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LAPORAN PENERIMAAN DAN LEMBAR PEMAKAIAN OBAT

( LP-LPO )
KABUPATEN : BADUNG
PELAPOR
UPT PUSKESMAS : KUTA UTARA AN BULAN :
PERMINTA
PUSKESMAS PEMBANTU YANG ADA :5 AN BULAN :
PROVINSI : Bali
UGD

STOK PENERIMA PEMAKAI
HARGA AWAL AN AN
NO NAMA OBAT SATUAN
SATUAN
JUMLAH JUMLAH JUMLAH

1 Acyclovir tablet 400 mg Tablet 750 100 200 80

2 Acyclovir cream 5 % Tube 2,999.964 5 5 5

3 Air Raksa Botol 103,536 -

4 Akarbos 50 mg Tablet 1,976.282 -

5 Alopurinol tablet 100 mg Tablet 120 50 100 50

6 Ambroxol syrup Botol 3,300 -

7 Ambroxol tablet 30 mg Tablet 125.070 - 100 100

8 Aminofilin tablet 200 mg Tablet 104.500 -

9 Amlodipine 5 mg T ablet 1,090 - 390 50

10 Amoksisilin kapletl 500 mg Kaplet 370 300 800 1,100

11 Amoksisilin kapsul 250 mg Kapsul 216 -

12 Amoksisilin sirup kering 125 mg/5ml Botol 3,699.300 40 30

13 Ampisilin kaplet 500 mg Kapsul 336 -

14 Antalgin (Metampiron) tablet 500 mg Tablet 47 -

15 Antasida DOEN kombinasi Tablet 134.992 200 400 300

16 Antasida DOEN suspensi Botol 2,643 1 1

17 Anti Hemoroid DOEN Kombinasi Sup 1,470 - 10 8

18 Aqua pro Injeksi steril, bebas pirogen Fles 1,500 5 5

19 As. Benzoat 3% + As. Salisilat 6% (W-F) salep Pot 1,154 -

20 As.Salicylsat 2% + Belerang 4 % (2-4) salep Pot 825 -

21 Asam Askorbat (Vit C) tablet 50 mg Tablet 19 - 400 400

22 Asam Folat Tablet 62 -

23 Asam mefenamat tab 500 mg Tablet 176.000 -
Basitrasin 500 IU/g + Polimiksin 10.000 IU/g Tube
2,517 20
24 - 20

25 Besi II Sulfat tablet kombinasi Tablet 27 90

26 Betahistin mesilat 6 mg Tablet 924 -

27 Betametason krim 0.1% Tube 1,865.6 3 3

28 Captopril 12,5 mg Tablet 71 - 300 150

29 Captopril 25 mg Tablet 138 - 200 100

30 Cetirizine 10 mg Tablet 330 -

31 Counterpain Tube 18,700 -

32 Deksametason injeksi 5 mg/ml - 1 ml Ampul 641 4

33 Deksametason tablet 0,5 mg Tablet 24 300 200 450

34 Dekstrometorfan sirup 10 mg/5 ml Botol 2,400 -

35 Dekstrometorfan tablet 15 mg Tablet 36 -

36 Demacolin tablet kombinasi Tablet 185 -

37 Devitalisasi Pasta (Non Arsen) Botol 388,994 -

38 Diasepam Inj 5 mg/ml Ampul 873 -

39 Diasepam Rectal 5 mg/2,5 ml Tube 28,380 15 8

40 Diazepam tablet 2 mg Tablet 13 -

41 Difenhidramin HCl inj 10 mg/ml-1 ml Ampul 960 5 5

42 Digoksin tablet 0,25 mg Tablet 83 -

43 Doksisiklin Tablet 229.999 -

44 Efedrin HCl tablet 25 mg Tablet 35 -

45 Epinefrina (adrenalin) Injeksi 0,1% - 1 ml Ampul 432 4 2 1

46 Erytromicin 500 mg Tablet 535 100 50

47 Erytromicin syrup Botol 6,523 6 6

48 Etakridina ( rivanol ) larutan 0.1% Botol 1,799.600 -

49 Etanol (alkohol) 70 % 1000 ml Botol 26,488 1.0 1

50 Etil Klorida spray Botol 81,392 2 2 2

51 Eugenol cairan Botol 3,178 -

52 Famotidin tablet 20 mg Tablet 113 -
53 Fenilbutason tablet Tablet 72 -
54 Fenobarbital Inj Ampul 670 -
55 Fenobarbital tablet 30 mg Tablet 32 -
56 Fenol Gliserol tetes telinga 10% Botol 1,008 -
57 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ampul 978 10

58 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet 681 100 -

59 Fitomethadion Inj 2 mg/ml Ampul 13,200 -

60 Frisium (clobazam) 40 mg Tube 950 -

61 Furosemid tablet 40 mg Tablet 72 30 30

62 Garam Oralit untuk 200 ml air Sak 440 40 60 50

63 Gentamicin salep kulit Tube 1,650 -

64 Gentamicin Sulfat TM 0,3% Botol 3,000 -

65 Gentian Violet larutan 1 % Botol 450 -

66 Glibenklamid tablet 5 mg Tablet 72 -

67 Glikasid 80 mg Tablet 1,914.000 -

68 Gliseril Guayakolat tablet 100 mg Tablet 23 -

69 Glukosa larutan infus 10 % steril (Produk lokal) Fles 4,100 -

70 Glukosa larutan infus 5 % steril (Produk lokal) Fles 3,821 -

71 Griseofulvin tablet 125 mg, micronized Tablet 225 -

72 Haloperidol 0.5 mg Tablet 60.236 -

73 Haloperidol tablet 1,5 mg Tablet 123 -

74 Haloperidol tablet 5 mg Tablet 60 -

75 Hidroklorotiazid (HCT) tablet 25 mg Tablet 36 -

76 Hidrokortison krim 2,5 % Tube 2,999.700 20 20

77 Ibuprofen tablet 200 mg Tablet 104.995 -

78 Ibuprofen tablet 400 mg Tablet 148 - 200 300

79 Isoniasid (INH) 100 Mg Tablet 38 -

80 Isosorbid Di Nitrat Tablet 65 -

81 Kalsium Hidroksida Pasta Kotak 102,363 -

82 Kalsium Laktat (Kalk) tablet 500 mg Tablet 52 -
Kapas pcs 1

83 Karbamazepin tablet 200 mg Tablet 246.455 -

84 Ketokonazole cream 2 % 15 gram Tube 4,666 -

85 Ketokonazole tablet 200 mg Tablet 372 -

86 Ketorolac Inj 30 mg Ampul 13,365.000 -

87 Klindamycin 300 mg Tablet 685 -

88 Kloramfenikol kapsul 250 mg Kapsul 153 -

89 Kloramfenikol tetes telinga 3 % Botol 1,000 -

90 Kloramphenikol salep mata 1 % Tube 1,563 -

91 Kloramphenikol Tetes Mata Botol 2,499.200 -

92 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 23.9998 - 800 800

93 Klorfenol Kamfer Menthol (CHKM) Botol 55,000 -
94 Klorpromazin HCl tablet salut 100 mg Tablet 104 -
95 Klorpromazin HCl tablet salut 25 mg Tablet 31 -
96 Kotrimoksazol Suspensi Botol 3,500.20 7 7

97 Kotrimoksazol tablet 480 mg kombinasi Tablet 165 400 - 50

98 Kotrimoksazol tablet pediatrik 120 mg Tablet 50 -

99 Levertran salep (salep minyak ikan) Pot 1,350 -

100 Lidokain injeksi Ampul 1,009.998 45 80 80

101 Lidokain Kompositum Ampul 1,033.303 74 74

102 Lisol Botol 49,862 1 1 1

103 Loperamid tablet 2 mg Tablet 96 50 50

104 Loratadin tablet 10 mg Tablet 333 -

105 Meloksikam 15 mg Tablet 1,199 -

106 Meloksikam 7,5 mg Tablet 692 -

107 Metformin 500 mg Tablet 182 80 40

108 Methyl Prednisolon 4 mg Tablet 509 100 80

109 Metilergometrin Maleat 0,125 mg Tablet 110 -

110 Metilergometrin Maleat inj 0,200 mg-1 ml Ampul 1,490 -

662 - 116 Natrium Diklofenac tablet 50 mg Tablet 217.000 - 115 Natrium Diklofenac tablet 25 mg Botol 167.375.5 ml Tube 12.H.500 - 122 Okitetrasiklin Salep Kulit 3 % Tube 1.199.B6) tablet 10 mg Tablet 14.672.700.227 - .336 - 139 Retinol (vit.700 2 1 3 142 Risperidon 2 mg Tablet 2.000 IU/g Tablet 289 - 121 Obat Batuk Hitam ( O.482 250 200 150 146 Salicyl spiritus Botol 2.000 IU kapsul lunak Tablet 462 - 141 Ringer Laktat larutan infus steril (Produk lokal) botol 5.995 - 136 Prednison tablet 5 mg Tablet 38 200 100 200 137 Ranitidin Tablet 200 100 100 138 Ranitidin Inj 25 mg/2 ml Ampul 2.025 8 2 148 Sefadroxil Syrup Botol 7.919.000 2 2 2 132 Perhidrol ( H2O2) 3 % Botol 10.A) 200.785 - 125 Omeprazol 20 mg Tablet 408 60 120 180 126 Papaverin Tab 40 mg Tablet 57 - 127 Paraformaldehid tablet Tablet 60 - 128 Parasetamol Rektal 125 mg/2.400 5 7 8 118 New Diatabs Tablet 1.899.000 IU tablet salut Tablet 317 - 140 Retinol (vit.500 1 10 6 Salbutamol inhaler Botol 1 .9% steril Fles 4.000 - 129 Parasetamol sirup 120 mg/5 ml Botol 1.000 - 143 Salbutamol Nebuliser Ampul 10.725 5 10 15 plester/ultrafix/hipavix pcs 15 15 130 Parasetamol tablet 500 mg Tablet 45 200 700 900 131 Perak Sulfadiazin 1% (Burnazin) Tube 33.984 5 5 124 Oksitosin inj 10iu/ml-1ml Ampul 1.300 600 600 134 Piroxicam tab 10 mg Tablet 74.B.998 - 135 Piroxicam tab 20 mg Tablet 104.675 - 123 Oksitetrasiklin HCl salep mata 1 % Tube 1.800 1 - 133 Piridoksin HCl (Vit.914 5 5 Metoklopramid hcl 5 mg/ml Ampul - 112 Metoklopramid tablet 5 mg (primperan) Tablet 73 - 113 Metronidazol tablet 500 mg Tablet 200 200 200 114 Mummifying Pasta Botol 527.A) 100. - 144 Salbutamol tablet 2 mg Tablet 88 - 145 Salbutamol tablet 4 mg Tablet 97.532.111 Metoklopramid syrup Botol 1. ) cairan Botol 2.750 - 147 Salisil Bedak 2 % Botol 1.668 100 100 117 Natrium Klorida larutan infus 0.000 - 119 Nifedipin Tablet 108 - 120 Nistatin tablet vaginal 100.

000 .500 1 1 174 Yodium povidon larutan 10% 30ml Botol 2.999 - 152 Serum Anti Tetanus Injeksi 1. 200 200 158 Sohobion 5000 mg Tablet 1.300 20 11 18 Tetagam inj Ampul 10 6 163 Tetracain TM 0.500 IU/ampul Ampul 61.88 - 184 Miconazol Tube 1718.3 . 10 10 .659 - 151 Serum Anti Bisa Ular Polivalen injeksi 50 ml Ampul 273.B12) injeksi 500 mcg-ml Ampul 473 154 Silver Amalgam Botol 261. 8 5 175 Zinc tablet 20 mg Tablet 472.997 - 179 Astaxanthin 2 mg Tablet 2379.445 - 161 Supra Livron ( Multivitamin ) Tablet 372.75 - 185 NB Salep Tube 20.149 Sefadroxil tablet 500 mg Capsul 700 100 100 150 Semen Seng Fosfat serbuk dan cairan Botol 80.739 - 168 Tramadol Inj 5m mg/ml Ampul 6.402.216 - 178 Asetosal 100 mg Tablet 95.667 - 180 Bisacodyl 5 mg (Dulcolax) Tablet 2079 - 181 Hyoscine-N-Butilbromide 10 mg (Scopma) Tablet 1040.301.088 - 164 Tetrasiklin HCl kapsul 250 mg Kapsul 66 - 165 Tetrasiklin HCl kapsul 500 mg Kapsul 257 - 166 Thiamin HCl (Vit.16 - 182 Hyoscine-N-Butilbromide Inj 20 mg/ml (Buscopan I Ampul 2467.5% Botol 3.000 - 169 Triflouperazin 5 mg Tablet 380 - 170 Triheksifenidil Hidroklorida tablet 2 mg Tablet 41 - 171 Trikresol Formalin Botol 97.368 - 160 Sulfasetamida Natrium tetes mata 15 % Botol 3.750 - 172 Vitamin B Kompleks tablet Tablet 22 500 300 800 173 Yodium povidon larutan 10% 300ml Botol 14.800 - 153 Sianokobalamin (Vit.7 - 177 Antalgin Injeksi Ampul 3302.498 - 183 Magnesium Sulfat Inj 40% 25 ml Ampul 1947.6 - 186 Ondancetron 8 mg Tablet 2596 - 187 Ondansetron 8 mg inj Ampul 10384 - 188 Parasetamol Drop Botol 4799.977 - 162 Supratul Lembar 11.B1) tablet 50mg Tablet 37.100 - 159 Spironolakton 25 mg Tablet 346.395 - 155 Simetidin tablet 200 mg Tablet 72 - 156 Sinvastatin tablet 10 mg Tablet 513 - 157 Siprofloxacin Tab 500 mg Tablet 240 .494 - 176 Alletrol Tetes Mata botol 11590.817.B1) injeksi 100mg/ml-1ml Ampul 467 - 167 Thiamin HCl Mononitrat (Vit.

189 Pilokarpin tetes mata 2% Botol 5214 - 190 Prenatin Plus Tablet 763.004 - 199 Albotyl Botol 21801 - 200 Salbutamol Inhaler Botol 63.750 1 201 Handschoon kotak 202 Borax botol 0 203 Etanol 70 % 100 ml botol 4 5 9 204 Erlaflu Syr botol 0 205 Erpakap Syr botol 0 206 Kalcii Gluconat 100 mg/ml ampul 0 208 Pyrantel Syr botol 0 210 Fletcer powder/ liquid botol 0 211 Infuset anak pcs 5 5 212 Glass Ionomer botol 0 213 Chateter 18 G pcs 0 214 Alcohol Sweb pcs 0 216 Dexoximetasone Salep Kulit Tube 0 217 Tumpatan Permanen ( Z 100 ) botol 0 218 Tumpatan Sementara ( civitron ) botol 0 219 Endometasone N botol 0 220 ETSA ( email preponata ) botol 0 221 Crisofen botol 0 222 Wing neddle pcs 6 223 Silk kotak 0 224 Procurma Syr botol 0 225 Glimepiride 1 mg tablet 0 226 Glimepiride 2 mg tablet 0 227 Pehacain inj ampul 0 228 Molexflu tablet 0 229 Domperidon Drop botol 0 230 SD Bioline pcs 0 231 Mata Bor Gigi ( round bor ) pcs 0 232 Mata Bor Gigi ( Fissue bor) pcs 0 .874 - 195 Ibuprofen Sirup Botol 8250 - 196 Domperidon Sirup Botol 3624 - 197 Scabisid Salep Tube 21499.4 - 191 Sohobion Injeksi Ampul 6490 - 192 Sucralfate 500 mg Tablet 1090.32 - 193 Tiamfenikol 500 mg Tablet 616 - 194 Xanvit Plus 60 ml Botol 16.5 - 198 Kalium Diklofenak Tablet 708.

10 pcs 0 254 Pisau Bedah no.233 Mata Bor Gigi ( longseng bor ) pcs 0 234 Reagen Syphilis ( trefonema ) pcs 0 235 Reagen 3 vikia test 0 236 Reagen 2 Tridot test 0 237 Reagen 1 vitec test 0 238 Ducoprola HIV 1 dan 2 test 0 239 Oncoprobe test 0 240 Micropipet 5 : 50 ml kotak 0 241 micropipet 5 : 200 ml kotak 0 242 micropipet 200 : 1000 kotak 0 243 Mucogard Syr botol 0 244 Bisacodyl supp supp 0 245 Domperidon Syr botol 0 246 Metronidazole supp ( Flagyl ) supp 0 247 Polikresulen ( aptil ) botol 0 248 Ramipril tab tablet 0 249 Zink Drop botol 0 250 Zirkum kid syr botol 0 10 10 251 Nutrifar tab tablet 0 252 Biomeriux Vikia test 0 253 Mess no. 11 pcs 70 30 255 Pisau Bedah no. 12 pcs 0 256 Tabung EDTA pcs 0 257 Tranfusion set pcs 0 258 Ultrasound Transmision gel pcs 0 259 Countrol N ( Reagen erma ) set 0 260 Albendazole tablet 400 mg Tablet 0 261 Underpad pcs 0 262 Plester pcs 0 1 1 263 Ergotamin Tablet 0 264 Masker box 5 5 265 Klindamycin 150 mg Tablet 0 266 Sterilisasi akar (Rochus) botol 0 267 Kasa 40x80 rol 0 6 6 268 Kasa 4x3 rol 85 50 269 Kasa 2x80 rol 10 10 270 kasa 16x60 rol 0 kasa 4x15 rol 20 10 30 271 Kasa 40x40 rol 10 10 272 Alat Suntik 5 ml kotak 5 5 .

5 rol 81 400 0 296 foley cateter biji 8494200 3 297 widal test set 2189000 0 298 Tabung serum (tutup merah ) set 350900 0 299 Tabung serum dg gel (kuning) set 491700 0 300 Tabung glucosa ( abu abu) set 456500 0 301 strip urine 11 set 914100 0 302 tabung centrifuge pcs 4950 0 303 Inverted bur pcs 33000 0 304 needle 22G Flashback pcs 165000 0 305 Rak micropipet acriic 8 lubang pcs 1061500 0 306 chirurgic goves size 8. 13 cm x 8.0 piece 7980 0 307 aximed examination gloves M dus 44100 0 500 500 308 aximed examination gloves S dus 44100 400 600 700 309 aximed syringe 3 cc dus 78750 0 310 reagen rapid tes hiv ke 2 one step hiv 0 311 balsem cap kaki 3 0 CAVITRON 0 XYLLO 0 .0 75 C 26 M RB box 5 0 5 275 Tabung Reaksi 3 ml disposible bag 0 276 Blood Lancet box 0 277 Reagen Kimia Darah kotak 0 278 Alat Suntik 2.273 Alat Suntik 10 ml kotak 0 274 DemeLENE 2.7 cm paket 9900 0 300 300 291 plastik klip obat uk. 10 cm x 7 cm paket 7920 0 500 200 292 Nurse cup biji 649 0 293 blood tranfusion set piece 15015 0 294 urine bag biji 15015 2 295 elastic bandage uk 7.5 cc box 108 50 130 279 Verorab vial 289 0 66 280 BCG vial 0 281 Polio botol 0 282 Campak botol 0 283 Pentabio botol 0 284 Hepatitis botol 0 285 Tetanus Toksoid botol 0 286 Obat TBC Katagori I paket 0 287 DUK 60 X 60 0 288 IV Cateter no 20 G kotak 257 400 8 8 289 IV Cateter no 22 G kotak 257400 0 290 Plastik klip obat uk.5 x 4.

 19651204 198903 2017       . Ni Putu Purlimaningsih Made Sukawati Ni Luh Rustini NIP.SEIDE 0 DELLA 0 GRATIS BAYAR PHB/ASKES JUMLAH KUNJUNGAN RESEP  Mengetahui/Menyetujui  Yang Menyerahkan  Yang meminta Pimpinan Puskesmas Kuta Utara Petugas gudang puskesmas  Pelapor petugas ugd                        dr. 197911202006042006 NIP.

PEMAKAIAN OBAT Jan-16 Feb-17 DOKUMENNOMOR TANGGAL IFK PUSKESMAS SISA STOK PERMINTAAN TERIMA KET JUMLAH JUMLAH JUMLAH 220 0 5 5 0 0 100 50 0 0 500 0 340 0 3.000 0 20 90 90 0 10 150 100 100 200 .000 0 10 20 0 0 300 300 0 10 2 10 0 0 0 0 1.000 0 0 1.

0 100 0 4 - 50 500 0 0 0 0 0 7 - 0 0 0 0 0 100 5 - 50 100 0 10 0 0 2 0 0 0 0 0 0 10 - 100 - 0 0 0 100 50 0 0 0 0 0 0 0 0 .

0 0 0 0 0 0 24 0 -100 200 0 0 0 0 0 0 0 24 0 0 0 0 0 0 24 0 24 0 100 0 0 0 0 10 350 - 0 0 45 80 0 1 0 100 0 100 0 0 40 - 20 200 0 0 .

0 10 0 10 0 100 0 200 0 0 0 200 4 8 0 200 0 0 0 0 24 10 - 0 0 200 0 0 0 0 10 0 20 0 3.000 0 0 100 300 0 200 0 0 0 0 5 0 5 10 1 - 0 300 0 6 - 0 .000 2 2 1 - 0 1.

000 0 5 3 8 0 100 0 0 0 0 500 0 0 0 0 0 0 0 0 0 10 . 0 300 0 0 0 0 0 0 0 0 1.000 0 0 0 0 13 10 4 10 0 0 0 0 0 1.000 0 0 0 0 0 1.

0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 10 0 0 0 0 0 0 5 0 0 0 5 0 0 0 0 0 0 6 0 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 40 0 0 0 0 0 0 0 0 10 0 0 5 0 0 0 5 35 50 0 10 0 0 30 0 10 10 .

0 0 5 0 0 0 28 100 223 0 0 0 0 0 0 0 0 0 5 0 0 1000 300 0 0 2 0 3 0 0 0 0 0 0 0 0 0 0 0 1000 300 1000 0 0 0 0 0 .

0 0 PHB/ASKES JUMLAH  Yang meminta Pelapor petugas ugd        Ni Luh Rustini   .

LAPORAN PENERIMAAN DAN LEMBAR PEMAKAIAN OBAT ( LP-LPO ) KABUPATEN : BADUNG PELAPOR UPT PUSKESMAS : KUTA UTARA AN BULAN : PERMINTA PUSKESMAS PEMBANTU YANG ADA :5 AN BULAN : PROVINSI : Bali UGD STOK PENERIMA PEMAKAI HARGA AWAL AN AN NO NAMA OBAT SATUAN SATUAN JUMLAH JUMLAH JUMLAH 1 Acyclovir tablet 400 mg Tablet 750 100 0 2 Acyclovir cream 5 % Tube 2.154 - 20 As. 500 200 11 Amoksisilin kapsul 250 mg Kapsul 216 - 12 Amoksisilin sirup kering 125 mg/5ml Botol 3.1% Tube 1.090 - 10 Amoksisilin kapletl 500 mg Kaplet 370 .999. 60 60 27 Betametason krim 0.300 .1 ml Ampul 641 4 33 Deksametason tablet 0.6 . 10 5 3 Air Raksa Botol 103.000 IU/g Tube 2. 100 50 6 Ambroxol syrup Botol 3. 500 200 34 Dekstrometorfan sirup 10 mg/5 ml Botol 2.865.300 - 7 Ambroxol tablet 30 mg Tablet 125.25 mg Tablet 83 - 43 Doksisiklin Tablet 229.536 - 4 Akarbos 50 mg Tablet 1.500 - 9 Amlodipine 5 mg T ablet 1. 60 20 13 Ampisilin kaplet 500 mg Kapsul 336 - 14 Antalgin (Metampiron) tablet 500 mg Tablet 47 - 15 Antasida DOEN kombinasi Tablet 134.700 - 32 Deksametason injeksi 5 mg/ml . Salisilat 6% (W-F) salep Pot 1.400 - 35 Dekstrometorfan tablet 15 mg Tablet 36 - 36 Demacolin tablet kombinasi Tablet 185 - 37 Devitalisasi Pasta (Non Arsen) Botol 388.964 .282 - 5 Alopurinol tablet 100 mg Tablet 120 .992 . 10 10 18 Aqua pro Injeksi steril. 20 20 25 Besi II Sulfat tablet kombinasi Tablet 27 - 26 Betahistin mesilat 6 mg Tablet 924 .070 - 8 Aminofilin tablet 200 mg Tablet 104.994 - 38 Diasepam Inj 5 mg/ml Ampul 873 - 39 Diasepam Rectal 5 mg/2. 600 400 22 Asam Folat Tablet 62 - 23 Asam mefenamat tab 500 mg Tablet 176. bebas pirogen Fles 1. 500 300 16 Antasida DOEN suspensi Botol 2.999 - .000 - 24 Basitrasin 500 IU/g + Polimiksin 10. 10 7 28 Captopril 12.500 5 5 19 As.380 10 10 5 40 Diazepam tablet 2 mg Tablet 13 - 41 Difenhidramin HCl inj 10 mg/ml-1 ml Ampul 960 5 5 42 Digoksin tablet 0.517 .5 mg Tablet 71 - 29 Captopril 25 mg Tablet 138 . 6 5 17 Anti Hemoroid DOEN Kombinasi Sup 1.470 .Salicylsat 2% + Belerang 4 % (2-4) salep Pot 825 - 21 Asam Askorbat (Vit C) tablet 50 mg Tablet 19 .5 ml Tube 28.699. 100 100 30 Cetirizine 10 mg Tablet 330 - 31 Counterpain Tube 18.643 .976.5 mg Tablet 24 . Benzoat 3% + As.

600 - 49 Etanol (alkohol) 70 % 1000 ml Botol 26. micronized Tablet 225 - 72 Haloperidol 0. 100 - 59 Fitomethadion Inj 2 mg/ml Ampul 13.799.000 - 68 Gliseril Guayakolat tablet 100 mg Tablet 23 - 69 Glukosa larutan infus 10 % steril (Produk lokal) Fles 4.488 8.200 - 92 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 23. 100 30 47 Erytromicin syrup Botol 6.5 mg Tablet 60.1% Botol 1.9998 .100 - 70 Glukosa larutan infus 5 % steril (Produk lokal) Fles 3.499. 100 70 62 Garam Oralit untuk 200 ml air Sak 440 .5 mg Tablet 123 - 74 Haloperidol tablet 5 mg Tablet 60 - 75 Hidroklorotiazid (HCT) tablet 25 mg Tablet 36 - 76 Hidrokortison krim 2.914.392 2 2 2 51 Eugenol cairan Botol 3.365.236 - 73 Haloperidol tablet 1.008 - 57 Fitomenadion (Vit. 10 4 48 Etakridina ( rivanol ) larutan 0.666 - 85 Ketokonazole tablet 200 mg Tablet 372 - 86 Ketorolac Inj 30 mg Ampul 13.5 % Tube 2.0 5 5 50 Etil Klorida spray Botol 81.999.1 ml Ampul 432 5 .995 - 78 Ibuprofen tablet 400 mg Tablet 148 . 400 200 79 Isoniasid (INH) 100 Mg Tablet 38 - 80 Isosorbid Di Nitrat Tablet 65 - 81 Kalsium Hidroksida Pasta Kotak 102. 24 4 77 Ibuprofen tablet 200 mg Tablet 104.700 .200 - 60 Frisium (clobazam) 40 mg Tube 950 - 61 Furosemid tablet 40 mg Tablet 72 .000 - 65 Gentian Violet larutan 1 % Botol 450 - 66 Glibenklamid tablet 5 mg Tablet 72 - 67 Glikasid 80 mg Tablet 1.K1) injeksi 10 mg/ml . 100 60 63 Gentamicin salep kulit Tube 1.563 - 91 Kloramphenikol Tetes Mata Botol 2. 1 46 Erytromicin 500 mg Tablet 535 .650 - 64 Gentamicin Sulfat TM 0.363 - 82 Kalsium Laktat (Kalk) tablet 500 mg Tablet 52 - Kapas pcs 1 83 Karbamazepin tablet 200 mg Tablet 246.000 - 90 Kloramphenikol salep mata 1 % Tube 1.178 - 52 Famotidin tablet 20 mg Tablet 113 - 53 Fenilbutason tablet Tablet 72 - 54 Fenobarbital Inj Ampul 670 - 55 Fenobarbital tablet 30 mg Tablet 32 - 56 Fenol Gliserol tetes telinga 10% Botol 1.000 - 94 Klorpromazin HCl tablet salut 100 mg Tablet 104 - 95 Klorpromazin HCl tablet salut 25 mg Tablet 31 - 96 Kotrimoksazol Suspensi Botol 3.821 - 71 Griseofulvin tablet 125 mg.523 .20 - .1% .K1) tablet salut gula 10 mg Tablet 681 .3% Botol 3.500. 400 400 93 Klorfenol Kamfer Menthol (CHKM) Botol 55.44 Efedrin HCl tablet 25 mg Tablet 35 - 45 Epinefrina (adrenalin) Injeksi 0.455 - 84 Ketokonazole cream 2 % 15 gram Tube 4.000 - 87 Klindamycin 300 mg Tablet 685 - 88 Kloramfenikol kapsul 250 mg Kapsul 153 - 89 Kloramfenikol tetes telinga 3 % Botol 1.1 ml Ampul 978 10 58 Fitomenadion (Vit.

025 .862 1 1 1 103 Loperamid tablet 2 mg Tablet 96 .984 .000 - 143 Salbutamol Nebuliser Ampul 10. 300 100 137 Ranitidin Tablet 200 300 200 138 Ranitidin Inj 25 mg/2 ml Ampul 2.303 14 60 60 102 Lisol Botol 49.725 .998 2 125 80 101 Lidokain Kompositum Ampul 1.336 - 139 Retinol (vit. 15 10 plester/ultrafix/hipavix pcs 15 15 130 Parasetamol tablet 500 mg Tablet 45 .500 - 122 Okitetrasiklin Salep Kulit 3 % Tube 1.998 - 135 Piroxicam tab 20 mg Tablet 104.000 - 129 Parasetamol sirup 120 mg/5 ml Botol 1.200 mg-1 ml Ampul 1.199 - 106 Meloksikam 7.A) 200.B6) tablet 10 mg Tablet 14.375.H.500 7 .490 - 111 Metoklopramid syrup Botol 1.400 8 5 8 118 New Diatabs Tablet 1.125 mg Tablet 110 - 110 Metilergometrin Maleat inj 0. 200 100 117 Natrium Klorida larutan infus 0. 10 2 .700 5 2 5 142 Risperidon 2 mg Tablet 2.914 .750 - 147 Salisil Bedak 2 % Botol 1. - 144 Salbutamol tablet 2 mg Tablet 88 - 145 Salbutamol tablet 4 mg Tablet 97. ) cairan Botol 2.000 - 115 Natrium Diklofenac tablet 25 mg Botol 167.995 - 136 Prednison tablet 5 mg Tablet 38 .785 - 125 Omeprazol 20 mg Tablet 408 .000 2 2 2 132 Perhidrol ( H2O2) 3 % Botol 10.A) 100. 1.350 - 100 Lidokain injeksi Ampul 1. 200 200 114 Mummifying Pasta Botol 527. 100 20 108 Methyl Prednisolon 4 mg Tablet 509 .919.482 .000 - 119 Nifedipin Tablet 108 - 120 Nistatin tablet vaginal 100. 10 5 124 Oksitosin inj 10iu/ml-1ml Ampul 1. 6 Salbutamol inhaler Botol 1 .000 800 131 Perak Sulfadiazin 1% (Burnazin) Tube 33.97 Kotrimoksazol tablet 480 mg kombinasi Tablet 165 . 300 50 146 Salicyl spiritus Botol 2.675 - 123 Oksitetrasiklin HCl salep mata 1 % Tube 1.672.000 IU/g Tablet 289 - 121 Obat Batuk Hitam ( O.800 1 - 133 Piridoksin HCl (Vit.9% steril Fles 4.000 400 134 Piroxicam tab 10 mg Tablet 74.033. 1. 12 112 Metoklopramid tablet 5 mg (primperan) Tablet 73 - 113 Metronidazol tablet 500 mg Tablet 200 .B. 20 15 Metoklopramid hcl 5 mg/ml Ampul 12 .199.532. 90 30 126 Papaverin Tab 40 mg Tablet 57 - 127 Paraformaldehid tablet Tablet 60 - 128 Parasetamol Rektal 125 mg/2.899.668 .5 mg Tablet 692 - 107 Metformin 500 mg Tablet 182 . 100 50 104 Loratadin tablet 10 mg Tablet 333 - 105 Meloksikam 15 mg Tablet 1.662 - 116 Natrium Diklofenac tablet 50 mg Tablet 217. 500 100 98 Kotrimoksazol tablet pediatrik 120 mg Tablet 50 - 99 Levertran salep (salep minyak ikan) Pot 1.000 IU tablet salut Tablet 317 - 140 Retinol (vit. 200 100 109 Metilergometrin Maleat 0.009.5 ml Tube 12.300 .700.000 IU kapsul lunak Tablet 462 - 141 Ringer Laktat larutan infus steril (Produk lokal) botol 5.

16 - 182 Hyoscine-N-Butilbromide Inj 20 mg/ml (Buscopan I Ampul 2467.500 IU/ampul Ampul 61.395 - 155 Simetidin tablet 200 mg Tablet 72 - 156 Sinvastatin tablet 10 mg Tablet 513 - 157 Siprofloxacin Tab 500 mg Tablet 240 - 158 Sohobion 5000 mg Tablet 1.75 - 185 NB Salep Tube 20.B1) tablet 50mg Tablet 37.739 - 168 Tramadol Inj 5m mg/ml Ampul 6.6 - 186 Ondancetron 8 mg Tablet 2596 - 187 Ondansetron 8 mg inj Ampul 10384 - 188 Parasetamol Drop Botol 4799.999 - 152 Serum Anti Tetanus Injeksi 1.368 - 160 Sulfasetamida Natrium tetes mata 15 % Botol 3.874 - 195 Ibuprofen Sirup Botol 8250 - 196 Domperidon Sirup Botol 3624 - 197 Scabisid Salep Tube 21499.750 1 .5% Botol 3.498 - 183 Magnesium Sulfat Inj 40% 25 ml Ampul 1947.004 - 199 Albotyl Botol 21801 - 200 Salbutamol Inhaler Botol 63.300 .4 - 191 Sohobion Injeksi Ampul 6490 - 192 Sucralfate 500 mg Tablet 1090.402.977 - 162 Supratul Lembar 11.B1) injeksi 100mg/ml-1ml Ampul 467 - 167 Thiamin HCl Mononitrat (Vit.800 - 153 Sianokobalamin (Vit.817.148 Sefadroxil Syrup Botol 7.088 - 164 Tetrasiklin HCl kapsul 250 mg Kapsul 66 - 165 Tetrasiklin HCl kapsul 500 mg Kapsul 257 - 166 Thiamin HCl (Vit.667 - 180 Bisacodyl 5 mg (Dulcolax) Tablet 2079 - 181 Hyoscine-N-Butilbromide 10 mg (Scopma) Tablet 1040.100 - 159 Spironolakton 25 mg Tablet 346.000 - 175 Zinc tablet 20 mg Tablet 472.32 - 193 Tiamfenikol 500 mg Tablet 616 - 194 Xanvit Plus 60 ml Botol 16.227 - 149 Sefadroxil tablet 500 mg Capsul 700 - 150 Semen Seng Fosfat serbuk dan cairan Botol 80.5 - 198 Kalium Diklofenak Tablet 708.301.445 - 161 Supra Livron ( Multivitamin ) Tablet 372. 10 10 189 Pilokarpin tetes mata 2% Botol 5214 - 190 Prenatin Plus Tablet 763. 10 10 Tetagam inj Ampul 10 2 163 Tetracain TM 0.997 - 179 Astaxanthin 2 mg Tablet 2379.7 - 177 Antalgin Injeksi Ampul 3302.88 - 184 Miconazol Tube 1718.B12) injeksi 500 mcg-ml Ampul 473 4 10 14 154 Silver Amalgam Botol 261.750 - 172 Vitamin B Kompleks tablet Tablet 22 - 173 Yodium povidon larutan 10% 300ml Botol 14.000 - 169 Triflouperazin 5 mg Tablet 380 - 170 Triheksifenidil Hidroklorida tablet 2 mg Tablet 41 - 171 Trikresol Formalin Botol 97.3 .494 - 176 Alletrol Tetes Mata botol 11590.216 - 178 Asetosal 100 mg Tablet 95.659 - 151 Serum Anti Bisa Ular Polivalen injeksi 50 ml Ampul 273.500 1 1 174 Yodium povidon larutan 10% 30ml Botol 2.

201 Handschoon kotak 0 6 6 202 Borax botol 0 203 Etanol 70 % 100 ml botol 9 0 9 204 Erlaflu Syr botol 0 205 Erpakap Syr botol 0 206 Kalcii Gluconat 100 mg/ml ampul 0 208 Pyrantel Syr botol 0 210 Fletcer powder/ liquid botol 0 211 Infuset anak pcs 5 212 Glass Ionomer botol 0 213 Chateter 18 G pcs 0 214 Alcohol Sweb pcs 0 216 Dexoximetasone Salep Kulit Tube 0 217 Tumpatan Permanen ( Z 100 ) botol 0 218 Tumpatan Sementara ( civitron ) botol 0 219 Endometasone N botol 0 220 ETSA ( email preponata ) botol 0 221 Crisofen botol 0 222 Wing neddle pcs 6 223 Silk kotak 0 224 Procurma Syr botol 0 225 Glimepiride 1 mg tablet 0 226 Glimepiride 2 mg tablet 0 227 Pehacain inj ampul 0 20 20 228 Molexflu tablet 0 229 Domperidon Drop botol 0 230 SD Bioline pcs 0 231 Mata Bor Gigi ( round bor ) pcs 0 232 Mata Bor Gigi ( Fissue bor) pcs 0 233 Mata Bor Gigi ( longseng bor ) pcs 0 234 Reagen Syphilis ( trefonema ) pcs 0 235 Reagen 3 vikia test 0 236 Reagen 2 Tridot test 0 237 Reagen 1 vitec test 0 238 Ducoprola HIV 1 dan 2 test 0 239 Oncoprobe test 0 240 Micropipet 5 : 50 ml kotak 0 241 micropipet 5 : 200 ml kotak 0 242 micropipet 200 : 1000 kotak 0 243 Mucogard Syr botol 0 244 Bisacodyl supp supp 0 245 Domperidon Syr botol 0 246 Metronidazole supp ( Flagyl ) supp 0 247 Polikresulen ( aptil ) botol 0 248 Ramipril tab tablet 0 249 Zink Drop botol 0 250 Zirkum kid syr botol 0 251 Nutrifar tab tablet 0 252 Biomeriux Vikia test 0 253 Mess no. 12 pcs 0 256 Tabung EDTA pcs 0 257 Tranfusion set pcs 0 . 10 pcs 0 254 Pisau Bedah no. 11 pcs 100 30 255 Pisau Bedah no.

258 Ultrasound Transmision gel pcs 0 259 Countrol N ( Reagen erma ) set 0 260 Albendazole tablet 400 mg Tablet 0 261 Underpad pcs 0 262 Plester pcs 0 263 Ergotamin Tablet 0 264 Masker box 1 3 4 265 Klindamycin 150 mg Tablet 0 266 Sterilisasi akar (Rochus) botol 0 267 Kasa 40x80 rol 0 1 3 268 Kasa 4x3 rol 10 75 50 269 Kasa 2x80 rol 20 10 270 kasa 16x60 rol 0 kasa 4x15 rol 20 10 30 271 Kasa 40x40 rol 0 10 10 272 Alat Suntik 5 ml kotak 5 5 273 Alat Suntik 10 ml kotak 0 274 DemeLENE 2.5 rol 81 400 0 296 foley cateter biji 8494200 3 297 widal test set 2189000 0 298 Tabung serum (tutup merah ) set 350900 0 299 Tabung serum dg gel (kuning) set 491700 0 300 Tabung glucosa ( abu abu) set 456500 0 301 strip urine 11 set 914100 0 302 tabung centrifuge pcs 4950 0 303 Inverted bur pcs 33000 0 304 needle 22G Flashback pcs 165000 0 305 Rak micropipet acriic 8 lubang pcs 1061500 0 306 chirurgic goves size 8.5 cc box 50 130 130 279 Verorab vial 349 0 60 280 BCG vial 0 281 Polio botol 0 282 Campak botol 0 283 Pentabio botol 0 284 Hepatitis botol 0 285 Tetanus Toksoid botol 0 286 Obat TBC Katagori I paket 0 287 DUK 60 X 60 0 288 IV Cateter no 20 G kotak 257 400 8 8 289 IV Cateter no 22 G kotak 257400 0 290 Plastik klip obat uk.0 75 C 26 M RB box 5 0 5 275 Tabung Reaksi 3 ml disposible bag 0 276 Blood Lancet box 0 277 Reagen Kimia Darah kotak 0 278 Alat Suntik 2.7 cm paket 9900 0 291 plastik klip obat uk. 13 cm x 8.5 x 4. 10 cm x 7 cm paket 7920 0 500 200 292 Nurse cup biji 649 0 293 blood tranfusion set piece 15015 0 294 urine bag biji 15015 2 295 elastic bandage uk 7.0 piece 7980 0 307 aximed examination gloves M dus 44100 0 200 200 308 aximed examination gloves S dus 44100 0 200 200 309 aximed syringe 3 cc dus 78750 0 310 reagen rapid tes hiv ke 2 one step hiv 0 .

311 balsem cap kaki 3 0 CAVITRON 0 XYLLO 0 SEIDE 0 DELLA 0 GRATIS BAYAR PHB/ASKES JUMLAH KUNJUNGAN RESEP  Mengetahui/Menyetujui  Yang Menyerahkan  Yang meminta Pimpinan Puskesmas Kuta Utara Petugas gudang puskesmas  Pelapor petugas ugd                        dr. 197911202006042006 NIP. Ni Putu Purlimaningsih Made Sukawati Ni Luh Rustini NIP. 19651204 198903 2017       .

10 - - - 200 200 - - .R PEMAKAIAN OBAT Dec-16 Jan-17 DOKUMENNOMOR TANGGAL IFK PUSKESMAS SISA STOK PERMINTAAN TERIMA KET JUMLAH JUMLAH JUMLAH 100 0 5 5 - - 50 50 - - . 60 3 10 - . 200 - - 4 - 300 200 - - - - - 15 - - - - - . 100 . 20 - . 200 300 300 - 40 - - 200 300 1 10 .

500 - - - - . - 4 - 70 6 - 8 5 2 2 ### - - - - - - 10 - 100 - - - 30 40 50 - - - - - - - - - - - - - 20 - 200 200 - - - - 1 - - - - - - - - - .

20 200 1. 10 . 200 - 100 100 5 8 - - - - - 5 - - 60 30 - - - 5 10 . 100 .000 2 2 1 - 600 500 - - 200 100 100 200 - - - 2 5 - 1 10 1 - - 250 50 - 8 - .400 - - - 45 80 14 50 1 50 - - - - 80 - 100 - - - 5 10 .

10 8 5 - - - - - - - - - - . 10 - - - - - - - - - - - 1 .- - - - - 14 10 - - - - - - - - . 5 - - - - - - - - - - - - - - .

50 - - - - - - - - - - - - - - - - - - - - - - - - - - 70 - - - . 10 - - - - - 5 - - - - - - - - - 6 - - - - . 8 - ..

4 - - 4 5 35 50 10 0 - . 5 - - 300 - - 2 - 3 - - - - - - - - - - 400 500 400 500 - - . 30 . - - - - - - . 10 10 - . 5 - - - 50 100 289 - - - - - - - - .

- - - - - PHB/ASKES JUMLAH  Yang meminta Pelapor petugas ugd        Ni Luh Rustini   .