LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : PUSBAN MATA AIR PELAPORAN BULAN Apr-21 GFK

KACAMATAN : WARU PERMINTAAN BULAN / PERIODE mei 2021 PUSK WARU (harus diisi)
KABUPATEN : PENAJAM PASER UTARA DINKES

PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAAN KETE-

NO KEMASAN STOK AWAL JUMLAH
MAAN DIAAN KAIAN STOK OPT TAAN PROGRAM ASKES APBD 1 APBD 2 LAIN-LAIN RANGAN
1 3 4 5 8 9 10 11 12 13 14 15 16 17
1 Acetylcystein 200 mg Cap. Box @ 60
2 Acyclovir 200 mg Tab. Ktk 100 tab
3 Acyclovir 400 mg ktk 10 x 10
4 Acyclovir cream Tube
5 Allopurinol 100mg Tab. Kotak 10 x 10 tab 20 100 120 10 110 0
6 Allopurinol 300 mg Tab. Box @ 100
7 Ambroxol syr. Botol 0 5 5 1 4 0
8 Ambroxol Tab. Box @ 100 0 100 100 10 90 0
9 Amlodipin 10 mg ktk 3 x 10
10 Amlodipin 5 mg ktk 3 x 10
11 Amoksisilin 250 mg ktk 10x 10
12 Amoksisilin 500 mg ktk 10x 11 0 0 0 0 0 100
13 Amoksisilin sirup kering 125 mg/5 ml botol 60 ml 5
14 Antasida doen tablet kotak ktk 10 x10 110 0 110 50 60
15 Antasida syr botol 0 5 5 1 4 0
16 Antides ( Attapulgite ) ktk 100
17 Antihemoroid supp
18 Aqua pro inj btl
19 Asam Askorbat Tab 50 mg ktk 10 x 10 10 100 110 10 100 0
20 Asam folat (Profolat) kotak 10 x 10
21 Asam Mefenamat 250 mg kotak 10 x 10
22 Asam Mefenamat 500 mg kotak 10 x 10 0 100 100 30 70 0
23 Asam retinoat 0,05% krim Tube
24 Asam tranexamat 500 mg (Nexitra) Box @ 50
25 Aseptic Gel ( Hand sanitaizer ) 500mL Botol 0
26 Atropin 0.5 mg tablet ktk 100 tablet
27 Atropin injeksi im/iv/sk 0,25 mg/ml ktk 30 amp @ 1 ml
28 Attapulgit (Pularex) 630 mg kotak 5 x 10
29 Bedak salycil Tube 0 0 0 0 5
30 Betahistine 6 mg ktk 30
31 Betamethasone salep Tube
32 Bioplacenton Tulle Box @ 10
33 Bisacodil 10 mg Supp. (Dulcolax) ktk 5 sup
34 Bisacodil 5 mg Supp. (Dulcolax) ktk 6 sup
35 Bisacodil 5 mg Tab. (Dulcolax) Box
36 Captopril 12,5 mg ktk 10 x 10 30 0 30 10 20 100
 PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAAN KETE-
NO KEMASAN STOK AWAL JUMLAH
MAAN DIAAN KAIAN STOK OPT TAAN PROGRAM ASKES APBD 1 APBD 2 LAIN-LAIN RANGAN
37 Captopril 25 mg ktk 10 x 10 tablet
38 Cetirizine 10 mg ktk 10 x 10 20 100 120 20 100 0
39 Cetirizine sirup botol 0 0 0 0 5
40 Chloramfenikol salep (Bufacetin) Tube
41 Chlorampenikol tetes mata Botol
42 Chlorampenikol tetes telinga Botol
43 Ciprofloxacin 500 mg ktk 10 x 10
44 Clindamycin 300 mg HCI tab ktk 50
45 Cloramfenikol Salep Mata Box @ 24
46 Cyanokobalamin ( Vitamin B12 ) inj ktk 100
47 Cyanokobalamin ( Vitamin B12 ) tab ktk 100 50 0 50 0 50 0
48 Deksamethasone injeksi ktk 100 ampul x 1 ml
49 Deksamethasone Tablet btl 10 x 10 tablet 90 0 90 0 90 0
50 Difenhidramin HCL injeksi ktk 30 amp @1 ml
51 Dimenhidrinat 50 mg btl 100
52 Doksisiklin 100 mg Ktk 100
53 Domperidon 10 mg kotak 10 x 10 0 0 0 0
54 Domperidon Sirup btl
55 Dumin rektal 125 mg Pcs
56 Efinefrin 1 mg inj ktk 100 ampul x 1 ml
57 Ergotamin + Caffein Tab. Botol
58 Furosemid 40 mg ktk 10 x 10
59 Garam Oralit ktk 100 20 20 0 20
60 Gentamicin Salep kulit Box @ 10
61 Gentamisin sulfat tetes mata 0,3% botol 3 3 0 3
62 Gentian Violet Box @ 24
63 Glibenclamid 5 mg Tab. kotak 10 x 10
64 Gliceril Guaiakolat Tab. Box @ 100 0 100 100 0 100 0
65 Glimepirid 2 mg tab Box @ 30
66 Glucosa 10% infus Box @ 20
67 Glukosa larutan infus 5 % btl 500 ml
68 Griseofulvin 125 mg Tab. kotak 10 x 10
69 Guanistrep syr. Botol
70 Hidrokortisone Cream 2,5 % tube @ 5 g 0 0 0 0 5
71 Hydrocortisone 1 % salep Tube
72 Hyosine-N--Butilbromida Tab Box @ 100
73 Ibuprofen Syr. Botol
74 Ibuprofen tablet 200 mg ktk 10 x 10 tablet
75 Ibuprofen tablet 400 mg ktk 10 x 10 tablet
76 Isosorbit dinitrat tablet 5 mg ktk 10 x 10 tablet
77 Kalsium laktat ( Kalk ) tablet 500 mg ktk 10 x 10 tablet 10 100 110 20 90 0
78 Ketokonazol krim 2% tube 10 gram 0 0 0 0 0 0
79 Ketokonazole 200 mg Tab. kotak 5 x 10 3 0 3 3 0 5
80 Ketorolac inj 30 mg ktk 12 ampul
 PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAAN KETE-
NO KEMASAN STOK AWAL JUMLAH
MAAN DIAAN KAIAN STOK OPT TAAN PROGRAM ASKES APBD 1 APBD 2 LAIN-LAIN RANGAN
81 Kloramfenikol 250 mg botol 250 kaps
82 Klorfeniramin Maleat 4 mg ( CTM ) ktk 100 tablet 0 100 100 0 100 0
83 Kotrimoksasol 480 mg ktk 100 80 80 0 80
84 Kotrimoksasol sirup btl 100 ml
85 Lidocain 2 % inj ktk 100
86 Lidokain komp injeksi, kombinasi ktk 30 amp
87 Loperamid 2 mg ktk 10 x 10
88 Loratadine tab 10 mg ktk 10x 10
89 Lysol btl 1000 ml
90 Magnesium sulfat inj 20% btl
91 Metformin 500 mg ktk 10 x 10 40 100 140 0 140 0 0
92 Metilergometrin injeksi ktk 100
93 Metilergometrin tab 0,125 mg ktk 10 x 10 tablet
94 Metilprednisolon 4 mg ktk 10 x 10
95 Metronidazol 500 mg ktk 100
96 Miconazole 2% krem tube 10 gram
97 Natrium Chlorida 0,9 % kotak @ 20 btl
98 Natrium diklofenak 25 mg kotak 50 tablet
99 Natrium diklofenak 50 mg kotak 50 tablet 0 100 100 30 70 0
100 Nifedipin tab ktk 10 x 10 tablet
101 Nistatin vagina tablet 100.000 IU / g ktk 10 x 10 tablet
102 Nystatin Drop (Cazetin) Botol
103 OBH syr. Botol
104 Omeprazol 20 mg ktk 3x 10
105 Oxytetracycline Salep kulit Box @ 25
106 Oxytetracycline Salep Mata Box @ 25
107 Oxytocin injeksi btl 15 ml
108 Parasetamol 120 mg/5 ml Sirup btl 60 ml 0 5 5 2 3 0
109 Parasetamol 500 mg ktk 10 x 10 tablet 65 0 65 50 15 0
110 Permetrin 5 % / Scabimide krim 10 g Tube
111 Phenol Glycerol TTS telinga btl
112 Phitomenadion Vit K ktk 10 x 10 tablet
113 Phitomenadion Vit K inj ktk 30
114 Piroxicam 10 mg Tab. Box @ 100 0 0 0 0 0 ED
115 Povidon Iodida 10 % 300 ml btl 300 ml
116 Prednison 5 mg ktk 10 x 10 tablet
117 Pyridoxin ( Vitamin B6 ) tablet 10 mg ktk 10 x 10 tablet 0 0 0 0
118 Ranitidin HCL 50 mg/ml kotak 10 ampul
119 Ranitidine Tablet 150 mg ktk 10 x 10 0 100 100 10 90 0
120 Ringer Laktat Infus btl
121 Salbutamol tablet 2 mg ktk 10 x 10 tablet
122 Salep 2- 4 Tube 5
123 Sefadroxil 125 mg syr Botol
124 Sefadroxil 500 mg kotak 10 x 10
 PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAAN KETE-
NO KEMASAN STOK AWAL JUMLAH
MAAN DIAAN KAIAN STOK OPT TAAN PROGRAM ASKES APBD 1 APBD 2 LAIN-LAIN RANGAN
125 SF Ktk 30 10 120 130 30 100 0
126 Simvastatin 10 mg ktk 30 0 100 100 0 100 0
127 Tiamin (Vitamin B1) 50 mg ktk 100 tab
128 Vaksin HBO (HB unijeck 1 dosis) ktk 100 vial
129 Vit B Komplek Tablet ktk 10 x 10 0 100 100 10 90 0
130 Vitamin A Biru (100.000 IU) Botol 50 kapsul
131 Vitamin A Merah (200.000 IU) Botol 50 kapsul
132 Zink tablet ktk 10 x 10
133 Zirkum kids sirup botol

BMHP
1 Alat Suntik Sekali Pakai 1 ml 100 set / kotak
2 Alat Suntik Sekali Pakai 3 ml 100 set / kotak
3 Alat Suntik Sekali Pakai 5 ml 101 set / kotak
4 Alkohol 70 % 1 Liter Botol
5 Alkohol Swab 0,5 % pcs 0
6 Bisturi ktk 100 pcs
7 Blood set Pcs
8 Cat Gut Plain 3/0 Box @ 24
9 Catgut/benang bedah No.2/0 dgn jarum ktk 24 pcs
10 Foley Catheter 18 pcs
11 Folley Catheter 16 F Box @ 10
12 Folley Catheter 18 F Box @ 10
13 H2O2 1 liter Botol
14 Hand Scoon 7 ktk 50 pasang
15 Hand Scoon L ktk 100 0 0
16 Hand Scoon M ktk 100 0
17 Hand Scoon S ktk 100
18 Hand Scoon steril ktk 50 pasang
19 Infusion Dewasa ktk 50
20 Infusion set anak set / kantong
21 IV Catheter No. 18 G 50 buah / kotak
22 IV Catheter No. 20 G 50 buah / kotak
23 IV Catheter No. 22 G 50 buah / kotak
24 IV Catheter No. 24 G 50 buah / kotak
25 IV Catheter No. 26 G 50 buah / kotak
26 Kasa hidrofil 40 x 80 cm pcs
27 Kasa Pembalut Hidrofil 4m x 5 cm roll/50
28 Kasa steril 16 cm x 16 cm ktk
29 Kertas puyer Pcs
30 Masker N95 Box @ 20
31 Masker tali hijab ktk 50 pcs
32 Masker tali ikat Ties Aximed ktk 50 pcs 1 1
33 Mucus extractor pcs
 PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAAN KETE-
NO KEMASAN STOK AWAL JUMLAH
MAAN DIAAN KAIAN STOK OPT TAAN PROGRAM ASKES APBD 1 APBD 2 LAIN-LAIN RANGAN
34 Needle 23 G pcs
35 Needle 24 G pcs
36 Polifix 5 cmx 10 m roll
37 Polifix 5 cmx5 m roll
38 Pot salep 20 gr Pot
39 Sendok obat Pcs
40 Silk (Benang Bedah Sutera) No. 3/0 roll
41 Silk 4/0 Box @ 12
42 Silk 5/0 Box @ 12
43 Tes kehamilan Box @ 50
44 Ultrasonic Gel 250 mL Botol
45 Umbilical Cord Klem ktk 50 pcs
46 Underpad Box @ 10
47 Urin Bag 10 pcs

Tambahan :

Lembar 1 : Gudang Farmasi

Lembar 2 : Dinas Kesehatan Kab. Kota
Lembar 3 : Puskesmas

Umum BPJS Jumlah

JUMLAH KUNJUNGAN RESEP Bayar Tidak bayar (harus diisi)
35 35

Mengetahui/Menyetujui Yang menyerahkan Yang menerima

Kepala Dinkes kab./Kota Petugas GF Kab / Kota Petugas Puskesmas
GF Kab / Kota
 PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAAN KETE-
NO KEMASAN STOK AWAL JUMLAH
MAAN DIAAN KAIAN STOK OPT TAAN PROGRAM ASKES APBD 1 APBD 2 LAIN-LAIN RANGAN
(……………………………………….….…………………) (…………………………..………………...……...……..)
NIP. NIP. NIP.
 LAPORAN OBAT & PERBEKALAN KESEHATAN DI PUSBAN
WILAYAH KERJA UPT. PUSKESMAS WARU
BULAN DESEMBER TAHUN 2019

PUSBAN API
No. Nama Obat Satuan
Stok awal Penerimaan

1 Aceptic Gell Botol

2 Acetylcystein 200 mg Cap. ktk 100 20 100
3 Acyclovir 200 mg Tab ktk 100 90
4 Acyclovir 400 mg Tab ktk 100
5 Acyclovir Cream Tube 5
6 Alat suntik 3 mL Box @ 100 24
7 Alat suntik 5 mL Box @ 100 3
8 Alkohol 70 % btl 1 liter
9 Alkohol swab. Box @ 100
10 Allopurinol 100 mg Tab. ktk 100 30
11 Ambroxol Syr. Botol 6
12 Ambroxol Tab. ktk 100 30
13 Amlodipin 5 mg ktk 30 70
14 Amoksisilin 250 mg ktk 10x 10
15 Amoksisilin 500 mg ktk 10x 11 20 100
16 Amoxycillin Syr. Botol 10 20
17 Antasida syr. Botol 7 5
18 Antasida Tab. ktk 10x 10 60 100
19 Antihaemoroid Supp Box @ 10
20 Asam Askorbat Tab 50 mg ktk 10 x 10 50 100
21 Asam Folat 400 mg (Profolat) ktk 10 x 10 50 100
22 Asam Mefenamat 250 mg kotak 10 x 10 70
23 Asam Mefenamat 500 mg kotak 10 x 10
24 Attapulgit (Pularex) Box @ 50
25 Betahistine 6mg tab. ktk 10 x 10
26 Betamethason Salep ktk 25 2 5
27 Calsium Laktat (Kalk) 500 mg Tab. ktk 100 110
28 Captopril 12,5 mg ktk 10 x 10 30
29 Captopril 25 mg ktk 10 x 10
30 Cefadroxil 500 mg Kap. ktk 100
31 Cetirizine 10 mg ktk 10 x 10 100
32 Cetirizine sirup botol
33 Cyanocobalamin ( Vitamin B12 ) tab. Ktk 100 100
34 Cyanokobalamin ( Vitamin B12 ) inj ktk 100 10
35 Deksamethasone injeksi ktk 100 ampul x 1 ml 10
36 Deksamethasone Tab. ktk 100 50 100
37 Domperidone syr Botol
38 Domperidone tab. ktk 100
39 Ethyl Klorida semprot Botol 500 ml
40 Fe ktk 100 70
41 Garam Oralit ktk 100 25
42 Gentamicine Salep Kulit Tube
43 Gentamicine Tetes mata Botol 2 5
44 Gentian violet Botol
45 Glibenclamide 5 mg Tab. ktk 100 20
46 Glyceryl Guaicolat ktk 100
47 Hand Scoon L ktk 100
48 Hand Scoon M ktk 100 74
49 Hand Scoon Steril 7 ktk 100
50 Hidrokortisone Cream 2,5 % tube @ 5 g 3
51 Ibuprofen 400 mg tab. ktk 100 200
52 Ibuprofen sirup btl 60 ml
53 Kassa 4 x 15 Roll 50
54 Kassa 4 x 5 Roll
55 Kassa Steril Kotak
56 Ketoconazole salep ktk 25 tube
57 Klorfeniramin Maleat 4 mg ( CTM ) ktk 100 tablet 50 100
58 Kotrimoksasol 480 mg ktk 100
59 Kotrimoksasol syr. ktk 100
60 Lidocain 2 % comp. inj. Ampul
61 Lidocain 2 % inj ktk 100 2
62 Lysol btl
63 Masker tali ikat Ties Aximed ktk 50 pcs
64 Metformin 500 mg ktk 10x 10
65 Methylprednisolon 4 mg Tab. ktk 10 x 10 tablet 40
66 Metoclopramide Syr (Lexapram) Botol
67 Metoclopramide tab. Box @ 100
68 Metronidazole 500 mg Tab. ktk 10x 10
69 Miconazole 2% krem ktk 24 7 5
70 NaCl infus Box @ 20
71 Natrium Diklofenak 50 mg Tab. Box @ 50 100
72 Nifedipine Tab. ktk 10x 10
73 Nystatin Vag. ktk 10x 10
74 Omeprazol 20 mg ktk 3x 10
75 Paracetamol tab 500 mg ktk 100 tablet 100
76 Parasetamol Sirup btl 20
77 Piroxicam 10 mg Tab. Box @ 100
78 Povidone Iodida Botol
79 Pyridoxin Tab. ktk 100 100
80 Ranitidin HCL 50 mg/ml kotak 10 ampul 10
81 Ranitidine Tab. ktk 100
82 Ringer laktat Infus Box@ 20
83 Safety Box 5 liter Pcs 1
84 Salbutamol tablet 2 mg ktk 10 x 10 tablet 30
85 Simvastatin 10 mg ktk 30 20
86 Stik Glucosa Benechek ktk 50 pcs
87 Tes kehamilan Pcs
88 Thiamin ( vitamin B1 ) kotak 100 30 100
89 Utrasonic Gell Botol
90 Vit B Komplek Tablet btl 100 100
91 Vitamin A Biru 100.000 IU Botol 50 kapsul
92 Vitamin A Merah 200.000 IU Botol 50 kapsul
93 Zink syr Botol
94 Zink tablet ktk 10 x 10

TOTAL KESELURUHAN
KESEHATAN DI PUSBAN
KESMAS WARU
AHUN 2019

PUSBAN API-API
Stok akhir
Pemakaian Total
Sisa Harga satuan
0 Rp 25,000 Rp -
80 40 Rp 412
20 70 Rp 236 Rp 16,520
Rp 9,500 Rp -
5 Rp 7,000 Rp -
15 9 Rp 494 Rp 4,446
0 3 Rp 685 Rp 2,055
0 Rp 8,029 Rp -
0 Rp 11,975 Rp -
30 Rp 99 Rp -
6 Rp 333
10 20 Rp 150,000
40 30 Rp 48,950 Rp 1,468,500
0 Rp 207 Rp -
90 30 Rp 233 Rp 6,990
20 10 Rp 13,750 Rp 137,500
10 2 Rp 2,098 Rp 4,196
120 40 Rp 56 Rp 2,240
0 Rp 3,642 Rp -
70 80 Rp 120 Rp 9,600
60 90 Rp 60 Rp 5,400
70 Rp 175 Rp -
0 Rp 103 Rp -
0 Rp 175 Rp -
0 Rp 119 Rp -
6 1 Rp 1,373 Rp 1,373
50 60 Rp 1,155 Rp 69,300
10 20 Rp 65 Rp 1,300
0 Rp 80 Rp -
0 Rp 11,750 Rp -
40 60 Rp 438 Rp 26,280
0 Rp 7,000 Rp -
30 70 Rp 49 Rp 3,430
8 2 Rp 1,226 Rp 2,452
5 5 Rp 308 Rp 1,540
90 60 Rp 150,000 Rp 9,000,000
0 Rp 150,000 Rp -
0 Rp 90 Rp -
0 Rp 223,850 Rp -
70 Rp 409 Rp -
10 15 Rp 7,150 Rp 107,250
0 Rp 5,000 Rp -
4 3 Rp 10,065 Rp 30,195
0 Rp 3,023 Rp -
0 20 Rp 64 Rp 1,280
0 Rp 110 Rp -
Rp 683 Rp -
50 24 Rp 1,034 Rp 24,816
0 Rp 1,029 Rp -
1 2 Rp 604 Rp 1,208
150 50 Rp 2,283 Rp 114,150
0 Rp 596 Rp -
6 44 Err:509 Err:509
0 Rp 9,879 Rp -
0 Rp 3,472 Rp -
0 Rp 135 Rp -
70 80 Rp 157 Rp 12,560
0 Rp 959 Rp -
0 Rp 223 Rp -
0 Rp 2,533 Rp -
0 2 Rp 2,678 Rp 5,356
0 Rp 286 Rp -
0 Rp 24,254 Rp -
0 Rp 2,577 Rp -
10 30 Rp 329 Rp 9,870
0 Rp 1,925 Rp -
0 Rp 3,360 Rp -
0 Rp 45 Rp -
7 5 Rp 220 Rp 1,100
0 Rp 2,122 Rp -
40 60 Rp 875 Rp 52,500
0 Rp 150 Rp -
0 Rp 48,175 Rp -
0 Rp 3,800 Rp -
80 20 Rp 83 Rp 1,660
20 Rp 25,500 Rp -
0 Rp 18,833 Rp -
0 Rp 3,926 Rp -
20 80 Rp 60 Rp 4,800
7 3 Rp 1,716 Rp 5,148
0 Rp 1,085 Rp -
Rp 253 Rp -
0 1 Rp 15,026 Rp 15,026
0 30 Rp 2,600 Rp 78,000
0 20 Rp 528 Rp 10,560
0 Rp 7,369 Rp -
0 Rp 1,167 Rp -
80 50 Rp 796 Rp 39,800
0 Rp 3,450 Rp -
60 40 Rp 2,590 Rp 103,600
0 Rp 4,236 Rp -
0 Rp 21,150 Rp -
0 Rp 479 Rp -
0 Rp 285 Rp -

Err:509

Pengelola Obat

Edriani, S.Farm.,Apt.
Nip. 198501182006042002