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NO. 1 NO.

2
dr. Galang Keanu, Sp.PD dr. Azzizul Hakki Sp. KK
SP. 3233 / 222 / 2020 Jl. Sukodono No. 9 Surabaya
Alamat : Jam Praktek : SP. 564 / 123 / 2021
Jl. Mojosari No. 1 Surabaya 06.00 - 10.00 wib Jam Praktek : 06.00 - 10.00 wib
Surabaya, Surabaya,

R/ Theophyllin 50mg R/ Atropin Sulfas 3 mg


Glucose 100mg SL qs
m f pulv dtd No. X m f pulv No. XII
S t dd pulv 1 pc S 2 dd pulv 1 pc

Pro : An. Anindya (7 th) Pro : An. Alya (3 th)

NO. 3 NO. 4
dr. Galang Keanu, Sp.PD dr. Azzizul Hakki Sp. KK
SP. 3233 / 222 / 2020 Jl. Sukodono No. 9 Surabaya
Alamat : Jam Praktek : SP. 564 / 123 / 2021
Jl. Mojosari No. 1 Surabaya 06.00 - 10.00 wib Jam Praktek : 06.00 - 10.00 wib
Surabaya, Surabaya,

R/ Acetosal 2.5 R/ Acetaminofen 150mg


Glucose ad 5 g Coffein 5mg
m f pulv No. X Glucose qs
S t dd pulv 1 pc m f pulv dtd No. X
S 2 dd pulv 1 pc

Pro : An. Riki (25 kg) Pro : An. Zarra (5 th)


No. 9 No. 10
dr. Aminuddin Sp. PD dr. Gavin Mada
(Spesialis Penyakit Dalam) (Praktek Umum)
SIP : 256 / IDI / 2015 SIP : 456 / IDI / 2016
Jl. Garuda 702 Surabaya Jl. Merpati 12 Surabaya
Senin - Jumat : 07.00 - 09.00 wib Senin - Jumat : 19.00 - 21.00 wib

iter 5x R/ Codein 10 mg
R/ INH 100mg Ambroxol tab 1/2
Pyridoxine HCl 10mg Dexamethasone tab 1/5
m f cap dtd No. XV m f cap dtd No. X
S 1 dd 1 S 3 dd 1
dihabiskan

Pro : An. Lyra (25 kg) Pro An. Leica (15 tahun)

No 11 No 12
dr. Aminuddin Sp. PD dr. Gavin Mada
(Spesialis Penyakit Dalam) (Praktek Umum)
SIP : 256 / IDI / 2015 SIP : 456 / IDI / 2016
Jl. Garuda 702 Surabaya Jl. Merpati 12 Surabaya
Senin - Jumat : 07.00 - 09.00 wib Senin - Jumat : 19.00 - 21.00 wib

R/ Aminophyllin 5 tab R/ Paracetamol tab 1/2


Prednison 5 tab GG tab 1/2
m f pulv da in cap No. XV CTM tab 1/2
S t dd 1 cap m f pulv dtd No. X
S t dd 1 pc

Pro : An. Lana (11 tahun) Pro : Luna (7 tahun)


NO. 13 NO. 14
dr. Aminuddin Sp. PD dr. Gavin Mada
(Spesialis Penyakit Dalam) (Praktek Umum)
SIP : 256 / IDI / 2015 SIP : 456 / IDI / 2016
Jl. Garuda 702 Surabaya Jl. Merpati 12 Surabaya
Senin - Jumat : 07.00 - 09.00 wib Senin - Jumat : 19.00 - 21.00 wib

R/ Acid Salycil 2% R/ Menthol 2.5


Acid Boric 3% Champora 1
Sulfur praec 1% Talc Venet ad 100
Talk ad 30
m p pulv adspers m p pulv adspers
Sue S bedak

--- da 20 ---

Pro : An. Flora Pro : An. Hana


Jl. Seruni 10 Surabaya Jl. Kemuning 18 Surabaya

NO. 15 NO. 16
dr. Aminuddin Sp. PD dr. Gavin Mada
(Spesialis Penyakit Dalam) (Praktek Umum)
SIP : 256 / IDI / 2015 SIP : 456 / IDI / 2016
Jl. Garuda 702 Surabaya Jl. Merpati 12 Surabaya
Senin - Jumat : 07.00 - 09.00 wib Senin - Jumat : 19.00 - 21.00 wib

R/ Acid Salycil 2 R/ Calamin 5


Balsam Peru 0.2 ZnO 1
MgO 10 Champora 0.5
ZnO 10 Menthol 0.5
Talcum ad 100 Talcum ad 100
m d S pulv adspers m f pulv adspers
Sue SUE

--- da 25 ---

Pro : An. Flora (15) Pro : An. Hana (12 th)


No. 19 No. 20
dr. Amiuddin Sp. PD dr. Gavin Mada
(Spesialis Penyakit Dalam) (Praktek Umum)
SIP : 256 / IDI / 2015 SIP : 456 / IDI / 2016
Jl. Garuda 702 Surabaya Jl. Merpati 12 Surabaya
Senin - Jumat : 07.00 - 09.00 wib Senin - Jumat : 19.00 - 21.00 wib

R/ Salep 2-4 20 R/ Camphora 1


Menthol 0.2 Ol. Cocos 1
m f ungt. Adeps lanae ad 20
SUE m f ungt
SUE

Pro : An. Meta Pro : Nn. Citra

No. 21 No. 22
dr. Amiuddin Sp. PD dr. Gavin Mada
(Spesialis Penyakit Dalam) (Praktek Umum)
SIP : 256 / IDI / 2015 SIP : 456 / IDI / 2016
Jl. Garuda 702 Surabaya Jl. Merpati 12 Surabaya
Senin - Jumat : 07.00 - 09.00 wib Senin - Jumat : 19.00 - 21.00 wib

R/ Iodii 2 R/ Ol. Iecoris Aseli 40


Kalii Iodii 3 Cera flava 10
Aqua dest 5 Vaselin flava 50
Ungt. Simplex 90 m.d.S.U.E
m.d.S.U.E
--- da 30 g --- --- da 25 g ---

Pro : Tn. Ferro Pro : Ny. Wanti


No. 23 No. 24
dr. Amiuddin Sp. PD dr. Gavin Mada
(Spesialis Penyakit Dalam) (Praktek Umum)
SIP : 256 / IDI / 2015 SIP : 456 / IDI / 2016
Jl. Garuda 702 Surabaya Jl. Merpati 12 Surabaya
Senin - Jumat : 07.00 - 09.00 wib Senin - Jumat : 19.00 - 21.00 wib

R/ Acid. Stearat 15 R/ Acid. Salycil 400mg


Cera alba 2 ZnO 5
Vaselin alba 8 Amylum Tritici 5
TEA 1.5 Vaselin flava ad 20
Propilen glikol 8 m. f. pasta
Aqua dest 65.6
m. f. ungt

--- da 25g---

Pro : Nn. Bianca Pro : An. Made

No. 25 No. 26
dr. Amiuddin Sp. PD dr. Gavin Mada
(Spesialis Penyakit Dalam) (Praktek Umum)
SIP : 256 / IDI / 2015 SIP : 456 / IDI / 2016
Jl. Garuda 702 Surabaya Jl. Merpati 12 Surabaya
Senin - Jumat : 07.00 - 09.00 wib Senin - Jumat : 19.00 - 21.00 wib

R/ Paracetamol 250 mg R/ Amoxicillin 200 mg


Codein 10 mg Phenobarbital 15 mg
Oleosachara Ment. Pip 200 mg Oleosachara Citri 200 mg
m f pulv dtd No. X m f pulv dtd No. X
S t dd 1 pulv S b dd 1 pulv
Pro : An. Wike (12 tahun) Pro : An. Jehan (10 tahun)
NO. 1 NO. 2
dr. Galang Keanu, Sp.PD dr. Azzizul Hakki Sp. OG
SP. 3233 / 222 / 2020 Jl. Sukodono No. 9 Surabaya
Alamat : Jam Praktek : SP. 564 / 123 / 2021
Jl. Mojosari No. 1 Surabaya 06.00 - 10.00 wib Jam Praktek : 06.00 - 10.00 wib
Surabaya, Surabaya,

R/ Piton - S No. II R/ Durabolin inj No. II


Simm Simm

Pro : Ny. Anindya (37 th) Pro : Ny. Alya (33 th)

NO. 3 NO. 4
dr. Galang Keanu, Sp.PD dr. Azzizul Hakki Sp. OG
SP. 3233 / 222 / 2020 Jl. Sukodono No. 9 Surabaya
Alamat : Jam Praktek : SP. 564 / 123 / 2021
Jl. Mojosari No. 1 Surabaya 06.00 - 10.00 wib Jam Praktek : 06.00 - 10.00 wib
Surabaya, Surabaya,

R/ Proviron No. XVIII R/ Progynova 28 No. XXX


S 1 dd 1 S 1 dd 1

Pro : Ny. Rika (40 th) Pro : Ny. Zarra (45 th)

NO. 5 NO. 6
dr. Galang Keanu, Sp.PD dr. Azzizul Hakki Sp. OG
SP. 3233 / 222 / 2020 Jl. Sukodono No. 9 Surabaya
Alamat : Jam Praktek : SP. 564 / 123 / 2021
Jl. Mojosari No. 1 Surabaya 06.00 - 10.00 wib Jam Praktek : 06.00 - 10.00 wib
Surabaya, Surabaya,
R/ Lynoral No. XV R/ Primolut N No. II
Suc S 1 dd 1

Pro : Ny. Zafrin (46 th) Pro : Ny. Reina (37 th)

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