700020 HENDRI RUDIANTO 155,452.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SPASMINAL TABLET 10.00 TAB 817.00 8,170.00 0 1

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

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

98 RD20220217-0009 17/02/2022 EP20220217-0011 2022021700025 SURIANSYAH 88,530.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1
99 RD20220217-0010 17/02/2022 EP20220217-0014 2022021700026 FANIA AQILA BR SINUKABAN 219,186.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 149 of 190

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-February-2022 s/d 28-February-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/ PROZA SYR 1.00 FLS 117,000.00 117,000.00 0 1

R/ SANMOL F SYR 60ML 1.00 BTL 36,186.00 36,186.00 0 1

100 RD20220217-0011 17/02/2022 EP20220217-0013 2022021700029 JANWAR CANDRA SINUKABAN 146,030.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

101 RD20220217-0012 17/02/2022 EP20220217-0012 2022021700030 IKA BUDIYATNI 70,950.0

R/ SANMOL 500 MG TABLET 5.00 TAB 408.00 2,040.00 0 1

R/ EPEXOL TAB 10.00 TAB 1,141.00 11,410.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

102 RD20220217-0013 17/02/2022 EP20220217-0016 2022021700031 ELKANA 262,776.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

103 RD20220217-0014 17/02/2022 EP20220217-0015 2022021700034 LUSIA DAMAI YANA MURNI 129,962.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

104 RD20220217-0015 17/02/2022 EP20220217-0019 2022021700035 AUDINA 161,892.0

R/ SPASMINAL TABLET 10.00 TAB 817.00 8,170.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

105 RD20220217-0016 17/02/2022 EP20220217-0017 2022021700036 MARIA ANA LIPAT 60,000.0

R/ PARACETAMOL INFUS 1.00 FLS 60,000.00 60,000.00 1 0

1GR/100 ML
106 RD20220217-0017 17/02/2022 EP20220217-0020 2022021700037 MUHAMMAD HANAFI 187,398.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ AMLODIPINE 5 MG TAB 5.00 TAB 1,200.00 6,000.00 1 0

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 150 of 190

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-February-2022 s/d 28-February-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

107 RD20220217-0018 17/02/2022 EP20220217-0018 2022021700041 YUNI LUKITO KARYA 40,891.0

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

KAPLET
R/ CEFIXIME 100 MG CAP 6.00 CAP 3,233.00 19,398.00 1 0

R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1

108 RD20220217-0019 17/02/2022 EP20220217-0021 2022021700043 SARLES SINAGA 185,478.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

109 RD20220217-0020 17/02/2022 EP20220217-0022 2022021700045 TARULI SINAGA 37,746.0

R/ BECOM C KAPLET 10.00 KAPLET 2,166.00 21,660.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
110 RD20220217-0021 17/02/2022 EP20220217-0023 2022021700049 CAROLINA SIMANJUNTAK 271,128.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

111 RD20220217-0022 17/02/2022 EP20220217-0008 2022021700051 FRENTRY SIHOMBING 24,360.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

112 RD20220217-0023 17/02/2022 EP20220217-0024 2022021700054 ANA MARIANA 24,520.0

R/ ASERING 500 ML INF 1.00 FLS 10,800.00 10,800.00 0 1

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

113 RD20220217-0024 17/02/2022 EP20220217-0025 2022021700058 ZHAO ZHANGLANG 61,580.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

114 RD20220217-0025 17/02/2022 EP20220217-0026 2022021700059 HERDALINA MANURUNG 113,972.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ RHINOS SR KAPSUL 6.00 CAP 8,067.00 48,402.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 151 of 190

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-February-2022 s/d 28-February-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

115 RD20220217-0026 17/02/2022 EP20220217-0026 2022021700061 HERDALINA MANURUNG 159,102.0

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

116 RD20220217-0027 17/02/2022 EP20220217-0027 2022021700062 ADISTY DIANE ROLIS 160,583.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

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

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

117 RD20220217-0028 17/02/2022 EP20220217-0028 2022021700063 GABARIELLA SABA TINI M 191,260.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

118 RD20220217-0029 17/02/2022 EP20220217-0024 2022021700064 ANA MARIANA 24,360.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

119 RD20220218-0022 18/02/2022 EP20220218-0016 2022021800043 YUNI ANGGELA GINTING 250,604.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

R/ MERTIGO 6 MG TAB 6.00 TAB 4,987.00 29,922.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

120 RD20220218-0023 18/02/2022 EP20220218-0017 2022021800044 ELFIRITA SIMATUPANG 63,527.0

R/ PROZA KAPLET 3.00 KAPLET 11,500.00 34,500.00 0 1

R/ MEFINAL 500 MG KAPLET 6.00 KAPLET 2,019.00 12,114.00 0 1

R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1

121 RD20220218-0024 18/02/2022 EP20220218-0020 2022021800045 NICHOLAS SERGIO 17,600.0

SITUMORANG

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

122 RD20220218-0025 18/02/2022 EP20220218-0020 2022021800046 NICHOLAS SERGIO 38,100.0

 SITUMORANG

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 152 of 190

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-February-2022 s/d 28-February-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/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

123 RD20220218-0026 18/02/2022 EP20220218-0018 2022021800047 RIKI HAMDANI 119,122.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 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

124 RD20220218-0027 18/02/2022 EP20220218-0019 2022021800048 IRMAYA SARI 141,362.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ RHINOS SR KAPSUL 6.00 CAP 8,067.00 48,402.00 0 1

(PREKURSOR)
R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

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

125 RD20220218-0028 18/02/2022 EP20220218-0021 2022021800049 YESAYA TARIGAN 228,716.0

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ MEFINAL 500 MG KAPLET 6.00 KAPLET 2,019.00 12,114.00 0 1

126 RD20220218-0029 18/02/2022 EP20220218-0022 2022021800050 VENNY MALINDRA 104,580.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

127 RD20220218-0030 18/02/2022 EP20220218-0024 2022021800051 OKTARIANI 218,282.0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

128 RD20220218-0031 18/02/2022 EP20220218-0025 2022021800052 TOMMY ROLIS 152,103.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

129 RD20220218-0032 18/02/2022 EP20220218-0026 2022021800055 LATIFA RAMDONA 125,768.0

R/ ASAM MEFENAMAT 500 MG 6.00 KAPLET 458.00 2,748.00 1 0
KAPLET
R/ DOMPERIDON 10 MG TAB 10.00 TAB 545.00 5,450.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 153 of 190

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-February-2022 s/d 28-February-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/ PROPEPSA 100 ML SYR 1.00 FLS 83,070.00 83,070.00 0 1

R/ PROZA KAPLET 3.00 KAPLET 11,500.00 34,500.00 0 1

130 RD20220218-0033 18/02/2022 EP20220218-0027 2022021800056 SEPRIO 263,112.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

131 RD20220218-0034 18/02/2022 EP20220218-0028 2022021800057 ALIZKA ILLONA GULTOM 109,288.0

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

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

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

R/ L BIO SACHET 3.00 SACH 9,800.00 29,400.00 0 1

132 RD20220218-0035 18/02/2022 EP20220218-0029 2022021800058 ABEDNEGO SIMAGUNSONG 280,124.0

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

R/ RHINOS SR KAPSUL 6.00 CAP 8,067.00 48,402.00 0 1

(PREKURSOR)
R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

133 RD20220218-0037 18/02/2022 EP20220218-0032 2022021800061 ANDIKA PUTRA 266,472.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

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

134 RD20220218-0038 18/02/2022 EP20220218-0032 2022021800062 ANDIKA PUTRA 1,375.0

R/ SIDIADRYL 150MG/15ML INJ 1.00 CC 1,375.00 1,375.00 0 1

135 RD20220218-0039 18/02/2022 EP20220218-0033 2022021800064 DEWI FEBRIANTI 110,803.0

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

R/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

136 RD20220218-0040 18/02/2022 EP20220218-0034 2022021800065 SYAFRI ELDI 209,614.0

R/ MEFINAL 500 MG KAPLET 6.00 KAPLET 2,019.00 12,114.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 154 of 190

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-February-2022 s/d 28-February-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/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

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

137 RD20220219-0018 19/02/2022 EP20220219-0015 2022021900035 WANSI SITUMORANG 60,000.0

R/ PARACETAMOL INFUS 1.00 FLS 60,000.00 60,000.00 1 0

1GR/100 ML
138 RD20220219-0019 19/02/2022 EP20220219-0014 2022021900039 CINTA JUMAGAR SIANIAPAR 37,780.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ BECOM C KAPLET 5.00 KAPLET 2,166.00 10,830.00 0 1

139 RD20220219-0020 19/02/2022 EP20220219-0016 2022021900040 183,485.0

R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1

R/ BECOM C KAPLET 5.00 KAPLET 2,166.00 10,830.00 0 1

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

R/ CERINI 10 MG TABLET 10.00 TAB 4,716.00 47,160.00 0 1

140 RD20220219-0021 19/02/2022 EP20220219-0017 2022021900041 ZAINUDDIN MANALU 360,780.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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

141 RD20220219-0022 19/02/2022 EP20220219-0018 2022021900043 MALUL ANSARI BATUBARA 248,638.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

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

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

142 RD20220219-0023 19/02/2022 EP20220219-0019 2022021900044 SRI PUTRI ANANDA 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

143 RD20220219-0024 19/02/2022 EP20220219-0020 2022021900046 ENDAH 190,122.0

DWI
RIYANI
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

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

R/ BECOM C KAPLET 5.00 KAPLET 2,166.00 10,830.00 0 1

144 RD20220219-0025 19/02/2022 EP20220219-0019 2022021900047 SRI PUTRI ANANDA 190,122.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 155 of 190

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-February-2022 s/d 28-February-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 6.00 CAP 12,672.00 76,032.00 0 1

R/ BECOM C KAPLET 5.00 KAPLET 2,166.00 10,830.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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

145 RD20220221-0016 21/02/2022 EP20220221-0017 2022022100042 WIMBI TRIANDA 111,052.0

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

146 RD20220221-0017 21/02/2022 EP20220221-0018 2022022100043 DIKI PRATAMA PUTRA 23,978.0

R/ CEFIXIME 100 MG CAP 6.00 CAP 3,233.00 19,398.00 1 0

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

KAPLET
147 RD20220221-0018 21/02/2022 EP20220221-0019 2022022100045 DELFINORA PASARIBU 316,004.0

R/ LANFIX 100 MG KAPSUL 6.00 TAB 29,568.00 177,408.00 0 1

R/ CERINI 10 MG TABLET 6.00 TAB 4,716.00 28,296.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

148 RD20220221-0019 21/02/2022 EP20220221-0021 2022022100047 ROIS IGREYA BARUS 21,493.0

R/ SAGESTAM 10 GR CREAM 1.00 TUBE 16,913.00 16,913.00 0 1

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

KAPLET
149 RD20220221-0020 21/02/2022 EP20220221-0020 2022022100048 DINI OKTAVIA GULTOM 12,908.0

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

R/ AMOXICILLIN 500 MG KAPLET 4.00 KAPLET 1.00 482.00 6,068.00 1 0

AMBROXOL 30 MG TAB 4.00 TAB 285.00 0.00 1 0

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

CETIRIZINE 10 MG TAB 2.00 TAB 1,000.00 0.00 1 0

150 RD20220221-0021 21/02/2022 EP20220221-0022 2022022100049 BETI LISTITE 81,770.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

151 RD20220221-0022 21/02/2022 EP20220221-0023 2022022100050 FAYTRIMA LUMBANGAOL 220,682.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 156 of 190

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-February-2022 s/d 28-February-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 6.00 CAP 12,672.00 76,032.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

152 RD20220221-0023 21/02/2022 EP20220221-0025 2022022100051 ARNOLD TAMBA 10,000.0

R/ FARBION INJ 1.00 AMP 10,000.00 10,000.00 0 1

153 RD20220221-0024 21/02/2022 EP20220221-0025 2022022100055 ARNOLD TAMBA 190,412.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

154 RD20220221-0025 21/02/2022 EP20220221-0027 2022022100057 YULIANA TARIHORAN 113,664.0

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ CERINI 10 MG TABLET 6.00 TAB 4,716.00 28,296.00 0 1

155 RD20220221-0026 21/02/2022 EP20220221-0026 2022022100058 RAIHAN DHEFAL VAN HALEN 215,982.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

156 RD20220221-0027 21/02/2022 EP20220221-0024 2022022100059 AZKA NAUFAL AL MUSTOFA 110,423.0

R/ PROPYRETIC 80 MG SUPP 1.00 SUPP 9,269.00 9,269.00 0 1

(BPJS)
R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1
(BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ STESOLID 10 MG/2.5 ML 1.00 TUBE 50,181.00 50,181.00 0 0

RECTAL TUBE
157 RD20220221-0028
(PSIKOTROPIKA) 21/02/2022 EP20220221-0024 2022022100060 AZKA NAUFAL AL MUSTOFA 52,953.0

R/ SUNGKUP OKSIGEN ANAK 1.00 PCS 52,953.00 52,953.00 0 1

158 RD20220221-0029 21/02/2022 EP20220221-0028 2022022100061 ARIS KASNUR 111,360.0

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 157 of 190

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-February-2022 s/d 28-February-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

159 RD20220221-0030 21/02/2022 EP20220221-0029 2022022100070 FLOWERIDA SITANGGANG 259,457.0

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

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ VOMIZOLE 20 MG TAB 5.00 TAB 19,433.00 97,165.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

160 RD20220221-0032 21/02/2022 EP20220221-0024 2022022100074 AZKA NAUFAL AL MUSTOFA 50,150.0

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

161 RD20220222-0017 22/02/2022 EP20220222-0018 2022022200026 MONIKA TAMBA 134,570.0

R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

162 RD20220222-0018 22/02/2022 EP20220222-0019 2022022200027 PUTRI KIRANTI 266,930.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ GITAS PLUS TAB 6.00 TAB 8,388.00 50,328.00 0 1

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

163 RD20220222-0019 22/02/2022 EP20220222-0020 2022022200028 SASTRINDU MAWANTI 300,482.0

BR.MANIK

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ GITAS PLUS TAB 10.00 TAB 8,388.00 83,880.00 0 1

164 RD20220222-0020 22/02/2022 EP20220222-0021 2022022200030 ALFIY FADHILILLAH 130,270.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

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

165 RD20220222-0021 22/02/2022 EP20220222-0023 2022022200031 RAHMAT PRATAMA 3,880.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0
KAPLET
166 RD20220222-0022 22/02/2022 EP20220222-0022 2022022200032 MENTERIA SIHOTANG 112,746.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 158 of 190

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-February-2022 s/d 28-February-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/ CERINI 10 MG TABLET 6.00 TAB 4,716.00 28,296.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
167 RD20220222-0023 22/02/2022 EP20220222-0024 2022022200034 MELVA N OMPUSUNGGU 108,720.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

168 RD20220222-0024 22/02/2022 EP20220222-0025 2022022200035 ALBERTUS REFILINO RICOAC 2,750.0

R/ SIDIADRYL 150MG/15ML INJ 2.00 CC 1,375.00 2,750.00 0 1

169 RD20220222-0025 22/02/2022 EP20220222-0025 2022022200036 ALBERTUS REFILINO RICOAC 206,302.0

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

170 RD20220222-0026 22/02/2022 EP20220222-0026 2022022200037 DENTO 66,758.0

R/ INBUMIN TAB 250 MG 5.00 TAB 8,556.00 42,780.00 0 1

R/ CEFIXIME 100 MG CAP 6.00 CAP 3,233.00 19,398.00 1 0

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

KAPLET
171 RD20220222-0027 22/02/2022 EP20220222-0026 2022022200038 DENTO 5,610.0

R/ BISTURI NO. 22 1.00 PCS 5,610.00 5,610.00 0 1

172 RD20220222-0028 22/02/2022 EP20220222-0027 2022022200039 27,500.0

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

173 RD20220223-0013 23/02/2022 EP20220223-0012 2022022300024 GRACE OMPUSUNGGU 36,835.0

R/ CETIRIZINE 10 MG TAB 6.00 TAB 1,000.00 6,000.00 1 0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ PARACETAMOL 500 MG 10.00 KAPLET 388.00 3,880.00 1 0
KAPLET
R/ VITAMIN C XON-CE KAPLET 5.00 KAPLET 1.00 5.00 0 1

174 RD20220223-0014 23/02/2022 EP20220223-0013 2022022300025 RANA AFRILIA PUTRI 177,512.0

R/ BUSCOPAN TAB 10 MG 10.00 TAB 4,398.00 43,980.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 159 of 190

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-February-2022 s/d 28-February-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 6.00 CAP 12,672.00 76,032.00 0 1

175 RD20220223-0015 23/02/2022 EP20220223-0014 2022022300029 FIRDO HAPE PURBA 18,940.0

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,485.00 14,850.00 1 0

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

176 RD20220223-0016 23/02/2022 EP20220223-0015 2022022300030 SANDRA RIZALDI 115,000.0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

177 RD20220223-0017 23/02/2022 EP20220223-0016 2022022300031 ELVINA SARI BANGUN 11,733.0

R/ PROPYRETIC 240 MG SUPP 1.00 SUPP 11,733.00 11,733.00 0 1

(BPJS)
178 RD20220225-0002 25/02/2022 EP20220225-0003 2022022500008 DEWARNI PANGGABEAN 88,530.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

179 RD20220225-0003 25/02/2022 EP20220225-0006 2022022500010 FARID ASNGARI 41,486.0

R/ GENTALEX 5 MG CREAM 1.00 TUBE 4,576.00 4,576.00 0 1

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

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

180 RD20220225-0004 25/02/2022 EP20220225-0007 2022022500011 ADISTY DIANE ROLIS 135,190.0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

181 RD20220225-0005 25/02/2022 EP20220225-0008 2022022500013 DEASY HARYANI 268,782.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

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

R/ ZEMINDO 60 ML SYR 2.00 BTL 52,800.00 105,600.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

182 RD20220225-0006 25/02/2022 EP20220225-0010 2022022500016 RUDI ARDIAN 264,450.0

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

R/ BUSCOPAN TAB 10 MG 10.00 TAB 4,398.00 43,980.00 0 1

183 RD20220225-0007 25/02/2022 EP20220225-0009 2022022500017 SEFRINA SUSANTI SINAGA 122,740.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 160 of 190

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-February-2022 s/d 28-February-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/ FLAMAR EMULGEL 20 GR 1.00 TUBE 22,550.00 22,550.00 0 1

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

184 RD20220225-0008 25/02/2022 EP20220225-0011 2022022500018 APUL MARPAUNG 11,050.0

R/ CENDO LYTEERS 0,5 ML 2.00 FLS 5,525.00 11,050.00 0 1

MINIDOSE
185 RD20220225-0009 25/02/2022 EP20220225-0013 2022022500019 RENA MEYLANI 136,978.0

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ CENDO XITROL 5 ML EYE 1.00 DROP 36,788.00 36,788.00 0 0

DROP
186 RD20220225-0010 25/02/2022 EP20220225-0014 2022022500020 LIDIA BR SIANTURI 5,450.0

R/ DOMPERIDON 10 MG TAB 10.00 TAB 545.00 5,450.00 1 0

187 RD20220225-0011 25/02/2022 EP20220225-0015 2022022500024 FITRI JULIYANI 187,810.0

R/ TREMENZA TABLET 10.00 TAB 2,001.00 20,010.00 0 1

(PREKURSOR)
R/ ZEMINDO 60 ML SYR 1.00 BTL 52,800.00 52,800.00 0 1

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

188 RD20220225-0013 25/02/2022 EP20220225-0019 2022022500030 HIDAYAH PUTRI ANDANI 194,894.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

R/ FREGO 5 MG TAB 3.00 TAB 8,448.00 25,344.00 0 0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

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

189 RD20220225-0016 25/02/2022 EP20220225-0021 2022022500036 FEDERICO PRATAMA 16,088.0

SITUMORANG

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

190 RD20220225-0017 25/02/2022 EP20220225-0020 2022022500037 IDARIA AGNES SINAGA 4,680.0

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

191 RD20220226-0004 26/02/2022 EP20220226-0004 2022022600006 NADILA PUTRI ARANI 274,302.0

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

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

R/ KETOROLAC 10 MG TAB 10.00 TAB 3,520.00 35,200.00 1 0

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

192 RD20220226-0005 26/02/2022 EP20220226-0003 2022022600007 MEYSTAVIA BERTA WAHYU 116,646.0
RENGGANIS

Print Date:7/14/2022 Print Time: 2:11:10PM Page 161 of 190

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-February-2022 s/d 28-February-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/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ TREMENZA TABLET 6.00 TAB 2,001.00 ### 0 1

(PREKURSOR)
R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1
(OOT)
193 RD20220226-0006 26/02/2022 EP20220226-0005 2022022600008 YOGI FAJRI 252,247.0

R/ BENOSON M 5 GR CREAM 1.00 TUBE 75,625.00 75,625.00 0 1

R/ ZOLLOCID CAPS 6.00 CAP 12,672.00 76,032.00 0 1

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ EPERISON 50 MG TAB 10.00 TAB 2,290.00 22,900.00 1 0

194 RD20220226-0007 26/02/2022 EP20220226-0006 2022022600009 ANDRI HADI SURYA 35,200.0

R/ KETOROLAC 10 MG TAB 10.00 TAB 3,520.00 35,200.00 1 0

195 RD20220226-0008 26/02/2022 EP20220226-0007 2022022600011 RENGGA 218,248.0

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

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/ TREMENZA TABLET 6.00 TAB 2,001.00 12,006.00 0 1

(PREKURSOR)
R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1
(OOT)
196 RD20220226-0009 26/02/2022 EP20220226-0008 2022022600014 ABID RAFFASYAH PRANAJA 30,473.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

R/ PROPYRETIC 160 MG SUPP 1.00 SUPP 9,973.00 9,973.00 0 1

(BPJS)
Total Dokter DR. SHINLY MEIVINITA GINTING 24,811,003.0
Print Date:7/14/2022 Print Time: 2:11:10PM Page 162 of 190
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-February-2022 s/d 28-February-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 RI20220219-0030 19/02/2022 RI20220219-0004 RI20220219-0030 BERLIANA SIREGAR 258,284.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

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

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

R/ ONDANSETRON 8 MG INJ 3.00 AMP 10,000.00 30,000.00 1 0

2 RI20220219-0031 19/02/2022 RI20220219-0004 RI20220219-0031 BERLIANA SIREGAR 19,532.0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

3 RI20220220-0016 20/02/2022 RI20220219-0004 RI20220220-0016 BERLIANA SIREGAR 118,652.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0
(BPJS)
R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

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

KAPLET
4 RI20220221-0005 21/02/2022 RI20220219-0004 RI20220221-0005 BERLIANA SIREGAR 166,627.0

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 3.00 FLS 9,766.00 29,298.00 0 1

R/ MEMUCIL 600 MG 1.00 TAB 14,000.00 14,000.00 0 1

EFFERVESCENT
R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 103,950.00 103,950.00 1 0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

5 RI20220221-0023 21/02/2022 RI20220219-0004 RI20220221-0023 BERLIANA SIREGAR 320,191.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

6 RI20220221-0029 21/02/2022 RI20220219-0004 RI20220221-0029 BERLIANA SIREGAR 24,360.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 163 of 190

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-February-2022 s/d 28-February-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

7 RI20220222-0020 22/02/2022 RI20220219-0004 RI20220222-0020 BERLIANA SIREGAR 462,420.0

R/ NACL 0.9 % 500 ML INF 3.00 FLS 13,333.00 39,999.00 1 0

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

KAPLET
R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 103,950.00 103,950.00 1 0

R/ RESFAR 25 ML 1.00 FLS 280,192.00 280,192.00 0 1

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

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

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ HANDSCOEN STERILE 1.00 PSG 18,900.00 18,900.00 0 1

(GAMMEX) NO. 7
8 RI20220222-0043 22/02/2022 RI20220219-0004 RI20220222-0043 BERLIANA SIREGAR 1,485.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
9 RI20220223-0003 23/02/2022 RI20220222-0001 RI20220223-0003 DORLINA NUR HIDAYAH 46,586.0
PANJAITAN

R/ CEFOTAXIME 1 GR INJ 1.00 VIAL 9,355.00 9,355.00 1 0

R/ SPUIT 5 CC (TERUMO) 1.00 PCS 5,600.00 5,600.00 0 1

R/ VIATRIN 0,125 MG TABLET 3.00 TAB 3,575.00 10,725.00 0 0

R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

R/ ASAM MEFENAMAT 500 MG 3.00 KAPLET 458.00 1,374.00 1 0

KAPLET
10 RI20220223-0004 23/02/2022 RI20220222-0001 RI20220223-0004 DORLINA NUR HIDAYAH 230,813.0
PANJAITAN

R/ PETHIDIN HCL 50 MG/ML INJ 1.00 AMP 26,300.00 26,300.00 0 0

(NARKOTIKA)
R/ HANDSCOEN STERIL NO. 6.5 3.00 PSG 21,162.00 63,486.00 0 1

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

R/ ATROPIN SULFAS INJ 1.00 AMP 3,375.00 3,375.00 1 0

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

R/ ASAM TRANEKSAMAT INJ 1.00 AMP 10,000.00 10,000.00 1 0

500MG/5ML
R/ CEFOTAXIME 1 GR INJ 1.00 VIAL 9,355.00 9,355.00 1 0

R/ RANITIDINE 50MG/2ML INJ 1.00 AMP 8,800.00 8,800.00 1 0

R/ VALISANBE 5 MG/2 ML INJ 1.00 AMP 23,554.00 23,554.00 0 0

(PSIKOTROPIKA)
R/ RL 500 ML INF 1.00 FLS 9,766.00 9,766.00 0 1

R/ HANDSCOEN STERIL NO. 7.5 1.00 PSG 27,000.00 27,000.00 0 1

R/ METHYLERGOMETRIN MALEAT 2.00 AMP 4,890.00 9,780.00 1 0

INJ (OOT)
R/ SET DARAH 1.00 PCS 7,157.00 7,157.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

11 RI20220223-0006 23/02/2022 RI20220222-0001 RI20220223-0006 DORLINA NUR HIDAYAH 24,975.0
PANJAITAN

Print Date:7/14/2022 Print Time: 2:11:10PM Page 164 of 190

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-February-2022 s/d 28-February-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/ FOLEY CATHETER NO. 16 1.00 PCS 24,975.00 24,975.00 0 1

12 RI20220223-0015 23/02/2022 RI20220219-0004 RI20220223-0015 BERLIANA SIREGAR 115,914.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

R/ ESOMEPRAZOLE INJ (BPJS) 1.00 VIAL 103,950.00 103,950.00 1 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/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,485.00 1,485.00 1 0

CAPSUL
13 RI20220223-0025 23/02/2022 RI20220222-0001 RI20220223-0025 DORLINA NUR HIDAYAH 20,936.0
PANJAITAN

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
R/ SPUIT 3 CC (TERUMO) 1.00 PCS 4,600.00 4,600.00 1 0

R/ NACL 0.9 % 500 ML INF 1.00 FLS 13,333.00 13,333.00 1 0

14 RI20220223-0033 23/02/2022 RI20220222-0001 RI20220223-0033 DORLINA NUR HIDAYAH 33,320.0

PANJAITAN

R/ BIONEMI CAPSUL 10.00 CAP 2,282.00 22,820.00 0 1

R/ CEFADROXYL 500 MG CAPSUL 10.00 CAP 1,050.00 10,500.00 1 0

15 RI20220224-0004 24/02/2022 RI20220219-0004 RI20220224-0004 BERLIANA SIREGAR 12,255.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

16 RI20220224-0017 24/02/2022 RI20220219-0004 RI20220224-0017 BERLIANA SIREGAR 4,455.0

R/ ACETYLCYSTEIN 200 MG 3.00 CAP 1,485.00 4,455.00 1 0

CAPSUL
17 RI20220225-0003 25/02/2022 RI20220219-0004 RI20220225-0003 BERLIANA SIREGAR 7,800.0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

18 RI20220226-0016 26/02/2022 RI20220219-0004 RI20220226-0016 BERLIANA SIREGAR 65,000.0

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ DEVIT 1000 IU 3.00 TAB 2,600.00 7,800.00 0 1

19 RI20220226-0020 26/02/2022 RI20220219-0004 RI20220226-0020 BERLIANA SIREGAR 24,360.0

R/ SURFLO NO. 22 VENFLON 2.00 PCS 12,180.00 24,360.00 1 0

20 RI20220227-0002 27/02/2022 RI20220219-0004 RI20220227-0002 BERLIANA SIREGAR 1,667.0

R/ ACETYLCYSTEIN 200 MG 1.00 CAP 1,667.00 1,667.00 1 0

CAPSUL
21 RI20220227-0012 27/02/2022 RI20220219-0004 RI20220227-0012 BERLIANA SIREGAR 42,680.0
R/ DEVIT 1000 IU 10.00 TAB 2,600.00 26,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 165 of 190

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-February-2022 s/d 28-February-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/ VITAMIN C XON-CE KAPLET 10.00 KAPLET 1.00 10.00 0 1

R/ ACETYLCYSTEIN 200 MG 10.00 CAP 1,667.00 16,670.00 1 0

CAPSUL
22 RJ20220207-0007 07/02/2022 OP20220207-0006 2022020700010 HERLINA SUPARTINI 35,750.0

R/ VIATRIN 0,125 MG TABLET 10.00 TAB 3,575.00 35,750.00 0 0

23 RJ20220207-0008 07/02/2022 OP20220207-0013 2022020700012 WITA SUKMA 46,200.0

R/ NORELUT 5 MG TAB 7.00 TAB 6,600.00 46,200.00 0 1

24 RJ20220207-0009 07/02/2022 OP20220207-0015 2022020700014 RUSTINA IRMAYANTI 683,190.0

TAMPUBOLON

R/ CORMEGA SOFT CAPS 30.00 CAP 13,200.00 396,000.00 0 1

R/ HI BONE KAPLET 30.00 KAPLET 4,000.00 120,000.00 0 1

R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.00 167,190.00 0 1

25 RJ20220214-0007 14/02/2022 OP20220214-0006 2022021400008 YELVIDA 167,190.0

R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.00 167,190.00 0 1

26 RJ20220216-0007 16/02/2022 OP20220216-0010 2022021600008 RANI SEVENTINA 683,190.0

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

R/ HI BONE KAPLET 30.00 KAPLET 4,000.00 120,000.00 0 1

27 RJ20220221-0006 21/02/2022 OP20220221-0013 2022022100006 RENATA NZELINA SITOHANG 167,190.0

R/ FOLAMIL GENIO CAPSUL 30.00 TAB 5,573.00 167,190.00 0 1

Total Dokter DR. STEVEN, SP.OG 3,785,022.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 166 of 190
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-February-2022 s/d 28-February-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. TIMBUL M. SILITONGA

1 RD20220201-0001 01/02/2022 EP20220201-0001 2022020100001 EKA VALINTINA 14,260.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ DOMPERIDON 10 MG TAB 10.00 TAB 545.00 5,450.00 1 0

R/ NEW DIATAB TABLET 10.00 TAB 696.00 6,960.00 0 1

2 RD20220201-0002 01/02/2022 EP20220201-0001 2022020100002 EKA VALINTINA 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

3 RD20220202-0001 02/02/2022 EP20220202-0001 2022020200001 GABBRIEL TIO GABE 71,920.0

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
R/ DOMPERIDON 10 MG TAB 10.00 TAB 545.00 5,450.00 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 742.00 7,420.00 1 0

4 RD20220202-0002 02/02/2022 EP20220202-0002 2022020200002 JANWAR CANDRA SINUKABAN 388,200.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

5 RD20220205-0003 05/02/2022 EP20220205-0003 2022020500006 ADITYA CHANDRA 361,670.0

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ SUCRALFATE SYR 100 ML 1.00 FLS 57,200.00 57,200.00 1 0

R/ PROZA KAPLET 10.00 KAPLET 11,500.00 115,000.00 0 1

6 RD20220205-0004 05/02/2022 EP20220205-0004 2022020500008 FARAMITA YOLANDA 245,588.0

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 408.00 4,080.00 0 1

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

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

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

7 RD20220206-0001 06/02/2022 EP20220206-0004 2022020600006 MEXI 17,600.0

R/ PAMOL 125 MG SUPP 1.00 SUPP 17,600.00 17,600.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 167 of 190

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-February-2022 s/d 28-February-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

8 RD20220206-0004 06/02/2022 EP20220206-0005 2022020600008 BERLAN .L.PASARIBU 24,050.0

R/ AMLODIPINE 10 MG TAB 10.00 TAB 1,847.00 18,470.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ VITAMIN B COMPLEX TAB 10.00 TAB 150.00 1,500.00 1 0

9 RD20220207-0001 07/02/2022 EP20220207-0002 2022020700001 JODI CAVIN TANSESE MUNTHE 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

10 RD20220207-0002 07/02/2022 EP20220207-0002 2022020700002 JODI CAVIN TANSESE MUNTHE 94,570.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

11 RD20220207-0003 07/02/2022 EP20220207-0003 2022020700004 DICKY ARDIANSYAH 85,704.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

R/ SANADRYL EXP 120 ML SYR 1.00 BTL 20,134.00 20,134.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

12 RD20220207-0004 07/02/2022 EP20220207-0004 2022020700005 CHELVIN RAMADHAN 201,870.0

PRATAMA

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

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

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

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
13 RD20220207-0005 07/02/2022 EP20220207-0005 2022020700006 DERISMANTO MUNTHE 297,460.0

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 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

14 RD20220207-0006 07/02/2022 EP20220207-0006 2022020700007 VINA NOVISRAMULYA 62,180.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANMOL FORTE TAB 10.00 TAB 468.00 4,680.00 0 1

15 RD20220207-0007 07/02/2022 EP20220207-0009 2022020700008 RINI ANDRIANI BR SINAGA 55,950.0

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1
(OOT)

Print Date:7/14/2022 Print Time: 2:11:10PM Page 168 of 190

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-February-2022 s/d 28-February-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 5,800.00 29,000.00 0 1

16 RD20220207-0008 07/02/2022 EP20220207-0008 2022020700009 BAYU WIDI SASONGKO ###

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

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

17 RD20220207-0009 07/02/2022 EP20220207-0007 2022020700010 NORMAH 4,980.0

R/ AMBROXOL 30 MG TAB 10.00 TAB 160.00 1,600.00 1 0

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

R/ SALBUTAMOL 2 MG TAB 10.00 TAB 118.00 1,180.00 1 0

18 RD20220207-0010 07/02/2022 EP20220207-0007 2022020700011 NORMAH 80,690.0

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 7,890.00 7,890.00 0 1
(BPJS)
19 RD20220207-0011 07/02/2022 EP20220207-0011 2022020700012 JHON ANDRYANTO SILAEN 60,030.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

20 RD20220207-0012 07/02/2022 EP20220207-0012 2022020700015 MULIANTA SITEPU 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
21 RD20220207-0013 07/02/2022 EP20220207-0013 2022020700019 FATMAWATI 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
22 RD20220207-0014 07/02/2022 EP20220207-0013 2022020700020 FATMAWATI 32,975.0

R/ FOLEY CATHETER NO. 16 1.00 PCS 24,975.00 24,975.00 0 1

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

23 RD20220207-0015 07/02/2022 EP20220207-0013 2022020700021 FATMAWATI 96,910.0

R/ MEROPENEM INJEKSI 1 GR 1.00 VIAL 96,250.00 96,250.00 1 0

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

24 RD20220207-0016 07/02/2022 EP20220207-0014 2022020700022 NURMA PARHUSIP 16,950.0

R/ DOMPERIDON 10 MG TAB 10.00 TAB 545.00 5,450.00 1 0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 169 of 190

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-February-2022 s/d 28-February-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

25 RD20220208-0007 08/02/2022 EP20220208-0007 2022020800012 LIDWINA NOVENA SARODJA 75,460.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

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

R/ METHYLON 4 MG TAB 10.00 TAB 3,163.00 31,630.00 0 1

26 RD20220208-0008 08/02/2022 EP20220208-0008 2022020800013 WAHID HUSIN 117,698.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

R/ EPEXOL SYRUP 1.00 BTL 23,788.00 23,788.00 0 1

27 RD20220208-0009 08/02/2022 EP20220208-0009 2022020800014 DARMAWATI 11,500.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ OMEPRAZOLE 20 MG CAP 10.00 CAP 742.00 7,420.00 1 0

28 RD20220208-0010 08/02/2022 EP20220208-0009 2022020800015 DARMAWATI 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
29 RD20220208-0011 08/02/2022 EP20220208-0010 2022020800016 IBROHIM 206,470.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

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

R/ CORTIDEX 0,5 MG TAB 10.00 TAB 399.00 3,990.00 0 1

30 RD20220208-0012 08/02/2022 EP20220208-0011 2022020800018 RATU AYU DIRGANTARA 216,420.0

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

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

31 RD20220208-0013 08/02/2022 EP20220208-0012 2022020800019 RAHMA PATIKAWA 204,410.0

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

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

R/ MEFINAL 500 MG KAPLET 10.00 KAPLET 2,019.00 20,190.00 0 1

32 RD20220208-0014 08/02/2022 EP20220208-0013 2022020800020 YOHANES HANRI PORTARE 6,280.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 170 of 190

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-February-2022 s/d 28-February-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/ DEXAMETHASON 0,5 MG TAB 10.00 TAB 220.00 2,200.00 1 0

33 RD20220208-0015 08/02/2022 EP20220208-0014 2022020800021 NATALINA TAMBUNAN 12.0

R/ VITAMIN C XON-CE KAPLET 12.00 KAPLET 1.00 12.00 0 1

34 RD20220208-0016 08/02/2022 EP20220208-0015 2022020800024 CHRISTOPER HP SITANGGANG 63,360.0

R/ OMEPRAZOLE 40 MG INJ 1.00 VIAL 63,360.00 63,360.00 1 0

(BPJS)
35 RD20220210-0001 10/02/2022 EP20220210-0001 2022021000001 VIOLA DWI AMELIZA 98,250.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

R/ COLERGIS TABLET 10.00 TAB 3,667.00 36,670.00 0 1

R/ PROZA KAPLET 5.00 KAPLET 11,500.00 57,500.00 0 1

36 RD20220211-0001 11/02/2022 EP20220211-0001 2022021100001 FITRI NURAINI 272,540.0

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/ VOMETA FT 10 MG TAB 10.00 TAB 5,867.00 58,670.00 0 1

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

37 RD20220211-0028 11/02/2022 EP20220211-0028 2022021100052 HELDERIKA SILITONGA 240,470.0

R/ RHINOS SR KAPSUL 10.00 CAP 8,067.00 80,670.00 0 1

(PREKURSOR)
R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

R/ PROVITAL PLUS CAPS 5.00 CAP 5,800.00 29,000.00 0 1

Total Dokter DR. TIMBUL M. SILITONGA 4,160,835.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 171 of 190
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-February-2022 s/d 28-February-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 RI20220201-0001 01/02/2022 RI20220130-0002 RI20220201-0001 RAFAEL AGUSTIAN DUHA 82,000.0

R/ D5 +1/2 NS 500 ML (WIDA) 4.00 FLS 20,500.00 82,000.00 0 1

2 RI20220201-0002 01/02/2022 RI20220129-0003 RI20220201-0002 WAI RUI CHIN 41,000.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

3 RI20220201-0003 01/02/2022 RI20220130-0003 RI20220201-0003 RIRIN APRILLYA 348,475.0

R/ SPUIT 3 CC (TERUMO) 5.00 PCS 4,600.00 23,000.00 1 0

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

R/ SPUIT 10 CC ( TERUMO ) 5.00 PCS 11,242.00 56,210.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ PICYN 750 MG INJ 2.00 VIAL 103,125.00 206,250.00 0 1

4 RI20220201-0004 01/02/2022 RI20220130-0001 RI20220201-0004 HEZRON SITOMPUL 69,015.0

R/ D5 + 1/4 NS 500 ML ( WIDA ) 3.00 FLS 23,005.00 69,015.00 0 1

5 RI20220201-0005 01/02/2022 RI20220129-0003 RI20220201-0005 WAI RUI CHIN 268,833.0

R/ STESOLID 10 MG/2ML 3.00 AMP 16,108.00 48,324.00 0 0

INJEKSI (PSIKOTROPIKA)
R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0
INJ (BPJS)
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) 3.00 FLS 20,500.00 61,500.00 0 1

6 RI20220201-0007 01/02/2022 RI20220131-0001 RI20220201-0007 REYNALDI SINURAT 34,023.0

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

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

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

7 RI20220201-0008 01/02/2022 RI20220130-0002 RI20220201-0008 RAFAEL AGUSTIAN DUHA 389,219.0

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ STESOLID 10 MG/2ML 2.00 AMP 16,108.00 32,216.00 0 0

INJEKSI (PSIKOTROPIKA)
R/ SAGESTAM 40 MG INJ 3.00 AMP 19,993.00 59,979.00 0 1

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

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

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0

INJ (BPJS)
8 RI20220201-0010 01/02/2022 RI20220126-0001 RI20220201-0010 RANEL ELVANO PANGARIBUAN 117,614.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 172 of 190

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-February-2022 s/d 28-February-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/ ZINC SIRUP 20 MG/5ML 1.00 FLS 11,000.00 11,000.00 0 1

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

R/ INTERLAC SACHET 6.00 SACH 10,000.00 60,000.00 0 1

9 RI20220201-0011 01/02/2022 RI20220201-0001 RI20220201-0011 TEGAR TRI ATMAJA 20,625.0

R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0

10 RI20220201-0013 01/02/2022 RI20220129-0003 RI20220201-0013 WAI RUI CHIN 156,559.0

R/ SURFLO NO. 26 (VENFLON) 1.00 PCS 42,150.00 42,150.00 0 1

R/ KAPAS ALKOHOL 3.00 PCS 303.00 909.00 0 1

R/ SURFLO NO. 24 VENFLON 1.00 PCS 34,200.00 34,200.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

11 RI20220202-0003 02/02/2022 RI20220130-0002 RI20220202-0003 RAFAEL AGUSTIAN DUHA 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

12 RI20220202-0005 02/02/2022 RI20220129-0003 RI20220202-0005 WAI RUI CHIN 109,030.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

R/ SURFLO NO. 26 (VENFLON) 1.00 PCS 42,150.00 42,150.00 0 1

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

R/ SURFLO NO. 24 VENFLON 1.00 PCS 34,200.00 34,200.00 0 1

13 RI20220202-0008 02/02/2022 RI20220201-0002 RI20220202-0008 SITI NURLIYA 29,298.0

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

14 RI20220202-0009 02/02/2022 RI20220130-0002 RI20220202-0009 RAFAEL AGUSTIAN DUHA 209,318.0

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0

INJ (BPJS)
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/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ SAGESTAM 40 MG INJ 2.00 AMP 19,993.00 39,986.00 0 1

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

15 RI20220202-0010 02/02/2022 RI20220201-0001 RI20220202-0010 TEGAR TRI ATMAJA 63,015.0

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

Print Date:7/14/2022 Print Time: 2:11:10PM Page 173 of 190

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-February-2022 s/d 28-February-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) 3.00 FLS 20,500.00 61,500.00 0 1

16 RI20220202-0015 02/02/2022 RI20220130-0003 RI20220202-0015 RIRIN APRILLYA 286,645.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

R/ RHINOS JUNIOR SYR (PREK) 1.00 BTL 52,800.00 52,800.00 0 0

R/ AMBROXOL 15 MG/5ML SYR 1.00 FLS 12,375.00 12,375.00 1 0

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

17 RI20220202-0016 02/02/2022 RI20220130-0001 RI20220202-0016 HEZRON SITOMPUL 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

18 RI20220202-0017 02/02/2022 RI20220129-0003 RI20220202-0017 WAI RUI CHIN 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

19 RI20220202-0030 02/02/2022 RI20220202-0003 RI20220202-0030 CHIARA GRACE. H.S 75,120.0

R/ ASERING 500 ML INF 2.00 FLS 37,560.00 75,120.00 0 1

20 RI20220203-0001 03/02/2022 RI20220130-0002 RI20220203-0001 RAFAEL AGUSTIAN DUHA 75,000.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

21 RI20220203-0005 03/02/2022 RI20220201-0001 RI20220203-0005 TEGAR TRI ATMAJA 63,015.0

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

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

22 RI20220203-0006 03/02/2022 RI20220202-0003 RI20220203-0006 CHIARA GRACE. H.S 114,195.0

R/ ASERING 500 ML INF 3.00 FLS 37,560.00 112,680.00 0 1

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

23 RI20220203-0007 03/02/2022 RI20220130-0002 RI20220203-0007 RAFAEL AGUSTIAN DUHA 165,553.0

R/ SAGESTAM 40 MG INJ 1.00 AMP 19,993.00 19,993.00 0 1

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 3,003.00 6,006.00 1 0

INJ (BPJS)
R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

R/ VALISANBE 5 MG/2 ML INJ 1.00 AMP 23,554.00 23,554.00 0 0

(PSIKOTROPIKA)
24 RI20220203-0008 03/02/2022 RI20220131-0001 RI20220203-0008 REYNALDI SINURAT 33,468.0

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

R/ CURCUMA FCT TAB 3.00 TAB 885.00 2,655.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 174 of 190

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-February-2022 s/d 28-February-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

25 RI20220203-0009 03/02/2022 RI20220201-0002 RI20220203-0009 SITI NURLIYA 30,813.0

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

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

26 RI20220203-0022 03/02/2022 RI20220131-0001 RI20220203-0022 REYNALDI SINURAT 1,770.0

R/ CURCUMA FCT TAB 2.00 TAB 885.00 1,770.00 0 1

27 RI20220203-0026 03/02/2022 RI20220130-0002 RI20220203-0026 RAFAEL AGUSTIAN DUHA 156,006.0

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 3,003.00 6,006.00 1 0

INJ (BPJS)
28 RI20220203-0027 03/02/2022 RI20220203-0001 RI20220203-0027 GRACELESA AMORA SITORUS 235,123.0

R/ D5 + 1/4 NS 500 ML ( WIDA ) 3.00 FLS 23,005.00 69,015.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ STESOLID 10 MG/2ML 1.00 AMP 16,108.00 16,108.00 0 0

INJEKSI (PSIKOTROPIKA)
29 RI20220204-0002 04/02/2022 RI20220202-0003 RI20220204-0002 CHIARA GRACE. H.S 37,560.0

R/ ASERING 500 ML INF 1.00 FLS 37,560.00 37,560.00 0 1

30 RI20220204-0005 04/02/2022 RI20220203-0001 RI20220204-0005 GRACELESA AMORA SITORUS 197,525.0

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

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 23,005.00 46,010.00 0 1

31 RI20220204-0006 04/02/2022 RI20220130-0002 RI20220204-0006 RAFAEL AGUSTIAN DUHA 285,680.0

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ SAGESTAM 40 MG INJ 2.00 AMP 19,993.00 39,986.00 0 1

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0

INJ (BPJS)
R/ PULMICORT 0.5 MG/ML NEB 3.00 FLS 7,890.00 23,670.00 0 1
(BPJS)
R/ KAPAS ALKOHOL 5.00 PCS 303.00 1,515.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

32 RI20220204-0009 04/02/2022 RI20220130-0002 RI20220204-0009 RAFAEL AGUSTIAN DUHA ###

R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

R/ FLUCONAZOLE 150 MG TAB 2.00 TAB 1.00 29,700.00 60,400.00 1 0

KERTAS PERKAMEN BERLOGO 10.00 LBR 100.00 0.00 0 1

33 RI20220204-0010 04/02/2022 RI20220203-0001 RI20220204-0010 GRACELESA AMORA SITORUS 52,938.0

R/ KANDISTATIN DROP 1.00 FLS 52,938.00 52,938.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 175 of 190

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-February-2022 s/d 28-February-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

34 RI20220204-0012 04/02/2022 RI20220131-0001 RI20220204-0012 REYNALDI SINURAT 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

35 RI20220204-0013 04/02/2022 RI20220201-0002 RI20220204-0013 SITI NURLIYA 19,589.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

R/ PARACETAMOL 500 MG 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
36 RI20220204-0023 04/02/2022 RI20220204-0003 RI20220204-0023 KAILA PEPAYOSA HUTASOIT 259,240.0

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

R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0

R/ D5 + 1/4 NS 500 ML ( WIDA ) 3.00 FLS 23,005.00 69,015.00 0 1

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

R/ SAGESTAM 40 MG INJ 3.00 AMP 19,993.00 59,979.00 0 1

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

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

37 RI20220204-0024 04/02/2022 RI20220130-0002 RI20220204-0024 RAFAEL AGUSTIAN DUHA 20,625.0

R/ CETIRIZINE SIRUP 1.00 BTL 20,625.00 20,625.00 1 0

38 RI20220204-0025 04/02/2022 RI20220204-0003 RI20220204-0025 KAILA PEPAYOSA HUTASOIT 110,550.0

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

R/ SURFLO NO. 26 (VENFLON) 1.00 PCS 42,150.00 42,150.00 0 1

39 RI20220204-0027 04/02/2022 RI20220130-0002 RI20220204-0027 RAFAEL AGUSTIAN DUHA 41,000.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

40 RI20220204-0029 04/02/2022 RI20220201-0001 RI20220204-0029 TEGAR TRI ATMAJA 41,000.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

41 RI20220205-0001 05/02/2022 RI20220204-0003 RI20220205-0001 KAILA PEPAYOSA HUTASOIT 132,786.0

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ SAGESTAM 40 MG INJ 2.00 AMP 19,993.00 39,986.00 0 1

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

42 RI20220205-0002 05/02/2022 RI20220130-0002 RI20220205-0002 RAFAEL AGUSTIAN DUHA 9,036.0

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 3,003.00 6,006.00 1 0

INJ (BPJS)
R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1
43 RI20220205-0005 05/02/2022 RI20220203-0001 RI20220205-0005 GRACELESA AMORA SITORUS 196,010.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 176 of 190

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-February-2022 s/d 28-February-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 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 23,005.00 46,010.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

44 RI20220205-0006 05/02/2022 RI20220202-0003 RI20220205-0006 CHIARA GRACE. H.S 44,239.0

R/ PARACETAMOL 500 MG 5.00 KAPLET 185.00 925.00 1 0

KAPLET
R/ COBAZIM 3000MCG 3.00 CAP 14,438.00 43,314.00 0 1

45 RI20220205-0007 05/02/2022 RI20220201-0001 RI20220205-0007 TEGAR TRI ATMAJA 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

46 RI20220205-0016 05/02/2022 RI20220204-0003 RI20220205-0016 KAILA PEPAYOSA HUTASOIT 75,000.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

47 RI20220206-0002 06/02/2022 RI20220130-0002 RI20220206-0002 RAFAEL AGUSTIAN DUHA 9,009.0

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0

INJ (BPJS)
48 RI20220206-0003 06/02/2022 RI20220204-0003 RI20220206-0003 KAILA PEPAYOSA HUTASOIT 94,993.0

R/ SAGESTAM 40 MG INJ 1.00 AMP 19,993.00 19,993.00 0 1

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

49 RI20220206-0006 06/02/2022 RI20220203-0001 RI20220206-0006 GRACELESA AMORA SITORUS 196,010.0

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 23,005.00 46,010.00 0 1

50 RI20220206-0009 06/02/2022 RI20220130-0002 RI20220206-0009 RAFAEL AGUSTIAN DUHA 68,400.0

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

51 RI20220206-0010 06/02/2022 RI20220203-0001 RI20220206-0010 GRACELESA AMORA SITORUS 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

52 RI20220206-0019 06/02/2022 RI20220204-0003 RI20220206-0019 KAILA PEPAYOSA HUTASOIT 75,000.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

53 RI20220206-0022 06/02/2022 RI20220206-0004 RI20220206-0022 PITRA PRATAMA GURUSINGA 63,015.0

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

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

54 RI20220207-0007 07/02/2022 RI20220204-0003 RI20220207-0007 KAILA PEPAYOSA HUTASOIT 75,000.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

55 RI20220207-0014 07/02/2022 RI20220130-0002 RI20220207-0014 RAFAEL AGUSTIAN DUHA 28,875.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 177 of 190

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-February-2022 s/d 28-February-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/ ERYSANBE 60 ML SYR 1.00 FLS 28,875.00 28,875.00 0 1

56 RI20220207-0016 07/02/2022 RI20220206-0004 RI20220207-0016 PITRA PRATAMA GURUSINGA 41,000.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

57 RI20220207-0020 07/02/2022 RI20220204-0003 RI20220207-0020 KAILA PEPAYOSA HUTASOIT 75,000.0

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

58 RI20220208-0017 08/02/2022 RI20220206-0004 RI20220208-0017 PITRA PRATAMA GURUSINGA 61,500.0

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

59 RI20220209-0016 09/02/2022 RI20220206-0004 RI20220209-0016 PITRA PRATAMA GURUSINGA 43,314.0

R/ COBAZIM 3000MCG 3.00 CAP 14,438.00 43,314.00 0 1

60 RI20220211-0014 11/02/2022 RI20220211-0003 RI20220211-0014 MUHAMMAD HASAN 804,199.0

HERWANTO

R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1

R/ RANTIN INJ 50 MG/ 2ML 2.00 AMP 20,000.00 40,000.00 0 1

R/ SANMOL INFUS 2.00 FLS 86,029.00 172,058.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ BIOCEF 1 GR INJ 2.00 VIAL 197,120.00 394,240.00 0 1

R/ SPUIT 10 CC ( TERUMO ) 3.00 PCS 11,242.00 33,726.00 0 1

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

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

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

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

61 RI20220211-0017 11/02/2022 RI20220211-0003 RI20220211-0017 MUHAMMAD HASAN 61,500.0

HERWANTO

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

62 RI20220211-0022 11/02/2022 RI20220211-0004 RI20220211-0022 NAURA SYAKIRA ARSYIDINATA 74,318.0

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

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

63 RI20220211-0023 11/02/2022 RI20220211-0001 RI20220211-0023 KRISTIAN KERANS 320,881.0

R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

R/ VALISANBE 5 MG/2 ML INJ 1.00 AMP 23,554.00 23,554.00 0 0

(PSIKOTROPIKA)
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1
R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0

INJ (BPJS)
Print Date:7/14/2022 Print Time: 2:11:10PM Page 178 of 190
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-February-2022 s/d 28-February-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

64 RI20220211-0024 11/02/2022 RI20220211-0006 RI20220211-0024 KATARINA FITRIA 41,337.0

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ RL 500 ML INF 3.00 FLS 9,766.00 29,298.00 0 1

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0

INJ (BPJS)
65 RI20220211-0026 11/02/2022 RI20220211-0006 RI20220211-0026 KATARINA FITRIA 555.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
66 RI20220211-0033 11/02/2022 RI20220211-0007 RI20220211-0033 JHON RENALDO MANURUNG 804,053.0

R/ SANMOL INFUS 3.00 FLS 86,029.00 258,087.00 0 1

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ BIOCEF 1 GR INJ 2.00 VIAL 197,120.00 394,240.00 0 1

R/ ELKANA CL SYR 1.00 FLS 70,331.00 70,331.00 0 1

R/ SAGESTAM 40 MG INJ 2.00 AMP 19,993.00 39,986.00 0 1

R/ DEXAMETHASON 5MG/1ML INJ 3.00 AMP 3,003.00 9,009.00 1 0

67 RI20220212-0003 12/02/2022 RI20220211-0007 RI20220212-0003 JHON RENALDO MANURUNG 512,150.0

R/ BIOCEF 1 GR INJ 2.00 VIAL 197,120.00 394,240.00 0 1

R/ DEXAMETHASON 5MG/1ML INJ 3.00 AMP 3,003.00 9,009.00 1 0

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

R/ SAGESTAM 40 MG INJ 2.00 AMP 19,993.00 39,986.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ RANITIDINE 50MG/2ML INJ 3.00 AMP 8,800.00 26,400.00 1 0

68 RI20220212-0004 12/02/2022 RI20220211-0006 RI20220212-0004 KATARINA FITRIA 28,324.0

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0

INJ (BPJS)
R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

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

69 RI20220212-0005 12/02/2022 RI20220211-0003 RI20220212-0005 MUHAMMAD HASAN 498,601.0

HERWANTO

R/ BIOCEF 1 GR INJ 1.00 VIAL 197,120.00 197,120.00 0 1

R/ SPUIT 3 CC (TERUMO) 5.00 PCS 4,600.00 23,000.00 1 0

R/ SPUIT 10 CC ( TERUMO ) 3.00 PCS 11,242.00 33,726.00 0 1

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

R/ LAMETIC 4 MG INJ 1.00 AMP 42,240.00 42,240.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ PARAMOL 1GR/100 ML INF 2.00 FLS 70,000.00 140,000.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 179 of 190

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-February-2022 s/d 28-February-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/ RANTIN INJ 50 MG/ 2ML 1.00 AMP 20,000.00 20,000.00 0 1

70 RI20220212-0006 12/02/2022 RI20220211-0004 RI20220212-0006 NAURA SYAKIRA ARSYIDINATA 42,515.0

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

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

71 RI20220212-0007 12/02/2022 RI20220211-0003 RI20220212-0007 MUHAMMAD HASAN 4,568.0

HERWANTO

R/ NALD 18 ( TERUMO) 1.00 PCS 4,568.00 4,568.00 0 1

72 RI20220212-0011 12/02/2022 RI20220211-0001 RI20220212-0011 KRISTIAN KERANS 156,888.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

73 RI20220212-0017 12/02/2022 RI20220211-0007 RI20220212-0017 JHON RENALDO MANURUNG 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

74 RI20220212-0018 12/02/2022 RI20220212-0001 RI20220212-0018 MUHAMMAD HUSEIN 22,106.0

HERWANTO

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

75 RI20220212-0019 12/02/2022 RI20220211-0003 RI20220212-0019 MUHAMMAD HASAN 88,530.0

HERWANTO

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

R/ SURFLO NO. 22 VENFLON 1.00 PCS 12,180.00 12,180.00 1 0

76 RI20220212-0022 12/02/2022 RI20220211-0003 RI20220212-0022 MUHAMMAD HASAN 4.0

HERWANTO

R/ MASKER KN 95 4.00 PCS 1.00 4.00 0 1

77 RI20220213-0001 13/02/2022 RI20220211-0006 RI20220213-0001 KATARINA FITRIA 1,028.0

R/ IBUPROFEN 400 MG TAB 2.00 TAB 514.00 1,028.00 1 0

78 RI20220213-0002 13/02/2022 RI20220212-0001 RI20220213-0002 MUHAMMAD HUSEIN 206,250.0

HERWANTO

R/ PICYN 750 MG INJ 2.00 VIAL 103,125.00 206,250.00 0 1

79 RI20220213-0003 13/02/2022 RI20220211-0007 RI20220213-0003 JHON RENALDO MANURUNG 21,600.0

R/ ASERING 500 ML INF 2.00 FLS 10,800.00 21,600.00 0 1

80 RI20220213-0004 13/02/2022 RI20220211-0003 RI20220213-0004 MUHAMMAD HASAN 633,600.0

HERWANTO

R/ BIOCEF 1 GR INJ 3.00 VIAL 197,120.00 591,360.00 0 1

R/ LAMETIC 4 MG INJ 1.00 AMP 42,240.00 42,240.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 180 of 190

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-February-2022 s/d 28-February-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

81 RI20220213-0005 13/02/2022 RI20220212-0001 RI20220213-0005 MUHAMMAD HUSEIN 51,040.0

HERWANTO

R/ RANITIDINE 50MG/2ML INJ 1.00 AMP 8,800.00 8,800.00 1 0

R/ LAMETIC 4 MG INJ 1.00 AMP 42,240.00 42,240.00 0 1

82 RI20220213-0006 13/02/2022 RI20220211-0007 RI20220213-0006 JHON RENALDO MANURUNG 426,640.0

R/ ASERING 500 ML INF 3.00 FLS 10,800.00 32,400.00 0 1

R/ BIOCEF 1 GR INJ 2.00 VIAL 197,120.00 394,240.00 0 1

83 RI20220213-0009 13/02/2022 RI20220211-0004 RI20220213-0009 NAURA SYAKIRA ARSYIDINATA 41,000.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

84 RI20220213-0011 13/02/2022 RI20220211-0006 RI20220213-0011 KATARINA FITRIA 28,541.0

R/ DEXAMETHASONE 5MG/1ML 3.00 AMP 3,003.00 9,009.00 1 0

INJ (BPJS)
R/ RL 500 ML INF 2.00 FLS 9,766.00 19,532.00 0 1

85 RI20220213-0014 13/02/2022 RI20220212-0003 RI20220213-0014 AURELIA TASHA TAMPUBOLON 6,006.0

R/ DEXAMETHASON 5MG/1ML INJ 2.00 AMP 3,003.00 6,006.00 1 0

86 RI20220213-0015 13/02/2022 RI20220211-0003 RI20220213-0015 MUHAMMAD HASAN 33,684.0

HERWANTO

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

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

87 RI20220213-0016 13/02/2022 RI20220212-0001 RI20220213-0016 MUHAMMAD HUSEIN 92,959.0

HERWANTO

R/ NS 0.9 100 ML (PIGGY BACK) 1.00 FLS 19,430.00 19,430.00 1 0

R/ DEXAMETHASON 5MG/1ML INJ 1.00 AMP 3,003.00 3,003.00 1 0

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

R/ MOMETASON CREAM 10 GR 1.00 TUBE 20,000.00 20,000.00 1 0

R/ SPUIT 10 CC ( TERUMO ) 3.00 PCS 11,242.00 33,726.00 0 1

88 RI20220213-0019 13/02/2022 RI20220213-0001 RI20220213-0019 MARIA GISELA NONA 356,987.0

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

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

R/ PARACETAMOL INFUS 1.00 FLS 58,438.00 58,438.00 1 0

1GR/100 ML
R/ SPUIT 10 CC ( TERUMO ) 2.00 PCS 11,242.00 22,484.00 0 1

R/ SPUIT 3 CC (TERUMO) 4.00 PCS 4,600.00 18,400.00 1 0

R/ PICYN 750 MG INJ 2.00 VIAL 103,125.00 206,250.00 0 1

89 RI20220213-0020 13/02/2022 RI20220212-0001 RI20220213-0020 MUHAMMAD HUSEIN 50,150.0
HERWANTO

Print Date:7/14/2022 Print Time: 2:11:10PM Page 181 of 190

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-February-2022 s/d 28-February-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/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

90 RI20220214-0003 14/02/2022 RI20220211-0003 RI20220214-0003 MUHAMMAD HASAN 84,300.0

HERWANTO

R/ SURFLO NO. 26 (VENFLON) 2.00 PCS 42,150.00 84,300.00 0 1

91 RI202202 14/02/2022 RI20220211-0004 RI20220214-0004 NAURA SYAKIRA ARSYIDINATA 41,000.0

14-0004

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

92 RI20220214-0005 14/02/2022 RI20220212-0001 RI20220214-0005 MUHAMMAD HUSEIN 41,000.0

HERWANTO

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

93 RI20220214-0011 14/02/2022 RI20220211-0007 RI20220214-0011 JHON RENALDO MANURUNG 6,006.0

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 3,003.00 6,006.00 1 0

INJ (BPJS)
94 RI20220214-0015 14/02/2022 RI20220212-0003 RI20220214-0015 AURELIA TASHA TAMPUBOLON 156,888.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ ELKANA SYR 1.00 FLS 28,875.00 28,875.00 0 1

95 RI20220214-0016 14/02/2022 RI20220211-0006 RI20220214-0016 KATARINA FITRIA 555.0

R/ PARACETAMOL 500 MG 3.00 KAPLET 185.00 555.00 1 0

KAPLET
96 RI20220214-0017 14/02/2022 RI20220211-0007 RI20220214-0017 JHON RENALDO MANURUNG 632,765.0

R/ VIVENA INJ 1.00 VIAL 73,000.00 73,000.00 0 1

R/ DEXAMETHASON 5MG/1ML INJ 3.00 AMP 3,003.00 9,009.00 1 0

R/ BIOCEF 1 GR INJ 2.00 VIAL 197,120.00 394,240.00 0 1

R/ ASERING 500 ML INF 4.00 FLS 10,800.00 43,200.00 0 1

R/ TROMBUFIT SACHET 10.00 SACH 7,333.00 73,330.00 0 1

R/ SAGESTAM 40 MG INJ 2.00 AMP 19,993.00 39,986.00 0 1

97 RI20220214-0018 14/02/2022 RI20220211-0003 RI20220214-0018 MUHAMMAD HASAN 134,031.0

HERWANTO

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

98 RI20220214-0025 14/02/2022 RI20220212-0001 RI20220214-0025 MUHAMMAD HUSEIN 204,362.0

HERWANTO

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ ELKANA CL SYR 1.00 FLS 70,331.00 70,331.00 0 1

99 RI20220214-0028 14/02/2022 RI20220211-0006 RI20220214-0028 KATARINA FITRIA 1,850.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 182 of 190

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-February-2022 s/d 28-February-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 10.00 KAPLET 185.00 1,850.00 1 0

KAPLET
100 RI20220214-0030 14/02/2022 RI20220213-0001 RI20220214-0030 MARIA GISELA NONA 372,650.0

R/ RANITIDINE 50MG/2ML INJ 3.00 AMP 8,800.00 26,400.00 1 0

R/ PICYN 750 MG INJ 2.00 VIAL 103,125.00 206,250.00 0 1

R/ PARAMOL 1GR/100 ML INF 2.00 FLS 70,000.00 140,000.00 0 1

101 RI20220215-0004 15/02/2022 RI20220211-0007 RI20220215-0004 JHON RENALDO MANURUNG 299,760.0

R/ SANMOL 500 MG TABLET 10.00 TAB 408.00 4,080.00 0 1

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

102 RI20220215-0005 15/02/2022 RI20220213-0001 RI20220215-0005 MARIA GISELA NONA 47,678.0

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

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

103 RI20220216-0021 16/02/2022 RI20220216-0002 RI20220216-0021 MECHTILDIS NOVELIA AURA 286,500.0

LADDY

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

104 RI20220216-0030 16/02/2022 RI20220216-0002 RI20220216-0030 MECHTILDIS NOVELIA AURA 41,000.0

LADDY

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

105 RI20220217-0009 17/02/2022 RI20220216-0002 RI20220217-0009 MECHTILDIS NOVELIA AURA 294,215.0

LADDY

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 20,500.00 41,000.00 0 1

R/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

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

106 RI20220218-0006 18/02/2022 RI20220216-0002 RI20220218-0006 MECHTILDIS NOVELIA AURA 266,000.0

LADDY

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 20,500.00 41,000.00 0 1

107 RI20220218-0020 18/02/2022 RI20220216-0002 RI20220218-0020 MECHTILDIS NOVELIA AURA 861.0

LADDY

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

108 RI20220218-0031 18/02/2022 RI20220218-0003 RI20220218-0031 NICHOLAS SERGIO 117,606.0

SITUMORANG

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 183 of 190

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-February-2022 s/d 28-February-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

109 RI20220219-0008 19/02/2022 RI20220216-0002 RI20220219-0008 MECHTILDIS NOVELIA AURA 166,230.0

LADDY

R/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

110 RI20220219-0010 19/02/2022 RI20220218-0003 RI20220219-0010 NICHOLAS SERGIO 63,810.0

SITUMORANG

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ D5 + 1/4 NS 500 ML ( WIDA ) 2.00 FLS 23,005.00 46,010.00 0 1

111 RI20220219-0024 19/02/2022 RI20220219-0002 RI20220219-0024 SHYALOMI LETHISIA KHEREN 307,330.0

MANURUNG

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ KAPAS ALKOHOL 10.00 PCS 303.00 3,030.00 0 1

R/ AQUADES 25 ML 50.00 CC 356.00 17,800.00 0 1

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

112 RI20220220-0004 20/02/2022 RI20220219-0002 RI20220220-0004 SHYALOMI LETHISIA KHEREN 75,000.0

MANURUNG

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

113 RI20220220-0009 20/02/2022 RI20220216-0002 RI20220220-0009 MECHTILDIS NOVELIA AURA 7,333.0

LADDY

R/ TROMBUFIT SACHET 1.00 SACH 7,333.00 7,333.00 0 1

114 RI20220220-0012 20/02/2022 RI20220216-0002 RI20220220-0012 MECHTILDIS NOVELIA AURA 225,000.0

LADDY

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

115 RI20220220-0013 20/02/2022 RI20220218-0003 RI20220220-0013 NICHOLAS SERGIO 75,000.0

SITUMORANG

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

116 RI20220220-0015 20/02/2022 RI20220219-0002 RI20220220-0015 SHYALOMI LETHISIA KHEREN 225,000.0

MANURUNG

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

117 RI20220220-0027 20/02/2022 RI20220216-0002 RI20220220-0027 MECHTILDIS NOVELIA AURA 61,500.0

LADDY

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

118 RI20220220-0028 20/02/2022 RI20220218-0003 RI20220220-0028 NICHOLAS SERGIO 61,500.0

SITUMORANG

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

119 RI20220220-0029 20/02/2022 RI20220219-0002 RI20220220-0029 SHYALOMI LETHISIA KHEREN 61,500.0

MANURUNG
R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 184 of 190

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-February-2022 s/d 28-February-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

120 RI20220220-0032 20/02/2022 RI20220218-0003 RI20220220-0032 NICHOLAS SERGIO 104,418.0

SITUMORANG

R/ KAPAS ALKOHOL 6.00 PCS 303.00 1,818.00 0 1

R/ SURFLO NO. 24 VENFLON 3.00 PCS 34,200.00 102,600.00 0 1

121 RI20220220-0033 20/02/2022 RI20220218-0003 RI20220220-0033 NICHOLAS SERGIO 84,300.0

SITUMORANG

R/ SURFLO NO. 26 (VENFLON) 2.00 PCS 42,150.00 84,300.00 0 1

122 RI20220220-0037 20/02/2022 RI20220218-0003 RI20220220-0037 NICHOLAS SERGIO 154,215.0

SITUMORANG

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

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

R/ SURFLO NO. 26 (VENFLON) 2.00 PCS 42,150.00 84,300.00 0 1

123 RI20220220-0038 20/02/2022 RI20220219-0002 RI20220220-0038 SHYALOMI LETHISIA KHEREN 233,900.0

MANURUNG

R/ PICYN 750 MG INJ (BPJS) 3.00 VIAL 75,000.00 225,000.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

124 RI20220220-0046 20/02/2022 RI20220220-0002 RI20220220-0046 WALID MARZUQI SARUMPAET 202,000.0

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

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

125 RI20220221-0009 21/02/2022 RI20220219-0002 RI20220221-0009 SHYALOMI LETHISIA KHEREN 199,900.0

MANURUNG

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

126 RI20220221-0010 21/02/2022 RI20220220-0002 RI20220221-0010 WALID MARZUQI SARUMPAET 199,900.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

127 RI20220221-0011 21/02/2022 RI20220216-0002 RI20220221-0011 MECHTILDIS NOVELIA AURA 75,000.0

LADDY

R/ PICYN 750 MG INJ (BPJS) 1.00 VIAL 75,000.00 75,000.00 0 1

128 RI20220221-0031 21/02/2022 RI20220220-0002 RI20220221-0031 WALID MARZUQI SARUMPAET 97,657.0

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

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 3,003.00 6,006.00 1 0

R/ SAGESTAM 40 MG INJ 2.00 AMP 19,993.00 39,986.00 0 1

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 185 of 190

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-February-2022 s/d 28-February-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

129 RI20220221-0032 21/02/2022 RI20220218-0003 RI20220221-0032 NICHOLAS SERGIO 22,106.0

SITUMORANG

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

130 RI20220221-0034 21/02/2022 RI20220220-0002 RI20220221-0034 WALID MARZUQI SARUMPAET 50,150.0

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

131 RI20220221-0035 21/02/2022 RI20220216-0002 RI20220221-0035 MECHTILDIS NOVELIA AURA 8,900.0

LADDY

R/ AQUADES 25 ML 25.00 CC 356.00 8,900.00 0 1

132 RI20220221-0040 21/02/2022 RI20220216-0002 RI20220221-0040 MECHTILDIS NOVELIA AURA 43,314.0

LADDY

R/ COBAZIM 3000MCG 3.00 CAP 14,438.00 43,314.00 0 1

133 RI20220222-0001 21/02/2022 RI20220221-0002 RI20220222-0001 AZKA NAUFAL AL MUSTOFA 71,486.0

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

R/ SAGESTAM 40 MG INJ 2.00 AMP 19,993.00 39,986.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

134 RI20220222-0003 22/02/2022 RI20220221-0002 RI20220222-0003 AZKA NAUFAL AL MUSTOFA 37,206.0

R/ SPUIT 50 ML (WITHOUT 1.00 PCS 37,206.00 37,206.00 0 1

NEEDLE) ONEMED
135 RI20220222-0004 22/02/2022 RI20220220-0002 RI20220222-0004 WALID MARZUQI SARUMPAET 3,003.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
136 RI20220222-0006 22/02/2022 RI20220221-0002 RI20220222-0006 AZKA NAUFAL AL MUSTOFA 196,253.0

R/ ELEKTRODY EKG ANAK 5.00 PCS 13,066.00 65,330.00 0 1

SKINTACT
R/ STESOLID 10 MG/2.5 ML 1.00 TUBE 50,181.00 50,181.00 0 0
RECTAL TUBE
R/ STESOLID 10 MG/2ML
(PSIKOTROPIKA) 1.00 AMP 16,108.00 16,108.00 0 0
INJEKSI (PSIKOTROPIKA)
R/ NORAGES INJEKSI 500MG/2ML 1.00 AMP 11,481.00 11,481.00 0 1

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
137 RI20220222-0012 22/02/2022 RI20220220-0002 RI20220222-0012 WALID MARZUQI SARUMPAET 150,000.0

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

138 RI20220222-0013 22/02/2022 RI20220219-0002 RI20220222-0013 SHYALOMI LETHISIA KHEREN 43,314.0

MANURUNG

R/ COBAZIM 3000MCG 3.00 CAP 14,438.00 43,314.00 0 1

139 RI20220222-0048 22/02/2022 RI20220220-0002 RI20220222-0048 WALID MARZUQI SARUMPAET 3,003.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0
INJ (BPJS)

Print Date:7/14/2022 Print Time: 2:11:10PM Page 186 of 190

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-February-2022 s/d 28-February-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

140 RI20220223-0019 23/02/2022 RI20220220-0002 RI20220223-0019 WALID MARZUQI SARUMPAET 20,500.0

R/ D5 +1/2 NS 500 ML (WIDA) 1.00 FLS 20,500.00 20,500.00 0 1

141 RI20220226-0018 26/02/2022 RI20220226-0001 RI20220226-0018 ABID RAFFASYAH PRANAJA 215,444.0

R/ PARAMOL 1GR/100 ML INF 2.00 FLS 70,000.00 140,000.00 0 1

R/ NALD 18 ( TERUMO) 2.00 PCS 4,568.00 9,136.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ STESOLID 10 MG/2ML 1.00 AMP 16,108.00 16,108.00 0 0

INJEKSI (PSIKOTROPIKA)
R/ SPUIT 3 CC (TERUMO) 2.00 PCS 4,600.00 9,200.00 1 0

142 RI20220226-0019 26/02/2022 RI20220226-0001 RI20220226-0019 ABID RAFFASYAH PRANAJA 13,000.0

R/ SELANG O2 ANAK 2.00 PCS 6,500.00 13,000.00 0 1

143 RI20220226-0021 26/02/2022 RI20220226-0001 RI20220226-0021 ABID RAFFASYAH PRANAJA 6,500.0

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

144 RI20220227-0005 27/02/2022 RI20220226-0001 RI20220227-0005 ABID RAFFASYAH PRANAJA 41,000.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

145 RI20220227-0015 27/02/2022 RI20220227-0002 RI20220227-0015 DIAZ JOSHUA SIMAMORA 538,200.0

R/ AQUADES 25 ML 75.00 CC 356.00 26,700.00 0 1

R/ D5 +1/2 NS 500 ML (WIDA) 3.00 FLS 20,500.00 61,500.00 0 1

R/ PICYN 750 MG INJ (BPJS) 6.00 VIAL 75,000.00 450,000.00 0 1

146 RI20220227-0018 27/02/2022 RI20220227-0002 RI20220227-0018 DIAZ JOSHUA SIMAMORA 3,003.0

R/ DEXAMETHASONE 5MG/1ML 1.00 AMP 3,003.00 3,003.00 1 0

INJ (BPJS)
147 RI20220228-0004 28/02/2022 RI20220226-0001 RI20220228-0004 ABID RAFFASYAH PRANAJA 41,000.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

148 RI20220228-0005 28/02/2022 RI20220227-0002 RI20220228-0005 DIAZ JOSHUA SIMAMORA 47,006.0

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ DEXAMETHASONE 5MG/1ML 2.00 AMP 3,003.00 6,006.00 1 0

INJ (BPJS)
149 RI20220228-0006 28/02/2022 RI20220228-0001 RI20220228-0006 TERESIA AYULINA TIVANY 191,000.0
SIALLAGAN

R/ D5 +1/2 NS 500 ML (WIDA) 2.00 FLS 20,500.00 41,000.00 0 1

R/ PICYN 750 MG INJ (BPJS) 2.00 VIAL 75,000.00 150,000.00 0 1

150 RI20220228-0009 28/02/2022 RI20220228-0002 RI20220228-0009 GRASELLA SESILIA SIMAMORA 41,000.0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 187 of 190

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-February-2022 s/d 28-February-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 20,500.00 41,000.00 0 1

151 RI20220228-0013 28/02/2022 RI20220228-0001 RI20220228-0013 TERESIA AYULINA TIVANY 1,467.0

SIALLAGAN

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

R/ KAPAS ALKOHOL 2.00 PCS 303.00 606.00 0 1

152 RI20220228-0014 28/02/2022 RI20220228-0002 RI20220228-0014 GRASELLA SESILIA SIMAMORA 2,419.0

R/ KAPAS ALKOHOL 2.00 PCS 303.00 606.00 0 1

R/ NALD 23 (ONEMED) 1.00 PCS 1,813.00 1,813.00 0 1

153 RI20220228-0015 28/02/2022 RI20220227-0002 RI20220228-0015 DIAZ JOSHUA SIMAMORA 1,813.0

R/ NALD 23 (ONEMED) 1.00 PCS 1,813.00 1,813.00 0 1

154 RJ20220207-0001 07/02/2022 OP20220207-0001 2022020700001 SITI NURLIYA 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

155 RJ20220207-0002 07/02/2022 OP20220207-0002 2022020700002 REYNALDI SINURAT 43,314.0

R/ COBAZIM 3000MCG 3.00 CAP 14,438.00 43,314.00 0 1

156 RJ20220207-0003 07/02/2022 OP20220207-0003 2022020700003 FADHILLA INAYAH.S 50,150.0

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

157 RJ20220207-0004 07/02/2022 OP20220207-0003 2022020700004 FADHILLA INAYAH.S 388,062.0

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ ELKANA CL SYR 1.00 FLS 70,331.00 70,331.00 0 1

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

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

R/ COLERGIS 60 ML SYR 1.00 FLS 61,600.00 61,600.00 0 1

R/ EPEXOL DROPS 1.00 DROP 51,700.00 51,700.00 0 1

158 RJ20220209-0001 09/02/2022 OP20220209-0001 2022020900001 TEGAR TRI ATMAJA 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

159 RJ20220209-0002 09/02/2022 OP20220209-0002 2022020900002 CHIARA GRACE. H.S 43,314.0

R/ COBAZIM 3000MCG 3.00 CAP 14,438.00 43,314.00 0 1

160 RJ20220209-0009 09/02/2022 OP20220209-0015 2022020900011 RAFAEL AGUSTIAN DUHA 5,913.0

R/ COBAZIM 1000MCG 1.00 CAP 5,913.00 5,913.00 0 1

161 RJ20220211-0001 11/02/2022 OP20220211-0001 2022021100001 KAILA PEPAYOSA HUTASOIT 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

Print Date:7/14/2022 Print Time: 2:11:10PM Page 188 of 190

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-February-2022 s/d 28-February-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

162 RJ20220211-0002 11/02/2022 OP20220211-0002 2022021100002 PITRA PRATAMA GURUSINGA 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

163 RJ20220216-0001 16/02/2022 OP20220216-0001 2022021600001 NAURA SYAKIRA ARSYIDINATA 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

164 RJ20220216-0002 16/02/2022 OP20220216-0002 2022021600002 MARIA GISELA NONA 70,331.0

R/ ELKANA CL SYR 1.00 FLS 70,331.00 70,331.00 0 1

165 RJ20220216-0003 16/02/2022 OP20220216-0004 2022021600003 RIZKY FEBRIAN SIANIPAR 70,331.0

R/ ELKANA CL SYR 1.00 FLS 70,331.00 70,331.00 0 1

166 RJ20220216-0004 16/02/2022 OP20220216-0004 2022021600004 RIZKY FEBRIAN SIANIPAR 963.0

R/ KAPAS ALKOHOL 1.00 PCS 303.00 303.00 0 1

R/ NALD 25 (ONEMED) 1.00 PCS 660.00 660.00 0 1

167 RJ20220216-0005 16/02/2022 OP20220216-0004 2022021600005 RIZKY FEBRIAN SIANIPAR 363,000.0

R/ VAKSIN VARICELLA 1.00 VIAL 363,000.00 363,000.00 0 0

168 RJ20220218-0001 18/02/2022 OP20220218-0001 2022021800002 NAJWA ALMIRA 137,280.0

R/ FLEET ENEMA 1.00 TUBE 137,280.00 137,280.00 0 1

169 RJ20220221-0011 21/02/2022 OP20220221-0015 2022022100012 SHALYTTA AVICHAYIL DJAGUN 308,344.0

R/ ELKANA CL SYR 1.00 FLS 70,331.00 70,331.00 0 1

R/ ISPRINOL 60 ML SYR 1.00 FLS 110,000.00 110,000.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

170 RJ20220223-0001 23/02/2022 OP20220223-0001 2022022300002 DIKA ANDRIANTO 528,563.0

OMPUSUNGGU

R/ SPORETIK SYRUP 100 MG/5ML 1.00 FLS 111,925.00 111,925.00 0 1

R/ ISPRINOL 60 ML SYR 1.00 FLS 110,000.00 110,000.00 0 1

R/ ELKANA CL SYR 1.00 FLS 70,331.00 70,331.00 0 1

R/ SANMOL 60 ML SYR 1.00 FLS 16,088.00 16,088.00 0 1

R/ COLERGIS 60 ML SYR 1.00 FLS 61,600.00 61,600.00 0 1

R/ TREMENZA 60 ML SYR (PREK) 1.00 FLS 28,188.00 28,188.00 0 1

R/ SANADRYL DMP 120 ML SYR 1.00 BTL 26,950.00 26,950.00 0 1

(OOT)
R/ MOTADERM 10 GR CREAM 1.00 TUBE 1.00 89,375.00 103,481.00 0 1
 POT KOSONG 10 ML 2.00 UNT 3,263.00 0.00 0 0

KETOCONAZOLE 10 GR CREAM 1.00 TUBE 7,580.00 0.00 1 0

Print Date:7/14/2022 Print Time: 2:11:10PM Page 189 of 190

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-February-2022 s/d 28-February-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

171 RJ20220223-0002 23/02/2022 OP20220223-0004 2022022300003 SHYALOMI LETHISIA KHEREN 43,314.0

MANURUNG

R/ COBAZIM 3000MCG 3.00 CAP 14,438.00 43,314.00 0 1

172 RJ20220225-0001 25/02/2022 OP20220225-0001 2022022500001 WALID MARZUQI SARUMPAET 17,739.0

R/ COBAZIM 1000MCG 3.00 CAP 5,913.00 17,739.00 0 1

173 RJ20220225-0002 25/02/2022 OP20220225-0002 2022022500002 MECHTILDIS NOVELIA AURA 43,314.0

LADDY

R/ COBAZIM 3000MCG 3.00 CAP 14,438.00 43,314.00 0 1

174 RJ20220225-0003 25/02/2022 OP20220225-0003 2022022500003 RAFAEL AGUSTIAN DUHA 72,256.0

R/ SUNGKUP NEBULIZER ANAK 1.00 PCS 50,150.00 50,150.00 0 1

R/ SANMOL 15 ML DROP 1.00 FLS 22,106.00 22,106.00 0 1

SALBUTAMOL 4 MG TAB 4.00 TAB 162.00 0.00 1 0

KERTAS PERKAMEN BERLOGO 15.00 LBR 100.00 0.00 0 1

Total Dokter DR. YURI SP.A 21,015,113.0

Grand Total 188,569,996.0
Print Date:7/14/2022 Print Time: 2:11:10PM Page 190 of 190
 Jumlah

Non Generik
ormula

17,600.00

295,888.00

143,945.00

194,435.00

70,400.00

8,165.00

183,110.00

0
22,653.00
 Jumlah

Non Generik
ormula

58,048.00

26,010.00

58,898.00

10,800.00

89,952.00
 Jumlah

Non Generik
ormula

1,500.00

3,350.00

1,500.00

6,350.00
 Jumlah

Non Generik
ormula

66,960.00

18,360.00

5,810.00

3,892.00

91,804.00

71,392.00

20,190.00

20,190.00

13,880.00

66,390.00
0

0
 Jumlah

Non Generik
ormula

18,644.00

64,190.00

42,360.00

13,880.00

9,960.00

3,892.00

70,282.00

64,190.00

0
3,892.00
 Jumlah

Non Generik
ormula

4,820.00

3,892.00

78,870.00
 Jumlah

Non Generik
ormula

18,460.00

59,617.00

27.00

4,960.00

14,048.00

7,357.00

2,451.00

69,712.00

37,929.00

0
331,645.00
 Jumlah

Non Generik
ormula

47,758.00

10,626.00

7,150.00

17,800.00

213,705.00

25,019.00

137,890.00

0
 0

352,515.00
 Jumlah

ormula

46,000.00

20,852.00

1,714.00

1,200.00

25,661.00

968,093.00

326,563.00

0
92,000.00
 Jumlah

Non Generik
ormula

80,107.00

7,157.00

171,156.00

204,132.00

473,004.00

8,085.00

21,040.00
 0

5,075.00
 Jumlah

Non Generik
ormula

415,470.00

176,790.00

177,675.00

67,500.00

434,136.00

24,360.00

19,532.00

19,532.00

442,170.00

0
0

0
 Jumlah

Non Generik
ormula

152,490.00

555.00

282,738.00

5,075.00

253,440.00

7,024.00

54,137.00

318,048.00

126,529.00

0
0
 Jumlah

Non Generik
ormula

46,813.00

79,972.00

7,024.00

102,510.00

555.00

91,059.00

154,286.00

15,400.00

86,604.00

157,533.00
0
 Jumlah

Non Generik
ormula

170,111.00

70,315.00

136,486.00

10,626.00

7,150.00

1,850.00

44,000.00

69,500.00

16,006.00

39,999.00

309,280.00
0

0
 Jumlah

Non Generik
ormula

56,000.00

305,040.00

61,876.00

61,876.00

10,626.00

187,143.00

39,999.00

861.00

137,505.00

0
110,799.00
 Jumlah

Non Generik
ormula

31,288.00

49,575.00

165,872.00

660.00

134,328.00

88,200.00

134,328.00

0
137,505.00

0
 Jumlah

Non Generik
ormula

25,771.00

47,738.00

128,538.00

111,622.00

29,298.00

198,715.00

40,827.00

1,813.00

0
76,232.00

0
 Jumlah

Non Generik
ormula

31,288.00

71,937.00

157,836.00

28,432.00

13,613.00

388.00

113,488.00

63,360.00
0
 Jumlah

Non Generik
ormula

176,018.00

129,492.00

50,418.00

20,909.00

8,900.00

78,361.00

444,611.00

0
0

0
 Jumlah

Non Generik
ormula

1,667.00

001,141.00

280,192.00

280,192.00

63,360.00

382,241.00

0
0

0
 Jumlah

Non Generik
ormula

21,340.00

2,250.00

39,999.00

60,552.00

69,000.00

69,000.00

69,000.00

139,805.00

87,000.00

45,855.00
0
 Jumlah

Non Generik
ormula

118,973.00

319,645.00

8,925.00

1,850.00

2,775.00

4,576.00

1,850.00

84,570.00
0

0
 Jumlah

Non Generik
ormula

69,000.00

294,570.00

137,505.00

5,820.00

69,000.00

27,600.00

84,570.00

204,443.00

4,576.00

5,825.00

44,341.00
 Jumlah

Non Generik
ormula

92,520.00

119,300.00

206,470.00

245,800.00

204,410.00

253,000.00

41,468.00
0

1
 Jumlah

Non Generik
ormula

249,435.00

1,850.00

26,950.00

239,382.00

132,528.00

125,200.00

152,190.00

93,538.00

0
0

0
 Jumlah

Non Generik
ormula

142,250.00

228,990.00

20,190.00

339,285.00

242,870.00

197,768.00

63,360.00
0
 Jumlah

Non Generik
ormula

1,850.00

190,740.00

63,360.00

61,900.00

159,800.00

64,020.00

190,740.00

17,600.00
0
 Jumlah

Non Generik
ormula

15,813.00

138,938.00

66,000.00

82,088.00

7,940.00

224,910.00

58,438.00

69,760.00

136,360.00
0

0
 Jumlah

Non Generik
ormula

27,180.00

95,838.00

211,449.00

63,360.00

95,300.00

73,430.00

39,670.00

14,050.00
0
 Jumlah

Non Generik
ormula

188,900.00

105,876.00

150,020.00

63,360.00

31,000.00

77,690.00

361,250.00

10,000.00

0
206,470.00
 Jumlah

Non Generik
ormula

63,360.00

20,170.00

63,360.00

12,000.00

0.00

388.00

138,080.00

75,528.00

297,460.00

0
0

0
 Jumlah

Non Generik
ormula

253,870.00

107,700.00

7,340.00

5,168.00

44,680.00

146,000.00

114,690.00

29,890.00

0
112,198.00

0
 Jumlah

Non Generik
ormula

281,020.00

110,276.00

115,360.00

36,910.00

11,990.00

88,410.00

0
0

0
 Jumlah

Non Generik
ormula

88,410.00

63,360.00

42,740.00

6,640.00

9,330.00

63,360.00

63,360.00

3,880.00
0
 Jumlah

Non Generik
ormula

17,600.00

68,680.00

131,208.00

288,660.00

17,600.00

17,600.00

0.00

13,990.00

0
84,820.00
 Jumlah

Non Generik
ormula

521,318.00

251,085.00

313,634.00

78,658.00

73,000.00

0
191,290.00

0
 Jumlah

Non Generik
ormula

448,924.00

10,956.00

114,735.00

72,270.00

8,910.00

85,016.00

63,360.00
0
 Jumlah

Non Generik
ormula

122,470.00

268,929.00

10,080.00

326,563.00

7,813.00

50,625.00

179,872.00

200,218.00

0
0

0
 Jumlah

Non Generik
ormula

160,038.00

60,630.00

67,180.00

8,900.00

190,070.00

238,780.00

8,900.00

8,900.00

231,062.00
0
 Jumlah

Non Generik
ormula

208,948.00

244,020.00

17,600.00

134,888.00

116,352.00

148,920.00

377,240.00
0
 Jumlah

Non Generik
ormula

20,500.00

494,734.00

73,000.00

284,890.00

83,732.00

46,694.00

1
0
 Jumlah

Non Generik
ormula

508,591.00

73,000.00

36,910.00

34,220.00

10,626.00

199,654.00

237,013.00

29,570.00
0

0
 Jumlah

Non Generik
ormula

44,773.00

232,446.00

184,569.00

619,360.00

580,805.00

0
0

0
 Jumlah

Non Generik
ormula

61,600.00

183,455.00

172,500.00

127,910.00

80,670.00

135,190.00

114,700.00

164,836.00
0
 Jumlah

Non Generik
ormula

484,950.00

508,010.00

371,948.00

218,450.00

0
143,000.00
 Jumlah

Non Generik
ormula

8,390.00

148,540.00

127,189.00

522,024.00

73,000.00

184,689.00

68,750.00
 0

117,280.00
 Jumlah

Non Generik
ormula

107,760.00

293,325.00

140,230.00

20,500.00

73,000.00

253,651.00

0
63,360.00

0
 Jumlah

Non Generik
ormula

2,448.00

285,979.00

211,200.00

211,200.00

220,049.00

211,200.00

10,830.00

169,932.00

540,594.00
0

0
 Jumlah

Non Generik
ormula

191,700.00

282,575.00

61,600.00

83,530.00

20,500.00

61,600.00

456,138.00

0
0
 Jumlah

Non Generik
ormula

61,600.00

539,254.00

217,800.00

540,884.00

356,685.00

272,585.00

0
0
 Jumlah

Non Generik
ormula

449,280.00

378,968.00

226,406.00

326,319.00

259,550.00

80,000.00

4,685.00
0

0
 Jumlah

Non Generik
ormula

45,868.00

73,000.00

336,989.00

401,719.00

344,915.00

15,813.00

22,146.00

0
19,840.00
 Jumlah

Non Generik
ormula

169,903.00

62,944.00

302,308.00

35,200.00

20,500.00

72,384.00
 Jumlah

Non Generik
ormula

292,600.00

77,350.00

267,790.00

215,590.00

421,335.00

450,380.00

72,934.00
0
 Jumlah

Non Generik
ormula

195,620.00

219,700.00

209,790.00

275,924.00

61,990.00

267,790.00

371,900.00

0
 0

333,790.00
 Jumlah

Non Generik
ormula

113,418.00

108,300.00

62,080.00

85,868.00

98,800.00

77,275.00

70,000.00

274,916.00
0
 Jumlah

Non Generik
ormula

52,800.00

84,913.00

93,710.00

168,822.00

104,480.00

63,360.00

93,225.00
 Jumlah

Non Generik
ormula

443,470.00

37,540.00

63,360.00

327,470.00

146,445.00

105,678.00

18,360.00

41,260.00
0
 Jumlah

Non Generik
ormula

307,380.00

39,296.00

96,939.00

80,000.00

203,210.00

63,360.00

392,240.00

0
0

0
 Jumlah

Non Generik
ormula

6,600.00

63,360.00

11,340.00

89,516.00

119,080.00

315,870.00

167,190.00

20,500.00

164,082.00

20,500.00
0
 Jumlah

Non Generik
ormula

138,610.00

20,500.00

382,990.00

30,473.00

247,862.00

121,508.00

11,733.00

63,215.00

0
0

0
 Jumlah

Non Generik
ormula

272,930.00

101,090.00

395,992.00

167,910.00

77,990.00

86,090.00

0
327,470.00
 Jumlah

Non Generik
ormula

76,588.00

153,520.00

78,190.00

64,168.00

143,810.00

310,940.00

305,800.00

0
121,530.00

0
 Jumlah

Non Generik
ormula

63,140.00

175,440.00

176,468.00

78,190.00

97,763.00

63,360.00

100,660.00

86,940.00
0
 Jumlah

Non Generik
ormula

52,540.00

145,858.00

289,410.00

88,350.00

0
0

0
 Jumlah

Non Generik
ormula

148,320.00

20,190.00

65,876.00

315,870.00

377,470.00

155,540.00

0
4,580.00
 Jumlah

Non Generik
ormula

155,540.00

155,540.00

100,660.00

217,903.00

46,000.00

28,880.00

110,111.00
1

0
 Jumlah

Non Generik
ormula

107,485.00

294,933.00

20,190.00

125,003.00

5,140.00

80,603.00

0
0

0
 Jumlah

Non Generik
ormula

295,275.00

212,570.00

154,575.00

315,870.00

51,820.00

175,859.00

0
0
 Jumlah

Non Generik
ormula

100,190.00

85,140.00

28,040.00

197,870.00

39,500.00

95,140.00

323,770.00

85,140.00

10.00
0
 Jumlah

Non Generik
ormula

189,178.00

387,358.00

3,880.00

190,998.00

462,870.00

120,140.00

3,880.00
0
 Jumlah

Non Generik
ormula

136,810.00

35,715.00

9,973.00

119,080.00

197,070.00

128,040.00

36,910.00

141,860.00

4,580.00
0
 Jumlah

Non Generik
ormula

20,500.00

315,870.00

4,576.00

105,463.00

3,880.00

20,500.00

250,113.00

250,113.00

70,700.00

0
0
 Jumlah

Non Generik
ormula

2,460.00

134,420.00

66,510.00

58,710.00

305,970.00

251,715.00

89,519.00
 Jumlah

Non Generik
ormula

116,850.00

1,310.00

8,100.00

12,180.00

17,800.00

102,215.00

41,568.00

150,240.00

548,071.00

0
0

0
 Jumlah

Non Generik
ormula

64,643.00

101,902.00

38,056.00

885.00

92,760.00

521,157.00

7,160.00
0

0
 Jumlah

Non Generik
ormula

185.00

90,283.00

658,660.00

1,000.00

582,025.00

23,788.00

7,800.00

98,900.00

0
0

0
 Jumlah

Non Generik
ormula

45,377.00

846,946.00

37,098.00

6,519.00

7,800.00

77,440.00

44,500.00

19,532.00

45,360.00

83,029.00
0
 Jumlah

Non Generik
ormula

38,198.00

547,495.00

259,223.00

8,970.00

152,822.00

0
0

0
 Jumlah

Non Generik
ormula

1,770.00

13,333.00

7,157.00

50,882.00

556,420.00

96,505.00

65,628.00

0
0

0
 Jumlah

Non Generik
ormula

1,770.00

29,597.00

17,800.00

29,700.00

25,344.00

885.00

75,120.00

13,435.00

98,441.00

112,680.00
0
 Jumlah

Non Generik
ormula

51,734.00

84,648.00

61,161.00

227,685.00

13,333.00

61,187.00

37,580.00

29,298.00

0
39,999.00
 Jumlah

Non Generik
ormula

349,167.00

94,428.00

133,975.00

9,533.00

19,600.00

2,451.00

2,140.00

84,480.00

675.00
0
 Jumlah

Non Generik
ormula

102,916.00

337,920.00

5,804.00

112,680.00

33,600.00

42,324.00

42,324.00

685.00

1,485.00

13,333.00

73,126.00
0

0
 Jumlah

Non Generik
ormula

41,514.00

142,835.00

97,278.00

233,921.00

205,065.00

0
0
 Jumlah

Non Generik

48,284.00

106,689.00

198,486.00

198,486.00

338,968.00

29,700.00

25,195.00

0
0

0
 Jumlah

Non Generik
ormula

8,850.00

4,050.00

168,960.00

10,626.00

2,025.00

13,720.00

126,720.00

63,360.00

96,498.00

265,813.00

0
0

0
 Jumlah

Non Generik
ormula

150,950.00

38,894.00

162,000.00

162,000.00

8,085.00

83,088.00

4,455.00
 0

1,200.00
 Jumlah

Non Generik
ormula

21,252.00

8,850.00

331,833.00

444,522.00

136,610.00

254,440.00

17,800.00

0
225,786.00
 Jumlah

Non Generik
ormula

47,664.00

888,394.00

21,040.00

16,134.00

32,715.00

21,952.00

0
0

0
 Jumlah

Non Generik
ormula

700,228.00

27,822.00

48,573.00

44,500.00

26,003.00

2,603.00

83,070.00
0
 Jumlah

Non Generik
ormula

122,448.00

21,600.00

13,720.00

21,600.00

10,800.00

1,485.00

20,134.00

22,484.00

488,472.00

16,772.00

0
0

0
 Jumlah

Non Generik
ormula

42,324.00

104,732.00

52,697.00

97,818.00

677,818.00

675,218.00
0

0
 Jumlah

Non Generik
ormula

5,430.00

145,800.00

145,800.00

24,200.00

52,855.00

406,094.00

247,101.00

0
0

0
 Jumlah

Non Generik
ormula

162,730.00

482,974.00

73,042.00

476,533.00

0
0

0
 Jumlah

Non Generik
ormula

144,486.00

42,324.00

33,915.00

66,570.00

634,979.00

13,275.00

66,468.00

437,556.00

0
0

0
 Jumlah

Non Generik
ormula

27,150.00

14,000.00

10,160.00

30,000.00

52,377.00

6,930.00

555.00

25,770.00

19,532.00

59,187.00

0
 0

118,617.00
 Jumlah

Non Generik
ormula

490,533.00

413,388.00

36,570.00

67,843.00

0
0

0
 Jumlah

Non Generik
ormula

491,913.00

29,784.00

555.00

52,800.00

52,800.00

217,379.00

162,741.00

0
0

0
 Jumlah

Non Generik
ormula

14,760.00

13,333.00

62,967.00

105,810.00

31,286.00

10,000.00

13,741.00

228,141.00

0
0

0
 Jumlah

Non Generik
ormula

63,507.00

735,249.00

67,136.00

61,008.00

0
21,600.00
 Jumlah

Non Generik
ormula

61,867.00

50,219.00

25,190.00

273,815.00

8,850.00

8,250.00

130,210.00
0
 Jumlah

Non Generik
ormula

21,600.00

63,360.00

6,930.00

7,803.00

57,200.00

21,803.00

7,803.00

63,360.00

885.00

293,843.00

0
0

0
 Jumlah

Non Generik
ormula

878,452.00

13,720.00

158,644.00

124,545.00
0
 Jumlah

Non Generik
ormula

591,048.00

56,882.00

171,422.00

0
167,603.00
 Jumlah

Non Generik
ormula

161,051.00

62,901.00

66,003.00

736,053.00

0
0

0
 Jumlah

Non Generik
ormula

110,467.00

81,364.00

2,451.00

52,800.00

5,075.00

254,524.00

217,800.00

550.00

36,855.00

13,720.00
0
 Jumlah

Non Generik
ormula

501,258.00

72,900.00

194,400.00

194,400.00

194,400.00

19,532.00

34,860.00

660.00

5,373.00

39,999.00

80,658.00

0
0

0
 Jumlah

Non Generik
ormula

42,294.00

44,397.00

652,112.00

516,594.00

288,877.00
0
 Jumlah

Non Generik
ormula

691,228.00

892,635.00

453,284.00

0
0

0
 Jumlah

Non Generik
ormula

136,527.00

535,352.00

21,803.00

12,730.00

26,480.00

0
14,000.00

0
 Jumlah

Non Generik
ormula

122,170.00

25,626.00

8,100.00

42,080.00

6,664.00

3,003.00

2,750.00

34,860.00

13,720.00

9,876.00

0
0

0
 Jumlah

Non Generik
ormula

39,999.00

243,179.00

32,400.00

165,003.00

574,302.00

496,247.00

0
0

0
 Jumlah

Non Generik
ormula

355,327.00

561,299.00

809,560.00

83,782.00

103,238.00
0
 Jumlah

Non Generik
ormula

21,803.00

708,991.00

24,360.00

77,486.00

77,486.00

56,700.00

14,670.00

15,900.00

3,003.00
0
 Jumlah

Non Generik
ormula

68,010.00

84,585.00

69,720.00

20,490.00

42,080.00

21,040.00

4,050.00

26,939.00

63,360.00

13,993.00
0

1
 Jumlah

Non Generik
ormula

18,688.00

186,502.00

207,266.00

50,188.00

509,373.00

0
0

0
 Jumlah

Non Generik
ormula

801,426.00

45,370.00

42,715.00

172,778.00

31,264.00
0
 Jumlah

Non Generik
ormula

442,633.00

476,473.00

10,225.00

125,361.00

2,655.00

0
46,380.00

0
 Jumlah

Non Generik
ormula

6,930.00

8,942.00

100,000.00

100,000.00

20,790.00

1,000.00

1,485.00

1,485.00

1,485.00

1,485.00

885.00

12,786.00

0
0
 Jumlah

Non Generik
ormula

62,088.00

8,132.00

257,474.00

209,052.00

303,461.00

0
0

0
 Jumlah

Non Generik
ormula

306,546.00

156,252.00

251,687.00

13,107.00

0
0
 Jumlah

Non Generik
ormula

354,852.00

252,921.00

544,901.00

62,665.00

71,350.00

0
0

0
 Jumlah

Non Generik
ormula

4,850.00

12,258.00

13,422.00

81,867.00

16,077.00

13,422.00

12,258.00

0
0

0
 Jumlah

Non Generik
ormula

12,258.00

144,615.00

181,809.00

129,009.00

145,800.00

145,800.00

4,455.00

310,366.00

0
 0

81,864.00
 Jumlah

Non Generik
ormula

81,779.00

160,500.00

87,600.00

87,600.00

7,803.00

7,150.00

54,625.00

20,533.00
 0

424,762.00
 Jumlah

Non Generik
ormula

51,150.00

614,524.00

32,400.00

5,001.00

62,417.00

21,600.00

0
67,500.00

0
 Jumlah

Non Generik
ormula

31,600.00

196,120.00

9,318.00

854,147.00

7,150.00
0
 Jumlah

Non Generik
ormula

128,130.00

120,315.00

294.00

21,040.00

12,180.00

1,667.00

48,555.00

97,972.00

19,729.00

0
0

1
 Jumlah

Non Generik
ormula

319,574.00

912,631.00

52,927.00

52,800.00

327,992.00

0
0
 Jumlah

Non Generik
ormula

372,298.00

23,788.00

2,775.00

368,356.00

185,010.00

8,085.00

15,975.00

76,434.00

0
0

0
 Jumlah

Non Generik
ormula

7,329.00

5,140.00

13,275.00

13,275.00

40,035.00

70,000.00

47,650.00

17,020.00

91,059.00

8,850.00

497,424.00
0

0
 Jumlah

Non Generik
ormula

8,981.00

507,340.00

7,160.00

85,984.00

115,500.00

4,650.00

16,975.00

2,058.00

13,275.00

8,175.00

0
61,188.00

0
 Jumlah

Non Generik
ormula

591,885.00

1,850.00

54,781.00

233,481.00

74,051.00

5,310.00

236,551.00

5,310.00
0
 Jumlah

Non Generik
ormula

388,712.00

16,142.00

53,038.00

8,850.00

5,820.00

13,275.00

71,220.00

8,996.00

29,509.00

190,180.00
0
 Jumlah

Non Generik
ormula

5,820.00

106,575.00

108,405.00

13,020.00

1,925.00

65,220.00

5,310.00

38,562.00
 Jumlah

Non Generik
ormula

204,966.00

20,500.00

8,158.00

272,516.00

4,741.00

291,788.00

208,744.00

1
47,105.00
 Jumlah

Non Generik
ormula

178,530.00

11,242.00

266,472.00

4,020.00

205,520.00

82,500.00

32,274.00

0
 0

120,002.00
 Jumlah

Non Generik
ormula

24,940.00

2,600.00

92,773.00

255,910.00

29,619.00

87,474.00

401,402.00

0
0

0
 Jumlah

Non Generik
ormula

1,850.00

13,190.00

36,788.00

18,420.00

140,170.00

21,493.00

4,580.00

60,500.00

66,112.00

20,500.00
 0

131,014.00
 Jumlah

Non Generik
ormula

158,978.00

267,290.00

323,438.00

234,432.00

117,153.00

394,680.00

0
0

0
 Jumlah

Non Generik
ormula

208,292.00

271,076.00

28,461.00

41,368.00

243,504.00

217,405.00

127,194.00
0
 Jumlah

Non Generik
ormula

119,122.00

1,850.00

13,710.00

164,082.00

32,489.00

153,315.00

213,186.00

0
0

0
 Jumlah

Non Generik
ormula

393,220.00

210,032.00

196,272.00

89,773.00

278,182.00

176,932.00

0
0
 Jumlah

Non Generik
ormula

284,178.00

148,150.00

234,432.00

58,438.00

174,232.00

10,100.00

104,740.00

221,470.00
0

0
 Jumlah

Non Generik
ormula

168,296.00

194,440.00

23,650.00

35,733.00

92,061.00

56,320.00

23,486.00

23,486.00
0

0
 Jumlah

Non Generik
ormula

10,626.00

10,626.00

101,036.00

92,430.00

58,438.00

65,220.00

132,012.00

68,874.00

0
148,122.00

0
 Jumlah

Non Generik
ormula

119,122.00

70,350.00

101,000.00

129,212.00

56,496.00

270,878.00

0
0

0
 Jumlah

Non Generik
ormula

20,500.00

295,148.00

9,269.00

72,978.00

206,470.00

155,452.00

88,530.00

0
219,186.00

0
 Jumlah

Non Generik
ormula

146,030.00

70,950.00

262,776.00

129,962.00

161,892.00

60,000.00

187,398.00

0
0
 Jumlah

Non Generik
ormula

40,891.00

185,478.00

37,746.00

271,128.00

24,360.00

24,520.00

61,580.00

113,972.00

0
0
 Jumlah

Non Generik
ormula

159,102.00

160,583.00

191,260.00

24,360.00

250,604.00

63,527.00

17,600.00

38,100.00
0
 Jumlah

Non Generik
ormula

119,122.00

141,362.00

228,716.00

104,580.00

218,282.00

152,103.00

125,768.00
0

0
 Jumlah

Non Generik
ormula

263,112.00

109,288.00

280,124.00

266,472.00

1,375.00

110,803.00

209,614.00
0
 Jumlah

Non Generik
ormula

60,000.00

37,780.00

183,485.00

360,780.00

248,638.00

92,430.00

190,122.00

0
 0

190,122.00
 Jumlah

Non Generik
ormula

111,052.00

23,978.00

316,004.00

21,493.00

12,908.00

81,770.00

0
220,682.00

0
 Jumlah

Non Generik
ormula

10,000.00

190,412.00

113,664.00

215,982.00

110,423.00

52,953.00

111,360.00

0
0
 Jumlah

Non Generik
ormula

259,457.00

50,150.00

134,570.00

266,930.00

300,482.00

130,270.00

3,880.00
 0

112,746.00
 Jumlah

Non Generik
ormula

108,720.00

2,750.00

206,302.00

66,758.00

5,610.00

27,500.00

36,835.00

177,512.00
0

0
 Jumlah

Non Generik
ormula

18,940.00

115,000.00

11,733.00

88,530.00

41,486.00

135,190.00

268,782.00

264,450.00

0
122,740.00
 Jumlah

Non Generik
ormula

11,050.00

136,978.00

5,450.00

187,810.00

194,894.00

16,088.00

4,680.00

274,302.00

0
116,646.00
 Jumlah

Non Generik
ormula

252,247.00

35,200.00

218,248.00

30,473.00

11,003.00
 Jumlah

Non Generik
ormula

258,284.00

19,532.00

118,652.00

166,627.00

320,191.00

0
24,360.00

0
 Jumlah

Non Generik
ormula

462,420.00

1,485.00

46,586.00

230,813.00

0
24,975.00
 Jumlah

Non Generik
ormula

115,914.00

20,936.00

33,320.00

12,255.00

4,455.00

7,800.00

65,000.00

24,360.00

1,667.00

42,680.00
0
 Jumlah

Non Generik
ormula

35,750.00

46,200.00

683,190.00

167,190.00

683,190.00

167,190.00

85,022.00
 Jumlah

Non Generik
ormula

14,260.00

63,360.00

71,920.00

388,200.00

361,670.00

245,588.00

17,600.00
0
 Jumlah

Non Generik
ormula

24,050.00

63,360.00

94,570.00

85,704.00

201,870.00

297,460.00

62,180.00

55,950.00
0
 Jumlah

Non Generik
ormula

4,980.00

80,690.00

60,030.00

63,360.00

63,360.00

32,975.00

96,910.00

16,950.00

0
0

0
 Jumlah

Non Generik
ormula

75,460.00

117,698.00

11,500.00

63,360.00

206,470.00

216,420.00

204,410.00

6,280.00
0
 Jumlah

Non Generik
ormula

12.00

63,360.00

98,250.00

272,540.00

240,470.00

60,835.00
 Jumlah

Non Generik
ormula

82,000.00

41,000.00

348,475.00

69,015.00

268,833.00

34,023.00

389,219.00

0
117,614.00
 Jumlah

Non Generik
ormula

20,625.00

156,559.00

76,350.00

109,030.00

29,298.00

209,318.00

63,015.00
0
 Jumlah

Non Generik
ormula

286,645.00

17,739.00

17,739.00

75,120.00

75,000.00

63,015.00

114,195.00

165,553.00

33,468.00

0
0

0
 Jumlah

Non Generik
ormula

30,813.00

1,770.00

156,006.00

235,123.00

37,560.00

197,525.00

285,680.00

0
52,938.00

0
 Jumlah

Non Generik
ormula

17,739.00

19,589.00

259,240.00

20,625.00

110,550.00

41,000.00

41,000.00

132,786.00

9,036.00

0
196,010.00
 Jumlah

Non Generik
ormula

44,239.00

17,739.00

75,000.00

9,009.00

94,993.00

196,010.00

68,400.00

17,739.00

75,000.00

63,015.00

75,000.00

0
28,875.00
 Jumlah

Non Generik
ormula

41,000.00

75,000.00

61,500.00

43,314.00

804,199.00

61,500.00

74,318.00

320,881.00

0
0

0
 Jumlah

Non Generik
ormula

41,337.00

555.00

804,053.00

512,150.00

28,324.00

498,601.00

0
0

0
 Jumlah

Non Generik
ormula

42,515.00

4,568.00

156,888.00

21,600.00

22,106.00

88,530.00

4.00

1,028.00

206,250.00

21,600.00

633,600.00

0
0
 Jumlah

Non Generik
ormula

51,040.00

426,640.00

41,000.00

28,541.00

6,006.00

33,684.00

92,959.00

356,987.00

0
50,150.00
 Jumlah

Non Generik
ormula

84,300.00

41,000.00

41,000.00

6,006.00

156,888.00

555.00

632,765.00

134,031.00

204,362.00

0
1,850.00
 Jumlah

Non Generik
ormula

372,650.00

299,760.00

47,678.00

286,500.00

41,000.00

294,215.00

266,000.00

861.00

117,606.00

0
0
 Jumlah

Non Generik
ormula

166,230.00

63,810.00

307,330.00

75,000.00

7,333.00

225,000.00

75,000.00

225,000.00

61,500.00

61,500.00

61,500.00
0
 Jumlah

Non Generik
ormula

104,418.00

84,300.00

154,215.00

233,900.00

202,000.00

199,900.00

199,900.00

75,000.00

97,657.00

0
0

0
 Jumlah

Non Generik
ormula

22,106.00

50,150.00

8,900.00

43,314.00

71,486.00

37,206.00

3,003.00

196,253.00

150,000.00

43,314.00

3,003.00
0
 Jumlah

Non Generik
ormula

20,500.00

215,444.00

13,000.00

6,500.00

41,000.00

538,200.00

3,003.00

41,000.00

47,006.00

191,000.00

0
41,000.00
 Jumlah

Non Generik
ormula

1,467.00

2,419.00

1,813.00

17,739.00

43,314.00

50,150.00

388,062.00

17,739.00

43,314.00

5,913.00

0
17,739.00

0
 Jumlah

Non Generik
ormula

17,739.00

17,739.00

70,331.00

70,331.00

963.00

363,000.00

137,280.00

308,344.00

528,563.00

0
1

0
 Jumlah

Non Generik
ormula

43,314.00

17,739.00

43,314.00

72,256.00

15,113.00
69,996.00