format bbk - 2016

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DINAS KESEHATAN KABUPATEN BANDUNG D

BUKTI BARANG KELUAR ( BBK )

NO : ...

Diserah

Pesanan dari : ......................................................................... Pesana

Tanggal :........................................................ No : 7 Tanggal

No Nama Barang Banyaknya Keterangan No

1

Ambroxol Syr 60 41

Ambroxol Tab !00 4

" Amlodipin 10 "00 4"

4 Amlodipin ! 1#0 44

! Amoxi$illin !00 !00 4!

6 Amoxi$illin !0 "00 46

% Amoxi$illin Syr %0 4%

# An&asid Syr 100 4#

' An&asid Tab 1!00 4'

10 (e&ason Salep 10 !011 )e*adroxil Syr 0 !1

1 )ap&opril 1+! 400 !

1" )ap&opril ! "00 !"

14 )T, 1!00 !4

1! )o&rimoxa-ole Syr 0 !!

16 )o&rimoxa-ole Deasa 1000 !6

1% Dexame&hasone Tab !00 !%

1# /ry&hromy$ine !0 00 !#

1' Domperidone Tab "00 !'

0 Ae&hanolm %0 1 2 6 60

1 Orali& 00 61

3en&amy$in S.. !0 6

" 3en&amy$in 5n. 0 6"

4 3libenklamid 00 64

! 3lkosa ! 40 6!

6 7ydro$or&isone S.. 10 66

% 5bpro*en 400 1!00 6%

# )hlorampheni$olm 00 6#

' )hlorampheni$olm S.,. 4 6'

"0 2ido$ain %0 %0

"1 ,y$ona-ole S.. !

" ,e&ronida-ole !00 400

"" 8i&amin Syr "0"4 8i&amin Tab 400

NO : 007!ANPK"I#0$%

Diserahkan kepada : Pera&atan

8/19/2019 Format Bbk - 2016

2/152

"! Na&rim (i$arbona& 1000

"6 Na&rim Di$lo*ena$ 00

"% Na)l 5n*s 40

"# ,olagi& "00

"' O(7 "0

40 Pon*l Syr !

Arasari+ # ,ei 01!

9ang menyerahkan 9ang menerima 9ang m

.................................. ............................ .Sns

DINAS KESEHATAN KABUPATEN BANDUNG



Tanggal :........................................................ No : $ Tanggal


1

Amoxi$yllin !00 mg "00 1

Dopler 3elly !

" oley )a&he&her No. 1# 10 "

4 5n*se& Deasa 0 4

! 5.8. )a&he&her No. 1# 0 !

6 ;7 O&o& 16 $m "0 %

# ,asker 100

' ,e&hergin 5n. 0

10 ,e&ronida-ole !00 mg 100

11 ,isopros&ol !0

1 ,l&i?i&amin Tab 00

1" Para$e&amol Tab 100

14 Plas&ik (esar

1! Sarng Tangan NS 400

16 Sarng Tangan S&eril !0

1% Tran*se& !

1# @mbilikal lem 0

NO : .001;ANPK"$#0$% NO : ...

Diserahkan kepada : P'NED Diserah

8/19/2019 Format Bbk - 2016

3/152

1' @nderpad 0

0 @rine (ag 1

1

"

4

!

6

%

#

'

"0

"1

"""

"4

"!

"6

"%

"#

"'

40

Arasari+ .1" ;anari 016


Snsn Smirah (dn /is .Sns




Tanggal :........................................................ No : Tanggal


1 1

NO : .........*"PK"+#0$, NO : ...

Diserahkan kepada : P-.t- /arga-y- Diserah

8/19/2019 Format Bbk - 2016

4/152

" "

4 4

! !

6 6

% %

# #

' '

10 10

11 11

1 1

1" 1"

14 14

1! 1!16 16

1% 1%

1# 1#

1' 1'

0 0

1 1

" "

4 4

! !

6 6

% %

# #

' '

"0 "0

"1 "1

" "

"" ""

"4 "4

"! "!

"6 "6

"% "%

"# "#

"' "'

40 40

Arasari+ # ,ei 01!


Snsn Smirah 2$iano .Sns

8/19/2019 Format Bbk - 2016

5/152




Tanggal :........................................................ No : % Tanggal


1

Ambroxol syr 10 1

Ambroxol &ab 100

" Amlodipin 10 60 "

4 Amoxi$yllin !00 "00 4

! Amoxi$yllin Syr 10 !

6 An&a$ida Syr 10 6

% An&a$ida Tab 00 %

# A$y$lo?ir S.. ! #

' (e&ason S.. " '

10 )ap&ropil 1+! 00 10

11 )o&rimoxa-ole Syr 10 11

1 )T, "00 1

1" Dexame&hasone Tab 00 1"14 Ae&hanolm %0 1 2 1 14

1! 3ly$eril 3aia$ola&e !00 1!

16 7ydro$or&isone S.. 10 16

1% 5n*se& Deasa 10 1%

1# 5.8. )a&he&her No. 1# ! 1#

1' )al$im 2a$&as !00 1'

0 asa S&eril 16 > 16 $m 0 0

1 )hlorampheni$olm S.,. ! 1

,e&hyl /rgome&rin 5n. 10

" ,$os /x&ra$&or ! "

4 ,l&i?i&amin Tab 100 4

! O(7 10 !

6 Oxy&e&ra$y$line S.. ! 6

% Oxy&e&ra$y$line S.,. ! %

# Oxy&osin 5n. 10 #

' Para$e&amol Tab 1000 '

NO : .........*"PK"+#0$, NO : ...

Diserahkan kepada : Po.ke.1e. /arga-y- Diserah

8/19/2019 Format Bbk - 2016

6/152

"0 Para$e&amol Drop ! "0

"1 Para$e&amol Syr ! "1

" Ples&er 1 "

"" Pon*l Syr 10 ""

"4 Pralex Tab !0 "4

"! ani&idine Tab 00 "!

"6 inger 2ak&a& 5n*s 0 "6

"% Sarng Tangan NS 100 "%

"# errosi Sl*as "0 "#

"' @nderpad 10 "'

40 8i&amin ( )ompleks Tab 100

41 8i&amin ) !0 mg Tab !00

4 8i& mg>ml 5n. ! 9ang m

4" 8i&amin Syr

8/19/2019 Format Bbk - 2016

7/152

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8/152


Tanggal :........................................................ No : $0 Tanggal


1

Ambroxol &ab 1#00 41

Ambroxol syr 140 4

" Amlodipin 10mg 1!"0 4"

4 Amoxy$illin !00mg 6"00 44

! Amoxy$illin !0mg 4600 4!

6 Amoxy$illin syr "00 46

% An&algin !00mg %00 4%

# An&a$id syr 4%! 4#

' Chi&e*eld sk 1 4'

10 Ansol spp 0 !0

11 As ,e*enama& !00mg 00 !1

1 A$y$lo?ir sk 1! !

1" A-y&romi$in !00 100 !"

14 )ap&opr !mg 400 !4

1! )T, "00 !!

16 o&rim syr !!

1% o&rim D 00

1# Dexame& ""00

1' Dia- mg 00

0 /&hanol %0 100ml 60

1 enok &k 14

8i& &ab 100

" rosemid %0

4 3en&ian ?iole& "0

! 7alop 0.!mg 00

6 7idro sk 1%

% 5bp syr 600

# 5bp 400mg "00

' alk 1000

"0 ke&okona-ole 00

"1 loram*e !0mg 1400

" ,e&ro !00mg '00"" ,e&hyl pred !00

"4 ,l&i?i&amin kap 1600

"! Ni*edipin 100

"6 aominal syr #0

"% Oxy&e&ra sk #

"# Oxy&e&ra sm 6#

"' Para$e& &ab 1%#00

40 Para$e& drop !6

Arasari+ 0 ,ei 01!

8/19/2019 Format Bbk - 2016

9/152

9ang menyerahkan 9ang menerima 9ang

Snsn Smirah Snsn .

8/19/2019 Format Bbk - 2016

10/152

INAS KESEHATAN KABUPATEN BANDUNG


...........................................................................................................

kan kepada : ....................................................................................

n dari : ..............................................................................................

:..................................................................... No.................

Nama Barang Banyaknya Keteran

gan

Pon*l Tab 00

Omepra-ole "00

Oxy&e&ra$y$line S.. !

Ondanse&rone 5n. !0

Para$e&amol Drop 11

Para$e&amol Syr %!

Para$e&amol Tab "000

Prednisone ! 1000

ani&idine 1!0 1000

Salb&amol "00Salb&amol Nebli-er 0

inger 2ak&as 5n*s !00

8i& (1 5n 1

8i& ( )ompleks 100

oley )a&he&her No.1# %

5.8. )a&he&her No.1# 0

5.8. )a&he&her No. 0 !0

5.8. )a&he&her No. 0

5.8. )a&he&her No. 4 !0

asa 4 x 10 $m 100

asa 16 x 16 $m 1!0

,asker 00

Ples&er

Sarng Tangan NS , 400

Silk 60

Plas&ik e$il 0

7ipa*ix 10

Ondanse&ron 5n. !0

8/19/2019 Format Bbk - 2016

11/152

Arasari+ ..# ,ei 01!

enyerahkan 9ang menerima

Smirah obby



n dari : ..............................................................................................

:.....................................................................


gan

2idokain in 1"0

,asker 100

Sarng &angan NS S "00

Sarng &angan NS , 00

Ae&hanolm %0 1 2

3lkosa ! 5n*s 10

Spi& " ml 100

.00 ;ANPK"$#0$%

kan kepada : .P'L GIGI

No.**#

8/19/2019 Format Bbk - 2016

12/152

Arasari+ ..1" ;anari 016


Smirah Dina



n dari : ..............................................................................................

:.....................................................................

Nama Barang Banyaknya Keterangan

Amlodipine 10 60

.............."PK"+#0$,

kan kepada : .P-.t- Baro.

No.**,

8/19/2019 Format Bbk - 2016

13/152

Amoxi$yllin !00 00

Amoxi$yllin Syr !

An&asida Syr 10

An&algin !00 00

)ap&ropil 1+! 100

)ap&ropil ! 00

)T, 00

Dexame&hasone Tab "00

3li$eryl 3aia$ola&e !00

7ydro$hloro&hi-ide ! mg 100

5bpro*en 400 mg 00

)al$im 2a$&as !00 mg 00

)hlorampheni$ol S.,. !

,e&ronida-ole !00 100O(7 10

Orali& !

Para$e&amol Tab 400

Para$e&amol Syr !

Pon*l Syr 10

Pralex Tab !0

Salb&amol mg &ab !0

errosi Sl*as 0

8i&amin ) !0 mg 00

8i&amin Syr

8/19/2019 Format Bbk - 2016

14/152



n dari : ..............................................................................................

:.....................................................................


Ambroxol syr 10

Ambroxol &ab 100

Amoxi$yllin !0 100

Amoxi$yllin !00 "00

Amoxi$yllin Syr 10

An&a$ida Syr 10

An&a$ida Tab 00

An&algin !00 100

(e&ason S.. !

Na&rim (i$arbona& 00

)o&rimoxa-ole 4#0 mg 100

)o&rimoxa-ole Syr 10

)T, "00Dexame&hasone Tab 100

Ae&hanolm %0 1 2 1

3en&amy$in S.. !

3ly$eril 3aia$la&e !00

5bpro*en 400 mg 100

asa S&eril 16 > 16 $m 10

,e&hyil /rgome&rin 5n. !

,e&ronida-ole !00 mg 100

,l&i?i&amin Tab. 100

O(7 10

Oxy&er&asiklin S.. !

Oxy&osin 5n. !

Para$e&amol Tab "00

Para$e&amol Drop !

Para$e&amol Syr 0

Pon*l Syr 10

.............."PK"+#0$,

kan kepada : *Po.ke.1e. "ang-n !aya

No.**7

8/19/2019 Format Bbk - 2016

15/152

Pralex Tab !0

ani&idine &ab 100

Salb&amol mg Tab !0

errosi Sl*a& 1!

8i&amin (1 Tab 1000

8i&amin ( )omplex Tab 400

8i&amin ) !0 mg Tab "00

8i&amin mg > ml 5n. 10

8i&amin Syr

8/19/2019 Format Bbk - 2016

16/152

)o&rimoxa-ole Syr 10

)T, 00

Dexame&hasone Tab 00

3ly$eril 3aia$ola&e !00

7ydro$or&isone S.. 10

5bpro*en 400 mg 100

)al$im 2a$&as !00 mg !00

)hlorampheni$ol S.,. 10

,e&hyl /rgome&rin 5n. 10

,e&hyl /rgome&rin Tab !0

,e&ronida-ole !00 mg 100

,l&i?i&amin Tab 100

Ni*edipine 10 mg &ab !0

Nys&a&ine 8agina 0O(7 1!

Orali %!

Oxy&e&ra$y$line S.. !

Oxy&osin 5n. 10

Para$e&amol Tab 600

Para$e&amol Syr 0

Pon*l Syr 10

Pon*l Tab 100

ani&idine Tab 100

inger 2ak&as 5n*s 0

Salb&amol mg &ab !0

Salep 4 !

Sarng Tangan S&eril 10

errosi Sl*a& "0

8i&amin (1 Tab 1000

8i&amin ( )ompleks Tab 400

8i&amin ) !0 mg Tab "00

8i&amin mg > ml 5n. 10

8i&amin Syr

8/19/2019 Format Bbk - 2016

17/152

n dari : ..............................................................................................

:.....................................................................


Piroxikam 600

(e&adine "00ml !

Pred "00

ani&idin &ab 00

Salb& mg #00

4 sk #

(iopl$en&on sk 10

Sim?as&a&in 100

)endo &m '4

8i& (1 &ab "000

Bink syr 100

8i& () &ab ""00

,asker !0

Polybag 7> 6,ar

Arasari+ ..0 ,ei 01!

No.*

8/19/2019 Format Bbk - 2016

18/152

menyerahkan 9ang menerima

nsn Smirah Snsn

8/19/2019 Format Bbk - 2016

19/152



N' : % A6PK"+I#0$,******************************************************* N' : ***

D.era8kan ke6a1a : **P-.t- /arga-y-****************************** D.era


Tanggal :........................................................ No : ....1 Tanggal


1 Al2oprinol 00 1

Ambroxol syr "0 " Ambroxol &ab 00 "

4 Amlodipin 10mg '0 4

! Amoxi$illin !00mg !00 !

6 Amoxi$illin !0mg 00 6

% Amoxi$illin syr 0 %

# An&a$id syr "0 #

' As me*e !00mg 00 '

10 A$y$lo?ir sk ! 10

11 )ap&opril 1.!mg 00 11

1 )ap&opril !mg 00 1

1" )T, !00 1"

14 )o&rim syr ! 14

1! )o&rim &ab 100 1!

16 Dexame& !00 16

1% 8i& 100 1%

1# rosemide !0 1#

1' 7idro sk 10 1'

0 ,e&ronida-ole !00mg 100 0

1 (i$na& 100 1

Ni*edipin !0

" Oxy&e&ra sk 10 "

4 Oxy&e&ra sm 10 4

! Para$e&amol #00 !

6 Piroxi$am 0mg 00 6

% (e&adine "00ml 1 %

# Pred 00 #

' ani&idin "00 '

"0 Salb& mg 100 "0

"1 4 sk 10 "1

" Sim?as&a&in !0 "

8/19/2019 Format Bbk - 2016

20/152

"" )endo &m ! 33

"4 8i& () !00 34

"! ,asker !0 35

"6 assa 4x!$m 10

"% Plas&ik klip k 4 pak

Arasari+ ..! ;ni 01!


..Snsn Smirah 2$iano ....Sns



N' : 7 A6PK"+I#0$,******************************************************* N' : ***

D.era8kan ke6a1a : **Po.ke.1e. /arga-y-************************ D.era


Tanggal :........................................................ No : ...." Tanggal


1 Amoxi$illin !00mg "00 1

,e&ronida-ole !00mg 100

" Para$e&amol 1000 "

4 As me*e !00mg 100 4

! An&a$id syr "0 !

6 ani&idin 100 6

% Bink &ab 100 %

# )T, 00

' alk !00

10 i?anol

11 Alkohol %0 100ml !

1 (e&adine "00ml 1

1" assa s&eril 16x16 1!

14 kapas !0mg 1

1! Oxy&e&ra sm !

16 7idro sk 10

1% Ambroxol syr 1!

8/19/2019 Format Bbk - 2016

21/152

1# Abo$a&h no.1# !

1' Oxy&era sk !

0 @nderpad 10

1 Spi& 1ml 100

8i&alex &ab 100

" Sabn $air 1

4 Bink &ab 100

!

6

%

#

'

"0

"1

"

""

"4

"!

"6

Arasari+ ..! ;ni 01!


..Snsn Smirah (dn a&ih ....Sns



N' : ,0 A6PK"+I#0$,******************************************************* NO : ....

D.era8kan ke6a1a : **Pera&atan******************************************* Diserah


Tanggal :........................................................ No : ....!........ Tanggal


1 Al2oprinol 100 41

Ambroxol syr !0 4

8/19/2019 Format Bbk - 2016

22/152

" Ambroxol &ab "00 4"

4 Amlodipin 10mg "60 44

! Amoxi$illin !00mg 00 4!


% Amoxi$illin syr !! 4%

# An&a$id syr 1!0 4#

' As me*e !00mg 600 4'

10 A$y$lo?ir sk ! !0

11 A$y$lo?ir &ab 100 !1

1 )ap&opril 1.!mg 00 !

1" $ap&opril !mg 100 !"

14 )T, 1000 !4

1! )o&rim syr 0 !!

16 )o&rim &ab !00 !6

1% Dexame& &ab #00 !%

1# Dia-epam re$&al ! !#

1' Dia-epam in "0 !'

0 enok &k 10 60

1 Alkohol %0 100ml 10 61

Orali& 100 6

" 7idro sk 0 6"4 alk !00mg !00

! loram*eni$ol !0mg 1000

6 Piroxi$am 0mg 00

% 2ido$ain in '0

# ,e&o$lorpram in 66

' ,e&ronida-ole !00mg 00

"0 8i&alex $ap 00

"1 ,e&hyl Ped 00

" (i$na& '00

"" Oxy&e&ra sk 4

"4 Oxy&era sm 10

"! Para$e& !00mg %00

"6 Piroxi$am 0mg 00

"% Omepra-ol &ab 60

"# (e&adine "00ml ""' ani&in &ab 1000

40 Bink syr !

Arasari+ ..6 ;ni 01!


8/19/2019 Format Bbk - 2016

23/152

............................... ..................................... ....Sns



N' : ,$ A6PK"+I#0$,******************************************************* N' : **

D.era8kan ke6a1a : **Pone1*********************************************** D.era


Tanggal :........................................................ No : ****%******** Tanggal



As me*e !00mg 100

" S 100 "

4 ,e&hergin &ab 100 4

! ,e&ronida-ole !00mg 100 !

6 ,l&i?i&amin kaps 00 6

% Oxy&e&ra sm 10 %

# Para$e&amol !00mg !00 #' (e&adine "00ml '

10 2 in*s 0 10

11 er&as @S3 rol (2@D 11

1 Spi& 1ml 100 1

1" Spi& " ml 00 1"

14 )a&g& 4 (2@D 14

1! 5n*se& deasa 0 1!

16 58.$a&h No+1# 0 (2@D 16

1% 58.$a&h No+0 0 (2@D 1%

1# apas !0gr 1 1#

1' assa s&eril 16x16 "0 1'

0 ,asker 100 0

1 Sarng &angan s&eril %.! !0 (2@D 1

@nderpad 10

" Amlodipin 10mg "0 "

4 Spi& !0ml (2@D 4

! !

6

%

#

'

"0

8/19/2019 Format Bbk - 2016

24/152

"1

"

""

"4

"!

"6

"%

"#

"'

40



..Snsn Smirah........... ...(dn /is.................. ....Sns



N' : ,# A6PK"+I#0$,******************************************************* N' : **

D.era8kan ke6a1a : **P-.t- "ekar3aya******************************* D.era


Tanggal :........................................................ No : ****2******** Tanggal


1 Ambroxol syr 1! 1

Ambroxol &ab 100

" Amlodipin 10mg 60 "


! Amoxi$illin !0mg 00 !

6 Amoxi$illin syr 10 6

% An&algin !00mg 100 %

# An&a$id syr 10 #

' As me*e !00mg 100 '

10 A$y$lo?ir sk ! 10

11 A$y$lo?ir &ab !0 11

1 )ap&opril 1.!mg 100 1

1" )ap&opril !mg 100 1"

14 )T, 100 14

1! o&rim syr 1! 1!

8/19/2019 Format Bbk - 2016

25/152

16 o&rim &ab 100 16

1% Dexame& 00 1%

1# i?anol 1#

1' /&anol %0 100ml 1'

0 rosemid !0 0

1 Orali& 100 1

7idro sk 10

" alk !00mg !00 "

4 ,e&ro !00mg 100 4

! (i$na& 00 !

6 Ni*edipin !0

% Oba& diare syr 1!

# Para$e& !00mg 1000

' Pred 00

"0 ani& &ab 100

"1 Salb& mg 100

" )endo &m !

"" 8i& () !00

"4 loram*eni$ol syr 10

"!

"6"%

"#

"'

40



..Snsn Smirah........... ...(dn 7 esih.................. ....Sns

8/19/2019 Format Bbk - 2016

26/152



N' : , A6PK"+I#0$,******************************************************* N' : *

D.era8kan ke6a1a : **Loket o4at**************************************** D.era

Pesanan dari : ......................................................................... Pesan

Tanggal :........................................................ No : ****$0**** Tangg


1 Ambroxol syr 100 41

Ambroxol &ab 100 4

" Aminop &ab 100 4"


! Amoxi$illin !00mg !'006 Amoxi$illin syr 1!

% An&algin !00mg '00

# An&a$id syr "!

' /rgo&amin 100

10 8i& ) 000

11 As me*e 600

1 A$y$lo?ir sk 10

8/19/2019 Format Bbk - 2016

27/152

1" A$y$lo?ir &ab 1!0

14 )ap&opril 1.! %00

1! )ap&opril ! !00

16 )T, "000

1% o&rim syr 100

1# ko&rim &ab "001' Dexame& "400

0 Dia-ep &ab 00

1 /ry&rom !0mg 400

8i& &ab 00

" ros &ab 100

4 Orall& "00

! 5SS 100

6 7)T 1000

% 7idro sk %'

# alk !00mg 000

' ,e&hergin &ab !0

"0 ,e&ro !00mg "00

"1 ,e&hyl pred "00

" Oxy&e&ra sk #1

"" Oxy&e&ra sm 60"4 Para$e& !00mg %000

"! Piroxi$am 600

"6 (e&adine "00ml

"% Pred &ab 600

"# ani& &ab "00

"' Salb& mg 600

40 Sim?as& &ab 1!0

Arasari+ ..1! ;ni 01!


................................ .................................. ....Sn

8/19/2019 Format Bbk - 2016

28/152



******7 A6PK"+I#0$,

kan ke6a1a : ****P-.t- Baro.

n dari : ..............................................................................................

:..................................................................... No : ......................


gan

Ambroxol syr 0

Ambroxol &ab 00Amlodipin 10mg 60

Amoxi$illin !00mg 100

An&a$id syr 0

As me*e !00mg 100

)ap&opril !mg 100

)o&rim syr 10

Dexame& 100

7idro sk !

Para$e& &ab 00

ani&idin &ab 100

)endo &m !

8i& () !00

8/19/2019 Format Bbk - 2016

29/152

Arasari+ ...! ;ni 01!........................

nyerahkan 9ang menerima

n Smirah (dn 5nne..........



******2 A6PK"+I#0$,

kan ke6a1a : ****Po Gg

n dari : ..............................................................................................

:..................................................................... No : ...4...................


gan

apas !0mg

Alkohol %0 100ml 10

(e&adine "00ml 1

Spi& "ml 100

2ido$ain in '0

,asker !0

Albo&hyl $ons& 1

8/19/2019 Format Bbk - 2016

30/152

Arasari+ ...! ;ni 01!........................


n Smirah 2ina...................



.........................................................................................................

kan kepada : ...................................................................................

n dari : ..............................................................................................

:..................................................................... No : .....................


gan

Salb&amol mg 00

4 sk !

8/19/2019 Format Bbk - 2016

31/152

(iopla$en&on elly 10

8i& (1 in 100

)endo &m 10

8i& () %00

Spi& "ml 00

)a&g& 1" (2@D

5n*se& anak !0

5n*se& deasa 100

58.)a&h No.1# 0 (2@D

58.)a&h No.0 0 (2@D

58.)a&h No. 40 (2@D

58.)a&h No.4 40 (2@D

apas

assa glng 1

,asker !0

Silk 4 (2@D

2oma&lle 0

Plas&ik k ! pak (2@D

Plas&ik ( 1 pak (2@D

@rine bag 10 (2@D

Arasari+ ...6 ;ni 01!........................


8/19/2019 Format Bbk - 2016

32/152

n Smirah obby



#A6PK"+I#0$,**************************************************************************

kan ke6a1a : ***Po.ke.1e. "ang-n3aya***************************************

n dari : ..............................................................................................

:..................................................................... No : *7******************


gan

Ambroxol syr 0


An&a$id syr 10

As me*e !00mg 100

S 0

)T, 00

/&anol %0 100ml !

Orali& 1007idro sk 10

,e&ro !00mg 100

Oxy&e&ra sm !

Para$e& !00mg 600

8i& (6 1000

ani& &ab 100

)endo &m !

8i& () "00

apas 1

assa 4x10 10

Abo$a&h no 1# !

)a&g& !

8/19/2019 Format Bbk - 2016

33/152

Arasari+ ...10 ;ni 01!........................


n Smirah (dn 5mas........



9A6PK"+I#0$,**************************************************************************

kan ke6a1a : ***Po.ke.1e. "ekar3aya*****************************************

n dari : ..............................................................................................

:..................................................................... No : *5******************


gan

Amoxi$illin !00mg "00

Para$e& !00mg 400

As me*e !00mg 100

An&a$id syr 1!

Bink &ab 100

8i& () !00

S 0

assa s&eril 16x16 10

alk !00mg !00

8/19/2019 Format Bbk - 2016

34/152

Arasari+ ...10 ;ni 01!........................


n Smirah (dn 7 esih.......

8/19/2019 Format Bbk - 2016

35/152



***********************************************************************************************************

8kan ke6a1a : ********************************************************************************

n dari : ..............................................................................................

l :..................................................................... No : ******************

Nama Barang Banyaknya terangan

)endo &m 66

8i& (5 &ab %000

Bink syr !

8i& () "000

8/19/2019 Format Bbk - 2016

36/152

Arasari+ ...1! ;ni 01!


sn Smirah Snsn Smirah

8/19/2019 Format Bbk - 2016

37/152



N' : !-PK"+II#0$,****************************************** N' :

D.era8kan ke6a1a : **P-.t- /arga-y-***************** D.era

Pesanan dari : ........................................................... Pesan

Tanggal :............................................... No : .... Tangg


1 Al2oprinol 400 1

Ambroxol &ab !00

" Amlodipin 10mg 10 "

4 Amoxi$illin !00mg !00 4

! Amoxi$illin !0mg 00 !


% An&a$id syr "0 %

# An&a$id &ab 400 #' As me*e !00mg 00 '

10 )ap&opril 1.!mg 00 10

11 )ap&opril !mg "00 11

1 )T, "00 1

1" )o&rim D &ab 100 1"

14 Dexame& 00 14

1! 3liben$lamide &ab 100 1!

16 7idro sk 0 16

1% loram*e !0mg 100 1%

1# ,e&hyl pred 4mg 100 1#

1' ,l&i?i&amin &ab 100 1'

0 Oxy&e&ra sm 10 0

1 Para$e&amol syr ! 1

Para$e&amol 1000

" Pred 00

4 ani&idin "00

! 8i& (5 &ab 1000

6 8i& () 1000

% assa 4x!$m 11

# Ples&er 1

' Sarng T NS No 2 100

"0 Sabn $air 1

"1 Plas&ik klip k # pak

8/19/2019 Format Bbk - 2016

38/152

Arasari+ ..1" ;li 01!


..Snsn Smirah 2$iano ....Sn



N' : !-PK"+II#0$,******************************************* N' :

D.era8kan ke6a1a : **Po.ke.1e. /arga-y-******** D.era

Pesanan dari : ............................................................ Pesan

Tanggal :............................................... No : .... Tangg



,e&ro !00mg 00

" Para$e&amol #00 "

4 Para$e&amol syr ! 4

! As ,e*e !00mg 00 !

6 An&a$id syr 0 6

% An&a$id &ab 1 %

# ani& &ab 100

' )T, "00

8/19/2019 Format Bbk - 2016

39/152

10 Ambroxol &ab 00

11 Ni*edipin &ab "0

1 i?anol !

1" (e&adin "00ml 1

14 Alkohol "00ml "1! assa 16x16 1!

16 apas 1

1% Oxy&era Sm 10

1# 7idro Sk 10

1' 4 Sk !

0 Salb& mg !0

1 Neo in 10

(e&a Sk !" Amlodipin 10mg "0

4 @nderpad 10

! Spi& 1ml 100

6 3en&ian 8iole& !

% Sarng T NS No.2 100

# Albo&hyl $on$ 1

' Ples&er 1



..Snsn Smirah (dn a&ih ....Sn

8/19/2019 Format Bbk - 2016

40/152



N' : !-PK"+II#0$,***************************************** NO : .

D.era8kan ke6a1a : **Pera&atan***************************** Disera


Tanggal :............................................... No : ............ Tangg


1 Al2oprinol 00 41

Ambroxol &ab 1000 4

" Amlodipin 10mg "00 4"


! Amoxi$illin !0mg 00 4!

6 Amoxi$illin syr !0 46

% An&a$id syr 1!0 4%

# An&a$id &ab 1000 4#

' As me*e !00mg 1000 4'

10 A$y$lo?ir sk 10 !0

11 A$y$lo?ir &ab 00 !1

1 (e&a Sk 1! !

1" $ap&opril !mg 00 !"

14 )o&rim syr 0 !4

1! )o&rim &ab %00 !!16 Domperidon &ab 100 !6

1% enok &k 4 !%

1# Alkohol %0 "00ml 10 !#

1' Orali& 100 !'

0 7idro sk 4 60

1 e&okona-ole &ab !0 61

loram*eni$ol !0mg 1100 6

" 2ido$ain in '0 6"

4 Oxy&era sm 1! 64

! Para$e& syr !0 6!

6 Para$e& !00mg !00

% Piroxi$am 0mg 00

# Omepra-ol &ab "0

' Albo&hyl $on$ 1

"0 (e&adine "00ml !"1 (e&adine "0ml !

8/19/2019 Format Bbk - 2016

41/152

" ani&in &ab 1000

"" ani&in in 00

"4 Pred &ab 1000

"! Bink syr !

"6 inger 2ak&a& in* !00"% Salb& Neb 100

"# Salb& &ab mg 00

"' 4 Sk 10

40 (iopla$en&on ell 10



............................... ..................................... ....Sn



N' : !-PK"+II#0$,************************************* N' : *

D.era8kan ke6a1a : **Pone1****************************** D.era

Pesanan dari : ...................................................... Pesan

Tanggal :............................................. No : ************ Tangg



An&a$id &b 00

" As me*e !00mg 100 "

4 S !0 4

! ,e&hergin &ab 100 !

6 ,e&ro !00mg 00 6

% Para$e&amol !00mg 00 %

# (e&adine "00ml #

' 2 in*s 40 '

8/19/2019 Format Bbk - 2016

42/152

10 Spi& "ml 100 10

11 Spi& ! ml 100 11

1 )a&g& 4 (2@D 1

1" 5n*se& deasa 0 1"

14 58.$a&h No+1# 0 (2@D 141! 58.$a&h No+0 0 (2@D 1!

16 assa s&eril 16x16 "0 16

1% ,asker 100 1%

1# Ples&er 1#

1' Sarng T NS , 00 (2@D 1'

0 Sarng T NS 2 100 (2@D 0

1 Sarng T s&eril %.! !0 (2@D 1

@nderpad 0 " Dopler ell "

4 Amlodipin 10mg 60 4

! @rine bag ! !

6

%

#

'



..Snsn Smirah........... ...(dn /is.................. ....Sn

8/19/2019 Format Bbk - 2016

43/152



N' : !-PK"+II#0$,*************************************** N' : *

D.era8kan ke6a1a : **P-.t- "ekar3aya**************** D.era


Tanggal :.............................................. No : ************ Tangg


1 Ambroxol &ab 00 1

Amlodipin 10mg 60

" Amoxi$illin !00mg 00 "


! An&a$id syr 10 !

6 An&a$id &ab "00 6

% As me*e !00mg 100 %# )ap&opril 1.!mg 100 #

' )T, "00 '

10 Para$e& syr 0 10

11

1

8/19/2019 Format Bbk - 2016

44/152



..Snsn Smirah........... ...(dn 7 esih.................. ....Sn



N' : *********!-PK"+II#0$,*********************************** N' : *

D.era8kan ke6a1a : **Loket o4at********************** D.era

Pesanan dari : ........................................................ Pesan

Tanggal :........................................ No : ****$0**** Tangg


1 Allop "00 41

Ambroxol !00 4

" Amlodipin 1'0 4"

4 Amox !00mg "000 44

! Amox syr 110 4!

6 An&a$id syr !0 46

% An&a$id &ab 1100 4%

# /rgo&amin 100

' Ansol !0

8/19/2019 Format Bbk - 2016

45/152

10 As me*e 1600

11 A$y$ sk 10

1 (e&a sk 100

1" )ap&op 1.! %00

14 )T, 40001! o&rim syr '0

16 o&rim D 600

1% /ry&rom !0 !00

1# /&anol %0 "00ml "

1' i?anol "

0 Orali& 100

1 3liben$lamid 100

7idro sk #0" e&ona-ol !0

4 loro $ap 600

! ,e&ro !00mg '00

6 Ni*edipin &ab 0

% aominal syr 10!

# Oxy&e&ra sm 1!

' Para$e& !00mg 10100

"0 Para$e& syr #%

"1 Pyran&el 100

" Piroxi$am %00

"" (e&adin "00ml 1

"4 (e&adin "0ml !

"! Pred &ab 16!0

"6 ani& &ab 100

"% Salb& 00"# 4 sk #

"' Sim?as&a&in 400

40 Te&ra !0mg 1000

Arasari+ ..% ;li 01!


................................ .................................. ....Sn

8/19/2019 Format Bbk - 2016

46/152



!-PK"+II#0$,**********************************************

8kan ke6a1a : ****P-.t- Baro.******************************************************

n dari : ..............................................................................................

l :..................................................................... No : ................


gan

Allop &ab 100

Ambroxol &ab "00

Amlodipin 10mg '0


Amoxi$illin syr 10

An&a$id syr 0

An&a$id &ab 00

As ,e*e !00mg 100A$y$lo?ir sk !

o&rim D &ab 100

3en&ian 8iole& !

7idro Sk 10

loram*e !0mg 00

Para$e& syr !

Para$e& &ab !00

Piroxi$am 0mg 100

Prednison &ab 1!0

ani& &ab 100

8i& (5 &ab "00

Bink syr !

apas 1

,asker !0

8/19/2019 Format Bbk - 2016

47/152

Arasari+ ... 1" ;li 01!.


sn Smirah (dn 5nne..........



!-PK"+II#0$,*********************************************

8kan ke6a1a : ****Po Gg*********************************

n dari : ..............................................................................................

l :..................................................................... No : .........


gan

apas !0mg

Alkohol %0 "00ml 4

(e&adine "00ml 1

Spi& "ml 100

2ido$ain in '0

,asker !0

Al?ogyl

8/19/2019 Format Bbk - 2016

48/152

Arasari+ ...1" ;li 01!..........


sn Smirah ................................

8/19/2019 Format Bbk - 2016

49/152



...........................................................................................................

kan kepada : ...................................................................................

n dari : ..............................................................................................

l :..................................................................... No : ................


gan

Sim?as&a&in 100

8i& (5 &ab 1000

8i& () 1000

Spi& "ml "00

Spi& !ml 100

)anla D !

)anla A !

)a&g& 4 (2@D

)a&h No 1# % (2@D

5n*se& anak !0

5n*se& deasa !0

58.)a&h No.6 10 (2@D

58.)a&h No.0 0 (2@D

58.)a&h No. 0 (2@D

58.)a&h No.4 10 (2@Dapas !

kassa 4x10 !0

,asker "00

Ples&er #

Silk 0 (2@D

2oma&lle 0

Sabn $air 1

Plas&ik k 14 pak (2@D

Plas&ik ( pak (2@D

Sarng T s&eril %.! !0

8/19/2019 Format Bbk - 2016

50/152

Arasari+ 1" ;li 01!..........


sn Smirah obby



* !-PK"+II#0$,*********************************************

8kan ke6a1a : ***Po.ke.1e. "ang-n3aya***************************************

n dari : ..............................................................................................

l :..................................................................... No : **************


gan

Ambroxol &ab 00


An&a$id syr 10

An&a$id &ab "00

8i& ) &ab 1000

As ,e*e !00mg 100

(e&a Sk !

)T, 00

,e&ro !00mg 100

8/19/2019 Format Bbk - 2016

51/152

Ni*edipin &ab !0

Para$e& syr 0

Para$e& !00mg !00

ani& &ab 00

Salb& mg !04 Sk !

8i& () !00

Bink syr !

Spi& " ml 100

kassa 4x10 10

Ples&er 1

Sarng T NS , 100

Sabn $air 13en&ian 8iole& !

Neo in 10

2 "

Abo$a&h 1# !

,e&hergin in !

5n*se& D !

)a& g& !

Arasari+ .1" ;li 01!........


sn Smirah (dn 5mas........

8/19/2019 Format Bbk - 2016

52/152



* !-PK"+II#0$,*********************************************

8kan ke6a1a : ***Po.ke.1e. "ekar3aya*****************************************

n dari : ..............................................................................................

l :..................................................................... No : **************



,e&ro !00mg 100

Para$e& syr 10

As me*e !00mg 100

An&a$id &ab 00

An&a$id syr 10

Bink syr !8i& (6 &ab 1000

Ambroxol &ab 100

S 0

Spi& " ml 100

Orali& 100

8/19/2019 Format Bbk - 2016

53/152

Arasari+ .1" ;li 01!.........


sn Smirah (dn 7 esih.......



***********************************************************************************************************

8kan ke6a1a : ********************************************************************************

n dari : ..............................................................................................

l :..................................................................... No : ******************


gan

8i&amin (5 &ab %00

T7 00

Bink syr 60

8i&amin () 1"00

Spi& "ml #00

Sabn $air

Plas&ik 6

8/19/2019 Format Bbk - 2016

54/152

Arasari+ ...% ;li 01!.........



8/19/2019 Format Bbk - 2016

55/152



N' : %7 Ag.PK"+III#0$,*************************************** N' :

D.era8kan ke6a1a : **P-.t- /arga-y-***************** D.er


Tanggal :............................................... No : ...." Tangg


1 Al2oprinol 100 1

Aminop &ab 100

" Amlodipin 10mg &ab 60 "

4 Amox !00mg &ab 400 4

! Amox !0mg &ab 100 !

6 Amox syr 0 6

% An&algin !oomg &ab 00 %

# An&a$id syr "0 #' Asam me*e !00mg 00 '

10 (e&ason sk 10 10

11 )ap&ro 1.!mg &ab 100 11

1 )ap&ro !mg &ab "00 1

1" )T, &ab 00 1"

14 enox &k 10 14

1! (i$na& &ab 100 1!

16 O(7 "0 16

1% Oxy&e&ra sk ! 1%

1# Para$e& syr 0 1#

1' Para$e& !00mg &ab 1000 1'

0 Piroxi$am 0mg 00 0

1 (e&hadin "00ml 1 1

ani& &ab 100

" Plas&ik ( 6 pak "

4 Plas&ik 1 pak 4

!

6

8/19/2019 Format Bbk - 2016

56/152

Arasari+ ..6 Ags&s 01!





N' : 7$ Ag.PK"+II#0$,**************************************** N' :

D.era8kan ke6a1a : **Po.ke.1e. /arga-y-******** D.er


Tanggal :............................................... No : E%E.... Tangg


1 Amoxi$illin !00mg "00

,e&ro !00mg 00

" Para$e&amol #00

4 Para$e&amol syr !

! As ,e*e !00mg 00

6 An&a$id &ab 00

% An&a$id syr !

# ani& &ab 00

' Bink syr !

8/19/2019 Format Bbk - 2016

57/152

10 () &ab "00

11 8i& ) !0mg !00

1 )T, 00

1" )ap&op ! mg 100

14 Ni*edipin 10mg !01! alk !00mg !00

16 i?anol "

1% Alkohol %0 "00ml

1# (e&adin 1

1' assa 16>16 10

0 7idro sk 10

1 Salb& mg !0

Neo in 10" O(7 1!

4 (e&ason sk !

! @nderpad 10

6 Amlodipin 10mg 60

% Spi& 1ml 100

# Ples&er 1

'




8/19/2019 Format Bbk - 2016

58/152



N' : %, Ag.PK"+III#0$,************************************** NO : .



Tanggal :............................................... No : ........1.... Tangg


1 Al2oprinol 00 41

Ambroxol &ab !00 4

" Aminop 00mg &ab 100 4"


! Amox !00mg !00 4!

6 Amox syr !! 46

% An&al !00mg 00 4%

# An&a$id syr 100 4#

' An&a$id &ab #00 4'

10 As me*e !00mg !00 !0

11 A$y$lo?ir sk 10 !1

1 A$y$lo?ir 400mg 00 !

1" (e&ason sk 1! !"

14 )ap&op ! 00 !4

1! )T, 600 !!16 o&rim syr ! !6

1% o&rim 4#0mg "00 !%

1# /ry&rom syr 10 !#

1' /ry&rom !0mg 100 !'

0 Domperindon &ab 100 60

1 Alkohol %0 "00ml 6 61

Orali& 100 6

" 3lkosa ! in* 40 6"

4 7)T !mg 00 64

! 7idro sk 4 6!

6 loram !0mg !00 66

% ,e&ro !00mg 100 6%

# (i$na& !00mg !00 6#

' Na$l in* 40 6'

"0 O(7 100 %0"1 O,B 0mg "0 %1

8/19/2019 Format Bbk - 2016

59/152

" Para$e& syr !0 %

"" Para$e& !00mg !00 %"

"4 8i& (6 10mg 1000 %4

"! Piroxi$am 0mg 00

"6 (e&adin "0ml !"% (e&adin "00ml !

"# Prednison !mg 1000

"' ani& 1!0mg !00

40 Salb& mg 00



............................... ..................................... ....Sn



N' : %% Ag.PK"+III#0$,******************************** N' : *

D.era8kan ke6a1a : **Pone1****************************** D.er


Tanggal :............................................. No : ******#****** Tangg



An&a$id syr 10

" As me*e !00mg 00 "

4 /&anol %0 1 &r 4

! Neo in 0 !

6 2idokain in "0 6

% ,e&hergin &ab 100 %

# ,&ehergin in 10 #

' ,e&ro !00mg 100 '

8/19/2019 Format Bbk - 2016

60/152

10 Para$e& !00mg "00 10

11 (e&adin "00ml 11

1 inger lak&a& in* 0 1

1" Spi& "ml 100 1"

14 )a& g& 1 141! apas !0mg 1 1!

16 assa s&eril 16x16 60 16

1% ,asker 100 1%

1# Sarng T NS , 100 1#

1' Sarng T NS S 100 1'

0 Sarng T NS 2 100 0

1 Sarng T s&eril %.! !0 1

@nderpad 0 " @mbilikal klem 0 "

4 Dopler ell 4

! Amlodipin 10mg 60 !

6 @rine bag ! 6

% Plas&ik ( 1

# Oxy&osin in 100




8/19/2019 Format Bbk - 2016

61/152



N' : %5 Ag.PK"+III#0$,************************************ N' : *

D.era8kan ke6a1a : **P-.t- "ekar3aya**************** D.er


Tanggal :.............................................. No : *******,***** Tangg


1 o&rim syr 0 1

7idro sk 10

" alk !00mg 00 "

4 ,e&ro !00mg &ab 100 4

! Para$e& syr 0 !

6 Pred !mg 00 6

% ani& 1!0mg 100 %# Sim?as 10mg 100 #

' Bink syr ! '

10

11

1

8/19/2019 Format Bbk - 2016

62/152






N' : ***79**Ag.PK"+III#0$,********************************* N' : *

D.era8kan ke6a1a : **Loket o4at********************** D.er


Tanggal :........................................ No : ****5**** Tangg


1 Allop 600 41

Ambroxol 600 4

" Aminop &ab 100 4"

4 Amlodipin 10mg ''0 44

! Amox !00mg 600 4!

6 Amox syr 6! 46

% An&a$id syr %! 4%

# An&a$id &ab '00 4#

' As *ola& 1mg "00

8/19/2019 Format Bbk - 2016

63/152

10 8i& ) !0mg 1000

11 As me*e !00mg 600

1 A$y$lo?ir sk 1!

1" (e&ason sk 40

14 )ap&op !mg 4001! )o&rim syr '!

16 )o&rim 4#0mg 00

1% Dia-epam mg 00

1# /&anol %0 1l& "

1' enox &k 14

0 Orali& 00

1 33 4#00

3liben$lamid 100" 7idro sk 1!%

4 alk !00mg #00

! loro !0mg !00

6 (i$na& &ab 400

% Ni*edip &ab %0

# Oxy&e&ra sm !

' O(7 "!

"0 Para$e& !00mg #'00

"1 Para$e& syr ""4

" 8i& (6 &ab 1%00

"" Piroxi$am 0mg !00

"4 Phenyl b&a- &ab %00

"! (e&adin "0ml 4

"6 Prednison &ab "600

"% ani& 1!0mg 1'00"# 4 sk '

"' 8i& (1 &ab 1"00

40 T7 TA( "00



................................ .................................. ....Sn

8/19/2019 Format Bbk - 2016

64/152



%2 Ag.PK"+III#0$,**********************************************

8kan ke6a1a : ****P-.t- Baro.******************************************************

n dari : ..............................................................................................

l :..................................................................... No : .......4.....


gan

Allop &ab 100

Amlodipin 10mg '0

Amox !00mg 100

Amox syr 10

An&a$id syr 0

An&a$id &ab 100

8i& ) !0mg !00

As me*e !00mg 100)T, 100

o&rim syr 10

/&anol %0 "00ml 1

33 00

7)T !mg 00

7idro sk 10

O(7 0

Para$e& syr !

Para$e& !00mg !00

8i& (6 10mg "00

Piroxi$am 0mg 100

(e&adin "00ml 1

Prednison !mg 00

ani& 1!0mg 100

Salb& mg !0

8i& (1 !0mg 00

8i& () 100

Bink syr !

8/19/2019 Format Bbk - 2016

65/152

Arasari+ ... 6 Ags&s 01!.





Ag.PK"+III#0$,*********************************************

8kan ke6a1a : **********************************************************

n dari : ..............................................................................................

l :..................................................................... No : .........


gan

8/19/2019 Format Bbk - 2016

66/152

Arasari+ ... Ags&s 01!..........


sn Smirah ...............Dina 3,.................

8/19/2019 Format Bbk - 2016

67/152



...........................................................................................................

kan kepada : ...................................................................................

n dari : ..............................................................................................

l :..................................................................... No : ................


gan

inger 2ak&a& in* "00

4 sk 10

(iopla$en&on sk 10

Sim?as&a&in 10mg 100

)endo &m 10

8i& (1 !0mg 1000

8i& () #00

Spi& 1ml 00

Spi& "ml "00

Spi& !ml 100

Spi& 10ml 100

)a&g& 11

. )a&h 16 !

. )a&h 1# 10

5n*se& anak !05n*se& deasa 100

58.)a&h 1# 1!

58.)a&h 0 0

58.)a&h 4 "0

58.)a&h 6 0

apas !0mg !

assa 4>10 !0

assa 16>16 60

Ples&er %

Sarng &angan NS 2 100


Sarng &angan s&eril % !0

Silk 10

@rin bag 10

Sabn $air 2oma&lle 0

8/19/2019 Format Bbk - 2016

68/152

8/19/2019 Format Bbk - 2016

69/152

/&anol %0 "00ml

8i& k &ab 100

Neo in 10

7idro sk !

,e&ro !00mg 100O(7 10

Para$e& syr 0

Para$e& &ab !00

(e&adine "00ml 1

ani& 1!0mg 100

4 sk !

8i& () &ab 00

Bink syr !Spi& "ml 100

apas 1

assa 4>1! 10

@nderpad 10

Arasari+ .10 Ags&s 01!.....



8/19/2019 Format Bbk - 2016

70/152



* 70 Ag.PK"+III#0$,******************************************


n dari : ..............................................................................................

l :..................................................................... No : ******%********


gan

Para$e& !00mg !00

Para$e& syr 10

As me*e !00mg 100

An&a$id syr 10

Bink syr !

8i& (5 &ab !00

8i& () &ab "00O(7 10

Ni*edip 10mg "0

assa 16>16 10

Sarng &angan s&eril % 10

alk !00mg !00

8/19/2019 Format Bbk - 2016

71/152

8/19/2019 Format Bbk - 2016

72/152

Arasari+ E1 Ags&s 01!..



8/19/2019 Format Bbk - 2016

73/152



N' : 7% Se6PK"I#0$,*************************************** N' :

D.era8kan ke6a1a : **P-.t- /arga-y-***************** D.er


Tanggal :............................................... No : ....4...... Tangg


1 Allop 100mg &ab "00 1

Amlodipin 10mg &ab "0

" Amox !00mg &ab !00 "

4 Amox !0mg kap 00 4

! Amox syr 0 !

6 An&a$id syr "0 6

% An&a$id &ab "00 %

# Ansol spp 10 #' (e&ason sk 10 '

10 )ap&rop 1.!mg &ab "00 10

11 )ap&rop !mg &ab 00 11

1 )T, "00 1

1" )o&rim syr ! 1"

14 $o&rim ds &ab 100 14

1! 3liben$lamid &ab 100 1!

16 33 &ab 1000 16

1% 7idro sk 10 1%

1# O((7 syr "! 1#

1' Par$e& syr "0 1'

0 Para$e& !00mg &ab #00 0

1 Piroxi$am &ab 00 1

Pred &ab !00

" ani&idin &ab 00 "

4 Salb& mg &ab 100 4

! 4 sk ! !

6 Sim?as&a&in 10mg &ab 100 6

% 8i& (5 &ab 1000

# 8i& () &ab #00

' assa 4>10 10

"0 Sabn $air 1

"1 Bink syr 10" Plas&ik klip !

8/19/2019 Format Bbk - 2016

74/152

Arasari+ ..14 Sep&ember 01!





N' : 20 Se6PK"I#0$,**************************************** N' :

D.era8kan ke6a1a : **Po.ke.1e. /arga-y-******** D.er


Tanggal :............................................... No : E%E.... Tangg


1 Amox !00mg &ab "00 1

)o&rim ds &ab 100

" ,e&ro !00mg &ab 00 "

4 Para$e& !00mg &ab #00 4

! Para$e& syr ! !

6 An&a$id &ab 00 6

% An&a$id syr 0

# ani&idin &ab 100

' Bink syr 10

8/19/2019 Format Bbk - 2016

75/152

10 Bink &ab 100

11 8i& (5 &ab !00

1 8i& (6 &ab 1000

1" 8i& () &ab 00

14 8i& ) !0mg &ab 10001! )T, "00

16 33 &ab !00

1% )ap&op 1.!mg &ab 00

1# 7)T !mg &ab 00

1' i?anol 4

0 Alkohol %0 1000ml 1

1 (e&adin "00ml 1

assa s&eril16>16 1!" apas 1

4 Oxy sm !

! 7idro sk 10

6 Salb&amol mg &ab 100

% O(7 syr 0

# (e&son sk 10

' @nderpad 10

"0 Sabn $air 1

"1 Sarng T NS no.2 100




8/19/2019 Format Bbk - 2016

76/152



N' : 79 Se6PK"I#0$,************************************** NO : .

D.era8kan ke6a1a : **Pera&atan************************* Disera


Tanggal :............................................... No : .......1..... Tangg


1 Allop 100mg &ab 00 41

Amox !00mg &ab !00 4

" Amox !0mg kap !00 4"

4 Amox syr !0 44

! An&algin !00mg &ab 1000 4!

6 An&a$id syr 100 46

% An&a$id &ab #00 4%

# Ansol spp 10 4#

' 8i& ) !0mg &ab 1000 4'

10 As me*e !00mg &ab !00 !0

11 A$y$lo?ir sk 10 !1

1 A$y$lo?ir 400mg &ab 00 !

1" (e&ason sk 1! !"

14 )ap&op 1.!mg &ab 00 !4

1! )ap&op !mg &ab 00 !!16 )T, &ab 1000 !6

1% )o&rim syr 0 !%

1# )o&rim ds &ab !00 !#

1' Dia-epam re$&al ! !'

0 /&anol %0 1000ml % 60

1 enox &k ! 61

8i& &ab 100 6

" Orali& sak 100 6"

4 3en&ian ?iole& ! 64

! 3lkosa ! in* 40 6!

6 33 &ab 1000 66

% 7)T !mg &ab 00 6%

# 7idro sk 4 6#

' e&okona-ole &ab !0 6'

"0 loro !0mg kap !00 %0"1 2idokain in '0 %1

8/19/2019 Format Bbk - 2016

77/152

" ,e&ro !00mg &ab 00 %

"" (i$na& !00mg &ab !00 %"

"4 Na$l in* 40 %4

"! O(7 syr 100

"6 Para$e& syr #0"% Para$e& !00mg &ab "000

"# Piroxi$am &ab 00

"' (e&adin "0ml !

40 (e&adin "00ml !

Arasari+ ..14 sep&ember 01!


............................... ..................................... ....Sn



N' : 7 Se6PK"I#0$,******************************** N' : *



Tanggal :............................................. No : *******#***** Tangg


1 Amox !00mg &ab "00 1

An&a$id &ab 100

" /&anol %0 1000ml "

4 8i& Neo in 60 4

! 3liserin ! !

6 2idokain in "0 6

% ,e&hergin in 0 %

# ,e&ro !00mg &ab 00 #

' Oxy&e&ra sm ! '

8/19/2019 Format Bbk - 2016

78/152

8/19/2019 Format Bbk - 2016

79/152

8/19/2019 Format Bbk - 2016

80/152






N' : **2#*Se6PK"I#0$,********************************* N' : *

D.era8kan ke6a1a : **Loket o4at********************** D.er


Tanggal :........................................ No : ***$0**** Tangg


1 Allop !00 41

Ambroxol &ab !00 4

" Aminop &ab 400 4"

4 Amox !00mg "'00 44

! Amox !0mg 1000 4!

6 Amox syr 1#0 46

% An&al !00mg 400 4%

# An&a$id syr 1! 4#

' An&a$id &ab '00 4'

8/19/2019 Format Bbk - 2016

81/152

10 Ansol spp 10 !0

11 8i& ) !0mg 4000 !1

1 As me*e !00mg 00 !

1" A$y$lo?ir sk 1! !"

14 (e&ason sk !0 !41! )ap& 1.!mg 100

16 )ap& !mg 1000

1% )T, !100

1# )o&rim syr 160

1' )o&rim Ds %00

0 /&anol %0 1000ml "

1 enok &k 1#

Orali& 600" 33 "!00

4 3liben 100

! 7)T 600

6 7idro sk #0

% alk &ab 100

# e&ona-ol 1!0

' loro !0mg 1!00

"0 ,e&ro !00mg 00

"1 (i$na& "00

" Oxy&e&ra sm 60

"" O(7 !00

"4 Para$e& &ab %'00

"! Para$e& syr ""6

"6 (6 &ab "000

"% Piroxi$am '00"# Pred &ab 600

"' ani& &ab 1400

40 4 sk "

Arasari+ .. Sep&ember 01!


................................ .................................. ....Sn

8/19/2019 Format Bbk - 2016

82/152

8/19/2019 Format Bbk - 2016

83/152

Arasari+ 14 Sep&ember 01!





7, Se6PK"I#0$,*********************************************

8kan ke6a1a : **********************************************************

n dari : ..............................................................................................

l :..................................................................... No : ....".....


gan

Alkohol %0 1000ml

assa gl 1

Spi& 1ml 00

assa 4>10 0

Sarng T NS no., 00

8/19/2019 Format Bbk - 2016

84/152



sn Smirah ...............Dina 3,.................

8/19/2019 Format Bbk - 2016

85/152



...........................................................................................................

kan kepada : ...................................................................................

n dari : ..............................................................................................

l :..................................................................... No : ................


gan

Pred &ab 1000

ani&idin &ab %00

Salb&amol mg &ab 00

Salb& neb 60

4 sk 6

Sim?as&a&in &ab 100

Te&ra !0mg kap 00

8i& (5 &ab 1000

8i& () &ab #00

Bink &ab 100

Spi& 1ml 00

Spi& "ml 00

Spi& !ml 100

Spi& 10ml 100

Abo$a& 1# 0Abo$a& 0 !0

Abo$a& 4 1!

Abo$a& 6 1!

apas 4

assa 4>10 !0

kassa s&eril 16>16 60

assa gl 1

,asker 00

ples&er 10

Sarng T NS S 100

Sarng T NS , "00

Sarng T NS 2 100

Silk 4#

Sabn $air "

8aselin sab 0Plas&ik #

8/19/2019 Format Bbk - 2016

86/152

Plas&ik ( %

Scabimet sk 5

Metoclopramid inj 90



sn Smirah obby



* 2$Se6PK"I#0$,******************************************

8kan ke6a1a : ***Po.ke.1e. "ang-n3aya***************************************

n dari : ..............................................................................................

l :..................................................................... No : *********5*****


gan

Amox !00mg &ab "00

An&algin !00mg &ab 100

An&a$id syr 0

An&a$id &ab 00

(e&ason sk !

)ap&op !mg &ab 100

)T, &ab 00

$o&rim ds &ab 100

i?anol

8/19/2019 Format Bbk - 2016

87/152

8/19/2019 Format Bbk - 2016

88/152



* 75 Se6PK"I#0$,******************************************


n dari : ..............................................................................................

l :..................................................................... No : *****7*********


gan

,e&ro !00mg &ab 100

Para$e& !00mg &ab !00

Para$e& syr 1!

An&a$id &ab 00

An&a$id syr 1!

8i& (5 &ab 00

O(7 syr !alk !00mg &ab 100

S$abime& sk

8/19/2019 Format Bbk - 2016

89/152

Arasari+ .14 Sep&ember 01!





***********************************************************************************************************

8kan ke6a1a : ********************************************************************************

n dari : ..............................................................................................

l :..................................................................... No : *********$0***


gan

Sim?as& &ab "00

Te&ra !0mg "00

(1 &ab !"00

Bink syr 0

Bink &ab %00

() &ab 6!00

Spi& "ml 00

apas "

@ri& parame&er !00

8/19/2019 Format Bbk - 2016

90/152

Plas&ik k 1%

Plas&ik b 111

A$&ren T3 1!

A$&ren oles 1!

A$&ren 3lkos %!

Arasari+ Sep&ember 01!



8/19/2019 Format Bbk - 2016

91/152



N' : 2%'ktPK"#0$,*************************************** N' :

D.era8kan ke6a1a : **P-.t- /arga-y-************* D.er


Tanggal :............................................... No : ..4.. Tangg


1 Alloprinol 100mg "00 1

Amox !00mg 400

" Amox !0mg "00 "

4 Amox syr 0 4

! An&algin !00mg "00 !

6 An&a$id syr ! 6

% An&a$id &ab 400 %

# (e&ason sk 10 #' )ap&op 1.!mg "00 '

10 )ap&op !mg "00 10

11 )T, 00 11

1 )o&rim 4#0mg 100 1

1" 3liben$l &ab 100 1"

14 loro !0mg 100 14

1! Ni*edipin !0 1!

16 O(7 10 16

1% Para$e& syr 1! 1%

1# Para$e& !00mg 1000 1#

1' Piroxi$am 0mg 00 1'

0 4 sk ! 0

1 Plas&ik ! 1

" "

4 4

!

6

8/19/2019 Format Bbk - 2016

92/152

Arasari+ ..! Ok&ober 01!





N' : 50'ktPK"#0$,**************************************** N' :

D.era8kan ke6a1a : **Po.ke.1e. /arga-y-*** D.er

Pesanan dari : ....................................................... Pesan

Tanggal :........................................... No : #EE.... Tangg


1 Amox !00mg "00 1

Amox syr !

" )o&rim ds &ab 100 "

4 )o&rim syr !

! ,e&ro !00mg 00

6 Para$e& !00mg '00

% Para$e& syr 1!

# An&a$id &ab 00

' An&a$id syr !

8/19/2019 Format Bbk - 2016

93/152

10 ani& 00

11 Bink &ab 100

1 8i& (5 &ab !00

1" 8i& (6 &ab !00

14 8i& () 001! 8i& ) !0mg 1000

16 )T, "00

1% 33 &ab !00

1# )ap&op 1.!mg 100

1' )ap&op !mg 100

0 7)T !mg 00

1 alk !00mg !00

Orali& 100" (e&adin "00ml 1

4 assa 16>16 0

! apas 1

6 Oxy&ra sm 10

% 7idro sk 10

# A$y$lo?ir sk !

' ,e&hergin in !

"0 Oxy&osin in 10

"1 Neo in 10

" O(7 !

"" ,$os exp

"4 (e&ason sk !

"! @nderpad 10

"6 Spi& 1ml 100

"% ST non s&eril , 100"# Bink syr 10

"' an!la d"s 3

40

Arasari+ 1 Ok&ober 01!



8/19/2019 Format Bbk - 2016

94/152



N' : 29'ktPK"#0$,************************************** NO : .



Tanggal :............................................... No : ....1........ Tangg


1 Alloprinol 100mg 00 41

Amox !00mg 000 4

" Amox !0mg !00 4"

4 Amox syr !0 44

! An&a$id syr 1!0 4!

6 An&a$id &ab #00 46

% A$y$lo?ir sk 10 4%

# 3liben$lamid 100 4#

' (e&ason sk 1! 4'

10 )ap&op 1.!mg 00 !0

11 )ap&op !mg 00 !1

1 )T, #00 !

1" o&rim syr 0 !"

14 o&rim 4#0mg !00 !4

1! Dia-epam re$& ! !!16 /ry&rom syr ! !6

1% Dimenhidrina& &ab 100 !%

1# /&anol %0 1000ml " !#

1' enok &k ! !'

0 8i& &ab 100 60

1 Orali& 100 61

38 10 6

" 3lkosa ! in* 0 6"

4 33 &ab 1000 64

! 7)T !mg 00 6!

6 7idro sk 4 66

% loro !0mg "00 6%

# ,e&ro !00mg 100 6#

' (i$na& &ab !00 6'

"0 Na$l in* 40 %0"1 O(7 100 %1

8/19/2019 Format Bbk - 2016

95/152

" Oxy&e&ra sm 10 %

"" Para$e& syr 100 %"

"4 Para$e& !00mg !00 %4

"! Piroxi$am 0mg 00

"6 Po?idon "00ml "% Po?idon "0ml "

"# Pred !mg 1000

"' ani& &ab #00

40 Salb& mg 00

Arasari+ ..% Ok&ober 01!


............................... ..................................... ....Sn



N' : 2'ktPK"#0$,******************************** N' : *



Tanggal :............................................. No : *****#******* Tangg


1 Amox !00mg 00 1

As ,e*e !00mg 100

" Spi& "ml 00 "

4 Spi& !ml 100 4

! 5n*se& ds 10 !

6 58 )a&h 1# 10 6

% ,asker !0 %

# ST non s&eril , 100 #

' ST non s&eril S 100 '

8/19/2019 Format Bbk - 2016

96/152

10 @nderpad 10 10

11 @mbilikal klem ! 11

1 ;elly dopler 4 1

1" @rine bag ! 1"

14 Plas&ik ( " 141! Nela&hon )a&h 1 ! 1!

16 Pipa endo&rakeal .! 1 16

1% Pipa endo&rakeal ".0 1 1%

1# Pipa endo&rakeal ".! 1 1#

1' Pipa endo&rakeal 4.0 1 1'

0 )a&h penghisap ! 1 0

1 )a&h penghisap 6 1 1

)a&h penghisap # 1 " )a&h penghisap 10 1 "

4 )a&h penghisap 1 1 4

! )a&h penghisap 14 1 !

6 er&as lakms 1 6

% er&as saring 10 %

# er&as @S3 1 #

' S&ile& 4." 1 '

"0 )anla ds !

"1 )anla anak

" )a&h penghisap 1# 1

Arasari+ .! Ok&ober 01!



8/19/2019 Format Bbk - 2016

97/152

8/19/2019 Format Bbk - 2016

98/152

8/19/2019 Format Bbk - 2016

99/152

10 )ap& 1.!mg 1"00

11 )ap& !mg 1"00

1 )T, !'00

1" o&rim syr 110

14 o&rim ds &ab "001! /ry&ro !0mg 400

16 Orali& "00

1% 38 !

1# 33 "000

1' 7)T 600

0 7idro sk #1

1 alk 1000

,e&ro !00mg 1000" (i$na& 00

4 Oxy&e&ra sm 6!

! O(7 ""!

6 Para$e& &ab '400

% Para$e& syr "14

# 8i& (6 "!00

' Pirox 0mg 1000

"0 Pred #00

"1 ani& 100

" Sim?as 10mg 00

"" 8i& (5 4000

"4 Bink syr 40

"! Bink &ab 600

"6 8i& () 1"00

"% Spi& "ml 00"# Plas&ik ( %4

"' Plas&ik 1"0

40 Obek glass 0

Arasari+ ..1! Ok&ober 01!


................................ .................................. ....Sn

8/19/2019 Format Bbk - 2016

100/152



27'ktPK"#0$,**********************************************

8kan ke6a1a : ****P-.t- Baro.******************************************************

n dari : ..............................................................................................

l :..................................................................... No : ....!........


gan

Alloprinol 100mg 100

Amox !00mg 00

Amox syr !

An&a$id syr 10

An&a$id &ab 100

(e&ason sk !

)T, "00

33 &ab !00Oxy&e&ra sm !

Para$e& syr 1!

Para$e& !00mg !00

8i& (6 &ab !00

Piroxi$am 0mg 100

Pred !mg 00

ani& &ab 100

4 sk !

8i& (5 &ab !00

8i& () &ab 00

Bink &ab 100

8/19/2019 Format Bbk - 2016

101/152

Arasari+ ! Ok&ober 01!





2, 'ktPK"#0$,******************************************

8kan ke6a1a : ******Po Gg*************************************

n dari : ..............................................................................................

l :............................................ No : ..."......


gan

Spi& "ml 100


2idokain in 100

8/19/2019 Format Bbk - 2016

102/152

Arasari+ ! Ok&ober 01!


sn Smirah ...............Dina 3,.................

8/19/2019 Format Bbk - 2016

103/152



...........................................................................................................

kan kepada : ...................................................................................

n dari : ..............................................................................................

l :..................................................................... No : ................


gan

2 !00

4 sk !

Sim?as&a&in 10mg 100

8i& (5 &ab 1000

8i& () &ab #00

Bink &ab 100

Bink syr !

Spi& 1ml 00

Spi& "ml 00

Spi& !ml 100

5n*se& anak 0

58 )a&h 0 4%

58 )a&h %0

58 )a&h 4 6

58 )a&h 6 !0apas

assa 4>! 100

,asker 1!0

Ples&er 14

ST non s&eril 2 100

ST non s&eril , 100

Silk "6

Sabn $air

Plas&ik !

Plas&ik ( "

Sendok oba& 100

(is&ri !0

7ipa*ix %

;arm he$& kli& !

2idokain in 60Na& di$ !0mg "00

8/19/2019 Format Bbk - 2016

104/152

8/19/2019 Format Bbk - 2016

105/152

,e&ro !00mg 100

(i$na& !00mg 00

O(7 10

Oxy&e&ra sm !

Para$e& syr 1!Para$e& !00mg !00

(e&adin "00ml 1

ani& 100

8i& () "00

Spi& "ml 100

apas 1

Ples&er ( 1

Sabn $air 1Neo in 10

Oxy&osin in 10

2 in*

,e&hergin in !

5n*se& D !

)a&g& !

ST s&eril % 10

Arasari+ .1 Ok&ober 01!



8/19/2019 Format Bbk - 2016

106/152



* 25'ktPK"#0$,******************************************


n dari : ..............................................................................................

l :..................................................................... No : *****7*********


gan

Amox !00mg 00

,e&ro !00mg 100

Para$e& syr 1!

An&a$id &ab 00

An&a$id syr 1!

ani& &ab 100

(i$na& !00mg 100Bink &ab 100

8i& &ab 100

)T, 100

O(7 10

33 !00

alk !00mg "00

/rgome&rin in 10

Oxy&osin in 10

Neo in 10

Orali& 100

Ples&er ( 1

Oxy&e&ra sm !

7idro sk !

4 sk !

ST s&eril % !

ST s&eril %.! !

8/19/2019 Format Bbk - 2016

107/152

Arasari+ .1 Ok&ober 01!





***********************************************************************************************************

8kan ke6a1a : ********************************************************************************

n dari : ..............................................................................................

l :..................................................................... No : ******************


gan

Spiri&s 1000ml 10

Tip ning "

De$k glass "

Na& di$ !0mg %00

8/19/2019 Format Bbk - 2016

108/152

Arasari+ 1! Ok&ober 01!



8/19/2019 Format Bbk - 2016

109/152



N' : No;PK"I#0$,***************************************** N' :

D.era8kan ke6a1a : **P-.t- /arga-y-******************** D.er


Tanggal :............................................... No : .... Tangg


1 Alloprinol 100mg "00 1

Aminop &ab 100

" Amox !00mg !00 "

4 Amox !0mg "00 4

! Amox syr 0 !

6 An&a$id &ab !00 6

% 8i& ) &ab !00 %

# (e&a sk 1! #' )ap& 1.!mg 100 '

10 )ap& !mg "00 10

11 )T, "00 11

1 )o&rim syr ! 1

1" Dexa &ab "00 1"

14 3liben$ &ab 100 14

1! 7idro sk 10 1!

16 5bp 400mg "00 16

1% 8i&amin syr 0 1%

1# (i$na& &ab 100 1#

1' Na&rim di$klo* !0mg 100 1'

0 Ni*edip &ab !0 0

1 O(7 ! 1

Pon*l syr 1!

" Oxy&e&ra sm 10 "

4 Para$e& syr ! 4

! Para$e& !00mg 1000 !

6 8i& (6 &ab !00 6

% Pred &ab 00 %

# Salb& &ab 100

' 8i& (5 &ab 1000

"0 8i& () &ab !00

"1 ,asker !0" Ples&er 1

8/19/2019 Format Bbk - 2016

110/152

"" Pon*l &ab 100

"4 Plas&ik ( "

"! Plas&ik 4

Arasari+ .14 No?ember 01!





N' : No;PK"I#0$,************************************* N' :

D.era8kan ke6a1a : **Po.ke.1e. /arga-y- D.er

Pesanan dari : ....................................................... Pesan

Tanggal :........................................... No : EE.... Tangg


1 Amox !00mg "00 41

Amox syr ! 4

" o&rim syr ! 4"

4 ,e&ro !00mg 100 44

! Para$e& !00mg 1000

6 Para$e& syr !

% An&a$id &ab 00

format bbk - 2016

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