Form PKPA Apotek 1 (Lembar Konseling)

 

P]FL[BL LB]JF P]ANBWI FPA[BLB] P]AC]FO W[RKI PBHKIKILFH FPA[BLB] NFLR[FW NF]OFWI, RHI^B]WI[FW FHKFDFW

Ha : 06/PLPF/M/63 [fhccfd : --=063 Obhccfht Ha : [fhccfd : -

KALROBH P]FL[IL NA]O F 6 (DBOMF]FH LAHWBDIHC) Hfof

Wan Ofrif, W. Nfro

Ha. MP

6506;6707;

Fhclffh

II/=065

6

F. IK IKBH BH[I [I[F [FW W OFEF OFEFWI WIWS WSF F [bopf PLPF Fpabl Im Imuhkf, ^b ^bbrfh,Pfkfhc, Wuofrf Mfrf FPF/ Yuri Fdki, O. Wi, Fp Pbomiomihc 6 Pbomiomihc = Pra. Kr Kr. Fk Fkbl Zf Zforuk Fkhfh, OW, Fp

M. ]IH ]IHGIF GIFH H PBDFLWFH PBDFLWFHFFH FFH LAH LAHWBD WBDIHC IHC L]I ]I[B [B]I ]IF F PFWI PFWIBH BH//LBDR LBDRF F]CF ]CF PFWI PFWIB BH

6. Pfsi Pfsibh bh lahkisi lahkisi leusus leusus (pbkiftri, (pbkiftri, cbriftri, cbriftri, cfhccufh cfhccufh nuhcsi nuhcsi efti kfh/ftfu kfh/ftfu cihjfd, imu efoid kfh obhyusui). =. Pfsibh kbhcfh tbrfpi jfhclf pf pfhjfhc/pbhyflit hjfhc/pbhyflit lrahis (oisfdhyf: [M, KO, FIKW, bpidbpsi). 7. Pfsi Pfsibh bh yfhc obhccuhflfh obhccuhflfh Amft kbhcfh ihstrulsi ihstrulsi leusus (pbhccuhffh (pbhccuhffh lartilastbraik kbhcfh tfppbrihc kawh/ann ). ). ;. Pfsi Pfsibh bh yfhc obhccuhfl obhccuhflfh fh Amft kbhcfh kbhcfh ihkbls ihkbls tbrfpi tbrfpi sbopit (kicalsih, (kicalsih, nbhitaih, tbanidih). 2. Pf Pfsi sibh bh kbhc kbhcfh fh padi padinf nfro rofs fsi< i< pfsi pfsibh bh obhb obhbri riof of mbmb mbmbrf rfpf pf Amft Amft uhtu uhtul l ihki ihkilf lfsi si pbhy pbhyfl flit it yfhc yfhc sfof sfof.. Kfdf Kfdfo o lbda lbdaop opal al ihi ihi jucf jucf tb tbro rofs fsul ul pbombr pbo mbrifh ifh dbmie dbmie kfri kfri sftu sftu Amft Amft uhtul uhtul pbhyfl pbhyflit it yfhc yfhc kilbtf kilbtfeu euii kfpft kfpft kisbomuelfh kbhcfh sftu jbhis Amft. >. Pfsibh kbhcfh tihclft tihclft lbpftuefh lbpftuefh rbhkfe rbhkfe 3. Pfsibh dfih-dfih (sbmutlfh) ..................................... ................................................................. ................................... ....... =

[FEFP LBCIF[FH LAHWBDIHC

6. Obomulf laouhilfsi laouhilfsi fhtfrf Fpatblbr kbhcfh kbhcfh pfsibh =. Ob Obhi hidf dfii pbof pbofef efof ofh h pfsi pfsibh bh tbht tbhtfh fhc c pbhc pbhccu cuhf hffh fh Amft Amft obdf obdfdu duii [erbb  Priob Vubstiahs, yfitu: Vubstiahs, yfitu: f. Fpf yfhc kisfopfilfh kaltbr kaltbr tbhtfhc Amft Fhkf1 Fhkf1 m. Fpf yfhc kijbdfslfh adbe kaltbr tbhtfhc gfrf gfrf pboflfifh Amft Fhkf1 Fhkf1 g. Fpf yfhc kijbdfslfh kijbdfslfh adbe kaltbr kaltbr tbhtfhc efsid efsid yfhc kiefrfplfh kiefrfplfh sbtbdfe sbtbdfe Fhkf obhbriof tbrfpi Amft tbrsbmut1 7. Ob Obhcc hccfdi fdi ihnaro ihnarofsi fsi dbmie dbmie dfhjut dfhjut kbhcfh kbhcfh obombr obombrii lbsbop lbsbopftf ftfh h lbpfkf lbpfkf pfsibh uhtul obhcblspdarfsi ofsfdfe pbhccuhffh Amft ;. Ob Obomb ombril rilfh fh pbhjbd pbhjbdfsf fsfh h lbpfkf lbpfkf pfsibh pfsibh uhtul uhtul obhyb obhybdbs dbsfil filfh fh ofsfdf ofsfdfe e pbhccuhffh Amft 2. Obdflulfh vbrinilfsi vbrinilfsi fleir uhtul uhtul obofstilfh pbofefofh pbofefofh pfsibh Fpatblbr obhkaluo Fpatblbr obhkaluobhtfs bhtfsilfh ilfh lahsbdihc lahsbdihc kbhcfh kbhcfh oboihtf oboihtf tfhkf tfhcfh tfhcfh pfsibh pfsib h sbmfcfi sbmfcfi multi multi mfewf mfewf pfsibh pfsibh obofefoi obofefoi ihnarofsi ihnarofsi yfhc kimbrilfh kimbrilfh kfdfo lahsbdihc.

 

7

GF[F[FH JFSFMFH PFWIBH ([erbb Priob Vubstahs)

;

PB][FHYFFH PFWIBH

2

WF]FH KF KFH ] ]B BHGFHF [I [IHKFL DF DFHJR[

Efri/[fhccfd

G. PBHCBWFEFH [fhkf fhcfh Pfsibh