LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

PUSTU/POSKESDES/POSYANDU/PROGRAM(*) : LIPU BOGU

BULAN PEMAKAIAN : MEI
BULAN PERMINTAAN : JUNI
TAHUN : 2020
SATUAN STOK PENERI PERSE PEMA RUSAK/ SISA PERMIN
KODE NAMA OBAT TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK TAAN
1 2 3 4 5 6=4+5 7 8 9=6-7-8 11
OBAT CAIR
1 Alkohol 70% 1000 ml botol - - - - - - 1
2 Ambroxol sirup botol 3
3 Amoxicillin sirup botol 4
4 Antalgin inj ampul -
5 Antasida sirup botol 5
6 Cetirizine sirup botol 4
Cotrimoksazole (anak) Komb tiap 5 ml :
Sulfametoksazol 200 mg + Trimetoprim 40 mg botol
7
8 Diphenhydramine inj ampul 10
9 Erythromycin sirup botol 2
10 Furosemide inj ampul -
11 Ibuprofen sirup botol -
12 Ketorolac inj ampul -
13 Lidocaine inj ampul -
14 Lysol cairan botol -
15 Methylergometrin maleate inj ampul -
16 Metoklopramide sirup botol -
17 Omegdiar sirup botol -
18 Pacdin cough sirup botol -
19 Paracetamol infus botol -
20 Pirantel Pamoat Sirup 125 mg/5 mL botol -
21 Povidone 300 ml botol -
22 Ranitidine inj ampul -
23 Renalyte electrolytes botol -
24 Rivanol 300 ml botol -
25 Vit amin B12 inj ampul -
26 ZINCPRO Sulfate 10 mg/mL botol 10
-
OBAT PADAT
27 Acyclovir 400 mg tablet -
106 Albendazole 400 mg tablet -
107 Allopurinol 100 mg tablet 100
109 Ambroksol 30 mg tablet 100
113 Amlodipine 5 mg tablet -
114 Amoxicillin 500 mg tablet 100
115 Antalgin 500 mg tablet -
116 Antasida doen tablet 100
118 Asam Folat 1 mg tablet -
119 Asam mefenamat 500 mg tablet 100
120 Asam traneksamat 500 mg tablet -
122 Attapulgite tablet -
123 Betahistin tab tablet -
127 Bisoprolol 5 mg tablet -
128 Bromhexine 8 mg tablet -
129 Calsium lactate 500 mg tablet -
130 Captopril 12,5 mg tablet 100
135 Cetirizine 10 mg tablet -
136 Chloramphenicol 500 mg tablet -
137 Chlorpheniramine 4 mg tablet 100
138 Ciprofloxacin 500 mg tablet -
144 Cotrimoxazole 480 mg tablet 30
145 Cotrimoksazole Forte Kombinasi tablet -
146 Dapyrin tablet -
147 Dexamethasone 0,5 mg tablet -
152 Diklofenac sodium 50 mg tablet -
155 Domperidone 10 mg tablet -
162 Erythromycin 500 mg tablet -
165 Furosemide 40 mg tablet -
166 Glibenclamide 5 mg tablet -
167 Glimepiride 2 mg tablet -
168 Glimepiride 4 mg tablet -
169 Glyceryl guaiacolate 100 mg tablet -
171 Griseofulvin 125 mg tablet -
173 Hydrochlorothiazide 25 mg tablet -
175 Ibuprofen 400 mg tablet -
176 Isosorbid Dinitrat 5 mg tablet -
179 Ketoconazole 200 mg tablet -
184 Lanzoprasol 30 mg tablet -
187 Loperamide 2 mg tablet -
189 Meloxicam tab 7,5 mg tablet -
193 Metilergometrin maleat tab 0,125 mg tablet -
195 Metilprednisolon tab 4 mg tablet 100
196 Metoclopramide 10 mg tablet -
201 Nifedipine 10 mg tablet -
210 Ondansetron 4 mg tablet -
211 Ondansetron 8 mg tablet -
215 Paracetamol 500 mg tablet 50
219 Prednison 5 mg tablet -
225 Pyrantel tab 125 mg tablet -
226 Ranitidine 150 mg tablet -
227 Salbutamol 2 mg tablet -
228 Salbutamol 4 mg tablet 100
230 Simvastatin 10 mg tablet 60
232 Sucralfate 500 mg (ULSIDEX) tablet -
234 Tetrasiklin 500 mg tablet -
235 Thiamphenicol 500 mg tablet -
238 Tablet Tambah Darah tablet 60
239 Valsartan tab 80 mg tablet -
241 Vitamin A 100.000 IU tablet -
242 Vitamin A 200.000 IU tablet -
243 Vitamin B complex tablet 100
244 Vitamin B1 50 mg tablet 100
245 Vitamin B6 10 mg tablet 100
246 Vitamin B12 tablet -
247 Vitamin C 50 mg tablet 100
248 Vitamin K 10 mg tablet -
249 VIDABION Cal. Multivitamin tablet 100
250 Zinc 20 mg tablet 100

OBAT SALEP/SERBUK
271 Acyclovir cream tube -

Aseptic alkohol gel antiseptic pembersih tangan botol 1

272
Antifungi DOEN Salep, Kombinasi : Asam
pot -
273 Benzoat 6% + Asam Salisilat 3%
AntiBakteri Salep : Basitrasin 500 IU/g +
Polimiksin 10.000 Iu/g tube -
274
275 Betametason cream tube 5
278 Burnazin silver sulphadiazine tube -
280 Chloramphenicol salep kulit tube -
281 Chloramphenicol salep mata tube 5
282 Cutimed gel tube -
283 Desoximetasone cream tube -
284 Diclofenac sodium gel tube -
285 Fucilex Krim Sodium Fusidat 20% 20 mg/mL tube -
286 Gentamicin salep mata tube -
287 Garam Oralit Serbuk Kombinasi sachet 10
288 Hydrocortisone cream tube 5
289 Ichtyol salep pot -
290 Ketoconazole cream tube 5
291 Lidocain jelly dispo -
292 Miconazole cream tube -
293 My Jelli tube -
294 Nebacetin salep tube -
295 Salep 2-4 pot -
296 Salisil bedak kotak -
298 Sabun anti bakteri 500 ml botol -
299 Thrombophob gel tube -
300 Ultrasound gel USG botol -

OBAT LAINNYA -
304 Bisturi no. 11 pcs -
305 Bisturi no. 12 pcs -
306 Bisturi no. 20 pcs -
307 Bisturi no. 22 pcs -
308 Blood Lancet pcs -
309 Catgut Chrom 3/0 Rol 100 meter roll -
310 Catgut Chromic 2/0 + jarum pcs -
311 Catgut Chromic 3/0 + jarum pcs -
312 Catgut plain 2/0 + jarum pcs -
313 Catgut plain 3/0 + jarum pcs -
314 Celemek / Apron pcs -
324 Fixation N.W. 10x10 Rol -
325 Fixation N.W. 10x15 Rol -
332 Handscoen Examination Gloves S psg -
333 Handscoen Examination Gloves M psg 100
334 Handscoen Examination Gloves L psg -
335 Handscoen Steril Obsgyn psg -
336 Handscoen steril no. 6,5 psg -
337 Handscoen steril no. 7 psg -
338 Handscoen steril no. 7,5 psg -
339 Handscoen steril no. 8 psg 100
341 HCG test pcs -
342 HUMAN HUMASENS plus Uric Acid Test Strips -
HUMAN HUMASENS plus Total Cholesterol Test
343 Strips -

344 HUMAN HUMASENS plus Glucose Test Strips

352 Jarum jahit No. 10 pcs
353 Jarum jahit No. 11 pcs
354 Jarum jahit No. 12 pcs
355 Jarum jahit No. 13 pcs
356 Jarum jahit No. 14 pcs
357 Jarum jahit No. 15 pcs
358 Jarum jahit No. 9 pcs
359 Jarum otot besar pcs
360 Jarum otot kecil pcs
364 Kapas putih 250 g bungkus
365 Kasa hidrofil 40yard x 80cm roll
366 Kasa hidrofil 4m x 10cm rol
367 Kasa hidrofil 4m x 5cm rol
368 Kasa sterile 16x16cm pcs 25
372 Masker pcs
382 Paper Tape 1.25 x 9.14 Rol
383 Paper Tape 2.5 x 9.14 Rol
384 Paper Tape 5.0 x 9.14 Rol
385 Paper Tape 7.5 x 9.14 Rol
386 Pembalut Gibs rol
387 Pen Needle Set
388 Plester Bulat pcs
389 Plester coklat yard Leukoplast rol
392 Plester putih Polifix rol
395 Silk 2/0 pcs
396 Silk 3/0 pcs 100
408 Swab, 4-PLY -
409 Syringe 1 cc pcs
410 Syringe 3 cc pcs
411 Syringe 5 cc pcs
412 Syringe 10 cc pcs
413 Syringe 20 cc pcs
414 Syringe 50 cc pcs
415 Test Anti HCV Strip test
416 Test Anti HIV 1/2 Cassette test
417 Test HBsAg strip test
418 Test Malaria HRP2/pLDH (Pf/PAN) combo test
- - - - - 2,095

ASKES/
UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP TIDAK

BAYAR BAYAR

MENGETAHUI YANG MENYERAHKAN YANG MELAPORKAN

KEPALA PUSKESMAS BIONTONG PJ. GUDANG OBAT PJ. PROGRAM / PUSTU

HERMANTO PONTOH, AMD.Gz NIA KURNIAWATI H. DATUELA

NIP. 19800422 200902 1 002 NIP.19931206 201502 2 001
PUSTU/POSKESDES/POSYANDU/PROGRA
M(*) : LIPU BOGU
BULAN PEMAKAIAN : JUNI
BULAN PERMINTAAN : JULI
TAHUN : 2020
KO NAMA OBAT SATUAN STOK PENERI PERSE PEMA RUSAK/ SISA PERMIN
DE TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK TAAN
1 2 3 4 5 6=4+5 7 8 9=6-7-8 11
OBAT CAIR
1 Alkohol 70% 1000 ml botol - 1 1 1 - - 1
2 Ambroxol sirup botol - 3 3 3 - - 10
3 Amoxicillin sirup botol - 4 4 3 - 1 5
4 Antalgin inj ampul - - - - - - -
5 Antasida sirup botol - 5 5 5 - - 10
6 Cetirizine sirup botol - 4 4 4 - - 10
Cotrimoksazole (anak) Komb tiap 5 ml :
7 Sulfametoksazol 200 mg + Trimetoprim botol
40 mg
8 Diphenhydramine inj ampul - 10 10 4 - 6 4
Domperidone Sirup botol - 2 2 1 - 1 3
9 Erythromycin sirup botol - - - - - - 2
10 Furosemide inj ampul - - - - - - -
11 Ibuprofen sirup botol - - - - - - 5
12 Ketorolac inj ampul - - - - - - -
13 Lidocaine inj ampul - - - - - - 10
14 Lysol cairan botol - - - - - - -
15 Methylergometrin maleate inj ampul - - - - - - -
16 Metoklopramide sirup botol - - - - - - 2
17 Omegdiar sirup botol - - - - - - 3
18 Pacdin cough sirup botol - - - - - - 5
19 Paracetamol infus botol - - - - - - -
20 Pirantel Pamoat Sirup 125 mg/5 mL botol - - - - - - 2
21 Povidone 300 ml botol - - - - - - -
22 Ranitidine inj ampul - - - - - - -
23 Renalyte electrolytes botol - - - - - - -
24 Rivanol 300 ml botol - - - - - - -
25 Vit amin B12 inj ampul - 10 10 10 - - 15
26 ZINCPRO Sulfate 10 mg/mL botol - - - - - - 3
OBAT PADAT
27 Acyclovir 400 mg tablet - - - - - - -
106 Albendazole 400 mg tablet - - - - - - -
107 Allopurinol 100 mg tablet - 100 100 20 - 80 -
109 Ambroksol 30 mg tablet - 100 100 70 - 30 70
113 Amlodipine 5 mg tablet - - - - - - 100
114 Amoxicillin 500 mg tablet - 100 100 37 - 63 -
115 Antalgin 500 mg tablet - - - - - - -
116 Antasida doen tablet - 100 100 100 - - 100
118 Asam Folat 1 mg tablet - - - - - - -
119 Asam mefenamat 500 mg tablet - 100 100 100 - - 100
120 Asam traneksamat 500 mg tablet - - - - - - 30
122 Attapulgite tablet - - - - - - -
123 Betahistin tab tablet - - - - - - -
127 Bisoprolol 5 mg tablet - - - - - - -
128 Bromhexine 8 mg tablet - - - - - - 100
129 Calsium lactate 500 mg tablet - - - - - - 50
Captopril 12,5 mg 200
130 Captopril 25 mg tablet - 100 100 100 - - 10
135 Cetirizine 10 mg tablet - - - - - - 100
136 Chloramphenicol 500 mg tablet - - - - - - -
137 Chlorpheniramine 4 mg tablet - 100 100 100 - - 200
138 Ciprofloxacin 500 mg tablet - - - - - - -
144 Cotrimoxazole 480 mg tablet - 30 30 6 - 24 -
145 Cotrimoksazole Forte Kombinasi tablet - - - - - - -
146 Dapyrin tablet - - - - - - -
147 Dexamethasone 0,5 mg tablet - - - - - - 50
152 Diklofenac sodium 50 mg tablet - - - - - - 100
155 Domperidone 10 mg tablet - - - - - - 50
162 Erythromycin 500 mg tablet - - - - - - 50
165 Furosemide 40 mg tablet - - - - - - -
166 Glibenclamide 5 mg tablet - - - - - - 100
167 Glimepiride 2 mg tablet - - - - - - 50
168 Glimepiride 4 mg tablet - - - - - - -
169 Glyceryl guaiacolate 100 mg tablet - - - - - - 100
171 Griseofulvin 125 mg tablet - - - - - - -
173 Hydrochlorothiazide 25 mg tablet - - - - - - -
175 Ibuprofen 400 mg tablet - - - - - - 100
176 Isosorbid Dinitrat 5 mg tablet - - - - - - -
179 Ketoconazole 200 mg tablet - - - - - - 30
184 Lanzoprasol 30 mg tablet - - - - - - 30
187 Loperamide 2 mg tablet - - - - - - 50
189 Meloxicam tab 7,5 mg tablet - - - - - - 30
193 Metilergometrin maleat tab 0,125 mg tablet - - - - - - -
195 Metilprednisolon tab 4 mg tablet - 100 100 26 - 74 -
196 Metoclopramide 10 mg tablet - - - - - - -
201 Nifedipine 10 mg tablet - - - - - - 50
210 Ondansetron 4 mg tablet - - - - - - -
211 Ondansetron 8 mg tablet - - - - - - -
215 Paracetamol 500 mg tablet - 50 50 50 - - 100
219 Prednison 5 mg tablet - - - - - - -
225 Pyrantel tab 125 mg tablet - - - - - - -
226 Ranitidine 150 mg tablet - - - - - - -
227 Salbutamol 2 mg tablet - - - - - - -
228 Salbutamol 4 mg tablet - 100 100 - - 100 -
230 Simvastatin 10 mg tablet - 60 60 60 - - 100
232 Sucralfate 500 mg (ULSIDEX) tablet - - - - - - 50
234 Tetrasiklin 500 mg tablet - - - - - - -
235 Thiamphenicol 500 mg tablet - - - - - - -
238 Tablet Tambah Darah tablet - 60 60 - - 60 -
239 Valsartan tab 80 mg tablet - - - - - - -
241 Vitamin A 100.000 IU tablet - - - - - - -
242 Vitamin A 200.000 IU tablet - - - - - - -
243 Vitamin B complex tablet - 100 100 60 - 40 50
244 Vitamin B1 50 mg tablet - 100 100 30 - 70 -
245 Vitamin B6 10 mg tablet - 100 100 50 - 50 -
246 Vitamin B12 tablet - - - - - - -
247 Vitamin C 50 mg tablet - 100 100 76 - 24 100
248 Vitamin K 10 mg tablet - - - - - - 30
249 VIDABION Cal. Multivitamin tablet - 100 100 60 - 40 -
250 Zinc 20 mg tablet - 100 100 20 - 80 -
OBAT SALEP/SERBUK
252 Acyclovir cream tube - - - - - - -
Aseptic alkohol gel antiseptic pembersih botol - 1 1 1 - - 1
253 tangan

Antifungi DOEN Salep, Kombinasi : Asam pot - - - - - - -

Benzoat 6% + Asam Salisilat 3%
254

AntiBakteri Salep : Basitrasin 500 IU/g +

Polimiksin 10.000 Iu/g tube - - - - - - 5
255
275 Betametason cream tube - 5 5 4 - 1 5
278 Burnazin silver sulphadiazine tube - - - - - - 3
280 Chloramphenicol salep kulit tube - - - - - - -
281 Chloramphenicol salep mata tube - 5 5 1 - 4 -
282 Cutimed gel tube - - - - - - 3
283 Desoximetasone cream tube - - - - - - 5
284 Diclofenac sodium gel tube - - - - - - 5
Fucilex Krim Sodium Fusidat 20% 20 tube - - - - - - -
285 mg/mL
286 Gentamicin salep mata tube - - - - - - -
287 Garam Oralit Serbuk Kombinasi sachet - 10 10 8 - 2 10
288 Hydrocortisone cream tube - 5 5 1 - 4 -
289 Ichtyol salep pot - - - - - - 3
290 Ketoconazole cream tube - 5 5 1 - 4 -
291 Lidocain jelly dispo - - - - - - -
292 Miconazole cream tube - - - - - - -
293 My Jelli tube - - - - - - -
294 Nebacetin salep tube - - - - - - -
295 Salep 2-4 pot - - - - - - 5
296 Salisil bedak kotak - - - - - - 5
298 Sabun anti bakteri 500 ml botol - - - - - - 1
299 Thrombophob gel tube - - - - - - -
300 Ultrasound gel USG botol - - - - - -
OBAT LAINNYA
304 Bisturi no. 11 pcs - - - - - - 5
305 Bisturi no. 12 pcs - - - - - - 5
306 Bisturi no. 20 pcs - - - - - - 5
307 Bisturi no. 22 pcs - - - - - - 5
308 Blood Lancet pcs - - - - - - 5
309 Catgut Chrom 3/0 Rol 100 meter roll - - - - - - 1
310 Catgut Chromic 2/0 + jarum pcs - - - - - - 5
311 Catgut Chromic 3/0 + jarum pcs - - - - - - 5
312 Catgut plain 2/0 + jarum pcs - - - - - - 5
313 Catgut plain 3/0 + jarum pcs - - - - - - 5
314 Celemek / Apron pcs - - - - - - -
324 Fixation N.W. 10x10 Rol - - - - - - -
325 Fixation N.W. 10x15 Rol - - - - - - -
332 Handscoen Examination Gloves S psg - - - - - - -
333 Handscoen Examination Gloves M psg - - - - - - -
334 Handscoen Examination Gloves L psg - 100 100 10 - 90 -
335 Handscoen Steril Obsgyn psg - - - - - - 2
336 Handscoen steril no. 6,5 psg - - - - - - -
337 Handscoen steril no. 7 psg - - - - - - -
338 Handscoen steril no. 7,5 psg - - - - - - 5
339 Handscoen steril no. 8 psg - - - - - - -
341 HCG test pcs - 100 100 4 96 -
HUMAN HUMASENS plus Uric Acid Test
- - - - - - -
342 Strips
HUMAN HUMASENS plus Total - - - - - - -
343 Cholesterol Test Strips
HUMAN HUMASENS plus Glucose Test - - - - - - -
344 Strips
352 Jarum jahit No. 10 pcs
353 Jarum jahit No. 11 pcs
354 Jarum jahit No. 12 pcs
355 Jarum jahit No. 13 pcs
356 Jarum jahit No. 14 pcs
357 Jarum jahit No. 15 pcs
358 Jarum jahit No. 9 pcs
359 Jarum otot besar pcs
360 Jarum otot kecil pcs
364 Kapas putih 250 g bungkus
365 Kasa hidrofil 40yard x 80cm roll
366 Kasa hidrofil 4m x 10cm rol
367 Kasa hidrofil 4m x 5cm rol
368 Kasa sterile 16x16cm pcs
372 Masker pcs - 25 25 25 - - 50
382 Paper Tape 1.25 x 9.14 Rol
383 Paper Tape 2.5 x 9.14 Rol
384 Paper Tape 5.0 x 9.14 Rol
385 Paper Tape 7.5 x 9.14 Rol
386 Pembalut Gibs rol
387 Pen Needle Set
388 Plester Bulat pcs
389 Plester coklat yard Leukoplast rol
392 Plester putih Polifix rol 1
395 Silk 2/0 pcs
396 Silk 3/0 pcs
408 Swab, 4-PLY - 100 100 26 - 74 -
409 Syringe 1 cc pcs - - - - - - 20
410 Syringe 3 cc pcs
411 Syringe 5 cc pcs
412 Syringe 10 cc pcs
413 Syringe 20 cc pcs
414 Syringe 50 cc pcs
415 Test Anti HCV Strip test
416 Test Anti HIV 1/2 Cassette test
417 Test HBsAg strip test

Test Malaria HRP2/pLDH (Pf/PAN) combo test

418
4 2,100 2,095 1,084 1,018 2,556

ASKES/
UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP TIDAK

BAYAR BAYAR 4 34

24 5

MENGETAHUI YANG MENYERAHKAN YANG MELAPORKAN

KEPALA PUSKESMAS BIONTONG PJ. GUDANG OBAT PJ. PROGRAM / PUSTU

HERMANTO PONTOH, AMD.Gz NIA KURNIAWATI H. DATUELA

NIP. 19800422 200902 1 002 NIP.19931206 201502 2 001
PUSTU/POSKESDES/POSYANDU/
PROGRAM(*) : LIPU BOGU
BULAN PEMAKAIAN : JULI
BULAN PERMINTAAN : AGUSTUS
TAHUN : 2020
KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA RUSAK/ SISA
TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK
1 2 3 4 5 6=4+5 7 8 9=6-7-8
OBAT CAIR
1 Alkohol 70% 1000 ml botol - 1 - 1 - 1
2 Ambroxol sirup botol - - - - -
3 Amoxicillin sirup botol 1 5 6 - - 6
4 Antalgin inj ampul - - - - - -
5 Antasida sirup botol - 10 10 10 - -
6 Cetirizine sirup botol - - - - - -

Cotrimoksazole (anak)
7 Komb tiap 5 ml : botol - - - - -
Sulfametoksazol 200 mg
+ Trimetoprim 40 mg

8 Diphenhydramine inj ampul 6 - 5 - -

9 Domperidone Sirup botol 1 3 4 - - 4
10 Erythromycin sirup botol - - - - - -
11 Furosemide inj ampul - - - - - -
12 Ibuprofen sirup botol - - - - - -
13 Ketorolac inj ampul - - - - - -
14 Lidocaine inj ampul - 10 10 - - 10
15 Lysol cairan botol - - - - - -

16 Methylergometrin ampul - - - - - -
maleate inj
17 Metoklopramide sirup botol - - - - - -
18 Omegdiar sirup botol - - - - - -
19 Pacdin cough sirup botol - - - - - -
20 Paracetamol infus botol - - - - - -
Pirantel Pamoat Sirup
21 125 mg/5 mL botol - - - - - -

22 Povidone 300 ml botol - - - - - -

23 Ranitidine inj ampul - - - - - -
24 Renalyte electrolytes botol - - - - - -
25 Rivanol 300 ml botol - - - - - -
26 Vit amin B12 inj ampul - 15 15 3 3 9
ZINCPRO Sulfate 10
27 mg/mL botol - - - - - -

OBAT PADAT
28 Acyclovir 400 mg tablet - - - - - -
29 Albendazole 400 mg tablet - - - - - -
30 Allopurinol 100 mg tablet 80 - 80 20 - 60
31 Ambroksol 30 mg tablet 30 100 130 100 - 30
32 Amlodipine 5 mg tablet - - - - - -
33 Amoxicillin 500 mg tablet 63 - 63 20 - 33
34 Antalgin 500 mg tablet - - - - - -
35 Antasida doen tablet - 100 100 100 - -
36 Asam Folat 1 mg tablet - - - - - -

37 Asam mefenamat 500 tablet - 100 100 100 - -

mg
Asam traneksamat 500
38 mg tablet - - - - - -

29 Attapulgite tablet - - - - - -
40 Betahistin tab tablet - - - - - -
41 Bisoprolol 5 mg tablet - - - - - -
42 Bromhexine 8 mg tablet - - - - - -
43 Calsium lactate 500 mg tablet - - - - - -
44 Captopril 12,5 mg 200 200 156 44
45 Captopril 25 mg tablet - - - - - -
46 Cetirizine 10 mg tablet - - - - - -

47 Chloramphenicol 500 mg tablet - - - - - -

48 Chlorpheniramine 4 mg tablet - 100 100 100 - -

49 Ciprofloxacin 500 mg tablet - - - - - -
50 Cotrimoxazole 480 mg tablet 24 - 24 - - 24
Cotrimoksazole Forte
51 Kombinasi tablet - - - - - -

52 Dapyrin tablet - - - - - -
53 Dexamethasone 0,5 mg tablet - 50 50 50 - -

54 Diklofenac sodium 50 mg tablet - - - - - -

55 Domperidone 10 mg tablet - - - - - -
56 Erythromycin 500 mg tablet - - - - - -
57 Furosemide 40 mg tablet - - - - - -
58 Glibenclamide 5 mg tablet - 100 100 30 - 70
59 Glimepiride 2 mg tablet - 50 50 - - 50
60 Glimepiride 4 mg tablet - - - - - -
Glyceryl guaiacolate 100
61 mg tablet - - - - - -

62 Griseofulvin 125 mg tablet - - - - - -

Hydrochlorothiazide 25
63 mg tablet - - - - - -

64 Ibuprofen 400 mg tablet - - - - - -

65 Isosorbid Dinitrat 5 mg tablet - - - - - -
66 Ketoconazole 200 mg tablet - - - - - -
67 Lanzoprasol 30 mg tablet - - - - - -
68 Loperamide 2 mg tablet - - - - - -
69 Meloxicam tab 7,5 mg tablet - - - - - -
Metilergometrin maleat
70 tablet - - - - - -
tab 0,125 mg
71 Metilprednisolon tab 4 tablet 74 74 74 10 - 64
mg
72 Metoclopramide 10 mg tablet - - - - - -
73 Nifedipine 10 mg tablet - 50 50 23 37
74 Ondansetron 4 mg tablet - - - - - -
75 Ondansetron 8 mg tablet - - - - - -
76 Paracetamol 500 mg tablet - 200 200 67 - 133
77 Prednison 5 mg tablet - - - - - -
78 Pyrantel tab 125 mg tablet - - - - - -
79 Ranitidine 150 mg tablet - - - - - -
80 Salbutamol 2 mg tablet - - - - - -
81 Salbutamol 4 mg tablet 100 100 100 - - 100
82 Simvastatin 10 mg tablet - 100 100 90 - 10
Sucralfate 500 mg
83 (ULSIDEX) tablet - 50 50 50 - -

84 Tetrasiklin 500 mg tablet - - - - - -

85 Thiamphenicol 500 mg tablet - - - - - -
86 Tablet Tambah Darah tablet 60 - 60 10 - 50
87 Valsartan tab 80 mg tablet - - - - - -
88 Vitamin A 100.000 IU tablet - - - - - -
89 Vitamin A 200.000 IU tablet - - - - - -
90 Vitamin B complex tablet 40 50 90 - - 90
91 Vitamin B1 50 mg tablet 70 - 70 10 - 60
92 Vitamin B6 10 mg tablet 50 - 50 46 - 4
93 Vitamin B12 tablet - 100 100 26 - 74
94 Vitamin C 50 mg tablet 24 100 124 54 - 70
95 Vitamin K 10 mg tablet - 100 100 - - 100
VIDABION Cal.
96 tablet 40 100 100 60 - 40
Multivitamin
97 Zinc 20 mg tablet 80 - 80 10 - 70
OBAT SALEP/SERBUK
98 Acyclovir cream tube - - - - - -
Aseptic alkohol gel
99 antiseptic pembersih botol - - - - - -
tangan

Antifungi DOEN Salep,

Kombinasi : Asam
100 Benzoat 6% + Asam pot - - - - - -
Salisilat 3%

AntiBakteri Salep :
101 Basitrasin 500 IU/g + tube - - - - - -
Polimiksin 10.000 Iu/g
102 Betametason cream tube 1 5 6 - - 6
Burnazin silver
103 sulphadiazine tube - - - - - -

Chloramphenicol salep
104 kulit tube - - - - - -
105 Chloramphenicol salep tube 4 - 4 1 - 3
mata
106 Cutimed gel tube - - - - - -
107 Desoximetasone cream tube - 5 5 2 - 3
108 Diclofenac sodium gel tube - - - - - -
Fucilex Krim Sodium
109 Fusidat 20% 20 mg/mL tube - - - - - -

110 Gentamicin salep mata tube - - - - - -

Garam Oralit Serbuk
111 sachet 2 10 12 11 - 1
Kombinasi
112 Hydrocortisone cream tube 4 - 4 - - 4
113 Ichtyol salep pot - - - - - -
114 Ketoconazole cream tube 4 - 4 1 - 3
115 Lidocain jelly dispo - - - - - -
116 Miconazole cream tube - - - - - -
117 My Jelli tube - - - - - -
118 Nebacetin salep tube - - - - - -
119 Salep 2-4 pot - 5 5 - - 5
120 Salisil bedak kotak - - - - - -
Sabun anti bakteri 500
121 ml botol - - - - - -

122 Thrombophob gel tube - - - - - -

123 Ultrasound gel USG botol - - - - - -
OBAT LAINNYA - - - - - -
124 Bisturi no. 11 pcs - 5 5 - - 5
125 Bisturi no. 12 pcs - 5 5 - - 5
126 Bisturi no. 20 pcs - - - - - -
127 Bisturi no. 22 pcs - - - - - -
128 Blood Lancet pcs - - - - - -

129 Catgut Chrom 3/0 Rol roll - - - - - -

100 meter
Catgut Chromic 2/0 +
130 jarum pcs - - - - - -

Catgut Chromic 3/0 +

131 jarum pcs - - - - - -

132 Catgut plain 2/0 + jarum pcs - - - - - -

133 Catgut plain 3/0 + jarum pcs - - - - - -

134 Celemek / Apron pcs - - - - - -

135 Fixation N.W. 10x10 Rol - - - - - -
136 Fixation N.W. 10x15 Rol - - - - - -

137 Handscoen Examination psg - - - - - -

Gloves S
Handscoen Examination
138 Gloves M psg - - - - - -

139 Handscoen Examination psg 90 - 90 10 - 80

Gloves L
140 Handscoen Steril Obsgyn psg - 2 2 - - 2

141 Handscoen steril no. 6,5 psg - - - - - -

142 Handscoen steril no. 7 psg - - - - - -

143 Handscoen steril no. 7,5 psg - 5 5 - - 5

144 Handscoen steril no. 8 psg - - - - - -

145 HCG test pcs 96 - 96 3 93

146 HUMAN HUMASENS plus - - - - - -

Uric Acid Test Strips

HUMAN HUMASENS plus

147 Total Cholesterol Test - - - - - -
Strips
HUMAN HUMASENS plus
148 Glucose Test Strips - - - - - -

149 Jarum jahit No. 10 pcs

150 Jarum jahit No. 11 pcs - -
151 Jarum jahit No. 12 pcs - - - - - -
152 Jarum jahit No. 13 pcs - - - - - -
153 Jarum jahit No. 14 pcs - - - - - -
154 Jarum jahit No. 15 pcs - - - - - -
155 Jarum jahit No. 9 pcs - - - - - -
156 Jarum otot besar pcs - - - - - -
157 Jarum otot kecil pcs - - - - - -
158 Kapas putih 250 g bungkus 20 - 20 - - 20

159 Kasa hidrofil 40yard x roll - - - - - -

80cm

160 Kasa hidrofil 4m x 10cm rol - - - - - -

161 Kasa hidrofil 4m x 5cm rol - - - - - -

162 Kasa sterile 16x16cm pcs - - - - - -
163 Masker pcs - - - - - -
164 Paper Tape 1.25 x 9.14 Rol - - - - - -
165 Paper Tape 2.5 x 9.14 Rol - - - - - -
166 Paper Tape 5.0 x 9.14 Rol - - - - - -
167 Paper Tape 7.5 x 9.14 Rol - - - - - -
168 Pembalut Gibs rol - - - - - -
169 Pen Needle Set - - - - - -
170 Plester Bulat pcs - - - - - -
Plester coklat yard
171 Leukoplast rol - - - - - -

172 Plester putih Polifix rol - - - - - -

173 Silk 2/0 pcs - - - - - -
174 Silk 3/0 pcs - - - - - -
175 Swab, 4-PLY 74 - 74 70 - 4
176 Syringe 1 cc pcs - 20 20 10 - 10
 177 Syringe 3 cc pcs 20 - 20 8 - 12
178 Syringe 5 cc pcs - - - - - -
179 Syringe 10 cc pcs - - - - - -
180 Syringe 20 cc pcs - - - - - -
181 Syringe 50 cc pcs - - - - - -
182 Test Anti HCV Strip test - - - - - -

183 Test Anti HIV 1/2 test - - - - - -

Cassette
184 Test HBsAg strip test - - - - - -

185 Test Malaria HRP2/pLDH test - - - - - -

(Pf/PAN) combo

1,062 1,935 2,767 1,274 1,504

ASKES/
UMUM JUMLAH
BPJS
JUMLAH KUNJUNGAN
RESEP BAYAR TIDAK
BAYAR 16 38
20 2

MENGETAHUI YANG MENYERAHKAN YANG MELAPORKAN

KEPALA PUSKESMAS BIONTONG PJ. GUDANG OBAT PJ. PROGRAM / PUSTU

HERMANTO PONTOH, AMD.Gz NIA KURNIAWATI H. DATUELA

NIP. 19800422 200902 1 002 NIP.19931206 201502 2 001
PERMIN
TAAN
11

10
-
-
10
10

-
-
2
-
-
-

2
3
5
-

-
-
-
-
-

-
-
-
100
100
100
-
100
-

100

30

-
-
-
100
-
100
100
100

100
-
-

-
100

100

-
50
-
-
-
-

100

100
-

100

-
 -

-
-
-
-
-
-
-
-
-
-
100

100

-
-
-
-
-
-
-
-
100
-
-
-

-
 -

3
-
5

20

-
3
-
-
-
-
-
-
5

-
-
-
-
-
-
-
-

-
-
-

-
 -

-
-

-
-
-
-
-
-
-
-

-
-
50
-
-
-
-
-
-
-

100
10
 -
-
-
-
-
-

2,142

LAPORKAN
AM / PUSTU

ATI H. DATUELA
6 201502 2 001
PUSTU/POSKESDES/POSYANDU/
PROGRAM(*) : LIPU BOGU
BULAN PEMAKAIAN : AGUSTUS
BULAN PERMINTAAN : SEPTEMBER
TAHUN : 2020
KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA RUSAK/ SISA
TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK
1 2 3 4 5 6=4+5 7 8 9=6-7-8
OBAT CAIR
1 Alkohol 70% 1000 ml botol 1 - 1 1 - 1
2 Ambroxol sirup botol - - - - -
3 Amoxicillin sirup botol 6 - 6 2 - 4
4 Antalgin inj ampul - - - - - -
5 Antasida sirup botol - - - 10 - -
6 Cetirizine sirup botol - - - - - -

Cotrimoksazole (anak)
7 Komb tiap 5 ml : botol - - - - - -
Sulfametoksazol 200 mg
+ Trimetoprim 40 mg

8 Diphenhydramine inj ampul - - 5 - -

9 Domperidone Sirup botol 4 - 4 - - 4
10 Erythromycin sirup botol - - - - - -
11 Furosemide inj ampul - - - - - -
12 Ibuprofen sirup botol - - - - - -
13 Ketorolac inj ampul - - - - - -
14 Lidocaine inj ampul 10 - 10 - - 10
15 Lysol cairan botol - - - - - -

16 Methylergometrin ampul - - - - - -
maleate inj
17 Metoklopramide sirup botol - - - - - -
18 Omegdiar sirup botol - - - - - -
19 Pacdin cough sirup botol - - - - - -
20 Paracetamol infus botol - - - - - -
Pirantel Pamoat Sirup
21 125 mg/5 mL botol - - - - - -

22 Povidone 300 ml botol - - - - - -

23 Ranitidine inj ampul - - - - - -
24 Renalyte electrolytes botol - - - - - -
25 Rivanol 300 ml botol - - - - - -
26 Vit amin B12 inj ampul 9 - 9 3 3 9
ZINCPRO Sulfate 10
27 mg/mL botol - - - - - -

OBAT PADAT
28 Acyclovir 400 mg tablet - - - - - -
29 Albendazole 400 mg tablet - - - - - -
30 Allopurinol 100 mg tablet 60 - 60 20 - 60
31 Ambroksol 30 mg tablet 30 - 30 100 - 30
32 Amlodipine 5 mg tablet - - - - - -
33 Amoxicillin 500 mg tablet 33 - 33 20 - 33
34 Antalgin 500 mg tablet - - - - - -
35 Antasida doen tablet - - - 100 - -
36 Asam Folat 1 mg tablet - - - - - -

37 Asam mefenamat 500 tablet - - - 100 - -

mg
Asam traneksamat 500
38 mg tablet - - - - - -

29 Attapulgite tablet - - - - - -
40 Betahistin tab tablet - - - - - -
41 Bisoprolol 5 mg tablet - - - - - -
42 Bromhexine 8 mg tablet - - - - - -
43 Calsium lactate 500 mg tablet - - - - - -
44 Captopril 12,5 mg 44 - 44 156 44
45 Captopril 25 mg tablet - - - - - -
46 Cetirizine 10 mg tablet - - - - - -

47 Chloramphenicol 500 mg tablet - - - - - -

48 Chlorpheniramine 4 mg tablet - - - 100 - -

49 Ciprofloxacin 500 mg tablet - - - - - -
50 Cotrimoxazole 480 mg tablet 24 - 24 - - 24
Cotrimoksazole Forte
51 Kombinasi tablet - - - - - -

52 Dapyrin tablet - - - - - -
53 Dexamethasone 0,5 mg tablet - - - 50 - -

54 Diklofenac sodium 50 mg tablet - - - - - -

55 Domperidone 10 mg tablet - - - - - -
56 Erythromycin 500 mg tablet - - - - - -
57 Furosemide 40 mg tablet - - - - - -
58 Glibenclamide 5 mg tablet 70 - 70 30 - 70
59 Glimepiride 2 mg tablet 50 - 50 - - 50
60 Glimepiride 4 mg tablet - - - - - -
Glyceryl guaiacolate 100
61 mg tablet - - - - - -

62 Griseofulvin 125 mg tablet - - - - - -

Hydrochlorothiazide 25
63 mg tablet - - - - - -

64 Ibuprofen 400 mg tablet - - - - - -

65 Isosorbid Dinitrat 5 mg tablet - - - - - -
66 Ketoconazole 200 mg tablet - - - - - -
67 Lanzoprasol 30 mg tablet - - - - - -
68 Loperamide 2 mg tablet - - - - - -
69 Meloxicam tab 7,5 mg tablet - - - - - -
Metilergometrin maleat
70 tablet - - - - - -
tab 0,125 mg
71 Metilprednisolon tab 4 tablet 64 - 64 10 - 64
mg
72 Metoclopramide 10 mg tablet - - - - - -
73 Nifedipine 10 mg tablet 37 - 37 23 37
74 Ondansetron 4 mg tablet - - - - - -
75 Ondansetron 8 mg tablet - - - - - -
76 Paracetamol 500 mg tablet 133 - 133 67 - 133
77 Prednison 5 mg tablet - - - - - -
78 Pyrantel tab 125 mg tablet - - - - - -
79 Ranitidine 150 mg tablet - - - - - -
80 Salbutamol 2 mg tablet - - - - - -
81 Salbutamol 4 mg tablet 100 - 100 - - 100
82 Simvastatin 10 mg tablet 10 - 10 90 - 10
Sucralfate 500 mg
83 (ULSIDEX) tablet - - - 50 - -

84 Tetrasiklin 500 mg tablet - - - - - -

85 Thiamphenicol 500 mg tablet - - - - - -
86 Tablet Tambah Darah tablet 50 - 50 10 - 50
87 Valsartan tab 80 mg tablet - - - - - -
88 Vitamin A 100.000 IU tablet - - - - - -
89 Vitamin A 200.000 IU tablet - - - - - -
90 Vitamin B complex tablet 90 - 90 - - 90
91 Vitamin B1 50 mg tablet 60 - 60 10 - 60
92 Vitamin B6 10 mg tablet 4 - 4 46 - 4
93 Vitamin B12 tablet 74 - 74 26 - 74
94 Vitamin C 50 mg tablet 70 - 70 54 - 70
95 Vitamin K 10 mg tablet 100 - 100 - - 100
VIDABION Cal.
96 tablet 40 - 40 60 - 40
Multivitamin
97 Zinc 20 mg tablet 70 - 70 10 - 70
OBAT SALEP/SERBUK
98 Acyclovir cream tube - - - - - -
Aseptic alkohol gel
99 antiseptic pembersih botol - - - - - -
tangan

Antifungi DOEN Salep,

Kombinasi : Asam
100 Benzoat 6% + Asam pot - - - - - -
Salisilat 3%

AntiBakteri Salep :
101 Basitrasin 500 IU/g + tube - - - - - -
Polimiksin 10.000 Iu/g
102 Betametason cream tube 6 - 6 - - 6
Burnazin silver
103 sulphadiazine tube - - - - - -

Chloramphenicol salep
104 kulit tube - - - - - -
105 Chloramphenicol salep tube 3 - 3 1 - 3
mata
106 Cutimed gel tube - - - - - -
107 Desoximetasone cream tube 3 - 3 2 - 3
108 Diclofenac sodium gel tube - - - - - -
Fucilex Krim Sodium
109 Fusidat 20% 20 mg/mL tube - - - - - -

110 Gentamicin salep mata tube - - - - - -

Garam Oralit Serbuk
111 sachet 1 - 1 11 - 1
Kombinasi
112 Hydrocortisone cream tube 4 - 4 - - 4
113 Ichtyol salep pot - - - - - -
114 Ketoconazole cream tube 3 - 3 1 - 3
115 Lidocain jelly dispo - - - - - -
116 Miconazole cream tube - - - - - -
117 My Jelli tube - - - - - -
118 Nebacetin salep tube - - - - - -
119 Salep 2-4 pot 5 - 5 - - 5
120 Salisil bedak kotak - - - - - -
Sabun anti bakteri 500
121 ml botol - - - - - -

122 Thrombophob gel tube - - - - - -

123 Ultrasound gel USG botol - - - - - -
OBAT LAINNYA - - - - - -
124 Bisturi no. 11 pcs 5 - 5 - - 5
125 Bisturi no. 12 pcs 5 - 5 - - 5
126 Bisturi no. 20 pcs - - - - - -
127 Bisturi no. 22 pcs - - - - - -
128 Blood Lancet pcs - - - - - -

129 Catgut Chrom 3/0 Rol roll - - - - - -

100 meter
Catgut Chromic 2/0 +
130 jarum pcs - - - - - -

Catgut Chromic 3/0 +

131 jarum pcs - - - - - -

132 Catgut plain 2/0 + jarum pcs - - - - - -

133 Catgut plain 3/0 + jarum pcs - - - - - -

134 Celemek / Apron pcs - - - - - -

135 Fixation N.W. 10x10 Rol - - - - - -
136 Fixation N.W. 10x15 Rol - - - - - -

137 Handscoen Examination psg - - - - - -

Gloves S
Handscoen Examination
138 Gloves M psg - - - - - -

139 Handscoen Examination psg 80 - 80 10 - 80

Gloves L
140 Handscoen Steril Obsgyn psg 2 - 2 - - 2

141 Handscoen steril no. 6,5 psg - - - - - -

142 Handscoen steril no. 7 psg - - - - - -

143 Handscoen steril no. 7,5 psg 5 - 5 - - 5

144 Handscoen steril no. 8 psg - - - - - -

145 HCG test pcs 93 - 93 3 93

146 HUMAN HUMASENS plus - - - - - -

Uric Acid Test Strips

HUMAN HUMASENS plus

147 Total Cholesterol Test - - - - - -
Strips
HUMAN HUMASENS plus
148 Glucose Test Strips - - - - - -

149 Jarum jahit No. 10 pcs

150 Jarum jahit No. 11 pcs -
151 Jarum jahit No. 12 pcs - - - - - -
152 Jarum jahit No. 13 pcs - - - - - -
153 Jarum jahit No. 14 pcs - - - - - -
154 Jarum jahit No. 15 pcs - - - - - -
155 Jarum jahit No. 9 pcs - - - - - -
156 Jarum otot besar pcs - - - - - -
157 Jarum otot kecil pcs - - - - - -
158 Kapas putih 250 g bungkus 20 - 20 - - 20

159 Kasa hidrofil 40yard x roll - - - - - -

80cm

160 Kasa hidrofil 4m x 10cm rol - - - - - -

161 Kasa hidrofil 4m x 5cm rol - - - - - -

162 Kasa sterile 16x16cm pcs - - - - - -
163 Masker pcs - - - - - -
164 Paper Tape 1.25 x 9.14 Rol - - - - - -
165 Paper Tape 2.5 x 9.14 Rol - - - - - -
166 Paper Tape 5.0 x 9.14 Rol - - - - - -
167 Paper Tape 7.5 x 9.14 Rol - - - - - -
168 Pembalut Gibs rol - - - - - -
169 Pen Needle Set - - - - - -
170 Plester Bulat pcs - - - - - -
Plester coklat yard
171 Leukoplast rol - - - - - -

172 Plester putih Polifix rol - - - - - -

173 Silk 2/0 pcs - - - - - -
174 Silk 3/0 pcs - - - - - -
175 Swab, 4-PLY 4 - 4 70 - 4
176 Syringe 1 cc pcs 10 - 10 10 - 10
 177 Syringe 3 cc pcs 12 - 12 8 - 12
178 Syringe 5 cc pcs - - - - - -
179 Syringe 10 cc pcs - - - - - -
180 Syringe 20 cc pcs - - - - - -
181 Syringe 50 cc pcs - - - - - -
182 Test Anti HCV Strip test - - - - - -

183 Test Anti HIV 1/2 test - - - - - -

Cassette
184 Test HBsAg strip test - - - - - -

185 Test Malaria HRP2/pLDH test - - - - - -

(Pf/PAN) combo

1,508 5 1,504 1,276 1,502

ASKES/
UMUM JUMLAH
BPJS
JUMLAH KUNJUNGAN
RESEP BAYAR TIDAK
BAYAR 4 20
16 1

MENGETAHUI YANG MENYERAHKAN YANG MELAPORKAN

KEPALA PUSKESMAS BIONTONG PJ. GUDANG OBAT PJ. PROGRAM / PUSTU

HERMANTO PONTOH, AMD.Gz NIA KURNIAWATI H. DATUELA

NIP. 19800422 200902 1 002 NIP.19931206 201502 2 001
PERMIN
TAAN
11

10
-
-
10
10

-
-
2
-
-
-

2
3
5
-

-
-
-
-
-

-
-
-
100
100
100
-
100
-

100

30

-
-
-
100
-
100
100
100

100
-
-

-
100

100

-
50
-
-
-
-

100

100
-

100

-
 -

-
-
-
-
-
-
-
-
-
-
100

100

-
-
-
-
-
-
-
-
100
-
-
-

-
 -

3
-
5

20

-
3
-
-
-
-
-
-
5

-
-
-
-
-
-
-
-

-
-
-

-
 -

-
-

-
-
-
-
-
-
-
-

-
-
50
-
-
-
-
-
-
-

100
10
 -
-
-
-
-
-

2,142

LAPORKAN
AM / PUSTU

ATI H. DATUELA
6 201502 2 001
 POSYANDU/PROGR
AM(*) : LIPU BOGU
BULAN PEMAKAIAN : AGUSTUS
BULAN PERMINTAAN : SEPTEMBER
TAHUN : 2020
KODE NAMA SATUAN STOK PENERI PERSE PEMA RUSAK/ SISA PERMIN
OBAT TERKECIL AWAL MAAN DIAAN KAIAN EXP STOK TAAN
1 2 3 4 5 6=4+5 7 8 9=6-7-8 11
OBAT CAIR
Alkohol
1 70% 1000 botol 1 - 1 1 - 1
ml
Ambroxol
2 sirup botol - - - - - 10

Amoxicillin
3 botol 6 - 6 2 - 4 -
sirup

4 Antalgin ampul - - - - - - -
inj

5 Antasida botol - - - 10 - - 10
sirup
Cetirizine
6 sirup botol - - - - - - 10

Cotrimoks
azole
(anak)
Komb tiap
5 ml :
7 Sulfameto botol - - - - - - -
ksazol 200
mg +
Trimetopri
m 40 mg

8 Diphenhyd ampul - - 5 - - -
ramine inj

Domperid
9 botol 4 - 4 - - 4 -
one Sirup

10 Erythromy botol - - - - - - 2
cin sirup

11 Furosemid ampul - - - - - - -
e inj
Ibuprofen
12 sirup botol - - - - - - -

13 Ketorolac ampul - - - - - - -
inj

14 Lidocaine ampul 10 - 10 - - 10
inj
Lysol
15 cairan botol - - - - - - -
 Methylerg
16 ometrin ampul - - - - - - -
maleate inj

Metoklopr
17 amide botol - - - - - - 2
sirup
Omegdiar
18 sirup botol - - - - - - 3

Pacdin
19 cough botol - - - - - - 5
sirup
Paracetam
20 ol infus botol - - - - - - -

Pirantel
21 Pamoat botol - - - - - - 2
Sirup 125
mg/5 mL

Povidone
22 300 ml botol - - - - - - -

23 Ranitidine ampul - - - - - - -
inj
Renalyte
24 electrolyte botol - - - - - - -
s
Rivanol
25 botol - - - - - - -
300 ml

26 Vit amin ampul 9 - 9 3 3 9 -

B12 inj
ZINCPRO
27 Sulfate 10 botol - - - - - - -
mg/mL
OBAT
PADAT

28 Acyclovir tablet - - - - - - -
400 mg

29 Albendazol tablet - - - - - - -
e 400 mg

Allopurinol
30 100 mg tablet 60 - 60 20 - 60 -

Ambroksol
31 30 mg tablet 30 - 30 100 - 30 100

32 Amlodipin tablet - - - - - - 100

e 5 mg

33 Amoxicillin tablet 33 - 33 20 - 33 100

500 mg
Antalgin
34 500 mg tablet - - - - - - -
35 Antasida tablet - - - 100 - - 100
doen

36 Asam Folat tablet - - - - - - -

1 mg

Asam
37 mefenama tablet - - - 100 - - 100
t 500 mg

Asam
38 traneksam tablet - - - - - - 30
at 500 mg

29 Attapulgite tablet - - - - - - -

40 Betahistin tablet - - - - - - -
tab
Bisoprolol
41 5 mg tablet - - - - - - -

Bromhexin
42 e 8 mg tablet - - - - - - 100

Calsium
43 lactate 500 tablet - - - - - - -
mg
Captopril
44 12,5 mg 44 - 44 156 44 100

Captopril
45 25 mg tablet - - - - - - 100

46 Cetirizine tablet - - - - - - 100

10 mg
Chloramph
47 enicol 500 tablet - - - - - - -
mg

Chlorpheni
48 ramine 4 tablet - - - 100 - - 100
mg

Ciprofloxac
49 in 500 mg tablet - - - - - - -

Cotrimoxa
50 zole 480 tablet 24 - 24 - - 24 -
mg

Cotrimoks
51 azole Forte tablet - - - - - - -
Kombinasi

52 Dapyrin tablet - - - - - - -
 Dexameth
53 asone 0,5 tablet - - - 50 - - 100
mg

Diklofenac
54 sodium 50 tablet - - - - - - 100
mg

55 Domperid tablet - - - - - - -
one 10 mg

56 Erythromy tablet - - - - - - 50
cin 500 mg

Furosemid
57 e 40 mg tablet - - - - - - -

Glibencla
58 mide 5 mg tablet 70 - 70 30 - 70 -

Glimepirid
59 e 2 mg tablet 50 - 50 - - 50 -

60 Glimepirid tablet - - - - - - -
e 4 mg
Glyceryl
61 guaiacolat tablet - - - - - - 100
e 100 mg
Griseofulvi
62 n 125 mg tablet - - - - - - -

Hydrochlor
63 othiazide tablet - - - - - - -
25 mg

64 Ibuprofen tablet - - - - - - 100

400 mg
Isosorbid
65 Dinitrat 5 tablet - - - - - - -
mg

Ketoconaz
66 ole 200 mg tablet - - - - - -

Lanzopras
67 ol 30 mg tablet - - - - - -

Loperamid
68 e 2 mg tablet - - - - - - 100

69 Meloxicam tablet - - - - - -
tab 7,5 mg

Metilergo
70 metrin tablet - - - - - - -
maleat tab
0,125 mg
 Metilpred
71 nisolon tab tablet 64 - 64 10 - 64 -
4 mg

Metoclopr
72 amide 10 tablet - - - - - - -
mg

73 Nifedipine tablet 37 - 37 23 37 -
10 mg
Ondansetr
74 on 4 mg tablet - - - - - - -

Ondansetr
75 on 8 mg tablet - - - - - - -

76 Paracetam tablet 133 - 133 67 - 133 -

ol 500 mg

77 Prednison tablet - - - - - - -
5 mg
Pyrantel
78 tab 125 tablet - - - - - - -
mg
Ranitidine
79 tablet - - - - - - -
150 mg

80 Salbutamo tablet - - - - - - -
l 2 mg

81 Salbutamo tablet 100 - 100 - - 100 -

l 4 mg
Simvastati
82 n 10 mg tablet 10 - 10 90 - 10 100

Sucralfate
83 500 mg tablet - - - 50 - - 100
(ULSIDEX)
Tetrasiklin
84 500 mg tablet - - - - - - -

Thiamphe
85 nicol 500 tablet - - - - - - -
mg

Tablet
86 Tambah tablet 50 - 50 10 - 50 -
Darah

87 Valsartan tablet - - - - - - -
tab 80 mg

88 Vitamin A tablet - - - - - - -
100.000 IU

Vitamin A
89 200.000 IU tablet - - - - - - -

Vitamin B
90 complex tablet 90 - 90 - - 90 -
91 Vitamin B1 tablet 60 - 60 10 - 60 -
50 mg
Vitamin B6
92 10 mg tablet 4 - 4 46 - 4 100

Vitamin
93 tablet 74 - 74 26 - 74 -
B12
Vitamin C
94 50 mg tablet 70 - 70 54 - 70 -

95 Vitamin K tablet 100 - 100 - - 100 -

10 mg

VIDABION
Cal.
96 Multivitam tablet 40 - 40 60 - 40 -
in

97 Zinc 20 mg tablet 70 - 70 10 - 70 -

OBAT
SALEP/SER
BUK
Acyclovir
98 tube - - - - - - -
cream

Aseptic
alkohol gel
99 antiseptic botol - - - - - - 1
pembersih
tangan

Antifungi
DOEN
Salep,
Kombinasi
100 pot - - - - - - -
: Asam
Benzoat
6% + Asam
Salisilat 3%

AntiBakteri
Salep :
Basitrasin
101 500 IU/g + tube - - - - - - 5
Polimiksin
10.000
Iu/g

102 Betametas tube 6 - 6 - - 6 -

on cream
 Burnazin
silver
103 sulphadiazi tube - - - - - - 3
ne

Chloramph
104 enicol tube - - - - - - -
salep kulit

Chloramph
105 enicol tube 3 - 3 1 - 3 -
salep mata

Cutimed
106 tube - - - - - - 3
gel
Desoximet
107 asone tube 3 - 3 2 - 3 -
cream

108 Diclofenac tube - - - - - - 5

sodium gel

Fucilex
Krim
109 Sodium tube - - - - - - -
Fusidat
20% 20
mg/mL

Gentamici
110 n salep tube - - - - - - -
mata

Garam
111 Oralit sachet 1 - 1 11 - 1 20
Serbuk
Kombinasi

Hydrocorti
112 sone tube 4 - 4 - - 4 -
cream
Ichtyol
113 salep pot - - - - - - 3

Ketoconaz
114 ole cream tube 3 - 3 1 - 3 -

Lidocain
115 jelly dispo - - - - - - -

Miconazol
116 e cream tube - - - - - - -

117 My Jelli tube - - - - - - -

118 Nebacetin tube - - - - - - -

salep
119 Salep 2-4 pot 5 - 5 - - 5 -
120 Salisil kotak - - - - - - 5
bedak

Sabun anti
121 bakteri botol - - - - - - 1
500 ml

122 Thrombop tube - - - - - - -

hob gel
Ultrasound
123 gel USG botol - - - - - - -

OBAT
LAINNYA - - - - - - -

Bisturi no.
124 11 pcs 5 - 5 - - 5 -

125 Bisturi no. pcs 5 - 5 - - 5 -

12
Bisturi no.
126 20 pcs - - - - - - -

Bisturi no.
127 22 pcs - - - - - - -

Blood
128 Lancet pcs - - - - - - -

Catgut
Chrom 3/0
129 Rol 100 roll - - - - - - -
meter

Catgut
130 Chromic pcs - - - - - - -
2/0 +
jarum

Catgut
Chromic
131 3/0 + pcs - - - - - - -
jarum

Catgut
132 plain 2/0 + pcs - - - - - - -
jarum

Catgut
133 plain 3/0 + pcs - - - - - - -
jarum

134 Celemek / pcs - - - - - - -

Apron
Fixation
135 N.W. Rol - - - - - - -
10x10

Fixation
136 N.W. Rol - - - - - - -
10x15
 Handscoen
137 Examinatio psg - - - - - - -
n Gloves S

Handscoen
138 Examinatio psg - - - - - - -
n Gloves M

Handscoen
139 Examinatio psg 80 - 80 10 - 80 -
n Gloves L

Handscoen
140 Steril psg 2 - 2 - - 2 -
Obsgyn

Handscoen
141 steril no. psg - - - - - - -
6,5

142 Handscoen psg - - - - - - -

steril no. 7

Handscoen
143 steril no. psg 5 - 5 - - 5 -
7,5

144 Handscoen psg - - - - - - -

steril no. 8

145 HCG test pcs 93 - 93 3 93 -

HUMAN
HUMASEN
146 S plus Uric - - - - - - -
Acid Test
Strips

HUMAN
HUMASEN
S plus
147 Total - - - - - - -
Cholestero
l Test
Strips
 HUMAN
HUMASEN
148 S plus - - - - - - -
Glucose
Test Strips

149 Jarum jahit pcs

No. 10

150 Jarum jahit pcs -

No. 11

151 Jarum jahit pcs - - - - - - -

No. 12

152 Jarum jahit pcs - - - - - - -

No. 13

153 Jarum jahit pcs - - - - - - -

No. 14

154 Jarum jahit pcs - - - - - - -

No. 15

155 Jarum jahit pcs - - - - - - -

No. 9

156 Jarum otot pcs - - - - - - -

besar

Jarum otot
157 kecil pcs - - - - - - -

Kapas
158 putih 250 bungkus 20 - 20 - - 20 -
g

Kasa
hidrofil
159 40yard x roll - - - - - - -
80cm

Kasa
160 hidrofil 4m rol - - - - - - -
x 10cm

Kasa
161 hidrofil 4m rol - - - - - - -
x 5cm

Kasa
162 sterile pcs - - - - - - -
16x16cm
163 Masker pcs - - - - - - 50
164 Paper Tape Rol - - - - - - -
165 Paper Tape Rol - - - - - - -
166 Paper Tape Rol - - - - - - -
167 Paper Tape Rol - - - - - - -

168 Pembalut rol - - - - - - -

Gibs
Pen
169 Needle Set - - - - - - -

Plester
170 pcs - - - - - - -
Bulat

Plester
171 coklat yard rol - - - - - - -
Leukoplast

Plester
172 putih rol - - - - - - 1
Polifix
173 Silk 2/0 pcs - - - - - -
174 Silk 3/0 pcs - - - - - -

175 Swab, 4- 4 - 4 70 - 4 100

PLY
Syringe 1
176 cc pcs 10 - 10 10 - 10 10

Syringe 3
177 cc pcs 12 - 12 8 - 12 -

Syringe 5
178 pcs - - - - - - -
cc

179 Syringe 10 pcs - - - - - - -

cc

180 Syringe 20 pcs - - - - - - -

cc
Syringe 50
181 cc pcs - - - - - - -

182 Test Anti test - - - - - - -

HCV Strip
Test Anti
183 HIV 1/2 test - - - - - - -
Cassette

184 Test HBsAg test - - - - - - -

strip

Test
Malaria
185 HRP2/pLD test - - - - - - -
H (Pf/PAN)
combo
1,508 5 1,504 1,276 1,502 2,142