Lembar Kontrol Pemakaian Obat Poli Saraf Tanggal : Dokter :

No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 Nama Obat Noperten 5, 10 mg Calcigard Retart 20 Tenapril 2,5 dan 5 Biscor 5 mg Apazol 0,5 & 1 mg Anxiblox 10 mg Cameloc 7,5 & 15 mg Trunal DX 50 mg Diaversa 1 &2 mg Glukodex 80 mg Lodem 30 mg Probenid 500 mg Esvat 10 & 20 mg Leparson 100 mg Nopress 20 mg Ulsidex Vastigo 6 mg Levaside Noocephal 400, 800, 1200 mg Recolin 500 mg Epsonal Siberid 5 & 10 mg Neuraxon 5000 mg Memorex Prednox 4, 8, 16 mg Arkine 2 mg Rocoz 10 mg Astika 100 Glukotika 500 & 850 mg Irtan 150 & 300 mg Mapryl 1 & 2 mg Phenintoin 100 mg Ergotika 1 & 4,5 mg Ginggo force Hyperchol 100, 200 MR, 300 mg Ikaneuron 5000 mg Ikaphen 100 mg Metifer 500 mg Resibron 800, 1200mg Vaskuprax 100 & 200 Actapin 5 & 10 mg Placta 75 mg Vivace 2,5 & 5 & 10 mg Alpentin 100 & 300 mg Remachox 7,5 & 15 mg Actazolam 0,5 & 1 mg Deflamat CR 75 &100 mg Pemakaian Total

48 49 50 51 52 53 54 55

Osteofree Candesartan TI 8 &16 mg Actos (pleoglitason) 15 & 30 mg Micardis 80 mg Sifrol 0,375 & 0,75mg Depakote ER 250 & 500 mg Betaserc 8 mg Cardace 2,5 & 5 mg