LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

Kode : 73730411
Puskesmas : Wara Barat

STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR

NO NAMA OBAT SATUAN
JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH
1 3 4 6 8 10=6+8 12 14=12-(10+20)

1 Acyclovir cream Tube 30 0 30 0 30

2 Acyclovir tablet 200 mg Tablet 900 0 900 200 700
3 Ambroxol syr 15 mg/5 ml Botol - 3300 3300 1,900 1,400
4 Ambroxol tablet Tablet 100 0 100 50 50
5 Allopurinol 100 mg tablet 300 0 300 300 -
6 Amlodipin tab 5 mg Tablet 1,300 0 1300 900 400
7 Amlodipin tab 10 mg Tablet 1,400 0 1400 0 1,400
8 Amoksisilin kaplet 500 mg Kaplet 800 1200 2000 900 1,100
9 Amoksisilin kaplet 250 mg Kaplet 2,400 3000 5400 3,500 1,900
10 Amoksisilin sirup kering 125 mg/ 5 ml Botol 500 0 500 200 300
11 Amoksisilin Forte Dry Syrup 250 mg/5 ml Botol 150 200 350 0 350
Antasida DOEN
Droptablet kunyah, kombinasi
12 Amoksisilin 100 mg.ml
Aluminium Hidroksida 200 mg + Botol - 0 0 0 -
13 Magnesium Hidroksida 200 mg Tablet - 10 10 0 10
14 Antasida Doen
Anti Bakteri SyrSalep Kombinasi :
Doen Botol 1,650 0 1650 250 1,400
15 Basitrasin
Antihemeroid DOEN Kombinasi : Bismut Tube 100 0 100 50 50
16 Subgalat 150 mg + Heksaklorofen 250 mg Supp - 0 0 0 -
17 Asam Mefenamat kaplet 500 mg Kaplet 30 0 30 17 13
18 Asam Folat 1 mg tab 2,600 2000 4600 1,500 3,100
19 Atapulgit (Akita) Tab - 0 0 0 -
20 Betametason cream 0,1 % Tube 550 0 550 0 550
21 Bisacodil Tab Tab 75 200 275 25 250
22 Bisacodyl 10 mg (Dulcolax) Supp - 0 0 0 -
23 Codein 10 mg Tablet - 100 100 3 97
24 Ceterizine tab tab - 0 0 0 -
25 Ceterzine syr btl - 0 0 0 -
26 Deksametason tab 0,5 mg Tablet 50 0 50 0 50
27 Deksametason Injeksi Ampul 100 4500 4600 1,000 3,600
28 Diltiazem Tablet 95 0 95 0 95
29 Diazepam tab 2 mg Tablet 100 0 100 0 100
30 Diazepam inj 5 mg (HBr) Tab - 0 0 0 -
31 Dimenhidrinat tab 50 mg Tablet 10 0 10 0 10
32 Domperidon susp Botol 200 0 200 0 200
33 Domperidon tab 10 mg Tablet 100 0 100 0 100
34 Ethanol 1000 ml Botol 1,650 0 1650 150 1,500
35 Ethanol 300 ml Botol - 1 1 0 1
36 Fenobarbital tablet 30 mg Tablet - 0 0 0 -
37 Fitomenadion Inj 2 mg / ml Ampul - 0 0 0 -
38 Furosemid tablet 40 mg Tablet - 90 90 0 90
39 Gentamicin tts Mata Tube - 200 200 0 200
40 Gentamisin salep kulit 0,1 % Tube 24 24 48 24 24
41 Gentamisin salep Mata 0,3% Tube 96 0 96 0 96
42 Gentian violet Botol - 48 48 0 48
43 Glibenklamid tablet 5 mg Tablet - 0 0 0 -
44 Glukosa 5 % Botol 1,600 0 1600 200 1,400
45 Griseofulvin 125 mg Tablet 58 0 58 0 58
46 Hidroklortiazid tab 25 mg Tablet - 0 0 0 -
47 Hidrokortison Krim 2,5 % Tube - 0 0 0 -
48 Haloperidol 1,5 mg Tablet 50 96 146 74 72
49 Ibuprofen susp 200 mg / 5 ml Botol 500 500 1000 90 910
50 Ibuprofen tablet 400 mg Tablet 60 60 120 0 120
51 Isosorbid dinitrat Tablet 2,500 2000 4500 1,200 3,300
52 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 200 0 200 0 200
53 Ketokenazole tab 200 mg Tablet 1,200 0 1200 600 600
54 Kloramfenicol 500 mg Tablet - 0 0 0 -
55 Kloramfenikol susp 125 mg./ 5 ml Botol - 0 0 0 -
56 Kloramfenikol tetes Telinga 3 % Botol 60 0 60 0 60
57 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 20 0 20 0 20
58 Kotrimoksazol Suspensi Kombinasi Sulfamet btl 1,000 0 1000 500 500
59 Kotrimoksazol 480 mg Tablet 50 0 50 0 50
60 Lisol Botol 1,300 0 1300 100 1,200
61 Loratadin 10 mg tablet - 0 0 0 -
62 Loperamid 2 mg tablet 2,500 0 2500 400 2,100
63 lidocain comp Ampul 1,750 0 1750 430 1,320
64 Metilprednisolon tab 4 mg Tablet - 60 60 0 60
65 Metoklopramid tab 10 mg Tablet 180 0 180 38 (758)
66 Metronidazole tab 500 mg Tablet 2,700 3000 5700 1,530 4,170
67 Lactulosa Tablet 48 0 48 0 48
68 Miconazole cream 2 % Tube 1,200 0 1200 200 1,000
69 Meloxicam Tablet 1,200 0 1200 0 1,200
70 Metformin Tablet - 0 0 0 -
71 Natrium Klorida Larutan Infus 0,9% Botol 24 96 120 0 120
72 Nifedipin tablet 10 mg Tablet 1,700 0 1700 400 1,300
73 Nistatin tab Vaginal 100.000 IU Tablet 800 0 800 400 400
74 Natrium Diklofenak 50 mg Tablet 300 100 400 0 400
75 Novatusin syr Botol 87 0 87 3 84
76 Oksitetrasiklin HCl Salep Kulit 3 % Tube 200 0 200 0 200
77 Omeprazole Tablet 100 0 100 0 100
78 Oxytocin Injeksi Ampul 1,600 0 1600 400 1,200
79 Paracetamol Syr Botol - 60 60 60 -
80 Paracetamol tab 500 mg Tablet - 0 0 0 -
81 Piroxicam 10 mg Tablet 3,300 0 3300 2,400 900
82 Chlodin Handrub Botol 36 0 36 0 36
83 Prednison tablet 5 mg Tablet 100 200 300 0 300
84 Piridoksin (Vitamin B6 ) Tablet 10 mg tablet - 0 0 0 -
85 Piridoksin (Vitamin B6 ) Tablet 25 mg tablet 1,200 3000 4200 1,800 1,700
86 Ranitidin Tab Tablet 1,500 0 1500 0 1,500
87 Ringer Laktat Larutan Infus Btl 20 0 20 0 20
88 Salbutamol tab 2 mg Tablet 4 0 4 0 4
89 Salisil Bedak 2 % Tube - 0 0 0 -
90 Samcodin tab Tablet 1,100 0 1100 0 1,100
91 Simvastatin tab 20 mg Tablet 2,200 0 2200 800 1,400
92 Suplemen ABC syr Botol - 0 0 0 -
93 Siprofloxacin 500 mg Ampul 1,500 0 1500 0 1,500
94 Salep Whitefields Tube - 40 40 13 27
95 Thiamin (vit.B1) Tab 50 mg (HCl / Nitrat) Tablet 1,500 0 1500 0 1,500
96 Triheksifenidil 2 mg tab Tablet 3 0 3 0 3
97 Tetrasiklin 500 mg Tablet - 0 0 0 -
98 Vaksin Hepatitis B Rekombinan Bayi / Neonvial 1,600 0 1600 400 1,200
99 Vitamin B Kompleks tab Tablet - 0 0 0 -
100 Vaksin rabies vial - 0 0 0 -
101 Zink Tab Tablet - 1000 1000 0 1,000
ALAT KESEHATAN 400 0 400 400 -
102 Alat Suntik 0,5 ml pcs - 0 0 0 -
103 Alat suntik sekali pakai 1 ml pcs 1,200 300 1500 1,500 -
104 Alat suntik sekali pakai 3 ml pcs - 0 0 0 -
105 Alat suntik sekali pakai 5 ml pcs - 0 0 0 -
106 Apron pcs - 0 0 0 -
107 Bisturi Pcs - 0 0 0 -
108 Cat Gut set - 0 0 0 -
109 Handscoon Steril pcs - 0 0 0 -
110 Handscoon Non Steril M pcs - 0 0 0 -
111 Handscoon Gynecology PCS - 0 0 0 -
112 Infusion set Dewasa PCS - 0 0 0 -
113 IV Catheter No. 18 G PCS - 0 0 0 (18)
114 Kasa steril uk. 16 x 16 rol 700 0 700 0 700
115 Kapas Alkohol Botol 9 0 9 0 9
116 Kasa Hidrofil uk.40 x 80 cm rol - 0 0 0 -
117 Kasa pembalut Hidrofil 4 x 15 cm rol 6 0 6 0 6
118 Kasa Pembalut Hidrofil 4 m x 5 cm rol - 0 0 0 -
119 Lancef pcs 130 100 230 0 230
120 Makser Hijab pcs - 300 300 0 300
121 Masker earloop pcs - 100 100 0 100
122 Masker N95 pcs 14 0 14 0 14
123 IV Catheter No. 18 G pcs 50 0 50 0 50
124 IV Catheter No. 20 G pcs 20 0 20 0 20
125 Pot Dahak Pcs 8 0 8 0 8
126 Slide (Objek gelas) Pcs - 20 20 0 20
127 Silk Black 3/0 os 24 mm Pcs 8 0 8 0 8
128 IV Catheter No. 22 G Pcs - 0 0 0 -
129 IV Catheter No. 24 G Pcs 200 0 200 0 200
130 Vaksin Carrier P2 (DBD) box 8 4 12 0 12
131 Vaksin Carrier P2 (HIV) Pak 50 0 50 0 50
OBAT GIGI - 0 0 0 -
132 Etsa Magnum / Etching gel box 100 0 100 0 100
133 Cotton Roll box 150 200 350 0 350
134 Dental Needle 306 Size 16 mm pcs 150 200 350 0 350
135 Eugenol Cairan pcs 15 0 15 0 15
136 Glass ionomer Fuji pcs - 0 0 0 -
137 Hexabond pcs 3 3 6 0 6
138 Glass Ionomer ART pcs - 0 0 0 -
139 Kaca Mirror pcs - 0 0 0 -
140 Micro Aplikator btl 22 0 22 0 22
141 Mumying Paste Botol 5 0 5 0 5
142 Surgispon botol 5 0 5 0 5
143 Zink Phosfat Cemend btl - 0 0 0 -
REAGENS - 0 0 0 -
145 ABO Screen btl - 0 0 0 -
146 Asam Asetat btl - 0 0 0 -
147 E D T A 10 % 100 ml ktk - 0 0 0 -
148 Earlich Botol - 0 0 0 -
149 Giemza100 pcs - 0 0 0 -
150 Gel USG pcs - 0 0 0 -
151 Methanol 250 Botol - 0 0 0 -
152 Reagens ZN Botol - 0 0 0 -
153 Spritus Botol - 0 0 0 -
154 Strip HIV 1/2.ONE STEP RAPID TEST /R3 pket - 0 0 0 -
155 Strip HIV (KHB Dianostik) Kit /Antibody (r2) pket - 0 0 0 -
156 X pert MTB Rif acsay kit pket - 0 0 0 -
157 Strip Kolesterol Nesco Box - 0 0 0 -
158 Strip Glukosa Box - 0 0 0 -
159 Strip Asam urat box - 0 0 0 -
160 clodin 0,4% Botol - 0 0 0 -
161 clodin 0,5% Botol - 0 0 0 -
 Mengetahui/Menyetujui Yang Menyerahkan Yang Memin
Kepala Dinas Kesehatan Kab/Kota Kepala IFK Kepala Puske

NIP : NIP : NIP :

N OBAT

Bulan : Oktober
Tahun : 2022

EXPIRE
PEMBERIAN /RUSAK
PERMINTAAN KET
JUMLAH NILAI JUMLAH
17 18 19 20 23
900
700

18
 Yang Meminta Yang Menerima
Kepala Puskesmas Petugas Puskesmas

Rahima Habir, S.Si., Apt

NIP : 19760209201412 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (BUFFER STO

Kode : 73730411
Puskesmas : Wara Barat

STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR

NO NAMA OBAT SATUAN
JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH
1 3 4 6 8 10=6+8 12 14=12-(10+20)

1 Albendazol tab 300 0 300 0 300

2 Albendazol tab tab - 0 0 0 -
3 Alat Suntik 0,5 ml pcs 1,800 0 1,800 0 1,800
4 Alat Suntik 0,05 ml pcs - 0 0 0 -
5 Alat suntik 5 ml pcs - 0 0 0 -
6 Amitriptilin tab 25 mg tab 100 0 100 0 100
7 Ampicillin Inj 1000 mg(Kesnak) vial 10 10 20 0 20
8 Calcii gluconas inj 24 0 24 0 24
9 clorpromazim Tab - 0 0 0 -
10 Clobazam 10 mg Tab - 0 0 0 -
11 Clozapin 25 mg tab 130 500 630 80 550
12 Cotrimoksazol 960 Tablet 80 0 80 0 80
13 Garam oralit serbuk kombinasi: 20 0 20
Fluconazole
Natrium 0,70150 mg klorida 0,30 g,
g kalium tab 20 0
14 Tribatrium Sitrat dihidrat 0,58 g bungkus 100 0 100 55 45
15 Diazepam inj 5 mg Ampul 10 10 20 0 20
16 Haloperidol 5 mg tab 75 0 75 0 75
17 Metilergometrin Ampul 10 0 10 0 10
18 Magsnium Sulfat (MgSO4)20 % Ampul 12 0 12 0 12
19 OAT FDC Kategori 2 paket - 0 0 0 -
20 Kombipak Kategori I paket - 0 0 0 -
21 OAT Kategori Anak FDC paket - 0 0 0 -
22 OAT Kategori I paket - 0 0 0 -
23 OAT Kategori Harian Paket 3 0 3 2 1
24 Oxytetrasiklin 1 % SM Tube - 0 0 0 -
25 Phenobarbital Injeksi 50 mg/ml Ampul - 0 0 0 -
26 Phitomenadion 2 mg/ml injeksi Ampul 30 0 30 4 26
27 Retinol 100.000 IU Kap.Lunak kapsul 100 0 100 0 100
28 Retinol 200.000 IU Kap.lunak kapsul 650 0 650 0 650
29 Resperidon 2 mg tab tab 388 30 418 0 418
30 Trhexipenidil tab 535 0 535 125 410
31 Trifluoperazine HCl 5 mg tab - 0 0 0 -
32 Masker Stopamed 3 ply Earloop (HIV) pcs - 0 0 0 -
33 Masker N95 (TB) pcs - 0 0 0 -
34 Tablet Tambah Darah tab 4,410 1000 5,410 1,110 4,300
35 Zink tab 800 0 800 400 400
36 Giemza 500 ml Btl - 0 0 0 -
37 BD vacutainer pcs - 0 0 0 -
38 Endo Vacuntube steril pcs - 0 0 0 -
39 Freezing Tubes Pcs - 0 0 0 -
40 RDT Combo Malaria test 50 0 50 0 50
Abacair 120 mg + 3TC 60 mg (FDC
41 Anak) btl - 0 0 0 -
42 Zidovudine btl - 0 0 0 -
43 Nevirapine btl - 0 0 0 -
44 Dolutegravir btl 2 0 2 0 2
45 Efavirenz btl 1 0 1 0 1
46 Lamivudine btl 1 0 1 0 1
47 TDF + 3TC + EFV (Dewasa) btl 1 0 1 0 1
48 TDF 300 + 3 TC / Telado Btl - 0 0 0 -
49 Tenofovir btl 1 0 1 0 1
50 Zidovudine
Lopinavir 40+ mg
Lamivudine (Duviral
/ Ritonafir 10 ) btl - 0 0 0 -
51 mg( Aluvia) Btl - 0 0 0 -
52 Lopinavir / Ritonafir (LPV K 200/50 mg Btl - 3 3 1 2
53 Strip HbSag pcs - 0 0 0 -
54 Rapid Test HIV 1 (Virocheck HIV) (R1) pcs - 0 0 0 -
55 Rapid Diagnostik Test (R2) pcs - 0 0 0 -
56 Standar Q HIV 1/2 Ab 3 -Line (R3) pcs - 0 0 0 -
57 Vaksin HbIg pcs - 0 0 0 -
58 Vaksin rabies pcs - 25 25 25 -
59 Vaksin Maningitis pcs - 0 0 0 -
60 Spesimen Carrier (termos Specimen pcs - 0 0 0 -
61 Syringe (Spoit 1 cc) pcs - 0 0 0 -
62 Needle 23 G 1/4 Jam pcs - 12 12 12 -
63 Vaksin Hepatitis B Uniject (HB0) 1ds pcs - 0 0 0 -
64 Vaksin BCG (bacillus Callmette Guerin) pcs - 0 0 0 -
65 vaksin Polio (APV)10 ds pcs - 0 0 0 -
66 Vaksin Polia (IPV) 5 ds pcs - 0 0 0 -
67 Vaksin DPT-HB-HIB 5 ds pcs - 0 0 0 -
68 Vaksin MR pcs - 0 0 0 -
69 Micropipet 61/1000 ml M2 pcs - 0 0 0 -
70 Vaksin TD 10 ds pcs - 0 0 0 -
71 Anuscopy pcs - 0 0 0 -
72 Masker N95 (TB) pcs 0 0 0 -
73 Mineral mix bungkus 0 0 0
UFFER STOK)

Bulan : Oktober
Tahun : 2022

EXPIRE/RUSAK
STOK PERMINTAAN KET
OPTIMUM JUMLAH
16 17 20 23

-
-
-
-
-
-
- 10
-
-
-
-
-
-
100
-
-
-
-
-
-
-
-
-
-
-
-
5
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-