LAPORAN PEMAKAIAN DAN LEMBAR PERM

PUSKESMAS (LPLPO)
PUSKESMAS : Kartini
KECAMATAN : Siantar barat PELAPORAN BULAN / PERIODE
KOTA : Pematangsiantar PERMINTAAN BULAN/PERIODE

SISA PENERI- PERSE- PEMA-

SATU- STOK MAAN DIAAN KAIAN
NO NAMA OBAT AN AKHIR OBAT OBAT OBAT
BULAN BULAN BULAN BULAN
Januari Februari Februari Februari
1 2 3 4 5 6=(4 + 5) 7=(6 - 8)
1 Acetyl Cysteine 200 mg Kapsul 1 0 1 0
2 Alat Suntik 1 ml Buah 0 0 0 0
3 Alat Suntik 2,5 - 3 ml Buah 87 100 187 30
4 Albendazole Tablet 0 300 300 300
5 Alluprinol Tablet 100 mg Tablet 437 100 537 190
6 Alluprinol Tablet 300 mg Tablet 4 0 4 0
7 Alkohol Swab Lembar 0 400 400 100
8 Amoksisillin S. Kering 250 mg Botol 0 0 0 0
9 Amoksisillin Kapsul 250 mg Kapsul 460 0 460 45
10 Amoksisillin Kaplet 500 mg Kaplet 1871 300 2171 637
11 Amlodipin Tablet 5 mg Tablet 0 0 0 0
12 Amlodipin Tablet 10 mg Tablet 1034 400 1434 685
13 Anios Gel 1L Botol 0 0 0 0
14 Antasida Doen Tab 500 mg Tablet 910 600 1510 717
15 Antasida Syrup Botol 5 10 15 1
16 Anti Fungi Doen Komb 3 gr Pot 120 0 120 4
17 Ampicillin Inj Vial 0 0 0 0
18 As. Askorbat ( Vit. C.) Tab 50 mg Tablet 481 2000 2481 1205
19 Asam Folat 1 mg Tablet 0 0 0 0
20 As. Mefenamat Tablet 500 mg Tablet 903 0 903 542
21 Asiklovir Krim 5% Tube 0 0 0 0
22 Asiklovir Tablet 200 mg Tablet 56 0 56 50
(1)
23 Asiklovir Tablet 400 mg Tablet 0 0 0 0
24 Azitromisin Kapsul 0 0 0 0
25 Ambroxol Tab Tablet 7 0 7 0
26 Ambroxol Syr Botol 171 150 321 111
27 Betametason 0,1% Tube 0 0 0 0
28 Besi II Sulfat (FE) Tablet 20840 7600 28440 70
29 Betahistin Tab 6 mg Tablet 596 0 596 150
30 Bufacetin Salp Kulit Tube 35 0 35 7
31 Bioron Injeksi Ampul 0 0 0 0
32 Bacitracin cream Tube 3 0 3 3
33 Catheter IV 20G Pcs 0 0 0 0
34 Catheter IV 22G Pcs 0 0 0 0
35 Catheter IV 24G Pcs 0 0 0 0
36 Cefadroxil Kapsul 500 mg Kapsul 0 0 0 0
37 Cefadroxil Syr Krg 125 mg/5 ml Botol 0 0 0 0
38 Cefixime sirup 100 mg/5 ml Botol 0 0 0 0
39 Cefixime Kapsul 200 mg Kapsul 0 0 0 0
40 Captopril Tablet 25 mg Tablet 675 0 675 40
41 Captopril Tablet 12,5 mg Tablet 0 500 500 0
42 Catgut no.2/0 dengan jarum bedah Buah 6 0 6 6
43 Clindamysin Tab 150 mg Tablet 0 0 0 0
44 Cetirizine Syrup 5 mg/5 ml Botol 0 15 15 2
45 Cetirizine Tab 10 mg Tablet 293 1500 1793 933
46 Cerebrofort Syrup Botol 0 0 0 0
47 Deksametason Inj 5 mg/1 ml Ampul 102 0 102 0
48 Deksametason Tablet 0,5 mg Tablet 0 0 0 0
49 Diazepam Tablet 5 mg Tablet 499.5 0 499.5 20
50 Doksisiklin Kaplet 100 mg Kaplet 100 200 300 20
51 Domperidon 10 mg Tablet 650 0 650 95
52 Domperidon Suspensi 5 mg Botol 43 0 43 3
53 Dipenhidramin Inj Ampul 123 0 123 61
54 Dulcolax Suppositoria Tablet 0 0 0 0
55 Etanol (Alkohol 70%) 1 L Botol 2 0 2 2
56 Etakridin 0,1% (Rivanol) Botol 13 0 13 0
57 Etilklorida Semprot Botol 0 0 0 0
(2)
58 Epinefrin Inj Ampul 0 0 0 0
59 Eritromisin Syr 200 mg/5 ml Botol 5 0 5 0
60 Eritromisin Kaplet 250 mg Kaplet 410 0 410 0
61 Eritromisin Kaplet 500 mg Kaplet 51 0 51 10
Eughenol Botol 0 0 0 0
62 Fitomenadion Injeksi (Vit. K) Ampul 60 0 60 0
63 Fitomenadion Tablet Tablet 3 0 3 0
64 Fixomull 5 cm X 5 m/ples Rol 0 0 0 0
65 Furosemide Tablet 40 mg Tablet 171 0 171 0
66 Fenobarbital Tablet 30 mg Tablet 350 0 350 0
67 Fenobarbital Injeksi Ampul 0 0 0 0
68 Fucilex Cream Tube 8 0 8 0
69 Garam Oralit 200 ml Saset 0 0 0 0
70 Gentamisin Salp Mata Tube 0 0 0 0
71 Gentamisin Sulfat Tetes mata Botol 0 0 0 0
72 Gentian Violet Larutan 1% Botol 0 0 0 0
73 Glibenklamide Tablet 5 mg Tablet 490 0 490 110
74 Glimepiride 1 mg Tablet 0 0 0 0
75 Glimepiride 2 mg Tablet 0 0 0 0
76 Handsanitizer clodin Botol 18 0 18 12
77 Grisiofulfin Tablet 125 mg Tablet 385 0 385 10
78 Haloperidol 0,5 Tablet 78 0 78 0
79 Hanscun Steril Pasang 0 0 0 0
79 Hanscun Non Steril L Pasang 0 0 0 0
80 Hanscun Non steril M Pasang 0 0 0 0
81 Hidrokartison Krim 2,5% Tube 36 24 60 30
82 Ibufropen sirup 100 mg/5 ml Botol 49 0 49 3
83 Iliadin 0,5 Dewasa Botol 5 0 5 0
84 Infus Larutan RL Botol 4 0 4 0
85 Infus Larutan Nacl 0,9 % Botol 0 0 0 0
86 Infus Set Dewasa Set 0 0 0 0
87 ISDN(Isosorbit) Tablet 0 0 0 0
88 Kalsium Laktat Tablet 500 mg Tablet 1360 0 1360 260
89 Kapas 250 mg Bungkus 21 0 21 2
90 Kapas 500 mg Bungkus 19 0 19 0
(3)
91 Kasa Hydrofil Steril 16 x 16 cm Kotak 0 0 0 0
92 Kasa Pembalut 2 x 80 cm Rol 65 0 65 10
93 Kasa Pembalut 4 x 5 cm Rol 51 0 51 5
94 Kasa Pembalut 4 x 10 cm Rol 6 0 6 0
95 Kasa Pembalut 4 x 15 cm Rol 0 0 0 0
96 Ketoprofen tab 100 mg Tablet 0 0 0 0
97 Ketokonazol krim 2 % Tube 0 0 0 0
98 Ketokonazol Tablet 200 mg Tablet 274 100 374 30
99 Klobazam Tablet 0 0 0 0
100 Klozapin Tablet 0 0 0 0
101 Kloramfenikol Tetes Kuping 3% Botol 0 0 0 0
102 Kloramfenikol Kapsul 250 mg Kapsul 0 0 0 0
103 Kloramfenikol Kapsul 500 mg Kapsul 0 0 0 0
104 Kloramfenikol Salap Mata 1% Tube 0 0 0 0
105 Klorfeniramin Maleat tab 4 mg Kapsul 957 500 1457 377
106 Kotrimoksazol Sirup 60 ml Botol 25 100 125 1
107 Kotrimoksazol 480 mg Tablet 596 0 596 10
108 Kotrimoksazol 960 mg(Forte) Tablet 290 0 290 0
109 Lansoprazole Tab 30 mg Kapsul 499 600 1099 904
110 Leucoplast 7,5 X 4,5 cm Rol 0 0 0 0
111 Leucoplast 2,5 X 4,5 cm Rol 13 0 13 0
112 Lisol Tersabun 1000 ml Botol 0 0 0 0
113 Lidokain 2%(HCl)+Epinefrin Ampul 177 0 177 30
114 Loperamide 2 mg Tablet 0 0 0 0
115 Loratadine 10 mg Tablet 573 0 573 212
116 Masker Plus 3 Ply Set 300 700 1000 1000
117 Meloxicam Tab 7,5 mg Tablet 0 0 0 0
118 Meloxicam Tab 15 mg Tablet 0 0 0 0
119 Metformin 500mg Tablet 0 600 600 70
120 Metformin 850 mg Tablet 0 0 0 0
121 Metilergometrin Maleat Injeksi Ampul 0 0 0 0
122 Metilergometrin Maleat Tablet Tablet 200 0 200 0
123 Metil Prednisolon Tablet 4 mg Tablet 0 0 0 0
(4)
124 Metil Prednisolon Tablet 8 mg Tablet 591 200 791 122
125 Metoclopramida 10 mg Tablet 390 0 390 0
126 Metronidazol Syrup Tablet 10 0 10 0
127 Metoclopramida 5 mg Tablet 230 0 230 20
128 Metronidazol Tablet 500 mg Tablet 0 0 0 0
129 Mikonazol Krim 2% Tube 9 0 9 8
130 MgSO4 Kotak 0 2 2 0
131 Natrium BiKarbonat Tab 500 mg Tablet 0 0 0 0
132 Neo Diagon Atapulgit 650 mg Tablet 285 0 285 82
133 Nistatin Vaginal Tab 100.000 IU Tablet 61 0 61 0
134 Nat. Diklofenak Tab 25 mg Tablet 571 400 971 601
135 Nat. Diklofenak Tab 50 mg Tablet 0 0 0 0
136 Nifedifin (Adalat Oros) 30mg Tablet 0 0 0 0
137 OAT Kategori I Kotak 0 0 0 0
138 Oksitetrasiklin HCl S. Kulit 3% Tube 0 0 0 0
139 Oksitetrasiklin HCl S. Mata 1% Tube 71 0 71 3
140 Omeprazole Kapsul 0 0 0 0
141 Parasetamol Sirup 120 mg Botol 76 0 76 28
142 Parasetamol Drop 60 mg/0,6 ml Botol 63 0 63 31
143 Parasetamol Tablet 500 mg Tablet 997 0 997 775
144 Pehacain Injeksi Ampul 0 0 0 0
145 Pehavral Kaplet 0 0 0 0
146 Proxidon 400 Kapsul 0 0 0 0
147 Plesterin Rol 19 0 19 1
148 Plester 5 cm x 5 m Rol 28 0 28 2
149 Pot Sputum Kuning Pot 0 0 0 0
150 Povidon Iodida Lar 10% 300 ml Ampul 15 0 15 0
151 Povidon Iodida Lar 10% 30 ml Botol 28 0 28 0
152 Povidon Iodida Lar 10% 60 ml Botol 7 0 7 0
153 Prednison Tablet 5 mg Tablet 570 0 570 30
154 Pirantel Pamoat 125 mg Tablet 0 0 0 0
155 Pirantel Pamoat Syrup Botol 2 0 2 0
156 Piridoksin 10 mg (Vit. B.6) Tablet 609 0 609 95
(5)
157 Propranolol 10 mg Tablet 0 0 0 0
158 Propranolol 40 mg Tablet 0 0 0 0
159 Blood Lancet Set 0 400 400 400
160 Reagen Gula Darah(Benechek) Stik 0 200 200 200
161 Reagen Cholesterol(Benechek) Stik 0 100 100 100
162 Reagen Asam Urat(Benechek) Stik 0 100 100 100
163 Resperidone Tablet 0 0 0 0
164 Retaphyl Theophillyne 300 mg Tablet 0 0 0 0
165 Sabun Antibakteri Botol 0 0 0 0
166 Salbutamol 2 mg Tablet 400 0 400 10
167 Merjapit-c 500/Vit.C 500 Tablet 0 0 0 0
168 Salisil Bedak 2 % Kotak 0 0 0 0
169 Salap 24 Krim Pot 83 0 83 23
170 Samcorbex Kaplet 0 0 0 0
171 Siprofloksasin 500 mg Tablet 0 0 0 0
172 Sianokobalamin Inj.(Vit B12) Ampul 46 0 46 2
173 Sianokobalamin (Vit B12) Tablet 0 600 600 10
174 Simvastatin Tablet 10 mg Tablet 300 300 600 50
175 Simvastatin Tablet 20 mg Tablet 778 0 778 335
176 Tetagam Pcs 0 0 0 0
177 Tetrasiklin Kapsul 250 mg Kapsul 480 0 480 0
178 Tetrasiklin Kapsul 500 mg Kapsul 600 0 600 0
179 Thiamin 50 mg(Vit.B1) Tablet 2352 0 2352 160
180 Timolol Tetes Mata Botol 0 0 0 0
181 Vitamin B.Complex Tablet 1206 2200 3406 1421
182 Vit A 100.000ui Kapsul 0 0 0 0
183 Vit A 200.000 ui Kapsul 50 150 200 0
184 Zink Tablet 20 mg Tablet 0 0 0 0
185 Zink Syrup Botol 1 0 1 0
186 Reagen SD HIV (Bioline) Set 0 0 0 0
187 Reagen TB(Zeil Nelson) Kotak 0 0 0 0
188 Sipilis Set 0 0 0 0
189 HIV Ab3-Line Set 0 0 0 0
189 ATS Tetagam Vial 0 0 0 0
190 KHB Set 0 0 0 0
(6)
191 Diagnostar Set 0 0 0 0
192 Mikropipet Buah 0 0 0 0
193 Betadin Salep Tube 0 0 0 0
194 HBSAG Set 0 0 0 0
195 Coverall (APD) Pcs 0 0 0 0
196 Face Shield Pcs 0 0 0 0
197 Nurse cap Pcs 0 0 0 0
198 Desinfektan 1L Botol 0 0 0 0
199 Santa E Tablet 100 0 100 0
200 Cutti cell Lembar 111 0 111 4
201 Handrub Fresco Btl 0 0 0 0
202 Vitamin C 500mg Tablet 35 0 35 35
203 Seviplex Tablet 0 0 0 0
204 E-Care Botol 0 42 42 42
 205 Stericlin 5 0 5 0

UMUM
JUMLAH KUNJUNGAN RESEP
Bayar
1 2

Mengetahui / Menyetujui
Kepala Dinas Kesehatan Yang Menyerahkan Yang Meminta
Kota Pematangsiantar Ka.sie Farmasi,Alkes dan PKRT Pimpinan Puskesmas Kartin

Dr.Ronald H.Saragih.M.Kes Sermy I Swita Sinaga,M.Kes Zakia Husna Nasution, SKM

NIP. 19620818 199003 1 005 NIP:19670503 198903 2 003 NIP.
AKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS (LPLPO)
DOKUMEN NOMOR TANGGAL
: Maret 2022 GFK /GFK/PE/IV/ 2022
: April 2022 PUSKESMAS 400/ /PKMK/IV/2022 APRIL 2022

SISA STOK PERMIN- PEMBERIAN

STOK OPT TAAN
OBAT OBAT OBAT KET
DAK DAU PROG LAIN2 JUMLAH
BULAN BULAN BULAN
Februari ……………. Maret
8 9 10 11 12 13 14 15 16
1 0 500
0 0 0
157 o 0
0 0 0
347 0 500
4 0 500
300 0 0
0 0 50
415 0 500
1534 0 0
0 0 500
749 0 800
0 0 0
793 0 2000
14 0 20
116 0 0
0 0 0
1276 0 1500
0 0 0
361 0 1000
0 0 10
6 0 100
(1)
0 0 100
0 0 500
7 0 600
210 0 0
0 0 24
28370 0 0
446 0 100
28 0 0
0 0 0
0 0 0
 0 0 0
0 0 0
0 0 0
0 0 500
0 0 30
0 0 0
0 0 180
635 0 0
500 0 0
0 0 0
0 0 500
13 0 10
860 0 500
0 0 30
102 0 0
0 0 500
479.5 0 0
280 0 0
555 0 0
40 0 0
62 0 0
0 0 0
0 0 0
13 0 0
0 0 5
(2)
0 0 2
5 0 10
410 0 0
41 0 100
0 0 5
60 0 0
3 0 200
0 0 0
171 0 0
350 0 0
0 0 0
8 0 0
0 0 0
0 0 15
0 0 20
0 0 0
380 0 300
0 0 0
0 0 500
 6 0 5
375 0 0
78 0 0
0 0 0
0 0 0
0 0 100
30 0 24
46 4 0
5 0 0
4 0 0
0 0 3
0 0 0
0 0 0
1100 0 0
19 2 0
19 0 0
(3)
0 0 10
55 0 0
46 0 0
6 0 0
0 0 0
0 0 0
0 0 0
344 0 100
0 0 100
0 0 0
0 0 20
0 0 0
0 0 200
0 0 0
1080 0 2500
124 0 40
586 12 0
290 0 0
195 0 1000
0 0 0
13 0 0
0 0 5
147 0 0
0 0 500
361 0 200
0 0 1000
0 0 0
0 0 500
 530 0 0
0 0 0
0 0 0
200 0 0
0 0 500
(4)
669 0 500
390 0 0
10 0 0
210 0 0
0 0 200
1 0 24
2 0 0
0 0 0
203 0 100
61 0 0
370 0 0
0 0 0
0 0 0
0 0 0
0 0 0
68 0 0
0 0 500
48 0 50
32 0 0
222 0 0
0 0 0
0 0 0
0 0 0
18 0 0
26 0 0
0 0 0
15 0 0
28 0 0
7 0 0
540 36 500
0 0 0
2 0 0
514 114 1000
(5)
0 0 0
0 0 0
0 0 200
0 0 0
0 0 100
 0 0 100
0 0 0
0 0 0
0 0 10
390 0 200
0 0 1300
0 0 0
60 0 0
0 0 0
0 0 500
44 0 0
590 0 0
550 0 0
443 0 0
0 0 0
480 0 0
600 0 100
2192 0 0
0 0 0
1985 0 1500
0 0 0
200 0 0
0 0 100
1 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
(6)
0 0 0
0 0 0
0 0 10
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 0 0
107 0 10
0 0 0
0 0 300
0 0 0
0 0 0
 5 0

UMUM
JKN JUMLAH
Bayar Tidak
2 3 4 5

Yang Meminta Yang menerima

Pimpinan Puskesmas Kartini Petugas Puskesmas Kahean

Zakia Husna Nasution, SKM Carolina Panjaitan, S.Si, Apt

NIP. 19821015 201101 2 006