REKAPAN LAPORAN PEMAKAIAN DAN L

PUSKESMAS PORTO HARIA

BULAN : JANUARI
TAHUN : 2022

PUSKESMAS PORTO HARIA

SATUAN
NO NAMA BARANG
STOK PENERIMAAN PER- PE- SISA PER-
AWAL KET.
SEDIAAN MAKAIAN STOK MINTAAN
DAK JKN TOTAL

TABLET

1 Albendazol 400 mg Tablet 10,200 0 10,200 10,200

2 Alopurinol 100 mg Tablet 8,500 0 8,500 700 7,800

3 Alprazolam 0,25 mg Tablet 0 0 0 0

4 Alprazolam 0,5 mg Tablet 0 0 0 0

5 Alprazolam 1 mg Tablet 0 0 0 0

6 Ambroksol 30 mg Tablet 0 0 0 0
1,000
7 Aminofilin 150 mg (Decafil Tablet 0 0 0 0
150)

8 Aminofilin 200 mg Tablet 0 0 0 0

9 Amiodaron 200 mg Tablet 0 0 0 0

(Kendaron)

10 Amitriptilin 25 mg Tablet 285 0 285 285

11 Amlodipin 10 mg Tablet 0 0 0 0
1,500
12 Amlodipin 5 mg Tablet 500 0 500 500 0
1,000
13 Amoksisilin 500 mg Tablet 8,500 0 8,500 900 7,600

14 Antasida Tablet Kunyah Tablet 14,100 0 14,100 1700 12,400

15 Antimalaria (Sulfadoxin) Tablet 0 0 0 0

16 Asam Asetilsalisilat 100 mg Tablet 0 0 0 0

(Asetosal)

17 Asam Asetilsalisilat 80 mg Tablet 0 0 0 0

(Miniaspi)

18 Asam Folat 1 mg Tablet 0 0 0 0

2,000
19 Asam Mefenamat 500 mg Tablet 12,700 0 12,700 200 12,500

Asam Pipemidat 400mg

20 (Urinter) Tablet 0 0 0 0

21 Asiklovir 200 mg Tablet 1,900 0 1,900 1,900

22 Asiklovir 400 mg Tablet 0 0 0 0

23 Atenolol 100 mg (Betablok) Tablet 0 0 0 0

24 Betahistin 6 mg Tablet 150 0 150 150 0

Dehidroartemisin (DHP-
25 Frimal) Tablet 0 0 0 0
100
26 Deksametason 0,5 mg Tablet 0 0 0 0
1,000
27 Diazepam 2 mg Tablet 196 0 196 49 147

28 Diazepam 5 mg Tablet 116 0 116 113 3

200
29 Dietilkarbamazin 100mg Tablet 0 0 0 0

30 Digoksin 0,25 mg Tablet 0 0 0 0

31 Dimenhidrinat 50 mg Tablet 400 0 400 400

32 Doksisiklin 100 mg Kapsul 0 0 0 0

33 Ergotamin 1 mg + Kafein Tablet 200 0 200 200

50 mg

34 Eritromisin 250 mg Kapsul 0 0 0 0

500
35 FDC Kat. Anak Paket 0 0 0 0

36 FDC Kat. II Paket 0 0 0 0

37 Fenitoin 100 mg Kapsul 0 0 0 0

38 Fenitoin 30 mg Tablet 0 0 0 0

39 Fenobarbital 30 mg Tablet 0 0 0 0

40 Furosemid 40 mg Tablet 5,600 0 5,600 5,600

41 Glibenklamid 2,5 mg Tablet 0 0 0 0

(Harmida 2,5)

42 Glibenklamid 5 mg Tablet 18,100 0 18,100 18,100

43 Gliklazid tab lepas lambat Tablet 0 0 0 0

60 mg (Diamicron)

44 Glimepirid 1 mg Tablet 100 0 100 100

45 Glimepirid 2 mg Tablet 350 0 350 350

46 Glimepirid 3 mg Tablet 300 0 300 300

47 Griseofulvin 125 mg Tablet 700 0 700 700

48 Griseofulvin 500 mg Tablet 0 0 0 0

49 Guaifenisin / GG Tablet 21,600 0 21,600 21,600

50 Haloperidol 0,5 mg Tablet 0 0 0 0

51 Haloperidol 1,5 mg Tablet 0 0 0 0

52 Haloperidol 2 mg Tablet 0 0 0 0
(Lodomer 2)

53 Haloperidol 5 mg Tablet 0 0 0 0

54 Hidroklortiazid 25 mg Tablet 1,300 0 1,300 1,300

55 Ibuprofen 200 mg Tablet 0 0 0 0

1,000
56 Ibuprofen 400 mg Tablet 0 0 0 0
1,000
57 Isoniazid 300 mg Tablet 100 0 100 100

58 Isosorbid Dinitrat 5 mg Tablet 0 0 0 0

100
59 Kalium Klorida 600mg (KSR Tablet 0 0 0 0
600mg)

60 Kalsitriol (Oscal) Tablet 0 0 0 0

61 Kalsium Karbonat 500mg Tablet 0 0 0 0

(Calprosis-D)

62 Kalsium Laktat 500 mg Tablet 0 0 0 0

2,000
63 Kandesartan 8 mg Tablet 0 0 0 0

64 Kaptopril 12,5 mg Tablet 9,000 0 9,000 1000 8,000

65 Kaptopril 25 mg Tablet 0 0 0 0
500
66 Karbamazepin 200 mg Tablet 0 0 0 0

67 Ketokonazol 200 mg Tablet 0 0 0 0

500
68 Kloramfenikol 250mg Kapsul 0 0 0 0
69 Kloramfenikol 500 mg Kapsul 0 0 0 0
(Chloramex) 500
70 Klorfeniramin 4 mg (CTM) Tablet 31,200 0 31,200 3100 28,100

71 Klorpromazin 100 mg Tablet 0 0 0 0

72 Klopidogrel 300 mg (Plavix Tablet 0 0 0 0

300 mg)

73 Klopidogrel 75 mg Tablet 0 0 0 0

74 Klindamisin 300 mg Tablet 0 0 0 0

300
75 Kodein 10 mg Tablet 314 0 314 314

76 Kodein 15 mg Tablet 0 0 0 0

77 Kodein 20 mg Tablet 0 0 0 0

78 Kotrimoksazol 400/80mg Tablet 0 0 0 0

500
79 Kuinin 200mg Tablet 0 0 0 0

80 Levotiroksin (Euthyrox 50 Tablet 0 0 0 0

mg)

81 Lansoprazol 30 mg Tablet 0 0 0 0
1,000
82 Loratadin 10 mg Tablet 0 0 0 0
500
83 Lorazepam 2mg Tablet 0 0 0 0
Medroksi Progesteron
84 Asetat 10mg (Provera Tablet 0 0 0 0
10mg)
Medroksi Progesteron
85 Asetat 100 mg (Provera Tablet 0 0 0 0
100mg)
86 Metformin 500 mg Tablet 0 0 0 0
2,000
87 Metformin 850 mg Tablet 400 0 400 400

Metildopa 250 mg
88 (Dopamet) Tablet 0 0 0 0

89 Metilergometrin tab 0,125 Tablet 0 0 0 0

mg

90 Metilprednisolon 16 mg Tablet 0 0 0 0

91 Metilprednisolon 4 mg Tablet 0 0 0 0
1,000
92 Metoklopramid 10 mg Tablet 500 0 500 500

93 Metronidazol 250 mg Tablet 0 0 0 0

94 Metronidazol 500 mg Tablet 0 0 0 0

200
95 N-Asetil Sistein 200 mg Tablet 0 0 0 0
500
96 Natrium diklofenak 25mg Tablet 0 0 0 0
1,000
97 Natrium diklofenak 50mg Tablet 0 0 0 0
1,000
98 Nifedipin 20 mg Tablet 0 0 0 0
100
99 Nifedipin 30 mg Tablet 0 0 0 0

100 Nistatin 100.000IU Tablet Tablet 300 0 300 300

Vaginal
Nistatin 500.000IU Tablet
101 Tablet 0 0 0 0
Salut

102 Ofloksasin 200 mg Tablet 50 0 50 50

103 Ofloksasin 400 mg Tablet 0 0 0 0

104 Omeprazol 20 mg Kapsul 0 0 0 0

500
105 Ondansetron 4 mg Tablet 0 0 0 0

106 Ondansetron 8 mg Tablet 0 0 0 0

107 Parasetamol 500 mg Tablet 0 0 0 0
10,000
108 Pirantel Pamoat 125 mg Tablet 400 0 400 400

109 Pirantel Pamoat 250 mg Tablet 0 0 0 0

(Pantrin)

110 Prednison 5 mg Tablet 3,600 0 3,600 500 3,100

111 Primakuin 15 mg Tablet 1,000 0 1,000 1,000

112 Propranolol 10 mg Tablet 0 0 0 0

113 Propranolol 40 mg Tablet 0 0 0 0

114 Ranitidin 150 mg Tablet 0 0 0 0

500
115 Risperidon 1 mg Tablet 0 0 0 0

Rivaroksaban 20 mg
116 (Xarelto 20) Tablet 0 0 0 0

117 Salbutamol 4mg Tablet 0 0 0 0

118 Sefadroksil 500 mg Kapsul 0 0 0 0

500
119 Sefiksim 200 mg Tablet 0 0 0 0
500
120 Setirizin 10 mg Tablet 0 0 0 0
500
121 Simvastatin 10 mg Tablet 0 0 0 0
300
122 Simvastatin 20 mg Tablet 600 0 600 600
1,000
123 Siprofloksasin 500 mg Tablet 0 0 0 0

124 Spironolakton 100 mg Tablet 0 0 0 0

125 Spironolakton 25 mg Tablet 0 0 0 0

Teofilin 150 mg
126 (Bronsolvan) Tablet 0 0 0 0

127 Tetrasiklin 500 mg Kapsul 0 0 0 0

128 Tiamizol 10 mg (Thyrozol, Tablet 0 0 0 0

Antityroid)

129 Triheksifenidil 2mg Tablet 0 0 0 0

130 Vitamin A 100.000 IU Kapsul 500 0 500 500

(Retinol - Biru)
Vitamin A 200.000 IU
131 (Retinol - Merah) Kapsul 6,050 0 6,050 6,050

132 Vitamin B kompleks Tablet 1,000 0 1,000 1000 0

5,000
133 Vitamin B1 (Tiamin) 50mg Tablet 24,000 0 24,000 4800 19,200

134 Vitamin B6 (Piridoksin) 10 Tablet 9,100 0 9,100 1200 7,900

mg

135 Vitamin B12 Tablet 0 0 0 0

(Sianokobalamin) 50mcg 5,000
Vitamin C (Asam Askorbat)
136 50mg Tablet 4,000 0 4,000 2100 1,900

137 Vitamin K1 (Fitomenadion) Tablet 300 0 300 300

10 mg

138 Zink tablet disperse 20 mg Tablet 4,000 0 4,000 4,000

SIRUP 0 0 0 0

139 Albendazol Suspensi 200 Botol 0 0 0 0

mg/5mL
140 Ambroksol Sirup Botol 0 0 0 0

141 Amoksisilin Sirup Forte 250 Botol 0 0 0 0

mg/5mL
142 Antasida Suspensi Botol 0 0 0 0

143 Domperidon drop 5mg/mL Botol 0 0 0 0

144 Domperidon Sirup Botol 0 0 0 0
5mg/5mL
145 Eritromisin Sirup Kering Botol 0 0 0 0
200mg/5mL
146 Ibuprofen Suspensi Botol 0 0 0 0
100mg/5 mL
147 Kloramfenikol Suspensi Botol 0 0 0 0

148 Kotrimoksazol Suspensi Botol 13 0 13 13

200/40mg
149 Laktulosa Sirup Botol 3 0 3 3
3,335g/5mL
150 Metoklopramid Sirup Botol 0 0 0 0
5mg/5mL (Lexapram)
151 Metronidazol Suspensi Botol 0 0 0 0
125mg/5mL
Parasetamol Drop
152 Botol 0 0 0 0
100mg/mL
153 Parasetamol Sirup Botol 80 0 80 80
120mg/5mL
154 Pirantel Pamoat Susp Botol 3 0 3 3
125mg/5mL
155 Salbutamol Sirup 2mg/5mL Botol 0 0 0 0

156 Sefadroksil Sirup Botol 5 0 5 5

125mg/5mL
157 Sefiksim Sirup 100mg/5mL Botol 0 0 0 0

158 Setirizin Sirup 5mg/5mL Botol 0 0 0 0

159 Sukralfat Suspensi Botol 0 0 0 0

500mg/5mL
160 Zink Pro 10 mg/mL Botol 0 0 0 0

161 Zink syrup 20 mg/5 mL Botol 54 0 54 54

SALEP/ INJEKSI/ SUPPO/ 0 0 0 0
CAIRAN INFUS
162 Air Untuk Injeksi 25 ml Flac 100 0 100 100
Albumin 25%-100ml
163 Botol 0 0 0 0
(Octalbin 25%)
164 Albumin 5%-250 ml Botol 0 0 0 0
(Octalbin 5%)
165 Albumin Serum inj. 20% Botol 0 0 0 0
100 mL (Biotest)
166 Aminofilin inj 24 mg/mL Ampul 0 0 0 0

167 Amiodaron inj. 50mg/mL Ampul 0 0 0 0

168 Antifungi salep Tube 72 0 72 72

Antihemoroid Suppositoria Suppo
169 2 gr 85 0 85 85

170 Asam Traneksamat inj. 100 Ampul 6 0 6 6

mg/mL
171 Asam Traneksamat inj. Ampul 1 0 1 1
50mg/mL
172 Asiklovir SM 3% (Lacyvir) Tube 0 0 0 0

173 Atropin inj 0,25 mg/mL Ampul 0 0 0 0

174 Bedak Salisil 2% Pot 0 0 0 0

Benzatin Penisilin 1,2 jt
175 IU/mL Vial 0 0 0 0

176 Benzatin Penisilin 2,4 jt Vial 0 0 0 0

IU/mL
177 Betametason 0,05% Tube 0 0 0 0
(Skizon 5 gr)
178 Betametason Krim 0,1% Tube 0 0 0 0
300
179 Betametason Dipropionat Tube 0 0 0 0
Krim 0,05%
180 Bisakodil Supp 10 mg Suppo 3 0 3 3
(Dulcolax)
Bisakodil Supp 5 mg
181 (Dulcolax) Suppo 0 0 0 0

182 Deksametason inj 5mg/mL Ampul 47 0 47 47

183 Desoksimetason 0,25% Tube 0 0 0 0

184 Diazepam inj 5 mg Ampul 0 0 0 0

185 Diazepam Enema 10 Rectal 0 0 0 0

mg/2,5mL (Stesolid10mg)
186 Diazepam Enema 5 mg/2,5 Rectal 15 0 15 15
mL (Stesolid 5mg)
187 Difenhidramin inj 10mg/mL Ampul 23 0 23 23

188 Dobutamin HCl 250 mg/5 Ampul 0 0 0 0

ml (50mg/mL)
189 Dobutamin-Hameln inj. Ampul 0 0 0 0
12,5 mg/mL
190 Dopamin HCl inj. 4mg/mL Ampul 0 0 0 0

191 Efedrin inj 50 mg/mL Ampul 0 0 0 0

192 Epinefrin inj. 0,1% - Ampul 0 0 0 0

1mg/mL 5
193 Esomeprazol serb inj 40mg Vial 0 0 0 0

194 Eugenol cairan Botol 2 0 2 2

195 Fenitoin inj. 50 mg/mL Ampul 0 0 0 0

196 Fenobarbital inj. 50mg/mL Ampul 0 0 0 0

197 Fenoterol Cairan Ih 0,1% Vial 0 0 0 0

(Berotec Solution)
198 Fentanil inj 0,0785mg Ampul 0 0 0 0

199 Furosemid inj 10 mg/mL Ampul 0 0 0 0

200 Gentamisin SM 0,3% Tube 0 0 0 0

201 Glukosa 5% larutan infus Botol 19 0 19 19

202 Haloperidol inj. 50 mg Ampul 0 0 0 0

(Haldol Decanoas)
203 Human Albumin 5% 50ml Botol 0 0 0 0

204 Hidrokortison krim 2,5% Tube 0 0 0 0

205 Hidrokortison Krim 1% Tube 0 0 0 0

300
Hepatitis B Imunoglobulin
206 220 IU/mL (HyperHep Flac 0 0 0 0
0,5ml)
Insulin Long Acting
207 Pen 0 0 0 0
100IU/mL (Levemir)
208 Insulin Rapid Acting Pen 0 0 0 0
100IU/mL (Novorapid)
Ipratropium Br aerosol
209 0,025% 20 mcg/puff Botol 0 0 0 0
(Atrovent)
Ipratropium Br inhalasi 0,5
210 Botol 0 0 0 0
mg (Combivent) 20
211 KA EN 1B, larutan infus Flac 1 0 1 1

212 KA EN 3A, larutan infus Flac 2 0 2 2

213 Kalium Klorida (KCL) Inj. Flac 0 0 0 0

214 Kalsium Glukonat inj. 10% Ampul 5 0 5 5

215 Kloramfenikol Salep 2% Tube 48 0 48 48

(Bufacetin) 300
Kloramfenikol Salep Mata
216 1%
Tube 96 0 96 96

217 Klonidin inj150 mcg/mL Ampul 0 0 0 0

(Catapres)
218 Karbogliserin tetes telinga Botol 0 0 0 0
10% (Fenol Gliserol)
Ketamin - hameln
219 50mg/mL
Vial 0 0 0 0

220 Ketamin (Ivanes) 50mg/mL Vial 0 0 0 0

221 Ketokonazol krim 2% Tube 100 0 100 100

Ketoprofen Sup 100 mg
222 (Protofen) Suppo 0 0 0 0

223 Ketorolak inj. 30 mg/mL Ampul 0 0 0 0

224 Larutan Dialisis Peritoneal Flac 0 0 0 0

Rendah Kalsium (Dianeal)
225 lidocain inj 2% Ampul 500 0 500 500

226 Lidokain inj 2% + Epinefrin Ampul 90 0 90 90

227 Magnesium Sulfat inj. 20% Flac 0 0 0 0

228 Magnesium Sulfat inj. 40% Flac 0 0 0 0

229 Manitol, cairan infus Flac 2 0 2 2

Medroksi Progesteron
230 Asetat 150mg/3mL inj. Vial 0 0 0 0
(Deponeo)
231 Meropenem 0,5 g Vial 0 0 0 0

232 Metilprednisolon inj. Vial 0 0 0 0

500mg
233 Metilprednisolon serb inj Vial 0 0 0 0
125 mg
234 Metronidazol infus Botol 8 0 8 8
5mg/mL
235 Mikonazol krim 2% Tube 192 0 192 192

236 NaCl 0,9%, larutan infus Flac 20 0 20 20

237 Nikardipin Inj. 1mg/mL Ampul 0 0 0 0

238 Nistatin Drops 100.000 IU Botol 7 0 7 7

Oksimetazolin tetes hidung
239 Botol 0 0 0 0
(Iliadin 0,05%)
240 Oksitetrasiklin SM 1% Tube 100 0 100 100

241 Ondansetron inj. 4mg Ampul 0 0 0 0

242 Oksitosin inj 10 IU/mL Ampul 0 0 0 0

243 Parasetamol infus 10 Botol 0 0 0 0

mg/mL
244 Perak Sulfadiazin Krim Tube 4 0 4 4

245 Ranitidin inj 25 mg/mL Ampul 100 0 100 100

246 Ringer Lactat, larutan infus Flac 200 0 200 200

247 Salbutamol aerosol 100 Botol 0 0 0 0

mcg (Salbulin)
248 Salep 2-4 Pot 216 0 216 216

249 Sefotaksim inj. 1000 mg Vial 14 0 14 14

250 Seftriakson inj. 1000 mg Vial 0 0 0 0

251 Sefuroksim inj Vial 0 0 0 0

252 Siprofloksasin inf. 2mg/mL Botol 0 0 0 0

253 Streptomisin inj 1 gr Vial 2 0 2 2

254 Tramadol inj. 50 mg/mL Ampul 0 0 0 0

255 Vaksin Rabies (Verorab) Vial 0 0 0 0

Vitamin B12
256 (Sianokobalamin) inj. Ampul 100 0 100 100
500mcg/mL
Vitamin B6 (Piridoksin) inj.
257 100mg Ampul 20 0 20 20

258 Zyprexa / Olanzapine 10mg Vial 0 0 0 0

Artemether inj. 80mg/ml Ampul 0 0 0 0

Bisoprolol tab 5mg Tablet 0 0 0 0

Flusinolon asetonid salep Tube 0 0 0 0
0,025% (Dermasolon)
Glimipirid tablet 4mg Tablet 0 0 0 0

Glukosa 10% larutan infus Botol 0 0 0 0

KAEN 3B larutan infus Flac 1 0 1 1

Omeprazol inj. 40mg Ampul 0 0 0 0

Tablet Tambah Darah Tablet 49,400 0 49,400 8,200 41,200

Gliklazid tab lepas lambat Tablet 0 0 0 0
30 mg (Diamicron)
Amoksisilin Sirup 125 Botol 0 0 0 0
mg/5mL
Domperidon 10mg Tablet 0 0 0 0

Eritromisin500 mg Kapsul 0 0 0 0
Nifedipin 20 mg (Adalat Tablet 0 0 0 0
Oros 20)
TAMBAHAN

Tetrasiklin 250 mg Kapsul 0 0 0 0

Amoksisilin 250 mg Tablet 0 0 0 0

Desoksimetason 0,25% Tube 0 0 0 0
(Dexocort krim)
 Ibuprofen Suspensi Botol 0 0 0 0
200mg/5 mL
Metilergometrin inj. Ampul 0 0 0 0

Pil KB Oral Kombinasi siklus 0 0 0 0

Chloramphenicol salp kult Tube 0 0 0 0

Gavisal Drops Botol 0 0 0 0

Lansoprazole 30mg inj Ampul 0 0 0 0

Noretisterone 5mg 0 0 0 0

Ofloxacin 400 mg Tablet 150 0 150 150

KAEN MG, Larutan Infus Flac 0 0 0 0

Asiklovir krim 5% Tube 0 0 0 0

Neurobion inj Ampul 0 0 0 0

Meloksikam 15mg tab Tablet 0 0 0 0

Piroksikam 20 mg tab Tablet 0 0 0 0

Neo Diaform tab Tablet 0 0 0 0

Salbutamol 2mg tab Tablet 1,800 0 1,800 1,800

Citikolin inj Ampul 0 0 0 0

Demacolin tab Tablet 0 0 0 0

Antibakteri Doen Tube 0 0 0 0
Bacitracin - Polimiksin
Simetidin 200mg Tablet 0 0 0 0

Efedrin Hcl tab 25 mg Tablet 0 0 0 0

Etil klorida spray Botol 0 0 0 0

Gentamisin inj Ampul 0 0 0 0

Levofloksasin 500mg Tablet 0 0 0 0

0 0 0

0 0 0 0

PERBEKALAN KESEHATAN 0 0 0 0

1 Abbocath no. 18 Pcs 85 0 85 85

2 Abbocath no. 20 Pcs 50 0 50 50

3 Abbocath no. 22 Pcs 250 0 250 250

4 Abbocath no. 24 Pcs 300 0 300 300

5 Abbocath no. 26 Pcs 70 0 70 70

6 Alkohol 70% 1 liter Botol 107 0 107 107

7 Alkohol 70% 1 liter Botol 0 0 0 0

8 Alkohol Peroxida 500ml Botol 21 0 21 21

100Pcs/
9 Alkohol Swab Kotak 2,225 0 2,225 1000 1,225
1000
10 Arm Sling L Pcs 57 0 57 57

11 Arm Sling M Pcs 54 0 54 54

12 Arm Sling S Pcs 57 0 57 57

13 Aseptik 500 cc + dispenser Botol 9 0 9 9

14 Autoclick Lancing Device Pcs 1 0 1 1

15 Blood Lancet Kotak 81 0 81 81

16 Blood Transfusion Set Pcs 0 0 0 0

17 Catgut Chromic 0, 75 cm, Pcs 0 0 0 0

40mm CG278
18 Catgut Chromic 1, 90 cm, Pcs 0 0 0 0
36mm CG228
19 Catgut Chromic 2, 90 cm, Pcs 0 0 0 0
45 mm CG209
20 Catgut Chromic 2/0, 37cm, Pcs 0 0 0 0
90 mm CG315
21 Catgut Chromic 2/0, 75cm, Pcs 0 0 0 0
26 mm CG296
22 Catgut Chromic 3/0 Pcs 0 0 0 0

23 Catgut Chromic 3/0, 24 Pcs 5 0 5 5

mm, 75 cm CG342
24 Catgut Chromic 3/0, 25 Pcs 0 0 0 0
mm, 75 cm CG344
25 Catgut Chromic 4/0, 16 Pcs 0 0 0 0
mm, 75 cm CG366
26 Catgut Chromic 4/0, 20 Pcs 0 0 0 0
mm, 75 cm CG372
Catgut Plain 0, 30 mm, 75
27 Pcs 0 0 0 0
cm PG132
28 Catgut Plain 1, 90 cm, Pcs 0 0 0 0
1/2mayo, 30 mm PG114
29 Catgut Plain 2/0 HR 20mm Pcs 0 0 0 0
Catgut Plain 2/0, 24 mm,
30 Pcs 0 0 0 0
75 cm gabler
31 Catgut Plain 2/0, 24 mm, Pcs 0 0 0 0
75 cm PG142
32 Catgut Plain 2/0, 30 mm, Pcs 0 0 0 0
75 cm PG146
33 Catgut Plain 3/0 Pcs 72 0 72 72

34 Catgut Plain 3/0 DS 19mm Pcs 13 0 13 13

35 Catgut Plain 3/0 HR 20mm Pcs 12 0 12 12

Catgut Plain 3/0, 23 mm,
36 Pcs 0 0 0 0
75 cm PG168-1
37 Catgut Plain 3/0, 30 mm, Pcs 0 0 0 0
75 cm PG174
38 Catgut Plain 4/0, DS 16mm Pcs 0 0 0 0

39 Cervical Collar Pcs 16 0 16 16

40 Colostomy bag Pcs 0 0 0 0

41 Dermavix S IV Pcs 75 0 75 75

42 Dermavix T 10 x 15 cm Pcs 110 0 110 110

43 Dermavix T 10 x 25 cm Pcs 140 0 140 140

44 Dermavix T 10 x 8 cm Pcs 190 0 190 190

45 Dermavix t 5 x 7 cm Pcs 25 0 25 25

46 Ecodine 1 liter Botol 0 0 0 0

47 Feeding Tube 5FR 100 cm Pcs 0 0 0 0

48 Feeding Tube 8FR 100 cm Pcs 0 0 0 0

49 Fetal Doppler Pcs 0 0 0 0

50 Foley Catheter 2 way no. Pcs 5 0 5 5

12 (Urocare)
Foley Catheter 2 way no.
51 14 (Urocare)
Pcs 5 0 5 5

52 Foley Catheter 2 way no. Pcs 13 0 13 13

16 (Urocare)
53 Foley Catheter 2 way no. Pcs 20 0 20 20
18 (Urocare)
Foley Catheter 2 way no.
54 20 (Urocare)
Pcs 0 0 0 0

55 Foley Catheter 2 way no. Pcs 0 0 0 0

22 (Urocare)
56 Foley Catheter 2 way no. Pcs 5 0 5 5
24 (Urocare)
57 Foley Catheter 3 way no 20 Pcs 0 0 0 0

58 Foley Catheter 3 way no 22 Pcs 0 0 0 0

59 Foley Catheter 3 way no 24 Pcs 0 0 0 0

60 Foley Catheter no. FR18 Pcs 0 0 0 0

61 Foley Catheter Ped 2 no. Pcs 1 0 1 1

10
62 Foley Catheter Ped 2 no. 6 Pcs 3 0 3 3
63 Foley Catheter Ped 2 no. 8 Pcs 0 0 0 0

64 Handscum (Surgical Pasang 0 0 0 0

Gloves) No. 6,5 150
65 Handscum (Surgical Pasang 0 0 0 0
Gloves) No.7 150
66 Handscum (Surgical Pasang 0 0 0 0
Gloves) No. 7,5 150
67 Handsanitizer Botol 5 0 5 5

68 Infus Set Anak Pcs 300 0 300 300

69 Infus set Dewasa Pcs 25 0 25 25

70 Jet Nebuliser Mask Anak Pcs 11 0 11 11

71 Jet Nebuliser Mask Dewasa Pcs 13 0 13 13

72 Kapas 500 gram Roll 8 0 8 8

73 Kapas Pembalut 1000gr Roll 11 0 11 11

74 Kapas pembalut 250 gr Roll 10 0 10 10

75 Kasa Hidrofil 4m x 10cm Roll 40 0 40 40

76 Kasa Hidrofil 4m x 15cm Roll 222 0 222 222

77 Kasa Hidrofil 4m x 5cm Roll 300 0 300 300

78 Kasa Hidrofil 40m x 80cm Roll 28 0 28 28

10Pcs/
79 Kasa Hidrofil Steril 16x16 Kotak 2,496 0 2,496 2,496

80 Kasa Steril 10 x 10 cm Roll 0 0 0 0

81 Leukoplast 2,5 x 4,5 Roll 49 0 49 49

82 Leukoplast 7,5 x 4,5 Roll 46 0 46 46

83 Lysol 1 L Botol 10 0 10 10

84 Masker N95 Pcs 9 0 9 9

85 Masker Surgical (One Med) Pcs 0 0 0 0

20
Maxter Exam Non Powder
86 Kotak 100 0 100 100
L
87 Maxter Exam Non Powder Kotak 5 0 5 5
M
88 Maxter Exam Non Powder Kotak 3 0 3 3
S
Maxter Exam Non Powder
89 XS
Kotak 0 0 0 0

90 Norta Catheter 2 Way Ch Pcs 0 0 0 0

14/200
91 Norta Catheter 2 Way Ch Pcs 0 0 0 0
16/200
Norta Catheter 2 Way Ch
92 18/200
Pcs 0 0 0 0

93 Norta Catheter 2 Way Ch Pcs 0 0 0 0

20/200
94 Norta Catheter 3 Way Ch Pcs 0 0 0 0
22/100
Norta Catheter 3 Way Ch
95 24/100
Pcs 0 0 0 0

96 Norta Catheter ped 2 Way Pcs 0 0 0 0

Ch 10
97 Norta Catheter ped 2 Way Pcs 0 0 0 0
Ch 6
200Pcs/
98 Plesterin Bulat Kotak 4,400 0 4,400 4400 0
10000
99 Plesterin Elastis Kotak 0 0 0 0
24strip/
100 Plesterin Elastis Jumbo Kotak 70 0 70 70
Plesterin Non Woven 10
101 cm x 5 m Roll 115 0 115 115

102 Plesterin Non Woven 15 Roll 43 0 43 43

cm x 5 m
103 Plesterin Non Woven 5 cm Roll 17 0 17 17
x5m
104 Pot Dahak Pcs 0 0 0 0

105 Povidon Iodine 300 ml Botol 16 0 16 16

106 Provein 2/0 26 mm, 75 cm Pcs 1 0 1 1

PV830
107 Provein 3/0 26 mm, 75 cm Pcs 1 0 1 1
PV856
108 Provein 5/0 18 mm, 45 cm Pcs 1 0 1 1
PV888
109 Provein 6/0 13 mm, 45 cm Pcs 1 0 1 1
PV894
110 Rivanol 300 cc Botol 24 0 24 24

111 Safe Glove Surgical 6 ½ Pasang 0 0 0 0

112 Safe Glove Surgical 7 Pasang 0 0 0 0

113 Safe Glove Surgical 7 ½ Pasang 0 0 0 0

114 Safe Glove Surgical 8 Pasang 20 0 20 20

115 Sarung Tangan Obgyn Pasang 74 0 74 74

50Psg/
116 Shoe Cover Ktk 14 0 14 14

117 Silk Black 2/0, 25 mm, 75 Pcs 0 0 0 0

cm BS636
Silk Black 2/0, 30 mm, 75
118 Pcs 0 0 0 0
cm BS640-1
119 Silk Black 3/0 HR 20mm Pcs 0 0 0 0

120 Silk Black 3/0, 26 mm, 75 Pcs 1 0 1 1

cm BS668
Silk Black 3/0, 75cm, 19
121 Pcs 0 0 0 0
mm BS656-1
122 Silk Black 5/0, 13 mm, 45 Pcs 0 0 0 0
cm BS695
123 Silk Braided 2/0 Pcs 36 0 36 36

124 Silk Braided 3/0 Pcs 25 0 25 25

125 Silk Braided Black 3/0 HR Pcs 0 0 0 0

30 mm
126 Softpad 60 x 90 cm non Pcs 80 0 80 80
steril
100pcs/
127 Spoit 0,5 ml Kotak 100 0 100 100

128 Spoit 1 ml Pcs 1,000 0 1,000 1,000

129 Spoit 10 ml Pcs 500 0 500 500

130 Spoit 2,5 ml Pcs 1,400 0 1,400 1,400

50pcs/
131 Spoit 20 ml kotak 0 0 0 0

132 Spoit 3 ml Pcs 1,400 0 1,400 1,400

133 Spoit 5 ml Pcs 700 0 700 700

20pcs/
134 Spoit 50 ml kotak 19 0 19 19

135 Suction Catheter FR 10 Pcs 1 0 1 1

136 Suction Catheter FR 14 Pcs 0 0 0 0

137 Suction Catheter FR 16 Pcs 0 0 0 0

138 Suction Catheter FR 18 Pcs 0 0 0 0

139 Suction Catheter FR 6 Pcs 2 0 2 2

140 Surgical Mask 3 Ply Earloop Pcs 0 0 0 0

141 Surgical Mask 3 Ply Tie On Pcs 0 0 0 0

142 U Pad Steril 60 x 90 cm Pcs 0 0 0 0

143 Ultra One Tes Kehamilan Pcs 0 0 0 0

144 Uniflex 10 cm x 4,5 cm Roll 1 0 1 1

145 Uniflex 15 cm x 4,5 cm Roll 3 0 3 3

146 Uniflex 7,5 cm x 4,5 cm Roll 1 0 1 1

147 Urine Bag Pcs 19 0 19 19

148 Wing Needle no. 21 G Pcs 0 0 0 0

Catgut no 2/0 Pcs 0 0 0 0

Catgut no 3/0 Pcs 0 0 0 0

 Foley Catheter no. FR16 Pcs 0 0 0 0

Silk Black 3/0 HR 30mm Pcs 0 0 0 0

Povidon Iodine 1000 ml Botol 0 0 0 0

Kasa Roll Kecil Roll 0 0 0 0

Kapas berlemak 500 gram Roll 0 0 0 0

Povidon Iodine 10% 60 ml Botol 0 0 0 0

Kapas 100 g Roll 0 0 0 0

T
A Onemed Umbilical Cord Pcs 0 0 0 0
M klem (Penjepit Tali Pusar)
B
Autocheck Stick Urid acid Dos 0 0 0 0
A
H Autocheck Stick Gula
A Dos 0 0 0 0
Darah
N
Autocheck Stick Kolesterol Dos 0 0 0 0

Plester 12,5mm x 4,5 m Roll 0 0 0 0

Plester 7,5mm x 4,5 m Roll 0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TDK BAYAR

Mengetahui,
Pimpinan Puskesmas

dr. Joanne. Juliette. Fransz

NIP. 19810412 201001 2 015
 LAMPIRAN PERMINTAAN OBAT PUSKESMAS PORTO HARIA

NO NAMA OBAT DAN BMHP SATUAN PERMINTAAN KET

1 Ambroksol 30 mg Tablet 1,000

2 Amlodipin 10 mg Tablet 1,500

3 Amlodipin 5 mg Tablet 1,000

4 Asam Folat 1 mg Tablet 2,000

5 Dehidroartemisin (DHP-Frimal) Tablet 100

6 Deksametason 0,5 mg Tablet 1,000

7 Diazepam 5 mg Tablet 200

8 Eritromisin 250 mg Kapsul 500

9 Ibuprofen 200 mg Tablet 1,000

10 Ibuprofen 400 mg Tablet 1,000

11 Isosorbid Dinitrat 5 mg Tablet 100

12 Kalsium Laktat 500 mg Tablet 2,000

13 Kaptopril 25 mg Tablet 500

14 Ketokonazol 200 mg Tablet 500

15 Kloramfenikol 500 mg (Chloramex) Kapsul 500

16 Klindamisin 300 mg Tablet 300

17 Kotrimoksazol 400/80mg Tablet 500

18 Lansoprazol 30 mg Tablet 1,000

19 Loratadin 10 mg Tablet 500

20 Metformin 500 mg Tablet 2,000

21 Metilprednisolon 4 mg Tablet 1,000

22 Metronidazol 500 mg Tablet 200

23 N-Asetil Sistein 200 mg Tablet 500

24 Natrium diklofenak 25mg Tablet 1,000

25 Natrium diklofenak 50mg Tablet 1,000

26 Nifedipin 20 mg Tablet 100

27 Omeprazol 20 mg Kapsul 500

28 Parasetamol 500 mg Tablet 10,000

29 Ranitidin 150 mg Tablet 500

30 Sefadroksil 500 mg Kapsul 500

31 Sefiksim 200 mg Tablet 500

32 Setirizin 10 mg Tablet 500

33 Simvastatin 10 mg Tablet 300

34 Simvastatin 20 mg Tablet 1,000

35 Vitamin B kompleks Tablet 5,000

36 Vitamin B12 (Sianokobalamin) 50mcg Tablet 5,000

37 Betametason Krim 0,1% Tube 300

38 Epinefrin inj. 0,1% - 1mg/mL Ampul 5

39 Hidrokortison Krim 1% Tube 300

40 Ipratropium Br inhalasi 0,5 mg (Combivent) Botol 20

41 Kloramfenikol Salep 2% (Bufacetin) Tube 300

42 Alkohol Swab 100Pcs/ Kotak 1000

43 Masker Surgical (One Med) Pcs 20

44 Plesterin Bulat 200Pcs/Kotak 10000