Format Lplpo 2018

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
KODE PUSKESMAS : P9106070101

NAMA PUSKESMAS : TEMINABUAN DIPERIKSA DISIAPKAN DISERAHKAN PEMAKAIAN
DISTRIK : TEMINABUAN BULAN Januari
KABUPATEN : SORONG SELATAN TAHUN 2018
PROVINSI : PAPUA BARAT
STOK PEMBERIAN
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN EXPIRE SISA STOK STOK OPT PERMINTAAN
AWAL APBD KAB APBD PROV BUFF STOK
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT
1 ALKOHOL 70% 100 ML Btl - -

2 ALKOHOL 70% 300 ML Btl - -
3 ALLOPURINOL TABLET 100 MG Tab - -
4 AMAROPO PLUS TABLET Tab - -
5 AMBROKSOL SIRUP 15 MG/ML Btl - -
6 AMBROKSOL TABLET 30 MG Tab - -
7 AMINOFILIN INJEKSI 24 MG/ML Ampul - -
8 AMINOFILIN TABLET 200 MG Tab - -
9 AMITRIPTYLIN TAB 25 MG Tab - -
10 AMLODIPIN TABLET 10 MG Tab - -
11 AMLODIPIN TABLET 5 MG Tab - -
12 AMOKSISILLIN KAPLET 250 MG Kapsul - -
13 AMOKSISILLIN KAPLET 500 MG Tab - -
14 AMOKSISILLIN SIRUP KERING 125 MG/5ML Btl - -
15 AMOKSISILLIN SIRUP KERING FORTE 250 Btl
MG/5ML - -
16 AMPISILLIN INJEKSI 1 GRAM Vial - -
17 AMPISILLIN SIRUP KERING 125 MG/5ML Btl - -
Page 1 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
18 AMPISILLIN TABLET 500 MG Tab - -
19 ANTALGIN INJEKSI 250 MG/ML Amp - -
20 ANTALGIN TABLET 500 MG Tab - -
21 ANTASIDA DOEN SUSPENSI KOMBINASI Btl - -
22 ANTASIDA DOEN TABLET KUNYAH KOMBINASI Tab - -
23 ANTIFUNGI SALEP, KOMBINASI: ASAM BENZOAT POT
6% + ASAM SALISILAT 3% - -
24 ANTIHEMOROID DOEN KOMBINASI Supp - -
25 AQUA PRO INJEKSI STERIL 20 ML Vial - -
26 ASAM ASCORBAT TABLET 250 MG Tab - -
27 ASAM ASCORBAT( VIT. C) TABLET 50 MG Tab - -
28 ASAM ASETILSALISILAT TABLET 80 MG Tab - -
29 ASAM FOLAT TABLET 0,4 MG Tab - -
30 ASAM MEFENAMAT TABLET 500 MG Tab - -
31 ASAM TRANEXAMAT INJEKSI 100 MG/5 ML Ampul - -
32 ASAM TRANEXAMAT TABLET 500 MG Tab - -
33 ASIFIT TABLET Tab - -
34 ASIKLOVIR KRIM 5% Tube - -
35 ASIKLOVIR TABLET 200 MG Tab - -
36 ASIKLOVIR TABLET 400 MG Tab - -
37 ATROPIN SULFAT INJ. 0,25 MG/ML-1ML Ampul - -
38 BECARBON TABLET Tab - -
39 BECEFORT SIRUP Btl - -
40 BECEFORT TABLET Tab - -
41 BENZATIN BENSIL PENISILIN 1,2 JT UI/VIAL Vial - -
42 BENZATIN BENSIL PENISILIN 2,4 JT UI/VIAL Vial - -
43 BETAHISTIN MESILAT TABLET 6 MG Tab - -
BETAMETASON CREAM 0,1% (SEBAGAI
Tube
44 VALERAT) - -
45 BIORON INJEKSI Ampul - -
46 BIORON TABLET Tab - -
47 CAIRAN ASERING Btl - -
Page 2 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
48 CAIRAN MANITOL LAR INFUS 20% Btl - -
49 CAIRAN OTSURAN 70 Btl - -
50 CALCIDOL SYRUP Btl - -
51 CAPTOPRIL TABLET 12,5 MG Tab - -
52 CAPTOPRIL TABLET 25 MG Tab - -
53 CAPTOPRIL TABLET 50 MG Tab - -
54 CARBAMAZEPIN TABLET 200 MG Tab - -
55 CEFADROKSIL KAPSUL 250 MG Kaps - -
56 CEFADROKSIL KAPSUL 500 MG Kapsul - -
57 CEFADROKSIL SIRUP 125 MG/60 ML Btl - -
58 CEFOTAXIME INJEKSI 1 GR vial - -
59 CENDO XYTROL TM Btl - -
60 CLINDAMISIN KAPSUL 150 MG Kaps - -
61 CLINDAMISIN KAPSUL 300 MG Kapsul - -
62 CLOBAZAM TABLET 10 MG Tab - -
63 CLORPROMAZIN INJEKSI 5 mg/ml Ampul - -
64 CLORPROMAZIN TABLET 25 MG Tab - -
65 Amp
CYANOCOBALAMIN (B-12) INJEKSI 500 mcg/ml - -
66 CYANOCOBALAMIN (B-12) TABLET 50 MCG Tab - -
67 DASABION KAPSUL Kaps - -
68 DEKSAMETHASON INJEKSI 5 MG/ML-1ML Ampul - -
69 DEKSAMETHASON TABLET 0,5 MG Tab - -
70 DESOKSIMETASON SALEP 0,25% Tub - -
71 DEVITALISASI PASTA Btl - -
72 DEXTAMIN TABLET Tab - -
73 DIAZEPAM INJEKSI 5 MG/ML- 2 ML Amp - -
74 DIAZEPAM TABLET 2 MG Tab - -
75 DIAZEPAM TABLET 5 MG Tab - -
76 DIFENHIDRAMIN HCl INJEKSI 10 MG/ML Ampul - -
77 DIGOKSIN TABLET 0,25 MG Tab - -
78 DOKSISIKLIN TABLET 100 MG Kaps - -
Page 3 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
79 DOMPERIDON SUSPENSI 5 MG/5ML Btl - -
80 DOMPERIDON TABLET 10 MG Tab - -
81 DULCOLAX SUPPO ANAK 5 MG Supp - -
82 DULCOLAX SUPPO DEWASA 10 MG Supp - -
83 DULCOLAX TABLET Tab - -
84 EFEDRIN INJEKSI 50 MG/ML Ampul - -
85 EFEDRIN TABLET 25 MG Tab - -
86 EPINEFRIN HCl (ADRENALIN) INJEKSI 0,1% Ampul - -
87 ERGOTAMIN TABLET 1 MG Tab - -
88 ERITROMISIN KAPSUL 250 MG Kapsul - -
89 ERITROMISIN KAPSUL 500 MG Kapsul - -
90 ERITROMISIN SYRUP 200 MG/5 ML Btl - -
91 ETAKRIDIN (RIVANOL) LARUTAN 0,1% Btl - -
92 ETAMBUTOL TABLET 250 MG Tab - -
93 ETAMBUTOL TABLET 500 MG Tab - -
94 ETIL KLORIDA SEMPROT Btl - -
95 EUGENOL CAIRAN Btl - -
96 FENITOIN NATRIUM TABLET 100 MG Tab - -
97 FENITOIN NATRIUM TABLET 30 MG Tab - -
98 FENOL GLISEROL TT 10% Btl - -
99 FITUNO Tab - -
100 FLUKONAZOL KAPSUL 150 MG Kapsul - -
101 FOLAMIL GENIO KAPSUL Kaps - -
102 FUROSEMID TABLET 40 MG Tab - -
103 GENTAMYCIN INJEKSI 40 MG/ML Ampul - -
104 GENTAMYCIN SALEP KULIT 0,1% Tube - -
105 GENTAMYCIN SALEP MATA 0,3% Tube - -
106 GENTAMYCIN SULFAT TETES MATA 0,3% Btl - -
107 GENTIAN VIOLET Btl - -
108 GLASS IONOMER CEMENT ART Set - -
109 GLIBENKLAMID TABLET 5 MG Tab - -
110 GLIMEPIRID TABLET 1 MG Tab - -
Page 4 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
111 GLIMEPIRID TABLET 4 MG Tab - -
112 GLUKOSA LARUTAN INFUS 10% STERIL Btl - -
113 GLUKOSA LARUTAN INFUS 5% STERIL Btl - -
114 GLYCERIL GUAIACOLAT TABLET 100 MG Tab - -
115 GRISEOFULVIN TABLET 125 MG Tab - -
116 GUAIFENESIN TABLET 100 MG Tab - -
117 HEMAFORT TABLET Tab - -
118 HIDROCLOROTIAZID TABLET 25 MG Tab - -
119 HIDROKORTISON KRIM 25% Tube - -
120 HUSTAB P TABLET Tab - -
121 IBUPROFEN SUSPENSI 100 MG/5 ML Btl - -
122 IBUPROFEN TABLET 200 MG Tab - -
123 IBUPROFEN TABLET 400 MG Tab - -
124 ICHTAMOL (ICHTYOL) SALEP Pot - -
125 ISONIAZID TABLET 100 MG Tab - -
126 ISONIAZID TABLET 300 MG Tab - -
127 ISOSORBIT DINITRAT INJEKSI 10 MG/10 ML Ampul - -
128 ISOSORBIT DINITRAT TABLET SUB 5 MG Tab - -
129 KALIUM DIKLOFENAK TABLET 25 MG Tab - -
130 KALIUM DIKLOFENAK TABLET 50 MG Tab - -
131 KALSIUM HIDROKSIDA PASTA Tube - -
132 KALSIUM LACTAT TABLET 500 MG Tab - -
133 KANDESARTAN TABLET 16 MG Tab - -
134 KANDESARTAN TABLET 8 MG Tab - -
135 KETOCONAZOLE KRIM 2% Tube - -
136 KETOCONAZOLE TABLET 200 MG Tab - -
137 KETOROLAC INJEKSI 30 MG/ML Ampul - -
KININA DIHIDROKLORIDA (KINA) INJEKSI 25%-2
Amp
138 ML - -
139 KLORAMFENIKOL KAPSUL 250 MG Kaps - -
140 KLORAMFENIKOL KAPSUL 500 MG Kapsul - -
141 KLORAMFENIKOL SALEP KULIT 2% Tube - -
Page 5 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
142 KLORAMFENIKOL SALEP MATA 1% Tube - -
143 KLORAMFENIKOL TETES TELINGA 3% Btl - -
KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG Tab
144 - -
145 KLORFENOL MENTOL (CHKM) Btl - -
KOTRIMOKSAZOL SUSPENSI KOMB. 240 Btl
146 MG/5ML - -
147 KOTRIMOKSAZOL TABLET 120 MG PEDIATRIK Tab - -
148 KOTRIMOKSAZOL TABLET 480 MG Tab - -
149 KOTRIMOKSAZOL TABLET 960 MG Tab - -
150 LACBON TABLET Tab - -
151 LAKTULOSA SIRUP 3,335 G/5 ML Btl - -
LIDOCAIN 2% (HCl) + EPINEFRIN INJEKSI Ampul
152 1:80.000-2 ml - -
153 LIDOCAIN NON EPINEFRIN INJEKSI 2% Ampul - -
154 LIVRON BPLEX Tab - -
155 LOPERAMID TABLET 2 MG Tab - -
156 LORATADIN TABLET 10 MG Tab - -
157 MAGNESIUM SUFAT INJEKSI (Mg SO4) 20 % Vial - -
158 MELOKSIKAM TABLET 15 MG Tab - -
159 METANEURON TABLET Tab - -
160 METFORMIN TABLET 500 MG Tab - -
161 METHIL ERGOMETRIN INJEKSI 0,2 MG/ML Ampul - -
162 METHIL ERGOMETRIN TABLET 0,125 MG Tab - -
163 METILPREDNISOLON TABLET 16 MG Tab - -
166 METOKLOPRAMIDE TABLET 10 MG Tab - -
167 METRONIDAZOL OVULA Supp - -
168 METRONIDAZOL TABLET 250 MG Tab - -
169 METRONIDAZOL TABLET 500 MG Tab - -
Page 6 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
170 MIKONAZOL KRIM 2% Tube - -
171 MUMMIFYING PASTA Btl - -
172 NATRIUM DIKLOFENAK TABLET 25 MG Tab - -
173 NATRIUM DIKLOFENAK TABLET 50 MG Tab - -
174 NATRIUM KLORIDA LARUTAN INFUS 0,9% Btl - -
175 NIFEDIPIN TABLET 10 MG Tab - -
176 NISTATIN SUSPENSION Btl - -
177 NISTATIN VAGINAL TABLET 100.000 IU/G Tab - -
178 NOZA TABLET Tab - -
179 OBH SYRUP 200 ML Btl - -
180 OKSITETRASIKLIN SALEP KULIT 3% Tube - -
181 OKSITETRASIKLIN SALEP MATA 1% Tube - -
182 OKSITOSIN INJEKSI 10 IU/ML Ampul - -
183 OMEPRASOL KAPSUL 20 MG Kapsul - -
184 OMEPRAZOL INJEKSI 40 MG / 10 ML Amp - -
185 ORALIT 200 ML Sach - -
186 PAPAVERIN HCl TABLET 40 MG Tab - -
187 PARASETAMOL DROPS 100 MG/ML Btl - -
188 PARASETAMOL SIRUP 120 MG/ML Btl - -
189 PARASETAMOL TABLET 500 MG Tab - -
190 PEHACAIN INJEKSI Amp - -
191 PHENOBARBITAL INJEKSI 50 MG/ML Ampul - -
192 PHENOBARBITAL TABLET 30 MG Tab - -
193 PIRACETAM TABLET 400 MG Tab - -
194 PIRANTEL SIRUP 125 MG /5 ML Btl - -
195 PIRANTEL TABLET (BASE) 125 MG Tab - -
196 PIRIMETAMIN+SULFADOKSIN KOMBINASI Tab - -
197 PIROKSIKAM TABLET 10 MG Tab - -
198 PIROKSIKAM TABLET 20 MG Tab - -
199 PREDNISON TABLET 5 MG Tab - -
200 PRIMAKUIN TABLET 15 MG Tab - -
201 PROKAIN PENISILLIN INJEKSI 3 JT IU Vial - -
Page 7 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
202 PROPANOLOL HCl TABLET 40 MG Tab - -
203 PYRAZINAMID TABLET 500 MG Tab - -
QUININ TABLET 200 MG (222 MG SBG GARAM) Tab
204 - -
205 RANITIDIN INJEKSI 25 MG/ML Amp - -
206 RANITIDIN TABLET 150 MG Tab - -
207 RIFAMPICIN KAPSUL 300 MG Kapsul - -
208 RIFAMPICIN KAPSUL 450 MG Kapsul - -
209 RINGER LAKTAT LARUTAN CAIRAN INFUS Btl - -
210 SALBUTAMOL CAIRAN IH 0,1% Botol - -
211 SALBUTAMOL SIRUP BTL - -
212 SALBUTAMOL TABLET 2 MG Tab - -
213 SALBUTAMOL TABLET 4 MG Tab - -
214 SALEP 2-4 KOMBINASI Pot - -
215 SALISIL BEDAK 2% Ktk - -
216 SEFIKSIM KAPSUL 100 MG Kapsul - -
217 SEFIKSIM SIRUP KERING 100 MG / 5 ML Btl - -
218 SEFTRIAKSON INJEKSI 1 GR Vial - -
219 SEMEN SENG FOSFAT SERBUK & CAIRAN Btl - -
220 SERUM ABU POLIVALEN INJEKSI Vial - -
221 SERUM ANTI TETANUS INJEKSI 1.500 IU Amp - -
222 SETIRIZIN KAPSUL 10 MG Kapsul - -
223 SETIRIZIN SIRUP 5 MG/ML Btl - -
224 SIMVASTATIN TABLET 10 MG Tab - -
225 SIMVASTATIN TABLET 20 MG Tab - -
226 SIPROFLOKSACIN TABLET 500 MG Tab - -
227 STESOLID INJEKSI Amp - -
228 STESOLID SUPPO 10 MG/2,5 ML Supp - -
229 STESOLID SUPPO 5 MG/2,5 ML Supp - -
230 STREPTOMYCIN SULFAT INJEKSI 1 G Vial - -
231 SUKRALFAT SIRUP 500 MG/ 5 ML, 100 ML Botol - -
TABLET TAMBAH DARAH KOMBINASI (FE.
232 Tab - -
FUMARAT 60 MG + AS. FOLAT 0,4 MG)
Page 8 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
233 TETRACYCLIN KAPSUL 250 MG Kapsul - -
234 TETRACYCLIN KAPSUL 500 MG Kapsul - -
235 VICAL SYRUP Btl - -
236 VIT. A (RETINOL) 100.000 IU KAPSUL LUNAK Kapsul - -
237 VIT. A (RETINOL) 200.000 IU KAPSUL LUNAK Kaps - -
238 VIT. B KOMPLEKS TABLET Tab - -
239 VIT. B1 (THIAMIN) INJEKSI 100 MG/ML-1ML Amp - -
240 VIT. B1 (THIAMIN) TABLET 50 MG Tab - -
241 VIT. B6 (PYRIDOKSIN HCl) TABLET 10 MG Tab - -
242 VIT. B6 (PYRIDOKSIN HCl) TABLET 25 MG Tab - -
243 VIT. K INFANT INJEKSI 2 MG/ML Ampul - -
244 VIT. K INJEKSI (PHYTOMENADION) 10MG/ML Amp - -
245 VIT. K TAB. SALUT (PHYTOMENADION) 10MG Tab - -
246 VOMETA DROPS 5 MG/ML Btl - -
247 YODIUM POVIDON LARUTAN 10% 300 ML Btl - -
248 YODIUM POVIDON LARUTAN 10% 60 ML Btl - -
249 ZINK SIRUP 10 MG/ML Btl - -
250 ZINK TABLET DISPERSIBLE 20 MG Tab - -
II BMHP
1 ABBOCATH (I.V CATHETER) NO.18 Pcs - -

5 ALKOHOL SWAB Pcs - -
6 BIOPLACENTON TULLE Pcs - -
7 BISTURI Pcs - -
8 BLOOD LANCET Pcs - -
9 CATGUT CROMIC 2/0 + JARUM BEDAH Pcs - -
10 CATGUT CROMIC 3/0 + JARUM BEDAH Pcs - -
11 CATGUT PLAIN 2/0 + JARUM BEDAH Pcs - -
Page 9 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
12 CATGUT PLAIN 3/0 + JARUM BEDAH Pcs - -
13 CATGUT SILK 2/0 + JARUM BEDAH Pcs - -
14 CATGUT SILK 3/0 + JARUM BEDAH Pcs - -
15 CUVETTES DIASPECT Pcs - -
16 DECK GLASS 20X20 Pcs - -
17 DISPOSABLE DENTAL NEEDLE 16 mm Pcs - -
18 ELASTIC BANDAGE 10 CM X 4,5 M Roll - -
19 ELASTIC BANDAGE 15 CM X 4,5 M Roll - -
20 ELASTIC BANDAGE 7,5 CM X 4,5 M Roll - -
21 FOLLEY CATHETER NO.16 Pcs - -
25 HIDROGEN PEROKSIDA (H2O2) 3% 100 ML Btl - -
26 INFUSION SET ANAK Set - -
27 INFUSION SET DEWASA Set - -
28 KAPAS PEMBALUT 100 Gr Bks - -
31 KASA HYDROFIL 2 X 80 CM Roll - -
32 KASA HYDROFIL 4 M X 10 CM Roll - -
35 KASA HYDROFIL 40 Y X 80 CM Roll - -
36 KASA STERIL HYDROFIL 16X16 Ktk - -
37 KASA STERIL HYDROFIL 18X22 Ktk - -
38 KLINIPET 20 Pcs - -
42 KONDOM Pcs - -
43 LARUTAN TURC Btl - -
Page 10 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
44 LENS PAPER Pcs - -
45 LISOL (DESINFECTAN) 1 LITER Btl - -
46 MASKER Pcs - -
47 MICROPIPET TIPS (YELLOW) Pcs - -
48 NGT NO. 16 Set - -
49 NGT NO. 18 Set - -
50 NGT NO. 3.5 Set - -
51 NGT NO. 5 Set - -
52 NGT NO. 8 Set - -
53 OBJECT GLASS Pcs - -
54 PARAFORMALDEHID (FORMALIN CAIR) Btl - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - -
56 PIPET TIP BLUE Pcs - -
57 PIPET TIP YELLOW Pcs - -
58 PLESTER 1 X 5 CM Roll - -
59 PLESTER 2,5 CM X 4,5 M Roll - -
60 PLESTER 5 CM X 4,5 M Roll - -
61 PLESTER 7.5 CM X 4,5 M Roll - -
62 POLIFIX 10 CM X 5 M Roll - -
63 POLIFIX 5 CM X 5 M Roll - -
64 REAGEN BILIRUBIN TOTAL/DIREK Kit - -
65 REAGEN CREANTINI Kit - -
66 REAGEN DILUENT Kit - -
67 REAGEN GLUKOSA Kit - -
68 REAGEN GOLONGAN DARAH A Pcs - -
69 REAGEN GOLONGAN DARAH AB Pcs - -
70 REAGEN GOLONGAN DARAH ANTI D RHESUS Pcs - -
71 REAGEN GOLONGAN DARAH B Pcs - -
72 REAGEN KOLESTROL HDL Kit - -
73 REAGEN KOLESTROL LDL Kit - -
74 REAGEN KOLESTROL TOTAL Kit - -
75 REAGEN LYSE Pcs - -
Page 11 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
76 REAGEN NATRIUM CITRAT 3,8 Kit - -
77 REAGEN RINSE Pcs - -
78 REAGEN SGOT Kit - -
79 REAGEN SGPT Kit - -
80 REAGEN TRGIYSERIDA Kit - -
81 REAGEN UREUM Kit - -
82 REAGEN URIC ACID Kit - -
83 SAFETY BOX Pcs - -
84 SALISIL SPIRITUS Btl - -
85 SARUNG TANGAN BLUE NITRIL Psg - -
86 SARUNG TANGAN NON STERIL Psg - -
87 SARUNG TANGAN OBGYN Psg - -
88 SARUNG TANGAN STERIL Psg - -
89 SPIRITUS Btl - -
90 SPOIT (ALAT SUNTIK SEKALI PAKAI) 1 ML Pcs - -
92 SPOIT (ALAT SUNTIK SEKALI PAKAI) 2,5/3 ML Pcs - -
95 STICK NARKOBA (AMPHETAMIN STRIP) Pcs - -
96 STICK NARKOBA (THC STRIP) Pcs - -
97 STICK TEST ASAM URAT Pcs - -
98 STICK TEST GLUKOSA Pcs - -
99 STICK TEST KOLESTEROL Pcs - -
100 TABUNG EDTA Pcs - -
101 TABUNG MICRO Pcs - -
102 TABUNG PLN PLH 13X100 6.0 Pcs - -
103 TES KEHAMILAN Pcs - -
104 TEST URIN CYBOW Pcs - -
105 UMBILICAL CORD CLAMPS Pcs - -
106 URINE BAG STERIL Pcs - -
107 WING NEEDLE No.21 Pcs - -
Page 12 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
108 WING NEEDLE No.25 Pcs - -
III PROGRAM
1 ALBENDAZOLE TABLET 400 MG Tab - -

2 ARTESUNAT INJEKSI Vial - -
3 BLOOD LANCET Pcs - -
4 DIETILCARMAZIN TABLET 100 MG Tab - -
5 FORMULA 100 Sachet - -
6 FORMULA 75 Sachet - -
7 FORMULA MIX Sachet - -
8 GIEMSA Btl - -
9 HCL Btl - -
10 IMERSION OIL Btl - -
11 KOH 10% Btl - -
12 KY JELLY Tube - -
13 MDT MULTI BACILLARY (MB) ANAK Blist - -
14 MDT MULTI BACILLARY (MB) DEWASA Blist - -
15 MDT PAUCI BACILLARY (PB) ANAK Blist - -
16 MDT PAUCI BACILLARY (PB) DEWASA Blist - -
17 METHYLEN BLUE 0,3% Btl - -
18 MINERAL MIX Paket - -
19 NaCl 0,9% 100 ml Btl - -
20 OAT KATEGORI ANAK Paket - -
21 OAT KATEGORI I FDC Paket - -
22 OAT KATEGORI II FDC Paket - -
23 OAT SISIPAN Paket - -
24 OBAT ANTI MALARIA (DHP) Tablet - -
25 POT SPUTUM Pcs - -
26 PRIMAKUIN TABLET 15 MG Tablet - -
27 QUININ TABLET 200 MG (222 MG SBG GARAM) Tablet - -
Page 13 of 360
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1 2 3 4 5 6 7 8 9 10 11 12 13 14
28 RDT MALARIA Pcs - -
29 REAGEN CD4 TYPE I Pcs - -
30 REAGEN ZEHL NEILSEN Kit - -
31 RPR ANTIGEN Pcs - -
32 TES KIT HIV INTEC Pcs - -
33 TES KIT HIV ONCOPROBE Pcs - -
34 TES KIT HIV VIKIA Pcs - -
35 TP RAPID HIV (SD BIOLINE HIV) Pcs - -
36 TP RAPID SYPHILIS (SD BIOLINE SYPHILIS) Pcs - -
37 - -
38 - -
39 - -
40 - -
Mengetahui,
Plt. Kepala Dinas Kesehatan Yang Menyerahkan, Yang Meminta, Pengelola Obat P
Kabupaten Sorong Selatan Kepala Seksi Kefarmasian Kepala Puskesmas
Agus Konjol, SKM Endiyonarsi, S.Farm., Apt Nama Kapus Nama Pengelol
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 14 of 360
LAPORAN
Februari
2018
KET
PROGRAM
15 16
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PROGRAM
15 16
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PROGRAM
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PROGRAM
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PROGRAM
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PROGRAM
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PROGRAM
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PROGRAM
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PROGRAM
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PROGRAM
15 16
elola Obat Puskesmas
a Pengelola Obat
Page 28 of 360
(LPLPO)

DISTRIK : TEMINABUAN BULAN Februari
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT
1 ALKOHOL 70% 100 ML Btl - - -

3 ALLOPURINOL TABLET 100 MG Tab - - -
4 AMAROPO PLUS TABLET Tab - - -
5 AMBROKSOL SIRUP 15 MG/ML Btl - - -
6 AMBROKSOL TABLET 30 MG Tab - - -
7 AMINOFILIN INJEKSI 24 MG/ML Ampul - - -
8 AMINOFILIN TABLET 200 MG Tab - - -
9 AMITRIPTYLIN TAB 25 MG Tab - - -
10 AMLODIPIN TABLET 10 MG Tab - - -
12 AMOKSISILLIN KAPLET 250 MG Kapsul - - -
13 AMOKSISILLIN KAPLET 500 MG Tab - - -
14 AMOKSISILLIN SIRUP KERING 125 MG/5ML Btl - - -
15 AMOKSISILLIN SIRUP KERING FORTE 250 Btl
MG/5ML - - -
16 AMPISILLIN INJEKSI 1 GRAM Vial - - -
17 AMPISILLIN SIRUP KERING 125 MG/5ML Btl - - -
Page 31 of 360
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18 AMPISILLIN TABLET 500 MG Tab - - -
19 ANTALGIN INJEKSI 250 MG/ML Amp - - -
20 ANTALGIN TABLET 500 MG Tab - - -
21 ANTASIDA DOEN SUSPENSI KOMBINASI Btl - - -
22 ANTASIDA DOEN TABLET KUNYAH KOMBINASI Tab - - -
23 ANTIFUNGI SALEP, KOMBINASI: ASAM BENZOAT POT
6% + ASAM SALISILAT 3% - - -
24 ANTIHEMOROID DOEN KOMBINASI Supp - - -
25 AQUA PRO INJEKSI STERIL 20 ML Vial - - -
26 ASAM ASCORBAT TABLET 250 MG Tab - - -
27 ASAM ASCORBAT( VIT. C) TABLET 50 MG Tab - - -
28 ASAM ASETILSALISILAT TABLET 80 MG Tab - - -
29 ASAM FOLAT TABLET 0,4 MG Tab - - -
30 ASAM MEFENAMAT TABLET 500 MG Tab - - -
31 ASAM TRANEXAMAT INJEKSI 100 MG/5 ML Ampul - - -
32 ASAM TRANEXAMAT TABLET 500 MG Tab - - -
33 ASIFIT TABLET Tab - - -
34 ASIKLOVIR KRIM 5% Tube - - -
35 ASIKLOVIR TABLET 200 MG Tab - - -
37 ATROPIN SULFAT INJ. 0,25 MG/ML-1ML Ampul - - -
38 BECARBON TABLET Tab - - -
39 BECEFORT SIRUP Btl - - -
40 BECEFORT TABLET Tab - - -
41 BENZATIN BENSIL PENISILIN 1,2 JT UI/VIAL Vial - - -
43 BETAHISTIN MESILAT TABLET 6 MG Tab - - -
Tube
44 VALERAT) - - -
45 BIORON INJEKSI Ampul - - -
46 BIORON TABLET Tab - - -
47 CAIRAN ASERING Btl - - -
Page 32 of 360
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48 CAIRAN MANITOL LAR INFUS 20% Btl - - -
49 CAIRAN OTSURAN 70 Btl - - -
50 CALCIDOL SYRUP Btl - - -
51 CAPTOPRIL TABLET 12,5 MG Tab - - -
52 CAPTOPRIL TABLET 25 MG Tab - - -
54 CARBAMAZEPIN TABLET 200 MG Tab - - -
55 CEFADROKSIL KAPSUL 250 MG Kaps - - -
56 CEFADROKSIL KAPSUL 500 MG Kapsul - - -
57 CEFADROKSIL SIRUP 125 MG/60 ML Btl - - -
58 CEFOTAXIME INJEKSI 1 GR vial - - -
59 CENDO XYTROL TM Btl - - -
60 CLINDAMISIN KAPSUL 150 MG Kaps - - -
61 CLINDAMISIN KAPSUL 300 MG Kapsul - - -
62 CLOBAZAM TABLET 10 MG Tab - - -
63 CLORPROMAZIN INJEKSI 5 mg/ml Ampul - - -
64 CLORPROMAZIN TABLET 25 MG Tab - - -
65 Amp
CYANOCOBALAMIN (B-12) INJEKSI 500 mcg/ml - - -
66 CYANOCOBALAMIN (B-12) TABLET 50 MCG Tab - - -
67 DASABION KAPSUL Kaps - - -
68 DEKSAMETHASON INJEKSI 5 MG/ML-1ML Ampul - - -
69 DEKSAMETHASON TABLET 0,5 MG Tab - - -
70 DESOKSIMETASON SALEP 0,25% Tub - - -
71 DEVITALISASI PASTA Btl - - -
72 DEXTAMIN TABLET Tab - - -
73 DIAZEPAM INJEKSI 5 MG/ML- 2 ML Amp - - -
74 DIAZEPAM TABLET 2 MG Tab - - -
76 DIFENHIDRAMIN HCl INJEKSI 10 MG/ML Ampul - - -
77 DIGOKSIN TABLET 0,25 MG Tab - - -
78 DOKSISIKLIN TABLET 100 MG Kaps - - -
Page 33 of 360
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79 DOMPERIDON SUSPENSI 5 MG/5ML Btl - - -
80 DOMPERIDON TABLET 10 MG Tab - - -
81 DULCOLAX SUPPO ANAK 5 MG Supp - - -
82 DULCOLAX SUPPO DEWASA 10 MG Supp - - -
83 DULCOLAX TABLET Tab - - -
84 EFEDRIN INJEKSI 50 MG/ML Ampul - - -
85 EFEDRIN TABLET 25 MG Tab - - -
86 EPINEFRIN HCl (ADRENALIN) INJEKSI 0,1% Ampul - - -
87 ERGOTAMIN TABLET 1 MG Tab - - -
88 ERITROMISIN KAPSUL 250 MG Kapsul - - -
90 ERITROMISIN SYRUP 200 MG/5 ML Btl - - -
91 ETAKRIDIN (RIVANOL) LARUTAN 0,1% Btl - - -
92 ETAMBUTOL TABLET 250 MG Tab - - -
94 ETIL KLORIDA SEMPROT Btl - - -
95 EUGENOL CAIRAN Btl - - -
96 FENITOIN NATRIUM TABLET 100 MG Tab - - -
98 FENOL GLISEROL TT 10% Btl - - -
99 FITUNO Tab - - -
100 FLUKONAZOL KAPSUL 150 MG Kapsul - - -
101 FOLAMIL GENIO KAPSUL Kaps - - -
102 FUROSEMID TABLET 40 MG Tab - - -
103 GENTAMYCIN INJEKSI 40 MG/ML Ampul - - -
104 GENTAMYCIN SALEP KULIT 0,1% Tube - - -
105 GENTAMYCIN SALEP MATA 0,3% Tube - - -
106 GENTAMYCIN SULFAT TETES MATA 0,3% Btl - - -
107 GENTIAN VIOLET Btl - - -
108 GLASS IONOMER CEMENT ART Set - - -
109 GLIBENKLAMID TABLET 5 MG Tab - - -
110 GLIMEPIRID TABLET 1 MG Tab - - -
Page 34 of 360
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112 GLUKOSA LARUTAN INFUS 10% STERIL Btl - - -
114 GLYCERIL GUAIACOLAT TABLET 100 MG Tab - - -
115 GRISEOFULVIN TABLET 125 MG Tab - - -
116 GUAIFENESIN TABLET 100 MG Tab - - -
117 HEMAFORT TABLET Tab - - -
118 HIDROCLOROTIAZID TABLET 25 MG Tab - - -
119 HIDROKORTISON KRIM 25% Tube - - -
120 HUSTAB P TABLET Tab - - -
121 IBUPROFEN SUSPENSI 100 MG/5 ML Btl - - -
122 IBUPROFEN TABLET 200 MG Tab - - -
124 ICHTAMOL (ICHTYOL) SALEP Pot - - -
125 ISONIAZID TABLET 100 MG Tab - - -
127 ISOSORBIT DINITRAT INJEKSI 10 MG/10 ML Ampul - - -
128 ISOSORBIT DINITRAT TABLET SUB 5 MG Tab - - -
129 KALIUM DIKLOFENAK TABLET 25 MG Tab - - -
131 KALSIUM HIDROKSIDA PASTA Tube - - -
132 KALSIUM LACTAT TABLET 500 MG Tab - - -
133 KANDESARTAN TABLET 16 MG Tab - - -
135 KETOCONAZOLE KRIM 2% Tube - - -
136 KETOCONAZOLE TABLET 200 MG Tab - - -
137 KETOROLAC INJEKSI 30 MG/ML Ampul - - -
Amp
138 ML - - -
139 KLORAMFENIKOL KAPSUL 250 MG Kaps - - -
140 KLORAMFENIKOL KAPSUL 500 MG Kapsul - - -
141 KLORAMFENIKOL SALEP KULIT 2% Tube - - -
Page 35 of 360
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142 KLORAMFENIKOL SALEP MATA 1% Tube - - -
143 KLORAMFENIKOL TETES TELINGA 3% Btl - - -
144 - - -
145 KLORFENOL MENTOL (CHKM) Btl - - -
146 MG/5ML - - -
147 KOTRIMOKSAZOL TABLET 120 MG PEDIATRIK Tab - - -
148 KOTRIMOKSAZOL TABLET 480 MG Tab - - -
150 LACBON TABLET Tab - - -
151 LAKTULOSA SIRUP 3,335 G/5 ML Btl - - -
152 1:80.000-2 ml - - -
153 LIDOCAIN NON EPINEFRIN INJEKSI 2% Ampul - - -
154 LIVRON BPLEX Tab - - -
155 LOPERAMID TABLET 2 MG Tab - - -
156 LORATADIN TABLET 10 MG Tab - - -
157 MAGNESIUM SUFAT INJEKSI (Mg SO4) 20 % Vial - - -
158 MELOKSIKAM TABLET 15 MG Tab - - -
159 METANEURON TABLET Tab - - -
160 METFORMIN TABLET 500 MG Tab - - -
161 METHIL ERGOMETRIN INJEKSI 0,2 MG/ML Ampul - - -
162 METHIL ERGOMETRIN TABLET 0,125 MG Tab - - -
163 METILPREDNISOLON TABLET 16 MG Tab - - -
166 METOKLOPRAMIDE TABLET 10 MG Tab - - -
167 METRONIDAZOL OVULA Supp - - -
168 METRONIDAZOL TABLET 250 MG Tab - - -
Page 36 of 360
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170 MIKONAZOL KRIM 2% Tube - - -
171 MUMMIFYING PASTA Btl - - -
172 NATRIUM DIKLOFENAK TABLET 25 MG Tab - - -
174 NATRIUM KLORIDA LARUTAN INFUS 0,9% Btl - - -
175 NIFEDIPIN TABLET 10 MG Tab - - -
176 NISTATIN SUSPENSION Btl - - -
177 NISTATIN VAGINAL TABLET 100.000 IU/G Tab - - -
178 NOZA TABLET Tab - - -
179 OBH SYRUP 200 ML Btl - - -
180 OKSITETRASIKLIN SALEP KULIT 3% Tube - - -
181 OKSITETRASIKLIN SALEP MATA 1% Tube - - -
182 OKSITOSIN INJEKSI 10 IU/ML Ampul - - -
183 OMEPRASOL KAPSUL 20 MG Kapsul - - -
184 OMEPRAZOL INJEKSI 40 MG / 10 ML Amp - - -
185 ORALIT 200 ML Sach - - -
186 PAPAVERIN HCl TABLET 40 MG Tab - - -
187 PARASETAMOL DROPS 100 MG/ML Btl - - -
188 PARASETAMOL SIRUP 120 MG/ML Btl - - -
189 PARASETAMOL TABLET 500 MG Tab - - -
190 PEHACAIN INJEKSI Amp - - -
191 PHENOBARBITAL INJEKSI 50 MG/ML Ampul - - -
192 PHENOBARBITAL TABLET 30 MG Tab - - -
193 PIRACETAM TABLET 400 MG Tab - - -
194 PIRANTEL SIRUP 125 MG /5 ML Btl - - -
195 PIRANTEL TABLET (BASE) 125 MG Tab - - -
196 PIRIMETAMIN+SULFADOKSIN KOMBINASI Tab - - -
197 PIROKSIKAM TABLET 10 MG Tab - - -
199 PREDNISON TABLET 5 MG Tab - - -
200 PRIMAKUIN TABLET 15 MG Tab - - -
201 PROKAIN PENISILLIN INJEKSI 3 JT IU Vial - - -
Page 37 of 360
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1 2 3 4 5 6 7 8 9 10 11 12 13 14
202 PROPANOLOL HCl TABLET 40 MG Tab - - -
203 PYRAZINAMID TABLET 500 MG Tab - - -
204 - - -
205 RANITIDIN INJEKSI 25 MG/ML Amp - - -
206 RANITIDIN TABLET 150 MG Tab - - -
207 RIFAMPICIN KAPSUL 300 MG Kapsul - - -
209 RINGER LAKTAT LARUTAN CAIRAN INFUS Btl - - -
210 SALBUTAMOL CAIRAN IH 0,1% Botol - - -
211 SALBUTAMOL SIRUP BTL - - -
212 SALBUTAMOL TABLET 2 MG Tab - - -
214 SALEP 2-4 KOMBINASI Pot - - -
215 SALISIL BEDAK 2% Ktk - - -
216 SEFIKSIM KAPSUL 100 MG Kapsul - - -
217 SEFIKSIM SIRUP KERING 100 MG / 5 ML Btl - - -
218 SEFTRIAKSON INJEKSI 1 GR Vial - - -
219 SEMEN SENG FOSFAT SERBUK & CAIRAN Btl - - -
220 SERUM ABU POLIVALEN INJEKSI Vial - - -
221 SERUM ANTI TETANUS INJEKSI 1.500 IU Amp - - -
222 SETIRIZIN KAPSUL 10 MG Kapsul - - -
223 SETIRIZIN SIRUP 5 MG/ML Btl - - -
224 SIMVASTATIN TABLET 10 MG Tab - - -
226 SIPROFLOKSACIN TABLET 500 MG Tab - - -
227 STESOLID INJEKSI Amp - - -
228 STESOLID SUPPO 10 MG/2,5 ML Supp - - -
230 STREPTOMYCIN SULFAT INJEKSI 1 G Vial - - -
231 SUKRALFAT SIRUP 500 MG/ 5 ML, 100 ML Botol - - -
232 Tab - - -
Page 38 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
233 TETRACYCLIN KAPSUL 250 MG Kapsul - - -
235 VICAL SYRUP Btl - - -
236 VIT. A (RETINOL) 100.000 IU KAPSUL LUNAK Kapsul - - -
237 VIT. A (RETINOL) 200.000 IU KAPSUL LUNAK Kaps - - -
238 VIT. B KOMPLEKS TABLET Tab - - -
239 VIT. B1 (THIAMIN) INJEKSI 100 MG/ML-1ML Amp - - -
240 VIT. B1 (THIAMIN) TABLET 50 MG Tab - - -
241 VIT. B6 (PYRIDOKSIN HCl) TABLET 10 MG Tab - - -
243 VIT. K INFANT INJEKSI 2 MG/ML Ampul - - -
244 VIT. K INJEKSI (PHYTOMENADION) 10MG/ML Amp - - -
245 VIT. K TAB. SALUT (PHYTOMENADION) 10MG Tab - - -
246 VOMETA DROPS 5 MG/ML Btl - - -
247 YODIUM POVIDON LARUTAN 10% 300 ML Btl - - -
249 ZINK SIRUP 10 MG/ML Btl - - -
250 ZINK TABLET DISPERSIBLE 20 MG Tab - - -
II BMHP
1 ABBOCATH (I.V CATHETER) NO.18 Pcs - - -

5 ALKOHOL SWAB Pcs - - -
6 BIOPLACENTON TULLE Pcs - - -
7 BISTURI Pcs - - -
8 BLOOD LANCET Pcs - - -
9 CATGUT CROMIC 2/0 + JARUM BEDAH Pcs - - -
11 CATGUT PLAIN 2/0 + JARUM BEDAH Pcs - - -
Page 39 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
13 CATGUT SILK 2/0 + JARUM BEDAH Pcs - - -
15 CUVETTES DIASPECT Pcs - - -
16 DECK GLASS 20X20 Pcs - - -
17 DISPOSABLE DENTAL NEEDLE 16 mm Pcs - - -
18 ELASTIC BANDAGE 10 CM X 4,5 M Roll - - -
20 ELASTIC BANDAGE 7,5 CM X 4,5 M Roll - - -
21 FOLLEY CATHETER NO.16 Pcs - - -
25 HIDROGEN PEROKSIDA (H2O2) 3% 100 ML Btl - - -
26 INFUSION SET ANAK Set - - -
27 INFUSION SET DEWASA Set - - -
28 KAPAS PEMBALUT 100 Gr Bks - - -
31 KASA HYDROFIL 2 X 80 CM Roll - - -
32 KASA HYDROFIL 4 M X 10 CM Roll - - -
35 KASA HYDROFIL 40 Y X 80 CM Roll - - -
36 KASA STERIL HYDROFIL 16X16 Ktk - - -
38 KLINIPET 20 Pcs - - -
42 KONDOM Pcs - - -
43 LARUTAN TURC Btl - - -
Page 40 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
44 LENS PAPER Pcs - - -
45 LISOL (DESINFECTAN) 1 LITER Btl - - -
46 MASKER Pcs - - -
47 MICROPIPET TIPS (YELLOW) Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
53 OBJECT GLASS Pcs - - -
54 PARAFORMALDEHID (FORMALIN CAIR) Btl - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
56 PIPET TIP BLUE Pcs - - -
57 PIPET TIP YELLOW Pcs - - -
58 PLESTER 1 X 5 CM Roll - - -
59 PLESTER 2,5 CM X 4,5 M Roll - - -
60 PLESTER 5 CM X 4,5 M Roll - - -
61 PLESTER 7.5 CM X 4,5 M Roll - - -
62 POLIFIX 10 CM X 5 M Roll - - -
64 REAGEN BILIRUBIN TOTAL/DIREK Kit - - -
65 REAGEN CREANTINI Kit - - -
66 REAGEN DILUENT Kit - - -
67 REAGEN GLUKOSA Kit - - -
68 REAGEN GOLONGAN DARAH A Pcs - - -
69 REAGEN GOLONGAN DARAH AB Pcs - - -
70 REAGEN GOLONGAN DARAH ANTI D RHESUS Pcs - - -
71 REAGEN GOLONGAN DARAH B Pcs - - -
72 REAGEN KOLESTROL HDL Kit - - -
73 REAGEN KOLESTROL LDL Kit - - -
74 REAGEN KOLESTROL TOTAL Kit - - -
75 REAGEN LYSE Pcs - - -
Page 41 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
76 REAGEN NATRIUM CITRAT 3,8 Kit - - -
77 REAGEN RINSE Pcs - - -
78 REAGEN SGOT Kit - - -
79 REAGEN SGPT Kit - - -
80 REAGEN TRGIYSERIDA Kit - - -
81 REAGEN UREUM Kit - - -
82 REAGEN URIC ACID Kit - - -
83 SAFETY BOX Pcs - - -
84 SALISIL SPIRITUS Btl - - -
85 SARUNG TANGAN BLUE NITRIL Psg - - -
86 SARUNG TANGAN NON STERIL Psg - - -
87 SARUNG TANGAN OBGYN Psg - - -
88 SARUNG TANGAN STERIL Psg - - -
89 SPIRITUS Btl - - -
90 SPOIT (ALAT SUNTIK SEKALI PAKAI) 1 ML Pcs - - -
92 SPOIT (ALAT SUNTIK SEKALI PAKAI) 2,5/3 ML Pcs - - -
95 STICK NARKOBA (AMPHETAMIN STRIP) Pcs - - -
96 STICK NARKOBA (THC STRIP) Pcs - - -
97 STICK TEST ASAM URAT Pcs - - -
98 STICK TEST GLUKOSA Pcs - - -
99 STICK TEST KOLESTEROL Pcs - - -
100 TABUNG EDTA Pcs - - -
101 TABUNG MICRO Pcs - - -
102 TABUNG PLN PLH 13X100 6.0 Pcs - - -
103 TES KEHAMILAN Pcs - - -
104 TEST URIN CYBOW Pcs - - -
105 UMBILICAL CORD CLAMPS Pcs - - -
106 URINE BAG STERIL Pcs - - -
107 WING NEEDLE No.21 Pcs - - -
Page 42 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM
1 ALBENDAZOLE TABLET 400 MG Tab - - -

2 ARTESUNAT INJEKSI Vial - - -
4 DIETILCARMAZIN TABLET 100 MG Tab - - -
5 FORMULA 100 Sachet - - -
7 FORMULA MIX Sachet - - -
8 GIEMSA Btl - - -
9 HCL Btl - - -
10 IMERSION OIL Btl - - -
11 KOH 10% Btl - - -
12 KY JELLY Tube - - -
13 MDT MULTI BACILLARY (MB) ANAK Blist - - -
14 MDT MULTI BACILLARY (MB) DEWASA Blist - - -
15 MDT PAUCI BACILLARY (PB) ANAK Blist - - -
16 MDT PAUCI BACILLARY (PB) DEWASA Blist - - -
17 METHYLEN BLUE 0,3% Btl - - -
18 MINERAL MIX Paket - - -
19 NaCl 0,9% 100 ml Btl - - -
20 OAT KATEGORI ANAK Paket - - -
21 OAT KATEGORI I FDC Paket - - -
22 OAT KATEGORI II FDC Paket - - -
23 OAT SISIPAN Paket - - -
24 OBAT ANTI MALARIA (DHP) Tablet - - -
25 POT SPUTUM Pcs - - -
26 PRIMAKUIN TABLET 15 MG Tablet - - -
-
Page 43 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
28 RDT MALARIA Pcs - - -
29 REAGEN CD4 TYPE I Pcs - - -
30 REAGEN ZEHL NEILSEN Kit - - -
31 RPR ANTIGEN Pcs - - -
32 TES KIT HIV INTEC Pcs - - -
33 TES KIT HIV ONCOPROBE Pcs - - -
34 TES KIT HIV VIKIA Pcs - - -
35 TP RAPID HIV (SD BIOLINE HIV) Pcs - - -
36 TP RAPID SYPHILIS (SD BIOLINE SYPHILIS) Pcs - - -
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 44 of 360
LAPORAN
Maret
2018
KET
PROGRAM
15 16
Page 45 of 360
KET
PROGRAM
15 16
Page 46 of 360
KET
PROGRAM
15 16
Page 47 of 360
KET
PROGRAM
15 16
Page 48 of 360
KET
PROGRAM
15 16
Page 49 of 360
KET
PROGRAM
15 16
Page 50 of 360
KET
PROGRAM
15 16
Page 51 of 360
KET
PROGRAM
15 16
Page 52 of 360
KET
PROGRAM
15 16
Page 53 of 360
KET
PROGRAM
15 16
Page 54 of 360
KET
PROGRAM
15 16
Page 55 of 360
KET
PROGRAM
15 16
Page 56 of 360
KET
PROGRAM
15 16
Page 57 of 360
KET
PROGRAM
15 16
a Pengelola Obat
Page 58 of 360
(LPLPO)

DISTRIK : TEMINABUAN BULAN Maret
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

15 AMOKSISILLIN SIRUP KERING FORTE 250 Btl - - -
MG/5ML
Page 61 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
23 ANTIFUNGI SALEP, KOMBINASI: ASAM BENZOAT POT - - -
6% + ASAM SALISILAT 3%
Tube
44 VALERAT) - - -
Page 62 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 63 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 64 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 65 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 66 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 67 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 68 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 69 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 70 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 71 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 72 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 73 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 74 of 360
LAPORAN
April
2018
KET
PROGRAM
15 16
Page 75 of 360
KET
PROGRAM
15 16
Page 76 of 360
KET
PROGRAM
15 16
Page 77 of 360
KET
PROGRAM
15 16
Page 78 of 360
KET
PROGRAM
15 16
Page 79 of 360
KET
PROGRAM
15 16
Page 80 of 360
KET
PROGRAM
15 16
Page 81 of 360
KET
PROGRAM
15 16
Page 82 of 360
KET
PROGRAM
15 16
Page 83 of 360
KET
PROGRAM
15 16
Page 84 of 360
KET
PROGRAM
15 16
Page 85 of 360
KET
PROGRAM
15 16
Page 86 of 360
KET
PROGRAM
15 16
Page 87 of 360
KET
PROGRAM
15 16
a Pengelola Obat
Page 88 of 360
(LPLPO)

DISTRIK : TEMINABUAN BULAN April
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

15 AMOKSISILLIN SIRUP KERING FORTE 250 Btl - -
MG/5ML -
Page 91 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
23 ANTIFUNGI SALEP, KOMBINASI: ASAM BENZOAT POT - -
6% + ASAM SALISILAT 3% -
Tube
44 VALERAT) - - -
Page 92 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 93 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 94 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 95 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 96 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 97 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 98 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 99 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 100 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 101 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 102 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 103 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 104 of 360

LAPORAN
Mei
2018
KET
PROGRAM
15 16
Page 105 of 360

KET
PROGRAM
15 16
Page 106 of 360

KET
PROGRAM
15 16
Page 107 of 360

KET
PROGRAM
15 16
Page 108 of 360

KET
PROGRAM
15 16
Page 109 of 360

KET
PROGRAM
15 16
Page 110 of 360

KET
PROGRAM
15 16
Page 111 of 360

KET
PROGRAM
15 16
Page 112 of 360

KET
PROGRAM
15 16
Page 113 of 360

KET
PROGRAM
15 16
Page 114 of 360

KET
PROGRAM
15 16
Page 115 of 360

KET
PROGRAM
15 16
Page 116 of 360

KET
PROGRAM
15 16
Page 117 of 360

KET
PROGRAM
15 16
a Pengelola Obat
Page 118 of 360

(LPLPO)

DISTRIK : TEMINABUAN BULAN Mei
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

MG/5ML -
Page 121 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tube
44 VALERAT) - - -
Page 122 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 123 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 124 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 125 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 126 of 360

STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 127 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 128 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 129 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 130 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 131 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 132 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 133 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 134 of 360

LAPORAN
Juni
2018
KET
PROGRAM
15 16
Page 135 of 360

KET
PROGRAM
15 16
Page 136 of 360

KET
PROGRAM
15 16
Page 137 of 360

KET
PROGRAM
15 16
Page 138 of 360

KET
PROGRAM
15 16
Page 139 of 360

KET
PROGRAM
15 16
Page 140 of 360

KET
PROGRAM
15 16
Page 141 of 360

KET
PROGRAM
15 16
Page 142 of 360

KET
PROGRAM
15 16
Page 143 of 360

KET
PROGRAM
15 16
Page 144 of 360

KET
PROGRAM
15 16
Page 145 of 360

KET
PROGRAM
15 16
Page 146 of 360

KET
PROGRAM
15 16
Page 147 of 360

KET
PROGRAM
15 16
a Pengelola Obat
Page 148 of 360

(LPLPO)

DISTRIK : TEMINABUAN BULAN Juni
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

MG/5ML -
Page 151 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tube
44 VALERAT) - - -
Page 152 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 153 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 154 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 155 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 156 of 360

STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 157 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 158 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 159 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 160 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 161 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 162 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 163 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 164 of 360

LAPORAN
Juli
2018
KET
PROGRAM
15 16
Page 165 of 360

KET
PROGRAM
15 16
Page 166 of 360

KET
PROGRAM
15 16
Page 167 of 360

KET
PROGRAM
15 16
Page 168 of 360

KET
PROGRAM
15 16
Page 169 of 360

KET
PROGRAM
15 16
Page 170 of 360

KET
PROGRAM
15 16
Page 171 of 360

KET
PROGRAM
15 16
Page 172 of 360

KET
PROGRAM
15 16
Page 173 of 360

KET
PROGRAM
15 16
Page 174 of 360

KET
PROGRAM
15 16
Page 175 of 360

KET
PROGRAM
15 16
Page 176 of 360

KET
PROGRAM
15 16
Page 177 of 360

KET
PROGRAM
15 16
a Pengelola Obat
Page 178 of 360

(LPLPO)

DISTRIK : TEMINABUAN BULAN Juli
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

MG/5ML -
Page 181 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tube
44 VALERAT) - - -
Page 182 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 183 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 184 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 185 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 186 of 360

STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 187 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 188 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 189 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 190 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 191 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 192 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 193 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 194 of 360

LAPORAN
Agustus
2018
KET
PROGRAM
15 16
Page 195 of 360

KET
PROGRAM
15 16
Page 196 of 360

KET
PROGRAM
15 16
Page 197 of 360

KET
PROGRAM
15 16
Page 198 of 360

KET
PROGRAM
15 16
Page 199 of 360

KET
PROGRAM
15 16
Page 200 of 360

KET
PROGRAM
15 16
Page 201 of 360

KET
PROGRAM
15 16
Page 202 of 360

KET
PROGRAM
15 16
Page 203 of 360

KET
PROGRAM
15 16
Page 204 of 360

KET
PROGRAM
15 16
Page 205 of 360

KET
PROGRAM
15 16
Page 206 of 360

KET
PROGRAM
15 16
Page 207 of 360

KET
PROGRAM
15 16
a Pengelola Obat
Page 208 of 360

(LPLPO)

DISTRIK : TEMINABUAN BULAN Agustus
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

MG/5ML -
Page 211 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tube
44 VALERAT) - - -
Page 212 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 213 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 214 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 215 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 216 of 360

STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 217 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 218 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 219 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 220 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 221 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 222 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 223 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 224 of 360

LAPORAN
September
2018
KET
PROGRAM
15 16
Page 225 of 360

KET
PROGRAM
15 16
Page 226 of 360

KET
PROGRAM
15 16
Page 227 of 360

KET
PROGRAM
15 16
Page 228 of 360

KET
PROGRAM
15 16
Page 229 of 360

KET
PROGRAM
15 16
Page 230 of 360

KET
PROGRAM
15 16
Page 231 of 360

KET
PROGRAM
15 16
Page 232 of 360

KET
PROGRAM
15 16
Page 233 of 360

KET
PROGRAM
15 16
Page 234 of 360

KET
PROGRAM
15 16
Page 235 of 360

KET
PROGRAM
15 16
Page 236 of 360

KET
PROGRAM
15 16
Page 237 of 360

KET
PROGRAM
15 16
a Pengelola Obat
Page 238 of 360

(LPLPO)

DISTRIK : TEMINABUAN BULAN September
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

MG/5ML -
Page 241 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tube
44 VALERAT) - - -
Page 242 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 243 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 244 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 245 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 246 of 360

STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 247 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 248 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 249 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 250 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 251 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 252 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 253 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 254 of 360

LAPORAN
Oktober
2018
KET
PROGRAM
15 16
Page 255 of 360

KET
PROGRAM
15 16
Page 256 of 360

KET
PROGRAM
15 16
Page 257 of 360

KET
PROGRAM
15 16
Page 258 of 360

KET
PROGRAM
15 16
Page 259 of 360

KET
PROGRAM
15 16
Page 260 of 360

KET
PROGRAM
15 16
Page 261 of 360

KET
PROGRAM
15 16
Page 262 of 360

KET
PROGRAM
15 16
Page 263 of 360

KET
PROGRAM
15 16
Page 264 of 360

KET
PROGRAM
15 16
Page 265 of 360

KET
PROGRAM
15 16
Page 266 of 360

KET
PROGRAM
15 16
Page 267 of 360

KET
PROGRAM
15 16
a Pengelola Obat
Page 268 of 360

(LPLPO)

DISTRIK : TEMINABUAN BULAN Oktober
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

MG/5ML -
Page 271 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tube
44 VALERAT) - - -
Page 272 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 273 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 274 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 275 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 276 of 360

STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 277 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 278 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 279 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 280 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 281 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 282 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 283 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 284 of 360

LAPORAN
November
2018
KET
PROGRAM
15 16
Page 285 of 360

KET
PROGRAM
15 16
Page 286 of 360

KET
PROGRAM
15 16
Page 287 of 360

KET
PROGRAM
15 16
Page 288 of 360

KET
PROGRAM
15 16
Page 289 of 360

KET
PROGRAM
15 16
Page 290 of 360

KET
PROGRAM
15 16
Page 291 of 360

KET
PROGRAM
15 16
Page 292 of 360

KET
PROGRAM
15 16
Page 293 of 360

KET
PROGRAM
15 16
Page 294 of 360

KET
PROGRAM
15 16
Page 295 of 360

KET
PROGRAM
15 16
Page 296 of 360

KET
PROGRAM
15 16
Page 297 of 360

KET
PROGRAM
15 16
a Pengelola Obat
Page 298 of 360

(LPLPO)

DISTRIK : TEMINABUAN BULAN November
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

MG/5ML -
Page 301 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tube
44 VALERAT) - - -
Page 302 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 303 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 304 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
Page 305 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
Page 306 of 360

STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 307 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
Page 308 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
Page 309 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
Page 310 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
Page 311 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Page 312 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
Page 313 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 314 of 360

LAPORAN
Desember
2018
KET
PROGRAM
15 16
Page 315 of 360

KET
PROGRAM
15 16
Page 316 of 360

KET
PROGRAM
15 16
Page 317 of 360

KET
PROGRAM
15 16
Page 318 of 360

KET
PROGRAM
15 16
Page 319 of 360

KET
PROGRAM
15 16
Page 320 of 360

KET
PROGRAM
15 16
Page 321 of 360

KET
PROGRAM
15 16
Page 322 of 360

KET
PROGRAM
15 16
Page 323 of 360

KET
PROGRAM
15 16
Page 324 of 360

KET
PROGRAM
15 16
Page 325 of 360

KET
PROGRAM
15 16
Page 326 of 360

KET
PROGRAM
15 16
Page 327 of 360

KET
PROGRAM
15 16
a Pengelola Obat
Page 328 of 360

(LPLPO)

DISTRIK : TEMINABUAN BULAN Desember
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
I OBAT

MG/5ML -
Page 331 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tube
44 VALERAT) - - -
Page 332 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
65 Amp
Page 333 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
99 FITUNO Tab - - -
Page 334 of 360
STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Amp
138 ML - - -
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
144 - - -
146 MG/5ML - - -
152 1:80.000-2 ml - - -
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
204 - - -
232 Tab - - -
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
II BMHP

7 BISTURI Pcs - - -
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
42 KONDOM Pcs - - -
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
46 MASKER Pcs - - -
48 NGT NO. 16 Set - - -
49 NGT NO. 18 Set - - -
50 NGT NO. 3.5 Set - - -
51 NGT NO. 5 Set - - -
52 NGT NO. 8 Set - - -
55 pH PAPER 3,8-5,4 / 0-14 Pcs - - -
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
III PROGRAM

8 GIEMSA Btl - - -
9 HCL Btl - - -
11 KOH 10% Btl - - -
19 NaCl 0,9% 100 ml Btl - - -
-
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STOK PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
37 - - - - -
38 - - - - -
39 - - - - -
40 - - - - -
Mengetahui,
Nip. 19600214 198603 1 018 Nip. 19820313 201201 1 001 NIP. NIP.
Page 344 of 360

LAPORAN
Januari
2019
KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
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KET
PROGRAM
15 16
a Pengelola Obat
Page 358 of 360

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE PUSKESMAS : P9106070101

1 ALKOHOL 70% 100 ML Btl - -

1 ABBOCATH (I.V CATHETER) NO.18 Pcs - -

1 ALBENDAZOLE TABLET 400 MG Tab - -

elola Obat Puskesmas

KODE PUSKESMAS : P9106070101

1 ALKOHOL 70% 100 ML Btl - - -

1 ABBOCATH (I.V CATHETER) NO.18 Pcs - - -

1 ALBENDAZOLE TABLET 400 MG Tab - - -

elola Obat Puskesmas

KODE PUSKESMAS : P9106070101

1 ALKOHOL 70% 100 ML Btl - - -

1 ABBOCATH (I.V CATHETER) NO.18 Pcs - - -

1 ALBENDAZOLE TABLET 400 MG Tab - - -

elola Obat Puskesmas

KODE PUSKESMAS : P9106070101

1 ALKOHOL 70% 100 ML Btl - - -

1 ABBOCATH (I.V CATHETER) NO.18 Pcs - - -

1 ALBENDAZOLE TABLET 400 MG Tab - - -

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elola Obat Puskesmas

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KODE PUSKESMAS : P9106070101

1 ALKOHOL 70% 100 ML Btl - - -

Page 126 of 360

1 ABBOCATH (I.V CATHETER) NO.18 Pcs - - -

1 ALBENDAZOLE TABLET 400 MG Tab - - -

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elola Obat Puskesmas

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KODE PUSKESMAS : P9106070101

1 ALKOHOL 70% 100 ML Btl - - -

Page 156 of 360

1 ABBOCATH (I.V CATHETER) NO.18 Pcs - - -

1 ALBENDAZOLE TABLET 400 MG Tab - - -

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