LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

( LPLPO )

KODE RSUD/PUSKESMAS :
PUSKESMAS : SUNGAI BUNUT LAPORAN BULAN : JANUARI 2020
KECAMATAN : BTS ULU PERMINTAAN BULAN :-
KAB / KODYA : MUSI RAWAS NOMOR :
PROPINSI : SUMATERA SELATAN TANGGAL :

STOK PENERI PERSE PEMA- SISA STOK PERMIN PEMBERIAN

KODE NAMA OBAT SATUAN
AWAL MAAN DIAAN KAIAN STOK OPT TAAN APBD ASKES APT LAIN JML KET
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15 16
TABLET

1 Alopurinol tablet 100 mg Tablet 100 0 100 100

2 Aminofilin tab 200 mg Tablet 480 0 480 0 480
3 Amlodipin 5mg tab Tablet 1500 0 1500 600 900
4 Amoksisillin kapl 500 mg Tablet 9300 0 9300 700 8600
5 Antasida DOEN tablet, kombinasi : Tablet 2700 0 2700 200 2500
6 Asam Askorbat ( Vit.C ) tablet 50 mg Tablet 1000 0 1000 100 900
7 Asam Mefenamat 500mg Tablet 1350 0 1350 550 800
8 Asiclovir 200 mg Tablet 1200 0 1200 100 1100
9 Asiclovir 400 mg Tablet 1800 0 1800 300 1500
10 Atapulgit tab 600mg Tablet 200 0 200 200 0
11 Asetyl Systein tab Tablet 500 0 500 200 300
12 Betahistin mesilat tab 6mg Tablet 700 0 700 100 600
13 Captopril tab. 50 mg Tablet 400 0 400 400 0
14 Cefadroxil 500 mg Tablet 800 0 800 400 400
15 Cefixime kap 100mg Tablet 0 0 0 0 0
16 Cetirizine tab 10mg Tablet 1500 0 1500 400 1100
17 Cyprofloksasin 500 mg tablet Tablet 2500 0 2500 2500
18 Deksametason tablet 0,5 mg Tablet 6400 0 6400 1100 5300
19 Diazepam tablet 2 mg Tablet 0 0 0 0 0
20 Diazepam tablet 2 mg Tablet 0 0 0 0 0
21 Digoksin tablet 0.25 mg Tablet 300 0 300 0 300
22 Domperidone 10 mg Tablet 1000 0 1000 400 600
23 Erythromicin 500 mg kapsul Tablet 2100 0 2100 100 2000
24 Fenitoin Natrium kapsul 100 mg kapsul 0 0 0 0 0
25 Fenoksimetil Penisilin tablet 250 mg Tablet 0 0 0 0 0
26 Fitomenadion ( Vit.K1 ) tablet salut 10 mg Tablet 1000 0 1000 1000
27 Glimepiride 3mg tab Tablet 1500 0 1500 500 1000
28 Grisiofulvin tablet 125 mg, micronized Tablet 700 0 700 500 200
29 Haloperidol tablet 1,5 mg Tablet 1500 0 1500 0 1500
30 Hemafort kapsul Tablet 0 0 0 0 0
31 Hidroklortiazide (HCT) Tablet 1000 0 1000 0 1000
32 Ibuprofen tablet 200 mg Tablet 0 0 0 0 0
33 Ibuprofen tablet 400 mg Tablet 3700 0 3700 1400 2300
34 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 100 0 100 0 100
35 Kalsium Laktat tablet 500 mg Tablet 2200 0 2200 1400 800
36 Ketokonazole 200mg tab Tablet 300 0 300 0 300
37 Kloramfenicol 500mg Tablet 400 0 400 0 400
38 Kodein tablet 10mg Tablet 0 0 0 0 0
39 Kombinasi (Pirimetamin 25 mg + Sulfadoxin 500 mg T Tablet 0 0 0 0 0
40 Kotrimoksazol tablet 480 mg Tablet 0 0 0 0 0
41 Kuinina tab 200mg Tablet 0 0 0 0 0
42 Lansoprazole 30mg tab Tablet 160 0 160 100 60
43 Lexavit kaplet Tablet 0 0 0 0 0
44 Loperamide 2mg tab Tablet 200 0 200 200 0
45 Metilergometrin Maleat (Metilergometrin) ta Tablet 200 0 200 0 200
46 Metronidazole tablet 500mg Tablet 0 0 0 0 0
47 Molexflu Kaplet Tablet 0 0 0 0 0
48 Molaneuron tab Tablet 0 0 0 0 0
49 Na Diklofenac tab 25mg Tablet 2000 0 2000 500 1500
50 Nipedipin tab. 10 mg Tablet 0 0 0 0 0
51 Nistatin tablet vagina 100.000 IU/g Tablet 200 0 200 200
52 Nistatin tablet vagina 500.000 IU/g Tablet 140 0 140 0 140
53 Novamox 500mg Tablet 0 0 0 0 0
54 OAT Kategori I/III paket 0 0 0 0 0
55 OAT Kategori II paket 0 0 0 0 0
56 OAT Kategori Anak paket 0 0 0 0 0
57 Omeprazole 30mg Tablet 600 0 600 300 300
58 Papaverin tab Tablet 0 0 0 0 0
59 Parasetamol tablet 500 mg Tablet 9200 0 9200 1600 7600
60 Pirantel tablet 125 mg Tablet 67 0 67 0 67
61 Piridoksin tablet 10 mg Tablet 200 0 200 0 200
62 Prednison tablet 5 mg Tablet 3300 0 3300 0 3300
63 Propanolol tablet 40 mg Tablet 900 0 900 0 900
64 Propiltiourasil tablet 100 mg Tablet 500 0 500 0 500
65 Ranitidin tab 150 mg Tablet 0 0 0 0 0
66 Retinol (Vit A 100.000.IU) Tablet 0 0 0 0 0
67 Retinol (Vit A 200.000.IU) Tablet 0 0 0 0 0
68 Salbutamol tablet 2 mg Tablet 1000 0 1000 400 600
69 Spinorolactone 25mg tab Tablet 0 0 0 0 0
70 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tablet 2500 0 2500 0 2500
71 Vitamin B Komplek tablet Tablet 1800 0 1800 1800
72 Metformin Tablet 0 0 0 0 0
73 Metoclopramide HCL 10 mg Tablet 2600 0 2600 700 1900
74 CTM Tablet 2200 0 2200 900 1300
75 Methil Prednison Tablet 300 0 300 100 200
76 Clindamycin Tablet 0 0 0 0 0
77 Simvastatin Tablet 630 0 630 630 0
78 Zink Tablet 0 0 0 0 0
79 Hustab Tablet 200 0 200 200 0
80 furosemide 40 mg Tablet 32O 0 320 120 200
81 isoniazide 300 mg Tablet 0 0 0 0 0
82 Risperidone 2 mg Tablet 500 0 500 0 500
83 chlopromazine 100 mg Tablet 500 0 500 500
84 Fe Tablet 0 0 0 0 0
85 Trihexypenidil 2 mg Tablet 0 0 0 0 0
86 Apara Tablet 0 0 0 0 0
87 Pehapral Tablet 0 0 0 0 0
88 Diclopenak Sodium Tablet 2400 0 2400 2400
89 Scopasma Plus Tablet 500 0 500 300 200
90 Amitriptulinehidroklorida Tablet 200 0 200 200
91 Clobazam Tablet 200 0 200 200

SYRUP

1 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 54 0 54 14 40

2 Amoksisilin sirup kering 250 mg/5 ml Botol 60 ml 0 0 0 0 0
3 Cefadroxil syrup 250 mg/ml Btl 60ml 30 0 30 14 16
4 Cefixime Syr 100mg /5ml Btl 60ml 0 0 0 0 0
5 Cetirizine Syrup Btl 60ml 50 0 50 13 37
6 Erythromicin Syrup Btl 60ml 105 0 105 105
7 Flucetin Syrup Btl 60ml 0 0 0 0 0
8 Garam Oralit untuk 200 ml air sach 0 0 0 0 0
9 Klorampenikol 125mg/5ml suspensi Btl 60ml 40 0 40 8 32
10 Kotrimoksazole suspensi, kombinasi : Btl 60ml 0 0 0 0 0
11 Obat Batuk Hitam ( OBH ) sirup Btl 60ml 76 0 76 76
12 Parasetamol Drop btl 15ml 0 0 0 0 0
13 Parasetamol sirup 120 mg/5 ml btl 60ml 134 0 134 134
14 Pirantel 125 mg/ml suspensi Btl 60ml 0 0 0 0 0
15 Vical Syrup Btl 0 0 0 0 0
16 Zinc (Zirkum) 20mg/5ml syrup Btl 60ml 26 0 26 8 18
17 Alpara syp Btl 60ml 0 0 0 0 0
18 Donperidon syp Btl 60ml 36 0 36 0 36
19 Recovit Syp Btl 60ml 24 0 24 2 22

INJEKSI

1 Aqua pro injeksi steril, bebas Pirogen Vial 20 0 20 12 8

2 Aminofillin injeksi 24 mg/ml-10 ml Ampul 0 0 0 0 0
3 Asam Traneksamat inj 100mg/ml Ampul 10 0 10 0 10
4 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0 0 0 0 0
5 Asetyl Systein ( Flumucil) injeksi Ampul 0 0 0 0 0
6 Benzatin Penisillin inj Vial 0 0 0 0 0
7 Cefotaxim Injeksi 1 gr Vial 50 0 50 3 47
8 Deksametason injeksi 5 mg/ml - 1 ml Ampul 200 0 200 75 125
9 Diazepam injeksi lar 5mg/2,5ml rec Tube 5gr 0 0 0 0 0
10 Difenhidramin HCl injeksi 10 mg/ml-1 ml Ampul 166 0 166 76 90
11 Epinefrin HCl/Bitartrat (Epinefrin/Adrenalin) inj 0,1 % Tablet 0 0 0 0 0
12 Fitomenadion (Vit.K) injeksi 2 mg/ml - 1 ml Ampul 0 0 0 0 0
13 Furosemide injeksi Ampul 0 0 0 0 0
14 Furosemide injeksi Ampul 20 0 20 6 14
15 Gentamisin Injeksi Ampul 50 0 50 0 50
16 Magnesium Sulfat inj (IV) 20%-25ml vial 0 0 0 0 0
17 Metilergometrin Maleat injeksi Ampul 0 0 0 0 0
18 Oksitocin injeksi Ampul 0 0 0 0 0
19 Ondansetron 4mg/2ml injeksi Ampul 0 0 0 0 0
20 Pehacain injeksi Ampul 0 0 0 0 0
21 Serum Anti Bisa Ular Polivalen inj.5ml(ABU vial 2 0 2 2
22 Serum Anti Tetanus inj.1.500 IU/ampul (AT vial 0 0 0 0 0
23 Sianokobalamin (Vit.B12) inj. 500mcg/ml-1m Ampul 267 0 267 67 200
24 Tetagam human tetanus inj vial 10 0 10 10
25 Vaksin Rabies Vero vial 4 0 4 4
26 Natrium Klorida Larutan infus 0.9 % steril btl 500ml 82 0 82 82
27 Ringer Laktat larutan infus steril btl 500ml 104 0 104 104
28 Glukosa infus5% btl 500ml 122 0 122 122
29 Lidokain Ampul 167 0 167 77 90
30 Omeprazole Ampul 0 0 0 0 0
31 Ranitidine Ampul 0 0 0 0 0
32 Tranecxamic Ampul 10 0 10 0 10
33 Haloperidol Ampul 12 0 12 0 12
 OBAT LUAR

1 Anti Haemorroid DOEN Kombinasi Supps Suppos 0 0 0 0 0

2 Asam Fusidat krim 20mg/gr Tube 5gr 0 0 0 0 0
3 Betametason krim 0.1 % Tube 5gr 90 0 90 47 43
4 Devitalisasi pasta ( Devitec) Tablet 0 0 0 0 0
5 Domperidone Susp 5mg/5ml Btl 100ml 0 0 0 0 0
6 Etakridin ( Rivanol ) larutan 0.1 % Btl 300ml 34 0 34 19 15
7 Etanol 70 % Btl 100ml 0 0 0 0 0
8 Etanol 70 % 1L BTl 1000ml 6 0 6 1 5
9 Etanol Swab serenity box 0 0 0 0 0
10 Etil Klorida semprot btl 100ml 2 0 2 0 2
11 Fenol Gliserol tetes telinga 10 % btl 15ml 24 0 24 24
12 Garam Oralit untuk 200 ml air sach 0 0 0 0 0
13 Gentamisin sulfat tetes mata 0.3 % btl 15ml 36 0 36 12 24
14 Glukosa larutan infus 5 % steril btl 500ml 129 0 129 29 100
15 Hidrokortison krim 2.5 % Tube 5gr 48 0 48 48
16 Kloramfenikol salep mata 1 % Tube 5gr 52 0 52 21 31
17 Kloramfenikol Salep Kulit 2% Tube 5gr 76 0 76 4 72
18 Lisol / Protektor BTl 1000ml 0 0 0 0 0
19 Lysol/Kresol 50% btl 1000ml 0 0 0 0 0
20 Mikonazol krim 2 % Tube 5gr 92 0 92 13 79
21 Polikresulen btl 15ml 0 0 0 0 0
22 Salep 2 - 4 kombinasi pot 0 0 0 0 0
23 Salep 2 - 4 kombinasi pot 134 0 134 0 134
24 Salisyl Bedak 2 % Tablet 23 0 23 0 23
25 Temporary Stopping Fletcher serbuk&caira Tablet 0 0 0 0 0
26 Wida WI Unicap 1000ml btl 500ml 0 0 0 0 0
27 Yodium Povidon larutan 10 % 30 ml Btl 30ml 0 0 0 0 0
28 Yodium Povidon larutan 10 % 300 ml Btl 300ml 0 0 0 0 0
29 Yodium Povidon larutan 10 % 60 ml Btl 60ml 68 0 68 0 68
30 Acyclovir Rube 5 gr 76 0 76 76
31 Bufacetine Rube 5 gr 75 0 75 75

PERBEKALAN KESEHATAN

1 Abocat No. 20 G jellco Pcs 172 0 172 0 172

2 Abocath No. 22 G jellco Pcs 0 0 0 0 0
4 Abocath No. 24 G jellco Pcs 164 0 164 0 164
5 Abocat No. 20 G Serenity Pcs 0 0 0 0 0
6 Abocath No. 22 G Serenity Pcs 0 0 0 0 0
7 Abocath No. 24 G Serenity Pcs 0 0 0 0 0
8 Alat Suntik sekali pakai 1 ml Pcs 0 0 0 0 0
9 Alat Suntik sekali pakai 2.5 ml Pcs 1200 0 1200 0 1200
10 Alat Suntik sekali pakai 5 ml Pcs 1500 0 1500 1000 500
11 Alat Suntik 1cc Aximed Pcs 0 0 0 0 0
12 Alat Suntik 3cc Aximed Pcs 0 0 0 0 0
13 Alat Suntik 5cc Aximed Pcs 0 0 0 0 0
14 Auto Disable Syringe (ADS) 0,05ml Pcs 0 0 0 0 0
15 Auto Disable Syringe (ADS) 0,5ml Pcs 0 0 0 0 0
16 Auto Disable Syringe (ADS) 5ml Pcs 0 0 0 0 0
17 Blood Lancet Twice Serenity box 0 0 0 0 0
18 Benecheck plus Glucose Test 50's box 0 0 0 0 0
19 Benecheck plus Cholesterol Test 50's box 0 0 0 0 0
20 Benecheck plus Glucose Test 50's box 0 0 0 0 0
21 Catgut Chromic3/0 HR 26MM Sach 0 0 0 0 0
22 Catgut Plain 3/0 HR 26MM Sach 156 0 156 36 120
23 Catgut Chromic3/0 HR 26MM serenity Sach 72 0 72 24 48
24 Hand Scun 7,5 Serenity psg 0 0 0 0 0
25 Hand Scun 7,5 psg 137 0 137 24 113
26 Hand Scun 7 psg 0 0 0 0 0
27 Hand Scun 8 Serenity psg 0 0 0 0 0
28 Human Humansens Plus Unit 0 0 0 0 0
29 Humansens Plus Glucose Test Strip Dus 0 0 0 0 0
30 Humansens Plus Total Cholesterol Test Str Dus 0 0 0 0 0
31 Humansens Plus Total Urid Acid Test Strip Dus 0 0 0 0 0
32 Infus set anak Serenity set 0 0 0 0 0
33 Infusion set dewasa Serenity set 0 0 0 0 0
34 Infusion set anak set 0 0 0 0 0
35 Infusion set dewasa set 52 0 52 0 52
36 Kapas Pembalut Hydrophyl 250 gram Bungkus 9 0 9 0 9
37 Kapas Pembalut Hydrophil 250 gram Bungkus 0 0 0 0 0
38 Kapas Pembalut Hydrophil 500gram roll 0 0 0 0 0
39 Kasa pembalut 16 x 16cm Kotak 12 0 12 4 8
40 Kassa pembalut Hidrofil 4 m x 10 cm Rol 0 0 0 0 0
41 masker Aximed box 0 0 0 0 0
42 masker ktk 50 pcs 250 0 250 0 250
43 Plester 5 yards x 1 inch roll 8 0 8 0 8
44 Plester 5 yards x 2 inch/ Polifix roll 0 0 0 0 0
45 Polygyp 10 cm X2,75m roll 0 0 0 0 0
46 Polygyp 15 cm X2,75m roll 0 0 0 0 0
47 Pembalut elastis Polycrepe 10cmX4,55m roll 0 0 0 0 0
48 Pembalut elastis Polycrepe 15cmX4,55m roll 0 0 0 0 0
49 Selang Catheter No 14 pcs 7 0 7 2 5
50 Selang Catheter No 16 pcs 0 0 0 0 0
51 Selang Catheter No 12 pcs 0 0 0 0 0
52 Selang Catheter No 16 Serenity pcs 0 0 0 0 0
53 Safety Onemed Box dus 0 0 0 0 0
54 Silk No. 3/0 serenity sach 0 0 0 0 0
55 Silk No. 3/0 HR 26 MM sach 120 0 120 120
56 Urine bag pcs 24 0 24 0 24
57 Urine bag Onemed pcs 0 0 0 0 0
58 Wing Neadle 25G pcs 0 0 0 0 0
59 Wing Neadle 27 G pcs 0 0 0 0 0
 60 Wing Neadle 27 G pcs 0 0 0 0 0
61 Wing Neadle 27 G pcs 0 0 0 0 0
62 Paper tape pcs 30 0 30 0 30

GENERIK NON GENERIK ESSENSIAL NON ESSENSIAL

TOTAL NON TOTAL
INJEKSI ORAL ORAL INJEKSI PEMAKAIA PEMAKAIAN
N
A.BIO Non A. Bio Non A. Bio Non A. Bio Non.A.BIO A.BIO Non.A.BIO A.BIO GENERIK PATENT GENERIK PATENT GENERIK PATENT

Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima/ Melapor Yang Menerima

Kepala Dinas Kesehatan Kabupaten Musi Rawas Kepala Gudang Farmasi Kab. Musi Rawas Ka UPT Puskesmas Sungai Bunut Petugas Puskesmas Sungai Bunut

drg. Hj. Mipta Hulummi, M.Kes Sulaiman.S, Si,Apt Azmali Thamrin,SKM KUSNITA,Amd.Keb
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