DUS Ghe 2

INSTALASI FARMASI RSUD DR. SOETOMO DFP 1!
LEM"AR PEN#O"ATAN
No. DMK Nama/Umur ""/#"/!P# Alamat Alerg(
DOKUMEN FARMASI PASIEN

IRNA/Ruangan: Medik / Pa em II
: -.AP / .P. / *e0s(s : *esa$ se1a$ 3 ar( yll2 nyer( 'a'a 3,42 +atu$ 3/42 'a a$ 3/42 'emam 3/4 R(5ayat 0enya$(t : 1. Post MR* ) ar( yll $arena .or Pulmonale '(sease 2. -(0ertens( 'engan r(5ayat 0engo+atan : *0(ronola$ton 32) mg,6,64 Ir+esartan 31)6 mg,6,64 D(agnosa Alasan MR* #gl MR*/KR*
Lembar Ke : 1
: 12.27.79.88 Ruangan Asal : Palem II : Ny. M / 73 ta un !/ P : $g / %m / m2 : &ono%olo Mu'(n ) *ura+aya :,
: 67/16/13 s.' 22/16/13 MR* : 17 ar( Keterangan KR* : *em+u /PP/Men(nggal Nama Do$ter : 'r. A Nama A0ote$er : 8retta N($en P
S$a$u% Pa%ien a. Umum +. As$es %. In ealt '. 9am$esmas e. 9am$es'a :. PK* g. 9PK#- . *K#M (. !a(n,la(n:
LEM"AR PEN#UMPUL DATA REKAMAN PEMERIKSAAN MIKRO"IOLO#I

Nama : Ny.M Umur : 73 ta un 9en(s Kelam(n : !/P No 1 2 3 ? ) 7 7 8 9 16 11 12 9;NI* *P;*IM;N "" : #" : "*A : Kg %m m2 Ruang / No.DMK : Palem II / 12.27.79.88 #anggal MR* : 67/16/13 s.' 22/16/13 317 ar(4 #anggal KR* : -A*I! KU!#UR IN#;RM;DIA#;
Dara 3Macrococcus caseolyticus4
Da a$ 3Staphylococcus coagulase -4
R;*I*#;N Pen(%(ll(n 8 =>a%(ll(n #etra%y%l(ne ;ryt romy%(n !e@o:lo>a%(n Mo>(:lo>a%(n 8entamy%(n Pen(%(ll(n 8 =>a%(ll(n .otr(mo>aAol ;ryt romy%(n !e@o:lo>a%(n
*;N*I#I< . loram0 en(%ol
, .l(n'amy%(ne . loram0 en(%ol .l(n'amy%(ne
LEM"AR PENILAIAN PPO

UP< N=.DMK NAMA UMUR No 1. 2. 3. ?. ). 7. 7. 8. 9. 16. 11. 12. 13. 1?. 1). 17. #gl D(agnosa -.AP / .P. / *e0s(s #era0( <urosem('e 2 > 1 am0ul Dentol(n ne+ule t(a0 7 1am "(sol@on 26 tetes / 1am *0(ronola$ton 1 > 2) mg Parasetamol 3 > )66 mg Ran(t('(n 2 > )6 mg Ir+esartan 1 > 1)6 mg 7) mg .e:taA('(m 3 > 1 gram !e@o:lo>a%(n 1 > 7)6 mg P arma'ol )66 mg Ketorola% 3 > 1 am0ul . loram0 en(%ol 3 > 1 gram Nore0 (ne0r(n 0um0 In:us PE .e:(>(me 2 > 166 mg Am+ro>ol 3 > 1 ta+ &um a' DB R #R C C C C C C C C C C C C C C C C 17 I R C C C C C C C C C C C C C C C C 17 #R R C C C C C C C C C C C C C C C C 17 P #R R C C C C C C C C C C C C C C C C 17 C C C C C C C C C C 1) 1 = #R R C C C C C C D #R : Palem II : 12.27.79.88 : Ny. M : 73 ta un R# R #R C C C C C C C C C C C C C C C C 17 * R C C C C C C C C C C C C C C C C 17 #R R C C C C C C C C C C C C C C C C 17 ! #R
TA"EL RASIONALITAS DRU# UTILI(ATION STUD) *DUS+ SMF I. PEN)AKIT PARU N,. RM / Nama Diagn,%a / Tindakan Te-a$ Ru$e Pemberian Te-a$ Lama Pemberian Te-a$ K,ndi%i Pa%ien
Te-a$ Indika%i
Te-a$ &eni% Oba$
Te-a$ D,%i%
N,. RM : 12.27.79.88 D. : -.AP / .P. / *e0s(s .e:taA('(m 3 > 1 gram !e@o:lo>a%(n 1 > 7)6 mg . loram0 en(%ol 3 > 1 gram .e:(>(me 2 > 166 mg P arma'ol )66 mg Ketorola% 3 > 1 am0ul te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at te0at
<o$us tera0( : ant(+(ot($a2 analget($2 s(tostat($a2 'an su0lemen
LEM"AR PEN#UMPUL DATA / DUS Nama Pas(en No. RM

N,. 1. 2. 3. ?. ). 7. 7. 8. 9. 16. 11. 12. 13. 1?. 1). 17. Nama Oba$ <urosem('e Dentol(n ne+ule "(sol@on *0(ronola$ton Parasetamol Ran(t('(n Ir+esartan .e:taA('(m !e@o:lo>a%(n P arma'ol Ketorola% . loram0 en(%ol Nore0 (ne0r(n 0um0. In:us PE .e:(>(me Am+ro>ol &um a' 2 > 166 mg 3 > 1 ta+
: Ny. K : 12.28.?7.97
D,%i% 2 > 1 am0ul t(a0 7 1am 26 tetes / 1am 1 > 2) mg 3 > )66 mg 2 > )6 mg 1 > 1)6 mg 7) mg 3 > 1 gram 1 > 7)6 mg )66 mg 3 > 1 am0ul 3 > 1 gram 0 7 1? 1? 7 1 2 22 ? 3 2 ? 7 2 12 1 1 162 C C C C C C 72 36 C C C C C C C 1 Ke-a$u'an #enerik 6 C C C / Ke%e%uaian F. &amke%ma% 2314 6 / C C C C C C C C C C C C C C C C 162 DP5O 2314 6 / FRS 2314 6 C C C C C C C C C C C C C C C C 162 / PDT Paru 6 / Lain / Lain 6 /
INFORMATION OF ANTI"IOTI7 USA#E

Name ,8 An$ibi,$i9 *#eneri9 / "rand+ .e:taA('(m !e@o:lo>a%(n . loram0 en(% ol .e:(>(me Dai : D,%e *mg+ 3>1 gram 1> 7)6mg 3>1 gram 3 > 166 mg R,u !$e (.@ (.@ (.@ 0.o T:-e ,8 T'era-: ;m0(r(s ;m0(r(s De:(n(t(: #> !an1utan KR* Indi9a$i,n *UTI; e$9+ -.AP -.AP -.AP -.AP Da: ,8 An$ibi,$i9 U%age *%$ar$ 8r,m da: ,n admi%%i,n+ 1 2 C 4 C C < C C C C C C C C C C C C C C = > ? @ A 13 11 12 14 1< 1= 1>
N,. 1. 2. 3. ?.
N,. 1. 2. 3. ?.
Name ,8 An$ibi,$i9 *#eneri9 / "rand+ .e:taA('(m !e@o:lo>a%(n . loram0 en(% ol .e:(>(me
Dai : D,%e *mg+ 3>1 gram 1> 7)6mg 3>1 gram 3 > 166 mg
R,u !$e (.@ (.@ (.@ 0.o
T:-e ,8 T'era-: ;m0(r(s ;m0(r(s De:(n(t(: #> !an1utan KR*
Indi9a$i,n *UTI; e$9+ -.AP -.AP -.AP -.AP
Da: ,8 An$ibi,$i9 U%age *%$ar$ 8r,m da: ,n admi%%i,n+ 1? C 1@ 1A 23 21 22 24 2< 2= 2> 2? 2@ 2A 43 41
PEN##UNAAN ANTI"IOTIKA NO RM/ DIA#NOSA PASIEN/ NAMA MA5ASISBA No. RM D> : 12.27.79.88 : &ENIS ANTI"IOTIKA *diberi $anda C + EETENDED EMPIRIS DEFINITIF EMPIRIS PROFILAKSIS *<@!?2 Dam+ *F< 'ari+ #> : .e:taA('(m C Rute : (@ Dos(s : 3 > 1 gram NAMA ANTI"IOTIKA /RUTE/ DOSIS #> : !e@o:lo>a%(n Rute : (@ Dos(s : 1 > 7)6 mg #> : . loram0 en(%ol Rute : (@ Dos(s : 3 > 1 gram #> : .e:(>(me Rute : 0.o Dos(s : 3 > 166 mg LAMA PEN##UNAAN
NO. 1.
-.AP / .P. / *e0s(s
2.
Pas(en : Ny. M Nama M s : 8retta NP No. RM : 12.27.79.88 D> :

-.AP / .P. / *e0s(s
3.

-.AP / .P. / *e0s(s
?.

-.AP / .P. / *e0s(s
Pas(en : Ny. M Nama M s : 8retta NP
TIDAK TEPAT PASIEN N,. 1. 2. N, RM PERMASALA5AN DATA )AN# MENDUKUN# REKOMENDASI

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INSTALASI FARMASI RSUD DR. SOETOMO DFP 1!

DOKUMEN FARMASI PASIEN

: 12.27.79.88 Ruangan Asal : Palem II : Ny. M / 73 ta un !/ P : $g / %m / m2 : &ono%olo Mu'(n ) *ura+aya :,

LEM"AR PEN#UMPUL DATA REKAMAN PEMERIKSAAN MIKRO"IOLO#I

Dara 3Macrococcus caseolyticus4

*;N*I#I< . loram0 en(%ol

, .l(n'amy%(ne . loram0 en(%ol .l(n'amy%(ne

LEM"AR PENILAIAN PPO

Te-a$ &eni% Oba$

<o$us tera0( : ant(+(ot($a2 analget($2 s(tostat($a2 'an su0lemen

LEM"AR PEN#UMPUL DATA / DUS Nama Pas(en No. RM

INFORMATION OF ANTI"IOTI7 USA#E

Name ,8 An$ibi,$i9 *#eneri9 / "rand+ .e:taA('(m !e@o:lo>a%(n . loram0 en(% ol .e:(>(me

R,u !$e (.@ (.@ (.@ 0.o

T:-e ,8 T'era-: ;m0(r(s ;m0(r(s De:(n(t(: #> !an1utan KR*

Indi9a$i,n *UTI; e$9+ -.AP -.AP -.AP -.AP

Da: ,8 An$ibi,$i9 U%age *%$ar$ 8r,m da: ,n admi%%i,n+ 1? C 1@ 1A 23 21 22 24 2< 2= 2> 2? 2@ 2A 43 41

-.AP / .P. / *e0s(s

Pas(en : Ny. M Nama M s : 8retta NP No. RM : 12.27.79.88 D> :

Pas(en : Ny. M Nama M s : 8retta NP No. RM : 12.27.79.88 D> :

Pas(en : Ny. M Nama M s : 8retta NP No. RM : 12.27.79.88 D> :

Pas(en : Ny. M Nama M s : 8retta NP

TIDAK TEPAT PASIEN N,. 1. 2. N, RM PERMASALA5AN DATA )AN# MENDUKUN# REKOMENDASI

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;NI#I< . loram0 en(%ol