LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

UNIT PENERIMA : PUSKESMAS WARIS BULAN : MARET

KECAMATAN : WARIS TAHUN : 2021
KABUPATEN : KEEROM
PROVINSI : PAPUA

NO NAMA BARANG SEDIAAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED SISA STOK STOK OPT PERMINTAAN PEMBERIAN KET

1 ACYCLOVIR SALEP 5 % SALEP 0 0 0 0 0 0 24

2 ACYCLOVIR TABLET 400 MG TABLET 500 0 500 0 0 500 0
3 ALBENDAZOLE TABLET 400 MG TABLET 1,200 0 1,200 0 0 1,200 0
4 ALKOHOL 70% 1 LITER BOTOL 2 0 2 0 0 2 5
5 ALKOHOL SWAB 2 PLY 100 PCS PIECES 4,800 0 4,800 0 0 4,800 0
6 ALLOPURINOL TABLET 100 MG TABLET 1,000 0 1,000 200 0 800 500
7 AMBROXOL SIRUP 15 MG/5 ML SIRUP 0 300 300 50 0 250 300
8 AMBROXOL TABLET 30 MG TABLET 4,000 1,000 5,000 1,000 0 4,000 500
9 AMINOPHYLLINE INJEKSI 24 MG\/ML INJEKSI 46 0 46 0 0 46 0
10 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 0 0 0 0 0 0 0
11 AMINOPHYLLINE TABLET 150 MG TABLET 0 0 0 0 0 0 0
12 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0 0 0 0 0
13 AMITRIPTYLINE TABLET 25 MG TABLET 0 0 0 0 0 0 0
14 AMLODIPINE TABLET 10 MG TABLET 2,250 0 2,250 0 0 2,250 0
15 AMLODIPINE TABLET 5 MG TABLET 1,500 0 1,500 50 0 1,450 300
16 AMOXYCILLIN SIRUP 125 MG/5 ML SIRUP 218 0 218 0 0 218 0
17 AMOXYCILLIN SIRUP 250 MG\/5 ML SIRUP 180 0 180 10 0 170 120
18 AMOXYCILLIN TABLET 250 MG TABLET 4,000 0 4,000 0 0 4,000 1,000
19 AMOXYCILLIN TABLET 500 MG TABLET 4,800 0 4,800 910 0 3,890 1,000
20 AMPICILLIN INJEKSI 1 G\/VIAL INJEKSI 0 0 0 0 0 0 24
21 ANISOL 100 ML BOTOL 0 0 0 0 0 0 0
22 ANTACIDA SIRUP 400 MG\/5 ML SIRUP 100 0 100 0 100 0 120
23 ANTACIDA TABLET TABLET 2,300 500 2,800 1,000 0 1,800 200
ANTIFUNGI: ASAM SALICYLICUM 30 MG, ASAM BENZOICUM
24 POT 20 48 68 0 0 68 0
60 MG
25 ANTIHEMOROID DOEN SUPPOSITORIA 2 gr SUPPOSITORIA 20 0 20 0 0 20 0
26 AQUA PRO INJEKSI INJEKSI INJEKSI 0 0 0 0 0 0 0
27 ARTESUNATE INJEKSI 60 MG INJEKSI 7 0 7 0 0 7 0
28 ARTICULATING PAPER FARCIAL PIECES 0 0 0 0 0 0 0
29 ASAM ASETAT Botol 0 0 0 0 0 0 0
30 ASAM FOLAT 400 MCG (PROFOLAT) TABLET 400 0 400 0 0 400 0
31 ASAM MEFENAMAT TABLET 500 MG TABLET 600 2,000 2,600 500 0 2,100 500
32 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 0 1,000 1,000 500 0 500 2,000
33 ASEPTIC GEL 500 CC PIECES 0 5 5 2 0 3 5
34 ATROPINE SULPHATE INJEKSI 0.25 MG/ML INJEKSI 90 0 90 0 0 90 0
35 ATTAPULGITE TABLET 600 MG TABLET 0 0 0 0 0 0 300
36 BENECHECK 3 IN 1 ALAT PEMERIKSAAN PIECES 0 1 1 1 0 0 0
37 AZITHROMYCIN TABLET 500 MG TABLET 0 200 200 20 0 180 300
38 BACITRACIN|POLYMYXIN B SULPHATE SALEP 5 G SALEP 0 0 0 0 0 0 48
39 BENZATHINE BENZYLPENICILLIN INJEKSI 120000 IU INJEKSI 1 0 1 0 0 1 12
40 BENZATHINE BENZYLPENICILLIN INJEKSI 240000 IU INJEKSI 2 0 2 0 0 2 12
41 BENZATHINE BENZYLPENICILLIN INJEKSI 30000 IU INJEKSI 0 0 0 0 0 0 0
42 BETAMETHASONE DIPROPIONATE CREAM 0.5% 10 GR TUBE TUBE 0 0 0 0 0 0 0
43 BETAMETHASONE SALEP 0.1% SALEP 0 0 0 0 0 0 48
44 BISACODYL SUPPOSITORIA 10 MG SUPPOSITORIA 5 0 5 0 0 5 0
45 BISACODYL SUPPOSITORIA 5 MG SUPPOSITORIA 0 0 0 0 0 0 0
46 BISACODYL TABLET 5 MG TABLET 100 0 100 0 0 100 100
47 BISTURI NO. 22 PIECES 50 100 150 50 0 100 100
48 BLOOD LANCETS 26 G PIECES 500 0 500 0 0 500 0
49 BLOOD TRANSFUSION SET ONEMED PIECES 0 0 0 0 0 0 0
50 BOX SLIDE BOX 0 0 0 0 0 0 0
51 CAFFEINE|ERGOTAMINE TARTRATE TABLET 1 MG|50 MG TABLET 0 0 0 0 0 0 0
52 Calcium hydroxide cavity liner 0 0 0 0 0 0 0 0
53 CALCIUM LACTATE TABLET 500 MG TABLET 0 0 0 0 0 0 2,000
54 CAPTOPRIL TABLET 12.5 MG TABLET 1,200 0 1,200 0 0 1,200 0
55 CAPTOPRIL TABLET 25 MG TABLET 1,100 0 1,100 0 0 1,100 0
56 CARBAMAZEPINE TABLET 200 MG TABLET 0 0 0 0 0 0 0
57 CAT GUT CHROMIC 2\/0 (24 PCS) PIECES 0 0 0 0 0 0 0
58 CAT GUT CHROMIC NO.3\/0 PIECES 24 0 24 0 0 24 0
59 CAT GUT PLAIN 2\/0 PIECES 0 0 0 0 0 0 0
60 CAT GUT PLAIN 3\/0 PIECES 36 0 36 0 0 36 0
61 CEFADROXIL SIRUP 125 MG/ML SIRUP 100 120 220 0 0 220 0
62 CEFADROXIL SIRUP 250 MG SIRUP 60 0 60 0 0 60 60
63 CEFADROXIL TABLET 500 MG TABLET 200 500 700 200 0 500 500
64 CETIRIZINE SIRUP 5 MG/ML SIRUP 0 0 0 0 0 0 120
65 CETIRIZINE TABLET 10 MG TABLET 0 90 90 90 0 0 300
66 CHLORAMPHENICOL DROPS 0.5% DROPS 0 0 0 0 0 0 0
67 CHLORAMPHENICOL KAPSUL 250 MG KAPSUL 0 0 0 0 0 0 500
68 CHLORAMPHENICOL SALEP MATA 1% SALEP 0 0 0 0 0 0 48
69 CHLORAMPHENICOL SALEP KULIT 2% SALEP 0 0 0 0 0 0 0
70 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 87 0 87 0 0 87 60
71 CHLORAMPHENICOL TABLET 500 MG TABLET 200 0 200 0 0 200 300
72 CHLORINE 1000 ppm 1 TABLET\/1 LITER BOTOL 0 0 0 0 0 0 0
73 CHLORPHENIRAMINE TABLET 4 MG TABLET 6,500 0 6,500 0 0 6,500 0
74 CHLORPROMAZIN HCL TABLET SALUT SELAPUT TABLET 0 0 0 0 0 0 0
75 CHLORPROMAZINE HCL INJEKSI 5 MG\/ML INJEKSI 0 0 0 0 0 0 0
76 CHLORPROMAZINE HCL TABLET 100 MG TABLET 0 0 0 0 0 0 0
77 CHLORPROMAZINE INJEKSI 25 MG/ML INJEKSI 0 0 0 0 0 0 0
78 Cholesterol (total) test system SET 34 0 34 0 0 34 0
79 CIPROFLOXACIN TABLET 500 MG (SEBAGAI HCL) TABLET 0 0 0 0 0 0 500
80 CLINDAMYCIN TABLET 150 MG TABLET 150 200 350 100 0 250 250
81 CODEINE TABLET 10 MG TABLET 0 0 0 0 0 0 0
82 CORTISONE ACETATE INJEKSI 25 MG/ML INJEKSI 0 0 0 0 0 0 0
83 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 150 0 150 0 0 150 0
84 COTRIMOXAZOLE TABLET 480 MG TABLET 700 500 1,200 0 0 1,200 300
85 COTRIMOXAZOLE TABLET 960 MG TABLET 0 0 0 0 0 0 0
86 CRESOPHATE PASTE 25 GR BOTOL 0 0 0 0 0 0 0
87 CRESOPHEN LIQUID NO.2 15 ML BOTOL 0 0 0 0 0 0 0
88 CRESOPHENE BOTOL 0 0 0 0 0 0 0
89 CYANOCOBALAMIN INJEKSI 500 MCG/ML INJEKSI 100 0 100 4 0 96 0
90 CYANOCOBALAMIN TABLET 50 MCG TABLET 2,800 2,000 4,800 500 0 4,300 200
91 DEVITALISASI PASTA NON ARSEN 6 GR BOX 0 0 0 0 0 0 0
92 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 23 0 23 12 0 11 20
93 DEXAMETHASONE TABLET 0.5 MG TABLET 1,600 0 1,600 1,600 0 0 2,000
94 DIAZEPAM ENEMA 5 MG/2.5 ML ENEMA 10 0 10 0 0 10 0
95 DIAZEPAM INJEKSI 5 MG\/ML AMPUL 20 0 20 0 0 20 0
96 DIAZEPAM TABLET 5 MG TABLET 186 0 186 0 0 186 0
97 DIETHYLCARBAMAZINE TABLET 100 MG TABLET 4,000 0 4,000 0 0 4,000 0
DIHYDROARTEMISININ|PIPERAQUINE PHOSPHATE
98 TABLET 1,602 1,800 3,402 585 0 2,817 2,000
TABLET 40 MG|320 MG
99 DILTIAZEM TABLET 30 MG TABLET 0 0 0 0 0 0 0
100 DIPHENHYDRAMINE INJEKSI INJEKSI 300 0 300 0 0 300 0
101 DOMPERIDONE SIRUP 5 MG/5 ML SIRUP 20 0 20 10 0 10 60
102 DOMPERIDONE TABLET 10 MG TABLET 0 0 0 0 0 0 0
103 DOXYCYCLINE TABLET 100 MG TABLET 300 500 800 100 0 700 300
104 ELASTIC VERBAND ROLL 0 5 5 2 0 3 5
105 EPINEPHRINE INJEKSI 1 MG\/ML INJEKSI 39 10 49 0 39 10 50
106 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 0 0 0 0 0 0 60
107 ERYTHROMYCIN TABLET 500 MG TABLET 0 0 0 0 0 0 500
108 ETAKRIDIN LIQUID 0.1 % LIQUID 0 0 0 0 0 0 0
109 EUGENOL LIQUID 10 ML BOTOL 0 0 0 0 0 0 0
110 FEEDING TUBE NO 5 100 CM SET 0 0 0 0 0 0 0
111 FENOTEROL HYDROBROMIDE LIQUID 0.1 % LIQUID 0 0 0 0 0 0 0
112 FERROUS FUMARATE TABLET TABLET 4,000 3,780 7,780 90 0 7,690 0
113 FLUCONAZOLE TABLET 150 MG TABLET 0 100 100 100 0 0 100
114 FOLEY CATHETER 2 WAY NO 10 SET 0 0 0 0 0 0 0
115 FOLEY CATHETER 2 WAY NO 14 SET 0 0 0 0 0 0 0
116 FOLIC ACID TABLET 1 MG TABLET 200 0 200 0 0 200 0
117 FOLLEY CATHETER 2 WAY NO. 18 PIECES 0 0 0 0 0 0 0
118 FORMALIN 1000 ML BOTOL 0 0 0 0 0 0 0
119 FRAMYCETIN SULPHATE TULLE 1 % TULLE 0 0 0 0 0 0 0
120 FUROSEMIDE TABLET 40 MG TABLET 300 0 300 0 0 300 0
121 GARAM ORALIT SERBUK SERBUK 100 500 600 100 0 500 100
122 GENTAMYCIN SALEP 0.1 % SALEP 0 0 0 0 0 0 0
123 GENTAMYCIN SALEP 1 % SALEP 10 0 10 10 0 0 24
124 GIPS PUTIH PIECES 0 0 0 0 0 0 0
125 GLIBENCLAMIDE TABLET 5 MG TABLET 200 0 200 0 0 200 0
126 GLIMEPIRIDE TABLET 2 MG TABLET 200 0 200 0 0 200 0
127 GLUCOSE INFUS 10 % INFUS 0 0 0 0 0 0 0
128 GLUCOSE INFUS 5 % INFUS 80 0 80 0 0 80 0
129 Glucose test system SET 0 0 0 0 0 0 0
130 GLYCEROL LIQUID LIQUID 0 0 0 0 0 0 0
131 GLYCERYL DISTEARATE TABLET 100 MG TABLET 5,900 0 5,900 400 0 5,500 500
132 GRISEOFULVIN TABLET 125 MG TABLET 7,500 0 7,500 3,300 0 4,200 1,000
133 GRISEOFULVIN TABLET 500 MG TABLET 0 0 0 0 0 0 0
134 GUTTAP POINT NO 45 - 80 META 0 0 0 0 0 0 0 0
135 HYDCAL CALCIUM HYDROXIDE LINER SET 0 0 0 0 0 0 0
136 HYDROCHLOROTHIAZIDE TABLET 25 MG TABLET 500 0 500 0 0 500 0
137 HYDROCORTISONE SALEP 2.5 % SALEP 24 48 72 0 0 72 0
138 HYOSCINE TABLET 10 MG TABLET 0 0 0 0 0 0 0
139 IBUPROFEN SIRUP 100 MG/5 ML SIRUP 0 0 0 0 0 0 60
140 IBUPROFEN TABLET 200 MG TABLET 1,500 2,000 3,500 500 0 3,000 500
141 IBUPROFEN TABLET 400 MG TABLET 1,800 0 1,800 1,000 0 800 1,000
142 ICHTHYOL SALEP 10 % SALEP 0 0 0 0 0 0 24
143 Immersion hydrobath BOTOL 0 0 0 0 0 0 0
144 INFUS SET PIECES 971 0 971 0 0 971 0
145 INFUS SET PEDIATRIC PIECES 1,461 0 1,461 0 0 1,461 0
146 Iodoform (Mummifying Pasta) BOTOL 0 0 0 0 0 0 0
147 ISONIAZID TABLET 300 MG TABLET 0 0 0 0 0 0 0
148 ISOSORBIDE DINITRATE TABLET 5 MG TABLET 0 0 0 0 0 0 100
149 JARUM JAHIT KULIT G 12 PIECES 0 0 0 0 0 0 0
150 JARUM JAHIT KULIT G 15 PIECES 0 0 0 0 0 0 0
151 JARUM JAHIT KULIT G 8 PIECES 0 0 0 0 0 0 0
152 JARUM JAHIT KULIT NO 13 PIECES 0 0 0 0 0 0 0
153 JARUM JAHIT OTOT E 000 PIECES 0 0 0 0 0 0 0
154 JARUM JAHIT OTOT GR 11 PIECES 0 0 0 0 0 0 0
155 JARUM JAHIT OTOT GR 13 PIECES 0 0 0 0 0 0 0
156 JARUM JAHIT OTOT GR 14 PIECES 0 0 0 0 0 0 0
157 JARUM JAHIT OTOT GR 8 PIECES 0 0 0 0 0 0 0
158 KACA SLIDE PIECES 10,108 0 10,108 0 0 10,108 0
159 KACA SLIDE TES TB BOX 0 0 0 0 0 0 0
160 KALSIUM GLUKONAT INJEKSI 100 MG\/ML AMPUL 0 24 24 0 0 24 0
161 Kalsium Hidroksida Pasta BOTOL 0 0 0 0 0 0 0
162 KANAMYCIN INJEKSI 1 G/VIAL INJEKSI 0 0 0 0 0 0 0
163 KAPAS PEMBALUT SET 250 G SET 9 3 12 0 0 12 0
164 KASA 2Y X 80 CM ROLL 26 0 26 0 0 26 0
165 KASA HYDROFIL 4 M X 15 CM ROLL 31 0 31 0 0 31 0
166 KASA HYDROFIL 4 M X 3 CM ROLL 303 0 303 0 0 303 0
167 KASA HYDROFIL 40 M X 80 CM ROLL 0 0 0 0 0 0 0
168 KASA HYDROFIL STERIL 16 x 16 ROLL 180 0 180 0 0 180 0
169 KASA LIPAT 40 X 40 STERIL PIECES 390 0 390 0 0 390 0
170 KERTAS EKG ROLL 0 0 0 0 0 0 0
171 KERTAS PUYER LEMBAR 0 0 0 0 0 0 0
172 KERTAS SARING 58 X 58 CM PIECES 0 0 0 0 0 0 0
173 KETOCONAZOLE SALEP 2% SALEP 0 25 25 0 0 25 25
174 KETOCONAZOLE TABLET 200 MG TABLET 250 500 750 250 0 500 500
175 Klorfenol Kamfer Menthol (CHKM) BOTOL 0 0 0 0 0 0 0
176 KUININ TABLET 200 MG TABLET 700 0 700 0 0 700 0
177 LARUTAN EOSIN 2% 100 ML LARUTAN 0 0 0 0 0 0 0
178 LARUTAN HCL 0,1 N 100 ML BOTOL 0 0 0 0 0 0 0
179 LARUTAN TURK 100 ML BOTOL 0 0 0 0 0 0 0
180 LIDOCAINE INJEKSI 2% INJEKSI 0 100 100 0 0 100 0
181 LIDOCAINE SPRAY 10 MG/DOSIS SPRAY 0 0 0 0 0 0 3
LIDOKAIN INJEKSI 2% HCL + EPINEPHRINE INJEKSI
182 INJEKSI 8 0 8 0 0 8 0
1:80.000 - 2 ML
183 LOPERAMIDE TABLET 2 MG TABLET 0 0 0 0 0 0 500
184 LORATADINE TABLET 10 MG TABLET 750 150 900 150 0 750 0
185 LYSOL CONCENTRATE BOTOL 8 0 8 0 0 8 0
186 MAGNESIUM SULFAT INJEKSI 20 % INJEKSI 0 0 0 0 0 0 0
187 MAGNESIUM SULFAT INJEKSI 40 % INJEKSI 10 0 10 0 0 10 0
188 MASKER (KARET) PIECES 250 200 450 100 0 350 200
189 MASKER N95 PIECES 0 0 0 0 0 0 0
190 MASKER OKSIGEN BAYI (MAXIFLOW) PIECES 0 0 0 0 0 0 0
191 MASKER OKSIGEN DEWASA (MAXIFLOW) PIECES 0 0 0 0 0 0 0
 MDT COMBI MB ADULT : RIFAMPICIN 300 MG,
192 TABLET 335 0 335 0 0 335 0
CLOFAZIMINE 100 MG | DAPSON 100 MG
MDT COMBI MB CHILD : RIFAMPICIN 300 MG, CLOFAZIMINE
193 TABLET 0 0 0 0 0 0 0
50 MG | DAPSON 50 MG
MDT COMBI PB ADULT : RIFAMPICIN BP 300 MG |DAPSON
194 TABLET 0 0 0 0 0 0 0
100 MG
MDT COMBI PB CHILD : RIFAMPICIN BP\/RIMACTANE 300
195 TABLET 0 0 0 0 0 0 0
MG + 150 MG | DAPSON 100 MG
196 MEDROXYPROGESTERONE ACETATE INJEKSI 3 ML INJEKSI 0 0 0 0 0 0 0
197 METAMPIRON (ANTALGIN) INJEKSI 250 MG/ML INJEKSI 0 30 30 0 0 30 0
198 METAMPIRON (ANTALGIN) TABLET 500 MG TABLET 0 0 0 0 0 0 0
199 METFORMIN HCL TABLET 500 MG TABLET 600 0 600 0 0 600 0
200 METFORMIN TABLET 850 MG TABLET 0 0 0 0 0 0 0
201 METHANOL 2,5 LITER BOTOL 0 0 0 0 0 0 0
202 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 28 0 28 28 0 0 24
203 METHYLERGOMETRINE TABLET 0.125 MG TABLET 600 0 600 0 0 600 0
204 METHYLPREDNISOLONE TABLET 16 MG TABLET 900 0 900 0 0 900 0
205 METOCLOPRAMIDE TABLET 5 MG TABLET 700 1,000 1,700 0 0 1,700 0
206 METRONIDAZOLE INFUS 5 G/100 ML INFUS 0 5 5 0 0 5 0
207 METRONIDAZOLE TABLET 500 MG TABLET 0 400 400 200 0 200 300
208 MICONAZOLE SALEP 2% SALEP 24 48 72 0 0 72 0
209 MINERAL MIX SERBUK 8 G SACHET 0 0 0 0 0 0 0
210 MUCUS EXTRACTOR PIECES 0 0 0 0 0 0 0
211 MULTIVITAMIN DROPS DROPS 0 20 20 0 0 20 20
212 MULTIVITAMIN SIRUP SIRUP 40 50 90 0 0 90 60
213 MY JELLY TUBE 0 0 0 0 0 0 0
214 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1,000 1,000 2,000 0 0 2,000 0
215 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 700 500 1,200 0 0 1,200 300
216 NIFEDIPINE TABLET 10 MG TABLET 500 0 500 0 0 500 0
217 NYSTATIN TABLET 10000 IU TABLET 900 0 900 0 0 900 0
218 NYSTATIN TABLET 50000 IU TABLET 0 0 0 0 0 0 0
219 OAT KATEGORI II- (FDC) PAKET 0 0 0 0 0 0 0
220 OBH SIRUP 100 ML SIRUP 0 0 0 0 0 0 0
221 OBH SIRUP 60 ML SIRUP 100 120 220 8 0 212 0
222 OMEPRAZOLE KAPSUL 20 MG KAPSUL 150 300 450 150 0 300 300
223 OXYCAN BOTOL 0 0 0 0 0 0 0
224 Oxygen gas analyzer TABUNG 0 1 1 0 0 1 0
225 OXYTETRACYCLINE 3 % SALEP KULIT SALEP KULIT 0 25 25 0 0 25 0
226 OXYTOCIN INJEKSI 10 IU\/ML INJEKSI 0 100 100 0 0 100 0
227 PAKET STOP TB KATEGORI 1 PAKET 1 0 1 0 0 1 0
228 PAKET STOP TB OAT ANAK PAKET 1 0 1 0 0 1 0
229 PAMPERS DEWASA PIECES 0 0 0 0 0 0 0
230 PAPAVERINE INJEKSI 40 MG/ML INJEKSI 0 0 0 0 0 0 0
231 PAPAVERINE TABLET 40 MG TABLET 700 0 700 0 0 700 0
232 PAPER POINT NO 15 - 40 0 0 0 0 0 0 0 0
233 PARACETAMOL DROPS 100 MG/ML 0 0 0 0 0 0 0 0
234 PARACETAMOL INFUS BOTOL 1 5 6 0 0 6 0
235 PARACETAMOL SIRUP 120 MG\/5 ML SIRUP 409 0 409 203 0 206 120
236 PARACETAMOL TABLET 500 MG TABLET 16,400 0 16,400 400 0 16,000 0
237 PERMETHRIN SALEP 5 % SALEP 0 0 0 0 0 0 0
238 PHENOBARBITAL INJEKSI 50 MG\/ML INJEKSI 27 0 27 0 0 27 0
239 PHENOL GLYCEROL 10% (TETES TELINGA) CAIRAN 24 24 48 0 0 48 0
240 PHENOXYMETHYLPENICILLIN TABLET 250 MG TABLET 0 0 0 0 0 0 0
241 PHENOXYMETHYLPENICILLIN TABLET 500 TABLET 0 0 0 0 0 0 0
242 PHENYTOIN TABLET 30 MG TABLET 0 0 0 0 0 0 0
243 PHYTOMENADIONE (VITAMIN K) INJEKSI INJEKSI 12 60 72 0 0 72 0
244 PHYTOMENADIONE (VITAMIN K) TABLET 10 MG TABLET 2,000 0 2,000 0 0 2,000 0
245 PIPETMAN P 200 N ( 20 - 200 UL ) MICROPIPETTE PIECES 0 0 0 0 0 0 0
246 PIROXICAM TABLET 10 MG TABLET 0 1,000 1,000 0 0 1,000 0
247 PIROXICAM TABLET 20 MG TABLET 800 500 1,300 400 0 900 100
248 PLESTER ROLL 3 0 3 0 0 3 2
249 PLESTER BULAT PIECES 100 0 100 0 0 100 100
250 PLESTER HIPOALERGENIC 1/2 DGN DISPENSER ROLL 0 0 0 0 0 0 0
251 POT SPUTUM PIECES 0 0 0 0 0 0 0
252 POVIDONE IODINE 30 ML BOTTLE 3 0 3 0 0 3 0
253 POVIDONE IODINE 10% 300ML CAIRAN 20 24 44 2 0 42 0
254 POVIDONE IODINE 1000 ML BOTOL 1 5 6 1 0 5 0
255 PREDNISONE TABLET 5 MG TABLET 0 0 0 0 0 0 1,000
256 PRIMAQUINE TABLET 15 MG TABLET 4,000 0 4,000 0 0 4,000 0
257 PYRANTEL PAMOATE SIRUP SIRUP 20 0 20 0 0 20 60
258 PYRANTEL PAMOATE TABLET 125 MG TABLET 150 1,000 1,150 0 0 1,150 0
259 PYRANTEL PAMOATE TABLET 250 MG (BASE) TABLET 600 0 600 0 0 600 0
260 PYRIDOXINE TABLET 10 MG TABLET 0 0 0 0 0 0 0
261 RANITIDINE INJEKSI 25 MG/ML INJEKSI 95 0 95 15 0 80 0
262 RANITIDINE INJEKSI 50 MG/2 ML INJEKSI 0 0 0 0 0 0 0
263 RANITIDINE TABLET 150 MG TABLET 1,000 0 1,000 0 0 1,000 0
264 RAPID 1 HIV (SD) KIT 0 0 0 0 0 0 0
265 Rapid HIV 2 TEST PIECES 0 0 0 0 0 0 0
266 RAPID TEST MALARIA PIECES 0 100 100 25 0 75 100
267 RDT SYPHILIS (HUMAN) PIECES 50 0 50 0 0 50 0
268 RDT SYPHILIS RPR 100 ANTIGEN TEST PIECES 0 0 0 0 0 0 0
269 REAGEN GIEMSA 500 ML BOTOL 1 0 1 0 0 1 0
270 REAGEN ZIEHL NEELSEN 100 ML BOTOL 1 0 1 0 0 1 0
271 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0 0 0 0 100
272 RETINOL PALMITATE TABLET 200000 IU TABLET 200 0 200 0 0 200 0
273 SAFEGLOVE PF (ONEMED) SIZE 6,5 PIECES 0 0 0 0 0 0 0
274 SAFEGLOVE PF (ONEMED) SIZE 7,5 PIECES 0 0 0 0 0 0 0
275 SAFEGLOVE PP (ONEMED) SIZE 6,5 PIECES 0 0 0 0 0 0 100
276 SAFEGLOVE PP (ONEMED) SIZE 7.5 PIECES PIECES 200 50 250 0 0 250 0
277 SAFETY BOX (POLYSAFE) BOX 0 0 0 0 0 0 0
278 SALBUTAMOL TABLET 2 MG (SEBAGAI SULFAT) TABLET 1,000 0 1,000 0 0 1,000 0
279 SALBUTAMOL TABLET 4 MG (SEBAGAI SULFAT) TABLET 900 0 900 0 0 900 100
SALEP 2-4 KOMBINASI: ASAM SALISILAT 2% + BELERANG
280 TUBE 45 48 93 18 0 75 0
ENDAP 4%
281 SALICYLIC ACID SERBUK 2% SERBUK 18 36 54 0 0 54 0
282 SARUNG TANGAN ANCEL NON POWDER M ( LATEX M) PIECES 100 0 100 0 0 100 0
283 SARUNG TANGAN ANCEL NON POWDER S PIECES 300 0 300 0 0 300 0
284 SARUNG TANGAN MICROGRIP NO 6.5 PIECES 2,000 0 2,000 0 0 2,000 0
285 SARUNG TANGAN NON STERIL SIZE M PIECES 0 0 0 0 0 0 0
286 SARUNG TANGAN PANJANG KARET NON STERIL PIECES 60 0 60 0 0 60 0
287 SILK SUTURE 3\/0 PIECES 25 0 25 0 0 25 0
288 SIMVASTATIN TABLET 10 MG TABLET 330 1,200 1,530 90 0 1,440 0
289 SODIUM CHLORIDE INFUS 0.9 % INFUS 41 0 41 0 0 41 0
290 RINGER LAKTAT INFUS INFUS 62 0 62 0 0 62 0
291 SONY PAPER USG PIECES 0 0 0 0 0 0 0
292 SPIRITUS 250 ML BOTOL 0 0 0 0 0 0 0
293 SPUIT 0.5 CC INSULIN PIECES 0 0 0 0 0 0 0
294 SPUIT 1 CC INSULIN PIECES 0 0 0 0 0 0 0
295 SPUIT 10 CC PIECES 80 0 80 0 0 80 0
296 SPUIT 2,5 CC PIECES 0 100 100 10 0 90 100
297 SPUIT 3 CC PIECES 0 100 100 10 0 90 100
298 SPUIT 5 CC PIECES 500 0 500 0 0 500 0
299 STERACATH MEDICAL CATHETER 18G X 33 MM PIECES 0 0 0 0 0 0 0
300 STERACATH MEDICAL CATHETER 20G X 33 MM PIECES 138 50 188 48 0 140 0
301 STERACATH MEDICAL CATHETER 22G X 25 MM PIECES 81 50 131 0 0 131 0
302 STERACATH MEDICAL CATHETER 24G X 19 MM PIECES 129 0 129 0 0 129 0
303 STERACATH MEDICAL CATHETER 26G X 3\/4 MM PIECES 176 0 176 0 0 176 0
304 STOMACH TUBE 14 FR (125 CM) PIECES 0 0 0 0 0 0 0
305 STOMACH TUBE 16 FR (125 CM) PIECES 0 0 0 0 0 0 0
306 STOMACH TUBE 18 FR (125 CM) PIECES 0 0 0 0 0 0 0
307 STRIP HbsAg PIECES 0 0 0 0 0 0 0
308 STRIP TES KEHAMILAN (ONEMED ULTRAONE) PIECES 0 50 50 0 0 50 50
309 SUCTION CATHETER NO 14 PIECES 0 0 0 0 0 0 0
310 SULFADOXINE|PYRIMETHAMINE TABLET 500 MG|25 MG TABLET 0 0 0 0 0 0 200
311 SURGICAL GOWN PIECES 0 0 0 0 0 0 0
312 TETANUS ANTITOXIN INJEKSI 1500 IU\/ML INJEKSI 20 0 20 0 0 20 0
313 TETRACYCLINE TABLET 250 MG TABLET 0 0 0 0 0 0 0
314 TETRACYCLINE TABLET 500 MG TABLET 0 0 0 0 0 0 0
315 THIAMINE TABLET 50 MG TABLET 0 0 0 0 0 0 500
316 TRAMADOL INJEKSI 100 MG/2 ML INJEKSI 0 0 0 0 0 0 0
317 TRANEXAMIC ACID INJEKSI 250 MG/ML INJEKSI 0 0 0 0 0 0 20
318 TARIFID TETES TELINGA BOTOL 0 0 0 0 0 0 0
319 TRIHEXYPHENIDYL TABLET 2 MG TABLET 0 0 0 0 0 0 0
TUBE EDTA PLH 13 X 75 3.0 BLBE LAV (VACUTAINER WITH
320 PIECES 0 0 0 0 0 0 0
EDTA)
321 UMBILICAL CORD CLAMP PIECES 0 0 0 0 0 0 0
322 UNDERPAD 60 X 90 LEMBAR 0 0 0 0 0 0 0
323 URETHER CATHETER NO 6 PIECES 0 0 0 0 0 0 0
324 Uric acid test system SET 0 0 0 0 0 0 0
325 URINE BAG PIECES 0 0 0 0 0 0 0
326 VACUTAINER K3 EDTA 3 ML PIECES 0 0 0 0 0 0 0
327 VIKIA HIV 1\/2 TEST 100 0 100 0 0 100 0
328 VITAMIN B COMPLEX TABLET 25 MG TABLET 1,500 1,000 2,500 800 0 1,700 300
329 WING NEEDLE NO. 23 (ONEMED) PCS 0 0 0 0 0 0 0
330 WING NEEDLE NO. 25 (ONEMED) PCS 0 0 0 0 0 0 0
331 YELLOW TIP AXYGEN PIECES 0 0 0 0 0 0 0
332 ZINC SULPHATE SIRUP 20 MG\/5 ML BOTOL 60 ML BOTOL 0 0 0 0 0 0 0
333 ZINC SULPHATE TABLET 20 MG/TABLET TABLET 0 2,000 2,000 500 0 1,500 500
334 RAPID HBsAgWB ( HEPATITIS ) PIECES 130 0 130 0 0 130 0
335 GIEMSA BOTOL 1 0 1 0 0 1 0
336 ALLOPURINOL TABLET 300 MG TABLET 0 0 0 0 0 0 300
337 NEUROBION 5000 INJ INJEKSI 0 0 0 0 0 0 20
338 COMBIVENT INJEKSI VIAL 0 0 0 0 0 0 50
339 PIL KB KOMBINASI STRIP 0 0 0 0 0 0 0
340 CHLOROQUINE PCS 0 0 0 0 0 0 0
341 ALKOHOL 70% 300ML BOTOL 0 0 0 0 0 0 0
342 RAPID TEST KADER MALARIA PIECES 0 0 0 0 0 0 200
343 THERMO GUN PIECES 0 0 0 0 0 0 0
344 SILK SUTURE 2\/0 PIECES 36 0 36 0 0 36 0
345 PROTEIN URINE TEST PIECES 100 0 100 0 0 100 0
346 METHANOL 100ml BOTOL 0 2 2 1 0 1 0
347 Rapid Test Covid-19 TEST 0 0 0 0 0 0 0
348 OXYTETRACYCLINE 1 % SALEP MATA TUBE 0 0 0 0 0 0 0
349 Onemed OneClean Disinvectan BOTOL 2 0 2 0 0 2 0
350 Vitamin B6 10MG TABLET 1,100 0 1,100 0 0 1,100 0
351 OTSU MgSO4 BOTOL 43 0 43 0 0 43 0
352 Ventolin Nebuliser Ampul 0 0 0 0 0 0 50
353 Combivent Nebuliser Ampul 0 0 0 0 0 0 50
354 NEUROBION 5000 INJ Ampul 0 0 0 0 0 0 0
355 APD Cover all Set 0 100 100 0 0 100 0
356 Glucos test strip stick 0 300 300 0 0 300 0
357 Etil Klorida lain-lain 100 ml (Etil klorida spray) BOTOL 0 0 0 0 0 0 0
358 ABBOCATH NO. 22 PIECES 0 0 0 0 0 0 0
359 ABBOCATH NO. 20 PIECES 0 0 0 0 0 0 0
360 GENTAMISIN 0.3% SALEP MATA TUBE 0 0 0 0 0 0 24
361 SAFEGLOVE PP (ONEMED) SIZE 7 PIECES PIECES 200 50 250 50 0 200 0
362 Salep Whitfield TUBE 0 0 0 0 0 0 0
363 Metronidazole Sirup BOTOL 0 50 50 0 0 50 50
364 HCL 0.1 N 100 ML BOTOL 0 5 5 1 0 4 0
 JKN UMUM TOTAL
JUMLAH KUNJUNGAN RESEP
0 371 371

Mengetahui/ Menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kab. Keerom Petugas IFK Keerom Kepala Puskesmas Waris Petugas Puskesmas Waris

(dr. Ronny. J.A. Situmorang) (Herlina Pabuntang, S. Si, Apt) (Leonardus Ibe, SKM) (Lasty Florentine, S.Farm., Apt)
NIP. 19740223 200502 1 002 NIP. 19800809 200502 1 003 NIP. 19671231199302 1 012 NRPK. 26.7.0509483