LABEL

NAMA : .................................. PASIEN

DOKTER : .................................
TANGGAL : ..................................

GENERAL ANASTESI
NO URAIAN JML TAMBAHAN
1 AQUA PRO INJ 1
2 ASERING 2
3 ATROPIN SULFAT INJ 2
4 BACTERIAL FILTER HME 1
5 DISP SYRINGE 10 CC 2 ,
6 DISP SYRINGE 3 CC 4
7 DISP SYRINGE 5 CC 1
8 ELEKTRODA ECG DEWASA 3
9 FENTANYL 2
10 FRESOFOL INJ 1
11 KETOROLAC 30 MG INJ 1
12 MAS SURGICAL CAP 2
13 MASKER KERTAS PREMIUM 3
14 MASKER SELANG O2 DEWASA/ANAK 1
15 NEOSTIGMINE INJ 2
16 ONDANCENTRON INJ 1
17 POLYFLEX 18 1
18 SARUNG TANGAN (M) NON STERIL 5
19 SARUNG TANGAN (S) NON STERIL 5
20 SUCTION CATETER 16 1
21 TRAMADOL INJ 1
22 TRAMUS INJ/NOVERON INJ 1
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LABEL
PASIEN
FORM OPERASI
NAMA : .............................................
DOKTER : ............................................
TANGGAL : ............................................

REGIONAL ANASTESI
NO URAIAN JML TAMBAHAN
1 AQUA PRO INJ 1
2 ASERING 2
3 DISP SYRINGE 10 CC 1
4 DISP SYRINGE 3 CC 1
5 DISP SYRINGE 5 CC 1
6 ELEKTRODA ECG DEWASA 3
7 EPHEDRIN INJ 1
8 MARCAIN INJ 1
9 MAS NURSING CAP 2
10 MASKER KERTAS PREMIUM 3
11 POLYFLEX 18 1
12 SARUNG TANGAN STERIL NO 7 1
13 SARUNG TANGAN STERIL NO 7.5 1
14 SELANG O2 ADULT 1
15 SPINOCAN 25 1
16 SPINOCAN 26 1