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dr. Sarah Fauzianisa Jl. Perjuangan No. 17 SIP. 017/945/DINKES/Sp/2008

dr. Sarah Fauzianisa. Jl. Perjuangan No. 17 SIP. 017/945/DINKES/Sp/2008 Bandung,

R/

20 / 11

Parafin liq Sirupus simplek Vanilin Aethanolum 90% Aqua ad

Bandung, 20 / 11 / 2018 Iter 1x

/ 2018 Iter 1x

R/

25 ml 5 ml 2 mg 3 ml 50 mL

Parafin liq Sirupus simplek Vanilin Aethanolum 90% Aqua ad Mf. potio Sue

Mf. potio Sue

Pro : Wilena Umur:

Pro : Wilena Umur: Alamat:

Alamat:

Obat tidak boleh diganti tanpa sepengetahuan dokter

Obat tidak boleh diganti tanpa sepengetahuan dokter

dr. Dirgahayu Jl. Semangat, No.45 SIP. 008/106/DINKES/2006 Bandung, 20 / 11

R/

OBH Dupleks CTM Sirupus simpleks Ol. Menthae Pip. m.f potio s. t d d cth I

Pro : Ninda Umur: Alamat:

25 ml 5 ml 2 mg 3 ml 50 mL

dr. Dirgahayu Jl. Semangat, No.45 SIP. 008/106/DINKES/2006

/ 2018

100 ml 0,1 30 gtt II 150 ml

Bandung, 20 / 11

R/

OBH Dupleks CTM Sirupus simpleks Ol. Menthae Pip. m.f potio s. t d d cth I

Pro : Ninda Umur: Alamat:

/ 2018

100 ml 0,1 30 gtt II 150 ml

Permintaan OTC No

1 2 3

NamaObat

Obat bebas Obat bebas terbatas Perbekalan kesehatan

Jumlah/satuan

1 strip 1 strip 1 buah

Permintaan DEPO RawatJalan No 1 2

NamaObat

Suppositoria Salep

Jumlah

1 10 g

Satuan

buah buah

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