Bidan Neng Uma Akromah, AM. Keb

Transkripsi

1 Bidan Neng Uma Akromah, AM. Keb Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Kec. Kotabaru Kab. Karawang 41373, Telp Atas Nama: RINCIAN BIAYA PERSALINAN NO RINCIAN BIAYA KET TOTAL 1 Pertolongan Bidan Rp Rp 2 Perawatan Ibu&Bayi Rp Rp 3 Pemakaian Alkes Rp Rp 4 Handscoen&FaceMask Rp Rp 5 Syringe Rp Rp 6 Iodine/Alkohol Rp Rp 7 Kassa/Tamponade Rp Rp 8 UnderPad/Pampers Rp Rp 9 Oxytocin inj. 10 IU Rp Rp 10 Phytomenadion inj. Rp Rp 11 Methylergometrin inj. Rp Rp 12 Vaksin Hep-B inj. Rp Rp 13 Amoxicillin tab. Rp Rp 14 Ferum tab. Rp Rp 15 As. Mefenamat tab. Rp Rp 16 Vit. A Cap. Rp Rp 17 Abocath 20 Rp Rp 18 Infus/Blood Set Rp Rp 19 Cairan Elektrolit 500 ml Rp Rp 20 Intervensi Ibu: Rp Rp 21 Intervensi Bayi: Rp Rp 22 Lain 2 Rp TOTAL Rp Karawang,... Penolong Persalinan, Neng Uma Akromah, AM. Keb

2 IKATAN BIDAN INDONESIA (IBI) SURAT KETERANGAN LAHIR Yang bertanda tangan di bawah ini, menerangkan bahwa:... ( thn ) Nama Suami :... ( thn ) Alamat :... Telah melahirkan seorang anak yang bernama:... Anak ke- :... Jenis Kelamin :... Hari, tanggal/jam lahir :... Berat Badan Lahir :... gram, PB :... cm, LK :... cm Sidik Sidik Kaki Kiri Bayi Sidik Kaki Kanan Bayi Sidik Ibu jari Kiri Ibu jari Kanan Ibu Ibu Demikian surat keterangan lahir ini dibuat dengan penuh tanggung jawab. Saksi-saksi: Karawang,... Penolong Persalinan, Neng Uma Akromah, AM. Keb

3 Telah diterima dari :... Uang sejumlah :... :... Untuk pembayaran :... :... :... Karawang, 00 September 2013 Terbilang Rp.

4 DAFTAR OBAT 1 Albendazol tablet 400 mg ktk 5 x 6 tablet Alopurinol tablet 100 mg ktk 10 x 10 tablet Amilorida tablet 5 mg (HCI) ktk 10 x 10 tablet Aminofilin injeksi 24 mg/ml ktk ml Aminofilin tablet 200 mg btl 100 tablet Amitriptilin tablet salut 25 mg (HCI) ktk 10 x 10 tablet salut Amoksisilin Anhidrat tablet 500 mg ktk 10 x10 tablet Amoksisilin Anhidrat kapsul 250 mg ktk 12 x 10 kapsul ktk 10 x 10 kapsul Amoksisilin sirup kering 125 mg/ 5 ml btl 60 ml Ampisilin serbuk injeksi i.m./i.v mg/ml ktk 10 vial Ampisilin serbuk injeksi i.m./i.v. 500 mg/vial ktk 10 vial Antasida DOEN I tablet kunyah, kombinasi : btl 1000 tablet kunyah Aluminium Hidroksida 200 mg ktk 10 x 10 tablet kunyah magnesium Hidroksida 200 mg 13 Antasida DOEN II suspensi, kombinasi : btl 60 ml Aluminium Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml 14 Antihemoroid DOEN kombinasi : ktk 10 supp Bismut subgalat 150 mg Heksaklorofen 2,5 mg 15 Antimalaria DOEN kombinasi : ktk 10 x 10 tablet Pirimetamin 25 mg Sulfadoksin 500 mg 16 Antiparkinson DOEN tablet kombinasi : ktk 10 x 10 tablet Karbidopa 25 mg Levodova 250 mg 17 Asam Asetilsalisilat tablet 500 mg (Asetosal) ktk 10 x 10 tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) ktk 10 x10 tablet Asam Askorbat (Vitamin C) tablet 50 mg btl 1000 tablet Asam Folat tablet 1 mg btl 100 tablet Asiklovir tablet 400 mg ktk 10 x 10 tablet ktk 50 tablet ktk 3 x 10 tablet Asiklovir tablet 200 mg ktk 50 tablet ktk 10 x 10 tablet ktk 3 x 10 tablet Asiklovir krim 5% tube 2 gram Atropin injeksi i.m./i.v/s.k. 0,25 mg/ml (Sulfat) ktk 30 1 ml Atropin tetes mata 0,5% (sulfat) btl 5 ml Benzatin benzil Penisilin 2,4 juta IU/vial ktk ml Benzatin benzil Penisilin 1,2 juta IU/vial ktk ml Besi (II) sulfat 7 H2O tablet salut 300 mg btl 1000 tablet salut Betametason krim 0,1% (sebagai valerat) tube 5 gram Deksametason injeksi i.v. 5 mg/ml ktk ml Deksametason tablet 0,5 mg btl 1000 tablet ktk 10 x 10 tablet Dekstrometorfan sirup 10 mg/5 ml (HBr) btl 60 ml 4.056

5 33 Dekstrometorfan tablet 15 mg (HBr) btl 1000 tablet ktk 10 x 10 tablet Diazepam injeksi 5 mg/ml ktk 30 2 ml Diazepam tablet 5 mg btl 1000 tablet btl 250 tablet Diazepam tablet 2 mg btl 1000 tablet Difenhidramin injeksi i.m. 10 mg/ml (HCI) ktk 30 1 ml Digoksin tablet 0,25 mg ktk 10 x 10 tablet Dikloksalisin kapsul 250 mg ktk 25 x 4 kapsul Diltiazem HCI tablet 30 mg ktk 10 x 10 tablet Dimenhidrinat tablet 50 mg btl 100 tablet Doksisiklin kapsul 100 mg ktk 10 x 10 tablet Efedrin tablet 25 mg (HCI) btl 1000 tablet Ekstrak Belladona tablet 10 mg btl 1000 tablet Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCI) ktk 30 1 ml Eritromisin kapsul 500 mg ktk 10 x 10 kapsul Eritromisin kapsul 250 mg ktk 12 x 10 kapsul ktk 10 x 10 kapsul Eritromisin sirup 200 mg/ 5 ml btl 60 ml Etambutol tablet salut 500 mg (HCI) ktk 10 x 10 tablet salut Etambutol tablet 250 mg (HCI) ktk 20 x 10 tablet Fenilbutason tablet 200 mg btl 1000 tablet Fenobarbital tablet 30 mg btl 1000 tablet Fenobarbital injeksi i.m./i.v. 50 mg/ml ktk 30 1 ml Fenoksimetil Penisilin tablet 500 mg ktk 10 x 10 tablet Fenoksimetil Penisilin tablet 250 mg ktk 10 x 10 tablet Fitomenadion (Vitamin K) injeksi 10 mg/ml ktk 30 1 ml Fitomenadion (Vitamin K) tablet salut 10 mg btl 100 tablet salut Flour tablet 0,5 mg btl 100 tablet Furosemid injeksi i.v./i.m. 10 mg/ml ktk 25 2 ml Furosemid tablet 40 mg ktk 20 x 10 tablet ktk 10 x 10 tablet Garam Oralit I serbuk, kombinasi : ktk 100 sachet Natrium 0,70 g ktk 25 sachet Kalium klorida 0,30 g tiap sachet untuk Trinatrium sitrat dihidrat 0,58 g 200 ml air Glukosa Anhidrat 4 g 62 Gentamisin injeksi 80 mg/ml (sebagai Sulfat) ktk 1 2 ml Gentamisin salep kulit tube 5 gram Glibenklamida tablet 5 mg ktk 10 x 10 tablet Gliseril guaiakolat tablet 100 mg btl 1000 tablet Glukosa larutan infus 10 % btl 500 ml Glukosa larutan infus 5 % btl 500 ml Griseofulvin tablet 125 mg, Micronized ktk 10 x 10 tablet Haloperidol tablet 5 mg ktk 10 x 10 tablet Haloperidol tablet 1,5 mg ktk 10 x 10 tablet Haloperidol tablet 0,5 mg ktk 10 x 10 tablet Hidroklorotiazida tablet 25 mg btl 1000 tablet

6 73 Hidrokortison krim 2 % (Asetat) tube 5 g Ibuproten tablet 400 mg ktk 10 x 10 tablet Ibuproten tablet 200 mg btl 100 tablet Isoniazid tablet 300 mg btl 1000 tablet Isoniazid tablet 100 mg btl 1000 tablet Isosorbid Dinitrat tablet sublingual 5 mg ktk 10 x 10 tablet Kalsium Laktat (Kalk) tablet 500 mg btl 1000 tablet Kaptropil tablet 25 mg ktk 10 x 10 tablet ktk 6 x 10 tablet Kaptropil tablet 12,5 mg ktk 10 x 10 tablet ktk 6 x 10 tablet Ketamin injeksi 10 mg ktk ml Kloramfenikol kapsul 250 mg btl 1000 kapsul btl 250 kapsul ktk 12 x 10 kapsul Kloramfenikol suspensi 125 mg/ 5 ml btl 60 ml Kloramfenikol tetes telinga 3 % btl 5 ml Klorfeniramina Maleat (CTM) tablet 4 mg btl 1000 tablet Klorokuin tablet 150 mg btl 1000 tablet Klorpromazin injeksi i.m. 25 mg/ml (HCI) ktk 30 2 ml Klorpromazin injeksi i.m. 5 mg/ml (HCI) ktk 30 1 ml Klorpromazin tablet salut 100 mg (HCI) btl 1000 tablet salut Klorpromazin tablet salut 25 mg (HCI) btl 1000 tablet salut Kotrimoksazol DOEN I (dewasa) kombinasi : ktk 10 x 10 tablet Sulfametoksazol 400 mg Trimetoprim 20 mg 93 Kotrimoksazol DOEN II (pediatrik) kombinasi : ktk 10 x10 tablet Sulfametoksazol 100 mg Trimetoprim 20 mg 94 Kuinin injeksi i.v. 25% (sebagai 2 HCI) ktk ml Kuinin tablet 222 mg (H2SO4.7H2O) btl 1000 tablet Lidokain injeksi 2% (HCI) + Epinefrin 1 : ml ktk 30 2 ml Lidokain injeksi 2% (HCI) ktk ml Mebendazol tablet 100 mg ktk 5 x 6 tablet Metampiron tablet 500 mg btl 1000 tablet ktk 10 x 10 tablet Metampiron injeksi 250 mg ktk 30 2 ml Metformin tablet salut 500 mg ktk 10 x 10 tablet salut Metilergometrin tablet salut 0,125 mg (Maleat) ktk 10 x 10 tablet Metronidazol tablet 500 mg ktk 10 x 10 tablet Mertonidazol tablet 250 mg ktk 10 x 10 tablet Mikonazol krim/salep 2% (Nitrat) tube 10 g Natrium Bikarbonat tablet 500 mg btl 1000 tablet Natrium Klorida larutan infus 0,9 % btl 500 ml Natrium Thiosulfat injeksi i.v. 25% ktk ml Nifedifin tablet 10 mg ktk 10 x 10 tablet Nistatin tablet salut IU/ g ktk 10 x 10 tablet salut

7 111 Nistatin vaginal tablet IU/ g ktk 10 x10 tablet vaginal Oksitetrasiklin injeksi i.v. 50 mg/ml (HCI) ktk ml Oksitetrasiklin salep mata 1% (HCI) tube 3,5 gram Parasetamol sirup 120 mg / 5 ml btl 60 ml Parasetamol tablet 500 mg btl 1000 tablet ktk 10 x 10 tablet Parasetamol tablet 100 mg btl 100 tablet Perfenazin tablet 4 mg (HCI) btl 100 tablet Pilokarpin tetes mata 2 % (HCI/ Nitrat) btl 5 ml Pirazinamid tablet 500 mg ktk 10 x 10 tablet Pirantel tab. Score (base) 125 mg ktk 25 x 4 tablet score ktk 30 x 2 tablet score Piridoksin (Vitamin B6) tablet 10 mg (HCI) btl 1000 tablet Primakuin tablet 15 mg btl 1000 tablet Podivon lodida larutan 10% btl 1000 ml btl 300 ml btl 60 ml btl 30 ml Prazikuantel tablet 600 mg btl 100 tablet Prazosin tablet 1 mg (HCI) btl 100 tablet Frednison tablet 5 mg btl 1000 tablet Prokain Benzil Penisilin G. injeksi 3 jt IU/vial ktk ml Propanolol tablet 40 mg (HCI) ktk 10 x 10 tablet Propanolol tablet 10 mg (HCI) ktk 10 x 10 tablet Propiltiourasil tablet 100 mg btl 100 tablet Ranitidin tablet 150 mg ktk 10 x 10 tablet ktk 3 x 10 tablet Reserpin tablet 0,25 mg btl 1000 tablet Reserpin tablet 0,10 mg btl 250 tablet Retinol (Vitamin A) IU kapsul lunak btl 50 kapsul lunak Retinol (Vitamin A) IU kapsul lunak btl 50 kapsul lunak Retinol (Vitamin A) tablet IU btl 1000 tablet Rifampisin kaplet 600 mg ktk 10 x 10 kaplet Rifampisin tablet salut 450 mg ktk 10 x 10 tablet salut Rifampisin kapsul 300 mg ktk 12 x 10 kapsul ktk 10 x 10 kapsul Ringer Laktat larutan infus btl 500 ml Salbutamol tablet 4 mg (sebagai Sulfat) ktk 10 x 10 tablet Salbutamol tablet 2 mg (sebagai Sulfat) ktk 10 x 10 tablet Sianokobalamin (Vitamin B 12) injeksi 500 mcg ktk ml Siprofloksasin tablet 500 mg (sebagai HCI) ktk 5 x 10 tablet Streptomisin serbuk injeksi i.v mg/ml ktk ml Sulfadimidin tablet 500 mg btl 1000 tablet 133, Tetrasiklin kapsul 500 mg ktk 10 x 10 kapsul

8 148 Tetrasiklin kapsul 250 mg btl 1000 kapsul Tiamin (Vitamin B1) injeksi 100 mg/ml ktk 30 1 ml Tiamin (Vitamin B1) tablet 50 mg (HCI/ Nitrat) btl 1000 tablet Triheksifenidil tablet 2 mg ktk 10 x 10 tablet Verapamil tablet 80 mg (HCI) ktk 10 x 10 tablet Vitamin B Kompleks tablet btl 1000 tablet NAMA ALAT PARTUS SET 1 Braun Stadler. Episiotomy Scissor 14 cm 2 Busch. Umbilical Scissor 16 cm 3 Standard Operating Scissor STR - Sh / Bl 14 cm 4 Mayo Hegar. Needle Holder 14 cm 5 Thumb Dressing Forsep. 14 cm 6 Tissue Forsep. (1x2 teeth) 14 cm 7 Kocher. Haemostatic Forsep STR 14 cm 8 Rochester. Pean Haemostatic Forsep STR 14 cm 9 Beacham. Amniotic Membrane Perforator (1/2 Kocher) 16 cm 10 Female Catheter Metal Fr Needle Case (50x30x6 mm) 12 Measuring Tape. For Baby (Reactable Type) 1,5 m 13 Umbilical Cord Clamp 14 Alcohol

9 Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung Jl. Jend. Sudirman Dsn. Sukamulya 34 RT 02/09 Ds. Pucung

10 NO DAFTAR OBAT KET Abocath 20 Alcohol 70%300 ml ACEVIT/VITALENE Vit A IU Dos 3 x 10 kaplet Amoksisilin tablet 500 mg Ktk 10 x10 tablet ANDALAN pil kombinasi ANDALAN LAKTASI pil Antasida tablet kunyah, kombinasi: Aluminium Hidroksida 200 mg Magnesium Hidroksida 200 mg Btl 1000 tablet kunyah Ktk 10 x 10 tablet kunyah ANTIMO Dimenhidrinat tab Asam Askorbat (Vitamin C) Tablet 50 mg btl 1000 tablet Asam Mefenamat tablet 500 mg Baby Kit (Dress & Soap) Bag Midwife Kit Besi (II) sulfat 7 H2O tablet salut 300 mg Btl 1000 tablet salut CALADRYL/CALARE/CALAMEC lotion Calsium Lactate (Calc) tablet 500 mg Btl 1000 tablet CAPTOPRIL tablet 25 mg Catheter nelaton small CAVIPLE/VIFFERON Dos 10 x Chromic Catgut 2 in&out CYCLOFEM 0,5 ml Deksametason tablet 0,5 mg DEPO Progestin 1 ml Btl 1000 tablet Ktk 10 x 10 tablet DETRAL tablet DIANE/YASMIN pil KB ERLACYCLIN salep mata Fenobarbital tab Tablet 30 mg btl 1000 tablet

11 Fitomenadion (Vitamin K) injeksi 10 mg/ml Ktk 30 1 ml Gentamisin cream Tube 5 gram Glukosa larutan infus 10 % Btl 500 ml Handscoen Infus Set Kapas Kasa steril KOMPOLA syrup Kotrimoksazol kombinasi: Sulfametoksazol 100 mg Trimetoprim 20 mg Steril per pasang Box Box Gulung Ktk 10 x10 tablet Btl sirup (pediatrik) Lidokain injeksi 2% (HCI) Ktk ml MELAAN/LAAME tab Methylergometrin tablet salut 0,125 mg POSPARGIN/METHOVIN Metoclopramide tab Ktk 10 x 10 tablet METSOCRIM Desoksimetason cream MICROLA Tube MILNA Toddler Biscuit Balita Molagit tab MOMILEN Baby Care Diaper Rash cream MOMILEN Intensive Tummy Tube 15gr Tube 15gr MOMILEN Maternity Care Nursing cream Needle Hecting: skin&muscle Syringe: No Tube 15gr NELICORT/OTOPAIN tetes telinga Botol 10 ml NEOCENTA/CENTABIO gel Oksitetrasiklin salep mata 1% (HCI) Tube 3,5 gram Oksitosin inj 10 IU Parasetamol tablet 100 mg Btl 100 tablet Podivon lodine larutan 10% Btl 300 ml Btl 30 ml 2.808

12 POSTINOR-2 Progestin 0,75mg/tab PREGNABION Allylestrenol 5 mg Provenit supp (analgetik manual plasenta) REMCO sirup anak Retinol (Vitamin A) IU kapsul lunak Btl 50 kapsul lunak Ringer Laktat larutan infus Btl 500 ml Salbutamol tablet 4 mg Ktk 10 x 10 tablet Syringe 1cc 3cc 6cc Test Blood Indicator (pro/glu/cho) Test Lakmus Blue/Red Test Urine Indicator (pro/glu/uric) Test Urine Hcg pack Timbangan Bayi meja&gantung THROMBOPHOB Heparin gel TRANEAMIC tab 250gr TRANEC tab 500gr Umbilical Cord Clamp disposible Under Pad Vaccine BCG Vaccine Campak Vaccine DPT Vaccine Hep-B Uniject Vaccine TT Vaccine Polio Zinc tab