ruangan : DPJP: ruangan : DPJP:

nama pasien : Rm : nama pasien : Rm :

sc sc
no bmhp jmlh no bmhp jmlh
1 Chromic tapper No 2 1 1 Chromic tapper No 2 1
2 Plan tapper No 0 1 2 Plan tapper No 0 1
3 T-Vio tapper No 1 1 3 T-Vio tapper No 1 1
4 Cuticel 1 4 Cuticel 1
5 Bisturi no 20 1 5 Bisturi no 20 1
6 Hand scond steril 7/5 4 6 Hand scond steril 7/5 4
7 NaCl 1 7 NaCl 1
8 Oxytocin 3 8 Oxytocin 3
9 Metergin 1 9 Metergin 1
10 Kalnex Inj 500mg 2 10 Kalnex Inj 500mg 2
11 Ranitidine 1 11 Ranitidine 1
12 RL 3 12 RL 3
13 Foley Cateter no 18 1 13 Foley Cateter no 18 1
14 Urine Bag 1 14 Urine Bag 1
15 Spuit 10cc 2 15 Spuit 10cc 2
16 cefotaxime / ceftriaxone 2 16 cefotaxime / ceftriaxone 2
17 spuit 5 cc 1 17 spuit 5 cc 1
18 spuit 1 cc 1 18 spuit 1 cc 1
19 spuit 3 cc 3 19 spuit 3 cc 3

ruangan : DPJP: ruangan : DPJP:

nama pasien : Rm : nama pasien : Rm :
set bayi set bayi
no bmhp jmlh no bmhp jmlh
1 hand scond steril no 7 2 1 hand scond steril no 7 2
2 klam umbilikal 1 2 klam umbilikal 1
3 spuit 1cc 1 3 spuit 1cc 1
4 Vit k / Phytomenadion amp 1 4 Vit k / Phytomenadion amp 1
5 suction no 8 1 5 suction no 8 1
6 nasal kanul bayi 1 6 nasal kanul bayi 1

ruangan : DPJP: ruangan : DPJP:

nama pasien : Rm : nama pasien : Rm :
anastesi spinal anastesi spinal
no bmhp jmlh no bmhp jmlh
1 hand scond steril no 7 2 1 hand scond steril no 7 2
2 spinocan no 26/27 1 2 spinocan no 26/27 1
3 spuit 5 cc 2 3 spuit 5 cc 2
4 spuit 3 2 4 spuit 3 2
5 spuit 10 2 5 spuit 10 2
6 Bupivacaine 1 6 Bupivacaine 1
7 Ephedrine HCl amp 1 7 Ephedrine HCl amp 1
8 Tramadol HCl amp (WAJIB RESEP) 1 8 Tramadol HCl amp (WAJIB RESEP) 1
9 Ketorolac 3% 1 9 Ketorolac 3% 1
10 Ondansetron amp 1 10 Ondansetron amp 1
11 Nasal Canula Dewasa 1 11 Nasal Canula Dewasa 1
12 RL 3 12 RL 3
13 HES 1 13 HES 1
14 Metoclopramide 1 14 Metoclopramide 1
15 Aquabidest 1 15 Aquabidest 1
ruangan : DPJP: ruangan : DPJP:
nama pasien : Rm : nama pasien :
anastesi umum anastesi kuret
no bmhp jmlh no
1 hand scond steril no 7 2 1
2 Fentanyl 0.05 mg/ml(WAJIB RESEP) 1 2
3 Propofol / Fresofol 1 3
4 Rocuronium amp 1 4
5 Tramadol HCl amp(WAJIB RESEP) 1 5
6 Ketorolac 3% 1 6
7 Ondansetron amp 1 7
8 Dexametasone amp 2 8
9 Atropine Sulfat amp 1 9
10 Suction Catheter no 12 1 10
11 Nasal Canula Dewasa 1 11
12 RL 2
13 HES 1
14 Spuit 10cc 2
15 Spuit 5cc 2
16 Spuit 3cc 2
ruangan : DPJP: ruangan : DPJP:
nama pasien : Rm : nama pasien :
anastesi kuret anastesi spinal
bmhp jmlh no
hand scond steril no 7 2 1
Fentanyl 0.05 mg/ml(WAJIB RESEP) 1 2
Propofol 1 3
Midazolam 1 4
Ondansetron injek 1 5
Ranitidine injek 1 6
Nasal Canula Dewasa 1 7
RL 2 8
Spuit 10cc 2 9
Spuit 5cc 2 10
Spuit 3cc 2 11
12
13
14
15
ruangan : DPJP:
nama pasien : Rm :
anastesi spinal
bmhp jmlh
hand scond steril no 7 2
spinocan no 26/27 1
spuit 5 cc 2
spuit 3 2
spuit 10 2
Bupivacaine 1
Ephedrine HCl amp 1
Tramadol HCl amp (WAJIB RESEP) 1
Ketorolac 3% 1
Ondansetron amp 1
Nasal Canula Dewasa 1
RL 3
HES 1
Metoclopramide 1
Aquabidest 1
.
ruangan : DPJP: ruangan : DPJP:
nama pasien : Rm : nama pasien :
Histerektomi / Laparatomi anastesi umum
no bmhp jmlh no
1 chromic tapper No 2 1 1
2 plan tapper No 0 1 2
3 T-Vio tapper No 1 2 3
4 Cuticel 1 4
5 Bisturi No 20 1 5
6 Handscoon steril no 7,5 4 6
7 Nacl 1 7
8 Rl 1 8
9 9
10 10
11 11
12 12
13 13
14 14
15
16
ruangan : DPJP:
nama pasien : Rm :
anastesi umum
bmhp jmlh
hand scond steril no 7 2
Fentanyl 0.05 mg/ml(WAJIB RESEP) 1
Propofol / Fresofol 1
Rocuronium amp 1
Tramadol HCl amp(WAJIB RESEP) 1
Ketorolac 3% 1
Ondansetron amp 1
Dexametasone amp 2
Atropine Sulfat amp 1
Suction Catheter no 12 1
Nasal Canula Dewasa 1
RL 2
HES 1
Spuit 10cc 2
Spuit 5cc 2
Spuit 3cc 2
ruangan : DPJP: ruangan : DPJP:
nama pasien : Rm : nama pasien :
Rehecting jahitan anastesi spinal
no bmhp jmlh no
1 T-Vio tapper No 3/0 1 1
2 Chromic cutting No 3/0 1 2
3 Nylon cutting No 3/0 1 3
4 Cuticel 1 4
5 Bisturi No 15 1 5
6 Handscoon steril no 7,5 4 6
7 Nacl 1 7
8 Rl 1 8
9 9
10 10
11
12
13
ruangan : DPJP:
nama pasien : Rm :
anastesi spinal
bmhp jmlh
hand scond steril no 7 2
spinocan no 26/27 1
syringe 3cc & 5cc & 10cc 2&2&2
Bupivacaine / Quanocaine 1
Ephedrine HCl amp 1
Tramadol HCl amp (WAJIB RESEP) 1
Ketorolac 3% 1
Ondansetron amp 1
Nasal Canula Dewasa 1
RL 3
HES 1
Metoclopramide 1
Aquabidest 1
ruangan : DPJP: ruangan : DPJP:
nama pasien : Rm : nama pasien :
Partus set bayi
no bmhp jmlh no
1 Infus set 1 1
2 Abocath no 18 1 2
3 abocath no 20 1 3
4 Rl 3 4
5 oxytocin 5 5
6 metergin 2 6
7 Handscoon steril no 7,5 3
8 lidocain 1
9 chromic No 2/3/0 1
10 kateter no 18 1
11 spuit 10 cc 1
12 spuit 5 cc 2
13 spuit 3 cc 5
14 spuit 1 cc 1
15 nasal kanul dewasa 1
16 misoprostol 3
ruangan : DPJP:
nama pasien : Rm :
set bayi
bmhp jmlh
hand scond steril no 7 2
klam umbilikal 1
spuit 1cc 1
Vit k / Phytomenadion amp 1
suction no 8 1
nasal kanul bayi 1