apendiktomy apendiktomy

TGL/RM : / TGL/RM : /
NAMA : NAMA :
DOKTER : DOKTER :
CORET YANG TAK TERPAKAI !!! CORET YANG TAK TERPAKAI !!!
NO NAMA BHP JUMLAH TAMBAHAN NO NAMA BHP JUMLAH TAMBAHAN
1 Alkohol 70% 100 ml 1 btl 1 Alkohol 70% 100 ml 1 btl
2 Alkohol swap 10 2 Alkohol swap 10
3 Appron 5 3 Appron 5
4 benang 1 4 benang 1
5 benang 1 5 benang 1
6 benang 1 6 benang 1
7 buvicain/regivel 1 amp 7 buvicain/regivel 1 amp
8 Canul Oksigen Dws 1 8 Canul Oksigen Dws 1
9 Connecting Tube 1 9 Connecting Tube 1
10 Darm Gause 1 10 Darm Gause 1
11 Daryantulle 1 11 Daryantulle 1
12 Durapore 20 cm 12 Durapore 20 cm
13 E-Care Handscrub 300 ml 13 E-Care Handscrub 300 ml
14 Ecron 1 vial 14 Ecron 1 vial
15 Elektroda 3 15 Elektroda 3
16 Ephedrine 1 amp 16 Ephedrine 1 amp
17 Fentanyl 1 amp 17 Fentanyl 1 amp
18 Folley Kateter No. . . . . . . 1 18 Folley Kateter No. . . . . . . 1
19 Gammex 8 19 Gammex 8
20 Hansaplas Jumbo 1 20 Hansaplas Jumbo 1
21 Infus D5NS Otsu 500 ml 1 flb 21 Infus D5NS Otsu 500 ml 1 flb
22 Infus NaCl 500ml Otsu 1 22 Infus NaCl 500ml Otsu 1
23 Infus RD 5% Otsu 500 ml 1 flb 23 Infus RD 5% Otsu 500 ml 1 flb
24 Infus RL Otsu 500 ml 2 flb 24 Infus RL Otsu 500 ml 2 flb
25 Iodine Povidone 300ml 1 btl 25 Iodine Povidone 300ml 1 btl
26 Kassa steril 90 26 Kassa steril 90
27 Ketorolac 30 mg 1 amp 27 Ketorolac 30 mg 1 amp
28 Lidocain 1 amp 28 Lidocain 1 amp
29 LMA NO . . . . . . . . . . . . . . . 1 29 LMA NO . . . . . . . . . . . . . . . 1
30 Masker Disposible 8 30 Masker Disposible 8
31 Masterzym 50ml 31 Masterzym 50ml
32 Mess MM19 1 32 Mess MM19 1
33 Nitrogen 10 lpm 33 Nitrogen 10 lpm
34 Nurse Cap 9 34 Nurse Cap 9
35 Ondansetron 8 ml 1 amp 35 Ondansetron 8 ml 1 amp
36 Oxygen 10 lpm 36 Oxygen 10 lpm
37 Pouches 200x200cm 70 cm 37 Pouches 200x200cm 70 cm
38 Presep 0,5 8 38 Presep 0,5 8
39 Propofol / Nopovel 1 vial 39 Propofol / Nopovel 1 vial
40 Prostigmin 2 amp 40 Prostigmin 2 amp
41 Sefoflurane / Sojuren 50 ml 41 Sefoflurane / Sojuren 50 ml
42 Sensi Glove / pasang 8 42 Sensi Glove / pasang 8
43 Spinocan No . . . . . . . . . . . 1 43 Spinocan No . . . . . . . . . . . 1
44 Spuit 10cc 2 44 Spuit 10cc 2
45 Spuit 1cc 1 45 Spuit 1cc 1
46 Spuit 3cc 5 46 Spuit 3cc 5
47 Spuit 5cc 5 47 Spuit 5cc 5
48 Steril Wrap 5 buah 48 Steril Wrap 5 buah
49 Suction kateter N0 10 1 49 Suction kateter N0 10 1
50 Sulfat Atropin 2 amp 50 Sulfat Atropin 2 amp
51 Surgical Blade No 20 1 51 Surgical Blade No 20 1
52 T-brush 3 52 T-brush 3
53 Transofix 1 53 Transofix 1
54 Underpad 2 54 Underpad 2
55 Urine Bag 1 55 Urine Bag 1
56 Water Steril 25ml 3 btl 56 Water Steril 25ml 3 btl
57 Winner / Plester 10x5 35 cm 57 Winner / Plester 10x5 35 cm
58 58
59 59
60 60
61 61
62 62
63 63
64 64
65 65
Nama Petugas : Nama Petugas :