LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

PUSTU/POSKESDES :
BULAN :
TAHUN : 2022
STOK RUSAK/ SISA STOK
NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
AWAL ED STOK OPTIMUM
ACETYLCYSTEINE TABLET 200 MG TABLET
ALLOPURINOL TABLET 100 MG TABLET
ASAM FOLAT TABLET
AMLODIPINE TABLET 10 MG TABLET
AMLODIPINE TABLET 5 MG TABLET
AMOXYCILLIN SIRUP 125 MG/5 ML SIRUP
AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP
AMOXYCILLIN TABLET 250 MG TABLET
AMOXYCILLIN TABLET 500 MG TABLET
ASPIRIN (ASETOSAL) TABLET 80 MG TABLET
ATAPULGIT TABLET 630 MG TABLET

ANTACIDA DOEN II SUSPENSI (ALLUMUNIUM HIDROKSIDA

SUSP
200mg+MAGNESIUM HIDROKSIDA 200mg)

ANTASIDA DOEN I TABLET KUNYAH KOMBINASI (ALUMUNIUM

TABLET
HIDROKSIDA 200 MG| MAGNESIUM HIDROKSIDA 200 MG) TABLET

ANTIFUNGI: ASAM SALICYLICUM 30 MG, ASAM BENZOICUM 60 MG POT

ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET

ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET
ASAM MEFENAMAT TABLET 500 MG TABLET
ACYCLOVIR TABLET 200 MG TABLET
ACYCLOVIR TABLET 400 MG TABLET
BETAHISTINE TABLET 6 MG TABLET
BISACODYL TABLET 5 MG TABLET
CEFADROXIL TABLET 250 MG TABLET
CEFADROXIL TABLET 500 MG TABLET
COTRIMOXAZOLE (DOEN I DEWASA) : Sulfametoxazole 400 mg +
TABLET
Trimetoprim 80 mg tablet

COTRIMOXAZOLE SUSPENSI KOMBINASI: SULFAMETOXAZOLE 200 MG +

BOTOL
TRIMETROPIN 40 MG\/5 ML
CAPTOPRIL TABLET 12.5 MG TABLET
CAPTOPRIL TABLET 25 MG TABLET
CETIRIZINE SIRUP 1 MG/ML SIRUP
CETIRIZINE TABLET 10 MG TABLET
CHLORAMPHENICOL SALEP KULIT 2% SALEP
CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP
CHLORPHENIRAMINE TABLET 4 MG TABLET
DEXAMETHASONE 0.5 MG TABLET TABLET
DIMENHYDRINATE TABLET 50 MG TABLET
GLUCOSE INFUS 5 % INFUS
GRISEOFULVIN TABLET 125 MG TABLET
IBUPROFEN SUSPENSI BOTOL
IBUPROFEN TABLET 200 MG TABLET
KALSIUM LAKTAT 500 MG TABLET
KETOCONAZOLE SALEP 2% SALEP
METILPREDNISOLON TABLET 4 MG TABLET
METOCLOPRAMIDE TABLET 10 MG TABLET
SODIUM CHLORIDE INFUS 0.9 % (NaCl infus) INFUS
NATRIUM DIKLOFENAK TABLET 50 MG TABLET
OMEPRAZOLE KAPSUL 20 MG KAPSUL
ONDANSETRON TABLET 4 MG TABLET
PARACETAMOL SIRUP 120 MG/5 ML SIRUP
PARACETAMOL TABLET 500 MG TABLET
PIRIDOKSIN HCL ( VIT. B6 ) 10 MG TABLET
PIROXICAM TABLET
PREDNISONE TABLET 5 MG TABLET
RANITIDINE TABLET 150 MG TABLET
RINGER LAKTAT 500 ML BOTOL
SALBUTAMOL TABLET 2 MG TABLET
SIANOKOBALAMIN TABLET 50 MCG TABLET
THIAMINE (VITAMIN B1) 50 MG TABLET
VITAMIN B COMPLEX TABLET 25 MG TABLET
ZINC TABLET
BMHP
SPUIT 0,5 ML PIECES
ALAT SUNTIK 1 ML PIECES
ALAT SUNTIK 3 ML PIECES
ALAT SUNTIK 5 ML PIECES
ALKACIDE 1 LITER BOTOL
ALKOHOL LIQUID 70 % LIQUID
ALKOHOL SWAB PIECES
INFUSET DEWASA SET
Infusion Set Anak PIECES
IV CATHETER NO.18 PCS
IV CATHETER NO.20 PCS
IV CATHETER NO.22 PCS

Yang Menyerahkan Mengetahui Yang Menerima

Pustu/ Poskesdes .......................................... Kepala Puskesmas Petugas Farmasi

(.....................................................................) Ristin Apriani, SKM, MM Apt. Farida Natalia, S.Farm

NIP. 19780426 200501 2 012 NIP: 19861223 202203 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

PUSTU/POSKESDES :
BULAN :
TAHUN : 2022
STOK RUSAK/ SISA STOK
NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
AWAL ED STOK OPTIMUM
ACETYLCYSTEINE TABLET 200 MG TABLET
ALLOPURINOL TABLET 100 MG TABLET
ASAM FOLAT TABLET
AMLODIPINE TABLET 10 MG TABLET
AMLODIPINE TABLET 5 MG TABLET
AMOXYCILLIN SIRUP 125 MG/5 ML SIRUP
AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP
AMOXYCILLIN TABLET 250 MG TABLET
AMOXYCILLIN TABLET 500 MG TABLET
ASPIRIN (ASETOSAL) TABLET 80 MG TABLET
ATAPULGIT TABLET 630 MG TABLET

ANTACIDA DOEN II SUSPENSI (ALLUMUNIUM HIDROKSIDA

SUSP
200mg+MAGNESIUM HIDROKSIDA 200mg)

ANTASIDA DOEN I TABLET KUNYAH KOMBINASI (ALUMUNIUM

TABLET
HIDROKSIDA 200 MG| MAGNESIUM HIDROKSIDA 200 MG) TABLET

ANTIFUNGI: ASAM SALICYLICUM 30 MG, ASAM BENZOICUM 60 MG POT

ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET

ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET
ASAM MEFENAMAT TABLET 500 MG TABLET
ACYCLOVIR TABLET 200 MG TABLET
ACYCLOVIR TABLET 400 MG TABLET
BETAHISTINE TABLET 6 MG TABLET
BISACODYL TABLET 5 MG TABLET
CEFADROXIL TABLET 250 MG TABLET
CEFADROXIL TABLET 500 MG TABLET
COTRIMOXAZOLE (DOEN I DEWASA) : Sulfametoxazole 400 mg +
TABLET
Trimetoprim 80 mg tablet
COTRIMOXAZOLE SUSPENSI KOMBINASI: SULFAMETOXAZOLE 200 MG +
BOTOL
TRIMETROPIN 40 MG\/5 ML
CAPTOPRIL TABLET 12.5 MG TABLET
CAPTOPRIL TABLET 25 MG TABLET
CETIRIZINE SIRUP 1 MG/ML SIRUP
CETIRIZINE TABLET 10 MG TABLET
CHLORAMPHENICOL SALEP KULIT 2% SALEP
CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP
CHLORPHENIRAMINE TABLET 4 MG TABLET
DEXAMETHASONE 0.5 MG TABLET TABLET
DIMENHYDRINATE TABLET 50 MG TABLET
GLUCOSE INFUS 5 % INFUS
GRISEOFULVIN TABLET 125 MG TABLET
IBUPROFEN SUSPENSI BOTOL
IBUPROFEN TABLET 200 MG TABLET
KALSIUM LAKTAT 500 MG TABLET
KETOCONAZOLE SALEP 2% SALEP
METILPREDNISOLON TABLET 4 MG TABLET
METOCLOPRAMIDE TABLET 10 MG TABLET
SODIUM CHLORIDE INFUS 0.9 % (NaCl infus) INFUS
NATRIUM DIKLOFENAK TABLET 50 MG TABLET
OMEPRAZOLE KAPSUL 20 MG KAPSUL
ONDANSETRON TABLET 4 MG TABLET
PARACETAMOL SIRUP 120 MG/5 ML SIRUP
PARACETAMOL TABLET 500 MG TABLET
PIRIDOKSIN HCL ( VIT. B6 ) 10 MG TABLET
PIROXICAM TABLET
PREDNISONE TABLET 5 MG TABLET
RANITIDINE TABLET 150 MG TABLET
RINGER LAKTAT 500 ML BOTOL
SALBUTAMOL TABLET 2 MG TABLET
SIANOKOBALAMIN TABLET 50 MCG TABLET
THIAMINE (VITAMIN B1) 50 MG TABLET
VITAMIN B COMPLEX TABLET 25 MG TABLET
ZINC TABLET
BMHP
SPUIT 0,5 ML PIECES
ALAT SUNTIK 1 ML PIECES
ALAT SUNTIK 3 ML PIECES
ALAT SUNTIK 5 ML PIECES
ALKACIDE 1 LITER BOTOL
ALKOHOL LIQUID 70 % LIQUID
ALKOHOL SWAB PIECES
INFUSET DEWASA SET
Infusion Set Anak PIECES
IV CATHETER NO.18 PCS
IV CATHETER NO.20 PCS
IV CATHETER NO.22 PCS

Yang Menyerahkan Mengetahui Yang Menerima

Pustu/ Poskesdes .......................................... Kepala Puskesmas Petugas Farmasi

(.....................................................................) Ristin Apriani, SKM, MM Apt. Farida Natalia, S.Farm

NIP. 19780426 200501 2 012 NIP: 19861223 202203 2 003