PUSKESMAS : BULAN :

KODE : TAHUN :
KABUPATEN :
PROPINSI :
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( L B 2 )

Instalasi Farmasi
STOK SISA STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAANKETERANGAN
AWAL STOK OPT
1 2 3 4 5 6=(4+5 ) 7 8=(6-7 ) 9 10 11
1 ACT( Artesunat 50 mg + Amodiaquin 200 mg ) tablet 0 0
2 Alat Suntik Sekali Pakai 1 ml pcs 0 0
3 Alat Suntik sekali Pakai 2.5 ml pcs 0 0
4 Alat Suntik sekali Pakai 5 ml pcs 0 0
5 Albendazol 400 mg tablet 0 0
6 Alkohol Swab kotak 0 0
7 Alopurinol 100 mg tablet 0 0
8 Ambroxol tablet tablet 0 0
9 Ambroxol syrup 15 mg / ml botol 0 0
10 Aminophylin 200 mg tablet 0 0
11 Aminophylin injeksi ampul 0 0
12 Amitriptilin Hcl 25 mg tablet 0 0
13 Amlodipin 5 mg tablet 0 0
14 Amoksisilin 250 mg kaplet 0 0
15 Amoksisilin 500 mg kapsul 0 0
16 Amoksisilin syrup botol 0 0
17 Antasida Doen Komb syrup botol 0 0
18 Antasida Doen kombinasi tablet 0 0
19 Anti Bakteri Doen salep tube 0 0
20 Anti Fungi Doen Komb.( Whitfield ) pot 0 0
21 Antihemoroid suppos suppos 0 0
22 Antimigrain Doen ( Ergotamin ) tablet 0 0
23 Aqua proinjeksi vial 0 0
24 Artemeter Injeksi 1 ml : 80 mg ampul 0 0
25 Artesunate injeksi 60 ml vial 0 0
26 Asam Ascorbat ( Vit C ) 50 mg tablet 0 0
27 Asam Ascorbat ( Vit C ) 250 mg tablet 0 0
 STOK SISA STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAANKETERANGAN
AWAL STOK OPT
1 2 3 4 5 6=(4+5 ) 7 8=(6-7 ) 9 10 11
28 Asam Mefenamat 500 mg kaplet 0 0
29 Asam Traneksamat injeksi ampul 0 0
30 Asiklovir 200 mg tablet 0 0
31 Asiklovir 400 mg tablet 0 0
32 Asiklovir crem 5 % tube 0 0
33 Atapulgit 600 mg tablet 0 0
34 Atropin sulfat 0.5 mg tablet 0 0
35 Atropin Sulfat injeksi ampul 0 0
36 Betametason crem tablet 0 0
37 Cat Gut sack 0 0
38 Captopril 25 mg tablet 0 0
39 Captopril 12.5 mg tablet 0 0
40 Cefadroxil 500 mg tablet 0 0
41 Cefadroxil syrup botol 0 0
42 Cefotaxim injeksi vial 0 0
43 Ceterizin syrup botol 0 0
44 Cetirizin 10 mg tablet 0 0
45 Ciproploxacin 500 mg tablet 0 0
46 Deksametason 0.5 mg tablet tablet 0 0
47 Deksametason injeksi ampul 0 0
48 Devitalisasi pasta btl 0 0
49 Diazepam 2 mg tablet 0 0
50 Diazepam injeksi 5 mg / 1 ml ampul 0 0
51 Diazepam Rectal 5 mg / 2.5 ml tube 0 0
52 Difenhidramin Hcl injeksi ampul 0 0
53 Digoxin 0.25 mg tablet 0 0
54 Dimenhidrinat 50 mg tablet 0 0
55 Domperidon 10 mg tablet 0 0
56 Doxycyklin 100 mg kapsul 0 0
57 E t a n o l 70 % 1 Liter botol 0 0
58 E t a n o l 70 % 100 ml botol 0 0
59 Efedrin Hcl 25 mg tablet 0 0
60 Epinefrin Hcl injeksi ampul 0 0
61 Erytromycin 500 mg kaplet 0 0
62 Erytromycin syrup botol 0 0
63 Etakridin ( Rivanol ) cairan ampul 0 0
 STOK SISA STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAANKETERANGAN
AWAL STOK OPT
1 2 3 4 5 6=(4+5 ) 7 8=(6-7 ) 9 10 11
64 Etil klorida semprot tabung 0 0
65 Eugenol cairan btl 0 0
66 Fenobarbital 30 mg tablet 0 0
67 Fenobarbital injeksi 50 mg / ml ampul 0 0
68 Fenol gliserol tetes telinga botol 0 0
69 Fitomenadion ( vit K ) 10 mg tab tablet 0 0
70 Fitomenadion ( vit K ) 10 mg / 1 ml ampul 0 0
71 Foly Cateter no 16 pices 0 0
72 Foly cateter No 18 pices 0 0
73 Furosemid 40 mg tablet 0 0
74 Garam Oralit 200 ml bungkus 0 0
75 Gentamycin injeksi ampul 0 0
76 Gentamycin salep mata 0.3 % tube 0 0
77 Gentamycin tetes mata 0.3 % tube 0 0
78 Gentian violet 1 % botol 0 0
79 Glass Ionomer Cemen ( GC IX ) set 0 0
80 Glibenklamid 5 mg tablet 0 0
81 Glikasida 80 mg tablet 0 0
82 Gliseril Guayakolat 100 mg tablet 0 0
83 Glukosa Lar infus 10 % kolf 0 0
84 Glukosa lar infus 5 % kolf 0 0
85 Griseofulvin 125 mg tablet 0 0
86 Haloperidol 0.5 mg tablet 0 0
87 Haloperidol 1.5 mg tablet 0 0
88 Haloperidol 5 mg tablet 0 0
89 Haloperidol injeksi ampil 0 0
90 Hand Scoond pasang 0 0
91 Hand scoond steril pices 0 0
92 HCl 0,1 N botol
93 Hidrogen Peroksida 3 % (H2O2) botol 0 0
94 Hidroklortiazid ( HCT ) 25 mg tablet 0 0
95 Hidrokortison crem 2.5 % tube 0 0
96 Ibuprofen 200 mg tablet 0 0
97 Ibuprofen 400 mg tablet 0 0
98 Ibuprofen syrup 100 mg / ml botol 0 0
99 Infusion set Anak bungkus 0 0
 STOK SISA STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAANKETERANGAN
AWAL STOK OPT
1 2 3 4 5 6=(4+5 ) 7 8=(6-7 ) 9 10 11
100 Infusion set Dewasa bungkus 0 0
101 Isosorbit Dinitrat 5 mg tablet 0 0
102 IV cateter no. 18 G buah 0 0
103 IV cateter no. 20 G buah 0 0
104 IV cateter no. 22 G buah 0 0
105 IV cateter no. 24 G buah 0 0
106 Kalsium hidroksida pasta pot 0 0
107 Kalsium Laktat 500 mg tablet 0 0
108 Kapas Pembalut 250 gr bungkus 0 0
109 Karbamazepin 200 mg tablet 0 0
110 Kasa kompres 40 x 40 cm bungkus 0 0
111 Kasa pembalut 18 x 22 cm bungkus 0 0
112 Kasa pembalut 4 x 10 cm rol 0 0
113 Kasa pembalut 4 x 5 cm rol 0 0
114 Kasa Pembalut 4 x 15 cm rol 0 0
115 Keterolak injeksi vial 0 0
116 Ketokonazol 200 mg tablet 0 0
117 Ketokonazol krim 2.5 % tube 0 0
118 Kinina 200 mg tablet tablet 0 0
119 Kinina injeksi ampul 0 0
120 Kloramfenikol 250 mg kapsul 0 0
121 Kloramfenikol salep kulit 2 % tube 0 0
122 Kloramfenikol salep mata 1 % tube 0 0
123 Kloramfenikol tetes Mata botol 0 0
124 Klorfeniramin maleat ( CTM ) 4 mg tablet 0 0
125 Klorokina posfat 250 mg tablet 0 0
126 Klorpromazin Hcl 100 mg tablet 0 0
127 Klorpromazin Hcl 25 mg tablet 0 0
128 Klorpromazin Hcl inj 25 mg / 1 ml ampul 0 0
129 Komb.Primetamin + Sulfadoxin 500 mg tablet 0 0
130 Kotrimoxazol syrup botol 0 0
131 Kotrimoxazol 480 mg tablet 0 0
132 L I s o l 1 Liter botol 0 0
133 Larutan Benedict botol 0 0
134 Larutan Eosin 2 % botol 0 0
135 Larutan Etanol asam botol 0 0
 STOK SISA STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAANKETERANGAN
AWAL STOK OPT
1 2 3 4 5 6=(4+5 ) 7 8=(6-7 ) 9 10 11
136 Larutan giemsa stain botol 0 0
137 Larutan Karbol Fuksin botol 0 0
138 Larutan Metilan Biru botol 0 0
139 Larutan Turk botol 0 0
140 Lidocain Comp injeksi ampul 0 0
141 Loperamid 2 mg tablet 0 0
142 Loratadin 10 mg tablet 0 0
143 Masker Ear Lop pices 0 0
144 Masker Ties On pices 0 0
145 Masker N 95 pices 0 0
146 Metergin 0.125 mg tablet 0 0
147 Metergin injeksi 0.200 mg / 1 ml ampul 0 0
148 Metformin 500 mg tablet 0 0
149 Metil Prednisolon 4 mg tablet 0 0
150 Metoklopramid 10 mg tablet 0 0
151 Metolon Injeksi 5 mg / 2 ml ampul 0 0
152 Metronidazol suspensi botol 0 0
153 Metronidazol tab 500 mg tablet 0 0
154 Miconazol crem tube 0 0
155 Monoklorkamfer mentol cair botol 0 0
156 Multi Vitamin syrup botol 0 0
157 Mumiying Pasta pot 0 0
158 Natrium Bikarbonat 500 mg tablet 0 0
159 Natrium Diklifenak 50 mg tablet 0 0
160 Natrium Klorida 0.9 % kolf 0 0
161 Nipedipin 10 mg tablet 0 0
162 Nistatin 100.000 IU tablet 0 0
163 Nistatin 500.000 IU tablet 0 0
164 Obat Anti Tuberkulosis Kategori I paket 0 0
165 Obat Anti Tuberkulosis Kategori II paket 0 0
166 Obat Anti Tuberkulosis Kategori anak paket 0 0
167 Obat Anti Tuberkulosis Kategori Sisipan paket 0 0
168 Obat Batuk hitam ( OBH ) botol 0 0
169 Oksitetrasiklin 3 % salep kulit tube 0 0
170 Oksitetrasiklin Hcl 1 % salep mata tube 0 0
171 Oksitetrasiklin Hcl inj 50 mg - 10 ml vial 0 0
 STOK SISA STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAANKETERANGAN
AWAL STOK OPT
1 2 3 4 5 6=(4+5 ) 7 8=(6-7 ) 9 10 11
172 Oksitocin Injeksi ampul 0 0
173 Omeprazol 20 mg tablet 0 0
174 Ondansetron injeksi ampul 0 0
175 Papaverin 40 mg tablet 0 0
176 Parasetamol 100 mg tablet 0 0
177 Parasetamol 500 mg tablet 0 0
178 Parasetamol Drop botol 0 0
179 Parasetamol Syrup botol 0 0
180 Perak Sulfadiazin krim tube 0 0
181 Pirantel Pamoat 365 mg tablet 0 0
182 Piridoxin Hcl 10 mg tablet 0 0
183 Piroxicam 10 mg kapsul 0 0
184 Plester 5 x 500 inchi rol 0 0
185 Policlen botol 0 0
186 Prednison 5 mg tablet 0 0
187 Primaquin 15 mg tablet 0 0
188 Propanolol Hcl 10 mg tablet 0 0
189 Propiltiourasil ( PTU ) 100 mg tablet 0 0
190 Ranitidin 150 mg tablet 0 0
191 Ranitidin injeksi ampul 0 0
192 Resperidon 2 mg tablet 0 0
193 Ringer Laktat lar infus kolf 0 0
194 Salbutamol 2 mg tablet 0 0
195 Salbutamol 4 mg tablet 0 0
196 Salep 2 - 4 pot 0 0
197 Salisil bedak 2 % bungkus 0 0
198 Sefiksin 100 mg tablet 0 0
199 Semen Seng Posfat serbuk dan cairan set 0 0
200 Serum Anti Bisa Ular Polivalen 50 ml vIal 0 0
201 Serum Anti Tetanus 1.500 IU (ATS ) ampul 0 0
202 Sianokobolamin ( B12) tablet tablet 0 0
203 Sianokobolamin injeksi ( Vit B 12 ) ampul 0 0
204 Silk 18 mm x 75 cm sachet 0 0
205 Silk 25 mm x 75 cm sachet 0 0
206 Simvastatin 10 mg tablet 0 0
207 Sulfasetamid natrium Tetes mata 15 % botol 0 0
 STOK SISA STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAANKETERANGAN
AWAL STOK OPT
1 2 3 4 5 6=(4+5 ) 7 8=(6-7 ) 9 10 11
208 Tablet Tambah Darah tablet 0 0
209 Temporary Stoping Fletcher dan cairan botol 0 0
210 Tetrasiklin Hcl 250 mg kapsul 0 0
211 Tetrasiklin Hcl 500 mg kapsul 0 0
212 Thiamin Hcl ( Vit B1 ) injeksi ampul 0 0
213 Thiamin Hcl tablet 50 mg tablet 0 0
214 Tramadol injeksi 50 mg / ml ampul 0 0
215 Trihexilpenidil 2 mg tablet 0 0
216 Urin Bag pices 0 0
217 Vitamin A 100.000 IU kapsul 0 0
218 Vitamin A 200.000 IU kapsul 0 0
219 Vitamin B Complek tablet 0 0
220 Xilocain spray tabung 0 0
221 Yodium Povidon larutan 30 ml botol 0 0
222 Yodium Povidon larutan 300 ml botol 0 0
223 Zinc tablet 0 0
224 Zinc syrup 20 mg / 5 ml botol 0 0
225 0 0
226 0 0
227 0 0
228 0 0

JUMLAH KUNJUNGAN

Mengetahui
Pimpinan Puskesmas Pelapor

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 LAPORAN VAKSIN

STOK
NO NAMA OBAT SATUAN PRNRERIMAAN PERSEDIAAN
AWAL
1 2 3 4 5 6=(4+5 )
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
KSIN

SISA
PEMAKAIAN PERMINTAAN KETERANGAN
STOK
7 8=(6-7 ) 10 11
0
0
0
0
0
0
0
0
0
0
0