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  • Form Data Sampling Kesesuaian Peresepan DGN Formularium

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    Tiara Febriani
    12 views16 pages
    This document is a form reporting drug availability data from a community health center in January 2019. It consists of a table listing the date of each drug procurement event, and whether any drugs procured were absent from the clinic's formulary. Of the 105 procurement events recorded, only one (on January 11th) included a drug, Basitracin, that was not in the formulary. The form is signed by the head of the health center and the pharmacy manager.

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    FORM DATA SAMPLING KESESUAIAN PERESEPAN DGN FORMULARIUM

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    This document is a form reporting drug availability data from a community health center in January 2019. It consists of a table listing the date of each drug procurement event, and whether any drugs procured were absent from the clinic's formulary. Of the 105 procurement events recorded, only one (on January 11th) included a drug, Basitracin, that was not in the formulary. The form is signed by the head of the health center and the pharmacy manager.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    12 views16 pages

    Form Data Sampling Kesesuaian Peresepan DGN Formularium

    Uploaded by

    Tiara Febriani
    This document is a form reporting drug availability data from a community health center in January 2019. It consists of a table listing the date of each drug procurement event, and whether any drugs procured were absent from the clinic's formulary. Of the 105 procurement events recorded, only one (on January 11th) included a drug, Basitracin, that was not in the formulary. The form is signed by the head of the health center and the pharmacy manager.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 16

    FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM

    BULAN : …JANUARI 2019……………………………………………………….


    NAMA JENIS OBAT YANG TIDAK TERSEDIA
    NO TANGGAL JUMLAH ITEM OBAT
    DALAM FORMULARIUM
    1 1/2/2019 0
    2 1/2/2019 0
    3 1/2/2019 0
    4 1/2/2019 0
    5 1/3/2019 0
    6 1/3/2019 0
    7 1/3/2019 0
    8 1/3/2019 0
    9 1/4/2019 0
    10 1/4/2019 0
    11 1/4/2019 0
    12 1/4/2019 0
    13 1/5/2019 0
    14 1/5/2019 0
    15 1/5/2019 0
    16 1/5/2019 0
    17 1/7/2019 0
    18 1/7/2019 0
    19 1/7/2019 0
    20 1/7/2019 0
    21 1/8/2019 0
    22 1/8/2019 0
    23 1/8/2019 0
    24 1/8/2019 0
    25 1/9/2019 0
    26 1/9/2019 0
    27 1/9/2019 0
    28 1/9/2019 0
    29 1/10/2019 0
    30 1/10/2019 0
    31 1/10/2019 0
    32 1/10/2019 0
    33 1/11/2019 Basitracin 1
    34 1/11/2019 0
    35 1/11/2019 0
    36 1/11/2019 0
    37 1/12/2019 0
    38 1/12/2019 0
    39 1/12/2019 0
    40 1/12/2019 0
    41 1/14/2019 0
    42 1/14/2019 0
    43 1/14/2019 0
    44 1/14/2019 0
    45 1/15/2019 0
    46 1/15/2019 0
    47 1/15/2019 0
    48 1/15/2019 0
    49 1/16/2019 0
    50 1/16/2019 0
    51 1/16/2019 0
    52 1/16/2019 0
    53 1/17/2019 0
    54 1/17/2019 0
    55 1/17/2019 0
    56 1/17/2019 0
    57 1/18/2019 0
    58 1/18/2019 0
    59 1/18/2019 0
    60 1/18/2019 0
    61 1/19/2019 0
    62 1/19/2019 0
    63 1/19/2019 0
    64 1/19/2019 0
    65 1/21/2019 0
    66 1/21/2019 0
    67 1/21/2019 0
    68 1/21/2019 0
    69 1/22/2019 0
    70 1/22/2019 0
    71 1/22/2019 0
    72 1/22/2019 0
    73 1/23/2019 0
    74 1/23/2019 0
    75 1/23/2019 0
    76 1/23/2019 0
    77 1/24/2019 0
    78 1/24/2019 0
    79 1/24/2019 0
    80 1/24/2019 0
    81 1/25/2019 0
    82 1/25/2019 0
    83 1/25/2019 0
    84 1/25/2019 0
    85 1/26/2019 0
    86 1/26/2019 0
    87 1/26/2019 0
    88 1/26/2019 0
    89 1/28/2019 0
    90 1/28/2019 0
    91 1/28/2019 0
    92 1/28/2019 0
    93 1/29/2019 0
    94 1/29/2019 0
    95 1/29/2019 0
    96 1/29/2019 0
    97 1/29/2019 0
    98 1/30/2019 0
    99 1/30/2019 0
    100 1/30/2019 0
    101 1/30/2019 0
    102 1/31/2019 0
    103 1/31/2019 0
    104 1/31/2019 0
    105 1/31/2019 0

    Total Item Obat Yang Tidak Tersedia Dalam Formularium 1

    Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

    dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm


    NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001
    FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM
    BULAN : FEBRUARI 2019………………………………………………………….
    NAMA JENIS OBAT YANG TIDAK TERSEDIA
    NO TANGGAL JUMLAH ITEM OBAT
    DALAM FORMULARIUM
    1 2/1/2019 0
    2 2/1/2019 0
    3 2/1/2019 0
    4 2/1/2019 0
    5 2/2/2019 0
    6 2/2/2019 0
    7 2/2/2019 0
    8 1/2/2019 0
    9 2/4/2019 0
    10 2/4/2019 0
    11 2/4/2019 0
    12 2/4/2019 0
    13 2/6/2019 0
    14 2/6/2019 0
    15 2/6/2019 0
    16 2/6/2019 0
    17 2/7/2019 0
    18 2/7/2019 0
    19 2/7/2019 0
    20 2/7/2019 0
    21 2/8/2019 0
    22 2/8/2019 0
    23 2/8/2019 0
    24 2/8/2019 0
    25 2/9/2019 0
    26 2/9/2019 0
    27 2/9/2019 0
    28 2/9/2019 0
    29 2/11/2019 0
    30 2/11/2019 0
    31 2/11/2019 0
    32 2/11/2019 0
    33 2/12/2019 0
    34 2/12/2019 0
    35 2/12/2019 0
    36 2/12/2019 0
    37 13-02-109 0
    38 2/13/2019 0
    39 2/13/2019 0
    40 2/13/2019 0
    41 2/14/2019 0
    42 2/14/2019 0
    43 2/14/2019 0
    44 2/14/2019 0
    45 2/15/2019 0
    46 2/15/2019 0
    47 2/15/2019 0
    48 2/15/2019 0
    49 2/16/2019 0
    50 2/16/2019 0
    51 2/16/2019 0
    52 2/16/2019 0
    53 2/18/2019 0
    54 2/18/2019 0
    55 2/18/2019 0
    56 2/18/2019 0
    57 2/19/2019 0
    58 2/19/2019 0
    59 2/19/2019 0
    60 2/19/2019 0
    61 2/20/2019 0
    62 2/20/2019 0
    63 2/20/2019 0
    64 2/20/2019 0
    65 2/21/2019 0
    66 2/21/2019 0
    67 2/21/2019 0
    68 2/21/2019 0
    69 2/22/2019 0
    70 2/22/2019 0
    71 2/22/2019 0
    72 2/22/2019 0
    73 2/23/2019 0
    74 2/23/2019 0
    75 2/23/2019 0
    76 2/23/2019 0
    77 2/25/2019 0
    78 2/25/2019 0
    79 2/25/2019 0
    80 2/25/2019 0
    81 2/26/2019 0
    82 2/26/2019 0
    83 2/26/2019 0
    84 2/26/2019 0
    85 2/27/2019 0
    86 2/27/2019 0
    87 2/27/2019 0
    88 2/27/2019 0
    89 2/28/2019 0
    90 2/28/2019 0
    91 2/28/2019 0
    92 2/28/2019 0

    Total Item Obat Yang Tidak Tersedia Dalam Formularium 0

    Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

    dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm


    NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001
    FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM
    BULAN : MARET 2019………………………………………………………….
    NAMA JENIS OBAT YANG TIDAK TERSEDIA
    NO TANGGAL JUMLAH ITEM OBAT
    DALAM FORMULARIUM
    1 3/1/2019 0
    2 3/1/2019 0
    3 3/1/2019 0
    4 3/1/2019 0
    5 3/2/2019 0
    6 3/2/2019 0
    7 3/2/2019 0
    8 3/2/2019 0
    9 3/4/2019 0
    10 3/4/2019 0
    11 3/4/2019 0
    12 3/4/2019 0
    13 3/5/2019 0
    14 3/5/2019 0
    15 3/5/2019 0
    16 3/5/2019 0
    17 3/6/2019 0
    18 3/6/2019 0
    19 3/6/2019 0
    20 3/6/2019 0
    21 3/8/2019 0
    22 3/8/2019 0
    23 3/8/2019 0
    24 3/8/2019 0
    25 3/9/2019 0
    26 3/9/2019 0
    27 3/9/2019 0
    28 3/9/2019 0
    29 3/11/2019 0
    30 3/11/2019 0
    31 3/11/2019 0
    32 3/11/2019 0
    33 3/12/2019 Basitracin 1
    34 3/12/2019 0
    35 3/12/2019 0
    36 3/12/2019 0
    37 3/13/2019 0
    38 3/13/2019 0
    39 3/13/2019 0
    40 3/13/2019 0
    41 3/14/2019 0
    42 3/14/2019 0
    43 3/14/2019 0
    44 3/14/2019 0
    45 3/15/2019 0
    46 3/15/2019 0
    47 3/15/2019 0
    48 3/15/2019 0
    49 3/16/2019 0
    50 3/16/2019 0
    51 3/16/2019 0
    52 3/16/2019 0
    53 3/18/2019 0
    54 3/18/2019 0
    55 3/18/2019 0
    56 3/18/2019 0
    57 3/19/2019 0
    58 3/19/2019 0
    59 3/19/2019 0
    60 3/19/2019 0
    61 3/20/2019 0
    62 3/20/2019 0
    63 3/20/2019 0
    64 3/20/2019 0
    65 3/21/2019 0
    66 3/21/2019 0
    67 3/21/2019 0
    68 3/21/2019 0
    69 3/22/2019 0
    70 3/22/2019 0
    71 3/22/2019 0
    72 3/22/2019 0
    73 3/23/2019 0
    74 3/23/2019 0
    75 3/23/2019 0
    76 3/23/2019 0
    77 3/25/2019 0
    78 3/25/2019 0
    79 3/25/2019 0
    80 25-03--2019 0
    81 3/26/2019 0
    82 3/26/2019 0
    83 3/26/2019 0
    84 3/26/2019 0
    85 3/27/2019 0
    86 3/27/2019 0
    87 3/27/2019 0
    88 3/27/2019 0
    89 3/28/2019 0
    90 3/28/2019 0
    91 3/28/2019 0
    92 3/28/2019 0
    93 3/29/2019 0
    94 3/29/2019 0
    95 3/29/2019 0
    96 3/29/2019 0
    97 3/29/2019 0
    98 3/30/2019 0
    99 3/30/2019 0
    100 3/30/2019 0
    101 3/30/2019 0

    Total Item Obat Yang Tidak Tersedia Dalam Formularium 1

    Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

    dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm


    NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001
    FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM
    BULAN : APRIL 2019………………………………………………………….
    NAMA JENIS OBAT YANG TIDAK TERSEDIA
    NO TANGGAL
    DALAM FORMULARIUM
    1 4/1/2019
    2 4/1/2019
    3 4/1/2019
    4 4/1/2019
    5 4/2/2019
    6 4/2/2019
    7 4/2/2019
    8 4/2/2019
    9 4/4/2019
    10 4/4/2019
    11 4/4/2019
    12 4/4/2019
    13 4/5/2019
    14 4/5/2019
    15 4/5/2019
    16 4/5/2019 Dextrofren sirup
    17 4/6/2019
    18 4/6/2019
    19 4/6/2019
    20 4/6/2019
    21 4/8/2019
    22 4/8/2019
    23 4/8/2019
    24 4/8/2019
    25 4/9/2019
    26 4/9/2019
    27 4/9/2019
    28 4/9/2019
    29 4/10/2019
    30 4/10/2019
    31 4/10/2019
    32 4/10/2019
    33 4/11/2019 Basitracin
    34 4/11/2019
    35 4/11/2019
    36 4/11/2019
    37 4/12/2019
    38 4/12/2019
    39 4/12/2019
    40 4/12/2019
    41 4/13/2019
    42 4/13/2019
    43 4/13/2019
    44 4/13/2019
    45 4/15/2019 Curbeplex
    46 4/15/2019
    47 4/15/2019
    48 4/15/2019
    49 4/16/2019
    50 4/16/2019
    51 4/16/2019
    52 4/16/2019
    53 3/17/2019
    54 3/17/2019
    55 3/17/2019
    56 3/17/2019
    57 3/18/2019
    58 3/18/2019
    59 3/18/2019
    60 3/18/2019
    61 4/20/2019
    62 4/20/2019
    63 4/20/2019
    64 4/20/2019
    65 4/22/2019
    66 4/22/2019
    67 4/22/2019
    68 4/22/2019
    69 4/23/2019
    70 4/23/2019
    71 4/23/2019
    72 4/23/2019
    73 4/24/2019
    74 4/24/2019
    75 4/24/2019
    76 4/24/2019
    77 4/25/2019
    78 4/25/2019
    79 4/25/2019
    80 4/25/2019
    81 4/26/2019
    82 4/26/2019
    83 4/26/2019
    84 4/26/2019
    85 4/27/2019
    86 4/27/2019
    87 4/27/2019
    88 4/27/2019
    89 4/29/2019
    90 4/29/2019
    91 4/29/2019
    92 4/29/2019
    93 4/30/2019
    94 4/30/2019
    95 4/30/2019
    96 4/30/2019
    Total Item Obat Yang Tidak Tersedia Dalam Formularium

    Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

    dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm


    NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001
    DENGAN FORMULARIUM
    ………………………….

    JUMLAH ITEM OBAT

    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    1
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    1
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    1
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0
    0

    Pengelola Obat Puskesmas

    Tiara Febriani, Amd. Farm


    NIP. 19980203 201903 2 001
    FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM
    BULAN : MEI 2019………………………………………………………….
    NAMA JENIS OBAT YANG TIDAK TERSEDIA
    NO TANGGAL JUMLAH ITEM OBAT
    DALAM FORMULARIUM
    1 5/2/2019 0
    2 5/2/2019 0
    3 5/2/2019 0
    4 5/2/2019 0
    5 5/3/2019 0
    6 5/3/2019 0
    7 5/3/2019 0
    8 5/3/2019 0
    9 5/4/2019 0
    10 5/4/2019 0
    11 5/4/2019 0
    12 5/4/2019 0
    13 5/6/2019 0
    14 5/6/2019 0
    15 5/6/2019 0
    16 5/6/2019 0
    17 5/7/2019 0
    18 5/7/2019 0
    19 5/7/2019 0
    20 5/7/2019 0
    21 5/8/2019 0
    22 5/8/2019 0
    23 5/8/2019 0
    24 5/8/2019 0
    25 5/9/2019 0
    26 5/9/2019 0
    27 5/9/2019 0
    28 5/9/2019 0
    29 5/10/2019 0
    30 5/10/2019 0
    31 5/10/2019 0
    32 5/10/2019 0
    33 5/11/2019 Basitracin 1
    34 5/11/2019 0
    35 5/11/2019 0
    36 5/11/2019 0
    37 5/13/2019 0
    38 5/13/2019 0
    39 5/13/2019 0
    40 5/13/2019 0
    41 5/14/2019 0
    42 5/14/2019 0
    43 5/14/2019 0
    44 5/14/2019 0
    45 5/15/2019 0
    46 5/15/2019 0
    47 5/15/2019 0
    48 5/15/2019 0
    49 5/16/2019 0
    50 5/16/2019 Curbiplex 1
    51 5/16/2019 0
    52 5/16/2019 0
    53 5/17/2019 0
    54 5/17/2019 0
    55 5/17/2019 0
    56 5/17/2019 0
    57 5/18/2019 0
    58 5/18/2019 0
    59 5/18/2019 0
    60 5/18/2019 0
    61 5/20/2019 0
    62 5/20/2019 0
    63 5/20/2019 0
    64 5/20/2019 0
    65 5/21/2019 0
    66 5/21/2019 0
    67 5/21/2019 0
    68 5/21/2019 0
    69 5/22/2019 0
    70 5/22/2019 0
    71 5/22/2019 0
    72 5/22/2019 0
    73 5/23/2019 0
    74 5/23/2019 0
    75 5/23/2019 0
    76 5/23/2019 0
    77 5/24/2019 0
    78 5/24/2019 0
    79 5/24/2019 0
    80 5/24/2019 0
    81 5/25/2019 0
    82 5/25/2019 0
    83 5/25/2019 0
    84 5/25/2019 0
    85 5/27/2019 0
    86 5/27/2019 0
    87 5/27/2019 0
    88 5/27/2019 0
    89 5/28/2019 0
    90 5/28/2019 0
    91 5/28/2019 0
    92 5/28/2019 0
    93 5/29/2019 0
    94 5/29/2019 0
    95 5/29/2019 0
    96 5/29/2019 0
    97 5/31/2019 0
    98 5/31/2019 0
    99 5/31/2019 0
    100 5/31/2019 0

    Total Item Obat Yang Tidak Tersedia Dalam Formularium 2

    Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

    dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm


    NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001

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