Lplpo Umum

Form.
: LPLPO Puskesmas
Laporan Pemakaian dan Lembar Permintaan Obat
PUSTU GOBLEG
Puskesmas Banjar II Dokumen Nomor Tanggal
Kecamatan Banjar Pelaporan Bulan : JANUARI 2021 Depo Farm
Kabupaten Buleleng Permintaan Bulan : FEBRUARI 2021 Puskesmas
Stok Sisa Stok Pemberian

No. Nama Obat Satuan Penerimaan Persediaan Pemakaian Permintaan Ket.
Awal Stok Optimum APBD Lain-lain Jumlah
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
TABLET/KAPSUL/KAPLET
1 Acyclovir tablet 200 mg Tablet 70 70 0 70
2 Acyclovir tablet 400 mg Tablet
3 Albendazol tablet 400 mg Tablet
4 Alopurinol tablet 100 mg Tablet 0
5 Alopurinol tablet 300 mg Tablet
6 Alprazolam tablet 0,25 mg Tablet
7 Ambroxol tablet 30 mg Tablet
8 Aminofilin tablet 200 mg Tablet 100 100 0 100
9 Amitriptilin tablet 25 mg. Tablet
10 Amlodipin tablet 10 mg Tablet
11 Amlodipin tablet 5 mg Tablet 50 300 350 220 130
12 Amoksisilin kapsul 250 mg Kapsul

13 Amoksisilin kapsul 500 mg Kapsul 200 200 80 120
14 Antalgin (Metampiron) tablet 500 mg Tablet
15 Antasida DOEN tablet 500 mg Tablet 50 50 50 0
16 Artesdiaquine tablet Tablet
17 Asam Asetil Salisilat tablet 80 - 100 mg. Tablet
18 Asam Askorbat (Vit. C) tablet 50 mg Tablet 0 0 0 0
19 Asam Folat tablet Tablet 40 40 10 30
20 Asam Mefenamat tablet 500 mg Tablet
21 Asam Traneksamat tablet 500 mg. Tablet
22 Asiklovir 400 mg tablet Tablet
23 Attapulgite 600 mg tablet Tablet
24 Azithromycin tablet 500 Tablet
25 Besi (II) Sulfat (Tambah darah) tablet Tablet
26 Betahistine Mesilat tablet Tablet 100 100 20 80
27 Bisoprolol tablet 5 mg. Tablet
28 Bromhexin tablet 8 mg Tablet
29 Calsium Laktat (Kalk) tablet 500 mg Tablet
30 Candesartan tablet 16 mg Tablet
32 Captopril tablet 12,5 mg Tablet
33 Captopril tablet 25 mg Tablet
34 Carbamazepin tablet 200 mg Tablet
35 Cefadroxil kapsul 500 mg Kapsul
36 Chloramfenikol kapsul 250 mg Kapsul
37 Chlorfeniramin Maleat (CTM) tablet 4 mg Tablet 100 100 10 90
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
38 Chlorpromazin HCL tablet salut 100 mg Tablet
39 Chorpromazin HCL tablet salut 25 mg Tablet
40 Cimetidine 200 mg tablet Tablet
41 Ciprofloxacin 500 mg kaptab Tablet
42 Clobazam 10 mg tablet Tablet
43 Clopidogrel tablet 75 mg Tablet
44 Codein HCL tablet 10 mg Tablet
45 Cotrimoksazol tablet, 480 mg Tablet
46 Dexametason tablet 0,5 mg Tablet
47 Diapet kapsul Kapsul
48 Diazepam tablet 2 mg Tablet
50 Digoksin tablet 0,25 mg Tablet
51 Diklofenak Natrium/Sodium 25 mg tablet Tablet
53 Diltiazem tablet Tablet
54 Doxyciclin 100 mg tablet Tablet
55 Ergotamin Tartat komb./Antimigren DOEN Tablet kombinasi Tablet
56 Erythromicin kapsul 500 mg Tablet
57 Ethambutol HCL tablet 250 mg Tablet
58 Fenitoin Natrium kapsul 100 mg Kapsul
59 Fenitoin Natrium Kapsul 30 mg Kapsul
60 Fenobarbital tablet 100 mg Tablet
62 Fenoksimetil Penisilin tablet 500 mg Tablet
63 Fitometadion (Vit. K1) tablet salut gula 10 mg Tablet
64 Fluor tablet 0,5 mg Tablet
65 Furosemida tablet 40 mg Tablet
66 Garam Oralit untuk 200 ml air Sachet
67 Glibenklamid Tablet 5 mg Tablet 20 0 20 0 20
68 Glikuidon tablet Tablet
69 Glimepirid tablet 1 mg Tablet
71 Gliseril Guaiakolat tablet 100 mg Tablet
72 Griseofulvin tablet 125 mg Tablet
73 Haloperidol tablet 0,5 mg Tablet
75 Haloperidol tablet 5 mg Tablet
76 Hidroklorotiazid (HCT) tablet 25 mg Tablet
77 Ibuprofen tablet 200 mg Tablet
79 Iodiol kapsul lunak Kapsul
80 Isoniazid tablet (INH) 100 mg Tablet
82 Isosorbid Dinitrat (ISDN) tablet sublingual 5 mg Tablet
83 Ketokonazol 200 mg tab. Tablet
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
84 Ketoprofen tablet 100 mg Tablet
85 Klorokuin tablet 250 mg Tablet
86 Kuinina (Kina) tablet 222 mg Tablet
87 Lanzoprazol kapsul Tablet
88 Lisinopril tablet 10 mg Tablet
90 Livron B plex tablet Tablet
91 Loperamid tablet 2 mg Tablet
92 Loratadin tablet 10 mg Tablet
93 Mebendazol tablet 100 mg Tablet
94 Meloxicam tablet 15 mg Tablet
95 Metformin tablet 500 Tablet 20 20 0 20
96 Metil Prednisolon tablet 4 mg Tablet 100
97 Metilergometrin Maleat tablet salut 0,125 mg Tablet 100 0 100 0 100
98 Metoclopramid tablet 10 mg Tablet
99 Metronidazol tablet 250 mg Tablet
100 Metronidazol tablet 500 mg Tablet 100
101 Multivitamin tablet Tablet
102 Natrium Bikarbonat tablet 500 mg Tablet
103 Nifedipin 10 mg tablet Tablet
104 Nistatin tablet salut 500.000 iu Tablet 90 90 0 90
105 Obat Antituberkulosis FDC Katagori 1 & 3 Paket tablet Paket
106 Obat Antituberkulosis FDC Katagori 2 Paket tablet Paket
107 Obat Antituberkulosis Kategori Anak Paket tablet Paket
108 Obat Antituberkulosis Kategori Sisipan Paket tablet Paket
109 Obat batuk kering tablet (DMP + Anti Histamin) Tablet
110 Obat demam, batuk, pilek tablet (PCT 500 mg, dmp, ctm, gg, Tablet
111 Obat flu tablet (PCT, PP,CTM) Tablet
112 Obat Kusta Paket MB & PB Treatment/MDT Anak Paket
113 Obat Kusta Paket MB & PB Treatment/MDT Dewasa Paket
114 Obat pilek tablet (triprolidin, pseudoefedrin) Tablet
115 Ofloxacin tablet 400 mg Tablet 20 100 120 50 70
116 Omeprazol kapsul 20 mg. Tablet
117 Ondansentron tablet 4 mg Tablet
118 Oseltamivir tablet 75 mg Tablet
119 Papaverin tablet 40 mg Tablet
120 Paraformaldehida tablet 1 gam Tablet
121 Parasetamol tablet 500 mg Tablet
122 Phenylbutason tablet 200 Tablet
123 Piracetam kapsul 1200 mg Tablet
124 Piridoksin HCL (Vit. B6) Tablet 10 mg Tablet
125 Piroxicam kapsul 10 mg Kapsul
126 Piroxicam kapsul 20 mg Kapsul 100
127 Prazikuantel tablet 600 mg Tablet
128 Prednison tablet 5 mg Tablet
129 Primaquin tablet 15 mg Tablet
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
130 Propanolol tablet 10 mg Tablet
132 Propil Tiourasil (PTU) 100 mg tablet Tablet
133 Pyrantel Pamoat 125 mg tablet Tablet
134 Ramipril tablet 2,5 mg Tablet
135 Ramipril tablet 5 mg Tablet
136 Ranitidin tablet 150 mg Tablet
137 Reserpin Tablet 0,10 mg Tablet
139 Retinol (Vit.A ) kapsul 100.000 iu Kapsul
141 Rifampisin Kapsul 300 mg Kapsul
144 Risperidon tablet 2 mg Tablet
146 Salbutamol tablet 2 mg Tablet
148 Setirizin tablet 10 mg Tablet
149 Simvastatin tablet 10 mg Tablet
150 Spironolacton tablet 100 mg. Tablet
151 Sucralfat Tablet 500 mg Tablet
152 Tetrasiklin HCL kapsul 250 mg Kapsul
153 Tetrasiklin HCL Kapsul 500 mg Kapsul
154 Thiamphenicol kapsul 500 mg Kapsul
155 Tiamin HCL/Monotatrat (Vit. B1) Tablet 50 mg Tablet
156 Tramadol tablet 50 mg Tablet
157 Triheksilfenidil (THP) Hidroklorida tablet 2 mg Tablet
158 Valsartan tablet 80 mg Tablet
159 Vitamin B Complex tablet Tablet 250 0 250 40 210
160 Vitamin Neurotropik tablet Tablet
161 Zinc 20 mg tablet Tablet
417 Kotrimoksazol Tab.Peiatrik 120 mg Tablet
OBAT MATA, TELINGA & MULUT

162 Borax Gliserin Botol
163 Chloramfenikol salep mata 1% Tube
164 Chloramfenikol tetes mata Botol
165 Chloramfenikol tetes telinga 3 % Botol
166 Fenol Gliserol tetes telinga 10% Botol
167 Gentamisin salep mata 0,3% Tube
168 Gentamisin Sulfat 0,3% Tetes Mata Botol
169 Oksitetresiklin HCL salep mata 1% Tube 24 0 24 1 23
170 Sulfasetamida Natrium tetes mata 15%-5ml Botol
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
INJEKSI
171 Aminofilin injeksi 24 mg/ml-10ml Ampul
172 Amoksisilin injeksi Ampul
173 Antalgin (Metampiron) injeksi 250 mg/ml-2ml Ampul
174 Aqua pro injeksi steril bebas pirogen Vial
175 Artemeter Injeksi. Ampul
176 Artesunate Injeksi Vial
177 Asam Traneksamat Injeksi. Ampul
178 Atrofin Sulfat Injeksi 0,25 mg/ml-1 ml Ampul
179 Benzatin Benzil Penicillin Injeksi 1,2 juta iu/vial Vial
181 Chloramfenikol serbuk injeksi 1000 mg/ml Vial
182 Chlorpromazin HCL injeksi 25 mg/ml-1ml Ampul
184 Dexametason Injeksi Ampul 5 0 5 0 5
185 Diazepam injeksi 10mg/ml Ampul
186 Diazepam injeksi 5 mg/ml Ampul
187 Difenhidramin HCL injeksi 10 mg/ml-1ml Ampul
188 Epinefrina HCL/Bitatrat (Epinefrin/Adrenalin) injeksi Ampul
189 Fenobarbital injeksi 50 mg/ml-2ml Ampul
190 Furosemid injeksi Ampul
191 Gentamisin injeksi 40 mg/ml Ampul
192 Haloperidol injeksi (IM) 5 mg/ml Ampul
193 Haloperidol injeksi inkesi (IM) 50 mg/ml Ampul
194 Hiosin Butilbromid injeksi 20 mg/ml Ampul
195 Human tetanus imunoglobulin injeksi (i.m) 250 UI Ampul
196 Kalsium Glukonat injeksi Ampul
197 Ketorolac injeksi 10 mg/ml Ampul
198 Kuinina Dihidroklorida Injeksi 25%-2ml Ampul
199 Lidokain injeksi 2% (HCL) Ampul
200 Lidokain Komp.injeksi, Komb.: Lidokain HCL 2% + Epinefrin Ampul
201 Metilergometrin Maleat injeksi. 0,200 mg 1ml Ampul
202 Metilprednisolon injeksi 125 mg/2 mL Vial
203 Metoclopramid Injeksi. Ampul
204 MgSO4 20% Injeksi. Vial
206 Natrium Tiosulfat injeksi 25%-10ml Vial
207 Oksitetrasiklin HCL injeksi i.m 50 mg/ml 10 ml Vial
208 Oksitosin injeksi 10iu/ml-1ml Ampul
209 Omeperazol injeksi 40 mg/10 ml Vial
210 Ondansetron 4 mg/ml Injeksi Ampul
211 Papaverin Injeksi Ampul
212 Piracetam Injeksi Ampul
213 Procain Benzil Penisilin injeksi 3 juta iu/vial Vial
214 Ranitidin Injeksi. Ampul
215 Sefotaksim injeksi 1 g Ampul
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
216 Seftriakson injeksi Vial
217 Serum Anti bisa Ular Polivalen Injeksi 5 ml Vial
218 Serum Anti Tetanus (ATS) injeksi 1.500 iu/amp Ampul
219 Sianokobalamin (Vit. B12) injeksi 500 mcg/ml-1ml Ampul
220 Streptomisin Sulfat serbuk injeksi 1.000 mg/vial Vial
222 Ventolin Nebolizer Ampul
223 Vit. K 10 mg/ml-1ml injeksi Ampul
224 Vit. K Infant 2mg/ml Injeksi Ampul
SALEP DAN SUPP

225 Acyclovir 5 % Cream Tube
226 Anti Bakteri DOEN Salep kombinasi (Bacitrasin- Neomicin) Pot
227 Anti Hemoroid DOEN kombinasi supp Supp
228 Antifungi DOEN Salep kombinasi (White Field Salep) Pot
229 Betametason krim 0,1 % Tube
230 Betametason Neomisin krim Tube
231 Bioplacenton Jelly Tube
232 Bisakodil supp. Anak Supp
233 Bisakodil supp. Dewasa Supp
234 Desoksimetason + Neomicin Cream Tube
235 Diazepam 10 mg/2,5 ml Supp Rectal Dewasa Tube
236 Diazepam 5 mg/2,5 ml Supp Rectal Anak Tube
237 Gameksan emulsi 1% Botol
238 Gentamisin Salep Kulit Tube
239 Gentian Violet larutan 1% Botol
240 Hidrokortison krim 2,5% Tube
241 Ketokonazol 2 % Krim. Tube
242 Ketoprofen 100 mg Supp. Supp
243 Levertran Zalf 15 g Pot
244 Lidocain gel Tube
245 Miconazole 2% Cream Tube
246 Nistatin tablet Vaginal 100.000 iu/g Supp Tab vag
247 Oksigen gas dalam tabung (Oxycan) Tabung
248 Oksitetrasiklin HCL salep kulit 3% Tube
249 Paracetamol 125 mg/2,5 ml Supp Rectal Tube
250 Paracetamol 250 mg/4 ml Supp Rectal Tube
251 Permetrin 5% Salep Tube
252 Placenta + Neomycin Cream Tube
253 Polikresulen (Albothyl) 10 ml Solution Botol
254 Salep 2-4, Komb.: As. Salisilat 2% + Belerang Endap 4% Pot 10 0 10 0 10
255 Salisil Bedak Tabur 2 % Pot
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OBAT GIGI
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
256 Air Raksa dental use Botol
257 Devitalisasi Pasta (Non Arsen) Pot
258 Etil Klorida semprot Botol
259 Eugenol cairan Botol
260 Glass Ionomer Cement (GC IX) Set
261 Kalsium Hidroksida Pasta/Cement Botol
262 Monoklorkamfer Mentol cairan (CHKM) Botol
263 Mummifying Pasta/Iodoform Pasta Botol
264 Semen Zeng Fosfat serbuk dan cairan Botol
265 Silver Amalgam Serbuk Botol
266 Temporary Stopping (Fletcher) Serbuk dan Cairan Set
267 Trikresol Formalin (TKF) Cairan Botol
CAIRAN
268 Etakridin (Rivanol) larutan 0,1% Botol 1 0 1 1 0
269 Etanol 70 % Botol 1
270 Glukosa larutan infus 10% steril 500 ml Botol
272 Glukosa larutan infus steril 5 g/100 ml Botol
273 Glukosa larutan infus steril 5%-1/2 NS 500 ml Botol
275 H2O2/Hidrogen Peroksida (Perhidrol) 3% Botol
276 Natrium Klorida (NaCl) infus 0,9% 500 ml Botol
277 Povidon Iodine larutan 10% 30 ml Botol
278 Povidon iodine larutan 10% 300 ml Botol
279 Ringer Laktat larutan Infus Steril 500 ml Botol 2 0 2 0 2
280 Salisil Spiritus 10 % Botol
SIRUP
281 Albendazol sup 200mg/5 ml Botol
282 Amoksisilin sirup kering 125 mg/5 ml Botol
283 Amoksisilin sirup kering forte 250 mg/5 ml Botol
284 Antasida DOEN suspensi btl. 60 ml Botol 10 10 9 1
285 Chloramfenikol suspensi 125 mg/ 5 ml Botol
286 Cotrimoksazol suspensi 240 mg/5ml Botol 1 5 6 1 5
287 Domperidon Syrup 60 ml Botol
288 Erythromicin sirup Botol
289 Ibuprofen sirip 100 mg/ 5 ml Botol
290 Metronidazol sirup 125 mg/5 ml Botol
291 Multivitamin sirup Botol
292 Nistatin Drop Botol
293 Obat Batuk Hitam (OBH) sirup Botol
294 Obat batuk sirup ( DMP + CTM) Botol
295 Obat flu batuk pilek sirup (pct 120-130 mg, dmp, ctm, gg,pp) Botol
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
296 Obat flu batuk pilek sirup (pct 120-130 mg, efedrin, gg, ctm) Botol
297 Obat flu batuk pilek sirup (pct 250 mg, dmp,pp, gg, ctm) Botol
298 Parasetamol drop 100 mg/ml Botol
299 Parasetamol Sirup 120 mg/5 ml Botol 5 5 1 4
300 Setirizin sirup 5 mg/5 ml Botol
301 Sukralfat syrup Botol
302 Thiamphenicol syrup Botol
303 Zinc sirup 10 mg/5ml Botol
BHP & BAHAN LAB

304 Abbocat set Anak (No 24) Buah
305 Abbocat set Dewasa (16 - 22) Buah 2 2 0 2
306 Alat Suntik Sekali Pakai 1 ml Piece
307 Alat suntik sekali pakai 3 ml Piece
311 Aseptik gel Botol
312 Blood Lancet Box
313 Blood Transfusion Set Piece
314 Cangkang Kapsul no. 0 Bungkus
316 Chromic Catgut 2/0 75 Cm sachet
318 Chromic Catgut Rol 2/0 100 M Roll
320 Cito brush (pembersih tabung) Buah
321 Cover glass Set
322 Cuka dixi Botol
323 Dermalon* 3/0 75 cm Piece
325 Feeding Tube 100 cm, no. 6 Piece
327 Folly Kateter 16 Piece
330 Gliserin Botol
331 Holder Buah
332 Infusion Set anak Set
333 Infusion Set dewasa Set 1 0 1 0 1
334 Jarum Disposible 23 G Piece 0 0
335 Jarum Dysposible 26 G Piece
336 Jarum Jahit (bedah) No. 9 s/d 14 Pack
337 Jarum vanoject/ Vacuntainer Piece
338 Kaca Sediaan Piece
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
339 Kapas Lidi Steril Bungkus
340 Kapas Pembalut/Absorben 250 g Bungkus 1 0 1 0 1
341 Kapas Pembalut/Absorben500 g Roll
342 Kasa Kompres 40/40 steril Bungkus
343 Kasa Pembalut Hydrophil 16 cm x 16 cm Piece
344 Kasa Pembalut Hydrophil 3 cm x 4 meter Roll 10 10 10 0
345 Kasa Pembalut Hydrophil 5 cm x 4 meter Roll
349 Kassa Gulung 80 cm x 40 Yard Roll
350 Kertas Puyer Bungkus
351 Klorin 5,25 % Botol
352 KY Jely USG Botol
353 Larutan Asam Alkohol Botol
354 Larutan Asam Klorida 0,1 N Btl
355 Larutan Karbol Puksin Botol
356 Larutan KOH 1% Botol
357 Larutan Metanol Botol
358 Larutan Methylen Blue Botol
359 Lizol mengandung Kresol Botol
360 Masker Piece
361 Masker N 95 Piece
362 Metilin blue Botol
363 Muchus Suction (Penghisap Lendir) Piece
364 Oxyflow Nasal Oxygen Anak Piece
365 Oxyflow Nasal Oxygen Dewasa Piece
366 PH paper 3,8 - 5,4 Roll
367 Pisau Bedah Piece
368 Plain Catgut 2/0 75 cm sachet
370 Plain Catgut Rol 2/0 100 m Roll
372 Plester Kain 5 cm x 5 m Roll
374 Plester Kain 2,5 cm x 4,5 m Roll
375 Plester Kain 5 cm x 4,5 m Roll
377 Plastik Klip Obat 7 x 10 cm Bungkus
378 Plastik Klip Obat 8.7 x 13 cm Bungkus
379 Pot Dahak Pot
380 Pot Salep 10 Gr Pot
382 Reagensia ABX 60 atphalyse Liter
383 Reagensia ABX 60 cleaner Liter
384 Reagensia ABX 60 minilidi Liter
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
385 Sabun Anti Bakteri Botol
386 Safety box Buah
387 Sarung Tangan Karet (Hand Scund) L Piece
388 Sarung Tangan Karet (Hand Scund) M Piece
389 Sarung Tangan Karet (Hand Scund) S Piece
390 Sarung Tangan Obgyn Pasang
391 Sarung Tangan Steril No. 7 Pasang
392 Sarung Tangan Steril No. 7.5 Pasang
393 Silk 2/0 Rol 100 M Roll
395 Silk 2/0 75 cm sachet 3 3 3 0
396 Silk 3/0 75 cm sachet
398 Stomach Tube, 85 cm, no. 16 Piece
400 Sufratule Piece
401 Tabung criyo 15 ml Tube
402 Tabung vancuntainer 5 cc Piece
403 Tissue Box
404 Torniquet Buah
405 Tri -Way With Extention Piece
406 Umbilical Cord Clamp Piece
407 Underpad Piece
408 Urobag Piece
409 Wing Nedle 19 G Buah
412 Yelow tip isi 1000 pcs Peace
Umum BPJS Lain-lain Jumlah

Jumlah Kunjungan Resep
13 22 0 35
Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Melaporkan

Ka. Dinas Kesehatan Kab. Buleleng Petugas Depo Farmasi Ka. Puskesmas: ……………… PJ. Pustu Munduk
( ) ( ) ( ) Ni Putu Lindayani
NIP. NIP. NIP. NIP. 197608172002122009
Form.: LPLPO Puskesmas
PUSTU GOBLEG
Kecamatan Banjar Pelaporan Bulan :Pebruari 2021 Depo Farm
Kabupaten Buleleng Permintaan Bulan :Maret 2021 Puskesmas

1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
4 Alopurinol tablet 100 mg Tablet 0 100
8 Aminofilin tablet 200 mg Tablet
11 Amlodipin tablet 5 mg Tablet 130 130 130 0 200

13 Amoksisilin kapsul 500 mg Kapsul 120 120 90 30 100
15 Antasida DOEN tablet 500 mg Tablet 100
18 Asam Askorbat (Vit. C) tablet 50 mg Tablet
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
45 Cotrimoksazol tablet, 480 mg Tablet 100 100 0 100
67 Glibenklamid Tablet 5 mg Tablet 20 100 120 120 100
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
95 Metformin tablet 500 Tablet 20 100 120 120 0 100
96 Metil Prednisolon tablet 4 mg Tablet 100 100 0 100
98 Metoclopramid tablet 10 mg Tablet 70 0 70 30 40
104 Nistatin tablet salut 500.000 iu Tablet 90 90 10 80
115 Ofloxacin tablet 400 mg Tablet 70 70 30 40
126 Piroxicam kapsul 20 mg Kapsul 100
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14

1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
INJEKSI
205 MgSO4 40% Injeksi. Vial 2
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
SALEP DAN SUPP

240 Hidrokortison krim 2,5% Tube 24 24 1 23
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OBAT GIGI
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
CAIRAN
269 Etanol 70 % Botol 1 1 0 1
SIRUP
283 Amoksisilin sirup kering forte 250 mg/5 ml Botol 10 10 5 5
284 Antasida DOEN suspensi btl. 60 ml Botol 1 20 21 12 9
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
299 Parasetamol Sirup 120 mg/5 ml Botol 4 10 14 7 7
BHP & BAHAN LAB

305 Abbocat set Dewasa (16 - 22) Buah
321 Cover glass Set
322 Cuka dixi Botol
330 Gliserin Botol
331 Holder Buah
334 Jarum Disposible 23 G Piece
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
344 Kasa Pembalut Hydrophil 3 cm x 4 meter Roll 10
360 Masker Piece
379 Pot Dahak Pot
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
386 Safety box Buah
395 Silk 2/0 75 cm sachet 5
400 Sufratule Piece
403 Tissue Box
404 Torniquet Buah
407 Underpad Piece
408 Urobag Piece

15 29 0 44

( ) ( ) ( ) Gusti Ayu anik Ariani

NIP. NIP. NIP. Nip 196703011988012003
PUSTU GOBLEG
Kecamatan Banjar Pelaporan Bulan : Maret 2021 Depo Farm
Kabupaten Buleleng Permintaan Bulan : April 2021 Puskesmas

1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
8 Aminofilin tablet 200 mg Tablet
11 Amlodipin tablet 5 mg Tablet 300 300 270 30

15 Antasida DOEN tablet 500 mg Tablet
26 Betahistine Mesilat tablet Tablet 60 60 60 0 100
37 Chlorfeniramin Maleat (CTM) tablet 4 mg Tablet 60 60 60
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
67 Glibenklamid Tablet 5 mg Tablet 0 100
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
96 Metil Prednisolon tablet 4 mg Tablet 100 100 100 0 100
98 Metoclopramid tablet 10 mg Tablet 40 0 40 40 0 100
104 Nistatin tablet salut 500.000 iu Tablet 80 80 80
115 Ofloxacin tablet 400 mg Tablet 40 40 0 40
124 Piridoksin HCL (Vit. B6) Tablet 10 mg Tablet 0
126 Piroxicam kapsul 20 mg Kapsul 0 0 0 0 0 100
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14

1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
INJEKSI
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
SALEP DAN SUPP

240 Hidrokortison krim 2,5% Tube 23 0 23 0 23
246 Nistatin tablet Vaginal 100.000 iu/g Supp Tab vag 0 0
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OBAT GIGI
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
CAIRAN
269 Etanol 70 % Botol 1 1 1 0
276 Natrium Klorida (NaCl) infus 0,9% 500 ml Botol 0 0 0 0
SIRUP
283 Amoksisilin sirup kering forte 250 mg/5 ml Botol 5 0 5 3 2
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
BHP & BAHAN LAB

307 Alat suntik sekali pakai 3 ml Piece 0 0 0 0
321 Cover glass Set
322 Cuka dixi Botol
330 Gliserin Botol
331 Holder Buah
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
359 Lizol mengandung Kresol Botol 1 0 1 1 0
360 Masker Piece
379 Pot Dahak Pot
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
386 Safety box Buah
395 Silk 2/0 75 cm sachet 5 5 2 3
400 Sufratule Piece
403 Tissue Box
404 Torniquet Buah
407 Underpad Piece
408 Urobag Piece

14 22 0 36

Ka. Dinas Kesehatan Kab. Buleleng Petugas Depo Farmasi Ka. Puskesmas: ……………… PJ. Pustu Gobleg
( ) ( ) ( ) Gusti Ayu anik Ariani

NIP. NIP. NIP. Nip 196703011988012003
PUSTU GOBLEG
Kecamatan Banjar Pelaporan Bulan : April 2021 Depo Farm
Kabupaten Buleleng Permintaan Bulan :Mei 2021 Puskesmas

1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14

15 Antasida DOEN tablet 500 mg Tablet 0
18 Asam Askorbat (Vit. C) tablet 50 mg Tablet
37 Chlorfeniramin Maleat (CTM) tablet 4 mg Tablet 60 60 50 10 100
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
67 Glibenklamid Tablet 5 mg Tablet 100
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
96 Metil Prednisolon tablet 4 mg Tablet 100 100 30 70
98 Metoclopramid tablet 10 mg Tablet 100 100 10 90
100 Metronidazol tablet 500 mg Tablet 0 0 0 0 100
115 Ofloxacin tablet 400 mg Tablet
126 Piroxicam kapsul 20 mg Kapsul 0 0
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
159 Vitamin B Complex tablet Tablet 140 0 140 140 0 exd

168 Gentamisin Sulfat 0,3% Tetes Mata Botol 5
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
INJEKSI
200 Lidokain Komp.injeksi, Komb.: Lidokain HCL 2% + Epinefrin Ampul 3 0 3 0 3
205 MgSO4 40% Injeksi. Vial 0 0 0 0 0
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
SALEP DAN SUPP

`
OBAT GIGI
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
CAIRAN
268 Etakridin (Rivanol) larutan 0,1% Botol 1 1 1 0
269 Etanol 70 % Botol
SIRUP
283 Amoksisilin sirup kering forte 250 mg/5 ml Botol 2 0 2 2 0
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
BHP & BAHAN LAB

307 Alat suntik sekali pakai 3 ml Piece 0 0 0 0
316 Chromic Catgut 2/0 75 Cm sachet 0 0 0 0
321 Cover glass Set
322 Cuka dixi Botol
330 Gliserin Botol
331 Holder Buah
334 Jarum Disposible 23 G Piece 0 0 0 0
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
340 Kapas Pembalut/Absorben 250 g Bungkus 0 0 0 0
360 Masker Piece
379 Pot Dahak Pot
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
386 Safety box Buah
395 Silk 2/0 75 cm sachet 3 3 3 0 5
400 Sufratule Piece
403 Tissue Box
404 Torniquet Buah
407 Underpad Piece
408 Urobag Piece

9 13 0 22

Ka. Dinas Kesehatan Kab. Buleleng Petugas Depo Farmasi Ka. Puskesmas: ……………… pj Pustu Gobleg
( ) ( ) ( ) Gusti Ayu Anik Ariani

NIP. NIP. NIP. Nip 1967 03 01 1988 01 2 003
PUSTU GOBLEG

Kecamatan Banjar Pelaporan Bulan ;Mei 2021 Depo Farm
Kabupaten Buleleng Permintaan Bulan ;Juni 2021 Puskesmas

1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
13 Amoksisilin kapsul 500 mg Kapsul 140 140 70 70
15 Antasida DOEN tablet 500 mg Tablet 0 0 0 0
26 Betahistine Mesilat tablet Tablet 40 40 40 0 100
45 Cotrimoksazol tablet, 480 mg Tablet 50 50 50
61 Fenobarbital tablet 30 mg Tablet 100
67 Glibenklamid Tablet 5 mg Tablet 200 200 80 120
95 Metformin tablet 500 Tablet 70 70 70 0 100
96 Metil Prednisolon tablet 4 mg Tablet
98 Metoclopramid tablet 10 mg Tablet 90 0 90 50 40
100 Metronidazol tablet 500 mg Tablet 0 0 0 0 100
103 Nifedipin 10 mg tablet Tablet 0 0 0 0 0 10
115 Ofloxacin tablet 400 mg Tablet
124 Piridoksin HCL (Vit. B6) Tablet 10 mg Tablet 0 0 0
126 Piroxicam kapsul 20 mg Kapsul 0 0 0 0 0 100
159 Vitamin B Complex tablet Tablet 0

168 Gentamisin Sulfat 0,3% Tetes Mata Botol 5 5 0 5
INJEKSI
200 Lidokain Komp.injeksi, Komb.: Lidokain HCL 2% + Epinefrin Ampul 3 0 3 1 2
205 MgSO4 40% Injeksi. Vial 0 0 0 0 0
SALEP DAN SUPP

228 Antifungi DOEN Salep kombinasi (White Field Salep) Pot 0 0 0 0 0
246 Nistatin tablet Vaginal 100.000 iu/g Supp Tab vag 0 0 0
`
OBAT GIGI
CAIRAN
269 Etanol 70 % Botol
SIRUP
282 Amoksisilin sirup kering 125 mg/5 ml Botol 10
283 Amoksisilin sirup kering forte 250 mg/5 ml Botol 10
284 Antasida DOEN suspensi btl. 60 ml Botol
286 Cotrimoksazol suspensi 240 mg/5ml Botol 10
299 Parasetamol Sirup 120 mg/5 ml Botol 5 0 5 0 5 10
301 Sukralfat syrup Botol 8 8 8 0 10
BHP & BAHAN LAB

307 Alat suntik sekali pakai 3 ml Piece 6 0 6 0 6
316 Chromic Catgut 2/0 75 Cm sachet 1 0 1 0 1
321 Cover glass Set
322 Cuka dixi Botol
330 Gliserin Botol
331 Holder Buah
340 Kapas Pembalut/Absorben 250 g Bungkus
344 Kasa Pembalut Hydrophil 3 cm x 4 meter Roll 5 5 5 0 5
360 Masker Piece
379 Pot Dahak Pot
386 Safety box Buah
400 Sufratule Piece
403 Tissue Box
404 Torniquet Buah
407 Underpad Piece
408 Urobag Piece

10 18 0 28
NIP. NIP. NIP. NIP. 197608172002122009
Puskesmas Banjar II
Kecamatan Banjar
Kabupaten Buleleng
No. Nama Obat

1 2
1 Acyclovir tablet 200 mg
3 Albendazol tablet 400 mg
4 Alopurinol tablet 100 mg
6 Alprazolam tablet 0,25 mg
7 Ambroxol tablet 30 mg
8 Aminofilin tablet 200 mg
9 Amitriptilin tablet 25 mg.
10 Amlodipin tablet 10 mg
12 Amoksisilin kapsul 250 mg
14 Antalgin (Metampiron) tablet 500 mg
15 Antasida DOEN tablet 500 mg
16 Artesdiaquine tablet
17 Asam Asetil Salisilat tablet 80 - 100 mg.
18 Asam Askorbat (Vit. C) tablet 50 mg
19 Asam Folat tablet
20 Asam Mefenamat tablet 500 mg
21 Asam Traneksamat tablet 500 mg.
22 Asiklovir 400 mg tablet
23 Attapulgite 600 mg tablet
24 Azithromycin tablet 500
25 Besi (II) Sulfat (Tambah darah) tablet
26 Betahistine Mesilat tablet
27 Bisoprolol tablet 5 mg.
28 Bromhexin tablet 8 mg
29 Calsium Laktat (Kalk) tablet 500 mg
30 Candesartan tablet 16 mg
32 Captopril tablet 12,5 mg
33 Captopril tablet 25 mg
34 Carbamazepin tablet 200 mg
35 Cefadroxil kapsul 500 mg
36 Chloramfenikol kapsul 250 mg
37 Chlorfeniramin Maleat (CTM) tablet 4 mg
38 Chlorpromazin HCL tablet salut 100 mg
39 Chorpromazin HCL tablet salut 25 mg
40 Cimetidine 200 mg tablet
41 Ciprofloxacin 500 mg kaptab
42 Clobazam 10 mg tablet
43 Clopidogrel tablet 75 mg
44 Codein HCL tablet 10 mg
45 Cotrimoksazol tablet, 480 mg
46 Dexametason tablet 0,5 mg
47 Diapet kapsul
48 Diazepam tablet 2 mg
50 Digoksin tablet 0,25 mg
51 Diklofenak Natrium/Sodium 25 mg tablet
53 Diltiazem tablet
54 Doxyciclin 100 mg tablet
55 Ergotamin Tartat komb./Antimigren DOEN Tablet kombinasi
56 Erythromicin kapsul 500 mg
57 Ethambutol HCL tablet 250 mg
58 Fenitoin Natrium kapsul 100 mg
59 Fenitoin Natrium Kapsul 30 mg
60 Fenobarbital tablet 100 mg
62 Fenoksimetil Penisilin tablet 500 mg
63 Fitometadion (Vit. K1) tablet salut gula 10 mg
64 Fluor tablet 0,5 mg
65 Furosemida tablet 40 mg
66 Garam Oralit untuk 200 ml air
67 Glibenklamid Tablet 5 mg
68 Glikuidon tablet
69 Glimepirid tablet 1 mg
71 Gliseril Guaiakolat tablet 100 mg
72 Griseofulvin tablet 125 mg
73 Haloperidol tablet 0,5 mg
75 Haloperidol tablet 5 mg
76 Hidroklorotiazid (HCT) tablet 25 mg
77 Ibuprofen tablet 200 mg
79 Iodiol kapsul lunak
80 Isoniazid tablet (INH) 100 mg
82 Isosorbid Dinitrat (ISDN) tablet sublingual 5 mg
83 Ketokonazol 200 mg tab.
84 Ketoprofen tablet 100 mg
85 Klorokuin tablet 250 mg
86 Kuinina (Kina) tablet 222 mg
87 Lanzoprazol kapsul
88 Lisinopril tablet 10 mg
90 Livron B plex tablet
91 Loperamid tablet 2 mg
92 Loratadin tablet 10 mg
93 Mebendazol tablet 100 mg
94 Meloxicam tablet 15 mg
95 Metformin tablet 500
96 Metil Prednisolon tablet 4 mg
97 Metilergometrin Maleat tablet salut 0,125 mg
98 Metoclopramid tablet 10 mg
99 Metronidazol tablet 250 mg
101 Multivitamin tablet
102 Natrium Bikarbonat tablet 500 mg
103 Nifedipin 10 mg tablet
104 Nistatin tablet salut 500.000 iu
105 Obat Antituberkulosis FDC Katagori 1 & 3 Paket tablet
106 Obat Antituberkulosis FDC Katagori 2 Paket tablet
107 Obat Antituberkulosis Kategori Anak Paket tablet
108 Obat Antituberkulosis Kategori Sisipan Paket tablet
109 Obat batuk kering tablet (DMP + Anti Histamin)
110 Obat demam, batuk, pilek tablet (PCT 500 mg, dmp, ctm, gg,
111 Obat flu tablet (PCT, PP,CTM)
112 Obat Kusta Paket MB & PB Treatment/MDT Anak
113 Obat Kusta Paket MB & PB Treatment/MDT Dewasa
114 Obat pilek tablet (triprolidin, pseudoefedrin)
115 Ofloxacin tablet 400 mg
116 Omeprazol kapsul 20 mg.
117 Ondansentron tablet 4 mg
118 Oseltamivir tablet 75 mg
119 Papaverin tablet 40 mg
120 Paraformaldehida tablet 1 gam
121 Parasetamol tablet 500 mg
122 Phenylbutason tablet 200
123 Piracetam kapsul 1200 mg
124 Piridoksin HCL (Vit. B6) Tablet 10 mg
125 Piroxicam kapsul 10 mg
127 Prazikuantel tablet 600 mg
128 Prednison tablet 5 mg
129 Primaquin tablet 15 mg
130 Propanolol tablet 10 mg
132 Propil Tiourasil (PTU) 100 mg tablet
133 Pyrantel Pamoat 125 mg tablet
134 Ramipril tablet 2,5 mg
135 Ramipril tablet 5 mg
136 Ranitidin tablet 150 mg
137 Reserpin Tablet 0,10 mg
139 Retinol (Vit.A ) kapsul 100.000 iu
141 Rifampisin Kapsul 300 mg
144 Risperidon tablet 2 mg
146 Salbutamol tablet 2 mg
148 Setirizin tablet 10 mg
149 Simvastatin tablet 10 mg
150 Spironolacton tablet 100 mg.
151 Sucralfat Tablet 500 mg
152 Tetrasiklin HCL kapsul 250 mg
153 Tetrasiklin HCL Kapsul 500 mg
154 Thiamphenicol kapsul 500 mg
155 Tiamin HCL/Monotatrat (Vit. B1) Tablet 50 mg
156 Tramadol tablet 50 mg
157 Triheksilfenidil (THP) Hidroklorida tablet 2 mg
158 Valsartan tablet 80 mg
159 Vitamin B Complex tablet
160 Vitamin Neurotropik tablet
161 Zinc 20 mg tablet
417 Kotrimoksazol Tab.Peiatrik 120 mg

162 Borax Gliserin
163 Chloramfenikol salep mata 1%
164 Chloramfenikol tetes mata
165 Chloramfenikol tetes telinga 3 %
166 Fenol Gliserol tetes telinga 10%
167 Gentamisin salep mata 0,3%
168 Gentamisin Sulfat 0,3% Tetes Mata
169 Oksitetresiklin HCL salep mata 1%
170 Sulfasetamida Natrium tetes mata 15%-5ml
INJEKSI
171 Aminofilin injeksi 24 mg/ml-10ml
172 Amoksisilin injeksi
173 Antalgin (Metampiron) injeksi 250 mg/ml-2ml
174 Aqua pro injeksi steril bebas pirogen
175 Artemeter Injeksi.
176 Artesunate Injeksi
177 Asam Traneksamat Injeksi.
178 Atrofin Sulfat Injeksi 0,25 mg/ml-1 ml
179 Benzatin Benzil Penicillin Injeksi 1,2 juta iu/vial
181 Chloramfenikol serbuk injeksi 1000 mg/ml
182 Chlorpromazin HCL injeksi 25 mg/ml-1ml
184 Dexametason Injeksi
185 Diazepam injeksi 10mg/ml
186 Diazepam injeksi 5 mg/ml
187 Difenhidramin HCL injeksi 10 mg/ml-1ml
188 Epinefrina HCL/Bitatrat (Epinefrin/Adrenalin) injeksi
189 Fenobarbital injeksi 50 mg/ml-2ml
190 Furosemid injeksi
191 Gentamisin injeksi 40 mg/ml
192 Haloperidol injeksi (IM) 5 mg/ml
193 Haloperidol injeksi inkesi (IM) 50 mg/ml
194 Hiosin Butilbromid injeksi 20 mg/ml
195 Human tetanus imunoglobulin injeksi (i.m) 250 UI
196 Kalsium Glukonat injeksi
197 Ketorolac injeksi 10 mg/ml
198 Kuinina Dihidroklorida Injeksi 25%-2ml
199 Lidokain injeksi 2% (HCL)
200 Lidokain Komp.injeksi, Komb.: Lidokain HCL 2% + Epinefrin
201 Metilergometrin Maleat injeksi. 0,200 mg 1ml
202 Metilprednisolon injeksi 125 mg/2 mL
203 Metoclopramid Injeksi.
204 MgSO4 20% Injeksi.
206 Natrium Tiosulfat injeksi 25%-10ml
207 Oksitetrasiklin HCL injeksi i.m 50 mg/ml 10 ml
208 Oksitosin injeksi 10iu/ml-1ml
209 Omeperazol injeksi 40 mg/10 ml
210 Ondansetron 4 mg/ml Injeksi
211 Papaverin Injeksi
212 Piracetam Injeksi
213 Procain Benzil Penisilin injeksi 3 juta iu/vial
214 Ranitidin Injeksi.
215 Sefotaksim injeksi 1 g
216 Seftriakson injeksi
217 Serum Anti bisa Ular Polivalen Injeksi 5 ml
218 Serum Anti Tetanus (ATS) injeksi 1.500 iu/amp
219 Sianokobalamin (Vit. B12) injeksi 500 mcg/ml-1ml
220 Streptomisin Sulfat serbuk injeksi 1.000 mg/vial
222 Ventolin Nebolizer
223 Vit. K 10 mg/ml-1ml injeksi
224 Vit. K Infant 2mg/ml Injeksi
SALEP DAN SUPP

225 Acyclovir 5 % Cream
226 Anti Bakteri DOEN Salep kombinasi (Bacitrasin- Neomicin)
227 Anti Hemoroid DOEN kombinasi supp
228 Antifungi DOEN Salep kombinasi (White Field Salep)
229 Betametason krim 0,1 %
230 Betametason Neomisin krim
231 Bioplacenton Jelly
232 Bisakodil supp. Anak
233 Bisakodil supp. Dewasa
234 Desoksimetason + Neomicin Cream
235 Diazepam 10 mg/2,5 ml Supp Rectal Dewasa
236 Diazepam 5 mg/2,5 ml Supp Rectal Anak
237 Gameksan emulsi 1%
238 Gentamisin Salep Kulit
239 Gentian Violet larutan 1%
240 Hidrokortison krim 2,5%
241 Ketokonazol 2 % Krim.
242 Ketoprofen 100 mg Supp.
243 Levertran Zalf 15 g
244 Lidocain gel
245 Miconazole 2% Cream
246 Nistatin tablet Vaginal 100.000 iu/g Supp
247 Oksigen gas dalam tabung (Oxycan)
248 Oksitetrasiklin HCL salep kulit 3%
249 Paracetamol 125 mg/2,5 ml Supp Rectal
250 Paracetamol 250 mg/4 ml Supp Rectal
251 Permetrin 5% Salep
252 Placenta + Neomycin Cream
253 Polikresulen (Albothyl) 10 ml Solution
254 Salep 2-4, Komb.: As. Salisilat 2% + Belerang Endap 4%
255 Salisil Bedak Tabur 2 %
OBAT GIGI
256 Air Raksa dental use
257 Devitalisasi Pasta (Non Arsen)
258 Etil Klorida semprot
259 Eugenol cairan
260 Glass Ionomer Cement (GC IX)
261 Kalsium Hidroksida Pasta/Cement
262 Monoklorkamfer Mentol cairan (CHKM)
263 Mummifying Pasta/Iodoform Pasta
264 Semen Zeng Fosfat serbuk dan cairan
265 Silver Amalgam Serbuk
266 Temporary Stopping (Fletcher) Serbuk dan Cairan
267 Trikresol Formalin (TKF) Cairan
CAIRAN
268 Etakridin (Rivanol) larutan 0,1%
269 Etanol 70 %
270 Glukosa larutan infus 10% steril 500 ml
272 Glukosa larutan infus steril 5 g/100 ml
273 Glukosa larutan infus steril 5%-1/2 NS 500 ml
275 H2O2/Hidrogen Peroksida (Perhidrol) 3%
276 Natrium Klorida (NaCl) infus 0,9% 500 ml
277 Povidon Iodine larutan 10% 30 ml
278 Povidon iodine larutan 10% 300 ml
279 Ringer Laktat larutan Infus Steril 500 ml
280 Salisil Spiritus 10 %
SIRUP
281 Albendazol sup 200mg/5 ml
282 Amoksisilin sirup kering 125 mg/5 ml
283 Amoksisilin sirup kering forte 250 mg/5 ml
284 Antasida DOEN suspensi btl. 60 ml
285 Chloramfenikol suspensi 125 mg/ 5 ml
286 Cotrimoksazol suspensi 240 mg/5ml
287 Domperidon Syrup 60 ml
288 Erythromicin sirup
289 Ibuprofen sirip 100 mg/ 5 ml
290 Metronidazol sirup 125 mg/5 ml
291 Multivitamin sirup
292 Nistatin Drop
293 Obat Batuk Hitam (OBH) sirup
294 Obat batuk sirup ( DMP + CTM)
295 Obat flu batuk pilek sirup (pct 120-130 mg, dmp, ctm, gg,pp)
296 Obat flu batuk pilek sirup (pct 120-130 mg, efedrin, gg, ctm)
297 Obat flu batuk pilek sirup (pct 250 mg, dmp,pp, gg, ctm)
298 Parasetamol drop 100 mg/ml
299 Parasetamol Sirup 120 mg/5 ml
300 Setirizin sirup 5 mg/5 ml
301 Sukralfat syrup
302 Thiamphenicol syrup
303 Zinc sirup 10 mg/5ml
BHP & BAHAN LAB

304 Abbocat set Anak (No 24)
305 Abbocat set Dewasa (16 - 22)
306 Alat Suntik Sekali Pakai 1 ml
307 Alat suntik sekali pakai 3 ml
311 Aseptik gel
312 Blood Lancet
313 Blood Transfusion Set
314 Cangkang Kapsul no. 0
316 Chromic Catgut 2/0 75 Cm
318 Chromic Catgut Rol 2/0 100 M
320 Cito brush (pembersih tabung)
321 Cover glass
322 Cuka dixi
323 Dermalon* 3/0 75 cm
325 Feeding Tube 100 cm, no. 6
327 Folly Kateter 16
330 Gliserin
331 Holder
332 Infusion Set anak
333 Infusion Set dewasa
334 Jarum Disposible 23 G
335 Jarum Dysposible 26 G
336 Jarum Jahit (bedah) No. 9 s/d 14
337 Jarum vanoject/ Vacuntainer
338 Kaca Sediaan
339 Kapas Lidi Steril
340 Kapas Pembalut/Absorben 250 g
341 Kapas Pembalut/Absorben500 g
342 Kasa Kompres 40/40 steril
343 Kasa Pembalut Hydrophil 16 cm x 16 cm
344 Kasa Pembalut Hydrophil 3 cm x 4 meter
349 Kassa Gulung 80 cm x 40 Yard
350 Kertas Puyer
351 Klorin 5,25 %
352 KY Jely USG
353 Larutan Asam Alkohol
354 Larutan Asam Klorida 0,1 N
355 Larutan Karbol Puksin
356 Larutan KOH 1%
357 Larutan Metanol
358 Larutan Methylen Blue
359 Lizol mengandung Kresol
360 Masker
361 Masker N 95
362 Metilin blue
363 Muchus Suction (Penghisap Lendir)
364 Oxyflow Nasal Oxygen Anak
365 Oxyflow Nasal Oxygen Dewasa
366 PH paper 3,8 - 5,4
367 Pisau Bedah
368 Plain Catgut 2/0 75 cm
370 Plain Catgut Rol 2/0 100 m
372 Plester Kain 5 cm x 5 m
374 Plester Kain 2,5 cm x 4,5 m
375 Plester Kain 5 cm x 4,5 m
377 Plastik Klip Obat 7 x 10 cm
378 Plastik Klip Obat 8.7 x 13 cm
379 Pot Dahak
380 Pot Salep 10 Gr
381 Pot Salep 20 Gr
382 Reagensia ABX 60 atphalyse
383 Reagensia ABX 60 cleaner
384 Reagensia ABX 60 minilidi
385 Sabun Anti Bakteri
386 Safety box
387 Sarung Tangan Karet (Hand Scund) L
388 Sarung Tangan Karet (Hand Scund) M
389 Sarung Tangan Karet (Hand Scund) S
390 Sarung Tangan Obgyn
391 Sarung Tangan Steril No. 7
392 Sarung Tangan Steril No. 7.5
393 Silk 2/0 Rol 100 M
394 Silk 3/0 Rol 100 M
395 Silk 2/0 75 cm
396 Silk 3/0 75 cm
397 Silk 4/0 75 cm
398 Stomach Tube, 85 cm, no. 16
400 Sufratule
401 Tabung criyo 15 ml
402 Tabung vancuntainer 5 cc
403 Tissue
404 Torniquet
405 Tri -Way With Extention
406 Umbilical Cord Clamp
407 Underpad
408 Urobag
409 Wing Nedle 19 G
410 Wing Nedle 23 G
411 Wing Nedle 25 G
412 Yelow tip isi 1000 pcs
Mengetahui/Menyetujui
Ka. Dinas Kesehatan Kab. Buleleng
( )
NIP.
PUSTU GOBLEG
Pelaporan Bulan ;JUNI 2021

Permintaan Bulan ;JULI 2021
Stok
Satuan Penerimaan Persediaan Pemakaian
Awal
3 4 5 6 (4 + 5) 7
Tablet 70 70 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 40
Kapsul
Kapsul 70 70 70
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 50 50 10
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 30
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 50 50 50
Tablet
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Tablet
Tablet 100 100
Tablet
Tablet
Tablet
Tablet
Sachet
Tablet 120 0 120 30
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 30
Tablet
Tablet 80 0 80 10
Tablet 40 0 40 40
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 80 80 30
Paket
Paket
Paket
Paket
Tablet
Tablet
Tablet
Paket
Paket
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Kapsul
Kapsul
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Botol
Tube
Botol
Botol
Botol
Tube
Botol 5 0 5
Tube 19 0 19 3
Botol
Ampul
Ampul
Ampul
Vial
Ampul
Vial
Ampul
Ampul
Vial
Vial
Vial
Ampul
Ampul
Ampul 5 0 5 0
Ampul
Ampul 0 0 0
Ampul 0 0 0
Ampul 0 0
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul 2 0 2 2
Ampul
Vial
Ampul
Vial
Vial 0 0 0 0
Vial
Vial
Ampul
Vial
Ampul
Ampul
Ampul
Vial
Ampul
Ampul
Vial
Vial
Ampul
Ampul
Vial
Vial
Ampul
Ampul
Ampul
Tube
Pot
Supp
Pot 0 0 0 0
Tube 0 0
Tube
Tube
Supp
Supp
Tube
Tube
Tube
Botol
Tube
Botol
Tube 22 0 22 0
Tube
Supp
Pot
Tube
Tube 0 0 0
Tab vag 0 0
Tabung
Tube
Tube
Tube
Tube
Tube
Botol
Pot 10 0 10 0
Pot
Botol
Pot
Botol
Botol
Set
Botol
Botol
Botol
Botol
Botol
Set
Botol
Botol 0 0 0
Botol 0 0 0
Botol
Botol
Botol
Botol
Botol
Botol
Botol 0 0 0
Botol
Botol
Botol 2 0 2 0
Botol
Botol
Botol
Botol
Botol 0
Botol
Botol 10 10 1
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol 10 10 0
Botol 5 5
Botol 10 10 2
Botol
Botol
Buah
Buah
Piece
Piece
Piece
Piece
Piece
Botol
Box
Piece
Bungkus
Bungkus
sachet 1 0 1 1
sachet
Roll
Roll
Buah
Set
Botol
Piece
Piece
Piece
Piece
Piece
Piece
Piece
Botol
Buah
Set
Set 1 0 1 0
Piece 0 0 0
Piece
Pack
Piece
Piece
Bungkus
Bungkus 0 0 0
Roll
Bungkus
Piece
Roll 10 10
Roll
Roll
Roll
Roll
Roll
Bungkus
Botol
Botol
Botol
Btl
Botol
Botol
Botol
Botol
Botol 0
Piece
Piece
Botol
Piece
Piece
Piece
Roll
Piece
sachet
sachet
Roll
Roll
Roll
Roll
Roll
Roll
Roll
Bungkus
Bungkus
Pot
Pot
Pot
Liter
Liter
Liter
Botol
Buah
Piece
Piece
Piece
Pasang
Pasang
Pasang
Roll
Roll
sachet
sachet
sachet
Piece
Piece
Piece
Tube
Piece
Box
Buah
Piece
Piece
Piece
Piece
Buah
Buah
Buah
Peace

7 15 0 22
Yang Menyerahkan
Petugas Depo Farmasi
( )
NIP.
ntaan Obat
Dokumen Nomor
Depo Farm
Puskesmas
Sisa Stok Pemberian

Permintaan
Stok Optimum APBD Lain-lain
8 (6 - 7) 9 ((7x4)-8) 10 11 12
70
60
40
70
0 100
100
90
70
70
0 100
50
100
5
16
5
0
0
0 5
0
0
22
0
0
10
0
2
10
5
8
0
1
0
10
0
Jumlah
22
Yang Meminta Yang Melaporkan

Ka. Puskesmas: ……………… PJ. Pustu Munduk
( ) Ni Putu Lindayani
NIP. NIP. 197608172002122009
rm.: LPLPO Puskesmas
Tanggal
mberian
Ket.
Jumlah
13 (11 + 12) 14
Yang Melaporkan
PJ. Pustu Munduk
Ni Putu Lindayani
NIP. 197608172002122009
JU
Puskesmas Banjar II
Kecamatan Banjar
Kabupaten Buleleng
No. Nama Obat

1 2
TABLET/K
47 Diapet kapsul
53 Diltiazem tablet
68 Glikuidon tablet
OBAT MATA,
162 Borax Gliserin
I
SALEP
244 Lidocain gel
OB
259 Eugenol cairan
C
269 Etanol 70 %

292 Nistatin Drop
301 Sukralfat syrup
BHP &
311 Aseptik gel
312 Blood Lancet
321 Cover glass
322 Cuka dixi
330 Gliserin
331 Holder
338 Kaca Sediaan
350 Kertas Puyer
351 Klorin 5,25 %
352 KY Jely USG
356 Larutan KOH 1%
357 Larutan Metanol
360 Masker
361 Masker N 95
362 Metilin blue
366 PH paper 3,8 - 5,4
367 Pisau Bedah
379 Pot Dahak
380 Pot Salep 10 Gr
381 Pot Salep 20 Gr
386 Safety box
393 Silk 2/0 Rol 100 M
394 Silk 3/0 Rol 100 M
395 Silk 2/0 75 cm
396 Silk 3/0 75 cm
397 Silk 4/0 75 cm
400 Sufratule
403 Tissue
404 Torniquet
407 Underpad
408 Urobag
409 Wing Nedle 19 G
410 Wing Nedle 23 G
411 Wing Nedle 25 G
( )
NIP.
PUSTU GOBLEG
Pelaporan Bulan : JULI 2021

Permintaan Bulan : AGUSTUS 2021
Stok
Awal
3 4 5 6 (4 + 5) 7
Tablet 70 0 70 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 60 0 60 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 40 0 40 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 100 100 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 70 0 70 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Tablet 0 100 100 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 100 100 0
Tablet 0 0 0 0
Kapsul 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Tablet 0 0 0 0
Tablet 100 0 100 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Sachet 0 0 0 0
Tablet 90 0 90 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Kapsul 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 70 0 70 0
Tablet 0 0 0 0
Tablet 70 0 70 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 50 0 50 0
Paket 0 0 0 0
Paket 0 0 0 0
Paket 0 0 0 0
Paket 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Paket 0 0 0 0
Paket 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Kapsul 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0
Tablet 0 0 0 0

Botol 0 0 0 0
Tube 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Tube 0 0 0 0
Botol 5 0 5 0
Tube 16 0 16 0
Botol 0 0 0 0
INJEKSI
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Vial 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 5 0 5 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Vial 0 0 0 0
Vial 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Vial 0 0 0 0
Vial 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
Ampul 0 0 0 0
SALEP DAN SUPP

Tube 0 0 0 0
Pot 0 0 0 0
Supp 0 0 0 0
Pot 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Supp 0 0 0 0
Supp 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Botol 0 0 0 0
Tube 0 0 0 0
Botol 0 0 0 0
Tube 22 0 22 0
Tube 0 0 0 0
Supp 0 0 0 0
Pot 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Tab vag 0 0 0 0
Tabung 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Tube 0 0 0 0
Botol 0 0 0 0
Pot 10 0 10 0
Pot 0 0 0 0
OBAT GIGI
Botol 0 0 0 0
Pot 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Set 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Set 0 0 0 0
Botol 0 0 0 0
CAIRAN
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 2 0 2 0
Botol 0 0 0 0
SIRUP
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 9 0 9 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 10 0 10 0
Botol 5 0 5 0
Botol 8 0 8 0
Botol 0 0 0 0
Botol 0 0 0 0
BHP & BAHAN LAB

Buah 0 0 0 0
Buah 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Botol 0 0 0 0
Box 0 0 0 0
Piece 0 0 0 0
Bungkus 0 0 0 0
Bungkus 0 0 0 0
sachet 0 0 0 0
sachet 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Buah 0 0 0 0
Set 0 0 0 0
Botol 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Botol 0 0 0 0
Buah 0 0 0 0
Set 0 0 0 0
Set 1 0 1 0
Piece 0 0 0 0
Piece 0 0 0 0
Pack 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Bungkus 0 0 0 0
Bungkus 0 0 0 0
Roll 0 0 0 0
Bungkus 0 0 0 0
Piece 0 0 0 0
Roll 10 0 10 0
Roll 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Bungkus 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Btl 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Botol 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Botol 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Roll 0 0 0 0
Piece 0 0 0 0
sachet 0 0 0 0
sachet 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
Bungkus 0 0 0 0
Bungkus 0 0 0 0
Pot 0 0 0 0
Pot 0 0 0 0
Pot 0 0 0 0
Liter 0 0 0 0
Liter 0 0 0 0
Liter 0 0 0 0
Botol 0 0 0 0
Buah 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Pasang 0 0 0 0
Pasang 0 0 0 0
Pasang 0 0 0 0
Roll 0 0 0 0
Roll 0 0 0 0
sachet 0 0 0 0
sachet 0 0 0 0
sachet 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Tube 0 0 0 0
Piece 0 0 0 0
Box 0 0 0 0
Buah 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Piece 0 0 0 0
Buah 0 0 0 0
Buah 0 0 0 0
Buah 0 0 0 0
Peace 0 0 0 0

0 0 0 0
Yang Menyerahkan
( )
NIP.
ntaan Obat
Dokumen Nomor
Depo Farm
Puskesmas
Sisa Stok Pemberian

Permintaan
8 (6 - 7) 9 ((7x4)-8) 10 11 12
70
0
0
0
0
0
0
0
0
0
60
0
0
0
0
0
0
0
40
0
0
0
100
0
0
70
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
90
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
70
0
70
0
0
0
0
0
0
50
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
22
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
0
10
5
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Jumlah
0

( ) Gusti Ayu Anik Ariani, A.Md. K
NIP. NIP. 196703011988012003
Tanggal
mberian
Ket.
Jumlah
13 (11 + 12) 14
Yang Melaporkan
PJ. Pustu Munduk
usti Ayu Anik Ariani, A.Md. Keb.
NIP. 196703011988012003
PUSTU GOBLEG
Puskesmas Banjar II
Kecamatan Banjar Pelaporan Bulan : AGUSTUS 2021
Kabupaten Buleleng Permintaan Bulan :SEPTEMBER 2021
Stok
No. Nama Obat Satuan Penerimaan Persediaan
Awal
1 2 3 4 5 6 (4 + 5)
1 Acyclovir tablet 200 mg Tablet 70 70
2 Acyclovir tablet 400 mg Tablet 0 0
3 Albendazol tablet 400 mg Tablet 0 0
6 Alprazolam tablet 0,25 mg Tablet 0 0
7 Ambroxol tablet 30 mg Tablet 0 0
8 Aminofilin tablet 200 mg Tablet 0 0
9 Amitriptilin tablet 25 mg. Tablet 0 0
10 Amlodipin tablet 10 mg Tablet 0 0
11 Amlodipin tablet 5 mg Tablet 60 60
12 Amoksisilin kapsul 250 mg Kapsul 0 0
13 Amoksisilin kapsul 500 mg Kapsul 0 0
14 Antalgin (Metampiron) tablet 500 mg Tablet 0 0
15 Antasida DOEN tablet 500 mg Tablet 0 0
16 Artesdiaquine tablet Tablet 0 0
17 Asam Asetil Salisilat tablet 80 - 100 mg. Tablet 0 0
18 Asam Askorbat (Vit. C) tablet 50 mg Tablet 0 0
19 Asam Folat tablet Tablet 40 40
20 Asam Mefenamat tablet 500 mg Tablet 0 0
21 Asam Traneksamat tablet 500 mg. Tablet 0 0
22 Asiklovir 400 mg tablet Tablet 0 0
23 Attapulgite 600 mg tablet Tablet 100 100
24 Azithromycin tablet 500 Tablet 0 0
25 Besi (II) Sulfat (Tambah darah) tablet Tablet 0 0
26 Betahistine Mesilat tablet Tablet 70 70
27 Bisoprolol tablet 5 mg. Tablet 0 0
28 Bromhexin tablet 8 mg Tablet 0 0
29 Calsium Laktat (Kalk) tablet 500 mg Tablet 0 0
30 Candesartan tablet 16 mg Tablet 0 0
31 Candesartan tablet 8 mg Tablet 0 0
32 Captopril tablet 12,5 mg Tablet 0 0
33 Captopril tablet 25 mg Tablet 0 0
34 Carbamazepin tablet 200 mg Tablet 0 0
35 Cefadroxil kapsul 500 mg Kapsul 0 0
36 Chloramfenikol kapsul 250 mg Kapsul 0 0
37 Chlorfeniramin Maleat (CTM) tablet 4 mg Tablet 100 100
38 Chlorpromazin HCL tablet salut 100 mg Tablet 0 0
39 Chorpromazin HCL tablet salut 25 mg Tablet 0 0
40 Cimetidine 200 mg tablet Tablet 0 0
41 Ciprofloxacin 500 mg kaptab Tablet 0 0
42 Clobazam 10 mg tablet Tablet 0 0
43 Clopidogrel tablet 75 mg Tablet 0 0
44 Codein HCL tablet 10 mg Tablet 0 0
45 Cotrimoksazol tablet, 480 mg Tablet 100 100
46 Dexametason tablet 0,5 mg Tablet 0 0
47 Diapet kapsul Kapsul 0 0
48 Diazepam tablet 2 mg Tablet 0 0
49 Diazepam tablet 5 mg Tablet 0 0
50 Digoksin tablet 0,25 mg Tablet 0 0
51 Diklofenak Natrium/Sodium 25 mg tablet Tablet 0 0
52 Diklofenak Natrium/Sodium 50 mg tablet Tablet 0 0
53 Diltiazem tablet Tablet 0 0
54 Doxyciclin 100 mg tablet Tablet 0 0
55 Ergotamin Tartat komb./Antimigren DOEN Tablet kombinasi Tablet 0 0
56 Erythromicin kapsul 500 mg Tablet 0 0
57 Ethambutol HCL tablet 250 mg Tablet 0 0
58 Fenitoin Natrium kapsul 100 mg Kapsul 0 0
59 Fenitoin Natrium Kapsul 30 mg Kapsul 0 0
60 Fenobarbital tablet 100 mg Tablet 0 0
61 Fenobarbital tablet 30 mg Tablet 100 100
62 Fenoksimetil Penisilin tablet 500 mg Tablet 0 0
63 Fitometadion (Vit. K1) tablet salut gula 10 mg Tablet 0 0
64 Fluor tablet 0,5 mg Tablet 0 0
65 Furosemida tablet 40 mg Tablet 0 0
66 Garam Oralit untuk 200 ml air Sachet 0 0
67 Glibenklamid Tablet 5 mg Tablet 90 90
68 Glikuidon tablet Tablet 0 0
69 Glimepirid tablet 1 mg Tablet 0 0
70 Glimepirid tablet 2 mg Tablet 0 0
71 Gliseril Guaiakolat tablet 100 mg Tablet 0 0
72 Griseofulvin tablet 125 mg Tablet 0 0
73 Haloperidol tablet 0,5 mg Tablet 0 0
74 Haloperidol tablet 1,5 mg Tablet 0 0
75 Haloperidol tablet 5 mg Tablet 0 0
76 Hidroklorotiazid (HCT) tablet 25 mg Tablet 0 0
77 Ibuprofen tablet 200 mg Tablet 0 0
78 Ibuprofen tablet 400 mg Tablet 0 0
79 Iodiol kapsul lunak Kapsul 0 0
80 Isoniazid tablet (INH) 100 mg Tablet 0 0
81 Isoniazid tablet (INH) 300 mg Tablet 0 0
82 Isosorbid Dinitrat (ISDN) tablet sublingual 5 mg Tablet 0 0
83 Ketokonazol 200 mg tab. Tablet 0 0
84 Ketoprofen tablet 100 mg Tablet 0 0
85 Klorokuin tablet 250 mg Tablet 0 0
86 Kuinina (Kina) tablet 222 mg Tablet 0 0
87 Lanzoprazol kapsul Tablet 0 0
88 Lisinopril tablet 10 mg Tablet 0 0
89 Lisinopril tablet 5 mg Tablet 0 0
90 Livron B plex tablet Tablet 0 0
91 Loperamid tablet 2 mg Tablet 0 0
92 Loratadin tablet 10 mg Tablet 0 0
93 Mebendazol tablet 100 mg Tablet 0 0
94 Meloxicam tablet 15 mg Tablet 0 0
95 Metformin tablet 500 Tablet 70 70
96 Metil Prednisolon tablet 4 mg Tablet 0 0
97 Metilergometrin Maleat tablet salut 0,125 mg Tablet 70 70
98 Metoclopramid tablet 10 mg Tablet 0 0
99 Metronidazol tablet 250 mg Tablet 0 0
100 Metronidazol tablet 500 mg Tablet 0 0
101 Multivitamin tablet Tablet 0 0
102 Natrium Bikarbonat tablet 500 mg Tablet 0 0
103 Nifedipin 10 mg tablet Tablet 0 0
104 Nistatin tablet salut 500.000 iu Tablet 50 50
105 Obat Antituberkulosis FDC Katagori 1 & 3 Paket tablet Paket 0 0
106 Obat Antituberkulosis FDC Katagori 2 Paket tablet Paket 0 0
107 Obat Antituberkulosis Kategori Anak Paket tablet Paket 0 0
108 Obat Antituberkulosis Kategori Sisipan Paket tablet Paket 0 0
109 Obat batuk kering tablet (DMP + Anti Histamin) Tablet 0 0
110 Obat demam, batuk, pilek tablet (PCT 500 mg, dmp, ctm, gg, Tablet 0 0
111 Obat flu tablet (PCT, PP,CTM) Tablet 0 0
112 Obat Kusta Paket MB & PB Treatment/MDT Anak Paket 0 0
113 Obat Kusta Paket MB & PB Treatment/MDT Dewasa Paket 0 0
114 Obat pilek tablet (triprolidin, pseudoefedrin) Tablet 0 0
115 Ofloxacin tablet 400 mg Tablet 0 0
116 Omeprazol kapsul 20 mg. Tablet 0 0
117 Ondansentron tablet 4 mg Tablet 0 0
118 Oseltamivir tablet 75 mg Tablet 0 0
119 Papaverin tablet 40 mg Tablet 0 0
120 Paraformaldehida tablet 1 gam Tablet 0 0
121 Parasetamol tablet 500 mg Tablet 0 0
122 Phenylbutason tablet 200 Tablet 0 0
123 Piracetam kapsul 1200 mg Tablet 0 0
124 Piridoksin HCL (Vit. B6) Tablet 10 mg Tablet 0 0
127 Prazikuantel tablet 600 mg Tablet 0 0
128 Prednison tablet 5 mg Tablet 0 0
129 Primaquin tablet 15 mg Tablet 0 0
130 Propanolol tablet 10 mg Tablet 0 0
131 Propanolol tablet 40 mg Tablet 0 0
132 Propil Tiourasil (PTU) 100 mg tablet Tablet 0 0
133 Pyrantel Pamoat 125 mg tablet Tablet 0 0
134 Ramipril tablet 2,5 mg Tablet 0 0
135 Ramipril tablet 5 mg Tablet 0 0
136 Ranitidin tablet 150 mg Tablet 0 0
137 Reserpin Tablet 0,10 mg Tablet 0 0
138 Reserpin Tablet 0,25 mg Tablet 0 0
139 Retinol (Vit.A ) kapsul 100.000 iu Kapsul 0 0
140 Retinol (Vit.A ) kapsul 200.000 iu Kapsul 0 0
141 Rifampisin Kapsul 300 mg Kapsul 0 0
144 Risperidon tablet 2 mg Tablet 0 0
145 Risperidon tablet 3 mg Tablet 0 0
146 Salbutamol tablet 2 mg Tablet 0 0
147 Salbutamol tablet 4 mg Tablet 0 0
148 Setirizin tablet 10 mg Tablet 0 0
149 Simvastatin tablet 10 mg Tablet 0 0
150 Spironolacton tablet 100 mg. Tablet 0 0
151 Sucralfat Tablet 500 mg Tablet 0 0
152 Tetrasiklin HCL kapsul 250 mg Kapsul 0 0
153 Tetrasiklin HCL Kapsul 500 mg Kapsul 0 0
154 Thiamphenicol kapsul 500 mg Kapsul 0 0
155 Tiamin HCL/Monotatrat (Vit. B1) Tablet 50 mg Tablet 0 0
156 Tramadol tablet 50 mg Tablet 0 0
157 Triheksilfenidil (THP) Hidroklorida tablet 2 mg Tablet 0 0
158 Valsartan tablet 80 mg Tablet 0 0
159 Vitamin B Complex tablet Tablet 0 0
160 Vitamin Neurotropik tablet Tablet 0 0
161 Zinc 20 mg tablet Tablet 0 0
417 Kotrimoksazol Tab.Peiatrik 120 mg Tablet 0 0
0
OBAT MATA, TELINGA & MULUT 0
162 Borax Gliserin Botol 0 0
163 Chloramfenikol salep mata 1% Tube 0 0
164 Chloramfenikol tetes mata Botol 0 0
165 Chloramfenikol tetes telinga 3 % Botol 0 0
166 Fenol Gliserol tetes telinga 10% Botol 0 0
167 Gentamisin salep mata 0,3% Tube 0 0
168 Gentamisin Sulfat 0,3% Tetes Mata Botol 5 5
169 Oksitetresiklin HCL salep mata 1% Tube 16 16
170 Sulfasetamida Natrium tetes mata 15%-5ml Botol 0 0
0
0
INJEKSI 0 0
171 Aminofilin injeksi 24 mg/ml-10ml Ampul 0 0
172 Amoksisilin injeksi Ampul 0 0
173 Antalgin (Metampiron) injeksi 250 mg/ml-2ml Ampul 0 0
174 Aqua pro injeksi steril bebas pirogen Vial 0 0
175 Artemeter Injeksi. Ampul 0 0
176 Artesunate Injeksi Vial 0 0
177 Asam Traneksamat Injeksi. Ampul 0 0
178 Atrofin Sulfat Injeksi 0,25 mg/ml-1 ml Ampul 0 0
179 Benzatin Benzil Penicillin Injeksi 1,2 juta iu/vial Vial 0 0
180 Benzatin Benzil Penicillin Injeksi 2,4 juta iu/vial Vial 0 0
181 Chloramfenikol serbuk injeksi 1000 mg/ml Vial 0 0
182 Chlorpromazin HCL injeksi 25 mg/ml-1ml Ampul 0 0
183 Chlorpromazin HCL injeksi 5 mg/ml-2ml Ampul 0 0
184 Dexametason Injeksi Ampul 5 5
185 Diazepam injeksi 10mg/ml Ampul 0 0
186 Diazepam injeksi 5 mg/ml Ampul 0 0
187 Difenhidramin HCL injeksi 10 mg/ml-1ml Ampul 0 0
188 Epinefrina HCL/Bitatrat (Epinefrin/Adrenalin) injeksi Ampul 0 0
189 Fenobarbital injeksi 50 mg/ml-2ml Ampul 0 0
190 Furosemid injeksi Ampul 0 0
191 Gentamisin injeksi 40 mg/ml Ampul 0 0
192 Haloperidol injeksi (IM) 5 mg/ml Ampul 0 0
193 Haloperidol injeksi inkesi (IM) 50 mg/ml Ampul 0 0
194 Hiosin Butilbromid injeksi 20 mg/ml Ampul 0 0
195 Human tetanus imunoglobulin injeksi (i.m) 250 UI Ampul 0 0
196 Kalsium Glukonat injeksi Ampul 0 0
197 Ketorolac injeksi 10 mg/ml Ampul 0 0
198 Kuinina Dihidroklorida Injeksi 25%-2ml Ampul 0 0
199 Lidokain injeksi 2% (HCL) Ampul 0 0
200 Lidokain Komp.injeksi, Komb.: Lidokain HCL 2% + Epinefrin Ampul 0 0
201 Metilergometrin Maleat injeksi. 0,200 mg 1ml Ampul 0 0
202 Metilprednisolon injeksi 125 mg/2 mL Vial 0 0
203 Metoclopramid Injeksi. Ampul 0 0
204 MgSO4 20% Injeksi. Vial 0 0
205 MgSO4 40% Injeksi. Vial 0 0
206 Natrium Tiosulfat injeksi 25%-10ml Vial 0 0
207 Oksitetrasiklin HCL injeksi i.m 50 mg/ml 10 ml Vial 0 0
208 Oksitosin injeksi 10iu/ml-1ml Ampul 0 0
209 Omeperazol injeksi 40 mg/10 ml Vial 0 0
210 Ondansetron 4 mg/ml Injeksi Ampul 0 0
211 Papaverin Injeksi Ampul 0 0
212 Piracetam Injeksi Ampul 0 0
213 Procain Benzil Penisilin injeksi 3 juta iu/vial Vial 0 0
214 Ranitidin Injeksi. Ampul 0 0
215 Sefotaksim injeksi 1 g Ampul 0 0
216 Seftriakson injeksi Vial 0 0
217 Serum Anti bisa Ular Polivalen Injeksi 5 ml Vial 0 0
218 Serum Anti Tetanus (ATS) injeksi 1.500 iu/amp Ampul 0 0
219 Sianokobalamin (Vit. B12) injeksi 500 mcg/ml-1ml Ampul 0 0
220 Streptomisin Sulfat serbuk injeksi 1.000 mg/vial Vial 0 0
221 Streptomisin Sulfat serbuk injeksi 1.500 mg/vial Vial 0 0
222 Ventolin Nebolizer Ampul 0 0
223 Vit. K 10 mg/ml-1ml injeksi Ampul 0 0
224 Vit. K Infant 2mg/ml Injeksi Ampul 0 0
0
0
SALEP DAN SUPP 0
225 Acyclovir 5 % Cream Tube 0 0
226 Anti Bakteri DOEN Salep kombinasi (Bacitrasin- Neomicin) Pot 0 0
227 Anti Hemoroid DOEN kombinasi supp Supp 0 0
228 Antifungi DOEN Salep kombinasi (White Field Salep) Pot 0 0
229 Betametason krim 0,1 % Tube 0 0
230 Betametason Neomisin krim Tube 0 0
231 Bioplacenton Jelly Tube 0 0
232 Bisakodil supp. Anak Supp 0 0
233 Bisakodil supp. Dewasa Supp 0 0
234 Desoksimetason + Neomicin Cream Tube 0 0
235 Diazepam 10 mg/2,5 ml Supp Rectal Dewasa Tube 0 0
236 Diazepam 5 mg/2,5 ml Supp Rectal Anak Tube 0 0
237 Gameksan emulsi 1% Botol 0 0
238 Gentamisin Salep Kulit Tube 0 0
239 Gentian Violet larutan 1% Botol 0 0
240 Hidrokortison krim 2,5% Tube 22 22
241 Ketokonazol 2 % Krim. Tube 0 0
242 Ketoprofen 100 mg Supp. Supp 0 0
243 Levertran Zalf 15 g Pot 0 0
244 Lidocain gel Tube 0 0
245 Miconazole 2% Cream Tube 0 0
246 Nistatin tablet Vaginal 100.000 iu/g Supp Tab vag 0 0
247 Oksigen gas dalam tabung (Oxycan) Tabung 0 0
248 Oksitetrasiklin HCL salep kulit 3% Tube 0 0
249 Paracetamol 125 mg/2,5 ml Supp Rectal Tube 0 0
250 Paracetamol 250 mg/4 ml Supp Rectal Tube 0 0
251 Permetrin 5% Salep Tube 0 0
252 Placenta + Neomycin Cream Tube 0 0
253 Polikresulen (Albothyl) 10 ml Solution Botol 0 0
254 Salep 2-4, Komb.: As. Salisilat 2% + Belerang Endap 4% Pot 10 10
255 Salisil Bedak Tabur 2 % Pot 0 0
0
0
OBAT GIGI 0 0
256 Air Raksa dental use Botol 0 0
257 Devitalisasi Pasta (Non Arsen) Pot 0 0
258 Etil Klorida semprot Botol 0 0
259 Eugenol cairan Botol 0 0
260 Glass Ionomer Cement (GC IX) Set 0 0
261 Kalsium Hidroksida Pasta/Cement Botol 0 0
262 Monoklorkamfer Mentol cairan (CHKM) Botol 0 0
263 Mummifying Pasta/Iodoform Pasta Botol 0 0
264 Semen Zeng Fosfat serbuk dan cairan Botol 0 0
265 Silver Amalgam Serbuk Botol 0 0
266 Temporary Stopping (Fletcher) Serbuk dan Cairan Set 0 0
267 Trikresol Formalin (TKF) Cairan Botol 0 0
0
0
CAIRAN 0 0
268 Etakridin (Rivanol) larutan 0,1% Botol 0 0
269 Etanol 70 % Botol 0 0
270 Glukosa larutan infus 10% steril 500 ml Botol 0 0
271 Glukosa larutan infus 5% steril 500 ml Botol 0 0
272 Glukosa larutan infus steril 5 g/100 ml Botol 0 0
273 Glukosa larutan infus steril 5%-1/2 NS 500 ml Botol 0 0
274 Glukosa larutan infus steril 5%-1/4 NS 500 ml Botol 0 0
275 H2O2/Hidrogen Peroksida (Perhidrol) 3% Botol 0 0
276 Natrium Klorida (NaCl) infus 0,9% 500 ml Botol 0 0
277 Povidon Iodine larutan 10% 30 ml Botol 0 0
278 Povidon iodine larutan 10% 300 ml Botol 0 0
279 Ringer Laktat larutan Infus Steril 500 ml Botol 2 2
280 Salisil Spiritus 10 % Botol 0 0
0
0
SIRUP 0 0
281 Albendazol sup 200mg/5 ml Botol 0 0
282 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0
283 Amoksisilin sirup kering forte 250 mg/5 ml Botol 0 0
284 Antasida DOEN suspensi btl. 60 ml Botol 0 0
285 Chloramfenikol suspensi 125 mg/ 5 ml Botol 0 0
286 Cotrimoksazol suspensi 240 mg/5ml Botol 9 9
287 Domperidon Syrup 60 ml Botol 0 0
288 Erythromicin sirup Botol 0 0
289 Ibuprofen sirip 100 mg/ 5 ml Botol 0 0
290 Metronidazol sirup 125 mg/5 ml Botol 0 0
291 Multivitamin sirup Botol 0 0
292 Nistatin Drop Botol 0 0
293 Obat Batuk Hitam (OBH) sirup Botol 0 0
294 Obat batuk sirup ( DMP + CTM) Botol 0 0
295 Obat flu batuk pilek sirup (pct 120-130 mg, dmp, ctm, gg,pp) Botol 0 0
296 Obat flu batuk pilek sirup (pct 120-130 mg, efedrin, gg, ctm) Botol 0 0
297 Obat flu batuk pilek sirup (pct 250 mg, dmp,pp, gg, ctm) Botol 0 0
298 Parasetamol drop 100 mg/ml Botol 0 0
299 Parasetamol Sirup 120 mg/5 ml Botol 10 10
300 Setirizin sirup 5 mg/5 ml Botol 5 5
301 Sukralfat syrup Botol 8 8
302 Thiamphenicol syrup Botol 0 0
303 Zinc sirup 10 mg/5ml Botol 0 0
0 0
0 0
BHP & BAHAN LAB 0 0
304 Abbocat set Anak (No 24) Buah 0 0
305 Abbocat set Dewasa (16 - 22) Buah 0 0
306 Alat Suntik Sekali Pakai 1 ml Piece 0 0
307 Alat suntik sekali pakai 3 ml Piece 0 0
308 Alat suntik sekali pakai 5 ml Piece 0 0
311 Aseptik gel Botol 0 0
312 Blood Lancet Box 0 0
313 Blood Transfusion Set Piece 0 0
314 Cangkang Kapsul no. 0 Bungkus 0 0
315 Cangkang Kapsul no. 1 Bungkus 0 0
316 Chromic Catgut 2/0 75 Cm sachet 0 0
317 Chromic Catgut 3/0 75 Cm sachet 0 0
318 Chromic Catgut Rol 2/0 100 M Roll 0 0
319 Chromic Catgut Rol 3/0 100 M Roll 0 0
320 Cito brush (pembersih tabung) Buah 0 0
321 Cover glass Set 0 0
322 Cuka dixi Botol 0 0
323 Dermalon* 3/0 75 cm Piece 0 0
324 Dermalon* 4/0 75 cm Piece 0 0
325 Feeding Tube 100 cm, no. 6 Piece 0 0
326 Feeding Tube 100 cm, no. 8 Piece 0 0
327 Folly Kateter 16 Piece 0 0
330 Gliserin Botol 0 0
331 Holder Buah 0 0
332 Infusion Set anak Set 0 0
333 Infusion Set dewasa Set 1 1
334 Jarum Disposible 23 G Piece 0 0
335 Jarum Dysposible 26 G Piece 0 0
336 Jarum Jahit (bedah) No. 9 s/d 14 Pack 0 0
337 Jarum vanoject/ Vacuntainer Piece 0 0
338 Kaca Sediaan Piece 0 0
339 Kapas Lidi Steril Bungkus 0 0
340 Kapas Pembalut/Absorben 250 g Bungkus 0 0
341 Kapas Pembalut/Absorben500 g Roll 0 0
342 Kasa Kompres 40/40 steril Bungkus 0 0
343 Kasa Pembalut Hydrophil 16 cm x 16 cm Piece 0 0
344 Kasa Pembalut Hydrophil 3 cm x 4 meter Roll 10 10
349 Kassa Gulung 80 cm x 40 Yard Roll 0 0
350 Kertas Puyer Bungkus 0 0
351 Klorin 5,25 % Botol 0 0
352 KY Jely USG Botol 0 0
353 Larutan Asam Alkohol Botol 0 0
354 Larutan Asam Klorida 0,1 N Btl 0 0
355 Larutan Karbol Puksin Botol 0 0
356 Larutan KOH 1% Botol 0 0
357 Larutan Metanol Botol 0 0
358 Larutan Methylen Blue Botol 0 0
359 Lizol mengandung Kresol Botol 0 0
360 Masker Piece 0 0
361 Masker N 95 Piece 0 0
362 Metilin blue Botol 0 0
363 Muchus Suction (Penghisap Lendir) Piece 0 0
364 Oxyflow Nasal Oxygen Anak Piece 0 0
365 Oxyflow Nasal Oxygen Dewasa Piece 0 0
366 PH paper 3,8 - 5,4 Roll 0 0
367 Pisau Bedah Piece 0 0
368 Plain Catgut 2/0 75 cm sachet 0 0
369 Plain Catgut 3/0 75 cm sachet 0 0
370 Plain Catgut Rol 2/0 100 m Roll 0 0
371 Plain Catgut Rol 3/0 100 m Roll 0 0
372 Plester Kain 5 cm x 5 m Roll 0 0
373 Plester Kain 10 cm x 5 m Roll 0 0
374 Plester Kain 2,5 cm x 4,5 m Roll 0 0
375 Plester Kain 5 cm x 4,5 m Roll 0 0
376 Plester Kain 7,5 cm x 4,5 m Roll 0 0
377 Plastik Klip Obat 7 x 10 cm Bungkus 0 0
378 Plastik Klip Obat 8.7 x 13 cm Bungkus 0 0
379 Pot Dahak Pot 0 0
380 Pot Salep 10 Gr Pot 0 0
381 Pot Salep 20 Gr Pot 0 0
382 Reagensia ABX 60 atphalyse Liter 0 0
383 Reagensia ABX 60 cleaner Liter 0 0
384 Reagensia ABX 60 minilidi Liter 0 0
385 Sabun Anti Bakteri Botol 0 0
386 Safety box Buah 0 0
387 Sarung Tangan Karet (Hand Scund) L Piece 0 0
388 Sarung Tangan Karet (Hand Scund) M Piece 0 0
389 Sarung Tangan Karet (Hand Scund) S Piece 0 0
390 Sarung Tangan Obgyn Pasang 0 0
391 Sarung Tangan Steril No. 7 Pasang 0 0
392 Sarung Tangan Steril No. 7.5 Pasang 0 0
393 Silk 2/0 Rol 100 M Roll 0 0
394 Silk 3/0 Rol 100 M Roll 0 0
395 Silk 2/0 75 cm sachet 0 0
398 Stomach Tube, 85 cm, no. 16 Piece 0 0
399 Stomach Tube, 85 cm, no. 18 Piece 0 0
400 Sufratule Piece 0 0
401 Tabung criyo 15 ml Tube 0 0
402 Tabung vancuntainer 5 cc Piece 0 0
403 Tissue Box 0 0
404 Torniquet Buah 0 0
405 Tri -Way With Extention Piece 0 0
406 Umbilical Cord Clamp Piece 0 0
407 Underpad Piece 0 0
408 Urobag Piece 0 0
409 Wing Nedle 19 G Buah 0 0
412 Yelow tip isi 1000 pcs Peace 0 0
0
0
Umum BPJS Lain-lain

0 15 0
Mengetahui/Menyetujui Yang Menyerahkan
Ka. Dinas Kesehatan Kab. Buleleng Petugas Depo Farmasi
( ) ( )
NIP. NIP.
intaan Obat
Dokumen Nomor Tanggal

S 2021 Depo Farm
ER 2021 Puskesmas
Sisa Stok Pemberian

Pemakaian Permintaan Ket.
Stok Optimum APBD Lain-lain Jumlah
7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
70
0
0
0
0
0
0
0
0
0
60
0
0
0
0
0
0
0
40
0
0
0
100
0
0
70
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
90
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
70
0
70
0
0
0
0
0
0
50
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
22
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
0
10
5 0
5 3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
5 5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Jumlah
15
NIP. NIP. 197608172002122009
PUSTU GOBLEG

Kecamatan Banjar Pelaporan Bulan : September 2021 Depo Farm
Kabupaten Buleleng Permintaan Bulan : Oktober 2021 Puskesmas
Stok Penerima Persediaa Pemakaia Sisa Stok Pemberian

No. Nama Obat Satuan Permintaan Ket.
Awal an n n Stok Optimum APBD Lain-lain Jumlah
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 ((7x4)-8) 10 11 12 13 (11 + 12) 14
1 Acyclovir tablet 200 mg Tablet 70 70 70
2 Acyclovir tablet 400 mg Tablet 0 0 0
3 Albendazol tablet 400 mg Tablet 0 0 0
4 Alopurinol tablet 100 mg Tablet 0 0 0
5 Alopurinol tablet 300 mg Tablet 0 0 0
6 Alprazolam tablet 0,25 mg Tablet 0 0 0
7 Ambroxol tablet 30 mg Tablet 0 0 0
8 Aminofilin tablet 200 mg Tablet 0 0 0
9 Amitriptilin tablet 25 mg. Tablet 0 0 0
10 Amlodipin tablet 10 mg Tablet 0 0 0
11 Amlodipin tablet 5 mg Tablet 60 60 60
12 Amoksisilin kapsul 250 mg Kapsul 0 0 0
13 Amoksisilin kapsul 500 mg Kapsul 0 0 0
14 Antalgin (Metampiron) tablet 500 mg Tablet 0 0 0
15 Antasida DOEN tablet 500 mg Tablet 0 0 0
16 Artesdiaquine tablet Tablet 0 0 0
17 Asam Asetil Salisilat tablet 80 - 100 mg. Tablet 0 0 0
18 Asam Askorbat (Vit. C) tablet 50 mg Tablet 0 0 0
19 Asam Folat tablet Tablet 40 40 40
20 Asam Mefenamat tablet 500 mg Tablet 0 0 0
21 Asam Traneksamat tablet 500 mg. Tablet 0 0 0
22 Asiklovir 400 mg tablet Tablet 0 0 0
23 Attapulgite 600 mg tablet Tablet 100 100 100
24 Azithromycin tablet 500 Tablet 0 0 0
25 Besi (II) Sulfat (Tambah darah) tablet Tablet 0 0 0
26 Betahistine Mesilat tablet Tablet 70 70 70
27 Bisoprolol tablet 5 mg. Tablet 0 0 0
28 Bromhexin tablet 8 mg Tablet 0 0 0
29 Calsium Laktat (Kalk) tablet 500 mg Tablet 0 0 0
30 Candesartan tablet 16 mg Tablet 0 0 0
31 Candesartan tablet 8 mg Tablet 0 0 0
32 Captopril tablet 12,5 mg Tablet 0 0 0
33 Captopril tablet 25 mg Tablet 0 0 0
34 Carbamazepin tablet 200 mg Tablet 0 0 0
35 Cefadroxil kapsul 500 mg Kapsul 0 0 0
36 Chloramfenikol kapsul 250 mg Kapsul 0 0 0
37 Chlorfeniramin Maleat (CTM) tablet 4 mg Tablet 100 100 100
38 Chlorpromazin HCL tablet salut 100 mg Tablet 0 0 0
39 Chorpromazin HCL tablet salut 25 mg Tablet 0 0 0
40 Cimetidine 200 mg tablet Tablet 0 0 0
41 Ciprofloxacin 500 mg kaptab Tablet 0 0 0
42 Clobazam 10 mg tablet Tablet 0 0 0
43 Clopidogrel tablet 75 mg Tablet 0 0 0
44 Codein HCL tablet 10 mg Tablet 0 0 0
45 Cotrimoksazol tablet, 480 mg Tablet 100 100 100
46 Dexametason tablet 0,5 mg Tablet 0 0 0
47 Diapet kapsul Kapsul 0 0 0
48 Diazepam tablet 2 mg Tablet 0 0 0
49 Diazepam tablet 5 mg Tablet 0 0 0
50 Digoksin tablet 0,25 mg Tablet 0 0 0
51 Diklofenak Natrium/Sodium 25 mg tablet Tablet 0 0 0
52 Diklofenak Natrium/Sodium 50 mg tablet Tablet 0 0 0
53 Diltiazem tablet Tablet 0 0 0
54 Doxyciclin 100 mg tablet Tablet 0 0 0
55 Ergotamin Tartat komb./Antimigren DOEN Tablet kombinasi Tablet 0 0 0
56 Erythromicin kapsul 500 mg Tablet 0 0 0
57 Ethambutol HCL tablet 250 mg Tablet 0 0 0
58 Fenitoin Natrium kapsul 100 mg Kapsul 0 0 0
59 Fenitoin Natrium Kapsul 30 mg Kapsul 0 0 0
60 Fenobarbital tablet 100 mg Tablet 0 0 0
61 Fenobarbital tablet 30 mg Tablet 100 100 100
62 Fenoksimetil Penisilin tablet 500 mg Tablet 0 0 0
63 Fitometadion (Vit. K1) tablet salut gula 10 mg Tablet 0 0 0
64 Fluor tablet 0,5 mg Tablet 0 0 0
65 Furosemida tablet 40 mg Tablet 0 0 0
66 Garam Oralit untuk 200 ml air Sachet 0 0 0
67 Glibenklamid Tablet 5 mg Tablet 90 90 90
68 Glikuidon tablet Tablet 0 0 0
69 Glimepirid tablet 1 mg Tablet 0 0 0
70 Glimepirid tablet 2 mg Tablet 0 0 0
71 Gliseril Guaiakolat tablet 100 mg Tablet 0 0 0
72 Griseofulvin tablet 125 mg Tablet 0 0 0
73 Haloperidol tablet 0,5 mg Tablet 0 0 0
74 Haloperidol tablet 1,5 mg Tablet 0 0 0
75 Haloperidol tablet 5 mg Tablet 0 0 0
76 Hidroklorotiazid (HCT) tablet 25 mg Tablet 0 0 0
77 Ibuprofen tablet 200 mg Tablet 0 0 0
78 Ibuprofen tablet 400 mg Tablet 0 0 0
79 Iodiol kapsul lunak Kapsul 0 0 0
80 Isoniazid tablet (INH) 100 mg Tablet 0 0 0
81 Isoniazid tablet (INH) 300 mg Tablet 0 0 0
82 Isosorbid Dinitrat (ISDN) tablet sublingual 5 mg Tablet 0 0 0
83 Ketokonazol 200 mg tab. Tablet 0 0 0
84 Ketoprofen tablet 100 mg Tablet 0 0 0
85 Klorokuin tablet 250 mg Tablet 0 0 0
86 Kuinina (Kina) tablet 222 mg Tablet 0 0 0
87 Lanzoprazol kapsul Tablet 0 0 0
88 Lisinopril tablet 10 mg Tablet 0 0 0
89 Lisinopril tablet 5 mg Tablet 0 0 0
90 Livron B plex tablet Tablet 0 0 0
91 Loperamid tablet 2 mg Tablet 0 0 0
92 Loratadin tablet 10 mg Tablet 0 0 0
93 Mebendazol tablet 100 mg Tablet 0 0 0
94 Meloxicam tablet 15 mg Tablet 0 0 0
95 Metformin tablet 500 Tablet 70 70 70
96 Metil Prednisolon tablet 4 mg Tablet 0 0 0
97 Metilergometrin Maleat tablet salut 0,125 mg Tablet 70 70 70
98 Metoclopramid tablet 10 mg Tablet 0 0 0
99 Metronidazol tablet 250 mg Tablet 0 0 0
100 Metronidazol tablet 500 mg Tablet 0 0 0
101 Multivitamin tablet Tablet 0 0 0
102 Natrium Bikarbonat tablet 500 mg Tablet 0 0 0
103 Nifedipin 10 mg tablet Tablet 0 0 0
105 Obat Antituberkulosis FDC Katagori 1 & 3 Paket tablet Paket 0 0 0
106 Obat Antituberkulosis FDC Katagori 2 Paket tablet Paket 0 0 0
107 Obat Antituberkulosis Kategori Anak Paket tablet Paket 0 0 0
108 Obat Antituberkulosis Kategori Sisipan Paket tablet Paket 0 0 0
109 Obat batuk kering tablet (DMP + Anti Histamin) Tablet 0 0 0
110 Obat demam, batuk, pilek tablet (PCT 500 mg, dmp, ctm, gg, Tablet 0 0 0
111 Obat flu tablet (PCT, PP,CTM) Tablet 0 0 0
112 Obat Kusta Paket MB & PB Treatment/MDT Anak Paket 0 0 0
113 Obat Kusta Paket MB & PB Treatment/MDT Dewasa Paket 0 0 0
114 Obat pilek tablet (triprolidin, pseudoefedrin) Tablet 0 0 0
115 Ofloxacin tablet 400 mg Tablet 0 0 0
116 Omeprazol kapsul 20 mg. Tablet 0 0 0
117 Ondansentron tablet 4 mg Tablet 0 0 0
118 Oseltamivir tablet 75 mg Tablet 0 0 0
119 Papaverin tablet 40 mg Tablet 0 0 0
120 Paraformaldehida tablet 1 gam Tablet 0 0 0
121 Parasetamol tablet 500 mg Tablet 0 0 0
122 Phenylbutason tablet 200 Tablet 0 0 0
123 Piracetam kapsul 1200 mg Tablet 0 0 0
124 Piridoksin HCL (Vit. B6) Tablet 10 mg Tablet 0 0 0
125 Piroxicam kapsul 10 mg Kapsul 0 0 0
126 Piroxicam kapsul 20 mg Kapsul 0 0 0 100
127 Prazikuantel tablet 600 mg Tablet 0 0 0
128 Prednison tablet 5 mg Tablet 0 0 0
129 Primaquin tablet 15 mg Tablet 0 0 0
130 Propanolol tablet 10 mg Tablet 0 0 0
131 Propanolol tablet 40 mg Tablet 0 0 0
132 Propil Tiourasil (PTU) 100 mg tablet Tablet 0 0 0
133 Pyrantel Pamoat 125 mg tablet Tablet 0 0 0
134 Ramipril tablet 2,5 mg Tablet 0 0 0
135 Ramipril tablet 5 mg Tablet 0 0 0
136 Ranitidin tablet 150 mg Tablet 0 0 0
137 Reserpin Tablet 0,10 mg Tablet 0 0 0
138 Reserpin Tablet 0,25 mg Tablet 0 0 0
139 Retinol (Vit.A ) kapsul 100.000 iu Kapsul 0 0 0
140 Retinol (Vit.A ) kapsul 200.000 iu Kapsul 0 0 0
141 Rifampisin Kapsul 300 mg Kapsul 0 0 0
144 Risperidon tablet 2 mg Tablet 0 0 0
145 Risperidon tablet 3 mg Tablet 0 0 0
146 Salbutamol tablet 2 mg Tablet 0 0 0
147 Salbutamol tablet 4 mg Tablet 0 0 0
148 Setirizin tablet 10 mg Tablet 0 0 0
149 Simvastatin tablet 10 mg Tablet 0 0 0
150 Spironolacton tablet 100 mg. Tablet 0 0 0
151 Sucralfat Tablet 500 mg Tablet 0 0 0
152 Tetrasiklin HCL kapsul 250 mg Kapsul 0 0 0
153 Tetrasiklin HCL Kapsul 500 mg Kapsul 0 0 0
154 Thiamphenicol kapsul 500 mg Kapsul 0 0 0
155 Tiamin HCL/Monotatrat (Vit. B1) Tablet 50 mg Tablet 0 0 0
156 Tramadol tablet 50 mg Tablet 0 0 0
157 Triheksilfenidil (THP) Hidroklorida tablet 2 mg Tablet 0 0 0
158 Valsartan tablet 80 mg Tablet 0 0 0
159 Vitamin B Complex tablet Tablet 0 0 0
160 Vitamin Neurotropik tablet Tablet 0 0 0
161 Zinc 20 mg tablet Tablet 0 0 0
417 Kotrimoksazol Tab.Peiatrik 120 mg Tablet 0 0 0
0 0 0
OBAT MATA, TELINGA & MULUT 0 0 0
162 Borax Gliserin Botol 0 0 0
163 Chloramfenikol salep mata 1% Tube 0 0 0
164 Chloramfenikol tetes mata Botol 0 0 0
165 Chloramfenikol tetes telinga 3 % Botol 0 0 0
166 Fenol Gliserol tetes telinga 10% Botol 0 0 0
167 Gentamisin salep mata 0,3% Tube 0 0 0
168 Gentamisin Sulfat 0,3% Tetes Mata Botol 5 5 5
169 Oksitetresiklin HCL salep mata 1% Tube 16 16 16
170 Sulfasetamida Natrium tetes mata 15%-5ml Botol 0 0 0
0 0 0
0 0 0
INJEKSI 0 0 0
171 Aminofilin injeksi 24 mg/ml-10ml Ampul 0 0 0
172 Amoksisilin injeksi Ampul 0 0 0
173 Antalgin (Metampiron) injeksi 250 mg/ml-2ml Ampul 0 0 0
174 Aqua pro injeksi steril bebas pirogen Vial 0 0 0
175 Artemeter Injeksi. Ampul 0 0 0
176 Artesunate Injeksi Vial 0 0 0
177 Asam Traneksamat Injeksi. Ampul 0 0 0
178 Atrofin Sulfat Injeksi 0,25 mg/ml-1 ml Ampul 0 0 0
179 Benzatin Benzil Penicillin Injeksi 1,2 juta iu/vial Vial 0 0 0
180 Benzatin Benzil Penicillin Injeksi 2,4 juta iu/vial Vial 0 0 0
181 Chloramfenikol serbuk injeksi 1000 mg/ml Vial 0 0 0
182 Chlorpromazin HCL injeksi 25 mg/ml-1ml Ampul 0 0 0
183 Chlorpromazin HCL injeksi 5 mg/ml-2ml Ampul 0 0 0
184 Dexametason Injeksi Ampul 5 5 5
185 Diazepam injeksi 10mg/ml Ampul 0 0 0
186 Diazepam injeksi 5 mg/ml Ampul 0 0 0
187 Difenhidramin HCL injeksi 10 mg/ml-1ml Ampul 0 0 0
188 Epinefrina HCL/Bitatrat (Epinefrin/Adrenalin) injeksi Ampul 0 0 0
189 Fenobarbital injeksi 50 mg/ml-2ml Ampul 0 0 0
190 Furosemid injeksi Ampul 0 0 0
191 Gentamisin injeksi 40 mg/ml Ampul 0 0 0
192 Haloperidol injeksi (IM) 5 mg/ml Ampul 0 0 0
193 Haloperidol injeksi inkesi (IM) 50 mg/ml Ampul 0 0 0
194 Hiosin Butilbromid injeksi 20 mg/ml Ampul 0 0 0
195 Human tetanus imunoglobulin injeksi (i.m) 250 UI Ampul 0 0 0
196 Kalsium Glukonat injeksi Ampul 0 0 0
197 Ketorolac injeksi 10 mg/ml Ampul 0 0 0
198 Kuinina Dihidroklorida Injeksi 25%-2ml Ampul 0 0 0
199 Lidokain injeksi 2% (HCL) Ampul 0 0 0
200 Lidokain Komp.injeksi, Komb.: Lidokain HCL 2% + Epinefrin Ampul 0 0 0
201 Metilergometrin Maleat injeksi. 0,200 mg 1ml Ampul 0 0 0
202 Metilprednisolon injeksi 125 mg/2 mL Vial 0 0 0
203 Metoclopramid Injeksi. Ampul 0 0 0
204 MgSO4 20% Injeksi. Vial 0 0 0
205 MgSO4 40% Injeksi. Vial 0 0 0
206 Natrium Tiosulfat injeksi 25%-10ml Vial 0 0 0
207 Oksitetrasiklin HCL injeksi i.m 50 mg/ml 10 ml Vial 0 0 0
208 Oksitosin injeksi 10iu/ml-1ml Ampul 0 0 0
209 Omeperazol injeksi 40 mg/10 ml Vial 0 0 0
210 Ondansetron 4 mg/ml Injeksi Ampul 0 0 0
211 Papaverin Injeksi Ampul 0 0 0
212 Piracetam Injeksi Ampul 0 0 0
213 Procain Benzil Penisilin injeksi 3 juta iu/vial Vial 0 0 0
214 Ranitidin Injeksi. Ampul 0 0 0
215 Sefotaksim injeksi 1 g Ampul 0 0 0
216 Seftriakson injeksi Vial 0 0 0
217 Serum Anti bisa Ular Polivalen Injeksi 5 ml Vial 0 0 0
218 Serum Anti Tetanus (ATS) injeksi 1.500 iu/amp Ampul 0 0 0
219 Sianokobalamin (Vit. B12) injeksi 500 mcg/ml-1ml Ampul 0 0 0
220 Streptomisin Sulfat serbuk injeksi 1.000 mg/vial Vial 0 0 0
221 Streptomisin Sulfat serbuk injeksi 1.500 mg/vial Vial 0 0 0
222 Ventolin Nebolizer Ampul 0 0 0
223 Vit. K 10 mg/ml-1ml injeksi Ampul 0 0 0
224 Vit. K Infant 2mg/ml Injeksi Ampul 0 0 0
0 0 0
0 0 0
SALEP DAN SUPP 0 0 0
225 Acyclovir 5 % Cream Tube 0 0 0
226 Anti Bakteri DOEN Salep kombinasi (Bacitrasin- Neomicin) Pot 0 0 0
227 Anti Hemoroid DOEN kombinasi supp Supp 0 0 0
228 Antifungi DOEN Salep kombinasi (White Field Salep) Pot 0 0 0
229 Betametason krim 0,1 % Tube 0 0 0
230 Betametason Neomisin krim Tube 0 0 0
231 Bioplacenton Jelly Tube 0 0 0
232 Bisakodil supp. Anak Supp 0 0 0
233 Bisakodil supp. Dewasa Supp 0 0 0
234 Desoksimetason + Neomicin Cream Tube 0 0 0
235 Diazepam 10 mg/2,5 ml Supp Rectal Dewasa Tube 0 0 0
236 Diazepam 5 mg/2,5 ml Supp Rectal Anak Tube 0 0 0
237 Gameksan emulsi 1% Botol 0 0 0
238 Gentamisin Salep Kulit Tube 0 0 0
239 Gentian Violet larutan 1% Botol 0 0 0
240 Hidrokortison krim 2,5% Tube 22 22 22
241 Ketokonazol 2 % Krim. Tube 0 0 0
242 Ketoprofen 100 mg Supp. Supp 0 0 0
243 Levertran Zalf 15 g Pot 0 0 0
244 Lidocain gel Tube 0 0 0
245 Miconazole 2% Cream Tube 0 0 0
246 Nistatin tablet Vaginal 100.000 iu/g Supp Tab vag 0 0 0
247 Oksigen gas dalam tabung (Oxycan) Tabung 0 0 0
248 Oksitetrasiklin HCL salep kulit 3% Tube 0 0 0
249 Paracetamol 125 mg/2,5 ml Supp Rectal Tube 0 0 0
250 Paracetamol 250 mg/4 ml Supp Rectal Tube 0 0 0
251 Permetrin 5% Salep Tube 0 0 0
252 Placenta + Neomycin Cream Tube 0 0 0
253 Polikresulen (Albothyl) 10 ml Solution Botol 0 0 0
254 Salep 2-4, Komb.: As. Salisilat 2% + Belerang Endap 4% Pot 10 10 10
255 Salisil Bedak Tabur 2 % Pot 0 0 0
0 0 0
0 0 0
OBAT GIGI 0 0 0
256 Air Raksa dental use Botol 0 0 0
257 Devitalisasi Pasta (Non Arsen) Pot 0 0 0
258 Etil Klorida semprot Botol 0 0 0
259 Eugenol cairan Botol 0 0 0
260 Glass Ionomer Cement (GC IX) Set 0 0 0
261 Kalsium Hidroksida Pasta/Cement Botol 0 0 0
262 Monoklorkamfer Mentol cairan (CHKM) Botol 0 0 0
263 Mummifying Pasta/Iodoform Pasta Botol 0 0 0
264 Semen Zeng Fosfat serbuk dan cairan Botol 0 0 0
265 Silver Amalgam Serbuk Botol 0 0 0
266 Temporary Stopping (Fletcher) Serbuk dan Cairan Set 0 0 0
267 Trikresol Formalin (TKF) Cairan Botol 0 0 0
0 0 0
0 0 0
CAIRAN 0 0 0
268 Etakridin (Rivanol) larutan 0,1% Botol 0 0 0
269 Etanol 70 % Botol 0 0 0
270 Glukosa larutan infus 10% steril 500 ml Botol 0 0 0
271 Glukosa larutan infus 5% steril 500 ml Botol 0 0 0
272 Glukosa larutan infus steril 5 g/100 ml Botol 0 0 0
273 Glukosa larutan infus steril 5%-1/2 NS 500 ml Botol 0 0 0
274 Glukosa larutan infus steril 5%-1/4 NS 500 ml Botol 0 0 0
275 H2O2/Hidrogen Peroksida (Perhidrol) 3% Botol 0 0 0
276 Natrium Klorida (NaCl) infus 0,9% 500 ml Botol 0 0 0
277 Povidon Iodine larutan 10% 30 ml Botol 0 0 0
278 Povidon iodine larutan 10% 300 ml Botol 0 0 0
279 Ringer Laktat larutan Infus Steril 500 ml Botol 2 2 2
280 Salisil Spiritus 10 % Botol 0 0 0
0 0 0
0 0 0
SIRUP 0 0 0
281 Albendazol sup 200mg/5 ml Botol 0 0 0
282 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0
283 Amoksisilin sirup kering forte 250 mg/5 ml Botol 0 0 0
284 Antasida DOEN suspensi btl. 60 ml Botol 0 0 0
285 Chloramfenikol suspensi 125 mg/ 5 ml Botol 0 0 0
286 Cotrimoksazol suspensi 240 mg/5ml Botol 9 9 9
287 Domperidon Syrup 60 ml Botol 0 0 0
288 Erythromicin sirup Botol 0 0 0
289 Ibuprofen sirip 100 mg/ 5 ml Botol 0 0 0
290 Metronidazol sirup 125 mg/5 ml Botol 0 0 0
291 Multivitamin sirup Botol 0 0 0
292 Nistatin Drop Botol 0 0 0
293 Obat Batuk Hitam (OBH) sirup Botol 0 0 0
294 Obat batuk sirup ( DMP + CTM) Botol 0 0 0
295 Obat flu batuk pilek sirup (pct 120-130 mg, dmp, ctm, gg,pp) Botol 0 0 0
296 Obat flu batuk pilek sirup (pct 120-130 mg, efedrin, gg, ctm) Botol 0 0 0
297 Obat flu batuk pilek sirup (pct 250 mg, dmp,pp, gg, ctm) Botol 0 0 0
298 Parasetamol drop 100 mg/ml Botol 0 0 0
299 Parasetamol Sirup 120 mg/5 ml Botol 10 10 10 10
300 Setirizin sirup 5 mg/5 ml Botol 0 0 0
301 Sukralfat syrup Botol 3 3 3
302 Thiamphenicol syrup Botol 0 0 0
303 Zinc sirup 10 mg/5ml Botol 0 0 0
0 0 0
0 0 0
BHP & BAHAN LAB 0 0 0
304 Abbocat set Anak (No 24) Buah 0 0 0
305 Abbocat set Dewasa (16 - 22) Buah 0 0 0
306 Alat Suntik Sekali Pakai 1 ml Piece 0 0 0
307 Alat suntik sekali pakai 3 ml Piece 0 0 0
308 Alat suntik sekali pakai 5 ml Piece 0 0 0
311 Aseptik gel Botol 0 0 0
312 Blood Lancet Box 0 0 0
313 Blood Transfusion Set Piece 0 0 0
314 Cangkang Kapsul no. 0 Bungkus 0 0 0
315 Cangkang Kapsul no. 1 Bungkus 0 0 0
316 Chromic Catgut 2/0 75 Cm sachet 0 0 0
317 Chromic Catgut 3/0 75 Cm sachet 0 0 0
318 Chromic Catgut Rol 2/0 100 M Roll 0 0 0
319 Chromic Catgut Rol 3/0 100 M Roll 0 0 0
320 Cito brush (pembersih tabung) Buah 0 0 0
321 Cover glass Set 0 0 0
322 Cuka dixi Botol 0 0 0
323 Dermalon* 3/0 75 cm Piece 0 0 0
324 Dermalon* 4/0 75 cm Piece 0 0 0
325 Feeding Tube 100 cm, no. 6 Piece 0 0 0
326 Feeding Tube 100 cm, no. 8 Piece 0 0 0
327 Folly Kateter 16 Piece 0 0 0
330 Gliserin Botol 0 0 0
331 Holder Buah 0 0 0
332 Infusion Set anak Set 0 0 0
333 Infusion Set dewasa Set 1 1 1
334 Jarum Disposible 23 G Piece 0 0 0
335 Jarum Dysposible 26 G Piece 0 0 0
336 Jarum Jahit (bedah) No. 9 s/d 14 Pack 0 0 0
337 Jarum vanoject/ Vacuntainer Piece 0 0 0
338 Kaca Sediaan Piece 0 0 0
339 Kapas Lidi Steril Bungkus 0 0 0
340 Kapas Pembalut/Absorben 250 g Bungkus 0 0 0
341 Kapas Pembalut/Absorben500 g Roll 0 0 0
342 Kasa Kompres 40/40 steril Bungkus 0 0 0
343 Kasa Pembalut Hydrophil 16 cm x 16 cm Piece 0 0 0
344 Kasa Pembalut Hydrophil 3 cm x 4 meter Roll 5 5 5
349 Kassa Gulung 80 cm x 40 Yard Roll 0 0 0
350 Kertas Puyer Bungkus 0 0 0
351 Klorin 5,25 % Botol 0 0 0
352 KY Jely USG Botol 0 0 0
353 Larutan Asam Alkohol Botol 0 0 0
354 Larutan Asam Klorida 0,1 N Btl 0 0 0
355 Larutan Karbol Puksin Botol 0 0 0
356 Larutan KOH 1% Botol 0 0 0
357 Larutan Metanol Botol 0 0 0
358 Larutan Methylen Blue Botol 0 0 0
359 Lizol mengandung Kresol Botol 0 0 0
360 Masker Piece 0 0 0
361 Masker N 95 Piece 0 0 0
362 Metilin blue Botol 0 0 0
363 Muchus Suction (Penghisap Lendir) Piece 0 0 0
364 Oxyflow Nasal Oxygen Anak Piece 0 0 0
365 Oxyflow Nasal Oxygen Dewasa Piece 0 0 0
366 PH paper 3,8 - 5,4 Roll 0 0 0
367 Pisau Bedah Piece 0 0 0
368 Plain Catgut 2/0 75 cm sachet 0 0 0
369 Plain Catgut 3/0 75 cm sachet 0 0 0
370 Plain Catgut Rol 2/0 100 m Roll 0 0 0
371 Plain Catgut Rol 3/0 100 m Roll 0 0 0
372 Plester Kain 5 cm x 5 m Roll 0 0 0
373 Plester Kain 10 cm x 5 m Roll 0 0 0
374 Plester Kain 2,5 cm x 4,5 m Roll 0 0 0
375 Plester Kain 5 cm x 4,5 m Roll 0 0 0
376 Plester Kain 7,5 cm x 4,5 m Roll 0 0 0
377 Plastik Klip Obat 7 x 10 cm Bungkus 0 0 0
378 Plastik Klip Obat 8.7 x 13 cm Bungkus 0 0 0
379 Pot Dahak Pot 0 0 0
380 Pot Salep 10 Gr Pot 0 0 0
381 Pot Salep 20 Gr Pot 0 0 0
382 Reagensia ABX 60 atphalyse Liter 0 0 0
383 Reagensia ABX 60 cleaner Liter 0 0 0
384 Reagensia ABX 60 minilidi Liter 0 0 0
385 Sabun Anti Bakteri Botol 0 0 0
386 Safety box Buah 0 0 0
387 Sarung Tangan Karet (Hand Scund) L Piece 0 0 0
388 Sarung Tangan Karet (Hand Scund) M Piece 0 0 0
389 Sarung Tangan Karet (Hand Scund) S Piece 0 0 0
390 Sarung Tangan Obgyn Pasang 0 0 0
391 Sarung Tangan Steril No. 7 Pasang 0 0 0
392 Sarung Tangan Steril No. 7.5 Pasang 0 0 0
393 Silk 2/0 Rol 100 M Roll 0 0 0
394 Silk 3/0 Rol 100 M Roll 0 0 0
395 Silk 2/0 75 cm sachet 0 0 0
396 Silk 3/0 75 cm sachet 0 0 0
397 Silk 4/0 75 cm sachet 0 0 0
398 Stomach Tube, 85 cm, no. 16 Piece 0 0 0
399 Stomach Tube, 85 cm, no. 18 Piece 0 0 0
400 Sufratule Piece 0 0 0
401 Tabung criyo 15 ml Tube 0 0 0
402 Tabung vancuntainer 5 cc Piece 0 0 0
403 Tissue Box 0 0 0
404 Torniquet Buah 0 0 0
405 Tri -Way With Extention Piece 0 0 0
406 Umbilical Cord Clamp Piece 0 0 0
407 Underpad Piece 0 0 0
408 Urobag Piece 0 0 0
409 Wing Nedle 19 G Buah 0 0 0
412 Yelow tip isi 1000 pcs Peace 0 0 0
0 0 0
0 0 0

0 0 0

NIP. NIP. NIP. NIP. 197608172002122009
Puskesmas Banjar II
Kecamatan Banjar
Kabupaten Buleleng
No. Nama Obat

1 2
47 Diapet kapsul
53 Diltiazem tablet
68 Glikuidon tablet

162 Borax Gliserin
INJEKSI
SALEP DAN SUPP

244 Lidocain gel
OBAT GIGI
259 Eugenol cairan
CAIRAN
269 Etanol 70 %
SIRUP
292 Nistatin Drop
301 Sukralfat syrup
BHP & BAHAN LAB

311 Aseptik gel
312 Blood Lancet
321 Cover glass
322 Cuka dixi
330 Gliserin
331 Holder
338 Kaca Sediaan
350 Kertas Puyer
351 Klorin 5,25 %
352 KY Jely USG
356 Larutan KOH 1%
357 Larutan Metanol
360 Masker
361 Masker N 95
362 Metilin blue
366 PH paper 3,8 - 5,4
367 Pisau Bedah
379 Pot Dahak
380 Pot Salep 10 Gr
381 Pot Salep 20 Gr
386 Safety box
393 Silk 2/0 Rol 100 M
394 Silk 3/0 Rol 100 M
395 Silk 2/0 75 cm
396 Silk 3/0 75 cm
397 Silk 4/0 75 cm
400 Sufratule
403 Tissue
404 Torniquet
407 Underpad
408 Urobag
409 Wing Nedle 19 G
410 Wing Nedle 23 G
411 Wing Nedle 25 G
( )
NIP.
PUSTU GOBLEG
Pelaporan Bulan : JANUARI 2021

Permintaan Bulan : FEBRUARI 2021
Stok
Awal
3 4 5 6 (4 + 5) 7
Tablet 70 70 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 0
Tablet
Tablet
Tablet 50 300 350 220
Kapsul
Kapsul 200 200 80
Tablet
Tablet 50 50 50
Tablet
Tablet
Tablet 0 0 0
Tablet 40 40 10
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 20
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Tablet 100 100 10
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet 50
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Tablet
Tablet 40 0 40 40
Tablet
Tablet
Tablet
Tablet
Sachet
Tablet 70 0 70 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 0 100 0
Tablet 70 0 70 0
Tablet
Tablet 0 0 0
Tablet
Tablet
Tablet 0 0 0 0
Tablet
Paket
Paket
Paket
Paket
Tablet
Tablet
Tablet
Paket
Paket
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 60 0 60 10
Kapsul
Kapsul 0 0 0 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Kapsul
Kapsul
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul 100 0 100 0
Kapsul
Tablet 430 0 430 10
Tablet
Tablet
Tablet
Tablet 410 0 410 80
Tablet
Tablet
Tablet
Botol
Tube
Botol
Botol
Botol
Tube
Botol 5 0 5 2
Tube 31 0 31 0
Botol
Ampul
Ampul
Ampul
Vial
Ampul
Vial
Ampul
Ampul
Vial
Vial
Vial
Ampul
Ampul
Ampul 5 0 5 0
Ampul
Ampul 2 0 2 0
Ampul 5 0 5 0
Ampul 5 0 5 0
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul 3 0 3 0
Ampul
Vial
Ampul
Vial
Vial 0 0 0 0
Vial
Vial
Ampul
Vial
Ampul
Ampul
Ampul
Vial
Ampul
Ampul
Vial
Vial
Ampul
Ampul
Vial
Vial
Ampul
Ampul
Ampul
Tube
Pot
Supp
Pot 0 0 0 0
Tube 7 0 7 0
Tube
Tube
Supp
Supp
Tube
Tube
Tube
Botol
Tube
Botol
Tube 25 0 25 0
Tube
Supp
Pot
Tube
Tube 4 0 4 0
Tab vag 4 0 4 4
Tabung
Tube
Tube
Tube
Tube
Tube
Botol
Pot 10 0 10 0
Pot
Botol
Pot
Botol
Botol
Set
Botol
Botol
Botol
Botol
Botol
Set
Botol
Botol 1 0 1 0
Botol 1 0 1 0
Botol
Botol
Botol
Botol
Botol
Botol
Botol 5 0 5 0
Botol
Botol
Botol 2 0 2 0
Botol
Botol
Botol
Botol 29 0 29 3
Botol 15 0 15 1
Botol
Botol 8 0 8 1
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol 8 0 8 4
Botol
Botol
Botol
Botol
Buah
Buah
Piece
Piece 6 0 6 0
Piece
Piece
Piece
Botol
Box
Piece
Bungkus
Bungkus
sachet 1 0 1 0
sachet
Roll
Roll
Buah
Set
Botol
Piece
Piece
Piece
Piece
Piece
Piece
Piece
Botol
Buah
Set
Set 5 0 5 0
Piece 20 0 20 0
Piece
Pack
Piece
Piece
Bungkus
Bungkus 3 0 3 0
Roll
Bungkus
Piece
Roll
Roll
Roll
Roll 5 0 5 0
Roll
Roll
Bungkus
Botol
Botol
Botol
Btl
Botol
Botol
Botol
Botol
Botol 1 0 1 1
Piece
Piece
Botol
Piece
Piece
Piece
Roll
Piece
sachet
sachet
Roll
Roll
Roll
Roll
Roll
Roll
Roll
Bungkus
Bungkus
Pot
Pot
Pot
Liter
Liter
Liter
Botol
Buah
Piece
Piece
Piece
Pasang
Pasang
Pasang
Roll
Roll
sachet
sachet
sachet
Piece
Piece
Piece
Tube
Piece
Box
Buah
Piece
Piece
Piece
Piece
Buah
Buah
Buah
Peace

11 31 0 42
Yang Menyerahkan
( )
NIP.
ntaan Obat
Dokumen Nomor
Depo Farm
Puskesmas
Sisa Stok Pemberian

Permintaan
8 (6 - 7) 9 ((7x4)-8) 10 11 12
70
100
130
120
0
30
80
90
150
0 100
70
100
70
0 100
0 10
50
0 100
100
420
330
3
31
5
2
5
5
0
0
7
25
4
0
10
1
1
5
2
26
14
4 10
6
1
5
20
5
0
Jumlah
42

NIP. NIP. 197608172002122009
Tanggal
mberian
Ket.
Jumlah
13 (11 + 12) 14
Yang Melaporkan
PJ. Pustu Munduk
Ni Putu Lindayani
NIP. 197608172002122009
Puskesmas Banjar II
Kecamatan Banjar
Kabupaten Buleleng
No. Nama Obat

1 2
47 Diapet kapsul
53 Diltiazem tablet
68 Glikuidon tablet

162 Borax Gliserin
INJEKSI
SALEP DAN SUPP

244 Lidocain gel
OBAT GIGI
259 Eugenol cairan
CAIRAN
269 Etanol 70 %
SIRUP
292 Nistatin Drop
301 Sukralfat syrup
BHP & BAHAN LAB

311 Aseptik gel
312 Blood Lancet
321 Cover glass
322 Cuka dixi
330 Gliserin
331 Holder
338 Kaca Sediaan
350 Kertas Puyer
351 Klorin 5,25 %
352 KY Jely USG
356 Larutan KOH 1%
357 Larutan Metanol
360 Masker
361 Masker N 95
362 Metilin blue
366 PH paper 3,8 - 5,4
367 Pisau Bedah
379 Pot Dahak
380 Pot Salep 10 Gr
381 Pot Salep 20 Gr
386 Safety box
393 Silk 2/0 Rol 100 M
394 Silk 3/0 Rol 100 M
395 Silk 2/0 75 cm
396 Silk 3/0 75 cm
397 Silk 4/0 75 cm
400 Sufratule
403 Tissue
404 Torniquet
407 Underpad
408 Urobag
409 Wing Nedle 19 G
410 Wing Nedle 23 G
411 Wing Nedle 25 G
( )
NIP.
PUSTU GOBLEG

Stok
Awal
3 4 5 6 (4 + 5) 7
Tablet 70 70 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 0
Tablet
Tablet
Tablet 50 300 350 220
Kapsul
Kapsul 200 200 80
Tablet
Tablet 50 50 50
Tablet
Tablet
Tablet 0 0 0
Tablet 40 40 10
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 20
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Tablet 100 100 10
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet 50
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Tablet
Tablet 40 0 40 40
Tablet
Tablet
Tablet
Tablet
Sachet
Tablet 70 0 70 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 0 100 0
Tablet 70 0 70 0
Tablet
Tablet 0 0 0
Tablet
Tablet
Tablet 0 0 0 0
Tablet
Paket
Paket
Paket
Paket
Tablet
Tablet
Tablet
Paket
Paket
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 60 0 60 10
Kapsul
Kapsul 0 0 0 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Kapsul
Kapsul
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul 100 0 100 0
Kapsul
Tablet 430 0 430 10
Tablet
Tablet
Tablet
Tablet 410 0 410 80
Tablet
Tablet
Tablet
Botol
Tube
Botol
Botol
Botol
Tube
Botol 5 0 5 2
Tube 31 0 31 0
Botol
Ampul
Ampul
Ampul
Vial
Ampul
Vial
Ampul
Ampul
Vial
Vial
Vial
Ampul
Ampul
Ampul 5 0 5 0
Ampul
Ampul 2 0 2 0
Ampul 5 0 5 0
Ampul 5 0 5 0
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul 3 0 3 0
Ampul
Vial
Ampul
Vial
Vial 0 0 0 0
Vial
Vial
Ampul
Vial
Ampul
Ampul
Ampul
Vial
Ampul
Ampul
Vial
Vial
Ampul
Ampul
Vial
Vial
Ampul
Ampul
Ampul
Tube
Pot
Supp
Pot 0 0 0 0
Tube 7 0 7 0
Tube
Tube
Supp
Supp
Tube
Tube
Tube
Botol
Tube
Botol
Tube 25 0 25 0
Tube
Supp
Pot
Tube
Tube 4 0 4 0
Tab vag 4 0 4 4
Tabung
Tube
Tube
Tube
Tube
Tube
Botol
Pot 10 0 10 0
Pot
Botol
Pot
Botol
Botol
Set
Botol
Botol
Botol
Botol
Botol
Set
Botol
Botol 1 0 1 0
Botol 1 0 1 0
Botol
Botol
Botol
Botol
Botol
Botol
Botol 5 0 5 0
Botol
Botol
Botol 2 0 2 0
Botol
Botol
Botol
Botol 29 0 29 3
Botol 15 0 15 1
Botol
Botol 8 0 8 1
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol 8 0 8 4
Botol
Botol
Botol
Botol
Buah
Buah
Piece
Piece 6 0 6 0
Piece
Piece
Piece
Botol
Box
Piece
Bungkus
Bungkus
sachet 1 0 1 0
sachet
Roll
Roll
Buah
Set
Botol
Piece
Piece
Piece
Piece
Piece
Piece
Piece
Botol
Buah
Set
Set 5 0 5 0
Piece 20 0 20 0
Piece
Pack
Piece
Piece
Bungkus
Bungkus 3 0 3 0
Roll
Bungkus
Piece
Roll
Roll
Roll
Roll 5 0 5 0
Roll
Roll
Bungkus
Botol
Botol
Botol
Btl
Botol
Botol
Botol
Botol
Botol 1 0 1 1
Piece
Piece
Botol
Piece
Piece
Piece
Roll
Piece
sachet
sachet
Roll
Roll
Roll
Roll
Roll
Roll
Roll
Bungkus
Bungkus
Pot
Pot
Pot
Liter
Liter
Liter
Botol
Buah
Piece
Piece
Piece
Pasang
Pasang
Pasang
Roll
Roll
sachet
sachet
sachet
Piece
Piece
Piece
Tube
Piece
Box
Buah
Piece
Piece
Piece
Piece
Buah
Buah
Buah
Peace

11 31 0 42
Yang Menyerahkan
( )
NIP.
ntaan Obat
Dokumen Nomor
Depo Farm
Puskesmas
Sisa Stok Pemberian

Permintaan
8 (6 - 7) 9 ((7x4)-8) 10 11 12
70
100
130
120
0
30
80
90
150
0 100
70
100
70
0 100
0 10
50
0 100
100
420
330
3
31
5
2
5
5
0
0
7
25
4
0
10
1
1
5
2
26
14
4 10
6
1
5
20
5
0
Jumlah
42

NIP. NIP. 197608172002122009
Tanggal
mberian
Ket.
Jumlah
13 (11 + 12) 14
Yang Melaporkan
PJ. Pustu Munduk
Ni Putu Lindayani
NIP. 197608172002122009
DES
Puskesmas Banjar II
Kecamatan Banjar
Kabupaten Buleleng
No. Nama Obat

1 2
47 Diapet kapsul
53 Diltiazem tablet
68 Glikuidon tablet

162 Borax Gliserin
INJEKSI
SALEP DAN SUPP

244 Lidocain gel
OBAT GIGI
259 Eugenol cairan
CAIRAN
269 Etanol 70 %
SIRUP
292 Nistatin Drop
301 Sukralfat syrup
BHP & BAHAN LAB

311 Aseptik gel
312 Blood Lancet
321 Cover glass
322 Cuka dixi
330 Gliserin
331 Holder
338 Kaca Sediaan
350 Kertas Puyer
351 Klorin 5,25 %
352 KY Jely USG
356 Larutan KOH 1%
357 Larutan Metanol
360 Masker
361 Masker N 95
362 Metilin blue
366 PH paper 3,8 - 5,4
367 Pisau Bedah
379 Pot Dahak
380 Pot Salep 10 Gr
381 Pot Salep 20 Gr
386 Safety box
393 Silk 2/0 Rol 100 M
394 Silk 3/0 Rol 100 M
395 Silk 2/0 75 cm
396 Silk 3/0 75 cm
397 Silk 4/0 75 cm
400 Sufratule
403 Tissue
404 Torniquet
407 Underpad
408 Urobag
409 Wing Nedle 19 G
410 Wing Nedle 23 G
411 Wing Nedle 25 G
( )
NIP.
PUSTU GOBLEG

Stok
Awal
3 4 5 6 (4 + 5) 7
Tablet 70 70 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 0
Tablet
Tablet
Tablet 50 300 350 220
Kapsul
Kapsul 200 200 80
Tablet
Tablet 50 50 50
Tablet
Tablet
Tablet 0 0 0
Tablet 40 40 10
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 100 20
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Tablet 100 100 10
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet 50
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Tablet
Tablet 40 0 40 40
Tablet
Tablet
Tablet
Tablet
Sachet
Tablet 70 0 70 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 100 0 100 0
Tablet 70 0 70 0
Tablet
Tablet 0 0 0
Tablet
Tablet
Tablet 0 0 0 0
Tablet
Paket
Paket
Paket
Paket
Tablet
Tablet
Tablet
Paket
Paket
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet 60 0 60 10
Kapsul
Kapsul 0 0 0 0
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul
Kapsul
Kapsul
Kapsul
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Kapsul 100 0 100 0
Kapsul
Tablet 430 0 430 10
Tablet
Tablet
Tablet
Tablet 410 0 410 80
Tablet
Tablet
Tablet
Botol
Tube
Botol
Botol
Botol
Tube
Botol 5 0 5 2
Tube 31 0 31 0
Botol
Ampul
Ampul
Ampul
Vial
Ampul
Vial
Ampul
Ampul
Vial
Vial
Vial
Ampul
Ampul
Ampul 5 0 5 0
Ampul
Ampul 2 0 2 0
Ampul 5 0 5 0
Ampul 5 0 5 0
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul
Ampul 3 0 3 0
Ampul
Vial
Ampul
Vial
Vial 0 0 0 0
Vial
Vial
Ampul
Vial
Ampul
Ampul
Ampul
Vial
Ampul
Ampul
Vial
Vial
Ampul
Ampul
Vial
Vial
Ampul
Ampul
Ampul
Tube
Pot
Supp
Pot 0 0 0 0
Tube 7 0 7 0
Tube
Tube
Supp
Supp
Tube
Tube
Tube
Botol
Tube
Botol
Tube 25 0 25 0
Tube
Supp
Pot
Tube
Tube 4 0 4 0
Tab vag 4 0 4 4
Tabung
Tube
Tube
Tube
Tube
Tube
Botol
Pot 10 0 10 0
Pot
Botol
Pot
Botol
Botol
Set
Botol
Botol
Botol
Botol
Botol
Set
Botol
Botol 1 0 1 0
Botol 1 0 1 0
Botol
Botol
Botol
Botol
Botol
Botol
Botol 5 0 5 0
Botol
Botol
Botol 2 0 2 0
Botol
Botol
Botol
Botol 29 0 29 3
Botol 15 0 15 1
Botol
Botol 8 0 8 1
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol
Botol 8 0 8 4
Botol
Botol
Botol
Botol
Buah
Buah
Piece
Piece 6 0 6 0
Piece
Piece
Piece
Botol
Box
Piece
Bungkus
Bungkus
sachet 1 0 1 0
sachet
Roll
Roll
Buah
Set
Botol
Piece
Piece
Piece
Piece
Piece
Piece
Piece
Botol
Buah
Set
Set 5 0 5 0
Piece 20 0 20 0
Piece
Pack
Piece
Piece
Bungkus
Bungkus 3 0 3 0
Roll
Bungkus
Piece
Roll
Roll
Roll
Roll 5 0 5 0
Roll
Roll
Bungkus
Botol
Botol
Botol
Btl
Botol
Botol
Botol
Botol
Botol 1 0 1 1
Piece
Piece
Botol
Piece
Piece
Piece
Roll
Piece
sachet
sachet
Roll
Roll
Roll
Roll
Roll
Roll
Roll
Bungkus
Bungkus
Pot
Pot
Pot
Liter
Liter
Liter
Botol
Buah
Piece
Piece
Piece
Pasang
Pasang
Pasang
Roll
Roll
sachet
sachet
sachet
Piece
Piece
Piece
Tube
Piece
Box
Buah
Piece
Piece
Piece
Piece
Buah
Buah
Buah
Peace

11 31 0 42
Yang Menyerahkan
( )
NIP.
ntaan Obat
Dokumen Nomor
Depo Farm
Puskesmas
Sisa Stok Pemberian

Permintaan
8 (6 - 7) 9 ((7x4)-8) 10 11 12
70
100
130
120
0
30
80
90
150
0 100
70
100
70
0 100
0 10
50
0 100
100
420
330
3
31
5
2
5
5
0
0
7
25
4
0
10
1
1
5
2
26
14
4 10
6
1
5
20
5
0
Jumlah
42

NIP. NIP. 197608172002122009
Tanggal
mberian
Ket.
Jumlah
13 (11 + 12) 14
Yang Melaporkan
PJ. Pustu Munduk
Ni Putu Lindayani
NIP. 197608172002122009

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12 Amoksisilin kapsul 250 mg Kapsul

OBAT MATA, TELINGA & MULUT

SALEP DAN SUPP

BHP & BAHAN LAB

Umum BPJS Lain-lain Jumlah

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Melaporkan

( ) ( ) ( ) Gusti Ayu Anik Ariani

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OBAT MATA, TELINGA & MULUT

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OBAT MATA, TELINGA & MULUT

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