Lplpo 1

LAPORAN PEMAKAIAN DAN LEMBAR PERMIN
PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Desember 2015
: Januari 2016
NO
NAMA OBAT
SATUAN
Stok Awal Penerimaan

4
Jumlah
Persediaan
6
Pemakaian Stok akhir

7
Acyclovir tab 200mg
TABLET
Acyclovir tab 400mg
TABLET
Air Raksa Dental Use
BOTOL
Alat Suntik Sekali Pakai 1 ml
SET
SET
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
Alopurinol Tablet 100 mg
TABLET
11
Ambroxol syrup 15mg/5ml
BOTOL
12
Ambroxol tab 30 mg
TABLET
13
Aminofilin Injeksi 24 mg/ ml
AMPUL
14
Aminofilin Tablet 200 mg
TABLET
15
Amitriptilin HCL 25 mg
TABLET
16
Amlodipin Tablet 10 mg
TABLET
120
17
TABLET
90
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
20
Amoksisilin + Asam Klavulanat
TABLET
21
Amoksisilin Syrup 125 mg/ 5 ml
BOTOL
22
Ampisilin Kaplet 500 mg
Kaplet
23
Ampisillin Serbuk 1.000 mg injeksi
24
Antalgin Injeksi 250 mg/ ml
AMPUL
25
Antalgin tab (Metampiron) 500 mg
TABLET
26
Antasida DOEN I tablet kunyah
TABLET
27
Antasida DOEN II suspensi,
Botol
28
Anti Bakteri DOEN salep kombinasi
TUBE
29
Anti fungi DOEN Kombinasi
30
Anti Hemoroid Doen Kombinasi
31
Antihemoroid Kapsul
32
Antimigren tablet: Ergotamin Tartrat 1 mg + Kof
33
Aqua Proinjeksi Steril
34
35
36
VIAL
400
400
400
100
100
0
100
100
100
100
200
100
0
200
100
120
120
240
120
120
210
120
90
5000
5000
0
5000
0
30
200
230
20
20
40
0
200
30
20
20
1000
3500
150
50
25
1000
1000
3500
3500
150
50
100
75
25
50
POT
SUP
Kapsul
TABLET
VIAL
50
Asam Asetil Salisilat Tablet 100mg
TABLET
100
Asam Askorbat 50 mg
TABLET
Asam Mefenamat 500 mg
TABLET
50
10
40
100
300
100
300
1500
1500
300
1500
0
0
37
Asam Traneksamat injeksi 100 mg/ml
Ampul
38
Atropin Sulfat Injeksi 0,25 mg
AMPUL
39
Bekarbon
TABLET
40
Benzatin B. P. Injek 2,4 juta UI
VIAL
41
Betametason Krim 0,1 %- 5 mg
TUBE
42
Bisakodil Suppositoria 10 mg
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
Bromhexin Tablet 8 mg
47
Ca-Glukonas injeksi IV 10%
48
Captopril Tablet 25 mg
TABLET
49
Catgut Chromic No.2/0
Sachet
50
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
Cefadroxil Kapsul 500 mg
KAPSUL
54
Cetirizin Tablet 10mg
TABLET
55
Cimetidine Tablet 200 mg
TABLET
56
Clindamycin Kapsul 150mg
KAPSUL
57
KAPSUL
58
Clobazam Tablet 10 mg
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
61
Cyprofloxacin Tablet 500 mg
TABLET
62
Deksametason Injeksi 5 mg/ ml
AMPUL
25
75
100
50
50
Supp
TABLET
Botol
TABLET
Ampul
20
20
2000
1500
100
400
2600
2000
1500
20
1500
1000
500
500
100
100
3000
2000
1000
63
Deksametason Tablet 0,5 mg
TABLET
64
Devitalisasi Pasa Non Arsen
BOTOL
65
Dextran 6%
BOTOL
66
Diazepam Injeksi 5 mg/ ml- 2 ml
AMPUL
20
20
67
Diazepam Rectal Tube 5mg
Tube
68
Diazepam Tablet 2 mg
TABLET
770
770
20
750
69
TABLET
70
Difenhidramin HCL Injeksi
AMPUL
71
Digoxin 0,25 mg
72
Domperidon Syrup
73
Domperidon Tablet 10mg
TABLET
74
Doxycilkin 100 mg kapsul
KAPSUL
75
Efedrin HCL 25 mg
76
Ekstrak Belladone 10 mg
77
20
10
10
TABLET
Botol
10
300
500
200
800
500
300
200
200
TABLET
TABLET
Epinefrin (Adrenalin) injeksi 0,1 %
AMPUL
78
Eritromisin sirup 200 mg/ 5 ml
BOTOL
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
Etakridine ( Rivanol ) 0,1 %
BOTOL
82
Etambutol 500 mg
TABLET
300
300
15
10
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
25
10
15
10
10
85
Etil Klorida Semprot
BOTOL
86
Eugenol Cairan
BOTOL
87
Extrak Plasenta dan Neomisin Jeli
tuBE
88
Fenilbutazone Tablet 200 mg
TABLET
89
Fenobarbital Injeksi 50 mg/ ml
AMPUL
30
30
30
90
Fenobarbital Tablet 30 mg
TABLET
10
10
10
91
Fenoksimetil Penisilina 250 mg
TABLET
92
TABLET
93
Fenolgliserol TT 10 % 5 ml
BOTOL
94
Fitomenadion Injeksi 10 mg/ ml
AMPUL
95
AMPUL
96
Fitomenadion Salut Gula 10 mg
TABLET
97
Fluoksetin 10 mg
TABLET
98
Folley Catheter No. 18
Buah
99
30
30
0
1
30
Buah
100 Forinokresol (TKF) 10 ml
BOTOL
101 Furosemid Tablet 40 mg
TABLET
102 Garam Oralit 200 ml Air
SASE
200
200
200
0
40
103 Gentamisin injeksi 40 mg/ ml
AMPUL
104 Gentamisin Salep Kulit 0.1%
TUBE
105 Gentian Violet Larutan 1 % 10 ml
BOTOL
106 Glass Ionomer Cement ( Fuji GC IX )
BOTOL
107 Glibenklamid 5 mg
TABLET
108 Gliseril Guayakolat 100 mg
TABLET
Botol
109 Gliseril Guayakolat Syrup
40
100
100
10
100
30
110
Gliserin lar. 50%
BOTOL
111
Glukosa Larutan Infus 10% Steril
BOTOL
112
VIAL
113
BOTOL
20
114
Griseofulvin 125 mg, micronized
TABLET
100
20
200
20
100
100
115
Haloperidol 0,5mg
TABLET
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
Haloperidol injeksi 5 mg/ml
AMPUL
119
AMPUL
Botol
121 Hidrogen Peroksida Lar. 3 %
BOTOL
122 Hidroklorotiazid ( HCT ) 25 mg
TABLET
120 Hand Sanitizer
123 Hidrokortison Krim 2,5 %
TUBE
124 Hyoscine N Butilbromide 10 mg
TABLET
125 Ibuprofen 200 mg
TABLET
TABLET
127 Ibuprofen suspensi 200mg/5ml
BOTOL
128 Infusion Set Anak
SET
129 Infusion Set Dewasa
SET
24
24
500
2500
50
300
48
48
500
500
2500
2500
50
50
300
300
130 Isoniazid 300 mg
TABLET
131 Isosorbid dinitrat 5 mg
TABLET
Buah
132 IV Catheter/abocath No. 18
Buah
15
134 IV Catheter/abocath No.22
Buah
15
Buah
15
10
10
10
25
25
25
25
25
25
136 Kalium Diklofenak 50 mg
TABLET
137 Kalsium Hidroksida Pasta
KOTAK
138 Kalsium Laktat 500 mg
TABLET
139 Kapas Pembalut 250 mg
ROL
140 Karbamazepin 200 mg
TABLET
200
200
200
141 Kasa Kompres 16x16 steril
KOTAK
142 Kasa Pembalut 36 mx 80 cm
ROL
143 Kasa Pembalut Hidrofil 4 m x 10 cm
ROL
ROL
145 Ketokonazol 200 mg
TABLET
146 Ketokonazol Krim 2 %
Tube 15 g
147 Kloramfenikol 250 mg
KAPSUL
148 Kloramfenikol SM
100
100
24
200
24
24
200
24
24
TUBE
0
24
149 Kloramfenikol TM 0.5 % 5 ml
BOTOL
150 Kloramfenikol TT 3 % 5 ml
BOTOL
151 Klorfeniramin Maleat (CTM) 4 mg
TABLET
152 Klorfenol kamfer Mentol(CHKM) Cairan
BOTOL
153 Klorin Cair Lar. 5%
BOTOL
154 Klorpromazine tab 100mg
TABLET
TABLET
156 Komb : Pirimetamin+sulfadoxin
TABLET
Botol 10 ml
vial
157 Komposit Resin

158 Kontrasepsi injek depo/ KB 3 bln
159 Kontrasepsi Oral (Pil KB)
Blister
160 Kotrimoksazole Suspensi
BOTOL
161 Kotrimoksazole Tablet Dewasa
TABLET
162 Larutan Benedict 100 ml
BOTOL
163 Larutan Eosin 2 % 100 ml
BOTOL
164 Larutan Etanol asam 100 ml
BOTOL
165 Larutan Giemsa stain 100 ml
BOTOL
166 Larutan Iodine Test
BOTOL
167 Larutan Karbol Fuksin 100 ml
BOTOL
168 Larutan Metilen Biru
BOTOL
169 Larutan Turk
BOTOL
Botol
170 Laxadin Syrup

171 Levertrans Salep
0
50
100
POT
150
0
100
50
AMPUL
173 Lidokain Jeli 2%
Syringe
174 Lidokain Komp Injeksi
AMPUL
175 Lisol
176 Loratadin tab 10mg
BOTOL 1L
TABLET
100
100
172 Lidokain Injeksi 2%
100
200
200
4
200
177 Lubricating Jeli (Aquagel)
Tube
178 Magnesium Sulfat Injeksi 20 %
VIAL
VIAL
180 Masker 3 Fly earloop
Buah
200
200
0
100
100
181 Masker N95 Single valve
Buah
182 Mebendazol tablet 100mg
TABLET
183 Meloxicam 15mg
TABLET
184 Metformin HCl Tablet 500mg
TABLET
185 Metil Prednisolon 4 mg
TABLET
186 Metildopa tab sal 250 mg
TABLET
0
300
300
0
200
100
0
150
150
0
50
100
100
100
187 Metilergometrin Maleat Inj. 0,200
AMPUL
188 Metilergometrin Maleat tab 0,125 mg
TABLET
189 Metisoprinol
TABLET
190 Metoklopramide 10 mg
TABLET
191 Metoklopramide Drop 5mg/ml
BOTOL
192 Metoklopramide injeksi 5mg/ml
AMPUL
193 Metoklopramide syrup 5mg/ml
BOTOL
194 Metronidazol Larutan infus 5mg/ml
BOTOL
200
20
10
200
20
20
10
0
10
195 metronidazol ovula
Ovula
196 Metronidazol suppositoria 500mg
Supp
10
10
10
197 Metronidazole 250 mg
TABLET
TABLET
200
TUBE
24
199 Mikonazol krim 2%

200 Mometason Furoat Krim 0.1%
300
10
Tube 10g
500
500
24
24
10
10
201 Multivitamin Syrup
Botol
202 Multivitamin tablet
Caplet
203 Mummifying Fasta
BOTOL
204 Narium Tiroksin 100 g
TABLET
205 Natrium Bikarbonat 500 mg
TABLET
60
60
206 Natrium bikarbonat injeksi

207 Natrium Diklofenak 50 mg
208 Natrium Fusidat Krim
VIAL
TABLET
tube
209 Natrium Klorida Infus 0,9 % Steril
BOTOL
210 Nipedifin 10 mg
TABLET
211
Nistatin 100.000 IU/ Gram Vaginal
60
20
20
10
TABLET
20
10
10
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
214 OAT Kategori 2/FDC 2
PAKET
215 OAT Kategori 3
PAKET
216 OAT Kategori Anak
PAKET
217 OAT Sisipan
PAKET
218 Obat Batuk Hitam ( OBH ) 100 ml
BOTOL
219 Obat Batuk Pilek Kombinasi Syrup
BOTOL
220 Obat Batuk Pilek Kombinasi Tablet
TABLET
Obat Diare Syrup (Kombinasi Attapulgit 700mg

221 + Pektin 66 mg per 15 ml)
TABLET
222 Obat Diare Tablet
TABLET
223 Obat Flu Kombinasi Tablet
TABLET
224 Ofloxacin tab 400mg
TABLET
225 Oksigen Kaleng
Botol
226 Oksimetazolin Tetes Hidung 0,025%
Botol
227 Oksitetrasiklin HCL Inj 1m 50 mg
VIAL
228 Oksitetrasiklin HCL SK 1 % 3,5 Gr
TUBE
229 Oksitetrasiklin HCL SM 1 % 3,5 Gr
TUBE
230 Oksitosin Injeksi 10 IU/ ml
AMPUL
231 Omeprazol injeksi 40 mg/ 10 ml
AMPUL
232 Omeprazol Kapsul 20 mg
KAPSUL
233 Ondansetron 4 mg
TABLET
480
90
480
360
120
90
30
60
234 Ondansetron inj 4 mg/ 2 mL
Ampul
235 Papaverin 40 mg/ ml injeksi
AMPUL
236 Parasetamol Drops
BOTOL
56
56
237 Parasetamol Syrup 120 mg/ ml
BOTOL
238 Parasetamol tablet 100 mg
TABLET
TABLET
240 Pembalut Gips
56
504
504
10000
3000
Rol
241 Permetrin Krim 5% (Scabimite)
504
13000
0
10000
3000
10
TUBE
10
0
10
242 Pirantel Pamoat 125 mg
TABLET
243 Pirantel Suspensi 125mg/5ml
BOTOL
244 Piridoksin HCL 10 mg
TABLET
245 Piroxicam 20 mg
KAPSUL
246 Plester 6 Yards x 2 Inch
ROL
247 Polikresulen 360 mg 10 ml
BOTOL
248 Povidon Iodida 10 % 30 ml

250 PP test
251 Prednison 5 mg
252 Prokain Benzil Penisili 3 Jt IU
0
2
BOTOL
BOTOL
Buah
TABLET
VIAL
TABLET
254 Propranolol HCL 40 mg
TABLET
255 Pyrazinamide 500 mg
TABLET
256 Ranitidin Injek
0
4
253 Propiltiourasil tablet 100mg
200
500
200
0
100
100
500
50
2500
Ampul
50
10
40
2800
2500
300
257 Ranitidin tablet 150mg
TABLET
258 Reserpin 0,25 mg
TABLET
259 Retinol (Vit. A) 100.000 IU
KAPSUL
KAPSUL
261 Rifampisin 300 mg
KAPSUL
KAPSUL
KAPSUL
264 Risperidon Tablet 2 mg
TABLET
265 RL Larutan infus Steril 500ml
BOTOL
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
269 Salbutamol Cairan inhalasi 0,1 %
Botol plastik
300
500
60
200
200
200
260
100
100
60
500
20
500
200
0
200
300
20
20
270 Salbutamol Inhalasi /Aerosol 100 mcg/dosis (Ven
Botol
271 Salep 2-4 Komb.
POT
272 Salisil Bedak 2 % 50 Gram
KOTAK
273 Sarung tangan Gynecology
Pasang
274 Sarung tangan No. 6.5
Pasang
275 Sarung tangan No. 7
Pasang
Pasang
200
200
200
200
200
200
277 Sarung Tangan Periksa L
Buah
278 Sarung Tangan Periksa M
Buah
279 Sefiksim syrup kering 100mg/5ml
BOTOL
280 Sefixime 100 mg
TABLET
281 Semen Seng Fosfat Serbuk + Cair
BOTOL
282 Serum ABU Injek. 5 ml (ABU I )
VIAL 5 ml
283 Serum ADS 20.000 iu
VIAL 5 ml
AMPUL
284 Serum ATS Injek. 1.500 IU

VIAL
286 Sianokobalamin Injeksi 500mcg/ ml
AMPUL
287 Silk No 3/0( Benang Bedah Sutera)
SACHET
288 Silver Amalgam serbuk 65-75 %
BOTOL
289 Simvastatin 10mg
TABLET
72
72
36
0
500
500
36
0
300
200
290 Stomach Tube No. 12
Buah
291 Strip Test Asam Urat
Pak 25
292 Strip Test Glukosa
Pak 50
293 Strip Test Kolesterol
Pak 10
294 Sulfasetamida Na. TM 15 % 5ml
BOTOL
295 Tablet Tambah Darah Dewasa
TABLET
296 Tablet Tambah Darah Dewasa 2 (Hemafort)
TABLET
297 Temporary Stopping Fletcher
SET
298 Test HIV I (Vikia)
Buah
299 Test HIV II (intec)
Buah
300 Test HIV III (Onco)
Buah
301 Test Siphylis
Buah
302 Tetrasiklin HCL 250 mg
KAPSUL
KAPSUL
304 Thiamfenikol kap 500mg
KAPSUL
305 Thiamfenikol Syrup
BOTOL
306 Thiamin HCL (Vit. B1 ) Injek.100 mg
AMPUL
50
50
307 Thiamin HCL (Vit. B1) 100 mg
TABLET
TABLET
309 Tramadol tablet 50mg
TABLET
310 Trifluoferazin 5 mg
TABLET
311
KAPSUL
Buah
Trihexyphenidil HCL 2 mg
312 Umbilical cord klem
50
313 Urea Krim 10 % (Soft U Derm)
TUBE
314 Urine Bag
BUAH
20
20
20
315 Vaksin Anti Rabies Vero
KUUR
316 Vitamin B. Komplek
TABLET
1000
1000
317 Vitamin B12 tablet 50mg
TABLET
318 Vitamin Neurotropik
TABLET
0
10
319 Wing Needle No.25,27
BUAH
10
10
320 Zink dispersibel tablet
TABLET
500
500
1000
500
321
322
323
324
325
Mengetahui/menyetujui,
Kepala Dinas Kesehatan Kab. Cianjur
Yang menyerahkan,
Kepala Seksi Farmasi & Pengawasan Mamin
.
NIP.
.
NIP. .
AR PERMINTAAN OBAT (LPLPO)

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Oba

Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
20
20
20
0
500
500
1000
1000
3500
3500
3500
3500
0
0
0
0
0
0
0
0
0
0
Stok Awal
10
0
0
0
0
0
0
12
12
12
150
150
150
0
0
0
1500
1500
1500
0
0
0
0
0
500
500
500
0
0
200
0
0
0
0
0
0
0
0
0
0
15
15
15
0
0
0
0
0
300
300
300
0
0
0
0
25
25
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
60
60
60
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
20
20
20
10
10
10
20
20
20
0
0
0
0
0
0
0
0
0
50
48
48
0
0
0
0
0
0
0
0
0
0
0
0
1500
0
0
0
0
0
0
0
0
0
300
300
300
0
0
48
48
48
0
0
0
1
0
0
0
0
60
60
60
100
100
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
500
500
1
0
0
0
20
20
20
0
0
0
400
0
0
0
0
0
0
15
20
15
20
15
20
0
0
0
0
0
0
0
30
20
20
0
0
0
0
0
0
1500
1500
1500
0
0
0
0
0
0
0
0
0
0
0
0
0
30
0
0
0
0
5
0
0
0
0
0
30
30
30
0
0
20
20
20
0
0
0
1000
1000
1000
0
0
0
0
0
0
0
0
0
0
0
0
1000
1000
1000
0
0
0
0
0
2500
2500
2500
0
0
0
0
0
0
0
0
0
200
200
0
200
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
10
10
0
0
0
0
0
0
0
0
0
0
18000
0
0
1
0
0
0
0
0
0
1000
500
500
50
50
50
0
0
2000
2000
2000
0
0
0
0
0
0
0
0
1500
1500
1500
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas
drg. Tutik Suprihatin, M.Kes
NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas
Fitriah Nurhayani, Apt

NIP. 19860609 201101 2 001
Laporan Mutasi Obat JKN PKM

: Desember 2015
Penerimaan Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Januari 2016
: Februari 2016
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
Acyclovir tab 400mg
TABLET
400
400
BOTOL
SET
SET
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
400
11
BOTOL
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
16
TABLET
120
120
17
TABLET
90
90
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
20
TABLET
21
BOTOL
30
30
22
Kaplet
120
90
30
0
0
0
0
40
23
VIAL
20
20
40
24
AMPUL
25
TABLET
1000
1000
1000
26
TABLET
3500
3500
27
Botol
100
100
28
TUBE
50
50
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
3500
100
50
0
0
0
Kapsul
TABLET
VIAL
40
40
TABLET
100
100
100
35
Asam Askorbat 50 mg
TABLET
36
TABLET
40
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
50
50
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
Ampul
20
20
48
TABLET
500
1500
2000
49
Sachet
50
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
500
500
1000
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
61
TABLET
62
AMPUL
50
0
0
Supp
12
12
TABLET
150
150
12
Botol
TABLET
60
90
20
1800
800
200
200
1000
63
TABLET
1000
1000
64
BOTOL
0
0
65
Dextran 6%
BOTOL
66
AMPUL
20
20
20
4
700
67
Tube
15
15
68
TABLET
750
750
69
TABLET
70
AMPUL
10
10
10
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
300
300
600
74
KAPSUL
200
200
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
78
BOTOL
15
25
40
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
400
100
20
11
50
200
100
20
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
60
95
AMPUL
60
60
96
TABLET
0
0
97
Fluoksetin 10 mg
TABLET
98
Buah
99
Buah
BOTOL
TABLET
SASE
AMPUL
30
30
30
TUBE
BOTOL
BOTOL
TABLET
TABLET
Botol
110
Gliserin lar. 50%
BOTOL
111
BOTOL
20
20
20
112
VIAL
10
10
10
113
BOTOL
20
20
20
114
TABLET
100
100
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
TABLET
TABLET
500
500
TABLET
100
48
0
0
500
0
0
BOTOL
SET
50
50
50
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
200
200
200
KOTAK
ROL
ROL
ROL
TABLET
300
300
Tube 15 g
24
24
KAPSUL
TUBE
48
48
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
60
60
157 Komposit Resin

300
24
0
0
0
48
2
60
100
50
0
0
Blister
100
100
BOTOL
50
50
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
170 Laxadin Syrup

0
0
POT
AMPUL
Syringe
AMPUL
BOTOL 1L
TABLET
500
500
Tube
VIAL
175 Lisol
VIAL
Buah
100
100
300
200
50
50
20
Buah
20
20
TABLET
183 Meloxicam 15mg
TABLET
TABLET
100
100
TABLET
TABLET
100
100
100
0
0
100
AMPUL
TABLET
100
100
100
189 Metisoprinol
TABLET
TABLET
15
20
BOTOL
15
15
AMPUL
20
20
10
10
10

BOTOL
BOTOL
0
0
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
20
20
Botol
Caplet
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
1500
1500
1500
tube
BOTOL
210 Nipedifin 10 mg
TABLET
211
15
10
TABLET
10
10
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
TABLET
221 Obat Diare Syrup (Kombinasi Attapulgit 700mg + TABLET
TABLET
TABLET
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
30
30
KAPSUL
120
120
TABLET
60
60
Ampul
20
20
AMPUL
BOTOL
56
56
BOTOL
10
120
20
0
60
10
10
0
56
0
0
1000
3000
TABLET
1000
1000
TABLET
3000
3000
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

0
0
ROL
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
1000
1000
1000
VIAL
TABLET
TABLET
100
100
100
TABLET
500
500
500
Ampul
40
40
TABLET
300
2500
2800
TABLET
KAPSUL
KAPSUL
KAPSUL
KAPSUL
KAPSUL
TABLET
100
100
100
BOTOL
200
200
251 Prednison 5 mg
256 Ranitidin Injek

40
2800
200
0
0
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
300
300
268 Salbutamol 4 mg
TABLET
200
200
Botol plastik
20
20
20
300
100
0
100
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
10
10
10
VIAL
AMPUL
SACHET
36
36
BOTOL
TABLET
200
200
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
500
500
BOTOL
50
50
50
AMPUL
50
50
50
TABLET
TABLET
2000
2000
2000
TABLET
TABLET
311
KAPSUL
Buah
TUBE
314 Urine Bag
BUAH
20
20
20
KUUR
TABLET
TABLET
1500
1500
36
0
0
200
200
200
300
1300
TABLET
BUAH
10
10
TABLET
321 0
322 0
323
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
200
300
200
200
300
300
0
0
0
0
0
0
0
0
0
0
0
0
0
120
120
120
120
120
120
0
0
0
0
0
200
70
130
200
0
0
3000
50
50
3000
3000
50
50
50
50
0
0
0
0
100
100
100
0
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
100
100
0
0
0
0
0
0
1500
1500
1500
0
0
0
0
0
800
800
800
0
500
500
0
0
0
0
0
1000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
60
60
60
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
120
120
120
0
100
90
90
0
0
0
100
100
100
0
0
150
100
0
100
100
0
500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
1000
96
96
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
450
450
0
0
48
48
48
48
48
0
0
0
0
0
0
0
0
0
100
100
100
100
100
100
100
100
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200
200
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
500
500
0
0
0
0
0
0
10
20
10
10
0
0
0
0
0
0
0
0
0
0
0
0
100
20
100
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
50
50
0
0
0
700
700
700
0
0
30
30
30
0
0
0
0
12
10
10
0
0
0
100
100
100
0
0
100
100
100
0
0
50
2500
50
50
0
0
0
0
0
0
0
0
300
300
300
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
400
400
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
300
300
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Januari 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Februari 2016
: Maret 2016
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
200
200
200
Acyclovir tab 400mg
TABLET
300
300
300
BOTOL
SET
SET
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
11
BOTOL
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
16
TABLET
120
120
17
TABLET
120
120
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
20
TABLET
21
BOTOL
22
Kaplet
60
60
60
60
40
23
VIAL
200
200
24
AMPUL
25
TABLET
1000
1000
1000
26
TABLET
3000
3000
27
Botol
50
50
28
TUBE
50
50
50
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
3000
50
160
0
0
Kapsul
TABLET
VIAL
100
100
TABLET
100
100
100
35
Asam Askorbat 50 mg
TABLET
36
TABLET
20
80
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
100
100
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
Ampul
20
20
48
TABLET
200
1500
1700
49
Sachet
50
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
200
800
1000
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
20
20
100
0
0
Supp
12
12
TABLET
90
90
12
Botol
TABLET
30
60
20
700
200
1000
800
20
11
67
Tube
11
11
68
TABLET
50
50
50
69
TABLET
70
AMPUL
10
10
10
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
200
200
200
74
KAPSUL
100
100
100
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
60
60
60
78
BOTOL
20
20
20
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
120
120
120
96
TABLET
97
Fluoksetin 10 mg
TABLET
90
90
90
98
Buah
99
Buah
BOTOL
TABLET
100
100
100
SASE
AMPUL
30
30
TUBE
BOTOL
100
100
100
BOTOL
TABLET
TABLET
Botol
25
110
Gliserin lar. 50%
BOTOL
111
BOTOL
20
20
20
112
VIAL
10
10
10
113
BOTOL
20
20
20
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
48
TUBE
96
96
TABLET
48
0
TABLET
TABLET
BOTOL
SET
50
50
50
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
200
200
200
KOTAK
ROL
ROL
ROL
TABLET
450
450
Tube 15 g
KAPSUL
TUBE
48
48
48
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
Blister
100
100
BOTOL
100
100
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

100
350
0
100
100
100
0
0
0
POT
AMPUL
Syringe
AMPUL
175 Lisol
BOTOL 1L
TABLET
200
200
400
Tube
VIAL
200
200
VIAL
Buah
50
50
50
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
500
500
TABLET
TABLET
100
100
100
200
300
AMPUL
TABLET
100
100
100
189 Metisoprinol
TABLET
TABLET
BOTOL
10
10
10
AMPUL
10
10

BOTOL
BOTOL
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
15
15
15
Botol
Caplet
BOTOL
TABLET
100
100
100
TABLET
VIAL
60
60
60
TABLET
1500
1500
tube
BOTOL
210 Nipedifin 10 mg
TABLET
211
500
1000
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
TABLET
TABLET
TABLET
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
1
1
3
2
0
TUBE
TUBE
AMPUL
AMPUL
20
20
20
KAPSUL
TABLET
60
60
60
40
Ampul
10
50
60
AMPUL
20
0
BOTOL
BOTOL
200
TABLET
700
700
TABLET
Rol
TUBE
30
30
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

ROL
10
10
BOTOL
BOTOL
BOTOL
250 PP test
20
500
10
10
2
0
0
0
0
100
500
Buah
100
100
TABLET
1000
1000
VIAL
TABLET
100
100
100
TABLET
100
100
100
TABLET
500
500
500
Ampul
50
50
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
KAPSUL
KAPSUL
TABLET
100
100
BOTOL
300
300
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
100
100
Botol plastik
20
20
20
251 Prednison 5 mg
256 Ranitidin Injek

20
70
300
100
0
500
30
30
0
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
10
10
10
VIAL
AMPUL
SACHET
BOTOL
TABLET
400
400
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
300
300
BOTOL
50
50
AMPUL
50
50
50
TABLET
TABLET
2000
2000
TABLET
TABLET
311
KAPSUL
300
300
300
Buah
TUBE
314 Urine Bag
BUAH
20
20
20
KUUR
TABLET
TABLET
1300
1300
100
300
30
1000
300
0
20
1000
0
300
1000
TABLET
BUAH
TABLET
321 0
322 0
323
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
100
100
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5000
200
5000
5000
200
200
0
0
0
0
0
0
0
1000
1000
1000
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
500
0
0
0
0
0
1000
0
0
5000
0
0
0
0
25
25
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
24
24
24
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
24
24
0
0
0
0
0
0
0
0
0
100
100
300
2000
100
100
20
300
2000
20
300
2000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
1000
96
96
500
500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
500
500
0
0
0
0
0
0
0
10
10
10
0
0
0
0
0
0
0
0
0
0
2000
0
0
0
0
0
0
0
0
400
400
400
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1000
500
500
0
500
500
500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Februari 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Maret 2016
: April 2016
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN
100
100
Acyclovir tab 200mg
TABLET
200
200
Acyclovir tab 400mg
TABLET
300
300
300
BOTOL
SET
SET
100
100
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
20
80
11
BOTOL
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
16
TABLET
60
60
60
17
TABLET
60
60
60
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
160
160
24
AMPUL
25
TABLET
1000
1000
1000
26
TABLET
5000
5000
5000
27
Botol
200
200
150
50
28
TUBE
50
50
50
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
20
140
Kapsul
TABLET
VIAL
80
80
TABLET
100
100
35
Asam Askorbat 50 mg
TABLET
1000
1000
36
TABLET
30
50
100
700
300
0
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
12
12
TABLET
60
60
12
Botol
TABLET
Ampul
20
20
20
TABLET
1000
1000
300
700
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
800
800
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
20
20
18
67
Tube
25
25
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
10
10
10
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
200
200
200
74
KAPSUL
100
100
100
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
60
60
78
BOTOL
20
20
20
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
30
300
20
30
500
40
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
24
24
94
AMPUL
95
AMPUL
120
120
96
TABLET
97
Fluoksetin 10 mg
TABLET
90
90
90
98
Buah
99
12
12
0
20
100
Buah
BOTOL
TABLET
100
100
100
SASE
AMPUL
25
25
TUBE
BOTOL
100
100
BOTOL
TABLET
TABLET
Botol
0
0

110
Gliserin lar. 50%
BOTOL
10
15
0
50
50
111
BOTOL
20
20
20
112
VIAL
10
10
113
BOTOL
20
20
20
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
TABLET
24
24
0
TABLET
TABLET
BOTOL
SET
50
50
50
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
200
200
200
KOTAK
ROL
ROL
ROL
TABLET
350
350
Tube 15 g
KAPSUL
TUBE
48
48
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
Blister
20
20
20
BOTOL
300
300
150
150
TABLET
2000
2000
500
1500
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

150
200
0
0
24
100
24
POT
AMPUL
Syringe
AMPUL
BOTOL 1L
TABLET
200
200
100
100
Tube
VIAL
175 Lisol
VIAL
Buah
50
50
0
0
50
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
300
300
TABLET
TABLET
100
100
0
100
200
0
100
AMPUL
TABLET
100
100
100
189 Metisoprinol
TABLET
TABLET
BOTOL
10
10
AMPUL

BOTOL
BOTOL
10
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
15
15
10
Botol
96
96
20
76
Caplet
500
500
500
BOTOL
TABLET
100
100
TABLET
VIAL
60
60
60
TABLET
1000
1000
tube
BOTOL
210 Nipedifin 10 mg
TABLET
211
0
100
300
700
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
TABLET
TABLET
TABLET
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
20
20
KAPSUL
TABLET
60
60
Ampul
20
20
20
AMPUL
BOTOL
BOTOL
TABLET
500
500
1000
TABLET
Rol
TUBE
10
10
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

0
10
10
0
20
600
10
400
ROL
10
10
BOTOL
BOTOL
BOTOL
250 PP test
40
Buah
TABLET
500
500
VIAL
TABLET
100
100
TABLET
100
100
100
TABLET
500
500
500
Ampul
30
30
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
KAPSUL
KAPSUL
TABLET
30
30
30
BOTOL
400
400
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
20
20
20
251 Prednison 5 mg
256 Ranitidin Injek

0
300
200
0
100
30
340
60
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
10
10
10
VIAL
AMPUL
SACHET
BOTOL
TABLET
300
300
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
20
20
AMPUL
50
50
50
TABLET
TABLET
1000
1000
TABLET
200
10
1000
100
10
0
0
TABLET
311
KAPSUL
300
300
Buah
TUBE
314 Urine Bag
BUAH
20
20
KUUR
TABLET
TABLET
1000
1000
600
400
500
0
30
270
15
TABLET
500
500
BUAH
TABLET
500
500
321 0
322 0
323
8
500
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
100
100
100
0
0
0
0
210
210
210
210
210
210
0
5000
5000
5000
0
0
0
0
0
0
5000
5000
5000
0
50
50
50
0
24
20
20
0
0
0
0
500
500
500
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
60
60
60
0
0
0
500
0
0
0
0
0
0
0
0
500
500
0
0
0
100
100
100
0
0
5000
0
0
10
0
0
0
0
0
0
200
200
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
144
0
0
0
0
0
0
0
0
0
40
40
40
0
0
0
0
0
0
10
10
10
0
0
0
500
0
0
0
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
24
24
0
0
0
0
0
0
0
0
100
100
100
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
100
0
100
100
0
0
0
0
0
0
20
20
20
0
0
0
0
0
0
0
0
500
500
500
0
0
0
0
0
0
0
0
0
0
0
0
200
200
200
200
192
192
0
100
0
0
0
0
0
0
0
0
24
0
0
0
0
0
0
0
56
56
56
0
0
0
0
0
0
0
1000
0
0
0
0
0
0
0
0
0
0
0
0
0
2000
2000
2000
0
100
100
100
100
100
100
0
0
0
0
340
340
340
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200
200
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1500
10
0
10
10
0
0
0
0
0
0
0
0
0
0
0
0
500
500
500
0
1000
1000
1000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Maret 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: April 2016
: Mei 2016
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
300
300
BOTOL
SET
SET
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
300
80
100
11
BOTOL
100
100
12
Ambroxol tab 30 mg
TABLET
0
0
13
AMPUL
14
TABLET
15
TABLET
16
TABLET
210
210
150
60
17
TABLET
210
210
150
60
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
5000
5000
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
140
140
24
AMPUL
25
TABLET
1000
1000
500
500
26
TABLET
5000
5000
4500
500
27
Botol
50
50
50
28
TUBE
50
50
50
29
POT
30
SUP
20
20
31
Antihemoroid Kapsul
32
33
34
0
5000
40
100
0
0
20
Kapsul
TABLET
VIAL
50
50
20
30
TABLET
100
100
100
35
Asam Askorbat 50 mg
TABLET
300
500
800
800
36
TABLET
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
12
12
TABLET
30
60
90
12
Botol
TABLET
Ampul
TABLET
700
700
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
500
500
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
100
100
100
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
18
18
18
67
Tube
20
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
10
10
10
71
Digoxin 0,25 mg
TABLET
200
200
72
Domperidon Syrup
Botol
73
TABLET
200
200
74
KAPSUL
100
100
100
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
20
20
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
90
0
700
500
15
100
100
0
200
10
10
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
12
12
94
AMPUL
95
AMPUL
100
100
96
TABLET
97
Fluoksetin 10 mg
TABLET
90
90
98
Buah
99
12
0
0
70
30
0
30
60
Buah
BOTOL
TABLET
100
100
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol
100
110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
40
40
40
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
10
10
BOTOL
TABLET
120 Hand Sanitizer
0
10
24
TUBE
24
24
TABLET
0
0
TABLET
TABLET
BOTOL
SET
50
50
SET
TABLET
TABLET
Buah
0
50
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
200
200
KOTAK
ROL
ROL
ROL
TABLET
200
200
Tube 15 g
KAPSUL
TUBE
24
24
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
157 Komposit Resin

0
60
200
140
0
0
0
24
100
Blister
BOTOL
150
150
150
TABLET
1500
1500
1500
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
170 Laxadin Syrup

POT
AMPUL
Syringe
AMPUL
BOTOL 1L
TABLET
100
100
100
Tube
VIAL
VIAL
Buah
175 Lisol
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
200
200
TABLET
TABLET
100
100
100
0
100
100
AMPUL
TABLET
100
100
100
189 Metisoprinol
TABLET
TABLET
BOTOL
AMPUL
20
20

BOTOL
BOTOL
20
0
9
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
10
10
10
Botol
76
76
50
26
Caplet
500
500
500
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
700
700
tube
BOTOL
210 Nipedifin 10 mg
TABLET
211
700
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
200
200
200
BOTOL
192
192
192
TABLET
TABLET
TABLET
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
10
10
KAPSUL
TABLET
40
40
20
20
Ampul
20
20
20
AMPUL
BOTOL
56
56
56
BOTOL
TABLET
400
400
TABLET
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

0
2
8
0
400
ROL
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
200
200
VIAL
TABLET
TABLET
100
100
100
TABLET
500
500
500
Ampul
TABLET
2000
2000
TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
30
30
30
BOTOL
60
340
400
360
40
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
20
20
251 Prednison 5 mg
256 Ranitidin Injek

0
200
2000
10
10
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
200
200
BOTOL
200
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
10
10
10
VIAL
AMPUL
SACHET
BOTOL
TABLET
100
100
100
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
10
10
20
AMPUL
50
50
50
TABLET
TABLET
TABLET
20
TABLET
311
KAPSUL
270
270
Buah
TUBE
314 Urine Bag
BUAH
15
15
15
KUUR
TABLET
TABLET
400
400
400
500
0
70
200
TABLET
500
500
BUAH
TABLET
1000
1000
321 0
322 0
323
8
800
200
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
200
200
200
0
0
100
80
80
0
0
0
0
0
100
100
100
0
0
0
100
100
100
150
150
150
150
150
150
0
5000
5000
5000
0
0
0
0
0
0
4500
4500
50
50
50
4500
50
50
50
0
20
20
20
0
0
0
0
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
180
180
180
100
0
0
0
2000
2000
2000
0
0
0
0
0
1000
1000
1000
0
500
500
0
0
0
0
1000
0
0
4000
0
0
15
15
15
0
15
15
15
0
0
0
0
30
600
30
30
600
600
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15
15
15
0
0
48
500
48
48
0
0
0
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1000
0
0
0
0
0
0
0
0
0
200
200
200
0
0
48
48
48
0
0
0
0
0
0
0
0
100
100
100
100
100
100
250
250
250
2500
2500
2500
0
0
0
0
0
0
0
0
0
0
200
200
200
0
0
0
500
500
500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
0
0
50
50
50
0
0
0
20
20
20
0
0
0
0
0
0
0
0
25
25
25
25
24
24
500
500
500
0
0
1000
1000
0
0
0
0
0
0
0
0
0
0
200
192
0
192
192
0
50
0
0
1000
500
600
600
0
0
0
0
0
24
0
0
0
0
0
0
0
0
0
1000
1000
1000
0
0
50
50
50
0
0
0
0
6
0
0
0
0
1000
1000
1000
0
0
0
0
100
100
100
2500
2500
2500
0
0
0
0
0
0
0
360
360
360
0
0
0
0
0
0
30
30
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200
200
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
18000
1000
18000
500
18000
500
0
0
0
0
0
0
0
1000
20
0
20
20
0
0
0
0
0
0
0
0
0
0
0
0
1000
500
500
0
500
500
500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: April 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Mei 2016
: Juni 2016
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
200
200
200
BOTOL
SET
SET
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
80
100
11
BOTOL
100
100
12
Ambroxol tab 30 mg
TABLET
0
0
13
AMPUL
14
TABLET
15
TABLET
100
100
16
TABLET
60
150
210
210
17
TABLET
60
150
210
210
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
5000
5000
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
100
100
24
AMPUL
25
TABLET
500
500
500
26
TABLET
500
4500
5000
4000
27
Botol
50
50
50
28
TUBE
50
50
25
25
29
POT
30
SUP
20
20
20
31
Antihemoroid Kapsul
32
33
34
100
0
5000
40
60
1000
Kapsul
TABLET
VIAL
30
30
TABLET
35
Asam Askorbat 50 mg
TABLET
36
TABLET
10
20
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
12
12
TABLET
180
180
12
Botol
TABLET
Ampul
TABLET
2000
2000
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
1000
1000
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
100
100
100
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
15
15
66
AMPUL
18
18
67
Tube
15
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
10
10
10
71
Digoxin 0,25 mg
TABLET
100
100
100
72
Domperidon Syrup
Botol
30
30
30
73
TABLET
600
600
200
400
74
KAPSUL
100
100
100
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
10
10
10
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
120
60
0
1200
700
15
800
300
0
18
10
10
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
30
30
96
TABLET
97
Fluoksetin 10 mg
TABLET
60
60
98
Buah
99
30
0
0
30
30
Buah
BOTOL
TABLET
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol

110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
40
40
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
15
15
BOTOL
TABLET
120 Hand Sanitizer
40
0
12
48
TUBE
48
48
TABLET
0
0
TABLET
TABLET
BOTOL
SET
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
140
140
KOTAK
ROL
ROL
ROL
TABLET
200
200
Tube 15 g
KAPSUL
TUBE
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
Blister
100
100
BOTOL
250
250
200
50
TABLET
2500
2500
2200
300
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

0
40
100
100
100
100
0
100
POT
AMPUL
200
200
Syringe
AMPUL
BOTOL 1L
TABLET
500
500
Tube
VIAL
VIAL
Buah
175 Lisol
0
200
0
400
100
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
100
100
100
TABLET
TABLET
100
100
100
AMPUL
50
50
TABLET
100
100
189 Metisoprinol
TABLET
TABLET
BOTOL
20
20
AMPUL

BOTOL
BOTOL
50
100
10
10
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
25
25
25
Botol
26
24
50
50
Caplet
500
500
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
1000
1000
tube
BOTOL
210 Nipedifin 10 mg
TABLET
211
300
1000
200
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
192
192
TABLET
TABLET
TABLET
600
600
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
32
600
160
TUBE
TUBE
AMPUL
AMPUL
KAPSUL
TABLET
20
20
Ampul
AMPUL
BOTOL
56
56
BOTOL
TABLET
1000
1000
TABLET
Rol
TUBE
50
50
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

0
5
3
0
20
56
0
0
1000
50
ROL
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
1000
1000
VIAL
TABLET
TABLET
100
100
100
TABLET
500
500
500
Ampul
100
100
100
TABLET
2500
2500
1600
900
251 Prednison 5 mg
256 Ranitidin Injek

0
1000
TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
BOTOL
40
360
400
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
10
10
10
360
40
Botol
271 Salep 2-4 Komb.
POT
KOTAK
30
30
Pasang
Pasang
Pasang
30

Pasang
Buah
Buah
200
200
BOTOL
200
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
10
10
VIAL
AMPUL
SACHET
BOTOL
TABLET
100
100
100
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
18000
18000
18000
TABLET
500
500
500
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
20
20
20
AMPUL
50
50
50
TABLET
TABLET
TABLET
10
TABLET
311
KAPSUL
200
200
Buah
TUBE
314 Urine Bag
BUAH
15
15
KUUR
TABLET
TABLET
0
100
10
TABLET
500
500
BUAH
TABLET
200
500
700
321 0
322 0
323
400
100
100
8
100
600
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
100
80
80
0
0
0
0
0
100
96
96
400
0
0
0
0
210
210
210
210
210
210
0
5000
5000
5000
0
0
0
60
60
60
0
0
4000
100
4000
100
4000
100
0
0
0
0
100
0
0
400
400
400
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
60
60
60
0
0
0
1000
1000
1000
0
0
0
0
0
1000
700
700
0
0
0
0
0
0
0
0
0
0
0
0
10
10
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
48
1000
48
48
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
3
0
0
0
0
0
24
24
24
0
0
0
0
0
0
0
0
100
100
100
250
250
250
3000
3000
3000
0
0
0
0
0
0
0
0
0
0
300
300
300
0
0
0
400
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200
0
0
0
0
0
0
0
0
25
25
25
0
0
0
0
0
0
0
0
300
300
300
0
0
1000
1000
0
200
200
200
0
0
16
16
16
0
0
0
10
10
10
0
100
0
0
1000
100
0
0
1000
1000
800
800
0
0
0
0
0
24
0
0
0
600
120
120
120
0
20
0
0
0
1000
1000
1000
0
0
0
0
0
0
0
12
12
12
0
0
0
0
1000
1000
1000
0
0
0
0
200
200
200
1500
1500
1500
0
0
0
0
0
0
0
400
400
400
0
200
0
0
0
0
0
50
50
50
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
500
500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
24
0
0
0
0
0
0
0
0
0
0
1500
0
0
0
0
0
0
0
0
0
0
5
0
0
0
400
400
400
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Mei 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Lampiran Berita Acara Stok Opname Obat Sem

Puskesmas................... Kabupaten Cia
NO
Nama Obat
Satuan
PERSEDIAAN AWAL
PENERIMAAN
1-Jan-16
1 Jan-30 Juni 2016
Harga
Barang
Acyclovir tab 200mg
TABLET
Acyclovir tab 400mg
5
6
7
8
9
10
11
Rupiah
Barang
237.00
TABLET
345.00
400
BOTOL
220,000.00
SET
748.00
Buah
1,188.00
260
SET
748.00
SET
847.00
Albendazol tab
TABLET
338.00
Alkohol Swab
KOTAK
10,000.00
TABLET
86.00
BOTOL
3,251.00
296
12
Ambroxol tab 30 mg
TABLET
125.00
13
AMPUL
3,822.00
14
TABLET
90.00
15
TABLET
112.00
100
16
TABLET
330.00
120
39,600
690
17
TABLET
187.00
90
16,830
690
18
Amoksisilin 250 mg
KAPSUL
211.00
19
Amoksisilin 500 mg
TABLET
272.00
15000
20
TABLET
5,051.00
21
BOTOL
2,445.00
30
22
Kaplet
381.00
23
VIAL
5,100.00
20
24
AMPUL
1,200.00
25

TABLET
124.22
1000
26
75.00
25000
27
Botol
2,100.00
100
210,000
400
28
TUBE
2,516.00
50
125,800
150
29
POT
1,904.00
30
SUP
3,045.00
40
31
Antihemoroid Kapsul
Kapsul
1,474.77
32
Antimigren tablet: Ergotamin Tartrat 1 mg + Kofein 50
TABLET
135.00
33
1,400.00
40
56,000
34
TABLET
116.00
100
11,600
35
Asam Askorbat 50 mg
TABLET
95.00
1500
36
TABLET
200.64
37
Ampul
3,334.00
38
AMPUL
1,350.00
39
Bekarbon
TABLET
36.52
40
13,400.00
TABLET
VIAL
VIAL
138,000
73,350
102,000
200
500
0
0
280
100
400
41
TUBE
1,520.00
50
42
Supp
6,045.00
43
Supp
4,990.00
44
Bisaprolol tab 5mg
TABLET
645.00
45
Bromhexin Syrup
Botol
46
47
7,800.00
20
156,000
48
TABLET
80.00
500
40,000
6000
49
Sachet
5,583.33
50
Sachet
5,583.33
51
Catgut plain No.2/0
Sachet
5,583.33
52
Catgut Plain No.3/0
Sachet
5,583.33
53
KAPSUL
510.00
54
TABLET
181.00
500
55
TABLET
108.00
56
KAPSUL
361.00
57
KAPSUL
553.00
58
TABLET
900.00
59
Clozapin 25 mg
TABLET
1,550.00
60
Codein 20 mg
TABLET
1,100.00
100
61
TABLET
255.00
62
AMPUL
1,580.00
63
TABLET
68.00
1000
64
BOTOL
390,000.00
65
Dextran 6%
BOTOL
35,526.00
15
66
AMPUL
3,300.00
20
67
Tube
11,525.00
68
TABLET
50.00
750
69
TABLET
90.00
70
AMPUL
1,054.00
10
71
Digoxin 0,25 mg
TABLET
97.00
200
72
Domperidon Syrup
3,333.00
30
73
TABLET
167.00
300
50,100
900
74
KAPSUL
220.00
200
44,000
75
Efedrin HCL 25 mg
TABLET
42.60
76
TABLET
38.00
77
AMPUL
8,100.00
60
78
BOTOL
7,700.00
15
79
Erythromicin 250 mg
KAPSUL
497.00
80
Erythromicin 500 mg
KAPSUL
930.00
81
BOTOL
2,550.00
82
Etambutol 500 mg
TABLET
545.00
300
83
Etanol 70 % 100 ml
BOTOL
2,500.00
84
Etanol 70 % 1000 ml
BOTOL
21,500.00
85
BOTOL
114,400.00
86
Eugenol Cairan
BOTOL
16,667.00
87
tuBE
9,500.00
88
97.00
TABLET
Ampul
Botol
TABLET
76,000
100
450
6,050.00
50.07
12
90,500
68,000
66,000
37,500
10,540
115,500
163,500
33,334
3000
0
65
0
0
0
25
89
AMPUL
1,800.00
30
54,000
90
TABLET
90.00
10
900
91
TABLET
272.00
92
TABLET
465.00
93
BOTOL
2,042.00
24
94
AMPUL
1,548.77
95
AMPUL
8,250.00
180
96
TABLET
634.00
97
Fluoksetin 10 mg
TABLET
419.00
90
98
Buah
8,000.00
99
Buah
8,000.00
100
Forinokresol (TKF) 10 ml
BOTOL
49,500.00
101
Furosemid Tablet 40 mg
TABLET
85.00
100
102
Garam Oralit 200 ml Air

Gentamisin injeksi 40 mg/ ml
275.00
103
AMPUL
3,399.00
30
104
Gentamisin Salep Kulit 0.1%
TUBE
1,800.00
105
Gentian Violet Larutan 1 % 10 ml
BOTOL
1,750.00
100
106
Glass Ionomer Cement ( Fuji GC IX )
BOTOL
442,200.00
107
Glibenklamid 5 mg
TABLET
56.00
108
Gliseril Guayakolat 100 mg
TABLET
27.90
109
Gliseril Guayakolat Syrup
Botol
6,470.00
110
Gliserin lar. 5%
SASE
101,970
BOTOL 100ml
5,333.00
111
BOTOL
5,700.00
20
112
VIAL
14,524.00
10
113
BOTOL
5,200.00
60
114
TABLET
219.00
100
21,900
115
Haloperidol 0,5mg
TABLET
59.00
200
11,800
116
Haloperidol 1,5 mg
TABLET
69.00
117
Haloperidol 5 mg
TABLET
96.00
118
AMPUL
6,250.00
119
AMPUL
83,333.00
120
Hand Sanitizer
Botol
23,650.00
28
121
Hidrogen Peroksida Lar. 3 %
BOTOL 100 ml
4,730.00
122
Hidroklorotiazid ( HCT ) 25 mg
123
Hidrokortison Krim 2,5 %
124
Hyoscine N Butilbromide 10 mg
125
126
127
128
TABLET
48.00
2,798.00
240
TABLET
405.00
Ibuprofen 200 mg
TABLET
110.00
500
Ibuprofen 400 mg
TABLET
149.00
Ibuprofen suspensi 200mg/5ml
BOTOL
4,499.00
Infusion Set Anak
SET
7,920.00
50
129
Infusion Set Dewasa
SET
6,435.00
130
Isoniazid 300 mg
TABLET
139.00
131
Isosorbid dinitrat 5 mg
TABLET
88.00
132
IV Catheter/abocath No. 18
Buah
7,700.00
133
Buah
7,700.00
134
IV Catheter/abocath No.22
Buah
7,700.00
135
Buah
7,700.00
136
Kalium Diklofenak(Flamigra)
TABLET
425.00
TUBE
55,000
396,000
137
Kalsium Hidroksida Pasta
KOTAK
100,100.00
138
Kalsium Laktat 500 mg
TABLET
52.00
139
Kapas Pembalut 250 mg
24,000.00
140
Karbamazepin 200 mg
TABLET
245.00
200
141
Kasa Kompres 16x16 steril
KOTAK
7,900.00
142
Kasa Pembalut 36 mx 80 cm
ROL
130,000.00
143
Kasa Pembalut Hidrofil 4 m x 10 cm
ROL
2,300.00
144
ROL
1,100.00
145
Ketokonazol 200 mg
TABLET
300.00
950
146
Ketokonazol Krim 2 %
Tube 15 g
2,569.00
24
147
Kloramfenikol 250 mg
KAPSUL
249.00
148
Kloramfenikol SM
TUBE
1,600.00
96
149
Kloramfenikol TM 0.5 % 5 ml
BOTOL
4,400.00
150
Kloramfenikol TT 3 % 5 ml
BOTOL
1,599.00
151
Klorfeniramin Maleat (CTM) 4 mg
TABLET
51.00
152
Klorfenol kamfer Mentol(CHKM) Cairan
BOTOL
55,000.00
153
Klorin Cair Lar. 5%
BOTOL
28,380.00
154
Klorpromazine tab 100mg
TABLET
133.00
155
TABLET
68.00
156
Komb : Pirimetamin+sulfadoxin
TABLET
478.00
157
Komposit Resin
370,700.00
158
Kontrasepsi injek depo/ KB 3 bln
vial
6,124.98
560
159
Kontrasepsi Oral (Pil KB)
Blister
2,089.00
320
160
Kotrimoksazole Suspensi
BOTOL
2,145.00
50
161
Kotrimoksazole Tablet Dewasa
TABLET
149.00
7500
162
Larutan Benedict 100 ml
BOTOL
29,040.00
163
Larutan Eosin 2 % 100 ml
BOTOL
260,150.00
164
Larutan Etanol asam 100 ml
BOTOL
68,640.00
165
Larutan Giemsa stain 100 ml
BOTOL
523,380.00
166
Larutan Iodine Test
BOTOL
6,930.00
167
Larutan Karbol Fuksin 100 ml
BOTOL
67,540.00
168
Larutan Metilen Biru
BOTOL
68,640.00
169
Larutan Turk
BOTOL
35,310.00
170
Laxadin Syrup
Botol
12,450.00
171
Levertrans Salep
POT
2,000.00
172
Lidokain Injeksi 2%
839.00
500
173
Lidokain Jeli 2%
40,000.00
174
Lidokain Komp Injeksi
AMPUL
2,957.40
175
Lisol
BOTOL 1000ML
41,000.00
176
Loratadin tab 10mg
154.00
1200
177
Lubricating Jeli (Aquagel)
Tube
34,528.00
178
Magnesium Sulfat Injeksi 20 %
VIAL
2,078.00
179
VIAL
2,629.00
180
Masker 3 Fly earloop
Box @ 50
1,100.00
100
181
Masker N95 Single valve
Buah
7,920.00
20
182
Mebendazol tablet 100mg
TABLET
210.00
183
Meloxicam 15mg
TABLET
1,199.00
184
Metformin HCl Tablet 500mg
TABLET
112.50
100
ROL
Botol 10 ml
AMPUL
Syringe 10 g
TABLET
49,000
61,656
107,250
164,000
110,000
11,250
900
500
185
Metil Prednisolon 4 mg
TABLET
205.00
186
Metildopa tab sal 250 mg
TABLET
800.00
100
187
Metilergometrin Maleat Inj. 0,200
AMPUL
1,500.00
188
Metilergometrin Maleat tab 0,125 mg
TABLET
154.00
100
189
Metisoprinol
TABLET
3,135.00
190
Metoklopramide 10 mg
TABLET
110.00
191
Metoklopramide Drop 5mg/ml
BOTOL
12,132.00
45
192
Metoklopramide injeksi 5mg/ml
AMPUL
960.00
20
193
Metoklopramide syrup 5mg/ml
BOTOL
2,600.00
45
194
Metronidazol Larutan infus 5mg/ml
BOTOL
9,950.00
10
99,500
195
metronidazol ovula
Ovula
3,850.00
19,250
196
Metronidazol suppositoria 500mg
Supp
3,220.00
10
32,200
197
Metronidazole 250 mg
TABLET
110.00
198
TABLET
199
Mikonazol krim 2%
200
Mometason Furoat Krim 0.1%
201
Multivitamin Syrup
202
Multivitamin tablet
203
Mummifying Fasta
204
Narium Tiroksin 100 g
205
Natrium Bikarbonat 500 mg
206
Natrium bikarbonat injeksi
VIAL
207
Natrium Diklofenak 50 mg
TABLET
208
Natrium Fusidat Krim
209
210
211
80,000
15,400
0
100
50
0
160.00
TUBE
3,000.00
Tube 10g
17,820.00
45
Botol
6,500.00
120
Caplet
672.46
1800
BOTOL
100,430.00
TABLET
1,550.00
100
TABLET
19.00
6,200.00
60
200.00
3500
tube
6,490.00
Natrium Klorida Infus 0,9 % Steril
BOTOL
4,700.00
200
Nipedifin 10 mg
TABLET
100.00
TABLET
480.00
10
212
OAT FDC 1,3
PAKET
359,900.00
16
213
OAT Kategori 1
PAKET
288,199.00
214
OAT Kategori 2/FDC 2
PAKET
1,199,990.00
215
OAT Kategori 3
PAKET
154,000.00
216
OAT Kategori Anak
PAKET
214,900.00
10
217
OAT Sisipan
PAKET
160,000.00
218
Obat Batuk Hitam ( OBH ) 100 ml
BOTOL
4,180.00
200
219
Obat Batuk Pilek Kombinasi Syrup
BOTOL
7,403.00
384
220
Obat Batuk Pilek Kombinasi Tablet
TABLET
797.50
221
Obat Diare Syrup (Kombinasi Attapulgit 700mg +

Pektin 66 mg per 15 ml)
TABLET
5,000.00
222
Obat Diare Tablet
TABLET
413.00
223
Obat Flu Kombinasi Tablet
TABLET
790.00
1400
224
Ofloxacin tab 400mg
TABLET
650.00
225
Oksigen Kaleng
Botol
38,940.00
226
Oksimetazolin Tetes Hidung 0,025%
Botol
27,550.00
227
Oksitetrasiklin HCL Inj 1m 50 mg
VIAL
3,488.00
228
Oksitetrasiklin HCL SK 1 % 3,5 Gr
TUBE
1,529.00
229
Oksitetrasiklin HCL SM 1 % 3,5 Gr
TUBE
1,600.00
230
Oksitosin Injeksi 10 IU/ ml
AMPUL
1,900.00
231
Omeprazol injeksi 40 mg/ 10 ml
AMPUL
36,000.00
30
232
Omeprazol Kapsul 20 mg
KAPSUL
211.00
120
372,000
4,800
82,650
25,320
233
Ondansetron 4 mg
234
Ondansetron inj 4 mg/ 2 mL
235
236
TABLET
716.00
60
42,960
Ampul
2,400.00
Papaverin 40 mg/ ml injeksi
AMPUL
1,150.00
Parasetamol Drops
BOTOL
5,200.00
56
237
Parasetamol Syrup 120 mg/ ml
BOTOL
1,438.00
238
Parasetamol tablet 100 mg
TABLET
73.26
4200
239
TABLET
240
Pembalut Gips
241
Permetrin Krim 5% (Scabimite)
242
Pirantel Pamoat 125 mg
243
Pirantel Suspensi 125mg/5ml
244
291,200
70
0
56
89.00
3000
Rol
42,000.00
TUBE
12,155.00
80
TABLET
296.00
BOTOL
8,360.00
Piridoksin HCL 10 mg
TABLET
118.00
245
Piroxicam 20 mg
KAPSUL
91.96
246
Plester 6 Yards x 2 Inch
ROL
35,532.00
38
247
Polikresulen 360 mg 10 ml
BOTOL
17,393.00
248
Povidon Iodida 10 % 30 ml
BOTOL
2,163.00
249
BOTOL
14,203.00
250
PP test
Buah
781.00
100
251
Prednison 5 mg
TABLET
150.50
3000
252
Prokain Benzil Penisili 3 Jt IU
7,290.00
253
Propiltiourasil tablet 100mg
TABLET
290.00
100
254
Propranolol HCL 40 mg
TABLET
106.00
100
10,600
255
Pyrazinamide 500 mg
TABLET
206.00
500
103,000
256
Ranitidin Injek
1,140.00
40
45,600
350
257
Ranitidin tablet 150mg
120.00
300
36,000
8500
258
Reserpin 0,25 mg
TABLET
88.00
259
Retinol (Vit. A) 100.000 IU
KAPSUL
260.00
100
260
KAPSUL
459.00
100
261
Rifampisin 300 mg
KAPSUL
501.00
262
Rifampisin 450 mg
KAPSUL
790.00
263
Rifampisin 600 mg
KAPSUL
1,100.00
264
Risperidon Tablet 2 mg
TABLET
1,008.00
100
100,800
265
RL Larutan infus Steril 500ml
BOTOL
5,200.00
200
1,040,000
1800
266
Sacharum Lactis
kaleng
344,740.00
267
Salbutamol 2 mg
TABLET
59.00
300
268
Salbutamol 4 mg
TABLET
97.00
269
Salbutamol Cairan inhalasi 0,1 %
6,600.00
20
270
Salbutamol Inhalasi /Aerosol 100 mcg/dosis (Ventolin

inh)
Dus, botol 200

dosis
63,750.00
271
Salep 2-4 Komb.
POT
2,429.00
272
Salisil Bedak 2 % 50 Gram
KOTAK
1,250.00
80
273
Sarung tangan Gynecology
Pasang
12,980.00
274
Sarung tangan No. 6.5
Pasang
5,000.00
275
Sarung tangan No. 7
Pasang
5,000.00
276
Pasang
5,000.00
277
Sarung Tangan Periksa L
462.00
278
Sarung Tangan Periksa M
462.00
900
279
Sefiksim syrup kering 100mg/5ml
BOTOL
8,800.00
280
Sefixime 100 mg
TABLET
841.48
VIAL
Ampul
TABLET
Botol plastik
Buah
Buah
267,000
120
34,786
17,700
132,000
0
0
200
0
281
Semen Seng Fosfat Serbuk + Cair
282
283
284
Serum ATS Injek. 1.500 IU
285
286
Sianokobalamin Injeksi 500mcg/ ml
AMPUL
287
Silk No 3/0( Benang Bedah Sutera)
288
Silver Amalgam serbuk 65-75 %
289
Simvastatin 10mg
290
Stomach Tube No. 12
Buah
291
Strip Test Asam Urat
Pak 25
292
Strip Test Glukosa
Pak 50
293
Strip Test Kolesterol
294
295
BOTOL
247,170.00
Serum ABU Injek. 5 ml (ABU I )
VIAL 5 ml
468,270.00
Serum ADS 20.000 iu
VIAL 5 ml
945,252.00
AMPUL
125,235.00
10
VIAL
525,000.00
1,078.00
SACHET
6,600.00
36
BOTOL
200,000.00
TABLET
169.00
200
3,718.00
196,900.00
234,190.00
Pak 10
361,900.00
Sulfasetamida Na. TM 15 % 5ml
BOTOL
3,226.00
Tablet Tambah Darah Dewasa
TABLET
42.00
18000
296
Tablet Tambah Darah Dewasa 2 (Hemafort)
TABLET
689.70
500
297
Temporary Stopping Fletcher
SET
59,070.00
298
Test HIV I (Vikia)
Buah
38,170.00
299
Test HIV II (intec)
Buah
39,490.00
300
Test HIV III (Onco)
Buah
47,740.00
301
Test Siphylis
Buah
30,470.00
302
Tetrasiklin HCL 250 mg
KAPSUL
148.00
303
KAPSUL
206.00
304
Thiamfenikol kap 500mg
KAPSUL
550.00
500
305
Thiamfenikol Syrup
BOTOL
5,000.00
80
306
Thiamin HCL (Vit. B1 ) Injek.100 mg
AMPUL
680.00
50
307
Thiamin HCL (Vit. B1) 100 mg
TABLET
81.00
308
TABLET
38.00
2000
309
Tramadol tablet 50mg
TABLET
322.00
310
Trifluoferazin 5 mg
TABLET
405.00
311
KAPSUL
322.00
300
312
Umbilical cord klem
Buah
1,000.00
313
Urea Krim 10 % (Soft U Derm)
TUBE
6,400.00
44,800
314
Urine Bag
BUAH
3,000.00
20
60,000
315
Vaksin Anti Rabies Vero
KUUR
314,000.00
316
Vitamin B. Komplek
TABLET
107.00
317
Vitamin B12 tablet 50mg
TABLET
57.00
1500
318
Vitamin Neurotropik
TABLET
1900
319
Wing Needle No.25,27
BUAH
320
Zink dispersibel tablet
TABLET
321
322
323
237,600
33,800
34,000
0
0
400
933.54
1,400.00
10
473.00
2000
324
325
Jumlah
14,000
6,145,846
Mengetahui,
Kepala Puskesmas .....................................
........................................................................
NIP......................................................
Opname Obat Semester 1 per 30 Juni 2016

....... Kabupaten Cianjur Tahun 2016
PENERIMAAN
PEMAKAIAN
1 Jan-30 Juni 2016
1 Jan-30 Juni 2016
Rupiah
Barang
STOK AKHIR PER 30 JUNI 2016

TOTAL (Gabungan Gudang
PKM dan Jaringan)
Rupiah
Barang
Rupiah
Di Gudang Puskesmas
Barang
Di Jaringan Puskesmas
Harga
Barang
Rupiah
47,400
100
23,700
100
23,700
100
23,700
172,500
700
241,500
200
69,000
69,000
200
80
308,880
180
213,840
80
95,040
95,040
24
962,296
0
272
884,272
24
78,024
78,024
11,200
100
11,200
100
11,200
227,700
780
257,400
30
9,900
30
9,900
129,030
750
140,250
30
5,610
30
5,610
4,080,000
0
13500
30
1,428,000
-
0
230
0
3,672,000
73,350
1,173,000
-
1,500
408,000
1,500
408,000
70
500
70
-
500
62,110
1,875,000
25000
1,875,000
840,000
500
1,050,000
377,400
200
503,200
121,800
120
121,800
62,110
140,000
40
62,110
357,000
124,220
500
357,000
168,000
20
28,000
20
28,000
34,800
34,800
46,400
200
23,200
300
300
142,500
1500
142,500
152,000
-
150
0
228,000
-
90
6
290,250
360
232,200
90
58,050
58,050
480,000
20
156,000
5500
440,000
1,000
80,000
1,000
80,000
543,000
90
110,000
-
3500
10
0
1000
532,890
-
15
633,500
11,000
90
99,000
99,000
532,890
68,000
-
16,500
15
49,500
15
49,500
45
518,625
20
230,500
20
230,500
700
35,000
50
2,500
50
2,500
749,125
10
10,540
19,400
200
19,400
99,990
30
99,990
150,300
1200
200,400
110
24,200
90
90
40
486,000
20
162,000
40
192,500
40
308,000
19,800
324,000
19,800
324,000
300
300
16,667
50,001
163,500
163,500
30
54,000
30
54,000
10
900
10
900
30
49,008
1,485,000
37,710
24
0
180
0
60
49,008
1,485,000
25,140
30
12,570
12,570
15
50
8,500
100
15
8,500
50,985
-
15
-
50,985
-
175,000
50
87,500
50
442,200
442,200
87,500
50,985
87,500
114,000
20
114,000
145,240
58,096
312,000
60
312,000
100
21,900
200
662,200
671,520
22
0
0
192
500
50
6
-
87,144
200
520,300
537,216
-
6
48
11,800
141,900
87,144
48
134,304
11,800
141,900
134,304
55,000
396,000
100
100
390,000
285,000
24,500
100
-
24,500
-
390,000
24,500
3
390,000
950
285,000
24
61,656
153,600
96
153,600
55,000
55,000
741,400
741,400
3,429,989
460
2,817,491
100
612,498
100
612,498
668,480
220
459,580
100
208,900
100
208,900
1,930,500
800
1,716,000
150
321,750
150
321,750
1,117,500
5500
819,500
2,000
298,000
2,000
298,000
300
419,500
200
167,800
164,000
184,800
1200
138,112
300
251,700
251,700
184,800
138,112
100
110,000
20
158,400
158,400
-
56,250
600
67,500
80,000
75,000
0
100
0
100
80,000
-
100
80,000
100
80,000
50
75,000
75,000
50
15,400
545,940
45
545,940
19,200
20
19,200
117,000
45
117,000
9,950
89,550
89,550
19,250
19,250
10
32,200
10
32,200
801,900
20
356,400
25
445,500
25
445,500
780,000
70
455,000
50
325,000
50
325,000
1,210,428
1800
1,210,428
155,000
700,000
940,000
0
100
0
0
3200
0
160
155,000
640,000
752,000
60
372,000
60
372,000
300
60,000
300
60,000
40
40
188,000
188,000
10
4,800
16
5,758,400
5,758,400
100
2,149,000
-
10
0
2,149,000
-
836,000
200
836,000
2,842,752
284
2,102,452
100
740,300
740,300
700
1,106,000
194,700
0
700
0
553,000
-
700
-
553,000
-
77,880
82,650
116,820
1,080,000
553,000
116,820
30
1,080,000
120
25,320
85,920
120
85,920
60
168,000
70
168,000
291,200
307,692
0
112
0
582,400
-
42,960
60
600
3600
263,736
600
3000
267,000
972,400
80
972,400
43,956
42,960
43,956
1,350,216
28
994,896
10
10
34,786
100
78,100
100
78,100
451,500
2900
436,450
100
29,000
100
29,000
100
10,600
399,000
240
273,600
1,020,000
8800
1,056,000
355,320
15,050
355,320
15,050
500
103,000
500
103,000
150
171,000
150
171,000
26,000
100
26,000
100
26,000
45,900
100
45,900
100
45,900
100
100,800
1800
9,360,000
200
9,360,000
1,040,000
1,040,000
300
17,700
200
19,400
10
66,000
10
10
19,400
100,000
80
200
100,000
66,000
66,000
415,800
300
600
0
277,200
-
300
-
138,600
-
138,600
-
1,252,350
0
10
1,252,350
36
67,600
600
237,600
101,400
756,000
18000
756,000
344,850
500
344,850
59,070
59,070
275,000
500
275,000
400,000
80
400,000
50
34,000
100
76,000
96,600
2000
0
0
200
76,000
64,400
32,200
-
32,200
32,000
12,800
12,800
15
45,000
10
30,000
30,000
15,000
100
10
85,500
1500
85,500
1,773,726
1900
1,773,726
2,800
11,200
11,200
1800
851,400
200
94,600
200
94,600
946,000
0
-
69,346,501
65,269,456
10,222,891
Cianjur, 30 Juni 2016
10,222,891
Pengelola Obat Puskesmas ...........................
........................................................................
NIP......................................................
LAPORAN PEMAKAIAN DAN LEMBAR PERMINT

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Juni 2016
: Juli 2016
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
200
200
200
BOTOL
SET
SET
80
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
11
BOTOL
96
96
12
Ambroxol tab 30 mg
TABLET
72
24
0
13
AMPUL
14
TABLET
15
TABLET
100
100
16
TABLET
210
210
180
30
17
TABLET
210
210
180
30
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
5000
5000
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
60
60
120
24
AMPUL
25
TABLET
500
500
500
26
TABLET
1000
4000
5000
5000
27
Botol
100
100
100
28
TUBE
25
25
25
29
POT
30
SUP
20
20
31
Antihemoroid Kapsul
32
33
34
100
0
3500
50
1500
70
0
20
Kapsul
TABLET
VIAL
20
20
20
TABLET
400
400
35
Asam Askorbat 50 mg
TABLET
36
TABLET
100
300
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
Ampul
48
TABLET
800
1000
1800
49
Sachet
50
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
300
700
1000
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
100
100
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
18
18
67
Tube
10
10
20
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
10
10
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
400
400
400
74
KAPSUL
100
100
10
90
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
10
10
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
Supp
12
12
TABLET
60
60
120
30
90
Botol
TABLET
0
0
800
1000
1000
0
10
10
10
90
15
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
96
TABLET
97
Fluoksetin 10 mg
TABLET
30
30
30
98
Buah
99
Buah
BOTOL
TABLET
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol

110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
48
TABLET
TABLET
TABLET
BOTOL
SET
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
100
100
100
KOTAK
ROL
ROL
ROL
TABLET
100
100
Tube 15 g
KAPSUL
TUBE
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
100
Blister
100
100
BOTOL
50
250
300
150
150
TABLET
300
3000
3300
1300
2000
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

100
100
POT
AMPUL
300
300
300
Syringe
AMPUL
BOTOL 1L
TABLET
100
100
Tube
VIAL
VIAL
Buah
175 Lisol
0
100
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
100
100
TABLET
TABLET
100
100
100
AMPUL
50
50
50
TABLET
189 Metisoprinol
TABLET
TABLET
BOTOL
10
10
AMPUL
25
25

BOTOL
BOTOL
0
100
10
0
0
25
0
9
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
25
25
25
Botol
50
50
50
Caplet
200
300
500
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
1000
1000
tube
BOTOL
200
200
210 Nipedifin 10 mg
TABLET
211
500
700
300
0
160
40
0
TABLET
212 OAT FDC 1,3
PAKET
16
16
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
10
10
217 OAT Sisipan
PAKET
BOTOL
BOTOL
160
160
TABLET
TABLET
TABLET
800
800
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
16
0
10
60
100
100
700
0
0
TUBE
TUBE
AMPUL
AMPUL
KAPSUL
TABLET
120
120
Ampul
AMPUL
BOTOL
BOTOL
TABLET
1000
1000
TABLET
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

0
3
0
0
60
400
600
ROL
12
12
BOTOL
BOTOL
BOTOL
250 PP test
60
10
Buah
TABLET
1000
1000
VIAL
TABLET
TABLET
100
100
TABLET
500
500
Ampul
200
200
50
150
TABLET
900
1500
2400
2400
251 Prednison 5 mg
256 Ranitidin Injek

0
900
100
100
0
500
TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
BOTOL
40
400
440
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
10
10
10
240
200
Botol
271 Salep 2-4 Komb.
POT
KOTAK
50
50
Pasang
Pasang
Pasang
50

Pasang
Buah
Buah
500
500
BOTOL
200
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
VIAL
AMPUL
SACHET
BOTOL
TABLET
100
100
Buah
Pak 25
Pak 50
Pak 10
100
300
BOTOL
TABLET
18000
18000
18000
0
0
TABLET
500
500
500
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
20
20
20
AMPUL
50
50
50
TABLET
TABLET
TABLET
TABLET
311
KAPSUL
100
100
100
Buah
TUBE
314 Urine Bag
BUAH
10
15
KUUR
TABLET
TABLET
TABLET
100
400
500
BUAH
TABLET
600
600
321 0
322 0
323
500
10
0
8
400
200
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
72
0
0
0
0
0
180
180
0
0
5000
0
0
0
0
0
0
0
5000
50
100
0
0
30
0
0
0
0
0
2000
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Juni 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
LAPORAN PEMAKAIAN DAN LEMBAR PERMINT

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Juli 2016
: Agustus 2016
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
200
200
200
BOTOL
SET
SET
80
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
11
BOTOL
24
24
24
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
100
100
100
16
TABLET
30
30
30
17
TABLET
30
30
30
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
1500
1500
1500
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
70
70
70
24
AMPUL
25
TABLET
500
500
500
26
TABLET
27
Botol
28
TUBE
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
Kapsul
TABLET
VIAL
20
20
20
TABLET
300
300
300
35
Asam Askorbat 50 mg
TABLET
36
TABLET
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
TABLET
90
90
90
Botol
TABLET
Ampul
TABLET
1000
1000
1000
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
90
90
90
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
15
15
15
67
Tube
20
20
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
74
KAPSUL
90
90
90
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
96
TABLET
97
Fluoksetin 10 mg
TABLET
30
30
30
98
Buah
99
Buah
BOTOL
TABLET
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol

110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
48
TABLET
TABLET
TABLET
BOTOL
SET
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
100
100
100
KOTAK
ROL
ROL
ROL
TABLET
Tube 15 g
KAPSUL
TUBE
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
100
Blister
100
100
100
BOTOL
150
150
150
TABLET
2000
2000
2000
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

POT
AMPUL
300
300
300
Syringe
AMPUL
BOTOL 1L
TABLET
Tube
VIAL
VIAL
Buah
175 Lisol
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
TABLET
TABLET
100
100
100
AMPUL
50
50
50
TABLET
189 Metisoprinol
TABLET
TABLET
BOTOL
AMPUL

BOTOL
BOTOL
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
25
25
25
Botol
50
50
50
Caplet
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
300
300
300
tube
BOTOL
40
40
40
210 Nipedifin 10 mg
TABLET
211
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
100
100
100
TABLET
TABLET
TABLET
700
700
700
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
KAPSUL
TABLET
60
60
60
Ampul
AMPUL
BOTOL
BOTOL
TABLET
600
600
600
TABLET
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

ROL
10
10
10
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
100
100
100
VIAL
TABLET
TABLET
TABLET
500
500
500
Ampul
150
150
150
TABLET
251 Prednison 5 mg
256 Ranitidin Injek

TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
BOTOL
200
200
200
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
10
10
10
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
300
300
300
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
VIAL
AMPUL
SACHET
BOTOL
TABLET
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
AMPUL
TABLET
TABLET
TABLET
TABLET
311
KAPSUL
100
100
100
Buah
TUBE
314 Urine Bag
BUAH
10
10
10
KUUR
TABLET
TABLET
TABLET
BUAH
TABLET
200
200
200
321 0
322 0
323
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Juli 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Agustus 2016
: September 201
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
200
200
200
BOTOL
SET
SET
80
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
11
BOTOL
24
24
24
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
100
100
100
16
TABLET
30
30
30
17
TABLET
30
30
30
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
1500
1500
1500
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
70
70
70
24
AMPUL
25
TABLET
500
500
500
26
TABLET
27
Botol
28
TUBE
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
Kapsul
TABLET
VIAL
20
20
20
TABLET
300
300
300
35
Asam Askorbat 50 mg
TABLET
36
TABLET
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
TABLET
90
90
90
Botol
TABLET
Ampul
TABLET
1000
1000
1000
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
90
90
90
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
15
15
15
67
Tube
20
20
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
74
KAPSUL
90
90
90
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
96
TABLET
97
Fluoksetin 10 mg
TABLET
30
30
30
98
Buah
99
Buah
BOTOL
TABLET
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol

110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
48
TABLET
TABLET
TABLET
BOTOL
SET
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
100
100
100
KOTAK
ROL
ROL
ROL
TABLET
Tube 15 g
KAPSUL
TUBE
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
100
Blister
100
100
100
BOTOL
150
150
150
TABLET
2000
2000
2000
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

POT
AMPUL
300
300
300
Syringe
AMPUL
BOTOL 1L
TABLET
Tube
VIAL
VIAL
Buah
175 Lisol
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
TABLET
TABLET
100
100
100
AMPUL
50
50
50
TABLET
189 Metisoprinol
TABLET
TABLET
BOTOL
AMPUL

BOTOL
BOTOL
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
25
25
25
Botol
50
50
50
Caplet
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
300
300
300
tube
BOTOL
40
40
40
210 Nipedifin 10 mg
TABLET
211
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
100
100
100
TABLET
TABLET
TABLET
700
700
700
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
KAPSUL
TABLET
60
60
60
Ampul
AMPUL
BOTOL
BOTOL
TABLET
600
600
600
TABLET
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

ROL
10
10
10
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
100
100
100
VIAL
TABLET
TABLET
TABLET
500
500
500
Ampul
150
150
150
TABLET
251 Prednison 5 mg
256 Ranitidin Injek

TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
BOTOL
200
200
200
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
10
10
10
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
300
300
300
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
VIAL
AMPUL
SACHET
BOTOL
TABLET
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
AMPUL
TABLET
TABLET
TABLET
TABLET
311
KAPSUL
100
100
100
Buah
TUBE
314 Urine Bag
BUAH
10
10
10
KUUR
TABLET
TABLET
TABLET
BUAH
TABLET
200
200
200
321 0
322 0
323
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Agustus 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: September 201
: Oktober 2016
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
200
200
200
BOTOL
SET
SET
80
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
11
BOTOL
24
24
24
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
100
100
100
16
TABLET
30
30
30
17
TABLET
30
30
30
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
1500
1500
1500
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
70
70
70
24
AMPUL
25
TABLET
500
500
500
26
TABLET
27
Botol
28
TUBE
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
Kapsul
TABLET
VIAL
20
20
20
TABLET
300
300
300
35
Asam Askorbat 50 mg
TABLET
36
TABLET
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
TABLET
90
90
90
Botol
TABLET
Ampul
TABLET
1000
1000
1000
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
90
90
90
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
15
15
15
67
Tube
20
20
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
74
KAPSUL
90
90
90
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
96
TABLET
97
Fluoksetin 10 mg
TABLET
30
30
30
98
Buah
99
Buah
BOTOL
TABLET
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol

110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
48
TABLET
TABLET
TABLET
BOTOL
SET
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
100
100
100
KOTAK
ROL
ROL
ROL
TABLET
Tube 15 g
KAPSUL
TUBE
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
100
Blister
100
100
100
BOTOL
150
150
150
TABLET
2000
2000
2000
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

POT
AMPUL
300
300
300
Syringe
AMPUL
BOTOL 1L
TABLET
Tube
VIAL
VIAL
Buah
175 Lisol
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
TABLET
TABLET
100
100
100
AMPUL
50
50
50
TABLET
189 Metisoprinol
TABLET
TABLET
BOTOL
AMPUL

BOTOL
BOTOL
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
25
25
25
Botol
50
50
50
Caplet
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
300
300
300
tube
BOTOL
40
40
40
210 Nipedifin 10 mg
TABLET
211
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
100
100
100
TABLET
TABLET
TABLET
700
700
700
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
KAPSUL
TABLET
60
60
60
Ampul
AMPUL
BOTOL
BOTOL
TABLET
600
600
600
TABLET
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

ROL
10
10
10
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
100
100
100
VIAL
TABLET
TABLET
TABLET
500
500
500
Ampul
150
150
150
TABLET
251 Prednison 5 mg
256 Ranitidin Injek

TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
BOTOL
200
200
200
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
10
10
10
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
300
300
300
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
VIAL
AMPUL
SACHET
BOTOL
TABLET
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
AMPUL
TABLET
TABLET
TABLET
TABLET
311
KAPSUL
100
100
100
Buah
TUBE
314 Urine Bag
BUAH
10
10
10
KUUR
TABLET
TABLET
TABLET
BUAH
TABLET
200
200
200
321 0
322 0
323
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: September 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Oktober 2016
: Nopember 201
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
200
200
200
BOTOL
SET
SET
80
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
11
BOTOL
24
24
24
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
100
100
100
16
TABLET
30
30
30
17
TABLET
30
30
30
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
1500
1500
1500
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
70
70
70
24
AMPUL
25
TABLET
500
500
500
26
TABLET
27
Botol
28
TUBE
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
Kapsul
TABLET
VIAL
20
20
20
TABLET
300
300
300
35
Asam Askorbat 50 mg
TABLET
36
TABLET
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
TABLET
90
90
90
Botol
TABLET
Ampul
TABLET
1000
1000
1000
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
90
90
90
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
15
15
15
67
Tube
20
20
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
74
KAPSUL
90
90
90
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
96
TABLET
97
Fluoksetin 10 mg
TABLET
30
30
30
98
Buah
99
Buah
BOTOL
TABLET
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol

110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
48
TABLET
TABLET
TABLET
BOTOL
SET
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
100
100
100
KOTAK
ROL
ROL
ROL
TABLET
Tube 15 g
KAPSUL
TUBE
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
100
Blister
100
100
100
BOTOL
150
150
150
TABLET
2000
2000
2000
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

POT
AMPUL
300
300
300
Syringe
AMPUL
BOTOL 1L
TABLET
Tube
VIAL
VIAL
Buah
175 Lisol
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
TABLET
TABLET
100
100
100
AMPUL
50
50
50
TABLET
189 Metisoprinol
TABLET
TABLET
BOTOL
AMPUL

BOTOL
BOTOL
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
25
25
25
Botol
50
50
50
Caplet
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
300
300
300
tube
BOTOL
40
40
40
210 Nipedifin 10 mg
TABLET
211
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
100
100
100
TABLET
TABLET
TABLET
700
700
700
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
KAPSUL
TABLET
60
60
60
Ampul
AMPUL
BOTOL
BOTOL
TABLET
600
600
600
TABLET
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

ROL
10
10
10
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
100
100
100
VIAL
TABLET
TABLET
TABLET
500
500
500
Ampul
150
150
150
TABLET
251 Prednison 5 mg
256 Ranitidin Injek

TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
BOTOL
200
200
200
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
10
10
10
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
300
300
300
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
VIAL
AMPUL
SACHET
BOTOL
TABLET
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
AMPUL
TABLET
TABLET
TABLET
TABLET
311
KAPSUL
100
100
100
Buah
TUBE
314 Urine Bag
BUAH
10
10
10
KUUR
TABLET
TABLET
TABLET
BUAH
TABLET
200
200
200
321 0
322 0
323
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Oktober 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Nopember 201
: Desember 201
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
200
200
200
BOTOL
SET
SET
80
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
11
BOTOL
24
24
24
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
100
100
100
16
TABLET
30
30
30
17
TABLET
30
30
30
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
1500
1500
1500
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
70
70
70
24
AMPUL
25
TABLET
500
500
500
26
TABLET
27
Botol
28
TUBE
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
Kapsul
TABLET
VIAL
20
20
20
TABLET
300
300
300
35
Asam Askorbat 50 mg
TABLET
36
TABLET
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
TABLET
90
90
90
Botol
TABLET
Ampul
TABLET
1000
1000
1000
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
90
90
90
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
15
15
15
67
Tube
20
20
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
74
KAPSUL
90
90
90
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
96
TABLET
97
Fluoksetin 10 mg
TABLET
30
30
30
98
Buah
99
Buah
BOTOL
TABLET
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol

110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
48
TABLET
TABLET
TABLET
BOTOL
SET
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
100
100
100
KOTAK
ROL
ROL
ROL
TABLET
Tube 15 g
KAPSUL
TUBE
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
100
Blister
100
100
100
BOTOL
150
150
150
TABLET
2000
2000
2000
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

POT
AMPUL
300
300
300
Syringe
AMPUL
BOTOL 1L
TABLET
Tube
VIAL
VIAL
Buah
175 Lisol
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
TABLET
TABLET
100
100
100
AMPUL
50
50
50
TABLET
189 Metisoprinol
TABLET
TABLET
BOTOL
AMPUL

BOTOL
BOTOL
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
25
25
25
Botol
50
50
50
Caplet
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
300
300
300
tube
BOTOL
40
40
40
210 Nipedifin 10 mg
TABLET
211
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
100
100
100
TABLET
TABLET
TABLET
700
700
700
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
KAPSUL
TABLET
60
60
60
Ampul
AMPUL
BOTOL
BOTOL
TABLET
600
600
600
TABLET
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

ROL
10
10
10
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
100
100
100
VIAL
TABLET
TABLET
TABLET
500
500
500
Ampul
150
150
150
TABLET
251 Prednison 5 mg
256 Ranitidin Injek

TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
BOTOL
200
200
200
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
10
10
10
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
300
300
300
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
VIAL
AMPUL
SACHET
BOTOL
TABLET
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
AMPUL
TABLET
TABLET
TABLET
TABLET
311
KAPSUL
100
100
100
Buah
TUBE
314 Urine Bag
BUAH
10
10
10
KUUR
TABLET
TABLET
TABLET
BUAH
TABLET
200
200
200
321 0
322 0
323
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Nopember 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN
PELAPORAN BULAN
PERMINTAAN BULAN
:
:
: CIANJUR
: Desember 201
: Januari 2017
Jumlah
Persediaan
NO
NAMA OBAT
SATUAN

7
Acyclovir tab 200mg
TABLET
100
100
100
Acyclovir tab 400mg
TABLET
200
200
200
BOTOL
SET
SET
80
80
80
SET
SET
Albendazol tab
TABLET
Alkohol Swab
KOTAK
10
TABLET
11
BOTOL
24
24
24
12
Ambroxol tab 30 mg
TABLET
13
AMPUL
14
TABLET
15
TABLET
100
100
100
16
TABLET
30
30
30
17
TABLET
30
30
30
18
Amoksisilin 250 mg
KAPSUL
19
Amoksisilin 500 mg
TABLET
1500
1500
1500
20
TABLET
21
BOTOL
22
Kaplet
23
VIAL
70
70
70
24
AMPUL
25
TABLET
500
500
500
26
TABLET
27
Botol
28
TUBE
29
POT
30
SUP
31
Antihemoroid Kapsul
32
33
34
Kapsul
TABLET
VIAL
20
20
20
TABLET
300
300
300
35
Asam Askorbat 50 mg
TABLET
36
TABLET
37
Ampul
38
AMPUL
39
Bekarbon
TABLET
40
VIAL
41
TUBE
42
Supp
43
44
Bisaprolol tab 5mg
45
Bromhexin Syrup
46
47
48
49
50
Supp
TABLET
90
90
90
Botol
TABLET
Ampul
TABLET
1000
1000
1000
Sachet
Sachet
51
Catgut plain No.2/0
Sachet
52
Catgut Plain No.3/0
Sachet
53
KAPSUL
54
TABLET
55
TABLET
56
KAPSUL
57
KAPSUL
58
TABLET
59
Clozapin 25 mg
TABLET
60
Codein 20 mg
TABLET
90
90
90
61
TABLET
62
AMPUL
63
TABLET
64
BOTOL
65
Dextran 6%
BOTOL
66
AMPUL
15
15
15
67
Tube
20
20
20
68
TABLET
50
50
50
69
TABLET
70
AMPUL
71
Digoxin 0,25 mg
TABLET
72
Domperidon Syrup
Botol
73
TABLET
74
KAPSUL
90
90
90
75
Efedrin HCL 25 mg
TABLET
76
TABLET
77
AMPUL
40
40
40
78
BOTOL
79
Erythromicin 250 mg
KAPSUL
80
Erythromicin 500 mg
KAPSUL
81
BOTOL
82
Etambutol 500 mg
TABLET
300
300
300
83
Etanol 70 % 100 ml
BOTOL
84
Etanol 70 % 1000 ml
BOTOL
85
BOTOL
86
Eugenol Cairan
BOTOL
87
tuBE
88
TABLET
89
AMPUL
30
30
30
90
TABLET
10
10
10
91
TABLET
92
TABLET
93
BOTOL
94
AMPUL
95
AMPUL
96
TABLET
97
Fluoksetin 10 mg
TABLET
30
30
30
98
Buah
99
Buah
BOTOL
TABLET
SASE
AMPUL
15
15
15
TUBE
BOTOL
50
50
50
BOTOL
TABLET
TABLET
Botol

110
Gliserin lar. 50%
BOTOL
111
BOTOL
112
VIAL
113
BOTOL
114
TABLET
115
Haloperidol 0,5mg
TABLET
200
200
200
116
Haloperidol 1,5 mg
TABLET
117
Haloperidol 5 mg
TABLET
118
AMPUL
119
AMPUL
Botol
BOTOL
TABLET
120 Hand Sanitizer
TUBE
48
48
48
TABLET
TABLET
TABLET
BOTOL
SET
SET
TABLET
TABLET
Buah
Buah
Buah
Buah
TABLET
KOTAK
TABLET
ROL
TABLET
100
100
100
KOTAK
ROL
ROL
ROL
TABLET
Tube 15 g
KAPSUL
TUBE
BOTOL
BOTOL
TABLET
BOTOL
BOTOL
TABLET
TABLET
TABLET
Botol 10 ml
vial
100
100
100
Blister
100
100
100
BOTOL
150
150
150
TABLET
2000
2000
2000
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
169 Larutan Turk
BOTOL
Botol
157 Komposit Resin

170 Laxadin Syrup

POT
AMPUL
300
300
300
Syringe
AMPUL
BOTOL 1L
TABLET
Tube
VIAL
VIAL
Buah
175 Lisol
Buah
TABLET
183 Meloxicam 15mg
TABLET
TABLET
TABLET
TABLET
100
100
100
AMPUL
50
50
50
TABLET
189 Metisoprinol
TABLET
TABLET
BOTOL
AMPUL

BOTOL
BOTOL
Ovula
Supp
10
10
10
TABLET
TABLET
TUBE
Tube 10g
25
25
25
Botol
50
50
50
Caplet
BOTOL
TABLET
TABLET
VIAL
60
60
60
TABLET
300
300
300
tube
BOTOL
40
40
40
210 Nipedifin 10 mg
TABLET
211
TABLET
212 OAT FDC 1,3
PAKET
213 OAT Kategori 1
PAKET
PAKET
215 OAT Kategori 3
PAKET
PAKET
217 OAT Sisipan
PAKET
BOTOL
BOTOL
100
100
100
TABLET
TABLET
TABLET
700
700
700
TABLET
225 Oksigen Kaleng
Botol
Botol
VIAL
TUBE
TUBE
AMPUL
AMPUL
KAPSUL
TABLET
60
60
60
Ampul
AMPUL
BOTOL
BOTOL
TABLET
600
600
600
TABLET
Rol
TUBE
TABLET
BOTOL
TABLET
245 Piroxicam 20 mg
KAPSUL
240 Pembalut Gips

ROL
10
10
10
BOTOL
BOTOL
BOTOL
250 PP test
Buah
TABLET
100
100
100
VIAL
TABLET
TABLET
TABLET
500
500
500
Ampul
150
150
150
TABLET
251 Prednison 5 mg
256 Ranitidin Injek

TABLET
KAPSUL
100
100
100
KAPSUL
100
100
100
KAPSUL
KAPSUL
KAPSUL
TABLET
BOTOL
200
200
200
266 Sacharum Lactis
kaleng
267 Salbutamol 2 mg
TABLET
268 Salbutamol 4 mg
TABLET
Botol plastik
10
10
10
Botol
271 Salep 2-4 Komb.
POT
KOTAK
Pasang
Pasang
Pasang

Pasang
Buah
Buah
300
300
300
BOTOL
280 Sefixime 100 mg
TABLET
BOTOL
VIAL 5 ml
VIAL 5 ml
AMPUL
VIAL
AMPUL
SACHET
BOTOL
TABLET
Buah
Pak 25
Pak 50
Pak 10
BOTOL
TABLET
TABLET
SET
Buah
Buah
Buah
301 Test Siphylis
Buah
KAPSUL
KAPSUL
KAPSUL
BOTOL
AMPUL
TABLET
TABLET
TABLET
TABLET
311
KAPSUL
100
100
100
Buah
TUBE
314 Urine Bag
BUAH
10
10
10
KUUR
TABLET
TABLET
TABLET
BUAH
TABLET
200
200
200
321 0
322 0
323
324
325
0
0
0
0
Yang menyerahkan,
.
NIP.
.
NIP. .

SMAS
DOKUMEN
PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN
NOMOR
TANGGAL
Laporan Mutasi Ob
Stok
Optimum
Permintaan
10
Bulan
PEMBERIAN
DAU
BPJS
PROGRAM
DAK
Lain-lain
Jumlah
11
12
13
14
15
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Stok Awal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yang meminta,
Kepala Puskesmas

NIP. 19650408 199403 2 002
Yang Menerima,
Petugas Puskesmas

NIP. 19860609 201101 2 001
0
0

: Desember 2016
Penerimaan
Pemakaian
Stok Akhir
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Lampiran Berita Acara Stok Opname Obat Semes

Puskesmas................... Kabupaten Cia
NO
Nama Obat
Satuan
PERSEDIAAN AWAL
PENERIMAAN
1-Jul-16
1 Jul-31 Desember 2016
Harga
Barang
Acyclovir tab 200mg
TABLET
Acyclovir tab 400mg
5
6
7
8
9
10
11
Rupiah
Barang
237.00
100
23,700
TABLET
345.00
200
69,000
BOTOL
220,000.00
SET
748.00
Buah
1,188.00
80
SET
748.00
SET
847.00
Albendazol tab
TABLET
338.00
Alkohol Swab
KOTAK
2,000.00
TABLET
86.00
BOTOL
3,251.00
24
12
Ambroxol tab 30 mg
TABLET
125.00
13
AMPUL
3,822.00
14
TABLET
90.00
15
TABLET
112.00
100
11,200
16
TABLET
330.00
30
9,900
17
TABLET
187.00
30
5,610
18
Amoksisilin 250 mg
KAPSUL
211.00
19
Amoksisilin 500 mg
TABLET
272.00
1500
20
TABLET
5,051.00
21
BOTOL
2,445.00
22
Kaplet
381.00
23
VIAL
5,100.00
70
24
AMPUL
1,200.00
25

TABLET
124.22
500
26
75.00
27
Botol
2,100.00
28
TUBE
2,516.00
29
POT
1,904.00
30
SUP
3,045.00
31
Antihemoroid Kapsul
Kapsul
1,474.77
32
Antimigren tablet: Ergotamin Tartrat 1 mg + Kofein 50
TABLET
135.00
33
1,400.00
20
28,000
34
TABLET
116.00
300
34,800
35
Asam Askorbat 50 mg
TABLET
95.00
36
TABLET
200.64
37
Ampul
3,334.00
38
AMPUL
1,100.00
39
Bekarbon
TABLET
36.52
40
13,400.00
TABLET
VIAL
VIAL
95,040
78,024
408,000
357,000
62,110
0
0
0
0
0
41
TUBE
1,520.00
42
Supp
6,045.00
43
Supp
4,990.00
90
44
Bisaprolol tab 5mg
TABLET
645.00
45
Bromhexin Syrup
Botol
6,050.00
46
50.07
47
7,800.00
1000
48
TABLET
80.00
49
Sachet
5,583.33
50
Sachet
5,583.33
51
Catgut plain No.2/0
Sachet
5,583.33
52
Catgut Plain No.3/0
Sachet
5,583.33
53
KAPSUL
509.00
54
TABLET
181.00
55
TABLET
108.00
56
KAPSUL
361.00
57
KAPSUL
553.00
58
TABLET
900.00
59
Clozapin 25 mg
TABLET
1,550.00
90
60
Codein 20 mg
TABLET
1,100.00
61
TABLET
255.00
62
AMPUL
1,580.00
63
TABLET
68.00
64
BOTOL
390,000.00
65
Dextran 6%
BOTOL
35,526.00
15
66
AMPUL
3,300.00
67
Tube
11,525.00
68
TABLET
50.00
69
TABLET
90.00
70
AMPUL
1,054.00
71
Digoxin 0,25 mg
TABLET
97.00
72
Domperidon Syrup
3,333.00
73
TABLET
167.00
90
74
KAPSUL
220.00
75
Efedrin HCL 25 mg
TABLET
42.60
76
TABLET
38.00
40
77
AMPUL
8,100.00
78
BOTOL
7,700.00
79
Erythromicin 250 mg
KAPSUL
497.00
80
Erythromicin 500 mg
KAPSUL
930.00
81
BOTOL
2,550.00
300
82
Etambutol 500 mg
TABLET
545.00
83
Etanol 70 % 100 ml
BOTOL
2,500.00
84
Etanol 70 % 1000 ml
BOTOL
21,500.00
85
BOTOL
114,400.00
86
Eugenol Cairan
BOTOL
16,667.00
87
tuBE
9,500.00
88
97.00
TABLET
Ampul
Botol
TABLET
36,270
0
0
0
7,800,000
139,500
532,890
20
66,000
50
576,250
15,030
1,520
765,000
89
AMPUL
1,800.00
30
54,000
90
TABLET
90.00
10
900
91
TABLET
272.00
92
TABLET
465.00
93
BOTOL
2,042.00
94
AMPUL
1,548.77
95
AMPUL
8,250.00
96
TABLET
634.00
97
Fluoksetin 10 mg
TABLET
419.00
30
98
Buah
8,000.00
99
Buah
8,000.00
100
Forinokresol (TKF) 10 ml
BOTOL
49,500.00
101
Furosemid Tablet 40 mg
TABLET
85.00
102
Garam Oralit 200 ml Air

Gentamisin injeksi 40 mg/ ml
275.00
103
AMPUL
3,399.00
15
104
Gentamisin Salep Kulit 0.1%
TUBE
1,800.00
105
Gentian Violet Larutan 1 % 10 ml
BOTOL
1,750.00
50
106
Glass Ionomer Cement ( Fuji GC IX )
BOTOL
442,200.00
107
Glibenklamid 5 mg
TABLET
56.00
108
Gliseril Guayakolat 100 mg
TABLET
27.90
109
Gliseril Guayakolat Syrup
Botol
6,470.00
110
Gliserin lar. 5%
SASE
12,570
50,985
87,500
0
0
0
BOTOL 100ml
5,333.00
111
BOTOL
5,700.00
112
VIAL
14,524.00
113
BOTOL
5,200.00
114
TABLET
219.00
115
Haloperidol 0,5mg
TABLET
59.00
200
116
Haloperidol 1,5 mg
TABLET
69.00
117
Haloperidol 5 mg
TABLET
96.00
118
AMPUL
6,250.00
119
AMPUL
83,333.00
120
Hand Sanitizer
Botol
23,650.00
121
Hidrogen Peroksida Lar. 3 %
BOTOL 100 ml
4,730.00
122
Hidroklorotiazid ( HCT ) 25 mg
123
Hidrokortison Krim 2,5 %
124
Hyoscine N Butilbromide 10 mg
125
126
127
128
TABLET
87,144
11,800
141,900
48.00
2,798.00
48
TABLET
405.00
Ibuprofen 200 mg
TABLET
110.00
Ibuprofen 400 mg
TABLET
149.00
Ibuprofen suspensi 200mg/5ml
BOTOL
4,499.00
Infusion Set Anak
SET
7,920.00
129
Infusion Set Dewasa
SET
6,435.00
130
Isoniazid 300 mg
TABLET
139.00
131
Isosorbid dinitrat 5 mg
TABLET
88.00
132
Buah
7,700.00
133
Buah
7,700.00
134
Buah
7,700.00
135
Buah
7,700.00
136
Kalium Diklofenak(Flamigra)
TABLET
425.00
TUBE
134,304
137
Kalsium Hidroksida Pasta
KOTAK
100,100.00
138
Kalsium Laktat 500 mg
TABLET
52.00
139
Kapas Pembalut 250 mg
24,000.00
140
Karbamazepin 200 mg
TABLET
245.00
100
141
Kasa Kompres 16x16 steril
KOTAK
7,900.00
142
Kasa Pembalut 36 mx 80 cm
ROL
130,000.00
143
ROL
2,300.00
144
ROL
1,100.00
145
Ketokonazol 200 mg
TABLET
300.00
146
Ketokonazol Krim 2 %
Tube 15 g
4,700.00
147
Kloramfenikol 250 mg
KAPSUL
249.00
148
Kloramfenikol SM
TUBE
1,600.00
149
Kloramfenikol TM 0.5 % 5 ml
BOTOL
4,400.00
150
Kloramfenikol TT 3 % 5 ml
BOTOL
1,599.00
151
Klorfeniramin Maleat (CTM) 4 mg
TABLET
51.00
152
Klorfenol kamfer Mentol(CHKM) Cairan
BOTOL
55,000.00
153
Klorin Cair Lar. 5%
BOTOL
28,380.00
154
TABLET
133.00
155
TABLET
68.00
156
Komb : Pirimetamin+sulfadoxin
TABLET
478.00
157
Komposit Resin
370,700.00
158
Kontrasepsi injek depo/ KB 3 bln
vial
6,124.98
100
612,498
159
Kontrasepsi Oral (Pil KB)
Blister
2,089.00
100
208,900
160
Kotrimoksazole Suspensi
BOTOL
2,145.00
150
321,750
161
Kotrimoksazole Tablet Dewasa
TABLET
149.00
2000
298,000
162
Larutan Benedict 100 ml
BOTOL
29,040.00
163
Larutan Eosin 2 % 100 ml
BOTOL
260,150.00
164
Larutan Etanol asam 100 ml
BOTOL
68,640.00
165
Larutan Giemsa stain 100 ml
BOTOL
523,380.00
166
Larutan Iodine Test
BOTOL
6,930.00
167
Larutan Karbol Fuksin 100 ml
BOTOL
67,540.00
168
Larutan Metilen Biru
BOTOL
68,640.00
169
Larutan Turk
BOTOL
35,310.00
170
Laxadin Syrup
Botol
12,450.00
171
Levertrans Salep
POT
2,000.00
172
Lidokain Injeksi 2%
839.00
300
173
Lidokain Jeli 2%
40,000.00
174
Lidokain Komp Injeksi
AMPUL
2,957.40
175
Lisol
BOTOL 1000ML
41,000.00
176
Loratadin tab 10mg
154.00
177
Lubricating Jeli (Aquagel)
Tube
34,528.00
178
VIAL
2,078.00
179
VIAL
2,629.00
180
Masker 3 Fly earloop
Box @ 50
1,100.00
181
Masker N95 Single valve
Buah
7,920.00
182
Mebendazol tablet 100mg
TABLET
210.00
183
Meloxicam 15mg
TABLET
1,199.00
184
Metformin HCl Tablet 500mg
TABLET
112.50
ROL
Botol 10 ml
AMPUL
Syringe 10 g
TABLET
24,500
390,000
251,700
0
0
0
185
Metil Prednisolon 4 mg
TABLET
205.00
186
Metildopa tab sal 250 mg
TABLET
800.00
100
80,000
187
Metilergometrin Maleat Inj. 0,200
AMPUL
1,500.00
50
75,000
188
Metilergometrin Maleat tab 0,125 mg
TABLET
154.00
189
Metisoprinol
TABLET
3,135.00
190
Metoklopramide 10 mg
TABLET
110.00
191
Metoklopramide Drop 5mg/ml
BOTOL
12,132.00
192
Metoklopramide injeksi 5mg/ml
AMPUL
960.00
193
Metoklopramide syrup 5mg/ml
BOTOL
2,600.00
194
Metronidazol Larutan infus 5mg/ml
BOTOL
9,950.00
89,550
195
metronidazol ovula
Ovula
3,850.00
19,250
196
Metronidazol suppositoria 500mg
Supp
3,220.00
10
32,200
197
TABLET
110.00
198
TABLET
199
Mikonazol krim 2%
200
Mometason Furoat Krim 0.1%
201
Multivitamin Syrup
202
Multivitamin tablet
203
Mummifying Fasta
204
Narium Tiroksin 100 g
205
Natrium Bikarbonat 500 mg
206
Natrium bikarbonat injeksi
VIAL
207
Natrium Diklofenak 50 mg
TABLET
208
Natrium Fusidat Krim
209
210
211
160.00
TUBE
3,000.00
Tube 10g
17,820.00
25
445,500
Botol
6,500.00
50
325,000
Caplet
672.46
BOTOL
100,430.00
TABLET
1,550.00
TABLET
19.00
6,200.00
60
372,000
200.00
300
60,000
tube
6,490.00
Natrium Klorida Infus 0,9 % Steril
BOTOL
4,700.00
40
Nipedifin 10 mg
TABLET
100.00
TABLET
480.00
212
OAT FDC 1,3
PAKET
359,900.00
213
OAT Kategori 1
PAKET
288,199.00
214
OAT Kategori 2/FDC 2
PAKET
1,199,990.00
215
OAT Kategori 3
PAKET
154,000.00
216
OAT Kategori Anak
PAKET
214,900.00
217
OAT Sisipan
PAKET
160,000.00
218
Obat Batuk Hitam ( OBH ) 100 ml
BOTOL
4,180.00
219
Obat Batuk Pilek Kombinasi Syrup
BOTOL
7,403.00
100
220
Obat Batuk Pilek Kombinasi Tablet
TABLET
797.50
221
Obat Diare Syrup (Kombinasi Attapulgit 700mg +

Pektin 66 mg per 15 ml)
TABLET
5,000.00
222
Obat Diare Tablet
TABLET
413.00
223
Obat Flu Kombinasi Tablet
TABLET
790.00
700
224
Ofloxacin tab 400mg
TABLET
650.00
225
Oksigen Kaleng
Botol
38,940.00
226
Oksimetazolin Tetes Hidung 0,025%
Botol
27,550.00
227
Oksitetrasiklin HCL Inj 1m 50 mg
VIAL
3,488.00
228
Oksitetrasiklin HCL SK 1 % 3,5 Gr
TUBE
1,529.00
229
Oksitetrasiklin HCL SM 1 % 3,5 Gr
TUBE
1,600.00
230
Oksitosin Injeksi 10 IU/ ml
AMPUL
1,820.00
231
Omeprazol injeksi 40 mg/ 10 ml
AMPUL
36,000.00
232
Omeprazol Kapsul 20 mg
KAPSUL
211.00
188,000
740,300
553,000
116,820
0
0
0
0
0
233
Ondansetron 4 mg
234
ondansetron inj 4 mg/ 2 mL
235
236
TABLET
716.00
60
42,960
Ampul
2,400.00
Papaverin 40 mg/ ml injeksi
AMPUL
1,150.00
Parasetamol Drops
BOTOL
5,200.00
237
Parasetamol Syrup 120 mg/ ml
BOTOL
1,438.00
238
TABLET
73.26
600
239
TABLET
240
Pembalut Gips
241
Permetrin Krim 5% (Scabimite)
242
Pirantel Pamoat 125 mg
243
Pirantel Suspensi 125mg/5ml
244
43,956
89.00
Rol
42,000.00
TUBE
11,475.00
TABLET
296.00
BOTOL
8,360.00
Piridoksin HCL 10 mg
TABLET
23.00
245
Piroxicam 20 mg
KAPSUL
91.96
246
Plester 6 Yards x 2 Inch
ROL
17,600.00
10
247
Polikresulen 360 mg 10 ml
BOTOL
17,393.00
248
BOTOL
2,163.00
249
BOTOL
14,203.00
250
PP test
251
Prednison 5 mg
252
Prokain Benzil Penisili 3 Jt IU
253
Propiltiourasil tablet 100mg
254
255
256
Ranitidin Injek
257
Ranitidin tablet 150mg
258
Reserpin 0,25 mg
TABLET
88.00
259
KAPSUL
260.00
100
26,000
260
KAPSUL
459.00
100
45,900
261
Rifampisin 300 mg
KAPSUL
501.00
262
Rifampisin 450 mg
KAPSUL
660.00
263
Rifampisin 600 mg
KAPSUL
913.00
264
Risperidon Tablet 2 mg
TABLET
1,008.00
265
RL Larutan infus Steril 500ml
BOTOL
5,200.00
200
266
Sacharum Lactis
kaleng
344,740.00
267
Salbutamol 2 mg
TABLET
59.00
268
Salbutamol 4 mg
TABLET
97.00
269
Salbutamol Cairan inhalasi 0,1 %
6,600.00
10
270
Salbutamol Inhalasi /Aerosol 100 mcg/dosis (Ventolin

inh)
Dus, botol 200

dosis
63,750.00
271
Salep 2-4 Komb.
POT
2,000.00
272
Salisil Bedak 2 % 50 Gram
KOTAK
1,250.00
273
Sarung tangan Gynecology
Pasang
12,980.00
274
Pasang
5,000.00
275
Sarung tangan No. 7
Pasang
5,000.00
276
Pasang
5,000.00
277
Sarung Tangan Periksa L
462.00
278
Sarung Tangan Periksa M
462.00
300
279
Sefiksim syrup kering 100mg/5ml
BOTOL
8,800.00
280
Sefixime 100 mg
TABLET
841.48
176,000
Buah
781.00
TABLET
150.50
100
7,290.00
TABLET
290.00
Propranolol HCL 40 mg
TABLET
106.00
Pyrazinamide 500 mg
TABLET
206.00
500
103,000
1,140.00
150
171,000
120.00
VIAL
Ampul
TABLET
Botol plastik
Buah
Buah
15,050
1,040,000
66,000
138,600
281
Semen Seng Fosfat Serbuk + Cair
282
283
284
285
286
Sianokobalamin Injeksi 500mcg/ ml
AMPUL
287
Silk No 3/0( Benang Bedah Sutera)
288
Silver Amalgam serbuk 65-75 %
289
Simvastatin 10mg
290
Stomach Tube No. 12
Buah
291
Strip Test Asam Urat
Pak 25
292
Strip Test Glukosa
Pak 50
293
Strip Test Kolesterol
294
295
BOTOL
247,170.00
Serum ABU Injek. 5 ml (ABU I )
VIAL 5 ml
468,270.00
Serum ADS 20.000 iu
VIAL 5 ml
945,252.00
AMPUL
125,235.00
VIAL
525,000.00
1,078.00
SACHET
6,600.00
BOTOL
200,000.00
TABLET
169.00
3,718.00
196,900.00
234,190.00
Pak 10
361,900.00
Sulfasetamida Na. TM 15 % 5ml
BOTOL
3,226.00
Tablet Tambah Darah Dewasa
TABLET
42.00
296
Tablet Tambah Darah Dewasa 2 (Hemafort)
TABLET
689.70
297
Temporary Stopping Fletcher
SET
59,070.00
298
Test HIV I (Vikia)
Buah
38,170.00
299
Test HIV II (intec)
Buah
39,490.00
300
Test HIV III (Onco)
Buah
47,740.00
301
Test Siphylis
Buah
30,470.00
302
KAPSUL
148.00
303
KAPSUL
206.00
304
Thiamfenikol kap 500mg
KAPSUL
550.00
305
Thiamfenikol Syrup
BOTOL
5,000.00
306
Thiamin HCL (Vit. B1 ) Injek.100 mg
AMPUL
680.00
307
TABLET
81.00
308
TABLET
38.00
309
Tramadol tablet 50mg
TABLET
322.00
310
Trifluoferazin 5 mg
TABLET
405.00
311
KAPSUL
322.00
100
312
Umbilical cord klem
Buah
1,000.00
313
Urea Krim 10 % (Soft U Derm)
TUBE
6,400.00
12,800
314
Urine Bag
BUAH
3,000.00
10
30,000
315
Vaksin Anti Rabies Vero
KUUR
450,000.00
316
Vitamin B. Komplek
TABLET
107.00
317
Vitamin B12 tablet 50mg
TABLET
57.00
318
Vitamin Neurotropik
TABLET
93,354.03
319
Wing Needle No.25,27
BUAH
1,400.00
11,200
320
Zink dispersibel tablet
TABLET
473.00
200
94,600
321
322
323
324
325
Jumlah
32,200
-
18,949,181
Mengetahui,
Kepala Puskesmas .....................................
........................................................................
NIP......................................................
pname Obat Semester 2 per 31 Desember 2016

....... Kabupaten Cianjur Tahun 2016
PENERIMAAN
PEMAKAIAN
Rupiah
Barang
STOK AKHIR PER 31 DESEMBER 2016

TOTAL (Gabungan Gudang
PKM dan Jaringan)
Rupiah
Barang
Rupiah
Di Gudang Puskesmas
Barang
Di Jaringan Puskesmas
Harga
Barang
Rupiah
100
23,700
100
23,700
200
69,000
200
69,000
80
80
24
24
100
11,200
100
11,200
30
9,900
30
9,900
30
5,610
30
5,610
70
70
500
500
20
28,000
20
28,000
300
34,800
300
34,800
1,500
95,040
78,024
408,000
357,000
62,110
1,500
95,040
78,024
408,000
357,000
62,110
36,270
36,270
0
-
90
90
15
532,890
15
20
66,000
20
66,000
50
576,250
50
576,250
90
90
40
40
300
300
1,000
7,800,000
139,500
15,030
1,520
765,000
1,000
7,800,000
139,500
532,890
15,030
1,520
765,000
30
54,000
30
54,000
10
900
10
900
30
30
15
15
50
50
200
48
12,570
50,985
-
6
-
87,500
87,144
12,570
50,985
-
87,144
200
6
-
11,800
141,900
87,500
141,900
48
134,304
11,800
134,304
100
100
100
612,498
100
612,498
100
208,900
100
208,900
150
321,750
150
321,750
2,000
298,000
2,000
298,000
300
300
24,500
-
390,000
251,700
24,500
3
390,000
251,700
100
50
80,000
100
80,000
75,000
50
75,000
89,550
89,550
19,250
19,250
10
32,200
10
32,200
25
445,500
25
445,500
50
325,000
50
325,000
60
372,000
60
372,000
300
60,000
300
60,000
40
40
100
100
700
700
188,000
740,300
553,000
-
116,820
188,000
740,300
553,000
3
116,820
60
42,960
60
600
600
10
10
100
100
500
103,000
500
103,000
150
171,000
150
171,000
100
26,000
100
26,000
100
45,900
100
45,900
200
200
10
10
300
300
43,956
176,000
15,050
1,040,000
66,000
138,600
42,960
43,956
176,000
15,050
1,040,000
66,000
138,600
100
100
12,800
12,800
10
30,000
10
30,000
11,200
11,200
200
94,600
200
94,600
32,200
-
32,200
-
0
-
18,949,181
Cianjur, 31 Desember 2016
18,949,181
Pengelola Obat Puskesmas ...........................
........................................................................
NIP......................................................

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LAPORAN PEMAKAIAN DAN LEMBAR PERMIN

Stok Awal Penerimaan

Pemakaian Stok akhir

Acyclovir tab 200mg

Acyclovir tab 400mg

Air Raksa Dental Use

Alat Suntik Sekali Pakai 1 ml

Alat Suntik Sekali Pakai 10 ml

Alat Suntik Sekali Pakai 3 ml

Alat Suntik Sekali Pakai 5 ml

Alopurinol Tablet 100 mg

Ambroxol syrup 15mg/5ml

Aminofilin Injeksi 24 mg/ ml

Aminofilin Tablet 200 mg

Amoksisilin + Asam Klavulanat

Amoksisilin Syrup 125 mg/ 5 ml

Ampisilin Kaplet 500 mg

Ampisillin Serbuk 1.000 mg injeksi

Antalgin Injeksi 250 mg/ ml

Antalgin tab (Metampiron) 500 mg

Antasida DOEN I tablet kunyah

Antasida DOEN II suspensi,

Anti Bakteri DOEN salep kombinasi

Anti fungi DOEN Kombinasi

Anti Hemoroid Doen Kombinasi

Antimigren tablet: Ergotamin Tartrat 1 mg + Kof

Aqua Proinjeksi Steril

Asam Asetil Salisilat Tablet 100mg

Asam Mefenamat 500 mg

Asam Traneksamat injeksi 100 mg/ml

Atropin Sulfat Injeksi 0,25 mg

Benzatin B. P. Injek 2,4 juta UI

Betametason Krim 0,1 %- 5 mg

Bisaprolol tab 5mg

Ca-Glukonas injeksi IV 10%

Catgut Chromic No.2/0

Catgut Chromic No.3/0

Catgut plain No.2/0

Catgut Plain No.3/0

Cefadroxil Kapsul 500 mg

Cetirizin Tablet 10mg

Cimetidine Tablet 200 mg

Clindamycin Kapsul 150mg

Clindamycin Kapsul 300mg

Cyprofloxacin Tablet 500 mg

Deksametason Injeksi 5 mg/ ml

Deksametason Tablet 0,5 mg

Devitalisasi Pasa Non Arsen

Diazepam Injeksi 5 mg/ ml- 2 ml

Diazepam Rectal Tube 5mg

Difenhidramin HCL Injeksi

Domperidon Tablet 10mg

Doxycilkin 100 mg kapsul

Epinefrin (Adrenalin) injeksi 0,1 %

Eritromisin sirup 200 mg/ 5 ml

Etakridine ( Rivanol ) 0,1 %

Etil Klorida Semprot

Extrak Plasenta dan Neomisin Jeli

Fenilbutazone Tablet 200 mg

Fenobarbital Injeksi 50 mg/ ml

Fenoksimetil Penisilina 250 mg

Fenoksimetil Penisilina 500 mg

Fitomenadion Injeksi 10 mg/ ml