LAPORAN PEMAKAIAN DAN LEMBAR

PUSKESMAS : KARANGAN PELAPORAN BULAN

KECAMATAN : KARANGAN PERMINTAAN BULAN/PE
KABUPATEN : KUTAI TIMUR

STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
AWAL

1 2 3 4 5 6
JENIS TABLET /KAPSUL/KAPLET
1 Allilestrenol 5 mg Tablet 0
2 Allopurinol 100 mg Tablet 700 700
3 Allopurinol 300 mg Tablet 0
4 Ambroksol 30 mg Tablet 600 600
5 Aminofilin 150 mg Tablet 0
6 Aminofilin 200 mg Tablet 0
7 Amitriphyllin 25 mg Tablet 0
8 Amlodipin 10 mg Tablet 1110 1110
9 Amlodipin 5 mg Tablet 300 300
10 Amoksisilin 250 mg Tablet 0
11 Amoksisilin 500 mg Tablet 200 2000 2200
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
17 Asam askorbat (vitamin C) 50 mg Tablet 3000 3000
18 Asam folat 0,4 mg Tablet 0
19 Asam folat 1 mg Tablet 0
20 Asam folat 5 mg Tablet 0
21 Asam Mefenamat 250 mg Capsul 0
22 Asam Mefenamat 500 mg Tablet 1000 2000 3000
23 Asam traneksamat 500 mg Tablet 0
24 Asam ursodeoksikolat 250 mg Kapsul 0
25 Asiklovir 200 mg Tablet 300 500 800
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
33 Betahistin 6 mg Tablet 450 450
34 Bisakodil 5 mg Tablet 90 90
35 Bisoprolol 5 mg Tablet 0
36 Bromheksin 8 mg tablet 0
37 Dapson 100 mg Tablet 0
38 Deksametason 0,5 mg Tablet 200 2000 2200
39 Dekstromenorfan 15 mg Tablet 0

40 Dekstrometorfan-Gliseril guaikolat-PPA- Tablet 0

CTM kombinasi
41 Diazepam 2 mg Tablet 0
42 Diazepam 5 mg Tablet 0
43 Digoksin 0,25 mg Tablet 1400 1400
44 diltiazem 30 mg Tablet 0
45 Dimenhidrinat 50 mg Tablet 200 200
46 Domperidon 10 mg Tablet 700 700
47 Efedrin 25 mg Tablet 0
48 Ekstrak graptofili-sitrus bioflavonoid kapsul 0
49 Ekstrak kurkuma 20 mg tablet 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
54 Eritromisin 500 mg tablet 200 200
55 Etambutol 250 mg Tablet 0
56 Etambutol 400 mg Tablet 0
57 famotidin 20 mg Tablet 0
58 Fenitoin 100 mg Kapsul 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
66 Ferro sulfat-asam folat (kombinasi) Tablet 0
67 Fitomenadion (Vit K1) 10 mg Tablet 0
68 Fluoksetin 10 mg Kapsul 0
69 Fluoksetin 20 mg Kapsul 0
70 Furosemid 40 mg Tablet 500 500
71 Gabapentin 300 mg Tablet 0
72 Glibenklamid 2,5 mg Tablet 0
73 Glibenklamid 5 mg Tablet 300 300
74 Glimipiride 1 mg Tablet 0
 75 Glimipiride 2 mg Tablet 0
76 Glipizid 5mg Tablet 0
77 Gliseril guaikolat 100 mg Tablet 400 400
78 Gliseril trinitrat 0,5 mg Tablet 0
79 Griseofulvin 125 mg Tablet 700 700
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 100 100
86 Hiosin butilbromida 10 mg Tablet 0
87 Hiosin butilbromida-parasetamol komb Tablet 0
88 Ibuprofen 200 mg Tablet 0
89 Ibuprofen 400 mg Tablet 600 1000 1600
90 Irbesartan 300 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 1100 1100
95 Kalium diklofenak 50 mg Tablet 0
96 Kalium klorida 600 mg Tablet 0
97 Kalsium karbonat 500 mg Tablet 0
98 Kalsium Laktat (Kalk) 500 mg Tablet 100 1500 1600
99 Kaolin-pektin komb Tablet 0
100 Kaptopril 12,5 mg Tablet 500 500
101 Kaptopril 25 mg Tablet 900 900
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
106 Ketokonazol 200 mg Tablet 700 700
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
112 Klopidogrel 75 mg Tablet 0
113 Kloramfenikol 250 mg kapsul 0
114 Kloramfenikol 500 mg Kapsul 0
115 Klorfeniramin 4 mg Tablet 1200 1200
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
121 Kodein 10 mg Tablet 0
122 Kodein HCL 10 mg Tablet 144 144
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

127 Laktobasilus-bifidobakterium longun- sachet 0

streptokokus serbuk kombinasi
128 Lansoprazole 30 mg Kapsul 0
129 Levofloksasin sal selaput 500 mg Tablet 100 100
130 Lisonopril 10 mg Tablet 0
131 Loperamid 2 mg Tablet 300 300
132 Loratadin 10 mg Tablet 600 600
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
142 Metformin 500 mg Kaplet 0
143 Metformin 850 mg Tablet 0
144 Methysoprinol 500 mg Tablet 0
145 Metil Ergometrin 0,125 mg Tablet 200 200
146 Metildopa 250 mg Tablet 0
147 Metilprednisolon 16 mg Tablet 0
148 Metilprednisolon 4 mg Tablet 600 600
149 Metilprednisolon 8 mg Tablet 0
150 Metoklopramid 10 mg Tablet 0
151 Metoklopramid 5 mg Tablet 2500 2500
152 Metronidazol 250 mg Tablet 200 200
153 Metronidazol 500 mg Tablet 400 500 900
154 Misoprostol 200 mcg tablet 0
155 n-Asetil sistein 200 mg kapsul 0
156 Natrium bikarbonat 500 mg Tablet 0
157 Natrium Diclofenat 25 mg Tablet 1100 1100
158 Natrium Diclofenat 50 mg Tablet 0
159 Nifedipin 10 mg Tablet 200 200
160 Nistatin sal gula 500.000 IU Tablet 0
161 Nitrofurantoin 50 mg Tablet 0
162 Omeprazole 20 mg Kapsul 0
163 Ondansetron 8 mg Tablet 0
164 Papaverin 40 mg Tablet 0
165 Parasetamol 500 mg Tablet 600 3000 3600

166 Parasetamol-gliseril gualikolat-PPA-CTM tablet 0

kombinasi
167 Piracetam 800 mg Tablet 0
168 Pirantel Pamoat 125 mg Tablet 0
169 Pirantel Pamoat 250 mg Tablet 0
170 Piridoksin (Vit B6) 10 mg Tablet 400 400
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
179 Ranitidin 150 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
184 Salbutamol 4 mg Tablet 700 700
185 Sefadroksil 250 mg Kapsul 0
186 Sefadroksil 500 mg Kapsul 800 800
187 Sefiksim sal selaput 100 mg Tablet 0
188 Sefiksim sal selaput 200 mg Tablet 200 200
189 Setirizin tab 10 mg Tablet 300 300
190 Sianokobalamin (vit B12) 50 mcg Tablet 700 700
191 Simetidin 200 mg Tablet 0
192 Simvastatin 10 mg Tablet 1560 1560
193 Simvastatin 20 mg Tablet 900 900
194 Simvastatin 40 mg Tablet 0
195 Siprofloksasin sal selaput 500 mg Tablet 700 700
196 Sitikolin 500 mg Tablet 0
197 Spironolakton 100 mg Tablet 0
198 Spironolakton 25 mg Tablet 0
199 Sukralfat 500 mg Tablet 200 200
200 Teofilin 150 mg Tablet 600 600
201 Tetrasiklin 250 mg kapsul 0
202 Tetrasiklin 500 mg Kapsul 100 100
203 Tiamfenikol 500 mg Tablet 0
204 Tiamin (Vit B1) 50 mg Tablet 1000 1000
205 Tramadol tab 50 mg tablet 296 296
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
212 Vit B1 100 mg-Vit B6 200 mg-Vit B12 200 tablet 0
mcg kombinasi
213 Vitamin B Kompleks Tablet 4000 4000
OBAT JENIS SYRUP
1 Ambroksol drop 15 mg/ml botol 0
2 Ambroksol sy 15 mg/5 ml Botol 110 110
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
6 Antasida Suspensi Botol 0 0
7 Domperidon drop 5 mg/ml botol 0
8 Domperidon Syrup 5 mg/5ml Botol 80 80
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
13 Ibuprofen syrup 100mg/5 ml Botol 53 53
14 Ibuprofen syrup 200mg/5ml Botol 0
15 Kaolin-pektin kombinasi sirup botol 0
16 Karbamazepin sy 100 mg/ 5 ml Botol 0
17 Kloramfenikol Suspensi 125 mg/5 ml Botol 50 50
18 Kotrimoksazol Suspensi 240 mg/ 5 ml Botol 95 95
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
24 Metoklopramid sy 5 mg/5 ml Botol 0
25 Metoklopramid drop 2 mg/ml Botol 0
26 Metronidazol suspensi 125 mg / 5 ml botol 0
27 Nistatin susp 100.000 IU/ml botol 0
28 Obat Batuk Hitam Sy Botol 75 75
29 Parasetamol 120 mg / 5 ml Syrup Botol 0
30 Parasetamol Drops 100 mg/ml Botol 0

31 Parasetamol-CTM-guaifenesin-PPA sirup botol 0

kombinasi
32 Pirantel pamoat susp 125 mg / 5 ml 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
36 Salbutamol-Guaifenesin kombinasi sy botol 0
37 sefadroksil syr kering 125 mg/5 ml Botol 0
38 sefadroksil syr kering 250 mg/5 ml Botol 0
39 Sefiksim sy 100 mg / 5 ml Botol 0
40 Setrizin Syrup 5 mg/5ml Botol 40 40
41 Sukralfat Susp 500 mg/5 ml Botol 0
42 Tiamfenikol sy 125 mg/5 ml botol 0
 43 Valproat sy 250 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
1 Air untuk Injeksi 25 ml Botol 18 24 42
2 Alat Suntik sekali pakai 1 ml kotak 2 2
3 Alat suntik sekali pakai 10 ml kotak 1 1
4 Alat Suntik sekali pakai 2,5 ml kotak 0
5 Alat suntik sekali pakai 3 ml kotak 1 3 4
6 Alat suntik sekali pakai 5 ml kotak 3 3
7 alkohol swab kotak 3 3
8 Benang cat gut chromic 2/0 sachet 12 12
9 Benang cat gut plain 3/0 sachet 24 24
10 Benang Suture Silk 2/0 Pcs 36 36
11 Benang Suture Silk 3/0 Sachet 0
12 Benang suture silk 4/0 sachet 0
13 Blood lancet kotak 2 2
14 crepe/bandage 7,5 cm x 4,5 cm pcs 0
15 Etakridin laktat 0,1% botol 0
16 Etanol cairan 70% botol 0
17 Handschon ginekologi pcs 5 5
18 Handschon non steril kotak 1 9 10
19 Handschon steril Pcs 10 10 20
20 Hidrogen peroksida cairan 3% botol 0
21 Imersi oil 100 cc botol 0
22 Infusion set Anak Set 60 60
23 Infusion set Dewasa Set 100 100
24 IV cath no 20 pcs 0
25 IV cath no 18 pcs 50 50 100
26 IV cath no 22 pcs 100 100
27 IV cath no 24 pcs 0
28 IV cath no 26 pcs 20 20
29 Jarum Bedah set 0
30 K.Y. Jelly tube 0
31 Kalsium hipoklorit serbuk botol 0
32 Kapas 250 mg Bungkus 0
33 Kapas 1000 gram Bungkus 3 3
34 Kapas Berlemak 500 mg Bungkus 0
35 Kapas Kompres 40/40 steril Kotak 0
36 Kasa gulung 40 x 80 cm Rol 5 5
37 Kasa Pembalut 2 M x 80 CM Rol 5 5
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 2 40 42
41 Klorheksidin lar 15% botol 0
42 Masker earloop kotak 2 5 7
43 Masker kerudung/hijab kotak 5 5
44 Masker N95 kotak 1 1
45 needle 24G x 25 mm kotak 0 1 1
46 needle 26G x 13 mm kotak 1 1
47 NGT no 16 pcs 5 5
48 NGT no 18 pcs 5 5
49 Nonwoven fixation 20 cm x 5 M roll 1 1
50 Oksigen ih tabung 0
53 Plester uk 5 cm roll 10 10
54 Povidon Iodin lar 100 mg/ml botol 1 1
55 PP Test kotak 1 1
56 selang oksigen anak pcs 4 4
57 selang oksigen dewasa pcs 4 4
58 selang oksigen neonatus pcs 3 3
59 Strip asam urat botol 3 3
60 Strip Glukosa botol 3 3
61 Strip kolesterol botol 3 3
62 surgical blade (bisturi) kotak 0
63 tongue spatel (kayu) kotak 0
64 urine bag pcs 10 10
65 urine cath no 18 pcs 13 13
66 urine cath no 16 pcs 0
OBAT SUNTIK / INJEKSI / INHALASI ( AMPUL / VIAL ) 0
1 Aminofilin Injeksi 24 mg/ml Ampul 30 30
2 ampisilin serbuk inj 1000 mg vial 0
3 ampisilin serbuk inj 250 mg vial 0
4 asam traneksamat 100 mg/ml Ampul 0
5 Asam traneksamat 50 mg/ml Ampul 10 10
6 Atropin Injeksi 0,25 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 40 40
14 D5 1/4 NS infus Botol 0
15 Deksametason Injeksi 5 mg/ml Ampul 165 165
16 Diazepam Injeksi 5 mg/ml Ampul
17 Difenhidramin Injeksi 10 mg/ml Ampul 0 30 30
18 Diltiazem serb inj 50 mg vial 0
19 Dopamin inj 40 mg/ml Ampul 0
20 Epinefrin Injeksi 0,1 % ml Ampul 6 6
21 Esomeprazole serb inj 40 mg Ampul 0
22 fenitoin inj 50 mg/ml Ampul 0
23 Fitomenadion (Vit K1) Injeksi 10 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 6 6
28 Glukosa 5 % Infus Botol 20 20
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
49 Klorpromazin Injeksi 25 mg/ml Ampul 0
50 Klorpromazin Injeksi 5 mg/ml Ampul 0
51 Lidocain inj 2% Ampul 80 100 180
52 Lidokain 2% + epinefrin inj 2 ml Ampul 60 60
53 Magnesium Sulfat 20 % flakon 12 12
54 Metamizol inj 500 mg/ml Ampul 84 84
 55 Metoklopramid Inj 5 mg/ml Ampul 0
56 Nalokson inj 0,4 mg/ml Ampul 0
57 Natrium Klorida 0,9% infus Botol 0 140 140
58 Natrium Tiosulfat inj 25% Ampul 0
59 Omeprazole serb inj 40 mg Ampul 11 11
60 Ondansetron inj 2 mg/ml Ampul 170 170
61 Papaverin Injeksi Ampul 0
62 Parasetamol 1000 mg infus 100 ml botol 0
63 Petidin Injeksi 50 mg/2 ml Ampul 10 10
64 Piridoksin (vit B6) inj 50 mg/ml Ampul 0
65 Prokain benzil penisilin serb inj 3 juta IU vial 0
66 Ranitidin Injeksi 25 mg/ml Ampul 110 110
67 Ringer asetat infus botol 0
68 Ringer laktat infus Botol 80 260 340
69 Salbutamol cairan ih 1 mg/ml Ampul 0
70 Sefotaksim serb inj 1000 mg vial 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
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
80 sianokobalamin (vit B12) Inj 500 mcg/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 )
1 Asiklovir salep Kulit 5% Tube 150 150
Anti Bakteri Komb : Basitrasin+Polimiksin
2 tube 25 25
salep kulit
 Anti fungi komb : as benzoat+as salisilat
3 tube 0
salep kulit
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
11 Bedak Salisil serb 2% Botol 55 55

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

salep kulit kombinasi
13 Betametason krim 0,05 % Tube 0
14 Betametason krim 0,1 % tube 41 41
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 34 34
19 Boraks gliserin cairan botol 0
20 desoksimetason salp 0,25 % tube 0
21 Diazepam enema 10 mg/ 2,5 ml suppo 0
22 Diazepam enema 5 mg/ 2,5 ml suppo 0
23 Diklofenak dietilamin gel 10 mg/gr tube 0
24 Fenol Gliserol tetes telinga 10 % Botol 18 18
25 Fluoresein tts mata 2,5 mg/ml botol 0
26 Framisetin sulfat tulle 1% lembar 0
27 Gentamicin salep mata 0,3% tube 0
28 Gentamicin Tetes Mata 0,3% Tube 24 24
29 Gentamisin salep Kulit 0,1% Tube 0
30 Gentian Violet Larutan 1 % Botol 0
31 Gliserin cairan obat luar 100mg/ml botol 9 9
32 Heparin sodium gel 20.000 IU/100 gr tube 0
33 Hidrokortison 2,5 % Cream Tube 72 72
34 Ichtammolum salep kulit pot 0
35 Kalamin lotio Botol 0
36 Kalium Permagnat Serbuk Pot 0
37 Karbogliserin tetes telinga 10% botol 0
38 Ketokonazol 2 % Krim Tube 50 50
39 Ketokonazol scalp sol 2% botol 0
40 Ketoprofen 100 mg rectal Suppo 10 10
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 suppo 0

IU kombinasi
51 Metronidazol ovula 500 mg ovula 0
52 Metronidazol sup 500 mg tube 0
53 Mikonazole Krim 2% Tube 16 24 40
54 Mikonazole serbuk 2% botol 0
55 Mometason furoat 0,1 % cream 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 botol 0

kombinasi
59 Neomisin-Basitrasin powder botol 0
60 Nistatin tab vaginal 100.000 IU Tablet 0
61 Ofloksasin tetes telinga 3% botol 0
62 Oksimetazolin tetes hidung 0,025% botol 0
63 Oksimetazolin tetes hidung 0,05% botol 0
64 Olopatadin tetes mata 0,1% Botol 0
65 Parasetamol rectal 125 mg/2,5 ml suppo 0
66 Parasetamol rectal 250mg/2,5 ml suppo 0
67 Perak sulfadiazin krim 1% Tube 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 botol 0

mata kombinasi

73 Polimiksin-Neomisin-Fludrokortison- botol 0
Lidokain tetes telinga kombinasi
74 Povidon Iodin mouthwash 100 ml botol 0
75 Salep 2-4 Pot 2 2
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, botol 0

champora 60 mg tetes telinga
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)
1 Albendazol susp 200 mg/ 5 ml Botol 0
2 Albendazol 400 mg Tablet 200 200
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 120 120
17 DHP (Dihidroartemisin-piperakuin) komb Tablet 0
18 Dietil Karbamazin 100 mg Tablet 0
19 Doksisiklin 100 mg Kapsul 100 100
20 Fenobarbital Injeksi 50 mg/ml Ampul 0 0
21 Ferro Sulfat sal selaput 300 mg tablet 0
22 Fitomenadion (Vit K1) Injeksi 2 mg/ml Ampul 30 30
23 Garam Oralit Kombinasi serbuk Bungkus 100 100
24 Gentamisin inj 40 mg/ml Ampul 45 45
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 vial 0

progesteron asetat inj 150 mg/3 ml
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
39 Metil Ergometrin 0,2 mg/ml Ampul 153 153
40 Metronidazol infus 5 mg/ml Botol 10 10
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
50 Oksitosin Injeksi 10 IU/ml Ampul 0
51 Prednison 5 mg Tablet 200 200
 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
67 Zink 20 mg Tablet 400 500 900
OBAT GIGI / PERAWATAN GIGI
1 articulating paper 0
2 Aquadest 500 ml botol 0
3 Bahan tumpatan sementara lar/serbuk 0
4 Etil Klorida Spray 100 ml botol 2 2
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- 0

paraklorfenol-campor

16 Kombinasi : lidokain-medisinal creosote 0

phenol-eugenol-benzil alkohol

17 Kombinasi : tramsinolon asetonid - 0

dementilklortetrasiklin pasta
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
OBAT TIDAK ADA DI DAFTAR
1 Antalgin 500 mg Tablet 0
2 Betablok 50 mg Tablet 30 30
3 Becefort Tablet 0
4 Calporosis Tablet 840 840
5 Concor 1,25 mg Tablet 150 150
6 Concor 10 mg Tablet 60 60
7 Gemfibrozil Tablet 480 480
8 Hemorogard Tablet 150 150
9 Neo Diagon Tablet 400 400
10 Ofloksasin 200 mg Tablet 0
11 Ondansetron 4 mg Tablet 0
12 Nistatin vaginal 100.000 IU Ovula 0
13 Alletrol Botol 0
14 Bioplacenton Tube 5 5
15 Cendo Lyters Botol 10 10
16 Molakrim Tube 0 0
17 Soft U-derm Tube 21 21
18 Febrinex Botol 0
19 Laxadin Botol 24 24
20 Nifudiar Botol 0
21 Antalgin Ampul 9 9
22 Atrovent Botol 0
23 Avamys Botol 2 2
24 Calci Glukonas Ampul 0
25 Combivent Tube 0
26 Dumin Rectal Tube 15 15
27 Illiadin Botol 0
28 Metyl Prednisolon Ampul 13 13
29 Ventolin Tube 19 19
30 urine cath no 12 pcs 7 7
31 Masker Nebu Anak pcs 0 0
32 Masker Nebu Dewasa pcs 0 0
33 Alat Suntik sekali pakai 0,05 ml Box 1 1
34 Stesolid 5 5
35 b Tablet 1000 1000

UMUM JAMKESDA
Tidak BPJS
Bayar JKP
JUMLAH KUJUNGAN RESEP Bayar

145 66 65
 Yang Meminta Mengetahui/ Menyetujui
Kepala UPT.Puskesmas Kepala Dinkes II/ GFK

dr. Carlos Alfons Sibarani …………………………………………

NIP. 19780520 201412 1 001 NIP:

n
KAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
FORM : LPLPO PUSKESMAS KARANG
ORAN BULAN : SEPTEMBER NO / TGL DOKUMEN
ERMINTAAN BULAN/PERIODE : GFK
PUSK
DINKES

PEMBERIAN
SISA
PEMAKAIAN PERMINTAAN INPRES ASKES APBD APBD LAIN JUMLAH
STOK
I II LAIN
7 8 9 10

0 700

300 300

0 1110
0 300

600 1600

700 2300

700 2300

0 800
 0 450
0 90

500 1700

0 1400

0 200
0 700

0 200

0 500

0 300
 0 400

0 700

0 100

300 1300

0 1100

400 1200

100 400
0 900

0 700

100 1100

0 144
 0 100

0 300
0 600

0 200

0 600

0 2500
0 200
100 800

100 1000

0 200

600 3000
200 200

100 600

100 700

0 200
100 200
100 600

120 1440
0 900

200 500

200 0
0 600

0 100

200 800
0 296
900 3100

0 110

0 80

0 53

0 50
15 80

0 75

0 40
12 30
0 2
0 1

0 4
0 3
0 3
0 12
0 24
0 36

0 2

0 5
7 3
0 20

0 60
0 100

0 100
0 100

0 20

1 2

0 5
0 5
2 40

1 6
0 5
0 1
0 1
0 1
0 5
0 5
0 1

0 10
0 1
0 1
0 4
0 4
0 3
1 2
1 2
1 2

0 10
0 13

0 30

0 10

0 40

0 165
30 0

1 5

0 6
0 20

0 180
30 30
4 8
10 74
20 120

0 11
10 160

20 90

140 200

0 150

0 25
5 50

0 41

0 0

0 18

0 24

0 9

0 72

0 50

0 0
0 40

0 2

0 200
0 120

0 100

0 30
0 100
0 45

4 149
0 10

28 172
200 700

1 1
 0 30

60 780
0 150
0 60
0 480
0 150
0 400

0 5
0 10

0 21

0 24

0 9

0 2

0 15

0 13
0 19
0 7

0 1
1 4
0 1000

JAMKESDA
Jumlah
sktm

276
 Yang Menyerahkan Yang Menerima
Petugas GFK Petugas Puskesmas

…………………………………… Afid Amaluddin, A.Md.Farm

NIP. NIP. 19960331 201903 1 006
USKESMAS KARANGAN

Masa ED KETERANG
AN

11 12

Oct-20

Nov-20

Jul-21
Sep-20

May-21

Mar-21

Jun-20
 Jul-20

Apr-20

Feb-23
Dec-20

May-22

Jan-21

Jul-23
Sep-22

Aug-20

Aug-20

Jun-20

Jul-20

Jul-20

Jul-20

Oct-20

Jul-20
Apr-21

Jul-20
May-21

Jan-20

May-21

Sep-20
Jun-20
Nov-21

Jul-23

Jan-20
Feb-21

Apr-22

Jan-20

Mar-20
Mar-20
Mar-23

Jul-20
Jul-20

Jun-20

Feb-21
Jun-22

Jun-20
Aug-22
Mar-21
Dec-21
Sep-20

Aug-20

Aug-20

Oct-19

May-20

Nov-21

Jul-20
Apr-20

Oct-22
Nov-22
Sep-22
Mar-22
Oct-22
Sep-22
Oct-22
 Jan-23

Sep-22

Mar-22
Apr-22
Mar-22

May-21

Apr-20
Mar-21

Jan-20
May-21
Apr-21

Aug-20

Apr-21

Aug-21

Oct-22
Mar-21

ED

Aug-20

Jun-21

Jul-20

Feb-22

Apr-22

ED
Nov-21

Jul-21

Mar-20
Mar-22

Aug-20

Nov-19
Oct-20
Nov-19

Mar-20

Apr-20
Jul-20
May-20
Nov-20

Mar-21
Mar-20
Mar-20
Oct-19

Apr-23
Apr-21

Mar-20
Aug-20
Jun-21
Jun-20
Sep-21
Aug-20

Aug-21

Feb-20

Apr-21

May-20
Jul-20

Nov-21
Aug-22
A.Md.Farm
01903 1 006