LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )

PUSKESMAS
PUSKESMAS : CIBITUNG DOKUMEN NOMOR TANGGAL
KECAMATAN : CIBITUNG DINKES KAB/KOTA
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : APRIL 2019 GFK KAB/KOTA
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : MEI 2019 PUSKESMAS 4/2/2019

PEMBERIAN
Jumlah Stok Stok Jumlah
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian JUMLAH
Persediaan Akhir Optimum Permintaan DAU/A JKN PROG
BUFFER LAIN
PBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
( 4+5 ) (6-7)
1 Albendazol Tablet 400 mg Tablet 0 0 0 0 0 0 0
2 Alkacid 1 L High Leve Desinfectant Botol 2 0 2 0 2 0 0
3 Alkazyme Sachet 25 mg Botol 2 0 2 0 2 0 0
4 Allopurinol tablet 100 mg Tablet 500 0 500 500 0 0 2000
5 Alprazolam 1 mg Tablet 0 0 0 0 0 0 0
6 Ambroxol tablet 30 mg Tablet 0 0 0 0 0 0 1000
7 Ambroxol sirup Botol 0 0 0 0 0 0 400
8 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 0 0 0 0 0 0 0
9 Aminofilin Tablet 200 mg Tablet 0 0 0 0 0 0 0
10 Amitriptilin HCL Tablet 25 mg Tablet 0 0 0 0 0 0 0
11 Amoksisilin 500 mg tablet Tablet 1500 5000 6500 5500 1000 0 5000
12 Amoksisillin Sirup Kering 125 mg/5 ml Botol 0 0 0 0 0 0 0
13 Amoksisilin Forte sirup kering 250mg Botol 275 600 875 575 300 0 0
14 Amoksisilin Injeksi 1 gr Vial 0 0 0 0 0 0 0
15 Amlodipin 5 mg Tablet 300 600 900 720 80 0 500
16 Amlodipin 10 mg Tablet 200 600 800 690 110 0 500
17 Analog insulin Long Acting Pen 0 0 0 0 0 0 0
18 Analog insulin Mix Acting Pen 0 0 0 0 0 0 0
19 Antalgin (Metampiron) tablet 500 mg Tablet 0 0 0 0 0 0 2000
20 Anti Fungi DOEN Pot 0 0 0 0 0 0 0
21 Anti Bakteri DOEN salep kombinasi : Tube 35 100 135 125 10 0 100
22 Antasida DOEN suspensi Botol 120 500 620 350 270 0 0
23 ANTASIDA DOEN Tablet Tablet 1500 4000 5500 4600 900 0 4000
24 Antiparkinson Tablet ( Levopar ) Tablet 0 0 0 0 0 0 0
25 Anti Septik Hand Rub Botol 0 0 0 0 0 0 0
26 Anti Septik Surgikal Hand Scrub Botol 0 0 0 0 0 0 0
27 Anti hemoroid doen kombinasi supp 0 0 0 0 0 0 0
28 Antimigren DOEN Kombinasi : Tablet 0 0 0 0 0 0 0
29 Antiparkinson DOEN tablet Kombinasi : Tablet 0 0 0 0 0 0 0
30 Ampisilin Injeksi 1 gr Vial 0 0 0 0 0 0 0
31 Aqua Pro Injeksi Vial 0 0 0 0 0 0 0
32 Asering Botol 0 0 0 0 0 0 0
33 Asam Askorbat tablet 50 mg Tablet 300 1000 1300 1200 100 0 1000
34 Asam Fusidat Cream Tube 0 0 0 0 0 0 100
35 Asam Traneksamat Inj 5% Ampul 0 0 0 0 0 0 0
36 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0 0
37 Artermeter injeksi Ampul 0 0 0 0 0 0 0
38 Artesunate injeksi 60 mg/ml vial 0 0 0 0 0 0 0
39 Asam Folat Tablet 0 0 0 0 0 0 1000
40 Asetyl Cysteine Kapsul 390 2640 3030 2370 300 0 2460
41 Asam Asetil Salicilat 100 mg tablet Tablet 0 0 0 0 0 0
42 Asam Asetil Salicilat 80 mg tablet Tablet 0 0 0 0 0 0 0
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 0 0 0 0 0 0 0
44 Asiklovir tablet 200 mg Tablet 0 0 0 0 0 0 500
45 Asiklovir tablet 400 mg Tablet 0 0 0 0 0 0 0
46 Asiklovir Cream 5% Tube 5 1 6 6 0 0 100
47 Atropin Sulfat tablet 0,5 mg Tablet 0 0 0 0 0 0 0
48 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial 0 0 0 0 0 0 0
49 Aximed Foleycath no 16 Set 5 50 55 50 5 0 50
50 Berotek Mereted Aerosol 100 mg Bok 0 0 0 0 0 0 0
51 Betadine Salep Antiseptik 5 mg Tube 16 0 16 16 0 0 96
52 Betametason krim 0,1 % Tube 25 20 45 45 0 0 100
53 Catgut / Benang Bedah No.2/0 Tablet 0 0 0 0 0 0 0
54 Catgut / Benang Bedah No.3/0 Tablet 100 36 136 36 100 0 10
55 Bisakodil Suppositoria supp 0 0 0 0 0 0 0
56 Bisoprolol 2,5 MG Tablet 0 0 0 0 0 0 0
57 Bisoprolol 5 MG Tablet 0 0 0 0 0 0 0
58 Cairan Pembersih ( Protektor ) Botol 0 0 0 0 0 0 0
59 Captopril Tablet 25 mg Tablet 0 0 0 0 0 0 500
60 Captopril Tablet 12,5 mg Tablet 150 500 650 600 50 0 500
61 Carbamazepin 200 mg tablet Tablet 0 0 0 0 0 0 0
62 Cefadroxil Capsul 500 mg Capsul 0 0 0 0 0 0 2000
63 Cefixime Capsul 100 mg Capsul 0 0 0 0 0 0 500
64 Cefixime Sirup Botol 0 0 0 0 0 0 100
65 Cefotaksime 1 gr Injeksi Vial 0 0 0 0 0 0 0
66 Cetirizine sirup 5 mg/5 ml Botol 0 0 0 0 0 0 100
67 Ciprofloxcacin 500 mg tablet Tablet 150 500 650 600 50 0 500
68 Clobazam 10 mg Tablet Tablet 0 0 0 0 0 0 0
69 Clozapine 25 mg Tablet Tablet 0 0 0 0 0 0 0
70 Combivent UDV 2,5 mg + 0,5 mg / 2,5 ml Vial 0 0 0 0 0 0 5
71 D-Artepp tablet Tablet 0 0 0 0 0 0 0
72 Deksametason tablet 0,5 mg Tablet 1000 5000 6000 5000 1000 0 5000
73 Deksametason injeksi 1 ml Ampul 15 50 65 35 30 0 0
74 Doxicyclin 500mg capsul 0 0 0 0 0 0 0
75 Dekstrometorfan tablet 15 mg Tablet 0 0 0 0 0 0 0
76 Dekstrometorfan sirup Botol 0 0 0 0 0 0 0
77 Diazepam Rektal 0,5 mg supp 0 0 0 0 0 0 0
78 Diazepam tablet 2 mg Tablet 0 0 0 0 0 0 0
79 Diazepam injeksi 2 ml Ampul 0 0 0 0 0 0 0
80 Diazepam tablet 5 mg Tablet 40 0 40 10 30 0 0
81 Diazepam Larutan Rektal 2 mg/ml Tube 0 0 0 0 0 0 0
82 Diltiazem Tablet 0 0 0 0 0 0 0
83 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul 20 120 140 120 20 0 120
84 Digoksin tablet 0,25 mg Tablet 0 0 0 0 0 0 0
85 Efedrin HCL tablet 25 mg Tablet 0 0 0 0 0 0 0
86 Domperidon 10mg Tablet Tablet 0 0 0 0 0 0 500
Dextral syrup Botol 0 180 180 90 90 0 0
87 Ekstrak Belladona tablet 10 mg Tablet 0 0 0 0 0 0 0
88 Epinefrina HCL/Bitartrat Injeksi Ampul 0 0 0 0 0 0 0
89 Etakridin ( Rivanol ) larutan 0,1% Botol 0 0 0 0 0 0 2
90 Etambutol 500 mg Tablet 0 0 0 0 0 0 0
91 Etanol 70 % Botol 0 0 0 0 0 0 4
92 EritroMICYN kapsul 250 mg capsul 0 0 0 0 0 0 0
93 Erytromicin sirup 125 mg Botol 0 0 0 0 0 0 0
94 Erytromicin kapsul 500 mg Kapsul 0 0 0 0 0 0 0
95 Etil Klorida Semprot Botol 0 0 0 0 0 0 0
96 Fenitoin Natrium kapsul 30 mg Kapsul 0 0 0 0 0 0 0
97 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul 0 0 0 0 0 0 0
98 Fenobarbital Tablet 30 mg Tablet 0 0 0 0 0 0 0
99 Fenoksimetil Penisilina tablet 250 mg Tablet 0 0 0 0 0 0 0
100 Fenoksimetil Penisilina tablet 500 mg Tablet 0 0 0 0 0 0 0
101 Fenol Gliserol tetes telinga 10 % Botol 0 48 48 48 0 0 0
102 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul 24 0 24 24 0 0 40
103 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 0 0 0 0 0 0 500
104 Flufenazine decanoat inj 25mg/ml Ampul 0 0 0 0 0 0 0
105 Fluor tablet 0,5 mg Tablet 0 0 0 0 0 0 0
106 Furosemida tablet 40 mg Tablet 0 0 0 0 0 0 600
107 Glimepiride 2 mg Tablet 0 0 0 0 0 0 500
108 Glimepiride 4 mg Tablet 0 0 0 0 0 0 0
109 Garam Oralit Sachet 100 500 600 500 100 0 500
110 Glibenclamid tablet 5 mg Tablet 0 0 0 0 0 0 0
111 Gentamicin Salep Kulit Tube 0 0 0 0 0 0 100
112 Gentamicin Salep mata Tube 0 0 0 0 0 0 0
113 Gentamicin tetes mata Botol 48 48 96 96 96 0 96
114 Glicerin Guaiacolat ( GG ) 100 mg Tablet 0 0 0 0 0 0 0
115 Griseofulvin tablet 500 mg, Tablet 0 0 0 0 0 0 500
116 Griseofulvin tablet 250 mg, Tablet 0 0 0 0 0 0 0
117 Griseofulvin tablet 125 mg, Tablet 150 500 650 600 50 0 500
118 Guaifenesin 100 mg Tablet 0 0 0 0 0 0 3000
119 Hidroklorotiazid (HCT) tab. 25 mg Tablet 0 0 0 0 0 0 0
120 Gemfibrozil Tablet 0 0 0 0 0 0 0
121 Glukosa larutan infus 10% steril Botol 0 0 0 0 0 0 0
122 Glukosa larutan infus 5 % steril Botol 0 0 0 0 0 0 0
123 Gentamisin Injeksi Vial 0 0 0 0 0 0 0
124 Haloperidol 0,5 mg tablet Tablet 0 0 0 0 0 0 0
125 Glikazid 80 mg Tablet Tablet 0 0 0 0 0 0 0
126 Haloperidol 5 mg Tablet Tablet 0 0 0 0 0 0 0
127 Haloperidol 2 mg tablet Tablet 0 0 0 0 0 0 0
128 Haloperidol Inj. Ampul 0 0 0 0 0 0 0
129 Hidrokortison krim 2,5% Tube 0 0 0 0 0 0 96
130 Ibuprofen tablet 200 mg Tablet 0 0 0 0 0 0 500
131 Ibuprofen tablet 400 mg Tablet 0 0 0 0 0 0 0
132 Ibuprofen Suspensi Tablet 0 0 0 0 0 0 100
133 Isoniazid (INH) 100 mg tab. Tablet 0 0 0 0 0 0 0
134 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 500 0 500 0 500 0 0
135 Jarum Jahit (Bedah) No. 9 s/d 14 Biji 0 0 0 0 0 0 0
136 Imunomodulator sirup( STIMUNO) Botol 0 0 0 0 0 0 100
137 Kalsium Laktat (Kalk) tablet 500 mg Tablet 0 2000 2000 1800 200 0 2000
138 Ketorolac inj Ampul 70 0 70 20 50 0 0
139 Kalsium Glukonas Injeksi Ampul 0 0 0 0 0 0 0
140 Karbogliserin Tetes telinga Botol 0 0 0 0 0 0 48
141 Kloramphenicol 500 mg capsul 0 0 0 0 0 0 500
142 Kloramphenicol 250 mg Kapsul 100 500 600 540 60 0 500
143 Kaen 3 B cairan infus Botol 0 0 0 0 0 0 0
144 Kloramfenikol salep mata 1 % Tube 0 0 0 0 0 0 96
145 Kloramfenikol tetes telinga 3% Tube 0 0 0 0 0 0 0
146 Kloramfenikol salep kulit Tube 0 96 96 76 20 0 96
147 Kloramfenikol Tetes mata Botol 0 0 0 0 0 0 96
148 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 1000 5000 6000 5000 1000 0 5000
149 Klorokuin tablet 150 mg Tablet 0 0 0 0 0 0 0
150 Kloramfenikol suspensi Botol 0 0 0 0 0 0 50
151 Ketokonazol Kream Tube 0 0 0 0 0 0 50
152 Ketokonazol Tablet 200 mg Tablet 50 200 250 200 50 0 200
153 Klorpromazin HCL tablet salut 25 mg Tablet 0 0 0 0 0 0 0
154 Klorpromazin HCL tablet salut 100 mg Tablet 0 0 0 0 0 0 0
155 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul 0 0 0 0 0 0 0
156 Kifadene tablet 20 mg Tablet 0 0 0 0 0 0 1000
157 Kotrimoksazol Dewasa Tablet 480 MG Tablet 200 1000 1200 1100 100 0 1000
158 Kotrimoksazol Suspensi Botol 0 0 0 0 0 0 300
159 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol 0 0 0 0 0 0 0
160 Lactobacilus serbuk Sachet 0 0 0 0 0 0 0
161 Lidocain injeksi 2 ml Ampul 50 100 150 50 100 0 0
162 Lidocain 2%+efinefrin injeksi Ampul 0 0 0 0 0 0 0
163 Lisinopril 5 mg tablet Tablet 0 0 0 0 0 0 0
164 Lisinopril 10 mg tablet Tablet 0 0 0 0 0 0 0
165 Loperamid 2 mg tablet Tablet 200 1000 1200 1000 200 0 1000
166 Magnesium Sulfat injeksi 25 ml Vial 18 0 18 0 18 0 0
167 Mebendazol Sirup 100 mg/5 ml Vial 0 0 0 0 0 0 0
168 MDT MB Anak Tablet Tablet 0 0 0 0 0 0 0
169 MDT MB Dewasa Tablet Tablet 0 0 0 0 0 0 0
170 MDT PB Dewasa Tablet Tablet 0 0 0 0 0 0 0
171 MDT PB Anak Tablet Tablet 0 0 0 0 0 0 0
172 Metamizole 500 mg Tablet 300 1000 1300 1000 300 0 1000
173 Metformin 500 mg Tablet Tablet 0 0 0 0 0 0 500
174 Metilergometrin Maleat (Metilergometrin) injeksi 1 ml Ampul 80 100 180 140 40 0 0
175 Metilergometrin tablet Tablet 0 0 0 0 0 0 0
176 Metronidazol infus / injeksi Botol 0 0 0 0 0 0 0
177 Metronidazol ovula tab.supp 0 0 0 0 0 0 0
178 Metronidazol 500 mg Tablet 0 0 0 0 0 0 500
179 Metronidazol suspensi Botol 0 0 0 0 0 0 50
180 Methilprednisolon tablet 8 mg Tablet 0 0 0 0 0 0 1000
181 Metoklopramid Sirup Botol 0 60 60 30 30 0 0
182 Metoklopramid tablet Tablet 0 0 0 0 0 0 0
183 Mikonazol kream Tube 0 0 0 0 0 0 50
184 Multivitamin Anak ( Lytakur ) Botol 30 144 174 104 70 0 0
185 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet 400 2000 2400 2200 200 0 2000
186 Multivitamin Dewasa ( Panviton ) Tablet 0 0 0 0 0 0 2000
Molagit Tablet Tablet 0 10 10 7 3 0 0
187 Natrium Klorida Cairan Infus ( NaCl ) Botol 0 40 40 20 20 0 0
188 Natrium Diklofenak 25 mg Tablet Tablet 0 0 0 0 0 0 0
189 Natrium Diklofenak 50 mg Tablet Tablet 0 0 0 0 0 0 0
190 Nistatin tablet vaginal 100.000 IU/g Tube 0 0 0 0 0 0 0
191 Obat Anti tuberkulosis sisipan Paket 0 0 0 0 0 0 0
192 Nifedipine Tablet 10 mg Tablet 0 0 0 0 0 0 0
193 Obat anti Diare suspensi Botol 0 0 0 0 0 0 100
194 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 0 0 0 0 0 0 500
195 Obat Antituberkulosis kategori 2 Paket 0 0 0 0 0 0 0
196 Obat Antituberkulosis kategori 1 Paket 0 0 0 0 0 0 0
197 Obat Antituberkulosis Kategori Anak Paket 0 0 0 0 0 0 0
198 Obat Batuk Flu Kapsul Kapsul 200 0 200 200 0 0 1200
199 Obat Batuk Hitam (OBH) Botol 0 0 0 0 0 0 0
200 Obat Batuk Sirup Herbal ( Herbacop ) Botol 0 0 0 0 0 0 96
201 Ofloxsacin Tetes Telinga Tube 0 0 0 0 0 0 0
202 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 24 100 124 84 40 0 0
203 Oksitetrasiklin HCL salep mata 1% Botol 0 0 0 0 0 0 0
204 Omeprazol injeksi Ampul 0 0 0 0 0 0 20
205 Omeprazol Kapsul 20 mg capsul 200 600 800 500 300 0 600
206 Ondancentron Tablet 4 mg Tablet 0 0 0 0 0 0 120
207 Ondancentron injeksi 4 mg Ampul 0 0 0 0 0 0 10
208 Parafin Dresing ( Bioplacenton Tull ) pcs 0 0 0 0 0 0 0
209 Parasetamol tablet 100 mg Tablet 0 0 0 0 0 0 0
210 Parasetamol tablet 500 mg Tablet 1500 7000 8500 6000 2500 0 6000
211 Paracetamol Sirup 120 mg/5 ml Botol 150 1000 1150 650 500 0 0
212 Paracetamol Drop Botol 12 112 124 64 60 0 0
213 Permetrin Krim 5 % Tube 0 0 0 0 0 0 0
214 Pirantel Sirup Botol 0 0 0 0 0 0 50
215 Pirantel tablet 125 mg Tablet 0 0 0 0 0 0 0
216 Pirazinamid Botol 0 0 0 0 0 0 0
217 Polikresulen Tube 0 0 0 0 0 0 0
218 piridoksin HCL (VIT B6) tablet 10mg Botol 0 0 0 0 0 0 1000
219 Piroksikam tablet 10 mg Tablet 0 0 0 0 0 0 1000
220 Piroksikam tablet 20 mg Tablet 0 0 0 0 0 0 0
221 Plester non woven 5 cm x 5m Rol 2 5 7 5 2 0 3
222 Policlean Handrub Botol 2 3 5 3 2 0 3
223 Polifix 5 cm x 1 m Botol 0 0 0 0 0 0 0
224 Prazikuantel tablet 600 mg Botol 0 0 0 0 0 0 0
225 povidon lodida 10% 300 ml Botol 0 5 5 5 0 0 5
226 povidon lodida 10% 60 ml Tablet 0 0 0 0 0 0 30
227 Prednison Tablet 5 mg Tablet 0 1000 1000 900 100 0 0
228 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul 0 0 0 0 0 0 0
229 Primakuin Tablet 0 0 0 0 0 0 0
230 Propanolol HCL tablet 10 mg Tablet 0 0 0 0 0 0 0
231 Probenesid 500 mg tablet Tablet 0 0 0 0 0 0 0
232 Rivanol 300 ml Botol 0 5 5 3 2 0 0
233 Resperidone 2 mg tablet Tablet 0 0 0 0 0 0 0
234 Reserpin tablet 0,25 mg Tablet 0 0 0 0 0 0 0
235 Ranitidin injeksi Ampul 30 0 30 30 0 0 0
236 Ranitidin tablet Tablet 400 2000 2400 2200 2000 0 2000
237 Retinol (Vitamin A) kapsul 200.000 IU capsul 0 0 0 0 0 0 0
238 Retinol (Vitamin A) kapsul 100.000 IU capsul 0 0 0 0 0 0 0
239 Ringer Laktat cairan infus Botol 20 60 80 46 40 0 0
240 Ringer Laktat cairan infus ( OSTU ) Botol 20 80 100 40 60 0 0
241 Salbutamol tablet 4mg Tablet 0 0 0 0 0 0 500
242 Salbutamol Tablet 2 mg Tablet 30 300 330 300 30 0 300
243 Salbutamol Nebulizer ( Ventolin ) Vial 0 0 0 0 0 0 20
244 Salicil bedak Kotak 0 0 0 0 0 0 50
245 Salep kombinasi Tube 0 0 0 0 0 0 50
246 Saraya Alsof A 500 ml Botol 0 0 0 0 0 0 0
247 Saraya Alsof Pure 500 ml Botol 0 0 0 0 0 0 0
248 Setirizin Tablet 10 mg Tablet 0 0 0 0 0 0 620
249 Salep 2-4 Tube 0 0 0 0 0 0 48
250 Serum Anti Bisa Ular Inj. 5ml Vial 2 0 2 2 0 0 4
251 Serum Anti Tetanus ( Tetagam ) inj 1500 IU Vial 0 0 0 0 0 0 2
252 Sukralfat syrup Botol 0 0 0 0 0 0 0
253 Sukralfat tablet 500 mg Tablet 0 0 0 0 0 0 0
254 Simvastatin 10 mg tablet Tablet 200 600 800 600 200 0 500
255 Simvastatin 20 mg tablet Tablet 150 500 650 500 150 0 500
256 Sianokobalamin Injeksi Ampul 0 0 0 0 0 0 100
257 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube 0 0 0 0 0 0 0
258 Tablet Penambah Darah Tablet 820 0 820 820 0 0 0
259 Temporary Stopping Fletcher serbuk & cairan Tablet 0 0 0 0 0 0 0
260 Tetrakain HCL tetes mata 0,5% Tube 0 0 0 0 0 0 0
261 Tetrasiklin 250 mg capsul capsul 0 0 0 0 0 0 0
262 Tetrasiklin 500 mg capsul capsul 0 0 0 0 0 0 0
263 Thiamin ( Vit.B1) tab. Tablet 300 1000 1300 1000 300 0 1000
264 Thiamin ( Vit.B1) Inj. Ampul 0 0 0 0 0 0 60
265 Triheksilfenidil Hcl 2 mg tablet Tablet 0 0 0 0 0 0 0
266 Underpad Lembar 5 50 55 50 5 0 50
267 Urine Bag Biji 48 0 48 0 48 0 0
268 Vitamin B komplek Tablet 500 2000 2500 1800 500 0 2000
269 WIDA KDN 1 Larutan Botol 0 40 40 20 20 0 0
270 Zink sirup Botol 0 0 0 0 0 0 100
271 Zink tablet 20 mg Tablet 0 0 0 0 0 0 500
272
NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
273
274 Alat suntik 10 ml Pcs
275 Alat suntik 20 CC Pcs
276 Alat suntik 1 ml Pcs
277 Alat suntik 2,5 ml Pcs 0 0 0 0 0 0 0
278 Alat suntik 3 ml Pcs 0 500 500 300 200 0 200
279 Alat suntik syringe 3 cc Pcs
280 Alat suntik 5 ml Pcs
281 Alkohol swab Sachet 0 4 4 4 0 0 3
282 Alkohol 70 % 1 L Botol 0 0 0 0 0 0 0
283 Cat Gut no 2/0 Sachet 0 1 1 1 0 0 0
284 Cat Gut no 3/0 Sachet
285 Cathetter Jelly Biji 30 0 30 10 20 0 0
286 Demetech Silk 3/0 Set
287 E Care I.V Dresing Lembar
288 Folly No 14 Catether pcs
289 Folly No 16 Catether pcs
290 I.V Cathetter No. 20 Set
291 I.V Cathetter No. 22 Set 0 50 50 40 10 50
292 I.V Cathetter No. 24 Set 0 50 50 20 30 20
293 I.V Cathetter No. 26 Set
294 Infuset Anak Set
295 Infuset Dewasa Set 0 100 100 60 40 100
296 Infuset Dewasa (Otsuka) Set
297 Jarum Insulin Tablet
298 Kapas Berlemak 250 gr Bungkus 0 0 0 0 0 0 0
299 Kapas Berlemak 500 gr Bungkus
300 Kasa 4 m x 10 cm Rol 0 0 0 0 0 0 10
301 Kasa Hidrofil 36 x 80 cm Rol 0 0 0 0 0 0 0
302 Kasa pembalut 2 m x 80 cm Pak 0 30 30 20 10 0 30
303 Kasa kompres 40/40 Lembar 0 0 0 0 0 0 0
304 Kasa Steril 16 x 16 cm Kotak 0 50 50 30 20 0 50
305 Masker tali (E Care Surgical Mask Tie On) Lembar 0 100 100 100 0 0 200
306 Masker karet Lembar
307 Nasal Canula Oksigen Set
308 Plester 1" Rol
309 Sarung tangan M (Non Steril) Aximed Pasang
310 Sarung tangan no 6,5 Cosmo Pasang
311 Sarung tangan no 6,5 Steril Pasang 0 0 0 0 0 0 50
312 Sarung tangan no 7,0 Steril Pasang 0 0 0 0 0 0 50
313 Sarung tangan Gynecolog no 7 Pasang 20 80 100 10 90 0 0
314
NAMA OBAT REAGEN
315
316 Chikungunya IgM (Reagen) Kotak
317 Dengue IgM / IgM ( Reagen ) Kotak
318 Leptospira IgM (Reagen) Kotak
319 NS1 Antigen Test (Reagen) Kotak
320 Albumin (Reagen) Kotak
321 Bilirubin T/D (Reagen) Kotak
322 Cellclean (CL-50) (Reagen) Kotak
323 Celloack (PK-30L) (Reagen) Kotak
324 Cholesterol (Reagen) Kotak
325 Cholesterol Stik (Reagen) Kotak 0 0 0 0 0 0 0
326 CK-MB (Reagen) Kotak
327 Eight Check ( LNH ) Serial
328 Hematologi Calibrator (Nscs 1000 ) Botol
329 HBSAG Box
330 Creatinin Kotak
331 Glukosa Kotak 0 0 0 0 0 0 0
332 GOT ( ALAT ) Kotak
333 GPT ( ALAT ) Kotak
334 HDL Cholesterol ( Precipitan ) Kotak
335 Hemoglobin Kotak 0
336 LDL Cholesterol Kotak
337 Total Protein Kotak 0
338 Trigleserida Kotak
339 Urea Kotak
340 Uric Acid Kotak 0 0 0 0 0 0 0
341 Strip Narkoba 6 Parameter Kotak
342 Strip Narkoba 5 Parameter Kotak
343 Strip Narkoba 3 Parameter Kotak
344 Stik Uric Acid Kotak
345
NAMA OBAT GIGI
346
347 Articulating Paper (Kertas warna penanda oklusi) Kotak
348 Anastesi Citojek Box
349 Bahan Tumpatan sementara Botol
350 Bonding Syringe
351 Carpule Citojek Kotak
352 Composite Nanohibrid A1 Tube
353 Composite Nanohibrid A2 Tube
354 Composite Nanohibrid A3 Tube
355 Composite Nanohibrid A3,5 Tube
356 Cairan Desinfectan ( Perendaman Instrumen Gigi ) Botol
357 Cairan untuk desinfectan pembersih permukaan Botol
358 Disclosing Solution Botol
359 Etcing Gel Pcs
360 Eugenol Cairan Botol
361 Formokesol Botol
362 Glass Ionomer ART Pot
363 Jarum citojek uk 16 mm Box
364 Chlorfeson Kamfer menthol ( CHKM ) Cairan Botol
365 Kalsium Hidroksida pasta Botol
366 Mummifiying Fasta Botol
367 Natrium Hipoklorit airan konsentrat 5% Botol
368 Pasta Devitalisasi ( Non Arsen ) Tube
369 Paper Points 15-40 mm Box
370 Spon Gelatin Cubicis 1x1x1 cm (Spongostan) Botol
371 Semen seng Fosfat serbuk Set
372 Temporary Filling Fasta Set
373 Tooth Stain Remover ( TSR ) Botol
374 Wipes Desinfektan Botol
375 NAMA OBAT VAKSIN
376
377 Vaksin HB Uniject Pcs
378 Vaksin BCG Ampul
379 Vaksin Pentabio ( DPT - HB - Hib ) Vial 0 0 0 0 0
380 Vaksin Polio b OPV Vial 0 0 0 0 0
381 Vaksin Polio IPV Vial 0 0 0 0 0
382 Vaksin Campak Vial 0 0 0 0 0
383 Vaksin Tetanus Toxoid Vial 0 0 0 0 0
384 Vaksin TD Vial 0 0 0 0 0
385 Vaksin DT Vial 0 0 0 0 0
386
387 ADS 0,05 ml Unit 0 0 0 0 0
388 ADS 0,5 ml Unit
389 ADS 5 ml Unit
390 Safety Box Unit
391
392 Droper Polio Vial
393 Pelarut Vaksin Campak Vial
394 Pelarut Vaksin BCG Vial

JUMLAH KUNJUNGAN :
Pasien Umum Rawat jalan
Pasien Rawat Inap
Pasien Askes / JKN

RAWAT RAWAT
JUMLAH KUNJUNGAN PUSKESMAS JALAN INAP
JUMLAH
2. Lap. Psikotropika & Narkotika
UMUM / BAYAR 365 0 365 3. Lap. Pemakaian Serum ABU
UMUM / TIDAK BAYAR 0 0 0 4. Lap. 20 Pemakaian Obat Terbanyak
JKN 2858 0 2858
TOTAL KUNJUNGAN 3223

Mengetahui / Menyetujui
KEPALA DINAS KESEHATAN YANG MENYERAHKAN YANG MEMINTA YANG MEMINTA :
KABUPATEN PANDEGLANG KEPALA UPT. GUDANG FARMASI KEPALA PUSKESMAS PETUGAS OBAT PUSKESMAS

………………………………………… …………………………………………………… Khamdan Pramana,SST Mkes Reni Lia Safitri,AMKep

NIP. NIP. NIP. 197611212006041007 NIP. TKK