LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

UNIT PENERIMA : PUSKESMAS RIJALI

KECAMATAN : SIRIMAU BULAN
KABUPATEN/KOTA : AMBON TAHUN
PROVINSI : MALUKU
STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
1 Acetylstein kapsul 200 mg Kaps 0 0 0
2 Albendazol 400 mg Tab 0 0 0
3 Allopurinol tab 100 mg Tab 1100 1100 500 600 3000
4 Allopurinol tab 300 mg Tab 700 700 0 700 1000
5 Ambroksol 30 mg Tab 0 0 0 0 3000
6 Aminophilin inj Amp 0 0 0
7 Aminophilin tab 200 mg Tab 0 0 0
8 Amitriptillin 25 mg Tab 0 0 0
9 Amlodipin 5 mg Tab 6300 6300 1550 4750 5000
10 Amlodipin 10 mg Tab 330 330 330 0 3000
11 Amoksisilin 250 mg Tab 0 0 0
12 Amoksisilin 500 mg Tab 6800 6800 3400 3400 5000
13 Amoksisilin Syr Kering 125 mg/5ml Btl 20 20 0 20 50
14 Amoksisilin Sirup Forte Btl 0 0 0
15 Antalgin tab 500 mg Tab 0 0 0
16 Antalgin Injeksi Amp 0 0 0
17 Antasida Sirup Btl 0 0 0
18 Antasida Tablet Tab 1300 1000 2300 2300 0 5000
19 Anti Bakteri Doen (Bacitrasin Salep) Tube 0 0 0
20 Anti Fungi Salep ( Salep Whitfield) Pot 50 50 8 42
21 Anti Hemoroid Suppositoria Suppo 50 50 0 50
22 Anti Migren Komb ergotamin Tab 0 0 0
23 Aqua Pro Injeksi steril Vial 24 24 9 15
24 Asam Askorbat (Vit C) tablet 50 mg Tab 7900 7900 3300 4600 5000
25 Asam Askorbat (Vit C) tablet 250 mg Tab 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
26 Asam Mefenamat 500 mg Tab 6900 6900 1500 5400 5000
27 Asam Traneksamat inj Amp 0 0 0
28 Asam Folat Tab 400 400 0 400 1000
29 Asetosal 100 mg Tab 0 0 0
30 Asam Asetilsalisilat (Aspilet,Miniaspi) Tab 0 0 0
31 Asiklovir 200 mg Tab 0 0 0
32 Asiklovir 400 mg Tab 500 500 0 500 1000
33 Asiklovir cream Tube 20 20 10 10 50
34 Atorvastatin 20 mg Tab 270 270 0 270
35 Atropin Injeksi 0.25 mg/ml Amp 0 0 0 0
36 Azytromicyn tab Tab 0 0 0
37 Benzatin Benzil Peniciline Injeksi Vial 10 10 2 8
38 Betadine Solution - 60 ml Btl 0 0 0
39 Betadine Solution - 1000 ml Btl 0 0 0
40 Besi II Sulfat (Tablet tambah darah) Tab 7500 9000 16500 16500 0 20000
41 Betahistin Mesilat 6 mg Tab 0 0 0
42 Betametason Cream Tube 75 75 25 50 200
43 Calcium Gluconate Injeksi Amp 0 0 0
44 Calsium Laktat (kalk) tab 500 mg Tab 11400 11400 1400 10000
45 Captopril 25 mg Tab 6300 6300 400 5900
46 Captopril 50 mg Tab 0 0 0
47 CD Asthenof Tetes Mata MD 0.6 ml Strip 0 0 0
48 CD Augenthonic Tetes Mata MD 0,6ml Strip 0 0 0
49 CD Carpine 1% Tetes Mata Btl 0 0 0
50 CD Catarlent Tetes Mata Btl 0 0 0
51 CD Catarlent Tetes Mata MD 0.6ml Strip 0 0 0
52 CD Efrisel 10% Tetes Mata Btl 0 0 0
53 CD Fenicol 0.25% Tetes Mata Btl 0 0 0
54 CD Floxa Tetes Mata MD 0.6 ml Strip 0 0 0
55 CD Genta 0.3% Tetes Mata Btl 0 0 0
56 CD Lyteers Tetes Mata Btl 100 100 0 100 100
57 CD Lyteers Tetes Mata MD 0.6 ml Strip 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
58 CD Mydriatil 0.5% Tetes Mata Btl 0 0 0
59 CD Pantocaine 0.5% Tetes Mata Btl 0 0 0
60 CD Pantocaine 2% Tetes Mata Btl 0 0 0
61 CD Polydek Tetes Mata Btl 0 0 0
62 CD Timol 0.5% Tetes Mata Btl 0 0 0
63 CD Tropin 0.5% Tetes Mata Btl 0 0 0
64 CD Xitrol Salep Mata Tube 0 0 0
65 CD Xitrol Tetes Mata MD 0.6 ml Strip 0 0 0
66 CD Xitrol Tetes Mata Btl 0 0 0
67 Cetrizin 10 mg Tab 1300 1300 800 500
68 Cetirizine Sirup 60 Ml Btl 0 0 0
69 Cefadroksil 500 mg Tab 0 0 0
70 Cefadroksil Sirup 125mg/5ml Btl 5 5 0 5
71 Cefiksim 100mg Kaps 0 0 0
72 Cefiksim Azitromisin Komb Tab Paket 0 0 0
73 Cefotaksim inj Vial 0 0 0
74 Ceftriakson inj Vial 0 0 0
75 Citicolin Injeksi Amp 0 0 0
76 Ciprofloksasin 500 mg Tab 300 300 100 200
77 Clyndamisin 300 mg Kaps 360 360 0 360
78 Chlorfeniramin maleat (CTM) tab 4 mg Tab 6500 6500 800 5700
79 Chlorampenicol 250 mg (Mucrotinal) Kaps 0 0 0
80 Chloramfenicol 500 mg Kaps 0 0 0
81 Chlorampenicol Salep Mata Tube 0 0 0
82 Chlorampenikol susp 125 mg/ 5 ml (Novachlor) Btl 0 0 0
83 Chlorampenikol Tetes Telinga (Erlamycetin/Recco) Btl 0 0 0
84 Cimetidin 200 mg Tab 0 0 0
85 Combivent UDV 0.5 mg (Farbivent) Vial 0 0 0
86 Colcitine Tab 0 0 0
87 Cotrimoksazol Suspensi Btl 145 145 0 145
88 Cotrimoksazol 480 mg Tab 2000 2000 300 1700
89 Cyanokobalamin ( Vit.B12) Injeksi Amp 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
90 Cyanokobalamin ( Vit.B12) Tablet Tab 0 0 0
91 Dexametason 0,5 mg tab Tab 0 0 0
92 Dexametason injeksi 5 mg/ml - 1ml Amp 37 37 1 36
93 Dextrose 5% Infus Btl 0 0 0
94 Dextrose 10% Infus Btl 0 0 0
95 Difenhidramin Inj. 10 mg/ml- 1ml Amp 55 55 0 55
96 Digoksin 0.25 mg Tab 0 0 0
97 Diltiazem HCl Tab 0 0 0
98 Dimenhidrinat 50 mg Tab 0 0 0
99 Doksisiklin kapsl 100 mg Kaps 0 0 0
100 Domperidon 10 mg Tab 1000 1000 600 400
101 Domperidone Sirup Btl 0 0 0
102 Dulcolax Tab (Bisacodly) Tab 0 0 0
103 Dulcolax Suppo 5 mg Suppo 12 12 0 12
104 Dulcolax Suppo 10 mg Suppo 0 0 0
105 Efedrin HCl 25mg/Bromifar Tab 0 0 0
106 Epinephrine Injeksi 0.1% Amp 10 10 0 10
107 Erytromicine 250 mg Tab 0 0 0
108 Erytromicine 500 mg Tab 2000 2000 500 1500
109 Erytromicine Sirup Kering Btl 0 0 0
110 Etanol 70 % - 300 ml Btl 0 0 0
111 Etanol 70 % - 1000 ml Btl 19 19 3 16
112 Fenol Gliserol Tetes Telinga Btl 0 0 0
111 Fenitoin 10 Mg Tab 0 0 0
112 Fitomenadion Inj 2 mg Amp 8 8 1 7
113 Fitomenadion Inj 10 mg Amp 0 0 0
114 Fitomenadion 10 mg Tablet Tab 0 0 0
115 Fluconazole 150 mg Tab 0 0 0
116 Furosemid 40 mg tab Tab 300 300 0 300
117 Furosemid inj Amp 0 0 0
118 Garam Oralit Sase 400 400 100 300
119 Gentamisin inj Amp 10 10 0 10
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
120 Gentamisin 0,1% Salep Kulit Tube 0 0 0
121 Gentamisin Salep Mata Tube 0 0 0
122 Gentamisin Tetes Mata Botol 0 0 0
123 Gentian Violet 1% Btl 23 23 0 23
124 Glibenklamid tablet 5 mg Tab 1000 1000 100 900
125 Gliseril Guayakolat tablet 100 mg/Guaifenesin Tab 5500 5500 2600 2900
126 Glimepirid 1 mg Tab 0 0 0
127 Glimepirid 2 mg Tab 650 650 250 400
128 Glimepirid 4 mg Tab 0 0 0
129 Glukosa Infus 10 % steril Btl 0 0 0
130 Glukosa Infus 5 % steril Btl 0 0 0
131 Griseovulfin 125 mg Tab 500 500 100 400
132 Hidroklortiaside (HCT) tablet 25 mg Tab 520 520 0 520
133 Hidrokortison cream 2,5 % Tube 264 264 24 240
134 H2O2 Cairan Btl 4 4 0 4
135 Ibuprofen 200 mg Tab 0 0 0
136 Ibuprofen 400 mg Tab 4300 4300 900 3400
137 Ibuprofen suspensi Btl 60 60 0 60
138 Isosorbid dinitrat sub lingual 5 mg Tab 100 100 0 100
139 Ketokonasole 200 mg Tab 1000 1000 0 1000
140 Ketokonazole Krim Tube 139 139 5 134
141 Ketorolac Injeksi Amp 0 0 0
142 Kombipak (Azyt-Cefix) Paket 0 0 0
143 Klorpromazin HCl tablet 100 mg Tab 0 0 0
144 Lexamet / Tidifar Tab 0 0 0
145 Lidokain inj Comp + Epinefrine 2 ml Amp 35 35 35 0
146 Lidocaine 2% Amp 0 0 0
147 Lisol - 1000 ml Btl 3 5 8 3 5
148 Loperamid 2 mg Tab 0 0 0
149 Loratadin 10mg Tab 200 200 0 200
150 Magnesium Sulfat (MgSO4) 20 Vial 9 9 0 9
151 Magnesium Sulfat (MgSO4) 40 Amp 0 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
152 Metformin HCl 500 mg Tab 2950 2950 2150 800
153 Metformin HCl 850 mg Tab 0 0 0 0
154 Metilergometrin Maleat injeksi Amp 0 0 0 0
155 Metilergometrin Maleat 0.125 mg Tab 400 400 0 400
156 Metilprednisolon 4 mg Tab 800 800 800 0
157 Metilprednisolon 8 mg Tab 0 0 0
158 Metilprednisolon 16 mg Tab 0 0 0
159 Metoklopramide 10 mg Tab 0 0 0
160 Metrodinasole tab 250 mg Tab 0 0 0
161 Metrodinasole tab 500 mg Tab 1500 1500 0 1500
162 Mikonasole Krim/salep 2% Tube 115 115 72 43
163 Mikrodial (Pil KB) Strip 0 0 0 0
164 Miniaspi 80 mg Tab 0 0 0 0
165 Natrium Diklofenak tab 50 mg Tab 1500 1500 1500 0
166 Natrium klorida lar.Infus 0,9 % steril Btl 32 32 6 26
167 Nifedipin tab 10 mg Tab 100 100 0 100
168 Nistatin 500.000 IU Tab 0 0 0 0
169 Nistatin 100.000 IU Tab 200 200 0 200
170 Oksitetrasiklin HCl inj 50 mg/ml-10 ml Vial 0 0 0 0
171 Oksitetrasiklin HCl Salep mata Tube 0 0 0 0
172 Oksitetrasiklin HCl Salep Kulit Tube 0 0 0 0
173 Oksitosin inj 10 IU/ml-1ml Amp 23 23 0 23
174 Omeprazole 20 mg Kaps 450 450 450 0
175 Ondansentron inj Amp 11 11 5 6
176 Oxibiotic Injeksi Vial 0 0 0 0
177 Papaverin 40 mg Tab 0 0 0 0
178 Parasetamol Drops Btl 0 0 0 0
179 Parasetamol Syrup 120 mg/ 5 ml Btl 340 340 25 315
180 Parasetamol 500 mg Tab 7800 7800 3200 4600
181 Pehacain inj Amp 0 0 0 0
182 Piracetam 400 mg Tab 0 0 0 0
183 Piracetam Injeksi Amp 0 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
184 Piroksikam 10 mg Tab 0 0 0 0
185 Piroksikam 20 mg Tab 0 0 0 0
186 Povidon iodida 10 % - 30 ml Btl 0 0 0 0
187 Povidon iodida 10 % - 60 ml Btl 0 0 0 0
188 Povidon iodida 10 % - 300 ml Btl 0 0 0 0
189 Povidon iodida 10 % - 1000 ml Btl 0 0 0 0
190 Prednison 5 mg Tab 0 0 0 0
191 Primakuin Tab 0 0 0 0
192 Probenid 500 mg Tab 0 0 0 0
193 Propranolol HCl 40 mg Tab 0 0 0 0
194 Propil tiouracil tablet 100 mg Tab 200 200 0 200
195 Pyrantel tab 125 mg Tab 0 0 0 0
196 Pyrantel Sirup Btl 0 0 0 0
197 Pyridoxin 10 mg (vit.B6) tablet Tab 0 0 0 0
198 Ranitidin inj Amp 19 19 14 5
199 Ranitidin tablet 150 mg Tab 1000 1000 2000 800 1200
200 Resperidon 2 mg Tab 0 0 0 0
201 Retinol 100.000 IU Softkaps 500 500 200 300
202 Retinol 200.000 IU Softkaps 1250 1250 50 1200
203 Rimfampicin 450 mg Kaps 0 0 0 0
204 Ringer lactat lar.infus Btl 40 40 1 39
205 Rivanol larutan 0,1 % Btl 8 8 0 8
206 Salbutamol 4 mg tab Tab 0 0 0 0
207 Salep 2-4 Pot 80 80 0 80
208 Salicyl bedak 2 % Ktk 54 54 6 48
209 Simvastatin tab 10 mg Tab 700 700 700 0
210 Simvastatin tab 20 mg Tab 3850 3850 1650 2200
211 Spironolactone 100 mg Tab 0 0 0 0
212 Sulfadiazine Krim Tube 0 0 0 0
213 Tetraciklin HCL kap 500 mg Kaps 0 0 0 0
214 Thiamin HCL injeksi Amp 0 0 0 0
215 Thiamin HCL/Mononitrat (Vit. B1) tab 50 mg Tab 4400 4400 1400 3000
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
216 Vitamin B compleks tab Tab 5400 5400 2900 2500
217 Vitamin B 12 Tablet Tab 0 0 0 0
218 Zink Tablet Tab 0 0 0 0
219 Zink Sirup Btl 0 0 0 0
OBAT - OBAT TERTENTU ( OOT )
1 Carbamazepin tablet 200mg Tab 0 0 0
2 Dores Tab 0 0 0
3 Haloperidol 1.5 mg Tab 0 0 0
4 Haloperidol 5 mg Tab 0 0 0
5 Lodomer 2 mg Tab 0 0 0
6 Triheksifenidil Tablet 2 mg Tab 0 0 0

NARKOTIKA
1 Kodein Fosfat tab 10 mg Tab 35 35 0 35
2 Kodein Fosfat tab 15 mg Tab 0 0 0

PSIKOTROPIKA
1 Alprazolam 0,25 mg Tab 0 0 0
2 Alprazolam 1 mg Tab 0 0 0
3 Diazepam 2 mg tab Tab 0 0 0
4 Diazepam 5 mg tab Tab 260 260 21 239
5 Diazepam Injeksi Amp 0 0 0
6 Diazepam Rektal Tube 0 0 0
7 Fenobarbital tab. 30 mg Tab 0 0 0
9 Metaneuron Tab 0 0 0
10 Stesolid supp 5 mg Tube 0 0 0
11 Stesolid supp 10 mg Tube 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
12 Valisanbe Tablet 2 mg Tab 0 0 0
13 Valisanbe Tablet 5 mg Tab 0 0 0
14 melidox Tab 95 95 40 55
15 Risperidone 2mg tab 150 150 0 150

OBAT GIGI
1 Anastetik Lokal Gigi Ampul 0 0 0
2 Anastetik Lokal Gigi Kombinasi Ampul 0 0 0
3 Bonding (master bond) Btl 0 0 0
4 Calsium Hidroksida Pasta Tube 0 0 0
5 Caviton Ktk 0 0 0
6 Clorfenol Khamfer Menthol (CHKM) Btl 0 0 0
7 Devitalisasi Pasta (non arsen) Btl 0 0 0
8 ETSA email Preparator Kotak 0 0 0
9 Ethyl kloride semprot Btl 0 0 0
10 Eugenol Cairan Btl 0 0 0
11 Glass Ionomer Cement Btl 0 0 0
12 Glass Ionomer Cement (Fuji FX) 0 0 0
13 Komposit A3 3M Anterior Kotak 0 0 0
14 Mummifying pasta Btl/ktk 0 0 0
15 Pasta Devitalasi (Pulpx) Kotak 0 0 0
16 Semen Seng fosfat serbuk dan cairan Btl/ Set 0 0 0
17 Trikresol Formaldehid Btl 0 0 0
18 Xylocain Spray Btl 0 0 0

PERBEKALAN KESEHATAN
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
1 Acticare Antiseptik Gen/5L 0 0 0 0
2 Acticare Antiseptik Btl/500ml 13 13 0 13
3 Acticare Antiseptik Sabun Scrub Btl/500ml 12 12 0 12
4 Acticare Handscrub / Sabun Scrub Gen/5L 2 2 0 2
5 Alat Suntik Sekali Pakai 0.05 ml Pcs 1000 1000 0 1000
6 Alat Suntik Sekali Pakai 0.5 ml Pcs 4700 4700 0 4700
7 Alat Suntik Sekali Pakai 0.3 ml Pcs 0 0 0 0
8 Alat Suntik sekali pakai 1 ml Pcs 1136 1136 0 1136
9 Alat suntik sekali pakai 3 ml Pcs 1500 1500 0 1500
10 Alat suntik sekali pakai 5 ml Pcs 550 550 0 550
11 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0
12 Alkohol 70% 1L Botol 0 0 0
13 Alkohol Swab Pcs 1100 1100 600 500
14 Aseptic Gel 500cc + Dispenser Btl 0 0 0
15 Aseptic Gel 5 liter Galon 9 9 0 9
16 Blood Lancet Pcs 1600 1600 200 1400
17 Blood Transfusi Set Pcs 0 0 0
18 Bracket ADS Btl 0 0 0
19 Cangkang Kapsul Kaps 0 0 0
20 Catgut Cromic No. 3/0 Pcs 23 23 23 0
21 Catgut Cromic No. 2/0 Pcs 12 12 12 0
22 Catgut Plain No. 3/0 Pcs 34 34 34 0
23 Catgut Plain No. 2/0 Pcs 0 0 0 0
24 Chili Plast 12,5 x4,5 Pcs 0 0 0 0
25 Cover Glass Pcs 2000 2000 0 2000
26 Cuticell 10 x 10 cm Pcs 0 0 0
27 Fixomul Rol 0 0 0
28 Folley Cateter No. 16 Pcs 5 5 0 5
29 Folley Cateter No. 18 Pcs 4 4 0 4
30 HCl 0,1 N Solution Btl 0 0 0 0
31 Infusion set anak Set 0 0 0 0
32 Infusion set dewasa Set 27 27 0 27
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
33 IV Cateter No. 20 G Pcs 25 25 0 25
34 IV Cateter No. 22 G Pcs 0 0 0 0
35 IV Cateter No. 24 G Pcs 25 25 0 25
36 Kapas 250 gr Bks 13 13 0 13
37 Kapas 500 gr Bks 8 8 0 8
38 Kapas 1000 gr Bks 3 3 0 3
39 Kasa Hydrofil steril 16 x 16 cm Lembar 304 304 4 300
40 Kasa Hydrofil steril 10 x 10 cm Rol 0 0 0 0
41 Kasa Hydrofil steril 5 x 5 cm Rol 0 0 0 0
42 Kasa Pembalut Hydrofil 4 x 3 cm Rol 0 0 0 0
43 Kasa Pembalut Hydrofil 4 x 5 cm Rol 300 300 0 300
44 Kasa Pembalut Hydrofil 4 x 10 cm Rol 0 0 0 0
45 Kasa Pembalut Hydrofil 4 x 15cm Rol 300 300 0 300
46 Kasa Pembalut Hydrofil 40 x 80 yard Rol 0 0 0 0
47 Klip Obat 8 x 15 cm Pcs 0 0 0 0
48 Klip Obat 10 x 15 cm Pcs 0 0 0 0
49 Klip Obat 5 x 8 cm Pcs 900 900 0 900
50 Klip Obat 6 x 10 cm Pcs 8900 8900 0 8900
51 Klip Obat 7 x 10 cm Pcs 1200 1200 0 1200
52 Klip Obat 8 x 12 cm Pcs 3600 3600 0 3600
53 Masker Nebulizer Anak Buah 2 2 0 2
54 Masker Nebulizer Dewasa Buah 2 2 0 2
55 Leukoplast 1625H Rol 15 15 0 15
56 Maxter Exam Non Powder L Pcs 0 0 0 0
57 Maxter Exam Non Powder M Pcs 4600 4600 1600 3000
58 Maxter Exam Non Powder S Pcs 0 0 0 0
59 Masker Bedah Pcs 100 100 0 100
60 Nurce Cap Pcs 1600 1600 0 1600
61 Object Glass Pcs 0 0 0 0
62 One Scrub 500 cc + Dispenser Btl 0 0 0 0
63 One scrub 5 L Galon 35 35 0 35
64 Plesterin Pcs 6000 6000 0 6000
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
65 Plester 12,5 x 5 cm Rol 0 0 0 0
66 Plester 5 x 2 cm Rol 2 2 0 2
67 Safa Gloves No. 6 Pasang 0 0 0 0
68 Safa Gloves No. 7 Pasang 0 0 0 0
69 Safa Gloves No. 7,5 Pasang 0 0 0 0
70 Safa Gloves No. 8 Pasang 0 0 0 0
71 Safety Box Buah 5 5 0 5
72 Seide Benang Bedah uk. 100 ml Pcs 0 0 0 0
73 Surgeon Cup Pcs 0 0 0 0
74 Surgical Gloves Steril Pcs 33 33 0 33
75 Surgical Gloves Non Steril Pcs 0 0 0 0
76 Surgical Mask Earloop Plus Pcs 4000 4000 1500 2500
77 Surgical Mask Earloop Pcs 0 0 0 0
78 Surgical Mask With Visor Pcs 0 0 0 0
79 Surgical Mask Tie On Pcs 0 0 0 0
80 Surgical Grown Spulance Pcs 0 0 0 0
81 Surgical Blades No 11 Pcs 48 48 0 48
82 Surgical Blades No 12 Pcs 87 87 0 87
83 Surgical Needles Skin No. 12 Pcs 0 0 0 0
84 Silk 2/0 Pcs 142 142 142 0
85 Silk 3/0 Pcs 0 0 0 0
86 Test Glukosa Stik 850 850 850
87 Test Uric Acid Easy Touch Stik 275 275 275
88 Test Hemoglobin Easy Touch Stik 50 50 50
89 Test Kolesterol Easy Touch Stik 0 0 0
90 Test Beneheck Multisystem 3 in 1 Unit 0 0 0
91 Test Glukosa Beneheck Pcs/50 1400 1400 1400
92 Test Kolesterol Beneheck Pcs/10 0 0 0
93 Test Uric Acid Beneheck Pcs/25 75 75 75
94 Ultra/Ultraone Tes Hamil Pcs 150 150 150
95 Umbilical Pcs 38 38 38
96 Underpads Pcs 20 20 20
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
97 Urine Bag Steril Pcs 0 0 0 0
98 USG Jelly 250 ml Btl 0 0 0 0
99 Ultra Sound Transmision Gel Galon 0 0 0 0
100 Water One 1 L Btl 0 0 0 0

TAMBAHAN
1 Alpara Tab Tab 300 300 300 0
2 Amoxillin drop Btl 10 10 0 10
3 Arkine Btl 826 826 0 826
4 Anaton sirup Btl 316 316 0 316
5 Becefort sirup Tab 1600 1600 0 1600
6 Becefort tablet Tab 1 1 1 0
bisacodyl tab 100 100 100 0
7 Buscopan Injeksi Btl 0 0 0
8 Buscopan Plus tab Btl 200 200 0 200
9 caviplex drop ( Recovit Drop) Tab 0 0 0
10 Caviplex SIRUP Tab 0 0 0
11 Caviplex tab Tab 0 0 0
12 Cotrimoxazole 960mg Tab 0 0 0
13 Demacolin sirup Tab 0 0 0
14 Demacolin tab Tab 84 84 0 84
15 Dextral sirup Pcs 150 150 0 150
16 Dextral tablet Tab 0 0 0
17 Farbion Tablet tab 0 0 0
18 Fermia Tablet Tab 0 0 0
19 Geriavita Tab Tab 0 0 0
20 Lexadon (Domperidon) 10mg Tab 0 0 0
21 Molacort 0,5mg Tab 8700 8700 0 8700
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
22 Molagit tab Tab 400 400 0 400
23 Molaneuron tab Tab 0 0 0
Molapect Btl 138 0
24 Molapect Tab 700 0 0 0
25 Molavir Cream tab 0 0 0
26 Salbutamol 2 mg tab 0 0 0
27 Noza tab psg 0 0 0
28 Pharmaton Formula tab 0 0 0
29 Sarung Tangan Obgyn tab 0 0 0
30 Sivit Zinc tab 0 0 0
31 Titan Tab tab 0 0 0
32 Vitamin C 500mg Tab 0 0 0
Molapect tab pcs 4 0
33 Natrium Diklofenac 25mg Btl 4 0 0 0
34 Nistatin drop btl 0 0 0
35 Alat Suntik sekali pakai 0.3ml btl 700 0 700
36 Molapect tab Tab 700 138 0 138
37 Molapect sirup Gen/5L 138 0 0 0
38 Molexdine btl 0 0 0
39 Chlodine 4% 500ml tab 0 0 0
40 Chlodine 0,5% handrub Tab 10 0 10
41 Amoksisilin drop Tab 10 400 0 400
42 Hyoscine Butulbromide 10mg Tab 400 4000 0 4000
43 Livron-B Plex Saset 4000 0 0 0
44 Neurodex Botol 0 0 0
45 Neurobion Tablet Ktk 0 0 0
46 Taburia (Mineral Mix) Ktk 0 0 0
47 KN-3B Ktk 0 0 0
48 AMG Gloves Size M Pcs 0 0 0
49 AMG Gloves Size L Pcs 0 0 0
50 Antigen Tes Kit Unit 0 0 0
51 Blood Glucose Test Strip Btl 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
52 Daryantul Btl 0 0 0
53 Test Easy Touch 3 in 1 Gen/5L 0 0 0
54 Hand Sanitizer Alcohol Based 500 Ml Rol 0 0 0
55 Hand Sanitizer Alcohol Based 5L gen Gen 0 0 0
56 Hand Wash 5L Btl 0 0 0
57 Kasa Hidrofil 100 Y × 80 Cm Rol 0 0 0
58 Metraclin Jerrycan Cleaner Rol 0 0 0
Metraclin Jerrycan Spray Cleaner Unit 0 0 0
Zink Oxide Plaster 7,5 × 4.5 cm 0 0 0
Wound Dressing/Pharmafix 0 0 0
3 In 1 Monitoring System Speed GCU 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
KALAN BAHAN COVID-19 0
1 0 0 0
2 Pcs 0 0 0
3 Pcs 0 0 0
4 Tab 0 0 0
5 Alas Kaki pcs 0 0 0
6 Alkohol swab Pcs 0 0 0
7 APD Set Pcs 0 0 0
8 Azitromicin Pcs 0 0 0
9 Baju Hasmat pcs 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
10 Baju Hijau Tab 0 0 0
11 Baju Merah pcs 0 0 0
12 Baju XL (Coveral) Tab 0 0 0
13 Becom Zet Tab 0 0 0
14 Comvit C Pcs 0 0 0
15 Face Shield Tab 0 0 0
16 Fatigon pcs 0 0 0
17 Handsanitizer 5Liter pcs 0 0 0
18 Helm pcs 0 0 0
19 Hevit C Tab 0 0 0
20 Hidrokloroquin Tab 0 0 0
21 Kacamata Google pcs 0 0 0
22 Kloroquin Pcs 0 0 0
23 Masker Bedah Tab 0 0 0
24 Masker 4 PLY Pcs 0 0 0
25 Masker KN-95 Pcs 0 0 0
26 Masker N95 pcs 0 0 0
27 Natur E pcs 0 0 0
28 Oseltamir Phosphate psg 0 0 0
29 Plesterin Pcs 0 0 0
30 RDT (Antibodi) pcs 0 0 0
31 RDT (Antigen) Pcs 0 0 0
32 Riboquin pcs 0 0 0
33 Sarung Tangan Golden Glove Pcs 0 0 0
34 Sarung Tangan non steril Tab 0 0 0
35 Sarung Tangan Orange Tab 0 0 0
35 Sarung Tangan steril Tab 0 0 0
36 Sepatu Boat Pcs 0 0 0
37 Solida Coveral (Baju) Pcs 0 0 0
38 Sprayer Desinfektan Pcs 0 0 0
39 Surgical Gown Tab 0 0 0
40 Surgical Masker Earloop Plus 3Ply Tab 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
41 Termometer tab 0 0 0
42 Vacum Tube pcs 0 0 0
Vit D3 100mg Gen/5L 0
Vitacimin Blueberry 0
Vitamin B compleks tab (Bantuan) 0
Vitamin C 250 mg 0
0
OBAT PROGRAM 0
FILARIASIS 0
1 0
2 0
Tab 0
0
Albendazol 0
Diethylcarbamazepine ( DEC ) 0 0 0
1 0 0 0
2 Pcs 0 0 0
3 Pcs 0 0 0
4 Amp 0 0 0
5 Alat suntik sekali pakai 1 ml Pcs 0 0 0
6 Alat suntik sekali pakai 3 ml Amp 0 0 0
7 Asam traneksamat inj. Vial 0 0 0
8 Blooad Lancet Botol 0 0 0
9 CA.Glukonas inj Tube 0 0 0
10 Depogeston Injeksi 3 Bulan Amp 0 0 0
11 HCl 0,1 N Solution Strip 0 0 0
12 Oxytetracyclin Salep Mata Tab 0 0 0
13 Oxytoxin Injeksi Tab 0 0 0
14 Pil KB Kombinasi Tab 0 0 0
15 Pyrantel 125 mg Set 0 0 0
16 Retinol 100.000 IU (Vit A) Tab 0 0 0
17 Retinol 200.000 IU (Vit A) Pcs 0 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
18 Susuk KB Pcs 0 0 0
19 Tablet tambah darah komb Amp 0 0 0
Ultra Test ONEMed Sach 0
Urine Gluco Protein Test 0
Vit. K (Fitomenadion) Injeksi 0
Formula F75 0
0
TB PARU 0 0 0
1 0 0 0
2 Tab 0 0 0
3 paket 0 0 0
4 paket 0 0 0
5 Isoniazid BP 100 mg paket 0 0 0
6 OAT FDC Anak paket 0 0 0
OAT FDC kat 1 Pcs 0
OAT FDC kat 2 0
OAT FDC Sisipan 0
Sputum Pot 0
VAKSIN / IMUNISASI
1 0 0
2 Pcs 0 0
3 Pcs 0 0
4 Pcs 0 0
5 Alat Suntik 0,5 cc Pcs 0 0
6 Alat Suntik 0,05 cc Pcs 0 0
7 Alat Suntik 5 cc Bks 0 0
8 Alkohol 70% 1000 ml Pcs 0 0
9 Handscoen Pcs 0 0
10 Kapas Pembalut HIDROFIL 250 gram Vial 0 0
11 Masker Vial 0 0
12 Safety Box Vial 0 0
13 Vaksin BCG Vial 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
14 Vaksin Campak Vial 0 0
15 Vaksin DT Vial 0 0
16 Vaksin DPT - HB - HIB Vial 0 0
17 Vaksin HB0 Vial 0 0
18 Vaksin IPV Vial 0 0
19 Vaksin MR Vial 0 0
20 Vaksin Polio Vial 0 0
Vaksin Rabies ( VERORAB ) Vial
Vaksin Td
Vaksin PCV
Vaksin Rotavirus
1 0 0
2 Vial 0 0
3 Tab 0 0
4 Pcs 0 0
5 Aqua Pro injeksi Vial 0 0
6 Acyclovir 400 mg Strip 0 0
7 Alcohol Swab Tab 0 0
8 Benzatin Benzil Penicillin Injeksi Tab 0 0
9 Combipak : Azithro + Sefixim Pcs 0 0
10 Efavirenz 600 mg Tab 0 0
11 FDC Tab 0 0
12 Handscoen Tab 0 0
13 Lamivudine 150 mg Strip 0 0
14 Lamivudine 150 mg + Zidovudine Strip 0 0
15 Nivirapine 200 mg Strip 0 0
16 Rapid test Shypilis Strip 0 0
17 Rapid Tset HBSAg Strip 0 0
18 Rapid test 1 HIV Tab 0 0
19 Rapid test 2 HIV Pcs 0 0
20 Rapid test 3 HIV Pcs 0 0
Tenofovir 300 mg Pcs
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
Vacuum Tube
Vacuumtainer ( Needle)
Yellow Tip

MALARIA
21 0 0
22 Pcs 0 0
23 Tab 0 0
24 Btl 0 0
25 Blood Lancet Btl 0 0
26 Darplex ( DHP ) Pcs 0 0
27 Giemsa Pcs 0 0
28 Immersion Oil Tab 0 0
29 Kelambu Tab 0 0
30 Microslide test 0 0
Primakuin Pcs
Quinine 200 mg
RDT
Slide Box

DIARE
31 0 0
32 sach 0 0
Tab

Oralit
Zink

OBAT BPJS
510 Andalan inj 1 bln Vial 0 0 0
511 Andalan inj 3 bln Vial 20 20 6 14
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
512 Bioplacenton jelly Tube 0 0 0
4 Tab 0 0
5 Acyclovir 400 mg vial 0 0
6 Ambroxol syr vial 0 0
7 Amlodipin 10mg tube 0 0
8 Andalan inj 1 bln tube 0 0
9 Andalan inj 3 bln Tab 0 0
10 Betametason Cream strip 0 0
11 Bioplacenton Tab 0 0
12 Bisoprolol 5mg Tab 0 0
13 C.xitrol MDS Tab 0 0
14 Candesartan 16mg Tab 0 0
15 Candesartan 8mg strip 0 0
16 Caviplex Tab strip 0 0
17 Cefadroxil 500mg kapsul btl 0 0
18 Cendo Lyteers tab 0 0
19 Cendo Polydex vial 0 0
20 Cendo Xitrol btl 0 0
21 Ciprofloxacin 500mg tab 0 0
22 Combiven UDV tab 0 0
23 Curcuma plus syr Btl 0 0
24 Curcuma Tab tab 0 0
25 Demacolin Tab tab 0 0
26 Domperidon syr btl 0 0
27 Dulcolax Tab amp 0 0
28 Enervon C tab tube 0 0
29 Epexol Drop Tab 0 0
30 Farbion Inj Tab 0 0
31 Gentamicin SK Tab 0 0
32 Glimepirid 2mg tab 0 0
33 Griseofulvin 500mg tube 0 0
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
34 Meloxicam 15mg btl 0 0
35 Methylprednisolon 4mg btl 0 0
36 Microlax supo tab 0 0
37 Mucera drop amp 0 0
38 New Baby Cough suppo 0 0
39 Omeprazole 20 mg amp 0 0
40 Pitogin injeksi vial 0 0
41 Pyrexin 80 mg Suppo btl 0 0
42 Ranitidin inj btl 0 0
43 Respiven Nebul btl 0 0
44 Revital Syr tube 0 0
45 San B plex drop Tab 0 0
46 Sanmol drop tab 0 0
47 Scabimite 10gr Tab 0 0
48 Scopma tab Btl 0 0
49 Simvastatin 10mg tube 0 0
50 Simvastatin 20mg vial 0 0
51 Sucralfate syr Tab 0 0
52 Thrombophob Gel Tab 0 0
53 Ventolin tab 0 0
54 Vitalong C tab 0 0
55 Vitamin B12 tab btl 0 0
56 Zecaneuron pcs 0 0
57 Prednison 5 mg pcs 0 0
58 Mucos drop Tab 0 0
59 Maxiflow dewasa Kaps 0 0
60 Maxiflow anak tab 0 0
61 Amlodipin 5 mg tab 0 0
62 Cefixime 200mg tab 0 0
63 Allopurinol 300 tab 0 0
Parasetamol 500mg tab
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6-(7+8) 10
Cetrizin 10 mg
Vitamin B6
Analsik

H KUNJUNGAN RESEP
JUMLAH
RESEP BPJS
BAYAR GRATIS/KTP
120 747 634 1501

Ambon, 2023

Yang Menerima
Yang Meminta/Melapor Petugas Puskesmas
Pimpinan Puskesmas

( )
: JANUARI
: 2023

PERMINTAAN KET

11 12
PERMINTAAN KET

11 12

pkm tiahahu
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11 12

2000

50

1000

5000
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2000

1000
PERMINTAAN KET

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Formulir Pelaporan Obat
FORM PEMANTAUAN KETERSEDIAAN OBAT DAN VAKSIN INDIKATOR DI PUSKESMAS
PERIODE PELAPORAN : JULI 2022
NAMA PUSKESMAS : Ch. M. Tiahahu ALAMAT : Jl. Imam Bonjol
PROVINSI : Maluku PENANGGUNG JAW:Paulina B. Pelasula, S.Si., Apt
NO HP : 0852-5624-6516 EMAIL :

BENTUK KETERSEDIAAN JUMLAH

NO NAMA OBAT KET
SEDIAAN ADA/TIDAK SISA STOK
1 2 3 4 5 6
1 Albendazol /Pirantel Pamoat Tablet 1 4987 / 146
2 Alopurinol Tablet 1 3290
3 Amlodipin/Kaptopril Tablet 1 990/3046
4 Amoksisilin 500 mg Tablet 1 1445
5 Amoksisilin sirup Botol 1 24
Antasida tablet kunyah/ Tablet/Botol 1 5460 /0
6 antasida suspensi
7 Asam Askorbat (Vitamin C) Tablet 1 3343

8 Asiklovir 200mg / 400 mg Tablet 0/1 0/618

9 Betametason salep Tube 1 25

Deksametason Tablet/Vial/Ampul 1 3420 / 8
10 tablet/deksametason injeksi
11 Diazepam injeksi 5 mg/ml Ampul 1 4
12 Diazepam 2 mg/ 5mg Tablet 1/0 115 /0
Dihidroartemsin+piperakuin
13 (DHP) dan primaquin Tablet 1/.1 0/100

14 Difenhidramin Inj. 10 mg/ml Ampul 1 28

Epinefrin (Adrenalin) injeksi Ampul 1 0
15 0,1 % (sebagai HCl)
Fitomenadion (Vitamin K)
16 injeksi 2 mg/ 10 mg Ampul 1/0 7/0

Furosemid 40 Tablet 1 55/36

17 mg/Hidroklorotiazid (HCT)
18 Garam Oralit serbuk Kantong 1 329
19 Glibenklamid/Metformin Tablet 1 515 / 2500
20 Hidrokortison krim/salep Tube 1 85
Kotrimoksazol (dewasa)
kombinasi Tablet/Botol 1 /.1 468 /0
21 tablet/Kotrimoksazol
suspensi
22 Lidokain inj Vial 1 94
23 Magnesium Sulfat injeksi Vial 1 10
Metilergometrin Maleat Ampul 1 0
24 injeksi 0,200 mg-1 ml
25 Natrium Diklofenak Tablet 1 2500
26 OAT FDC Kat 1 Paket 1 12
27 Oksitosin injeksi Ampul 1 0
Parasetamol sirup 120 mg / Botol 1 156
28 5 ml
29 Parasetamol 500 mg Tablet 1 405
30 Prednison 5 mg Tablet 1 93
31 Ranitidin 150 mg Tablet 1 230
32 Retinol 100.000/200.000 IU Kapsul 1 950/1750
33 Salbutamol Tablet 1 38
Salep Mata/Tetes Mata
34 Antibiotik Tube 1 41

35 Simvastatin Tablet 1 2820

36 Siprofloksasin Tablet 1 477
37 Tablet Tambah Darah Tablet 1 25410
38 Triheksifenidil Tablet 1 0
39 Vitamin B6 (Piridoksin) Tablet 1 0
40 Zinc 20 mg Tablet 1 1200
41 Vaksin Hepatitis B Vial 1 14
42 Vaksin BCG Ampul 1 5
43 Vaksin DPT-HB-HIB Vial 1 13
44 Vaksin Polio Vial 1 15
Vaksin Campak/Vaksin Vial/Ampul 1 161
45 Rubella

Keterangan :
* Kolom Ketersediaan (4) :
* Diisi dengan angka 1 jika obat tersebut tersedia untuk pelayanan
* Diisi dengan angka 0 jika obat tersebut tidak tersedia untuk pelayanan
* Kolom Jumlah Sisa Stok (5) : diisi jumlah stok terakhir obat di puskesmas pada periode pelaporan
 Ambon, 29 JUNI 2022
Mengetahui,
Kepala Puskesmas CH.M.Tiahahu Penanggung Jawab Farmasi

dr. Senda Wattimena, M.K.M Apt. Paulina B. Pelasula, S.Si.

NIP : 197109272006042019 NIP :
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

UNIT PENERIMA : Puskesmas Rijali

KECAMATAN : SIRIMAU BULAN : Januari
KABUPATEN/KOTA : AMBON TAHUN : 2023
PROVINSI : MALUKU
STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
1 Acetylstein kapsul 200 mg Kaps
2 Albendazol 400 mg Tab
3 Allopurinol tab 100 mg Tab 0
4 Allopurinol tab 300 mg Tab 0
5 Ambroksol 30 mg Tab
6 Aminophilin inj Amp
7 Aminophilin tab 200 mg Tab
8 Amitriptillin 25 mg Tab
9 Amlodipin 5 mg Tab
10 Amlodipin 10 mg Tab
11 Amoksisilin 250 mg Tab
12 Amoksisilin 500 mg Tab
13 Amoksisilin Syr Kering 125 mg/5ml Btl
14 Amoksisilin Sirup Forte Btl
15 Antalgin tab 500 mg Tab
16 Antalgin Injeksi Amp
17 Antasida Sirup Btl
18 Antasida Tablet Tab
19 Anti Bakteri Doen (Bacitrasin Salep) Tube
20 Anti Fungi Salep Pot
21 Anti Hemoroid Suppositoria Suppo
22 Anti Migren Komb ergotamin Tab
23 Aqua Pro Injeksi steril Vial
24 Asam Askorbat (Vit C) tablet 50 mg Tab
25 Asam Askorbat (Vit C) tablet 250 mg Tab
26 Asam Mefenamat 500 mg Tab
27 Asam Traneksamat inj Amp
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
28 Asam Folat Tab
29 Asetosal 100 mg Tab
30 Asiklovir 200 mg Tab
31 Asiklovir 400 mg Tab
32 Asiklovir cream Tube
33 Atorvastatin 20 mg Tab
34 Atropin Injeksi 0.25 mg/ml Amp
35 Azytromicyn tab Tab
36 Benzatin Benzil Peniciline Injeksi Vial
37 Betadine Solution - 60 ml Btl
38 Betadine Solution - 1000 ml Btl
39 Besi II Sulfat (Tablet tambah darah) Tab
40 Betahistin Mesilat 6 mg Tab
41 Betametason Cream Tube
42 Calcium Gluconate Injeksi Amp
43 Calsium Laktat (kalk) tab 500 mg Tab
44 Captopril 25 mg Tab
45 Captopril 50 mg Tab
46 CD Asthenof Tetes Mata MD 0.6 ml Strip
47 CD Augenthonic Tetes Mata MD 0,6ml Strip
48 CD Carpine 1% Tetes Mata Btl
49 CD Catarlent Tetes Mata Btl
50 CD Catarlent Tetes Mata MD 0.6ml Strip
51 CD Efrisel 10% Tetes Mata Btl
52 CD Fenicol 0.25% Tetes Mata Btl
53 CD Floxa Tetes Mata MD 0.6 ml Strip
54 CD Genta 0.3% Tetes Mata Btl
55 CD Lyteers Tetes Mata Btl
56 CD Lyteers Tetes Mata MD 0.6 ml Strip
57 CD Mydriatil 0.5% Tetes Mata Btl
58 CD Pantocaine 0.5% Tetes Mata Btl
59 CD Pantocaine 2% Tetes Mata Btl
60 CD Polydek Tetes Mata Btl
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
61 CD Timol 0.5% Tetes Mata Btl
62 CD Tropin 0.5% Tetes Mata Btl
63 CD Xitrol Salep Mata Tube
64 CD Xitrol Tetes Mata MD 0.6 ml Strip
65 CD Xitrol Tetes Mata Btl
66 Cetrizin 10 mg Tab
67 Cefadroksil 500 mg Tab
68 Cefadroksil Sirup Btl
69 Cefiksim 100mg Kaps
70 Cefiksim Azitromisin Komb Tab Paket
71 Cefotaksim inj Vial
72 Ceftriakson inj Vial
73 Citicolin Injeksi Amp
74 Ciprofloksasin 500 mg Tab
75 Clyndamisin 300 mg Kaps
76 Chlorfeniramin maleat (CTM) tab 4 mg Tab
77 Chlorampenicol 250 mg Kaps
78 Chloramfenicol 500 mg Kaps
79 Chlorampenicol Salep Mata Tube
80 Chlorampenikol susp 125 mg/ 5 ml Btl
81 Chlorampenikol Tetes Telinga Btl
82 Cimetidin 200 mg Tab
83 Combivent UDV 0.5 mg Vial
84 Colcitine Tab
85 Cotrimoksazol Suspensi Btl
86 Cotrimoksazol 480 mg Tab
87 Cyanokobalamin ( Vit.B12) Injeksi Amp
88 Cyanokobalamin ( Vit.B12) Tablet Tab
89 Dexametason 0,5 mg tab Tab
90 Dexametason injeksi 5 mg/ml - 1ml Amp
91 Dextrose 5% Infus Btl
92 Dextrose 10% Infus Btl
93 Difenhidramin Inj. 10 mg/ml- 1ml Amp
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
94 Digoksin 0.25 mg Tab
95 Diltiazem HCl Tab
96 Dimenhidrinat 50 mg Tab
97 Doksisiklin kapsl 100 mg Kaps
98 Domperidon 10 mg Tab
99 Domperidone Sirup Btl
100 Dulcolax Tab Tab
101 Dulcolax Suppo 5 mg Suppo
102 Dulcolax Suppo 10 mg Suppo
103 Efedrin HCl 25mg/Bromifar Tab
104 Epinephrine Injeksi 0.1% Amp
105 Erytromicine 250 mg Tab
106 Erytromicine 500 mg Tab
107 Erytromicine Sirup Kering Btl
108 Etanol 70 % - 300 ml Btl
109 Etanol 70 % - 1000 ml Btl
110 Fenol Gliserol Tetes Telinga Btl
111 Fitomenadion Inj 2 mg Amp
112 Fitomenadion Inj 10 mg Amp
113 Fitomenadion 10 mg Tablet Tab
114 Fluconazole 150 mg Tab
115 Furosemid 40 mg tab Tab
116 Furosemid inj Amp
117 Garam Oralit Sase
118 Gentamisin inj Amp
119 Gentamisin 0,1% Salep Kulit Tube
120 Gentian Violet 1% Btl
121 Glibenklamid tablet 5 mg Tab
122 Gliseril Guayakolat tablet 100 mg/Guaifenes Tab
123 Glimepirid 1 mg Tab
124 Glimepirid 2 mg Tab
125 Glimepirid 4 mg Tab
126 Glukosa Infus 10 % steril Btl
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
127 Glukosa Infus 5 % steril Btl
128 Griseovulfin 125 mg Tab
129 Hidroklortiaside (HCT) tablet 25 mg Tab
130 Hidrokortison cream 2,5 % Tube
131 H2O2 Cairan Btl
132 Ibuprofen 200 mg Tab
133 Ibuprofen 400 mg Tab
134 Ibuprofen suspensi Btl
135 Isosorbid dinitrat sub lingual 5 mg Tab
136 Ketokonasole 200 mg Tab
137 Ketokonazole Krim Tube
138 Ketorolac Injeksi Amp
139 Kombipak (Azyt-Cefix) Paket
140 Klorpromazin HCl tablet salut 25 mg Tab
141 Lexamet / Tidifar Tab
142 Lidokain inj Comp + Epinefrine 2 ml Amp
143 Lisol - 1000 ml Btl
144 Loperamid 2 mg Tab
145 Loratadin 10mg Tab
146 Magnesium Sulfat (MgSO4) 20 Vial
147 Magnesium Sulfat (MgSO4) 40 Amp
148 Metformin HCl 500 mg Tab
149 Metformin HCl 850 mg Tab
150 Metilergometrin Maleat injeksi Amp
151 Metilergometrin Maleat 0.125 mg Tab
152 Metilprednisolon 4 mg Tab
153 Metilprednisolon 8 mg Tab
154 Metilprednisolon 16 mg Tab
155 Metoklopramide 10 mg Tab
156 Metrodinasole tab 250 mg Tab
157 Metrodinasole tab 500 mg Tab
158 Mikonasole Krim/salep 2% Tube
159 Mikrodial (Pil KB) Strip
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
160 Miniaspi 80 mg Tab
161 Natrium Diklofenak tab 50 mg Tab
162 Natrium klorida lar.Infus 0,9 % steril Btl
163 Nifedipin tab 10 mg Tab
164 Nistatin 500.000 IU Tab
165 Nistatin 100.000 IU Tab
166 Oksitetrasiklin HCl inj 50 mg/ml-10 ml Vial
167 Oksitetrasiklin HCl Salep mata Tube
168 Oksitosin inj 10 IU/ml-1ml Amp
169 Omeprazole 20 mg Kaps
170 Ondansentron inj Amp
171 Oxibiotic Injeksi Vial
172 Papaverin 40 mg Tab
173 Parasetamol Drops Btl
174 Parasetamol Syrup 120 mg/ 5 ml Btl
175 Parasetamol 500 mg Tab
176 Pehacain inj Amp
177 Piracetam 400 mg Tab
178 Piracetam Injeksi Amp
179 Piroksikam 10 mg Tab
180 Piroksikam 20 mg Tab
181 Povidon iodida 10 % - 30 ml Btl
182 Povidon iodida 10 % - 60 ml Btl
183 Povidon iodida 10 % - 300 ml Btl
184 Povidon iodida 10 % - 1000 ml Btl
185 Prednison 5 mg Tab
186 Primakuin Tab
187 Probenid 500 mg Tab
188 Propranolol HCl 40 mg Tab
189 Propil tiouracil tablet 100 mg Tab
190 Pyrantel tab 125 mg Tab
191 Pyrantel Sirup Btl
192 Pyridoxin 10 mg (vit.B6) tablet Tab
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
193 Ranitidin inj Amp
194 Ranitidin tablet 150 mg Tab
195 Resperidon 2 mg Tab
196 Retinol 100.000 IU Softkaps
197 Retinol 200.000 IU Softkaps
198 Rimfampicin 450 mg Kaps
199 Ringer lactat lar.infus Btl
200 Rivanol larutan 0,1 % Btl
201 Salbutamol 4 mg tab Tab
202 Salep 2-4 Pot
203 Salicyl bedak 2 % Ktk
204 Simvastatin tab 10 mg Tab
205 Simvastatin tab 20 mg Tab
206 Spironolactone 100 mg Tab
207 Sulfadiazine Krim Tube
208 Tetraciklin HCL kap 500 mg Kaps
209 Thiamin HCL injeksi Amp
210 Thiamin HCL/Mononitrat (Vit. B1) tab 50 m Tab
211 Vitamin B compleks tab Tab
212 Vitamin B 12 Tablet Tab
213 Zink Tablet Tab
214 Zink Sirup Btl
OBAT - OBAT TERTENTU ( OOT )
215 Carbamazepin tablet 200mg Tab
216 Dores Tab
217 Haloperidol 1.5 mg Tab
218 Haloperidol 5 mg Tab
219 Lodomer 2 mg Tab
220 Triheksifenidil Tablet 2 mg Tab
NARKOTIKA
221 Kodein Fosfat tab 10 mg Tab
222 Kodein Fosfat tab 15 mg Tab
PSIKOTROPIKA
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
223 Alprazolam 0,25 mg Tab
224 Alprazolam 1 mg Tab
225 Diazepam 2 mg tab Tab
226 Diazepam Injeksi Amp
227 Fenobarbital tab. 30 mg Tab
228 Metaneuron Tab
229 Stesolid supp 5 mg Tube
230 Stesolid supp 10 mg Tube
231 Valisanbe Tablet 2 mg Tab
232 Valisanbe Tablet 5 mg Tab
OBAT GIGI
233 Bonding (master bond) Btl
234 Calsium Hidroksida Pasta Tube
235 Caviton Ktk
236 Clorfenol Khamfer Menthol (CHKM) Btl
237 Devitalisasi Pasta (non arsen) Btl
238 ETSA email Preparator Kotak
239 Ethyl kloride semprot Btl
240 Eugenol Cairan Btl
241 Glass Ionomer Cement Btl
242 Komposit A3 3M Anterior Kotak
243 Mummifying pasta Btl/ktk
244 Semen Seng fosfat serbuk dan cairan Btl/ Set
245 Trikresol Formaldehid Btl
246 Xylocain Spray Btl
PERBEKALAN KESEHATAN
247 Acticare Antiseptik Gen/5L
248 Acticare Antiseptik Btl/500ml
249 Acticare Antiseptik Sabun Scrub Btl/500ml
250 Acticare Handscrub / Sabun Scrub Gen/5L
251 Alat Suntik Sekali Pakai 0.05 ml Pcs
252 Alat Suntik Sekali Pakai 0.5 ml Pcs
253 Alat Suntik sekali pakai 1 ml Pcs
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
254 Alat suntik sekali pakai 3 ml Pcs
255 Alat suntik sekali pakai 5 ml Pcs
256 Alat suntik sekali pakai 10 ml Pcs
257 Alkohol Swab Pcs
258 Aseptic Gel 500cc + Dispenser Btl
259 Aseptic Gel 5 liter Galon
260 Blood Lancet Pcs
261 Blood Transfusi Set Pcs
262 Bracket ADS Btl
263 Cangkang Kapsul Kaps
264 Catgut Cromic No. 3/0 Pcs
265 Catgut Cromic No. 2/0 Pcs
266 Catgut Plain No. 3/0 Pcs
267 Catgut Plain No. 2/0 Pcs
268 Chili Plast 12,5 x4,5 Pcs
269 Cover Glass Pcs
270 Cuticell 10 x 10 cm Pcs
271 Fixomul Rol
272 Folley Cateter No. 16 Pcs
273 Folley Cateter No. 18 Pcs
274 HCl 0,1 N Solution Btl
275 Infusion set anak Set
276 Infusion set dewasa Set
277 IV Cateter No. 20 G Pcs
278 IV Cateter No. 22 G Pcs
279 IV Cateter No. 24 G Pcs
280 Kapas 250 gr Bks
281 Kapas 500 gr Bks
282 Kapas 1000 gr Bks
283 Kasa Hydrofil steril 16 x 16 cm Lembar
284 Kasa Hydrofil steril 10 x 10 cm Rol
285 Kasa Hydrofil steril 5 x 5 cm Rol
286 Kasa Pembalut Hydrofil 4 x 3 cm Rol
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
287 Kasa Pembalut Hydrofil 4 x 5 cm Rol
288 Kasa Pembalut Hydrofil 4 x 10 cm Rol
289 Kasa Pembalut Hydrofil 4 x 15cm Rol
290 Kasa Pembalut Hydrofil 40 x 80 yard Rol
291 Klip Obat 8 x 15 cm Pcs
292 Klip Obat 10 x 15 cm Pcs
293 Klip Obat 5 x 8 cm Pcs
294 Klip Obat 6 x 10 cm Pcs
295 Klip Obat 7 x 10 cm Pcs
296 Klip Obat 8 x 12 cm Pcs
297 Masker Nebulizer Anak Buah
298 Masker Nebulizer Dewasa Buah
299 Leukoplast 1625H Rol
300 Maxter Exam Non Powder L Pcs
301 Maxter Exam Non Powder M Pcs
302 Maxter Exam Non Powder S Pcs
303 Masker Bedah Pcs
304 Nurce Cap Pcs
305 Object Glass Pcs
306 One Scrub 500 cc + Dispenser Btl
307 One scrub 5 L Galon
308 Plesterin Pcs
309 Plester 12,5 x 5 cm Rol
310 Plester 5 x 2 cm Rol
311 Safa Gloves No. 6 Pasang
312 Safa Gloves No. 7 Pasang
313 Safa Gloves No. 7,5 Pasang
314 Safa Gloves No. 8 Pasang
315 Safety Box Buah
316 Seide Benang Bedah uk. 100 ml Pcs
317 Surgeon Cup Pcs
318 Surgical Gloves Steril Pcs
319 Surgical Gloves Non Steril Pcs
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
320 Surgical Mask Earloop Plus Pcs
321 Surgical Mask Earloop Pcs
322 Surgical Mask With Visor Pcs
323 Surgical Mask Tie On Pcs
324 Surgical Grown Spulance Pcs
325 Surgical Blades No 11 Pcs
326 Surgical Blades No 12 Pcs
327 Surgical Needles Skin No. 12 Pcs
328 Silk 2/0 Pcs
329 Silk 3/0 Pcs
330 Test Glukosa Stik
331 Test Uric Acid Stik
332 Test Hemoglobin Stik
333 Test Kolesterol Stik
334 Test Beneheck Multisystem 3 in 1 Unit
335 Test Glukosa Beneheck Pcs/50
336 Test Kolesterol Beneheck Pcs/10
337 Test Uric Acid Beneheck Pcs/25
338 Ultra/Ultraone Tes Hamil Pcs
339 Umbilical Pcs
340 Underpads Pcs
341 Urine Bag Steril Pcs
342 USG Jelly 250 ml Btl
343 Ultra Sound Transmision Gel Galon
344 Water One 1 L Btl
PERBEKALAN BAHAN COVID-19
345 Alas Kaki Pcs
346 APD Set Pcs
347 Azitromicin Tab
348 Baju Hasmat pcs
349 Baju Hijau Pcs
350 Baju Merah Pcs
351 Baju XL (Coveral) Pcs
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
352 Face Shield pcs
353 Fatigon Tab
354 Helm pcs
355 Hevit C Tab
356 Hidrokloroquin Tab
357 Kacamata Google Pcs
358 Kloroquin Tab
359 Masker Bedah pcs
360 Masker KN-95 pcs
361 Masker N95 pcs
362 Natur-E Tab
363 Oseltamir Phosphate Tab
364 RDT (Antibodi) pcs
365 RDT (Antigen) Pcs
366 Riboquin Tab
367 Sarung Tangan steril Pcs
368 Sarung Tangan non steril Pcs
369 Sarung Tangan Golden Glove pcs
370 Sarung Tangan Orange pcs
371 Sepatu Boat psg
372 Sprayer Desinfektan Pcs
373 Solida Coveral (Baju) pcs
374 Surgical Masker Earloop Plus 3Ply Pcs
375 Termometer pcs
376 Vacum Tube Pcs
377 Vitacimin Blueberry Tab
378 Vitamin B compleks tab (Bantuan) Tab
379 Vitamin C 250 mg Tab
TAMBAHAN
1 Molaneuron tab
2 farbion tab
3 farbion inj ampul
4 Becefort tab
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
5 Becefort sy btl
6 Fermia tab
7 Formula 75 sach
8 Dextral Syr btl
9 Vitamin C 500 mg mersi tab
10 Geriavita tab tab
11 Handsanitizer Gen 5 L Gen/5L
12 Comvit kaps kaps
13 Bcom Zet Tab
14 D3 1000 IU Tab
15 Kotrimoksasol 960 mg tab
16 Betadine Gargle (kumur) btl
17 Alpara tab
18 Amoksisilin drop btl
19 Buscopan plus tab
20 Lisol 5L Gen 5L
21 Molagit tab
22 Noza tab
23 Nistatin Drop btl
24
25
26
27
28
29
30
OBAT PROGRAM
FILARIASIS
1 Albendazol Tab
2 Diethylcarbamazepine ( DEC ) Tab
GIZI / KIA
3 Alat suntik sekali pakai 1 ml Pcs
4 Alat suntik sekali pakai 3 ml Pcs
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
5 Asam traneksamat inj. Amp
6 Blooad Lancet Pcs
7 CA.Glukonas inj Amp
8 Depogeston Injeksi 3 Bulan Vial
9 HCl 0,1 N Solution Botol
10 Oxytetracyclin Salep Mata Tube
11 Oxytoxin Injeksi Amp
12 Pil KB Kombinasi Strip
13 Pyrantel 125 mg Tab
14 Retinol 100.000 IU (Vit A) Tab
15 Retinol 200.000 IU (Vit A) Tab
16 Susuk KB Set
17 Tablet tambah darah komb Tab
18 Ultra Test ONEMed Pcs
19 Urine Gluco Protein Test Pcs
20 Vit. K (Fitomenadion) Injeksi Amp
TB PARU
21 Isoniazid BP 100 mg Tab
22 OAT FDC Anak paket
23 OAT FDC kat 1 paket
24 OAT FDC kat 2 paket
25 OAT FDC Sisipan paket
26 Sputum Pot Pcs
VAKSIN / IMUNISASI
27 Alat Suntik 0,5 cc Pcs
28 Alat Suntik 0,05 cc Pcs
29 Alat Suntik 5 cc Pcs
30 Alkohol 70% 1000 ml Pcs
31 Handscoen Pcs
32 Kapas Pembalut HIDROFIL 250 gram Bks
33 Masker Pcs
34 Safety Box Pcs
35 Vaksin BCG Vial
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
36 Vaksin Campak Vial
37 Vaksin DT Vial
38 Vaksin DPT - HB - HIB Vial
39 Vaksin HB0 Vial
40 Vaksin IPV Vial
41 Vaksin MR Vial
42 Vaksin Polio Vial
43 Vaksin Rabies ( VERORAB ) Vial
44 Vaksin Td Vial
IMS / HIV
45 Aqua Pro injeksi Vial
46 Acyclovir 400 mg Tab
47 Alcohol Swab Pcs
48 Benzatin Benzil Penicillin Injeksi Vial
49 Combipak : Azithro + Sefixim Strip
50 Efavirenz 600 mg Tab
51 FDC Tab
52 Handscoen Pcs
53 Lamivudine 150 mg Tab
54 Lamivudine 150 mg + Zidovudine Tab
55 Nivirapine 200 mg Tab
56 Rapid test Shypilis Strip
57 Rapid Tset HBSAg Strip
58 Rapid test 1 HIV Strip
59 Rapid test 2 HIV Strip
60 Rapid test 3 HIV Strip
61 Tenofovir 300 mg Tab
62 Vacuum Tube Pcs
63 Vacuumtainer ( Needle) Pcs
64 Yellow Tip Pcs
MALARIA
65 Blood Lancet Pcs
66 Darplex ( DHP ) Tab
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
67 Giemsa Btl
68 Immersion Oil Btl
69 Kelambu Pcs
70 Microslide Pcs
71 Primakuin Tab
72 Quinine 200 mg Tab
73 RDT test
74 Slide Box Pcs
DIARE
75 Oralit sach
76 Zink Tab
OBAT BPJS
1 tube
2 tab
3 vial
4 tab
5 tab
6 tube
7 Kaps
8 btl
9 tab
10 Kaps
11 tube
12 tab
13 btl
14 btl
15 tab
16 tab
17 btl
18 tab
19
20

RESEP
JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR GRATIS/KTP BPJS
 STOK RUSAK/ SISA STOK
NO NAMA OBAT SEDIAAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL KADALUARSA STOK OPTIMUM
1 2 3 4 5 6 = 4+5 7 8 9 = 6 - (7+8) 10 11 12
Ambon,

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