NAMA : DOKUMEN NOMOR TANGGAL

PUSKESMAS : CIEMAS PUSKESMAS CIEMAS

KECAMATAN : CIEMAS PELAPORAN BULAN/ PERIODE : SUB UNIT
KABUPATEN : SUKABUMI PERMINTAAN BULAN/ PERIODE :

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA AKHIR PERMINTAAN PEMBERIAN KET
1 2 3 4 5 6 7 8 9 10 11
1 Air untuk injeksi (Aqua pro injeksi) 20 ml botol
2 Glukosa Larutan infus 5% steril 500 ml botol
3 Natrium Klorida lart.infus 0,9% steril - 500 ml botol
4 Ringer Laktat larutan infus steril - 500 ml botol
5 Allupurinol 100 mg Tablet tablet
6 Aminofillin inj 24 mg /ml-10ml tablet
7 Aminophylin tablet 200mg tablet
8 Amitriptilin HCl tablet salut 25 mg tablet
9 Amlodipin 5 mg tablet
10 Amoksisilin Kaplet 500 mg kapsul
11 Amoksisilin Kapsul 250 mg tablet
12 Amoksisilin sirup kering 125 mg/5 ml botol
13 Amoksisilin sirup kering Forte 250 mg/5 ml botol
14 Antasida Suspensi 60 ml botol
15 Antasida DOEN tablet kombinasi tablet
16 Anti fungi DOEN komb sk pot
17 Anti Hemoroid DOEN kombinasi supp
18 Antimigren DOEN kombinasi tablet
19 Asam Asetil Salisilat (Asetosal) tablet 80 mg tablet
20 Asam Askorbat (Vit.C) tablet 50 mg tablet
21 Asam folat tablet 1 mg tablet
22 Asam mefenamat 500 mg tablet
23 Asetyl sestein 200mg tube
24 Asiklovir Tablet 400 mg tablet
25 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml botol
26 Attalpugite tab 600 mg tablet
27 Benzatin Benzil Penisilin inj.1.2 juta IU/vial tablet
28 Betahistin maleat tablet
29 Betametasone Krim 0.1% tube
30 Bisakodil Supp 10 mg supp
31 Bisoprolol tablet tablet
32 Captopril 12,5 mg tablet
33 Captopril tablet 25 mg tablet
34 Deksametason injeksi 5 mg/ml - 1 ml ampul
35 Deksametasone tablet 0.5mg tablet
36 Diasepam 2 mg tablet tablet
37 Diazepam Inj 5 ml/2ml ampul
38 Diazepam lar rektal 5mg/2,5ml supp
39 Dietilkarbamazin sitrat tablet 100 mg tablet
40 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul
41 Digoksin tablet 0,25 mg tablet
42 Doksisiklin 100 mg tablet
43 Domperidon tablet 10 mg tablet
44 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul
45 Erytromycin 250 mg tablet
46 Etambutol HCL 250 mg tube
47 Fenitoin Na kaps 100 mg kapsul
48 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
49 Fenobarbital tablet 30 mg tablet
50 Fenofibrat kaps 100 mg tablet
51 Fenoksimetil Penisilina tablet 500 mg tablet
52 Fitomenadion (Vit.K1) tablet salut 10 mg tablet
53 Furosemid tablet 40 mg tablet
54 Gentamisin tetes mata tablet
55 Glibenklamid tablet 5 mg tablet
56 Glimepiride tablet
57 Griseofulvin tablet 125 mg, micronized tablet
58 Hidroklorotiazid (HCT) tablet 25 mg tablet
59 Hidrokortison krim 2,5 % tube
60 Ibuprofen Suspensi 100mg 5ml botol
61 Ibuprofen tablet 400 mg tablet
62 Isoniazid tablet 300 mg
63 Isosorbid Dinitrat 5 mg tablet sublingual sup
64 Kalsium Glukonat Inj 100 mg/ml botol
65 Kalsium lakate (kalk) tablet tablet
66 Karbamazepin tablet 200 mg tablet
67 Karbogliserin Tetes Telinga 10% pot
68 Ketokonazol krim 2 % tube
69 Ketokonazol Tablet 200 mg tablet
70 Klindamicin 300 mg tablet
71 Klopidogrel tab 75 mg tablet
72 Kloramfenikol Kapsul 500 mg tablet
73 Kloramfenikol salep kulit 2% (bufacetin) tube
74 Kloramfenikol Salep Mata 1% - 3,5 gr tube
75 Klorfeniramin Maleat (CTM) tablet 4 mg tablet
76 Klorpromazin HCL tablet 100 mg tablet
77 Klorpromazin inj. 25 mg/ml ampul
78 Kodein HCl tablet 10 mg tablet
79 Kotrimoksazol forte tablet tablet
80 Kotrimoksazol 480 tablet tablet
81 Kotrimoksazol suspensi kombinasi botol
82 Lansoprazol 30 mg tablet
83 Lidokain inj. 2% ampul
84 Lidokain komp. injeksi kombinasi ampul
85 Loratadin tab 10 mg tablet
86 Mebendazol tablet
87 Metformin tablet 500 mg tablet
88 metil dopa tab 250 mg tablet
89 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul
90 Metilergometrin Maleat tablet salut 0,125 mg tablet
91 Metilprednisolon tablet tablet
92 Metoklorpropamid tablet 10 mg tablet
 93 Metronidazol sirup 125mg/5ml botol
94 Metronidazol tablet 500 mg tablet
95 Miconazol SK tube
96 Natrium bikarbonat tablet 500 mg tablet
97 Natrium Diklofenac 25 mg tablet
98 Nifedifin tablet 10 mg tablet
99 Nistatin 100.000 IU/gram tablet vaginal supp
100 Nistatin tablet salut gula 500.000 IU/g tablet
101 Oksitetrasiklin HCl salep 3% - 5 gram tube
102 Omeprazol 20 mg tablet
103 Ondansentron tab 8 mg tablet
104 parasetamol drop botol
105 Parasetamol Kaplet 500 mg tablet
106 Parasetamol sirup botol
107 Permetrin/scabimite krim 5 % tube
108 Pirantel Pamoat tablet 125 mg tablet
109 Pirazinamid tablet 500 mg tablet
110 Piridoksin HCl (Vit.B6) tablet 10 mg tablet
111 Prednison tablet 5 mg tablet
112 Propranolol HCl tablet 10 mg tablet
113 Ranitidin Injeksi 25 mg/ml ampul
114 Ranitidin tablet 150 mg tablet
115 Rifampisin Kapsul 600 mg tablet
116 Salbutamol tablet 2 mg tablet
117 Salep 2 - 4 kombinasi pot
118 Setirizin sir 5 mg/ 5 ml botol
119 Sianokobalamin (Vitamin B12) 50 mg tablet
120 Simvastatin 20 mg tablet
121 Teofilin tab 150 mg tablet
122 Tetrasiklin HCl Kapsul 500 mg tablet
123 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg tablet
124 Vitamin B komplek tablet tablet
125 Terbutaline sulfat ih 2.5 mg/ml supp
126 Budesonid ih .5 mg/ml supp
127 Guapenasin 100 mg tablet
128 OBH botol
129 Sterezin 5mg tablet
130 klorampenikol TT botol
131 Ambroxol sirup botol
132 bioplasenton tube
133 piroxikam tablet
134 multivit dewasa tablet
135 multivit sirup botol
136 Nistatin dropp botol
137 cefadroxil 500mg tablet
138 cefadroxil sirup botol
139 ciprofloxacin tablet
140 sukralpat botol
141 Oksitosin Injeksi 10 IU/ml ampul
142 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul
143 Magnesium Sulfat Injeksi 40% ampul
144 Kalsium Glukonat Injeksi 10% ampul
145 Ampisilin Injeksi 1000 mg/vial ampul
146 Gentamisin Injesi 40 mg/ml ampul
147 Metronidazol infus 5 mg/ml ampul
148 Fitomenadion (vit K1) injeksi 2 mg/ml ampul
149 Levotiroksin 50 mcg tablet
150 Oksitetrasiklin HCL Salep mata 1% tube
151 Ampicilin serb injeksi 1000 ml/vial ampul
152 Gentamisin injeksi 40 mg/ml ampul
153 Fenobarbital injeksi 50 mg/ml ampul
154 Diazepam injeksi 5 mg/ml ampul
155 Alat suntik sekali pakai 1 ml sach
156 Alat suntik sekali pakai 3 ml sach
157 Alat suntik sekali pakai 5 ml sach
158 alat suntik sekali pakai 10 ml sach
159 Alkohol Swab sach
160 autodisable no 0,05 ml sach
161 autodisable no. 0,5 ml sach
162 bloodset sach
163 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm sach
164 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm sach
165 ECG/USG jelly 82gr sach
166 Folley Catheter 2 way no 16 sach
167 Folley Catheter 2 way no 18 sach
168 Handscoon Non steril sach
169 Ukuran L sach
170 Ukuran M sach
171 Ukuran S sach
172 Handscoon steril sach
173 Ukuran 6.5 sach
174 Ukuran 7.0 sach
175 Ukuran 7.5 sach
176 ID Patient Adult/Dewasa Biru sach
177 ID Patient Adult/Dewasa Pink sach
178 Infusion set anak sach
179 Infusion set dewasa sach
180 IV Catheter G - 18 sach
181 IV Catheter G - 20 sach
182 IV Catheter G - 22 sach
183 Kasa hidrofil 16x16 (steril) sach
184 Kasa Kompres 40/40 steril sach
185 Kasa Pembalut 2 m x 80 cm sach
186 Kapas 250 gr sach
187 Masker sach
188 Tie on sach
189 Hijab sach
190 masker oksigen sach
191 Plester sach
192 Plester Polifix 5 cm x 1 m sach
193 Policrepe Pembalut Elastis 7,5 cm x 4,55 m sach
194 Silk 2/0 + jarum 1/2 GT 35 mm Curved Cutting sach
195 Silk 3/0 + jarum 1/2 GT 35 mm Curved Cutting sach
196 Urine bag sach
197 pot sampel sach
198 Elastic Verban 4 Inci sach
199 Alkohol 70% - 1000 ml botol
200 Antiseptik Hand Rub 500 ml botol
201 Cairan sterilisasi alat botol
202 Lisol 1 liter botol
203 Povidon Iodida 500 ml botol
204 Povidon Iodida 60 ml botol
205 Rivanol larutan 0,1% - 300 cc botol

Mengetahui, Menyetujui Yang Menyerahkan Yang Melaporkan/ Meminta

Kepala UPTD Puskesmas Ciemas Petugas Gudang Obat Puskesmas

Llis Herlina,A.M.Keb Agus Nuryadin, S.Sos Geralda Bintang Herdiana

NIP. 197105271991012001 NIP. 1970072009011002