Lplpo 2019

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
INSTANSI : PUSKESMAS MOKODITEK NOMOR DOKUMEN :

KECAMATAN : BOLANG ITANG TIMUR BULAN PEMAKAIAN : DESEMBER
KABUPATEN : BOLAANG MONGONDOW UTARA BULAN PERMINTAAN : JANUARI 2019
PROPINSI : SULAWESI UTARA TAHUN : 2018
PEMBERIAAN
SATUAN STOK PENERI PERSE PEMA RUSAK/ SISA STOK PERMIN
KODE NAMA OBAT FORNAS
TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK OPTIMUM TAAN DAK APBD I DAU LAIN (TK)
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11 12 13 14 15 16
OBAT CAIR
1 Alkohol 70% 100 ml botol - - - - - - 100 1,2,3
2 Alkohol 70% 1000 ml botol 2 - 2 - - - 1,2,3
3 Ambroxol sirup botol 120 - 120 60 60
4 Aminophylline inj ampul - - - 1,2,3
5 Amoxicillin drops botol - - - - - 1,2,3
6 Amoxicillin sirup botol 50 - 50 50 - 100 1,2,3
Analog insulin Apidra inj pen - - - - - 1,2,3

7
Analog insulin Lantus inj pen - - - - - 1,2,3
8
9 Antalgin inj ampul - - - - -
10 Gastrucid botol 79 96 175 151 24 100
11 Antasida sirup botol - - - - - 1,2,3
12 Aqua pro inj flacon - - - - - 1,2,3
13 Asering infus botol - - - - - 1,2,3
14 Atropin sulfate inj ampul 100 - 100 - 100 1,2,3
Cefadroxil syr 125 mg/5 ml botol 15 - 15 - 15 1,2,3

15
16 Cefixime sirup botol 6 - 6 - 6 2.3
17 Cefotaxime inj vial 6 - 6 - 6 - 2.3
18 Ceftriaxone inj vial 2 - 2 - 2 - 2.3
19 Cetirizine sirup botol 5 - 5 5 - 50 1,2,3
20 Chloramphenicol sirup botol 13 - 13 - 13 1,2,3
Chloramphenicol tetes botol - - - - - 1,2,3
21 telinga
22 Citicholine inj ampul - - - - -
Curbion sirup multivitamin botol - - - - - 100

23
24 Dexamethasone inj ampul 190 - 190 - 190 1,2,3
25 Diazepam Inj ampul - - - - - 1,2,3
26 Diphenhydramine inj ampul 24 - 24 - 24 1,2,3
27 Domperidone sirup botol - - - - - - 1,2,3
28 Epinephrine inj ampul 187 - 187 - 187 1,2,3
29 Erythromycin sirup botol - - - - - 1,2,3
30 Formalin cairan liter - - - - -
31 Furosemide inj ampul - - - - - 1,2,3
32 Gentamicin inj ampul - - - - - 2.3
Gentamisin Tetes mata botol 15 - 15 3 12 2.3

33
34 Gentian violet botol - - - - -
35 Glukosa 10% infus botol - - - - - 1,2,3
36 Glukosa 40% inj flacon - - - - - 1,2,3
37 Glukosa 5% infus botol 16 - 16 - 16 1,2,3
38 H2O2 3% botol - - - - - 1,2,3
Hyoscine butylbromide inj ampul - - - - - 2.3

39
40 Ibuprofen sirup botol 32 - 32 15 17 1,2,3
Karbogliserin Tetes Telinga botol - - - - -
41 10%
42 KAEN 3A infus botol - - - - - 1,2,3
43 KAEN 3B infus botol 10 - 10 - 10 1,2,3
KCL 7.46% Kalium Klorida flacon 24 - 24 - 24 1,2,3
44 OTSU 25 MI
45 Ketamine inj vial - - - - - 1,2,3
46 Ketorolac inj ampul - - - - 2.3
Kloramfenikol tetes mata botol 338 - 338 138 200 1,2,3

47
48 Lidocaine inj ampul 940 - 940 20 920 1,2,3
49 Lysol cairan botol - - -
Magnesium Sulfat 20% inj flacon 10 - 10 - 10 1,2,3

50
Magnesium Sulfat 40% inj flacon - - - - 1,2,3
51
Methylergometrin maleate ampul 100 - 100 - 100 1,2,3
52 inj
53 Metoklopramide sirup botol 7 - 7 - 7 20 1,2,3
54 Metronidazole infus botol - - - - 1,2,3
Natrium klorida 0,9% infus botol 120 - 120 - 120 1,2,3

55
56 Nelydex tetes mata botol - - - - -
57 Omegdiar sirup botol 19 - 19 19 - 50
58 Omeprazole inj vial - - 1,2,3
59 Ondansetron inj ampul 55 - 55 - 55 2.3
60 Otopain tetes telinga botol - - - -
61 Oxytocin inj ampul 170 - 170 30 140 1,2,3
62 Pacdin cough sirup botol 160 - 160 144 16 150
63 Paracetamol drops botol - - - - - 1,2,3
64 Paracetamol infus botol - - - - - 3
65 Paracetamol sirup botol 123 - 123 103 20 100 1,2,3
66 Phenobarbital inj ampul 15 - 15 - 15 2.3
67 Piracetam inj ampul - - - - -
68 Pirantel Sirup botol - - - - - 1,2,3
69 Povidone 300 ml botol 4 5 9 1 8 1,2,3
70 Povidone 60 ml botol - - - - - 1,2,3
71 Ranitidine inj ampul 100 - 100 15 85 2.3
72 Renalyte electrolytes botol 36 - 36 36 - 1,2,3
73 Ringer Laktat infus botol 110 - 110 - 110 1,2,3
74 Rivanol 300 ml botol 6 - 6 1 5 1,2,3
75 Salbutamol sirup botol - - - - - 2.3
Sodium Bicarbonate inj flacon - - - - - 2.3

76
77 Sucralfate sirup botol - - - - - 100 2.3
Tetagam inj human tetanus vial - - - - - 1,2,3
78
79 Tramadol inj ampul 50 - 50 - 50 2.3
80 Tranexamic Acid inj ampul - - - - - 2.3
81 Vit amin B12 inj ampul 129 - 129 29 100 1,2,3
82 Vitamin B1 inj ampul - - - - - 60
83 Vitamin K inj 2 mg ampul - 30 30 - 30 1,2,3
84 Voluven HES 6% botol - - - - - 1,2,3
85 Zinc pro drops botol 11 - 11 - 11 50 1,2,3
-
-
OBAT PADAT -
86 Acetosal 100 mg tablet 50 - 50 - 50 2.3
87 Acetylcysteine 200 mg tablet 1,800 - 1,800 1,800 1,2,3
Acetysalicylic acid 80 mg tablet 100 - 100 - 100 1,2,3

88
ACT (artesunate + tablet - - -
89 amodiaquin)
90 Acyclovir 400 mg tablet 100 - 100 50 50 500 1,2,3
91 Albendazole 400 mg tablet - - - - - 1,2,3
92 Allopurinol 100 mg tablet 800 - 800 400 400 500 1,2,3
93 Ambroksol 30 mg tablet 400 - 400 400 -
94 Aminophillin 150 mg tablet - - - - - 1,2,3
95 Amlodipine 10 mg tablet 570 - 570 510 60 500 1,2,3
96 Amlodipine 5 mg tablet 240 - 240 - 240 500 1,2,3
97 Amoxicillin 500 mg tablet 2,100 1,000 3,100 1,400 1,700 1000 1,2,3
98 Antalgin 500 mg tablet - - - - -
99 Antasida doen tablet 2,400 1,000 3,400 2,700 700 2000 1,2,3
100 Asam Folat 1 mg tablet - - - - - 1,2,3
Asam mefenamat 500 mg tablet 2,100 1,000 3,100 600 2,500 1,2,3
101
Asam traneksamat 500 mg tablet - - - - - 2.3
102
103 Asiklovir 200 mg tablet - - - - - 1,2,3
105 Asiklovir 400 mg tablet - 1,000 1,000 - 1,000
106 Azitromisin Kap 500 mg kaplet 40 - 40 - 40
107 Attapulgite tablet 200 - 200 100 100 500 1,2,3
108 Betahistin tab tablet - 1,000 1,000 - 1,000 2.3
Bisakodil (Dulcolax) Supp 5 tablet - - - - - 1,2,3
109 mg
Bisakodil (Dulcolax) Supp 10
tablet - - - - - 1,2,3
110 mg
111 Bisacodyl Tab 5 mg tablet 270 - 270 30 240 1,2,3
112 Bisoprolol 5 mg tablet - - - - - 2.3
113 Bromhexine 8 mg tablet 500 - 500 500 - 2000
114 Calsium lactate 500 mg tablet 800 - 800 - 800 1,2,3
115 Captopril 12,5 mg tablet - - - - - 1000 1,2,3
116 Captopril 25 mg tablet - - - - - 1000 1,2,3
117 Captopril 50 mg tablet 300 300 600 450 150 500 1,2,3
118 Cefadroxil 500 mg tablet - 300 300 100 200 500 2.3
119 Cefixime 100 mg tablet 300 - 300 250 50 500 2.3
120 Cetirizine 10 mg tablet - - - - - 2.3
Chloramphenicol 500 mg tablet - - - - - 2.3

121
Chlorpheniramine 4 mg tablet 1,800 600 2,400 1,800 600 2000 1,2,3
122
123 Ciprofloxacin 500 mg tablet 400 - 400 - 400 1,2,3
124 Citicoline 500 mg tablet - - - - -
125 Clindamycin 150 mg tablet 700 - 700 - 700 1,2,3
126 Clobazam tab 10 mg tablet - - - - - 2.3
127 Colchicine 0,5 mg tablet - - - - - 1,2,3
128 Cotrimoxazole 480 mg tablet 300 - 300 100 200 1500 1,2,3
129 Dapyrin tablet - - -
Dexamethasone 0,5 mg tablet 900 - 900 900 - 3000 1,2,3

130
131 Diazepam 2 mg tablet - - - - - 1,2,3
Diazepam stesolid 10mg supositoria - - - - - 1,2,3

132
Diazepam stesolid 5mg supositoria - - - - - - 1,2,3
133
Diklofenac sodium 50 mg tablet - - - - - 1,2,3
134
135 Diltiazem tab 30 mg tablet - - - - 1,2,3
136 Domperidone 10 mg tablet 600 - 600 500 100 500 1,2,3
137 Doxycycline 100 mg tablet - - - - - 1,2,3
Dumin rectal 125 mg supositoria 13 - 13 - 13

138
Dumin rectal 250 mg supositoria - - - - -
139
140 Ergotamine caffeine tablet - - - - - 1,2,3
141 Erythromycin 500 mg tablet 800 - 800 - 800 1,2,3
142 Fenitoin tablet - - - - - 1,2,3
143 Fenobarbital 30 mg tablet - - - - - 1,2,3
144 Furosemide 40 mg tablet 300 - 300 - 300 1,2,3
145 Glibenclamide 5 mg tablet 400 - 400 - 400 1,2,3
146 Glimepiride 2 mg tablet - - - - - 1,2,3
Glyceryl guaiacolate 100 mg tablet - - - - -

147
Glyceryl trinitrate 500 mcg tablet - - - - - 1,2,3
148
149 Griseofulvin 125 mg tablet 1,200 - 1,200 600 600 500 1,2,3
150 Haloperidol 0,5 mg tablet - - - 2.3
Hydrochlorothiazide 25 mg tablet 600 - 600 - 600 1,2,3

151
Hyoscine butylbromide 10 tablet - - - - 1,2,3
152 mg
153 Ibuprofen 400 mg tablet 2,800 - 2,800 1,400 1,400 1,2,3
154 Isosorbid Dinitrat 5 mg tablet - 500 500 - 500 1,2,3
155 Kalium aspartate tablet - - - - - 2.3
Kalsium Karbonat
(CALPOROSIS D) Kap 500mg kaplet - - - - -
156
157 Ketoconazole 200 mg tablet - - - - - 1,2,3
Ketoprofen supo supositoria - - - - - 2.3

158
159 Kloramfenikol 250 mg tablet - - - - - 1,2,3
160 Klorpromazin 100 mg tablet - - - - - 1,2,3
161 Kuinin sulfat 222 mg tablet 1,200 - 1,200 - 1,200 1,2,3
162 Lanzoprasol 30 mg tablet 60 - 60 60 - 2.3
163 Levofloxacin 500 mg tablet - - - - - 2.3
164 Lincomycin 500 mg tablet - - - - -
165 Loperamide 2 mg tablet - 1,000 1,000 - 1,000 2.3
166 Loratadine 10 mg tablet 100 - 100 100 - 1,2,3
167 Meloxicam tab 7,5 mg tablet 1,000 - 1,000 - 1,000
168 Metformin 500 mg tablet 1,000 - 1,000 - 1,000 1,2,3
169 Methisoprinol 500 mg tablet - - - -
170 Methyldopa 250 mg tablet - - - - - 2.3
Metilergometrin maleat tab tablet - 1,000 1,000 - 1,000 1,2,3

171
172 Metilprednisolon tab tablet - 1,000 1,000 - 1,000 1,2,3
173 Metoclopramide 10 mg tablet - 1,000 1,000 - 1,000 1,2,3
174 Metoclopramide 5 mg tablet - - - - - 1,2,3
175 Metronidazol 500 mg tablet - - - - - 1,2,3
Metronidazole supo supositoria - - - - - 2.3

176
177 Microlax rectal tube - - - - -
Natriuum Diklofenak 50 Mg Tablet - 1,000 1,000 - 1,000

178
179 Nifedipine 10 mg tablet 200 - 200 - 200 1,2,3
180 Norit botol - - - - - 1,2,3
181 Nystatin 500.000 IU tablet - - - - - 1,2,3
OAT kategori Sisipan - KDT kotak - - - - - 1,2,3

182
183 Omegavit multivitamin tablet - - - - -
184 Omeprazole 20 mg tablet - - - - - 1,2,3
185 Omesivaks tablet - 600 600 - 600
186 Ondansetron 4 mg tablet 180 - 180 - 180 2.3
Paket stop TB kategori I kotak - - - - - 1,2,3

188
189 Panviton multivitamin tablet - - - - -
190 Papaverin 40 mg tablet - - - - -
191 Paracetamol 500 mg tablet 1,400 1,000 2,400 1,900 500 2000 1,2,3
192 Piracetam 400 mg tablet - - - - -
194 Piroxicam 20 mg tablet - - - - -
195 Prednison 5 mg tablet 1,600 - 1,600 100 1,500 1,2,3
196 Prenase multivitamin tablet - - - - -
197 Primaquine 15 mg tablet - - - - - 1,2,3
198 Probenecid 500 mg tablet - - - - - 1,2,3
199 Propanolol 10 mg tablet - - - - - 1,2,3
Propylthiouracil 100 mg tablet - - - - - 1,2,3

200
210 Pyrantel tab 125 mg tablet 2,000 - 2,000 - 2,000 1,2,3
202 Ranitidine 150 mg tablet 100 2,000 2,100 400 - 1,700 1,2,3
203 Salbutamol 2 mg tablet - 1,000 1,000 300 - 700 1,2,3
204 Salbutamol 4 mg tablet 700 - 700 100 600 1,2,3
Salbutamol nebules 2,5 mg tablet - - - - -

205
206 Simvastatin 10 mg tablet 1,170 - 1,170 240 930 1,2,3
207 Spironolactone 100 mg tablet - - - 1,2,3
208 Sucralfate 500 mg tablet 540 - 540 - 540 2.3
209 Tablet tambah darah tablet 3,150 - 3,150 650 2,500 1,2,3
210 Tetrasiklin 250 mg tablet - - - - - 1,2,3
211 Tetrasiklin 500 mg tablet - - - - 1,2,3
212 Thiamphenicol 500 mg tablet - - - - -
213 Tilomix tablet - - - - -
214 Triheksifenidil 2mg tablet - - - - - 1,2,3
215 Ulsidex 500 Mg tablet 500 - 500 - 500
216 Valsartan tab 80 mg tablet - - - - - - 2.3
Vitalamin multivitamin tablet - - - - -

217
218 Vitamin A 100.000 IU tablet - 500 500 - 500 1,2,3
219 Vitamin A 200.000 IU tablet 150 - 150 - 150 1,2,3
220 Vitamin B complex tablet 1,000 - - - - 1,2,3
221 Vitamin B1 50 mg tablet 1,000 - - - - 1,2,3
222 Vitamin B6 10 mg tablet 1,400 - 1,400 100 1,300 1,2,3
223 Vitamin C 50 mg tablet 1,600 - 1,600 1,000 600 1,2,3
224 Vitamin K 10 mg tablet - - - - - 1,2,3
225 Zinc 20 mg tablet 700 - 700 400 300 1,2,3
-
OBAT GIGI - GAS - - - - -
Calciumpolystyrene sachet - - - - -
226 Kalitakee
227 Dental gipsum kg - - - - -
Komposit a A2, A3, A 3,5 botol - - - - -
228 solareX
229 L Bio sachet - - -
Oxymetazoline Nasal Spray botol - - - - -
230 Iliadin 0,05%
231 -
232 OBAT SALEP/SERBUK - - - - -
Antifungi DOEN Salep,

Kombinasi: Asam Bensoat pot - - - - -
6% Asam Salisilat 3%
233
AntiBakteri Salep: Basitrasin
500 IU/g + Polimiksin tube - - - - -
234 10.000 Iu/g
235 Basitrasin salep tube - - - -
sabun anti bakteri 500 ml tube - - - - -

236
Garam Oralit Serbuk sachet 470 - 470 70 400
237 Kombinasi
238 Acyclovir cream tube - - - - -
Aseptic alkohol gel

antiseptic pembersih tangan botol - - - - -
239
240 Betametason cream tube - - - - - 1,2,3
241 Bioplacenton gel tube - - - - -
242 Bricasma terbutaline can - - - - -
Burnazin silver tube - - - - - 1,2,3
243 sulphadiazine
244 Caladine lotion botol - - - - -
Chloramphenicol salep kulit tube - - - - - 1,2,3
245
Chloramphenicol salep tube - - - - - 1,2,3
246 mata
247 Cutimed gel tube - - - - -
Desoximetasone cream tube - - - - - 2.3

248
249 Diclofenac sodium gel tube - - - - -
Gentamicin salep mata tube - - - - - 2.3

244
245 Hydrocortisone cream tube - - - - - 1,2,3
246 Ichtyol salep pot - - - - -
247 Ketoconazole cream tube - - - - - 1,2,3
248 Lidocain jelly dispo - - - - - 1,2,3
249 Miconazole cream tube - - - - - 1,2,3
250 Nebacetin salep tube - - - - -
251 Salep 2-4 pot - - - - - 1,2,3
252 Salisil bedak kotak - - - - - 1,2,3
253 Sodium fusidat Fucilex tube - - - - - 2.3
254 Thrombophob gel tube - - - - -
255 Ultrasound gel USG botol - - - - -
- - - - -
- - -
OBAT LAINNYA -
Apron One Plastik Onemed lembar 40 - 40 - 40 1,2,3

256
BeneCheck Plus Glucose strip - - - - - - 1,2,3
257 Test Strip 50's
BeneCheck Plus Total strip - - - - - - 1,2,3

Cholesterol Test Strip 10`s
258
BeneCheck Plus Uric Test strip - - - - - - 1,2,3
259 Strip 25`s
Absorbent paper points 15- kotak - - - - - 1,2,3
260 40
Absorbent paper points 45- kotak - - - - - 1,2,3
261 80
262 Alkohol swab pcs 100 - 100 - 100
263 Bisturi no. 11 pcs 100 - 100 - 100
264 Bisturi no. 18 pcs 100 - 100 - 100
265 Bisturi no. 20 pcs 100 - 100 - 100
266 Bisturi no. 22 pcs 200 - 200 - 200
Catgut Chrom 3/0 Rol 100 roll - - - - -
267 meter
Catgut Chromic 2/0 + jarum pcs 48 - 48 - 48

268
Catgut Chromic 3/0 + jarum pcs 48 - 48 - 48
269
Catgut plain 2/0 + jarum pcs 48 - 48 - 48
270
271
272 Celemek / Apron pcs - - - - -
273 Cutimed siltec 10x10cm pcs 10 - 10 - 10
274 Cutimed sorbact 7x9cm pcs - - - - -
275 Duk steril disposible pcs - - - - -
Foley catheter 2 way no. 16 pcs 20 - 20 - 20

276
Foley catheter 2 way no. 18 pcs - - - - -
277
278
279
Gutta percha points 15-40 pcs - - - - - 1,2,3

280
Gutta percha points 45-80 pcs - - - - - 1,2,3
281
282 Handscoen ginekologi psg - - - - -
Handscoen non steril Large psg - - - - -

283
Handscoen non steril psg 350 - 350 200 150 500
284 Medium
Handscoen steril obsgyn psg 175 - 175 25 150
285
286 Handscoen steril psg - - - - -
Handscoen steril no. 6,5 psg - - - - -

287
288 Handscoen steril no. 7 psg - - - - -

289
290 Handscoen steril no. 8 psg - - - - -
Handscoen Examination
291 psg - 500 500 500
Glovers L
291 HCG test pcs 138 - 138 18 120
292 Infusion set Anak pcs 50 - 50 - 50
293 Infusion set Dewasa pcs 77 - 77 - 77
294 IV cannula no. 18 pcs 65 - 65 - 65
295 IV cannula no. 20 pcs - - - - -
296 IV cannula no. 22 pcs 75 - 75 - 75
297 IV cannula no. 24 pcs 50 - 50 - 50
298 IV cannula no. 26 pcs 10 - 10 - 10
299 Jarum jahit No. 10 pcs - - - - -
301 Jarum jahit No. 12 pcs 60 - 60 - 60
306 Jarum otot besar pcs - - - - -
307 Jarum otot kecil pcs - - - - -
Jarum untuk insulin pen pcs - - - - -

308
309 Kacamata Anti infeksi pcs - - - - -
310 Kapas Berlemak 500 g bungkus - - - - -
311 Kapas putih 250 g bungkus - - - - -
Kasa hidrofil 40yard x 80cm roll - - - - -

312
Kasa hidrofil 4m x 10cm rol 100 - 100 - 100
313
314 Kasa hidrofil 4m x 5cm rol 200 - 200 - 200
315 Kasa sterile 16x16cm pcs 1,600 - 1,600 - 1,600 3000
316 Klem tali pusat pcs 100 - 100 - 100
317 Masker pcs 450 - 450 450
Masker Nebulizer Set Anak pcs 25 - 25 - 25
318 Besmed
Masker Nebulizer Set pcs 25 - 25 - 25
319 Dewasa Basmed
Micro brush doche

Disposable micro buckets - - - - -
applicators 1A6542 Fine
(1,5mm) warna kuning, biru
320
321 Mucous extractor FR 10 pcs - - - - -
322 NGT no.16 pcs 9 - 9 - 9
323 NGT no.18 pcs 9 - 9 - 9
324 NGT no.3,5 pcs - - - - -
325 NGT no.5 pcs - - - - -
326 NGT no.8 pcs - - - - -
327 Oxygen nasal cannula Anak pcs - - - - -
328 Oxygen nasal cannula Dewaspcs - - - - -
329 Oxygen Mask Anak pcs 70 - 70 - 70
330 Oxygen Mask Dewasa pcs 75 - 75 - 75
331 Pembalut Gibs rol 75 - 75 - 75
Plester coklat yard rol 6 - - - -
332 Leukoplast
3333 Plester Infus dermafix pcs 50 - 50 - 50
334 Plester luka bakar pcs - - - - -
Policrepe pembalut Elastis rol - - - - -
335 10cm x 4,55m
336 Plester putih Polifix rol 9 - 9 - 9
Plester rawat luka anti air
dermafix t 10x25cm pcs - - - - -
337
338 Safety box pcs 12 - 12 - 12
339 Silk 2/0 pcs 40 - 40 - 40
340 Silk 3/0 pcs 30 - 30 30
341 Suction catheter FR 10 pcs - - - - -
348 Sputum Pot Pieces 100 - 100 - 100
Surgical gown baju operasi L pcs 10 - 10 - 10

349
Surgical gown baju operasi pcs - - - - -
350 M
Surgical gown baju operasi pcs - - - - -
351 XL
352 Syringe 1 cc pcs 195 - 195 100 185
353 Syringe 10 cc pcs 100 - 100 - 100
354 Syringe 20 cc pcs 50 - 50 - 50
355 Syringe 3 cc pcs 400 - 400 - 400
356 Syringe 5 cc pcs 100 - 100 - 100
357 Syringe 50 cc pcs - - - - -
Test Anti HIV 1/2 Cassette test - - - - -

358
359 Test HBsAg strip test - - - - -
Test Malaria HRP2/pLDH test - - - - -

(Pf/PAN) combo
360
361 Topi Operasi pcs 100 - 100 - 100
362 Urine Bag pcs 48 - 48 - 48
softpad (underpad) 60x90 pcs 90 - 90 90
363 cm
364 Venflon no. 20 pcs 50 - 50 - 50
54,746 17,431 70,171 8 50,878 24,980 -
UMUM ASKES/ BPJS JUMLAH
JUMLAH KUNJUNGAN TIDAK

BAYAR
RESEP BAYAR
JUMLAH KUNJUNGAN
RESEP
s
(LPLPO)

KECAMATAN : BOLANG ITANG TIMUR BULAN PEMAKAIAN : JANUARI 2019
KABUPATEN : BOLAANG MONGONDOW UTARA BULAN PERMINTAAN : FEBRUARI 2019
PEMBERIAAN
KODE NAMA OBAT FORNAS
TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK OPTIMUM TAAN DAK APBD I DAU LAIN (TK)
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11 12 13 14 15 16
OBAT CAIR
Alkohol 70% 100 ml botol - - - - - - 1,2,3

1
Alkohol 70% 1000 ml botol - 20 20 - - 20 1,2,3

2
Ambroxol sirup botol 60 120 180 41 139
3
Aminophylline inj ampul - - - - 1,2,3
4
Amoxicillin drops botol - - - - - 50 1,2,3
5
Amoxicillin sirup botol - 23 23 23 - 100 1,2,3
6
Analog insulin Apidra inj pen - - - - 1,2,3

7

8
Antalgin inj ampul - - - - - 30
9
10 Gastrucid botol 24 216 240 92 148
11 Antasida sirup botol - - - - - 1,2,3
12 Aqua pro inj flacon - - - - - 1,2,3
Cefadroxil syr 125 mg/5 botol - - - - - 1,2,3
15 ml
16 Cefixime sirup botol 6 - 6 - 6 2.3
17 Cefotaxime inj vial - - - - - - 2.3
18 Ceftriaxone inj vial - - - - - - 2.3
19 Cetirizine sirup botol - 150 150 15 - 135 1,2,3
20 Chotrimoksazole syr botol - 50 50 10 40
Chloramphenicol sirup botol 13 - 13 - 13 1,2,3

21
22 telinga
Curbion sirup botol - 60 60 30 30
24 multivitamin
25 Dexamethasone inj ampul 190 - 190 42 148 1,2,3
26 Diazepam Inj ampul - - - - - 1,2,3
Diphenhydramine inj ampul 24 - 24 24 - 100 1,2,3

27
29 Epinephrine inj ampul 187 - 187 - 187 1,2,3
Gentamisin Tetes mata botol 12 - 12 2 10 2.3

34
36 Glukosa 10% infus botol - - - - - 1,2,3
37 Glukosa 40% inj flacon - - - - - 1,2,3
38 Glukosa 5% infus botol 16 - 16 - 16 - 10 1,2,3
39 H2O2 3% botol - - - - - 1,2,3
Hyoscine butylbromide ampul - - - - - 2.3
40 inj
41 Ibuprofen sirup botol 17 - 17 9 8 50 1,2,3
Karbogliserin Tetes botol - - - - -
42 Telinga 10%
44 KAEN 3B infus botol 10 - 10 - 10 1,2,3
KCL 7.46% Kalium
flacon 24 - 24 4 20 1,2,3
45 Klorida OTSU 25 MI
47 Ketorolac inj ampul - - - - 2.3
Kloramfenikol tetes botol 200 - 200 - - 1,2,3
48 mata
49 Lidocaine inj ampul 920 - 920 20 900 1,2,3
50 Lysol cairan botol - - -
Magnesium Sulfat 20% flacon 10 - 10 - 10 1,2,3
51 inj
Magnesium Sulfat 40% flacon - - - - 1,2,3
52 inj
Methylergometrin ampul 100 - 100 - 100 1,2,3
53 maleate inj
Metoklopramide sirup botol 7 100 107 17 90 1,2,3

54
Metronidazole infus botol - 5 5 3 2 1,2,3
55
Natrium klorida 0,9% botol 120 - 120 28 92 1,2,3
56 infus
58 Omegdiar sirup botol - 50 50 6 44
60 Ondansetron inj ampul 55 - 55 10 45 2.3
Otopain tetes telinga botol - - - -

61
62 Oxytocin inj ampul 140 - 140 - 140 1,2,3
63 Pacdin cough sirup botol 16 288 304 91 213
64 Paracetamol drops botol - - - - - 1,2,3
66 Paracetamol sirup botol 20 100 120 52 68 1,2,3
69 Pirantel Sirup botol - - - - - 1,2,3
70 Povidone 300 ml botol 8 - 8 5 3 5 1,2,3
Renalyte electrolytes botol - 12 12 12 - 50 1,2,3

73
74 Ringer Laktat infus botol 110 - 110 - 110 1,2,3
75 Rivanol 300 ml botol 5 - 5 4 1 5 1,2,3

77
78 Sucralfate sirup botol - - - - - 2.3
Tetagam inj human vial - - - - - 1,2,3
79 tetanus
80 Tramadol inj ampul 50 - 50 - 50 2.3
82 Vit amin B12 inj ampul 100 - 100 - 100 1,2,3
83 Vitamin B1 inj ampul - - - - -
84 Vitamin K inj 2 mg ampul 30 - 30 - 30 1,2,3
86 Zinc pro drops botol 11 50 61 33 28 1,2,3
-
-
OBAT PADAT -
87 Acetosal 100 mg tablet 50 - 50 - - 2.3
Acetylcysteine 200 mg tablet 1,800 - 1,800 - 1,800 1,2,3

88
Acetysalicylic acid 80 tablet 100 - 100 - 100 1,2,3
89 mg
90 amodiaquin)
91 Acyclovir 400 mg tablet 50 - 50 - 50 1,2,3
92 Albendazole 400 mg tablet - - - - - 1,2,3
93 Allopurinol 100 mg tablet 400 1,000 1,400 300 1,100 1,2,3
94 Ambroksol 30 mg tablet - - - - -
Aminophillin 150 mg tablet - - - - - 1,2,3
95
96 Amlodipine 10 mg tablet 60 900 960 360 600 1,2,3
97 Amlodipine 5 mg tablet 240 - - - - 1,2,3
98 Amoxicillin 500 mg tablet 1,700 2,000 3,700 800 2,900 1,2,3
100 Antasida doen tablet 700 18,800 19,500 1,800 17,700 1,2,3
101 Asam Folat 1 mg tablet - 500 500 100 400 1,2,3
Asam mefenamat 500 tablet 2,500 - 2,500 700 1,800 1,2,3
102 mg
Asam traneksamat 500 tablet - - - - - 2.3
103 mg
105 Asiklovir 400 mg tablet 1,000 - 1,000 - -
Azitromisin Kap 500 mg kaplet 40 - 40 - 40

106
107 Attapulgite tablet 100 - 100 - - 1,2,3
108 Betahistin tab tablet 1,000 - 1,000 - 1,000 2.3
Bisakodil (Dulcolax) tablet - - - - - 1,2,3

Supp 5 mg
109
Bisakodil (Dulcolax) tablet - - - - - 1,2,3

Supp 10 mg
110
111 Bisacodyl Tab 5 mg tablet 240 - 240 - 240 1,2,3
112 Bisoprolol 5 mg tablet - - - - - 2.3
113 Bromhexine 8 mg tablet - - - - -
Calsium lactate 500 mg tablet 800 300 1,100 700 400 1,2,3
114
115 Captopril 12,5 mg tablet - 2,500 2,500 400 2,100 1,2,3
116 Captopril 25 mg tablet - - - - - 1,2,3
117 Captopril 50 mg tablet 150 - 150 100 50 1,2,3
118 Cefadroxil 500 mg tablet 200 800 1,000 800 200 1000 2.3
119 Cefixime 100 mg tablet 50 - 50 - - 2.3
120 Cetirizine 10 mg tablet - - - - - 2.3
Chloramphenicol 500 tablet - - - - - 2.3
121 mg
Chlorpheniramine 4 mg tablet 600 4,000 4,600 1,800 2,800 1,2,3
122
Ciprofloxacin 500 mg tablet 400 - 400 - 400 1,2,3
123
125 Clindamycin 150 mg tablet 700 - 700 - 700 1,2,3
126 Clobazam tab 10 mg tablet - - - - - 2.3
Cotrimoxazole 480 mg tablet 200 1,500 1,700 700 1,000 1,2,3

128
Dexamethasone 0,5 mg tablet - 2,500 2,500 1,500 1,000 1500 1,2,3

130
Diazepam 5 mg tablet - 5 5 - 5
Diazepam stesolid 10mg supositoria - - - - - 1,2,3

132
Diazepam stesolid 5mg supositoria - - - - - - 1,2,3
133
Diklofenac sodium 50 tablet - - - - - 1,2,3
134 mg
135 Diltiazem tab 30 mg tablet - - - - 1,2,3
136 Domperidone 10 mg tablet 100 1,500 1,600 100 1,500 1,2,3
137 Doxycycline 100 mg tablet - - - - - 1,2,3
Dumin rectal 125 mg supositoria 13 - 13 - 13

138
139
Ergotamine caffeine tablet - - - - - 1,2,3
140
141 Erythromycin 500 mg tablet 800 - 800 - 800 1,2,3
142 Fenitoin tablet - - - - - 1,2,3
143 Fenobarbital 30 mg tablet - - - - - 1,2,3
145 Glibenclamide 5 mg tablet 400 - 400 300 100 1,2,3
Glyceryl guaiacolate 100 tablet - 600 600 500 100 2000
147 mg
Glyceryl trinitrate 500 tablet - - - - - 1,2,3
148 mcg
149 Griseofulvin 125 mg tablet 600 500 1,100 - 1,100 1,2,3
Hydrochlorothiazide 25 tablet 600 - 600 - 600 1,2,3
151 mg
Hyoscine butylbromide tablet - - - - 1,2,3
152 10 mg
153 Ibuprofen 400 mg tablet 1,400 - 1,400 1,000 400 2000 1,2,3
Isosorbid Dinitrat 5 mg tablet 500 - 500 - 500 1,2,3

154
Kalsium Karbonat
(CALPOROSIS D) Kap kaplet - - - - -
156 500mg
Ketoconazole 200 mg tablet - - - - - 1,2,3

157
Ketoprofen supo supositoria - - - - - 2.3
158
Kloramfenikol 250 mg tablet - - - - - 1,2,3
159
Klorpromazin 100 mg tablet - - - - - 1,2,3
160
Kuinin sulfat 222 mg tablet 1,200 - 1,200 600 600 1,2,3
161
162 Lanzoprasol 30 mg tablet - - - - - 2.3
165 Loperamide 2 mg tablet 1,000 - 1,000 - 1,000 2.3
166 Loratadine 10 mg tablet - - - - - 1,2,3
Meloxicam tab 7,5 mg tablet 1,000 - 1,000 - 1,000

167
168 Metformin 500 mg tablet 1,000 - 1,000 - 1,000 1,2,3
Methisoprinol 500 mg tablet - - - -

169
170 Methyldopa 250 mg tablet - - - - - 2.3
Metilergometrin maleat tablet 1,000 - 1,000 - 1,000 1,2,3
171 tab
Metilprednisolon tab tablet 1,000 - 1,000 100 900 1,2,3
172
Metoclopramide 10 mg tablet 1,000 - 1,000 - 1,000 1,2,3
173
Metoclopramide 5 mg tablet - - - - - 1,2,3
174
Metronidazol 500 mg tablet - 100 100 100 - 2000 1,2,3
175
176
Natriuum Diklofenak 50 Tablet 1,000 - 1,000 - 1,000
178 Mg
179 Nifedipine 10 mg tablet 200 - 200 - 200 1,2,3
180 Norit botol - - - - - 1,2,3
181 Nystatin 500.000 IU tablet - - - - - 1,2,3
OAT kategori Sisipan -
kotak - - - - - 1,2,3
182 KDT
Omegavit multivitamin tablet - - - - -

183
184 Omeprazole 20 mg tablet - - - - - 1,2,3
185 Omesivaks tablet 600 - 600 - 600

188
Panviton multivitamin tablet - - - - -
189
191 Paracetamol 500 mg tablet 500 18,500 19,000 2,400 16,600 1,2,3
195 Prednison 5 mg tablet 1,500 - 1,500 100 1,400 1,2,3
Prenase multivitamin tablet - - - - -

196

200
201 Pyrantel tab 125 mg tablet 2,000 - 2,000 - 2,000 1,2,3
202 Ranitidine 150 mg tablet 1,700 1,000 2,700 1,800 - 900 1500 1,2,3
203 Salbutamol 2 mg tablet 700 - 700 100 - 600 1,2,3
204 Salbutamol 4 mg tablet 600 - 600 - 600 1,2,3
Salbutamol nebules 2,5 tablet - - - - -
205 mg
206 Simvastatin 10 mg tablet 930 - 930 - 930 1,2,3
Spironolactone 100 mg tablet - - - 1,2,3

207
208 Sucralfate 500 mg tablet 540 - 540 180 360 2.3
Tablet tambah darah tablet 2,500 11,200 13,700 1,000 12,700 1,2,3
209
Thiamphenicol 500 mg tablet - - - - -

212
215 Ulsidex 500 Mg tablet 500 - 500 - 500
216 Valsartan tab 80 mg tablet - - - - - - 2.3

217
Vitamin A 100.000 IU tablet 500 200 700 - 700 1,2,3
218
Vitamin A 200.000 IU tablet 150 4,000 4,150 2,450 1,700 1,2,3
219
220 Vitamin B complex tablet 1,000 3,000 4,000 2,400 1,600 2000 1,2,3
221 Vitamin B1 50 mg tablet 1,000 - 1,000 - 1,000 1,2,3
222 Vitamin B6 10 mg tablet 1,300 - 1,300 - 1,300 1,2,3
223 Vitamin C 50 mg tablet 600 8,000 8,600 1,300 7,300 1,2,3
224 Vitamin K 10 mg tablet - - - - - 1,2,3
225 Zinc 20 mg tablet 300 1,500 1,800 1,400 400 2000 1,2,3
-
226 Kalitakee
Komposit a A2, A3, A 3,5 botol - - - - -
228 solareX
Oxymetazoline Nasal botol - - - - -

Spray Iliadin 0,05%
230
231 -
232 OBAT SALEP/SERBUK - - - - -

Kombinasi: Asam pot - - - - -
Bensoat 6% Asam
Salisilat 3%
233
AntiBakteri Salep:
Basitrasin 500 IU/g + tube - - - - -
Polimiksin 10.000 Iu/g
234
sabun anti bakteri 500 tube - - - - -
236 ml
Garam Oralit Serbuk sachet 400 - 400 200 200
237 Kombinasi
Aseptic alkohol gel
antiseptic pembersih botol - - - - -
239 tangan
240 Betametason cream tube - - - - - 1,2,3

Bricasma terbutaline can - - - - -

242
Burnazin silver tube - - - - - 20 1,2,3
243 sulphadiazine
245 kulit
246 mata
Desoximetasone cream tube - - - - - 2.3

248
Diclofenac sodium gel tube - - - - -
249
Gentamicin salep mata tube - - - - - 20 2.3
250
Hydrocortisone cream tube - - - - - 20 1,2,3
251
252 Ichtyol salep pot - - - - - 50
253 Ketoconazole cream tube - - - - - 1,2,3
254 Lidocain jelly dispo - - - - - 1,2,3
255 Miconazole cream tube - 1 1 - 1 1,2,3
257 Salep 2-4 pot - - - - - 1,2,3
258 Salisil bedak kotak - - - - - 1,2,3
Sodium fusidat Fucilex tube - - - - - 2.3

259
260 Thrombophob gel tube - - - - - 20
261 Ultrasound gel USG botol - - - - -
Oxitetrasiklin 1% salep tube - 25 25 5 20
262 mata
- - -
OBAT LAINNYA -
Apron One Plastik lembar 40 - 40 - 40 1,2,3
263 Onemed
BeneCheck Plus Glucose strip - 50 50 - - 50 1,2,3

Test Strip 50's
264
BeneCheck Plus Total
Cholesterol Test Strip strip - 50 50 - - 50 1,2,3
265 10`s
BeneCheck Plus Uric strip - 50 50 - - 50 1,2,3
266 Test Strip 25`s
Absorbent paper points kotak - - - - - 1,2,3
267 15-40
268 45-80
269 Alkohol swab pcs 100 - 100 - 100
270 Bisturi no. 11 pcs 100 - 100 - 100
271 Bisturi no. 18 pcs 100 - 100 - 100
272 Bisturi no. 20 pcs 100 - 100 - 100
273 Bisturi no. 22 pcs 200 - 200 - 200
Catgut Chrom 3/0 Rol roll - - - - -
274 100 meter
Catgut Chromic 2/0 + pcs 48 - 48 - 48
275 jarum
276 jarum

277
278
Cutimed siltec 10x10cm pcs 10 - 10 - 10

280
Cutimed sorbact 7x9cm pcs - - - - -
281
Duk steril disposible pcs - - - - -
282
Foley catheter 2 way no. pcs 20 - 20 - 20
283 16
Foley catheter 2 way no. pcs - - - - -
284 18
Foley catheter 2 way no.
pcs 20 - 20 - 20
285 20
286 6
287 8
Gutta percha points 15- pcs - - - - - 1,2,3
288 40
289 80
Handscoen ginekologi psg - - - - -

290
Handscoen non steril psg - - - - -
291 Large
Handscoen non steril psg 150 - 150 - 150
292 Medium
Handscoen steril obsgyn psg 150 - 150 - 150

293

295
Handscoen steril no. 7 psg - 150 150 10 140
296
Handscoen steril no. 7,5 psg - 50 50 - 50
297
Handscoen steril no. 8 psg - - - - -
298
Handscoen Examination psg

299 500 - 500 100 400
Glovers L
Handscoen Examination psg

300 - 500 500 - 500
Glovers M
301 HCG test pcs 120 - 120 20 100

Infusion set Dewasa pcs 77 400 477 17 460

303
304 IV cannula no. 18 pcs 65 - 65 - 65
305 IV cannula no. 20 pcs - - - - -
306 IV cannula no. 22 pcs 75 - 75 26 49
307 IV cannula no. 24 pcs 50 - 50 - 50
308 IV cannula no. 26 pcs 10 - 10 - 10
314 Jarum jahit No. 15 pcs - - - -

318
Kacamata Anti infeksi pcs - - - - -
319
Kapas Berlemak 500 g bungkus - - - - -
320
321 Kapas putih 250 g bungkus - - - - -
Kasa hidrofil 40yard x roll - - - - -
322 80cm

323
324
Kasa sterile 16x16cm pcs 1,600 3,200 4,800 100 4,700
325
327 Masker pcs 450 - 450 50 400
328 Anak Besmed

Dewasa Basmed
329
Micro brush doche
Disposable micro
applicators 1A6542 Fine buckets - - - - -
(1,5mm) warna kuning,
biru
330
Mucous extractor FR 10 pcs - - - - -
331
332 NGT no.16 pcs 9 - 9 - 9
333 NGT no.18 pcs 9 - 9 - 9
334 NGT no.3,5 pcs - - - - -
335 NGT no.5 pcs - - - - -
336 NGT no.8 pcs - - - - -
337 Oxygen nasal cannula An pcs - - - - -
338 Oxygen nasal cannula De pcs - - - - -
Plester coklat yard rol - - - - -
342 Leukoplast
Plester Infus dermafix pcs 50 - 50 2 48

343
344 Pen needle pcs - 5 5 - 5
Policrepe pembalut rol - - - - -
346 Elastis 10cm x 4,55m
347 Plester putih Polifix rol 9 - 9 1 8
Plester rawat luka anti
air dermafix t 10x25cm pcs - - - - -
348
349 Safety box pcs 12 - 12 - 12
350 Silk 2/0 pcs 40 - 40 - 40
351 Silk 3/0 pcs 30 - 30 6 24
Suction catheter FR 10 pcs - - - - -

352
353
354
355
356
357
358
Surgical gown baju
pcs 10 - 10 - 10
360 operasi L
Surgical gown baju pcs - - - - -
361 operasi M
362 operasi XL
363 Syringe 1 cc pcs 185 - 185 85 100
364 Syringe 10 cc pcs 100 - 100 - 100
365 Syringe 20 cc pcs 50 - 50 - 50
366 Syringe 3 cc pcs 400 - 400 100 300
367 Syringe 5 cc pcs 100 - 100 - 100
369 Syringe 50 cc pcs - - - - -
Test Anti HIV 1/2 test - - - - -
370 Cassette
Test Malaria HRP2/pLDH test - - - - -

(Pf/PAN) combo
372
373 Topi Operasi pcs 100 - 100 - 100
374 Urine Bag pcs 48 - 48 - 48
softpad (underpad) pcs 90 - 90 90
375 60x90 cm
376 Venflon no. 20 pcs 50 - 50 - 50
52,863 90,630 143,253 16 114,610 14,530 -

BAYAR
RESEP BAYAR
s Mokoditek, Januari 2019

MENGETAHUI
KEPALA DINAS KESEHATAN YANG MENERIMA
KAB. BOLAANG YANG MENYERAHKAN YANG MELAPORKAN
KEPALA INSTALASI FARMASI & KEPALA PUSKESMAS MOKODITEK PETUGAS GUDANG OBAT
MONGONDOW UTARA
PERBEKALAN KESEHATAN
JUSNAN C. MOKOGINTA, DESI IRAWATI GONIBALA, S. Kep

ASIA, S.Si, Apt LINDA R E TIMBAN, S.Man.Kes
MARS NIP. 19880124 201102 2 004
NIP. 19840909 201102 2 001 NIP. 19681231 198910 2 010
NIP. 19671105 200012 1
003
(LPLPO)
INSTANSI : PUSKESMAS MOKODITEK

KECAMATAN : BOLANG ITANG TIMUR
KABUPATEN : BOLAANG MONGONDOW UTARA
PROPINSI : SULAWESI UTARA
SATUAN STOK PENERI PERSE PEMA RUSAK/ SISA

KODE NAMA OBAT TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK
1 2 3 4 5 6=4+5 7 8 9=6-7-8
OBAT CAIR
1 Alkohol 70% 100 ml botol - - - - - -
Alkohol 70% 1000 ml botol 37 - 37 - - 37

2
3 Ambroxol sirup botol - - -
4 Aminophylline inj ampul - - - -
5 Amoxicillin drops botol - - - - -
6 Amoxicillin sirup botol - - - - -
Analog insulin Apidra inj pen - - - -

7
Analog insulin Lantus inj pen - - - - -
8
10 Gastrucid botol - - - - -
11 Antasida sirup botol 60 100 160 60 100
12 Aqua pro inj flacon 18 18 - 18
13 Asering infus botol - - - - -
14 Atropin sulfate inj ampul 100 - 100 - 100
Cefadroxil syr 125 mg/5 botol 5 - 5 - 5
15 ml
16 Cefixime sirup botol 6 - 6 - 6 -
17 Cefotaxime inj vial - - - - - -
18 Ceftriaxone inj vial - - - - - -
19 Cetirizine sirup botol 90 - 90 20 - 70
Chotrimoksazole syr botol 10 50 60 6 54

20
Chloramphenicol sirup botol 9 - 9 3 6
21
Chloramphenicol tetes botol - - - - -
22 telinga
Curbion sirup botol - - - - -
24 multivitamin
25 Dexamethasone inj ampul 128 - 128 20 108
26 Diazepam Inj ampul 10 - 10 - 10
Diphenhydramine inj ampul 120 - 120 - 120
27
28 Domperidone sirup botol - - - - - -
29 Epinephrine inj ampul 187 - 187 - 187
30 Erythromycin sirup botol - - - - -
32 Furosemide inj ampul - - - - -
33 Gentamicin inj ampul - - - - -
Gentamisin Tetes mata botol 4 - 4 2 2

34
36 Glukosa 10% infus botol - - -
37 Glukosa 40% inj flacon - -
38 Glukosa 5% infus botol 40 - 40 - - 40
39 H2O2 3% botol - - - - -
Hyoscine butylbromide ampul - - - - -
40 inj
41 Ibuprofen sirup botol 43 43 15 28
42 Telinga 10%
43 KAEN 3A infus botol - - - - -
44 KAEN 3B infus botol 10 - 10 - 10
KCL 7.46% Kalium flacon - - - - - -
46 Ketamine inj vial - - - - -
47 Ketorolac inj ampul 164 164 - 164
Kloramfenikol tetes botol - - - - -
48 mata
49 Lidocaine inj ampul 900 - 900 30 870
50 Lysol cairan botol 18 18 1 17
Magnesium Sulfat 20% flacon - - - - -
51 inj
Magnesium Sulfat 40% flacon - - - - - -
52 inj
Methylergometrin
ampul - 100 100 - - 100
53 maleate inj
Metoklopramide sirup botol 78 - 78 10 68

54
Metronidazole infus botol 62 62 - 62
55
Natrium klorida 0,9% botol 68 - 68 18 50
56 infus
58 Omegdiar sirup botol 28 - 28 10 18
59 Omeprazole inj vial - -
60 Ondansetron inj ampul 45 - 45 - 45
Otopain tetes telinga botol - - - -

61
62 Oxytocin inj ampul 700 700 - 700 -
63 Pacdin cough sirup botol 129 - 129 45 84
64 Paracetamol drops botol - - - - -
65 Paracetamol infus botol - - - - -
66 Paracetamol sirup botol - - - -
67 Phenobarbital inj ampul - - - - -
69 Pirantel Sirup botol 100 - 100 100 -
70 Povidone 300 ml botol 25 25 1 24
71 Povidone 60 ml botol - - - - -
72 Ranitidine inj ampul 23 - 23 23 -
Renalyte electrolytes botol - - - - -

73
74 Ringer Laktat infus botol - 40 40 20 - 20
75 Rivanol 300 ml botol 25 25 1 24
76 Salbutamol sirup botol - - - - -
Sodium Bicarbonate inj flacon - - - - -

77
78 Sucralfate sirup botol - - - - -
Tetagam inj human vial - - - - -
79 tetanus
80 Tramadol inj ampul 50 - 50 - 50
81 Tranexamic Acid inj ampul - - - - -
82 Vit amin B12 inj ampul 99 - 99 - 99
84 Vitamin K inj 2 mg ampul - 30 30 - 30
85 Voluven HES 6% botol - - - - -
86 Zinc pro drops botol - 50 50 22 28
87 Water One 1 L Botol - 20 20 - 20
88
-
OBAT PADAT -
89 Acetosal 100 mg tablet - - - - -
Acetylcysteine 200 mg tablet - - -

90
Acetysalicylic acid 80 tablet 100 - 100 100 -
91 mg
92 amodiaquin)
93 Acyclovir 400 mg tablet 850 - 850 250 600
Albendazole 400 mg tablet 900 900 - 900

94
95 Allopurinol 100 mg tablet 400 2,000 2,400 800 1,600
96 Ambroksol 30 mg tablet - - - - -
Aminophillin 150 mg tablet - - - - -

97
98 Amlodipine 10 mg tablet - -
99 Amlodipine 5 mg tablet 1,200 1,200 1,200
100 Amoxicillin 500 mg tablet 1,300 2,000 3,300 1,600 1,700
102 Antasida doen tablet 13,900 - 13,900 3,100 10,800
103 Asam Folat 1 mg tablet 900 900 300 600
Asam mefenamat 500 tablet 9,700 9,700 1,600 - 8,100
104 mg
Asam traneksamat 500 tablet - - - - -
105 mg
106 Asiklovir 200 mg tablet - - - - -
107 Asiklovir 400 mg tablet - -
Azitromisin Kap 500 mg kaplet -

108
109 Attapulgite tablet 900 900 900
110 Betahistin tab tablet 600 - 600 400 200
Bisakodil (Dulcolax) supositoria - -

Supp 5 mg
111
Bisakodil (Dulcolax) supositoria - -

Supp 10 mg
112
113 Bisacodyl Tab 5 mg tablet -
114 Bisoprolol 5 mg tablet - - -
115 Bromhexine 8 mg tablet - - - - -
Calsium lactate 500 mg tablet 2,000 2,000 900 1,100

116
117 Captopril 12,5 mg tablet 3,100 3,100 1,100 2,000
118 Captopril 25 mg tablet - - - - -
119 Captopril 50 mg tablet - -
120 Cefadroxil 500 mg tablet
121 Cefixime 100 mg tablet - - - - -
122 Cetirizine 10 mg tablet 600 600 100 500
Chloramphenicol 500 tablet 300 300 200 100
123 mg
Chlorpheniramine 4 mg tablet 3,800 - 3,800 2,400 1,400

124
Ciprofloxacin 500 mg tablet 200 - 200 100 100
125
127 Clindamycin 150 mg tablet 2,300 2,300 550 1,750
Clobazam tab 10 mg tablet - - - - -

128
129 Colchicine 0,5 mg tablet - - - - -
Cotrimoxazole 480 mg tablet 1,100 - 1,100 100 1,000

130
Dexamethasone 0,5 mg tablet 5,800 - 5,800 2,100 3,700

132
133 Diazepam 2 mg tablet - - - - -
134 Diazepam 5 mg tablet 5 - 5 - 5
Diazepam stesolid supositoria - - - - -
135 10mg
Diazepam stesolid 5mg supositoria - - - - - -

136
Diklofenac sodium 50 tablet 900 - 900 - 900
137 mg
Diltiazem tab 30 mg tablet - - - -

138
Domperidone 10 mg tablet 1,200 - 1,200 200 1,000
139
140 Doxycycline 100 mg tablet 400 - 400 - 400
Dumin rectal 125 mg supositoria - - - - - -

141
142
Ergotamine caffeine tablet - - - - -
143
Erythromycin 500 mg tablet 600 - 600 - 600
144
145 Fenitoin tablet - - - - -
146 Fenobarbital 30 mg tablet - - - - -
147 Furosemide 40 mg tablet 200 - 200 - 200
Glibenclamide 5 mg tablet 300 - 300 - 300

148
149 Glimepiride 2 mg tablet - - - - -
Glyceryl guaiacolate tablet - - - - -
150 100 mg
Glyceryl trinitrate 500 tablet - - - - - -
151 mcg
152 Griseofulvin 125 mg tablet 2,200 - 2,200 2,200
153 Haloperidol 0,5 mg tablet - - -
Hydrochlorothiazide 25 tablet 200 - 200 - 200
154 mg
Hyoscine butylbromide tablet - - - - -
155 10 mg
156 Ibuprofen 400 mg tablet 900 2,000 2,900 1,500 1,400
Isosorbid Dinitrat 5 mg tablet 400 - 400 - 400

157
158 Kalium aspartate tablet - - - - -
Kalsium Karbonat
159 500mg
Ketoconazole 200 mg tablet - - - - -

160
161 Ketoprofen supo supositoria - - - - -
Kloramfenikol 250 mg tablet - - - - -

162
Klorpromazin 100 mg tablet - - - - -
163
Kuinin sulfat 222 mg tablet 1,200 - 1,200 - 1,200
164
165 Lanzoprasol 30 mg tablet 920 - 920 200 720
166 Levofloxacin 500 mg tablet - - - - -
168 Loperamide 2 mg tablet 1,400 - 1,400 300 1,100
169 Loratadine 10 mg tablet - - - - -
Meloxicam tab 7,5 mg tablet 1,650 - 1,650 250 1,400
170
171 Metformin 500 mg tablet 600 - 600 - 600 -

172
173 Methyldopa 250 mg tablet - - - - -
Metilergometrin maleat tablet 1,000 - 1,000 - 1,000
174 tab
Metilprednisolon tab tablet 500 - 500 - 500

175
Metoclopramide 10 mg tablet 800 - 800 - 800
176
Metoclopramide 5 mg tablet - - - - -
177
Metronidazol 500 mg tablet - - - - -
178
Metronidazole supo supositoria - - - - -
179
Natriuum Diklofenak 50 Tablet - - - - -
181 Mg
182 Nifedipine 10 mg tablet 1,000 - 1,000 - 1,000
183 Norit botol - - - - -
184 Nystatin 500.000 IU tablet - - - - -
OAT kategori Sisipan - kotak - - - - -
185 KDT
Omegavit multivitamin tablet - - - - -

186
187 Omeprazole 20 mg tablet - - - - -
188 Omesivaks tablet - - - - -
189 Ondansetron 4 mg tablet 180 - 180 24 156
190 Ondansetron 8 mg tablet - - - - - -
Paket stop TB kategori I kotak - - - - -

191
Panviton multivitamin tablet - - - - -
192
Paracetamol 500 mg tablet 11,800 - 11,800 3,200 8,600

194
198 Prednison 5 mg tablet 11,400 - 11,400 - 11,400
Prenase multivitamin tablet - - - - -

199
200 Primaquine 15 mg tablet - - - - -
201 Probenecid 500 mg tablet - - - - -
202 Propanolol 10 mg tablet - - - - -
Propylthiouracil 100 mg tablet - - - - -

203
204 Pyrantel tab 125 mg tablet 2,000 - 2,000 - 2,000
205 Ranitidine 150 mg tablet 1,000 - 1,000 1,000 - -
206 Salbutamol 2 mg tablet 1,500 - 1,500 - - 1,500
207 Salbutamol 4 mg tablet 1,400 - 1,400 - 1,400
208 mg
209 Simvastatin 10 mg tablet 420 - 420 270 150 -
Spironolactone 100 mg tablet 500 500 - 500

210
211 Sucralfate 500 mg tablet 300 - 300 60 240
Tablet tambah darah tablet 11,270 - 11,270 8,050 8,620 1,800

212
213 Tetrasiklin 250 mg tablet - - - -
214 Tetrasiklin 500 mg tablet 500 - 500 - 500

215
217 Triheksifenidil 2mg tablet - - - - -
218 Ulsidex 500 Mg tablet - - - - -
Valsartan tab 80 mg tablet - - - - - -

219
220
Vitamin A 100.000 IU tablet 600 300 900 50 850
221
Vitamin A 200.000 IU tablet - - - - - -
222
223 Vitamin B complex tablet 7,800 - 7,800 2,700 5,100
224 Vitamin B1 50 mg tablet 900 - 900 500 400
225 Vitamin B6 10 mg tablet 2,000 - 2,000 800 1,200
226 Vitamin C 50 mg tablet 4,800 - 4,800 1,500 3,300
227 Vitamin K 10 mg tablet 200 - 200 - 200
228 Zinc 20 mg tablet 4,100 - 4,100 1,300 2,800
-
229 OBAT GIGI - GAS - - - - -
Calciumpolystyrene
sachet - - - - -
230 Kalitakee
Komposit a A2, A3, A botol - - - - -
232 3,5 solareX

Spray Iliadin 0,05%
234
-
OBAT SALEP/SERBUK - - - - -

Kombinasi: Asam pot 42 - 42 - 42
Bensoat 6% Asam
Salisilat 3%
229
AntiBakteri Salep:
Basitrasin 500 IU/g + tube 20 - 20 13 7
230
sabun anti bakteri 500 tube - - - - -
232 ml
Garam Oralit Serbuk
sachet 300 - 300 - 300
233 Kombinasi
Aseptic alkohol gel
antiseptic pembersih botol 54 - 54 2 52
235 tangan
Betametason cream tube 75 - 75 5 70

236

238
Burnazin silver tube 20 - 20 5 15
239 sulphadiazine
Chloramphenicol salep tube - - - - -
241 kulit
Chloramphenicol salep tube - 48 48 24 24
242 mata
Desoximetasone cream tube 20 20 8 12

244
245
Gentamicin salep mata tube - - - - -
246
Hydrocortisone cream tube 206 - 206 5 201
247
248 Ichtyol salep pot - - - - -
Ketoconazole cream tube 75 - 75 5 70

249
250 Lidocain jelly dispo - - - - -
251 Miconazole cream tube 48 - 48 5 43
253 Salep 2-4 pot 43 - 43 17 26
254 Salisil bedak kotak 135 - 135 - 135
Sodium fusidat Fucilex tube 15 - 15 5 10

255
256 Thrombophob gel tube - - - - -
257 Ultrasound gel USG botol 4 - 4 - 4
Oxitetrasiklin 1% salep tube 6 - 6 - 6
258 mata
- - -
OBAT LAINNYA -
Apron One Plastik lembar 40 - 40 - 40
259 Onemed
BeneCheck Plus
Glucose Test Strip 50's strip 50 50 100 - - 100
260
Cholesterol Test Strip strip 50 - 50 - - 50
261 10`s
BeneCheck Plus Uric strip 50 - 50 - - 50
262 Test Strip 25`s
Absorbent paper points kotak - - - - -
263 15-40
Absorbent paper points kotak - - - - -
264 45-80
265 Alkohol swab pcs 100 - 100 - 100
266 Bisturi no. 11 pcs 100 - 100 - 100
267 Bisturi no. 18 pcs 100 - 100 - 100
268 Bisturi no. 20 pcs 100 - 100 - 100
269 Bisturi no. 22 pcs 200 - 200 - 200
270 100 meter
271 jarum
272 jarum
Catgut plain 2/0 + pcs 48 - 48 - 48
273 jarum
274 jarum
Cutimed siltec 10x10cm pcs 10 - 10 - 10

276
277
278
Foley catheter 2 way
pcs 20 - 20 - 20
279 no. 16
Foley catheter 2 way pcs - - - - -
280 no. 18
Foley catheter 2 way pcs 20 - 20 - 20
281 no. 20
282 no. 6
283 no. 8
Gutta percha points 15-
pcs - - - - -
284 40
Gutta percha points 45- pcs - - - - -
285 80

286
287 Large
Handscoen non steril psg 150 - 150 - 150
288 Medium
Handscoen steril psg 150 - 150 - 150
289 obsgyn
Handscoen steril no. 6,5 psg - 400 400 - 400

291
Handscoen steril no. 7 psg 140 - 140 40 100
292
Handscoen steril no. 7,5 psg 50 - 50 - 50
293
Handscoen steril no. 8 psg - 400 400 - 400
294
Handscoen Examination psg 400 - 400 - 400

Glovers L
295
Handscoen Examination psg 500 - 500 50 450

Glovers M
296
297 HCG test pcs 100 - 100 - 100
Infusion set Dewasa pcs 460 - 460 10 450

299
300 IV cannula no. 18 pcs 65 - - - -
301 IV cannula no. 20 pcs - 100 100 - 100
302 IV cannula no. 22 pcs 49 - 49 - 49
303 IV cannula no. 24 pcs 50 - 50 - 50
304 IV cannula no. 26 pcs 10 - 10 - 10

314
315
316
317 Kapas putih 250 g bungkus - 1 1 - 1
Kasa hidrofil 40yard x roll - - - - -
318 80cm

319
320
Kasa sterile 16x16cm pcs 4,700 - 4,700 500 4,200
321
323 Masker pcs 400 - 400 100 300
324 Anak Besmed

Dewasa Basmed
325
Micro brush doche
Disposable micro
biru
326
327
328 NGT no.16 pcs 9 - 9 - 9
329 NGT no.18 pcs 9 - 9 - 9
330 NGT no.3,5 pcs - - - - -
331 NGT no.5 pcs - - - - -
332 NGT no.8 pcs - - - - -
333 Oxygen nasal cannula Anpcs - - - - -
334 Oxygen nasal cannula D pcs - - - - -
Plester coklat yard rol - - - - -
338 Leukoplast
Plester Infus dermafix pcs 48 - 48 - 48

339
340 Pen needle pcs 5 - 5 - 5

Elastis 10cm x 4,55m
342
344
345 Safety box pcs 12 - 12 - 2
346 Silk 2/0 pcs 40 - 40 - 40
347 Silk 3/0 pcs 24 - 24 - 24

348
349
350
351
352
353
354
355 Sputum Pot Pieces 100 - 100 20 80
Surgical gown baju pcs 10 - 10 - 10
356 operasi L
357 operasi M
358 operasi XL
359 Syringe 1 cc pcs 100 - 100 - 100
360 Syringe 10 cc pcs 100 - 100 - 100
361 Syringe 20 cc pcs 50 - 50 - 50
362 Syringe 3 cc pcs 300 - 300 100 200
363 Syringe 5 cc pcs 100 - 100 - 100
364 Syringe 50 cc pcs - - - - -
365 Cassette
Test Malaria
HRP2/pLDH (Pf/PAN) test - - - - -
367 combo
368 Topi Operasi pcs 100 - 100 - 100

369 Urine Bag pcs 48 - 48 - 48
softpad (underpad) pcs 90 - 90 90
370 60x90 cm
371 Venflon no. 20 pcs 50 - 50 - 50
143,752 7,689 151,376 10,076 108,364

BAYAR
RESEP BAYAR
s
MENGETAHUI
KEPALA DINAS KESEHATAN
YANG MENYERAHKAN YANG MELAPORKAN
KAB. BOLAANG
KEPALA INSTALASI FARMASI & KEPALA PUSKESMAS MOKODITEK
MONGONDOW UTARA
PERBEKALAN KESEHATAN
JUSNAN C. MOKOGINTA,
ASIA, S.Si, Apt LINDA R E TIMBAN, S.Man.Kes
MARS
NIP. 19840909 201102 2 001 NIP. 19681231 198910 2 010
NIP. 19671105 200012 1
003
MBAR PERMINTAAN OBAT
O)
NOMOR DOKUMEN :
BULAN PEMAKAIAN Mei 2019
BULAN PERMINTAAN Juni 2019
TAHUN : 2019
PEMBERIAAN
STOK PERMIN
OPTIMUM TAAN FORNAS
DAK APBD I DAU LAIN (TK)
10 11 12 13 14 15 16
1,2,3
1,2,3
200
1,2,3
100 1,2,3
200 1,2,3
1,2,3
1,2,3
200
100 1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
25 2.3
2.3
2.3
1,2,3
1,2,3
20 1,2,3
200
1,2,3
1,2,3
1,2,3
50 1,2,3
1,2,3
1,2,3
1,2,3
2.3
20 2.3
50
1,2,3
1,2,3
1,2,3
5 1,2,3
2.3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
2.3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
50
1,2,3
2.3
100 1,2,3
100 1,2,3
3
200 1,2,3
2.3
1,2,3
1,2,3
1,2,3
100 2.3
50 1,2,3
1,2,3
1,2,3
2.3
2.3
100 2.3
20 1,2,3
2.3
2.3
1,2,3
100
1,2,3
1,2,3
1,2,3
500 2.3
1,2,3
500 1,2,3
1,2,3
1,2,3
1,2,3
3000
1,2,3
2000 1,2,3
2000 1,2,3
2000 1,2,3
1,2,3
500 1,2,3
1,2,3
500 2.3
1,2,3
1,2,3
2.3
10 1,2,3
10 1,2,3
100 1,2,3
2.3
3000
1,2,3
1,2,3
2000 1,2,3
2000 1,2,3
2000 2.3
1000 2.3
2.3
500 2.3
2000 1,2,3
500 1,2,3
1,2,3
2.3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
10 1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
10
10
1,2,3
1,2,3
100 1,2,3
500 1,2,3
1,2,3
1,2,3
1,2,3
5000
1,2,3
1,2,3
500 2.3
1,2,3
1,2,3
1,2,3
1,2,3
2.3
1,2,3
2.3
1,2,3
1,2,3
1,2,3
2.3
2.3
2.3
500 1,2,3
1000 1,2,3
2.3
1,2,3
1,2,3
1,2,3
1,2,3
1000 1,2,3
2.3
1,2,3
1,2,3
1,2,3
1,2,3
2000
1,2,3
2.3
2.3
1,2,3
3000
1,2,3
1000
1000
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
2000 1,2,3
1,2,3
1,2,3
1000 1,2,3
1,2,3
2.3
2000 1,2,3
1,2,3
1,2,3
1000
1,2,3
500 2.3
1000
1,2,3
600 1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
50
1,2,3
24
1,2,3
1,2,3
1,2,3
2.3
2.3
1,2,3
20
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
2.3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
-
Mokoditek, Februari 2019
MELAPORKAN YANG MENERIMA

KESMAS MOKODITEK PETUGAS GUDANG OBAT
TIMBAN, S.Man.Kes DESI IRAWATI GONIBALA, S. Kep

1231 198910 2 010 NIP. 19880124 201102 2 004
H
(LPLPO)

KECAMATAN : BOLANG ITANG TIMUR BULAN PEMAKAIAN : Juni
KABUPATEN : BOLAANG MONGONDOW UTARA BULAN PERMINTAAN : Juli
PEMBERIAAN
KODE NAMA OBAT TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK OPTIMUM TAAN DAK APBD I DAU LAIN FORNAS (TK)
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11 12 13 14 15 16
OBAT CAIR
1 Alkohol 70% 100 ml botol - - - - - - 1,2,3
2 Alkohol 70% 1000 ml botol 37 - 37 - - 36 1,2,3

3 Ambroxol sirup botol 50 50 25 - 25 100
4 Aminophylline inj ampul - - - - 1,2,3
5 Amoxicillin drops botol - - - - - 100 1,2,3
6 Amoxicillin sirup botol - - - - - 200 1,2,3

7
8
10 Gastrucid botol - - - - - 200
11 Antasida sirup botol 100 200 300 85 215 1,2,3
12 Aqua pro inj flacon 18 - 18 2 16 1,2,3
Cefadroxil syr 125 mg/5 botol 5 - 5 2 3 - 10 1,2,3
15 ml
16 Cefixime sirup botol - - - - - - 25 2.3
19 Cetirizine sirup botol 50 - 50 25 - 25 50 1,2,3
Chotrimoksazole syr botol 94 94 25 69

20
Chloramphenicol sirup botol 6 - 6 - 6 1,2,3
21
Chloramphenicol tetes botol - - - - - 20 1,2,3
22 telinga
Curbion sirup botol - - - - - 100
24 multivitamin
25 Dexamethasone inj ampul 108 - 108 - 108 1,2,3
26 Diazepam Inj ampul 10 - 10 - 10 1,2,3
Diphenhydramine inj ampul 120 - 120 30 90 1,2,3

27
28 Domperidone sirup botol - - - - - - 50 1,2,3
29 Epinephrine inj ampul 100 100 - - 100 1,2,3
Gentamisin Tetes mata botol 2 - 2 2 - - 20 2.3

34
35 Gentian violet botol - - - - - 20
36 Glukosa 10% infus botol - - - 1,2,3
37 Glukosa 40% inj flacon - - 1,2,3
38 Glukosa 5% infus botol 35 - 35 - - 35 1,2,3
39 H2O2 3% botol - - - - - 3 1,2,3
40 inj
41 Ibuprofen sirup botol 68 - 68 7 61 - 1,2,3
42 Telinga 10%
44 KAEN 3B infus botol 10 - 10 - 10 - 1,2,3
KCL 7.46% Kalium
flacon - - - - - - 1,2,3
47 Ketorolac inj ampul - - - - - 2.3
Kloramfenikol tetes
botol - - - - - 1,2,3
48 mata
49 Lidocaine inj ampul 870 - 870 - 870 1,2,3
50 Lysol cairan botol 16 16 2 - 14
Magnesium Sulfat 20% flacon - - - - - 1,2,3
51 inj
Magnesium Sulfat 40% flacon - - - - - - 1,2,3
52 inj
Methylergometrin ampul 100 - 100 - - 100 1,2,3
53 maleate inj
Metoklopramide sirup botol 58 - 58 4 54 1,2,3

54
Metronidazole infus botol 62 - 62 - 62 1,2,3
55
Natrium klorida 0,9% botol 30 60 90 15 75 1,2,3
56 infus
Otopain tetes telinga botol - - - - 25

61
62 Oxytocin inj ampul 70 - 70 - - 70 1,2,3
63 Pacdin cough sirup botol 24 48 72 64 - 8 100
64 Paracetamol drops botol - - - - - 100 1,2,3
66 Paracetamol sirup botol - 50 50 25 - 25 100 1,2,3
67 Phenobarbital inj ampul - 30 30 - 30 2.3
69 Pirantel Sirup botol 50 - 50 - - 50 1,2,3
70 Povidone 300 ml botol 24 - 24 - - 24 1,2,3
72 Ranitidine inj ampul 100 100 200 20 180 2.3
Renalyte electrolytes botol - - - - - 50 1,2,3

73
74 Ringer Laktat infus botol 10 100 110 10 - 100 1,2,3
75 Rivanol 300 ml botol 24 - 24 - 24 1,2,3

77
Tetagam inj human vial - - - - - 20 1,2,3
79 tetanus
80 Tramadol inj ampul 50 - 50 - - 50 2.3
82 Vit amin B12 inj ampul 88 - 88 - 88 1,2,3
86 Zinc pro drops botol - 30 30 15 - 15 1,2,3
87 Water One 1 L Botol - 20 20 - 20
88
-
OBAT PADAT -
89 Acetosal 100 mg tablet - - - - - 500 2.3
Acetylcysteine 200 mg tablet - - - 1,2,3

90
Acetysalicylic acid 80 tablet - - - - - - 500 1,2,3
91 mg
92 amodiaquin)
93 Acyclovir 400 mg tablet 600 500 1,100 - - 1,100 1,2,3
Albendazole 400 mg tablet 900 900 - 900 1,2,3

94
95 Allopurinol 100 mg tablet 1,600 - 1,600 400 1,200 1,2,3
96 Ambroksol 30 mg tablet - 1,000 1,000 800 200 2000
97
98 Amlodipine 10 mg tablet - - - - - 1000 1,2,3
99 Amlodipine 5 mg tablet 1,200 900 2,100 300 - 1,800 1,2,3
100 Amoxicillin 500 mg tablet 3,300 3,300 800 - 2,500 1,2,3
102 Antasida doen tablet 9,200 - 9,200 1,700 - 7,500 1,2,3
103 Asam Folat 1 mg tablet 1,200 - 1,200 - - 1,200 1,2,3
Asam mefenamat 500 tablet 8,000 - 8,100 500 - 7,500 1,2,3
104 mg
Asam traneksamat 500 tablet - - - - - 500 2.3
105 mg
107 Asiklovir 400 mg tablet - - - - -
Azitromisin Kap 500 mg kaplet 20 - 20 - - 20

108
109 Attapulgite tablet 900 900 900 1,2,3
110 Betahistin tab tablet 200 - 200 - 200 2.3
Bisakodil (Dulcolax) supositoria - - 20 1,2,3

Supp 5 mg
111

Supp 10 mg
112
113 Bisacodyl Tab 5 mg tablet - 300 1,2,3
114 Bisoprolol 5 mg tablet 400 - 400 - 400 2.3
115 Bromhexine 8 mg tablet - - - - - 1000
Calsium lactate 500 mg tablet 1,100 - 1,100 - 1,100 1,2,3

116
117 Captopril 12,5 mg tablet 1,500 - 1,500 900 600 1,2,3
119 Captopril 50 mg tablet - - 2000 1,2,3
120 Cefadroxil 500 mg tablet 2000 2.3
121 Cefixime 100 mg tablet - - - - - 1000 2.3
122 Cetirizine 10 mg tablet 200 500 700 200 - 600 2.3
Chloramphenicol 500 tablet 100 - 100 - - 100 500 2.3
123 mg
Chlorpheniramine 4 mg tablet 800 1,000 1,800 1,500 - 300 2000 1,2,3

124
Ciprofloxacin 500 mg tablet - - - - - - 1,2,3
125
127 Clindamycin 150 mg tablet 1,500 - 1,500 250 1,250 1,2,3
Clobazam tab 10 mg tablet - - - - - 2.3

128
Cotrimoxazole 480 mg tablet 1,500 - 1,500 - - 1,500 1,2,3

130
Dexamethasone 0,5 mg tablet 3,400 - 3,400 1,700 - 1,700 1,2,3

132
Diazepam stesolid supositoria - - - - - 20 1,2,3
135 10mg
Diazepam stesolid 5mg supositoria - - - - - - 20 1,2,3

136
Diklofenac sodium 50 tablet 900 500 1,400 200 1,200 1,2,3
137 mg
Diltiazem tab 30 mg tablet - - - - 1,2,3

138
Domperidone 10 mg tablet 1,000 - 1,000 500 500 1,2,3
139
140 Doxycycline 100 mg tablet 400 - 400 - 400 1,2,3
Dumin rectal 125 mg supositoria - - - - - - 20

141
Dumin rectal 250 mg supositoria - - - - - 20
142
Ergotamine caffeine tablet - - - - - 300 1,2,3
143
Erythromycin 500 mg tablet 500 - 500 300 200 1,2,3
144
145 Fenitoin tablet - - - - - 100 1,2,3
146 Fenobarbital 30 mg tablet - - - - - 300 1,2,3
Glibenclamide 5 mg tablet 300 - 300 - 300 1,2,3

148
Glyceryl guaiacolate
tablet - 1,000 1,000 300 700 1000
150 100 mg
Glyceryl trinitrate 500 tablet - - - - - - 1,2,3
151 mcg
152 Griseofulvin 125 mg tablet 2,200 - 2,200 400 1,800 1,2,3
154 mg
Hyoscine butylbromide tablet - - - - - 100 1,2,3
155 10 mg
156 Ibuprofen 400 mg tablet 900 500 1,400 800 600 500 1,2,3

157
Kalsium Karbonat
159 500mg
Ketoconazole 200 mg tablet - - - - - 1,2,3

160
161 Ketoprofen supo supositoria - - - - - 10 2.3

162
163
Kuinin sulfat 222 mg tablet 1,200 - 1,200 - 1,200 1,2,3
164
165 Lanzoprasol 30 mg tablet 520 500 1,020 - - 1,020 2.3
169 Loratadine 10 mg tablet - - - - - 500 1,2,3
Meloxicam tab 7,5 mg tablet 1,400 - 1,400 - 1,400
170
171 Metformin 500 mg tablet 600 - 600 - 600 - 1000 1,2,3

172
173 Methyldopa 250 mg tablet - - - - - 1000 2.3
Metilergometrin maleat tablet 800 - 800 - - 800 1,2,3
174 tab
Metilprednisolon tab tablet 300 1,000 1,300 - - 1,300 1,2,3

175
Metoclopramide 10 mg tablet 800 1,000 1,800 - 1,800 1,2,3
176
Metoclopramide 5 mg tablet - - - - - 1000 1,2,3
177
Metronidazol 500 mg tablet - - - - - 1000 1,2,3
178
179
180 Microlax rectal tube - - - - - 15
Natriuum Diklofenak 50 Tablet - - - - - 1000
181 Mg
182 Nifedipine 10 mg tablet 1,000 - 1,000 - 1,000 1,2,3
183 Norit botol - - - - - 10 1,2,3
184 Nystatin 500.000 IU tablet - - - - - 100 1,2,3
OAT kategori Sisipan - kotak - - - - - 1,2,3
185 KDT
Omegavit multivitamin tablet - - - - - 2000

186
187 Omeprazole 20 mg tablet - - - - - 1000 1,2,3
188 Omesivaks tablet - - - - -
189 Ondansetron 4 mg tablet 144 - 144 24 120 2.3
190 Ondansetron 8 mg tablet - - - - - - 500 2.3

191
Panviton multivitamin tablet - - - - - 1000
192
Paracetamol 500 mg tablet 7,000 - 7,000 2,200 - 4,800 1,2,3
194
195 Piracetam 400 mg tablet - - - - - 1000
197 Piroxicam 20 mg tablet - - - - - 1000
198 Prednison 5 mg tablet 11,100 - 11,100 - 1,100 10,000 1,2,3
Prenase multivitamin tablet - - - - - 1000

199

203
204 Pyrantel tab 125 mg tablet 2,000 - 2,000 200 - 1,2,3
205 Ranitidine 150 mg tablet 500 500 1,000 500 - 500 1000 1,2,3
206 Salbutamol 2 mg tablet 1,300 - 1,300 - - 1,300 1,2,3
207 Salbutamol 4 mg tablet 1,200 - 1,200 - - 1,200 1,2,3
208 mg
209 Simvastatin 10 mg tablet 1,440 - 1,440 480 - 960 1,2,3
Spironolactone 100 mg tablet 200 200 - 200 500 1,2,3

210
211 Sucralfate 500 mg tablet 240 - 240 - 240 2.3
Tablet tambah darah tablet 2,580 1,800 4,380 780 - 3,600 1000 1,2,3
212
214 Tetrasiklin 500 mg tablet 400 1,000 1,400 - 1,400 1,2,3

215
216 Tilomix tablet - - - - - 1000
Valsartan tab 80 mg tablet - - - - - - 2.3

219
220
Vitamin A 100.000 IU tablet 850 - 850 - 850 1,2,3
221
Vitamin A 200.000 IU tablet 550 - 550 100 - 450 1,2,3
222
223 Vitamin B complex tablet 4,000 - 4,000 1,400 - 2,600 1,2,3
224 Vitamin B1 50 mg tablet 200 2,000 2,200 - - 2,200 1,2,3
225 Vitamin B6 10 mg tablet 800 - 800 - - 800 1,2,3
226 Vitamin C 50 mg tablet 2,700 - 2,700 - - 2,700 1,2,3
227 Vitamin K 10 mg tablet 200 - 200 100 100 1,2,3
228 Zinc 20 mg tablet 2,800 - 2,800 700 2,100 1,2,3
-
229 OBAT GIGI - GAS - - - - -
230 Kalitakee
232 3,5 solareX

Spray Iliadin 0,05%
234
-
OBAT SALEP/SERBUK - - - - -
Kombinasi: Asam
229 pot - - - - - 50
Bensoat 6% Asam
Salisilat 3%
AntiBakteri Salep:
Basitrasin 500 IU/g + tube 3 - 3 3 - 50
230
231 Basitrasin salep tube - - - - 50
sabun anti bakteri 500 tube - - - - - 10
232 ml
Garam Oralit Serbuk sachet 40 - 40 40 - - 200
233 Kombinasi
234 Acyclovir cream tube - - - - - 50
Aseptic alkohol gel
antiseptic pembersih botol 48 - 48 - - 48
235 tangan
Betametason cream tube 70 - 70 - 70 1,2,3

236
4 Bioplacenton gel tube - - - - - 24

238
Burnazin silver tube 12 - 12 5 7 1,2,3
239 sulphadiazine
Chloramphenicol salep tube - - - - - 24 1,2,3
241 kulit
Chloramphenicol salep tube 24 - 24 - 24 1,2,3
242 mata
Desoximetasone cream tube 7 - 7 2 - 5 2.3

244
245
246
Hydrocortisone cream tube 201 - 201 - - 201 1,2,3
247
Ketoconazole cream tube 70 - 70 - - 70 1,2,3

249
250 Lidocain jelly dispo - - - - - 10 1,2,3
251 Miconazole cream tube 43 - 43 10 - 33 1,2,3
253 Salep 2-4 pot 15 - 15 5 - 10 20 1,2,3
254 Salisil bedak kotak 125 - 125 - 125 1,2,3
Sodium fusidat Fucilex tube 6 - 6 6 - 20 2.3

255
257 Ultrasound gel USG botol 4 - 4 - 4 - 3
Oxitetrasiklin 1% salep tube 2 - 2 2 - - 24
258 mata
- - -
OBAT LAINNYA -
Apron One Plastik lembar 40 - 40 20 20 50 1,2,3
259 Onemed
BeneCheck Plus strip 150 - 150 - - 150 1,2,3

Glucose Test Strip 50's
260
Cholesterol Test Strip strip 170 - 170 40 - 130 1,2,3
261 10`s
BeneCheck Plus Uric strip 175 - 175 25 - 150 1,2,3
262 Test Strip 25`s
263 15-40
264 45-80
265 Alkohol swab pcs 400 - 400 - - 400
266 Bisturi no. 11 pcs 90 - 90 - - 90
267 Bisturi no. 18 pcs - - - - - -
268 Bisturi no. 20 pcs 100 - 100 - 100
269 Bisturi no. 22 pcs 200 - 200 10 190
270 100 meter
271 jarum
Catgut Chromic 3/0 + pcs -
272 jarum
273 jarum
274 jarum
Cutimed siltec 10x10cm pcs - - - - -

276
277
278
279 no. 16
Foley catheter 2 way pcs - 50 50 - 50
280 no. 18
281 no. 20
282 no. 6
283 no. 8
284 40
Gutta percha points 45-
pcs - - - - - 1,2,3
285 80

286
287 Large
288 Medium
289 obsgyn
290 Handscoen steril psg - - - - - 100
Handscoen steril no. 6,5 psg 150 - 150 50 - 100 100

291
Handscoen steril no. 7 psg 50 - 50 50 - - 300
292
293
Handscoen steril no. 8 psg 300 - 300 - - 300
294
Handscoen Examination psg 200 - 200 200 - - 0

Glovers L
295
Handscoen Examination psg - 1,000 100 200 - 800

Glovers M
296
297 HCG test pcs 113 - 113 - 113
Infusion set Dewasa pcs 435 - 435 35 - 400

299
300 IV cannula no. 18 pcs 50 - 50 - - 50
301 IV cannula no. 20 pcs 194 - 194 - - 194
302 IV cannula no. 22 pcs 50 - 50 - 50
303 IV cannula no. 24 pcs 72 - 72 - 72
304 IV cannula no. 26 pcs 40 - 40 - 40
309 Jarum jahit No. 14 pcs 12 - 12 - - 12

314
315
316
317 Kapas putih 250 g bungkus 4 - 4 - - 4
Kasa hidrofil 40yard x roll 4 - 4 - 4
318 80cm

319
320
Kasa sterile 16x16cm pcs 1,600 - 1,600 1,040 - 560
321
322 Klem tali pusat pcs 50 - 50 - - 50
323 Masker pcs 550 - 550 300 - 250 500
Masker Nebulizer Set
pcs 25 - 25 - 25
324 Anak Besmed
Masker Nebulizer Set pcs 20 - 20 - - 20
Dewasa Basmed
325
Micro brush doche
Disposable micro
biru
326
327
328 NGT no.16 pcs 20 - 20 10 - 10
329 NGT no.18 pcs 10 - 10 - 10
330 NGT no.3,5 pcs - - - - -
331 NGT no.5 pcs - - - - -
332 NGT no.8 pcs - - - - -
333 Oxygen nasal cannula Anpcs 40 - 40 40
334 Oxygen nasal cannula D pcs 55 - 55 - 55
335 Oxygen Mask Anak pcs 100 - 100 - - 100
337 Pembalut Gibs rol - - - - -
Plester coklat yard rol 3 - 3 - 3
338 Leukoplast
Plester Infus dermafix pcs 50 - 50 - - 50

339
340 Pen needle pcs - - - - - 10
341 Plester luka bakar pcs - - - - - 10

342
343 Plester putih Polifix rol 6 - 6 - 6
344
345 Safety box pcs 8 - 8 - - 8
346 Silk 2/0 pcs 72 - 72 - - 72
347 Silk 3/0 pcs - - - - -
348
349
350
351
352
353
Suction catheter FR 8 pcs - 10 10 10 - -
354
Surgical gown baju pcs 9 - 9 2 7
356 operasi L
Surgical gown baju pcs - - - - - 10
357 operasi M
358 operasi XL
359 Syringe 1 cc pcs 3,100 - 3,100 100 - 3,000
360 Syringe 10 cc pcs 90 - 90 - 90
361 Syringe 20 cc pcs 45 - 45 - 45
362 Syringe 3 cc pcs 1,900 - 1,900 200 - 1,700
363 Syringe 5 cc pcs 200 - 200 - 200
364 Syringe 50 cc pcs - - - - -
365 Cassette
Test Malaria
367 combo
368 Topi Operasi pcs - - - - - 100

369 Urine Bag pcs 44 - 44 - - 44
softpad (underpad) pcs 130 - 130 30 - 100
370 60x90 cm
371 Venflon no. 20 pcs - - - -
Fixation M.W 10x10 5 5 5
Fixation M.W 15x10 1 1 1
Paper Tape 7,5 cm 1 1 1
Paper Tape 5cm 2 2 2
Water One 1 L 20 20 20
One Clain 2 2 2
DHP Frimal 18 18 18
MDT Dewasa 5 - 5 - 5
107,741 15,548 122,489 10,263 99,013 -
JUMLAH KUNJUNGAN
RESEP BAYAR TIDAK BAYAR
246 502
256 20
Mokoditek, Juni 2019
MENGETAHUI
KEPALA DINAS KESEHATAN YANG MENYERAHKAN YANG MENERIMA
KEPALA INSTALASI FARMASI & PERBEKALAN YANG MELAPORKAN
KAB. BOLAANG MONGONDOW UTARA KEPALA PUSKESMAS MOKODITEK PETUGAS GUDANG OBAT
KESEHATAN
YUL DJENAAN, A.Md.Kep MOH HUSNI PONTOH, A.Md Kep

JUSNAN C. MOKOGINTA, MARS ASIA, S.Si, Apt NIP. 19950206 201903 1 004
NIP. 19671105 200012 1 003 NIP. 19840909 201102 2 001 NIP. 19700606 199304 2 013
H
(LPLPO)

KECAMATAN : BOLANG ITANG TIMUR BULAN PEMAKAIAN : September
KABUPATEN : BOLAANG MONGONDOW UTARA BULAN PERMINTAAN : Oktober
PEMBERIAAN
KODE NAMA OBAT TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK OPTIMUM TAAN DAK APBD I DAU LAIN FORNAS (TK)
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11 12 13 14 15 16
OBAT CAIR
1 Alkohol 70% 100 ml botol - - - - - - 1,2,3
2 Alkohol 70% 1000 ml botol 35 - 35 4 - 31 1,2,3

3 Ambroxol sirup botol 82 - 82 19 - 63
4 Aminophylline inj ampul - - - - 1,2,3
5 Amoxicillin drops botol - 20 20 10 10 1,2,3
6 Amoxicillin sirup botol - - - - - 1,2,3

7
8
10 Gastrucid botol - - - - -
11 Antasida sirup botol 115 - 115 81 34 1,2,3
12 Aqua pro inj flacon 16 - 16 3 13 1,2,3
14 Atropin sulfate inj ampul 100 - 100 2 98 1,2,3
Cefadroxil syr 125 mg/5 botol - - - - - - 1,2,3
15 ml
16 Cefixime sirup botol - - - - - - 2.3
19 Cetirizine sirup botol 108 - 108 57 - 51 1,2,3
Chotrimoksazole syr botol 46 46 11 35

20
21 Chloramphenicol sirup botol 4 - 4 - 4 1,2,3
22 telinga
Curbion sirup botol - - - - -
24 multivitamin
25 Dexamethasone inj ampul 103 - 103 - 72 31 1,2,3
26 Diazepam Inj ampul 10 - 10 - 10 1,2,3
27 Diphenhydramine inj ampul 60 - 60 - 60 1,2,3
29 Epinephrine inj ampul 100 100 5 - 95 1,2,3
34 Gentamisin Tetes mata botol - - - - - - 2.3

36 Glukosa 10% infus botol - - - 1,2,3
37 Glukosa 40% inj flacon - - 1,2,3
38 Glukosa 5% infus botol 34 - 34 - - 34 1,2,3
39 H2O2 3% botol - - - - - 3 1,2,3
40 inj
41 Ibuprofen sirup botol 48 - 48 3 45 1,2,3
42 Telinga 10%
44 KAEN 3B infus botol - - - - - - 1,2,3
KCL 7.46% Kalium flacon - - - - - - 1,2,3
47 Ketorolac inj ampul - 30 30 3 27 2.3
Kloramfenikol tetes mata botol - - - - - 1,2,3
48
49 Lidocaine inj ampul 870 - 870 - 870 1,2,3
50 Lysol cairan botol 12 12 1 - 11
Magnesium Sulfat 20% flacon - - - - - 1,2,3
51 inj
Magnesium Sulfat 40% flacon - - - - - - 1,2,3
52 inj
Methylergometrin ampul 100 - 100 - - 100 1,2,3
53 maleate inj
Metoklopramide sirup botol 22 - 22 20 2 50 1,2,3

54
Metronidazole infus botol 59 - 59 - 59 1,2,3
55
Natrium klorida 0,9% botol 40 - 40 20 20 1,2,3
56 infus
Otopain tetes telinga botol - - - - 25

61
62 Oxytocin inj ampul 70 - 70 - - 70 1,2,3
63 Pacdin cough sirup botol 18 48 66 45 - 21 48
64 Paracetamol drops botol - 20 20 11 9 20 1,2,3
66 Paracetamol sirup botol 5 - 5 5 - - 100 1,2,3
69 Pirantel Sirup botol - - - - - - 1,2,3
70 Povidone 300 ml botol 23 - 23 5 - 18 1,2,3
Renalyte electrolytes botol - - - - - 50 1,2,3

73
74 Ringer Laktat infus botol 76 - 76 26 - 50 1,2,3
75 Rivanol 300 ml botol 22 - 22 4 18 1,2,3

77
Tetagam inj human vial - - - - - 20 1,2,3
79 tetanus
80 Tramadol inj ampul 50 - 50 - - 50 2.3
82 Vit amin B12 inj ampul - - - - - 30 1,2,3
86 Zinc pro drops botol - - - - - - 100 1,2,3
87 Water One 1 L Botol 20 - 20 - 20
88 Metamizole ampul 100 100 100
OBAT PADAT -
89 Acetosal 100 mg tablet - - - - - 200 2.3
Acetylcysteine 200 mg tablet - - - 1,2,3

90
Acetysalicylic acid 80 tablet - - - - - - 200 1,2,3
91 mg
92 amodiaquin)
93 Acyclovir 400 mg tablet 700 - 700 150 - 550 1,2,3
Albendazole 400 mg tablet 660 660 120 540 1,2,3

94
95 Allopurinol 100 mg tablet 500 - 500 500 - 1000 1,2,3
96 Ambroksol 30 mg tablet 1,000 - 1,000 400 600 1000

97
98 Amlodipine 10 mg tablet 500 500 300 - 200 500 1,2,3
99 Amlodipine 5 mg tablet 1,800 - 1,800 1,200 - 600 1,2,3
100 Amoxicillin 500 mg tablet 900 900 900 - - 2000 1,2,3
102 Antasida doen tablet 2,000 7,000 9,000 3,800 - 5,200 1,2,3
103 Asam Folat 1 mg tablet 1,200 - 1,200 800 - 400 500 1,2,3
Asam mefenamat 500 tablet 5,600 - 5,600 - - 5,600 1,2,3
104 mg
Asam traneksamat 500
tablet - - - - - 500 2.3
105 mg
Azitromisin Kap 500 mg kaplet 20 - 20 - - 20

107
108 Attapulgite tablet 700 700 200 500 1,2,3
109 Betahistin tab tablet 600 - 600 100 500 2.3

Supp 5 mg
110
111 Bisakodil (Dulcolax)
Supp 10 mg supositoria - - 10 1,2,3
112 Bisacodyl Tab 5 mg tablet - 300 1,2,3

113 Bisoprolol 5 mg tablet 300 - 300 - 300 2.3
114 Bromhexine 8 mg tablet - - - - - 1000
Calsium lactate 500 mg tablet 1,000 - 1,000 800 200 1000 1,2,3
115
116 Captopril 12,5 mg tablet 400 500 900 700 200 500 1,2,3
118 Captopril 50 mg tablet - - 1000 1,2,3
119 Cefadroxil 500 mg tablet 2000 2.3
120 Cefixime 100 mg tablet - - - - - 1000 2.3
121 Cetirizine 10 mg tablet - 500 600 200 - 300 500 2.3
Chloramphenicol 500 tablet 100 - 100 - - 100 2.3
122 mg
Chlorpheniramine 4 mg tablet 500 1,000 1,500 1,300 - 200 2000 1,2,3

123
Ciprofloxacin 500 mg tablet - - - - - - 1,2,3
124
126 Clindamycin 150 mg tablet 1,150 - 1,150 150 1,000 1,2,3
Clobazam tab 10 mg tablet - - - - - 2.3

127
Cotrimoxazole 480 mg tablet 900 - 900 - - 900 1,2,3

129
Dexamethasone 0,5 mg tablet - 2,000 2,000 600 - 1,400 1,2,3

131
Diazepam stesolid supositoria - - - - - 20 1,2,3
134 10mg
Diazepam stesolid 5mg supositoria - - - - - - 20 1,2,3

135
Diklofenac sodium 50 tablet 650 - 650 100 550 1,2,3
136 mg
Diltiazem tab 30 mg tablet - - - - 1,2,3

137
Domperidone 10 mg tablet 300 500 800 400 400 1,2,3
138
139 Doxycycline 100 mg tablet 400 - 400 - 400 1,2,3
Dumin rectal 125 mg supositoria - - - - - - 20

140
Dumin rectal 250 mg supositoria - - - - - 20
141
Ergotamine caffeine tablet - - - - - 300 1,2,3
142
Erythromycin 250 mg tablet 200 - 200 - 200 1,2,3
143
144 Fenitoin tablet - - - - - 100 1,2,3
145 Fenobarbital 30 mg tablet - - - - - 300 1,2,3
Glibenclamide 5 mg tablet 200 - 200 - 200 1,2,3

147
Glyceryl guaiacolate
tablet 800 1,000 1,800 1,100 700 1000
149 100 mg
Glyceryl trinitrate 500 tablet - - - - - - 1,2,3
150 mcg
151 Griseofulvin 125 mg tablet 1,700 - 1,700 - 1,700 1,2,3
153 mg
Hyoscine butylbromide tablet - - - - - 1,2,3
154 10 mg
155 Ibuprofen 400 mg tablet - 500 500 400 100 1000 1,2,3

156
Kalsium Karbonat
158 500mg
Ketoconazole 200 mg tablet 75 - 75 - 75 1,2,3

159
160 Ketoprofen supo supositoria - - - - - 2.3

161
162
Kuinin sulfat 222 mg tablet 1,000 - 1,000 - 1,000 1,2,3
163
164 Lanzoprasol 30 mg tablet 760 - 760 140 - 620 2.3
168 Loratadine 10 mg tablet - - - - - 500 1,2,3
Meloxicam tab 7,5 mg tablet 1,220 - 1,220 20 1,200

169
170 Metformin 500 mg tablet - - - - - - 1000 1,2,3

171
172 Methyldopa 250 mg tablet - - - - - 500 2.3
Metilergometrin maleat tablet 800 - 800 - - 800 1,2,3
173 tab
Metilprednisolon tab tablet 800 - 800 - - 800 1,2,3

174
Metoclopramide 10 mg tablet 3,500 1,000 4,500 - 4,500 1,2,3
175
Metoclopramide 5 mg tablet - - - - 1,2,3
176
Metronidazol 500 mg tablet - 500 500 200 300 500 1,2,3
177
Metronidazole supo supositoria - 10 10 - 10 2.3
178
179 Microlax rectal tube - - - - - 15
Natriuum Diklofenak 50 Tablet - - - - - 1000
180 Mg
181 Nifedipine 10 mg tablet 1,000 - 1,000 - 1,000 1,2,3
182 Norit botol - - - - - 10 1,2,3
183 Nystatin 500.000 IU tablet - - - - - 100 1,2,3
OAT kategori Sisipan - kotak - - - - - 1,2,3
184 KDT
Omegavit multivitamin tablet - - - - - 2000

185
186 Omeprazole 20 mg tablet - - - - - 1000 1,2,3
187 Ondansetron 4 mg tablet - - - - - 200 2.3
188 Ondansetron 8 mg tablet - - - - - - 200 2.3

189
Panviton multivitamin tablet - - - - - 1000
190
Paracetamol 500 mg tablet 15,700 - 15,700 3,200 - 12,500 1,2,3

192
195 Piroxicam 20 mg tablet - - - - - 1000
196 Prednison 5 mg tablet 9,700 - 9,700 - - 9,700 1,2,3
Prenase multivitamin tablet - - - - - 500

197

201
202 Pyrantel tab 125 mg tablet - - - - - 1,2,3
203 Ranitidine 150 mg tablet - 500 500 300 - 200 1000 1,2,3
204 Salbutamol 2 mg tablet 1,100 - 1,100 100 - 1,000 1,2,3
205 Salbutamol 4 mg tablet 900 - 900 200 - 700 1,2,3
206 mg
207 Simvastatin 10 mg tablet 1,860 - 1,860 570 - 1,290 1,2,3
Spironolactone 100 mg tablet 200 200 - 200 1,2,3

208
209 Sucralfate 500 mg tablet - - - - - 500 2.3
Tablet tambah darah tablet 2,700 - 2,700 1,050 - 1,650 1000 1,2,3
210
212 Tetrasiklin 500 mg tablet 1,100 - 1,100 - 1,100 1,2,3

213
214 Tilomix tablet - - - - - 1000
Valsartan tab 80 mg tablet - - - - - - 2.3

217
218
Vitamin A 100.000 IU tablet 850 - 850 50 800 1,2,3
219
Vitamin A 200.000 IU tablet 450 - 450 50 - 400 1,2,3
220
221 Vitamin B complex tablet 8,500 - 8,500 2,500 - 6,000 1,2,3
222 Vitamin B1 50 mg tablet 2,200 - 2,200 - - 2,200 1,2,3
223 Vitamin B6 10 mg tablet 400 - 400 400 - - 1000 1,2,3
224 Vitamin C 50 mg tablet 7,300 - 7,300 500 - 6,800 1,2,3
225 Vitamin K 10 mg tablet 100 - 100 - 100 1,2,3
226 Zinc 20 mg tablet 600 - 600 100 500 - 1000 1,2,3
227 Resperidone 2mg tablet 90 90 10 80
Calciumpolystyrene
sachet - - - - -
227 Kalitakee
229 3,5 solareX
Oxymetazoline Nasal Spray
Iliadin 0,05% botol - - - - -
231
232 -
233 OBAT SALEP/SERBUK
Kombinasi: Asam pot 48 - 48 - 48
Bensoat 6% Asam
Salisilat 3%
234
AntiBakteri Salep:
Basitrasin 500 IU/g + tube - - - - - 24
235
sabun anti bakteri 500
tube - - - - - 10
237 ml
Garam Oralit Serbuk sachet 180 - 180 26 - 154
238 Kombinasi
239 Acyclovir cream tube - - - - - 50
Aseptic alkohol gel
antiseptic pembersih botol 45 - 45 4 - 41
240 tangan
Betametason cream tube 46 - 46 1 45 1,2,3

241
242 Bioplacenton gel tube - - - - - 24

243
Burnazin silver tube 5 - 5 - 5 1,2,3
244 sulphadiazine
Chloramphenicol salep tube - - - - - 24 1,2,3
246 kulit
Chloramphenicol salep tube 10 - 10 - 10 1,2,3
247 mata
Desoximetasone cream tube - 11 11 6 - 5 2.3

249
250
251
Hydrocortisone cream tube 153 - 153 - - 153 1,2,3
252
Ketoconazole cream tube 70 - 70 - - 70 1,2,3

254
255 Lidocain jelly dispo - - - - - 10 1,2,3
256 Miconazole cream tube - 24 24 - - 24 1,2,3
258 Salep 2-4 pot 14 - 14 - - 14 1,2,3
259 Salisil bedak kotak 125 - 125 - 125 1,2,3
Sodium fusidat Fucilex tube 10 10 20 - 20 2.3

260
262 Ultrasound gel USG botol - - - - - - 5
Oxitetrasiklin 1% salep tube - 24 24 - - 24
263 mata
OBAT LAINNYA -
Apron One Plastik lembar 60 - 60 - 60 1,2,3
263 Onemed
BeneCheck Plus
Glucose Test Strip 50's strip 150 - 150 50 - 100 1,2,3
264
Cholesterol Test Strip strip 110 - 110 70 - 40 1,2,3
265 10`s
BeneCheck Plus Uric strip 100 - 100 50 - 50 1,2,3
266 Test Strip 25`s
267 15-40
268 45-80
269 Alkohol swab pcs 100 - 100 100 - 100 300
270 Bisturi no. 11 pcs - - - - - -
271 Bisturi no. 18 pcs - - - - - -
272 Bisturi no. 20 pcs 100 - 100 - 100
273 Bisturi no. 22 pcs 190 - 190 - 190
274 100 meter
275 jarum
Catgut Chromic 3/0 + pcs -
276 jarum
277 jarum
278 jarum
Cutimed siltec 10x10cm pcs - - - - -

279
280
281
Foley catheter 2 way pcs - 10 10 10
282 no. 16
283 no. 18
284 no. 20
Foley catheter 2 way
pcs 20 - 20 - 20
285 no. 6
Foley catheter 2 way pcs 28 - 28 8 20
286 no. 8
287 40
288 80

289
290 Large
291 Medium
292 obsgyn
293 Handscoen steril psg - - - - - 100
Handscoen steril no. 6,5 psg 100 - 100 50 - 50 200

294
Handscoen steril no. 7 psg 400 - 400 50 - 350
295
Handscoen steril no. 7,5 psg 400 - 400 - 400
296
Handscoen steril no. 8 psg 300 - 300 - - 300
297
Handscoen Examination psg 100 - 100 100 - -

Glovers L
298
Handscoen Examination psg 100 600 700 400 - 300

Glovers M
299
300 HCG test pcs 42 - 42 42 -
301 Infusion set Anak pcs 40 - 40 6 34
Infusion set Dewasa pcs 400 - 400 - - 400

302
303 IV cannula no. 18 pcs 50 - 50 - - 50
304 IV cannula no. 20 pcs 144 - 144 - - 144
305 IV cannula no. 22 pcs - - - - - - 50
306 IV cannula no. 24 pcs 72 - 72 - 72
307 IV cannula no. 26 pcs 40 - 40 - 40
311 Jarum jahit No. 13 pcs 24 - 24 12 12
312 Jarum jahit No. 14 pcs - - - - - -

317
318
319 Kapas Berlemak 500 g bungkus - - - - -
320 Kapas putih 250 g bungkus 3 - 3 1 - 2
Kasa hidrofil 40yard x roll 2 - 2 1 1
321 80cm
Kasa hidrofil 4m x 10cm rol 50 - 50 5 45
322
323
Kasa sterile 16x16cm pcs 3,120 - 3,120 880 - 2,240
324
325 Klem tali pusat pcs 50 - 50 - - 50
326 Masker pcs 2,600 - 2,600 400 - 2,200
327 Anak Besmed
Masker Nebulizer Set
Dewasa Basmed pcs 20 - 20 - - 20
328
329
Micro brush doche
Disposable micro
biru

330
331 NGT no.16 pcs 18 - 18 - - 18
332 NGT no.18 pcs - - - - -
333 NGT no.3,5 pcs - - - - -
334 NGT no.5 pcs - - - - -
335 NGT no.8 pcs - - - - -
Oxygen nasal cannula pcs 40 - 40 40
336 Anak
Oxygen nasal cannula pcs 50 - 50 - 50
337 Dewasa
338 Oxygen Mask Anak pcs 100 - 100 5 - 95
339 Oxygen Mask Dewasa pcs 95 - 95 5 90
340 Pembalut Gibs rol - - - - -
Plester coklat yard rol 3 - 3 - 3
341 Leukoplast
Plester Infus dermafix pcs 50 - 50 - - 50

342
343 Pen needle pcs - - - - - 10
344 Plester luka bakar pcs - - - - - 10
345 Policrepe pembalut rol - - - - -

347 air dermafix t 10x25cm pcs - - - - -
348 Safety box pcs 7 - 7 1 - 6

349 Silk 2/0 pcs 72 - 72 12 - 60
350 Silk 3/0 pcs - - - - -
357 Suction catheter FR 8 pcs - - - - - -
358 Sputum Pot Pieces 80 - 80 20 60
Surgical gown baju pcs 7 - 7 - 7
359 operasi L
Surgical gown baju pcs - - - - - 10
360 operasi M
361 operasi XL
362 Syringe 1 cc pcs 2,885 - 2,885 85 - 2,800
363 Syringe 10 cc pcs 90 - 90 20 70
364 Syringe 20 cc pcs 45 - 45 - 45
365 Syringe 3 cc pcs 1,600 - 1,600 - - 1,600
366 Syringe 5 cc pcs 200 - 200 - 200
367 Syringe 50 cc pcs - - - - -
368 Cassette
Test Malaria
370 combo
371 Topi Operasi pcs 100 100 100
372 Urine Bag pcs 44 - 44 4 - 40
softpad (underpad) pcs 90 - 90 30 - 60 100
373 60x90 cm
374 Venflon no. 20 pcs - - - -
375 Fixation M.W 10x10 4 4 4
376 Fixation M.W 15x10 1 1 1
377 Paper Tape 7,5 cm 1 1 1
378 Paper Tape 5cm 2 2 2
379 Paper Tape 2,5 cm 3 3 3
380 Paper Tape 1,25 cm 4 4 1 3
381 Water One 1 L 20 20 20
382 One Clain 1 1 1 -
383 DHP Frimal 18 18 18
384 MDT Dewasa 3 - 3 1 2
107,945 16,307 124,352 10,263 97,356 -
JUMLAH KUNJUNGAN
RESEP
BAYAR TIDAK BAYAR
Mokoditek, September 2019
MENGETAHUI YANG MELAPORKAN YANG MENERIMA

KEPALA DINAS KESEHATAN YANG MENYERAHKAN KEPALA PUSKESMAS MOKODITEK PETUGAS GUDANG OBAT
KAB. BOLAANG MONGONDOW UTARA KEPALA INSTALASI FARMASI & PERBEKALAN
KESEHATAN
YUL DJENAAN, A.Md.Kep MOH HUSNI PONTOH, A.Md Kep
Sri Yulastri Paputungan, S.Si NIP. 19700606 199304 2 013 NIP. 19950206 201903 1 004
JUSNAN C. MOKOGINTA, MARS NIP. 19851225 201001 2 004
NIP. 19671105 200012 1 003
H
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Lplpo 2019

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Lplpo 2019

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

INSTANSI : PUSKESMAS MOKODITEK NOMOR DOKUMEN :

Analog insulin Apidra inj pen - - - - - 1,2,3

Cefadroxil syr 125 mg/5 ml botol 15 - 15 - 15 1,2,3

Curbion sirup multivitamin botol - - - - - 100

Gentamisin Tetes mata botol 15 - 15 3 12 2.3

Hyoscine butylbromide inj ampul - - - - - 2.3

Kloramfenikol tetes mata botol 338 - 338 138 200 1,2,3

Magnesium Sulfat 20% inj flacon 10 - 10 - 10 1,2,3

Natrium klorida 0,9% infus botol 120 - 120 - 120 1,2,3

Sodium Bicarbonate inj flacon - - - - - 2.3

Acetysalicylic acid 80 mg tablet 100 - 100 - 100 1,2,3

Chloramphenicol 500 mg tablet - - - - - 2.3

Dexamethasone 0,5 mg tablet 900 - 900 900 - 3000 1,2,3

Diazepam stesolid 10mg supositoria - - - - - 1,2,3

Dumin rectal 125 mg supositoria 13 - 13 - 13

Glyceryl guaiacolate 100 mg tablet - - - - -

Hydrochlorothiazide 25 mg tablet 600 - 600 - 600 1,2,3

Ketoprofen supo supositoria - - - - - 2.3

Metilergometrin maleat tab tablet - 1,000 1,000 - 1,000 1,2,3

Metronidazole supo supositoria - - - - - 2.3

Natriuum Diklofenak 50 Mg Tablet - 1,000 1,000 - 1,000

OAT kategori Sisipan - KDT kotak - - - - - 1,2,3

Paket stop TB kategori I kotak - - - - - 1,2,3

Propylthiouracil 100 mg tablet - - - - - 1,2,3

Salbutamol nebules 2,5 mg tablet - - - - -

Vitalamin multivitamin tablet - - - - -

Antifungi DOEN Salep,

235 Basitrasin salep tube - - - -

sabun anti bakteri 500 ml tube - - - - -

Aseptic alkohol gel

Desoximetasone cream tube - - - - - 2.3

Gentamicin salep mata tube - - - - - 2.3

Apron One Plastik Onemed lembar 40 - 40 - 40 1,2,3

BeneCheck Plus Total strip - - - - - - 1,2,3

Catgut Chromic 2/0 + jarum pcs 48 - 48 - 48

Foley catheter 2 way no. 16 pcs 20 - 20 - 20

Gutta percha points 15-40 pcs - - - - - 1,2,3

Handscoen non steril Large psg - - - - -

Handscoen steril no. 6,5 psg - - - - -

Handscoen steril no. 7,5 psg - - - - -

Jarum untuk insulin pen pcs - - - - -

Kasa hidrofil 40yard x 80cm roll - - - - -

Micro brush doche

Surgical gown baju operasi L pcs 10 - 10 - 10

Test Anti HIV 1/2 Cassette test - - - - -

Test Malaria HRP2/pLDH test - - - - -

JUMLAH KUNJUNGAN TIDAK

INSTANSI : PUSKESMAS MOKODITEK NOMOR DOKUMEN :

Alkohol 70% 100 ml botol - - - - - - 1,2,3

Alkohol 70% 1000 ml botol - 20 20 - - 20 1,2,3

Analog insulin Apidra inj pen - - - - 1,2,3

Analog insulin Lantus inj pen - - - - - 1,2,3

Chloramphenicol sirup botol 13 - 13 - 13 1,2,3

Diphenhydramine inj ampul 24 - 24 24 - 100 1,2,3

Gentamisin Tetes mata botol 12 - 12 2 10 2.3

Metoklopramide sirup botol 7 100 107 17 90 1,2,3

Otopain tetes telinga botol - - - -

Renalyte electrolytes botol - 12 12 12 - 50 1,2,3

Sodium Bicarbonate inj flacon - - - - - 2.3

Acetylcysteine 200 mg tablet 1,800 - 1,800 - 1,800 1,2,3

Azitromisin Kap 500 mg kaplet 40 - 40 - 40

Bisakodil (Dulcolax) tablet - - - - - 1,2,3