LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( L P L P O )

NAMA PUSKESMAS : Meninting NO DOC

KAB/KOTA : Lombok Barat TAHUN
LAPORAN PERIODE/BULAN : OKTOBER TANGGAL
PERMINTAAN PERIODE/BULAN : NOVEMBER

PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11

ALAT KESEHATAN

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set 3068 3068 87 2981 320 0
2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set 730 730 227 503 426 100
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set 346 346 55 291 50 0
4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" Set 4 4 8 8 0 0 20
5 Benang Operasi - Catgut Plain 2/0 + jarum 1/2 GT 35 mm Set 50 50 13 37 10 50
6 Benang Operasi - Catgut Chromic 2/0 + jarum 1/2 GT 35 mm Set 0 0 0 0 0
7 Benang Operasi - Catgut Plain 3/0 + jarum 1/2 GT 35 mm Set 243 243 30 213 16 0
8 Benang Operasi - Catgut Chromic 3/0 + jarum 1/2 GT 35 mm Set 0 0 0 0 0
9 Benang Operasi - Silk 2/0 + jarum 1/2 GT 35 mm Set 0 0 0 0 0
10 Benang Operasi - Silk 3/0 + jarum 1/2 GT 35 mm Set 83 83 36 47 120 0
11 HAND SCOUND STERIL NO 7 Pasang 324 324 324 0 0
12 HAND SCOUND STERIL NO 7,5 Pasang 607 607 27 580 166 0
13 HAND SCOUND NON STERIL UK L Lembar 0 0 0 0 0
14 HAND SCOUND NON STERIL UK M Lembar 1632 1632 800 832 3,056 2,224
15 HYPAFIX 10 x 5 CM Pasang 21 21 0 21 4 10
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
16 Infus Set, IV, Wing needle - Infusion Set Pediatric (60 drops/m set 267 267 1 266 0 0
17 Infus Set, IV, Wing needle - Infusion Set Dewasa (20 drops/ml set 667 667 63 604 230 0
18 Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 mm buah 479 479 74 405 130 0
19 Infus Set, IV, Wing needle - I.V Catheter No. 20 G x 1 1/4 " buah 20 20 20 0 82 0
20 Infus Set, IV, Wing needle - I.V Catheter No. 22 G x 1 " buah 73 73 10 63 24 0
21 Infus Set, IV, Wing needle - I.V Catheter No. 24 G x 3/4 " buah 75 75 8 67 20 0
22 Infus Set, IV, Wing needle - I.V Catheter No. 26 G x 1/2 " buah 25 25 6 19 20 0
23 Infus Set, IV, Wing needle - Wing Needle 21G set 0 0 0 0 0
24 Infus Set, IV, Wing needle - Wing Needle 23G set 0 0 0 2 0
25 Infus Set, IV, Wing needle - Wing Needle 25G set 0 0 0 0 0
26 Infus Set, IV, Wing needle - Wing Needle 27G set 0 0 0 0 0
27 Jarum Jahit Bedah pcs 0 0 0 0 0
28 Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 gr Roll 10 10 10 4 5
29 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 80 cm Roll 0 5 5 3 2 4 0
30 Kasa, Verband, Kapas - Kasa Hydrophil Steril 16 x 16 cm lembar 56 56 8 48 122 0
31 Kasa, Verband, Kapas - Kasa Hydrophil Steril 18 x 22 cm Lembar 0 0 0 0 0
32 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 3 cm Roll 50 50 25 25 50 50
33 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 10 cm Roll 0 100 100 13 87 62 0
34 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 15 cm Roll 0 0 0 0 0
35 Kasa, Verband, Kapas - Kasa Pembalut 2 x 80 cm Roll 108 108 50 58 0 0
36 MESS 11 pcs 234 234 15 219 52 0
37 MESS 21 pcs 88 88 0 88 0 0
38 MESS 22 pcs 0 0 0 0 0
39 PEMBALUT GIPS 3 INCI buah 0 0 0 0 0
40 PLESTER 5 YARDS X 2 INCHI Roll 18 18 18 2 10
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
41 Surgical Mask - 3 ply Tie on (tali) pcs 500 500 500 0 150 0
42 Surgical Mask - 3 ply Earloop (karet) pcs 1030 1030 0 1030 100 0
43 Urologi - Folley Catheter 2 way No. 16 pcs 0 0 0 2 0
44 Urologi - Folley Catheter 2 way No. 18 pcs 10 10 2 8 0 0
45 Urologi - Urine Bag Standard Steril 2 Lt (T Valve) pcs 14 14 11 3 6 0
0 0 0
TABLET DAN SERBUK ORAL 0 0 0
0 0 0
46 Asam Asetilsalisilat (asetosal) tablet 100 mg Tablet 209 209 209 60 0
47 Asam Asetilsalisilat (asetosal) tablet 500 mg Tablet 0 0 0 0 0
48 Albendazol tablet/kapsul/kaplet 400 mg Tablet 9996 9996 0 9996 23,562 10,000 ed
49 Alopurinol tablet/kapsul/kaplet 100 mg Tablet 278 278 145 133 160 0
50 ALPRAZOLAM TABLET 1 MG Tablet 0 0 0 0 0
51 AMBROXOL 30 MG TAB Tablet 1255 2000 3255 2020 1235 0 3,000
52 Aminofilin tablet scored 200 mg Tablet 0 0 0 0 0
53 Amitriptilin tablet salut 25 mg (HCl) Tablet 300 300 300 0 0
54 Amlodipin tablet 5 mg Tablet 0 5100 5100 0 5100 0 3,000
55 Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet 2141 4000 6141 4513 1628 12,316 20,000
56 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidr Tablet 0 5000 5000 2267 2733 0 10,000
57 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 0 0 0 0 0
58 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0 0 2,000
59 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 0 2000 2000 1418 582 1,700 2,000
60 Asam Folat tablet/kapsul/kaplet 1 mg Tablet 2830 2830 396 2434 1,060 0
61 ASAM MEFENAMAT 500 MG TAB Kaplet 1055 2000 3055 1668 1387 2,594 2,000
62 ASAM TRANEXAMAT TABLET 500 MG Tablet 0 0 0 0 0
63 ASAM VALPROAT 250 MG Tablet 0 0 0 0 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
64 Asiklovir tablet/kapsul/kaplet 400 mg Tablet 0 0 0 132 0
65 ATTAPULGIT TABLET 600 MG Tablet 315 500 815 360 455 400 500
66 BETAHISTIN MESILAT TABLET 6 MG Tablet 396 396 70 326 60 500
67 Bisakodil 5 mg (dulkolax) Tablet 120 120 5 115 0
68 D H P TAB Tablet 21 50 71 184 -113 152 180
69 Deksametason tablet 0,5 mg Tablet 0 3000 3000 475 2525 0 3,000
70 DIAZEPAM 2 MG TAB Tablet 0 0 0 0 100
71 DIAZEPAM 5 MG TAB Tablet 0 0 0 0 0
72 Digoksin tablet 0,25 mg Paket 0 0 0 0 0
73 Dimenhidrinat tablet 50 mg Tablet 0 0 0 0 0
74 Domperidon tablet 10 mg Tablet 320 320 10 310 0 500
75 Doksisiklin tablet/kapsul/kaplet 100 mg Tablet 0 0 0 0 0
76 EFEDRIN HCL 25 MG TAB Tablet 0 0 0 0 0
77 ERYTHROMYCIN 500 MG Tablet 0 0 0 0 0
78 Fenitoin kapsul/kaplet 100 mg Tablet 0 0 0 0 0
79 FENITOIN NATRIUM 30 MG KAPSUL Kapsul 0 0 0 0 0
80 Fenobarbital tablet/kapsul/kaplet 100 mg Kapsul 0 0 0 0 0
81 Fenobarbital tablet/kapsul/kaplet 30 mg Kapsul 0 0 0 140 0
82 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet 650 200 850 80 770 242 1,000
83 Furosemid tablet 40 mg Tablet 2053 2053 50 2003 50 0
84 Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g kali Sachet 649 2400 3049 747 2302 1,930 0
85 Glibenklamid tablet 5 mg Tablet 1530 500 2030 880 1150 570 2,000
86 Glimepiride tablet 1 mg Tablet 1028 200 1228 310 918 194 3,000
87 Glimepiride tablet 2 mg Tablet 0 0 0 0 0 0
88 GLISERYL GUAIAKOLAT 100 MG TAB Tablet 0 0 0 0 0 5,000
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
89 Griseofulvin tablet 125 mg Tablet 0 0 0 0 0 0
90 Haloperidol tablet 0,5 mg Tablet 0 0 0 0 0 0
91 Haloperidol tablet 1,5 mg Tablet 0 0 0 0 0 0
92 Haloperidol tablet 5 mg Tablet 250 0 250 250 0 0
93 HYOCINA N BUTILBROMID 10 MG TAB Tablet 365 0 365 200 165 0 500
94 Ibuprofen tablet 400 mg Tablet 0 0 0 0 1,640 2,500
95 ISOSORBID DINITRAT SUB LINGUAL 5 MG Tablet 297 0 297 297 0 0
96 KALSIUM LAKTAT 500 MG Tablet 0 2000 2000 0 2000 0 2,000
97 Kaptopril tablet scored 12,5 mg Tablet 900 0 900 190 710 760 1,000
98 Kaptopril tablet scored 25 mg Tablet 932 3000 3932 750 3182 0 2,000
99 Karbamazepin tablet 200 mg Tablet 47 0 47 47 36
100 KETOKONZOL TABLET 200 MG Tablet 0 0 0 0 0 0
101 Kloramfenikol tablet/kapsul/kaplet 250 mg Tablet 0 0 0 0 0 2,000
102 KLORFENIRAMINI MALEAT TAB 4 MG( CTM ) Tablet 0 5000 5000 1711 3289 0 5,000
103 KLORPROMAZIN 100 MG TAB (HCL) Tablet 386 386 386 0 0
104 KODEINA 10 MG TAB Tablet 0 0 0 0 0
105 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam fo Tablet 99855 99855 6150 93705 12,040 0
106 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol Tablet 2990 2990 820 2170 1,176 0
107 KUININE TAB SALUT SELAPUT 222 MG Tablet 0 0 0 0 0
108 LOPERAMID TAB 2 MG Tablet 0 1000 1000 150 850 0 500
109 LORATADIN TABLET 10 MG Tablet 0 0 0 0 0
110 METFORMIN HCL TABLET 500 MG Tablet 300 1000 1300 450 850 460 1,000
111 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 Tablet 80 80 30 50 0 0
112 Metoklopramide tablet 5 mg Tablet 0 0 0 0
113 Metoklopramide tablet 10 mg Tablet 313 3000 3313 450 2863 460 3,000
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
114 METRONIDAZOLE 250 MG TAB Tablet 0 0 0 0 0
115 METRONIDAZOLE 500 MG TAB Tablet 0 0 0 0 2,000
116 MINERAL MIX SERBUK Tablet 0 0 0 0 0
117 MULTI MICRO NUTRIEN Sachet 0 0 0 0 0
118 MULTIVITAMIN ANAK TABLET HISAP T ablet hisap 0 0 0 0 0
119 NATRIUM DIKLOFENAK 50 MG TAB Tablet 1540 300 1840 743 1097 0 2,000
120 Nifedipin tablet/kapsul 10 mg Tablet 783 300 1083 222 861 160 1,000
121 Nistatin tablet salut 500.000 IU/ g Tablet 77 77 77 0 0
122 OAT KAT ANAK FDC Paket 0 0 0 0 0
123 OAT KAT ANAK KOMB Paket 3 3 1 2 0 0
124 OAT KAT I KOMB Paket 0 0 0 0 0
125 OAT KAT I.3 FDC Paket 20 20 12 8 22 0
126 OAT KAT II FDC Paket 1 1 1 0 0 0
127 OAT KAT SISIPAN FDC Paket 0 0 0 0 0
128 Omeprazol kapsul/kaplet 20 mg kaplet 6300 6300 175 6125 394 0
129 Parasetamol tablet 100 mg Tablet 0 0 0 0 0
130 Parasetamol tablet 500 mg Tablet 4885 16000 20885 11383 9502 27,448 10,000
131 PERFENAZIN TAB 4 MG Tablet 0 0 0 0 0
132 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) Tablet 2095 1000 3095 1291 1804 460 3,000
133 PIROKSIKAM 10 MG TAB Tablet 0 0 0 1,200 2,000
134 PIROKSIKAM 20 MG TAB Tablet 0 0 0 0 0
135 Prednison tablet/kapsul/kaplet 5 mg Tablet 271 2000 2271 2100 171 1,600 2,000
136 PRIMAKUIN TABLET 15 MG Tablet 0 0 0 0 200
137 PROPANOLOL 40 MG TAB (HCL) Tablet 500 500 500 0 0
138 PROPILTIOURASIL 100 MG TAB Tablet 72 72 72 0 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
139 PYRANTEL SCORE (BASE) 125 MG TAB Tablet 0 0 0 0 0
140 Ranitidin tablet 150 mg Tablet 855 855 195 660 0 1,000
141 RETINOL 100 000 IU KAPSUL (VIT A BIRU) Kapsul Lunak 300 300 300 0 0
142 RETINOL 200 000 IU CAP (VIT A MERAH) Kapsul Lunak 3996 3996 3996 0 0
143 SALBUTAMOL 4 MG TAB Tablet 687 1000 1687 424 1263 934 1,000
144 Setirizin tablet 10 mg Tablet 0 0 0 0 2,000
145 Simvastatin tablet 20 mg Tablet 270 270 230 40 440 500
146 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 210 200 410 140 270 0 500
147 SPIRONOLAKTON TABLET 25 MG Tablet 0 0 0 0 0
148 TETRASIKLIN 500 KAPSUL Kapsul 0 0 0 0 0
149 THIAMPENICOL KAPSUL 250 MG Kapsul 0 0 0 0 1,000
150 THIAMPENICOL KAPSUL 500 MG Kapsul 0 0 0 0 0
151 THIAMIN HCL 50 MG TAB ( VIT B1 ) Tablet 182 500 682 90 592 0 0
152 TRIHEKSIFENIDIL HCL 2 MG TAB Tablet 58 58 58 0 0
153 VIT B KOMPLEK TAB Tablet 727 17000 17727 5265 12462 0 10,000
154 ZINC TAB 20 MG Tablet 1025 2500 3525 559 2966 0 2,000
0 0 0
SYRUP 0 0 0
0 0 0
155 AMBROXOL SYR 15 mg/ml Botol 175 175 27 148 12 0
156 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 0 0 200
157 Amoksisilin sirup kering forte 250 mg/5 ml Botol 90 250 340 269 71 180 200
158 Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksi Botol 108 50 158 44 114 50 0
159 DOMPERIDON SYRUP Botol 0 0 0 20 0
160 Kloramfenikol suspensi 125 mg/ 5 ml Botol 111 111 0 111 0 0
161 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Tri Botol 0 200 200 39 161 0 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
162 Metoklopramide sirup 5 mg/ 5 ml Botol 105 100 205 62 143 76 100
163 METRONIDAZOL SUSPENSI Botol 0 0 0 0 0
164 MULTIVITAMIN SYR Botol 161 161 26 135 176 150
165 NISTATIN SUSPESI Botol 0 0 0 0 0
166 O B H SYR Botol 0 0 0 34 120
167 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol 0 0 0 0 300
168 Parasetamol sirup 120 mg / 5 ml Botol 0 300 300 112 188 0 200
ibuprofen syr botol 241 241 91 150 40 50
INJEKSI 0 0 0 0 0
0 0 0 0 0
169 Aminofilin injeksi 24 mg/ml Ampul 0 0 0 0 0
170 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial 46 46 21 25 78 50
171 ASAM TRANEXAMAT INJEKSI 50 MG / ML Ampul 0 0 0 0 0
172 AQUA PRO INJ STERIL Vial 18 18 6 12 22 10
173 CEFTRIAXON 1 GR INJ Vial 0 0 0 0 0
174 Deksametason injeksi i.v./i.m. 5 mg/ml Ampul 179 179 5 174 2 0
175 Diazepam injeksi i.v./i.m 5 mg/ml Ampul 27 27 27 0 0
176 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Ampul 90 90 5 85 14 0
177 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml Ampul 138 138 4 134 12 0
178 Fenitoin injeksi 50 mg/ml Ampul 0 0 0 0 0
179 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul 0 0 0 0 0
180 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 254 254 47 207 24 50
181 FUROSEMID INJ IV/IM 10 MG/ML Ampul 0 0 0 0 0
182 Gentamisin injeksi 40 mg/ ml Ampul 0 0 0 0 0
183 HYOCINA N BUTILBROMID INJ 20 MG Ampul 68 68 68 0 50 ED
184 KALSIUM GLUKONAS INJ 100 MG/ML Ampul 15 15 0 15 0 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
185 Kloramfenikol serb inj 1000 mg/mL Vial 0 0 0 0 0
186 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul 888 888 10 878 212 0
187 Lidokain injeksi 2% (HCL) Ampul 106 106 24 82 0 0
188 MAGNESIUM SULFAT 20 % INJ 25 ML Vial 9 9 9 0 0
189 MAGNESIUM SULFAT 40 % INJ 25 ML Vial 29 29 29 0 36 10 ED
190 Metoklopramide INJ 5 MG/ML Ampul 0 0 0 0 50 ED
191 Metilergometrin Maleat injeksi 0,200 mg-1 ml Ampul 184 184 184 2 0
192 Oksitosin injeksi 10 IU/ml Ampul 174 174 66 108 120 100
193 OXYTETRACIKLIN HCL INJ IM 50 MG/ML 10 ML Vial 0 0 0 0 0
194 RANITIDIN INJ 25 MG/2 ML Ampul 80 80 18 62 0 0
195 Sianokobalamin (vitamin B12) injeksi 500 mcg Ampul 0 0 0 0 0
196 THIAMIN INJ ( VIT BI ) 100 MG/ML Ampul 0 0 0 0 0
197 0ndansentron inj Ampul 0 0 0 0 20
OBAT KHUSUS 0 0 0 0 0
0 0 0 0 0
197 Antihemoroid, kombinasi: bismut subgalat 150 mg heksakloro SUPP 83 83 0 83 28 0
198 BISACODYL SUPP (DULCOLAX) 10 MG / Stolax supp SUPP 0 0 0 0 0
199 Diazepam larutan rektal 5 mg/2,5 mL (stesolit rectal) TUBE 13 13 2 11 4 0
200 MICROLAX 0 0 0 0 5
201 NISTATIN VAGINAL TAB 100 000 IU/GR TABLET 333 333 1 332 0 0
202 PARASETAMOL SUPP 80 MG SUPP 0 0 0 0 0
203 PARASETAMOL SUPP 125 MG SUPP 0 0 0 0 0
204 SABU I 5 ML VIAL 5 5 5 0 0
205 SALBUTAMOL (AS SULPHATE) 2,5 MG/2,5 ML NEBULS Ampul 20 60 80 23 57 110 50
206 SERUM ATS 1 500 IU VIAL 15 15 1 14 0 0
207 Serum ATS 20.000 IU 0 0 0 0 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
BISACODYL SUPP (DULCOLAX) 5 MG / Stolax supp SUPP 15 15 15 4 0
CAIRAN 0 0 0 0 0
0 0 0 0 0
208 Glukosa larutan infus 10 % steril Botol 0 0 0 0 0
209 Glukosa larutan infus 40 % steril Botol 0 0 0 0 0
210 Glukosa larutan infus 5 % steril Botol 43 43 2 41 8 20
211 Nacl 0,9% Botol 17 17 13 4 10 50
212 Ringer Laktat larutan infus Botol 125 100 225 88 137 198 100
0 0 0
OBAT LUAR 0 0 0
0 0 0
213 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g Polim Tube 0 0 0 0 200
214 ANTI FUNGI DOEN KOMB Pot 0 0 0 0 0
215 ASIKLOVIR CREAM 5% Tube 85 25 110 48 62 0 100
216 BETAMETASON CREAM 0,1 % Tube 3104 3104 120 2984 150 0
217 FENOL GLISEROL TT 10% TUBE 146 146 10 136 8 0
218 GENTAMICIN SK 0,1% Botol 50 50 37 13 0 50
219 GENTAMICIN SALEP MATA 0,3% Tube 0 0 0 36 50
220 GENTAMISIN SULFAT TETES MATA Tube 20 24 44 5 39 34 30
221 GENTIAN VIOLET LART 1% Botol 0 0 0 0 0
222 HEXACHLOROCYLOHEXANE 0,5% (Peditox) Botol 0 0 0 0 0
223 HIDROGEN PEROKSIDA LARUTAN 3% Botol 0 0 0 0 0
224 HIDROKORTISON CREAM 2,5 % Tube 0 0 0 0 50
225 ICHTIOL SALEP HITAM Pot 17 17 17 6 0
226 KALIUM PERMANGANAT SERBUK Pot 57 57 1 56 8 0
227 KETOKONAZOL KRIM 2% Tube 83 83 28 55 136 200
228 Kloramfenikol salep mata 1 % Tube 252 252 42 210 140 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
229 Kloramfenikol teter telinnga 3 % Botol 0 0 0 0 0
230 MICONAZOLE CREAM 2% Tube 0 0 0 0 200
231 OKSITETRASIKLIN SK 3% Tube 0 0 0 0 100
232 OKSITETRASIKLIN SM 1% Tube 0 0 0 0
233 Povidon Iodida larutan 10% 30 ml Botol 0 0 0 2 ED
234 Povidon Iodida larutan 10% 300 ml Botol 73 73 1 72 4 0
235 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4 Botol 38 24 62 58 4 50 46
236 SALEP LUKA BAKAR (bioplacenton) Pot 0 0 0 0 0
237 Bedak salisil serbuk 2% Tube 0 0 0 0 50
238 SULFASETAMID NATRIUM TM 15 % Kotak 0 0 0 0 0
0 0 0
OBAT GIGI 0 0 0
0 0 0
239 DEVITALISASI PASTA ( NON ARSEN ) Pot 0 0 0 0 0
240 ETIL KLORIDA SPRAY Botol 9 9 9 0 0
241 EUGENOL CAIRAN Botol 5 5 5 0 0
242 GLASS IONOMER CEMENT ART Botol 0 0 0 0 0
243 KALSIUM HIDROKSIDA PASTA Pot 0 0 0 0 0
244 KLORFENOL KAMFER MENTHOL (CHKM) Botol 2 2 2 0 0
245 MUMMIFYING PASTA Pot 0 0 0 0 0
246 POLIKRESULEN (ALBOTYL) Botol 7 7 7 0 0
247 SEMEN SENG FOSFAT SERBUK + CAIRAN Pot 0 0 0 0 0
248 SPONGOSTAN Kotak 0 0 0 0 0
249 TEMPORARY STOPPING FLETCER SERBUK+CAIRAN (caviton) Pot 0 0 0 0 0
250 TRIKRESOL FORMALIN (TKF) Botol 0 0 0
0 0 0
BAHAN LABORATORIUM 0 0 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
0 0 0
251 CARIK CELUP / URIN TES 3 GPH Stik 0 0 0 0 0
252 CARIK CELUP / URIN TES 11 GPH Stik 0 0 0 0 0
253 Antiseptik dan Disinfektan - alkohol 70% 100 ml Botol 134 134 1 133 2 0
254 Antiseptik dan Disinfektan - alkohol 70% 1 liter Botol 251 251 4 247 4 0
255 GLISERIN Botol 0 0 0 0 0
256 HB TEST KIT Set 0 0 0 0 0
257 KIT GOL DARAH Set 0 0 0 0 0
258 LART AS ACETAT Botol 0 0 0 0 0
259 LART ASAM KLORIDA 0,1 N Botol 2 2 2 0 0
260 LAR ASAM KLORIDA 0,1% Botol 0 0 0 0 0
261 LART BARIUM CHLORIDA 10 % Botol 0 0 0 0 0
262 LART BENEDICT Botol 0 0 0 0 0
263 LART E D T A 10 % Botol 2 2 2 0 0
264 LART ETANOL ASAM Botol 0 0 0 0 0
265 LART KOH 10 % Botol 0 0 0 0 0
266 LART NACL 0,9 % Botol 0 0 0 0 0
267 LART NATRIUM CITRAT 0,38 % Botol 0 0 0 0 0
268 LART ASAM CITRAT 3,8% Botol 0 0 0 0 0
269 LART REES ECKER Botol 0 0 0 0 0
270 LART SCHLESINGER Botol 0 0 0 0 0
271 LART TURK Botol 2 2 2 0 0
272 OIL EMERSI Botol 0 0 0 0 0
273 PP TEST Stik 0 0 0 0 0
274 RDT TEST MALARIA Stik 0 0 0 0 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
275 STIK GULA DARAH Stik 0 0 0 0 200
276 STIK ASAM URAT Stik 0 0 0 0 200
277 STIK KOLESTEROL Stik 0 0 0 0 200
278 STIK HBSAG Stik 0 0 0 0 0
279 STIK HBSAG Stik 0 0 0 0 0
280 WIDAL TEST Set 0 0 0 0 100
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
0 0 0
REAGEN 0 0 0
0 0 0
281 REAGEN ABX MINIDIL LMG PAKET 0 0 0 0 0
282 REAGEN ABC MINILYSE LMG PAKET 0 0 0 0 0
283 REAGEN ABX MINICLEAN PAKET 0 0 0 0 0
284 REAGEN ABX MINOTROL PAKET 0 0 0 0 0
0 0 0
TAMBAHAN 0 0 0
285 handscound obgin non steril ktk 165 165 0 165 0 0
286 handscound obgin steril ktk 50 50 0 50 0 0
287 kasa40 x 40 ktk 200 200 0 200 0 0
289 Gluco protein tube 20 20 0 20 0 0
290 ultra one btl 0 0 0 4 0
291 Novaldo (metamizole ) inj btl 23 23 13 10 14 0
292 Resperidon2 ktk 200 200 0 200 0 0
293 hb sahli 2 2 2 0 0
294 hcl 0.1 4 4 4 0 0
295 blood lancet 4 4 4 0 0
296 auto clic 2 2 2 0 0
297 ergotamin TABLET 0 0 0 0 0
298 Sulfadiazin silver tube 5 5 1 4 0 0
299 nassal canula anak Buah 5 5 2 3 0 0
300 nassal canula bayi Buah 5 5 2 3 0 0
301 nassal canula dewasa Buah 5 5 2 3 0 0
302 Nebulizer with mask dewasa Buah 5 5 2 3 0 0
303 Nebulizer with mask anak Buah 5 5 2 3 0 0
304 ASETIL SISTEIN KTK 11970 7920 12210 0 12210 8000
305 HEMOBION Box 0 0 0 0
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
306 underved 50 50 5 45

LAPORAN OBAT YANG DIBUTUHKAN PUSKESMAS MENINTING

NO NAMA OBAT STOK AWAL PENERIMAA PERSEDIAAN PEMAKAIAN SISA STOK KET
N
1 CAPTOPRIL 25 MG 1200 1200 0 1200
2 Stik Asam Urat 182 182 44 57
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
3 Attalpulgite 0 0
4 Bacitracin sk 0 0
5 PRIMAQUIN 265 265 101 0
6 erla ear drop 7 7 7 0
7 jarum tindik 0 0
8 Kotry syr 45 59 104 39 0
9 Gliseril Guaakolat 0 5000 5000 566
10 Gentamicin SK 0 0
11 STIK URIN 3P 100 200 300 190 110
12 stik gula darah 141 150 291 154 137
13 KLORAM TETES MATA 0 0 0
14 Kalsium Laktat 2139 2139 740 1399
15 ANTASIDA TAB 0 0 0
16 SLIDE 10 10 6 4
17 prednison 0 0 0
18 SALISIL 56 56 40 16
19 VIT B6 0 0 0
20 VIT B COMPLEX 0 0 0
21 Widal 2 2 1 1
22 tyamfenikol 500mg 300 300 190 110
23 CTM 1475 1475 475 1000
24 AMBROXOL TAB 2804 2804 1000 1804
25 METRONIDAZOLE 500 0 2000 2000 165 1835
26 RANITIDIN INJ 0 0 0
27 ACYCLOVIR ZK 0 0 0
28 ibupropen 480 0 2000 2000 490 1510
29 SALBUTAMOL TAB 100 100 100 0
30 NATRIUM DICLOFENAK 0 0 0
31 LOPERAMID 500 500 500 0
32 PARACETAMOL SYR 120ml 126 300 426 140 286
33 DEXAMETHASON TAB 0 0 0
34 KARTU GOLDAR 235 235 50 185
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11
35 STIK KOLESTEROL 69 150 219 44 175
36 BLOOD LANCET 5ktk 6ktk 11KTK 8KTK 3KTK
37 Cetirizin 0 0 0
38 Betahistin 0 0 0
39 larutan EDTA 0 1 1 1 0
40 objek glass 7101box/720m 0 0 0
41 METOCLOPERAMID TAB 0 0 0
42 AMLODIPIN 1020 1020 1020 0
43 AMBROXOL SYR 43 43 27 16
44 STIK URINE 10P 100 100 100 0
45 LART RESS ECKER 0 1 1 0
46 PP TEST 60 150 100 100 0
47 METANOL 0 1 1 0
48 OIL MERSI 0 1 1 0

UMUM

TIDAK BAYAR ASKES

JUMLAH KUNJUNGAN RESEP BAYAR
GAKIN UKS LAIN
1105 1900 0 183 47

Mengetahui Yang Menyerahkan Yang Menerima/ Melapor Yang Menerima

Kepala Dinas Kesehatan Kab. Lobar Kepala UPTD IFK Lobar Pemimpin UPT BLUD Puskesmas Pengelola Obat Pusk

Drs. H Rachman Sahnan Putra M. Kes Hj. Bq. Endang Suprihartini, Msi.,Apt. Rosmayadi, Skm,Mph Sayu Nyoman Niti
NIP :19610512 198203 1 009 NIP. 19680916200112 2 003 NIP: 196812121990031014 NIP. 1972080219950
 PEMBERIAN
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
NO NAMA OBAT SATUAN APBD APBN
3 4 5=3+4 6 7=5-6 8 9=8-7 10 11

KETERANGAN :
LEMBAR PERTAMA (ASLI) : IFK
LEMBAR KEDUA : DIKES LOBAR
LEMBAR KETIGA : ARSIP / PUSKESMAS
:
: 2018
:

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KES JUMLAH

7 3235

ng Menerima
a Obat Puskesmas

Nyoman Nitiari
208021995032003