LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OB

PUSKESMAS
PUSKESMAS : MENES
KECAMATAN : MENES
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : APRIL 2021
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : MEI 2021

Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
1 Alprazolam Tablet - - - - -
2 Albendazol Tablet 400 mg Tablet - - - - -
3 Allopurinol tablet 100 mg Tablet 700 - 700 100 600
4 Ambroxol sirup Botol - - - - -
5 Ambroxol tablet 30 mg Tablet - - - - -
6 Aminofilin Tablet 200 mg Tablet - - - - -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul - - - - -
8 Amlodipin 10 mg Tablet 870 900 1,770 270 1,500
9 Amlodipin Besilate 5 mg Tablet 1,080 600 1,680 840 840
10 Amoksisilin Forte sirup kering 250mg Botol - - - - -
11 Amoksisilin Injeksi 1 gr Vial - - - - -
12 Amoksisilin Tablet 500 mg Tablet 12,700 - 12,700 2,400 10,300
13 Amoksisillin kapsul 250 mg Kapsul - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 373 100 473 97 376
15 Ampisilin Injeksi 1 gr Vial - - - - -
16 Analog insulin Long Acting Pen - - - - -
17 Analog insulin Mix Acting Pen - - - - -
18 Antalgin (Metampiron) tablet 500 mg Tablet - - - - -
19 Antalgin (Metampiron) tablet 500 mg Tablet - - - - -
20 Antasida DOEN suspensi Botol 115 - 115 43 72
21 ANTASIDA DOEN Tablet Tablet 10,400 1,000 11,400 2,700 8,700
22 Anti Bakteri DOEN ( Bacitrasin ) Tube - - - - -
23 anti hemoroid doen kombinasi supp - - - - -
24 Antifungi DOEN Tube - - - - -
25 Antimigren DOEN Kombinasi : Tablet - - - - -
26 Antiparkinson DOEN tablet Kombinasi : Tablet - - - - -
27 Antiparkinson Tablet ( Levopar ) Tablet - - - - -
28 Aqua Pro Injeksi Vial - - - - -
29 Artermeter injeksi Ampul - - - - -
30 Artesunate injeksi 60 mg/ml vial - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 7,640 - 7,640 1,090 6,550
32 Asam Ascorbat ( Vit. C ) 50 MG (BTT PROV) Tablet 3,350 - 3,350 350 3,000
33 Asam Asetilsalisilat 80mg Tablet 140 - 140 - 140
34 Asam Folat Botol 800 - 800 - 800
35 Asam Fusidat Cream Tube - - - - -
36 Asam Klorida 0,1 N Botol - - - - -
37 Asam Mefenamat 500 mg Tablet 3,920 - 3,920 370 3,550
38 Asam Traneksamat Inj 5% Ampul 35 - 35 15 20
39 Asering Botol 80 200 280 260 20
40 Asetosal tablet 500 mg Tablet - - - - -
41 Asetyl Cysteine Capsul 6,660 - 6,660 1,620 5,040
42 Asiklovir Cream 5% Tube - - - - -
43 Asiklovir tablet 200 mg Tablet - - - - -
44 Asiklovir tablet 400 mg Tablet 350 - 350 - 350
45 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 50 - 50 - 50
46 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - - - - -
47 Atropin Sulfat tablet 0,5 mg Tablet - - - - -
48 Berotec Metered Aerosol 100 mg Bok - - - - -
49 Betadine Salep Antiseptik 5 mg Tube 10 - 10 - 10
50 Betametason krim 0,1 % Tube - - - - -
51 Bisakodil Suppositoria supp - - - - -
52 Bisoprolol 2,5 mg Tablet - - - - -
53 Bisoprolol 5 mg Tablet - - - - -
54 Cairan Infus KN-3B Botol - - - - -
55 Cairan Infus Wida KDN 1 Botol - - - - -
56 Cairan Pembersih ( Protektor ) Botol - - - - -
57 Captopril Tablet 12,5 mg Tablet 450 - 450 200 250
58 Captopril Tablet 25 mg Tablet - - - - -
59 Cefadroxil Capsul 500 mg Capsul - - - - -
60 Cefixime Capsul 100 mg Capsul - - - - -
61 Cefixime Sirup Botol - - - - -
62 Cefotaksime 1 gr Injeksi Vial - - - - -
63 Cetirizine Capsul 50 mg Capsul - - - - -
64 Cetirizine sirup 5 mg/5 ml Botol - - - - -
65 Ciprofloxcacin 500 mg tablet Tablet - - - - -
66 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul - - - - -
67 D-Artepp tablet Tablet - - - - -
68 Deksametason tablet 0,5 mg Tablet 5,950 - 5,950 750 5,200
69 Deksametason Injeksi Ampul 15 - 15 15 -
70 Dekstran 70 - larutan infus 6% steril Botol - - - - -
71 Dekstrometorfan sirup Botol - - - - -
72 Dekstrometorfan tablet 15 mg Tablet - - - - -
73 Diazepam Injeksi Ampul 24 - 24 8 16
74 Diazepam Rektal 0,5 mg / 2 ml supp 12 - 12 2 10
75 Diazepam tablet 2 mg Tablet - - - - -
76 Diazepam tablet 5 mg Tablet 106 - 106 9 97
77 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul 19 - 19 - 19
78 Digoksin tablet 0,25 mg Tablet - - - - -
79 Diltiazem Tablet - - - - -
80 Doksisiklin Kapsul 100 mg Capsul 100 - 100 - 100
81 Domperidon 10mg Tablet Tablet 340 - 340 340 -
82 Domperidon Suspensi 5 mg/ 5 ml Botol 80 - 80 4 76
83 Doxicyclin 500mg capsul - - - - -
84 Efedrin HCLTablet 25 mg Tablet - - - - -
85 Epinefrina HCL/Bitartrat Injeksi Ampul 75 - 75 - 75
86 Eritromicyn kapsul 250 mg capsul - - - - -
87 Erytromicin kapsul 500 mg Kapsul 400 - 400 400 -
88 Erytromicin sirup 125 mg Botol - - - - -
89 Etakridin ( Rivanol ) larutan 0,1% Botol - - - - -
90 Etambutol 500 mg Tablet - - - - -
91 Etanol 70 % Botol - - - - -
92 Etil Klorida Semprot Botol - - - - -
93 Fenitoin Natrium kapsul 30 mg Kapsul - - - - -
94 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - - - - -
95 Fenobarbital tablet 30 mg Tablet 101 100 201 175 26
96 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - -
97 Fenol Gliserol tetes telinga 10 % Botol 24 - 24 - 24
98 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - - - -
99 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 300 - 300 100 200
100 Flufenazine Deconat Inj 25 mg/ml Ampul 7 - 7 2 5
101 Furosemida tablet 40 mg Tablet 230 - 230 30 200
102 Furosemide Injeksi Ampul - - - - -
103 Garam Oralit Sachet 200 - 200 - 200
104 Gemfibrozil 300 mg Tablet - - - - -
105 Gentamicin Injeksi Ampul - - - - -
106 Gentamicin Salep Kulit Tube - - - - -
107 Gentamicin Salep mata Tube - - - - -
108 Gentamicin Tetes Mata Botol 24 24 48 - 48
109 Gentian Violet 1 % Botol - - - - -
110 Glibenclamid tablet 5 mg Tablet 200 - 200 - 200
111 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - -
112 Glikazid 80 mg Tablet Tablet - - - - -
113 Glimepiride 2 mg Tablet 600 - 600 300 300
114 Glukosa larutan infus 10% steril Botol - - - - -
115 Glukosa larutan infus 5 % steril Botol - - - - -
116 Griseofulvin tablet 125mg Tablet - - - - -
117 Griseofulvin tablet 500 mg, Tablet 200 - 200 - 200
118 Guaiafenesin 100 mg Tablet - - - - -
119 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 500 - 500 - 500
120 Hidrokortison krim 2,5% Tube - - - - -
121 Ibuprofen Suspensi Tablet - - - - -
122 Ibuprofen tablet 200 mg Tablet - - - - -
123 Ibuprofen tablet 400 mg Tablet - - - - -
124 Imunomodulator sirup( STIMUNO) Botol - - - - -
125 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 180 100 280 - 280
126 Kalsium Glukonas Injeksi Ampul 72 - 72 - 72
127 Kalsium Laktat (Kalk) tablet 500 mg Tablet - - - - -
128 Kapas Berlemak 500 mg Bungkus - - - - -
129 Ketokonazol Kream Tube - - - - -
130 Ketokonazol Tablet 200 mg Tablet 100 - 100 50 50
131 Ketorolac inj Ampul 140 100 240 120 120
132 Kifadene tablet 20 mg Tablet - - - - -
133 Kloramfenikol salep kulit Tube 72 24 96 48 48
134 Kloramfenikol salep mata 1 % capsul - - - - -
135 Kloramfenikol suspensi Botol 50 - 50 - 50
136 Kloramfenikol tetes telinga 3% Tube - - - - -
137 Kloramphenicol 250 mg Capsul - - - - -
138 Kloramphenicol 500 mg capsul 200 - 200 - 200
139 Kloramphenicol Tetes Mata Botol - - - - -
140 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 1,700 2,000 3,700 2,400 1,300
141 Klorokuin tablet 150 mg Tablet - - - - -
142 Klorpromazin HCL tablet salut 25 mg Tablet - - - - -
143 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet - - - - -
144 Kotrimoksazol Dewasa Tablet 480 mg Tablet 1,100 500 1,600 200 1,400
145 Kotrimoksazol Sirup / Suspensi Botol 128 - 128 38 90
146 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - - - - -
147 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - - - - -
148 Lactobacilus serbuk Sachet - - - - -
149 Lidocain 2%+efinefrin injeksi Ampul 140 60 200 - 200
150 Lidocain injeksi 2 ml Ampul 80 100 180 60 120
151 Lisinopril 10 mg tablet Tablet - - - - -
152 Lisinopril 5 mg tablet Tablet - - - - -
153 Loperamid 4 mg tablet Tablet - - - - -
154 Lytacur Sirup Botol - - - - -
155 Magnesium Sulfat Inj. 25 ml Ampul - - - - -
156 Magnesium Sulfat inj 40% 25ml Ampul - - - - -
157 Metamizol 500 mg Tablet - - - - -
158 Metformin 500 mg Tablet Tablet 200 - 200 200 -
159 Methilprednisolon tablet 8 mg Tablet - - - - -
160 Metilergometrin Maleat injeksi 1 ml Ampul - - - - -
161 Metilergometrin Maleat Tablet Tablet 90 - 90 - 90
162 Metoklopramid Suspensi Botol - - - - -
163 Metoklopramid tablet Tablet - - - - -
164 Metronidazol 500 mg Tablet - - - - -
165 Metronidazol infus / injeksi Botol - - - - -
166 Metronidazol Ovula supp - - - - -
167 Metronidazol suspensi Botol - - - - -
168 Mikonazol kream Tube 19 - 19 - 19
169 Multivitamin Anak Sirup Botol 171 - 171 71 100
170 Multivitamin Anak Sirup / Stimuno Syr (BANKEU) Botol 94 - 94 3 91
171 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - - - -
172 Multivitamin Dewasa (HB Vit) Box 27 - 27 - 27
173 Multivitamin Dewasa / OXYVIT (BANKEU) Box 51 - 51 2 49
174 Natrium Diklofenak 25 mg Tablet Tablet - - - - -
175 Natrium Diklofenak 50 mg Tablet Tablet 590 - 590 350 240
176 Natrium Klorida Cairan Infus ( NaCL ) Botol 80 20 100 40 60
177 Nifedipine Tablet 10 mg Tablet - - - - -
178 Nistatin tablet vaginal 100.000 IU/g Tube 205 - 205 1 204
179 Obat anti Diare suspensi Botol - - - - -
180 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 1,150 - 1,150 200 950
181 Obat Batuk Flu ( Molexflu ) Tablet 17 10 27 7 20
182 Obat Batuk Hitam (OBH) Botol - - - - -
183 Obat Batuk Sirup Herbal ( Herbacop ) Botol 163 - 163 39 124
184 Ofloxsacin Tetes Telinga Tube - - - - -
185 Oksitetrasiklin HCL salep mata 1% Botol 475 - 475 - 475
186 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - - - -
187 Omeprazol injeksi Ampul - - - - -
188 Omeprazol Kapsul 20 mg capsul - - - - -
189 Ondancentron injeksi 4 mg Ampul - - - - -
190 Ondancentron Tablet4 mg Tablet 450 - 450 120 330
191 Paracetamol Drop 15 ml Botol 120 - 120 8 112
192 Paracetamol Sirup 120 mg/5 ml Botol 365 200 565 270 295
193 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - -
194 Parasetamol tablet 100 mg Tablet - - - - -
195 Parasetamol tablet 500 mg Tablet 14,500 5,000 19,500 4,920 14,580
196 Permetrin Krim 5 % Tube - - - - -
197 Pirantel Sirup Botol - - - - -
198 Pirantel tablet 125 mg Tablet - - - - -
199 Pirazinamid Botol - - - - -
200 Piridoksin HCL (VIT B6) tablet 10mg Botol 3,900 1,000 4,900 1,400 3,500
201 Piroksikam tablet 20 mg Tablet - - - - -
202 Polikresulen Tube - - - - -
203 Povidon lodida 10% 300 ml - - - - -
204 Povidon lodida 10% 60 ml Tablet - - - - -
205 Prazikuantel tablet 600 mg Botol - - - - -
206 Prednison Tablet 5 mg Tablet 800 - 800 300 500
207 Primakuin 15 mg Tablet - - - - -
208 Probenesid 500 mg tablet Tablet - - - - -
209 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul - - - - -
210 Propanolol HCL tablet 10 mg Tablet - - - - -
211 Ranitidin injeksi Ampul 200 300 500 220 280
212 Ranitidin tablet Tablet - - - - -
213 Resperidone 2 mg tablet Tablet - - - - -
214 Ringer Laktat cairan infus (Otsuka) Botol - - - - -
215 Ringer Laktat cairan infus (Widatra) Botol - - - - -
216 Ringer Laktat (2020) Botol 80 - 80 80 -
217 Salbutamol Tablet 2 mg Tablet 750 - 750 400 350
218 Salbutamol tablet 4mg Tablet - - - - -
219 Salep 2-4 Tube - - - - -
220 Salep kombinasi cream ( Berloson ) Tube - - - - -
221 Salicil bedak Kotak - - - - -
222 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial - 5 5 2 3
223 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial - - - - -
224 Sianokobalamin Injeksi Ampul - - - - -
225 Simvastatin 10 mg tablet Tablet - - - - -
226 Simvastatin 20 mg tablet Tablet 700 - 700 70 630
227 Sukralfat Suspensi Botol - - - - -
228 Sukralfat tablet 500 mg Tablet - - - - -
229 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube - - - - -
230 Temporary Stopping Fletcher serbuk & cairan Tablet - - - - -
231 Tetrakain HCL tetes mata 0,5% Tube - - - - -
232 Tetrasiklin 250 mg capsul capsul - - - - -
233 Tetrasiklin 500 mg capsul capsul - - - - -
234 Tiamin Tablet 50 mg ( B1 ) Tablet 400 500 900 200 700
235 Ventolin Nebulizer Ampul - - - - -
236 Vitamin B komplek Tablet 2,650 - 2,650 2,150 500
237 Vitamin B komplek (BTT PROV) Tablet 3,000 - 3,000 1,350 1,650
238 Zink sirup Botol 18 - 18 6 12
239 Zink tablet 20 mg Tablet 1,530 - 1,530 370 1,160

OBAT PROGRAM
1 Albendazol Tablet 400 mg Tablet 9,270 - 6,720 - 6,720
2 Isoniazid Tablet 100 mg Tablet - - - - -
3 Obat Antituberkulosis kategori 1 Paket 7 - 7 5 2
4 Obat Antituberkulosis Kategori 2 Paket 2 - 2 - 2
5 Obat Antituberkulosis Kategori Anak Paket 1 - 1 - 1
6 Pot Dahak Non Steril Biji - - - - -
7 Pot Dahak Steril Biji - - - - -
8 Reagen Ziehl Neelsen Kit - - - - -
9 MDT MB Anak Tablet Tablet - - - - -
10 MDT MB Dewasa Tablet Tablet 3 - 3 - 3
11 MDT PB Dewasa Tablet Tablet - - - - -
12 MDT PB Anak Tablet Tablet - - - - -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul - - - - -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul - - - - -
15 Tablet Penambah Darah ( FE ) Tablet 120,960 - 120,960 26,460 94,500
16 Amitriptilin tablet 25 mg Tablet 150 - 150 41 109
17 Carbamazepin 200 mg tablet Tablet - - - - -
18 Clobazam 10 mg Tablet Tablet 239 - 239 - 239
19 Clozapine 25 mg Tablet Tablet - - - - -
20 Fenitoin Natrium kapsul 30 mg capsul - - - - -
21 Haloperidol 1,5 mg Tablet Tablet - - - - -
22 Haloperidol 2 mg tablet Tablet 1,070 - 1,070 241 829
23 Haloperidol 5 mg Tablet Tablet 883 - 883 856 27
24 Haloperidol Injeksi Ampul 15 - 15 - 15
25 INH 100mg Tablet 100 - 100 - 100
26 Klorpromazin HCL tablet salut 100 mg Tablet 845 - 845 735 110
27 Klorpromazine Tablet 25 mg Tablet - - - - -
28 Triheksilfenidil Hcl 2 mg tablet Tablet 1,005 - 1,005 921 84
29 Dehydro Artemisin 40mg + Piperaquin 320mg (DHP) Tablet - - - - -
30 Risperidone 2mg Tablet - - - - -

B NAMA BAHAN MEDIS HABIS PAKAI (BMHP )

1 Alat Semprot (Pompa Spray) Unit 1 - 1 - 1

2 Alat Semprot Punggung Elektrik (BANKEU) Unit 1 - 1 - 1
3 Alat suntik 1 ml Pcs 144 300 444 320 124
4 Alat suntik 10 ml Pcs - - - - -
5 Alat suntik 2,5 ml Pcs - - - - -
6 Alat suntik 20 ml Pcs - - - - -
7 Alat suntik 3 cc (Remedi) - - - - -
8 Alat suntik 3 ml Pcs 500 300 800 450 350
9 Alat suntik 3 cc (Program) Box 9 - 9 - 9
10 Alat suntik 5 ml pcs 380 - 380 144 236
11 Alkazide 1 L High Level Desinfectant Botol 2 - 2 - 2
12 Alkazyme Sachet 25 mg Pack 2 - 2 - 2
13 Alkohol 70 % 1 L Botol - - - - -
14 Alkohol swab Sachet 12 - 12 - 12
15 Alkohol swab (Vaksin Covid-19) Buah 388 - 388 388 -
16 Anti Septik Hand Rub Botol - - - - -
17 Anti Septik Surgikal Hand Scrub Botol - - - - -
18 APD MEDIS SET (BANKEU2) Set - - - - -
19 APD MEDIS SET (BANKEU) Set - - - - -
20 APD (HAZMAT) Pcs 58 - 58 10 48
21 Cat Gut no 2/0 Sachet - - - - -
22 Cat Gut no 3/0 Sachet - - - - -
23 Cat Gut No 3/0 (24 mm) Sachet - - - - -
24 Cat Gut No 3/0 (26 mm) Sachet - - - - -
25 Cathetter Jelly Biji - - - - -
26 Demetech Silk 3/0 Set - - - - -
27 Desinfectan Stericide 5L (BANKEU) Galon 2 - 2 - 2
28 Desinfectan Stericide 5L (BANKEU2) Galon - - - - -
29 E Care I.V Dresing Pcs 285 - 285 - 285
30 E-Care Surgical Mask Tie On Lembar - - - - -
31 Face Drager (COVID) Pcs 3 - 3 - 3
32 Face Drager (BANKEU) Unit 3 - 3 - 3
33 Face Shielld (BANKEU2) Pcs 40 - 40 - 40
34 Folly No 14 Catether pcs - - - - -
35 Folly No 16 Catether pcs - - - - -
36 Forehead Thermometer Microlife (DID) Unit 1 - 1 - 1
37 Handsanitizer 5L (BANKEU) Galon 6 - 6 - 6
38 Hazmat Protect U Coverall (BANKEU) Pcs 150 - 150 - 150
39 I.V Cathetter No. 20 Set 150 - 150 40 110
40 I.V Cathetter No. 22 Set 200 100 300 65 235
41 I.V Cathetter No. 24 Set 150 - 150 20 130
42 I.V Cathetter No. 26 Set - - - - -
43 Infuset Anak Set 248 - 248 20 228
44 Infuset Dewasa Set 309 - 309 79 230
45 Jarum Insulin Tablet - - - - -
46 Kantong Jenazah (CSR BJB) Buah 3 - 3 - 3
47 Kantong Jenazah (BANKEU) Buah 5 - 5 - 5
48 Kapas Berlemak 250 gr Bungkus 7 - 7 1 6
49 Kapas Berlemak 500 gr Bungkus - - - - -
50 Kasa 4 m x 10 cm Rol - - - - -
51 Kasa 3 m x 15 cm Rol 290 - 290 45 245
52 Kasa Hidrofil 36 x 80 cm Rol - - - - -
53 Kasa Pembalut 2 x 80 cm Pack 43 - 43 10 33
54 Kasa Steril 16 x 16 cm Kotak 40 - 40 40 -
55 Lisol 1 L Botol - - - - -
56 Masker Bedah 3ply (BANKEU) Box - 20 20 3 17
57 Masker KN95 (PROV) Pcs 100 - 100 - 100
58 Masker N95 (CSR BJB) Pcs 20 - 20 - 20
59 Masker N95 (BANKEU) Pcs 34 - 34 - 34
60 Masker N95 (PROV) Pcs 180 - 180 - 180
61 Masker karet Ear Loop Lembar - - - - -
62 Masker tali Tube - - - - -
63 Masker Hijab Box - - - - -
64 Masker N95 Buah - - - - -
65 Nasal Canula Oksigen Set - - - - -
66 Plester 1" Rol - - - - -
67 Plester Kertas 2,5 cm Rol - - - - -
68 Plester Kertas 1,25 cm x 9,14 cm Rol 69 - 69 26 43
69 Plester Non Woven 5cm x 5 cm Rol - - - - -
70 Policlean Botol 14 - 14 - 14
71 Polifik Kotak - - - - -
72 Rapid Test (BANKEU) Box - - - - -
73 Rapid Antigen (Kemenkes) Test - - - - -
74 Saraya Alsof A 500 ml Botol - - - - -
75 Saraya Alsof Pure 500 ml Botol - - - - -
76 Sarung Tangan Gynecolog No 7 Pasang 43 - 43 - 43
77 Sarung Tangan Gynecolog No 7 (BANKEU) Pasang 50 - 50 - 50
78 Sarung tangan M (Non Steril) Pasang - - - - -
79 Sarung tangan no 6,5 Pasang - - - - -
80 Sarung tangan no 6,5 Steril Gloves Pasang - - - - -
81 Sarung tangan no 6,5 Steril (BANKEU) Pasang - 300 300 250 50
82 Sarung tangan no 7,0 Steril Pasang 250 200 450 - 450
83 Sarung tangan Steril Panjang (CSR BJB) Pasang 10 - 10 1 9
84 Sepatu Boots (CSR BJB) Pasang 11 - 11 - 11
85 Silk Black 3/0 26mm Sachet 12 60 72 - 72
86 Underpad Lembar 90 - 90 - 90
87 Urine Bag Biji - - - - -

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial - - - - -

2 Vaksin BCG Vial 29 - 29 - 29
3 Vaksin DT Vial 62 - 62 - 62
4 Vaksin HB 0 Pcs 50 - 50 - 50
5 Vaksin HBIG Vial - - - - -
6 Vaksin Measless Rubella (MR) Vial 2 - 2 - 2
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 26 - 26 - 26
8 Vaksin Polio B OPV Vial 17 - 17 - 17
9 Vaksin Polio IPV Vial 41 - 41 - 41
10 Vaksin TD Vial 18 - 18 - 18
11 Vaksin Tuberculin Vial - - - - -
12 Vaksin Covid-19 Vial 46 10 56 10 46
13 ADS 0,005 ml Unit 112 - 112 - 112
14 ADS 0,5 ml Unit 470 85 555 85 470
15 ADS 5 ml Unit 281 - 281 - 281
16 Safety Box Unit 3 1 4 1 3
17 ADS 0,5 ML (COVID) Pcs - - - - -

NAMA OBAT REAGEN

1 Albumin (Reagen) Kotak - - - - -

2 anti A Monoclonal ( GolDar 10 ml) Vial - - - - -
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial - - - - -
4 Anti B Monoclonal ( GolDar 10ml) Vial - - - - -
5 Anti D Monoclonal ( GolGar 10ml) Vial - - - - -
6 Benecheck Plus Cholesterol Test Strip - - - - -
7 Benecheck Plus Glukosa Test Strip - - - - -
8 Benecheck Plus Uric Test Strip - - - - -
9 Bilirubin T/D (Reagen) Kotak - - - - -
10 Brilian Green Bile Broth Kotak - - - - -
11 Cellclean (CL-50) (Reagen) Kotak - - - - -
12 Cellpack (PK-30L) (Reagen) Kotak - - - - -
13 Chikungunya IgM (Reagen) Kotak - - - - -
14 Cholesterol (Reagen) Kotak - - - - -
15 Cholesterol Stik (Reagen) Kotak - - - - -
16 CK-MB (Reagen) Kotak - - - - -
17 Creatinin Reagen Kit - - - - -
18 Dengue IgM / IgM ( Reagen ) Kotak - - - - -
19 Eight Check ( LNH ) Serial - - - - -
20 Febrile Antingen H Parathpy Vial - - - - -
21 Febrile Antingen H-A Parathpy Vial - - - - -
22 Febrile Antingen H-B Parathpy Vial - - - - -
23 Febrile Antingen H-C Parathpy Vial - - - - -
24 Febrile Antingen O Parathpy Vial - - - - -
25 Febrile Antingen O-A Parathpy Vial - - - - -
26 Febrile Antingen O-B Parathpy Vial - - - - -
27 Febrile Antingen O-C Parathpy Vial - - - - -
28 Glukosa Reagen Kotak - - - - -
29 GOT ( ALAT ) Kotak - - - - -
30 GPT ( ALAT ) Kotak - - - - -
31 HBSAG Reagen Box - - - - -
32 HCG Strip Vial - - - - -
33 HDL Cholesterol ( Precipitan ) Kotak - - - - -
34 Hematologi Calibrator (Nscs 1000 ) Botol - - - - -
35 Hemoglobin Reagen Kotak - - - - -
36 Lactose Broth 500 mg Botol - - - - -
37 LDL Cholesterol Kotak - - - - -
38 Leptospira IgM (Reagen) Kotak - - - - -
39 Micropippets MT-1-up to 200 ui Pcs - - - - -
40 MIcropippets MT-up to 1 ml Pcs - - - - -
41 NS1 Antigen Test (Reagen) Kotak - - - - -
42 Pipet Ukur 10 ml biji - - - - -
43 Poch Pack D (II) Reagen Kotak - - - - -
44 Poch Pack L (II) Reagen Kotak - - - - -
45 Stik Uric Acid Kotak - - - - -
46 Strip Narkoba 3 Parameter Kotak - - - - -
47 Strip Narkoba 5 Parameter Kotak - - - - -
48 Strip Narkoba 6 Parameter Kotak - - - - -
49 Total Protein Kotak - - - - -
50 Trigleserida Kotak - - - - -
51 Urea Kotak - - - - -
52 Uric Acid Kotak - - - - -
53 Rapid Tes Sypillis Buah - - - - -
NAMA OBAT REAGEN PROGRAM HIV - - - - -
1 Rapid 1 HIV (SD Bioline ) Tes 650 - 650 - 650
2 Rapid 2 HIV (Fokus ) Tes - - - - -
3 Rapid 3 HIV (Biomeriux Vikia ) Tes - - - - -
4 SD Biosensore Standart Q Syphlis Tes - - - - -
5 RPR Syphlis ( Fokus ) Tes - - - - -
6 Reagen CD4 Control Tes - - - - -
7 Reagen CD4 Mobile Tes - - - - -
 8 RPR Syphlis Komponen Kit - - - - -
9 Anuscopy Buah 1 - 1 - 1
10 Kertas PH Indikator Buah - - - - -
11 Rotator Buah - - - - -
12 Tip. Uk.60 Bks - - - - -
13 Tip. Uk.61 Bks - - - - -
14 Pronto / Holder Buah - - - - -
15 Flashback Blood Buah - - - - -
16 BD Vaccutaines Tube Buah - - - - -
17 Rapid Sypilis (Trepocheck) Tes - - - - -
18 Sarung tangan Disposible (Safe Guard) Box - - - - -
- - - - -
NAMA OBAT GIGI
- - - - -
1 Anastesi Citojek Box - - - - -
2 Articulating Paper (Kertas warna penanda oklusi) Kotak - - - - -
3 Bahan Tumpatan sementara Botol - - - - -
4 Bonding Syringe 2 - 2 - 2
5 Cairan Desinfectan ( Perendaman Instrumen Gigi ) Botol - - - - -
6 Cairan untuk desinfectan pembersih permukaan Botol - - - - -
7 Carpule Citojek Kotak 4 - 4 - 4
8 Chlorfeson Kamfer menthol ( CHKM ) Cairan Botol - - - - -
9 Composite Nanohibrid A1 Tube 1 - 1 - 1
10 Composite Nanohibrid A2 Tube - - - - -
11 Composite Nanohibrid A3 Tube - - - - -
12 Composite Nanohibrid A3,5 Tube - - - - -
13 Devitalisasi Pasta Pot - - - - -
14 Devitalisasi Pulpa Pak 1 - 1 - 1
15 Disclosing Solution Botol - - - - -
16 Etcing Gel Pcs - - - - -
17 Etil Klorida Semprot Botol - - - - -
18 Endomethason Pak 2 - 2 - 2
19 Eugenol Cairan Botol - - - - -
20 Formokesol Botol - - - - -
21 Gas Powred Jet Injector Botol 12 - 12 - 12
22 Glass Ionomer Cement ART Pot - - - - -
23 Glass Ionomer Cement Fuji 9 Pak 2 - 2 - 2
24 Jarum citojek uk 16 mm Box - - - - -
25 Kalsium Hidroksida pasta Botol - - - - -
26 Klorhekdidin Larutan 2 % Botol - - - - -
27 Mummifiying Fasta Botol - - - - -
28 Natrium Hipoklorit airan konsentrat 5% Botol - - - - -
29 Paper Points 15-40 mm Box - - - - -
30 Pasta Devitalisasi ( Non Arsen ) Tube - - - - -
31 Pasta Pengisi Saluran Akar Syringe - - - - -
32 Semen seng Fosfat serbuk Set - - - - -
33 Spon Gelatin Cubicis 1x1x1 cm (Spongostan) Botol - - - - -
34 Temporary Filling Fasta Set - - - - -
35 Temporary Restorative Hydraulic CAVITON White Pak 2 - 2 - 2
36 Tooth Stain Remover ( TSR ) Botol - - - - -
37 Wipes Desinfektan Botol - - - - -

RAWAT
JUMLAH KUNJUNGAN PUSKESMAS JALAN RAWAT INAP JUMLAH

UMUM / BAYAR 0
UMUM / TIDAK BAYAR 0
JKN 0
TOTAL KUNJUNGAN 0

Mengetahui / Menyetujui
KEPALA DINAS KESEHATAN YANG MENYERAHKAN YANG MEMIN
KABUPATEN PANDEGLANG KEPALA UPT. GUDANG FARMASI KEPALA PUSKES

………………………………………… …………………………………………………… Hj. NONOK NATAES

NIP. NIP. NIP. 19680508 1987
KAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN NOMOR TANGGAL
DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS

Jumlah PEMBERIAN
Stok
Perminta BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
an STOK

9 10 11 12 13 14 15 16

-
-
120
-
-
-
-
324
1,008 1200
-
-
2,880
-
116 100
-
-
-
-
-
52
3,240 3000
-
-
-
-
-
-
-
-
-
1,308 2000
420
-
-
-
-
444
18
312 200
-
1,944
-
-
-
-
-
-
 -
-
-
-
-
-
-
-
-
240 200
-
-
-
-
-
-
-
-
-
-
900

-
-
-
10
2
-
11
-
-
-
- 200
408 300
5
-
-
-
-
480
-
-
-
-
-
-
-
210 100
-
-
-
120
2
36
-
-
-
-
-
-
 -
-
-
-
-
360 500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
60
144 300
-
58 72
-
-
-
-
-
-
2,880 3000
-
-
-
240
46
-
-
-
-
72
-
-
-
-
-
-
-
240 2000
-
-
-
-
-
-
-
-
-
 - 24
85 100
4
-
-
2
-
420
48 100
-
1
-
240
8 10
-
47
-
-
-
-
-
-
144
10
324 300
-
-
5,904 5000
-
-
-
-
1,680 1000
-
-
-
-
-
360
-
-
-
-
264 500
-
-
-
-
96 200
480
- 500
-
-
-
2 5
-
-
-
84
-
 -
-
-
-
-
-
240
-
2,580 3000
1,620
7
444

-
-
6
-
-
-
-
-
-
-
-
-
-
-
31,752
49
-
-
-
-
-
289
1,027
-
-
882
-
1,105
-
-

-
-
384 300
-
-
-
-
540 500
-
173
 -
-
-
-
466
-
-
-
-
12
-
- 60
-
-
- 10
-
-
-
-
-
-
-
-
- 20
- 20
-
-
-
48 50
78 50
24 50
-
24
95
-
-
-
1
-
-
54
-
12
48 200
-
4 25
-
-
-
-
-
-
-
-
-
-
-
31 24
-
- 5
 -
-
-
-
-
-
-
-
-
-
300
-
1
-
-
-
- 20

-
-
-
-
-
-
-
-
-
-
-
12
-
102
-
1
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 -
-
-
-
-

Harap Dilampirkan : 1. LB 1

2. Lap. Psikotropika & Narkotika

3. Lap. Pemakaian Serum ABU
4. Lap. 20 Pemakaian Obat Terbanyak

YANG MEMINTA YANG MEMINTA :

KEPALA PUSKESMAS PETUGAS OBAT PUSKESMAS

Hj. NONOK NATAESAH, SKM RD. ISTI YULISTINA, S.Far., Apt

NIP. 19680508 198703 2 001 NIP. 19840717 200604 2 017
 LAPORAN PEMAKAIAN DAN LEMBA
PUSKES
PUSKESMAS : MENES
KECAMATAN : MENES
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE
PROVINSI : BANTEN

Penerimaan
Stok
N0 NAMA OBAT SATUAN
Awal DAK
1 2 3 4 5

1 Alprazolam Tablet -
2 Albendazol Tablet 400 mg Tablet -
3 Allopurinol tablet 100 mg Tablet 700
4 Ambroxol sirup Botol -
5 Ambroxol tablet 30 mg Tablet -
6 Aminofilin Tablet 200 mg Tablet -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul -
8 Amlodipin 10 mg Tablet 870 900
9 Amlodipin Besilate 5 mg Tablet 1,080 600
10 Amoksisilin Forte sirup kering 250mg Botol -
11 Amoksisilin Injeksi 1 gr Vial -
12 Amoksisilin Tablet 500 mg Tablet 12,700
13 Amoksisillin kapsul 250 mg Kapsul -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 373 100
15 Ampisilin Injeksi 1 gr Vial -
16 Analog insulin Long Acting Pen -
17 Analog insulin Mix Acting Pen -
18 Antalgin (Metampiron) tablet 500 mg Tablet -
19 Antalgin (Metampiron) tablet 500 mg Tablet -
20 Antasida DOEN suspensi Botol 115
21 ANTASIDA DOEN Tablet Tablet 10,400 1,000
22 Anti Bakteri DOEN ( Bacitrasin ) Tube -
23 anti hemoroid doen kombinasi supp -
24 Antifungi DOEN Tube -
25 Antimigren DOEN Kombinasi : Tablet -
26 Antiparkinson DOEN tablet Kombinasi : Tablet -
27 Antiparkinson Tablet ( Levopar ) Tablet -
28 Aqua Pro Injeksi Vial -
29 Artermeter injeksi Ampul -
30 Artesunate injeksi 60 mg/ml vial -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 7,640
32 Asam Ascorbat ( Vit. C ) 50 MG (BTT PROV) Tablet 3,350
33 Asam Asetilsalisilat 80mg Tablet 140
34 Asam Folat Botol 800
35 Asam Fusidat Cream Tube -
36 Asam Klorida 0,1 N Botol -
37 Asam Mefenamat 500 mg Tablet 3,920
38 Asam Traneksamat Inj 5% Ampul 35
39 Asering Botol 80 200
40 Asetosal tablet 500 mg Tablet -
41 Asetyl Cysteine Capsul 6,660
42 Asiklovir Cream 5% Tube -
43 Asiklovir tablet 200 mg Tablet -
44 Asiklovir tablet 400 mg Tablet 350
45 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 50
46 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial -
47 Atropin Sulfat tablet 0,5 mg Tablet -
48 Berotec Metered Aerosol 100 mg Bok -
49 Betadine Salep Antiseptik 5 mg Tube 10
50 Betametason krim 0,1 % Tube -
51 Bisakodil Suppositoria supp -
52 Bisoprolol 2,5 mg Tablet -
53 Bisoprolol 5 mg Tablet -
54 Cairan Infus KN-3B Botol -
55 Cairan Infus Wida KDN 1 Botol -
56 Cairan Pembersih ( Protektor ) Botol -
57 Captopril Tablet 12,5 mg Tablet 450
58 Captopril Tablet 25 mg Tablet -
59 Cefadroxil Capsul 500 mg Capsul -
60 Cefixime Capsul 100 mg Capsul -
61 Cefixime Sirup Botol -
62 Cefotaksime 1 gr Injeksi Vial -
63 Cetirizine Capsul 50 mg Capsul -
64 Cetirizine sirup 5 mg/5 ml Botol -
65 Ciprofloxcacin 500 mg tablet Tablet -
66 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul -
67 D-Artepp tablet Tablet -
68 Deksametason tablet 0,5 mg Tablet 5,950
69 Deksametason Injeksi Ampul 15
70 Dekstran 70 - larutan infus 6% steril Botol -
71 Dekstrometorfan sirup Botol -
72 Dekstrometorfan tablet 15 mg Tablet -
73 Diazepam Injeksi Ampul 24
74 Diazepam Rektal 0,5 mg / 2 ml supp 12
75 Diazepam tablet 2 mg Tablet -
76 Diazepam tablet 5 mg Tablet 106
77 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul 19
78 Digoksin tablet 0,25 mg Tablet -
79 Diltiazem Tablet -
80 Doksisiklin Kapsul 100 mg Capsul 100
81 Domperidon 10mg Tablet Tablet 340
82 Domperidon Suspensi 5 mg/ 5 ml Botol 80
83 Doxicyclin 500mg capsul -
 84 Efedrin HCLTablet 25 mg Tablet -
85 Epinefrina HCL/Bitartrat Injeksi Ampul 75
86 Eritromicyn kapsul 250 mg capsul -
87 Erytromicin kapsul 500 mg Kapsul 400
88 Erytromicin sirup 125 mg Botol -
89 Etakridin ( Rivanol ) larutan 0,1% Botol -
90 Etambutol 500 mg Tablet -
91 Etanol 70 % Botol -
92 Etil Klorida Semprot Botol -
93 Fenitoin Natrium kapsul 30 mg Kapsul -
94 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul -
95 Fenobarbital tablet 30 mg Tablet 101 100
96 Fenoksimetil Penisilina tablet 250 mg Tablet -
97 Fenol Gliserol tetes telinga 10 % Botol 24
98 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul -
99 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 300
100 Flufenazine Deconat Inj 25 mg/ml Ampul 7
101 Furosemida tablet 40 mg Tablet 230
102 Furosemide Injeksi Ampul -
103 Garam Oralit Sachet 200
104 Gemfibrozil 300 mg Tablet -
105 Gentamicin Injeksi Ampul -
106 Gentamicin Salep Kulit Tube -
107 Gentamicin Salep mata Tube -
108 Gentamicin Tetes Mata Botol 24 24
109 Gentian Violet 1 % Botol -
110 Glibenclamid tablet 5 mg Tablet 200
111 Glicerin Guaiacolat ( GG ) 100 mg Tablet -
112 Glikazid 80 mg Tablet Tablet -
113 Glimepiride 2 mg Tablet 600
114 Glukosa larutan infus 10% steril Botol -
115 Glukosa larutan infus 5 % steril Botol -
116 Griseofulvin tablet 125mg Tablet -
117 Griseofulvin tablet 500 mg, Tablet 200
118 Guaiafenesin 100 mg Tablet -
119 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 500
120 Hidrokortison krim 2,5% Tube -
121 Ibuprofen Suspensi Tablet -
122 Ibuprofen tablet 200 mg Tablet -
123 Ibuprofen tablet 400 mg Tablet -
124 Imunomodulator sirup( STIMUNO) Botol -
125 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 180 100
126 Kalsium Glukonas Injeksi Ampul 72
127 Kalsium Laktat (Kalk) tablet 500 mg Tablet -
128 Kapas Berlemak 500 mg Bungkus -
129 Ketokonazol Kream Tube -
130 Ketokonazol Tablet 200 mg Tablet 100
131 Ketorolac inj Ampul 140 100
132 Kifadene tablet 20 mg Tablet -
133 Kloramfenikol salep kulit Tube 72 24
134 Kloramfenikol salep mata 1 % capsul -
135 Kloramfenikol suspensi Botol 50
136 Kloramfenikol tetes telinga 3% Tube -
137 Kloramphenicol 250 mg Kapsul -
138 Kloramphenicol 500 mg Kapsul 200
139 Kloramphenicol Tetes Mata Botol -
140 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 1,700 2,000
141 Klorokuin tablet 150 mg Tablet -
142 Klorpromazin HCL tablet salut 25 mg Tablet -
143 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet -
144 Kotrimoksazol Dewasa Tablet 480 mg Tablet 1,100 500
145 Kotrimoksazol Sirup / Suspensi Botol 128
146 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul -
147 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol -
148 Lactobacilus serbuk Sachet -
149 Lidocain 2%+efinefrin injeksi Ampul 140 60
150 Lidocain injeksi 2 ml Ampul 80 100
151 Lisinopril 10 mg tablet Tablet -
152 Lisinopril 5 mg tablet Tablet -
153 Loperamid 4 mg tablet Tablet -
154 Lytacur Sirup Botol -
155 Magnesium Sulfat Inj. 25 ml Ampul -
156 Magnesium Sulfat inj 40% 25ml Ampul -
157 Metamizol 500 mg Tablet -
158 Metformin 500 mg Tablet Tablet 200
159 Methilprednisolon tablet 8 mg Tablet -
160 Metilergometrin Maleat injeksi 1 ml Ampul
161 Metilergometrin Maleat Tablet Tablet 90
162 Metoklopramid Suspensi Botol -
163 Metoklopramid tablet Tablet -
164 Metronidazol 500 mg Tablet -
165 Metronidazol infus / injeksi Botol -
166 Metronidazol Ovula supp -
167 Metronidazol suspensi Botol -
168 Mikonazol kream Tube 19
169 Multivitamin Anak Sirup Botol 171
170 Multivitamin Anak Sirup / Stimuno Syr (BANKEU) Botol 94
171 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet -
172 Multivitamin Dewasa (HB Vit) Box 27
173 Multivitamin Dewasa / OXYVIT (BANKEU) Box 51
174 Natrium Diklofenak 25 mg Tablet Tablet -
175 Natrium Diklofenak 50 mg Tablet Tablet 590
176 Natrium Klorida Cairan Infus ( NaCL ) Botol 80
177 Nifedipine Tablet 10 mg Tablet -
178 Nistatin tablet vaginal 100.000 IU/g Tube 205
179 Obat anti Diare suspensi Botol -
180 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 1,150
181 Obat Batuk Flu ( Molexflu ) Tablet 17
182 Obat Batuk Hitam (OBH) Botol -
183 Obat Batuk Sirup Herbal ( Herbacop ) Botol 163
184 Ofloxsacin Tetes Telinga Tube -
185 Oksitetrasiklin HCL salep mata 1% Botol 475
186 Oksitosin injeksi 10 IU/ml - 1 ml Ampul -
187 Omeprazol injeksi Ampul -
188 Omeprazol Kapsul 20 mg capsul -
189 Ondancentron injeksi 4 mg Ampul -
190 Ondancentron Tablet4 mg Tablet 450
191 Paracetamol Drop 15 ml Botol 120
192 Paracetamol Sirup 120 mg/5 ml Botol 365
193 Parafin Dresing ( Bioplacenton Tull ) pcs -
194 Parasetamol tablet 100 mg Tablet -
195 Parasetamol tablet 500 mg Tablet 14,500 5,000
196 Permetrin Krim 5 % Tube -
197 Pirantel Sirup Botol -
198 Pirantel tablet 125 mg Tablet -
199 Pirazinamid Botol -
200 Piridoksin HCL (VIT B6) tablet 10mg Botol 3,900 1,000
201 Piroksikam tablet 20 mg Tablet -
202 Polikresulen Tube -
203 Povidon lodida 10% 300 ml Botol -
204 Povidon lodida 10% 60 ml Botol -
205 Prazikuantel tablet 600 mg Tablet -
206 Prednison Tablet 5 mg Tablet 800
207 Primakuin 15 mg Tablet -
208 Probenesid 500 mg tablet Tablet -
209 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul -
210 Propanolol HCL tablet 10 mg Tablet -
211 Ranitidin injeksi Ampul 200 300
212 Ranitidin tablet Tablet -
213 Resperidone 2 mg tablet Tablet -
214 Ringer Laktat cairan infus (Otsuka) Botol -
215 Ringer Laktat cairan infus (Widatra) Botol -
216 Ringer Laktat (2020) Botol 80
217 Salbutamol Tablet 2 mg Tablet 750
218 Salbutamol tablet 4mg Tablet -
219 Salep 2-4 Tube -
220 Salep kombinasi cream ( Berloson ) Tube -
221 Salicil bedak Kotak -
222 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial - 5
223 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial -
224 Sianokobalamin Injeksi Ampul -
225 Simvastatin 10 mg tablet Tablet -
226 Simvastatin 20 mg tablet Tablet 700
227 Sukralfat Suspensi Botol -
228 Sukralfat tablet 500 mg Tablet -
229 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube -
230 Temporary Stopping Fletcher serbuk & cairan Tablet -
231 Tetrakain HCL tetes mata 0,5% Tube -
232 Tetrasiklin 250 mg capsul capsul -
233 Tetrasiklin 500 mg capsul capsul -
234 Tiamin Tablet 50 mg ( B1 ) Tablet 400 500
235 Ventolin Nebulizer Ampul -
236 Vitamin B komplek Tablet 2,650
237 Vitamin B komplek (BTT PROV) Tablet 3,000
238 Zink sirup Botol 18
239 Zink tablet 20 mg Tablet 1,530

OBAT PROGRAM
1 Albendazol Tablet 400 mg Tablet 6,720
2 Isoniazid Tablet 100 mg Tablet -
3 Obat Antituberkulosis kategori 1 Paket 7
4 Obat Antituberkulosis Kategori 2 Paket 2
5 Obat Antituberkulosis Kategori Anak Paket 1
6 Pot Dahak Non Steril Biji -
7 Pot Dahak Steril Biji -
8 Reagen Ziehl Neelsen Kit -
9 MDT MB Anak Tablet Tablet -
10 MDT MB Dewasa Tablet Tablet 3
11 MDT PB Dewasa Tablet Tablet -
12 MDT PB Anak Tablet Tablet -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul -
15 Tablet Penambah Darah ( FE ) Tablet 120,960
16 Amitriptilin tablet 25 mg Tablet 150
17 Carbamazepin 200 mg tablet Tablet -
18 Clobazam 10 mg Tablet Tablet 239
19 Clozapine 25 mg Tablet Tablet -
20 Fenitoin Natrium kapsul 30 mg capsul -
21 Haloperidol 1,5 mg Tablet Tablet -
22 Haloperidol 2 mg tablet Tablet 1,070
23 Haloperidol 5 mg Tablet Tablet 883
24 Haloperidol Injeksi Ampul 15
25 INH 100mg Tablet 100
26 Klorpromazin HCL tablet salut 100 mg Tablet 845
27 Klorpromazine Tablet 25 mg Tablet -
28 Triheksilfenidil Hcl 2 mg tablet Tablet 1,005
29 Dehydro Artemisin 40mg + Piperaquin 320mg (DHP) Tablet -
30 Risperidone 2mg Tablet -
B NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
1 Alat Semprot (Pompa Spray) Unit 1
2 Alat Semprot Punggung Elektrik (BANKEU) Unit 1
3 Alat suntik 1 ml Pcs 144
4 Alat suntik 10 ml Pcs -
5 Alat suntik 2,5 ml Pcs -
6 Alat suntik 20 ml Pcs -
7 Alat suntik 3 cc (Remedi) Pcs -
8 Alat suntik 3 ml Pcs 500
9 Alat suntik 3 cc (Program) Box 9
10 Alat suntik 5 ml pcs 380
11 Alkazide 1 L High Level Desinfectant Botol 2
12 Alkazyme Sachet 25 mg Pack 2
13 Alkohol 70 % 1 L Botol -
14 Alkohol swab Sachet 12
15 Alkohol swab (Vaksin Covid-19) Buah 388
16 Anti Septik Hand Rub Botol -
17 Anti Septik Surgikal Hand Scrub Botol -
18 APD MEDIS SET (BANKEU2) Set -
19 APD MEDIS SET (BANKEU) Set -
20 APD (HAZMAT) Pcs 58
21 Cat Gut no 2/0 Sachet -
22 Cat Gut no 3/0 Sachet -
23 Cat Gut No 3/0 (24 mm) Sachet -
24 Cat Gut No 3/0 (26 mm) Sachet -
25 Cathetter Jelly Biji -
26 Demetech Silk 3/0 Set -
27 Desinfectan Stericide 5L (BANKEU) Galon 2
28 Desinfectan Stericide 5L (BANKEU2) Galon -
29 E Care I.V Dresing Pcs 285
30 E-Care Surgical Mask Tie On Lembar -
31 Face Drager (COVID) Pcs 3
32 Face Drager (BANKEU) Unit 3
33 Face Shielld (BANKEU2) Pcs 40
34 Folly No 14 Catether pcs -
35 Folly No 16 Catether pcs -
36 Forehead Thermometer Microlife (DID) Unit 1
37 Handsanitizer 5L (BANKEU) Galon 6
38 Hazmat Protect U Coverall (BANKEU) Pcs 150
39 I.V Cathetter No. 20 Set 150
40 I.V Cathetter No. 22 Set 200
41 I.V Cathetter No. 24 Set 150
42 I.V Cathetter No. 26 Set -
43 Infuset Anak Set 248
44 Infuset Dewasa Set 309
45 Jarum Insulin Tablet -
46 Kantong Jenazah (CSR BJB) Buah 3
47 Kantong Jenazah (BANKEU) Buah 5
48 Kapas Berlemak 250 gr Bungkus 7
49 Kapas Berlemak 500 gr Bungkus -
50 Kasa 4 m x 10 cm Rol -
51 Kasa 3 m x 15 cm Rol 290
52 Kasa Hidrofil 36 x 80 cm Rol -
53 Kasa Pembalut 2 x 80 cm Pack 43
54 Kasa Steril 16 x 16 cm Kotak 40
55 Lisol 1 L Botol -
56 Masker Bedah 3ply (BANKEU) Box -
57 Masker KN95 (PROV) Pcs 100
58 Masker N95 (CSR BJB) Pcs 20
59 Masker N95 (BANKEU) Pcs 34
60 Masker N95 (PROV) Pcs 180
61 Masker karet Ear Loop Lembar -
62 Masker tali Tube -
63 Masker Hijab Box -
64 Masker N95 Buah -
65 Nasal Canula Oksigen Set -
66 Plester 1" Rol -
67 Plester Kertas 2,5 cm Rol -
68 Plester Kertas 1,25 cm x 9,14 cm Rol 69
69 Plester Non Woven 5cm x 5 cm Rol -
70 Policlean Botol 14
71 Polifik Kotak -
72 Rapid Test (BANKEU) Box -
73 Rapid Antigen (Kemenkes) Test -
74 Saraya Alsof A 500 ml Botol -
75 Saraya Alsof Pure 500 ml Botol -
76 Sarung Tangan Gynecolog No 7 Pasang 43
77 Sarung Tangan Gynecolog No 7 (BANKEU) Pasang 50
78 Sarung tangan M (Non Steril) Pasang -
79 Sarung tangan no 6,5 Pasang -
80 Sarung tangan no 6,5 Steril Gloves Pasang -
81 Sarung tangan no 6,5 Steril (BANKEU) Pasang -
82 Sarung tangan no 7,0 Steril Pasang 250 200
83 Sarung tangan Steril Panjang (CSR BJB) Pasang 10
84 Sepatu Boots (CSR BJB) Pasang 11
85 Silk Black 3/0 26mm Sachet 12 60
86 Underpad Lembar 90
87 Urine Bag Biji -

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial -

2 Vaksin BCG Vial 29
3 Vaksin DT Vial 62
4 Vaksin HB 0 Pcs 50
5 Vaksin HBIG Vial -
6 Vaksin Measless Rubella (MR) Vial 2
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 26
8 Vaksin Polio B OPV Vial 17
9 Vaksin Polio IPV Vial 41
10 Vaksin TD Vial 18
11 Vaksin Tuberculin Vial -
12 Vaksin Covid-19 Vial 46
13 ADS 0,005 ml Unit 112
14 ADS 0,5 ml Unit 470
15 ADS 5 ml Unit 281
16 Safety Box Unit 3
17 ADS 0,5 ML (COVID) Pcs

NAMA OBAT REAGEN

1 Albumin (Reagen) Kotak -

2 anti A Monoclonal ( GolDar 10 ml) Vial -
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial -
4 Anti B Monoclonal ( GolDar 10ml) Vial -
5 Anti D Monoclonal ( GolGar 10ml) Vial -
6 Benecheck Plus Cholesterol Test Strip -
7 Benecheck Plus Glukosa Test Strip -
8 Benecheck Plus Uric Test Strip -
9 Bilirubin T/D (Reagen) Kotak -
10 Brilian Green Bile Broth Kotak -
11 Cellclean (CL-50) (Reagen) Kotak -
12 Cellpack (PK-30L) (Reagen) Kotak -
13 Chikungunya IgM (Reagen) Kotak -
14 Cholesterol (Reagen) Kotak -
15 Cholesterol Stik (Reagen) Kotak -
16 CK-MB (Reagen) Kotak -
17 Creatinin Reagen Kit -
18 Dengue IgM / IgM ( Reagen ) Kotak -
19 Eight Check ( LNH ) Serial -
20 Febrile Antingen H Parathpy Vial -
21 Febrile Antingen H-A Parathpy Vial -
22 Febrile Antingen H-B Parathpy Vial -
23 Febrile Antingen H-C Parathpy Vial -
24 Febrile Antingen O Parathpy Vial -
25 Febrile Antingen O-A Parathpy Vial -
26 Febrile Antingen O-B Parathpy Vial -
27 Febrile Antingen O-C Parathpy Vial -
28 Glukosa Reagen Kotak -
29 GOT ( ALAT ) Kotak -
30 GPT ( ALAT ) Kotak -
31 HBSAG Reagen Box -
32 HCG Strip Vial -
33 HDL Cholesterol ( Precipitan ) Kotak -
34 Hematologi Calibrator (Nscs 1000 ) Botol -
35 Hemoglobin Reagen Kotak -
36 Lactose Broth 500 mg Botol -
37 LDL Cholesterol Kotak -
38 Leptospira IgM (Reagen) Kotak -
39 Micropippets MT-1-up to 200 ui Pcs -
40 MIcropippets MT-up to 1 ml Pcs -
41 NS1 Antigen Test (Reagen) Kotak -
42 Pipet Ukur 10 ml biji -
43 Poch Pack D (II) Reagen Kotak -
44 Poch Pack L (II) Reagen Kotak -
45 Stik Uric Acid Kotak -
46 Strip Narkoba 3 Parameter Kotak -
47 Strip Narkoba 5 Parameter Kotak -
48 Strip Narkoba 6 Parameter Kotak -
49 Total Protein Kotak -
50 Trigleserida Kotak -
51 Urea Kotak -
52 Uric Acid Kotak -
53 Rapid Tes Sypillis Buah -

NAMA OBAT REAGEN PROGRAM HIV

1 Alkohol Swab (Program) Box 9
2 Biolarvasida Botol 15
3 Microlite White Bungkus 9
4 Object Glass (2020) Box 35
5 Pot Dahak Sample Container Steril Buah 1,000
6 Reagen Ziehl Neelsen (2020) Kit 40
7 Rapid 1 HIV (SD Bioline ) Tes 650
8 Rapid 2 HIV (Fokus ) Tes -
9 Rapid 2 HIV Lot. 401190912 (KHB) Tes 50
10 Rapid 3 HIV (Biomeriux Vikia ) Tes -
11 Rapid 3 HIV (Diagnostar) Tes 50
12 Rapid HIV Siphilys Duo Box 36
13 Rapid Syphilis (Trepocheck) Tes 500
14 SD Biosensore Standart Q Syphlis Tes -
15 RDT DBD Tes 15
16 RPR Syphlis ( Fokus ) Tes -
17 Reagen CD4 Control Tes -
18 Reagen CD4 Mobile Tes -
19 RPR Syphlis Komponen Kit -
20 Anuscopy Buah 1
21 Kertas PH Indikator Buah -
22 Rotator Buah -
23 Tip. Uk.60 Bks -
24 Tip. Uk.61 Bks -
25 Pronto / Holder Buah -
26 Alkohol Swab Box -
27 Safety Box Buah -
28 Flashback Blood Buah -
29 BD Vaccutaines Tube Buah -
30 Rapid Hbsag Tes -
NAMA OBAT GIGI

1 Anastesi Citojek Box -

2 Articulating Paper (Kertas warna penanda oklusi) Kotak -
3 Bahan Tumpatan sementara Botol -
4 Bonding Syringe 2
5 Cairan Desinfectan ( Perendaman Instrumen Gigi ) Botol -
6 Cairan untuk desinfectan pembersih permukaan Botol -
7 Carpule Citojek Kotak 4
8 Chlorfeson Kamfer menthol ( CHKM ) Cairan Botol -
9 Composite Nanohibrid A1 Tube 1
10 Composite Nanohibrid A2 Tube -
11 Composite Nanohibrid A3 Tube -
12 Composite Nanohibrid A3,5 Tube -
13 Devitalisasi Pasta Pot -
14 Devitalisasi Pulpa Pak 1
15 Disclosing Solution Botol -
16 Etcing Gel Pcs -
17 Etil Klorida Semprot Botol -
18 Endomethason Pak 2
19 Eugenol Cairan Botol -
20 Formokesol Botol -
21 Gas Powred Jet Injector Botol 12
22 Glass Ionomer Cement ART Pot -
23 Glass Ionomer Cement Fuji 9 Pak 2
24 Jarum citojek uk 16 mm Box -
25 Kalsium Hidroksida pasta Botol -
26 Klorhekdidin Larutan 2 % Botol -
27 Mummifiying Fasta Botol -
28 Natrium Hipoklorit airan konsentrat 5% Botol -
29 Paper Points 15-40 mm Box -
30 Pasta Devitalisasi ( Non Arsen ) Tube -
31 Pasta Pengisi Saluran Akar Syringe -
32 Semen seng Fosfat serbuk Set -
33 Spon Gelatin Cubicis 1x1x1 cm (Spongostan) Botol -
34 Temporary Filling Fasta Set -
35 Temporary Restorative Hydraulic CAVITON White Pak 2
36 Tooth Stain Remover ( TSR ) Botol -
37 Wipes Desinfektan Botol -
KAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN
DINKES KAB/KOTA
AN / PERIODE : APRIL 2021 GFK KAB/KOTA
PUSKESMAS

Penerimaan
Jumlah Jumlah
APBD PROG LAIN 2 Penerimaan Persediaan

5 6
( 4+5 ) 1 2 3 4 5 6
- -
- -
- 700
- -
- -
- -
- -
900 1,770
600 1,680
- -
- -
- 12,700
- -
100 473
- -
- -
- -
- -
- -
- 115
1,000 11,400
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 7,640
- 3,350
- 140
- 800
- -
 - -
- 3,920
- 35
200 280
- -
- 6,660 120
- -
- -
- 350
- 50
- -
- -
- -
- 10
- -
- -
- -
- -
- -
- -
- -
- 450
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 5,950
- 15
- -
- -
- -
- 24
- 12
- -
- 106
- 19
- -
- -
- 100
- 340
- 80
- -
 - -
- 75
- -
- 400
- -
- -
- -
- -
- -
- -
- -
100 201
- -
- 24
- -
- 300
- 7
- 230
- -
- 200
- -
- -
- -
- -
24 48
- -
- 200
- -
- -
- 600
- -
- -
- -
- 200
- -
- 500
- -
- -
- -
- -
- -
100 280
- 72
- -
- -
- -
- 100
100 240
 - -
24 96
- -
- 50
- -
- -
- 200
- -
2,000 3,700
- -
- -
- -
500 1,600
- 128
- -
- -
- -
60 200
100 180
- -
- -
- -
- -
- -
- -
- -
- 200
- -
- -
- 90
- -
- -
- -
- -
- -
- -
- 19
- 171
- 94
- -
- 27
- 51
- -
- 590
20 20 100
- -
- 205
- -
 - 1,150
10 10 27
- -
- 163
- -
- 475
- -
- -
- -
- -
- 450
- 120
200 200 565
- -
- -
5,000 19,500
- -
- -
- -
- -
1,000 4,900
- -
- -
- -
- -
- -
- 800
- -
- -
- -
- -
300 500
- -
- -
- -
- -
- 80
- 750
- -
- -
- -
- -
5 5
- -
- -
- -
- 700
- -
 - -
- -
- -
- -
- -
- -
500 900
- -
- 2,650
- 3,000
- 18
- 1,530

- 6,720
- -
- 7
- 2
- 1
- -
- -
- -
- -
- 3
- -
- -
- -
- -
- 120,960
- 150
- -
- 239
- -
- -
- -
- 1,070
- 883
- 15
- 100
- 845
- -
- 1,005
- -
- -
 - 1
- 1
300 300 444
- -
- -
- -
- -
300 300 800
- 9
- 380
- 2
- 2
- -
- 12
- 388
- -
- -
- -
- -
- 58
- -
- -
- -
- -
- -
- -
- 2
- -
- 285
- -
- 3
- 3
- 40
- -
- -
- 1
- 6
- 150
- 150
100 100 300
- 150
- -
- 248
- 309
- -
- 3
- 5
 - 7
- -
- -
- 290
- -
- 43
- 40
- -
20 20 20
- 100
- 20
- 34
- 180
- -
- -
- -
- -
- -
- -
- -
- 69
- -
- 14
- -
- -
- -
- -
- -
- 43
- 50
- -
- -
- -
300 300 300
200 450
- 10
- 11
60 72
- 90
- -

- -
- 29
- 62
- 50
- -
 - 2
- 26
- 17
- 41
- 18
- -
10 10 56
- 112
85 85 555
- 281
1 1 4

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- 9
- 15
- 9
- 35
- 1,000
- 40
- 650
- -
-
- -
- 50
- 36
- 500
- -
- 15
- -
- -
- -
- -
- 1
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- 2
- -
- -
- 4
- -
- 1
- -
- -
- -
- -
- 1
- -
- -
- -
- 2
- -
- -
- 12
- -
- 2
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 2
- -
- -
 DOKUMEN NOMOR TANGGAL
NKES KAB/KOTA
FK KAB/KOTA
USKESMAS

Pemakaian Perhari / Tanggal diloket

7
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

50 100
50 50 50 100

300 200 200 200 200

12 10 35

10
200 300 300 200 200 300 200

300 200 200

200
120 180 240 120

100

200 100
 100

100

30
200 300 200 200 200

100
6 6 9

100

5 5 5 5
2

100 100
 1

4 8 10

30 60

50 15 13 4

200 300 300 300 200 200

200 200 300 200

100 100 100

50 70

20 50
 200 300 200 200 200 200

6
100 10 100
 Pengeluaran Sub Unit

22 23 24 25 26 27 28 29 30 31 UGD PONED IMUN Dll

100

20 100
80 120 240 50 100

200 200 200 200 500

10 5 25

6 7 20
200 200 300 300

200 190
150
 100 70 200
15
260

120 180 120 120 120 180

100

100 100 250

15

8
2

310 30
4
100 200

175

100 200

50
120
 48

200 200 200 300 400

100
10 7

30 30

100

4 16 31
1

50 100
40

1
 200
1 5

6 11

30
6 2
21 100 59 8

200 300 100 200 2000 620

300 200

220

80
200 80

2
 100 100

200 300 200 150

1350

100 60

26460
41

241
856

735

921
320

450

144

388

10

40
65
20

20
79
 1

45

10
40

26

250

1
10

85

1
 Jumlah Stok
Pengeluaran AkhirBulan
8 9
(1+ s.d31 + sub unit) (6-8)
0 0
0 0
100 600
0 0
0 0
0 0
0 0
270 1500
840 840
0 0
0 0
2400 10300
0 0
97 376
0 0
0 0
0 0
0 0
0 0
43 72
2700 8700
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1090 6550
350 3000
0 140
0 800
0 0
 0 0
370 3550
15 20
260 20
0 0
1620 5040
0 0
0 0
0 350
0 50
0 0
0 0
0 0
0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 250
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
750 5200
15 0
0 0
0 0
0 0
8 16
2 10
0 0
9 97
0 19
0 0
0 0
0 100
340 0
4 76
0 0
 0 0
0 75
0 0
400 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
175 26
0 0
0 24
0 0
100 200
2 5
30 200
0 0
0 200
0 0
0 0
0 0
0 0
0 48
0 0
0 200
0 0
0 0
300 300
0 0
0 0
0 0
0 200
0 0
0 500
0 0
0 0
0 0
0 0
0 0
0 280
0 72
0 0
0 0
0 0
50 50
120 120
 0 0
48 48
0 0
0 50
0 0
0 0
0 200
0 0
2400 1300
0 0
0 0
0 0
200 1400
38 90
0 0
0 0
0 0
0 200
60 120
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 0
0 0
0 0
0 90
0 0
0 0
0 0
0 0
0 0
0 0
0 19
71 100
3 91
0 0
0 27
2 49
0 0
350 240
40 60
0 0
1 204
0 0
 200 950
7 20
0 0
39 124
0 0
0 475
0 0
0 0
0 0
0 0
120 330
8 112
270 295
0 0
0 0
4920 14580
0 0
0 0
0 0
0 0
1400 3500
0 0
0 0
0 0
0 0
0 0
300 500
0 0
0 0
0 0
0 0
220 280
0 0
0 0
0 0
0 0
80 0
400 350
0 0
0 0
0 0
0 0
2 3
0 0
0 0
0 0
70 630
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
200 700
0 0
2150 500
1350 1650
6 12
370 1160

0 6720
0 0
5 2
0 2
0 1
0 0
0 0
0 0
0 0
0 3
0 0
0 0
0 0
0 0
26460 94500
41 109
0 0
0 239
0 0
0 0
0 0
241 829
856 27
0 15
0 100
735 110
0 0
921 84
0 0
0 0
 0 1
0 1
320 124
0 0
0 0
0 0
0 0
450 350
0 9
144 236
0 2
0 2
0 0
0 12
388 0
0 0
0 0
0 0
0 0
10 48
0 0
0 0
0 0
0 0
0 0
0 0
0 2
0 0
0 285
0 0
0 3
0 3
0 40
0 0
0 0
0 1
0 6
0 150
40 110
65 235
20 130
0 0
20 228
79 230
0 0
0 3
0 5
 1 6
0 0
0 0
45 245
0 0
10 33
40 0
0 0
3 17
0 100
0 20
0 34
0 180
0 0
0 0
0 0
0 0
0 0
0 0
0 0
26 43
0 0
0 14
0 0
0 0
0 0
0 0
0 0
0 43
0 50
0 0
0 0
0 0
250 50
0 450
1 9
0 11
0 72
0 90
0 0

0 0
0 29
0 62
0 50
0 0
 0 2
0 26
0 17
0 41
0 18
0 0
10 46
0 112
85 470
0 281
1 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
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 9
0 15
0 9
0 35
0 1000
0 40
0 650
0 0
0 0
0 0
0 50
0 36
0 500
0 0
0 15
0 0
0 0
0 0
0 0
0 1
0 0
0 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 4
0 0
0 1
0 0
0 0
0 0
0 0
0 1
0 0
0 0
0 0
0 2
0 0
0 0
0 12
0 0
0 2
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