LAPORAN PEMAKAIAN DAN LEMBAR

PUSKESMAS SURADE
KECAMATAN SURADE
ALAMAT JL. RAYA SURADE NO.53
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN
UMUM BPJS UMUM BPJS UMUM
OBAT 0
1 Albendazol tablet 400 mg Tab 0 0 0 0
2 Allupurinol 100 mg Tablet Tab 2,500 19,700 1,700 2500
3 Aloclair plus gel BOTOL 0 0 0 0
4 Aminofillin inj 24 mg /ml-10ml ampul 0 0 0 0
5 Aminophylin tablet 200mg Tab 0 0 0 0
6 Amitriptilin HCl tablet salut 25 mg Tab 0 0 0 0
7 Amlodipin 5 mg Tab 1,200 0 480 1200
8 Amoksisilin kaplet 500 mg kaplet 38,000 0 10,000 38000
9 Amoksisilin kapsul 250 mg KAPSUL 0 0 0 0
Amoksisilin sirup kering 125 mg/5 ml
10 BOTOL 0 0 300 0
Amoksisilin sirup kering Forte 250
11 mg/5 ml BOTOL 0 0 0 0
12 ampisilin inj IM/IV 1000 mg/ml ampul 0 0 0 0
Antalgin (Metampiron) tablet 500 mg
13 Tab 3000 0 2000 3000
14 Antasida Suspensi 60 ml BOTOL 90 0 50 90
15 Antasida DOEN tablet kombinasi Tab 17,400 0 3,500 17400
Anti Bakteri DOEN salep kombinasi
16 tube 0 0 0 0
17 Anti fungi DOEN komb sk tube 0 0 24 0
18 Anti Hemoroid DOEN kombinasi supp 0 0 20 0
19 Antimigren DOEN kombinasi Tab 0 0 0 0
20 Antiparkinson DOEN Tab 0 0 0 0
21 Artesunat serb inj 60 mg/ml ampul 0 0 0 0
22 Artesunate tablet (ACT) Tab 0 0 0 0
Asam Asetil Salisilat (Asetosal) tablet
23 80 mg Tab 0 0 0 0
Asam Askorbat (Vit.C) tablet 50 mg
24 Tab 600 0 1000 600
25 asam folat tablet 1 mg Tab 0 0 0 0
26 Asam mefenamat 500 mg kaplet 4,500 0 1,500 4500
27 Asam Mefenamat Kapsul 250 mg KAPSUL 2,000 0 1,500 2000
28 Asiklovir Krem 5% tube 50 0 50 50
29 Asiklovir tablet 200 mg Tab 0 0 0 0
30 Asiklovir Tablet 400 mg Tab 300 3,500 400 300
 Atropin Sulfat injeksi 0,25 mg/ml - 1
31 ml ampul 10 0 0 10
32 Atropin Sulfat tablet 0,5 mg Tab 0 0 0 0
33 Attalpugite tab 600 mg Tab 1800 0 5000 1800
Benzatin Benzil Penisilin inj.1.2 juta
34 IU/vial ampul 0 0 0 0
35 Betahistin maleat Tab 390 0 120 390
36 Betametasone Krim 0.1% tube 264 0 96 264
37 Bisakodil Supp 10 mg supp 0 0 0 0
38 Captopril 12,5 mg Tab 0 0 0 0
39 Captopril tablet 25 mg Tab 12,400 17,000 1,700 12400
40 Ciprofloksasin 500 mg tablet Tab 0 0 2000 0
Deksametason injeksi 5 mg/ml - 1 ml
41 ampul 90 0 0 90
42 Deksametasone tablet 0.5mg Tab 0 0 5000 0
43 Diasepam 5 mg tablet Tab 700 0 0 700
44 Diazepam Inj 5 ml/2ml ampul 0 0 0 0
45 Diazepam lar rektal 5mg/2,5ml tube 0 0 0 0
Dietilkarbamazin sitrat tablet 100 mg
46 Tab 0 0 0 0
Difenhidramin HCl injeksi 10 mg/ml -
47 1 ml ampul 0 0 0 0
48 Digoksin tablet 0,25 mg Tab 600 0 100 600
49 Doksisiklin 100 mg ampul 0 0 0 0
50 Domperidon Syrup BOTOL 0 0 0 0
51 Domperidon tablet 10 mg Tab 0 0 200 0
Epinefrina (adrenalin) injeksi 0,1% - 1
52 ml ampul 0 0 0 0
53 Erytromycin 250 mg KAPSUL 0 0 0 0
54 Erytromycin syr 200mg/5 ml BOTOL 0 0 0 0
55 Etambutol HCL 250 mg Tab 0 0 0 0
56 Fenitoin Na kaps 100 mg KAPSUL 0 0 0 0
Fenobarbital injeksi 50 mg/ml - 2 ml
57 ampul 0 0 0 0
58 Fenobarbital tablet 30 mg Tab 0 0 1000 0
59 Fenofibrat kaps 100 mg KAPSUL 120 0 0 120
Fenoksimetil Penisilina tablet 250 mg
60 Tab 0 0 0 0
Fenoksimetil Penisilina tablet 500 mg
61 Tab 0 0 0 0
Fitomenadion (Vit.K1) tablet salut 10
62 mg Tab 2,100 0 300 2100
63 Fitomenadion injeksi 2 mg/ml ampul 1410 0 0 1410
64 Furosemid tablet 40 mg Tab 800 3,700 200 800
65 Garam oralit 200 ml air sachet 4,150 0 1200 4150
 66 Gentamicin inj 40 mg//ml ampul 0 0 0 0
67 Gentamisin tetes mata BOTOL 0 0 0 0
68 Glibenklamid tablet 5 mg Tab 3,700 0 0 3700
69 Gliseril Guayakolat tablet 100 mg Tab 15,600 0 3000 15600
70 Gliserin guayakolat syrup BOTOL 0 0 0 0
Griseofulvin tablet 125 mg,
71 micronized Tab 2,300 0 900 2300
72 Haloperidol 0,5 mg tablet Tab 0 0 0 0
73 Haloperidol 1,5 mg tablet Tab 300 6,740 0 300
74 Haloperidol 5 mg Tab 0 0 0 0
Hidroklorotiazid (HCT) tablet 25 mg
75 Tab 0 0 0 0
76 Hidrokortison krim 2,5 % tube 120 0 48 120
77 Ibuprofen tablet 200 mg Tab 0 0 0 0
78 Ibuprofen tablet 400 mg Tab 7,800 0 1800 7800
79 Isoniazid tablet 100 mg Tab 0 0 0 0
80 Isoniazid tablet 300 mg Tab 0 0 0 0
Isosorbid Dinitrat 5 mg tablet
81 sublingual Tab 0 0 100 0
82 Kalsium alginate gel tube 0 0 0 0
83 Kalsium Glukonat Inj 100 mg/ml ampul 24 0 0 0 24
84 Kalsium lakate (kalk) tablet Tab 4000 0 0 0 4000
85 Karbamazepin tablet 200 mg Tab 1,300 4000 400 0 1300
86 Karbogliserin Tetes Telinga 10% BOTOL 48 0 0 0 48
87 Ketokonazol krim 2 % tube 75 24 50 0 75
88 Ketokonazol Tablet 200 mg Tab 5,150 0 1000 0 5150
89 Klindamicin 300 mg KAPSUL 0 0 0 0 0
90 Klopidogrel tab 75 mg Tab 0 0 0 0 0
91 Kloramfenikol kapsul 500 mg KAPSUL 1,100 1,400 0 0 1100
Kloramfenikol salep kulit 2%
92 (bufacetin) tube 0 0 0 0 0
Kloramfenikol Salep Mata 1% - 3,5 gr
93 BOTOL 480 0 120 0 480
Kloramfenikol Tetes Telinga 3% - 5 ml
94 BOTOL 0 0 0 0 0
Klorfeniramin Maleat (CTM) tablet 4
95 mg Tab 30,170 0 5000 0 30170
96 Klorpromazin HCL tablet 100 mg Tab 0 0 0 0 0
97 Klorpromazin inj. 25 mg/ml ampul 0 0 0 0 0
98 Kodein HCl tablet 10 mg Tab 0 0 0 0 0
99 Kotrimoksazol forte tablet Tab 4800 0 1000 0 4800
Kotrimoksazol suspensi kombinasi
100 BOTOL 600 0 200 0 600
101 Kuinin (Kina) tablet 200 mg Tab 0 0 0 0 0
 Kuinin dihidroklorida inj 25 %-2 ml
102 ampul 0 0 0 0 0
103 Lansoprazol 30 mg Tab 0 0 200 0 0
104 Lidokain inj. 2% ampul 200 0 100 0 200
105 Lidokain komp. injeksi kombinasi ampul 70 0 60 0 70
106 Loratadin tab 10 mg Tab 0 0 0 0 0
Magnesium Sulfat injeksi (IV) 40% - 25
107 ml ampul 0 0 0 0 0
108 Mebendazol tablet 100 mg Tab 0 0 0 0 0
109 Metformin tablet 500 mg Tab 6,700 0 1700 0 6700
110 metil dopa tab 250 mg Tab 0 0 0 0 0
Metilergometrin Maleat injeksi 0,200
111 mg - 1ml ampul 0 0 0 0 0
Metilergometrin Maleat tablet salut
112 0,125 mg Tab 1900 600 200 0 1900
113 Metilprednisolon tablet Tab 0 0 0 0 0
114 Metoklorpropamid tablet 5 mg Tab 800 0 200 0 800
115 Metronidazol sirup 125mg/5ml BOTOL 0 0 0 0 0
116 Metronidazol tablet 250 mg Tab 5000 0 0 0 5000
117 Metronidazol tablet 500 mg Tab 6200 0 1700 0 6200
118 Miconazol SK tube 48 0 24 0 48
119 Multivitamin sirup BOTOL 150 0 100 0 150
120 Multivitamin Tablet Dewasa Tab 4,800 0 0 0 4800
121 Natrium bikarbonat tablet 500 mg Tab 3000 0 0 0 3000
122 Natrium Diklofenac 25 mg Tab 0 0 500 0 0
123 Nifedifin tablet 10 mg Tab 700 0 0 0 700
Nistatin 100.000 IU/gram tablet
124 vaginal supp 487 400 0 0 487
Nistatin tablet salut gula 500.000
125 IU/g Tab 400 1000 0 0 400
126 Obat batuk Hitam (OBH) BOTOL 150 0 50 0 150
Oksitetrasiklin HCl salep 3% - 5 gram
127 tube 0 0 0 0 0
128 Oksitosin injeksi 10 IU/ml - 1 ml ampul 40 0 300 0 40
129 Omeprazol 20mg Tab 810 0 150 0 810
130 Ondansentron tab 8 mg Tab 0 0 120 0 0
131 parasetamol drop BOTOL 0 0 0 0 0
132 Parasetamol kaplet 500 mg Tab 49,800 0 33,600 0 49800
133 Parasetamol sirup BOTOL 450 0 300 0 450
134 Permetrin/scabimite krim 5 % tube 0 0 0 0 0
135 Pirantel Pamoat tablet 125 mg Tab 170 0 0 0 170
136 Pirazinamid tablet 500 mg Tab 0 0 0 0 0
Piridoksin HCl (Vit.B6) tablet 10 mg
137 Tab 6,200 0 1000 0 6200
138 Prednison tablet 5 mg Tab 2,700 0 1000 0 2700
139 Probiokid kapsul 30 0 0 0 30
140 Propiltiourasil tablet 100 mg Tab 300 0 0 0 300
141 Propranolol HCl tablet 10 mg Tab 100 0 0 0 100
142 Pyrazinamid tablet 500 mg Tab 0 0 0 0 0
143 Ranitidin Injeksi 25 mg/ml ampul 97 0 30 0 97
144 Ranitidin tablet 150 mg Tab 1,500 0 1000 0 1500
145 Retinol (Vit.A) 100.000 IU kapsul KAPSUL 0 0 0 0 0
146 Retinol (Vit.A) 200.000 IU kapsul KAPSUL 0 0 0 0 0
147 Rifampisin kapsul 300 mg KAPSUL 0 0 0 0 0
148 Rifampisin kapsul 450 mg KAPSUL 0 0 0 0 0
149 Rifampisin kapsul 600 mg KAPSUL 0 0 0 0 0
150 Salbutamol Cairan ih 0,1% BOTOL 0 0 0 0 0
151 Salbutamol tablet 4 mg Tab 7,300 0 0 0 7300
152 Salep 2 - 4 kombinasi tube 144 504 48 0 144
153 Salisil Bedak 2% - 50 gram tube 274 0 100 0 274
154 Sefadroksil Kapsul 500 mg KAPSUL 0 15,400 0 0 0
155 Sefadroksil Syrup 250 mg BOTOL 0 0 0 0 0
156 Sefiksim kapsul 100 mg KAPSUL 0 0 0 0 0
157 Sertirizin tablet 10 mg Tab 0 0 0 0 0
158 Setirizin sir 5 mg/ 5 ml BOTOL 0 0 0 0 0
Sianokobalamin (Vitamin B12) 50 mg
159 Tab 0 0 1000 0 0
160 Simvastatin 20 mg Tab 0 0 400 0 0
161 Tablet ferro fumarat 60mg as folat 0. Tab 0 0 0 0 0
162 Teofilin tab 150 mg Tab 0 0 0 0 0
163 Tetrasiklin HCl kapsul 250 mg KAPSUL 7000 0 0 0 7000
164 Tetrasiklin HCl kapsul 500 mg KAPSUL 150 0 500 0 150
Tiamin HCl/Mononitrat (Vit.B1) tablet
165 50 mg Tab 17,700 0 2000 0 17700
166 Triheksifenidil HCl 2 mg tablet Tab 1,400 0 0 0 1400
167 Vermox tablet (obat cacing) Tab 0 0 0 0 0
168 Vitamin B komplek tablet Tab 11,800 0 1400 0 11800
169 Zink syrup 20 mg/5 ml BOTOL 0 0 50 0 0
170 Zink tablet disp 20 mg Tab 2,800 0 200 0 2800
AN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PELAPORAN BULAN Januari
TAHUN 2018

PERSEDIAAN PEMAKAIAN STOK AKHIR

BPJS UMUM BPJS UMUM BPJS

0 0 0
0 0 0
19700 2500 19700
0 0 0
0 0 0
0 0 0
0 0 0
0 1200 0
0 38000 0
0 0 0

0 0 0

0 0 0
0 0 0

0 3000 0
0 90 0
0 17400 0

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0

0 600 0
0 0 0
0 4500 0
0 2000 0
0 50 0
0 0 0
3500 300 3500
 0 10 0
0 0 0
0 1800 0

0 0 0
0 390 0
0 264 0
0 0 0
0 0 0
17000 12400 17000
0 0 0

0 90 0
0 0 0
0 700 0
0 0 0
0 0 0

0 0 0

0 0 0
0 600 0
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
0 120 0

0 0 0

0 0 0

0 2100 0
0 1410 0
3700 800 3700
0 4150 0
 0 0 0
0 0 0
0 3700 0
0 15600 0
0 0 0

0 2300 0
0 0 0
6740 300 6740
0 0 0

0 0 0
0 120 0
0 0 0
0 7800 0
0 0 0
0 0 0

0 0 0
0 0 0
0 24 0
0 4000 0
4000 1300 4000
0 48 0
24 75 24
0 5150 0
0 0 0
0 0 0
1400 1100 1400

0 0 0

0 480 0

0 0 0

0 30170 0
0 0 0
0 0 0
0 0 0
0 4800 0

0 600 0
0 0 0
 0 0 0
0 0 0
0 200 0
0 70 0
0 0 0

0 0 0
0 0 0
0 6700 0
0 0 0

0 0 0

600 1900 600

0 0 0
0 800 0
0 0 0
0 5000 0
0 6200 0
0 48 0
0 150 0
0 4800 0
0 3000 0
0 0 0
0 700 0

400 487 400

1000 400 1000

0 150 0

0 0 0
0 40 0
0 810 0
0 0 0
0 0 0
0 49800 0
0 450 0
0 0 0
0 170 0
0 0 0

0 6200 0
0 2700 0
 0 30 0
0 300 0
0 100 0
0 0 0
0 97 0
0 1500 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 7300 0
504 144 504
0 274 0
15400 0 15400
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
0 0 0
0 0 0
0 7000 0
0 150 0

0 17700 0
0 1400 0
0 0 0
0 11800 0
0 0 0
0 2800 0
Januari
2018