Lplpo 2019

LAPORAN PEMAKAIAN DAN LEMBAR P
PUSKESMAS : TROSOBO
KECAMATAN :TAMAN
KABUPATEN : SIDOARJO
PELAPORAN PERIODE JANUARI 2019
PERMINTAAN PERIODE : ……………………………………..
NO NAMA OBAT SATUAN STOK AWAL
1 2 3 4
(1a) ANALG,ANTIP,AN.INFL NON NARKOTIK

1 Analsik tab Tablet 2,282
2 Antalgin 500 mg tab Tablet 1,560
3 Asam Mefenamat 500 mg tab Tablet 35,404
4 Asetosal 100 mg tab Tablet -
5 Aspilets 80 mg tab Tablet 3,741
6 Diklofenak Kalium 50 mg tab Tablet -
7 Diklofenak Na. 50 mg tab Tablet 16,902
8 Eprinoc tab Tablet -
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 430
10 Ibuprofen 200 mg tab Tablet -
11 Ibuprofen 400 mg tab Tablet 4,660
12 Meloxicam 15 mg supp Suppositoria 70
13 Meloxicam 15 mg tab Tablet -
14 Meloxicam 7,5 mg tab Tablet 266
15 Metoklopramid 10 mg Tablet 1,570
16 Metoklopramid inj. 5 mg/ml Ampul 20
17 Molakrim krim Tube 30 g 10
18 Nonflamin tab Tablet -
19 Parasetamol 500 mg tab Tablet 79,795
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 170
21 Piroksikam 10 mg tab Tablet 3,980
22 Piroksikam 20 mg tab Tablet -
23 Profenid supp Suppositoria 25
24 Proris supp Suppositoria 146
25 Santagesic inj. Ampul
26 Tramadol injeksi 50 mg/ml Ampul
27 Tramadol kap 50 mg Tablet
(1b) ANALGETIK NARKOTIK
1 Pethidin HCl 50 mg/ml inj Ampul
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 19,647
(2) ANESTESI LOKAL

1 Etil Klorida semprot Botol 100 ml 5
2 Ketamin / Ketalar inj. 100 mg/ml Vial 10 ml -
3 Lidokain inj 2% (HCl) / 2 ml Ampul 450
4 Lidokain komb inj / 2 ml Ampul 920
5 Xylocain spray Botol 50 ml
(3) AN.EPILEPSI, AN.KONV, AN.ASIETAS, SEDATIV, HIPNOTIK, AN.PSIKOTIK

1 Alprazolam 0,5 mg Tablet 815
2 Diazepam 2 mg Tablet 1,389
3 Diazepam 5 mg Tablet -
4 Diazepam inj. 5 mg/ 2 ml Ampul -
5 Fenitoin kapsul 100 mg Kapsu; 1,240
6 Fenobarbital 100 mg Tablet -
8 Fenobarbital inj. 50 mg/ml Ampul 120
9 Haloperidol 0.5 mg tab Tablet 3,775
10 Haloperidol 1,5 mg Tablet -
11 Haloperidol inj 50 mg/ml Ampul -
12 Klobazam 10 mg tab Tablet -
13 Klorpromazin HCl 100 mg tab Tablet -
14 Klorpromazin HCl inj 25 mg/ml Ampul -
15 Trifluoperazine 5 mg tab Tablet 480
16 Stesolid rectal 5 mg Tube 8
(4) ANTI PARKINSON

1 Levopar tab Tablet
2 Triheksifenidil 2 mg Tablet 594
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 761
2 Deproz 20 mg Tablet
(6) ANTI MIGREN

1 Anti Migren (Komb. Ergot+Kafein) Tablet 470
2 Betahistin Mesilat 6 mg Tablet
(7) ANTI ANGINA - ANTI ARITMIA

1 Isosorbit Dinitrat 5 mg Tablet 205
2 Nifedipin 10 mg Tablet
3 Nifedipin GITS (Adalat Oros) 30 mg Tablet
4 Propanolol 10 mg Tablet
(8) ANTI HIPERTENSI-DIURETIKA
1 Amlodipin 5 mg Tablet 6,760
2 Amlodipin 10 mg Tablet 900
3 Bisoprolol Fumarat 5 mg Tablet 7,610
4 Captopril 25 mg Tablet 4,180
5 Furosemid 40 mg Tablet 730
6 Furosemid inj. Ampul -
7 H.C.T 25 mg Tablet 5,440
8 Lisinopril 10 mg Tablet
9 Valsartan tab 80 mg / Diovan 80 Tablet
(9) GLUKOSIDA JANTUNG

1 Digoksin 0,25 mg Tablet 500
2 Verapamil 80 mg Tablet
(10) OBAT PD SHOK-ANTI ASMA KORTIKOSTEROID

1 Aminofilin 200 mg Tablet 538
2 Aminofilin inj 24 mg Ampul -
3 Bisolvon solution 10 mg/5 ml Botol 50 ml -
4 Bisolvon injeksi 2 mg/ml Ampul -
5 Bricasma inj 0,5 mg/ml Ampul -
6 Deksamethason 0,5 mg Tablet 50,759
7 Deksamethason inj 5 mg/ml Ampul 410
8 Efedrin HCl 25 mg Tablet -
9 Epinefrin inj. Ampul 415
10 Methylprednisolon 4 mg Tablet 10,626
11 Prednison 5 mg Tablet -
12 Salbutamol 2 mg Tablet 525
13 Salbutamol sirup (Astharol) Botol 60 ml -
14 Ventolin Nebulizer Ampul 380
(11) ANTI TUSIF

1 Dexmolex sirup Botol 100 ml 60
2 Kodein 10 mg Tablet 1,154
3 Sanadryl DMP sirup Botol 60 ml -
4 Tuzalos tab Tablet 1,602
-
(12) EKSPEKTORAN -
1 Ambroxol HCl 30 mg Tablet 3,624
2 Ambroxol syrup Botol 60 ml 101
3 Gliseril Guayakolat 100 mg Tablet 2,677
4 Hustab sirup Botol 60 ml -
5 Hustab tab Tablet 1,200
6 OBH Plus Anak Botol 60 ml -
7 OBH Plus Dewasa Botol 60 ml 190
8 Sanadryl Expectorant Botol 60 ml 24
-
(13) ANTI INFLUENZA -
1 Alpara tab Tablet -
2 Alpara sirup Botol 60 ml -
3 Protexinal tab Tablet 7,513
4 Protexinal sirup Botol 60 ml 60
5 Tremenza tab Tablet 1,893
(14) ANTASIDA
1 Antasida DOEN I tab Tablet 22,743
2 Antasida DOEN II sirup Botol 60 ml 92
3 Cimetidin 200 mg Tablet 2,915
4 Cytotec Tablet -
5 Famotidine 20 mg Tablet -
6 Omeprazole kap 20 mg Tablet 3,410
7 Ranitidin tab 150 mg Tablet 343
8 Ranitidin inj 25 mg/2 ml Ampul 160
9 Sanmag suspensi Botol 120 ml -
10 Sanmag tab Tablet 508
(15) OBAT DIARE-KESEIMBANGAN CAIRAN ELEKTROLIT

1 Asering infus Botol 500 ml
2 D5 + 1/2 NS Botol 500 ml
3 D5 + 1/4 NS Botol 500 ml
4 Dehaf Sachet
5 KAEN 3A Botol 500 ml
6 KAEN 3B Botol 500 ml
7 L-Bio Sachet
8 Loperamide Tablet
9 Molagit tab Tablet
10 Na. Klorida 0,9% infus Botol 500 ml 245
11 Na. Klorida 0,9% piggy bag Botol 100 ml -
12 Neo Kaolana suspensi Botol 60 ml -
13 New Diaform Tablet 4,574
14 Oralit 200 ml Sachet 354
15 Ringer Laktat infus Botol 500 ml 10
16 Zink tab dispersible 20 mg Tablet 591
17 Zink sirup 20 mg/5 ml Botol 60 ml
(16) LAKSAN
1 Bicolax tab 5 mg Tablet -
2 Dulcolax supp 5 mg Suppositoria 8
3 Stolax supp 10 mg Suppositoria 43
(17) ANTI SPASMODIK
1 Atropin Sulfat inj 0,25 mg/ml Ampul
2 Braxidin tab Tablet
3 Buscopan inj Ampul 7
4 Buscopan tab Tablet 291
5 Buscopan plus Tablet
6 Ekstrak Belladona 10 mg Tablet
(18) ANTI HISTAMIN

1 Ceterizine sirup Botol 60 ml
2 Cetirizine tab 10 mg Tablet 2,955
3 Difenhidramin inj Ampul 90
4 Klorfeniramin Maleat 4 mg Tablet 58,852
5 Loratadine 10 mg Tablet 1,464
(19) LARUTAN NUTRISI

1 Aminofluid Softbag 500 ml
2 Glukose 10% infus 500 ml Botol 500 ml 20
3 Glukose 40% inj 25 ml Ampul 76
(20) TIROID ANTAGONIS

1 Propiltiourasil 100 mg Tablet
(21) ANTI DIABETIK ORAL

1 Glibenklamid 5 mg Tablet 8,480
2 Glimipiride 2 mg Tablet 15,460
3 Metformin tab 500 mg Tablet 21,669
(22) ANTI DIABETIK PARENTERAL

1 Apidra Solostar 100 IU/ml Pen
2 Lantus Solostar 100 IU/ml Pen
(23) VITAMIN DAN MINERAL

1 Anemolat tab / Asam folat tab Tablet
2 Asam Askorbat 50 mg Tablet 1,001
3 Becom C kaplet Kaplet 178
4 Calcii Gluconas inj Ampul 48
5 Caldece tab effervecent Tablet -
6 Cavit D3 Tablet 430
7 Elkana sirup Botol 60 ml -
8 Elkana tab Tablet -
9 Glucosamin tab Tablet 288
10 Hepagard tab Tablet 560
11 Kalsium Laktat 500 mg Tablet 23,728
12 Neurosanbe 5000 Tablet -
13 Neurosanbe inj Ampul 110
14 Neurosanbe Plus Tablet 171
15 Neurosanbe tab Tablet -
16 Osteotin tab Tablet 184
17 Pharmaton Vit Tablet -
18 Piridoksin 10 mg (Vit. B6) Tablet 40,283
19 Procurma Plus sirup Botol 60 ml -
20 Santa E 200 mg tablet hisap Tablet 100
21 Sianokobalamin tab Tablet 9,826
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul 84
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 14,632
24 Vit. B kompleks Tablet 24,539
(24) ANTI BAKTERI SISTEMIK, ANTISEPTIK SAL.KEMIH

1 Amoksisilin 500 mg Tablet 13,263
2 Amoksisilin inj. Ampul -
3 Amoksisilin sirup kering Botol 60 ml 496
4 Ampisilin 500 mg Kaplet
5 Ampisilin inj. Ampul
6 Ampisilin sirup kering Botol 60 ml
7 Azitomisin 250 mg kaplet Kaplet
8 Biothicol sirup kering Botol 60 ml 22
9 Cefadroxil 500 mg Kaplet 7,134
10 Cefadroxil sirup kering Botol 60 ml
11 Cefalexin 500 mg Tablet
12 Cefixime kapsul 100 mg Kapsul 3,045
13 Cefixime sirup Botol 30 ml
14 Cefotaxime injeksi 1 g Ampul 60
15 Ceftriaxone injeksi 1 g Ampul -
16 Ciprofloxacin 500 mg Tablet 3,296
17 Claneksi sirup Tablet
18 Co-Amoksiklav Tablet
19 Colsancetine inj Ampul
20 Eritromisin 250 mg Tablet
21 Eritromisin 500 mg Kaplet 282
22 Eritromisin sirup kering Botol 60 ml 103
23 Gentamisin inj. 40 mg/ml Ampul -
24 Klindamisin 300 mg Kapsul 460
25 Kloramfenikol 250 mg Kapsul
26 Kloramfenikol sirup Botol 60 ml 200
27 Kotrimoksasol 480 mg Tablet 27,374
28 Kotrimoksasol suspensi Botol 60 ml 206
29 Levofloksasin 500 mg Tablet 499
30 Linkomisin kapsul 500 mg Tablet
31 Ofloxacin 400 mg Tablet
32 Spyramisin 500 mg Tablet 1,460
33 Tetrasiklin 500 mg Tablet
34 Thiamphenikol 500 mg Tablet 2,219
(25) ANTI VIRUS

1 Acyclovir 200 mg tab Tablet
2 Acyclovir 400 mg tab Tablet 5,501
3 Acyclovir cream Tube 48
(26) ANTI FUNGI

1 Griseofulvin 125 mg Tablet 505
2 Ketokonazol 200 mg Tablet 73
3 Nistatin 100.000 IU tab.vag Tablet 536
4 Nistatin 500.000 IU tab Tablet
(27) ANTI TUBERKULOSIS

1 Etambutol 500 mg tab salut Tablet
2 I.N.H 100 mg Tablet
4 Kanamycin inj 1 g Vial
5 OAT FDC Kategori 1 Paket
7 OAT FDC Kategori Anak Paket
8 OAT FDC Sisipan Paket
9 Pyrazinamid 500 mg Tablet
10 Streptomycin S inj 1 g Vial
11 Rifampisin 450 mg Tablet
(28) ANTI SEPTIK, DESINFEKTAN

1 Etakridina larutan 0,1% Botol 300 ml
2 Etanol 70% Botol 100 ml 41
3 H2O2 3% Botol 1000 ml 28
4 Klorin Botol 500 ml 22
5 Lisol 50% Botol 1000 ml 14
6 Paraformaldehid 1 g Tablet -
7 Povidon Iodida larutan 10% Botol 300 ml 8
8 Softa-Man Botol 500 ml 15
9 Softaskin Botol 500 ml 32
(29) ANTELMENTIK
1 Albendazol 400 mg Tablet
2 Mebendazol 100 mg Tablet
3 Mebendazol sirup 30 ml Botol 30 ml
4 Pirantel 125 mg Tablet
(30) ANTI AMUBIASIS

1 Metronidazol 500 mg Tablet
2 Metronidazol infus Botol 100 ml
(31) OBAT YG MEMPENGARUHI DARAH, ANTI ANEMIA

1 Besi (II) Sulfat tab Sachet 62,456
2 Besi sirup Botol 150 ml
3 Sianokobalamin inj (Vit. B 12) Ampul
4 Vitalex kap Kaplet
(32) HEMOSTATIK
1 Adona AC-17 10 mg Tablet
2 Adona inj 5 ml Ampul
3 Fitomenadion 10 mg (Vit. K) Tablet 1,270
4 Fitomenadion inj (Vit. K) Ampul 308
5 Magnesium Sulfat 20% Vial 9
6 Magnesium Sulfat 40% Vial
7 Plasminex inj. Ampul
8 Plasminex tab Tablet
9 Vit. K infant inj Ampul
(33) PRODUK DAN SUBTITUEN PLASMA

1 Widahes infus Botol 500 ml
(34) SERUM
1 ABU I Polivalen 5 ml Vial
2 ATS 1.500 IU Ampul 6
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 990
2 Metilergometrin inj Ampul 100
3 Oksitosin inj 10 IU/ml-1 ml Ampul 78
(36) RELAKSAN UTERUS

1 Papaverin 40 mg Tablet 239
(37) ANTI INFLAMASI SALEP

1 Betametason krem 0,1% Tube 480
2 Betason N krem Tube -
3 Hidrokortison krem 2,5% Tube 160
(38) PERANGSANG JARINGAN GRANULASI

1 Bioplacenton gel Tube 22
2 Prontosan Solution Botol 350 ml
3 Prontosan Gel Botol 30 ml
(39) ANTI BAKTERI

1 Anti Bakteri DOEN s.k Tube 28
2 Gentamisin salep kulit 0,1% Tube 109
3 Kloramfekort H krem Tube 120
4 Oksitetrasiklin HCl sk 3% Tube 75
-
(40) ANTI FUNGI SALEP -
1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 300
2 Ketokonazol cream 2% Tube 210
3 Miconazol cream 2% Tube 3
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 49
2 Scabicide Tube 10
(42) ANTI SEPTIK

1 P.K serbuk 5 gram Botol
(43) LAIN-LAIN OBAT KULIT

1 Ikhtamol salep 15 g Pot 93
2 Salisil bedak 2% Kotak 28
3 Salisil spiritus Botol
(44) ANTI SISTEMIK MATA

1 Berry vision tab Tablet
2 Retinol 100.000 IU (Vit. A) Kapsul
3 Retinol 200.000 IU Kapsul
(45) ANESTESI LOKAL MATA

1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml
(46) ANTI INFEKSI MATA

1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 67
2 Kloramfenikol 0,5% t.m Botol 5 ml 297
3 Kloramfenikol 1% s.m Tube 5 g 78
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 156
5 Polidemisin eye drop Botol 5 ml
6 Sulfasetamid Natrium 15% t.m Botol 5 ml
(47) LAIN-LAIN OBAT MATA

1 Catalin Opth Botol 15 ml
2 Cendolyteers tetes mata Botol 5 ml 232
(48) ANTI INFEKSI THT

1 Kloramfenikol 3% t.t Botol 32
(49) LAIN-LAIN INFEKSI THT

1 Fenol gliserol 10% t.t Botol 70
(50) ANTI FILARIASIS

1 Dietilkarbamasin Sitrat 100 mg Tablet
(51) ANTI HEMOROID

1 Anti Hemoroid supp Suppositoria 522
2 Anusol Suppositoria
3 Borraginol N Salep Tube 15 g
4 Borraginol N Supp Suppositoria
5 Hemorogard tab Tablet
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 3,948
2 Domperidon sirup Botol 60 ml 173
3 Domperidon tab Tablet 5,238
4 Mediamer B6 Tablet -
5 Ondansetron 8 mg tab Tablet 4,628
6 Ondansetron 4 mg/2 ml inj. Ampul 100
(53) ANTI HIPERKOLESTEROLEMIA

1 Gemfibrozil kapsul 300 mg Tablet 545
2 Kalsium Atorvastatin Tablet 7,013
3 Lipitor 20 mg Tablet -
4 Simvastatin tab 10 mg Tablet 4,709
(54) NOOTROPIK
1 Piracetam 400 mg Tablet 980
2 Piracetam inj 1 g/5 ml Ampul
3 Piracetam inj 3 g / 15 ml Ampul
(55) IMMUNDILATOR
1 Imunos sirup Botol 60 ml
2 Imunos tablet Tablet 281
(56) PROGRAM GIZI

1 Biskuit Bungkus
2 Biskuit MP-ASI Bungkus
3 Iodina Test Botol
4 Susu Dancow Bungkus
5 Susu Mineral Mix Bungkus
6 Susu Mom and Me Bungkus
7 Susu Pan-Enteral Bungkus
8 Susu Proten Bungkus
9 Taburia Sachet
10 Zink Sirup Botol 60 ml
(57) PROGRAM P2PL
1 Albendazole 400 mg tablet
2 Box Slide pcs
3 OAT FDC paket
4 OAT FDC Anak paket
5 OAT FDC Kategori II paket
6 Obyek Glass pcs
7 Reagen Intech pcs
8 Reagen Oncoprobe pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs
13 Susu Proten bungkus
(58) PROGRAM GANGGUAN JIWA

1 Alkohol swab pcs
2 Amitriptilin 25 mg tablet
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 15
6 Combipack pcs -
7 Fluconazole 150 mg tablet -
8 Haldol inj. ampul 16
9 Haloperidol 1.5 mg tablet
10 Haloperidol 5 mg tablet
11 Handscoon pcs
12 Holder Prontho pcs
13 Klorpromazin 100 mg tablet
15 Lodomer inj. ampul
16 Mantoux tab tablet
17 Micropipet pcs
18 pH Paper pcs
19 Phenitoin 100 mg tablet
20 Risperidon 2 mg tablet 346
21 SD Reagen Syphillis pcs
22 Tabung Vacutainer Merah pcs
23 Trifluoperazin 5 mg tablet
24 Triheksifenidil 5 mg tablet
(59) OBAT GIGI

1 Alvogyl (Septodont) Botol 10 g 6
2 Caustener rapid Botol 6,5 g 4
3 Cavit (Tumpatan sementara) Set 28
4 Cresophene (Septodont) Botol 7,5 g 12
5 Elite semen Botol 1
6 Estelite Composite Set 3
7 Ectsa gel (Denta merica) Syringe 12 g 9
8 Eugenol Botol 10 ml 29
9 Forinokresol / Formocresol Botol 10 ml -
10 Glass Ionomer Cement (Fuji II LC) Set -
11 Glass Ionomer Cement (Fuji IX) Set 15
12 Kalsium Hidroksida pasta Tube 12
13 Klorfenol Kamfer Mentol (CHKM) Botol 20 ml 4
14 Mumifying pasta Botol 7 g 8
15 Spongostan Pcs 50
16 Te-econom bond Botol 8
17 Temporary Stopping Fletcher Botol 11
18 Tooth Cleansing (Occo) Botol 15 ml 13
19 Vinafluor Tablet 2
(60) OBAT TOPIKAL MULUT

1 Bufacomb Iob (Zenith) Tube
2 Gentian violet 1% Botol 10 ml 43
3 Minosep gargle 0.2% Botol 60 ml 24
4 Polikresulen (Metakresol) Botol 10 ml
(61) BAHAN MEDIS HABIS PAKAI (BMHP)

1 Alat suntik 1xpakai 0.05 ml Pcs
3 Alat suntik 1xpakai 1 ml Pcs 500
4 Alat Suntik 1xpakai 3 ml Pcs 1,400
7 Aqua pro injeksi Vial 40
8 Aquadest steril 500 ml Botol 500 ml 4
9 Blood Lancet Pcs -
10 Blue tape Pcs -
11 Cat-gut dg jarum 2/0 Sachet 10
13 Catton swap Pcs -
14 Cerplast Pcs -
15 Cover glass Pcs -
16 Folley Cath 12 Pcs 20
19 Folley Cath 20 Pcs
21 Gelang Bayi Lahir Pcs
22 Gelang Ibu Melahirkan Pcs
23 Handscoon Panjang Pcs
24 Handscoon uk. L Pcs 4,250
25 Handscoon uk. M Pcs 13,900
26 Handscoon uk. S Pcs -
27 Hipavix 5 x 5 m Rol 5
28 Holder Pronto Pcs -
29 I.V. Catheter 16 Pcs -
31 I.V. Catheter 20 Pcs 225
34 Infusion set anak Pcs 145
35 Infusion set dewasa Pcs 70
36 Jarum jahit (bedah) no. 13 Pcs 36
39 Jarum Jahit (bedah) no. 12 Pcs 88
40 Jarum Suntik no. 25 Pcs 1,250
41 Jarum Vacutainer 21 Pcs
43 Kapas berlemak 500 g Bungkus
44 Kapas pembalut 250 g Bungkus
45 Kasa elastis 3x4 cm Rol
46 Kasa elstis 4x10 cm Rol
47 Kasa kompres 40/40 steril Pcs
48 Kasa Pembalut 1 yard 40m x 80 Rol 49
49 Kasa pembalut 2 m x 80 cm Rol -
50 Kasa pembalut hid 4 x 10 cm Rol 143
52 Kasa Steril 16 x 16 cm Pcs 87
53 Kertas Puyer Pcs 51,000
54 Lomatull Pcs 94
55 Masker Pcs 4,250
56 Masker O2 anak Pcs 20
57 Masker O2 dewasa Pcs 13
58 Mesh 11 Lancip Pcs 410
59 Microburet Pcs -
60 Nasal Canula Anak Pcs 245
61 Nasal Canula Dewasa Pcs 241
62 Needle Novofine Pcs
63 Obyek glass Pcs
64 Pipet thoma Erythrocyt Pcs
65 Pipet thoma Leucocyt Pcs
66 Plester 2.5 cm x 4.5 m Rol 51
67 Plester 7.5 cm x 4.5 m Rol -
68 Pot urine 10 ml Pcs -
69 Sharp Collector Pcs
70 Silk (benang bedah sutra) dg jarum Sachet 45
71 Silk tanpa jarum 2/0 Sachet 24
73 Slim Zuiker Pcs 5
74 Sputum pot Pcs
75 Tab. Kapiler Hematokrit Pcs
76 Tabung Vacutainer Kuning Pcs
77 Tabung Vacutainer Merah Pcs
78 Tabung Vacutainer Ungu Pcs
79 Tissue Lensa Kotak
80 Tranfusion Set Dewasa Pcs
81 Umbilical Pcs
82 Urine Bag Pcs 35
83 White tape Pcs
84 Wing Needle 25 Pcs
86 Yellow tape Pcs
BULAN LB1+BOR SETORAN
JANUARI 2019 3881 28.619.000
Mengetahui :
KEPALA PUSKESMAS TROSOBO
KABUPATEN SIDOARJO
Dr.ARIF RAHMAN NURDIANTO

NIP. 19870416201101 2 007
N DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
DOKUMEN TANGGAL
PUSKESMAS
GFK
PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
5 6 7 8 9
- 2,282 292 1,990

1,600 3,160 1,935 1,225
- 35,404 3,688 31,716
- - - -
- 3,741 34 3,707
- - - -
- 16,902 2,392 14,510
- - - -
- 430 17 413
- - - -
- 4,660 2,304 2,356
- 70 - 70
- - - -
- 266 260 6
- 1,570 - 1,570
- 20 - 20
- 10 10 -
- - - -
- 79,795 4,868 74,927
- 170 93 77
- 3,980 540 3,440
- - - -
- 25 4 21
- 146 11 135
- 19,647 1,115 18,532
- 5 - 5
- - - -
- 450 - 450
- 920 - 920
- 815 64 751
- 1,389 2 1,387
- - - -
- - - -
- 1,240 60 1,180
- - - -
- - - -
- 120 - 120
- 3,775 590 3,185
- - - -
- - - -
- - - -
- - - -
- - - -
- 480 30 450
- 8 8 -
- 594 350 244
- 761 145 616
- 470 20 450
- 205 6 199
- 6,760 1,260 5,500
- 900 200 700
- 7,610 180 7,430
- 4,180 1,025 3,155
- 730 10 720
- - - -
- 5,440 195 5,245
- 500 - 500
- 538 - 538
- - - -
- - - -
- - - -
- - - -
- 50,759 6,858 43,901
- 410 410 -
- - - -
- 415 - 415
- 10,626 255 10,371
- - - -
- 525 475 50
- - - -
- 380 20 360
- 60 - 60
- 1,154 218 936
- - - -
- 1,602 44 1,558
- - - -
- - - -
- 3,624 3,315 309
- 101 11 90
- 2,677 2,677 -
- - - -
- 1,200 366 834
- - - -
- 190 16 174
- 24 - 24
- - - -
- - - -
- - - -
- - - -
- 7,513 1,329 6,184
- 60 - 60
- 1,893 251 1,642
- -
-
- 22,743 4,449 18,294
- 92 24 68
- 2,915 519 2,396
- - - -
- - - -
- 3,410 1,910 1,500
- 343 343 -
- 160 30 130
- - - -
300 808 730 78
- 245 20 225
- - - -
- - - -
- 4,574 1,757 2,817
- 354 5 349
- 10 10 -
- 591 50 541
36 36 16 20
- 8 8 -
- 43 16 27
- 7 2 5
- 291 7 284
- 2,955 1,307 1,648

- 90 90 -
- 58,852 3,340 55,512
- 1,464 194 1,270
- 20 2 18
- 76 6 70
- 35 19 16
- 8,480 450 8,030

- 15,460 1,470 13,990
- 21,669 5,250 16,419
3,000 4,001 3,303 698

- 178 178 -
- 48 - 48
- - - -
- 430 125 305
- - - -
- - - -
- 288 - 288
- 560 - 560
- 23,728 2,515 21,213
- - - -
- 110 - 110
- 171 171 -
- - - -
- 184 24 160
- - - -
- 40,283 1,651 38,632
- - - -
- 100 20 80
- 9,826 1,050 8,776
- 84 84 -
- 14,632 3,410 11,222
- 24,539 6,011 18,528
- 13,263 6,222 7,041

- - - -
- 496 39 457
- 22 - 22
- 7,134 1,919 5,215
- 3,045 1,191 1,854
- 60 - 60
- - - -
- 3,296 810 2,486
- 282 10 272
- 103 - 103
- - - -
- 460 170 290
- 200 - 200
- 27,374 1,260 26,114
- 206 29 177
- 499 50 449
- 1,460 - 1,460
- 2,219 976 1,243
- 5,501 590 4,911

- 48 14 34
- 505 40 465
- 73 40 33
- 536 14 522
- 41 9 32
- 28 - 28
- 22 - 22
- 14 - 14
- - - -
- 8 4 4
- 15 3 12
- 32 5 27
- 62,456 780 61,676
- 1,270 10 1,260
- 308 - 308
- 9 - 9
- 6 4 2
- 990 - 990
- 100 - 100
- 78 - 78
3,000 839 620 219
- 480 44 436
- - - -
- 160 14 146
- 22 4 18
- 28 5 23
- 109 54 55
- 120 - 120
- 75 - 75
- - - -
- - - -
- 300 - 300
- 210 17 193
24 27 20 7
- 49 8 41
- 10 - 10
- 93 1 92
- 28 8 20
- 67 1 66
- 297 29 268
- 78 9 69
- 156 1 155
- 232 6 226
- 32 11 21
- 70 3 67
- 522 29 493
- 3,948 1,100 2,848

- 173 - 173
- 5,238 141 5,097
- - - -
- 4,628 928 3,700
- 100 40 60
- 545 10 535
- 7,013 327 6,686
- - - -
- 4,709 860 3,849
- 980 120 860
- 281 - 281
300 315 70 245
- - - -
- - - -
- 16 - 16
- 346 110 236
- 6 - 6
- 4 - 4
- 28 - 28
- 12 - 12
- 1 - 1
- 3 - 3
- 9 - 9
- 29 - 29
- - - -
- - - -
- 15 - 15
- 12 - 12
- 4 - 4
- 8 - 8
- 50 - 50
- 8 - 8
- 11 - 11
- 13 - 13
- 2 - 2
- 43 8 35
- 24 - 24
- 500 5 495
- 1,400 300 1,100
- 700 5 695
- 200 5 195
- 40 - 40
- 4 - 4
- - - -
- - - -
- 10 - 10
- 145 - 145
- - - -
- - - -
- - - -
- 20 - 20
- 20 - 20
- 20 - 20
- 4,250 600 3,650
- 13,900 1,100 12,800
- - - -
- 5 - 5
- - - -
- - - -
- - - -
- 225 10 215
- 378 30 348
- 267 10 257
- 145 - 145
- 70 40 30
- 36 - 36
- 24 - 24
- 24 - 24
- 88 - 88
- 1,250 - 1,250
- 49 2 47
- - - -
- 143 50 93
- 358 5 353
- 87 - 87
- 51,000 3,000 48,000
- 94 5 89
- 4,250 500 3,750
- 20 - 20
- 13 - 13
- 410 - 410
- - - -
- 245 - 245
- 241 - 241
- 51 3 48
- - - -
- - - -
- -
- 45 - 45
- 24 - 24
- 106 - 106
- 5 - 5
- 35 - 35
TOTAL
KUNJUNGAN
3481
PENANGGUNG JAWAB PENGELOLA OBAT

PUSKESMAS TROSOBO
Tgl,4 Pebruari 2019
NUR INDAH AL RISMAWATI

NIP. 196605101989032013
PARAF
KETERANGAN
10
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
PUSKESMAS : TROSOBO DOKUMEN TANGGAL PARAF

KECAMATAN :TAMAN
PUSKESMAS
PELAPORAN PERIODE :FEBRUARI 2019
GFK
PERMINTAAN PERIODE :
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KETERANGAN
1 2 3 4 5 6 7 8 9 10

1 Analsik tab Tablet 1,990 - 1,990 356 1,634
2 Antalgin 500 mg tab Tablet 1,225 900 2,125 1,676 449
3 Asam Mefenamat 500 mg tab Tablet 31,716 - 31,716 4,376 27,340
4 Asetosal 100 mg tab Tablet - - - - -
5 Aspilets 80 mg tab Tablet 3,707 - 3,707 60 3,647
6 Diklofenak Kalium 50 mg tab Tablet - 500 500 - 500
7 Diklofenak Na. 50 mg tab Tablet 14,510 - 14,510 2,502 12,008
8 Eprinoc tab Tablet - - - - -
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 413 - 413 90 323
10 Ibuprofen 200 mg tab Tablet - - - - -
11 Ibuprofen 400 mg tab Tablet 2,356 - 2,356 1,267 1,089
12 Meloxicam 15 mg supp Suppositoria 70 - 70 - 70
13 Meloxicam 15 mg tab Tablet - - - - -
14 Meloxicam 7,5 mg tab Tablet 6 200 206 206 -
15 Metoklopramid 10 mg Tablet 1,570 500 2,070 - 2,070
16 Metoklopramid inj. 5 mg/ml Ampul 20 - 20 - 20
17 Molakrim krim Tube 30 g - - - - -
18 Nonflamin tab Tablet - - - - -
19 Parasetamol 500 mg tab Tablet 74,927 - 74,927 5,309 69,618
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 77 - 77 77 -
21 Piroksikam 10 mg tab Tablet 3,440 - 3,440 466 2,974
22 Piroksikam 20 mg tab Tablet - - - - -
23 Profenid supp Suppositoria 21 10 31 5 26
24 Proris supp Suppositoria 135 50 185 70 115
25 Santagesic inj. Ampul - - - - -
26 Tramadol injeksi 50 mg/ml Ampul - - - - -
27 Tramadol kap 50 mg Tablet - 300 300 - 300
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 18,532 - 18,532 640 17,892
(2) ANESTESI LOKAL

1 Etil Klorida semprot Botol 100 ml 5 17 22 5 17
2 Ketamin / Ketalar inj. 100 mg/ml Vial 10 ml - - - - -
3 Lidokain inj 2% (HCl) / 2 ml Ampul 450 - 450 - 450
4 Lidokain komb inj / 2 ml Ampul 920 - 920 - 920

1 Alprazolam 0,5 mg Tablet 751 1,000 1,751 150 1,601
2 Diazepam 2 mg Tablet 1,387 - 1,387 4 1,383
3 Diazepam 5 mg Tablet - 400 400 - 400
4 Diazepam inj. 5 mg/ 2 ml Ampul - 60 60 - 60
5 Fenitoin kapsul 100 mg Kapsu; 1,180 400 1,580 60 1,520
6 Fenobarbital 100 mg Tablet - - - - -
7 Fenobarbital 30 mg Tablet - 400 400 - 400
8 Fenobarbital inj. 50 mg/ml Ampul 120 - 120 - 120
9 Haloperidol 0.5 mg tab Tablet 3,185 - 3,185 990 2,195
10 Haloperidol 1,5 mg Tablet - - - - -
11 Haloperidol inj 50 mg/ml Ampul - - - - -
12 Klobazam 10 mg tab Tablet - - - - -
13 Klorpromazin HCl 100 mg tab Tablet - 6,000 6,000 560 5,440
14 Klorpromazin HCl inj 25 mg/ml Ampul - - - - -
15 Trifluoperazine 5 mg tab Tablet 450 1,000 1,450 100 1,350
16 Stesolid rectal 5 mg Tube - 15 15 2 13
(4) ANTI PARKINSON

1 Levopar tab Tablet - 200 200 - 200
2 Triheksifenidil 2 mg Tablet 244 3,000 3,244 480 2,764
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 616 1,500 2,116 198 1,918
2 Deproz 20 mg Tablet - - - - -
(6) ANTI MIGREN
1 Anti Migren (Komb. Ergot+Kafein) Tablet 450 500 950 20 930

1 Isosorbit Dinitrat 5 mg Tablet 199 - 199 119 80
2 Nifedipin 10 mg Tablet - 300 300 240 60

1 Amlodipin 5 mg Tablet 5,500 - 5,500 1,320 4,180
2 Amlodipin 10 mg Tablet 700 - 700 700 -
3 Bisoprolol Fumarat 5 mg Tablet 7,430 1,000 8,430 400 8,030
4 Captopril 25 mg Tablet 3,155 - 3,155 905 2,250
5 Furosemid 40 mg Tablet 720 500 1,220 64 1,156
6 Furosemid inj. Ampul - - - - -
7 H.C.T 25 mg Tablet 5,245 - 5,245 150 5,095

1 Digoksin 0,25 mg Tablet 500 - 500 - 500

1 Aminofilin 200 mg Tablet 538 500 1,038 - 1,038
2 Aminofilin inj 24 mg Ampul - - - - -
3 Bisolvon solution 10 mg/5 ml Botol 50 ml - - - - -
4 Bisolvon injeksi 2 mg/ml Ampul - - - - -
5 Bricasma inj 0,5 mg/ml Ampul - - - - -
6 Deksamethason 0,5 mg Tablet 43,901 - 43,901 6,735 37,166
7 Deksamethason inj 5 mg/ml Ampul - - - - -
8 Efedrin HCl 25 mg Tablet - - - - -
9 Epinefrin inj. Ampul 415 100 515 - 515
10 Methylprednisolon 4 mg Tablet 10,371 - 10,371 255 10,116
11 Prednison 5 mg Tablet - - - - -
12 Salbutamol 2 mg Tablet 50 400 450 269 181
13 Salbutamol sirup (Astharol) Botol 60 ml - - - - -
14 Ventolin Nebulizer Ampul 360 100 460 - 460
- - - - -
(11) ANTI TUSIF - - - - -
1 Dexmolex sirup Botol 100 ml 60 - 60 - 60
2 Kodein 10 mg Tablet 936 2,400 3,336 96 3,240
3 Sanadryl DMP sirup Botol 60 ml - - - - -
4 Tuzalos tab Tablet 1,558 - 1,558 12 1,546
- - - - -
(12) EKSPEKTORAN - - - - -
1 Ambroxol HCl 30 mg Tablet 309 7,000 7,309 2,129 5,180
2 Ambroxol syrup Botol 60 ml 90 - 90 41 49
3 Gliseril Guayakolat 100 mg Tablet - 6,000 6,000 2,967 3,033
4 Hustab sirup Botol 60 ml - - - - -
5 Hustab tab Tablet 834 - 834 834 -
6 OBH Plus Anak Botol 60 ml - - - - -
7 OBH Plus Dewasa Botol 60 ml 174 - 174 94 80
8 Sanadryl Expectorant Botol 60 ml 24 72 96 29 67
- - - - -
(13) ANTI INFLUENZA - - - - -
1 Alpara tab Tablet - - - - -
2 Alpara sirup Botol 60 ml - - - - -
3 Protexinal tab Tablet 6,184 - 6,184 1,285 4,899
4 Protexinal sirup Botol 60 ml 60 - 60 6 54
5 Tremenza tab Tablet 1,642 800 2,442 276 2,166
-
(14) ANTASIDA
1 Antasida DOEN I tab Tablet 18,294 - 18,294 4,365 13,929
2 Antasida DOEN II sirup Botol 60 ml 68 200 268 60 208
3 Cimetidin 200 mg Tablet 2,396 - 2,396 592 1,804
4 Cytotec Tablet - - - - -
5 Famotidine 20 mg Tablet - - - - -
6 Omeprazole kap 20 mg Tablet 1,500 - 1,500 1,285 215
7 Ranitidin tab 150 mg Tablet - 5,000 5,000 287 4,713
8 Ranitidin inj 25 mg/2 ml Ampul 130 - 130 - 130
9 Sanmag suspensi Botol 120 ml - - - - -
10 Sanmag tab Tablet 78 2,000 2,078 158 1,920
- - - - -
2 D5 + 1/2 NS Botol 500 ml
3 D5 + 1/4 NS Botol 500 ml
4 Dehaf Sachet
7 L-Bio Sachet
8 Loperamide Tablet - 1,000 1,000 - 1,000
9 Molagit tab Tablet - 750 750 - 750
10 Na. Klorida 0,9% infus Botol 500 ml 225 - 225 10 215
11 Na. Klorida 0,9% piggy bag Botol 100 ml - - - - -
12 Neo Kaolana suspensi Botol 60 ml - - - - -
13 New Diaform Tablet 2,817 - 2,817 997 1,820
14 Oralit 200 ml Sachet 349 - 349 - 349
15 Ringer Laktat infus Botol 500 ml - 60 60 35 25
16 Zink tab dispersible 20 mg Tablet 541 - 541 20 521
17 Zink sirup 20 mg/5 ml Botol 60 ml - - - - -
- - - - -
(16) LAKSAN - - - - -
1 Bicolax tab 5 mg Tablet 20 - 20 16 4
2 Dulcolax supp 5 mg Suppositoria - - - - -
3 Stolax supp 10 mg Suppositoria 27 - 27 27 -
- - - - -
(17) ANTI SPASMODIK - - - - -
1 Atropin Sulfat inj 0,25 mg/ml Ampul - 200 200 - 200
2 Braxidin tab Tablet - 400 400 - 400
3 Buscopan inj Ampul 5 - 5 - 5
4 Buscopan tab Tablet 284 - 284 66 218
(18) ANTI HISTAMIN

2 Cetirizine tab 10 mg Tablet 1,648 1,860 3,508 846 2,662
3 Difenhidramin inj Ampul - - - - -
4 Klorfeniramin Maleat 4 mg Tablet 55,512 - 55,512 3,282 52,230
5 Loratadine 10 mg Tablet 1,270 - 1,270 107 1,163
- - - - -
(19) LARUTAN NUTRISI - - - - -
1 Aminofluid Softbag 500 ml - - - - -
2 Glukose 10% infus 500 ml Botol 500 ml 18 - 18 - 18
3 Glukose 40% inj 25 ml Ampul 70 - 70 - 70
4 Glukose 5% infus 500 ml Botol 500 ml 16 - 16 - 16
- - - - -
(20) TIROID ANTAGONIS - - - - -
1 Propiltiourasil 100 mg Tablet - - - - -
- - - - -
(21) ANTI DIABETIK ORAL - - - - -
1 Glibenklamid 5 mg Tablet 8,030 - 8,030 515 7,515
2 Glimipiride 2 mg Tablet 13,990 - 13,990 1,245 12,745
3 Metformin tab 500 mg Tablet 16,419 - 16,419 4,570 11,849


1 Anemolat tab / Asam folat tab Tablet - 600 600 - 600
2 Asam Askorbat 50 mg Tablet 698 2,000 2,698 2,579 119
3 Becom C kaplet Kaplet - 200 200 - 200
4 Calcii Gluconas inj Ampul 48 - 48 - 48
5 Caldece tab effervecent Tablet - - - - -
6 Cavit D3 Tablet 305 - 305 305 -
7 Elkana sirup Botol 60 ml - - - - -
8 Elkana tab Tablet - - - - -
9 Glucosamin tab Tablet 288 - 288 116 172
10 Hepagard tab Tablet 560 - 560 50 510
11 Kalsium Laktat 500 mg Tablet 21,213 - 21,213 15,002 6,211
12 Neurosanbe 5000 Tablet - - - - -
13 Neurosanbe inj Ampul 110 50 160 150 10
14 Neurosanbe Plus Tablet - - - - -
15 Neurosanbe tab Tablet - 1,000 1,000 - 1,000
16 Osteotin tab Tablet 160 420 580 84 496
17 Pharmaton Vit Tablet - - - - -
18 Piridoksin 10 mg (Vit. B6) Tablet 38,632 - 38,632 2,198 36,434
19 Procurma Plus sirup Botol 60 ml - - - - -
20 Santa E 200 mg tablet hisap Tablet 80 - 80 - 80
21 Sianokobalamin tab Tablet 8,776 - 8,776 2,075 6,701
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul - - - - -
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 11,222 - 11,222 2,359 8,863
24 Vit. B kompleks Tablet 18,528 - 18,528 6,769 11,759

1 Amoksisilin 500 mg Tablet 7,041 - 7,041 5,878 1,163
2 Amoksisilin inj. Ampul - - - - -
3 Amoksisilin sirup kering Botol 60 ml 457 - 457 76 381
8 Biothicol sirup kering Botol 60 ml 22 - 22 - 22
9 Cefadroxil 500 mg Kaplet 5,215 - 5,215 1,713 3,502
12 Cefixime kapsul 100 mg Kapsul 1,854 - 1,854 989 865
14 Cefotaxime injeksi 1 g Ampul 60 - 60 30 30
15 Ceftriaxone injeksi 1 g Ampul - - - - -
16 Ciprofloxacin 500 mg Tablet 2,486 - 2,486 300 2,186
21 Eritromisin 500 mg Kaplet 272 1,000 1,272 - 1,272
22 Eritromisin sirup kering Botol 60 ml 103 - 103 1 102
23 Gentamisin inj. 40 mg/ml Ampul - - - - -
24 Klindamisin 300 mg Kapsul 290 400 690 - 690
26 Kloramfenikol sirup Botol 60 ml 200 - 200 25 175
27 Kotrimoksasol 480 mg Tablet 26,114 - 26,114 1,914 24,200
28 Kotrimoksasol suspensi Botol 60 ml 177 - 177 67 110
29 Levofloksasin 500 mg Tablet 449 - 449 10 439
32 Spyramisin 500 mg Tablet 1,460 - 1,460 - 1,460
33 Tetrasiklin 500 mg Tablet - - - - -
34 Thiamphenikol 500 mg Tablet 1,243 - 1,243 916 327
(25) ANTI VIRUS

2 Acyclovir 400 mg tab Tablet 4,911 2,400 7,311 160 7,151
3 Acyclovir cream Tube 34 - 34 2 32
(26) ANTI FUNGI

1 Griseofulvin 125 mg Tablet 4,911 2,400 7,311 160 7,151
2 Ketokonazol 200 mg Tablet 34 - 34 2 32
3 Nistatin 100.000 IU tab.vag Tablet 522 - 522 - 522


2 Etanol 70% Botol 100 ml 32 - 32 12 20
3 H2O2 3% Botol 1000 ml 28 - 28 7 21
4 Klorin Botol 500 ml 22 1 23 2 21
5 Lisol 50% Botol 1000 ml 14 - 14 - 14
6 Paraformaldehid 1 g Tablet - - - - -
7 Povidon Iodida larutan 10% Botol 300 ml 4 - 4 1 3
8 Softa-Man Botol 500 ml 12 - 12 3 9
9 Softaskin Botol 500 ml 27 - 27 3 24
(29) ANTELMENTIK
4 Pirantel 125 mg Tablet - 500 500 8 492
(30) ANTI AMUBIASIS


1 Besi (II) Sulfat tab Sachet 61,676 - 61,676 420 61,256
2 Besi sirup Botol 150 ml - - - - -
3 Sianokobalamin inj (Vit. B 12) Ampul - 100 100 10 90
4 Vitalex kap Kaplet -
(32) HEMOSTATIK
3 Fitomenadion 10 mg (Vit. K) Tablet 1,260 - 1,260 10 1,250
4 Fitomenadion inj (Vit. K) Ampul 308 - 308 - 308
5 Magnesium Sulfat 20% Vial 9 - 9 - 9

(34) SERUM
1 ABU I Polivalen 5 ml Vial - 2 2 - 2
2 ATS 1.500 IU Ampul 2 20 22 - 22
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 990 - 990 4 986
2 Metilergometrin inj Ampul 100 - 100 - 100
3 Oksitosin inj 10 IU/ml-1 ml Ampul 78 - 78 - 78
- - - - -
(36) RELAKSAN UTERUS - - - - -
1 Papaverin 40 mg Tablet 219 900 1,119 256 863
- - - - -
(37) ANTI INFLAMASI SALEP - - - - -
1 Betametason krem 0,1% Tube 436 - 436 41 395
2 Betason N krem Tube - - - - -
3 Hidrokortison krem 2,5% Tube 146 - 146 14 132
- - - - -
(38) PERANGSANG JARINGAN GRANULASI - - - - -
1 Bioplacenton gel Tube 18 - 18 1 17
(39) ANTI BAKTERI

1 Anti Bakteri DOEN s.k Tube 23 - 23 - 23
2 Gentamisin salep kulit 0,1% Tube 55 - 55 55 -
3 Kloramfekort H krem Tube 120 - 120 - 120
4 Oksitetrasiklin HCl sk 3% Tube 75 - 75 - 75
- - - - -
(40) ANTI FUNGI SALEP - - - - -
1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 300 - 300 - 300
2 Ketokonazol cream 2% Tube 193 - 193 6 187
3 Miconazol cream 2% Tube 7 72 79 30 49
- - - - -
(41) ANTI SCABIES - - - - -
1 Salep 2-4 30 g Pot 41 - 41 8 33
2 Scabicide Tube 10 10 20 10 10
- - - - -
(42) ANTI SEPTIK - - - - -
1 P.K serbuk 5 gram Botol - 24 24 - 24
- - - - -
(43) LAIN-LAIN OBAT KULIT - - - - -
1 Ikhtamol salep 15 g Pot 92 - 92 33 59
2 Salisil bedak 2% Kotak 20 30 50 18 32


1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml - 24 24 - 24

1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 66 - 66 17 49
2 Kloramfenikol 0,5% t.m Botol 5 ml 268 - 268 19 249
3 Kloramfenikol 1% s.m Tube 5 g 69 - 69 8 61
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 155 - 155 1 154

2 Cendolyteers tetes mata Botol 5 ml 226 - 226 8 218
1 Kloramfenikol 3% t.t Botol 21 50 71 7 64
- - - - -
(49) LAIN-LAIN INFEKSI THT - - - - -
1 Fenol gliserol 10% t.t Botol 67 - 67 11 56

(51) ANTI HEMOROID

1 Anti Hemoroid supp Suppositoria 493 - 493 20 473
2 Anusol Suppositoria - - - - -
3 Borraginol N Salep Tube 15 g - - - - -
4 Borraginol N Supp Suppositoria - - - - -
5 Hemorogard tab Tablet - - - - -
- - - - -
(52) ANTI EMETIK - - - - -
1 Dimenhidrinat 50 mg Tablet 2,848 - 2,848 1,130 1,718
2 Domperidon sirup Botol 60 ml 173 - 173 41 132
3 Domperidon tab Tablet 5,097 - 5,097 40 5,057
4 Mediamer B6 Tablet - - - - -
5 Ondansetron 8 mg tab Tablet 3,700 - 3,700 382 3,318
6 Ondansetron 4 mg/2 ml inj. Ampul 60 50 110 - 110
- - - - -
(53) ANTI HIPERKOLESTEROLEMIA - - - - -
1 Gemfibrozil kapsul 300 mg Tablet 535 - 535 10 525
2 Kalsium Atorvastatin Tablet 6,686 - 6,686 283 6,403
3 Lipitor 20 mg Tablet - - - - -
4 Simvastatin tab 10 mg Tablet 3,849 - 3,849 1,095 2,754
- - - - -
(54) NOOTROPIK - - - - -
1 Piracetam 400 mg Tablet 860 - 860 206 654
2 Piracetam inj 1 g/5 ml Ampul - - - - -
3 Piracetam inj 3 g / 15 ml Ampul - - - - -
- - - - -
(55) IMMUNDILATOR - - - - -
1 Imunos sirup Botol 60 ml - - - - -
2 Imunos tablet Tablet 281 - 281 - 281
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 245 - 245 145 100
6 Combipack pcs - - - - -
7 Fluconazole 150 mg tablet - - - - -
8 Haldol inj. ampul 16 50 66 - 66
11 Handscoon pcs
15 Lodomer inj. ampul 24 24 24
17 Micropipet pcs
18 pH Paper pcs
20 Risperidon 2 mg tablet 236 200 436 90 346
(59) OBAT GIGI

1 Alvogyl (Septodont) Botol 10 g 6 1 7 - 7
2 Caustener rapid Botol 6,5 g 4 - 4 - 4
3 Cavit (Tumpatan sementara) Set 28 - 28 2 26
4 Cresophene (Septodont) Botol 7,5 g 12 2 14 - 14
5 Elite semen Botol 1 2 3 - 3
6 Estelite Composite Set 3 3 6 - 6
7 Ectsa gel (Denta merica) Syringe 12 g 9 - 9 - 9
8 Eugenol Botol 10 ml 29 4 33 1 32
9 Forinokresol / Formocresol Botol 10 ml - 2 2 - 2
10 Glass Ionomer Cement (Fuji II LC) Set - 3 3 - 3
11 Glass Ionomer Cement (Fuji IX) Set 15 - 15 - 15
12 Kalsium Hidroksida pasta Tube 12 2 14 - 14
13 Klorfenol Kamfer Mentol (CHKM) Botol 20 ml 4 2 6 - 6
14 Mumifying pasta Botol 7 g 8 2 10 - 10
15 Spongostan Pcs 50 100 150 - 150
16 Te-econom bond Botol 8 - 8 1 7
17 Temporary Stopping Fletcher Botol 11 - 11 - 11
18 Tooth Cleansing (Occo) Botol 15 ml 13 2 15 - 15
19 Vinafluor Tablet 2 2 4 2 2

1 Bufacomb Iob (Zenith) Tube - 48 48 1 47
2 Gentian violet 1% Botol 10 ml 35 - 35 5 30
3 Minosep gargle 0.2% Botol 60 ml 24 - 24 - 24

3 Alat suntik 1xpakai 1 ml Pcs 495 - 495 100 395
4 Alat Suntik 1xpakai 3 ml Pcs 1,100 1,000 2,100 400 1,700
5 Alat suntik 1xpakai 5 ml Pcs 695 - 695 - 695
7 Aqua pro injeksi Vial 40 - 40 - 40
8 Aquadest steril 500 ml Botol 500 ml 4 - 4 - 4
9 Blood Lancet Pcs
10 Blue tape Pcs
11 Cat-gut dg jarum 2/0 Sachet 10 - 10 - 10
12 Cat-gut dg jarum 3/0 Sachet 145 3 148 - 148
13 Catton swap Pcs - - - - -
14 Cerplast Pcs - - - - -
15 Cover glass Pcs - - - - -
16 Folley Cath 12 Pcs 20 - 20 - 20
17 Folley Cath 16 Pcs 20 - 20 - 20
18 Folley Cath 18 Pcs 20 - 20 - 20
19 Folley Cath 20 Pcs - - - - -
21 Gelang Bayi Lahir Pcs - - - - -
22 Gelang Ibu Melahirkan Pcs - - - - -
23 Handscoon Panjang Pcs - - - - -
24 Handscoon uk. L Pcs 3,650 - 3,650 1,000 2,650
25 Handscoon uk. M Pcs 12,800 - 12,800 100 12,700
26 Handscoon uk. S Pcs - - - - -
27 Hipavix 5 x 5 m Rol 5 10 15 4 11
28 Holder Pronto Pcs
29 I.V. Catheter 16 Pcs
30 I.V. Catheter 18 Pcs - 100 100 - 100
31 I.V. Catheter 20 Pcs 215 100 315 10 305
32 I.V. Catheter 22 Pcs 348 - 348 24 324
33 I.V. Catheter 24 Pcs 257 100 357 - 357
34 Infusion set anak Pcs 145 - 145 10 135
35 Infusion set dewasa Pcs 30 - 30 20 10
36 Jarum jahit (bedah) no. 13 Pcs 36 - 36 - 36
39 Jarum Jahit (bedah) no. 12 Pcs 88 - 88 - 88
40 Jarum Suntik no. 25 Pcs 1,250 - 1,250 - 1,250
41 Jarum Vacutainer 21 Pcs - - - - -
43 Kapas berlemak 500 g Bungkus - - - - -
44 Kapas pembalut 250 g Bungkus - 12 12 1 11
45 Kasa elastis 3x4 cm Rol - - - - -
46 Kasa elstis 4x10 cm Rol - - - - -
47 Kasa kompres 40/40 steril Pcs - - - - -
48 Kasa Pembalut 1 yard 40m x 80 Rol 47 - 47 2 45
49 Kasa pembalut 2 m x 80 cm Rol - - - - -
50 Kasa pembalut hid 4 x 10 cm Rol 93 - 93 - 93
51 Kasa pembalut hid 4 x 5 cm Rol 353 100 453 - 453
52 Kasa Steril 16 x 16 cm Pcs 87 100 187 - 187
53 Kertas Puyer Pcs 48,000 - 48,000 3,000 45,000
54 Lomatull Pcs 89 100 189 80 109
55 Masker Pcs 3,750 - 3,750 850 2,900
56 Masker O2 anak Pcs 20 - 20 - 20
57 Masker O2 dewasa Pcs 13 - 13 - 13
58 Mesh 11 Lancip Pcs 410 - 410 - 410
59 Microburet Pcs - - - - -
60 Nasal Canula Anak Pcs 245 - 245 - 245
61 Nasal Canula Dewasa Pcs 241 - 241 - 241
63 Obyek glass Pcs
66 Plester 2.5 cm x 4.5 m Rol 48 15 63 2 61
67 Plester 7.5 cm x 4.5 m Rol
68 Pot urine 10 ml Pcs - - - - -
69 Sharp Collector Pcs - - - - -
70 Silk (benang bedah sutra) dg jarum Sachet 45 - 45 36 9
71 Silk tanpa jarum 2/0 Sachet 24 - 24 - 24
72 Silk tanpa jarum 3/0 Sachet 106 - 106 36 70
73 Slim Zuiker Pcs 5 - 5 - 5
74 Sputum pot Pcs
81 Umbilical Pcs
82 Urine Bag Pcs 35 - 35 - 35
83 White tape Pcs
86 Yellow tape Pcs
TOTAL
KUNJUNGAN
FEBRUARI 2019 3858 Rp.27.777.000 3.495
Mengetahui :
KEPALA PUSKESMAS TROSOBO PENANGGUNG JAWAB PENGELOLA OBAT
KABUPATEN SIDOARJO PUSKESMAS TROSOBO
Tgl,8 Maret 2019
Dr.ARIF RAHMAN NURDIANTO NUR INDAH AL RISMAWATI

NIP. 19870416 201101 1 007 NIP. 196605101989032013

KECAMATAN :TAMAN
PUSKESMAS
PELAPORAN PERIODE : MARET 2019
GFK
PERMINTAAN PERIODE : II
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KETERANGAN
1 2 3 4 5 6 7 8 9 10

1 Analsik tab Tablet 1,634 - 1,634 316 1,318
2 Antalgin 500 mg tab Tablet 449 - 449 294 155 5,000
5 Aspilets 80 mg tab Tablet 3,647 - 3,647 500 3,147
6 Diklofenak Kalium 50 mg tab Tablet 500 - 500 - 500
7 Diklofenak Na. 50 mg tab Tablet 12,008 - 12,008 2,140 9,868 3,500
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 323 - 323 124 199
11 Ibuprofen 400 mg tab Tablet 1,089 200 1,289 1,179 110 5,000
14 Meloxicam 7,5 mg tab Tablet - - - - - 2,000
15 Metoklopramid 10 mg Tablet 2,070 - 2,070 - 2,070
19 Parasetamol 500 mg tab Tablet 69,618 - 69,618 6,419 63,199
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml - - - - - 250
22 Piroksikam 20 mg tab Tablet - - - - - 1,500
23 Profenid supp Suppositoria 26 - 26 11 15 10
24 Proris supp Suppositoria 115 - 115 10 105 50
25 Santagesic inj. Ampul - - - - - 50
27 Tramadol kap 50 mg Tablet 300 - 300 - 300
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 17,892 - 17,892 1,050 16,842
(2) ANESTESI LOKAL

1 Etil Klorida semprot Botol 100 ml 17 - 17 1 16
3 Lidokain inj 2% (HCl) / 2 ml Ampul 450 - 450 200 250
4 Lidokain komb inj / 2 ml Ampul 920 - 920 60 860

1 Alprazolam 0,5 mg Tablet 1,601 - 1,601 213 1,388
3 Diazepam 5 mg Tablet - - - - -
4 Diazepam inj. 5 mg/ 2 ml Ampul 60 - 60 30 30
5 Fenitoin kapsul 100 mg Kapsu; 1,520 - 1,520 120 1,400
7 Fenobarbital 30 mg Tablet 400 - 400 - 400
9 Haloperidol 0.5 mg tab Tablet 2,195 - 2,195 870 1,325
10 Haloperidol 1,5 mg Tablet - - - - -
11 Haloperidol inj 50 mg/ml Ampul 50 - 50 1 49
13 Klorpromazin HCl 100 mg tab Tablet 5,440 - 5,440 620 4,820
15 Trifluoperazine 5 mg tab Tablet 1,350 - 1,350 150 1,200
16 Stesolid rectal 5 mg Tube 13 - 13 - 13
(4) ANTI PARKINSON

1 Levopar tab Tablet 200 - 200 - 200
2 Triheksifenidil 2 mg Tablet 2,764 - 2,764 580 2,184
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 1,918 - 1,918 150 1,768 -
(6) ANTI MIGREN

1 Anti Migren (Komb. Ergot+Kafein) Tablet 930 - 930 30 900

1 Isosorbit Dinitrat 5 mg Tablet 80 - 80 80 -
2 Nifedipin 10 mg Tablet 60 - 60 - 60 1,000

1 Amlodipin 5 mg Tablet 4,180 - 4,180 2,471 1,709 6,000
2 Amlodipin 10 mg Tablet
3 Bisoprolol Fumarat 5 mg Tablet 8,030 - 8,030 270 7,760
4 Captopril 25 mg Tablet 2,250 - 2,250 790 1,460 2,500
5 Furosemid 40 mg Tablet 1,156 - 1,156 100 1,056
6 Furosemid inj. Ampul 10
7 H.C.T 25 mg Tablet 5,095 - 5,095 585 4,510

1 Digoksin 0,25 mg Tablet 500 0 500 0 500

1 Aminofilin 200 mg Tablet 1,038 - 1,038 16 1,022
2 Aminofilin inj 24 mg Ampul
3 Bisolvon solution 10 mg/5 ml Botol 50 ml
4 Bisolvon injeksi 2 mg/ml Ampul
5 Bricasma inj 0,5 mg/ml Ampul
6 Deksamethason 0,5 mg Tablet 37,166 - 37,166 6,707 30,459
8 Efedrin HCl 25 mg Tablet
9 Epinefrin inj. Ampul 515 - 515 30 485
10 Methylprednisolon 4 mg Tablet 10,116 - 10,116 389 9,727
11 Prednison 5 mg Tablet
12 Salbutamol 2 mg Tablet 181 400 581 487 94 1,500
14 Ventolin Nebulizer Ampul 460 - 460 60 400
(11) ANTI TUSIF

1 Dexmolex sirup Botol 100 ml 60 - 60 16 44
2 Kodein 10 mg Tablet 1,080 - 1,080 149 931 1,000
4 Tuzalos tab Tablet 1,546 - 1,546 420 1,126 800
(12) EKSPEKTORAN
1 Ambroxol HCl 30 mg Tablet 5,180 - 5,180 1,673 3,507 5,000
2 Ambroxol syrup Botol 60 ml 49 - 49 29 20 100
3 Gliseril Guayakolat 100 mg Tablet 3,033 - 3,033 3,033 - 12,000
4 Hustab sirup Botol 60 ml - - - - -
5 Hustab tab Tablet - - - - -
6 OBH Plus Anak Botol 60 ml - - - - -
7 OBH Plus Dewasa Botol 60 ml 80 - 80 46 34 200
8 Sanadryl Expectorant Botol 60 ml 67 - 67 26 41 150
(13) ANTI INFLUENZA

1 Alpara tab Tablet
2 Alpara sirup Botol 60 ml
3 Protexinal tab Tablet 4,893 - 4,893 1,212 3,681 1,500
4 Protexinal sirup Botol 60 ml 60 - 60 - 60
5 Tremenza tab Tablet 2,166 - 2,166 604 1,562 800
(14) ANTASIDA
1 Antasida DOEN I tab Tablet 13,929 - 13,929 4,532 9,397 6,000
2 Antasida DOEN II sirup Botol 60 ml 208 - 208 92 116 200
6 Omeprazole kap 20 mg Tablet 215 300 515 515 - 3,000
7 Ranitidin tab 150 mg Tablet 4,713 - 4,713 981 3,732 1,000
8 Ranitidin inj 25 mg/2 ml Ampul 130 - 130 100 30
10 Sanmag tab Tablet 1,920 - 1,920 214 1,706 1,000

2 D5 + 1/2 NS Botol 500 ml 40
3 D5 + 1/4 NS Botol 500 ml 20
4 Dehaf Sachet
7 L-Bio Sachet
8 Loperamide Tablet 1,000 - 1,000 - 1,000
9 Molagit tab Tablet 750 - 750 66 684
10 Na. Klorida 0,9% infus Botol 500 ml 145 - 145 10 135
12 Neo Kaolana suspensi Botol 60 ml - - - - -
13 New Diaform Tablet 1,820 - 1,820 820 1,000 4,000
14 Oralit 200 ml Sachet 349 - 349 - 349 1,000
15 Ringer Laktat infus Botol 500 ml 25 - 25 20 5 80
16 Zink tab dispersible 20 mg Tablet 521 - 521 40 481
(16) LAKSAN
1 Bicolax tab 5 mg Tablet 4 - 4 4 - 72
2 Dulcolax supp 5 mg Suppositoria 20
3 Stolax supp 10 mg Suppositoria 40
(17) ANTI SPASMODIK

1 Atropin Sulfat inj 0,25 mg/ml Ampul 200 - 200 - 200
2 Braxidin tab Tablet 400 - 400 112 288 500
3 Buscopan inj Ampul 5 - 5 1 4 20
4 Buscopan tab Tablet 218 - 218 50 168 300
(18) ANTI HISTAMIN

1 Ceterizine sirup Botol 60 ml 2,500
2 Cetirizine tab 10 mg Tablet 2662 0 2662 852 1810
3 Difenhidramin inj Ampul 0 0 0 0 0 90
4 Klorfeniramin Maleat 4 mg Tablet 52230 0 52230 3606 48624
5 Loratadine 10 mg Tablet 1163 0 1163 239 924

2 Glukose 10% infus 500 ml Botol 500 ml 18 0 18 0 18 20
3 Glukose 40% inj 25 ml Ampul 70 0 70 0 70 10
4 Glukose 5% infus 500 ml Botol 500 ml 16 0 16 0 16 20


1 Glibenklamid 5 mg Tablet 7515 0 7515 800 6715
2 Glimipiride 2 mg Tablet 12745 0 12745 1260 11485
3 Metformin tab 500 mg Tablet 11849 0 11849 4800 7049 10,000


1 Anemolat tab / Asam folat tab Tablet 600 0 600 0 600
2 Asam Askorbat 50 mg Tablet 119 0 119 119 0 10,000
3 Becom C kaplet Kaplet 200 0 200 120 80 800
4 Calcii Gluconas inj Ampul 48 0 48 0 48
5 Caldece tab effervecent Tablet
6 Cavit D3 Tablet 500
7 Elkana sirup Botol 60 ml
8 Elkana tab Tablet
9 Glucosamin tab Tablet 50 0 50 50 0 1,000
10 Hepagard tab Tablet 510 0 510 110 400
11 Kalsium Laktat 500 mg Tablet 6211 0 6211 5280 931 5,000
12 Neurosanbe 5000 Tablet 0 0 0 0 0
13 Neurosanbe inj Ampul 40 0 40 20 20 30
14 Neurosanbe Plus Tablet 0 0 0 0 0
15 Neurosanbe tab Tablet 1000 0 1000 110 890 1,000
16 Osteotin tab Tablet 496 0 496 175 321
17 Pharmaton Vit Tablet 0 0 0 0 0
18 Piridoksin 10 mg (Vit. B6) Tablet 36434 0 36434 4052 32382
19 Procurma Plus sirup Botol 60 ml 0 0 0 0 0
20 Santa E 200 mg tablet hisap Tablet 80 0 80 12 68
21 Sianokobalamin tab Tablet 6701 0 6701 2540 4161 3,000
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul 0 0 0 0 0
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 8863 0 8863 3541 5322 10,000
24 Vit. B kompleks Tablet 11759 0 11759 7550 4209 12,000
25,000
1 Amoksisilin 500 mg Tablet 1163 5500 6663 6404 259
2 Amoksisilin inj. Ampul 0 0 0 0 0
3 Amoksisilin sirup kering Botol 60 ml 381 0 381 75 306 200
8 Biothicol sirup kering Botol 60 ml 22 0 22 11 11
9 Cefadroxil 500 mg Kaplet 3502 0 3502 2088 1414 5,000
12 Cefixime kapsul 100 mg Kapsul 865 0 865 865 0 3,000
14 Cefotaxime injeksi 1 g Ampul
15 Ceftriaxone injeksi 1 g Ampul
16 Ciprofloxacin 500 mg Tablet 2186 0 2186 900 1286 2,000
21 Eritromisin 500 mg Kaplet 1272 0 1272 0 1272
22 Eritromisin sirup kering Botol 60 ml 102 0 102 20 82
23 Gentamisin inj. 40 mg/ml Ampul
24 Klindamisin 300 mg Kapsul 690 0 690 0 690
26 Kloramfenikol sirup Botol 60 ml 175 0 175 6 169
27 Kotrimoksasol 480 mg Tablet 24200 0 24200 3567 20633
28 Kotrimoksasol suspensi Botol 60 ml 110 0 110 75 35 200
29 Levofloksasin 500 mg Tablet 439 0 439 160 279
32 Spyramisin 500 mg Tablet 1460 0 1460 400 1060
34 Thiamphenikol 500 mg Tablet 327 700 1027 1026 1 3,000
(25) ANTI VIRUS

2 Acyclovir 400 mg tab Tablet 7151 0 7151 491 6660
3 Acyclovir cream Tube 32 0 32 7 25 100
(26) ANTI FUNGI

1 Griseofulvin 125 mg Tablet 385 0 385 90 295
2 Ketokonazol 200 mg Tablet 0 0 0 0 0 400
3 Nistatin 100.000 IU tab.vag Tablet 522 0 522 399 123


2 Etanol 70% Botol 100 ml 20 0 20 3 17 10
3 H2O2 3% Botol 1000 ml 21 0 21 0 21
4 Klorin Botol 500 ml 21 0 21 0 21
5 Lisol 50% Botol 1000 ml 14 0 14 0 14 10
6 Paraformaldehid 1 g Tablet 0 0 0 0 0
7 Povidon Iodida larutan 10% Botol 300 ml 3 0 3 1 2 10
8 Softa-Man Botol 500 ml 9 0 9 0 9
9 Softaskin Botol 500 ml 24 0 24 0 24
(29) ANTELMENTIK
1 Albendazol 400 mg Tablet 120
4 Pirantel 125 mg Tablet 500 0 500 0 500
(30) ANTI AMUBIASIS

1 Metronidazol 500 mg Tablet 1,200

1 Besi (II) Sulfat tab Sachet 61256 0 61256 6750 54506
3 Sianokobalamin inj (Vit. B 12) Ampul 90 0 90 0 90
(32) HEMOSTATIK
3 Fitomenadion 10 mg (Vit. K) Tablet 1250 0 1250 230 1020
4 Fitomenadion inj (Vit. K) Ampul 308 0 308 0 308
5 Magnesium Sulfat 20% Vial 9 0 9 0 9

(34) SERUM
1 ABU I Polivalen 5 ml Vial 2 0 2 0 2
2 ATS 1.500 IU Ampul 22 0 22 2 20
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 986 0 986 0 986
2 Metilergometrin inj Ampul 100 0 100 0 100 30
3 Oksitosin inj 10 IU/ml-1 ml Ampul 78 0 78 0 78

1 Papaverin 40 mg Tablet 863 0 863 364 499 2,000

1 Betametason krem 0,1% Tube 395 0 395 83 312
2 Betason N krem Tube 0 0 0 0 0 150
3 Hidrokortison krem 2,5% Tube 132 0 132 44 88

1 Bioplacenton gel Tube 17 0 17 1 16
(39) ANTI BAKTERI

1 Anti Bakteri DOEN s.k Tube 23 0 23 23 0 75
2 Gentamisin salep kulit 0,1% Tube 0 0 0 0 0 150
3 Kloramfekort H krem Tube 120 0 120 21 99
4 Oksitetrasiklin HCl sk 3% Tube 75 0 75 1 74
(40) ANTI FUNGI SALEP

1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 300 0 300 80 220
2 Ketokonazol cream 2% Tube 187 0 187 13 174
3 Miconazol cream 2% Tube 49 0 49 25 24 72
(41) ANTI SCABIES
1 Salep 2-4 30 g Pot 33 0 33 29 4 72
2 Scabicide Tube 10 0 10 0 10 10
(42) ANTI SEPTIK

1 P.K serbuk 5 gram Botol 24 0 24 0 24

1 Ikhtamol salep 15 g Pot 59 0 59 21 38
2 Salisil bedak 2% Kotak 32 0 32 13 19 50


1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 24 0 24 0 24

1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 49 0 49 1 48
2 Kloramfenikol 0,5% t.m Botol 5 ml 249 0 249 34 215
3 Kloramfenikol 1% s.m Tube 5 g 61 0 61 8 53
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 154 0 154 27 127

2 Cendolyteers tetes mata Botol 5 ml 218 0 218 10 208

1 Kloramfenikol 3% t.t Botol 64 0 64 9 55 50

1 Fenol gliserol 10% t.t Botol 56 0 56 3 53

(51) ANTI HEMOROID

1 Anti Hemoroid supp Suppositoria 473 0 473 24 449
5 Hemorogard tab Tablet 300
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 1718 0 1718 640 1078 1,000
2 Domperidon sirup Botol 60 ml 132 0 132 17 115
3 Domperidon tab Tablet 5057 0 5057 44 5013
4 Mediamer B6 Tablet 0 0 0 0 0
5 Ondansetron 8 mg tab Tablet 3368 0 3368 322 3046
6 Ondansetron 4 mg/2 ml inj. Ampul 60 0 60 0 60

1 Gemfibrozil kapsul 300 mg Tablet 525 0 525 24 501
2 Kalsium Atorvastatin Tablet 6403 0 6403 474 5929
3 Lipitor 20 mg Tablet 0 0 0 0 0
4 Simvastatin tab 10 mg Tablet 2754 0 2754 860 1894
(54) NOOTROPIK
1 Piracetam 400 mg Tablet 654 0 654 260 394 500
2 Piracetam inj 1 g/5 ml Ampul 10
(55) IMMUNDILATOR
2 Imunos tablet Tablet 281 0 281 60 221
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 100 0 100 100 0
6 Combipack pcs
7 Fluconazole 150 mg tablet
8 Haldol inj. ampul 16 0 16 0 16
11 Handscoon pcs
17 Micropipet pcs
18 pH Paper pcs
(59) OBAT GIGI

1 Alvogyl (Septodont) Botol 10 g 7 0 7 0 7
2 Caustener rapid Botol 6,5 g 4 0 4 0 4
3 Cavit (Tumpatan sementara) Set 26 0 26 0 26
4 Cresophene (Septodont) Botol 7,5 g 14 0 14 0 14
5 Elite semen Botol 3 0 3 0 3
6 Estelite Composite Set 6 0 6 0 6
7 Ectsa gel (Denta merica) Syringe 12 g 9 0 9 0 9
8 Eugenol Botol 10 ml 32 0 32 0 32
9 Forinokresol / Formocresol Botol 10 ml 0 0 0 0 0
10 Glass Ionomer Cement (Fuji II LC) Set 3 0 3 0 3
11 Glass Ionomer Cement (Fuji IX) Set 15 0 15 0 15
12 Kalsium Hidroksida pasta Tube 14 0 14 0 14
13 Klorfenol Kamfer Mentol (CHKM) Botol 20 ml 6 0 6 0 6
14 Mumifying pasta Botol 7 g 10 0 10 0 10
15 Spongostan Pcs 150 0 150 0 150
16 Te-econom bond Botol 7 0 7 0 7
17 Temporary Stopping Fletcher Botol 14 0 14 0 14
18 Tooth Cleansing (Occo) Botol 15 ml 15 0 15 0 15
19 Vinafluor Tablet 2 0 2 0 2

1 Bufacomb Iob (Zenith) Tube 47 0 47 2 45
2 Gentian violet 1% Botol 10 ml 30 0 30 3 27
3 Minosep gargle 0.2% Botol 60 ml 24 0 24 0 24

3 Alat suntik 1xpakai 1 ml Pcs 395 0 395 100 295
4 Alat Suntik 1xpakai 3 ml Pcs 195 0 195 0 195 1,000
7 Aqua pro injeksi Vial 40 0 40 10 30 100
8 Aquadest steril 500 ml Botol 500 ml 4 0 4 0 4
9 Blood Lancet Pcs 0 0 0 0 0
10 Blue tape Pcs 0 0 0 0 0
11 Cat-gut dg jarum 2/0 Sachet 10 0 10 0 10
12 Cat-gut dg jarum 3/0 Sachet 148 0 148 0 148
13 Catton swap Pcs 0 0 0 0 0
14 Cerplast Pcs 0 0 0 0 0
15 Cover glass Pcs 0 0 0 0 0
16 Folley Cath 12 Pcs 20 0 20 0 20
17 Folley Cath 16 Pcs 20 0 20 0 20
18 Folley Cath 18 Pcs 20 0 20 0 20
24 Handscoon uk. L Pcs 2650 0 2650 100 2550
25 Handscoon uk. M Pcs 12400 0 12400 300 12100
26 Handscoon uk. S Pcs
27 Hipavix 5 x 5 m Rol 11 0 11 4 7
30 I.V. Catheter 18 Pcs 100 0 100 0 100
31 I.V. Catheter 20 Pcs 305 0 305 0 305
32 I.V. Catheter 22 Pcs 324 0 324 20 304
33 I.V. Catheter 24 Pcs 357 0 357 57 300
34 Infusion set anak Pcs 135 0 135 35 100
35 Infusion set dewasa Pcs 10 50 60 30 30 200
36 Jarum jahit (bedah) no. 13 Pcs 36 0 36 0 36
39 Jarum Jahit (bedah) no. 12 Pcs 88 0 88 0 88
40 Jarum Suntik no. 25 Pcs 1250 0 1250 0 1250
44 Kapas pembalut 250 g Bungkus 11 0 11 1 10 6
48 Kasa Pembalut 1 yard 40m x 80 Rol 45 0 45 2 43
49 Kasa pembalut 2 m x 80 cm Rol
50 Kasa pembalut hid 4 x 10 cm Rol 193 0 193 0 193
51 Kasa pembalut hid 4 x 5 cm Rol 453 0 453 0 453
52 Kasa Steril 16 x 16 cm Pcs 187 0 187 0 187
53 Kertas Puyer Pcs 45000 0 45000 3000 42000
54 Lomatull Pcs 109 0 109 40 69 100
55 Masker Pcs 2900 0 2900 800 2100 1,000
56 Masker O2 anak Pcs 20 0 20 0 20
57 Masker O2 dewasa Pcs 13 0 13 0 13
58 Mesh 11 Lancip Pcs 410 0 410 0 410
59 Microburet Pcs 0 0 0 0 0
60 Nasal Canula Anak Pcs 245 0 245 0 245
61 Nasal Canula Dewasa Pcs 241 0 241 0 241
63 Obyek glass Pcs
66 Plester 2.5 cm x 4.5 m Rol 61 0 61 0 61
68 Pot urine 10 ml Pcs
70 Silk (benang bedah sutra) dg jarum Sachet 9 0 9 0 9
71 Silk tanpa jarum 2/0 Sachet 24 0 24 0 24
72 Silk tanpa jarum 3/0 Sachet 70 0 70 0 70
73 Slim Zuiker Pcs 5 0 5 0 5
74 Sputum pot Pcs
81 Umbilical Pcs
82 Urine Bag Pcs 35 0 35 0 35
83 White tape Pcs
86 Yellow tape Pcs
TOTAL
KUNJUNGAN
MARET 2019 3822 Rp 33.079.500 3.522
Mengetahui :
tgl 8 april 2019
Dr. ARIF RAHMAN NURDIANTO NUR INDAH AL RISMAWATI

NIP. 19870416 201101 2 007 NIP. 196605101989032013
LAPORAN PEMAKAIAN DAN LEMBAR PE
PUSKESMAS : TROSOBO
KECAMATAN :TAMAN
PELAPORAN PERIODE : APRIL 2019
NO NAMA OBAT SATUAN STOK AWAL
1 2 3 4

1 Analsik tab Tablet 1,318
2 Antalgin 500 mg tab Tablet 155
3 Asam Mefenamat 500 mg tab Tablet 22,978
4 Asetosal 100 mg tab Tablet -
5 Aspilets 80 mg tab Tablet 3,147
6 Diklofenak Kalium 50 mg tab Tablet 500
7 Diklofenak Na. 50 mg tab Tablet 9,868
8 Eprinoc tab Tablet -
10 Ibuprofen 200 mg tab Tablet -
11 Ibuprofen 400 mg tab Tablet 110
13 Meloxicam 15 mg tab Tablet -
14 Meloxicam 7,5 mg tab Tablet -
15 Metoklopramid 10 mg Tablet 2,070
16 Metoklopramid inj. 5 mg/ml Ampul 20
17 Molakrim krim Tube 30 g -
18 Nonflamin tab Tablet -
19 Parasetamol 500 mg tab Tablet 63,199
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml -
21 Piroksikam 10 mg tab Tablet 2,094
22 Piroksikam 20 mg tab Tablet -
23 Profenid supp Suppositoria 15
25 Santagesic inj. Ampul -
26 Tramadol injeksi 50 mg/ml Ampul -
27 Tramadol kap 50 mg Tablet 300
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 16,842
(2) ANESTESI LOKAL

2 Ketamin / Ketalar inj. 100 mg/ml Vial 10 ml -

1 Alprazolam 0,5 mg Tablet 1,388
2 Diazepam 2 mg Tablet 1,751
3 Diazepam 5 mg Tablet -
4 Diazepam inj. 5 mg/ 2 ml Ampul 30
5 Fenitoin kapsul 100 mg Kapsu; 1,400
7 Fenobarbital 30 mg Tablet 400
9 Haloperidol 0.5 mg tab Tablet 1,325
10 Haloperidol 1,5 mg Tablet -
11 Haloperidol inj 50 mg/ml Ampul 49
12 Klobazam 10 mg tab Tablet -
13 Klorpromazin HCl 100 mg tab Tablet 4,820
14 Klorpromazin HCl inj 25 mg/ml Ampul -
15 Trifluoperazine 5 mg tab Tablet 1,200
(4) ANTI PARKINSON

1 Levopar tab Tablet 200
2 Triheksifenidil 2 mg Tablet 2,184
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 1,768
2 Deproz 20 mg Tablet -
-
(6) ANTI MIGREN
1 Anti Migren (Komb. Ergot+Kafein) Tablet 900
2 Betahistin Mesilat 6 mg Tablet -
1 Isosorbit Dinitrat 5 mg Tablet -
2 Nifedipin 10 mg Tablet 60

1 Amlodipin 5 mg Tablet 1,709
2 Amlodipin 10 mg Tablet -
3 Bisoprolol Fumarat 5 mg Tablet 7,760
4 Captopril 25 mg Tablet 1,460
5 Furosemid 40 mg Tablet 1,056
6 Furosemid inj. Ampul -
7 H.C.T 25 mg Tablet 4,510
8 Lisinopril 10 mg Tablet -
9 Valsartan tab 80 mg / Diovan 80 Tablet -
10 Valsartan tab 160 mg / Diovan 160 Tablet -
-
(9) GLUKOSIDA JANTUNG -
1 Digoksin 0,25 mg Tablet 500

1 Aminofilin 200 mg Tablet 1,022
2 Aminofilin inj 24 mg Ampul -
3 Bisolvon solution 10 mg/5 ml Botol 50 ml -
4 Bisolvon injeksi 2 mg/ml Ampul -
5 Bricasma inj 0,5 mg/ml Ampul -
6 Deksamethason 0,5 mg Tablet 30,459
7 Deksamethason inj 5 mg/ml Ampul -
8 Efedrin HCl 25 mg Tablet -
10 Methylprednisolon 4 mg Tablet 9,727
11 Prednison 5 mg Tablet -
13 Salbutamol sirup (Astharol) Botol 60 ml -
(11) ANTI TUSIF

2 Kodein 10 mg Tablet 931
4 Tuzalos tab Tablet 1,126
(12) EKSPEKTORAN
1 Ambroxol HCl 30 mg Tablet 3,507
3 Gliseril Guayakolat 100 mg Tablet
4 Hustab sirup Botol 60 ml
5 Hustab tab Tablet
6 OBH Plus Anak Botol 60 ml
(13) ANTI INFLUENZA

1 Alpara tab Tablet
3 Protexinal tab Tablet 3,681
4 Protexinal sirup Botol 60 ml 60
5 Tremenza tab Tablet 1,562
(14) ANTASIDA
1 Antasida DOEN I tab Tablet 9,397
3 Cimetidin 200 mg Tablet 1,368
4 Cytotec Tablet -
5 Famotidine 20 mg Tablet -
6 Omeprazole kap 20 mg Tablet -
7 Ranitidin tab 150 mg Tablet 3,732
9 Sanmag suspensi Botol 120 ml -
10 Sanmag tab Tablet 1,706

2 D5 + 1/2 NS Botol 500 ml -
3 D5 + 1/4 NS Botol 500 ml -
4 Dehaf Sachet
7 L-Bio Sachet
8 Loperamide Tablet 1,000
9 Molagit tab Tablet 684
11 Na. Klorida 0,9% piggy bag Botol 100 ml -
12 Neo Kaolana suspensi Botol 60 ml -
13 New Diaform Tablet 1,000
(16) LAKSAN
1 Bicolax tab 5 mg Tablet -
2 Dulcolax supp 5 mg Suppositoria -
3 Stolax supp 10 mg Suppositoria -
(17) ANTI SPASMODIK

1 Atropin Sulfat inj 0,25 mg/ml Ampul 200
2 Braxidin tab Tablet 288
3 Buscopan inj Ampul 4
4 Buscopan tab Tablet 168
(18) ANTI HISTAMIN

2 Cetirizine tab 10 mg Tablet 1,810
3 Difenhidramin inj Ampul -
4 Klorfeniramin Maleat 4 mg Tablet 48,624
5 Loratadine 10 mg Tablet 924

3 Glukose 40% inj 25 ml Ampul 70


1 Glibenklamid 5 mg Tablet 6,715
2 Glimipiride 2 mg Tablet 11,485
3 Metformin tab 500 mg Tablet 7,049


1 Anemolat tab / Asam folat tab Tablet 600
2 Asam Askorbat 50 mg Tablet -
5 Caldece tab effervecent Tablet -
6 Cavit D3 Tablet -
7 Elkana sirup Botol 60 ml -
8 Elkana tab Tablet -
9 Glucosamin tab Tablet -
11 Kalsium Laktat 500 mg Tablet 931
12 Neurosanbe 5000 Tablet -
14 Neurosanbe Plus Tablet -
15 Neurosanbe tab Tablet 890
17 Pharmaton Vit Tablet -
18 Piridoksin 10 mg (Vit. B6) Tablet 32,382
19 Procurma Plus sirup Botol 60 ml -
21 Sianokobalamin tab Tablet 4,161
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul -
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 5,322
24 Vit. B kompleks Tablet 4,209

1 Amoksisilin 500 mg Tablet 259
2 Amoksisilin inj. Ampul -
8 Biothicol sirup kering Botol 60 ml 11
9 Cefadroxil 500 mg Kaplet 1,414
12 Cefixime kapsul 100 mg Kapsul -
16 Ciprofloxacin 500 mg Tablet 1,286
21 Eritromisin 500 mg Kaplet 1,272
23 Gentamisin inj. 40 mg/ml Ampul -
27 Kotrimoksasol 480 mg Tablet 20,633
32 Spyramisin 500 mg Tablet 1,060
34 Thiamphenikol 500 mg Tablet 1
(25) ANTI VIRUS

2 Acyclovir 400 mg tab Tablet 6,660
(26) ANTI FUNGI

2 Ketokonazol 200 mg Tablet -


3 H2O2 3% Botol 1000 ml 21
4 Klorin Botol 500 ml 21
5 Lisol 50% Botol 1000 ml 14
6 Paraformaldehid 1 g Tablet -
(29) ANTELMENTIK
4 Pirantel 125 mg Tablet 500
(30) ANTI AMUBIASIS


1 Besi (II) Sulfat tab Sachet 54,506
2 Besi sirup Botol 150 ml -
3 Sianokobalamin inj (Vit. B 12) Ampul 90
(32) HEMOSTATIK
3 Fitomenadion 10 mg (Vit. K) Tablet 1,020
5 Magnesium Sulfat 20% Vial 9

(34) SERUM
1 ABU I Polivalen 5 ml Vial 2
2 ATS 1.500 IU Ampul 20
(35) OKSITOSIK

1 Papaverin 40 mg Tablet 499

2 Betason N krem Tube -

(39) ANTI BAKTERI

1 Anti Bakteri DOEN s.k Tube -
2 Gentamisin salep kulit 0,1% Tube -

1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 220
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 4
2 Scabicide Tube 10
(42) ANTI SEPTIK

1 P.K serbuk 5 gram Botol 24

1 Ikhtamol salep 15 g Pot 38
2 Salisil bedak 2% Kotak 19


1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 24


-
(48) ANTI INFEKSI THT -
-
(49) LAIN-LAIN INFEKSI THT -

(51) ANTI HEMOROID

1 Anti Hemoroid supp Suppositoria 449
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 1,078
3 Domperidon tab Tablet 5,013
4 Mediamer B6 Tablet -
5 Ondansetron 8 mg tab Tablet 3,046

2 Kalsium Atorvastatin Tablet 5,929
3 Lipitor 20 mg Tablet -
4 Simvastatin tab 10 mg Tablet 1,894
(54) NOOTROPIK
(55) IMMUNDILATOR
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet -
6 Combipack pcs
8 Haldol inj. ampul 16
11 Handscoon pcs
17 Micropipet pcs
18 pH Paper pcs
(59) OBAT GIGI

4 Cresophene (Septodont) Botol 7,5 g 14
9 Forinokresol / Formocresol Botol 10 ml -
10 Glass Ionomer Cement (Fuji II LC) Set 3
14 Mumifying pasta Botol 7 g 10
18 Tooth Cleansing (Occo) Botol 15 ml 15

1 Bufacomb Iob (Zenith) Tube 45

4 Alat Suntik 1xpakai 3 ml Pcs 1,300
8 Aquadest steril 500 ml Botol 500 ml 4
9 Blood Lancet Pcs
10 Blue tape Pcs
13 Catton swap Pcs
14 Cerplast Pcs
15 Cover glass Pcs
24 Handscoon uk. L Pcs 2,550
44 Kapas pembalut 250 g Bungkus 10
49 Kasa pembalut 2 m x 80 cm Rol -
53 Kertas Puyer Pcs 42,000
54 Lomatull Pcs 69
55 Masker Pcs 2,100
59 Microburet Pcs
63 Obyek glass Pcs
66 Plester 2.5 cm x 4.5 m Rol 61
70 Silk (benang bedah sutra) dg jarum Sachet 9
74 Sputum pot Pcs
81 Umbilical Pcs
82 Urine Bag Pcs 35
83 White tape Pcs
86 Yellow tape Pcs
APRIL 2019 4187 Rp.28.031.500
Mengetahui :
KABUPATEN SIDOARJO
dr. ARIF RAHMAN NURDIANTO.

NIP. 19870416201101 1 007
N DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
DOKUMEN TANGGAL
PUSKESMAS
GFK
PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
5 6 7 8 9
- 1,318 348 970

- 155 155 -
- 22,978 5,765 17,213
- - - -
- 3,147 80 3,067
- 500 - 500
5,600 15,468 2,086 13,382
- - - -
- 199 60 139
- - - -
110 110 -
- 70 - 70
- - - -
- - - -
- 2,070 - 2,070
- 20 - 20
- - - -
- - - -
10,000 73,199 4,352 68,847
300 300 56 244
- 2,094 560 1,534
- - - -
- 15 1 14
- 105 10 95
100 100 11 89
- - - -
- 300 - 300
- 16,842 980 15,862
- 16 - 16
- - - -
- 250 - 250
- 860 - 860
- 1,388 187 1,201

- 1,751 10 1,741
- - - -
- 30 - 30
- 1,400 90 1,310
- - - -
- 400 - 400
- 120 - 120
- 1,325 1,020 305
3,000 3,000 - 3,000
- 49 - 49
- - - -
- 4,820 600 4,220
- - - -
- 1,200 60 1,140
- 13 8 5
- 200 - 200
- 2,184 495 1,689
- 1,768 280 1,488

- - - -
- - - -
- -
- 900 10 890
500 500 16 484
500 500 30 470
3,000 3,060 340 2,720
9,000 10,709 2,075 8,634

- - - -
- 7,760 260 7,500
1,000 2,460 945 1,515
- 1,056 40 1,016
- - - -
- 4,510 400 4,110
- - - -
- - - -
- - - -
- - - -
- - - -
- 500 500 -
- 1,022 - 1,022
- - - -
- - - -
- - - -
- - - -
- 30,459 6,785 23,674
100 100 10 90
- - - -
- 485 - 485
3,000 12,727 1,500 11,227
- - - -
5,000 5,094 418 4,676
- - - -
- 400 8 392
- 44 44 -
1,000 1,931 238 1,693
- - - -
1,500 2,626 1,081 1,545
1,000 4,507 3,127 1,380

- 20 4 16
- 34 16 18
- 41 6 35
- 3,681 495 3,186

- 60 - 60
- 1,562 544 1,018
16,800 26,197 4,534 21,663

300 416 24 392
- 1,368 150 1,218
- - - -
- - - -
2,910 2,910 414 2,496
- 3,732 798 2,934
100 130 - 130
- - - -
1,000 2,706 306 2,400
40 40 3 37
20 20 - 20
- 1,000 - 1,000
- 684 112 572
- 135 - 135
- - - -
24 24 - 24
- 1,000 594 406
200 549 36 513
60 65 34 31
1,000 1,481 30 1,451
450 450 32 418

36 36 16 20
50 50 - 50
- 200 - 200
600 888 284 604
15 19 2 17
- 168 40 128
4,340 6,150 1,469 4,681

90 90 10 80
- 48,624 3,461 45,163
- 924 185 739
20 38 5 33
- 70 50 20
20 36 5 31
- 6,715 610 6,105

- 11,485 1,625 9,860
50,000 57,049 7,049 50,000
- 600 - 600
14,000 14,000 1,978 12,022
- 80 40 40
24 72 - 72
- - - -
1,000 1,000 120 880
- - - -
500 500 - 500
- - - -
- 400 110 290
5,700 6,631 3,090 3,541
- - - -
30 50 - 50
- - - -
1,000 1,890 441 1,449
- 321 66 255
- - - -
- 32,382 5,021 27,361
- - - -
- 68 68 -
10,000 14,161 1,310 12,851
- - - -
13,600 18,922 3,090 15,832
30,000 34,209 4,852 29,357
30,000 30,259 5,017 25,242

- - - -
- 306 52 254
- 11 7 4
15,000 16,414 2,524 13,890
2,000 2,000 160 1,840
100 110 10 100

5,000 6,286 480 5,806
- 1,272 7 1,265
- 82 32 50
- - - -
- 690 60 630
- 169 24 145
- 20,633 2,672 17,961
300 335 37 298
1,000 1,279 425 854
- 1,060 1,060 -
3,000 3,001 1,532 1,469
- 6,660 370 6,290

- 25 20 5
- 295 30 265
1,500 1,500 120 1,380
600 723 323 400
10 27 4 23
- 21 - 21
- 21 1 20
10 24 1 23
- - - -
10 12 2 10
10 19 3 16
10 34 3 31
- 500 4 496
- 54,506 6,600 47,906

- - - -
- 90 20 70
-
700 1,720 140 1,580

- 308 - 308
9 9
- 2 - 2
- 20 2 18
1,000 1,986 10 1,976

200 300 - 300
100 178 - 178
- 499 394 105
- 312 48 264
- - - -
- 88 53 35
15 31 - 31
100 100 26 74
100 100 52 48
- 99 39 60
50 124 24 100
- 220 104 116

- 174 2 172
72 96 40 56
192 196 14 182

- 10 2 8
- 24 - 24
- 38 38 -
30 49 14 35
- 24 - 24
- 48 2 46
- 215 45 170
- 53 14 39
- 127 1 126
- 208 11 197
- - - -
- - - -
30 85 17 68
- - - -
- - - -
- 53 7 46
- 449 118 331
2,000 3,078 1,100 1,978

- 115 10 105
- 5,013 144 4,869
- - - -
360 3,406 308 3,098
- 60 50 10
- 501 - 501
600 6,529 380 6,149
- - - -
- 1,894 845 1,049
- 394 290 104
- 221 - 221
150 150 100 50
- 16 - 16
800 946 232 714
- 7 - 7
- 4 - 4
- 26 - 26
- 14 - 14
- 3 - 3
- 6 - 6
- 9 - 9
- 32 - 32
- - - -
- 3 - 3
- 15 - 15
- 14 - 14
- 6 - 6
- 10 - 10
- 150 - 150
- 7 - 7
- 14 - 14
- 15 - 15
- 2 - 2
- 45 8 37
- 27 7 20
- 24 - 24
- 295 - 295
1,000 2,300 600 1,700
- 695 100 595
- 195 195 -
120 150 10 140
- 4 4 -
- 10 - 10
- 148 - 148
- 20 - 20
20 40 - 40
10 30 - 30
- 2,550 200 2,350

- 12,100 400 11,700
- - - -
- 7 4 3
- 100 - 100
- 305 - 305
- 304 36 268
- 300 20 280
- 100 - 100
200 230 30 200
36 72 - 72
- 24 - 24
- 24 - 24
- 88 - 88
800 2,050 100 1,950
10 20 1 19
- 43 3 40
- - - -
- 193 150 43
- 453 100 353
- 187 - 187
- 42,000 120 41,880
200 269 35 234
1,250 3,350 750 2,600
- 20 - 20
- 13 - 13
2 412 - 412
- 245 - 245
- 241 - 241
- 61 18 43
- 9 - 9
36 60 - 60
- 70 - 70
25 30 - 30
100 135 - 135
TOTAL
KUNJUNGAN
3.205

PUSKESMAS TROSOBO
Tgl,7 Mei 2019

NIP. 196605101989032013
PARAF
KETERANGAN
10

KECAMATAN :TAMAN PUSKESMAS
PELAPORAN PERIODE : APRIL 2019 (APBD) GFK
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET.
1 2 3 4 5 6 7 8 9 10

1 Analsik tab Tablet 1,318 - 1,318 348 970
2 Antalgin 500 mg tab Tablet 155 - 155 155 -
5 Aspilets 80 mg tab Tablet -
6 Diklofenak Kalium 50 mg tab Tablet 500 - 500 - 500
7 Diklofenak Na. 50 mg tab Tablet 5,600 5,600 - 5,600
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 90 - 90 - 90
11 Ibuprofen 400 mg tab Tablet 110 110 110 -
14 Meloxicam 7,5 mg tab Tablet - - - - -
15 Metoklopramid 10 mg Tablet 2,070 - 2,070 - 2,070
19 Parasetamol 500 mg tab Tablet 63,199 10,000 73,199 4,352 68,847
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml - 300 300 56 244
22 Piroksikam 20 mg tab Tablet - - - - -
23 Profenid supp Suppositoria 15 - 15 1 14
24 Proris supp Suppositoria 105 - 105 10 95
25 Santagesic inj. Ampul - 100 100 11 89
27 Tramadol kap 50 mg Tablet 300 - 300 - 300
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 7,500 - 7,500 - 7,500
(2) ANESTESI LOKAL

1 Etil Klorida semprot Botol 100 ml 16 - 16 - 16
3 Lidokain inj 2% (HCl) / 2 ml Ampul 250 - 250 - 250
4 Lidokain komb inj / 2 ml Ampul 750 - 750 - 750

1 Alprazolam 0,5 mg Tablet 1,388 - 1,388 187 1,201
3 Diazepam 5 mg Tablet - - - - -
4 Diazepam inj. 5 mg/ 2 ml Ampul 30 - 30 - 30
5 Fenitoin kapsul 100 mg Kapsu; 400 - 400 - 400
7 Fenobarbital 30 mg Tablet 400 - 400 - 400
9 Haloperidol 0.5 mg tab Tablet -
10 Haloperidol 1,5 mg Tablet - 3,000 3,000 - 3,000
11 Haloperidol inj 50 mg/ml Ampul 49 - 49 - 49
13 Klorpromazin HCl 100 mg tab Tablet 4,820 - 4,820 600 4,220
15 Trifluoperazine 5 mg tab Tablet 1,200 - 1,200 60 1,140
16 Stesolid rectal 5 mg Tube 13 - 13 8 5
(4) ANTI PARKINSON

1 Levopar tab Tablet 200 - 200 - 200
2 Triheksifenidil 2 mg Tablet 2,184 - 2,184 495 1,689
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 1,768 - 1,768 280 1,488
- - - - -
(6) ANTI MIGREN - -
1 Anti Migren (Komb. Ergot+Kafein) Tablet 900 - 900 10 890
2 Betahistin Mesilat 6 mg Tablet - 500 500 16 484

1 Isosorbit Dinitrat 5 mg Tablet - 500 500 30 470
2 Nifedipin 10 mg Tablet 60 3,000 3,060 340 2,720

1 Amlodipin 5 mg Tablet - 9,000 9,000 366 8,634
2 Amlodipin 10 mg Tablet - - - - -
3 Bisoprolol Fumarat 5 mg Tablet 1,000 - 1,000 1,000
4 Captopril 25 mg Tablet 1,460 1,000 2,460 945 1,515
5 Furosemid 40 mg Tablet 1,056 - 1,056 40 1,016
6 Furosemid inj. Ampul - - - - -
7 H.C.T 25 mg Tablet 4,510 - 4,510 400 4,110
8 Lisinopril 10 mg Tablet - - - - -
9 Valsartan tab 80 mg / Diovan 80 Tablet - - - - -
- - - - -
(9) GLUKOSIDA JANTUNG - - - - -
1 Digoksin 0,25 mg Tablet 500 - 500 500 -
1 Aminofilin 200 mg Tablet 1,022 - 1,022 - 1,022
2 Aminofilin inj 24 mg Ampul - - - - -
3 Bisolvon solution 10 mg/5 ml Botol 50 ml - - - - -
4 Bisolvon injeksi 2 mg/ml Ampul - - - - -
5 Bricasma inj 0,5 mg/ml Ampul - - - - -
6 Deksamethason 0,5 mg Tablet 20,000 - 20,000 20,000
7 Deksamethason inj 5 mg/ml Ampul - 100 100 10 90
8 Efedrin HCl 25 mg Tablet - - - - -
9 Epinefrin inj. Ampul 335 - 335 - 335
10 Methylprednisolon 4 mg Tablet 1,000 3,000 4,000 - 4,000
11 Prednison 5 mg Tablet - - - - -
12 Salbutamol 2 mg Tablet 94 5,000 5,094 418 4,676
14 Ventolin Nebulizer Ampul 300 - 300 300
(11) ANTI TUSIF

1 Dexmolex sirup Botol 100 ml 44 - 44 44 -
2 Kodein 10 mg Tablet 931 1,000 1,931 238 1,693
4 Tuzalos tab Tablet 1,126 1,500 2,626 1,081 1,545
(12) EKSPEKTORAN
1 Ambroxol HCl 30 mg Tablet 3,507 1,000 4,507 3,127 1,380
2 Ambroxol syrup Botol 60 ml 20 - 20 4 16
3 Gliseril Guayakolat 100 mg Tablet
5 Hustab tab Tablet
7 OBH Plus Dewasa Botol 60 ml 34 - 34 16 18
8 Sanadryl Expectorant Botol 60 ml 41 - 41 6 35
(13) ANTI INFLUENZA

1 Alpara tab Tablet
3 Protexinal tab Tablet 3,681 - 3,681 495 3,186
4 Protexinal sirup Botol 60 ml 60 - 60 - 60
5 Tremenza tab Tablet 1,562 - 1,562 544 1,018
(14) ANTASIDA
1 Antasida DOEN I tab Tablet 9,397 16,800 26,197 4,534 21,663
2 Antasida DOEN II sirup Botol 60 ml 116 300 416 24 392
6 Omeprazole kap 20 mg Tablet - 2,910 2,910 414 2,496
7 Ranitidin tab 150 mg Tablet 3,732 - 3,732 798 2,934
8 Ranitidin inj 25 mg/2 ml Ampul 100 100 - 100
10 Sanmag tab Tablet 1,706 1,000 2,706 306 2,400

2 D5 + 1/2 NS Botol 500 ml - 40 40 3 37
3 D5 + 1/4 NS Botol 500 ml - 20 20 - 20
4 Dehaf Sachet
7 L-Bio Sachet
8 Loperamide Tablet 1,000 - 1,000 - 1,000
9 Molagit tab Tablet 684 - 684 112 572
10 Na. Klorida 0,9% infus Botol 500 ml 135 - 135 - 135
12 Neo Kaolana suspensi Botol 60 ml - 24 24 - 24
13 New Diaform Tablet 1,000 - 1,000 594 406
14 Oralit 200 ml Sachet 349 200 549 36 513
15 Ringer Laktat infus Botol 500 ml 5 60 65 34 31
16 Zink tab dispersible 20 mg Tablet 481 1,000 1,481 30 1,451
(16) LAKSAN
1 Bicolax tab 5 mg Tablet - 450 450 32 418
2 Dulcolax supp 5 mg Suppositoria - 36 36 16 20
3 Stolax supp 10 mg Suppositoria - 50 50 - 50
(17) ANTI SPASMODIK

1 Atropin Sulfat inj 0,25 mg/ml Ampul 200 - 200 - 200
2 Braxidin tab Tablet 288 600 888 284 604
3 Buscopan inj Ampul 4 15 19 2 17
4 Buscopan tab Tablet 168 - 168 40 128
(18) ANTI HISTAMIN

2 Cetirizine tab 10 mg Tablet 1,810 4,340 6,150 1,469 4,681
3 Difenhidramin inj Ampul - 90 90 10 80
4 Klorfeniramin Maleat 4 mg Tablet -
5 Loratadine 10 mg Tablet 924 - 924 185 739

2 Glukose 10% infus 500 ml Botol 500 ml 18 20 38 5 33
3 Glukose 40% inj 25 ml Ampul 70 - 70 50 20
4 Glukose 5% infus 500 ml Botol 500 ml 16 20 36 5 31


1 Glibenklamid 5 mg Tablet 6,715 - 6,715 610 6,105
2 Glimipiride 2 mg Tablet -
3 Metformin tab 500 mg Tablet 50,000 50,000 50,000

1 Anemolat tab / Asam folat tab Tablet 600 - 600 - 600
2 Asam Askorbat 50 mg Tablet - 14,000 14,000 1,978 12,022
3 Becom C kaplet Kaplet 80 - 80 40 40
4 Calcii Gluconas inj Ampul 48 24 72 - 72
5 Caldece tab effervecent Tablet - - - - -
6 Cavit D3 Tablet - 1,000 1,000 120 880
7 Elkana sirup Botol 60 ml - - - - -
8 Elkana tab Tablet - 500 500 - 500
9 Glucosamin tab Tablet - - - - -
10 Hepagard tab Tablet 400 - 400 110 290
11 Kalsium Laktat 500 mg Tablet - 5,700 5,700 876 4,824
12 Neurosanbe 5000 Tablet - - - - -
13 Neurosanbe inj Ampul 20 30 50 - 50
14 Neurosanbe Plus Tablet - - - - -
15 Neurosanbe tab Tablet 890 1,000 1,890 441 1,449
16 Osteotin tab Tablet 321 - 321 66 255
17 Pharmaton Vit Tablet - - - - -
18 Piridoksin 10 mg (Vit. B6) Tablet 19,500 - 19,500 19,500
19 Procurma Plus sirup Botol 60 ml - - - - -
20 Santa E 200 mg tablet hisap Tablet 68 - 68 68 -
21 Sianokobalamin tab Tablet 4,161 10,000 14,161 1,310 12,851
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul - - - - -
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 5,322 13,600 18,922 3,090 15,832
24 Vit. B kompleks Tablet 30,000 30,000 643 29,357

1 Amoksisilin 500 mg Tablet 259 30,000 30,259 5,017 25,242
2 Amoksisilin inj. Ampul - - - - -
3 Amoksisilin sirup kering Botol 60 ml 306 - 306 52 254
8 Biothicol sirup kering Botol 60 ml 11 - 11 7 4
9 Cefadroxil 500 mg Kaplet 1,414 15,000 16,414 2,524 13,890
12 Cefixime kapsul 100 mg Kapsul - 2,000 2,000 160 1,840
14 Cefotaxime injeksi 1 g Ampul 100 100 100
16 Ciprofloxacin 500 mg Tablet 1,286 5,000 6,286 480 5,806
21 Eritromisin 500 mg Kaplet 1,272 - 1,272 7 1,265
22 Eritromisin sirup kering Botol 60 ml 50 - 50 - 50
23 Gentamisin inj. 40 mg/ml Ampul - - - - -
24 Klindamisin 300 mg Kapsul 690 - 690 60 630
26 Kloramfenikol sirup Botol 60 ml 169 - 169 24 145
27 Kotrimoksasol 480 mg Tablet 5,633 - 5,633 2,672 2,961
28 Kotrimoksasol suspensi Botol 60 ml 35 300 335 37 298
29 Levofloksasin 500 mg Tablet 279 1,000 1,279 425 854
32 Spyramisin 500 mg Tablet 1,060 - 1,060 1,060 -
34 Thiamphenikol 500 mg Tablet 1 3,000 3,001 1,532 1,469
(25) ANTI VIRUS

2 Acyclovir 400 mg tab Tablet 4,800 - 4,800 - 4,800
3 Acyclovir cream Tube 25 - 25 20 5
(26) ANTI FUNGI

1 Griseofulvin 125 mg Tablet 295 - 295 30 265
2 Ketokonazol 200 mg Tablet - 1,500 1,500 120 1,380
3 Nistatin 100.000 IU tab.vag Tablet 123 600 723 323 400


2 Etanol 70% Botol 100 ml 17 10 27 4 23
3 H2O2 3% Botol 1000 ml 21 - 21 - 21
4 Klorin Botol 500 ml 21 - 21 1 20
5 Lisol 50% Botol 1000 ml 14 10 24 1 23
7 Povidon Iodida larutan 10% Botol 300 ml 2 10 12 2 10
8 Softa-Man Botol 500 ml 9 10 19 3 16
9 Softaskin Botol 500 ml 24 10 34 3 31
(29) ANTELMENTIK
4 Pirantel 125 mg Tablet 500 - 500 4 496
(30) ANTI AMUBIASIS

1 Besi (II) Sulfat tab Sachet 54,506 - 54,506 6,600 47,906
2 Besi sirup Botol 150 ml - - - - -
3 Sianokobalamin inj (Vit. B 12) Ampul 90 - 90 20 70
(32) HEMOSTATIK
3 Fitomenadion 10 mg (Vit. K) Tablet 990 700 1,690 110 1,580
4 Fitomenadion inj (Vit. K) Ampul 308 - 308 - 308
5 Magnesium Sulfat 20% Vial 9 9 9

(34) SERUM
1 ABU I Polivalen 5 ml Vial 2 - 2 - 2
2 ATS 1.500 IU Ampul 20 - 20 2 18
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 986 1,000 1,986 10 1,976
2 Metilergometrin inj Ampul 100 200 300 - 300
3 Oksitosin inj 10 IU/ml-1 ml Ampul 78 100 178 - 178

1 Papaverin 40 mg Tablet 499 - 499 394 105

1 Betametason krem 0,1% Tube -
2 Betason N krem Tube - - - - -
3 Hidrokortison krem 2,5% Tube -

1 Bioplacenton gel Tube 16 15 31 - 31
(39) ANTI BAKTERI

1 Anti Bakteri DOEN s.k Tube - 100 100 26 74
2 Gentamisin salep kulit 0,1% Tube - 100 100 52 48
3 Kloramfekort H krem Tube 99 - 99 39 60
4 Oksitetrasiklin HCl sk 3% Tube 74 50 124 24 100

1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 220 - 220 104 116
2 Ketokonazol cream 2% Tube -
3 Miconazol cream 2% Tube 24 72 96 40 56
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 4 192 196 14 182
2 Scabicide Tube 10 - 10 2 8
(42) ANTI SEPTIK

1 P.K serbuk 5 gram Botol 24 - 24 - 24

1 Ikhtamol salep 15 g Pot 38 - 38 38 -
2 Salisil bedak 2% Kotak 19 30 49 14 35


1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 24 - 24 - 24

1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 48 - 48 2 46
2 Kloramfenikol 0,5% t.m Botol 5 ml 215 - 215 45 170
3 Kloramfenikol 1% s.m Tube 5 g 53 - 53 14 39
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 127 - 127 1 126

2 Cendolyteers tetes mata Botol 5 ml 208 - 208 11 197
- - - - -
(48) ANTI INFEKSI THT - - - - -
1 Kloramfenikol 3% t.t Botol 55 30 85 17 68
- - - - -
(49) LAIN-LAIN INFEKSI THT - - - - -
1 Fenol gliserol 10% t.t Botol 53 - 53 7 46

(51) ANTI HEMOROID

1 Anti Hemoroid supp Suppositoria -
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 1,078 2,000 3,078 1,100 1,978
2 Domperidon sirup Botol 60 ml 115 - 115 10 105
3 Domperidon tab Tablet 513 - 513 144 369
4 Mediamer B6 Tablet - - - - -
5 Ondansetron 8 mg tab Tablet 360 360 360
6 Ondansetron 4 mg/2 ml inj. Ampul 60 - 60 50 10

1 Gemfibrozil kapsul 300 mg Tablet 501 - 501 - 501
2 Kalsium Atorvastatin Tablet 600 600 600
4 Simvastatin tab 10 mg Tablet 1,894 - 1,894 845 1,049
(54) NOOTROPIK
1 Piracetam 400 mg Tablet 394 - 394 290 104
(55) IMMUNDILATOR
2 Imunos tablet Tablet 221 - 221 - 221
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet - 150 150 100 50
6 Combipack pcs
8 Haldol inj. ampul 16 - 16 - 16
11 Handscoon pcs
17 Micropipet pcs
18 pH Paper pcs
(59) OBAT GIGI

1 Alvogyl (Septodont) Botol 10 g 7 - 7 - 7
2 Caustener rapid Botol 6,5 g 4 - 4 - 4
3 Cavit (Tumpatan sementara) Set 26 - 26 - 26
4 Cresophene (Septodont) Botol 7,5 g 14 - 14 - 14
5 Elite semen Botol 3 - 3 - 3
6 Estelite Composite Set 6 - 6 - 6
7 Ectsa gel (Denta merica) Syringe 12 g 9 - 9 - 9
8 Eugenol Botol 10 ml 32 - 32 - 32
9 Forinokresol / Formocresol Botol 10 ml - - - - -
10 Glass Ionomer Cement (Fuji II LC) Set 3 - 3 - 3
11 Glass Ionomer Cement (Fuji IX) Set 15 - 15 - 15
12 Kalsium Hidroksida pasta Tube 14 - 14 - 14
13 Klorfenol Kamfer Mentol (CHKM) Botol 20 ml 6 - 6 - 6
14 Mumifying pasta Botol 7 g 10 - 10 - 10
15 Spongostan Pcs 150 - 150 - 150
16 Te-econom bond Botol 7 - 7 - 7
17 Temporary Stopping Fletcher Botol 14 - 14 - 14
18 Tooth Cleansing (Occo) Botol 15 ml 15 - 15 - 15
19 Vinafluor Tablet 2 - 2 - 2

1 Bufacomb Iob (Zenith) Tube 45 - 45 8 37
2 Gentian violet 1% Botol 10 ml 27 - 27 7 20
3 Minosep gargle 0.2% Botol 60 ml 24 - 24 - 24

4 Alat Suntik 1xpakai 3 ml Pcs 1,300 1,000 2,300 600 1,700
5 Alat suntik 1xpakai 5 ml Pcs 695 - 695 100 595
6 Alat suntik 1xpakai 10 ml Pcs 195 - 195 195 -
7 Aqua pro injeksi Vial 30 120 150 10 140
8 Aquadest steril 500 ml Botol 500 ml 4 - 4 4 -
9 Blood Lancet Pcs
10 Blue tape Pcs
13 Catton swap Pcs
14 Cerplast Pcs
15 Cover glass Pcs
16 Folley Cath 12 Pcs 20 - 20 - 20
17 Folley Cath 16 Pcs 20 20 40 - 40
18 Folley Cath 18 Pcs 20 10 30 - 30
24 Handscoon uk. L Pcs -
25 Handscoon uk. M Pcs 6,000 - 6,000 - 6,000
27 Hipavix 5 x 5 m Rol 7 - 7 4 3
30 I.V. Catheter 18 Pcs 100 - 100 - 100
31 I.V. Catheter 20 Pcs - -
33 I.V. Catheter 24 Pcs 300 - 300 20 280
34 Infusion set anak Pcs 100 - 100 - 100
35 Infusion set dewasa Pcs 30 200 230 30 200
36 Jarum jahit (bedah) no. 13 Pcs 36 36 72 - 72
39 Jarum Jahit (bedah) no. 12 Pcs 88 - 88 - 88
40 Jarum Suntik no. 25 Pcs 1,250 800 2,050 100 1,950
44 Kapas pembalut 250 g Bungkus 10 10 20 1 19
48 Kasa Pembalut 1 yard 40m x 80 Rol 43 - 43 3 40
49 Kasa pembalut 2 m x 80 cm Rol - - - - -
50 Kasa pembalut hid 4 x 10 cm Rol 193 - 193 150 43
51 Kasa pembalut hid 4 x 5 cm Rol 453 - 453 100 353
52 Kasa Steril 16 x 16 cm Pcs 187 - 187 - 187
53 Kertas Puyer Pcs 42,000 - 42,000 120 41,880
54 Lomatull Pcs 69 200 269 35 234
55 Masker Pcs 2,100 1,250 3,350 750 2,600
56 Masker O2 anak Pcs 20 - 20 - 20
57 Masker O2 dewasa Pcs 13 - 13 - 13
58 Mesh 11 Lancip Pcs 410 2 412 - 412
59 Microburet Pcs
60 Nasal Canula Anak Pcs 245 - 245 - 245
61 Nasal Canula Dewasa Pcs 241 - 241 - 241
63 Obyek glass Pcs
66 Plester 2.5 cm x 4.5 m Rol 61 - 61 18 43
70 Silk (benang bedah sutra) dg jarum Sachet 9 - 9 - 9
71 Silk tanpa jarum 2/0 Sachet 24 36 60 - 60
72 Silk tanpa jarum 3/0 Sachet 70 - 70 - 70
73 Slim Zuiker Pcs 5 25 30 - 30
74 Sputum pot Pcs
81 Umbilical Pcs
82 Urine Bag Pcs 35 100 135 - 135
83 White tape Pcs
86 Yellow tape Pcs
TOTAL
KUNJUNGAN
APRIL 2019 4187 Rp.28.031.500 3.205
Mengetahui :
Sidoarjo, 7 Mei 2019
dr. ARIF RAHMAN NURDIANTO NUR INDAH AL RISMAWATI
NIP. 19870416201101 1 007 NIP. 196605101989032013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OB
PUSKESMAS : TROSOBO
KECAMATAN :TAMAN
PELAPORAN PERIODE : MEI 2019
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN
1 2 3 4 5 6

1 Analsik tab Tablet 970 - 970
2 Antalgin 500 mg tab Tablet - - -
3 Asam Mefenamat 500 mg tab Tablet 17,213 - 17,213
4 Asetosal 100 mg tab Tablet - - -
5 Aspilets 80 mg tab Tablet 3,067 - 3,067
6 Diklofenak Kalium 50 mg tab Tablet 500 - 500
7 Diklofenak Na. 50 mg tab Tablet 13,382 - 13,382
8 Eprinoc tab Tablet - - -
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 139 - 139
10 Ibuprofen 200 mg tab Tablet - - -
11 Ibuprofen 400 mg tab Tablet - 1,000 1,000
12 Meloxicam 15 mg supp Suppositoria 70 - 70
13 Meloxicam 15 mg tab Tablet - - -
14 Meloxicam 7,5 mg tab Tablet - - -
15 Metoklopramid 10 mg Tablet 2,070 - 2,070
16 Metoklopramid inj. 5 mg/ml Ampul 20 - 20
17 Molakrim krim Tube 30 g - - -
18 Nonflamin tab Tablet - - -
19 Parasetamol 500 mg tab Tablet 68,847 - 68,847
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 244 - 244
21 Piroksikam 10 mg tab Tablet 1,534 - 1,534
22 Piroksikam 20 mg tab Tablet - - -
23 Profenid supp Suppositoria 14 - 14
24 Proris supp Suppositoria 95 - 95
25 Santagesic inj. Ampul 89 - 89
26 Tramadol injeksi 50 mg/ml Ampul - - -
27 Tramadol kap 50 mg Tablet 300 - 300
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 15,862 - 15,862
(2) ANESTESI LOKAL
1 Etil Klorida semprot Botol 100 ml 16 - 16
2 Ketamin / Ketalar inj. 100 mg/ml Vial 10 ml - - -
3 Lidokain inj 2% (HCl) / 2 ml Ampul 250 - 250
4 Lidokain komb inj / 2 ml Ampul 860 - 860
5 Xylocain spray Botol 50 ml 5 - 5

1 Alprazolam 0,5 mg Tablet 1,201 - 1,201
2 Diazepam 2 mg Tablet 1,741 - 1,741
3 Diazepam 5 mg Tablet - - -
4 Diazepam inj. 5 mg/ 2 ml Ampul 30 - 30
5 Fenitoin kapsul 100 mg Kapsu; 1,310 - 1,310
6 Fenobarbital 100 mg Tablet - - -
7 Fenobarbital 30 mg Tablet 400 - 400
8 Fenobarbital inj. 50 mg/ml Ampul 120 - 120
9 Haloperidol 0.5 mg tab Tablet 305 600 905
10 Haloperidol 1,5 mg Tablet 3,000 1,000 4,000
11 Haloperidol inj 50 mg/ml Ampul 49 - 49
12 Klobazam 10 mg tab Tablet - - -
13 Klorpromazin HCl 100 mg tab Tablet 4,220 - 4,220
14 Klorpromazin HCl inj 25 mg/ml Ampul - - -
15 Trifluoperazine 5 mg tab Tablet 1,140 - 1,140
16 Stesolid rectal 5 mg Tube 5 - 5
(4) ANTI PARKINSON

1 Levopar tab Tablet 200 - 200
2 Triheksifenidil 2 mg Tablet 1,689 - 1,689
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 1,488 1,000 2,488
2 Deproz 20 mg Tablet - - -
- - -
(6) ANTI MIGREN -
1 Anti Migren (Komb. Ergot+Kafein) Tablet 890 - 890
2 Betahistin Mesilat 6 mg Tablet 484 - 484

1 Isosorbit Dinitrat 5 mg Tablet 470 - 470
2 Nifedipin 10 mg Tablet 2,720 - 2,720
3 Nifedipin GITS (Adalat Oros) 30 mg Tablet - - -
4 Propanolol 10 mg Tablet - - -
- - -
(8) ANTI HIPERTENSI-DIURETIKA - - -
1 Amlodipin 5 mg Tablet 8,634 - 8,634
2 Amlodipin 10 mg Tablet - - -
3 Bisoprolol Fumarat 5 mg Tablet 7,500 - 7,500
4 Captopril 25 mg Tablet 1,515 - 1,515
5 Furosemid 40 mg Tablet 1,016 - 1,016
6 Furosemid inj. Ampul - - -
7 H.C.T 25 mg Tablet 4,110 - 4,110
8 Lisinopril 10 mg Tablet - - -
9 Valsartan tab 80 mg / Diovan 80 Tablet - - -
- - -
(9) GLUKOSIDA JANTUNG - - -
1 Digoksin 0,25 mg Tablet - - -
2 Verapamil 80 mg Tablet - - -
- - -
(10) OBAT PD SHOK-ANTI ASMA KORTIKOSTEROID - - -
1 Aminofilin 200 mg Tablet 1,022 - 1,022
2 Aminofilin inj 24 mg Ampul - - -
3 Bisolvon solution 10 mg/5 ml Botol 50 ml - - -
4 Bisolvon injeksi 2 mg/ml Ampul - - -
5 Bricasma inj 0,5 mg/ml Ampul - - -
6 Deksamethason 0,5 mg Tablet 23,674 - 23,674
7 Deksamethason inj 5 mg/ml Ampul 90 - 90
8 Efedrin HCl 25 mg Tablet - - -
9 Epinefrin inj. Ampul 485 - 485
10 Methylprednisolon 4 mg Tablet 11,227 - 11,227
11 Prednison 5 mg Tablet - - -
12 Salbutamol 2 mg Tablet 4,676 - 4,676
13 Salbutamol sirup (Astharol) Botol 60 ml - - -
14 Ventolin Nebulizer Ampul 392 - 392
- - -
(11) ANTI TUSIF - - -
1 Dexmolex sirup Botol 100 ml - - -
2 Kodein 10 mg Tablet 1,693 - 1,693
3 Sanadryl DMP sirup Botol 60 ml - - -
4 Tuzalos tab Tablet 1,545 - 1,545
- - -
(12) EKSPEKTORAN - - -
1 Ambroxol HCl 30 mg Tablet 1,380 200 1,580
2 Ambroxol syrup Botol 60 ml 16 - 16
3 Gliseril Guayakolat 100 mg Tablet - 4,700 4,700
4 Hustab sirup Botol 60 ml - - -
5 Hustab tab Tablet - - -
6 OBH Plus Anak Botol 60 ml - - -
7 OBH Plus Dewasa Botol 60 ml 18 - 18
8 Sanadryl Expectorant Botol 60 ml 35 - 35
(13) ANTI INFLUENZA

1 Alpara tab Tablet
3 Protexinal tab Tablet 3,186 - 3,186
4 Protexinal sirup Botol 60 ml 60 - 60
5 Tremenza tab Tablet 1,018 - 1,018
- - -
(14) ANTASIDA - - -
1 Antasida DOEN I tab Tablet 21,663 - 21,663
2 Antasida DOEN II sirup Botol 60 ml 392 - 392
3 Cimetidin 200 mg Tablet 1,218 - 1,218
4 Cytotec Tablet - - -
5 Famotidine 20 mg Tablet - - -
6 Omeprazole kap 20 mg Tablet 2,496 - 2,496
7 Ranitidin tab 150 mg Tablet 2,934 - 2,934
8 Ranitidin inj 25 mg/2 ml Ampul 130 50 180
9 Sanmag suspensi Botol 120 ml - - -
10 Sanmag tab Tablet 2,400 - 2,400
- - -
(15) OBAT DIARE-KESEIMBANGAN CAIRAN ELEKTROLIT - - -
1 Asering infus Botol 500 ml - - -
2 D5 + 1/2 NS Botol 500 ml 37 - 37
3 D5 + 1/4 NS Botol 500 ml 20 - 20
4 Dehaf Sachet - - -
5 KAEN 3A Botol 500 ml - - -
6 KAEN 3B Botol 500 ml - - -
7 L-Bio Sachet - - -
8 Loperamide Tablet 1,000 - 1,000
9 Molagit tab Tablet 572 600 1,172
10 Na. Klorida 0,9% infus Botol 500 ml 135 - 135
11 Na. Klorida 0,9% piggy bag Botol 100 ml - - -
12 Neo Kaolana suspensi Botol 60 ml 24 - 24
13 New Diaform Tablet 406 1,000 1,406
14 Oralit 200 ml Sachet 513 - 513
15 Ringer Laktat infus Botol 500 ml 31 60 91
16 Zink tab dispersible 20 mg Tablet 1,451 - 1,451
17 Zink sirup 20 mg/5 ml Botol 60 ml - - -
- - -
(16) LAKSAN - - -
1 Bicolax tab 5 mg Tablet 418 - 418
2 Dulcolax supp 5 mg Suppositoria 20 - 20
3 Stolax supp 10 mg Suppositoria 50 - 50
- - -
(17) ANTI SPASMODIK - - -
1 Atropin Sulfat inj 0,25 mg/ml Ampul 200 - 200
2 Braxidin tab Tablet 604 - 604
3 Buscopan inj Ampul 17 - 17
4 Buscopan tab Tablet 128 - 128
5 Buscopan plus Tablet - - -
6 Ekstrak Belladona 10 mg Tablet - - -
- - -
(18) ANTI HISTAMIN - - -
1 Ceterizine sirup Botol 60 ml - - -
2 Cetirizine tab 10 mg Tablet 4,681 - 4,681
3 Difenhidramin inj Ampul 80 - 80
4 Klorfeniramin Maleat 4 mg Tablet 45,163 - 45,163
5 Loratadine 10 mg Tablet 739 - 739
- - -
(19) LARUTAN NUTRISI - - -
1 Aminofluid Softbag 500 ml - - -
2 Glukose 10% infus 500 ml Botol 500 ml 33 - 33
3 Glukose 40% inj 25 ml Ampul 20 - 20
- - -
(20) TIROID ANTAGONIS - - -
1 Propiltiourasil 100 mg Tablet - - -
- - -
(21) ANTI DIABETIK ORAL - - -
1 Glibenklamid 5 mg Tablet 6,105 - 6,105
2 Glimipiride 2 mg Tablet 9,860 - 9,860
3 Metformin tab 500 mg Tablet 50,000 - 50,000
- - -
(22) ANTI DIABETIK PARENTERAL - - -
1 Apidra Solostar 100 IU/ml Pen - - -
2 Lantus Solostar 100 IU/ml Pen - - -
- - -
(23) VITAMIN DAN MINERAL - - -
1 Anemolat tab / Asam folat tab Tablet 600 - 600
2 Asam Askorbat 50 mg Tablet 12,022 - 12,022
3 Becom C kaplet Kaplet 40 - 40
4 Calcii Gluconas inj Ampul 72 - 72
5 Caldece tab effervecent Tablet - - -
6 Cavit D3 Tablet 880 - 880
7 Elkana sirup Botol 60 ml - - -
8 Elkana tab Tablet 500 - 500
9 Glucosamin tab Tablet - - -
10 Hepagard tab Tablet 290 - 290
11 Kalsium Laktat 500 mg Tablet 3,541 - 3,541
12 Neurosanbe 5000 Tablet - - -
13 Neurosanbe inj Ampul 50 - 50
14 Neurosanbe Plus Tablet - - -
15 Neurosanbe tab Tablet 1,449 - 1,449
16 Osteotin tab Tablet 255 - 255
17 Pharmaton Vit Tablet - - -
18 Piridoksin 10 mg (Vit. B6) Tablet 27,361 - 27,361
19 Procurma Plus sirup Botol 60 ml - - -
20 Santa E 200 mg tablet hisap Tablet - - -
21 Sianokobalamin tab Tablet 12,851 - 12,851
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul - - -
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 15,832 - 15,832
24 Vit. B kompleks Tablet 29,357 - 29,357

1 Amoksisilin 500 mg Tablet 25,242 - 25,242
2 Amoksisilin inj. Ampul - - -
3 Amoksisilin sirup kering Botol 60 ml 254 - 254
8 Biothicol sirup kering Botol 60 ml 4 - 4
9 Cefadroxil 500 mg Kaplet 13,890 - 13,890
12 Cefixime kapsul 100 mg Kapsul 1,840 - 1,840
14 Cefotaxime injeksi 1 g Ampul 100 - 100
15 Ceftriaxone injeksi 1 g Ampul - - -
16 Ciprofloxacin 500 mg Tablet 5,806 - 5,806
21 Eritromisin 500 mg Kaplet 1,265 - 1,265
22 Eritromisin sirup kering Botol 60 ml 50 - 50
23 Gentamisin inj. 40 mg/ml Ampul - - -
24 Klindamisin 300 mg Kapsul 630 - 630
26 Kloramfenikol sirup Botol 60 ml 145 - 145
27 Kotrimoksasol 480 mg Tablet 17,961 - 17,961
28 Kotrimoksasol suspensi Botol 60 ml 298 - 298
29 Levofloksasin 500 mg Tablet 854 - 854
32 Spyramisin 500 mg Tablet
34 Thiamphenikol 500 mg Tablet 1,469 - 1,469
(25) ANTI VIRUS

2 Acyclovir 400 mg tab Tablet 6,290 - 6,290
3 Acyclovir cream Tube 5 - 5
(26) ANTI FUNGI

1 Griseofulvin 125 mg Tablet 265 - 265
2 Ketokonazol 200 mg Tablet 1,380 - 1,380
3 Nistatin 100.000 IU tab.vag Tablet 400 - 400


2 Etanol 70% Botol 100 ml 23 - 23
3 H2O2 3% Botol 1000 ml 21 - 21
4 Klorin Botol 500 ml 20 - 20
5 Lisol 50% Botol 1000 ml 23 - 23
6 Paraformaldehid 1 g Tablet - - -
7 Povidon Iodida larutan 10% Botol 300 ml 10 - 10
8 Softa-Man Botol 500 ml 16 - 16
9 Softaskin Botol 500 ml 31 - 31
- - -
(29) ANTELMENTIK - - -
1 Albendazol 400 mg Tablet - - -
2 Mebendazol 100 mg Tablet - - -
3 Mebendazol sirup 30 ml Botol 30 ml - - -
4 Pirantel 125 mg Tablet 496 - 496
- - -
(30) ANTI AMUBIASIS - - -
1 Metronidazol 500 mg Tablet - - -
2 Metronidazol infus Botol 100 ml - - -
- - -
(31) OBAT YG MEMPENGARUHI DARAH, ANTI ANEMIA - - -
1 Besi (II) Sulfat tab Sachet 47,906 - 47,906
2 Besi sirup Botol 150 ml - - -
3 Sianokobalamin inj (Vit. B 12) Ampul 70 - 70
-
(32) HEMOSTATIK - - -
1 Adona AC-17 10 mg Tablet - - -
2 Adona inj 5 ml Ampul - - -
3 Fitomenadion 10 mg (Vit. K) Tablet 1,580 - 1,580
4 Fitomenadion inj (Vit. K) Ampul 308 - 308
5 Magnesium Sulfat 20% Vial 9 - 9
6 Magnesium Sulfat 40% Vial -

(34) SERUM
1 ABU I Polivalen 5 ml Vial 2 - 2
2 ATS 1.500 IU Ampul 18 - 18
- - -
(35) OKSITOSIK - - -
1 Metilergometrin 0,125 mg Tablet 1,976 - 1,976
2 Metilergometrin inj Ampul 300 - 300
3 Oksitosin inj 10 IU/ml-1 ml Ampul 178 - 178
- - -
(36) RELAKSAN UTERUS - - -
1 Papaverin 40 mg Tablet 105 - 105
- - -
(37) ANTI INFLAMASI SALEP - - -
1 Betametason krem 0,1% Tube 264 - 264
2 Betason N krem Tube - - -
3 Hidrokortison krem 2,5% Tube 35 - 35
- - -
(38) PERANGSANG JARINGAN GRANULASI - - -
1 Bioplacenton gel Tube 31 - 31
2 Prontosan Solution Botol 350 ml - - -
3 Prontosan Gel Botol 30 ml - - -
- - -
(39) ANTI BAKTERI - - -
1 Anti Bakteri DOEN s.k Tube 74 - 74
2 Gentamisin salep kulit 0,1% Tube 48 10 58
3 Kloramfekort H krem Tube 60 - 60
4 Oksitetrasiklin HCl sk 3% Tube 100 - 100
- - -
(40) ANTI FUNGI SALEP - - -
1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 116 - 116
2 Ketokonazol cream 2% Tube 172 - 172
3 Miconazol cream 2% Tube 56 - 56
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 182 - 182
2 Scabicide Tube 8 - 8
- - -
(42) ANTI SEPTIK - - -
1 P.K serbuk 5 gram Botol 24 - 24
- - -
(43) LAIN-LAIN OBAT KULIT - - -
1 Ikhtamol salep 15 g Pot - - -
2 Salisil bedak 2% Kotak 35 - 35


1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 24 - 24

1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 46 - 46
2 Kloramfenikol 0,5% t.m Botol 5 ml 170 - 170
3 Kloramfenikol 1% s.m Tube 5 g 39 - 39
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 126 - 126
5 Polidemisin eye drop Botol 5 ml - - -
6 Sulfasetamid Natrium 15% t.m Botol 5 ml - - -
- - -
(47) LAIN-LAIN OBAT MATA - - -
1 Catalin Opth Botol 15 ml - - -
2 Cendolyteers tetes mata Botol 5 ml 197 - 197
- - -
1 Kloramfenikol 3% t.t Botol 68 - 68
- - -
1 Fenol gliserol 10% t.t Botol 46 - 46
- - -
(50) ANTI FILARIASIS -
(51) ANTI HEMOROID

1 Anti Hemoroid supp Suppositoria 331 - 331
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 1,978 - 1,978
2 Domperidon sirup Botol 60 ml 105 - 105
3 Domperidon tab Tablet 4,869 - 4,869
4 Mediamer B6 Tablet - - -
5 Ondansetron 8 mg tab Tablet 3,098 - 3,098
6 Ondansetron 4 mg/2 ml inj. Ampul 10 40 50
- - -
(53) ANTI HIPERKOLESTEROLEMIA - - -
1 Gemfibrozil kapsul 300 mg Tablet 501 - 501
2 Kalsium Atorvastatin Tablet 6,149 - 6,149
3 Lipitor 20 mg Tablet - - -
4 Simvastatin tab 10 mg Tablet 1,049 - 1,049
- - -
(54) NOOTROPIK - - -
1 Piracetam 400 mg Tablet 104 400 504
2 Piracetam inj 1 g/5 ml Ampul 10 - 10
3 Piracetam inj 3 g / 15 ml Ampul - - -
- - -
(55) IMMUNDILATOR - - -
1 Imunos sirup Botol 60 ml - - -
2 Imunos tablet Tablet 221 - 221
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 50 200 250
6 Combipack pcs - - -
7 Fluconazole 150 mg tablet - - -
8 Haldol inj. ampul 16 - 16
9 Haloperidol 1.5 mg tablet - - -
10 Haloperidol 5 mg tablet - 3,000 3,000
11 Handscoon pcs
15 Lodomer inj. ampul 24 24
17 Micropipet pcs
18 pH Paper pcs
20 Risperidon 2 mg tablet 714 - 714
(59) OBAT GIGI

1 Alvogyl (Septodont) Botol 10 g 7 - 7
2 Caustener rapid Botol 6,5 g 4 - 4
3 Cavit (Tumpatan sementara) Set 26 - 26
4 Cresophene (Septodont) Botol 7,5 g 14 - 14
5 Elite semen Botol 3 - 3
6 Estelite Composite Set 6 - 6
7 Ectsa gel (Denta merica) Syringe 12 g 9 - 9
8 Eugenol Botol 10 ml 32 - 32
9 Forinokresol / Formocresol Botol 10 ml - - -
10 Glass Ionomer Cement (Fuji II LC) Set 3 - 3
11 Glass Ionomer Cement (Fuji IX) Set 15 - 15
12 Kalsium Hidroksida pasta Tube 14 - 14
13 Klorfenol Kamfer Mentol (CHKM) Botol 20 ml 6 - 6
14 Mumifying pasta Botol 7 g 10 - 10
15 Spongostan Pcs 150 - 150
16 Te-econom bond Botol 7 - 7
17 Temporary Stopping Fletcher Botol 14 - 14
18 Tooth Cleansing (Occo) Botol 15 ml 15 - 15
19 Vinafluor Tablet 2 - 2

1 Bufacomb Iob (Zenith) Tube 37 - 37
2 Gentian violet 1% Botol 10 ml 20 - 20
3 Minosep gargle 0.2% Botol 60 ml 24 - 24
3 Alat suntik 1xpakai 1 ml Pcs 295 - 295
4 Alat Suntik 1xpakai 3 ml Pcs 1,700 - 1,700
6 Alat suntik 1xpakai 10 ml Pcs
7 Aqua pro injeksi Vial 140 - 140
8 Aquadest steril 500 ml Botol 500 ml
9 Blood Lancet Pcs
10 Blue tape Pcs
11 Cat-gut dg jarum 2/0 Sachet 10 - 10
13 Catton swap Pcs - - -
14 Cerplast Pcs - - -
15 Cover glass Pcs - - -
16 Folley Cath 12 Pcs 20 - 20
19 Folley Cath 20 Pcs - - -
21 Gelang Bayi Lahir Pcs - - -
22 Gelang Ibu Melahirkan Pcs - - -
23 Handscoon Panjang Pcs - - -
24 Handscoon uk. L Pcs 2,350 - 2,350
25 Handscoon uk. M Pcs 11,700 - 11,700
26 Handscoon uk. S Pcs - - -
27 Hipavix 5 x 5 m Rol 3 11 14
28 Holder Pronto Pcs - - -
29 I.V. Catheter 16 Pcs - - -
30 I.V. Catheter 18 Pcs 100 - 100
31 I.V. Catheter 20 Pcs 305 - 305
32 I.V. Catheter 22 Pcs 268 - 268
33 I.V. Catheter 24 Pcs 280 - 280
34 Infusion set anak Pcs 100 - 100
35 Infusion set dewasa Pcs 200 - 200
36 Jarum jahit (bedah) no. 13 Pcs 72 - 72
39 Jarum Jahit (bedah) no. 12 Pcs 88 - 88
40 Jarum Suntik no. 25 Pcs 1,950 - 1,950
41 Jarum Vacutainer 21 Pcs - - -
43 Kapas berlemak 500 g Bungkus - - -
44 Kapas pembalut 250 g Bungkus 19 - 19
48 Kasa Pembalut 1 yard 40m x 80 Rol 40 - 40
49 Kasa pembalut 2 m x 80 cm Rol - - -
50 Kasa pembalut hid 4 x 10 cm Rol 43 - 43
52 Kasa Steril 16 x 16 cm Pcs 187 - 187
53 Kertas Puyer Pcs 41,880 - 41,880
54 Lomatull Pcs 234 - 234
55 Masker Pcs 2,600 - 2,600
56 Masker O2 anak Pcs 20 - 20
57 Masker O2 dewasa Pcs 13 - 13
58 Mesh 11 Lancip Pcs 412 - 412
59 Microburet Pcs
60 Nasal Canula Anak Pcs 245 - 245
61 Nasal Canula Dewasa Pcs 241 - 241
62 Needle Novofine Pcs - - -
63 Obyek glass Pcs - - -
64 Pipet thoma Erythrocyt Pcs - - -
65 Pipet thoma Leucocyt Pcs - - -
66 Plester 2.5 cm x 4.5 m Rol 40 - 40
67 Plester 7.5 cm x 4.5 m Rol - - -
68 Pot urine 10 ml Pcs - - -
69 Sharp Collector Pcs -
70 Silk (benang bedah sutra) dg jarum Sachet 9 - 9
71 Silk tanpa jarum 2/0 Sachet 60 - 60
73 Slim Zuiker Pcs 30 - 30
74 Sputum pot Pcs
81 Umbilical Pcs
82 Urine Bag Pcs 135 - 135
83 White tape Pcs
86 Yellow tape Pcs
TOTAL
KUNJUNGAN
MEI 2019
Mengetahui :
KABUPATEN SIDOARJO
Dr.Arif Rahman Nurdianto.

NIP. 19870416201101 1 997
PERMINTAAN OBAT PUSKESMAS
DOKUMEN TANGGAL PARAF

PUSKESMAS
GFK
PEMAKAIAN SISA STOK PERMINTAAN KETERANGAN
7 8 9 10
287 683
- -
5,596 11,617
- -
2,070 997
40 460
2,796 10,586
- -
11 128
- -
586 414
15 55
- -
- -
- 2,070
- 20
- -
- -
9,879 58,968
83 161
510 1,024
- -
14 -
10 85
32 57
- -
- 300
1,380 14,482
3 13
- -
- 250
70 790
- 5
173 1,028
60 1,681
- -
- 30
1,310 -
- -
- 400
- 120
905 -
- 4,000
5 44
- -
660 3,560
- -
120 1,020
5 -
- 200
620 1,069
225 2,263
- -
- -
- 890
118 366
110 360
240 2,480
- -
- -
- -
- -
- -
1,550 7,084
- -
250 7,250
940 575
145 871
- -
334 3,776
- -
- -
- -
- -
- -
- -
- -
- -
- -
4 1,018
- -
- -
- -
- -
4,684 18,990
20 70
- -
100 385
1,549 9,678
- -
503 4,173
- -
52 340
- -
- -
- -
132 1,561
- -
202 1,343
- -
- -
1,580 -
16 -
1,750 2,950
- -
- -
- -
18 -
28 7
1,023 2,163
15 45
264 754
- -
- -
5,428 16,235
27 365
600 618
- -
- -
548 1,948
1,085 1,849
130 50
- -
605 1,795
- -
- -
- -
11 26
11 9
- -
- -
- -
- -
110 890
745 427
30 105
- -
- 24
388 1,018
113 400
59 32
280 1,171
- -
- -
- -
85 333
12 8
- 50
- -
- -
- 200
305 299
10 7
128 -
- -
- -
- -
- -
- -
898 3,783
60 20
3,974 41,189
459 280
- -
- -
- -
- 33
- 20
- 31
- -
- -
- -
- -
- -
90 6,015
1,873 7,987
5,070 44,930
- -
- -
- -
- -
- -
- -
- 600
3,086 8,936
40 -
- 72
- -
40 840
- -
10 490
- -
16 274
1,785 1,756
- -
10 40
- -
687 762
220 35
- -
18,149 9,212
- -
- -
1,310 11,541
- -
2,828 13,004
5,489 23,868
5,322 19,920
- -
64 190
4 -
1,405 12,485
709 1,131
- 100
- -
660 5,146
8 1,257
- 50
- -
30 600
145 -
3,310 14,651
55 243
390 464
1,105 364
390 5,900
5 -
20 245
50 1,330
137 263
3 20
- 21
1 19
2 21
- -
- 10
10 6
5 26
- -
- -
- -
- -
- -
- 496
- -
- -
- -
- -
- -
- -
9,870 38,036
- -
- 70
-
-
- -
- -
- -
320 1,260
- 308
- 9
-
- 2
2 16
- -
- -
720 1,256
- 300
- 178
- -
- -
105 -
- -
- -
74 190
- -
31 4
- -
- -
14 17
- -
- -
- -
- -
1 73
58 -
16 44
25 75
- -
- -
- 116
39 133
20 36
40 142
7 1
- -
- -
- 24
- -
- -
- -
16 19
- 24
1 45
34 136
6 33
32 94
- -
- -
- -
- -
- -
8 189
- -
11 57
- -
5 41
- -
55 276
1,230 748
11 94
46 4,823
- -
426 2,672
30 20
- -
- -
12 489
606 5,543
- -
970 79
- -
- -
340 164
- 10
- -
- -
- -
- -
8 213
180 70
- -
- -
5 11
- -
30 2,970
4 20
320 394
- 7
- 4
6 20
4 10
- 3
- 6
- 9
5 27
- -
3 -
4 11
- 14
- 6
- 10
30 120
- 7
4 10
4 11
- 2
8 29
4 16
- 24
200 95
300 1,400
- 595
- 140
- 10
- 148
- -
- -
- -
- 20
- 40
- 30
- -
- -
- -
- -
- -
900 1,450
700 11,000
- -
9 5
- -
- -
- 100
60 245
30 238
28 252
- 100
76 124
- 72
- 24
- 24
- 88
250 1,700
- -
- -
- -
2 17
3 37
- -
10 33
- 353
- 187
4,380 37,500
140 94
450 2,150
2 18
10 3
22 390
- 245
5 236
- -
- -
- -
- -
6 34
- -
- -
-
- 9
10 50
20 50
- 30
15 120
PUSKESMAS TROSOBO
Tgl,10 Juni 2019

NIP. 196605101989032013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
OBAT APBD
PUSKESMAS : TROSOBO
KECAMATAN :TAMAN
PELAPORAN PERIODE : MEI 2019
1 2 3 4 5 6

23 Profenid supp Suppositoria 14 - 14
(1c) ANTIPIRAI
(2) ANESTESI LOKAL

4 Lidokain komb inj / 2 ml Ampul -

5 Fenitoin kapsul 100 mg Kapsu; 1,310 - 1,310
9 Haloperidol 0.5 mg tab Tablet
(4) ANTI PARKINSON

(5) ANTI DEPRESI

- - -
(6) ANTI MIGREN -

- - -
5 Furosemid 40 mg Tablet 1,016 - 1,016
7 H.C.T 25 mg Tablet 4,110 - 4,110
- - -
- - -
- - -
- - -
1 Ambroxol HCl 30 mg Tablet 1,380 200 1,580
2 Ambroxol syrup Botol 60 ml 16 - 16
3 Gliseril Guayakolat 100 mg Tablet - 4,700 4,700
(13) ANTI INFLUENZA

1 Alpara tab Tablet
5 Tremenza tab Tablet 1,018 - 1,018
- - -
(14) ANTASIDA - - -
3 Cimetidin 200 mg Tablet 1,218 - 1,218
8 Ranitidin inj 25 mg/2 ml Ampul 100 100
- - -
1 Asering infus Botol 500 ml - - -
2 D5 + 1/2 NS Botol 500 ml 37 - 37
3 D5 + 1/4 NS Botol 500 ml 20 - 20
8 Loperamide Tablet 1,000 - 1,000
9 Molagit tab Tablet 572 600 1,172
10 Na. Klorida 0,9% infus Botol 500 ml -
13 New Diaform Tablet 406 1,000 1,406
- - -
(16) LAKSAN - - -
- - -
4 Buscopan tab Tablet 128 - 128
- - -
- - -
- - -
- - -
- - -
- - -
3 Becom C kaplet Kaplet 40 - 40
15 Neurosanbe tab Tablet 1,449 - 1,449

8 Biothicol sirup kering Botol 60 ml 4 - 4
22 Eritromisin sirup kering Botol 60 ml -
27 Kotrimoksasol 480 mg Tablet 2,961 2,000 4,961
(25) ANTI VIRUS

(26) ANTI FUNGI



2 Etanol 70% Botol 100 ml 23 - 23
3 H2O2 3% Botol 1000 ml 21 - 21
5 Lisol 50% Botol 1000 ml 23 - 23
- - -
- - -
- - -
-

(34) SERUM
2 ATS 1.500 IU Ampul 18 - 18
- - -
- - -
1 Papaverin 40 mg Tablet 105 - 105
- - -
- - -
- - -
2 Gentamisin salep kulit 0,1% Tube 48 10 58
- - -
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 182 - 182
- - -
- - -



- - -
- - -
- - -
- - -
(51) ANTI HEMOROID

(52) ANTI EMETIK

2 Domperidon sirup Botol 60 ml -
3 Domperidon tab Tablet 369 - 469
5 Ondansetron 8 mg tab Tablet 360 - 360
6 Ondansetron 4 mg/2 ml inj. Ampul 10 40 50
- - -
2 Kalsium Atorvastatin Tablet 600 - 600
- - -
3 Piracetam inj 3 g / 15 ml Ampul - - -
- - -
1 Imunos sirup Botol 60 ml - - -
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 50 200 250
11 Handscoon pcs
15 Lodomer inj. ampul 24 24
17 Micropipet pcs
18 pH Paper pcs
20 Risperidon 2 mg tablet 714 - 714
(59) OBAT GIGI



9 Blood Lancet Pcs
10 Blue tape Pcs
13 Catton swap Pcs - - -
14 Cerplast Pcs - - -
15 Cover glass Pcs - - -
28 Holder Pronto Pcs - -
30 I.V. Catheter 18 Pcs 100 - 100
33 I.V. Catheter 24 Pcs 280 - 280
43 Kapas berlemak 500 g Bungkus - - -
55 Masker Pcs 2,600 - 2,600
59 Microburet Pcs
66 Plester 2.5 cm x 4.5 m Rol 40 - 40
74 Sputum pot Pcs
81 Umbilical Pcs
83 White tape Pcs
86 Yellow tape Pcs
TOTAL
KUNJUNGAN
MEI 2019
Mengetahui :
KABUPATEN SIDOARJO
Dr. Arif Rahman Nurdianto.

NIP. 19870416201101 1 007
LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS
GFK
7 8 9 10
287 683
- -
5,596 11,617
- -
40 460
5,600
- -
11 128
- -
586 414
15 55
- -
- -
- 2,070
- 20
- -
- -
9,879 58,968
83 161
510 1,024
- -
14 -
10 85
32 57
- -
- 300
7,500
3 13
- -
- 250
- 5
173 1,028
60 1,681
- -
- 30
1,310 -
- -
- 400
- 120
-
- 4,000
5 44
- -
660 3,560
- -
120 1,020
5 -
- 200
620 1,069
225 2,263
- -
- -
- 890
118 366
110 360
240 2,480
- -
- -
- -
- -
- -
1,550 7,084
- -
1,000
940 575
145 871
- -
334 3,776
- -
- -
- -
- -
- -
- -
- -
- -
- -
4 1,018
- -
- -
- -
- -
20,000
20 70
- -
170
4,000
- -
503 4,173
- -
200
- -
- -
- -
132 1,561
- -
202 1,343
- -
- -
1,580 -
16 -
1,750 2,950
- -
- -
- -
18 -
28 7
1,023 2,163
15 45
264 754
- -
- -
5,428 16,235
27 365
600 618
- -
- -
548 1,948
1,085 1,849
100
- -
605 1,795
- -
- -
- -
11 26
11 9
- -
- -
- -
- -
110 890
745 427
- -
- 24
388 1,018
113 400
59 32
280 1,171
- -
- -
- -
85 333
12 8
- 50
- -
- -
- 200
305 299
10 7
128 -
- -
- -
- -
- -
- -
898 3,783
60 20
459 280
- -
- -
- -
- 33
- 20
- 31
- -
- -
- -
- -
- -
90 6,015
5,070 44,930
- -
- -
- -
- -
- -
- -
- 600
3,086 8,936
40 -
- 72
- -
40 840
- -
10 490
- -
16 274
1,785 1,756
- -
10 40
- -
687 762
220 35
- -
19,500
- -
- -
1,310 11,541
- -
2,828 13,004
5,489 23,868
5,322 19,920
- -
64 190
4 -
1,405 12,485
709 1,131
- 100
- -
660 5,146
8 1,257
-
- -
30 600
145 -
861 4,100
55 243
390 464
1,105 364
4,800
5 -
20 245
50 1,330
137 263
3 20
- 21
1 19
2 21
- -
- 10
10 6
5 26
- -
- -
- -
- -
- -
- 496
- -
- -
- -
- -
- -
- -
9,870 38,036
- -
- 70
-
-
- -
- -
- -
320 1,260
- 308
- 9
-
- 2
2 16
- -
- -
720 1,256
- 300
- 178
- -
- -
105 -
- -
- -
- -
- -
- -
14 17
- -
- -
- -
- -
1 73
58 -
16 44
25 75
- -
- -
- 116
20 36
40 142
7 1
- -
- -
- 24
- -
- -
- -
16 19
- 24
1 45
34 136
6 33
32 94
- -
- -
- -
- -
- -
8 189
- -
11 57
- -
5 41
- -
55 276
1,230 748
46 323
- -
360
30 20
- -
- -
12 489
600
- -
970 79
- -
- -
340 164
- 10
- -
- -
- -
- -
8 213
180 70
- -
- -
5 11
- -
30 2,970
4 20
320 394
- 7
- 4
6 20
4 10
- 3
- 6
- 9
5 27
- -
3 -
4 11
- 14
- 6
- 10
30 120
- 7
4 10
4 11
- 2
8 29
4 16
- 24
200 95
300 1,400
- 595
- 140
- 10
- 148
- -
- -
- -
- 20
- 40
- 30
- -
- -
- -
- -
- -
1,200 4,800
- -
9 5
- -
- -
- 100
28 252
- 100
76 124
- 72
- 24
- 24
- 88
250 1,700
- -
- -
- -
2 17
3 37
- -
10 33
- 353
- 187
4,380 37,500
140 94
450 2,150
2 18
10 3
22 390
- 245
5 236
- -
- -
- -
- -
6 34
- -
- -
-
- 9
10 50
20 50
- 30
15 120
PUSKESMAS TROSOBO
Tgl,10 Juni 2019

NIP. 196605101989032013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS : TROSOBO
KECAMATAN :TAMAN
PELAPORAN PERIODE : JUNI 2019
PERMINTAAN PERIODE : III
1 2 3 4 5 6

5 Aspilets 80 mg tab Tablet 997 - 997
11 Ibuprofen 400 mg tab Tablet 414 - 414
23 Profenid supp Suppositoria - - -
(1b) ANALGETIK NARKOTIK - - -
1 Pethidin HCl 50 mg/ml inj Ampul - - -
(1c) ANTIPIRAI - - -
- - -
(2) ANESTESI LOKAL -

5 Fenitoin kapsul 100 mg Kapsu; - 500 500
9 Haloperidol 0.5 mg tab Tablet - - -
10 Haloperidol 1,5 mg Tablet 4,000 - 4,000
16 Stesolid rectal 5 mg Tube
(4) ANTI PARKINSON

(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 2,263 - 2,263
- - -
(6) ANTI MIGREN -

4 Captopril 25 mg Tablet 575 - 575
5 Furosemid 40 mg Tablet 871 - 871
7 H.C.T 25 mg Tablet 3,776 - 3,776
- - -
- - -
- - -
- - -
1 Ambroxol HCl 30 mg Tablet - - -
2 Ambroxol syrup Botol 60 ml - - -
3 Gliseril Guayakolat 100 mg Tablet 2,950 - 2,950
7 OBH Plus Dewasa Botol 60 ml - - -
- - -
(13) ANTI INFLUENZA - - -
1 Alpara tab Tablet - - -
2 Alpara sirup Botol 60 ml - - -
5 Tremenza tab Tablet 754 - 754
- - -
(14) ANTASIDA - - -
3 Cimetidin 200 mg Tablet 618 - 618
8 Ranitidin inj 25 mg/2 ml Ampul 150 - 150
- - -
(15) OBAT DIARE-KESEIMBANGAN CAIRAN ELEKTROLIT -
2 D5 + 1/2 NS Botol 500 ml 26 - 26
3 D5 + 1/4 NS Botol 500 ml 9 - 9
8 Loperamide Tablet 890 - 890
9 Molagit tab Tablet 427 - 427
13 New Diaform Tablet 1,018 - 1,018
15 Ringer Laktat infus Botol 500 ml 32 - 32
- - -
(16) LAKSAN - - -
- - -
4 Buscopan tab Tablet - - -
- - -
- - -
- - -
- - -


3 Becom C kaplet Kaplet - - -
15 Neurosanbe tab Tablet 762 - 762

4 Ampisilin 500 mg Kaplet - - -
5 Ampisilin inj. Ampul - - -
6 Ampisilin sirup kering Botol 60 ml - - -
7 Azitomisin 250 mg kaplet Kaplet - - -
8 Biothicol sirup kering Botol 60 ml -
17 Claneksi sirup Tablet -
26 Kloramfenikol sirup Botol 60 ml
34 Thiamphenikol 500 mg Tablet 364 - 364
(25) ANTI VIRUS

3 Acyclovir cream Tube - - -
- - -
(26) ANTI FUNGI - - -


2 Etanol 70% Botol 100 ml 20 - 20
3 H2O2 3% Botol 1000 ml 21 - 21
5 Lisol 50% Botol 1000 ml 21 - 21
(29) ANTELMENTIK
(30) ANTI AMUBIASIS


(32) HEMOSTATIK

(34) SERUM
2 ATS 1.500 IU Ampul 16 - 16
(35) OKSITOSIK

1 Papaverin 40 mg Tablet


(39) ANTI BAKTERI

2 Gentamisin salep kulit 0,1% Tube - - -
- - -
- - -
(41) ANTI SCABIES - - -
1 Salep 2-4 30 g Pot 142 - 142
- - -
- - -
3 Salisil spiritus Botol - - -
- - -
(44) ANTI SISTEMIK MATA - - -
1 Berry vision tab Tablet - - -
2 Retinol 100.000 IU (Vit. A) Kapsul - - -
3 Retinol 200.000 IU Kapsul - - -
- - -
(45) ANESTESI LOKAL MATA - - -
-
(46) ANTI INFEKSI MATA - - -
5 Polidemisin eye drop Botol 5 ml -
- - -
- - -
(48) ANTI INFEKSI THT - - -
- - -
(49) LAIN-LAIN INFEKSI THT - - -
- - -
(50) ANTI FILARIASIS - - -
1 Dietilkarbamasin Sitrat 100 mg Tablet -
(51) ANTI HEMOROID

(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 748 - 748
6 Ondansetron 4 mg/2 ml inj. Ampul 20 - 20

4 Simvastatin tab 10 mg Tablet 79 600 679
- - -
1 Piracetam 400 mg Tablet 164 - 164
(55) IMMUNDILATOR
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL
2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet
6 Combipack pcs
10 Haloperidol 5 mg tablet 2,970 - 2,970
11 Handscoon pcs
17 Micropipet pcs
18 pH Paper pcs
20 Risperidon 2 mg tablet 394 0 394
(59) OBAT GIGI

10 Glass Ionomer Cement (Fuji II LC) Set - - -


9 Blood Lancet Pcs
10 Blue tape Pcs
13 Catton swap Pcs
14 Cerplast Pcs
15 Cover glass Pcs
27 Hipavix 5 x 5 m Rol 5 - 5
30 I.V. Catheter 18 Pcs 100 - 100
31 I.V. Catheter 20 Pcs 245 - 245
32 I.V. Catheter 22 Pcs 238 - 238
33 I.V. Catheter 24 Pcs 252 - 252
45 Kasa elastis 3x4 cm Rol - - -
46 Kasa elstis 4x10 cm Rol - - -
47 Kasa kompres 40/40 steril Pcs - - -
55 Masker Pcs 2,150 - 2,150
59 Microburet Pcs - - -
66 Plester 2.5 cm x 4.5 m Rol 34 - 34
74 Sputum pot Pcs
81 Umbilical Pcs
83 White tape Pcs
86 Yellow tape Pcs
TOTAL
KUNJUNGAN
JUNI 2019 2800 19.981.000 2400
Mengetahui :
KABUPATEN SIDOARJO
dr.ARIF RAHMAN NURDIANTO

NIP. 19870416201101 1 007
ERMINTAAN OBAT PUSKESMAS

PUSKESMAS
GFK
7 8 9 10
354 329
- -
5,140 6,477
- -
733 264
104 356
1,826 8,760
- -
8 120
- -
414 -
- 55
- -
- -
- 2,070
- 20
- -
- -
11,677 47,291
42 119
470 554
- -
- -
- 85
- 57
- -
- 300
- -
- -
- -
540 13,942
- -
- 13
- -
- 250
290 500
103 925
5 1,676
- -
- 30
360 140
- -
- 400
- 120
- -
390 3,610
14 30
- -
820 2,740
- -
120 900
- 200
725 344
259 2,004
- -
- -
10 880
80 286
91 269
- 2,480
1,610 5,474
- -
50 7,200
450 125
60 811
- -
60 3,716
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 1,018
- -
- -
- -
- -
3,751 15,239
- 70
- -
250 135
363 9,315
- -
310 3,863
- -
- 340
- -
- -
- -
222 1,339
- -
832 511
- -
- -
- -
- -
1,709 1,241
- -
- -
- -
- -
7 -
- -
- -
- -
- -
226 1,937
- 45
157 597
- -
- -
2,111 14,124
20 345
100 518
- -
- -
462 1,486
120 1,729
150 -
- -
260 1,535
- -
- 26
- 9
- -
- -
- -
- -
- 890
356 71
- 105
- -
2 22
960 58
48 352
- 32
27 1,144
- -
- -
- -
34 299
6 2
3 47
- -
- -
- 200
172 127
- 7
- -
- -
- -
- -
- -
- -
664 3,119
- 20
1,802 39,387
140 140
- -
- -
- -
- 33
20 -
- 31
- -
- -
- -
- -
- -
290 5,725
1,396 6,591
4,100 40,830
- 600
1,519 7,417
- -
- 72
- -
30 810
- -
- 490
- -
- 274
930 826
- -
- 40
- -
270 492
35 -
- -
8,382 830
- -
- -
720 10,821
- -
1,584 11,420
2,786 21,082
3,167 16,753
- -
46 144
- -
- -
- -
- -
1,452 11,033
1,131 -
- 100
- -
250 4,896
- 1,257
- 50
140 460
640 16,011
32 211
205 259
347 17
330 5,570
- -
- -
- -
70 175
- 1,330
- 263
1 19
12 9
19 -
- 21
- -
2 8
- 6
21 5
- 496
3,810 34,226
- -
- 70
-
100 1,160
- 308
9 -
- 2
- 16
110 1,146
- 300
- 178
30 160
- -
13 39
3 14
26 47
- -
22 22
6 69
- -
- -
8 108
- 133
20 16
- -
- -
3 139
1 -
- -
- -
- 24
- -
- -
- -
6 13
- -
- -
- -
- -
- -
- -
- -
- -
- 24
-
- -
1 44
15 121
2 31
2 92
- -
- -
- -
- -
4 185
- -
- -
4 53
- -
- -
24 17
- -
- -
25 251
380 368
4 90
20 4,803
- -
196 2,476
- 20
- 489
360 5,183
- -
480 199
- -
- -
164 -
- 10
- 213
- 11
- -
630 2,340
110 284
- 7
- 4
8 12
- 10
- 3
- 6
- 9
7 20
- -
- -
- 11
4 10
- 6
4 6
30 90
- 7
- 10
5 6
- 2
7 22
2 14
1 23
- 95
100 1,300
- 595
18 122
10 -
- 148
- 20
- 40
- 30
- -
- -
- -
- -
- -
200 1,250
300 10,700
- -
5 -
- -
- -
- 100
- 245
- 238
200 52
- 100
10 114
- 72
- 24
- 24
- 88
200 1,500
1 16
- -
- -
- -
- 37
- -
- 33
- 353
- 187
1,500 36,000
40 54
400 1,750
- 18
- 3
- 390
- -
- 245
- 236
- -
- -
- -
- -
- 34
- -
- -
-
- 9
- 50
- 50
- 30
- 120

PUSKESMAS TROSOBO
Tgl,3 Juli 2019

NIP. 196605101989032013
PUSKESMAS : TROSOBO
KECAMATAN :TAMAN
PELAPORAN PERIODE : JUNI 2019
PERMINTAAN PERIODE : III
1 2 3 4 5 6

1 Analsik tab Tablet 683 683
2 Antalgin 500 mg tab Tablet - -
3 Asam Mefenamat 500 mg tab Tablet 11,617 11,617
4 Asetosal 100 mg tab Tablet - -
6 Diklofenak Kalium 50 mg tab Tablet 460 460
7 Diklofenak Na. 50 mg tab Tablet 5,600 5,600
8 Eprinoc tab Tablet - -
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 128 128
10 Ibuprofen 200 mg tab Tablet - -
11 Ibuprofen 400 mg tab Tablet 414 414
12 Meloxicam 15 mg supp Suppositoria 55 55
13 Meloxicam 15 mg tab Tablet - -
14 Meloxicam 7,5 mg tab Tablet - -
15 Metoklopramid 10 mg Tablet 2,070 2,070
16 Metoklopramid inj. 5 mg/ml Ampul 20 20
17 Molakrim krim Tube 30 g - -
18 Nonflamin tab Tablet - -
19 Parasetamol 500 mg tab Tablet 58,968 58,968
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 161 161
21 Piroksikam 10 mg tab Tablet 1,024 1,024
22 Piroksikam 20 mg tab Tablet - -
23 Profenid supp Suppositoria - -
24 Proris supp Suppositoria 85 85
25 Santagesic inj. Ampul 57 57
26 Tramadol injeksi 50 mg/ml Ampul - -
27 Tramadol kap 50 mg Tablet 300 300
(1b) ANALGETIK NARKOTIK -
1 Pethidin HCl 50 mg/ml inj Ampul -
(1c) ANTIPIRAI -
Alopurinol 100 mg Tablet 7,500 7,500
-
1 Etil Klorida semprot Botol 100 ml 13 13
2 Ketamin / Ketalar inj. 100 mg/ml Vial 10 ml - -
3 Lidokain inj 2% (HCl) / 2 ml Ampul 250 250
4 Lidokain komb inj / 2 ml Ampul -
5 Xylocain spray Botol 50 ml 5 5
-
(3) AN.EPILEPSI, AN.KONV, AN.ASIETAS, SEDATIV, HIPNOTIK, AN.PSIKOTIK -
1 Alprazolam 0,5 mg Tablet 1,028 1,028
2 Diazepam 2 mg Tablet 1,681 1,681
3 Diazepam 5 mg Tablet - -
4 Diazepam inj. 5 mg/ 2 ml Ampul 30 30
5 Fenitoin kapsul 100 mg Kapsu; - -
6 Fenobarbital 100 mg Tablet - -
7 Fenobarbital 30 mg Tablet 400 400
8 Fenobarbital inj. 50 mg/ml Ampul 120 120
9 Haloperidol 0.5 mg tab Tablet - -
10 Haloperidol 1,5 mg Tablet 4,000 4,000
11 Haloperidol inj 50 mg/ml Ampul 44 44
12 Klobazam 10 mg tab Tablet - -
13 Klorpromazin HCl 100 mg tab Tablet 3,560 3,560
14 Klorpromazin HCl inj 25 mg/ml Ampul - -
15 Trifluoperazine 5 mg tab Tablet 1,020 1,020
16 Stesolid rectal 5 mg Tube - -
-
(4) ANTI PARKINSON -
1 Levopar tab Tablet 200 200
2 Triheksifenidil 2 mg Tablet 1,069 1,069
-
(5) ANTI DEPRESI -
1 Amitriptilin HCl 25 mg Tablet 2,263 2,263
2 Deproz 20 mg Tablet - -
- -
(6) ANTI MIGREN -
1 Anti Migren (Komb. Ergot+Kafein) Tablet 890 890
2 Betahistin Mesilat 6 mg Tablet 366 366
-
(7) ANTI ANGINA - ANTI ARITMIA -
1 Isosorbit Dinitrat 5 mg Tablet 360 360
2 Nifedipin 10 mg Tablet 2,480 2,480
3 Nifedipin GITS (Adalat Oros) 30 mg Tablet - -
4 Propanolol 10 mg Tablet - -
- -
(8) ANTI HIPERTENSI-DIURETIKA - -
1 Amlodipin 5 mg Tablet 7,084 7,084
2 Amlodipin 10 mg Tablet - -
3 Bisoprolol Fumarat 5 mg Tablet 1,000 1,000
4 Captopril 25 mg Tablet 575 575
5 Furosemid 40 mg Tablet 871 871
6 Furosemid inj. Ampul - -
7 H.C.T 25 mg Tablet 3,776 3,776
8 Lisinopril 10 mg Tablet - -
9 Valsartan tab 80 mg / Diovan 80 Tablet - -
- -
(9) GLUKOSIDA JANTUNG - -
1 Digoksin 0,25 mg Tablet - -
2 Verapamil 80 mg Tablet - -
- -
(10) OBAT PD SHOK-ANTI ASMA KORTIKOSTEROID - -
1 Aminofilin 200 mg Tablet 1,018 1,018
2 Aminofilin inj 24 mg Ampul - -
3 Bisolvon solution 10 mg/5 ml Botol 50 ml - -
4 Bisolvon injeksi 2 mg/ml Ampul - -
5 Bricasma inj 0,5 mg/ml Ampul - -
6 Deksamethason 0,5 mg Tablet 20,000 20,000
7 Deksamethason inj 5 mg/ml Ampul 70 70
8 Efedrin HCl 25 mg Tablet - -
9 Epinefrin inj. Ampul 170 170
10 Methylprednisolon 4 mg Tablet 4,000 4,000
11 Prednison 5 mg Tablet - -
12 Salbutamol 2 mg Tablet 4,173 4,173
13 Salbutamol sirup (Astharol) Botol 60 ml - -
14 Ventolin Nebulizer Ampul 200 200
- -
(11) ANTI TUSIF - -
1 Dexmolex sirup Botol 100 ml - -
2 Kodein 10 mg Tablet 1,561 1,561
3 Sanadryl DMP sirup Botol 60 ml - -
4 Tuzalos tab Tablet 1,343 1,343
- -
(12) EKSPEKTORAN - -
1 Ambroxol HCl 30 mg Tablet - -
2 Ambroxol syrup Botol 60 ml - -
3 Gliseril Guayakolat 100 mg Tablet 2,950 2,950
4 Hustab sirup Botol 60 ml - -
5 Hustab tab Tablet - -
6 OBH Plus Anak Botol 60 ml - -
7 OBH Plus Dewasa Botol 60 ml - -
8 Sanadryl Expectorant Botol 60 ml 7 7
-
(13) ANTI INFLUENZA -
1 Alpara tab Tablet -
2 Alpara sirup Botol 60 ml -
3 Protexinal tab Tablet 2,163 2,163
4 Protexinal sirup Botol 60 ml 45 45
5 Tremenza tab Tablet 754 754
- -
(14) ANTASIDA - -
1 Antasida DOEN I tab Tablet 16,235 16,235
2 Antasida DOEN II sirup Botol 60 ml 365 365
3 Cimetidin 200 mg Tablet 618 618
4 Cytotec Tablet - -
5 Famotidine 20 mg Tablet - -
6 Omeprazole kap 20 mg Tablet 1,948 1,948
7 Ranitidin tab 150 mg Tablet 1,849 1,849
9 Sanmag suspensi Botol 120 ml - -
10 Sanmag tab Tablet 1,795 1,795
- -
(15) OBAT DIARE-KESEIMBANGAN CAIRAN ELEKTROLIT - -
1 Asering infus Botol 500 ml - -
2 D5 + 1/2 NS Botol 500 ml 26 26
3 D5 + 1/4 NS Botol 500 ml 9 9
4 Dehaf Sachet - -
5 KAEN 3A Botol 500 ml - -
6 KAEN 3B Botol 500 ml - -
7 L-Bio Sachet - -
8 Loperamide Tablet 890 890
9 Molagit tab Tablet 427 427
10 Na. Klorida 0,9% infus Botol 500 ml -
11 Na. Klorida 0,9% piggy bag Botol 100 ml - -
12 Neo Kaolana suspensi Botol 60 ml 24 24
13 New Diaform Tablet 1,018 1,018
14 Oralit 200 ml Sachet 400 400
15 Ringer Laktat infus Botol 500 ml 32 32
16 Zink tab dispersible 20 mg Tablet 1,171 1,171
17 Zink sirup 20 mg/5 ml Botol 60 ml - -
- -
(16) LAKSAN - -
1 Bicolax tab 5 mg Tablet 333 333
2 Dulcolax supp 5 mg Suppositoria 8 8
3 Stolax supp 10 mg Suppositoria 50 50
- -
(17) ANTI SPASMODIK - -
1 Atropin Sulfat inj 0,25 mg/ml Ampul 200 200
2 Braxidin tab Tablet 299 299
3 Buscopan inj Ampul 7 7
4 Buscopan tab Tablet - -
5 Buscopan plus Tablet - -
6 Ekstrak Belladona 10 mg Tablet - -
- -
(18) ANTI HISTAMIN - -
1 Ceterizine sirup Botol 60 ml - -
2 Cetirizine tab 10 mg Tablet 3,783 3,783
3 Difenhidramin inj Ampul 20 20
5 Loratadine 10 mg Tablet 280 280
- -
(19) LARUTAN NUTRISI - -
1 Aminofluid Softbag 500 ml - -
2 Glukose 10% infus 500 ml Botol 500 ml 33 33
3 Glukose 40% inj 25 ml Ampul 20 20
- -
(20) TIROID ANTAGONIS - -
1 Propiltiourasil 100 mg Tablet - -
- -
(21) ANTI DIABETIK ORAL - -
1 Glibenklamid 5 mg Tablet 6,015 6,015
3 Metformin tab 500 mg Tablet 44,930 44,930
- -
(22) ANTI DIABETIK PARENTERAL - -
1 Apidra Solostar 100 IU/ml Pen - -
2 Lantus Solostar 100 IU/ml Pen - -
- -
(23) VITAMIN DAN MINERAL - -
1 Anemolat tab / Asam folat tab Tablet 600 600
2 Asam Askorbat 50 mg Tablet 8,936 8,936
3 Becom C kaplet Kaplet - -
4 Calcii Gluconas inj Ampul 72 72
5 Caldece tab effervecent Tablet - -
6 Cavit D3 Tablet 840 840
7 Elkana sirup Botol 60 ml - -
8 Elkana tab Tablet 490 490
9 Glucosamin tab Tablet - -
10 Hepagard tab Tablet 274 274
11 Kalsium Laktat 500 mg Tablet 1,756 1,756
12 Neurosanbe 5000 Tablet - -
13 Neurosanbe inj Ampul 40 40
14 Neurosanbe Plus Tablet - -
15 Neurosanbe tab Tablet 762 762
16 Osteotin tab Tablet 35 35
17 Pharmaton Vit Tablet - -
18 Piridoksin 10 mg (Vit. B6) Tablet 19,500 19,500
19 Procurma Plus sirup Botol 60 ml - -
20 Santa E 200 mg tablet hisap Tablet - -
21 Sianokobalamin tab Tablet 11,541 11,541
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul - -
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 13,004 13,004
24 Vit. B kompleks Tablet 23,868 23,868
-
(24) ANTI BAKTERI SISTEMIK, ANTISEPTIK SAL.KEMIH -
1 Amoksisilin 500 mg Tablet 19,920 19,920
2 Amoksisilin inj. Ampul - -
3 Amoksisilin sirup kering Botol 60 ml 190 190
4 Ampisilin 500 mg Kaplet -
5 Ampisilin inj. Ampul -
6 Ampisilin sirup kering Botol 60 ml -
7 Azitomisin 250 mg kaplet Kaplet -
8 Biothicol sirup kering Botol 60 ml - -
9 Cefadroxil 500 mg Kaplet 12,485 12,485
10 Cefadroxil sirup kering Botol 60 ml -
11 Cefalexin 500 mg Tablet -
12 Cefixime kapsul 100 mg Kapsul 1,131 1,131
13 Cefixime sirup Botol 30 ml -
14 Cefotaxime injeksi 1 g Ampul 100 100
15 Ceftriaxone injeksi 1 g Ampul - -
16 Ciprofloxacin 500 mg Tablet 5,146 5,146
18 Co-Amoksiklav Tablet -
19 Colsancetine inj Ampul -
20 Eritromisin 250 mg Tablet -
21 Eritromisin 500 mg Kaplet 1,257 1,257
22 Eritromisin sirup kering Botol 60 ml -
23 Gentamisin inj. 40 mg/ml Ampul - -
24 Klindamisin 300 mg Kapsul 600 600
25 Kloramfenikol 250 mg Kapsul -
26 Kloramfenikol sirup Botol 60 ml - -
27 Kotrimoksasol 480 mg Tablet 4,100 4,100
28 Kotrimoksasol suspensi Botol 60 ml 243 243
29 Levofloksasin 500 mg Tablet 464 464
30 Linkomisin kapsul 500 mg Tablet -
31 Ofloxacin 400 mg Tablet -
32 Spyramisin 500 mg Tablet -
33 Tetrasiklin 500 mg Tablet -
34 Thiamphenikol 500 mg Tablet 364 364
-
(25) ANTI VIRUS -
1 Acyclovir 200 mg tab Tablet -
2 Acyclovir 400 mg tab Tablet 4,800 4,800
3 Acyclovir cream Tube - -
-
(26) ANTI FUNGI -
1 Griseofulvin 125 mg Tablet 245 245
2 Ketokonazol 200 mg Tablet 1,330 1,330
3 Nistatin 100.000 IU tab.vag Tablet 263 263
4 Nistatin 500.000 IU tab Tablet -
-
(27) ANTI TUBERKULOSIS -
1 Etambutol 500 mg tab salut Tablet -
2 I.N.H 100 mg Tablet -
4 Kanamycin inj 1 g Vial -
5 OAT FDC Kategori 1 Paket -
7 OAT FDC Kategori Anak Paket -
8 OAT FDC Sisipan Paket -
9 Pyrazinamid 500 mg Tablet -
10 Streptomycin S inj 1 g Vial -
11 Rifampisin 450 mg Tablet -
-
(28) ANTI SEPTIK, DESINFEKTAN -
1 Etakridina larutan 0,1% Botol 300 ml -
2 Etanol 70% Botol 100 ml 20 20
3 H2O2 3% Botol 1000 ml 21 21
4 Klorin Botol 500 ml 19 19
5 Lisol 50% Botol 1000 ml 21 21
6 Paraformaldehid 1 g Tablet - -
7 Povidon Iodida larutan 10% Botol 300 ml 10 10
8 Softa-Man Botol 500 ml 6 6
9 Softaskin Botol 500 ml 26 26
- -
(29) ANTELMENTIK - -
1 Albendazol 400 mg Tablet - -
2 Mebendazol 100 mg Tablet - -
3 Mebendazol sirup 30 ml Botol 30 ml - -
4 Pirantel 125 mg Tablet 496 496
- -
(30) ANTI AMUBIASIS - -
1 Metronidazol 500 mg Tablet - -
2 Metronidazol infus Botol 100 ml - -
- -
(31) OBAT YG MEMPENGARUHI DARAH, ANTI ANEMIA - -
1 Besi (II) Sulfat tab Sachet 38,036 38,036
2 Besi sirup Botol 150 ml - -
3 Sianokobalamin inj (Vit. B 12) Ampul 70 70
-
(32) HEMOSTATIK - -
1 Adona AC-17 10 mg Tablet - -
2 Adona inj 5 ml Ampul - -
3 Fitomenadion 10 mg (Vit. K) Tablet 1,260 1,260
4 Fitomenadion inj (Vit. K) Ampul 308 308
5 Magnesium Sulfat 20% Vial 9 9
7 Plasminex inj. Ampul -
8 Plasminex tab Tablet -
9 Vit. K infant inj Ampul -
-
(33) PRODUK DAN SUBTITUEN PLASMA -
1 Widahes infus Botol 500 ml -
-
(34) SERUM -
1 ABU I Polivalen 5 ml Vial 2 2
2 ATS 1.500 IU Ampul 16 16
- -
(35) OKSITOSIK - -
1 Metilergometrin 0,125 mg Tablet 1,256 1,256
2 Metilergometrin inj Ampul 300 300
3 Oksitosin inj 10 IU/ml-1 ml Ampul 178 178
- -
(36) RELAKSAN UTERUS - -
1 Papaverin 40 mg Tablet - -
- -
(37) ANTI INFLAMASI SALEP - -
2 Betason N krem Tube - -
- -
(38) PERANGSANG JARINGAN GRANULASI - -
1 Bioplacenton gel Tube 17 17
2 Prontosan Solution Botol 350 ml - -
3 Prontosan Gel Botol 30 ml - -
- -
(39) ANTI BAKTERI - -
1 Anti Bakteri DOEN s.k Tube 73 73
2 Gentamisin salep kulit 0,1% Tube - -
3 Kloramfekort H krem Tube 44 44
4 Oksitetrasiklin HCl sk 3% Tube 75 75
- -
(40) ANTI FUNGI SALEP - -
1 Anti Fungi DOEN (As.Benz 60+As.Sal 3 Pot 116 116
3 Miconazol cream 2% Tube 36 36
-
(41) ANTI SCABIES -
1 Salep 2-4 30 g Pot 142 142
2 Scabicide Tube 1 1
- -
(42) ANTI SEPTIK - -
1 P.K serbuk 5 gram Botol 24 24
- -
(43) LAIN-LAIN OBAT KULIT - -
1 Ikhtamol salep 15 g Pot - -
2 Salisil bedak 2% Kotak 19 19
3 Salisil spiritus Botol -
-
(44) ANTI SISTEMIK MATA -
1 Berry vision tab Tablet -
2 Retinol 100.000 IU (Vit. A) Kapsul -
3 Retinol 200.000 IU Kapsul -
-
(45) ANESTESI LOKAL MATA -
1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 24 24
-
(46) ANTI INFEKSI MATA -
1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 45 45
2 Kloramfenikol 0,5% t.m Botol 5 ml 136 136
3 Kloramfenikol 1% s.m Tube 5 g 33 33
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 94 94
5 Polidemisin eye drop Botol 5 ml - -
6 Sulfasetamid Natrium 15% t.m Botol 5 ml - -
- -
(47) LAIN-LAIN OBAT MATA - -
1 Catalin Opth Botol 15 ml - -
2 Cendolyteers tetes mata Botol 5 ml 189 189
- -
1 Kloramfenikol 3% t.t Botol 57 57
- -
1 Fenol gliserol 10% t.t Botol 41 41
- -
-
(51) ANTI HEMOROID -
1 Anti Hemoroid supp Suppositoria 276 276
2 Anusol Suppositoria -
3 Borraginol N Salep Tube 15 g -
4 Borraginol N Supp Suppositoria -
5 Hemorogard tab Tablet -
-
(52) ANTI EMETIK -
1 Dimenhidrinat 50 mg Tablet 748 748
2 Domperidon sirup Botol 60 ml -
3 Domperidon tab Tablet 323 323
4 Mediamer B6 Tablet - -
5 Ondansetron 8 mg tab Tablet 360 360
6 Ondansetron 4 mg/2 ml inj. Ampul 20 20
- -
(53) ANTI HIPERKOLESTEROLEMIA - -
1 Gemfibrozil kapsul 300 mg Tablet 489 489
2 Kalsium Atorvastatin Tablet 600 600
3 Lipitor 20 mg Tablet - -
4 Simvastatin tab 10 mg Tablet 79 79
- -
(54) NOOTROPIK - -
1 Piracetam 400 mg Tablet 164 164
2 Piracetam inj 1 g/5 ml Ampul 10 10
3 Piracetam inj 3 g / 15 ml Ampul - -
- -
(55) IMMUNDILATOR - -
1 Imunos sirup Botol 60 ml - -
2 Imunos tablet Tablet 213 213
-
(56) PROGRAM GIZI -
1 Biskuit Bungkus -
2 Biskuit MP-ASI Bungkus -
3 Iodina Test Botol -
4 Susu Dancow Bungkus -
5 Susu Mineral Mix Bungkus -
6 Susu Mom and Me Bungkus -
7 Susu Pan-Enteral Bungkus -
8 Susu Proten Bungkus -
9 Taburia Sachet -
10 Zink Sirup Botol 60 ml -
-
(57) PROGRAM P2PL -
1 Albendazole 400 mg tablet -
2 Box Slide pcs -
3 OAT FDC paket -
4 OAT FDC Anak paket -
5 OAT FDC Kategori II paket -
6 Obyek Glass pcs -
7 Reagen Intech pcs -
8 Reagen Oncoprobe pcs -
9 Reagen SD HIV pcs -
10 Reagen Vikia pcs -
11 Reagen Zn set -
12 Sputum Pot pcs -
13 Susu Proten bungkus -
-
(58) PROGRAM GANGGUAN JIWA -
1 Alkohol swab pcs -
2 Amitriptilin 25 mg tablet -
3 Anuscope pcs -
4 Blue Tape pcs -
5 Clozapin 25 mg tablet 70 - 70
11 Handscoon pcs - - -
12 Holder Prontho pcs - - -
13 Klorpromazin 100 mg tablet - - -
15 Lodomer inj. ampul - - -
16 Mantoux tab tablet - - -
17 Micropipet pcs - - -
18 pH Paper pcs - - -
19 Phenitoin 100 mg tablet - - -
20 Risperidon 2 mg tablet 284 1,000 1,284
Carmabazepin 200 mg tablet
(59) OBAT GIGI -

1 Alvogyl (Septodont) Botol 10 g 7 7
2 Caustener rapid Botol 6,5 g 4 4
3 Cavit (Tumpatan sementara) Set 20 20
4 Cresophene (Septodont) Botol 7,5 g 10 10
5 Elite semen Botol 3 3
6 Estelite Composite Set 6 6
7 Ectsa gel (Denta merica) Syringe 12 g 9 9
8 Eugenol Botol 10 ml 27 27
9 Forinokresol / Formocresol Botol 10 ml - -
10 Glass Ionomer Cement (Fuji II LC) Set - -
11 Glass Ionomer Cement (Fuji IX) Set 11 11
12 Kalsium Hidroksida pasta Tube 14 14
13 Klorfenol Kamfer Mentol (CHKM) Botol 20 ml 6 6
14 Mumifying pasta Botol 7 g 10 10
15 Spongostan Pcs 120 120
16 Te-econom bond Botol 7 7
17 Temporary Stopping Fletcher Botol 10 10
18 Tooth Cleansing (Occo) Botol 15 ml 11 11
19 Vinafluor Tablet 2 2
-
(60) OBAT TOPIKAL MULUT -
1 Bufacomb Iob (Zenith) Tube 29 29
2 Gentian violet 1% Botol 10 ml 16 16
3 Minosep gargle 0.2% Botol 60 ml 24 24
4 Polikresulen (Metakresol) Botol 10 ml -
-
(61) BAHAN MEDIS HABIS PAKAI (BMHP) -
1 Alat suntik 1xpakai 0.05 ml Pcs -
3 Alat suntik 1xpakai 1 ml Pcs 95 95
4 Alat Suntik 1xpakai 3 ml Pcs 1,400 1,400
6 Alat suntik 1xpakai 10 ml Pcs -
7 Aqua pro injeksi Vial 140 140
8 Aquadest steril 500 ml Botol 500 ml -
10 Blue tape Pcs -
11 Cat-gut dg jarum 2/0 Sachet 10 10
13 Catton swap Pcs - -
14 Cerplast Pcs - -
15 Cover glass Pcs - -
16 Folley Cath 12 Pcs 20 20
19 Folley Cath 20 Pcs - -
21 Gelang Bayi Lahir Pcs - -
22 Gelang Ibu Melahirkan Pcs - -
23 Handscoon Panjang Pcs - -
25 Handscoon uk. M Pcs 4,800 4,800
26 Handscoon uk. S Pcs - -
27 Hipavix 5 x 5 m Rol 5 5
30 I.V. Catheter 18 Pcs 100 100
34 Infusion set anak Pcs 100 100
35 Infusion set dewasa Pcs 124 124
36 Jarum jahit (bedah) no. 13 Pcs 72 72
39 Jarum Jahit (bedah) no. 12 Pcs 88 88
40 Jarum Suntik no. 25 Pcs 1,700 1,700
41 Jarum Vacutainer 21 Pcs - -
43 Kapas berlemak 500 g Bungkus - -
44 Kapas pembalut 250 g Bungkus 17 17
45 Kasa elastis 3x4 cm Rol -
46 Kasa elstis 4x10 cm Rol -
47 Kasa kompres 40/40 steril Pcs -
48 Kasa Pembalut 1 yard 40m x 80 Rol 37 37
49 Kasa pembalut 2 m x 80 cm Rol - -
50 Kasa pembalut hid 4 x 10 cm Rol 33 33
52 Kasa Steril 16 x 16 cm Pcs 187 187
53 Kertas Puyer Pcs 37,500 37,500
54 Lomatull Pcs 94 94
55 Masker Pcs 2,150 2,150
56 Masker O2 anak Pcs 18 18
57 Masker O2 dewasa Pcs 3 3
58 Mesh 11 Lancip Pcs 390 390
59 Microburet Pcs -
60 Nasal Canula Anak Pcs 245 245
61 Nasal Canula Dewasa Pcs 236 236
62 Needle Novofine Pcs - -
63 Obyek glass Pcs - -
64 Pipet thoma Erythrocyt Pcs - -
65 Pipet thoma Leucocyt Pcs - -
66 Plester 2.5 cm x 4.5 m Rol 34 34
67 Plester 7.5 cm x 4.5 m Rol - -
68 Pot urine 10 ml Pcs - -
70 Silk (benang bedah sutra) dg jarum Sachet 9 9
71 Silk tanpa jarum 2/0 Sachet 50 50
73 Slim Zuiker Pcs 30 30
74 Sputum pot Pcs -
75 Tab. Kapiler Hematokrit Pcs -
76 Tabung Vacutainer Kuning Pcs -
77 Tabung Vacutainer Merah Pcs -
78 Tabung Vacutainer Ungu Pcs -
79 Tissue Lensa Kotak -
80 Tranfusion Set Dewasa Pcs -
81 Umbilical Pcs -
82 Urine Bag Pcs 120 120
83 White tape Pcs -
84 Wing Needle 25 Pcs -
86 Yellow tape Pcs -
TOTAL
KUNJUNGAN
JUNI 2019 2800 19.981.000 2400
Mengetahui :
KABUPATEN SIDOARJO

NIP. 19870416 21101 1 007

PUSKESMAS
GFK
7 8 9 10
354 329 1,500

- -
5,140 6,477 7,000
-
- 300
104 356 500
5,600 7,000
-
8 120
-
414 - 5,000
55
-
- 6,000
2,070
20
-
-
11,677 47,291
42 119 150
470 554 1,500
-
- 50
55 30 100
57 100
-
300
-
-
-
7,500
-
-
13
-
140 110
-
5
-
-
103 925
5 1,676
- -
- 30
- - 500
- -
- 400
- 120
- -
390 3,610
14 30
- -
820 2,740
- -
120 900
- 25
-
-
200
725 344 1,500
-
-
289 1,974
-
-
-
10 880
80 286 300
-
-
91 269
- 2,480
-
-
-
-
-
1,610 5,474 2,000
-
1,000
450 125
60 811
- -
60 3,716
-
-
-
-
-
-
-
-
-
1,018
-
- 3
-
-
- 20,000
- 70 60
- -
170
- 4,000
-
310 3,863
-
200
-
-
- 50
222 1,339 1,000
- -
832 511 1,000
- -
- -
- - 3,000
- - 100
1,709 1,241 10,000
- -
- -
- -
- - 150
7 - 100
-
-
-
-
226 1,937 1,500
- 45 50
157 597 1,000
- -
- -
2,111 14,124 5,000
20 345
100 518 300
- -
- -
462 1,486 2,000
120 1,729 1,500
100 - 100
- -
260 1,535 1,500
- -
-
-
- 26 20
- 9 40
- -
- -
- -
- -
- 890
356 71 900
- -
- -
2 22
1,018 2,000
48 352 500
- 32 100
27 1,144
- -
- -
- -
34 299
6 2 20
23 27 50
- -
- -
- 200
172 127 600
- 7 20
- 500
-
-
-
-
-
664 3,119 3,000
- 20 60
- -
140 140 500
- -
- -
- -
- 33
20 -
- 31
- -
- -
- -
- -
- -
290 5,725
- -
4,100 40,830
-
-
-
-
-
-
- 600
1,519 7,417 5,000
- - 1,000
- 72
- -
30 810
- -
- 490
- - 1,200
- 274
930 826 2,000
- -
- 40
- -
270 492 800
35 -
- -
8,382 11,118 1,000
- -
- -
720 10,821
- -
1,584 11,420 5,000
2,786 21,082
-
-
3,167 16,753 15,000
- -
46 144 200
- -
- -
- -
- -
- 50
1,452 11,033
-
-
1,131 - 2,000
-
- 100
- -
250 4,896
-
-
-
-
- 1,257
- -
-
140 460
-
-
640 3,460
32 211
205 259
-
-
-
-
347 17 2,000
-
-
-
4,800
- 100
-
-
70 175
1,330
263
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1 19
12 9
19 - 6
- 21
- -
2 8
- 6 6
21 5 6
-
-
-
-
-
- 496
-
-
- 1,000
-
-
-
3,810 34,226
- -
- 70
-
-
-
-
-
100 1,160
- 308
9 -
-
-
-
-
-
-
-
-
-
- 2
6 10
-
-
110 1,146
- 300
- 178
-
-
-
-
-
- -
- - 100
- - 50
-
-
3 14
-
-
-
-
26 47 50
- - 150
22 22 48
6 69
- -
- -
58 58 24
- -
20 16 72
- -
- -
3 139
1 - 24
- -
- -
- 24
- -
- -
- -
6 13 60
- -
- -
- -
- -
- -
- -
- -
- -
- 24
- -
- -
1 44
15 121
33 - 75
2 92
-
- -
- -
- -
- -
4 185
- -
- -
4 53 30
- -
- -
24 17 48
- -
- -
-
-
-
25 251
-
-
-
-
-
-
380 368 1,500
-
20 303
- -
- 360
- 20
-
-
- 489
600
- -
79 2,500
- -
- -
164 - 800
- 10
-
-
-
-
- 213
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
30 40
- -
- -
10 1
- -
320 2,020
- -
- -
- -
- -
- -
- -
- -
- -
- -
120 1,164 300
-
- 7
- 4
8 12
- 10
- 3
- 6
- 9
7 20
- -
- -
- 11
4 10
- 6
4 6
30 90
- 7
- 10
5 6
- 2
-
-
7 22 48
2 14 48
1 23
-
-
-
-
-
- 95
100 1,300 1,500
- 595
- 100
18 122 50
- 10
-
-
10 -
- 148
-
-
-
20
40
30
-
-
-
-
-
-
300 4,500
-
5 - 10
-
- -
- 100
- - 100
- - 100
- 252
100
10 114 100
- 72
- 24
- 24
- 88
200 1,500
-
-
-
1 16 10
-
- -
- -
- 37
- -
- 33 100
- 353
- 187
1,500 36,000
40 54 100
400 1,750 100 kotak /masker hijab
18
- 3
- 390
- -
- 245
- 236
- -
- -
- -
- -
- 34
- -
- -
- -
- 9
- 50
- 50
- 30
- -
-
-
-
-
-
-
-
120
- -
-
-
-

PUSKESMAS TROSOBO
Tgl,4 Juli 2019

NIP. 196605101989032013
PUSKESMAS : TROSOBO
KECAMATAN :TAMAN
PELAPORAN PERIODE : JULI 2019
1 2 3 4 5 6

6 Diklofenak Kalium 50 mg tab Tablet 356 1,000 1,356
7 Diklofenak Na. 50 mg tab Tablet 8,760 5,600 14,360
8 Eprinoc tab Tablet - 300 300
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 119 200 319
21 Piroksikam 10 mg tab Tablet 554 - 554
23 Profenid supp Suppositoria - 60 60
- - -

1 Alprazolam 0,5 mg Tablet 925 - 925
5 Fenitoin kapsul 100 mg Kapsu; 140 - 140
11 Haloperidol inj 50 mg/ml Ampul - 30
14 Klorpromazin HCl inj 25 mg/ml Ampul - 210 210
15 Trifluoperazine 5 mg tab Tablet 900 - 900
16 Stesolid rectal 5 mg Tube - 25 25
- - -
(4) ANTI PARKINSON - - -
2 Triheksifenidil 2 mg Tablet 344 2,000 2,344
(5) ANTI DEPRESI

(6) ANTI MIGREN

2 Betahistin Mesilat 6 mg Tablet 286 2,000 2,286

3 Nifedipin GITS (Adalat Oros) 30 m Tablet

1 Amlodipin 5 mg Tablet 5,474 9,000 14,474
4 Captopril 25 mg Tablet 125 7,500 7,625
7 H.C.T 25 mg Tablet 3,716 1,200 4,916
- - -
- - -
7 Deksamethason inj 5 mg/ml Ampul 70 60 130
- - -
1 Dexmolex sirup Botol 100 ml - 60 60
2 Kodein 10 mg Tablet 1,339 1,000 2,339
4 Tuzalos tab Tablet 511 1,000 1,511
- - -
3 Gliseril Guayakolat 100 mg Tablet 1,241 40,800 42,041
5 Hustab tab Tablet - 1,500 1,500
7 OBH Plus Dewasa Botol 60 ml - 160 160
8 Sanadryl Expectorant Botol 60 ml - - -
- - -
3 Protexinal tab Tablet 1,937 5,200 7,137
4 Protexinal sirup Botol 60 ml 45 50 95
(14) ANTASIDA -
1 Antasida DOEN I tab Tablet 14,124 16,800 30,924
6 Omeprazole kap 20 mg Tablet 1,486 2,910 4,396
8 Ranitidin inj 25 mg/2 ml Ampul - 100 100

1 Asering infus Botol 500 ml - 24 24
2 D5 + 1/2 NS Botol 500 ml 26 20 46
3 D5 + 1/4 NS Botol 500 ml 9 40 49
9 Molagit tab Tablet 71 3,000 3,071
13 New Diaform Tablet - - -
14 Oralit 200 ml Sachet 352 5,400 5,752
16 Zink tab dispersible 20 mg Tablet 1,144 1,000 2,144
(16) LAKSAN
2 Dulcolax supp 5 mg Suppositoria 2 30 32
3 Stolax supp 10 mg Suppositoria 30 50 80
- - -
3 Buscopan inj Ampul 7 10 17
5 Buscopan plus Tablet - 400 400
(18) ANTI HISTAMIN

2 Cetirizine tab 10 mg Tablet 3,119 2,480 5,599
3 Difenhidramin inj Ampul 20 60 80
5 Loratadine 10 mg Tablet 140 750 890
- - -
3 Glukose 40% inj 25 ml Ampul - - -




2 Asam Askorbat 50 mg Tablet 7,417 7,000 14,417
9 Glucosamin tab Tablet - 900 900
10 Hepagard tab Tablet 274 150 424
11 Kalsium Laktat 500 mg Tablet 826 16,800 17,626
16 Osteotin tab Tablet - - -
18 Piridoksin 10 mg (Vit. B6) Tablet 830 7,000 7,830
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 11,420 13,600 25,020
- - -
(24) ANTI BAKTERI SISTEMIK, ANTISEPTIK SAL.KEM - - -
1 Amoksisilin 500 mg Tablet 16,753 18,000 34,753
3 Amoksisilin sirup kering Botol 60 ml 144 300 444
8 Biothicol sirup kering Botol 60 ml - 50 50
12 Cefixime kapsul 100 mg Kapsul 250 300 550
25 Kloramfenikol 250 mg Kapsul - 5,000 5,000
29 Levofloksasin 500 mg Tablet 259 300 559
34 Thiamphenikol 500 mg Tablet 17 1,900 1,917
(25) ANTI VIRUS

3 Acyclovir cream Tube - 200 200
(26) ANTI FUNGI



2 Etanol 70% Botol 100 ml 19 96 115
3 H2O2 3% Botol 1000 ml 9 - 9
4 Klorin Botol 500 ml - - -
5 Lisol 50% Botol 1000 ml 21 - 21
8 Softa-Man Botol 500 ml 6 10 16
9 Softaskin Botol 500 ml 5 10 15
(29) ANTELMENTIK
1 Albendazol 400 mg Tablet 17,010 17,010
(30) ANTI AMUBIASIS


(32) HEMOSTATIK

(34) SERUM
2 ATS 1.500 IU Ampul 10 - 10
(35) OKSITOSIK


1 Betametason krem 0,1% Tube 160 150 310
2 Betason N krem Tube - 200 200
3 Hidrokortison krem 2,5% Tube 39 120 159
- - -
(39) ANTI BAKTERI

- - -
1 Anti Fungi DOEN (As.Benz 60+As. Pot 50 48 98
3 Miconazol cream 2% Tube 16 72 88
- - -
1 Salep 2-4 30 g Pot 139 - 139
2 Scabicide Tube - 20 20
(42) ANTI SEPTIK


1 Ikhtamol salep 15 g Pot


- - -
3 Kloramfenikol 1% s.m Tube 5 g - 120 120

- - -
- - -
1 Fenol gliserol 10% t.t Botol 17 120 137
- - -
1 Dietilkarbamasin Sitrat 100 mg Tablet - - -
- - -
(51) ANTI HEMOROID - - -
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 368 2,000 2,368
- - -
4 Simvastatin tab 10 mg Tablet 199 5,040 5,239
- - -
(55) IMMUNDILATOR
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
25 Carbamazepin 200 mg tablet 1,400 1,400
(59) OBAT GIGI


1 Bufacomb Iob (Zenith) Tube 22 48 70

3 Alat suntik 1xpakai 1 ml Pcs 95 200 295
4 Alat Suntik 1xpakai 3 ml Pcs 1,300 1,800 3,100
6 Alat suntik 1xpakai 10 ml Pcs - 200 200
7 Aqua pro injeksi Vial 122 120 242
9 Blood Lancet Pcs
10 Blue tape Pcs
11 Cat-gut dg jarum 2/0 Sachet
13 Catton swap Pcs
14 Cerplast Pcs
15 Cover glass Pcs
27 Hipavix 5 x 5 m Rol - 30 30
30 I.V. Catheter 18 Pcs 100 - 100
31 I.V. Catheter 20 Pcs 245 100 345
32 I.V. Catheter 22 Pcs 238 100 338
33 I.V. Catheter 24 Pcs 52 - 52
35 Infusion set dewasa Pcs 114 100 214
44 Kapas pembalut 250 g Bungkus 16 20 36
49 Kasa pembalut 2 m x 80 cm Rol - 50 50
50 Kasa pembalut hid 4 x 10 cm Rol 33 200 233
54 Lomatull Pcs 54 100 154
55 Masker Pcs 1,750 2,000 3,750
63 Obyek glass Pcs
66 Plester 2.5 cm x 4.5 m Rol 34 - 34
70 Silk (benang bedah sutra) dg jaru Sachet
72 Silk tanpa jarum 3/0 Sachet 50 1 51
74 Sputum pot Pcs 30 - 30
81 Umbilical Pcs
83 White tape Pcs
86 Yellow tape Pcs
TOTAL
KUNJUNGAN
Juli 2019 3900 25.035.500 3.414
Mengetahui :
KABUPATEN SIDOARJO
NIP. 19870416201101 1 007
AR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS
GFK
7 8 9 10
329 -
- -
5,685 792
- -
65 199
356 1,000
3,156 11,204
27 273
17 103
- -
- -
15 40
- -
- -
510 1,560
- 20
- -
- -
9,730 37,561
72 247
290 264
- -
- 60
- 30
- 57
- -
16 284
- -
- -
- -
1,366 12,576
- -
1 12
- -
- 250
- 500
- 5
123 802
45 1,631
- -
- 30
105 35
- -
- 400
- 120
- -
795 2,815
15 15
- -
890 1,850
1 209
120 780
5 20
- -
- -
- 200
600 1,744
270 1,734
880 -
123 2,163
250 19
110 2,370
2,740 11,734
- -
1,150 6,050
1,022 6,603
75 736
- -
570 4,346
- -
- -
- -
- -
- -
- -
- -
- -
- -
10 1,008
- -
- -
- -
- -
4,687 10,552
- 130
- -
- 135
1,982 7,333
- -
291 3,572
- -
- 340
- -
- -
- 60
254 2,085
- -
704 807
- -
- -
- -
- -
3,874 38,167
- -
- 1,500
- -
1 159
- -
- -
- -
- -
- -
600 6,537
10 85
196 401
4,584 26,340
23 322
270 248
- -
- -
792 3,604
383 1,346
15 85
- -
539 996
- 24
- 46
- 49
- -
- -
- -
- -
10 880
807 2,264
10 95
- -
3 19
- -
3,695 2,057
23 109
1,155 989
10 289
5 27
- 80
- -
- -
- 200
27 100
- 17
- -
132 268
903 4,696
- 80
2,369 37,018
121 769
- -
- -
- -
- 33
- -
- 31
315 5,410
2,730 3,861
7,400 33,430
- 600
2,969 11,448
- -
- 72
- -
494 316
- -
- 490
30 870
- 424
1,123 16,503
- -
- 40
- -
288 204
- -
- -
241 7,589
- -
- -
1,040 9,781
- -
2,740 22,280
5,363 15,719
- -
- -
4,376 30,377
- -
44 400
1 49
1,898 9,135
110 440
- 100
770 4,126
123 1,134
- 50
- -
460 -
280 4,720
6,137 9,874
23 188
303 256
386 1,531
160 5,410
1 199
20 155
20 1,310
14 249
2 113
- 9
- -
- 21
- -
1 7
5 11
- 15
17,010 -
4 492
810 33,416
- -
- 70
-
30 1,130
- 308
- 2
- 10
- 1,146
- 300
- 178
46 264
7 193
19 140
- -
- -
5 9
8 39
- -
22 -
25 44
- -
- -
1 97
12 121
21 67
- -
- -
22 117
- 20
- 24
7 6
4 20
- -
- -
5 39
31 90
11 109
7 85
9 176
- -
- -
9 44
- -
- -
24 113
- -
- -
- -
- -
- -
25 226
500 1,868
2 88
1,150 3,653
- -
230 2,246
- 20
- -
- -
24 465
883 4,300
- -
670 4,569
- -
- -
64 100
- 10
- 213
30 40
- -
- -
10 1
- -
320 2,020
- -
- -
- -
- -
- -
- -
- -
- -
- -
120 1164
1,400
- 7
- 4
- 12
- 10
- 3
- 6
- 9
1 19
- -
- -
- 11
- 10
- 6
- 6
- 90
- 7
- 10
- 6
2 -
22 48
1 13
- 23
95 200
900 2,200
- 595
- 200
- 242
- 148
- 20
- 40
- 30
750 500
900 9,800
- -
6 24
- -
- -
- 100
- 345
40 298
- 52
- 100
10 204
- 72
- 24
- 24
- 88
- 1,500
4 32
- -
- -
- -
- 37
- 50
50 183
50 503
- 187
3,000 33,000
17 137
650 3,100
- 18
- 3
- 390
- -
- 245
- 236
5 29
- 9
- 51
- 50
- 30
- 120

PUSKESMAS TROSOBO
Tgl,8 Agustus 2019
NIP. 196605101989032013
PUSKESMAS : TROSOBO
KECAMATAN :TAMAN
PELAPORAN PERIODE : JULI 2019 LPLPO APBD
1 2 3 4 5 6

1 Analsik tab Tablet 329 329
5 Aspilets 80 mg tab Tablet - -
6 Diklofenak Kalium 50 mg tab Tablet 356 1,000 1,356
8 Eprinoc tab Tablet - 300 300
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 119 200 319
21 Piroksikam 10 mg tab Tablet 554 - 554
23 Profenid supp Suppositoria - 60 60
(1b) ANALGETIK NARKOTIK - -
1 Pethidin HCl 50 mg/ml inj Ampul - -
(1c) ANTIPIRAI - -
- -
(2) ANESTESI LOKAL - -
4 Lidokain komb inj / 2 ml Ampul - -
- -
(3) AN.EPILEPSI, AN.KONV, AN.ASIETAS, SEDATIV, HIPNOTI - -
11 Haloperidol inj 50 mg/ml Ampul - 30
14 Klorpromazin HCl inj 25 mg/ml Ampul - 210 210
16 Stesolid rectal 5 mg Tube - 25 25
- -
(4) ANTI PARKINSON - -
2 Triheksifenidil 2 mg Tablet 344 2,000 2,344
- -
(5) ANTI DEPRESI - -
- -
(6) ANTI MIGREN - -
2 Betahistin Mesilat 6 mg Tablet 286 2,000 2,286
- -
(7) ANTI ANGINA - ANTI ARITMIA - -
- -
(8) ANTI HIPERTENSI-DIURETIKA - -
4 Captopril 25 mg Tablet 125 7,500 7,625
7 H.C.T 25 mg Tablet 3,716 1,200 4,916
- -
- -
7 Deksamethason inj 5 mg/ml Ampul 70 60 130
- -
(11) ANTI TUSIF - -
1 Dexmolex sirup Botol 100 ml - 60 60
2 Kodein 10 mg Tablet 1,339 1,000 2,339
4 Tuzalos tab Tablet 511 1,000 1,511
- -
3 Gliseril Guayakolat 100 mg Tablet 1,241 40,800 42,041
5 Hustab tab Tablet - 1,500 1,500
7 OBH Plus Dewasa Botol 60 ml - 160 160
8 Sanadryl Expectorant Botol 60 ml - -
- -
(13) ANTI INFLUENZA - -
1 Alpara tab Tablet - -
2 Alpara sirup Botol 60 ml - -
3 Protexinal tab Tablet 1,937 5,200 7,137
4 Protexinal sirup Botol 60 ml 45 50 95
- -
(14) ANTASIDA - -
1 Antasida DOEN I tab Tablet 14,124 16,800 30,924
6 Omeprazole kap 20 mg Tablet 1,486 2,910 4,396
8 Ranitidin inj 25 mg/2 ml Ampul - 100 100
- -
(15) OBAT DIARE-KESEIMBANGAN CAIRAN ELEKTROLIT - -
1 Asering infus Botol 500 ml - 24 24
2 D5 + 1/2 NS Botol 500 ml 26 20 46
3 D5 + 1/4 NS Botol 500 ml 9 40 49
9 Molagit tab Tablet 71 3,000 3,071
14 Oralit 200 ml Sachet 352 5,400 5,752
16 Zink tab dispersible 20 mg Tablet 1,144 1,000 2,144
- -
(16) LAKSAN - -
2 Dulcolax supp 5 mg Suppositoria 2 30 32
3 Stolax supp 10 mg Suppositoria 30 50 80
- - -
3 Buscopan inj Ampul 7 10 17
5 Buscopan plus Tablet - 400 400
- -
(18) ANTI HISTAMIN - -
2 Cetirizine tab 10 mg Tablet 3,119 2,480 5,599
3 Difenhidramin inj Ampul 20 60 80
5 Loratadine 10 mg Tablet 140 750 890
- - -
3 Glukose 40% inj 25 ml Ampul - - -
- -
(20) TIROID ANTAGONIS - -
1 Propiltiourasil 100 mg Tablet - -
- -
(21) ANTI DIABETIK ORAL - -
- -
(22) ANTI DIABETIK PARENTERAL - -
1 Apidra Solostar 100 IU/ml Pen - -
2 Lantus Solostar 100 IU/ml Pen - -
- -
(23) VITAMIN DAN MINERAL - -
9 Glucosamin tab Tablet - 900 900
10 Hepagard tab Tablet 274 150 424
11 Kalsium Laktat 500 mg Tablet 826 16,800 17,626
18 Piridoksin 10 mg (Vit. B6) Tablet 830 7,000 7,830
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 11,420 13,600 25,020
- -
(24) ANTI BAKTERI SISTEMIK, ANTISEPTIK SAL.KEMIH - -
1 Amoksisilin 500 mg Tablet 16,753 18,000 34,753
3 Amoksisilin sirup kering Botol 60 ml 144 300 444
7 Azitomisin 250 mg kaplet Kaplet -
8 Biothicol sirup kering Botol 60 ml - 50 50
12 Cefixime kapsul 100 mg Kapsul 250 300 550
25 Kloramfenikol 250 mg Kapsul - 5,000 5,000
29 Levofloksasin 500 mg Tablet 259 300 559
(25) ANTI VIRUS - -

1 Acyclovir 200 mg tab Tablet - -
3 Acyclovir cream Tube - 200 200
- -
(26) ANTI FUNGI - -
4 Nistatin 500.000 IU tab Tablet - -
- -
(27) ANTI TUBERKULOSIS - -
1 Etambutol 500 mg tab salut Tablet - -
2 I.N.H 100 mg Tablet - -
3 I.N.H 300 mg Tablet - -
4 Kanamycin inj 1 g Vial - -
5 OAT FDC Kategori 1 Paket - -
7 OAT FDC Kategori Anak Paket - -
8 OAT FDC Sisipan Paket - -
9 Pyrazinamid 500 mg Tablet - -
10 Streptomycin S inj 1 g Vial - -
11 Rifampisin 450 mg Tablet - -
12 Rifampisin 600 mg Tablet - -
- -
(28) ANTI SEPTIK, DESINFEKTAN - -
1 Etakridina larutan 0,1% Botol 300 ml - -
2 Etanol 70% Botol 100 ml 19 96 115
3 H2O2 3% Botol 1000 ml 9 - 9
4 Klorin Botol 500 ml - - -
5 Lisol 50% Botol 1000 ml 21 - 21
8 Softa-Man Botol 500 ml 6 10 16
9 Softaskin Botol 500 ml 5 10 15
- -
(29) ANTELMENTIK - -
1 Albendazol 400 mg Tablet 17,010 17,010
- -
(30) ANTI AMUBIASIS - -
1 Metronidazol 500 mg Tablet - -
2 Metronidazol infus Botol 100 ml - -
- -
(31) OBAT YG MEMPENGARUHI DARAH, ANTI ANEMIA - -
(32) HEMOSTATIK

(34) SERUM
2 ATS 1.500 IU Ampul 10 - 10
- -
(35) OKSITOSIK - -


1 Betametason krem 0,1% Tube 150 150
2 Betason N krem Tube - 200 200
3 Hidrokortison krem 2,5% Tube 120 120
- - -
2 Prontosan Solution Botol 350 ml - -
3 Prontosan Gel Botol 30 ml - -
- -
(39) ANTI BAKTERI - -
- - -
1 Anti Fungi DOEN (As.Benz 60+As.Sal Pot 50 48 98
2 Ketokonazol cream 2% Tube - \
3 Miconazol cream 2% Tube 16 72 88
- - -
1 Salep 2-4 30 g Pot 139 - 139
2 Scabicide Tube - 20 20
(42) ANTI SEPTIK


3 Salisil spiritus Botol - -
- -
(44) ANTI SISTEMIK MATA - -
1 Berry vision tab Tablet - -
2 Retinol 100.000 IU (Vit. A) Kapsul - -
3 Retinol 200.000 IU Kapsul - -
- -
(45) ANESTESI LOKAL MATA - -
- - -
3 Kloramfenikol 1% s.m Tube 5 g - 120 120

- - -
- - -
1 Fenol gliserol 10% t.t Botol 17 120 137
- - -
- - -
2 Anusol Suppositoria - -
3 Borraginol N Salep Tube 15 g - -
4 Borraginol N Supp Suppositoria - -
5 Hemorogard tab Tablet - -
- -
(52) ANTI EMETIK - -
1 Dimenhidrinat 50 mg Tablet 368 2,000 2,368
5 Ondansetron 8 mg tab Tablet 360 - 360
- - -
2 Kalsium Atorvastatin Tablet 600 - 600
4 Simvastatin tab 10 mg Tablet 199 5,040 5,239
- - -
(55) IMMUNDILATOR
- -
(56) PROGRAM GIZI - -
1 Biskuit Bungkus - -
2 Biskuit MP-ASI Bungkus - -
3 Iodina Test Botol - -
4 Susu Dancow Bungkus - -
5 Susu Mineral Mix Bungkus - -
6 Susu Mom and Me Bungkus - -
7 Susu Pan-Enteral Bungkus - -
8 Susu Proten Bungkus - -
9 Taburia Sachet - -
10 Zink Sirup Botol 60 ml - -
- -
(57) PROGRAM P2PL - -
1 Albendazole 400 mg tablet - -
2 Box Slide pcs - -
3 OAT FDC paket - -
4 OAT FDC Anak paket - -
5 OAT FDC Kategori II paket - -
6 Obyek Glass pcs - -
7 Reagen Intech pcs - -
8 Reagen Oncoprobe pcs - -
9 Reagen SD HIV pcs - -
10 Reagen Vikia pcs - -
11 Reagen Zn set - -
12 Sputum Pot pcs - -
13 Susu Proten bungkus - -
- -
(58) PROGRAM GANGGUAN JIWA - -
1 Alkohol swab pcs - -
2 Amitriptilin 25 mg tablet - -
3 Anuscope pcs - -
4 Blue Tape pcs - -
25 Carbamazepine 200 mg tablet 1,400 1,400
(59) OBAT GIGI - -

- -
(60) OBAT TOPIKAL MULUT - -
1 Bufacomb Iob (Zenith) Tube 22 48 70
4 Polikresulen (Metakresol) Botol 10 ml - -
- -
(61) BAHAN MEDIS HABIS PAKAI (BMHP) 0 -
1 Alat suntik 1xpakai 0.05 ml Pcs - -
3 Alat suntik 1xpakai 1 ml Pcs 95 200 295
4 Alat Suntik 1xpakai 3 ml Pcs 1,300 1,800 3,100
6 Alat suntik 1xpakai 10 ml Pcs - 200 200
7 Aqua pro injeksi Vial 122 120 242
9 Blood Lancet Pcs
10 Blue tape Pcs
11 Cat-gut dg jarum 2/0 Sachet
13 Catton swap Pcs
14 Cerplast Pcs
15 Cover glass Pcs
27 Hipavix 5 x 5 m Rol - 30 30
30 I.V. Catheter 18 Pcs 100 - 100
33 I.V. Catheter 24 Pcs 52 - 52
35 Infusion set dewasa Pcs 114 100 214
44 Kapas pembalut 250 g Bungkus 16 20 36
49 Kasa pembalut 2 m x 80 cm Rol - 50 50
54 Lomatull Pcs 54 100 154
55 Masker Pcs 1,750 2,000 3,750
63 Obyek glass Pcs
66 Plester 2.5 cm x 4.5 m Rol 34 - 34
70 Silk (benang bedah sutra) dg jarum Sachet
72 Silk tanpa jarum 3/0 Sachet 50 1 51
74 Sputum pot Pcs 30 - 30
81 Umbilical Pcs
83 White tape Pcs
86 Yellow tape Pcs
TOTAL
KUNJUNGAN
JULI 2019 3900 25.035.500 3414
Mengetahui :
KABUPATEN SIDOARJO
NIP. 19870416201101 1 007

PUSKESMAS
GFK
7 8 9 10
329
5,685 792
356 1,000
2,008 9,192
27 273
17 103
- -
- -
15 40
- -
- -
510 1,560
9,730 37,561
72 247
290 264
- -
- 60
- 30
- 57
- -
16 284
7,500
1 12
110
123 802
45 1,631
- -
- 30
105 35
- -
- 400
- 120
- -
795 2,815
15 15
- -
890 1,850
1 209
120 780
5 20
- 200
600 1,744
270 1,734
880 -
123 2,163
250 19
110 2,370
2,740 11,734
1,000
1,022 6,603
75 736
- -
570 4,346
10 1,008
- -
- -
- -
- -
4,687 15,313
- 130
- -
- 135
4,000
291 3,572
200
- 60
254 2,085
- -
704 807
3,874 38,167
- -
- 1,500
- -
1 159
600 6,537
10 85
196 401
4,584 26,340
23 322
270 248
- -
- -
792 3,604
383 1,346
15 85
- -
539 996
- 24
- 46
- 49
- -
- -
- -
- -
10 880
807 2,264
10 95
- -
3 19
- -
3,695 2,057
23 109
1,155 989
10 289
5 27
- 80
- -
- -
- 200
27 100
- 17
- -
132 268
903 4,696
- 80
121 769
- -
- -
- -
- 33
- -
- 31
315 5,410
7,400 33,430
- 600
2,969 11,448
- -
- 72
- -
494 316
- -
- 490
30 870
- 424
1,123 16,503
- -
- 40
- -
288 204
- -
- -
241 7,589
- -
- -
1,040 9,781
- -
2,740 22,280
5,363 15,719
4,376 30,377
- -
44 400
1 49
1,898 9,135
110 440
- 100
770 4,126
123 1,134
- 50
- -
460 -
280 4,720
3,460
23 188
303 256
386 1,531
4,800
1 199
20 155
20 1,310
14 249
2 113
- 9
- -
- 21
- -
1 7
5 11
- 15
17,010 -
4 492
810 33,416
- -
- 70
-
30 1,130
- 308
- 2
- 10
- 1,146
- 300
- 178
150
7 193
120
- -
- -
5 9
8 39
- -
22 -
25 44
- -
- -
1 97
21 67
- -
- -
22 117
- 20
- 24
7 6
4 20
- -
- -
5 39
31 90
11 109
7 85
9 176
- -
- -
9 44
- -
- -
24 113
- -
- -
- -
- -
- -
25 226
500 1,868
2 88
3 300
- -
360
- 20
- -
- -
24 465
600
- -
670 4,569
- -
- -
64 100
- 10
- 213
30 40
- -
- -
10 1
- -
320 2,020
- -
- -
- -
- -
- -
- -
- -
- -
- -
120 1164
1,400
- 7
- 4
- 12
- 10
- 3
- 6
- 9
1 19
- -
- -
- 11
- 10
- 6
- 6
- 90
- 7
- 10
- 6
2 -
22 48
1 13
- 23
95 200
900 2,200
- 595
- 200
- 242
- 148
- 20
- 40
- 30
900 3,600
- -
6 24
- -
- -
- 100
- 100
40 60
- 52
- 100
10 204
- 72
- 24
- 24
- 88
- 1,500
4 32
- -
- -
- -
- 37
- 50
50 183
50 503
- 187
3,000 33,000
17 137
650 3,100
- 18
- 3
- 390
- -
- 245
- 236
5 29
- 9
- 51
- 50
- 30
- 120

PUSKESMAS TROSOBO
Tgl,8 Agustus 2019
NIP. 196605101989032013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBA
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : AGUSTUS 2019 (all)
NO NAMA OBAT SATUAN HARGA SATUAN STOK AWAL PENERIMAAN PERSEDIAAN
1 2 3 4 5 6 7

1 Analsik tab Tablet - -
5 Aspilets 80 mg tab Tablet 300 300
6 Diklofenak Kalium 50 mg tab Tablet 1,000 1,000
8 Eprinoc tab Tablet 273 273
21 Piroksikam 10 mg tab Tablet 264 264
23 Profenid supp Suppositoria 60 60
(1b) ANALGETIK NARKOTIK - -
1 Pethidin HCl 50 mg/ml inj Ampul - -
(1c) ANTIPIRAI - -
- -
4 Lidokain komb inj / 2 ml Ampul 1,080 1,080
-
(3) AN.EPILEPSI, AN.KONV, AN.ASIETAS, SEDATIV, HIPNOTIK, AN.PSIKOTIK -
1 Alprazolam 0,5 mg Tablet 802 802
2 Diazepam 2 mg Tablet 1,631 1,631
3 Diazepam 5 mg Tablet 400 400
5 Fenitoin kapsul 100 mg Kapsu; 115 115
12 Haloperidol inj 50 mg/ml Ampul 15 15
15 Klorpromazin HCl inj 25 mg/ml Ampul 209 209
16 Trifluoperazine 5 mg tab Tablet 780 780
17 Stesolid rectal 5 mg Tube 20 20
-
(4) ANTI PARKINSON -
-
(5) ANTI DEPRESI -
2 Deproz 20 mg Tablet -
-
(6) ANTI MIGREN -
1 Anti Migren (Komb. Ergot+Kafein) Tablet - -
2 Betahistin Mesilat 6 mg Tablet 2,163 2,163
-
(7) ANTI ANGINA - ANTI ARITMIA -
1 Isosorbit Dinitrat 5 mg Tablet 1,158 1,158
3 Nifedipin GITS (Adalat Oros) 30 mg Tablet -
4 Propanolol 10 mg Tablet -
-
(8) ANTI HIPERTENSI-DIURETIKA -
4 Captopril 25 mg Tablet 7,500 7,500
7 H.C.T 25 mg Tablet 9,330 9,330
- -
- -
1 Aminofilin 200 mg Tablet 1,180 1,180
2 Aminofilin inj 24 mg Ampul 60 60
- -
(11) ANTI TUSIF - -
1 Dexmolex sirup Botol 100 ml 60 60
4 Tuzalos tab Tablet 807 807
- -
5 Hustab tab Tablet 1,500 1,500
7 OBH Plus Dewasa Botol 60 ml 159 159
8 Sanadryl Expectorant Botol 60 ml - -
- -
(13) ANTI INFLUENZA - -
3 Protexinal tab Tablet 6,537 6,537
-
(14) ANTASIDA -
7 Ranitidin tab 150 mg Tablet 1,346 1,346
9 Sanmag suspensi Botol 120 ml - -
10 Sanmag tab Tablet 996 996
-
1 Asering infus Botol 500 ml 24 24
2 D5 + 1/2 NS Botol 500 ml 54 54
3 D5 + 1/4 NS Botol 500 ml 53 53
4 Dehaf Sachet - -
7 L-Bio Sachet - -
9 Molagit tab Tablet 2,264 2,264
10 Na. Klorida 0,9% infus Botol 500 ml 164 164
13 New Diaform Tablet - -
14 Oralit 200 ml Sachet 2,057 2,057
16 Zink tab dispersible 20 mg Tablet 2,000 2,000
17 Zink sirup 20 mg/5 ml Botol 60 ml -
-
(16) LAKSAN -
- -
(17) ANTI SPASMODIK - -
2 Braxidin tab Tablet 100 100
4 Buscopan tab Tablet - -
5 Buscopan plus Tablet 268 268
6 Ekstrak Belladona 10 mg Tablet -
-
(18) ANTI HISTAMIN -
1 Ceterizine sirup Botol 60 ml -
4 Klorfeniramin Maleat 4 mg Tablet 37,018 37,018

-
(20) TIROID ANTAGONIS -
1 Propiltiourasil 100 mg Tablet -
-
(21) ANTI DIABETIK ORAL -
2 Glimipiride 2 mg Tablet 3,861 3,861
-
(22) ANTI DIABETIK PARENTERAL -
1 Apidra Solostar 100 IU/ml Pen -
2 Lantus Solostar 100 IU/ml Pen -
-
(23) VITAMIN DAN MINERAL -
3 Becom C kaplet Kaplet - -
6 Cavit D3 Tablet 316 316
9 Glucosamin tab Tablet 870 870
16 Osteotin tab Tablet - -
21 Sianokobalamin tab Tablet 9,781 9,781

4 Ampisilin 500 mg Kaplet -
5 Ampisilin inj. Ampul -
6 Ampisilin sirup kering Botol 60 ml -
7 Azitomisin 500 mg kaplet Kaplet 120 120
8 Biothicol sirup kering Botol 60 ml 49 49
10 Cefadroxil sirup kering Botol 60 ml -
11 Cefalexin 500 mg Tablet -
12 Cefixime kapsul 100 mg Kapsul 440 440
13 Cefixime sirup Botol 30 ml -
15 Ceftriaxone injeksi 1 g Ampul -
18 Co-Amoksiklav Tablet -
19 Colsancetine inj Ampul -
20 Eritromisin 250 mg Tablet -
21 Eritromisin 500 mg Kaplet 1,134 1,134
22 Eritromisin sirup kering Botol 60 ml 107 107
24 Klindamisin 300 mg Kapsul - -
25 Kloramfenikol 250 mg Kapsul 4,720 4,720
26 Kloramfenikol sirup Botol 60 ml 46 46
27 Kotrimoksasol 960 mg Tablet 15,000 15,000
30 Linkomisin kapsul 500 mg Tablet -
31 Ofloxacin 400 mg Tablet -
32 Spyramisin 500 mg Tablet -
33 Tetrasiklin 500 mg Tablet -
34 Thiamphenikol 500 mg Tablet 1,531 1,531
-
(25) ANTI VIRUS -
1 Acyclovir 200 mg tab Tablet -
3 Acyclovir cream Tube 199 199
-
(26) ANTI FUNGI -
2 Ketokonazol 200 mg Tablet 1,310 1,310
4 Nistatin 500.000 IU tab Tablet -
-
(27) ANTI TUBERKULOSIS -
1 Etambutol 500 mg tab salut Tablet -
4 Kanamycin inj 1 g Vial -
7 OAT FDC Kategori Anak Paket -
8 OAT FDC Sisipan Paket -
9 Pyrazinamid 500 mg Tablet -
10 Streptomycin S inj 1 g Vial -
-
(28) ANTI SEPTIK, DESINFEKTAN -
1 Etakridina larutan 0,1% Botol 300 ml -
2 Etanol 70% Botol 100 ml 113 113
3 H2O2 3% Botol 1000 ml 9 9
4 Klorin Botol 500 ml 3 3
5 Lisol 50% Botol 1000 ml 22 22
-
(29) ANTELMENTIK -
1 Albendazol 400 mg Tablet - -
2 Mebendazol 100 mg Tablet -
3 Mebendazol sirup 30 ml Botol 30 ml -
-
(30) ANTI AMUBIASIS -
1 Metronidazol 500 mg Tablet -
2 Metronidazol infus Botol 100 ml -
-
(31) OBAT YG MEMPENGARUHI DARAH, ANTI ANEMIA -
(32) HEMOSTATIK
1 Adona AC-17 10 mg Tablet -
2 Adona inj 5 ml Ampul -
3 Fitomenadion 10 mg (Vit. K) Tablet 1,130 1,130
7 Plasminex inj. Ampul -
8 Plasminex tab Tablet -
9 Vit. K infant inj Ampul -
-
(33) PRODUK DAN SUBTITUEN PLASMA -
1 Widahes infus Botol 500 ml -
-
(34) SERUM -
2 ATS 1.500 IU Ampul 13 13
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 1,146 1,146

1 Papaverin 40 mg Tablet -

2 Betason N krem Tube 193 193
- -
(38) PERANGSANG JARINGAN GRANULASI - -
2 Prontosan Solution Botol 350 ml -
3 Prontosan Gel Botol 30 ml -
-
(39) ANTI BAKTERI -
3 Kloramfekort H krem Tube - -

1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 97 97
2 Ketokonazol cream 2% Tube 109 109
(41) ANTI SCABIES
1 Salep 2-4 30 g Pot 117 117
(42) ANTI SEPTIK

-
(43) LAIN-LAIN OBAT KULIT -
1 Ikhtamol salep 15 g Pot -
-
(44) ANTI SISTEMIK MATA -
1 Berry vision tab Tablet -
2 Retinol 100.000 IU (Vit. A) Kapsul -
3 Retinol 200.000 IU Kapsul -
-
- -
(46) ANTI INFEKSI MATA - -
5 Polidemisin eye drop Botol 5 ml -
6 Sulfasetamid Natrium 15% t.m Botol 5 ml 25 25
-
(47) LAIN-LAIN OBAT MATA -
1 Catalin Opth Botol 15 ml -
- -
(48) ANTI INFEKSI THT - -
- -
(49) LAIN-LAIN INFEKSI THT - -
- -
(50) ANTI FILARIASIS - -
1 Dietilkarbamasin Sitrat 100 mg Tablet - -
- -
(51) ANTI HEMOROID - -
3 Borraginol N Salep Tube 15 g -
4 Borraginol N Supp Suppositoria -
5 Hemorogard tab Tablet -
-
(52) ANTI EMETIK -
1 Dimenhidrinat 50 mg Tablet 2,890 2,890
2 Domperidon sirup Botol 60 ml 100 100
3 Domperidon tab Tablet 60 60
5 Ondansetron 8 mg tab Tablet 2,246 2,246
-
(53) ANTI HIPERKOLESTEROLEMIA - -
2 Kalsium Atorvastatin Tablet 4,300 4,300
4 Simvastatin tab 10 mg Tablet 4,569 4,569
(54) NOOTROPIK
3 Piracetam inj 3 g / 15 ml Ampul -
(55) IMMUNDILATOR
1 Imunos sirup Botol 60 ml -
(56) PROGRAM GIZI

1 Biskuit Bungkus -
2 Biskuit MP-ASI Bungkus -
3 Iodina Test Botol -
4 Susu Dancow Bungkus -
5 Susu Mineral Mix Bungkus -
6 Susu Mom and Me Bungkus -
7 Susu Pan-Enteral Bungkus -
8 Susu Proten Bungkus -
9 Taburia Sachet -
10 Zink Sirup Botol 60 ml -
(57) PROGRAM P2PL

1 Albendazole 400 mg tablet -
2 Box Slide pcs -
3 OAT FDC paket -
4 OAT FDC Anak paket -
5 OAT FDC Kategori II paket -
6 Obyek Glass pcs -
7 Reagen Intech pcs -
8 Reagen Oncoprobe pcs -
9 Reagen SD HIV pcs -
10 Reagen Vikia pcs
11 Reagen Zn set -
12 Sputum Pot pcs -
13 Susu Proten bungkus -

1 Alkohol swab pcs -
2 Amitriptilin 25 mg tablet -
3 Anuscope pcs -
4 Blue Tape pcs -
5 Clozapin 25 mg tablet 130 130
6 Combipack pcs 29 29
7 Fluconazole 150 mg tablet - -
8 Haldol inj. ampul
9 Haloperidol 1.5 mg tablet - -
10 Haloperidol 5 mg tablet 2,020 2,020
11 Handscoon pcs - -
12 Holder Prontho pcs - -
13 Klorpromazin 100 mg tablet - -
14 Klorpromazin 25 mg tablet - -
15 Lodomer drop drop 5 5
16 Mantoux tab tablet - -
17 Micropipet pcs - -
18 pH Paper pcs - -
19 Phenitoin 100 mg tablet - -
20 Risperidon 2 mg tablet 2600 2,600
21 SD Reagen Syphillis pcs -
22 Tabung Vacutainer Merah pcs -
23 Trifluoperazin 5 mg tablet -
24 Triheksifenidil 5 mg tablet -
(59) OBAT GIGI

4 Cresophene (Septodont) Botol 7,5 g 10 10
9 Forinokresol / Formocresol Botol 10 ml 6 6
10 Glass Ionomer Cement (Fuji II LC) Set 3 3
11 Glass Ionomer Cement (Fuji IX) Set - -
14 Mumifying pasta Botol 7 g 6 6
18 Tooth Cleansing (Occo) Botol 15 ml 6 6


8 Aquadest steril 500 ml Botol 500 ml -
10 Blue tape Pcs -
11 Cat-gut dg jarum 2/0 Sachet -
14 Cerplast Pcs -
19 Folley Cath 20 Pcs -
21 Gelang Bayi Lahir Pcs -
22 Gelang Ibu Melahirkan Pcs -
23 Handscoon Panjang Pcs -
24 Handscoon uk. L Pcs 900 900
52 Jarum Vacutainer 21 Pcs -
54 Kapas berlemak 500 g Bungkus -
56 Kasa elastis 3x4 cm Rol - -
57 Kasa elstis 4x10 cm Rol - -
58 Kasa kompres 40/40 steril Pcs - -
60 Kasa pembalut 2 m x 80 cm Rol 60 60
64 Kertas Puyer Pcs 33,000 33,000
66 Masker Pcs 3,100 3,100
69 Mesh 11 Lancip Pcs 1,400 1,400
70 Microburet Pcs - -
73 Needle Novofine Pcs -
74 Obyek glass Pcs -
75 Pipet thoma Erythrocyt Pcs -
76 Pipet thoma Leucocyt Pcs -
78 Plester 7.5 cm x 4.5 m Rol 36 36
81 Silk (benang bedah sutra) dg jarum Sachet -
85 Sputum pot Pcs -
92 Umbilical Pcs -
94 White tape Pcs -
TOTAL
KUNJUNGAN
AGUSTUS 2019
Mengetahui : SIDOARJO, 6 AGUSTU

KEPALA PUSKESMAS TROSOBO PENANGGUNG JAWAB PEN
KABUPATEN SIDOARJO PUSKESMAS TROS
dr.ARIF RAHMAN NURDIANTO NUR INDAH AL RISM

NIP. 19870416201101 1 007 NIP. 1966051019890
MINTAAN OBAT PUSKESMAS

PUSKESMAS
GFK
TOTAL
HARGA
8 9 10 11 12
- -
- -
1,410 3,090
- -
- 300
724 276
2,734 8,470
181 92
59 44
- -
- -
- 50
- -
- -
20 1,780
5 15
- -
- -
30,927 6,634
59 188
264 -
- -
8 52
11 19
1 56
- -
76 524
-
- -
-
2,019 10,557
-
-
- 15
- -
152 98
60 1,020
- 5
-
-
602 200
1,321 310
- 400
15 315
60 55
- -
- 400
90 30
- -
180 2,830
12 3
- -
1,300 550
29 180
580 200
- 20
-
-
- 200
244 1,500
-
-
64 1,670
- -
-
-
- -
275 1,888
-
-
90 1,068
300 2,070
- -
- -
- -
-
-
3,184 8,550
- -
130 6,378
300 7,200
326 410
- -
210 9,120
- -
- -
- -
-
-
- -
- -
-
-
120 1,060
- 60
- -
- -
- -
1,530 11,470
- 130
- -
- 390
423 14,777
- -
279 3,293
- -
5 335
-
-
7 53
200 3,670
- -
807 -
-
-
- -
- -
4,695 33,472
- -
220 1,280
- -
32 127
- -
-
-
- -
- -
634 5,903
57 28
71 330
-
-
5,218 21,122
32 290
148 100
- -
- -
636 2,968
736 610
27 133
- -
354 642
-
-
- 24
- 54
- 53
- -
- -
- -
- -
10 870
- 2,264
- 164
- -
1 18
- -
672 1,385
40 69
60 1,940
- -
-
-
16 304
- 30
23 57
-
-
- 200
100 -
7 10
- -
126 142
- -
-
-
- -
1,546 3,150
5 75
3,907 33,111
359 410
- -
33 - ED : 8/19 QTY : 33
- 20
5 26
-
-
- -
-
-
360 5,050
1,841 2,020
6,950 26,480
-
-
- -
- -
-
-
- 600
3,253 8,195
- -
48 24
- -
288 28
- -
90 400
382 488
- 440
713 15,790
- -
- 50
- -
204 -
- -
- -
1,296 6,293
- -
- -
2,806 6,975
- -
3,120 19,160
546 15,173
754 29,623
- -
108 292
- -
- -
- -
- 120
29 20
2,165 6,970
- -
- -
440 -
- -
70 30
- -
786 3,340
- -
- -
- -
- -
331 803
- 107
- -
- -
190 4,530
- 46
1,400 13,600
40 210
256 -
- -
- -
- -
- -
426 1,105
-
-
- -
500 6,000
11 188
-
-
- 250
220 1,090
- 438
- -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
- -
17 96
1 8
1 2
- 22
- -
5 2
1 49
5 10
-
-
- -
- -
- -
4 488
-
-
- -
- -
-
-
710 34,890
- -
- 90
- -
- -
- -
93 1,037
248 60
- -
- -
- -
- -
- -
-
-
- -
-
-
- 2
- 13
216 930
100 200
178 - ED : 8/19, QTY :178
- -
30 234
61 132
- 140
-
-
9 - ED : 8/19, QTY : 9
- -
- -
-
-
11 28
- -
- -
42 2
49 48
5 104
39 28
25 92
1 19
- 24
-
-
- -
6 -
- -
-
-
- -
- -
- -
-
-
- 20
-
-
18 21
52 38
7 102
22 63
- -
- 25
-
-
- -
24 152
-
11 33
-
-
24 89
-
-
- -
-
-
20 265
- -
- -
- -
- -
-
-
270 2,620
2 98
10 50
- -
386 1,860
- 40
-
-
45 420
1,978 2,322
- -
1,299 3,270
100 -
1 9
- -
- -
93 120
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
- 130
2 27
-
-
1,060 960
-
-
-
-
1 4
-
-
-
-
90 2,510
-
-
-
-
7 -
9 -
3 9
7 3
2 2
2 4
17 6
- 23
- 6
- 3
- -
10 -
1 5
6 -
- 4
4 3
9 1
6 -
- 2
- 60
- 16
- 23
-
- -
- 200
500 1,700
295 300
- 400
208 192
- -
- -
- -
- -
- 192
- -
- -
- -
20 -
- 40
20 10
- -
- -
- -
- -
- -
- 900
400 9,400
- -
3 21
- -
40 -
10 90
95 250
12 363
- 99
20 80
14 190
- 72
- 24
- 24
52 36
100 1,400
- -
- -
- -
5 27
- -
- -
- -
5 32
- 60
20 480
28 475
87 100
33,000 -
10 290
2,100 1,000
- 18
- 20
- 1,400
- -
- 250
- 240
- -
- -
- -
- -
- -
36 - ED : 3/19 QTY : 36
- -
- -
-
- 72
- 72
- 10
- -
- -
- -
- -
- -
- -
- -
- -
- 30
- -
- -
- -
- -
SIDOARJO, 6 AGUSTUS 2019

ANGGUNG JAWAB PENGELOLA OBAT
PUSKESMAS TROSOBO

NIP. 196605101989032013
LAPORAN PEM
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : AGUSTUS 2019
PERMINTAAN PERIODE : TRIWULAN IV
NO NAMA OBAT SATUAN HARGA STOK

SATUAN AWAL
1 2 3 4

1 Analsik tab Tablet
2 Antalgin 500 mg tab Tablet
3 Asam Mefenamat 500 mg tab Tablet 100 4,500
4 Asetosal 100 mg tab Tablet
5 Aspilets 80 mg tab Tablet
6 Diklofenak Kalium 50 mg tab Tablet 706 1,000
7 Diklofenak Na. 50 mg tab Tablet 115 11,204
8 Eprinoc tab Tablet 1650 273
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml
10 Ibuprofen 200 mg tab Tablet
11 Ibuprofen 400 mg tab Tablet
13 Meloxicam 15 mg tab Tablet
14 Meloxicam 7,5 mg tab Tablet
15 Metoklopramid 10 mg Tablet 108 1,800
17 Molakrim krim Tube 30 g
18 Nonflamin tab Tablet
19 Parasetamol 500 mg tab Tablet 53 37,561
21 Piroksikam 10 mg tab Tablet 132 264
22 Piroksikam 20 mg tab Tablet
23 Profenid supp Suppositoria 2380 60
26 Tramadol injeksi 50 mg/ml Ampul
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 97 7,500
(2) ANESTESI LOKAL

2 Ketamin / Ketalar inj. 100 mg/ml Vial 10 ml
4 Lidokain komb inj / 2 ml Ampul 1845 570

2 Diazepam 2 mg Tablet 45 1,631
6 Fenobarbital 100 mg Tablet
9 Haloperidol 0.5 mg tab Tablet
10 Haloperidol 1,5 mg Tablet 66 3,010
12 Haloperidol inj 50 mg/ml (Haldol Dacanoat) Ampul 97500 15
13 Klobazam 10 mg tab Tablet
14 Klorpromazin HCl 100 mg tab Tablet 147 1,850
(4) ANTI PARKINSON

2 Triheksifenidil 2 mg Tablet 88 1,744
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 167 1,734
(6) ANTI MIGREN

1 Anti Migren (Komb. Ergot+Kafein) Tablet
2 Betahistin Mesilat 6 mg Tablet 110 2,163

1 Isosorbit Dinitrat 5 mg - 2018 Tablet 89 658
2 Isosorbit Dinitrat 5 mg - 2019 Tablet 89 500
3 Nifedipin 10 mg Tablet 104 2,370

1 Amlodipin 5 mg Tablet 70 11,734
2 Amlodipin 10 mg Tablet
3 Bisoprolol Fumarat 5 mg Tablet
4 Captopril 25 mg Tablet 75 7,500
6 Furosemid inj. Ampul
7 H.C.T 25 mg Tablet 155 9,330

1 Digoksin 0,25 mg Tablet

1 Aminofilin 200 mg Tablet 139 1,180
3 Bisolvon solution 10 mg/5 ml Botol 50 ml
4 Bisolvon injeksi 2 mg/ml Ampul
5 Bricasma inj 0,5 mg/ml Ampul
6 Deksamethason 0,5 mg Tablet 44 13,000
8 Efedrin HCl 25 mg Tablet
10 Methylprednisolon 4 mg Tablet 134 4,000
11 Prednison 5 mg Tablet
12 Salbutamol 4 mg - 2018 Tablet 70 572
13 Salbutamol 4 mg - 2019 Tablet 70 3,000
14 Salbutamol sirup (Astharol) Botol 60 ml
(11) ANTI TUSIF

2 Kodein 10 mg Tablet 571 3,870
4 Tuzalos tab Tablet 929 807
(12) EKSPEKTORAN
1 Ambroxol HCl 30 mg Tablet
2 Ambroxol syrup Botol 60 ml
3 Gliseril Guayakolat 100 mg Tablet 88 38,167
5 Hustab tab Tablet 458 1,500
8 Sanadryl Expectorant Botol 60 ml
(13) ANTI INFLUENZA

1 Alpara tab Tablet
3 Protexinal tab Tablet 352 6,537
(14) ANTASIDA
1 Antasida DOEN I tab Tablet 54 26,340
4 Cytotec Tablet
5 Famotidine 20 mg Tablet
6 Omeprazole kap 20 mg Tablet 130 3,604
7 Ranitidin tab 150 mg Tablet 105 1,346
10 Sanmag suspensi Botol 120 ml
11 Sanmag tab Tablet 902 996
2 D5 + 1/2 NS Botol 500 ml 9776 54
3 D5 + 1/4 NS Botol 500 ml 9724 53
4 Dehaf Sachet
7 L-Bio Sachet
9 Molagit tab Tablet 477 2,264
10 Na. Klorida 0,9% infus Botol 500 ml
11 Na. Klorida 0,9% piggy bag Botol 100 ml
13 New Diaform Tablet
14 Oralit 200 ml Sachet 257 2,057
16 Zink tab dispersible 20 mg Tablet 524 2,000
(16) LAKSAN
(17) ANTI SPASMODIK

2 Braxidin tab Tablet 1127.5 100
4 Buscopan tab Tablet
5 Buscopan plus Tablet 1210 268
(18) ANTI HISTAMIN

2 Cetirizine tab 10 mg Tablet 90 4,696
4 Klorfeniramin Maleat 4 mg Tablet

2 Glukose 10% infus 500 ml - 2018 Botol 500 ml 7500 13
3 Glukose 10% infus 500 ml - 2019 Botol 500 ml 7500 20


1 Glibenklamid 5 mg Tablet 119 5,410
2 Glimipiride 2 mg Tablet
3 Metformin tab 500 mg Tablet 96 33,430


2 Asam Askorbat 50 mg Tablet 105 11,448
3 Becom C kaplet Kaplet
5 Caldece tab effervecent Tablet
6 Cavit D3 Tablet 1622.5 316
7 Elkana sirup Botol 60 ml
9 Glucosamin tab Tablet 807 870
11 Kalsium Laktat 500 mg Tablet 59 16,503
12 Neurosanbe 5000 Tablet
14 Neurosanbe Plus Tablet
16 Osteotin tab Tablet
17 Pharmaton Vit Tablet
18 Piridoksin 10 mg (Vit. B6) Tablet 123 7,589
19 Procurma Plus sirup Botol 60 ml
20 Santa E 200 mg tablet hisap Tablet
21 Sianokobalamin tab Tablet 51 9,781
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 85 22,280
24 Vit. B kompleks Tablet 83 15,719

1 Amoksisilin 500 mg Tablet 233 30,377
2 Amoksisilin inj. Ampul
8 Biothicol sirup kering Botol 60 ml 5940 49
9 Cefadroxil 500 mg Kaplet 478 9,135
16 Ciprofloxacin 500 mg Tablet 265 4,126
21 Eritromisin 500 mg Kaplet 750 1,134
22 Eritromisin sirup kering Botol 60 ml
24 Klindamisin 300 mg Kapsul
25 Kloramfenikol 250 mg Kapsul 10 4,720
27 Kotrimoksasol 480 mg Tablet
34 Thiamphenikol 500 mg Tablet 1069.2 1,531
(25) ANTI VIRUS

2 Acyclovir 400 mg tab Tablet 380 4,800
(26) ANTI FUNGI

2 Ketokonazol 200 mg Tablet 270 1,310


2 Etanol 70% Botol 100 ml 4000 96
3 H2O2 3% Botol 1000 ml 24200 9
4 Sterizym Botol 5 L 712800 3
5 Lisol 50% Botol 1000 ml 40997 22
6 Paraformaldehid 1 g Tablet
(29) ANTELMENTIK
(30) ANTI AMUBIASIS


1 Besi (II) Sulfat tab Sachet 355 36,880
(32) HEMOSTATIK
Fitomenadion 10 mg (Vit. K) - 2018 Tablet 691 430
3 Fitomenadion 10 mg (Vit. K) - 2019 Tablet 710 700

(34) SERUM
2 ATS 1.500 IU Ampul 130999 13
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 210 1,146


2 Betason N krem Tube 4620 193

(39) ANTI BAKTERI

3 Kloramfekort H krem Tube
1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 4496 97
2 Ketokonazol cream 2% Tube
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 2620 117
(42) ANTI SEPTIK







1 Kloramfenikol 3% t.t - 2018 Botol 6050 14
2 Kloramfenikol 3% t.t - 2019 Botol 6050 30


(51) ANTI HEMOROID

1 Anti Hemoroid supp Suppositoria
(52) ANTI EMETIK
1 Dimenhidrinat 50 mg Tablet 105 2,890
2 Domperidon sirup Botol 60 ml
3 Domperidon tab Tablet
4 Mediamer B6 Tablet
5 Ondansetron 8 mg tab Tablet 351 360

2 Kalsium Atorvastatin Tablet 795 600
3 Lipitor 20 mg Tablet
4 Simvastatin tab 10 mg Tablet 111 4,569
(54) NOOTROPIK
(55) IMMUNDILATOR
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
8 Haldol inj. 5mg/ml ampul
10 Haloperidol 5 mg tablet 80 2,020
11 Handscoon pcs
15 Lodomer drop drop 16500 5
17 Micropipet pcs
18 pH Paper pcs
20 Risperidon 2 mg tablet 546 2600
(59) OBAT GIGI

4 Cresophene (Septodont)/Cresotin Liq Botol 7,5 g 242000 10
14 Mumifying pasta/Cresotin Pasta Botol 7 g 198000 6
18 Tooth Cleansing (Occo)/ Poliren no. 1 Botol 15 ml 176000 6


4 Alat Suntik 1xpakai 3 ml Pcs 113.8 2,200
9 Blood Lancet Pcs
10 Blue tape Pcs
11 Cat-gut dg jarum 2/0 (Cromic) Sachet
12 Cat-gut dg jarum 3/0 (Plain) Sachet 134000 192
13 Catton swap Pcs
14 Cerplast Pcs
15 Cover glass Pcs
25 Handscoon uk. M Pcs 356.2 5,400
27 Hipavix 5 x 5 m Rol 37440 24
37 Jarum jahit (bedah) no. 13 - 2017 Pcs 2291 36
38 Jarum jahit (bedah) no. 13 - 2019 Pcs 917 36
42 Jarum Suntik no. 25 Pcs 33 1,500
56 Kertas Puyer Pcs 77 33,000
58 Masker Pcs 440 3,100
61 Mesh 11 Lancip Pcs 3000 1,400
62 Microburet Pcs
66 Obyek glass Pcs
70 Plester 7.5 cm x 4.5 m Rol 35532 36
77 Sputum pot Pcs
84 Umbilical Pcs
86 White tape Pcs
89 Yellow tape Pcs
TOTAL
KUNJUNGAN
AGUSTUS 2019 19.396.500 3.144
Mengetahui :
KABUPATEN SIDOARJO
NIP. 19870416201101 1 007
APBD
PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PENERIMAAN

STOK AWAL
(Rp) (Rp)
5 6 7 8 9 10
4,500 1,410 3,090 450,000 -
1,000 724 276 706,000 -

11,204 2,734 8,470 1,288,460 -
273 181 92 450,450 -
50 50 - 330,000 -
1,800 20 1,780 194,400 -

20 5 15 132,000 -
37,561 30,927 6,634 1,990,733 -

247 59 188 273,429 -
264 264 - 34,848 -
60 8 52 142,800 -
30 11 19 154,500 -
57 1 56 165,300 -
600 76 524 495,000 -
7,500 - 7,500 727,500 -

- -
- -
15 - 15 4,515,000 -
250 152 98 215,000 -

570 - 570 1,051,650 -
5 - 5 886,080 -
802 602 200 70,576 -

1,631 1,321 310 73,395 -
400 - 400 43,600 -
330 15 315 1,379,400 -
115 60 55 69,460 -
400 - 400 68,400 -

120 90 30 222,840 -
3,010 180 2,830 198,660 -

15 12 3 1,462,500 -
1,850 1,300 550 271,950 -

209 29 180 259,787 -
780 580 200 209,820 -
20 - 20 251,460 -
200 - 200 129,800 -

1,744 244 1,500 153,472 -
1,734 64 1,670 289,578 -
2,163 275 1,888 237,930 -
658 90 568 58,562 -

500 - 500 44,500 -
2,370 300 2,070 246,480 -
11,734 3,184 8,550 821,380 -
7,500 300 7,200 562,500 -

736 326 410 56,672 -
9,330 210 9,120 1,446,150 -

1,180 120 1,060 164,020 -
60 - 60 167,340 -
13,000 1,530 11,470 572,000 -

130 - 130 142,610 -
100 10 90 140,800 -
4,000 - 4,000 536,000 -
572 279 293 40,040 -

3,000 - 3,000 210,000 -
200 5 195 800,000 -
60 7 53 528,000 -
3,870 200 3,670 2,209,770 -
- - - - -
807 807 - 749,703 -
- -
- -
38,167 4,695 33,472 3,358,696 -
1,500 220 1,280 687,000 -
159 32 127 769,560 -
6,537 634 5,903 2,301,024 -

85 36 49 1,037,850 -
401 71 330 595,084 -
26,340 5,218 21,122 1,422,360 -

322 82 240 648,830 -
248 148 100 54,560 -
3,604 636 2,968 468,520 -

1,346 736 610 141,330 -
60 27 33 83,400 -
100 - 100 115,500 -
996 354 642 898,392 -

24 - 24 222,600 -
54 - 54 527,904 -
53 - 53 515,372 -
880 10 870 78,320 -

2,264 74 2,190 1,079,928 -
19 1 18 246,620 -
2,057 257 1,800 528,649 -

109 40 69 779,350 -
2,000 60 1,940 1,048,000 -
320 16 304 96,000 -

30 - 30 180,000 -
80 23 57 472,000 -
- -
- -
200 200 200 319,000 -
100 100 - 112,750 -
17 7 10 157,080 -
268 126 142 324,280 -
4,696 1,546 3,150 422,640 -

80 5 75 87,600 -
769 359 410 94,587 -
13 13 - 97,500 -
20 20 - 150,000 -
20 - 20 20,020 -
11 5 6 75,900 -
20 - 20 138,000 -
5,410 360 5,050 643,790 -

33,430 6,950 26,480 3,209,280 -
600 - 600 42,000 -

11,448 3,253 8,195 1,202,040 -
72 48 24 750,600 -
316 309 7 512,710 -
490 90 400 397,390 -

870 382 488 702,090 -
440 - 440 484,000 -
16,503 713 15,790 973,677 -
50 - 50 259,350 -
204 204 - 230,112 -
7,589 1,296 6,293 933,447 -
9,781 2,806 6,975 498,831 -
22,280 3,120 19,160 1,893,800 -

15,719 546 15,173 1,304,677 -
30,377 754 29,623 7,077,841 -
400 108 292 1,451,200 -
120 - 120 213,360 -

49 29 20 291,060 -
9,135 2,165 6,970 4,366,530 -
440 440 - 1,042,800 -
100 70 30 420,000 -
4,126 786 3,340 1,093,390 -
1,134 331 803 850,500 -

4,720 190 4,530 47,200 -
46 - 46 216,200 -
250 40 210 513,000 -

256 256 - 126,464 -
1,531 426 1,105 1,636,945 -
4,800 - 4,800 1,824,000 -

199 11 188 612,920 -
250 - 250 61,250 -

1,310 220 1,090 353,700 -
438 - 438 245,280 -
96 - 96 384,000 -
9 1 8 217,800 -
3 1 2 2,138,400 -
22 - 22 901,934 -
7 5 2 126,000 -
50 1 49 1,100,000 -
15 5 10 937,365 -
492 4 488 141,204 -
36,880 1,990 34,890 13,092,400 -
90 - 90 93,150 -
430 93 337 297,130 -

700 - 700 497,000 -
308 248 60 1,093,400 -
2 - 2 959,992 -
13 - 13 1,702,987 -
1,146 216 930 240,660 -

200 - 200 591,800 -
178 178 - 213,422 -
150 - 150 201,000 -

193 61 132 891,660 -
140 - 140 346,500 -
9 9 - 143,262 -
39 11 28 114,036 -
44 42 2 88,396 -
97 49 48 436,112 -
67 39 28 228,738 -
117 25 92 306,540 -
20 1 19 236,500 -
24 - 24 54,600 -
6 6 - 14,520 -
20 - 20 293,000 -
39 18 21 156,000 -
90 52 38 292,500 -
109 7 102 205,029 -
85 22 63 235,620 -
25 - 25 307,750 -
176 24 152 3,366,000 -
14 11 3 84,700 -
30 - 30 181,500 -
113 24 89 292,670 -
2,890 270 2,620 303,450 -
360 - 360 126,360 -

40 - 40 66,000 -
465 45 420 134,385 -

600 - 600 477,000 -
4,569 1,299 3,270 507,159 -
100 100 - 45,100 -

10 1 9 66,000 -
213 93 120 1,522,950 -

130 - 130 145,730 -
29 29 - - -
2,020 1,060 960 161,600 -
5 1 4 82,500 -
2,600 90 2,510 1,419,600 -
7 7 - 4,450,600 -
9 9 - 366,300 -
12 3 9 1,716,000 -
10 7 3 2,420,000 -
4 2 2 660,000 -
6 2 4 8,946,000 -
23 17 6 4,048,000 -
23 - 23 432,952 -
6 - 6 396,000 -
3 - 3 1,006,500 -
10 10 - 2,750,000 -
6 1 5 330,000 -
6 4 2 1,188,000 -
4 - 4 36,960 -
7 4 3 1,876,000 -
10 9 1 1,210,000 -
6 - 6 1,056,000 -
2 - 2 1,540 -
60 - 60 900,000 -
16 - 16 21,024 -
23 - 23 379,500 -
200 - 200 28,600 -

2,200 500 1,700 250,360 -
595 295 300 952,000 -
400 - 400 74,800 -
242 208 192 692,120 -
192 - 192 25,728,000 -
20 20 - 160,000 -
40 - 40 440,000 -
30 20 10 330,000 -
900 - 900 320,400 -

5,400 - 5,400 1,923,480 -
24 3 21 898,560 -
90 - 90 1,323,900 -
250 - 250 2,175,000 -
250 - 250 2,175,000 -
100 20 80 792,000 -
104 14 90 873,600 -
100 - 100 792,000 -
36 - 36 82,476 -
36 - 36 33,012 -
24 - 24 22,008 -
24 - 24 22,008 -
88 52 36 80,696 -
1,500 100 1,400 49,500 -
12 5 7 288,000 -
20 - 20 412,000 -
37 5 32 4,810,000 -
60 - 60 564,000 -
500 20 480 1,150,000 -
503 28 475 553,300 -
187 87 100 1,477,300 -
33,000 - 33,000 2,541,000 -
300 10 290 1,559,400 -
3,100 2,100 1,000 1,364,000 -
18 - 18 356,400 -
20 - 20 396,000 -
1,400 - 1,400 4,200,000 -
250 - 250 1,375,000 -

240 - 240 1,320,000 -
36 36 - 1,279,152 -
72 - 72 219,960 -
72 - 72 1,612,800 -
25 - 25 176,000 -
30 - 30 174,240 -
224,432,504 -
SIDOARJO, 7 SEPTEMBER 2019

PUSKESMAS TROSOBO
NIP. 196605101989032013
PUSKESMAS

PUSKESMAS
GFK
PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KETERANGAN
(Rp) (Rp) (Rp)

11 12 13 14 15
2,000
1,000
450,000 141,000 309000 15,000
200
706,000 511,144 194856 5,000
1,288,460 314,410 974050
450,450 298,650 151800 600
100
1,000
5,000
330,000 330,000 0 ED : 10/19
2,500
194,400 2,160 192240
132,000 33,000 99000
30
1,990,733 1,639,131 351602 15,000

273,429 65,313 208116 100
34,848 34,848 0
2,000
142,800 19,040 123760
154,500 56,650 97850 50
165,300 2,900 162400 200
495,000 62,700 432300
727,500 - 727500
- -
- -
4,515,000 - 4515000
215,000 130,720 84280

1,051,650 - 1051650
886,080 - 886080
70,576 52,976 17600 500

73,395 59,445 13950 ED : 11/19
43,600 - 43600
1,379,400 62,700 1316700
69,460 36,240 33220 500
68,400 - 68400
222,840 167,130 55710
198,660 11,880 186780

1,462,500 1,170,000 292500
271,950 191,100 80850 2,000

259,787 36,047 223740
209,820 156,020 53800 500
251,460 - 251460
129,800 - 129800
153,472 21,472 132000
289,578 10,688 278890
200
237,930 30,250 207680
58,562 8,010 50552

44,500 - 44500
246,480 31,200 215280
821,380 222,880 598500 3,000
562,500 22,500 540000

56,672 25,102 31570
1,446,150 32,550 1413600

164,020 16,680 147340
167,340 - 167340
572,000 67,320 504680 5,000

142,610 - 142610
140,800 14,080 126720

536,000 - 536000
40,040 19,530 20510

210,000 - 210000
800,000 20,000 780000
528,000 61,600 466400

2,209,770 114,200 2095570 2,000
- - 0
749,703 749,703 0 2,000
- -
- -
3,000
3,358,696 413,160 2945536
687,000 100,760 586240 1,500
769,560 154,880 614680 50

120
2,301,024 223,168 2077856 3,000

1,037,850 439,560 598290
595,084 105,364 489720 2,000
1,422,360 281,772 1140588

648,830 165,230 483600
54,560 32,560 22000
468,520 82,680 385840 3,000

141,330 77,280 64050 2,500
83,400 37,530 45870 200
115,500 - 115500
898,392 319,308 579084 2,500

222,600 - 222600
527,904 - 527904
515,372 - 515372
78,320 890 77430

1,079,928 35,298 1044630 3,000
246,620 12,980 233640

2,000
528,649 66,049 462600
779,350 286,000 493350 40
1,048,000 31,440 1016560
96,000 4,800 91200 200

180,000 - 180000
472,000 135,700 336300
- -
- -
319,000 319,000 319000
112,750 112,750 0 1,000
157,080 64,680 92400 50
324,280 152,460 171820 1,000
422,640 139,140 283500 3,000

87,600 5,475 82125
94,587 44,157 50430 500
97,500 97,500 0
150,000 150,000 0 20
20,020 - 20020
75,900 34,500 41400
138,000 - 138000
643,790 42,840 600950

8,000
3,209,280 667,200 2542080 10,000
42,000 - 42000
1,202,040 341,565 860475 3,000
1,500
750,600 500,400 250200
512,710 501,353 11357.5 1,000
397,390 72,990 324400

702,090 308,274 393816 1,800
484,000 - 484000
973,677 42,067 931610
259,350 - 259350 50
230,112 230,112 0 1,500

600
933,447 159,408 774039
498,831 143,106 355725

30
1,893,800 265,200 1628600
1,304,677 45,318 1259359 6,000
7,077,841 175,682 6902159
1,451,200 391,824 1059376 100
213,360 - 213360
291,060 172,260 118800 50
4,366,530 1,034,870 3331660 3,000
1,042,800 1,042,800 0 1,500
420,000 294,000 126000 50
1,093,390 208,290 885100
850,500 248,250 602250

1,000
47,200 1,900 45300
216,200 - 216200
513,000 82,080 430920

126,464 126,464 0 600
1,636,945 455,479 1181466 2,500
1,824,000 - 1824000
612,920 33,880 579040 50
61,250 - 61250 300

353,700 59,400 294300
245,280 - 245280
0
384,000 - 384000 50
217,800 24,200 193600
2,138,400 712,800 1425600
901,934 - 901934
126,000 90,000 36000 12

1,100,000 22,000 1078000
937,365 312,455 624910
141,204 1,148 140056
1,000
13,092,400 706,450 12385950
93,150 - 93150
297,130 64,263 232867 ED : 10/19

497,000 - 497000 ED : 10/19
1,093,400 880,400 213000
10
10
959,992 - 959992
1,702,987 - 1702987
240,660 45,360 195300

591,800 - 591800
213,422 213,422 0 30
500
201,000 - 201000
891,660 281,820 609840 100
346,500 - 346500
143,262 143,262 0 12
114,036 32,164 81872 50

150
50
88,396 84,378 4018 50
436,112 220,304 4656
228,738 133,146 1876 75
306,540 65,500 241040

236,500 11,825 224675
54,600 - 54600
14,520 14,520 0 100
293,000 - 293000
156,000 72,000 84000

292,500 169,000 123500 100
205,029 13,167 191862
235,620 60,984 174636
307,750 - 307750 ED : 1/20
3,366,000 459,000 2907000
84,700 66,550 18150 50

181,500 - 181500
292,670 62,160 230510 25
30
300
303,450 28,350 275100 600
126,360 - 126360 360

66,000 - 66000 60
134,385 13,005 121380

477,000 - 477000
507,159 144,189 362970
45,100 45,100 0 1,500

66,000 6,600 59400
1,522,950 664,950 858000

145,730 - 145730
- - 0
161,600 84,800 76800
82,500 16,500 66000
1,419,600 49,140 1370460
4,450,600 4,450,600 0
366,300 366,300 0
1,716,000 429,000 1287000
2,420,000 1,694,000 726000
660,000 330,000 330000
8,946,000 2,982,000 5964000
4,048,000 2,992,000 1056000
432,952 - 432952
396,000 - 396000
1,006,500 - 1006500 2
2,750,000 2,750,000 0
330,000 55,000 275000
1,188,000 792,000 396000
36,960 - 36960
1,876,000 1,072,000 804000
1,210,000 1,089,000 121000 2
1,056,000 - 1056000
1,540 - 1540
900,000 - 900000
21,024 - 21024 48
379,500 - 379500
28,600 - 28600
250,360 56,900 193460 1,000
952,000 472,000 480000
74,800 - 74800
692,120 594,880 549120
10
25,728,000 - 25728000
160,000 160,000 0
440,000 - 440000
330,000 220,000 110000
320,400 - 320400
1,923,480 - 1923480
898,560 112,320 786240
-
1,323,900 - 1323900
2,175,000 - 2175000
2,175,000 - 2175000
792,000 158,400 633600

873,600 117,600 756000 100
792,000 - 792000
82,476 - 82476
33,012 - 33012
22,008 - 22008
22,008 - 22008
80,696 47,684 33012
49,500 3,300 46200
288,000 120,000 168000

412,000 - 412000
4,810,000 650,000 4160000

564,000 - 564000
1,150,000 46,000 1104000
553,300 30,800 522500
1,477,300 687,300 790000
2,541,000 - 2541000
1,559,400 51,980 1507420 100
1,364,000 924,000 440000 1,000
356,400 - 356400
396,000 - 396000
4,200,000 - 4200000
1,375,000 - 1375000
1,320,000 - 1320000
1,279,152 1,279,152 0 10
219,960 - 219960
1,612,800 - 1612800
176,000 - 176000
174,240 - 174240
224,432,504 49,575,180 Rp 175,323,337

PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : SEPTEMBER 2019
PERSEDI
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN
AAN
1 2 3 4 5 6

1 Neuroval tab Tablet - 1,000 1,000
2 Antalgin 500 mg tab Tablet - 1,000 1,000
6 Diklofenak Kalium 50 mg tab Tablet 276 750 1,026
8 Eprinoc tab Tablet 92 - 92
16 Sotatic inj. 5 mg/ml Ampul 15 - 15
23 Suprafenid supp Suppositoria 52 - 52
25 Antagin inj. Ampul 56 - 56
(1c) ANTIPIRAI
(2) ANESTESI LOKAL

4 Lidokain komb inj / 2 ml Ampul 1,020 - 1,020

2 Diazepam 2 mg Tablet 310 - 310
3 Diazepam 5 mg Tablet 400 - 400
11 Haldol Decanoat inj 50 mg/ml Ampul 3 100 103
13 Klorpromazin HCl 100 mg tab Tablet 550 - 550
14 Klorpromazin HCl inj 25 mg/ml Ampul 180 - 180
(4) ANTI PARKINSON

2 Triheksifenidil 2 mg Tablet 1,500 2,000 3,500
-
(5) ANTI DEPRESI -
(6) ANTI MIGREN

1 Anti Migren (Komb. Ergot+Kafein) Tablet - - -
2 Betahistin Mesilat 6 mg Tablet 1,888 - 1,888
1 Isosorbit Dinitrat 5 mg Tablet 1,068 - 1,068

7 H.C.T 25 mg Tablet 9,120 - 9,120


2 Aminofilin inj 24 mg Ampul 60 - 60
(11) ANTI TUSIF

1 Dexmolex sirup Botol 100 ml 53 - 53
4 Tuzalos tab Tablet - - -
(12) EKSPEKTORAN
3 Gliseril Guayakolat 100 mg Tablet 33,472 - 33,472
5 Hustab tab Tablet 1,280 - 1,280
8 Sanadryl Expectorant Botol 60 ml - - -
(13) ANTI INFLUENZA

3 Molexflu tab Tablet 800 - 800
4 Colpica tab Tablet 5,000 - 5,000
5 Demacolin tab Tablet 103 - 103
6 Molexflu sirup Botol 60 ml 38 - 38
7 Demacolin syr Botol 60 ml 42 - 42
(14) ANTASIDA
7 Ranitidin tab 150 mg Tablet 610 - 610
8 Ranitidin inj 25 mg/2 ml Ampul 133 - 133
9 Sanmag tab Tablet 642 - 642
10 Ulsidex tab Tablet 500 - 500

1 Asering infus Botol 500 ml 24 - 24
2 D5 + 1/2 NS Botol 500 ml 54 - 54
3 D5 + 1/4 NS Botol 500 ml 53 - 53
9 Molagit tab Tablet 2,264 - 2,264
14 Oralit 200 ml Sachet 1,385 - 1,385
15 Ringer Laktat infus Botol 500 ml 69 - 69
(16) LAKSAN
1 Bisacodyl tab 5 mg Tablet 304 - 304
(17) ANTI SPASMODIK

2 Braxidin tab Tablet - - -
3 Hyosin Bromida inj Ampul 10 - 10
4 Scopma tab Tablet 142 - 142
(18) ANTI HISTAMIN


2 Glukose 10% infus 500 ml Botol 500 ml - - -


2 Glimipiride 2 mg Tablet 2,020 2,000 4,020

9 Glucosamin tab Tablet 488 - 488
15 Neurosanbe tab Tablet - - -

4 Ampisilin 500 mg Kaplet - - -
5 Ampisilin inj. Ampul - - -
6 Ampisilin sirup kering Botol 60 ml - - -
7 Azitomisin 250 mg kaplet Kaplet 120 - 120
8 Dionicol sirup kering Botol 60 ml 20 - 20
10 Cefadroxil sirup kering Botol 60 ml - - -
11 Cefalexin 500 mg Tablet - - -
12 Cefixime kapsul 100 mg Kapsul - - -
13 Cefixime sirup Botol 30 ml - - -
17 Claneksi sirup Tablet - - -
18 Co-Amoksiklav Tablet - - -
19 Colsancetine inj Ampul - - -
20 Eritromisin 250 mg Tablet - - -
21 Eritromisin 500 mg Kaplet 803 - 803
24 Klindamisin 300 mg Kapsul - - -
25 Kloramfenikol 250 mg Kapsul 4,530 - 4,530
29 Levofloksasin 500 mg Tablet - - -
30 Linkomisin kapsul 500 mg Tablet - - -
31 Ofloxacin 400 mg Tablet - - -
32 Spyramisin 500 mg Tablet - - -
33 Tetrasiklin 500 mg Tablet - - -
(25) ANTI VIRUS

1 Acyclovir 200 mg tab Tablet - - -
(26) ANTI FUNGI

4 Nistatin 500.000 IU tab Tablet - - -

6 OAT FDC Kategori 2 Paket 2 2

1 Etakridina larutan 0,1% Botol 300 ml - - -
2 Etanol 70% Botol 100 ml 96 - 96
3 H2O2 3% Botol 1000 ml 8 - 8
5 Lisol 50% Botol 1000 ml 22 - 22
8 Softa-Man (Aseptic Gel) Botol 500 ml 49 - 49
9 Softaskin (0ne Scrub) Botol 500 ml 10 - 10
(29) ANTELMENTIK
(30) ANTI AMUBIASIS


4 Vitalex kap Kaplet - - -
(32) HEMOSTATIK
(34) SERUM
2 ATS 1.500 IU Ampul 13 - 13
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 930 - 930
3 Oksitosin inj 10 IU/ml-1 ml Ampul - - -

(37) ANTI INFLAMASI SALEP -

2 Nisagon krem Tube 132 - 132

1 Bioplacenton gel Tube
(39) ANTI BAKTERI

3 Kloramfekort H krem Tube - - -

(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 92 - 92
2 Scabimite Tube 19 - 19
-
(42) ANTI SEPTIK -
2 Salisil bedak 2% Kotak


-
(46) ANTI INFEKSI MATA -
6 Sulfasetamid Natrium 15% t.m Botol 5 ml 25 - 25




(51) ANTI HEMOROID

2 Anusol Suppositoria - - -
3 Borraginol N Salep Tube 15 g - - -
4 Borraginol N Supp Suppositoria - - -
5 Hemorogard tab Tablet - - -
(52) ANTI EMETIK


(54) NOOTROPIK
1 Piracetam 400 mg Tablet - -
(55) IMMUNDILATOR
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
6 Combipack pcs 27 - 27
7 Carbamazepin tablet 1,800 - 1,800
8 Haldol inj. ampul
10 Haloperidol 5 mg tablet 960 - 960
11 Handscoon pcs
15 Haloperidol inj (Lodomer) ampul - 72 72
16 Lodomer Drop Drop 4 6 10
18 Micropipet pcs
19 pH Paper pcs
21 Risperidon 2 mg tablet 2,510 - 2,510
(59) OBAT GIGI

1 Alvogyl (Septodont) Botol 10 g - - -
2 Caustener rapid Botol 6,5 g - - -
4 Cresophene (Cresotin Liq) Botol 7,5 g 3 - 3
9 Forinokresol / Formocresol Botol 10 ml 6 - 6
11 Glass Ionomer Cement (Fuji IX) Set - - -
14 Mumifying pasta (Cresotin Pasta) Botol 7 g 6 6
17 Temporary Stopping Fletcher (Citodur) Botol 1 - 1
18 Tooth Cleansing (Occo) /Poliren No. 1 Botol 15 ml 6 - 6

4 Polikresulen (Metakresol) Botol 10 ml - - -

1 Alat suntik 1xpakai 0.05 ml Pcs - - -
2 Alat suntik 1xpakai 0.5 ml Pcs - - -
8 Aquadest steril 500 ml Botol 500 ml - -
9 Blood Lancet Pcs - -
10 Blue tape Pcs - -
11 Cat-gut dg jarum 2/0 Sachet - -
14 Cerplast Pcs - -
55 Kertas Puyer Pcs - -
57 Masker box 60 60
60 Mesh 11 Lancip (Biru) Pcs 1,200 1,200
61 Mesh 11 Lancip (merah) Pcs 200 200
65 Needle Novofine Pcs - -
66 Obyek glass Pcs - -
67 Pipet thoma Erythrocyt Pcs - -
68 Pipet thoma Leucocyt Pcs - -
71 Pot urine 10 ml Pcs - -
72 Sharp Collector Pcs - -
74 Silk dengan jarum 2/0 Sachet 72 72
77 Sputum pot Pcs - -
78 Tab. Kapiler Hematokrit Pcs - -
79 Tabung Vacutainer Kuning Pcs - -
80 Tabung Vacutainer Merah Pcs - -
81 Tabung Vacutainer Ungu Pcs - -
82 Tissue Lensa Kotak - -
83 Tranfusion Set Dewasa Pcs - -
84 Umbilical Pcs - -
86 White tape Pcs - -
87 Wing Needle 25 Pcs - -
88 Wing Needle 27 Pcs - -
89 Yellow tape Pcs - -
90 Stericide Botol 500 ml 7 7
Viorex Botol 500 ml 10 10
TOTAL
KUNJUNGAN
Sep-19
Mengetahui :
KABUPATEN SIDOARJO

NIP. 19870416201101 1 007

PUSKESMAS
GFK
PEMAKAI
SISA STOK PERMINTAAN KETERANGAN
AN
7 8 9 10
176 824
79 921
2,720 370
- -
300 -
412 614
3,725 4,745
5 87
44 -
- -
- -
50 -
- -
- -
30 1,750
- 15
- -
- -
3,570 3,064
111 77
- -
- -
- 52
13 6
- 56
- -
30 494
1,497 9,060
3 12
- -
- 98
- 1,020
- 5
95 105
310 -
- 400
- 315
55 -
- -
3 397
- 30
- -
2,290 5,540
13 90
- -
550 -
- 180
- 600
- 20
- 200
175 3,325
-
-
186 1,484
- -
- -
258 1,630
68 1,000
520 1,550
- -
- -
- -
3,400 5,150
- -
340 6,038
1,390 5,810
110 300
- -
440 8,680
- -
- -
- -
60 1,000
- 60
- -
- -
- -
4,290 7,180
- 130
- -
90 300
2,830 11,947
- -
223 3,070
- -
55 280
9 44
742 2,928
- -
- -
- -
- -
4,035 29,437
- -
1,004 276
- -
31 96
- -
- -
- -
652 148
- 5,000
64 39
- 38
- 42
178 152
4,049 17,073
64 226
100 -
- -
- -
790 2,178
610 -
43 90
642 -
30 470
- 24
- 54
- 53
- -
- -
- -
- -
- 870
877 1,387
20 144
- -
6 12
- -
664 721
39 30
1,150 790
- -
20 284
- 30
- 77
200 -
- -
- 10
52 90
- -
- -
- -
924 2,226
- 75
2,456 30,655
190 220
- -
- -
20 -
- 26
2,665 2,385
2,370 1,650
7,470 19,010
30 570
3,225 4,970
- -
- 24
- -
28 -
- -
100 300
488 -
20 420
3,590 12,200
- -
- 50
- -
- -
- -
- -
803 5,490
- -
- -
1,600 5,375
- -
2,425 16,735
4,958 10,215
6,129 23,494
- -
73 219
- -
- -
- -
19 101
4 16
1,757 5,213
- -
- -
- -
- -
10 20
- -
221 3,119
- -
- -
- -
- -
324 479
13 94
- -
- -
60 4,470
1 45
1,452 12,148
40 170
- -
- -
- -
- -
- -
508 597
- -
150 5,850
4 184
80 170
40 1,050
14 424
- -
15
2
- -
24 72
- 8
2 -
1 21
- -
1 1
- 49
1 9
- 488
1,030 33,860
- -
- 90
- -
- -
- -
357 680
60 -
- 2
3 10
- 930
200 -
- -
-
20 214
43 89
16 124
16 12
- -
- -
2 -
- 48
9 95
20 8
15 77
- 19
-
-
- 24
-
5 15
-
-
21 -
33 5
5 97
1 62
- -
- 25
- -
26 126
10 23
4 85
50 215
- -
- -
- -
- -
750 1,870
9 89
50 -
- -
174 1,686
20 20
- 420
963 1,359
- -
1,815 1,455
- -
- 9
- -
-
120
45 85
- 27
- 1,800
500 460
- 72
2 8
290 2,220
- -
- -
2 7
- 3
- 2
- 4
- 6
17 6
- 6
- 3
- -
- 8
- 5
- 6
- 200
- 3
- 1
- 6
- 200
1 59
1 15
4 19
- -
- -
- -
- 200
300 1,400
100 200
- 400
- 192
- -
- -
- -
- -
192 -
- -
- -
- -
- -
10 30
10 -
- -
- -
- -
- -
- -
400 500
- 12,500
- -
5 16
- -
- -
- 90
70 180
10 353
25 74
- 80
20 170
- 84
- 36
- 24
- 12
- 36
- 36
- 1,400
- -
- -
- -
3 24
- -
- -
- -
- 32
- 60
10 470
- 575
20 80
- -
290 -
16 44
- 18
- 20
- 1,200
- 200
- -
- 250
- 240
-
-
-
-
-
-
-
-
- -
- 72
48 24
- 25
-
-
-
-
-
-
-
-
- 30
-
-
-
-
- 7
10

NIP. 196605101989032013
LAPORAN PEMAKAIAN
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : SEPTEMBER 2019
NO NAMA OBAT SATUAN HARGA
1 2 3

1 Neuroval tab Tablet 968
2 Antalgin 500 mg tab Tablet 198
3 Asam Mefenamat 500 mg tab Tablet 103
4 Asetosal 100 mg tab Tablet 0
5 Aspilets 80 mg tab Tablet 0
6 Diklofenak Kalium 50 mg tab Tablet 706
7 Diklofenak Na. 50 mg tab Tablet 115
8 Eprinoc tab Tablet 1650
13 Meloxicam 15 mg tab Tablet 0
14 Meloxicam 7,5 mg tab Tablet 0
15 Metoklopramid 10 mg Tablet 108
16 Sotatic inj. 5 mg/ml Ampul 4664
17 Molakrim krim Tube 30 g 0
18 Nonflamin tab Tablet 0
19 Parasetamol 500 mg tab Tablet 53
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 1107
21 Piroksikam 10 mg tab Tablet 0
22 Piroksikam 20 mg tab Tablet 0
23 Suprafenid supp Suppositoria 2380
25 Antalgin inj. Ampul 2900
26 Tramadol injeksi 50 mg/ml Ampul 0
27 Tramadol kap 50 mg Tablet 825
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 97
(2) ANESTESI LOKAL

2 Ketamin / Ketalar inj. 100 mg/ml Vial 10 ml 0
5 Xylocain spray Botol 50 ml 177216

1 Alprazolam 0,5 mg Tablet 88
2 Diazepam 2 mg Tablet 45
3 Diazepam 5 mg Tablet 109
4 Diazepam inj. 5 mg/ 2 ml Ampul 4180
5 Fenitoin kapsul 100 mg Kapsu; 604
9 Haloperidol 0.5 mg tab Tablet 0
10 Haloperidol 1,5 mg Tablet 59
12 Haloperidol inj 50 mg/ml (Haldol Da Ampul 3600
13 Klobazam 10 mg tab Tablet 0
14 Klorpromazin HCl 100 mg tab Tablet 147
15 Klorpromazin HCl inj 25 mg/ml Ampul 1243
16 Trifluoperazine 5 mg tab Tablet 274
(4) ANTI PARKINSON

1 Levopar tab Tablet 649
2 Triheksifenidil 2 mg Tablet 85
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 167
(6) ANTI MIGREN

1 Anti Migren (Komb. Ergot+Kafein) Tablet
2 Betahistin Mesilat 6 mg Tablet 110

1 Isosorbit Dinitrat 5 mg - 2018 Tablet 89
2 Isosorbit Dinitrat 5 mg - 2019 Tablet 89
3 Nifedipin 10 mg Tablet 104

3 Bisoprolol Fumarat 5 mg Tablet 0
4 Captopril 25 mg Tablet 75
5 Furosemid 40 mg Tablet 77
6 Furosemid inj. Ampul 0
7 H.C.T 25 mg Tablet 155


1 Aminofilin 200 mg Tablet 113
Aminofillin 200 mg (Decafil) 139
2 Aminofilin inj 24 mg Ampul 3822
3 Bisolvon solution 10 mg/5 ml Botol 50 ml 0
4 Bisolvon injeksi 2 mg/ml Ampul 0
5 Bricasma inj 0,5 mg/ml Ampul 0
6 Deksamethason 0,5 mg Tablet 32
8 Efedrin HCl 25 mg Tablet 0
10 Methylprednisolon 4 mg Tablet 134
11 Prednison 5 mg Tablet 0
14 Salbutamol sirup (Astharol) Botol 60 ml 0
(11) ANTI TUSIF

2 Kodein 10 mg Tablet 571
3 Sanadryl DMP sirup Botol 60 ml
4 Tuzalos tab Tablet 0
(12) EKSPEKTORAN
1 Ambroxol HCl 30 mg Tablet 0
3 Gliseril Guayakolat 100 mg Tablet 88
4 Hustab sirup Botol 60 ml 0
5 Hustab tab Tablet 458
6 OBH Plus Anak Botol 60 ml 0
(13) ANTI INFLUENZA

1 Alpara tab Tablet 0
2 Alpara sirup Botol 60 ml 0
3 Molexflu tab Tablet 396
4 Colpica tab Tablet 352
5 Demacolin tab Tablet 170
6 Molexflu sirup Botol 60 ml 6710
7 Demacolin syr Botol 60 ml 12210
8 Tremenza tab Tablet 1484
(14) ANTASIDA
1 Antasida DOEN I tab Tablet 54
3 Cimetidin 200 mg Tablet 220
4 Cytotec Tablet
5 Famotidine 20 mg Tablet
6 Omeprazole kap 20 mg Tablet 130
7 Ranitidin tab 150 mg Tablet 105
9 Sanmag tab Tablet 642
10 Ulsidex tab Tablet 296

1 Asering infus Botol 500 ml 9275
2 D5 + 1/2 NS Botol 500 ml 9776
3 D5 + 1/4 NS Botol 500 ml 9724
4 Dehaf Sachet 0
5 KAEN 3A Botol 500 ml 0
6 KAEN 3B Botol 500 ml 0
7 L-Bio Sachet 0
8 Loperamide Tablet 89
9 Molagit tab Tablet 477
11 Na. Klorida 0,9% piggy bag Botol 100 ml 0
12 Neo Kaolana suspensi Botol 60 ml 12980
13 New Diaform Tablet
17 Zink sirup 20 mg/5 ml Botol 60 ml 0
(16) LAKSAN
1 Bisacodyl tab 5 mg Tablet 300
2 Dulcolax supp 5 mg Suppositoria 6,000
3 Dulcolax supp 10 mg Suppositoria 5,900
(17) ANTI SPASMODIK

1 Atropin Sulfat inj 0,25 mg/ml Ampul -
2 Braxidin tab Tablet -
3 Hyosin Bromida inj Ampul 9,240
4 Buscopan tab Tablet 1,210
5 Buscopan plus Tablet -
6 Ekstrak Belladona 10 mg Tablet -
(18) ANTI HISTAMIN

1 Ceterizine sirup Botol 60 ml -
2 Cetirizine tab 10 mg Tablet 90
3 Difenhidramin inj Ampul 1,095
5 Loratadine 10 mg Tablet 123

1 Aminofluid Softbag 500 ml -
3 Glukose 10% infus 500 ml - 2019 Botol 500 ml -
4 Glukose 40% inj 25 ml Ampul 1,001


1 Glibenklamid 5 mg Tablet 119
2 Glimipiride 2 mg Tablet 207
3 Metformin tab 500 mg Tablet 96


1 Anemolat tab / Asam folat tab Tablet 70
2 Asam Askorbat 50 mg Tablet 105
5 Caldece tab effervecent Tablet 0
6 Cavit D3 Tablet 1622.5
7 Elkana sirup Botol 60 ml 0
8 Elkana tab Tablet 811
9 Glucosamin tab Tablet 807
11 Kalsium Laktat 500 mg Tablet 59
12 Neurosanbe 5000 Tablet 0
14 Neurosanbe Plus Tablet 0
15 Neurosanbe tab Tablet 0
17 Pharmaton Vit Tablet 0
18 Piridoksin 10 mg (Vit. B6) Tablet 123
19 Procurma Plus sirup Botol 60 ml 0
21 Sianokobalamin tab Tablet 51
22 Tiamin HCl (Vit. B1) inj 100 mg/ml Ampul 0
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 85
24 Vit. B kompleks Tablet 83

1 Amoksisilin 500 mg Tablet 233
2 Amoksisilin inj. Ampul 0
4 Ampisilin 500 mg Kaplet 0
5 Ampisilin inj. Ampul 0
6 Ampisilin sirup kering Botol 60 ml 0
7 Azitomisin 500 mg kaplet Kaplet 1778
8 Dionicol sirup kering Botol 60 ml 5940
9 Cefadroxil 500 mg Kaplet 478
10 Cefadroxil sirup kering Botol 60 ml 0
11 Cefalexin 500 mg Tablet 0
12 Cefixime kapsul 200 mg Kapsul 0
13 Cefixime sirup Botol 30 ml 0
15 Ceftriaxone injeksi 1 g Ampul 0
16 Ciprofloxacin 500 mg Tablet 265
17 Claneksi sirup Tablet 0
18 Co-Amoksiklav Tablet 0
19 Colsancetine inj Ampul 0
20 Eritromisin 250 mg Tablet 0
21 Eritromisin 500 mg Kaplet 750
23 Gentamisin inj. 40 mg/ml Ampul 0
25 Kloramfenikol 250 mg Kapsul 10
27 Kotrimoksasol 480 mg Tablet 0
30 Linkomisin kapsul 500 mg Tablet 0
31 Ofloxacin 400 mg Tablet 0
32 Spyramisin 500 mg Tablet 0
33 Tetrasiklin 500 mg Tablet 0
34 Thiamphenikol 500 mg Tablet 1070
(25) ANTI VIRUS

2 Acyclovir 400 mg tab Tablet 380
(26) ANTI FUNGI

2 Ketokonazol 200 mg Tablet 270

5 OAT FDC Kategori 1 Paket 359985
6 OAT FDC Kategori 2 Paket 1297889

1 Etakridina larutan 0,1% Botol 300 ml 0
3 H2O2 3% Botol 1000 ml 24200
4 Sterizym Botol 5 L 712800
5 Lisol 50% Botol 1000 ml 40997
6 Paraformaldehid 1 g Tablet
(29) ANTELMENTIK
4 Pirantel 125 mg Tablet 287
(30) ANTI AMUBIASIS


1 Besi (II) Sulfat tab Sachet 355
2 Besi sirup Botol 150 ml 0
3 Sianokobalamin inj (Vit. B 12) Ampul 1035
4 Vitalex kap Kaplet 0
(32) HEMOSTATIK
3 Fitomenadion 10 mg (Vit. K) - 2019 Tablet 710

(34) SERUM
1 ABU I Polivalen 5 ml Vial 479996
2 ATS 1.500 IU Ampul 130999
(35) OKSITOSIK


2 Nisagon krem Tube 4620
(39) ANTI BAKTERI

1 Anti Bakteri DOEN s.k Tube 2924

1 Anti Fungi DOEN (As.Benz 60+As.Sa Pot 4496
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 2620
2 Scabicide Tube 11825
(42) ANTI SEPTIK

1 P.K serbuk 5 gram Botol 2275



1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 14650

5 Polidemisin eye drop Botol 5 ml 0
6 Sulfasetamid Natrium 15% t.m Botol 5 ml 12310




(51) ANTI HEMOROID

1 Anti Hemoroid supp Suppositoria
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 105
3 Domperidon tab Tablet 0
4 Mediamer B6 Tablet 0
5 Ondansetron 8 mg tab Tablet 351

2 Kalsium Atorvastatin Tablet 795
3 Lipitor 20 mg Tablet
4 Simvastatin tab 10 mg Tablet 111
(54) NOOTROPIK
2 Piracetam inj 1 g/5 ml Ampul 6600
(55) IMMUNDILATOR
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 1121
6 Combipack pcs 0
7 Carbamazepin tab tablet 230
8 Haldol inj. 5mg/ml ampul
10 Haloperidol 5 mg tablet 80
11 Handscoon pcs
15 Haloperidol inj (Lodomer) ampul 5000
16 Lodomer Drop Drop 18700
18 Micropipet pcs
19 pH Paper pcs
(59) OBAT GIGI

4 Cresophene (Septodont)/Cresotin Li Botol 7,5 g 242000
9 Forinokresol / Formocresol Botol 10 ml 66000
10 Glass Ionomer Cement (Fuji II LC) Set 335500
14 Mumifying pasta/Cresotin Pasta Botol 7 g 198000
18 Tooth Cleansing (Occo)/ Poliren no. Botol 15 ml 176000

1 Bufacomb Iob (Zenith) Tube 15000

1 Alat suntik 1xpakai 0.05 ml Pcs 0
2 Alat suntik 1xpakai 0.5 ml Pcs 0
4 Alat Suntik 1xpakai 3 ml Pcs 113.8
9 Blood Lancet Pcs
10 Blue tape Pcs
11 Cat-gut dg jarum 2/0 (Cromic) Sachet
12 Cat-gut dg jarum 3/0 (Plain) Sachet 134000
13 Catton swap Pcs
14 Cerplast Pcs
15 Cover glass Pcs
24 Handscoon uk. L Pcs 356
25 Handscoon uk. M Pcs 356
43 Jarum Suntik no. 25 Pcs 330
52 Kasa pembalut 2 m x 80 cm Rol 9400
56 Kertas Puyer Pcs 77
57 Lomatull Pcs 5198
58 Masker Box 22000
63 Microburet Pcs
67 Obyek glass Pcs
78 Sputum pot Pcs
85 Umbilical Pcs
86 Urine Bag Pcs 5808
87 White tape Pcs
90 Yellow tape Pcs
91 Sterizide Pcs 87120
92 Viorex botol 67650
SEPTEMBER 2019 19.396.500
MENGETAHUI
KABUPATEN SIDOARJO
NIP. 19870416201101 1 007
RAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
APBD
STOK PENERI PERSE PEMA SISA STOK

STOK AWAL
AWAL MAAN DIAAN KAIAN
(Rp)
4 5 6 7 8 9
- 1,000 1,000 176 824 -

- 1,000 1,000 79 921 -
3,090 - 3,090 2,720 370 318,270
- - - - - -
- - - - - -
276 750 1,026 412 614 194,856
8,470 - 8,470 3,725 4,745 974,050
92 - 92 5 87 151,800
- - - - - -
- - - - - -
- - - - - -
50 - 50 50 - 330,000
- - - - - -
- - - - - -
1,780 - 1,780 30 1,750 192,240
15 - 15 - 15 69,960
- - - - - -
- - - - - -
6,634 - 6,634 3,570 3,064 351,602
188 - 188 111 77 208,116
- - - - - -
- - - - - -
52 - 52 - 52 123,760
19 - 19 13 6 97,850
56 - 56 - 56 162,400
- - - - - -
524 - 524 30 494 432,300
7,500 - 7,500 - 7,500 727,500
15 - 15 3 12 4,515,000
- - - - - -
98 - 98 - 98 84,280
570 - 570 - 570 1,051,650
5 - 5 - 5 886,080
OTIK, AN.PSIKOTIK
200 - 200 95 105 17,600
310 - 310 310 - 13,950
400 - 400 360 40 43,600
315 - 315 - 315 1,316,700
55 - 55 55 - 33,220
- - - - - -
400 - 400 3 397 68,400
30 - 30 - 30 52,200
- - - - - -
2,830 5,000 7,830 2,290 5,540 166,970
3 100 103 13 90 10,800
- - - - - -
550 - 550 550 - 80,850
180 - 180 - 180 223,740
600 - 600 - 600 164,400
20 - 20 - 20 251,460
200 - 200 - 200 129,800

1,500 2,000 3,500 175 3,325 127,500
1,670 - 1,670 186 1,484 278,890

- - -
- - -
2,163 2,163 275 1,888 237,930
568 568 68 500 50,552

500 500 - 500 44,500
2,070 2,070 520 1,550 215,280
- - -
- - -
- - -
8,550 - 8,550 3,400 5,150 598,500

- - - - - -
- - - - - -
7,200 - 7,200 1,390 5,810 540,000
410 - 410 110 300 31,570
- - - - - -
9,120 - 9,120 440 8,680 1,413,600
- - -
- - -
- - -
560 - 560 60 500 63,280

500 - 500 - 500 69,500
60 - 60 - 60 229,320
- - - - - -
- - - - - -
- - - - - -
11,470 - 11,470 4,290 7,180 367,040
130 - 130 - 130 142,610
- - - - - -
390 - 390 90 300 549,120
4,000 - 4,000 - 4,000 536,000
- - - - - -
3,293 - 3,293 223 3,070 230,510
- - - - - -
335 - 335 55 280 1,340,000
53 - 53 9 44 466,400
3,670 - 3,670 742 2,928 2,095,570
- - - - - -
- - - - - -
- - - - - -
- - - - - -
33,472 - 33,472 4,035 29,437 2,945,536
- - - - - -
1,280 - 1,280 1,004 276 586,240
- - - - - -
127 - 127 31 96 614,680
- - - - - -
- - - - - -
- - - - - -
800 - 800 652 148 316,800
5,000 - 5,000 - 5,000 1,760,000
103 - 103 64 39 17,510
38 - 38 - 38 254,980
42 - 42 - 42 512,820
330 - 330 178 152 489,720
- - -
- - -
21,122 - 21,122 4,049 17,073 1,140,588
290 - 290 64 226 584,350
100 - 100 100 - 22,000
- - - - - -
- - - - - -
2,968 - 2,968 790 2,178 385,840
610 - 610 610 - 64,050
133 - 133 43 90 153,615
- 642 642 642 - -
500 - 500 30 470 148,000
24 - 24 - 24 222,600
54 - 54 - 54 527,904
53 - 53 - 53 515,372
- - - - - -
- - - - - -
- - - - - -
- - - - - -
870 - 870 - 870 77,430
2,264 - 2,264 877 1,387 1,079,928
- - - - - -
- - - - - -
18 - 18 6 12 233,640
- - - - - -
1,385 - 1,385 664 721 355,945
69 - 69 39 30 493,350
1,940 - 1,940 1,150 790 1,016,560
- - - - - -
304 - 304 20 284 91,200
30 - 30 - 30 180,000
77 - 77 - 77 454,300
200 - 200 200 - -

- - - - - -
10 - 10 - 10 92,400
142 - 142 52 90 171,820
- - - - - -
- - - - - -
- - - - - -
3,150 - 3,150 924 2,226 283,500
75 - 75 - 75 82,125
- - - - - -
410 - 410 190 220 50,430
- - - - - -
- - - - - -
20 - 20 20 - 20,020
6 6 - 6 41,400
20 20 - 20 138,000
- - -
5,050 - 5,050 2,665 2,385 600,950
- 2,000 2,000 350 1,650 -
26,480 - 26,480 7,470 19,010 2,542,080
600 - 600 30 570 42,000

8,195 - 8,195 3,225 4,970 860,475
- - - - - -
24 - 24 - 24 250,200
- - - - - -
28 - 28 28 - 45,430
- - - - - -
400 - 400 100 300 324,400
488 - 488 488 - 393,816
440 - 440 20 420 484,000
15,790 - 15,790 3,590 12,200 931,610
- - - - - -
50 - 50 - 50 259,350
- - - - - -
- - - - - -
- - - - - -
- - - - - -
6,293 - 6,293 803 5,490 774,039
- - - - - -
- - - - - -
6,975 - 6,975 1,600 5,375 355,725
- - - - - -
19,160 - 19,160 2,425 16,735 1,628,600
15,173 - 15,173 4,958 10,215 1,259,359
29,623 - 29,623 6,129 23,494 6,902,159

- - - - - -
292 - 292 73 219 1,059,376
- - - - - -
- - - - - -
- - - - - -
120 - 120 19 101 213,360
20 - 20 4 16 118,800
6,970 - 6,970 1,757 5,213 3,331,660
- - - - - -
- - - - - -
- - - - - -
- - - - - -
30 - 30 10 20 126,000
- - - - - -
3,340 - 3,340 221 3,119 885,100
- - - - - -
- - - - - -
- - - - - -
- - - - - -
803 - 803 324 479 602,250
- - - - - -
- - - - - -
- - - - - -
4,530 - 4,530 60 4,470 45,300
46 - 46 1 45 216,200
- - - - - -
210 - 210 40 170 430,920
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1,105 - 1,105 508 597 1,182,350
- - - - - -
4,800 - 4,800 - 4,800 1,824,000
188 - 188 4 184 579,040
250 - 250 80 170 61,250

1,090 - 1,090 40 1,050 294,300
438 - 438 14 424 245,280
- - - - - -
- - -
- - -
- - -
- - -
18 18 3 15 6,479,730
- 2 2 2 - -
- - -
- - -
- - -
- - -
- - -
- - -
- - - - - -
96 - 96 24 72 384,000
8 - 8 - 8 193,600
2 - 2 2 - 1,425,600
22 - 22 1 21 901,934
- - - - - -
2 - 2 1 1 36,000
49 - 49 - 49 1,078,000
10 - 10 1 9 624,910
- - -
- - -
- - -
488 - 488 - 488 140,056
- - -
- - -
34,890 - 34,890 1,030 33,860 12,385,950

- - - - - -
90 - 90 - 90 93,150
- - - - - -
- - - - - -
- - - - - -
1,037 - 1,037 357 680 736,270
60 60 60 - 213,000
- - -
- - -
- - -
- - -
- - -
2 - 2 - 2 959,992
13 - 13 3 10 1,702,987
930 - 930 - 930 195,300

200 - 200 200 - 591,800
- - - - - -
150 - 150 - 150 201,000

132 - 132 43 89 609,840
140 - 140 16 124 346,500
28 - 28 16 12 81,872
- - - - - -
- - - - - -
2 - 2 2 - 4,018
48 - 48 - 48 215,808
- - - - - -
28 - 28 20 8 95,592
92 - 92 15 77 241,040
19 - 19 - 19 224,675
24 - 24 - 24 54,600
20 - 20 5 15 293,000
- - - - - -
38 - 38 33 5 123,500
102 - 102 5 97 191,862
63 - 63 1 62 174,636
- - - - - -
25 - 25 - 25 307,750
- - - - - -
152 - 152 26 126 2,907,000
33 - 33 10 23 199,650
89 - 89 4 85 230,510
2,620 - 2,620 750 1,870 275,100

- - - - - -
- - - - - -
- - - - - -
360 - 360 - 360 126,360
40 - 40 20 20 66,000
420 - 420 - 420 121,380

600 - 600 - 600 477,000
- - - - - -
3,270 - 3,270 1,815 1,455 362,970
- - - - -
9 9 - 9 59,400
- - - - -
- - - -
120 120 120 858,000
- - -
- - -
- - -
- - -
130 - 130 45 85 145,730
27 - 27 - 27 -
1,800 1,800 - 1,800 414,000
- - -
- - -
960 - 960 500 460 76,800
- - -
- - -
- - -
- - -
- 72 72 - 72 -
4 6 10 2 8 74,800
- - -
- - -
- - -
- - -
2,510 - 2,510 290 2,220 1,370,460
- - -
- - -
- - -
- - -
- - - - - -
- - - - - -
9 - 9 2 7 1,287,000
3 - 3 - 3 726,000
2 - 2 - 2 330,000
4 - 4 - 4 5,964,000
6 - 6 - 6 1,056,000
23 - 23 17 6 432,952
6 - 6 - 6 396,000
3 - 3 - 3 1,006,500
- - - - - -
8 - 8 - 8 2,200,000
5 - 5 - 5 275,000
6 6 - 6 1,188,000
200 - 200 - 200 1,848,000
3 - 3 - 3 804,000
1 - 1 - 1 121,000
6 - 6 - 6 1,056,000
200 - 200 - 200 154,000
- - -
- - -
60 - 60 1 59 900,000
16 - 16 1 15 21,024
23 23 4 19 379,500
- - - - - -
- - - - - -
- - - - - -
200 200 - 200 28,600
1,700 1,700 300 1,400 193,460
300 300 100 200 480,000
400 400 - 400 74,800
192 192 - 192 549,120
- - - - -
- - - - -
- - - - -
- - - - -
192 192 192 - 25,728,000
- - - - -
- - - - -
- - - - -
- - - - -
40 40 10 30 440,000
10 10 10 - 110,000
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
900 900 400 500 320,400
12,500 12,500 - 12,500 4,450,000
- - - - -
21 21 5 16 786,240
- - - - -
- - - - -
90 90 - 90 1,323,900
250 250 70 180 2,175,000
250 250 - 250 2,175,000
- - - - -
80 80 - 80 633,600
90 90 20 70 756,000
100 100 - 100 792,000
84 84 - 84 77,028
36 36 - 36 33,012
24 24 - 24 22,008
12 12 - 12 11,004
36 36 - 36 33,012
36 36 - 36 33,012
1,400 1,400 - 1,400 462,000
- - -
- - -
- - -
27 27 3 24 556,200
- - -
- - -
- - - - -
32 32 - 32 4,160,000
60 60 - 60 564,000
480 480 10 470 1,104,000
575 575 - 575 632,500
100 100 20 80 790,000
- - - - -
290 290 290 - 1,507,420
60 60 16 44 1,320,000
18 18 - 18 356,400
20 20 - 20 396,000
1,200 1,200 - 1,200 699,600
200 200 - 200 600,000
- - -
250 250 - 250 1,375,000
240 240 - 240 1,320,000
- - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
72 72 - 72 219,960
72 72 48 24 1,612,800
25 25 - 25 176,000
- - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
30 30 - 30 174,240
- - -
- - - -
- - - -
- - - -
7 7 - 7 609,840
10 10 - 10 676,500
187,822,872
TOTAL
KUNJUNGAN
3.144

NIP. 196605101989032013
NTAAN OBAT PUSKESMAS
PUSKESMAS
GFK
PENERI PERSE PEMA SISA PERMIN

MAAN DIAAN KAIAN STOK TAAN
(Rp) (Rp) (Rp) (Rp) (Rp)
10 11 12 13
968,000 968,000 170,368 797,632

198,000 198,000 15,642 182,358
- 318,270 280,160 38,110
- - - -
- - - -
529,500 724,356 290,872 433,484
- 974,050 428,375 545,675
- 151,800 8,250 143,550
- - - -
- - - -
- - - -
- 330,000 330,000 -
- - - -
- - - -
- 192,240 3,240 189,000
- 69,960 - 69,960
- - - -
- - - -
- 351,602 189,210 162,392
- 208,116 122,877 85,239
- - - -
- - - -
- 123,760 - 123,760
- 97,850 66,950 30,900
- 162,400 - 162,400
- - - -
- 432,300 24,750 407,550
- 727,500 - 727,500
- 4,515,000 903,000 3,612,000

- - - -
- 84,280 - 84,280
- 1,051,650 - 1,051,650
- 886,080 - 886,080
- 17,600 8,360 9,240

- 13,950 13,950 -
- 43,600 39,240 4,360
- 1,316,700 - 1,316,700
- 33,220 33,220 -
- - - -
- 68,400 513 67,887
- 52,200 - 52,200
- - - -
295,000 461,970 135,110 326,860
360,000 370,800 46,800 324,000
- - - -
- 80,850 80,850 -
- 223,740 - 223,740
- 164,400 - 164,400
- 251,460 - 251,460
- 129,800 - 129,800
170,000 297,500 14,875 282,625
- 278,890 31,062 247,828

- - - -
- - - -
- 237,930 30,250 207,680
- 50,552 6,052 44,500

- 44,500 - 44,500
- 215,280 54,080 161,200
- - - -
- - - -
- - - -
- 598,500 238,000 360,500

- - - -
- - - -
- 540,000 104,250 435,750
- 31,570 8,470 23,100
- - - -
- 1,413,600 68,200 1,345,400
- - - -
- - - -
- - - -
- 63,280 6,780 56,500

- 69,500 - 69,500
- 229,320 - 229,320
- - - -
- - - -
- - - -
- 367,040 137,280 229,760
- 142,610 - 142,610
- - - -
- 549,120 126,720 422,400
- 536,000 - 536,000
- - - -
- 230,510 15,610 214,900
- - - -
- 1,340,000 220,000 1,120,000
- 466,400 79,200 387,200

- 2,095,570 423,682 1,671,888
- - - -
- - - -
- - - -
- - - -
- 2,945,536 355,080 2,590,456
- - - -
- 586,240 459,832 126,408
- - - -
- 614,680 150,040 464,640
- - - -
- - - -
- - - -
- 316,800 258,192 58,608
- 1,760,000 - 1,760,000
- 17,510 10,880 6,630
- 254,980 - 254,980
- 512,820 - 512,820
- 489,720 264,152 225,568
- - - -
- - - -
- 1,140,588 218,646 921,942
- 584,350 128,960 455,390
- 22,000 22,000 -
- - - -
- - - -
- 385,840 102,700 283,140
- 64,050 64,050 -
- 153,615 49,665 103,950
412,164 412,164 412,164 -
- 148,000 8,880 139,120
- 222,600 - 222,600
- 527,904 - 527,904
- 515,372 - 515,372
- - - -
- - - -
- - - -
- - - -
- 77,430 - 77,430
- 1,079,928 418,329 661,599
- - - -
- - - -
- 233,640 77,880 155,760
- - - -
- 355,945 170,648 185,297
- 493,350 278,850 214,500
- 1,016,560 602,600 413,960
- - - -
- 91,200 6,000 85,200
- 180,000 - 180,000
- 454,300 - 454,300
- - - -
- - - -
- 92,400 - 92,400
- 171,820 62,920 108,900
- - - -
- - - -
- - - -
- 283,500 83,160 200,340
- 82,125 - 82,125
- - - -
- 50,430 23,370 27,060
- - - -
- - - -
- 20,020 20,020 -
- 41,400 - 41,400
- 138,000 - 138,000
- - - -
- 600,950 317,135 283,815
414,000 414,000 72,450 341,550
- 2,542,080 717,120 1,824,960
- 42,000 2,100 39,900

- 860,475 338,625 521,850
- - - -
- 250,200 - 250,200
- - - -
- 45,430 45,430 -
- - - -
- 324,400 81,100 243,300
- 393,816 393,816 -
- 484,000 22,000 462,000
- 931,610 211,810 719,800
- - - -
- 259,350 - 259,350
- - - -
- - - -
- - - -
- - - -
- 774,039 98,769 675,270
- - - -
- - - -
- 355,725 81,600 274,125
- - - -
- 1,628,600 206,125 1,422,475
- 1,259,359 411,514 847,845
- 6,902,159 1,428,057 5,474,102

- - - -
- 1,059,376 264,844 794,532
- - - -
- - - -
- - - -
- 213,360 33,782 179,578
- 118,800 23,760 95,040
- 3,331,660 839,846 2,491,814
- - - -
- - - -
- - - -
- - - -
- 126,000 42,000 84,000
- - - -
- 885,100 58,565 826,535
- - - -
- - - -
- - - -
- - - -
- 602,250 243,000 359,250
- - - -
- - - -
- - - -
- 45,300 600 44,700
- 216,200 4,700 211,500
- - - -
- 430,920 82,080 348,840
- - - -
- - - -
- - - -
- - - -
- - - -
- 1,182,350 543,560 638,790
- - - -
- 1,824,000 - 1,824,000
- 579,040 12,320 566,720
- 61,250 19,600 41,650

- 294,300 10,800 283,500
- 245,280 7,840 237,440
- - - -
- - - -
- - - -
- - - -
- - - -
- 6,479,730 1,079,955 5,399,775
2,595,778 2,595,778 2,595,778 -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 384,000 96,000 288,000
- 193,600 - 193,600
- 1,425,600 1,425,600 -
- 901,934 40,997 860,937
- - - -
- 36,000 18,000 18,000
- 1,078,000 - 1,078,000
- 624,910 62,491 562,419
- - - -
- - - -
- - - -
- 140,056 - 140,056
- - - -
- - - -
- 12,385,950 365,650 12,020,300

- - - -
- 93,150 - 93,150
- - - -
- - - -
- - - -
- 736,270 253,470 482,800
- 213,000 213,000 -
- - - -
- - - -
- - - -
- - - -
- - - -
- 959,992 - 959,992
- 1,702,987 392,997 1,309,990
- 195,300 - 195,300
- 591,800 591,800 -
- - - -
- 201,000 - 201,000
- 609,840 198,660 411,180
- 346,500 39,600 306,900
- 81,872 46,784 35,088
- - - -
- - - -
- 4,018 4,018 -
- 215,808 - 215,808
- - - -
- 95,592 68,280 27,312
- 241,040 39,300 201,740

- 224,675 - 224,675
- 54,600 - 54,600
- 293,000 73,250 219,750
- - - -
- 123,500 107,250 16,250
- 191,862 9,405 182,457
- 174,636 2,772 171,864
- - - -
- 307,750 - 307,750
- - - -
- 2,907,000 497,250 2,409,750
- 199,650 60,500 139,150
- 230,510 10,360 220,150
- 275,100 78,750 196,350

- - - -
- - - -
- - - -
- 126,360 - 126,360
- 66,000 33,000 33,000
- 121,380 - 121,380
- 477,000 - 477,000
- - - -
- 362,970 201,465 161,505
- - - -
- 59,400 - 59,400
- - - -
- - - -
- 858,000 858,000 -
- - - -
- - - -
- - - -
- - - -
- 145,730 50,445 95,285
- - - -
- 414,000 - 414,000
- - - -
- - - -
- 76,800 40,000 36,800
- - - -
- - - -
- - - -
- - - -
360,000 360,000 - 360,000
112,200 187,000 37,400 149,600
- - - -
- - - -
- - - -
- - - -
- 1,370,460 158,340 1,212,120
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1,287,000 286,000 1,001,000
- 726,000 - 726,000
- 330,000 - 330,000
- 5,964,000 - 5,964,000
- 1,056,000 - 1,056,000
- 432,952 320,008 112,944
- 396,000 - 396,000
- 1,006,500 - 1,006,500
- - - -
- 2,200,000 - 2,200,000
- 275,000 - 275,000
- 1,188,000 - 1,188,000
- 1,848,000 - 1,848,000
- 804,000 - 804,000
- 121,000 - 121,000
- 1,056,000 - 1,056,000
- 154,000 - 154,000
- - - -
- - - -
- 900,000 15,000 885,000
- 21,024 1,314 19,710
- 379,500 66,000 313,500
- - - -
- - - -
- - - -
- 28,600 - 28,600
- 193,460 34,140 159,320
- 480,000 160,000 320,000
- 74,800 - 74,800
- 549,120 - 549,120
- - - -
- - - -
- - - -
- - - -
- 25,728,000 25,728,000 -
- - - -
- - - -
- - - -
- - - -
- 440,000 110,000 330,000
- 110,000 110,000 -
- - - -
- - - -
- - - -
- - - -
- - - -
- 320,400 142,400 178,000
- 4,450,000 - 4,450,000
- - - -
- 786,240 187,200 599,040
- - - -
- - - -
- 1,323,900 - 1,323,900
- 2,175,000 609,000 1,566,000
- 2,175,000 - 2,175,000
- - - -
- 633,600 - 633,600
- 756,000 168,000 588,000
- 792,000 - 792,000
- 77,028 - 77,028
- 33,012 - 33,012
- 22,008 - 22,008
- 11,004 - 11,004
- 33,012 - 33,012
- 33,012 - 33,012
- 462,000 - 462,000
- - - -
- - - -
- - - -
- 556,200 61,800 494,400
- - - -
- - - -
- - - -
- 4,160,000 - 4,160,000
- 564,000 - 564,000
- 1,104,000 23,000 1,081,000
- 632,500 - 632,500
- 790,000 158,000 632,000
- - - -
- 1,507,420 1,507,420 -
- 1,320,000 352,000 968,000
- 356,400 - 356,400
- 396,000 - 396,000
- 699,600 - 699,600
- 600,000 - 600,000
- - - -
- 1,375,000 - 1,375,000
- 1,320,000 - 1,320,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 219,960 - 219,960
- 1,612,800 1,075,200 537,600
- 176,000 - 176,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 174,240 - 174,240
- - - -
- - - -
- - - -
- - - -
- 609,840 - 609,840
- 676,500 - 676,500
6,414,642 194,237,514 56,485,263 137,752,251
KET.
15
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : OKTOBER 2019 ALL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN
1 2 3 4 5

1 Neuroval tab Tablet 824 1,500
2 Antalgin 500 mg tab Tablet 921 10,000
3 Asam Mefenamat 500 mg tab Tablet 370 15,000
5 Aspilets 80 mg tab Tablet - -
6 Diklofenak Kalium 50 mg tab Tablet 614 -
7 Diklofenak Na. 50 mg tab Tablet 4,745 -
8 Eprinoc tab Tablet 87 -
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml - 100
12 Meloxicam 15 mg supp Suppositoria - -
15 Metoklopramid 10 mg Tablet 1,750 -
16 Sotatic inj. 5 mg/ml Ampul 15 -
17 Molakrim krim Tube 30 g - 30
23 Suprafenid supp Suppositoria 52 -
24 Proris supp Suppositoria 6 -
25 Antagin inj. Ampul 56 100
27 Tramadol kap 50 mg Tablet 494 -
(1c) ANTIPIRAI
Alopurinol 100 mg Tablet 10,557 -
(2) ANESTESI LOKAL

1 Etil Klorida semprot Botol 100 ml 12 -
3 Lidokain inj 2% (HCl) / 2 ml Ampul 98 -
4 Lidokain komb inj / 2 ml Ampul 1,020 -
5 Xylocain spray Botol 50 ml 5 -

3 Diazepam 5 mg Tablet 400 -
4 Diazepam inj. 5 mg/ 2 ml Ampul 315 -
5 Fenitoin kapsul 100 mg Kapsu; - -
7 Fenobarbital 30 mg Tablet 397 -
8 Fenobarbital inj. 50 mg/ml Ampul 30 -
10 Haloperidol 1,5 mg Tablet 5,540 -
11 Haldol Decanoat inj 50 mg/ml Ampul 90 -
13 Klorpromazin HCl 100 mg tab Tablet - -
14 Klorpromazin HCl inj 25 mg/ml Ampul 180 -
15 Trifluoperazine 5 mg tab Tablet 600 -
16 Stesolid rectal 5 mg Tube 20 -
(4) ANTI PARKINSON

1 Levopar tab Tablet 200 -
2 Triheksifenidil 2 mg Tablet 3,325 -
(5) ANTI DEPRESI

1 Amitriptilin HCl 25 mg Tablet 1,484 -
(6) ANTI MIGREN

1 Anti Migren (Komb. Ergot+Kafein) Tablet - 200
2 Betahistin Mesilat 6 mg Tablet 1,630 -

1 Isosorbit Dinitrat 5 mg Tablet 1,000 -
2 Nifedipin 10 mg Tablet 1,550 -

3 Bisoprolol Fumarat 5 mg Tablet 6,038 -
4 Captopril 25 mg Tablet 5,810 -
5 Furosemid 40 mg Tablet 300 -
7 H.C.T 25 mg Tablet 8,680 -


1 Aminofilin 200 mg Tablet 1,000 -
2 Aminofilin inj 24 mg Ampul 60 -
6 Deksamethason 0,5 mg Tablet 7,180 -
7 Deksamethason inj 5 mg/ml Ampul 130 -
9 Epinefrin inj. Ampul 300 -
10 Methylprednisolon 4 mg Tablet 11,947 -
12 Salbutamol 4 mg Tablet 3,070 -
14 Ventolin Nebulizer Ampul 280 -
(11) ANTI TUSIF

1 Dexmolex sirup Botol 100 ml 44 -
4 Tuzalos tab Tablet - -
(12) EKSPEKTORAN
3 Gliseril Guayakolat 100 mg Tablet 29,437 -
5 Hustab tab Tablet 276 1,500
8 Sanadryl Expectorant Botol 60 ml - 72
(13) ANTI INFLUENZA

3 Molexflu tab Tablet 148 -
4 Colpica tab Tablet 5,000 3,000
5 Demacolin tab Tablet 39 -
6 Molexflu sirup Botol 60 ml 38 -
7 Demacolin syr Botol 60 ml 42 -
8 Quantidex tab Tablet 152 2,000
(14) ANTASIDA
1 Antasida DOEN I tab Tablet 17,073 -
2 Antasida DOEN II sirup Botol 60 ml 226 -
3 Cimetidin 200 mg Tablet - -
7 Ranitidin tab 150 mg Tablet - -
9 Sanmag tab Tablet - 2,500
10 Ulsidex tab Tablet 470 -

1 Asering infus Botol 500 ml 24 -
2 D5 + 1/2 NS Botol 500 ml 54 -
3 D5 + 1/4 NS Botol 500 ml 53 -
4 Dehaf Sachet - -
7 L-Bio Sachet - -
8 Loperamide Tablet 870 -
10 Na. Klorida 0,9% infus Botol 500 ml 144 -
12 Neo Kaolana suspensi Botol 60 ml 12 -
14 Oralit 200 ml Sachet 721 -
16 Zink tab dispersible 20 mg Tablet 790 -
(16) LAKSAN
1 Bisacodyl tab 5 mg Tablet 284 -
2 Dulcolax supp 5 mg Suppositoria 30 -
3 Dulcolax supp 10 mg Suppositoria 77 -
(17) ANTI SPASMODIK

1 Atropin Sulfat inj 0,25 mg/ml Ampul - -
2 Braxidin tab Tablet - -
3 Hyosin Bromida inj Ampul 10 20
4 Scopma tab Tablet 90 -
5 Scopma plus Tablet - 300
(18) ANTI HISTAMIN

3 Difenhidramin inj Ampul 75 -
4 Klorfeniramin Maleat 4 mg Tablet 30,655 -

2 Glukose 10% infus 500 ml Botol 500 ml - 20
3 Glukose 40% inj 25 ml Ampul - -
4 Glukose 5% infus 500 ml Botol 500 ml 26 -


1 Glibenklamid 5 mg Tablet 2,385 -


1 Anemolat tab / Asam folat tab Tablet 570 -
3 Pritavit kaplet Kaplet - 1,500
4 Calcii Gluconas inj Ampul 24 -
6 Caldetri Tablet - 300
8 Elkana tab Tablet 300 -
9 Glucosamin tab Tablet - 1,800
10 Hepagard tab Tablet 420 -
11 Kalsium Laktat 500 mg Tablet 12,200 -
15 Neurosanbe tab Tablet - -
16 Osteotin tab Tablet - 600
18 Piridoksin 10 mg (Vit. B6) Tablet 5,490 -
21 Sianokobalamin tab Tablet 5,375 -
23 Tiamin HCl 50 mg (Vit. B1) tab Tablet 16,735 -

1 Amoksisilin 500 mg Tablet 23,494 -
4 Ampisilin 500 mg Kaplet - -
5 Ampisilin inj. Ampul - -
6 Ampisilin sirup kering Botol 60 ml - -
7 Azitomisin 250 mg kaplet Kaplet 101 -
8 Dionicol sirup kering Botol 60 ml 16 50
10 Cefadroxil sirup kering Botol 60 ml - -
11 Cefalexin 500 mg Tablet - -
12 Cefixime kapsul 200 mg Kapsul - 300
13 Cefixime sirup Botol 30 ml - -
16 Ciprofloxacin 500 mg Tablet 3,119 -
17 Claneksi sirup Tablet - -
18 Co-Amoksiklav Tablet - -
19 Colsancetine inj Ampul - -
20 Eritromisin 250 mg Tablet - -
21 Eritromisin 500 mg Kaplet 479 -
22 Eritromisin sirup kering Botol 60 ml 94 -
24 Klindamisin 150 mg Kapsul - 1,000
25 Kloramfenikol 250 mg Kapsul 4,470 -
26 Kloramfenikol sirup Botol 60 ml 45 -
27 Kotrimoksasol 960 mg Tablet 12,148 -
28 Kotrimoksasol suspensi Botol 60 ml 170 -
29 Levofloksasin 500 mg Tablet - 600
30 Linkomisin kapsul 500 mg Tablet - -
31 Ofloxacin 400 mg Tablet - -
32 Spyramisin 500 mg Tablet - -
33 Tetrasiklin 500 mg Tablet - -
34 Thiamphenikol 500 mg Tablet 597 -
(25) ANTI VIRUS

2 Acyclovir 400 mg tab Tablet 5,850 -
(26) ANTI FUNGI

2 Ketokonazol 200 mg Tablet 1,050 -
3 Nistatin 100.000 IU tab.vag Tablet 424 -

5 OAT FDC Kategori 1 Paket 15 -

3 H2O2 3% Botol 1000 ml 8 -
4 Klorin Botol 500 ml - -
5 Lisol 50% Botol 1000 ml 21 -
8 Softa-Man (Aseptic Gel) Botol 500 ml 49 -
9 Softaskin (0ne Scrub) Botol 500 ml 9 -
(29) ANTELMENTIK
4 Pirantel 125 mg Tablet 488 -
(30) ANTI AMUBIASIS


1 Besi (II) Sulfat tab Sachet 34,890 -
3 Sianokobalamin inj (Vit. B 12) Ampul 90 -
4 Vitalex kap Kaplet - -
(32) HEMOSTATIK
3 Fitomenadion 10 mg (Vit. K) Tablet 680 -
4 Fitomenadion inj (Vit. K) Ampul - -
5 Magnesium Sulfat 20% Vial - 10
6 Magnesium Sulfat 40% Vial - 10
7 Plasminex inj. Ampul - -
8 Plasminex tab Tablet - -
9 Vit. K infant inj Ampul - -

(34) SERUM
1 ABU I Polivalen 5 ml Vial 2 -
2 ATS 1.500 IU Ampul 10 -
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 930 -
2 Metilergometrin inj Ampul - -
3 Oksitosin inj 10 IU/ml-1 ml Ampul - -


1 Betametason krem 0,1% Tube 214 -
2 Nisagon krem Tube 89 100
3 Hidrokortison krem 2,5% Tube 124 -

(39) ANTI BAKTERI

1 Anti Bakteri DOEN s.k Tube 12 -
3 Klorfeson krem Tube - 48
4 Oksitetrasiklin HCl sk 3% Tube - 50

1 Anti Fungi DOEN (As.Benz 60+As.Sal 30) Pot 48 -
2 Ketokonazol cream 2% Tube 95 -
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 77 -
2 Scabimite Tube 19 -
(42) ANTI SEPTIK

1 P.K serbuk 5 gram Botol 24 -



1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 15 -

1 Gentamisin Sulfat 0,3% t.m Botol 5 ml - -
2 Kloramfenikol 0,5% t.m Botol 5 ml 5 -
3 Kloramfenikol 1% s.m Tube 5 g 97 -
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 62 -
6 Sulfasetamid Natrium 15% t.m Botol 5 ml 25 -

2 Cendolyteers tetes mata Botol 5 ml 126 -

1 Kloramfenikol 3% t.t Botol 23 -


(51) ANTI HEMOROID

5 Hemorogard tab Tablet - 300
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 1,870 600
2 Domperidon sirup Botol 60 ml 89 -
3 Domperidon tab Tablet - -
5 Ondansetron 8 mg tab Tablet 1,686 -

1 Gemfibrozil kapsul 300 mg Tablet 420 -
2 Kalsium Atorvastatin Tablet 1,359 -
4 Simvastatin tab 10 mg Tablet 1,455 -
(54) NOOTROPIK
2 Piracetam inj 1 g/5 ml Ampul 9 -
(55) IMMUNDILATOR
1 Imunos sirup Botol 60 ml -
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 85 4,150
6 Combipack pcs 27 -
7 Carbamazepin tablet 1,800 -
8 Haldol inj. ampul
10 Haloperidol 5 mg tablet 460 -
11 Handscoon pcs
13 Clozapin 100 mg tablet - 400
15 Haloperidol inj (Lodomer) ampul 72 72
16 Lodomer Drop Drop 8 6
18 Micropipet pcs
19 pH Paper pcs
21 Risperidon 2 mg tablet 2,220 -
(59) OBAT GIGI

1 Alvogyl (Septodont) Botol 10 g - -
2 Caustener rapid Botol 6,5 g - -
3 Cavit (Tumpatan sementara) Set 7 -
4 Cresophene (Cresotin Liq) Botol 7,5 g 3 -
5 Elite semen Botol 2 -
6 Estelite Composite Set 4 -
7 Ectsa gel (Denta merica) Syringe 12 g 6 -
8 Eugenol Botol 10 ml 6 -
9 Forinokresol / Formocresol Botol 10 ml 6 -
12 Kalsium Hidroksida pasta Tube 8 -
13 Klorfenol Kamfer Mentol (CHKM) Botol 20 ml 5 -
14 Mumifying pasta (Cresotin Pasta) Botol 7 g 6
15 Spongostan Pcs 200 -
16 Te-econom bond Botol 3 -
17 Temporary Stopping Fletcher (Citodur) Botol 1 2
18 Tooth Cleansing (Occo) /Poliren No. 1 Botol 15 ml 6 -
19 Vinafluor Tablet 200 -

1 Bufacomb Iob (Zenith) Tube 59 -
2 Gentian violet 1% Botol 10 ml 15 -

8 Aquadest steril 1000 ml Botol 1000 ml - 10
10 Blue tape Pcs -
14 Cerplast Pcs -
17 Folley Cath 16 Pcs 30 -
21 Gelang Bayi Lahir Pcs -
22 Gelang Ibu Melahirkan Pcs -
23 Handscoon Panjang Pcs -
24 Handscoon uk. L Pcs 500
28 Holder Pronto Pcs -
45 Kapas berlemak 500 g Bungkus -
47 Kasa elastis 3x4 cm Rol -
48 Kasa elstis 4x10 cm Rol -
49 Kasa kompres 40/40 steril Pcs -
51 Kasa pembalut 2 m x 80 cm Rol 60
55 Kertas Puyer Pcs -
56 Lomatull Pcs -
57 Masker box 44 10
60 Mesh 11 Lancip (Biru) Pcs 1,200
61 Mesh 11 Lancip (merah) Pcs 200
62 Microburet Pcs -
66 Obyek glass Pcs
74 Silk dengan jarum 2/0 Sachet 72
75 Silk dengan jarum 3/0 Sachet 24
77 Sputum pot Pcs
84 Umbilical Pcs
85 Urine Bag Pcs 30
86 White tape Pcs
89 Yellow tape Pcs
90 Stericide Botol 500 ml 7
91 Viorex Botol 500 ml 10
TOTAL
KUNJUNGAN
Oct-19
Mengetahui :
KABUPATEN SIDOARJO

NIP. 19870416201101 1 007
R PERMINTAAN OBAT PUSKESMAS

PUSKESMAS
GFK
PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KETERANGAN
6 7 8 9 10
2,324 308 2,016

10,921 957 9,964
15,370 2,690 12,680
- - -
- - -
614 614 -
4,745 2,073 2,672
87 87 -
100 17 83
- - -
- - -
- - -
- - -
- - -
1,750 70 1,680
15 - 15
30 11 19
- - -
18,064 2,819 15,245
177 120 57
- - -
- - -
52 16 36
6 6 -
156 - 156
- - -
494 50 444
10,557 4,222 6,335
12 2 10
- - -
98 - 98
1,020 30 990
5 - 5
605 312 293
- - -
400 55 345
315 - 315
- - -
- - -
397 7 390
30 - 30
- - -
5,540 - 5,540
90 - 90
- - -
- - -
180 - 180
600 60 540
20 5 15
200 - 200
3,325 660 2,665
1,484 270 1,214

- - -
200 - 200
1,630 330 1,300
1,000 71 929
1,550 520 1,030
- - -
- - -
- - -
8,150 3,990 4,160

- - -
6,038 2,281 3,757
5,810 967 4,843
300 110 190
- - -
8,680 637 8,043
- - -
- - -
- - -
1,000 50 950
60 - 60
- - -
- - -
- - -
7,180 3,027 4,153
130 - 130
- - -
300 - 300
11,947 3,190 8,757
- - -
3,070 310 2,760
- - -
280 20 260
44 36 8
4,928 - 4,928
- - -
- - -
- - -
- - -
29,437 3,461 25,976
- - -
1,776 540 1,236
- - -
146 12 134
72 12 60
- - -
- - -
148 148 -
8,000 537 7,463
39 39 -
38 - 38
42 - 42
2,152 195 1,957
17,073 2,483 14,590

226 (18) 244
- - -
- - -
- - -
5,088 1,608 3,480
- - -
290 - 290
2,500 132 2,368
470 90 380
24 5 19
54 - 54
53 - 53
- - -
- - -
- - -
- - -
870 100 770
2,887 803 2,084
144 40 104
- - -
12 - 12
- - -
721 128 593
70 20 50
790 110 680
- - -
284 34 250
30 3 27
77 9 68
- - -
- - -
30 - 30
90 90 -
300 3 297
- - -
- - -
4,706 1,219 3,487
75 - 75
30,655 2,300 28,355
720 263 457
- - -
20 - 20
- - -
26 - 26
2,385 - 2,385
9,650 1,501 8,149
29,010 6,420 22,590
570 30 540
7,970 2,668 5,302
1,500 115 1,385
24 - 24
- - -
300 25 275
- - -
300 300 -
1,800 169 1,631
420 40 380
12,200 2,030 10,170
- - -
100 - 100
- - -
- - -
600 235 365
- - -
5,490 1,090 4,400
- - -
- - -
5,375 2,280 3,095
- - -
16,735 1,482 15,253
16,215 5,277 10,938
23,494 3,343 20,151

- - -
339 95 244
- - -
- - -
- - -
101 30 71
66 21 45
8,213 1,534 6,679
- - -
- - -
300 256 44
- - -
70 20 50
- - -
3,119 629 2,490
- - -
- - -
- - -
- - -
479 479 -
94 20 74
- - -
1,000 130 870
4,470 100 4,370
45 6 39
12,148 1,014 11,134
170 23 147
600 25 575
- - -
- - -
- - -
- - -
597 308 289
- - -
5,850 495 5,355
234 35 199
470 80 390
1,050 120 930
424 116 308
- - -
15 6 9
- - -
- - -
122 23 99
8 - 8
- - -
21 - 21
- - -
13 1 12
49 1 48
9 1 8
488 - 488
34,890 1,030 33,860

- - -
90 - 90
- - -
- - -
- - -
680 36 644
- - -
10 - 10
10 - 10
- - -
- - -
- - -
2 - 2
10 - 10
930 - 930
- - -
- - -
- -
214 48 166
189 53 136
124 27 97
12 4 8
- - -
48 11 37
50 11 39
48 - 48
95 8 87
80 28 52
77 8 69
19 2 17
24 6 18
- -
15 - 15
- -
- -
- - -
5 5 -
97 5 92
62 - 62
- - -
25 4 21
- - -
126 37 89
23 11 12
109 12 97
295 95 200
- - -
- - -
- - -
300 10 290
2,470 860 1,610

89 14 75
- - -
- - -
1,686 288 1,398
80 - 80
420 - 420
1,359 917 442
- - -
1,455 965 490
- - -
9 3 6
- - -
- - -
120 20 100
4,235 320 3,915
27 - 27
1,800 - 1,800
460 460 -
400
144 72 72
10 2 8
2,510 290 2,010
- - -
- - -
7 - 7
3 - 3
2 - 2
4 - 4
6 - 6
6 - 6
6 - 6
5 2 3
- - -
8 - 8
5 - 5
6 - 6
200 - 200
3 - 3
3 - 3
6 - 6
200 - 200
59 8 51
15 1 14
19 - 19
- - -
- - -
- - -
200 100 100
2,400 300 2,100
200 - 200
400 - 400
192 57 135
10 - 10
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
30 - 30
- - -
- - -
- - -
- - -
- - -
- - -
500 - 500
12,500 1,300 11,200
- - -
16 10 6
- - -
- - -
90 - 90
180 10 170
353 28 325
74 10 64
80 - 80
270 39 231
84 - 84
36 - 36
24 - 24
12 - 12
36 - 36
36 - 36
1,400 - 1,400
- - -
- - -
- - -
24 6 18
- - -
- - -
- - -
32 2 30
60 - 60
470 10 460
575 120 455
80 2 78
- - -
- - -
54 16 38
18 - 18
20 5 15
1,200 - 1,200
200 - 200
- - -
250 - 250
240 - 240
- -
- -
- -
- -
- -
- -
- -
- -
- - -
72 - 72
24 12 12
25 - 25
- -
- -
- -
- -
- -
- -
- -
- -
30 - 30
- -
- -
- -
- -
7 - 7
10 10

NIP. 196605101989032013
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : OKTOBER 2019 APBD

NO NAMA OBAT SATUAN HARGA STOK AWAL
(Rp)
1 2 3 4 5 6 7 8 9

1 Neuroval tab Tablet 968 824 1,500 2,324 308 2,016 797,632
2 Antalgin 500 mg tab Tablet 198 921 10,000 10,921 957 9,964 182,358
3 Asam Mefenamat 500 mg tab Tablet 103 370 15,000 15,370 2,690 12,680 38,110
4 Asetosal 100 mg tab Tablet 0 - - - - - -
5 Aspilets 80 mg tab Tablet 0 - - - - - -
6 Diklofenak Kalium 50 mg tab Tablet 706 614 - 614 614 - 433,484
7 Diklofenak Na. 50 mg tab Tablet 115 4,745 - 4,745 2,073 2,672 545,675
8 Eprinoc tab Tablet 1650 87 - 87 87 - 143,550
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 2721 - 100 100 17 83 -
10 Ibuprofen 200 mg tab Tablet 0 - - - - - -
11 Ibuprofen 400 mg tab Tablet 0 - - - - - -
12 Meloxicam 15 mg supp Suppositoria 0 - - - - - -
13 Meloxicam 15 mg tab Tablet 0 - - - - - -
14 Meloxicam 7,5 mg tab Tablet 0 - - - - - -
15 Metoklopramid 10 mg Tablet 108 1,750 - 1,750 70 1,680 189,000
16 Sotatic inj. 5 mg/ml Ampul 4664 15 - 15 - 15 69,960
17 Molakrim krim Tube 30 g 13200 - 30 30 11 19 -
18 Nonflamin tab Tablet 0 - - - - - -
19 Parasetamol 500 mg tab Tablet 53 3,064 15,000 18,064 2,819 15,245 162,392
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 1107 77 100 177 120 57 85,239
21 Piroksikam 10 mg tab Tablet 0 - - - - - -
22 Piroksikam 20 mg tab Tablet 0 - - - - - -
23 Suprafenid supp Suppositoria 2380 52 - 52 16 36 123,760
24 Proris supp Suppositoria 5150 6 - 6 6 - 30,900
25 Antalgin inj. Ampul 2900 56 100 156 - 156 162,400
26 Tramadol injeksi 50 mg/ml Ampul 0 - - - - - -
27 Tramadol kap 50 mg Tablet 825 494 - 494 50 444 407,550
- - -
Alopurinol 100 mg Tablet 97 7,500 - 7,500 1,165 6,335 727,500
- - -
(2) ANESTESI LOKAL - - -
1 Etil Klorida semprot Botol 100 ml 301000 12 - 12 2 10 3,612,000
2 Ketamin / Ketalar inj. 100 mg/m Vial 10 ml 0 - - - - - -
3 Lidokain inj 2% (HCl) / 2 ml Ampul 860 98 - 98 - 98 84,280
4 Lidokain komb inj / 2 ml Ampul 1845 570 - 570 - 570 1,051,650
5 Xylocain spray Botol 50 ml 177216 5 - 5 - 5 886,080
- - -
(3) AN.EPILEPSI, AN.KONV, AN.ASIETAS, SEDATIV, HIPNOTIK, AN.PSIKOTI - - -
1 Alprazolam 0,5 mg Tablet 88 105 500 605 312 293 9,240
2 Diazepam 2 mg Tablet 45 - - - - - -
3 Diazepam 5 mg Tablet 109 400 - 400 55 345 43,600
4 Diazepam inj. 5 mg/ 2 ml Ampul 4180 315 - 315 - 315 1,316,700
5 Fenitoin kapsul 100 mg Kapsu; 604 - - - - - -
6 Fenobarbital 100 mg Tablet 0 - - - - - -
7 Fenobarbital 30 mg Tablet 171 397 - 397 7 390 67,887
8 Fenobarbital inj. 50 mg/ml Ampul 1740 30 - 30 - 30 52,200
9 Haloperidol 0.5 mg tab Tablet 0 - - - - - -
10 Haloperidol 1,5 mg Tablet 59 5,540 - 5,540 - 5,540 326,860
12 Haloperidol inj 50 mg/ml (Hald Ampul 3600 90 - 90 - 90 324,000
13 Klobazam 10 mg tab Tablet 0 - - - - - -
14 Klorpromazin HCl 100 mg tab Tablet 147 - - - - - -
15 Klorpromazin HCl inj 25 mg/ml Ampul 1243 180 - 180 - 180 223,740
16 Trifluoperazine 5 mg tab Tablet 274 600 - 600 60 540 164,400
17 Stesolid rectal 5 mg Tube 12573 20 - 20 5 15 251,460
- - -
1 Levopar tab Tablet 649 200 - 200 - 200 129,800
2 Triheksifenidil 2 mg Tablet 85 3,325 - 3,325 660 2,665 282,625
- - -
(5) ANTI DEPRESI - - -
1 Amitriptilin HCl 25 mg Tablet 167 1,484 - 1,484 270 1,214 247,828
2 Deproz 20 mg Tablet - - - - - -
- - -
(6) ANTI MIGREN - - -
1 Anti Migren (Komb. Ergot+Kafe Tablet 173 - 200 200 - 200 -
2 Betahistin Mesilat 6 mg Tablet 110 1,630 - 1,630 330 1,300 179,300
- - -
(7) ANTI ANGINA - ANTI ARITMIA - - -
1 Isosorbit Dinitrat 5 mg - 2018 Tablet 89 500 - 500 - 500 44,500
2 Isosorbit Dinitrat 5 mg - 2019 Tablet 89 500 - 500 71 429 44,500
3 Nifedipin 10 mg Tablet 104 1,550 - 1,550 520 1,030 161,200
4 Nifedipin GITS (Adalat Oros) Tablet 0 - - - - - -
5 Propanolol 10 mg Tablet 0 - - - - - -
6 Propanolol 40 mg Tablet 0 - - - - -
- - -
1 Amlodipin 5 mg Tablet 70 5,150 3,000 8,150 3,990 4,160 360,500
2 Amlodipin 10 mg Tablet 0 - - - - - -
3 Bisoprolol Fumarat 5 mg Tablet 0 - - - - - -
4 Captopril 25 mg Tablet 75 5,810 - 5,810 967 4,843 435,750
5 Furosemid 40 mg Tablet 77 300 - 300 110 190 23,100
6 Furosemid inj. Ampul 0 - - - - - -
7 H.C.T 25 mg Tablet 155 8,680 - 8,680 637 8,043 1,345,400
8 Lisinopril 10 mg Tablet - - - - - -
9 Valsartan tab 80 mg / Diovan 8 Tablet - - - - - -
10 Valsartan tab 160 mg / Diovan Tablet - - - - - -
- - -
- - -
1 Aminofilin 200 mg Tablet 113 500 - 500 - 500 56,500
Aminofillin 200 mg (Decafil) 139 500 - 500 50 450 69,500
2 Aminofilin inj 24 mg Ampul 3822 60 - 60 - 60 229,320
3 Bisolvon solution 10 mg/5 ml Botol 50 ml 0 - - - - - -
4 Bisolvon injeksi 2 mg/ml Ampul 0 - - - - - -
5 Bricasma inj 0,5 mg/ml Ampul 0 - - - - - -
6 Deksamethason 0,5 mg Tablet 32 7,180 - 7,180 3,027 4,153 229,760
7 Deksamethason inj 5 mg/ml Ampul 1097 130 - 130 - 130 142,610
8 Efedrin HCl 25 mg Tablet 0 - - - - - -
9 Epinefrin inj. Ampul 1408 300 - 300 - 300 422,400
10 Methylprednisolon 4 mg Tablet 134 4,000 - 4,000 - 4,000 536,000
11 Prednison 5 mg Tablet 0 - - - - - -
12 Salbutamol 4 mg Tablet 70 3,070 - 3,070 310 2,760 214,900
14 Salbutamol sirup (Astharol) Botol 60 ml 0 - - - - - -
15 Ventolin Nebulizer Ampul 4000 280 - 280 160 120 1,120,000
- - -
1 Dexmolex sirup Botol 100 ml 8800 44 - 44 36 8 387,200
2 Kodein 10 mg Tablet 571 2,928 2,000 4,928 - 4,928 1,671,888
3 Sanadryl DMP sirup Botol 60 ml - - - - - -
4 Tuzalos tab Tablet 0 - - - - - -
- - -
1 Ambroxol HCl 30 mg Tablet 0 - - - - - -
2 Ambroxol syrup Botol 60 ml 0 - - - - - -
3 Gliseril Guayakolat 100 mg Tablet 88 29,437 - 29,437 3,461 25,976 2,590,456
4 Hustab sirup Botol 60 ml 0 - - - - - -
5 Hustab tab Tablet 458 276 1,500 1,776 540 1,236 126,408
6 OBH Plus Anak Botol 60 ml 0 - - - - - -
7 OBH Plus Dewasa Botol 60 ml 4840 96 50 146 12 134 464,640
8 Sanadryl Expectorant Botol 60 ml 10560 - 72 72 12 60 -
- - -
1 Alpara tab Tablet 0 - - - - - -
2 Alpara sirup Botol 60 ml 0 - - - - - -
3 Molexflu tab Tablet 396 148 - 148 148 - 58,608
4 Colpica tab Tablet 352 5,000 3,000 8,000 537 7,463 1,760,000
5 Demacolin tab Tablet 170 39 - 39 39 - 6,630
6 Molexflu sirup Botol 60 ml 6710 38 - 38 - 38 254,980
7 Demacolin syr Botol 60 ml 12210 42 - 42 - 42 512,820
8 Quantidex tab Tablet 880 152 2,000 2,152 195 1,957 133,760
- - -
(14) ANTASIDA - - -
1 Antasida DOEN I tab Tablet 54 17,073 - 17,073 2,483 14,590 921,942
2 Antasida DOEN II sirup Botol 60 ml 2015 226 - 226 (18) 244 455,390
3 Cimetidin 200 mg Tablet 220 - - - - - -
4 Cytotec Tablet - - - - - -
5 Famotidine 20 mg Tablet - - - - - -
6 Omeprazole kap 20 mg Tablet 130 2,178 2,910 5,088 1,608 3,480 283,140
7 Ranitidin tab 150 mg Tablet 105 - - - - - -
8 Ranitidin inj 25 mg/2 ml Ampul 1155 90 200 290 - 290 103,950
9 Sanmag tab Tablet 930 - 2,500 2,500 132 2,368 -
10 Ulsidex tab Tablet 296 470 - 470 90 380 139,120
- - -
1 Asering infus Botol 500 ml 9275 24 - 24 5 19 222,600
2 D5 + 1/2 NS Botol 500 ml 9776 54 - 54 - 54 527,904
3 D5 + 1/4 NS Botol 500 ml 9724 53 - 53 - 53 515,372
4 Dehaf Sachet 0 - - - - - -
5 KAEN 3A Botol 500 ml 0 - - - - - -
6 KAEN 3B Botol 500 ml 0 - - - - - -
7 L-Bio Sachet 0 - - - - - -
8 Loperamide Tablet 89 870 - 870 100 770 77,430
9 Molagit tab Tablet 477 1,387 1,500 2,887 803 2,084 661,599
10 Na. Klorida 0,9% infus Botol 500 ml 0 - - - - - -
11 Na. Klorida 0,9% piggy bag Botol 100 ml 0 - - - - - -
12 Neo Kaolana suspensi Botol 60 ml 12980 12 - 12 - 12 155,760
13 New Diaform Tablet - - - - - -
14 Oralit 200 ml Sachet 257 721 - 721 128 593 185,297
15 Ringer Laktat infus Botol 500 ml 7150 30 40 70 20 50 214,500
16 Zink tab dispersible 20 mg Tablet 524 790 - 790 110 680 413,960
17 Zink sirup 20 mg/5 ml Botol 60 ml 0 - - - - - -
- - -
(16) LAKSAN - - -
1 Bisacodyl tab 5 mg Tablet 300 284 - 284 34 250 85,200
2 Dulcolax supp 5 mg Suppositoria 6,000 30 - 30 3 27 180,000
3 Dulcolax supp 10 mg Suppositoria 5,900 77 - 77 9 68 454,300
- - -
1 Atropin Sulfat inj 0,25 mg/ml Ampul - - - - - - -
2 Braxidin tab Tablet - - - - - - -
3 Hyosin Bromida inj Ampul 9,240 10 20 30 - 30 92,400
4 Scopma tab Tablet 1,210 90 - 90 90 - 108,900
5 Scopma plus Tablet - - 300 300 3 297 -
6 Ekstrak Belladona 10 mg Tablet - - - - - - -
- - -
1 Ceterizine sirup Botol 60 ml - - - - - - -
2 Cetirizine tab 10 mg Tablet 90 2,226 2,480 4,706 1,219 3,487 200,340
3 Difenhidramin inj Ampul 1,095 75 - 75 - 75 82,125
4 Klorfeniramin Maleat 4 mg Tablet - - - - - - -
5 Loratadine 10 mg Tablet 123 220 500 720 263 457 27,060
- - -
1 Aminofluid Softbag 500 ml - - - - - - -
3 Glukose 10% infus 500 ml - 20 Botol 500 ml - - 20 20 - 20 -
4 Glukose 40% inj 25 ml Ampul 1,001 - - - - - -
5 Glukose 5% infus 500 ml Botol 500 ml 6900 6 6 - 6 41,400
6 Glukose 5% infus 500 ml Botol 500 ml 6900 20 20 - 20 138,000
- - -
- - -
1 Glibenklamid 5 mg Tablet 119 2,385 - 2,385 - 2,385 283,815
2 Glimipiride 2 mg Tablet 207 1,650 8,000 9,650 1,501 8,149 341,550
3 Metformin tab 500 mg Tablet 96 19,010 10,000 29,010 6,420 22,590 1,824,960
- - -
- - -
1 Anemolat tab / Asam folat tab Tablet 70 570 - 570 30 540 39,900
2 Asam Askorbat 50 mg Tablet 105 4,970 3,000 7,970 2,668 5,302 521,850
3 Pritavit kaplet Kaplet 1045 - 1,500 1,500 115 1,385 -
4 Calcii Gluconas inj Ampul 10425 24 - 24 - 24 250,200
5 Caldece tab effervecent Tablet 0 - - - - - -
6 Caldetri Tablet 1375 - 300 300 25 275 -
7 Elkana sirup Botol 60 ml 0 - - - - - -
8 Elkana tab Tablet 811 300 - 300 300 - 243,300
9 Glucosamin tab Tablet 807 - 1,800 1,800 169 1,631 -
10 Hepagard tab Tablet 1100 420 - 420 40 380 462,000
11 Kalsium Laktat 500 mg Tablet 59 12,200 - 12,200 2,030 10,170 719,800
12 Neurosanbe 5000 Tablet 0 - - - - - -
13 Neurosanbe inj Ampul 5187 50 - 50 - 50 259,350
14 Mersibion inj Ampul 3025 - 50 50 - 50 -
15 Neurosanbe Plus Tablet 0 - - - - - -
16 Neurosanbe tab Tablet 0 - - - - - -
17 Osteotin tab Tablet 3284 - 600 600 235 365 -
18 Pharmaton Vit Tablet 0 - - - - - -
19 Piridoksin 10 mg (Vit. B6) Tablet 123 5,490 - 5,490 1,090 4,400 675,270
20 Procurma Plus sirup Botol 60 ml 0 - - - - - -
21 Santa E 200 mg tablet hisap Tablet 0 - - - - - -
22 Sianokobalamin tab Tablet 51 5,375 - 5,375 2,280 3,095 274,125
23 Tiamin HCl (Vit. B1) inj 100 mg Ampul 0 - - - - - -
24 Tiamin HCl 50 mg (Vit. B1) tab Tablet 85 16,735 - 16,735 1,482 15,253 1,422,475
25 Vit. B kompleks Tablet 83 10,215 6,000 16,215 5,277 10,938 847,845
- - -
(24) ANTI BAKTERI SISTEMIK, ANTISEPTIK SAL.KEMIH - - -
1 Amoksisilin 500 mg Tablet 233 23,494 - 23,494 3,343 20,151 5,474,102
2 Amoksisilin inj. Ampul 0 - - - - - -
3 Amoksisilin sirup kering Botol 60 ml 3628 219 120 339 95 244 794,532
4 Ampisilin 500 mg Kaplet 0 - - - - - -
5 Ampisilin inj. Ampul 0 - - - - - -
6 Ampisilin sirup kering Botol 60 ml 0 - - - - - -
7 Azitomisin 500 mg kaplet Kaplet 1778 101 - 101 30 71 179,578
8 Dionicol sirup kering Botol 60 ml 5940 16 50 66 21 45 95,040
9 Cefadroxil 500 mg Kaplet 478 5,213 3,000 8,213 1,534 6,679 2,491,814
10 Cefadroxil sirup kering Botol 60 ml 0 - - - - - -
11 Cefalexin 500 mg Tablet 0 - - - - - -
12 Cefixime kapsul 200 mg Kapsul 2370 - 300 300 256 44 -
13 Cefixime sirup Botol 30 ml 0 - - - - - -
14 Cefotaxime injeksi 1 g Ampul 4482 20 50 70 20 50 89,640
15 Ceftriaxone injeksi 1 g Ampul 0 - - - - - -
16 Ciprofloxacin 500 mg Tablet 265 3,119 - 3,119 629 2,490 826,535
17 Claneksi sirup Tablet 0 - - - - - -
18 Co-Amoksiklav Tablet 0 - - - - - -
19 Colsancetine inj Ampul 0 - - - - - -
20 Eritromisin 250 mg Tablet 0 - - - - - -
21 Eritromisin 500 mg Kaplet 750 479 - 479 479 - 359,250
22 Eritromisin sirup kering Botol 60 ml 0 94 - 94 20 74 -
23 Gentamisin inj. 40 mg/ml Ampul 0 - - - - - -
24 Klindamisin 300 mg Kapsul 715 - 1,000 1,000 130 870 -
25 Kloramfenikol 250 mg Kapsul 10 4,470 - 4,470 100 4,370 44,700
26 Kloramfenikol sirup Botol 60 ml 4700 45 - 45 6 39 211,500
27 Kotrimoksasol 480 mg Tablet 0 - - - - - -
28 Kotrimoksasol suspensi Botol 60 ml 2052 170 - 170 23 147 348,840
29 Levofloksasin 500 mg Tablet 424 - 600 600 25 575 -
30 Linkomisin kapsul 500 mg Tablet 0 - - - - - -
31 Ofloxacin 400 mg Tablet 0 - - - - - -
32 Spyramisin 500 mg Tablet 0 - - - - - -
33 Tetrasiklin 500 mg Tablet 0 - - - - - -
34 Thiamphenikol 500 mg Tablet 1070 597 - 597 308 289 638,790
- - -
(25) ANTI VIRUS - - -
1 Acyclovir 200 mg tab Tablet - - - - - -
2 Acyclovir 400 mg tab Tablet 380 4,800 - 4,800 - 4,800 1,824,000
3 Acyclovir cream Tube 3080 184 50 234 35 199 566,720
- - -
1 Griseofulvin 125 mg Tablet 210 170 300 470 80 390 35,700
2 Ketokonazol 200 mg Tablet 270 1,050 - 1,050 120 930 283,500
3 Nistatin 100.000 IU tab.vag Tablet 560 424 - 424 116 308 237,440
4 Nistatin 500.000 IU tab Tablet - - - - - -
- - -
(27) ANTI TUBERKULOSIS - - -
1 Etambutol 500 mg tab salut Tablet - - -
2 I.N.H 100 mg Tablet - - -
4 Kanamycin inj 1 g Vial - - -
5 OAT FDC Kategori 1 Paket 359985 15 - 15 6 9 5,399,775
6 OAT FDC Kategori 2 Paket 1297889 - - - - - -
7 OAT FDC Kategori Anak Paket - - -
8 OAT FDC Sisipan Paket - - -
9 Pyrazinamid 500 mg Tablet - - -
10 Streptomycin S inj 1 g Vial - - -
11 Rifampisin 450 mg Tablet - - -
- - -
(28) ANTI SEPTIK, DESINFEKTAN - - -
1 Etakridina larutan 0,1% Botol 300 ml 0 - - - - - -
2 Etanol 70% Botol 100 ml 4000 72 50 122 23 99 288,000
3 H2O2 3% Botol 1000 ml 24200 8 - 8 - 8 193,600
4 Klorin ( Sterizim) Botol 5 L 712800 - - - - - -
5 Lisol 50% Botol 1000 ml 40997 21 - 21 - 21 860,937
6 Paraformaldehid 1 g Tablet - - - - - -
7 Povidon Iodida larutan 10% Botol 300 ml 18000 1 12 13 1 12 18,000
8 Softa-Man Botol 500 ml 22000 49 - 49 1 48 1,078,000
9 Softaskin Botol 500 ml 62491 9 - 9 1 8 562,419
- - -
4 Pirantel 125 mg Tablet 287 488 - 488 - 488 140,056
- - -
- - -
1 Besi (II) Sulfat tab Sachet 355 34,890 - 34,890 1,030 33,860 12,385,950
2 Besi sirup Botol 150 ml 0 - - - - - -
3 Sianokobalamin inj (Vit. B 12) Ampul 1035 90 - 90 - 90 93,150
4 Vitalex kap Kaplet 0 - - - - - -
- - -
1 Adona AC-17 10 mg Tablet - - - - - -
2 Adona inj 5 ml Ampul - - - - - -
3 Fitomenadion 10 mg (Vit. K) - Tablet 710 680 - 680 36 644 482,800
4 Fitomenadion inj (Vit. K) Ampul 0 - - - - - -
5 Magnesium Sulfat 20% Vial 3328 - 10 10 - 10 -
6 Magnesium Sulfat 40% Vial 3796 - 10 10 - 10 -
7 Plasminex inj. Ampul - - - - - -
8 Plasminex tab Tablet - - - - - -
9 Vit. K infant inj Ampul - - - - - -
- - -
(33) PRODUK DAN SUBTITUEN PLASMA - - -
1 Widahes infus Botol 500 ml - - -
- - -
(34) SERUM - - -
1 ABU I Polivalen 5 ml Vial 479996 2 - 2 - 2 959,992
2 ATS 1.500 IU Ampul 130999 10 - 10 - 10 1,309,990
- - -
1 Metilergometrin 0,125 mg Tablet 210 930 - 930 - 930 195,300
2 Metilergometrin inj Ampul 2959 200 - 200 200 - 591,800
3 Oksitosin inj 10 IU/ml-1 ml Ampul 1199 - - - - - -
- - -
1 Papaverin 40 mg Tablet - - -
- - -
1 Betametason krem 0,1% Tube 1340 150 - 150 - 150 201,000
2 Nisagon krem Tube 4620 89 100 189 53 136 411,180
3 Hidrokortison krem 2,5% Tube 2475 124 - 124 27 97 306,900
- - -
1 Bioplacenton gel Tube 15918 - - -
- - -
1 Anti Bakteri DOEN s.k Tube 2924 12 - 12 4 8 35,088
2 Gentamisin salep kulit 0,1% Tube 0 - - - - - -
3 Klorfeson krem Tube 8360 - 48 48 11 37 -
4 Oksitetrasiklin HCl sk 3% Tube 2006 - 50 50 11 39 -
- - -
1 Anti Fungi DOEN (As.Benz 60+ Pot 4496 48 - 48 - 48 215,808
2 Ketokonazol cream 2% Tube 0 - - - - - -
3 Miconazol cream 2% Tube 3414 8 72 80 28 52 27,312
- - -
1 Salep 2-4 30 g Pot 2620 77 - 77 8 69 201,740
2 Scabicide Tube 11825 19 - 19 2 17 224,675
- - -
1 P.K serbuk 5 gram Botol 2275 24 - 24 6 18 54,600
- - -
2 Salisil bedak 2% Kotak - - -
- - -
- - -
1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 14650 15 - 15 - 15 219,750
- - -
1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 4000 - - - - - -
2 Kloramfenikol 0,5% t.m Botol 5 ml 3250 5 - 5 5 - 16,250
3 Kloramfenikol 1% s.m Tube 5 g 1881 97 - 97 5 92 182,457
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 2772 62 - 62 - 62 171,864
5 Polidemisin eye drop Botol 5 ml 0 - - - - - -
6 Sulfasetamid Natrium 15% t.m Botol 5 ml 12310 25 - 25 4 21 307,750
- - -
1 Catalin Opth Botol 15 ml - - - - - -
2 Cendolyteers tetes mata Botol 5 ml 19125 126 - 126 37 89 2,409,750
- - -
1 Kloramfenikol 3% t.t Botol 6050 23 - 23 11 12 139,150
- - -
1 Fenol gliserol 10% t.t Botol 2590 85 24 109 12 97 220,150
- - -
- - -
1 Anti Hemoroid supp Suppositoria 3167 - 30 30 - 30 -
2 Anusol Suppositoria - - - - - -
3 Borraginol N Salep Tube 15 g - - - - - -
4 Borraginol N Supp Suppositoria - - - - - -
5 Hemorogard tab Tablet 1614 - 300 300 10 290 -
- - -
(52) ANTI EMETIK - - -
1 Dimenhidrinat 50 mg Tablet 105 1,870 600 2,470 860 1,610 196,350
2 Domperidon sirup Botol 60 ml 0 - - - - - -
3 Domperidon tab Tablet 0 - - - - - -
4 Mediamer B6 Tablet 0 - - - - - -
5 Ondansetron 8 mg tab Tablet 351 1,686 - 1,686 288 1,398 591,786
6 Ondansetron 4 mg/2 ml inj. Ampul 1070 20 60 80 - 80 21,400
- - -
1 Gemfibrozil kapsul 300 mg Tablet 289 420 - 420 - 420 121,380
2 Kalsium Atorvastatin Tablet 795 1,359 - 1,359 917 442 1,080,405
3 Lipitor 20 mg Tablet - - - - - -
4 Simvastatin tab 10 mg Tablet 111 1,455 - 1,455 965 490 161,505
- - -
1 Piracetam 400 mg Tablet 451 - - - - - -
2 Piracetam inj 1 g/5 ml Ampul 6600 9 - 9 3 6 59,400
3 Piracetam inj 3 g / 15 ml Ampul - - - - - -
- - -
2 Imunos tablet Tablet 7150 120 120 20 100 858,000
- - -
(56) PROGRAM GIZI - - -
1 Biskuit Bungkus - - -
2 Biskuit MP-ASI Bungkus - - -
3 Iodina Test Botol - - -
4 Susu Dancow Bungkus - - -
5 Susu Mineral Mix Bungkus - - -
6 Susu Mom and Me Bungkus - - -
7 Susu Pan-Enteral Bungkus - - -
8 Susu Proten Bungkus - - -
9 Taburia Sachet - - -
10 Zink Sirup Botol 60 ml - - -
- - -
(57) PROGRAM P2PL - - -
1 Albendazole 400 mg tablet - - -
2 Box Slide pcs - - -
3 OAT FDC paket - - -
4 OAT FDC Anak paket - - -
5 OAT FDC Kategori II paket - - -
6 Obyek Glass pcs - - -
7 Reagen Intech pcs - - -
8 Reagen Oncoprobe pcs - - -
9 Reagen SD HIV pcs - - -
10 Reagen Vikia pcs - - -
11 Reagen Zn set - - -
12 Sputum Pot pcs - - -
13 Susu Proten bungkus - - -
- - -
(58) PROGRAM GANGGUAN JIWA - - -
1 Alkohol swab pcs - - -
2 Amitriptilin 25 mg tablet - - -
3 Anuscope pcs - - -
4 Blue Tape pcs - - -
5 Clozapin 25 mg tablet 1121 85 4,150 4,235 320 3,915 95,285
6 Combipack pcs 0 27 - 27 - 27 -
7 Carbamazepin tab tablet 230 1,800 - 1,800 - 1,800 414,000
8 Haldol inj. 5mg/ml ampul - - -
10 Haloperidol 5 mg tablet 80 460 - 460 460 - 36,800
13 Clozapin 100 mg tablet 3280 - 400 400 - 400 -
15 Haloperidol inj (Lodomer) ampul 5000 72 72 144 72 72 360,000
16 Lodomer Drop Drop 18700 8 6 14 6 8 149,600
21 Risperidon 2 mg tablet 546 2,510 - 2,510 290 2,220 1,370,460
22 SD Reagen Syphillis pcs - - -
23 Tabung Vacutainer Merah pcs - - -
24 Trifluoperazin 5 mg tablet - - -
25 Triheksifenidil 5 mg tablet - - -
- - -
(59) OBAT GIGI - - -
1 Alvogyl (Septodont) Botol 10 g 635800 - - - - - -
2 Caustener rapid Botol 6,5 g 40700 - - - - - -
3 Cavit (Tumpatan sementara) Set 143000 7 - 7 - 7 1,001,000
4 Cresophene (Septodont)/CresotBotol 7,5 g 242000 3 - 3 - 3 726,000
5 Elite semen Botol 165000 2 - 2 - 2 330,000
6 Estelite Composite Set 1491000 4 - 4 - 4 5,964,000
7 Ectsa gel (Denta merica) Syringe 12 g 176000 6 - 6 - 6 1,056,000
8 Eugenol Botol 10 ml 18824 6 - 6 - 6 112,944
9 Forinokresol / Formocresol Botol 10 ml 66000 6 - 6 - 6 396,000
10 Glass Ionomer Cement (Fuji II Set 346500 3 2 5 2 3 1,039,500
11 Glass Ionomer Cement (Fuji IX Set 572000 - - - - - -
12 Kalsium Hidroksida pasta Tube 275000 8 - 8 - 8 2,200,000
13 Klorfenol Kamfer Mentol (CHK Botol 20 ml 55000 5 - 5 - 5 275,000
14 Mumifying pasta/Cresotin Past Botol 7 g 198000 6 6 - 6 1,188,000
15 Spongostan Pcs 9240 200 - 200 - 200 1,848,000
16 Te-econom bond Botol 268000 3 - 3 - 3 804,000
17 Temporary Stopping Fletcher Botol 528000 1 2 3 - 3 528,000
18 Tooth Cleansing (Occo)/ Polire Botol 15 ml 176000 6 - 6 - 6 1,056,000
19 Vinafluor Tablet 770 200 - 200 - 200 154,000
- - -
(60) OBAT TOPIKAL MULUT - - -
1 Bufacomb Iob (Zenith) Tube 15000 59 - 59 8 51 885,000
2 Gentian violet 1% Botol 10 ml 1314 15 - 15 1 14 19,710
3 Minosep gargle 0.2% Botol 60 ml 16500 19 19 - 19 313,500
4 Polikresulen (Metakresol) Botol 10 ml - - - - - -
- - -
(61) BAHAN MEDIS HABIS PAKAI (BMHP) - - -
1 Alat suntik 1xpakai 0.05 ml Pcs 0 - - - - - -
2 Alat suntik 1xpakai 0.5 ml Pcs 0 - - - - - -
3 Alat suntik 1xpakai 1 ml Pcs 143 200 200 100 100 28,600
4 Alat Suntik 1xpakai 3 ml Pcs 113.8 1,400 1,000 2,400 300 2,100 159,320
5 Alat suntik 1xpakai 5 ml Pcs 1600 200 200 - 200 320,000
7 Aqua pro injeksi Vial 2860 192 192 57 135 549,120
8 Aquadest steril 500 ml Botol 500 ml 10500 - 10 10 - 10 -
9 Blood Lancet Pcs - - - - -
10 Blue tape Pcs - - - - -
11 Cat-gut dg jarum 2/0 (Cromic) Sachet - - - - -
12 Cat-gut dg jarum 3/0 (Plain) Sachet 134000 - - - - -
16 Folley Cath 12 Pcs 8000 - - - - -
17 Folley Cath 16 Pcs 11000 30 - 30 - 30 330,000
18 Folley Cath 18 Pcs 11000 - - - - -
24 Handscoon uk. L Pcs 356 500 500 - 500 178,000
25 Handscoon uk. M Pcs 356 12,500 12,500 1,300 11,200 4,450,000
27 Hipavix 5 x 5 m Rol 37440 16 16 10 6 599,040
28 Holder Pronto Pcs - - - - -
29 I.V. Catheter 16 Pcs - - - - -
30 I.V. Catheter 18 Pcs 14710 90 90 - 90 1,323,900
31 I.V. Catheter 20 Pcs 8700 180 180 10 170 1,566,000
32 I.V. Catheter 22 Pcs 8700 250 250 - 250 2,175,000
33 I.V. Catheter 24 Pcs 7334 - - - - -
34 Infusion set anak Pcs 7920 80 80 - 80 633,600
35 Infusion set dewasa Pcs 8400 70 - 70 39 31 588,000
36 Infusion set dewasa Pcs 7920 100 100 200 - 200 792,000
37 Jarum jahit (bedah) no. 13 Pcs 917 84 84 - 84 77,028
42 Jarum Jahit (bedah) no. 12 Pcs 917 36 36 - 36 33,012
43 Jarum Suntik no. 25 Pcs 330 1,400 1,400 - 1,400 462,000
47 Kapas pembalut 250 g Bungkus 20600 24 24 6 18 494,400
51 Kasa Pembalut 1 yard 40m x 8 Rol 130000 32 32 2 30 4,160,000
52 Kasa pembalut 2 m x 80 cm Rol 9400 60 60 - 60 564,000
53 Kasa pembalut hid 4 x 10 cm Rol 2300 470 470 10 460 1,081,000
54 Kasa pembalut hid 4 x 5 cm Rol 1100 575 575 120 455 632,500
55 Kasa Steril 16 x 16 cm Pcs 7900 80 80 2 78 632,000
56 Kertas Puyer Pcs 77 - - - - -
57 Lomatull Pcs 5198 - - - - -
58 Masker Box 22000 44 10 54 16 38 968,000
59 Masker O2 anak Pcs 19800 18 18 - 18 356,400
60 Masker O2 dewasa Pcs 19800 20 20 5 15 396,000
61 Mesh 11 Lancip Pcs 583 1,200 1,200 - 1,200 699,600
62 Mesh 11 Lancip Pcs 3000 200 200 - 200 600,000
64 Nasal Canula Anak Pcs 5500 250 250 - 250 1,375,000
65 Nasal Canula Dewasa Pcs 5500 240 240 - 240 1,320,000
73 Sharp Collector Pcs - - -
74 Silk (benang bedah sutra) dg j Sachet - - - - -
75 Silk tanpa jarum 2/0 Sachet 3055 72 72 - 72 219,960
76 Silk tanpa jarum 3/0 Sachet 22400 24 24 12 12 537,600
77 Slim Zuiker Pcs 7040 25 25 - 25 176,000
78 Sputum pot Pcs - - -
79 Tab. Kapiler Hematokrit Pcs - - -
80 Tabung Vacutainer Kuning Pcs - - -
81 Tabung Vacutainer Merah Pcs - - -
82 Tabung Vacutainer Ungu Pcs - - -
83 Tissue Lensa Kotak - - -
84 Tranfusion Set Dewasa Pcs - - -
85 Umbilical Pcs - - -
86 Urine Bag Pcs 5808 30 30 - 30 174,240
87 White tape Pcs - - -
88 Wing Needle 25 Pcs - - -
90 Yellow tape Pcs - - -
91 Sterizide Pcs 87120 7 7 - 7 609,840
92 Viorex botol 67650 10 10 - 10 676,500
141,142,014
TOTAL
KUNJUNGAN
OKTOBER 2019
MENGETAHUI
KABUPATEN SIDOARJO

dr.ARIF RAHMAN NURDIANTO NIP. 196605101989032013
NIP. 19870416201101 1 007
MINTAAN OBAT PUSKESMAS
PUSKESMAS
GFK
PENERI PERSE PEMA SISA PERMIN KET.

(Rp) (Rp) (Rp) (Rp)
10 11 12 13 14 15
1,452,000 2,249,632 298,144 1,951,488

1,980,000 2,162,358 189,486 1,972,872
1,545,000 1,583,110 277,070 1,306,040
- - - -
- - - - 200
- 433,484 433,484 - 1,000
- 545,675 238,395 307,280 2,000
- 143,550 143,550 -
272,100 272,100 46,257 225,843
- - - - 3,000
- - - -
- - - -
- - - -
- - - - 500
- 189,000 7,560 181,440
- 69,960 - 69,960
396,000 396,000 145,200 250,800
- - - -
795,000 957,392 149,407 807,985
110,700 195,939 132,840 63,099 100
- - - - 500
- - - -
- 123,760 38,080 85,680
- 30,900 30,900 - 50
290,000 452,400 - 452,400
- - - -
- 407,550 41,250 366,300
- - - -
- - - -
- - - -
- - - -
- 727,500 113,005 614,495
- - - -
- - - -
- 3,612,000 602,000 3,010,000
- - - -
- 84,280 - 84,280
- 1,051,650 - 1,051,650
- 886,080 - 886,080
- - - -
- - - -
44,000 53,240 27,456 25,784 500
- - - -
- 43,600 5,995 37,605
- 1,316,700 - 1,316,700
- - - - 300
- - - -
- 67,887 1,197 66,690
- 52,200 - 52,200
- - - -
- 326,860 - 326,860
- 324,000 - 324,000
- - - -
- - - - 1,000
- 223,740 - 223,740
- 164,400 16,440 147,960
- 251,460 62,865 188,595
- - - -
- - - -
- 129,800 - 129,800
- 282,625 56,100 226,525
- - - -
- - - -
- 247,828 45,090 202,738
- - - -
- - - -
- - - -
34,600 34,600 - 34,600
- 179,300 36,300 143,000 300
- - - -
- - - -
- 44,500 - 44,500
- 44,500 6,319 38,181
- 161,200 54,080 107,120
- - - -
- - - -
- - - -
- - - -
- - - -
210,000 570,500 279,300 291,200 1,500
- - - -
- - - -
- 435,750 72,525 363,225
- 23,100 8,470 14,630 300
- - - -
- 1,345,400 98,735 1,246,665
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 56,500 - 56,500
- 69,500 6,950 62,550
- 229,320 - 229,320
- - - -
- - - -
- - - -
- 229,760 96,864 132,896 2,000
- 142,610 - 142,610
- - - -
- 422,400 - 422,400
- 536,000 - 536,000
- - - - 1,000
- 214,900 21,700 193,200
- - - -
- 1,120,000 640,000 480,000
- - - -
- - - -
- 387,200 316,800 70,400
1,142,000 2,813,888 - 2,813,888
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 2,590,456 304,568 2,285,888
- - - -
687,000 813,408 247,320 566,088
- - - -
242,000 706,640 58,080 648,560
760,320 760,320 126,720 633,600
- - - -
- - - -
- - - -
- - - -
- 58,608 58,608 -
1,056,000 2,816,000 189,024 2,626,976
- 6,630 6,630 -
- 254,980 - 254,980
- 512,820 - 512,820
1,760,000 1,893,760 171,600 1,722,160
- - - -
- - - -
- 921,942 134,082 787,860
- 455,390 (36,270) 491,660
- - - -
- - - -
- - - -
378,300 661,440 209,040 452,400
- - - -
231,000 334,950 - 334,950
2,325,000 2,325,000 122,760 2,202,240
- 139,120 26,640 112,480
- - - -
- - - -
- 222,600 46,375 176,225
- 527,904 - 527,904
- 515,372 - 515,372
- - - -
- - - -
- - - -
- - - -
- 77,430 8,900 68,530
715,500 1,377,099 383,031 994,068
- - - -
- - - -
- 155,760 - 155,760
- - - -
- 185,297 32,896 152,401
286,000 500,500 143,000 357,500
- 413,960 57,640 356,320
- - - -
- - - -
- - - -
- 85,200 10,200 75,000
- 180,000 18,000 162,000
- 454,300 53,100 401,200
- - - -
- - - -
- - - -
- - - -
184,800 277,200 - 277,200
- 108,900 108,900 -
- - - - 300
- - - -
- - - -
- - - -
- - - -
223,200 423,540 109,710 313,830
- 82,125 - 82,125
- - - -
61,500 88,560 32,349 56,211
- - - -
- - - -
- - - -
- - - -
- - - -
- 41,400 - 41,400
- 138,000 - 138,000
- - - -
- - - -
- - - -
- - - -
- - - -
- 283,815 - 283,815
1,656,000 1,997,550 310,707 1,686,843
960,000 2,784,960 616,320 2,168,640
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 39,900 2,100 37,800
315,000 836,850 280,140 556,710
1,567,500 1,567,500 120,175 1,447,325
- 250,200 - 250,200
- - - -
412,500 412,500 34,375 378,125
- - - -
- 243,300 243,300 -
1,452,600 1,452,600 136,383 1,316,217
- 462,000 44,000 418,000
- 719,800 119,770 600,030
- - - -
- 259,350 - 259,350
151,250 151,250 - 151,250
- - - -
- - - -
1,970,400 1,970,400 771,740 1,198,660
- - - -
- 675,270 134,070 541,200
- - - -
- - - -
- 274,125 116,280 157,845 1,000
- - - -
- 1,422,475 125,970 1,296,505
498,000 1,345,845 437,991 907,854
- - - -
- - - -
- 5,474,102 778,919 4,695,183
- - - -
435,360 1,229,892 344,660 885,232
- - - -
- - - -
- - - -
- 179,578 53,340 126,238
297,000 392,040 124,740 267,300
1,434,000 3,925,814 733,252 3,192,562
- - - -
- - - -
711,000 711,000 606,720 104,280
- - - -
224,100 313,740 89,640 224,100
- - - -
- 826,535 166,685 659,850
- - - -
- - - -
- - - -
- - - -
- 359,250 359,250 - 500
- - - -
- - - -
715,000 715,000 92,950 622,050
- 44,700 1,000 43,700
- 211,500 28,200 183,300
- - - -
- 348,840 47,196 301,644
254,400 254,400 10,600 243,800
- - - -
- - - -
- - - -
- - - -
- 638,790 329,560 309,230 2,000
- - - -
- - - -
- - - -
- 1,824,000 - 1,824,000
154,000 720,720 107,800 612,920
- - - -
- - - -
63,000 98,700 16,800 81,900
- 283,500 32,400 251,100
- 237,440 64,960 172,480
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 5,399,775 2,159,910 3,239,865
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
200,000 488,000 92,000 396,000
- 193,600 - 193,600
- - - - 5
- 860,937 - 860,937
- - - -
216,000 234,000 18,000 216,000
- 1,078,000 22,000 1,056,000
- 562,419 62,491 499,928
- - - -
- - - -
- - - -
- - - -
- - - -
- 140,056 - 140,056
- - - -
- - - -
- - - - 2,000
- - - -
- - - -
- - - -
- 12,385,950 365,650 12,020,300
- - - -
- 93,150 - 93,150
- - - -
- - - -
- - - -
- - - -
- - - -
- 482,800 25,560 457,240
- - - -
33,280 33,280 - 33,280
37,960 37,960 - 37,960
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 959,992 - 959,992
- 1,309,990 - 1,309,990
- - - -
- - - -
- 195,300 - 195,300
- 591,800 591,800 -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 201,000 - 201,000
462,000 873,180 244,860 628,320
- 306,900 66,825 240,075
- - - -
- - - -
- - - - 20
- - - -
- - - -
- - - -
- - - -
- 35,088 11,696 23,392
- - - -
401,280 401,280 91,960 309,320
100,300 100,300 22,066 78,234
- - - -
- - - -
- 215,808 - 215,808
- - - -
245,808 273,120 95,592 177,528
- - - -
- - - -
- 201,740 20,960 180,780
- 224,675 23,650 201,025
- - - -
- - - -
- 54,600 13,650 40,950
- - - -
- - - -
- - - -
- - - - 50
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 219,750 - 219,750
- - - -
- - - -
- - - -
- 16,250 16,250 - 50
- 182,457 9,405 173,052
- 171,864 - 171,864
- - - -
- 307,750 49,240 258,510
- - - -
- - - -
- - - -
- 2,409,750 707,625 1,702,125
- - - -
- - - -
- 139,150 66,550 72,600 50
- - - -
- - - -
62,160 282,310 31,080 251,230
- - - -
- - - -
- - - -
- - - -
- - - -
95,010 95,010 - 95,010
- - - -
- - - -
- - - -
484,200 484,200 16,140 468,060
- - - -
- - - -
63,000 259,350 90,300 169,050
- - - -
- - - - 200
- - - -
- 591,786 101,088 490,698
64,200 85,600 - 85,600
- - - -
- - - -
- 121,380 - 121,380
- 1,080,405 729,015 351,390 500
- - - -
- 161,505 107,115 54,390 1,000
- - - -
- - - -
- - - -
- 59,400 19,800 39,600
- - - -
- - - -
- - - -
- - - -
- 858,000 143,000 715,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
4,652,150 4,747,435 358,720 4,388,715
- - - -
- 414,000 - 414,000
- - - -
- - - -
- 36,800 36,800 -
- - - -
- - - -
1,312,000 1,312,000 - 1,312,000
- - - -
360,000 720,000 360,000 360,000
112,200 261,800 112,200 149,600
- - - -
- - - -
- - - -
- - - -
- 1,370,460 158,340 1,212,120
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1,001,000 - 1,001,000
- 726,000 - 726,000
- 330,000 - 330,000
- 5,964,000 - 5,964,000
- 1,056,000 - 1,056,000
- 112,944 - 112,944
- 396,000 - 396,000
693,000 1,732,500 693,000 1,039,500
- - - -
- 2,200,000 - 2,200,000
- 275,000 - 275,000
- 1,188,000 - 1,188,000
- 1,848,000 - 1,848,000
- 804,000 - 804,000
1,056,000 1,584,000 - 1,584,000
- 1,056,000 - 1,056,000
- 154,000 - 154,000
- - - -
- - - -
- 885,000 120,000 765,000
- 19,710 1,314 18,396
- 313,500 - 313,500
- - - -
- - - -
- - - -
- - - -
- - - -
- 28,600 14,300 14,300
113,800 273,120 34,140 238,980
- 320,000 - 320,000
- 74,800 - 74,800
- 549,120 163,020 386,100
105,000 105,000 - 105,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 330,000 - 330,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 178,000 - 178,000
- 4,450,000 462,800 3,987,200
- - - -
- 599,040 374,400 224,640 20
- - - -
- - - -
- 1,323,900 - 1,323,900
- 1,566,000 87,000 1,479,000
- 2,175,000 - 2,175,000
- - - -
- 633,600 - 633,600
- 588,000 327,600 260,400
792,000 1,584,000 - 1,584,000
- 77,028 - 77,028
- 33,012 - 33,012
- 22,008 - 22,008
- 11,004 - 11,004
- 33,012 - 33,012
- 33,012 - 33,012
- 462,000 - 462,000
- - - -
- - - -
- - - -
- 494,400 123,600 370,800
- - - -
- - - -
- - - -
- 4,160,000 260,000 3,900,000
- 564,000 - 564,000
- 1,081,000 23,000 1,058,000
- 632,500 132,000 500,500
- 632,000 15,800 616,200
- - - -
- - - - 100
220,000 1,188,000 352,000 836,000 20
- 356,400 - 356,400
- 396,000 99,000 297,000
- 699,600 - 699,600
- 600,000 - 600,000
- - - -
- 1,375,000 - 1,375,000
- 1,320,000 - 1,320,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - 10
- - - -
- - - -
- - - -
- 219,960 - 219,960
- 537,600 268,800 268,800 36
- 176,000 - 176,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 174,240 - 174,240
- - - -
- - - -
- - - -
- - - -
- 609,840 - 609,840
- 676,500 - 676,500
42,334,478 183,476,492 25,437,822 158,038,670
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : NOVEMBER 2019 ALL
1 2 3 4 5 6

1 Neuroval tab Tablet 2,016 2,016
2 Antalgin 500 mg tab Tablet 9,964 9,964
5 Aspilets 80 mg tab Tablet - 200 200
6 Diklofenak Kalium 50 mg tab Tablet - -
16 Sotatic inj. 5 mg/ml Ampul 15 15
17 Molakrim krim Tube 30 g 19 19
23 Suprafenid supp Suppositoria 36 36
24 Proris supp Suppositoria - -
25 Antalgin inj. Ampul 156 156
(1c) ANTIPIRAI
(2) ANESTESI LOKAL


1 Alprazolam 0,5 mg Tablet 293 500 793
5 Fenitoin kapsul 100 mg Kapsu; - 300 300
11 Haldol Decanoat inj 50 mg/ml Ampul 90 14 104
12 Klobazam 10 mg tab Tablet - 1,300 1,300
13 Klorpromazin HCl 100 mg tab Tablet - 6,200 6,200
(4) ANTI PARKINSON

2 Triheksifenidil 2 mg Tablet 2,665 9,000 11,665
(5) ANTI DEPRESI

(6) ANTI MIGREN

2 Betahistin Mesilat 6 mg Tablet 1,300 300 1,600

3 Nifedipin GITS (Adalat Oros) 30 m Tablet - -
5 Furosemid 40 mg Tablet 190 300 490
7 H.C.T 25 mg Tablet 8,043 8,043


1 Aminofilin 200 mg Tablet 950 950
11 Prednison 5 mg Tablet - 1,000 1,000
(11) ANTI TUSIF

(12) EKSPEKTORAN
5 Hustab tab Tablet 1,236 1,236
(13) ANTI INFLUENZA

3 Molexflu tab Tablet - -
5 Demacolin tab Tablet - -
6 Molexflu sirup Botol 60 ml 38 38
7 Demacolin syr Botol 60 ml 42 42
8 Quantidex tab Tablet 1,957 1,957
(14) ANTASIDA
10 Ulsidex tab Tablet 380 380

2 D5 + 1/2 NS Botol 500 ml 54 54
3 D5 + 1/4 NS Botol 500 ml 53 53
4 Dehaf Sachet - -
7 L-Bio Sachet - -
16 Zink tab dispersible 20 mg Tablet 680 680
(16) LAKSAN
1 Bisacodyl tab 5 mg Tablet 250 250
(17) ANTI SPASMODIK

4 Scopma tab Tablet - -
5 Scopma plus Tablet 297 200 497
(18) ANTI HISTAMIN






3 Pritavit kaplet Kaplet 1,385 1,385
6 Caldetri Tablet 275 275
8 Elkana tab Tablet - -
9 Glucosamin tab Tablet 1,631 1,631
21 Sianokobalamin tab Tablet 3,095 1,000 4,095

21 Eritromisin 500 mg Kaplet - 500 500
22 Eritromisin sirup kering Botol 60 ml 74 74
24 Klindamisin 150 mg Kapsul 870 870
27 Kotrimoksasol 960 mg Tablet - -
(25) ANTI VIRUS

(26) ANTI FUNGI

2 Ketokonazol 200 mg Tablet 930 930


3 H2O2 3% Botol 1000 ml 8 8
5 Lisol 50% Botol 1000 ml 21 21
8 Softa-Man (Aseptic Gel) Botol 500 ml 48 48
9 Softaskin (0ne Scrub) Botol 500 ml 8 8
(29) ANTELMENTIK
1 Albendazol 400 mg Tablet -
-
1 Metronidazol 500 mg Tablet 2,000 2,000
-
(32) HEMOSTATIK
3 Fitomenadion 10 mg (Vit. K) Tablet 644 644

(34) SERUM
2 ATS 1.500 IU Ampul 10 10
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 930 930



(39) ANTI BAKTERI

3 Klorfeson krem Tube 37 37

1 Anti Fungi DOEN (As.Benz 60+As. Pot 48 48
(41) ANTI SCABIES

1 Salep 2-4 30 g Pot 69 69
2 Scabimite Tube 17 17
(42) ANTI SEPTIK


2 Salisil bedak 2% Kotak - 50 50



2 Kloramfenikol 0,5% t.m Botol 5 ml - -




(51) ANTI HEMOROID

5 Hemorogard tab Tablet 290 290
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 1,610 1,610
3 Domperidon tab Tablet - 200 200

2 Kalsium Atorvastatin Tablet 442 510 952
4 Simvastatin tab 10 mg Tablet 490 600 1,090
(54) NOOTROPIK
(55) IMMUNDILATOR
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 3,915 250 4,165
7 Carbamazepin tablet 1,800 1,800
8 Haldol inj. ampul -
9 Haloperidol 1.5 mg tablet -
11 Handscoon pcs -
12 Holder Prontho pcs -
14 Klorpromazin 25 mg tablet -
17 Mantoux tab tablet -
18 Micropipet pcs -
19 pH Paper pcs -
20 Phenitoin 100 mg tablet - 8 8
21 Risperidon 2 mg tablet 2,220 2,900 5,120
(59) OBAT GIGI
4 Cresophene (Cresotin Liq) Botol 7,5 g 3 3
17 Temporary Stopping Fletcher (Cito Botol 3 3
18 Tooth Cleansing (Occo) /Poliren N Botol 15 ml 6 6


8 Aquadest steril 1000 ml Botol 1000 ml 10 10
14 Cerplast Pcs - -
56 Lomatull Pcs - 100 100
57 Masker box 38 10 48
73 Silk (benang bedah sutra) dg jaru Sachet - -
75 Silk dengan jarum 3/0 Sachet 12 24 36
77 Sputum pot Pcs -
84 Umbilical Pcs -
86 White tape Pcs -
91 Sterizym botol 5 Liter - 1 1
92 Viorex Botol 500 ml 10 10
TOTAL
KUNJUNGAN
Nov-19
Mengetahui :
KABUPATEN SIDOARJO
NIP. 19870416201101 1 007

PUSKESMAS
GFK
7 8 9 10
362 1,654
1,790 8,174
5,445 7,235
- -
110 90
- -
2,000 2,672
- -
42 41
- -
- -
- -
- -
- -
1,506 174
- 15
19 -
- -
4,828 10,417
(24) 81
(382) 382
- -
4 32
- -
- 156
- -
104 340
535 5,800
4 6
- -
- 98
- 990
- 5
132 661
- -
- 345
- 315
- 300
- -
- 390
- 30
- -
- 5,540
10 94
30 1,270
360 5,840
- 180
80 460
- 15
- 200
535 11,130
288 12,726
- -
- 200
270 1,330
148 781
510 520
- -
- -
-
4,090 1,570
- -
1,464 2,293
1,395 3,448
105 385
- -
573 7,470
- -
- -
- -
11 939
- 60
- -
- -
- -
3,322 831
- 130
- -
- 300
3,083 5,674
102 898
327 2,433
- -
40 220
8 -
13 4,915
- -
- -
- -
- -
3,201 22,775
- -
717 519
- -
30 104
31 29
- -
- -
- -
336 7,127
- -
- 38
2 40
114 1,843
12,590 2,000
56 188
- -
- -
- -
1,614 1,866
- -
90 200
285 2,083
66 314
- 19
- 54
- 53
- -
- -
- -
- -
100 670
964 1,120
24 80
- -
- 12
- -
447 146
10 40
280 400
- -
20 230
3 24
6 62
- -
- -
- 30
- -
234 263
- -
- -
1,083 2,404
- 75
3,055 25,300
274 183
- -
- 20
- -
26 -
- 2,385
2,724 5,425
7,000 15,590
40 500
3,612 1,690
131 1,254
- 24
- -
72 203
- -
- -
165 1,466
40 340
3,350 6,820
- -
- 100
- -
- -
17 348
- -
1,364 3,036
- -
- -
2,266 1,829
- -
4,140 11,113
4,600 6,338
3,951 16,200
- -
80 164
- -
- -
- -
18 53
5 40
1,159 5,520
- -
- -
44 -
- -
- 50
- -
890 1,600
- -
- -
- -
- -
60 440
74 -
- -
498 372
560 3,810
- 39
- -
20 127
42 533
- -
- -
- -
- -
309 1,980
- -
650 4,705
52 147
136 254
70 860
108 200
- -
5 4
- -
- -
12 87
- 8
- -
1 20
- -
1 11
3 45
1 7
-
-
-
- 488
-
-
650 1,350
-
-
-
4,990 28,870
- -
- 90
- -
- -
- -
84 560
- -
- 10
- 10
- -
- -
- -
- 2
- 10
- 930
- -
- -
-
16 150
50 86
11 86
4 4
- -
4 33
- 39
- 48
5 82
37 15
6 63
6 11
- 18
14 36
-
- 15
- -
- -
9 83
1 61
- -
9 12
- -
33 56
5 7
17 80
52 148
- -
- -
- -
- 290
773 837
18 57
10 190
- -
156 1,242
20 60
114 306
586 366
- -
930 160
- -
- 6
- -
- -
- 100
- -
- -
- -
- -
345 3,820
- 27
10 1,790
-
-
180 1,420
-
-
- 400
-
- 72
- 8
-
-
-
- 8 8
470 4,650 4,650
- -
- -
- -
- -
- -
- -
- 7
- 3
- 2
- 4
- 6
- 6
- 6
- 3
- -
- 8
- 5
- 6
- 200
- 3
- 3
- 6
- 200
6 45
3 11
- 19
- -
- -
- -
- 100
200 1,900
- 200
- 400
12 123
- 10
- -
- -
- -
- -
- -
- -
- -
- -
- 30
- -
- -
- -
- -
- -
- -
500 -
1,300 9,900
- -
3 3
- -
- -
- 90
- 170
10 315
- 64
- 80
18 213
- 84
- 36
- 24
- 12
- 36
- 36
- 1,400
- -
- -
- -
2 16
- -
- -
- -
2 28
10 50
130 330
5 450
- 78
- -
100 -
17 31
- 18
- 15
- 1,200
- 200
- -
2 248
10 230
-
-
-
-
-
-
-
-
- -
- 72
- 36
- 25
-
-
-
-
-
-
-
-
- 30
-
-
-
-
- 7
- 1
9 1
TOTAL
KUNJUNGAN

NIP. 196605101989032013
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : NOVEMBER 2019 APBD

(Rp)
1 2 3 4 5 6 7 8 9

1 Neuroval tab Tablet 968 2,016 2,016 362 1,654 1,951,488
2 Antalgin 500 mg tab Tablet 198 9,964 9,964 1,790 8,174 1,972,872
3 Asam Mefenamat 500 mg tab Tablet 103 12,680 12,680 5,445 7,235 1,306,040
4 Asetosal 100 mg tab Tablet 0 - - - - -
5 Miniaspi 80 mg Tablet 99 - 200 200 110 90 -
6 Diklofenak Kalium 50 mg tab Tablet 706 - - - - -
7 Diklofenak Na. 50 mg tab Tablet 115 2,672 2,000 4,672 2,000 2,672 307,280
8 Eprinoc tab Tablet 1650 - - - - -
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 2721 83 83 42 41 225,843
10 Ibuprofen 200 mg tab Tablet 0 - - - - -
12 Meloxicam 15 mg supp Suppositoria 0 - - - - -
13 Meloxicam 15 mg tab Tablet 0 - - - - -
14 Meloxicam 7,5 mg tab Tablet 0 - - - - -
15 Metoklopramid 10 mg Tablet 108 1,680 1,680 1,506 174 181,440
16 Sotatic inj. 5 mg/ml Ampul 4664 15 15 - 15 69,960
17 Molakrim krim Tube 30 g 13200 19 19 19 - 250,800
18 Nonflamin tab Tablet 0 - - - - -
19 Parasetamol 500 mg tab Tablet 53 15,245 15,245 4,828 10,417 807,985
20 Parasetamol sirup 120 mg/5 ml Botol 60 ml 1107 57 100 157 76 81 63,099
21 Piroksikam 10 mg tab Tablet 133 - 500 500 118 382 -
22 Piroksikam 20 mg tab Tablet 0 - - - - -
23 Suprafenid supp Suppositoria 2380 36 36 4 32 85,680
24 Proris supp Suppositoria 5150 - - - - -
25 Antalgin inj. Ampul 2900 156 156 - 156 452,400
26 Tramadol injeksi 50 mg/ml Ampul 0 - - - - -
27 Tramadol kap 50 mg Tablet 825 444 444 104 340 366,300
- - -
Alopurinol 100 mg Tablet 97 6,335 6,335 535 5,800 614,495
- - -
1 Etil Klorida semprot Botol 100 ml 301000 10 10 4 6 3,010,000
2 Ketamin / Ketalar inj. 100 mg/ml Vial 10 ml 0 - - - - -
3 Lidokain inj 2% (HCl) / 2 ml Ampul 860 98 98 - 98 84,280
4 Lidokain komb inj / 2 ml Ampul 1845 570 570 - 570 1,051,650
5 Xylocain spray Botol 50 ml 177216 5 5 - 5 886,080
- - -
(3) AN.EPILEPSI, AN.KONV, AN.ASIETAS, SEDATIV, HIPNOTIK, AN.PSIKOT - - -
1 Alprazolam 0,5 mg Tablet 88 293 500 793 132 661 25,784
2 Diazepam 2 mg Tablet 45 - - - - -
3 Diazepam 5 mg Tablet 109 345 345 - 345 37,605
4 Diazepam inj. 5 mg/ 2 ml Ampul 4180 315 315 - 315 1,316,700
5 Fenitoin kapsul 100 mg Kapsu; 605 - 300 300 - 300 -
6 Fenobarbital 100 mg Tablet 0 - - - - -
7 Fenobarbital 30 mg Tablet 171 390 390 - 390 66,690
8 Fenobarbital inj. 50 mg/ml Ampul 1740 30 30 - 30 52,200
9 Haloperidol 0.5 mg tab Tablet 0 - - - - -
10 Haloperidol 1,5 mg Tablet 59 5,540 5,540 - 5,540 326,860
12 Haloperidol inj 50 mg/ml (Haldo Ampul 97500 90 14 104 10 94 8,775,000
13 Klobazam 10 mg tab Tablet 739 - 1,300 1,300 30 1,270 -
14 Klorpromazin HCl 100 mg tab Tablet 147 - 6,200 6,200 360 5,840 -
15 Klorpromazin HCl inj 25 mg/ml Ampul 1243 180 180 - 180 223,740
16 Trifluoperazine 5 mg tab Tablet 274 540 540 80 460 147,960
17 Stesolid rectal 5 mg Tube 12573 15 15 - 15 188,595
- - -
1 Levopar tab Tablet 649 200 200 - 200 129,800
2 Triheksifenidil 2 mg Tablet 91 2,665 9,000 11,665 535 11,130 242,515
- - -
1 Amitriptilin HCl 25 mg Tablet 167 1,214 11,800 13,014 288 12,726 202,738
- - -
1 Anti Migren (Komb. Ergot+Kafein Tablet 173 200 200 - 200 34,600
2 Betahistin Mesilat 6 mg Tablet 110 1,300 300 1,600 270 1,330 143,000
- - -
1 Isosorbit Dinitrat 5 mg - 2018 Tablet 89 929 929 148 781 82,681
3 Nifedipin 10 mg Tablet 104 1,030 1,030 510 520 107,120
4 Nifedipin GITS (Adalat Oros) 30 Tablet 0 - - - - -
6 Propanolol 40 mg Tablet 0 - - -
-
(8) ANTI HIPERTENSI-DIURETIKA -
2 Amlodipin 10 mg Tablet 0 - - - - -
3 Bisoprolol Fumarat 5 mg Tablet 0 - - - - -
4 Captopril 25 mg Tablet 75 4,843 4,843 1,395 3,448 363,225
5 Furosemid 40 mg Tablet 77 190 300 490 105 385 14,630
6 Furosemid inj. Ampul 0 - - - - -
7 H.C.T 25 mg Tablet 155 8,043 8,043 573 7,470 1,246,665
- - -
- - -
1 Aminofilin 200 mg Tablet 113 500 500 - 500 56,500
Aminofillin 200 mg (Decafil) Tablet 139 450 450 11 439 62,550
2 Aminofilin inj 24 mg Ampul 3822 60 60 - 60 229,320
3 Bisolvon solution 10 mg/5 ml Botol 50 ml 0 - - - - -
4 Bisolvon injeksi 2 mg/ml Ampul 0 - - - - -
5 Bricasma inj 0,5 mg/ml Ampul 0 - - - - -
6 Deksamethason 0,5 mg Tablet 32 4,153 4,153 3,322 831 132,896
7 Deksamethason inj 5 mg/ml Ampul 1097 130 130 - 130 142,610
8 Efedrin HCl 25 mg Tablet 0 - - - - -
9 Epinefrin inj. Ampul 1408 300 300 - 300 422,400
10 Methylprednisolon 4 mg Tablet 134 4,000 4,000 - 4,000 536,000
11 Prednison 5 mg Tablet 68 - 1,000 1,000 102 898 -
12 Salbutamol 4 mg Tablet 70 2,760 2,760 327 2,433 193,200
14 Salbutamol sirup (Astharol) Botol 60 ml 0 - - - - -
15 Ventolin Nebulizer Ampul 4000 120 120 - 120 480,000
- - -
1 Dexmolex sirup Botol 100 ml 8800 8 8 8 - 70,400
2 Kodein 10 mg Tablet 571 4,928 4,928 13 4,915 2,813,888
4 Tuzalos tab Tablet - - - - -
- - -
1 Ambroxol HCl 30 mg Tablet 0 - - - - -
2 Ambroxol syrup Botol 60 ml 0 - - - - -
3 Gliseril Guayakolat 100 mg Tablet 88 25,976 25,976 3,201 22,775 2,285,888
4 Hustab sirup Botol 60 ml 0 - - - - -
5 Hustab tab Tablet 458 1,236 1,236 717 519 566,088
6 OBH Plus Anak Botol 60 ml 0 - - - - -
7 OBH Plus Dewasa Botol 60 ml 4840 134 134 30 104 648,560
8 Sanadryl Expectorant Botol 60 ml 10560 60 60 31 29 633,600
- - -
1 Alpara tab Tablet 0 - - - - -
2 Alpara sirup Botol 60 ml 0 - - - - -
3 Molexflu tab Tablet 396 - - - - -
4 Colpica tab Tablet 352 7,463 7,463 336 7,127 2,626,976
5 Demacolin tab Tablet 170 - - - - -
6 Molexflu sirup Botol 60 ml 6710 38 38 - 38 254,980
7 Demacolin syr Botol 60 ml 12210 42 42 2 40 512,820
8 Quantidex tab Tablet 880 1,957 1,957 114 1,843 1,722,160
- - -
(14) ANTASIDA - - -
1 Antasida DOEN I tab Tablet 54 14,590 14,590 12,590 2,000 787,860
2 Antasida DOEN II sirup Botol 60 ml 2015 244 244 56 188 491,660
3 Cimetidin 200 mg Tablet 220 - - - - -
6 Omeprazole kap 20 mg Tablet 130 3,480 3,480 1,614 1,866 452,400
7 Ranitidin tab 150 mg Tablet 105 - - - - -
8 Ranitidin inj 25 mg/2 ml Ampul 1155 290 290 90 200 334,950
9 Sanmag tab Tablet 930 2,368 2,368 285 2,083 2,202,240
10 Ulsidex tab Tablet 296 380 380 66 314 112,480
- - -
1 Asering infus Botol 500 ml 9275 19 19 - 19 176,225
2 D5 + 1/2 NS Botol 500 ml 9776 54 54 - 54 527,904
3 D5 + 1/4 NS Botol 500 ml 9724 53 53 - 53 515,372
4 Dehaf Sachet 0 - - - - -
5 KAEN 3A Botol 500 ml 0 - - - - -
6 KAEN 3B Botol 500 ml 0 - - - - -
7 L-Bio Sachet 0 - - - - -
8 Loperamide Tablet 89 770 770 100 670 68,530
9 Molagit tab Tablet 477 2,084 2,084 964 1,120 994,068
10 Na. Klorida 0,9% infus Botol 500 ml 0 - - - - -
11 Na. Klorida 0,9% piggy bag Botol 100 ml 0 - - - - -
12 Neo Kaolana suspensi Botol 60 ml 12980 12 12 - 12 155,760
13 New Diaform Tablet - - - - -
14 Oralit 200 ml Sachet 257 593 593 447 146 152,401
15 Ringer Laktat infus Botol 500 ml 7150 50 50 10 40 357,500
16 Zink tab dispersible 20 mg Tablet 524 680 680 280 400 356,320
17 Zink sirup 20 mg/5 ml Botol 60 ml 0 - - - - -
- - -
(16) LAKSAN - - -
1 Bisacodyl tab 5 mg Tablet 300 250 250 20 230 75,000
2 Dulcolax supp 5 mg Suppositoria 6,000 27 27 3 24 162,000
- - -
1 Atropin Sulfat inj 0,25 mg/ml Ampul - - - - - -
2 Braxidin tab Tablet - - - - - -
3 Hyosin Bromida inj Ampul 9,240 30 30 - 30 277,200
4 Scopma tab Tablet 1,210 - - - - -
5 Scopma plus Tablet 1,375 297 200 497 234 263 408,375
6 Ekstrak Belladona 10 mg Tablet - - - - -
- - -
1 Ceterizine sirup Botol 60 ml - - - - - -
2 Cetirizine tab 10 mg Tablet 90 3,487 3,487 1,083 2,404 313,830
3 Difenhidramin inj Ampul 1,095 75 75 - 75 82,125
4 Klorfeniramin Maleat 4 mg Tablet - - - - - -
5 Loratadine 10 mg Tablet 123 457 457 274 183 56,211
- - -
1 Aminofluid Softbag 500 ml - - - - - -
3 Glukose 10% infus 500 ml - 201Botol 500 ml - 20 20 - 20 -
4 Glukose 40% inj 25 ml Ampul 1,001 - - - - -
5 Glukose 5% infus 500 ml Botol 500 ml 6900 26 26 26 - 179,400
- - -
- - -
1 Glibenklamid 5 mg Tablet 119 2,385 2,385 - 2,385 283,815
2 Glimipiride 2 mg Tablet 207 8,149 8,149 2,724 5,425 1,686,843
3 Metformin tab 500 mg Tablet 96 22,590 22,590 7,000 15,590 2,168,640
- - -
- - -
1 Anemolat tab / Asam folat tab Tablet 70 540 540 40 500 37,800
2 Asam Askorbat 50 mg Tablet 105 5,302 5,302 3,612 1,690 556,710
3 Pritavit kaplet Kaplet 1045 1,385 1,385 131 1,254 1,447,325
4 Calcii Gluconas inj Ampul 10425 24 24 - 24 250,200
5 Caldece tab effervecent Tablet 0 - - - - -
6 Caldetri Tablet 1375 275 275 72 203 378,125
7 Elkana sirup Botol 60 ml 0 - - - - -
8 Elkana tab Tablet 811 - - - - -
9 Glucosamin tab Tablet 807 1,631 1,631 165 1,466 1,316,217
10 Hepagard tab Tablet 1100 380 380 40 340 418,000
11 Kalsium Laktat 500 mg Tablet 59 10,170 10,170 3,350 6,820 600,030
12 Neurosanbe 5000 Tablet 0 - - - - -
13 Neurosanbe inj Ampul 5187 50 50 - 50 259,350
14 Mersibion inj Ampul 3025 50 50 - 50 151,250
15 Neurosanbe Plus Tablet 0 - - - - -
16 Neurosanbe tab Tablet 0 - - - - -
17 Osteotin tab Tablet 3284 365 365 17 348 1,198,660
18 Pharmaton Vit Tablet 0 - - - - -
19 Piridoksin 10 mg (Vit. B6) Tablet 123 4,400 4,400 1,364 3,036 541,200
20 Procurma Plus sirup Botol 60 ml 0 - - - - -
21 Santa E 200 mg tablet hisap Tablet 0 - - - - -
22 Sianokobalamin tab Tablet 51 3,095 1,000 4,095 2,266 1,829 157,845
23 Tiamin HCl (Vit. B1) inj 100 mg/ Ampul 0 - - - - -
24 Tiamin HCl 50 mg (Vit. B1) tab Tablet 85 15,253 15,253 4,140 11,113 1,296,505
25 Vit. B kompleks Tablet 83 10,938 10,938 4,600 6,338 907,854
- - -
1 Amoksisilin 500 mg Tablet 233 20,151 20,151 3,951 16,200 4,695,183
2 Amoksisilin inj. Ampul 0 - - - - -
3 Amoksisilin sirup kering Botol 60 ml 3628 244 244 80 164 885,232
4 Ampisilin 500 mg Kaplet 0 - - - - -
5 Ampisilin inj. Ampul 0 - - - - -
6 Ampisilin sirup kering Botol 60 ml 0 - - - - -
7 Azitomisin 500 mg kaplet Kaplet 1778 71 71 18 53 126,238
8 Dionicol sirup kering Botol 60 ml 5940 45 45 5 40 267,300
9 Cefadroxil 500 mg Kaplet 478 6,679 6,679 1,159 5,520 3,192,562
10 Cefadroxil sirup kering Botol 60 ml 0 - - - - -
11 Cefalexin 500 mg Tablet 0 - - - - -
12 Cefixime kapsul 200 mg Kapsul 2370 44 44 44 - 104,280
13 Cefixime sirup Botol 30 ml 0 - - - - -
14 Cefotaxime injeksi 1 g Ampul 4482 50 50 - 50 224,100
15 Ceftriaxone injeksi 1 g Ampul 0 - - - - -
16 Ciprofloxacin 500 mg Tablet 265 2,490 2,490 890 1,600 659,850
17 Claneksi sirup Tablet 0 - - - - -
18 Co-Amoksiklav Tablet 0 - - - - -
19 Colsancetine inj Ampul 0 - - - - -
20 Eritromisin 250 mg Tablet 0 - - - - -
21 Eritromisin 500 mg Kaplet 750 - 500 500 60 440 -
22 Eritromisin sirup kering Botol 60 ml 0 74 74 74 - -
23 Gentamisin inj. 40 mg/ml Ampul 0 - - - - -
24 Klindamisin 150 mg Kapsul 715 870 870 498 372 622,050
25 Kloramfenikol 250 mg Kapsul 10 4,370 4,370 560 3,810 43,700
26 Kloramfenikol sirup Botol 60 ml 4700 39 39 - 39 183,300
27 Kotrimoksasol 480 mg Tablet 0 - - - - -
28 Kotrimoksasol suspensi Botol 60 ml 2052 147 147 20 127 301,644
29 Levofloksasin 500 mg Tablet 424 575 575 42 533 243,800
30 Linkomisin kapsul 500 mg Tablet 0 - - - - -
31 Ofloxacin 400 mg Tablet 0 - - - - -
32 Spyramisin 500 mg Tablet 0 - - - - -
33 Tetrasiklin 500 mg Tablet 0 - - - - -
34 Thiamphenikol 500 mg Tablet 825 289 2,000 2,289 309 1,980 238,425
- - -
1 Acyclovir 200 mg tab Tablet - - - - -
2 Acyclovir 400 mg tab Tablet 380 4,800 4,800 95 4,705 1,824,000
3 Acyclovir cream Tube 3080 199 199 52 147 612,920
- - -
1 Griseofulvin 125 mg Tablet 210 390 390 136 254 81,900
2 Ketokonazol 200 mg Tablet 270 930 930 70 860 251,100
3 Nistatin 100.000 IU tab.vag Tablet 560 308 308 108 200 172,480
4 Nistatin 500.000 IU tab Tablet - - - - -
- - -
5 OAT FDC Kategori 1 Paket 359985 9 9 5 4 3,239,865
6 OAT FDC Kategori 2 Paket - - - - -
- - -
1 Etakridina larutan 0,1% Botol 300 ml 0 - - - - -
2 Etanol 70% Botol 100 ml 4000 99 99 12 87 396,000
3 H2O2 3% Botol 1000 ml 24200 8 8 - 8 193,600
4 Klorin Botol 5 L 0 - - - - -
5 Lisol 50% Botol 1000 ml 40997 21 21 1 20 860,937
7 Povidon Iodida larutan 10% Botol 300 ml 18000 12 12 1 11 216,000
8 Softa-Man (biru) Botol 500 ml 22000 48 48 3 45 1,056,000
9 Softaskin (nerah) Botol 500 ml 62491 8 8 1 7 499,928
- - -
4 Pirantel 125 mg Tablet 287 488 488 - 488 140,056
- - -
1 Metronidazol 500 mg Tablet 220 2,000 2,000 650 1,350 -
- - -
1 Besi (II) Sulfat tab Sachet 355 33,860 33,860 4,990 28,870 12,020,300
2 Besi sirup Botol 150 ml 0 - - - - -
3 Sianokobalamin inj (Vit. B 12) Ampul 1035 90 90 - 90 93,150
4 Vitalex kap Kaplet 0 - - - - -
- - -
1 Adona AC-17 10 mg Tablet - - - - -
2 Adona inj 5 ml Ampul - - - - -
3 Fitomenadion 10 mg (Vit. K) - 2 Tablet 710 644 644 84 560 457,240
4 Fitomenadion inj (Vit. K) Ampul 0 - - - - -
5 Magnesium Sulfat 20% Vial 3328 10 10 - 10 33,280
7 Plasminex inj. Ampul - - - - -
8 Plasminex tab Tablet - - - - -
9 Vit. K infant inj Ampul - - - - -
- - -
- - -
(34) SERUM - - -
1 ABU I Polivalen 5 ml Vial 479996 2 2 - 2 959,992
2 ATS 1.500 IU Ampul 130999 10 10 - 10 1,309,990
- - -
1 Metilergometrin 0,125 mg Tablet 210 930 930 - 930 195,300
2 Metilergometrin inj Ampul 2959 - - - - -
3 Oksitosin inj 10 IU/ml-1 ml Ampul 1199 - - - - -
- - -
- - -
1 Betametason krem 0,1% Tube 1340 150 150 - 150 201,000
2 Nisagon krem Tube 4620 136 136 50 86 628,320
3 Hidrokortison krem 2,5% Tube 2475 97 97 11 86 240,075
- - -
- - -
1 Anti Bakteri DOEN s.k Tube 2924 8 8 4 4 23,392
2 Gentamisin salep kulit 0,1% Tube 0 - - - - -
3 Klorfeson krem Tube 8360 37 37 4 33 309,320
4 Oksitetrasiklin HCl sk 3% Tube 2006 39 39 - 39 78,234
- - -
1 Anti Fungi DOEN (As.Benz 60+A Pot 4496 48 48 - 48 215,808
2 Ketokonazol cream 2% Tube 0 - - - - -
3 Miconazol cream 2% Tube 3414 52 52 37 15 177,528
- - -
1 Salep 2-4 30 g Pot 2620 69 69 6 63 180,780
2 Scabicide Tube 11825 17 17 6 11 201,025
- - -
1 P.K serbuk 5 gram Botol 2275 18 18 - 18 40,950
- - -
2 Salisil bedak 2% Kotak 2200 - 50 50 14 36 -
- - -
- - -
1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 14650 15 15 - 15 219,750
- - -
1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 4000 - - - - -
2 Kloramfenikol 0,5% t.m Botol 5 ml 3250 - - - - -
3 Kloramfenikol 1% s.m Tube 5 g 1881 92 92 9 83 173,052
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 2772 62 62 1 61 171,864
5 Polidemisin eye drop Botol 5 ml 0 - - - - -
6 Sulfasetamid Natrium 15% t.m Botol 5 ml 12310 21 21 9 12 258,510
- - -
1 Catalin Opth Botol 15 ml - - - - -
2 Cendolyteers tetes mata Botol 5 ml 19125 89 89 33 56 1,702,125
- - -
1 Kloramfenikol 3% t.t Botol 6050 12 12 5 7 72,600
- - -
1 Fenol gliserol 10% t.t Botol 2590 97 97 17 80 251,230
- - -
- - -
1 Anti Hemoroid supp Suppositoria 3167 30 30 - 30 95,010
5 Hemorogard tab Tablet 1614 290 290 - 290 468,060
- - -
1 Dimenhidrinat 50 mg Tablet 105 1,610 1,610 773 837 169,050
2 Domperidon sirup Botol 60 ml 0 - - - - -
3 Domperidon tab Tablet 85 - 200 200 10 190 -
4 Mediamer B6 Tablet 0 - - - - -
5 Ondansetron 8 mg tab Tablet 351 1,398 1,398 1,038 360 490,698
6 Ondansetron 4 mg/2 ml inj. Ampul 1070 80 80 20 60 85,600
- - -
1 Gemfibrozil kapsul 300 mg Tablet 289 420 420 114 306 121,380
2 Kalsium Atorvastatin Tablet 795 442 510 952 586 366 351,390
4 Simvastatin tab 10 mg Tablet 111 490 600 1,090 930 160 54,390
- - -
1 Piracetam 400 mg Tablet 451 - - - - -
2 Piracetam inj 1 g/5 ml Ampul 6600 6 6 - 6 39,600
- - -
2 Imunos tablet Tablet 7150 100 100 - 100 715,000
- - -
- - -
- - -
5 Clozapin 25 mg tablet 1121 3,915 250 4,165 345 3,820 4,388,715
6 Combipack pcs 0 27 27 - 27 -
7 Carbamazepin tab tablet 230 1,800 1,800 10 1,790 414,000
10 Haloperidol 5 mg tablet 56 - 1,600 1,600 180 1,420 -
13 Clozapin 100 mg tablet 3280 400 400 - 400 1,312,000
15 Haloperidol inj (Lodomer) ampul 5000 72 72 - 72 360,000
16 Lodomer Drop Drop 18700 8 8 - 8 149,600
20 Sikzonoate 25 mg inj inj 59800 - 8 8 - 8 -
21 Risperidon 2 mg tablet 273 2,220 2,900 5,120 470 4,650 606,060
- - -
1 Alvogyl (Septodont) Botol 10 g 635800 - - - - -
2 Caustener rapid Botol 6,5 g 40700 - - - - -
3 Cavit (Tumpatan sementara) Set 143000 7 7 - 7 1,001,000
4 Cresophene (Septodont)/CresotiBotol 7,5 g 242000 3 3 - 3 726,000
5 Elite semen Botol 165000 2 2 - 2 330,000
6 Estelite Composite Set 1491000 4 4 - 4 5,964,000
7 Ectsa gel (Denta merica) Syringe 12 g 176000 6 6 - 6 1,056,000
8 Eugenol Botol 10 ml 18824 6 6 - 6 112,944
9 Forinokresol / Formocresol Botol 10 ml 66000 6 6 - 6 396,000
10 Glass Ionomer Cement (Fuji II L Set 346500 3 3 - 3 1,039,500
11 Glass Ionomer Cement (Fuji IX) Set 572000 - - - - -
12 Kalsium Hidroksida pasta Tube 275000 8 8 - 8 2,200,000
13 Klorfenol Kamfer Mentol (CHKMBotol 20 ml 55000 5 5 - 5 275,000
14 Mumifying pasta/Cresotin Pasta Botol 7 g 198000 6 6 - 6 1,188,000
15 Spongostan Pcs 9240 200 200 - 200 1,848,000
16 Te-econom bond Botol 268000 3 3 - 3 804,000
17 Temporary Stopping Fletcher Botol 528000 3 3 - 3 1,584,000
18 Tooth Cleansing (Occo)/ Poliren Botol 15 ml 176000 6 6 - 6 1,056,000
19 Vinafluor Tablet 770 200 200 - 200 154,000
- - -
1 Bufacomb Iob (Zenith) Tube 15000 51 51 6 45 765,000
2 Gentian violet 1% Botol 10 ml 1314 14 14 3 11 18,396
3 Minosep gargle 0.2% Botol 60 ml 16500 19 19 - 19 313,500
4 Polikresulen (Metakresol) Botol 10 ml - - - - -
- - -
1 Alat suntik 1xpakai 0.05 ml Pcs 0 - - - - -
4 Alat Suntik 1xpakai 3 ml Pcs 113.8 2,100 2,100 200 1,900 238,980
8 Aquadest steril 500 ml Botol 500 ml 10500 10 10 - 10 105,000
16 Folley Cath 12 Pcs 8000 - - - - -
17 Folley Cath 16 Pcs 11000 30 30 - 30 330,000
18 Folley Cath 18 Pcs 11000 - - - - -
24 Handscoon uk. L Pcs 356 500 500 500 - 178,000
25 Handscoon uk. M Pcs 356 11,200 11,200 1,300 9,900 3,987,200
27 Hipavix 5 x 5 m Rol 37440 6 6 3 3 224,640
29 I.V. Catheter 16 Pcs - - - - -
30 I.V. Catheter 18 Pcs 14710 90 90 - 90 1,323,900
31 I.V. Catheter 20 Pcs 8700 170 170 - 170 1,479,000
32 I.V. Catheter 22 Pcs 8700 250 250 10 240 2,175,000
33 I.V. Catheter 24 Pcs 7334 - - - - -
35 Infusion set dewasa Pcs 8400 31 31 18 13 260,400
36 Infusion set dewasa Pcs 7920 200 200 - 200 1,584,000
43 Jarum Suntik no. 25 Pcs 330 1,400 1,400 - 1,400 462,000
52 Kasa pembalut 2 m x 80 cm Rol 9400 60 60 10 50 564,000
53 Kasa pembalut hid 4 x 10 cm Rol 2300 460 460 130 330 1,058,000
55 Kasa Steril 16 x 16 cm Pcs 7900 78 78 - 78 616,200
56 Kertas Puyer Pcs - - - - -
57 Lomatull Pcs 5520 - 100 100 100 - -
58 Masker Box 22000 38 10 48 17 31 836,000
59 Masker O2 anak Pcs 19800 18 18 - 18 356,400
60 Masker O2 dewasa Pcs 19800 15 15 - 15 297,000
61 Mesh 11 Lancip Pcs 583 1,200 1,200 - 1,200 699,600
62 Mesh 11 Lancip Pcs 3000 200 200 - 200 600,000
64 Nasal Canula Anak Pcs 5500 250 250 2 248 1,375,000
65 Nasal Canula Dewasa Pcs 5500 240 240 10 230 1,320,000
74 Silk (benang bedah sutra) dg ja Sachet - - - - -
75 Silk jarum 2/0 Sachet 3055 72 72 - 72 219,960
76 Silk jarum 3/0 Sachet 13800 12 24 36 - 36 165,600
77 Slim Zuiker Pcs 7040 25 25 - 25 176,000
86 Urine Bag Pcs 5808 30 30 - 30 174,240
91 Sterizide Pcs 87120 7 7 - 7 609,840
92 Sterizym botol 712800 - 1 1 - 1
93 Viorex botol 67650 10 10 2 8 676,500
166,133,970
TOTAL
KUNJUNGAN
NOVEMBER 2019
MENGETAHUI
KABUPATEN SIDOARJO

dr.ARIF RAHMAN NURDIANTO NIP. 196605101989032013
NIP. 19870416201101 1 007
NTAAN OBAT PUSKESMAS
PUSKESMAS
GFK

(Rp) (Rp) (Rp) (Rp)
10 11 12 13 14 15
- 1,951,488 350,416 1,601,072 1,000

- 1,972,872 354,420 1,618,452
- 1,306,040 560,835 745,205 10,000
- - - -
19,800 19,800 10,890 8,910 300
- - - - 2,000
230,000 537,280 230,000 307,280 5,000
- - - -
- 225,843 114,282 111,561 200
- - - -
- - - - 4,000
- - - -
- - - -
- - - - 1,000
- 181,440 162,648 18,792
- 69,960 - 69,960
- 250,800 250,800 - 50
- - - -
- 807,985 255,884 552,101 15,000
110,700 173,799 84,132 89,667 300
66,500 66,500 15,694 50,806 1,000
- - - -
- 85,680 9,520 76,160 20
- - - - 50
- 452,400 - 452,400
- - - -
- 366,300 85,800 280,500
- - - -
- - - -
- - - -
- - - -
- 614,495 51,895 562,600 1,000
- - - -
- - - -
- 3,010,000 1,204,000 1,806,000 12
- - - -
- 84,280 - 84,280
- 1,051,650 - 1,051,650
- 886,080 - 886,080
- - - -
- - - -
44,000 69,784 11,616 58,168 500
- - - -
- 37,605 - 37,605
- 1,316,700 - 1,316,700
181,500 181,500 - 181,500
- - - -
- 66,690 - 66,690
- 52,200 - 52,200
- - - -
- 326,860 - 326,860
1,365,000 10,140,000 975,000 9,165,000
960,700 960,700 22,170 938,530
911,400 911,400 52,920 858,480
- 223,740 - 223,740
- 147,960 21,920 126,040
- 188,595 - 188,595
- - - -
- - - -
- 129,800 - 129,800
819,000 1,061,515 48,685 1,012,830
- - - -
- - - -
1,970,600 2,173,338 48,096 2,125,242
- - - -
- - - -
- - - -
- 34,600 - 34,600
33,000 176,000 29,700 146,300
- - - -
- - - -
- 82,681 13,172 69,509
- 107,120 53,040 54,080 1,000
- - - -
- - - -
- - - -
- - - -
- - - -
105,000 396,200 286,300 109,900 7,000
- - - -
- - - -
- 363,225 104,625 258,600 1,000
23,100 37,730 8,085 29,645 1,000
- - - -
- 1,246,665 88,815 1,157,850
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 56,500 - 56,500
- 62,550 1,529 61,021
- 229,320 - 229,320
- - - -
- - - -
- - - -
- 132,896 106,304 26,592 7,000
- 142,610 - 142,610
- - - -
- 422,400 - 422,400
- 536,000 - 536,000 2,000
68,000 68,000 6,936 61,064 2,500
- 193,200 22,890 170,310
- - - -
- 480,000 - 480,000
- - - -
- - - -
- 70,400 70,400 - 60
- 2,813,888 7,423 2,806,465
- - - -
- - - - 1,000
- - - -
- - - -
- - - - 2,000
- - - -
- 2,285,888 281,688 2,004,200
- - - -
- 566,088 328,386 237,702 1,500
- - - -
- 648,560 145,200 503,360 100
- 633,600 327,360 306,240 72
- - - -
- - - -
- - - -
- - - -
- - - -
- 2,626,976 118,272 2,508,704
- - - -
- 254,980 - 254,980
- 512,820 24,420 488,400
- 1,722,160 100,320 1,621,840
- - - -
- - - -
- 787,860 679,860 108,000 6,000
- 491,660 112,840 378,820 100
- - - -
- - - -
- - - -
- 452,400 209,820 242,580 2,400
- - - -
- 334,950 103,950 231,000
- 2,202,240 265,050 1,937,190 1,000
- 112,480 19,536 92,944
- - - -
- - - -
- 176,225 - 176,225
- 527,904 - 527,904
- 515,372 - 515,372
- - - -
- - - -
- - - -
- - - -
- 68,530 8,900 59,630
- 994,068 459,828 534,240 750
- - - -
- - - -
- 155,760 - 155,760
- - - - 3,000
- 152,401 114,879 37,522 500
- 357,500 71,500 286,000 40
- 356,320 146,720 209,600
- - - -
- - - -
- - - -
- 75,000 6,000 69,000
- 162,000 18,000 144,000
- 401,200 35,400 365,800 30
- - - -
- - - -
- - - -
- - - - 1,000
- 277,200 - 277,200
- - - -
275,000 683,375 321,750 361,625 500
- - - -
- - - -
- - - -
- - - -
- 313,830 97,470 216,360 1,200
- 82,125 - 82,125
- - - -
- 56,211 33,702 22,509 600
- - - -
- - - -
- - - -
- - - -
- - - -
- 179,400 179,400 -
- - - -
- - - -
- - - - 500
- - - -
- - - -
- 283,815 - 283,815
- 1,686,843 563,868 1,122,975
- 2,168,640 672,000 1,496,640 1,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 37,800 2,800 35,000
- 556,710 379,260 177,450 6,000
- 1,447,325 136,895 1,310,430
- 250,200 - 250,200
- - - -
- 378,125 99,000 279,125 300
- - - -
- - - -
- 1,316,217 133,155 1,183,062 900
- 418,000 44,000 374,000
- 600,030 197,650 402,380
- - - -
- 259,350 - 259,350
- 151,250 - 151,250
- - - -
- - - - 1,200
- 1,198,660 55,828 1,142,832 600
- - - -
- 541,200 167,772 373,428 3,000
- - - -
- - - -
51,000 208,845 115,566 93,279 6,000
- - - -
- 1,296,505 351,900 944,605
- 907,854 381,800 526,054 8,000
- - - -
- - - -
- 4,695,183 920,583 3,774,600
- - - -
- 885,232 290,240 594,992 120
- - - -
- - - -
- - - -
- 126,238 32,004 94,234
- 267,300 29,700 237,600
- 3,192,562 554,002 2,638,560 2,000
- - - -
- - - -
- 104,280 104,280 - 1,500
- - - -
- 224,100 - 224,100
- - - -
- 659,850 235,850 424,000
- - - -
- - - -
- - - -
- - - -
375,000 375,000 45,000 330,000 300
- - - -
- - - -
- 622,050 356,070 265,980 750
- 43,700 5,600 38,100
- 183,300 - 183,300
- - - -
- 301,644 41,040 260,604
- 243,800 17,808 225,992
- - - -
- - - -
- - - -
- - - -
1,650,000 1,888,425 254,925 1,633,500
- - - -
- - - -
- - - -
- 1,824,000 36,100 1,787,900
- 612,920 160,160 452,760
- - - -
- - - -
- 81,900 28,560 53,340
- 251,100 18,900 232,200
- 172,480 60,480 112,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 3,239,865 1,799,925 1,439,940
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 396,000 48,000 348,000
- 193,600 - 193,600
- - - - 5
- 860,937 40,997 819,940
- - - -
- 216,000 18,000 198,000
- 1,056,000 66,000 990,000
- 499,928 62,491 437,437
- - - -
- - - -
- - - -
- - - -
- - - -
- 140,056 - 140,056
- - - -
- - - -
440,000 440,000 143,000 297,000 3,000
- - - -
- - - -
- - - -
- 12,020,300 1,771,450 10,248,850
- - - -
- 93,150 - 93,150
- - - -
- - - -
- - - -
- - - -
- - - -
- 457,240 59,640 397,600
- - - -
- 33,280 - 33,280
- 37,960 - 37,960
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 959,992 - 959,992
- 1,309,990 - 1,309,990
- - - -
- - - -
- 195,300 - 195,300
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 201,000 - 201,000
- 628,320 231,000 397,320 50
- 240,075 27,225 212,850
- - - -
- - - -
- - - - 10
- - - -
- - - -
- - - -
- - - -
- 23,392 11,696 11,696
- - - - 50
- 309,320 33,440 275,880 50
- 78,234 - 78,234
- - - -
- - - -
- 215,808 - 215,808
- - - -
- 177,528 126,318 51,210 50
- - - -
- - - -
- 180,780 15,720 165,060
- 201,025 70,950 130,075
- - - -
- - - -
- 40,950 - 40,950
- - - -
- - - -
- - - -
110,000 110,000 30,800 79,200 50
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 219,750 - 219,750
- - - -
- - - -
- - - -
- - - - 125
- 173,052 16,929 156,123
- 171,864 2,772 169,092
- - - -
- 258,510 110,790 147,720
- - - -
- - - -
- - - -
- 1,702,125 631,125 1,071,000 50
- - - -
- - - -
- 72,600 30,250 42,350 50
- - - -
- - - -
- 251,230 44,030 207,200
- - - -
- - - -
- - - -
- - - -
- - - -
- 95,010 - 95,010
- - - -
- - - -
- - - -
- 468,060 - 468,060
- - - -
- - - -
- 169,050 81,165 87,885 2,000
- - - -
17,000 17,000 850 16,150 500
- - - -
- 490,698 364,338 126,360
- 85,600 21,400 64,200
- - - -
- - - -
- 121,380 32,946 88,434
405,450 756,840 465,870 290,970 3,000
- - - -
66,600 120,990 103,230 17,760
- - - -
- - - -
- - - - 2,000
- 39,600 - 39,600
- - - -
- - - -
- - - -
- - - -
- 715,000 - 715,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
280,250 4,668,965 386,745 4,282,220
- - - -
- 414,000 2,300 411,700
- - - -
- - - -
89,600 89,600 10,080 79,520
- - - -
- - - -
- 1,312,000 - 1,312,000
- - - -
- 360,000 - 360,000
- 149,600 - 149,600
- - - -
- - - -
- - - -
478,400 478,400 - 478,400
791,700 1,397,760 128,310 1,269,450
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1,001,000 - 1,001,000
- 726,000 - 726,000
- 330,000 - 330,000
- 5,964,000 - 5,964,000
- 1,056,000 - 1,056,000
- 112,944 - 112,944
- 396,000 - 396,000
- 1,039,500 - 1,039,500 5
- - - -
- 2,200,000 - 2,200,000
- 275,000 - 275,000
- 1,188,000 - 1,188,000
- 1,848,000 - 1,848,000
- 804,000 - 804,000
- 1,584,000 - 1,584,000 2
- 1,056,000 - 1,056,000
- 154,000 - 154,000
- - - -
- - - -
- 765,000 90,000 675,000
- 18,396 3,942 14,454 24
- 313,500 - 313,500
- - - -
- - - -
- - - -
- - - -
- - - -
- 14,300 - 14,300
- 238,980 22,760 216,220
- 320,000 - 320,000
- 74,800 - 74,800
- 386,100 34,320 351,780
- 105,000 - 105,000
- - - -
- - - -
- - - - 24
- - - - 24
- - - -
- - - -
- - - -
- - - -
- 330,000 - 330,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 178,000 178,000 -
- 3,987,200 462,800 3,524,400
- - - -
- 224,640 112,320 112,320 20
- - - -
- - - -
- 1,323,900 - 1,323,900
- 1,479,000 - 1,479,000
- 2,175,000 87,000 2,088,000
- - - -
- 633,600 - 633,600
- 260,400 151,200 109,200
- 1,584,000 - 1,584,000
- 77,028 - 77,028
- 33,012 - 33,012
- 22,008 - 22,008
- 11,004 - 11,004
- 33,012 - 33,012
- 33,012 - 33,012
- 462,000 - 462,000
- - - -
- - - -
- - - -
- 370,800 41,200 329,600
- - - -
- - - -
- - - -
- 3,900,000 260,000 3,640,000
- 564,000 94,000 470,000
- 1,058,000 299,000 759,000
- 500,500 5,500 495,000
- 616,200 - 616,200
- - - -
552,000 552,000 552,000 -
220,000 1,056,000 374,000 682,000 20
- 356,400 - 356,400
- 297,000 - 297,000
- 699,600 - 699,600
- 600,000 - 600,000
- - - -
- 1,375,000 11,000 1,364,000
- 1,320,000 55,000 1,265,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 219,960 - 219,960
331,200 496,800 - 496,800
- 176,000 - 176,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 174,240 - 174,240
- - - -
- - - -
- - - -
- - - -
- 609,840 - 609,840
- 676,500 135,300 541,200
13,041,500 179,175,470 26,383,013 152,792,457
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : DESEMBER 2019 ALL
1 2 3 4 5 6

1 Neuroval tab Tablet 1,654 1,654
2 Antalgin 500 mg tab Tablet 8,174 8,174
5 Aspilets 80 mg tab Tablet 90 300 390
6 Diklofenak Kalium 50 mg tab Tablet - -
15 Metoklopramid 10 mg Tablet 174 174
16 Sotatic inj. 5 mg/ml Ampul 15 15
21 Piroksikam 10 mg tab Tablet 382 1,000 1,382
23 Suprafenid supp Suppositoria 32 32
24 Proris supp Suppositoria - -
25 Antalgin inj. Ampul 156 156
(1c) ANTIPIRAI
(2) ANESTESI LOKAL


11 Haldol Decanoat inj 50 mg/ml Ampul 94 94
12 Klobazam 10 mg tab Tablet 1,270 1,270
(4) ANTI PARKINSON

-
(5) ANTI DEPRESI -
(6) ANTI MIGREN

2 Betahistin Mesilat 6 mg Tablet 1,330 1,330
2 Nifedipin 10 mg Tablet 520 520

5 Furosemid 40 mg Tablet 385 300 685
7 H.C.T 25 mg Tablet 7,470 7,470


1 Aminofilin 200 mg Tablet 939 939
6 Deksamethason 0,5 mg Tablet 831 831
10 Methylprednisolon 4 mg Tablet 5,674 1,000 6,674
11 Prednison 5 mg Tablet 898 1,000 1,898
(11) ANTI TUSIF

1 Dexmolex sirup Botol 100 ml - -
(12) EKSPEKTORAN
5 Hustab tab Tablet 519 519
(13) ANTI INFLUENZA

3 Molexflu tab Tablet - -
5 Demacolin tab Tablet - -
6 Molexflu sirup Botol 60 ml 38 38
7 Demacolin syr Botol 60 ml 40 40
8 Quantidex tab Tablet 1,843 1,843
(14) ANTASIDA
10 Ulsidex tab Tablet 314 314

2 D5 + 1/2 NS Botol 500 ml 54 54
3 D5 + 1/4 NS Botol 500 ml 53 53
4 Dehaf Sachet - -
7 L-Bio Sachet - -
16 Zink tab dispersible 20 mg Tablet 400 400
(16) LAKSAN
1 Bisacodyl tab 5 mg Tablet 230 230
(17) ANTI SPASMODIK

4 Scopma tab Tablet - -
5 Scopma plus Tablet 263 263
(18) ANTI HISTAMIN


4 Glukose 5% infus 500 ml Botol 500 ml - -



3 Pritavit kaplet Kaplet 1,254 1,254
6 Caldetri Tablet 203 203
8 Elkana tab Tablet - -
9 Glucosamin tab Tablet 1,466 1,466
21 Sianokobalamin tab Tablet 1,829 5,000 6,829
24 Vit. B kompleks Tablet 6,338 10,000 16,338

12 Cefixime kapsul 200 mg Kapsul - -
21 Eritromisin 500 mg Kaplet 440 440
22 Eritromisin sirup kering Botol 60 ml - -
24 Klindamisin 150 mg Kapsul 372 1,000 1,372
27 Kotrimoksasol 960 mg Tablet - -
34 Thiamphenikol 500 mg Tablet 1,980 1,980
(25) ANTI VIRUS

(26) ANTI FUNGI

2 Ketokonazol 200 mg Tablet 860 860

Masker (TB) kotak - 118 118
3 H2O2 3% Botol 1000 ml 8 8
5 Lisol 50% Botol 1000 ml 20 20
8 Softa-Man (Aseptic Gel) Botol 500 ml 45 45
9 Softaskin (0ne Scrub) Botol 500 ml 7 7
(29) ANTELMENTIK
1 Albendazol 400 mg Tablet -
-
1 Metronidazol 500 mg Tablet 1,350 5,000 6,350
-
-
(32) HEMOSTATIK -
3 Fitomenadion 10 mg (Vit. K) Tablet 560 560
(34) SERUM
2 ATS 1.500 IU Ampul 10 10
(35) OKSITOSIK
1 Metilergometrin 0,125 mg Tablet 930 930



(39) ANTI BAKTERI

3 Klorfeson krem Tube 33 33
-
(40) ANTI FUNGI SALEP -
1 Anti Fungi DOEN (As.Benz 60+As.S Pot 48 48
-
(41) ANTI SCABIES -
1 Salep 2-4 30 g Pot 63 63
2 Scabimite Tube 11 11
-
(42) ANTI SEPTIK -
-
(43) LAIN-LAIN OBAT KULIT -
1 Ikhtamol salep 15 g Pot -
2 Salisil bedak 2% Kotak 36 100 136



2 Kloramfenikol 0,5% t.m Botol 5 ml - 50 50
-
(47) LAIN-LAIN OBAT MATA -
-
1 Kloramfenikol 3% t.t Botol 7 50 57
-
-
(51) ANTI HEMOROID

5 Hemorogard tab Tablet 290 290
(52) ANTI EMETIK

1 Dimenhidrinat 50 mg Tablet 837 837
3 Domperidon tab Tablet 190 200 390

2 Kalsium Atorvastatin Tablet 366 900 1,266
4 Simvastatin tab 10 mg Tablet 160 160
(54) NOOTROPIK
1 Piracetam 400 mg Tablet - 500 500
(55) IMMUNDILATOR
(56) PROGRAM GIZI

1 Biskuit Bungkus
3 Iodina Test Botol
9 Taburia Sachet
(57) PROGRAM P2PL

2 Box Slide pcs
3 OAT FDC paket
6 Obyek Glass pcs
7 Reagen Intech pcs
9 Reagen SD HIV pcs
10 Reagen Vikia pcs
11 Reagen Zn set
12 Sputum Pot pcs

1 Alkohol swab pcs
3 Anuscope pcs
4 Blue Tape pcs
5 Clozapin 25 mg tablet 3,820 3,820
7 Carbamazepin tablet 1,790 1,790
8 Haldol inj. ampul -
9 Haloperidol 1.5 mg tablet -
10 Haloperidol 5 mg tablet 1,420 1,420
11 Handscoon pcs -
12 Holder Prontho pcs -
14 Klorpromazin 25 mg tablet -
17 Mantoux tab tablet -
18 Micropipet pcs -
19 pH Paper pcs -
20 Sikzonoate 25 mg inj ampul 8 8
21 Risperidon 2 mg tablet 4,650 4,650
22 SD Reagen Syphillis pcs -
23 Tabung Vacutainer Merah pcs -
24 Trifluoperazin 5 mg tablet -
25 Triheksifenidil 5 mg tablet -
(59) OBAT GIGI

4 Cresophene (Cresotin Liq) Botol 7,5 g 3 3
17 Temporary Stopping Fletcher (Citod Botol 3 3
18 Tooth Cleansing (Occo) /Poliren No Botol 15 ml 6 6


8 Aquadest steril 1000 ml Botol 1000 ml 10 10
14 Cerplast Pcs - -
24 Handscoon uk. L Pcs - -
56 Lomatull Pcs - -
57 Masker box 31 31
73 Silk (benang bedah sutra) dg jarum Sachet - -
77 Sputum pot Pcs -
84 Umbilical Pcs -
86 White tape Pcs -
91 Sterizym botol 5 Liter 1 1
92 Viorex Botol 500 ml 8 8
TOTAL
KUNJUNGAN
Dec-19
Mengetahui :
KABUPATEN SIDOARJO
NIP. 19870416201101 1 007
RMINTAAN OBAT PUSKESMAS

PUSKESMAS
GFK
7 8 9 10
244 1,410
1,052 7,122
2,907 4,328
- -
130 260
- -
2,672 -
- -
23 18
- -
20 4,980
- -
- -
- -
- 174
- 15
- -
- -
2,362 8,055
64 17
- 1,382
- -
13 19
- -
- 156
- -
40 300
1,265 4,535
1 5
- -
- 98
30 960
- 5
101 560
- -
10 335
15 300
80 220
- -
- 390
- 30
- -
- 5,540
94 -
60 1,210
600 5,240
- 180
230 230
- 15
- 200
490 10,640
-
-
456 12,270
- -
- 200
226 1,104
23 758
20 500
- -
- -
-
1,570 15,000
- -
409 1,884
1,618 1,830
300 385
- -
720 6,750
- -
- -
- -
- 939
- 60
- -
- -
- -
831 -
- 130
- -
- 300
2,321 4,353
1,171 727
293 2,140
- -
- 220
- -
226 4,689
- -
- -
- -
- -
3,929 18,846
- -
519 -
- -
9 95
13 16
- -
- -
- -
772 6,355
- -
- 38
1 39
174 1,669
2,000 -
53 135
- -
- -
- -
630 1,236
- -
- 200
188 1,895
100 214
- 19
- 54
1 52
- -
- -
- -
- -
220 450
603 517
30 50
- -
- 12
- -
146 -
10 30
- 400
- -
20 210
- 24
1 61
- -
- -
- 30
- -
148 115
- -
- -
935 1,469
- 75
1,628 23,672
183 -
- -
5 15
- -
- -
- 2,385
2,067 3,358
6,980 8,610
- 500
2,577 4,113
111 1,143
- 24
- -
23 180
- -
- -
184 1,282
50 290
2,038 4,782
- -
50 50
- -
- -
60 288
- -
396 2,640
- -
- -
1,735 5,094
- -
1,826 9,287
3,403 12,935
3,322 12,878
- -
51 113
- -
- -
- -
10 43
4 36
915 4,605
- -
- -
- -
- -
- 50
- -
660 940
- -
- -
- -
- -
195 245
- -
- -
492 880
210 3,600
- 39
- -
19 108
20 513
- -
- -
- -
- -
220 1,760
- -
530 4,175
41 106
90 164
90 770
- 200
- -
3 1
- -
- 118
- -
12 75
1 7
- -
1 19
- -
- 11
4 41
2 5
-
-
-
- 488
-
-
102 6,248
-
-
-
3,180 25,690
- -
- 90
- -
-
-
- -
- -
90 470
- -
- 10
- 10
- -
- -
- -
2 -
10 -
- 930
- -
- -
-
3 147
42 44
30 56
2 2
- -
6 27
12 27
-
-
- 48
53 29
15 -
-
-
11 52
2 9
-
-
- 18
-
-
-
28 108
-
-
15 -
- -
11 39
32 51
4 57
- -
12 -
-
-
- -
37 19
-
-
9 48
-
-
10 70
-
-
-
41 107
- -
- -
- -
- 290
335 502
22 35
242 148
- -
178 1,064
- 60
174 132
342 924
- -
160 -
- 500
6 -
- -
- -
- 100
- -
- -
- -
- -
105 3,715
- 27
- 1,790
-
-
270 1,150
-
-
40 360
-
- 72
- 8
-
-
-
- 8
150 4,500
-
-
-
-
- -
- -
2 5
- 3
1 1
1 3
- 6
1 5
- 6
2 1
- -
2 6
- 5
5 1
50 150
- 3
1 2
- 6
- 200
11 34
1 10
5 14
- -
- -
- -
- 100
300 1,600
100 100
- 400
15 108
- 10
- -
- -
- -
- -
- -
- -
- -
- -
- 30
- -
- -
- -
- -
- -
- -
- -
900 9,000
- -
9 24
- -
- -
10 80
20 150
20 295
4 60
- 80
23 190
- 84
- 36
- 24
- 12
- 36
- 36
100 1,300
- -
- -
- -
1 15
- -
- -
- -
1 27
- 50
50 280
100 350
5 73
- -
- -
14 17
- 18
- 15
- 1,200
- 200
- -
- 248
- 230
-
-
-
-
-
-
-
-
- -
36 36
24 12
- 25
-
-
-
-
-
-
-
-
1 29
-
-
-
-
- 7
- 1
- 8
TOTAL
KUNJUNGAN

NIP. 196605101989032013
PUSKESMAS : TROSOBO
KECAMATAN : TAMAN
PELAPORAN PERIODE : DESEMBER 2019 APBD

(Rp)
1 2 3 4 5 6 7 8 9

1 Neuroval tab Tablet 968 1,654 1,654 244 1,410 1,601,072
2 Antalgin 500 mg tab Tablet 198 8,174 8,174 1,052 7,122 1,618,452
3 Asam Mefenamat 500 mg tab Tablet 103 7,235 7,235 2,907 4,328 745,205
4 Asetosal 100 mg tab Tablet 0 - - - - -
5 Miniaspi 80 mg Tablet 99 90 300 390 130 260 8,910
6 Diklofenak Kalium 50 mg tab Tablet 706 - - - - -
7 Diklofenak Na. 50 mg tab Tablet 115 2,672 2,672 2,672 - 307,280
8 Eprinoc tab Tablet 1650 - - - - -
9 Ibuprofen 100 mg/5 ml sirup Botol 60 ml 2721 41 41 23 18 111,561
11 Ibuprofen 400 mg tab Tablet 363 - 5,000 5,000 20 4,980 -
12 Meloxicam 15 mg supp Suppositoria 0 - - - - -
13 Meloxicam 15 mg tab Tablet 0 - - - - -
14 Meloxicam 7,5 mg tab Tablet 0 - - - - -
15 Metoklopramid 10 mg Tablet 108 174 174 - 174 18,792
16 Sotatic inj. 5 mg/ml Ampul 4664 15 15 - 15 69,960
17 Molakrim krim Tube 30 g 13200 - - - - -
18 Nonflamin tab Tablet 0 - - - - -
19 Parasetamol 500 mg tab Tablet 53 10,417 10,417 2,362 8,055 552,101
20 Parasetamol sirup 120 mg/5 mlBotol 60 ml 1107 81 81 64 17 89,667
21 Piroksikam 10 mg tab Tablet 133 382 1,000 1,382 - 1,382 50,806
22 Piroksikam 20 mg tab Tablet 0 - - - - -
23 Suprafenid supp Suppositoria 2380 32 32 13 19 76,160
24 Proris supp Suppositoria 5150 - - - - -
25 Antalgin inj. Ampul 2900 156 156 - 156 452,400
26 Tramadol injeksi 50 mg/ml Ampul 0 - - - - -
27 Tramadol kap 50 mg Tablet 825 340 340 40 300 280,500
- - -
Alopurinol 100 mg Tablet 97 5,800 5,800 1,265 4,535 562,600
- - -
1 Etil Klorida semprot Botol 100 ml 301000 6 6 1 5 1,806,000
2 Ketamin / Ketalar inj. 100 mg/mVial 10 ml 0 - - - - -
3 Lidokain inj 2% (HCl) / 2 ml Ampul 860 98 98 - 98 84,280
4 Lidokain komb inj / 2 ml Ampul 1845 570 570 - 570 1,051,650
5 Xylocain spray Botol 50 ml 177216 5 5 - 5 886,080
- - -
(3) AN.EPILEPSI, AN.KONV, AN.ASIETAS, SEDATIV, HIPNOTIK, AN.PSIK - - -
1 Alprazolam 0,5 mg Tablet 88 661 661 101 560 58,168
2 Diazepam 2 mg Tablet 45 - - - - -
3 Diazepam 5 mg Tablet 109 345 345 10 335 37,605
4 Diazepam inj. 5 mg/ 2 ml Ampul 4180 315 315 15 300 1,316,700
5 Fenitoin kapsul 100 mg Kapsu; 605 300 300 80 220 181,500
6 Fenobarbital 100 mg Tablet 0 - - - - -
7 Fenobarbital 30 mg Tablet 171 390 390 - 390 66,690
8 Fenobarbital inj. 50 mg/ml Ampul 1740 30 30 - 30 52,200
9 Haloperidol 0.5 mg tab Tablet 0 - - - - -
10 Haloperidol 1,5 mg Tablet 59 5,540 5,540 - 5,540 326,860
12 Haloperidol inj 50 mg/ml (Daca Ampul 97500 94 94 94 - 9,165,000
13 Klobazam 10 mg tab Tablet 739 1,270 1,270 60 1,210 938,530
14 Klorpromazin HCl 100 mg tab Tablet 147 5,840 5,840 600 5,240 858,480
15 Klorpromazin HCl inj 25 mg/ml Ampul 1243 180 180 - 180 223,740
16 Trifluoperazine 5 mg tab Tablet 274 460 460 230 230 126,040
17 Stesolid rectal 5 mg Tube 12573 15 15 - 15 188,595
- - -
1 Levopar tab Tablet 649 200 200 - 200 129,800
2 Triheksifenidil 2 mg Tablet 91 11,130 11,130 490 10,640 1,012,830
- - -
1 Amitriptilin HCl 25 mg Tablet 167 12,726 12,726 456 12,270 2,125,242
- - -
1 Anti Migren (Komb. Ergot+Kafei Tablet 173 200 200 - 200 34,600
2 Betahistin Mesilat 6 mg Tablet 110 1,330 1,330 226 1,104 146,300
- - -
1 Isosorbit Dinitrat 5 mg - 2018 Tablet 89 781 781 23 758 69,509
3 Nifedipin 10 mg Tablet 104 520 520 20 500 54,080
4 Nifedipin GITS (Adalat Oros) 3 Tablet 0 - - - - -
6 Propanolol 40 mg Tablet 0 - - -
- - -
2 Amlodipin 10 mg Tablet 0 - - - - -
3 Bisoprolol Fumarat 5 mg Tablet 0 - - - - -
4 Captopril 25 mg Tablet 75 3,448 3,448 1,618 1,830 258,600
5 Furosemid 40 mg Tablet 77 385 385 - 385 29,645
6 Furosemid inj. Ampul 0 - - - - -
7 H.C.T 25 mg Tablet 155 7,470 7,470 720 6,750 1,157,850
10 Valsartan tab 160 mg / Diovan Tablet - - - - -
- - -
- - -
1 Aminofilin 200 mg Tablet 113 500 500 - 500 56,500
Aminofillin 200 mg (Decafil) Tablet 139 439 439 - 439 61,021
2 Aminofilin inj 24 mg Ampul 3822 60 60 - 60 229,320
3 Bisolvon solution 10 mg/5 ml Botol 50 ml 0 - - - - -
4 Bisolvon injeksi 2 mg/ml Ampul 0 - - - - -
5 Bricasma inj 0,5 mg/ml Ampul 0 - - - - -
6 Deksamethason 0,5 mg Tablet 32 831 831 831 - 26,592
7 Deksamethason inj 5 mg/ml Ampul 1097 130 130 - 130 142,610
8 Efedrin HCl 25 mg Tablet 0 - - - - -
9 Epinefrin inj. Ampul 1408 300 300 - 300 422,400
10 Methylprednisolon 4 mg Tablet 134 4,000 1,000 5,000 1,000 4,000 536,000
11 Prednison 5 mg Tablet 68 898 898 171 727 61,064
12 Salbutamol 4 mg Tablet 70 2,433 2,433 293 2,140 170,310
14 Salbutamol sirup (Astharol) Botol 60 ml 0 - - - - -
15 Ventolin Nebulizer Ampul 4000 120 120 - 120 480,000
- - -
1 Dexmolex sirup Botol 100 ml 8800 - - - - -
2 Kodein 10 mg Tablet 571 4,915 4,915 226 4,689 2,806,465
4 Tuzalos tab Tablet - - - - -
- - -
1 Ambroxol HCl 30 mg Tablet 0 - - - - -
2 Ambroxol syrup Botol 60 ml 0 - - - - -
3 Gliseril Guayakolat 100 mg Tablet 88 22,775 22,775 3,929 18,846 2,004,200
4 Hustab sirup Botol 60 ml 0 - - - - -
5 Hustab tab Tablet 458 519 519 519 - 237,702
6 OBH Plus Anak Botol 60 ml 0 - - - - -
7 OBH Plus Dewasa Botol 60 ml 4840 104 104 9 95 503,360
8 Sanadryl Expectorant Botol 60 ml 10560 29 29 13 16 306,240
- - -
1 Alpara tab Tablet 0 - - - - -
2 Alpara sirup Botol 60 ml 0 - - - - -
3 Molexflu tab Tablet 396 - - - - -
4 Colpica tab Tablet 352 7,127 7,127 772 6,355 2,508,704
5 Demacolin tab Tablet 170 - - - - -
6 Molexflu sirup Botol 60 ml 6710 38 38 - 38 254,980
7 Demacolin syr Botol 60 ml 12210 40 40 1 39 488,400
8 Quantidex tab Tablet 880 1,843 1,843 174 1,669 1,621,840
- - -
(14) ANTASIDA - - -
1 Antasida DOEN I tab Tablet 54 2,000 2,000 2,000 - 108,000
2 Antasida DOEN II sirup Botol 60 ml 2015 188 188 53 135 378,820
3 Cimetidin 200 mg Tablet 220 - - - - -
6 Omeprazole kap 20 mg Tablet 130 1,866 1,866 630 1,236 242,580
7 Ranitidin tab 150 mg Tablet 105 - - - - -
8 Ranitidin inj 25 mg/2 ml Ampul 1155 200 200 - 200 231,000
9 Sanmag tab Tablet 930 2,083 2,083 188 1,895 1,937,190
10 Ulsidex tab Tablet 296 314 314 100 214 92,944
- - -
1 Asering infus Botol 500 ml 9275 19 19 - 19 176,225
2 D5 + 1/2 NS Botol 500 ml 9776 54 54 - 54 527,904
3 D5 + 1/4 NS Botol 500 ml 9724 53 53 1 52 515,372
4 Dehaf Sachet 0 - - - - -
5 KAEN 3A Botol 500 ml 0 - - - - -
6 KAEN 3B Botol 500 ml 0 - - - - -
7 L-Bio Sachet 0 - - - - -
8 Loperamide Tablet 89 670 670 220 450 59,630
9 Molagit tab Tablet 477 1,120 1,120 603 517 534,240
10 Na. Klorida 0,9% infus Botol 500 ml 0 - - - - -
11 Na. Klorida 0,9% piggy bag Botol 100 ml 0 - - - - -
12 Neo Kaolana suspensi Botol 60 ml 12980 12 12 - 12 155,760
13 New Diaform Tablet - - - - -
14 Oralit 200 ml Sachet 257 146 146 146 - 37,522
15 Ringer Laktat infus Botol 500 ml 7150 40 40 10 30 286,000
16 Zink tab dispersible 20 mg Tablet 524 400 400 - 400 209,600
17 Zink sirup 20 mg/5 ml Botol 60 ml 0 - - - - -
- - -
(16) LAKSAN - - -
1 Bisacodyl tab 5 mg Tablet 300 230 230 20 210 69,000
2 Dulcolax supp 5 mg Suppositoria 6,000 24 24 - 24 144,000
- - -
1 Atropin Sulfat inj 0,25 mg/ml Ampul - - - - - -
2 Braxidin tab Tablet - - - - - -
3 Hyosin Bromida inj Ampul 9,240 30 30 - 30 277,200
4 Scopma tab Tablet 1,210 - - - - -
5 Scopma plus Tablet 1,375 263 263 148 115 361,625
6 Ekstrak Belladona 10 mg Tablet - - - - -
- - -
1 Ceterizine sirup Botol 60 ml - - - - - -
2 Cetirizine tab 10 mg Tablet 90 2,404 2,404 935 1,469 216,360
3 Difenhidramin inj Ampul 1,095 75 75 - 75 82,125
4 Klorfeniramin Maleat 4 mg Tablet - - - - - -
5 Loratadine 10 mg Tablet 123 183 183 183 - 22,509
- - -
1 Aminofluid Softbag 500 ml - - - - - -
3 Glukose 10% infus 500 ml - 20Botol 500 ml - 20 20 5 15 -
4 Glukose 40% inj 25 ml Ampul 1,001 - - - - -
5 Glukose 5% infus 500 ml Botol 500 ml 6900 - - - - -
- - -
- - -
1 Glibenklamid 5 mg Tablet 119 2,385 2,385 - 2,385 283,815
2 Glimipiride 2 mg Tablet 207 5,425 5,425 2,067 3,358 1,122,975
3 Metformin tab 500 mg Tablet 96 15,590 15,590 6,980 8,610 1,496,640
- - -
- - -
1 Anemolat tab / Asam folat tab Tablet 70 500 500 - 500 35,000
2 Asam Askorbat 50 mg Tablet 105 1,690 5,000 6,690 2,577 4,113 177,450
3 Pritavit kaplet Kaplet 1045 1,254 1,254 111 1,143 1,310,430
4 Calcii Gluconas inj Ampul 10425 24 24 - 24 250,200
5 Caldece tab effervecent Tablet 0 - - - - -
6 Caldetri Tablet 1375 203 203 23 180 279,125
7 Elkana sirup Botol 60 ml 0 - - - - -
8 Elkana tab Tablet 811 - - - - -
9 Glucosamin tab Tablet 807 1,466 1,466 184 1,282 1,183,062
10 Hepagard tab Tablet 1100 340 340 50 290 374,000
11 Kalsium Laktat 500 mg Tablet 59 6,820 6,820 2,038 4,782 402,380
12 Neurosanbe 5000 Tablet 0 - - - - -
13 Neurosanbe inj Ampul 5187 50 50 50 - 259,350
14 Mersibion inj Ampul 3025 50 50 - 50 151,250
15 Neurosanbe Plus Tablet 0 - - - - -
16 Neurosanbe tab Tablet 0 - - - - -
17 Osteotin tab Tablet 3284 348 348 60 288 1,142,832
18 Pharmaton Vit Tablet 0 - - - - -
19 Piridoksin 10 mg (Vit. B6) Tablet 123 3,036 3,036 396 2,640 373,428
20 Procurma Plus sirup Botol 60 ml 0 - - - - -
21 Santa E 200 mg tablet hisap Tablet 0 - - - - -
22 Sianokobalamin tab Tablet 51 1,829 5,000 6,829 1,735 5,094 93,279
23 Tiamin HCl (Vit. B1) inj 100 mg Ampul 0 - - - - -
24 Tiamin HCl 50 mg (Vit. B1) tab Tablet 85 11,113 11,113 1,826 9,287 944,605
25 Vit. B kompleks Tablet 83 6,338 10,000 16,338 3,403 12,935 526,054
- - -
1 Amoksisilin 500 mg Tablet 233 16,200 16,200 3,322 12,878 3,774,600
2 Amoksisilin inj. Ampul 0 - - - - -
3 Amoksisilin sirup kering Botol 60 ml 3628 164 164 51 113 594,992
4 Ampisilin 500 mg Kaplet 0 - - - - -
5 Ampisilin inj. Ampul 0 - - - - -
6 Ampisilin sirup kering Botol 60 ml 0 - - - - -
7 Azitomisin 500 mg kaplet Kaplet 1778 53 53 10 43 94,234
8 Dionicol sirup kering Botol 60 ml 5940 40 40 4 36 237,600
9 Cefadroxil 500 mg Kaplet 478 5,520 5,520 915 4,605 2,638,560
10 Cefadroxil sirup kering Botol 60 ml 0 - - - - -
11 Cefalexin 500 mg Tablet 0 - - - - -
12 Cefixime kapsul 200 mg Kapsul 2370 - - - - -
13 Cefixime sirup Botol 30 ml 0 - - - - -
14 Cefotaxime injeksi 1 g Ampul 4482 50 50 - 50 224,100
15 Ceftriaxone injeksi 1 g Ampul 0 - - - - -
16 Ciprofloxacin 500 mg Tablet 265 1,600 1,600 660 940 424,000
17 Claneksi sirup Tablet 0 - - - - -
18 Co-Amoksiklav Tablet 0 - - - - -
19 Colsancetine inj Ampul 0 - - - - -
20 Eritromisin 250 mg Tablet 0 - - - - -
21 Eritromisin 500 mg Kaplet 750 440 440 195 245 330,000
22 Eritromisin sirup kering Botol 60 ml 0 - - - - -
23 Gentamisin inj. 40 mg/ml Ampul 0 - - - - -
24 Klindamisin 150 mg Kapsul 715 372 1,000 1,372 492 880 265,980
25 Kloramfenikol 250 mg Kapsul 10 3,810 3,810 210 3,600 38,100
26 Kloramfenikol sirup Botol 60 ml 4700 39 39 - 39 183,300
27 Kotrimoksasol 480 mg Tablet 0 - - - - -
28 Kotrimoksasol suspensi Botol 60 ml 2052 127 127 19 108 260,604
29 Levofloksasin 500 mg Tablet 424 533 533 20 513 225,992
30 Linkomisin kapsul 500 mg Tablet 0 - - - - -
31 Ofloxacin 400 mg Tablet 0 - - - - -
32 Spyramisin 500 mg Tablet 0 - - - - -
33 Tetrasiklin 500 mg Tablet 0 - - - - -
34 Thiamphenikol 500 mg Tablet 825 1,980 1,980 220 1,760 1,633,500
- - -
1 Acyclovir 200 mg tab Tablet - - - - -
2 Acyclovir 400 mg tab Tablet 380 4,705 4,705 530 4,175 1,787,900
3 Acyclovir cream Tube 3080 147 147 41 106 452,760
- - -
1 Griseofulvin 125 mg Tablet 210 254 254 90 164 53,340
2 Ketokonazol 200 mg Tablet 270 860 860 90 770 232,200
3 Nistatin 100.000 IU tab.vag Tablet 560 200 200 - 200 112,000
4 Nistatin 500.000 IU tab Tablet - - - - -
- - -
5 OAT FDC Kategori 1 Paket 359985 4 4 3 1 1,439,940
6 OAT FDC Kategori 2 Paket - - - - -
13 Masker (TB) kotak 17014 - 118 118 - 118 -
1 Etakridina larutan 0,1% Botol 300 ml 0 - - - - -
2 Etanol 70% Botol 100 ml 4000 87 87 12 75 348,000
3 H2O2 3% Botol 1000 ml 24200 8 8 1 7 193,600
4 Klorin Botol 5 L 0 - - - - -
5 Lisol 50% Botol 1000 ml 40997 20 20 1 19 819,940
7 Povidon Iodida larutan 10% Botol 300 ml 18000 11 11 - 11 198,000
8 Softa-Man (biru) Botol 500 ml 22000 45 45 4 41 990,000
9 Softaskin (nerah) Botol 500 ml 62491 7 7 2 5 437,437
- - -
4 Pirantel 125 mg Tablet 287 488 488 - 488 140,056
- - -
1 Metronidazol 500 mg Tablet 220 1,350 5,000 6,350 102 6,248 297,000
- - -
1 Besi (II) Sulfat tab Sachet 355 28,870 28,870 3,180 25,690 10,248,850
2 Besi sirup Botol 150 ml 0 - - - - -
3 Sianokobalamin inj (Vit. B 12) Ampul 1035 90 90 - 90 93,150
4 Vitalex kap Kaplet 0 - - - - -
- - -
1 Adona AC-17 10 mg Tablet - - - - -
2 Adona inj 5 ml Ampul - - - - -
3 Fitomenadion 10 mg (Vit. K) - Tablet 710 560 560 90 470 397,600
4 Fitomenadion inj (Vit. K) Ampul 0 - - - - -
7 Plasminex inj. Ampul - - - - -
8 Plasminex tab Tablet - - - - -
9 Vit. K infant inj Ampul - - - - -
- - -
- - -
(34) SERUM - - -
1 ABU I Polivalen 5 ml Vial 479996 2 2 2 - 959,992
2 ATS 1.500 IU Ampul 130999 10 10 10 - 1,309,990
- - -
1 Metilergometrin 0,125 mg Tablet 210 930 930 - 930 195,300
2 Metilergometrin inj Ampul 2959 - - - - -
3 Oksitosin inj 10 IU/ml-1 ml Ampul 1199 - - - - -
- - -
- - -
1 Betametason krem 0,1% Tube 1340 150 150 3 147 201,000
2 Nisagon krem Tube 4620 86 86 42 44 397,320
3 Hidrokortison krem 2,5% Tube 2475 86 86 30 56 212,850
- - -
- - -
1 Anti Bakteri DOEN s.k Tube 2924 4 4 2 2 11,696
2 Gentamisin salep kulit 0,1% Tube 0 - - - - -
3 Klorfeson krem Tube 8360 33 33 6 27 275,880
4 Oksitetrasiklin HCl sk 3% Tube 2006 39 39 12 27 78,234
- - -
1 Anti Fungi DOEN (As.Benz 60+ Pot 4496 48 48 - 48 215,808
2 Ketokonazol cream 2% Tube 0 - - - - -
3 Miconazol cream 2% Tube 3414 15 15 15 - 51,210
- - -
1 Salep 2-4 30 g Pot 2620 63 63 11 52 165,060
2 Scabicide Tube 11825 11 11 2 9 130,075
- - -
1 P.K serbuk 5 gram Botol 2275 18 18 - 18 40,950
- - -
2 Salisil bedak 2% Kotak 2420 36 100 136 28 108 87,120
- - -
- - -
1 Tetrakain HCl 0,5% t.m - 5 ml Botol 5 ml 14650 15 15 15 - 219,750
- - -
1 Gentamisin Sulfat 0,3% t.m Botol 5 ml 4000 - - - - -
2 Kloramfenikol 0,5% t.m Botol 5 ml 8250 - 50 50 11 39 -
3 Kloramfenikol 1% s.m Tube 5 g 1881 83 83 32 51 156,123
4 Oksitetrasiklin HCl 1% s.m Tube 5 g 2772 61 61 4 57 169,092
5 Polidemisin eye drop Botol 5 ml 0 - - - - -
6 Sulfasetamid Natrium 15% t.mBotol 5 ml 12310 12 12 12 - 147,720
- - -
1 Catalin Opth Botol 15 ml - - - - -
2 Cendolyteers tetes mata Botol 5 ml 19125 56 56 37 19 1,071,000
- - -
1 Kloramfenikol 3% t.t Botol 7040 7 50 57 9 48 49,280
- - -
1 Fenol gliserol 10% t.t Botol 2590 80 80 10 70 207,200
- - -
- - -
1 Anti Hemoroid supp Suppositoria 3167 30 30 - 30 95,010
5 Hemorogard tab Tablet 1614 290 290 - 290 468,060
- - -
1 Dimenhidrinat 50 mg Tablet 105 837 837 335 502 87,885
2 Domperidon sirup Botol 60 ml 0 - - - - -
3 Domperidon tab Tablet 85 190 190 42 148 16,150
4 Mediamer B6 Tablet 0 - - - - -
5 Ondansetron 8 mg tab Tablet 351 360 360 - 360 126,360
6 Ondansetron 4 mg/2 ml inj. Ampul 1070 60 60 - 60 64,200
- - -
1 Gemfibrozil kapsul 300 mg Tablet 289 306 306 174 132 88,434
2 Kalsium Atorvastatin Tablet 795 366 900 1,266 342 924 290,970
4 Simvastatin tab 10 mg Tablet 111 160 160 160 - 17,760
- - -
1 Piracetam 400 mg Tablet 440 - 500 500 - 500 -
2 Piracetam inj 1 g/5 ml Ampul 6600 6 6 6 - 39,600
- - -
2 Imunos tablet Tablet 7150 100 100 - 100 715,000
- - -
- - -
- - -
5 Clozapin 25 mg tablet 1121 3,820 3,820 105 3,715 4,282,220
6 Combipack pcs 0 27 27 - 27 -
7 Carbamazepin tab tablet 230 1,790 1,790 - 1,790 411,700
10 Haloperidol 5 mg tablet 56 1,420 1,420 270 1,150 79,520
13 Clozapin 100 mg tablet 3280 400 400 40 360 1,312,000
15 Haloperidol inj (Lodomer) ampul 5000 72 72 - 72 360,000
16 Lodomer Drop Drop 18700 8 8 - 8 149,600
20 Sikzonoate 25 mg inj ampul 59800 8 8 - 8 478,400
21 Risperidon 2 mg tablet 273 4,650 4,650 150 4,500 1,269,450
- - -
1 Alvogyl (Septodont) Botol 10 g 635800 - - - - -
2 Caustener rapid Botol 6,5 g 40700 - - - - -
3 Cavit (Tumpatan sementara) Set 143000 7 7 2 5 1,001,000
4 Cresophene (Septodont)/Cresot
Botol 7,5 g 242000 3 3 - 3 726,000
5 Elite semen Botol 165000 2 2 1 1 330,000
6 Estelite Composite Set 1491000 4 4 1 3 5,964,000
7 Ectsa gel (Denta merica) Syringe 12 g 176000 6 6 - 6 1,056,000
8 Eugenol Botol 10 ml 18824 6 6 1 5 112,944
9 Forinokresol / Formocresol Botol 10 ml 66000 6 6 - 6 396,000
10 Glass Ionomer Cement (Fuji II Set 346500 3 3 2 1 1,039,500
11 Glass Ionomer Cement (Fuji IX) Set 572000 - - - - -
12 Kalsium Hidroksida pasta Tube 275000 8 8 2 6 2,200,000
13 Klorfenol Kamfer Mentol (CHKM Botol 20 ml 55000 5 5 - 5 275,000
14 Mumifying pasta/Cresotin PastaBotol 7 g 198000 6 6 5 1 1,188,000
15 Spongostan Pcs 9240 200 200 50 150 1,848,000
16 Te-econom bond Botol 268000 3 3 - 3 804,000
17 Temporary Stopping Fletcher Botol 528000 3 3 1 2 1,584,000
18 Tooth Cleansing (Occo)/ Poliren
Botol 15 ml 176000 6 6 - 6 1,056,000
19 Vinafluor Tablet 770 200 200 - 200 154,000
- - -
1 Bufacomb Iob (Zenith) Tube 15000 45 45 11 34 675,000
2 Gentian violet 1% Botol 10 ml 1314 11 11 1 10 14,454
3 Minosep gargle 0.2% Botol 60 ml 16500 19 19 5 14 313,500
4 Polikresulen (Metakresol) Botol 10 ml - - - - -
- - -
4 Alat Suntik 1xpakai 3 ml Pcs 113.8 1,900 1,900 300 1,600 216,220
5 Alat suntik 1xpakai 5 ml Pcs 1600 200 200 100 100 320,000
8 Aquadest steril 500 ml Botol 500 ml 10500 10 10 - 10 105,000
16 Folley Cath 12 Pcs 8000 - - - - -
17 Folley Cath 16 Pcs 11000 30 30 - 30 330,000
18 Folley Cath 18 Pcs 11000 - - - - -
24 Handscoon uk. L Pcs 356 - - - - -
25 Handscoon uk. M Pcs 356 9,900 9,900 900 9,000 3,524,400
27 Hipavix 5 x 5 m Rol 37440 3 30 33 9 24 112,320
29 I.V. Catheter 16 Pcs - - - - -
30 I.V. Catheter 18 Pcs 14710 90 90 10 80 1,323,900
31 I.V. Catheter 20 Pcs 8700 170 170 20 150 1,479,000
32 I.V. Catheter 22 Pcs 8700 240 240 - 240 2,088,000
33 I.V. Catheter 24 Pcs 7334 - - - - -
35 Infusion set dewasa Pcs 8400 13 13 13 - 109,200
36 Infusion set dewasa Pcs 7920 200 200 10 190 1,584,000
43 Jarum Suntik no. 25 Pcs 330 1,400 1,400 100 1,300 462,000
52 Kasa pembalut 2 m x 80 cm Rol 9400 50 50 - 50 470,000
55 Kasa Steril 16 x 16 cm Pcs 7900 78 78 5 73 616,200
56 Kertas Puyer Pcs - - - - -
57 Lomatull Pcs 5520 - - - - -
58 Masker Box 22000 31 31 14 17 682,000
59 Masker O2 anak Pcs 19800 18 18 - 18 356,400
60 Masker O2 dewasa Pcs 19800 15 15 - 15 297,000
61 Mesh 11 Lancip Pcs 583 1,200 1,200 - 1,200 699,600
62 Mesh 11 Lancip Pcs 3000 200 200 - 200 600,000
64 Nasal Canula Anak Pcs 5500 248 248 - 248 1,364,000
65 Nasal Canula Dewasa Pcs 5500 230 230 - 230 1,265,000
74 Silk (benang bedah sutra) dg j Sachet - - - - -
75 Silk jarum 2/0 Sachet 3055 72 72 36 36 219,960
76 Silk jarum 3/0 Sachet 13800 36 36 24 12 496,800
77 Slim Zuiker Pcs 7040 25 25 - 25 176,000
86 Urine Bag Pcs 5808 30 30 1 29 174,240
91 Sterizide Pcs 87120 7 7 - 7 609,840
92 Sterizym botol 712800 1 1 - 1 712,800
93 Viorex botol 67650 8 8 - 8 541,200
153,520,107
TOTAL
KUNJUNGAN
DESEMBER 2019
MENGETAHUI
KABUPATEN SIDOARJO
dr.ARIF RAHMAN NURDIANTO NUR INDAH AL RISMAWATI

NIP. 19870416201101 1 007 NIP. 196605101989032013
RMINTAAN OBAT PUSKESMAS
PUSKESMAS
GFK

(Rp) (Rp) (Rp) (Rp)
10 11 12 13 14 15
- 1,601,072 236,192 1,364,880

- 1,618,452 208,296 1,410,156
- 745,205 299,421 445,784
- - - -
29,700 38,610 12,870 25,740
- - - -
- 307,280 307,280 -
- - - -
- 111,561 62,583 48,978
- - - -
1,815,000 1,815,000 7,260 1,807,740
- - - -
- - - -
- - - -
- 18,792 - 18,792
- 69,960 - 69,960
- - - -
- - - -
- 552,101 125,186 426,915
- 89,667 70,848 18,819
133,000 183,806 - 183,806
- - - -
- 76,160 30,940 45,220
- - - -
- 452,400 - 452,400
- - - -
- 280,500 33,000 247,500
- - - -
- - - -
- - - -
- - - -
- 562,600 122,705 439,895
- - - -
- - - -
- 1,806,000 301,000 1,505,000
- - - -
- 84,280 - 84,280
- 1,051,650 - 1,051,650
- 886,080 - 886,080
- - - -
- - - -
- 58,168 8,888 49,280
- - - -
- 37,605 1,090 36,515
- 1,316,700 62,700 1,254,000
- 181,500 48,400 133,100
- - - -
- 66,690 - 66,690
- 52,200 - 52,200
- - - -
- 326,860 - 326,860
- 9,165,000 9,165,000 -
- 938,530 44,340 894,190
- 858,480 88,200 770,280
- 223,740 - 223,740
- 126,040 63,020 63,020
- 188,595 - 188,595
- - - -
- - - -
- 129,800 - 129,800
- 1,012,830 44,590 968,240
- - - -
- - - -
- 2,125,242 76,152 2,049,090
- - - -
- - - -
- - - -
- 34,600 - 34,600
- 146,300 24,860 121,440
- - - -
- - - -
- 69,509 2,047 67,462
- 54,080 2,080 52,000
- - - -
- - - -
- - - -
- - - -
- - - -
1,050,000 1,159,900 109,900 1,050,000
- - - -
- - - -
- 258,600 121,350 137,250
- 29,645 - 29,645
- - - -
- 1,157,850 111,600 1,046,250
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 56,500 - 56,500
- 61,021 - 61,021
- 229,320 - 229,320
- - - -
- - - -
- - - -
- 26,592 26,592 -
- 142,610 - 142,610
- - - -
- 422,400 - 422,400
134,000 670,000 134,000 536,000
- 61,064 11,628 49,436
- 170,310 20,510 149,800
- - - -
- 480,000 - 480,000
- - - -
- - - -
- - - -
- 2,806,465 129,046 2,677,419
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 2,004,200 345,752 1,658,448
- - - -
- 237,702 237,702 -
- - - -
- 503,360 43,560 459,800
- 306,240 137,280 168,960
- - - -
- - - -
- - - -
- - - -
- - - -
- 2,508,704 271,744 2,236,960
- - - -
- 254,980 - 254,980
- 488,400 12,210 476,190
- 1,621,840 153,120 1,468,720
- - - -
- - - -
- 108,000 108,000 -
- 378,820 106,795 272,025
- - - -
- - - -
- - - -
- 242,580 81,900 160,680
- - - -
- 231,000 - 231,000
- 1,937,190 174,840 1,762,350
- 92,944 29,600 63,344
- - - -
- - - -
- 176,225 - 176,225
- 527,904 - 527,904
- 515,372 9,724 505,648
- - - -
- - - -
- - - -
- - - -
- 59,630 19,580 40,050
- 534,240 287,631 246,609
- - - -
- - - -
- 155,760 - 155,760
- - - -
- 37,522 37,522 -
- 286,000 71,500 214,500
- 209,600 - 209,600
- - - -
- - - -
- - - -
- 69,000 6,000 63,000
- 144,000 - 144,000
- 365,800 5,900 359,900
- - - -
- - - -
- - - -
- - - -
- 277,200 - 277,200
- - - -
- 361,625 203,500 158,125
- - - -
- - - -
- - - -
- - - -
- 216,360 84,150 132,210
- 82,125 - 82,125
- - - -
- 22,509 22,509 -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 283,815 - 283,815
- 1,122,975 427,869 695,106
- 1,496,640 670,080 826,560
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 35,000 - 35,000
525,000 702,450 270,585 431,865
- 1,310,430 115,995 1,194,435
- 250,200 - 250,200
- - - -
- 279,125 31,625 247,500
- - - -
- - - -
- 1,183,062 148,488 1,034,574
- 374,000 55,000 319,000
- 402,380 120,242 282,138
- - - -
- 259,350 259,350 -
- 151,250 - 151,250
- - - -
- - - -
- 1,142,832 197,040 945,792
- - - -
- 373,428 48,708 324,720
- - - -
- - - -
255,000 348,279 88,485 259,794
- - - -
- 944,605 155,210 789,395
830,000 1,356,054 282,449 1,073,605
- - - -
- - - -
- 3,774,600 774,026 3,000,574
- - - -
- 594,992 185,028 409,964
- - - -
- - - -
- - - -
- 94,234 17,780 76,454
- 237,600 23,760 213,840
- 2,638,560 437,370 2,201,190
- - - -
- - - -
- - - -
- - - -
- 224,100 - 224,100
- - - -
- 424,000 174,900 249,100
- - - -
- - - -
- - - -
- - - -
- 330,000 146,250 183,750
- - - -
- - - -
715,000 980,980 351,780 629,200
- 38,100 2,100 36,000
- 183,300 - 183,300
- - - -
- 260,604 38,988 221,616
- 225,992 8,480 217,512
- - - -
- - - -
- - - -
- - - -
- 1,633,500 181,500 1,452,000
- - - -
- - - -
- - - -
- 1,787,900 201,400 1,586,500
- 452,760 126,280 326,480
- - - -
- - - -
- 53,340 18,900 34,440
- 232,200 24,300 207,900
- 112,000 - 112,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1,439,940 1,079,955 359,985
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
2,007,652 2,007,652 - 2,007,652
- - - -
- - - -
- 348,000 48,000 300,000
- 193,600 24,200 169,400
- - - -
- 819,940 40,997 778,943
- - - -
- 198,000 - 198,000
- 990,000 88,000 902,000
- 437,437 124,982 312,455
- - - -
- - - -
- - - -
- - - -
- - - -
- 140,056 - 140,056
- - - -
- - - -
1,100,000 1,397,000 22,440 1,374,560
- - - -
- - - -
- - - -
- 10,248,850 1,128,900 9,119,950
- - - -
- 93,150 - 93,150
- - - -
- - - -
- - - -
- - - -
- - - -
- 397,600 63,900 333,700
- - - -
- 33,280 - 33,280
- 37,960 - 37,960
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 959,992 959,992 -
- 1,309,990 1,309,990 -
- - - -
- - - -
- 195,300 - 195,300
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 201,000 4,020 196,980
- 397,320 194,040 203,280
- 212,850 74,250 138,600
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 11,696 5,848 5,848
- - - -
- 275,880 50,160 225,720
- 78,234 24,072 54,162
- - - -
- - - -
- 215,808 - 215,808
- - - -
- 51,210 51,210 -
- - - -
- - - -
- 165,060 28,820 136,240
- 130,075 23,650 106,425
- - - -
- - - -
- 40,950 - 40,950
- - - -
- - - -
- - - -
242,000 329,120 67,760 261,360
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 219,750 219,750 -
- - - -
- - - -
- - - -
412,500 412,500 90,750 321,750
- 156,123 60,192 95,931
- 169,092 11,088 158,004
- - - -
- 147,720 147,720 -
- - - -
- - - -
- - - -
- 1,071,000 707,625 363,375
- - - -
- - - -
352,000 401,280 63,360 337,920
- - - -
- - - -
- 207,200 25,900 181,300
- - - -
- - - -
- - - -
- - - -
- - - -
- 95,010 - 95,010
- - - -
- - - -
- - - -
- 468,060 - 468,060
- - - -
- - - -
- 87,885 35,175 52,710
- - - -
- 16,150 3,570 12,580
- - - -
- 126,360 - 126,360
- 64,200 - 64,200
- - - -
- - - -
- 88,434 50,286 38,148
715,500 1,006,470 271,890 734,580
- - - -
- 17,760 17,760 -
- - - -
- - - -
220,000 220,000 - 220,000
- 39,600 39,600 -
- - - -
- - - -
- - - -
- - - -
- 715,000 - 715,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 4,282,220 117,705 4,164,515
- - - -
- 411,700 - 411,700
- - - -
- - - -
- 79,520 15,120 64,400
- - - -
- - - -
- 1,312,000 131,200 1,180,800
- - - -
- 360,000 - 360,000
- 149,600 - 149,600
- - - -
- - - -
- - - -
- 478,400 - 478,400
- 1,269,450 40,950 1,228,500
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1,001,000 286,000 715,000
- 726,000 - 726,000
- 330,000 165,000 165,000
- 5,964,000 1,491,000 4,473,000
- 1,056,000 - 1,056,000
- 112,944 18,824 94,120
- 396,000 - 396,000
- 1,039,500 693,000 346,500
- - - -
- 2,200,000 550,000 1,650,000
- 275,000 - 275,000
- 1,188,000 990,000 198,000
- 1,848,000 462,000 1,386,000
- 804,000 - 804,000
- 1,584,000 528,000 1,056,000
- 1,056,000 - 1,056,000
- 154,000 - 154,000
- - - -
- - - -
- 675,000 165,000 510,000
- 14,454 1,314 13,140
- 313,500 82,500 231,000
- - - -
- - - -
- - - -
- - - -
- - - -
- 14,300 - 14,300
- 216,220 34,140 182,080
- 320,000 160,000 160,000
- 74,800 - 74,800
- 351,780 42,900 308,880
- 105,000 - 105,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 330,000 - 330,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 3,524,400 320,400 3,204,000
- - - -
1,123,200 1,235,520 336,960 898,560
- - - -
- - - -
- 1,323,900 147,100 1,176,800
- 1,479,000 174,000 1,305,000
- 2,088,000 - 2,088,000
- - - -
- 633,600 - 633,600
- 109,200 109,200 -
- 1,584,000 79,200 1,504,800
- 77,028 - 77,028
- 33,012 - 33,012
- 22,008 - 22,008
- 11,004 - 11,004
- 33,012 - 33,012
- 33,012 - 33,012
- 462,000 33,000 429,000
- - - -
- - - -
- - - -
- 329,600 20,600 309,000
- - - -
- - - -
- - - -
- 3,640,000 130,000 3,510,000
- 470,000 - 470,000
- 759,000 115,000 644,000
- 495,000 110,000 385,000
- 616,200 39,500 576,700
- - - -
- - - -
- 682,000 308,000 374,000
- 356,400 - 356,400
- 297,000 - 297,000
- 699,600 - 699,600
- 600,000 - 600,000
- - - -
- 1,364,000 - 1,364,000
- 1,265,000 - 1,265,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 219,960 109,980 109,980
- 496,800 331,200 165,600
- 176,000 - 176,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 174,240 5,808 168,432
- - - -
- - - -
- - - -
- - - -
- 609,840 - 609,840
- 712,800 - 712,800
- 541,200 - 541,200
11,659,552 165,179,659 35,652,514 129,527,145

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LAPORAN PEMAKAIAN DAN LEMBAR P

NO NAMA OBAT SATUAN STOK AWAL

(1a) ANALG,ANTIP,AN.INFL NON NARKOTIK

(2) ANESTESI LOKAL

(3) AN.EPILEPSI, AN.KONV, AN.ASIETAS, SEDATIV, HIPNOTIK, AN.PSIKOTIK

(4) ANTI PARKINSON

(5) ANTI DEPRESI

(6) ANTI MIGREN

(7) ANTI ANGINA - ANTI ARITMIA

(9) GLUKOSIDA JANTUNG

(10) OBAT PD SHOK-ANTI ASMA KORTIKOSTEROID

(11) ANTI TUSIF

(15) OBAT DIARE-KESEIMBANGAN CAIRAN ELEKTROLIT

(18) ANTI HISTAMIN

(19) LARUTAN NUTRISI

(20) TIROID ANTAGONIS

(21) ANTI DIABETIK ORAL

(22) ANTI DIABETIK PARENTERAL

(23) VITAMIN DAN MINERAL

(24) ANTI BAKTERI SISTEMIK, ANTISEPTIK SAL.KEMIH

(25) ANTI VIRUS

(26) ANTI FUNGI

(27) ANTI TUBERKULOSIS

(28) ANTI SEPTIK, DESINFEKTAN

(30) ANTI AMUBIASIS

(31) OBAT YG MEMPENGARUHI DARAH, ANTI ANEMIA

(33) PRODUK DAN SUBTITUEN PLASMA

(36) RELAKSAN UTERUS

(37) ANTI INFLAMASI SALEP

(38) PERANGSANG JARINGAN GRANULASI

(39) ANTI BAKTERI

(41) ANTI SCABIES

(42) ANTI SEPTIK

(43) LAIN-LAIN OBAT KULIT

(44) ANTI SISTEMIK MATA

(45) ANESTESI LOKAL MATA

(46) ANTI INFEKSI MATA

(47) LAIN-LAIN OBAT MATA

(48) ANTI INFEKSI THT

(49) LAIN-LAIN INFEKSI THT

(50) ANTI FILARIASIS

(51) ANTI HEMOROID

(52) ANTI EMETIK

(53) ANTI HIPERKOLESTEROLEMIA

(56) PROGRAM GIZI

(58) PROGRAM GANGGUAN JIWA

(59) OBAT GIGI

(60) OBAT TOPIKAL MULUT

(61) BAHAN MEDIS HABIS PAKAI (BMHP)

BULAN LB1+BOR SETORAN

JANUARI 2019 3881 28.619.000

Dr.ARIF RAHMAN NURDIANTO

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

- 2,282 292 1,990

- 594 350 244

- 761 145 616

- 2,955 1,307 1,648

- 8,480 450 8,030

3,000 4,001 3,303 698

- 13,263 6,222 7,041

- 3,045 1,191 1,854

- 5,501 590 4,911

3,000 839 620 219