Penggunaan Obat Pada Pasien Ibu Hamil di Poliklinik Obstetri dan Ginekologi di RSUD Dr. Pirngadi Medan Tahun 2014

Lampiran 1. Tabel Pengumpulan Data

TABEL DATA PASIEN IBU HAMIL DI POLIKLINIK OBSTETRI DAN GINEKOLGI RSUD Dr. PIRNGADI MEDAN TAHUN 2014

1

00.94.33.98

Usia
Pasien
(tahun)
33

2
3
4

00.87.04.61
00.74.59.73
00.76.96.93


25
29
28

No. No. Rekam Medis

5

6
7

00.89.25.93

00.85.38.04
00.91.28.34

30

25
34


Usia
Kehamilan
(minggu)
39 -- 40

Paritas

Obat

Dosis

Metode Pembayaran

Multigravida

1x1

BPJS Kesehatan


34 -- 36
37 -- 38
19 -- 20

Secundagravida
Multigravida
Primigravida

Roborantia
Vitamin B
Complex
Roborantia
OBH syrup
Vitamin B
Complex
Vitamin C
Vitamin B6
Vitamin B
Complex
Lactos Calsicy

Roborantia
Roborantia
Vitamin B
Complex
Sulfa Ferrous

3x1
1x1
3x1C

Askes
Umum
Umum

1x1
1x1
1x1

PBI


2x1
1x1
1x1
1x1

Non PBI
Non PBI

32 -- 34

38 -- 40
33 -- 34

Multigravida

Secundagravida
Multigravida

36 -- 37


2x1
2x1

47
Universitas Sumatera Utara

8

00.61.92.74

37

9
10
11
12

00.89.18.89
00.77.76.99
00.54.03.16

00.90.81.55

27
31
31
30

13
14
15
16

00.83.09.95
00.79.79.79
00.93.43.69
00.92.16.55

25
32
31

29

24 -- 26
30 -- 32
38 -- 39
38 -- 39
34 -- 35
38 -- 40
8 -- 10
14 -- 16
23 -- 24
32 -- 34
32 -- 34
38 -- 40
38 -- 40
12 -- 13

Secundagravida

Primigravida

Multigravida
Multigravida
Primigravida

Multigravida
Secundagravida
Secundagravida
Multigravida

18 -- 20
24 -- 26
35 -- 36

17

00.92.00.36

26

38 -- 40


Primigravida

Vitamin B
Complex
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Vitamin B
Complex
Roborantia
Roborantia
Roborantia
Roborantia
Amoxicillin
Ranitidine

Roborantia
Roborantia
Roborantia
Sulfa Ferrous
Vitamin B
Complex
Roborantia

1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
3 x 500 mg
3x1
3x1
1x1
1x1
1x1
1x1
1x1

Umum

Non PBI
Non PBI
Umum
Non PBI

Umum
Non PBI
Non PBI
PBI

Umum

48
Universitas Sumatera Utara

18

00.93.09.94

22

12 -- 14
22 -- 24

Primigravida

24 -- 26
30 -- 31
34 -- 36

19

00.93.95.85

24

20

00.93.00.45

31

21

00.93.82.45

31

22
23

24

00.92.88.15
00.91.75.35

00.93.30.22

37
21

24

36 -- 38
38 -- 40
34 -- 35
36 -- 38
30 -- 32

39 -- 40
32 -- 34
34 -- 36

34 -- 36

Primigravida
Secundagravida
Multigravida

Secundagravida
Secundagravida

Primigravida

Roborantia
Sulfa Ferrous
Vitamin B
Complex
Asam Folat
Obimin AF
Roborantia
Roborantia
Vitamin B
Complex
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Vitamin B
Complex
Nifedipin
Roborantia
Roborantia
Sulfa Ferrous
Vitamin B
Complex
Volavit
Roborantia

1x1
1x1

PBI

1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
4 x 10 mg
1x1
1x1
1x1
1x1
1x1
1x1

Non PBI
Non PBI
PBI

Non PBI
Non PBI

Non PBI

49
Universitas Sumatera Utara

25
26

00.93.61.22
00.78.62.12

23
34

26 -- 28
4 -- 5

Primigravida
Multigravida

27

00.92.79.22

29

Primigravida

28
29
30
31

00.93.78.32
00.93.49.42
00.92.83.62
00.93.22.92

21
16
17
42

32 -- 34
35 -- 36
36 -- 38
38 -- 40
34 -- 36
38 -- 40
7 -- 8

Primigravida
Primigravida
Primigravida
Primigravida

32
33
34
35
36
37
38
39
40
41

00.83.25.62
00.82.73.61
00.93.98.41
00.92.27.71
00.93.45.31
00.78.63.69
00.93.53.39
00.94.25.59
00.82.78.17
00.93.03.57

34
38
13
22
27
22
22
33
31
29

18 -- 20
34 -- 35
36 -- 37
39 -- 40
36
28 -- 29
38 -- 40
16
37 -- 38
36 -- 38

Multigravida
Primigravida
Primigravida
Secundagravida
Secundagravida
Secundagravida
Primigravida
Multigravida
Multigravida
Multigravida

Roborantia
Cefadroxil
Transamin
Duphaston
Roborantia
Nifedipin
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Premaston
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Folavit
Roborantia

1x1
2 x 500 mg
1x1
2x1
1x1
3 x 10 mg
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1

Non PBI
Umum

Non PBI

Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI

50
Universitas Sumatera Utara

42
43
44
45

00.93.33.67
00.84.74.77
00.94.80.06
00.93.77.06

19
41
35
27

46
47
48
49
50
51

00.94.58.26
00.94.49.36
00.15.83.06
00.94.13.76
00.80.36.86
00.81.09.96

52
53

00.93.69.96
00.73.45.45

54
55
56
57
58
59

00.56.01.75
00.93.72.15
00.79.66.04
00.63.80.13
00.93.08.38
00.82.45.89

29
29
43
29
36
24

40
38 -- 39
38 -- 39
38 --39
40
38 -- 39
38 -- 40
38 -- 39
38 -- 40
34 -- 36
26 -- 28

Secundagravida
Secundagravida
Multigravida
Secundagravida
Primigravida
Secundagravida

26
33

38 -- 40
30 -- 32

Multigravida
Multigravida

33
15
30
34
41
27

38 -- 40
38 -- 40
37 -- 38
37 -- 38
38 -- 39
36 -- 37

Primigravida
Primigravida
Multigravida
Secundagravida

Secundagravida
Primigravida
Primigravida
Secundagravida
Multigravida
Primigravida

Nifedipin
Roborantia
Roborantia
Roborantia
Lynoral
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Asam Folat
Roborantia
Roborantia
Sulfa Ferrous
Vitamin B
Complex
Amoxicillin
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia

3 x 10 mg
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
3 x 500 mg
1x1
1x1
1x1
1x1
1x1
1x1

Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI

Non PBI
Non PBI
Non PBI
Non PBI
Medan Sehat
Non PBI

51
Universitas Sumatera Utara

60
61

62

00.94.27.69
00.83.32.89

00.81.25.37

21
25

38
24 -- 25

Multigravida
Primigravida

44

34 -- 35
37 -- 38

Multigravida

63
64
65

00.94.80.06
00.93.86.28
00.94.53.36

35
23
30

36 -- 38
38 -- 39
6 -- 8

Multigravida
Primigravida
Primigravida

66

00.93.60.16

37

38 -- 39

Primigravida

67
68
69
70
71
72
73
74

00.93.97.70
00.94.08.16
00.92.40.16
00.93.55.70
00.75.16.20
00.93.50.40
00.77.14.90
00.90.16.27

40
26
26
24
27
24
30
24

38 -- 39
34 -- 35
38 -- 40
35 -- 36
36 -- 37
38 -- 40
38 -- 40
30 -- 32

Primigravida
Secundagravida
Secundagravida
Secundagravida
Primigravida
Primigravida
Primigravida
Primigravida

Roborantia
Flagystatin Ovula
Nifedipin
Obimin AF
Asam Folat
Vitamin B
Complex
Sulfa Ferrous
Roborantia
Roborantia
Asam Folat
Sulfa Ferrous
Nifedipin
Sulfa Ferrous
Vitamin B
Complex
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia

1x1
1x1
1x1
1x1
2x1
2x1
2x1
1x1
1x1
1x1
1x1
1 x 10 mg
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1

PBI
Non PBI

Non PBI

Non PBI
Non PBI
Non PBI
Umum

Non PBI
Umum
Non PBI
Non PBI
Non PBI
Non PBI
Non PBI
Umum

52
Universitas Sumatera Utara

75
76

77
78
79
80
81
82
83
84
85
86

00.94.58.97
00.91.83.40

00.83.03.07
00.92.13.37
00.92.20.98
00.92.80.67
00.93.33.88
00.81.73.68
00.86.19.18
00.83.20.17
00.81.11.27
00.81.53.56

24
18

37
32
32
24
39
28
23
29
31
31

24 -- 25
26 -- 27

32 -- 34
34 -- 36
36 -- 37
38 -- 40
37 -- 38
38 -- 40
28 -- 30
38 -- 39
39 -- 40
35 -- 36
36 -- 37

Primigravida
Primigravida

Multigravida
Multigravida
Secundagravida
Primigravida
Multigravida
Multigravida
Secundagravida
Primigravida
Primigravida
Secundagravida

Vibrion
Sohobion 5000
Ranitidine tab
Metoclopramide
tab
Ulsicral Syrup
Cotrimoxazole tab
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Roborantia
Nifedipin
Metildopa
Vitamin E
Vitamin C

1x1
1x1
2x1
2x1
3x1C
3 x 400 mg
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
1x1
4 x 10 mg
2x1
1x1
1x1

Umum
Non PBI

Non PBI
Umum
Non PBI
Non PBI
Non PBI
Non PBI
Umum
Non PBI
Non PBI
Non PBI

53
Universitas Sumatera Utara

Lampiran 2. Surat Permohonan Izin Pengambilan Data Penelitian

54
Universitas Sumatera Utara

Lampiran 3.Surat Izin Penelitian Di Ruang Rekam Medis RSUD Dr.Pirngadi
Medan

55
Universitas Sumatera Utara

Lampiran 4.Surat Keterangan Selesai Penelitian

56
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