PUSKESMAS GEMPOL

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSTU / POLINDES

PUSTU / POLINDES : WATUKOSEK
BULAN / TAHUN : MARET 2020

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN KET
1 Allupurinol tablet 10 mg tab 0 0 0 0 0 0
2 Amoksisillin tablet 500 mg tab 100 500 600 500 100 500
3 Amoksisillin sirup 125 mg/5ml btl 3 15 18 18 0 20
4 Acyclovir tablet tab 0 0 0 0 0 5
5 Antasida Doen tablet tab 100 200 300 200 100 300
6 Asam Mefenamat tablet 500 mg tab 100 300 400 400 0 300
7 Asam Askorbat tablet 50 mg tab 0 0 0 10 0 0
8 Cairan RL btl 0 0 0 0 0 0
9 Captopril tablet 25 mg tab 50 100 150 100 50 200
10 Deksametasone tablet 0,5 mg tab 100 300 400 400 0 300
11 Salbutamol tab 0 0 0 0 0 0
12 Etanol/Alkohol 70 % btl 0 1 1 0 0 1
13 Erythromycin Sirup btl 2 10 12 12 0 15
14 Fitomenadion/Vit K injeksi amp 0 0 0 0 0 0
15 Garam Oralit 200 ml sak 0 0 0 2 0 0
16 Gentian Violet larutan 1% btl 0 0 0 0 0 0
17 Antasida Syr btl 1 5 6 6 0 5
18 Griseofulvin tablet 125 mg tab 0 0 0 10 0 0
19 Gentamicin salep kulit 3% tube 0 5 5 4 0 0
20 Acyclovir salep tube 0 0 0 0 0 5
21 Hidrokortison krim 2,5% btl 0 3 3 3 0 3
22 Handscoon Non Steril set 0 0 0 0 0 0
23 Hemafort tab 0 0 0 0 0 0
24 Kertas puyer krts 0 0 0 0 0 0
25 Kalsium Laktat tablet 500mg tab 0 200 200 100 100 200
26 Kapas 250gr bks 0 0 0 0 0 0
27 Kasa 2m x 80m bks 0 0 0 0 0 0
28 Kasa/Verband 4cm x 10cm roll 0 0 0 0 0 0
29 Klorampenikol kapsul 250 mg kaps 100 0 100 100 0 100
30 Klorampenikol salep mata 1 % tube 0 0 0 0 0 0
31 Klorampenikol tetes telinga 3% btl 0 3 3 0 0 0
32 Klorfeniramin Maleat/CTM tablet tab 100 100 200 100 100 100
33 Kotrimoxasol Sirup btl 0 10 10 0 10 10
34 Kotrimoxasol tablet dewasa tab 0 100 100 100 0 100
35 Masker pack 0 50 50 50 0 50
36 Metronidazole tablet 250 mg tab 0 0 0 0 0 0
37 ERITROMICYN 500 mg bks 0 100 100 50 50 100
38 Parasetamol Sirup 120/ 5 ml btl 0 15 15 15 0 20
39 Parasetamol tablet 500 mg tab 100 700 800 700 100 700
40 Acetylcysteine cap 0 0 0 0 0 0
41 Piridoksin/Vit B6 tablet tab 0 0 0 0 0 100
42 Plester roll 0 0 0 0 0 0
43 Prednison tablet 5 mg tab 100 0 100 100 0 200
44 Plastik Klip bks 0 0 0 0 0 0
45 Plastik 1 kg bks 0 0 0 0 0 0
46 Salisil bedak pack 1 5 6 5 1 5
47 Spuit 1ml tab 0 20 20 10 0 10
48 Spuit 0,5cc bks 50 100 150 50 50 0
49 Spuit 3cc bks 0 50 50 50 50 50
50 Spuit 5 cc bks 5 0 5 4 1 0
51 Ambroxol tab 0 100 100 100 0 200
52 Sendok Sirup biji 0 0 0 0 0 50
53 Tablet tambah darah/FE tab 100 300 400 50 350 300
54 Tiamin/ Vit B1 tablet 50 mg tab 100 200 300 300 0 200
55 Vit BC tablet tab 0 400 400 400 0 400
56 Zink tab 0 0 0 0 0 0
57 Bromhexine HCl Syr btl 0 15 15 3 12 20
58 Povidon 300cc btl 0 0 0 0 0 0
59 Zink Syr btl 0 0 0 0 0 0
60 OBH Syr btl 0 15 15 0 15 20

Bayar ASKES KIS/JPS BPJS Cuma2 Jumlah

400 50 450

Jumlah Retribusi Yang Disetor

Mengetahui Yang menyerahkan Yang meminta/melapor

Kepala Puskesmas Petugas Gudang Pustu/Polindes

HARDI INDRIYANTO Ssi, Apt TITIK NUR AINI

drg. Achmad Muchtar NIP. 19770215 201001 1009 NIP. 19840601 2006 04 2018
NIP. 19641025 199203 1 006
OBAT EMERGENCY POLINDES CARAT NOPEMBER 2017

NO NAMA BARANG JUMLAH TAHUN EXIPIRED

2018 2019 2020 2021 2022
1 Inj. Aminophiline 1 Amp JUNI
2 Inj. Diphenhydramin 2 Amp MARET
3 Inj. Metylergometrin 3 Amp JANUARI
4 Inj. Dexametasone 3 Amp SEPTEMBER
5 Inj. Ephinephrine 3 Amp SEPTEMBER MARET
6 Spuit 2,5 cc 3 Bj JUNI
7 Aqua Pro injection 3 Bj 19-Jan
8 Cairan RL 1 Bj MARET
9 Cairan NaCl 0,9 % 1 Bj JANUARI
10 Infus set dewasa 2 Bj 9-Sep