LAPORAN PEMAKAIAN DAN LEMBAR PER

( LPLPO )

KODE PUSKESMAS
NAMA PUSKESMAS PUSKESMAS
DESA / PONKESDES SENGON
KECAMATAN NGAMBON
KABUPATEN BOJONEGORO
PROPINSI JAWA TIMUR

STOK
NO Kode Obat NAMA OBAT SATUAN PENERIMAANPERSEDIAAN
AWAL
1 2 3 4 5 6 7
Generik PKD
1 A001 ALOPURINOL TABLET 300 MG TABLET 100 400 500
2 A002 AMBROXOL SIRUP 15 MG/ML - 60 ML BOTOL - - -
3 A003 AMBROXOL TABLET 30 MG TABLET 50 200 250
4 A004 AMINOFILIN INJEKSI 24 MG/ML - 10 ML AMPUL - - -
5 A005 AMINOFILIN TABLET 200 MG TABLET - - -
6 A006 AMLODIPIN TABLET 5 MG TABLET 50 200 250
7 A007 AMOKSISILIN KAPLET 500 MG KAPLET 50 300 350
8 A008 AMOKSISILIN SIRUP KERING 125 MG/5 ML - 60 BOTOL - - -
9 A009 AMPISILIN INJEKSI 1 GRAM VIAL - - -
10 A010 ANTALGIN 500 MG/ML /METAMIZOL INJ - 2 ML AMPUL - - -
11 A011 ANTASIDA DOEN SUSPENSI - 60 ML BOTOL - - -
12 A012 ANTASIDA DOEN TABLET KOMBINASI TABLET 20 300 320
13 A013 ANTI BAKTERI SALEP KOMB (Basitasin 500 IU/g: TUBE - - -
14 A014 ANTI FUNGI SALEP KOMB (asam benzoat 6% : as POT - 5 5
15 A015 ANTI HEMOROID DOEN KOMBINASI SUPPOSITORIA - - -
16 A016 ANTI MIGRAIN KOMB (Ergotamin 1 mg : Kafein TABLET - - -
17 A017 AQUA PRO INJ 25 ML BOTOL - - -
18 A018 ASAM ASKORBAT TABLET 50 MG TABLET - - -
19 A019 ASAM MEFENAMAT KAPLET 500 MG KAPLET 50 400 450
20 A020 ASAM TRANEKSAMAT INJEKSI 50 MG/ML-5 ML AMPUL - - -
21 A021 ASERING 500 ML BOTOL - - -
22 A022 ASETOSAL TABLET 80 MG / MINIASPI 80 MG TABLET - - -
23 A023 ASIKLOVIR KRIM 5% - 5 G TUBE - - -
24 A024 ASIKLOVIR TABLET 400 MG TABLET 50 - 50
25 A025 ATROPIN SULFAT INJEKSI 0,25 MG/ML - 2ML AMPUL - - -
26 A026 ATROPIN SULFAT TABLET 0,5 MG TABLET - - -
27 A027 ATAPULGIT TAB / ANTIDES TAB TABLET - - -
28 A028 BETAHISTIN MESILAT TABLET 6 MG TABLET - - -
29 A029 BETAMETASON KRIM 0,1% - 5 G TUBE - - -
30 A030 BISAKODIL TABLET 5 MG TABLET - - -
31 A031 BISOKODIL SUPP ANAK 5 MG / DULCOLAX 5 SUPPOSITORIA - - -
32 A032 BISOKODIL SUPP DEWASA 10 MG / DULCOLAX SUPPOSITORIA - - -
33 A033 BROMHEKSIN TABLET 8 MG TABLET - - -
34 A034 CITHICOLIN INJEKSI 125 MG / ML-2 ML AMPUL - - -
35 A035 DEKSAMETASON INJEKSI I.V 5 MG/ML - 2 ML AMPUL - - -
36 A036 DEKSAMETASON TABLET 0,5 MG TABLET - 400 400
37 A037 DIAZEPAM ENEMA 5 MG/2,5 ML (STESOLID) TUBE - - -
38 A038 DIFENHIDRAMIN INJEKSI I.M 10 MG/ML (HCL) - AMPUL - - -
39 A039 DIGOKSIN TABLET 0,25 MG TABLET - - -
40 A040 DIMENHIDRINAT TABLET 50 MG TABLET - - -
41 A041 DOPAMIN INJEKSI 200 MG/ ML AMPUL - - -
42 A042 DOMPERIDON TABLET 10 MG TABLET - - -
43 A043 DOMPERIDON SIRUP 5 MG /5 ML BOTOL - - -
44 A044 EPINEFRIN (ADRENALIN) INJEKSI 0,1% AMPUL - - -
45 A045 ERITROMISIN KAPSUL 500 MG KAPSUL - - -
46 A046 ERITROMISIN SIRUP 200 MG/5 ML - 60 ML BOTOL - - -
47 A047 ETANOL 70%-100 ML BOTOL - - -
48 A048 FENITOIN NATRIUM KAPSUL 100 MG KAPSUL - - -
49 A049 FENOBARBITAL INJEKSI 50 MG/ML - 2 ML AMPUL - - -
50 A050 FENOBARBITAL TABLET 30 MG TABLET - - -
51 A051 FENOL GLISEROL TETES TELINGA 10% - 5 ML BOTOL - - -
52 A052 FITOMENADION (VIT.K1) TABLET 10 MG TABLET - - -
53 A053 FRAMISETIN SULFAT 1 % BIJI - - -
54 A054 FUROSEMID INJEKSI 10 MG/ML - 2 ML AMPUL - - -
55 A055 FUROSEMID TABLET 40 MG TABLET - - -
56 A056 GENTAMISIN SALEP KULIT 0,1% TUBE - - -
57 A057 GENTAMISIN TETES MATA 0,3% TUBE - 10 10
58 A058 GENTIAN VIOLET LARUTAN 1% BOTOL - - -
59 A059 GLIBENKLAMID TABLET 5 MG TABLET - 200 200
60 A060 GLIMEPIRID TABLET 2 MG TABLET - - -
61 A061 GLISERIL GUAIAKOLAT TABLET 100 MG TABLET - - -
62 A062 GLUKOSA 5 % + 0,225 % NaCl - 500 ML (D5 1/4 BOTOL - - -
63 A063 GLUKOSA 5 % + 0,45 % NaCl - 500 ML (D5 1/2 BOTOL - - -
64 A064 GLUKOSA LARUTAN INFUS 10 % STERIL - 500 BOTOL - - -
65 A065 GLUKOSA LARUTAN INFUS 40 % STERIL - 25 M BOTOL - - -
66 A066 GLUKOSA LARUTAN INFUS 5 % STERIL - 500 M BOTOL - - -
67 A067 GRISEOFULVIN TABLET 125 MG TABLET - - -
68 A068 HIDROKLOROTHIAZID (HCT) TABLET 25 MG TABLET - - -
69 A069 HIDROKORTISON KRIM 2,5% TUBE - - -
70 A070 HIOSIN BUTILBROMIDA INJEKSI 20 MG/ML AMPUL - - -
71 A071 HIOSIN BUTILBROMIDA TABLET 10 MG TABLET - - -
72 A072 IBUPROFEN TABLET 200 MG TABLET - 500 500
73 A073 IBUPROFEN SYRUP 200 MG/ 5 ML BOTOL - - -
74 A074 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 TABLET - - -
75 A075 KAPTOPRIL TABLET 25 MG TABLET - 500 500
76 A076 KARBAMAZEPIN TABLET 200 MG TABLET - - -
77 A077 KARBAZOKROM Na TAB 10 MG TABLET - - -
78 A078 KA EN 3 A INFUS BOTOL - - -
79 A079 KA EN 3 B INFUS BOTOL - - -
80 A080 KETOKONAZOL KRIM 2 % TUBE - - -
81 A081 KETOKONAZOL TABLET 200 MG TABLET - - -
82 A082 KETOPROFEN SUPPOSITORIA 100 MG SUPPOSITORIA - - -
83 A083 KLINDAMISIN KAPSUL 300 MG KAPSUL - - -
84 A084 KLORAMFENIKOL KAPSUL 250 MG KAPSUL - - -
85 A085 KLORAMFENIKOL SALEP MATA 1 % - 5 G TUBE - - -
86 A086 KLORAMFENIKOL SUSPENSI 125 MG/ 5 ML - 6 BOTOL - - -
87 A087 KLORAMFENIKOL TETES TELINGA 1 % BOTOL - - -
88 A088 KLORAMFENIKOL TETES MATA 0,5 % BOTOL - - -
89 A089 KLORFENIRAMINA MALEAT TABLET 4 MG ( CT TABLET - - -
90 A090 KODEIN TABLET 10 MG TABLET - - -
91 A091 KOTRIMOKSAZOL DEWASA TABLET 480 MG TABLET - - -
92 A092 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL - - -
93 A093 LIDOKAIN INJEKSI KOMP (Lidokain injeksi 2% + E AMPUL - - -
94 A094 LIDOKAIN INJEKSI 2% - 2 ML AMPUL - - -
95 A095 LITROL TETES MATA/ ALLETROL BOTOL - - -
96 A096 LOPERAMID TABLET 2 MG TABLET - - -
97 A097 LORATADIN TABLET 10 MG TABLET - - -
98 A098 METFORMIN HCL TABLET 500 MG TABLET - - -
99 A099 METFORMIN HCL TABLET 850 MG TABLET - - -
100 A100 METOKLOPRAMID INJEKSI 5 MG/ML- 2 ML AMPUL - - -
101 A101 METOKLOPRAMID SIRUP 5 MG / 5 ML- 60 ML BOTOL - - -
102 A102 METOKLOPRAMID TABLET TABLET - - -
103 A103 METRONIDAZOL TABLET 500 MG TABLET - - -
104 A104 MIKONAZOL KRIM 2% TUBE - - -
105 A105 NATRIUM DIKLOFENAK TABLET 50 MG TABLET - 500 500
106 A106 NATRIUM KLORIDA LARUTAN INFUS 0,9 % - 5 BOTOL - - -
107 A107 NEPHROLIT KAPSUL KAPSUL - - -
108 A108 NEUROTROPIK INJEKSI AMPUL - - -
109 A109 NIFEDIPIN TABLET 10 MG TABLET - 100 100
110 A110 NISTATIN TABLET SALUT 500.000 IU TABLET - - -
111 A111 NISTATIN TABLET VAGINAL 100.000 IU TAB VAG - - -
112 A112 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL - - -
113 A113 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUBE - - -
114 A114 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE - - -
115 A115 OMEPERAZOL KAPSUL 20 MG KAPSUL - - -
116 A116 PARASETAMOL SIRUP 120 MG/ 5 ML BOTOL - - -
 117 A117 PARASETAMOL TABLET 500 MG TABLET 100 200 300
118 A118 PARASETAMOL DROPS 100 MG/ML BOTOL - - -
119 A119 PERAK SULFADIAZIN 1 % KRIM TUBE - - -
120 A120 PERHIDROL 3 % (H2O2) 100 ML BOTOL - - -
121 A121 PIRASETAM INJEKSI 1 G / 5 ML AMPUL - - -
122 A122 PIRASETAM TABLET 800 MG TABLET - - -
123 A123 PIRIDOKSIN HCL (VITAMIN B6) TABLET 10 MG TABLET - - -
124 A124 PIROKSIKAM TABLET 10 MG TABLET - - -
125 A125 POVIDON IODIN 10% 60 ML BOTOL - - -
126 A126 POVIDON IODIN 10% 300 ML BOTOL - - -
127 A127 PREDNISON TABLET 5 MG TABLET - - -
128 A128 PERMETRIN 5 % (SCABIMITE KRIM - 10 G) TUBE - - -
129 A129 PROPRANOLOL TABLET 10 MG TABLET - - -
130 A130 PROPRANOLOL TABLET 40 MG TABLET - - -
131 A131 PROPILTIOURASIL TABLET 100 MG TABLET - - -
132 A132 RANITIDIN INJEKSI 25 MG/ML - 2ML AMPUL - - -
133 A133 RANITIDIN TABLET 150 MG TABLET - - -
134 A134 RINGER LAKTAT - 500 ML BOTOL - - -
135 A135 SALBUTAMOL TABLET 2 MG TABLET - 200 200
136 A136 SALBUTAMOL NEBULIZER (VENTOLIN 2,5 MG/ AMPUL - - -
137 A137 SALEP 2-4 POT 30 G POT - - -
138 A138 SALISIL BEDAK 2% -100 G KOTAK - - -
139 A139 SEFADROKSIL KAPSUL 500 MG KAPSUL - - -
140 A140 SEFTRIAKSON SERBUK INJEKSI 1 G / VIAL VIAL - - -
141 A141 SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML ( VIAL - - -
142 A142 SERUM ANTI TETANUS INJ. 1.500 IU/ML ( A.T.S AMPUL - - -
143 A143 SIMETIDIN TABLET 200 MG TABLET - - -
144 A144 SIMVASTATIN TABLET 10 MG TABLET - - -
145 A145 SIPROFLOKSASIN TABLET SALUT 500 MG TABLET - - -
146 A146 TERBUTALIN TABLET 2,5 MG TABLET - - -
147 A147 TETRAKAIN HCL TETES MATA 0,5 % (CENDO BOTOL - - -
148 A148 TETRASIKLIN KAPSUL 500 MG KAPSUL - - -
149 A149 TIAMIN (VITAMIN B1) TABLET 50 MG TABLET - - -
150 A150 VITAMIN B KOMPLEKS TABLET TABLET - 500 500

Program Gigi
151 B001 ETILKLORIDA SEMPROT - 200 ML BOTOL - - -
152 B002 EUGENOL CAIRAN 10 ML BOTOL - - -
153 B003 GLASS IONOMER CEMENT ART BOTOL - - -
154 B004 KALSIUM HIDROKSIDA PASTA KOTAK - - -
155 B005 SEMEN SENG FOSFAT SERBUK DAN CAIRAN BOTOL - - -
156 B006 TUMPATAN SEMENTARA POT - - -

Program KEJIWAAN
157 C001 AMITRIPTILIN TABLET SALUT 25 MG TABLET - - -
 158 C002 ALPRAZOLAM TABLET 1 MG TABLET - - -
159 C003 ASAM VALPROAT 250 MG (DEPAKOTE 250 MG TABLET - - -
160 C004 DIAZEPAM INJEKSI 5 MG/ML - 2 ML AMPUL - - -
161 C005 DIAZEPAM TABLET 2 MG TABLET - - -
162 C006 DIAZEPAM TABLET 5 MG TABLET - - -
163 C007 ESCITALOPRAM OKSALAT TABLET 10 MG TABLET - - -
164 C008 FLUOKSETIN KAPSUL 10 MG KAPSUL - - -
165 C009 FLUOKSETIN KAPSUL 20 MG KAPSUL - - -
166 C010 FLUPHENAZINE DECANOATE / SIKZONOATE 25 AMPUL - - -
167 C011 HALOPERIDOL TABLET 1,5 MG TABLET - - -
168 C012 HALOPERIDOL TABLET 5 MG TABLET - - -
169 C013 HALOPERIDOL INJEKSI 5 MG/ML (LODOMER) AMPUL - - -
170 C014 KLOBAZAM TABLET 10 MG TABLET - - -
171 C015 KLORPROMAZIN INJEKSI I.M 25 MG/ML AMPUL - - -
172 C016 KLORPROMAZIN TABLET SALUT 100 MG TABLET - - -
173 C017 KLOZAPIN TABLET 25 MG TABLET - - -
174 C018 KLOZAPIN TABLET 100 MG TABLET - - -
175 C019 LAMOTRIGIN TABLET 50 MG TABLET - - -
176 C020 LITIUM KARBONAT TABLET 400 MG TABLET - - -
177 C021 LORAZEPAM TABLET 2 MG TABLET - - -
178 C022 OLANZEPIN TABLET SALUT 10 MG TABLET - - -
179 C023 RISPERIDON TABLET 2 MG TABLET - - -
180 C024 SERTRALIN TABLET SALUT 5 MG TABLET - - -
181 C025 TRIHEKSIFENIDIL TABLET 2 MG TABLET - - -
182 C026 TRIFLUOPERAZIN TABLET SALUT 5 MG TABLET - - -

Program KIA dan GIZI

183 D001 FITOMENADION (VIT.K1) INJ. 2 MG/ML - 1 ML AMPUL - - -
184 D002 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET - 200 200
185 D003 KALSIUM GLUKONAS IV 10% ( 100 MG/ML) -10 AMPUL - - -
186 D004 MAGNESIUM SULFAT INJEKSI 20 % - 25 ML AMPUL - - -
187 D005 MAGNESIUM SULFAT INJEKSI 40 % - 25 ML AMPUL - - -
188 D006 METILDOPA TABLET 250 MG TABLET - - -
189 D007 METILERGOMETRIN MALEAT INJEKSI 200 MC AMPUL - - -
190 D008 METILERGOMETRIN MALEAT TABLET SALUT 0 TABLET - - -
191 D009 MINERAL MIX SACHET - - -
192 D010 OKSITOSIN INJEKSI 10 IU/ML - 2 ML AMPUL - - -
193 D011 RETINOL (VITAMIN A) 100.000 IU KAPSUL LUN KAPSUL - - -
194 D012 RETINOL (VITAMIN A) 200.000 IU KAPSUL LUN KAPSUL - - -
195 D013 TABLET TAMBAH DARAH KOMBINASI TABLET - - -

Program HIV dan IMS

196 E001 KOMBINASI AZITHROMISIN 500 MG + SEFIKSI TABLET - - -
197 E002 EFAVIRENZ (EFV) TABLET 600 MG TABLET - - -
198 E003 LAMIVUDIN (3TC) TABLET 150 MG TABLET - - -
 199 E004 NEVIRAPIN (NVP) TABLET 200 MG TABLET - - -
200 E005 TENOFOVIR 300+LAMIVUDIN 300+EFAVIRENZ 6 TABLET - - -
201 E006 TENOFOVIR (TDF) TABLET 300 MG TABLET - - -
202 E007 ZIDOVUDIN (ZDV) KAPSUL 100 MG KAPSUL - - -
203 E008 ZIDOVUDIN (ZDV) 300 MG + LAMIVUDIN (3TC) TABLET - - -
204 E009 ZIDOVUDIN (ZDV) 60 MG + LAMIVUDIN (3TC) 3 TABLET - - -
205 E010 ZIDOVUDIN SIRUP 10 MG/ML BOTOL - - -

Progam Kusta
206 F001 MDT MB DEWASA (MERAH) / 6 BLISTER PAKET - - -
207 F002 MDT PB DEWASA (HIJAU) / 6 BLISTER PAKET - - -
208 F003 MDT MB ANAK (ORANGE) / 6 BLISTER PAKET - - -
209 F004 MDT PB ANAK (BIRU) / 6 BLISTER PAKET - - -

Progam TB
210 G001 OAT FDC KATEGORI 1 PAKET - - -
211 G002 OAT FDC KATEGORI 2 PAKET - - -
212 G003 OAT FDC ANAK PAKET - - -
213 G004 OAT KOMBIPAK DEWASA PAKET - - -
214 G005 OAT KOMBIPAK ANAK PAKET - - -
215 G006 ISONIAZID (INH) TABLET 100 MG TABLET - - -
216 G007 MULTIVITAMIN TABLET TABLET - - -

Program Diare
217 H001 GARAM ORALIT SERBUK SACHET - - -
218 H002 ZINK TABLET 20 MG TABLET - - -

Program Filariasis
219 I001 ALBENDAZOL TABLET 400 MG TABLET - - -

Reagen
220 J001 HIV RAPID TEST TRI LINE (INTEC) TEST - - -
221 J002 HIV RAPID TEST (FOKUS DIAGNOSTIC) TEST - - -
222 J003 HIV RAPID TEST (ONCOPROPE) TEST - - -
223 J004 HIV RAPID TEST (RIGHT SIGN) TEST - - -
224 J005 HIV RAPID TEST (VIKIA) TEST - - -
225 J006 HIV RAPID TEST (SD) TEST - - -
226 J007 IODINA TEST KIT BOTOL - - -
227 J008 LARUTAN MINYAK IMERSI 50 ML BOTOL - - -
228 J009 NEEDLE 25 G/ SWING NEEDLE PCS - - -
229 J010 REAGEN ZIEHL NEELSON (ZN) PAKET - - -
230 J011 RPR HEXAGON SYPHILIS/TEST KIT TEST - - -
231 J012 BIO SIPILIS (SD) TEST - - -
232 J013 HbSAg Test (SD) TEST - - -
233 J014 REAGEN GOLONGAN DARAH TEST - - -
 234 J015 PP TEST TEST - - -

Bahan Medis Habis Pakai

235 K001 ALAT SUNTIK SEKALI PAKAI 0,05 ML BIJI - - -
236 K002 ALAT SUNTIK SEKALI PAKAI 0,5 ML BIJI - - -
237 K003 ALAT SUNTIK SEKALI PAKAI 1 ML BIJI - - -
238 K004 ALAT SUNTIK SEKALI PAKAI 3 ML BIJI - - -
239 K005 ALAT SUNTIK SEKALI PAKAI 5 ML BIJI - - -
240 K006 ALAT SUNTIK SEKALI PAKAI 10 ML BIJI - - -
241 K007 BLOOD SET / TRANFUSI SET BIJI - - -
242 K008 CAT GUT CHROMIC 2/0/3/0 KOTAK - - -
243 K009 CAT GUT PLAIN 2/0 KOTAK - - -
244 K010 FOLEY CATHETER 2 WAY NO. 16 BIJI - - -
245 K011 FOLEY CATHETER 2 WAY NO. 18 BIJI - - -
246 K012 HANDSCHOON NONSTERIL S KOTAK - - -
247 K013 HANDSCHOON NONSTERIL M KOTAK - - -
248 K014 HANDSCHOON NONSTERIL L KOTAK - - -
249 K015 HANDSCHOON STERIL NO. 7 PASANG - - -
250 K016 HANDSCHOON STERIL NO. 7,5 PASANG - - -
251 K017 KAPAS PEMBALUT 250 G BIJI - - -
252 K018 KASA HIDROFIL 36 X 80 CM BIJI - - -
253 K019 KASA HIDROFIL 40 X 80 CM BIJI - - -
254 K020 KASA HIDROFIL STERIL 16 X 16 CM BIJI - - -
255 K021 KASA HIDROFIL STERIL 18 X 22 CM BIJI - - -
256 K022 KASA HIDROFIL 4 M X 5 CM BIJI - - -
257 K023 KASA HIDROFIL 4 M X 10 CM BIJI - - -
258 K024 MASKER BIJI - - -
259 K025 MASKER N-95 (1870) BIJI - - -
260 K026 PLESTER / HANSAPLAST 7,5 cm x 4,5 m BIJI - - -
261 K027 SAFETY BOX 2,5 LITER BIJI - - -
262 K028 SAFETY BOX 5 LITER BIJI - - -
263 K029 STEROFORM BIJI - - -

Program Imunisasi
264 L001 VAKSIN HEPATITIS B (HB. UNIJECT) VIAL - - -
265 L002 VAKSIN BCG VIAL - - -
266 L003 VAKSIN POLIO 10 DS VIAL - - -
267 L004 VAKSIN DT VIAL - - -
268 L005 VAKSIN Td VIAL - - -
269 L006 VAKSIN IPV VIAL - - -
270 L007 VAKSIN DPT-HB-Hib (Pentavalen) VIAL - - -
VAKSIN MR
271 L008 VIAL - - -
272 L009 VAKSIN CAMPAK VIAL - - -
- - -
 BAYAR
JUMLAH KUNJUNGAN
GRATIS
RESEP
BPJS

MENGETAHUI / MENYETUJUI YANG MENYERAHKAN

Plt. KEPALA DINAS KESEHATAN KEPALA INFALKES

dr. ANI PUJININGRUM, M.Mkes ITA DIANITA WULANDARI,S Farm,Apt

Pembina NIP. 19821030 201101 2 007
NIP. 19731008 200312 2 006
DAN LEMBAR PERMINTAAN OBAT
( LPLPO )

NO. DOKUMEN TANGGAL

IFK TERIMA KEMBALI
PUSKESMAS

BULAN : DES
TAHUN : 2022

STOK PEMBERIAN
PEMAKAIAN SISA STOK PERMINTAAN KETERANGAN
OPTIMUM APBD PROGRAM LAIN-LAIN JUMLAH
8 9 10 11 12 13 14 15 16

100 400
-
50 200
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-
100 150
100 250
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100 220
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- 5
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150 300
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- 50
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 -
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100 300 400
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- 10 10
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50 150 200
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 500 500
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150 350 500
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150 350 500
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250 (150) 100
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- 5
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200 100 500
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50 150 -
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100 400 500

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50 150 500
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 TOTAL PERESEPAN (R/)
35 OBAT GENERIK 35
35
OBAT NON GENERIK

YANG MEMINTA / MELAPOR YANG MENERIMA

KEPALA UPTD PUSKESMAS PETUGAS PUSKESMAS

drg.SANTI ASTY EDY SUPRIANTO, Amd.Kep

NIP. 197802282006042029