DAFTAR STOK RUANG ALKES IGD

BULAN :

BULAN
NO NAMA ALKES JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath 16 10 pcs
2 Abbocath 26 10 pcs
3 Alkohol swab 10 pcs
4 Arm sling L 1 pcs
5 BTS OB 10 pcs
6 Elektrode 10 pcs
7 Feeding tube 3,5 1 pcs
8 Feeding tube 8 1 pcs
9 Foley Cath 14 5 pcs
10 Foley Cath 16 5 pcs
11 Foley Cath 18 5 pcs
12 Foley Cath 22 5 pcs
13 Foley Cath 24 5 pcs
14 Foley Cath 8 5 pcs
15 Gillete 10 pcs
16 Hansaplast 10 pcs
17 Leukoplast 7,5 x 4,5 1 roll
18 Masker Neb Anak 5 pcs
19 Masker Neb Dewasa 5 pcs
20 Masker Non Rebreathing Anak 5 pcs
21 Masker Non Rebreathing Dewasa 5 pcs
22 Maxiflow Anak 5 pcs
23 Maxiflow Dewasa 5 pcs
24 Mikro Tabung 2 pcs
25 Mucus Ext 3 pcs
26 Needle 25 10 pcs
27 Oropharyngeal 100 1 pcs
28 Oropharyngeal 80 1 pcs
29 Oropharyngeal 90 1 pcs
30 Otsucath 18 10 pcs
31 Otsucath 20 10 pcs
32 Otsucath 22 10 pcs
 BULAN
NO NAMA ALKES JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12
33 Otsucath 24 10 pcs
34 Otsuset Makro 10 pcs
35 Otsuset Mikro 10 pcs
36 Oxyflow Anak 5 pcs
37 Oxyflow Bayi 5 pcs
38 Oxyflow Dewasa 5 pcs
39 Perfusor Tubing White 3 pcs
40 Spalk 5 x 15 3 pcs
41 Spalk 5 x10 3 pcs
42 Stomach tube 14 3 pcs
43 Stomach tube 16 3 pcs
44 Stomach tube 20 3 pcs
45 Sucthion cath 6 3 pcs
46 Sucthion cath 8 3 pcs
47 Sucthion cath 10 3 pcs
48 Sucthion cath 12 3 pcs
49 Sucthion cath 14 3 pcs
50 Sucthion cath 16 3 pcs
51 Syringe 1 cc OM 10 pcs
52 Syringe 10 cc OM 10 pcs
53 Syringe 3 cc OM 10 pcs
54 Syringe 5 cc OM 10 pcs
55 Syringe 50 cc OM 5 pcs
56 Three Way 3 pcs
57 Urine bag 10 pcs
PJ Alkes Ruangan

PJ Farmasi
 DAFTAR STOK RUANG OBAT IGD
TAHUN :

BULAN
NO NAMA OBAT JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12
1 METAMIZOLE INJ 10 ampul
2 AMLODIPIN 10 MG 5 tablet
3 AMLODIPIN 5 MG 5 tablet
4 ASTIKA TAB 5 tablet
5 ASAM TRANEXAMAT INJ 250 MG 5 ampul
6 ASAM TRANEXAMAT INJ 500 MG 5 ampul
7 CAPTOPRIL 25 MG TAB 5 tablet
8 CITICOLIN 250 MG INJ 5 ampul
9 CITICOLIN 500 MG INJ 5 ampul
10 CLOPIDOGREL TAB 5 tablet
11 GENTAMYCIN CR 5 tube
12 INFUS ASERING 6 fls
13 INFUS D10 3 fls
14 INFUS D5 % 3 fls
15 INFUS D5 1/2 NS 3 fls
16 INFUS D5 1/4 NS 3 fls
17 INFUS FIMAHES 3 fls
18 INFUS KAEN 3B 3 fls
19 INFUS PZ 10 fls
20 INFUS RD 5 3 fls
21 INFUS RL 10 fls
22 ISDN TAB 5 tablet
23 KETOROLAC 3% INJ 10 ampul
24 LIDOCAIN INJ 10 ampul
25 ONDANCENTRON 4 MG INJ 5 ampul
26 ONDANCENTRON 8 MG INJ 5 ampul
27 PIRACETAM 1 GR INJ 3 ampul
28 PIRACETAM 3 GR INJ 3 ampul
29 PROPYRETIC 160 MG SUPP 5 supp
30 PROPYRETIC 80 MG SUPP 5 supp
31 PZ 25 ML 5 fls
32 RANITIDIN INJ 5 ampul
 BULAN
NO NAMA OBAT JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12
33 METOCLOPRAMIDE INJ 10 ampul
34 COMBIVEN NEBULE 5 respules
35 VENTOLIN NEBULE 5 respules
36 PROTOFEN SUPP 5 supp
37 PULIMCORT NEBULE 5 respules
38 TETAGAM INJ 1 vial
PJ Alkes Ruangan

PJ Farmasi
 DAFTAR EMERGENSI IGD

NO. NAMA OBAT JUMLAH ED

1 EPHINEPRINE INJ 2 AMPUL Nov-20
2 EPHEDRIN INJ 2 AMPUL Jul-21
3 DIAZEPAM INJ 1 AMPUL Sep-20
4 STESOLID 5 MG SUPP 1 SUPP
5 STESOLID 10 MG SUPP 1 SUPP Oct-21
6 DUMIN SUPP 1 SUPP
7 SIBITAL INJ 1 AMPUL Dec-21

DAFTAR EMERGENSI IGD

NO. NAMA OBAT JUMLAH ED NO. NAMA OBAT JUMLAH ED

1 ATROPIN SULFAS 2 AMPUL Feb-20 10 DOPAMIN INJ 2 AMPUL Jul-20
2 AMINOPHYLIN INJ 2 AMPUL Feb-22 11 PHENYTOIN INJ 10 AMPUL Aug-20
3 AMIODARON / TIARYT INJ 2 AMPUL Nov-20 12 FUROSEMID INJ 5 AMPUL Sep-20
4 DEXAMETHASONE INJ 5 AMPUL Oct-20 13 Ca GLUCONAS INJ 2 AMPUL Apr-21
5 DIPHENHIDRAMINE INJ 5 AMPUL Sep-21 14 NOREPINEPRINE INJ 2 AMPUL Apr-20
6 DIGOXIN INJ 2 AMPUL Aug-20 15 CEDOCARD INJ 1 AMPUL Nov-20
7 D40 % 5 FLS Feb-21
8 D10% 1 FLS Aug-22
9 MEYLON 2 FLS May-20
10 KCL 2 FLS May-20

DAFTAR EMERGENSI CODE BLUE

NO. NAMA OBAT JUMLAH ED

DAFTAR EMERGENSI KIT AMBULANCE 1 EPHINEPRINE INJ 2 AMPUL Mar-20
2 D40 % 3 FLS May-20
NO. NAMA OBAT JUMLAH ED 3 PZ 500 ML 1 FLS Sep-22
1 EPHINEPRINE INJ 2 AMPUL Mar-20 4 D 10 % 1 FLS Apr-20
2 D40 % 3 FLS Feb-21 5 WFI 25 ML 2 FLS Dec-20
3 PZ 500 ML 1 FLS Mar-22 6 RL 500 ML 1 FLS Mar-22
4 D 10 % 1 FLS Mar-21 7 DEXAMETHASONE INJ 2 AMPUL Dec-19
5 WFI 25 ML 2 FLS Dec-20
6 RL 500 ML 1 FLS Sep-21

DAFTAR EMERGENSI VK

NO. NAMA OBAT JUMLAH ED

DAFTAR EMERGENSI VK 1 OXYTOCIN INJ 8 AMPUL Sep-20
2 METHYLERGOMETRIN INJ 2 AMPUL Sep-22
NO. NAMA OBAT JUMLAH ED 3 EPHINEPRINE INJ 2 AMPUL Mar-20
1 Ca GLUCONAS INJ 1 AMPUL Apr-21
2 DEXAMETHASONE INJ 4 AMPUL Oct-20
3 DUVADILAN INJ 2 AMPUL Jun-20
4 ASAM TRANEXAMAT 500 MG INJ 1 AMPUL Sep-22
 5 GASTRUL TAB 4 TABLET Jun-20
6 D10 % 1 FLS Apr-20
7 Mg SO4 20 % 2 FLS Sep-22
8 Mg SO4 40 % 2 FLS Jun-20

DAFTAR EMERGENSI RADIOLOGI

NO. NAMA OBAT JUMLAH ED

1 FUROSEMIDE INJ 1 AMPUL Mar-20
2 LIDOCAIN INJ 1 AMPUL Sep-22
3 DEXAMETHASONE INJ 4 AMPUL Oct-20
4 ONDANCENTRON 4 MG INJ 2 AMPUL Jun-20
5 EPHINEPRINE INJ 1 AMPUL Mar-20
6 UDOPA INJ 4 TABLET Jun-20
7 ATROPIN SULFAS INJ 1 FLS Feb-20
8 DIPHENHIDRAMINE INJ 2 FLS Sep-21
 FORM SUPERVISI EMERGENSI

UNIT :
BULAN :

NO . NAMA OBAT JUMLAH ED KET

1 ATROPIN SULFAS INJ 2 AMPUL
2 AMINOPHYLIN INJ 2 AMPUL
3 AMIODARONE INJ ( TIARYT INJ ) 2 AMPUL
4 DEXAMETHASONE INJ 5 AMPUL
5 DIAZEPAM INJ 1 AMPUL
6 DIPHENHIDRAMINE INJ 5 AMPUL
7 DIGOXIN INJ 2 AMPUL
8 DOPAMIN INJ 2 AMPUL
9 EPHINEPRINE INJ 2 AMPUL
10 FENITOIN INJ 10 AMPUL
11 FUROSEMIDE INJ 5 AMPUL
12 Ca GLUCONAS INJ 2 AMPUL
13 D 40 % 5 FLS
14 D 10 % 1 FLS
15 MEYLON 2 FLS
16 STESOLID 10 MG SUPP 1 SUPP
17 STESOLID 5 MG SUPP 1 SUPP
18 DUMIN SUPP 1 SUPP
19 SIBITAL INJ 1 AMPUL
20 NOREPHINEPRINE INJ 2 AMPUL
21 KCL 2 FLS
22 CEDOCARD INJ 1 AMPUL
23 EPHEDRIN INJ 2 AMPUL

MOJOKERTO,

PETUGAS SUPERVISI PETUGAS UNIT

( ) ( )
 DAFTAR STOK RUANG ALKES EMERGENSI KIT AMBULANCE
TAHUN :

BULAN
NO NAMA ALKES JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12
1 INFUSET MAKRO 1 PCS
2 BTS OB 1 PCS
3 SYRINGE 1 CC OM 2 PCS
4 SYRINGE 3 CC OM 2 PCS
5 SYRINGE 5 CC OM 2 PCS
6 SYRINGE 10 CC OM 2 PCS
7 NASAL CANUL ANAK 1 pcs
8 NASAL CANUL DEWASA 1 pcs
9 OTSUCATH 18 1 pcs
10 OTSUCATH 20 1 pcs
11 OTSUCATH 22 1 pcs
12 OTSUCATH 24 1 pcs
13 HANSAPLAST 5 pcs
14 ALKOHOL SWAB 10 pcs
15 FOLEY CATH 14 1 PCS
16 FOLEY CATH 16 1 PCS
17 URINNE BAG 2 PCS
18 HAND GLOVE 3 PSG
19 SYRINGE 50 CC CATH TIP 1 PCS
20 MASKER REBREATHING ANAK 1 PCS
21 MASKER REBREATHING DEWASA 1 PCS
22 MASKER NON REBREATHING ANAK 1 PCS
23 MASKER NON REBREATHING DEWASA 1 PCS
24 GUEDEL MAYO 80 1 PCS
25 GUEDEL MAYO 100 1 PCS
26 SURGICAL MASK 5 pcs
27 LEUKOPLAST 5 CM X 4,5 M 1 ROLL
PJ Alkes Ruangan
PJ Farmasi
 DAFTAR STOK OBAT EMERGENSI KIT AMBULANCE
TAHUN :

BULAN
NO NAMA OBAT JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12
1 EPHINEPRINE INJ 2 AMPUL
2 D 40 % 3 FLS
3 D5% 1 FLS
4 PZ 500 ML 1 FLS
5 RL 500 ML 1 FLS
6 WFI 25 ML 2 FLS
PJ Alkes Ruangan
PJ Farmasi
 DAFTAR STOK RUANG ALKES EMERGENSI CODE BLUE
TAHUN :

BULAN
NO NAMA ALKES JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12
1 INFUSET MAKRO 1 PCS
2 BTS OB 1 PCS
3 SYRINGE 1 CC OM 2 PCS
4 SYRINGE 3 CC OM 2 PCS
5 SYRINGE 5 CC OM 2 PCS
6 SYRINGE 10 CC OM 2 PCS
7 NASAL CANUL ANAK 1 pcs
8 NASAL CANUL DEWASA 1 pcs
9 OTSUCATH 18 1 pcs
10 OTSUCATH 20 1 pcs
11 OTSUCATH 22 1 pcs
12 OTSUCATH 24 1 pcs
13 HANSAPLAST 5 pcs
14 ALKOHOL SWAB 10 pcs
15 FOLEY CATH 14 1 PCS
16 FOLEY CATH 16 1 PCS
17 URINNE BAG 2 PCS
18 HAND GLOVE 3 PSG
19 SYRINGE 50 CC CATH TIP 1 PCS
20 MASKER REBREATHING ANAK 1 PCS
21 MASKER REBREATHING DEWASA 1 PCS
22 MASKER NON REBREATHING ANAK 1 PCS
23 MASKER NON REBREATHING DEWASA 1 PCS
24 GUEDEL MAYO 80 1 PCS
25 GUEDEL MAYO 100 1 PCS
26 SURGICAL MASK 5 pcs
27 LEUKOPLAST 7.5 CM X 4,5 M 1 ROLL
PJ Alkes Ruangan
PJ Farmasi
 DAFTAR STOK OBAT EMERGENSI CODE BLUE
TAHUN :

BULAN
NO NAMA OBAT JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12
1 EPHINEPRINE INJ 2 AMPUL
2 DEXAMETHASONE INJ 2 AMPUL
3 D 40 % 3 FLS
4 D5% 1 FLS
5 PZ 500 ML 1 FLS
6 RL 500 ML 1 FLS
7 WFI 25 ML 2 FLS
PJ Alkes Ruangan
PJ Farmasi