LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

( LPLPO )

KODE RSUD/PUSKESMAS :
PUSKESMAS : MANGUNHARJO LAPORAN BULAN : OKTOBER 2021
KECAMATAN : PURWODADI PERMINTAAN BULAN :
KAB / KODYA : MUSI RAWAS NOMOR :
PROPINSI : SUMATERA SELATAN TANGGAL :

PENERI PERSE PEMA- SISA STOK PERMIN PEMBERIAN JML KET

KODE NAMA OBAT SATUAN STOK AWAL
MAAN DIAAN KAIAN STOK OPT TAAN APBD ASKES APT LAIN 15 16
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
TABLET

1 Alopurinol tab 100mg Tablet 0 0 0 0 0

2 Alpara tab Tablet 0 0 0 0 0
3 Alprazolam 0,5mg Tablet 0 0 0 0 0
4 Ambroxol 30mg Tablet 0 0 0 0 0
5 Aminofilin tab 200mg Tablet 400 0 400 0 400
6 Amitriptiline Tablet 0 0 0 0 0
7 Amlodipin tab 5mg Tablet 0 0 0 0
8 Amoksisillin kapl 500mg Kaplet 1100 0 1100 900 200
9 Antasida DOEN tablet, kombinasi : Tablet 2100 2000 4100 700 3400
10 Asam asetyl Salisilat 80 mg Tablet 0 500 500 0 500
11 Asam Askorbat ( Vit.C ) tab 50mg Tablet 0 0 0 0 0
12 Asam Folat 1 mg Tablet 0 0 0 0 0
13 Asam Mefenamat tab 500mg Tablet 0 0 0 0 0
14 Asetyl Systein tab Tablet 1500 1000 2500 400 2100
15 Asiclovir tab 200mg Tablet 0 0 0 0 0
16 Asiclovir tab 400mg Tablet 0 0 0 0 0
17 Atapulgit tab 600mg/ Antides Tablet 0 0 0 0 0
18 Betahistin mesilat tab 6mg Tablet 0 0 0 0 0
19 Captopril tab 50mg Tablet 0 0 0 0 0
20 Captopril 25mg Tablet 0 2000 2000 300 1700
21 Carbamazepin 200mg Tablet 0 0 0 0 0
22 Cefadroxil kaps 500mg Kapsul 0 0 0 0 0
23 Cefixime kaps 100mg Kapsul 0 0 0 0 0
24 Cetirizine tab 10mg Tablet 900 2000 2900 300 2600
25 Clobazam 10mg tab Tablet 0 0 0 0 0
26 Clozapine 25mg Tablet 0 0 0 0 0
27 Cyprofloksasin tab 500mg Tablet 0 0 0 0 0
28 Deksametason tab 0,5mg Tablet 0 4000 4000 100 3900
29 Diazepam tab 2mg Tablet 0 0 0 0 0
30 Diazepam tab 5mg Tablet 0 0 0 0 0
31 Digoksin tab 0.25mg Tablet 500 0 500 0 500
32 Domperidone tab 10mg Tablet 600 1000 1600 100 1500
33 Erythromicin kaps 500mg Tablet 0 0 0 0 0
34 Fenitoin Natrium kaps 100mg Kapsul 0 0 0 0 0
35 Ferro Fumaratkapsul lunak 300mg Tablet 0 0 0 0 0
36 Fitomenadion ( Vit.K1 ) tablet salut 10mg Tablet 100 0 100 100 0
37 Furosemide tab Tablet 700 0 700 0 700
38 Glibenklamide 5mg Tablet 1500 0 1500 300 1200
39 Glimepiride tab 3mg Tablet 700 0 700 700 0
40 Grisiofulvin tablet 125 mg, micronized Tablet 0 0 0 0 0
41 Haloperidol tab 1,5mg Tablet 0 0 0 0 0
42 Haloperidol tab 5mg Tablet 0 0 0 0 0
43 Hemafort kapsul Tablet 0 0 0 0 0
44 Hidroklortiazide (HCT) Tablet 0 0 0 0 0
45 Hustab P Tablet 0 0 0 0 0
46 Hustap Tablet 0 3000 3000 300 2700
47 Hyosin Butilbromide Tablet 0 0 0 0 0
48 Ibuprofen tab 200mg Tablet 0 0 0 0 0
49 Ibuprofen tab 400mg Tablet 0 0 0 0 0
50 Isosorbid Dinitrat tablet sublingual 5mg Tablet 310 0 310 10 300
51 Kalsium Laktat tab 500mg Tablet 700 1500 2200 300 1900
52 Ketokonazole tab 200mg Tablet 0 0 0 0 0
53 Klindamycin 300mg Tablet 0 0 0 0 0
54 Kloramfenicol kaps 500mg kapsul 400 800 1200 0 1200
55 Klorfeniramin maleat (CTM) 4mg Tablet 0 0 0 0 0
56 Klorpromazine 100mg Tablet 0 0 0 0 0
57 Kodein tab 10mg Tablet 0 0 0 0 0
58 Komb(Pirimetamin 25 mg + Sulfadoxin 500 mg Tab Tablet 0 0 0 0 0
59 Kotrimoksazol tab 480mg Kapsul 600 1500 2100 0 2100
60 Lansoprazole kaps 30mg Tablet 0 0 0 0 0
61 Lexavit kaplet Tablet 0 0 0 0 0
62 Loperamide tab 2mg Tablet 0 0 0 0 0
63 Loratadine 10mg Tablet 0 0 0 0 0
64 Meloxicam 7,5 Tablet 0 0 0 0 0
65 Metformin 500mg Tablet 500 2000 2500 200 2300
66 Methylprednisolon 4mg Tablet 1600 0 1600 100 1500
67 Metilergometrin Maleat tab Kaplet 0 0 0 0 0
68 Metoklopramide Tablet 0 0 0 0 0
69 Metronidazole tab 500mg Tablet 0 0 0 0 0
70 Molaneuron tab Tablet 0 0 0 0 0
71 Molexflu Kaplet Tablet 0 0 0 0 0
72 Diklofenac sodium tab 25mg Tablet 2550 0 2550 1650 900
73 Nipedipin tab 10mg Tablet 0 0 0 100 0
74 Nistatin tablet vagina 100.000 IU/g Kaplet 100 1000 1100 0 1100
75 Nistatin tablet vagina 500.000 IU/g Paket 0 0 0 0 0
76 OAT Kategori Anak Tablet 0 0 0 0 0
77 OAT Kategori I/III Paket 0 0 0 0 0
78 OAT Kategori II Kapsul 0 0 0 0 0
79 Omeprazole kaps 30mg Tablet 0 0 0 0 0
80 Parasetamol tab 500mg Tablet 3990 5000 8990 3690 5300
81 Pehavral Tablet 0 1000 1000 200 800
82 Pirantel tab 125mg Tablet 200 0 200 0 200
83 Piridoksin tab 10mg Tablet 1400 0 1400 100 1300
84 Prednison tab 5mg Tablet 0 2000 2000 0 2000
85 Propanolol tab 40mg Tablet 900 0 900 0 900
86 Propiltiourasil tab 100mg Tablet 0 0 0 0 0
87 Ranitidin tab 150mg Tablet 400 0 400 200 200
88 Risperidone 2mg Tablet 0 0 0 0 0
89 Salbutamol tab 2mg Tablet 200 0 200 0 200
90 Simvastatin 10mg Tablet 450 300 750 30 720
91 Spinorolactone tab 25mg Tablet 0 0 0 0 0
92 Tiamin HCl/Mononitrat (Vit.B1) tab 50mg Tablet 400 1000 1400 400 1000
93 Trifluoferazine Tablet 0 0 0 0 0
94 Trihexypenidil 2 mg Tablet 0 0 0 0 0
95 Vitamin B Komplek tablet Tablet 0 0 0 0 0
96 Na Diklofenac tab 50mg Tablet 0 0 0 0 0
97 Zink tablet Tablet 260 0 260 0 260
98 Bisacodil 5mg Tablet 0 0 0 0 0
99 ergotamin coffein Tablet 0 0 0 0 0
100 Etadium Tablet 0 0 0 0 0
101 Etaneural Tablet 0 0 0 0 0
102 Intunal F Tablet 0 0 0 0 0
103 Spasmolit Tablet 0 0 0 0 0
104 Arcapec Tablet 0 0 0 0 0
SYRUP
105 Alpara syrup Botol 60 ml 0 0 0 0 0
106 Ambroxol syrup Botol 60 ml 0 0 0 0 0
107 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 12 0 12 0 12
108 Amoksisilin sirup kering 250 mg/5 ml Botol 60 ml 0 0 0 0 0
109 Antacida Doen Suspensi Botol 60 ml 20 0 20 20 0
110 Cefadroxil syrup 250 mg/ml Botol 60 ml 96 0 96 13 83
111 Cefixime Syr 100mg/5ml Botol 60 ml 0 0 0 0 0
112 Cetirizine Syrup Botol 60 ml 25 0 25 8 17
113 Dextrofen syrup Botol 60 ml 0 0 0 0 0
114 Domperidone Syrup Botol 60 ml 0 0 0 0 0
115 Erythromicin Syrup Botol 60 ml 0 0 0 0 0
116 Flucetin Syrup Botol 60 ml 0 0 0 0 0
117 Garam Oralit untuk 200 ml air bungkus 0 0 0 0 0
118 Ibuprefen suspensi 200mg/5ml Botol 60 ml 0 0 0 0 0
119 Klorampenikol 125mg/5ml suspensi Botol 60 ml 0 0 0 0 0
120 Kotrimoksazole suspensi, kombinasi : Botol 60 ml 85 0 85 0 85
121 Metronidazole Syrup Botol 60 ml 0 0 0 0 0
122 Obat Batuk Hitam ( OBH ) Syrup Botol 60 ml 0 0 0 0 0
123 Parasetamol Drop Botol 60 ml 58 0 58 58 0
124 Parasetamol Syrup 120 mg/5 ml Botol 60 ml 168 0 168 0 168
125 Pirantel 125 mg/ml suspensi Botol 60 ml 38 0 38 0 38
126 Recovit syrup Botol 60 ml 0 0 0 0 0
127 Vical Syrup Botol 60 ml 0 0 0 0 0
128 Zinc (Zirkum) Syrup 20mg/5ml Botol 60 ml 42 0 42 42 0
129 Etaflusin syrup Botol 60 ml 0 0 0 0 0
130 Camivita syrup Botol 60 ml 0 0 0 0 0
131 Aminofillin inj 24mg/ml-10ml Ampul 0 0 0 0 0
132 Aqua pro inj steril, bebas Pirogen vial 0 0 0 0 0
133 Asam Traneksamat inj 100mg/ml Ampul 20 0 20 0 20
134 Asetyl Systein ( Flumucil) inj Ampul 0 0 0 0 0
135 Atropin Sulfat inj 0,25mg/ml - 1ml Ampul 0 0 0 0 0
136 Benzatin Penisillin inj Ampul 0 0 0 0 0
137 Cefotaxim inj 1gr vial 270 0 270 20 250
138 Deksametason inj 5mg/ml - 1ml Ampul 255 0 255 0 255
139 Diazepam inj lar 5mg/2,5ml rec Ampul 0 0 0 0 0
140 Diazepam injeksi Ampul 0 0 0 0 0
141 Difenhidramin HCl inj 10mg/ml-1ml Ampul 270 0 270 17 253
142 Epinefrin HCl inj 0,1% Ampul 180 0 180 0 180
143 Fitomenadion (Vit.K) inj 2mg/ml - 1ml Ampul 15 0 15 15 0
144 Furosemide inj Ampul 25 0 25 0 25
145 Gentamisin inj Ampul 0 0 0 0 0
146 Haloperidol Decanoas Ampul 0 0 0 0 0
147 Hyosin Butilbromide Ampul 0 0 0 0 0
148 Lidocain2% + Efineprin injeksi Ampul 0 0 0 0 0
149 Magnesium Sulfat inj (IV) 40%-25ml Ampul 18 0 18 0 18
150 Metilergometrin Maleat inj Ampul 100 0 100 0 100
151 Oksitosin inj Ampul 0 0 0 0 0
152 Omeprazole injeksi vial 0 0 0 0 0
153 Ondansetron inj 4mg/2ml Ampul 120 0 120 30 90
154 Pehacain inj Ampul 0 0 0 0 0
155 Ranitidine injeksi Ampul 200 0 200 0 200
156 Serum Anti Bisa Ular Polivalen inj.5ml(ABU I) vial 3 0 3 0 3
157 Serum Anti Tetanus inj.1.500 IU/ampul (ATS) Ampul 0 0 0 0 0
158 Sianokobalamin (Vit.B12) inj 500mcg/ml-1ml Ampul 200 0 200 0 200
159 Tetagam human tetanus inj Ampul 0 0 0 0 0
160 Vaksin Rabies Verorab Ampul 1 0 1 0 1
161 Glukosa larutan infus 5% steril btl 500ml 60 0 60 0 60
162 Natrium Klorida larutan infus 0.9% steril Botol 500ml 60 0 60 0 60
163 Ringer Laktat larutan infus steril Botol 500ml 140 0 140 2 138
164 Wida WI Unicap 1000ml Botol1000ml 0 0 0 0 0
165 Becombin 5000 injeksi Ampul 0 0 0 0 0
166 Gavistal injeksi Ampul 20 0 20 0 20
167 Paracetamol infus Botol 100ml 11 0 11 0 11

168 Acyclovir cream Tube 5gr 10 0 10 10 10

169 Anti Haemorroid DOEN Kombinasi Supps supp 20 0 20 0 20
170 Asam Fusidat krim 20mg/gr Tube 5gr 0 0 0 0 0
171 Betametason krim 0.1% Tube 5gr 42 0 42 0 42
172 Bisacodil Supp 10mg supp 15 0 15 15 0
173 Bisacodil Supp 5mg supp 0 0 0 0 0
174 Devitalisasi pasta Pot 1 0 1 1 0
175 Etanol Swab Serenity pcs 0 0 0 0 0
176 Etanol 70% Botol 100ml 0 0 0 0 0
177 Etil Klorida semprot btl 100ml 0 0 0 0 0
178 Fenol Gliserol tetes telinga 10% btl 15ml 0 0 0 0 0
179 Gentamisin sulfat tetes mata 0.3% btl 15ml 42 0 42 5 37
180 Hidrokortison krim 2.5% Tube 5gr 81 0 81 0 81
181 Kloramfenikol Salep Kulit 2% Tube 5gr 26 0 26 2 24
182 Kloramfenikol Salep Mata 1% Tube 5gr 43 0 43 5 37
183 Lysol/Kresol 50% btl 1000ml 0 0 0 0 0
184 Mikonazol krim 2% Tube 5gr 0 0 0 0 0
185 Salep 2-4 kombinasi Pot 0 0 0 0 0
186 Salisyl Bedak 2% kotak 39 0 39 2 37
187 Ventolin Nebuler Tube 0 0 0 0 0
188 Combivent neb tube 0 0 0 0 0
189 Eugenol cairan 10ml btl 10ml 2 0 2 0 2

1 Abbocath 20 GEA Pcs 0 100 100 0 100

2 Abbocath 22 GEA Pcs 125 0 125 5 120
3 Abbocath 24GEA Pcs 150 0 150 10 140
4 Abocath No. 18 G Serenity Pcs 0 0 0 0 0
5 Abocath No. 20 G jellco Pcs 0 0 0 0 0
6 Abocath No. 20 G Aximed Pcs 50 0 50 10 40
7 Abocath No. 22 G Serenity Pcs 0 0 0 0 0
8 Abocath No. 24 G Serenity Pcs 0 0 0 0 0
9 Abocath No. 24 G Jelco Pcs 0 0 0 0 0
10 Abocath No. 24G aximed Pcs 0 0 0 0 0
11 Alat Suntik 1cc Aximed Pcs 0 0 0 0 0
12 Alat Suntik 3cc Aximed pcs 0 0 0 0 0
13 Alat Suntik 5cc Aximed pcs 0 0 0 0 0
14 Alat Suntik sekali pakai 1ml Pcs 0 0 0 0 0
15 Alat Suntik sekali pakai 2,5 ml Pcs 0 1000 1000 0 1000
16 Alat Suntik sekali pakai 5ml Pcs 0 200 200 0 200
17 Auto Disable Syringe (ADS) 0,5ml pcs 0 0 0 0 0
18 Auto Disable Syringe (ADS) 5ml pcs 0 0 0 0 0
19 Benecheck plus Cholesterol Test 50's box 0 0 0 0 0
20 Benecheck plus Glucose Test 50's box 0 0 0 0 0
21 Benecheck plus monitoring system 3 in 1 box 0 0 0 0 0
22 Benecheck plus Urid Acid 50's box 0 0 0 0 0
23 Blood Lancet Twice Serenity box 0 0 0 0 0
24 Blood Tranfusi set Pcs 48 0 48 0 48
25 Catgut Chromic3/0 HR 26MM sach 60 0 60 0 60
26 Catgut Chromic3/0 HR 26MM serenity sach 0 0 0 0 0
27 Catgut Cromic 2/0 sach Serenity/silk sach 0 0 0 0 0
28 Catgut Cromic 3/0 HR 30 MM sach 0 0 0 0 0
29 Catgut Plain 2/0 sach sach 0 0 0 0 0
30 Catgut Plain 3/0 HR 26MM sach 60 0 60 0 60
31 Hand Scun S psg 0 0 0 0 0
32 Hand Scun 7,5 Serenity psg 0 0 0 0 0
33 Hand Scun M psg 0 0 0 0 0
34 Hand scuun 7,5 psg 0 0 0 0 0
35 Infus set anak Serenity pcs 0 0 0 0 0
36 Infusion set anak Pcs 0 0 0 0 0
37 Infusion set dewasa Pcs 44 0 44 0 44
38 Infusion set dewasa Serenity Pcs 0 0 0 0 0
39 Kapas Pembalut 250gram Onemed Roll 7 0 7 0 7
40 Kapas Pembalut 500gram Onemed Roll 11 0 11 0 11
41 Kapas Pembalut Hydrophyl 250gram Roll 0 0 0 0 0
42 Kasa pembalut 16x16cm ktk 0 0 0 0 0
43 Kasa pembalut 16x16cm Onemed ktk 0 0 0 0 0
44 Kassa pembalut Hidrofil 4m x 10cm Pcs 0 0 0 0 0
45 Kassa pembalut Hidrofil 4m x 10cm Roll 50 0 50 30 50
46 Masker pcs 0 0 0 0 0
47 Masker Aximed pcs 0 0 0 0 0
48 Pembalut elastis Polycrepe 10cm x 4,55m Roll 7 0 7 0 7
49 Pembalut elastis Polycrepe 15cm x 4,55m Roll 5 0 5 0 5
50 Plester 5 yards x 2 inch/Polifix(hansaplas 2,5) Roll 50 0 50 0 50
51 Plester 5 yards x 2inch paper tape Roll 0 0 0 0 0
52 Plester roll 1,25x 5m Roll 0 0 0 0 0
53 Plester roll 2,5x 5m roll 0 0 0 0 0
54 Polygyp 10cm x 2,75m Roll 0 0 0 0 0
55 Polygyp 15cm x 2,75m Roll 0 0 0 0 0
56 Safety Onemed Box box 0 0 0 0 0
57 Selang Catheter no 12 Pcs 18 0 18 0 18
58 Selang Catheter no 18 Pcs 27 0 27 0 27
59 Selang Catheter no 24 Pcs 0 0 0 0 0
60 Selang Catheter No.14 pcs 0 0 0 0 0
61 Selang Catheter No.14 Serenity Pcs 0 0 0 0 0
62 Selang Catheter No.16 pcs 0 0 0 0 0
63 Selang Catheter No.16 Serenity Pcs 0 0 0 0 0
64 Silk No.3/0 HR 26 MM Sach 0 96 96 0 96
65 Silk No.3/0 Serenity sach 0 0 0 0 0
66 Urine bag Pcs 0 0 0 0 0
67 Urine bag Onemed Pcs 0 0 0 0 0
68 Venflon No 18 Pcs 0 0 0 0 0
69 Venflon No 24 Pcs 50 0 50 0 50
70 Venflon No 26 Pcs 0 0 0 0 0
71 Venflon No 20 Pcs 0 0 0 0 0
72 Venflon No 22 Pcs 50 0 50 0 50
73 Wing Neadle 25G Pcs 0 0 0 0 0
74 Wing Neadle 27G Pcs 0 0 0 0 0
75 Etakridin ( Rivanol ) larutan 0.1% btl 300ml 0 0 0 0 0
76 Etanol 70% 1L Botol 1000ml 20 0 20 0 20
77 Lysol/Protektor btl 1000ml 0 0 0 0 0
78 Yodium Povidon larutan 10% 300ml botol 300ml 2 0 2 0 2
79 Yodium Povidon larutan 10% 30ml Botol 30ml 0 0 0 0 0
80 Yodium Povidon larutan 10% 60ml botol 60ml 51 0 51 51
81 Cavit G rf 25G botol 0 0 0 0 0
82 Ketac UniversalHM intro kit botol 0 0 0 0 0
83 Pramono Clorofenol Biodinamika kotak 0 0 0 0 0
84 PulpX Denpo (Devitec) kotak 0 0 0 0 0
85 Tricresolformalina (TKF) kotak 0 0 0 0 0

TOTAL
PEMAKAIAN
 GENERIK NON GENERIK ESSENSIAL NON ESSENSIAL NON TOTAL
PEMAKAIAN
INJEKSI ORAL ORAL INJEKSI TOTAL PATENT
PEMAKAIAN
A.BIO Non A. Bio Non A. Bio Non A. Bio Non.A.BIO A.BIO Non.A.BIO A.BIO GENERIK PATENT GENERIK PATENT GENERIK

Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima/ Melapor Yang Menerima

Plt. Kepala Dinas Kesehatan Kabupaten Musi Rawas Kepala Gudang Farmasi Kab. Musi Rawas Ka UPT Puskesmas Mangunharjo Petugas Puskesmas Mangunharjo

Dr.Ir.H.Nanti Kasih, M.T Sulaiman.S, Si,Apt YULI ZULAIKHA SKM Devi Senja Novelia Dwiyanti, S.Si,Apt
NIP.19670525 199403 1 001 NIP.19760521 200604 1 006 Nip. 19710527 199301 2001 Nip.19801201 200604 2 008