LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

Kode Puskesmas : Lb. 2

Puskesmas : Ansus Hal. 1
Distrik : Yapen Barat Bulan : September
Kabupaten : Kepulauan Yapen Tahun : 2022
Provinsi : Papua

SISA STOK
NO. NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED PERMINTAAN PEMBERIAN KETERANGAN
STOK OPT

1 Acetylcysteine 200 mg Tablet 0 2,000 2,000 1,600 0 400 3,400 3,000

2 Allopurinol 100 mg Tablet Tablet 500 1,700 2,200 2,100 0 100 5,100 5,000
3 Ambroksol 30 mg tab Tablet 600 1,500 2,100 1,700 0 400 2,900 2,500
4 Aminofillin 200 mg Tablet Tablet 0 0 0 0 0 0 0 0
5 Aminofillin Injeksi 24 mg/ml-10 ml Ampul 0 0 0 0 0 0 0 0
6 Amlodipin 5 mg tab Tablet 100 500 600 300 0 300 900 600
7 Amlodipin 10 mg tab Tablet 0 300 300 90 0 210 360 150
8 Amoksisillin 125 mg Sirup/ 5 ml Botol 60 ml 0 89 89 89 0 0 89 300
9 Amoksisillin 250 mg kapsul Kapsul 0 0 0 0 0 0 0 0
10 Amoksisillin 250 mg Sirup/ 5 ml Botol 60 ml 0 0 0 0 0 0 0 0
11 Amoksisillin 500 mg Tablet Tablet 0 15,000 15,000 13,700 0 1,300 33,500 32,200
12 Ampisillin 1000 mg Injeksi (Vicillin) Vial 10 20 30 5 0 25 5 25
13 Antalgin injeksi Ampul 0 0 0 0 0 0 0 0
14 Antasid DOEN Tablet kombinasi Tablet 0 4,000 4,000 3,200 0 800 4,700 4,000
15 Antasid Suspensi Botol 60 ml 20 100 120 112 0 8 187 200
16 Anti Bakteri DOEN Salep kombinasi tube 0 0 0 0 0 0 0 0
17 Anti Fungi DOEN Kombinasi Pot 6 24 30 30 0 0 81 81
18 Anti Haemoroid Suppositoria supp 0 0 0 0 0 0 0 5
19 Aqua Demin Onelab 1 Ltr Botol 1L 0 0 0 0 0 0 0 0
20 Aqua Pro Injeksi Bebas Pirogen Botol 25 ml 0 20 20 5 0 15 17 2
21 Asam Askorbat 50 mg Tablet Tablet 700 5,000 5,700 2,400 0 3,300 4,500 0
22 Asam Mefenamat 500 mg Tablet 1,300 5,000 6,300 3,100 0 3,200 6,100 3,000
23 Asam Traneksamat injeksi 100 mg/ml Ampul 0 20 20 0 0 20 0 0
24 Asam Traneksamat 500 mg Tablet 0 0 0 0 0 0 0 0
25 Asiklovir 2% cream Tube 0 10 10 10 0 0 10 100
26 Asiklovir Tablet 200 mg Tablet 100 0 100 100 0 0 100 100
 27 Asiklovir Tablet 400 mg Tablet 50 0 50 0 0 50 0 100
28 Azithromycin 500 mg tablet Tablet 80 0 80 0 0 80 0 0
29 Betametasone Krim 0,1% tube 0 100 100 100 0 0 220 220
30 Captopril Tablet 12,5 mg Tablet 100 500 600 200 0 400 200 0

: Lb. 2
Puskesmas Hal. 2

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED PERMINTAAN PEMBERIAN KETERANGAN
STOK OPT

NO. Captopril Tablet 25 mg Tablet 0 0 0 0 0 0 0 0

30 Cefadroxyl 250 mg sirker btl 60 ml 53 50 103 88 0 15 241 226
31 Cefadroxyl 500 mg kapsul Kapsul 1,000 0 1000 700 0 300 1,300 1000
32 Cefixime 100 mg Kapsul 90 0 90 0 0 90 0 0
33 Ceftriaxone injeksi 1 g Vial 10 0 10 10 0 0 40 10
34 Cetirizine 10 mg Tablet 0 0 0 0 0 0 0 0
35 Cetirizine 5 mg/5 ml Ampul 0 0 0 0 0 0 0 0
36 Ciprofloxacin 500 mg Tablet 100 0 100 0 0 100 0 0
37 Citicolin injeksi Ampul 0 0 0 0 0 0 0 0
38 Deksametasone 0,5 mg tab Tablet 3,000 10,000 13,000 7,000 0 6,000 14,500 8500
39 Deksametasone 5 mg/ml-1 ml inj Ampul 160 200 360 108 0 252 180 0
40 Difenhidramin HCl Injeksi 10 mg/ml-10 ml Vial 0 0 0 0 0 0 0 0
37 Difenhidramin HCl Injeksi 10 mg/ml-1 ml Ampul 15 30 45 37 0 8 97 0
38 Digoxin Tablet 0,5 mg Tablet 100 0 100 0 0 100 0 0
39 Dimenhidrinat tablet 50 mg Tablet 200 0 200 0 0 200 0 0
40 Domperidon 10 mg Tablet Tablet 0 500 500 500 0 0 500 500
41 Domperidon 5 mg/5 ml sirup Botol 60 ml 0 0 0 0 0 0 0 0
42 Epinefrin HCL inj Ampul 0 0 0 0 0 0 0 0
43 Ergotamine Caffeine Botol 0 0 0 0 0 0 0 0
44 Erythromycin 200 mg/ml Botol 0 30 30 30 0 0 30 50
44 Eritromisin kapsul 250 mg Kapsul 200 500 700 300 200 (ED) 200 200 0
44 Erythromycin 500 mg Kaplet Tablet 100 500 600 200 0 400 0 0
45 Etakridina ( Rivanol ) Larutan 0,1% 100 ml botol 100 ml 10 0 10 9 0 1 4 3
46 Etakridina ( Rivanol ) Larutan 0,1% 300 ml Botol 300 ml 6 0 6 6 0 0 0 0
47 Etanol 70% Larutan Btl 100 ml 0 0 0 0 0 0 0 0
48 Etanol 70% Larutan Btl 300 ml 8 0 8 3 0 5 0 5
49 Etanol 70% Larutan Btl 1000 ml 5 0 5 3 0 2 0 5
50 Etil Klorida Semprot Btl 100 ml 0 0 0 0 0 0 0 0
51 Fenilbutazon tablet 200 mg Tablet 0 0 0 0 0 0 0 0
52 Fenol Gliserol Tetes Telinga 10% botol 6 0 6 0 ED 0 0 0
53 Fitomenadion (vit. K) Injeksi 10 mg/ml-1 ml Ampul 15 40 55 33 0 22 78 30
 54 Fitomenadion (vit. K) Tablet 10 mg Tablet 0 300 300 300 0 0 900 900
55 Furosemid injeksi 10 mg/ml Ampul 0 0 0 0 0 0 0 0
56 Furosemid Tablet 40 mg Tablet 200 400 600 0 0 600 0 0
57 Garam Oralit untuk 200 ml air sacc 374 500 874 204 0 670 294 0
58 Gentamisin injeksi 40 mg/ ml Ampul 0 0 0 0 0 0 0 0
59 Gentamicin salep mata Tube 5 13 18 18 0 0 42 42
60 Gentamicin Sulfat 0,3% tetes mata Botol 22 0 22 0 ED 0 0 0
61 Gentamicin salep kulit 0,1% Tube 0 140 140 130 0 10 250 240
62 Gentian Violet Larutan 1% Botol 8 0 8 4 0 4 4 0
63 Glibenklamida Tablet 5 mg Tablet 500 0 500 0 0 500 0 0
64 Glimepiride Tablet 0 0 0 0 0 0 0 0
65 Gliseril Guaiakolat Tablet 100 mg Tablet 300 20,000 20300 10,500 0 9800 24,600 14800
66 Glukosa 10 % btl 500 ml 0 0 0 0 0 0 0 0
67
: Lb. 2
Puskesmas Hal. 3

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Glukosa Larutan Infus 5% Steril Botol 500 ml 41 0 41 4 0 37 10 20

68 Griseofulvin Tablet 125 mg Tablet 800 0 800 800 0 0 1,100 2,000
69 Hidrokortison Krim 2,5% Tube 0 18 18 18 0 0 18 100
70 Ibuprofen Tablet 200 mg Tablet 2,400 6,000 8400 7,400 0 1000 15,500 14500
71 Ibuprofen Tablet 400 mg Tablet 1,400 4,000 5400 2,500 0 2900 5,500 2600
72 Icthyol Salap Pot 30 G 0 0 0 0 0 0 0 0
73 Isosorbid Dinitrat Tab.Sublingual 5 mg Tablet 0 0 0 0 0 0 0 0
74 Kalium Permangat KMN04 Pot 10 0 10 0 0 10 0 0
75 Kalsium Laktat Tablet 500 mg Tablet 1,300 2,000 3300 1,900 0 1400 4,000 2600
75 Ketokenazol cream Tube 0 20 20 20 0 0 60 100
76 Ketokenazol Tablet 200 mg Tablet 200 150 350 300 0 50 450 400
77 Ketorolac 30 mg/ml Ampul 0 0 0 0 0 0 0 0
78. Klindamisin 300 mg kapsul Kapsul 0 0 0 0 0 0 0 0
78 Kloramfenikol 250 mg kapsul Kapsul 0 0 0 0 0 0 0 0
79 Kloramfenikol Salep Kulit Tube 0 0 0 0 0 0 0 0
80 Kloramfenikol Salep Mata 1% Tube 0 0 0 0 0 0 0 0
81 Kloramfenikol Tetes Telinga 3% Botol 5 ml 0 0 0 0 0 0 0 0
82 Klorfeniramin Maleat Tablet 4 mg tablet 288 7,896 8184 8,184 0 0 15,684 16,000
83 Kloroquin Tablet 250 mg Tablet 0 0 0 0 0 0 0 0
84 Kotrimoksazol 480 mg tablet Tablet 800 3,000 3800 2,400 0 1400 4,200 2800
85 Kotrimoksazol Suspensi Botol 60 ml 10 100 110 75 0 35 168 133
86 Levertran salep(Minyak Ikan Salep) Pot 30 gr 0 0 0 0 0 0 0 0
87 Lidocain comp inj Ampul 0 0 0 0 0 0 0 0
88 Lidocain injeksi (PEHACAIN) Ampul 0 0 0 0 0 0 0 0
89 Lidokaina 2 %. Injeksi Ampul 82 100 182 56 0 126 86 100
90 Lisol Mengandung Kresol Tersabun 50% Botol 1L 0 0 0 0 0 0 0 0
91 Loperamid tablet 2 mg Tablet 0 0 0 0 0 0 0 0
92 Loratadin tablet 10 mg Tablet 0 0 0 0 0 0 0 0
93 Magnesium sulfat inj (IV) 20% - 25 ml Vial 0 0 0 0 0 0 0 3
94 Magnesium sulfat inj (IV) 40% - 25 ml Vial 0 0 0 0 0 0 0 3
95 Metformin 500 mg tab Tablet 0 200 200 100 0 100 400 300
96 Metil prednisolone 4 mg tab Tablet 0 0 0 0 0 0 0 0
97 Metilergometrin Maleat Injeksi Ampul 20 0 20 0 0 20 0 0
98 Metilergometrin Maleat Tablet 0,125 mg Tablet 100 200 300 200 0 100 200 300
99 Metoklopramide 10 mg tab Tablet 200 0 200 0 0 200 0 0
100 Metoklopramide injeksi Ampul 0 0 0 0 0 0 0 10
101 Metronidazol Tablet 250 mg Tablet 0 0 0 0 0 0 0 0
102 Metronidazol Tablet 500 mg Tablet 0 1,500 1500 600 0 900 900 0
103 Metronidazol infus Botol 100 ml 0 0 0 0 0 0 0 0
104 Myconazol Krim 10 gram tube 0 48 48 48 0 0 105 105
104 : Lb. 2
Hal. 4

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Natrium Diklofenak Tablet 25 mg Tablet 0 1,500 1,500 850 0 650 2,500 2,000
105 Natrium Diklofenak Tablet 50 mg Tablet 0 750 750 100 0 650 100 0
106 Natrium Klorida Infus 0,9% Steril Botol 500 ml 51 0 51 9 0 42 15 0
107 Nifedipin Tablet Tablet 200 0 200 100 0 100 400 300
108 Nistatin Tablet 500.000 IU Tablet 100 0 100 0 0 100 0 0
109 Nistatin Tablet Vagina 100.000 IU Tablet 40 0 40 0 0 40 0 0
110 Obat Batuk Hitam (OBH) Sirup Botol 60 ml 0 0 0 0 0 0 0 0
111 Oksiterasiklin HCl Salep Kulit 3% tube 0 75 75 75 0 0 135 150
112 Oksiterasiklin HCl Salep Mata 1% tube 0 0 0 0 0 0 0 50
113 Oksitosin Injeksi 10 IU/ ml (Pitogin) Ampul 22 20 42 23 0 19 88 70
114 Omeprazole injeksi Vial 0 0 0 0 0 0 0 0
115 Omeprazole 20 mg caps Kapsul 30 0 30 30 0 0 0 200
116 Ondansentron 4 mg/ 2 ml inj Ampul 5 0 5 5 0 0 5 10
117 Papaverin HCl 40 mg Tablet Tablet 0 0 0 0 0 0 0 0
118 Parasetamol Drops 100 mg/ml Botol 0 0 0 0 0 0 0 0
119 Parasetamol Sirup 120 mg/ 5 ml Botol 60 ml 0 150 150 150 0 0 330 330
 120 Paracetamol 500 mg Tablet 0 13,000 13,000 12,600 0 400 26,100 25,700
121 Piracetam Tablet 0 0 0 0 0 0 0 0
121 Pirantel tablet 125 mg Tablet 52 0 52 0 0 52 0 0
122 Pirantel sirup Botol 44 0 44 0 0 44 0 0
123 Piridoxin HCl (Vit. B6) Tablet 10 mg Tablet 0 1,200 1,200 1,000 0 200 3,100 2,900
123 Piroksikam 20 mg tablet Tablet 500 1,500 2,000 1,100 0 900 2,900 2,000
124 Povidone Iodine 10% Botol 30 ml 7 0 7 7 0 0 13 13
125 Povidone Iodine 10% Botol 300 ml 0 10 10 5 0 5 14 9
126 Povidone Iodine 10% btl/60ml 0 10 10 0 0 10 8 0
127 Prednisone Tablet 5 mg Tablet 1,100 2,000 3,100 1,500 0 1,600 5,000 3,400
128 Prokain Benzil Penisillin 2,4 Juta IU Injeksi Vial 0 0 0 0 0 0 0 0
129 Prokain Benzil Penisillin 3 Juta IU Injeksi Vial 10 0 10 2 0 8 2 0
130 Ranitidine Injeksi 50 mg/2 ml Ampul 10 60 70 40 0 30 70 40
131 Ranitidine Tablet 150 mg Tablet 500 2,500 3,000 2,300 0 700 4,700 4,000
132 Ringer Laktat Infus Botol 500 ml 155 0 155 143 0 12 287 275
133 Salbutamol Tablet 2 mg Tablet 200 0 200 0 0 200 0 0
134 Salbutamol Tablet 4 mg Tablet 300 0 300 100 0 200 500 300
135 Salep 2-4 Pot 30 g 0 96 96 96 0 0 168 168
136 Salisil Bedak 2% Pot 50 g 2 50 52 32 0 20 86 66
137 Serum Anti Bisa Ular Inj. 5 ml Vial 0 0 0 0 0 0 0 1
138 Serum Anti Bisa Ular II Vial 0 0 0 0 0 0 0 0
139 Serum Anti Tetanus Injeksi 1.500 UI Ampul 0 0 0 0 0 0 0 0
140 Sianokobalamin (Vit. B12) Inj Ampul 249 200 449 139 0 310 298 100
141 Sianokobalamin (Vit. B12) tablet Tablet 100 2,000 2,100 500 0 1,600 1,400 0
142 Simvastatin 10 mg Tablet Tablet 100 0 100 0 0 100 0 0
143 : Lb. 2
Puskesmas Hal. 5

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Suldoksin pirimetamin tablet Tablet 0 0 0 0 0 0 0 0

144 Tetrasiklin HCL Kapsul 250 mg Kapsul 0 0 0 0 0 0 0 0
145 Tetrasiklin HCL Kapsul 500 mg Kapsul 0 0 0 0 0 0 0 0
146 Tiamin HCl (Vit B1) Injeksi Ampul 0 0 0 0 0 0 0 0
147 Tiamin HCl (Vit B1) Tablet 50 mg Tablet 1,400 2,000 3400 2,300 0 1100 5,000 3900
148 Vitamin B Compleks Tablet Tablet 400 6,000 6400 5,300 0 1100 11,600 10500
149 Vitamin C 500 Tablet 0 0 0 0 0 0 0 0
150 Zink Dispersible Tablet 500 100 600 300 0 300 900 600
150 Zink Sirup Botol 2 0 2 0 ED 2 0 0
151
152
 OBAT PATEN
Ambeven caps kapsul 0 0 0 0 0 0 0 100
1 Antoxid Kapsul kkapsul 0 600 600 600 0 0 900 900
2 Aspilet chew tab Tablet 0 0 0 0 0 0 0 0
2 Becomzet Tablet 200 0 200 200 0 0 200 200
3 Bicolax tab Tablet 0 0 0 0 0 0 0 0
3 Biosanbe Capsul kapsul 0 0 0 0 0 0 0 0
4 Burnazin Cream Tube 0 0 0 0 0 0 0 0
5 Caviplex (Vit D) Tablet 90 60 150 0 0 150 0 0
6 Caviplex drops Botol 10 ml 0 0 0 0 0 0 0 0
6 Cendo Lyteers tetes mata Botol 0 0 0 0 0 0 0 0
7 Cendo Tobro eye drop botol 0 0 0 0 0 0 0 0
8 Cendo Xitrol eye minidose strip 0 0 0 0 0 0 0 0
9 Combantrin Syrup Botol 34 50 84 1 0 83 0 0
10 Diapet ktk/100 0 0 0 0 0 0 0 0
11 Dulcolax Tablet Tablet 5 0 5 3 0 2 0 0
12 Dulcolax supp 5 mg anak supp 0 12 12 0 0 12 0 0
13 Dulcolax supp 10 mg dws supp 0 10 10 0 0 10 0 0
14 Eutirox Tablet 200 0 200 0 0 200 0 0
15 Elkana Tablet 0 1,100 1100 800 0 300 1,300 1000
15. Fermia Kapsul kapsul 0 0 0 0 0 0 0 0
15 Flutamol tablet Tablet 0 0 0 0 0 0 0 0
16 Gentamicin SM (Cendo Genta) btl 0 0 0 0 0 0 0 0
17 : Lb. 2
Puskesmas Hal. 6

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Hufabion kaps kapsul 0 0 0 0 0 0 0 0

18 Hufadryl sirup botol 0 0 0 0 0 0 0 0
19 Hystolan tablet Tablet 0 0 0 0 0 0 0 0
20 Imboost F Tablet Tablet 0 0 0 0 0 0 0 0
21 Kina drage Tablet 0 0 0 0 0 0 0 0
22 Neo Entrostop Tablet 6x24's Tablet 0 240 240 240 0 0 672 672
23 Neo Protifed Tablet Tablet 0 0 0 0 0 0 0 500
24 Neurobion injeksi Ampul 21 0 21 21 0 0 37 37
24 Neurosanbe Tablet 0 0 0 0 0 0 0 0
25 New diatabs Tablet 0 0 0 0 0 0 0 100
26 Novabion kapsul 0 0 0 0 0 0 0 0
27 Nymico Oral Drops (Nistatin) Botol 1 10 11 4 0 7 9 2
28 Osteoflam Tablet 0 0 0 0 0 0 0 500
29 Paramex Tsblet 0 0 0 0 0 0 0 0
30 Poncofen Kaplet Tablet 0 0 0 0 0 0 0 0
31 Premaston Tablet 0 0 0 0 0 0 0 0
32 Prenatin DF Kaplet Tablet 0 0 0 0 0 0 0 0
33 Procurma syrup Botol 0 0 0 0 0 0 0 20
34 Protexinal sirup Botol 0 0 0 0 0 0 0 0
35 Quantidex Tablet 0 0 0 0 0 0 0 500
36 San B Plex Oral Drops Botol 0 0 0 0 0 0 0 0
34 Selcom C Tablet 0 0 0 0 0 0 0 0
35 Univit syrup Botol 0 0 0 0 0 0 0 0
36 Lycalvit syrup Botol 0 0 0 0 0 0 0 0
37 Asedas Botol 0 0 0 0 0 0 0 20
38 Trifedrin Tablet 0 0 0 0 0 0 0 500
39 Scabicid Tube 0 0 0 0 0 0 0 0
40 Scabimite Tube 0 0 0 0 0 0 0 0
41. Vicalcyn syrup botol 7 0 7 7 0 0 7 20
42.
NARKOTIK
Kodein 10 mg tab Tablet 0 0 0 0 0 0 0 0
1
PSIKOTROPIKA
Clobazam 10 mg Tablet 0 0 0 0 0 0 0 0
1 Diazepam 2 mg Tablet Tablet 100 0 100 0 ED 100 0 0
2 Diazepam 5 mg Tablet Tablet 100 0 100 0 0 100 0 0
3 Diazepam Injeksi 10 mg/ml-2ml Ampul 0 0 0 0 0 0 0 0
4 Fenobarbital Injeksi 50 mg/ml- 2 ml Ampul 5 0 5 0 0 5 0 0
5 Fenobarbital Tablet 30 mg Tablet 100 0 100 0 0 100 0 0
6 Stesolid Injeksi 5 mg/ml-2ml Ampul 0 0 0 0 0 0 0 0
7 Stesolid rectal tube tube 0 0 0 0 0 0 0 0
8
 : Lb. 2
Puskesmas Hal. 7

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. PROGRAM FILARIASIS 0

Albendazol 400 mg Tablet Tablet 700 0 700 0 ED 700 0 0
1 Dietilkarbamasin sitrat Tablet Tablet 0 0 0 0 0 0 0 0
2
PROGRAM MALARIA
Artemeter injeksi i.m Ampul 0 0 0 0 0 0 0 0
1 Artesunat injeksi i.v Vial 0 40 40 29 0 11 41 50
2 Doksisiklin Kapsul Kapsul 0 0 0 0 0 0 0 0
3 Kuinina (Kinin) Tablet 222 mg 7 H2O Tablet 108 0 108 0 0 108 0 0
4 Obat Anti Malaria Tablet 2,142 2,025 4167 3,384 0 783 7,758 7,000
5 Primaquin Tablet 15 mg Tablet 50 1,000 1050 1,050 0 0 1,050 2,000
6
PROGRAM TBC
OAT Combipak Kat 1 Paket 0 0 0 0 0 0 0 0
1 OAT Kategori Anak FDC Paket 0 0 0 0 0 0 0 0
2 OAT Kategori I FDC Paket 0 0 0 0 0 0 0 0
3 OAT Kategori II FDC Paket 0 0 0 0 0 0 0 0
4

PRGRAM KUSTA
Obat Kusta MDT MB Anak blister 0 0 0 0 0 0 0 0
1 Obat Kusta MDT MB Dewasa blister 0 0 0 0 0 0 0 0
2 Obat Kusta MDT PB Anak blister 0 0 0 0 0 0 0 0
3 Obat Kusta MDT PB Dewasa blister 0 0 0 0 0 0 0 0
4
PROGRAM GIZI
Retinol (Vit A) Kapsul 100.000 IU Kapsul 0 300 300 300 0 0 900 0
1 Retinol (Vit A) Kapsul 200.000 IU Kapsul 200 600 800 700 0 100 1,750 0
2 Tablet Tambah Darah Komb. Tablet 900 8,600 9,500 6,000 0 3,500 12,000 8,500
3 Mineral Mix sacc 0 0 0 0 0 0 0 0
4

OBAT- OBAT KHUSUS

Amitriptyline 25 mg Tablet 0 0 0 0 0 0 0 0
1 Bamgetol Tablet 0 0 0 0 0 0 0 0
2 Carbamazepin Tablet 0 0 0 0 0 0 0 0
 3 Chlorpromazine 100 mg tablet Tablet 0 0 0 0 0 0 0 0
4 Chlorpromazine injeksi Ampul 0 0 0 0 0 0 0 0
5 : Lb. 2
Puskesmas Hal. 8

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Haloperidol 0,5 mg tablet Tablet 0 0 0 0 0 0 0 0

6 Haloperidol 5 mg tablet Tablet 0 0 0 0 0 0 0 0
7 Haloperidol Injeksi Ampul 0 0 0 0 0 0 0 0
8 Klozapin 25 mg tablet Tablet 0 0 0 0 0 0 0 0
9 Lodomer Injeksi Ampul 0 0 0 0 0 0 0 0
10 Risperidon 2 mg Tablet Tablet 0 0 0 0 0 0 0 0
11 Triheksifenidil 2 mg tablet Tablet 0 0 0 0 0 0 0 0
12

VAKSIN DAN IMMUNOGLOBULIN

Vaksin BCG 10 ds vial 0 0 0 0 0 0 0 0
1 Vaksin DT 10 ds vial 0 0 0 0 0 0 0 0
2 Vaksin campak 10 Ds vial 0 0 0 0 0 0 0 0
3 Vaksin polio 10 Ds vial 0 0 0 0 0 0 0 0
4 Vaksin Hepatitis B / HBIG syiringe 0 0 0 0 0 0 0 0
5 Vaksin DTP-HB 5 Ds vial 0 0 0 0 0 0 0 0
6 Vaksin TD vial 0 0 0 0 0 0 0 0
7 HBIg syiringe 0 0 0 0 0 0 0 0
8

BMHP
Abbocath / IV catheter 18 G Set 38 0 38 0 0 38 0 0
1 Abbocath / IV catheter 20 G Set 45 100 145 27 0 118 42 0
2 Abbocath / IV catheter 22 G Set 48 37 85 29 0 56 62 10
3 Abbocath / IV catheter 24 G Set 32 50 82 12 0 70 36 0
4 Abbocath / IV catheter 26 G Set 10 20 30 11 0 19 11 10
5 Alat suntik 0,5 ml pcs 200 100 300 200 0 100 200 100
6 Alat Suntik Sekali Pakai 0.05 ml pcs 200 0 200 2 0 198 2 0
7 Alat Suntik Sekali Pakai 1 ml pcs 220 0 220 1 0 219 1 0
8 Alat Suntik Sekali Pakai 2,5 ml pcs 255 200 455 111 0 344 189 0
9 Alat Suntik Sekali Pakai 3 ml pcs 302 1,000 1302 96 0 1206 231 0
 10 Alat Suntik Sekali Pakai 5 ml pcs 120 1,000 1120 116 0 1004 278 0
11 Alkohol Swab pcs 0 1,000 1000 0 0 1000 0 0
12
: Lb. 2
Puskesmas Hal. 9

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Anisol btl 0 0 0 0 0 0 0 0

13 Aseptan Lig Botol 500 ml 0 5 5 2 0 3 5 0
14 Aseptic gel Botol 500 ml 5 0 5 3 0 2 6 0
15 Autoclick device Set 0 0 0 0 0 0 0 0
16 Baju Hazmat Set 10 0 10 7 0 3 7 0
17. Bisturi / Scalpel No 23 pcs 18 100 118 45 0 73 129 56
17 Blood Lancet pcs 0 0 0 0 0 0 0 0
18 Blood Lancet 26 G pcs 200 1,000 1200 0 0 1200 0 0
19 Bola isap/bulb filler / karet pompa pipet pcs 0 0 0 0 0 0 0 0
20 Box Slide / Kotak Sediaan Box 0 0 0 0 0 0 0 0
21 Buku TB 05 Buku 0 0 0 0 0 0 0 0
22 Buku TB 06 Buku 0 0 0 0 0 0 0 0
23 Buku TB 09 Buku 0 0 0 0 0 0 0 0
24 Buku TB 10 Buku 0 0 0 0 0 0 0 0
25 Buku TB 12 buku 0 0 0 0 0 0 0 0
26 Catgut/Benang bedah no.2/0-3/0 pcs 91 48 139 56 0 83 110 27
27 Folley Catheter 2 way 16 Fr set 2 0 2 1 0 1 1 0
28 Folley Catheter 2 way 18 Fr Set 1 0 1 0 0 1 0 0
29 Formalin btl 1 L 0 0 0 0 0 0 0 0
30 Handscrub / one scrub 500 ml btl 500 ml 3 0 3 1 0 2 1 0
31 Hb Sahli paket 0 0 0 0 0 0 0 0
32 Hidrogen Peroksida (H2O2) Btl 100 ml 0 0 0 0 0 0 0 0
33 Imersi Oil Btl 25 ml 0 0 0 0 0 0 0 0
34 Imersi Oil btl 20 ml btl 0 0 0 0 0 0 0 0
35 Infusion Set Anak Set 32 0 32 25 0 7 58 51
36 Infusion Set Dewasa Set 7 50 57 57 0 0 135 135
37 Jarum Hecting Kulit OneMed BT11 pcs 0 0 0 0 0 0 0 0
38 Jarum Hecting Kulit OneMed BT13 pcs 0 0 0 0 0 0 0 0
39 Jarum Hecting Kulit OneMed BT9 pcs 0 0 0 0 0 0 0 0
40 Jarum Hecting Kulit OneMed GR13 pcs 0 0 0 0 0 0 0 0
41 Jarum Hecting Kulit OneMed GR9 pcs 0 0 0 0 0 0 0 0
42 Jarum Hecting Kulit OneMed GT11 pcs 0 0 0 0 0 0 0 0
43 Jarum Hecting Kulit OneMed GT13 pcs 0 0 0 0 0 0 0 0
 44 Jarum Hecting Kulit OneMed GT14 pcs 0 0 0 0 0 0 0 0
45 Jarum Hecting Kulit OneMed GT15 pcs 0 0 0 0 0 0 0 0
46 Jarum Hecting Kulit OneMed GT15 pcs 0 0 0 0 0 0 0 0
47 Jarum Hecting Otot OneMed GR11 pcs 0 0 0 0 0 0 0 0
48 Kantong Urine (Urine Bag) 2 L Set 13 0 13 2 0 11 6 0
49 : Lb. 2
Puskesmas Hal. 10

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Kapas Berlemak 500 gram Rol 3 0 3 0 0 3 0 0

50 Kapas Pembalut 250 gram Rol 3 10 13 4 0 9 4 0
51 Kapas Pembalut 50 gram Rol 0 0 0 0 0 0 0 0
52 Kapass Pembalut 100 gram Rol 7 0 7 5 0 2 14 12
53 Kapas 25 gram Rol 10 0 10 5 0 5 14 9
53 Kasa Hidrofil 36 x 80 cm Rol 5 0 5 1 0 4 1 0
53 Kasa Kompres 40/40 Steril Rol 0 0 0 0 0 0 0 0
54 Kasa Pembalut 2 m x 80 cm Rol 15 0 15 5 0 10 8 10
55 Kasa Pembalut 4 y x 10 cm Rol 31 0 31 19 0 12 55 43
56 Kasa Pembalut 4 y x 15 cm Rol 15 100 115 60 0 55 120 100
57 Kasa Pembalut 4 y x 3 cm Rol 0 0 0 0 0 0 0 0
58 Kasa Steril 16 X 16 Cm Ktk/16 9 30 39 33 0 6 66 100
59 Kertas Lakmus bks/5 0 0 0 0 0 0 0 0
60 Kertas pH 0-14 (indikator universal) strip tes 0 0 0 0 0 0 0 0
61 Kertas Puyer lembar 0 0 0 0 0 0 0 0
62 Larutan EDTA Btl 100 ml 0 0 0 0 0 0 0 0
63 Larutan Giemsa Stain btl 500 ml 0 0 0 0 0 0 0 0
64 Larutan HCl 0,1 N Btl/100 ml 0 0 0 0 0 0 0 0
65 Larutan Turk btl/20 0 0 0 0 0 0 0 0
66 Masker Anak pcs 50 0 50 50 0 0 0 0
67. Masker Bedah/ Surgical Mask pcs 400 1,000 1400 800 0 600 1,160 600
67 Masker N95 pcs 0 25 25 25 0 0 85 85
68 Metanol Btl 100 ml 0 2 2 2 0 0 8 0
69 Micropipet fix vol 500 set 0 0 0 0 0 0 0 0
70 Mortir and Stamper Besar set 2 0 2 0 0 2 0 0
71 Mortir and Stamper kecil Set 1 0 1 0 0 1 0 0
72 Mortir and Stamper sedang Set 2 0 2 0 0 2 0 0
73 Nesco strip cholesterol (lama) strip tes 0 0 0 0 0 0 0 0
74 Nesco strip glucose (lama) strip tes 0 0 0 0 0 0 0 0
75 Nesco strip haemoglobin (lama) strip tes 0 0 0 0 0 0 0 0
76 Nesco strip uric acid (lama) strip tes 0 0 0 0 0 0 0 0
 77 Nurse cup pcs 54 100 154 20 0 134 20 0
78 Pipet tetes kca ex lokal panjang pcs 0 0 0 0 0 0 0 0
79 Pipet tetes kca ex lokal pendek pcs 0 0 0 0 0 0 0 0
80 Plastik klip 5x8 pcs 1,000 1,000 2,000 700 0 1,300 1,000 1,000
81 Plastik Klip Obat 7 x 10 cm pcs 0 3,000 3,000 2,100 0 900 3,000 3,000
82 Plastik Klip Obat 8,7 x 13 cm pcs 0 1,400 1400 1,400 0 0 2,900 3,000
83 Plester 1.25 cm x 4.5 m (0.5 x 5) (7,5 cm x 5 m) Rol 0 15 15 9 0 6 36 30
84 Hipafix Rol 0 0 0 0 0 0 0 20
85 Plester 5 cm x 4.5 m (2 x 5) (10 cm x 5 m) Rol 0 0 0 0 0 0 0 0
85 Pot Sputum pot 0 0 0 0 0 0 0 0
86 Rak Tabung Reaksi pcs 0 0 0 0 0 0 0 0
87 : Lb. 2
Puskesmas Hal. 11

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Rapid Diagnostic Test (RDT) Malaria strip tes 75 500 575 575 0 0 950 1,000
88 Rapid Diagnostic Test (RDT) SD Bioline HBsAg strip tes 0 0 0 0 0 0 0 0
89 Rapid Diagnostic Test (RDT) Syphilis Hexagon/frambusia strip tes 0 0 0 0 0 0 0 0
90 Rapid Test HIV (SD) strip tes 0 0 0 0 0 0 0 0
91 Rapid Test HIV 1(Triline) strip tes 0 0 0 0 0 0 0 0
91 Rapid Test HIV 1 Right sign strip tes 0 0 0 0 0 0 0 0
92 Rapid Test HIV 2 (Focus) strip tes 0 0 0 0 0 0 0 0
93 Rapid Test HIV 2 (Oncoprobe) strip tes 0 0 0 0 0 0 0 0
94 Rapid Test HIV 3 (Vikia) strip tes 0 0 0 0 0 0 0 0
95 Reagen Zehl nielsen paket 0 0 0 0 0 0 0 0
96 Sarung Tangan Bedah No 6,5 steril Pasang 50 0 50 27 0 23 75 52
97 Sarung Tangan Bedah No 7 steril Pasang 9 0 9 9 0 0 9 100
98 Sarung Tangan Bedah No 7.5 steril Pasang 15 200 215 165 0 50 330 280
99 Sarung Tangan Bedah No 8 steril Pasang 41 100 141 59 0 82 134 52
100 Sarung Tangan Bedah No 8,5 steril Pasang 0 0 0 0 0 0 0 0
101 Sarung Tangan Exam uk. L (8-9) Pasang 100 300 400 400 0 0 850 1,000
102 Sarung Tangan Exam uk. M (7-8) Pasang 0 400 400 400 0 0 1,000 1000
103 Sarung Tangan Exam uk. S (6-7) Pasang 0 200 200 200 0 0 200 200
104 Selotif 0 0 0 0 0 0 0 0
105 Sarung Tangan Obgyn No 7.5 Pasang 43 50 93 81 0 12 255 50
105 Silk (Benang bedah sutera) No. 2/0 + jarum pcs 0 0 0 0 0 0 0 0
106 Silk (Benang bedah sutera) No. 3/0 pcs 36 72 108 20 0 88 35 0
107 Silk (Benang bedah sutera) No. 2/0 Rol 0 0 0 0 0 0 0 0
108 Slide MLR (Reg) Slide 0 0 0 0 0 0 0 0
109 Slide TB Slide 0 0 0 0 0 0 0 0
 110 Spirtus btl 1 Liter 0 0 0 0 0 0 0 0
111 Suction 46 cm pcs 5 0 5 0 0 5 0 0
112 Tes Kehamilan strip strip tes 0 0 0 0 0 0 0 100
112 Urine Strip 10 parameter strip tes 0 0 0 0 0 0 0 0
113 Vaculab Plain (Tutup Merah) pcs 0 0 0 0 0 0 0 0
114 Vacutainer tutup ungu pcs 0 0 0 0 0 0 0 0
115 Wing Nedle 25G set 8 0 8 0 0 8 0 0
116 Underpad set 5 50 55 22 0 33 52 20
117 umbilical cord klem (nylon) pcs 0 100 100 0 0 100 50 0
118 BAHAN GIGI
Articulating paper box 0 0 0 0 0 0 0 0
1 Bahan Bonding (Stae)/masterbond botol 5ml 0 0 0 0 0 0 0 0
2 Bahan Etching / scotchbond (3M) botol 15ml 0 0 0 0 0 0 0 0
3 Bahan Tambalan Komposit A2 ( 3M) tube 0 0 0 0 0 0 0 0
4 Bahan Tambalan Komposit A3/ A3.5 ( 3M) tube 0 0 0 0 0 0 0 0
5 : Lb. 2
Puskesmas Hal. 12

SISA STOK
NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED STOK OPT
PERMINTAAN PEMBERIAN KETERANGAN

NO. Bahan Tumpatan Sementara (cavit (3M)) tube 0 0 0 0 0 0 0 0

6 Calxyl/ calxyl blue tube 0 0 0 0 0 0 0 0
7 Caustinerf/ pulp X botol 0 0 0 0 0 0 0 0
8 Cresotin liquid 1 botol 0 0 0 0 0 0 0 0
9 Cresotin liquid 2 botol 0 0 0 0 0 0 0 0
10 Disposible Dental Needle 30 G pcs 0 0 0 0 0 0 0 0
11 Eugenol botol 15 ml 0 0 0 0 0 0 0 0
12 GIC (pink dan putih) Fuji 7 box 0 0 0 0 0 0 0 0
13 Gutta Percha 15 mm- 40 mm set 0 0 0 0 0 0 0 0
14 Gutta Percha 45 mm- 80 mm set 0 0 0 0 0 0 0 0
15 Hemaspoon pcs 0 0 0 0 0 0 0 0
16 Kalsium Hidroksida Pasta (Hydcal) botol 100ml 0 0 0 0 0 0 0 0
17 Klorfenol Kamfer Mentol (CHKM) botol 0 0 0 0 0 0 0 0
18 Mumifikasi pasta tube 0 0 0 0 0 0 0 0
19 N2 (pink)/ eugentin/ iodoform paste botol 0 0 0 0 0 0 0 0
20 Trikresolformalin botol 0 0 0 0 0 0 0 0
21 paper point 15-40mm set 0 0 0 0 0 0 0 0
22 paper point 45-80mm set 0 0 0 0 0 0 0 0
23
 UMUM ASKES/BPJS JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR

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