File Stok Opname Puskes 2013

LAMPIRAN BERITA ACARA
JUMLAH SISA STOK PER 31 DESEMBER 2013

PUSKESMAS JALAKSANA
KECAMATAN JALAKSANA
KABUPATEN KUNINGAN
SISA STOK
HARGA SATUAN PER 31 JUMLAH HARGA
NO NAM A OBAT SATUAN KET
(RP) DESEMBER 2013 (RP)
1 2 3 4 5 6=4x5 7
1 Air Raksa Dental Use Botol 330,000.00 0 -
2 Alat suntik sekali pakai 1 ml Set 794.10 89 70,674.90
3 Alat suntik sekali pakai 2,5 ml Set 1,001.00 71 71,071.00
4 Alat suntik sekali pakai 5 ml Set 999.99 36 35,999.64
5 Albendazole 400 mg Tablet 406.67 0 -
6 Alopurinol tablet 100 mg Tablet 105.00 399 41,895.00
7 Aminofillin injeksi 24 mg/ml-10 ml Ampul 2,566.67 0 -
8 Aminofillin tablet 200 mg Tablet 87.15 459 40,001.85
9 Amitriptillin Hcl tablet 25 mg Tablet 102.00 230 23,460.00
10 Amoksisillin 250 mg Kapsul 200.00 889 177,800.00
11 Amoksisillin 500 mg Kaplet 220.00 3889 855,580.00
12 Amoksisillin sirup kering 125 mg/5ml Botol 2,300.00 54 124,200.00
13 Antalgin 500 mg Tablet 124.22 3341 415,019.02
14 Antalgin injeksi 250 mg/ml-2ml Ampul 1,200.00 0 -
15 Antasida Doen komb / btl Tablet 30.53 0 -
16 Anti Bakteri Doen Komb Tube 2,491.00 83 206,753.00
17 Anti Fungi Doen Komb Pot 1,904.40 38 72,367.20
18 Anti Hemoroid Doen komb Supp 2,000.00 0 -
19 Antimigren Doen KOMB Tablet 123.00 93 11,439.00
20 Aqua Pro Injeksi 20 ml Vial 5,000.00 0 -
21 Asam Askorbat 50 mg tablet Tablet 32.00 7175 229,600.00
22 Asetosal 100 mg Tablet 100.00 0 -
23 Asetosal 500 mg Tablet 162.00 139 22,518.00
24 Betametason Krim 0,1 %- 5g Tube 1,520.00 58 88,160.00
25 Catgut/Benang Bedah No.2/0-3/0 Sachet 24,584.00 0 -
26 Deksametason injk 5mg/ml-1ml Ampul 907.77 0 -
27 Deksametason tablet 0,5 mg Tablet 52.58 8352 439,148.16
28 Dekstrometorfan Hbr sirup 10 mg/5ml-60 ml Botol 2,400.00 0 -
29 Dekstrometorfan Hbr tablet 15 mg Tablet 35.64 516 18,390.24
30 Devitalisasi Pasta Botol 429,000.00 0 -
31 Diazepam injeksi 5 m/ml-2ml Ampul 2,366.67 26 61,533.42
32 Diazepam tablet 2 mg Tablet 19.80 713 14,117.40
33 Diazepam tablet 5 mg Tablet 29.00 0 -
34 Difenhidramin injeksi 10 mg/ml-1ml Ampul 960.00 66 63,360.00
35 Digoksin tablet 0,25 mg Tablet 91.00 232 21,112.00
36 Efedrin Hcl tablet 25 mg Tablet 51.26 285 14,609.10
37 Ekstrak Belladone 10 mg Tablet 38.00 300 11,400.00
38 Epinefrin injeksi Ampul 1,500.00 0 -
39 Etakridin Larutan 0,1% Botol 2,212.16 8 17,697.28
40 Etanol 70 % 1.000 ml Botol 17,000.00 3 51,000.00
41 Etil Klorida Semprot -100 ml Botol 105,000.00 0 -
42 Eugenol Cairan -10 ml Botol 59,000.00 0 -
43 Fenitoin Natrium kapsul 100 mg Kapsul 79.54 70 5,567.80
44 Fenobarbital injeksi 50 mg Ampul 670.00 0 -
45 Fenobarbital tablet 30 mg Tablet 61.00 410 25,010.00
46 Fenoksimetil Penisilin 250 mg Tablet 272.00 181 49,232.00
47 Fenoksimetil Penisillin 500 mg Tablet 465.00 200 93,000.00
48 Fenol Gliserol Tetes Telinga 10%-5ml Botol 1,008.00 0 -
49 Fitomenadion Injeksi 10 mg/ml-1ml Ampul 1,566.00 0 -
50 Fitomenadion tablet 10 mg Tablet 579.00 419 242,601.00
51 Furosemid tab 40 mg Tablet 78.00 27 2,106.00
52 Gameksan Emulsi 1%-100 ml Botol 2,200.00 0 -
53 Garam Oralit 200 ml Air Sachet 292.00 946 276,232.00
54 Gentian Violet Larutan 1%-10 ml Botol 895.00 37 33,115.00
55 Glass Ionomer cement Set 765,600.00 0 -
56 Glibenklamid Tablet 5 mg Tablet 54.00 597 32,238.00
57 Gliseril Guayakolat 100 mg Tablet 27.50 3958 108,845.00
58 Gliserin-100 ml Botol 4,180.00 0 -
59 Glukosa Larutan infus 10 % Steril -500 ml Botol 5,727.00 0 -
60 Glukosa Larutan infus5 % Steril -500 ml Botol 5,313.00 0 -
61 Griseofulvin tablet 125 mg Tablet 228.00 77 17,556.00
SISA STOK
1 2 3 4 5 6=4x5 7
62 Haloperidol 0,5 mg tablet Tablet 52.52 195 10,241.40
63 Haloperidol 1,5 mg tablet Tablet 60.47 130 7,861.10
64 Hidroklortiazid (HCT) tablet 25 mg Tablet 36.26 545 19,761.70
65 Hidrokortison Krim 2,5 % Tube 2,541.00 8 20,328.00
66 Ibuprofen tablet 200 mg Tablet 92.57 723 66,928.11
67 Ibuprofen tablet 400 mg Tablet 145.00 1654 239,830.00
68 Infus set Anak Set 4,000.00 5 20,000.00
69 Infus set Dewasa Set 3,465.00 6 20,790.00
70 Kalsium Hidroksida Pasta Botol 323,400.00 0 -
71 Kalsium Laktat 500 mg tablet Tablet 52.00 3805 197,860.00
72 Kapas Pembalut Adsorbens 250 g Bungkus 11,401.00 3 34,203.00
73 Karbamazepin tablet 200 mg Tablet 243.00 381 92,583.00
74 Kassa 2 m x 80 cm Rol 8,900.00 0 -
75 Kassa 4 m x 3 cm Rol 750.00 3 2,250.00
76 Kassa Kompres 40 x 40 steril Bungkus 1,393.00 0 -
77 Kassa Pembalut Hidrofil 4 m x 15 cm Rol 3,375.00 9 30,375.00
78 Kloramfenikol kapsul 250 mg Kapsul 245.83 286 70,307.38
79 Kloramfenikol salep mata 1%-3,5 g Tube 1,562.00 0 -
80 Kloramfenikol tetes telinga 3%-5 ml Botol 1,599.00 48 76,752.00
81 Klorfeniramin Maleat 4 mg tablet Tablet 26.00 8704 226,304.00
82 Kloroquin fosfat tab 250 mg Tablet 58.44 855 49,966.20
83 Klorpromazin Hcl tablet salut 100 mg Tablet 122.00 1227 149,694.00
84 Klorpromazin Hcl tablet salut 25 mg Tablet 38.00 520 19,760.00
85 Kotrimoksazol 480 mg tablet Tablet 152.00 1765 268,280.00
86 Kotrimoksazol Pedriatik tab komb Tablet 76.00 578 43,928.00
87 Kotrimoksazol suspensi kombinasi Botol 2,574.00 122 314,028.00
88 Lidokain Komp injeksi kombinasi Ampul 1,295.00 50 64,750.00
89 Lisol Botol 47,369.00 0 -
90 Magnesium Sulfat Injeksi (IV) 40%-25 ml Ampul 1,947.00 0 -
91 Magnesium Sulfat Serbuk Sachet 10,266.00 0 -
92 Metilergometrin Maleat Injeksi 0,200 mg-1mlAmpul 1,291.53 0 -
93 Metilergometrin Maleat tablet 0,125 g Tablet 121.00 372 45,012.00
94 Metronidazol 250 mg tablet Tablet 122.80 278 34,138.40
95 Monoklorkamfer Mentol Cairan Botol 72,600.00 0 -
96 Mummifying Pasta Botol 541,200.00 0 -
97 Natrium Bikarbonat tablet 500 mg Tablet 14.30 1446 20,677.80
98 Natrium Klorida Larutan infus 0,9%-Steril 50 Botol 4,900.00 3 14,700.00
99 Nistatin 100.000 IU/gram Tablet Vagina Tablet 345.00 140 48,300.00
100 Nistatin 500.000 IU/gram Tablet Salut Tablet 640.00 65 41,600.00
101 Obat Antituberkulosis FDC I & II Paket 1,200,000.00 0 -
102 Obat Antituberkulosis FDC I & III Paket 360,000.00 0 -
103 Obat Antituberkulosis Kategori Anak Paket 127,200.00 0 -
104 Obat Antituberkulosis Kategori 1 Paket 288,200.00 0 -
105 Obat Antituberkulosis Sisipan Dewasa Paket 160,000.00 0 -
106 Obat Batuk Hitam (OBH) Cairan 100 ml Botol 1,258.95 137 172,476.15
107 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial 3,100.00 0 -
108 Oksiterasiklin Salep mata 1%-3,5g Tube 1,600.00 80 128,000.00
109 Oksitetrasiklin Hcl salep kulit 3%-5g Tube 1,529.00 96 146,784.00
110 Oksitosin injeksi 10 IU/ml-1ml Ampul 1,785.00 0 -
111 Parasetamol sirup 120 mg/5ml-60 ml Botol 1,318.90 48 63,307.20
112 Parasetamol tablet 100 mg Tablet 32.23 152 4,898.96
113 Parasetamol tablet 500 mg Tablet 44.99 24119 1,085,113.81
114 Pirantel Pamoat tablet 365 mg Tablet 309.99 224 69,437.76
115 Piridoksin Hcl tablet 10 mg Tablet 17.40 5777 100,519.80
116 Plester 5 yard x 2 inchi Rol 23,500.00 3 70,500.00
117 Polikresulen 360 mg/g-10 ml Botol 25,600.00 0 -
118 Povidon iodida 10% 1000 ml Botol 42,000.00 0 -
120 Povidon iodida 10% 300 ml Botol 14,500.00 1 14,500.00
122 Prednison tablet 5 mg Tablet 52.00 1941 100,932.00
123 Propanolol Hcl tablet 40 mg Tablet 121.00 190 22,990.00
124 Propiltiurasil tablet 100 mg Tablet 246.00 135 33,210.00
125 Reserpin 0,25 mg tablet Tablet 88.00 1137 100,056.00
126 Retinol 100.000 IU Kapsul Kapsul 242.00 0 -
127 Retinol 200.000 IU Kapsul Kapsul 431.54 0 -
128 Ringer Laktat Laruta infus Steril -500 ml Botol 5,200.00 8 41,600.00
129 Salbutamol 2 mg tablet Tablet 59.82 0 -
130 Salep 2-4 kombinasi Pot 1,800.00 81 145,800.00
131 Salisil bedak 2% -50 gr Kotak 1,120.00 36 40,320.00
132 Semen Seng Fosfat Serbuk & Cairan Botol 165,000.00 0 -
133 Serum ABU I Vial 398,450.00 0 -
134 Vaksin Anti Rabies (VAR) Vial 126,500.00 0 -
135 Serum Anti Tetanus injeksi 1500 IU/ampul Ampul 91,600.00 4 366,400.00
136 Serum Anti Tetanus injeksi 20000 IU/ampul Vial 340,000.00 0 -
137 Sianokobalamin injeksi 500 mcg/ml-1ml Ampul 916.00 0 -
138 Silk( Benang Bedah Sutra ) No 3/0 Sachet 6,984.00 15 104,760.00
139 Silver Amalgam Serbuk 65-75% Botol 363,000.00 0 -
140 Sulfasetamid tetes mata 15 %-5ml Botol 3,226.00 37 119,362.00
141 Syntetic Filling Material Set 400,000.00 0 -
142 Tablet Tambah Darah Kombinasi Tablet 44.00 0 -
143 Temporary Stopping Fletcher Serbuk & Cair Set 34,000.00 0 -
144 Tetrasiklin 250 mg Kapsul 152.00 1105 167,960.00
145 Thiamin Hcl injeksi 100 mg/ml-1ml Ampul 680.00 30 20,400.00
SISA STOK
1 2 3 4 5 6=4x5 7
146 Tiamin Hcl /Mononitrat tablet 50 mg Tablet 37.80 8688 328,406.40
147 Triheksifenidil Hidroklorida 2 mg tablet Tablet 40.00 0 -
148 Trikesol formalin ( T K F ) Cairan 10 ml Botol 85,800.00 0 -
149 Vaksin BCG Vial 52,492.00 -
150 Vaksin Campak Vial 25,641.00 -
151 Vaksin DPT-HB Vial 46,475.00 -
152 Vaksin DPT-HB/Hib Vial 70,323.00 -
153 Vaksin DT Vial 16,412.00 -
154 Vaksin HB-UNIJECT Pcs 19,096.00 -
155 Vaksin Polio Vial 17,094.00 -
156 Vaksin TT Vial 13,475.00 -
157 Vitamin B .Komplek tablet Tablet 22.20 5134 113,974.80
158 Abbocath no 18 ( IV Chateter 18 ) Buah 5,840.62 0 -
159 Abbocath No 20 ( IV Chateter 20 ) Buah 5,840.62 2 11,681.24
160 Abbocath No 22 ( IV Chateter 22 ) Buah 5,840.62 2 11,681.24
161 Abbocath No 24 ( IV Chateter 24 ) Buah 5,840.62 0 -
162 ADS (Auto Disposable Syringe) 0,05 ml set 1,995.00 0 -
163 ADS (Auto Disposable Syringe) 0,5 ml set 1,395.00 0 -
164 Alat suntik sekali pakai 10 ml Set 2,257.50 0 -
165 Alprazolam tablet 1 mg Tablet 900.00 71 63,900.00
166 Ambroksol sirup 60 ml Botol 2,400.00 19 45,600.00
167 Ambroksol tablet 30 mg Tablet 95.00 25 2,375.00
168 Amlodipin tablet Tablet 240.00 335 80,400.00
169 Amoksisillin DS 250 mg / 5 ml Botol 5,900.00 87 513,300.00
170 Amoksisillin serbuk injeksi 1000 mg vial 7,396.00 0 -
171 Ampisilin sirup 125 mg / 5 ml Botol 3,300.00 0 -
172 Ampisilin 250 mg kapsul Kapsul 269.00 0 -
173 Ampisillin injeksi 1000 mg Ampul 4,000.00 0 -
174 Ampisillin kaplet 500 mg Tablet 381.00 372 141,732.00
175 Antasida + Simetikon tablet (Myloxan ) Tablet 248.00 591 146,568.00
176 Antasida Doen Suspensi Botol 2,430.00 16 38,880.00
177 Antasida DOEN tablet kotak Tablet 77.94 7477 582,757.38
178 Antidiare suspensi (Kaolimec ) Botol 7,700.00 0 -
179 Antidotum oral tablet (Bekarbon) Tablet 115.51 330 38,118.30
180 Anti Hipertensi (Tensigard) Tablet 2,021.00 0 -
181 Antihistamin komb tablet (Soldextam) Tablet 498.85 632 315,273.20
182 Antispasmodik (Spasminal) Tablet 594.00 98 58,212.00
183 Antitusiva sirup (Dexophan sirup) Botol 9,850.00 0 -
184 Antitusiva tablet Tablet 330.00 0 -
185 Asam Folat Tablet 57.80 0 -
186 Asam Mefenamat 250 mg Tablet 76.00 0 -
187 Asam Mefenamat 500 mg Tablet 95.00 1127 107,065.00
188 Asiklovir 200 mg Tablet 239.00 147 35,133.00
189 Asiklovir 400 mg tablet Tablet 571.33 223 127,406.59
190 Asiklovir 5 % Cream Tube 2,152.00 10 21,520.00
191 Betahistin mesilat Tablet 924.00 0 -
192 Bisoprolol 5 mg tablet Tablet 2,321.67 0 -
193 Bromheksin tablet Tablet 50.70 0 -
194 Captopril 12,5 mg Tablet 72.00 1590 114,480.00
195 Captopril 25 mg Tablet 88.00 342 30,096.00
196 Cefadroksil 125 mg / 5 ml sirup Botol 5,200.00 0 -
197 Cefadroksil 500 mg Tablet 520.00 0 -
198 Cefiksim kapsul 100 mg Kapsul 2,394.59 0 -
199 Cefotaksim injeksi 1 gr Ampul 6,860.00 0 -
200 Ceftriakson injeksi 1 gr / vial Ampul 8,000.00 0 -
201 Cetirizin sirup Botol 7,837.00 0 -
202 Cetirizin tablet 10 mg Tablet 225.00 0 -
203 Cimetidin 200 mg tablet Tablet 108.00 689 74,412.00
204 Cyprofloxacin 500 mg Tablet 250.00 754 188,500.00
205 Dimenhidrinat tablet Tablet 96.00 54 5,184.00
206 Domperidon tablet 10 mg Tablet 176.00 160 28,160.00
207 Donperidon sirup Botol 3,624.00 46 166,704.00
208 Eritromisin 200 mg / 5 ml Botol 6,525.00 0 -
209 Eritromisin 250 mg Kapsul 337.82 1400 472,948.00
210 Eritromisin 500 mg Kapsul 920.00 0 -
211 Etambutol 500 mg Tablet 308.60 0 -
212 Famotidin tablet 20 mg Tablet 113.10 0 -
213 Famotidin tablet 40 mg Tablet 177.00 0 -
214 Folley Catheter no 14 Set 8,490.00 0 -
217 Furosemid injeksi i.v / i.m ng / ml Ampul 1,035.04 0 -
218 Gemfibrozil tablet 600 mg Tablet 475.66 0 -
219 Gentamisin injeksi 80 mg / 2 ml Vial 2,566.00 0 -
220 Gentamisin salep kulit 0,1 % Tube 1,350.00 24 32,400.00
221 Gliseril Guayakolat sirup (Daganak sirup) Botol 4,200.00 0 -
222 Glucosa Lar Infus Steril 40 % 25 ml Botol 1,040.00 0 -
SISA STOK
1 2 3 4 5 6=4x5 7
223 Haloperidol 5 mg Tablet 122.29 190 23,235.10
224 Ibuprofen sirup Botol 3,465.00 38 131,670.00
225 Ichtyol Salep Kulit Pot 6,325.00 5 31,625.00
226 Isoniazid tablet 300 mg Tablet 66.14 0 -
227 Kalium Diklofenak 25 mg Tablet 390.84 0 -
228 Kalium Diklofenak 50 mg Tablet 708.02 619 438,264.38
229 Kassa 16 x 16 Kotak 7,920.00 0 -
230 Ketokonazole krim 2 % - 15 gr Tube 4,050.00 17 68,850.00
231 Ketokonazole tablet 200 mg Tablet 410.00 58 23,780.00
232 Ketoprofen tablet 100 mg Tablet 1,227.60 0 -
233 Ketoprofen injeksi 100 mg / 1 ml Ampul 5,197.50 0 -
234 Ketorolac injeksi 30 mg Ampul 13,365.00 0 -
235 Ketorolac injeksi 10 mg Ampul 7,500.00 0 -
236 Klindamisin 150 mg Kapsul 382.00 0 -
237 Klindamisin 300 mg Kapsul 527.00 226 119,102.00
238 Kloramfenikol suspensi 125 mg/5ml Botol 2,574.00 0 -
239 Kloramfenikol tetes mata Botol 2,500.00 0 -
240 Lansoprazole tablet Tablet 1,283.80 0 -
241 Levofloksasin tab 500 mg Tablet 1,200.00 0 -
242 Lidokain injeksi 2 % Tablet 770.25 0 -
243 Linkomisin kapsul 500 mg Kapsul 650.00 0 -
244 Loperamid Hcl Tablet 90.00 64 5,760.00
245 Loratadin tablet 10 mg Tablet 333.08 0 -
246 Masker Set 1,125.00 14 15,750.00
247 Meloksikam 15 mg tablet Tablet 348.00 151 52,548.00
248 Meloksikam Suppositoria Supp 7,700.00 0 -
249 Metformin Hcl tablet 500 mg Tablet 105.00 250 26,250.00
250 Metilprednisolon tablet 4 mg Tablet 295.83 171 50,586.93
251 Metoklopramid tablet 10 mg Tablet 89.00 69 6,141.00
252 Metoklorpropamid injk 5 mg/ 5 ml Ampul 960.00 0 -
253 Metronidazole 500 mg tablet Tablet 220.00 202 44,440.00
254 Metronidazole infus 500 mg / 100 ml Ampul 24,000.00 0 -
255 Mikonazole krem 2 % - 10 gr Tube 3,000.00 20 60,000.00
256 Mineral Mix 8 gr Sashet 2,475.00 0 -
257 Multivitamin + Mineral tablet (Hemafort) Tablet 720.00 1893 1,362,960.00
258 Multivitamin sirup ( Recovit ) Botol 6,050.00 49 296,450.00
259 Natrium Diklofenak 50 mg Tablet 174.00 741 128,934.00
260 Natrum Diklofenak 25 mg Tablet 134.00 0 -
261 Neddle No 23 Set 5,770.00 0 -
262 Neo Diaform Tablet 154.00 380 58,520.00
263 Neurotropik Tablet 605.00 1635 989,175.00
264 Nipedifin 10 mg Tablet 129.00 169 21,801.00
265 O B H Plus ( Excosin) 60 ml Botol 8,140.00 57 463,980.00
266 OAT FDC Kat Anak Paket 215,000.00 0 -
267 Obat Batuk Cair ( Coredryl ) Botol 5,500.00 0 -
268 Ofloxasin tablet 400 mg Tablet 873.00 0 -
269 Omeprazole 20 mg kapsul Tablet 265.00 63 16,695.00
270 Papaverin Hcl tablet Tablet 63.00 0 -
271 Paracetamol Drop Botol 5,227.00 18 94,086.00
272 Piracetam 400 mg Tablet 501.60 0 -
273 Piracetam 800 mg Tablet 836.00 0 -
274 Piracetam injeksi 3 g / 15 ml Ampul 19,800.00 0 -
275 Piroksikam 20 mg Tablet 91.96 282 25,932.72
276 Primakuin tablet 15 mg Tablet 68.30 0 -
277 Ranitidin 150 mg tablet Tablet 105.00 359 37,695.00
278 Ranitidin injeksi 25 mg / ml Ampul 2,570.00 0 -
279 Rifampisin tablet 450 mg Tablet 450.00 0 -
280 Salbutamol 4 mg tablet Tablet 85.00 0 -
281 Salep luka bakar tube 14,209.00 24 341,016.00
282 Sarung tangan no 6 Pcs 4,250.00 0 -
283 Sarung tangan no 7 Pcs 4,250.00 7 29,750.00
284 Sarung tangan no 7,5 Pcs 4,250.00 8 34,000.00
285 Sianokobalamin tablet 50 mcg Tablet 12.36 0 -
286 Simvastatin tablet 10 mg Tablet 180.00 290 52,200.00
287 Spironolakton tablet 25 mg Tablet 346.30 0 -
288 Tetrasiklin 500 mg Kapsul 206.00 42 8,652.00
289 Thiamfenikol kapsul Kapsul 616.00 600 369,600.00
290 Tramadol injeksi 50 mg/ ml Ampul 6,402.00 0 -
291 Tramadol tablet 50 mg Tablet 322.00 110 35,420.00
292 Urine Bag set 4,000.00 10 40,000.00
293 Zinc tablet 20 mg Tablet 455.00 225 102,375.00
TOTAL JUMLAH RP : 18,959,058.06
CatataKolom 5 : Diisi dengan sisa stok obat dan perbekalan kesehatan puskesmas per 31 Desember 2013
Kolom 6 : Diisi dengan mengalikan ( kolom 4 ) harga satuan X ( kolom 5 ) sisa stok obat
Kuningan, 08 JANUARI 2014
Mengetahui Petugas Pengelola Obat

Kepala UPTD Puskesmas JALAKSANA UPTD Puskesmas JALAKSANA
H.TATANG MUHTAR,SKM.MM.Kes IDA FARIDA,S.Farm

NIP.19740307 199403 1002 NIP.19690316 199203 2 002
LAPORAN STOK OP
TA
UPTD PUSKESMAS : JALAKSANA
KECAMATAN : JALAKSANA
KABUPATEN : KUNINGAN
GUDANG
NO NAM A OBAT
SATUAN SISA
KARTU FISIK
1 2 3 4 5 6
1 Air Raksa Dental Use Botol
2 Alat suntik sekali pakai 1 ml Set
3 Alat suntik sekali pakai 2,5 ml Set
5 Albendazole 400 mg Tablet
6 Alopurinol tablet 100 mg Tablet
7 Aminofillin injeksi 24 mg/ml-10 ml Ampul
8 Aminofillin tablet 200 mg Tablet
9 Amitriptillin Hcl tablet 25 mg Tablet
10 Amoksisillin 250 mg Kapsul
11 Amoksisillin 500 mg Kaplet
12 Amoksisillin sirup kering 125 mg/5ml Botol
13 Antalgin 500 mg Tablet
14 Antalgin injeksi 250 mg/ml-2ml Ampul
15 Antasida Doen komb / btl Tablet
16 Anti Bakteri Doen Komb Tube
17 Anti Fungi Doen Komb Pot
18 Anti Hemoroid Doen komb Supp
19 Antimigren Doen KOMB Tablet
20 Aqua Pro Injeksi 20 ml Vial
21 Asam Askorbat 50 mg tablet Tablet
22 Asetosal 100 mg Tablet
23 Asetosal 500 mg Tablet
24 Betametason Krim 0,1 %- 5g Tube
25 Catgut/Benang Bedah No.2/0-3/0 Sachet
26 Deksametason injk 5mg/ml-1ml Ampul
27 Deksametason tablet 0,5 mg Tablet
28 Dekstrometorfan Hbr sirup 10 mg/5ml-60 ml Botol
29 Dekstrometorfan Hbr tablet 15 mg Tablet
30 Devitalisasi Pasta Botol
31 Diazepam injeksi 5 m/ml-2ml Ampul
32 Diazepam tablet 2 mg Tablet
33 Diazepam tablet 5 mg Tablet
34 Difenhidramin injeksi 10 mg/ml-1ml Ampul
35 Digoksin tablet 0,25 mg Tablet
36 Efedrin Hcl tablet 25 mg Tablet
37 Ekstrak Belladone 10 mg Tablet
38 Epinefrin injeksi Ampul
39 Etakridin Larutan 0,1% Botol
40 Etanol 70 % 1.000 ml Botol
41 Etil Klorida Semprot -100 ml Botol
42 Eugenol Cairan -10 ml Botol
43 Fenitoin Natrium kapsul 100 mg Kapsul
44 Fenobarbital injeksi 50 mg Ampul
45 Fenobarbital tablet 30 mg Tablet
46 Fenoksimetil Penisilin 250 mg Tablet
47 Fenoksimetil Penisillin 500 mg Tablet
48 Fenol Gliserol Tetes Telinga 10%-5ml Botol
49 Fitomenadion Injeksi 10 mg/ml-1ml Ampul
50 Fitomenadion tablet 10 mg Tablet
51 Furosemid tab 40 mg Tablet
52 Gameksan Emulsi 1%-100 ml Botol
53 Garam Oralit 200 ml Air Sachet
54 Gentian Violet Larutan 1%-10 ml Botol
55 Glass Ionomer cement Set
56 Glibenklamid Tablet 5 mg Tablet
57 Gliseril Guayakolat 100 mg Tablet
58 Gliserin-100 ml Botol
59 Glukosa Larutan infus 10 % Steril -500 ml Botol
60 Glukosa Larutan infus5 % Steril -500 ml Botol
61 Griseofulvin tablet 125 mg Tablet
62 Haloperidol 0,5 mg tablet Tablet
63 Haloperidol 1,5 mg tablet Tablet
64 Hidroklortiazid (HCT) tablet 25 mg Tablet
65 Hidrokortison Krim 2,5 % Tube
66 Ibuprofen tablet 200 mg Tablet
67 Ibuprofen tablet 400 mg Tablet
68 Infus set Anak Set
69 Infus set Dewasa Set
70 Kalsium Hidroksida Pasta Botol
71 Kalsium Laktat 500 mg tablet Tablet
72 Kapas Pembalut Adsorbens 250 g Bungkus
73 Karbamazepin tablet 200 mg Tablet
74 Kassa 2 m x 80 cm Rol
75 Kassa 4 m x 3 cm Rol
76 Kassa Kompres 40 x 40 steril Bungkus
77 Kassa Pembalut Hidrofil 4 m x 15 cm Rol
78 Kloramfenikol kapsul 250 mg Kapsul
79 Kloramfenikol salep mata 1%-3,5 g Tube
80 Kloramfenikol tetes telinga 3%-5 ml Botol
81 Klorfeniramin Maleat 4 mg tablet Tablet
82 Kloroquin fosfat tab 250 mg Tablet
83 Klorpromazin Hcl tablet salut 100 mg Tablet
84 Klorpromazin Hcl tablet salut 25 mg Tablet
85 Kotrimoksazol 480 mg tablet Tablet
86 Kotrimoksazol Pedriatik tab komb Tablet
87 Kotrimoksazol suspensi kombinasi Botol
88 Lidokain Komp injeksi kombinasi Ampul
89 Lisol Botol
90 Magnesium Sulfat Injeksi (IV) 40%-25 ml Ampul
91 Magnesium Sulfat Serbuk Sachet
92 Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul
93 Metilergometrin Maleat tablet 0,125 g Tablet
94 Metronidazol 250 mg tablet Tablet
95 Monoklorkamfer Mentol Cairan Botol
96 Mummifying Pasta Botol
97 Natrium Bikarbonat tablet 500 mg Tablet
98 Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol
99 Nistatin 100.000 IU/gram Tablet Vagina Tablet
100 Nistatin 500.000 IU/gram Tablet Salut Tablet
101 Obat Antituberkulosis FDC I & II Paket
102 Obat Antituberkulosis FDC I & III Paket
103 Obat Antituberkulosis Kategori Anak Paket
104 Obat Antituberkulosis Kategori 1 Paket
105 Obat Antituberkulosis Sisipan Dewasa Paket
106 Obat Batuk Hitam (OBH) Cairan 100 ml Botol
107 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial
108 Oksiterasiklin Salep mata 1%-3,5g Tube
109 Oksitetrasiklin Hcl salep kulit 3%-5g Tube
110 Oksitosin injeksi 10 IU/ml-1ml Ampul
111 Parasetamol sirup 120 mg/5ml-60 ml Botol
112 Parasetamol tablet 100 mg Tablet
113 Parasetamol tablet 500 mg Tablet
114 Pirantel Pamoat tablet 365 mg Tablet
115 Piridoksin Hcl tablet 10 mg Tablet
116 Plester 5 yard x 2 inchi Rol
117 Polikresulen 360 mg/g-10 ml Botol
118 Povidon iodida 10% 1000 ml Botol
122 Prednison tablet 5 mg Tablet
123 Propanolol Hcl tablet 40 mg Tablet
124 Propiltiurasil tablet 100 mg Tablet
125 Reserpin 25 mg tablet Tablet
126 Retinol 100.000 IU Kapsul Kapsul
127 Retinol 200.000 IU Kapsul Kapsul
128 Ringer Laktat Laruta infus Steril -500 ml Botol
129 Salbutamol 2 mg tablet Tablet
130 Salep 2-4 kombinasi Pot
131 Salisil bedak 2% -50 gr Kotak
132 Semen Seng Fosfat Serbuk & Cairan Botol
133 Serum ABU I Vial
134 Vaksin Anti Rabies (VAR) Vial
135 Serum Anti Tetanus injeksi 1500 IU/ampul Ampul
136 Serum Anti Tetanus injeksi 20000 IU/ampul Vial
137 Sianokobalamin injeksi 500 mcg/ml-1ml Ampul
138 Silk( Benang Bedah Sutra ) No 3/0 Sachet
139 Silver Amalgam Serbuk 65-75% Botol
140 Sulfasetamid tetes mata 15 %-5ml Botol
141 Syntetic Filling Material Set
142 Tablet Tambah Darah Kombinasi Tablet
143 Temporary Stopping Fletcher Serbuk & Cairan Set
144 Tetrasiklin 250 mg Kapsul
145 Thiamin Hcl injeksi 100 mg/ml-1ml Ampul
146 Tiamin Hcl /Mononitrat tablet 50 mg Tablet
147 Triheksifenidil Hidroklorida 2 mg tablet Tablet
148 Trikesol formalin ( T K F ) Cairan 10 ml Botol
149 Vaksin BCG Vial
150 Vaksin Campak Vial
151 Vaksin DPT-HB Vial
152 Vaksin DPT-HB/Hib Vial
153 Vaksin DT Vial
154 Vaksin HB-UNIJECT Pcs
155 Vaksin Polio Vial
156 Vaksin TT Vial
157 Vitamin B .Komplek tablet Tablet
158 Abbocath no 18 ( IV Chateter 18 ) Buah
159 Abbocath No 20 ( IV Chateter 20 ) Buah
162 ADS (Auto Disposable Syringe) 0,05 ml set
163 ADS (Auto Disposable Syringe) 0,5 ml set
165 Alprazolam tablet 1 mg Tablet
166 Ambroksol sirup 60 ml Botol
167 Ambroksol tablet 30 mg Tablet
168 Amlodipin tablet Tablet
169 Amoksisillin DS 250 mg / 5 ml Botol
170 Amoksisillin serbuk injeksi 1000 mg vial
171 Ampisilin sirup 125 mg / 5 ml Botol
172 Ampisilin 250 mg kapsul Kapsul
173 Ampisillin injeksi 1000 mg Ampul
174 Ampisillin kaplet 500 mg Tablet
175 Antasida + Simetikon tablet (Myloxan ) Tablet
176 Antasida Doen Suspensi Botol
177 Antasida DOEN tablet kotak Tablet
178 Antidiare suspensi (Kaolimec ) Botol
179 Antidotum oral tablet (Bekarbon) Tablet
180 Anti Hipertensi (Tensigard) Tablet
181 Antihistamin komb tablet (Soldextam) Tablet
182 Antispasmodik (Spasminal) Tablet
183 Antitusiva sirup (Dexophan sirup) Botol
184 Antitusiva tablet Tablet
185 Asam Folat Tablet
186 Asam Mefenamat 250 mg Tablet
187 Asam Mefenamat 500 mg Tablet
188 Asiklovir 200 mg Tablet
189 Asiklovir 400 mg tablet Tablet
190 Asiklovir 5 % Cream Tube
191 Betahistin mesilat Tablet
192 Bisoprolol 5 mg tablet Tablet
193 Bromheksin tablet Tablet
194 Captopril 12,5 mg Tablet
195 Captopril 25 mg Tablet
196 Cefadroksil 125 mg / 5 ml sirup Botol
197 Cefadroksil 500 mg Tablet
198 Cefiksim kapsul 100 mg Kapsul
199 Cefotaksim injeksi 1 gr Ampul
200 Ceftriakson injeksi 1 gr / vial Ampul
201 Cetirizin sirup Botol
202 Cetirizin tablet 10 mg Tablet
203 Cimetidin 200 mg tablet Tablet
204 Cyprofloxacin 500 mg Tablet
205 Dimenhidrinat tablet Tablet
206 Domperidon tablet 10 mg Tablet
207 Donperidon sirup Botol
208 Eritromisin 200 mg / 5 ml Botol
209 Eritromisin 250 mg Kapsul
210 Eritromisin 500 mg Kapsul
211 Etambutol 500 mg Tablet
212 Famotidin tablet 20 mg Tablet
213 Famotidin tablet 40 mg Tablet
214 Folley Catheter no 14 Set
217 Furosemid injeksi i.v / i.m ng / ml Ampul
218 Gemfibrozil tablet 600 mg Tablet
219 Gentamisin injeksi 80 mg / 2 ml Vial
220 Gentamisin salep kulit 0,1 % Tube
221 Gliseril Guayakolat sirup (Daganak sirup) Botol
222 Glucosa Lar Infus Steril 40 % 25 ml Botol
223 Haloperidol 5 mg Tablet
224 Ibuprofen sirup Botol
225 Ichtyol Salep Kulit Pot
226 Isoniazid tablet 300 mg Tablet
227 Kalium Diklofenak 25 mg Tablet
228 Kalium Diklofenak 50 mg Tablet
229 Kassa 16 x 16 Kotak
230 Ketokonazole krim 2 % - 15 gr Tube
231 Ketokonazole tablet 200 mg Tablet
232 Ketoprofen tablet 100 mg Tablet
233 Ketoprofen injeksi 100 mg / 1 ml Ampul
234 Ketorolac injeksi 30 mg Ampul
235 Ketorolac injeksi 10 mg Ampul
236 Klindamisin 150 mg Kapsul
237 Klindamisin 300 mg Kapsul
238 Kloramfenikol suspensi 125 mg/5ml Botol
239 Kloramfenikol tetes mata Botol
240 Lansoprazole tablet Tablet
241 Levofloksasin tab 500 mg Tablet
242 Lidokain injeksi 2 % Tablet
243 Linkomisin kapsul 500 mg Kapsul
244 Loperamid Hcl Tablet
245 Loratadin tablet 10 mg Tablet
246 Masker Set
247 Meloksikam 15 mg tablet Tablet
248 Meloksikam Suppositoria Supp
249 Metformin Hcl tablet 500 mg Tablet
250 Metilprednisolon tablet 4 mg Tablet
251 Metoklopramid tablet 10 mg Tablet
252 Metoklorpropamid injk 5 mg/ 5 ml Ampul
253 Metronidazole 500 mg tablet Tablet
254 Metronidazole infus 500 mg / 100 ml Ampul
255 Mikonazole krem 2 % - 10 gr Tube
256 Mineral Mix 8 gr Sashet
257 Multivitamin + Mineral tablet (Hemafort) Tablet
258 Multivitamin sirup ( Recovit ) Botol
259 Natrium Diklofenak 50 mg Tablet
260 Natrum Diklofenak 25 mg Tablet
261 Neddle No 23 Set
262 Neo Diaform Tablet
263 Neurotropik Tablet
264 Nipedifin 10 mg Tablet
265 O B H Plus ( Excosin) 60 ml Botol
266 OAT FDC Kat Anak Paket
267 Obat Batuk Cair ( Coredryl ) Botol
268 Ofloxasin tablet 400 mg Tablet
269 Omeprazole 20 mg kapsul Tablet
270 Papaverin Hcl tablet Tablet
271 Paracetamol Drop Botol
272 Piracetam 400 mg Tablet
273 Piracetam 800 mg Tablet
274 Piracetam injeksi 3 g / 15 ml Ampul
275 Piroksikam 20 mg Tablet
276 Primakuin tablet 15 mg Tablet
277 Ranitidin 150 mg tablet Tablet
278 Ranitidin injeksi 25 mg / ml Ampul
279 Rifampisin tablet 450 mg Tablet
280 Salbutamol 4 mg tablet Tablet
281 Salep luka bakar tube
282 Sarung tangan no 6 Pcs
283 Sarung tangan no 7 Pcs
284 Sarung tangan no 7,5 Pcs
285 Sianokobalamin tablet 50 mcg Tablet
286 Simvastatin tablet 10 mg Tablet
287 Spironolakton tablet 25 mg Tablet
288 Tetrasiklin 500 mg Kapsul
289 Thiamfenikol kapsul Kapsul
290 Tramadol injeksi 50 mg/ ml Ampul
291 Tramadol tablet 50 mg Tablet
292 Urine Bag set
293 Zinc tablet 20 mg Tablet
294
295
296
297
298
299
300
Mengetahui
Kepala Puskesmas
.......................................................................
.....................................................................
NIP.
LAPORAN STOK OPNAME PER 31 DESEMBER
TAHUN 2013
U R A I A N
GUDANG LOKET OBAT LAIN - LAIN
SELISIH SELISIH SELISIH
CATATAN FISIK CATATAN FISIK
+ - + - + -
7 8 9 10 11 12 13 14 15 16
Petugas Pengelola Obat Yang Melaksanakan Stok
................................................ ..................................................
NIP. NIP
JUMLAH
KET
SELISIH
FISIK
+ -
17 18 19 20
Yang Melaksanakan Stok
..................................................

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LAMPIRAN BERITA ACARA

JUMLAH SISA STOK PER 31 DESEMBER 2013

Kuningan, 08 JANUARI 2014

Mengetahui Petugas Pengelola Obat

H.TATANG MUHTAR,SKM.MM.Kes IDA FARIDA,S.Farm

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