LAPORAN PEMAKAIAN DAN LEM

PUSKESMAS TEPIAN BARU PELAPORAN BULAN

KECAMATAN BENGALON PERMINTAAN BULAN/PERIODE
KABUPATEN KUTAI TIMUR

NO NAMA OBAT SATUAN Januari Febuari Maret

1 2 3 4 5 6
165 Parasetamol 500 mg Tablet 1100 2800 2500
50 CTM 4 mg Tab 1300 1500 1000
11 Amoksisilin 500 mg Tablet 2200 2100 2100
66 Ferro sulfat-asam folat (kombinasi) Tablet 1700 1200 2600
157 Natrium Diclofenat 25 mg Tablet 1650 2000 2000
213 Vitamin B Kompleks Tablet 1600 2400 3000
38 Deksametason 0,5 mg Tablet 1700 1200 1100
22 Asam Mefenamat 500 mg Tablet - 0 -
77 Gliseril guaikolat 100 mg Tablet 900 400 1100
101 Kaptopril 25 mg Tablet 1300 500 700
17 Asam askorbat (vitamin C) 50 mg Tablet 800 500 1000
179 Ranitidin 150 mg Tablet 1000 600 800
4 Antalgin tablet tablet - 400 1100
204 Tiamin (Vit B1) 50 mg Tablet - 0 300
186 Sefadroksil 500 mg Kapsul 700 400 200
189 Setirizin tab 10 mg Tablet 1000 300 600
148 Metilprednisolon 4 mg Tablet 900 300 800
98 Kalsium Laktat (Kalk) 500 mg Tablet 300 200 200
170 Piridoksin (Vit B6) 10 mg Tablet - 300 400
158 Natrium Diclofenat 50 mg Tablet 900 600 800
142 Metformin 500 mg Kaplet 300 0 500
8 Amlodipin 10 mg Tablet 150 150 270
25 Asiklovir 200 mg Tablet 800 300 300
184 Salbutamol 4 mg Tablet 300 100 200
68 Ringer laktat infus Botol 100 100 280
164 Papaverin 40 mg Tablet 400 200 500
8 Becefort tablet tablet 500 100 -
 2 Allopurinol 100 mg Tablet 100 0 300
33 Betahistin 6 mg Tablet 300 0 300
155 n-Asetil sistein 200 mg kapsul - 180 180
89 Ibuprofen 400 mg Tablet - 0 -
195 Siprofloksasin sal selaput 500 mg Tablet 100 400 200
153 Metronidazol 500 mg Tablet 100 500
192 Simvastatin 10 mg Tablet 30 120 120
79 Griseofulvin 125 mg Tablet - 0 300
46 Domperidon 10 mg Tablet 100 0 600
Vit B1 100 mg-Vit B6 200 mg-Vit B12 200
212
mcg kombinasi
tablet 300 100 100
73 Glibenklamid 5 mg Tablet 200 0 300
67 Zink 20 mg Tablet 100 100 100
4 Ambroksol 30 mg Tablet 800 100 100
106 Ketokonazol 200 mg Tablet 200 0 100
130 Lisonopril 10 mg Tablet - 800 -
131 Loperamid 2 mg Tablet - 100 -
8 Calporosis Tab - 150 420
54 Eritromisin 500 mg tablet 100 0 300
151 Metoklopramid 5 mg Tablet 100 0 -
193 Simvastatin 20 mg Tablet 100 0 300
49 Ekstrak kurkuma 20 mg tablet - 0 100
187 Sefiksim sal selaput 100 mg Tablet - 0 -
29 Parasetamol 120 mg / 5 ml Syrup Botol 50 150 75
39 Nitrokaf Forte tablet - 0 -
66 Ranitidin Injeksi 25 mg/ml Ampul 50 20 100
23 Garam Oralit Kombinasi serbuk Bungkus 75 100 100
2 Ambroksol sy 15 mg/5 ml Botol - 15 45
52 Lidokain 2% + epinefrin inj 2 ml Ampul 30 30 30
6 Antasida Suspensi Botol 9 50 65
19 Asam folat 1 mg Tablet - 0 -
90 Irbesartan 300 mg Tablet - 400 -
132 Loratadin 10 mg Tablet - 0 200
45 Dimenhidrinat 50 mg Tablet - 0 -
203 Tiamfenikol 500 mg Tablet 100 0 -
28 Glukosa 5 % Infus Botol 30 20 20
162 Omeprazole 20 mg Kapsul 240 0 -
163 Ondansetron 8 mg Tablet 84 0 60
11 Bioron Injeksi ampul 15 35 20
147 Metilprednisolon 16 mg Tablet 0 -
150 Metoklopramid 10 mg Tablet - 0 -
199 Sukralfat 500 mg Tablet - 0 200
 8 Domperidon Syrup 5 mg/5ml Botol - 20 30
54 Metamizol inj 500 mg/ml Ampul 10 0 -
57 Natrium Klorida 0,9% infus Botol 40 0 20
1 Komb. Piretamin + Sulfadoxin Tab - 0 -
112 Klopidogrel 75 mg Tablet - 180 -
12 Hemorogard Caps - 0 60
11 Bedak Salisil serb 2% Botol 15 3 24
24 Asam ursodeoksikolat 250 mg Kapsul - 0 -
17 Vip Albumin Caps - 0 30
17 DHP (Dihidroartemisin-piperakuin) komb Tablet - 0 -
50 Oksitosin Injeksi 10 IU/ml Ampul 4 6 35
60 Nistatin tab vaginal 100.000 IU Tablet 20 0 20
70 Sefotaksim serb inj 1000 mg vial 12 6 110
34 Bisakodil 5 mg Tablet - 30 60
13 Ibuprofen syrup 100mg/5 ml Botol - 15 10
60 Ondansetron inj 2 mg/ml Ampul 10 10 10
38 Ketokonazol 2 % Krim Tube 25 5 20
18 Kotrimoksazol Suspensi 240 mg/ 5 ml Botol 11 7 3
39 Metil Ergometrin 0,2 mg/ml Ampul - 0 -
58 Fenitoin 100 mg Kapsul - 0 -
70 Furosemid 40 mg Tablet - 0 100
152 Metronidazol 250 mg Tablet - 100 -
159 Nifedipin 10 mg Tablet - 0 -
28 Obat Batuk Hitam Sy Botol - 20 30
51 Lidocain inj 2% Ampul 100 0 -
1 Asiklovir salep Kulit 5% Tube 50 5 -
2 Albendazol 400 mg Tablet - 0 -
3 Pyrazinamide 500 mg Tab - 0 -
16 Uriter ( Pipemidic Acid ) Caps - 100 -
37 sefadroksil syr kering 125 mg/5 ml Botol 13 83 -
27 Gentamicin salep mata 0,3% tube 11 2 -
23 Fitomenadion (Vit K1) Injeksi 10 mg/ml Ampul 0 -
53 Mikonazole Krim 2% Tube 11 7 6
15 Claritromycin 500 mg kapsul - 0 -
33 Lacto B Sach - 0 -
28 Gentamicin Tetes Mata 0,3% Tube 24 0 -
 6 Atropin Injeksi 0,25 mg/ml Ampul - 0 85
55 Metoklopramid Inj 5 mg/ml Ampul - 20 10
33 Hidrokortison 2,5 % Cream Tube 6 5 5
13 Betametason krim 0,05 % Tube 25 0 9
40 Setrizin Syrup 5 mg/5ml Botol - 18 20
Anti Bakteri Komb : Basitrasin+Polimiksin
2 salep kulit tube 0 -

80 sianokobalamin (vit B12) Inj 500 mcg/ml Ampul - 4 -

1 Air untuk Injeksi 25 ml Botol 18 0 -
205 Tramadol tab 50 mg tablet 50 0 -
24 IV cath no 20 pcs - 0 50
25 IV cath no 18 pcs - 0 50
26 IV cath no 22 pcs - 0 50
27 IV cath no 24 pcs - 0 50
5 Asam traneksamat 50 mg/ml Ampul - 0 -
15 Deksametason Injeksi 5 mg/ml Ampul 3 10 -
14 Ofloxacin 400 mg Tab - 0 50
6 Oksitetracyklin zalf 3% Tube - 25 -
26 Alletrol Compositum T.M Btl - 0 -
24 Metoklopramid sy 5 mg/5 ml Botol - 0 -
24 Fenol Gliserol tetes telinga 10 % Botol 5 1 7
10 Bioplacenton tube 11 13 1
32 Pirantel pamoat susp 125 mg / 5 ml Botol - 10 -
21 Esomeprazole serb inj 40 mg Ampul - 0 -
20 desoksimetason salp 0,25 % tube - 0 2
49 Klorpromazin Injeksi 25 mg/ml Ampul 2 28 -
38 Molakrim 30 gram tube 3 1 8
41 Otopain Ear Drop botol 6 2 15
65 Parasetamol rectal 125 mg/2,5 ml suppo 2 11 3
61 Voltadex 1% gel tube 5 10 2
66 Parasetamol rectal 250mg/2,5 ml suppo 2 6 4
7 Oksitetracyklin zalf mata 1% Tube - 2 -
55 Mometason furoat 0,1 % cream Tube - 0 -
5 Asering 500 ml botol - 0 -
13 Bufacetin salep 15 gram tube - 4 -
31 Interzol SS 2% botol - 0 -
42 Tiamfenikol sy 125 mg/5 ml botol - 0 -
59 Vermox 500 mg tablet - 5 -
41 Sukralfat Susp 500 mg/5 ml Botol - 0 -
 62 Parasetamol 1000 mg infus 100 ml botol - 0 3
45 Pehacain injeksi ampul 0 -
48 Piracetam injeksi ampul - 10 -
42 Diazepam 5 mg Tablet - 0 -
121 Kodein 10 mg Tablet - 0 -
21 Dulcolax 5 mg suppo 1 1 7
57 Vagizol Ovula suppo - 0 -
17 Kloramfenikol Suspensi 125 mg/5 ml Botol - 0 6
25 Metoklopramid drop 2 mg/ml Botol - 0 -
43 Valproat sy 250 mg/ 5 ml Botol - 0 -
32 Isotic 0,25 mg Tetes mata botol - 0 -
22 Metil Prednisolone 500 mg Injeksi Vial - 0 -
24 Nerilon Cream Tube - 0 -
32 Fakku suppo Supp - 0 -
62 Oksimetazolin tetes hidung 0,025% botol - 0 8
49 Nonwoven fixation 20 cm x 5 M roll - 1 -
53 Plester uk 5 cm roll - 2 -
53 Magnesium Sulfat 20 % flakon - 0 -
34 Kompolax sirup botol - 0 -
56 ThromboGel 10 gr tube 1 0 -
7 Bactesyn vial - 0 -
1 Biplacenton Tulle pcs - 0 -
30 Y- Rins Btl - 0 -
36 Salbutamol-Guaifenesin kombinasi sy botol - 0 -
16 Etanol cairan 70% botol 1 0 3
22 Diazepam enema 5 mg/ 2,5 ml suppo - 3 -
59 Neomisin-Basitrasin powder botol - 1 -
31 Borraginol -N Suppo Supp - 0 -
42 Masker earloop kotak 0 -
43 Masker kerudung/hijab kotak 0 -
16 Diazepam Injeksi 5 mg/ml Ampul - 0 1
67 Perak sulfadiazin krim 1% Tube - 1 1
40 Metronidazol infus 5 mg/ml Botol - 0 2
6 Atroven 20 mcg pcs - 0 -
29 Seretide Inhaler pcs - 0 -
46 Sarung Tangan UK.S Box - 0 2
47 Sarung Tangan UK.M Box - 0 2
33 Kapas 1000 gram Bungkus - 0 -
4 Etil Klorida Spray 100 ml botol 0 -
34 Flixotide Nebulizer Box - 0 -
43 Kapas Kompres One Med Ktk - 0 -
59 Omeprazole serb inj 40 mg Ampul - 0 -
54 Mikonazole serbuk 2% botol - 0 -
38 Damegut Chromic 70 x 25 mm Box - 0 -
39 Damegut Plain 2.0 75 x 30 mm Box - 0 -
48 Sarung Tangan UK.L Box - 0 -
3 Allopurinol 300 mg Tablet - 0 -
5 Aminofilin 150 mg Tablet 0 -
6 Aminofilin 200 mg Tablet - 0 -
7 Amitriphyllin 25 mg Tablet - 0 -
9 Amlodipin 5 mg Tablet - 0 -
10 Amoksisilin 250 mg Tablet - 0 -
12 Antasida Tablet - 0 -
13 Artemether-Lumafantrin (Kombinasi) Tablet 0 -
14 Asam asetil salisilat (asetosal) 100 mg Tablet 0 -
15 Asam asetil salisilat (asetosal) 80 mg Tablet 0 -
16 Asam askorbat (vitamin C) 250 mg Tablet - 0 -
18 Asam folat 0,4 mg Tablet 0 -
20 Asam folat 5 mg Tablet 0 -
21 Asam Mefenamat 250 mg Capsul - 0 -
23 Asam traneksamat 500 mg Tablet 0 -
26 Asiklovir 400 mg Tablet - 0 -
27 Atapulgit Tablet 0 -
28 Atenolol 50 mg Tablet - 0 -
29 Atorvastatin 20 mg Tablet 0 -
30 Atropin sulfat 0,5 mg Tablet - 0 -
31 Benserazid-levodopa (kombinasi) Tablet 0 -
32 Betahistin 24 mg Tablet 0 -
35 Bisoprolol 5 mg Tablet 0 -

36 Bromheksin 8 mg tablet 0 -

37 Dapson 100 mg Tablet 0 -

39 Dekstromenorfan 15 mg Tablet - 0 -
40 Dekstrometorfan-Gliseril guaikolat-PPA-
CTM kombinasi Tablet - 0 -
41 Diazepam 2 mg Tablet - 0 -
43 Digoksin 0,25 mg Tablet - 0 -
44 diltiazem 30 mg Tablet 0 -
47 Efedrin 25 mg Tablet - 0 -
48 Ekstrak graptofili-sitrus bioflavonoid kapsul 0 -
50 Ergokalsiferol (Vit D2) 50 mg Tablet 0 -
51 Ergotamin 1 mg Tablet 0 -
52 Ergotamin-Kafein (kombinasi) Tablet - 0 -
53 Eritromisin 250 mg Capsul 0 -
55 Etambutol 250 mg Tablet - 0 -
56 Etambutol 400 mg Tablet - 0 -
57 famotidin 20 mg Tablet 0 -
59 Fenitoin 30 mg Kapsul - 0 -
60 Fenobarbital 100 mg Tablet - 0 -
61 Fenobarbital 30 mg Tablet - 0 -
62 Fenoksimetil penisilin (Penisilin V) 250 mg Tablet 0 -
63 Fenoksimetil penisilin (Penisilin V) 500 mg Tablet 0 -
64 Ferro fumarat 300 mg kapsul 0 -
Ferro glukonat-Vit C-asam folat-vit B12-
65 Kupri sulfat-Mangan sulfat-sorbitol Tablet 0 -
kombinasi
67 Fitomenadion (Vit K1) 10 mg Tablet 0 -
68 Fluoksetin 10 mg Kapsul 0 -
69 Fluoksetin 20 mg Kapsul 0 -
71 Gabapentin 300 mg Tablet 0 -
72 Glibenklamid 2,5 mg Tablet 0 -
74 Glimipiride 1 mg Tablet - 0 -
75 Glimipiride 2 mg Tablet 0 -
76 Glipizid 5mg Tablet 0 -
78 Gliseril trinitrat 0,5 mg Tablet 0 -
80 Griseofulvin 250 mg Tablet 0 -
81 Griseofulvin 500 mg Tablet 0 -
82 Haloperidol 1,5 mg Tablet 0 -
83 Haloperidol 2 mg Tablet 0 -
84 Haloperidol 5 mg Tablet - 0 -
85 Hidroklortiazid 25 mg Tablet - 0 -
86 Hiosin butilbromida 10 mg Tablet 0 -
87 Hiosin butilbromida-parasetamol komb Tablet 0 -
88 Ibuprofen 200 mg Tablet - 0 -
91 Isoksuprin 20 mg Tablet 0 -
92 Isoniazid 100 mg Tablet - 0 -
93 Isoniazid 300 mg Tablet - 0 -
94 Isosorbid Dinitrat 5 mg Tablet - 0 -
95 Kalium diklofenak 50 mg Tablet - 0 -
96 Kalium klorida 600 mg Tablet 0 -
97 Kalsium karbonat 500 mg Tablet 0 -

99 Kaolin-pektin komb Tablet 0 -

100 Kaptopril 12,5 mg Tablet - 0 -
102 Kaptopril 50 mg Tablet - 0 -
103 Karbamazepin 100 mg Tablet 0 -
104 Karbamazepin 200 mg Tablet - 0 -
105 Karbon aktif 0,5 mg Tablet 0 -
107 Ketoprofen 50 mg Tablet 0 -
108 Klindamisin 150 mg Kapsul 0 -
109 Klindamisin 300 mg Kapsul 0 -
110 Klofazimin 100 mg Kapsul 0 -
111 Klofazimin 50 mg Kapsul 0 -
113 Kloramfenikol 250 mg kapsul - 0 -
114 Kloramfenikol 500 mg Kapsul 0 -
115 Klorfeniramin 4 mg Tablet 0 -
116 Klorpromazin 100 mg Tablet - 0 -
117 Klorpromazin 25 mg Tablet - 0 -
118 Klortalidon 50 mg Tablet 0 -
119 Klozapin 100 mg Tablet 0 -
120 Klozapin 25 mg Tablet 0 -
122 Kodein HCL 10 mg Tablet - 0 -
123 Kodein HCL 20 mg Tablet 0 -
124 Kolkisin 500 mcg Tablet 0 -
125 Kotrimoksazol 480 mg Tablet - 0 -
126 Kotrimoksazol forte 960 mg tablet 0 -
Laktobasilus-bifidobakterium longun-
127
streptokokus serbuk kombinasi
sachet 0 -
128 Lansoprazole 30 mg Kapsul - 0 -
129 Levofloksasin sal selaput 500 mg Tablet - 0 -
133 Lorazepam 0,5 mg Tablet 0 -
134 Lorazepam 1 mg Tablet 0 -
135 Lorazepam 2 mg Tablet 0 -
136 Mebendazol 100 mg Tablet - 0 -
137 Mebendazol 500 mg Tablet 0 -
138 Mebhidrolin napadisilat 50 mg tablet 0 -
139 Meloksikam 15 mg Tablet 0 -
140 Meloksikam 7,5 mg Tablet - 0 -
141 Metenamin mandelat sal enterik 500 mg Tablet 0 -
143 Metformin 850 mg Tablet 0 -
144 Methysoprinol 500 mg Tablet 0 -
145 Metil Ergometrin 0,125 mg Tablet - 0 -
146 Metildopa 250 mg Tablet 0 -
149 Metilprednisolon 8 mg Tablet 0 -
154 Misoprostol 200 mcg tablet 0 -
156 Natrium bikarbonat 500 mg Tablet 0 -
160 Nistatin sal gula 500.000 IU Tablet 0 -
161 Nitrofurantoin 50 mg Tablet 0 -
Parasetamol-gliseril gualikolat-PPA-CTM
166 kombinasi tablet 0 -
167 Piracetam 800 mg Tablet 0 -
168 Pirantel Pamoat 125 mg Tablet - 0 -
169 Pirantel Pamoat 250 mg Tablet 0 -
171 Piridoksin (Vit B6) 25 mg Tablet 0 -
172 Piroksikam 10 mg Capsul - 0 -
173 Piroksikam 20 mg Capsul - 0 -
174 Prazikuantel 600 mg Tablet 0 -
175 Probenesid 500 mg Tablet - 0 -
176 Propanolol 10 mg Tablet - 0 -
177 Propiltiourasil 100 mg Tablet 0 -
178 Pseudoefedrin 30 mg tablet 0 -
180 Rifampisin 300 mg Kapsul 0 -
181 Risperidon 1 mg Tablet 0 -
182 Risperidon 2 mg Tablet 0 -
183 Salbutamol 2 mg Tablet - 0 -
185 Sefadroksil 250 mg Kapsul 0 -
188 Sefiksim sal selaput 200 mg Tablet - 0 -
190 Sianokobalamin (vit B12) 50 mcg Tablet - 0 -
191 Simetidin 200 mg Tablet - 0 -
194 Simvastatin 40 mg Tablet 0 -
196 Sitikolin 500 mg Tablet - 0 -
197 Spironolakton 100 mg Tablet 0 -
198 Spironolakton 25 mg Tablet - 0 -
200 Teofilin 100 mg Tablet - 0 -
201 Tetrasiklin 250 mg kapsul 0 -
202 Tetrasiklin 500 mg Kapsul - 0 -
206 Triheksifenidil 2 mg Tablet - 0 -
207 Valproat lepas lambat 250 mg Tablet 0 -
208 Valproat lepas lambat 500 mg Tablet 0 -
209 Valproat sal enterik 250 mg Tablet 0 -
210 Valsiklovir 500 mg Tablet 0 -
 Vit A-vit D-vit B1-vit B2-Vit B6-Vit B12-
nikotinamid-vit C-vit E-Kalsium
211 pantotenat-Biotin-asamfilat-Ferro tablet 0 -
fumarat-asam glutamat-Zink-Mangan-
Fluor-Iodium kombinasi

OBAT JENIS SYRUP 0 -

1 Ambroksol drop 15 mg/ml botol - 0 -
3 Amoksisilin drops 100 mg/ml Botol 0 -
4 Amoksisilin Syrup Kering 125 mg/5ml Botol - 0 -
5 Amoksisilin Syrup Kering 250 mg/5ml Botol - 0 -
7 Domperidon drop 5 mg/ml botol 0 -
9 Ergokalsiferol (vit D2) susp 10.000 IU/ml botol 0 -
10 Eritromisin Sy kering 200 mg / 5 ml Botol - 0 -
11 Ferro sulfat sy 150 mg/5ml botol 0 -
12 Haloperidol drop 2 mg/ml botol 0 -
14 Ibuprofen syrup 200mg/5ml Botol 0 -
15 Kaolin-pektin kombinasi sirup botol 0 -
16 Karbamazepin sy 100 mg/ 5 ml Botol 0 -
19 laktulosa sy 3,335 gr/5 ml botol 0 -
20 Lugol larutan botol 0 -
21 Mebendazol sy 100 mg /5 ml Botol 0 -
22 Metadon sy 50 mg/5ml botol 0 -
23 Methysoprinol sy 250 mg/5 ml botol 0 -
26 Metronidazol suspensi 125 mg / 5 ml botol 0 -
27 Nistatin susp 100.000 IU/ml botol 0 -
30 Parasetamol Drops 100 mg/ml Botol - 0 -

31 Parasetamol-CTM-guaifenesin-PPA sirup
kombinasi botol - 0 -

33 Pseudoefedrin drop 7,5 mg/0,8 ml botol 0 -

34 Pseudoefedrin sy 30 mg/5 ml botol 0 -
35 Salbutamol sy 2 mg/5 ml botol - 0 -
38 sefadroksil syr kering 250 mg/5 ml Botol 0 -
39 Sefiksim sy 100 mg / 5 ml Botol - 0 -

vit A-vit D-vit B1-vit B2-Vit B6-Vit B12-

nikotinamid-vit C-vit E-Kalsium
44 pantotenat-Biotin-asamfilat-Ferro botol 0 -
fumarat-asam glutamat-Zink-Mangan-
Fluor-Iodium kombinasi syrup

45 Zink drop 10 mg/ml botol 0 -

 46 zink syrup 10 mg/5 ml botol - 0 -
BAHAN MEDIS HABIS PAKAI DAN BAHAN LABORATORIUM 0 -
2 Alat Suntik sekali pakai 1 ml kotak - 0 -
3 Alat suntik sekali pakai 10 ml kotak 0 -
4 Alat Suntik sekali pakai 2,5 ml kotak - 0 -
5 Alat suntik sekali pakai 3 ml kotak - 0 -
6 Alat suntik sekali pakai 5 ml kotak - 0 -
7 alkohol swab kotak 0 -
8 Benang cat gut chromic 2/0 sachet 0 -
9 Benang cat gut plain 3/0 sachet 0 -
10 Benang Suture Silk 2/0 Pcs 0 -
11 Benang Suture Silk 3/0 Sachet 0 -
12 Benang suture silk 4/0 sachet 0 -
13 Blood lancet kotak 0 -
14 crepe/bandage 7,5 cm x 4,5 cm pcs 0 -
15 Etakridin laktat 0,1% botol 0 -
17 Handschon ginekologi kotak 0 -
18 Handschon non steril kotak 0 -
19 Handschon steril kotak 0 -
20 Hidrogen peroksida cairan 3% botol 0 -
21 Imersi oil 100 cc botol 0 -
22 Infusion set Anak Set 0 -
23 Infusion set Dewasa Set 0 -
28 IV cath no 26 pcs 0 -
29 Jarum Bedah set 0 -
30 K.Y. Jelly tube 0 -
31 Kalsium hipoklorit serbuk botol 0 -
32 Kapas 250 mg Bungkus - 0 -
34 Kapas Berlemak 500 mg Bungkus 0 -
35 Kapas Kompres 40/40 steril Kotak 0 -
36 Kasa gulung 40 x 80 cm Rol 0 -
37 Kasa Pembalut 2 M x 80 CM Rol - 0 -
38 Kasa Pembalut Hidropil 4M x 15 CM Rol 0 -
39 Kasa Pembalut Hidropil 4M x 3 CM Rol 0 -
40 Kasa steril 16x16 kotak 0 -
41 Klorheksidin lar 15% botol 0 -
 44 Masker N95 kotak 0 -
45 needle 24G x 25 mm kotak 0 -
46 needle 26G x 13 mm kotak 0 -
47 NGT no 16 pcs 0 -
48 NGT no 18 pcs 0 -
50 Oksigen ih tabung 0 -
54 Povidon Iodin lar 100 mg/ml botol 0 -
55 PP Test kotak 0 -
56 selang oksigen anak pcs 0 -
57 selang oksigen dewasa pcs 0 -
58 selang oksigen neonatus pcs 0 -
59 Strip asam urat botol 0 -
60 Strip Glukosa botol 0 -

61 Strip kolesterol botol 0 -

62 surgical blade (bisturi) kotak 0 -

63 tongue spatel (kayu) kotak 0 -
64 urine bag pcs 0 -
65 urine cath no 18 pcs 0 -
66 urine cath no 16 pcs 0 -
OBAT SUNTIK / INJEKSI / INHALASI ( AMPUL / VIAL ) 0 -
1 Aminofilin Injeksi 24 mg/ml Ampul - 0 -
2 ampisilin serbuk inj 1000 mg vial - 0 -
3 ampisilin serbuk inj 250 mg vial 0 -
4 asam traneksamat 100 mg/ml Ampul 0 -
7 Benzatin benzil penisilin 1,2 juta IU/ml Vial - 0 -
8 Benzatin benzil penisilin 2,4 juta IU/ml Vial - 0 -
9 Budesonid cairan ih 0,25 mg/ml Ampul 0 -
10 Budesonid cairan ih 0,5 mg/ml Ampul 0 -
11 Budesonid serb ih 100 mcg/dosis spray 0 -
12 Budesonid serb ih 200 mcg/dosis spray 0 -
13 D5 1/2 NS infus Botol 0 -
14 D5 1/4 NS infus Botol 0 -
17 Difenhidramin Injeksi 10 mg/ml Ampul - 0 -
18 Diltiazem serb inj 50 mg vial 0 -
19 Dopamin inj 40 mg/ml Ampul 0 -
20 Epinefrin Injeksi 0,1 % ml Ampul 0 -
22 fenitoin inj 50 mg/ml Ampul 0 -
24 Flufenazin inj 25 mg/ml Ampul 0 -
25 Furosemid inj 10 mg/ml Ampul 0 -
26 Glukosa 10 % Infus Botol - 0 -
27 Glukosa 40 % Infus Botol - 0 -
29 Haloperidol inj 5 mg/ml Ampul - 0 -
30 Haloperidol inj 50 mg/ml Ampul 0 -
31 Hepatitis B Imunoglobulin Inj 150 IU/1,5 ml Ampul 0 -
32 Hepatitis B Imunoglobulin Inj 220 IU/ml Ampul 0 -
33 Hidrokortison serb inj 100 mg vial 0 -
34 Hiosin butilbromida inj 20 mg/ml Ampul 0 -
35 Human tetanus imunoglobulin inj 250 IU Ampul 0 -
36 Human tetanus imunoglobulin inj 500 IU Ampul 0 -
37 Ipratropium bromida aerosol 20 mcg/puf spray 0 -
38 Ipratropium bromida cairan ih 0,025% Ampul 0 -
39 Ipratropium bromida-salbutamol cairan ih Ampul 0 -
40 Isoksuprin 2 mg/10 ml Ampul 0 -
41 KA-EN 3A infus botol 0 -
42 KA-EN 3B infus botol 0 -
43 Kanamisin serb injeksi 1000 mg vial 0 -
44 Ketamin inj 100 mg/ml Ampul 0 -
45 Ketamin inj 50 mg/ml Ampul 0 -
46 Ketoprofen inj 25 mg/ml Ampul 0 -
47 Ketorolac inj 25 mg/ml Ampul - 0 -
48 Klonidin inj 150 mcg/ml Ampul 0 -
50 Klorpromazin Injeksi 5 mg/ml Ampul 0 -
56 Nalokson inj 0,4 mg/ml Ampul 0 -
58 Natrium Tiosulfat inj 25% Ampul 0 -
61 Papaverin Injeksi Ampul 0 -
63 Petidin Injeksi 50 mg/2 ml Ampul - 0 -
64 Piridoksin (vit B6) inj 50 mg/ml Ampul 0 -
65 Prokain benzil penisilin serb inj 3 juta IU vial 0 -
67 Ringer asetat infus botol 0 -
69 Salbutamol cairan ih 1 mg/ml Ampul 0 -
71 Sefotaksim serb inj 500 mg Vial - 0 -
 72 Seftriakson serb inj 1000 mg vial - 0 -
73 Serum Anti Bisa Ular I Injeksi 50 ml Ampul 0 -
74 Serum anti rabies inj 100 IU/ml Ampul 0 -
75 Serum anti rabies inj 200-400 IU/ml Ampul 0 -
76 Serum anti tetanus (ATS) inj 1.500 IU/ml Ampul 0 -
77 Serum anti tetanus (ATS) inj 10.000 IU/ml Ampul 0 -
78 Serum anti tetanus (ATS) inj 20.000 IU/ml Ampul 0 -
79 Serum anti tetanus (ATS) inj 5.000 IU/ml Ampul 0 -
81 Sitikolin inj 250 mg/2 ml Ampul 0 -
82 Streptomisin serb injeksi 1000 mg vial 0 -
83 Terbutalin cairan ih 2,5 mg/ml Ampul 0 -
84 Terbutalin inj 0,5 mg/ml Ampul 0 -
85 Tetanus toxoid inj Ampul 0 -
86 Tramadol inj 100 mg/2 ml Ampul - 0 -
87 Triamsinolon asetonid inj 10 mg/ml Ampul 0 -
88 Tuberkulin serb inj 2 TU/0,1 ml Ampul 0 -

89 Vit B1 100 mg-Vit B6 100 mg-Vit B12 5000

mcg kombinasi injeksi Ampul 0 -

OBAT LUAR ( TUBE,POT DAN SUPPO ) 0 -

Anti fungi komb : as benzoat+as salisilat
3 salep kulit tube 0 -

4 Anti Hemoroid kombinasi Suppo - 0 -

5 Asam asetat tetes telinga 2% botol 0 -
6 Asam salisilat lar 0,1% Botol 0 -
7 Asam salisilat salep kulit 10% tube 0 -
8 Asam salisilat salep kulit 2% tube 0 -
9 Asam salisilat salep kulit 5% tube 0 -
10 Atropin tetes mata 1% botol 0 -

12 Betametason 0,1%+Neomisin sulfat 0,5%

salep kulit kombinasi tube 0 -

14 Betametason krim 0,1 % tube 0 -

15 Betametason salep 0,1 % tube 0 -
16 Betametason tetes mata 1 mg/ml botol 0 -
17 Bisakodil 10 mg suppo 0 -
18 Bisakodil 5 mg Suppo 0 -
19 Boraks gliserin cairan botol 0 -
21 Diazepam enema 10 mg/ 2,5 ml suppo 0 -
23 Diklofenak dietilamin gel 10 mg/gr tube 0 -
25 Fluoresein tts mata 2,5 mg/ml botol 0 -
26 Framisetin sulfat tulle 1% lembar 0 -
29 Gentamisin salep Kulit 0,1% Tube - 0 -
30 Gentian Violet Larutan 1 % Botol 0 -
31 Gliserin cairan obat luar 100mg/ml botol 0 -
32 Heparin sodium gel 20.000 IU/100 gr tube 0 -
34 Ichtammolum salep kulit pot 0 -
35 Kalamin lotio Botol 0 -
36 Kalium Permagnat Serbuk Pot 0 -
37 Karbogliserin tetes telinga 10% botol 0 -
39 Ketokonazol scalp sol 2% botol 0 -
40 Ketoprofen 100 mg rectal Suppo 0 -
41 Kloramfenikol tetes telinga 0 -
42 Kloramphenicol Salap Mata 1% Tube 0 -
43 Kloramphenicol Salep kulit 2% tube 0 -
44 Kloramphenicol tetes mata 0,5% botol - 0 -
45 Kloramphenicol tetes mata 1% botol 0 -
46 Klotrimazol tab vaginal 100 mg Tablet 0 -
47 Lidokain gel 2% tube 0 -
48 liquor carbonis detergens lar 5% botol 0 -
49 Mentol-eugenol-metil salisilat krim tube 0 -

50 Metronidazol 500 mg + Nistatin 100.000

IU kombinasi suppo 0 -

51 Metronidazol ovula 500 mg ovula 0 -

52 Metronidazol sup 500 mg tube 0 -
56 Natrium diklofenak tts mata 1 mg/ml botol 0 -
57 Natrium fusidat salep 2% tube 0 -

58 Natrium klorida-Kalium klorida tetes mata

kombinasi botol 0 -

61 Ofloksasin tetes telinga 3% botol 0 -

63 Oksimetazolin tetes hidung 0,05% botol 0 -
64 Olopatadin tetes mata 0,1% Botol 0 -
68 Permetrin krim 5% tube 0 -
69 Pilokarpin tetes mata 2% botol 0 -
70 Plasenta extract-Neomisin salep kulit Tube 0 -
71 Podofilin tingtur 25% botol 0 -
 72 Polimiksin-Neomisin-deksametason tetes
mata kombinasi botol 0 -
73 Polimiksin-Neomisin-Fludrokortison- botol 0 -
Lidokain tetes telinga kombinasi
74 Povidon Iodin mouthwash 100 ml botol 0 -
75 Salep 2-4 Pot - 0 -
76 Siprofloksasin tetes mata 3% botol 0 -
77 Tetrakain 0,5% tetes mata botol 0 -
78 Tetrasiklin salep kulit 3% tube 0 -

79 Thymol 10 mg, ol. methae 20 mg,

champora 60 mg tetes telinga botol 0 -
80 Timolol tetes mata 0,25% botol 0 -
81 Timolol tetes mata 0,5% botol 0 -
82 Triamsinolon asetonid 1 mg ointment kulit tube 0 -
83 Urea krim 10% tube 0 -
84 Urea krim 20% tube 0 -
OBAT PROGRAM ( PAKET,SET,BUNGKUS) 0 -
1 Albendazol susp 200 mg/ 5 ml Botol - 0 -
3 Ampisilin injeksi 1000 mg vial 0 -
4 Artesunat inj 60 mg Vial 0 -
5 ARV efavirenz 200 mg Tablet 0 -
6 ARV efavirenz 600 mg Tablet 0 -
7 ARV kombinasi FDC anak Tablet 0 -
8 ARV lamivudin150 mg Tablet 0 -
9 ARV lopinavir-ritonavir Tablet 0 -
10 ARV nefirapin 200 mg Kapsul 0 -
11 ARV tenofovir 300 mg Tablet 0 -
12 ARV tenofovir-emtrisitabin Tablet 0 -
13 ARV tenofovir-lamivudin-efavirenz Tablet 0 -
14 ARV zidofudin 100 Kapsul 0 -
15 ARV zidovudin-lamivudin Tablet 0 -
16 Azithromicyn 500 mg Tablet 0 -
18 Dietil Karbamazin 100 mg Tablet - 0 -
19 Doksisiklin 100 mg Kapsul - 0 -
20 Fenobarbital Injeksi 50 mg/ml Ampul - 0 -
21 Ferro Sulfat sal selaput 300 mg tablet 0 -
22 Fitomenadion (Vit K1) Injeksi 2 mg/ml Ampul - 0 -
24 Gentamisin inj 40 mg/ml Ampul 0 -
25 Kalsium glukonat inj 10% Ampul 0 -
26 Kontrasepsi AKDR Copper T set 0 -
27 Kontrasepsi AKDR IUD Cu T 380 A set 0 -
28 Kontrasepsi AKDR IUD levonorgestrel set 0 -
29 Kontrasepsi implan etonogestrel implan 0 -
30 Kontrasepsi implan levonogestrel implan 0 -
31 Kontrasepsi oral kombinasi Tablet 0 -
32 Kontrasepsi oral linestrenol 0,5 mg tablet 0 -

33 Kontrasepsi parenteral medroksi

progesteron asetat inj 150 mg/3 ml vial 0 -

34 Kontrasepsi parenteral siklofem vial 0 -

35 Kuinin 200 mg Tablet 0 -

36 Kuinin inj 25% Ampul 0 -
37 Levotiroksin 50 mcg tablet 0 -
38 Magnesium Sulfat 40% flakon - 0 -
41 Mineral mix sachet 0 -
42 OAT anak 2KDT (FDC) Tablet 0 -
43 OAT anak 3KDT (FDC) Tablet 0 -
44 OAT anak Kombipak A paket 0 -
45 OAT anak Kombipak B paket 0 -
46 OAT dewasa 2KDT (FDC) Tablet 0 -
47 OAT dewasa 4KDT (FDC) Tablet 0 -
48 OAT dewasa Kombipak II paket 0 -
49 OAT dewasa Kombipak III paket 0 -
51 Prednison 5 mg Tablet - 0 -
52 Primakuin 15 mg Tablet - 0 -
53 Retinol (Vit A) 100.000 IU kapsul 0 -
54 Retinol (Vit A) 200.000 IU kapsul 0 -
55 Tetrasiklin salep mata 1% tube 0 -
56 Vaksin BCG inj 0,75 mg/ml + pelarut Ampul 0 -
57 Vaksin bivalen OPV drop 10 dosis 0 -
58 Vaksin Campak inj + pelarut Ampul 0 -
59 Vaksin DT inj 40/15 If per ml Ampul 0 -
60 Vaksin hepatitis rekombinan 0,5 ml Uniject 0 -
61 Vaksin kombinasi DPT-HB-Hib Inj Ampul 0 -
62 Vaksin Measless Rubella Inj 0,5 ml Ampul 0 -
63 Vaksin polio IPV inj 0,5 ml Ampul 0 -
64 Vaksin rabies inj + booster Ampul 0 -
65 Vaksin rabies inj 2,5 IU Ampul 0 -
 66 Vaksin Td Inj 15/4 lf per ml Ampul 0 -
OBAT GIGI / PERAWATAN GIGI 0 -
1 articulating paper 0 -
2 Aquadest 500 ml botol 0 -
3 Bahan tumpatan sementara lar/serbuk 0 -
5 Eugenol Cairan 0 -
6 Ferrakrilum cairan 1% 0 -
7 Fluor topikal 0 -
8 formokresol cairan 0 -
9 Glass Ionomer ART serb/larutan 0 -
10 Gutta percha-paper points 15-40 mm 0 -
11 Gutta percha-paper points 45-80 mm 0 -
12 Kalsium Hidroksida Pasta 0 -
13 Klorfenol kamfer mentol (CHKM) cairan 0 -
14 Klorheksidin lar 0,2% 0 -

15 Kombinasi : deksametason asetat-thymol-

paraklorfenol-campor 0 -

16 Kombinasi : lidokain-medisinal creosote

phenol-eugenol-benzil alkohol 0 -

17 Kombinasi : tramsinolon asetonid -

dementilklortetrasiklin pasta 0 -

18 Komposit resin set 0 -

20 Lidokain salep 5% tube 0 -
21 Lidokain spray oral 10% botol 0 -
22 Natrium hipoklorit 5% 0 -
23 Pasta devitalisasi (non arsen) 0 -
24 Pasta pengisi saluran akar 0 -
25 surgical ginggival pack pasta 0 -
LAMPIRAN TAMBAHAN
1 Abate pcs 0 -
2 Alprazolam 0,5 mg tablet 0 -
3 Aminofusin PAED botol 0 -
9 Berotec 0,1% solution pcs - 0 -
12 Biosat - 1,5 (ATS 1500 UI) ampul 0 -
14 Catapres 0,15 mg/ml ampul 0 -
16 Clopidogrel 75 mg tablet 0 -
17 Combivent 2,5 ml pcs 0 -
18 Concor 1.25 mg tablet - 0 -
19 Concor 10 mg tablet - 0 -
20 Contramo tablet 0 -
22 Elizac 20 mg tablet 0 -
23 Ezelin insulin pen 0 -
24 Fetik suppo suppo - 0 -
25 Fucilex krim tube 0 -
26 Gavistal drop botol 0 -
27 Gliserol botol - 0 -
28 Haldol Decanoas ampul 0 -
29 Hico Gel tube - 0 -
30 Hytroz 1 mg tablet 0 -
33 Isotic 0,50 Tetes mata botol 0 -
35 Laxadine emulsi 736 mg botol - 0 -
36 Lexapram syrup botol 0 -
37 Manitol 20 % botol 0 -
40 Noza Kaplet tablet - 0 -
42 Otsu KCL 7,46% botol 0 -
43 Oxytetracyclin Salep Kulit tube 0 -
44 Pan Amin G 500 ml botol 0 -
46 Pehavask 10 mg tablet 0 -
47 Penicillin G Cristal vial 0 -
49 Recodryl Injeksi ampul 0 -
50 Saltam 4 mg tablet 0 -
51 Sancorbin injeksi ampul 0 -
52 Sikzonoate injeksi ampul 0 -
53 Soft U-Derm cream tube - 0 -
54 Suprafenid 100 mg suppo 0 -
55 Tarivid Otic Solution botol - 0 -
58 Ventolin Nebules 2,5 mg pcs - 0 -
60 Vitamin K1 injeksi ampul 0 -
62 Voluven 6% botol 0 -
BMHP TAMBAHAN 0 -
2 Folley Cath.2 way No.12 pcs 0 -
3 Folley Cath.2 way No.18 pcs 0 -
 4 Folley Cath.2 way No.6 pcs 0 -
TIDAK ADA DALAM LPLPO FORM BARU 0 -
2 Propanolol 40 mg Tab - 0 -
4 Yodium Povidon Larutan 10% 1L Btl - 0 -
5 Antalgin Injeksi Amp - 0 -
9 Euthyrox 50 ug ( Levothyroxine ) Tab - 0 -
10 Gemfibrozil 300 mg Caps - 0 -
11 Gliquidon Tab - 0 -
13 Ofloxacin 200 mg Tab - 0 -
15 Pehavral (Multivitamin Mineral ) Tab - 0 -
18 Bisolvon Syrup Btl - 0 -
19 Crofed Syrup Btl - 0 -
20 Dextrofen ( Dextro, Dexc, phenil ) Btl - 0 -
21 Nifudiar Btl - 0 -
23 Acdat Cream ( Fusidic Acid ) Tube - 0 -
25 Synorcus ( Flucinolone Acetonide ) Tube - 0 -
27 Avamys Nasal Spray Btl - 0 -
28 Cendo lyteers T.M Btl - 0 -
35 Canula Oxygen Neonate pcs - 0 -
36 Canula Oxygen Anak pcs - 0 -
37 Canula Oxygen Dewasa pcs - 0 -
40 Damesilk 3.0 75 x 26 mm Box - 0 -
41 Damesilk 4.0 45 x 19 mm Box - 0 -
42 Daryantulle Box - 0 -
44 Masker Nebulizer Anak pcs - 0 -
45 Masker Nebulizer Dewasa pcs - 0 -
49 Becefort ( Multivitamin ) Btl - 0 -
JENIS TABLET /KAPSUL/KAPLET
1 Allilestrenol 5 mg Tablet
51 Metamizole 500 mg Tab

UMUM JAMKESDA
Tidak BPJS
JUMLAH KUJUNGAN RESEP Bayar JKP
Bayar
 JUMLAH KUJUNGAN RESEP

498 119 678

Yang Meminta Mengetahui/ Menyetujui

Kepala UPT.Puskesmas Kepala Dinkes II/ GFK

Sukirno, SKM.,M.AP. Hj. Ratnawati, S.Si., Apt.

NIP. 19750306 199503 1 002 NIP. 19610808 200701 2 005
PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
FORM : LPLPO PUSKESMAS
: SEPTEMBER 2019 NO / TGL DOKUMEN
AN/PERIODE : OKTOBER 2019 GFK
PUSK
DINKES

Jumlah
April Mei Juni Juli Agustus September Pemakaian

7 8 9 10 11 12
2600 2400 3000 3000 4400 3500 25300
2500 2400 1600 3100 3000 2300 18700
2100 1700 1700 1600 2200 1900 17600
6300 800 500 500 3140 600 17340
1400 1100 2000 1700 1500 2400 15750
1500 - - 0 0 2400 10900
1200 600 700 1200 1100 400 9200
- - - 1400 2600 2700 6700
- 1200 800 400 1500 100 6400
500 300 600 1000 700 700 6300
100 300 300 400 600 1100 5100
600 900 1100 0 0 0 5000
1500 1000 1000 0 0 0 5000
100 - 300 800 1200 1800 4500
200 200 500 500 1100 600 4400
200 300 200 150 650 500 3900
200 300 300 100 500 200 3600
500 300 100 300 800 400 3100
- 200 500 0 800 900 3100
600 - - 0 0 0 2900
- 300 1700 0 0 0 2800
420 120 240 150 650 500 2650
100 - - 100 100 400 2100
100 300 300 100 400 300 2100
260 260 360 200 240 300 2100
300 400 100 100 0 0 2000
300 300 400 300 0 0 1900
200 - 300 500 300 100 1800
- - - 0 600 600 1800
- 120 120 180 360 600 1740
- - - 0 1200 500 1700
- 200 100 500 200 0 1700
- 100 - 400 400 0 1500
60 30 180 270 300 300 1410
200 - - 500 200 100 1300
200 300 - 0 0 0 1200
300 400 - 0 0 0 1200
300 - 200 0 0 100 1100
100 200 - 200 100 200 1100
- - - 0 0 0 1000
200 150 - 100 250 0 1000
- - - 0 0 0 800
- - 300 0 200 200 800
150 30 - 0 0 0 750
- - - 100 0 200 700
- - 300 0 200 0 600
- - - 200 0 0 600
- - 100 300 0 0 500
- - 200 0 300 0 500
125 100 - 0 0 0 500
500 - - 0 0 0 500
70 - 80 30 100 40 490
100 100 - 0 0 0 475
40 50 100 75 85 40 450
90 30 20 30 60 90 410
85 20 80 100 0 0 409
200 - 200 0 0 0 400
- - - 0 0 0 400
50 - - 100 50 0 400
- - 200 100 0 0 300
- - 100 0 100 0 300
40 7 20 80 40 0 257
- - - 0 0 0 240
48 - - 0 0 48 240
55 30 35 0 40 0 230
- - - 0 0 210 210
- - 200 0 0 0 200
- - - 0 0 0 200
 - 25 25 50 0 50 200
- 10 80 0 0 100 200
80 20 20 0 0 20 200
- - - 200 0 0 200
- - - 0 0 0 180
- - - 0 0 120 180
15 20 20 17 40 17 171
- - - 150 0 0 150
- 120 - 0 0 0 150
- 144 - 0 0 0 144
- 5 - 63 25 0 138
- 10 10 70 0 0 130
- - - 0 0 0 128
- - - 30 0 0 120
16 - - 39 35 0 115
- - 10 0 30 40 110
- 10 15 25 9 0 109
- 5 - 6 52 20 104
- - - 101 0 0 101
- - - 100 0 0 100
- - - 0 0 0 100
- - - 0 0 0 100
100 - - 0 0 0 100
- 10 - 20 20 0 100
- - - 0 0 0 100
- - - 20 11 14 100
- - - 0 100 0 100
- - - 100 0 0 100
- - - 0 0 0 100
- - - 0 0 0 96
83 - - 0 0 0 96
30 - 30 0 30 0 90
- 16 8 14 10 18 90
- - - 0 90 0 90
- - - 90 0 0 90
- 24 24 0 0 16 88
- - - 0 0 0 85
- 10 40 0 0 0 80
8 8 16 0 24 8 80
8 8 25 0 0 0 75
- 20 - 0 10 0 68
- - - 5 20 40 65
- - - 0 58 0 62
6 - - 6 13 12 55
- - - 0 0 0 50
- - - 0 0 0 50
- - - 0 0 0 50
- - - 0 0 0 50
- - - 0 0 0 50
- - - 0 50 0 50
- - 10 22 0 5 50
- - - 0 0 0 50
- - - 0 24 0 49
- - 7 17 24 0 48
6 6 - 0 35 0 47
10 24 - 0 0 0 47
3 7 8 0 4 0 47
- 5 - 0 24 0 39
36 - - 0 0 0 36
18 - - 0 0 13 33
- - - 0 0 0 30
2 4 - 6 3 3 30
- 5 - 0 0 0 28
4 6 - 0 0 0 26
1 3 1 0 3 1 26
1 9 - 0 3 0 25
6 - - 1 16 0 25
- 24 - 0 0 0 24
- - 24 0 0 0 24
20 - - 0 0 0 24
- - - 24 0 0 24
- - - 23 0 0 23
- 18 - 0 0 0 23
- - - 20 0 0 20
1 - 3 1 0 12 20
- - 20 0 0 0 20
- - - 0 0 10 20
- - 3 3 13 0 19
- - 18 0 0 0 18
- 7 - 0 0 0 16
10 - 4 0 0 0 14
- - - 0 5 0 11
- - - 0 10 0 10
- - 10 0 0 0 10
- - 10 0 0 0 10
- - - 0 10 0 10
10 - - 0 0 0 10
- 10 - 0 0 0 10
- - - 0 0 0 8
- 1 1 1 2 0 6
- - - 0 0 4 6
6 - - 0 0 0 6
2 - - 0 4 0 6
2 - 2 0 1 0 6
- - 5 0 0 0 5
1 - 1 1 2 0 5
- 1 2 1 1 0 5
- 4 - 0 0 0 4
- - - 0 0 0 4
1 - - 0 0 0 4
- - 3 0 0 0 4
- 4 - 0 0 0 4
- - - 0 0 3 3
- - - 0 0 3 3
- - 2 0 0 0 3
- 1 - 0 0 0 3
- - 1 0 0 0 3
- - - 3 0 0 3
- - 3 0 0 0 3
- - - 1 0 0 3
- - - 0 0 1 3
- 2 - 0 0 0 2
- 0 0 0 0 2 2
- - - 0 2 0 2
- - 2 0 0 0 2
- - 1 0 0 0 1
- - - 0 0 1 1
- - - 0 0 1 1
- - - 0 0 1 1
- - - 0 0 1 1
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -

- - - 0 0 0 -

- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -

- - - 0 0 0 -

- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -

- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -

- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -

- - - 0 0 0 -

- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
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- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -
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- - - 0 0 0 -
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- - - 0 0 0 -
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- - - 0 0 0 -
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- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
- - - 0 0 0 -
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JAMKESDA
Total Item Obat Jumlah Item Obat % Penggunaan Obat
Jumlah
sktm Dalam R/ Generik Generik
1295 71 55 129%

Yang Menyerahkan Yang Menerima

Petugas GFK Petugas Puskesmas

Efrizal, S.Farm., Apt. Arif Mahendra, S.Farm., Apt.

NIP. 19830405 201001 1 029 NRTK2D. 6408.19910806.2017.6377
M : LPLPO PUSKESMAS
TGL DOKUMEN

Masa ED KETERAN
GAN

11 12
Expire
Expire

Expire
enggunaan Obat
Generik
 129%

Yang Menerima
Petugas Puskesmas

rif Mahendra, S.Farm., Apt.

K2D. 6408.19910806.2017.6377