LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

BULAN: 2023

PUSTU/POLINDES/POSKESDES :
KECAMATAN : SILAT HILIR
KABUPATEN : KAPUAS HULU
PROPINSI : KALIMANTAN BARAT

KODE STOK PENGELU SISA PEMBERI

NAMA OBAT SATUAN AWAL
PENERIM PERSEDIA
ARAN/PE STOCK
PERMINT
AN
KET
OBAT AAN AN AAN
MAKAIAN

1 2 3 4 5 6 7 8 9 10 11

GENERIK

10277 Acetylcysteine 200 mg CAPSUL

10231 Acetylsalicylic Acid 80 mg TABLET

10003 Acyclovir 200 mg TABLET

10264 Acyclovir 400 mg TABLET

10004 Acyclovir CR 5% TUBE

10005 Albendazole TABLET

10263 Albendazole Sirup 200 mg/5 ml BOTOL

10006 Allopurinol tablet 100 mg TABLET

10007 Alopurinol tablet 300 mg TABLET

10009 Ambroxol 30 mg TABLET

10010 Ambroxol syrup BOTOL

10015 Amlodipin 10 mg TABLET

10014 Amlodipin 5 mg TABLET

10018 Amoksisilin Sirup Kering 125 mg/5 mL BOTOL

10229 Amoksisilin Forte Sirup Kering BOTOL

10017 Amoksisilin kaplet 500 mg TABLET

10016 Amoksisilin kapsul 250 mg TABLET

10024 Antasida DOEN Sirup BOTOL

10025 Antasida DOEN Tablet TABLET

10026 Anti Bakteri DOEN Salep TUBE

10028 Anti Hemoroid DOEN SUPP

10027 Antifungi salep kulit POT

10030 Aqua pro Injeksi steril bebas pirogen VIAL

10259 Asam Folat 0.4 mg TABLET

10094 Asam Folat 1 mg TABLET

Asam Mefenamat tablet salut selaput
10033 TABLET
500 mg
10247 Attapulgite 600 mg TABLET

10276 Betahistin 6 mg TABLET

10037 Betametason krim 0.1% TUBE

10252 Bisakodil 5 mg TABLET

10261 Bisakodil Supp 10 mg SUPP

10260 Bisakodil Supp 5 mg SUPP

10039 Bromheksin 8 mg TABLET

10040 Calsium Lactat 500 mg TABLET

10042 Captopril 25 mg TABLET

10043 Captopril 50 mg TABLET

10049 Cetirizin sirup BOTOL

10050 Cetirizin tablet 10 mg TABLET

10246 Chloramfenikol Salep Kulit 2% TUBE

10052 Chloramfenikol salep mata 1 % TUBE

10054 Chloramfenikol tetes mata BOTOL

10055 Chloramfenikol tetes telinga 3% BOTOL

10057 Chlorpeniramin Maleat 4 mg TABLET

10061 Cimetidin 200 mg TABLET

10066 Cotrimoksazol Dewasa 480 mg TABLET

10067 Cotrimoksazol Pediatrik 120 mg TABLET

10068 Cotrimoksazol sirup 240 mg/ 5 ml BOTOL

KODE STOK PENGELU SISA PEMBERI
NAMA OBAT SATUAN PENERIM PERSEDIA PERMINT KET
OBAT AWAL
AAN AN
ARAN/PE STOCK
AAN
AN
MAKAIAN

1 2 3 4 5 6 7 8 9 10 11

10262 Cotrimoksazole Forte 960 mg TABLET

10070 Dexametason 0.5 mg TABLET

10069 Dexametason injeksi AMPUL

10077 Difenhidramin HCl inj 10 mg/ml-1 ml AMPUL

10295 Dimenhidrinat 50 mg TABLET

10081 Domperidon 10 mg TABLET

10080 Domperidon syrup BOTOL

10087 Etakridin ( Rivanol ) 300 ml BOTOL

10289 Etanol 70 % 100 ml BOTOL

10219 Etanol 70% 1 Liter BOTOL

10218 Etanol 70% 300 mL BOTOL

10092 Fenol Gliserol tetes telinga 10% BOTOL

10097 Garam Oralit untuk 200 ml air BUNGKUS

10099 Gentamisin salep kulit 0.1 % TUBE

10294 Gentamisin Salep Mata 0.3 % TUBE

10225 Gentamisin Tetes Mata BOTOL

10100 Gentian Violet larutan 1 % BOTOL

10101 Glibenklamid 5 mg TABLET

10265 Glimepiride 2 mg TABLET

10230 Glimepiride tab 1 mg TABLET

10102 Gliseril Guayakolat 100 mg TABLET

10256 Hidrokortison Krim 1% TUBE

10111 Hidrokortison krim 2.5 % TUBE

10314 Hiosina Butilbromida TABLET

10113 Ibuprofen 200 mg TABLET

10114 Ibuprofen 400 mg TABLET

10258 Ibuprofen Sirup 200 mg/5 ml BOTOL

10115 Ichtyol Zalf POT

Kalium Clorida larutan infus 7,46 %
10348 BOTOL
steril
10117 Kalium Permanganat POT

10316 Kaolin + Pektin TABLET

10120 Ketokonazol 200 mg TABLET

10119 Ketokonazol cream TUBE

10121 Ketoprofen 100 mg TABLET

10123 Levertran zalf POT

10331 Lidokain 2% inj AMPUL

10126 Lisol BOTOL

10127 Loperamid TABLET

10128 Loratadin 10 mg TABLET

10129 Magnesium Sulfat inj (IV) 20 %- 25 ml VIAL

10130 Magnesium Sulfat inj (IV) 40% - 25 ml VIAL

10134 Metformin 500 mg TABLET

10137 Metil Prednisolon 4 mg TABLET

10340 Metil Prednisolon 8 mg TABLET

10238 Metoclopramide 5 mg TABLET

10140 Metokloperamid 10 mg TABLET

10139 Metokloperamid injeksi AMPUL

10142 Metronidazol 500 mg TABLET

10248 Metronidazole Sirup 125 mg/5 ml BOTOL

10143 Mikonazol krim TUBE

10147 Natrium Diklofenak 25 mg TABLET

10148 Natrium Diklofenak 50 mg TABLET

Natrium Klorida Larutan Infus 0.9 %
10149 BOTOL
Steril
KODE STOK PENGELU SISA PEMBERI
NAMA OBAT SATUAN PENERIM PERSEDIA PERMINT KET
OBAT AWAL
AAN AN
ARAN/PE STOCK
AAN
AN
MAKAIAN

1 2 3 4 5 6 7 8 9 10 11

10151 Nifedipin 10 mg TABLET

10254 Nistatin Suspensi 100.000 UI/mL BOTOL

10154 OBH Syrup BOTOL

10162 Oksitetrasiklin HCl injeksi 50 mg VIAL

10164 Oksitetrasiklin HCl salep kulit 3 % TUBE

10163 Oksitetrasiklin HCl salep mata 1 % TUBE

10165 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL

10166 Omeprazol 20 mg CAPSUL

10168 Papaverin tablet TABLET

10172 Parasetamol 500 mg TABLET

10169 Parasetamol drop BOTOL

10170 Parasetamol sirup 120 mg/5 ml BOTOL

10266 Permetrin Krim 5% TUBE

10176 Pirantel 125 mg TABLET

10226 Pirantel Sirup BOTOL

10177 Piroksikam 20 mg TABLET

10216 Povidon Iodida 10% 30 ml BOTOL

10243 Povidon Iodida 10% 60 ml BOTOL

10217 Povidon Iodida 10% 300 ml BOTOL

10255 Povidon Iodine 10% 1 Liter BOTOL

10178 Prednison 5 mg TABLET

10181 Propiltiourasil 100 mg TABLET

10184 Ranitidin 150 mg TABLET

10183 Ranitidin Injeksi AMPUL

10185 Retinol ( Vit A ) 100.000 IU Kapsul lunak CAPSUL

10186 Retinol ( Vit A ) 200.000 IU Kapsul lunak CAPSUL

Ringer Laktat larutan infus steril (Produk
10187 BOTOL
lokal)
10287 Sabun Antibakteri BOTOL

10189 Salbutamol 2 mg TABLET

10232 Salbutamol 4 mg TABLET

10188 Salep 2-4 kombinasi POT

10190 Salisil Bedak 2 % PCS

10193 Simvastatin 10 mg TABLET

10228 Simvastatin 20 mg TABLET

10241 Spironolactone 25 mg TABLET

10194 Tablet tambah darah TABLET

10204 Thiamin (Vit B1) 50 mg TABLET

10203 Thiamin (Vit B1) Injeksi 100 mg/ml-1 ml AMPUL

10208 Vitamin B Komplek TABLET

10206 Vitamin B12 500 mcg-ml AMPUL

10207 Vitamin B12 tablet TABLET

10205 Vitamin B6 10 mg TABLET

10278 Vitamin B6 25 mg TABLET

10302 Vitamin B6 100 mg TABLET

10242 Vitamin B6 Injeksi AMPUL

10209 Vitamin C 50 mg TABLET

10210 Vitamin C 250 mg TABLET

10325 Vitamin C 500 mg TABLET

10211 Vitamin K 2 mg/ml - 1 ml AMPUL

10213 Vitamin K infant AMPUL

10212 Vitamin K Tablet TABLET

10214 Zink Sirup BOTOL

10215 Zink Tablet TABLET

 KODE STOK PENGELU SISA PEMBERI
NAMA OBAT SATUAN PENERIM PERSEDIA PERMINT KET
OBAT AWAL
AAN AN
ARAN/PE STOCK
AAN
AN
MAKAIAN

1 2 3 4 5 6 7 8 9 10 11

NON GENERIK -

20025 Alpara Sirup BOTOL

20053 Anaton TABLET

20044 Becefort TABLET

20020 Becefort Sirup BOTOL

20030 Bioron TABLET

20042 Dextral KAPLET

20033 Febrinex Sirup 60 mL BOTOL

20005 Hemafort TABLET

20006 Hustab TABLET

20043 Molexflu TABLET

20048 Multivitamin TABLET

20049 Multivitamin Sirup BOTOL

20010 Pehacain Inj AMPUL

20011 Pehavral TABLET

BAHAN MEDIS HABIS PAKAI -

30003 Alat Suntik Sekali Pakai 1 ml PCS

30005 Alat Suntik Sekali Pakai 3 ml PCS

30006 Alat Suntik Sekali Pakai 5 ml PCS

30007 Alat Suntik Sekali Pakai 10 ml PCS

30008 Alat Suntik Sekali Pakai 20 ml PCS

30109 Alat Suntik Sekali Pakai 50 ml PCS

30069 Alkohol Swab 2% PCS

30189 APD Set PAKET

30086 Apron One Plastik KANTONG

30075 Aquagel Jely TUBE

30065 Aseptic gel + Disp 500 ml BOTOL

30186 Aseptic Gel 5 L GALON

30009 Benang Sutra Silk 3/0 dgn jarum bedah PCS

30010 Bisturi PCS

30011 Blood Lancet BOX

30012 Blood Transfusi set PCS

30013 Catgut / Benang Bedah No. 2/0 chromic PCS

30014 Catgut / Benang Bedah No. 2/0 plain PCS

30015 Catgut / Benang Bedah No. 3/0 chromic PCS

30016 Catgut / Benang Bedah No. 3/0 plain PCS

30180 Cover All PCS

30018 Daryantulle / Exeltulle (Framisetin) PCS

30118 Disposible Dental/ Jarum Citoject BOX

30171 Folley Catheter no. 10 PCS

30172 Folley Catheter no. 12 PCS

30173 Folley Catheter no. 14 PCS

30019 Folley Catheter No.16 PCS

30020 Folley Catheter No.18 PCS

30022 Infusion set anak PCS

30023 Infusion set dewasa PCS

30202 Isolation Gown Size. L PASANG

30024 IV Catheter No. 18 G PCS

30025 IV Catheter No. 20 G PCS

30026 IV Catheter No. 22 G PCS

30027 IV Catheter No. 24 G PCS

30028 IV Catheter No. 26 G PCS

30029 Jarum + Benang Silk PCS

 KODE STOK PENGELU SISA PEMBERI
NAMA OBAT SATUAN PENERIM PERSEDIA PERMINT KET
OBAT AWAL
AAN AN
ARAN/PE STOCK
AAN
AN
MAKAIAN

1 2 3 4 5 6 7 8 9 10 11

30036 Kasa Pembalut 2 m x 80 cm PCS

30162 Kasa Pembalut 3.6 m x 5 cm PCS

30163 Kasa Pembalut 3.6 m x 10 cm PCS

30164 Kasa Pembalut 3.6 m x 15 cm PCS

30062 Kasa Sterile 16 x 16 KOTAK

30041 Masker PCS

30188 Masker Kain PCS

30187 Masker KN-95 PCS

30099 Masker N95 PCS

30165 Masker Nebulizer Anak PCS

30127 Masker Nebulizer Dewasa PCS

30066 Masker Oksigen Infant/Bayi PCS

30067 Masker Oksigen Anak PCS

30068 Masker Oksigen Dewasa PCS

30102 Nasal O2 size XS PCS

30103 Nasal O2 size S PCS

30104 Nasal O2 size M PCS

30105 Nasal O2 size L PCS

30070 Nurse Cap (Tutup Kepala) KOTAK

30082 OneSept Solution 500 ml BOTOL

30043 Penjepit Tali Pusat PCS

30208 Plaster Hansaplas BOX

30184 Plester Putih 15 cm x 5 m ROL

30076 Sarung Tangan L Non Steril PCS

30060 Sarung Tangan M Non Steril PCS

30185 Sarung Tangan S Non Steril PCS

30046 Sarung Tangan Steril 6.5 PCS

30047 Sarung Tangan Steril 7 PCS

30048 Sarung Tangan Steril 7.5 PCS

30050 Sarung Tangan Steril 14 ( Obgyn ) PCS

30209 Sarung Tangan Steril Obgyn M PASANG

30125 Shoe Cover (sarung kaki) BOX

30193 Shoe Cover (Sarung Sepatu) Panjang PCS

30053 Test kehamilan PCS

30079 Underpad Non Steril PACK

30055 Urine Bag PCS

LAIN-LAIN -

Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima

Plt. Kepala Puskesmas Silat Hilir Pengelola Obat Puskesmas Penanggungjawab
Silat Hilir Pustu/Polindes/Poskesdes

Ns. Juanda Sitepu, S.Kep apt. Lintang Astanovseda W, S.Farm ……………………………………………..

NIP. 19890613 201101 1 001 NIP. 19981108 202203 2 009 NIP.