2020 Far332p A3 48401 1 201709004 1

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dr. Rio Haryanto Dr.

Dea Rizqi Fadillah


Jl. Dagan No. 77 Yogyakarta Jl. Blok Duku No. 10 Cibubur, Jakarta
Telp. 0274-993847 SIP No. 05/VIII/1997

No.10A Yogyakarta, 13 Feb 2022 No.10B Jakarta, 13 Feb 2022

R/ Dextrometorphan HBr 15 mg R/ Parasetamol 120mg/ 5ml


Ephedrine 25 mg PGS qs
Aminophyllin 150 mg Sir. simplex 20
CTM 4 mg m.f susp 60 ml
Lactas Calcium 300 mg S prn cth I max 3x sehari
m.f. pulv. da.in.caps. d.t.d no. X
S.3.d.d. caps . I

Pro : Tn. Samsul Bahri


Umur : 45 th Pro: Bintang (5 th)
Alamat : Jl. Wirobrajan No. 280 Yogyakarta

dr. Nadia Wilson dr. Siska Widianti


SIP.: No.169/DS-08/11.V/1999 SIP.: No.157/DS-06/10.V/1998
Jl. Angin Mamiri 18 Gorontalo Jl. Teuku Umar No. 23 Palangkaraya
Telp. (0435) 72516 Telp. (0536) 925516

No.10C Gorontalo, 13 Feb 2022 No.10D Palangkaraya, 13 Feb 2022


R/ Benzocain 0,050
Tannin 2,5 R/ Lotio Kumerfeldi 100 ml
Adeps 5 m.f Lotion
Vaselin flavum ad 25 S. acne lotion
mf. Ungt
S salep wasir ue
Pro : Nn. Anita
Pro : Kelly Alamat : Jl. Semeru II/34 Palangkaraya
Alamat : Jl Biak II/7 Gorontalo

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