Blangko LPLPO DAK 2018

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK
( LPLPO ) DAK
UPT PKM : BULAN : JANUARI
KECAMATAN : TAHUN : 2018
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10
1 Acyclovir tab 200 mg Tablet 0 0 0
2 Acyclovir tab 400 mg Tablet 0 0 0
3 Acyclovir cream 5 % Tube 0 0 0
4 Albendazol 400 mg Tablet 0 0 0
5 Alkohol 70 % 1 liter Botol 0 0 0
6 Allopurinol 100 mg Tablet 0 0 0
7 Alprazolam 0.5 mg Tablet 0 0 0
8 Ambroxol Syr 60 ml Botol 0 0 0
9 Ambroxol tab 30 mg Tablet 0 0 0
10 Amlodipin 5 mg Tablet 0 0 0
11 Amoksisillina kapl 250mg Kapsul 0 0 0
12 Amoksisillina sirker 125 mg / 5 ml Botol 0 0 0
13 Antasida Doen Tab Tablet 0 0 0
14 Antasida sir Botol 0 0 0
15 Anti Hemaroid supp supp 0 0 0
16 Aqua Pro Inj 25 ml Steril Botol 0 0 0
17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0
18 Asam Mefenamat 500 mg Tablet 0 0 0
19 Attapulgite tab 600 mg Tablet 0 0 0
20 Atropin Sulfat 0.5 mg Tablet 0 0 0
21 Besi II Sulfat Tablet 0 0 0
22 Betametason Krim Tube 0 0 0
23 Captopril 12.5 mg Tablet 0 0 0
24 Captopril 25 mg Tablet 0 0 0
25 Captopril 50 mg Tablet 0 0 0
26 Carbamazepin 200 mg Tablet 0 0 0
27 Deksametason Inj Ampul 0 0 0
28 Deksametason 0,5 mg Tablet 0 0 0
29 Dekstromethorphan syrup Kombinasi Botol 0 0 0
30 Diazepam Tab 2 mg Tablet 0 0 0
31 Diltiazem HCL 30mg Tablet 0 0 0
32 Dipenhidramin Inj Ampul 0 0 0
33 Doksisiklin 100 mg Tablet 0 0 0
34 Domperidom Tablet 0 0 0
35 Efedrina HCL 25 mg Tablet 0 0 0
36 Ergotamin tartrat 50 mg Tablet 0 0 0
37 Erytromicin Syr Botol 0 0 0
38 Etakridine kom Botol 0 0 0
39 Etanol Botol 0 0 0
40 Fenobarbital tab 30 mg Tablet 0 0 0
41 Ferro Fumarat 60 mg + as.folat Tablet 0 0 0
42 Fitomenadion Tablet Tablet 0 0 0
43 Furrosemida tab Tablet 0 0 0
44 Furrosemida inj Ampul 0 0 0
45 Garam Oralit Tablet 0 0 0

KET
1 2 3 4 5 6 7 8 9 10
46 Gentamicin SK 0,1 % Tube 100 100 0 100
47 Gentamicin Tetes Mata 0,3% Botol 0 0 0
48 Glibenklamida tab 5 mg Tablet 0 0 0
49 Glimepiride 2 mg Tablet 0 0 0
50 Glukosa Lar. Inf 5 % Botol 0 0 0
51 Griseofulvin tab 125 mg Tablet 0 0 0
52 Halloperidol 1.5 mg Tablet 0 0 0
53 Halloperidol 5 mg Tablet 0 0 0
54 Hidroklorotiazid ( HCT ) 25 mg Tablet 0 0 0
55 Hidrokortison Krim Tube 0 0 0
56 Ibuprofen tab.200 mg Tablet 0 0 0
57 Illiadin Drops 0.025 % Botol 0 0 0
58 Illiadin Spray 0.05 % Botol 0 0 0
59 Kals Laktat tab.500 mg Tablet 0 0 0
60 Ketokonazol tablet 200 mg Tablet 0 0 0
61 Ketokonazol cream Tube 0 0 0
62 Kloramfenikol salep mata Tube 0 0 0
63 Kloramfenicol kaps 250 mg Kapsul 0 0 0
64 Kloramfenicol tetes telinga 10 ml Botol 0 0 0
65 Klorpromazin 100 mg Tablet 0 0 0
66 Kodein HCL 10 mg Tablet 0 0 0
67 Kotrimoksazol syrup Botol 0 0 0
68 Kotrimoksazol 480mg Tab Tablet 0 0 0
69 Lansoprazole 30 mg Kapsul 0 0 0
70 Larutan PK Botol 0 0 0
71 Levertrans Salp 25 gr Tube 0 0 0
72 Levofloxacin 500 mg Tablet 0 0 0
73 Loperamid 2 mg Tablet 0 0 0
74 Magnesium Sulfat Inj 20% Ampul 0 0 0
75 Magnesium Sulfat Inj 40% Ampul 0 0 0
76 Medroksi Progeston Asetat Vial 0 0 0
77 Metformin 500 mg Tablet 0 0 0
78 Metilergometrin Tab. Tablet 0 0 0
79 Metilprednisolon 4 mg Tablet 0 0 0
80 Metoclopramide 10 mg Tablet 0 0 0
81 Metronidazole Syr Botol 0 0 0
82 Metronidazole 500 mg Tablet 0 0 0
83 Mikonazole Cream Tube 0 0 0
84 Natrium Bikarbonat Tablet 0 0 0
85 Natrium Diklofenac 50 mg Tablet 0 0 0
86 Natrium Klorida 0.9 % Botol 0 0 0
87 Nifedipin 10 mg Tablet 0 0 0
88 Obat Batuk hitam Botol 0 0 0
89 Obat Kategori II Paket 0 0 0
90 Obat Kategori Anak Paket 0 0 0
91 Oksitetrasiklin Salep Mata Tube 0 0 0
92 Oksitetrasiklin Salep Kulit Tube 0 0 0
93 Omeprazole 20 mg Kapsul 0 0 0
94 Parasetamol Drops Botol 0 0 0
95 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0
96 Parasetamol Tablet 500 mg Tablet 0 0 0
97 Pehacain Inj Ampul 0 0 0
98 Pirantel tab 125 mg Tablet 0 0 0

99 Piridoksin (Vit B.6) 10 mg Tablet 0 0 0

KET
1 2 3 4 5 6 7 8 9 10
100 Prednison 5 mg Tablet 100 100 0 100
101 Propanolol 10 mg Tablet 0 0 0
102 Ranitidin Tablet 0 0 0
103 Ranitidin Inj Ampul 0 0 0
104 Ringer Lactat Infus Botol 0 0 0
105 Salbutamol 4 mg Tablet 0 0 0
106 Salep 2- 4 Tube 0 0 0
107 Salisil Bedak 2 % kotak 0 0 0
108 Sefadroksil Syr Botol 0 0 0
109 Setirizine tab Tablet 0 0 0
110 Sefotaxim 500 mg Inj vial 0 0 0
111 Sianocobalamin Inj 500 mcg/ml Ampul 0 0 0
112 Simvastatin 20 mg Tablet 0 0 0
113 Siprofloksasin 500 mg Tablet 0 0 0
114 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0
115 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0
116 Tetrasiklin 250 mg Kapsul 0 0 0
117 Tiamin HCL ( Vit B1 ) 50 mg Tablet 0 0 0
118 Tramadol Injeksi Ampul 0 0 0
119 Triheksifenidil 2 mg Tablet 0 0 0
120 Ventolin Nebule Kotak 0 0 0
121 Vitamin B Complek Tablet 0 0 0
122 Yodium Povidon 30 ml Botol 0 0 0
123 Zink Syr Botol 0 0 0
124 Zink tab Tablet 0 0 0
0 0 0
0 0 0
OBAT GIGI
125 Caviton Pot 0 0 0
126 Curaspon Botol 0 0 0
127 Etil Klorida semprot Botol 0 0 0
128 Eugenol Cairan Botol 0 0 0
129 Glass ionomer cement ART Botol 0 0 0
130 Kalsium Hidroksida Pasta Botol 0 0 0
131 Mumfying Pasta Botol 0 0 0
132 Semen Seng Fosfat Botol 0 0 0
133 Temporary Stopping Pletcer Botol 0 0 0
0 0 0
BMHP 0
134 Alat Cek Darah Paket 0 0 0
135 Alat Suntik 2,5 cc Unit 0 0 0
136 Alat Suntik 5 cc Unit 0 0 0
137 Alat Suntik 10 cc Unit 0 0 0
138 Benecheck Glucose 50s Strip 0 0 0
139 Benecheck Total Chol 10s Strip 0 0 0
140 Benecheck Urid Acid 25s Strip 0 0 0
141 Blood Tranfusion Set Kantong 0 0 0
142 Catgut 2/0 Pcs 0 0 0
143 Catgut 3/0 Pcs 0 0 0
144 Catgut 5/0 Pcs 0 0 0
145 Foley Chateter Pediatrik Pcs 0 0 0

146 Foley Chateter Adult Pcs 0 0 0
147 Hand Scun Set 0 0 0
148 Handscun Non Steril Kotak 0 0 0

KET
1 2 3 4 5 6 7 8 9 10
149 Handscun Obgyn Steril pcs 100 100 0 100
150 HB SAHLI Set 0 0 0
151 Infusion set anak Kantong 0 0 0
152 Infusion set dewasa Kantong 0 0 0
153 Infusion set Y Connector Kantong 0 0 0
154 I.V Cateter 18 G Buah 0 0 0
159 Kapas Rol 0 0 0
160 Kasa Pembalut 4m x 10 cm Rol 0 0 0
161 Kasa Pembalut 4m x 15 cm Rol 0 0 0
162 Kasa Steril 10 x10 cm pack 0 0 0
163 Larutan Anti Sera A 10 ml Botol 0 0 0
164 Larutan Anti Sera B 10 ml Botol 0 0 0
165 Larutan HCl 0,1 N 100 ml Botol 0 0 0
166 Masker Pcs 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0
168 Nasal Oxygen Pcs 0 0 0
169 Oksigen Masker Pcs 0 0 0
170 Paper Tape (plester kertas) Rol 0 0 0
171 Plester 5 yard x 2 inch Rol 0 0 0
172 Plester bening 2 x 8 inch + Obat (Duoderm) Lembar 0 0 0
173 Plester bening 4 x 4 inch + Obat (Duoderm) Lembar 0 0 0
174 Silk Pcs 0 0 0
175 Spiritus 500 ml Botol 0 0 0
176 Surgical Blade Steril Pcs 0 0 0
177 Test Uji Kehamilan 25 MU/ml Strip 0 0 0
178 Urine Bag Pcs 0 0 0
179 USG Gel 250 ml Tube 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Mengetahui
Kepala UPT Puskesmas Pengelola Obat PKM
( ) ( )
Nip. Nip.
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) DAK
BULAN JANUARI 2018
PUSKESMAS :
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir tab 200 mg Tablet 0 0 0 0 0
3 Acyclovir cream 5 % Tube 0 0 0 0 0
4 Albendazol 400 mg Tablet 0 0 0 0 0
5 Alkohol 70 % 1 liter Botol 0 0 0 0 0
6 Allopurinol 100 mg Tablet 0 0 0 0 0
7 Alprazolam 0.5 mg Tablet 0 0 0 0 0
8 Ambroxol Syr 60 ml Botol 0 0 0 0 0
9 Ambroxol tab 30 mg Tablet 0 0 0 0 0
10 Amlodipin 5 mg Tablet 0 0 0 0 0
11 Amoksisillina kapl 250mg Kapsul 0 0 0 0 0
12 Amoksisillina sirker 125 mg / 5 ml Botol 0 0 0 0 0
13 Antasida Doen Tab Tablet 0 0 0 0 0
14 Antasida sir Botol 0 0 0 0 0
15 Anti Hemaroid supp supp 0 0 0 0 0
16 Aqua Pro Inj 25 ml Steril Botol 0 0 0 0 0
17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0
18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0
19 Attapulgite tab 600 mg Tablet 0 0 0 0 0
20 Atropin Sulfat 0.5 mg Tablet 0 0 0 0 0
21 Besi II Sulfat Tablet 0 0 0 0 0
22 Betametason Krim Tube 0 0 0 0 0
23 Captopril 12.5 mg Tablet 0 0 0 0 0
24 Captopril 25 mg Tablet 0 0 0 0 0
26 Carbamazepin 200 mg Tablet 0 0 0 0 0
27 Deksametason Inj Ampul 0 0 0 0 0
28 Deksametason 0,5 mg Tablet 0 0 0 0 0
29 Dekstromethorphan syrup Kombinasi Botol 0 0 0 0 0
30 Diazepam Tab 2 mg Tablet 0 0 0 0 0

NO NAMA OBAT SATUAN Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
31 Diltiazem HCL 30mg Tablet 0 0 0 0 0
32 Dipenhidramin Inj Ampul 0 0 0 0 0
33 Doksisiklin 100 mg Tablet 0 0 0 0 0
34 Domperidom Tablet 0 0 0 0 0
35 Efedrina HCL 25 mg Tablet 0 0 0 0 0
36 Ergotamin tartrat 50 mg Tablet 0 0 0 0 0
37 Erytromicin Syr Botol 0 0 0 0 0
38 Etakridine kom Botol 0 0 0 0 0
39 Etanol Botol 0 0 0 0 0
40 Fenobarbital tab 30 mg Tablet 0 0 0 0 0
41 Ferro Fumarat 60 mg + as.folat Tablet 0 0 0 0 0
42 Fitomenadion Tablet Tablet 0 0 0 0 0
43 Furrosemida tab Tablet 0 0 0 0 0
44 Furrosemida inj Ampul 0 0 0 0 0
45 Garam Oralit Tablet 0 0 0 0 0
46 Gentamicin SK 0,1 % Tube 100 0 100 0 100
47 Gentamicin Tetes Mata 0,3% Botol 0 0 0 0 0
48 Glibenklamida tab 5 mg Tablet 0 0 0 0 0
49 Glimepiride 2 mg Tablet 0 0 0 0 0
50 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0
51 Griseofulvin tab 125 mg Tablet 0 0 0 0 0
52 Halloperidol 1.5 mg Tablet 0 0 0 0 0
53 Halloperidol 5 mg Tablet 0 0 0 0 0
54 Hidroklorotiazid ( HCT ) 25 mg Tablet 0 0 0 0 0
55 Hidrokortison Krim Tube 0 0 0 0 0
56 Ibuprofen tab.200 mg Tablet 0 0 0 0 0
57 Illiadin Drops 0.025 % Botol 0 0 0 0 0
58 Illiadin Spray 0.05 % Botol 0 0 0 0 0
59 Kals Laktat tab.500 mg Tablet 0 0 0 0 0
60 Ketokonazol tablet 200 mg Tablet 0 0 0 0 0
61 Ketokonazol cream Tube 0 0 0 0 0
62 Kloramfenikol salep mata Tube 0 0 0 0 0
63 Kloramfenicol kaps 250 mg Kapsul 0 0 0 0 0

64 Kloramfenicol tetes telinga 10 ml Botol 0 0 0 0 0
65 Klorpromazin 100 mg Tablet 0 0 0 0 0
66 Kodein HCL 10 mg Tablet 0 0 0 0 0
67 Kotrimoksazol syrup Botol 0 0 0 0 0
68 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0
69 Lansoprazole 30 mg Kapsul 0 0 0 0 0
70 Larutan PK Botol 0 0 0 0 0
71 Levertrans Salp 25 gr Tube 0 0 0 0 0
72 Levofloxacin 500 mg Tablet 0 0 0 0 0
73 Loperamid 2 mg Tablet 0 0 0 0 0
74 Magnesium Sulfat Inj 20% Ampul 0 0 0 0 0
76 Medroksi Progeston Asetat Vial 0 0 0 0 0
77 Metformin 500 mg Tablet 0 0 0 0 0
78 Metilergometrin Tab. Tablet 0 0 0 0 0
79 Metilprednisolon 4 mg Tablet 0 0 0 0 0
80 Metoclopramide 10 mg Tablet 0 0 0 0 0
81 Metronidazole Syr Botol 0 0 0 0 0
82 Metronidazole 500 mg Tablet 0 0 0 0 0
83 Mikonazole Cream Tube 0 0 0 0 0
84 Natrium Bikarbonat Tablet 0 0 0 0 0
85 Natrium Diklofenac 50 mg Tablet 0 0 0 0 0
86 Natrium Klorida 0.9 % Botol 0 0 0 0 0
87 Nifedipin 10 mg Tablet 0 0 0 0 0
88 Obat Batuk hitam Botol 0 0 0 0 0
89 Obat Kategori II Paket 0 0 0 0 0
90 Obat Kategori Anak Paket 0 0 0 0 0
91 Oksitetrasiklin Salep Mata Tube 0 0 0 0 0
92 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
93 Omeprazole 20 mg Kapsul 0 0 0 0 0
94 Parasetamol Drops Botol 0 0 0 0 0
95 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0
96 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0

97 Pehacain Inj Ampul 0 0 0 0 0
98 Pirantel tab 125 mg Tablet 0 0 0 0 0
99 Piridoksin (Vit B.6) 10 mg Tablet 0 0 0 0 0
100 Prednison 5 mg Tablet 100 0 100 0 100
101 Propanolol 10 mg Tablet 0 0 0 0 0
102 Ranitidin Tablet 0 0 0 0 0
103 Ranitidin Inj Ampul 0 0 0 0 0
104 Ringer Lactat Infus Botol 0 0 0 0 0
105 Salbutamol 4 mg Tablet 0 0 0 0 0
106 Salep 2- 4 Tube 0 0 0 0 0
107 Salisil Bedak 2 % kotak 0 0 0 0 0
108 Sefadroksil Syr Botol 0 0 0 0 0
109 Setirizine tab Tablet 0 0 0 0 0
110 Sefotaxim 500 mg Inj vial 0 0 0 0 0
111 Sianocobalamin Inj 500 mcg/ml Ampul 0 0 0 0 0
112 Simvastatin 20 mg Tablet 0 0 0 0 0
113 Siprofloksasin 500 mg Tablet 0 0 0 0 0
114 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0
115 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
116 Tetrasiklin 250 mg Kapsul 0 0 0 0 0
117 Tiamin HCL ( Vit B1 ) 50 mg Tablet 0 0 0 0 0
118 Tramadol Injeksi Ampul 0 0 0 0 0
119 Triheksifenidil 2 mg Tablet 0 0 0 0 0
120 Ventolin Nebule Kotak 0 0 0 0 0
121 Vitamin B Complek Tablet 0 0 0 0 0
122 Yodium Povidon 30 ml Botol 0 0 0 0 0
123 Zink Syr Botol 0 0 0 0 0
124 Zink tab Tablet 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0
125 Caviton Pot 0 0 0 0 0

126 Curaspon Botol 0 0 0 0 0
Etil Klorida semprot Botol 0 0 0 0 0
128 Eugenol Cairan Botol 0 0 0 0 0
129 Glass ionomer cement ART Botol 0 0 0 0 0
130 Kalsium Hidroksida Pasta Botol 0 0 0 0 0
131 Mumfying Pasta Botol 0 0 0 0 0
132 Semen Seng Fosfat Botol 0 0 0 0 0
133 Temporary Stopping Pletcer Botol 0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
134 Alat Cek Darah Paket 0 0 0 0 0
135 Alat Suntik 2,5 cc Unit 0 0 0 0 0
136 Alat Suntik 5 cc Unit 0 0 0 0 0
138 Benecheck Glucose 50s Strip 0 0 0 0 0
139 Benecheck Total Chol 10s Strip 0 0 0 0 0
140 Benecheck Urid Acid 25s Strip 0 0 0 0 0
141 Blood Tranfusion Set Kantong 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
145 Foley Chateter Pediatrik Pcs 0 0 0 0 0
146 Foley Chateter Adult Pcs 0 0 0 0 0
147 Hand Scun Set 0 0 0 0 0
148 Handscun Non Steril Kotak 0 0 0 0 0
149 Handscun Obgyn Steril pcs 100 0 100 0 100
150 HB SAHLI Set 0 0 0 0 0
151 Infusion set anak Kantong 0 0 0 0 0
152 Infusion set dewasa Kantong 0 0 0 0 0
153 Infusion set Y Connector Kantong 0 0 0 0 0
154 I.V Cateter 18 G Buah 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
160 Kasa Pembalut 4m x 10 cm Rol 0 0 0 0 0
162 Kasa Steril 10 x10 cm pack 0 0 0 0 0
163 Larutan Anti Sera A 10 ml Botol 0 0 0 0 0
164 Larutan Anti Sera B 10 ml Botol 0 0 0 0 0
165 Larutan HCl 0,1 N 100 ml Botol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
167 Nald 0.3 x 21 mm ( Nald Gigi ) Pcs 0 0 0 0 0
168 Nasal Oxygen Pcs 0 0 0 0 0
169 Oksigen Masker Pcs 0 0 0 0 0
170 Paper Tape (plester kertas) Rol 0 0 0 0 0
171 Plester 5 yard x 2 inch Rol 0 0 0 0 0
172 Plester bening 2 x 8 inch + Obat (Duoderm) Lembar 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
175 Spiritus 500 ml Botol 0 0 0 0 0
176 Surgical Blade Steril Pcs 0 0 0 0 0
177 Test Uji Kehamilan 25 MU/ml Strip 0 0 0 0 0
178 Urine Bag Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
Kepala Puskesmas Pengelola Obat PKM
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : FEBRUARI
STOK PENERI PERSE PEMA STOK PERMIN

NO NAMA OBAT SATUAN KET
1 2 3 4 5 6 7 8 9 10
1 Acyclovir tab 200 mg Tablet 0 0 0 0
3 Acyclovir cream 5 % Tube 0 0 0 0
4 Albendazol 400 mg Tablet 0 0 0 0
5 Alkohol 70 % 1 liter Botol 0 0 0 0
6 Allopurinol 100 mg Tablet 0 0 0 0
7 Alprazolam 0.5 mg Tablet 0 0 0 0
8 Ambroxol Syr 60 ml Botol 0 0 0 0
9 Ambroxol tab 30 mg Tablet 0 0 0 0
10 Amlodipin 5 mg Tablet 0 0 0 0
11 Amoksisillina kapl 250mg Kapsul 0 0 0 0
12 Amoksisillina sirker 125 mg / 5 ml Botol 0 0 0 0
13 Antasida Doen Tab Tablet 0 0 0 0
14 Antasida sir Botol 0 0 0 0
15 Anti Hemaroid supp supp 0 0 0 0
16 Aqua Pro Inj 25 ml Steril Botol 0 0 0 0
17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0
18 Asam Mefenamat 500 mg Tablet 0 0 0 0
19 Attapulgite tab 600 mg Tablet 0 0 0 0
20 Atropin Sulfat 0.5 mg Tablet 0 0 0 0
21 Besi II Sulfat Tablet 0 0 0 0
22 Betametason Krim Tube 0 0 0 0
23 Captopril 12.5 mg Tablet 0 0 0 0
24 Captopril 25 mg Tablet 0 0 0 0
26 Carbamazepin 200 mg Tablet 0 0 0 0
27 Deksametason Inj Ampul 0 0 0 0
28 Deksametason 0,5 mg Tablet 0 0 0 0
29 Dekstromethorphan syrup Kombinasi Botol 0 0 0 0
30 Diazepam Tab 2 mg Tablet 0 0 0 0
31 Diltiazem HCL 30mg Tablet 0 0 0 0
32 Dipenhidramin Inj Ampul 0 0 0 0
33 Doksisiklin 100 mg Tablet 0 0 0 0
34 Domperidom Tablet 0 0 0 0
35 Efedrina HCL 25 mg Tablet 0 0 0 0
36 Ergotamin tartrat 50 mg Tablet 0 0 0 0
37 Erytromicin Syr Botol 0 0 0 0
38 Etakridine kom Botol 0 0 0 0
39 Etanol Botol 0 0 0 0
40 Fenobarbital tab 30 mg Tablet 0 0 0 0
41 Ferro Fumarat 60 mg + as.folat Tablet 0 0 0 0
42 Fitomenadion Tablet Tablet 0 0 0 0
43 Furrosemida tab Tablet 0 0 0 0
44 Furrosemida inj Ampul 0 0 0 0
45 Garam Oralit Tablet 0 0 0 0

KET
1 2 3 4 5 6 7 8 9 10
47 Gentamicin Tetes Mata 0,3% Botol 0 0 0 0
48 Glibenklamida tab 5 mg Tablet 0 0 0 0
49 Glimepiride 2 mg Tablet 0 0 0 0
50 Glukosa Lar. Inf 5 % Botol 0 0 0 0
51 Griseofulvin tab 125 mg Tablet 0 0 0 0
52 Halloperidol 1.5 mg Tablet 0 0 0 0
53 Halloperidol 5 mg Tablet 0 0 0 0
54 Hidroklorotiazid ( HCT ) 25 mg Tablet 0 0 0 0
55 Hidrokortison Krim Tube 0 0 0 0
56 Ibuprofen tab.200 mg Tablet 0 0 0 0
57 Illiadin Drops 0.025 % Botol 0 0 0 0
58 Illiadin Spray 0.05 % Botol 0 0 0 0
59 Kals Laktat tab.500 mg Tablet 0 0 0 0
60 Ketokonazol tablet 200 mg Tablet 0 0 0 0
61 Ketokonazol cream Tube 0 0 0 0
62 Kloramfenikol salep mata Tube 0 0 0 0
63 Kloramfenicol kaps 250 mg Kapsul 0 0 0 0
64 Kloramfenicol tetes telinga 10 ml Botol 0 0 0 0
65 Klorpromazin 100 mg Tablet 0 0 0 0
66 Kodein HCL 10 mg Tablet 0 0 0 0
67 Kotrimoksazol syrup Botol 0 0 0 0
68 Kotrimoksazol 480mg Tab Tablet 0 0 0 0
69 Lansoprazole 30 mg Kapsul 0 0 0 0
70 Larutan PK Botol 0 0 0 0
71 Levertrans Salp 25 gr Tube 0 0 0 0
72 Levofloxacin 500 mg Tablet 0 0 0 0
73 Loperamid 2 mg Tablet 0 0 0 0
74 Magnesium Sulfat Inj 20% Ampul 0 0 0 0
76 Medroksi Progeston Asetat Vial 0 0 0 0
77 Metformin 500 mg Tablet 0 0 0 0
78 Metilergometrin Tab. Tablet 0 0 0 0
79 Metilprednisolon 4 mg Tablet 0 0 0 0
80 Metoclopramide 10 mg Tablet 0 0 0 0
81 Metronidazole Syr Botol 0 0 0 0
82 Metronidazole 500 mg Tablet 0 0 0 0
83 Mikonazole Cream Tube 0 0 0 0
84 Natrium Bikarbonat Tablet 0 0 0 0
85 Natrium Diklofenac 50 mg Tablet 0 0 0 0
86 Natrium Klorida 0.9 % Botol 0 0 0 0
87 Nifedipin 10 mg Tablet 0 0 0 0
88 Obat Batuk hitam Botol 0 0 0 0
89 Obat Kategori II Paket 0 0 0 0
90 Obat Kategori Anak Paket 0 0 0 0
91 Oksitetrasiklin Salep Mata Tube 0 0 0 0
92 Oksitetrasiklin Salep Kulit Tube 0 0 0 0
93 Omeprazole 20 mg Kapsul 0 0 0 0
94 Parasetamol Drops Botol 0 0 0 0
95 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0
96 Parasetamol Tablet 500 mg Tablet 0 0 0 0
97 Pehacain Inj Ampul 0 0 0 0
98 Pirantel tab 125 mg Tablet 0 0 0 0

99 Piridoksin (Vit B.6) 10 mg Tablet 0 0 0 0

KET
1 2 3 4 5 6 7 8 9 10
101 Propanolol 10 mg Tablet 0 0 0 0
102 Ranitidin Tablet 0 0 0 0
103 Ranitidin Inj Ampul 0 0 0 0
104 Ringer Lactat Infus Botol 0 0 0 0
105 Salbutamol 4 mg Tablet 0 0 0 0
106 Salep 2- 4 Tube 0 0 0 0
107 Salisil Bedak 2 % kotak 0 0 0 0
108 Sefadroksil Syr Botol 0 0 0 0
109 Setirizine tab Tablet 0 0 0 0
110 Sefotaxim 500 mg Inj vial 0 0 0 0
111 Sianocobalamin Inj 500 mcg/ml Ampul 0 0 0 0
112 Simvastatin 20 mg Tablet 0 0 0 0
113 Siprofloksasin 500 mg Tablet 0 0 0 0
114 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0
115 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0
116 Tetrasiklin 250 mg Kapsul 0 0 0 0
117 Tiamin HCL ( Vit B1 ) 50 mg Tablet 0 0 0 0
118 Tramadol Injeksi Ampul 0 0 0 0
119 Triheksifenidil 2 mg Tablet 0 0 0 0
120 Ventolin Nebule Kotak 0 0 0 0
121 Vitamin B Complek Tablet 0 0 0 0
122 Yodium Povidon 30 ml Botol 0 0 0 0
123 Zink Syr Botol 0 0 0 0
124 Zink tab Tablet 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
125 Caviton Pot 0 0 0 0
126 Curaspon Botol 0 0 0 0
127 Etil Klorida semprot Botol 0 0 0 0
128 Eugenol Cairan Botol 0 0 0 0
129 Glass ionomer cement ART Botol 0 0 0 0
130 Kalsium Hidroksida Pasta Botol 0 0 0 0
131 Mumfying Pasta Botol 0 0 0 0
132 Semen Seng Fosfat Botol 0 0 0 0
133 Temporary Stopping Pletcer Botol 0 0 0 0
0 0 0 0
BMHP 0 0
134 Alat Cek Darah Paket 0 0 0 0
135 Alat Suntik 2,5 cc Unit 0 0 0 0
136 Alat Suntik 5 cc Unit 0 0 0 0
138 Benecheck Glucose 50s Strip 0 0 0 0
139 Benecheck Total Chol 10s Strip 0 0 0 0
140 Benecheck Urid Acid 25s Strip 0 0 0 0
141 Blood Tranfusion Set Kantong 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0
145 Foley Chateter Pediatrik Pcs 0 0 0 0

146 Foley Chateter Adult Pcs 0 0 0 0
147 Hand Scun Set 0 0 0 0
148 Handscun Non Steril Kotak 0 0 0 0

KET
1 2 3 4 5 6 7 8 9 10
150 HB SAHLI Set 0 0 0 0
151 Infusion set anak Kantong 0 0 0 0
152 Infusion set dewasa Kantong 0 0 0 0
153 Infusion set Y Connector Kantong 0 0 0 0
154 I.V Cateter 18 G Buah 0 0 0 0
159 Kapas Rol 0 0 0 0
160 Kasa Pembalut 4m x 10 cm Rol 0 0 0 0
162 Kasa Steril 10 x10 cm pack 0 0 0 0
163 Larutan Anti Sera A 10 ml Botol 0 0 0 0
164 Larutan Anti Sera B 10 ml Botol 0 0 0 0
165 Larutan HCl 0,1 N 100 ml Botol 0 0 0 0
166 Masker Pcs 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
168 Nasal Oxygen Pcs 0 0 0 0
169 Oksigen Masker Pcs 0 0 0 0
170 Paper Tape (plester kertas) Rol 0 0 0 0
171 Plester 5 yard x 2 inch Rol 0 0 0 0
172 Plester bening 2 x 8 inch + Obat (Duoderm) Lembar 0 0 0 0
174 Silk Pcs 0 0 0 0
175 Spiritus 500 ml Botol 0 0 0 0
176 Surgical Blade Steril Pcs 0 0 0 0
177 Test Uji Kehamilan 25 MU/ml Strip 0 0 0 0
178 Urine Bag Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN FEBRUARI 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

127 Etil Klorida semprot Botol 0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : MARET

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN MARET 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : APRIL

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN APRIL 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : MAI

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN MAI 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : JUNI

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN JUNI 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : JULI

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN JULI 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : AGUSTUS

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN AGUSTUS 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : SEPTEMBER

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN SEPTEMBER 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : OKTOBER

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN OKTOBER 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : NOVEMBER

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN NOVEMBER 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
( LPLPO ) DAK
UPT PKM : BULAN : DESEMBER

KET
1 2 3 4 5 6 7 8 9 10

KET
1 2 3 4 5 6 7 8 9 10


KET
1 2 3 4 5 6 7 8 9 10
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0
0 0 0 0
BMHP 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0


KET
1 2 3 4 5 6 7 8 9 10
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
BULAN DESEMBER 2018
PUSKESMAS :
NO NAMA OBAT SATUAN



106 Salep 2- 4 Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0

0 0 0 0 0
BMHP 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0

159 Kapas Rol 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
LAPORAN PENERIMAAN OBAT DAK
TAHUN 2018
UPT PUSKESMAS :
BULAN Ket
NO NAMA OBAT SATUAN JUMLAH
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES
1 Acyclovir tab 200 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Acyclovir tab 400 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Acyclovir cream 5 % Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Albendazol 400 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Alkohol 70 % 1 liter Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Allopurinol 100 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Alprazolam 0.5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Ambroxol Syr 60 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Ambroxol tab 30 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Amlodipin 5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Amoksisillina kapl 250mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Amoksisillina sirker 125 mg / 5 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Antasida Doen Tab Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Antasida sir Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Anti Hemaroid supp supp 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Aqua Pro Inj 25 ml Steril Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Attapulgite tab 600 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Atropin Sulfat 0.5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Besi II Sulfat Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Betametason Krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Captopril 12.5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Captopril 25 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Captopril 50 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Carbamazepin 200 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Deksametason Inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Deksametason 0,5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Dekstromethorphan syrup Kombinasi Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Diazepam Tab 2 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0

NO NAMA OBAT SATUAN BULAN Ket
JUMLAH
31 Diltiazem HCL 30mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Dipenhidramin Inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Doksisiklin 100 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Domperidom Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
35 Efedrina HCL 25 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Ergotamin tartrat 50 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Erytromicin Syr Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Etakridine kom Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Etanol Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Fenobarbital tab 30 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Ferro Fumarat 60 mg + as.folat Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Fitomenadion Tablet Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Furrosemida tab Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Furrosemida inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Garam Oralit Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Gentamicin SK 0,1 % Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Gentamicin Tetes Mata 0,3% Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Glibenklamida tab 5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Glimepiride 2 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Halloperidol 5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Hidroklorotiazid ( HCT ) 25 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Hidrokortison Krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Ibuprofen tab.200 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Illiadin Drops 0.025 % Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Illiadin Spray 0.05 % Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Kals Laktat tab.500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Ketokonazol tablet 200 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Ketokonazol cream Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Kloramfenikol salep mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Kloramfenicol kaps 250 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0

JUMLAH
64 Kloramfenicol tetes telinga 10 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Klorpromazin 100 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Kodein HCL 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Kotrimoksazol syrup Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
68 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Lansoprazole 30 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Larutan PK Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Levertrans Salp 25 gr Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Levofloxacin 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Loperamid 2 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Magnesium Sulfat Inj 20% Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Magnesium Sulfat Inj 40% Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
76 Medroksi Progeston Asetat Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Metformin 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Metilergometrin Tab. Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
79 Metilprednisolon 4 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Metoclopramide 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
81 Metronidazole Syr Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
82 Metronidazole 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
83 Mikonazole Cream Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
84 Natrium Bikarbonat Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
85 Natrium Diklofenac 50 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
86 Natrium Klorida 0.9 % Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
87 Nifedipin 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
88 Obat Batuk hitam Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Obat Kategori II Paket 0 0 0 0 0 0 0 0 0 0 0 0 0
90 Obat Kategori Anak Paket 0 0 0 0 0 0 0 0 0 0 0 0 0
91 Oksitetrasiklin Salep Mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
92 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
93 Omeprazole 20 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
94 Parasetamol Drops Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
95 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0

JUMLAH
97 Pehacain Inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
98 Pirantel tab 125 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
99 Piridoksin (Vit B.6) 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
100 Prednison 5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
101 Propanolol 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
102 Ranitidin Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
103 Ranitidin Inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
104 Ringer Lactat Infus Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
105 Salbutamol 4 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
106 Salep 2- 4 Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Salisil Bedak 2 % kotak 0 0 0 0 0 0 0 0 0 0 0 0 0
108 Sefadroksil Syr Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
109 Setirizine tab Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Sefotaxim 500 mg Inj vial 0 0 0 0 0 0 0 0 0 0 0 0 0
111 Sianocobalamin Inj 500 mcg/ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
112 Simvastatin 20 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
113 Siprofloksasin 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
115 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Tetrasiklin 250 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
117 Tiamin HCL ( Vit B1 ) 50 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
118 Tramadol Injeksi Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
119 Triheksifenidil 2 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
120 Ventolin Nebule Kotak 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Vitamin B Complek Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
122 Yodium Povidon 30 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
123 Zink Syr Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
124 Zink tab Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0
125 Caviton Pot 0 0 0 0 0 0 0 0 0 0 0 0 0

126 Curaspon Botol 0 0 0 0 0 0 0 0 0 0 0 0 0

JUMLAH
Etil Klorida semprot Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
128 Eugenol Cairan Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
129 Glass ionomer cement ART Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
130 Kalsium Hidroksida Pasta Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
131 Mumfying Pasta Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
132 Semen Seng Fosfat Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
133 Temporary Stopping Pletcer Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
BMHP 0 0 0 0 0 0 0 0 0 0 0 0 0
134 Alat Cek Darah Paket 0 0 0 0 0 0 0 0 0 0 0 0 0
135 Alat Suntik 2,5 cc Unit 0 0 0 0 0 0 0 0 0 0 0 0 0
136 Alat Suntik 5 cc Unit 0 0 0 0 0 0 0 0 0 0 0 0 0
137 Alat Suntik 10 cc Unit 0 0 0 0 0 0 0 0 0 0 0 0 0
138 Benecheck Glucose 50s Strip 0 0 0 0 0 0 0 0 0 0 0 0 0
139 Benecheck Total Chol 10s Strip 0 0 0 0 0 0 0 0 0 0 0 0 0
140 Benecheck Urid Acid 25s Strip 0 0 0 0 0 0 0 0 0 0 0 0 0
141 Blood Tranfusion Set Kantong 0 0 0 0 0 0 0 0 0 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
145 Foley Chateter Pediatrik Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
146 Foley Chateter Adult Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
147 Hand Scun Set 0 0 0 0 0 0 0 0 0 0 0 0 0
148 Handscun Non Steril Kotak 0 0 0 0 0 0 0 0 0 0 0 0 0
149 Handscun Obgyn Steril pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
150 HB SAHLI Set 0 0 0 0 0 0 0 0 0 0 0 0 0
151 Infusion set anak Kantong 0 0 0 0 0 0 0 0 0 0 0 0 0
152 Infusion set dewasa Kantong 0 0 0 0 0 0 0 0 0 0 0 0 0
153 Infusion set Y Connector Kantong 0 0 0 0 0 0 0 0 0 0 0 0 0
154 I.V Cateter 18 G Buah 0 0 0 0 0 0 0 0 0 0 0 0 0
155 I.V Cateter 20 G Buah 0 0 0 0 0 0 0 0 0 0 0 0 0

156 I.V Cateter 22 G Buah 0 0 0 0 0 0 0 0 0 0 0 0 0
157 I.V Cateter 24 G Buah 0 0 0 0 0 0 0 0 0 0 0 0 0

JUMLAH
158 I.V Cateter 26 G Buah 0 0 0 0 0 0 0 0 0 0 0 0 0
159 Kapas Rol 0 0 0 0 0 0 0 0 0 0 0 0 0
160 Kasa Pembalut 4m x 10 cm Rol 0 0 0 0 0 0 0 0 0 0 0 0 0
161 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0 0 0 0 0 0 0 0
162 Kasa Steril 10 x10 cm pack 0 0 0 0 0 0 0 0 0 0 0 0 0
163 Larutan Anti Sera A 10 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
164 Larutan Anti Sera B 10 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
165 Larutan HCl 0,1 N 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
166 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
167 Nald 0.3 x 21 mm ( Nald Gigi ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
168 Nasal Oxygen Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
169 Oksigen Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
170 Paper Tape (plester kertas) Rol 0 0 0 0 0 0 0 0 0 0 0 0 0
171 Plester 5 yard x 2 inch Rol 0 0 0 0 0 0 0 0 0 0 0 0 0
172 Plester bening 2 x 8 inch + Obat (Duoderm) Lembar 0 0 0 0 0 0 0 0 0 0 0 0 0
173 Plester bening 4 x 4 inch + Obat (Duoderm) Lembar 0 0 0 0 0 0 0 0 0 0 0 0 0
174 Silk Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
175 Spiritus 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
176 Surgical Blade Steril Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
177 Test Uji Kehamilan 25 MU/ml Strip 0 0 0 0 0 0 0 0 0 0 0 0 0
178 Urine Bag Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.
LAPORAN PEMAKAIA
TAHUN 20
UPT PUSKESMAS :
NO NAMA OBAT SATUAN

JAN FEB MAR APR

NO NAMA OBAT SATUAN
JAN FEB MAR APR

NO NAMA OBAT SATUAN
JAN FEB MAR APR

NO NAMA OBAT SATUAN
JAN FEB MAR APR
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0

NO NAMA OBAT SATUAN
JAN FEB MAR APR
Etil Klorida semprot Botol 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0
143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0

NO NAMA OBAT SATUAN
JAN FEB MAR APR
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm ( Nald Gigi ) Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
Kepala Puskesmas
( )
Nip.
ORAN PEMAKAIAN OBAT DAK
TAHUN 2018
BULAN
MAI JUNI JULI AGUST SEPT OKT NOV DES
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
BULAN
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
BULAN
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
BULAN
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
BULAN
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
BULAN
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Pengelola Obat PKM
( )
Nip.
Ket
JUMLAH
0
Ket
JUMLAH
0
Ket
JUMLAH
0
Ket
JUMLAH
0
Ket
JUMLAH
0
Ket
JUMLAH
0
LAPORAN TAHUNAN OBAT DAK
TAHUN 2018
UPT PKM :
SALDO 1 JAN PENERIMAAN PEMAKAIAN SALDO 31

NO NAMA OBAT SATUAN 2018 2018 2018 DES 2018
KET

NO NAMA OBAT SATUAN SALDO 1 JAN PENERIMAAN PEMAKAIAN SALDO 31
KET
2018 2018 2018 DES 2018


KET
2018 2018 2018 DES 2018
106 Salep 2- 4 Tube 0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
0 0 0 0
BMHP 0 0 0 0
142 Catgut 2/0 Pcs 0 0 0 0

143 Catgut 3/0 Pcs 0 0 0 0
144 Catgut 5/0 Pcs 0 0 0 0

KET
2018 2018 2018 DES 2018
159 Kapas Rol 0 0 0 0
167 Nald 0.3 x 21 mm ( Nald Gigi ) Pcs 0 0 0 0
174 Silk Pcs 0 0 0 0
179 USG Gel 250 ml Tube 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Mengetahui
( ) ( )
Nip. Nip.

Blangko LPLPO DAK 2018

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Blangko LPLPO DAK 2018

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Copyright:

Available Formats

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK

UPT PKM : BULAN : JANUARI

KECAMATAN : TAHUN : 2018

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

1 Acyclovir tab 200 mg Tablet 0 0 0

2 Acyclovir tab 400 mg Tablet 0 0 0

3 Acyclovir cream 5 % Tube 0 0 0

4 Albendazol 400 mg Tablet 0 0 0

5 Alkohol 70 % 1 liter Botol 0 0 0

6 Allopurinol 100 mg Tablet 0 0 0

7 Alprazolam 0.5 mg Tablet 0 0 0

8 Ambroxol Syr 60 ml Botol 0 0 0

9 Ambroxol tab 30 mg Tablet 0 0 0

11 Amoksisillina kapl 250mg Kapsul 0 0 0

12 Amoksisillina sirker 125 mg / 5 ml Botol 0 0 0

13 Antasida Doen Tab Tablet 0 0 0

14 Antasida sir Botol 0 0 0

15 Anti Hemaroid supp supp 0 0 0

16 Aqua Pro Inj 25 ml Steril Botol 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0

19 Attapulgite tab 600 mg Tablet 0 0 0

20 Atropin Sulfat 0.5 mg Tablet 0 0 0

21 Besi II Sulfat Tablet 0 0 0

22 Betametason Krim Tube 0 0 0

23 Captopril 12.5 mg Tablet 0 0 0

26 Carbamazepin 200 mg Tablet 0 0 0

27 Deksametason Inj Ampul 0 0 0

28 Deksametason 0,5 mg Tablet 0 0 0

29 Dekstromethorphan syrup Kombinasi Botol 0 0 0

30 Diazepam Tab 2 mg Tablet 0 0 0

31 Diltiazem HCL 30mg Tablet 0 0 0

32 Dipenhidramin Inj Ampul 0 0 0

33 Doksisiklin 100 mg Tablet 0 0 0

35 Efedrina HCL 25 mg Tablet 0 0 0

36 Ergotamin tartrat 50 mg Tablet 0 0 0

37 Erytromicin Syr Botol 0 0 0

38 Etakridine kom Botol 0 0 0

40 Fenobarbital tab 30 mg Tablet 0 0 0

41 Ferro Fumarat 60 mg + as.folat Tablet 0 0 0

42 Fitomenadion Tablet Tablet 0 0 0

43 Furrosemida tab Tablet 0 0 0

44 Furrosemida inj Ampul 0 0 0

45 Garam Oralit Tablet 0 0 0

46 Gentamicin SK 0,1 % Tube 100 100 0 100

47 Gentamicin Tetes Mata 0,3% Botol 0 0 0

48 Glibenklamida tab 5 mg Tablet 0 0 0

50 Glukosa Lar. Inf 5 % Botol 0 0 0

51 Griseofulvin tab 125 mg Tablet 0 0 0

52 Halloperidol 1.5 mg Tablet 0 0 0

54 Hidroklorotiazid ( HCT ) 25 mg Tablet 0 0 0

55 Hidrokortison Krim Tube 0 0 0

56 Ibuprofen tab.200 mg Tablet 0 0 0

57 Illiadin Drops 0.025 % Botol 0 0 0

58 Illiadin Spray 0.05 % Botol 0 0 0

59 Kals Laktat tab.500 mg Tablet 0 0 0

60 Ketokonazol tablet 200 mg Tablet 0 0 0

61 Ketokonazol cream Tube 0 0 0

62 Kloramfenikol salep mata Tube 0 0 0

63 Kloramfenicol kaps 250 mg Kapsul 0 0 0

64 Kloramfenicol tetes telinga 10 ml Botol 0 0 0

65 Klorpromazin 100 mg Tablet 0 0 0