FORM PERMINTAAN BHP VITRECTOMI

Tanggal : Jumlah Pasien :

NO NAMA BARANG STOK PAKAI SISA
1 Kaset Consteletion Vitrex
2 Eye Drape 3L 40X60
3 Eye Drape 3L 100x70
4 Benang 8.0
5 Trilac Inj
6 SF6
7 C3F8
8 SO 1300
9 Needle 20
10 Flot Needle
11 BSS
12 Spuit 1 cc
13 Spuit 3 cc
14 Spuit 5 cc
15 Spuit 10 cc
16 Healon
17 Appavisc
18 Lidocain Inj
19 Salticin Inj
20 Ephineprine Inj
21 Indexon Inj
22 Slit 2.75
23 Cresent
24 Straight
25 Maxter 7.5
26 Vasco 7.5
27 Maxter 6.5
28 Cathacol
29 Mayo
30 Gown
31 Wida Steril 1L
32 Cravit ED
33 Floxa MD
34 Pantocain 2% ED
35 Needle 23
36 Needle 26
37 Needle 30
38 Canul Hidrodiseksi
39 Membran Blu
40 Marcain Inj
41 Laser Probe
42 Benang 10.0

PERAWAT FARMASI
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