Form Pemantauan Penggunaan Obat Dalam Pelaksanaan Jkn Di Rumah Sakit

March 23, 2019 | Author: RINDA | Category: N/A
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Form Pemantauan Penggunaan Obat Dalam Pelaksanaan Jkn Di Rumah Sakit...

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FORM PEMANTAUAN PEMANTAUAN PENGGUNAAN OBAT DALAM PELAKSANAAN JKN DI RUMAH SAKIT KABUPATEN KABUPATEN / KOTA TAHUN 2015

KAB/ KOTA

: ………………………………………………….....

SARANA DI DIKUNJUNGI

: …… …………………………………………………….

PEJABA PEJABAT T YG DIKUNJ DIKUNJUNG UNGII

: ....... .......... ....... ....... ...... ....... ....... ....... ....... ...... ....... ....... ...... ....... ....... ...... ....... ....... ....... ....... ...... ....... ....... ...

JUMLAH JUMLAH TENAGA TENAGA APOTEKER APOTEKER : ............ .................. ............. .............. ............. ............. .............. .............. ............. ............. .............. ......... .. TENA TENAGA GA TTK TTK .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. NON NON FARMAS RMASII .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. KEPAL KEPALA A INST INSTALA ALASI SI FARMASI FARMASI

: .............. .................... ............. .............. .............. ............. ............. .............. .............. .........

STATUS RSUD JUMLAH TEMPAT TEMPAT TIDUR AKREDITASI

: BLUD/TIDAK BLUD : : A/B/C/D .. ........ PELAYANAN

A. PERENCANAAN DAN PENGADAAN:

1. Pemili!" #$!% $e&'!(!&)!" F#&m*l!&i*m N!(i#"!l

+!

/

%i'!)  

Be&!,! i%em :.......................................................................................................................... -. ,emili!" O$!% $e&'!(!&)!" D!%!& #$!% E(e"(i!l N!(i#"!l DOEN0

+!

/

%i'!) 

Be&!,! I%em : ....................................................................................................................... . Pemili!" O$!% $e&'!(!&)!" F#&m*l!&i*m R*m! S!)i%

+!

/

%i'!) 

Be&!,! I%em :....................................................................................................................... 2. Pe"3!'!!" #$!% $e&'!(!&)!" E4C!%!l#3

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%i'!) 

J*ml! '!"! '!" I%em :...................................................................................................... 5. Pe"3!'!!" $e&'!(!&)!" Te"'e&/Lel!"3 Te"'e&/Lel!"3

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J*ml! '!"! '!" I%em : .................................................................................................... 6. Pe"3!'!!" #$!% me"33*"!)!" D!"! l!i"

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J*ml! D!"! '!" I%em :..................................................................................................... 6. T#%!l T#%!l D!"! Pe"3!'!!" O$!% T!*" T!*" -715 A. PENYIMPANAN

1. Tem,!% ,e , e"+im,!"!" 'i

: G*'!"3/A,#%e)  

-. O$!% 'i ' i le%!))!" ,! , !'!

: P!le%/R!)/L!"%!i/Lem!&i

. O$!% 'i(im,!" $e&'!(!&)!" A$8!'/Se'i!!" l!i""+! :

+!

/

%i'!)

2. M*%!(i #$!% 'i9!%!% ,!'! )!&%* (%#)

:

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%i'!)  

5. Pe"9!%!%!" 'il!)*)!" (9& &*%i" 8i)! %e&8!'i m*%!(i

:

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%i'!) 

6. Pe"+im,!"!" O$!% 'il!)*)!" (e9!&! FIFO

:

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. Pe"+im,!"!" O$!% 'il!)*)!" (e9!&! FEFO

:

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B. PENDISTRIBUSIAN

1. Pe"3el*!&!" O$!% $e&'!(!&)!" Re(e,/UDD -. Pe&mi"%!!" R*!"3!" me"33*"!)!" F#&m/B*)*

: :

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. Ji)! %i'!) me)!"i(me +!"3 'i3*"!)!" :   ................................................................................................................................................ ................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ .................................................................................... C. LAMPIRAN PEMAKAIAN OBAT TW 1,2 DAN  ! J"#$"%& ' S()*(+(% 2015TAHUN 2015

D. PERMASALAHAN YANG DIHADAPI / DITEMUI PENGGUNAAN FORMULARIUM NASIONAL DAN FORMULARIUM RUMAH SAKIT PELAYANAN PENGOBATAN

DALAM

............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ E. S A R A N ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................... MENGETAHUI

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