Lplpo Sep 2016

CATATAN HARIAN PEMAKAIAN OBAT DAN PERBEKALAN
1 SEPTEMBER 2016
SATUAN
No. NAMA OBAT KEMASAN
I.A. OBAT ESENSIAL/GENERIK
1 Alopurinol tablet 100 mg tablet 10
2 Alprazolam tablet 0,25 mg tablet
3 Ambroksol sirup 15 mg/ml botol 60 ml 6
4 Ambroxol tablet 30 mg tablet
5 Aminofilin injeksi 24 mg/ml ampul
6 Aminofilin tablet 200 mg tablet
7 Amitriptilin tablet 25 mg tablet
8 Amlodipin tablet 10 mg tablet
10 Amoksisilin 500 mg + klavulanat 125 mg tablet kaplet
11 Amoksisilin kaplet 500 mg tablet 83
12 Amoksisilin kapsul 250 mg kapsul
13 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml
14 Amoksisilin sirup kering forte 250 mg/5 ml Botol 60 ml
15 Ampisilin serbuk injeksi I.M./I.V. 1000 mg/ml vial
16 Antalgin (Metampiron) tablet 500 mg tablet
17 Antasida DOEN I tablet kunyah kombinasi tablet 76
18 Antasida DOEN II Suspensi, kombinasi botol-60ml 2
19 Antibakteri DOEN salep komb : Basitrasin 500 IU/g tube
20 + polimiksin
Antifungi DOEN10.000 IU/g
kombinasi : Asam Benzoat 6% + pot
21 Asam Salisilat DOEN
Antihemoroid 3 % kombinasi (Generik) supp
22 Antimigrain : ergotamin tartrat 1 mg + kofein 60 mg tablet
23 Aqua pro injeksi steril, bebas pirogen vial
24 Asam Asetil Salisilat tablet 100 mg (Asetosal) tablet
25 Asam asetil salisilat 80 mg tablet
26 Asam Askorbat (Vitamin C) tablet 50 mg tablet 16
27 Asam folat tablet 1 mg tablet
28 Asam mefenamat kaplet 500 mg tablet 22
29 Asam mefenamat kaplet 250 mg Tablet
30 Asam traneksamat injeksi 100 mg/ml ampul
31 Asiklovir krim 5 % tube 5 gram
32 Asiklovir tablet 200 mg tablet
34 Atapulgit tablet 600 mg tablet 30
35 Atropin injeksi i.m./i.v./s.c. 0,25 mg/ml ampul
36 Betahistin mesilat tablet 6 mg tablet
37 Betametason cream 0,1 % tube
38 Betametason tetes mata 1 mg/ml botol
39 Bisakodil suppositoria 5 mg (Dulcolax) supp
40 Bromheksin tablet 8 mg tablet
41 Cetirizine kapsul 10 mg kapsul 10
42 Cetirizine sirup 5 mg/5 ml botol 60 ml
43 Deksametason injeksi i.v. 5 mg/ml ampul
44 Deksametason tablet 0,5 mg tablet 80
45 Dekstrometorfan sirup 10 mg/5 ml (HBr) botol 60 ml
46 Dekstrometorfan tablet 15 mg (HBr) tablet
45 Diazepam larutan rectal 5 mg / 2,5 ml (Stesolid) rect tube
47 Diazepam injeksi 5 mg/ml ampul
48 Diazepam tablet 2 mg tablet 3
49 Difenhidramin injeksi i.m. 10 mg/ml (HCl) ampul
50 Digoksin tablet 0,25 mg tablet
51 Diltiazem HCl Tablet 30 mg tablet
52 Dimenhidrinat tablet 50 mg tablet 7
53 Doksisiklin kapsul 100 mg kapsul
53 Domperidon suspensi 5 mg/5 ml botol-60ml
54 Domperidon tablet 10 mg tablet
55 Efedrin HCl tablet 25 mg tablet
56 Ekstraks beladona tablet 10 mg tablet
57 Epinefrin (Adrenalin) injeksi 0,1 % sebagai HCl) ampul
58 Eritromisin kapsul 250 mg kapsul
60 Eritromisin sirup 200 mg/5 ml botol
61 Etakridin (Rivanol) larutan 0,1 % botol 300 ml
62 Etanol 70 % botol 100 ml
64 Fenilbutason 200 mg tablet tablet
65 Fenitoin Natrium Kapsul 100 mg kapsul
66 Fenobarbital tablet 30 mg tablet
67 Fenobarbital injeksi ampul
68 Fenolgliserol tetes telinga 10 % botol
69 Fitomenadion (Vit. K) injeksi 10 mg/ml ampul
70 Fitomenadion (Vit. K) tablet salut gula 10 mg tablet
71 Furosemida injeksi 1.v/i.m 10 mg/ml ampul
72 Furosemida tablet 40 mg tablet
73 Gameksan lotion 1 % botol-30 ml/tube
74 Gemfibrosil kapsul 300 mg kapsul
75 Gemfibrozil kapsul 600 mg kapsul
76 Gentamisin salep kulit 0,1% tube
77 Gentamisin salep mata 0,3 % botol
78 Gentamisin sulfat tetes mata 0,3% botol 5 ml
79 Gentian violet larutan 1 % botol
80 Glibenklamid tablet 5 mg tablet 20
81 Gliclazid 80 mg tablet tablet
82 Glimepirid tablet 2 mg tablet
83 Gliseril Guayakolat tablet 100 mg tablet 73
84 Gliserin lar 50 % botol-100 ml
85 Glukosa larutan infus 10 % botol 500 ml
86 Glukosa larutan infus 40 % ampul
88 Griseofulvin tablet 125 mg micronized tablet
89 Haloperidol injeksi 5 mg/ml ampul
91 Haloperidol tablet 1,5 mg tablet
92 Haloperidol tablet 2 mg tablet
94 Hidroklorotiazida tablet 25 mg tablet
95 Hidrokortison krim 2,5% tube 2
96 Hyoscine-N-Butilbromide tablet 10 mg (Spashi) tablet
97 Ibuprofen sirup 100 mg/5 ml botol
98 Ibuprofen tablet 200 mg tablet
100 Isoniasida tablet 100 mg tablet
101 Isosorbid dinitrat tablet sublingual 5 mg tablet
102 Kalium diklofenak 50 mg tablet tablet
103 Kalsium laktat tablet 500 mg tablet 38
104 Kaptopril tablet 12,5 mg tablet
105 Kaptopril tablet 25 mg tablet 18
106 Karbamazepin tablet 200 mg tablet
107 Ketokonazol krim 2 % tube 15 gram 1
108 Ketokonazol tablet 200 mg tablet 10
109 Ketorolac injeksi 10 mg ampul 1 ml
111 Klindamisin kapsul 300 mg kapsul
112 Klobazam tablet 10 mg tablet
113 Klonidin tablet 0,15 mg tablet
114 Kloramfenikol injeksi 1000 mg/ml vial
115 Kloramfenikol kapsul 250 mg kapsul
116 Kloramfenikol kapsul 250 mg (Licoklor) kapsul
116 Kloramfenikol salep mata 1 % tube 5 gram 3
117 Kloramfenikol salep kulit (Bufacetin) tube
118 Kloramfenikol suspensi 125 mg/5 ml botol 60 ml
119 Kloramfenikol tetes mata 0,5 % botol 5 ml
120 Kloramfenikol tetes telinga 3 % botol 5 ml 2
121 Klorfeniramin maleat (CTM) tablet 4 mg tablet 123
122 Klorpromazin tablet salut 100 mg (HCl) tablet
124 Kodein tablet 10 mg tablet
125 Kotrimoksasol DOEN I (dewasa) komb. tablet 38
126 Kotrimoksasol suspensi botol 60 ml
127 Lamivudin tablet 150 mg tablet
128 Lanzoprazol kapsul 30 mg kapsul
129 Larutan mengandung elektrolit : (Asering) botol 500 ml
130 Larutan mengandung elektrolit : (KAEN 3A) botol 500 ml
131 Larutan mengandung elektrolit : (KAEN 3B) botol 500 ml
132 Levotiroksin tablet 100 mg (Euthyrox) tablet
133 Lidokain injeksi 2 % ampul
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : 80.000-2 m ampul
135 Lidokain semprot 10 % botol
136 Lisol, mengandung kresol tersabun 50% botol 1000 ml
137 Magnesium sulfat injeksi 20 % ampul
139 Mebendazol sirup 100 mg/5 ml botol 30 ml
140 Mebendazol tablet 100 mg tablet
141 Mekobalamin tablet 500 mg tablet
142 Meloksikam 7.5 mg tablet
143 Metformin HCl tablet 500 mg tablet
144 Metil Prednisolon tablet 4 mg tablet
146 Metilergometrin Maleat injeksi 0,200 mg - 1 ml ampul
147 Metilergometrin maleat tablet 0,125 mg tablet
148 Metoklopramid injeksi 5 mg/ml ampul
149 Metoklopramid sirup 5 mg/5 ml botol
150 Metoklopramid tablet 10 mg tablet
152 Metronidasol sirup 125 mg/5 ml (Novagyl) botol 60 ml
153 Metronidasol tablet 250 mg tablet
154 Metronidasol tablet 500 mg tablet 10
155 Metronidazol infus 500 mg/100 ml botol-100 ml
156 Mikonazol krim 2 % tube
157 Natrium Diklofenak tablet 25 mg tablet
158 Natrium Diklofenak tablet 50 mg tablet 46
159 Natrium Klorida Larutan Infus 0,9% steril botol-500 ml
160 Nifedipin tablet 10 mg tablet
161 Nifedipin tablet 20 mg SR tablet
162 Nistatin vaginal tablet 100.000 IU/g tablet
163 Obat Batuk Hitam (OBH) cairan botol-100 ml
164 Oksitetrasiklin injeksi i.m. 50 mg/ml-10 ml vial
165 Oksitetrasiklin salep kulit 3% tube 5 gram
166 Oksitetrasiklin salep mata 1% tube
167 Oksitosin injeksi 10 IU/ml - 1 ml ampul
168 Omeprazol injeksi 40 mg/10 ml vial
169 Omeprazol kapsul 20 mg kapsul
170 Ondansentron injeksi 4 mg / 2 ml ampul
171 Papaverin injeksi ampul
172 Papaverin tablet 40 mg tablet
173 Parasetamol drops botol 15 ml
174 Parasetamol sirup 120 mg/5 ml botol 2
175 Parasetamol tablet 500 mg tablet 168
176 Petidin injeksi (Narkotika) ampul
177 Piracetam 800 mg tablet tablet
178 Piracetam injeksi 1 gram/5 ml ampul
179 Pirantel tablet score 125 mg tablet
180 Piridoksin (Vit. B6) tablet 10 mg tablet 146
181 Piroksikam kapsul 20 mg tablet
182 Piroksikam tablet 10 mg tablet
183 Polikresolsulfonat cairan 50 mg/ml (APTYL) botol 10 ml
184 Povidon iodida larutan 10 % 30 ml botol 30 ml 1
185 Povidon iodida larutan 10 % 60 ml botol 60 ml
187 Prednison tablet 5 mg tablet
188 Propanolol tablet 10 mg tablet
189 Propiltiourasil tablet 100 mg tablet
190 Ranitidin injeksi 25 mg/2 ml ampul
191 Ranitidin tablet 150 mg tablet 42
192 Rifampisin kaplet salut 450 mg kaplet
193 Rifampisin kapsul 300 mg kapsul
194 Ringer laktat larutan infus botol 500 ml
195 Risperidon tablet tablet
196 Salbutamol cairan inhales 0,1 % botol 2,5 ml
197 Salbutamol tablet 2 mg tablet
198 Salbutamol tablet 4 mg tablet 10
199 Salep 2-4, Kombinasi Asam Salisilat 2% + Belerang pot
200 endap 4%
Salisil bedak 2% kotak-50 gram 5
201 Sefadroksil 500 mg kapsul kapsul
202 Sefadroksil kapsul 250 mg kaplet
204 Sefadroksil sirup kering 125 mg/5 ml botol
206 Sefotaksim serbuk injeksi 1000 mg/vial vial
208 Seftriakson serbuk injeksi 1 gr/vial vial
209 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I) vial 5 ml
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul (ATS) vial 1.500
211 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml ampul
212 Simetidin tablet 200 mg tablet 12
213 Simvastatin tablet 10 mg tablet
215 Siprofloksasin tablet 250 mg tablet
217 Spironolakton tablet 25 mg tablet
218 Sukralfat tablet 500 mg (Ulsidex) tablet
219 Sukralfat suspensi (Ulsafate) botol
220 Sulfasetamid Na tetes mata 15 % botol
221 Tetrasiklin kapsul 250 mg kapsul
223 Tiamfenikol kapsul 500 mg kapsul
224 Tiamin (Vitamin B1) injeksi 100 mg/ml ampul
225 Tiamin (Vitamin B1) tablet 50 mg tablet 154
226 Tramadol kapsul 50 mg tablet
227 Trifluoperazin 5 mg tablet tablet
228 Triheksifenidil tablet 2 mg tablet
229 Vaksin rabies untuk manusia set
230 Vitamin B Kompleks tablet tablet 140
B OBAT DAN BAHAN KEDOKTERAN GIGI

1 Air raksa dental use botol
2 Alvogyl paste dus
3 Amalgam Perak (Silver Alloy) botol
4 Articulating papper kotak
5 Bahan pensteril gigi : Trikresol formalin botol
6 Bahan tambalan sementara gigi siap pakai (Cavit) botol 28 gram
7 Devitalisasi pasta (Non Arsen) botol/kotak
8 Etil klorida spray vial/100 ml
9 Eugenol cairan botol@10 ml
10 Fuji VII dus
11 Glass inonomer cement ART set/botol
12 Gutta percha dan papper point : 15 - 40 kotak/pasang
14 Kalsium hidroksida pasta kotak 2 tube
15 Klorfenol Kamfer Menthol (CHKM) botol 10 ml
16 Mummifying pasta botol/kotak
17 Pasta pengisi saliran akar botol
18 Semen Seng Fosfat serbuk dan cairan set/botol
19 Spon gelatin cubicles 1x1x1 box-10
20 Temporary stoping fletcher serbuk+cairan botol @ 100 gram
C OBAT TAMBAHAN / BRANDED

1 Anti asma/bronkodilator inhalasi (ventolin) vial
2 Anti asma/bronkodilator nebulizer (ventolin) vial
3 Antibiotik injeksi serbuk (seftriakson 1 g) vial
4 Antidiare sirup : .. botol 60 ml
5 Antidiare sirup : Neo Kaominal botol 60 ml
6 Antidiare Tablet : .. tablet
7 Antidiare Tablet (Molagit) tablet
8 Antidiare Tablet (Omegdiar) tablet
8 Antihemoroid DOEN (Superhoid) supp
9 Antihistamin kombinasi (Pritacort) tablet
10 Antiinfeksi kulit (luka bakar) pot 1
11 Antiinflamasi gel (Provenid) tube 30 gr
12 Antikretinisme tablet tablet
13 Antiscabies krim (Scabicid) tube 10 gram
14 Antispasme injeksi (Spashi) vial
15 Antispasme/analgetik tablet : .. tablet
17 Antispasme/analgetik tablet (SCOPMA) tablet
16 Laksantia tablet 5 mg : tablet
19 Laksantia tablet 5 mg (Laxana) tablet
20 Multivitamin + mineral + biotin tablet (Caviplex) kaplet
17 Multivitamin + mineral sirup (Recovit) botol 100 ml 2
18 Multivitamin + mineral utk ibu hamil (Vitabion) kaplet
19 Multivitamin + minyak ikan (untuk ibu menyusui) N kapsul
20 Multivitamin geriatri (Osteos) kaplet
21 Multivitamin kaplet : . kaplet
26 Multivitamin kaplet (Pritavit) kaplet
27 Multivitamin kaplet (VITALAMIN) kaplet 12
22 Multivitamin kaplet salut gula kaplet
23 Multivitamin sirup : .. Botol
24 Multivitamin sirup + DHA (Caviplex + DHA) botol 60 ml
25 Multivitamin tabur untuk balita Saset
26 Nasal dekongestan tablet ( Alerfed) tablet
27 Neurotropik 5000 injeksi ampul
28 Neurotropik kaplet : kaplet
29 Neurotropik kaplet (Nutrifar) kaplet
30 Nutrisi/Vitamin injeksi (Alinamin F) ampul
31 Nutrisi/vitamin tablet (Aspar K) tablet
32 Obat antifibrinolitik kapsul (NEXITRA) kotak-50 kaplet
33 Obat Antiflu kombinasi (Tremenza) botol 60 ml
34 Obat Antiulkus peptikum tablet (Nucral) tablet
35 Obat batuk / flu sirup : . botol 100 ml
42 Obat batuk / flu sirup : Erphaflu botol 60 ml
43 Obat batuk / flu sirup : Erphakaf botol 100 ml
44 Obat batuk / flu sirup : Fortusin botol 60 ml
45 Obat batuk / flu sirup : Iafed botol 60 ml
36 Vasodilator perifer (Citicholin) ampul
D OBAT ASLI INDONESIA (OAI)

1 Asifit kapsul
2 Batugin elixir botol
3 Enkasari botol
4 Fitogen Dragge kapsul
5 Hepagard kapsul
6 Imulan kapsul kapsul
7 Imulan sirup botol 60 ml
8 Kurkumex sirup botol 60 ml
9 Kurkumex tablet kaplet
10 OB Herbal botol
11 Tensigard kapsul kapsul
12 Xanvit sirup botol
II PERBEKALAN KESEHATAN
1 Alat suntik sekali pakai 1 ml set
2 Alat suntik sekali pakai 2,5 ml (Stera) set
4 Alkohol swab box
5 Bbraun Intrafix with microdriper set
6 Bisturi (mata pisau) Pcs
7 Blood lancet 28 box-100
8 Blood Tranfusion set Pcs
9 Catgut / benang bedah No. 2/0 - 3/0 Kotak@24x75 cm
10 Catgut chromic 2/0 100 M kotak
12 Catgut chromic 2/0 saset/pack
14 Catgut plain 2/0 saset/pack
12 Dermafix T 10 x 15 cm rol
14 Developer untuk Film Rontgen Botol 5 ltr Repl 20 ltr
15 Desinfektan - Aseptin liquid botol-500 ml
16 Film Rontgen ukuran 24 x 30 lembar
18 Fixer untuk Film Rontgen Galon 20 liter
19 Folley catheter No. 16 Pcs
21 Infus set (Otsu Y) pices
22 Infus set dengan micridripper (Otsu) pices
23 Infus set anak set/kantong
24 Infus set dewasa set/kantong
25 IV catheter No. 18 G buah
29 Jarum jahit kombinasi set
30 Kapas pembalut/absorben 250 gram bungkus
31 Kasa 10 x 10 cm rol
32 Kasa hidrofil 80 cm x 40 yard rol
33 Kasa hidrofil steril ukuran 16 x 16 box
34 Kasa hidrofil ukuran 16 x 16 lembar
35 Kasa kompres 40/40 steril bungkus
36 Kasa pembalut hidrofil 4 m x 10 cm roll
37 Kasa pembalut hidrofil 4 m x 15 cm elastic rol
39 Kertas EKG ( 50 x 30) rol
40 KY Jelly 28 gram / Aquagel jelly tube
41 Masker, Earloop pcs
42 Masker, tie on Pcs
43 Mata Bor gigi buah
44 Micropipet Socorex - Acua pieces
45 - Volume 1 - 10 uL set
47 - Volume 100 - 1000 uL set
48 Nasal oxygen canula adult sraight pieces
49 Nasal oxygen canula - child pieces
50 Penutup luka dengan antibiotika Pcs
51 Plester 2.5 cm x 4.5 m (Leucoplast) rol
52 Plester 5 yards x 2 inchi rol
53 Plester hypafix 5 cm x 5 m rol
54 Plester kain 1,25 cm x 4,5 m (Leukoplast) Rol
55 Pot sputum buah
56 Sarung tangan steril nomor 6,5 pasang
57 Sarung tangan steril nomor 7 pasang
59 Sarung tangan steril nomor 8
60 Sarung tangan ukuran M sekali pakai Pcs
61 Sarung tangan ukuran S sekali pakai Pcs
62 Silk (benang bedah sutera no 2/0 dg jarum kotak
64 Silk 3/0 jarum 3/8 26 M (demetech) box-12 pacs
68 Tabung oksigen 1 m3 + regulator set
69 Urine bag Pcs
70 Under pad buah
71 Wing needle 23 G - 25 G buah
TAMBAHAN PERBEKALAN KESEHATAN

1 Alat pengukur HB 201 + analizer unit
2 Dek glass (cover glass) box
3 Microcuvet Hb 201 buah
4 Object glass box
5 Occu check (alat pemegang lancet ROCHE) kit
6 Softclick lanciet 200 box
7 Softclick lancing device kit
8 Tabung hematokrit botol
III REAGEN
1 Aquabidest steril botol 500 ml
3 Pemeriksaan kadar gula darah
Glocodoctor Box-50 test
Accutrand 25 strip
Easy Touch box/25
Nesco gluco strip box/25
Glucostar box/25
4 Reagen Pemeriksaan Asam Urat
Nesco box-25
Easy Touch box-25
UA Sure box-25
5 Reagen Pemeriksaan Kolesterol
Accutrand box/25
Easy touch cholesterol box-10
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
7 Reagen untuk spektrofotometr
- Reagen glukosa box-4 btl
- Reagen Trigliserida box-4 btl
- Reagen asam urat box-4 btl
8 Larutan amonium oksalat 1 % Botol 100 ml
9 Larutan Asam Klorida 0,1 N Botol 100 ml
10 Larutan Benedict Botol 100 ml
11 Larutan EDTA 10 % Botol 100 ml
12 Larutan Eosin Botol 100 ml
13 Larutan Giemsa Stain Botol 100 ml
14 Larutan Karbol Fuksin Botol 100 ml
15 Larutan Metanol Botol 100 ml
16 Larutan Metilen Blue Botol 100 ml
17 Larutan Natrium citrat Botol 100 ml
18 Larutan Perhidrol (H2O2) Botol 100 ml
19 Larutan Turk Botol 100 ml
20 Larutan Ziehl Neelsen set
21 Reagen pemeriksaan yodium botol
22 Reagen dan alat pengujian lab makanan 100 tes / unit
23 Rapid Diagnostic Test Malaria kit-25 tes
24 Rapid test Leptospirosis box/50 strip
25 Rapid test Chikungunya tes
26 Rapid test demam berdarah kit-25 tes
27 Tes Kehamilan
PPTEST Box 40 tes
HCG strip (answer) strip
UltraOne tes kehamilan box-50 strip
28 Trigliserida
- Accutrend) box / 25
- Multicare box / 25
29 Tes HBsAG S/P strip (Answer) box-25 strip
30 Tes HIV I & II Antibody Card (IR-100c) tes
31 Urine Test 10 Parameter btl - 100 test
32 Widal Test Tg H (SS-01) Botol 5 ml
33 Widal Test Tg O (SS-90) Botol 5 ml
34 Tes Narkoba
- Metamfetamin strip
- Cocain strip
- Cannabidoid strip
- Benzodiasepin strip
- Babiturat strip
35 Reagen Mantoux ampul
36 Tes Golongan darah
- Anti A Botol 10 ml
- Anti B Botol 10 ml
- Anti AB Botol 10 ml
36 Oil emersi botol 25 ml
IV OBAT PROGRAM MALARIA (P2M)

1 ACT (Artesunate tablet 50 mg + Amodiaquin Anhydr tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + diper tablet
3 Artemeter injeksi 1 ml 80 mg ampul
4 Artesunat injeksi vial 60 mg vial
5 Kloroquin tablet 150 mg tablet
6 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 m tablet
7 Kuinin Dihidroklorida injeksi 25% - 2 ml ampul
8 Kuinin tablet 222 mg (H2SO4.7H2O) tablet
9 Primaquin tablet 15 mg tablet
10 Doksisiklin kapsul 100 mg tablet
V OBAT PROGRAM DIARE (P2M)

1 Garam oralit serbuk kombinasi saset
2 Zink Dispersible 20 mg tablet
VI. OBAT PROGRAM FILARIA (KAKI GAJAH)

1 Dietil karbamasin sitrat tablet
VII OBAT PROGRAM KELAMIN /SIFILIS (P2M)

1 Benzatin Benzil Penisilin injeksi 2,4 juta IU vial
VIII OBAT PROGRAM KUSTA (P2M)

IX OBAT PROGRAM FLU BURUNG

1 Oseltamivir kapsul kapsul
X OBAT PROGRAM GIZI (KIA)

1 Retinol (Vitamin A) 100.000 IU kapsul lunak kapsul
3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam Ftablet 40
4 Mineral Mix saset
5 Iodol kapsul kapsul
XI. OBAT PROGRAM KECACINGAN (P2M)

1 Albendazol tablet 400 mg tablet
2 Albendazol suspensi 200 mg/5 ml botol 10 ml
3 Pirantel pamoat tablet 125 mg tablet
XII. OBAT ANTI TUBERKULOSIS

1 Obat FDC kategori 1 paket
3 Obat FDC Sisipan paket
4 OAT Anak paket
5 OAT Kombipak 1 paket
XIII. PROGRAM P2 ANTIVIRAL

Zidovudin + lamivudin (300 mg/150 mg tablet
Efavirenz 600 mg tablet
Tenofovir (TDF) 300 mg tablet
Nevirapin 200 mg tablet
XIV. PROGRAM KUSTA
Obat MDT Kusta PB Dewasa blister
Obat MDT Kusta MB Anak blister
Obat MDT Kusta MB Dewasa blister
UMUM JKN
BAYAR
JUMLAH KUNJUNNGAN RESEP
1370 1152
Mengetahui
Kepala Dinas Kesehatan Plt. Kepala UPT Instalasi Fa
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayanto, A

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1
DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
1 SEPTEMBER 2016
JML
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2
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12
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0
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40
0
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0
0
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0
0
JKN RAWAT IN AP JUMLAH
82 2604
Purworejo, .
Yang meminta Yang menerima
lt. Kepala UPT Instalasi Farmasi Kepala Puskesmas Cangkrep
. Petugas Puskesmas .
Drs. Nanang Wijayanto, Apt. ( . ( .

) )
NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002 NIP. 19671004 199312 1 002
CATATAN HARIAN PEMAKAIAN OB
SATUAN
3 Ambroksol sirup 15 mg/ml botol 60 ml
4 Ambroxol tablet 30 mg tablet 90
9 Amlodipin tablet 5 mg tablet 15
13 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 11
+ polimiksin 10.000 IU/g
20 Antifungi DOEN kombinasi : Asam Benzoat 6% + pot
22 Antimigrain : ergotamin tartrat 1 mg + kofein 60 m tablet
27 Asam folat tablet 1 mg tablet 15
48 Diazepam tablet 2 mg tablet
74 Gemfibrosil kapsul 300 mg kapsul 12
78 Gentamisin sulfat tetes mata 0,3% botol 5 ml 2
99 Ibuprofen tablet 400 mg tablet 12
107 Ketokonazol krim 2 % tube 15 gram
108 Ketokonazol tablet 200 mg tablet
117 Kloramfenikol salep kulit (Bufacetin) tube 1
118 Kloramfenikol suspensi 125 mg/5 ml botol 60 ml 4
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : 80.000-2 ampul
143 Metformin HCl tablet 500 mg tablet 10
145 Metil Prednisolon tablet 8 mg tablet 10
181 Piroksikam kapsul 20 mg tablet 20
199 Salep 2-4, Kombinasi Asam Salisilat 2% + pot
200 Belerang endap
Salisil bedak 2% 4% kotak-50 gram
204 Sefadroksil sirup kering 125 mg/5 ml botol 0
212 Simetidin tablet 200 mg tablet
214 Simvastatin tablet 30 mg tablet 20
216 Siprofloksasin tablet 500 mg tablet 50

2 Alvogyl paste dus
10 Fuji VII dus

10 Antiinfeksi kulit (luka bakar) pot
35 Obat batuk / flu sirup : Sancodryl botol 100 ml 6

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin Anhyd tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kepala Dinas Kesehatan Plt. Kepala UPT Insta
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijay

NIP. 19621204 198803 1 011 NIP. 19680601 199
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijay

NIP. 19621204 198803 1 011 NIP. 19680601 199
RIAN PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
2 SEPTEMBER 2016
1152 82 2604
Yang meminta
Plt. Kepala UPT Instalasi Farmasi Kepala Puskesmas .
Cangkrep
Drs. Nanang Wijayanto, Apt. ( . )

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
CANGKREP
JML
10
0
0
90
0
0
0
0
15
0
99
0
11
0
0
0
113
2
0
0
0
0
0
0
0
15
15
18
0
0
0
0
0
20
0
0
0
0
0
0
10
0
0
87
0
0
0
0
0
0
0
0
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
12
0
0
0
2
0
50
0
0
89
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
12
0
0
0
2
0
5
0
0
0
0
0
0
0
0
0
0
0
1
1
4
0
1
92
0
0
0
15
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
10
0
10
0
0
0
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0
12
0
0
0
86
0
0
0
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0
0
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0
0
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0
0
13
194
0
0
0
0
33
20
0
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0
0
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24
0
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0
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30
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99
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98
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6
0
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0
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0
0
0
0
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0
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0
0
0
0
0
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0
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0
0
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0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
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0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMAKA
SATUAN
17 Antasida DOEN I tablet kunyah kombinasi tablet
20 + polimiksin
41 Cetirizine kapsul 10 mg kapsul
52 Dimenhidrinat tablet 50 mg tablet
72 Furosemida tablet 40 mg tablet 5
77 Gentamisin salep mata 0,3 % botol 1
80 Glibenklamid tablet 5 mg tablet
91 Haloperidol tablet 1,5 mg tablet 20
105 Kaptopril tablet 25 mg tablet
116 Kloramfenikol salep mata 1 % tube 5 gram
120 Kloramfenikol tetes telinga 3 % botol 5 ml
122 Klorpromazin tablet salut 100 mg (HCl) tablet 10
126 Kotrimoksasol suspensi botol 60 ml 4
199 Salep 2-4, Kombinasi Asam Salisilat 2% + pot 1
200 Belerang endap
Salisil bedak 2% 4% kotak-50 gram 2

2 Alvogyl paste dus
10 Fuji VII dus

5 Antidiare sirup : Neo Kaominal botol 60 ml 3
19 Laksantia tablet 5 mg (Laxana) tablet 4
35 Obat batuk / flu sirup : Sancodryl botol 100 ml 1

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip







3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam tablet 120
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kepala Dinas Kesehatan
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes.

NIP. 19621204 198803 1 011
Kabupaten Purworejo

NIP. 19621204 198803 1 011
AN HARIAN PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
3 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
CANGKREP
JML
10
0
0
0
0
0
0
15
0
0
178
0
4
0
0
0
0
4
0
0
0
0
0
0
0
43
0
36
0
0
0
0
0
26
0
0
0
0
0
0
0
0
0
203
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
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0
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0
0
5
0
0
0
0
1
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0
0
0
0
45
0
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0
0
20
0
0
0
2
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0
0
0
0
0
0
23
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
114
10
0
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10
4
0
0
0
0
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0
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0
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0
0
0
0
0
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0
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20
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0
0
0
0
0
40
0
0
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0
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0
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0
0
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8
230
0
0
0
0
86
6
0
0
1
0
0
0
0
0
0
34
0
0
0
0
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0
1
2
0
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0
0
0
0
0
26
0
0
0
0
0
0
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0
149
0
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50
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0
0
0
3
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0
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0
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0
0
0
0
4
0
5
0
0
0
0
0
73
0
0
0
0
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0
0
0
0
0
0
0
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1
0
0
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0
0
0
0
0
0
0
0
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0
0
0
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0
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120
0
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0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
. ) ( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMAKAIAN O
SATUAN
1 Alopurinol tablet 100 mg tablet
10 Amoksisilin 500 mg + klavulanat 125 mg ta kaplet
15 Ampisilin serbuk injeksi I.M./I.V. 1000 mg/m vial
19 Antibakteri DOEN salep komb : Basitrasin tube
500 IU/g + polimiksin 10.000 IU/g
20 Antifungi DOEN kombinasi : Asam Benzoat pot
21 6% + Asam Salisilat
Antihemoroid 3%
DOEN kombinasi (Generik) supp
22 Antimigrain : ergotamin tartrat 1 mg + kofe tablet
24 Asam Asetil Salisilat tablet 100 mg (Asetosa tablet
28 Asam mefenamat kaplet 500 mg tablet
29 Asam mefenamat kaplet 250 mg Tablet 12
31 Asiklovir krim 5 % tube 5 gram 3
45 Diazepam larutan rectal 5 mg / 2,5 ml (Stesrect tube
46 Diazepam larutan rectal 10 mg / 2,5 ml (Sterect tube
57 Epinefrin (Adrenalin) injeksi 0,1 % sebagai ampul
62 Etanol 70 % botol 100 ml 5
70 Fitomenadion (Vit. K) tablet salut gula 10 tablet
95 Hidrokortison krim 2,5% tube
96 Hyoscine-N-Butilbromide tablet 10 mg (Spa tablet
101 Isosorbid dinitrat tablet sublingual 5 mg tablet 10
103 Kalsium laktat tablet 500 mg tablet
129 Larutan mengandung elektrolit : (Asering)botol 500 ml
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : 8 ampul
146 Metilergometrin Maleat injeksi 0,200 mg - ampul
155 Metronidazol infus 500 mg/100 ml botol-100 ml 1
179 Pirantel tablet score 125 mg tablet 5
191 Ranitidin tablet 150 mg tablet
199 Salep 2-4, Kombinasi Asam Salisilat 2% + pot 1
200 Belerang endap
209 Serum Anti Bisa Ular Polivalen Injeksi 5 ml vial 5 ml
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul ( vial 1.500
211 Sianokobalamin (Vitamin B12) injeksi 500 ampul

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai botol 28 gram
10 Fuji VII dus

2 Anti asma/bronkodilator nebulizer (ventolin vial
15 Antispasme/analgetik tablet : . tablet
20 Multivitamin + mineral + biotin tablet (Cavi kaplet
18 Multivitamin + mineral utk ibu hamil (Vitab kaplet
19 Multivitamin + minyak ikan (untuk ibu men kapsul
24 Multivitamin sirup + DHA (Caviplex + DHA)botol 60 ml

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
2 Alat suntik sekali pakai 2,5 ml (Stera) set 100
4 Alkohol swab box
30 Kapas pembalut/absorben 250 gram bungkus 1
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
60 Sarung tangan ukuran M sekali pakai Pcs 100
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaqui tablet
2 Arteraquin (dihydro artemisin 40 mg tablet tablet
6 Kombinasi Pirimetamin 25 mg + Sulfadoks tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 m tablet 30
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM JKN
BAYAR
1370 1152
Mengetahui
Kepala Dinas Kesehatan Plt. Kepala UPT Instalasi Far
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayanto, Ap

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1 0
Kabupaten Purworejo

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1 0
HARIAN PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
'5 SEPTEMBER 2016
82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
NGKREP
JML
0
0
0
0
0
0
0
20
26
0
109
0
4
0
0
0
107
5
0
0
0
0
0
0
0
63
120
0
12
0
3
0
0
20
0
0
0
0
0
0
0
0
0
141
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
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0
0
0
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15
0
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0
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35
0
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64
0
0
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22
0
0
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0
0
12
0
10
0
0
0
0
0
0
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0
0
0
0
0
0
0
1
0
0
0
0
123
0
0
0
50
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
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1
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0
36
0
0
0
0
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0
0
0
0
0
0
0
10
276
0
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5
104
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1
2
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1
3
0
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0
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0
30
0
10
0
10
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170
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65
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91
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100
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100
0
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0
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0
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0
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0
0
0
0
0
0
0
30
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0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMAKAIA
SATUAN
10 Amoksisilin 500 mg + klavulanat 125 mg table kaplet
18 Antasida DOEN II Suspensi, kombinasi botol-60ml
19 Antibakteri DOEN salep komb : Basitrasin 500 tube
IU/g + polimiksin 10.000 IU/g
20 Antifungi DOEN kombinasi : Asam Benzoat 6% pot
21 + Asam Salisilat
Antihemoroid 3 %kombinasi (Generik)
DOEN supp
22 Antimigrain : ergotamin tartrat 1 mg + kofein tablet
45 Diazepam larutan rectal 5 mg / 2,5 ml (Stesolid rect tube
46 Diazepam larutan rectal 10 mg / 2,5 ml (Stesoli rect tube
106 Karbamazepin tablet 200 mg tablet 15
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : 80.00 ampul
174 Parasetamol sirup 120 mg/5 ml botol
200 Belerang endap
209 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU vial 5 ml
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul (ATS vial 1.500
211 Sianokobalamin (Vitamin B12) injeksi 500 mcg ampul

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai (Cavbotol 28 gram
10 Fuji VII dus

20 Multivitamin + mineral + biotin tablet (Caviple kaplet
17 Multivitamin + mineral sirup (Recovit) botol 100 ml
19 Multivitamin + minyak ikan (untuk ibu menyusu kapsul
35 Obat batuk / flu sirup :Sancodryl botol 100 ml 9

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin An tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + d tablet
6 Kombinasi Pirimetamin 25 mg + Sulfadoksin 5 tablet

1 Garam oralit serbuk kombinasi saset 3





3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + tablet 90
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
Kabupaten Purworejo

NIP. 19621204 198803 1 011
ATAN HARIAN PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
'6 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
AS CANGKREP
JML
0
0
0
0
0
0
0
10
0
0
130
0
3
0
0
0
40
0
0
0
0
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0
0
0
14
66
0
0
0
0
0
0
36
0
0
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0
0
10
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0
75
0
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62
0
18
15
3
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0
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2
1
0
0
0
75
0
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97
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10
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66
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178
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12
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0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
90
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
. ) ( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEM
SATUAN
11 Amoksisilin kaplet 500 mg tablet
20 + polimiksin
26 Asam Askorbat (Vitamin C) tablet 50 mg tablet
34 Atapulgit tablet 600 mg tablet
36 Betahistin mesilat tablet 6 mg
39 Bisakodil suppositoria 5 mg (Dulcolax)
44 Deksametason tablet 0,5 mg tablet
83 Gliseril Guayakolat tablet 100 mg tablet
121 Klorfeniramin maleat (CTM) tablet 4 mg tablet
125 Kotrimoksasol DOEN I (dewasa) komb. tablet
175 Parasetamol tablet 500 mg tablet
180 Piridoksin (Vit. B6) tablet 10 mg tablet
200 Belerang endap
225 Tiamin (Vitamin B1) tablet 50 mg tablet
230 Vitamin B Kompleks tablet tablet

2 Alvogyl paste dus
10 Fuji VII dus

27 Multivitamin kaplet (VITALAMIN) kaplet
35 Obat batuk / flu sirup :Samcodryl botol 100 ml

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip







3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
CATATAN HARIAN PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
7 SEPTEMBER 2016
XXH
20
20
60
80
2
36
12
159
NB
11
1
21
18
1
1
2
34
1
40
7
218
86
18
30
2
3
23
120
2
6
87
3
1152 82 2604
Yang meminta

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
SMAS CANGKREP
JML
20
0
0
0
0
0
0
20
0
0
60
#VALUE!
1
0
0
0
80
2
0
0
0
0
0
0
0
36
12
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
159
0
#VALUE!
0
0
#VALUE!
0
#VALUE!
0
0
11
0
0
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0
0
0
0
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0
0
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1
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21
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18
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1
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34
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40
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0
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7
218
0
0
0
0
86
0
0
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0
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0
0
0
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18
0
0
0
0
0
0
30
2
3
0
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23
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120
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2
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6
0
0
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0
0
87
0
0
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0
0
0
0
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0
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0
0
0
0
0
JUMLAH
Purworejo, .
ng meminta Yang menerima
Cangkrep Petugas Puskesmas .
. ) ( . )
1004 199312 1 002 NIP. 19671004 199312 1 002
SATUAN
10 Amoksisilin 500 mg + klavulanat 125 mg tab kaplet
Antihemoroid 3%
24 Asam Asetil Salisilat tablet 100 mg (Asetosal tablet
45 Diazepam larutan rectal 5 mg / 2,5 ml (Steso rect tube
46 Diazepam larutan rectal 10 mg / 2,5 ml (Stes rect tube
57 Epinefrin (Adrenalin) injeksi 0,1 % sebagai H ampul
70 Fitomenadion (Vit. K) tablet salut gula 10 m tablet
96 Hyoscine-N-Butilbromide tablet 10 mg (Spas tablet
146 Metilergometrin Maleat injeksi 0,200 mg - 1 ampul
200 Belerang endap
209 Serum Anti Bisa Ular Polivalen Injeksi 5 ml ( vial 5 ml
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul (A vial 1.500
211 Sianokobalamin (Vitamin B12) injeksi 500 m ampul

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai ( botol 28 gram
10 Fuji VII dus

18 Multivitamin + mineral utk ibu hamil (Vitabi kaplet
19 Multivitamin + minyak ikan (untuk ibu meny kapsul
33 Obat Antiflu kombinasi (Tremenza) botol 60 ml 2

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin tablet
6 Kombinasi Pirimetamin 25 mg + Sulfadoksi tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
8 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
AS CANGKREP
JML
0
0
0
0
0
0
0
10
0
0
95
0
3
0
0
0
120
2
0
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0
10
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30
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67
2
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133
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0
0
0
0
0
0
0
0
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0
0
0
0
0
0
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0
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0
0
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0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
20 IU/g + polimiksin
Antifungi 10.000 IU/g
DOEN kombinasi : Asam Benzoat 6% pot
21 + Asam Salisilat
DOEN supp
33 Asiklovir tablet 400 mg tablet 10
37 Betametason cream 0,1 % tube 3
100 Isoniasida tablet 100 mg tablet 0
119 Kloramfenikol tetes mata 0,5 % botol 5 ml 1
200 Belerang endap

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai (Cav botol 28 gram
10 Fuji VII dus

18 Multivitamin + mineral utk ibu hamil (Vitabion) kaplet 34
19 Multivitamin + minyak ikan (untuk ibu menyusu kapsul
33 Obat Antiflu kombinasi (Tremenza) botol 60 ml 1
35 Obat batuk / flu sirup : Sancodril botol 100 ml 5

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin An tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + d tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
9 SEPTEMBER 2016
34
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
CANGKREP
JML
0
0
4
0
0
0
0
25
0
0
131
0
0
0
0
0
80
0
0
0
0
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0
0
50
40
0
0
0
1
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10
10
0
0
3
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73
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56
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179
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0
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0
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0
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0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
20 + polimiksin
23 Aqua pro injeksi steril, bebas pirogen vial 16
200 endap 4%

2 Alvogyl paste dus
10 Fuji VII dus

19 Multivitamin + minyak ikan (untuk ibu menyusui) Nu kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin Anhydra tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + dipera tablet
6 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam Fotablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
10 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
CANGKREP
JML
0
0
0
0
0
0
0
10
0
0
70
0
7
0
0
0
68
0
0
0
0
0
16
0
0
80
20
0
62
0
0
0
0
20
0
0
0
0
0
0
0
0
0
151
0
0
0
0
0
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148
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12
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30
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40
0
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0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
6 Aminofilin tablet 200 mg tablet 10
10 Amoksisilin 500 mg + klavulanat 125 m kaplet
14 Amoksisilin sirup kering forte 250 mg/ Botol 60 ml
15 Ampisilin serbuk injeksi I.M./I.V. 1000 vial
17 Antasida DOEN I tablet kunyah kombin tablet
19 Antibakteri DOEN salep komb : tube
Basitrasin 500 IU/g +
20 Antifungi DOEN kombinasi : Asam polimiksin pot
21 Benzoat 6% +DOEN
Antihemoroid Asam kombinasi
Salisilat 3 %
(Generi supp
22 Antimigrain : ergotamin tartrat 1 mg + tablet
24 Asam Asetil Salisilat tablet 100 mg (As tablet
26 Asam Askorbat (Vitamin C) tablet 50 m tablet 50
45 Dekstrometorfan sirup 10 mg/5 ml (HB botol 60 ml
45 Diazepam larutan rectal 5 mg / 2,5 ml ( rect tube
46 Diazepam larutan rectal 10 mg / 2,5 ml rect tube
49 Difenhidramin injeksi i.m. 10 mg/ml (H ampul 40
57 Epinefrin (Adrenalin) injeksi 0,1 % seb ampul
70 Fitomenadion (Vit. K) tablet salut gula tablet
92 Haloperidol tablet 2 mg tablet 20
94 Hidroklorotiazida tablet 25 mg tablet 2
96 Hyoscine-N-Butilbromide tablet 10 mg tablet
101 Isosorbid dinitrat tablet sublingual 5 m tablet
121 Klorfeniramin maleat (CTM) tablet 4 m tablet 177
129 Larutan mengandung elektrolit : (Aseri botol 500 ml
130 Larutan mengandung elektrolit : (KAENbotol 500 ml
131 Larutan mengandung elektrolit : (KAENbotol 500 ml
134 Lidokain injeksi 2 % (HCl) + epinefrin ampul
136 Lisol, mengandung kresol tersabun 50botol 1000 ml
146 Metilergometrin Maleat injeksi 0,200 m ampul
147 Metilergometrin maleat tablet 0,125 m tablet
152 Metronidasol sirup 125 mg/5 ml (Novagbotol 60 ml
159 Natrium Klorida Larutan Infus 0,9% sterbotol-500 ml
163 Obat Batuk Hitam (OBH) cairan botol-100 ml 3
164 Oksitetrasiklin injeksi i.m. 50 mg/ml-1 vial
199 Salep 2-4, Kombinasi Asam Salisilat pot
200 2% + Belerang
Salisil bedak 2%endap 4% kotak-50 gram
209 Serum Anti Bisa Ular Polivalen Injeksi 5 vial 5 ml
210 Serum Anti Tetanus Injeksi 1500 IU/Am vial 1.500
211 Sianokobalamin (Vitamin B12) injeksi ampul

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pa botol 28 gram
10 Fuji VII dus
12 Gutta percha dan papper point : 15 - 4kotak/pasang
13 Gutta percha dan papper point : 45 - 6kotak/pasang
20 Temporary stoping fletcher serbuk+cai botol @ 100 gram

1 Anti asma/bronkodilator inhalasi (vento vial
2 Anti asma/bronkodilator nebulizer (vent vial
3 Antibiotik injeksi serbuk (seftriakson 1 vial
4 Antidiare sirup : . botol 60 ml
15 Antispasme/analgetik tablet : tablet
20 Multivitamin + mineral + biotin tablet kaplet
18 Multivitamin + mineral utk ibu hamil (V kaplet
19 Multivitamin + minyak ikan (untuk ibu kapsul
24 Multivitamin sirup + DHA (Caviplex + botol 60 ml
34 Obat Antiulkus peptikum tablet (Nucral tablet
35 Obat batuk / flu sirup : botol 100 ml
45 Obat batuk / flu sirup : Samcodryl botol 60 ml 10

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
37 Kasa pembalut hidrofil 4 m x 15 cm ela rol
38 Kasa pembalut hidrofil 4 m x 3 cm elas rol
47 - Volume 100 - 1000 uL set
54 Plester kain 1,25 cm x 4,5 m (Leukopla Rol
55 Pot sputum buah
62 Silk (benang bedah sutera no 2/0 dg j kotak
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
5 Occu check (alat pemegang lancet RO kit
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
22 Reagen dan alat pengujian lab makana100 tes / unit
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodi tablet
2 Arteraquin (dihydro artemisin 40 mg ta tablet
6 Kombinasi Pirimetamin 25 mg + Sulfa tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM JKN
BAYAR
1370 1152
Mengetahui
Kepala Dinas Kesehatan Plt. Kepala UPT Instalasi Farma
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayanto, Apt.

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1 002
13 SEPTEMBER 2016
82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
ANGKREP
JML
10
0
0
0
0
10
0
32
0
0
248
0
4
0
0
0
0
1
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0
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50
4
0
30
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10
0
0
1
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90
0
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177
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
SATUAN
20 + polimiksin
200 endap 4%

2 Alvogyl paste dus
10 Fuji VII dus

19 Multivitamin + minyak ikan (untuk ibu menyusui) Nu kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

2 Arteraquin (dihydro artemisin 40 mg tablet + dipera tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam Fotablet 20
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
14 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
CANGKREP
JML
30
0
0
0
0
20
0
30
0
0
115
0
3
0
0
0
46
1
0
0
0
0
0
0
0
66
0
0
12
0
0
0
0
40
0
0
1
0
0
0
10
0
0
194
0
0
0
0
0
0
0
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
10
0
0
1
0
0
0
0
0
37
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12
0
0
0
16
0
0
10
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
102
0
0
0
13
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
156
0
0
0
0
46
6
0
0
0
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
12
0
0
0
30
0
0
0
0
0
0
0
0
70
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
105
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
21 + Asam Salisilat
DOEN supp
22 Antimigrain : ergotamin tartrat 1 mg + kofein 60 tablet
141 Mekobalamin tablet 500 mg tablet 10
156 Mikonazol krim 2 % tube 1
177 Piracetam 800 mg tablet tablet 10
200 Belerang endap
209 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I vial 5 ml
211 Sianokobalamin (Vitamin B12) injeksi 500 mcg/m ampul
228 Triheksifenidil tablet 2 mg tablet 40

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai (Cavit botol 28 gram
10 Fuji VII dus

19 Multivitamin + minyak ikan (untuk ibu menyusui kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin Anh tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + di tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + As tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
15 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
CANGKREP
JML
10
0
3
0
0
0
0
0
5
0
86
0
3
0
0
0
32
1
0
0
0
0
0
0
0
70
20
0
24
0
0
0
0
30
0
0
0
0
0
0
0
0
0
65
0
0
0
0
0
5
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
5
0
20
0
0
0
0
0
15
0
0
10
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
12
0
0
0
40
0
10
20
1
0
0
0
0
0
0
0
0
0
1
0
0
0
0
35
20
0
0
34
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
42
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
82
0
10
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12
0
0
0
10
0
0
0
0
0
0
0
0
164
0
0
40
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
42
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMAKAIAN
SATUAN
10 Amoksisilin 500 mg + klavulanat 125 mg t kaplet
15 Ampisilin serbuk injeksi I.M./I.V. 1000 mg/ vial
500 IU/g + polimiksin 10.000
20 Antifungi DOEN kombinasi : Asam IU/g pot
21 Benzoat 6% +DOEN
Salisilat 3 %
(Generik) supp
22 Antimigrain : ergotamin tartrat 1 mg + kof tablet
24 Asam Asetil Salisilat tablet 100 mg (Asetos tablet
45 Diazepam larutan rectal 5 mg / 2,5 ml (Ste rect tube
46 Diazepam larutan rectal 10 mg / 2,5 ml (St rect tube
130 Larutan mengandung elektrolit : (KAEN 3A botol 500 ml
131 Larutan mengandung elektrolit : (KAEN 3B botol 500 ml
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : ampul
200 Belerang endap
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul vial 1.500
223 Tiamfenikol kapsul 500 mg kapsul 20

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakaibotol 28 gram
10 Fuji VII dus

2 Anti asma/bronkodilator nebulizer (ventoli vial
20 Multivitamin + mineral + biotin tablet (Cav kaplet
18 Multivitamin + mineral utk ibu hamil (Vita kaplet
19 Multivitamin + minyak ikan (untuk ibu me kapsul
24 Multivitamin sirup + DHA (Caviplex + DHA botol 60 ml

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
27 IV catheter No. 22 G buah 50
28 IV catheter No. 24 G buah 50
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
5 Occu check (alat pemegang lancet ROCHE kit
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaqu tablet
2 Arteraquin (dihydro artemisin 40 mg table tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM JKN
BAYAR
1370 1152
Mengetahui
Kepala Dinas Kesehatan Plt. Kepala UPT Instalasi F
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayanto

NIP. 19621204 198803 1 011 NIP. 19680601 199312
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayanto

NIP. 19621204 198803 1 011 NIP. 19680601 199312
ARIAN PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
16 SEPTEMBER 2016
82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
GKREP
JML
0
0
0
0
0
0
0
20
0
0
60
0
8
0
0
0
106
2
0
0
0
0
0
0
0
30
30
0
20
0
0
0
0
10
0
0
0
0
0
0
0
0
0
62
0
0
0
0
0
0
0
0
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
10
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
20
0
0
0
1
0
0
0
0
0
0
0
0
0
0
1
3
0
0
94
0
0
0
30
1
0
0
0
0
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
0
0
6
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
5
240
0
0
0
0
18
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
1
0
0
0
0
0
0
0
0
0
0
0
24
0
0
0
0
0
0
0
0
0
0
20
0
120
0
0
0
0
0
0
0
0
0
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
45
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
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
( . )
NIP. 19671004 199312 1 002
SATUAN
10 Amoksisilin 500 mg + klavulanat 125 mg t kaplet
15 Ampisilin serbuk injeksi I.M./I.V. 1000 mg/ vial
500 IU/g + polimiksin 10.000
20 Antifungi DOEN kombinasi : Asam IU/g pot
21 Benzoat 6% +DOEN
Salisilat 3 %
(Generik) supp
22 Antimigrain : ergotamin tartrat 1 mg + ko tablet
24 Asam Asetil Salisilat tablet 100 mg (Asetos tablet
46 Diazepam larutan rectal 10 mg / 2,5 ml (St rect tube
96 Hyoscine-N-Butilbromide tablet 10 mg (Sp tablet
130 Larutan mengandung elektrolit : (KAEN 3A botol 500 ml
131 Larutan mengandung elektrolit : (KAEN 3B botol 500 ml
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : ampul
200 Belerang endap
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul vial 1.500
228 Triheksifenidil tablet 2 mg tablet 10

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakaibotol 28 gram
10 Fuji VII dus

2 Anti asma/bronkodilator nebulizer (ventoli vial
6 Antidiare Tablet : .. tablet 45
20 Multivitamin + mineral + biotin tablet (Ca kaplet
18 Multivitamin + mineral utk ibu hamil (Vita kaplet
19 Multivitamin + minyak ikan (untuk ibu me kapsul
24 Multivitamin sirup + DHA (Caviplex + DHA botol 60 ml

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
62 Silk (benang bedah sutera no 2/0 dg jaru kotak
63 Silk (benang bedah sutera no 3/0 dg jaru kotak
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
5 Occu check (alat pemegang lancet ROCHE kit
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaqu tablet
2 Arteraquin (dihydro artemisin 40 mg table tablet
6 Kombinasi Pirimetamin 25 mg + Sulfadok tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM JKN
BAYAR
1370 1152
Mengetahui
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayanto,

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1
Kabupaten Purworejo

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1
17 SEPTEMBER 2016
82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
NGKREP
JML
20
0
0
0
0
0
0
0
15
0
65
0
4
0
0
0
114
0
0
0
0
0
0
0
0
20
10
0
6
0
0
0
0
0
0
0
2
0
0
0
0
0
0
101
0
0
0
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
30
0
0
3
0
0
50
0
0
30
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
22
0
0
0
20
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
56
3
0
0
13
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
60
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
177
0
0
0
0
152
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
1
0
0
0
0
0
0
0
0
0
0
0
24
0
10
0
40
0
0
0
0
0
0
0
0
158
0
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
1
45
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
46
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
( . )
NIP. 19671004 199312 1 002
SATUAN
10 Amoksisilin 500 mg + klavulanat 125 m kaplet
14 Amoksisilin sirup kering forte 250 mg/5 Botol 60 ml
17 Antasida DOEN I tablet kunyah kombina tablet 100
Basitrasin 500 IU/g +
20 Antifungi DOEN kombinasi : Asam polimiksin pot
21 Benzoat 6% +DOEN
Salisilat 3 %
(Generik supp
22 Antimigrain : ergotamin tartrat 1 mg + tablet
24 Asam Asetil Salisilat tablet 100 mg (Ase tablet
26 Asam Askorbat (Vitamin C) tablet 50 m tablet 55
45 Dekstrometorfan sirup 10 mg/5 ml (HBr botol 60 ml
45 Diazepam larutan rectal 5 mg / 2,5 ml ( rect tube
49 Difenhidramin injeksi i.m. 10 mg/ml (HC ampul
56 Ekstraks beladona tablet 10 mg tablet 3
57 Epinefrin (Adrenalin) injeksi 0,1 % seba ampul
70 Fitomenadion (Vit. K) tablet salut gula tablet
101 Isosorbid dinitrat tablet sublingual 5 m tablet
121 Klorfeniramin maleat (CTM) tablet 4 m tablet 183
129 Larutan mengandung elektrolit : (Aseri botol 500 ml
130 Larutan mengandung elektrolit : (KAEN botol 500 ml
131 Larutan mengandung elektrolit : (KAEN botol 500 ml
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 ampul
136 Lisol, mengandung kresol tersabun 50 botol 1000 ml
146 Metilergometrin Maleat injeksi 0,200 m ampul
147 Metilergometrin maleat tablet 0,125 m tablet
152 Metronidasol sirup 125 mg/5 ml (Novag botol 60 ml
159 Natrium Klorida Larutan Infus 0,9% ster botol-500 ml
199 Salep 2-4, Kombinasi Asam Salisilat pot 2
200 2% + Belerang
Salisil bedak 2%endap 4% kotak-50 gram
209 Serum Anti Bisa Ular Polivalen Injeksi 5 vial 5 ml
210 Serum Anti Tetanus Injeksi 1500 IU/Amp vial 1.500

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pabotol 28 gram
10 Fuji VII dus
20 Temporary stoping fletcher serbuk+cai botol @ 100 gram

1 Anti asma/bronkodilator inhalasi (ventol vial
2 Anti asma/bronkodilator nebulizer (vent vial
18 Multivitamin + mineral utk ibu hamil (V kaplet
19 Multivitamin + minyak ikan (untuk ibu kapsul
34 Obat Antiulkus peptikum tablet (Nucral tablet
35 Obat batuk / flu sirup : botol 100 ml

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
38 Kasa pembalut hidrofil 4 m x 3 cm elast rol
47 - Volume 100 - 1000 uL set
54 Plester kain 1,25 cm x 4,5 m (Leukoplas Rol
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
5 Occu check (alat pemegang lancet RO kit
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
22 Reagen dan alat pengujian lab makana 100 tes / unit
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodi tablet
2 Arteraquin (dihydro artemisin 40 mg ta tablet
6 Kombinasi Pirimetamin 25 mg + Sulfad tablet






4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
19 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
AS CANGKREP
JML
10
0
0
0
0
0
0
30
0
0
130
0
2
0
0
0
100
1
0
0
0
0
0
0
0
55
0
0
12
0
1
0
0
0
0
0
0
0
0
0
10
0
0
70
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
20
0
0
0
0
0
65
0
0
106
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
2
0
1
0
183
0
0
0
10
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
0
0
0
0
0
0
0
29
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
80
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
2
0
0
0
0
0
0
0
0
0
0
0
0
42
30
0
0
20
0
0
0
0
0
0
0
0
180
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
0
0
0
0
0
86
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMAK
SATUAN
20 + polimiksin
88 Griseofulvin tablet 125 mg micronized tablet 15
101 Isosorbid dinitrat tablet sublingual 5 mg tablet 20
141 Mekobalamin tablet 500 mg tablet 20
148 Metoklopramid injeksi 5 mg/ml ampul 4
200 endap 4%

2 Alvogyl paste dus
10 Fuji VII dus


1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip







3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam Ftablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
N HARIAN PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
20 SEPTEMBER 2016
3 9,999
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
CANGKREP
JML
0
0
0
0
0
0
0
40
0
0
103
0
2
0
0
0
63
3
0
0
0
0
0
0
0
90
50
0
54
0
1
0
0
30
0
0
1
0
0
0
0
0
0
69
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15
0
30
0
0
0
0
0
20
0
0
0
0
0
0
0
15
0
0
0
20
0
0
0
0
0
0
12
0
20
0
103
0
56
35
0
0
0
0
0
0
0
0
0
0
1
0
1
1
1
84
10
0
0
44
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
10
0
0
0
0
4
0
0
0
0
0
0
0
2
0
54
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
195
0
0
0
0
143
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
18
0
0
0
30
0
0
0
0
0
0
10,037
0
254
0
0
0
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
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
34
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
20 + polimiksin
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : 80.000-2 ml ampul
195 Risperidon tablet 3
200 endap 4%
Salisil bedak 2% kotak-50 gram

2 Alvogyl paste dus
10 Fuji VII dus

19 Multivitamin + minyak ikan (untuk ibu menyusui) Nul kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

2 Arteraquin (dihydro artemisin 40 mg tablet + diperaq tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam Foltablet 30
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
TAN HARIAN PEMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
24 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
S CANGKREP
JML
0
0
0
0
0
0
0
0
0
0
111
0
0
0
0
0
99
2
0
0
0
0
0
0
0
80
11
0
0
0
0
0
0
32
0
0
0
0
0
0
0
0
0
48
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
11
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
71
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
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0
133
0
0
0
20
3
0
0
0
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0
0
0
0
0
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10
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18
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5
200
0
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44
6
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30
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20
0
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0
120
0
0
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0
30
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0
0
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0
0
0
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0
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1
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
3
0
0
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0
0
29
0
0
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0
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0
0
2
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0
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0
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0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
10 Amoksisilin 500 mg + klavulanat 125 kaplet
14 Amoksisilin sirup kering forte 250 mg/ Botol 60 ml
17 Antasida DOEN I tablet kunyah kombin tablet 86
20 Basitrasin 500 IU/g
Antifungi DOEN + polimiksin
kombinasi : Asam pot
21 Benzoat 6% +DOEN
Salisilat 3 %
(Generi supp
22 Antimigrain : ergotamin tartrat 1 mg tablet
23 Aqua pro injeksi steril, bebas pirogen vial 12
24 Asam Asetil Salisilat tablet 100 mg (A tablet
26 Asam Askorbat (Vitamin C) tablet 50 tablet 48
45 Dekstrometorfan sirup 10 mg/5 ml (HB botol 60 ml
49 Difenhidramin injeksi i.m. 10 mg/ml (H ampul
57 Epinefrin (Adrenalin) injeksi 0,1 % seb ampul
70 Fitomenadion (Vit. K) tablet salut gul tablet
101 Isosorbid dinitrat tablet sublingual 5 tablet
116 Kloramfenikol kapsul 250 mg (Licoklor kapsul
121 Klorfeniramin maleat (CTM) tablet 4 tablet 59
122 Klorpromazin tablet salut 100 mg (HCl tablet
129 Larutan mengandung elektrolit : (Aser botol 500 ml
130 Larutan mengandung elektrolit : (KAE botol 500 ml
131 Larutan mengandung elektrolit : (KAE botol 500 ml
134 Lidokain injeksi 2 % (HCl) + epinefrin ampul
136 Lisol, mengandung kresol tersabun 5 botol 1000 ml
146 Metilergometrin Maleat injeksi 0,200 ampul
147 Metilergometrin maleat tablet 0,125 tablet
152 Metronidasol sirup 125 mg/5 ml (Nova botol 60 ml
159 Natrium Klorida Larutan Infus 0,9% ste botol-500 ml
199 Salep 2-4, Kombinasi Asam Salisilat pot
200 2% + Belerang
Salisil bedak 2%endap 4% kotak-50 gram 1
206 Sefotaksim serbuk injeksi 1000 mg/via vial
209 Serum Anti Bisa Ular Polivalen Injeksi vial 5 ml
210 Serum Anti Tetanus Injeksi 1500 IU/Am vial 1.500
222 Tetrasiklin kapsul 500 mg kapsul 20

2 Alvogyl paste dus
5 Bahan pensteril gigi : Trikresol formali botol
6 Bahan tambalan sementara gigi siap pbotol 28 gram
10 Fuji VII dus
12 Gutta percha dan papper point : 15 - kotak/pasang
13 Gutta percha dan papper point : 45 - kotak/pasang
20 Temporary stoping fletcher serbuk+ca botol @ 100 gram

1 Anti asma/bronkodilator inhalasi (vent vial
2 Anti asma/bronkodilator nebulizer (ven vial
4 Antidiare sirup : . botol 60 ml
17 Antispasme/analgetik tablet (SCOPMA tablet
18 Multivitamin + mineral utk ibu hamil ( kaplet
19 Multivitamin + minyak ikan (untuk ib kapsul
21 Multivitamin kaplet : kaplet
34 Obat Antiulkus peptikum tablet (Nucra tablet
35 Obat batuk / flu sirup : Samcodryl botol 100 ml

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
37 Kasa pembalut hidrofil 4 m x 15 cm el rol
47 - Volume 100 - 1000 uL set
54 Plester kain 1,25 cm x 4,5 m (Leukopla Rol
55 Pot sputum buah
62 Silk (benang bedah sutera no 2/0 dg kotak
63 Silk (benang bedah sutera no 3/0 dg kotak
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
5 Occu check (alat pemegang lancet R kit
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
22 Reagen dan alat pengujian lab makan 100 tes / unit
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amod tablet
2 Arteraquin (dihydro artemisin 40 mg t tablet
6 Kombinasi Pirimetamin 25 mg + Sulfa tablet
7 Kuinin Dihidroklorida injeksi 25% - 2 m ampul






4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM JKN
BAYAR
1370 1152
Mengetahui
Kepala Dinas Kesehatan Plt. Kepala UPT Instalasi Farm
Kabupaten Purworejo

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1 00
21 SEPTEMBER 2016
82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
NGKREP
JML
10
0
0
0
0
0
0
0
0
0
50
0
6
0
0
0
86
2
0
0
0
0
12
0
0
48
61
0
30
0
0
0
0
26
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
6
0
0
0
0
2
2
0
30
0
0
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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6
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18
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36
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0
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1
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1
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59
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12
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36
0
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0
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0
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0
0
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6
231
0
0
0
0
40
0
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0
0
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26
0
0
0
0
0
0
10
0
1
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0
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6
15
0
0
40
0
0
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20
20
0
0
0
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36
0
0
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121
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0
0
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0
0
0
0
0
0
0
0
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0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMAKAI
SATUAN
20 Antifungi DOEN kombinasi : Asam Benzoat 6% pot
21 + Asam Salisilat
DOEN supp
88 Griseofulvin tablet 125 mg micronized tablet 10
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : 80.000- ampul
169 Omeprazol kapsul 20 mg kapsul 6
200 Belerang endap

2 Alvogyl paste dus
10 Fuji VII dus

19 Multivitamin + minyak ikan (untuk ibu menyusui) kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin Anhy tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + dip tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asa tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
22 SEPTEMBER 2016
20
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
S CANGKREP
JML
10
0
0
0
0
0
0
26
0
0
180
0
2
0
0
0
74
2
0
0
0
0
0
0
0
38
0
0
91
0
0
0
0
10
0
0
3
0
0
0
0
0
0
98
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
2
0
25
0
0
0
0
0
55
0
0
50
0
0
0
0
10
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
1
0
98
0
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40
2
0
0
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1
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30
0
0
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0
0
0
0
0
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6
0
0
0
0
0
119
0
0
0
0
70
18
0
0
0
0
0
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0
24
0
0
0
0
0
0
0
0
1
0
0
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0
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0
0
0
0
0
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40
0
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20
0
135
0
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35
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1
0
0
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2
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17
0
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0
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0
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3
0
0
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0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
10 Amoksisilin 500 mg + klavulanat 125 mg ta kaplet
15 Ampisilin serbuk injeksi I.M./I.V. 1000 mg/m vial
20 500 IU/g +
Antifungi polimiksin
DOEN 10.000
kombinasi IU/g Benzoat
: Asam pot
Antihemoroid 3%
24 Asam Asetil Salisilat tablet 100 mg (Asetosa tablet
45 Diazepam larutan rectal 5 mg / 2,5 ml (Stes rect tube
200 Belerang endap
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul ( vial 1.500

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai botol 28 gram
10 Fuji VII dus

2 Anti asma/bronkodilator nebulizer (ventolin vial
18 Multivitamin + mineral utk ibu hamil (Vitab kaplet 57
19 Multivitamin + minyak ikan (untuk ibu men kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaqui tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 m tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM JKN
BAYAR
1370 1152
Mengetahui
Kepala Dinas Kesehatan Plt. Kepala UPT Instala
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayan

NIP. 19621204 198803 1 011 NIP. 19680601 19931
23 SEPTEMBER 2016
82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
GKREP
JML
10
0
0
0
0
0
0
0
0
0
60
0
3
0
0
0
110
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
2
0
0
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131
0
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20
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23
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6
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61
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63
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3
138
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10
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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
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
57
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMAKAI
SATUAN
Antihemoroid 3%
46 Diazepam larutan rectal 10 mg / 2,5 ml (Stesol rect tube
57 Epinefrin (Adrenalin) injeksi 0,1 % sebagai HCl ampul
96 Hyoscine-N-Butilbromide tablet 10 mg (Spashi tablet
146 Metilergometrin Maleat injeksi 0,200 mg - 1 m ampul
200 Belerang endap
209 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (AB vial 5 ml

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai (Ca botol 28 gram
10 Fuji VII dus

18 Multivitamin + mineral utk ibu hamil (Vitabion kaplet
19 Multivitamin + minyak ikan (untuk ibu menyus kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin A tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + tablet
6 Kombinasi Pirimetamin 25 mg + Sulfadoksin tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
Kabupaten Purworejo

NIP. 19621204 198803 1 011
26 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
S CANGKREP
JML
20
0
0
0
0
0
0
65
0
0
158
0
2
0
0
0
110
3
0
0
0
0
0
0
0
30
0
0
36
0
0
0
0
30
0
0
0
0
0
0
0
0
0
126
0
0
0
0
0
0
0
0
0
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
4
0
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
16
10
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
134
0
0
0
10
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
0
0
0
0
0
0
0
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
214
0
0
0
0
86
0
0
0
1
0
0
0
0
0
0
6
0
0
0
0
0
0
10
0
1
0
0
0
0
0
0
0
0
0
0
0
6
0
10
0
0
0
0
0
0
0
0
0
0
140
0
0
0
0
56
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
62
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
10 Amoksisilin 500 mg + klavulanat 125 mg tab kaplet
14 Amoksisilin sirup kering forte 250 mg/5 ml Botol 60 ml 7
Antihemoroid 3%
22 Antimigrain : ergotamin tartrat 1 mg + kofei tablet
24 Asam Asetil Salisilat tablet 100 mg (Asetosal tablet
45 Diazepam larutan rectal 5 mg / 2,5 ml (Stesolrect tube
46 Diazepam larutan rectal 10 mg / 2,5 ml (Stesorect tube
57 Epinefrin (Adrenalin) injeksi 0,1 % sebagai HC ampul
96 Hyoscine-N-Butilbromide tablet 10 mg (Spash tablet
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : 80. ampul
146 Metilergometrin Maleat injeksi 0,200 mg - 1 ampul
200 Belerang endap
209 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (A vial 5 ml
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul (A vial 1.500
211 Sianokobalamin (Vitamin B12) injeksi 500 m ampul

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai botol
(C 28 gram
10 Fuji VII dus

20 Multivitamin + mineral + biotin tablet (Cavip kaplet
18 Multivitamin + mineral utk ibu hamil (Vitabio kaplet
19 Multivitamin + minyak ikan (untuk ibu menyu kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + tablet
6 Kombinasi Pirimetamin 25 mg + Sulfadoksin tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM JKN
BAYAR
1370 1152
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1
Kabupaten Purworejo

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1
27 SEPTEMBER 2016
82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
NGKREP
JML
15
0
0
0
0
6
0
0
0
0
86
0
0
7
0
0
103
4
0
0
0
0
0
0
0
0
40
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
78
0
0
0
0
0
0
0
0
0
5
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
1
0
0
0
0
30
0
0
0
0
0
0
0
0
30
0
0
0
0
0
0
36
0
0
0
83
0
20
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
68
15
0
0
25
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
36
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
138
0
0
0
0
0
6
0
0
0
0
0
0
0
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
20
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
( . )
NIP. 19671004 199312 1 002
SATUAN
21 + Asam Salisilat
DOEN supp
200 Belerang endap

2 Alvogyl paste dus
6 Bahan tambalan sementara gigi siap pakai (Cavi botol 28 gram
10 Fuji VII dus


1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip







3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + As tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
Kabupaten Purworejo

NIP. 19621204 198803 1 011
28 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
S CANGKREP
JML
60
0
0
0
0
0
0
5
0
0
50
0
2
0
0
0
84
0
0
0
0
0
0
0
0
40
20
0
18
0
0
0
0
40
0
0
0
0
0
0
0
0
0
117
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
0
1
0
10
0
0
28
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
37
0
0
0
20
1
0
0
0
0
0
0
0
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
163
0
0
0
0
96
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
48
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
0
0
0
0
0
0
0
0
0
0
150
0
0
0
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
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
#VALUE!
0
81
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
. ) ( . )
NIP. 19671004 199312 1 002
SATUAN
21 + Asam Salisilat
DOEN supp
33 Asiklovir tablet 400 mg tablet 10
70 Fitomenadion (Vit. K) tablet salut gula 10 mg tablet 6
200 Belerang endap

2 Alvogyl paste dus
10 Fuji VII dus


1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip







3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + As tablet 30
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
Kabupaten Purworejo

NIP. 19621204 198803 1 011
29 SEPTEMBER 2016
1152 82 2604
Yang meminta
Cangkrep

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
CANGKREP
JML
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
0
40
3
0
0
0
0
0
0
0
53
0
0
42
0
3
0
10
10
0
0
2
0
0
0
0
0
0
152
0
0
0
0
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
6
0
0
0
36
0
0
0
0
0
10
0
0
50
0
0
0
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0
0
0
10
0
0
0
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0
0
0
0
0
70
0
16
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0
0
115
5
0
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70
2
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0
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0
0
10
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20
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1
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44
0
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4
0
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0
0
0
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0
0
0
1
139
0
0
0
0
56
6
0
0
0
0
0
0
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0
12
0
0
0
0
0
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130
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0
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0
0
0
0
0
0
0
0
14
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JUMLAH
Purworejo, .
Yang menerima
Petugas Puskesmas .
. ) ( . )
NIP. 19671004 199312 1 002
. ) ( . )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMA
SATUAN
19 Antibakteri DOEN salep komb : Basitrasin 500 IU/g + tube
20 polimiksin 10.000kombinasi
Antifungi DOEN IU/g : Asam Benzoat 6% + pot
22 Antimigrain : ergotamin tartrat 1 mg + kofein 60 mg t tablet
200 endap 4%

2 Alvogyl paste dus
10 Fuji VII dus

19 Multivitamin + minyak ikan (untuk ibu menyusui) Nul kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin Anhydrat tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + diperaq tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam Fol tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
Kabupaten Purworejo

NIP. 19621204 198803 1 011
30 SEPTEMBER 2016
10
21
68
102
2
35
36
1
94
26
20
14
16
4
1
2
91
30
1
10
10
60
4
120
121
6
26
18
10
20
25
116
4
52
Repl 20 ltr
60
1152 82 2604
Yang meminta

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
KESMAS CANGKREP
JML
10
0
0
0
0
0
0
21
0
0
68
0
1
0
0
0
102
2
0
0
0
0
0
0
0
35
0
0
36
0
0
0
0
0
0
0
1
0
0
0
0
0
0
94
0
0
0
0
0
26
0
0
0
6
0
0
0
0
0
0
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0
0
0
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0
0
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6
0
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20
0
0
14
0
0
0
0
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0
0
0
0
0
0
1
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0
0
0
16
0
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0
0
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4
1
2
0
91
0
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0
30
1
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0
0
0
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0
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10
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60
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4
120
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0
0
121
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26
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18
0
10
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20
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25
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116
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60
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0
0
0
JUMLAH
Purworejo, .
. ) ( . )
1004 199312 1 002 NIP. 19671004 199312 1 002
. ) ( . )
1004 199312 1 002 NIP. 19671004 199312 1 002
SATUAN STOK PENERI JUMLAH PEMA- SISA STOK PERMIN-
No. NAMA OBAT KEMASAN AWAL MAAN KAIAN STOK OPTIMUM TAAN APBD
1 Anti asma/bronkodilator inhalasi (ventolin)
2 Anti asma/bronkodilator nebulizer (ventolin) vial 0 0 0 0 0
3 Antibiotik injeksi serbuk (seftriakson 1 g) vial 0 0 0 0 0
4 Antidiare sirup : .. botol 60 ml 0 0 0 0 0
5 Antidiare sirup : Neo Kaominal botol 60 ml 246 0 246 42 204
6 Antidiare Tablet : .. tablet 0 0 0 0 0
7 Antidiare Tablet (Molagit) tablet 0 0 0 0 0
8 Antidiare Tablet (Omegdiar) tablet 0 0 0 0 0
8 Antihemoroid DOEN (Superhoid) supp 0 0 0 0 0
9 Antihistamin kombinasi (Pritacort) tablet 0 0 0 0 0
10 Antiinfeksi kulit (luka bakar) pot 48 0 48 1 47
11 Antiinflamasi gel (Provenid) tube 30 gr 0 0 0 0 0
12 Antikretinisme tablet tablet 0 0 0 0 0
13 Antiscabies krim (Scabicid) tube 10 gram 0 0 0 0 0
14 Antispasme injeksi (Spashi) vial 0 0 0 0 0
15 Antispasme/analgetik tablet : .. tablet 0 0 0 0 0
17 Antispasme/analgetik tablet (SCOPMA) tablet 0 0 0 0 0 1,000
16 Laksantia tablet 5 mg : tablet 0 0 0 0 0
19 Laksantia tablet 5 mg (Laxana) tablet 100 0 100 100 0
20 Multivitamin + mineral + biotin tablet (Caviplex) kaplet 0 0 0 0 0
17 Multivitamin + mineral sirup (Recovit) botol 100 ml 184 0 184 184 0 300
18 Multivitamin + mineral utk ibu hamil (Vitabion) kaplet 0 0 0 0 0
19 Multivitamin + minyak ikan (untuk ibu menyusui) kapsul 0 0 0 0 0
20 Multivitamin geriatri (Osteos) kaplet 0 0 0 0 0
21 Multivitamin kaplet : . kaplet 0 0 0 0 0
26 Multivitamin kaplet (Pritavit) kaplet 0 0 0 0 0
27 Multivitamin kaplet (VITALAMIN) kaplet 2,700 1,500 4,200 2,100 2,100 1,000
22 Multivitamin kaplet salut gula kaplet 0 0 0 0 0
23 Multivitamin sirup : .. Botol 0 0 0 0 0
24 Multivitamin sirup + DHA (Caviplex + DHA) botol 60 ml 0 0 0 0 0
25 Multivitamin tabur untuk balita Saset 0 0 0 0 0
26 Nasal dekongestan tablet ( Alerfed) tablet 0 0 0 0 0 100
27 Neurotropik 5000 injeksi ampul 0 0 0 0 0
28 Neurotropik kaplet : kaplet 0 1,000 1,000 100 900
29 Neurotropik kaplet (Nutrifar) kaplet 0 0 0 0 0
30 Nutrisi/Vitamin injeksi (Alinamin F) ampul 0 0 0 0 0
31 Nutrisi/vitamin tablet (Aspar K) tablet 0 0 0 0 0 100
32 Obat antifibrinolitik kapsul (NEXITRA) kotak-50 kaplet 0 0 0 0 0
33 Obat Antiflu kombinasi (Tremenza) botol 60 ml 48 0 48 48 0
34 Obat Antiulkus peptikum tablet (Nucral) tablet 400 0 400 0 400
PEMBERIAN KET
DAK JKN PRO- APBD LAIN-2 JUMLAH
No. NAMA OBAT
1 Alopurinol tablet 100 mg
2 Alprazolam tablet 0,25 mg
3 Ambroksol sirup 15 mg/ml
4 Ambroxol tablet 30 mg
5 Aminofilin injeksi 24 mg/ml
6 Aminofilin tablet 200 mg
7 Amitriptilin tablet 25 mg
8 Amlodipin tablet 10 mg
9 Amlodipin tablet 5 mg
10 Amoksisilin 500 mg + klavulanat 125 mg tablet
11 Amoksisilin kaplet 500 mg
12 Amoksisilin kapsul 250 mg
13 Amoksisilin sirup kering 125 mg/5 ml
14 Amoksisilin sirup kering forte 250 mg/5 ml
15 Ampisilin serbuk injeksi I.M./I.V. 1000 mg/ml
16 Antalgin (Metampiron) tablet 500 mg
17 Antasida DOEN I tablet kunyah kombinasi
18 Antasida DOEN II Suspensi, kombinasi
19 Antibakteri DOEN salep komb : Basitrasin 500 IU/g +
20 polimiksin 10.000kombinasi
Antifungi DOEN IU/g : Asam Benzoat 6% + Asam
21 Salisilat 3 % DOEN kombinasi (Generik)
Antihemoroid
23 Aqua pro injeksi steril, bebas pirogen
24 Asam Asetil Salisilat tablet 100 mg (Asetosal)
25 Asam asetil salisilat 80 mg
26 Asam Askorbat (Vitamin C) tablet 50 mg
27 Asam folat tablet 1 mg
28 Asam mefenamat kaplet 500 mg
29 Asam mefenamat kaplet 250 mg
30 Asam traneksamat injeksi 100 mg/ml
31 Asiklovir krim 5 %
32 Asiklovir tablet 200 mg
33 Asiklovir tablet 400 mg
34 Atapulgit tablet 600 mg
35 Atropin injeksi i.m./i.v./s.c. 0,25 mg/ml
36 Betahistin mesilat tablet 6 mg
37 Betametason cream 0,1 %
38 Betametason tetes mata 1 mg/ml
39 Bisakodil suppositoria 5 mg (Dulcolax)
40 Bromheksin tablet 8 mg
41 Cetirizine kapsul 10 mg
42 Cetirizine sirup 5 mg/5 ml
43 Deksametason injeksi i.v. 5 mg/ml
44 Deksametason tablet 0,5 mg
45 Dekstrometorfan sirup 10 mg/5 ml (HBr)
46 Dekstrometorfan tablet 15 mg (HBr)
45 Diazepam larutan rectal 5 mg / 2,5 ml (Stesolid)
46 Diazepam larutan rectal 10 mg / 2,5 ml (Stesolid)
47 Diazepam injeksi 5 mg/ml
48 Diazepam tablet 2 mg
49 Difenhidramin injeksi i.m. 10 mg/ml (HCl)
50 Digoksin tablet 0,25 mg
51 Diltiazem HCl Tablet 30 mg
52 Dimenhidrinat tablet 50 mg
53 Doksisiklin kapsul 100 mg
53 Domperidon suspensi 5 mg/5 ml
54 Domperidon tablet 10 mg
55 Efedrin HCl tablet 25 mg
56 Ekstraks beladona tablet 10 mg
57 Epinefrin (Adrenalin) injeksi 0,1 % sebagai HCl)
58 Eritromisin kapsul 250 mg
60 Eritromisin sirup 200 mg/5 ml
61 Etakridin (Rivanol) larutan 0,1 %
62 Etanol 70 %
63 Etanol 70 %
64 Fenilbutason 200 mg tablet
65 Fenitoin Natrium Kapsul 100 mg
66 Fenobarbital tablet 30 mg
67 Fenobarbital injeksi
68 Fenolgliserol tetes telinga 10 %
69 Fitomenadion (Vit. K) injeksi 10 mg/ml
70 Fitomenadion (Vit. K) tablet salut gula 10 mg
71 Furosemida injeksi 1.v/i.m 10 mg/ml
72 Furosemida tablet 40 mg
73 Gameksan lotion 1 %
74 Gemfibrosil kapsul 300 mg
75 Gemfibrozil kapsul 600 mg
76 Gentamisin salep kulit 0,1%
77 Gentamisin salep mata 0,3 %
78 Gentamisin sulfat tetes mata 0,3%
79 Gentian violet larutan 1 %
80 Glibenklamid tablet 5 mg
81 Gliclazid 80 mg tablet
82 Glimepirid tablet 2 mg
83 Gliseril Guayakolat tablet 100 mg
84 Gliserin lar 50 %
85 Glukosa larutan infus 10 %
88 Griseofulvin tablet 125 mg micronized
89 Haloperidol injeksi 5 mg/ml
90 Haloperidol injeksi 50 mg/ml
91 Haloperidol tablet 1,5 mg
92 Haloperidol tablet 2 mg
93 Haloperidol tablet 5 mg
94 Hidroklorotiazida tablet 25 mg
95 Hidrokortison krim 2,5%
96 Hyoscine-N-Butilbromide tablet 10 mg (Spashi)
97 Ibuprofen sirup 100 mg/5 ml
98 Ibuprofen tablet 200 mg
99 Ibuprofen tablet 400 mg
100 Isoniasida tablet 100 mg
101 Isosorbid dinitrat tablet sublingual 5 mg
102 Kalium diklofenak 50 mg tablet
103 Kalsium laktat tablet 500 mg
104 Kaptopril tablet 12,5 mg
105 Kaptopril tablet 25 mg
106 Karbamazepin tablet 200 mg
107 Ketokonazol krim 2 %
108 Ketokonazol tablet 200 mg
109 Ketorolac injeksi 10 mg
110 Ketorolac injeksi 30 mg
111 Klindamisin kapsul 300 mg
112 Klobazam tablet 10 mg
113 Klonidin tablet 0,15 mg
114 Kloramfenikol injeksi 1000 mg/ml
115 Kloramfenikol kapsul 500 mg
116 Kloramfenikol kapsul 250 mg (Licoklor)
116 Kloramfenikol salep mata 1 %
117 Kloramfenikol salep kulit (Bufacetin)
118 Kloramfenikol suspensi 125 mg/5 ml
119 Kloramfenikol tetes mata 0,5 %
120 Kloramfenikol tetes telinga 3 %
121 Klorfeniramin maleat (CTM) tablet 4 mg
122 Klorpromazin tablet salut 100 mg (HCl)
123 Klorpromazin tablet salut 25 mg (HCl)
124 Kodein tablet 10 mg
125 Kotrimoksasol DOEN I (dewasa) komb.
126 Kotrimoksasol suspensi
127 Lamivudin tablet 150 mg
128 Lanzoprazol kapsul 30 mg
129 Larutan mengandung elektrolit : (Asering)
130 Larutan mengandung elektrolit : (KAEN 3A)
131 Larutan mengandung elektrolit : (KAEN 3B)
132 Levotiroksin tablet 100 mg (Euthyrox)
133 Lidokain injeksi 2 %
134 Lidokain injeksi 2 % (HCl) + epinefrin 1 : 80.000-2 ml
135 Lidokain semprot 10 %
136 Lisol, mengandung kresol tersabun 50%
137 Magnesium sulfat injeksi 20 %
138 Magnesium sulfat injeksi 40 %
139 Mebendazol sirup 100 mg/5 ml
140 Mebendazol tablet 100 mg
141 Mekobalamin tablet 500 mg
142 Meloksikam 7.5 mg
143 Metformin HCl tablet 500 mg
144 Metil Prednisolon tablet 4 mg
145 Metil Prednisolon tablet 8 mg
146 Metilergometrin Maleat injeksi 0,200 mg - 1 ml
147 Metilergometrin maleat tablet 0,125 mg
148 Metoklopramid injeksi 5 mg/ml
149 Metoklopramid sirup 5 mg/5 ml
150 Metoklopramid tablet 10 mg
151 Metoklopramid tablet 5 mg
152 Metronidasol sirup 125 mg/5 ml (Novagyl)
153 Metronidasol tablet 250 mg
154 Metronidasol tablet 500 mg
155 Metronidazol infus 500 mg/100 ml
156 Mikonazol krim 2 %
157 Natrium Diklofenak tablet 25 mg
158 Natrium Diklofenak tablet 50 mg
159 Natrium Klorida Larutan Infus 0,9% steril
160 Nifedipin tablet 10 mg
161 Nifedipin tablet 20 mg SR
162 Nistatin vaginal tablet 100.000 IU/g
163 Obat Batuk Hitam (OBH) cairan
164 Oksitetrasiklin injeksi i.m. 50 mg/ml-10 ml
165 Oksitetrasiklin salep kulit 3%
166 Oksitetrasiklin salep mata 1%
167 Oksitosin injeksi 10 IU/ml - 1 ml
168 Omeprazol injeksi 40 mg/10 ml
169 Omeprazol kapsul 20 mg
170 Ondansentron injeksi 4 mg / 2 ml
171 Papaverin injeksi
172 Papaverin tablet 40 mg
173 Parasetamol drops
174 Parasetamol sirup 120 mg/5 ml
175 Parasetamol tablet 500 mg
176 Petidin injeksi (Narkotika)
177 Piracetam 800 mg tablet
178 Piracetam injeksi 1 gram/5 ml
179 Pirantel tablet score 125 mg
180 Piridoksin (Vit. B6) tablet 10 mg
181 Piroksikam kapsul 20 mg
182 Piroksikam tablet 10 mg
183 Polikresolsulfonat cairan 50 mg/ml (APTYL)
184 Povidon iodida larutan 10 % 30 ml
187 Prednison tablet 5 mg
188 Propanolol tablet 10 mg
189 Propiltiourasil tablet 100 mg
190 Ranitidin injeksi 25 mg/2 ml
191 Ranitidin tablet 150 mg
192 Rifampisin kaplet salut 450 mg
193 Rifampisin kapsul 300 mg
194 Ringer laktat larutan infus
195 Risperidon tablet
196 Salbutamol cairan inhales 0,1 %
197 Salbutamol tablet 2 mg
198 Salbutamol tablet 4 mg
199 Salep 2-4, Kombinasi Asam Salisilat 2% + Belerang endap
200 4%
Salisil bedak 2%
201 Sefadroksil 500 mg kapsul
202 Sefadroksil kapsul 250 mg
203 Sefadroksil kapsul 500 mg
204 Sefadroksil sirup kering 125 mg/5 ml
205 Sefadroksil sirup kering 250 mg/5 ml
206 Sefotaksim serbuk injeksi 1000 mg/vial
207 Sefotaksim serbuk injeksi 500 mg/vial
208 Seftriakson serbuk injeksi 1 gr/vial
209 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I)
210 Serum Anti Tetanus Injeksi 1500 IU/Ampul (ATS)
211 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml
212 Simetidin tablet 200 mg
213 Simvastatin tablet 10 mg
214 Simvastatin tablet 30 mg
215 Siprofloksasin tablet 250 mg
216 Siprofloksasin tablet 500 mg
217 Spironolakton tablet 25 mg
218 Sukralfat tablet 500 mg (Ulsidex)
219 Sukralfat suspensi (Ulsafate)
220 Sulfasetamid Na tetes mata 15 %
221 Tetrasiklin kapsul 250 mg
222 Tetrasiklin kapsul 500 mg
223 Tiamfenikol kapsul 500 mg
224 Tiamin (Vitamin B1) injeksi 100 mg/ml
225 Tiamin (Vitamin B1) tablet 50 mg
226 Tramadol kapsul 50 mg
227 Trifluoperazin 5 mg tablet
228 Triheksifenidil tablet 2 mg
229 Vaksin rabies untuk manusia
230 Vitamin B Kompleks tablet

1 Air raksa dental use
2 Alvogyl paste
3 Amalgam Perak (Silver Alloy)
4 Articulating papper
5 Bahan pensteril gigi : Trikresol formalin
6 Bahan tambalan sementara gigi siap pakai (Cavit)
7 Devitalisasi pasta (Non Arsen)
8 Etil klorida spray
9 Eugenol cairan
10 Fuji VII
11 Glass inonomer cement ART
12 Gutta percha dan papper point : 15 - 40
13 Gutta percha dan papper point : 45 - 60
14 Kalsium hidroksida pasta
15 Klorfenol Kamfer Menthol (CHKM)
16 Mummifying pasta
17 Pasta pengisi saliran akar
18 Semen Seng Fosfat serbuk dan cairan
19 Spon gelatin cubicles 1x1x1
20 Temporary stoping fletcher serbuk+cairan

1 Anti asma/bronkodilator inhalasi (ventolin)
2 Anti asma/bronkodilator nebulizer (ventolin)
3 Antibiotik injeksi serbuk (seftriakson 1 g)
4 Antidiare sirup : ..
5 Antidiare sirup : Neo Kaominal
6 Antidiare Tablet : ..
7 Antidiare Tablet (Molagit)
8 Antidiare Tablet (Omegdiar)
8 Antihemoroid DOEN (Superhoid)
9 Antihistamin kombinasi (Pritacort)
10 Antiinfeksi kulit (luka bakar)
11 Antiinflamasi gel (Provenid)
12 Antikretinisme tablet
13 Antiscabies krim (Scabicid)
14 Antispasme injeksi (Spashi)
15 Antispasme/analgetik tablet : ..
17 Antispasme/analgetik tablet (SCOPMA)
16 Laksantia tablet 5 mg :
19 Laksantia tablet 5 mg (Laxana)
20 Multivitamin + mineral + biotin tablet (Caviplex)
17 Multivitamin + mineral sirup (Recovit)
18 Multivitamin + mineral utk ibu hamil (Vitabion)
19 Multivitamin + minyak ikan (untuk ibu menyusui) Nulacta
20 Multivitamin geriatri (Osteos)
21 Multivitamin kaplet : .
26 Multivitamin kaplet (Pritavit)
27 Multivitamin kaplet (VITALAMIN)
22 Multivitamin kaplet salut gula
23 Multivitamin sirup : ..
24 Multivitamin sirup + DHA (Caviplex + DHA)
25 Multivitamin tabur untuk balita
26 Nasal dekongestan tablet ( Alerfed)
27 Neurotropik 5000 injeksi
28 Neurotropik kaplet : Grahabion
29 Neurotropik kaplet (Nutrifar)
30 Nutrisi/Vitamin injeksi (Alinamin F)
31 Nutrisi/vitamin tablet (Aspar K)
32 Obat antifibrinolitik kapsul (NEXITRA)
33 Obat Antiflu kombinasi (Tremenza)
34 Obat Antiulkus peptikum tablet (Nucral)
35 Obat batuk / flu sirup : Samcodryl
42 Obat batuk / flu sirup : Erphaflu
43 Obat batuk / flu sirup : Erphakaf
44 Obat batuk / flu sirup : Fortusin
45 Obat batuk / flu sirup : Iafed
36 Vasodilator perifer (Citicholin)

1 Asifit kapsul
2 Batugin elixir
3 Enkasari
4 Fitogen Dragge
5 Hepagard
6 Imulan kapsul
7 Imulan sirup
8 Kurkumex sirup
9 Kurkumex tablet
10 OB Herbal
11 Tensigard kapsul
12 Xanvit sirup
1 Alat suntik sekali pakai 1 ml
2 Alat suntik sekali pakai 2,5 ml (Stera)
4 Alkohol swab
5 Bbraun Intrafix with microdriper
6 Bisturi (mata pisau)
7 Blood lancet 28
8 Blood Tranfusion set
9 Catgut / benang bedah No. 2/0 - 3/0
10 Catgut chromic 2/0 100 M
11 Catgut chromic 3/0 100 M
12 Catgut chromic 2/0
13 Catgut chromic 3/0
14 Catgut plain 2/0
15 Catgut plain 3/0
12 Dermafix T 10 x 15 cm
13 Dermafix T 5 x 7 cm
14 Developer untuk Film Rontgen
15 Desinfektan - Aseptin liquid
16 Film Rontgen ukuran 24 x 30
17 Film Rontgen ukuran 30 x 40
18 Fixer untuk Film Rontgen
19 Folley catheter No. 16
20 Folley catheter No. 18
21 Infus set (Otsu Y)
22 Infus set dengan micridripper (Otsu)
23 Infus set anak
24 Infus set dewasa
25 IV catheter No. 18 G
29 Jarum jahit kombinasi
30 Kapas pembalut/absorben 250 gram
31 Kasa 10 x 10 cm
32 Kasa hidrofil 80 cm x 40 yard
33 Kasa hidrofil steril ukuran 16 x 16
34 Kasa hidrofil ukuran 16 x 16
35 Kasa kompres 40/40 steril
36 Kasa pembalut hidrofil 4 m x 10 cm
37 Kasa pembalut hidrofil 4 m x 15 cm elastic
38 Kasa pembalut hidrofil 4 m x 3 cm elastic
39 Kertas EKG ( 50 x 30)
40 KY Jelly 28 gram / Aquagel jelly
41 Masker, Earloop
42 Masker, tie on
43 Mata Bor gigi
44 Micropipet Socorex - Acua
45 - Volume 1 - 10 uL
46 - Volume 10 - 100 uL
47 - Volume 100 - 1000 uL
48 Nasal oxygen canula adult sraight
49 Nasal oxygen canula - child
50 Penutup luka dengan antibiotika
51 Plester 2.5 cm x 4.5 m (Leucoplast)
52 Plester 5 yards x 2 inchi
53 Plester hypafix 5 cm x 5 m
54 Plester kain 1,25 cm x 4,5 m (Leukoplast)
55 Pot sputum
56 Sarung tangan steril nomor 6,5
58 Sarung tangan steril nomor 7,5
60 Sarung tangan ukuran M sekali pakai
61 Sarung tangan ukuran S sekali pakai
62 Silk (benang bedah sutera no 2/0 dg jarum
63 Silk (benang bedah sutera no 3/0 dg jarum
64 Silk 3/0 jarum 3/8 26 M (demetech)
68 Tabung oksigen 1 m3 + regulator
69 Urine bag
70 Under pad
71 Wing needle 23 G - 25 G

1 Alat pengukur HB 201 + analizer
2 Dek glass (cover glass)
3 Microcuvet Hb 201
4 Object glass
5 Occu check (alat pemegang lancet ROCHE)
6 Softclick lanciet 200
7 Softclick lancing device
8 Tabung hematokrit
III REAGEN
1 Aquabidest steril
2 Aquabidest steril
Glocodoctor
Accutrand
Easy Touch
Nesco gluco strip
Glucostar
Nesco
Easy Touch
UA Sure
Accutrand
Easy touch cholesterol
Nesco
Multicare
6 Hb Sahli
- Assistant
- Superior
- Reagen glukosa
- Reagen Trigliserida
- Reagen asam urat
8 Larutan amonium oksalat 1 %
9 Larutan Asam Klorida 0,1 N
10 Larutan Benedict
11 Larutan EDTA 10 %
12 Larutan Eosin
13 Larutan Giemsa Stain
14 Larutan Karbol Fuksin
15 Larutan Metanol
16 Larutan Metilen Blue
17 Larutan Natrium citrat
18 Larutan Perhidrol (H2O2)
19 Larutan Turk
20 Larutan Ziehl Neelsen
21 Reagen pemeriksaan yodium
22 Reagen dan alat pengujian lab makanan
23 Rapid Diagnostic Test Malaria
24 Rapid test Leptospirosis
25 Rapid test Chikungunya
26 Rapid test demam berdarah
27 Tes Kehamilan
PPTEST
HCG strip (answer)
UltraOne tes kehamilan
28 Trigliserida
- Accutrend)
- Multicare
29 Tes HBsAG S/P strip (Answer)
30 Tes HIV I & II Antibody Card (IR-100c)
31 Urine Test 10 Parameter
32 Widal Test Tg H (SS-01)
33 Widal Test Tg O (SS-90)
34 Tes Narkoba
- Metamfetamin
- Cocain
- Cannabidoid
- Benzodiasepin
- Babiturat
35 Reagen Mantoux
- Anti A
- Anti B
- Anti AB
36 Oil emersi

1 ACT (Artesunate tablet 50 mg + Amodiaquin Anhydrat tabl
2 Arteraquin (dihydro artemisin 40 mg tablet + diperaquin p
3 Artemeter injeksi 1 ml 80 mg
4 Artesunat injeksi vial 60 mg
5 Kloroquin tablet 150 mg
6 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg
7 Kuinin Dihidroklorida injeksi 25% - 2 ml
8 Kuinin tablet 222 mg (H2SO4.7H2O)
9 Primaquin tablet 15 mg

1 Garam oralit serbuk kombinasi
2 Zink Dispersible 20 mg

1 Dietil karbamasin sitrat

1 Benzatin Benzil Penisilin injeksi 2,4 juta IU

1 Prednison tablet 5 mg

1 Oseltamivir kapsul

1 Retinol (Vitamin A) 100.000 IU kapsul lunak
2 Retinol (Vitamin A) 200.000 IU kapsul lunak
3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam Folat 0,25
4 Mineral Mix
5 Iodol kapsul

1 Albendazol tablet 400 mg
2 Albendazol suspensi 200 mg/5 ml
3 Pirantel pamoat tablet 125 mg

1 Obat FDC kategori 1
2 Obat FDC kategori 2
3 Obat FDC Sisipan
4 OAT Anak
5 OAT Kombipak 1

Zidovudin + lamivudin (300 mg/150 mg
Efavirenz 600 mg
Tenofovir (TDF) 300 mg
Nevirapin 200 mg
XIV. PROGRAM KUSTA
Obat MDT Kusta PB Dewasa
Obat MDT Kusta MB Anak
Obat MDT Kusta MB Dewasa
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
SATUAN STOK PENERI PERSE
KEMASAN AWAL MAAN DIAAN 1 2
tablet 800 800 10 10

tablet 0 0
botol 60 ml 0
tablet 0
ampul 0 0
tablet 500 500 0 0
tablet 0 0
tablet 330 330 0 0
tablet 0 300 300 0 15
kaplet 0 0
tablet 7,000 5,000 12,000 83 99
kapsul 0 0
Botol 60 ml 113 240 353 0 11
Botol 60 ml 0 0
vial 40 40 0 0
tablet 1,000 1,000 0 0
tablet 3,700 3,700 76 113
botol-60ml 238 100 338 2 2
tube 0 0
pot 0 0
supp 0 0
tablet 0 0
vial 48 48 0 0
tablet 0 0
tablet 0 0
tablet 5,400 5,400 16 15
tablet 4,100 4,100 0 15
tablet
Tablet 1,700 1,700 0 0
ampul 10 10 0 0
tube 5 gram 0 50 50 0 0
tablet 200 200 0 0
tablet 200 200 0 0
tablet 700 1,000 1,700 30 20
ampul 0 0
tablet 0 0
tube 75 75 0 0
botol 0 0
supp 0 0
tablet 0 0
kapsul 400 400 10 10
botol 60 ml 0 0
ampul 0 0
tablet 6,000 4,000 10,000 80 87
botol 60 ml 0 0
tablet 0 0
rect tube 0 0
rect tube 0 0
ampul 20 20 0 0
tablet 200 200 400 3 0
ampul 0 0
tablet 200 200 0 0
tablet 0 0
tablet 200 1,000 1,200 7 10
kapsul 0 0
botol-60ml 0 0
tablet 0 0
tablet 0 0
tablet 0 0
ampul 53 53 0 0
kapsul 0 0
kapsul 0 0
kapsul 0 0
botol 0 0
botol 300 ml 0 0
botol 100 ml 85 85 0 0
botol 1000 ml 0 0
tablet 0 0
kapsul 0 0
tablet 200 200 0 0
ampul 0 0
botol 70 70 0 0
ampul 60 60 0 0
tablet 0 0
ampul 16 16 0 0
tablet 700 700 0 0
botol-30 ml/tube 0 0
kapsul 1,320 240 1,560 0 12
kapsul 0 0
tube 0 0
botol 48 48 0 0
botol 5 ml 96 96 0 2
botol 0 0
tablet
tablet 400 400 0 0
tablet 200 200 0 0
tablet 0 0
botol-100 ml 0 0
botol 500 ml 0 0
ampul 0 0
botol 500 ml 0 0
tablet 0 0
ampul 0 0
ampul 0 0
tablet 0 0
tablet 400 200 600 0 0
tablet 0 0
tablet 0 0
tube 72 72 2 1
tablet 0 0
botol 0 0
tablet 1,900 1,900 0 0
tablet 900 900 0 12
tablet 0 0
tablet 0 0
tablet 0 0
tablet 1,700 1,000 2,700 38 2
tablet 900 900 0 0
tablet 2,600 2,600 18 5
tablet 0 0
tube 15 gram 111 111 1 0
tablet 150 150 10 0
ampul 1 ml 0 24 24 0 0
ampul 1 ml 0 0
kapsul 0 0
tablet 600 600 0 0
tablet 0 0
vial 0 0
kapsul 500 500 0 0
kapsul 0 0
tube 5 gram 24 48 72 3 1
tube 96 96 0 1
botol 60 ml 150 150 0 4
botol 5 ml 0 0
botol 5 ml 0 144 144 2 1
tablet 5,600 5,600 123 92
tablet 288 288 0 0
tablet 0 0
tablet 0 0
tablet 3,300 3,300 38 15
botol 60 ml 274 274 0 0
tablet 0 0
kapsul 0 0
botol 500 ml 0 400 400 0 0
botol 500 ml 0 0
botol 500 ml 0 0
tablet 0 0
ampul 0 0
ampul 0 60 60 0 0
botol 0 0
botol 1000 ml 0 0
ampul 0 0
ampul 0 0
botol 30 ml 0 0
tablet 0 0
tablet 0 0
tablet 0 0
tablet 300 300 0 10
tablet 0 300 300 0 0
tablet 0
ampul 0 0
tablet 1,000 1,000 0 0
ampul 0 0
botol 0 0
tablet 0 0
tablet 0 0
botol 60 ml 0 0
tablet 0 0
tablet 500 500 10 12
botol-100 ml 9 50 59 0 0
tube 124 124 0 0
tablet 0 0
tablet 2,900 2,900 46 86
botol-500 ml 120 120 0 0
tablet 200 200 0 0
tablet 0 0
tablet 0 0
botol-100 ml 0 0
vial 0 0
tube 5 gram 0 0
tube 0 0
ampul 0 0
vial 0 0
kapsul 0 0
ampul 0 0
ampul 0 0
tablet 0 0
botol 15 ml 0 0
botol 0 120 120 2 13
tablet 9,300 9,300 168 194
ampul 0 0
tablet 0 0
ampul 0 0
tablet 100 100 0 0
tablet 5,900 5,900 146 33
tablet 5,000 5,000 0 20
tablet 0 0
botol 10 ml 19 19 0 0
botol 30 ml 0 10 10 1 0
botol 60 ml 15 15 0 0
botol 300 ml 0 0
tablet 0 0
tablet 0 0
tablet 0 0
ampul 0 0
tablet 100 500 600 42 24
kaplet 0 0
kapsul 0 0
botol 500 ml 284 284 0 0
tablet 200 200 0 0
botol 2,5 ml 0 0
tablet 0 0
tablet 900 300 1,200 10 30
pot 72 72 0 0
kotak-50 gram 77 77 5 0
kapsul 0 0
kaplet 0 0
kaplet 0 0
botol 0 0
botol 0 0
vial 0 200 200 0 0
vial 0 0
vial 0 0
vial 5 ml 0 0
vial 1.500 0 5 5 0 0
ampul 0 0
tablet 300 300 12 0
tablet 600 600 0 0
tablet 0
tablet 0 0
tablet 2,300 2,300 0 50
tablet 0 0
tablet 0 0
botol 0 0
botol 0 0
kapsul 0 0
kapsul 0 0
kapsul 0 0
ampul 0 0
tablet 1,800 5,000 6,800 154 70
tablet 0 0
tablet 0 0
tablet 0 0
set 0 0
tablet 2,437 3,000 5,437 140 99
0 0
0 0
botol 0 0
dus 0 0
botol 0 0
kotak 0 0
botol 0 0
botol 28 gram 0 0
botol/kotak 0 0
vial/100 ml 0 0
botol@10 ml 0 0
dus 0 0
set/botol 0 0
kotak/pasang 0 0
kotak/pasang 0 0
kotak 2 tube 0 0
botol 10 ml 0 0
botol/kotak 0 0
botol 0 0
set/botol 0 0
box-10 0 0
botol @ 100 gram 0 0
0 0
0 0
vial 0 0
vial 0 0
vial 0 0
botol 60 ml 0 0
botol 60 ml 246 246 0 0
tablet 0 0
tablet 0 0
tablet 0 0
supp 0 0
tablet 0 0
pot 48 48 1 0
tube 30 gr 0 0
tablet 0 0
tube 10 gram 0 0
vial 0 0
tablet 0 0
tablet 0 0
tablet 0 0
tablet 100 100 0 0
kaplet 0 0
botol 100 ml 184 184 2 4
kaplet 0 0
kapsul 0 0
kaplet 0 0
kaplet 0 0
kaplet 0 0
kaplet 2,700 1,500 4,200 12 98
kaplet 0 0
Botol 0 0
botol 60 ml 0 0
Saset 0 0
tablet 0 0
ampul 0 0
kaplet 0 1,000 1,000 0 0
kaplet 0 0
ampul 0 0
tablet 0 0
kotak-50 kaplet 0 0
botol 60 ml 48 48 0 0
tablet 400 400 0 0
botol 100 ml 0 200 200 0 6
botol 60 ml 0 0
botol 100 ml 0 0
botol 60 ml 0 0
botol 60 ml 0 0
ampul 0 0
0 0
0 0
0 0
botol 0 0
botol 0 0
kapsul 0 0
kapsul 0 0
kapsul 0 0
botol 60 ml 0 0
botol 60 ml 0 0
kaplet 0 0
botol 0 0
kapsul 0 0
botol 0 0
0 0
0 0
set 0 0
set 0 0
set 300 300 0 0
set 100 100 200 0 0
box 0 500 500 0 0
set 0 0
Pcs 0 0
box-100 600 600 0 0
Pcs 0 0
Kotak@24x75 cm 2 2 0 0
kotak 0 0
kotak 0 0
saset/pack 0 0
saset/pack 0 0
saset/pack 0 0
saset/pack 0 0
rol 0 30 30 0 0
rol 0 0
Botol 5 ltr Repl 20 ltr 0 0
botol-500 ml 0 48 48 0 0
lembar 0 0
lembar 0 0
Galon 20 liter 0 0
Pcs 6 10 16 0 0
Pcs 4 10 14 0 0
pices 0 0
pices 0 0
set/kantong 90 90 0 0
set/kantong 200 200 0 0
buah 0 0
buah 0 0
buah 100 100 200 0 0
buah 100 100 0 0
set 0 0
bungkus 6 5 11 0 0
rol 0 0
rol 5 5 0 0
box 0 10 10 0 0
lembar 0 0
bungkus 0 0
roll 87 87 0 0
rol 0 0
rol 0 0
rol 0 0
tube 0 0
pcs 0 0
Pcs 350 350 0 0
buah 0 0
pieces 0 0
set 1 1 0 0
set 1 1 0 0
set 1 1 0 0
pieces 0 0
pieces 0 0
Pcs 0 0
rol 0 0
rol 0 0
rol 0 0
Rol 19 19 0 0
buah 0 100 100 0 0
pasang 100 100 0 0
pasang 100 100 0 0
pasang 0 0 0 0
0 0
Pcs 200 300 500 0 0
Pcs 100 100 0 0
kotak 0 0
kotak 0 0
box-12 pacs 0 0
box-12 pacs 0 0
box-12 pacs 0 0
box-12 pacs 0 0
set 0 0
Pcs 15 15 0 0
buah 0 0
buah 0 0
0 0
0 0
unit 0 0
box 0 0
buah 0 0
box 0 0
kit 0 0
box 0 0
kit 0 0
botol 0 0
0 0
0 0
0 0
0 0
0 0
0 0
botol 500 ml 0 0
botol 1000 ml 0 0
0 0
Box-50 test 0 3 3 0 0
25 strip 0 5 5 0 0
box/25 0 3 3 0 0
box/25 0 0
box/25 0 0
0 0
box-25 0 0
box-25 0 3 3 0 0
box-25 0 0 0 0
0 0
box/25 0 0
box-10 3 3 0 0
box-10 0 0
box/25 0 0
0 0
set 0 0
set 0 0
0 0
box-4 btl 0 0
box-4 btl 0 0
box-4 btl 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
Botol 100 ml 0 0
set 0 0
botol 0 0
100 tes / unit 0 0
kit-25 tes 0 0
box/50 strip 0 0
tes 0 0
kit-25 tes 0 0
0 0
Box 40 tes 0 0
strip 0 0
box-50 strip 0 0
5 0 0
box / 25 0 5 5 0 0
box / 25 0 0
box-25 strip 0 0
tes 0 0
btl - 100 test 0 0
Botol 5 ml 0 0
Botol 5 ml 0 0
0 0
strip 0 0
strip 0 0
strip 2 2 0 0
strip 2 2 0 0
strip 2 2 0 0
ampul 0 0
0 0
Botol 10 ml 0 0
Botol 10 ml 0 0
Botol 10 ml 0 0
botol 25 ml 0 0
0 0
0 0
tablet 0 0
tablet 0 0
ampul 0 0
vial 0 0
tablet 0 0
tablet 0 0
ampul 0 0
tablet 0 0
tablet 0 0
0 0
0 0
saset 400 400 0 0
tablet 0 100 100 0 0
0 0
0 0
tablet 0 0
0 0
0 0
vial 0 0
0 0
0 0
tablet 0 0
0 0
0 0
kapsul 0 0
0 0
0 0
kapsul 0 0
kapsul 0 0
tablet 3,000 3,000 40 0
saset 0 0
kapsul 0 0
0 0
0 0
tablet 0 0
botol 10 ml 0 0
tablet 0 0
0 0
0 0
0 0
paket 0 0
paket 0 0
paket 0 0
paket 0 0
paket 0 0
0 0
0 0
tablet 0 0
tablet 0 0
tablet 0 0
tablet 0 0
0 0
0 0
blister 0 0
blister 0 0
blister 0 0
1,343 1,304
UMUM JKN
BAYAR
1370 1152
Plt. Kepala UPT Instalasi Farmasi
Drs. Nanang Wijayanto, Apt.

NIP. 19680601 199312 1 002
CATATAN HARIAN PEMAKAIAN OBAT DAN PERBEKALAN KE
1 SEPTEMBER 2016
3 4 5 6 7 ### 8 9 10
10 0 0 20 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 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 20 10 20 10 25 10
0 26 0 0 0 0 0
0 0 0 0 0 0 0
178 109 130 60 95 131 70
0 0 0 #VALUE! 0 0 0
4 4 3 1 3 0 7
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 107 40 80 120 80 68
4 5 0 2 2 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
43 63 14 36 0 50 80
0 120 66 12 10 40 20
0 12 0 0 0 0 62
0 0 0 0 0 0 0
0 3 0 0 0 1 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
26 20 36 0 30 10 20
0 0 0 0 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 10 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
203 141 75 159 0 73 151
0 0 0 0 0 0 0
0 0 0 #VALUE! 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 #VALUE! 0 0 0
0 0 5 0 0 6 0
0 0 0 #VALUE! 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 11 16 6 6
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 5 0 0 0 0 0
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1,513 1,892 1,608 #VALUE! 801 1,478 1,118
DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
SEPTEMBER 2016
TANGGAL PEMAKAIAN OBAT DAN BAHAN MEDIS HABIS PAKAI
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1,808 1,243 976 1,101 1,292
RAWAT IN AP JUMLAH
82 2604
Yang meminta
Kepala Puskesmas .
( . )
NIP. 19671004 199312 1 002
HABIS PAKAI
19 20 21 22 23 24 25 26
10 0 10 10 10 0 20
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 14 0 49
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 30 60 420
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
867 1,078 1,623 1,170 0
Purworejo, .
Yang menerima
Petugas Puskesmas .
( . )
NIP. 19671004 199312 1 002
PKD POS KMR JML
SISA
KES OBAT
35 300 500
0 0
0 0
0 0
0 0
64 100 400
0 0
330 0
29 90 210
0 0
75 2,600 9,400
0
75 278
0 0
0 40
0 1,000
147 2,100 1,600
47 291
0 0
0 0
0 0
0 0
0 48
0 0
0 0
78 1,100 4,300
3571 4,100 0
0 0
515 1,000 700
0 10
10 20 30
0 200
0 200
30 500 1,200
0 0
0 0
6 25 50
0 0
0 0
0 0
50 350
0 0
0 0
536 3,000 7,000
0 0
0
0 0
0 0
0 20
45 100 300
0 0
0 200
0 0
75 200 1,000
0 0
0 0
0 0
0 0
0 0
0 53
0 0
0 0
0 0
0 0
0 0
46 74 11
0 0
0 0
0 0
200 200 0
0 0
0 70
0 60
#REF! #REF!
0 16
94 200 500
0 0
367 660 900
0 0
0 0
33 48 0
90 96 0
0 0
0 0
250 150
0 200
0 0
0 0
0 0
0 0
0 0
25 -25
0 0
0 0
0 0
90 200 400
0 0
0 0
12 60
0 0
0 0
0 1,900
200 700
0 0
0 0
0 0
6 700 2,000
0 900
32 300 2,300
0 0
7 104
10 140
0 24
0 0
0 0
0 600
0 0
0 0
0 500
0 0
7 24 48
11 85
20 130
0 0
8 136
14 2,400 3,200
114 188 100
0 0
0 0
52 1,000 2,300
37 237
0 0
0 0
220 220 180
0 0
0 0
0 0
0 0
0 60
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 200 100
80 100 200
0 0
0 0
0 1,000
0 0
0 0
0 0
0 0
0 0
0 0
279 400 100
7 12 47
6 118
0 0
74 900 2,000
0 120
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
105 15
2159 6,300 3,000
0 0
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0 0
5 95
36 2,100 3,800
32 200 4,800
0 0
0 19
4 6
2 13
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52 300 300
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284 284 0
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87 300 900
6 66
26 51
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0 200
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1 1 4
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6 300 0
45 100 500
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191 700 1,600
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0 0
0 0
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20 -20
0 0
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20 3,100 3,700
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2070 2,937 2,500
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0 0
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18 42 204
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1 47
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96 100 0
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803 2,100 2,100
0 0
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0 0
0 0
0 0
0 0
100 900
0 0
0 0
0 0
0 0
45 48 0
0 400
50 100 100
0 0
0 0
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10 -10
0 0
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
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0 0
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300 -300
0 300
0 200
200 300
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0 600
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2 12 18
0 0
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1 47
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0 90
50 150
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50 150
50 50
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5 6
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2 2 3
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15 15 72
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150 150 200
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19 0
100 100 0
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500 0
100 100 0
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0 0
0 0
0 0
0 0
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0 15
0 0
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0 0
0 0
0 0
0 0
0 0
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1 4
1 2
0 0
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0 0
0 0
0 3
0 0
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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 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 2
0 2
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
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251 300 100
0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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420 2,580
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
CATATAN HARIAN PEMAKAIAN OBAT DAN
1 SE
SATUAN
1 Alopurinol tablet 100 tablet
2 Alprazolam tablet 0,2 tablet
3 Ambroksol sirup 15 mbotol 60 ml
4 Ambroxol tablet 30 m tablet
5 Aminofilin injeksi 24 ampul
6 Aminofilin tablet 200 tablet
7 Amitriptilin tablet 25 tablet
8 Amlodipin tablet 10 m tablet
10 Amoksisilin 500 mg + kaplet
11 Amoksisilin kaplet 50 tablet
12 Amoksisilin kapsul 25 kapsul
13 Amoksisilin sirup ker Botol 60 ml
14 Amoksisilin sirup keriBotol 60 ml
15 Ampisilin serbuk injek vial
16 Antalgin (Metampiron) tablet
17 Antasida DOEN I table tablet
18 Antasida DOEN II Suspbotol-60ml
19 Antibakteri DOEN tube
salep
20 Antifungi komb DOEN : pot
21 kombinasi
Antihemoroid: DOENAsamko supp
22 Antimigrain : ergotami tablet
23 Aqua pro injeksi steri vial
24 Asam Asetil Salisilat tablet
25 Asam asetil salisilat tablet
26 Asam Askorbat (Vitami tablet
27 Asam folat tablet 1 m tablet
28 Asam mefenamat kapl tablet
29 Asam mefenamat kapl Tablet
30 Asam traneksamat inj ampul
32 Asiklovir tablet 200 m tablet
33 Asiklovir tablet 400 m tablet
34 Atapulgit tablet 600 tablet
35 Atropin injeksi i.m./i. ampul
36 Betahistin mesilat tab tablet
37 Betametason cream 0 tube
38 Betametason tetes ma botol
39 Bisakodil suppositoria supp
40 Bromheksin tablet 8 tablet
41 Cetirizine kapsul 10 kapsul
42 Cetirizine sirup 5 mg/botol 60 ml
43 Deksametason injeksi ampul
44 Deksametason tablet tablet
45 Dekstrometorfan sirup botol 60 ml
46 Dekstrometorfan table tablet
45 Diazepam larutan rectarect tube
46 Diazepam larutan rectarect tube
47 Diazepam injeksi 5 m ampul
49 Difenhidramin injeksi ampul
50 Digoksin tablet 0,25 tablet
51 Diltiazem HCl Tablet tablet
52 Dimenhidrinat tablet tablet
53 Doksisiklin kapsul 10 kapsul
53 Domperidon suspensibotol-60ml
54 Domperidon tablet 10 tablet
55 Efedrin HCl tablet 25 tablet
56 Ekstraks beladona tab tablet
57 Epinefrin (Adrenalin) ampul
58 Eritromisin kapsul 25 kapsul
60 Eritromisin sirup 200 botol
61 Etakridin (Rivanol) labotol 300 ml
64 Fenilbutason 200 mg t tablet
65 Fenitoin Natrium Kap kapsul
66 Fenobarbital tablet 3 tablet
68 Fenolgliserol tetes te botol
69 Fitomenadion (Vit. K) ampul
70 Fitomenadion (Vit. K) tablet
71 Furosemida injeksi 1. ampul
72 Furosemida tablet 40 tablet
73 Gameksan lotion 1botol-30
% ml/tube
74 Gemfibrosil kapsul 3 kapsul
75 Gemfibrozil kapsul 6 kapsul
76 Gentamisin salep kuli tube
77 Gentamisin salep mat botol
78 Gentamisin sulfat tet botol 5 ml
79 Gentian violet larutan botol
80 Glibenklamid tablet 5 tablet
82 Glimepirid tablet 2 m tablet
83 Gliseril Guayakolat ta tablet
85 Glukosa larutan infusbotol 500 ml
86 Glukosa larutan infus ampul
87 Glukosa larutan infusbotol 500 ml
88 Griseofulvin tablet 1 tablet
89 Haloperidol injeksi 5 ampul
90 Haloperidol injeksi 5 ampul
91 Haloperidol tablet 1, tablet
92 Haloperidol tablet 2 tablet
93 Haloperidol tablet 5 tablet
94 Hidroklorotiazida tabl tablet
95 Hidrokortison krim 2, tube
96 Hyoscine-N-Butilbromi tablet
97 Ibuprofen sirup 100 m botol
98 Ibuprofen tablet 200 tablet
99 Ibuprofen tablet 400 tablet
100 Isoniasida tablet 100 tablet
101 Isosorbid dinitrat tab tablet
102 Kalium diklofenak 50 tablet
103 Kalsium laktat tablet tablet
104 Kaptopril tablet 12,5 tablet
105 Kaptopril tablet 25 m tablet
106 Karbamazepin tablet tablet
108 Ketokonazol tablet 2 tablet
109 Ketorolac injeksi 10 mampul 1 ml
110 Ketorolac injeksi 30 mampul 1 ml
111 Klindamisin kapsul 3 kapsul
112 Klobazam tablet 10 m tablet
113 Klonidin tablet 0,15 m tablet
114 Kloramfenikol injeksi vial
115 Kloramfenikol kapsul kapsul
116 Kloramfenikol kapsul kapsul
116 Kloramfenikol salep m tube 5 gram
117 Kloramfenikol salep ku tube
118 Kloramfenikol suspens botol 60 ml
119 Kloramfenikol tetes mbotol 5 ml
120 Kloramfenikol tetes tebotol 5 ml
121 Klorfeniramin maleat tablet
122 Klorpromazin tablet s tablet
123 Klorpromazin tablet s tablet
125 Kotrimoksasol DOEN I tablet
126 Kotrimoksasol suspens botol 60 ml
127 Lamivudin tablet 150 tablet
128 Lanzoprazol kapsul 3 kapsul
129 Larutan mengandungbotol el 500 ml
132 Levotiroksin tablet 1 tablet
134 Lidokain injeksi 2 % ( ampul
135 Lidokain semprot 10 botol
136 Lisol, mengandung kr botol 1000 ml
137 Magnesium sulfat inje ampul
138 Magnesium sulfat inje ampul
139 Mebendazol sirup 100botol 30 ml
140 Mebendazol tablet 10 tablet
141 Mekobalamin tablet 5 tablet
143 Metformin HCl tablet tablet
144 Metil Prednisolon tabl tablet
145 Metil Prednisolon tabl tablet
146 Metilergometrin Malea ampul
147 Metilergometrin malea tablet
148 Metoklopramid injeksi ampul
149 Metoklopramid sirup botol
150 Metoklopramid tablet tablet
151 Metoklopramid tablet tablet
152 Metronidasol sirup 12botol 60 ml
153 Metronidasol tablet 2 tablet
154 Metronidasol tablet 5 tablet
155 Metronidazol infus 50botol-100 ml
157 Natrium Diklofenak ta tablet
158 Natrium Diklofenak ta tablet
159 Natrium Klorida Larutabotol-500 ml
161 Nifedipin tablet 20 m tablet
162 Nistatin vaginal table tablet
163 Obat Batuk Hitam (OB botol-100 ml
164 Oksitetrasiklin injeks vial
165 Oksitetrasiklin salep ktube 5 gram
166 Oksitetrasiklin salep tube
167 Oksitosin injeksi 10 IU ampul
168 Omeprazol injeksi 40 vial
169 Omeprazol kapsul 20 kapsul
170 Ondansentron injeksi ampul
172 Papaverin tablet 40 m tablet
174 Parasetamol sirup 12 botol
175 Parasetamol tablet 5 tablet
176 Petidin injeksi (Narkot ampul
177 Piracetam 800 mg tab tablet
178 Piracetam injeksi 1 g ampul
179 Pirantel tablet score tablet
180 Piridoksin (Vit. B6) ta tablet
181 Piroksikam kapsul 20 tablet
182 Piroksikam tablet 10 tablet
183 Polikresolsulfonat cairan botol 10 ml
184 Povidon iodida laruta botol 30 ml
185 Povidon iodida laruta botol 60 ml
186 Povidon iodida larutabotol 300 ml
188 Propanolol tablet 10 tablet
189 Propiltiourasil tablet tablet
190 Ranitidin injeksi 25 m ampul
191 Ranitidin tablet 150 tablet
192 Rifampisin kaplet sal kaplet
193 Rifampisin kapsul 30 kapsul
194 Ringer laktat larutan botoli 500 ml
196 Salbutamol cairan inhbotol 2,5 ml
197 Salbutamol tablet 2 m tablet
198 Salbutamol tablet 4 m tablet
199 Salep 2-4, Kombinasi pot
200 Asam Salisilat
Salisil bedak 2%2% + kotak-50 gram
201 Sefadroksil 500 mg ka kapsul
202 Sefadroksil kapsul 25 kaplet
203 Sefadroksil kapsul 50 kaplet
204 Sefadroksil sirup ker botol
205 Sefadroksil sirup ker botol
206 Sefotaksim serbuk inj vial
207 Sefotaksim serbuk inj vial
208 Seftriakson serbuk inje vial
209 Serum Anti Bisa Ular P vial 5 ml
210 Serum Anti Tetanus In vial 1.500
211 Sianokobalamin (Vitam ampul
212 Simetidin tablet 200 tablet
213 Simvastatin tablet 10 tablet
214 Simvastatin tablet 30 tablet
215 Siprofloksasin tablet tablet
216 Siprofloksasin tablet tablet
217 Spironolakton tablet tablet
218 Sukralfat tablet 500 m tablet
219 Sukralfat suspensi (Ul botol
220 Sulfasetamid Na tete botol
221 Tetrasiklin kapsul 250 kapsul
222 Tetrasiklin kapsul 500 kapsul
223 Tiamfenikol kapsul 5 kapsul
224 Tiamin (Vitamin B1) i ampul
225 Tiamin (Vitamin B1) t tablet
226 Tramadol kapsul 50 m tablet
227 Trifluoperazin 5 mg ta tablet
228 Triheksifenidil tablet tablet
229 Vaksin rabies untuk m set
230 Vitamin B Kompleks ta tablet

2 Alvogyl paste dus
3 Amalgam Perak (Silver botol
5 Bahan pensteril gigi : botol
6 Bahan tambalan sementbotol 28 gram
7 Devitalisasi pasta (Nobotol/kotak
10 Fuji VII dus
11 Glass inonomer cemenset/botol
12 Gutta percha dan papp kotak/pasang
13 Gutta percha dan papp kotak/pasang
14 Kalsium hidroksida pa kotak 2 tube
15 Klorfenol Kamfer Menbotol 10 ml
17 Pasta pengisi saliran botol
18 Semen Seng Fosfat se set/botol
19 Spon gelatin cubicles box-10
20 Temporary stopingbotol
fle @ 100 gram

1 Anti asma/bronkodilato vial
2 Anti asma/bronkodilato vial
3 Antibiotik injeksi serb vial
4 Antidiare sirup : botol 60 ml
5 Antidiare sirup : Neo botol 60 ml
6 Antidiare Tablet : tablet
7 Antidiare Tablet (Molag tablet
8 Antidiare Tablet (Ome tablet
8 Antihemoroid DOEN (S supp
9 Antihistamin kombinasi tablet
10 Antiinfeksi kulit (luka pot
11 Antiinflamasi gel (Pro tube 30 gr
13 Antiscabies krim (Scabtube 10 gram
14 Antispasme injeksi (Sp vial
15 Antispasme/analgetik tablet
17 Antispasme/analgetik tablet
16 Laksantia tablet 5 tablet
19 Laksantia tablet 5 mg tablet
20 Multivitamin + mineral kaplet
17 Multivitamin + mineral botol 100 ml
18 Multivitamin + mineral kaplet
19 Multivitamin + minyak kapsul
20 Multivitamin geriatri kaplet
21 Multivitamin kaplet kaplet
26 Multivitamin kaplet (P kaplet
27 Multivitamin kaplet kaplet
22 Multivitamin kaplet sa kaplet
23 Multivitamin sirup : Botol
24 Multivitamin sirup + botol 60 ml
25 Multivitamin tabur unt Saset
26 Nasal dekongestan tabl tablet
27 Neurotropik 5000 injek ampul
28 Neurotropik kaplet kaplet
29 Neurotropik kaplet (Nu kaplet
30 Nutrisi/Vitamin injeksi ampul
31 Nutrisi/vitamin tablet tablet
32 Obat antifibrinolitikkotak-50 kaplet
33 Obat Antiflu kombinasbotol 60 ml
34 Obat Antiulkus peptik tablet
35 Obat batuk / flu siru botol 100 ml
42 Obat batuk / flu sirup botol 60 ml
43 Obat batuk / flu sirupbotol 100 ml
36 Vasodilator perifer (Ci ampul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
1 Alat suntik sekali paka set
4 Alkohol swab box
5 Bbraun Intrafix with m set
9 Catgut / benang bedah
Kotak@24x75 cm
10 Catgut chromic 2/0 1 kotak
11 Catgut chromic 3/0 1 kotak
12 Dermafix T 10 x 15 c rol
14 Developer untukBotol
Film 5 ltr Repl 20 ltr
15 Desinfektan - Aseptinbotol-500 ml
16 Film Rontgen ukuran 2 lembar
17 Film Rontgen ukuran 3 lembar
18 Fixer untuk Film RontGalon 20 liter
22 Infus set dengan micri pices
30 Kapas pembalut/abso bungkus
32 Kasa hidrofil 80 cm x rol
33 Kasa hidrofil steril uk box
34 Kasa hidrofil ukuran 1 lembar
35 Kasa kompres 40/40 stbungkus
36 Kasa pembalut hidrofi roll
37 Kasa pembalut hidrofil rol
38 Kasa pembalut hidrofil rol
40 KY Jelly 28 gram / Aqua tube
44 Micropipet Socorex - pieces
47 - Volume 100 - 1000 u set
48 Nasal oxygen canula a pieces
49 Nasal oxygen canula - pieces
50 Penutup luka dengan a Pcs
51 Plester 2.5 cm x 4.5 m rol
52 Plester 5 yards x 2 inc rol
53 Plester hypafix 5 cm rol
54 Plester kain 1,25 cm x Rol
55 Pot sputum buah
56 Sarung tangan steril pasang
60 Sarung tangan ukuran Pcs
61 Sarung tangan ukuran Pcs
62 Silk (benang bedah su kotak
63 Silk (benang bedah su kotak
64 Silk 3/0 jarum 3/8 26box-12 pacs
68 Tabung oksigen 1 m3 set
69 Urine bag Pcs
70 Under pad buah
71 Wing needle 23 G - 25 buah

1 Alat pengukur HB 201 unit
2 Dek glass (cover glass box
4 Object glass box
5 Occu check (alat pem kit
7 Softclick lancing devi kit
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Easy touch cholest box-10
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
- Reagen Trigliseri box-4 btl
- Reagen asam ura box-4 btl
8 Larutan amonium oksa Botol 100 ml
9 Larutan Asam KloridaBotol 100 ml
13 Larutan Giemsa StainBotol 100 ml
14 Larutan Karbol FuksinBotol 100 ml
16 Larutan Metilen BlueBotol 100 ml
17 Larutan Natrium citratBotol 100 ml
18 Larutan Perhidrol (H2Botol 100 ml
21 Reagen pemeriksaan botol
22 Reagen dan alat peng 100 tes / unit
23 Rapid Diagnostic Test kit-25 tes
24 Rapid test Leptospiros box/50 strip
25 Rapid test Chikungun tes
26 Rapid test demam berkit-25 tes
27 Tes Kehamilan
PPTEST Box 40 tes
UltraOne tes kehabox-50 strip
28 Trigliserida
29 Tes HBsAG S/P strip ( box-25 strip
30 Tes HIV I & II Antibody tes
31 Urine Test 10 Paramet btl - 100 test
32 Widal Test Tg H (SS-01Botol 5 ml
33 Widal Test Tg O (SS-90Botol 5 ml
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tabl tablet
2 Arteraquin (dihydro a tablet
3 Artemeter injeksi 1 m ampul
4 Artesunat injeksi vial vial
5 Kloroquin tablet 150 tablet
6 Kombinasi Pirimetami tablet
7 Kuinin Dihidroklorida ampul
8 Kuinin tablet 222 mg tablet

1 Garam oralit serbuk kombin saset


1 Benzatin Benzil Penisilin injvial



1 Retinol (Vitamin A) 100.000kapsul
2 Retinol (Vitamin A) 200.000kapsul
3 Tablet tambah darah kombin tablet
4 Mineral Mix saset

2 Albendazol suspensi 200 mbotol 10 ml
3 Pirantel pamoat tablet 125 tablet

4 OAT Anak paket

Zidovudin + lamivudin (30 tablet
XIV. PROGRAM KUSTA
Obat MDT Kusta PB Dewa blister
Obat MDT Kusta MB Dewablister
UMUM JKN
BAYAR
1370 1152
Mengetahui
Kepala Dinas Kesehatan Plt. Kepala UPT Instalasi Farmasi
Kabupaten Purworejo
dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayanto, Apt.

NIP. 19621204 198803 1 011 NIP. 19680601 199312 1 002
EMAKAIAN OBAT DAN PERBEKALAN KESEHATAN PUSKESMAS CANGKREP
1 SEPTEMBER 2016
RAWAT IN AP JUMLAH
82 2604
Purworejo,
Yang meminta Yang menerima
Kepala Puskesmas .
Cangkrep Petugas Puskesmas
( . ) (
NIP. 19671004 199312 1 002 NIP. 19671004 199312 1 0
JML
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Purworejo, .
Yang menerima
Petugas Puskesmas .
. )
NIP. 19671004 199312 1 002
CATATAN HARIAN PEMA
SATUAN
19 Antibakteri DOEN salep komb : Basitrasin 500 IU/g + tube
20 polimiksin 10.000
Antifungi DOEN IU/g
kombinasi : Asam Benzoat 6% + Asam pot
21 Salisilat 3 % DOEN kombinasi (Generik)
Antihemoroid supp
22 Antimigrain : ergotamin tartrat 1 mg + kofein 60 mg tabl tablet
200 endap 4%

2 Alvogyl paste dus
10 Fuji VII dus

19 Multivitamin + minyak ikan (untuk ibu menyusui) Nulact kapsul

1 Asifit kapsul
3 Enkasari botol
5 Hepagard kapsul
10 OB Herbal botol
4 Alkohol swab box
47 - Volume 100 - 1000 uL set
55 Pot sputum buah
69 Urine bag Pcs
70 Under pad buah

4 Object glass box
III REAGEN
Accutrand 25 strip
Easy Touch box/25
Glucostar box/25
Nesco box-25
Easy Touch box-25
UA Sure box-25
Accutrand box/25
Nesco box-10
Multicare box/25
6 Hb Sahli
- Assistant set
- Superior set
27 Tes Kehamilan
PPTEST Box 40 tes
28 Trigliserida
34 Tes Narkoba
- Cocain strip
- Cannabidoid strip
- Babiturat strip

1 ACT (Artesunate tablet 50 mg + Amodiaquin Anhydrat ta tablet
2 Arteraquin (dihydro artemisin 40 mg tablet + diperaquin tablet






3 Tablet tambah darah kombinasi : Besi II Sulfat 200 mg + Asam Folat 0 tablet
4 Mineral Mix saset


4 OAT Anak paket

XIV. PROGRAM KUSTA
UMUM
BAYAR
1370
Mengetahui
Kabupaten Purworejo

NIP. 19621204 198803 1 011
1 SEPTEMBER 2016
0 ml/tube
@ 100 gram
-50 kaplet
@24x75 cm
tr Repl 20 ltr
1152 82 2604
Yang meminta

NIP. 19680601 199312 1 002 NIP. 19671004 199312 1 002
KESMAS CANGKREP
JML
0
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JUMLAH
Purworejo, .
. ) ( . )
1004 199312 1 002 NIP. 19671004 199312 1 002

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CATATAN HARIAN PEMAKAIAN OBAT DAN PERBEKALAN

B OBAT DAN BAHAN KEDOKTERAN GIGI

C OBAT TAMBAHAN / BRANDED

D OBAT ASLI INDONESIA (OAI)

TAMBAHAN PERBEKALAN KESEHATAN

IV OBAT PROGRAM MALARIA (P2M)

V OBAT PROGRAM DIARE (P2M)

VI. OBAT PROGRAM FILARIA (KAKI GAJAH)

VII OBAT PROGRAM KELAMIN /SIFILIS (P2M)

VIII OBAT PROGRAM KUSTA (P2M)

IX OBAT PROGRAM FLU BURUNG

X OBAT PROGRAM GIZI (KIA)

XI. OBAT PROGRAM KECACINGAN (P2M)

XII. OBAT ANTI TUBERKULOSIS

XIII. PROGRAM P2 ANTIVIRAL

dr. KUSWANTORO, M.Kes. Drs. Nanang Wijayanto, A

JKN RAWAT IN AP JUMLAH

Drs. Nanang Wijayanto, Apt. ( . ( .

B OBAT DAN BAHAN KEDOKTERAN GIGI

C OBAT TAMBAHAN / BRANDED

D OBAT ASLI INDONESIA (OAI)

TAMBAHAN PERBEKALAN KESEHATAN

IV OBAT PROGRAM MALARIA (P2M)

V OBAT PROGRAM DIARE (P2M)

VI. OBAT PROGRAM FILARIA (KAKI GAJAH)

VII OBAT PROGRAM KELAMIN /SIFILIS (P2M)

VIII OBAT PROGRAM KUSTA (P2M)

IX OBAT PROGRAM FLU BURUNG

X OBAT PROGRAM GIZI (KIA)

XI. OBAT PROGRAM KECACINGAN (P2M)

XII. OBAT ANTI TUBERKULOSIS

XIII. PROGRAM P2 ANTIVIRAL

dr. KUSWANTORO, M.Kes. Drs. Nanang Wijay

dr. KUSWANTORO, M.Kes. Drs. Nanang Wijay

Drs. Nanang Wijayanto, Apt. ( . )

Drs. Nanang Wijayanto, Apt. ( . )

B OBAT DAN BAHAN KEDOKTERAN GIGI

C OBAT TAMBAHAN / BRANDED

D OBAT ASLI INDONESIA (OAI)

TAMBAHAN PERBEKALAN KESEHATAN

IV OBAT PROGRAM MALARIA (P2M)

V OBAT PROGRAM DIARE (P2M)

VI. OBAT PROGRAM FILARIA (KAKI GAJAH)

VII OBAT PROGRAM KELAMIN /SIFILIS (P2M)

VIII OBAT PROGRAM KUSTA (P2M)

IX OBAT PROGRAM FLU BURUNG

X OBAT PROGRAM GIZI (KIA)

XI. OBAT PROGRAM KECACINGAN (P2M)

XII. OBAT ANTI TUBERKULOSIS

XIII. PROGRAM P2 ANTIVIRAL

dr. KUSWANTORO, M.Kes.

dr. KUSWANTORO, M.Kes.

Drs. Nanang Wijayanto, Apt. ( . )

Drs. Nanang Wijayanto, Apt. ( . )

B OBAT DAN BAHAN KEDOKTERAN GIGI

C OBAT TAMBAHAN / BRANDED

D OBAT ASLI INDONESIA (OAI)

TAMBAHAN PERBEKALAN KESEHATAN

IV OBAT PROGRAM MALARIA (P2M)

V OBAT PROGRAM DIARE (P2M)

VI. OBAT PROGRAM FILARIA (KAKI GAJAH)

VII OBAT PROGRAM KELAMIN /SIFILIS (P2M)

VIII OBAT PROGRAM KUSTA (P2M)

IX OBAT PROGRAM FLU BURUNG