LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : JANUARI 2019
PERMINTAAN BULAN / PERIODE : FEBRUARI 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH
1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Allopurinol 100 mg Tab 500 500 400 100 500
2 Ambroxol 30 mg Tab 5000 5000 2000 3000 3000
3 Ambroxol Sirup 15 mg/5ml Btl 24 50 74 30 44
4 Aminofilin 200 mg Tab 0 0
5 Amitripilin 25 mg Tab 0 0
6 Amoksisilin 250 mg Kaps 0 0
7 Amoksisilin 500 mg Kapl 2600 2000 4600 2300 2300 2000
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl 197 0 197 47 150 20
9 Amlodipin 5 Mg Tab 1500 1500 600 900
10 Amlodipin 10 Mg Tab 2000 2000 720 1280 300
11 Antalgin Injeksi 250 mg ml - 2 ml Amp 0 0
12 Antalgin ( Metampiron ) 500 mg Tab 0 0
13 Antasida Doen Tab. Kombinasi Tab 2700 1000 3700 1700 2000 1000
14 Antasida Doen suspensi 60 ml Btl 88 50 138 138 0 150
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot 75 75 25 50 25
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot 0 0
17 Antihemoroid Supp 2 gr Supp 0 0
18 Anti Migrain Doen Tab 0 0
19 Anti Parkinson Doen Tab 0 0
20 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial 15 15 1 14
21 Aquadest Steril 1000 ml Btl 0 0
22 Asam Askorbat ( Vit. C ) 50 mg Tab 1200 1000 2200 1000 1200
23 Asam Mefenamat 500 mg Kapl 2200 1500 3700 1500 2200 1000
24 Asam Traneksamat 500 mg Tab 100 200 300 300
25 Asiklovir 200 mg Tab 200 1000 1200 200 1000
26 Asiklovir 400 mg Tab 600 600 150 450
27 Asiklovir Krim 5 % Tube 30 20 50 50
28 Aspilet Tab 0 0
29 Azithromicin 500 mg Tab 0 0
30 Artem injeksi 80 mg / 1 ml Vial 0 0
31 Air Raksa Dental Use Btl 0 0
32 Betametason krim 0,1 % Tube 0 0
33 Betahistin Tab 90 60 150 150 0 150
34 Betadin Kumur Btl 5 5 5
35 Caviplex Sirup Btl 0 0
36 Caviplex Tablet Tab 0 0
37 Clindamycin 300 mg Tab 0 100 100 100 0
38 Ciprofloksasin 500 mg Tab 100 100 100 0
39 Captopril 25 mg Tab 1000 1000 400 600
40 Cefadroxil 500 mg Kaps 300 500 800 300 500
41 Cefadroxil Sirup Btl 10 10 5 5
42 Cefixime 100 mg Caps 990 990 390 600 150
43 Cefixime Sirup Btl 10 10 5 5 5
44 Cetrizin Tab Tab 700 300 1000 450 550 500
45 Cetrizin Syrup Btl 7 50 57 57
46 Combiven UDV Vial 0 0
47 Caviplex Drops Btl 0 0
48 Curcuma Tab 500 500 100 400
49 Curbion Sirup Btl 81 100 181 80 101
50 Deksametason 0,5 mg Tab 2600 2500 5100 2200 2900
51 Deksametason injeksi 5 mg / ml Amp 0 0
52 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl 0 0
53 Dekstrometorfan Hbr 15 mg Tab 0 0
54 Diltiazem 30 mg Tab 0 0
55 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp 0 0
56 Dentoria Btl 0 0
57 Devitalisasi Pasta Btl 0 0
58 Dietil Karbamazepin 100 mg Tab 0 0
59 Domperidon 10 Mg Tab 500 500 200 300 200
60 Domperidon sirup Btl 0 0
61 Doksisiklin 100 mg Kaps 0 0
62 Dulcolax Supp Supp 0 0
63 Dulcolax Tablet Tab 90 90 90
64 Efedrin Hcl 25 mg Tab 0 0
65 Ekstrak Beladona 10 mg Tab 0 0
66 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp 0 0
67 Eritromisin 500 mg Kapl 300 300 300
68 Eritromisin Sirup Kering 200 mg / 5 ml Btl 0 0 0 20
69 Eugenol Btl 0 0
70 Fenilbutason 200 mg Tab 0 0
71 Fenobarbital 30 mg Tab 0 0
72 Fenol Gliserol Tetes Telinga Btl 0 0
73 Flunarizin 5 mg Tab 0 0
74 Fenitoin 100 mg Kaps 0 0
75 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp 0 0
76 Fitomenadion ( Vit K ) Salut 10 mg Tab 100 100 100
77 Forumen Tetes Telinga Btl 13 13 6 7 5
78 Furosemida 40 mg Tab 0 0
79 Garam Oralit 200 ml Air Sak 500 500 200 300
80 Gemfibrosil 300 mg Kaps 200 200 200
81 Gemfibrosil 600 mg Kaps 0 0
82 Gentian Violet Larutan 1 % Btl 0 0
83 Glibenklamid 5 mg Tab 0 0
84 Gliseril Guayakolat 100 mg Tab 5000 5000 300 4700
85 Griseofulvin 125 mg Tab 500 500 200 300
86 Gliserol Btl 0 0
87 Gentamisin Salep Mata Tube 0 0
88 Gentamisin Tetes Mata Btl 0 0
89 Gentamisin 0,1 % Salep kulit Tube 40 30 70 20 50
 90 Glass Ionomer Pcs 0 0
91 Glukosa Larutan Infus 5 % Btl 0 0
92 Glukosa Larutan Infus 10 % Btl 0 0
93 Hidroklortiazid ( HCT ) 25 mg Tab 0 0
94 Hidrokortison Krim 2,5 % Tube 48 96 144 72 72 24
95 Ibuprofen Sirup Btl 5 10 15 5 10
96 Ibuprofen 400 mg Tab 2000 1500 3500 2200 1300
97 Isosorbit Dinitrat Sublingual 5 mg Tab 0 0
98 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set 0 0
99 Kalium Permanganat Serbuk 5 gr Pot 0 0
100 Kalsium Laktat 500 mg Tab 0 0
101 Kalsium Hidroksida Pasta Btl 0 0
102 Karbamazepin 200 mg Tab 0 0
103 Kloramfenikol 250 mg Kaps 0 0
104 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0
105 Kloramfenikol Tetes Telinga 3 % Btl 0 0
106 Kloramfenikol Tetes Mata Btl 20 20 20
107 Klorfeniramin Maleat ( CTM ) 4 mg Tab 4400 3000 7400 3600 3800
108 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl 0 0
109 Ketokonazole 200 mg Tab 600 600 200 400
110 Ketokonazole Krim Tube 25 50 75 25 50
111 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab 0 0
112 Kotrimoksazol Pediatrik 120 mg Tab 0 0
113 Kotrimoksazol Dewasa 480 mg Tab 0 0
114 Kotrimoksazol Suspensi 240 mg / 5 ml Btl 0 0
115 Komposit Btl 0 0
116 Lansoprazol 30 Mg Kaps 0 0
117 Lidokain Comp. Injeksi 2 % Amp 0 0
118 Lisol 1 L Btl 0 0
119 Loperamid Tab Tab 200 200 200 0
120 Lisinopril 10 mg Tab 180 180 60 120
121 L-Bio Sact 30 30 30 0 60
122 Loratadin Tab Tab 0 0
123 Methylprednisolon 4 mg Tab 200 2000 2200 1200 1000 500
124 Meloxicam 7,5 mg Tab 500 500 250 250
125 Metronidazol 250 mg Tab 0 0
126 Metronidazol 500 mg Tab 300 300 600 200 400
127 Mikonazole Krim 2 % Tube 96 96 24 72
128 Methergin Tab 0 0
129 Methyldopa Tab 0 0
130 Microlax Tube 0 0
131 Metformin 500 Mg Tab 100 100 100 0 200
132 Nisagon Tube 0 0
133 Mummifying Pasta Btl 0 0
134 Natrium Diklofenak 25 mg Tab 0 0
135 Natrium Diklofenak 50 mg Tab 900 1000 1900 750 1150
136 Nifedipin Tab 0 0
137 Nistatin IU Vagina Tab 0 0
138 Nelydex Tetes Mata Btl 0 0
139 Obat Anti Tuberkulosis / F.D.C Paket 0 0
140 Obat Anti Tuberkulosis Anak Paket 0 0
141 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl 25 25 25 0 50
142 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial 0 0
143 Oksitetrasiklina Hcl Salep Mata 1 % Tube 50 50 25 25 25
144 Oksitetrasiklina Hcl Salep Kulit 3 % Tube 200 200 50 150
145 Oksitosin Injeksi 10 IU / 1 ml Amp 0 0
146 Omecidal Tab Tab 500 500 500 0 500
147 Omegdiar Tab 500 300 800 400 400 200
148 Vastral Tab Tab 4000 4000 2200 1800
149 Omeprazol 20 Mg Kaps 390 150 540 180 360
150 Ometrydril Sirup Btl 0 0
151 Parasetamol Sirup 120 mg / 5 ml Btl 130 150 280 116 164 100
152 Parasetamol 100 mg Tab 0 0
153 Parasetamol 500 mg Tab 5500 1500 7000 4400 2600 5000
154 Parasetamol Drop Btl 0 0 50
155 Parasetamol Suppositoria Tube 5 5 5
156 Pirantel Pamoat 125 mg Tab 0 0
157 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab 100 1000 1100 300 800 200
158 Piroksikam 10 mg Tab 0 0
159 Piroksikam 20 mg Tab 0 0
160 Prednison 5 mg Tab 500 500 400 100
161 Primakina 15 mg Tab 0 0
162 Propanolol Hcl 40 mg Tab 300 300 200 100
163 Propiltiourasil ( P.T.U ) 100 mg Tab 0 0
164 Pehavral Tab Tab 0 0
165 Quinina ( Kina ) Inj. 25 % / 2 ml Amp 0 0
166 Quinina ( Kina ) 200 mg Tab 0 0
167 Ranitidin 150 mg Tab 0 0
168 Reserpin 0,25 mg Tab 0 0
169 Retinol ( Vit. A ) 100.000 IU Tab 0 0
170 Retinol ( Vit. A ) 200.000 IU Tab 0 0
171 Ringer Laktat Lar. Infus Btl 13 13 13 0 20
172 Salbutamol 2 mg Tab 0 0
173 Salbutamol 4 mg Tab 300 300 300
174 Salisil Bedak 2 % Dos 90 90 20 70
175 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot 0 0
176 Sianokobalamin ( Vit. B 12 ) 50 mg Tab 1600 1000 2600 2600
177 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp 0 0
178 Silk ( Benang Bedah Sutera ) No. 3/0 Sak 0 0
179 Silver Amalgam Serbuk 65 - 75 % Btl 0 0
180 Simvastatin 10 Mg Tab 1000 1000 300 700
181 Simvastatin 20 Mg Tab 600 600 400 200 500
182 Semen Seng Fosfat Serbuk & Cairan Btl 0 0
183 Sulfadimidin 500 mg Tab 0 0
184 Sucralfat Suspensi Btl 17 17 17 0 30
185 Tetrasiklin Hcl 250 mg Kaps 0 0
186 Tetrasiklin Hcl 500 mg Kaps 0 0
187 Thiamfenikol 500 mg Kaps 0 0
188 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab 2800 2800 2800
189 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp 0 0
190 Tab.Tambah Darah ( Fe ) Tab 7500 7500 1900 5600
191 Tramadol Kaps 0 0
192 Vaksin Anti Rabies (VAR) Kuur 0 0
193 Vitamin B. Kompleks Tab 3300 1000 4300 2200 2100 2000
194 Larutan Hc. 0,1 N Btl 0 0
195 Larutan Gimsa 100 ml Btl 0 0
196 Larutan Carbol Fuksin 0,3 % Btl 0 0
197 Larutan Turk 100 ml Btl 0 0
198 Larutan Benedict Btl 0 0
199 Larutan Etanol Asam 3 % Btl 0 0
200 Larutan Metilen Biru 0,3 % Btl 0 0
201 Larutan Asam Sulfosalisilat Btl 0 0
202 Larutan Hayyam Btl 0 0
203 Larutan Metanol Btl 0 0
204 Larutan Xilen 100 ml Btl 0 0
205 Larutan Oil Emersi Btl 0 0
206 Larutan Eosin Btl 0 0
207 zink 20 mg Tab 0 0
208 MDT Paket 0 0
209 Vidabion Tab 0 0
210 Recolfar Tab 0 0
211 Bisoprolol 5 Mg Tab 0 0
212 Ketoprofen Suppositoria Supp 0 0
213 Neo Protifed Tab 100 100 100 0 500
214 Renalyte Btl 0 0
215 Salep Bioplasenton Tube 0 0
216 Scopma Plus Tab 100 100 200 100 100
217 Spironolakton 25 mg Tab 0 0
218 Tilomix Btl 1000 500 1500 700 800
219 Valsartan Tab 0 0
220 Alat Suntik Sekali Pakai 3 ml Pcs 400 200 600 100 500
221 Alat Suntik Sekali Pakai 5 ml Pcs 100 100 20 80
222 Alat Suntik Sekali Pakai 1 Ml Tab 200 200 200
223 Abbocath No. 18 / Intra Vena Catheter Pcs 31 31 2 29
224 Abbocath No. 20 / Intra Vena Catheter Pcs 20 20 5 15
225 Abbocath No. 24 / Intra Vena Catheter Pcs 0 0
226 Bisturi No. 11 Pcs 0 0
227 Cat Gut / Benang Bedah No.3/0 Pcs 0 0
228 Etakridina Larutan 0,1 % Rivanol Btl 0 0
229 Etanol 70 % / 1 L Btl 0 0
230 Etil Klorida Semprot Btl 0 0
231 Handscun Steril Psg 50 600 650 50 600
232 Handscun Non Steril Psg 1100 200 1300 300 1000

UMUM ASKES JUMLAH

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

GORONTALO, 2018
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 2018
G MENERIMA
USKESMAS SIPATANA

SULEMAN, S.Farm
0527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : FEBRUARI 2019
PERMINTAAN BULAN / PERIODE : MARET 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH
1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Allopurinol 100 mg Tab 100 500 600 500 100 500
2 Ambroxol 30 mg Tab 3000 3000 6000 2600 3400 1000
3 Ambroxol Sirup 15 mg/5ml Btl 44 10 54 35 19 30
4 Aminofilin 200 mg Tab 0 0 100
5 Amitripilin 25 mg Tab 0 0
6 Amoksisilin 250 mg Kaps 0 0
7 Amoksisilin 500 mg Kapl 2300 2000 4300 3300 1000 3000
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl 150 20 170 70 100
9 Amlodipin 5 Mg Tab 900 900 600 300 600
10 Amlodipin 10 Mg Tab 1280 300 1580 1080 500 500
11 Antalgin Injeksi 250 mg ml - 2 ml Amp 0 0
12 Antalgin ( Metampiron ) 500 mg Tab 0 0
13 Antasida Doen Tab. Kombinasi Tab 2000 1000 3000 2800 200 3500
14 Antasida Doen suspensi 60 ml Btl 150 150 100 50 150
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot 50 25 75 75
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot 0 0
17 Antihemoroid Supp 2 gr Supp 0 0
18 Anti Migrain Doen Tab 0 0
19 Anti Parkinson Doen Tab 0 0
22 Asam Askorbat ( Vit. C ) 50 mg Tab 1200 1200 1200 0 2500
23 Asam Mefenamat 500 mg Kapl 2200 1000 3200 800 2400 1500
24 Asam Traneksamat 500 mg Tab 0 0 300
25 Asiklovir 200 mg Tab 1000 1000 300 700
26 Asiklovir 400 mg Tab 0 0 1000
27 Asiklovir Krim 5 % Tube 50 50 50
28 Aspilet Tab 0 0
29 Azithromicin 500 mg Tab 0 0
30 Artem injeksi 80 mg / 1 ml Vial 0 0
31 Air Raksa Dental Use Btl 0 0
32 Betametason krim 0,1 % Tube 25 25 25
33 Betahistin Tab 0 150 150 90 60 150
34 Betadin Kumur Btl 5 5 5
35 Caviplex Sirup Btl 0 0
36 Caviplex Tablet Tab 0 0 500
37 Clindamycin 300 mg Tab 0 0
38 Ciprofloksasin 500 mg Tab 0 0
39 Captopril 25 mg Tab 600 500 1100 100 1000
40 Cefadroxil 500 mg Kaps 500 500 500 0 1000
41 Cefadroxil Sirup Btl 5 5 5
42 Cefixime 100 mg Caps 600 150 750 750
43 Cefixime Sirup Btl 0 0
44 Cetrizin Tab Tab 550 500 1050 450 600 200
45 Cetrizin Syrup Btl 57 57 7 50
46 Combiven UDV Vial 20 20 20
47 Caviplex Drops Btl 0 0
48 Curcuma Tab 400 400 400
49 Curbion Sirup Btl 101 101 86 15 150
50 Deksametason 0,5 mg Tab 2900 2900 2000 900 3000
51 Deksametason injeksi 5 mg / ml Amp 0 0
52 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl 0 0
53 Dekstrometorfan Hbr 15 mg Tab 0 0
54 Diltiazem 30 mg Tab 0 0
55 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp 0 0
56 Dentoria Btl 0 0
57 Devitalisasi Pasta Btl 0 0
58 Dietil Karbamazepin 100 mg Tab 0 0
59 Domperidon 10 Mg Tab 300 200 500 300 200 300
60 Domperidon sirup Btl 0 0 20
61 Doksisiklin 100 mg Kaps 0 0
62 Dulcolax Supp Supp 0 0
63 Dulcolax Tablet Tab 90 90 90
64 Efedrin Hcl 25 mg Tab 0 0
65 Ekstrak Beladona 10 mg Tab 0 0
66 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp 30 30 30
67 Eritromisin 500 mg Kapl 300 300 300
68 Eritromisin Sirup Kering 200 mg / 5 ml Btl 0 0 10
69 Eugenol Btl 0 0
70 Fenilbutason 200 mg Tab 0 0
71 Fenobarbital 30 mg Tab 0 0
72 Fenol Gliserol Tetes Telinga Btl 0 0
73 Flunarizin 5 mg Tab 0 0
74 Fenitoin 100 mg Kaps 0 0
75 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp 30 30 30
76 Fitomenadion ( Vit K ) Salut 10 mg Tab 100 100 100
77 Forumen Tetes Telinga Btl 7 7 7
78 Furosemida 40 mg Tab 0 0
79 Garam Oralit 200 ml Air Sak 300 300 300
80 Gemfibrosil 300 mg Kaps 200 200 200
81 Gemfibrosil 600 mg Kaps 0 0
82 Gentian Violet Larutan 1 % Btl 0 0 20
83 Glibenklamid 5 mg Tab 0 0
84 Gliseril Guayakolat 100 mg Tab 4700 4700 2000 2700 1000
85 Griseofulvin 125 mg Tab 300 300 300
86 Gliserol Btl 0 0
87 Gentamisin Salep Mata Tube 0 0
88 Gentamisin Tetes Mata Btl 0 0
89 Gentamisin 0,1 % Salep kulit Tube 50 20 70 70
90 Glass Ionomer Pcs 0 0
91 Glukosa Larutan Infus 5 % Btl 0 0
92 Glukosa Larutan Infus 10 % Btl 0 0
93 Hidroklortiazid ( HCT ) 25 mg Tab 0 0
94 Hidrokortison Krim 2,5 % Tube 72 24 96 24 72 24
95 Ibuprofen Sirup Btl 10 10 10
96 Ibuprofen 400 mg Tab 1300 1300 1300 0 3000
97 Isosorbit Dinitrat Sublingual 5 mg Tab 0 0
98 Isoniazid 100 mg (INH 100 mg) Tab 0 0 300
99 Kalium Permanganat Serbuk 5 gr Pot 0 0
100 Kalsium Laktat 500 mg Tab 0 0 200
101 Kalsium Hidroksida Pasta Btl 0 0
102 Karbamazepin 200 mg Tab 0 0
103 Kloramfenikol 250 mg Kaps 0 0
104 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0
105 Kloramfenikol Tetes Telinga 3 % Btl 0 0
106 Kloramfenikol Tetes Mata Btl 20 20 10 10 10
107 Klorfeniramin Maleat ( CTM ) 4 mg Tab 3800 3800 2400 1400 3000
108 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl 0 0
109 Ketokonazole 200 mg Tab 400 400 200 200 100
110 Ketokonazole Krim Tube 50 50 25 25 50
111 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab 0 0
112 Kotrimoksazol Pediatrik 120 mg Tab 0 0
113 Kotrimoksazol Dewasa 480 mg Tab 0 0
114 Kotrimoksazol Suspensi 240 mg / 5 ml Btl 0 0
115 Komposit Btl 0 0
116 Lansoprazol 30 Mg Kaps 0 0
117 Lidokain Comp. Injeksi 2 % Amp 62 62 62
118 Lisol 1 L Btl 0 0
119 Loperamid Tab Tab 0 0
120 Lisinopril 10 mg Tab 120 120 120
121 L-Bio Sact 0 30 30 20 10 50
122 Loratadin Tab Tab 0 0
123 Methylprednisolon 4 mg Tab 1000 500 1500 400 1100
124 Meloxicam 7,5 mg Tab 250 250 150 100 200
125 Metronidazol 250 mg Tab 0 0
126 Metronidazol 500 mg Tab 400 400 100 300
127 Mikonazole Krim 2 % Tube 72 72 24 48 24
128 Methergin Tab 0 0
129 Methyldopa Tab 0 0
130 Microlax Tube 0 0
131 Metformin 500 Mg Tab 200 200 100 100
132 Nisagon Tube 0 0
133 Mummifying Pasta Btl 0 0
134 Natrium Diklofenak 25 mg Tab 0 0
135 Natrium Diklofenak 50 mg Tab 1150 1150 1000 150 2000
136 Nifedipin Tab 0 0
137 Nistatin IU Vagina Tab 0 0
138 Nelydex Tetes Mata Btl 0 0
139 Obat Anti Tuberkulosis / F.D.C Paket 0 0 10
140 Obat Anti Tuberkulosis Anak Paket 0 0
141 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl 0 50 50 35 15 30
142 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial 0 0
143 Oksitetrasiklina Hcl Salep Mata 1 % Tube 25 25 25
144 Oksitetrasiklina Hcl Salep Kulit 3 % Tube 150 150 50 100
145 Oksitosin Injeksi 10 IU / 1 ml Amp 115 115 115
146 Omecidal Tab Tab 500 500 500
147 Omegdiar Tab 400 200 600 600 0 1000
148 Vastral Tab Tab 1800 1800 1800 0 5000
149 Omeprazol 20 Mg Kaps 360 360 300 60 450
150 Ometrydril Sirup Btl 0 0
151 Parasetamol Sirup 120 mg / 5 ml Btl 164 100 264 164 100 150
152 Parasetamol 100 mg Tab 0 0
153 Parasetamol 500 mg Tab 2600 5000 7600 3200 4400 1500
154 Parasetamol Drop Btl 0 0 50
155 Parasetamol Suppositoria Tube 0 0
156 Pirantel Pamoat 125 mg Tab 0 0
157 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab 800 200 1000 300 700 200
158 Piroksikam 10 mg Tab 0 0 500
159 Piroksikam 20 mg Tab 0 0
160 Prednison 5 mg Tab 100 100 100 0 2000
161 Primakina 15 mg Tab 0 0
162 Propanolol Hcl 40 mg Tab 100 100 100
163 Propiltiourasil ( P.T.U ) 100 mg Tab 0 0
164 Pehavral Tab Tab 0 0
165 Quinina ( Kina ) Inj. 25 % / 2 ml Amp 0 0
166 Quinina ( Kina ) 200 mg Tab 0 0
167 Ranitidin 150 mg Tab 0 0 2500
168 Reserpin 0,25 mg Tab 0 0
169 Retinol ( Vit. A ) 100.000 IU Tab 0 0
170 Retinol ( Vit. A ) 200.000 IU Tab 0 0
171 Ringer Laktat Lar. Infus Btl 0 20 20 8 12 20
172 Salbutamol 2 mg Tab 0 0
173 Salbutamol 4 mg Tab 0 0
174 Salisil Bedak 2 % Dos 70 70 10 60
175 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot 0 0 10
176 Sianokobalamin ( Vit. B 12 ) 50 mg Tab 2600 2600 900 1700
177 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp 96 96 30 66
178 Silk ( Benang Bedah Sutera ) No. 3/0 Sak 0 0
179 Silver Amalgam Serbuk 65 - 75 % Btl 0 0
180 Simvastatin 10 Mg Tab 700 700 350 350 200
181 Simvastatin 20 Mg Tab 200 500 700 150 550
182 Semen Seng Fosfat Serbuk & Cairan Btl 0 0
183 Sulfadimidin 500 mg Tab 0 0
184 Sucralfat Suspensi Btl 30 30 30
185 Tetrasiklin Hcl 250 mg Kaps 0 0
186 Tetrasiklin Hcl 500 mg Kaps 0 0
187 Thiamfenikol 500 mg Kaps 0 0
188 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab 2800 2800 400 2400
189 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp 0 0
190 Tab.Tambah Darah ( Fe ) Tab 5600 5600 2100 3500
191 Tramadol Kaps 0 0
192 Vaksin Anti Rabies (VAR) Kuur 0 0
193 Vitamin B. Kompleks Tab 2100 2000 4100 2900 1200 2500
194 Larutan Hc. 0,1 N Btl 0 0
195 Larutan Gimsa 100 ml Btl 0 0
196 Larutan Carbol Fuksin 0,3 % Btl 0 0
197 Larutan Turk 100 ml Btl 0 0
198 Larutan Benedict Btl 0 0
199 Larutan Etanol Asam 3 % Btl 0 0
200 Larutan Metilen Biru 0,3 % Btl 0 0
201 Larutan Asam Sulfosalisilat Btl 0 0
202 Larutan Hayyam Btl 0 0
203 Larutan Metanol Btl 0 0
204 Larutan Xilen 100 ml Btl 0 0
205 Larutan Oil Emersi Btl 0 0
206 Larutan Eosin Btl 0 0
207 zink 20 mg Tab 0 0
208 MDT Paket 0 0 1
209 Vidabion Tab 0 0 2000
210 Recolfar Tab 0 0
211 Bisoprolol 5 Mg Tab 0 0
212 Ketoprofen Suppositoria Supp 0 0
213 Neo Protifed Tab 0 500 500 100 400
214 Renalyte Btl 0 0
215 Salep Bioplasenton Tube 0 0
216 Scopma Plus Tab 100 100 100 0 300
217 Spironolakton 25 mg Tab 0 0
218 Tilomix Btl 800 800 200 600 500
219 Valsartan Tab 0 0
220 Alat Suntik Sekali Pakai 3 ml Pcs 0 0
221 Alat Suntik Sekali Pakai 5 ml Pcs 0 0
222 Alat Suntik Sekali Pakai 1 Ml Tab 0 0
223 Abbocath No. 18 / Intra Vena Catheter Pcs 49 49 49
224 Abbocath No. 20 / Intra Vena Catheter Pcs 21 21 21
225 Abbocath No. 24 / Intra Vena Catheter Pcs 49 49 49
226 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial 12 12 12
227 Aquadest Steril 1000 ml Btl 0 0
228 Bisturi No. 11 Pcs 0 0
229 Cat Gut / Benang Bedah No.3/0 Pcs 43 43 43
230 Etakridina Larutan 0,1 % Rivanol Btl 0 0
231 Etanol 70 % / 1 L Btl 5 5 5
232 Etil Klorida Semprot Btl 0 0 3
233 Handscun Steril Psg 600 600 100 500
234 Handscun Non Steril Psg 1000 1000 900 100 1000
235 Infus Set Anak Pcs 0 0
236 Infus Set Dewasa Pcs 52 52 52
237 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set 0 0
238 Kapas Pembalut 250 gr Rol 38 38 38
239 Kasa Steril 16 X 16 Dos 0 0
240 Kasa Kompres Steril 40 X 40 Bks 0 0
241 Kasa Pembalut 2 X 80 cm Rol 0 0
242 Kasa Pembalut 36 X 80 cm Rol 0 0
243 Kasa Pembalut Hidrofil 4 X 3 cm Rol 0 0
244 Kasa Pembalut Hidrofil 4 X 15 cm Rol 0 0
245 Masker Pcs 0 0 200
246 Natrium Klorida Lar. Infus 0,9 % Steril Btl 40 40 40
247 Needle / Naald No.23 G Pcs 0 0
248 Plester 5 Yard X 2 Inch Rol 4 4 4
249 Spon Gelatin Pcs 0 0
250 Wing needle / Scalp Vein Set Pcs 0 0
251 Yudium Povidon Lar. 10 % / 30 ml Btl 0 0
252 Yudium Povidon Lar. 10 % / 60 ml Btl 5 5 2 3 3
253 Yudium Povidon Lar. 10 % / 300 ml Btl 0 0
254 Dispo 0,05 ml Pcs 0 0 200
255 Dispo 0,5 ml Pcs 0 0 600
256 Umblical Cord Clem Pcs 0 0 50
257 Blood Lancet Pcs 0 0 500
258 Alkohol Swab Pcs 400 200 600 500 100 500
259 Dermafix 10 x 8 cm Pcs 0 0
260 Dermafix 10 x 20 cm Pcs 0 0
261 Plester Cerplast Aerofilm Pcs 0 0
262 Strip HCG Btl 0 0
263 Strip Glukosa Benechek Btl 0 0
264 Strip Cholestrol Benechek Btl 0 0
265 Strip Uric Acid Benechek Btl 0 0
266 Reagen Diluent Btl 0 0
267 Reagen Lyse Btl 0 0
268 Reagen Zheelnelsen Btl 0 0
269 Pelarut BCG Btl 0 0 30
270 Vaksin DPT-Hib Box 0 0 5

UMUM ASKES JUMLAH

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 2019
G MENERIMA
USKESMAS SIPATANA

SULEMAN, S.Farm
0527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : MARET 2019
PERMINTAAN BULAN / PERIODE : APRIL 2019

STOK
NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN
AWAL

1 2 3 4 5 6 7
1 Allopurinol 100 mg Tab 100 500 600 300
2 Ambroxol 30 mg Tab 3400 1000 4400 1300
3 Ambroxol Sirup 15 mg/5ml Btl 19 30 49 10
4 Aminofilin 200 mg Tab 0 100 100 0
5 Amitripilin 25 mg Tab 0
6 Amoksisilin 250 mg Kaps 0
7 Amoksisilin 500 mg Kapl 1000 3000 4000 2100
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl 100 100 60
9 Amlodipin 5 Mg Tab 300 600 900 300
10 Amlodipin 10 Mg Tab 500 500 1000 900
11 Antalgin Injeksi 250 mg ml - 2 ml Amp 0
12 Antalgin ( Metampiron ) 500 mg Tab 0
13 Antasida Doen Tab. Kombinasi Tab 200 3500 3700 2000
14 Antasida Doen suspensi 60 ml Btl 50 50 100 35
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot 75 0 75 0
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot 0
17 Antihemoroid Supp 2 gr Supp 0
18 Anti Migrain Doen Tab 0
19 Albendazol 400 mg Tab 0 90 90 0
22 Asam Askorbat ( Vit. C ) 50 mg Tab 0 2500 2500 1000
23 Asam Mefenamat 500 mg Kapl 2400 1500 3900 2100
24 Asam Traneksamat 500 mg Tab 0 300 300 200
25 Asiklovir 200 mg Tab 700 0 700 0
26 Asiklovir 400 mg Tab 0
27 Asiklovir Krim 5 % Tube 50 50 40
28 Aspilet Tab 0
29 Azithromicin 500 mg Tab 0
30 Artem injeksi 80 mg / 1 ml Vial 0
31 Air Raksa Dental Use Btl 0
32 Betametason krim 0,1 % Tube 0
33 Betahistin Tab 60 150 210 150
34 Betadin Kumur Btl 5 5
35 Caviplex Sirup Btl 0
36 Caviplex Tablet Tab 0
37 Clindamycin 300 mg Tab 0
38 Ciprofloksasin 500 mg Tab 0
39 Captopril 25 mg Tab 1000 0 1000 0
40 Cefadroxil 500 mg Kaps 0 1000 1000 700
41 Cefadroxil Sirup Btl 0
42 Cefixime 100 mg Caps 750 0 750 30
43 Cefixime Sirup Btl 5 5
44 Cetrizin Tab Tab 600 200 800 650
45 Cetrizin Syrup Btl 50 50
46 Combiven UDV Vial 20 20 5
47 Caviplex Drops Btl 0
48 Curcuma Tab 400 0 400 0
49 Curbion Sirup Btl 15 150 165 61
50 Deksametason 0,5 mg Tab 900 3000 3900 1000
51 Deksametason injeksi 5 mg / ml Amp 34 34
52 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl 0
53 Dekstrometorfan Hbr 15 mg Tab 0
54 Diltiazem 30 mg Tab 0
55 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp 0
56 Dentoria Btl 0
57 Devitalisasi Pasta Btl 0
58 Dietil Karbamazepin 100 mg Tab 0
59 Domperidon 10 Mg Tab 200 300 500 0
60 Domperidon sirup Btl 0 20 20 0
61 Doksisiklin 100 mg Kaps 0
62 Dulcolax Supp Supp 0
63 Dulcolax Tablet Tab 0
64 Efedrin Hcl 25 mg Tab 0
65 Ekstrak Beladona 10 mg Tab 0
66 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp 0
67 Eritromisin 500 mg Kapl 300 0 300 100
68 Eritromisin Sirup Kering 200 mg / 5 ml Btl 0
69 Eugenol Btl 0
70 Fenilbutason 200 mg Tab 0
71 Fenobarbital 30 mg Tab 0
72 Fenol Gliserol Tetes Telinga Btl 0
73 Flunarizin 5 mg Tab 0
74 Fenitoin 100 mg Kaps 0
75 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp 11 11
76 Fitomenadion ( Vit K ) Salut 10 mg Tab 100 0 100 0
77 Forumen Tetes Telinga Btl 7 7 5
78 Furosemida 40 mg Tab 0
79 Garam Oralit 200 ml Air Sak 300 0 300 200
80 Gemfibrosil 300 mg Kaps 200 0 200 0
81 Gemfibrosil 600 mg Kaps 0
82 Gentian Violet Larutan 1 % Btl 0 20 20 0
 83 Glibenklamid 5 mg Tab 0
84 Gliseril Guayakolat 100 mg Tab 2700 1000 3700 1300
85 Griseofulvin 125 mg Tab 300 0 300 200
86 Gliserol Btl 0
87 Gentamisin Salep Mata Tube 0
88 Gentamisin Tetes Mata Btl 0
89 Gentamisin 0,1 % Salep kulit Tube 70 0 70 0
90 Glass Ionomer Pcs 0
91 Glukosa Larutan Infus 5 % Btl 0
92 Glukosa Larutan Infus 10 % Btl 0
93 Hidroklortiazid ( HCT ) 25 mg Tab 0
94 Hidrokortison Krim 2,5 % Tube 72 24 96 48
95 Ibuprofen Sirup Btl 10 0 10 10
96 Ibuprofen 400 mg Tab 0 3000 3000 2300
97 Isosorbit Dinitrat Sublingual 5 mg Tab 0
98 Isoniazid 100 mg (INH 100 mg) Tab 0 300 300 200
99 Kalium Permanganat Serbuk 5 gr Pot 0
100 Kalsium Laktat 500 mg Tab 0 100 100 100
101 Kalsium Hidroksida Pasta Btl 0
102 Karbamazepin 200 mg Tab 0
103 Kloramfenikol 250 mg Kaps 0
104 Kloramfenikol Suspensi 125 mg/5ml Btl 0
105 Kloramfenikol Tetes Telinga 3 % Btl 0
106 Kloramfenikol Tetes Mata Btl 10 10 20 0
107 Klorfeniramin Maleat ( CTM ) 4 mg Tab 1400 3000 4400 2200
108 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl 0
109 Ketokonazole 200 mg Tab 200 100 300 0
110 Ketokonazole Krim Tube 25 50 75 0
111 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab 0
112 Kotrimoksazol Pediatrik 120 mg Tab 0
113 Kotrimoksazol Dewasa 480 mg Tab 0
114 Kotrimoksazol Suspensi 240 mg / 5 ml Btl 0
115 Komposit Btl 0
116 Lansoprazol 30 Mg Kaps 0
117 Lidokain Comp. Injeksi 2 % Amp 45 45
118 Lisol 1 L Btl 0
119 Loperamid Tab Tab 0
120 Lisinopril 10 mg Tab 120 120 30
121 L-Bio Sact 10 10 20 20
122 Loratadin Tab Tab 0
123 Methylprednisolon 4 mg Tab 1100 0 1100 800
124 Meloxicam 7,5 mg Tab 100 200 300 0
125 Metronidazol 250 mg Tab 0
126 Metronidazol 500 mg Tab 300 0 300 200
127 Mikonazole Krim 2 % Tube 48 24 72 24
128 Methergin Tab 0
129 Methyldopa Tab 0
130 Microlax Tube 0
131 Metformin 500 Mg Tab 100 100 100
132 Nisagon Tube 0
133 Mummifying Pasta Btl 0
134 Natrium Diklofenak 25 mg Tab 0
135 Natrium Diklofenak 50 mg Tab 150 250 400 400
136 Nifedipin Tab 0
137 Nistatin IU Vagina Tab 0
138 Nelydex Tetes Mata Btl 0
139 Obat Anti Tuberkulosis / F.D.C Paket 10 10
140 Obat Anti Tuberkulosis Anak Paket 0
141 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl 15 30 45 25
142 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial 0
143 Oksitetrasiklina Hcl Salep Mata 1 % Tube 25 0 25 0
144 Oksitetrasiklina Hcl Salep Kulit 3 % Tube 75 0 75 0
145 Oksitosin Injeksi 10 IU / 1 ml Amp 98 98
146 Omecidal Tab Tab 500 0 500 0
147 Omegdiar Tab 0 1000 1000 200
148 Vastral Tab Tab 0 2000 2000 1600
149 Omeprazol 20 Mg Kaps 60 450 510 150
150 Ometrydril Sirup Btl 0
151 Parasetamol Sirup 120 mg / 5 ml Btl 100 150 250 140
152 Parasetamol 100 mg Tab 0
153 Parasetamol 500 mg Tab 4600 1500 6100 3200
154 Parasetamol Drop Btl 0
155 Parasetamol Suppositoria Tube 3 3
156 Pirantel Pamoat 125 mg Tab 0
157 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab 700 200 900 600
158 Piroksikam 10 mg Tab 0 200 200 200
159 Piroksikam 20 mg Tab 0
160 Prednison 5 mg Tab 0 2000 2000 700
161 Primakina 15 mg Tab 0
162 Propanolol Hcl 40 mg Tab 100 100 200 0
163 Propiltiourasil ( P.T.U ) 100 mg Tab 0
164 Pehavral Tab Tab 0
165 Quinina ( Kina ) Inj. 25 % / 2 ml Amp 0
166 Quinina ( Kina ) 200 mg Tab 0
167 Ranitidin 150 mg Tab 0
168 Reserpin 0,25 mg Tab 0
169 Retinol ( Vit. A ) 100.000 IU Tab 0
170 Retinol ( Vit. A ) 200.000 IU Tab 0
171 Ringer Laktat Lar. Infus Btl 12 20 32 15
172 Salbutamol 2 mg Tab 0
173 Salbutamol 4 mg Tab 300 0 300 0
174 Salisil Bedak 2 % Dos 60 0 60 26
175 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot 0
176 Sianokobalamin ( Vit. B 12 ) 50 mg Tab 1700 0 1700 300
177 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp 65 65
178 Silk ( Benang Bedah Sutera ) No. 3/0 Sak 0
179 Silver Amalgam Serbuk 65 - 75 % Btl 0
180 Simvastatin 10 Mg Tab 350 200 550 400
181 Simvastatin 20 Mg Tab 550 0 550 0
182 Semen Seng Fosfat Serbuk & Cairan Btl 0
183 Sulfadimidin 500 mg Tab 0
184 Sucralfat Suspensi Btl 30 30 30
185 Tetrasiklin Hcl 250 mg Kaps 0
186 Tetrasiklin Hcl 500 mg Kaps 0
187 Thiamfenikol 500 mg Kaps 0
188 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab 2400 0 2400 1300
189 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp 0
190 Tab.Tambah Darah ( Fe ) Tab 3500 0 3500 1800
191 Tramadol Kaps 0
192 Vaksin Anti Rabies (VAR) Kuur 0
193 Vitamin B. Kompleks Tab 1200 2500 3700 2200
194 Larutan Hc. 0,1 N Btl 0
195 Larutan Gimsa 100 ml Btl 0
196 Larutan Carbol Fuksin 0,3 % Btl 0
197 Larutan Turk 100 ml Btl 0
198 Larutan Benedict Btl 0
199 Larutan Etanol Asam 3 % Btl 0
200 Larutan Metilen Biru 0,3 % Btl 0
201 Larutan Asam Sulfosalisilat Btl 0
202 Larutan Hayyam Btl 0
203 Larutan Metanol Btl 0
204 Larutan Xilen 100 ml Btl 0
205 Larutan Oil Emersi Btl 0
206 Larutan Eosin Btl 0
207 zink 20 mg Tab 0
208 MDT Paket 1 1
209 Vidabion Tab 0 1000 1000 600
210 Bisacodyl Tab Tab 90 0 90 0
211 Bisoprolol 5 Mg Tab 0
212 Ketoprofen Suppositoria Supp 0
213 Neo Protifed Tab 400 0 400 0
214 Renalyte Btl 0
215 Salep Bioplasenton Tube 0
216 Scopma Plus Tab 0 300 300 200
217 Spironolakton 25 mg Tab 0
218 Tilomix Tab 600 500 1100 600
219 Valsartan Tab 0
220 Alat Suntik Sekali Pakai 3 ml Pcs 0
221 Alat Suntik Sekali Pakai 5 ml Pcs 0
222 Alat Suntik Sekali Pakai 1 Ml Tab 0
223 Abbocath No. 18 / Intra Vena Catheter Pcs 49 49
224 Abbocath No. 20 / Intra Vena Catheter Pcs 21 21
225 Abbocath No. 24 / Intra Vena Catheter Pcs 49 49
226 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial 12 12
227 Aquadest Steril 1000 ml Btl 0
228 Bisturi No. 11 Pcs 0
229 Cat Gut / Benang Bedah No.3/0 Pcs 43 43 8
230 Etakridina Larutan 0,1 % Rivanol Btl 0
231 Etanol 70 % / 1 L Btl 3 0 3 1
232 Etil Klorida Semprot Btl 0 3 3 1
233 Handscun Steril Psg 500 500 100
234 Handscun Non Steril Psg 100 2000 2100 800
235 Infus Set Anak Pcs 0
236 Infus Set Dewasa Pcs 52 52
237 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set 0
238 Kapas Pembalut 250 gr Rol 38 38
239 Kasa Steril 16 X 16 Dos 0
240 Kasa Kompres Steril 40 X 40 Bks 0
241 Kasa Pembalut 2 X 80 cm Rol 0
242 Kasa Pembalut 36 X 80 cm Rol 0
243 Kasa Pembalut Hidrofil 4 X 3 cm Rol 0
244 Kasa Pembalut Hidrofil 4 X 15 cm Rol 0
245 Masker Pcs 200 200 200
246 Natrium Klorida Lar. Infus 0,9 % Steril Btl 40 40 2
247 Needle / Naald No.23 G Pcs 0
248 Plester 5 Yard X 2 Inch Rol 3 3
249 Spon Gelatin Pcs 0
250 Wing needle / Scalp Vein Set Pcs 0
251 Yudium Povidon Lar. 10 % / 30 ml Btl 0
252 Yudium Povidon Lar. 10 % / 60 ml Btl 3 3 6 1
253 Yudium Povidon Lar. 10 % / 300 ml Btl 0
254 Dispo 0,05 ml Pcs 200 200
255 Dispo 0,5 ml Pcs 600 600
256 Umblical Cord Clem Pcs 50 50 5
257 Blood Lancet Pcs 0
258 Alkohol Swab Pcs 100 500 600 500
259 Dermafix 10 x 8 cm Pcs 0
260 Dermafix 10 x 20 cm Pcs 0
261 Plester Cerplast Aerofilm Pcs 0
262 Strip HCG Btl 0
263 Strip Glukosa Benechek Btl 0
264 Strip Cholestrol Benechek Btl 0
265 Strip Uric Acid Benechek Btl 0
266 Tabung EDTA Pcs 0
267 Strip Urine Btl 0
268 Rapid HBSag Paket 0
269 Reagen Golongan Darah Paket 0
270 Reagen Diluent Btl 0
271 Reagen Lyse Btl 0
272 Reagen Zheelnelsen Btl 0
273 Vaksin BCG Vial 0
274 Vaksin Polio Vial 0
275 Vaksin TD Vial 0
276 Vaksin WP Vial 0
277 Pelarut BCG Btl 0
278 Vaksin DPT-Hib Box 0

UMUM ASKES

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN

KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt

NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003
MBAR PERMINTAAN OBAT (LPLPO)

SISA STOK PEMBERIAN

PERMINTAAN
STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH
8 9 10 12 13 15 16 17
300 300
3100 1000
39 20
100
0
0
1900 2000
40
600
100 1500
0
0
1700 2000
65 50
75
0
0
0
90
1500 1000
1800 2000
100 100
700
0 500
10 30
0
0
0
0
0
60 150
5
0
0
0
 0
1000
300 500
0 10
720
5
150 800
50
15
0
400
104 50
2900 1000
34
0
0
0
0
0
0
0
500
20
0
0
0
0
0
0
200
0
0
0
0
0
0
0
11
100
2 5
0
100 200
200
0
20
 0
2400 500
100 200
0
0
0
70
0
0
0
0
48 48
0 20
700 2000
0
100 100
0
0 200
0
0
0
0
0
20
2200 2000
0
300
75
0
0
0
0
0
0
45
0
0
90
0 50
0
300 1000
300
0
100 300
48
 0
0
0
0 200
0
0
0
0 1500
0
0
0
10
0
20
0
25
75
98
500
800
400 3000
360
0
110 100
0
2900 2000
0
3
0
300 500
0 500
0
1300 500
0
200
0
0
0
0
0 2000
0
0
0
17 10
0
 300
34 30
0
1400
65
0
0
150 500
550
0
0
0 Exp 20
0
0
0
1100 500
0
1700 11000
0
0
1500 2000
0
0
0
0
0
0
0
0
0
0
0
0 2
0
0
1
400 2000
90
0
0
400
0
0
100 200
0
 500 500
0
0
0
0
49
21
49
12
0
0
35
0
2 2
2
400
1300
0
52
0
38
0
0
0
0
0
0
0 500
38
0
3
0
0
0
5
0
200
600
45
0 500
100 500
0
0
0
0
 0
0
0
0 300
0 5
0 1
0 2
0 1
0 2
0 3
0 10
0 30
0 30
0 20
0 50
0 6

JUMLAH

GORONTALO, 2019
YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

ANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm

03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
2019
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : APRIL 2019
PERMINTAAN BULAN / PERIODE : MEI 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH
1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Allopurinol 100 mg Tab 300 300 600 200 400 500
2 Ambroxol 30 mg Tab 3100 1000 4100 1300 2800 3000
3 Ambroxol Sirup 15 mg/5ml Btl 39 20 59 31 28 50
4 Aminofilin 200 mg Tab 100 100 100
5 Amitripilin 25 mg Tab 0 0
6 Amoksisilin 250 mg Kaps 0 0
7 Amoksisilin 500 mg Kapl 1900 2000 3900 1400 2500 3500
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl 40 40 30 10 200
9 Amlodipin 5 Mg Tab 600 600 300 300 900
10 Amlodipin 10 Mg Tab 100 1500 1600 100 1500 500
11 Antalgin Injeksi 250 mg ml - 2 ml Amp 0 0
12 Antalgin ( Metampiron ) 500 mg Tab 0 0
13 Antasida Doen Tab. Kombinasi Tab 1700 2000 3700 1300 2400 3500
14 Antasida Doen suspensi 60 ml Btl 65 65 65 0 300
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot 75 75 75
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot 0 0
17 Antihemoroid Supp 2 gr Supp 0 0
18 Anti Migrain Doen Tab 0 0
19 Albendazol 400 mg Tab 90 90 90
22 Asam Askorbat ( Vit. C ) 50 mg Tab 1500 1000 2500 500 2000 2000
23 Asam Mefenamat 500 mg Kapl 1800 2000 3800 1000 2800 2500
24 Asam Traneksamat 500 mg Tab 100 100 200 200
25 Asiklovir 200 mg Tab 700 700 500 200 1000
26 Asiklovir 400 mg Tab 0 0 1000
27 Asiklovir Krim 5 % Tube 10 30 40 40
28 Aspilet Tab 0 0
29 Azithromicin 500 mg Tab 0 0
30 Artem injeksi 80 mg / 1 ml Vial 0 0
31 Air Raksa Dental Use Btl 0 0
32 Betametason krim 0,1 % Tube 0 0
33 Betahistin Tab 60 150 210 210
34 Betadin Kumur Btl 5 5 5
35 Caviplex Sirup Btl 0 0
36 Caviplex Tablet Tab 0 0
37 Clindamycin 300 mg Tab 0 0
38 Ciprofloksasin 500 mg Tab 0 0
39 Captopril 25 mg Tab 1000 1000 1000 0 1500
40 Cefadroxil 500 mg Kaps 300 500 800 300 500 1500
41 Cefadroxil Sirup Btl 10 10 10 0 30
42 Cefixime 100 mg Caps 720 720 120 600
43 Cefixime Sirup Btl 5 5 5
44 Cetrizin Tab Tab 150 800 950 250 700 1000
45 Cetrizin Syrup Btl 50 50 50
46 Combiven UDV Vial 15 15 15
47 Caviplex Drops Btl 0 0
48 Curcuma Tab 400 400 400
49 Curbion Sirup Btl 104 50 154 61 93 150
50 Deksametason 0,5 mg Tab 2900 1000 3900 1200 2700 3000
51 Deksametason injeksi 5 mg / ml Amp 34 34 34
52 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl 0 0
53 Dekstrometorfan Hbr 15 mg Tab 0 0
54 Diltiazem 30 mg Tab 0 0
55 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp 0 0
56 Dentoria Btl 0 0
57 Devitalisasi Pasta Btl 0 0
58 Dietil Karbamazepin 100 mg Tab 0 0
59 Domperidon 10 Mg Tab 500 500 400 100 600
60 Domperidon sirup Btl 10 10 10 0 20
61 Doksisiklin 100 mg Kaps 0 0
62 Dulcolax Supp Supp 0 0
63 Dulcolax Tablet Tab 0 0
64 Efedrin Hcl 25 mg Tab 0 0
65 Ekstrak Beladona 10 mg Tab 0 0
66 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp 0 0
67 Eritromisin 500 mg Kapl 200 200 200
68 Eritromisin Sirup Kering 200 mg / 5 ml Btl 0 0 10
69 Eugenol Btl 0 0
70 Fenilbutason 200 mg Tab 0 0
71 Fenobarbital 30 mg Tab 0 0
72 Fenol Gliserol Tetes Telinga Btl 0 0
73 Flunarizin 5 mg Tab 0 0 200
74 Fenitoin 100 mg Kaps 0 0
75 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp 11 11 11
76 Fitomenadion ( Vit K ) Salut 10 mg Tab 0 0
77 Forumen Tetes Telinga Btl 2 2 2
78 Furosemida 40 mg Tab 0 0
79 Garam Oralit 200 ml Air Sak 100 200 300 100 200 200
80 Gemfibrosil 300 mg Kaps 200 200 200
81 Gemfibrosil 600 mg Kaps 0 0
82 Gentian Violet Larutan 1 % Btl 20 20 20 0 50
83 Glibenklamid 5 mg Tab 0 0
84 Gliseril Guayakolat 100 mg Tab 2400 500 2900 2900
85 Griseofulvin 125 mg Tab 100 200 300 100 200 500
86 Gliserol Btl 0 0
87 Gentamisin Salep Mata Tube 0 0
88 Gentamisin Tetes Mata Btl 0 0
89 Gentamisin 0,1 % Salep kulit Tube 70 70 70
90 Glass Ionomer Pcs 0 0
91 Glukosa Larutan Infus 5 % Btl 0 0
92 Glukosa Larutan Infus 10 % Btl 0 0
93 Hidroklortiazid ( HCT ) 25 mg Tab 0 0
94 Hidrokortison Krim 2,5 % Tube 48 48 96 48 48 120
95 Ibuprofen Sirup Btl 20 20 20 10
96 Ibuprofen 400 mg Tab 0 0 5000
97 Isosorbit Dinitrat Sublingual 5 mg Tab 0 0
98 Isoniazid 100 mg (INH 100 mg) Tab 100 100 200 200 0 500
99 Kalium Permanganat Serbuk 5 gr Pot 0 0
100 Kalsium Laktat 500 mg Tab 0 0
101 Kalsium Hidroksida Pasta Btl 0 0
102 Karbamazepin 200 mg Tab 0 0
103 Kloramfenikol 250 mg Kaps 0 0
104 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0
105 Kloramfenikol Tetes Telinga 3 % Btl 0 0
106 Kloramfenikol Tetes Mata Btl 20 20 10 10
107 Klorfeniramin Maleat ( CTM ) 4 mg Tab 2200 2000 4200 2000 2200 6000
108 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl 0 0
109 Ketokonazole 200 mg Tab 300 300 150 150 300
110 Ketokonazole Krim Tube 75 75 75
111 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab 0 0
112 Kotrimoksazol Pediatrik 120 mg Tab 0 0
113 Kotrimoksazol Dewasa 480 mg Tab 0 0
114 Kotrimoksazol Suspensi 240 mg / 5 ml Btl 0 0
115 Komposit Btl 0 0
116 Lansoprazol 30 Mg Kaps 0 0
117 Lidokain Comp. Injeksi 2 % Amp 40 40 40
118 Lisol 1 L Btl 0 0
119 Loperamid Tab Tab 0 0
120 Lisinopril 10 mg Tab 90 90 30 60
121 L-Bio Sact 0 0 100
122 Loratadin Tab Tab 0 0
123 Methylprednisolon 4 mg Tab 100 100 100
124 Meloxicam 7,5 mg Tab 300 300 300 0 500
125 Metronidazol 250 mg Tab 0 0
126 Metronidazol 500 mg Tab 100 300 400 400 0 1500
127 Mikonazole Krim 2 % Tube 48 48 24 24
128 Methergin Tab 0 0
129 Methyldopa Tab 0 0
130 Microlax Tube 0 0
131 Metformin 500 Mg Tab 200 200 200 0 600
132 Nisagon Tube 0 0
133 Mummifying Pasta Btl 0 0
134 Natrium Diklofenak 25 mg Tab 0 0
135 Natrium Diklofenak 50 mg Tab 0 0 2000
136 Nifedipin Tab 0 0
137 Nistatin IU Vagina Tab 0 0
138 Nelydex Tetes Mata Btl 0 0
139 Obat Anti Tuberkulosis / F.D.C Paket 0 0 20
140 Obat Anti Tuberkulosis Anak Paket 0 0
141 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl 20 20 15 5 100
142 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial 0 0
143 Oksitetrasiklina Hcl Salep Mata 1 % Tube 25 25 25 0 50
144 Oksitetrasiklina Hcl Salep Kulit 3 % Tube 75 75 50 25 100
145 Oksitosin Injeksi 10 IU / 1 ml Amp 98 98 98
146 Omecidal Tab Tab 500 500 500
147 Omegdiar Tab 800 800 300 500 1500
148 Vastral Tab Tab 400 3000 3400 900 2500 5000
149 Omeprazol 20 Mg Kaps 360 360 150 210 600
150 Ometrydril Sirup Btl 20 20 20
151 Parasetamol Sirup 120 mg / 5 ml Btl 110 100 210 75 135 150
152 Parasetamol 100 mg Tab 0 0
153 Parasetamol 500 mg Tab 2900 2000 4900 2500 2400 6000
154 Parasetamol Drop Btl 0 0
155 Parasetamol Suppositoria Tube 0 0
156 Pirantel Pamoat 125 mg Tab 0 0
157 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab 300 500 800 200 600 1000
158 Piroksikam 10 mg Tab 0 0 1000
159 Piroksikam 20 mg Tab 0 0
160 Prednison 5 mg Tab 1300 500 1800 100 1700
161 Primakina 15 mg Tab 0 0
162 Propanolol Hcl 40 mg Tab 200 200 200
163 Propiltiourasil ( P.T.U ) 100 mg Tab 0 0
164 Pehavral Tab Tab 0 0
165 Quinina ( Kina ) Inj. 25 % / 2 ml Amp 0 0
166 Quinina ( Kina ) 200 mg Tab 0 0
167 Ranitidin 150 mg Tab 100 100 100
168 Reserpin 0,25 mg Tab 0 0
169 Retinol ( Vit. A ) 100.000 IU Tab 0 0
170 Retinol ( Vit. A ) 200.000 IU Tab 0 0
171 Ringer Laktat Lar. Infus Btl 17 10 27 8 19
172 Salbutamol 2 mg Tab 0 0
173 Salbutamol 4 mg Tab 300 300 300
174 Salisil Bedak 2 % Dos 34 34 6 28 30
175 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot 0 0
176 Sianokobalamin ( Vit. B 12 ) 50 mg Tab 1400 1400 900 500 1000
177 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp 0 0
178 Silk ( Benang Bedah Sutera ) No. 3/0 Sak 0 0
179 Silver Amalgam Serbuk 65 - 75 % Btl 0 0
180 Simvastatin 10 Mg Tab 150 500 650 250 400 500
181 Simvastatin 20 Mg Tab 550 550 50 500
182 Semen Seng Fosfat Serbuk & Cairan Btl 0 0
183 Sulfadimidin 500 mg Tab 0 0
184 Sucralfat Suspensi Btl 20 20 20 0 50
185 Tetrasiklin Hcl 250 mg Kaps 0 0
186 Tetrasiklin Hcl 500 mg Kaps 0 0
187 Thiamfenikol 500 mg Kaps 0 0
188 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab 1100 500 1600 500 1100 1500
189 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp 0 0
190 Tab.Tambah Darah ( Fe ) Tab 1700 11000 12700 12300 400 5000
191 Tramadol Kaps 0 0
192 Vaksin Anti Rabies (VAR) Kuur 8 8 8
193 Vitamin B. Kompleks Tab 1500 2000 3500 2200 1300 5000
194 Larutan Hc. 0,1 N Btl 0 0
195 Larutan Gimsa 100 ml Btl 0 0
196 Larutan Carbol Fuksin 0,3 % Btl 0 0
197 Larutan Turk 100 ml Btl 0 0
198 Larutan Benedict Btl 0 0
199 Larutan Etanol Asam 3 % Btl 0 0
200 Larutan Metilen Biru 0,3 % Btl 0 0
201 Larutan Asam Sulfosalisilat Btl 0 0
202 Larutan Hayyam Btl 0 0
203 Larutan Metanol Btl 0 0
204 Larutan Xilen 100 ml Btl 0 0
205 Larutan Oil Emersi Btl 0 0
206 Larutan Eosin Btl 0 0
207 zink 20 mg Tab 0 0
208 MDT Paket 0 0 4
209 Vidabion Tab 400 2000 2400 700 1700 2000
210 Bisacodyl Tab Tab 90 90 90
211 Bisoprolol 5 Mg Tab 0 0
212 Ketoprofen Suppositoria Supp 0 0
213 Neo Protifed Tab 400 400 200 200 500
214 Renalyte Btl 0 0
215 Salep Bioplasenton Tube 0 0
216 Scopma Plus Tab 100 200 300 300
217 Spironolakton 25 mg Tab 0 0
218 Tilomix Tab 500 500 200 300
219 Valsartan Tab 0 0
220 Alat Suntik Sekali Pakai 3 ml Pcs 0 0
221 Alat Suntik Sekali Pakai 5 ml Pcs 0 0
222 Alat Suntik Sekali Pakai 1 Ml Tab 0 0
223 Abbocath No. 18 / Intra Vena Catheter Pcs 49 49 49
224 Abbocath No. 20 / Intra Vena Catheter Pcs 21 21 21
225 Abbocath No. 24 / Intra Vena Catheter Pcs 49 49 49
226 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial 12 12 12
227 Aquadest Steril 1000 ml Btl 0 0
228 Bisturi No. 11 Pcs 0 0
229 Cat Gut / Benang Bedah No.3/0 Pcs 35 35 35
230 Etakridina Larutan 0,1 % Rivanol Btl 0 0
231 Etanol 70 % / 1 L Btl 2 2 4 1 3 3
232 Etil Klorida Semprot Btl 2 2 2
233 Handscun Steril Psg 400 400 50 350
234 Handscun Non Steril Psg 1300 1300 500 800 1000
235 Infus Set Anak Pcs 0 0
236 Infus Set Dewasa Pcs 52 52 5 47
237 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set 0 0
238 Kapas Pembalut 250 gr Rol 38 38 38
239 Kasa Steril 16 X 16 Dos 0 0
240 Kasa Kompres Steril 40 X 40 Bks 0 0
241 Kasa Pembalut 2 X 80 cm Rol 0 0
242 Kasa Pembalut 36 X 80 cm Rol 0 0
243 Kasa Pembalut Hidrofil 4 X 3 cm Rol 0 0
244 Kasa Pembalut Hidrofil 4 X 15 cm Rol 0 0
245 Masker Pcs 1000 1000 650 350 1000
246 Natrium Klorida Lar. Infus 0,9 % Steril Btl 38 38 21 17 20
247 Needle / Naald No.23 G Pcs 0 0
248 Plester 5 Yard X 2 Inch Rol 3 3 2 1 7
249 Spon Gelatin Pcs 0 0
250 Wing needle / Scalp Vein Set Pcs 0 0
251 Yudium Povidon Lar. 10 % / 30 ml Btl 0 0
252 Yudium Povidon Lar. 10 % / 60 ml Btl 5 5 4 1 10
253 Yudium Povidon Lar. 10 % / 300 ml Btl 0 0
254 Dispo 0,05 ml Pcs 0 0
255 Dispo 0,5 ml Pcs 0 0
256 Umblical Cord Clem Pcs 45 45 45
257 Blood Lancet Pcs 0 0
258 Alkohol Swab Pcs 100 500 600 200 400 300
259 Dermafix 10 x 8 cm Pcs 0 0
260 Dermafix 10 x 20 cm Pcs 0 0
261 Plester Cerplast Aerofilm Pcs 0 0
262 Strip HCG Btl 0 0
263 Strip Glukosa Benechek Btl 0 0
264 Strip Cholestrol Benechek Btl 0 0
265 Strip Uric Acid Benechek Btl 0 0
266 Tabung EDTA Pcs 300 300 300 0
267 Strip Urine Btl 0 0
268 Rapid HBSag Paket 0 0 1
269 Reagen Golongan Darah Paket 0 0 3
270 Reagen Diluent Btl 0 0 1
271 Reagen Lyse Btl 0 0 2
272 Reagen Zheelnelsen Btl 0 0 3
273 Vaksin BCG Vial 10 10 10 0
274 Vaksin Polio Vial 30 30 30
275 Vaksin TD Vial 30 30 30
276 Vaksin WP Vial 0 0
277 Pelarut BCG Btl 0 0
278 Vaksin DPT-Hib Box 60 60 60
279 Masker N-95 Pcs

UMUM ASKES JUMLAH

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

GORONTALO, 20
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA
dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
LO, 2019
YANG MENERIMA
GAS PUSKESMAS SIPATANA
ULEMAN, S.Farm
527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : JUNI 2019
PERMINTAAN BULAN / PERIODE : JULI 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN
AWAL
PENERIMAAN PERSEDIAN PEMAKAIAN
STOK OPTIMUM
PERMINTAAN
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH
1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Allopurinol 100 mg Tab 400 500 900 600 300 200
2 Ambroxol 30 mg Tab 2800 3000 5800 3800 2000 2000
3 Ambroxol Sirup 15 mg/5ml Btl 28 60 88 84 4 150
4 Aminofilin 200 mg Tab 100 100 100
5 Amitripilin 25 mg Tab 0 0
6 Amoksisilin 250 mg Kaps 0 0
7 Amoksisilin 500 mg Kapl 2500 3500 6000 4100 1900 3000
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl 10 10 10 0 100
9 Amlodipin 5 Mg Tab 300 900 1200 900 300 600
10 Amlodipin 10 Mg Tab 1500 500 2000 1100 900 500
11 Antalgin Injeksi 250 mg ml - 2 ml Amp 0 0
12 Antalgin ( Metampiron ) 500 mg Tab 0 0
13 Antasida Doen Tab. Kombinasi Tab 2400 3500 5900 4500 1400 3000
14 Antasida Doen suspensi 60 ml Btl 0 0 0 200
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot 75 75 75
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot 0 0 15
17 Antihemoroid Supp 2 gr Supp 0 0 20
18 Anti Migrain Doen Tab 0 0
19 Albendazol 400 mg Tab 90 90 90
22 Asam Askorbat ( Vit. C ) 50 mg Tab 2000 2000 4000 2200 1800
23 Asam Mefenamat 500 mg Kapl 2800 2500 5300 3200 2100 1500
24 Asam Traneksamat 500 mg Tab 200 200 200
25 Asiklovir 200 mg Tab 200 1000 1200 200 1000
26 Asiklovir 400 mg Tab 0 0 1000
27 Asiklovir Krim 5 % Tube 40 40 20 20 10
28 Aspilet Tab 0 0
29 Azithromicin 500 mg Tab 0 0
30 Artem injeksi 80 mg / 1 ml Vial 0 0
31 Air Raksa Dental Use Btl 0 0
32 Betametason krim 0,1 % Tube 0 0 50
33 Betahistin Tab 210 210 90 120
34 Betadin Kumur Btl 5 5 5
35 Caviplex Sirup Btl 0 0
36 Caviplex Tablet Tab 0 0
37 Clindamycin 300 mg Tab 0 0
38 Ciprofloksasin 500 mg Tab 0 0
39 Captopril 25 mg Tab 0 1500 1500 200 1300
40 Cefadroxil 500 mg Kaps 500 1500 2000 900 1100 200
41 Cefadroxil Sirup Btl 0 50 50 50 0 50
42 Cefixime 100 mg Caps 600 600 240 360
43 Cefixime Sirup Btl 5 5 5 0 15
44 Cetrizin Tab Tab 700 700 700 0 500
45 Cetrizin Syrup Btl 50 50 5 45
46 Combiven UDV Vial 15 15 4 11 20
47 Caviplex Drops Btl 0 0
48 Curcuma Tab 400 400 400
49 Curbion Sirup Btl 93 150 243 131 112 100
50 Deksametason 0,5 mg Tab 2700 3000 5700 2800 2900 1500
51 Deksametason injeksi 5 mg / ml Amp 34 34 34 0 100
52 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl 0 0
53 Dekstrometorfan Hbr 15 mg Tab 0 0
54 Diltiazem 30 mg Tab 0 0
55 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp 0 0 100
56 Dentoria Btl 0 0
57 Devitalisasi Pasta Btl 0 0
58 Dietil Karbamazepin 100 mg Tab 0 0
59 Domperidon 10 Mg Tab 100 600 700 200 500
60 Domperidon sirup Btl 0 15 15 15 0 25
61 Doksisiklin 100 mg Kaps 0 0
62 Dulcolax Supp Supp 0 0
63 Dulcolax Tablet Tab 0 0
64 Efedrin Hcl 25 mg Tab 0 0
65 Ekstrak Beladona 10 mg Tab 0 0
66 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp 60 60 60
67 Eritromisin 500 mg Kapl 200 200 200 0 300
68 Eritromisin Sirup Kering 200 mg / 5 ml Btl 0 0 25
69 Eugenol Btl 0 0
70 Fenilbutason 200 mg Tab 0 0 200
71 Fenobarbital 30 mg Tab 0 0
72 Fenol Gliserol Tetes Telinga Btl 0 0
73 Flunarizin 5 mg Tab 0 200 200 50 150
74 Fenitoin 100 mg Kaps 0 0
75 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp 11 11 11 0 EXP 50
76 Fitomenadion ( Vit K ) Salut 10 mg Tab 0 0
77 Forumen Tetes Telinga Btl 2 2 2 20
78 Furosemida 40 mg Tab 0 0
79 Garam Oralit 200 ml Air Sak 200 200 400 100 300
80 Gemfibrosil 300 mg Kaps 200 200 200
81 Gemfibrosil 600 mg Kaps 0 0
82 Gentian Violet Larutan 1 % Btl 0 24 24 24
83 Glibenklamid 5 mg Tab 0 0
84 Gliseril Guayakolat 100 mg Tab 2900 2900 1000 1900 500
85 Griseofulvin 125 mg Tab 200 500 700 700
86 Gliserol Btl 0 0
87 Gentamisin Salep Mata Tube 0 0
88 Gentamisin Tetes Mata Btl 0 0
89 Gentamisin 0,1 % Salep kulit Tube 70 70 70
90 Glass Ionomer Pcs 0 0
91 Glukosa Larutan Infus 5 % Btl 0 0 5
92 Glukosa Larutan Infus 10 % Btl 0 0
93 Hidroklortiazid ( HCT ) 25 mg Tab 0 0
94 Hidrokortison Krim 2,5 % Tube 48 120 168 24 144
95 Ibuprofen Sirup Btl 20 10 30 10 20
96 Ibuprofen 400 mg Tab 0 0 2000
97 Isosorbit Dinitrat Sublingual 5 mg Tab 0 0
98 Isoniazid 100 mg (INH 100 mg) Tab 0 500 500 500
99 Kalium Permanganat Serbuk 5 gr Pot 0 0
100 Kalsium Laktat 500 mg Tab 0 0 200
101 Kalsium Hidroksida Pasta Btl 0 0
102 Karbamazepin 200 mg Tab 0 0
103 Kloramfenikol 250 mg Kaps 0 0
104 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0
105 Kloramfenikol Tetes Telinga 3 % Btl 0 0 10
106 Kloramfenikol Tetes Mata Btl 10 10 10 10
107 Klorfeniramin Maleat ( CTM ) 4 mg Tab 2200 6000 8200 4600 3600 2000
108 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl 0 0
109 Ketokonazole 200 mg Tab 150 300 450 250 200 100
110 Ketokonazole Krim Tube 75 75 25 50 25
111 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab 0 0
112 Kotrimoksazol Pediatrik 120 mg Tab 0 0
113 Kotrimoksazol Dewasa 480 mg Tab 0 0
114 Kotrimoksazol Suspensi 240 mg / 5 ml Btl 0 0
115 Komposit Btl 0 0
116 Lansoprazol 30 Mg Kaps 0 0
117 Lidokain Comp. Injeksi 2 % Amp 40 40 40 0 150
118 Lisol 1 L Btl 0 0 3
119 Loperamid Tab Tab 0 0
120 Lisinopril 10 mg Tab 60 60 60
121 L-Bio Sact 0 0 50
122 Loratadin Tab Tab 0 0 1000
123 Methylprednisolon 4 mg Tab 0 0 1500
124 Meloxicam 7,5 mg Tab 0 500 500 500 0 1000
125 Metronidazol 250 mg Tab 0 0
126 Metronidazol 500 mg Tab 0 1500 1500 200 1300
127 Mikonazole Krim 2 % Tube 0 0 72
128 Methergin Tab 0 0
129 Methyldopa Tab 0 0 100
130 Microlax Tube 0 0 20
131 Metformin 500 Mg Tab 600 600 600
132 Nisagon Tube 0 0
133 Mummifying Pasta Btl 0 0
134 Natrium Diklofenak 25 mg Tab 0 0
135 Natrium Diklofenak 50 mg Tab 0 0 1000
136 Nifedipin Tab 0 0 100
137 Nistatin IU Vagina Tab 0 0
138 Nelydex Tetes Mata Btl 0 0
139 Obat Anti Tuberkulosis / F.D.C Paket 0 0
140 Obat Anti Tuberkulosis Anak Paket 2 2 2
141 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl 5 50 55 18 37 20
142 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial 0 0
143 Oksitetrasiklina Hcl Salep Mata 1 % Tube 0 50 50 50
144 Oksitetrasiklina Hcl Salep Kulit 3 % Tube 98 98 98 0 100
145 Oksitosin Injeksi 10 IU / 1 ml Amp 0 0 100
146 Omecidal Tab Tab 500 500 500 0 300
147 Omegdiar Tab 500 1500 2000 200 1800
148 Vastral Tab Tab 2500 5000 7500 2400 5100 1000
149 Omeprazol 20 Mg Kaps 210 600 810 510 300 300
150 Ometrydril Sirup Btl 20 15 35 35
151 Parasetamol Sirup 120 mg / 5 ml Btl 135 200 335 195 140 100
152 Parasetamol 100 mg Tab 0 0
153 Parasetamol 500 mg Tab 2400 10000 12400 6300 6100 1000
154 Parasetamol Drop Btl 0 0 50
155 Parasetamol Suppositoria Tube 0 0 10
156 Pirantel Pamoat 125 mg Tab 0 0 50
157 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab 600 1000 1600 300 1300 300
158 Piroksikam 10 mg Tab 0 0 500
159 Piroksikam 20 mg Tab 0 0 500
160 Prednison 5 mg Tab 1700 1700 1200 500 EXP 300
161 Primakina 15 mg Tab 0 0
162 Propanolol Hcl 40 mg Tab 200 200 200
163 Propiltiourasil ( P.T.U ) 100 mg Tab 0 0 500
164 Pehavral Tab Tab 0 0
165 Quinina ( Kina ) Inj. 25 % / 2 ml Amp 0 0
166 Quinina ( Kina ) 200 mg Tab 0 0
167 Ranitidin 150 mg Tab 0 0 2000
168 Reserpin 0,25 mg Tab 0 0
169 Retinol ( Vit. A ) 100.000 IU Tab 0 0
170 Retinol ( Vit. A ) 200.000 IU Tab 0 0
171 Ringer Laktat Lar. Infus Btl 0 0 40
172 Salbutamol 2 mg Tab 0 0
173 Salbutamol 4 mg Tab 300 300 300
174 Salisil Bedak 2 % Dos 28 28 28 20
175 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot 0 0 20
176 Sianokobalamin ( Vit. B 12 ) 50 mg Tab 500 1000 1500 900 600 1000
177 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp 0 0 100
178 Silk ( Benang Bedah Sutera ) No. 3/0 Sak 0 0
179 Silver Amalgam Serbuk 65 - 75 % Btl 0 0
180 Simvastatin 10 Mg Tab 0 0 700
181 Simvastatin 20 Mg Tab 500 500 400 100 300
182 Semen Seng Fosfat Serbuk & Cairan Btl 0 0
183 Sulfadimidin 500 mg Tab 0 0
184 Sucralfat Suspensi Btl 0 15 15 15 0 50
185 Tetrasiklin Hcl 250 mg Kaps 0 0
186 Tetrasiklin Hcl 500 mg Kaps 0 0
187 Thiamfenikol 500 mg Kaps 0 100 100 100 0
188 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab 1100 1500 2600 200 2400
189 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp 0 0
190 Tab.Tambah Darah ( Fe ) Tab 0 0
191 Tramadol Kaps 0 0
192 Vaksin Anti Rabies (VAR) Kuur 0 0
193 Vitamin B. Kompleks Tab 1300 5000 6300 4200 2100 2000
194 Larutan Hc. 0,1 N Btl 0 0 3
195 Larutan Gimsa 100 ml Btl 0 0
196 Larutan Carbol Fuksin 0,3 % Btl 0 0
197 Larutan Turk 100 ml Btl 0 0
198 Larutan Benedict Btl 0 0
199 Larutan Etanol Asam 3 % Btl 0 0 3
200 Larutan Metilen Biru 0,3 % Btl 0 0
201 Larutan Asam Sulfosalisilat Btl 0 0
202 Larutan Hayyam Btl 0 0
203 Larutan Metanol Btl 0 0
204 Larutan Xilen 100 ml Btl 0 0
205 Larutan Oil Emersi Btl 0 0 5
206 Larutan Eosin Btl 0 0
207 zink 20 mg Tab 0 500 500 200 300 300
208 MDT Paket 6 6 6 0 2
209 Vidabion Tab 1700 5000 6700 3800 2900 1500
210 Bisacodyl Tab Tab 90 90 90
211 Bisoprolol 5 Mg Tab 0 0
212 Ketoprofen Suppositoria Supp 0 20 20 20
213 Neo Protifed Tab 200 200 200 0 600
214 Renalyte Btl 0 0
215 Salep Bioplasenton Tube 0 0 30
216 Scopma Plus Tab 0 0 300
217 Spironolakton 25 mg Tab 0 0
218 Tilomix Tab 0 0 1000
219 Valsartan Tab 0 0
220 Alat Suntik Sekali Pakai 3 ml Pcs 0 0 0 500
221 Alat Suntik Sekali Pakai 5 ml Pcs 0 0
222 Alat Suntik Sekali Pakai 1 Ml Tab 0 0 300
223 Abbocath No. 18 / Intra Vena Catheter Pcs 49 49 42 7 50
224 Abbocath No. 20 / Intra Vena Catheter Pcs 21 21 21 0 50
225 Abbocath No. 24 / Intra Vena Catheter Pcs 49 49 49
226 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial 12 12 3 9 15
227 Aquadest Steril 1000 ml Btl 0 0
228 Bisturi No. 11 Pcs 0 0
229 Cat Gut / Benang Bedah No.3/0 Pcs 35 35 35 0 48
230 Etakridina Larutan 0,1 % Rivanol Btl 0 0
231 Etanol 70 % / 1 L Btl 3 3 6 1 5
232 Etil Klorida Semprot Btl 2 2 2
233 Handscun Steril Psg 350 350 100 250 100
234 Handscun Non Steril Psg 800 1000 1800 1600 200 1000
235 Infus Set Anak Pcs 0 0
236 Infus Set Dewasa Pcs 47 47 22 25 25
237 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set 0 0
238 Kapas Pembalut 250 gr Rol 35 35 35
239 Kasa Steril 16 X 16 Dos 0 100 100 57 43 50
240 Kasa Kompres Steril 40 X 40 Bks 0 0
241 Kasa Pembalut 2 X 80 cm Rol 0 0
242 Kasa Pembalut 36 X 80 cm Rol 0 0 3
243 Kasa Pembalut Hidrofil 4 X 3 cm Rol 0 0
244 Kasa Pembalut Hidrofil 4 X 15 cm Rol 0 0
245 Masker Pcs 350 1000 1350 600 750 300
246 Natrium Klorida Lar. Infus 0,9 % Steril Btl 17 20 37 19 18 20
247 Needle / Naald No.23 G Pcs 0 0
248 Plester 5 Yard X 2 Inch Rol 1 7 8 2 6
249 Spon Gelatin Pcs 0 0
250 Wing needle / Scalp Vein Set Pcs 0 0
251 Yudium Povidon Lar. 10 % / 30 ml Btl 0 0
252 Yudium Povidon Lar. 10 % / 60 ml Btl 1 1 1 0 5
253 Yudium Povidon Lar. 10 % / 300 ml Btl 0 0
254 Dispo 0,05 ml Pcs 0 0
255 Dispo 0,5 ml Pcs 0 0
256 Umblical Cord Clem Pcs 45 50 95 11 84
257 Blood Lancet Pcs 0 0 1000
258 Alkohol Swab Pcs 400 300 700 700 0 1000
259 Dermafix 10 x 8 cm Pcs 0 0
260 Dermafix 10 x 20 cm Pcs 0 0
261 Plester Cerplast Aerofilm Pcs 0 0
262 Strip HCG Btl 0 0
263 Strip Glukosa Benechek Btl 0 0
264 Strip Cholestrol Benechek Btl 0 0
265 Strip Uric Acid Benechek Btl 0 0
266 Tabung EDTA Pcs 0 0 200
267 Strip Urine Btl 0 0 2
268 Rapid HBSag Paket 1 1 1
269 Reagen Golongan Darah Paket 0 0 3
270 Reagen Diluent Btl 0 0 3
271 Reagen Lyse Btl 0 0 2
272 Reagen Zheelnelsen Btl 3 3 3 5
273 Masker N-95 Pcs 60 60 60
274 Objek Glas Pcs 0 0 200
275 Eter Alkohol Btl 0 0 2
276 Rapid HIV Paket 0 0 2
277 Rapid Sypilis Paket 0 0 2
278 My Jelly Btl 0 0 3
279 Vaksin BCG Vial 0 0
280 Vaksin Polio Vial 0 0
281 Vaksin TD Vial 0 0
282 Vaksin WP Vial 0 0
283 Pelarut BCG Btl 0 0
284 Vaksin DPT-Hib Box 0 0

UMUM ASKES JUMLAH

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA
dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : JULI 2019
PERMINTAAN BULAN / PERIODE : AGUSTUS 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Allopurinol 100 mg Tab 300 200 500 500 0 1000
2 Ambroxol 30 mg Tab 2000 2000 4000 3000 1000 5000
3 Ambroxol Sirup 15 mg/5ml Btl 4 120 124 69 55 150
4 Aminofilin 200 mg Tab 100 100 100
5 Amitripilin 25 mg Tab 0 0
6 Amoksisilin 250 mg Kaps 0 0
7 Amoksisilin 500 mg Kapl 1900 3000 4900 3100 1800 3000
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl 0 0 0 100
9 Amlodipin 5 Mg Tab 300 600 900 300 600 300
10 Amlodipin 10 Mg Tab 900 500 1400 1050 350 2000
11 Antalgin Injeksi 250 mg ml - 2 ml Amp 0 0
12 Antalgin ( Metampiron ) 500 mg Tab 0 0
13 Antasida Doen Tab. Kombinasi Tab 1400 2000 3400 3000 400 3500
14 Antasida Doen suspensi 60 ml Btl 0 0 200
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot 75 75 25 50 50
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot 0 0
17 Antihemoroid Supp 2 gr Supp 0 20 20 0 20
18 Anti Migrain Doen Tab 0 0
19 Albendazol 400 mg Tab 90 90 30 60
22 Asam Askorbat ( Vit. C ) 50 mg Tab 1800 1000 2800 1500 1300 2000
23 Asam Mefenamat 500 mg Kapl 2100 1500 3600 2700 900 3000
24 Asam Traneksamat 500 mg Tab 200 200 0 200
25 Asiklovir 200 mg Tab 1000 1000 1000
26 Asiklovir 400 mg Tab 0 0
27 Asiklovir Krim 5 % Tube 20 10 30 10 20
28 Aspilet Tab 0 0
29 Azithromicin 500 mg Tab 0 0
30 Artem injeksi 80 mg / 1 ml Vial 0 0
31 Air Raksa Dental Use Btl 0 0
32 Batugin Elixir Btl 0 0 10
33 Betametason krim 0,1 % Tube 50 50 50 0 25
34 Betahistin Tab 120 90 210 60 150 90
35 Betadin Kumur Btl 5 5 2 3 10
36 Caviplex Sirup Btl 0 0
37 Caviplex Tablet Tab 0 0
38 Clindamycin 300 mg Tab 0 0
39 Ciprofloksasin 500 mg Tab 0 0
40 Captopril 25 mg Tab 1300 1300 0 1300
41 Cefadroxil 500 mg Kaps 1100 200 1300 900 400 1500
42 Cefadroxil Sirup Btl 0 0 50
43 Cefixime 100 mg Caps 360 360 300 60
44 Cefixime Sirup Btl 50 50 16 34
45 Cetrizin Tab Tab 0 0 0 500
46 Cetrizin Syrup Btl 45 45 25 20 50
47 Combiven UDV Vial 11 11 11 0 20
48 Caviplex Drops Btl 0 0
49 Curcuma Tab 400 400 100 300
50 Curbion Sirup Btl 112 100 212 102 110
51 Deksametason 0,5 mg Tab 2900 1500 4400 2300 2100
52 Deksametason injeksi 5 mg / ml Amp 0 100 100 0 100
53 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl 0 0
54 Dekstrometorfan Hbr 15 mg Tab 0 0
55 Diltiazem 30 mg Tab 0 0
56 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp 120 120 92 28
57 Digenta Salep Tube 20 20 10 10
58 Dentoria Btl 0 0
59 Devitalisasi Pasta Btl 0 0
60 Dietil Karbamazepin 100 mg Tab 0 0
61 Domperidon 10 Mg Tab 500 500 400 100 600
62 Domperidon sirup Btl 0 0 0 25
63 Doksisiklin 100 mg Kaps 0 0
64 Dulcolax Supp Supp 0 0
65 Dulcolax Tablet Tab 0 0
66 Efedrin Hcl 25 mg Tab 0 0
67 Ekstrak Beladona 10 mg Tab 0 0
68 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp 60 60 60
69 Eritromisin 500 mg Kapl 0 300 300 0 300
70 Eritromisin Sirup Kering 200 mg / 5 ml Btl 0 0 30
71 Eugenol Btl 0 0
72 Fenilbutason 200 mg Tab 0 0 200
73 Fenobarbital 30 mg Tab 0 0
74 Fenol Gliserol Tetes Telinga Btl 0 0
75 Flunarizin 5 mg Tab 150 150 0 150
76 Fenitoin 100 mg Kaps 0 0
77 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp 0 0 30
78 Fitomenadion ( Vit K ) Salut 10 mg Tab 0 0 200
79 Forumen Tetes Telinga Btl 2 2 2 0 20
80 Furosemida 40 mg Tab 0 0
81 Garam Oralit 200 ml Air Sak 300 300 100 200 200
82 Gemfibrosil 300 mg Kaps 200 200 200 0 EXP
83 Gemfibrosil 600 mg Kaps 0 0
84 Gentian Violet Larutan 1 % Btl 24 24 0 24
85 Glibenklamid 5 mg Tab 0 0
86 Gliseril Guayakolat 100 mg Tab 1900 1900 1200 700
87 Griseofulvin 125 mg Tab 700 500 1200 0 1200
88 Gliserol Btl 0 0
89 Gentamisin Salep Mata Tube 0 0
90 Gentamisin Tetes Mata Btl 0 0
91 Gentamisin 0,1 % Salep kulit Tube 70 70 30 40 30
92 Glass Ionomer Pcs 0 0
93 Glukosa Larutan Infus 5 % Btl 5 5 0 5
94 Glukosa Larutan Infus 10 % Btl 0 0
95 Hidroklortiazid ( HCT ) 25 mg Tab 0 0
96 Hidrokortison Krim 2,5 % Tube 144 144 48 96 24
97 Ibuprofen Sirup Btl 20 20 9 11 20
98 Ibuprofen 400 mg Tab 0 0 3000
99 Isosorbit Dinitrat Sublingual 5 mg Tab 0 0
100 Isoniazid 100 mg (INH 100 mg) Tab 500 500 200 300
101 Kalium Permanganat Serbuk 5 gr Pot 0 0
102 Kalsium Laktat 500 mg Tab 0 0 500
103 Kalsium Hidroksida Pasta Btl 0 0
104 Karbamazepin 200 mg Tab 0 0 200
105 Kloramfenikol 250 mg Kaps 0 0
106 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0
107 Kloramfenikol Tetes Telinga 3 % Btl 0 10 10 10
108 Kloramfenikol Tetes Mata Btl 10 10 20 20
109 Klorfeniramin Maleat ( CTM ) 4 mg Tab 3600 2000 5600 2400 3200 2500
110 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl 0 0
111 Ketokonazole 200 mg Tab 200 100 300 150 150
112 Ketokonazole Krim Tube 50 25 75 0 75
113 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab 0 0
114 Kotrimoksazol Pediatrik 120 mg Tab 0 0
115 Kotrimoksazol Dewasa 480 mg Tab 0 0
116 Kotrimoksazol Suspensi 240 mg / 5 ml Btl 0 0
117 Komposit Btl 0 0
118 Lansoprazol 30 Mg Kaps 0 0
119 Lidokain Comp. Injeksi 2 % Amp 150 150 0 150
120 Lisol 1 L Btl 3 3 0 3
121 Loperamid Tab Tab 0 0
122 Lisinopril 10 mg Tab 60 60 0 60
123 L-Bio Sact 0 0
124 Loratadin Tab Tab 0 0
125 Methylprednisolon 4 mg Tab 0 0
126 Meloxicam 7,5 mg Tab 0 1000 1000 150 850
127 Metronidazol 250 mg Tab 0 0
128 Metronidazol 500 mg Tab 1300 1300 500 800
129 Mikonazole Krim 2 % Tube 0 72 72 0 72
130 Methergin Tab 0 0
131 Methyldopa Tab 0 0
132 Microlax Tube 0 0
133 Metformin 500 Mg Tab 600 600 600 0
134 Nisagon Tube 0 0
135 Mummifying Pasta Btl 0 0
136 Natrium Diklofenak 25 mg Tab 0 0
137 Natrium Diklofenak 50 mg Tab 0 0 2000
138 Nifedipin Tab 0 0 100
139 Nistatin IU Vagina Tab 0 0
140 Obat Anti Tuberkulosis / F.D.C Kat. II Btl 1 1 1 0
141 Obat Anti Tuberkulosis / F.D.C Paket 0 0 10
142 Obat Anti Tuberkulosis Anak Paket 0 0
143 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl 37 37 17 20 30
144 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial 0 0
145 Oksitetrasiklina Hcl Salep Mata 1 % Tube 50 50 25 25 25
146 Oksitetrasiklina Hcl Salep Kulit 3 % Tube 0 0 200
147 Oksitosin Injeksi 10 IU / 1 ml Amp 100 100 0 100
148 Omecidal Tab Tab 0 300 300 300 0 1000
149 Omegdiar Tab 1800 1800 400 1400
150 Vastral Tab Tab 5100 1000 6100 2200 3900
151 Omeprazol 20 Mg Kaps 300 300 600 300 300
152 Ometrydril Sirup Btl 35 35 35 0
153 Parasetamol Sirup 120 mg / 5 ml Btl 140 100 240 175 65 200
154 Parasetamol 100 mg Tab 0 0 0
155 Parasetamol 500 mg Tab 6100 1000 7100 3000 4100 2000
156 Parasetamol Drop Btl 0 0 100
157 Parasetamol Suppositoria Tube 0 0 10
158 Pirantel Pamoat 125 mg Tab 0 0 100
159 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab 1300 300 1600 300 1300
160 Piroksikam 10 mg Tab 0 0 1000
161 Piroksikam 20 mg Tab 0 0 1000
162 Prednison 5 mg Tab 0 300 300 0 300
163 Primakina 15 mg Tab 0 0
164 Propanolol Hcl 40 mg Tab 200 200 0 200
165 Propiltiourasil ( P.T.U ) 100 mg Tab 0 0 500
166 Pehavral Tab Tab 0 0
167 Quinina ( Kina ) Inj. 25 % / 2 ml Amp 0 0
168 Quinina ( Kina ) 200 mg Tab 0 0
169 Ranitidin 150 mg Tab 0 0 2000
170 Reserpin 0,25 mg Tab 0 0
171 Retinol ( Vit. A ) 100.000 IU Tab 0 0
172 Retinol ( Vit. A ) 200.000 IU Tab 0 0
173 Ringer Laktat Lar. Infus Btl 0 0
174 Salbutamol 2 mg Tab 0 0
175 Salbutamol 4 mg Tab 300 300 0 300
176 Salisil Bedak 2 % Dos 24 24 8 16
177 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot 0 0 30
178 Sianokobalamin ( Vit. B 12 ) 50 mg Tab 600 1000 1600 700 900 1000
179 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp 0 100 100 62 38 100
180 Silk ( Benang Bedah Sutera ) No. 3/0 Sak 0 0
181 Silver Amalgam Serbuk 65 - 75 % Btl 0 0
182 Simvastatin 10 Mg Tab 0 0 1000
183 Simvastatin 20 Mg Tab 100 300 400 400 0 1500
184 Semen Seng Fosfat Serbuk & Cairan Btl 0 0
185 Sulfadimidin 500 mg Tab 0 0
186 Sucralfat Suspensi Btl 0 0 50
187 Tetrasiklin Hcl 250 mg Kaps 0 0
188 Tetrasiklin Hcl 500 mg Kaps 0 0
189 Thiamfenikol 500 mg Kaps 0 0
190 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab 2400 2400 800 1600
191 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp 0 0
192 Tab.Tambah Darah ( Fe ) Tab 0 0
193 Tramadol Kaps 0 0
194 Vaksin Anti Rabies (VAR) Kuur 0 0
195 Vitamin B. Kompleks Tab 2100 2000 4100 3300 800
196 Larutan Hc. 0,1 N Btl 0 0
197 Larutan Gimsa 100 ml Btl 0 0
198 Larutan Carbol Fuksin 0,3 % Btl 0 0
199 Larutan Turk 100 ml Btl 0 0
200 Larutan Benedict Btl 0 0
201 Larutan Etanol Asam 3 % Btl 0 0
202 Larutan Metilen Biru 0,3 % Btl 0 0
203 Larutan Asam Sulfosalisilat Btl 0 0
204 Larutan Hayyam Btl 0 0
205 Larutan Metanol Btl 0 0
206 Larutan Xilen 100 ml Btl 0 0
207 Larutan Oil Emersi Btl 0 0
208 Larutan Eosin Btl 0 0
209 zink 20 mg Tab 300 300 600 300 300
210 MDT Paket 12 12 12 0
211 Vidabion Tab 2900 1500 4400 3000 1400 3500
212 Bisacodyl Tab Tab 90 90 90
213 Bisoprolol 5 Mg Tab 0 0
214 Ketoprofen Suppositoria Supp 20 20 20
215 Neo Protifed Tab 0 0 2000
216 Renalyte Btl 0 0
217 Salep Bioplasenton Tube 0 0 20
218 Scopma Plus Tab 100 100 100 200
219 Spironolakton 25 mg Tab 0 0
220 Tilomix Tab 0 0 1000
221 Valsartan Tab 0 0
222 Alat Suntik Sekali Pakai 3 ml Pcs 0 0 300
223 Alat Suntik Sekali Pakai 5 ml Pcs 0 0 200
224 Alat Suntik Sekali Pakai 1 Ml Tab 0 0
225 Abbocath No. 18 / Intra Vena Catheter Pcs 7 50 57 12 45
226 Abbocath No. 20 / Intra Vena Catheter Pcs 0 50 50 5 45
227 Abbocath No. 24 / Intra Vena Catheter Pcs 49 49 49
228 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial 9 9 9 0 20
229 Aquadest Steril 1000 ml Btl 0 0
230 Bisturi No. 11 Pcs 0 0 10
231 Cat Gut / Benang Bedah No.3/0 Pcs 0 40 40 40
232 Etakridina Larutan 0,1 % Rivanol Btl 0 0
233 Etanol 70 % / 1 L Btl 5 5 1 4
234 Etil Klorida Semprot Btl 2 2 2
235 Handscun Steril Psg 250 250 50 200
236 Handscun Non Steril Psg 200 2000 2200 700 1500 500
237 Infus Set Anak Pcs 0 0
238 Infus Set Dewasa Pcs 25 25 10 15 50
239 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set 0 0
240 Kapas Pembalut 250 gr Rol 35 35 0 35
241 Kasa Steril 16 X 16 Dos 43 50 93 26 67 10
242 Kasa Kompres Steril 40 X 40 Bks 0 0
243 Kasa Pembalut 2 X 80 cm Rol 0 0
244 Kasa Pembalut 36 X 80 cm Rol 0 3 3 3
245 Kasa Pembalut Hidrofil 4 X 3 cm Rol 0 0
246 Kasa Pembalut Hidrofil 4 X 15 cm Rol 0 0
247 Masker Pcs 750 300 1050 600 450 500
248 Natrium Klorida Lar. Infus 0,9 % Steril Btl 18 18 9 9
249 Needle / Naald No.23 G Pcs 0 0
250 Plester 5 Yard X 2 Inch Rol 6 6 3 3
251 Spon Gelatin Pcs 0 0
252 Wing needle / Scalp Vein Set Pcs 0 0
253 Yudium Povidon Lar. 10 % / 30 ml Btl 0 0
254 Yudium Povidon Lar. 10 % / 60 ml Btl 0 0 10
255 Yudium Povidon Lar. 10 % / 300 ml Btl 0 0
256 Dispo 0,05 ml Pcs 0 0 500
257 Dispo 0,5 ml Pcs 0 0 1000
258 Umblical Cord Clem Pcs 84 84 5 79
259 Blood Lancet Pcs 0 0 100
260 Alkohol Swab Pcs 1000 1000 500 500 500
261 Dermafix 10 x 8 cm Pcs 0 0
262 Dermafix 10 x 20 cm Pcs 0 0
263 Plester Cerplast Aerofilm Pcs 0 0
264 Strip HCG Btl 0 0
265 Strip Glukosa Benechek Btl 0 0
266 Strip Cholestrol Benechek Btl 0 0
267 Strip Uric Acid Benechek Btl 0 0
268 Pot Sputum Pot 0 0 100
269 Pot Urine Pot 0 0 100
270 Tabung EDTA Pcs 200 200 200 0
271 Strip Urine Btl 0 0
272 Rapid HBSag Paket 0 0
273 Reagen Golongan Darah Paket 0 0 3
274 Reagen Diluent Btl 0 0 3
275 Reagen Lyse Btl 0 0 3
276 Reagen Zheelnelsen Btl 0 0 3
277 Masker N-95 Pcs 0 0
278 Objek Glas Pcs 200 200 200 0
279 Eter Alkohol Btl 0 0
280 Rapid HIV Paket 2 2 2 0 2
281 Rapid Sypilis Paket 0 0
282 My Jelly Btl 0 3 3 3
283 Safety Box Box 0 0 2
284 Vaksin BCG Vial 0 0 20
285 Vaksin Polio Vial 0 0 30
286 Vaksin TD 0 0 10
287 Vaksin WP Vial 0 0
288 Pelarut BCG Btl 0 0
289 Vaksin IVP Vial 0 0 20
290 Vaksin DT Box 0 0 6
291 Vaksin DPT-Hib Vial 30 30 30 0 30

UMUM ASKES JUMLAH

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

Gorontalo. ………………………2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : AGUSTUS 2019
PERMINTAAN BULAN / PERIODE : SEPTEMBER 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Allopurinol 100 mg Tab 0 1000 1000 500 500 200
2 Ambroxol 30 mg Tab 1000 5000 6000 2800 3200 2500
3 Ambroxol Sirup 15 mg/5ml Btl 55 55 55 0 200
4 Aminofilin 200 mg Tab 100 0 100 0 100
5 Amitripilin 25 mg Tab 0 0
6 Amoksisilin 250 mg Kaps 0 0
7 Amoksisilin 500 mg Kapl 1800 3000 4800 1500 3300 1500
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl 0 0 100
9 Amlodipin 5 Mg Tab 600 300 900 600 300
10 Amlodipin 10 Mg Tab 350 2000 2350 750 1600 500
11 Antalgin Injeksi 250 mg ml - 2 ml Amp 0 0
12 Antalgin ( Metampiron ) 500 mg Tab 0 0
13 Antasida Doen Tab. Kombinasi Tab 400 1300 1700 1700 0 5000
14 Antasida Doen suspensi 60 ml Btl 0 0 200
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot 50 50 100 100
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot 0 0
17 Antihemoroid Supp 2 gr Supp 20 20 20
18 Anti Migrain Doen Tab 0 0
19 Albendazol 400 mg Tab 60 60 60
22 Asam Askorbat ( Vit. C ) 50 mg Tab 1300 1300 200 1100 200
23 Asam Mefenamat 500 mg Kapl 900 3000 3900 2000 1900 2500
24 Asam Traneksamat 500 mg Tab 200 200 200 0
25 Asiklovir 200 mg Tab 1000 1000 1000
26 Asiklovir 400 mg Tab 0 0
27 Asiklovir Krim 5 % Tube 20 20 20
28 Aspilet Tab 0 0
29 Azithromicin 500 mg Tab 0 0
30 Artem injeksi 80 mg / 1 ml Vial 0 0
31 Air Raksa Dental Use Btl 0 0
32 Batugin Elixir Btl 5 5 1 4 5
33 Betametason krim 0,1 % Tube 0 25 25 0 25
34 Betahistin Tab 150 90 240 90 150 90
35 Betadin Kumur Btl 3 3 3 0 10
36 Caviplex Sirup Btl 0 0
37 Caviplex Tablet Tab 0 0
38 Clindamycin 300 mg Tab 0 0
39 Ciprofloksasin 500 mg Tab 0 0
40 Captopril 25 mg Tab 1300 0 1300 0 1300
41 Cefadroxil 500 mg Kaps 400 1500 1900 800 1100 500
42 Cefadroxil Sirup Btl 0 50 50 0 50
43 Cefixime 100 mg Caps 60 120 180 180 0 300
44 Cefixime Sirup Btl 34 34 16 18 10
45 Cetrizin Tab Tab 0 0 1000
46 Cetrizin Syrup Btl 20 50 70 20 50
47 Combiven UDV Vial 0 0 20
48 Caviplex Drops Btl 0 0
49 Curcuma Tab 300 300 300
50 Curbion Sirup Btl 110 110 60 50 150
51 Deksametason 0,5 mg Tab 2100 3000 5100 2400 2700
52 Deksametason injeksi 5 mg / ml Amp 100 100 100
53 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl 0 0
54 Dekstrometorfan Hbr 15 mg Tab 0 0
55 Diltiazem 30 mg Tab 0 0
56 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp 28 300 328 58 270
57 Digenta Salep Tube 10 10 10 0
58 Dentoria Btl 0 0
59 Devitalisasi Pasta Btl 0 0
60 Dietil Karbamazepin 100 mg Tab 0 0
61 Domperidon 10 Mg Tab 100 600 700 400 300 400
62 Domperidon sirup Btl 0 0 25
63 Doksisiklin 100 mg Kaps 0 0
64 Dulcolax Supp Supp 0 0
65 Dulcolax Tablet Tab 0 0
66 Efedrin Hcl 25 mg Tab 0 0
67 Ekstrak Beladona 10 mg Tab 0 0
68 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp 60 60 0 60
69 Eritromisin 500 mg Kapl 300 300 200 100 200
70 Eritromisin Sirup Kering 200 mg / 5 ml Btl 0 0 20
71 Eugenol Btl 0 0
72 Fenilbutason 200 mg Tab 0 0
73 Fenobarbital 30 mg Tab 0 0
74 Fenol Gliserol Tetes Telinga Btl 0 0
75 Flunarizin 5 mg Tab 150 150 150
76 Fenitoin 100 mg Kaps 0 0
77 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp 0 0
78 Fitomenadion ( Vit K ) Salut 10 mg Tab 200 200 200
79 Forumen Tetes Telinga Btl 0 0
80 Furosemida 40 mg Tab 0 0
81 Garam Oralit 200 ml Air Sak 200 200 400 100 300
82 Gemfibrosil 300 mg Kaps 0 0
83 Gemfibrosil 600 mg Kaps 0 0
84 Gentian Violet Larutan 1 % Btl 24 24 24 0 24
85 Glibenklamid 5 mg Tab 0 0
86 Gliseril Guayakolat 100 mg Tab 700 1500 2200 500 1700
87 Griseofulvin 125 mg Tab 1200 1200 200 1000
88 Gliserol Btl 0 0
89 Gentamisin Salep Mata Tube 0 0
90 Gentamisin Tetes Mata Btl 0 0
91 Gentamisin 0,1 % Salep kulit Tube 40 20 60 20 40 30
92 Glass Ionomer Pcs 0 0
93 Glukosa Larutan Infus 5 % Btl 5 5 5
94 Glukosa Larutan Infus 10 % Btl 0 0
95 Hidroklortiazid ( HCT ) 25 mg Tab 0 0
96 Hidrokortison Krim 2,5 % Tube 96 24 120 48 72 48
97 Ibuprofen Sirup Btl 11 20 31 11 20
98 Ibuprofen 400 mg Tab 0 0 2500
99 Isosorbit Dinitrat Sublingual 5 mg Tab 0 0
100 Isoniazid 100 mg (INH 100 mg) Tab 300 300 300
101 Kalium Permanganat Serbuk 5 gr Pot 0 0
102 Kalsium Laktat 500 mg Tab 0 0
103 Kalsium Hidroksida Pasta Btl 0 0
104 Karbamazepin 200 mg Tab 0 0
105 Kloramfenikol 250 mg Kaps 0 0
106 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0
107 Kloramfenikol Tetes Telinga 3 % Btl 10 10 10 0
108 Kloramfenikol Tetes Mata Btl 20 20 10 10 10
109 Klorfeniramin Maleat ( CTM ) 4 mg Tab 3200 2500 5700 2100 3600 2000
110 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl 0 0
111 Ketokonazole 200 mg Tab 150 150 150
112 Ketokonazole Krim Tube 75 75 75
113 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab 0 0
114 Kotrimoksazol Pediatrik 120 mg Tab 0 0
115 Kotrimoksazol Dewasa 480 mg Tab 0 0
116 Kotrimoksazol Suspensi 240 mg / 5 ml Btl 0 0
117 Komposit Btl 0 0
118 Lansoprazol 30 Mg Kaps 0 0
119 Lidokain Comp. Injeksi 2 % Amp 150 150 70 80
120 Lisol 1 L Btl 3 3 1 2
121 Loperamid Tab Tab 0 0
122 Lisinopril 10 mg Tab 60 60 60 0
123 L-Bio Sact 0 0 50
124 Loratadin Tab Tab 0 0 1000
125 Methylprednisolon 4 mg Tab 0 0 1500
126 Meloxicam 7,5 mg Tab 850 850 300 550
127 Metronidazol 250 mg Tab 0 0
128 Metronidazol 500 mg Tab 800 800 800
129 Mikonazole Krim 2 % Tube 72 72 48 24 48
130 Methergin Tab 0 0
131 Methyldopa Tab 0 0
132 Microlax Tube 0 0
133 Metformin 500 Mg Tab 0 0 0
134 Nisagon Tube 0 0
135 Mummifying Pasta Btl 0 0
136 Natrium Diklofenak 25 mg Tab 0 0
137 Natrium Diklofenak 50 mg Tab 0 0 2000
138 Nifedipin Tab 0 0
139 Nistatin IU Vagina Tab 0 0
140 Obat Anti Tuberkulosis / F.D.C Kat. II Paket 0 0
141 Obat Anti Tuberkulosis / F.D.C Paket 10 10 10 0
142 Obat Anti Tuberkulosis Anak Paket 0 0
143 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl 20 20 5 15 30
144 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial 0 0
145 Oksitetrasiklina Hcl Salep Mata 1 % Tube 25 25 50 50
146 Oksitetrasiklina Hcl Salep Kulit 3 % Tube 0 0
147 Oksitosin Injeksi 10 IU / 1 ml Amp 100 100 100
148 Omecidal Tab Tab 0 1000 1000 300 700 500
149 Omegdiar Tab 1400 1400 400 1000
150 Vastral Tab Tab 3900 3900 2000 1900 2500
151 Omeprazol 20 Mg Kaps 300 300 90 210 150
152 Ometrydril Sirup Btl 0 0 0
153 Parasetamol Sirup 120 mg / 5 ml Btl 65 200 265 114 151 150
154 Parasetamol 100 mg Tab 0 0 0
155 Parasetamol 500 mg Tab 4100 2000 6100 3700 2400 3500
156 Parasetamol Drop Btl 0 0 50
157 Parasetamol Suppositoria Tube 0 0 5
158 Pirantel Pamoat 125 mg Tab 0 0 50
159 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab 1300 1300 1300
160 Piroksikam 10 mg Tab 0 0 500
161 Piroksikam 20 mg Tab 0 0
162 Prednison 5 mg Tab 300 300 300
163 Primakina 15 mg Tab 0 0
164 Propanolol Hcl 40 mg Tab 200 200 200
165 Propiltiourasil ( P.T.U ) 100 mg Tab 0 0 1000
166 Pehavral Tab Tab 0 0
167 Quinina ( Kina ) Inj. 25 % / 2 ml Amp 0 0
168 Quinina ( Kina ) 200 mg Tab 0 0 10
169 Ranitidin 150 mg Tab 0 0 2000
170 Reserpin 0,25 mg Tab 0 0
171 Retinol ( Vit. A ) 100.000 IU Tab 0 0
172 Retinol ( Vit. A ) 200.000 IU Tab 0 0
173 Ringer Laktat Lar. Infus Btl 0 0 20
174 Salbutamol 2 mg Tab 0 0
175 Salbutamol 4 mg Tab 300 300 300
176 Salisil Bedak 2 % Dos 16 16 10 6 20
177 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot 0 0 24
178 Sianokobalamin ( Vit. B 12 ) 50 mg Tab 900 1000 1900 600 1300 500
179 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp 38 100 138 38 100
180 Silk ( Benang Bedah Sutera ) No. 3/0 Sak 0 0
181 Silver Amalgam Serbuk 65 - 75 % Btl 0 0
182 Simvastatin 10 Mg Tab 0 0 500
183 Simvastatin 20 Mg Tab 0 0 500
184 Semen Seng Fosfat Serbuk & Cairan Btl 0 0
185 Sulfadimidin 500 mg Tab 0 0
186 Sucralfat Suspensi Btl 0 0
187 Tetrasiklin Hcl 250 mg Kaps 0 0
188 Tetrasiklin Hcl 500 mg Kaps 0 0
189 Thiamfenikol 500 mg Kaps 0 0
190 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab 1600 1600 1600
191 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp 0 0
192 Tab.Tambah Darah ( Fe ) Tab 0 0
193 Tramadol Kaps 0 0
194 Vaksin Anti Rabies (VAR) Kuur 0 0 4
195 Vitamin B. Kompleks Tab 800 800 800 0 5000
196 Larutan Hc. 0,1 N Btl 0 0
197 Larutan Gimsa 100 ml Btl 0 0
198 Larutan Carbol Fuksin 0,3 % Btl 0 0
199 Larutan Turk 100 ml Btl 0 0
200 Larutan Benedict Btl 0 0
201 Larutan Etanol Asam 3 % Btl 0 0
202 Larutan Metilen Biru 0,3 % Btl 0 0
203 Larutan Asam Sulfosalisilat Btl 0 0
204 Larutan Hayyam Btl 0 0
205 Larutan Metanol Btl 0 0
206 Larutan Xilen 100 ml Btl 0 0
207 Larutan Oil Emersi Btl 0 0
208 Larutan Eosin Btl 0 0
209 zink 20 mg Tab 300 300 300 0 500
210 MDT Paket 0 0
211 Vidabion Tab 1400 3500 4900 2700 2200
212 Bisacodyl Tab Tab 90 90 90
213 Bisoprolol 5 Mg Tab 0 0
214 Ketoprofen Suppositoria Supp 20 20 20
215 Neo Protifed Tab 0 0
216 Renalyte Btl 0 0
217 Salep Bioplasenton Tube 0 0
218 Scopma Plus Tab 100 100 100 0 500
219 Spironolakton 25 mg Tab 0 0
220 Tilomix Tab 0 0 1000
221 Valsartan Tab 0 0
222 Alat Suntik Sekali Pakai 3 ml Pcs 0 300 300 200 100 500
223 Alat Suntik Sekali Pakai 5 ml Pcs 0 200 200 200 0 200
224 Alat Suntik Sekali Pakai 1 Ml Tab 0 0 200
225 Abbocath No. 18 / Intra Vena Catheter Pcs 45 45 45
226 Abbocath No. 20 / Intra Vena Catheter Pcs 45 45 45
227 Abbocath No. 24 / Intra Vena Catheter Pcs 49 49 49
228 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial 0 30 30 10 20 10
229 Aquadest Steril 1000 ml Btl 0 0
230 Bisturi No. 11 Pcs 100 100 100
231 Cat Gut / Benang Bedah No.3/0 Pcs 40 40 2 38
232 Etakridina Larutan 0,1 % Rivanol Btl 0 0
233 Etanol 70 % / 1 L Btl 4 4 2 2 3
234 Etil Klorida Semprot Btl 2 2 2 0 2
235 Handscun Steril Psg 200 200 150 50 200
236 Handscun Non Steril Psg 1500 500 2000 900 1100 1000
237 Infus Set Anak Pcs 0 0
238 Infus Set Dewasa Pcs 15 30 45 45
239 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set 0 0
240 Kapas Pembalut 250 gr Rol 35 35 35
241 Kasa Steril 16 X 16 Dos 67 10 77 60 17 50
242 Kasa Kompres Steril 40 X 40 Bks 0 0
243 Kasa Pembalut 2 X 80 cm Rol 0 0
244 Kasa Pembalut 36 X 80 cm Rol 3 3 3
245 Kasa Pembalut Hidrofil 4 X 3 cm Rol 0 0
246 Kasa Pembalut Hidrofil 4 X 15 cm Rol 0 0
247 Masker Pcs 450 500 950 400 550 200
248 Natrium Klorida Lar. Infus 0,9 % Steril Btl 9 9 9 EXP
249 Needle / Naald No.23 G Pcs 0 0
250 Plester 5 Yard X 2 Inch Rol 3 3 3
251 Spon Gelatin Pcs 0 0
252 Wing needle / Scalp Vein Set Pcs 0 0
253 Yudium Povidon Lar. 10 % / 30 ml Btl 0 0
254 Yudium Povidon Lar. 10 % / 60 ml Btl 0 0 5
255 Yudium Povidon Lar. 10 % / 300 ml Btl 0 0
256 Dispo 0,05 ml Pcs 500 500 500 0 500
257 Dispo 0,5 ml Pcs 1000 1000 1000 0 1000
258 Umblical Cord Clem Pcs 79 79 30 49 20
259 Blood Lancet Pcs 0 0 500
260 Alkohol Swab Pcs 500 500 1000 300 700 500
261 Dermafix 10 x 8 cm Pcs 0 0
262 Dermafix 10 x 20 cm Pcs 0 0
263 Plester Cerplast Aerofilm Pcs 0 0
264 Strip HCG Btl 0 0
265 Strip Glukosa Benechek Btl 0 0
266 Strip Cholestrol Benechek Btl 0 0
267 Strip Uric Acid Benechek Btl 0 0
268 Pot Sputum Pot 0 200 200 200 0
269 Pot Urine Pot 0 100 100 100 0
270 Tabung EDTA Pcs 0 0
271 Strip Urine Btl 0 0
272 Rapid HBSag Paket 0 0
273 Reagen Golongan Darah Paket 0 0
274 Reagen Diluent Btl 0 0
275 Reagen Lyse Btl 0 0
276 Reagen Zheelnelsen Btl 3 3 3
277 Masker N-95 Pcs 0 0
278 Objek Glas Pcs 0 0
279 Eter Alkohol Btl 0 0
280 Rapid HIV Paket 1 1 1 2
281 Rapid Sypilis Paket 0 0
282 My Jelly Btl 3 3 1 2
283 Safety Box Box 50 50 50 0
284 Vaksin BCG Vial 0 0
285 Vaksin Polio Vial 0 0
286 Vaksin TD Vial 90 90 90 0 30
287 Vaksin WP Vial 0 0
288 Pelarut BCG Btl 20 20 20 0
289 Vaksin IVP Vial 20 20 20 0
290 Vaksin DT Box 42 42 42 0
291 Vaksin DPT-Hib Vial 30 30 30 0 30
292 Campak MR Vial 50
293 Polio Tetes Vial 30

UMUM ASKES JUMLAH

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

Gorontalo. ………………………2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : SEPTEMBER 2019
PERMINTAAN BULAN / PERIODE : OKTOBER 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Allopurinol 100 mg Tab
2 Ambroxol 30 mg Tab
3 Ambroxol Sirup 15 mg/5ml Btl
4 Aminofilin 200 mg Tab
5 Amitripilin 25 mg Tab
6 Amoksisilin 250 mg Kaps
7 Amoksisilin 500 mg Kapl
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl
9 Amlodipin 5 Mg Tab
10 Amlodipin 10 Mg Tab
11 Antalgin Injeksi 250 mg ml - 2 ml Amp
12 Antalgin ( Metampiron ) 500 mg Tab
13 Antasida Doen Tab. Kombinasi Tab
14 Antasida Doen suspensi 60 ml Btl
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot
17 Antihemoroid Supp 2 gr Supp
18 Anti Migrain Doen Tab
19 Albendazol 400 mg Tab
22 Asam Askorbat ( Vit. C ) 50 mg Tab
23 Asam Mefenamat 500 mg Kapl
24 Asam Traneksamat 500 mg Tab
25 Asiklovir 200 mg Tab
26 Asiklovir 400 mg Tab
27 Asiklovir Krim 5 % Tube
28 Aspilet Tab
29 Azithromicin 500 mg Tab
30 Artem injeksi 80 mg / 1 ml Vial
31 Air Raksa Dental Use Btl
32 Batugin Elixir Btl
33 Betametason krim 0,1 % Tube
34 Betahistin Tab
35 Betadin Kumur Btl
36 Caviplex Sirup Btl

37 Caviplex Tablet Tab

38 Clindamycin 300 mg Tab

39 Ciprofloksasin 500 mg Tab
40 Captopril 25 mg Tab
41 Cefadroxil 500 mg Kaps
42 Cefadroxil Sirup Btl
43 Cefixime 100 mg Caps
44 Cefixime Sirup Btl
45 Cetrizin Tab Tab
46 Cetrizin Syrup Btl
47 Combiven UDV Vial
48 Caviplex Drops Btl
49 Curcuma Tab
50 Curbion Sirup Btl
51 Deksametason 0,5 mg Tab
52 Deksametason injeksi 5 mg / ml Amp
53 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl
54 Dekstrometorfan Hbr 15 mg Tab
55 Diltiazem 30 mg Tab
56 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp
57 Digenta Salep Tube
58 Dentoria Btl
59 Devitalisasi Pasta Btl
60 Dietil Karbamazepin 100 mg Tab
61 Domperidon 10 Mg Tab
62 Domperidon sirup Btl
63 Doksisiklin 100 mg Kaps
64 Dulcolax Supp Supp

65 Dulcolax Tablet Tab

66 Efedrin Hcl 25 mg Tab

67 Ekstrak Beladona 10 mg Tab
68 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp
69 Eritromisin 500 mg Kapl
70 Eritromisin Sirup Kering 200 mg / 5 ml Btl
71 Eugenol Btl
72 Fenilbutason 200 mg Tab
73 Fenobarbital 30 mg Tab
74 Fenol Gliserol Tetes Telinga Btl
75 Flunarizin 5 mg Tab
76 Fenitoin 100 mg Kaps
77 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp
78 Fitomenadion ( Vit K ) Salut 10 mg Tab
79 Forumen Tetes Telinga Btl
80 Furosemida 40 mg Tab
81 Garam Oralit 200 ml Air Sak
82 Gemfibrosil 300 mg Kaps
83 Gemfibrosil 600 mg Kaps
84 Gentian Violet Larutan 1 % Btl
85 Glibenklamid 5 mg Tab
86 Gliseril Guayakolat 100 mg Tab
87 Griseofulvin 125 mg Tab
88 Gliserol Btl
89 Gentamisin Salep Mata Tube
90 Gentamisin Tetes Mata Btl
91 Gentamisin 0,1 % Salep kulit Tube
92 Glass Ionomer Pcs
93 Glukosa Larutan Infus 5 % Btl
94 Glukosa Larutan Infus 10 % Btl
95 Hidroklortiazid ( HCT ) 25 mg Tab
96 Hidrokortison Krim 2,5 % Tube
97 Ibuprofen Sirup Btl
98 Ibuprofen 400 mg Tab
99 Isosorbit Dinitrat Sublingual 5 mg Tab
100 Isoniazid 100 mg (INH 100 mg) Tab
101 Kalium Permanganat Serbuk 5 gr Pot
102 Kalsium Laktat 500 mg Tab
103 Kalsium Hidroksida Pasta Btl
104 Karbamazepin 200 mg Tab
105 Kloramfenikol 250 mg Kaps
106 Kloramfenikol Suspensi 125 mg/5ml Btl
107 Kloramfenikol Tetes Telinga 3 % Btl
108 Kloramfenikol Tetes Mata Btl
109 Klorfeniramin Maleat ( CTM ) 4 mg Tab
110 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl
111 Ketokonazole 200 mg Tab
112 Ketokonazole Krim Tube
113 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab
114 Kotrimoksazol Pediatrik 120 mg Tab
115 Kotrimoksazol Dewasa 480 mg Tab
116 Kotrimoksazol Suspensi 240 mg / 5 ml Btl
117 Komposit Btl
118 Lansoprazol 30 Mg Kaps
119 Lidokain Comp. Injeksi 2 % Amp
120 Lisol 1 L Btl
121 Loperamid Tab Tab
122 Lisinopril 10 mg Tab
123 L-Bio Sact
124 Loratadin Tab Tab
125 Methylprednisolon 4 mg Tab
126 Meloxicam 7,5 mg Tab
127 Metronidazol 250 mg Tab
128 Metronidazol 500 mg Tab
129 Mikonazole Krim 2 % Tube
130 Methergin Tab
131 Methyldopa Tab
132 Microlax Tube
133 Metformin 500 Mg Tab
134 Nisagon Tube
135 Mummifying Pasta Btl
136 Natrium Diklofenak 25 mg Tab
137 Natrium Diklofenak 50 mg Tab
138 Nifedipin Tab
139 Nistatin IU Vagina Tab
140 Obat Anti Tuberkulosis / F.D.C Kat. II Paket
141 Obat Anti Tuberkulosis / F.D.C Paket
142 Obat Anti Tuberkulosis Anak Paket
143 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl
144 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial
145 Oksitetrasiklina Hcl Salep Mata 1 % Tube
146 Oksitetrasiklina Hcl Salep Kulit 3 % Tube
147 Oksitosin Injeksi 10 IU / 1 ml Amp
148 Omecidal Tab Tab
149 Omegdiar Tab
150 Vastral Tab Tab
151 Omeprazol 20 Mg Kaps
152 Ometrydril Sirup Btl
153 Parasetamol Sirup 120 mg / 5 ml Btl
154 Parasetamol 100 mg Tab
155 Parasetamol 500 mg Tab
156 Parasetamol Drop Btl
157 Parasetamol Suppositoria Tube
158 Pirantel Pamoat 125 mg Tab
159 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab
160 Piroksikam 10 mg Tab
161 Piroksikam 20 mg Tab
162 Prednison 5 mg Tab
163 Primakina 15 mg Tab
164 Propanolol Hcl 40 mg Tab
165 Propiltiourasil ( P.T.U ) 100 mg Tab
166 Pehavral Tab Tab
167 Quinina ( Kina ) Inj. 25 % / 2 ml Amp
168 Quinina ( Kina ) 200 mg Tab
169 Ranitidin 150 mg Tab
170 Reserpin 0,25 mg Tab
171 Retinol ( Vit. A ) 100.000 IU Tab
172 Retinol ( Vit. A ) 200.000 IU Tab
173 Ringer Laktat Lar. Infus Btl
174 Salbutamol 2 mg Tab
175 Salbutamol 4 mg Tab
176 Salisil Bedak 2 % Dos
177 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot
178 Sianokobalamin ( Vit. B 12 ) 50 mg Tab
179 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp
180 Silk ( Benang Bedah Sutera ) No. 3/0 Sak
181 Silver Amalgam Serbuk 65 - 75 % Btl
182 Simvastatin 10 Mg Tab
183 Simvastatin 20 Mg Tab
184 Semen Seng Fosfat Serbuk & Cairan Btl
185 Sulfadimidin 500 mg Tab
186 Sucralfat Suspensi Btl
187 Tetrasiklin Hcl 250 mg Kaps
188 Tetrasiklin Hcl 500 mg Kaps
189 Thiamfenikol 500 mg Kaps
190 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab
191 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp
192 Tab.Tambah Darah ( Fe ) Tab
193 Tramadol Kaps
194 Vaksin Anti Rabies (VAR) Kuur
195 Vitamin B. Kompleks Tab
196 Larutan Hc. 0,1 N Btl
197 Larutan Gimsa 100 ml Btl
198 Larutan Carbol Fuksin 0,3 % Btl
199 Larutan Turk 100 ml Btl
200 Larutan Benedict Btl
201 Larutan Etanol Asam 3 % Btl
202 Larutan Metilen Biru 0,3 % Btl
203 Larutan Asam Sulfosalisilat Btl
204 Larutan Hayyam Btl
205 Larutan Metanol Btl
206 Larutan Xilen 100 ml Btl
207 Larutan Oil Emersi Btl
208 Larutan Eosin Btl
209 zink 20 mg Tab
210 MDT Paket
211 Vidabion Tab
212 Bisacodyl Tab Tab
213 Bisoprolol 5 Mg Tab
214 Ketoprofen Suppositoria Supp
215 Neo Protifed Tab
216 Renalyte Btl
217 Salep Bioplasenton Tube
218 Scopma Plus Tab
219 Spironolakton 25 mg Tab
220 Tilomix Tab
221 Valsartan Tab
222 Alat Suntik Sekali Pakai 3 ml Pcs
223 Alat Suntik Sekali Pakai 5 ml Pcs
224 Alat Suntik Sekali Pakai 1 Ml Tab
225 Abbocath No. 18 / Intra Vena Catheter Pcs
226 Abbocath No. 20 / Intra Vena Catheter Pcs
227 Abbocath No. 24 / Intra Vena Catheter Pcs
228 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial
229 Aquadest Steril 1000 ml Btl
230 Bisturi No. 11 Pcs
231 Cat Gut / Benang Bedah No.3/0 Pcs
232 Etakridina Larutan 0,1 % Rivanol Btl
233 Etanol 70 % / 1 L Btl
234 Etil Klorida Semprot Btl
235 Handscun Steril Psg
236 Handscun Non Steril Psg
237 Infus Set Anak Pcs
238 Infus Set Dewasa Pcs
239 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set
240 Kapas Pembalut 250 gr Rol
241 Kasa Steril 16 X 16 Dos
242 Kasa Kompres Steril 40 X 40 Bks
243 Kasa Pembalut 2 X 80 cm Rol
244 Kasa Pembalut 36 X 80 cm Rol
245 Kasa Pembalut Hidrofil 4 X 3 cm Rol
246 Kasa Pembalut Hidrofil 4 X 15 cm Rol
247 Masker Pcs
248 Natrium Klorida Lar. Infus 0,9 % Steril Btl
249 Needle / Naald No.23 G Pcs
250 Plester 5 Yard X 2 Inch Rol
251 Spon Gelatin Pcs
252 Wing needle / Scalp Vein Set Pcs
253 Yudium Povidon Lar. 10 % / 30 ml Btl
254 Yudium Povidon Lar. 10 % / 60 ml Btl
255 Yudium Povidon Lar. 10 % / 300 ml Btl
256 Dispo 0,05 ml Pcs
257 Dispo 0,5 ml Pcs
258 Umblical Cord Clem Pcs
259 Blood Lancet Pcs
260 Alkohol Swab Pcs
261 Dermafix 10 x 8 cm Pcs
262 Dermafix 10 x 20 cm Pcs
263 Plester Cerplast Aerofilm Pcs
264 Strip HCG Btl
265 Strip Glukosa Benechek Btl
266 Strip Cholestrol Benechek Btl
267 Strip Uric Acid Benechek Btl
268 Pot Sputum Pot
269 Pot Urine Pot
270 Tabung EDTA Pcs
271 Strip Urine Btl
272 Rapid HBSag Paket
273 Reagen Golongan Darah Paket
274 Reagen Diluent Btl
275 Reagen Lyse Btl
276 Reagen Zheelnelsen Btl
277 Masker N-95 Pcs
278 Objek Glas Pcs
279 Eter Alkohol Btl
280 Rapid HIV Paket
281 Rapid Sypilis Paket
282 My Jelly Btl
283 Safety Box Box
284 Vaksin BCG Vial
285 Vaksin Polio Vial
286 Vaksin TD Vial
287 Vaksin WP Vial
288 Pelarut BCG Btl
289 Vaksin IVP Vial
290 Vaksin DT Box
291 Vaksin DPT-Hib Vial
292 Campak MR Vial
293 Polio Tetes Vial

UMUM ASKES JUMLAH

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

Gorontalo. ………………………2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPL
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : OKTOBER 2019
PERMINTAAN BULAN / PERIODE : NOVEMBER 2019

STOK SISA
NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN
AWAL STOK

1 2 3 4 5 6 7 8
1 Allopurinol 100 mg Tab 300 300 600 400 200
2 Ambroxol 30 mg Tab 3700 0 3700 600 3100
3 Ambroxol Sirup 15 mg/5ml Btl 0 0 0 0 0
4 Aminofilin 200 mg Tab 100 0 100 0 100
5 Amitripilin 25 mg Tab 0 0 0 0 0
6 Amoksisilin 250 mg Kaps 0 0 0 0 0
7 Amoksisilin 500 mg Kapl 3100 2000 5100 1800 3300
8 Amoksisilin Sirup Kering 125 mg/5 ml Btl 0 0 0 0 0
9 Amlodipin 5 Mg Tab 0 600 600 300 300
10 Amlodipin 10 Mg Tab 1300 500 1800 500 1300
11 Antalgin Injeksi 250 mg ml - 2 ml Amp 0 0 0 0 0
12 Antalgin ( Metampiron ) 500 mg Tab 0 0 0 0 0
13 Antasida Doen Tab. Kombinasi Tab 0 5000 5000 2400 2600
14 Antasida Doen suspensi 60 ml Btl 0 200 200 150 50
15 Anti Bakteri Doen Komb.(Bacitracin) 5gr Pot 25 100 125 0 125
16 Antifungi Doen (Salep 3 - 6 ) 30 gr Pot 0 0 0 0 0
17 Antihemoroid Supp 2 gr Supp 20 0 20 0 20
18 Anti Migrain Doen Tab 0 0 0 0 0
19 Albendazol 400 mg Tab 60 0 60 0 60
22 Asam Askorbat ( Vit. C ) 50 mg Tab 600 1000 1600 0 1600
23 Asam Mefenamat 500 mg Kapl 3100 1000 4100 1000 3100
24 Asam Traneksamat 500 mg Tab 0 0 0 0 0
25 Asiklovir 200 mg Tab 800 0 800 0 800
26 Asiklovir 400 mg Tab 0 1000 1000 450 550
27 Asiklovir Krim 5 % Tube 20 0 20 20 0
28 Aspilet Tab 0 0 0 Err:522 Err:522
29 Azithromicin 500 mg Tab 0 0 0 Err:522 Err:522
30 Artem injeksi 80 mg / 1 ml Vial 0 0 0 Err:522 Err:522
31 Air Raksa Dental Use Btl 0 0 0 Err:522 Err:522
32 Batugin Elixir Btl 2 0 2 2 0
33 Betametason krim 0,1 % Tube 25 0 25 0 25
34 Betahistin Tab 240 0 240 0 240
35 Betadin Kumur Btl 0 0 0 Err:522 Err:522
36 Caviplex Sirup Btl 0 0 0 Err:522 Err:522
37 Caviplex Tablet Tab 0 0 0 Err:522 Err:522
38 Clindamycin 300 mg Tab 0 0 0 Err:522 Err:522
39 Ciprofloksasin 500 mg Tab 0 0 0 Err:522 Err:522
40 Captopril 25 mg Tab 1200 0 1200 0 1200
41 Cefadroxil 500 mg Kaps 1300 0 1300 400 900
42 Cefadroxil Sirup Btl 46 0 46 0 46
43 Cefixime 100 mg Caps 0 600 600 150 450
44 Cefixime Sirup Btl 19 0 19 0 19
45 Cetrizin Tab Tab 0 0 0 Err:522 Err:522
46 Cetrizin Syrup Btl 38 0 38 10 28
47 Combiven UDV Vial 0 20 20 10 10
48 Caviplex Drops Btl 0 0 0 0 0
49 Curcuma Tab 300 0 300 0 300
50 Curbion Sirup Btl 134 50 184 34 150
51 Deksametason 0,5 mg Tab 1600 1500 3100 600 2500
52 Deksametason injeksi 5 mg / ml Amp 70 0 70 0 70
53 Dekstrometorfan Hbr Sirup 10 mg / 5 ml Btl 0 0 0 Err:522 Err:522
54 Dekstrometorfan Hbr 15 mg Tab 0 0 0 Err:522 Err:522
55 Diltiazem 30 mg Tab 0 0 0 Err:522 Err:522
56 Difenhidramin Hcl Injeksi 10 mg / 1 ml Amp 60 300 360 0 360
57 Digenta Salep Tube 2 15 17 2 15
58 Dentoria Btl 0 0 0 0 0
59 Devitalisasi Pasta Btl 0 0 0 0 0
60 Dietil Karbamazepin 100 mg Tab 0 0 0 0 0
61 Domperidon 10 Mg Tab 700 0 700 500 200
62 Domperidon sirup Btl 0 0 0 0 0
63 Doksisiklin 100 mg Kaps 0 0 0 0 0
64 Dulcolax Supp Supp 0 0 0 0 0
65 Dulcolax Tablet Tab 0 0 0 0 0
66 Efedrin Hcl 25 mg Tab 0 0 0 0 0
67 Ekstrak Beladona 10 mg Tab 0 0 0 0 0
68 Epinefrin Hcl/Adrenalin Injeksi 0,1 mg Amp 60 0 60 0 60
69 Eritromisin 500 mg Kapl 300 0 300 0 300
70 Eritromisin Sirup Kering 200 mg / 5 ml Btl 0 0 0 Err:522 Err:522
71 Eugenol Btl 0 0 0 Err:522 Err:522
72 Fenilbutason 200 mg Tab 0 0 0 Err:522 Err:522
73 Fenobarbital 30 mg Tab 0 0 0 Err:522 Err:522
74 Fenol Gliserol Tetes Telinga Btl 0 0 0 Err:522 Err:522
75 Flunarizin 5 mg Tab 150 0 150 0 150
76 Fenitoin 100 mg Kaps 0 0 0 Err:522 Err:522
77 Fitomenadion ( Vit K ) Injeksi 10 mg/ ml Amp 78 0 78 0 78
78 Fitomenadion ( Vit K ) Salut 10 mg Tab 200 0 200 200 0
79 Forumen Tetes Telinga Btl 0 0 0 0 0
80 Furosemida 40 mg Tab 0 0 0 0 0
81 Garam Oralit 200 ml Air Sak 200 0 200 100 100
82 Gemfibrosil 300 mg Kaps 0 0 0 0 0
83 Gemfibrosil 600 mg Kaps 0 0 0 0 0
84 Gentian Violet Larutan 1 % Btl 0 0 0 0 0
85 Glibenklamid 5 mg Tab 0 0 0 0 0
86 Gliseril Guayakolat 100 mg Tab 1100 500 1600 500 1100
87 Griseofulvin 125 mg Tab 1500 0 1500 0 1500
88 Gliserol Btl 0 0 0 0 0
89 Gentamisin Salep Mata Tube 0 0 0 0 0
90 Gentamisin Tetes Mata Btl 0 0 0 0 0
91 Gentamisin 0,1 % Salep kulit Tube 40 0 40 20 20
92 Glass Ionomer Pcs 0 0 0 0 0
93 Glukosa Larutan Infus 5 % Btl 5 0 5 0 5
94 Glukosa Larutan Infus 10 % Btl 0 0 0 0 0
95 Hidroklortiazid ( HCT ) 25 mg Tab 0 0 0 0 0
96 Hidrokortison Krim 2,5 % Tube 120 0 120 24 96
97 Ibuprofen Sirup Btl 18 0 18 0 18
98 Ibuprofen 200 mg Tab 800 5000 5800 1500 4300
99 Isosorbit Dinitrat Sublingual 5 mg Tab 0 0 0 0 0
100 Isoniazid 100 mg (INH 100 mg) Tab 300 0 300 0 300
101 Kalium Permanganat Serbuk 5 gr Pot 0 0 0 0 0
102 Kalsium Laktat 500 mg Tab 0 500 500 300 200
103 Kalsium Hidroksida Pasta Btl 0 0 0 0 0
104 Karbamazepin 200 mg Tab 0 0 0 0 0
105 Kloramfenikol 250 mg Kaps 0 0 0 0 0
106 Kloramfenikol Suspensi 125 mg/5ml Btl 0 0 0 0 0
107 Kloramfenikol Tetes Telinga 3 % Btl 0 0 0 0 0
108 Kloramfenikol Tetes Mata Btl 0 30 30 0 30
109 Klorfeniramin Maleat ( CTM ) 4 mg Tab 3300 2500 5800 1900 3900
110 Klorfenol Mentol Kamfer ( CHKM ) 4 mg Btl 0 0 0 0 0
111 Ketokonazole 200 mg Tab 0 500 500 0 500
112 Ketokonazole Krim Tube 75 0 75 25 50
113 Sulfadoksin 500 mg + Pirimetamin 25 mg Tab 0 0 0 0 0
114 Kotrimoksazol Pediatrik 120 mg Tab 0 0 0 0 0
115 Kotrimoksazol Dewasa 480 mg Tab 0 0 0 0 0
116 Kotrimoksazol Suspensi 240 mg / 5 ml Btl 0 0 0 0 0
117 Komposit Btl 0 0 0 0 0
118 Lansoprazol 30 Mg Kaps 0 0 0 0 0
119 Lidokain Comp. Injeksi 2 % Amp 80 0 80 12 68
120 Lisol 1 L Btl 2 0 2 0 2
121 Loperamid Tab Tab 0 0 0 0 0
122 Lisinopril 10 mg Tab 0 0 0 0 0
123 L-Bio Sact 0 0 0 0 0
124 Loratadin Tab Tab 0 250 250 150 100
125 Methylprednisolon 4 mg Tab 0 3000 3000 200 2800
126 Meloxicam 7,5 mg Tab 100 0 100 100 0
127 Metronidazol 250 mg Tab 0 0 0 0 0
128 Metronidazol 500 mg Tab 600 0 600 200 400
129 Mikonazole Krim 2 % Tube 48 48 96 24 72
130 Methergin Tab 0 0 0 0 0
131 Methyldopa Tab 0 0 0 0 0
132 Microlax Tube 0 0 0 0 0
133 Metformin 500 Mg Tab 0 0 0 0 0
134 Nisagon Tube 0 0 0 0 0
135 Mummifying Pasta Btl 0 0 0 0 0
136 Natrium Diklofenak 25 mg Tab 0 0 0 0 0
137 Natrium Diklofenak 50 mg Tab 0 0 0 0 0
138 Nifedipin Tab 0 0 0 0 0
139 Nistatin IU Vagina Tab 0 0 0 0 0
140 Obat Anti Tuberkulosis / F.D.C Kat. II Paket 0 0 0 0 0
141 Obat Anti Tuberkulosis / F.D.C Paket 0 0 0 0 0
142 Obat Anti Tuberkulosis Anak Paket 0 0 0 0 0
143 Obat Batuk hitam ( OBH ) Cairan 100 ml Btl 5 0 5 5 0
144 Oksitetrasiklina Hcl Inj. Im 5 mg / 10 ml Vial 0 0 0 0 0
145 Oksitetrasiklina Hcl Salep Mata 1 % Tube 50 0 50 0 50
146 Oksitetrasiklina Hcl Salep Kulit 3 % Tube 0 0 0 0 0
147 Oksitosin Injeksi 10 IU / 1 ml Amp 100 0 100 0 100
148 Omecidal Tab Tab 700 500 1200 200 1000
149 Omegdiar Tab 700 300 1000 200 800
150 Vastral Tab Tab 2400 2500 4900 1300 3600
151 Omeprazol 20 Mg Kaps 120 450 570 240 330
152 Ometrydril Sirup Btl 0 0 0 0 0
153 Parasetamol Sirup 120 mg / 5 ml Btl 220 100 320 93 227
154 Parasetamol 100 mg Tab 0 0 0 0 0
155 Parasetamol 500 mg Tab 4100 1000 5100 2400 2700
156 Parasetamol Drop Btl 0 56 56 12 44
157 Parasetamol Suppositoria Tube 0 0 0 0 0
158 Pirantel Pamoat 125 mg Tab 0 0 0 0 0
159 Piridoksin Hcl ( Vit. B 6 ) 10 mg Tab 600 500 1100 100 1000
160 Piroksikam 10 mg Tab 0 0 0 0 0
161 Piroksikam 20 mg Tab 0 0 0 0 0
162 Prednison 5 mg Tab 200 200 400 100 300
163 Primakina 15 mg Tab 0 0 0 0 0
164 Propanolol Hcl 40 mg Tab 200 0 200 0 200
165 Propiltiourasil ( P.T.U ) 100 mg Tab 0 0 0 0 0
166 Pehavral Tab Tab 0 0 0 0 0
167 Quinina ( Kina ) Inj. 25 % / 2 ml Amp 0 0 0 0 0
168 Quinina ( Kina ) 200 mg Tab 0 0 0 0 0
169 Ranitidin 150 mg Tab 0 0 0 0 0
170 Reserpin 0,25 mg Tab 0 0 0 0 0
171 Retinol ( Vit. A ) 100.000 IU Tab 0 0 0 0 0
172 Retinol ( Vit. A ) 200.000 IU Tab 0 0 0 0 0
173 Ringer Laktat Lar. Infus Btl 9 20 29 5 24
174 Salbutamol 2 mg Tab 0 0 0 0 0
175 Salbutamol 4 mg Tab 300 0 300 0 300
176 Salisil Bedak 2 % Dos 6 0 6 2 4
177 Salicyl Zwavelzalf ( Salep 2 - 4 ) ) 15 mg Pot 0 0 0 0 0
178 Sianokobalamin ( Vit. B 12 ) 50 mg Tab 800 1000 1800 200 1600
179 Sianokobalamin ( Vit. B 12 ) Inj. 500 mg/ml Amp 35 100 135 3 132
180 Silk ( Benang Bedah Sutera ) No. 3/0 Sak 0 0 0 0 0
181 Silver Amalgam Serbuk 65 - 75 % Btl 0 0 0 0 0
182 Simvastatin 10 Mg Tab 0 1500 1500 210 1290
183 Simvastatin 20 Mg Tab 0 0 0 0 0
184 Semen Seng Fosfat Serbuk & Cairan Btl 0 0 0 0 0
185 Sulfadimidin 500 mg Tab 0 0 0 0 0
186 Sucralfat Suspensi Btl 0 0 0 0 0
187 Tetrasiklin Hcl 250 mg Kaps 0 0 0 0 0
188 Tetrasiklin Hcl 500 mg Kaps 0 0 0 0 0
189 Thiamfenikol 500 mg Kaps 0 0 0 0 0
190 Tiamin Hcl ( Vit. B 1 ) 50 mg Tab 800 500 1300 500 800
191 Tiamin Hcl ( Vit. B 1 ) Inj. 100 mg / 1 ml Amp 0 0 0 0 0
192 Tab.Tambah Darah ( Fe ) Tab 0 0 0 0 0
193 Tramadol Kaps 0 0 0 0 0
194 Vaksin Anti Rabies (VAR) Kuur 0 0 0 0 0
195 Vitamin B. Kompleks Tab 3000 3000 6000 1600 4400
196 Larutan Hc. 0,1 N Btl 0 0 0 0 0
197 Larutan Gimsa 100 ml Btl 0 0 0 0 0
198 Larutan Carbol Fuksin 0,3 % Btl 0 0 0 0 0
199 Larutan Turk 100 ml Btl 0 0 0 0 0
200 Larutan Benedict Btl 0 0 0 0 0
201 Larutan Etanol Asam 3 % Btl 0 0 0 0 0
202 Larutan Metilen Biru 0,3 % Btl 0 0 0 0 0
203 Larutan Asam Sulfosalisilat Btl 0 0 0 0 0
204 Larutan Hayyam Btl 0 0 0 0 0
205 Larutan Metanol Btl 0 0 0 0 0
206 Larutan Xilen 100 ml Btl 0 0 0 0 0
207 Larutan Oil Emersi Btl 0 0 0 0 0
208 Larutan Eosin Btl 0 0 0 0 0
209 zink 20 mg Tab 0 500 500 100 400
210 MDT Paket 0 0 0 0 0
211 Vidabion Tab 6000 6000 12000 2700 9300
212 Bisacodyl Tab Tab 90 0 90 0 90
213 Bisoprolol 5 Mg Tab 0 0 0 0 0
214 Ketoprofen Suppositoria Supp 20 0 20 0 20
215 Neo Protifed Tab 0 0 0 0 0
216 Renalyte Btl 0 0 0 0 0
217 Salep Bioplasenton Tube 0 0 0 0 0
218 Scopma Plus Tab 0 0 0 0 0
219 Spironolakton 25 mg Tab 0 0 0 0 0
220 Tilomix Tab 0 0 0 0 0
221 Valsartan Tab 0 0 0 0 0
222 Alat Suntik Sekali Pakai 3 ml Pcs 0 700 700 200 500
223 Alat Suntik Sekali Pakai 5 ml Pcs 0 0 0 0 0
224 Alat Suntik Sekali Pakai 1 Ml Tab 300 0 300 0 300
225 Abbocath No. 18 / Intra Vena Catheter Pcs 40 0 40 20 20
226 Abbocath No. 20 / Intra Vena Catheter Pcs 20 50 70 30 40
227 Abbocath No. 24 / Intra Vena Catheter Pcs 0 0 0 0 0
228 Aqua Pro Inj. Steril Bebas Pirogen 20 ml Vial 26 0 26 8 18
229 Aquadest Steril 1000 ml Btl 0 0 0 0 0
230 Bisturi No. 11 Pcs 100 0 100 0 100
231 Cat Gut / Benang Bedah No.3/0 Pcs 23 0 23 5 18
232 Etakridina Larutan 0,1 % Rivanol Btl 0 0 0 0 0
233 Etanol 70 % / 1 L Btl 5 0 5 2 3
234 Etil Klorida Semprot Btl 2 0 2 1 1
235 Handscun Steril Psg 150 250 400 150 250
236 Handscun Non Steril Psg 1000 1000 2000 400 1600
237 Infus Set Anak Pcs 0 0 0 0 0
238 Infus Set Dewasa Pcs 40 0 40 0 40
239 Jarum Jahit ( Bedah ) No. 7 s/d 16 Set 0 0 0 Err:522 Err:522
240 Kapas Pembalut 250 gr Rol 24 0 24 2 22
241 Kasa Steril 16 X 16 Dos 5 100 105 20 85
242 Kasa Kompres Steril 40 X 40 Bks 0 0 0 0 0
243 Kasa Pembalut 2 X 80 cm Rol 0 0 0 0 0
244 Kasa Pembalut 36 X 80 cm Rol 3 0 3 1 2
245 Kasa Pembalut Hidrofil 4 X 3 cm Rol 0 0 0 0 0
246 Kasa Pembalut Hidrofil 4 X 15 cm Rol 0 0 0 0 0
247 Masker Jilbab - Earloop Plus Pcs 150 1500 1650 650 1000
248 Natrium Klorida Lar. Infus 0,9 % Steril Btl 0 100 100 21 79
249 Needle / Naald No.23 G Pcs 0 0 0 0 0
250 Plester 5 Yard X 2 Inch Rol 2 0 2 0 2
251 Spon Gelatin Pcs 0 0 0 Err:522 Err:522
252 Wing needle / Scalp Vein Set Pcs 0 0 0 Err:522 Err:522
253 Yudium Povidon Lar. 10 % / 30 ml Btl 0 0 0 Err:522 Err:522
254 Yudium Povidon Lar. 10 % / 60 ml Btl 0 0 0 Err:522 Err:522
255 Yudium Povidon Lar. 10 % / 300 ml Btl 0 0 0 Err:522 Err:522
256 Dispo 0,05 ml Pcs 0 0 0 Err:522 Err:522
257 Dispo 0,5 ml Pcs 0 0 0 Err:522 Err:522
258 Umblical Cord Clem Pcs 49 0 49 4 45
259 Blood Lancet Pcs 0 10 10 1 9
260 Alkohol Swab Pcs 800 0 800 300 500
261 Dermafix 10 x 8 cm Pcs 0 0 0 0 0
262 Dermafix 10 x 20 cm Pcs 0 0 0 0 0
263 Plester Cerplast Aerofilm Pcs 0 0 0 0 0
264 Strip HCG Btl 0 0 0 0 0
265 Strip Glukosa Benechek Btl 0 0 0 0 0
266 Strip Cholestrol Benechek Btl 0 0 0 0 0
267 Strip Uric Acid Benechek Btl 0 0 0 0 0
268 Pot Sputum Pot 0 0 0 0 0
269 Pot Urine Pot 0 0 0 0 0
270 Tabung EDTA Pcs 0 0 0 0 0
271 Strip Urine Btl 0 0 0 0 0
272 Rapid HBSag Paket 0 0 0 0 0
273 Reagen Golongan Darah Paket 0 0 0 0 0
274 Reagen Diluent Btl 0 0 0 0 0
275 Reagen Lyse Btl 0 0 0 0 0
276 Reagen Zheelnelsen Btl 0 0 0 0 0
277 Masker N-95 Pcs 0 0 0 0 0
278 Objek Glas Pcs 0 0 0 0 0
279 Eter Alkohol Btl 0 0 0 0 0
280 Rapid HIV Paket 2 1 3 3 0
281 Rapid Sypilis Paket 0 0 0 0 0
282 My Jelly Btl 2 0 2 0 2
283 Safety Box Box 0 0 0 0 0
284 Vaksin BCG Vial 0 25 25 0 25
285 Vaksin Polio Vial 0 0 0 Err:522 Err:522
286 Vaksin TD Vial 0 0 0 Err:522 Err:522
287 Vaksin WP Vial 0 0 0 Err:522 Err:522
288 Pelarut BCG Btl 0 0 0 Err:522 Err:522
289 Vaksin IVP Vial 0 0 0 Err:522 Err:522
290 Vaksin DT Box 0 0 0 Err:522 Err:522
291 Vaksin DPT-Hib Vial 0 30 30 0 30
292 Campak MR Vial 0 0 0 Err:522 Err:522
293 Polio Tetes Vial 0 0 0 Err:522 Err:522
294 Vaksni HBSag Vial 0 0 0 0 0

UMUM ASKES JUMLAH

TIDAK
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN

KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt

NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003
PERMINTAAN OBAT (LPLPO)

STOK PEMBERIAN
PERMINTAAN
OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

9 10 12 13 15 16 17
600 400
900 0
0 100
0 0
0 0
0 0
2700 0
0 100
450 300
750 0
0 0
0 0
3600 1000
225 150
0 0
0 0
0 0
0 0
0 0
0 0
1500 0
0 200
0 0
675 200
30 30
0 0
0 100
0 0
0 0
3 5
0 25
0 0
0 0
 0 0
0 0
0 100
0 100
0 0
600 0
0 0
225 0
0 0
0 500
15 0
15 20
0 0
0 0
51 0
900 0
0 0
Err:522 0
Err:522 0
Err:522 0
0 0
3 0
0 0
0 0
0 0
750 500
0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
Err:522 10
Err:522 0
Err:522 0
Err:522 0
Err:522 0
0 0
0 0
0 0
300 100
 0 10
0 0
150 100
0 0
0 0
0 48
0 0
750 0
0 0
0 0
0 0
0 0
30 20
0 0
0 0
0 0
0 0
36 0
0 0
2250 0
0 0
0 0
0 0
450 200
0 0
0 0
0 0
0 0
0 0
0 0
2850 0
0 0
0 0
37.5 0
0 0
0 0
0 0
0 0
0 0
0 0
18 0
0 0
0 0
 0 30
0 150
225 100
300 0
150 500
0 0
300 0
36 0
0 0
0 0
0 5
0 1000
0 0
0 0
0 0
0 1000
0 100
0 0
0 0
0 0
0 0
7.5 20
0 0
0 0
0 100
0 0
300 0
300 0
1950 0
360 90
0 10
139.5 0
0 0
3600 1000
18 0
0 5
0 0
150 0
0 0
0 500
150 0
0 0
0 0
 0 500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
7.5 0
0 0
0 0
3 10
0 0
300 0
4.5 0
0 0
0 0
315 0
0 500
0 0
0 0
0 25
0 0
0 0
0 0
750 100
0 0
0 0
0 0
0 0
2400 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
150 0
0 0
4050 0
0 0
0 0
0 0
0 300
0 0
0 10
0 500
0 0
0 300
0 0
300 0
0 0
0 0
30 20
45 20
0 50
12 12
0 0
0 0
7.5 0
0 0
3 2
1.5 2
225 0
600 0
0 0
0 0
0 0
3 0
30 0
0 0
0 0
1.5 0
0 0
0 0
975 50
31.5 0
0 0
0 10
Err:522 0
Err:522 0
Err:522 5
Err:522 5
Err:522 0
Err:522 0
Err:522 0
6 0
1.5 0
450 200
0 0
0 0
0 0
0 0
0 20
0 20
0 0
0 50
0 0
0 0
0 0
0 4
0 1
0 0
0 0
0 0
0 0
0 0
0 0
4.5 3
0 3
0 0
0 0
0 20
Err:522 Err:522
Err:522 Err:522
Err:522 Err:522
Err:522 Err:522
Err:522 Err:522
Err:522 Err:522
0 30
Err:522 Err:522
Err:522 30
 0 2

Gorontalo. ………………………2019
YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA PUSKESMAS PENANGGUNG JAWAB APOTEK

dr. AINSYAH HARUN LAYLA RIZKY AMALIA GANI S,FARM.,APT

NIP. 19820811 201001 2 004 SIPA. 19930321/SIPA_13.71/II/2019
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : JANUARI 2019
PERMINTAAN BULAN / PERIODE : FEBRUARI 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Diazepam injeksi Amp 0 0
2 Diazepam 2 mg Tab 444 444 173 271
3 Diazepam 5 mg Tab 0 0 100
4 Haloperidol 0,5 Mg Tab 0 0
5 Haloperidol 1,5 Mg Tab 0 0 200
6 Haloperidol 5 Mg Tab 0 0
7 Klorpromazin Injeksi 5 mg / 2 ml Amp 0 0
8 Klorpromazin 25 mg Tab 0 0
9 Klorpromazin 100 mg Tab 0 0
10 Triheksifenidil Hcl 2 mg Tab 0 0 200
11 Risperidon Tab 0 0
12 Sikzonate Injeksi Amp 20 20 40 10 30

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 2019
G MENERIMA
USKESMAS SIPATANA

SULEMAN, S.Farm
0527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : FEBRUARI 2019
PERMINTAAN BULAN / PERIODE : MARET 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Diazepam injeksi Amp 25 25 1 24
2 Diazepam 2 mg Tab 271 271 96 175 200
3 Diazepam 5 mg Tab 0 0
4 Haloperidol 0,5 Mg Tab 0 0
5 Haloperidol 1,5 Mg Tab 200 200 50 150
6 Haloperidol 5 Mg Tab 0 0
7 Klorpromazin Injeksi 5 mg / 2 ml Amp 0 0
8 Klorpromazin 25 mg Tab 0 0
9 Klorpromazin 100 mg Tab 0 0 200
10 Triheksifenidil Hcl 2 mg Tab 200 200 150 50 200
11 Risperidon Tab 0 0 300
12 Sikzonate Injeksi Amp 30 30 30

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 2019
G MENERIMA
SKESMAS SIPATANA

SULEMAN, S.Farm
0527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : MARET 2019
PERMINTAAN BULAN / PERIODE : APRIL 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN PENERIMAAN PERSEDIAN PEMAKAIAN PERMINTAAN
AWAL STOK OPTIMUM
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Diazepam injeksi Amp 24 24 24
2 Diazepam 2 mg Tab 175 175 118 57 200
3 Diazepam 5 mg Tab 0 0
4 Haloperidol 0,5 Mg Tab 0 0
5 Haloperidol 1,5 Mg Tab 150 150 30 120
6 Haloperidol 5 Mg Tab 0 0
7 Klorpromazin Injeksi 5 mg / 2 ml Amp 0 0
8 Klorpromazin 25 mg Tab 0 0
9 Klorpromazin 100 mg Tab 200 200 15 185
10 Triheksifenidil Hcl 2 mg Tab 50 200 250 75 175
11 Risperidon Tab 300 300 125 175 100
12 Sikzonate Injeksi Amp 30 30 30

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
2019
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : APRIL 2019
PERMINTAAN BULAN / PERIODE : MEI 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN
AWAL
PENERIMAAN PERSEDIAN PEMAKAIAN
STOK OPTIMUM
PERMINTAAN

DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Diazepam injeksi Amp 24 24 24
2 Diazepam 2 mg Tab 57 57 57
3 Diazepam 5 mg Tab 0 0
4 Haloperidol 0,5 Mg Tab 0 0 200
5 Haloperidol 1,5 Mg Tab 120 120 30 90 200
6 Haloperidol 5 Mg Tab 0 0
7 Klorpromazin Injeksi 5 mg / 2 ml Amp 0 0
8 Klorpromazin 25 mg Tab 0 0
9 Klorpromazin 100 mg Tab 185 185 5 180
10 Triheksifenidil Hcl 2 mg Tab 175 175 25 150 400
11 Risperidon Tab 175 175 5 170
12 Sikzonate Injeksi Amp 30 30 15 15 25

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 2019
G MENERIMA
USKESMAS SIPATANA

SULEMAN, S.Farm
0527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : JUNI 2019
PERMINTAAN BULAN / PERIODE : JULI 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN
AWAL
PENERIMAAN PERSEDIAN PEMAKAIAN
STOK OPTIMUM
PERMINTAAN

DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Diazepam injeksi Amp 24 24 24
2 Diazepam 2 mg Tab 57 500 557 339 218
3 Diazepam 5 mg Tab 0 0
4 Haloperidol 0,5 Mg Tab 400 400 20 380
5 Haloperidol 1,5 Mg Tab 90 90 80 10 200
6 Haloperidol 5 Mg Tab 0 0
7 Klorpromazin Injeksi 5 mg / 2 ml Amp 0 0
8 Klorpromazin 25 mg Tab 0 0
9 Klorpromazin 100 mg Tab 180 180 180
10 Triheksifenidil Hcl 2 mg Tab 150 400 550 270 280 200
11 Risperidon Tab 170 170 170 0 300
12 Sikzonate Injeksi Amp 15 25 40 10 30

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : JULI 2019
PERMINTAAN BULAN / PERIODE : AGUSTUS 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN
AWAL
PENERIMAAN PERSEDIAN PEMAKAIAN
STOK OPTIMUM
PERMINTAAN
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Diazepam injeksi Amp 24 24 24
2 Diazepam 2 mg Tab 218 218 115 103
3 Diazepam 5 mg Tab 0 0
4 Haloperidol 0,5 Mg Tab 380 380 75 305
5 Haloperidol 1,5 Mg Tab 10 10 10 0 200
6 Haloperidol 5 Mg Tab 0 0
7 Klorpromazin Injeksi 5 mg / 2 ml Amp 0 0
8 Klorpromazin 25 mg Tab 0 0
9 Klorpromazin 100 mg Tab 180 180 180
10 Triheksifenidil Hcl 2 mg Tab 280 200 480 58 422 200
11 Risperidon Tab 0 300 300 53 247 300
12 Sikzonate Injeksi Amp 30 30 10 20

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : AGUSTUS 2019
PERMINTAAN BULAN / PERIODE : SEPTEMBER 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN
AWAL
PENERIMAAN PERSEDIAN PEMAKAIAN
STOK OPTIMUM
PERMINTAAN
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Diazepam injeksi Amp 24 24 24
2 Diazepam 2 mg Tab 103 500 603 166 437
3 Diazepam 5 mg Tab 0 0
4 Haloperidol 0,5 Mg Tab 305 305 108 197
5 Haloperidol 1,5 Mg Tab 10 10 10 0 200
6 Haloperidol 5 Mg Tab 0 0
7 Klorpromazin Injeksi 5 mg / 2 ml Amp 0 0
8 Klorpromazin 25 mg Tab 0 0
9 Klorpromazin 100 mg Tab 180 180 180
10 Triheksifenidil Hcl 2 mg Tab 480 200 680 120 560
11 Risperidon Tab 247 300 547 60 487
12 Sikzonate Injeksi Amp 20 20 15 5 15

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : SIPATANA
ALAMAT : JL. TONDANO KEL. BULOTADAA BARAT
PELAPORAN BULAN / PERIODE : OKTOBER 2019
PERMINTAAN BULAN / PERIODE : NOVEMBER 2019

STOK SISA STOK PEMBERIAN

NO NAMA OBAT / ABJAD SATUAN
AWAL
PENERIMAAN PERSEDIAN PEMAKAIAN
STOK OPTIMUM
PERMINTAAN
DAU/DAK BUFFER PROGRAM LAIN-LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 12 13 15 16 17
1 Diazepam injeksi Amp
2 Diazepam 2 mg Tab
3 Diazepam 5 mg Tab
4 Haloperidol 0,5 Mg Tab
5 Haloperidol 1,5 Mg Tab
6 Haloperidol 5 Mg Tab
7 Klorpromazin Injeksi 5 mg / 2 ml Amp
8 Klorpromazin 25 mg Tab
9 Klorpromazin 100 mg Tab
10 Triheksifenidil Hcl 2 mg Tab
11 Risperidon Tab
12 Sikzonate Injeksi Amp

GORONTALO, 2019
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MEMINTA / MELAPORKAN YANG MENERIMA
KEPALA DINKES KOTA GORONTALO KEPALA INSTALASI FARMASI KEPALA PUSKESMAS PETUGAS PUSKESMAS SIPATANA

dr. NUR ALBAR, Sp.PD.FINASIM AMELIA P. DATUNGSOLANG, S.Si, Apt dr. AINSYAH HARUN FADLUN SULEMAN, S.Farm
NIP. 19600907 198901 2 001 NIP. 198501102008 03 2 003 NIP. 19820811 201001 2 004 NIP. 19820527 200901 2 003