Lplpo 2020

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI

Kecamatan : LABUHAN MARINGGAI
Kabupaten : LAMPUNG TIMUR
Provinsi : LAMPUNG
Kode Nama Obat Sediaan Stok Awal Penerimaa

n Persediaan
247 ALLOPURINOL TABLET 100 MG TABLET 3766 1400 5166

415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 115 0 115
444 AMITRIPTYLINE TABLET 25 MG TABLET 600 0 600
445 AMLODIPINE TABLET 10 MG TABLET 285 450 735
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1163 400 1563
809 ANTACIDA TABLET 400 MG TABLET 44897 6700 51597
966 ASAM MEFENAMAT TABLET 500 MG TABLET 53290 2000 55290
923 ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET 1500 1800 3300
1479 BENZOIC ACID SALEP SALEP 0 0 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOSITO 55 0 55
1691 BISACODYL
BISMUTH SUPPOSITORIA 5 MG
SUBGALLATE|ZINC OXIDE|LIDOCAINE| SUPPOSITO 27 0 27
CALCIUM CHLORIDE DIHYDRATE|POTASSIUM
1702 HEXACHLOROPHENE SUPPOSITORIA 2 G LACTATE
CHLORIDE|SODIUM CHLORIDE|SODIUM SUPPOSITO 0 0 0
10160 INFUS INFUS 0 0 0
2005 CALCIUM LACTATE TABLET 500 MG TABLET 1860 4000 5860
2084 CARBAMAZEPINE TABLET 200 MG TABLET 920 0 920
2518 CETIRIZINE SIRUP 1 MG/ML SIRUP 44 0 44
2546 CETIRIZINE TABLET 10 MG TABLET 0 0 0
2601 CHLORAMPHENICOL SALEP 2% SALEP 9 0 9
2593 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 29 0 29
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 13820 120000 133820
2762 CHLORPROMAZINE TABLET 100 MG TABLET 6400 0 6400
2828 CIPROFLOXACIN TABLET 500 MG TABLET 6280 3300 9580
2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET 66710 6400 73110
3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 249 0 249
6645 COTRIMOXAZOLE TABLET TABLET 458 0 458
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 10 0 10
3443 DEXAMETHASONE TABLET 0.5 MG TABLET 151 0 151
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 4530 2700 7230
3983 DOMPERIDONE TABLET 10 MG TABLET 1530 1200 2730
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 139 17 156
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 102 0 102
4458 ERYTHROMYCIN TABLET 250 MG TABLET 950 300 1250
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0 0
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 20 0 20
945 FOLIC ACID TABLET 400 MCG TABLET 100 0 100
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 7 0 7
5167 GENTAMYCIN SALEP 0.3 % SALEP 5 0 5
5266 GLIMEPIRIDE TABLET 2 MG TABLET 1340 1950 3290
5300 GLUCOSE INFUS 5 % INFUS 20 0 20
5843 HYDROCORTISONE SALEP 2.5 % SALEP 37 120 157
5964 IBUPROFEN TABLET 200 MG TABLET 920 0 920
AK0902022 Intravascular administration
IPRATROPIUM set
BROMIDE|SALBUTAMOL 0 0 0 0
6238 SULPHATE LIQUID LIQUID 17 0 17
AK9005688 IV CATHETER NO 20 0 266 0 266
AK9005689 IV CATHETER NO 22 0 182 0 182
AK9005690 IV CATHETER NO 24 0 184 0 184
6535 KETOCONAZOLE SALEP 2% SALEP 0 0 0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 50 0 50
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 59 30 89
6998 LOPERAMIDE TABLET 2 MG TABLET 794 800 1594
7013 LORATADINE TABLET 10 MG TABLET 7600 1600 9200
7491 METFORMIN TABLET 500 MG TABLET 1670 1200 2870
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 165 0 165
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0 0
7651 METOCLOPRAMIDE TABLET 10 MG TABLET 140 0 140
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 36 0 36
7697 METRONIDAZOLE TABLET 500 MG TABLET 1270 900 2170
7727 MICONAZOLE SALEP 2% SALEP 42 0 42
8160 NIFEDIPINE TABLET 10 MG TABLET 2250 0 2250
8256 NYSTATIN OVULA 10000 IU OVULA 80 0 80
8573 PARACETAMOL DROPS 100 MG/ML DROPS 0 0 0
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 2099 150 2249
8593 PARACETAMOL TABLET 500 MG TABLET 140618 10000 150618
9246 PHENYTOIN TABLET 100 MG TABLET 400 0 400
AK0902040 Piston syringe 0 0 0 0
9673 PROPANOL TABLET 10 MG
PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID| TABLET 330 0 330
9805 RIFAMPICIN TABLET TABLET 0 0 0
1684 PYRIDOXINE TABLET 10 MG TABLET 2750 4100 6850
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET 0 0 0
AK9008969 SARUNG TANGAN STERIL NO 7 0 279 150 429
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 265 150 415
10482 SIMVASTATIN TABLET 10 MG TABLET 4140 2280 6420
SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET
10908 400 MG|80 MG TABLET 0 0 0
AK0501030 Syringe actuator for an injector 0 0 0 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 25 0 25
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0 0
11922 VITAMIN B COMPOUND TABLET TABLET 2600 4300 6900
12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP 0 0 0
TAMBAHAN
Penerimaa
Kode Nama Obat Sediaan Stok Awal n Persediaan
1 AMINOPHILLIN TABLET 200 TABLET 50 0 50

2 AMOKSISILIN TABLET 250 MG TABLET 0 0 0
4 AMOKSISILIN SIRUP 125 MG/5 ML TABLET 626 450 1076
5 ANTASIDA SUSPENSI SIRUP 30 0 30
6 ANTIHEMOROID SUPPOSITORIA SUPPOSITO 18 0 18
7 ANTIMIGREN:ERGOTAMIN+KAFEIN TABLET 180 0 180
8 ASETOSAL TABLET 80 MG TABLET 70 0 70
9 ASAM FOLAT TABLET 1 MG TABLET 1370 1700 3070
10 ASAM TRANEKSAMAT TABLET TABLET 0 0 0
11 ASAM TRANEKSAMAT INJEKSI 100MG/ML AMPUL 52 0 52
12 ASIKLOVIR TABLET 200 MG TABLET 45 0 45
14 ASIKLOVIR KRIM TUBE 0 0 0
15 ATROPIN SULFAT TABLET 0.5 MG TABLET 0 0 0
16 BEDAK SALISILAT SERBUK 2 % KOTAK 0 0 0
17 BETAMETHASON KRIM TUBE 65 25 90
19 DIGOKSIN TABLET 0.25 MG TABLET 25 0 25
20 ETAKRIDIN (RIVANOL) LARUTAN 0.1 % BOTOL 0 0 0
21 ETANOL 70 % BOTOL 86 0 86
22 EUGENOL CAIRAN BOTOL 8 0 8
23 FUROSEMIDE TABLET 40 MG TABLET 3145 3800 6945
24 FUROSEMIDE INJEKSI 10 MG/ML AMPUL 28 0 28
25 GENTIAN VIOLET LARUTAN 1 % BOTOL 0 0 0
26 GLIBENKLAMIDE TABLET 5 MG TABLET 0 0 0
27 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0
28 HALOPERIDOL TABLET 1.5 MG TABLET 0 0 0
29 HALOPERIDOL TABLET 5 MG TABLET 0 0 0
30 IBUPROFEN SIRUP 100 MG/5 ML TABLET 0 0 0
32 ISOSORBIT DINITRAT TABLET 5 MG TABLET 130 0 130
33 KAPTOPRIL TABLET 12.5 MG TABLET 0 0 0
34 KAPTOPRIL TABLER 25 MG TABLET 5635 0 5635
35 KAPTOPRIL TABLET 50 MG TABLET 0 0 0
36 KETOROLAT INJEKSI 30 MG/ML TABLET 0 0 0
37 KLOREAMFENIKOL KAPSUL 250 MG TABLET 0 0 0
38 MEBENDAZOL (VERMOKS) 100 MG TABLET 25 0 25
39 METILPREDNISOLON TABLET 4 MG TABLET 1520 500 2020
41 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0
42 NA KLORIDA INFUS 0.9 % TABLET 88 0 88
43 OKSITETRASIKLIN HCL SALEP MATA TUBE 0 0 0
44 PIRANTEL PAMOAT TABLET 0 0 0
45 POVIDON IODIDA LAR @30 ML BOTOL 20 0 20
48 RANITIDINE TABLET 150 MG TABLET 4075 2600 6675
49 SIPROFLOKSASIN TABLET 500 MH TABLET 0 0 0
50 TETRASIKLIN HCL KAPSUL 250 MG TABLET 0 0 0
52 ETYL KLORIDE SPRAY BOTOL 0 0 0
53 ASAM FOLAT 0,4 MG TABLET 0 0 0
54 DIAZEPAM TABLET 2 MG TABLET 280 0 280
55 DIAZEPAM INJ. 5 MG/ML AMPUL 18 0 18
56 GLUKOSA LAR INFUS 10% BOTOL 20 0 20
57 KLOREAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0
58 K:IPRATROPIUM Br.0,5MG+SALBUTAMOL UNIT 0 0 0
59 PROPILTIOURASIL 100 MG TABLET 100 0 100
60 RISPERIDONE 2 MG TABLET 300 0 300
61 NATRIUM FUSIDAT TUBE 5 0 5
62 PROPANOLOL 40 MG TABLET 280 0 280
63 CETIRIZINE SIRUP 5 MG/ML BOTOL 0 0 0
64 SALEP 2-4 KOMBINASI POT 79 48 127
65 KETOKONAZOLE 200 MG TABLET 700 600 1300
66 ATTAPULGIT KAPSUL 0 0 0
67 RINGER LAKTAT LAR.INFUS BOTOL 221 0 221
68 OMEPRAZOL 20 MG KASUL 530 0 530
69 Providon iodine Btl 300 ml 6 0 6
70 Spirinolakton tab 25 mg Ktk 100 tab 300 0 300
71 DHP tab Ktk 9 tab 9 0 9
Antibakteri, kombinasi : basitrasin 500 UI/g+ Tube
Polimiskin B 10.000 UI/g
72 66 24 90
Antifungi salep, kombinasi : asam benzoat 6%+ Ktk 24 Pot
asam salisilat 3%
73 105 48 153
74 Griseofulvin (micronized) tab scored 250 mg Tablet 290 0 290
75 Kloramfenikol salep mata 1% Tube 155 0 155
76 Salbutamol tab 2 mg Tablet 1950 1600 3550
77 Sianokobalamin (vitamin B12) tab 50 mcg Tablet 1760 1500 3260
78 Tiamin (vitamin B1) tab 50 mg Tablet 6690 2400 9090
79 Perak sulfadiazin krim 1% Tube 7 0 7
80 Stesolid Ktk 5 Supp 22 10 32
81 Karbamazepin 200 mg Kaplet 350 300 650
82 Triheksifenadil 2 mg Tablet 1900 700 2600
Bisakodil tab sal 5 mg Ktk 30
Tab 480
83 0 480
84 Isoniazid 300 mg Tablet 100 0 100
OBAT PROGRAM
Penerimaa
Kode Nama Obat Sediaan Stok Awal n Persediaan
85 ALBENDAZOLE TABLET 400 MG TABLET 830 120 950

86 GARAM ORALIT SACHET 599 0 599
87 GENTAMICIN INJEKSI AMP 9 0 9
88 MAGNESIUM SULFAT INJEKSI 40 % VIAL 0 0 0
89 GENTAMICIN SALEM MATA TUBE 3 0 3
90 OBAT FDC KATEGORI I PAKET 0 0 0
91 OBAT FDC KATEGORI II PAKET 0 0 0
92 OBAT FDC KATEGORI ANAK PAKET 0 0 0
93 OBAT FDC KATEGORI SISIPAN PAKET 0 0 0
94 PREDNISON TABLET 5 MG TABLET 2190 1900 4090
95 ZINK TABLET TABLET 0 0 0
96 FENOBARBITAL INJEK 50 MG AMPUL 85 0 85
97 TABLET TAMBAH DARAH TABLET 0 0 0
98 EPINEFRIN INJEKSI 1 MG/ML AMPUL 0 0 0
99 FITOMENADION TABLET TABLET 446 300 746
100 METIL ERGOMETRIN INJEKSI AMPUL 0 0 0
101 OKSITOSIN INJEKSI 10 UI/ML AMPUL 113 0 113
102 FITOMENADION INJEK 2 MG/ML AMPUL 213 0 213
ALAT DAN BARANG MEDIS HABIS PAKA

n Persediaan
103 ALAT SUNTIK SEKALI PAKAI 0.5 ML PACS 1550 0 1550

104 ALAT SUNTIK SEKALI PAKAI 1 ML PACS 0 0 0
107 INFUSET DEWASA PACS 80 0 80
108 INFUSET ANAK PACS 21 0 21
109 KAPAS ABSORBEN 250 G PACS 25 5 30
110 KASA HIDROFIL STERIL 16 X 16 CM PACS 10 11 21
111 KASA PEMBALUT 3 INCHI PACS 0 0 0
113 MASKER PACS 1555 100 1655
114 SILK NO 3/0 DENGAN JARUM BEDAH PACS 0 0 0
115 PLESTER 5 YARD X 2 INCHI PACS 0 0 0
116 URINE BAG PACS 61 10 71
117 CUTGUT 3 PACS 0 0 0
118 PEMBALUT GIPS PACS 3 0 3
119 FOLEY CATETER PACS 5 0 5
120 Aximed swab 2-ply Dus 44 45 89
121 Cannofix-PU (6 cm x 8 cm) Pcs 14 0 14
122 SNA Medika Poliban 10 cm x 2.7 m Roll 5 0 5
123 Alkazyme sachet 25 mg pack 2 0 2
124 Alat suntik sekali pake 5 ml pcs 85 100 185
125 Paper tape/1.25 cmx9,14m roll 41 0 41
126 Egypt pharmapfix (5cmx500cm) box 4 3 7
OBAT PENGADAAN JKN

Kode Nama Obat Sediaan Stok Awal Penerimaa Persediaan
n
127 Acyclovir tab 200mg tab 90 0 90
128 Activated Anttapulagit 630 mg (Puralex Activated) tab 0 0 0
129 Asam Mefenamat kapsul 250 mg kap 0 0 0
130 Atenolol 50 mg (Farnormin 50 mg) tab 0 0 0
131 Betametason TM (Betam ophtal eye drop 24's) botol 0 0 0
132 Bisakodil supp 10 mg (Stolax Suppositoria) supp 0 0 0
133 Captopril 12,5 mg tab 0 0 0
134 Clorampenikol SK (Bufacetin 15 mg salep) tube 0 0 0
135 Dexamethason 5mg/5ml injeksi amp 0 0 0
136 Furosemide 40 mg tab tab 0 0 0
137 Ibuprofen tab 200 mg (botol) tab 0 0 0
138 Lidocain spray (Xylocaine 10% spray) botol 0 0 0
139 Metoclopramid sirup (Lexapram sirup 5mg/ 5ml) botol 0 0 0
140 Nifedipin 10 mg tab 110 0 110
141 Ondansetron 4 mg tab 0 0 0
142 Parasetamol sirup 120 mg/ 5ml botol 481 0 481
143 Permethrin 5%(Scabimite cream) tube 0 0 0
144 Pytomenadion (botol) tab 0 0 0
145 Ranitidin tab 150 mg tab 0 0 0
146 Salbutamol 2 mg tab 0 0 0
147 Salep 2-4 kombinasi Pot 9 0 9
148 Spironolakton 25 mg tab 100 0 100
149 Vitamin B12 50 mg tab tab 0 0 0
150 Ventolin Nebules 2,5mg 20amp/b bok 0 0 0
151 Zink sirup 20mg/5ml (zirkum) Btl 0 0 0
152 Zinc 20 mg tab tab 0 0 0
153 Diphenhydramin (HCL) inj.10ml/ml Amp 0 0 0
154 Chloramex Cap 500 mg Kap 0 0 0
155 Methylprednisolon 4 mg Tab 0 0 0
156 Calcium Laktat tablet 500 mg tab 0 0 0
157 Hydrokortison Krim 1% tube 5 gr tube 5 0 5
158 Erytromycin kapsul 250 mg Kap 60 0 60
159 Vitamin B12 inj. 500mcg/ml amp 0 0 0
160 Dexamethason tablet 0,5 mg tablet 1900 0 1900
161 Kloraniramina maleat (CTM) tablet 4 mg Tablet 200 0 200
162 Tablet tambah darah Tablet 18300 0 18300
Jumlah Umum
Tidak
Kunjungan bayar
Mengetahui bayar BPJS
Plh UPTD Puskesmas Karya Tani Resep bayar
809 380 0 429
KARYANTO,S.Kep
NIP.197306151994031003
AR PERMINTAAN OBAT
Bulan DESEMBER
Tahun : 2018
Pemakaian Rusak/Ed Sisa Stok Stok Permintaa Pemberian Keteranga

Optimum n n
400 0 4766 0
4 0 111 0
0 0 600 0
20 0 715 0
120 0 1445 0
60 0 1503 0
2700 0 48897 0
1650 0 53640 0
90 0 3210 0
100 0 8920 0
0 0 0 0
3 0 52 0
2 0 25 0
0 0 0 0
0 0 0 0
110 0 5750 0
120 0 800 0
4 0 40 0
0 0 0 0
1 0 8 0
2 0 27 0
2300 0 131520 0
0 0 6400 0
0 0 700 0
1200 0 8380 0
3400 0 69710 0
25 0 224 0
30 0 428 0
0 0 10 0
0 0 151 0
200 0 7030 0
110 0 3060 0
300 0 2430 0
1 0 155 0
3 0 99 0
150 0 1100 0
0 0 0 0
5 0 15 0
0 0 100 0
0 0 7 0
0 0 5 0
150 0 3140 0
0 0 20 0
5 0 152 0
100 0 820 0
0 0 0 0
0 0 0 0
3 0 14 0
6 0 260 0
5 0 177 0
10 0 174 0
0 0 0 0
0 0 50 0
4 0 85 0
250 0 1344 0
200 0 9000 0
300 0 2570 0
5 0 160 0
0 0 0 0
0 0 140 0
5 0 31 0
50 0 2120 0
2 0 40 0
300 0 1950 0
0 0 80 0
0 0 0 0
102 0 2147 0
3650 0 146968 0
0 0 400 0
0 0 0 0
50 0 280 0
0 0 0 0
500 0 6350 0
0 0 0 0
0 0 0 0
20 0 409 0
15 0 400 0
1000 0 5420 0
0 0 0 0
0 0 0 0
3 0 22 0
0 0 0 0
650 0 6250 0
0 0 0 0
AN
Stok Permintaa Keteranga
Pemakaian Rusak/Ed Sisa Stok Optimum n Pemberian n
0 0 50 0
0 0 0 0
0 0 0 0
25 0 1051 0
30 0 0 0
2 0 16 0
0 0 180 0
10 0 60 0
250 0 2820 0
0 0 0 0
5 0 47 0
0 0 45 0
100 0 830 0
0 0 0 0
0 0 0 0
0 0 0 0
10 0 80 0
0 0 25 0
0 0 0 0
5 0 81 0
0 0 8 0
200 0 6745 0
1 0 27 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
10 0 120 0
0 0 0 0
600 0 5035 0
0 0 0 0
0 0 0 0
0 0 0 0
1 0 24 0
110 0 1910 0
0 0 60 0
0 0 0 0
5 0 83 0
0 0 0 0
0 0 0 0
2 0 18 0
0 0 0 0
0 0 0 0
500 0 6175 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
100 0 180 0
0 0 18 0
0 0 20 0
0 0 0 0
0 0 0 0
50 0 50 0
10 0 290 0
0 0 5 0
50 0 230 0
0 0 0 0
10 0 117 0
100 0 1200 0
0 0 0 0
15 0 206 0
30 0 500 0
0 0 6 0
100 0 200 0
0 0 9 0
5 0 85 0
10 0 143 0
20 0 270 0
5 0 150 0
350 0 3200 0
300 0 2960 0
400 0 8690 0
0 0 7 0
0 0 32 0
100 0 550 0
100 0 2500 0
50 0 430 0
0 0 100 0
RAM
Pemakaian Rusak/Ed Sisa Stok Optimum n Pemberian n
50 0 900 0
40 0 559 0
0 0 9 0
0 0 0 0
0 0 3 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
400 0 3690 0
0 0 0 0
5 0 80 0
0 0 0 0
0 0 0 0
50 0 696 0
0 0 0 0
5 0 108 0
5 0 208 0
DIS HABIS PAKAI

Optimum n n
150 0 1400
0 0 0
50 0 429
170 0 7778
5 0 75
2 0 19
1 0 29
0 0 21
0 0 0
0 0 14
150 0 1505
0 0 0
0 0 0
2 0 69
0 0 0
0 0 3
2 0 3
2 0 87
0 0 14
0 0 5
0 0 2
10 0 175
2 0 39
0 0 7
AAN JKN
Optimum n n
0 0 90
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
60 0 50
0 0 0
60 0 421
0 0 0
0 0 0
0 0 0
0 0 0
0 0 9
50 0 50
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 5
0 0 60
0 0 0
500 0 1400
0 0 200
500 0 17800
Jumlah
Karya Tani, 02 januari 2019
Petugas Obat Puskesmas Karya Tani
809
MU'LINATUN ANISAH
NIP.19750215 201407 2 001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : JANUARI

Kecamatan : LABUHAN MARINGGAI Tahun : 2019
Provinsi : LAMPUNG
Stok Keteranga
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum Permintaan Pemberian n
247 ALLOPURINOL TABLET 100 MG TABLET 4766 0 4766 240 0 4526 0
415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 111 0 111 2 0 109 0
444 AMITRIPTYLINE TABLET 25 MG TABLET 600 0 600 0 0 600 0
445 AMLODIPINE TABLET 10 MG TABLET 715 0 715 240 0 475 0
446 AMLODIPINE TABLET 5 MG TABLET 1445 0 1445 210 0 1235 0
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1503 0 1503 43 0 1460 0
809 ANTACIDA TABLET 400 MG TABLET 48897 0 48897 1500 0 47397 0
966 ASAM MEFENAMAT TABLET 500 MG TABLET 53640 0 53640 1550 0 52090 0
923 ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET 3210 0 3210 660 0 2550 0
926 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 8920 0 8920 575 0 8345 0
1479 BENZOIC ACID SALEP SALEP 0 0 0 0 0 0 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOSITORIA 52 0 52 0 0 52 0
BISMUTH SUBGALLATE|ZINC OXIDE|
1691 BISACODYL SUPPOSITORIA 5 MG
LIDOCAINE|HEXACHLOROPHENE SUPPOSITORIA 25 0 25 8 0 17 0
1702 SUPPOSITORIA
CHLORIDE|SODIUM2 G CHLORIDE|SODIUM SUPPOSITORIA 0 0 0 0 0 0 0
10160 LACTATE INFUS INFUS 0 0 0 0 0 0 0
2005 CALCIUM LACTATE TABLET 500 MG TABLET 5750 0 5750 430 0 5320 0
2084 CARBAMAZEPINE TABLET 200 MG TABLET 800 0 800 0 0 800 0
2518 CETIRIZINE SIRUP 1 MG/ML SIRUP 40 0 40 8 0 32 0
2546 CETIRIZINE TABLET 10 MG TABLET 0 0 0 0 0 0 0
2601 CHLORAMPHENICOL SALEP 2% SALEP 8 0 8 0 0 8 0
2593 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 27 0 27 7 0 20 0
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 131520 0 131520 1700 0 129820 0
2762 CHLORPROMAZINE TABLET 100 MG TABLET 6400 0 6400 0 0 6400 0
2763 CHLORPROMAZINE TABLET 25 MG TABLET 700 0 700 0 0 700 0
2828 CIPROFLOXACIN TABLET 500 MG TABLET 500
CLAVULANIC ACID|AMOXICILLIN TABLET 8380 0 8380 120 0 8260 0
2967 MG TABLET 69710 0 69710 1850 0 67860 0
3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 224 0 224 17 0 207 0
6645 COTRIMOXAZOLE TABLET TABLET 428 0 428 170 0 258 0
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 10 0 10 8 0 2 0
3443 DEXAMETHASONE TABLET 0.5 MG TABLET 151 0 151 105 0 46 0
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 7030 0 7030 100 0 6930 0
3690 DICLOFENAC SODIUM TABLET 50 MG TABLET 3060 0 3060 60 0 3000 0
3983 DOMPERIDONE TABLET 10 MG TABLET 2430 0 2430 190 0 2240 0
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 155 0 155 0 0 155 0
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 99 0 99 5 0 94 0
4458 ERYTHROMYCIN TABLET 250 MG TABLET 1100 0 1100 0 0 1100 0
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0 0 0 0 0 0
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 15 0 15 3 0 12 0
945 FOLIC ACID TABLET 400 MCG TABLET 100 0 100 0 0 100 0
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 7 0 7 6 0 1 0
5167 GENTAMYCIN SALEP 0.3 % SALEP 5 0 5 5 0 0 0
5266 GLIMEPIRIDE TABLET 2 MG TABLET 3140 0 3140 170 0 2970 0
5300 GLUCOSE INFUS 5 % INFUS 20 0 20 2 0 18 0
5843 HYDROCORTISONE SALEP 2.5 % SALEP 152 0 152 5 0 147 0
5964 IBUPROFEN TABLET 200 MG TABLET 820 0 820 110 0 710 0
5966 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0 0 0 0
AK0902022 Intravascular
IPRATROPIUMadministration set
BROMIDE|SALBUTAMOL 0 0 0 0 0 0 0 0
6238 SULPHATE LIQUID LIQUID 14 0 14 0 0 14 0
AK9005688 IV CATHETER NO 20 0 260 0 260 2 0 258 0
AK9005689 IV CATHETER NO 22 0 177 0 177 0 0 177 0
AK9005690 IV CATHETER NO 24 0 174 0 174 0 0 174 0
6535 KETOCONAZOLE SALEP 2% SALEP 0 0 0 0 0 0 0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 50 0 50 0 0 50 0
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 85 0 85 8 0 77 0
6998 LOPERAMIDE TABLET 2 MG TABLET 1344 0 1344 50 0 1294 0
7013 LORATADINE TABLET 10 MG TABLET 9000 0 9000 60 0 8940 0
7491 METFORMIN TABLET 500 MG TABLET 2570 0 2570 150 0 2420 0
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 160 0 160 0 0 160 0
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0 0 0 0 0 0
7651 METOCLOPRAMIDE TABLET 10 MG TABLET 140 0 140 70 0 70 0
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 31 0 31 5 0 26 0
7697 METRONIDAZOLE TABLET 500 MG TABLET 2120 0 2120 74 0 2046 0
7727 MICONAZOLE SALEP 2% SALEP 40 0 40 5 0 35 0
8160 NIFEDIPINE TABLET 10 MG TABLET 1950 0 1950 0 0 1950 0
8256 NYSTATIN OVULA 10000 IU OVULA 80 0 80 5 0 75 0
8573 PARACETAMOL DROPS 100 MG/ML DROPS 0 0 0 0 0 0 0
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 2147 0 2147 55 0 2092 0
8593 PARACETAMOL TABLET 500 MG TABLET 146968 0 146968 3180 0 143788 0
9246 PHENYTOIN TABLET 100 MG TABLET 400 0 400 0 0 400 0
AK0902040 Piston syringe 0 0 0 0 0 0 0 0
PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID| TABLET 280 0 280 0 0 280 0
9805 RIFAMPICIN TABLET TABLET 0 0 0 0 0 0 0
1684 PYRIDOXINE TABLET 10 MG TABLET 6350 0 6350 5 0 6345 0
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0 0 0 0 0
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET 0 0 0 0 0 0 0
AK9008969 SARUNG TANGAN STERIL NO 7 0 409 0 409 10 0 399 0
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 400 0 400 15 0 385 0
10482 SIMVASTATIN TABLET 10 MG
SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET TABLET 5420 0 5420 360 0 5060 0
10908 400 MG|80 MG TABLET 0 0 0 0 0 0 0
AK0501030 Syringe actuator for an injector 0 0 0 0 0 0 0 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 22 0 22 0 0 22 0
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0 0 0 0 0 0
11922 VITAMIN B COMPOUND TABLET TABLET 6250 0 6250 150 0 6100 0
12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP 0 0 0 0 0 0 0
TAMBAHAN
Stok Keteranga
1 AMINOPHILLIN TABLET 200 TABLET 50 0 50 10 0 40 0
2 AMOKSISILIN TABLET 250 MG TABLET 0 0 0 0 0 0 0
3 AMOKSISILIN TABLET 500 MG TABLET 0 0 0 0 0 0 0
4 AMOKSISILIN SIRUP 125 MG/5 ML TABLET 626 0 626 11 0 615 0
5 ANTASIDA SUSPENSI SIRUP 30 0 30 20 0 10 0
6 ANTIHEMOROID SUPPOSITORIA SUPPOSITORIA 18 0 18 5 0 13 0
7 ANTIMIGREN:ERGOTAMIN+KAFEIN TABLET 180 0 180 0 0 180 0
8 ASETOSAL TABLET 80 MG TABLET 70 0 70 0 0 70 0
9 ASAM FOLAT TABLET 1 MG TABLET 1370 0 1370 100 0 1270 0
10 ASAM TRANEKSAMAT TABLET TABLET 0 0 0 0 0 0 0
11 ASAM TRANEKSAMAT INJEKSI 100MG/ML AMPUL 52 0 52 3 0 49 0
12 ASIKLOVIR TABLET 200 MG TABLET 45 0 45 0 0 45 0
13 ASIKLOVIR TABLET 400 MG TABLET 930 0 930 0 0 930 0
14 ASIKLOVIR KRIM TUBE 0 0 0 0 0 0 0
15 ATROPIN SULFAT TABLET 0.5 MG TABLET 0 0 0 0 0 0 0
16 BEDAK SALISILAT SERBUK 2 % KOTAK 0 0 0 0 0 0 0
17 BETAMETHASON KRIM TUBE 65 0 65 5 0 60 0
19 DIGOKSIN TABLET 0.25 MG TABLET 25 0 25 15 0 10 0
20 ETAKRIDIN (RIVANOL) LARUTAN 0.1 % BOTOL 0 0 0 0 0 0 0
21 ETANOL 70 % BOTOL 86 0 86 6 0 80 0
22 EUGENOL CAIRAN BOTOL 8 0 8 2 0 6 0
23 FUROSEMIDE TABLET 40 MG TABLET 3145 0 3145 133 0 3012 0
24 FUROSEMIDE INJEKSI 10 MG/ML AMPUL 28 0 28 4 0 24 0
25 GENTIAN VIOLET LARUTAN 1 % BOTOL 0 0 0 0 0 0 0
26 GLIBENKLAMIDE TABLET 5 MG TABLET 0 0 0 0 0 0 0
27 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0 0 0 0 0
28 HALOPERIDOL TABLET 1.5 MG TABLET 0 30 30 0 0 30 0
29 HALOPERIDOL TABLET 5 MG TABLET 0 500 500 0 0 500 0
30 IBUPROFEN SIRUP 100 MG/5 ML TABLET 0 0 0 0 0 0 0
31 IBUPROFEN SIRUP 200 MG/5 ML TABLET 0 0 0 0 0 0 0
32 ISOSORBIT DINITRAT TABLET 5 MG TABLET 130 0 130 40 0 90 0
33 KAPTOPRIL TABLET 12.5 MG TABLET 0 0 0 0 0 0 0
34 KAPTOPRIL TABLER 25 MG TABLET 5635 0 5635 76 0 5559 0
35 KAPTOPRIL TABLET 50 MG TABLET 0 0 0 0 0 0 0
36 KETOROLAT INJEKSI 30 MG/ML TABLET 0 0 0 0 0 0 0
37 KLOREAMFENIKOL KAPSUL 250 MG TABLET 0 0 0 0 0 0 0
38 MEBENDAZOL (VERMOKS) 100 MG TABLET 25 0 25 8 0 17 0
39 METILPREDNISOLON TABLET 4 MG TABLET 1520 0 1520 100 0 1420 0
40 METRONIDAZOLE TABLET 250 MG TABLET 60 0 60 0 0 60 0
41 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0 0 0 0 0
42 NA KLORIDA INFUS 0.9 % TABLET 88 0 88 3 0 85 0
43 OKSITETRASIKLIN HCL SALEP MATA TUBE 0 0 0 0 0 0 0
44 PIRANTEL PAMOAT TABLET 0 0 0 0 0 0 0
45 POVIDON IODIDA LAR @30 ML BOTOL 20 0 20 0 0 20 0
48 RANITIDINE TABLET 150 MG TABLET 4075 0 4075 180 0 3895 0
49 SIPROFLOKSASIN TABLET 500 MH TABLET 0 0 0 0 0 0 0
50 TETRASIKLIN HCL KAPSUL 250 MG TABLET 0 0 0 0 0 0 0
51 TETRASIKLIN HCL KAPSUL 500 MG TABLET 0 0 0 0 0 0 0
52 ETYL KLORIDE SPRAY BOTOL 0 0 0 0 0 0 0
53 ASAM FOLAT 0,4 MG TABLET 0 0 0 0 0 0 0
54 DIAZEPAM TABLET 2 MG TABLET 280 0 280 60 0 220 0
55 DIAZEPAM INJ. 5 MG/ML AMPUL 18 0 18 0 0 18 0
56 GLUKOSA LAR INFUS 10% BOTOL 20 0 20 0 0 20 0
57 KLOREAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0 0 0 0 0
58 K:IPRATROPIUM Br.0,5MG+SALBUTAMOL UNIT 0 0 0 0 0 0 0
59 PROPILTIOURASIL 100 MG TABLET 100 0 100 0 0 100 0
60 RISPERIDONE 2 MG TABLET 300 0 300 0 0 300 0
61 NATRIUM FUSIDAT TUBE 5 0 5 0 0 5 0
62 PROPANOLOL 40 MG TABLET 280 0 280 0 0 280 0
63 CETIRIZINE SIRUP 5 MG/ML BOTOL 0 0 0 0 0 0 0
64 SALEP 2-4 KOMBINASI POT 79 0 79 5 0 74 0
65 KETOKONAZOLE 200 MG TABLET 700 0 700 20 0 680 0
66 ATTAPULGIT KAPSUL 0 0 0 0 0 0 0
67 RINGER LAKTAT LAR.INFUS BOTOL 221 0 221 3 0 218 0
68 OMEPRAZOL 20 MG KASUL 530 0 530 390 0 140 0
69 Providon iodine Btl 300 ml 6 0 6 0 0 6 0
70 Spirinolakton tab 25 mg Ktk 100 tab 300 0 300 0 0 300 0
71 DHP tab Ktk 9 tab 9 0 9 0 0 9 0
72 Antibakteri, kombinasi : basitrasin 500 UI/g+ Tube 66 0 66 0 0 66 0
Polimiskin B 10.000
Antifungi salep, UI/g : asam benzoat 6%+
kombinasi Ktk 24 Pot
73 105 0 105 0 0 105 0
asam salisilat 3%
Griseofulvin (micronized) tab scored 250 mg Tablet
74 290 0 290 0 0 290 0
75 Kloramfenikol salep mata 1% Tube 155 0 155 0 0 155 0
76 Salbutamol tab 2 mg Tablet 1950 0 1950 40 0 1910 0
77 Sianokobalamin (vitamin B12) tab 50 mcg Tablet 1760 0 1760 50 0 1710 0
78 Tiamin (vitamin B1) tab 50 mg Tablet 6690 0 6690 0 0 6690 0
79 Perak sulfadiazin krim 1% Tube 7 0 7 0 0 7 0
80 Stesolid Ktk 5 Supp 22 0 22 0 0 22 0
81 Karbamazepin 200 mg Kaplet 350 0 350 0 0 350 0
82 Triheksifenadil 2 mg Tablet 1900 0 1900 0 0 1900 0
83 Bisakodil tab sal 5 mg Ktk 30 Tab 480 0 480 0 0 480 0
84 Isoniazid 300 mg Tablet 100 0 100 0 0 100 0
OBAT PROGRAM
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Permintaan Pemberian Keteranga
Optimum n
85 ALBENDAZOLE TABLET 400 MG TABLET 830 0 830 10 0 820 0
86 GARAM ORALIT SACHET 599 0 599 58 0 541 0
87 GENTAMICIN INJEKSI AMP 9 0 9 0 0 9 0
88 MAGNESIUM SULFAT INJEKSI 40 % VIAL 0 0 0 0 0 0 0
89 GENTAMICIN SALEM MATA TUBE 3 0 3 0 0 3 0
90 OBAT FDC KATEGORI I PAKET 0 16 16 0 0 16 0
91 OBAT FDC KATEGORI II PAKET 0 1 1 0 0 1 0
92 OBAT FDC KATEGORI ANAK PAKET 0 0 0 0 0 0 0
93 OBAT FDC KATEGORI SISIPAN PAKET 0 0 0 0 0 0 0
94 PREDNISON TABLET 5 MG TABLET 2190 0 2190 400 0 1790 0
95 ZINK TABLET TABLET 0 0 0 0 0 0 0
96 FENOBARBITAL INJEK 50 MG AMPUL 85 0 85 0 0 85 0
97 TABLET TAMBAH DARAH TABLET 0 0 0 0 0 0 0
98 EPINEFRIN INJEKSI 1 MG/ML AMPUL 0 0 0 0 0 0 0
99 FITOMENADION TABLET TABLET 446 0 446 0 0 446 0
100 METIL ERGOMETRIN INJEKSI AMPUL 0 0 0 0 0 0 0
101 OKSITOSIN INJEKSI 10 UI/ML AMPUL 113 0 113 0 0 113 0
102 FITOMENADION INJEK 2 MG/ML AMPUL 213 0 213 0 0 213 0
ALAT DAN BARANG MEDIS HABIS PAKAI

Stok Keteranga
103 ALAT SUNTIK SEKALI PAKAI 0.5 ML PACS 1550 0 1550 150 0 1400
104 ALAT SUNTIK SEKALI PAKAI 1 ML PACS 0 0 0 0 0 0
107 INFUSET DEWASA PACS 80 0 80 5 0 75
108 INFUSET ANAK PACS 21 0 21 2 0 19
109 KAPAS ABSORBEN 250 G PACS 25 0 25 1 0 24
110 KASA HIDROFIL STERIL 16 X 16 CM PACS 10 0 10 0 0 10
111 KASA PEMBALUT 3 INCHI PACS 0 0 0 0 0 0
113 MASKER PACS 1555 0 1555 150 0 1405
114 SILK NO 3/0 DENGAN JARUM BEDAH PACS 0 0 0 0 0 0
115 PLESTER 5 YARD X 2 INCHI PACS 0 0 0 0 0 0
116 URINE BAG PACS 61 0 61 2 0 59
117 CUTGUT 3 PACS 0 0 0 0 0 0
118 PEMBALUT GIPS PACS 3 0 3 0 0 3
119 FOLEY CATETER PACS 5 0 5 2 0 3
120 Aximed swab 2-ply Dus 44 0 44 2 0 42
121 Cannofix-PU (6 cm x 8 cm) Pcs 14 0 14 0 0 14
122 SNA Medika Poliban 10 cm x 2.7 m Roll 5 0 5 0 0 5
123 Alkazyme sachet 25 mg pack 2 0 2 0 0 2
124 Alat suntik sekali pake 5 ml pcs 85 0 85 10 0 75
125 Paper tape/1.25 cmx9,14m roll 41 0 41 2 0 39
126 Egypt pharmapfix (5cmx500cm) box 4 0 4 0 0 4
OBAT PENGADAAN JKN

Stok Keteranga
127 Acyclovir tab 200mg tab 90 0 90 0 0 90
128 Activated Anttapulagit 630 mg (Puralex Activated tab 0 0 0 0 0 0
129 Asam Mefenamat kapsul 250 mg kap 0 0 0 0 0 0
130 Atenolol 50 mg (Farnormin 50 mg) tab 0 0 0 0 0 0
131 Betametason TM (Betam ophtal eye drop 24's) botol 0 0 0 0 0 0
132 Bisakodil supp 10 mg (Stolax Suppositoria) supp 0 0 0 0 0 0
133 Captopril 12,5 mg tab 0 0 0 0 0 0
134 Clorampenikol SK (Bufacetin 15 mg salep) tube 0 0 0 0 0 0
135 Dexamethason 5mg/5ml injeksi amp 0 0 0 0 0 0
136 Furosemide 40 mg tab tab 0 0 0 0 0 0
137 Ibuprofen tab 200 mg (botol) tab 0 0 0 0 0 0
138 Lidocain spray (Xylocaine 10% spray) botol 0 0 0 0 0 0
139 Metoclopramid sirup (Lexapram sirup 5mg/ 5ml) botol 0 0 0 0 0 0
140 Nifedipin 10 mg tab 110 0 110 60 0 50
141 Ondansetron 4 mg tab 0 0 0 0 0 0
142 Parasetamol sirup 120 mg/ 5ml botol 481 0 481 26 0 455
143 Permethrin 5%(Scabimite cream) tube 0 0 0 0 0 0
144 Pytomenadion (botol) tab 0 0 0 0 0 0
145 Ranitidin tab 150 mg tab 0 0 0 0 0 0
146 Salbutamol 2 mg tab 0 0 0 0 0 0
147 Salep 2-4 kombinasi Pot 9 0 9 3 0 6
148 Spironolakton 25 mg tab 100 0 100 50 0 50
149 Vitamin B12 50 mg tab tab 0 0 0 0 0 0
150 Ventolin Nebules 2,5mg 20amp/b bok 0 0 0 0 0 0
151 Zink sirup 20mg/5ml (zirkum) Btl 0 0 0 0 0 0
152 Zinc 20 mg tab tab 0 0 0 0 0 0
153 Diphenhydramin (HCL) inj.10ml/ml Amp 0 0 0 0 0 0
154 Chloramex Cap 500 mg Kap 0 0 0 0 0 0
155 Methylprednisolon 4 mg Tab 0 0 0 0 0 0
156 Calcium Laktat tablet 500 mg tab 0 0 0 0 0 0
157 Hydrokortison Krim 1% tube 5 gr tube 5 0 5 2 0 3
158 Erytromycin kapsul 250 mg Kap 60 0 60 0 0 60
159 Vitamin B12 inj. 500mcg/ml amp 0 0 0 0 0 0
160 Dexamethason tablet 0,5 mg tablet 1900 0 1900 310 0 1590
161 Kloraniramina maleat (CTM) tablet 4 mg Tablet 200 0 200 0 0 200
162 Tablet tambah darah Tablet 18300 0 18300 500 0 17800
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 04 Februari 2019
Plh UPTD Puskesmas Karya Tani Resep bayar Petugas Obat Puskesmas Karya Tani
718 318 0 400 718

KARYANTO,S.Kep MU'LINATUN ANISAH
NIP.197306151994031003 NIP.19750215 201407 2 001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : FEBRUARI

Provinsi : LAMPUNG
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Permintaa Pemberian Keteranga
Optimum n n
247 ALLOPURINOL TABLET 100 MG TABLET 4526 800 5326 200 0 5126
415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 109 0 109 3 0 106
444 AMITRIPTYLINE TABLET 25 MG TABLET 600 0 600 0 0 600
445 AMLODIPINE TABLET 10 MG TABLET 475 6000 6475 210 0 6265
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1460 0 1460 43 0 1417
809 ANTACIDA TABLET 400 MG TABLET 47397 0 47397 2150 0 45247
966 ASAM MEFENAMAT TABLET 500 MG TABLET 52090 3000 55090 1340 0 53750
923 ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET 2550 0 2550 450 0 2100
1479 BENZOIC ACID SALEP SALEP 0 0 0 0 0 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOSITORIA 52 40 92 6 0 86
LIDOCAINE|HEXACHLOROPHENE SUPPOSITORIA 17 30 47 4 0 43
1702 SUPPOSITORIA
CHLORIDE|SODIUM2 G CHLORIDE|SODIUM SUPPOSITORIA 0 0 0 0 0 0
10160 LACTATE INFUS INFUS 0 0 0 0 0 0
2005 CALCIUM LACTATE TABLET 500 MG TABLET 5320 5800 11120 1530 0 9590
2084 CARBAMAZEPINE TABLET 200 MG TABLET 800 0 800 50 0 750
2518 CETIRIZINE SIRUP 1 MG/ML SIRUP 32 50 82 15 0 67
2546 CETIRIZINE TABLET 10 MG TABLET 0 160 160 0 0 160
2601 CHLORAMPHENICOL SALEP 2% SALEP 8 0 8 0 0 8
2593 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 20 50 70 15 0 55
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 129820 19800 149620 2300 0 147320
2762 CHLORPROMAZINE TABLET 100 MG TABLET 6400 0 6400 100 0 6300
2828 CIPROFLOXACIN TABLET 500 MG TABLET 8260 0 8260 870 0 7390
CLAVULANIC ACID|AMOXICILLIN TABLET 500
2967 MG TABLET 67860 5000 72860 2100 0 70760
3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 207 0 207 10 0 197
6645 COTRIMOXAZOLE TABLET TABLET 258 0 258 50 0 208
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 2 0 2 0 0 2
3443 DEXAMETHASONE TABLET 0.5 MG TABLET 46 9700 9746 700 0 9046
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 6930 6050 12980 230 0 12750
3983 DOMPERIDONE TABLET 10 MG TABLET 2240 3700 5940 350 0 5590
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 155 100 255 5 0 250
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 94 0 94 5 0 89
4458 ERYTHROMYCIN TABLET 250 MG TABLET 1100 15 1115 50 0 1065
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0 0 0 0 0
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 12 0 12 2 0 10
945 FOLIC ACID TABLET 400 MCG TABLET 100 0 100 0 0 100
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 1 0 1 1 0 0
5167 GENTAMYCIN SALEP 0.3 % SALEP 0 24 24 5 0 19
5266 GLIMEPIRIDE TABLET 2 MG TABLET 2970 3000 5970 250 0 5720
5300 GLUCOSE INFUS 5 % INFUS 18 0 18 1 0 17
5843 HYDROCORTISONE SALEP 2.5 % SALEP 147 192 339 15 0 324
5964 IBUPROFEN TABLET 200 MG TABLET 710 900 1610 50 0 1560
BROMIDE|SALBUTAMOL 0 0 0 0 0 0 0
6238 SULPHATE LIQUID LIQUID 14 0 14 3 0 11
AK9005688 IV CATHETER NO 20 0 258 0 258 5 0 253
AK9005689 IV CATHETER NO 22 0 177 0 177 6 0 171
AK9005690 IV CATHETER NO 24 0 174 0 174 8 0 166
6535 KETOCONAZOLE SALEP 2% SALEP 0 25 25 2 0 23
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 50 0 50 0 0 50
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 77 200 277 14 0 263
6998 LOPERAMIDE TABLET 2 MG TABLET 1294 0 1294 130 0 1164
7013 LORATADINE TABLET 10 MG TABLET 8940 1250 10190 300 0 9890
7491 METFORMIN TABLET 500 MG TABLET 2420 900 3320 230 0 3090
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 160 0 160 5 0 155
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0 0 0 0 0
7651 METOCLOPRAMIDE TABLET 10 MG TABLET 70 0 70 70 0 0
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 26 50 76 5 0 71
7697 METRONIDAZOLE TABLET 500 MG TABLET 2046 0 2046 230 0 1816
7727 MICONAZOLE SALEP 2% SALEP 35 0 35 3 0 32
8160 NIFEDIPINE TABLET 10 MG TABLET 1950 0 1950 50 0 1900
8256 NYSTATIN OVULA 10000 IU OVULA 75 0 75 10 0 65
8573 PARACETAMOL DROPS 100 MG/ML DROPS 0 56 56 3 0 53
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 2092 100 2192 60 0 2132
8593 PARACETAMOL TABLET 500 MG TABLET 143788 2500 146288 3340 0 142948
9246 PHENYTOIN TABLET 100 MG TABLET 400 0 400 0 0 400
AK0902040 Piston syringe 0 0 0 0 0 0 0
PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID| TABLET 280 0 280 0 0 280
9805 RIFAMPICIN TABLET TABLET 0 0 0 0 0 0
1684 PYRIDOXINE TABLET 10 MG TABLET 6345 4100 10445 1020 0 9425
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0 0 0 0
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET 0 0 0 0 0 0
AK9008969 SARUNG TANGAN STERIL NO 7 0 399 0 399 16 0 383
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 385 0 385 12 0 373
SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET TABLET 5060 1680 6740 650 0 6090
10908 400 MG|80 MG TABLET 0 0 0 0 0 0
AK0501030 Syringe actuator for an injector 0 0 0 0 0 0 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 22 0 22 2 0 20
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0 0 0 0 0
11922 VITAMIN B COMPOUND TABLET TABLET 6100 0 6100 1700 0 4400
12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP 0 0 0 0 0 0
TAMBAHAN
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum n Pemberian n
1 AMINOPHILLIN TABLET 200 TABLET 40 0 40 0 0 40
2 AMOKSISILIN TABLET 250 MG TABLET 0 0 0 0 0 0
4 AMOKSISILIN SIRUP 125 MG/5 ML TABLET 615 360 975 39 0 936
5 ANTASIDA SUSPENSI SIRUP 10 150 160 10 0 150
6 ANTIHEMOROID SUPPOSITORIA SUPPOSITORIA 13 0 13 2 0 11
7 ANTIMIGREN:ERGOTAMIN+KAFEIN TABLET 180 0 180 10 0 170
8 ASETOSAL TABLET 80 MG TABLET 70 0 70 0 0 70
9 ASAM FOLAT TABLET 1 MG TABLET 1270 0 1270 110 0 1160
10 ASAM TRANEKSAMAT TABLET TABLET 0 0 0 0 0 0
11 ASAM TRANEKSAMAT INJEKSI 100MG/ML AMPUL 49 0 49 2 0 47
12 ASIKLOVIR TABLET 200 MG TABLET 45 0 45 0 0 45
14 ASIKLOVIR KRIM TUBE 0 0 0 0 0 0
15 ATROPIN SULFAT TABLET 0.5 MG TABLET 0 0 0 0 0 0
16 BEDAK SALISILAT SERBUK 2 % KOTAK 0 30 30 0 0 30
17 BETAMETHASON KRIM TUBE 60 100 160 18 0 142
19 DIGOKSIN TABLET 0.25 MG TABLET 10 0 10 0 0 10
20 ETAKRIDIN (RIVANOL) LARUTAN 0.1 % BOTOL 0 0 0 0 0 0
21 ETANOL 70 % BOTOL 80 0 80 10 0 70
22 EUGENOL CAIRAN BOTOL 6 0 6 3 0 3
23 FUROSEMIDE TABLET 40 MG TABLET 3012 2200 5212 60 0 5152
24 FUROSEMIDE INJEKSI 10 MG/ML AMPUL 24 0 24 2 0 22
25 GENTIAN VIOLET LARUTAN 1 % BOTOL 0 0 0 0 0 0
26 GLIBENKLAMIDE TABLET 5 MG TABLET 0 5800 5800 0 0 5800
27 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0 0 0 0
28 HALOPERIDOL TABLET 1.5 MG TABLET 30 0 30 10 0 20
29 HALOPERIDOL TABLET 5 MG TABLET 500 0 500 100 0 400
30 IBUPROFEN SIRUP 100 MG/5 ML TABLET 0 0 0 0 0 0
32 ISOSORBIT DINITRAT TABLET 5 MG TABLET 90 0 90 10 0 80
33 KAPTOPRIL TABLET 12.5 MG TABLET 0 0 0 0 0 0
34 KAPTOPRIL TABLER 25 MG TABLET 5559 700 6259 190 0 6069
35 KAPTOPRIL TABLET 50 MG TABLET 0 0 0 0 0 0
36 KETOROLAT INJEKSI 30 MG/ML TABLET 0 0 0 0 0 0
37 KLOREAMFENIKOL KAPSUL 250 MG TABLET 0 0 0 0 0 0
38 MEBENDAZOL (VERMOKS) 100 MG TABLET 17 0 17 17 0 0
39 METILPREDNISOLON TABLET 4 MG TABLET 1420 2700 4120 130 0 3990
41 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0 0 0 0
42 NA KLORIDA INFUS 0.9 % TABLET 85 20 105 5 0 100
43 OKSITETRASIKLIN HCL SALEP MATA TUBE 0 0 0 0 0 0
44 PIRANTEL PAMOAT TABLET 0 0 0 0 0 0
45 POVIDON IODIDA LAR @30 ML BOTOL 20 0 20 2 0 18
48 RANITIDINE TABLET 150 MG TABLET 3895 0 3895 200 0 3695
49 SIPROFLOKSASIN TABLET 500 MH TABLET 0 0 0 0 0 0
50 TETRASIKLIN HCL KAPSUL 250 MG TABLET 0 0 0 0 0 0
52 ETYL KLORIDE SPRAY BOTOL 0 0 0 0 0 0
53 ASAM FOLAT 0,4 MG TABLET 0 0 0 0 0 0
54 DIAZEPAM TABLET 2 MG TABLET 220 0 220 100 0 120
55 DIAZEPAM INJ. 5 MG/ML AMPUL 18 0 18 0 0 18
56 GLUKOSA LAR INFUS 10% BOTOL 20 0 20 2 0 18
57 KLOREAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0 0 0 0
58 K:IPRATROPIUM Br.0,5MG+SALBUTAMOL UNIT 0 0 0 0 0 0
59 PROPILTIOURASIL 100 MG TABLET 100 0 100 0 0 100
60 RISPERIDONE 2 MG TABLET 300 0 300 100 0 200
61 NATRIUM FUSIDAT TUBE 5 0 5 0 0 5
62 PROPANOLOL 40 MG TABLET 280 0 280 0 0 280
63 CETIRIZINE SIRUP 5 MG/ML BOTOL 0 0 0 0 0 0
64 SALEP 2-4 KOMBINASI POT 74 72 146 6 0 140
65 KETOKONAZOLE 200 MG TABLET 680 450 1130 50 0 1080
66 ATTAPULGIT KAPSUL 0 3000 3000 0 0 3000
67 RINGER LAKTAT LAR.INFUS BOTOL 218 0 218 6 0 212
68 OMEPRAZOL 20 MG KASUL 140 300 440 100 0 340
69 Providon iodine Btl 300 ml 6 0 6 0 0 6
70 Spirinolakton tab 25 mg Ktk 100 tab 300 0 300 0 0 300
71 DHP tab Ktk 9 tab 9 0 9 0 0 9
72 Antibakteri, kombinasi : basitrasin 500 UI/g+ Tube 66 125 191 10 0 181
Polimiskin B 10.000
73 105 48 153 5 0 148
asam salisilat 3%
74 290 200 490 50 0 440
75 Kloramfenikol salep mata 1% Tube 155 72 227 10 0 217
76 Salbutamol tab 2 mg Tablet 1910 2400 4310 90 0 4220
77 Sianokobalamin (vitamin B12) tab 50 mcg Tablet 1710 2000 3710 240 0 3470
78 Tiamin (vitamin B1) tab 50 mg Tablet 6690 2500 9190 230 0 8960
79 Perak sulfadiazin krim 1% Tube 7 3 10 1 0 9
80 Stesolid Ktk 5 Supp 22 0 22 1 0 21
81 Karbamazepin 200 mg Kaplet 350 0 350 50 0 300
82 Triheksifenadil 2 mg Tablet 1900 0 1900 100 0 1800
83 Bisakodil tab sal 5 mg Ktk 30 Tab 480 0 480 50 0 430
84 Isoniazid 300 mg Tablet 100 0 100 0 0 100
85 Phenol Glycerol/tetes telinga BOTOL 0 48 48 0 0 48
86 Copanol/parasetamol syrup botol 0 9 9 0 0 9
87 Iremax/parasetamol+ibuprofen TABLET 0 500 500 0 0 500
88 Lidocain injeksi 2% + Epineprin ampul 0 120 120 0 0 120
89 Nufit syrup BOTOL 0 9 9 0 0 9
90 N-asetil sestein kap 200 mg kap 0 120 120 0 0 120
91 Ranitidin HCL inj 25mg/ml ampul 0 0 0 0 0 0
OBAT PROGRAM
92 ALBENDAZOLE TABLET 400 MG TABLET 830 0 830 50 0 780
93 GARAM ORALIT SACHET 599 0 599 70 0 529
94 GENTAMICIN INJEKSI AMP 9 0 9 0 0 9
95 MAGNESIUM SULFAT INJEKSI 40 % VIAL 0 0 0 0 0 0
96 GENTAMICIN SALEM MATA TUBE 3 0 3 0 0 3
97 OBAT FDC KATEGORI I PAKET 16 0 16 0 0 16
98 OBAT FDC KATEGORI II PAKET 1 0 1 0 0 1
99 OBAT FDC KATEGORI ANAK PAKET 0 0 0 0 0 0
100 OBAT FDC KATEGORI SISIPAN PAKET 0 0 0 0 0 0
101 PREDNISON TABLET 5 MG TABLET 2190 0 2190 200 0 1990
102 ZINK TABLET TABLET 0 0 0 0 0 0
103 FENOBARBITAL INJEK 50 MG AMPUL 85 0 85 2 0 83
104 TABLET TAMBAH DARAH TABLET 0 0 0 0 0 0
105 EPINEFRIN INJEKSI 1 MG/ML AMPUL 0 0 0 0 0 0
106 FITOMENADION TABLET TABLET 446 0 446 50 0 396
107 METIL ERGOMETRIN INJEKSI AMPUL 0 0 0 0 0 0
108 OKSITOSIN INJEKSI 10 UI/ML AMPUL 113 0 113 10 0 103
109 FITOMENADION INJEK 2 MG/ML AMPUL 213 0 213 10 0 203

120 MASKER PACS 1405 0 1405 30 0 1375
123 URINE BAG PACS 59 0 59 2 0 57
124 CUTGUT 3 PACS 0 0 0 0 0 0
134 Aquagel sterile jely 82 gr tube 0 2 2 0 0 2
135 Catrejell lidocain 2% & CHG 0.05% tube 0 1 1 0 0 1
136 Hydrex surgicalscrub 500ml botol 0 5 5 0 0 5
137 Kasa hydropil 40 yard X 80 cm roll 0 5 5 0 0 5
138 Nasal Oxygen size L pcs 0 10 10 0 0 10
139 Nasal Oxygen size s roll 0 10 10 0 0 10
140 Sarung tangan steril 7.0 pair 0 1 1 0 0 1
141 sarung tangan steril 7.5 pair 0 1 1 0 0 1
142 Silk 3-0,76cm reserve cutting 3/8 cicle 16mm pcs 0 1 1 0 0 1
143 Underpad pcs 0 2 2 0 0 2
OBAT PENGADAAN JKN

150 Captopril 12,5 mg tab 0 0 0 0 0 0
157 Nifedipin 10 mg tab 50 0 50 0 0 50
169 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 02 Maret 2019
Ka.UPTD Puskesmas Karya Tani Resep bayar Petugas Obat Puskesmas Karya Tani
858 460 0 398 858

NIP.197306151994031003 NIP.19750215 201407 2 001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : MARET

Provinsi : LAMPUNG
Optimum n n
1702 SUPPOSITORIA
2967 MG TABLET 70760 0 70760 2320 0 68440
AK9005688 IV CATHETER NO 20 0 253 0 253 6 0 247
AK9005689 IV CATHETER NO 22 0 171 0 171 5 0 166
AK9005690 IV CATHETER NO 24 0 166 0 166 9 0 157
10908 400 MG|80 MG TABLET 0 0 0 0 0 0
TAMBAHAN
21 ETANOL 70 % BOTOL 70 0 70 5 0 65
71 DHP tab Ktk 9 tab 9 0 9 9 0 0
Polimiskin B 10.000
73 148 0 148 5 0 143
asam salisilat 3%
74 440 0 440 0 0 440
OBAT PROGRAM

120 MASKER PACS 1375 0 1375 50 0 1325
123 URINE BAG PACS 57 0 57 1 0 56
124 CUTGUT 3 PACS 0 0 0 0 0 0
143 Underpad pcs 2 0 2 0 0 2
144 Cholesterol test strip 10's Box 0 8 8 2 0 6
145 Glucose test strip 50's Box 0 20 20 3 0 17
146 Uric test strip 25's Box 0 8 8 1 0 7
OBAT PENGADAAN JKN

Optimum n n
153 Captopril 12,5 mg tab 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 02 April 2019
838 466 0 372 838

NIP.197306151994031003 NIP.19750215 201407 2 001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : APRIL

Provinsi : LAMPUNG
Optimum n n
1702 SUPPOSITORIA
2967 MG TABLET 68440 0 68440 2450 0 65990
AK9005688 IV CATHETER NO 20 0 247 0 247 5 0 242
AK9005689 IV CATHETER NO 22 0 166 0 166 2 0 164
AK9005690 IV CATHETER NO 24 0 157 0 157 5 0 152
10908 400 MG|80 MG TABLET 0 0 0 0 0 0
TAMBAHAN
21 ETANOL 70 % BOTOL 65 0 65 5 0 60
71 DHP tab Ktk 9 tab 0 0 0 0 0 0
Polimiskin B 10.000
73 143 0 143 3 0 140
asam salisilat 3%
74 440 0 440 50 0 390
OBAT PROGRAM

120 MASKER PACS 1325 0 1325 30 0 1295
123 URINE BAG PACS 56 0 56 0 0 56
124 CUTGUT 3 PACS 0 0 0 0 0 0
143 Underpad pcs 2 0 2 0 0 2
OBAT PENGADAAN JKN

Optimum n n
153 Captopril 12,5 mg tab 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 03 Mei 2019
877 447 0 430 877
KARYANTO,S.Kep DESLIA NURVITA UTAMI

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : MEI

Provinsi : LAMPUNG
Optimum n n
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOSITORIA
1702 2 G
CHLORIDE|SODIUM CHLORIDE|SODIUM SUPPOSITORIA 0 0 0 0 0 0
2967 MG TABLET 65990 10000 75990 2340 0 73650
AK0902022Intravascular
AK9005688IV CATHETER NO 20 0 242 0 242 6 0 236
AK9005689IV CATHETER NO 22 0 164 0 164 3 0 161
AK9005690IV CATHETER NO 24 0 152 0 152 4 0 148
AK0902040Piston syringe 0 0 0 0 0 0 0
9673 PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID|
PROPANOL TABLET 10 MG TABLET 230 300 530 30 0 500
AK9008969SARUNG TANGAN STERIL NO 7 0 358 0 358 14 0 344
AK9008970SARUNG TANGAN STERIL NO 7.5 0 343 0 343 12 0 331
10908 400 MG|80 MG TABLET 0 0 0 0 0 0
AK0501030Syringe actuator for an injector 0 0 0 0 0 0 0
TAMBAHAN
21 ETANOL 70 % BOTOL 60 0 60 5 0 55
66 ATTAPULGIT TABLET 2900 2000 4900 150 0 4750
71 DHP tab Ktk 9 tab 0 0 0 0 0 0
Polimiskin B 10.000
73 140 48 188 5 0 183
asam salisilat 3%
74 390 200 590 50 0 540
OBAT PROGRAM

120 MASKER PACS 1295 350 1645 45 0 1600
123 URINE BAG PACS 56 10 66 1 0 65
124 CUTGUT 3 PACS 0 0 0 0 0 0
143 Underpad pcs 2 20 22 0 0 22
OBAT PENGADAAN JKN

Optimum n n
148 Activated Anttapulagit 630 mg (Puralex Activated) tab 0 0 0 0 0 0
153 Captopril 12,5 mg tab 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 03 Juni 2019
794 344 0 450 794

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)

Provinsi : LAMPUNG
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan
247 ALLOPURINOL TABLET 100 MG TABLET 4476 0 4476

415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 93 0 93
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1612 0 1612
809 ANTACIDA TABLET 400 MG TABLET 38647 0 38647
966 ASAM MEFENAMAT TABLET 500 MG TABLET 52530 0 52530
1479 BENZOIC ACID SALEP SALEP 0 0 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOSITORIA 74 0 74
1691 BISACODYL
SUBGALLATE|ZINC OXIDE|LIDOCAINE| SUPPOSITORIA 33 0 33
1702 HEXACHLOROPHENECHLORIDE|SODIUM
CHLORIDE|SODIUM SUPPOSITORIA 2 G SUPPOSITORIA 0 0 0
10160 LACTATE INFUS INFUS 0 0 0
2005 CALCIUM LACTATE TABLET 500 MG TABLET 10980 0 10980
2084 CARBAMAZEPINE TABLET 200 MG TABLET 450 0 450
2546 CETIRIZINE TABLET 10 MG TABLET 160 0 160
2601 CHLORAMPHENICOL SALEP 2% SALEP 6 0 6
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 144410 0 144410
2828 CIPROFLOXACIN TABLET 500 MG TABLET 5240 0 5240
2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET 73650 0 73650
6645 COTRIMOXAZOLE TABLET TABLET 208 0 208
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 0 0 0
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 222 0 222
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 75 0 75
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0 0
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 4 0 4
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 0 0 0
5167 GENTAMYCIN SALEP 0.3 % SALEP 13 0 13
5300 GLUCOSE INFUS 5 % INFUS 15 0 15
5843 HYDROCORTISONE SALEP 2.5 % SALEP 461 0 461
BROMIDE|SALBUTAMOL 0 0 0 0
AK9005688 IV CATHETER NO 20 0 236 0 236
AK9005689 IV CATHETER NO 22 0 161 0 161
AK9005690 IV CATHETER NO 24 0 148 0 148
6535 KETOCONAZOLE SALEP 2% SALEP 18 0 18
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 0 0 0
6998 LOPERAMIDE TABLET 2 MG TABLET 964 0 964
7013 LORATADINE TABLET 10 MG TABLET 10490 0 10490
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 136 0 136
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0 0
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 58 0 58
8160 NIFEDIPINE TABLET 10 MG TABLET 1550 0 1550
8256 NYSTATIN OVULA 10000 IU OVULA 50 0 50
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 2120 0 2120
8593 PARACETAMOL TABLET 500 MG TABLET 133228 0 133228
AK0902040 Piston syringe 0 0 0 0
PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID| TABLET 500 0 500
1684 PYRIDOXINE TABLET 10 MG TABLET 9555 0 9555
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET 0 0 0
AK9008969 SARUNG TANGAN STERIL NO 7 0 344 0 344
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 331 0 331
SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET TABLET 4980 0 4980
10908 400 MG|80 MG TABLET 0 0 0
AK0501030 Syringe actuator for an injector 0 0 0 0
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0 0
11922 VITAMIN B COMPOUND TABLET TABLET 10580 0 10580
TAMBAHAN
1 AMINOPHILLIN TABLET 200 TABLET 40 0 40
4 AMOKSISILIN SIRUP 125 MG/5 ML TABLET 806 0 806
6 ANTIHEMOROID SUPPOSITORIA SUPPOSITORIA 8 0 8
7 ANTIMIGREN:ERGOTAMIN+KAFEIN TABLET 100 0 100
10 ASAM TRANEKSAMAT TABLET TABLET 0 0 0
16 BEDAK SALISILAT SERBUK 2 % KOTAK 20 0 20
17 BETAMETHASON KRIM TUBE 185 0 185
20 ETAKRIDIN (RIVANOL) LARUTAN 0.1 % BOTOL 0 0 0
21 ETANOL 70 % BOTOL 55 0 55
23 FUROSEMIDE TABLET 40 MG TABLET 9442 0 9442
26 GLIBENKLAMIDE TABLET 5 MG TABLET 10010 0 10010
29 HALOPERIDOL TABLET 5 MG TABLET 0 0 0
32 ISOSORBIT DINITRAT TABLET 5 MG TABLET 60 0 60
38 MEBENDAZOL (VERMOKS) 100 MG TABLET 0 0 0
41 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 0 0
44 PIRANTEL PAMOAT TABLET 0 0 0
53 ASAM FOLAT 0,4 MG TABLET 0 0 0
56 GLUKOSA LAR INFUS 10% BOTOL 16 0 16
59 PROPILTIOURASIL 100 MG TABLET 100 0 100
62 PROPANOLOL 40 MG TABLET 280 0 280
65 KETOKONAZOLE 200 MG TABLET 1180 0 1180
66 ATTAPULGIT TABLET 4750 0 4750
68 OMEPRAZOL 20 MG KASUL 410 0 410
69 Providon iodine Btl 300 ml 4 0 4
70 Spirinolakton tab 25 mg Ktk 100 tab 0 0 0
71 DHP tab Ktk 9 tab 0 0 0
72 Antibakteri, kombinasi : basitrasin 500 UI/g+ Tube 222 0 222
Polimiskin B 10.000
73 183 0 183
asam salisilat(micronized)
Griseofulvin 3% tab scored 250 mg Tablet
74 540 0 540
75 Kloramfenikol salep mata 1% Tube 239 0 239
76 Salbutamol tab 2 mg Tablet 5820 0 5820
77 Sianokobalamin (vitamin B12) tab 50 mcg Tablet 4720 0 4720
78 Tiamin (vitamin B1) tab 50 mg Tablet 10680 0 10680
79 Perak sulfadiazin krim 1% Tube 9 0 9
80 Stesolid Ktk 5 Supp 16 0 16
81 Karbamazepin 200 mg Kaplet 0 0 0
82 Triheksifenadil 2 mg Tablet 1450 0 1450
83 Bisakodil tab sal 5 mg Ktk 30 Tab 180 0 180
84 Isoniazid 300 mg Tablet 100 0 100
85 Phenol Glycerol/tetes telinga BOTOL 90 0 90
86 Copanol/parasetamol syrup botol 18 0 18
87 Iremax/parasetamol+ibuprofen TABLET 1000 0 1000
88 Lidocain injeksi 2% + Epineprin ampul 229 0 229
89 Nufit syrup BOTOL 18 0 18
90 N-asetil sestein kap 200 mg kap 120 0 120
91 Ranitidin HCL inj 25mg/ml ampul 0 0 0
OBAT PROGRAM
92 ALBENDAZOLE TABLET 400 MG TABLET 700 0 700
93 GARAM ORALIT SACHET 384 0 384
94 GENTAMICIN INJEKSI AMP 8 0 8
95 MAGNESIUM SULFAT INJEKSI 40 % VIAL 0 0 0
96 GENTAMICIN SALEM MATA TUBE 0 0 0
97 OBAT FDC KATEGORI I PAKET 6 0 6
98 OBAT FDC KATEGORI II PAKET 0 0 0
99 OBAT FDC KATEGORI ANAK PAKET 0 0 0
100 OBAT FDC KATEGORI SISIPAN PAKET 0 0 0
101 PREDNISON TABLET 5 MG TABLET 1540 0 1540
102 ZINK TABLET TABLET 0 0 0
103 FENOBARBITAL INJEK 50 MG AMPUL 65 0 65
104 TABLET TAMBAH DARAH TABLET 0 0 0
105 EPINEFRIN INJEKSI 1 MG/ML AMPUL 0 0 0
106 FITOMENADION TABLET TABLET 246 0 246
107 METIL ERGOMETRIN INJEKSI AMPUL 0 0 0
108 OKSITOSIN INJEKSI 10 UI/ML AMPUL 68 0 68
109 FITOMENADION INJEK 2 MG/ML AMPUL 173 0 173


120 MASKER PACS 1600 0 1600
134 Aquagel sterile jely 82 gr tube 4 0 4
135 Catrejell lidocain 2% & CHG 0.05% tube 1 0 1
136 Hydrex surgicalscrub 500ml botol 5 0 5
137 Kasa hydropil 40 yard X 80 cm roll 5 0 5
138 Nasal Oxygen size L pcs 10 0 10
139 Nasal Oxygen size s roll 10 0 10
140 Sarung tangan steril 7.0 pair 1 0 1
141 sarung tangan steril 7.5 pair 1 0 1
142 Silk 3-0,76cm reserve cutting 3/8 cicle 16mm pcs 1 0 1
143 Underpad pcs 22 0 22
144 Cholesterol test strip 10's Box 0 0 0
145 Glucose test strip 50's Box 15 0 15
146 Uric test strip 25's Box 5 0 5
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Puralex Activated) tab 0 0 0
151 Betametason TM (Betam ophtal eye drop 24's) botol 0 0 0
153 Captopril 12,5 mg tab 0 0 0
159 Metoclopramid sirup (Lexapram sirup 5mg/ 5ml) botol 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS
Ka.UPTD Puskesmas Karya Tani Resep bayar
599 262 0 337
KARYANTO,S.Kep
NIP.197306151994031003
NTAAN OBAT
Bulan : JUNI
Tahun : 2019
Pemakaian Rusak/Ed Sisa Stok Stok Permintaan Pemberian Keterangan

Optimum
200 0 4276
5 0 88
20 0 530
150 0 11345
570 0 7435
58 0 1554
1880 0 36767
1200 0 51330
100 0 1480
330 0 11925
0 0 0
2 0 72
3 0 30
0 0 0
0 0 0
1340 0 9640
60 0 390
3 0 53
30 0 130
0 0 6
2 0 43
2440 0 141970
150 0 5500
100 0 400
600 0 4640
2130 0 71520
3 0 182
0 0 208
0 0 0
700 0 15226
210 0 14530
190 0 10530
250 0 6990
10 0 212
4 0 71
50 0 865
0 0 0
3 0 1
0 0 100
0 0 0
1 0 12
260 0 6990
2 0 13
19 0 442
120 0 1140
0 0 0
0 0 0
1 0 3
6 0 230
4 0 157
3 0 145
3 0 15
0 0 0
10 0 224
50 0 914
180 0 10310
510 0 2010
3 0 133
0 0 0
0 0 0
5 0 53
200 0 1266
2 0 25
100 0 1450
12 0 38
3 0 95
70 0 2050
3800 0 129428
0 0 400
0 0 0
25 0 475
0 0 0
1000 0 8555
0 0 0
0 0 0
12 0 332
10 0 321
990 0 3990
0 0 0
0 0 0
2 0 13
0 0 0
1000 0 9580
0 0 0
Stok
Pemakaian Rusak/Ed Sisa Stok Optimum Permintaan Pemberian Keterangan
0 0 40
0 0 0
0 0 0
53 0 753
18 0 252
0 0 8
20 0 80
10 0 50
100 0 760
0 0 0
1 0 40
0 0 45
40 0 1320
0 0 0
0 0 0
2 0 18
5 0 180
0 0 10
0 0 0
4 0 51
0 0 0
200 0 9242
2 0 12
0 0 0
500 0 9510
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 60
0 0 0
180 0 5329
0 0 0
0 0 0
0 0 0
0 0 0
200 0 5200
0 0 60
0 0 0
3 0 90
0 0 0
0 0 0
1 0 14
0 0 0
0 0 0
320 0 2505
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 18
2 0 14
0 0 0
0 0 0
0 0 100
0 0 0
0 0 5
0 0 280
2 0 47
4 0 191
100 0 1080
160 0 4590
13 0 159
100 0 310
1 0 3
0 0 0
0 0 0
7 0 215
5 0 178
40 0 500
18 0 221
150 0 5670
200 0 4520
230 0 10450
1 0 8
2 0 14
0 0 0
650 0 800
100 0 80
0 0 100
5 0 85
1 0 17
0 0 1000
4 0 225
1 0 17
0 0 120
0 0 0
Stok
20 0 680
30 0 354
1 0 7
0 0 0
0 0 0
3 0 3
0 0 0
0 0 0
0 0 0
180 0 1360
0 0 0
4 0 61
0 0 0
0 0 0
50 0 196
0 0 0
8 0 60
7 0 166
ABIS PAKAI
Optimum
0 0 1260
0 0 0
75 0 104
160 0 4698
2 0 61
1 0 11
1 0 20
0 0 10
0 0 0
0 0 10
40 0 1560
0 0 0
0 0 0
1 0 64
0 0 0
0 0 3
1 0 18
2 0 42
1 0 10
0 0 5
0 0 4
6 0 54
1 0 29
0 0 4
0 0 4
0 0 1
0 0 5
0 0 5
0 0 10
0 0 10
0 0 1
0 0 1
0 0 1
0 0 22
0 0 0
1 0 14
1 0 4
KN
Stok
Pemakaian Rusak/Ed Sisa Stok Permintaan Pemberian Keterangan
Optimum
0 0 90
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 50
0 0 0
43 0 222
0 0 0
0 0 0
0 0 0
0 0 0
0 0 6
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 3
0 0 60
0 0 0
220 0 220
0 0 200
1350 0 12250
Jumlah Karya Tani, 03 Juli 2019

599
DESLIA NURVITA UTAMI

NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : JULI

Provinsi : LAMPUNG
Stok
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum Permintaan Pemberian Keterangan


BISMUTH SUBGALLATE|ZINC OXIDE|LIDOCAINE|HEXACHLOROPHENE
0
1702 SUPPOSITORIA 2 G SUPPOSITORIA 0 0 0 0 0
CALCIUM CHLORIDE DIHYDRATE|POTASSIUM CHLORIDE|SODIUM
10160 CHLORIDE|SODIUM LACTATE INFUS INFUS 0 0 0 0 0 0

2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET 71520 0 71520 2920 0 68600
AK0902022 Intravascular administration set 0 0 0 0 0 0 0
6238 IPRATROPIUM BROMIDE|SALBUTAMOL SULPHATE LIQUID LIQUID 3 0 3 0 0 3
AK9005688 IV CATHETER NO 20 0 230 0 230 5 0 225

AK9005689 IV CATHETER NO 22 0 157 0 157 4 0 153
AK9005690 IV CATHETER NO 24 0 145 0 145 5 0 140
9673 PROPANOL TABLET 10 MG TABLET 475 200 675 15 0 660
9805 PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID|RIFAMPICIN TABLET TABLET 0 0 0 0 0 0
10482 SIMVASTATIN TABLET 10 MG TABLET 3990 1680 5670 1200 0 4470

10908 SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 400 MG|80 MG TABLET 0 0 0 0 0 0
TAMBAHAN
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Permintaan Pemberian Keterangan
Optimum
17 BETAMETHASON KRIM 0,5MG/g TUBE 180 100 280 6 0 274
21 ETANOL 70 % BOTOL 51 0 51 4 0 47


Providon iodine Btl 300 ml
69 3 0 3 1 0 2
Spirinolakton tab 25 mg Ktk 100 tab
70 0 0 0 0 0 0
DHP tab Ktk 9 tab 0
71 0 0 0 0 0
Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiskin B 10.000 UI/g Tube
72 215 75 290 7 0 283
Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% Ktk 24 Pot
73 178 48 226 5 0 221
Griseofulvin (micronized) tab scored 250 mg Tablet 500
74 100 600 40 0 560
Kloramfenikol salep mata 1% Tube
75 221 72 293 18 0 275
Salbutamol tab 2 mg Tablet
76 5670 1000 6670 150 0 6520
Sianokobalamin (vitamin B12) tab 50 mcg Tablet 4520
77 1000 5520 200 0 5320
Tiamin (vitamin B1) tab 50 mg Tablet
78 10450 2000 12450 230 0 12220
Perak sulfadiazin krim 1% Tube
79 8 3 11 1 0 10
Stesolid Ktk 5 Supp 14
80 0 14 2 0 12
Karbamazepin 200 mg Kaplet
81 0 0 0 0 0 0
Triheksifenadil 2 mg Tablet
82 800 0 800 800 0 0
Bisakodil tab sal 5 mg Ktk 30 Tab 80
83 0 80 40 0 40
Isoniazid 300 mg Tablet
84 100 0 100 0 0 100
Phenol Glycerol/tetes telinga BOTOL
85 85 0 85 5 0 80
Copanol/parasetamol syrup botol 17
86 10 27 1 0 26
Iremax/parasetamol+ibuprofen TABLET
87 1000 0 1000 0 0 1000
Lidocain injeksi 2% + Epineprin ampul
88 225 90 315 3 0 312
Nufit syrup BOTOL 17
89 5 22 1 0 21
N-asetil sestein kap 200 mg kap
90 120 0 120 0 0 120
Ranitidin HCL inj 25mg/ml ampul
91 0 0 0 0 0 0
OBAT PROGRAM
Optimum


Stok
120 MASKER PACS 1560 0 1560 47 0 1513
123 URINE BAG PACS 64 0 64 1 0 63
124 CUTGUT 3 PACS 0 0 0 0 0 0
143 Underpad pcs 22 0 22 0 0 22
OBAT PENGADAAN JKN

Stok
153 Captopril 12,5 mg tab 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 03 Agustus 2019
751 302 0 449 751

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : AGUSTUS

Provinsi : LAMPUNG

n Persediaan Pemakaian Rusak/Ed Sisa Stok Stok
Optimum
Permintaa Pemberian Keteranga
n n

BISMUTH SUBGALLATE|ZINC OXIDE|LIDOCAINE|
1702 CALCIUM CHLORIDE DIHYDRATE|POTASSIUM
HEXACHLOROPHENE SUPPOSITORIA 2 G SUPPOSITORIA 0 0 0 0 0 0
CHLORIDE|SODIUM CHLORIDE|SODIUM LACTATE
10160 INFUS INFUS 0 0 0 0 0 0
68600
2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET 0 68600 2500 0 66100

AK0902022Intravascular administration set 0 0 0 0 0 0 0

IPRATROPIUM BROMIDE|SALBUTAMOL
AK9005688IV CATHETER NO 20 0 225 0 225 4 0 221
AK9005689IV CATHETER NO 22 0 153 0 153 4 0 149
AK9005690IV CATHETER NO 24 0 140 0 140 3 0 137

AK0902040Piston syringe 0 0 0 0 0 0 0
9673 PROPANOL TABLET 10 MG TABLET 660 0 660 10 0 650

PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID|
AK9008969SARUNG TANGAN STERIL NO 7 0 317 0 317 10 0 307
AK9008970SARUNG TANGAN STERIL NO 7.5 0 311 0 311 8 0 303

SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 0 0
10908 400 MG|80 MG TABLET 0 0 0 0
AK0501030Syringe actuator for an injector 0 0 0 0 0 0 0
TAMBAHAN
n Persediaan Pemakaian Rusak/Ed Sisa Stok Stok
Optimum
Permintaa Pemberian Keteranga
n n

21 ETANOL 70 % BOTOL 47 0 47 5 0 42



69 2 0 2 0 0 2
70 0 0 0 0 0 0
DHP tab Ktk 9 tab 0
71 0 0 0 0 0
72 Polimiskin B 10.000 UI/g 283 0 283 4 0 279
73 asam salisilat 3% 221 0 221 3 0 218
74 0 560 40 0 520
75 275 0 275 14 0 261
76 6520 0 6520 100 0 6420
77 0 5320 450 0 4870
78 12220 0 12220 400 0 11820
79 10 0 10 1 0 9
80 0 12 1 0 11
81 0 0 0 0 0 0
82 0 0 0 0 0 0
83 0 40 0 0 40
84 100 0 100 0 0 100
85 80 0 80 3 0 77
86 0 26 2 0 24
87 1000 0 1000 0 0 1000
88 312 0 312 2 0 310
89 0 21 0 0 21
90 120 0 120 0 0 120
91 0 0 0 0 0 0
OBAT PROGRAM
Penerimaa Stok Permintaa Keteranga
Kode Nama Obat Sediaan Stok Awal n Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum n Pemberian n


Kode Nama Obat Sediaan Stok Awal Penerimaa Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Permintaa Pemberian Keteranga
n Optimum n n
120 MASKER PACS 1513 0 1513 30 0 1483
123 URINE BAG PACS 63 0 63 1 0 62
124 CUTGUT 3 PACS 0 0 0 0 0 0
143 Underpad pcs 22 0 22 0 0 22
OBAT PENGADAAN JKN

Penerimaa Stok Permintaa Keteranga
Kode Nama Obat Sediaan Stok Awal n Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum n Pemberian n
153 Captopril 12,5 mg tab 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Tidak Jumlah
Kunjungan bayar
Mengetahui bayar BPJS Karya Tani, 03 September 2019
714 253 0 461 714

714 253 0 461 714
Ns.KARYANTO,S.Kep DESLIA NURVITA UTAMI,A.Md

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : september

Provinsi : LAMPUNG
Optimum n
13235 13235
926 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 0 280 0 12955

26 26
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOSITORIA 0 3 0 23
BISMUTH SUBGALLATE|ZINC OXIDE|LIDOCAINE| 0
1702 HEXACHLOROPHENE SUPPOSITORIA 2 G SUPPOSITORIA 0 0 0 0 0
10160 INFUS INFUS 0 0 0 0 0 0
12240 12240
2005 CALCIUM LACTATE TABLET 500 MG TABLET 0 1100 0 11140


3400 3400
2828 CIPROFLOXACIN TABLET 500 MG TABLET 0 600 0 2800
66100
1
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 0 1 0 0 1

AK0902022 Intravascular administration set 0 0 0 0 0 0 0

IPRATROPIUM BROMIDE|SALBUTAMOL SULPHATE
6238 LIQUID LIQUID 3 0 3 0 0 3
AK9005688 IV CATHETER NO 20 0 221 0 221 3 0 218
AK9005689 IV CATHETER NO 22 0 149 0 149 2 0 147
AK9005690 IV CATHETER NO 24 0 137 0 137 3 0 134
0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 0 0 0 0 0

694 694
6998 LOPERAMIDE TABLET 2 MG TABLET 0 150 0 544
11050
7013 LORATADINE TABLET 10 MG TABLET 0 11050 250 0 10800
127 127
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 0 4 0 123
0
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0 0 0 0

41 41
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 0 7 0 34
736
7697 METRONIDAZOLE TABLET 500 MG TABLET 0 736 200 0 536

1220 1220
8160 NIFEDIPINE TABLET 10 MG TABLET 0 80 0 1140
25
8256 NYSTATIN OVULA 10000 IU OVULA 0 25 3 0 22

1890 1890
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 0 75 0 1815
121428
8593 PARACETAMOL TABLET 500 MG TABLET 0 121428 5000 0 116428

0 0
AK0902040 Piston syringe 0 0 0 0 0
650
9673 PROPANOL TABLET 10 MG TABLET 0 650 20 0 630

SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 400 0 0
10908 MG|80 MG TABLET 0 0 0 0
0
AK0501030 Syringe actuator for an injector 0 0 0 0 0 0
TAMBAHAN
Optimum n

21 ETANOL 70 % BOTOL 42 0 42 10 0 32


69 2 0 2 0 0 2
70 0 0 0 0 0 0
DHP tab Ktk 9 tab 0
71 0 0 0 0 0
72 Polimiskin B 10.000 UI/g 279 0 279 5 0 274
73 asam salisilat 3% 218 0 218 3 0 215
74 0 520 50 0 470
75 261 0 261 20 0 241
76 6420 0 6420 200 0 6220
77 0 4870 1000 0 3870
78 11820 0 11820 800 0 11020
79 9 0 9 1 0 8
80 0 11 1 0 10
81 0 0 0 0 0 0
82 0 0 0 0 0 0
83 0 40 0 0 40
84 100 0 100 0 0 100
85 77 0 77 5 0 72
86 0 24 2 0 22
87 1000 0 1000 0 0 1000
88 310 0 310 2 0 308
89 0 21 0 0 21
90 120 0 120 0 0 120
91 0 0 0 0 0 0
OBAT PROGRAM
Optimum n


Stok Keteranga
120 MASKER PACS 1483 0 1483 40 0 1443
123 URINE BAG PACS 62 0 62 0 0 62
124 CUTGUT 3 PACS 0 0 0 0 0 0
143 Underpad pcs 22 0 22 0 0 22
OBAT PENGADAAN JKN

Optimum n
153 Captopril 12,5 mg tab 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 03 oktober 2019
Ka.UPTD Puskesmas Karya Tani Resep Petugas Obat Puskesmas Karya Tani
717 191 102 424 717

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : oktober

Provinsi : LAMPUNG
Stok
3476 3476
247 ALLOPURINOL TABLET 100 MG TABLET 0 280 0 3196
80
415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 0 80 1 0 79

10855 10855
445 AMLODIPINE TABLET 10 MG TABLET 0 350 0 10505
10075
446 AMLODIPINE TABLET 5 MG TABLET 0 10075 300 0 9775

30867 30867
809 ANTACIDA TABLET 400 MG TABLET 0 3000 0 27867
49530 1000
966 ASAM MEFENAMAT TABLET 500 MG TABLET 0 49530 0 48530
12955 12955
0
1479 BENZOIC ACID SALEP SALEP 0 0 0 0 0
23 23
LIDOCAINE|HEXACHLOROPHENE 0
1702 SUPPOSITORIA 2 G SUPPOSITORIA 0 0 0 0 0
CALCIUM CHLORIDE DIHYDRATE|
POTASSIUM CHLORIDE|SODIUM CHLORIDE|
10160 SODIUM LACTATE INFUS INFUS 0 0 0 0 0 0
11140 11140
120
2084 CARBAMAZEPINE TABLET 200 MG TABLET 0 120 120 0 0

10 10
2546 CETIRIZINE TABLET 10 MG TABLET 0 10 0 0
6
2601 CHLORAMPHENICOL SALEP 2% SALEP 0 6 0 0 6

136460 136460
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 0 3000 0 133460
4990
2762 CHLORPROMAZINE TABLET 100 MG TABLET 0 4990 300 0 4690

2800 2800
CLAVULANIC ACID|AMOXICILLIN TABLET
63100
2967 500 MG TABLET 0 63100 3000 0 60100

78 78
6645 COTRIMOXAZOLE TABLET TABLET 0 20 0 58
0
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 0 0 0 0 0

13860 13860
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 0 300 0 13560
9930
3690 DICLOFENAC SODIUM TABLET 50 MG TABLET 0 9930 450 0 9480
193 193
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 0 2 0 191
56
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 0 56 6 0 50

0 0
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0 0 0
FENOTEROL HYDROBROMIDE SPRAY 100
1
4736 MCG SPRAY 0 1 0 0 1

0 0
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 0 0 0 0
5
5167 GENTAMYCIN SALEP 0.3 % SALEP 0 5 0 0 5
9 9
5300 GLUCOSE INFUS 5 % INFUS 0 1 0 8
505
5843 HYDROCORTISONE SALEP 2.5 % SALEP 0 505 10 0 495

0 0
5966 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0
0
AK0902022 Intravascular administration set 0 0 0 0 0 0
218 218
AK9005688 IV CATHETER NO 20 0 0 2 0 216
147
AK9005689 IV CATHETER NO 22 0 0 147 2 0 145
AK9005690 IV CATHETER NO 24 0 134 0 134 3 0 131

8 8
6535 KETOCONAZOLE SALEP 2% SALEP 0 2 0 6
0

544 544
10800

123 123
0

34 34
536
1140 1140
22

1815 1815
116428
0 0
AK0902040 Piston syringe 0 0 0 0 0
630
5905 5905
1684 PYRIDOXINE TABLET 10 MG TABLET 0 1500 0 4405
0
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0 0 0
RIFAMPICIN|ISONIAZID TABLET 75 MG|50
10128 MG TABLET 0 0 0 0 0 0
300 300
AK9008969 SARUNG TANGAN STERIL NO 7 0 0 7 0 293
295
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 0 295 8 0 287

SULFAMETHOXAZOLE|TRIMETHOPRIM
0 0
10908 TABLET 400 MG|80 MG TABLET 0 0 0 0
0
AK0501030 Syringe actuator for an injector 0 0 0 0 0 0

0 0
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0 0 0
16230
11922 VITAMIN B COMPOUND TABLET TABLET 0 16230 1000 0 15230
TAMBAHAN
Optimum
40
1 AMINOPHILLIN TABLET 200 TABLET 0 40 0 0 40
1023
4 AMOKSISILIN SIRUP 125 MG/5 ML TABLET 0 1023 400 0 623

42
7 ANTIMIGREN:ERGOTAMIN+KAFEIN TABLET 0 42 0 0 42
0
10 ASAM TRANEKSAMAT TABLET TABLET 0 0 0 0 0

1330
13 ASIKLOVIR TABLET 400 MG TABLET 0 1330 50 0 1280

10
16 BEDAK SALISILAT SERBUK 2 % KOTAK 0 10 2 0 8

0
20 ETAKRIDIN (RIVANOL) LARUTAN 0.1 % BOTOL 0 0 0 0 0
21 ETANOL 70 % BOTOL 32 0 32 5 0 27

9612
23 FUROSEMIDE TABLET 40 MG TABLET 0 9612 180 0 9432

12910
26 GLIBENKLAMIDE TABLET 5 MG TABLET 0 12910 1200 0 11710

0
29 HALOPERIDOL TABLET 5 MG TABLET 0 0 0 0 0

60
32 ISOSORBIT DINITRAT TABLET 5 MG TABLET 0 60 0 0 60

0
35 KAPTOPRIL TABLET 50 MG TABLET 0 0 0 0 0
0
38 MEBENDAZOL (VERMOKS) 100 MG TABLET 0 0 0 0 0

2300
41 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0 2300 300 0 2000
0
44 PIRANTEL PAMOAT TABLET 0 0 0 0 0

0
47 POVIDON IODIDA LAR @1000 ML BOTOL 0 0 0 0 0

0
50 TETRASIKLIN HCL KAPSUL 250 MG TABLET 0 0 0 0 0

0
53 ASAM FOLAT 0,4 MG TABLET 0 0 0 0 0

9
56 GLUKOSA LAR INFUS 10% BOTOL 0 9 0 0 9

100
59 PROPILTIOURASIL 100 MG TABLET 0 100 0 0 100

280
62 PROPANOLOL 40 MG TABLET 0 280 0 0 280
1070
65 KETOKONAZOLE 200 MG TABLET 0 1070 100 0 970

310
68 OMEPRAZOL 20 MG KASUL 0 310 120 0 190
69 2 0 2 0 0 2
70 0 0 0 0 0 0
DHP tab Ktk 9 tab
0
71 0 0 0 0 0
72 Polimiskin B 10.000 UI/g 274 0 274 5 0 269
Antifungi salep, kombinasi : asam benzoat Ktk 24 Pot
73 6%+ asam salisilat 3% 215 0 215 4 0 211
470
74 0 470 60 0 410
75 241 0 241 10 0 231
76 6220 0 6220 250 0 5970
Sianokobalamin (vitamin B12) tab 50 mcg Tablet
3870
77 0 3870 900 0 2970
78 11020 0 11020 800 0 10220
79 8 0 8 0 0 8
Stesolid Ktk 5 Supp
10
80 0 10 0 0 10
81 0 0 0 0 0 0
82 0 0 0 0 0 0
Bisakodil tab sal 5 mg Ktk 30 Tab
40
83 0 40 0 0 40
84 100 0 100 0 0 100
85 72 0 72 3 0 69
Copanol/parasetamol syrup botol
22
86 0 22 0 0 22
87 1000 0 1000 0 0 1000
88 308 0 308 2 0 306
Nufit syrup BOTOL
21
89 0 21 0 0 21
90 120 0 120 0 0 120
91 0 0 0 0 0 0
OBAT PROGRAM
Optimum
450
92 ALBENDAZOLE TABLET 400 MG TABLET 0 450 80 0 370
199
93 GARAM ORALIT SACHET 0 199 89 0 110
7
94 GENTAMICIN INJEKSI AMP 0 7 0 0 7
0
95 MAGNESIUM SULFAT INJEKSI 40 % VIAL 0 0 0 0 0
0
96 GENTAMICIN SALEM MATA TUBE 0 0 0 0 0
0
97 OBAT FDC KATEGORI I PAKET 0 0 0 0 0
0
98 OBAT FDC KATEGORI II PAKET 0 0 0 0 0
0
99 OBAT FDC KATEGORI ANAK PAKET 0 0 0 0 0
0
100 OBAT FDC KATEGORI SISIPAN PAKET 0 0 0 0 0
730
101 PREDNISON TABLET 5 MG TABLET 0 730 150 0 580
0
102 ZINK TABLET TABLET 0 0 0 0 0
53
103 FENOBARBITAL INJEK 50 MG AMPUL 0 53 2 0 51
0
104 TABLET TAMBAH DARAH TABLET 0 0 0 0 0
0
105 EPINEFRIN INJEKSI 1 MG/ML AMPUL 0 0 0 0 0
56
106 FITOMENADION TABLET TABLET 0 56 10 0 46
0
107 METIL ERGOMETRIN INJEKSI AMPUL 0 0 0 0 0
48
108 OKSITOSIN INJEKSI 10 UI/ML AMPUL 0 48 2 0 46
145
109 FITOMENADION INJEK 2 MG/ML AMPUL 0 145 5 0 140

Stok
110 ALAT SUNTIK SEKALI PAKAI 0.5 ML PACS 1260

0 1260 0 0 1260
120 MASKER PACS 1443 0 1443 50 0 1393
123 URINE BAG PACS 62 0 62 0 0 62
124 CUTGUT 3 PACS 0 0 0 0 0 0
143 Underpad pcs 22 0 22 0 0 22
OBAT PENGADAAN JKN

Optimum
148 Activated Anttapulagit 630 mg (Puralex Activa tab 0 0 0 0 0 0
151 Betametason TM (Betam ophtal eye drop 24's botol 0 0 0 0 0 0
153 Captopril 12,5 mg tab 0 0 0 0 0 0
159 Metoclopramid sirup (Lexapram sirup 5mg/ 5m botol 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 03 november 2019
857 188 177 492 857

857 188 177 492 857

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : November

Provinsi : LAMPUNG
Optimum
3476 3476
80
10855 13285
10075
523 AMOXYCILLIN SIRUP KERING 250 MG/5 ML SIRUP 1394 120 1514 70 0 1444
30867 30867
49530 1500
12955 13255
0
23 23
1702 HEXACHLOROPHENE SUPPOSITORIA 2 G SUPPOSITORIA 0 0 0 0 0
CHLORIDE|SODIUM CHLORIDE|SODIUM
11140 11940
120
10 10
6
136460 138960
4990
2800 2800
63100
78 78
0
13860 16660
9930
193 193
56
0 0
1
0 0
5
9 9
505
0 0
0
AK0902022Intravascular administration set 0 0 0 0 0 0
218 218
AK9005688IV CATHETER NO 20 0 0 2 0 216
147
AK9005689IV CATHETER NO 22 0 0 147 3 0 144
AK9005690IV CATHETER NO 24 0 134 0 134 4 0 130
8 8
0
544 544
10800
123 123
0
34 34
536
1140 1140
22
1815 1815
116428
0 0
AK0902040Piston syringe 0 0 0 0 0
630
5905 6905
0
300 300
AK9008969SARUNG TANGAN STERIL NO 7 0 0 7 0 293
295
AK9008970SARUNG TANGAN STERIL NO 7.5 0 0 295 8 0 287

10908 400 MG|80 MG TABLET 0 0 0 0
0
AK0501030Syringe actuator for an injector 0 0 0 0 0 0
0 0
16230
TAMBAHAN
Optimum
40
1023
42
0
1330
10
0
21 ETANOL 70 % BOTOL 32 0 32 4 0 28
9612
12910
0
60
0

0
2300
0
0
0
0
9

100
280
1070
310
69 2 0 2 0 0 2
70 0 0 0 0 0 0
DHP tab Ktk 9 tab
0
71 0 0 0 0 0
72 Polimiskin B 10.000 UI/g
274 0 274 5 0 269
73 asam salisilat 3%
215 0 215 4 0 211
470
74 0 470 40 0 430
75 241 0 241 10 0 231
76 6220 500 6720 250 0 6470
3870
77 500 4370 1200 0 3170
78 11020 500 11520 1000 0 10520
79 8 0 8 0 0 8
Stesolid Ktk 5 Supp
10
80 0 10 0 0 10
81 0 0 0 0 0 0
82 0 0 0 0 0 0
40
83 0 40 0 0 40
84 100 0 100 0 0 100
85 72 0 72 3 0 69
22
86 5 27 2 0 25
87 1000 0 1000 0 0 1000
88 308 30 338 2 0 336
Nufit syrup BOTOL
21
89 5 26 0 0 26
90 120 0 120 0 0 120
91 0 0 0 0 0 0
OBAT PROGRAM
Stok
450
199
7
0
0
0
0
0
0
730
0
53
0
0
56
0
48
145

Stok

0 1260 0 0 1260
120 MASKER PACS 1443 0 1443 200 0 1243
123 URINE BAG PACS 62 10 72 0 0 72
124 CUTGUT 3 PACS 0 0 0 0 0 0
132 parmafix 5 cm x 500 cm box 0 20 20 0 0 20
133 paper tape 5.0 cm x 9,14 m roll 0 20 0 0 0 20
145 Underpad pcs 22 10 32 0 0 32
147 leukoplast 7,5 cm x 4,5m roll 0 2 2 0 0 2
148 sarung tangan size L BOX 0 1 1 0 0 1
149 E-CARE sterif lo / humidifier botol 0 1 1 0 0 1
150 masker ties on box 0 7 0 0 0 7
151 masker ear loop box 0 7 0 0 0 7
OBAT PENGADAAN JKN

Optimum
153 Captopril 12,5 mg tab 0 5000 5000 0 0 5000
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
182 Paracetamol 500 mg Tablet 0 8000 8000 0 0 8000
183 antasida doen Tablet 0 7000 7000 1000 0 6000
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 03 desember 2019
822 187 145 490 822

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : desember

Provinsi : LAMPUNG
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok
Optimum Permintaan Pemberian Keterangan
3176 3176
79
12885 12885
13025
AMOXYCILLIN SIRUP KERING 250 MG/5
523 ML SIRUP 1444 0 1444 90 0 1354
27867 27867
48330 1200
ASCORBIC ACID (VITAMIN C) TABLET 250
923 MG TABLET 540 0 540 380 0 160
ASCORBIC ACID (VITAMIN C) TABLET 50 12905 12905
926 MG TABLET 0 350 0 12555
0
20 20
LIDOCAINE|HEXACHLOROPHENE
0
1702 SUPPOSITORIA 2 G DIHYDRATE|
CALCIUM CHLORIDE SUPPOSITORIA 0 0 0 0 0
POTASSIUM CHLORIDE|SODIUM
10440 10440
0
10 10
6
135460 135460
4490
2000 2000
59600
2967 500 MG TABLET 0 59600 3000 0 56600
58 58
0
15760 15760
12130

191 191
40
0 0
FENOTEROL HYDROBROMIDE SPRAY 100 1
4736 MCG SPRAY 0 1 0 0 1
0 0
5
8 8
545
0 0
0
216 216
AK9005688IV CATHETER NO 20 0 0 2 0 214
144
AK9005689IV CATHETER NO 22 0 0 144 3 0 141
AK9005690IV CATHETER NO 24 0 130 0 130 2 0 128
6 6
LEVODOPA|BENSERAZIDE TABLET 100
0
6812 MG TABLET 0 0 0 0 0
434 434
10870

METHYLERGOMETRINE INJEKSI 0.2 119 119
7536 MG/ML INJEKSI 0 4 0 115
0
27 27
236
1040 1040
22
1755 1755
106428
0 0
610
PYRAZINAMIDE|ETHAMBUTOL|
9805 ISONIAZID|RIFAMPICIN TABLET TABLET 0 0 0 0 0 0
4905 4905
0
RIFAMPICIN|ISONIAZID TABLET 75 MG|
10128 50 MG TABLET 0 0 0 0 0 0
293 293
AK9008969SARUNG TANGAN STERIL NO 7 0 0 7 0 286
287
AK9008970SARUNG TANGAN STERIL NO 7.5 0 0 287 8 0 279

0 0
10908 TABLET 400 MG|80 MG TABLET 0 0 0 0
0
0 0
20730
TAMBAHAN
Stok
40
823

42

11 ASAM TRANEKSAMAT INJEKSI

100MG/ML AMPUL 27 0 27 5 0 22
1250
8
0
21 ETANOL 70 % BOTOL 28 0 28 4 0 24
9412
11410

0
60
0
0
1850
0
0
0
0
9
58 K:IPRATROPIUM
Br.0,5MG+SALBUTAMOL UNIT 0 0 0 0 0 0
100
280
1120

190
69 2 0 2 0 0 2
70 0 0 0 0 0 0
71 DHP tab Ktk 9 tab 0 0 0 0 0 0
Antibakteri, kombinasi : basitrasin 500 Tube
72 UI/g+ Polimiskin B 10.000 UI/g
269 0 269 5 0 264
Antifungi salep, kombinasi : asam Ktk 24 Pot
73 benzoat 6%+ asam salisilat 3% 211 0 211 4 0 207
Griseofulvin (micronized) tab scored 250 Tablet
430
74 mg 0 430 40 0 390
75 231 0 231 10 0 221
76 6470 0 6470 250 0 6220
Sianokobalamin (vitamin B12) tab 50 Tablet
3170
77 mcg 0 3170 1000 0 2170
78 10520 0 10520 1200 0 9320
79 8 0 8 0 0 8
Stesolid Ktk 5 Supp
10
80 0 10 0 0 10
81 0 0 0 0 0 0
82 0 0 0 0 0 0
40
83 Tab 0 40 0 0 40
84 100 0 100 0 0 100
85 69 0 69 3 0 66
25
86 5 30 2 0 28
87 1000 0 1000 0 0 1000
88 336 0 336 2 0 334
Nufit syrup BOTOL
26
89 0 26 0 0 26
90 120 0 120 0 0 120
91 0 0 0 0 0 0
OBAT PROGRAM
Stok
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Permintaan Pemberian Keterangan
Optimum
370
110
7
0
0
0
0
0
0
600
0
50
0
0
41
0
45
139

Stok
Optimum
120 MASKER PACS 1243 0 1243 200 0 1043
123 URINE BAG PACS 72 0 72 0 0 72
124 CUTGUT 3 PACS 0 0 0 0 0 0
144 Silk 3-0,76cm reserve cutting 3/8 cicle pcs 1 0 1 0 0 1
145 Underpad pcs 32 0 32 0 0 32
OBAT PENGADAAN JKN

Stok
148 Activated Anttapulagit 630 mg (Puralex Ac tab 0 0 0 0 0 0
151 Betametason TM (Betam ophtal eye drop 2 botol 0 0 0 0 0 0
152 Bisakodil supp 10 mg (Stolax Suppositoria supp 0 0 0 0 0 0
153 Captopril 12,5 mg tab 5000 0 5000 0 0 5000
154 Clorampenikol SK (Bufacetin 15 mg salep tube 0 0 0 0 0 0
159 Metoclopramid sirup (Lexapram sirup 5mg botol 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Tidak bayar Jumlah
Kunjungan
Mengetahui bayar BPJS Karya Tani, 03 januari 2020
789 131 133 525 789
KARYANTO,S.Kep.,Ns DESLIA NURVITA UTAMI,A.Md

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : januari

Provinsi : LAMPUNG
Optimum
3176 3176
79
12885 12885
13025
523 AMOXYCILLIN SIRUP KERING 250 MG/5 ML SIRUP 1444 0 1444 80 0 1364
27867 27867
48330 1500
12905 12905
0
20 20
1691 BISACODYLSUBGALLATE|ZINC
OXIDE| SUPPOSITORIA 0 10 0 10
LIDOCAINE|HEXACHLOROPHENE SUPPOSITORIA 0
1702 2 G
CALCIUM CHLORIDE DIHYDRATE|POTASSIUM SUPPOSITORIA 0 0 0 0 0
10440 10440
0
10 10
6
135460 135460
4490
2000 2000
59600
2967 MG TABLET 0 59600 3200 0 56400
58 58
0
15760 15760
12130
191 191
40
0 0
1
0 0
5
8 8
545
0 0
0
216 216
AK9005688IV CATHETER NO 20 0 0 2 0 214
144
AK9005689IV CATHETER NO 22 0 0 144 3 0 141
AK9005690IV CATHETER NO 24 0 130 0 130 2 0 128
6 6
0
434 434
10870
119 119
0
27 27
236
1040 1040
22
1755 1755
106428
0 0
610
4905 4905
0
293 293
AK9008969SARUNG TANGAN STERIL NO 7 pcs 0 5 0 288
287
AK9008970SARUNG TANGAN STERIL NO 7.5 pcs 0 287 8 0 279

10908 400 MG|80 MG TABLET 0 0 0 0
0

0 0
20730
TAMBAHAN
Stok
40
823
42
0
11
ASAM TRANEKSAMAT INJEKSI 100MG/ML AMPUL 27 0 27 5 0 22
1250
8
0
21 ETANOL 70 % BOTOL 28 0 28 5 0 23
9412
11410
0
60
0
0

1850
0
0
0
0
9
58
K:IPRATROPIUM Br.0,5MG+SALBUTAMOL UNIT 0 0 0 0 0 0
100

280
1120
190
69 2 0 2 0 0 2
70 0 0 0 0 0 0
DHP tab Ktk 9 tab
0
71 0 0 0 0 0
72 Polimiskin B 10.000 UI/g 269 0 269 10 0 259
73 asam salisilat 3% 211 0 211 7 0 204
430
74 0 430 50 0 380
75 231 0 231 20 0 211
76 6470 0 6470 300 0 6170
3170
77 0 3170 1500 0 1670
78 10520 0 10520 1200 0 9320
79 8 0 8 0 0 8
Stesolid Ktk 5 Supp
10
80 0 10 0 0 10
81 0 0 0 0 0 0
82 0 0 0 0 0 0
40
83 0 40 0 0 40
84 100 0 100 0 0 100
85 69 0 69 3 0 66
25
86 5 30 2 0 28
87 1000 0 1000 0 0 1000
88 336 0 336 2 0 334
Nufit syrup BOTOL
26
89 0 26 0 0 26
90 120 0 120 0 0 120
91 0 0 0 0 0 0
OBAT PROGRAM
Stok
370
110
7
0
0
0
0
0
0
600
0
50
0
0
41
0
45
139

Stok
1260
110 ALAT SUNTIK SEKALI PAKAI 0.5 ML PACS 0 1260 120 0 1140
120 MASKER PACS 1243 0 1243 200 0 1043
123 URINE BAG PACS 72 0 72 0 0 72
124 CUTGUT 3 PACS 0 0 0 0 0 0
145 Underpad pcs 32 0 32 0 0 32
OBAT PENGADAAN JKN

Optimum
153 Captopril 12,5 mg tab 5000 0 5000 1000 0 4000
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar BPJS Jumlah Karya Tani, 03 febuari 2020
751 131 134 486 751

NIP.197306151994031003 NIP.19961222 201903 2001
(LPLPO)
Unit Penerima : PUSKESMAS KARYA TANI Bulan : Febuari

Provinsi : LAMPUNG
Optimum
3176 3176
79
12885 12885
13025
AMOXYCILLIN SIRUP KERING 250
523 MG/5 ML SIRUP 1444 0 1444 70 0 1374
27867 27867
48330 2000
ASCORBIC ACID (VITAMIN C) TABLET
923 250 MG TABLET 540 0 540 100 0 440
ASCORBIC ACID (VITAMIN C) TABLET 12905 12905
926 50 MG TABLET 0 300 0 12605
0
20 20
LIDOCAINE|HEXACHLOROPHENE
0
1702 SUPPOSITORIA 2 G DIHYDRATE| SUPPOSITORIA
CALCIUM CHLORIDE 0 0 0 0 0
10440 10440
0
10 10
6
CHLORAMPHENICOL SIRUP 125
2593 MG/5ML SIRUP 10 0 10 0 0 10
135460 135460
4490
2000 2000
CLAVULANIC ACID|AMOXICILLIN
59600
2967 TABLET 500 MG TABLET 0 59600 3000 0 56600
COTRIMOXAZOLE SIRUP 240 MG/5
3202 ML SIRUP 133 0 133 10 0 123
58 58
0
15760 15760
12130

191 191
40
0 0
4736 100 MCG SPRAY 0 1 0 0 1
0 0
5
8 8
545
0 0
0
IPRATROPIUM BROMIDE|
6238 SALBUTAMOL SULPHATE LIQUID LIQUID 3 0 3 0 0 3
216 216
AK9005688IV CATHETER NO 20 0 0 2 0 214
144
AK9005689IV CATHETER NO 22 0 0 144 3 0 141
AK9005690IV CATHETER NO 24 0 130 0 130 2 0 128
6 6
LEVODOPA|BENSERAZIDE TABLET
0
6812 100 MG TABLET 0 0 0 0 0
434 434
10870

7536 MG/ML INJEKSI 0 10 0 109
METHYLPREDNISOLONE TABLET 8
0
7586 MG TABLET 0 0 0 0 0

METRONIDAZOLE SIRUP 125 MG/5
27 27
7688 ML SIRUP 0 5 0 22
236
1040 1040
22
1755 1755
106428
0 0
610
9805 ISONIAZID|RIFAMPICIN TABLET TABLET 0 0 0 0 0 0
4905 4905
RETINOL PALMITATE TABLET 100000
0
11896 IU TABLET 0 0 0 0 0
RIFAMPICIN|ISONIAZID TABLET 75
10128 MG|50 MG TABLET 0 0 0 0 0 0
293 293
AK9008969SARUNG TANGAN STERIL NO 7 pcs 0 5 0 288
287
AK9008970SARUNG TANGAN STERIL NO 7.5 pcs 0 287 8 0 279

SULFAMETHOXAZOLE| TABLET 2310 0 2310 700 0 1610
TRIMETHOPRIM TABLET 400 MG|80
0 0
10908 MG TABLET 0 0 0 0
0

TUBERCULIN PPD TABLET 10 TU/0.1 0 0
11719 ML TABLET 0 0 0 0
20730
TAMBAHAN
Stok
40
823

42
0

100MG/ML AMPUL 27 0 27 5 0 22
1250
8

ETAKRIDIN (RIVANOL) LARUTAN 0.1
0
20 % BOTOL 0 0 0 0 0
21 ETANOL 70 % BOTOL 28 0 28 5 0 23
9412
11410

0
60
0
0

NATRIUM DIKLOFENAK TABLET 50 1850
41 MG TABLET 0 1850 600 0 1250
0
0
0
0
9
58 K:IPRATROPIUM
Br.0,5MG+SALBUTAMOL UNIT 0 0 0 0 0 0
100
280
1120

190
69 2 0 2 0 0 2
70 0 0 0 0 0 0
DHP tab Ktk 9 tab
0
71 0 0 0 0 0
Antibakteri, kombinasi : basitrasin Tube
72 500 UI/g+ Polimiskin B 10.000 UI/g 269 0 269 10 0 259
73 benzoat 6%+ asam salisilat 3% 211 0 211 7 0 204
Griseofulvin (micronized) tab scored Tablet
430
74 250 mg 0 430 50 0 380
75 231 0 231 15 0 216
76 6470 0 6470 300 0 6170
3170
77 mcg 0 3170 500 0 2670
78 10520 0 10520 600 0 9920
79 8 0 8 0 0 8
Stesolid Ktk 5 Supp
10
80 0 10 0 0 10
81 0 0 0 0 0 0
82 0 0 0 0 0 0
40
83 Tab 0 40 0 0 40
84 100 0 100 0 0 100
85 69 0 69 3 0 66
25
86 5 30 2 0 28
87 1000 0 1000 0 0 1000
88 336 0 336 2 0 334
Nufit syrup BOTOL
26
89 0 26 0 0 26
90 120 0 120 0 0 120
91 0 0 0 0 0 0
OBAT PROGRAM
Stok
Optimum
370
110
7
0
0
0
0
0
0
600
0
50
0
0
41
0
45
139

Stok
Optimum
1260
110 ALAT SUNTIK SEKALI PAKAI 0.5 ML PACS 0 1260 120 0 1140
120 MASKER PACS 1243 0 1243 300 0 943
123 URINE BAG PACS 72 0 72 0 0 72
124 CUTGUT 3 PACS 0 0 0 0 0 0
144 Silk 3-0,76cm reserve cutting 3/8 cic pcs 1 0 1 0 0 1
145 Underpad pcs 32 0 32 0 0 32
OBAT PENGADAAN JKN

Stok

148 Activated Anttapulagit 630 mg (Puralex tab 0 0 0 0 0 0
151 Betametason TM (Betam ophtal eye dro botol 0 0 0 0 0 0
152 Bisakodil supp 10 mg (Stolax Supposito supp 0 0 0 0 0 0
153 Captopril 12,5 mg tab 5000 0 5000 1000 0 4000
154 Clorampenikol SK (Bufacetin 15 mg sa tube 0 0 0 0 0 0
159 Metoclopramid sirup (Lexapram sirup botol 0 0 0 0 0 0
160 Nifedipin 10 mg tab 50 0 50 0 0 50
172 Zinc 20 mg tab tab 0 0 0 0 0 0
Jumlah Umum
Tidak bayar Jumlah
Kunjungan
Mengetahui bayar BPJS Karya Tani, 03 Maret 2020
878 159 255 464 878

NIP.197306151994031003 NIP.19961222 201903 2001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBA
(LPLPO)

Provinsi : LAMPUNG
3176 3176
247 ALLOPURINOL TABLET 100 MG TABLET 0
79
415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 0 79
12885 15315
445 AMLODIPINE TABLET 10 MG TABLET 2430
13025
446 AMLODIPINE TABLET 5 MG TABLET 3300 16325
523 AMOXYCILLIN SIRUP KERING 250 MG/5 ML SIRUP 1444 120 1564
27867 27867
809 ANTACIDA TABLET 400 MG TABLET 0
48330
966 ASAM MEFENAMAT TABLET 500 MG TABLET 300 48630
923 MG TABLET 540 0 540
12905 13205
926 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 300
0
1479 BENZOIC ACID SALEP SALEP 0 0
20 20
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOSITORIA 0
1702 SUPPOSITORIA 2 G SUPPOSITORIA 0 0
10160 CHLORIDE|SODIUM LACTATE INFUS INFUS 0 0 0
10440 11240
2005 CALCIUM LACTATE TABLET 500 MG TABLET 800
0
2084 CARBAMAZEPINE TABLET 200 MG TABLET 0 0
10 10
2546 CETIRIZINE TABLET 10 MG TABLET 0
6
2601 CHLORAMPHENICOL SALEP 2% SALEP 0 6
135460 137960
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 2500
4490
2762 CHLORPROMAZINE TABLET 100 MG TABLET 0 4490
2000 2000
2967 500 MG TABLET 0 59600
58 58
6645 COTRIMOXAZOLE TABLET TABLET 0
0
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 0 0
15760 15760
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 0
12130
3690 DICLOFENAC SODIUM TABLET 50 MG TABLET 0 12130
191 191
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 0
40
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 0 40
0 0
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0
4736 MCG SPRAY 0 1
0 0
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 0
5
5167 GENTAMYCIN SALEP 0.3 % SALEP 0 5
8 8
5300 GLUCOSE INFUS 5 % INFUS 0
545
5843 HYDROCORTISONE SALEP 2.5 % SALEP 50 595
0 0
5966 IBUPROFEN TABLET 400 MG TABLET 0
0
AK0902022Intravascular administration set 0 0 0
216 216
AK9005688IV CATHETER NO 20 0 0
144
AK9005689IV CATHETER NO 22 0 0 144
AK9005690IV CATHETER NO 24 0 130 0 130
6 6
6535 KETOCONAZOLE SALEP 2% SALEP 0
0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 0 0
434 434
6998 LOPERAMIDE TABLET 2 MG TABLET 0
10870
7013 LORATADINE TABLET 10 MG TABLET 0 10870
119 119
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 0
0
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0

27 27
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 0
236
7697 METRONIDAZOLE TABLET 500 MG TABLET 0 236
1040 1040
8160 NIFEDIPINE TABLET 10 MG TABLET 0
22
8256 NYSTATIN OVULA 10000 IU OVULA 0 22
1755 1755
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 0
106428
8593 PARACETAMOL TABLET 500 MG TABLET 0 106428
0 0
AK0902040Piston syringe 0 0
610
9673 PROPANOL TABLET 10 MG TABLET 0 610
4905 5905
1684 PYRIDOXINE TABLET 10 MG TABLET 1000
0
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0
10128 MG TABLET 0 0 0
293 293
AK9008969SARUNG TANGAN STERIL NO 7 pcs 0
287
AK9008970SARUNG TANGAN STERIL NO 7.5 pcs 0 287

SULFAMETHOXAZOLE|TRIMETHOPRIM 0 0
10908 TABLET 400 MG|80 MG TABLET 0
0
AK0501030Syringe actuator for an injector 0 0 0
0 0
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0
20730
11922 VITAMIN B COMPOUND TABLET TABLET 6000 26730
TAMBAHAN
40
1 AMINOPHILLIN TABLET 200 TABLET 0 40
823
4 AMOKSISILIN SIRUP 125 MG/5 ML TABLET 0 823
42
7 ANTIMIGREN:ERGOTAMIN+KAFEIN TABLET 0 42
0
10 ASAM TRANEKSAMAT TABLET TABLET 0 0
11
ASAM TRANEKSAMAT INJEKSI 100MG/ML AMPUL 27 0 27
1250
13 ASIKLOVIR TABLET 400 MG TABLET 200 1450
8
16 BEDAK SALISILAT SERBUK 2 % KOTAK 0 8
17 BETAMETHASON KRIM 0,5MG/g TUBE 248 0 248

0
20 ETAKRIDIN (RIVANOL) LARUTAN 0.1 % BOTOL 0 0
21 ETANOL 70 % BOTOL 28 0 28
9412
23 FUROSEMIDE TABLET 40 MG TABLET 0 9412
11410
26 GLIBENKLAMIDE TABLET 5 MG TABLET 0 11410
0
29 HALOPERIDOL TABLET 5 MG TABLET 0 0
60
32 ISOSORBIT DINITRAT TABLET 5 MG TABLET 0 60
0
35 KAPTOPRIL TABLET 50 MG TABLET 0 0
0
38 MEBENDAZOL (VERMOKS) 100 MG TABLET 0 0

1850
41 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 2800 4650
0
44 PIRANTEL PAMOAT TABLET 0 0
0
47 POVIDON IODIDA LAR @1000 ML BOTOL 0 0
0
50 TETRASIKLIN HCL KAPSUL 250 MG TABLET 0 0
0
53 ASAM FOLAT 0,4 MG TABLET 0 0
9
56 GLUKOSA LAR INFUS 10% BOTOL 0 9
58
K:IPRATROPIUM Br.0,5MG+SALBUTAMOL UNIT 0 0 0
100
59 PROPILTIOURASIL 100 MG TABLET 0 100
280
62 PROPANOLOL 40 MG TABLET 0 280
1120
65 KETOKONAZOLE 200 MG TABLET 150 1270
190
68 OMEPRAZOL 20 MG KASUL 0 190
69 2 0 2
70 0 0 0
DHP tab Ktk 9 tab
0
71 0 0
72 UI/g+ Polimiskin B 10.000 UI/g
269 0 269
6%+ asam salisilat 3%
73 211 0 211
mg 430
74 0 430
75 231 0 231
76 6470 500 6970
3170
77 500 3670
78 10520 500 11020
79 8 0 8
Stesolid Ktk 5 Supp
10
80 0 10
81 0 0 0
82 0 0 0
40
83 0 40
84 100 0 100
85 69 0 69
25
86 5 30
87 1000 0 1000
88 336 30 366
Nufit syrup BOTOL
26
89 5 31
90 120 0 120
91 0 0 0
OBAT PROGRAM
370
92 ALBENDAZOLE TABLET 400 MG TABLET 0 370
110
93 GARAM ORALIT SACHET 0 110
7
94 GENTAMICIN INJEKSI AMP 0 7
0
95 MAGNESIUM SULFAT INJEKSI 40 % VIAL 0 0
0
96 GENTAMICIN SALEM MATA TUBE 0 0
0
97 OBAT FDC KATEGORI I PAKET 0 0
0
98 OBAT FDC KATEGORI II PAKET 0 0
0
99 OBAT FDC KATEGORI ANAK PAKET 0 0
0
100 OBAT FDC KATEGORI SISIPAN PAKET 0 0
600
101 PREDNISON TABLET 5 MG TABLET 0 600
0
102 ZINK TABLET TABLET 0 0
50
103 FENOBARBITAL INJEK 50 MG AMPUL 0 50
0
104 TABLET TAMBAH DARAH TABLET 0 0
0
105 EPINEFRIN INJEKSI 1 MG/ML AMPUL 0 0
41
106 FITOMENADION TABLET TABLET 0 41
0
107 METIL ERGOMETRIN INJEKSI AMPUL 0 0
45
108 OKSITOSIN INJEKSI 10 UI/ML AMPUL 0 45
139
109 FITOMENADION INJEK 2 MG/ML AMPUL 0 139
ALAT DAN BARANG MEDIS HABIS PA

1260
110 ALAT SUNTIK SEKALI PAKAI 0.5 ML PACS 0 1260
120 MASKER PACS 1243 0 1243
132 parmafix 5 cm x 500 cm box 20 20 40
133 paper tape 5.0 cm x 9,14 m roll 20 20 0
144 Silk 3-0,76cm reserve cutting 3/8 cicle 16m pcs 1 100 101
147 leukoplast 7,5 cm x 4,5m roll 2 2 4
148 sarung tangan size L BOX 1 1 2
149 E-CARE sterif lo / humidifier botol 1 1 2
150 masker ties on box 7 7 0
151 masker ear loop box 7 7 0
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Puralex Activ tab 0 0 0
151 Betametason TM (Betam ophtal eye drop 24' botol 0 0 0
153 Captopril 12,5 mg tab 5000 0 5000
159 Metoclopramid sirup (Lexapram sirup 5mg/ 5 botol 0 0 0
182 Paracetamol 500 mg Tablet 8000 0 8000
183 antasida doen Tablet 6000 0 7000
Jumlah Umum
Ka.UPTD Puskesmas Karya Tani Resep
506 169 176 531
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
MBAR PERMINTAAN OBAT
O)
Bulan : Maret
Tahun : 2020
Pemakaian Rusak/Ed Sisa Stok Stok

230 0 2946
4 0 75
90 0 300
350 0 14965
300 0 16025
70 0 1494
27867 0 0
2000
0 46630
100 0 440
300 0 12905
0 0 0
28 0 30
20 0 0
0 0 0
0 0 0
900 0 10340
0 0 0
0 0 0
0 0 10
0 0 6
0 0 10
3000 0 134960
4490 0 0
0 0 0
300 0 1700
3000 0 56600
10 0 123
10 0 48
0 0 0
1500 0 17176
800 0 14960
700 0 11430
150 0 7980
5 0 186
5 0 35
100 0 385
0 0 0
0 0 1
10 0 50
0 0 0
0 0 5
400 0 8180
2 0 6
20 0 575
200 0 480
0 0 0
0 0 0
0 0 3
2 0 214
3 0 141
2 0 128
1 0 5
0 0 0
5 0 179
100 0 334
300 0 10570
300 0 290
10 0 109
0 0 0
0 0 0
5 0 22
50 0 186
3 0 5
150 0 890
0 0 22
5 0 171
60 0 1695
106428 0 0
80 0 270
0 0 0
50 0 560
0 0 0
1800 0 4105
0 0 0
0 0 0
5 0 288
8 0 279
700 0 2210
0 0 0
0 0 0
0 0 10
0 0 0
2000 0 24730
0 0 0
HAN
Stok
0 0 40
0 0 0
0 0 0
200 0 623
50 0 682
0 0 8
0 0 42
0 0 30
320 0 0
0 0 0
5 0 22
10 0 15
130 0 1320
0 0 0
0 0 0
0 0 8
10 0 238
0 0 10
0 0 0
5 0 23
0 0 0
200 0 9212
1 0 8
0 0 0
1000 0 10410
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 60
0 0 0
2449 0 0
0 0 0
0 0 0
0 0 0
0 0 0
800 0 5250
0 0 50
600 0 4050
1 0 81
0 0 0
0 0 0
1 0 7
0 0 0
0 0 0
200 0 1425
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 17
1 0 8
0 0 0
0 0 0
0 0 100
0 0 0
0 0 5
0 0 280
6 0 19
8 0 230
150 0 1120
200 0 4150
5 0 116
60 0 130
0 0 2
0 0 0
0 0 0
10 0 259
7 0 204
50 0 380
15 0 216
300 0 6670
500 0 3170
600 0 10420
0 0 8
0 0 10
0 0 0
0 0 0
0 0 40
0 0 100
3 0 66
2 0 28
0 0 1000
2 0 364
0 0 31
0 0 120
0 0 0
OGRAM
Stok
50 0 320
110 0 0
0 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
80 0 520
0 0 0
5 0 45
0 0 0
0 0 0
15 0 26
0 0 0
3 0 42
20 0 119
MEDIS HABIS PAKAI

Stok
120 0 1140
0 0 14
4 0 2
100 0 3954
0 0 57
0 0 10
3 0 10
0 0 12
0 0 0
0 0 10
300 0 943
0 0 0
0 0 0
0 0 82
0 0 0
0 0 3
1 0 13
5 0 74
1 0 5
0 0 5
0 0 5
5 0 33
0 0 40
0 0 20
3 0 22
0 0 4
0 0 5
0 0 1
0 0 11
2 0 5
0 0 10
0 0 10
0 0 101
0 0 201
0 0 101
0 0 42
0 0 0
0 0 4
0 0 2
0 0 2
0 0 7
0 0 7
5 0 6
0 0 1
DAAN JKN
Stok
0 0 90
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1000 0 4000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 50
0 0 0
56 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 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 3
0 0 60
0 0 0
60 0 0
0 0 200
4000 0 4000
3000 0 4000
1900 0 3450
Jumlah Karya Tani, 02 April 2020

876
DESLIA NURVITA UTAMI,A.Md

NIP.19961222 201903 2001
(LPLPO)

Provinsi : LAMPUNG
3176 3176
AMINOPHYLLINE INJEKSI 25 79
415 MG/ML INJEKSI 0 79
12885 12885
13025
AMOXYCILLIN SIRUP KERING 250
523 MG/5 ML SIRUP 1444 0 1444
27867 27867
ASAM MEFENAMAT TABLET 500 48330
966 MG TABLET 0 48330
ASCORBIC ACID (VITAMIN C)
923 TABLET 250 MG TABLET 540 0 540
ASCORBIC ACID (VITAMIN C) 12905 12905
926 TABLET 50 MG TABLET 0
0
BISMUTH SUBGALLATE|ZINC 20 20
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOSITORIA
OXIDE|LIDOCAINE| 0
HEXACHLOROPHENE
CALCIUM CHLORIDE DIHYDRATE| 0
1702 SUPPOSITORIA 2G
POTASSIUM CHLORIDE|SODIUM SUPPOSITORIA 0 0
CHLORIDE|SODIUM LACTATE
10160 INFUS INFUS 0 0 0
10440 10440
0

10 10
6
2593 MG/5ML SIRUP 10 0 10
CHLORPHENIRAMINE TABLET 4 135460 135460
2745 MG TABLET 0
CHLORPROMAZINE TABLET 100 4490
2762 MG TABLET 0 4490
2000 2000
CLAVULANIC ACID|AMOXICILLIN 59600
2967 TABLET 500 MG TABLET 0 59600
COTRIMOXAZOLE SIRUP 240 MG/5
3202 ML SIRUP 133 0 133
58 58
DEXAMETHASONE INJEKSI 5 0
3416 MG/ML INJEKSI 0 0

DICLOFENAC SODIUM TABLET 25 15760 15760
3688 MG TABLET 0
DICLOFENAC SODIUM TABLET 50 12130
3690 MG TABLET 0 12130
191 191
ERYTHROMYCIN SIRUP 200 MG/5 40
4445 ML SIRUP 0 40
0 0
FENOTEROL HYDROBROMIDE 1
4736 SPRAY 100 MCG SPRAY 0 1
0 0
5
8 8
545
0 0
0
6238 SALBUTAMOL SULPHATE LIQUID LIQUID 3 0 3
216 216
144
AK9005690IV CATHETER NO 24 0 130 0 130
6 6
6812 100 MG TABLET 0 0
434 434
10870

7536 MG/ML INJEKSI 0
METHYLPREDNISOLONE TABLET 8 0
7586 MG TABLET 0 0

METRONIDAZOLE SIRUP 125 MG/5 27 27
7688 ML SIRUP 0
236
1040 1040
22

PARACETAMOL SIRUP 120 MG/5 1755 1755
8601 ML SIRUP 0
106428
0 0
610
9805 ISONIAZID|RIFAMPICIN TABLET TABLET 0 0 0
4905 4905
11896 100000 IU TABLET 0 0
10128 MG|50 MG TABLET 0 0 0
293 293
287

SULFAMETHOXAZOLE| TABLET 2310 0 2310
TRIMETHOPRIM TABLET 400 MG| 0 0
10908 80 MG TABLET 0
0

TUBERCULIN PPD TABLET 10 0 0
11719 TU/0.1 ML TABLET 0
20730
TAMBAHAN
40
823

42
0

100MG/ML AMPUL 27 0 27
1250
8

ETAKRIDIN (RIVANOL) LARUTAN 0
20 0.1 % BOTOL 0 0
21 ETANOL 70 % BOTOL 28 0 28
9412
11410
0
60
0
0

NATRIUM DIKLOFENAK TABLET 50 1850
41 MG TABLET 0 1850
0
0
0
0
9

58 K:IPRATROPIUM
Br.0,5MG+SALBUTAMOL UNIT 0 0 0
100
280
1120
190
69 2 0 2
70 0 0 0
DHP tab Ktk 9 tab
0
71 0 0
Antibakteri, kombinasi : basitrasin Tube
72 500 UI/g+ Polimiskin B 10.000 UI/g 269 0 269
73 benzoat 6%+ asam salisilat 3% 211 0 211
Griseofulvin (micronized) tab Tablet
scored 250 mg 430
74 0 430
75 231 0 231
76 6470 0 6470
Sianokobalamin (vitamin B12) tab Tablet
50 mcg 3170
77 0 3170
78 10520 0 10520
79 8 0 8
Stesolid Ktk 5 Supp
10
80 0 10
81 0 0 0
82 0 0 0
40
83 0 40
84 100 0 100
85 69 0 69
25
86 0 25
87 1000 0 1000
88 336 0 336
Nufit syrup BOTOL
26
89 0 26
90 120 0 120
91 0 0 0
OBAT PROGRAM
370
110
7
0
0
0
0
0
0
600
0
50
0
0
41
0
45
139

1260
120 MASKER PACS 1243 0 1243
144 Silk 3-0,76cm reserve cutting 3/8 c pcs 1 0 1
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Pural tab 0 0 0
151 Betametason TM (Betam ophtal eye botol 0 0 0
152 Bisakodil supp 10 mg (Stolax Suppos supp 0 0 0
153 Captopril 12,5 mg tab 5000 0 5000
154 Clorampenikol SK (Bufacetin 15 mg tube 0 0 0
158 Lidocain spray (Xylocaine 10% spra botol 0 0 0
159 Metoclopramid sirup (Lexapram siru botol 0 0 0
Jumlah Umum
500 111 83 515
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
N DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Bulan : April
Tahun : 2020

Optimum
150 0 3026
2 0 77
90 0 300
300 0 12585
200 0 12825
50 0 1394
26800 0 1067
3000
0 45330
80 0 460
200 0 12705
0 0 0
33 0 25
20 0 0
0 0 0
0 0 0
800 0 9640
0 0 0
0 0 0
0 0 10
0 0 6
0 0 10
2500 0 132960
4490 0 0
0 0 0
200 0 1800
3000 0 56600
33 0 100
10 0 48
0 0 0
1500 0 14176
800 0 14960
700 0 11430
150 0 7980
5 0 186
10 0 30
100 0 385
0 0 0
0 0 1
10 0 50
0 0 0
0 0 5
300 0 8280
1 0 7
22 0 523
100 0 580
0 0 0
0 0 0
0 0 3
1 0 215
2 0 142
2 0 128
1 0 5
0 0 0
5 0 179
100 0 334
300 0 10570
300 0 290
10 0 109
0 0 0
0 0 0
5 0 22
50 0 186
3 0 5
150 0 890
0 0 22
5 0 154
60 0 1695
106000 0 428
50 0 300
0 0 0
50 0 560
0 0 0
1000 0 3905
0 0 0
0 0 0
28 0 265
32 0 255
600 0 1710
0 0 0
0 0 0
0 0 10
0 0 0
2500 0 18230
0 0 0
AMBAHAN
Stok
0 0 40
0 0 0
0 0 0
200 0 623
50 0 482
0 0 8
0 0 42
0 0 30
200 0 120
0 0 0
5 0 22
10 0 15
130 0 1120
0 0 0
0 0 0
0 0 8
20 0 228
0 0 10
0 0 0
5 0 23
0 0 0
250 0 9162
1 0 8
0 0 0
900 0 10510
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 60
0 0 0
2449 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1000 0 4750
0 0 50
600 0 1250
2 0 80
0 0 0
0 0 0
1 0 7
0 0 0
0 0 0
200 0 1425
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 17
1 0 8
0 0 0
0 0 0
0 0 100
0 0 0
0 0 5
0 0 280
6 0 19
8 0 230
150 0 970
200 0 4150
5 0 116
60 0 130
0 0 2
0 0 0
0 0 0
10 0 259
7 0 204
50 0 380
15 0 216
300 0 6170
500 0 2670
600 0 9920
0 0 8
0 0 10
0 0 0
0 0 0
0 0 40
0 0 100
3 0 66
2 0 23
0 0 1000
2 0 334
0 0 26
0 0 120
0 0 0
AT PROGRAM
Optimum
50 0 320
110 0 0
0 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 0 500
0 0 0
5 0 45
0 0 0
0 0 0
10 0 31
0 0 0
3 0 42
20 0 119
ANG MEDIS HABIS PAKAI

Optimum
100 0 1160
0 0 7
4 0 2
100 0 3946
0 0 57
0 0 10
3 0 10
0 0 12
0 0 0
0 0 10
400 0 843
0 0 0
0 0 0
0 0 72
0 0 0
0 0 3
1 0 13
5 0 74
1 0 5
0 0 5
0 0 5
5 0 33
0 0 20
0 0 20
3 0 22
0 0 4
0 0 5
0 0 1
0 0 9
2 0 4
0 0 10
0 0 10
0 0 101
0 0 101
0 0 1
0 0 32
0 0 0
0 0 2
0 0 1
0 0 1
0 0 7
0 0 7
5 0 6
0 0 1
PENGADAAN JKN
Stok
0 0 90
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1000 0 4000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 50
0 0 0
56 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 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 3
0 0 60
0 0 0
60 0 0
0 0 200
8000 0 0
6000 0 1000
1500 0 3850
Jumlah Karya Tani, 03 Mei 2020

709

NIP.19961222 201903 2001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
(LPLPO)

Provinsi : LAMPUNG
Kode Nama Obat Sediaan Stok Awal Penerimaan
3176
79
415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 0
444 AMITRIPTYLINE TABLET 25 MG TABLET 390 0
12885
13025
523 AMOXYCILLIN SIRUP KERING 250 MG/5 ML SIRUP 1444 0
27867
48330
966 ASAM MEFENAMAT TABLET 500 MG TABLET 0
923 ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET 540 0
12905
0
1479 BENZOIC ACID SALEP SALEP 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOSITORIA 58 0
20
BISMUTH SUBGALLATE|ZINC OXIDE| SUPPOSITORIA 0
1702 SUPPOSITORIA 2 G DIHYDRATE|POTASSIUM
CALCIUM CHLORIDE SUPPOSITORIA 0
10160 LACTATE INFUS INFUS 0 0
10440
0
2084 CARBAMAZEPINE TABLET 200 MG TABLET 0
2518 CETIRIZINE SIRUP 1 MG/ML SIRUP 0 0
10
6
2601 CHLORAMPHENICOL SALEP 2% SALEP 0
2593 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 10 0
135460
4490
2762 CHLORPROMAZINE TABLET 100 MG TABLET 0
2000
59600
2967 MG TABLET 0
3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 133 0
58
0
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 0
3443 DEXAMETHASONE TABLET 0.5 MG TABLET 15676 0
15760
12130
3983 DOMPERIDONE TABLET 10 MG TABLET 8130 0
191
40
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 0
4458 ERYTHROMYCIN TABLET 250 MG TABLET 485 0
0
1
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 0
945 FOLIC ACID TABLET 400 MCG TABLET 60 0
0
5
5167 GENTAMYCIN SALEP 0.3 % SALEP 0
5266 GLIMEPIRIDE TABLET 2 MG TABLET 8580 0
8
545
5843 HYDROCORTISONE SALEP 2.5 % SALEP 0
5964 IBUPROFEN TABLET 200 MG TABLET 680 0
0
0
AK0902022 Intravascular administration set 0 0
6238 SULPHATE LIQUID LIQUID 3 0
216
AK9005688 IV CATHETER NO 20 0 0
144
AK9005689 IV CATHETER NO 22 0 0
AK9005690 IV CATHETER NO 24 0 130 0
6
0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 0
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 184 0
434
10870
7013 LORATADINE TABLET 10 MG TABLET 0
7491 METFORMIN TABLET 500 MG TABLET 590 0
119
0
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0
7651 METOCLOPRAMIDE TABLET 10 MG TABLET 0 0
27
236
7697 METRONIDAZOLE TABLET 500 MG TABLET 0
7727 MICONAZOLE SALEP 2% SALEP 8 0
1040
22
8256 NYSTATIN OVULA 10000 IU OVULA 0
8573 PARACETAMOL DROPS 100 MG/ML DROPS 159 0
1755
106428
8593 PARACETAMOL TABLET 500 MG TABLET 0
9246 PHENYTOIN TABLET 100 MG TABLET 350 0
0
AK0902040 Piston syringe 0 0
610
9673 PROPANOL TABLET 10 MG TABLET 0
9805 RIFAMPICIN TABLET TABLET 0 0
4905
0
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET 0 0
293
AK9008969 SARUNG TANGAN STERIL NO 7 pcs 0
287
AK9008970 SARUNG TANGAN STERIL NO 7.5 pcs 0
10482 SIMVASTATIN TABLET 10 MG TABLET 2310 0

SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET
0
10908 400 MG|80 MG TABLET 0
0
AK0501030 Syringe actuator for an injector 0 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 10 0
0
20730
11922 VITAMIN B COMPOUND TABLET TABLET 0
12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP 0 0
TAMBAHAN
40
1 AMINOPHILLIN TABLET 200 TABLET 0
2 AMOKSISILIN TABLET 250 MG TABLET 0 0
823
4 AMOKSISILIN SIRUP 125 MG/5 ML TABLET 0
5 ANTASIDA SUSPENSI SIRUP 532 0
6 ANTIHEMOROID SUPPOSITORIA SUPPOSITORIA 8 0
42
7 ANTIMIGREN:ERGOTAMIN+KAFEIN TABLET 0
8 ASETOSAL TABLET 80 MG TABLET 30 0
9 ASAM FOLAT TABLET 1 MG TABLET 320 0
0
10 ASAM TRANEKSAMAT TABLET TABLET 0
11
ASAM TRANEKSAMAT INJEKSI 100MG/ML AMPUL 27 0
1250
13 ASIKLOVIR TABLET 400 MG TABLET 0
14 ASIKLOVIR KRIM TUBE 0 0

15 ATROPIN SULFAT TABLET 0.5 MG TABLET 0 0
8
16 BEDAK SALISILAT SERBUK 2 % KOTAK 0
17 BETAMETHASON KRIM 0,5MG/g TUBE 248 0
19 DIGOKSIN TABLET 0.25 MG TABLET 10 0
0
20 ETAKRIDIN (RIVANOL) LARUTAN 0.1 % BOTOL 0
21 ETANOL 70 % BOTOL 28 0
22 EUGENOL CAIRAN BOTOL 0 0
9412
23 FUROSEMIDE TABLET 40 MG TABLET 0
24 FUROSEMIDE INJEKSI 10 MG/ML AMPUL 9 0
25 GENTIAN VIOLET LARUTAN 1 % BOTOL 0 0
11410
26 GLIBENKLAMIDE TABLET 5 MG TABLET 0
27 GRISEOFULVIN TABLET 125 MG TABLET 0 0
28 HALOPERIDOL TABLET 1.5 MG TABLET 0 0
0
29 HALOPERIDOL TABLET 5 MG TABLET 0
30 IBUPROFEN SIRUP 100 MG/5 ML TABLET 0 0
60
32 ISOSORBIT DINITRAT TABLET 5 MG TABLET 0
33 KAPTOPRIL TABLET 12.5 MG TABLET 0 0
34 KAPTOPRIL TABLER 25 MG TABLET 2449 0
0
35 KAPTOPRIL TABLET 50 MG TABLET 0
36 KETOROLAT INJEKSI 30 MG/ML TABLET 0 0
37 KLOREAMFENIKOL KAPSUL 250 MG TABLET 0 0
0
38 MEBENDAZOL (VERMOKS) 100 MG TABLET 0
39 METILPREDNISOLON TABLET 4 MG TABLET 5750 0
1850
41 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 0
42 NA KLORIDA INFUS 0.9 % TABLET 82 0

43 OKSITETRASIKLIN HCL SALEP MATA TUBE 0 0
0
44 PIRANTEL PAMOAT TABLET 0
0
47 POVIDON IODIDA LAR @1000 ML BOTOL 0
48 RANITIDINE TABLET 150 MG TABLET 1625 0
49 SIPROFLOKSASIN TABLET 500 MH TABLET 0 0
0
50 TETRASIKLIN HCL KAPSUL 250 MG TABLET 0
52 ETYL KLORIDE SPRAY BOTOL 0 0
0
53 ASAM FOLAT 0,4 MG TABLET 0
54 DIAZEPAM TABLET 2 MG TABLET 0 0
55 DIAZEPAM INJ. 5 MG/ML AMPUL 18 0
9
56 GLUKOSA LAR INFUS 10% BOTOL 0
57 KLOREAMFENIKOL KAPSUL 500 MG KAPSUL 0 0
58
K:IPRATROPIUM Br.0,5MG+SALBUTAMOL UNIT 0 0
100
59 PROPILTIOURASIL 100 MG TABLET 0
60 RISPERIDONE 2 MG TABLET 0 0
61 NATRIUM FUSIDAT TUBE 5 0
280
62 PROPANOLOL 40 MG TABLET 0
63 CETIRIZINE SIRUP 5 MG/ML BOTOL 25 0
64 SALEP 2-4 KOMBINASI POT 238 0
1120
65 KETOKONAZOLE 200 MG TABLET 0
66 ATTAPULGIT TABLET 4350 0
67 RINGER LAKTAT LAR.INFUS BOTOL 121 0
190
68 OMEPRAZOL 20 MG KASUL 0
69 2 0
70 0 0
DHP tab Ktk 9 tab
0
71 0
72 Polimiskin B 10.000 UI/g 269 0
73 asam salisilat 3% 211 0
430
74 0
75 231 0
76 6470 0
3170
77 0
78 10520 0
79 8 0
Stesolid Ktk 5 Supp
10
80 0
81 0 0
82 0 0
40
83 0
84 100 0
85 69 0
25
86 0
87 1000 0
88 336 0
Nufit syrup BOTOL
26
89 0
90 120 0
91 0 0
OBAT PROGRAM
370
92 ALBENDAZOLE TABLET 400 MG TABLET 0
110
93 GARAM ORALIT SACHET 0
7
94 GENTAMICIN INJEKSI AMP 0
0
95 MAGNESIUM SULFAT INJEKSI 40 % VIAL 0
0
96 GENTAMICIN SALEM MATA TUBE 0
0
97 OBAT FDC KATEGORI I PAKET 0
0
98 OBAT FDC KATEGORI II PAKET 0
0
99 OBAT FDC KATEGORI ANAK PAKET 0
0
100 OBAT FDC KATEGORI SISIPAN PAKET 0
600
101 PREDNISON TABLET 5 MG TABLET 0
0
102 ZINK TABLET TABLET 0
50
103 FENOBARBITAL INJEK 50 MG AMPUL 0
0
104 TABLET TAMBAH DARAH TABLET 0
0
105 EPINEFRIN INJEKSI 1 MG/ML AMPUL 0
41
106 FITOMENADION TABLET TABLET 0
0
107 METIL ERGOMETRIN INJEKSI AMPUL 0
45
108 OKSITOSIN INJEKSI 10 UI/ML AMPUL 0
139
109 FITOMENADION INJEK 2 MG/ML AMPUL 0
ALAT DAN BARANG MEDIS HABIS

1260
111 ALAT SUNTIK SEKALI PAKAI 1 ML PACS 7 0
114 INFUSET DEWASA PACS 57 0
115 INFUSET ANAK PACS 10 0
116 KAPAS ABSORBEN 250 G PACS 13 0
117 KASA HIDROFIL STERIL 16 X 16 CM PACS 12 0
118 KASA PEMBALUT 3 INCHI PACS 0 0
120 MASKER PACS 1243 0
121 SILK NO 3/0 DENGAN JARUM BEDAH PACS 0 0
122 PLESTER 5 YARD X 2 INCHI PACS 0 0
123 URINE BAG PACS 72 0
124 CUTGUT 3 PACS 0 0
125 PEMBALUT GIPS PACS 3 0
126 FOLEY CATETER PACS 14 0
127 Aximed swab 2-ply Dus 79 0
128 Cannofix-PU (6 cm x 8 cm) Pcs 6 0
129 SNA Medika Poliban 10 cm x 2.7 m Roll 5 0
130 Alkazyme sachet 25 mg pack 5 0
131 Alat suntik sekali pake 5 ml pcs 38 0
132 parmafix 5 cm x 500 cm box 20 0
133 paper tape 5.0 cm x 9,14 m roll 20 0
134 Paper tape/1.25 cmx9,14m roll 25 0
135 Egypt pharmapfix (5cmx500cm) box 4 0
136 Aquagel sterile jely 82 gr tube 5 0
137 Catrejell lidocain 2% & CHG 0.05% tube 1 0
138 Hydrex surgicalscrub 500ml botol 9 0
139 Kasa hydropil 40 yard X 80 cm roll 6 0
140 Nasal Oxygen size L pcs 10 0
141 Nasal Oxygen size s roll 10 0
142 Sarung tangan steril 7.0 pair 101 0
143 sarung tangan steril 7.5 pair 101 0
144 Silk 3-0,76cm reserve cutting 3/8 cicle 16mm pcs 1 0
145 Underpad pcs 32 0
146 Cholesterol test strip 10's Box 0 0
147 leukoplast 7,5 cm x 4,5m roll 2 0
148 sarung tangan size L BOX 1 0
149 E-CARE sterif lo / humidifier botol 1 0
150 masker ties on box 7 0
151 masker ear loop box 7 0
152 Glucose test strip 50's Box 11 0
153 Uric test strip 25's Box 1 0
OBAT PENGADAAN JKN

147 Acyclovir tab 200mg tab 90 0

148 Activated Anttapulagit 630 mg (Puralex Activate tab 0 0
149 Asam Mefenamat kapsul 250 mg kap 0 0
150 Atenolol 50 mg (Farnormin 50 mg) tab 0 0
151 Betametason TM (Betam ophtal eye drop 24's) botol 0 0
152 Bisakodil supp 10 mg (Stolax Suppositoria) supp 0 0
153 Captopril 12,5 mg tab 5000 0
154 Clorampenikol SK (Bufacetin 15 mg salep) tube 0 0
155 Dexamethason 5mg/5ml injeksi amp 0 0
156 Furosemide 40 mg tab tab 0 0
157 Ibuprofen tab 200 mg (botol) tab 0 0
158 Lidocain spray (Xylocaine 10% spray) botol 0 0
159 Metoclopramid sirup (Lexapram sirup 5mg/ 5ml) botol 0 0
160 Nifedipin 10 mg tab 50 0
161 Ondansetron 4 mg tab 0 0
162 Parasetamol sirup 120 mg/ 5ml botol 56 0
163 Permethrin 5%(Scabimite cream) tube 0 0
164 Pytomenadion (botol) tab 0 0
165 Ranitidin tab 150 mg tab 0 0
166 Salbutamol 2 mg tab 0 0
167 Salep 2-4 kombinasi Pot 6 0
168 Spironolakton 25 mg tab 0 0
169 Vitamin B12 50 mg tab tab 0 0
170 Ventolin Nebules 2,5mg 20amp/b bok 0 0
171 Zink sirup 20mg/5ml (zirkum) Btl 0 0
172 Zinc 20 mg tab tab 0 0
173 Diphenhydramin (HCL) inj.10ml/ml Amp 0 0
174 Chloramex Cap 500 mg Kap 0 0
175 Methylprednisolon 4 mg Tab 0 0
176 Calcium Laktat tablet 500 mg tab 0 0
177 Hydrokortison Krim 1% tube 5 gr tube 3 0
178 Erytromycin kapsul 250 mg Kap 60 0
179 Vitamin B12 inj. 500mcg/ml amp 0 0
180 Dexamethason tablet 0,5 mg tablet 60 0
181 Kloraniramina maleat (CTM) tablet 4 mg Tablet 200 0
182 Paracetamol 500 mg Tablet 8000 0
183 antasida doen Tablet 6000 0
184 Tablet tambah darah Tablet 5350 0
Jumlah Umum
Tidak bayar
Kunjungan
Mengetahui bayar
228 51 21
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
N DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Bulan : Mei
Tahun : 2020
Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Permintaan Pemberian Keterangan

Optimum
3176
100 0 3076
79 0 0 79
390 50 0 340
12885
120 0 12765
13025 200 0 12825
1444 50 0 1394
27867
26800 0 1067
150
48330 0 48180
540 80 0 460
12905
200 0 12705
0 0 0 0
58 33 0 25
20
20 0 0
0 0 0 0
0 0 0 0
10440
500 0 9940
0 0 0 0
0 0 0 0
10
0 0 10
6 0 0 6
10 0 0 10
135460
1000 0 134460
4490 2000 0 2490
0 0 0 0
2000
200 0 1800
59600 1400 0 58200
133 33 0 100
58
10 0 48
0 0 0 0
15676 1000 0 14676
15760
500 0 15260
12130 500 0 11630
8130 150 0 7980
191
5 0 186
40 10 0 30
485 100 0 385
0
0 0 0
1 0 0 1
60 10 0 50
0
0 0 0
5 0 0 5
8580 300 0 8280
8
1 0 7
545 22 0 523
680 100 0 580
0
0 0 0
0 0 0 0
3 0 0 3
216
1 0 215
144 2 0 142
130 2 0 128
6
1 0 5
0 0 0 0
184 5 0 179
434
100 0 334
10870 250 0 10620
590 300 0 290
119
10 0 109
0 0 0 0
0 0 0 0
27
5 0 22
236 50 0 186
8 3 0 5
1040
150 0 890
22 0 0 22
159 5 0 154
1755
60 0 1695
106428 106000 0 428
350 50 0 300
0
0 0 0
610 50 0 560
0 0 0 0
4905
900 0 4005
0 0 0 0
0 0 0 0
293
20 0 273
287 15 0 272
2310 600 0 1710
0
0 0 0
0 0 0 0
10 0 0 10
0
0 0 0
20730 1800 0 18930
0 0 0 0
AMBAHAN
Stok
Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum Permintaan Pemberian Keterangan
40 0 0 40
0 0 0 0
0 0 0 0
823 150 0 673
532 30 0 502
8 0 0 8
42 0 0 42
30 0 0 30
320 120 0 200
0 0 0 0
27 5 0 22
25 10 0 15
1250 130 0 1120
0 0 0 0
0 0 0 0
8 0 0 8
248 18 0 230
10 0 0 10
0 0 0 0
28 5 0 23
0 0 0 0
9412 250 0 9162
9 1 0 8
0 0 0 0
11410 1000 0 10410
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
60 0 0 60
0 0 0 0
2449 250 0 2199
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5750 1500 0 4250
50 0 0 50
1850 450 0 1400
82 2 0 80
0 0 0 0
0 0 0 0
8 1 0 7
0 0 0 0
0 0 0 0
1625 200 0 1425
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
18 1 0 17
9 1 0 8
0 0 0 0
0 0 0 0
100 0 0 100
0 0 0 0
5 0 0 5
280 0 0 280
25 6 0 19
238 8 0 230
1120 100 0 1020
4350 150 0 4200
121 5 0 116
190 60 0 130
2 0 0 2
0 0 0 0
0 0 0 0
269 10 0 259
211 7 0 204
430 40 0 390
231 15 0 216
6470 200 0 6270
3170 500 0 2670
10520 600 0 9920
8 0 0 8
10 0 0 10
0 0 0 0
0 0 0 0
40 0 0 40
100 0 0 100
69 3 0 66
25 2 0 23
1000 0 0 1000
336 2 0 334
26 0 0 26
120 0 0 120
0 0 0 0
T PROGRAM
Optimum
370 50 0 320
110 110 0 0
7 0 0 7
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
600 120 0 480
0 0 0 0
50 5 0 45
0 0 0 0
0 0 0 0
41 10 0 31
0 0 0 0
45 3 0 42
139 20 0 119
ANG MEDIS HABIS PAKAI

Optimum
1260 100 0 1160

7 0 0 7
6 4 0 2
4046 100 0 3946
57 0 0 57
10 0 0 10
13 3 0 10
12 0 0 12
0 0 0 0
10 0 0 10
1243 400 0 843
0 0 0 0
0 0 0 0
72 0 0 72
0 0 0 0
3 0 0 3
14 1 0 13
79 5 0 74
6 1 0 5
5 0 0 5
5 0 0 5
38 5 0 33
20 0 0 20
0 0 0 20
25 3 0 22
4 0 0 4
5 0 0 5
1 0 0 1
9 0 0 9
6 2 0 4
10 0 0 10
10 0 0 10
101 0 0 101
101 0 0 101
1 0 0 1
32 0 0 32
0 0 0 0
2 0 0 2
1 0 0 1
1 0 0 1
0 0 0 7
0 0 0 7
11 5 0 6
1 0 0 1
ENGADAAN JKN
Optimum
90 0 0 90
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5000 800 0 4200
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
50 0 0 50
0 0 0 0
56 56 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6 0 0 6
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
3 0 0 3
60 0 0 60
0 0 0 0
60 60 0 0
200 0 0 200
8000 8000 0 0
7000 6000 0 1000
5350 5000 0 350
Jumlah
BPJS Karya Tani, 03 Mei 2020
405 477

NIP.19961222 201903 2001
(LPLPO)

Provinsi : LAMPUNG
3176 3176
79
12885 12885
13025
523 ML SIRUP 1444 0 1444
27867 27867
48330
923 MG TABLET 540 0 540
12905 12905
926 MG TABLET 0
0
20 20
CALCIUM CHLORIDE SUPPOSITORIA 0 0
10440 10440
0
10 10
6
2593 MG/5ML SIRUP 10 0 10
135460 135460
4490
2000 2000
59600
2967 500 MG TABLET 0 59600
58 58
0
15760 15760
12130
191 191
40
0 0
1
4736 MCG SPRAY 0 1
0 0
5
8 8
545
0 0
0
216 216
144
AK9005690IV CATHETER NO 24 0 130 0 130
6 6
0
6812 MG TABLET 0 0
434 434
10870

0
27 27
236
1040 1040
22
1755 1755
106428
0 0
610
4905 4905
0
10128 50 MG TABLET 0 0 0
293 293
287

0 0
0
0 0
20730
TAMBAHAN
40
823
42
0

1250

8
0
21 ETANOL 70 % BOTOL 28 0 28
9412
11410
0
60
0
0
1850

0
0
0
0
9
58 K:IPRATROPIUM
100
280
1120
190
69 2 0 2
70 0 0 0
DHP tab Ktk 9 tab
0
71 0 0
72 UI/g+ Polimiskin B 10.000 UI/g 269 0 269
430
74 mg 0 430
75 231 0 231
76 6470 0 6470
3170
77 mcg 0 3170
78 10520 0 10520
79 8 0 8
Stesolid Ktk 5 Supp
10
80 0 10
81 0 0 0
82 0 0 0
40
83 0 40
84 100 0 100
85 69 0 69
25
86 0 25
87 1000 0 1000
88 336 0 336
Nufit syrup BOTOL
26
89 0 26
90 120 0 120
91 0 0 0
OBAT PROGRAM
370
110
7
0
0
0
0
0
0
600
0
50
0
0
41
0
45
139
ALAT DAN BARANG MEDIS HABIS PAK

1260
120 MASKER PACS 1243 0 1243
144 Silk 3-0,76cm reserve cutting 3/8 cicle pcs 1 0 1
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Puralex Ac tab 0 0 0
151 Betametason TM (Betam ophtal eye drop botol 0 0 0
152 Bisakodil supp 10 mg (Stolax Suppositoria supp 0 0 0
153 Captopril 12,5 mg tab 5000 0 5000
154 Clorampenikol SK (Bufacetin 15 mg salep tube 0 0 0
159 Metoclopramid sirup (Lexapram sirup 5mg botol 0 0 0
Jumlah Umum
382 110 94 492
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Bulan : Juni
Tahun : 2020

Optimum
1400 0 1776
79 0 0
80 0 310
150 0 12735
240 0 12785
67 0 1377
27100 0 767
300
0 48030
540 0 0
300 0 12605
0 0 0
0 0 58
20 0 0
0 0 0
0 0 0
1000 0 9440
0 0 0
0 0 0
0 0 10
0 0 6
0 0 10
1200 0 134260
4490 0 0
0 0 0
150 0 1850
1600 0 58000
10 0 123
10 0 48
0 0 0
1500 0 14176
1000 0 14760
1000 0 11130
200 0 7930
5 0 186
10 0 30
100 0 385
0 0 0
0 0 1
60 0 0
0 0 0
0 0 5
350 0 8230
1 0 7
20 0 525
180 0 500
0 0 0
0 0 0
0 0 3
1 0 215
2 0 142
2 0 128
1 0 5
0 0 0
5 0 179
100 0 334
250 0 10620
250 0 340
10 0 109
0 0 0
0 0 0
5 0 22
50 0 186
3 0 5
200 0 840
0 0 22
5 0 154
70 0 1685
106000 0 428
30 0 320
0 0 0
50 0 560
0 0 0
1000 0 3905
0 0 0
0 0 0
20 0 273
15 0 272
600 0 1710
0 0 0
0 0 0
0 0 10
0 0 0
2000 0 18730
0 0 0
MBAHAN
Stok
0 0 40
0 0 0
0 0 0
150 0 673
30 0 502
0 0 8
0 0 42
0 0 30
320 0 0
0 0 0
5 0 22
10 0 15
150 0 1100
0 0 0
0 0 0
0 0 8
208 0 40
0 0 10
0 0 0
5 0 23
0 0 0
250 0 9162
1 0 8
0 0 0
1000 0 10410
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 60
0 0 0
300 0 2149
0 0 0
0 0 0
0 0 0
0 0 0
1500 0 4250
0 0 50
500 0 1350
2 0 80
0 0 0
0 0 0
1 0 7
0 0 0
0 0 0
200 0 1425
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 17
1 0 8
0 0 0
0 0 0
0 0 100
0 0 0
0 0 5
0 0 280
6 0 19
8 0 230
100 0 1020
150 0 4200
5 0 116
60 0 130
0 0 2
0 0 0
0 0 0
10 0 259
7 0 204
40 0 390
15 0 216
200 0 6270
500 0 2670
600 0 9920
0 0 8
0 0 10
0 0 0
0 0 0
0 0 40
0 0 100
69 0 0
2 0 23
0 0 1000
2 0 334
0 0 26
0 0 120
0 0 0
T PROGRAM
Optimum
50 0 320
110 0 0
0 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
120 0 480
0 0 0
5 0 45
0 0 0
0 0 0
10 0 31
0 0 0
3 0 42
20 0 119
NG MEDIS HABIS PAKAI

Optimum
100 0 1160
0 0 7
4 0 2
100 0 3946
0 0 57
0 0 10
3 0 10
0 0 12
0 0 0
0 0 10
500 0 743
0 0 0
0 0 0
0 0 72
0 0 0
0 0 3
1 0 13
9 0 70
1 0 5
0 0 5
0 0 5
5 0 33
0 0 20
0 0 20
3 0 22
0 0 4
0 0 5
0 0 1
0 0 9
2 0 4
0 0 10
0 0 10
0 0 101
0 0 101
0 0 1
0 0 32
0 0 0
0 0 2
0 0 1
0 0 1
0 0 7
0 0 7
5 0 6
0 0 1
NGADAAN JKN
Optimum
0 0 90
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
800 0 4200
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 50
0 0 0
56 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 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 3
0 0 60
0 0 0
60 0 0
0 0 200
8000 0 0
6000 0 0
5350 0 0
Jumlah Karya Tani, 02 Juli 2020

696

NIP.19961222 201903 2001
(LPLPO)

Provinsi : LAMPUNG
3176 3176
79
12885 12885
13025
523 ML SIRUP 1444 0 1444
27867 27867
48330
923 250 MG TABLET 540 0 540
12905 12905
926 50 MG TABLET 0
0
20 20
CALCIUM CHLORIDE SUPPOSITORIA 0 0
10440 10440
0
10 10
6
2593 MG/5ML SIRUP 10 0 10
135460 135460
4490
2000 2000
CLAVULANIC ACID|AMOXICILLIN
59600
58 58
0
15760 15760
12130
191 191
40
0 0
FENOTEROL HYDROBROMIDE SPRAY
1
4736 100 MCG SPRAY 0 1
0 0
5
8 8
545
0 0
0
216 216
144
AK9005690IV CATHETER NO 24 0 130 0 130
6 6
0
6812 MG TABLET 0 0
434 434
10870

0
27 27
236
1040 1040
22
1755 1755
106428
0 0
610
4905 4905
0
11896 IU TABLET 0 0
10128 MG|50 MG TABLET 0 0 0
293 293
287

0 0
0

TUBERCULIN PPD TABLET 10 TU/0.1
0 0
11719 ML TABLET 0
20730
TAMBAHAN
40
823
42
0

1250

8
0
21 ETANOL 70 % BOTOL 28 0 28
9412
11410
0
60
0
0
1850

0
0
0
0
9
58 K:IPRATROPIUM
100
280
1120
190
69 2 0 2
70 0 0 0
DHP tab Ktk 9 tab
0
71 0 0
430
74 250 mg 0 430
75 231 0 231
76 6470 0 6470
3170
77 mcg 0 3170
78 10520 0 10520
79 8 0 8
Stesolid Ktk 5 Supp
10
80 0 10
81 0 0 0
82 0 0 0
40
83 0 40
84 100 0 100
85 69 0 69
25
86 0 25
87 1000 0 1000
88 336 0 336
Nufit syrup BOTOL
26
89 0 26
90 120 0 120
91 0 0 0
OBAT PROGRAM
370
110
7
0
0
0
0
0
0
600
0
50
0
0
41
0
45
139

1260
120 MASKER PACS 1243 0 1243
144 Silk 3-0,76cm reserve cutting 3/8 cicle pcs 1 0 1
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Puralex A tab 0 0 0
152 Bisakodil supp 10 mg (Stolax Suppositor supp 0 0 0
153 Captopril 12,5 mg tab 5000 0 5000
154 Clorampenikol SK (Bufacetin 15 mg sale tube 0 0 0
159 Metoclopramid sirup (Lexapram sirup 5m botol 0 0 0
Jumlah Umum
472 107 91 446
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
MBAR PERMINTAAN OBAT
O)
Bulan : Juli
Tahun : 2020

160 0 3016
20 0 59
60 0 330
200 0 12685
250 0 12775
50 0 1394
27100 0 767
300
0 48030
540 0 0
280 0 12625
0 0 0
0 0 58
20 0 0
0 0 0
0 0 0
1000 0 9440
0 0 0
0 0 0
0 0 10
0 0 6
0 0 10
1380 0 134080
4490 0 0
0 0 0
200 0 1800
1600 0 58000
10 0 123
10 0 48
0 0 0
200 0 15476
1000 0 14760
1000 0 11130
200 0 7930
8 0 183
10 0 30
100 0 385
0 0 0
0 0 1
60 0 0
0 0 0
0 0 5
380 0 8200
1 0 7
20 0 525
180 0 500
0 0 0
0 0 0
0 0 3
1 0 215
2 0 142
2 0 128
1 0 5
0 0 0
5 0 179
100 0 334
300 0 10570
490 0 100
19 0 100
0 0 0
0 0 0
5 0 22
50 0 186
3 0 5
200 0 840
0 0 22
5 0 154
70 0 1685
106000 0 428
30 0 320
0 0 0
50 0 560
0 0 0
1000 0 3905
0 0 0
0 0 0
20 0 273
15 0 272
600 0 1710
0 0 0
0 0 0
0 0 10
0 0 0
2000 0 18730
0 0 0
AHAN
Stok
0 0 40
0 0 0
0 0 0
323 0 500
50 0 482
0 0 8
0 0 42
0 0 30
320 0 0
0 0 0
5 0 22
10 0 15
150 0 1100
0 0 0
0 0 0
0 0 8
208 0 40
0 0 10
0 0 0
5 0 23
0 0 0
300 0 9112
1 0 8
0 0 0
1000 0 10410
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 60
0 0 0
400 0 2049
0 0 0
0 0 0
0 0 0
0 0 0
1500 0 4250
0 0 50
500 0 1350
2 0 80
0 0 0
0 0 0
1 0 7
0 0 0
0 0 0
200 0 1425
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 17
1 0 8
0 0 0
0 0 0
0 0 100
0 0 0
0 0 5
0 0 280
6 0 19
8 0 230
100 0 1020
150 0 4200
5 0 116
60 0 130
0 0 2
0 0 0
0 0 0
10 0 259
7 0 204
40 0 390
15 0 216
200 0 6270
500 0 2670
600 0 9920
0 0 8
0 0 10
0 0 0
0 0 0
0 0 40
0 0 100
69 0 0
2 0 23
0 0 1000
2 0 334
0 0 26
0 0 120
0 0 0
OGRAM
Optimum
370 0 0
110 0 0
0 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 0 400
0 0 0
5 0 45
0 0 0
0 0 0
10 0 31
0 0 0
2 0 43
10 0 129
MEDIS HABIS PAKAI

100 0 1160
0 0 7
4 0 2
200 0 3846
0 0 57
0 0 10
1 0 12
0 0 12
0 0 0
0 0 10
400 0 843
0 0 0
0 0 0
0 0 72
0 0 0
0 0 3
1 0 13
9 0 70
1 0 5
0 0 5
0 0 5
5 0 33
0 0 20
0 0 20
3 0 22
0 0 4
0 0 5
0 0 1
0 0 9
2 0 4
0 0 10
0 0 10
0 0 101
0 0 101
0 0 1
0 0 32
0 0 0
0 0 2
0 0 1
0 0 1
0 0 7
0 0 7
5 0 6
0 0 1
ADAAN JKN
Optimum
0 0 90
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
800 0 4200
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 50
0 0 0
56 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 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 3
0 0 60
0 0 0
60 0 0
0 0 200
8000 0 0
6000 0 0
5350 0 0
Jumlah Karya Tani, 03 Agustus 2020

644

NIP.19961222 201903 2001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
(LPLPO)

Provinsi : LAMPUNG
3176
79
12885
13025
27867
48330
12905
0
20
1702 HEXACHLOROPHENE SUPPOSITORIA 2 G
CALCIUM CHLORIDE DIHYDRATE|POTASSIUM SUPPOSITORIA 0
10160 INFUS INFUS 0 0
10440
0
10
6
135460
4490
2000
59600
2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET 0
58
0
15760
12130
191
40
0
1
0
5
8
545

0
0
AK0902022Intravascular administration set 0 0
IPRATROPIUM BROMIDE|SALBUTAMOL SULPHATE
6238 LIQUID LIQUID 3 0
216
144
6
0
434
10870
119
0
27
236
1040
22
1755
106428
0
610
4905
0
293
287
AK9008970SARUNG TANGAN STERIL NO 7.5 pcs 0

10908 MG|80 MG TABLET 0
0
AK0501030Syringe actuator for an injector 0 0
0
20730
TAMBAHAN
40
823
42
0
11
1250
8
0
9412
11410
0
60
0

0
1850
0
0
0
0
9
58
100
280

1120
190
69 2 0
70 0 0
DHP tab Ktk 9 tab
0
71 0
430
74 0
75 231 0
76 6470 0
3170
77 0
78 10520 0
79 8 0
Stesolid Ktk 5 Supp
10
80 0
81 0 0
82 0 0
40
83 0
84 100 0
85 69 0
25
86 0
87 1000 0
88 336 0
Nufit syrup BOTOL
26
89 0
90 120 0
91 0 0
OBAT PROGRAM
370
110
7
0
0
0
0
0
0
600
0
50
0
0
41
0
45
139
ALAT DAN BARANG MEDIS HABIS P

1260
OBAT PENGADAAN JKN

148 Activated Anttapulagit 630 mg (Puralex Activated) tab 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar
348 109 75
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
IAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Bulan : Agustus
Tahun : 2020

Optimum
3176
2000 0 1176
79 10 0 69
390 100 0 290
12885
1000 0 11885
13025 400 0 12625
1444 1444 0 0
27867
27000 0 867
1000
48330 0 47330
540 100 0 440
12905
500 0 12405
0 0 0 0
58 0 0 58
20
20 0 0
0 0 0 0
0 0 0 0
10440
3000 0 7440
0 0 0 0
0 0 0 0
10
0 0 10
6 0 0 6
10 0 0 10
135460
2000 0 133460
4490 4490 0 0
0 0 0 0
2000
200 0 1800
59600 2000 0 57600
133 10 0 123
58
10 0 48
0 0 0 0
15676 200 0 15476
15760
2500 0 13260
12130 2500 0 9630
8130 1000 0 7130
191
6 0 185
40 10 0 30
485 100 0 385
0
0 0 0
1 0 0 1
60 60 0 0
0
0 0 0
5 0 0 5
8580 400 0 8180
8
1 0 7
545 50 0 495
680 230 0 450

0
0 0 0
0 0 0 0
3 0 0 3
216
1 0 215
144 2 0 142
130 2 0 128
6
1 0 5
0 0 0 0
184 5 0 179
434
100 0 334
10870 400 0 10470
590 490 0 100
119
19 0 100
0 0 0 0
0 0 0 0
27
5 0 22
236 50 0 186
8 3 0 5
1040
200 0 840
22 0 0 22
159 5 0 154
1755
70 0 1685
106428 106000 0 428
350 30 0 320
0
0 0 0
610 50 0 560
0 0 0 0
4905
1000 0 3905
0 0 0 0
0 0 0 0
293
20 0 273
287 15 0 272
2310 600 0 1710
0
0 0 0
0 0 0 0
10 0 0 10
0
0 0 0
20730 2000 0 18730
0 0 0 0
TAMBAHAN
Optimum
40 0 0 40
0 0 0 0
0 0 0 0
823 823 0 0
532 50 0 482
8 0 0 8
42 0 0 42
30 0 0 30
320 320 0 0
0 0 0 0
27 5 0 22
25 10 0 15
1250 150 0 1100
0 0 0 0
0 0 0 0
8 0 0 8
248 200 0 48
10 0 0 10
0 0 0 0
28 5 0 23
0 0 0 0
9412 500 0 8912
9 1 0 8
0 0 0 0
11410 1000 0 10410
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
60 0 0 60
0 0 0 0
2449 400 0 2049
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5750 2000 0 3750
50 0 0 50
1850 500 0 1350
82 2 0 80
0 0 0 0
0 0 0 0
8 7 0 1
0 0 0 0
0 0 0 0
1625 500 0 1125
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
18 1 0 17
9 1 0 8
0 0 0 0
0 0 0 0
100 0 0 100
0 0 0 0
5 0 0 5
280 0 0 280
25 6 0 19
238 8 0 230
1120 150 0 970
4350 150 0 4200
121 5 0 116
190 60 0 130
2 0 0 2
0 0 0 0
0 0 0 0
269 20 0 249
211 7 0 204
430 40 0 390
231 20 0 211
6470 250 0 6220
3170 500 0 2670
10520 500 0 10020
8 0 0 8
10 0 0 10
0 0 0 0
0 0 0 0
40 0 0 40
100 0 0 100
69 69 0 0
25 2 0 23
1000 0 0 1000
336 2 0 334
26 0 0 26
120 0 0 120
0 0 0 0
BAT PROGRAM
Optimum
370 370 0 0
110 110 0 0
7 0 0 7
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
600 200 0 400
0 0 0 0
50 5 0 45
0 0 0 0
0 0 0 0
41 10 0 31
0 0 0 0
45 2 0 43
139 5 0 134
RANG MEDIS HABIS PAKAI

Optimum
1260 100 0 1160
7 0 0 7
6 4 0 2
4046 200 0 3846
57 0 0 57
10 0 0 10
13 1 0 12
12 0 0 12
0 0 0 0
10 0 0 10
1243 400 0 843
0 0 0 0
0 0 0 0
72 0 0 72
0 0 0 0
3 0 0 3
14 1 0 13
79 9 0 70
6 1 0 5
5 0 0 5
5 0 0 5
38 5 0 33
20 0 0 20
0 0 0 20
25 3 0 22
4 0 0 4
5 0 0 5
1 0 0 1
9 0 0 9
6 2 0 4
10 0 0 10
10 0 0 10
101 0 0 101
101 0 0 101
1 0 0 1
32 0 0 32
0 0 0 0
2 0 0 2
1 0 0 1
1 0 0 1
0 0 0 7
0 0 0 7
11 5 0 6
1 0 0 1
PENGADAAN JKN
Stok
90 0 0 90
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5000 800 0 4200
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
50 0 0 50
0 0 0 0
56 56 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6 0 0 6
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
3 0 0 3
60 0 0 60
0 0 0 0
60 60 0 0
200 0 0 200
8000 8000 0 0
7000 6000 0 0
5350 5350 0 0
BPJS Jumlah Karya Tani, 02 September 2020

485 669

NIP.19961222 201903 2001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OB
(LPLPO)

Provinsi : LAMPUNG
1176
69
11885
12625
867
47330
12405
0
0
LIDOCAINE|HEXACHLOROPHENE SUPPOSITORIA 0
1702 2 G
CALCIUM CHLORIDE DIHYDRATE|POTASSIUM SUPPOSITORIA 0
10160 LACTATE INFUS INFUS 0 0
7440
0
10
6
133460
0
1800
CLAVULANIC ACID|AMOXICILLIN TABLET 500 57600
2967 MG TABLET 0
48
0
13260
9630
185
30
0
1
0
5
7
495

0
0
6238 SULPHATE LIQUID LIQUID 3 0
215
142
5
0
334
10470
100
0
22
186
840
22
1685
428
0
560
3905
0
273
272

SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 0
10908 400 MG|80 MG TABLET 0
0
0
18730
TAMBAHAN
40
0
42
0
11
1100
8
0
8912
10410
0
60
0

0
1350
2800
NATRIUM DIKLOFENAK TABLET 25MG TABLET 0
0
0
0
0
8
58
100
280
970
130
69 2 0
70 0 0
DHP tab Ktk 9 tab
0
71 0
390
74 0
75 211 0
76 6220 0
2670
77 0
78 10020 0
79 8 0
Stesolid Ktk 5 Supp
10
80 0
81 0 0
82 0 0
40
83 0
84 100 0
85 0 0
23
86 0
87 1000 0
88 334 0
Nufit syrup BOTOL
26
89 0
90 120 0
METHYL ERGOTAMINE TABLET
91 100 0
KOTRIMOKSASOLE KOMBINASI TABLET
92 SULFAMETOKSAZON 1500 0
93 0 0
NIFEDIPIN 2O MG TABLET
94 0 0
NISTATIN 500.000 IU TAB SUPP
95 0 0
GENTAMISIN TETES MATA BOTOL
96 0 0
GENTAMISIN KREAM SALEP MATA BOTOL
97 0 0
PARACETAMOL/PYREXIN BOX
98 0 0
PARACETAMOL TTS 60MG/0,6 ML BOTOL
99 0 0
KLORAMFENIKOL SALEP KULIT TUBE
100 0 0
MAGNESIUM SULFAT INJ/MGSO4 AMPUL
0 0
ERGOTAMIN 1MG TABLET
0 0
KLINDAMISIN 300 MG TABLET
0 0
BISOPROLOL TABLET
0 0
OBAT PROGRAM
0
0
7
0
0
0
0
0
0
400
0
45
0
0
31
0
43
134

1160
sarung tangan size M box 5 0
SARUNG TANGAN SIZE S box 5 0
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Puralex Activated) tab 0 0
Jumlah Umum
Mengetahui Kunjungan bayar Tidak bayar
407 70 130
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
IAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Bulan : September
Tahun : 2020

Optimum
1176
800 0 376
69 10 0 59
290 100 0 190
11885
1000 0 10885
12625 500 0 12125
0 0 0 0
867
300 0 567
5000
47330 0 42330
440 240 0 200
12405
1000 0 11405
0 0 0 0
58 58 0 0
0
0 0 0
0 0 0 0
0 0 0 0
7440
3000 0 4440
0 0 0 0
0 0 0 0
10
100 0 -90
6 0 0 6
10 0 0 10
133460
2000 0 131460
0 0 0 0
0 0 0 0
1800
200 0 1600
57600 3000 0 54600
123 20 0 103
48
10 0 38
0 0 0 0
15476 500 0 14976
13260
2500 0 10760
9630 2500 0 7130
7130 2000 0 5130
185
6 0 179
30 10 0 20
385 100 0 285
0
0 0 0
1 0 0 1
0 0 0 0
0
0 0 0
5 0 0 5
8180 400 0 7780
7
1 0 6
495 40 0 455
450 300 0 150

0
0 0 0
0 0 0 0
3 0 0 3
215
1 0 214
142 2 0 140
128 2 0 126
5
1 0 4
0 0 0 0
179 5 0 174
334
100 0 234
10470 500 0 9970
100 100 0 0
100
19 0 81
0 0 0 0
0 0 0 0
22
5 0 17
186 50 0 136
5 3 0 2
840
200 0 640
22 0 0 22
154 5 0 149
1685
70 0 1615
428 328 0 100
320 30 0 290
0
0 0 0
560 50 0 510
0 0 0 0
3905
2000 0 1905
0 0 0 0
0 0 0 0
273
20 0 253
272 15 0 257
1710 1000 0 710
0
0 0 0
0 0 0 0
10 0 0 10
0
0 0 0
18730 3000 0 15730
0 0 0 0
TAMBAHAN
Optimum
40 0 0 40
0 0 0 0
0 0 0 0
0 0 0 0
482 100 0 382
8 0 0 8
42 0 0 42
30 0 0 30
0 0 0 0
0 0 0 0
22 5 0 17
15 10 0 5
1100 200 0 900
0 0 0 0
0 0 0 0
8 0 0 8
48 28 0 20
10 0 0 10
0 0 0 0
23 5 0 18
0 0 0 0
8912 500 0 8412
8 1 0 7
0 0 0 0
10410 2000 0 8410
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
60 0 0 60
0 0 0 0
2049 400 0 1649
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
3750 2000 0 1750
50 0 0 50
1350 500 0 850
2800 0 0 2800
80 2 0 78
0 0 0 0
0 0 0 0
1 0 0 1
0 0 0 0
0 0 0 0
1125 500 0 625
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
17 1 0 16
8 1 0 7
0 0 0 0
0 0 0 0
100 0 0 100
0 0 0 0
5 0 0 5
280 0 0 280
19 6 0 13
230 10 0 220
970 150 0 820
4200 200 0 4000
116 5 0 111
130 60 0 70
2 0 0 2
0 0 0 0
0 0 0 0
249 20 0 229
204 7 0 197
390 40 0 350
211 20 0 191
6220 250 0 5970
2670 1000 0 1670
10020 1000 0 9020
8 0 0 8
10 0 0 10
0 0 0 0
0 0 0 0
40 0 0 40
100 0 0 100
0 0 0 0
23 2 0 21
1000 0 0 1000
334 2 0 332
26 0 0 26
120 0 0 120
100 0 0 100
1500 0 0 1500
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
BAT PROGRAM
Stok
0 0 0 0
0 0 0 0
7 0 0 7
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
400 100 0 300
0 0 0 0
45 5 0 40
0 0 0 0
0 0 0 0
31 10 0 21
0 0 0 0
43 2 0 41
134 5 0 129
RANG MEDIS HABIS PAKAI

Stok
1160 100 0 1060

7 0 0 7
2 0 0 2
3846 200 0 3646
57 0 0 57
10 0 0 10
12 1 0 11
12 0 0 12
0 0 0 0
10 0 0 10
843 400 0 443
0 0 0 0
0 0 0 0
72 0 0 72
0 0 0 0
3 0 0 3
13 1 0 12
70 9 0 61
5 1 0 4
5 0 0 5
5 0 0 5
33 5 0 28
20 0 0 20
0 0 0 20
22 3 0 19
4 0 0 4
5 0 0 5
1 0 0 1
9 0 0 9
4 2 0 2
10 0 0 10
10 0 0 10
101 0 0 101
101 0 0 101
1 0 0 1
32 0 0 32
0 0 0 0
2 0 0 2
1 0 0 1
1 0 0 1
0 0 0 7
0 0 0 7
6 5 0 1
1 0 0 1
5 0 0 10
5 0 0 10
PENGADAAN JKN
Optimum
90 0 0 90
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
4200 800 0 3400
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
50 0 0 50
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6 0 0 6
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
3 0 0 3
60 0 0 60
0 0 0 0
0 0 0 0
200 0 0 200
0 0 0 0
7000 0 0 0
0 0 0 0
BPJS Jumlah Karya Tani, 02 Oktober 2020

614 814

NIP.19961222 201903 2001
(LPLPO)

Provinsi : LAMPUNG
876 1176
59
12085 12685
13325
523 ML SIRUP 0 0 0
6167 9167
43830
923 MG TABLET 200 0 200
926 MG TABLET 1500
0
0 0
10440 13940
0
1410 2410
6
138460 142460
0
1600 1600
2967 500 MG TABLET 4500 69100
38 38
0
10760 10760
7130
179 182
20
0 0
4736 MCG SPRAY 0 1
0 0
5
6 16
527

0 0
0
214 214
140
AK9005690IV CATHETER NO 24 0 126 10 136
4 4
LEVODOPA|BENSERAZIDE TABLET 100 0
6812 MG TABLET 0 0
234 234
10970

0
67 67
136
640 640
22
1715 1815
0
0 0
510
4205 5205
0
10128 50 MG TABLET 0 0 0
253 253
257

0
0 0
18130
TAMBAHAN
40
0
42
0
900
8
0
21 ETANOL 70 % BOTOL 18 0 18
8412
8410
0
60
34 KAPTOPRIL TABLER 12,5 MG TABLET 1649 1500 3149
0
24
karbogliserin tetes telinga botol 2 26

0
850
2800
NATRIUM DIKLOFENAK TABLET 25MG TABLET 1400 4200
0
0
0
0
7
58
K:IPRATROPIUM Br.0,5MG+SALBUTAMOL UNIT 0 0 0
100

280
820
70
69 2 0 2
70 0 0 0
DHP tab Ktk 9 tab
0
71 0 0
mg 350
74 0 350
75 191 24 215
76 5970 200 6170
1670
77 1500 3170
78 9020 1000 10020
79 8 5 13
Stesolid Ktk 5 Supp
10
80 0 10
81 0 0 0
82 0 0 0
Tab 40
83 0 40
84 100 0 100
85 0 0 0
21
86 0 21
87 1000 1000 2000
88 332 30 362
Nufit syrup BOTOL
26
89 0 26
90 120 900 1020
91 100 50 150
92 SULFAMETOKSAZON 1500 1000 2500
93 0 0 0
94 240 120 360
95 100 10 110
96 0 12 12
97 0 0 0
98 0 1800 1800
99 840 56 896
100 0 0 0
20 2 22
0 100 100
0 100 100
BISOPROLOL TABLET
0 100 100
OBAT PROGRAM
0
0
7
0
0
0
0
0
0
400
0
45
0
0
31
0
43
134

1060
120 MASKER PACS 443 0 443
126 FOLEY CATETER 16 & 18 PACS 12 5 17
134 Paper tape/2,5cmx9,14m roll 19 2 21
144 t-vio Silk 3-0,76cm reserve cutting 3/8 ci pcs 1 1 2
sarung tangan size M box 8 1 9
sarung tangan size S box 5 3 8
lancet ukuran 28 G ktk@100 6 2 8
heandrub 250 ml botol 29 4 33
scimar bs656 pcs 1 1 2
kassa gulung 15 cm pcs 0 10 10
stik glucosa ktk@25 8 4 8
stik kolesterol ktk@10 4 2 4
stik asam urat ktk@10 4 2 4
septalken desinfektan pembersih bad botol 12 3 15
SARUNG TANGAN SIZE S box 10 0 5
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Puralex Act tab 0 0 0
151 Betametason TM (Betam ophtal eye drop 2 botol 0 0 0
153 Captopril 12,5 mg tab 3400 0 3400
159 Metoclopramid sirup (Lexapram sirup 5mg/ botol 0 0 0
Jumlah Umum
Tidak bayar
Kunjungan
407 70 130 614
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
N LEMBAR PERMINTAAN OBAT
LPLPO)
Bulan : oktober
Tahun : 2020

Optimum
0 150 1176
0 0 59
0 0 190
500 0 12185
500 0 13725
0 0 0
1167 0 8000
34000 0 12830
0 0 200
3805 0 11400
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
12540 0 1400
0 0 0
0 0 0
400 0 2010
0 0 6
0 0 10
3000 0 139460
0 0 0
0 0 0
200 0 1400
0 0 69100
18 0 190
0 0 38
0 0 0
17476 0 500
1000 0 9760
1000 0 6130
2000 0 4830
0 0 182
0 0 20
0 0 285
0 0 0
0 0 1
0 0 400
0 0 0
0 0 17
3000 0 6180
3 0 13
20 0 531
150 0 0
0 0 0
0 0 0
0 0 3
0 0 214
0 0 150
0 0 136
0 0 4
0 0 0
4 0 170
50 0 184
0 0 11420
0 0 0
0 0 81
0 0 0
0 0 0
0 0 67
26 0 110
0 0 2
0 0 640
0 0 22
9 0 140
35 0 1780
0 0 0
0 0 335
0 0 0
0 0 560
0 0 0
2000 0 3205
0 0 0
0 0 0
0 0 253
0 0 257
500 0 2850
0 0 0
0 0 0
0 0 10
0 0 0
1500 0 18130
0 0 0
MBAHAN
Stok
0 0 40
0 0 0
0 0 0
0 0 0
382 0 50
0 0 8
0 0 42
0 0 30
0 0 0
0 0 0
0 0 17
5 0 0
0 0 1050
0 0 0
0 0 0
0 0 8
0 0 45
0 0 10
0 0 0
0 0 18
0 0 0
0 0 8612
0 0 7
0 0 0
0 0 9410
0 0 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 60
0 0 0
400 0 2749
0 0 0
0 0 26
0 0 0
0 0 0
0 0 0
50 0 2700
0 0 50
0 0 2250
0 0 4200
0 0 78
0 0 0
0 0 0
0 0 1
0 0 0
0 0 0
0 0 625
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 16
0 0 7
0 0 0
0 0 0
0 0 100
0 0 0
0 0 5
0 0 280
0 0 63
0 0 232
0 0 870
0 0 4500
111 0 2
0 0 70
0 0 2
0 0 0
0 0 0
0 0 229
0 0 209
0 0 350
0 0 215
2070 0 4100
0 0 3170
0 0 10020
0 0 13
0 0 10
0 0 0
0 0 0
0 0 40
0 0 100
0 0 0
0 0 21
0 0 2000
0 0 362
26 0 0
120 0 900
0 0 150
0 0 2500
0 0 0
0 0 360
0 0 110
0 0 12
0 0 0
0 0 1800
0 0 896
0 0 0
0 0 22
0 0 100
0 0 100
0 0 100
PROGRAM
Stok
0 0 0
0 0 0
0 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 600
0 0 0
0 0 45
0 0 0
0 0 0
0 0 81
0 0 0
0 0 48
0 0 134
G MEDIS HABIS PAKAI

Optimum
0 0 1060
0 0 7
0 0 2
0 0 3646
0 0 60
0 0 10
0 0 11
0 0 12
0 0 0
0 0 10
0 0 443
0 0 0
0 0 0
0 0 73
0 0 0
0 0 3
0 0 17
0 0 86
0 0 14
0 0 5
0 0 5
0 0 28
0 0 30
0 0 20
0 0 21
0 0 4
0 0 5
0 0 1
0 0 9
0 0 2
0 0 13
0 0 12
0 0 151
0 0 151
0 0 2
2 0 40
0 0 0
0 0 3
0 0 3
0 0 9
0 0 8
0 0 8
5 0 28
0 0 2
0 0 10
0 0 9
0 0 1
0 0 7
0 0 7
0 0 12
0 0 6
0 0 6
0 0 1
0 0 1
0 0 15
0 0 10
0 0 10
GADAAN JKN
Stok
Pemakaian Rusak/Ed Sisa Stok Permintaan Pemberian Keterangan
Optimum
0 0 90
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 3400
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 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
3 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Jumlah
Karya Tani, 02 vovember 2020
814

NIP.19961222 201903 2001
(LPLPO)

Provinsi : LAMPUNG
247 ALLOPURINOL TABLET 100 MG TABLET 1176 1176

0

0 59

0

0 13725
523 AMOXYCILLIN SIRUP KERING 250 MG/5 ML SIRUP 0 0 0
809 ANTACIDA TABLET 400 MG TABLET 8000 8000

0

0 12830
923 MG TABLET 200 0 200
926 MG TABLET 0

0 0

0
1702 CALCIUM CHLORIDE
SUPPOSITORIA 2 G DIHYDRATE| SUPPOSITORIA 0 0
2005 CALCIUM LACTATE TABLET 500 MG TABLET 1400 1400

0

0 0
2546 CETIRIZINE TABLET 10 MG TABLET 2010 2010

0

0 6
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 139460 139460

0
0 0
2828 CIPROFLOXACIN TABLET 500 MG TABLET 1400 1400

0
2967 500 MG TABLET 0 69100
6645 COTRIMOXAZOLE TABLET TABLET 38 38

0

0 0

0

0 6130
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 182 182

0

0 20
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0

0
4736 MCG SPRAY 1
0 1
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 0 0

0

0 17
5300 GLUCOSE INFUS 5 % INFUS 13 13

0

0 531

0

0 0
AK9005688IV CATHETER NO 20 0 214 214

0

0 150
AK9005690IV CATHETER NO 24 0 136 0 136
6535 KETOCONAZOLE SALEP 2% SALEP 4 4

0
0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 0 0
6998 LOPERAMIDE TABLET 2 MG TABLET 184 184

0

0 11420


0 0
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 67 67

0

0 110
8160 NIFEDIPINE TABLET 10 MG TABLET 640 640

0

0 22
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 1780 1780

0

0 0
AK0902040Piston syringe 0 0 0
0

0 560
1684 PYRIDOXINE TABLET 10 MG TABLET 3205 3205

0

0 0
10128 MG TABLET 0 0 0
AK9008969SARUNG TANGAN STERIL NO 7 pcs 253 253

0

0 257

10908 TABLET 400 MG|80 MG TABLET 0 0
0

0 0
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0

0
0 18130
TAMBAHAN

0 40

0 0
0 42

0 0

0 1050

0 8

0 0
21 ETANOL 70 % BOTOL 18 0 18

0 8612

0 9410


0 0

0 60

0 0
karbogliserin tetes telinga botol 26

0 26

0 0

0 2250
NATRIUM DIKLOFENAK TABLET 25MG TABLET 4200

0 4200

0 0

0 0

0 0

0 0

0 7

0 100

0 280

0 870
0 70
69 2 0 2
70 0 0 0
DHP tab Ktk 9 tab 0
71 0 0
72 Antibakteri, kombinasi : basitrasin 500 Tube
UI/g+ Polimiskin B 10.000 UI/g 229 0 229
73 6%+ asam salisilat 3% 209 0 209
Griseofulvin (micronized) tab scored 250 Tablet 350
74 mg 0 350
75 215 0 215
76 4100 0 4100
77 0 3170
78 10020 0 10020
79 13 0 13
80 0 10
81 0 0 0
82 0 0 0
83 0 40
84 100 0 100
85 0 0 0
86 0 21
87 2000 0 2000
88 362 0 362
Nufit syrup BOTOL 0
89 0 0
90 900 0 900
91 150 0 150
93 0 0 0
94 360 0 360
95 110 0 110
96 12 0 12
97 0 0 0
98 1800 0 1800
99 896 0 896
100 0 0 0
22 0 22
100 0 100
100 0 100
BISOPROLOL TABLET
100 0 100
OBAT PROGRAM

0 0

0 0

0 7

0 0

0 0

0 0

0 0

0 0

0 0

0 600

0 0
0 45

0 0

0 0

0 81

0 0

0 48

0 134


0 1060
111 ALAT SUNTIK SEKALI PAKAI 1 ML PACS 7

0 7

0 2
113 ALAT SUNTIK SEKALI PAKAI 3 ML PACS 3646

0 3646
114 INFUSET DEWASA PACS 60

3 63
115 INFUSET ANAK PACS 10

0 10
116 KAPAS ABSORBEN 250 G PACS 11

0 11
117 KASA HIDROFIL STERIL 16 X 16 CM PACS 12

0 12
118 KASA PEMBALUT 3 INCHI PACS 0

0 0
119 KASA PEMBALUT 4 INCHI PACS 10

0 10
120 MASKER PACS 443

0 443
121 SILK NO 3/0 DENGAN JARUM BEDAH PACS 0

0 0
144 t-vio Silk 3-0,76cm reserve cutting 3/8 cic pcs 2 0 2
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Puralex Activ tab 0 0 0
151 Betametason TM (Betam ophtal eye drop 24' botol 0 0 0
153 Captopril 12,5 mg tab 3400 0 3400
159 Metoclopramid sirup (Lexapram sirup 5mg/ 5 botol 0 0 0
KETOCONAZOLE SALEP 2% tube 0 50 0
METFORMIN TABLET 500 MG tablet 0 3000 0
betahistin tablet 0
RINGER LAKTAT LAR.INFUS plabot 0
Jumlah Umum
407 70 39 534
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
LEMBAR PERMINTAAN OBAT
LPO)
Bulan : Desember
Tahun : 2020

Optimum
0 150 1176
0 0 59
0 0 190
500 0 11685
500 0 13225
0 0 0
500 0 7500
400 0 12430
0 0 200
600 0 10800
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 0 1300
0 0 0
0 0 0
400 0 1610
0 0 6
0 0 10
1500 0 137960
0 0 0
0 0 0
100 0 1300
0 0 69100
18 0 172
0 0 38
0 0 0
500 0 0
1000 0 8760
1000 0 5130
150 0 4680
0 0 182
0 0 20
0 0 285
0 0 0
0 0 1
0 0 400
0 0 0
0 0 17
800 0 5380
3 0 10
20 0 511
0 0 0
0 0 0
0 0 0
0 0 3
0 0 214
0 0 150
0 0 136
0 0 4
0 0 0
4 0 166
50 0 134
100 0 11320
0 0 0
1 0 80
0 0 0
0 0 0
0 0 67
0 0 110
0 0 2
0 0 640
0 0 22
9 0 131
50 0 1730
0 0 0
0 0 335
0 0 0
0 0 560
0 0 0
2000 0 1205
0 0 0
0 0 0
0 0 253
0 0 257
500 0 2350
0 0 0
0 0 0
0 0 10
0 0 0
1500 0 16630
0 0 0
BAHAN
Optimum
0 0 40
0 0 0
0 0 0
0 0 0
0 0 50
0 0 8
0 0 42
0 0 30
0 0 0
0 0 0
0 0 17
0 0 0
0 0 1050
0 0 0
0 0 0
0 0 8
0 0 45
0 0 10
0 0 0
0 0 18
0 0 0
0 0 8612
0 0 7
0 0 0
400 0 9010
0 0 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 60
0 0 0
400 0 2349
0 0 0
0 0 26
0 0 0
0 0 0
0 0 0
50 0 2650
0 0 50
0 0 2250
0 0 4200
0 0 78
0 0 0
0 0 0
0 0 1
0 0 0
0 0 0
0 0 625
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 16
0 0 7
0 0 0
0 0 0
0 0 100
0 0 0
0 0 5
0 0 280
0 0 63
0 0 232
0 0 870
0 0 4500
0 0 2
0 0 70
0 0 2
0 0 0
0 0 0
0 0 229
0 0 209
0 0 350
0 0 215
700 0 3400
0 0 3170
0 0 10020
0 0 13
0 0 10
0 0 0
0 0 0
0 0 40
0 0 100
0 0 0
0 0 21
0 0 2000
0 0 362
0 0 0
50 0 850
0 0 150
0 0 2500
0 0 0
0 0 360
0 0 110
0 0 12
0 0 0
0 0 1800
0 0 896
0 0 0
0 0 22
0 0 100
0 0 100
0 0 100
ROGRAM
Optimum
0 0 0
0 0 0
0 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 600
0 0 0
0 0 45
0 0 0
0 0 0
0 0 81
0 0 0
0 0 48
0 0 134
MEDIS HABIS PAKAI

Optimum
0 0 1060
0 0 7
0 0 2
0 0 3646
0 0 63
0 0 10
0 0 11
0 0 12
0 0 0
0 0 10
0 0 443
0 0 0
0 0 0
0 0 73
0 0 0
0 0 3
0 0 17
0 0 86
0 0 14
0 0 5
0 0 5
0 0 28
0 0 30
0 0 20
0 0 21
0 0 4
0 0 5
0 0 1
0 0 9
0 0 2
0 0 13
0 0 12
0 0 151
0 0 151
0 0 2
2 0 38
0 0 0
0 0 3
0 0 3
0 0 9
0 0 8
0 0 8
5 0 23
0 0 2
0 0 10
0 0 9
0 0 1
0 0 7
0 0 7
1 0 11
0 0 6
1 0 6
0 0 1
0 0 1
1 0 14
0 0 10
0 0 10
GADAAN JKN
Optimum
0 0 90
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 3400
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 0 200
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 0 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 50
0 0 3000
0 0 0
0 0 0
0 0 0
0 0 1500
0 0 103
0 0 0
Jumlah Karya Tani, 29 desember 2020

643

NIP.19961222 201903 2001
(LPLPO)

Provinsi : LAMPUNG
1176 1176
59
11685 11685
13225
523 ML SIRUP 0 0 0
7500 7500
12430
923 250 MG TABLET 200 0 200
926 MG TABLET 0
0
0 0
1300 1300
0

1610 1610
6
2593 MG/5ML SIRUP 10 0 10
137960 137960
0
1300 1300
CLAVULANIC ACID|AMOXICILLIN 69100
38 38
0
8760 8760
5130
182 182
20
0 0
4736 100 MCG SPRAY 0 1
0 0
17

10 10
511
0 0
0
214 214
150
AK9005690IV CATHETER NO 24 0 136 0 136
4 4
LEVODOPA|BENSERAZIDE TABLET 100 0
6812 MG TABLET 0 0
134 134
11320

0
67 67
110
640 640
22

1730 1730
0
0 0
560
1205 1205
0
10128 MG|50 MG TABLET 0 0 0
253 253
257

0
0 0
16630
TAMBAHAN
40

0
42
0

1050
8
0
21 ETANOL 70 % BOTOL 18 0 18
8612
9010

0
60
0
26
karbogliserin tetes telinga botol 0 26
0
2250
4200
NATRIUM DIKLOFENAK TABLET 25MG TABLET 0 4200
0
0
0
0
7
58 K:IPRATROPIUM
100
280
870
70
69 2 0 2
70 0 0 0
DHP tab Ktk 9 tab
0
71 0 0
250 mg 350
74 0 350
75 215 0 215
76 3400 0 3400
mcg 3170
77 0 3170
78 10020 0 10020
79 13 0 13
Stesolid Ktk 5 Supp
10
80 0 10
81 0 0 0
82 0 0 0
40
83 0 40
84 100 0 100
85 0 0 0
21
86 0 21
87 2000 0 2000
88 362 0 362
Nufit syrup BOTOL
0
89 0 0
90 850 0 850
91 150 0 150
93 0 0 0
94 360 0 360
95 110 0 110
96 12 0 12
97 0 0 0
98 1800 0 1800
99 896 0 896
100 0 0 0
22 0 22
100 0 100
100 0 100
BISOPROLOL TABLET
100 0 100
OBAT PROGRAM
0
0
7
0
0
0
0
0
0
600
0
45
0
0
81
0
48
134
ALAT DAN BARANG MEDIS HABIS PAKA

1060
120 MASKER PACS 443 0 443
144 t-vio Silk 3-0,76cm reserve cutting 3/8 pcs 2 0 2
OBAT PENGADAAN JKN


148 Activated Anttapulagit 630 mg (Puralex A tab 0 0 0
152 Bisakodil supp 10 mg (Stolax Suppositor supp 0 0 0
153 Captopril 12,5 mg tab 3400 0 3400
154 Clorampenikol SK (Bufacetin 15 mg sale tube 0 0 0
159 Metoclopramid sirup (Lexapram sirup 5m botol 0 0 0
KETOCONAZOLE SALEP 2% tube 50 0 0
METFORMIN TABLET 500 MG tablet 3000 0 0
betahistin tablet 1000 0 1000
RINGER LAKTAT LAR.INFUS plabot 40 0 40
Jumlah Umum
Tidak bayar
Kunjungan
266 89 0 549
KARYANTO,S.Kep.,Ns
NIP.197306151994031003
N LEMBAR PERMINTAAN OBAT
PLPO)
Bulan : JANUARI
Tahun : 2021

Optimum
0 150 1176
0 0 59
0 0 190
300 0 11385
200 0 13025
0 0 0
400 0 7100
200 0 12230
0 0 200
350 0 10450
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
130 0 1170
0 0 0
0 0 0
200 0 1410
0 0 6
0 0 10
1000 0 136960
0 0 0
0 0 0
1300 0 0
1000 0 68100
20 0 152
0 0 38
0 0 0
0 0 0
800 0 7960
600 0 4530
150 0 4530
0 0 182
0 0 20
0 0 285
0 0 0
0 0 1
0 0 400
0 0 0
0 0 17
500 0 4880
5 0 5
25 0 486
0 0 0
0 0 0
0 0 0
0 0 3
0 0 214
0 0 150
0 0 136
0 0 4
0 0 0
5 0 161
50 0 84
100 0 11220
0 0 0
20 0 60
0 0 0
0 0 0
0 0 67
0 0 110
0 0 2
0 0 640
0 0 22
9 0 122
50 0 1680
0 0 0
0 0 335
0 0 0
0 0 560
0 0 0
300 0 905
0 0 0
0 0 0
0 0 253
0 0 257
500 0 1850
0 0 0
0 0 0
0 0 10
0 0 0
1000 0 15630
0 0 0
BAHAN
Optimum
0 0 40
0 0 0
0 0 0
0 0 0
0 0 50
0 0 8
0 0 42
0 0 30
0 0 0
0 0 0
0 0 17
0 0 0
50 0 1000
0 0 0
0 0 0
0 0 8
0 0 45
0 0 10
0 0 0
0 0 18
0 0 0
100 0 8512
0 0 7
0 0 0
400 0 8610
0 0 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 60
0 0 0
300 0 2049
0 0 0
0 0 26
0 0 0
0 0 0
0 0 0
50 0 2600
0 0 50
0 0 2250
0 0 4200
0 0 78
0 0 0
0 0 0
0 0 1
0 0 0
0 0 0
0 0 625
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 16
0 0 7
0 0 0
0 0 0
0 0 100
0 0 0
0 0 5
0 0 280
0 0 63
0 0 232
0 0 870
0 0 4500
0 0 2
0 0 70
0 0 2
0 0 0
0 0 0
0 0 229
0 0 209
0 0 350
0 0 215
700 0 2700
0 0 3170
0 0 10020
0 0 13
0 0 10
0 0 0
0 0 0
0 0 40
0 0 100
0 0 0
0 0 21
0 0 2000
0 0 362
0 0 0
30 0 820
0 0 150
0 0 2500
0 0 0
0 0 360
0 0 110
0 0 12
0 0 0
0 0 1800
0 0 896
0 0 0
0 0 22
0 0 100
0 0 100
0 0 100
ROGRAM
Optimum
0 0 0
0 0 0
0 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 600
0 0 0
0 0 45
0 0 0
0 0 0
0 0 81
0 0 0
0 0 48
0 0 134
G MEDIS HABIS PAKAI

Optimum
0 0 1060
0 0 7
0 0 2
346 0 3300
5 0 55
0 0 10
0 0 11
0 0 12
0 0 0
0 0 10
43 0 400
0 0 0
0 0 0
0 0 73
0 0 0
0 0 3
0 0 17
0 0 86
0 0 14
0 0 5
0 0 5
0 0 28
0 0 30
0 0 20
0 0 21
0 0 4
0 0 5
0 0 1
0 0 9
0 0 2
0 0 13
0 0 12
0 0 151
0 0 151
0 0 2
3 0 35
0 0 0
0 0 3
0 0 3
0 0 9
0 0 8
0 0 8
4 0 19
0 0 2
0 0 10
0 0 9
0 0 1
0 0 7
0 0 7
1 0 11
1 0 6
1 0 6
0 0 1
0 0 1
3 0 14
0 0 10
0 0 10
GADAAN JKN
Stok
0 0 90
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 3400
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 0 200
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 0 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 50
0 0 3000
0 0 1000
3 0 37
0 0 0
0 0 0
0 0 0
0 0 1500
0 0 103
0 0 0
Jumlah
Karya Tani, 02 FEBUARI 2021
638

NIP.19961222 201903 2001

Lplpo 2020

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

Unit Penerima : PUSKESMAS KARYA TANI

Kode Nama Obat Sediaan Stok Awal Penerimaa

247 ALLOPURINOL TABLET 100 MG TABLET 3766 1400 5166

1 AMINOPHILLIN TABLET 200 TABLET 50 0 50

85 ALBENDAZOLE TABLET 400 MG TABLET 830 120 950

ALAT DAN BARANG MEDIS HABIS PAKA

103 ALAT SUNTIK SEKALI PAKAI 0.5 ML PACS 1550 0 1550

OBAT PENGADAAN JKN

809 380 0 429

Pemakaian Rusak/Ed Sisa Stok Stok Permintaa Pemberian Keteranga

DIS HABIS PAKAI

Unit Penerima : PUSKESMAS KARYA TANI Bulan : JANUARI

ALAT DAN BARANG MEDIS HABIS PAKAI

OBAT PENGADAAN JKN

718 318 0 400 718

Unit Penerima : PUSKESMAS KARYA TANI Bulan : FEBRUARI

ALAT DAN BARANG MEDIS HABIS PAKAI

OBAT PENGADAAN JKN

858 460 0 398 858

Unit Penerima : PUSKESMAS KARYA TANI Bulan : MARET

ALAT DAN BARANG MEDIS HABIS PAKAI

OBAT PENGADAAN JKN

838 466 0 372 838

KARYANTO,S.Kep MU'LINATUN ANISAH

Unit Penerima : PUSKESMAS KARYA TANI Bulan : APRIL

ALAT DAN BARANG MEDIS HABIS PAKAI

OBAT PENGADAAN JKN

877 447 0 430 877

KARYANTO,S.Kep DESLIA NURVITA UTAMI

Unit Penerima : PUSKESMAS KARYA TANI Bulan : MEI

ALAT DAN BARANG MEDIS HABIS PAKAI

OBAT PENGADAAN JKN

794 344 0 450 794

KARYANTO,S.Kep DESLIA NURVITA UTAMI

Unit Penerima : PUSKESMAS KARYA TANI

Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan

247 ALLOPURINOL TABLET 100 MG TABLET 4476 0 4476

ALAT DAN BARANG MEDIS HABIS PAKAI

110 ALAT SUNTIK SEKALI PAKAI 0.5 ML PACS 1260 0 1260

OBAT PENGADAAN JKN

147 Acyclovir tab 200mg tab 90 0 90

599 262 0 337

Pemakaian Rusak/Ed Sisa Stok Stok Permintaan Pemberian Keterangan

Jumlah Karya Tani, 03 Juli 2019

DESLIA NURVITA UTAMI

Unit Penerima : PUSKESMAS KARYA TANI Bulan : JULI

247 ALLOPURINOL TABLET 100 MG TABLET 4276 0 4276 220 0 4056

415 AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 88 0 88 4 0 84

444 AMITRIPTYLINE TABLET 25 MG TABLET 530 0 530 40 0 490

445 AMLODIPINE TABLET 10 MG TABLET 11345 300 11645 240 0 11405

446 AMLODIPINE TABLET 5 MG TABLET 7435 3000 10435 110 0 10325

523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1554 0 1554 65 0 1489

1479 BENZOIC ACID SALEP SALEP 0 0 0 0 0 0

1690 BISACODYL SUPPOSITORIA 10 MG SUPPOSITORIA 72 0 72 3 0 69

1691 BISACODYL SUPPOSITORIA 5 MG SUPPOSITORIA 30 0 30 3 0 27

2084 CARBAMAZEPINE TABLET 200 MG TABLET 390 0 390 90 0 300

2518 CETIRIZINE SIRUP 1 MG/ML SIRUP 53 0 53 6 0 47

2546 CETIRIZINE TABLET 10 MG TABLET 130 0 130 90 0 40

2601 CHLORAMPHENICOL SALEP 2% SALEP 6 0 6 0 0 6

2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 141970 2000 143970 2610 0 141360

2762 CHLORPROMAZINE TABLET 100 MG TABLET 5500 0 5500 170 0 5330

2763 CHLORPROMAZINE TABLET 25 MG TABLET 400 0 400 110 0 290