LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

SUB UNIT PELAYANAN

SUB UNIT :
PUSKESMAS : TANJUNG LALAK
KECAMATAB : PULAU LAUT KEPULAUAN
KABUPATEN : KOTABARU

LAPORAN BULAN/PERIODE :
PERMINTAAN BULAN/PERIODE :
STOK PENERI PERSED PEMAK SISA PERMIN PEMBE
NO NAMA OBAT SATUAN KET.
AWAL MAAN AAN AIAN STOK TAAN RIAN
1 2 3 4 5 6 7 8 9 10 11
TABLET-KAPLET-KAPSUL
1 Acyclovir 400 mg Tablet
2 Acyclovir 200 mg Tablet
3 Allopurinol 300 mg Tablet
4 Allopurinol 100 mg Tablet
5 Amoxicillin 500 mg Tablet
7 Amlodipin 5 mg Tablet
8 Ambroxol 30 mg Tablet
9 Amitriptylin 25 mg Tablet
10 Aminophyllin 100 mg Tablet
11 Antasida Doen Tablet
12 Asam Mefenamat 500 mg Tablet
13 Asam Tranexamat 500 mg Tablet
14 Asam Ascorbat 50 mg (Vit.C) Tablet
15 Asam Ascorbat 250 mg (Vit.C) Tablet
16 Antalgin 500 mg (Metampiron) Tablet
17 Betahistine Mesilate 6 mg Tablet
18 Calcium Lactate 500 mg (KALK) Tablet
19 Captopril 12,5 mg Tablet
20 Captopril 25 mg Tablet
21 Captopril 50 mg Tablet
22 Ciprofloxacin 500 mg Tablet
23 Cefadroxyl 500 mg Kaplet
24 Cetirizine 10 mg Tablet
25 Cimetidin 200 mg Tablet
26 Chloramfenicol 250 mg Kapsul
27 Cotrimoxazole 480 mg Tablet
28 Cotri Pediatrik 120 mg Tablet
29 CTM 4 mg Tablet
30 Dexamethason 0,5 mg Tablet
31 Donperidon 10 mg Tablet
32 Digoxin 0,25 mg Tablet
33 Erytromicin 500 mg Tablet
34 Ergotamin Caffein Tablet
35 Ephedrin 25 mg Tablet
36 Furosemide 40 mg Tablet
37 Garam oralit Sashet
38 Griseuvulvin 125 mg Tablet
39 Glibenclamid 5 mg Tablet
40 Guaefenesin 100 mg (GG) Tablet
41 HCT 25 mg Tablet
42 Ibuprofen 400 mg Tablet
43 Ibuprofen 200 mg Tablet
44 ISDN 5 mg Tablet
45 IFASMA (Theophylin, Ephedrin) Tablet
46 Ketokonazol 200 mg Tablet
47 LAXAMEX,MELAXAN (Bisacodyl) Tablet
48 Methylergometrin 0,125 mg Tablet
49 Methyl Prednisolon 40 mg Tablet
50 Metronidazol 500 mg Tablet
51 Metronidazol 250 mg Tablet
52 Metformin 500 mg Tablet
53 Metochlorpramid Tablet
54 NADIK 50 mg Tablet
55 NADIK 25 mg Tablet
56 Nifedipin 10 mg Tablet
57 NOVADIUM (Loperamid 2 mg) Tablet
58 Nistatyn 100.000 IU Tablet
59 Nistatyn Vaginal 500.000 IU Tablet
60 NOZA Tablet
61 PCT 500 mg Tablet
62 Papaverin 40 mg Tablet
63 Phenitoin 30 mg Tablet
64 Pyridoxin HCL 10 mg (VIT.B6) Tablet
65 Piroxicam 20 mg Tablet
66 Pyrantel 125 mg Tablet
67 Ranitidin 150 mg Tablet
68 Simvastatin 10 mg Tablet
69 Sianocobalamin (VIT.B12) Tablet
70 SPASMECO (Hiosin-n- Tablet
butilbromid)
71 Tetracyclin 500 mg Kapsul
72 Thiamin HCL 50 mg (VIT. B1) Tablet
73 Thiamfenicol 500 mg Tablet
74 Vit.B Comp Tablet
75 Zink 10 mg Tablet

SYRUP
1 Amoxillin Syrup Kering Botol
2 Ambroxol Sy Botol
3 Antasida Sy Botol
4 Asam Mefenamat Sy Botol
5 Cotrimoxazol Suspensi Botol
6 Chloramfenicol Sy Botol
7 Cetirizine Sy Botol
8 Erytromicin Syrup kering Botol
9 GUANISTRIP, (Kolin,Pektin) Botol
10 Ibuprofen Sy Botol
12 NOVATUSIN ,PIMTRACOL,Sy Botol
13 OBH Sy Botol
14 PCT Sy Botol
16 TYALISIN Sy Botol

ZALF
1 Antifungi Doen Kombinasi Tube
2 Acyclovir 5% Tube
3 Bacitracin-Polimixin b 5 G Tube
4 Betamethasone 0,1% Tube
5 Chloramfenicol Tetes Telinga 3% Botol
6 Chloramfenicol Zalf Mata Tube
7 Gentamicin Zalf Kulit 0,1% Tube
8 Gentamicin Tetes Mata 0,3% Botol
9 Gentian Violet Botol
10 Hidrocortison Zalf Kulit 25% Tube
11 Ichtiol Zalf Pot
12 Ketokonazol 2% Tube
13 Levertran Pot
14 Miconazol 2% Tube
15 Oxytetracyclin Zalf Mata 1% Tube
16 Oxytertacyclin Zalf Kulit 3% Tube
17 Phenol Gliserol Tetes Telinga 10% Botol
18 SALEP 24 Pot
19 RECO Tetes Mata 1% (Chloramf) Botol
20 RECO Tetes TLG 1% (Chloramf) Botol
21 Salycil Talk Kotak
22
23

INJEKSI
1 ANTRAN Ampul
2 Antalgin Ampul
3 Aqua Steril Botol
4 Atropin Sulfat Ampul
5 Aminophyllin Ampul
6 Ceftriaxon Vial
7 Cefotaxim Vial
8 Dexamethason Ampul
9 Diphenhidramin HCL Ampul
10 Lidocain Ampul
11 METOLON (Metochlorpramid) Ampul
12 MYOMERGIN (Methylergometrin) Ampul
13 PITOGIN (Oxytocin) Ampul
14 Piracetam Vial
15 VIT. B1 (Thiamin HCL) Ampul
16 VIT. B12 (Cyanocobalamine) Ampul
17 VIT. K (Phytomenadion) Ampul
18 Glukosa 5% Botol
19 NaCL 0,9% Botol
20 Ringer Laktat Botol
21 Ranitidin Ampul

ALKES/BAHAN HABIS PAKAI

1 Alat Suntik 1 ml Set
2 Alat Suntik 2,5 ml Set
3 Alat Suntik 5 ml Set
4 Benang Catgut PLAN 3/0, 2/0 Roll
5 Benang Catgut CHROMIC 3/0,2/0 Roll
6 Benang SILK Roll
7 Chateter No.16 Set
8 Chateter No.18 Set
9 Etanol 70% 1000 ml Botol
10 Etanol 70% 100 ml Botol
11 Etakridin (RIVANOL) 300 ml Botol
12 Ethyl Chlorida Botol
13 Handscoen Pasang
14 HEPAFIX Roll
15 IV. Chateter No. 20 Set
16 IV. Chateter No. 22 Set
17 IV. Chateter No. 24 Set
18 INFUS SET DEWASA Set
19 INFUS SET ANAK Set
20 Kasa PEMBALUT Roll
21 Kasa HIDROFIL Roll
22 Kapas 250 gram Roll
23 Kapas 500 mg Roll
24 MASKER Buah
25 Povidon Iodine 10% 300 ml Botol
26 Povidon Iodine 10% 30 ml Botol
27 Plester Roll
28 Urine Bag Set
29 Ultrasonic Gel Botol
30 UMBILICALES CLAMP Set

UMUM BPJS JAMKESDA KS JUMLAH

JUMLAH KUNJUNGAN

Mengetahui,
Kepala Puskesmas Yang Menyerahkan Yang Melapor Yang Menerima
Petugas Pengelola Obat Petugas Pustu/Polindes
Puskesmas

Hasbullah, SKM ................................... ...................................... ...................................

NIP.19700403 199101 1 003