Lidi Floor Stock

LPLPO APOTEK
BULAN: JUNI 2018

KODE STOK PER PE SISA PERMIN PEMBE KET
NAMA OBAT TERIMA
OBAT AWAL SEDIAAN MAKAIAN STOK TAAN RIAN
101 Acyclovir krim - - - - -

102 Acyclovir tablet - 200 mg - - - - -
103 Acyclovir tablet - 400 mg 120 - 120 - 120
105 Alat Suntik 10 ml 7 - 7 - 7
106 Alat suntik sekali pakai 1 ml 43 - 43 - 43
107 Alat suntik sekali pakai 2,5 ml 265 - 265 - 265
108 Alat suntik sekali pakai 5 ml 34 - 34 - 34
109 Albendazol tablet 400 mg - - - - -
112 Alopurinol tablet 334 - 334 - 334
114 Ambroxol sirup 60 ml - - - - -
116 Aminofilina injeksi 24mg/ml-10ml 22 - 22 - 22
117 Aminofilina tablet 200 mg 163 - 163 - 163
118 Amitriptilina HCL tablet 25 mg 86 - 86 - 86
119 Amlodipin 10 mg 224 - 224 - 224
120 Amoksilin Forte Sirup Kering - - - - -
121 Amoksilin kaplet - 500 mg 1,457 - 1,457 - 1,457
122 Amoksilin kapsul - 250 mg 133 - 133 - 133
123 Amoksilin Sirup Kering 3 - 3 - 3
124 Ampisilina injeksi 1 gram 5 - 5 - 5
126 Antalgin tablet 500mg - - - - -
127 Antasi DOEN II Suspensi,Kombi - - - - -
128 Antasida Doen tablet 878 - 878 - 878
129 Anti Hemmoroid Suppositoria 14 - 14 - 14
131 Antifungi DOEN (As Benzoat 3%+As Sali 12 - 12 - 12
132 Antimigren DOEN (Ergotamina Trt + Kof - - - - -
133 Antrain injeksi 2ml /5 - - - - -
134 Aqua pro injeksi steril - 20 ml 24 - 24 - 24
139 Asam Askorbat (vit C) tablet 50 mg 198 - 198 - 198
140 Asam Mefenamat kaplet 500 mg 12 - 12 - 12
141 Asam tranexamat injeksi 100mg/ml 8 - 8 - 8
142 AsamTraneksamat HCL tablet 500mg 249 - 249 - 249
143 Aseptic Gel + Disp 500 ml - - - - -
144 Asetosal tablet 100 mg - - - - -
145 Asetosal tablet 80 mg 46 - 46 - 46
146 Attapulgit 600 mg - - - - -
147 Attapulgit 630 mg - - - - -
148 Atropina Sulfat injeksi 10 - 10 - 10
156 Betahistin Mesilat 6 mg - - - - -
157 Betametason krim 29 - 29 - 29
201 Bisoprolol tablet 5 mg 236 - 236 - 236
206 Calcium Gluconas infus - - - - -
207 Captopril tablet 12,5 mg 397 - 397 - 397
208 Captopril tablet 25 mg 606 - 606 - 606
209 Captopril tablet 50 mg 55 - 55 - 55
216 Cefadroxil kapsul 500 mg - - - - -
217 Cefixime 100mg - - - - -
218 Cefotaxim injeksi - - - - -
313 Cyprofloxacin kapsul 500 mg 268 - 268 - 268
314 Clobazam 10 mg 200 - 200 - 200
315 Clozapin 25 mg - - - - -
316 Daryan Tulle :Flamisetin Sulfat 10 x 10 - - - - -
317 Decullin tablet 30mg - - - - -
318 Deksametason Injeksi 5mg/ml 45 - 45 - 45
319 Deksametason tablet 0,5 mg 880 - 880 - 880
Dextral syrup
401 Diazepam Injeksi 5mg/ml-2ml 18 - 18 - 18
402 Diazepam tablet 2 mg 60 - 60 - 60
403 Diazepam tablet 5 mg - - - - -
405 Difenhidramina HCL injeksi 10 mg 54 - 54 - 54
406 Digoksina tablet 0,25 mg 95 - 95 - 95
407 Doksisiklin kapsul 100 mg 92 - 92 - 92
408 Domperidon tablet 10 mg - - - - -
409 Dulcolax supp Adult 10 mg / Bisakadil 14 - 14 - 14
410 Epinefrina HCL/Bitart injeksi 0.1% - l m 44 - 44 - 44
411 Erithromicin kaplet 500 mg 704 - 704 - 704
NAMA OBAT TERIMA
412 Erithromicin kapsul 250 mg - - - - -
413 Erithromicin sirup - 60 ml Kering 28 - 28 - 28
419 Feeding tube No. 10 - - - - -
420 Feeding tube No. 16 - - - - -
421 Feeding tube No. 5 3 - 3 - 3
422 Feeding tube No. 8 5 - 5 - 5
423 Fenitoina Natrium kapsul 100 mg - - - - -
424 Fenobarbital Injeksi 50mg/ml-2ml - - - - -
425 Fenobarbital tablet 30 mg - - - - -
426 Fenoksimetil Penisilina tablet 500 mg - - - - -
501 Fitomenadion injeksi 10mg/ml - - - - -
502 Fitomenadion injeksi 2 mg/ml 18 - 18 - 18
503 Fitomenadion tablet 10 mg 141 - 141 - 141
504 Flagil / Metronidazol Ovuo 500mg 19 - 19 - 19
506 Fluconazole 150 mg 159 - 159 - 159
508 Folley Catheter No. 14 - - - - -
509 Folley Catheter No. 16 9 - 9 - 9
510 Folley Catheter No. 18 11 - 11 - 11
511 Furosemida tablet 40 mg 91 - 91 - 91
512 Furosemide 10mg/ml injeksi 5 - 5 - 5
513 Garam Oralit untuk 200 ml air 353 - 353 - 353
514 Gentamycin injeksi 80 mg/2 ml 17 - 17 - 17
603 Gentamycin tetes mata - - - - -
606 Glibenklamida tablet 5 mg 259 - 259 - 259
607 Glimepiride 1 mg 17 - 17 - 17
608 Glimepiride 2 mg - - - - -
609 Gliseril Guayakolat tablet 100 mg - - - - -
611 Gliserin 100 ml 8 - 8 - 8
612 Glukosa infus 0,225% - 500 ml 21 - 21 - 21
613 Glukosa lar. infus 10% steril 20 - 20 - 20
616 Griseofulvin tablet 125mg - - - - -
617 Griseofulvin tablet 500 mg - - - - -
618 Haloperidol tablet 0.5 mg - - - - -
619 Haloperidol tablet 1.5 mg 10 - 10 - 10
620 Haloperidol tablet 2 mg - - - - -
621 Halopuridol tablet 5 mg 250 - 250 - 250
703 Hidrokortison Krim 2,5% 13 - 13 - 13
704 Ibuprofen suspensi 100 mg/ 5ml 9 - 9 - 9
705 Ibuprofen tablet 200 mg - - - - -
706 Ibuprofen tablet 400 mg - - - - -
708 Infusion set anak 31 - 31 - 31
709 Infusion set dewasa 23 - 23 - 23
710 IV Catether No.18 60 - 60 - 60
711 IV Catether No.20 42 - 42 - 42
712 IV Catether No.22 134 - 134 - 134
713 IV Catether No.24 53 - 53 - 53
715 Isoniazid 100 mg 141 - 141 - 141
716 Isoniazid 300 mg - - - - -
717 Isosorbid Dinitrat tablet 5 mg 157 - 157 - 157
718 KA-EN 3B infus - 500 ml 100 - 100 - 100
720 Kalsium Laktat tablet 500mg. - - - - -
722 Karbamazepin tablet 200 mg 80 - 80 - 80
804 Ketokonazol tablet 73 - 73 - 73
805 Ketokonazol Krim 2 % - - - - -
806 Klindamycin kapsul 150 mg - - - - -
807 Klindamycin kapsul 300 mg 278 - 278 - 278
808 Kloramfenikol kapsul 250 mg 394 - 394 - 394
809 Kloramfenikol Salep Mata 1% 10 - 10 - 10
810 Kloramfenikol sirup - 125 mg/ml -60ml 23 - 23 - 23
811 Kloramfenikol tetes mata 0,5% - 5 ml 30 - 30 - 30
901 Kloramfenikol tetes telinga 3% - - - - -
902 Klorfeniramina Maleat tablet 4mg 1,117 - 1,117 - 1,117
903 Klorpromazina HCL inj 25 mg/ml-1ml - - - - -
904 Klorpromazina HCL tab salut 100 mg - - - - -
905 Klorpromazina HCL tab salut 25 mg 2 - 2 - 2
906 Kodeina tablet. 10mg 50 - 50 - 50
907 Kotrimoksazol sirup 5 - 5 - 5
NAMA OBAT TERIMA
908 Kotrimoksazol tablet Adult 784 - 784 - 784
909 Kotrimoksazol tablet Forte 160 - 160 - 160
1002 Laxadin sirup 60 ml 7 - 7 - 7
1004 Levofloksasin tablet 500 mg 24 - 24 - 24
1101 Lidocain 2% injeksi 71 - 71 - 71
1102 Lidokaina Comp. Injeksi 2% 43 - 43 - 43
1104 Loperamide tablet - 2mg 155 - 155 - 155
1105 Loratadin - - - - -
1109 Magnesium Sulfat injeksi 20% 5 - 5 - 5
1110 Magnesium Sulfat injeksi 40% 4 - 4 - 4
1123 Metaneuron tablet - - - - -
1124 Metformin H Cl tablet 500 mg - - - - -
1126 Methylpredhisolon 8 mg - - - - -
1127 Metilergometrina injeksi 0,2 mg/ml -1 m 93 - 93 - 93
1128 Metilergometrina Maleat tablet 105 - 105 - 105
1129 Metoclopramide 5 mg - - - - -
1130 Metoklopramid 10 mg - - - - -
1131 Metoklopramid Syrup 60 ml - - - - -
1132 Metronidazol 500mg infus 11 - 11 - 11
1201 Metronidazol tablet 250 mg - - - - -
1202 Metronidazol tablet 500 mg 231 - 231 - 231
1210 Natrium Diklofenak 50 mg - - - - -
1211 Natrium Klorida larutan infus 0.9% 39 - 39 - 39
1213 Neurobat injeksi - - - - -
1217 Nistatin 100.000 IU/g tablet vaginal 21 - 21 - 21
1218 Nistatin 500.000 IU/g tablet oral 51 - 51 - 51
1219 Obat Antituberkulosis kat - Anak 3 - 3 - 3
1220 Obat Antituberkulosis kat - I 5 - 5 - 5
1221 Obat Antituberkulosis kat -II 2 - 2 - 2
1312 Oksitetrasiklina HCL salep kulit 3 % 1 - 1 - 1
1314 Oksitosina injeksi 10 IU/ml-1ml 44 - 44 - 44
1315 Omeprazol kapsul - - - - -
1316 Ondansetron tab 4 mg - - - - -
1317 Ondansetron tab 4 mg/2 ml Inj - Ktk 5 - - - - -
1318 Oxyflow Nasal Oxygen Anak 5 - 5 - 5
1319 Oxyflow Nasal Oxygen Dewasa 5 - 5 - 5
1320 Oxyflow Nasal Oxygen Bayi 5 - 5 - 5
1321 Paracetamol Drop 15 - 15 - 15
1322 Parasetamol sirup 120 mg/5ml 3 - 3 - 3
1323 Parasetamol tablet 500 mg 1,098 - 1,098 - 1,098
1324 Permetrin Krim 5% / Scabimite - - - - -
1327 Piracetam 800 mg tablet - - - - -
1328 Piracetam inj 1 gram/5ml - - - - -
1331 Piridoksina HCL tablet 10mg 1,006 - 1,006 - 1,006
1332 Piridoksina HCL tablet 25 mg - - - - -
1333 Piroxicam 20 mg - - - - -
1405 Prednison tablet 5 mg 361 - 361 - 361
1407 Propanolol HCL tablet 10 mg 170 - 170 - 170
1408 Propanolol HCL tablet 40 mg 131 - 131 - 131
1409 Propiltiourasil tablet 100 mg 100 - 100 - 100
1410 Ranitidin 150 mg - - - - -
1415 Retinol kap. lunak 200.000 IU 96 - 96 - 96
1416 Ringer Asetat infus - 500ml 12 - 12 - 12
1417 Ringer Laktat + Glucose 5% infus-500ml 16 - 16 - 16
1418 Ringer Laktat Larutan infus - 500 ml 102 - 102 - 102
1419 Risperidone 2 mg - - - - -
1501 Salbutamol 2 mg 148 - 148 - 148
1502 Salbutamol 4 mg 188 - 188 - 188
1503 Salep 2-4 DOEN (As.Salisilat 2%+Bele 46 - 46 - 46
1504 Salisil Bedak 2% - 50 gram 4 - 4 - 4
1508 Serum Anti Bisa Ular injeksi (ABU I) 1 - 1 - 1
1510 Serum Anti Tetanus injeksi 1.500 IU 1 - 1 - 1
1513 Sianokobalamina (Vit B12) injeksi 112 - 112 - 112
1514 Sikzonoate injeksi 25 mg /ml 10 - 10 - 10
1518 Simvastatin tablet 10 mg 767 - 767 - 767
1519 Spashi - Injeksi 5 - 5 - 5
1520 Spasminal tablet 122 - 122 - 122
1601 Stesolid Rectal 5 mg/2,5 ml 10 - 10 - 10
1604 Surgical glove no. 6 36 - 36 - 36
NAMA OBAT TERIMA
1606 Surgical Glove No. 7,5 65 - 65 - 65
1607 Surgical Glove No. 8 87 - 87 - 87
1609 Tablet Tambah Darah (Besi II Sulfat) t - - - - -
1611 Teosal tablet 165 - 165 - 165
1614 Thiamphenicol 500 mg - - - - -
1615 Three way Stop Cock 35 - 35 - 35
1617 Tiamina (Vit B1) tablet 50 mg 474 - 474 - 474
1618 Tiamina HCL injeksi 100mg/ml 15 - 15 - 15
1620 Tramadol injiksi 50 mg/ml 17 - 17 - 17
1621 Tramadol kapsul 50 mg 88 - 88 - 88
1622 Transfusion set 5 - 5 - 5
1625 Triheksifenidil Hcl tablet - 2 mg - - - - -
1627 Umbilical Cord 40 - 40 - 40
1628 Underpad 28 - 28 - 28
1629 Urine bag 7 - 7 - 7
1637 Ventolin Nebules /Salbutamol Cairan 2 - - - - -
1638 Voluven - Koloid HES BM 130.000 Lar in - - - - -
1701 Vitamin B Kompleks tablet 317 - 317 - 317
1702 Wida D5 1/2 NS 20 - 20 - 20
1703 Wing Needle bayi no.25 5 - 5 - 5
1707 ZINC tablet 20 mg 259 - 259 - 259
1708 Zircum KID sirup 8 - 8 - 8
2102 Efavirenz (EFV) 600mg 60 - 60 - 60
2103 Nevirapine ( NVP ) 200mg 120 - 120 - 120
2201 Zidofudine ( ZDV ) 300mg + Lamivudine 120 - 120 - 120
2301
Tenofovir 300+Lamivudin 300+Efavien 193 - 193 - 193
2302 Zidofudine ( ZDV ) 60mg + Lamivudine - - - - -
2303 Zidofudine (ZDV ) 100 mg tablet - - - - -
2401 Tenofovir 300 mg tablet - - - - -
2402 Efavirenz (EFV) 200 mg - - - - -
2501 Tenofovir 300 mg + Emcitritabine 200 ( - - - - -
2502 Abacavir (ABC) 300 mg - - - - -
2503 Lamivudine 150 mg tablet - - - - -
2601 Right Sign - - - - -
2602 Verorab Serum - - - - -
NELATO CATHETER NO:12 - - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
MYCONAZOLE SK 13 - 13 - 13
LAPORAN BULANAN PELAYANAN KEFARMASIAN DI PUSKESMAS
NAMA PUSKESMAS :JEMBER KIDUL
KABUPATEN/KOTA : JEMBER
PROVINSI :JAWA TIMUR
LAPORAN BULAN: JUNI 2018
JENIS PELAYANAN RESEP

N0 TANGGAL KONSELING INFORMASI OBAT
RAWAT JALAN RAWAT INAP
1 1-Apr-18 72 3 75
2 2-Apr-18 63 4 67
3 3-Apr-18 33 3 36
4 4-Apr-18 36 8 44
5 5-Apr-18 0 4 4
6 6-Apr-18 54 2 56
7 7-Apr-18 64 6 70
8 8-Apr-18 42 9 51
9 9-Apr-18 53 9 62
10 10-Apr-18 35 3 38
11 11-Apr-18 41 4 45
12 12-Apr-18 0 6 6
13 13-Apr-18 63 4 67
14 14-Apr-18 71 4 75
15 15-Apr-18 62 2 64
16 16-Apr-18 59 1 60
17 17-Apr-18 0 3 3
18 18-Apr-18 46 3 49
19 19-Apr-18 0 6 6
20 20-Apr-18 0 4 4
21 21-Apr-18 56 8 64
22 22-Apr-18 0 4 4
23 23-Apr-18 57 8 65
24 24-Apr-18 42 8 50
25 25-Apr-18 45 7 52
26 26-Apr-18 0 5 5
27 27-Apr-18 75 4 79
28 28-Apr-18 60 8 68
29 29-Apr-18 47 5 52
30 30-Apr-18 29 0 29
31 30-Dec-99 0 0 0
0 0 0
KIA/VK 0 0 0
BTPN 0 0 0
PUSLING 0 0 0
POSYANDU 33 0 33
PUSTU JEMBER KIDU 13 0 13
1251 145 0 1396

TOTAL
1396
JEMBER KIDUL, 02 JULI 2018

YANG MELAPORKAN MENGETAHUI
PENGELOLA OBAT KEPALA PUSKESMAS
TITIS AGUSTINA dr.RUMI ENGGARWATI

NIP. 19850816 201001 2 008 NIP.19790326 201412 2 001
TANGGAL:1 AGUSTUS 2018
NO
KETERANGAN
NAMA PASIEN
Acyclovir krim
Acyclovir tablet - 400 mg
Air raksa dental use
Alat Suntik 10 ml
Alat suntik sekali pakai 1 ml
Alat suntik sekali pakai 2,5 ml
Albendazol tablet 400 mg
Alkohol 95 %
Alkohol Swab
Alopurinol tablet
Alpara
Ambroxol sirup 60 ml
Ambroxol tablet 30 mg
Aminofilina injeksi 24mg/ml-10ml
Aminofilina tablet 200 mg
Amitriptilina HCL tablet 25 mg
Amlodipin 10 mg
Amoksilin Forte Sirup Kering
Amoksilin kaplet - 500 mg
Amoksilin Sirup Kering
Antalgin tablet 500mg
Antasida Doen tablet
Anti Hemmoroid Suppositoria
Antibakteri DOEN (Basitrasin +
Polimiksin)
Antifungi DOEN (As Benzoat 3%+As
Salisilat
Antimigren6%)DOEN (Ergotamina Trt +
Kofeina)
Antrain injeksi 2ml /5
Aqua pro injeksi steril - 20 ml
Aquadest steril - 1000 ml
Air utk Irigra Lar Infus 1000 ml

Aquagel Sterile Jely 82 gr
Asam Askorbat (vit C) tablet 50 mg
Asam Mefenamat kaplet 500 mg
Betametason krim
Bisoprolol tablet 5 mg
Captopril tablet 12,5 mg
Captopril tablet 25 mg
Deksametason tablet 0,5 mg
NO
KETERANGAN
NAMA PASIEN
Demacolin tablet
Dentin Conditioner / Mini Pack

Depo Progestin Injeksi 3 bln
Dermazin salep kulit 1% - 25gram
/BioplaN
Devitalisasi pasta
Dextral syrup
Dextran infus - 500 ml
Dextrofen Sirup
Diazepam Injeksi 5mg/ml-2ml
Diazepam tablet 2 mg
Diethylcarbamazine
Difenhidramina HCL injeksi 10 mg
Digoksina tablet 0,25 mg
Doksisiklin kapsul 100 mg
Domperidon tablet 10 mg
Erithromicin kaplet 500 mg
Erithromicin kapsul 250 mg
Erithromicin sirup - 60 ml Kering
Etanol 70% - 1000 ml
Etching+bonding Liquit SDI
Etil Klorida semprot
Eugenol Cairan - 10 ml
Farmoten 12,5 mg
Feeding tube No. 10
Feeding tube No. 16
Feeding tube No. 5
Feeding tube No. 8
Fenitoina Natrium kapsul 100 mg
Fitomenadion tablet 10 mg
Flagil / Metronidazol Ovuo 500mg
Fluoksetin 10 mg
Fluconazole 150 mg
Fluoride Sediaan Topical/Clinpro White

Folley Catheter No. 14
NO
KETERANGAN
NAMA PASIEN
Furosemida tablet 40 mg
Furosemide 10mg/ml injeksi
Garam Oralit untuk 200 ml air
Hidrokortison Krim 2,5%
Ibuprofen suspensi 100 mg/ 5ml
Ibuprofen tablet 200 mg
Isoniazid 100 mg
Isoniazid 300 mg
Isosorbid Dinitrat tablet 5 mg
KA-EN 3B infus - 500 ml
Kalsium Hidroksida pasta
Ketokonazol tablet
Ketokonazol Krim 2 %
Klindamycin kapsul 150 mg
Kloramfenikol kapsul 250 mg
Kloramfenikol Salep Mata 1%
Kloramfenikol sirup - 125 mg/ml -60ml
Kloramfenikol tetes mata 0,5% - 5 ml

Klorfeniramina Maleat tablet 4mg
Kotrimoksazol tablet Adult
Kotrimoksazol tablet Forte
Loperamide tablet - 2mg
Loratadin
Metformin H Cl tablet 500 mg
Metronidazol tablet 500 mg
Meylon injeksi
Mineral mix
Monoklorkamfer Mentol cairan
Mummifying pasta
Na ClO 5.,25 % dan CaOCl212 /
BYCLIN
Nasaflam 100 mg
Natrium Bikarbonat tablet 500 mg
Natrium Diklofenak 50 mg
Natrium Klorida larutan infus 0.9%
Neo Kaominal sirup
NO
KETERANGAN
NAMA PASIEN
Neurobat injeksi
Neurosanbe 5000 tablet
Nifedipin 10 mg tablet
Nistatin 100.000 IU suspensi

Nistatin 100.000 IU/g tablet vaginal
Nistatin 500.000 IU/g tablet oral
Obat Antituberkulosis kat - Anak
Obat Antituberkulosis kat - I
Obat Antituberkulosis kat -II
Obat Batuk Hitam cairan 100ml
OBAT KUSTA M B anak
OBAT KUSTA M B dewasa
OBAT KUSTA P B anak
OBAT KUSTA P B dewasa
Obat Malaria tablet

OBH Tropica Exta Mentol 60 ml
OBH Tropica Plus Anak Jeruk 60 ml
OBH Tropica Plus Mentol 60 ml
Obyek Glass
Oksigen Gas dalam tabung - 1m3
Oksitetrasiklina HCL salep kulit 3 %
Oksitetrasiklina HCL salep mata 1%
Oksitosina injeksi 10 IU/ml-1ml
Omeprazol kapsul
Ondansetron tab 4 mg
Ondansetron tab 4 mg/2 ml Inj - Ktk 5
Oxyflow Nasal Oxygen Anak
Oxyflow Nasal Oxygen Dewasa
Oxyflow Nasal Oxygen Bayi
Paracetamol Drop
Parasetamol sirup 120 mg/5ml
Parasetamol tablet 500 mg
Piridoksina HCL tablet 10mg
Prednison tablet 5 mg
Ranitidin 150 mg
Salbutamol 2 mg
NO
KETERANGAN
NAMA PASIEN
Salbutamol 4 mg
Salep 2-4 DOEN (As.Salisilat 2%
+Belerang Endap 4%)
Salisil Bedak 2% - 50 gram
Sarung Tangan Obgyn ( STERIL )
Semen Seng Fosfat
Semillas Non Woven 5x500cm
Serum Anti Bisa Ular injeksi (ABU I)
Serum Anti Dipteri injeksi 20.000 IU
Serum Anti Tetanus injeksi 1.500 IU
Serum Kontrol
Sianokobalamina (Vit B12) injeksi
Sikzonoate injeksi 25 mg /ml
Silk no 2/0, 24x13x60 cm
Silver Amalgam serbuk 65-75%
Simvastatin tablet 10 mg
Spashi - Injeksi
Spasminal tablet
Spironolactone 25 mg
Spons Gelatin cubicles 1x1x1cm
Stesolid Rectal 10 mg/2,5 ml
Stolax /Bisakodil Supp 10mg
Sulfasetamida tetes mata 15%
Surgical glove no. 6
Surgical Glove No. 7
Surgical Glove No. 7,5
Semilas Non Woven 10x 500cm
Tablet Tambah Darah (Besi II Sulfat)
tab.300mg
Teosal tablet
Tiamina (Vit B1) tablet 50 mg
Vitamin B Kompleks tablet
NO BPJS UMUM
KETERANGAN 0 72
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Acyclovir tablet - 400 mg 0
Air raksa dental use 0
Alat Suntik 10 ml 0
Alat suntik sekali pakai 1 ml 0
Alat suntik sekali pakai 2,5 ml 0
Albendazol tablet 400 mg 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Alpara 0
Ambroxol sirup 60 ml 0
Ambroxol tablet 30 mg 0
Aminofilina injeksi 24mg/ml-10ml 0
Aminofilina tablet 200 mg 0
Amitriptilina HCL tablet 25 mg 0
Amlodipin 10 mg 0
Amoksilin Forte Sirup Kering 0
Amoksilin kaplet - 500 mg 0
Amoksilin Sirup Kering 0
Antalgin tablet 500mg 0
Antasida Doen tablet 0
Anti Hemmoroid Suppositoria 0
Antibakteri DOEN (Basitrasin + 0
Polimiksin)
Antifungi DOEN (As Benzoat 3%+As 0
Salisilat
Antimigren6%)DOEN (Ergotamina Trt + 0
Kofeina)
Antrain injeksi 2ml /5 0
Aqua pro injeksi steril - 20 ml 0
Aquadest steril - 1000 ml 0
Air utk Irigra Lar Infus 1000 ml 0
Aquagel Sterile Jely 82 gr 0

Asam Askorbat (vit C) tablet 50 mg 0
Asam Mefenamat kaplet 500 mg 0
Betametason krim 0
Bisoprolol tablet 5 mg 0
Captopril tablet 12,5 mg 0
Captopril tablet 25 mg 0
Deksametason tablet 0,5 mg 0
NO BPJS UMUM
KETERANGAN 0 72
NAMA PASIEN
JUMLAH
Demacolin tablet 0
Dentin Conditioner / Mini Pack 0

Depo Progestin Injeksi 3 bln 0
0
/BioplaN
Devitalisasi pasta 0
Dextral syrup 0
Dextran infus - 500 ml 0
Dextrofen Sirup 0
Diazepam Injeksi 5mg/ml-2ml 0
Diazepam tablet 2 mg 0
Diethylcarbamazine 0
Difenhidramina HCL injeksi 10 mg 0
Digoksina tablet 0,25 mg 0
Doksisiklin kapsul 100 mg 0
Domperidon tablet 10 mg 0
Erithromicin kaplet 500 mg 0
Erithromicin kapsul 250 mg 0
Erithromicin sirup - 60 ml Kering 0
Etanol 70% - 1000 ml 0
Etching+bonding Liquit SDI 0
Etil Klorida semprot 0
Eugenol Cairan - 10 ml 0
Farmoten 12,5 mg 0
Feeding tube No. 10 0
Fenitoina Natrium kapsul 100 mg 0
Fitomenadion tablet 10 mg 0
Flagil / Metronidazol Ovuo 500mg 0
Fluoksetin 10 mg 0
Fluconazole 150 mg 0
Fluoride Sediaan Topical/Clinpro White 0

Folley Catheter No. 14 0
NO BPJS UMUM
KETERANGAN 0 72
NAMA PASIEN
JUMLAH
Furosemida tablet 40 mg 0
Furosemide 10mg/ml injeksi 0
Garam Oralit untuk 200 ml air 0
Hidrokortison Krim 2,5% 0
Ibuprofen suspensi 100 mg/ 5ml 0
Ibuprofen tablet 200 mg 0
Isoniazid 100 mg 0
Isoniazid 300 mg 0
Isosorbid Dinitrat tablet 5 mg 0
KA-EN 3B infus - 500 ml 0
Kalsium Hidroksida pasta 0
Ketokonazol tablet 0
Ketokonazol Krim 2 % 0
Klindamycin kapsul 150 mg 0
Kloramfenikol kapsul 250 mg 0
Kloramfenikol Salep Mata 1% 0
Kloramfenikol sirup - 125 mg/ml -60ml 0
Kloramfenikol tetes mata 0,5% - 5 ml 0

Klorfeniramina Maleat tablet 4mg 0
Kotrimoksazol tablet Adult 0
Kotrimoksazol tablet Forte 0
Loperamide tablet - 2mg 0
Loratadin 0
Metformin H Cl tablet 500 mg 0
Metronidazol tablet 500 mg 0
Meylon injeksi 0
Mineral mix 0
Monoklorkamfer Mentol cairan 0
Mummifying pasta 0
0
BYCLIN
Nasaflam 100 mg 0
Natrium Bikarbonat tablet 500 mg 0
Natrium Diklofenak 50 mg 0
Natrium Klorida larutan infus 0.9% 0
Neo Kaominal sirup 0
NO BPJS UMUM
KETERANGAN 0 72
NAMA PASIEN
JUMLAH
Neurobat injeksi 0
Neurosanbe 5000 tablet 0
Nifedipin 10 mg tablet 0
Nistatin 100.000 IU suspensi 0

Nistatin 100.000 IU/g tablet vaginal 0
Nistatin 500.000 IU/g tablet oral 0
Obat Antituberkulosis kat - Anak 0
Obat Antituberkulosis kat - I 0
Obat Antituberkulosis kat -II 0
Obat Batuk Hitam cairan 100ml 0
OBAT KUSTA M B anak 0
OBAT KUSTA M B dewasa 0
OBAT KUSTA P B anak 0
OBAT KUSTA P B dewasa 0
Obat Malaria tablet 0
OBH Tropica Exta Mentol 60 ml 0
OBH Tropica Plus Anak Jeruk 60 ml 0
OBH Tropica Plus Mentol 60 ml 0

Obyek Glass 0
Oksigen Gas dalam tabung - 1m3 0
Oksitetrasiklina HCL salep kulit 3 % 0
Oksitetrasiklina HCL salep mata 1% 0
Oksitosina injeksi 10 IU/ml-1ml 0
Omeprazol kapsul 0
Ondansetron tab 4 mg 0
Ondansetron tab 4 mg/2 ml Inj - Ktk 5 0
Oxyflow Nasal Oxygen Anak 0
Oxyflow Nasal Oxygen Dewasa 0

Oxyflow Nasal Oxygen Bayi 0
Paracetamol Drop 0
Parasetamol sirup 120 mg/5ml 0
Parasetamol tablet 500 mg 0
Piridoksina HCL tablet 10mg 0
Prednison tablet 5 mg 0
Ranitidin 150 mg 0
Salbutamol 2 mg 0
NO BPJS UMUM
KETERANGAN 0 72
NAMA PASIEN
JUMLAH
Salbutamol 4 mg 0
0
+Belerang Endap 4%)
Salisil Bedak 2% - 50 gram 0
Sarung Tangan Obgyn ( STERIL ) 0
Semen Seng Fosfat 0
Semillas Non Woven 5x500cm 0
Serum Anti Bisa Ular injeksi (ABU I) 0
Serum Anti Dipteri injeksi 20.000 IU 0
Serum Anti Tetanus injeksi 1.500 IU 0
Serum Kontrol 0
Sianokobalamina (Vit B12) injeksi 0
Sikzonoate injeksi 25 mg /ml 0
Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Silver Amalgam serbuk 65-75% 0
Simvastatin tablet 10 mg 0
Spashi - Injeksi 0
Spasminal tablet 0
Spironolactone 25 mg 0
Spons Gelatin cubicles 1x1x1cm 0
Stesolid Rectal 10 mg/2,5 ml 0
Stolax /Bisakodil Supp 10mg 0
Sulfasetamida tetes mata 15% 0
Surgical glove no. 6 0
Surgical Glove No. 7 0
Surgical Glove No. 7,5 0
Semilas Non Woven 10x 500cm 0
0
tab.300mg
Teosal tablet 0
Tiamina (Vit B1) tablet 50 mg 0
Vitamin B Kompleks tablet 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63
KETERANGAN
PASIEN
NAMA
Amlodipin 10 mg
Antifungi DOEN (As Benzoat 3%
+As Salisilat
Asam 6%)(vit C) tablet 50
Askorbat
mg
AsamTraneksamat HCL tablet
500mg
Betametason krim

Oksitetrasiklina HCL salep kulit 3
%
Permetrin Krim 5% / Scabimite
Spasminal tablet
NO BPJS UMUM
KETERANGAN 0 63
JUMLAH
PASIEN
NAMA
Amlodipin 10 mg 0
0
+As Salisilat
Asam 6%)(vit C) tablet 50
Askorbat
0
mg
AsamTraneksamat HCL tablet
0
500mg
Betametason krim 0

Oksitetrasiklina HCL salep kulit 3
0
%
Permetrin Krim 5% / Scabimite 0
Spasminal tablet 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 BPJS UMUM
KETERANGAN 0 33
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Alpara 0
Amlodipin 10 mg 0
Amoksilin kapsul - 250 mg 0
Antasi DOEN II Suspensi,Kombi 0
Antibakteri DOEN (Basitrasin + Polimiksin) 0
Antifungi DOEN (As Benzoat 3%+As Salisilat 6%) 0
Antimigren DOEN (Ergotamina Trt + Kofeina) 0

Asam tranexamat injeksi 100mg/ml 0
AsamTraneksamat HCL tablet 500mg 0
Aseptic Gel + Disp 500 ml 0
Asetosal tablet 100 mg 0
Attapulgit 600 mg 0
Attapulgit 630 mg 0
Atropina Sulfat injeksi 0
Autodisposable Syringe 0,05 ml 0
Autodisposable Syringe 0,5 ml (Soloshot) 0
Autodisposable Syringe 5 ml (Soloshot) 0
Azitromicin 250 mg tab 0
Bahan tumpatan sementara/Caviton 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 BPJS UMUM
KETERANGAN 0 33
NAMA PASIEN
JUMLAH
Becefort tablet 0
Benzatin Bensil Pen.inj 2,4 juta IU 0
Betahistin Mesilat 6 mg 0
Betametason krim 0
Cefixime 100mg 0
Cefotaxim injeksi 0
Ceftriaxone 1.Og inj Kering 0
Cendo Lyteer 0
Cetirizine Kapsul 10mg 0
Chlorhexidine gluconat 0,2% / ASEPTAN 0
Chlorhexidine gluconat 4% 500 cc + dispenser /
0
ONE SCROB
Chlorhexidine gluconat 0,5 W/v 70 % / ASEPTAN 0
Cyprofloxacin kapsul 500 mg 0
Dulcolax supp Adult 10 mg / Bisakadil 0
Epinefrina HCL/Bitart injeksi 0.1% - l ml 0
Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 BPJS UMUM
KETERANGAN 0 33
NAMA PASIEN
JUMLAH
Fenobarbital Injeksi 50mg/ml-2ml 0
Fenobarbital tablet 30 mg 0
Fenoksimetil Penisilina tablet 500 mg 0
Fitomenadion injeksi 10mg/ml 0
Fitomenadion injeksi 2 mg/ml 0
Fluoksetin 10 mg 0
Glimepiride 1 mg 0
Glimepiride 2 mg 0
Kalsium Laktat tablet 500mg. 0
Kloramfenikol tetes telinga 3% 0
Kotrimoksazol sirup 0
Lidokaina Comp. Injeksi 2% 0
Metformin HCL tablet 850mg 0
Methylpredhisolon 8 mg 0
Metilergometrina injeksi 0,2 mg/ml -1 ml 0
Metilergometrina Maleat tablet 0
Metoclopramide 5 mg 0
Metoklopramid 10 mg 0
Metoklopramid Syrup 60 ml 0
Metronidazol 500mg infus 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 BPJS UMUM
KETERANGAN 0 33
NAMA PASIEN
JUMLAH
Omeprazol kapsul 0

Paracetamol Drop 0
Piridoksina HCL tablet 25 mg 0
Piroxicam 20 mg 0
Plester 5 yard x 2 inch 0
Plester Flexible non woven 5 x 5 0
Plester Kain Roll 1,25cm x 4,5m 0
PM-ASI Biskuit 0
PMT Untuk BUMIL 0
PMT-AS biskuit 0
Polikresulen ( Metakresolsulfonat ) - 10 ml 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
Salep 2-4 DOEN (As.Salisilat 2%+Belerang Endap
0
4%)
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 BPJS UMUM
KETERANGAN 0 33
NAMA PASIEN
JUMLAH
Tablet Tambah Darah (Besi II Sulfat) tab.300mg 0
Thiamphenicol 500 mg 0
Three way Stop Cock 0
Tiamina HCL injeksi 100mg/ml 0
Topical Anastesi Gel/Prime Gel 0

Tramadol injiksi 50 mg/ml 0
Tramadol kapsul 50 mg 0
Transfusion set 0
Trifluoperazin 5 mg / Stesoli tab 0

Trigliserida ( 3X50 ST ) 0
Triheksifenidil Hcl tablet - 2 mg 0
Trikresol Formalin (Forinokresol) cairan - 10 ml 0
Umbilical Cord 0
Voluven - Koloid HES BM 130.000 Lar inf 0,6 % 0

ZINC tablet 20 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 36
NAMA PASIEN
JUMLAH
Amlodipin 10 mg 0
Betametason krim 0
Betametason N crem 0
Bisakodil Supp 10mg 0
Bist Mess No.24 0
Blood Lancet 0
Bonding Liq 0
Bunofa 400 0
Calcium Gluconas infus 0
Glimepiride 1 mg 0

Kodeina tablet. 10mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 36
NAMA PASIEN
JUMLAH
Kuinina Sulfat tablet 0
Kombipak Kategori 1 0
Lanzoprazol kapsul 30 mg 0
Laxadin sirup 60 ml 0
Leukoplast Hospital 7.50 cm x 4.5 m 0
Levofloksasin tablet 500 mg 0
Lidocain 2% injeksi 0
Lisol - 1000 ml 0
Paracetamol Drop 0
Spasminal tablet 0
0
tab.300mg
ZINC tablet 20 mg 0
TANGGAL:5 JULI 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Amlodipin 10 mg 0
Glimepiride 1 mg 0
Paracetamol Drop 0
Salbutamol 4 mg 0
tab.300mg 0
Ventolin Nebules /Salbutamol Cairan 0
2,5 mg
ZINC tablet 20 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 BPJS UMUM
KETERANGAN 0 54
NAMA PASIEN
JUMLAH
Acon Stik for Plano Test 0
Acyclovir krim 0
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Alpara 0
Amlodipin 10 mg 0
0
Polimiksin)
0
+As SalisilatDOEN
Antimigren 6%) (Ergotamina Trt
0
+ Kofeina)
Betametason krim 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 BPJS UMUM
KETERANGAN 0 54
NAMA PASIEN
JUMLAH
Deksametason Injeksi 5mg/ml 0
Demacolin tablet 0

0
/BioplaN
Dextral syrup 0
Dextrofen Sirup 0
Epinefrina HCL/Bitart injeksi 0.1%
0
- l ml
Gentamycin injeksi 80 mg/2 ml 0
Gentamycin salep kulit 0
Gentamycin salep mata 0

Gentamycin tetes mata 0
Gentian violet larutan 1% 0
Glass Ionomer Cement 0
Glibenklamida tablet 5 mg 0
Glimepiride 1 mg 0
Glimepiride 2 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 BPJS UMUM
KETERANGAN 0 54
NAMA PASIEN
JUMLAH
Isoniazid 100 mg 0
Kloramfenikol sirup - 125 mg/ml -
0
60ml
Klorpromazina HCL inj 25 mg/ml-1ml 0
Klorpromazina HCL tab 100 mg 0
Klorpromazina HCL tab salut 25 mg 0
Leukoplast Hospital 7.50 cm x 4.5 0

m
Lisol - 1000 ml 0
Paracetamol Drop 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 BPJS UMUM
KETERANGAN 0 54
NAMA PASIEN
JUMLAH
Ranitidin 150 mg 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
+Belerang Endap 4%)

Tablet Tambah Darah (Besi II
0
Sulfat) tab.300mg
ZINC tablet 20 mg 0
Zircum KID sirup 0
Tenofovir 300+Lamivudin
0
300+Efavien 600 Dewasa
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN

Alat Suntik 10 ml
Alopurinol tablet
Alpara
Amlodipin 10 mg
Asam tranexamat injeksi 100mg/ml
AsamTraneksamat HCL tablet 500mg
Betametason krim
Betametason N crem
Bisakodil Supp 10mg
Cyprofloxacin kapsul 500 mg
Clobazam 10 mg
Clozapin 25 mg
Daryan Tulle :Flamisetin Sulfat 10 x 10

cm
Decullin tablet 30mg
Deksametason Injeksi 5mg/ml
Diethylcarbamazine
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
Dulcolax supp Adult 10 mg / Bisakadil
Epinefrina HCL/Bitart injeksi 0.1% - l
ml
Farmoten 12,5 mg
Feeding tube No. 10
Feeding tube No. 16
Feeding tube No. 5
Feeding tube No. 8
Fenobarbital Injeksi 50mg/ml-2ml
Fenobarbital tablet 30 mg
Fenoksimetil Penisilina tablet 500 mg
Fitomenadion injeksi 10mg/ml
Fitomenadion injeksi 2 mg/ml
Fluoksetin 10 mg
Fluconazole 150 mg

Glibenklamida tablet 5 mg
Glimepiride 1 mg
Glimepiride 2 mg
Gliseril Guayakolat tablet 100 mg
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
Gliserin 1 liter
Gliserin 100 ml
Glukosa infus 0,225% - 500 ml
Glukosa lar. infus 10% steril
Griseofulvin tablet 125mg
Griseofulvin tablet 500 mg

Haloperidol tablet 0.5 mg
Haloperidol tablet 2 mg
Halopuridol tablet 5 mg
Haldol Decanoat 50 mg / ml inj
Haloperidol / lodomer Drops 15ml
Hidrogen Peroksida / H2O2
Hidroklortiazida tab 25 mg
Kalsium Laktat tablet 500mg.
Ketokonazol tablet
Kotrimoksazol sirup
Meylon injeksi
Mineral mix
Mummifying pasta
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN

BYCLIN
Nasaflam 100 mg
Neo Kaominal sirup
Neurobat injeksi

OBAT KUSTA M B anak
OBAT KUSTA P B anak
Obat Malaria tablet

Obyek Glass
Omeprazol kapsul
Paracetamol Drop
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN

Retinol kap. lunak 200.000 IU
Salbutamol 2 mg
Salbutamol 4 mg
+Belerang Endap 4%)
Spashi - Injeksi
Spasminal tablet
tab.300mg
ZINC tablet 20 mg
Zircum KID sirup
Tenofovir 300+Lamivudin 300+Efavien
600 Dewasa
MYCONAZOLE SK
ALKAZYME SAKSET
ALKACIDE
ACETYL CYSTEIN
63 64 BPJS UMUM
KETERANGAN 0 64
NAMA PASIEN
JUMLAH
Alat Suntik 10 ml 0
Alopurinol tablet 0
Alpara 0

Amlodipin 10 mg 0
Betametason krim 0

Clobazam 10 mg 0
Clozapin 25 mg 0

0
cm
Decullin tablet 30mg 0


63 64 BPJS UMUM
KETERANGAN 0 64
NAMA PASIEN
JUMLAH

0
ml
Etanol 70% - 1000 ml 0

Farmoten 12,5 mg 0

Fluoksetin 10 mg 0


Glimepiride 1 mg 0
Glimepiride 2 mg 0
Gliseril Guayakolat tablet 100 mg 0

63 64 BPJS UMUM
KETERANGAN 0 64
NAMA PASIEN
JUMLAH
Gliserin 1 liter 0
Gliserin 100 ml 0
Glukosa infus 0,225% - 500 ml 0
Glukosa lar. infus 10% steril 0
Griseofulvin tablet 125mg 0
Griseofulvin tablet 500 mg 0
Haloperidol tablet 0.5 mg 0

Haloperidol tablet 2 mg 0
Halopuridol tablet 5 mg 0
Haldol Decanoat 50 mg / ml inj 0
Haloperidol / lodomer Drops 15ml 0
Hidrogen Peroksida / H2O2 0
Hidroklortiazida tab 25 mg 0


Meylon injeksi 0
Mineral mix 0
Mummifying pasta 0
63 64 BPJS UMUM
KETERANGAN 0 64
NAMA PASIEN
JUMLAH
0
BYCLIN
Nasaflam 100 mg 0

Neurobat injeksi 0


Obyek Glass 0

Omeprazol kapsul 0
Paracetamol Drop 0
63 64 BPJS UMUM
KETERANGAN 0 64
NAMA PASIEN
JUMLAH
Retinol kap. lunak 200.000 IU 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
+Belerang Endap 4%)
Spashi - Injeksi 0
Spasminal tablet 0

0
tab.300mg
ZINC tablet 20 mg 0
Zircum KID sirup 0

0
600 Dewasa
MYCONAZOLE SK 0
ALKAZYME SAKSET 0
ALKACIDE 0
ACETYL CYSTEIN 0
0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 BPJS UMUM
KETERANGAN 0 42
JUMLAH
PASIEN
NAMA

Acyclovir krim 0
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Amlodipin 10 mg 0
Betametason krim 0
Clobazam 10 mg 0
Clozapin 25 mg 0
Daryan Tulle :Flamisetin Sulfat 10
0
x 10 cm
Glimepiride 1 mg 0
Glimepiride 2 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 BPJS UMUM
KETERANGAN 0 42
JUMLAH
PASIEN
NAMA

Lisol - 1000 ml 0
Ranitidin 150 mg 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
+Belerang Endap 4%)
Spasminal tablet 0

0
Sulfat) tab.300mg
Ventolin Nebules /Salbutamol
0
Cairan 2,5 mg
Voluven - Koloid HES BM 130.000
0
Lar inf 0,6 %
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 BPJS UMUM
KETERANGAN 0 53
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alopurinol tablet 0
Amlodipin 10 mg 0
Betametason krim 0

Glimepiride 1 mg 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 BPJS UMUM
KETERANGAN 0 53
NAMA PASIEN
JUMLAH
Piroxicam 20 mg 0
PM-ASI Biskuit 0
PMT Untuk BUMIL 0
PMT-AS biskuit 0
Prokaina Pen. G injeksi 3 juta IU 0
Propanolol HCL tablet 10 mg 0
Propiltiourasil tablet 100 mg 0
Ranitidin 150 mg 0
Ranitidin 50 mg / 2 ml Inj 0
RDT Malaria 0
Renadinac 25 mg 0
Ringer Asetat infus - 500ml 0
Ringer Laktat + Glucose 5% infus-500ml 0
Ringer Laktat Larutan infus - 500 ml 0
Risperidone 2 mg 0
Safe Glove Exam L 0
Safe Glove Exam M 0
Safe Glove Exam S 0
Safety box 2,5 LITER 0
Sakaneuron tablet 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
Spasminal tablet 0
ZINC tablet 20 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alat Suntik 10 ml 0
Alopurinol tablet 0
Amlodipin 10 mg 0
Antibakteri DOEN (Basitrasin + Polimiksin) 0
Antifungi DOEN (As Benzoat 3%+As Salisilat 6%) 0
Antimigren DOEN (Ergotamina Trt + Kofeina) 0
Betametason krim 0
Clobazam 10 mg 0
Clozapin 25 mg 0
Daryan Tulle :Flamisetin Sulfat 10 x 10 cm 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
Glimepiride 1 mg 0
Glimepiride 2 mg 0
Gliserin 1 liter 0
Gliserin 100 ml 0
Kasa Hidrofil 16x16 0
Kasa kompres steril 40cm/40cm 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
Kasa pembalut 2 m x 80 cm 0
Kasa Pembalut 4x10 cm 0
Kasa pembalut hidrofil 4mx 3cm 0
Kasa pembalut hidrofil 4mx15cm 0
Loratadin 0
Lytacur 60 ml 0
Levotiroksin tab 100mcg 0
Lexavit Kaplet 0
Magnesium Sulfat injeksi 20% 0
Maltodextrin tablet / TABURIA 0
Masker disposable 0
Masker Oksigen Dewasa 0
Meylon injeksi 0
Mineral mix 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
Mummifying pasta 0
Na ClO 5.,25 % dan CaOCl212 / BYCLIN 0
Nasaflam 100 mg 0
Neurobat injeksi 0
Salbutamol 4 mg 0
Salep 2-4 DOEN (As.Salisilat 2%+Belerang Endap 4%) 0
Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
Temporary Stopping Fletcher 0
Teosal tablet 0
Tetrasiklina HCl kapsul 500 mg 0
Thiampenicol Sirup 0
Transfusion set 0
Trikresol Formalin (Forinokresol) cairan - 10 ml 0
Umbilical Cord 0
Underpad 0
Urine bag 0
Uriscan Gen 11 / 10 Parameter 0
Uriscan Glucose 1 0
Uriscan GP2 for Reduksi + Albumin 0
USG Gel 250 ml 0
USG Gel 5 liter 0
Vaselin Alba 0
Ventolin / Salbutamol Inhaler 0,5 % 0
Ventolin Nebules /Salbutamol Cairan 2,5 mg 0
ZINC tablet 20 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
Zircum KID sirup 0
Nevirapine ( NVP ) 200mg 0
Zidofudine ( ZDV ) 300mg + Lamivudine ( 3TC ) 150mg 0
Tenofovir 300+Lamivudin 300+Efavien 600 Dewasa 0
ACETYL CYSTEIN 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
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
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
OBAT JKN 0
VITAMIN C 250 MG 0
METRONIDAZOL INFUS 5 MG/ML 0
GENTAMICIN INJEKSI 0
TABLET TAMBAH DARAH 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
PIRACETAM INJEKSI 0
HIOSINA BUTYL BROMIDA INJEKSI 0
BIOCOMBIN INJEKSI 0
KALSIUM LAKTAT TABLET 0
BETADINE ANTISEPTIK SOLUTION 0
ONDANCETRON INJEKSI 0
0
SAFE GLOVE SURGICAL 7 0
SAFE GLOVE SURGICAL 7,5 0
SAFE GLOVES EXAM S 0
SAFE GLOVES EXAM M 0
SAFE GLOVES EXAM L 0
MASKER N95 ONEMED 8810 0
SURGICAL MASK 3 PLY PLUS EL 0
OBJECT GLASS 0
COVER GLASS 0
ALKOHOL SWAB 0
ASEPTIC GEL 0
SABUN ANTI BAKTERI 0
BLOOD LANCET 0
ALKOHOL 70% 0
INFUSET ANAK 0
INFUSET DEWASA 0
MY JELLY 0
KAPAS PEMBALUT 0
KASSA STERIL 16*16 0
FOLLEY CATETER NO :16 0
FOOLEY CATETER NO :18 0
MAXI FLOW ANAK 0
MAXI FLOW BAYI 0
MAXI FLOW DEWASA 0
MASKER NEBULIZER ANAK 0
MASKER NEBULIZER DEWASA 0
STOMATCH TUBE FR 16 0
GLUCO PROTEIN TES 0
SPUILT 1 CC STERA 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BPJS UMUM
KETERANGAN 0 35
NAMA PASIEN
JUMLAH
SPUILT 5 CC STERA 0
SPUILT 10 CC STERA 0
SOFT PAD 60*90 0
SURGICAL BLADE BISS MESS 0
INDOREAGEN HCL 0,1 N 0
CHROMIC CAT GUT 3/0 0
KASSA PEMBALUT 4*5 M 0
SPUILT 3 CC STERA 0
AQUAJEL STERIL 5 GRAM 0
JELCO 18 G 0
JELCO 20 G 0
JELCO 22 G 0
JELCO 24 G 0
FOOLEY 2 WAY 18 0
FOLLEY 2 WAY 16 0
SUCTION CATETER 10 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 BPJS UMUM
KETERANGAN 0 41
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
Betametason krim 0
Clobazam 10 mg 0
Clozapin 25 mg 0
Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 BPJS UMUM
KETERANGAN 0 41
NAMA PASIEN
JUMLAH
Fluoksetin 10 mg 0
Glimepiride 1 mg 0
Glimepiride 2 mg 0
Gliserin 1 liter 0
Gliserin 100 ml 0
Isoniazid 100 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 BPJS UMUM
KETERANGAN 0 41
NAMA PASIEN
JUMLAH
Lisol - 1000 ml 0
Meylon injeksi 0
Mineral mix 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 BPJS UMUM
KETERANGAN 0 41
NAMA PASIEN
JUMLAH
Mummifying pasta 0
Nasaflam 100 mg 0
Neurobat injeksi 0
Obyek Glass 0
Omeprazol kapsul 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 BPJS UMUM
KETERANGAN 0 41
NAMA PASIEN
JUMLAH
Paracetamol Drop 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
Salep 2-4 DOEN (As.Salisilat 2%+Belerang Endap 4%) 0
Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0
ZINC tablet 20 mg 0
Zircum KID sirup 0
TANGGAL:12 JULI 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
KETERANGAN
NAMA PASIEN
Acon Stik for Plano Test

Acyclovir krim
Alat Suntik 10 ml
Alkohol 95 %
Alkohol Swab
Alopurinol tablet
Alpara
Amlodipin 10 mg
Aseptic Gel + Disp 500 ml
Asetosal tablet 100 mg
Attapulgit 600 mg
Attapulgit 630 mg
Atropina Sulfat injeksi
Autodisposable Syringe 0,05 ml
(Soloshot)
Autodisposable Syringe 5 ml (Soloshot)
Azitromicin 250 mg tab
Bahan tumpatan sementara/Caviton

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
KETERANGAN
NAMA PASIEN
Becefort tablet
Benzatin Bensil Pen.inj 2,4 juta IU
Betahistin Mesilat 6 mg
Betametason krim
Betametason N crem
Bisakodil Supp 10mg
Cefixime 100mg
Diethylcarbamazine
Epinefrina HCL/Bitart injeksi 0.1% - l ml

Gentamycin injeksi 80 mg/2 ml
Gentamycin salep kulit
Gentamycin salep mata

Gentamycin tetes mata
Gentian violet larutan 1%
Glass Ionomer Cement
Glimepiride 1 mg
Glimepiride 2 mg
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
KETERANGAN
NAMA PASIEN
Imipramine 25 mg
Infusion set anak
Infusion set dewasa
IV Catether No.18
IV Catether No.20
IV Catether No.22
IV Catether No.24
Iodina Test
Isoniazid 100 mg
Isoniazid 300 mg
Kalsium Hidroksida pasta
Ketokonazol tablet

Kloramfenikol tetes telinga 3%
Klorpromazina HCL inj 25 mg/ml-1ml
Klorpromazina HCL tab salut 100 mg
Kodeina tablet. 10mg
Kotrimoksazol sirup
Kuinina Sulfat tablet
Kombipak Kategori 1
Lanzoprazol kapsul 30 mg
Laxadin sirup 60 ml
Leukoplast Hospital 7.50 cm x 4.5 m

Levofloksasin tablet 500 mg
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
KETERANGAN
NAMA PASIEN
Lidocain 2% injeksi
Lidokaina Comp. Injeksi 2%
Lisol - 1000 ml
Loratadin
Lytacur 60 ml
Levotiroksin tab 100mcg
Lexavit Kaplet
Magnesium Sulfat injeksi 20%

Maltodextrin tablet / TABURIA
Masker disposable
Masker Oksigen Dewasa
Masker Surgical ear loop'50
Masker Surgical Plus 3 Ply Plus Earloop
Masker Surgical tie on'50
Masker Disposable (N95)
Mebendazol sirup 100 mg/ 5 ml
Mebendazol tablet 100 mg
Meloksikam tablet 15 mg
Meloksikam tablet 7,5 mg
Metamizole / Norages injeksi 500mg
Metaneuron tablet
Paracetamol Drop
Salbutamol 2 mg
Salbutamol 4 mg
+Belerang Endap
Salisil Bedak 2% -4%)
50 gram
Spasminal tablet
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
KETERANGAN
NAMA PASIEN
tab.300mg
ZINC tablet 20 mg
Zircum KID sirup
OBAT JKN
VITAMIN C 250 MG
METRONIDAZOL INFUS 5 MG/ML
GENTAMICIN INJEKSI
TABLET TAMBAH DARAH
PIRACETAM INJEKSI
HIOSINA BUTYL BROMIDA INJEKSI
BIOCOMBIN INJEKSI
KALSIUM LAKTAT TABLET
BETADINE ANTISEPTIK SOLUTION
ONDANCETRON INJEKSI
SAFE GLOVE SURGICAL 7

SAFE GLOVE SURGICAL 7,5
SAFE GLOVES EXAM S
SAFE GLOVES EXAM M
SAFE GLOVES EXAM L
MASKER N95 ONEMED 8810
SURGICAL MASK 3 PLY PLUS EL
OBJECT GLASS
COVER GLASS
ALKOHOL SWAB
ASEPTIC GEL
SABUN ANTI BAKTERI
BLOOD LANCET
ALKOHOL 70%
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
KETERANGAN
NAMA PASIEN
INFUSET ANAK
INFUSET DEWASA
MY JELLY
KAPAS PEMBALUT
KASSA STERIL 16*16
FOLLEY CATETER NO :16
FOOLEY CATETER NO :18
MAXI FLOW ANAK
MAXI FLOW BAYI
MAXI FLOW DEWASA
MASKER NEBULIZER ANAK
MASKER NEBULIZER DEWASA
STOMATCH TUBE FR 16
STOMATCH TUBE FR 18
GLUCO PROTEIN TES
SPUILT 1 CC STERA
SPUILT 5 CC STERA
SPUILT 10 CC STERA
SOFT PAD 60*90
SURGICAL BLADE BISS MESS
INDOREAGEN HCL 0,1 N
CHROMIC CAT GUT 3/0
KASSA PEMBALUT 4*5 M
SPUILT 3 CC STERA
AQUAJEL STERIL 5 GRAM
JELCO 18 G
JELCO 20 G
JELCO 22 G
JELCO 24 G
FOOLEY 2 WAY 18
FOLLEY 2 WAY 16
SUCTION CATETER 10
SUCTION CATETER 12
NO 62 63 64 65 66 67 68 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Alpara 0

Amlodipin 10 mg 0
Attapulgit 600 mg 0
Attapulgit 630 mg 0
0
(Soloshot)

NO 62 63 64 65 66 67 68 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Becefort tablet 0

Betametason krim 0

Cefixime 100mg 0


Glimepiride 1 mg 0
Glimepiride 2 mg 0

NO 62 63 64 65 66 67 68 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Imipramine 25 mg 0
Infusion set anak 0
Infusion set dewasa 0
IV Catether No.18 0
IV Catether No.20 0
IV Catether No.22 0
IV Catether No.24 0
Iodina Test 0
Isoniazid 100 mg 0
Isoniazid 300 mg 0




NO 62 63 64 65 66 67 68 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Lisol - 1000 ml 0
Loratadin 0
Lytacur 60 ml 0
Lexavit Kaplet 0
Masker disposable 0
Masker Surgical ear loop'50 0
Masker Surgical Plus 3 Ply Plus Earloop 0
Masker Surgical tie on'50 0

Masker Disposable (N95) 0
Mebendazol sirup 100 mg/ 5 ml 0
Mebendazol tablet 100 mg 0
Meloksikam tablet 15 mg 0
Meloksikam tablet 7,5 mg 0
Metamizole / Norages injeksi 500mg 0
Metaneuron tablet 0
Paracetamol Drop 0

Salbutamol 2 mg 0
Salbutamol 4 mg 0
Salep 2-4 DOEN (As.Salisilat 2% 0
+Belerang Endap
Salisil Bedak 2% -4%)
50 gram 0
Spasminal tablet 0

NO 62 63 64 65 66 67 68 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Tablet Tambah Darah (Besi II Sulfat) 0
tab.300mg
ZINC tablet 20 mg 0
Zircum KID sirup 0
OBAT JKN
VITAMIN C 250 MG
GENTAMICIN INJEKSI
TABLET TAMBAH DARAH
PIRACETAM INJEKSI
BIOCOMBIN INJEKSI
ONDANCETRON INJEKSI

SAFE GLOVES EXAM S
SAFE GLOVES EXAM M
SAFE GLOVES EXAM L
OBJECT GLASS
COVER GLASS
ALKOHOL SWAB
ASEPTIC GEL
SABUN ANTI BAKTERI
BLOOD LANCET
ALKOHOL 70%
NO 62 63 64 65 66 67 68 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
INFUSET ANAK
INFUSET DEWASA
MY JELLY
KAPAS PEMBALUT
KASSA STERIL 16*16
MAXI FLOW ANAK
MAXI FLOW BAYI
MAXI FLOW DEWASA
STOMATCH TUBE FR 16
STOMATCH TUBE FR 18
GLUCO PROTEIN TES
SPUILT 1 CC STERA
SPUILT 5 CC STERA
SPUILT 10 CC STERA
SOFT PAD 60*90
CHROMIC CAT GUT 3/0
SPUILT 3 CC STERA
JELCO 18 G
JELCO 20 G
JELCO 22 G
JELCO 24 G
FOOLEY 2 WAY 18
FOLLEY 2 WAY 16
SUCTION CATETER 10
SUCTION CATETER 12
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63
KETERANGAN
NAMA PASIEN

Acyclovir krim
Alat Suntik 10 ml
Alkohol 95 %
Alkohol Swab
Alopurinol tablet
Amlodipin 10 mg
Amoksilin kapsul - 250 mg
Antibakteri DOEN (Basitrasin + Polimiksin)
Antifungi DOEN (As Benzoat 3%+As Salisilat 6%)
Betametason krim
Betametason N crem
Bisakodil Supp 10mg
Bist Mess No.24
Blood Lancet
Bonding Liq
Bunofa 400
Calcium Gluconas infus
Cefixime 100mg
Clobazam 10 mg
Clozapin 25 mg
Daryan Tulle :Flamisetin Sulfat 10 x 10 cm
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63
KETERANGAN
NAMA PASIEN

Farmoten 12,5 mg
Feeding tube No. 10
Feeding tube No. 16
Feeding tube No. 5
Feeding tube No. 8
Fluoksetin 10 mg
Fluconazole 150 mg
Gentamycin tetes mata
Gentian violet larutan 1%
Glass Ionomer Cement
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63
KETERANGAN
NAMA PASIEN
Glimepiride 1 mg
Glimepiride 2 mg
Kloramfenikol tetes telinga 3%
Klorpromazina HCL inj 25 mg/ml-1ml
Kodeina tablet. 10mg
Kotrimoksazol sirup
Kuinina Sulfat tablet
Kombipak Kategori 1
Lanzoprazol kapsul 30 mg
Laxadin sirup 60 ml
Omeprazol kapsul
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63
KETERANGAN
NAMA PASIEN

Paracetamol Drop
Prokaina Pen. G injeksi 3 juta IU
Propanolol HCL tablet 10 mg
Propanolol HCL tablet 40 mg
Propiltiourasil tablet 100 mg
Ranitidin 150 mg
Ranitidin 50 mg / 2 ml Inj
RDT Malaria
Renadinac 25 mg
Ringer Asetat infus - 500ml
Ringer Laktat + Glucose 5% infus-500ml
Ringer Laktat Larutan infus - 500 ml
Risperidone 2 mg
Safe Glove Exam L
Safe Glove Exam M
Safe Glove Exam S
Safety box 2,5 LITER
Sakaneuron tablet
Salbutamol 2 mg
Salbutamol 4 mg
Salep 2-4 DOEN (As.Salisilat 2%+Belerang Endap 4%)
Sarung Tangan Obgyn ( STERIL )
Semen Seng Fosfat
Semillas Non Woven 5x500cm
Serum Anti Bisa Ular injeksi (ABU I)
Serum Anti Dipteri injeksi 20.000 IU
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63
KETERANGAN
NAMA PASIEN
Serum Kontrol
Spashi - Injeksi
Spasminal tablet
Tablet Tambah Darah (Besi II Sulfat) tab.300mg
ZINC tablet 20 mg
Zircum KID sirup
NO BPJS UMUM
KETERANGAN 0 63
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Amlodipin 10 mg 0
Antibakteri DOEN (Basitrasin + Polimiksin)
0
Antifungi DOEN (As Benzoat 3%+As Salisilat
0 6%)
Betametason krim 0
Bist Mess No.24 0
Blood Lancet 0
Bonding Liq 0
Bunofa 400 0
Cefixime 100mg 0
Clobazam 10 mg 0
Clozapin 25 mg 0
Daryan Tulle :Flamisetin Sulfat 10 x 100cm
NO BPJS UMUM
KETERANGAN 0 63
NAMA PASIEN
JUMLAH
Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0
Fluoksetin 10 mg 0
Fluoride Sediaan Topical/Clinpro White0
NO BPJS UMUM
KETERANGAN 0 63
NAMA PASIEN
JUMLAH
Glimepiride 1 mg 0
Glimepiride 2 mg 0
Omeprazol kapsul 0
NO BPJS UMUM
KETERANGAN 0 63
NAMA PASIEN
JUMLAH
Paracetamol Drop 0
Ranitidin 150 mg 0
RDT Malaria 0
Renadinac 25 mg 0
Ringer Laktat + Glucose 5% infus-500ml
0
Risperidone 2 mg 0
Safe Glove Exam L 0
Safe Glove Exam M 0
Safe Glove Exam S 0
Sakaneuron tablet 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
Salep 2-4 DOEN (As.Salisilat 2%+Belerang
0 Endap 4%)
Semen Seng Fosfat 0
NO BPJS UMUM
KETERANGAN 0 63
NAMA PASIEN
JUMLAH
Serum Kontrol 0
Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0
Tablet Tambah Darah (Besi II Sulfat) tab.300mg
0
ZINC tablet 20 mg 0
Zircum KID sirup 0
TANGGAL:14 Agustus 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 BPJS UMUM
KETERANGAN 0 71
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0

Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 BPJS UMUM
KETERANGAN 0 71
NAMA PASIEN
JUMLAH
Fluoksetin 10 mg 0
Glimepiride 1 mg 0
Glimepiride 2 mg 0

Semen Seng Fosfat 0

Serum Kontrol 0
Silk no 2/0, 24x13x60 cm 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 BPJS UMUM
KETERANGAN 0 71
NAMA PASIEN
JUMLAH
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0

ZINC tablet 20 mg 0
TANGGAL:15 APRIL 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Amlodipin 10 mg 0
0
Polimiksin)
0
+As SalisilatDOEN
Antimigren 6%) (Ergotamina
0
Trt + Kofeina)

Attapulgit 630 mg 0
Betametason krim 0
Glimepiride 1 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Glimepiride 2 mg 0
Gliserin 1 liter 0
Gliserin 100 ml 0

Isoniazid 100 mg 0
Isoniazid 300 mg 0
Kapas pembalut abs 250 gram 0
Karbamazepin tablet 200 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Loratadin 0
Paracetamol Drop 0
Ranitidin 150 mg 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
+Belerang Endap 4%)
Semen Seng Fosfat 0
Serum Kontrol 0

Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Spasminal tablet 0
Tablet Tambah Darah 0
Teosal tablet 0
NO UMUM
KETERANGAN 62
NAMA PASIEN

Amlodipin 10 mg
Amoksilin Forte Sirup Kering
Polimiksin)
+As SalisilatDOEN
Antimigren 6%) (Ergotamina
Trt + Kofeina)
Antrain injeksi 2ml /5
Air utk Irigra Lar Infus 1000 ml

Aquagel Sterile Jely 82 gr
Attapulgit 630 mg
Betametason krim
Betametason N crem
Bisakodil Supp 10mg
Diethylcarbamazine
Fluconazole 150 mg
Glimepiride 1 mg
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 BPJS UMUM
KETERANGAN 0 59
NAMA PASIEN
TOTAL
Alopurinol tablet 0
NO 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 48 49 50 51 52 53 54 55 56 57 58 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
0
+As Salisilat 6%)
Glimepiride 2 mg 0
0
Sulfat) tab.300mg
Teosal tablet 0
ZINC tablet 20 mg 0
Zircum KID sirup 0
NO 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 48 49 50 51 52 53 54 55 56 57 58 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
OBAT JKN
VITAMIN C 250 MG 0
PIRACETAM INJEKSI 0
BIOCOMBIN INJEKSI 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 BPJS UMUM
KETERANGAN 0 46
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
Cover Glass 18 x 18 cm 0
Carpiaton 100 mg 0
Catgut Chrom 2/0 + jarum 0
Catgut Chrom 3/0 + jarum 0
Catgut Plain 2/0 + jarum 0
Catgut Plain 3/0 + jarum 0
Cefadroxil kapsul 500 mg 0
Cefixime 100mg 0
Cefotaxim injeksi 0
Cendo Lyteer 0
Chlorhexidine gluconat 4% 500 cc + dispenser / ONE SCROB 0
Cimetidin tablet 200 mg 0
Clorin / One Clean 0
Composit Light Curing A2 0
Composit Light Curing A3,5 0
Corsafen 500 mg 0
Cover Glass 0
Cresopen (obat gigi) 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 BPJS UMUM
KETERANGAN 0 46
NAMA PASIEN
JUMLAH
Glimepiride 1 mg 0
Meylon injeksi 0
Mineral mix 0
Mummifying pasta 0
Nasaflam 100 mg 0
Neurobat injeksi 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 BPJS UMUM
KETERANGAN 0 46
NAMA PASIEN
JUMLAH
Paracetamol Drop 0
Piroxicam 20 mg 0
Ranitidin 150 mg 0
RDT Malaria 0
Renadinac 25 mg 0
Risperidone 2 mg 0
Safe Glove Exam L 0
Safe Glove Exam M 0
Safe Glove Exam S 0
Sakaneuron tablet 0
Salbutamol 2 mg 0
Spasminal tablet 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 BPJS UMUM
KETERANGAN 0 46
NAMA PASIEN
JUMLAH
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 42 43 44 45 46 47 48 49 BPJS UMUM
KETERANGAN 0 0
JUMLAH
Acyclovir krim 0
Alat Suntik 10 ml 0
Alopurinol tablet 0
Amlodipin 10 mg 0


Piroxicam 20 mg 0
Risperidone 2 mg 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 42 43 44 45 46 47 48 49 BPJS UMUM
KETERANGAN 0 0
JUMLAH
0
tab.300mg
Zircum KID sirup 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN

Acyclovir krim
Alopurinol tablet
Amlodipin 10 mg
Ampisilina injeksi 1 gram
Antalgin injeksi 24 mg/ml-10ml
Antasi DOEN II Suspensi,Kombi
Clobazam 10 mg
Clozapin 25 mg

cm
Diethylcarbamazine
ml
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN

Farmoten 12,5 mg
Feeding tube No. 10
Feeding tube No. 16
Feeding tube No. 5
Feeding tube No. 8
Fluoksetin 10 mg
Fluconazole 150 mg

Glimepiride 1 mg
Glimepiride 2 mg
Gliseril Guayakolat tablet 100 mg
Gliserin 1 liter
Gliserin 100 ml
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN

Griseofulvin tablet 125mg
Griseofulvin tablet 500 mg

Haloperidol tablet 2 mg
Halopuridol tablet 5 mg
Haldol Decanoat 50 mg / ml inj
Haloperidol / lodomer Drops 15ml
Hidrogen Peroksida / H2O2
Hidroklortiazida tab 25 mg
Kotrimoksazol sirup
Meylon injeksi
Mineral mix
Mummifying pasta
BYCLIN
Nasaflam 100 mg
Neo Kaominal sirup
Neurobat injeksi
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN

OBAT KUSTA M B anak
OBAT KUSTA P B anak
Obat Malaria tablet

Obyek Glass
Omeprazol kapsul
Paracetamol Drop
Piroxicam 20 mg
Salbutamol 2 mg
Salbutamol 4 mg
+Belerang Endap 4%)
Spasminal tablet
tab.300mg
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
ACETYL CYSTEIN
OBAT JKN
VITAMIN C 250 MG
GENTAMICIN INJEKSI
TABLET TAMBAH DARAH
PIRACETAM INJEKSI
BIOCOMBIN INJEKSI
ONDANCETRON INJEKSI
BMHP JKN
SAFE GLOVES EXAM S
SAFE GLOVES EXAM M
SAFE GLOVES EXAM L
OBJECT GLASS
COVER GLASS
ALKOHOL SWAB
ASEPTIC GEL
SABUN ANTI BAKTERI
BLOOD LANCET
ALKOHOL 70%
INFUSET ANAK
INFUSET DEWASA
MY JELLY
KAPAS PEMBALUT
KASSA STERIL 16*16
MAXI FLOW ANAK
MAXI FLOW BAYI
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
MAXI FLOW DEWASA

STOMATCH TUBE FR 16
STOMATCH TUBE FR 18
GLUCO PROTEIN TES
SPUILT 1 CC STERA
SPUILT 5 CC STERA
SPUILT 10 CC STERA
SOFT PAD 60*90
CHROMIC CAT GUT 3/0
SPUILT 3 CC STERA
JELCO 18 G
JELCO 20 G
JELCO 22 G
JELCO 24 G
FOOLEY 2 WAY 18
FOLLEY 2 WAY 16
SUCTION CATETER 10
SUCTION CATETER 12
0
0
0
0
0
0
0
0
0
0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
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
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
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
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alopurinol tablet 0
Amlodipin 10 mg 0
Ampisilina injeksi 1 gram 0
Antalgin injeksi 24 mg/ml-10ml 0
Clobazam 10 mg 0
Clozapin 25 mg 0
0
cm
0
ml
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0
Fluoksetin 10 mg 0

Glimepiride 1 mg 0
Glimepiride 2 mg 0
Gliserin 1 liter 0
Gliserin 100 ml 0
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH

Meylon injeksi 0
Mineral mix 0
Mummifying pasta 0
0
BYCLIN
Nasaflam 100 mg 0
Neurobat injeksi 0
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH

Obyek Glass 0
Omeprazol kapsul 0

Paracetamol Drop 0
Piroxicam 20 mg 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
+Belerang Endap 4%)
Spasminal tablet 0
0
tab.300mg
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
ACETYL CYSTEIN 0
0
OBAT JKN 0
VITAMIN C 250 MG 0
PIRACETAM INJEKSI 0
BIOCOMBIN INJEKSI 0
BMHP JKN 0
SAFE GLOVE SURGICAL 7,5 0
SAFE GLOVES EXAM S 0
SAFE GLOVES EXAM M 0
SAFE GLOVES EXAM L 0
MASKER N95 ONEMED 8810 0
SURGICAL MASK 3 PLY PLUS EL 0
OBJECT GLASS 0
COVER GLASS 0
ALKOHOL SWAB 0
ASEPTIC GEL 0
SABUN ANTI BAKTERI 0
BLOOD LANCET 0
ALKOHOL 70% 0
INFUSET ANAK 0
INFUSET DEWASA 0
MY JELLY 0
KAPAS PEMBALUT 0
KASSA STERIL 16*16 0
FOLLEY CATETER NO :16 0
FOOLEY CATETER NO :18 0
MAXI FLOW ANAK 0
MAXI FLOW BAYI 0
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
MAXI FLOW DEWASA 0
MASKER NEBULIZER ANAK 0
MASKER NEBULIZER DEWASA 0
GLUCO PROTEIN TES 0
SPUILT 1 CC STERA 0
SPUILT 5 CC STERA 0
SPUILT 10 CC STERA 0
SOFT PAD 60*90 0
SURGICAL BLADE BISS MESS 0
INDOREAGEN HCL 0,1 N 0
CHROMIC CAT GUT 3/0 0
SPUILT 3 CC STERA 0
JELCO 18 G 0
JELCO 20 G 0
JELCO 22 G 0
JELCO 24 G 0
FOOLEY 2 WAY 18 0
FOLLEY 2 WAY 16 0
0
0
0
0
0
0
0
0
0
0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 BPJS UMUM
KETERANGAN 0 56
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
Betametason krim 0
Clobazam 10 mg 0
Clozapin 25 mg 0
0
cm

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 BPJS UMUM
KETERANGAN 0 56
NAMA PASIEN
JUMLAH
Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0
Fluoksetin 10 mg 0

Glimepiride 1 mg 0
Glimepiride 2 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 BPJS UMUM
KETERANGAN 0 56
NAMA PASIEN
JUMLAH

Omeprazol kapsul 0

Paracetamol Drop 0
Petidina HCL injeksi 50 mg/ml-2ml 0
Pewarna Ziehl-Neesen / 1 set 0
Piracetam 800 mg tablet 0

Piracetam inj 1 gram/5ml 0
Pirantel Pamoat tablet 125 mg 0
Pirantel Susp 125mg / 5 ml 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 BPJS UMUM
KETERANGAN 0 56
NAMA PASIEN
JUMLAH
Ranitidin 150 mg 0
RDT Malaria 0
Renadinac 25 mg 0
Risperidone 2 mg 0
Safe Glove Exam L 0

Safe Glove Exam M 0
Safe Glove Exam S 0
Safety box 0
Sakaneuron tablet 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
+Belerang Endap 4%)
0
tab.300mg
ZINC tablet 20 mg 0
Zircum KID sirup 0
TANGGAL:22 JUNI 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
0
Polimiksin)
0
Salisilat 6%)
Attapulgit 630 mg 0
Betametason krim 0
Cefixime 100mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Glimepiride 1 mg 0
Glimepiride 2 mg 0

Isoniazid 100 mg 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Loratadin 0
Metaneuron tablet 0
Paracetamol Drop 0
Ranitidin 150 mg 0
Risperidone 2 mg 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
+Belerang Endap 4%)

0
tab.300mg
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Ventolin Nebules /Salbutamol Cairan 0

2,5 mg
ZINC tablet 20 mg 0
Zircum KID sirup 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 BPJS UMUM
KETERANGAN 0 57
NAMA PASIEN
JUMLAH
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Alpara 0
Amlodipin 10 mg 0
Betametason krim 0
Bist Mess No.24 0
Blood Lancet 0
Bonding Liq 0
Bunofa 400 0
Clobazam 10 mg 0
Clozapin 25 mg 0
0
cm
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 BPJS UMUM
KETERANGAN 0 57
NAMA PASIEN
JUMLAH

Glimepiride 1 mg 0
Glimepiride 2 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 BPJS UMUM
KETERANGAN 0 57
NAMA PASIEN
JUMLAH
0
Lisol - 1000 ml 0
Meylon injeksi 0
Mineral mix 0
Mummifying pasta 0
0
BYCLIN
Nasaflam 100 mg 0
Neurobat injeksi 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 BPJS UMUM
KETERANGAN 0 57
NAMA PASIEN
JUMLAH
Obyek Glass 0
Omeprazol kapsul 0

Paracetamol Drop 0
Piroxicam 20 mg 0
Salbutamol 2 mg 0

Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 BPJS UMUM
KETERANGAN 0 57
NAMA PASIEN
JUMLAH
0
tab.300mg
ZINC tablet 20 mg 0
Zircum KID sirup 0

Efavirenz (EFV) 600mg 0
Zidofudine ( ZDV ) 300mg + 0

Lamivudine ( 3TC ) 150mg
Tenofovir 300+Lamivudin 300+Efavien 0
600 Dewasa
0 0
MYCONAZOLE SK 0
ALKAZYME SAKSET 0
ALKACIDE 0
ACETYL CYSTEIN 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 BPJS UMUM
KETERANGAN 0 57
NAMA PASIEN
JUMLAH
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
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 BPJS UMUM
KETERANGAN 0 57
NAMA PASIEN
JUMLAH
0
0
0
0
0
0
0
0
OBAT JKN 0
VITAMIN C 250 MG 0
PIRACETAM INJEKSI 0
BIOCOMBIN INJEKSI 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 BPJS UMUM
KETERANGAN 0 42
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Amlodipin 10 mg 0
Clobazam 10 mg 0
Clozapin 25 mg 0
Daryan Tulle :Flamisetin Sulfat
0
10 x 10 cm
Glimepiride 1 mg 0
Glimepiride 2 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 BPJS UMUM
KETERANGAN 0 42
NAMA PASIEN
JUMLAH
ZINC tablet 20 mg 0
Zircum KID sirup 0
ALKACIDE 0
ACETYL CYSTEIN 0
0
OBAT JKN 0
VITAMIN C 250 MG 0
PIRACETAM INJEKSI 0
BIOCOMBIN INJEKSI 0
TANGGAL:25 AGUSTINA 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 BPJS UMUM
KETERANGAN 0 45
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
Polimiksin)
Salisilat 6%)DOEN (Ergotamina Trt +
Antimigren 0
Kofeina)

Betametason krim 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 BPJS UMUM
KETERANGAN 0 45
NAMA PASIEN
JUMLAH
Glimepiride 1 mg 0
Glimepiride 2 mg 0
0
60ml
Paracetamol Drop 0
Spashi - Injeksi 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 BPJS UMUM
KETERANGAN 0 45
NAMA PASIEN
JUMLAH
Spasminal tablet 0
0
tab.300mg
ZINC tablet 20 mg 0
Zircum KID sirup 0
MYCONAZOLE SK 0
ALKAZYME SAKSET 0
ALKACIDE 0
ACETYL CYSTEIN 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60BPJS
UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Alpara 0
Amlodipin 10 mg 0
Fluoksetin 10 mg 0
Glimepiride 1 mg 0
Glimepiride 2 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60BPJS
UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
0
60ml
Leukoplast Hospital 7.50 cm x 4.5 0

m
Lisol - 1000 ml 0
Loratadin 0
Lytacur 60 ml 0
Lexavit Kaplet 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60BPJS
UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH

Obyek Glass 0
Paracetamol Drop 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
+Belerang Endap 4%)
Semen Seng Fosfat 0
Serum Kontrol 0

Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60BPJS
UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
0
Sulfat) tab.300mg
Teosal tablet 0

Transfusion set 0

Trikresol Formalin (Forinokresol)
0
cairan - 10 ml
Umbilical Cord 0
Underpad 0
Urine bag 0
Uriscan Glucose 1 0
USG Gel 250 ml 0
USG Gel 5 liter 0
Vaselin Alba 0
Ventolin Nebules /Salbutamol 0

Cairan 2,5 mg
Zircum KID sirup 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN

Alopurinol tablet
Amlodipin 10 mg
Polimiksin)
Fluconazole 150 mg
Isoniazid 100 mg
Ketokonazol tablet
Salbutamol 2 mg
ZINC tablet 20 mg
Zircum KID sirup

Zoralin
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
PROGRAM IMUNISASI
Pelarut BCG
Vaksin MR
Vaksin DPT Hb - Hib / PENTABIO
Vaksin Polio bOPV 10 Dosis
Vaksin DT
Vaksin HB Unijeck
Vaksin Polio IPV 5 Dosis
Vaksin Td
vaksin TT / V. INFLUENZA
Vaksin Meningitis
VAKSIN BCG
Pen marker
PROGRAM IMS
Alcohol Swab
Cotton Applicators Sterile
Cover Glass
Hand Gloves
Immersion Oil
Kertas PH 3,8 - 4,2
KOH 10%
Methylated Spirit
Methylen Blue 0.3%
Nacl 0.9%
Object Glass
Reagen Sifilis RPR/kit (10ml untk 500 test)
Reagen Sifilis TPHA
Vaculab/Tabung darah plastic tutup merah
Xylol
Yellow dan Blue Tip
Reagen Rapid syphilis/Standar Diagnostic
Performa Test Strips/ Stik GDA ACCU
Safe-T Pro Uno
Focus TPHA
Total Hardness: 12-537 mg/ L CaCO3
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
Stip Glukosa Merk Easytouch

Stip Urid Acid Merk Easytouch
Stip Colesterol Merk Easytouch
Asam Cuka 25 %
Autocheck total Kolesterol 10 Strip
Spekulum Disposble
Cotton swab
Larutan Chlorine
Sputum Pot
Paket Alat Deteksi Resiko Kehamilan
Catridge TCM
Gluco Protein
Tube EDTA plh 13x75 3,0 blblce lav
Ultra Once Test Hamil
Widal Salmonella Thypi O Antigen A
Widal Salmonella Thypi O Antigen B
Widal Salmonella Thypi O Antigen C
Widal Salmonella Thypi O
Widal Salmonella Thypi H Antigen A
Widal Salmonella Thypi H Antigen B
Widal Salmonella Thypi H Antigen C
Widal Salmonella Thypi H
Control Positive Polyvalent
Control Negatif Polyvalent
HBsAg Strip Tes
HBsAb Strip Tes
Determine HIV
Rapid Syphilis
ICT Malaria
Golongan Darah Anti A
Golongan Darah Anti B
Golongan Darah Anti AB
Golongan Darah Anti D
Reagen Giemsa + Buffer Giemds
Stick Urine 10 PM
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
Strip Urine 11 PM
Strip Urine 3 PM
0
0
0
0
0
Pengecatan
Brilliant Cresyl Blue 1 %
Giemsa
Larutan Drabkin
Larutan Eosin 2 %
Larutan Turk
Oil Imersion
Pewarna Gram
Pewarna Rapid/ sediaan apus darah tepi/MDT
Pewarna Ziehl Nellsen
Xylol
PROGRAM HIV
Tes HIV I (Oncoprobe )
Tes HIV II ( Intech Triline ) )
Tes HIV III (Vikia )
Reagen I SD Bioline HIV 1/2
Reagen I Intec One Step Anti HIV Tri Line Tes Carrd
Reagen Penghitung CD 4
Reagen Penghitung CD 4 Control
Catridge TCM
Efavirenz (EFV) 600mg
Nevirapine ( NVP ) 200mg
Zidofudine ( ZDV ) 300mg +
600 Dewasa

Lamivudine 30mg+Nevirapine 50mg
( Triple FDC ) Anak
Zidofudine (ZDV ) 100 mg tablet
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
Tenofovir 300 mg tablet

Efavirenz (EFV) 200 mg
Tenofovir 300 mg + Emcitritabine 200 (FCT)
Abacavir (ABC) 300 mg
Lamivudine 150 mg tablet
Right Sign
Verorab Serum
NELATO CATHETER NO:12
CELEMEK
DUK 140*180 CM
DUK 50*60 CM
DUK 90*125 CM
DUK LUBANG BULAT 50*60 CM
JASS OPERASI WATER
SEPATU TERTUTUP
SEPREI KARET PREMIUM
TOPI TALI
WASH LAP 15*20
VACUNTAINER NA EDTA
SAFETY BOX 5 LITER
0
MYCONAZOLE SK
ACETYL CYSTEIN
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
KETERANGAN
NAMA PASIEN
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 75
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
Polimiksin)
Isoniazid 100 mg 0
Salbutamol 2 mg 0
ZINC tablet 20 mg 0
Zircum KID sirup 0
Zoralin 0
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 75
NAMA PASIEN
JUMLAH
PROGRAM IMUNISASI 0
Pelarut BCG 0
Vaksin MR 0
Vaksin DPT Hb - Hib / PENTABIO 0
Vaksin Polio bOPV 10 Dosis 0
Vaksin DT 0
Vaksin HB Unijeck 0
Vaksin Polio IPV 5 Dosis 0
Vaksin Td 0
vaksin TT / V. INFLUENZA 0
Vaksin Meningitis 0
VAKSIN BCG 0
Pen marker 0
PROGRAM IMS 0
Alcohol Swab 0
Cotton Applicators Sterile 0
Cover Glass 0
Hand Gloves 0
Immersion Oil 0
Kertas PH 3,8 - 4,2 0
KOH 10% 0
Methylated Spirit 0
Methylen Blue 0.3% 0

Nacl 0.9% 0
Object Glass 0
Reagen Sifilis RPR/kit (10ml untk 500 test) 0
Reagen Sifilis TPHA 0
Vaculab/Tabung darah plastic tutup merah 0
Xylol 0
Yellow dan Blue Tip 0
Reagen Rapid syphilis/Standar Diagnostic 0
Performa Test Strips/ Stik GDA ACCU 0
Safe-T Pro Uno 0
Focus TPHA 0
Total Hardness: 12-537 mg/ L CaCO3 0

NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 75
NAMA PASIEN
JUMLAH
Stip Glukosa Merk Easytouch 0
Stip Urid Acid Merk Easytouch 0
Stip Colesterol Merk Easytouch 0
Asam Cuka 25 % 0
Autocheck total Kolesterol 10 Strip 0

Spekulum Disposble 0
Cotton swab 0
Larutan Chlorine 0
Sputum Pot 0
Paket Alat Deteksi Resiko Kehamilan 0
Catridge TCM 0
Gluco Protein 0
Tube EDTA plh 13x75 3,0 blblce lav 0
Ultra Once Test Hamil 0
Widal Salmonella Thypi O Antigen A 0
Widal Salmonella Thypi O Antigen B 0
Widal Salmonella Thypi O Antigen C 0
Widal Salmonella Thypi O 0
Widal Salmonella Thypi H Antigen A 0
Widal Salmonella Thypi H Antigen B 0
Widal Salmonella Thypi H Antigen C 0
Widal Salmonella Thypi H 0
Control Positive Polyvalent 0
Control Negatif Polyvalent 0
HBsAg Strip Tes 0
HBsAb Strip Tes 0

Determine HIV 0
Rapid Syphilis 0
ICT Malaria 0
Golongan Darah Anti A 0
Golongan Darah Anti B 0
Golongan Darah Anti AB 0
Golongan Darah Anti D 0
Reagen Giemsa + Buffer Giemds 0
Stick Urine 10 PM 0
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 75
NAMA PASIEN
JUMLAH
Strip Urine 11 PM 0
Strip Urine 3 PM 0
0 0
0 0
0 0
0 0
0 0
Pengecatan 0
Brilliant Cresyl Blue 1 % 0
Giemsa 0
Larutan Drabkin 0
Larutan Eosin 2 % 0
Larutan Turk 0
Oil Imersion 0
Pewarna Gram 0
Pewarna Rapid/ sediaan apus darah tepi/MDT 0
Pewarna Ziehl Nellsen 0
Xylol 0
PROGRAM HIV 0
Tes HIV I (Oncoprobe ) 0
Tes HIV II ( Intech Triline ) ) 0
Tes HIV III (Vikia ) 0
Reagen I SD Bioline HIV 1/2 0
Reagen I Intec One Step Anti HIV Tri Line Tes Carrd 0
Reagen Penghitung CD 4 0
Reagen Penghitung CD 4 Control 0
Catridge TCM 0

Tenofovir 300+Lamivudin 300+Efavien 0
600 Dewasa

Lamivudine 30mg+Nevirapine 50mg 0
( Triple FDC ) Anak
Zidofudine (ZDV ) 100 mg tablet 0
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 75
NAMA PASIEN
JUMLAH
Tenofovir 300 mg tablet 0
Efavirenz (EFV) 200 mg 0
Tenofovir 300 mg + Emcitritabine 200 (FCT) 0
Abacavir (ABC) 300 mg 0
Lamivudine 150 mg tablet 0
Right Sign 0
Verorab Serum 0
NELATO CATHETER NO:12 0
CELEMEK 0
DUK 140*180 CM 0
DUK 50*60 CM 0
DUK 90*125 CM 0
DUK LUBANG BULAT 50*60 CM 0
JASS OPERASI WATER 0
SEPATU TERTUTUP 0
SEPREI KARET PREMIUM 0
TOPI TALI 0
WASH LAP 15*20 0
VACUNTAINER NA EDTA 0
SAFETY BOX 5 LITER 0
0 0
MYCONAZOLE SK 0
ACETYL CYSTEIN 0
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 BPJS UMUM
KETERANGAN 0 75
NAMA PASIEN
JUMLAH
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
KETERANGAN
NAMA PASIEN
Alopurinol tablet
Amlodipin 10 mg
Salisilat 6%)
Betametason krim
Farmoten 12,5 mg
Feeding tube No. 10
Feeding tube No. 16
Feeding tube No. 5
Feeding tube No. 8
Fluoksetin 10 mg
Fluconazole 150 mg
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
KETERANGAN
NAMA PASIEN
Ketokonazol tablet
Levofloksasin tablet 500 mg
Lidocain 2% injeksi
Salbutamol 2 mg
Endap 4%)
ACETYL CYSTEIN
NO BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
Salisilat 6%)
Betametason krim 0
Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0
Fluoksetin 10 mg 0
NO BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Salbutamol 2 mg 0
0
Endap 4%)
ACETYL CYSTEIN 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 40 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Alpara 0
Amlodipin 10 mg 0
Attapulgit 600 mg 0
Attapulgit 630 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 40 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Becefort tablet 0
Betametason krim 0
Bist Mess No.24 0
Blood Lancet 0
Bonding Liq 0
Bunofa 400 0
Clobazam 10 mg 0
Clozapin 25 mg 0

Demacolin tablet 0

Dermazin salep kulit 1% - 25gram /BioplaN 0
Dextral syrup 0
Dextrofen Sirup 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 40 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Fluoksetin 10 mg 0


Glimepiride 1 mg 0
Glimepiride 2 mg 0
Gliserin 1 liter 0
Gliserin 100 ml 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 40 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Imipramine 25 mg 0
Infusion set anak 0
Lisol - 1000 ml 0
Meylon injeksi 0
Mineral mix 0
Mummifying pasta 0
Nasaflam 100 mg 0
Neurobat injeksi 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 40 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH

Obyek Glass 0
Omeprazol kapsul 0

Paracetamol Drop 0
Piroxicam 20 mg 0
PM-ASI Biskuit 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 40 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
PMT Untuk BUMIL 0
PMT-AS biskuit 0
Ranitidin 150 mg 0
RDT Malaria 0
Renadinac 25 mg 0
Risperidone 2 mg 0
Safe Glove Exam L 0

Safe Glove Exam M 0
Safe Glove Exam S 0
Safety box 0
Sakaneuron tablet 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
0
Endap 4%)
Semen Seng Fosfat 0
Serum Kontrol 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 40 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH

Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0
0
tab.300mg
Teosal tablet 0

ZINC tablet 20 mg 0
Zircum KID sirup 0
MYCONAZOLE SK 0
ALKAZYME SAKSET 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 40 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
ALKACIDE 0
ACETYL CYSTEIN 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 BPJS UMUM
KETERANGAN 0 29
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Alpara 0
Amlodipin 10 mg 0
Attapulgit 600 mg 0
Attapulgit 630 mg 0
Betametason krim 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 BPJS UMUM
KETERANGAN 0 29
NAMA PASIEN
JUMLAH
Clobazam 10 mg 0
Clozapin 25 mg 0

Demacolin tablet 0

Dermazin salep kulit 1% - 25gram /BioplaN 0
Dextral syrup 0
Dextrofen Sirup 0
Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 BPJS UMUM
KETERANGAN 0 29
NAMA PASIEN
JUMLAH
Fluoksetin 10 mg 0

Glimepiride 1 mg 0
Glimepiride 2 mg 0
Isoniazid 100 mg 0
Isoniazid 300 mg 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 BPJS UMUM
KETERANGAN 0 29
NAMA PASIEN
JUMLAH

Lisol - 1000 ml 0
Paracetamol Drop 0
Salbutamol 4 mg 0
0
Endap 4%)
0
tab.300mg
ZINC tablet 20 mg 0
Zircum KID sirup 0
Zoralin 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 BPJS UMUM
KETERANGAN 0 29
NAMA PASIEN
JUMLAH
PROGRAM IMUNISASI 0
Pelarut BCG 0
Vaksin MR 0
Vaksin DT 0
Vaksin HB Unijeck 0
Vaksin Td 0
Vaksin Meningitis 0
VAKSIN BCG 0
Pen marker 0
PROGRAM IMS 0
Alcohol Swab 0
Cover Glass 0
Hand Gloves 0
Immersion Oil 0
Kertas PH 3,8 - 4,2 0
KOH 10% 0
Methylated Spirit 0
Nacl 0.9% 0
Object Glass 0
Xylol 0
Safe-T Pro Uno 0
Focus TPHA 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 BPJS UMUM
KETERANGAN 0 29
NAMA PASIEN
JUMLAH
Asam Cuka 25 % 0
Cotton swab 0
Larutan Chlorine 0
Sputum Pot 0
Catridge TCM 0
Gluco Protein 0
HBsAg Strip Tes 0
HBsAb Strip Tes 0

Determine HIV 0
Rapid Syphilis 0
ICT Malaria 0
Stick Urine 10 PM 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 BPJS UMUM
KETERANGAN 0 29
NAMA PASIEN
JUMLAH
Strip Urine 11 PM 0
Strip Urine 3 PM 0
0 0
0 0
0 0
0 0
0 0
Pengecatan 0
Giemsa 0
Larutan Drabkin 0
Larutan Eosin 2 % 0
Larutan Turk 0
Oil Imersion 0
Pewarna Gram 0
Pewarna Rapid/ sediaan apus darah tepi/MDT 0
Xylol 0
PROGRAM HIV 0
Catridge TCM 0
Zidofudine ( ZDV ) 60mg + Lamivudine 30mg+Nevirapine 50mg ( Triple FDC ) Anak 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 BPJS UMUM
KETERANGAN 0 29
NAMA PASIEN
JUMLAH
Right Sign 0
Verorab Serum 0
CELEMEK 0
DUK 140*180 CM 0
DUK 50*60 CM 0
DUK 90*125 CM 0
SEPATU TERTUTUP 0
TOPI TALI 0
WASH LAP 15*20 0
0 0
MYCONAZOLE SK 0
ALKAZYME SAKSET 0
ALKACIDE 0
ACETYL CYSTEIN 0
TANGGAL:31APRIL 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Acyclovir krim 0
0
Polimiksin)
Fluoksetin 10 mg 0
IV Catether No.20 0

Transfusion set 0

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Trikresol Formalin
0
(Forinokresol) cairan - 10 ml
Umbilical Cord 0
Underpad 0
Urine bag 0
Uriscan Glucose 1 0
USG Gel 250 ml 0
USG Gel 5 liter 0
Vaselin Alba 0

Cairan 2,5 mg
Wida D5 1/2 NS 0
Wing Needle bayi no.25 0
Yodium Povidon 10% - 30 ml 0
Yodium Povidon 1000 ml 0
ZINC tablet 20 mg 0
Zircum KID sirup 0
Zoralin 0
PROGRAM IMUNISASI 0
Pelarut BCG 0
Vaksin MR 0
Vaksin DT 0
Vaksin HB Unijeck 0
Vaksin Td 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
Vaksin Meningitis 0
VAKSIN BCG 0
Pen marker 0
PROGRAM IMS 0
Alcohol Swab 0
Cover Glass 0
Hand Gloves 0
Immersion Oil 0
Kertas PH 3,8 - 4,2 0
KOH 10% 0
Methylated Spirit 0
Object Glass 0
Determine HIV 0
Strip Urine 3 PM 0
0 0
Zidofudine ( ZDV ) 60mg + Lamivudine 30mg+Nevirapine 50mg ( Triple FDC ) Anak 0
Right Sign 0
Verorab Serum 0
CELEMEK 0
DUK 140*180 CM 0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
DUK 50*60 CM 0
DUK 90*125 CM 0
SEPATU TERTUTUP 0
TOPI TALI 0
WASH LAP 15*20 0
0 0
MYCONAZOLE SK 0
ALKAZYME SAKSET 0
ALKACIDE 0
ACETYL CYSTEIN 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 BPJS UMUM
KETERANGAN 0 0
NAMA PASIEN
JUMLAH
0
0
0
0
0
0
0
KAMAR BERSALIN/VK
JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 total
BPJS 0
UMUM 0
Alat Suntik 10 ml 0

Polimiksin)
Salisilat 6%)
Antimigren DOEN (Ergotamina Trt + 0
Kofeina)
Imipramine 25 mg 0
JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 total
BPJS 0
UMUM 0
Infusion set anak 0
IV Catether No.18 0
IV Catether No.20 0
IV Catether No.22 0
IV Catether No.24 0
Iodina Test 0
Isoniazid 100 mg 0
Isoniazid 300 mg 0

JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 total
BPJS 0
UMUM 0
0
Lisol - 1000 ml 0
Loratadin 0
Lytacur 60 ml 0

Lexavit Kaplet 0
Masker disposable 0
Metaneuron tablet 0
Metilergometrina injeksi 0,2 mg/ml -1 0

ml

JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 total
BPJS 0
UMUM 0
Meylon injeksi 0
Mineral mix 0
Mummifying pasta 0
Na ClO 5.,25 % dan CaOCl212 / 0

BYCLIN
Nasaflam 100 mg 0
Piroxicam 20 mg 0
PM-ASI Biskuit 0
PMT Untuk BUMIL 0
PMT-AS biskuit 0
Polikresulen ( Metakresolsulfonat ) - 0
10 ml
Ranitidin 150 mg 0
RDT Malaria 0
JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 total
BPJS 0
UMUM 0
Renadinac 25 mg 0
Tablet Tambah Darah (Besi II Sulfat) 0

tab.300mg
Umbilical Cord 0
Underpad 0
Urine bag 0
PUSLING
JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL
BPJS 0
UMUM 0
JUMLAH
PASIEN
NAMA

Bist Mess No.24 0
Blood Lancet 0
Bonding Liq 0
Bunofa 400 0
Clobazam 10 mg 0
Clozapin 25 mg 0
Daryan Tulle :Flamisetin Sulfat 10 x
0
10 cm

Glimepiride 1 mg 0
Glimepiride 2 mg 0
JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL
BPJS 0
UMUM 0
JUMLAH
PASIEN
NAMA

0
Lisol - 1000 ml 0
Loratadin 0
Lytacur 60 ml 0
Lexavit Kaplet 0
Masker disposable 0

JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL
BPJS 0
UMUM 0
JUMLAH
PASIEN
NAMA
Metaneuron tablet 0
Metilergometrina injeksi 0,2 mg/ml -1
0
ml
Meylon injeksi 0
Mineral mix 0
Mummifying pasta 0
0
BYCLIN
Nasaflam 100 mg 0
Neurobat injeksi 0

JULI 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL
BPJS 0
UMUM 0
JUMLAH
PASIEN
NAMA


Obyek Glass 0
Omeprazol kapsul 0

Paracetamol Drop 0
ZINC tablet 20 mg 0
Zircum KID sirup 0

P3K
AGUSTUS 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL
BPJS 0
UMUM 0
NAMA PASIEN
JUMLAH
Acyclovir krim 0
Alat Suntik 10 ml 0
Alkohol 95 % 0
Alkohol Swab 0
Alopurinol tablet 0
Alpara 0
Amlodipin 10 mg 0
Attapulgit 600 mg 0
Attapulgit 630 mg 0
AGUSTUS 2018
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL
BPJS 0
UMUM 0
NAMA PASIEN
JUMLAH
0
(Soloshot)
Autodisposable Syringe 5 ml
0
(Soloshot)

Becefort tablet 0
Betametason krim 0
Bist Mess No.24 0
Blood Lancet 0
Bonding Liq 0
Bunofa 400 0
BTPN
AGUSTUS 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH
Alopurinol tablet 0
Amlodipin 10 mg 0
Betametason krim 0
Demacolin tablet 0

0
/BioplaN
Dextral syrup 0
Dextrofen Sirup 0
AGUSTUS 2018
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 BPJS
KETERANGAN 0
NAMA PASIEN
JUMLAH

0
+Belerang Endap 4%)
ZINC tablet 20 mg 0
Zircum KID sirup 0

0
OBAT JKN 0
VITAMIN C 250 MG 0
PIRACETAM INJEKSI 0
BIOCOMBIN INJEKSI 0
AGUSTUS 2018
UGD FLOOR STOK
TANGGAL PENGGANTIAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
BPJS 0
UMUM 0
Alat Suntik 10 ml 0
Amlodipin 10 mg 0
Attapulgit 600 mg 0
Attapulgit 630 mg 0

0
(Soloshot)
Becefort tablet 0

Betametason krim 0

Bist Mess No.24 0
Blood Lancet 0
Bonding Liq 0
Bunofa 400 0
Demacolin tablet 0

0
/BioplaN
Dextral syrup 0
Dextrofen Sirup 0


Etanol 70% - 1000 ml 0
Farmoten 12,5 mg 0
UGD FLOOR STOK
BPJS 0
UMUM 0

Fluoksetin 10 mg 0



Imipramine 25 mg 0
Infusion set anak 0

IV Catether No.18 0
IV Catether No.20 0
IV Catether No.22 0
IV Catether No.24 0

Paracetamol Drop 0

Risperidone 2 mg 0
Safe Glove Exam L 0

Safe Glove Exam M 0
Safe Glove Exam S 0
Safety box 0
Sakaneuron tablet 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
UGD FLOOR STOK
BPJS 0
UMUM 0

0
+Belerang Endap 4%)

Semen Seng Fosfat 0
Serum Kontrol 0

Urine bag 0
ZINC tablet 20 mg 0
Zircum KID sirup 0

AGUSTUS 2018
UGD RAWAT INAP
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
TANGGAL
STATUS
NAMA PASIEN
Alat Suntik 10 ml
Alopurinol tablet
Amlodipin 10 mg
Attapulgit 600 mg
Attapulgit 630 mg
Autodisposable Syringe 0,5 ml (Soloshot)
Becefort tablet
Betametason krim
Betametason N crem
Bisakodil Supp 10mg
Bist Mess No.24
Blood Lancet
Bonding Liq
Bunofa 400
UGD RAWAT INAP
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
TANGGAL
STATUS
NAMA PASIEN
Cefotaxim injeksi
Ceftriaxone 1.Og inj Kering
Cendo Lyteer
Cetirizine Kapsul 10mg
Chlorhexidine gluconat 0,2% / ASEPTAN
Chlorhexidine gluconat 4% 500 cc + dispenser / ONE SCROB
Chlorhexidine gluconat 0,5 W/v 70 % / ASEPTAN
Cimetidin tablet 200 mg
Clorin / One Clean
Composit Light Curing A2
Composit Light Curing A3,5
Corsafen 500 mg
Cover Glass
Cresopen (obat gigi)
Glimepiride 2 mg
Infusion set anak
Infusion set dewasa
IV Catether No.18
IV Catether No.20
IV Catether No.22
IV Catether No.24
Iodina Test
UGD RAWAT INAP
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
TANGGAL
STATUS
NAMA PASIEN
Isoniazid 100 mg
Isoniazid 300 mg
Kotrimoksazol sirup
Lidocain 2% injeksi
Lisol - 1000 ml
Loratadin
Lytacur 60 ml
Lexavit Kaplet
Masker disposable
Metaneuron tablet
Metformin HCL tablet 850mg
Methylpredhisolon 8 mg
Metilergometrina injeksi 0,2 mg/ml -1 ml
Metilergometrina Maleat tablet
UGD RAWAT INAP
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
TANGGAL
STATUS
NAMA PASIEN
Metoclopramide 5 mg
Metoklopramid 10 mg
Metoklopramid Syrup 60 ml
Metronidazol 500mg infus
Omeprazol kapsul
Paracetamol Drop
Salbutamol 2 mg
Salbutamol 4 mg
Spashi - Injeksi
Spasminal tablet
UGD RAWAT INAP
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
TANGGAL
STATUS
NAMA PASIEN
Thiamphenicol 500 mg
Urine bag
Uriscan Gen 11 / 10 Parameter
Uriscan Glucose 1
Uriscan GP2 for Reduksi + Albumin
USG Gel 250 ml
USG Gel 5 liter
Vaselin Alba
Ventolin / Salbutamol Inhaler 0,5 %
Ventolin Nebules /Salbutamol Cairan 2,5 mg
Wida D5 1/2 NS
ZINC tablet 20 mg
Zircum KID sirup
ACETYL CYSTEIN
OBAT JKN
VITAMIN C 250 MG
GENTAMICIN INJEKSI
TABLET TAMBAH DARAH
PIRACETAM INJEKSI
BIOCOMBIN INJEKSI
ONDANCETRON INJEKSI
BMHP JKN
SPUILT 3 CC STERA
JELCO 18 G
JELCO 20 G
JELCO 22 G
JELCO 24 G
FOOLEY 2 WAY 18
FOLLEY 2 WAY 16
UGD RAWAT INAP
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
TANGGAL
STATUS
NAMA PASIEN
SUCTION CATETER 10
SUCTION CATETER 12
AGUSTUS 2018
UGD RAWAT INAP
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 101
TANGGAL
STATUS
NAMA PASIEN
Alat Suntik 10 ml
Alopurinol tablet
Amlodipin 10 mg
Attapulgit 600 mg
Attapulgit 630 mg
Becefort tablet
Betametason krim
Betametason N crem
Bisakodil Supp 10mg
Bist Mess No.24
Blood Lancet
Bonding Liq
Bunofa 400
UGD RAWAT INAP
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 101
TANGGAL
STATUS
NAMA PASIEN
Cefotaxim injeksi
Cendo Lyteer
Clorin / One Clean
Corsafen 500 mg
Cover Glass
Glimepiride 2 mg
Infusion set anak
Infusion set dewasa
IV Catether No.18
IV Catether No.20
IV Catether No.22
IV Catether No.24
Iodina Test
UGD RAWAT INAP
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 101
TANGGAL
STATUS
NAMA PASIEN
Isoniazid 100 mg
Isoniazid 300 mg
Kotrimoksazol sirup
Lidocain 2% injeksi
Lisol - 1000 ml
Loratadin
Lytacur 60 ml
Lexavit Kaplet
Masker disposable
Metaneuron tablet
UGD RAWAT INAP
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 101
TANGGAL
STATUS
NAMA PASIEN
Metoclopramide 5 mg
Metoklopramid 10 mg
Omeprazol kapsul
Paracetamol Drop
Salbutamol 2 mg
Salbutamol 4 mg
Spashi - Injeksi
Spasminal tablet
UGD RAWAT INAP
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 101
TANGGAL
STATUS
NAMA PASIEN
Urine bag
Uriscan Glucose 1
USG Gel 250 ml
USG Gel 5 liter
Vaselin Alba
Wida D5 1/2 NS
ZINC tablet 20 mg
Zircum KID sirup
ACETYL CYSTEIN
OBAT JKN
VITAMIN C 250 MG
GENTAMICIN INJEKSI
TABLET TAMBAH DARAH
PIRACETAM INJEKSI
BIOCOMBIN INJEKSI
ONDANCETRON INJEKSI
BMHP JKN
SPUILT 3 CC STERA
JELCO 18 G
JELCO 20 G
JELCO 22 G
JELCO 24 G
FOOLEY 2 WAY 18
FOLLEY 2 WAY 16
UGD RAWAT INAP
NO 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 101
TANGGAL
STATUS
NAMA PASIEN
SUCTION CATETER 10
SUCTION CATETER 12
AGUSTUS 2018
UGD RAWAT INAP
NO 102 103 104 105 106 107 108 109 110 111 112 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147
TANGGAL
STATUS
NAMA PASIEN
Alat Suntik 10 ml
Alopurinol tablet
Amlodipin 10 mg
Attapulgit 600 mg
Attapulgit 630 mg
Becefort tablet
Betametason krim
Betametason N crem
Bisakodil Supp 10mg
Bist Mess No.24
Blood Lancet
Bonding Liq
Bunofa 400
UGD RAWAT INAP
NO 102 103 104 105 106 107 108 109 110 111 112 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147
TANGGAL
STATUS
NAMA PASIEN
Cefotaxim injeksi
Cendo Lyteer
Clorin / One Clean
Corsafen 500 mg
Cover Glass
Glimepiride 2 mg
Infusion set anak
Infusion set dewasa
IV Catether No.18
IV Catether No.20
IV Catether No.22
IV Catether No.24
Iodina Test
UGD RAWAT INAP
NO 102 103 104 105 106 107 108 109 110 111 112 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147
TANGGAL
STATUS
NAMA PASIEN
Isoniazid 100 mg
Isoniazid 300 mg
Kotrimoksazol sirup
Lidocain 2% injeksi
Lisol - 1000 ml
Loratadin
Lytacur 60 ml
Lexavit Kaplet
Masker disposable
Metaneuron tablet
UGD RAWAT INAP
NO 102 103 104 105 106 107 108 109 110 111 112 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147
TANGGAL
STATUS
NAMA PASIEN
Metoclopramide 5 mg
Metoklopramid 10 mg
Omeprazol kapsul
Paracetamol Drop
Salbutamol 2 mg
Salbutamol 4 mg
Spashi - Injeksi
Spasminal tablet
UGD RAWAT INAP
NO 102 103 104 105 106 107 108 109 110 111 112 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147
TANGGAL
STATUS
NAMA PASIEN
Urine bag
Uriscan Glucose 1
USG Gel 250 ml
USG Gel 5 liter
Vaselin Alba
Wida D5 1/2 NS
ZINC tablet 20 mg
Zircum KID sirup
ACETYL CYSTEIN
OBAT JKN
VITAMIN C 250 MG
GENTAMICIN INJEKSI
TABLET TAMBAH DARAH
PIRACETAM INJEKSI
BIOCOMBIN INJEKSI
ONDANCETRON INJEKSI
BMHP JKN
SPUILT 3 CC STERA
JELCO 18 G
JELCO 20 G
JELCO 22 G
JELCO 24 G
FOOLEY 2 WAY 18
FOLLEY 2 WAY 16
UGD RAWAT INAP
NO 102 103 104 105 106 107 108 109 110 111 112 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147
TANGGAL
STATUS
NAMA PASIEN
SUCTION CATETER 10
SUCTION CATETER 12
AGUSTUS 2018
UGD RAWAT INAP
NO 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
TANGGAL 206
STATUS 0
NAMA PASIEN
JUMLAH
Alat Suntik 10 ml 0
Alopurinol tablet 0
Amlodipin 10 mg 0
Attapulgit 600 mg 0
Attapulgit 630 mg 0
Becefort tablet 0
Betametason krim 0
Bist Mess No.24 0
Blood Lancet 0
Bonding Liq 0
Bunofa 400 0
UGD RAWAT INAP
NO 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
TANGGAL 206
STATUS 0
NAMA PASIEN
JUMLAH
Cefotaxim injeksi 0
Cendo Lyteer 0
Chlorhexidine gluconat 4% 500 cc + dispenser / ONE SCROB 0
Cimetidin tablet 200 mg 0
Clorin / One Clean 0
Composit Light Curing A3,5 0
Corsafen 500 mg 0
Cover Glass 0
Cresopen (obat gigi) 0
Glimepiride 2 mg 0
Infusion set anak 0
IV Catether No.18 0
IV Catether No.20 0
IV Catether No.22 0
IV Catether No.24 0
Iodina Test 0
UGD RAWAT INAP
NO 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
TANGGAL 206
STATUS 0
NAMA PASIEN
JUMLAH
Isoniazid 100 mg 0
Isoniazid 300 mg 0
Lisol - 1000 ml 0
Loratadin 0
Lytacur 60 ml 0
Lexavit Kaplet 0
Masker disposable 0
Metaneuron tablet 0
UGD RAWAT INAP
NO 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
TANGGAL 206
STATUS 0
NAMA PASIEN
JUMLAH
Omeprazol kapsul 0
Paracetamol Drop 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0
UGD RAWAT INAP
NO 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
TANGGAL 206
STATUS 0
NAMA PASIEN
JUMLAH
Urine bag 0
Uriscan Glucose 1 0
USG Gel 250 ml 0
USG Gel 5 liter 0
Vaselin Alba 0
Ventolin Nebules /Salbutamol Cairan 2,5 mg 0
Wida D5 1/2 NS 0
ZINC tablet 20 mg 0
Zircum KID sirup 0
ACETYL CYSTEIN 0
0
OBAT JKN 0
VITAMIN C 250 MG 0
PIRACETAM INJEKSI 0
BIOCOMBIN INJEKSI 0
BMHP JKN 0
SPUILT 3 CC STERA 0
JELCO 18 G 0
JELCO 20 G 0
JELCO 22 G 0
JELCO 24 G 0
FOOLEY 2 WAY 18 0
FOLLEY 2 WAY 16 0
UGD RAWAT INAP
NO 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
TANGGAL 206
STATUS 0
NAMA PASIEN
JUMLAH
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
Imipramine 25 mg 0
Infusion set anak 0
IV Catether No.18 0
IV Catether No.20 0
IV Catether No.22 0
IV Catether No.24 0
Iodina Test 0
Isoniazid 100 mg 0
Isoniazid 300 mg 0
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
Kloramfenikol sirup - 125 mg/ml
0
-60ml
Leukoplast Hospital 7.50 cm x 0

4.5 m
Lisol - 1000 ml 0
Loratadin 0
Lytacur 60 ml 0
Lexavit Kaplet 0
Masker disposable 0
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH

Metaneuron tablet 0
Metilergometrina injeksi 0,2
0
mg/ml -1 ml
Meylon injeksi 0
Mineral mix 0
Mummifying pasta 0
Na ClO 5.,25 % dan
0
CaOCl212 / BYCLIN
Nasaflam 100 mg 0
Neurobat injeksi 0

Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH

Obyek Glass 0
Omeprazol kapsul 0

Paracetamol Drop 0


Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
Piroxicam 20 mg 0
PM-ASI Biskuit 0
PMT Untuk BUMIL 0
PMT-AS biskuit 0
Polikresulen
0
( Metakresolsulfonat ) - 10 ml
Ranitidin 150 mg 0
RDT Malaria 0
Renadinac 25 mg 0
Ringer Laktat + Glucose 5%
0
infus-500ml
Risperidone 2 mg 0
Safe Glove Exam L 0

Safe Glove Exam M 0
Safe Glove Exam S 0
Safety box 0
Sakaneuron tablet 0
Salbutamol 2 mg 0
Salbutamol 4 mg 0
Salep 2-4 DOEN (As.Salisilat
0
2%+Belerang Endap 4%)
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
Semen Seng Fosfat 0
Serum Kontrol 0

Silk no 2/0, 24x13x60 cm 0
Silk no 3/0, 24x13x60 cm 0
Spashi - Injeksi 0
Spasminal tablet 0
0
Sulfat) tab.300mg
Teosal tablet 0
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH

Transfusion set 0

Trikresol Formalin
0
(Forinokresol) cairan - 10 ml
Umbilical Cord 0
Underpad 0
Urine bag 0
Uriscan Glucose 1 0
USG Gel 250 ml 0
USG Gel 5 liter 0
Vaselin Alba 0

Cairan 2,5 mg
Wida D5 1/2 NS 0
Yodium Povidon 1000 ml 0
ZINC tablet 20 mg 0
Zircum KID sirup 0

Zoralin 0
PROGRAM IMUNISASI 0
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
Pelarut BCG 0
Vaksin MR 0
Vaksin DT 0
Vaksin HB Unijeck 0
Vaksin Td 0
Vaksin TT 0
Vaksin Meningitis 0
0
0
PROGRAM IMS 0
Alcohol Swab 0
Cover Glass 0
Hand Gloves 0
Immersion Oil 0
Kertas PH 3,8 - 4,2 0
KOH 10% 0
Methylated Spirit 0
Nacl 0.9% 0
Object Glass 0
Xylol 0
Safe-T Pro Uno 0
Focus TPHA 0
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
Asam Cuka 25 % 0
Cotton swab 0
Larutan Chlorine 0
Sputum Pot 0
Catridge TCM 0
Gluco Protein 0
HBsAg Strip Tes 0
HBsAb Strip Tes 0
Determine HIV 0
Rapid Syphilis 0
ICT Malaria 0
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
Stick Urine 10 PM 0
Strip Urine 11 PM 0
Strip Urine 3 PM 0
0
0
0
0
0
Pengecatan 0
Giemsa 0
Larutan Drabkin 0
Larutan Eosin 2 % 0
Larutan Turk 0
Oil Imersion 0
Pewarna Gram 0
Pewarna Rapid/ sediaan apus 0
darah tepi/MDT
Xylol 0
PROGRAM HIV 0
Catridge TCM 0

Tenofovir 300+Lamivudin 0
300+Efavien 600 Dewasa
Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
Lamivudine 30mg+Nevirapine
50mg ( Triple FDC ) Anak
Tenofovir 300 mg + 0
Emcitritabine 200 (FCT)

Right Sign 0
Verorab Serum


Apr-18
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
TANGGAL
KETERANGAN
NAMA PASIEN
JUMLAH
DAFTAR FLOOR STOK OBAT DI
UGD
NAMA OBAT JUMLAH
Alat Suntik 10 ml -
Amlodipin 10 mg 30
Asam Mefenamat kaplet 500 mg -
AsamTraneksamat HCL tablet 500m 41
Bisoprolol tablet 5 mg -
Cefotaxim injeksi -
Epinefrina HCL/Bitart injeksi 0.1%
5
- l ml
Gliserin 100 ml 2
Infusion set anak 5
IV Catether No.18 10
5
60ml
NAMA OBAT JUMLAH

Paracetamol Drop 5
Ringer Laktat + Glucose 5% infus-
5
500ml
Serum Anti Bisa Ular injeksi (ABU I) -
Serum Anti Tetanus injeksi 1.500 IU -
Spashi - Injeksi 5
Thiamphenicol 500 mg -
Transfusion set 2
Underpad
Cairan 2,5 mg -
Wida D5 1/2 NS 10
ZINC tablet 20 mg 50
METRONIDAZOL INFUS 5 MG/ML -
PIRACETAM INJEKSI 10
BIOCOMBIN INJEKSI 10
SEMUA OBAT YANG DI

DAFTAR HARAP DITULIS
DI RESEP
DAFTAR OBAT P3K
NAMA OBAT JUMLAH
Alat suntik sekali pakai 2,5 ml -

Amoksilin kaplet - 500 mg -
Antasida Doen tablet -
Captopril tablet 12,5 mg -
Deksametason Injeksi 5mg/ml -
Deksametason tablet 0,5 mg -
Difenhidramina HCL injeksi 10 mg -
Epinefrina HCL/Bitart injeksi 0.1% - l m -
Fitomenadion tablet 10 mg -
Folley Catheter No. 16 -
Garam Oralit untuk 200 ml air -
Glukosa lar. infus 5% steril -
Infusion set anak -
Infusion set dewasa -
IV Catether No.18 -
IV Catether No.20 -
IV Catether No.22 -
IV Catether No.24 -
Klorfeniramina Maleat tablet 4mg -
Lidocain 2% injeksi -
Loperamide tablet - 2mg -
Natrium Klorida larutan infus 0.9% -
Parasetamol tablet 500 mg -
Piridoksina HCL tablet 10mg -
Ringer Laktat Larutan infus - 500 ml -
Sianokobalamina (Vit B12) injeksi -
Surgical glove no. 6 -
Surgical Glove No. 7,5 -
Urine bag -
Vitamin B Kompleks tablet -
DAFTAR STOK TETAP OBAT APOTEK yg
DIPUSLING
NAMA STOK
OBAT TETAP
Antalgin tablet 500mg -
Asam Askorbat (vit C) tablet 50 mg -
Bisoprolol tablet 5 mg -
Ibuprofen tablet 400 mg -
Tiamina (Vit B1) tablet 50 mg -
OBAT JKN
VITAMIN C 250 MG 50
DAFTAR FLOOR STOK OBAT DI VK
NAMA OBAT STOK TETAP
Alat Suntik 10 ml 5
Antasida Doen tablet -
Asam Mefenamat kaplet 500 mg -
IV Catether No.18 5
IV Catether No.20 5
IV Catether No.22 5
Piridoksina HCL tablet 10mg -
Umbilical Cord 5
Underpad 10
Urine bag 2
OBAT JKN
SEMUA OBAT YANG DI DAFTAR

HARAP DITULIS DI RESEP
CHECK LIST KETERSEDIAAN OBAT EMERGENCY
SUB UNIT PELAYANAN :VK BULAN:
NAMA TGL JUMLAH TANGGAL
OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Alat suntik sekali pakai 5 ml -
Amlodipin 10 mg -
Cetirizine Kapsul 10mg -
Diethylcarbamazine -
Erithromicin sirup - 60 ml Kering -
Eugenol Cairan - 10 ml -
Flagil / Metronidazol Ovuo 500mg -
Kotrimoksazol sirup -
OBAT KUSTA M B anak -
OBAT KUSTA M B dewasa -
Oksitetrasiklina HCL salep kulit 3 % -
Cotton Applicators Sterile -
PARAF PETUGAS SUB UNIT LAYANAN
PARAF PETUGAS FARMASI
Penanggung Jawab Obat Emergency
Susiyati
NIP:19690817 199001 2 001
SUB UNIT PELAYANAN : POLI KB BULAN:
OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Aminofilina Injeksi 24 mg 1
Deksametason injeksi 5mg/ml -
Difenhedramine injeksi 10 mg -
Epinefrina HCL/Bitart injeksi 0.1% I ml -
Infuset dewasa -
Medicut 20 -
Ringer Laktat Larutan Infus 2

Dyah Ariatanti
NIP: 19710417 199103 2 008
SUB UNIT PELAYANAN :RAWAT INAP BULAN:
OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Amlodipin 10 mg -
Autodisposable Syringe 5 ml (Soloshot) -
Karbamazepin tablet 200 mg -
Ringer Laktat Larutan infus -
Nurochmini
NIP:19680317 198812 2 002
SUB UNIT PELAYANAN :UGD 24 JAM BULAN:
OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Amlodipin 10 mg -
Autodisposable Syringe 5 ml (Soloshot) -
Karbamazepin tablet 200 mg -

OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Nurochmini
NIP:19680317 198812 2 002
SUB UNIT PELAYANAN :BP/POLI UMUM BULAN:
OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Amlodipin 10 mg -
Wahyu Utami
NIP:19631203 198409 2 001
SUB UNIT PELAYANAN :KIA BULAN:
OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Amlodipin 10 mg -
Dyah Aristanti
NIP:19710417 199103 2 008
SUB UNIT PELAYANAN :POLI GIGI BULAN:
OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Amlodipin 10 mg -
drg.Hamid Dwi S
NIP:19710401 200801 1 011
SUB UNIT PELAYANAN : PUSTU JEMBER KIDUL BULAN:
OBAT ED OBAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Faulia Isnanda
NRPTT 13.4.027.518
FORMULIR PERMINTAAN REAGEN
PUSKESMAS JEMBER KIDUL
NO NAMA REAGENT SATUAN JUMLAH PERMINTAAN JUMLAH PEMBERIAN KET
Jember kidul,
Yang menerima Yang menyerahkan
Juli Nur Khomariah

NIP:19840730 200501 2 002
JADWAL KEGIATAN SUB UNIT APOTEK
NO NAMA KEGIATAN TAHUN 2016
JANUARI FEBRUARI MARET APRIL MEI JUNI JULI AGUSTUS SEPTEMBER OKTOBER NOVEMBER DESEMBER
1 BON OBAT RUTIN ke GFK 11 10 10 13 13 10

2 BON OBAT CITO ke GFK
3 BON OBAT TB MDR ke RS PARU
4 Pemeriksaan Pusling BTPN 8 3 6 10 12 4 7 3 6
Bon Obat Cito : Jika tidak ada distribusi rutin dilayani pagi hari
Jika ada distribusi rutin dilayani pukul 12.30 WIB
Bon obat TB MDR setiap 3 bulan sekali ke RS Paru Jember

NOMOR URUT NOMOR URUT NOMOR URUT NOMOR URUT
SIRCUMSISI SIRCUMSISI SIRCUMSISI SIRCUMSISI
41 42 43 44
NOMOR URUT NOMOR URUT NOMOR URUT NOMOR URUT

SIRCUMSISI SIRCUMSISI SIRCUMSISI SIRCUMSISI
45 46 47 48
NOMOR URUT NOMOR URUT

SIRCUMSISI SIRCUMSISI
49 50
GLIMEPIRIDE GLIMEPIRIDE VITAMIN B1
1 MG 2 MG 50 MG
DECULIN KARBAMAZEPIN TEOSAL
CAPTOPRIL ONDANCETRON
50 MG INJEKSI
JANUARI 2022
JANUARI 2022
JANUARI 2022
JANUARI 2022
JANUARI 2022
FEBRUARI 2022
FEBRUARI 2022
FEBRUARI 2022
FEBRUARI 2022
FEBRUARI 2022
MARET 2022
MARET 2022
MARET 2022
MARET 2022
MARET 2022
APRIL 2022
APRIL 2022
APRIL 2022
APRIL 2022
APRIL 2022
MEI 2022
MEI 2022
MEI 2022
MEI 2022
MEI 2022
JUNI 2022
JUNI 2022
JUNI 2022
JUNI 2022
JUNI 2022
JUNI 2022
JULI 2022
JULI 2022
JULI 2022
JULI 2022
JULI 2022
AGUSTUS 2022
AGUSTUS 2022
AGUSTUS 2022
AGUSTUS 2022
AGUSTUS 2022
SEPTEMBER 2022
SEPTEMBER 2022
SEPTEMBER 2022
SEPTEMBER 2022
SEPTEMBER 2022
o
E LIDI HARIAN DAN LEMBAR PENGGANTIAN OBAT FLOOR STOK
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16
17
18
19
20
21
22
23
24
YANG MEMINTA PETUGAS SUB UNIT YANG MENYERAHKAN PETUGAS R. FARMASI
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(CITO) (CITO)
UNIT : UNIT :
TGL : TGL :
NO. SATUA STOK PENERI PERSE PEMAK SISA PERMIN PEMBE NO. SATUA STOK PENERI PERSE PEMAK SISA PERMIN PEMBE
NAMA OBAT NAMA OBAT
URUT N AWAL MAAN DIAAN AIAN STOK TAAN RIAN URUT N AWAL MAAN DIAAN AIAN STOK TAAN RIAN
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
PENGELOLA GUDANG OBAT PETUGAS UNIT PENGELOLA GUDANG OBAT PETUGAS UNIT
TITIS AGUSTINA ...................................... TITIS AGUSTINA ......................................

NIP. 19850816 201001 2 008 NIP. NIP. 19850816 201001 2 008 NIP.
- - - -
- - - -
- - - -
(166) (100) (173) (93)
(1) - - (1)
(89) - (25) (64)
(346) - (44) (302)
(848) - (267) (581)
(902) - (52) (850)
(88) (10,290) (10,291) (87)
- - - -
(300) - (200) (100)
(424) - (161) (263)
- - - -
- - - -
- - - -
(16) (10) (7) (19)
(107) - - (107)
(186) - - (186)
(857) - (819) (38)
- - - -
(6,521) - (2,862) (3,659)
(485) - - (485)
(93) - (62) (31)
(13) - (8) (5)
ANTRAIN CAPTOPRIL
ANTALGIN GRISEOFULVIN INJEKSI 12,5 MG
THIAMPENICOL CYPROFLOXACIN THIAMPENICOL LEXAVIT
ALPARA METOKLORPAMID DEMACOLIN AMBROXOL

LEMBAR CHECKLIST PEMBERIAN INFORMASI OBAT PASIEN RAWAT JALAN
Puskesmas :Jember Kidul
Hari/Tgl :
TIDAK TERJADI KESALAHAN

RESPON
INFORMASI YANG DIBERIKAN
TIME
PEMBERIAN OBAT
UMUR
TANDA TANDA
KONTRA INDIKASI
PENUNJ
PENYIMPANAN
EFEK SAMPING
NO NAMA PASIEN POLI DIAGNOSE TANGAN NO BPJS TANGAN
NAMA OBAT
CARA PAKAI
STABILITAS
ANG
INTERAKSI
SEDIAAN
INDIKASI
PETUGAS PASIEN
DOSIS
(MENIT.D
(TAHUN)
ETIK)
Hari/Tgl :
TIDAK TERJADI KESALAHAN

INFORMASI YANG DIBERIKAN RESPON
PEMBERIAN OBAT
UMUR TIME
KONTRA INDIKASI
TANDA TANGAN
PENYIMPANAN
EFEK SAMPING
NO NAMA PASIEN POLI DIAGNOSE PENUNJANG TANDA TANGAN PASIEN
NAMA OBAT
CARA PAKAI
STABILITAS
PETUGAS
INTERAKSI
SEDIAAN
INDIKASI
DOSIS
(MENIT.
(TAHUN)
DETIK)
PEMERINTAH KABUPATEN JEMBER
DINAS KESEHATAN
UPT. PUSKESMAS JEMBER KIDUL
Jl.K.H.Siddiq no:78 Jember Telp(0331)-424744
JEMBER
Kode Pos 68131
DAFTAR HADIR RAPAT

Departemen Pengundang: :
TOPIK RAPAT : DATE :
NO NAMA DEPARTEMEN JABATAN PARAF HADIR PARAF TERIMA
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
PEMERINTAH KABUPATEN JEMBER
DINAS KESEHATAN
UPT. PUSKESMAS JEMBER KIDUL
Jl.K.H.Siddiq no:78 Jember Telp(0331)-424744
JEMBER
Kode Pos 68131
DAFTAR HADIR RAPAT

Departemen Pengundang: :
TOPIK RAPAT :
NO NAMA DEPARTEMEN JABATAN PARAF HADIR
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
MONITORING KETERSEDIAAN OBAT OAT
BULAN : TAHUN:2016
PEMAKAIAN
STOK TERIMA PERSED
NAMA PAKET OAT
AWAL GFK IAAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
STOK
AKHIR
OAT KATEGORI I
OAT KATEGORI II
OAT KATEGORI ANAK
Petugas Pengelola Program TB Petugas Kamar Obat
Wahyu Utami Juli Nur Khomariah

NIP:19631203 198409 2 001 NIP:19840730 200501 2 002
Jadwal Monitoring Ketersediaan Obat Emergency
di Sub Unit Pelayanan Puskesmas Jember Kidul
Tahun:2017
N Sub Unit layanan JANUARI FEBRUARI MARET APRIL MEI JUNI
o
I II III IV V I II III IV V I II III IV V I II III IV V I II III IV V I II III IV V
1. Poli Umum 7 14 21 27 31 4 11 18 25 28 4 11 18 25 31 1 8 15 22 29 6 13 20 27 31 3 10 17 24 30
2. Poli KIA 7 14 21 27 31 4 11 18 25 28 4 11 18 25 31 1 8 15 22 29 6 13 20 27 31 3 10 17 24 30
3. Poli KB 7 14 21 27 31 4 11 18 25 28 4 11 18 25 31 1 8 15 22 29 6 13 20 27 31 3 10 17 24 30
4. Poli Gigi 7 14 21 27 31 4 11 18 25 28 4 11 18 25 31 1 8 15 22 29 6 13 20 27 31 3 10 17 24 30
5. Kamar bersalin/VK 7 14 21 27 31 4 11 18 25 28 4 11 18 25 31 1 8 15 22 29 6 13 20 27 31 3 10 17 24 30
6. Rawat Inap 7 14 21 27 31 4 11 18 25 28 4 11 18 25 31 1 8 15 22 29 6 13 20 27 31 3 10 17 24 30
7. UGD 7 14 21 27 31 4 11 18 25 28 4 11 18 25 31 1 8 15 22 29 6 13 20 27 31 3 10 17 24 30
8. Pustu Jember Kidul 31 28 31 29 31 30
N Sub Unit layanan JULI AGUSTUS SEPTEMBER OKTOBER NOVEMBER DESEMBER

o I II III IV V I II III IV V I II III IV V I II III IV V I II III IV V I II III IV V
1. Poli Umum 1 8 15 22 31 5 12 19 26 31 2 9 16 23 30 7 14 21 28 31 4 11 18 25 30 2 9 16 23 30
2. Poli KIA 1 8 15 22 31 5 12 19 26 31 2 9 16 23 30 7 14 21 28 31 4 11 18 25 30 2 9 16 23 30
3. Poli KB 1 8 15 22 31 5 12 19 26 31 2 9 16 23 30 7 14 21 28 31 4 11 18 25 30 2 9 16 23 30
4. Poli Gigi 1 8 15 22 31 5 12 19 26 31 2 9 16 23 30 7 14 21 28 31 4 11 18 25 30 2 9 16 23 30
6. Rawat Inap 1 8 15 22 31 5 12 19 26 31 2 9 16 23 30 7 14 21 28 31 4 11 18 25 30 2 9 16 23 30
7. UGD 1 8 15 22 31 5 12 19 26 31 2 9 16 23 30 7 14 21 28 31 4 11 18 25 30 2 9 16 23 30
Mengetahui
Kepala puskesmas jember kidul Petugas Pengelola obat
dr.Apsari Juli Nur Khomariah

NIP:19610416 198902 2 003 NIP:19840730 200501 2 002
Jadwal Monitoring Ketersediaan Obat Emergency
di Sub Unit Pelayanan Puskesmas Jember Kidul
Tahun:2016
N Sub Unit layanan Juli Agustus September Oktober November Desember

o
I II III IV V I II III IV V I II III IV V I II III IV V I II III IV V I II III IV V
1. Poli Umum 2 9 16 23 30 6 13 20 27 31 3 10 17 24 30 1 8 15 22 29 5 12 19 26 30 3 10 17 24 31
2. Poli KIA 2 9 16 23 30 6 13 20 27 31 3 10 17 24 30 1 8 15 22 29 5 12 19 26 30 3 10 17 24 31
3. Poli KB 2 9 16 23 30 6 13 20 27 31 3 10 17 24 30 1 8 15 22 29 5 12 19 26 30 3 10 17 24 31
4. Poli Gigi 2 9 16 23 30 6 13 20 27 31 3 10 17 24 30 1 8 15 22 29 5 12 19 26 30 3 10 17 24 31
6. Rawat Inap 2 9 16 23 30 6 13 20 27 31 3 10 17 24 30 1 8 15 22 29 5 12 19 26 30 3 10 17 24 31
7. UGD 2 9 16 23 30 6 13 20 27 31 3 10 17 24 30 1 8 15 22 29 5 12 19 26 30 3 10 17 24 31
Mengetahui
Kepala puskesmas jember kidul Petugas Pengelola obat
dr.Apsari Juli Nur Khomariah

NIP:19610416 198902 2 003 NIP:19840730 200501 2 002
MONITORING NARKOTIKA DAN PSIKOTROPIKA
Jan-17
NAMA STOK TERIMAPERSE UGD BT TOTALSISA
OBAT AWAL DIAAN 1 2 3 4 5 6 7 9 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 26 30 31 FS KO PN PAKAISTOK
117 Diazepam Injeksi 5mg/ml-2

28 - 28 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 28
118 Diazepam tablet 2 mg

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
119 Diazepam tablet 5 mg

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
151 Fenobarbital Injeksi 50mg/

17 - 17 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 17
246 Kodeina tablet. 10mg

105 - 105 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 105
290 Metaneuron tablet
5 - 5 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5
456 Stesolid Rectal 5 mg/2,5 m

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
JADWAL PELAYANAN KESEHATAN PENSIUNAN DIBANK BTPN CABANG JEMBER
PUSKESMAS JEMBER KIDUL TAHUN 2017
BULAN JANUARI FEBRUARI MARET APRIL MEI JUNI JULI AGUSTUS SEPTEMBER OKTOBER NOVEMBER DESEMBER
HARI SENIN JUMAT SELASA JUMAT SENIN JUMAT RABU JUMAT SELASA
TANGGAL 9 3 4 5 3 4 6 3 5
Mengetahui
Kepala Puskesmas Jember Kidul
dr.Apsari
NIP:19610416 198902 2 003
RUANG FARMASI
RUANG FARMASI
NAMA PASIEN YG MENDAPAT SIKZONOAT INJEKSI
NO NAMA UMUR ALAMAT
1 SAIFULLAH 32 tahun JL. W. HASYIM
2 LILIK LISYOMINI 48 tahun JL. A. YANI 10/44
3 MADSOLEH 64 tahun JL. SULTAN AGUNG 1/241
4 FENNY 34 tahun jl. M. W. Hasyim
5 NANANG 37 tahun jl. M. W. Hasyim
6 WAWID 44 TAHUN JL. A. YANI VI
7 SALAM 37 TAHUN JL. W. HASYIM IV
8 FATHUR 27 TAHUN JL. KERTABUMI
9 RIZAL E. 44 TAHUN JL. TRUNOJOYO IX
10 M. HASAN R. 27 TAHUN JL. TRONOJOYO
11 NURMIATI 38 TAHUN JL. A. YANI
12
13
14
Jember.
Mengetahui
Kepala Puskesmas Jember Kidul
dr.RUMI ENGGARWATI
NIP.19790326 201412 2 001
OBAT STOK KOSONG/PERSEDIAAN SEDIKIT
RENCANA PENGADAAN DANA JKN
NO NAMA OBAT SATUAN RENCANA PENGADAAN JUMLAH
1 AMBROXOL SYRUP BOTOL MUCOPECT/EPEXOL 100
2 AMBROXOL TABLET TABLET MUCOPECT/EPEXOL 2000
3 AMLODIPIN TABLET TABLET NORVASK/TENSIVASK 1000
4 ALPARA TABLET ALPARA 2000
5 ASAM MEFENAMAT TABLET MEFINAL/MEFINTER 3000
6 ANTRAIN INJEKSI AMPUL NOVALGIN INJEKSI 600
7 ATTAPULGIT TABLET BIODEAR 2000
8 ETYL CLORIDE BOTOL ETYL CLORIDE 12
9 BETAHISTIN MESILAT TABLET MERISLON 600
10 BISS MESS SET BISS MESS 1000
11 CEFADROXIL KAPSUL CEFAT/BIDICEF 500
12 CETIRIZINE TABLET CETIRIZINE 500
13 CHLORIN BOTOL CHLORIN 24
14 DEMACOLIN TABLET ULTRAFLU/SANAFLU 3000
15 GLASS IONOMER BOTOL GLASS IONOMER 12
16 JARUM JAHIT 12,13,14,7,6 SET JARUM JAHIT 12,13,14,7,6 36
17 LANZOPRAZOLE KAPSUL COMPRAZ 600
18 LOPERAMID TABLET LODIA/NOVADIUM 3000
19 LYTACUR BOTOL CURCUMA PLUS EMULSION 100
20 METOKLORPAMID TABLET TABLET SOTATIC 1000
21 METOKLORPAMID SYRUP BOTOL SOTATIC SYRUP 100
22 METOKLORPAMID INJEKSI AMPUL SOTATIC 300
24 NEOKAOMINAL SYRUP BOTOL KAOPECTATE SYRUP 100
25 SAKANEURON TABLET NEUROBION 5000 3000
26 ONDANCETRON TABLET TABLET CEDANTRON 3000
27 ONDANCETRON INJEKSI AMPUL CEDANTRON INJEKSI 600
28 PARACETAMOL SYRUP BOTOL DUMIN/PANADOL 300
29 PIROXICAM TABLET PIROFEL/FELDENE 500
30 PRENASE/PRENATIN TABLET OBIMIN 1000
31 RANITIDIN/CIMETIDIN INJEKSI AMPUL ULSIKUR/ULCUMET 600
32 SALISIL BEDAK SET CALADIN/HEROCYN 100
33 DEXTRO,CTM,GG TABLET TUSERAN 3000
34 TETRACYCLIN 500 KAPSUL SUPERTETRA 3000
35 THIAMPENICOL SYRUP BOTOL BIOTYCOL SYRUP 50
36 AZITROMICIN TABLET AZITROMICIN 500
37 PODOVILIN TINCTURE BOTOL PODOVILIN TINCTURE 5
38 MEDIAMER B6 TABLET MEDIAMER B6 500
39 HP PRO KAPSUL HP PRO 500
40 CENDO CATARLENT BOTOL CENDO CATARLENT 50
41 NISTATIN DROP BOTOL CANDISTATIN DROP 50
42 CAT GUT CROMIC 3/0 SET CAT GUT CROMIC 3/0 72
43 SURGICAL GLOVES STERIL NO:6 SET SURGICAL GLOVES STERIL NO:6 1000
44 SURGICAL GLOVES STERIL NO:6,5 SET SURGICAL GLOVES STERIL NO:6,5 1000
45 SAFE GLOVE EXAM M SET SAFE GLOVE EXAM M 1000
46 SAFE GLOVE EXAM L SET SAFE GLOVE EXAM L 1000
OBAT STOK KOSONG
RENCANA PENGADAAN DANA JKN
NO NAMA OBAT SATUAN JUMLAH
1 GLISERIL GUAIAKOLAT/GUAFENISIN TABLET 48000
2 AMLODIPIN TABLET TABLET 2000
3 METAMIZOLE INJEKSI AMPUL 600
4 ATTAPULGIT TABLET 3000
5 ETYL CLORIDE BOTOL 12
6 TABLET 3000
PARACETAMOL 500 MG,PSEUDOEFEDRIN
7,5 MG,CTM 2 MG,COFEIN 10 MG
7 GLASS IONOMER BOTOL 12
8 JARUM JAHIT 12,13,14,7,6 SET 36
9 SYRUP CURCUMA(VITAMIN ANAK SYRUP) BOTOL 50
10 METOKLORPAMID TABLET TABLET 3000
11 METOKLORPAMID SYRUP BOTOL 100
12 NEOKAOMINAL SYRUP BOTOL 100
13 ONDANCETRON INJEKSI AMPUL 300
14 TETRACYCLIN 500 KAPSUL 2000
15 PODOVILIN TINCTURE BOTOL 3
16 NISTATIN DROP BOTOL 50
17 CAT GUT CROMIC 3/0 SET 72
18 SURGICAL GLOVES STERIL NO:6 SET 1000
19 SURGICAL GLOVES STERIL NO:6,5 SET 1000
20 SAFE GLOVE EXAM M SET 3000
21 SAFE GLOVE EXAM L SET 3000
22 KLORAMPENICOL 250 MG KAPSUL 2000
23 METFORMIN 500 MG TABLET 1000
24 ACYCLOVIR KRIM TUBE 100
25 AMBROXOL SYRUP BOTOL 300
26 ACETOSAL 80 MG TABLET 500
27 DEVITALISASI PASTA TUBE 12
28 MANGNESIUM SULFAT 20 % VIAL 10
29 URINE BAG SET 50
Hari/Tgl :
KESALAHAN PEMBERIAN
INFORMASI YANG DIBERIKAN RESPON
UMUR TIME
TIDAK TERJADI
PENUNJANG
KONTRA INDIKASI
PENYIMPANAN
EFEK SAMPING
TANDA TANDA
NAMA OBAT
CARA PAKAI
OBAT
STABILITAS
INTERAKSI
NO NAMA PASIEN POLI DIAGNOSE TANGAN TANGAN
SEDIAAN
INDIKASI
DOSIS
(TAHUN) PETUGAS (MENIT.DET PASIEN
IK)
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(CITO) (CITO)
UNIT : UNIT :
TGL : TGL :
NO. SATUA STOK PENERI PERSE PEMAK SISA PERMIN PEMBE NO. SATUA STOK PENERI PERSE PEMAK SISA PERMIN PEMBE
NAMA OBAT NAMA OBAT
URUT N AWAL MAAN DIAAN AIAN STOK TAAN RIAN URUT N AWAL MAAN DIAAN AIAN STOK TAAN RIAN
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
PENGELOLA GUDANG OBAT PETUGAS UNIT PENGELOLA GUDANG OBAT PETUGAS UNIT
TITIS AGUSTINA ...................................... TITIS AGUSTINA ......................................

NIP. 19850816 201001 2 008 NIP. NIP. 19850816 201001 2 008 NIP.
- - - -
- - - -
- - - -
(166) (100) (173) (93)
(1) - - (1)
(89) - (25) (64)
(346) - (44) (302)
(848) - (267) (581)
(902) - (52) (850)
(88) (10,290) (10,291) (87)
- - - -
(300) - (200) (100)
(424) - (161) (263)
- - - -
- - - -
- - - -
(16) (10) (7) (19)
(107) - - (107)
(186) - - (186)
(857) - (819) (38)
- - - -
(6,521) - (2,862) (3,659)
(485) - - (485)
(93) - (62) (31)
(13) - (8) (5)
ARSIP
RESEP JAN - APRIL
TAHUN 2018
ARSIP
KIE-
TAHUN 2017
LPLPO LIDI
HARIAN
UNIT UNIT
∞ POR
LAP.
∞ LPLPO
STOK
IFK
∞ NARKOTIK ∞ OPNAME
LAP. JKN
∞ PSIKOTROPIK
LAP.
JUMLAH
∞ LAP.
OBATJKN
∞ RESEP ∞ BMHP
∞ IKK
LAPORAN PERSEDIAAN LOGISTIK PMTS
PER 01 AGUSTUS 2018
NO. NAMA BARANG JUMLAH PERSEDIAAN KETERANGAN
1 KONDOM LAKI-LAKI 221
2 PELICIN 71
JEMBER, 09 AGUSTUS 2018

KEPALA PUSKESMAS JEMBER KIDUL
dr. RUMI ENGGARWATI

NIP. 19790326 201412 2 001
LAPORAN PERSEDIAAN LOGISTIK PMTS

PER 01 AGUSTUS 2018
NO. NAMA BARANG JUMLAH PERSEDIAAN KETERANGAN
1 KONDOM LAKI-LAKI 221
2 PELICIN 71
JEMBER, 09 AGUSTUS 2018

KEPALA PUSKESMAS JEMBER KIDUL
dr. RUMI ENGGARWATI

NIP. 19790326 201412 2 001

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LPLPO APOTEK

BULAN: JUNI 2018

101 Acyclovir krim - - - - -

JENIS PELAYANAN RESEP

1251 145 0 1396

JEMBER KIDUL, 02 JULI 2018

TITIS AGUSTINA dr.RUMI ENGGARWATI

Air utk Irigra Lar Infus 1000 ml

Dentin Conditioner / Mini Pack

Fluoride Sediaan Topical/Clinpro White

Kloramfenikol sirup - 125 mg/ml -60ml

Kloramfenikol tetes mata 0,5% - 5 ml

Nistatin 100.000 IU suspensi

Obat Malaria tablet

Air utk Irigra Lar Infus 1000 ml 0

Aquagel Sterile Jely 82 gr 0

Dentin Conditioner / Mini Pack 0

Fluoride Sediaan Topical/Clinpro White 0

Kloramfenikol sirup - 125 mg/ml -60ml 0

Kloramfenikol tetes mata 0,5% - 5 ml 0

Nistatin 100.000 IU suspensi 0

Obat Malaria tablet 0

OBH Tropica Exta Mentol 60 ml 0

OBH Tropica Plus Anak Jeruk 60 ml 0

OBH Tropica Plus Mentol 60 ml 0

Ondansetron tab 4 mg/2 ml Inj - Ktk 5 0

Oxyflow Nasal Oxygen Anak 0

Oxyflow Nasal Oxygen Dewasa 0

Erithromicin sirup - 60 ml Kering

Ibuprofen suspensi 100 mg/ 5ml

Kloramfenikol kapsul 250 mg

Erithromicin sirup - 60 ml Kering 0

Ibuprofen suspensi 100 mg/ 5ml 0

Kloramfenikol kapsul 250 mg 0

Air utk Irigra Lar Infus 1000 ml 0

Aquagel Sterile Jely 82 gr 0

Bahan tumpatan sementara/Caviton 0

Ceftriaxone 1.Og inj Kering 0

Ondansetron tab 4 mg/2 ml Inj - Ktk 5 0

Oxyflow Nasal Oxygen Anak 0

Oxyflow Nasal Oxygen Dewasa 0

Oxyflow Nasal Oxygen Bayi 0

Topical Anastesi Gel/Prime Gel 0

Trifluoperazin 5 mg / Stesoli tab 0

Trikresol Formalin (Forinokresol) cairan - 10 ml 0

Voluven - Koloid HES BM 130.000 Lar inf 0,6 % 0

Kloramfenikol sirup - 125 mg/ml -60ml 0

Kloramfenikol tetes mata 0,5% - 5 ml 0

Dentin Conditioner / Mini Pack 0

Gentamycin salep mata 0

Leukoplast Hospital 7.50 cm x 4.5 0

Sikzonoate injeksi 25 mg /ml 0

Acyclovir tablet - 400 mg

Daryan Tulle :Flamisetin Sulfat 10 x 10

Fluoride Sediaan Topical/Clinpro White

Griseofulvin tablet 500 mg

Na ClO 5.,25 % dan CaOCl212 /

Nistatin 100.000 IU suspensi

Obat Malaria tablet

Parasetamol sirup 120 mg/5ml

Aminofilina injeksi 24mg/ml-10ml 0

Bisakodil Supp 10mg 0

Daryan Tulle :Flamisetin Sulfat 10 x 10