BUKU MONITOR APOTIK :

(REKAPITULASI PELAYANAN APOTIK)

PT.NAYAKA
BULAN JANUARI 2014

OP IP HARGA
NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN
1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
I.
1 1/6/2014 AGUS SOFYAN Divask 10 10 Amlodipin 10 10 Rp 52,940
Kalmeco 500 30 Kalmeco 500 30 Rp 78,840
Neurobion 5000 10 Neurobion 5000 10 Rp 28,290
Kaltrofen 25 10 Ketoprofen 50 5 Rp 4,840
Diazepam 2mg 10 Diazepam 2mg 10 Rp 180
Forres 25 10 Myores 50 5 Rp 28,985
Provelyn 50 10 Ganin 4 Rp 39,324
m.f pulv dtd X m.f pulv dtd X

2 1/6/2014 FITRIA ANGGRAENI Clinbercin 300 10 Clindamicin 300 10 Rp 11,250

Tismazol 250 16 Metronidazol 250 16 Rp 3,296
Methylon 7 Methyl Predni 4 7 Rp 4,592
Toco E 7 Dalfarol 7 Rp 15,211
Becom Zet 7 Becom C 7 Rp 10,395

3 1/11/2014 HENI Episan Syr 1 Inpepsa Syr 1 Rp 63,250

Omeprazole 30 Omeprazole 30 Rp 29,430
Alganak 0,5 5 Alviz 0,5 5 Rp 11,880
Braxidin 20 Braxidin 20 Rp 18,700
4 1/24/2014 ALDI PERMANA Inpepsa Syr 1 Inpepsa Syr 1 Rp 63,250
Natrium Diklofenak 10 Natrium Diklofenak 10 Rp 2,290
Omeprazol 10 Omeprazol 10 Rp 9,810

5 1/24/2014 AGUS SOFYAN Codein 5mg 10 Codein 10mg 5 Rp 2,430

Diazepam 2mg 10 Diazepam 2mg 10 Rp 180
Forres 25mg 10 Myores 50 5 Rp 28,985
Kaltrofen 25mg 10 Ketoprofen 50 5 Rp 4,840
m.f pulv dtd X m.f pulv dtd X
Neurobion 5000 10 Neurobion 5000 10 Rp 28,290
Hexilon 8mg 10 Methyl Prednisolon 8mg 10 Rp 8,830
Lancid 5 Lansoprazole 5 Rp 11,000

6 1/25/2014 LITA JAHARA Gitas Plus 2 Gitas Plus 2 Rp 5,072

Kalnex 7 Kalnex 7 Rp 24,059
Opicef 500 12 Cefadroxil 500 12 Rp 13,200
Tismazol 250 16 Metronidazol 250 16 Rp 3,296
Trachon 1
Nonflamin 12 Nonflamin 12 Rp 54,588
Metilat 6 Pospargin 6 Rp 3,468
Sarung tangan 1 Sarung tangan 1 Rp 4,537
Mycospor cream 1 Mycorin cream 1 Rp 31,625
Thecort cream 1
m.f s.u.e m.f s.u.e

7 1/25/2014 SITI HOTIMAH Trogyl 250 12 Metronidazol 250 12 Rp 2,472

Kalnex 6 Kalnex 6 Rp 20,622
Methylon 7 Methyl Predni 4mg 7 Rp 4,655
Cebex 6 Becom C 6 Rp 8,910
 Cefadroxil 500 10 Cefadroxil 500 10 Rp 11,000
Sarung tangan 1 Sarung tangan 1 Rp 4,537

8 1/17/2014 BEEN Intunal F 10 Rhinofed 10 Rp 19,250

Rhinos SR 6 Rhinos SR 6 Rp 30,738
Dexamethason 10 Dexamethason 10 Rp 300
Zibramax 3 Azitromicin 3 Rp 41,250

9 1/25/2014 HJ HENI Captopril 25 20 Captopril 25 20 Rp 3,460

Esilgan 2mg 5 Alviz 0,5 5 Rp 11,880
Braxidin 20 Braxidin 20 Rp 18,700
Omeprazole 15 Omeprazole 15 Rp 14,715
Sanfuliq 10 Curvit 10 Rp 32,500

10 1/28/2014 ALDI PERMANA Omeprazole 10 Omeprazole 10 Rp 9,810

11 1/29/2014 SUKARTINI DEWI Silex Syr 1

Dansera 12 Nonflamin 12 Rp 54,588
Cefadroxil 500 12 Cefadroxil 500 12 Rp 13,200
Nutrimama 1 20 Obimin AF 20 Rp 21,880
Cebex 20 Becom C 20 Rp 29,700

12 1/30/2014 ROHIBAH Metilev 5 Levofloxacin 5 Rp 7,590

Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
Sanadryl Syr 1 Sanadryl Syr 1 Rp 12,065
 Rp 1,102,081

RAWAT INAP

1 12/31/2013 IIS SULASTRI RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 37,550
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Kaltrofen Supp 1 Protofen Supp 1 Rp 8,580
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Dispo 3cc 2 Dispo 3cc 2 Rp 5,362
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Aquabidest 1 Aquabidest 1 Rp 2,218
Sarung tangan 1 Sarung tangan 1 Rp 4,537
12/31/2013 IIS SULASTRI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
12/31/2013 IIS SULASTRI RL 1 RL 1 Rp 11,330
12/31/2013 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Otozol j 1 OMZ j 1 Rp 145,200
Inpepsa Syr 1 Inpepsa Syr 1 Rp 63,250
Gitas j 2 Buscopan j 2 Rp 47,354
Opigran j 3 Ondan 4 j 3 Rp 22,689
12/31/2013 IIS SULASTRI Kaltrofen Supp 1 Protofen Supp 1 Rp 8,580
Sanmol Inf 1 Farmadol Inf 1 Rp 72,600
1/1/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Gitas j 2 Buscopan j 2 Rp 47,354
Opigran j 3 Ondan 4 j 3 Rp 22,689
Otozol j 1 OMZ j 1 Rp 145,200
 Paracetamol Inf 1 Farmadol Inf 1 Rp 72,600
1/1/2014 IIS SULASTRI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ketorolac j 2 Ketorolac j 2 Rp 37,126
Metronidazol Inf 2 Metronidazol Inf 2 Rp 55,000
1/1/2014 IIS SULASTRI Dextrose 10 1 Dextrose 10 1 Rp 12,546
1/1/2014 IIS SULASTRI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
RL 3 RL 3 Rp 33,990
1/2/2013 IIS SULASTRI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ketorolac j 2 Ketorolac j 2 Rp 37,126
Metronidazol Inf 2 Metronidazol Inf 2 Rp 55,000
RL 2 RL 2 Rp 22,660
Dextrose 10 1 Dextrose 10 1 Rp 12,546
1/2/2014 IIS SULASTRI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ketorolac j 1 Ketorolac j 1 Rp 18,563
Metronidazol Inf 1 Metronidazol Inf 1 Rp 27,500
1/2/2014 IIS SULASTRI Tramadol j 3 Tramadol j 3 Rp 25,932
1/3/2014 IIS SULASTRI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ketorolac j 1 Ketorolac j 1 Rp 18,563
Metronidazol Inf 1 Metronidazol Inf 1 Rp 27,500
RL 1 RL 1 Rp 11,330
1/4/2014 IIS SULASTRI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Pamol tab 3 Paracetamol 3 Rp 264
1/5/2013 IIS SULASTRI Cefadroxil 500 15 Cefadroxil 500 15 Rp 16,500
New Diatab 15 New Diatab 15 Rp 7,215

2 1/2/2014 JOJOK MIHARJO RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 37,550
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Ranitidin j 1 Ranitidin j 1 Rp 3,213
 Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Paracetamol inf 1 Farmadol Inf 1 Rp 72,600
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 2 Dispo 3cc 2 Rp 5,362
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
1/3/2014 JOJOK MIHARJO Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
1/3/2014 JOJOK MIHARJO RL 3 RL 3 Rp 33,990
Antrain j 3 Novalgin j 3 Rp 31,362
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Fudanton 4 j 3 Ondan 4 j 3 Rp 22,689
1/4/2014 JOJOK MIHARJO RL 1 RL 1 Rp 11,330
Antrain j 2 Novalgin j 2 Rp 20,908
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 1 Ranitidin j 1 Rp 3,213
NaCl 2 NaCl 2 Rp 22,660
Ondan 8 j 3 Ondan 8 j 3 Rp 33,000
1/5/2014 JOJOK MIHARJO Cefixime 100 10 Cefixime 100 10 Rp 29,940
Ranitidin tab 10 Ranitidin tab 10 Rp 2,500
Ondan 4 tab 10 Ondan 4 tab 10 Rp 19,250
Sanmol tb 10 Paracetamol 10 Rp 880

3 1/8/2014 WARSUM SUPRIATNA RL 1 RL 1 Rp 11,330

Abbocat 22 1 Abbocat 22 1 Rp 24,500
Infuset 1 Infuset 1 Rp 12,500
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
 Episan Syr 1 Inpepsa Syr 1 Rp 63,250
New Diatab 3 New Diatab 3 Rp 1,443
Sanmol 3 Sanmol 3 Rp 264
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Aquabidest 1 Aquabidest 1 Rp 2,218
1/9/2014 WARSUM SUPRIATNA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
1/9/2014 WARSUM SUPRIATNA RL 3 RL 3 Rp 33,990
Sanmol 3 Sanmol 3 Rp 264
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Episan Syr 1 Inpepsa Syr 1 Rp 63,250
Biodiar 3 New Diatab 3 Rp 1,443
1/10/2014 WARSUM SUPRIATNA Ciprofloxacin 500 10 Ciprofloxacin 500 10 Rp 4,540
Omeprazol 15 Omeprazol 15 Rp 14,715
Braxidin tab 15 Braxidin tab 15 Rp 14,025

4 1/13/2014 SUKARTINI DEWI Cedantron 8 j 1 Ondan 8 j 1 Rp 11,000

D5% 2 D5% 2 Rp 25,742
RL 1 RL 1 Rp 11,330
Panamin G Inf 1 Panamin G Inf 1 Rp 56,760
Neurosanbe j 1 Neurobion 5000 j 1 Rp 7,722
Acytral Syr 1 Acytral Syr 1 Rp 30,250
Strocain 2 Strocain 2 Rp 3,988
Combopack 1 Combopack 1 Rp 37,550
 1/14/2014 SUKARTINI DEWI Trovensis 4 tab 2 Ondan 4 tab 2 Rp 3,850
Nevradin E 1 Trimate E 1 Rp 1,568
Nutrimama 1 1 Obimin AF 1 Rp 1,094
1/15/2014 SUKARTINI DEWI Trovensis 4 tab 30 Trovensis 4 tab 30 Rp 57,750
Nevradin E 15 Trimate E 15 Rp 23,520
Sanmol tab 5 Paracetamol 5 Rp 440

5 1/12/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800

Abbocat 24 1 Abbocat 24 1 Rp 26,334
Infuset 1 Infuset 1 Rp 12,500
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Mucos Drop 1 Mucos Drop 1 Rp 40,000
Sanmol Drop 1 Sanmol Drop 1 Rp 18,950
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Aquabidest 1 Aquabidest 1 Rp 2,218
1/12/2014 YUSUF MAHARDIKA Caryamil Drop 1 Caryamil Drop 1
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
1/13/2014 YUSUF MAHARDIKA Ventolin Neb 1 Ventolin Neb 1 Rp 11,000
Dex 100 1 Dex 100 1 Rp 12,512
1/14/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800
1/14/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800
1/14/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800
1/15/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800
1/15/2014 YUSUF MAHARDIKA Ventolin Neb 1 Ventolin Neb 1 Rp 11,000
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dex 100 1 Dex 100 1 Rp 12,512
1/16/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800
1/17/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800
1/17/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800
1/18/2014 YUSUF MAHARDIKA Cairan 4:1 1 Cairan 4:1 1 Rp 13,800
6 1/10/2014 BEEN RL 1 RL 1 Rp 11,330
Abbocat 22 1 Abbocat 22 1 Rp 23,897
Infuset 1 Infuset 1 Rp 12,500
Hansaplast 1 Hansaplast 1 Rp 500
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Ambroxol tab 3 Ambroxol tab 3 Rp 429
1/11/2014 BEEN Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na diklofenak 25 10 Na diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
1/11/2014 BEEN RL 1 RL 1 Rp 11,330
1/12/2014 BEEN Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Epexol Syr 1 Transbronco Syr 1 Rp 26,125
1/13/2014 BEEN Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Rhinos SR 2 Rhinos SR 2 Rp 10,246
Dexamethason j 2 Kalmethason j 2 Rp 15,840
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na diklofenak 25 10 Na diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
 1/14/2014 BEEN Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Dexamethason j 1 Kalmethason j 1 Rp 7,920
1/14/2014 BEEN Ranitidin tab 10 Ranitidin tab 10 Rp 2,500
Cefixime 100 10 Cefixime 100 10 Rp 29,940
Episan Syr 1 Inpepsa Syr 1 Rp 60,720
Epexol Syr 1 Transbronco Syr 1 Rp 26,125
Rhinos SR 10 Rhinos SR 10 Rp 51,230

7 1/21/2014 IIS SULASTRI RL 1 RL 1 Rp 11,330

Abbocat 22 1 Abbocat 22 1 Rp 23,897
Infuset 1 Infuset 1 Rp 12,500
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
OMZ j 1 OMZ j 1 Rp 121,000
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Episan Syr 1 Inpepsa Syr 1 Rp 60,270
Gitas j 1 Buscopan j 1 Rp 23,677
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Aquabidest 1 Aquabidest 1 Rp 2,218
1/21/2014 IIS SULASTRI RL 1 RL 1 Rp 11,330
1/22/2014 IIS SULASTRI RL 1 RL 1 Rp 11,330
OMZ j 1 OMZ j 1 Rp 121,000
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Gitas j 1 Buscopan j 1 Rp 23,677
1/22/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 8 j 2 Ondan 8 j 2 Rp 22,000
 Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
m.f pulv dtd X m.f pulv dtd X
1/23/2014 IIS SULASTRI Futrolit Inf 2 Futrolit Inf 2 Rp 114,124
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Microlax Sol 1 Microlax Sol 1 Rp 20,450
1/24/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 8 j 2 Ondan 8 j 2 Rp 22,000
1/24/2014 IIS SULASTRI Kaltrofen Supp 1 Protofen Supp 1 Rp 8,580
1/25/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
m.f pulv dtd X m.f pulv dtd X
1/25/2014 IIS SULASTRI Combopack 1 Combopack 1 Rp 46,200
1/26/2014 IIS SULASTRI Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
1/26/2014 IIS SULASTRI Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
1/27/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ketorolac j 2 Ketorolac j 2 Rp 42,340
Ondan 8 j 3 Ondan 8 j 3 Rp 33,000
 1/27/2014 IIS SULASTRI Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
1/27/2014 IIS SULASTRI Combopack 1 Combopack 1 Rp 46,200
1/28/2014 IIS SULASTRI Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
1/28/2014 IIS SULASTRI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ketorolac j 1 Ketorolac j 1 Rp 21,170
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
1/28/2014 IIS SULASTRI Na Diklofenak 25 6 Na Diklofenak 25 6 Rp 1,374
Ranitidin tab 10 Ranitidin tab 10 Rp 2,500
Q10 3 Becom C 3 Rp 4,455

8 1/24/2014 ROHIBAH NOVITASARI RL 1 RL 1 Rp 11,330

Abbocat 22 1 Abbocat 22 1 Rp 23,897
Infuset 1 Infuset 1 Rp 12,500
Hansaplast 1 Hansaplast 1 Rp 500
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Omeprazole j 1 OMZ j 1 Rp 121,000
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Sanmol tab 3 Sanmol tab 3 Rp 264
1/25/2014 ROHIBAH NOVITASARI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Pranza j 1 OMZ j 1 Rp 121,000
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alviz 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
1/25/2014 ROHIBAH NOVITASARI RL 1 RL 1 Rp 11,330
1/26/2014 ROHIBAH NOVITASARI Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
 Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Pranza j 1 OMZ j 1 Rp 121,000
1/26/2014 ROHIBAH NOVITASARI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263

9 1/28/2014 JUNAEDI RL 1 RL 1 Rp 11,330

Abbocat 22 1 Abbocat 22 1 Rp 23,897
Infuset 1 Infuset 1 Rp 12,500
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Episan Syr 1 Inpepsa Syr 1 Rp 60,720
Sanmol 3 Sanmol 3 Rp 264
Dispo 10 1 Dispo 10 1 Rp 3,750
Dispo 3 1 Dispo 3 1 Rp 2,681
Dispo 1 1 Dispo 1 1 Rp 4,158
1/28/2014 JUNAEDI RL 1 RL 1 Rp 11,330
1/29/2014 JUNAEDI RL 1 RL 1 Rp 11,330
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
1/29/2014 JUNAEDI Aminofluid Inf 1 Aminofluid Inf 1 Rp 105,484
Dexamethason j 3 Kalmethason j 3 Rp 23,760
Intunal F 3 Rhinofed 3 Rp 5,775
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Sanadryl Syr 1 Sanadryl Syr 1 Rp 12,065
1/30/2014 JUNAEDI Aminofluid Inf 1 Aminofluid Inf 1 Rp 105,484
1/30/2014 JUNAEDI Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Dexamethason tab 10 Dexamethason tab 10 Rp 300
 m.f pulv dtd X m.f pulv dtd X
Metilev 5 Levofloxacin 5 Rp 7,590

10 1/28/2014 JIHAN RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Bufect Syr 1 Bufect Syr 1
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
1/28/2014 JIHAN Mucos Syr 1 Transbronco Syr 1 Rp 26,125
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 12,512
1/28/2014 JIHAN RL 1 RL 1 Rp 11,330
1/29/2014 JIHAN RL 1 RL 1 Rp 11,330
1/29/2014 JIHAN RL 1 RL 1 Rp 11,330
1/30/2014 JIHAN RL 1 RL 1 Rp 11,330
1/31/2014 JIHAN Erysanbe Syr 1 Erysanbe Syr 1 Rp 26,077

11 1/29/2014 JANIM SUHERMAN RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 2 Dispo 3cc 2 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Aquabidest 1 Aquabidest 1 Rp 2,218
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Paracetamol 3 Paracetamol 3 Rp 264
Ambroxol 3 Ambroxol 3 Rp 429
1/30/2014 JANIM SUHERMAN Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
RL 1 RL 1 Rp 11,330
1/30/2014 JANIM SUHERMAN RL 2 RL 2 Rp 22,660
Sanmol tab 3 Sanmol tab 3 Rp 264
Ceftriaxone j 3 Ceftriaxone j 3 Rp 39,789
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Cortidex j 3 Kalmethason j 3 Rp 23,760
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Alganak 0,5 1 Alviz 0,5 1 Rp 2,376
1/31/2014 JANIM SUHERMAN RL 1 RL 1 Rp 11,330
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
1/31/2014 JANIM SUHERMAN Metilev 5 Levofloxacin 5 Rp 7,590

R. INAP Rp 7,931,305
R. JALAN Rp 1,134,257
Rp 9,065,562
 BIAYA ASAL
RP RS
11 12

Rp 233,399

Rp 44,744

Rp 123,260
Rp 75,350

Rp 84,555

Rp 139,845

Rp 52,196
Rp 91,538

Rp 81,255

Rp 9,810

Rp 119,368

Rp 46,761
Rp 1,102,081

Rp 1,612,457
Rp 499,052
Rp 374,552
Rp 272,564
Rp 314,765
Rp 903,829
Rp 2,058,066
Rp 838,548
Rp 547,211
Rp 210,352

Rp 299,909
Rp 7,931,305
Rp 1,134,257
Rp 9,065,562
BUKU MONITOR APOTIK :
(REKAPITULASI PELAYANAN APOTIK)
PT.NAYAKA
BULAN FEBRUARI 2014

OP IP HARGA
NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN
1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
I.
1 2/1/2014 LITA JAHARA Trinordiol 28 1
Trichodazol Plus Ovula 5 Vagizol Ovula 5 Rp 75,000
Govazol 1
Urispas 6 Urotractin 6 Rp 17,886
Cefadroxil 500 15 Cefadroxil 500 15 Rp 16,500
Trogyl 250 12 Metronidazol 250 12 Rp 1,272
Cebex 7 Becom C 7 Rp 8,547

2 2/3/2014 SITI NURJANAH Emineton 20 Ferrofort 20 Rp 33,000

Osfit DHA 20 Obimin AF 20 Rp 19,260
Cebex 20 Becom C 20 Rp 24,420

3 2/5/2014 JANIM Antasida tab 20 Antasida tab 20 Rp 2,280

Codein 10mg 20 Codein 10mg 20 Rp 9,720
Methyl Predni 4 20 Methyl Predni 4 20 Rp 13,120
Etaphylin tab 10 Bronsolvan tab 10 Rp 4,540
m.f pulv dtd XX m.f pulv dtd XX

4 2/5/2014 JIHAN ARAHMA NURAFISA Maltiron Syr 1 Elkana Syr 1 Rp 24,681

 Erysanbe Syr 1 Erysanbe Syr 1 Rp 26,077
Mucos 1 Transbronco Syr 1 Rp 26,125

5 2/10/2014 AZMI Vercmin Syr 1

Rimcure PAED 60
Pediagrow Syr 1 Elkana Syr 1 Rp 24,681

6 2/10/2014 ALVIAN Maltiron Syr 1 Elkana Syr 1 Rp 24,681

7 2/10/2014 FITRI AGUSTINA Cemicetin Salep Kulit 1 Cemicetin Salep Kulit 1 Rp 9,075
Vitamin C 10 Vitamin C 10 Rp 610
Vitamin B Complex 10 Vitamin B Complex 10 Rp 280

8 2/10/2014 ROJALI Myonep 10 Myores 10 Rp 56,680

Neurosanbe Plus 10 Neurosanbe Plus 10 Rp 11,350
Paracetamol 500 10 Paracetamol 500 10 Rp 880

9 2/14/2014 WAHIDIN Paracetamol 600 12 Paracetamol 600 12 Rp 1,056

Natrium Diklofenak 25 10 Natrium Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Ondan 4 tab 10 Ondan 4 tab 10 Rp 19,250

10 2/17/2014 MULYADI Omeprazole 15 Omeprazole 15 Rp 14,715

Flamar 50 20 Voltadex 50 20 Rp 20,740
Paracetamol 250 10 Paracetamol 250 10 Rp 880
Diazepam 1mg 10 Diazepam 2mg 10 Rp 180
m.f pulv dtd XX m.f pulv dtd XX
Fluimucyl 15 Fluimucyl 15 Rp 60,225
11 2/20/2014 WAHIDIN Paracetamol 600 18 Paracetamol 600 18 Rp 1,584
Natrium Diklofenak 25 15 Natrium Diklofenak 25 15 Rp 3,435
Alganak 0,5 15 Alviz 0,5 15 Rp 35,640
m.f pulv dtd X m.f pulv dtd X
Ciprofloxacin 500 10 Ciprofloxacin 500 10 Rp 4,540

12 2/20/2014 JAMALUDIN Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720

Ondan 4 tab 10 Ondan 4 tab 10 Rp 19,250

13 2/28/2014 MIMI JAMILAH Sarung tangan 1 Sarung tangan 1 Rp 4,537

Mycospore cream 1 Mycorin cream 1 Rp 31,625
Thecort cream 1
m.f cream m.f cream
Trichodazol Plus Ovula 5 Vagizol Ovula 5 Rp 75,000
Opicef 10 Cefadroxil 500 10 Rp 11,000
Anvomer B6 30 Anvomer B6 30 Rp 75,240
Procalma 15 Obimin AF 15 Rp 14,445
Nevradine E 15 Trimate E 15 Rp 23,520

Rp 995,017

RAWAT INAP

1 1/31/2014 AZMI MAULANA RL 1 RL 1 Rp 11,330

Abbocat 24 1 Abbocat 24 1 Rp 26,334
Infuset 1 Infuset 1 Rp 12,500
 Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dex 100 cc 1 Dex 100 cc 1 Rp 12,512
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Epexol Syr 1 Transbronco Syr 1 Rp 26,125
Sanmol Syr 1 Sanmol Syr 1 Rp 13,303
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Aquabidest 1 Aquabidest 1 Rp 2,218
2/1/2014 AZMI MAULANA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dexamethason j 1 Kalmethason j 1 Rp 6,050
Dex 100 cc 1 Dex 100 cc 1 Rp 12,512
2/1/2014 AZMI MAULANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/1/2014 AZMI MAULANA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dex 100 cc 1 Dex 100 cc 1 Rp 12,512
2/2/2014 AZMI MAULANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/2/2014 AZMI MAULANA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dex 100 cc 1 Dex 100 cc 1 Rp 12,512
PPD Test 1 PPD Test 1 Rp 70,250
2/2/2014 AZMI MAULANA Combopack 24 1 Combopack 24 1 Rp 46,200
2/3/2014 AZMI MAULANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/3/2014 AZMI MAULANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/4/2014 AZMI MAULANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/4/2014 AZMI MAULANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/4/2014 AZMI MAULANA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dex 100 cc 1 Dex 100 cc 1 Rp 12,512
2/5/2014 AZMI MAULANA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dex 100 cc 1 Dex 100 cc 1 Rp 12,512
2/5/2014 AZMI MAULANA Erysanbe Syr 1 Erysanbe Syr 1 Rp 26,077

2 2/3/2014 ALVIAN FADILI KAEN 3A 1 KAEN 3A 1 Rp 16,407

Combopack 1 Combopack 1 Rp 46,200
 Sanpicilin j 1 Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Colsancetin j 1 Rp 11,770
Kalmethason j 1 Kalmethason j 1 Rp 6,050
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Dispo 3cc 2 Dispo 3cc 2 Rp 2,681
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Aquabidest 1 Aquabidest 1 Rp 2,218
Sanmol Syr 1 Sanmol Syr 1 Rp 13,303
Mucos Syr 1 Transbronco Syr 1 Rp 26,125
2/4/2014 ALVIAN FADILI KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/4/2014 ALVIAN FADILI KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/4/2014 ALVIAN FADILI KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/4/2014 ALVIAN FADILI Sanpicilin j 1 Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Colsancetin j 1 Rp 11,770
2/5/2014 ALVIAN FADILI KAEN 3A 1 KAEN 3A 1 Rp 16,407
2/5/2014 ALVIAN FADILI Sanpicilin j 1 Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Colsancetin j 1 Rp 11,770
Kalmethason j 1 Kalmethason j 1 Rp 6,050
2/6/2014 ALVIAN FADILI Sanpicilin j 1 Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Colsancetin j 1 Rp 11,770
Kalmethason j 1 Kalmethason j 1 Rp 6,050
2/6/2014 ALVIAN FADILI Erysanbe Syr 1 Erysanbe Syr 1 Rp 26,077

3 2/4/2014 FITRI AGUSTINA RL 1 RL 1 Rp 11,330

Abbocat 20 1 Abbocat 20 1 Rp 24,500
Bloodset 1 Bloodset 1 Rp 21,313
2/4/2014 FITRI AGUSTINA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ketorolac j 1 Ketorolac j 1 Rp 21,170
2/4/2014 FITRI AGUSTINA RL 1 RL 1 Rp 11,330
 2/4/2014 FITRI AGUSTINA RL 1 RL 1 Rp 11,330
2/5/2014 FITRI AGUSTINA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ketorolac j 1 Ketorolac j 1 Rp 21,170
2/5/2014 FITRI AGUSTINA Clindamicin 300 10 Clindamicin 300 10 Rp 11,250
Asam Mefenamat 500 15 Asam Mefenamat 500 15 Rp 2,385

4 2/8/2014 ACENG Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263

Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Paracetamol tb 3 Paracetamol tb 3 Rp 264
Curcuma 3 Curcuma 3 Rp 2,103
RL 1 RL 1 Rp 11,330
Combopack 1 Combopack 1 Rp 46,200
2/8/2014 ACENG RL 1 RL 1 Rp 11,330
Sanmol Inf 3
Ceftriaxone j 3 Ceftriaxone j 3 Rp 39,789
Dex 100 1 Dex 100 1 Rp 12,512
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 8 j 3 Ondan 8 j 3 Rp 33,000
Lasal Syr 1 Lasal Syr 1 Rp 26,469
Cortidex j 2 Kalmethason j 2 Rp 12,100
Rhinos SR 2 Rhinos SR 2 Rp 10,164
Alganak 0,5 1 Alviz 0,5 1 Rp 2,376
2/8/2014 ACENG Combopack 1 Combopack 1 Rp 46,200
2/9/2014 ACENG RL 1 RL 1 Rp 11,330
Ceftriaxone j 3 Ceftriaxone j 3 Rp 39,789
 Ondan 8 j 2 Ondan 8 j 2 Rp 22,000
Sanmol Inf 3
Cortidex j 2 Kalmethason j 2 Rp 12,100
Rhinos SR 2 Rhinos SR 2 Rp 5,082
Alganak 0,5 1 Alviz 0,5 1 Rp 2,376
2/10/2014 ACENG RL 1 RL 1 Rp 11,330
Dex 100 1 Dex 100 1 Rp 12,512
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Rhinos SR 1 Rhinos SR 1 Rp 5,082
2/10/2014 ACENG RL 3 RL 3 Rp 33,990
Antrain j 3 Antrain j 3 Rp 34,650
Ceftriaxone j 3 Ceftriaxone j 3 Rp 39,789
Dex 100 1 Dex 100 1 Rp 12,512
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 8 j 3 Ondan 8 j 3 Rp 33,000
Rhinos SR 2 Rhinos SR 2 Rp 10,164
Alganak 0,5 1 Alviz 0,5 1 Rp 2,376
Largactil 25 1 Largactil 25 1 Rp 605
2/11/2014 ACENG RL 1 RL 1 Rp 11,330
Antrain j 1 Antrain j 1 Rp 11,550
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Rhinos SR 1 Rhinos SR 1 Rp 5,082
Largactil 25 1 Largactil 25 1 Rp 605
2/11/2014 ACENG Ceftriaxone j 3 Ceftriaxone j 3 Rp 39,789
Dex 100 1 Dex 100 1 Rp 12,512
Cefixime 200 10 Cefixime 200 10 Rp 29,940
Codipront 10 Codein 15 10 Rp 10,810
Rhinos SR 7 Rhinos SR 7 Rp 35,574
Largactil 25 10 Largactil 25 10 Rp 6,050
Omeprazole 15 Omeprazole 15 Rp 14,715
5 2/11/2014 JAMALUDIN RL 2 RL 2 Rp 22,660
Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dex 100 1 Dex 100 1 Rp 12,512
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Strocain 3 Strocain 3 Rp 5,739
Curcuma 3 Curcuma 3 Rp 2,103
2/11/2014 JAMALUDIN RL 1 RL 1 Rp 11,330
Sanmol Inf 1
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Ranitidin j 1 Ranitidin j 1 Rp 3,213
2/12/2014 JAMALUDIN Combopack 1 Combopack 1 Rp 46,200
2/12/2014 JAMALUDIN RL 1 RL 1 Rp 11,330
Sanmol Inf 1
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Ranitidin j 1 Ranitidin j 1 Rp 3,213
2/12/2014 JAMALUDIN Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Pranza j 1 OMZ j 1 Rp 121,000
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
2/13/2014 JAMALUDIN Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Pranza j 1 OMZ j 1 Rp 121,000
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Farmadol Inf 1
 Sanadryl Syr 1 Sanadryl Syr 1 Rp 12,065
2/14/2014 JAMALUDIN Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
2/14/2014 JAMALUDIN Futrolit Inf 2 Futrolit Inf 2 Rp 114,124
Futaxon j 1 Ceftriaxone j 1 Rp 13,263
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Farmadol Inf 1
2/15/2014 JAMALUDIN Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Futaxon j 1 Ceftriaxone j 1 Rp 13,263
Farmadol Inf 1
Codein 3 Codein 3 Rp 3,243
Dexamethason j 3 Kalmethason j 3 Rp 18,150
Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
2/16/2014 JAMALUDIN Dexamethason j 1 Kalmethason j 1 Rp 6,050
2/16/2014 JAMALUDIN Cefixime 100 10 Cefixime 100 10 Rp 29,940
Sanmol tab 10 Sanmol tab 10 Rp 880
Sanadryl Syr 1 Sanadryl Syr 1 Rp 12,065
Codein 10 Codein 10 Rp 10,810
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720

6 2/14/2014 WAHIDIN RL 1 RL 1 Rp 11,330

Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dex 100 1 Dex 100 1 Rp 12,512
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
2/15/2014 WAHIDIN Aminofluid Inf 3 Aminofluid Inf 3 Rp 316,452
 Fudanton j 2 Ondan 4 j 2 Rp 15,126
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
2/16/2014 WAHIDIN Aminofluid Inf 1 Aminofluid Inf 1 Rp 105,484
2/16/2014 WAHIDIN Aminofluid Inf 1 Aminofluid Inf 1 Rp 105,484
Fudanton j 1 Ondan 4 j 1 Rp 7,563
Ranitidin j 1 Ranitidin j 1 Rp 3,213
2/16/2014 WAHIDIN Aminofluid Inf 1 Aminofluid Inf 1 Rp 105,484
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Ranitidin j 2 Ranitidin j 2 Rp 6,426
2/17/2014 WAHIDIN Aminofluid Inf 1 Aminofluid Inf 1 Rp 105,484
Ranitidin j 1 Ranitidin j 1 Rp 3,213
2/17/2014 WAHIDIN Chloracef 6 Cefadroxil 500 6 Rp 6,600
Paracetamol 600 10 Paracetamol 600 10 Rp 880

7 2/17/2014 FABIANU RL 1 RL 1 Rp 11,330

Abbocat 24 1 Abbocat 24 1 Rp 26,334
Infuset 1 Infuset 1 Rp 12,500
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dexamethason j 1 Kalmethason j 1 Rp 6,050
Sanmol Inf 1
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Aquabidest 1 Aquabidest 1 Rp 2,218
2/17/2014 FABIANU Dex 100 1 Dex 100 1 Rp 12,512
2/17/2014 FABIANU RL 1 RL 1 Rp 11,330
2/17/2014 FABIANU Sanmol Syr 1 Sanmol Syr 1 Rp 13,303
 Alco Syr 1 Alco Syr 1 Rp 32,670
2/18/2014 FABIANU Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dexamethason j 1 Kalmethason j 1 Rp 6,050
2/18/2014 FABIANU RL 1 RL 1 Rp 11,330
2/18/2014 FABIANU RL 1 RL 1 Rp 11,330
2/19/2014 FABIANU Erysanbe Syr 1 Erysanbe Syr 1 Rp 26,077

8 2/20/2014 ZAHRA ALYA RL 1 RL 1 Rp 11,330

Combopack 24 1 Combopack 24 1 Rp 38,500
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Bufect Syr 1 Bufect Syr 1 Rp 16,706
Proris Supp 1 Proris Supp 1 Rp 5,706
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
2/21/2014 ZAHRA ALYA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 12,512
Mucos Syr 1 Transbronco Syr 1 Rp 26,125
2/21/2014 ZAHRA ALYA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 12,512
RL 1 RL 1 Rp 11,330
2/22/2014 ZAHRA ALYA RL 1 RL 1 Rp 11,330
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 12,512
2/22/2014 ZAHRA ALYA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 12,512
2/23/2014 ZAHRA ALYA Erysanbe Syr 1 Erysanbe Syr 1 Rp 26,077

9 2/19/2014 KUSSYAMSUL Combopack 1 Combopack 1 Rp 46,200

Lasix j 2 Furosemid j 2 Rp 2,588
Ranitidin j 2 Ranitidin j 2 Rp 6,426
 Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dex 100 1 Dex 100 1 Rp 12,512
2/19/2014 KUSSYAMSUL NaCl 1 NaCl 1 Rp 11,330
2/19/2014 KUSSYAMSUL NaCl 1 NaCl 1 Rp 11,330
2/19/2014 KUSSYAMSUL NaCl 1 NaCl 1 Rp 11,330
2/20/2014 KUSSYAMSUL NaCl 3 NaCl 1 Rp 11,330
Lasix j 1 Furosemid j 1 Rp 1,294
Laxadin Syr 1 Laxadin Syr 1 Rp 33,687
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 2 Ondan 4 j 2 Rp 15,126
Dex 100 1 Dex 100 1 Rp 12,512
2/20/2014 KUSSYAMSUL RL 1 RL 1 Rp 11,330
2/20/2014 KUSSYAMSUL NaCl 1 NaCl 1 Rp 11,330
2/20/2014 KUSSYAMSUL Combopack 1 Combopack 1 Rp 46,200
2/20/2014 KUSSYAMSUL NaCl 1 NaCl 1 Rp 11,330
2/20/2014 KUSSYAMSUL RL 1 RL 1 Rp 11,330
2/21/2014 KUSSYAMSUL Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
2/21/2014 KUSSYAMSUL NaCl 2 NaCl 2 Rp 22,660
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dex 100 1 Dex 100 1 Rp 12,512
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 2 Ondan 4 j 2 Rp 15,126
Lasix j 1 Furosemid j 1 Rp 1,294
2/21/2014 KUSSYAMSUL Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
2/22/2014 KUSSYAMSUL Combopack 1 Combopack 1 Rp 46,200
2/22/2014 KUSSYAMSUL Lasix j 1 Furosemid j 1 Rp 1,294
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
 Dex 100 1 Dex 100 1 Rp 12,512
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 2 Ondan 4 j 2 Rp 15,126
NaCl 3 NaCl 3 Rp 33,990
2/23/2014 KUSSYAMSUL Combopack 1 Combopack 1 Rp 46,200
2/23/2014 KUSSYAMSUL NaCl 1 NaCl 1 Rp 11,330
2/23/2014 KUSSYAMSUL NaCl 2 NaCl 2 Rp 22,660
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Laxadin Syr 1 Laxadin Syr 1 Rp 33,687
2/24/2014 KUSSYAMSUL Rocer 15 Omeprazole 15 Rp 14,715
Braxidin 15 Braxidin 15 Rp 14,025
Neciblok Syr 1 Inpepsa Syr 1 Rp 60,720

R. INAP Rp 5,553,686
R. JALAN Rp 1,134,257
Rp 6,687,943
 BIAYA ASAL
RP RS
11 12

Rp 119,205

Rp 76,680

Rp 29,660

Rp 76,883
Rp 24,681

Rp 24,681

Rp 9,965

Rp 68,910

Rp 107,076

Rp 96,740
Rp 45,199

Rp 79,970

Rp 235,367

Rp 995,017

Rp 504,792
Rp 347,569
Rp 168,730
Rp 785,611
Rp 1,515,679
Rp 898,774
Rp 215,991
Rp 279,729

Rp 836,811
Rp 5,553,686
Rp 1,134,257
Rp 6,687,943
BUKU MONITOR APOTIK :
(REKAPITULASI PELAYANAN APOTIK)
PT.NAYAKA
BULAN MARET 2014

NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN

1 2 3 4 5
RAWAT JALAN
I.
1 2/7/2014 INDRA KALBUKU Paracetamol 600 12
Na Diklofenak 25 10
Alganak 0,5 10
m.f pulv dtd X
Cefixime 100 6

2 3/3/2014 KUSSYAMSUL BAHRI Omeprazole 20

Folavit 10

3 3/17/2014 NANDAR Orasic 25 15

Kaltrofen 25 15
Forres 25 15
Amitriptilin 3mg 15
m.f pulv dtd XV
Hexilon 8mg 10
Lancid 5
Neurobion 5000 5

4 3/20/2014 YEYEN GUNARI Vagistin Ovula 5

Cefadroxil 500 12
Trachon 1
Procalma 15
Cebex 15

5 3/24/2014 NANDAR Hexilon 4mg 10

Tramadol 25mg 10
Kaltrofen 25mg 10
Forres 25mg 10
Amitriptilin 3mg 10
m.f pulv dtd X
Ranitidin 10
Neurobion 5000 5
Divask 5mg 5
 RAWAT INAP

1 3/16/2014 IMAM ANGGARA RL 1

Abbocat 24 1
Infuset 1
Ceftriaxone j 1
Sagestam j 1
Epexol Syr 1
Dexamethason j 1
Sanmol Inf 1
Dispo 10cc 1
Dispo 3cc 1
Dispo 1cc 1
Aquabidest 1
3/16/2014 IMAM ANGGARA KAEN 3A 1
3/16/2014 IMAM ANGGARA Ceftriaxone j 1
Dextrose 100 1
3/17/2014 IMAM ANGGARA Ceftriaxone j 1
Dextrose 100 1
Sagestam j 1
Dexamethason j 1
Mucos Syr 1
3/18/2014 IMAM ANGGARA KAEN 3A 1
3/18/2014 IMAM ANGGARA Meptin Syr 1

2 3/4/2014 NANDANG HIDAYAT RL 1

Combopack 1
Ceftriaxone j 1
Ranitidin j 1
Ondansetron j 1
Dispo 1cc 1
Dispo 3cc 2
Dispo 10cc 1
Paracetamol 3
3/4/2014 NANDANG HIDAYAT Futrolit Inf 3
Ceftriaxone j 2
Inpepsa Syr 1
Ondansetron j 3
Paracetamol 12
Na Diklofenak 25 10
Alganak 0,5 10
 m.f pulv dtd X
3/5/2014 NANDANAG HIDAYAT Futrolit Inf 3
Ceftriaxone j 2
Ondansetron j 3
Dextrose 100cc 1
3/6/2014 NANDANG HIDAYAT Chloracef 6
Futamel 6

3 3/28/2014 KOSIM NURSEHA RL 1

Combopack 1
Dispo 10cc 1
Dispo 5cc 1
Dispo 3cc 1
Dispo 1cc 1
Cefotaxime j 1
Ranitidin j 1
Buscopan j 1
New Diatab 10
Inpepsa Syr 1
3/28/2014 KOSIM NURSEHA RL 1
3/29/2014 KOSIM NURSEHA RL 1

4 3/26/2014 MOH. HENDRK BIN NURHALI RL 1

Combopack 1
Pantoprazole j 1
Ondan 8 j 1
Dispo10cc 1
Dispo 5cc 1
Antasida 3
3/26/2014 MOH. HENDRK BIN NURHALI RL 3
Pantoprazole j 2
Ondan 4 j 3
Gitas j 2
Antasida 3
3/27/2014 MOH. HENDRK BIN NURHALI RL 3
Pantoprazole j 2
Ondan 4 j 3
Gitas j 2
Antasida 3
3/28/2014 MOH. HENDRK BIN NURHALI RL 1
Pantoprazole j 1
3/28/2014 MOH. HENDRK BIN NURHALI Omeprazole 15
Braxidin 15
strocain 20

5 3/11/2014 YANDI RL 1
 Combopack 1
Futaxone j 2
Dextrose 100 1
Dispo 1 1
Dispo 10 1
Aquabidest 1
Pantotis j 1
New Diatab 3
3/12/2014 YANDI Futrolit inf 3
Pranza j 1
Elpicef j 2
Inpepsa Syr 1
Q10 2
Paracetamol 600 12
Na Dikofenak 25 10
Alganak 0,25 10
m.f pulv dtd X
3/12/2014 YANDI RL 1
Pantotis j 1
Ondansetron 8 j 1
Paramol Inf 1
New Diatab 1
3/13/2014 YANDI Dextrose 5% 1
3/13/2014 YANDI Pantoprazole j 1
Ondansetron 8 j 1
3/13/2014 YANDI Chloracef 6
Q10 3
Mucosta 10
 OP IP HARGA BIAYA
OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN RP
6 7 8 9 10 11

Paracetamol 600 12 Rp 1,056 Rp 45,920

Na Diklofenak 25 10 Rp 2,290
Alviz 0,5 10 Rp 24,610
m.f pulv dtd X
Cefixime 100 6 Rp 17,964

Omeprazole 20 Rp 19,620 Rp 28,690

Folavit 10 Rp 9,070

Tramadol 50 8 Rp 3,560 Rp 90,969

Ketoprofen 50 8 Rp 7,744
Myores 50 8 Rp 45,344
Amitriptilin 3mg 2 Rp 346
m.f pulv dtd XV
Methyl Predni 8 tb 10 Rp 8,830
Lansoprazole 5 Rp 11,000
Neurobion 5000 5 Rp 14,145

Vagizol Ovula 5 Rp 75,000 Rp 130,860

Cefadroxil 500 12 Rp 13,200
Itraconazol 1 Rp 9,900
Obimin AF 15 Rp 14,445
Becom C 15 Rp 18,315

Methyl Predni 4mg 10 Rp 6,560 Rp 74,081

Tramadol 50 5 Rp 2,225
Ketoprofen 50 5 Rp 4,840
Myores 50 5 Rp 28,340
Amitriptilin 3mg 2 Rp 346
m.f pulv dtd X
Ranitidin 10 Rp 2,500
Neurobion 5000 5 Rp 14,145
Amlodipin 5 5 Rp 15,125
 Rp 370,520 Rp 370,520

RL 1 Rp 11,330 Rp 355,469
Abbocat 24 1 Rp 26,334
Infuset 1 Rp 12,500
Ceftriaxone j 1 Rp 13,263
Gentamicin j 1 Rp 3,125
Transbronco Syr 1 Rp 26,125
Kalmethason j 1 Rp 7,920
Sanmol Inf 1 Rp 67,650
Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Rp 4,158
Aquabidest 1 Rp 2,218
KAEN 3A 1 Rp 16,407
Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Rp 10,010
Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Rp 10,010
Gentamicin j 1 Rp 3,125
Kalmethason j 1 Rp 7,920
Transbronco Syr 1 Rp 26,125
KAEN 3A 1 Rp 16,407
Meptin Syr 1 Rp 57,885

RL 1 Rp 11,330 Rp 644,134
Combopack 1 Rp 46,200
Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Rp 3,123
Ondansetron j 1 Rp 7,563
Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Rp 4,158
Paracetamol 3 Rp 264
Futrolit Inf 3 Rp 171,186
Ceftriaxone j 2 Rp 26,526
Inpepsa Syr 1 Rp 60,720
Ondansetron j 3 Rp 22,689
Paracetamol 12 Rp 1,056
Na Diklofenak 25 10 Rp 2,290
Alviz 0,5 10 Rp 23,760
m.f pulv dtd X
Futrolit Inf 3 Rp 171,186
Ceftriaxone j 2 Rp 26,526
Ondansetron j 3 Rp 22,689
Dextrose 100cc 1 Rp 10,010

Meloxicam 7,5 6 Rp 13,164

RL 1 Rp 11,330 Rp 175,076
Combopack 1 Rp 46,200
Dispo 10cc 1 Rp 3,750
Dispo 5cc 1 Rp 3,500
Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Rp 4,158
Cefotaxime j 1 Rp 12,054
Ranitidin j 1 Rp 3,213
Buscopan j 1
New Diatab 10 Rp 4,810
Inpepsa Syr 1 Rp 60,720
RL 1 Rp 11,330
RL 1 Rp 11,330

RL 1 Rp 11,330 Rp 1,046,322
Combopack 1 Rp 46,200
OMZ j 1 Rp 121,000
Ondan 8 j 1 Rp 11,000
Dispo10cc 1 Rp 3,750
Dispo 5cc 1 Rp 3,500
Acytral tab 3 Rp 2,064
RL 3 Rp 11,330
OMZ j 2 Rp 242,000
Ondan 4 j 3 Rp 22,689
Buscopan j 2 Rp 43,516
Acytral tab 3 Rp 2,064
RL 2 Rp 22,660
OMZ j 2 Rp 242,000
Ondan 4 j 3 Rp 22,689
Buscopan j 2 Rp 43,516
Acytral tab 3 Rp 2,064
RL 1 Rp 11,330
OMZ j 1 Rp 121,000
Omeprazole 15 Rp 14,715
Braxidin 15 Rp 14,025
strocain 20 Rp 31,880

RL 1 Rp 11,330 Rp 1,042,410
Combopack 1 Rp 46,200
Ceftriaxone j 2 Rp 26,526
Dextrose 100 1 Rp 10,010
Dispo 1 1 Rp 4,158
Dispo 10 1 Rp 3,750
Aquabidest 1 Rp 2,218
OMZ j 1 Rp 121,000
New Diatab 3 Rp 1,443
Futrolit inf 3 Rp 171,186
OMZ j 1 Rp 121,000
Ceftriaxone j 2 Rp 26,526
Inpepsa Syr 1 Rp 60,720
Becom C 2 Rp 2,442
Paracetamol 600 12 Rp 1,056
Na Dikofenak 25 10 Rp 2,290
Alviz 0,5 5 Rp 11,880
m.f pulv dtd X
RL 1 Rp 11,330
OMZ j 1 Rp 121,000
Ondansetron 8 j 1 Rp 11,000
Farmadol inf 1 Rp 72,600
New Diatab 1 Rp 481
Dextrose 5% 1 Rp 12,871
OMZ j 1 Rp 121,000
Ondansetron 8 j 1 Rp 11,000
Chloracef 6
Becom C 3 Rp 3,663
Mucosta 10 Rp 53,730

R. INAP Rp 3,263,411 Rp 3,263,411

R. JALAN Rp 370,520 Rp 370,520
Rp 3,633,931 Rp 3,633,931
ASAL
RS
12

Rp 296,439
Rp 999,603
BUKU MONITOR APOTIK :
(REKAPITULASI PELAYANAN APOTIK)
PT.NAYAKA
BULAN APRIL 2014

OP IP HARGA BIAYA
NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN RP
1 2 3 4 5 6 7 8 9 10 11
RAWAT JALAN
I.
1 4/2/2014 MOH HENDRIK Omeprazole 15 Omeprazole 15 Rp 14,715 Rp 67,000
Braxidin 15 Braxidin 15 Rp 14,025
Strocain 20 Strocain 20 Rp 38,260

2 4/4/2014 SUKARTINI DEWI Lactamed 20 Obimin AF 20 Rp 19,260 Rp 55,420

Obivit 20 Obimin AF 20 Rp 19,260
Elkana 20 Elkana 20 Rp 16,900

3 4/7/2014 ABDULLAH Omeprazole 15 Omeprazole 15 Rp 14,715 Rp 87,121

Strocain 20 Strocain 20 Rp 38,260
Meloxicam 7,5 20 Meloxicam 7,5 15 Rp 32,910
Paracetamol 300 20 Paracetamol 300 12 Rp 1,056
Diazepam 1mg 20 Diazepam 2mg 10 Rp 180
m.f pulv dtd XX m.f pulv dtd XX

4 4/7/2014 AZMI MAULANA Rimactacid PAED 60 Rimactacid PAED 60 Rp 164,160 Rp 164,160

5 4/7/2014 MIMI JAMILAH Silx syrup 1

Nonflamin 15 Nonflamin 15 Rp 68,235 Rp 178,575
Cefadroxil 500 15 Cefadroxil 500 15 Rp 16,500
 Cebex 20 Becom C 20 Rp 24,420
Procalma 20 Obimin AF 20 Rp 19,260
Anvomer B6 20 Anvomer B6 20 Rp 50,160

6 4/8/2014 SITI SAEBAH Vagistin Ovula 5 Vagizol Ovula 5 Rp 57,230 Rp 106,879

Trachon 1 Itraconazol 1 Rp 9,900
Cebex 7 Becom C 7 Rp 8,547
Cefadroxil 500 15 Cefadroxil 500 15 Rp 16,500
Gitas Plus 2 Gitas Plus 2 Rp 5,072
Promavit 10 Obimin AF 10 Rp 9,630

7 4/11/2014 MUSTOFA ADE KAMAL Paracetamol 600 10 Paracetamol 600 12 Rp 1,056 Rp 34,432
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
Afamed 6 Becom C 6 Rp 7,326

8 4/14/2014 MAULIDIA RAHMA PPD test 1 PPD test 1 Rp 70,250 Rp 70,250

9 4/14/2014 ARYANI Gitas Plus 2 Gitas Plus 2 Rp 5,072 Rp 130,370

Dansera 12 Nonflamin 12 Rp 54,588
Cefadroxil 500 12 Cefadroxil 500 12 Rp 13,200
Promavit 15 Obimin AF 15 Rp 14,445
Cebex 15 Becom C 15 Rp 18,315
Nonemi 15 Ferrofort 15 Rp 24,750

10 4/15/2014 SITI NURJANAH Adalat 10 15 Nifedipin 10 15 Rp 2,025 Rp 80,541

Pectocyl 200 15 Fluimucyl 200 15 Rp 60,225
Glisodin 7
Emineton 7 Ferrofort 7 Rp 11,550
Promavit 7 Obimin AF 7 Rp 6,741
11 4/25/2014 DEDI YUSUF Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720 Rp 86,075
Q10 5 Becom C 5 Rp 6,105
Ondansetron tab 10 Ondansetron tab 10 Rp 19,250

12 4/28/2014 KOKOM KOMARIAH Lactamed 15 Obimin AF 15 Rp 14,445 Rp 66,315

Obivit 15 Obimin AF 15 Rp 14,445
Elkana 15 Elkana 15 Rp 12,675
Nonemi 15 Ferrofort 15 Rp 24,750

13 4/30/2014 M AKBAR FALAH Cefat Forte Syr 1 Cefat Forte Syr 1 Rp 53,850 Rp 115,862
Lapisiv Syr 1
Rhelafen Syr 1 Rhelafen Syr 1 Rp 16,706
Mucos Syr 1 Mucos Syr 1 Rp 20,625
Pediagrow Syr 1 Elkana Syr 1 Rp 24,681

14 4/30/2014 AZMI MAULANA Rimactacid PAED 60 Rimactacid PAED 60 Rp 164,160 Rp 164,160

Rp 1,407,160 Rp 1,407,160

RAWAT INAP

1 3/29/2014 ABDULLAH BIN CAKIM RL 1 RL 1 Rp 11,330 Rp 1,526,408

Combopack 1 Combopack 1 Rp 46,200
 Dispo 1cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 5cc 1 Rp 3,500
Dispo 5cc 1 Dispo 3cc 1 Rp 2,681
Dispo 10cc 1 Dispo 1cc 1 Rp 4,158
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Pantoprazole j 1 OMZ j 1 Rp 121,000
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Paracetamol j 1 Farmadol Inf 1 Rp 72,600
Paracetamol tab 3 Paracetamol tab 3 Rp 264
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
3/29/2014 ABDULLAH BIN CAKIM RL 1 RL 1 Rp 11,330
Neurobion j 1 Neurobion j 1 Rp 8,976
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Pantoprazole j 1 OMZ j 1 Rp 121,000
Paracetamol j 1 Farmadol Inf 1 Rp 72,600
Cortidex j 1 Kalmethason j 1 Rp 7,920
3/29/2014 ABDULLAH BIN CAKIM Neurobion j 1 Neurobion j 1 Rp 8,976
3/30/2014 ABDULLAH BIN CAKIM RL 1 RL 1 Rp 11,330
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
3/30/2014 ABDULLAH BIN CAKIM RL 1 RL 1 Rp 11,330
Neurobion j 1 Neurobion j 1 Rp 8,976
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Pantoprazole j 1 OMZ j 1 Rp 121,000
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Cortidex j 3 Kalmethason j 3 Rp 23,760
3/31/2014 ABDULLAH BIN CAKIM Aminofluid inf 1 Aminofluid inf 1 Rp 105,484
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Paracetamol 600 3 Paracetamol 600 3 Rp 264
Na Diklofenak 25 3 Na Diklofenak 25 3 Rp 687
Alganak 0,5 3 Alviz 0,5 3 Rp 7,128
 m.f pulv dtd III m.f pulv dtd III
4/1/2014 ABDULLAH BIN CAKIM Combopack 1 Combopack 1 Rp 46,200
4/1/2014 ABDULLAH BIN CAKIM D5 3 D5 3 Rp 24,000
Neurobion j 1 Neurobion j 1 Rp 8,976
Q10 1 Becom C 1 Rp 1,221
Ranitidin j 2 Ranitidin j 2 Rp 6,426
4/2/2014 ABDULLAH BIN CAKLIM RL 3 RL 3 Rp 33,990
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Sanmol Inf 3 Farmadol Inf 3 Rp 217,800
Alganak 0,5 1 Alviz 0,5 1 Rp 2,376
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Cortidex j 2 Kalmethason j 2 Rp 15,840
D5 1 D5 1 Rp 8,000
4/3/2014 ABDULLAH BIN CAKIM Combopack 1 Combopack 1 Rp 46,200
4/3/2014 ABDULLAH BIN CAKIM Cefixime 200 10 Cefixime 200 10 Rp 54,450
Neurosanbe Plus 10 Neurosanbe Plus 10 Rp 12,000

2 4/12/2014 RIZKA PUTRI MELANI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263 Rp 424,566

Dextrose 100 1 Dextrose 100 1 Rp 10,010
L Bio 6 L Bio 6 Rp 33,000
L Zinc Syr 1
4/12/2014 RIZKA PUTRI MELANI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
L Bio 1 L Bio 1 Rp 5,500
4/13/2014 RIZKA PUTRI MELANI RL 1 RL 1 Rp 11,330
4/14/2014 RIZKA PUTRI MELANI RL 1 RL 1 Rp 11,330
Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Paracetamol Inf 1 Farmadol Inf 1 Rp 72,600
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dextrose 100 1 Dextrose 100 1 Rp 10,010
 4/13/2014 RIZKA PUTRI MELATI Combopack 1 Combopack 1 Rp 46,200
4/14/2014 RIZKA PUTRI MELATI Myco Z zalf 1
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 10,010
4/15/2014 RIZKA PUTRI MELATI RL 1 RL 1 Rp 11,330
4/15/2014 RIZKA PUTRI MELATI Claneksi Forte Syr 1 Claneksi Forte Syr 1 Rp 90,000

3 4/17/2014 SURADI JAYA RL 1 RL 1 Rp 11,330 Rp 1,015,456

Combopack 1 Combopack 1 Rp 46,200
Neurobion j 1 Neurobion j 1 Rp 8,976
Ketesse j 1 Ketesse j 1 Rp 59,320
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Dispo 3cc 3 Dispo 3cc 3 Rp 2,681
4/17/2014 SURADI JAYA RL 1 RL 1 Rp 11,330
Kalmeco j 3 Kalmeco j 3 Rp 31,680
Hexilon j 3 Methyl Predni j 3 Rp 133,032
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ketesse j 3 Ketesse j 3 Rp 177,960
Forres 3 myores 3 Rp 17,004
Kalxetin 20 1 Kalxetin 20 1 Rp 3,537
4/18/2014 SURADI JAYA Ranitidin j 2 Ranitidin j 2 Rp 6,426
RL 1 RL 1 Rp 11,330
Kalmeco j 3 Kalmeco j 3 Rp 31,680
Ketesse j 3 Ketesse j 3 Rp 177,960
Hexilon j 2 Methyl Predni j 2 Rp 88,688
Kalxetin 20 1 Kalxetin 20 1 Rp 3,537
Forres 3 Myores 3 Rp 17,004
4/19/2014 SURADI JAYA RL 1 RL 1 Rp 11,330
4/19/2014 SURADI JAYA Ketesse j 1 Ketesse j 1 Rp 59,320
Ranitidin j 1 Ranitidin j 1 Rp 3,213
4/19/2014 SURADI JAYA Orasic 25 15 Tramadol 50 8 Rp 3,560
Kaltrofen 25 15 Ketoprofen 50 8 Rp 7,744
 Amitriptilin 3mg 15 Amitriptilin 3mg 2 Rp 386
Forres 25 15 Myores 50 8 Rp 45,344
m.f pulv dtd XV m.f pulv dtd XV
Kalxetin 20 5 Kalxetin 20 5 Rp 17,685
Hexilon tab 10 Methyl predni 4 tab 10 Rp 6,560
Lancid 5 Lansoprazole 5 Rp 11,000

4 4/18/2014 DEDI YUSUF RL 1 RL 1 Rp 11,330 Rp 718,743

Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Sanmol tab 3 Paracetamol 500 3 Rp 264
Dexanta Syr 1 Acitral Syr 1 Rp 25,410
4/18/2014 DEDI YUSUF RL 1 RL 1 Rp 11,330
4/19/2014 DEDI YUSUF Futrolit inf 3 Futrolit inf 3 Rp 171,186
Ondan 4 j 2 Ondan 4 j 2 Rp 15,126
Elpicef j 1 Ceftriaxone j 1 Rp 13,263
Paracetamol 600 10 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alaganak 0,5 10 Alviz 0,5 10 Rp 23,760
m,f pulv dtd X m,f pulv dtd X
4/20/2014 DEDI YuSUF Futrolit inf 1 Futrolit inf 1 Rp 57,062
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ondan 8 j 2 Ondan 8 j 2 Rp 22,000
4/21/2014 DEDI YUSUF Futrolit inf 3 Futrolit inf 3 Rp 171,186
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Elpicef j 1 Ceftriaxone j 1 Rp 13,263
Pralax Syr 1 Pralax Syr 1 Rp 68,062
Paracetamol 600 3 Paracetamol 500 3 Rp 264

5 4/23/2014 AZMI MAULANA RL 1 RL 1 Rp 11,330 Rp 162,174

 Combopack 1 Combopack 1 Rp 46,200
Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Proris Supp 1 Proris Supp 1 Rp 5,706
Paracetamol Syr 1 Sanmol Syr 1 Rp 13,303
Dexamethason j 1 Kalmethason j 1 Rp 7,920
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
4/23/2014 AZMI MAULANA Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
4/23/2014 AZMI MAULANA RL 1 RL 1 Rp 11,330
4/24/2014 AZMI MAULANA RL 1 RL 1 Rp 11,330
4/24/2014 AZMI MAULANA Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
4/24/2014 AZMI MAULANA RL 1 RL 1 Rp 11,330

6 4/23/2014 AQILA KIRANA KAEN 3A 1 KAEN 3A 1 Rp 16,407 Rp 254,911

Combopack 1 Combopack 1 Rp 46,200
Ampicilin j 1 Ampicilin j 1 Rp 8,095
Gentamicin j 1 Gentamicin j 1 Rp 3,125
Lacto B 2 L Bio 2 Rp 11,000
Paracetamol Drop 1 Sanmol Drop 1 Rp 18,950
4/23/2014 AQILA KIRANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
4/23/2014 AQILA KIRANA Infuset 1 Infuset 1 Rp 12,500
4/24/2014 AQILA KIRANA Ampicilin j 1 Ampicilin j 1 Rp 8,095
Gentamicin j 1 Gentamicin j 1 Rp 3,125
4/24/2014 AQILA KIRANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
4/24/2014 AQILA KIRANA KAEN 3A 1 KAEN 3A 1 Rp 16,407
4/25/2014 AQILA KIRANA Ampicilin j 1 Ampicilin j 1 Rp 8,095
Gentamicin j 1 Gentamicin j 1 Rp 3,125
4/25/2014 AQILA KIRANA Terfacef j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Dextrose 100 1 Rp 10,010
4/26/2014 AQILA KIRANA Amoxilin Syr 1 Kalmoxilin Syr 1 Rp 24,750

Paracetamol Drop 1 Sanmol Drop 1 Rp 18,950

R. INAP Rp 4,102,258 Rp 4,102,258

R. JALAN Rp 1,407,160 Rp 1,407,160
Rp 5,509,418 Rp 5,509,418
ASAL
RS
12
BUKU MONITOR APOTIK :
(REKAPITULASI PELAYANAN APOTIK)
PT.NAYAKA
BULAN MEI 2014

OP IP HARGA
NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN
1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
I.
1 5/2/2014 SITI IIP KHOLIPAH Anvomer B6 15 Anvomer B6 15 Rp 34,620
Folavit 15 Folavit 15 Rp 13,605

2 5/2/2014 YEYEN GUNARI Adalat 10mg 30 Nifedipin 10mg 30 Rp 4,050

Pectocyl 200 30 Fluimucyl 30 Rp 120,450
Glisodin 15
Promavit 15 Obimin Af 15 Rp 14,445
Emineton 15 Ferrofort 15 Rp 24,750
Cebex 15 Becom C 15 Rp 18,315

3 5/12/2014 YANI SRI HANDAYANI Trovensis 4mg 40 Ondan 4mg 40 Rp 77,000

Nevradin E 20 Trimate E 20 Rp 31,360
Nutrimama 1 20 Obimin Af 20 Rp 19,260

4 5/12/2014 SUKARTINI DEWI Lactamed 20 Obimin AF 20 Rp 19,260

Obivit 20 Obimin AF 20 Rp 19,260
Elkana 20 Elkana 20 Rp 16,900
Cebex 20 Becom C 20 Rp 24,420

5 5/12/2014 MAULIDA RAHMA Apialys Drop 1

 Rimactacid PAED 30 Rimactacid PAED 30 Rp 82,080

6 5/19/2014 YENI YULIANAH Omeprazole 15 Omeprazole 15 Rp 14,715

Braxidin 20 Braxidin 20 Rp 19,260
Episan Syr 1 Inpepsa Syr 1 Rp 60,720

7 5/19/2014 YEYEN GUNARI Cataflam 15 Kaflam 15 Rp 56,715

Claneksi 500 15 Clavamox 15 Rp 206,250
Trogyl 250 12 Metronidazol 500 12 Rp 1,272
Cebex 7 Becom C 7 Rp 8,547
Madecassol cream 1
Sagestam cream 1 Sagestam cream 1 Rp 14,093
m.f s.u.e m.f s.u.e
Fenitrin 7 Ferrofort 7 Rp 11,550

8 5/22/2014 DINI HANDAYANI Gitas Plus 2 Gitas Plus 2 Rp 5,072

Nonflamin 12 Nonflamin 12 Rp 54,588
Cefabiotik 12 Cefabiotik 12 Rp 124,800
Folamil Genio 20 Obimin AF 20 Rp 19,260
Cester 20 Becom C 20 Rp 24,420
Fenitrin 20 Ferrofort 20 Rp 33,000

9 5/28/2014 HOLILAH Cafdroxil 500 15 Cafdroxil 500 15 Rp 16,500

Gitas Plus 2 Gitas Plus 2 Rp 5,072
Urispas 4 Urotractin 4 Rp 14,904
Dansera 12 Nonflamin 12 Rp 54,588

10 5/29/2014 MUSTOFA MST 10 MST 10

Dexmethason 10 Kalmethason 10 Rp 1,140

11 SAMRODIN Sagestam Cream 1 Sagestam Cream 1 Rp 14,093

Vitamin C 10 Vitamin C 10 Rp 610
 Vitamin B Complex 10 Vitamin B Complex 10 Rp 280

Rp 1,281,224

II
RAWAT INAP

1 4/29/2014 SYAMSIAH EKA SUKARYA Abbocat 22 1 Abbocat 22 1 Rp 24,500

Infuset 1 Infuset 1 Rp 12,500
Hansaplast 1 Hansaplast 1 Rp 500
RL Inf 1 RL Inf 1 Rp 11,330
4/30/2014 SYAMSIAH EKA SUKARYA RL Inf 1 RL Inf 1 Rp 11,330
5/1/2014 SYAMSIAH EKA SUKARYA RL Inf 1 RL Inf 1 Rp 11,330
5/1/2014 SYAMSIAH EKA SUKARYA RL Inf 1 RL Inf 1 Rp 11,330
5/1/2014 SYAMSIAH EKA SUKARYA RL Inf 1 RL Inf 1 Rp 11,330
5/2/2014 SYAMSIAH EKA SUKARYA Ranitidin j 1 Ranitidin j 1 Rp 3,213
Cortidex j 1 Kalmethason j 1 Rp 7,920
5/2/2014 SYAMSIAH EKA SUKARYA RL Inf 1 RL Inf 1 Rp 11,330
5/2/2014 SYAMSIAH EKA SUKARYA Amoxilin 500 30 Amoxilin 500 30 Rp 16,500
Paracetamol 500 30 Paracetamol 500 30 Rp 2,640

2 5/9/2014 YEYEN GUNARI Sintocinon j 2 Sintocinon j 2 Rp 33,128

Metergin j 1 Methergin j 1 Rp 14,950
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Sagestam j 1 Sagestam j 1 Rp 10,216
Epinefrin j 1 Epinefrin j 1 Rp 1,970
Neo K j 1 Neo K j 1 Rp 14,950
Abbocat 20 1 Abbocat 20 1 Rp 24,500
Bloodset 1 Bloodset 1 Rp 21,313
Dextrose Inf 1 Dextrose Inf 1 Rp 9,515
 Folley Chateter no.16 1 Folley Chateter no.16 1 Rp 24,300
Urine Bag 1 Urine Bag 1 Rp 7,425
Aquabidest 1 Aquabidest 1 Rp 2,218
Xylocain Jelly 1 Xylocain Jelly 1
Umbilical klemp 1 Umbilical klemp 1 Rp 3,000
Slim Bayi 1 Slim Bayi 1 Rp 14,850
5/9/2014 YEYEN GUNARI RL 1 RL 1 Rp 11,330
5/9/2014 YEYEN GUNARI Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Sagestam j 2 Sagestam j 2 Rp 20,432
Induxin j 3 Induxin j 3 Rp 30,936
Ketorolac j 3 Ketorolac j 3 Rp 63,510
Kaltrofen Supp 2 Kaltrofen Supp 2 Rp 27,500
5/9/2014 YEYEN GUNARI RL 1 RL 1 Rp 11,330
5/9/2014 YEYEN GUNARI Trogyl Inf 1 Metronidazol Inf 1 Rp 27,500
Forasi 2 Obimin AF 2 Rp 1,926
5/10/2014 YEYEN GUNARI RL Inf 1 RL Inf 1 Rp 11,330
5/10/2014 YEYEN GUNARI Combopack 1 Combopack 1 Rp 46,200
5/10/2014 YEYEN GUNARI RL Inf 1 RL Inf 1 Rp 11,330
5/10/2014 YEYEN GUNARI Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Sagestam j 1 Sagestam j 1 Rp 10,216
Ketopain j 3 Ketorolac j 3 Rp 63,510
Forasi 2 Obimin AF 2 Rp 1,926
Cebex 2 Becom C 2 Rp 2,442
Tismazol 250 4 Metronidazol 250 4 Rp 424
Nonemi 2 Ferrofort 2 Rp 3,300
Dansera 3 Dansera 3 Rp 12,375
Dextrose Inf 1 Dextrose Inf 1 Rp 9,515
5/11/2014 YEYEN GUNARI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Sagestam j 1 Sagestam j 1 Rp 10,216
Tysmazol 250 4 Metronidazol 250 4 Rp 424
Forasi 2 Obimin AF 2 Rp 1,926
Dansera 2 Dansera 2 Rp 8,250
 Nonemi 2 Ferrofort 2 Rp 3,300
Cebex 2 Becom C 2 Rp 2,442
Mefinal 2 Asam Mefenamat 2 Rp 318
5/12/2014 YEYEN GUNARI Biolincom 15 Lincomicin 15 Rp 16,080
Mefinal 8 Asam Mefenamat 8 Rp 1,272
Dansera 15 Dansera 15 Rp 61,875
Tismazol 250 12 Metronidazol 12 Rp 1,272
Forasi 10 Obimin AF 10 Rp 9,630
Tegaderm 1 Tegaderm 1
Cebex 5 Becom C 5 Rp 6,105
Nonemi 5 Ferrofort 5 Rp 8,250

3 5/18/2014 SAMRODIN RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Aquabidest 1 Aquabidest 1 Rp 2,218
5/19/2014 SAMRODIN RL 1 RL 1 Rp 11,330
5/19/2014 SAMRODIN RL 1 RL 1 Rp 11,330
5/20/2014 SAMRODIN RL 1 RL 1 Rp 11,330
5/20/2014 SAMRODIN Amoxicilin 10 Amoxicilin 10 Rp 5,500
Asam Mefenamat 500 10 Asam Mefenamat 500 10 Rp 1,590

R. INAP Rp 1,018,057
R. JALAN Rp 1,281,224
Rp 2,299,281
 BIAYA ASAL
RP RS
11 12

Rp 48,225

Rp 182,010

Rp 127,620

Rp 79,840

Rp 82,080
Rp 94,695

Rp 298,427

Rp 261,140

Rp 91,064

Rp 1,140

Rp 14,983
Rp 1,281,224

Rp 135,753

Rp 760,305
Rp 121,999

Rp 1,018,057
Rp 1,281,224
Rp 2,299,281
BUKU MONITOR APOTIK :
(REKAPITULASI PELAYANAN APOTIK)
PT.NAYAKA
BULAN JUNI 2014

NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN

1 2 3 4 5
RAWAT JALAN
I.
1 6/2/2014 YANI SRI HANDAYANI Anvomer B6 30
Silex Syr 1
Nonflamin 15
Rovadin 500 15
Sanmol tab 6
Nutrimama 1 20
Cebex 20

2 6/2/2014 AZMI MAULANA ISHAK Rimactacid PAED 60

3 6/2/2014 AR RAYHAN AL FARID Cefabiotik Syr 1

Alco Syr 1
Mucos Syr 1
Rhelaphen Syr 1

4 6/6/2014 FITRIA ANGGRAENI Mediol 2

5 6/7/2014 RIDWAN Omed 15

Braxidin 20
Episan Syr 1
Alganak 0,5 3

6 6/9/2014 MAULIDA RAHMA Rimactacid PAED 30

7 6/9/2014 ERNA HARTATI BUDIMAN Clinbercin 300 10

Nonflamin 10
Obimin AF 15
Nulacta 15
Cebex 15
Sarung tangan 1

8 6/13/2014 HARDIONO Omeprazole 20

Strocain 20
Meloxicam 7,5 20
 Paracetamol 300mg 12
Diazepam 1mg 10
m.f pulv dtd XX

9 6/13/2014 RIDWAN Omeprazole 20

Antasida 20
Flamar 50mg 20
Paracetamol 300 12
Diazepam 1mg 10
m.f pulv dtd XX

10 6/13/2014 FITRIA ANGGRAENI Ofertil 5

Clinbercin 300 10
Methylon 7
Trogyl 250 12
Toco E 8
Becom Zet 8
Sarung tangan 1

11 6/18/2014 FITRIA WULANDARI Likurmin Syr 1

12 6/19/2014 YENI YULIANAH Aminophilin 1/2 tab 8

Salbutamol 1/2 8
Dexamethason 1 15
Ambroxol 1 15
m.f pulv dtd XV
Paracetamol 600 12
Na diklofenak 25 10
Alganak 0,25 20
m.f pulv dtd X

13 6/19/2014 YAYAH ROKAYAH Dansera 10

Amoxicililn 500 10

14 6/21/2014 HARDIONO Omeprazole 15

Strocain 20
Meloxicam 7,5 20
Paracetamol 300 12
Diazepam 1mg 10
Methyl Prednisolon 2mg 10
m.f pulv dtd XX

15 6/23/2014 HARDIONO Omeprazole 15

Antasida 20
Flamar 50 20
Paracetamol 300 20
 Diazepam 2mg 20

16 24/06/2014 DWI TRISNAWATI Heptamyl 5

Fenitrin 7

17 26/06/2014 YENI YULIANAH Aminophylin 1/2 10

Dexamethason 1 10
Codein 1 10
Ambroxol 1 10
m.f pulv X
Inpepsa Syr 1
Paracetamol 600 12
Na Diklofenak 25 10
Alganak 0,5 10
m.f pulv X
Cefixime 100 6

18 26/06/2014 DELIA ERNINI Inpepsa Syr 1

Omeprazole 10
Metoclopramide 10
Gitas Plus 6

19 28/06/2014 HARDIONO Lansoprazole 20

Braxidin 20
Strocain 30

II
RAWAT INAP

1 5/30/2014 ERNA HARTATI BUDIMAN Dextrose 1

Ceftriaxone j 2
Sagestam j 1
Cataflam 3
Combopack 1
Dispo 10cc 1
Dispo 5cc 1
Dispo 3cc 1
Dispo 1cc 1
5/31/2014 ERNA HARTATI BUDIMAN Ceftriaxone j 2
Cataflam 3
Cebex 1
Biothicol 250 4
 Sagestam j 1
Dextrose 1
5/31/2014 ERNA HARTATI BUDIMAN Ceftriaxone j 1
Sagestam j 1
6/1/2014 ERNA HARTATI BUDIMAN Ceftriaxone j 2
Sagestam j 1
Cataflam 3
Nutrimama 3 1
Cebex 1
6/1/2014 ERNA HARTATI BUDIMAN Dextrose 1
6/2/2014 ERNA HARTATI BUDIMAN Claneksi 500 15
Cataflam 15
Nutrimama 3 7
Cebex 7
Trogyl 250 8

2 6/1/2014 M ALIF ALFAREZA 2A inf 1

Abbocat 24 1
Infuset 1
Ceftriaxone j 1
Sagestam j 1
Dexamethason j 1
Sanmol Syr 1
Lapisiv Syr 1
Dispo 10cc 1
Dispo 3cc 1
Aquabidest 1
6/1/2014 M ALIF ALFAREZA Ceftriaxone j 1
Dexamethason j 1
Dextrose 1
2A inf 1
6/2/2014 M ALIF ALFAREZA 3A inf 1

3 6/10/2014 FITRIA WULANDARI RL 1

Combopack 1
Dextrose 1
Sanmol Syr 1
Vometa Syr 1
Kalmethason j 1
Dispo 10cc 1
Dispo 3cc 1
6/11/2014 FITRIA WULANDARI Cetirizin Syr 1
6/11/2014 FITRIA WULANDARI RL 1
6/11/2014 FITRIA WULANDARI Ceftriaxone j 1
Dextrose 1
6/11/2014 FITRIA WULANDARI Proris Supp 1
 Sarung tangan 1
Fudanton 4j 1
6/11/2014 FITRIA WULANDARI Kalmethason j 2
Ceftriaxone j 2
Dex 100 1
6/12/2014 FITRIA WULANDARI RL 1
6/12/2014 FITRIA WULANDARI Bufect Syr 1
Ceftriaxone j 1
Dex 100 1
Kalmethason j 3
6/13/2014 FITRIA WULANDARI Ceftriaxone j 1
Dex 100 1
6/14/2014 FITRIA WULANDARI Vometa Syr 1
6/15/2014 FITRIA WULANDARI Likurmin Syr 1

4 6/16/2014 YENI YULIANAH RL 1

Abbocat 24 1
Infuset 1
Ceftriaxone j 1
Ranitidin j 1
Ondansetron j 1
Gitas j 1
Sanmol tab 3
Epexol Syr 1
Dispo 10cc 1
Dispo 3cc 1
Dispo 1cc 1
Aquabidest 1
6/16/2014 YENI YULIANAH Futrolit Inf 3
Ranitidin j 2
Inpepsa Syr 1
Paracetamol tab 3
6/17/2014 YENI YULIANAH Futrolit Inf 1
Ranitidin j 1
6/17/2014 YENI YULIANAH Futamel 6
Omed 6

5 6/16/2014 DWI TRISNAWATI Dextrose 1

RL 1
Cefotaxime j 1
Ranitidin j 1
Nerobion j 1
Dispo 10cc 1
Dispo 3cc 2
Dispo 1cc 1
Ambroxol tab 3
 6/17/2014 DWI TRISNAWATI Futrolit Inf 3
Paracetamol 3
Ceftriaxone j 1
Ranitidin j 2
Inpepsa Syr 1
6/18/2014 DWI TRISNAWATI Futrolit Inf 3
Paracetamol 3
Ceftriaxone j 1
Ranitidin j 1
6/19/2014 DWI TRISNAWATI Futrolit Inf 3
Paracetamol 3
Ceftriaxone j 1
Ranitidin j 1
6/19/2014 DWI TRISNAWATI Combopack 1
6/19/2014 DWI TRISNAWATI Futrolit Inf 1
6/20/2014 DWI TRISNAWATI Futrolit Inf 1
6/20/2014 DWI TRISNAWATI Paracetamol 10
Folavit 10
Nutrimama 3 10
Cester 10
Calcidin 10
Nonemi 7

6 6/18/2014 DELIA ERNINI RL 1

Combopack 1
Ceftriaxone j 2
Dex 100 1
Ranitidin j 1
Ondansetron j 1
Paracetamol tab 1
Dispo 10cc 1
Dispo 3cc 2
6/18/2014 DELIA ERNINI Aminofluid Inf 3
Ondansetron j 3
Ranitidin j 2
Nucral Syr 1
Paracetamol 600 4
Na Diklofenak 25 3
Alaganak 0,25 3
m.f pulv dtd X
6/19/2014 DELIA ERNINI Aminofluid Inf 3
Ondansetron j 3
Ranitidin j 2
Paracetamol 600 4
Na Diklofenak 25 3
Alaganak 0,25 3
 m.f pulv dtd X
6/20/2014 DELIA ERNINI Paracetamol 600 12
Na Diklofenak 25 10
Alaganak 0,25 10
m.f pulv dtd X
Omeprazole 10

7 27/06/2014 MUHIDIN Ceftizoxime j 1

RL 1
Combopack 1
28/06/2014 MUHIDIN Ceftriaxone j 2
Ketorolac 30mg j 3
Futrolit Inf 3
28/06/2014 MUHIDIN RL 1
28/06/2014 MUHIDIN Ceftizoxime j 1
RL 1
29/06/2014 MUHIDIN Ceftizoxime j 1
Ketorolac 30mg j 1
Futrolit Inf 1
30/06/2014 MUHIDIN RL 1
30/06/2014 MUHIDIN Ketorolac 30mg j 1
Futrolit Inf 1
30/06/2014 MUHIDIN Amoxicillin 10

Paracetamol 10
 OP IP HARGA BIAYA ASAL
OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN RP RS
6 7 8 9 10 11 12

Anvomer B6 30 Rp 75,240 Rp 254,739

Comtusi Syr 1 Rp 38,637
Nonflamin 15 Rp 68,235
Spiramycin 500 15 Rp 27,135
Sanmol tab 6 Rp 1,812
Obimin AF 20 Rp 19,260
Becom C 20 Rp 24,420

Rimactacid PAED 60 Rp 164,160 Rp 164,160

Cefabiotik Syr 1 Rp 52,400 Rp 127,901

Alco Syr 1 Rp 32,670
Transbronco Syr 1 Rp 26,125
Bufect Syr 1 Rp 16,706

Mediol 2

Omeprazole 15 Rp 14,715 Rp 101,263

Braxidin 20 Rp 18,700
Inpepsa Syr 1 Rp 60,720
Alviz 0,5 3 Rp 7,128

Rimactacid PAED 30 Rp 82,080 Rp 82,080

Clindamicin 300 10 Rp 11,250 Rp 108,482

Nonflamin 10 Rp 45,490
Obimin AF 15 Rp 14,445
Obimin AF 15 Rp 14,445
Becom C 15 Rp 18,315
Sarung tangan 1 Rp 4,537

Omeprazole 20 Rp 19,620 Rp 97,396

Strocain 20 Rp 38,260
Meloxicam 7,5 20 Rp 38,280
Paracetamol 300mg 12 Rp 1,056
Diazepam 1mg 10 Rp 180
m.f pulv dtd XX

Omeprazole 20 Rp 19,620 Rp 40,136

Antasida 20 Rp 2,280
Na Diklofenak 50 20 Rp 17,000
Paracetamol 500 12 Rp 1,056
Diazepam 1mg 10 Rp 180
m.f pulv dtd XX

Rp 31,419
Clindamicin 300 10 Rp 11,250
Methyl Prednisolon 4mg 7 Rp 4,592
Metronidazol 250 12 Rp 1,272

Becom C 8 Rp 9,768
Sarung tangan 1 Rp 4,537

Elkana CL Syr 1 Rp 56,900 Rp 56,900

Aminophilin 1/2 tab 8 Rp 648 Rp 31,229

Salbutamol 1/2 8 Rp 880
Dexamethason 1 15 Rp 450
Ambroxol 1 15 Rp 2,145
m.f pulv dtd XV
Paracetamol 600 12 Rp 1,056
Na diklofenak 25 10 Rp 2,290
Alviz 0,5 10 Rp 23,760
m.f pulv dtd X

Dansera 10 Rp 41,250 Rp 46,750

Amoxicililn 500 10 Rp 5,500

Omeprazole 15 Rp 14,715 Rp 102,851

Strocain 20 Rp 38,240
Meloxicam 7,5 20 Rp 42,100
Paracetamol 300 12 Rp 1,056
Diazepam 1mg 10 Rp 180
Methyl Prednisolon 2mg 10 Rp 6,560
m.f pulv dtd XX

Omeprazole 15 Rp 14,715 Rp 47,595

Acytral tab 20 Rp 13,760
Flamar 50 20 Rp 17,000
Paracetamol 300 20 Rp 1,760
Diazepam 2mg 20 Rp 360

Heptamyl 5 Rp 48,125 Rp 59,675

Ferrofort 7 Rp 11,550

Aminophylin 1/2 10 Rp 810 Rp 113,190

Dexamethason 1 10 Rp 300
Codein 1 10 Rp 4,860
Ambroxol 1 10 Rp 1,430
m.f pulv X
Inpepsa Syr 1 Rp 60,720
Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Rp 2,290
Alviz 0,5 10 Rp 23,760
m.f pulv X
Cefixime 100 6 Rp 17,964

Inpepsa Syr 1 Rp 60,720 Rp 97,236

Omeprazole 10 Rp 9,810
Primperan tab 10 Rp 11,490
Gitas Plus 6 Rp 15,216

Lansoprazole 20 Rp 44,000 Rp 120,110

Braxidin 20 Rp 18,720
Strocain 30 Rp 57,390

Rp 1,683,112 Rp 1,683,112

Dextrose 1 Rp 9,515 Rp 548,026

Ceftriaxone j 2 Rp 26,526
Sagestam j 1 Rp 10,216
Kaflam 3 Rp 11,343
Combopack 1 Rp 46,200
Dispo 10cc 1 Rp 3,750
Dispo 5cc 1 Rp 3,500
Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Rp 4,158
Ceftriaxone j 2 Rp 26,526
Kaflam 3 Rp 11,343
Becom C 1 Rp 1,221
Biothicol 250 4 Rp 8,952
Sagestam j 1 Rp 10,216
Dextrose 1 Rp 9,515
Ceftriaxone j 1 Rp 13,263
Sagestam j 1 Rp 10,216
Ceftriaxone j 2 Rp 26,526
Sagestam j 1 Rp 10,216
Kaflam 3 Rp 11,343
Obimin AF 1 Rp 963
Becom C 1 Rp 1,221
Dextrose 1 Rp 9,515
Clavamox 15 Rp 206,250
Kaflam 15 Rp 56,715
Obimin AF 7 Rp 6,741
Becom C 7 Rp 8,547
Metronidazol 250 8 Rp 848

2A inf 1 Rp 8,263 Rp 174,378

Abbocat 24 1 Rp 26,334
Infuset 1 Rp 12,500
Ceftriaxone j 1 Rp 13,263
Sagestam j 1 Rp 10,216
Kalmethason j 1 Rp 7,920
Sanmol Syr 1 Rp 13,303
Lapisiv Syr 1 Rp 18,562
Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Rp 2,681
Aquabidest 1 Rp 2,218
Ceftriaxone j 1 Rp 13,263
Kalmethason j 1 Rp 7,920
Dextrose 1 Rp 9,515
2A inf 1 Rp 8,263
3A inf 1 Rp 16,407

RL 1 Rp 11,330 Rp 454,177
Combopack 1 Rp 46,200
Dextrose 1 Rp 9,515
Sanmol Syr 1 Rp 13,303
Vometa Syr 1 Rp 54,945
Kalmethason j 1 Rp 7,920
Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Rp 2,681
Cetirizin Syr 1 Rp 22,275
RL 1 Rp 11,330
Ceftriaxone j 1 Rp 13,263
Dextrose 1 Rp 9,515
Proris Supp 1 Rp 5,706
Sarung tangan 1 Rp 4,537
Ondan 4 j 1 Rp 7,563
Kalmethason j 2 Rp 15,840
Ceftriaxone j 2 Rp 26,526
Dex 100 1 Rp 10,010
RL 1 Rp 11,330
Bufect Syr 1 Rp 16,706
Ceftriaxone j 1 Rp 13,263
Dex 100 1 Rp 10,010
Kalmethason j 3 Rp 23,760
Ceftriaxone j 1 Rp 13,263
Dex 100 1 Rp 10,010
Vometa Syr 1 Rp 54,945
Elakan Syr 1 Rp 24,681

RL 1 Rp 11,330 Rp 454,463
Abbocat 24 1 Rp 26,334
Infuset 1 Rp 12,500
Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Rp 3,213
Ondansetron j 1 Rp 7,563
Buscopan j 1 Rp 23,677
Sanmol tab 3 Rp 264
Transbronco Syr 1 Rp 26,125
Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Rp 4,158
Aquabidest 1 Rp 2,218
Futrolit Inf 3 Rp 171,186
Ranitidin j 2 Rp 6,426
Inpepsa Syr 1 Rp 60,720
Paracetamol tab 3 Rp 264
Futrolit Inf 1 Rp 57,062
Ranitidin j 1 Rp 3,213
Meloxicam 7,5 6 Rp 12,630
Omeprazole 6 Rp 5,886

Dextrose 1 Rp 9,515 Rp 897,796

RL 1 Rp 11,330
Cefotaxime j 1 Rp 12,054
Ranitidin j 1 Rp 3,213
Nerobion 5000 j 1 Rp 8,160
Dispo 10cc 1 Rp 3,750
Dispo 3cc 2 Rp 5,362
Dispo 1cc 1 Rp 4,158
Ambroxol tab 3 Rp 429
Futrolit Inf 3 Rp 171,186
Paracetamol 3 Rp 264
Ceftriaxone j 1 Rp 13,263
Ranitidin j 2 Rp 6,426
Inpepsa Syr 1 Rp 60,720
Futrolit Inf 3 Rp 171,186
Paracetamol 3 Rp 264
Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Rp 3,213
Futrolit Inf 3 Rp 171,186
Paracetamol 3 Rp 264
Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Rp 3,213
Combopack 1 Rp 46,200
Futrolit Inf 1 Rp 57,062
Futrolit Inf 1 Rp 57,062
Paracetamol 10 Rp 880
Folavit 10 Rp 9,070
Obimin AF 10 Rp 9,630
Becom C 10 Rp 12,210
Elkana 10 Rp 8,450
Ferrofort 7 Rp 11,550

RL 1 Rp 11,330 Rp 919,146
Combopack 1 Rp 46,200
Ceftriaxone j 2 Rp 26,526
Dex 100 1 Rp 10,010
Ranitidin j 1 Rp 3,213
Ondansetron j 1 Rp 7,563
Paracetamol tab 1 Rp 88
Dispo 10cc 1 Rp 3,750
Dispo 3cc 2 Rp 5,362
Aminofluid Inf 3 Rp 316,452
Ondansetron j 3 Rp 22,689
Ranitidin j 2 Rp 6,426
Inpepsa Syr 1 Rp 60,720
Paracetamol 600 4 Rp 352
Na Diklofenak 25 3 Rp 687
Alviz 0,5 3 Rp 7,128
m.f pulv dtd X
Aminofluid Inf 3 Rp 316,452
Ondansetron j 3 Rp 22,689
Ranitidin j 2 Rp 6,426
Paracetamol 600 4 Rp 352
Na Diklofenak 25 3 Rp 687
Alviz 0,5 3 Rp 7,128
m.f pulv dtd X
Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Rp 2,290
Alviz 0,5 10 Rp 23,760
m.f pulv dtd X
Omeprazole 10 Rp 9,810

Ceftizoxime j 1 Rp 137,500 Rp 928,086

RL 1 Rp 11,330
Combopack 1 Rp 46,200
Ceftriaxone j 2 Rp 26,526
Ketorolac 30mg j 3 Rp 63,510
Futrolit Inf 3 Rp 171,186
RL 1 Rp 11,330
Ceftizoxime j 1 Rp 137,500
RL 1 Rp 11,330
Ceftizoxime j 1 Rp 137,500
Ketorolac 30mg j 1 Rp 21,170
Futrolit Inf 1 Rp 57,062
RL 1 Rp 11,330
Ketorolac 30mg j 1 Rp 21,170
Futrolit Inf 1 Rp 57,062
Amoxicillin 10 Rp 5,500

Paracetamol 10 Rp 880

R. INAP Rp 4,376,072 Rp 4,376,072

R. JALAN Rp 1,683,112 Rp 1,683,112
Rp 6,059,184 Rp 6,059,184
Rp 1,292,901
Rp 3,447,986
BUKU MONITOR APOTIK :
(REKAPITULASI PELAYANAN APOTIK)
PT.NAYAKA
BULAN JULI 2014

OP IP HARGA
NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN
1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
I.
1 7/3/2014 YENI YULIANAH Codein 10mg 10 Codein 10mg 10 Rp 4,860
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Metoclopramide 10 Primperan tab 10 Rp 11,490
Omeprazole 10 Omeprazole 10 Rp 9,810

2 7/4/2014 DINI HANDAYANI Laxadin syr 1 Laxadin syr 1 Rp 33,687

Lactamed 15 Obimin AF 15 Rp 14,445
Obivit 15 Obimin AF 15 Rp 14,445
Calcidin 15 Elkana 15 Rp 12,675

3 7/5/2014 HARDIONO Omeprazole 15 Omeprazole 15 Rp 14,715

Braxidin 20 Braxidin 20 Rp 18,700
Antasida tab 20 Antasida tab 20 Rp 2,280
Na Diklofenak 50 20 Na Diklofenak 50 20 Rp 4,580
Paracetamol 300 20 Paracetamol 300 18 Rp 1,584
Diazepam 1mg 20 Diazepam 1mg 10 Rp 180
m.f pulv dtd XX m.f pulv dtd XX

4 7/7/2014 AZMI MAULANA ISHAK Rimactacid PAED 60 Rimactacid PAED 60 Rp 164,160

5 7/7/2014 UUN UNENGSIH Rifampicin 450 7 Rifampicin 450 7 Rp 3,941

Pulna 20 Santibi Plus 20 Rp 14,980
 Pyrazinamid 500 20 Pyrazinamid 500 20 Rp 5,500
Curcuma 20 Curcuma 20 Rp 14,020
ATP Dankos 20 ATP Dankos 20
Ranitidin 20 Ranitidin 20 Rp 5,000
Methyl Predni 4mg 20 Methyl Predni 4mg 20 Rp 13,120
Ambroxol 20 Ambroxol 20 Rp 2,860

6 7/7/2014 MAULIDA RAHMA Rimactacid PAED 30 Rimactacid PAED 30 Rp 82,080

7 7/10/2014 YENI YULIANAH Domperidone tab 10 Domperidone tab 10 Rp 5,200

Ranitidin 10 Ranitidin 10 Rp 2,500
Dexanta Syrup 1 Acytral Syrup 1 Rp 25,410
Alganak 0,25mg 5 Alviz 0,5 3 Rp 7,128

8 7/12/2014 HARDIONO Laxadin Syrup 1 Laxadin Syrup 1 Rp 33,687

Omeprazole 20 Omeprazole 20 Rp 19,620
Antasida tab 20 Antasida tab 20 Rp 2,280
Meloxicam 7,5 20 Meloxicam 7,5 20 Rp 42,100
Paracetamol 300 20 Paracetamol 300 18 Rp 1,584
Methyl Predni 4mg 20 Methyl Predni 4mg 20 Rp 13,120
Diazepam 1mg 20 Diazepam 1mg 10 Rp 180
m.f pulv da in cap XX m.f pulv da in cap XX

9 7/14/2014 UUN UNENGSIH Rifampicin 450 7 Rifampicin 450 7 Rp 3,941

Pulna 20 Santibi Plus 20 Rp 14,980
Pyrazinamid 500 20 Pyrazinamid 500 20 Rp 5,500
Curcuma 20 Curcuma 20 Rp 14,020
ATP Dankos 20 ATP Dankos 20
Ranitidin 20 Ranitidin 20 Rp 5,000
Methyl Predni 4mg 20 Methyl Predni 4mg 20 Rp 13,120
Ambroxol 20 Ambroxol 20 Rp 2,860

10 7/18/2014 HARDIONO Omeprazole 20 Omeprazole 20 Rp 19,620

Braxidin 20 Braxidin 20 Rp 18,700
 Fucoidan 10
Episan Syr 1 Inpepsa Syr 1 Rp 60,720

11 7/20/2014 ADNAN SHAFWAN Proris Supp 1 Proris Supp 1 Rp 5,706

Sarung tangan 1 Sarung tangan 1 Rp 4,537
Cefixime Syr 1 Cefixime Syr 1 Rp 37,813
Lacto B 8 l Bio 8 Rp 44,000
Sanmol Syr 1 Sanmol Syr 1 Rp 13,303

12 7/21/2014 UUN UNENGSIH Rifampicin 450 7 Rifampicin 450 7 Rp 3,941

Pulna 20 Santibi Plus 20 Rp 14,980
Pyrazinamid 500 20 Pyrazinamid 500 20 Rp 5,500
Curcuma 20 Curcuma 20 Rp 14,020
ATP Dankos 20 ATP Dankos 20
Ranitidin 20 Ranitidin 20 Rp 5,000
Methyl Predni 4mg 20 Methyl Predni 4mg 20 Rp 13,120
Ambroxol 20 Ambroxol 20 Rp 2,860

13 7/3/2014 MUHIDIN Amoxicillin 500 10 Amoxicillin 500 10 Rp 5,500

Paracetamol 10 Paracetamol 10 Rp 880

Rp 992,262

II
RAWAT INAP

1. 7/2/2014 MANJILA BELIA MAHFUD RGL 1 RGL 1 Rp 11,815

Combopack 1 Combopack 1 Rp 46,200
Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Gentamicin j 1 Sagestam j 1 Rp 10,216
Lacto B 1 L Bio 1 Rp 5,500
Zinkid Syr 1 Zinkid Syr 1 Rp 30,443
Vometa Syr 1 Vometa Syr 1 Rp 54,945
 Sanmol Syr 1 Sanmol Syr 1 Rp 13,303
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
7/2/2014 MANJILA BELIA MAHFUD Liprolac 10 L Bio 10 Rp 55,000
Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Gentamicin j 1 Sagestam j 1 Rp 10,216
RGL Inf 1 RGL Inf 1 Rp 11,815
7/2/2014 MANJILA BELIA MAHFUD RGL Inf 1 RGL Inf 1 Rp 11,815
7/3/2014 MANJILA BELIA MAHFUD Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Gentamicin j 1 Sagestam j 1 Rp 10,216
Liprolac 2 L Bio 2 Rp 11,000
7/4/2014 MANJILA BELIA MAHFUD RGL Inf 1 RGL Inf 1 Rp 11,815
7/5/2014 MANJILA BELIA MAHFUD Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Gentamicin j 1 Sagestam j 1 Rp 10,216
Liprolac 2 L Bio 2 Rp 11,000
7/5/2014 MANJILA BELIA MAHFUD RGL Inf 1 RGL Inf 1 Rp 11,815
7/5/2014 MANJILA BELIA MAHFUD Combopack 2 Combopack 2 Rp 92,400
7/5/2014 MANJILA BELIA MAHFUD Sanmol Inf 1 Sanmol Inf 1 Rp 13,303
7/5/2014 MANJILA BELIA MAHFUD Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Gentamicin j 1 Sagestam j 1 Rp 10,216
Liprolac 3 L Bio 3 Rp 16,500
7/6/2014 MANJILA BELIA MAHFUD RGL Inf 1 RGL Inf 1 Rp 11,815
7/6/2014 MANJILA BELIA MAHFUD Cefila Syr 1 Cefixime syr 1 Rp 37,813
Liprolac 10 L Bio 10 Rp 55,000

2. 7/3/2014 MAHFUD UBAEDI AMD RL Inf 1 RL Inf 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Sanlin 500 1 Sanlin 500 1 Rp 949
New Diatab 2 New Diatab 2 Rp 962
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 2 Dispo 3cc 2 Rp 5,362
 Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
7/4/2014 MAHFUD UBAEDI AMD KAEN 3B 3 KAEN 3B 3 Rp 49,221
Cefotaxime j 2 Cefotaxime j 2 Rp 24,108
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Sanlin 500 4 Sanlin 500 4 Rp 3,796
7/4/2014 MAHFUD UBAEDI AMD RL Inf 1 RL Inf 1 Rp 11,330
Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Sanlin 500 1 Sanlin 500 1 Rp 949
New Diatab 2 New Diatab 2 Rp 962
7/5/2014 MAHFUD UBAEDI AMD KAEN 3B 3 KAEN 3B 3 Rp 49,221
Cefotaxime j 2 Cefotaxime j 2 Rp 24,108
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Sanlin 500 4 Sanlin 500 4 Rp 3,796
New Diatab 6 New Diatab 6 Rp 2,886
7/6/2014 MAHFUD UBAEDI AMD Cefixime 100 6 Cefixime 100 6 Rp 17,964
Ranitidin 6 Ranitidin 6 Rp 1,500
Antasida 10 Acytral tab 10 Rp 6,880

3. 7/8/2014 RAHMAT HIDAYATULLAH Futrolit Inf 3 Futrolit Inf 3 Rp 171,186

Cholescor 3
Paracetamol 3 Paracetamol 3 Rp 264
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Nucral Syr 1 Inpepsa Syr 1 Rp 60,720
7/9/2014 RAHMAT HIDAYATULLAH Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Cholescor 3
Paracetamol 3 Paracetamol 3 Rp 264
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Paracetamol 600 4 Paracetamol 600 4 Rp 352
Na Diklofenak 25 3 Na Diklofenak 25 3 Rp 687
Alganak 0,5 3 Alviz 0,5 3 Rp 7,128
m.f da in cap III m.f da in cap III
 7/10/2014 RAHMAT HIDAYATULLAH Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Cholescor 3
7/10/2014 RAHMAT HIDAYATULLAH Paracetamol 600 4 Paracetamol 600 4 Rp 352
Na Diklofenak 25 3 Na Diklofenak 25 3 Rp 687
Alganak 0,5 3 Alviz 0,5 3 Rp 7,128
m.f da in cap III m.f da in cap III
Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Cholescor 2
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
7/11/2014 RAHMAT HIDAYATULLAH Ranitidin tab 10 Ranitidin tab 10 Rp 2,500
Ondansetron 4 tab 10 Ondansetron 4 tab 10 Rp 19,250
Cholescor 10
Sanmol 10 Sanmol 10 Rp 880

4. 7/10/2014 MAULIDA RAHMA RL 1 RL 1 Rp 11,330

Combopack 24 1 Combopack 24 1 Rp 46,200
Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Bufect Syr 1 Bufect Syr 1 Rp 16,706
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Burnazin salep 1 Centabio Salep 1 Rp 18,064
Sarung tangan 2 Sarung tangan 2 Rp 9,074
Kassa steril 1 Kassa steril 1 Rp 5,293
7/11/2014 MAULIDA RAHMA Ceftizoxime j 1 Ceftizoxime j 1 Rp 137,500
Paracetamol Inf 1 Farmadol Inf 1 Rp 72,600
Kassa gulung 5 Kassa gulung 5 Rp 12,305
Lomatuel 1 Lomatuel 1 Rp 17,160
NACL 3 NACL 3 Rp 33,990
Burnazin salep 1 Centabio Salep 1 Rp 18,064
7/12/2014 MAULIDA RAHMA Ceftizoxime j 1 Ceftizoxime j 1 Rp 137,500
7/12/2014 MAULIDA RAHMA RL 1 RL 1 Rp 11,330
7/13/2014 MAULIDA RAHMA Ceftizoxime j 1 Ceftizoxime j 1 Rp 137,500
Paracetamol Inf 1 Farmadol Inf 1 Rp 72,600
 7/13/2014 MAULIDA RAHMA Burnazin salep 1 Centabio Salep 1 Rp 18,064
Ceftizoxime j 1 Ceftizoxime j 1 Rp 137,500
Paracetamol Inf 1 Farmadol Inf 1 Rp 72,600
RL 1 RL 1 Rp 11,330
7/13/2014 MAULIDA RAHMA Kassa gulung 2 Kassa gulung 2 Rp 4,922
Supratul 1 Lomatuel 1 Rp 17,160
7/14/2014 MAULIDA RAHMA Supratul 1 Supratul 1 Rp 17,160
Kassa gulung 2 Kassa gulung 2 Rp 4,922
7/14/2014 MAULIDA RAHMA NACL 1 NACL 1 Rp 11,330
7/14/2014 MAULIDA RAHMA RL 1 RL 1 Rp 11,330
7/14/2014 MAULIDA RAHMA Cefabiotik Syr 2 Cefabiotik Syr 2 Rp 104,800
Paracetamol syr 2 Sanmol Syr 2 Rp 26,606
Sanosxyn Oxy 1
7/15/2014 MAULIDA RAHMA Ceftizoxime j 1 Ceftizoxime j 1 Rp 137,500
7/15/2014 MAULIDA RAHMA Supratul 1 Supratul 1 Rp 17,160

5. 7/16/2014 ACENG RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Paracetamol Tab 3 Paracetamol Tab 3 Rp 264
Ambroxol tab 3 Ambroxol tab 3 Rp 429
7/17/2014 ACENG RL 1 RL 1 Rp 11,330
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
7/17/2014 ACENG RL 3 RL 3 Rp 33,990
Ketorolac j 3 Ketorolac j 3 Rp 63,510
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 3 Ondan 4 j 3 Rp 22,689
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ambroxol tab 3 Ambroxol tab 3 Rp 429
 Antasida DOEN Syr 1 Acytral Syr 1 Rp 25,410
7/18/2014 ACENG Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Sanmol Tab 1 Sanmol Tab 1 Rp 88
7/18/2014 ACENG Cefixime 200mg 15 Cefixime 200mg 15 Rp 79,860
Omeprazole 10 Omeprazole 10 Rp 9,810
Codein 10mg 20 Codein 10mg 20 Rp 9,720
Ambroxol tab 20 Ambroxol tab 20 Rp 2,860
Etaphilin tab 1/2 20 Aminophilin tab 10 Rp 810
m.f pulv da in cap XX m.f pulv da in cap XX

6. 7/25/2014 AKBAR WIJAYA RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Vometa Syr 1 Vomitas Syr 1 Rp 54,945
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
7/25/2014 AKBAR WIJAYA RL 1 RL 1 Rp 11,330
7/25/2014 AKBAR WIJAYA Paracetamol Syr 1 Sanmol Syr 1 Rp 13,303
7/25/2014 AKBAR WIJAYA Cefotaxime j 1 Cefotaxime j 1 Rp 12,054
Vomceran j 4 1 Ondan 4 j 1 Rp 7,563
7/25/2014 AKBAR WIJAYA RL 1 RL 1 Rp 11,330
7/26/2014 AKBAR WIJAYA Likurmin Syr 1 Elkana Syr 1 Rp 24,681

R. INAP Rp 3,658,547
R. JALAN Rp 992,262
Rp 4,650,809
 BIAYA ASAL
RP RS
11 12

Rp 86,880

Rp 75,252

Rp 42,039

Rp 164,160

Rp 59,421
Rp 82,080

Rp 40,238

Rp 112,571

Rp 59,421

Rp 99,040
Rp 105,359

Rp 59,421

Rp 6,380

Rp 992,262

Rp 631,078
Rp 334,818
Rp 689,202
Rp 1,365,404
Rp 419,261
Rp 218,784

Rp 3,658,547
Rp 992,262
Rp 4,650,809
BUKU MONITOR APOTIK :
(REKAPITULASI PELAYANAN APOTIK)
PT.NAYAKA
BULAN AGUSTUS 2014

NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN

1 2 3 4 5
RAWAT JALAN
I.
1. 8/4/2014 UUN UNENGSIH Rifampicin 450 7
Pulna 20
Pyrazinamide 500 20
Curcuma 20
ATP Dankos 20
Ranitidin 20
Methyl Prednisolon 4mg 20
Ambroxol 20

2. 8/4/2014 SITI MAESAROH Clinbercin 300 10

Methylon 7
Trogyl 250 12
Cebex 5

3. 8/6/2014 MAULIDA RAHMA Rimactacid PAED 30

Likurmin Syr 1

4. 8/6/2014 SUKARTINI DEWI Procalma 10

Cebex 10
Fenitrin 10

5. 8/6/2014 AZMI MAULANA ISHAK Mucos Syr 1

Alco Plus DMP Syr 1
Rhelaphen Syr 1

6. 8/6/2014 KIKI NUGRAHA Inpepsa Syr 1

Fudanton 4mg 10
Omeprazole 10

7. 8/9/2014 SARIPUDIN B JAMSARI Paracetamol 600 12

Na Diklofenak 25 10
Zypraz 0,5 10
m.f pulv dtd X
Asthin Force 5
8. 8/11/2014 ADNAN SHAFWAN Apialys Drop 1
Maltiron Syr 1

9. 8/11/2014 UUN UNENGSIH Rifampicin 450 7

Pulna 20
Pyrazinamide 500 20
Curcuma 20
ATP Dankos 20
Ranitidin 20
Methyl Prednisolon 4mg 20
Ambroxol 20

10. 8/13/2014 DAVIN ALFARRIZIQ Lameson 1/4 20

Lasal 0,5 20
m.f pulv dtd XX
Sirupus Simplex 1
Mucos Syr 1
Maltiron Syr 1
Meptin Syr 1

11. 8/16/2014 SARIPUDIN MST 6

Omeprazole 10
Inpepsa Syr 1

12. 8/16/2014 SITI MAESAROH Andalan inj 1

Dispo 3cc 1
Needle no.23 1

13. 8/18/2014 DINI HANDAYANI Flagyl Forte 2

New Diatab 2
Sanlin 500 2
Vagistin Ovula 5
Mycospor cream 1
Thecort cream 1
m.f s.u.e
Cefadroxil 500 12
Sarung tangan 1
Promavit 7
Cebex 7

14. 8/18/2014 FATHAN MUGHNI Lapicef Forte Syr 1

Tarivid Otic 1
H2O2 3% 1
Mucos Syr 1
15. 8/18/2014 ABDUL WAHID Meptin Syr 1
Ambroxol Syr 2

16. 8/18/2014 UUN UNENGSIH Rifampicin 450 7

Pulna 20
Pyrazinamide 500 20
Curcuma 20
ATP Dankos 20
Ranitidin 20
Methyl Prednisolon 4mg 20
Ambroxol 20

17. 8/20/2014 DAVIN ALFARRIZIQ Lameson 1/4 40

Lasal 0,5mg 40
m.f dtd pulv XL
Sirupus Simplex 1

18. 8/20/2014 MUHAMAD ZAENAL ARIFIN Omeprazole 20

Antasid Syr 1
Neurosanbe Plus 10

19. 8/21/2014 IIS NURASIAH Paracetamol 600 12

Na Diklofenak 25 10
Dexamethason 1 10
m.f pulv da in cap XV

20. 8/22/2014 SITI KOMARIAH Cefadroxil 500 15

Tismazol 250 16
Kalnex 250 6
Cebex 6
Dansera 15
Sarung tangan 1

21. 8/22/2014 SUKARTINI Cefadroxil 500 12

Sarung tangan 1
Trogyl 250 12
Procalma 5
Cebex 5

22. 8/22/2014 NINDI ASMARA Madecassol Cream 1

Sagestam Cream 1
m.f s.u.e
Trogyl 250 12
Cataflam 15
Claneksi 15
Forasi 20
 Cebex 7
Nonemi 7

23. 8/25/2014 UUN UNENGSIH Rifampicin 450 7

Pulna 20
Pyrazinamide 500 20
Curcuma 20
ATP Dankos 20
Ranitidin 20
Methyl Prednisolon 4mg 20
Ambroxol 20

24. 8/26/2014 SARIPUDIN Paracetamol 600 15

Na Diklofenak 25 15
Dexamethason 15
m.f pulv dtd XV
Metoclopramid 10
Rhinos SR 6

25. 8/26/2014 NURWIAH Paracetamol 600 15

Na Diklofenak 25 15
Dexamethason 15
m.f pulv dtd XV
Sanadryl Syr 1
Omeprazol 10

26. 8/28/2014 IIS NURASIAH Omeprazole 10

Nucral Syr 1

27. 8/29/2014 HARSONO Sagestam Cream 1

Amoxicillin 500 10
Ketorolac tab 10

II
RAWAT INAP

1. 8/5/2014 ADNAN SHAFWAN N RL 1

Combopack 1
Cefotaxime j 1
Dispo 1cc 1
Dispo 10cc 1
Aquabidest 1
Sanmol Syr 1
 Mucos Syr 1
8/5/2014 ADNAN SHAFWAN N KA EN 3A inf 1
8/5/2014 ADNAN SHAFWAN N KA EN 3A inf 1
8/5/2014 ADNAN SHAFWAN N Cefotaxime j 1
8/6/2014 ADNAN SHAFWAN N KA EN 3A inf 1
8/6/2014 ADNAN SHAFWAN N KA EN 3A inf 1
8/7/2014 ADNAN SHAFWAN N KA EN 3A inf 1
8/7/2014 ADNAN SHAFWAN N Cefotaxime j 1
8/7/2014 ADNAN SHAFWAN N Cefspan Syr 1

2. 8/5/2014 KIKI NUGRAHA RL 1

Combopack 1
Ondan 4 j 1
Ranitidin j 1
Dispo 10cc 1
Dispo 3cc 1
Dispo 1cc 1
New Diatab 2
Sanmol Tab 2
8/6/2014 KIKI NUGRAHA New Diatab 6
Gitas j 3
Sanmol Tab 3
Ceftriaxone j 2
8/6/2014 KIKI NUGRAHA RL 2
8/6/2014 KIKI NUGRAHA RL 1
8/7/2014 KIKI NUGRAHA New Diatab 6
RL 1
Ceftriaxone j 2
Paracetamol 600 12
Na Diklofenak 25 10
Alganak 0,25 10
m.f pulv da in cap III
Sanadryl Syr 1
8/8/2014 KIKI NUGRAHA Paracetamol 600 12
Na Diklofenak 25 10
Dexamethason 1 10
m.f pulv da in cap III
Cefixime 100 6
FG Troches 10

3. 8/11/2014 NINIDI ASMARA Dex 5% 1

Combopack 1
Cyntocinon j 2
Methergin j 1
Ceftriaxone j 1
Epineprin j 1
 Neo K j 1
Folley Chateter No. 16 1
Urine Bag 1
Aquabidest 1
Xylocain Jelly 1
Umbilical Clemp 1
Slim Bayi 1
Dispo 1cc 1
Dispo 3cc 1
Dispo 10cc 1
8/12/2014 NINDI ASMARA Ceftriaxone j 2
Metronidazol Inf 2
Tramadol Inj 2
Futrolit Inf 3
Dispo 10cc 2
Dispo 3cc 2
8/12/2014 NINDI ASMARA Dex 5% 1
Ceftriaxone j 1
8/13/2014 NINDI ASMARA Metronidazol Inf 1
Tramadol Inj 1
8/13/2014 NINDI ASMARA Ceftriaxone j 2
Metronidazol Inf 2
Tradyl Inf 2
RL 2
Dex 5% 1
Dispo 10cc 2
Dispo 3cc 2
8/13/2014 NINDI ASMARA Combopack 1
8/14/2014 NINDI ASMARA Ceftriaxone j 2
Metronidazol Inf 2
Tramadol Inj 2
Dispo 10cc 2
Dispo 3cc 2
8/15/2014 NINDI ASMARA Cefadroxil 500 10
Becom Zet 10
Lactafit 20
Tegaderm 1

4. 8/12/2014 DION CHANDRA RL 1

Abbocat 22 1
Infuset 1
Hansaplast 1
Ceftriaxone j 2
Dex 100cc 1
Ranitidin j 1
Ondan 4 j 1
 Sanmol tab 3
8/13/2014 DION CHANDRA Futrolit Inf 3
Paracetamol 3
Ceftriaxone j 1
Elpicef j 1
Dex 100cc 1
8/14/2014 DION CHANDRA Futrolit Inf 3
Paracetamol 3
Ceftriaxone j 1
Elpicef j 1
Nacl 100 1
Paracetamol 600 4
Na Diklofenak 25 3
Alganak 0,25 3
m.f pulv da in cap III
8/15/2014 DION CHANDRA Afamed 10
Cholescor 10
Chloracef 10
Paracetamol 10

5. 8/15/2014 MUHAMAD ZAENAL Combopack 1

RL 3
Antrain j 3
Ranitidin j 2
Ondan 4 j 3
Ceftriaxone j 2
Dextrose 100cc 1
8/16/2014 MUHAMAD ZAENAL RL 3
Antrain j 3
Ranitidin j 2
Ondan 8 j 3
Ceftriaxone j 2
Dextrose 100cc 1
Methyl Predni j 1
Alprazolam 0,5 mg 1
8/17/2014 MUHAMAD ZAENAL RL 1
Antrain j 1
Methyl Predni j 1
8/17/2014 MUHAMAD ZAENAL Cefixime 100 6
Paracetamol 10
Ranitidin tab 6

6. 8/18/2014 MUHAMAD JAJULI RL 1

Combopack 1
Sanmol Syr 1
Proris Supp 1
 Sarung tangan 1
8/18/2014 MUHAMAD JAJULI Vomceran j 1
8/18/2014 MUHAMAD JAJULI Proris Supp 1
Kalmethason j 1
8/19/2014 MUHAMAD JAJULI RL 2
8/19/2014 MUHAMAD JAJULI RL 1
8/19/2014 MUHAMAD JAJULI Ceftriaxone j 1
Dextrose 100 1
8/19/2014 MUHAMAD JAJULI RL 1
8/20/2014 MUHAMAD JAJULI RL 1
8/21/2014 MUHAMAD JAJULI RL 1
8/21/2014 MUHAMAD JAJULI Ceftriaxone j 1
Dextrose 100 1
Vomceran j 1
8/21/2014 MUHAMAD JAJULI Sanpicilin j 1
Colsancetin j 1
8/21/2014 MUHAMAD JAJULI RL 1
8/21/2014 MUHAMAD JAJULI RL 1
8/22/2014 MUHAMAD JAJULI Norages j 1
Sanpicilin j 1
Colsancetin j 1
8/22/2014 MUHAMAD JAJULI Combopack 1
RL 1
8/22/2014 MUHAMAD JAJULI Proris Supp 2
8/22/2014 MUHAMAD JAJULI RL 1
8/22/2014 MUHAMAD JAJULI RL 1
8/23/2014 MUHAMAD JAJULI RL 1
8/24/2014 MUHAMAD JAJULI Sanpicilin j 1
Colsancetin j 1
8/24/2014 MUHAMAD JAJULI Cefixime Syr 1
Curvit CL Syr 1

7. 8/21/2014 HOLILAH Ceftriaxone j 1

Sagestam j 1
Sarung tangan 1
Kalmethason j 1
Dextrose 5% 1
Cyntocinon j 1
8/21/2014 HOLILAH Cefadroxil 500 3
Mefinal 2
Forasi 2
Tismazol 250 4
Dansera 3
Cebex 2
8/21/2014 HOLILAH Cefadroxil 500 12
Nonflamin 12
 Tismazol 250 12
Forasi 16
Cebex 5
Nonemi 5

8. 8/25/2014 HARSONO RL 1
Combopack 1
8/25/2014 HARSONO Ceftriaxone j 1
Amoxicillin 500 10
Ketorolac tab 10
RL 1
8/26/2014 HARSONO Ceftriaxone j 1
Ketorolac j 1
Amoxicillin 500 3
8/26/2014 HARSONO Amoxicillin 500 10
Paracetamol 10

9. 8/25/2014 AKBAR WIJAYA RL 1

Combopack 1
Cefotaxime j 1
Ondan 4 j 1
Dispo 1 cc 1
Dispo 3 cc 1
Dispo 10 cc 1
Aquabidest 1
Lacto B 2
8/25/2014 AKBAR WIJAYA RL 1
8/25/2014 AKBAR WIJAYA RL 1
Cefotaxime j 1
Ranitidin j 1
Ondan 4 j 1
Novalgin j 1
Lacto B 10
8/26/2014 AKBAR WIJAYA RL 1
Cefotaxime j 1
Ranitidin j 1
Ondan 4 j 1
Lacto B 10
Zinkid Syr
8/26/2014 AKBAR WIJAYA RL 1
8/26/2014 AKBAR WIJAYA RL 1
8/27/2014 AKBAR WIJAYA RL 1
8/27/2014 AKBAR WIJAYA RL 1
Cefotaxime j 1
Ranitidin j 1
Lacto B 10
8/28/2014 AKBAR WIJAYA RL 1
8/28/2014 AKBAR WIJAYA Likurmin Syr 1
 OP IP HARGA BIAYA
OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN RP
6 7 8 9 10 11

Rifampicin 450 7 Rp 3,941 Rp 59,421

Santibi Plus 20 Rp 14,980
Pyrazinamide 500 20 Rp 5,500
Curcuma 20 Rp 14,020
ATP Dankos 20
Ranitidin 20 Rp 5,000
Methyl Prednisolon 4mg 20 Rp 13,120
Ambroxol 20 Rp 2,860

Clindamicin 300 10 Rp 11,250 Rp 23,219

Methyl Prednisolon 4mg 7 Rp 4,592
Metronidazol 250mg 12 Rp 1,272
Becom c 5 Rp 6,105

Rimactacid PAED 30 Rp 82,080 Rp 121,680

Likurmin Syr 1 Rp 39,600

Obimin AF 10 Rp 9,630 Rp 38,340

Becom C 10 Rp 12,210
Ferofort 10 Rp 16,500

Transbronco Syr 1 Rp 31,680 Rp 81,886

Alco Plus DMP Syr 1 Rp 33,500
Bufect Syr 1 Rp 16,706

Inpepsa Syr 1 Rp 60,720 Rp 89,780

Ondan 4mg tab 10 Rp 19,250
Omeprazole 10 Rp 9,810

Paracetamol 600 12 Rp 1,056 Rp 33,211

Na Diklofenak 25 10 Rp 2,290
Alviz 0,5 10 Rp 23,760
m.f pulv dtd X
Becom C 5 Rp 6,105
Apialys Drop 1 Rp 36,300 Rp 36,300

Rifampicin 450 7 Rp 3,941 Rp 59,421

Pulna 20 Rp 14,980
Pyrazinamide 500 20 Rp 5,500
Curcuma 20 Rp 14,020
ATP Dankos 20
Ranitidin 20 Rp 5,000
Methyl Prednisolon 4mg 20 Rp 13,120
Ambroxol 20 Rp 2,860

Methyl Predni 4mg 5 Rp 3,280 Rp 93,395

Salbutamol 2mg 5 Rp 550
m.f pulv dtd XX

Transbronco Syr 1 Rp 31,680

Meptin Syr 1 Rp 57,885

Rp 70,530
Omeprazole 10 Rp 9,810
Inpepsa Syr 1 Rp 60,720

Andalan inj 1
Dispo 3cc 1
Needle no.23 1

Metronidazol 500 2 Rp 290 Rp 148,569

New Diatab 2 Rp 1,162
Tetraciclin 500 2 Rp 792
Gynoxa Ovula 5 Rp 81,675
Mycorin cream 1 Rp 31,625

m.f s.u.e
Cefadroxil 500 12 Rp 13,200
Sarung tangan 1 Rp 4,537
Obimin AF 7 Rp 6,741
Becom C 7 Rp 8,547

Cefadroxil Syr Forte 1 Rp 21,780 Rp 98,710

Ottopain tetes telinga 1 Rp 41,250
H2O2 3% 1 Rp 4,000
Transbronco Syr 1 Rp 31,680
Meptin Syr 1 Rp 57,885 Rp 64,345
Ambroxol Syr 2 Rp 6,460

Rifampicin 450 7 Rp 3,941 Rp 59,421

Santibi Plus 20 Rp 14,980
Pyrazinamide 500 20 Rp 5,500
Curcuma 20 Rp 14,020
ATP Dankos 20
Ranitidin 20 Rp 5,000
Methyl Prednisolon 4mg 20 Rp 13,120
Ambroxol 20 Rp 2,860

Methyl Predni 4mg 10 Rp 6,560 Rp 7,660

Salbutamol 2mg 10 Rp 1,100
m.f dtd pulv XL

Omeprazole 20 Rp 19,620 Rp 56,710

Acytral Syr 1 Rp 25,410
Neurosanbe Plus 10 Rp 11,680

Paracetamol 600 12 Rp 1,056 Rp 4,486

Na Diklofenak 25 10 Rp 2,290
Dexamethason 1 10 Rp 1,140
m.f pulv da in cap XV

Cefadroxil 500 15 Rp 16,500 Rp 118,916

Metronidazol 250 16 Rp 1,696
Kalnex 250 6 Rp 20,622
Becom C 6 Rp 7,326
Nonflamin 15 Rp 68,235
Sarung tangan 1 Rp 4,537

Cefadroxil 500 12 Rp 13,200 Rp 29,929

Sarung tangan 1 Rp 4,537
Metronidazol 250 12 Rp 1,272
Obimin AF 5 Rp 4,815
Becom C 5 Rp 6,105

Madecassol Cream 1 Rp 328,387

Sagestam Cream 1 Rp 13,873
m.f s.u.e
Metronidazol 250 12 Rp 1,272
Kaflam 50 15 Rp 56,085
Clavamox 500 tab 15 Rp 217,800
Obimin AF 20 Rp 19,260
Becom C 7 Rp 8,547
Ferrofort 7 Rp 11,550

Rifampicin 450 7 Rp 3,941 Rp 59,421

Santibi Plus 20 Rp 14,980
Pyrazinamide 500 20 Rp 5,500
Curcuma 20 Rp 14,020
ATP Dankos 20
Ranitidin 20 Rp 5,000
Methyl Prednisolon 4mg 20 Rp 13,120
Ambroxol 20 Rp 2,860

Paracetamol 600 18 Rp 1,584 Rp 48,957

Na Diklofenak 25 15 Rp 3,435
Kalmethason tab 15 Rp 1,710
m.f pulv dtd XV
Primperan 10 Rp 11,490
Rhinos SR 6 Rp 30,738

Paracetamol 600 15 Rp 1,584 Rp 28,604

Na Diklofenak 25 15 Rp 3,435
Kalmethason tab 15 Rp 1,710
m.f pulv dtd XV
Sanadryl Syr 1 Rp 12,065
Omeprazol 10 Rp 9,810

Omeprazole 10 Rp 9,810 Rp 70,530

Inpepsa Syr 1 Rp 60,720

Sagestam Cream 1 Rp 13,873 Rp 61,053

Amoxicillin 500 10 Rp 5,500
Ketorolac tab 10 Rp 41,680

Rp 1,892,881 Rp 1,892,881

RL 1 Rp 11,330 Rp 268,649
Combopack 1 Rp 46,200
Cefotaxime j 1 Rp 12,054
Dispo 1cc 1 Rp 4,158
Dispo 10cc 1 Rp 3,750
Aquabidest 1 Rp 2,218
Sanmol Syr 1 Rp 13,303
Transbronco Syr 1 Rp 31,680
KA EN 3A inf 1 Rp 16,407
KA EN 3A inf 1 Rp 16,407
Cefotaxime j 1 Rp 12,054
KA EN 3A inf 1 Rp 16,407
KA EN 3A inf 1 Rp 16,407
KA EN 3A inf 1 Rp 16,407
Cefotaxime j 1 Rp 12,054
Cefixime Syr 1 Rp 37,813

RL 1 Rp 11,330 Rp 304,236
Combopack 1 Rp 46,200
Ondan 4 j 1 Rp 7,563
Ranitidin j 1 Rp 3,213
Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Rp 4,158
New Diatab 2 Rp 1,162
Sanmol Tab 2 Rp 176
New Diatab 6 Rp 3,486
Buscopan j 3 Rp 71,031
Sanmol Tab 3 Rp 264
Ceftriaxone j 2 Rp 26,526
RL 2 Rp 22,660
RL 1 Rp 11,330
New Diatab 6 Rp 3,486
RL 1 Rp 11,330
Ceftriaxone j 2 Rp 26,526
Paracetamol 600 4 Rp 352
Na Diklofenak 25 3 Rp 687
Alviz 0,5 3 2376*3
m.f pulv da in cap III
Sanadryl Syr 1 Rp 12,065
Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Rp 2,290
Kalmethason 10 Rp 1,140
m.f pulv da in cap III
Cefixime 100 6 Rp 17,964
FG Troches 10 Rp 11,810

Dex 5% 1 Rp 12,871 Rp 974,718

Combopack 1 Rp 46,200
Syntosinon j 2 Rp 30,114
Pospargin j 1 Rp 6,875
Ceftriaxone j 1 Rp 13,263
Epineprin j 1 Rp 1,970
Neo K j 1
Folley Chateter No. 16 1 Rp 24,300
Urine Bag 1 Rp 7,425
Aquabidest 1 Rp 2,218
Xylocain Jelly 1 Rp 89,900
Umbilical Clemp 1 Rp 3,300
Slim Bayi 1 Rp 14,850
Dispo 1cc 1 Rp 4,158
Dispo 3cc 1 Rp 2,681
Dispo 10cc 1 Rp 3,750
Ceftriaxone j 2 Rp 26,526
Metronidazol Inf 2 Rp 55,000
Tramadol Inj 2 Rp 17,288
Futrolit Inf 3 Rp 171,186
Dispo 10cc 2 Rp 7,500
Dispo 3cc 2 Rp 5,362
Dex 5% 1 Rp 12,871
Ceftriaxone j 1 Rp 13,263
Metronidazol Inf 1 Rp 27,500
Tramadol Inj 1 Rp 8,644
Ceftriaxone j 2 Rp 26,526
Metronidazol Inf 2 Rp 55,000
Tramadol Inj 2 Rp 17,288
RL 2 Rp 22,660
Dex 5% 1 Rp 12,871
Dispo 10cc 2 Rp 7,500
Dispo 3cc 2 Rp 5,362
Combopack 1 Rp 46,200
Ceftriaxone j 2 Rp 26,526
Metronidazol Inf 2 Rp 55,000
Tramadol Inj 2 Rp 17,288
Dispo 10cc 2 Rp 7,500
Dispo 3cc 2 Rp 5,362
Cefadroxil 500 10 Rp 11,000
Zegavit 10 Rp 30,360
Obimin AF 20 Rp 19,260
Tegaderm 1

RL 1 Rp 11,330 Rp 533,635
Abbocat 22 1 Rp 24,500
Infuset 1 Rp 12,500
Hansaplast 1 Rp 500
Ceftriaxone j 2 Rp 26,526
Dex 100cc 1 Rp 10,010
Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Rp 7,563
Sanmol tab 3 Rp 264
Futrolit Inf 3 Rp 171,186
Paracetamol 3 Rp 264
Ceftriaxone j 1 Rp 13,263
Ceftriaxone j 1 Rp 13,263
Dex 100cc 1 Rp 10,010
Futrolit Inf 3 Rp 171,186
Paracetamol 3 Rp 264
Ceftriaxone j 1 Rp 13,263
Ceftriaxone j 1 Rp 13,263
Nacl 100 1 Rp 10,010
Paracetamol 600 4 Rp 352
Na Diklofenak 25 3 Rp 687
Alviz 0,5 3 Rp 7,128
m.f pulv da in cap III
Becom C 10 Rp 12,210

Paracetamol 10 Rp 880

Combopack 1 Rp 46,200 Rp 451,709

RL 3 Rp 33,990
Novalgin j 3 Rp 31,362
Ranitidin j 2 Rp 6,426
Ondan 4 j 3 Rp 22,689
Ceftriaxone j 2 Rp 26,526
Dextrose 100cc 1 Rp 10,010
RL 3 Rp 33,990
Novalgin j 3 Rp 31,362
Ranitidin j 2 Rp 6,426
Ondan 8 j 3 Rp 33,000
Ceftriaxone j 2 Rp 26,526
Dextrose 100cc 1 Rp 10,010
Methyl Predni j 1 Rp 44,344
Alviz 0,5 1 Rp 2,376
RL 1 Rp 11,330
Novalgin j 1 Rp 10,454
Methyl Predni j 1 Rp 44,344
Cefixime 100 6 Rp 17,964
Paracetamol 10 Rp 880
Ranitidin tab 6 Rp 1,500

RL 1 Rp 11,330 Rp 514,805
Combopack 1 Rp 46,200
Sanmol Syr 1 Rp 13,303
Proris Supp 1 Rp 5,706
Sarung tangan 1 Rp 4,537
Ondan 4 j 1 Rp 7,563
Proris Supp 1 Rp 5,706
Kalmethason j 1 Rp 8,250
RL 2 Rp 22,660
RL 1 Rp 11,330
Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Rp 10,010
RL 1 Rp 11,330
RL 1 Rp 11,330
RL 1 Rp 11,330
Ceftriaxone j 1 Rp 13,263
Dextrose 100 1 Rp 10,010
Kalmethason j 1 Rp 8,250
Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Rp 11,770
RL 1 Rp 11,330
RL 1 Rp 11,330
Novalgin j 1 Rp 10,454
Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Rp 11,770
Combopack 1 Rp 46,200
RL 1 Rp 11,330
Proris Supp 2 Rp 10,152
RL 1 Rp 11,330
RL 1 Rp 11,330
RL 1 Rp 11,330
Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Rp 11,770
Cefixime Syr 1 Rp 37,813
Elkana Syr 1 Rp 24,681

Ceftriaxone j 1 Rp 13,263 Rp 185,074

Sagestam j 1 Rp 10,216
Sarung tangan 1 Rp 4,537
Kalmethason j 1 Rp 8,250
Dextrose 5% 1 Rp 12,871
Syntocinon j 1 Rp 15,057
Cefadroxil 500 3 Rp 3,300
Asam Mefenamat 2 Rp 318
Obimin AF 2 Rp 1,926
Metronidazol 250 4 Rp 424
Nonflamin 3 Rp 13,647
Becom C 2 Rp 2,442
Cefadroxil 500 12 Rp 13,200
Nonflamin 12 Rp 54,588
Metronidazol 250 12 Rp 1,272
Obimin AF 16 Rp 15,408
Becom C 5 Rp 6,105
Ferrofort 5 Rp 8,250

RL 1 Rp 11,330 Rp 139,019
Combopack 1 Rp 46,200
Ceftriaxone j 1 Rp 13,263
Amoxicillin 500 3 Rp 1,650
Ketorolac tab 3 Rp 12,783
RL 1 Rp 11,330
Ceftriaxone j 1 Rp 13,263
Ketorolac j 1 Rp 21,170
Amoxicillin 500 3 Rp 1,650
Amoxicillin 500 10 Rp 5,500
Paracetamol 10 Rp 880

RL 1 Rp 11,330 Rp 402,756
Combopack 1 Rp 46,200
Cefotaxime j 1 Rp 12,054
Ondan 4 j 1 Rp 7,563
Dispo 1 cc 1 Rp 4,158
Dispo 3 cc 1 Rp 2,681
Dispo 10 cc 1 Rp 3,750
Aquabidest 1 Rp 2,218
L-Bio 2 Rp 11,000
RL 1 Rp 11,330
RL 1 Rp 11,330
Cefotaxime j 1 Rp 12,054
Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Rp 7,563
Novalgin j 1 Rp 10,454
L Bio 3 Rp 16,500
RL 1 Rp 11,330
Cefotaxime j 1 Rp 12,054
Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Rp 7,563
L Bio 3 Rp 16,500
Zinkid Syr 1 Rp 27,100
RL 1 Rp 11,330
RL 1 Rp 11,330
RL 1 Rp 11,330
RL 1 Rp 11,330
Cefotaxime j 1 Rp 12,054
Ranitidin j 1 Rp 3,213
L Bio 10 Rp 55,000
RL 1 Rp 11,330
Elkana Syr 1 Rp 24,681

R. INAP Rp 3,774,601 Rp 3,774,601

R. JALAN Rp 1,892,881 Rp 1,892,881
Rp 5,667,482 Rp 5,667,482
ASAL
RS
12
Rp 1,892,881

Rp 268,565
Rp 3,528,743
Rp 541,775
II
RAWAT INAP

1. 9/1/2014 SYAHARA REGINA PUTRI RL 1 RL 1

2A 1 2A 1
Combopack 1 Combopack 1
Novalgin j 1 Novalgin j 1
NcCl 100 1 NcCl 100 1
Brainact 250 j 1 Brainact 250 j 1
Ondan 4 j 1 Ondan 4 j 1
Dispo 1cc 1 Dispo 1cc 1
Dispo 3cc 3 Dispo 3cc 3
Aquabidest 1 Aquabidest 1
9/2/2014 SYAHARA REGINA PUTRI 3A 1 3A 1
9/2/2014 SYAHARA REGINA PUTRI M2O inf 1
Novalgin j 2 Novalgin j 2
Nacl 0,9 % 100ml 2 Nacl 0,9 % 100ml 2
Brainact 250 j 2 Brainact 250 j 2
Kalnex 250 j 2 Kalnex 250 j 2
Hexilon j 1 Methyl Predni j 1
9/2/2014 SYAHARA REGINA PUTRI Brainact 250 j 2 Brainact 250 j 2
9/2/2014 SYAHARA REGINA PUTRI Paracetamol Inf 1 Farmadol Inf 1
9/3/2014 SYAHARA REGINA PUTRI 3A 1 3A 1
9/3/2014 SYAHARA REGINA PUTRI M2O inf 1
Kalnex 250 j 2 Kalnex 250 j 2
Hexilon j 1 Methyl Predni j 1
Brainact 250 j 2 Brainact 250 j 2
Combopack 1 Combopack 1
9/4/2014 SYAHARA REGINA PUTRI Ibuprofen Syr 1 Ibuprofen Syr 1
Amoxicillin Syr 1 Kalmoxilin Syr 1
2. 9/14/2014 IIS SULASTRI 2A Inf 1 2A Inf 1
RL 1 RL 1
Abbocat 22 1 Abbocat 22 1
Infuset 1 Infuset 1
Kaltrofen j 2 Ketoprofen j 2
NaCl 100 1 NaCl 100 1
Pantoprazole j 1 OMZ j 1
Brainact 750 j 1 Brainact 250 j 3
Tramadol tab 2 Tramadol tab 2
Dispo 10cc 1 Dispo 10cc 1
Dispo 5cc 1 Dispo 5cc 1
9/15/2014 IIS SULASTRI Kaltrofen j 2 Ketoprofen j 2
NaCl 100 1 NaCl 100 1
Brainact 750 j 1 Brainact 250 j 3
Tramadol tab 2 Tramadol tab 2
9/15/2014 IIS SULASTRI Kaltrofen j 3 Ketoprofen j 2
NaCl 100 1 NaCl 100 1
Pranza j 1 OMZ j 1
Brainact 250 j 6 Brainact 250 j 6
Tramadol j 2 Tramadol j 2
Inpepsa Syr 1 Inpepsa Syr 1
9/15/2014 IIS SULASTRI Forres 3 Myores 3
9/16/2014 IIS SULASTRI Asering Inf 1 Asering Inf 1
9/16/2014 IIS SULASTRI NaCl 100 1 NaCl 100 1
2A Inf 1 2A Inf 1
9/16/2014 IIS SULASTRI Frego 5mg 1 Flunarizin 5 1
Merislon 1 Merislon 1
Kaltrofen j 1 Kaltrofen j 1
NaCl 100 1 NaCl 100 1
 Brainact 250 j 6 Brainact 250 j 6
Pranza j 1 Pantoprazole j 1
2A Inf 3 2A Inf 3
9/17/2014 IIS SULASTRI Merislon 7 Merislon 7
Ketoprofen 6 Ketoprofen 6
Omeprazole 5 Omeprazole 5
Brainact 500 tab 14 Brainact 500 tab 14

3. 9/13/2014 SHERGI AL GIFARI RGL Inf 1 RGL Inf 1

Ampicilin j 1 Sanpicillin j 1
Combopack 1 Combopack 1
Gentamicin j 1 Sagestam j 1
Sanmol Syr 1 Sanmol Syr 1
Proris Supp 1 Proris Supp 1
Dispo 10cc 1 Dispo 10cc 1
Dispo 3cc 1 Dispo 3cc 1
Dispo 1cc 1 Dispo 1cc 1
9/14/2014 SHERGI AL GIFARI Rhinos Neo Drop 1 Rhinofed 1
Ampicilin j 1 Sanpicillin j 1
Gentamicin j 1 Sagestam j 1
Dispo 10cc 1 Dispo 10cc 1
Dispo 3cc 1 Dispo 3cc 1
9/15/2014 SHERGI AL GIFARI RGL Inf 1 RGL Inf 1
9/16/2014 SHERGI AL GIFARI RL 1 RL 1
9/16/2014 SHERGI AL GIFARI Ampicilin j 1 Sanpicillin j 1
Gentamicin j 1 Sagestam j 1
9/17/2014 SHERGI AL GIFARI Lapicef Syr 1 Cefadroxil Syr 1

4. 9/10/2014 MUHAMAD FAIQ RL 1 RL 1

Combopack 1 Combopack 1
 Ceftriaxone j 1 Ceftriaxone j 1
Dex 100cc 1 Dex 100cc 1
Dispo 10cc 1 Dispo 10cc 1
Paracetamol Syr 1 Sanmol Syr 1
Ambroxol Syr 1 Transbrocno Syr 1
9/10/2014 MUHAMAD FAIQ Lacto B 2 L Bio 2
9/11/2014 MUHAMAD FAIQ RL 2 RL 2
9/11/2014 MUHAMAD FAIQ RL 1 RL 1
9/12/2014 MUHAMAD FAIQ Combopack 1 Combopack 1
RL 1 RL 1
9/15/2014 MUHAMAD FAIQ RL 1 RL 1
Abbocat 22 1 Abbocat 22 1
Infuset 1 Infuset 1
KAEN 3A 1 KAEN 3A 1
Cefotaxime j 1 Cefotaxime j 1
Ondan 4 j 1 Ondan 4 j 1
Vometa Syr 1 Vometa Syr 1
Dispo 10cc 1 Dispo 10cc 1
Dispo 1cc 1 Dispo 1cc 1
Dispo 3cc 1 Dispo 3cc 1
9/15/2014 MUHAMAD FAIQ KAEN 3A 1 KAEN 3A 1
9/15/2014 MUHAMAD FAIQ KAEN 3A 1 KAEN 3A 1
9/16/2014 MUHAMAD FAIQ KAEN 3A 1 KAEN 3A 1
9/16/2014 MUHAMAD FAIQ Cefotaxime j 2 Cefotaxime j 2
Ondan 4 j 1 Ondan 4 j 1
9/16/2014 MUHAMAD FAIQ KAEN 3A 1 KAEN 3A 1
9/17/2014 MUHAMAD FAIQ Cefotaxime j 2 Cefotaxime j 2
L Zinc Syr 1 Zinkid Syr 1
Lacto B 10 L Bio 10
Entrocare 10 Entrocare 10
 9/17/2014 MUHAMAD FAIQ RGL Inf 1 RGL Inf 1
9/17/2014 MUHAMAD FAIQ RGL Inf 1 RGL Inf 1
9/18/2014 MUHAMAD FAIQ Cefotaxime j 2 Cefotaxime j 2
Lacto B 2 Lacto B 2
Entrocare 2 Entrocare 2
9/18/2014 MUHAMAD FAIQ RGL Inf 1 RGL Inf 1
9/19/2014 MUHAMAD FAIQ RGL Inf 1 RGL Inf 1
9/20/2014 MUHAMAD FAIQ RGL Inf 1 RGL Inf 1
9/20/2014 MUHAMAD FAIQ Lacto B 6 Lacto B 6
Entrocare 6 Entrocare 6
Cefotaxime j 1 Cefotaxime j 1

5 9/27/2014 CADIM Z Ceftriaxone j 2 Ceftriaxone j 2

Ranitidin j 1 Ranitidin j 1
Dispo 10cc 1 Dispo 10cc 1
Dispo 3cc 1 Dispo 3cc 1
Dispo 1cc 1 Dispo 1cc 1
Diatab 3 Diatab 3
RL 1 RL 1
Combopack 1 Combopack 1
Ondan 8 j 1 Ondan 8 j 1
9/27/2014 CADIM Z Futrolit Inf 1 Futrolit Inf 1
9/28/2014 CADIM Z Fudanton 8 j 1 Ondan 8 j 1
Ranitidin j 1 Ranitidin j 1
RL 1 RL 1
Diatab 3 Diatab 3
9/28/2014 CADIM Z Ceftriaxone j 1 Ceftriaxone j 1
RL 1 RL 1
Ondan 8 j 3 Ondan 8 j 3
Ranitidin j 2 Ranitidin j 2
 Diatab 3 Diatab 3
Inpepsa Syr 1 Inpepsa Syr 1
9/29/2014 CADIM Z Ciprofloxacin 10 Ciprofloxacin 10
Omeprazole 15 Omeprazole 15
Fucoidan 10

R. INAP

R. JALAN
Rp 11,330 Rp 766,813
Rp 8,263
Rp 46,200
Rp 11,381
Rp 10,010
Rp 44,550
Rp 7,563
Rp 4,158
Rp 8,043
Rp 2,218
Rp 16,407

Rp 22,762
Rp 10,010
Rp 89,100
Rp 22,000
Rp 44,344
Rp 89,100
Rp 72,600
Rp 16,407

Rp 22,000
Rp 44,344
Rp 89,100
Rp 46,200
Rp 3,973
Rp 24,750
Rp 8,263 Rp 1,714,762
Rp 11,330
Rp 24,500
Rp 12,500
Rp 12,996
Rp 10,010
Rp 121,000
Rp 133,650
Rp 890
Rp 3,750
Rp 3,500
Rp 12,996
Rp 10,010
Rp 133,650
Rp 890
Rp 12,996
Rp 10,010
Rp 121,000
Rp 267,300
Rp 17,288
Rp 60,720
Rp 17,004
Rp 15,900
Rp 10,010
Rp 8,263
Rp 1,188
Rp 2,958
Rp 6,498
Rp 10,010
Rp 267,300
Rp 121,000
Rp 24,789
Rp 20,706
Rp 9,210
Rp 4,905
Rp 205,772

Rp 11,815 Rp 215,644
Rp 18,948
Rp 46,200
Rp 10,216
Rp 13,303
Rp 5,706
Rp 3,750
Rp 2,681
Rp 4,158
Rp 1,925
Rp 18,948
Rp 10,216
Rp 3,750
Rp 2,681
Rp 11,815
Rp 11,330
Rp 18,948
Rp 10,216
Rp 9,038

Rp 11,330 Rp 719,133
Rp 46,200
Rp 13,263
Rp 10,010
Rp 3,750
Rp 13,303
Rp 26,125
Rp 11,000
Rp 22,660
Rp 11,330
Rp 46,200
Rp 11,330
Rp 11,330
Rp 24,500
Rp 12,500
Rp 16,407
Rp 12,054
Rp 7,563
Rp 54,945
Rp 3,750
Rp 4,158
Rp 2,681
Rp 16,407
Rp 16,407
Rp 16,407
Rp 24,108
Rp 7,563
Rp 16,407
Rp 24,108
Rp 27,100
Rp 55,000
Rp 11,815
Rp 11,815
Rp 24,108
Rp 11,000

Rp 11,815
Rp 11,815
Rp 11,815
Rp 33,000

Rp 12,054

Rp 26,526 Rp 340,686
Rp 3,213
Rp 3,750
Rp 2,681
Rp 4,158
Rp 1,743
Rp 11,330
Rp 46,200
Rp 11,000
Rp 57,062
Rp 11,000
Rp 3,213
Rp 11,330
Rp 1,743
Rp 13,263
Rp 11,330
Rp 33,000
Rp 6,426
Rp 1,743
Rp 60,720
Rp 4,540
Rp 14,715

Rp 3,757,038 Rp 3,757,038
Rp 1,462,603 Rp 1,462,603
Rp 5,219,641 Rp 5,219,641
BUKU MONITOR APOTIK :
(REKAPITULASI PELAYANAN APOTEK)
PT.NAYAKA
BULAN OKTOBER 2014

OP IP HARGA
NO TGL/BL/TH NAMA PESERTA/PASIEN OBAT YANG DIRESEPKAN OBAT YANG DIBERIKAN
(RJ) (RI) SATUAN
1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
I.
1. 10/1/2014 SITI KOMARIAH Sarung tangan 1 Sarung tangan 1 Rp 4,537
Cefadroxil 500 12 Cefadroxil 500 12 Rp 13,200
Tismazol 250 16 Metronidazol 250 16 Rp 1,696
Dansera 12 Dansera 12 Rp 49,500
Gitas Plus 2 Gitas Plus 2 Rp 5,072
Cebex 5 Becom C 5 Rp 6,105
Urispas 6 Urotractin 6 Rp 21,462

2. 10/1/2014 MAULIDA RAHMA Rimactacid PAED 30 Rimactacid PAED 30 Rp 82,080

3. 10/2/2014 MARWIYAH Cefadroxil 500 3 Cefadroxil 500 3 Rp 3,300

Tismazol 250 4 Metronidazol 250 4 Rp 424
Cebex 2 Becom C 2 Rp 2,442

4. 10/7/2014 TASUM Paracetamol 600 10 Paracetamol 600 12 Rp 1,056

Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulc dtd X m.f pulc dtd X
Q10 6 Becom C 6 Rp 7,326
5. 10/8/2014 DINI HANDAYANI Madecasol Cream 1 Madecasol Cream 1 Rp 132,000
Sagestam cream 1 Sagestam cream 1 Rp 13,873
m.f s.u.e m.f s.u.e
Cataflam 15 Kaflam 15 Rp 56,085
Claneksi 500 15 Clavamox 15 Rp 217,800
Lactafar 7 Moloco B12 7 Rp 27,405
Trogyl 250 12 Metronidazol 250 12 Rp 1,272
Cebex 7 Becom C 7 Rp 8,547

6. 10/16/2014 SAAN BIN AMAT Paracetamol 600 10 Paracetamol 600 10 Rp 880

Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv X m.f pulv X
Unalium 10 Unalium 10 Rp 49,000
Cobazym 10 Becom C 10 Rp 12,210

7. 10/17/2014 TASUM Ibuprofen 400 10 Ibuprofen 400 10 Rp 1,850

Tramadol 15 Tramadol 15 Rp 6,675
Omeprazole 5 Omeprazole 5 Rp 4,905
Eperison 15 Myores 15 Rp 85,020

8. 10/17/2014 IIS SULASTRI Phenytoin 10 Phenytoin 10 Rp 7,560

Stesolid Supp 1 Stesolid Supp 1 Rp 44,550
Tramadol 10 Tramadol 10 Rp 4,450
Omeprazole 5 Omeprazole 5 Rp 4,905

9. 10/20/2014 SITI IIP KHOLIPAH Calcidin 15 Elkana 15 Rp 12,675

Nutrimama 3 15 Obimin AF 15 Rp 14,445
Nevradin E 15 Trimate E 15 Rp 23,520

10. 10/21/2014 IWAN SUHERMAN Codein 1 10 Codein 1 10 Rp 4,860

CTM 1 10 CTM 1 10 Rp 90
 Ambroxol 1 10 Ambroxol 1 10 Rp 1,430
Dexamethason 1 10 Dexamethason 1 10 Rp 300
m.f da in cap X m.f da in cap X
Cloracef 6
Asthin Force 10 Dalfarol 10 Rp 33,520
Tramifen 10 Tramifen 10 Rp 93,100

11. ENTIN KARTINI Nucral Syr 1 Inpepsa Syr 1 Rp 60,720

Paracetamol 600 12 Paracetamol 600 12 Rp 1,056
Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
Fudanton 4mg 10 Ondan 4 tab 10 Rp 19,250

12. 10/23/2014 NOPIYANTI Madecassol Cream 1

Sagestam Cream 1 Sagestam Cream 1 Rp 13,873
m.f pulv s.u.e m.f pulv s.u.e
Cataflam 50 15 Kaflam 50 15 Rp 56,085
Trogyl 250 12 Metronidazol 250 12 Rp 1,272
Cester 7 Becom C 7 Rp 8,547
Forasi 10 Moloco 10 Rp 39,150
Candistatyn Drop 1 Nymiko 1 Rp 37,400

13. 10/24/2014 TASUM IbuProfen 400 15 IbuProfen 400 15 Rp 2,775

Paracetamol 600 18 Paracetamol 600 18 Rp 1,584
Codein 1 15 Codein 1 15 Rp 16,215
m.f pulv dtd XV m.f pulv dtd XV
Omeprazole 5 Omeprazole 5 Rp 4,905
Forres 15 Myores 15 Rp 85,020

14. 10/27/2014 LITA JAHARA Faktu Salep 1

Lansoprazol 20 Lansoprazol 20 Rp 44,000
 Strocain 20 Strocain 20 Rp 38,260
Braxidin 20 Braxidin 20 Rp 18,700

15. 10/28/2014 ANDU WIJAYA Paracetamol 600 12 Paracetamol 600 12 Rp 1,056

Na Diklofenak 25 10 Na Diklofenak 25 10 Rp 2,290
Alganak 0,5 10 Alviz 0,5 10 Rp 23,760
m.f pulv dtd X m.f pulv dtd X
Omed 6 Omeprazole 6 Rp 5,886
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Metilev 5 Levofloxacin 5 Rp 7,590

16. 10/29/2014 MAULIDA RAHMA Rimactacid PAED 30 Rimactacid PAED 30 Rp 82,080

Rp 1,771,471

II
RAWAT INAP

1. 9/28/2014 ABU HERI BIN ONIH RL 1 RL 1 Rp 11,330

Abbocat 22 1 Abbocat 22 1 Rp 24,500
Infuset 1 Infuset 1 Rp 12,500
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dex 100 cc 1 Dex 100 cc 1 Rp 10,010
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Episan Syr 1 Inpepsa Syr 1 Rp 60,720
Sanmol tab 3 Sanmol tab 3 Rp 264
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
 Aquabidest 1 Aquabidest 1 Rp 2,218
9/28/2014 ABU HERI BIN ONIH Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Sanmol tab 3 Sanmol tab 3 Rp 264
9/29/2014 ABU HERI BIN ONIH RL 1 RL 1 Rp 11,330
9/29/2014 ABU HERI BIN ONIH RL 3 RL 3 Rp 33,990
Ketorolac j 2 Ketorolac j 2 Rp 42,340
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dex 100 cc 1 Dex 100 cc 1 Rp 10,010
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 2 Ondan 4 j 2 Rp 15,126
9/30/2014 ABU HERI BIN ONIH Ketorolac j 1 Ketorolac j 1 Rp 21,170
RL 1 RL 1 Rp 11,330
9/30/2014 ABU HERI BIN ONIH RL 3 RL 3 Rp 33,990
Ketorolac j 3 Ketorolac j 3 Rp 63,510
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 4 j 2 Ondan 4 j 2 Rp 15,126
Codipront tab 3 Codein 15mg 3 Rp 3,243
Vectrin 3 Fluimucil 3 Rp 12,045
Dex 100 cc 1 Dex 100 cc 1 Rp 10,010
10/1/2014 ABU HERI BIN ONIH Cefixime 200 10 Cefixime 200 10 Rp 53,240
Pantocer 10 Lansoprazole 10 Rp 22,000
Dexanta Syr 1 Acytral Syr 1 Rp 25,410
Afamed 10 Becom C 10 Rp 12,210

2. 9/28/2014 DINI HANDAYANI Dex 5% 1 Dex 5% 1 Rp 9,515

Abbocat 20 1 Abbocat 20 1 Rp 24,500
Bloodset 1 Bloodset 1 Rp 12,500
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Sagestam j 1 Sagestam j 1 Rp 10,216
 Methergin j 1 Methergin j 1 Rp 5,775
Xyntocinon j 2 Xyntocinon j 2 Rp 30,114
Neo K j 1 Neo K j 1
Slim Bayi 1 Slim Bayi 1 Rp 14,850
Umbilical Klemp 1 Umbilical Klemp 1 Rp 13,794
Folley Chateter no.16 1 Folley Chateter no.16 1 Rp 24,300
Urine Bag 1 Urine Bag 1 Rp 7,425
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Aquabidest 1 Aquabidest 1 Rp 2,218
Sarung tangan Gamex 1 Sarung tangan Gamex 1 Rp 3,300
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
9/28/2014 DINI HANDAYANI Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Metronidazol inf 2 Metronidazol inf 2 Rp 55,000
Tramadol j 2 Tramadol j 2 Rp 17,288
Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Dispo 10cc 2 Dispo 10cc 2 Rp 7,500
Dispo 3cc 2 Dispo 3cc 2 Rp 5,362
9/29/2014 DINI HANDAYANI Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Sagestam j 1 Sagestam j 1 Rp 10,216
Tismazol 250 4 Metronidazol 250 4 Rp 424
Forasi 2 Moloco 2 Rp 7,830
Nonflamin 3 Nonflamin 3 Rp 13,647
Cebex 2 Becom C 2 Rp 2,442
Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
9/30/2014 DINI HANDAYANI Combopack no.22 1 Combopack no.22 1 Rp 46,200
Sagestam j 1 Sagestam j 1 Rp 10,216
9/30/2014 DINI HANDAYANI Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Sagestam j 1 Sagestam j 1 Rp 10,216
Tismazol 250 4 Metronidazol 250 4 Rp 424
Forasi 2 Moloco 2 Rp 7,830
Nonflamin 3 Nonflamin 3 Rp 13,647
 Cebex 1 Becom C 1 Rp 1,221
Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
Silex Syr 1
10/1/2014 DINI HANDAYANI Biolincom 500 15 Lyncomicin 500 15 Rp 16,080
Tismazol 250 16 Metronidazol 250 16 Rp 1,696
Dansera 15 Dansera 15 Rp 61,875
Mefinal 6 Asam Mefenamat 500 6 Rp 954
Forasi 16 Moloco 16 Rp 62,640
Cebex 5 Becom C 5 Rp 6,105
Laxadin Syr 1 Laxadin Syr 1 Rp 33,687

3. 10/12/2014 POPI HAPSYAH RL 1 RL 1 Rp 11,330

Abbocat 22 1 Abbocat 22 1 Rp 24,500
Infuset 1 Infuset 1 Rp 12,500
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dexamethason j 1 Dexamethason j 1 Rp 1,038
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Cetirizin tab 3 Cetirizin tab 3 Rp 1,179
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
New Diatab 3 New Diatab 3 Rp 1,743
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Aquabidest 1 Aquabidest 1 Rp 2,218
10/12/2014 POPI HAPSYAH RL 1 RL 1 Rp 11,330
10/13/2014 POPI HAPSYAH RL 1 RL 1 Rp 11,330
Dexamethason j 1 Dexamethason j 1 Rp 1,038
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
New Diatab 3 New Diatab 3 Rp 1,743
Cetirizin tab 2 Cetirizin tab 2 Rp 786
10/13/2014 POPI HAPSYAH Paracetamol 3 Paracetamol 3 Rp 264
 10/14/2014 POPI HAPSYAH NACL 0/9% 3 NACL 0/9% 3 Rp 28,545
New Diatab 6 New Diatab 6 Rp 3,486
Lodia 2mg 2 Lodia 2mg 2 Rp 2,256
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 8 j 3 Ondan 8 j 3 Rp 33,000
Cefotaxime j 2 Cefotaxime j 2 Rp 24,108
10/14/2014 POPI HAPSYAH RL 1 RL 1 Rp 11,330
10/14/2014 POPI HAPSYAH Combopack no.22 1 Combopack no.22 1 Rp 46,200
10/15/2014 POPI HAPSYAH New Diatab 4 New Diatab 4 Rp 2,324
Lodia 2mg 2 Lodia 2mg 2 Rp 2,256
NACL 0/9% 3 NACL 0/9% 3 Rp 28,545
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Ondan 8 j 3 Ondan 8 j 3 Rp 33,000
Cefotaxime j 2 Cefotaxime j 2 Rp 24,108
10/15/2014 POPI HAPSYAH Ciprofloxacin 10 Ciprofloxacin 10 Rp 4,540
Omeprazole 15 Omeprazole 15 Rp 14,715
Antasid Syr 1 Acytral Syr 1 Rp 25,410
New Diatab 10 New Diatab 10 Rp 5,810

4. 10/13/2014 NOPIYANTI Kalmethason j 2 Kalmethason j 2 Rp 16,500

Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Sagestam j 1 Sagestam j 1 Rp 10,216
Combopack 20 1 Combopack 20 1 Rp 46,200
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 5cc 1 Dispo 5cc 1 Rp 3,500
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Folley Cateter No.16 1 Folley Cateter No.16 1 Rp 24,300
Urine Bag 1 Urine Bag 1 Rp 7,425
RL 1 RL 1 Rp 11,330
10/13/2014 NOPIYANTI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Trogyl Inf 1 Metronidazol Inf 1 Rp 27,500
 Ketopain j 3 Ketorolac j 3 Rp 63,510
Dex 5% 1 Dex 5% 1 Rp 9,515
Syntocinon j 2 Syntocinon j 2 Rp 30,114
10/14/2014 NOPIYANTI dex 5% 1 dex 5% 1 Rp 9,515
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Sagestam j 1 Sagestam j 1 Rp 10,216
10/14/2014 NOPIYANTI Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ketopain j 3 Ketorolac j 3 Rp 63,510
Tismazol 250 4 Metronidazol 250 4 Rp 424
Sagestam j 1 Sagestam j 1 Rp 10,216
Forasi 2 Moloco 2 Rp 7,830
Dansera 3 Dansera 3 Rp 12,375
Cebex 2 Becom C 2 Rp 2,442
10/14/2014 NOPIYANTI Dex 5% 1 Dex 5% 1 Rp 9,515
10/15/2014 NOPIYANTI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
10/15/2014 NOPIYANTI Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Sagestam j 1 Sagestam j 1 Rp 10,216
Tismazol 250 4 Metronidazol 250 4 Rp 424
Mefinal 3 Asam Mefenamat 3 Rp 477
Forasi 2 Moloco 2 Rp 7,830
Dansera 3 Dansera 3 Rp 12,375
Cebex 2 Becom C 2 Rp 2,442
10/16/2014 NOPIYANTI Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
10/16/2014 NOPIYANTI Biolincom 15 Lyncomicin 500 15 Rp 16,080
Mefinal 6 Asam Mefenamat 6 Rp 954
Tismazol 250 16 Metronidazol 250 16 Rp 1,696
Dansera 15 Dansera 15 Rp 61,875
Forasi 10 Moloco 10 Rp 39,150
Cebex 6 Becom C 6 Rp 7,326
Tegaderm 1 Tegaderm 1
Laxadin Syr 1 Laxadin Syr 1 Rp 33,687
5. 10/11/2014 SUBIH MUKLIS RL 1 RL 1 Rp 11,330
Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
Ranitidin j 1 Ranitidin j 1 Rp 3,213
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 5cc 1 Dispo 5cc 1 Rp 3,500
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Paracetamol 3 Paracetamol 3 Rp 264
New Diatab 6 New Diatab 6 Rp 3,486
10/12/2014 SUBIH MUKLIS RL 1 RL 1 Rp 11,330
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Fudanton 8 j 1 Ondan 8 j 1 Rp 11,000
Ranitidin j 1 Ranitidin j 1 Rp 3,213
10/12/2014 SUBIH MUKLIS RL 3 RL 3 Rp 33,990
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ondan 8 j 2 Ondan 8 j 2 Rp 22,000
Ranitidin j 2 Ranitidin j 2 Rp 6,426
Paracetamol 3 Paracetamol 3 Rp 264
New Diatab 3 New Diatab 3 Rp 1,743
10/13/2014 SUBIH MUKLIS Ondan 8 j 1 Ondan 8 j 1 Rp 11,000
10/13/2014 SUBIH MUKLIS Cefixime 100 10 Cefixime 100 10 Rp 37,940
Omeprazole 10 Omeprazole 10 Rp 9,810
Antasid tab 15 Acytral Tab 15 Rp 10,320

6. 10/14/2014 IWAN SUHERMAN Futrolit Inf 3 Futrolit Inf 3 Rp 171,186

Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Ambroxol Syr 1 Ambroxol Syr 1 Rp 3,230
Unalium 2 Unalium 2 Rp 9,800
Combopack 1 Combopack 1 Rp 46,200
Paracetamol 600 4 Paracetamol 600 4 Rp 352
 Na Diklofenak 25 3 Na Diklofenak 25 3 Rp 687
Alganak 0,5 3 Alviz 0,5 3 Rp 7,128
m.f pulv dtd III m.f pulv dtd III
10/15/2014 IWAN SUHERMAN Sanadryl Syr 1 Sanadryl Syr 1 Rp 12,065
Cholecor 3 Aspar K 3 Rp 7,200
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Futaxon j 1 Ceftriaxone j 1 Rp 13,263
Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Unalium 2 Unalium 2 Rp 9,800
Ambroxol tab 3 Ambroxol tab 3 Rp 429
10/16/2014 IWAN SUHERMAN Cholecor 3 Aspar K 3 Rp 7,200
Futaxon j 1 Ceftriaxone j 1 Rp 13,263
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Codein 1 3 Codein 1 3 Rp 3,054
CTM 1 3 CTM 1 3 Rp 27
Ambroxol 1 3 Ambroxol 1 3 Rp 429
Dexamethason 1 3 Dexamethason 1 3 Rp 90
m.f pulv dtd III m.f pulv dtd III
10/16/2014 IWAN SUHERMAN Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
10/16/2014 IWAN SUHERMAN Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
10/17/2014 IWAN SUHERMAN Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dex 100cc 1 Dex 100cc 1 Rp 10,010
Ambroxol tab 1 Ambroxol tab 1 Rp 143
Flunarizin 1 Unalium 1 Rp 4,900
Cholecor 1 Aspar K 1 Rp 2,400
10/17/2014 IWAN SUHERMAN Cefixime 200 10 Cefixime 200 10 Rp 53,240
Omeprazole 10 Omeprazole 10 Rp 9,810
Curcuma 10 Curcuma 10 Rp 7,010

7. 10/20/2014 ENTIN KARTINI RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
 Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Sanmol tab 3 Sanmol tab 3 Rp 264
Dexanta Syr 1 Acytral Syr 1 Rp 25,410
New Diatab 3 New Diatab 3 Rp 1,743
Ranitidin j 1 Ranitidin j 1 Rp 3,213
NACL 100cc 1 NACL 100cc 1 Rp 10,010
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 5cc 1 Dispo 5cc 1 Rp 3,500
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Fudanton 8 j 1 Ondan 8 j 1 Rp 11,000
10/20/2014 ENTIN KARTINI RL 1 RL 1 Rp 11,330
10/21/2014 ENTIN KARTINI RL 1 RL 1 Rp 11,330
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Ranitidin j 1 Ranitidin j 1 Rp 3,213
10/21/2014 ENTIN KARTINI Amiparen Inf 3 Amiparen Inf 3 Rp 329,547
Pycin j 1 Bactesyn j 1 Rp 190,000
Otozol j 1 OMZ j 1 Rp 121,000
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Paracetamol 600 4 Paracetamol 600 4 Rp 352
Na Diklonak 25 3 Na Diklonak 25 3 Rp 687
Alviz 0,5 3 Alviz 0,5 3 Rp 7,128
m.f pulv dtd III m.f pulv dtd III
10/22/2014 ENTIN KARTINI Combopack 1 Combopack 1 Rp 46,200
10/22/2014 ENTIN KARTINI Amiparen Inf 1 Amiparen Inf 1 Rp 109,849
Picyn j 1 Bactesyn j 1 Rp 190,000
Paracetamol 600 4 Paracetamol 600 4 Rp 352
Na Diklonak 25 3 Na Diklonak 25 3 Rp 687
Alviz 0,5 3 Alviz 0,5 3 Rp 7,128
m.f pulv dtd III m.f pulv dtd III
Codein 1 3 Codein 1 3 Rp 3,243
CTM 1 3 CTM 1 3 Rp 27
 Ambroxol 1 1 Ambroxol 1 1 Rp 143
m.f pulv dtd III m.f pulv dtd III
10/23/2014 ENTIN KARTINI Amiparen Inf 2 Amiparen Inf 2 Rp 219,698
Otozol j 1 OMZ j 1 Rp 121,000
Picyn j 1 Bactesyn j 1 Rp 190,000
Paracetamol 600 4 Paracetamol 600 4 Rp 352
Na Diklonak 25 3 Na Diklonak 25 3 Rp 687
Alviz 0,5 3 Alviz 0,5 3 Rp 7,128
m.f pulv dtd III m.f pulv dtd III
Codein 1 3 Codein 1 3 Rp 3,243
CTM 1 3 CTM 1 3 Rp 27
Ambroxol 1 1 Ambroxol 1 1 Rp 143
m.f pulv dtd III m.f pulv dtd III
10/24/2014 ENTIN KARTINI Sanadryl Syr 1 Sanadryl Syr 1 Rp 12,065
Zistic 3 Azitromicin 500 3 Rp 41,250
Tramifen 10 Tramadol 10 Rp 4,450
Toco E 5 Trimate E 5 Rp 7,840

8. 10/21/2014 IIS SULASTRI RL 1 RL 1 Rp 11,330

Abbocat 24 1 Abbocat 24 1 Rp 26,350
Infuset 1 Infuset 1 Rp 12,500
Hansaplast 1 Hansaplast 1 Rp 500
Ceftriaxone j 2 Ceftriaxone j 2 Rp 26,526
Dex 100cc 1 Dex 100cc 1 Rp 10,010
Ondan 4 j 1 Ondan 4 j 1 Rp 7,563
Omeprazole j 1 OMZ j 1 Rp 121,000
Paracetamol tab 3 Paracetamol tab 3 Rp 264
Cholescor 3
10/22/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Pralax Syr 1 Lactulax 1 Rp 68,062
Pantotis j 1 OMZ j 1 Rp 121,000
Nucral Syr 1 Inpepsa Syr 1 Rp 60,720
 Elpicef j 1 Ceftriaxone j 1 Rp 13,263
Paracetamol 600 4 Paracetamol 600 4 Rp 352
Na Diklonak 25 3 Na Diklonak 25 3 Rp 687
Alviz 0,5 3 Alviz 0,5 3 Rp 7,128
m.f pulv dtd III m.f pulv dtd III
10/23/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Otozol j 1 OMZ j 1 Rp 121,000
Elpicef j 1 Ceftriaxone j 1 Rp 13,263
Paracetamol 3 Paracetamol 3 Rp 264
10/23/2014 IIS SULASTRI Kaltrofen j 2 Ketoprofen j 2 Rp 13,720
NACL 100cc 5 NACL 100cc 5 Rp 50,050
Tramifen 2 Tramadol tab 2 Rp 17,288
Falpro Syr 1
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
10/24/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Otozol j 1 OMZ j 1 Rp 121,000
Elpicef j 1 Ceftriaxone j 1 Rp 13,263
Gitas j 2 Buscopan j 2 Rp 47,354
Paracetamol tab 3 Paracetamol tab 3 Rp 264
10/24/2014 IIS SULASTRI Kaltrofen j 1 Ketoprofen j 1 Rp 6,860
Tramifen 1 Tramadol tab 1 Rp 445
10/24/2014 IIS SULASTRI Frego 5mg 1 Unalium 5 1 Rp 4,900
Mertigo 6mg 2 Mertigo 6mg 2 Rp 6,324
10/25/2014 IIS SULASTRI Futrolit Inf 3 Futrolit Inf 3 Rp 171,186
Elpicef j 1 Ceftriaxone j 1 Rp 13,263
Paracetamol 3 Paracetamol 3 Rp 264
10/26/2014 IIS SULASTRI Frego 5mg 3 Unalium 5 3 Rp 14,700
Mertigo 6mg 3 Mertigo 6mg 3 Rp 9,486
10/26/2014 IIS SULASTRI Otozol j 1 OMZ j 1 Rp 121,000
Elpicef j 1 Ceftriaxone j 1 Rp 13,263
10/26/2014 IIS SULASTRI Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
10/26/2014 IIS SULASTRI Otozol j 1 OMZ j 1 Rp 121,000
 Elpicef j 1 Ceftriaxone j 1 Rp 13,263
Paracetamol 3 Paracetamol 3 Rp 264
Frego 5mg 1 Unalium 5 1 Rp 4,900
Mertigo 6mg 1 Mertigo 6mg 1 Rp 3,162
10/27/2014 IIS SULASTRI Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
10/27/2014 IIS SULASTRI Otozol j 1 OMZ j 1 Rp 121,000
Elpicef j 1 Ceftriaxone j 1 Rp 13,263
Paracetamol 3 Paracetamol 3 Rp 264
Microlax Supp 1 Microlax Supp 1 Rp 21,120
Nucral Syr 1 Inpepsa Syr 1 Rp 60,720
10/27/2014 IIS SULASTRI Mertigo 6mg 1 Mertigo 6mg 1 Rp 3,162
Futrolit Inf 1 Futrolit Inf 1 Rp 57,062
10/28/2014 IIS SULASTRI Combopack 1 Combopack 1 Rp 46,200
RL 1 RL 1 Rp 11,330
10/28/2014 IIS SULASTRI Omed 6 Omeprazole 6 Rp 5,886
Inpepsa Syr 1 Inpepsa Syr 1 Rp 60,720
Q10 5
10/28/2014 IIS SULASTRI Falpro Syr 1
Asam Folat 5 Folavit 5 Rp 4,305
Forneuro 5 Neurobion 5 Rp 6,325

9. 10/29/2014 BUDI PANGESTU RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
Ceftizoxime j 1 Ceftizoxime j 1 Rp 137,500
Ketesse j 1 Ketoprofen j 1 Rp 6,860
Garam Inggris 1 Garam Inggris 1 Rp 6,000
Dulcolax Supp 1 Dulcolax Supp 1 Rp 17,517
Kaltrofen j 1 Ketoprofen j 1 Rp 6,860
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 3cc 1 Dispo 3cc 1 Rp 2,681
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
10/29/2014 BUDI PANGESTU Ceftizoxime j 2 Ceftizoxime j 2 Rp 275,000
 Ketesse j 2 Ketoprofen j 2 Rp 13,720
RL 1 RL 1 Rp 11,330
10/30/2014 BUDI PANGESTU Ceftizoxime j 1 Ceftizoxime j 1 Rp 137,500
Ketesse j 1 Ketoprofen j 1 Rp 6,860
10/30/2014 BUDI PANGESTU RL 1 RL 1 Rp 11,330
10/30/2014 BUDI PANGESTU RL 1 RL 1 Rp 11,330
10/31/2014 BUDI PANGESTU Lyncomicin 500 10 Lyncomicin 500 10 Rp 10,720
Curcuma 5 Curcuma 5 Rp 3,505

R. INAP Rp 8,849,251
R. JALAN Rp 1,771,471
Rp 10,620,722
 BIAYA ASAL
RP RS
11 12

Rp 101,572

Rp 82,080

Rp 6,166

Rp 34,432
Rp 456,982

Rp 88,140

Rp 98,450

Rp 61,465

Rp 50,640

Rp 133,300
Rp 107,076

Rp 156,327

Rp 110,499

Rp 100,960
Rp 101,302

Rp 82,080

Rp 1,771,471

Rp 655,720
Rp 939,747
Rp 435,762
Rp 700,641
Rp 301,670

Rp 801,603
Rp 1,858,167
Rp 2,431,790
Rp 724,151
Rp 8,849,251
Rp 1,771,471
Rp 10,620,722
 11/9/2014 SYAHRIL SIDIK Cefixime 100 10 Cefixime 100 10 Rp 37,940
Ranitidin tab 10 Ranitidin tab 10 Rp 2,500
Paracetamol tab 10 Paracetamol tab 10 Rp 880

3. 11/10/2014 BILAL Kaen 3A Inf 1 Kaen 3A Inf 1 Rp 16,407

Sanpicilin j 1 Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Colsancetin j 1 Rp 11,770
Abbocat 24 1 Abbocat 24 1 Rp 26,350
Sanmol Drop 1 Sanmol Drop 1 Rp 18,950
11/11/2014 BILAL Kaen 3A Inf 1 Kaen 3A Inf 1 Rp 16,407
11/11/2014 BILAL Sanpicilin j 1 Sanpicilin j 1 Rp 18,948
Colsancetin j 1 Colsancetin j 1 Rp 11,770
Liprolac 10 L Bio 10 Rp 55,000
Entrocare 5
11/11/2014 BILAL Kaen 3A Inf 1 Kaen 3A Inf 1 Rp 16,407
11/12/2014 BILAL L Zinc Syr 1 Zinkid Syr 1 Rp 27,100
11/13/2014 BILAL Cefixime Syr 1 Cefixime Syr 1 Rp 37,813

4. 11/12/2014 MAULIDA RAHMA RL 1 RL 1 Rp 11,330

Combopack 1 Combopack 1 Rp 46,200
Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dispo 10cc 1 Dispo 10cc 1 Rp 3,750
Dispo 1cc 1 Dispo 1cc 1 Rp 4,158
Aqua inj 1 Aqua inj 1 Rp 2,218
Paracetamol Syr 1 Sanmol Syr 1 Rp 13,303
Mucos Syr 1 Transbronco Syr 1 Rp 26,125
11/13/2014 MAULIDA RAHMA RL 1 RL 1 Rp 11,330
11/13/2014 MAULIDA RAHMA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Dextrose 100cc 1 Dextrose 100cc 1 Rp 10,010
L Bio 2 L Bio 2 Rp 11,000
L Zinc Syr 1 Zinkid Syr 1 Rp 27,100
11/13/2014 MAULIDA RAHMA RL 1 RL 1 Rp 11,330
11/14/2014 MAULIDA RAHMA Ceftriaxone j 1 Ceftriaxone j 1 Rp 13,263
Rp 275,870

Rp 436,400
3. 12/6/2014 TRISNA HERDIANA Antasida tab 15
Codein 10mg 20
Ambroxol 1 20
Etaphylin 1/2 tab 10
m.f pulv da in cap XX
Paracetamol 15
Acytral Tab 15 Rp 10,320 Rp 31,405
Codein 10mg 20 Rp 9,720
Ambroxol 1 20 Rp 7,920
Aminophylin 1/2 10 Rp 1,360
m.f pulv da in cap XX
Paracetamol 15 Rp 2,085