Recap Lplpo 2022

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESM
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : DESEMBER

KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : JANUARI
KAB/KOTA : BALIKPAPAN TAHUN : 2023
PERMIN
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7)

A. OBAT GENERIK
1 Acyclovir tablet 200 mg 15 0 15 - 15 - -
2 Acyclovir tablet 400 mg 136 300 436 201 235 261 -
3 Albendazol Tablet 400 mg 85 100 185 - 185 - -
4 Allopurinol tablet 100 mg 995 0 995 637 358 828 500
5 Allopurinol tablet 300 mg 332 0 332 132 200 172 -
6 Ambroxol 30mg Tablet 0 0 - - - -
7 Ambroxol Syrup 0 - - - -
8 Amlodipin tablet 10 mg 2210 12,780 14,990 9,890 5100 12,857 7,770
9 Amlodipin tablet 5 mg 1660 5,370 7,030 2,440 4590 3,172 -
10 Amoksisilin 125 mg Sirup Kering 47 - 47 - 47 - -
11 Amoksisilin 250 mg Sirup Kering 0 - - - 0 - -
12 Amoksisilin Drop 0 - - - - -
13 Amoksisilin kaplet 500 mg 1788 1,000 2,788 188 2600 244 -
14 Amoksisilin kapsul 250 mg 0 - - - -
15 Antasida DOEN Tablet Komb.100's 0 1,300 1,300 500 800 650 -
16 Antasida DOEN Suspensi 0 - - - 0 - -
17 Anti Hemoroid Supositoria 12 30 42 35 7 46 39
18 Aqua pro injeksi 25 ml 0 - - - -
19 Aqua pro injeksi 100 ml 13 - 13 - 13 - -
20 Asam Askorbat (Vit C) Tablet 50 mg 845 2,000 2,845 1,155 1690 1,502 -
21 Asam Askorbat (Vit C) Tablet 250 mg 0 - - - 0 - -
22 Asam Folat 0,4 mg 385 300 685 405 280 527 200
23 Asam Mefenamat kaplet 500 mg 1002 2,400 3,402 1,752 1650 2,278 600
24 Asam Traneksamat 250 mg/5ml injeksi 0 - - - -
25 Asetil Sistein kapsul 200 mg 60's 7304 - 7,304 3,394 3910 4,412 502
26 Atrofin Sulfas Injeksi 0,25 mg 2 - 2 - 2 - -
27 Ats Inj. 1.500 IU 15 - 15 9 6 12 6
28 Attapulgit tablet 600 mg 0 - - - 0 - -
29 Betahistin 6 mg 953 - 953 534 419 694 300
30 Betametason krim 56 - 56 32 24 42 18
31 Bisakodil 5 mg 100 - 100 44 56 57 -
32 Captopril tablet 12,5 mg 0 - - - - 2,000
33 Captopril tablet 25 mg 1225 2,000 3,225 1,505 1720 1,957 200
34 Captopril tablet 50 mg 0 - - - -
35 Carbamazepin tablet 200 mg 0 - - - -
36 Cefadroxil 500 mg 0 600 600 70 530 91
37 Cetirizine Syrup 5mg/5ml 3 - 3 - 3 - -
38 Cetirizine tablet 10 mg 760 - 760 400 360 520 200
39 Ciprofloksasin tablet 500 mg 401 - 401 161 240 209 -
40 Deksametason 0,5 mg tablet 100"s 0 - - - - -
41 Deksametason Injeksi 11 2 13 4 9 5 -
42 Dextrose 5% 3 3 6 3 3 4 -
43 Difenhidramin Inj. 4 - 4 - 4 - -
44 Diltiazem tablet 30 mg 0 - - - -
45 Dimenhidrinat Tablet 50 mg 1037 - 1,037 337 700 438 -
46 Domperidon Susp 0 - - - 0 - -
47 Domperidon Tablet 649 600 1,249 655 594 852 300
48 Epinefrina Inj. 0,1% 1 ml 2 1 3 - 3 - -
49 Eritromisin Sirup 0 - - - - -
50 Eritromisin tablet 250 mg 0 - - - -
51 Etanol 70%/100 ml 0 - - - -
52 Etanol 70%/1000 ml 0 - - - -
53 Etanol 70%/ 5 liter 0 -
54 Etil Klorida Semprot 0 - - - -
55 Fenol Gliserol Tetes Tlg. 10% 3 28 31 5 26 7 -
56 Fletcher Serbuk 0 - - - -
57 Flukonazol Kapsul 150 mg 0 - - - -
58 Furosemida tablet 40 mg 0 - - - 0 - -
59 Garam Oralit 200 100 300 100 200 130 -
60 Gentamisin Salep Mata 0 - - - 0 0 12
61 Gentamisin Tetes Mata 0,3% 0 - - - 0 - -
62 Glibenklamida tablet 5 mg 40 - 40 - 40 - -
63 Glimepirid tablet 2 mg 2880 - 2,880 1,780 1100 1,780 700
64 Glimepirid tablet 1 mg 200 200 - 200 0 -
65 Griseofulvin tablet 125 mg 260 - 260 23 237 30 -
66 Hidroklorotiazid tablet 25 mg 495 - 495 129 366 168 -
67 Hidrokortison Krim 2,5 % 64 - 64 43 21 56 35
68 Hyoscin N Tablet 10 mg 20 100 120 60 60 78 -
69 Ibuprofen Susp. 100 mg/5 ml 0 - - - 0 - -
70 Ibuprofen Susp. 200 mg/5 ml 9 - 9 - 9 - -
71 Ibuprofen tablet 200 mg 0 - - - 2,000
72 Ibuprofen tablet 400 mg 1820 - 1,820 700 1120 910 -
73 Isoniazid (INH) 100 mg Tablet 100's 0 - - - -
74 Isosorbide dinitrat tablet 5 mg 67 67 - 67 - -
75 Kalsium Laktat 500 mg Tablet 100's 1305 2,300 3,605 1,505 2100 1,957 -
76 Ketokonazol krim 52 - 52 16 36 21 -
77 Ketokonazol tablet 200 mg 555 - 555 75 480 98 -
78 Ketorolac Injeksi 4 4 - 4 - -
79 Kloramfenikol 0.5 % tetes mata 0 - - - 12
80 Kloramfenikol Salep Mata 1% 0 - - - 12
81 Kloramfenikol sirup 0 - - - -
82 Kloramfenikol Tetes Telinga 3% 0 - - - -
83 Klorfeniramin Maleat tablet 4 mg 2300 2,300 4,600 3,160 1440 4,108 2,700
84 Kotrimoksazol Susp 6 - 6 - 6 - -
85 Kotrimoksazol Tab 480 mg 42 - 42 22 20 29 100
86 Lidocain Injeksi 2% (HCl) 65 24 89 31 58 40 -
87 Lidocain Injeksi 2% (HCL) + Epinefrin 10 10 - 10 - -
88 Loratadin tablet 645 800 1,445 445 1000 579 -
89 Magnesium Sulfat Injeksi 20% 0 - - - -
90 Magnesium Sulfat Injeksi 40% 0 - - - 0 - -
91 Metformin tab 500 mg 0 2,700 2,700 2,700 0 3,510 4,000
92 Metil Prednisolon tablet 4 mg 1134 - 1,134 834 300 1,084 800
93 Metoklorpramide tablet 10 mg 360 - 360 90 270 117 -
94 Metronidazol tablet 250 mg 0 - - - -
95 Metronidazol tablet 500 mg 0 0 - - - 1,000
96 MGSO4 40% Injeksi 3 0 3 - 3 - -
97 Mikonazol Krim 15 24 39 - 39 - -
98 Na. Diklofenak 25 mg 3613 0 3,613 1,413 2200 1,837 -
99 Na. Diklofenak 50 mg 150 100 250 50 200 65 -
100 Natrium Klorida Infus 0.9% 9 29 38 17 21 22 1
101 Nifedipin tablet 10 mg 0 - - - -
102 Nistatin susp 100.000 IU/mL 4 0 4 - 4 - -
103 Nistatin Vaginal tablet salut 100.000 IU/g 19 0 19 12 7 16 9
104 OAT FDC Kategori 1
105 OAT FDC Kategori 2 -
106 OAT FDC Kategori Anak -
107 OAT FDC Kategori Sisipan -
108 Oksitetrasiklina Salep Mata 1% 0 - - - 20
109 Oksitosin injeksi 5 16 21 5 16 7 -
110 Omeprazol Injeksi 40mg /10ml 2 0 2 2 0 3 3
111 Omeprazol kapsul 20 mg 684 1480 2,164 1,564 600 2,033 1,400
112 Parasetamol 500 mg Tablet 100's 1885 4800 6,685 3,245 3440 4,219 800
113 Parasetamol drops 0 0 - - 0 - -
114 Parasetamol Sirup 120 mg/5 ml 155 0 155 - 155 - -
115 Permetrin Krim 5% 18 47 65 33 32 43 11
116 Phytomenadion (Vit K) Tablet 10 mg 207 0 207 - 207 - -
117 Phytomenadion (Vit K1) Inj 10 mg/ml 0 - - - -
118 Phytomenadion (Vit K1) Inj 2 mg/ml 18 0 18 8 10 10 -
119 Pirantel Pamoat Tab.125 mg 88 0 88 16 72 21 -
120 Prednison 5 mg Tablet 100's 0 - - - -
121 Primakuin Tablet 15 mg 0 - - - -
122 Propiltiourasil tablet 100 mg 0 - - - -
123 Pyridoksin (Vit B6) Tablet 10 mg 0 - - - 1,000
124 Quinin tablet 0 - - - -
125 Ranitidin Tablet 1566 0 1,566 1,191 375 1,548 1,200
126 Reserpina 0.25 mg Tablet 100's 0 - - - -
127 Ringer Laktat 0 25 25 5 20 7 -
128 Risperidon Tablet 2 mg 0 - - - -
129 Rivanol Lar 0.1% 100 ml 0 - - - -
130 Rivanol Lar 0.1% 300 ml 0 - - - -
131 Sabu Inj. 5 ml 1 0 1 - 1 - -
132 Salbutamol cairan ih 0,1% 0 - - - -
133 Salbutamol tablet 2 mg 0 0 - - - 2,000
134 Salbutamol tablet 4 mg 0 0 - - - -
135 Salisil Bedak 2% 50 gram 4 0 4 4 0 5 5
136 Salisilat + Belerang Salep 0 3 3 3 0 4 4
137 Simvastatin tablet 10 mg 2380 3000 5,380 3,230 2150 4,199 2,100
138 Simvastatin tablet 20 mg 0 0 - - - -
139 Spon Gelatin 0 - - - -
140 Sulfadiazin Silver Krim 1% 35 gr (Burnazin) 0 0 - - - -
141 Tablet Tambah Darah 0 - - 0 -
142 Thiamin (Vit B1) Tablet 50 mg 0 - - - -
143 TKF Cairan 0 - - - -
144 Vit. B Kompleks tablet 2206 500 2,706 1,406 1300 1,828 500
145 Vitamin A 100.000 UI kapsul 0 - - - -
147 Yodium Povidon Lar 10% 15 ml 0 0 - - 0 - -
148 Yodium Povidon Lar 10% 30 ml 3 0 3 - 3 - -
149 Yodium Povidon Lar 10% 300 ml 0 - - - -
151 Yodium Povidon Lar 10% 1 liter 0 - - - -
152 Zinc Tab 20 mg 645 800 1,445 467 930 607 -
B. OBAT NON GENERIK -
1 Afolat Tablet 1 mg - - - -
2 Bufacetin Salep Kulit 12 54 66 35 31 35 4
3 Burnazin Cream 1 2 3 - 3 0 -
4 Curcuma FCT 2640 0 2,640 - 2640 0 -
5 Dulcolax supp 5 mg 4 6 10 2 8 3 -
6 Dulcolax supp 10 mg 10 15 25 8 17 10 -
7 Dulcolax/Bisacodyl tablet 5 mg 0 0 - - - -
8 Erlamycetin Tetes Telinga 57 0 57 10 47 13
9 Guanistrep Syrup 5 0 5 - 5 - -
10 Herbakof Syrup 139 0 139 - 139 -
11 Histigo 6 mg 0 0 - - - -
12 Trifason 0,5 mg 984 3900 4,884 2,786 2098 3,622 1,500
13 LidiaStop (Attapulgite) 483 200 683 248 435 322
14 Livron B Plex 1000 0 1,000 1,000 0 1,000 -
15 Lytacur Syrup 717 0 717 - 717 -
16 Novatusin Sirup 197 0 197 - 197 0
17 OBH Nellco 0 0 - - 0 -
18 Pulmicort 5 0 5 - 5 -
19 Ramvit C 500 mg 400 0 400 - 400 0
20 Reco Tetes Telinga 0 - - 0 -
21 Reco Tetes Mata 7 25 32 22 10 22 12
22 Scabicid Krim 0 - - 0 -
23 Stimuno Syrup 78 0 78 - 78 0
24 Vaksin Anti Rabies 19 0 19 - 19 0 -
25 BMHP Vaksin Anti Rabies 15 0 15 - 15 0
26 Ventolin Nebulizer 5 20 25 10 15 10 -
C. PSIKOTROPIKA
1 Diazepam 2 mg 59 59 - 59 -
2 Diazepam Injeksi 2 - 2 - 2 -
3 Stesolid rectal tube 5 mg 3 0 3 - 3 - -
4 Stesolid rectal tube 10 mg 5 0 5 - 5 -
D. OBAT-OBAT TERTENTU (OOT)

1 Amitriptilin tablet 25 mg - - -
2 Haloperidol tablet 1,5 mg 0 - - - - -
3 Haloperidol tablet 0,5 mg 130 - 130 - 130 - -
4 Haloperidol tablet 5 mg 70 - 70 - 70 - -
5 Triheksilfenidil HCl tablet 2 mg 0 - - - 200
6 Klorpromazina Tablet 100 mg 0 - - - - 100
8 Klorpromazina Inj. 25 mg/ml, 1 ml - - -
E. PREKURSOR
1 Antimigren tablet Kombinasi (ergotamin) 0 - - -
2 Metilergometrina tablet 0,125 mg 100 - 100 - 100 -
3 Metilergometrina Inj. 0.2 mg/ml 0 - - 0 -
F. BMHP
1 Alkazyme 25 mg - - 0
2 Alkohol Swab 22 0 22 6 16 8 -
3 Apron 9 9 - 9 0 -
4 Aseptic Gel 500 cc + dispenser 3 3 - 3 0 -
5 Blood Lancet @100 4 0 4 4 0 5 5
6 Blood Tranfusion Set 4 0 4 - 4 0 -
7 Catgut Chromic 2/0 8 0 8 - 8 0 -
8 Catgut Chromic 3/0 6 0 6 - 6 0 -
9 Catgut Plain 2/0 8 0 8 - 8 0 -
10 Catgut Plain 3/0 0 - - 0 -
11 Daryantullle 10 0 10 5 5 7 2
12 Dermafix-S IV 0 - - 0 -
13 Disposible 1 cc 40 50 90 30 60 39 -
14 Disposible 10 cc 12 0 12 - 12 0 -
15 Disposible 3 cc 50 260 310 160 150 208 58
16 Disposible 5 cc 25 35 60 25 35 33 -
17 Duo Band Series-12 (PINK) 25 25 - 25 0 -
18 Duo Band Series-18 (BLUE) 25 25 - 25 0 -
19 Folley Catheter No. 14 0 - - 0 -
21 Folley Catheter No. 18 4 4 - 4 0 -
22 H2O2 3% 0 - - 0 -
23 Handschoon Non Steril L @100 5 0 5 - 5 0 -
24 Handschoon Non Steril M 0 - - 0 -
25 Handschoon Non Steril S Powdered @100 0 - - 0 -
26 Handschoon Non Steril S PF @100 8 21 29 13 16 17 -
27 Handschoon Steril 6 3 0 3 - 3 0 -
28 Handschoon Steril 6,5 8 0 8 - 8 0 -
29 Handschoon Panjang Siku 6,5 10 0 10 3 7 4 -
31 HCG Test 1 0 1 - 1 0 -
32 Hibiscrup 1 0 1 - 1 0 -
33 Hypafix 10 x 5 0 0 - - 0 0 -
34 Hypafix 15 x 5 4 3 7 4 3 5 2
35 Hypafix 5 x 5 1 0 1 - 1 0 -
36 Infus Set Anak 4 0 4 - 4 0 -
37 Infus Set Dewasa 10 0 10 5 5 7 2
38 Iodium Test 0 - - 0 0 -
39 IV. Catheter No. 18 5 0 5 - 5 0 -
40 IV. Catheter No. 20 5 0 5 - 5 0 -
41 IV. Catheter No. 22 7 14 21 3 18 4 -
42 IV. Catheter No. 24 2 0 2 - 2 0 -
43 IV. Catheter No. 26 4 0 4 - 4 0 -
44 Jarum Heating No. 10 24 24 - 24 0 -
45 Jarum Heating No. 12 90 90 - 90 0 -
46 Jarum Heating No. 14 36 36 - 36 0 -
47 Jarum Heating No. 15 60 60 - 60 0 -
48 Jelly USG 3 0 3 1 2 1 -
49 Kapas Pembalut 250 gr 1 0 1 - 1 0 -
50 Kapas Pembalut 500 gr 0 - - 0 -
51 Kasa Kompres 40/40 Steril 0 - - 0 -
52 Kasa Kotak Steril 5 0 5 2 3 3 -
53 Kasa Pemb. Hid 4 M X 15 Cm 0 - - 0 -
54 Kasa Pemb. Hid 4 M X 3 Cm 7 7 - 7 0 -
55 Kasa Pembalut 2 x 80 cm 0 - - 0 -
56 Kasa Pembalut 36 x 80 cm 3 5 8 4 4 5 -
57 Kerta Puyer 0 0 - - 0 0 1
58 Leukoplast 2,5cm x 4,5 cm 1 1 - 1 0 -
59 Lisol 50% 2 2 - 2 0 -
60 Masker Hijab @50 0 10 10 10 0 13 13
61 Masker Karet @50 0 10 10 10 0 13 13
62 Masker Non Medis 3 Ply 0 - - 0 -
63 Nurse cap @100 1 0 1 - 1 0 -
64 Nylon No. 3/0 (Benang wajah) 0 - - 0 -
65 Nylon No. 6/0 (Benang Wajah) 0 - - 0 0 -
66 Pembalut Elastis 10 cm x 4,55 m (PRO CREPE)

0 - - 0 -
2 2 1 1 1 -
68 Pembalut Elastis 7,5 cm x 4,55 m (PRO CREPE)

0 - - 0 -
69 Plesterin Bulat Non Woven 24mm x 24mm 200's

3 0 3 - 3 0 -
70 Polyprepilene 3/0 D3 19 mm 0 0 - - 0 0 -
71 Pot Salep 30gr 0 0 - - 0 0 -
72 Pot Salep 50gr 12 50 62 62 0 81 81
73 Selang Oksigen Bayi 6 6 - 6 6 0
74 Selang Oksigen Anak 5 6 11 - 11 0 -
75 Selang Oksigen Dewasa 9 7 16 10 6 13 7
76 Softaman 5 5 - 5 0 -
77 Steril Surgical Blades (Aesculaps) 100's 0 - - 0 -
78 Stomach Tube No. 12 0 - - 0 -
80 Strip asam urat 0 - - 0 -
81 Strip glucose 0 - - 0 -
82 Strip kolesterol (Humases) '20s 0 0 - - 0 -
83 Strip trigliserid 0 - - 0 -
84 Suction Catheter No 10 4 4 - 4 0 1
85 Suction Catheter No 8 7 10 17 5 12 7 -
86 Sungkup Nebu Anak 7 0 7 3 4 4 -
87 Sungkup Nebu Dewasa 12 0 12 - 12 0 -
88 Suture Silk 2/0 10 11 21 10 11 13 2
89 Suture Silk 3/0 12 0 12 12 0 16 16
90 Umbilical Cord Clamps 50 0 50 - 50 0 -
91 Under Pad 13 29 42 10 32 13 -
92 Urine bag 5 0 5 - 5 0 -
OBAT PROGRAM
1 Albendazol Tablet 400 mg 0 0 - - 0 0
2 Albendazole Syrup 0 0 - - 0
3 Alive Nutribion @100 100 100 200 100 100 130
4 Ampicilin 1 gr 111 111 - 111 0
5 Calcii Gluconas 0 - - 0
6 Diazepam Injeksi 0 - - 0
7 Euthyrox 0 - - 0
8 Ferbion (PTM Lansia) 11100 0 11,100 3,500 7600 4550
9 Livron B Plex 2600 0 2,700 100 2600 130
10 Masker Non Medis 3 Ply - - 0
11 MDT MB Adult 0 4 4 4 0 0
12 MDT MB Child - - 0
13 Mineral Mix 0 2 2 2 0
14 Okxytetracyclin Salep Mata 0 - - 0
15 Tablet Tambah Darah 33470 0 33,470 - 33470 0
16 Taburia 0 0 - - 0 0
17 Vitamin A 100.000 UI kapsul 0 0 - - 0 0
18 Vitamin A 200.000 UI kapsul 0 0 - - 0
OBAT & ABHP P3K
1 Cefadroxil 500 mg 0 0 - - 0 0
2 Counterpain Gel 15 gr 0 0 - - 0
3 Counterpain Cool Gel 15 gr 4 0 4 - 4 0
4 Counterpain Cream 15 gr 1 0 1 - 1 0
5 Minyak Kayu Putih 15 ml 0 0 - - 0
6 Neurobion Tablet 0 0 - - 0 0
7 Thrombopop Gel 1 0 1 - 1 0
8 Voltadex Gel 0 0 - - 0 0
OBAT & VITAMIN COVID

1 Asam Askorbat 250 mg Tab 0 0 - - 0 -
2 Asetilsistein 200 mg (Memucil) 150 0 150 - 150 0 -
3 Azitromycin 500 mg 35 0 35 - 35 0
4 Azitromycin Kombipak 19 0 - - 19 0
5 Becefort Syrup 2 0 2 - 2 0
6 Bionicom Zinc 1990 0 1,990 - 1990 0
7 Cholecalciferol 400 IU 38 0 38 - 38 0
8 Curcuma FCT 3000 0 3,000 - 3000 0
9 D Trivit 230 0 230 - 230 0
10 Demacolin Tablet 1400 0 1,400 - 1400 0
11 Erdomex Syrup 7 0 7 - 7 0
12 Erdostein 120 0 120 - 120 0
13 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
14 Imbost Kids Syrup 47 0 47 - 47 0
15 Imunivit Tablet 500 0 500 - 500 0
16 Livron B plex 0 0 - - 0
17 Microlax Enema 4 ml 49 0 49 - 49 0
18 Momucil 200 mg 0 0 - - 0
19 OBH Nelco Syrup 0 0 - - 0 0
20 Ondansentron 4 mg tab 150 0 150 - 150 0
21 Oseltamivir 20 0 20 - 20 0
22 Pafivirapir 0 0 - - 0 0
23 Sucralfate Syrup 74 0 74 - 74 0
24 Zink Syrup 5 0 5 - 5 0
Vaksin
1 Vaksin BCG
2 Vaksin DPT/ DPT-HB/ DPT-HB-Hib
3 Vaksin Td
4 Vaksin Polio
5 IPV
6 MR
7 Hep B1 ds/Buah
Vitamin Pegawai
1 Bionicom Zink 0 1740 1740 1740 0 1740 -
2 HB VIT 500 0 0 0 0 0 0 -
Vitamin Proram KIA
1 Ferbion 0 0 - - 0 0 -
REAGEN & ABHP LABORATORIUM

1 Autocheck Cholestrol Stik 0 0 0 0 0 0
2 Benecheck Plus Urin Acid @25 0 0 0 0 0 0
3 Alkohol 70% 5 L 0 0 0 0 0 0
4 Chlodine 0,5% Handrub 0 0 0 0 0 0
5 Corona Ag Rapid Test Casette 0 0 0 0 0 0
6 Diluent For Mindray BC 3600 0 0 - 0 0 0 2
7 Glucosa Strip Accu check @100 0 0 0 0 0 0
8 Glucosa Strip GE @ 50 0 0 0 0 0 0
9 Hemoglobin Stick Mission @50's 0 0 0 0 0 0
10 Hepatitis B Imun Globin 0 0 0 0 0 0
11 Humasens Cholestrol Strip @20's 0 10 10 10 0 10
12 Humasens Uric Acid Strip @25's 0 5 5 5 0 5
13 Humasens Glucose Strip @50's 0 0 0 0 0 0
14 Obyek Glass Cat N0. 7105 0 0 0 0 0 0
15 RDT DBD Combo Igg/Igm 0 0 0 0 0 0
16 Reagen Gol. Darah (Anti A,B,AB & Rhesus) 0 0 0 0 0 0
17 Reagen HbsAg 0 0 0 0 0 0
18 Reagen HIV SD 0 0 0 0 0 0
19 Reagent Cat Ziehl Nellsen 0 0 0 0 0 0
20 Reagen Urine 3 Parameter 0 0 0 0 0 0 5
21 SD Bioline SYPHLIS 3.0 d 30's 0 0 0 0 0 0
22 SteriOne 5 Liter 0 0 0 0 0 0
23 Stik Asam Urat (BENECHECK) 0 0 0 0 0 0
24 Stik Kolestrol (BENECHECK) 0 0 0 0 0 0
25 Tabung EDTA 0 0 0 0 0 0
26 Tuberculin PPD 0 0 0 0 0 0
27 Virocheck Hbsag 0 0 0 0 0 0
28 Test Urine 3P 0 0 - 0 0 0
29 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0 -
30 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
OBAT & ABHP GIGI

1 Articulating Paper 0 0 0 0 0
2 Alevo Gym 0 0 0 0 0
3 Barbed Broach (Jarum Extepasi) 6's 0 0 0 0 0
4 Bur Fisure Diamond BB 79K-014 0 0 0 0 0
5 Bur Lurus Diamond C837-018 0 0 0 0 0
6 Cellulose Matrix Strip 0 0 0 0 0
7 CHKM (paramonochlorofenol) 20 ml 0 0 0 0 0
8 Cocoa Butter 10gr 0 0 0 0 0 -
9 Composite A2 dan A3 0 0 0 0 0
10 Composite Flow 0 0 0 0 0
11 Cotton Roll size 1 (12's) 0 0 0 0 0
12 Cresotin Liquid no.2 0 0 0 0 0
13 Cresotin Paste 0 0 0 0 0
14 Dentin Condotioner 25gr 0 0 0 0 0
15 Eugenol Cairan 0 0 0 0 0
16 Fuji VII White (powder + liquid) 0 0 0 0 0 -
17 Fuji IX EXT A3 (powder + liquid) 0 0 0 0 0
18 GC Gold Label IX Extra Capsul 30's 0 4 4 4 0 4
19 GC Gold Label VII Extra Capsul 30's 0 0 0 0 0
20 Glass Plate 0 0 0 0 0
21 Iodotin paste 2 gr 0 0 0 0 0
22 Kalsium Hidroksida Pasta 0 0 0 0 0
23 Matrix Interior 0 0 0 0 0
24 Microbrush 0 0 0 0 0
25 Pasta Pengisi Saluran akar with iodorm 0 0 0 0 0
26 Saliva Ejector 100's 0 0 0 0 0 -
27 Scothbond Universal 2 x 3 ml 0 0 0 0 0
28 51202 Single Bond 2 RF LA/APAC 0 0 0 0 0
29 Xylestein-A (Lidocain HCL + Epineprine HCL) 0 0 0 0 0
30 Zinc Phospat 0 0 0 0 0
31
32
ABHP TBC
1 Masker Surgical @50 9 9 1 8 1
2 Masker Kain 3 ply 49 49 0 49 0
3 Masker N95 @20 500 0 500 0 500 0
Obat BLUD
Obat Generik
1 Allopurinol 100 mg Tab 0 0 0 0
3 Amlodipin 10 mg 0 0 0 0
5 Asam Folat 100 0 100 0 100 0
6 Asam Mefenamat 500 mg 0 0 0 0
7 Asetilsistein 200 mg 0 0 0 0 0
8 Bedak Salisil 0 0 0 0
9 Burnazin Cream 0 0 0 0
10 Captopril 25mg 900 0 900 0 900 0
11 Cetirizin Syrup 0 0 0 0
12 Ciprofloxacin 500 mg 200 0 200 0 200 0
13 Daryantulle 0 0 0 0
14 Etil Klorid 1 0 1 0 1 0
15 Gentamisin Tetes Mata 0 0 0 0
16 Dexametason 0,5 mg 600 0 600 0 600 0
17 Domperidone Syrup 0 0 0 0 0 0
18 Glimepiride 2 mg 0 0 0 0
19 ISDN 5mg 100 0 100 0 100 0
20 Ibuprofen 400 mg 0 0 0 0 0
21 Kalsium Laktat 500 mg Tab 0 0 0 0 0
22 Ketokonazole Cream 15 0 15 0 15 0
23 Ketokonazole 200 mg 0 0 0 0 0 0
24 Loratadin 10 mg 0 0 0 0
25 Metformin 500 mg Tab 600 0 600 600 0 780
26 Metronidazole 500 mg Tab 1136 0 1136 136 1000 177
27 MGSO4 0 0 0 0 0
28 Nifedipin 10 mg Tab 100 0 100 0 100 0
29 Omeprazole 20 mg Tab 0 0 0 0
30 Omeprazole Injeksi 0 0 0 0 0
31 Phenol Glyserol 24 0 24 0 24 0
32 Ranitidin 100 0 100 0 100 0
33 Salbutamol 2 mg 1912 0 1912 412 1500 536
34 Salbutamol 4 mg 0 0 0 0
35 Simvastatin 10 mg 0 0 0
36 Vitamin B 6 1050 0 1050 550 500 715
37 Lidocain HCL Injeksi 80 80 0 80 0
38 Vitamin B complex 0 0 0
Obat Non Generik

1 Burnazin Cream 25 gr 2 0 2 0 2 0
2 Cazetin Drop 1 0 1 0 1 0
3 Dulcolax Suppo 10 mg Tab 0 0 0 0
4 Dulcolax tablet 5 mg 72 0 72 2 70 3
5 Farsycol Cream ( Kloramfenikol cream ) 5 0 5 0 5 0
6 Genoint Tetes Mata (gentamisin tetes mata) 0 0 0 0 0
7 Lecozinc 20 mg 0 0 0 0 0 0
8 Reco Tetes mata 0 0 0 0 0
9 Reco Tetes Telinga 0 0 0 0 0 0
10 Scabimite Salep 30 gr 0 0 0 0 0
11 Ventolin Nebulizer 170 0 170 0 170 0
12
ABHP
1 Bisturi no.11 80 0 80 0 80 0
2 Catgut Silk 3/0 0 0 0 0
3 Catgut Plain 3/0 24 0 24 0 24 0
4 Foley Catheter no.18 20 0 20 0 20 0
5 H2O2 800 ml 4 0 4 0 4 0
6 Handscoon Size S 0 0 0 0
7 Infuset Dewasa 18 0 18 0 18 0
8 Kassa Hidrofil 40 x 80 cm 0 0 0 0 0
9 Kertas CTG 80mm x 90mm EKG 0 0 0 0 0 0
10 Kertas Lakmus Merah 0 0 0 0 0
11 Masker Earloop 0 0 0 0
12 Masker Headloop 0 0 0 0
13 Masker O2 Dewasa 25 25 0 25 0
14 Povidone Iodine 1 liter 10 0 10 0 10 0
15 Selang Oxygen Anak 2 2 0 2 0
16 Selang Oxygen Dewasa 0 0 0 0
UMUM BPJS R. INAP JUMLAH
JUMLAH KUNJUNGAN RESEP
420 1638 2058
Yang Meminta Mengetahui/ Menyetujui

Pimpinan Puskesmas Kepala Instalasi Farmasi & Perbekkes
…………………………… ……………………………
SKESMAS
NO/TGL DOKUMEN
IFK
PKM
PEMBERIAN
JUMLAH KET
APBD APBN BUFFER PROGRAM DAK
10 11 12 13 14 15 16
RETUR
RETUR
RETUR
EXP
EXP
ED
EXP
RETUR
EXP
Balikpapan,
Petugas IFK
Yang Menerima 1. Menyiapkan : ………………..

Petugas Puskesmas
2. Memeriksa : ………………..
3. Pencatatan : ………………..
…………………………
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : NOVEMBER IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : DESEMBER PKM
PEMBERIAN
PERMIN
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT JUMLAH KET
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
3 Albendazol Tablet 400 mg 87 0 87 2 85 3 -
4 Allopurinol tablet 100 mg 750 600 1,350 355 995 462 -
5 Allopurinol tablet 300 mg 332 0 332 - 332 - -
10 Amoksisilin 125 mg Sirup Kering 6 41 47 - 47 - (47)
13 Amoksisilin kaplet 500 mg 2040 1,600 3,640 1,852 1788 2,408 600
15 Antasida DOEN Tablet Komb.100's 474 - 474 474 0 616 600
16 Antasida DOEN Suspensi 63 - 63 63 0 82 - RETUR
19 Aqua pro injeksi 100 ml 14 - 14 1 13 1 -
20 Asam Askorbat (Vit C) Tablet 50 mg 2400 - 2,400 1,555 845 2,022 1,200
22 Asam Folat 0,4 mg 590 100 690 305 385 397 -
23 Asam Mefenamat kaplet 500 mg 2060 1,100 3,160 2,158 1002 2,805 1,800
25 Asetil Sistein kapsul 200 mg 60's 2130 7,140 9,270 1,966 7304 2,556 -
27 Ats Inj. 1.500 IU 7 14 21 6 15 8 -
29 Betahistin 6 mg 304 1,000 1,304 351 953 456 -
30 Betametason krim 47 25 72 16 56 21 -
31 Bisakodil 5 mg 0 100 100 - 100 - -
33 Captopril tablet 25 mg 0 2,000 2,000 775 1225 1,008 -
37 Cetirizine tablet 10 mg 100 800 900 140 760 182 -
38 Ciprofloksasin tablet 500 mg 249 400 649 248 401 322 -
40 Deksametason Injeksi 11 - 11 - 11 - -
41 Dextrose 5% 1 2 3 - 3 - -
45 Domperidon Susp 147 - 147 147 0 191 - RETUR
46 Domperidon Tablet 614 1,000 1,614 965 649 1,255 600
47 Epinefrina Inj. 0,1% 1 ml 3 - 4 2 2 3 1
50 Etanol 70%/100 ml 0 - - - -
51 Etanol 70%/1000 ml 0 - - - -
54 Fenol Gliserol Tetes Tlg. 10% 3 5 8 5 3 7 4
58 Garam Oralit 401 - 401 201 200 261 100
62 Glimepirid tablet 2 mg 2030 2,200 4,230 1,350 2880 1,350 -
64 Griseofulvin tablet 125 mg 260 - 260 - 260 - -
65 Hidroklorotiazid tablet 25 mg 115 400 515 20 495 26 -
66 Hidrokortison Krim 2,5 % 66 36 102 38 64 49 -
67 Hyoscin N Tablet 10 mg 30 - 30 10 20 13 -
68 Ibuprofen Susp. 100 mg/5 ml 3 - 3 3 0 4 -
69 Ibuprofen Susp. 200 mg/5 ml 10 - 10 1 9 1 -
71 Ibuprofen tablet 400 mg 0 2,000 2,000 180 1820 234 -
74 Kalsium Laktat 500 mg Tablet 100's 1140 2,000 3,140 1,835 1305 2,386 1,100
75 Ketokonazol krim 14 59 73 21 52 27 -
76 Ketokonazol tablet 200 mg 260 400 660 105 555 137 -
82 Klorfeniramin Maleat tablet 4 mg 4810 700 5,510 3,391 2119 4,408 2,300
83 Kotrimoksazol Susp 8 - 8 2 6 3 -
84 Kotrimoksazol Tab 480 mg 70 - 70 28 42 36 -
85 Lidocain Injeksi 2% (HCl) 83 - 83 18 65 23 -
86 Lidocain Injeksi 2% (HCL) + Epinefrin 10 - 10 - 10 - -
87 Loratadin tablet 1693 - 1,693 1,048 645 1,362 700
90 Metformin tab 500 mg 3650 200 3,850 3,850 0 5,005 5,000
91 Metil Prednisolon tablet 4 mg 1305 700 2,005 871 1134 1,132 -
92 Metoklorpramide tablet 10 mg 0 500 500 140 360 182 -
95 MGSO4 40% Injeksi 3 0 3 - 3 - -
96 Mikonazol Krim 15 30 45 30 15 39 24
97 Na. Diklofenak 25 mg 4836 0 4,836 1,223 3613 1,590 -
98 Na. Diklofenak 50 mg 314 0 314 164 150 213 100
101 Nistatin susp 100.000 IU/mL 6 0 6 2 4 3 -
102 Nistatin Vaginal tablet salut 100.000 IU/g 19 0 19 - 19 - -
103 OAT FDC Kategori 1 4 0 4 - 4
105 OAT FDC Kategori Anak 0 1 1 1 0 -
110 Omeprazol kapsul 20 mg 1004 400 1,404 720 684 936 300
111 Parasetamol 500 mg Tablet 100's 1860 4600 6,460 4,575 1885 5,948 4,100
112 Parasetamol drops 33 0 33 33 0 43 - RETUR
114 Permetrin Krim 5% 18 25 43 25 18 33 15
118 Pirantel Pamoat Tab.125 mg 88 0 88 - 88 - -
124 Ranitidin Tablet 790 1700 2,490 924 1566 1,201 -
126 Ringer Laktat 4 0 4 4 0 5 5
128 Rivanol Lar 0.1% 100 ml 0 - - - -
129 Rivanol Lar 0.1% 300 ml 0 - - - -
130 Sabu Inj. 5 ml 1 0 1 - 1 - -
140 Tablet Tambah Darah 120 0 120 120 0 -
142 TKF Cairan 0 - - - -
143 Vit. B Kompleks tablet 3000 0 3,000 794 2206 1,032 -
151 Zinc Tab 20 mg 395 800 1,195 467 645 607 -

3 Burnazin Cream 1 2 3 2 1 2 1
4 Curcuma FCT 2960 0 2,960 320 2640 320 -
5 Dulcolax supp 5 mg 4 4 - 4 - -
6 Dulcolax supp 10 mg 9 5 14 4 10 5 -
10 Herbakof Syrup 139 0 139 - 139 -
11 Histigo 6 mg 0 0 - - - -
12 Trifason 0,5 mg 500 2800 3,300 2,316 984 3,011 2,000
14 Livron B Plex 1000 0 1,000 - 1000 0 -
15 Lytacur Syrup 717 0 717 - 717 -
16 Novatusin Sirup 197 0 197 - 197 0
17 OBH Nellco 0 0 - - 0 -
18 Pulmicort 5 0 5 - 5 -
19 Ramvit C 500 mg 400 0 400 - 400 0
21 Reco Tetes Mata 0 30 30 23 7 23 16
23 Stimuno Syrup 78 0 78 - 78 0
24 Vaksin Anti Rabies 20 0 20 1 19 1 -
26 Ventolin Nebulizer 0 30 30 25 5 25 20
C. PSIKOTROPIKA
1 Diazepam 2 mg 59 59 - 59 -
3 Stesolid rectal tube 5 mg 2 2 4 1 3 1 -

E. PREKURSOR
3 Metilergometrina Inj. 0.2 mg/ml 10 10 10 0 13.0 EXP
F. BMHP
2 Alkohol Swab 6 20 26 4 22 5 -
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 4 0 4 - 4 0 -
7 Catgut Chromic 2/0 8 0 8 - 8 0 -
8 Catgut Chromic 3/0 6 0 6 - 6 0 -
9 Catgut Plain 2/0 8 0 8 - 8 0 -
10 Catgut Plain 3/0 0 - - 0 -
11 Daryantullle 0 10 10 - 10 0 -
13 Disposible 1 cc 50 10 60 20 40 26 -
14 Disposible 10 cc 13 0 13 1 12 1 -
15 Disposible 3 cc 60 110 170 120 50 156 110
16 Disposible 5 cc 15 10 25 - 25 0 -
22 H2O2 3% 0 - - 0 -
26 Handschoon Non Steril S PF @100 3 15 18 10 8 13 5
29 Handschoon Panjang Siku 6,5 10 0 10 - 10 0 -
31 HCG Test 1 0 1 - 1 0 -
32 Hibiscrup 1 0 1 - 1 0 -
33 Hypafix 10 x 5 0 0 - - 0 0 -
34 Hypafix 15 x 5 0 6 6 2 4 3 -
35 Hypafix 5 x 5 1 0 1 - 1 0 -
36 Infus Set Anak 5 0 5 1 4 1 -
37 Infus Set Dewasa 17 0 17 7 10 9 -
38 Iodium Test 0 - - 0 0 -
39 IV. Catheter No. 18 5 0 5 - 5 0 -
40 IV. Catheter No. 20 5 0 5 - 5 0 -
41 IV. Catheter No. 22 6 1 7 - 7 0 -
42 IV. Catheter No. 24 2 0 2 - 2 0 -
43 IV. Catheter No. 26 4 0 4 - 4 0 -
44 Jarum Heating No. 10 24 24 - 24 0 -
45 Jarum Heating No. 12 90 90 - 90 0 -
46 Jarum Heating No. 14 36 36 - 36 0 -
47 Jarum Heating No. 15 60 60 - 60 0 -
48 Jelly USG 3 0 3 - 3 0 -
52 Kasa Kotak Steril 5 0 5 - 5 0 -
58 Lisol 50% 2 2 - 2 0 -
59 Masker Hijab @50 3 0 3 3 0 4 4
60 Masker Karet @50 0 0 - - 0 -
62 Nurse cap @100 1 0 1 - 1 0 -
64 Nylon No. 6/0 (Benang Wajah) 0 - - 0 0 - EXP

0 - - 0 -

2 2 - 2 0 -

0 - - 0 -

0 3 3 - 3 0 -
69 Polyprepilene 3/0 D3 19 mm 0 5 5 5 0 7 7
70 Pot Salep 30gr 0 0 - - 0 0 -
71 Pot Salep 50gr 0 50 50 38 12 49 37
75 Softaman 0 - - 0 -
83 Suction Catheter No 10 4 4 - 4 0 -
84 Suction Catheter No 8 7 0 7 - 7 0 -
87 Suture Silk 2/0 6 20 26 16 10 21 11
88 Suture Silk 3/0 0 12 12 - 12 0 -
90 Under Pad 13 0 13 - 13 0 -
91 Urine bag 5 0 5 - 5 0 -
OBAT PROGRAM
1 Ampicilin 1 gr 111 111 - 111 0 EXP
4 Euthyrox 0 - - 0
7 MDT MB Adult 0 0 - - 0 0
14 Tablet Tambah Darah 33670 0 33,670 200 33470 260
15 Taburia 0 0 - - 0 0
16 Livron B Plex 2700 0 2,700 100 2600 130
17 Alive Nutribion @100 0 100 100 - 100 0
OBAT & ABHP P3K
1 Cefadroxil 500 mg 0 0 - - 0 0
6 Neurobion Tablet 10 0 10 10 0 10

3 Azitromycin 500 mg 35 0 35 - 35 0
6 Bionicom Zinc 1990 0 1,990 - 1990 0
8 Curcuma FCT 3040 0 3,040 40 3000 52
9 D Trivit 230 0 230 - 230 0
12 Erdostein 120 0 120 - 120 0
13 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
15 Imunivit Tablet 500 0 500 - 500 0
18 Momucil 200 mg 0 0 - - 0
19 OBH Nelco Syrup 6 0 6 6 0 8 RETUR
21 Oseltamivir 20 0 20 - 20 0
22 Pafivirapir 0 0 - - 0 0 EXP
24 Zink Syrup 5 0 5 - 5 0
Vaksin
1 Vaksin BCG 0 0 3 3 0
2 Vaksin DPT/ DPT-HB/ DPT-HB-Hib 4 0 19 15 4
3 Vaksin Td 2 0 3 1 2
4 Vaksin Polio 11 0 19 8 11
5 IPV 5 0 10 5 5
6 MR 36 0 44 8 36
7 Hep B1 ds/Buah 15 0 22 7 15
Vitamin Pegawai
1 Bionicom Zink 0 0 0 0 0 0 -
2 HB VIT 500 0 0 0 0 0 0 -
Vitamin Proram KIA
1 Ferbion 0 0 - - 0 0 -

3 Alkohol 70% 5 L 0 0 0 0 0 0
6 Diluent For Mindray BC 3600 0 0 - 0 0 0
14 Obyek Glass Cat N0. 7105 0 0 0 0 0
18 Reagen HIV SD 0 0 0 0 0 0
24 Tabung EDTA 0 0 0 0 0 0
27 Test Urine 3P 0 0 - 0 0 0
28 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0 -
29 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
OBAT & ABHP GIGI

1 Articulating Paper 0 0 0 0
2 Alevo Gym 0 0 0 0 0
4 Bur Fisure Diamond BB 79K-014 0 0 0 0
5 Bur Lurus Diamond C837-018 0 0 0 0
31
32
ABHP TBC
3 Masker N95 @20 500 0 500 0 500 0
Obat BLUD
Obat Generik
5 Asam Folat 100 0 100 0 100 0
10 Captopril 25mg 1300 0 1300 400 900 520
14 Etil Klorid 1 0 1 0 1 0
16 Dexametason 0,5 mg 600 0 600 0 600 0
19 ISDN 5mg 100 0 100 0 100 0
20 Ibuprofen 400 mg 0 0 0 0 0
23 Ketokonazole 200 mg 50 0 50 50 0 65
25 Metformin 500 mg Tab 800 0 800 200 600 260
27 MGSO4 0 0 0 0 0
28 Nifedipin 10 mg Tab 100 0 100 0 100 0
32 Ranitidin 100 0 100 0 100 0
33 Salbutamol 2 mg 2100 0 2100 188 1912 244
36 Vitamin B 6 1300 0 1300 250 1050 325
Obat Non Generik

7 Lecozinc 20 mg 0 0 0 0 0 0
12
ABHP
1 Bisturi no.11 80 0 80 0 80 0
3 Catgut Plain 3/0 24 0 24 0 24 0
5 H2O2 800 ml 4 0 4 0 4 0
15 Selang Oxygen Anak 0 0 0 0

0 0 0 0

Pimpinan Puskesmas Kepala Instalasi Farmasi & Perbekkes Balikpapan,
Petugas IFK
Petugas Puskesmas
…………………………… …………………………… 2. Memeriksa : ………………..
…………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : OKTOBER IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : NOVEMBER PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
10 Amoksisilin 125 mg Sirup Kering 42 - 42 36 6 47 41
13 Amoksisilin kaplet 500 mg 1250 3,600 4,850 2,810 2040 3,653 1,600
15 Antasida DOEN Tablet Komb.100's 300 1,400 1,700 1,226 474 1,594 1,100
16 Antasida DOEN Suspensi 61 94 155 92 63 120 -
19 Aqua pro injeksi 100 ml 9 5 14 - 14 - -
22 Asam Folat 0,4 mg 890 200 1,090 500 590 650 100
25 Asetil Sistein kapsul 200 mg 60's (Memucil) 540 8,700 9,240 7,110 2130 9,243 7,140
27 Ats Inj. 1.500 IU 4 6 10 3 7 4 -
28 Attapulgit tablet 600 mg ( Neo Diagon) 162 - 162 162 0 211 -
29 Betahistin 6 mg 300 500 800 496 304 645 300
30 Betametason krim 74 - 74 27 47 35 -
31 Bisakodil 5 mg 0 - - - - 50
33 Captopril tablet 25 mg 0 - - - 0 - 2,000
36 Cetirizine Syrup 5mg/5ml 13 - 13 10 3 13 -
37 Cetirizine tablet 10 mg 56 200 256 156 100 203 100
40 Deksametason Injeksi 19 - 19 8 11 10 -
41 Dextrose 5% 3 - 3 2 1 3 2
42 Difenhidramin Inj. 3 2 5 1 4 1 -
44 Dimenhidrinat Tablet 50 mg 792 900 1,692 353 1339 459 -
45 Domperidon Susp 71 100 171 24 147 31 -
46 Domperidon Tablet 548 500 1,048 434 614 564 -
47 Epinefrina Inj. 0,1% 1 ml 3 - 4 1 3 1 -
50 Etanol 70%/100 ml 0 - - - -
51 Etanol 70%/1000 ml 0 - - - -
54 Fenol Gliserol Tetes Tlg. 10% 19 - 19 16 3 21 18
58 Garam Oralit 100 400 500 99 401 129 -
61 Glibenklamida tablet 5 mg 90 - 90 50 40 65 -
64 Griseofulvin tablet 125 mg 260 - 260 - 260 - -
66 Hidrokortison Krim 2,5 % 102 - 102 36 66 47 -
74 Kalsium Laktat 500 mg Tablet 100's 2495 500 2,995 1,855 1140 2,412 1,300
75 Ketokonazol krim 15 18 33 19 14 25 11
82 Klorfeniramin Maleat tablet 4 mg 1734 7,300 9,034 4,224 4810 5,491 700
84 Kotrimoksazol Tab 480 mg 80 - 80 10 70 13 -
87 Loratadin tablet 905 1,800 2,705 1,012 1693 1,316 -
90 Metformin tab 500 mg 3450 5,800 9,250 5,600 3650 7,280 3,600
91 Metil Prednisolon tablet 4 mg 934 1,900 2,834 1,529 1305 1,988 700
92 Metoklorpramide tablet 10 mg 384 - 384 384 0 499 100
95 MGSO4 40% Injeksi 3 0 3 - 3 - -
96 Mikonazol Krim 50 0 50 35 15 46 30
97 Na. Diklofenak 25 mg 992 5000 5,992 1,156 4836 1,503 -
98 Na. Diklofenak 50 mg 250 150 400 86 314 112 -
101 Nistatin susp 100.000 IU/mL 10 0 10 4 6 5 -
102 Nistatin Vaginal tablet salut 100.000 IU/g 21 10 31 12 19 16 -
103 OAT FDC Kategori 1 6 0 6 - 4
105 OAT FDC Kategori Anak 1 0 1 1 0 -
110 Omeprazol kapsul 20 mg 854 900 1,754 750 1004 975 -
112 Parasetamol drops 71 0 71 38 33 49 -
113 Parasetamol Sirup 120 mg/5 ml 136 130 266 111 155 144 -
114 Permetrin Krim 5% 11 32 43 25 18 33 15
115 Phytomenadion (Vit K) Tablet 10 mg 115 300 415 308 107 400 300
117 Phytomenadion (Vit K1) Inj 2 mg/ml 20 0 20 - 20 - -
124 Ranitidin Tablet 539 900 1,439 649 790 844 100
126 Ringer Laktat 6 1 7 3 4 4 -
128 Rivanol Lar 0.1% 100 ml 0 - - - -
129 Rivanol Lar 0.1% 300 ml 0 - - - -
130 Sabu Inj. 5 ml 1 0 1 - 1 - -
134 Salisil Bedak 2% 50 gram 14 12 26 11 15 14 -
135 Salisilat + Belerang Salep 2 0 2 - 2 - -
136 Simvastatin tablet 10 mg 2445 6600 9,045 3,805 5240 4,947 -
140 Tablet Tambah Darah 1790 0 1,790 1,670 120 2,171 -
142 TKF Cairan 0 - - - -
143 Vit. B Kompleks tablet 2710 1100 3,810 810 3000 1,053 -
151 Zinc Tab 20 mg 505 600 1,105 467 395 607 200

3 Burnazin Cream 0 2 2 1 1 1 0
4 Curcuma FCT 2960 0 2,960 - 2960 0 -
5 Dulcolax supp 5 mg 5 5 1 4 1 -
6 Dulcolax supp 10 mg 15 5 20 11 9 14 5
7 Dulcolax/Bisacodyl tablet 5 mg 0 0 - - - 50
8 Erlamysetin Tetes Telinga 0 15 15 4 11 5
9 Guanistrep Syrup 0 0 - - - 5
10 Herbakof Syrup 239 0 239 100 139 130
11 Histigo 6 mg 0 0 - - - -
12 Infason 0,5 mg 0 2300 2,300 1,800 500 2,340 1,800
14 Livron B Plex 1100 0 1,100 100 1000 100 -
15 Lytacur Syrup 0 717 717 - 717 -
16 Novatusin Sirup 238 0 238 41 197 41
17 OBH Nellco 0 0 - - 0 -
18 Pulmicort 0 5 5 - 5 -
19 Ramvit C 500 mg 400 0 400 - 400 0
21 Reco Tetes Mata 0 - - 0 12
23 Stimuno Syrup 87 0 87 9 78 9
26 Ventolin Nebulizer 0 0 - - 0 30
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 7 59 9
2 Diazepam Injeksi 3 - 3 1 2 1
3 Stesolid rectal tube 5 mg 0 5 5 3 2 4 2

4 Haloperidol tablet 5 mg 160 - 160 90 70 117 -
E. PREKURSOR
2 Metilergometrina tablet 0,125 mg 100 - 100 - 100 - EXP
3 Metilergometrina Inj. 0.2 mg/ml 10 10 - 10 - EXP
F. BMHP
2 Alkohol Swab 8 0 8 2 6 3 -
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 0 4 4 - 4 0 -
7 Catgut Chromic 2/0 4 6 10 2 8 3 -
8 Catgut Chromic 3/0 0 6 6 - 6 0 -
9 Catgut Plain 2/0 8 0 8 - 8 0 -
10 Catgut Plain 3/0 0 - - 0 -
11 Daryantullle 3 7 10 10 0 13 13
13 Disposible 1 cc 31 65 96 46 50 60 10
14 Disposible 10 cc 14 0 14 1 13 1 -
15 Disposible 3 cc 80 110 190 130 60 169 110
16 Disposible 5 cc 19 15 34 19 15 25 10
22 H2O2 3% 0 - - 0 -
26 Handschoon Non Steril S PF @100 3 0 3 - 3 0 -
31 HCG Test 1 1 2 1 1 1 -
32 Hibiscrup 1 0 1 - 1 0 -
33 Hypafix 10 x 5 0 0 - - 0 0 -
34 Hypafix 15 x 5 1 2 3 3 0 4 4
35 Hypafix 5 x 5 1 0 1 - 1 0 -
36 Infus Set Anak 5 0 5 - 5 0 -
37 Infus Set Dewasa 17 0 17 - 17 0 -
38 Iodium Test 0 - - 0 0 -
39 IV. Catheter No. 18 7 2 9 4 5 5 -
40 IV. Catheter No. 20 5 3 8 3 5 4 -
41 IV. Catheter No. 22 9 2 11 5 6 7 1
42 IV. Catheter No. 24 4 2 6 4 2 5 -
43 IV. Catheter No. 26 4 0 4 - 4 0 -
44 Jarum Heating No. 10 24 24 - 24 0 -
45 Jarum Heating No. 12 90 90 - 90 0 -
46 Jarum Heating No. 14 36 36 - 36 0 -
47 Jarum Heating No. 15 60 60 - 60 0 -
48 Jelly USG 1 2 3 - 3 0 -
49 Kapas Pembalut 250 gr 1 1 1 0 1 1
57 Leukoplast 2,5cm x 4,5 cm 0 - - 0 -
58 Lisol 50% 2 2 - 2 0 -
59 Masker Hijab @50 3 0 3 - 3 0 -
60 Masker Karet @50 0 0 - - 0 -
62 Nurse cap @100 1 0 1 - 1 0 -
64 Nylon No. 6/0 (Benang Wajah) 27 27 27 0 35 - EXP

0 - - 0 -

2 2 - 2 0 -

0 - - 0 -

2 0 2 2 0 3 3
70 Pot Salep 30gr 0 0 - - 0 0 -
71 Pot Salep 50gr 20 125 145 145 0 189 189
75 Softaman 0 - - 0 -
86 Sungkup Nebu Dewasa 12 10 22 10 12 13 -
87 Suture Silk 2/0 0 12 12 6 6 8 2
88 Suture Silk 3/0 0 0 - - 0 0 -
90 Under Pad 3 10 13 - 13 0 -
91 Urine bag 5 0 5 - 5 0 -
OBAT PROGRAM
1 Ampicilin 1 gr 111 111 - 111 0 EXP
4 Euthyrox 0 - - 0
7 MDT MB Adult 0 0 - - 0 0
14 Tablet Tambah Darah 37620 0 37,620 3,950 33670 5135
15 Taburia 0 0 - - 0 0
16 Livron B Plex 2700 0 2,700 1,100 1600 1430
OBAT & ABHP P3K

1 Cefadroxil 500 mg 0 0 - - 0 0
7 Thrombopop Gel 2 0 2 1 1 1
8 Voltadex Gel 1 0 1 1 0 1

3 Azitromycin 500 mg 35 0 35 - 35 0
6 Bionicom Zinc 1990 0 1,990 - 1990 0
8 Curcuma FCT 3040 0 3,040 - 3040 0
9 D Trivit 230 0 230 - 230 0
12 Erdostein 120 0 120 - 120 0
13 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
15 Imunivit Tablet 500 0 500 - 500 0
17 Microlax Enema 4 ml 50 0 50 1 49 1
18 Momucil 200 mg 0 0 - - 0
19 OBH Nelco Syrup 6 0 6 - 6 0
21 Oseltamivir 20 0 20 - 20 0
22 Pafivirapir 280 0 280 280 0 364 EXP
24 Zink Syrup 5 0 5 - 5 0
Vaksin
3 Vaksin Td 1 2 3 1 2
5 IPV 10 0 10 5 5
6 MR 44 0 44 8 36
7 Hep B1 ds/Buah 2 20 22 7 15
Vitamin Pegawai
1 Bionicom Zink 0 1740 1740 1740 0 1740 -
2 HB VIT 500 0 0 0 0 0 0 -
Vitamin Proram KIA
1 Ferbion 900 0 900 900 0 900 -

3 Alkohol 70% 5 L 0 0 0 0 0 0
14 Obyek Glass Cat N0. 7105 0 0 0 0 0
18 Reagen HIV SD 0 0 0 0 0 0
24 Tabung EDTA 0 0 0 0 0 0
27 Test Urine 3P 0 0 - 0 0 2
28 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0 -
29 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
OBAT & ABHP GIGI

2 Alevo Gym 0 0 0 0 0
18 GC Gold Label IX Extra Capsul 30's 0 0 0 0 0
31
32
ABHP TBC
3 Masker N95 @20 500 0 500 0 500 0
Obat BLUD
Obat Generik
5 Asam Folat 1000 0 1000 1000 0 1000
10 Captopril 25mg 3200 0 3200 1900 1300 2470
14 Etil Klorid 1 0 1 0 1 0
16 Dexametason 0,5 mg 1300 0 1300 1300 0 1690
19 ISDN 5mg 100 0 100 0 100 0
20 Ibuprofen 400 mg 0 0 0 0 0
23 Ketokonazole 200 mg 50 0 50 0 50 0
25 Metformin 500 mg Tab 800 0 800 0 800 0
27 MGSO4 0 0 0 0 0
28 Nifedipin 10 mg Tab 200 0 200 100 100 130
32 Ranitidin 100 0 100 0 100 0
33 Salbutamol 2 mg 2505 0 2505 405 2100 527
36 Vitamin B 6 1770 0 1770 470 1300 611
Obat Non Generik

7 Lecozinc 20 mg 0 0 0 0 0 0
12
ABHP
1 Bisturi no.11 80 0 80 0 80 0
3 Catgut Plain 3/0 24 0 24 0 24 0
5 H2O2 800 ml 4 0 4 0 4 0

611 1728 0 2339

Petugas IFK
Petugas Puskesmas
…………………………… …………………………… 2. Memeriksa : ………………..
…………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : OKTOBER IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : NOVEMBER PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
2 Acyclovir tablet 400 mg 0 450 450 411 39 534 500
3 Albendazol Tablet 400 mg 161 0 161 161 0 209 30 EXP
4 Allopurinol tablet 100 mg 345 1300 1,645 981 664 1,275 600
10 Amoksisilin 125 mg Sirup Kering 73 40 113 71 42 92 50
11 Amoksisilin 250 mg Sirup Kering 9 - 9 9 0 12 12
15 Antasida DOEN Tablet Komb.100's 1060 - 1,060 760 300 988 700
16 Antasida DOEN Suspensi 36 144 180 119 61 155 94
18 Aqua pro injeksi 25 ml 0 - - - 5
19 Asam Askorbat (Vit C) Tablet 50 mg 1045 2,800 3,845 3,125 720 4,063 3,300
21 Asam Folat 0,4 mg 0 1,000 1,000 110 890 143 -
25 Ats Inj. 1.500 IU 12 - 12 8 4 10 6
26 Attapulgit tablet 600 mg ( Neo Diagon) 376 - 376 214 162 278 100
27 Betahistin 6 mg 435 200 635 335 300 436 100
28 Betametason krim 100 - 100 26 74 34 -
29 Bisakodil 5 mg 0 - - - - 50
31 Captopril tablet 25 mg 0 - - - 0 - 2,000
34 Cetirizine Syrup 5mg/5ml 11 11 22 9 13 12 -
35 Cetirizine tablet 10 mg 0 100 100 44 56 57 100
37 Deksametason 0,5 mg tablet 100"s 0 - - - - 2,000
38 Deksametason Injeksi 21 - 21 2 19 3 -
39 Dextrose 5% 3 - 3 - 3 - -
40 Difenhidramin Inj. 4 - 4 1 3 1 -
43 Domperidon Susp 38 106 144 73 71 95 -
45 Epinefrina Inj. 0,1% 1 ml 2 3 4 1 3 1 -
47 Eritromisin tablet 250 mg 0 - - - - 0
48 Etanol 70%/100 ml 0 - - - -
49 Etanol 70%/1000 ml 0 - - - -
54 Flukonazol Kapsul 150 mg 0 - - - 4
56 Garam Oralit 227 100 327 227 100 295 200
57 Gentamisin Salep Mata 34 - 34 34 0 34 34
58 Gentamisin Tetes Mata 0,3% 3 - 3 3 0 4 20
60 Glimepirid tablet 2 mg 2065 1,600 3,665 2,205 1460 2,205 700
63 Hidroklorotiazid tablet 25 mg 90 100 190 30 160 39 -
64 Hidrokortison Krim 2,5 % 24 124 148 46 102 60 -
66 Ibuprofen Susp. 100 mg/5 ml 0 - - - - -
67 Ibuprofen Susp. 200 mg/5 ml 0 10 10 - 10 - -
68 Ibuprofen tablet 200 mg 0 - - - -
71 Isosorbide dinitrat tablet 5 mg 120 120 53 67 69 -
72 Kalsium Laktat 500 mg Tablet 100's 1835 1,000 2,835 340 2495 442 -
73 Ketokonazol krim 0 30 30 15 15 20 5
74 Ketokonazol tablet 200 mg 175 - 175 105 70 137 100
79 Kloramfenikol Tetes Telinga 3% 0 - - - 20
81 Kotrimoksazol Susp 3 9 12 2 10 3 -
82 Kotrimoksazol Tab 480 mg 100 - 100 20 80 26 - EXP
83 Lidocain Injeksi 2% (HCl) 0 5 5 5 0 7 100
85 Loratadin tablet 810 1,100 1,910 1,005 905 1,307 400
87 Magnesium Sulfat Injeksi 40% 0 - - - 0 -
88 Metformin tab 500 mg 2570 7,400 9,970 6,520 3450 8,476 5,000
89 Metil Prednisolon tablet 4 mg 475 1,000 1,475 541 934 703 -
93 MGSO4 40% Injeksi 2 1 3 - 3 - -
94 Mikonazol Krim 71 0 71 21 50 27 -
95 Na. Diklofenak 25 mg 1554 950 2,504 1,512 992 1,966 1,000
96 Na. Diklofenak 50 mg 435 0 435 185 250 241 -
98 Nifedipin tablet 10 mg 0 - - - 200
101 OAT FDC Kategori 1 10 0 10 4 6
103 OAT FDC Kategori Anak 2 0 2 1 1
106 Oksitosin injeksi 5 5 10 5 5 7 2
108 Omeprazol kapsul 20 mg 0 1800 1,800 946 854 1,230 400
110 Parasetamol drops 71 0 71 - 71 - -
111 Parasetamol Sirup 120 mg/5 ml 125 216 341 205 136 267 130
112 Permetrin Krim 5% 13 26 39 28 11 36 25
113 Phytomenadion (Vit K) Tablet 10 mg 140 0 140 25 115 33 -
120 Pyridoksin (Vit B6) Tablet 10 mg 0 - - - -
122 Ranitidin Tablet 550 800 1,350 811 539 1,054 500
124 Ringer Laktat 5 5 10 4 6 5 -
126 Rivanol Lar 0.1% 100 ml 0 - - - -
127 Rivanol Lar 0.1% 300 ml 0 - - - -
128 Sabu Inj. 5 ml 1 0 1 - 1 - -
133 Salisilat + Belerang Salep 1 2 3 1 2 1 -
137 Sulfadiazin Silver Krim 1% 35 gr (Burnazin) 0 0 - - - 3
138 Tablet Tambah Darah 990 900 1,890 100 1790 130 -
140 TKF Cairan 0 - - - -
141 Vit. B Kompleks tablet 2550 3100 5,650 2,940 2710 3,822 1,100
144 Yodium Povidon Lar 10% 15 ml 3 0 3 3 0 - -
148 Yodium Povidon Lar 10% 1 liter 0 - - - 3
149 Zinc Tab 20 mg 210 800 1,010 467 505 607 100

3 Curcuma FCT 3120 0 3,120 160 2960 208
5 Dulcolax supp 10 mg 15 0 15 - 15 - -
6 Dulcolax/Bisacodyl tablet 5 mg 0 0 - - - 50
7 Guanistrep Syrup 0 0 - - - -
8 Herbakof Syrup 0 240 240 1 239 1
9 Histigo 6 mg 0 0 - - - -
10 Livron B Plex 1200 0 1,200 100 1100 100 -
11 Novatusin Sirup 260 0 260 22 238 22
12 OBH Nellco 0 0 - - 0 20
13 Ramvit C 500 mg 400 0 400 - 400 0
14 Reco Tetes Telinga 0 - - 0 10
15 Reco Tetes Mata 0 - - 0 10
17 Stimuno Syrup 110 0 110 23 87 23
19 BMHP Vaksin Anti Rabies 0 20 20 5 15 5
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -
3 Stesolid rectal tube 5 mg 0 0 - - - 5

E. PREKURSOR
3 Metilergometrina Inj. 0.2 mg/ml 10 10 - 10 -
F. BMHP
2 Alkohol Swab 3 10 13 5 8 7 -
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 3 0 3 3 0 4 4
7 Catgut Chromic 2/0 8 0 8 4 4 5 1
8 Catgut Chromic 3/0 2 3 5 5 0 7 7
9 Catgut Plain 2/0 8 0 8 - 8 0 -
10 Catgut Plain 3/0 0 - - 0 -
11 Daryantullle 2 3 5 2 3 3 -
13 Disposible 1 cc 19 85 104 73 31 95 64
14 Disposible 10 cc 14 0 14 - 14 0 -
15 Disposible 3 cc 80 100 180 100 80 130 50
16 Disposible 5 cc 19 0 19 - 19 0 -
22 H2O2 3% 0 - - 0 -
30 Handschoon Steril 7 5 0 5 5 0 7 7
31 HCG Test 1 0 1 - 1 0 -
32 Hibiscrup 1 0 1 - 1 0 -
33 Hypafix 10 x 5 0 1 1 1 0 1 -
34 Hypafix 15 x 5 2 0 2 1 1 1 -
35 Hypafix 5 x 5 1 0 1 - 1 0 -
36 Infus Set Anak 2 3 5 - 5 0 -
37 Infus Set Dewasa 20 0 20 3 17 4 -
38 Iodium Test 5 5 5 0 7 7
39 IV. Catheter No. 18 7 7 - 7 0 -
40 IV. Catheter No. 20 5 0 5 - 5 0 -
41 IV. Catheter No. 22 9 0 9 - 9 0 -
42 IV. Catheter No. 24 4 0 4 - 4 0 -
43 IV. Catheter No. 26 4 0 4 - 4 0 -
44 Jarum Heating No. 10 24 24 - 24 0 -
45 Jarum Heating No. 12 90 90 - 90 0 -
46 Jarum Heating No. 14 36 36 - 36 0 -
47 Jarum Heating No. 15 60 60 - 60 0 -
48 Jelly USG 0 3 3 2 1 3 2
49 Kapas Pembalut 250 gr 1 1 - 1 0 -
56 Kasa Pembalut 40 x 80 cm 3 0 3 2 1 3 2
58 Lisol 50% 2 2 - 2 0 -
59 Masker Hijab @50 5 15 20 17 3 22 19
60 Masker Karet @50 0 0 - - 0 -
62 Nurse cap @100 1 0 1 - 1 0 -
64 Nylon No. 6/0 (Benang Wajah) 27 27 - 27 0 -

0 - - 0 -

2 2 - 2 0 -

0 - - 0 -

2 0 2 - 2 0 -
69 Polyprepilene 3/0 D3 19 mm 9 0 9 - 9 0 -
70 Pot Salep 30gr 25 50 75 75 0 98 98
71 Pot Salep 50gr 0 50 50 30 20 39 20
74 Selang Oksigen Dewasa 7 15 22 7 15 9 -
75 Softaman 0 - - 0 -
84 Suction Catheter No 8 4 3 7 5 2 7 5
87 Suture Silk 2/0 0 - - 0 -
88 Suture Silk 3/0 6 0 6 6 0 8 8
89 Umbilical Cord Clamps 35 0 35 35 0 46 46
90 Under Pad 13 0 13 10 3 13 10
91 Urine bag 5 0 5 - 5 0 -
OBAT PROGRAM
1 Ampicilin 1 gr 111 111 - 111 0
4 Euthyrox 0 - - 0
5 Ferbion (PTM Lansia) 0 18940 18,940 810 18130 1053
7 MDT MB Adult 0 3 3 3 0 0
15 Taburia 0 0 - - 0 0
16 Livron B Plex 2700 0 - - 2700
OBAT & ABHP P3K

1 Cefadroxil 500 mg 0 0 - - 0 0
6 Neurobion Tablet 20 0 20 - 20 0
8 Voltadex Gel 1 0 1 - 1 0

3 Azitromycin 500 mg 18 0 18 (17) 35 -22
5 Becefort Syrup 4 2 6 4 2 5
6 Bionicom Zinc 1990 0 1,990 - 1990 0
8 Curcuma FCT 3040 0 3,040 - 3040 0
9 D Trivit 230 0 230 - 230 0
12 Erdostein 120 0 120 - 120 0
13 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
15 Imunivit Tablet 500 0 500 - 500 0
18 Momucil 200 mg 0 0 - - 0
19 OBH Nelco Syrup 8 0 8 2 6 3
21 Oseltamivir 20 0 20 - 20 0
22 Pafivirapir 280 0 280 - 280 0
24 Zink Syrup 5 0 5 - 5 0
Vaksin
1 Vaksin BCG
3 Vaksin Td
4 Vaksin Polio
5 IPV
6 MR
7 Hep B1 ds/Buah
Vitamin Pegawai
1 HB VIT 500 0 0 0 0 0 0 -
Vitamin Proram KIA

1 Ferbion 2400 0 2,400 1,500 900 1500

3 Alkohol 70% 5 L 0 0 0 0 0 0
14 Obyek Glass Cat N0. 7105 0 0 0 0 0
18 Reagen HIV SD 0 0 0 0 0 0
24 Tabung EDTA 0 0 0 0 0 0
27 Test Urine 3P 0 0 - 0 0 2
28 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0 -
29 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
OBAT & ABHP GIGI

2 Alevo Gym 0 0 0 0 0
31
32
ABHP TBC
3 Masker N95 @20 0 500 500 0 500 0
Obat BLUD
Obat Generik
5 Asam Folat 1200 0 1200 200 1000 200
10 Captopril 25mg 5500 0 5500 2300 3200 2990
14 Etil Klorid 2 0 2 1 1 1
16 Dexametason 0,5 mg 5100 0 5100 3800 1300 4940
19 ISDN 5mg 100 0 100 0 100 0
20 Ibuprofen 400 mg 0 0 0 0 0
23 Ketokonazole 200 mg 50 0 50 0 50 0
25 Metformin 500 mg Tab 800 0 800 0 800 0
27 MGSO4 0 0 0 0 0
28 Nifedipin 10 mg Tab 200 0 200 0 200 0
32 Ranitidin 100 0 100 0 100 0
33 Salbutamol 2 mg 1400 1500 2900 395 2505 514
36 Vitamin B 6 100 2000 2100 330 1770 429
Obat Non Generik

7 Lecozinc 20 mg 0 0 0 0 0 0
12
ABHP
1 Bisturi no.11 90 100 190 110 80 110
3 Catgut Plain 3/0 24 0 24 0 24 0
5 H2O2 800 ml 4 0 4 0 4 0

572 1750 0 2322

Petugas IFK

Petugas Puskesmas
…………………………… …………………………… 2. Memeriksa : ………………..
…………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : AGUSTUS IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : SEPTEMBER PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
9 Amlodipin tablet 5 mg 4975 - 4,975 2,135 2840 2,776 -
10 Amoksisilin 125 mg Sirup Kering 90 - 90 17 73 22 -
15 Antasida DOEN Tablet Komb.100's 430 1,400 1,830 770 1060 1,001 -
19 Asam Askorbat (Vit C) Tablet 50 mg 0 3,000 3,000 1,955 1045 2,542 1,500
20 Asam Askorbat (Vit C) Tablet 250 mg 0 - - - - -
21 Asam Folat 0,4 mg 0 - - - - 1,000
25 Ats Inj. 1.500 IU 16 - 16 4 12 5 -
26 Attapulgit tablet 600 mg ( Neo Diagon) 212 300 512 136 376 177 -
27 Betahistin 6 mg 200 500 700 265 435 345 -
29 Bisakodil 5 mg 0 - - - - 50
31 Captopril tablet 25 mg 1385 - 1,385 1,385 0 1,801 2,000
35 Cetirizine tablet 10 mg 0 - - - 100
36 Ciprofloksasin tablet 500 mg 0 - - - - 500
37 Deksametason 0,5 mg tablet 100"s 0 - - - - 2,000
39 Dextrose 5% 3 - 3 - 3 - -
40 Difenhidramin Inj. 3 1 4 - 4 - -
42 Dimenhidrinat Tablet 50 mg 574 1,200 1,774 339 1435 441 -
43 Domperidon Susp 0 96 96 58 38 75 37
44 Domperidon Tablet 295 1,300 1,595 825 770 1,073 300
45 Epinefrina Inj. 0,1% 1 ml 2 2 4 2 2 3 1
47 Eritromisin tablet 250 mg 0 - - - - EXP
48 Etanol 70%/100 ml 0 - - - -
49 Etanol 70%/1000 ml 0 - - - -
52 Fenol Gliserol Tetes Tlg. 10% 14 14 8 6 10 4
54 Flukonazol Kapsul 150 mg 0 - - - 4
55 Furosemida tablet 40 mg 12 - 12 12 0 16 200
56 Garam Oralit 200 200 400 173 227 225 -
57 Gentamisin Salep Mata 26 14 40 6 34 6 -
58 Gentamisin Tetes Mata 0,3% 19 - 19 16 3 21 18
62 Griseofulvin tablet 125 mg 0 300 300 - 300 - -
64 Hidrokortison Krim 2,5 % 46 10 56 32 24 42 18
66 Ibuprofen Susp. 100 mg/5 ml 0 - - - - -
67 Ibuprofen Susp. 200 mg/5 ml 0 - - - 12
73 Ketokonazol krim 0 - - - 12
79 Kloramfenikol Tetes Telinga 3% 0 - - - 12
80 Klorfeniramin Maleat tablet 4 mg 1729 3,900 5,629 1,899 3730 2,469 -
82 Kotrimoksazol Tab 480 mg 0 100 100 - 100 - - EXP
83 Lidocain Injeksi 2% (HCl) 3 - 3 3 0 4 100
85 Loratadin tablet 2275 - 2,275 1,465 810 1,905 1,100
87 Magnesium Sulfat Injeksi 40% 0 - - - - -
88 Metformin tab 500 mg 5240 2,800 8,040 5,470 2570 7,111 4,600
89 Metil Prednisolon tablet 4 mg 0 700 700 225 475 293 -
93 MGSO4 40% Injeksi 4 0 4 2 2 3 1
94 Mikonazol Krim 30 65 95 24 71 31 -
95 Na. Diklofenak 25 mg 1094 1750 2,844 1,290 1554 1,677 150
96 Na. Diklofenak 50 mg 150 400 550 115 435 150 -
97 Natrium Klorida Infus 0.9% 13 0 13 5 8 7 -
99 Nistatin susp 100.000 IU/mL 0 - - - -
103 OAT FDC Kategori Anak
104 OAT FDC Kategori Sisipan
105 Oksitetrasiklina Salep Mata 1% 0 - - - -
106 Oksitosin injeksi 5 0 5 - 5 - 20
112 Permetrin Krim 5% 6 21 27 14 13 18 5
120 Pyridoksin (Vit B6) Tablet 10 mg 0 - - - -
122 Ranitidin Tablet 764 400 1,164 614 550 798 300
124 Ringer Laktat 7 6 13 8 5 10 5
126 Rivanol Lar 0.1% 100 ml 0 - - - -
127 Rivanol Lar 0.1% 300 ml 0 - - - -
128 Sabu Inj. 5 ml 1 0 1 - 1 - -
132 Salisil Bedak 2% 50 gram 1 24 25 - 25 - -
138 Tablet Tambah Darah 1065 1400 2,465 1,475 990 1,918 900
140 TKF Cairan 0 - - - -
149 Zinc Tab 20 mg 220 600 820 467 210 607 400

3 Curcuma FCT 0 3120 3,120 - 3120 -
5 Dulcolax supp 10 mg 0 15 15 - 15 - -
7 Ferbion 0 0 - - -
8 Ferbion (PTM Lansia) 0 500 500 500 0 650
9 Guanistrep Syrup 0 0 - - - -
10 Histigo 6 mg 0 0 - - - -
11 Livron B Plex 1435 600 2,035 835 1200 835 -
12 Novatusin Sirup 260 260 - 260 0
13 OBH Nellco 0 0 - - 0 0
14 Ramvit C 500 mg 400 0 400 - 400 0
15 Reco Tetes Telinga 0 - - 0 10
16 Reco Tetes Mata 0 - - 0 -
18 Stimuno Syrup 0 130 130 20 110 20
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -
3 Stesolid rectal tube 5 mg 0 0 - - -

6 Klorpromazina Tablet 100 mg 0 - - - - -
E. PREKURSOR
F. BMHP
2 Alkohol Swab 4 9 13 10 3 13 10
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 1 2 3 - 3 0 -
7 Catgut Chromic 2/0 8 0 8 - 8 0 -
8 Catgut Chromic 3/0 4 2 6 4 2 5 3
9 Catgut Plain 2/0 10 0 10 2 8 3 -
10 Catgut Plain 3/0 0 - - 0 -
11 Daryantullle 2 2 4 2 2 3 1
13 Disposible 1 cc 45 0 45 26 19 34 15
14 Disposible 10 cc 5 10 15 1 14 1 -
15 Disposible 3 cc 100 115 215 135 80 176 96
16 Disposible 5 cc 13 15 28 9 19 12 -
22 H2O2 3% 0 - - 0 -
28 Handschoon Steril 6,5 9 0 9 1 8 1 -
31 HCG Test 1 1 2 1 1 1 0
32 Hibiscrup 1 0 1 - 1 0 -
33 Hypafix 10 x 5 1 0 1 1 0 1 1
34 Hypafix 15 x 5 1 2 3 1 2 1 -
35 Hypafix 5 x 5 1 0 1 - 1 0 -
36 Infus Set Anak 2 0 2 - 2 0 3
37 Infus Set Dewasa 5 20 25 5 20 7 -
38 Iodium Test 5 5 - 5 0 -
39 IV. Catheter No. 18 7 7 - 7 0 -
40 IV. Catheter No. 20 3 2 5 - 5 0 -
41 IV. Catheter No. 22 3 6 9 - 9 0 -
42 IV. Catheter No. 24 4 0 4 - 4 0 -
43 IV. Catheter No. 26 4 0 4 - 4 0 -
44 Jarum Heating No. 10 24 24 - 24 0 -
45 Jarum Heating No. 12 90 90 - 90 0 -
46 Jarum Heating No. 14 36 36 - 36 0 -
47 Jarum Heating No. 15 60 60 - 60 0 -
48 Jelly USG 0 - - 0 -
54 Kasa Pemb. Hid 4 M X 3 Cm 9 9 2 7 3 -
58 Lisol 50% 2 2 - 2 0 -
59 Masker Hijab @50 10 5 15 10 5 13 8
60 Masker Karet @50 0 0 - - 0 -
62 Nurse cap @100 1 0 1 - 1 0 -

0 - - 0 -

2 2 - 2 0 -

0 - - 0 -

2 0 2 - 2 0 -
70 Pot Salep 30gr 50 75 125 100 25 130 105
71 Pot Salep 50gr 0 - - 0 -
74 Selang Oksigen Dewasa 0 7 7 - 7 0 -
75 Softaman 0 - - 0 -
85 Sungkup Nebu Anak 10 0 10 - 10 0 -
87 Suture Silk 2/0 0 - - 0 -
88 Suture Silk 3/0 20 0 20 14 6 18 12
90 Under Pad 10 3 13 - 13 0 -
91 Urine bag 5 0 5 - 5 0 -
OBAT PROGRAM
1 Ampicilin 1 gr 111 111 - 111 0
4 Euthyrox 0 - - 0
6 MDT MB Adult 0 0 - - 0
9 Albendazol Tablet 400 mg 0 1300 1,300 1,300 0 1690
11 Vitamin A 100.000 UI kapsul 0 1 1 1 0 1
14 Taburia 0 46 46 46 0 60
15 Livron B Plex 0 6850 - - 2700
OBAT & ABHP P3K
1 Cefadroxil 500 mg 20 0 20 20 0 20

3 Azitromycin 500 mg 18 0 18 - 18 0
5 Bionicom Zinc 1990 0 1,990 - 1990 0
7 Curcuma FCT 3040 0 3,040 - 3040 0
8 D Trivit 230 0 230 - 230 0
11 Erdostein 120 0 120 - 120 0
12 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
14 Imunivit Tablet 500 0 500 - 500 0
17 Momucil 200 mg 0 0 - - 0
18 OBH Nelco Syrup 10 0 10 2 8 3
20 Pafivirapir 280 0 280 - 280 0
21 Sucralfate Syrup 75 0 75 1 74 1
22 Zink Syrup 5 0 5 - 5 0
Vaksin
1 Vaksin BCG
3 Vaksin Td
4 Vaksin Polio
5 IPV
6 MR
7 Hep B1 ds/Buah
Vitamin Pegawai
1 HB VIT 500 0 1650 1650 1650 1650 -
Vitamin Proram KIA
1 Ferbion 3500 3,500 1,100 2400 1100

2 Benecheck Plus Urin Acid @25 0 0 0 0 0
3 Alkohol 70% 5 L 0 0 0 0
4 Chlodine 0,5% Handrub 0 0 0 0
5 Corona Ag Rapid Test Casette 0 0 0 0
6 Diluent For Mindray BC 3600 0 - 0 0
7 Glucosa Strip Accu check @100 0 0 0 0
8 Glucosa Strip GE @ 50 0 0 0 0
10 Hepatitis B Imun Globin 0 0 0 0 0
14 Obyek Glass Cat N0. 7105 0 0 0 0
15 RDT DBD Combo Igg/Igm 0 0 0 0 0
16 Reagen Gol. Darah (Anti A,B,AB & Rhesus) 0 0 0 0 0
17 Reagen HbsAg 0 0 0 0 0
18 Reagen HIV SD 0 0 0 0 0
19 Reagent Cat Ziehl Nellsen 0 0 0 0 0
21 SteriOne 5 Liter 0 0 0 0 0
22 Stik Asam Urat (BENECHECK) 0 0 0 0 0
23 Stik Kolestrol (BENECHECK) 0 0 0 0 0
24 Tabung EDTA 0 0 0 0 0
25 Tuberculin PPD 0 0 0 0 0
26 Virocheck Hbsag 0 75 75 75 75
27 Test Urine 3P 0 0 - 0 2
28 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 -
29 1470A3 2250 XT REST SYR 3G 0 0 0 0 0
OBAT & ABHP GIGI
2 Alevo Gym 0 0 0 0 0
31
32
ABHP TBC
1 Masker Surgical @50 17 17 17 17
2 Masker Kain 3 ply 49 49 49 49
Obat BLUD
Obat Generik
5 Asam Folat 1500 0 1500 300 1200 300
10 Captopril 25mg 0 6000 6000 500 5500 650
14 Etil Klorid 2 0 2 0 2 0
16 Dexametason 0,5 mg 1800 6200 8000 2900 5100 3770
19 ISDN 5mg 100 0 100 0 100 0
20 Ibuprofen 400 mg 0 0 0 0 0
23 Ketokonazole 200 mg 50 0 50 0 50 0
25 Metformin 500 mg Tab 800 0 800 0 800 0
26 Metronidazole 500 mg Tab 0 0 0 0 0
27 MGSO4 0 0 0 0 0
28 Nifedipin 10 mg Tab 200 0 200 0 200 0
31 Phenol Glyserol 24 0 24 0 24 0 EXP
32 Ranitidin 200 0 200 100 100 130
33 Salbutamol 2 mg 1700 0 1700 300 1400 390
36 Vitamin B 6 500 0 500 400 100 520
Obat Non Generik

7 Lecozinc 20 mg 300 0 300 300 0 519
12
ABHP
1 Bisturi no.11 0 100 100 10 90 10
3 Catgut Plain 3/0 24 0 24 0 24 0
5 H2O2 800 ml 4 0 4 0 4 0

0 0 0 0

Petugas IFK

Petugas Puskesmas
…………………………… …………………………… 2. Memeriksa : ………………..
…………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : JULI IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : AGUSTUS PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
6 Ambroxol 30mg Tablet 0 0 - - 0 - -
7 Ambroxol Syrup 0 - - 0 - -
12 Amoksisilin Drop 0 - - - 0 - -
14 Amoksisilin kapsul 250 mg 0 - - 0 - -
15 Antasida DOEN Tablet Komb.100's 530 300 830 400 430 520 300
18 Aqua pro injeksi 25 ml 0 - - 0 - 10
19 Asam Askorbat (Vit C) Tablet 50 mg 0 - - 0 - 3,000
20 Asam Askorbat (Vit C) Tablet 250 mg 0 - - - 0 - 500
21 Asam Folat 0,4 mg 0 - - - 0 - -
22 Asam Traneksamat 250 mg/5ml injeksi - - 0 - -
25 Ats Inj. 1.500 IU 2 15 17 1 16 1 -
26 Attapulgit tablet 600 mg ( Neo Diagon) 0 300 300 88 212 114 300
27 Betahistin 6 mg 305 300 605 405 200 527 -
29 Bisakodil 5 mg 0 - - - 0 - -
30 Captopril tablet 12,5 mg 0 - - - 0 - -
31 Captopril tablet 25 mg 2800 200 3,000 1,615 1385 2,100 715
32 Captopril tablet 50 mg - - 0 - -
33 Carbamazepin tablet 200 mg 0 - - 0 - -
35 Cetirizine tablet 10 mg 0 - - 0 - -
36 Ciprofloksasin tablet 500 mg 0 - - - 0 - -
37 Deksametason 0,5 mg tablet 100"s 0 - - - 0 - -
38 Deksametason Injeksi 12 10 22 22 0 29 29 EXP JULI 22
39 Dextrose 5% 3 - 3 - 3 - -
40 Difenhidramin Inj. 3 3 6 3 3 4 1
41 Diltiazem tablet 30 mg 0 - - 0 - -
42 Dimenhidrinat Tablet 50 mg 170 700 870 296 574 385 -
43 Domperidon Susp 0 - - - 0 - 20
44 Domperidon Tablet 259 600 859 564 295 733 400
46 Eritromisin Sirup 0 - - - 0 - -
47 Eritromisin tablet 250 mg 20 20 20 0 26 - EXP
48 Etanol 70%/100 ml 0 - - 0 - -
49 Etanol 70%/1000 ml 0 - - 0 - -
50 Etanol 70%/ 5 liter 0 0 -
51 Etil Klorida Semprot 0 - - 0 - -
52 Fenol Gliserol Tetes Tlg. 10% 14 14 - 14 - -
53 Fletcher Serbuk 0 - - 0 - -
54 Flukonazol Kapsul 150 mg 0 - - 0 - -
56 Garam Oralit 104 300 404 204 200 265 -
58 Gentamisin Tetes Mata 0,3% 3 43 46 27 19 35 16
62 Griseofulvin tablet 125 mg 0 - - 0 - 300
63 Hidroklorotiazid tablet 25 mg 100 - 100 - 100 - -
67 Ibuprofen Susp. 200 mg/5 ml 0 - - 0 - -
68 Ibuprofen tablet 200 mg 0 - - 0 - -
70 Isoniazid (INH) 100 mg Tablet 100's 0 - - 0 - -
72 Kalsium Laktat 500 mg Tablet 100's 1245 600 1,845 225 1620 293 -
73 Ketokonazol krim 0 - - 0 - -
76 Kloramfenikol 0.5 % tetes mata 0 - - 0 - -
77 Kloramfenikol Salep Mata 1% 0 - - 0 - -
78 Kloramfenikol sirup 0 - - 0 - -
79 Kloramfenikol Tetes Telinga 3% 0 - - 0 - -
82 Kotrimoksazol Tab 480 mg 110 - 110 110 0 143 100 EXP
85 Loratadin tablet 570 2,500 3,070 795 2275 1,034 -
86 Magnesium Sulfat Injeksi 20% 0 - - 0 - -
88 Metformin tab 500 mg 1715 8,000 9,715 4,475 5240 5,818 -
89 Metil Prednisolon tablet 4 mg 170 - 170 170 0 221 200
91 Metronidazol tablet 250 mg 0 - - 0 - -
92 Metronidazol tablet 500 mg 205 0 205 205 0 267 300
93 MGSO4 40% Injeksi 4 4 8 4 4 5 -
94 Mikonazol Krim 44 0 44 14 30 18 -
95 Na. Diklofenak 25 mg 366 1800 2,166 1,072 1094 1,394 -
96 Na. Diklofenak 50 mg 290 0 290 140 150 182 -
98 Nifedipin tablet 10 mg 0 - - 0 - -
99 Nistatin susp 100.000 IU/mL 0 - - 0 - -
101 OAT FDC Kategori 1 8 0 8 2 8 - (8)
102 OAT FDC Kategori 2 0 - - 0 - -
103 OAT FDC Kategori Anak 2 0 2 - 2 - (2)
104 OAT FDC Kategori Sisipan 0 - - 0 - -
105 Oksitetrasiklina Salep Mata 1% 0 - - 0 - -
106 Oksitosin injeksi 5 0 5 - 5 - -
107 Omeprazol Injeksi 40mg /10ml 0 10 10 4 6 5 -
110 Parasetamol drops 42 64 106 90 16 117 100
112 Permetrin Krim 5% 0 10 10 4 6 5 -
114 Phytomenadion (Vit K1) Inj 10 mg/ml 0 - - 0 - -
117 Prednison 5 mg Tablet 100's 0 - - 0 - -
118 Primakuin Tablet 15 mg 0 - - 0 - -
119 Propiltiourasil tablet 100 mg 0 - - 0 - -
120 Pyridoksin (Vit B6) Tablet 10 mg 0 - - 0 - -
121 Quinin tablet 0 - - 0 - -
122 Ranitidin Tablet 1000 200 1,200 436 764 567 -
123 Reserpina 0.25 mg Tablet 100's 0 - - 0 - -
124 Ringer Laktat 2 5 7 - 7 - -
125 Risperidon Tablet 2 mg 0 - - 0 - -
126 Rivanol Lar 0.1% 100 ml 0 - - 0 - -
127 Rivanol Lar 0.1% 300 ml 7 7 - 0 - - EXP
128 Sabu Inj. 5 ml 1 0 1 - 1 - -
129 Salbutamol cairan ih 0,1% 0 - - 0 - -
130 Salbutamol tablet 2 mg 0 0 - - 0 - 500
135 Simvastatin tablet 20 mg 0 0 - - 0 - -
136 Spon Gelatin 0 - - 0 - -
137 Sulfadiazin Silver Krim 1% 35 gr (Burnazin) 0 0 - - 0 - -
139 Thiamin (Vit B1) Tablet 50 mg 0 - - 0 - -
140 TKF Cairan 0 - - 0 - -
142 Vitamin A 100.000 UI kapsul 0 - - 0 - -
145 Yodium Povidon Lar 10% 30 ml 0 - - 0 - -
148 Yodium Povidon Lar 10% 1 liter 0 - - 0 - -
149 Zinc Tab 20 mg 368 300 668 467 220 607 400

1 Afolat Tablet 1 mg 0 - - - -
2 Bufacetin Salep Kulit 40 0 40 18 22 23 -
4 Dulcolax supp 10 mg 0 10 10 10 0 13 13
5 Dulcolax/Bisacodyl tablet 5 mg 0 0 - - 0 - 20
6 Guanistrep Syrup 0 0 -
7 Histigo 6 mg 0 0 - - 0 - -
8 Livron B Plex 1700 0 1,700 265 1435 265 -
9 OBH Nellco 0 0 - - 0 0 0
10 Ramvit C 500 mg 0 500 500 100 400 100
11 Reco Tetes Telinga 0 - - 0 - 10
12 Reco Tetes Mata 0 - - 0 - -
13 Scabicid Krim 0 - - 0 - -
15 Ventolin Nebulizer 0 0 - - 0 - 30
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -
2 Diazepam Injeksi 0 3 3 - 3 0
3 Stesolid rectal tube 5 mg 5 0 5 5 0 7 10 EXP

2 Haloperidol tablet 1,5 mg 0 - - - 0 - -
5 Triheksilfenidil HCl tablet 2 mg 0 - - 0 - 200
6 Klorpromazina Tablet 100 mg 0 - - - 0 - -
7 Klorpromazina Tablet 25 mg 0 - - - 0 - 200
E. PREKURSOR
1 Antimigren tablet Kombinasi (ergotamin) 21 21 21 0 - EXP
F. BMHP
2 Alkohol Swab 4 0 4 - 4 0 -
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 2 1 3 2 1 3 2
7 Catgut Chromic 2/0 8 0 8 - 8 0 -
8 Catgut Chromic 3/0 4 4 - 4 0 -
9 Catgut Plain 2/0 0 10 10 - 10 0 -
10 Catgut Plain 3/0 0 - - 0 0 -
11 Daryantullle 5 0 5 3 2 4 2
12 Dermafix-S IV 6 6 6 0 8 8
13 Disposible 1 cc 10 80 90 45 45 59 14
14 Disposible 10 cc 15 0 15 10 5 13 8
15 Disposible 3 cc 165 100 265 165 100 215 115
16 Disposible 5 cc 20 13 33 20 13 26 13
19 Folley Catheter No. 14 2 2 2 0 3 - EXP
20 Folley Catheter No. 16 0 - - 0 0 -
22 H2O2 3% 0 - - 0 0 -
24 Handschoon Non Steril M 0 - - 0 0 -
25 Handschoon Non Steril S Powdered @100 0 - - 0 0 -
29 Handschoon Panjang Siku 6,5 10 0 10 - 10 0
31 HCG Test 1 1 2 1 1 1 0
32 Hibiscrup 1 0 1 - 1 0 -
33 Hypafix 10 x 5 1 1 2 1 1 1 0
34 Hypafix 15 x 5 2 1 3 2 1 3 2
35 Hypafix 5 x 5 1 0 1 - 1 0 -
36 Infus Set Anak 5 0 5 3 2 4 2
37 Infus Set Dewasa 10 10 20 15 5 20 15
38 Iodium Test 5 5 - 5 0 -
39 IV. Catheter No. 18 7 7 - 7 0 -
40 IV. Catheter No. 20 4 3 7 4 3 5 2
41 IV. Catheter No. 22 10 0 10 7 3 9 6
42 IV. Catheter No. 24 4 0 4 - 4 0 -
43 IV. Catheter No. 26 4 0 4 - 4 0 -
44 Jarum Heating No. 10 24 24 - 24 0 -
45 Jarum Heating No. 12 90 90 - 90 0 -
46 Jarum Heating No. 14 36 36 - 36 0 -
47 Jarum Heating No. 15 60 60 - 60 0 -
48 Jelly USG 0 - - 0 0 -
50 Kapas Pembalut 500 gr 0 - - 0 0 -
51 Kasa Kompres 40/40 Steril 0 - - 0 0 -
52 Kasa Kotak Steril 9 7 16 8 8 10 2
53 Kasa Pemb. Hid 4 M X 15 Cm 0 - - 0 0 -
55 Kasa Pembalut 2 x 80 cm 0 - - 0 0 -
56 Kasa Pembalut 40 x 80 cm 0 4 4 - 4 0 -
57 Leukoplast 2,5cm x 4,5 cm 0 - - 0 0 -
58 Lisol 50% 2 2 - 2 0 -
59 Masker Hijab @50 0 10 10 - 10 0 -
60 Masker Karet @50 0 0 - - 0 0 -
61 Masker Non Medis 3 Ply 0 - - 0 0 -
62 Nurse cap @100 1 0 1 - 1 0 -
63 Nylon No. 3/0 (Benang wajah) 0 - - 0 0 -

0 - - 0 0 -

2 2 - 2 0 -

0 - - 0 0 -

2 0 2 - 2 0 -
70 Pot Salep 30gr 50 100 150 100 50 130 80
71 Pot Salep 50gr 0 - - 0 0 -
73 Selang Oksigen Anak 9 0 9 4 5 5 0
75 Softaman 0 - - 0 0 -
76 Steril Surgical Blades (Aesculaps) 100's 184 184 184 0 239 239 EXP
77 Stomach Tube No. 12 6 6 6 0 8 8 EXP
78 Stomach Tube No. 14 4 4 4 0 5 5 EXP
79 Strip asam urat 0 - - 0 0 -
80 Strip glucose 0 - - 0 0 -
81 Strip kolesterol (Humases) '20s 2 0 2 2 0 3 3
82 Strip trigliserid 0 - - 0 0 -
86 Sungkup Nebu Dewasa 0 20 20 10 10 13 3
87 Suture Silk 2/0 0 - - 0 0 -
88 Suture Silk 3/0 12 8 20 - 20 0 -
90 Under Pad 20 0 20 10 10 13 3
91 Urine bag 5 0 5 - 5 0 -
OBAT PROGRAM
1 Ampicilin 1 gr 111 111 - 111 0
2 Calcii Gluconas - - 0 0
3 Diazepam Injeksi 43 43 43 0 56 EXP
4 Euthyrox 250 250 250 0 325 EXP
5 Okxytetracyclin Salep Mata 500 500 - 0 0 EXP
6 MDT MB Adult 0 0 - - 0 0
9 Albendazol Tablet 400 mg 0 - - 0 0
10 Albendazole Syrup 0 - - 0 0
11 Vitamin A 100.000 UI kapsul 0 - - 0 0
13
OBAT & ABHP P3K
1 Cefadroxil 500 mg 40 0 40 20 20 20
2 Counterpain Gel 15 gr 0 0 - - 0 0
5 Minyak Kayu Putih 15 ml 0 0 - - 0 0
1 Asam Askorbat 250 mg Tab 0 0 - - 0 0 -
2 Asetilsistein 200 mg (Memucil) 180 0 180 30 150 39 -
3 Azitromycin 500 mg 18 0 18 - 18 0
5 Bionicom Zinc 2004 0 2,004 14 1990 18
7 Curcuma FCT 1840 1200 3,040 - 3040 0
8 D Trivit 140 90 230 - 230 0
11 Erdostein 120 0 120 - 120 0
12 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
14 Imunivit Tablet 400 100 500 - 500 0
15 Livron B plex 0 0 - - 0 0
16 Microlax Enema 4 ml 50 50 - 50 0
17 Momucil 200 mg 0 0 - - 0 0
18 OBH Nelco Syrup 11 0 11 1 10 1
20 Pafivirapir 280 0 280 - 280 0
22 Zink Syrup 0 5 5 - 5 0
Vaksin
1 Vaksin BCG 0 0 0 0
2 Vaksin DPT/ DPT-HB/ DPT-HB-Hib 0 0 0 0
3 Vaksin Td 0 0 0 0
4 Vaksin Polio 0 0 0 0
5 IPV 0 0 0 0
6 MR 0 0 0 0
7 Hep B1 ds/Buah 0 0 0 0
0 0 0
Vitamin Pegawai
1 HB VIT 500 0 0 0 0 0 0 -
Vitamin Proram KIA

1 Pehavral tab 0 - - 0

2 Alkohol 70% 5 L 0 2 2 2 2
3 Chlodine 0,5% Handrub 0 10 10 10 10
4 Corona Ag Rapid Test Casette 0 0 0 0 0
5 Diluent For Mindray BC 3600 0 2 2 2 2
6 Glucosa Strip Accu check @100 0 0 0 0 0
7 Glucosa Strip GE @ 50 0 0 0 0 0
10 Obyek Glass Cat N0. 7105 0 8 8 8 8
14 Reagen HIV SD 0 0 0 0 0 0
17 SteriOne 5 Liter 0 10 10 10 0 10
18 Stik Asam Urat (BENECHECK) 0 0 0 0 0 0 -
20 Tabung EDTA 0 0 0 0 0 0
22 Virocheck Hbsag 0 100 100 100 0 100
23 Test Urine 3P 0 0 - 0 0 2
OBAT & ABHP GIGI
1 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0
2 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
4 Alevo Gym 0 0 0 0 0 0 -
5 Barbed Broach (Jarum Extepasi) 6's 0 1 1 1 0 1
8 Cellulose Matrix Strip 0 0 0 0 0 0
9 CHKM (paramonochlorofenol) 20 ml 0 1 1 1 0 1
10 Cocoa Butter 10gr 0 1 1 1 0 1
11 Composite A2 dan A3 0 0 0 0
12 Composite Flow 0 0 0 0 0 -
13 Cotton Roll size 1 (12's) 0 1 1 1 0 1
14 Cresotin Liquid no.2 0 1 1 1 0 1
15 Cresotin Paste 0 1 1 1 0 1
17 Eugenol Cairan 0 1 1 1 0 1
18 Fuji VII White (powder + liquid) 0 0 0 0 0
19 Fuji IX EXT A3 (powder + liquid) 0 0 0 0 0 0
21 GC Gold Label VII Extra Capsul 30's 0 3 0 0 0 0
22 Glass Plate 0 0 0 0 0 0 -
24 Kalsium Hidroksida Pasta 0 1 1 1 0 1
27 Pasta Pengisi Saluran akar with iodorm 0 1 1 1 0 1
28 Saliva Ejector 100's 0 1 1 1 0 1
29 Scothbond Universal 2 x 3 ml 0 1 1 1 0 1
30 51202 Single Bond 2 RF LA/APAC 0 0 0 0 0 0
31 Xylestein-A (Lidocain HCL + Epineprine HCL) 0 1 1 1 0 1
32 Zinc Phospat 0 0 0 0 0 0
ABHP TBC
Obat BLUD
Obat Generik
2 Allopurinol 300 mg Tab 0 0 0 0 0
5 Asam Folat 1600 0 1600 100 1500 100
7 Asetilsistein 200 mg 0 0 0 0 0 0
8 Bedak Salisil 0 0 0 0 0
9 Burnazin Cream 0 0 0 0 0
10 Captopril 25mg 0 0 0 0 0
11 Cetirizin Syrup 0 0 0 0 0
13 Daryantulle 0 0 0 0 0
14 Etil Klorid 2 0 2 0 2 0
15 Gentamisin Tetes Mata 0 0 0 0 0
16 Dexametason 0,5 mg 1100 3000 4100 2300 1800 2990
19 ISDN 5mg 100 100 0 100 0
20 Ibuprofen 400 mg 100 0 100 100 0 130
23 Ketokonazole 200 mg 50 0 50 0 50 0
25 Metformin 500 mg Tab 800 0 800 0 800 0
27 MGSO4 12 12 12 0 16 EXP
28 Nifedipin 10 mg Tab 200 200 0 200 0
30 Omeprazole Injeksi 2 0 2 2 0 3
32 Ranitidin 200 0 200 0 200 0
33 Salbutamol 2 mg 1800 0 1800 100 1700 130
35 Simvastatin 10 mg 0 0 0 0
36 Vitamin B 6 800 0 800 300 500 390
38 Vitamin B complex 0 0 0 0
Obat Non Generik
1 Bimastan 500 mg 0 0 0 0
3 Cazetin Drop 10 0 10 4 6 7
4 Dulcolax Suppo 10 mg Tab 0 0 0 0 0
7 Genoint Tetes Mata (gentamisin tetes mata) 0 0 0 0 0 0
8 Lecozinc 20 mg 300 0 300 0 300 0
9 Reco Tetes mata 0 0 0 0 0 0
11 Scabimite Salep 30 gr 2 0 2 2 0 2
ABHP
1 Catgut Silk 3/0 0 0 0 0 0
2 Catgut Plain 3/0 43 0 43 19 24 19
4 H2O2 800 ml 5 0 5 1 4 0
5 Handscoon Size S 0 0 0 0 0
7 Kassa Hidrofil 40 x 80 cm 0 0 0 0 0 0
9 Kertas Lakmus Merah 0 0 0 0 0 0
10 Masker Earloop 0 0 0 0 0
11 Masker Headloop 0 0 0 0 0
15 Selang Oxygen Dewasa 0 0 0 0 0

Balikpapan,
Petugas IFK
0 0 0 0

Petugas Puskesmas
Pimpinan Puskesmas Kepala Instalasi Farmasi & Perbekkes 2. Memeriksa : ………………..
…………………………
…………………………… ……………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : JUNI IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : JULI PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
5 Allopurinol tablet 300 mg 0 0 - - 0 - -
10 Amoksisilin 125 mg Sirup Kering 126 30 156 31 125 40 -
14 Amoksisilin kapsul 250 mg 0 - - 0 - -
15 Antasida DOEN Tablet Komb.100's 634 500 1,134 604 530 785 300
16 Antasida DOEN Suspensi 92 - 92 37 55 48 -
17 Anti Hemoroid Supositoria 0 20 20 6 14 8 -
18 Aqua pro injeksi 25 ml 0 - - 0 - -
19 Asam Askorbat (Vit C) Tablet 50 mg 0 - - 0 - -
20 Asam Askorbat (Vit C) Tablet 250 mg 700 3,150 3,850 3,850 0 5,005 500
21 Asam Folat 0,4 mg 0 - - - 0 - -
24 Atrofin Sulfas Injeksi 0,25 mg 3 - 3 1 2 1 -
25 Ats Inj. 1.500 IU 6 9 15 13 2 17 15
26 Attapulgit tablet 600 mg 96 100 196 196 0 255 300
27 Betahistin 6 mg 0 500 500 195 305 254 -
29 Bisakodil 5 mg 4 - 4 4 0 5 -
30 Captopril tablet 12,5 mg 500 300 800 800 0 1,040 1,040
31 Captopril tablet 25 mg 4800 - 4,800 2,000 2800 2,600 -
38 Deksametason Injeksi 12 12 - 12 - 10 EXP JULI'22
39 Dextrose 5% 3 - 3 - 3 - -
42 Dimenhidrinat Tablet 50 mg 286 300 586 416 170 541 400
45 Epinefrina Inj. 0,1% 1 ml 2 1 4 1 3 1 -
47 Eritromisin tablet 250 mg 20 20 - 20 - - EXP
48 Etanol 70%/100 ml 0 - - 0 - -
49 Etanol 70%/1000 ml 0 - - 0 - -
50 Etanol 70%/ 5 liter 0 0 -
56 Garam Oralit 270 - 270 166 104 216 100
58 Gentamisin Tetes Mata 0,3% 0 20 20 17 3 22 19
60 Glimepirid tablet 2 mg 1265 1,400 2,665 1,985 680 1,985 1,300
62 Griseofulvin tablet 125 mg 0 - - 0 - -
63 Hidroklorotiazid tablet 25 mg 0 100 100 - 100 - -
81 Kotrimoksazol Susp 4 3 7 1 6 1 -
82 Kotrimoksazol Tab 480 mg 10 100 110 - 110 - -
83 Lidocain Injeksi 2% (HCl) 0 26 26 26 0 34 34
84 Lidocain Injeksi 2% (HCL) + Epinefrin 32 10 42 32 10 42 32
85 Loratadin tablet 600 2,300 2,900 2,330 570 3,029 2,500
88 Metformin tab 500 mg 1960 4,000 5,960 4,245 1715 5,519 3,800
89 Metil Prednisolon tablet 4 mg 600 - 600 430 170 559 400
92 Metronidazol tablet 500 mg 0 300 300 95 205 124 -
93 MGSO4 Injeksi 2 2 4 - 4 - -
94 Mikonazol Krim 26 41 67 23 44 30 -
95 Na. Diklofenak 25 mg 500 1500 2,000 1,634 366 2,124 1,800
96 Na. Diklofenak 50 mg 150 250 400 110 290 143 -
99 Nistatin susp 100.000 IU/mL 0 - - 0 - -
101 OAT FDC Kategori 1 8 10 18 2 8 - (8)
103 OAT FDC Kategori Anak 2 0 2 - 2 - (2)
107 Omeprazol Injeksi 40mg /10ml 0 0 - - 0 - -
109 Parasetamol 500 mg Tablet 100's (Novagesic) 870 3100 3,970 2,610 1360 3,393 2,000
112 Permetrin Krim 5% 0 8 8 8 0 10 10
122 Ranitidin Tablet 0 1000 1,000 - 1000 - -
124 Ringer Laktat 7 0 7 5 2 7 5
126 Rivanol Lar 0.1% 100 ml 0 - - 0 - -
127 Rivanol Lar 0.1% 300 ml 7 7 - 7 - - EXP
128 Sabu Inj. 5 ml 2 0 2 1 1 1 0
130 Salbutamol tablet 2 mg 0 0 - - 0 - -
131 Salbutamol tablet 4 mg 50 0 50 50 0 65 100
135 Simvastatin tablet 20 mg 0 0 - - 0 - -
136 Spon Gelatin 0 - - 0 - -
138 Tablet Tambah Darah 500 1900 2,400 1,595 805 2,074 1,300
140 TKF Cairan 0 - - 0 - -
149 Zinc Tab 20 mg 510 500 1,010 467 368 607 200

1 Afolat Tablet 1 mg 0 - - - -
4 Dulcolax supp 10 mg 0 - - - -
5 Dulcolax/Bisacodyl tablet 5 mg 0 15 15 15 0 20 -
7 Histigo 6 mg 0 0 - - 0 - -
8 Livron B Plex 1800 0 1,800 100 1700 100 -
9 OBH Nellco 0 0 - - 0 0 0
10 Reco Tetes Telinga 0 - - 0 - -
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -
2 Diazepam Injeksi - - -
3 Stesolid rectal tube 5 mg 5 0 5 - 5 - 10 EXP

3 Haloperidol tablet 0,5 mg 132 - 132 2 130 3 -
7 Klorpromazina Tablet 25 mg 64 - 64 64 0 83 200
E. PREKURSOR
1 Antimigren tablet Kombinasi (ergotamin) 21 21 - 21 -
F. BMHP
2 Alkohol Swab 4 3 7 3 4 4 (0)
3 Apron 9 9 - 9 0 -
4 Aseptic Gel 500 cc + dispenser 5 5 2 3 3 -
5 Blood Lancet @100 0 4 4 2 2 3 1
7 Catgut Chromic 2/0 8 0 8 - 8 0 -
8 Catgut Chromic 3/0 7 7 3 4 4 -
9 Catgut Plain 2/0 8 8 8 0 10 10
10 Catgut Plain 3/0 0 - - 0 0 -
11 Daryantullle 6 0 6 1 5 1 -
12 Dermafix-S IV 6 6 - 6 0 -
13 Disposible 1 cc 17 60 77 67 10 87 80
14 Disposible 10 cc 0 20 20 5 15 7 -
15 Disposible 3 cc 0 200 200 35 165 46 -
16 Disposible 5 cc 48 0 48 28 20 36 -
19 Folley Catheter No. 14 3 3 1 2 1 -
22 H2O2 3% 0 - - 0 0 -
30 HCG Test 1 0 1 - 1 0 -
31 Hibiscrup 1 0 1 - 1 0 -
32 Hypafix 10 x 5 0 1 1 - 1 0 -
33 Hypafix 15 x 5 2 0 2 - 2 0 -
34 Hypafix 5 x 5 1 0 1 - 1 0 -
35 Infus Set Anak 5 0 5 - 5 0 -
36 Infus Set Dewasa 0 10 10 - 10 0 -
37 Iodium Test 5 5 - 5 0 -
38 IV. Catheter No. 18 7 7 - 7 0 -
39 IV. Catheter No. 20 7 0 7 3 4 4 -
40 IV. Catheter No. 22 4 6 10 - 10 0 -
41 IV. Catheter No. 24 4 1 5 1 4 1 -
42 IV. Catheter No. 26 4 0 4 - 4 0 -
43 Jarum Heating No. 10 24 24 - 24 0 -
44 Jarum Heating No. 12 90 90 - 90 0 -
45 Jarum Heating No. 14 36 36 - 36 0 -
46 Jarum Heating No. 15 60 60 - 60 0 -
47 Jelly USG 0 - - 0 0 -
48 Kapas Pembalut 250 gr 2 2 1 1 1 -
56 Leukoplast 2,5cm x 4,5 cm 1 1 1 0 1 -
57 Lisol 50% 2 2 - 2 0 -
58 Masker Hijab @50 0 - - 0 0 -
59 Masker Karet @50 0 - - 0 0 -
60 Masker Non Medis 3 Ply 0 - - 0 0 10
61 Nurse cap @100 1 0 1 - 1 0 -
0 - - 0 0 -

2 2 - 2 0 -

0 - - 0 0 -

0 2 2 - 2 0 -
69 Pot Salep 30gr 35 75 110 60 50 78 -
70 Pot Salep 50gr 0 - - 0 0 -
71 Selang Oksigen Bayi 6 6 - 6 6 -
74 Softaman 0 - - 0 0 -
75 Steril Surgical Blades (Aesculaps) 100's 184 184 - 184 0 -
76 Stomach Tube No. 12 6 6 - 6 0 -
77 Stomach Tube No. 14 4 4 - 4 0 -
80 Strip kolesterol (Humases) '20s 2 0 2 - 2 0 -
84 Sungkup Nebu Anak 4 5 9 9 0 12 12
86 Suture Silk 2/0 0 - - 0 0 -
87 Suture Silk 3/0 12 15 27 15 12 20 8
89 Under Pad 20 0 20 - 20 0 -
90 Urine bag 3 4 7 2 5 3 -
OBAT PROGRAM
1 Ampicilin 1 gr 111 111 - 111 0
3 Diazepam Injeksi 43 43 - 43 0
4 Euthyrox 250 250 - 250 0 EXP
6 MDT MB Adult 0 2 2 2 0 0
13
OBAT & ABHP P3K
1 Cefadroxil 500 mg 70 0 70 30 40 30
2 Counterpain Gel 15 gr 2 0 2 2 0 2
3 Counterpain Cool Gel 15 gr 5 0 5 1 4 1
4 Counterpain Cream 15 gr 2 0 2 1 1 1
5 Minyak Kayu Putih 15 ml 1 0 1 1 0 1
1 Asam Askorbat 250 mg Tab 900 0 900 900 0 1170 -
2 Asetilsistein 200 mg (Memucil) 360 0 360 180 180 234 -
3 Azitromycin 500 mg 18 0 18 - 18 0
5 Curcuma FCT 1840 0 1,840 - 1840 0
7 D Trivit 140 0 140 140 0
8 Erdomex Syrup 5 0 5 5 0
9 Erdostein 120 0 120 - 120 0
10 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
12 Imunivit Tablet 400 0 400 - 400 0
13 Livron B plex 0 0 - - 0 0
14 OBH Nelco Syrup 11 0 11 - 11 0
15 Pafivirapir 280 0 280 - 280 0
17 Bionicom Zinc 2004 0 3,000 - 2004 0
18 Momucil 200 mg 300 0 300 300 0 390
Vaksin
3 Vaksin Td 0 0 0 0
5 IPV 0 0 0 0
6 MR 0 0 0 0
0 0 0
Vitamin Pegawai
1 HB VIT 500 0 0 0 0 0 0 -
Vitamin Proram KIA


2 Glucosa Strip GE @ 50 0 0 0 0 0
3 Glucosa Strip Accu check @100 0 0 0 0 0
4 SteriOne 5 Liter 0 0 0 0 0
7 Tuberculin PPD 0 0 0 0 0
8 Reagen HIV SD 0 0 0 0 0
9 SD Bioline SYPHLIS 3.0 d 30's 0 0 0 0 0
10 Reagen HbsAg 0 0 0 0 0
12 Corona Ag Rapid Test Casette 0 0 0 0 0
13 Tabung EDTA 0 0 0 0 0
15 Stik Asam Urat (BENECHECK) 0 0 0 0 0
18 Reagen Gol. Darah (Anti A,B,AB & Rhesus) 0 0 - 0 0 0 -
OBAT & ABHP GIGI
1 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0
2 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
4 Alevo Gym 0 0 0 0 0 0 -
12 Composite Flow 0 0 0 0 0 -
14 Cresotin Liquid no.2 0 1 1 1 0 1
15 Cresotin Paste 0 1 1 1 0 1
17 Eugenol Cairan 0 1 1 1 0 1
21 GC Gold Label VII Extra Capsul 30's 0 3 0 0 0 0
22 Glass Plate 0 0 0 0 0 0 -
29 Scothbond Universal 2 x 3 ml 0 1 1 1 0 1
32 Zinc Phospat 0 0 0 0 0 0
ABHP TBC
Obat BLUD
Obat Generik
5 Asam Folat 0 2000 2000 400 1600 400
14 Etil Klorid 0 3 3 1 2 1
16 Dexametason 0,5 mg 1800 3000 4800 3700 1100 4810
19 ISDN 5mg 100 100 0 100 0
20 Ibuprofen 400 mg 1308 0 1308 1208 100 1570
23 Ketokonazole 200 mg 130 0 130 80 50 104
25 Metformin 500 mg Tab 3000 0 3000 2200 800 2860
27 MGSO4 12 12 0 12 0
28 Nifedipin 10 mg Tab 295 295 95 200 124
32 Ranitidin 1200 0 1200 1000 200 1300
33 Salbutamol 2 mg 0 2000 2000 200 1800 260
36 Vitamin B 6 1645 0 1645 845 800 1099
Obat Non Generik

2 Burnazin Cream 25 gr 5 5 0 5 0
3 Cazetin Drop 15 15 5 10 9
8 Lecozinc 20 mg 500 0 500 200 300 346
9 Reco Tetes mata 0 50 50 50 0 50
12 Ventolin Nebulizer 0 0 0 0 0
ABHP
1 Catgut Silk 3/0 0 0 0 0 0
2 Catgut Plain 3/0 43 0 0 0 43 0
4 H2O2 800 ml 5 0 5 0 5 0
6 Infuset Dewasa 37 0 37 19 18 19

Balikpapan,
Petugas IFK
407 1358 0 1765

Petugas Puskesmas
…………………………
…………………………… ……………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : MEI IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : JUNI PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
5 Allopurinol tablet 300 mg 0 0 - - 0 - -
11 Amoksisilin 250 mg Sirup Kering 0 - - 0 - 12
14 Amoksisilin kapsul 250 mg 0 - - 0 - 200 0
15 Antasida DOEN Tablet Komb.100's 1074 400 1,474 840 634 1,092 500
16 Antasida DOEN Suspensi 0 100 100 8 92 10 -
17 Anti Hemoroid Supositoria 0 - - - 0 - 10
18 Aqua pro injeksi 25 ml 0 - - 0 - 10
19 Asam Askorbat (Vit C) Tablet 50 mg 0 - - 0 - 500
20 Asam Askorbat (Vit C) Tablet 250 mg 700 300 1,000 300 700 390 -
21 Asam Folat 0,4 mg 100 - 100 100 0 130 500
21 Asam Mefenamat kaplet 500 mg 1082 700 1,782 957 825 1,244 1,600
23 Asetil Sistein kapsul 200 mg 60's (Memucil) 570 1,470 2,040 1,278 762 1,661 900
25 Ats Inj. 1.500 IU 0 10 10 4 6 5 -
27 Betahistin 0 - - - 0 - 100
28 Betametason krim 19 29 48 24 24 31 7
29 Bisakodil 5 mg 20 - 20 16 4 21 17
30 Captopril tablet 12,5 mg 985 300 1,285 785 500 1,021 500
31 Captopril tablet 25 mg 300 4,800 5,100 300 4800 390 -
34 Cetirizine Syrup 5mg/5ml 12 5 17 15 2 20 18
38 Deksametason Injeksi 12 12 - 12 - -
39 Dextrose 5% 3 - 3 - 3 - -
42 Dimenhidrinat Tablet 50 mg 635 - 635 349 286 454 200
44 Domperidon Tablet 520 - 520 470 50 611 600
48 Etanol 70%/100 ml 0 - - 0 - -
49 Etanol 70%/1000 ml 0 - - 0 - -
50 Etanol 70%/ 5 liter 0 0 -
52 Fenol Gliserol Tetes Tlg. 10% 20 20 6 14 8 -
55 Furosemida tablet 40 mg 180 - 180 50 130 65 -
56 Garam Oralit 350 - 350 80 270 104 -
57 Gentamisin Salep Mata 0 - - - 0 - 24
58 Gentamisin Tetes Mata 0,3% 0 - - - -
60 Glimepirid tablet 2 mg 2245 600 2,845 1,580 1265 1,580 400
63 Hidroklorotiazid tablet 25 mg 0 - - 0 - 100
69 Ibuprofen tablet 400 mg 0 - - 0 - 500
73 Ketokonazol krim 0 - - 0 - 24
74 Ketokonazol tablet 200 mg 0 - - 0 - 200
76 Kloramfenikol 0.5 % tetes mata 0 - - 0 - 12
77 Kloramfenikol Salep Mata 1% 0 - - 0 - 24
83 Lidocain Injeksi 2% (HCl) 20 - 20 20 0 26 30
84 Lidocain Injeksi 2% (HCL) + Epinefrin 32 32 - 32 - 10
85 Loratadin tablet 689 600 1,289 689 600 896 300
88 Metformin tab 500 mg 0 5,000 5,000 3,040 1960 3,952 2,000
89 Metil Prednisolon tablet 4 mg 1013 - 1,013 413 600 537 -
92 Metronidazol tablet 500 mg 0 - - 0 - 300
93 MGSO4 Injeksi 5 0 5 3 2 4 2
94 Mikonazol Krim 22 21 43 17 26 22 -
95 Na. Diklofenak 25 mg 846 600 1,446 946 500 1,230 700
96 Na. Diklofenak 50 mg 240 100 340 190 150 247 100
99 Nistatin susp 100.000 IU/mL 5 5 5 0 7 7
101 OAT FDC Kategori 1 1 10 11 2 8 - -
103 OAT FDC Kategori Anak 2 0 2 - 2 - -
107 Omeprazol Injeksi 40mg /10ml 0 0 - - 0 - 12
112 Permetrin Krim 5% 0 - - 0 - 3
113 Phytomenadion (Vit K) Tablet 10 mg 0 - - 0 - 100
116 Pirantel Pamoat Tab.125 mg 0 - - 0 - -
122 Ranitidin Tablet 0 0 - - 0 - 1,000
124 Ringer Laktat 4 8 12 5 7 7 -
126 Rivanol Lar 0.1% 100 ml 0 - - 0 - -
127 Rivanol Lar 0.1% 300 ml 7 7 - 7 - -
128 Sabu Inj. 5 ml 0 2 2 - 2 - -
135 Simvastatin tablet 20 mg 50 0 50 50 0 65 300
136 Spon Gelatin 0 - - 0 - -
137 Sulfadiazin Silver Krim 1% 35 gr (Burnazin) 0 0 - - 0 - 3
140 TKF Cairan 0 - - 0 - -
149 Zinc Tab 20 mg 0 600 600 467 510 607 100

1 Afolat Tablet 1 mg 0 - - - 500
4 Dulcolax supp 10 mg 0 - - 0 - 12
5 Dulcolax/Bisacodyl tablet 5 mg 0 - - 0 - 48
7 Histigo 6 mg 0 0 - - 0 - 100
8 Livron B Plex 1800 0 1,800 - 1800 0 -
9 OBH Nellco 0 0 - - 0 0 0
10 Reco Tetes Telinga 0 - - 0 - 12
11 Reco Tetes Mata 0 - - 0 - 12
12 Scabicid Krim 0 - - 0 - 3
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -
3 Stesolid rectal tube 5 mg 5 0 5 - 5 - - EXP

3 Haloperidol tablet 0,5 mg 137 - 137 5 132 7 -
7 Klorpromazina Tablet 25 mg 94 - 94 30 64 39 200
E. PREKURSOR
3 Metilergometrina Inj. 0.2 mg/ml 15 15 5 10 6.5
F. BMHP
2 Alkohol Swab 6 2 8 4 4 5 1
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 3 0 3 3 0 4 4
7 Catgut Chromic 2/0 8 0 8 - 8 0 -
9 Catgut Plain 2/0 9 9 1 8 1 -
10 Catgut Plain 3/0 0 - - 0 0 -
11 Daryantullle 6 0 6 - 6 0 -
12 Dermafix-S IV 6 6 - 6 0 -
13 Disposible 1 cc 70 0 70 53 17 69 52
14 Disposible 10 cc 0 - - 0 0 10
15 Disposible 3 cc 150 0 150 150 0 195 200
16 Disposible 5 cc 90 0 90 42 48 55 -
22 H2O2 3% 0 - - 0 0 -
23 Handschoon Non Steril L @100 0 - - 0 0 5
27 Handschoon Steril 6 6 0 6 3 3 4 -
30 HCG Test 1 0 1 - 1 0 -
31 Hibiscrup 1 0 1 - 1 0 -
32 Hypafix 10 x 5 1 1 1 0 1 1
33 Hypafix 15 x 5 3 0 3 1 2 1 -
34 Hypafix 5 x 5 1 0 1 - 1 0 -
35 Infus Set Anak 8 0 8 3 5 4 -
36 Infus Set Dewasa 0 - - 0 0 -
37 Iodium Test 5 5 - 5 0 -
38 IV. Catheter No. 18 7 7 - 7 0 -
39 IV. Catheter No. 20 7 0 7 - 7 0 -
40 IV. Catheter No. 22 8 4 12 8 4 10 6
41 IV. Catheter No. 24 8 0 8 4 4 5 1
42 IV. Catheter No. 26 4 0 4 - 4 0 -
43 Jarum Heating No. 10 24 24 - 24 0 -
44 Jarum Heating No. 12 90 90 - 90 0 -
45 Jarum Heating No. 14 36 36 - 36 0 -
46 Jarum Heating No. 15 60 60 - 60 0 -
47 Jelly USG 0 - - 0 0 -
57 Lisol 50% 2 2 - 2 0 -
58 Masker Hijab @50 0 - - 0 0 -
59 Masker Karet @50 0 - - 0 0 -
61 Nurse cap @100 2 0 2 1 1 1 -
0 - - 0 0 -

2 2 - 2 0 -

0 - - 0 0 -

2 2 2 0 3 3
68 Polyprepilene 3/0 D3 19 mm 7 0 7 - 7 0 (7)
69 Pot Salep 30gr 30 100 130 95 35 124 100
70 Pot Salep 50gr 0 - - 0 0 -
71 Selang Oksigen Bayi 6 6 - 6 6 -
74 Softaman 0 - - 0 0 -
75 Steril Surgical Blades (Aesculaps) 100's 194 194 10 184 13 -
76 Stomach Tube No. 12 6 6 - 6 0 -
77 Stomach Tube No. 14 4 4 - 4 0 -
80 Strip kolesterol (Humases) '20s 0 2 2 - 2 0 -
84 Sungkup Nebu Anak 4 7 11 7 4 9 5
86 Suture Silk 2/0 0 - - 0 0 -
87 Suture Silk 3/0 12 21 33 21 12 27 15
89 Under Pad 20 0 20 - 20 0 -
90 Urine bag 3 3 - 3 0 -
OBAT PROGRAM
1 Ampicilin 1 gr 114 114 3 111 4
4 Euthyrox 250 250 - 250 0 EXP
6 MDT MB Adult 0 2 2 2 0 3
13
OBAT & ABHP P3K
1 Cefadroxil 500 mg 0 100 100 30 70 30
2 Counterpain Gel 15 gr 2 2 4 2 2 2
4 Counterpain Cream 15 gr 2 2 4 2 2 2
5 Minyak Kayu Putih 15 ml 3 3 6 5 1 5
7 Thrombopop Gel 2 2 4 2 2 2
8 Voltadex Gel 1 2 3 2 1 2
1 Asam Askorbat 250 mg Tab 900 0 900 - 900 0 -
3 Azitromycin 500 mg 18 0 18 - 18 0
5 Curcuma FCT 1840 0 1,840 - 1840 0
7 D Trivit 140 0 140 140 0
9 Erdostein 120 0 120 - 120 0
10 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
12 Imunivit Tablet 400 0 400 - 400 0
13 Livron B plex 0 0 - - 0 0
14 OBH Nelco Syrup 11 0 11 - 11 0
15 Pafivirapir 280 0 280 - 280 0
17 Bionicom Zinc 2004 0 3,000 - 2004 0
18 Momucil 200 mg 300 0 300 - 300 0
Vaksin
3 Vaksin Td 0 0 0 0
5 IPV 15 15 15 15
6 MR 11 11 11 11
7 Hep B1 ds/Buah 16 16 16 16
Vitamin Pegawai
1 HB VIT 500 0 1650 1650 1650 0 1650 -
Vitamin Proram KIA


3 SteriOne 5 Liter 0 0 0 0
5 Tuberculin PPD 0 0 0 0
6 Reagen HIV SD 0 0 0 0
7 SD Bioline SYPHLIS 3.0 d 30's 0 0 0 0
8 Reagen HbsAg 0 0 0 0
11 Tabung EDTA 0 0 0 0
12 Stik Kolestrol (BENECHECK) 0 0 0 0
13 Stik Asam Urat (BENECHECK) 0 0 0 0
14 Reagen Gol. Darah (Anti A,B,AB & Rhesus) 0 0 - - 0 0 -
OBAT & ABHP GIGI
1 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0
2 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
4 Alevo Gym 0 0 0 0 0 0 1
12 Composite Flow 0 0 0 0 0 1
21 Glass Plate 0 0 0 0 0 0 1
ABHP TBC
1 Masker Surgical @50 41 41 17 24 17
Obat BLUD
Obat Generik
14 Dexametason 0,5 mg 1800 0 1800 1700 100 2210
17 ISDN 5mg 100 100 0 100 0
18 Ibuprofen 400 mg 1308 0 1308 538 770 699
21 Ketokonazole 200 mg 130 0 130 72 58 94
23 Metformin 500 mg Tab 3000 0 3000 2200 800 2860
25 MGSO4 12 12 0 12 0
26 Nifedipin 10 mg Tab 295 295 29 266 38
30 Ranitidin 1200 0 1200 676 524 879
33 Vitamin B 6 1645 0 1645 365 1280 475
Obat Non Generik

2 Cazetin Drop 0 0 0
4 Dulcolax tablet 5 mg 0 0 0 0
7 Lecozinc 20 mg 500 0 500 170 330 294
ABHP
1 Catgut Silk 3/0 0 0 0 0 0
2 Catgut Plain 3/0 43 0 0 0 43 0
4 H2O2 800 ml 5 0 5 0 5 0
6 Infuset Dewasa 37 0 37 19 18 19
UMUM BPJS R. INAP GAKIN LANSIA JUMLAH

/KADER Balikpapan,
Petugas IFK
0 0 0 0 0 0

Petugas Puskesmas
…………………………
…………………………… ……………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : APRIL IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : MEI PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
4 Allopurinol tablet 100 mg 45 1000 1,045 605 440 787 400
11 Amoksisilin 250 mg Sirup Kering 0 - - 0 - -
12 Amoksisilin Drop 1 - 1 1 0 1 -
13 Amoksisilin kaplet 500 mg 170 2,500 2,670 1,085 1585 1,411 -
14 Amoksisilin kapsul 250 mg 0 - - 0 - - 0
15 Antasida DOEN Tablet Komb.100's 350 1,800 2,150 1,076 1074 1,399 325
17 Anti Hemoroid Supositoria 0 - - - 0 - 10
20 Asam Askorbat (Vit C) Tablet 250 mg 1500 - 1,500 800 700 1,040 300
21 Asam Folat 0,4 mg 420 - 420 320 100 416 300
23 Asetil Sistein kapsul 200 mg 60's (Memucil) 0 1,560 1,560 990 570 1,287 660
25 Ats Inj. 1.500 IU 1 - 1 1 0 1 1
26 Attapulgit tablet 600 mg 220 - 220 82 138 107 -
27 Betahistin 0 - - - 0 - -
29 Bisakodil 5 mg 20 - 20 - 20 - -
31 Captopril tablet 25 mg 1200 3,000 4,200 3,900 300 5,070 4,800
38 Deksametason Injeksi 12 12 - 12 - -
39 Dextrose 5% 3 - 3 - 3 - -
42 Dimenhidrinat Tablet 50 mg 550 400 950 315 635 410 -
44 Domperidon Tablet 400 500 900 380 520 494 -
46 Eritromisin Sirup 1 1 1 0 1 -
48 Etanol 70%/100 ml 0 - - 0 - -
49 Etanol 70%/1000 ml 0 - - 0 - -
50 Etanol 70%/ 5 liter 0 0 -
52 Fenol Gliserol Tetes Tlg. 10% 24 24 4 20 5 -
55 Furosemida tablet 40 mg 60 200 260 80 180 104 -
56 Garam Oralit 100 300 400 50 350 65 -
62 Hidroklorotiazid tablet 25 mg 15 15 15 0 20 -
73 Ketokonazol tablet 200 mg 0 - - 0 - -
74 Ketorolac Injeksi 5 5 1 4 1 -
79 Klorfeniramin Maleat tablet 4 mg 2534 500 3,034 1,364 1670 1,773 -
81 Kotrimoksazol Tab 480 mg 100 - 100 - 100 - -
82 Lidocain Injeksi 2% (HCl) 30 - 30 10 20 13 -
84 Loratadin tablet 170 1,100 1,270 581 689 755 -
87 Metformin tab 500 mg 4500 - 4,500 4,500 0 5,850 5,000
88 Metil Prednisolon tablet 4 mg 1290 - 1,290 277 1013 360 -
92 MGSO4 Injeksi 0 5 5 - 5 - -
93 Mikonazol Krim 2 24 26 4 22 5 -
94 Na. Diklofenak 25 mg 450 1500 1,950 1,104 846 1,435 600
95 Na. Diklofenak 50 mg 200 50 250 10 240 13 -
98 Nistatin susp 100.000 IU/mL 5 5 - 5 - -
100 OAT FDC Kategori 1 4 0 4 3 1 - -
108 Parasetamol 500 mg Tablet 100's (Novagesic) 2435 300 2,735 1,315 1420 1,710 -
111 Permetrin Krim 5% 0 - - 0 - -
112 Phytomenadion (Vit K) Tablet 10 mg 0 - - 0 - -
114 Phytomenadion (Vit K1) Inj 2 mg/ml 15 0 15 15 0 20 20
121 Ranitidin Tablet 0 0 - - 0 - -
123 Ringer Laktat 6 7 13 9 4 12 8
125 Rivanol Lar 0.1% 100 ml 0 - - 0 - -
126 Rivanol Lar 0.1% 300 ml 7 7 - 7 - -
127 Sabu Inj. 5 ml 0 - - 0 - -
130 Salbutamol tablet 4 mg 270 0 270 70 200 91 -
134 Simvastatin tablet 20 mg 0 50 50 - 50 - 300
135 Spon Gelatin 0 - - 0 - -
137 Tablet Tambah Darah 0 2000 2,000 400 1600 520 -
139 TKF Cairan 0 - - 0 - -
140 Vit. B Kompleks tablet 2370 1700 4,070 1,470 2600 1,911 -
148 Zinc Tab 20 mg 295 100 395 467 0 607 600

1 Afolat Tablet 1 mg 0 - - -
3 Dulcolax supp 5 mg 5 5 - 5 -
4 Dulcolax supp 10 mg 0 - - 0 - -
5 Dulcolax/Bisacodyl tablet 5 mg 0 - - 0 -
6 Guanistrep Syrup 0 0
7 Histigo 6 mg 0 0 - - 0 - -
8 Livron B Plex 1390 1700 3,090 1,290 1800 1,290 -
9 OBH Nellco 0 0 - - 0 0 -
13 Vaksin Anti Rabies 30 0 30 - 30 - -
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -

2 Haloperidol tablet 0,5 mg 0 - - 0
3 Haloperidol tablet 1,5 mg 137 137 - 137 -
4 Haloperidol tablet 5 mg 311 - 311 42 269 55
5 Triheksilfenidil HCl tablet 2 mg 5 5 - 0 - -
6 Klorpromazina Tablet 100 mg - - -
7 Klorpromazina Tablet 25 mg 136 - 136 42 94 55 -
E. PREKURSOR
2 Metilergometrina tablet 0,125 mg 0 100 100 - 100 -
F. BMHP
2 Alkohol Swab 12 0 12 6 6 8 2
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 3 0 3 - 3 0 -
7 Catgut Chromic 2/0 8 4 12 4 8 5 -
9 Catgut Plain 2/0 9 9 - 9 0 -
10 Catgut Plain 3/0 0 - - 0 0 -
12 Dermafix-S IV 6 6 - 6 0 -
13 Disposible 1 cc 90 0 90 20 70 26 -
14 Disposible 10 cc 0 - - 0 0 10
15 Disposible 3 cc 89 200 289 139 150 181 -
16 Disposible 5 cc 0 100 100 10 90 13 -
22 H2O2 3% 0 - - 0 0 -
23 Handschoon Non Steril L @100 0 - - 0 0 -
26 Handschoon Non Steril S PF 15 6 21 11 10 14 4
30 HCG Test 0 1 1 - 1 0 -
31 Hibiscrup 1 0 1 - 1 0 -
32 Hypafix 10 x 5 1 1 - 1 0 -
33 Hypafix 15 x 5 2 2 4 1 3 1 -
34 Hypafix 5 x 5 1 0 1 - 1 0 -
35 Infus Set Anak 8 0 8 - 8 0 -
37 Iodium Test 5 5 - 5 0 -
38 IV. Catheter No. 18 7 7 - 7 0 -
39 IV. Catheter No. 20 3 5 8 1 7 1 -
40 IV. Catheter No. 22 5 6 11 3 8 4 -
41 IV. Catheter No. 24 3 6 9 1 8 1 -
42 IV. Catheter No. 26 9 0 9 5 4 7 -
43 Jarum Heating No. 10 24 24 - 24 0 -
44 Jarum Heating No. 12 90 90 - 90 0 -
45 Jarum Heating No. 14 36 36 - 36 0 -
46 Jarum Heating No. 15 60 60 - 60 0 -
47 Jelly USG 0 - - 0 0 -
57 Lisol 50% 2 2 - 2 0 -
58 Masker Hijab @50 0 - - 0 0 -
59 Masker Karet @50 0 - - 0 0 -
61 Nurse cap @100 0 2 2 - 2 0 -

0 - - 0 0 -
2 2 - 2 0 -

0 - - 0 0 -

2 2 - 2 0 -
68 Polyprepilene 3/0 D3 19 mm 7 3 10 3 7 4 (3)
69 Pot Salep 30gr 50 75 125 95 30 124 94
70 Pot Salep 50gr 0 - - 0 0 -
72 Selang Oksigen Anak 7 5 12 7 5 9 4
73 Selang Oksigen Dewasa 8 0 8 3 5 4 -
74 Softaman 0 - - 0 0 -
75 Steril Surgical Blades (Aesculaps) 100's 194 194 - 194 0 -
76 Stomach Tube No. 12 6 6 - 6 0 -
77 Stomach Tube No. 14 4 4 - 4 0 -
80 Strip kolesterol 0 - - 0 0 -
86 Suture Silk 2/0 0 - - 0 0 -
87 Suture Silk 3/0 0 12 12 - 12 0 -
89 Under Pad 35 0 35 15 20 20 -
90 Urine bag 3 3 - 3 0 -
OBAT PROGRAM
1 Ampicilin 1 gr 114 114 - 114 0
3 Diazepam Injeksi 43 43 - 43 0 EXP
4 Euthyrox 250 250 - 250 0
6 MDT MB Adult 0 2 2 2 0 3
13
OBAT & ABHP P3K
1 Cefadroxil 500 mg 100 100 - 100 0
2 Counterpain Gel 15 gr 2 2 - 2 0
3 Counterpain Cream 15 gr 2 2 - 2 0
4 Minyak Kayu Putih 15 ml 3 3 - 3 0
6 Thrombopop Gel 2 2 - 2 0
7 Voltadex Gel 2 2 1 1 1
1 Asam Askorbat 250 mg Tab 400 500 900 - 900 0 -
3 Azitromycin 500 mg 18 0 18 - 18 0
5 Curcuma FCT 1840 0 1,840 - 1840 0
7 D Trivit 140 0 140 140 0
9 Erdostein 120 0 120 - 120 0
10 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
12 Imunivit Tablet 400 0 400 - 400 0
13 Livron B plex 0 0 - - 0 0
14 OBH Nelco Syrup 11 0 11 - 11 0
15 Pafivirapir 280 0 280 - 280 0
17 Bionicom Zinc 2194 0 3,000 996 2004 1295
18 Momucil 200 mg 300 300 600 300 300 390
Vaksin
1 Vaksin BCG 5 3 8 4 4 4
2 Vaksin DPT/ DPT-HB/ DPT-HB-Hib 0 40 40 5 35 5
3 Vaksin Td 0 2 2 2 0 2
5 IPV 18 18 3 15 3
6 MR 16 16 5 11 5
7 Hep B1 ds/Buah 22 22 6 16 6
Vitamin Pegawai
1 HB VIT 500 0 1560 1560 1560 0 1560 -
Vitamin Proram KIA


14 Reagen Gol. Darah (Anti A,B,AB & Rhesus) 0 0 - - 0 0 -
OBAT & ABHP GIGI
1 1470A2 2250 XT REST SYR 3G 0 1 1 1 0 1
2 1470A3 2250 XT REST SYR 3G 0 1 1 1 0 1
ABHP TBC
Obat BLUD
Obat Generik
14 Dexametason 0,5 mg 2800 0 2800 1000 1800 1300
17 ISDN 5mg 100 100 0 100 0
18 Ibuprofen 400 mg 1800 0 1800 492 1308 640
21 Ketokonazole 200 mg 150 0 150 20 130 26
23 Metformin 500 mg Tab 0 3000 3000 0 3000 0
25 MGSO4 12 12 0 12 0
26 Nifedipin 10 mg Tab 300 300 5 295 7
30 Ranitidin 1600 0 1600 400 1200 520
33 Vitamin B 6 1800 0 1800 155 1645 202
Obat Non Generik

7 Lecozinc 20 mg 0 500 500 0 500 0
ABHP
1 Catgut Silk 3/0 0 0 0 0 0
2 Catgut Plain 3/0 43 0 0 0 43 0
4 H2O2 800 ml 0 5 5 0 5 0

/KADER Balikpapan,
Petugas IFK
241 1009 2 1252
0 0
Petugas Puskesmas
…………………………
…………………………… ……………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : MARET IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : APRIL PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
4 Allopurinol tablet 100 mg 300 500 800 755 45 982 1,000
8 Amlodipin tablet 10 mg 0 - - - 0 - -
11 Amoksisilin 250 mg Sirup Kering 0 - - 0 - -
12 Amoksisilin Drop 1 - 1 - 1 - -
13 Amoksisilin kaplet 500 mg 1300 600 1,900 1,730 170 2,249 2,100
14 Amoksisilin kapsul 250 mg 0 - - 0 - - 0
17 Anti Hemoroid Supositoria 0 - - - 0 - -
20 Asam Askorbat (Vit C) Tablet 250 mg 1000 1,000 2,000 500 1500 650 -
21 Asam Folat 0,4 mg 200 300 500 80 420 104 -
21 Asam Mefenamat kaplet 500 mg 1900 - 1,900 1,634 266 2,124 1,900
23 Asetil Sistein kapsul 200 mg Kotak 60's 0 600 600 600 0 780 780
25 Ats Inj. 1.500 IU 6 - 6 5 1 7 6
26 Attapulgit tablet 600 mg 100 200 300 80 220 104 -
27 Betahistin 0 - - - 0 - -
29 Bisakodil 5 mg 20 - 20 - 20 - -
31 Captopril tablet 25 mg 1200 1,800 3,000 1,800 1200 2,340 1,100
34 Cetirizine Syrup 5mg/5ml 4 10 14 - 14 - -
38 Deksametason Injeksi 13 13 1 12 1 -
39 Dextrose 5% 0 3 3 - 3 - -
42 Dimenhidrinat Tablet 50 mg 900 - 900 350 550 455 -
44 Domperidon Tablet 400 300 700 300 400 390 -
46 Eritromisin Sirup - - 0 - -
47 Eritromisin tablet 250 mg 20 20 - 20 - -
48 Etanol 70%/100 ml 0 - - 0 - -
49 Etanol 70%/1000 ml 0 - - 0 - -
50 Etanol 70%/ 5 liter 0 0 -
55 Furosemida tablet 40 mg 88 88 28 60 36 -
56 Garam Oralit 100 - 100 - 100 - -
62 Hidroklorotiazid tablet 25 mg 30 30 15 15 20 -
71 Kalsium Laktat 500 mg Tablet 100's 3500 - 3,500 1,170 2330 1,521 -
80 Kotrimoksazol Susp 0 7 7 - 7 - -
81 Kotrimoksazol Tab 480 mg 0 100 100 - 100 - -
82 Lidocain Injeksi 2% (HCl) 30 - 30 - 30 - -
84 Loratadin tablet 0 600 600 430 170 559 400
87 Metformin tab 500 mg 1600 6,000 7,600 3,100 4500 4,030 -
88 Metil Prednisolon tablet 4 mg 800 700 1,500 210 1290 273 -
89 Metoklorpramide tablet 5 mg 200 - 200 - 200 - -
92 Mikonazol Krim 10 0 10 8 2 10 8
93 Na. Diklofenak 25 mg 700 800 1,500 1,050 450 1,365 900
94 Na. Diklofenak 50 mg 200 0 200 - 200 - -
97 Nistatin susp 100.000 IU/mL 5 5 - 5 - -
99 OAT FDC Kategori 1 7 0 7 3 4 - -
104 Oksitosin injeksi 10 9 19 14 5 18 13
107 Parasetamol 500 mg Tablet 100's (Novagesic) 1800 2700 4,500 2,065 2435 2,685 300
108 Parasetamol drops 0 - - 0 - -
110 Permetrin Krim 5% 0 - - 0 - -
120 Ranitidin Tablet 0 0 - - 0 - -
122 Ringer Laktat 12 4 16 10 6 13 7
124 Rivanol Lar 0.1% 100 ml 0 - - 0 - -
125 Rivanol Lar 0.1% 300 ml 7 7 - 7 - -
126 Sabu Inj. 5 ml 0 - - 0 - -
134 Spon Gelatin 0 - - 0 - -
135 Sulfadiazin Silver Krim 1% 35 gr (Burnazin) 2 0 2 2 0 3 3
136 Tablet Tambah Darah 600 0 600 600 0 780 800 EXP
138 TKF Cairan 0 - - 0 - -
147 Zinc Tab 20 mg 400 200 600 467 295 607 312

2 Bufacetin Salep Kulit / Fusycol Salep kulit 8 0 8 8 0 10 10
7 Histigo 6 mg 25 0 25 25 0 33 100
8 Livron B Plex 600 3200 3,800 2,410 1390 2,410 1,000
9 OBH Nellco 0 0 - - 0 0 -
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -

2 Haloperidol tablet 0,5 mg 0 - - 0
3 Haloperidol tablet 1,5 mg 137 137 - 137 -
4 Haloperidol tablet 5 mg 359 - 359 48 311 62
5 Triheksilfenidil HCl tablet 2 mg 0 - - 5 - -
7 Klorpromazina Tablet 25 mg 210 - 210 74 136 96 -
E. PREKURSOR
2 Metilergometrina tablet 0,125 mg 0 - - -
F. BMHP
2 Alkohol Swab 4 13 17 5 12 7 -
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 1 2 3 - 3 0 -
6 Blood Tranfusion Set 6 0 6 3 3 4 1
9 Catgut Plain 2/0 9 9 - 9 0 -
10 Catgut Plain 3/0 0 - - 0 0 -
12 Dermafix-S IV 6 6 - 6 0 -
13 Disposible 1 cc 23 100 123 33 90 43 -
14 Disposible 10 cc 0 - - 0 0 10
15 Disposible 3 cc 215 0 215 126 89 164 75
16 Disposible 5 cc 28 28 28 0 36 36
22 H2O2 3% 0 - - 0 0 -
23 Handschoon Non Steril L @100 0 - - 0 0 -
28 Handschoon Steril 6,5 4 10 14 10 4 13 9
30 HCG Test 1 1 1 0 1 1
31 Hibiscrup 1 1 - 1 0 -
32 Hypafix 10 x 5 1 1 - 1 0 -
33 Hypafix 15 x 5 3 0 3 1 2 1 -
34 Hypafix 5 x 5 1 0 1 - 1 0 -
35 Infus Set Anak 8 0 8 - 8 0 -
37 Iodium Test 5 5 - 5 0 -
38 IV. Catheter No. 18 7 7 - 7 0 -
39 IV. Catheter No. 20 3 3 - 3 0 -
40 IV. Catheter No. 22 3 8 11 6 5 8 3
41 IV. Catheter No. 24 3 3 - 3 0 -
42 IV. Catheter No. 26 9 0 9 - 9 0 -
43 Jarum Heating No. 10 24 24 - 24 0 -
44 Jarum Heating No. 12 90 90 - 90 0 -
45 Jarum Heating No. 14 36 36 - 36 0 -
46 Jarum Heating No. 15 60 60 - 60 0 -
47 Jelly USG 2 2 2 0 3 3
57 Lisol 50% 2 2 - 2 0 -
58 Masker Hijab @50 0 - - 0 0 -
59 Masker Karet @50 0 - - 0 0 -
60 Masker Non Medis 3 Ply 0 - - 0 0 10
61 Nurse cap @100 50 50 50 0 65 65

0 - - 0 0 -

3 3 1 2 1 -
0 - - 0 0 -

2 2 - 2 0 -
69 Pot Salep 30gr 25 125 150 100 50 130 80
70 Pot Salep 50gr 0 - - 0 0 -
72 Selang oksigen anak 2 6 8 1 7 1 -
73 Selang oksigen dewasa 8 0 8 - 8 0 -
74 Softaman 0 - - 0 0 -
75 Steril Surgical Blades (Aesculaps) 100's 200 200 6 194 8 -
76 Stomach Tube No. 12 6 6 - 6 0 -
77 Stomach Tube No. 14 4 4 - 4 0 -
80 Strip kolesterol 0 - - 0 0 10
86 Suture Silk 2/0 0 - - 0 0 -
87 Suture Silk 3/0 0 - - 0 0 -
89 Under Pad 13 35 48 13 35 17 -
90 Urine bag 3 3 - 3 0 -
OBAT PROGRAM
1 Ampicilin 1 gr 114 114 - 114 0
4 Euthyrox 250 250 - 250 0
6 MDT MB Adult 0 0 - - 0 0
9 Albendazol Tablet 400 mg 3300 3,300 3,300 0 4290
10 Albendazole Syrup 167 167 167 0 217
11 Vitamin A 100.000 UI kapsul 2 2 2 0 2
12 Vitamin A 200.000 UI kapsul 16 16 16 0 16
13 Reagen Gol. Darah (Anti A,B,AB & Rhesus) 0 0 - - 0 0 1
14
1 Asam Askorbat 250 mg Tab 400 0 400 - 400 0 400
2 Asetilsistein 200 mg 0 360 360 - 360 0 400
3 Azitromycin 500 mg 18 0 18 - 18 0
5 Curcuma FCT 1840 0 1,840 - 1840 0
7 D Trivit 150 0 150 140 0
9 Erdostein 120 0 120 - 120 0
10 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
12 Imunivit Tablet 400 0 400 - 400 0
13 Livron B plex 0 0 - - 0 0
14 OBH Nelco Syrup 11 0 11 - 11 0
15 Pafivirapir 280 0 280 - 280 0
17 Bionicom Zinc 2194 0 3,000 806 2194 1048
18 Momucil 200 mg 0 300 300 - 300 0
Vaksin
3 Vaksin Td 0 0 0 0 0
5 IPV 0 0 0 18 0
6 MR 0 0 0 16 0
7 Hep B1 ds/Buah 0 0 0 22 0
Vitamin Pegawai
1 HB VIT 500 0 1560 1560 1560 0 1560 1,560
Vitamin Proram KIA


4 Reagent Cat Ziehl Nellsen 0 0 0 0
OBAT & ABHP GIGI

1 1470A2 2250 XT REST SYR 3G 0 0 0 0 1
2 1470A3 2250 XT REST SYR 3G 0 0 0 0 1
5 Bur Fisure Diamond BB 79K-014 0 0 0 0 -
9 Cocoa Butter 10gr 0 0 0 0 1
13 Cresotin Liquid no.2 0 0 0 0 -
14 Cresotin Paste 0 0 0 0 -
16 Fuji VII White (powder + liquid) 0 0 0 0 -
19 GC Gold Label VII Extra Capsul 30's 0 0 0 0 -
20 Iodotin paste 2 gr 0 0 0 0 -
25 Saliva Ejector 100's 0 0 0 0 1
28 Zinc Phospat 0 0 0 0
ABHP TBC
Obat BLUD
Obat Generik
11 Ciprofloxacin 500 mg 0 0 0 0 0
14 Dexametason 0,5 mg 4210 0 4210 1410 2800 1833
17 ISDN 5mg 100 100 0 100 0
18 Ibuprofen 400 mg 2655 0 2655 855 1800 1112
21 Ketokonazole 200 mg 240 0 240 90 150 117
23 Metformin 500 mg Tab 0 0 0 0
25 MGSO4 12 12 0 12 0
26 Nifedipin 10 mg Tab 300 300 0 300 0
30 Ranitidin 1820 0 1820 220 1600 286
33 Vitamin B 6 2162 0 2162 362 1800 471
Obat Non Generik

7 Reco Tetes Telinga 25 25 15 10 15
ABHP
2 Catgut Plain 3/0 0 0 0 0 43 0
5 Infuset Dewasa 47 0 47 10 37 10

/KADER Balikpapan,
Petugas IFK
306 1234 3 1543
0 0
Petugas Puskesmas
…………………………
…………………………… ……………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : FEBRUARI IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : MARET PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
1 Acyclovir tablet 200 mg 162 0 162 - 162 -
3 Albendazol Tablet 400 mg 200 0 200 - 200 -
5 Allopurinol tablet 300 mg 70 0 70 - 70 -
6 Ambroxol 30mg Tablet 324 0 324 324 0 421 -
7 Ambroxol Syrup 0 - - 0 -
11 Amoksisilin 250 mg Sirup Kering - - 0 -
12 Amoksisilin Drop 2 2 1 1 1
14 Amoksisilin kapsul 250 mg 0 - - 0 - - EXP
17 Anti Hemoroid Supositoria 3 - 3 3 0 4 4
18 Aqua pro injeksi 25 ml 0 - - 0 -
19 Asam Askorbat (Vit C) Tablet 50 mg 0 - - 0 -
20 Asam Askorbat (Vit C) Tablet 250 mg 1382 1,000 2,382 1,382 1000 1,797 800
21 Asam Folat 370 200 570 370 200 481 300
21 Asam Mefenamat kaplet 500 mg 990 2,200 3,190 1,290 1900 1,677 -
22 Asam Traneksamat 250 mg/5ml injeksi - - 0 -
23 Asetil Sistein kapsul 200 mg Kotak 60's 0 600 600 600 0 780 780
24 Atrofin Sulfas Injeksi 0,25 mg 3 3 - 3 -
25 Ats Inj. 1.500 IU 6 6 - 6 -
27 Betahistin 0 - - 0 -
29 Bisakodil 5 mg 25 25 5 20 7
30 Captopril tablet 12,5 mg 815 1,200 2,015 715 1300 930 -
32 Captopril tablet 50 mg - - 0 -
33 Carbamazepin tablet 200 mg 0 - - 0 -
34 Cetirizine Syrup 5mg/5ml 9 6 15 11 4 14 10
35 Cetirizine tablet 10 mg 0 - - 0 -
36 Ciprofloksasin tablet 500 mg 310 200 510 210 300 273
37 Deksametason 0,5 mg tablet 100"s 740 - 740 740 0 962 -
38 Deksametason Injeksi 16 16 3 13 4
39 Dextrose 5% 2 2 2 0 3 3
40 Difenhidramin Inj. 0 5 5 - 5 - -
41 Diltiazem tablet 30 mg 0 - - 0 -
42 Dimenhidrinat Tablet 50 mg 240 1,100 1,340 440 900 572 -
43 Domperidon Susp 0 6 6 6 0 8 8
45 Epinefrina Inj. 0,1% 1 ml 3 2 4 2 2 3 1
46 Eritromisin Sirup - - 0 -
47 Eritromisin tablet 250 mg 20 20 - 20 -
48 Etanol 70%/100 ml 0 - - 0 -
49 Etanol 70%/1000 ml 0 - - 0 -
50 Etanol 70%/ 5 liter 0 0
51 Etil Klorida Semprot 0 - - 0 -
52 Fenol Gliserol Tetes Tlg. 10% 24 24 - 24 -
53 Fletcher Serbuk 0 - - 0 -
54 Flukonazol Kapsul 150 mg 0 - - 0 -
55 Furosemida tablet 40 mg 130 130 42 88 55
56 Garam Oralit 200 - 200 100 100 130
57 Gentamisin Tetes Mata 0,3% 0 - - -
58 Glibenklamida tablet 5 mg 225 100 325 125 200 163
60 Glimepirid tablet 1 mg 270 270 70 200 70
61 Griseofulvin tablet 125 mg 0 - - 0 - ED
62 Hidroklorotiazid tablet 25 mg 50 50 20 30 26
63 Hidrokortison Krim 2,5 % 57 168 225 81 144 105
64 Hyoscin N Tablet 10 mg 16 16 5 11 7
65 Ibuprofen Susp. 100 mg/5 ml 0 - - 0 -
67 Ibuprofen tablet 200 mg 0 - - 0 -
69 Isoniazid (INH) 100 mg Tablet 100's 0 - - 0 -
70 Isosorbide dinitrat tablet 5 mg 120 120 - 120 -
72 Ketokonazol krim 0 - - 0 -
74 Ketorolac Injeksi 5 5 - 5 -
75 Kloramfenikol 0.5 % tetes mata 0 - - 0 -
76 Kloramfenikol Salep Mata 1% 0 - - 0 -
77 Kloramfenikol sirup 0 - - 0 -
78 Kloramfenikol Tetes Telinga 3% 0 - - 0 -
80 Kotrimoksazol Susp 2 3 5 5 0 7 7
81 Kotrimoksazol Tab 480 mg 0 100 100 100 0 130 100
83 Lidocain Injeksi 2% (HCL) + Epinefrin 32 32 - 32 -
84 Loratadin tablet 210 300 510 510 0 663 600
85 Magnesium Sulfat Injeksi 20% 0 - - 0 -
86 Magnesium Sulfat Injeksi 40% 0 - - 0 -
87 Metformin tab 500 mg 2180 5,600 7,780 6,180 1600 8,034 6,000
88 Metil Prednisolon tablet 4 mg 280 1,700 1,980 1,180 800 1,534 700
89 Metoklorpramide tablet 5 mg 280 - 280 80 200 104
90 Metronidazol tablet 250 mg 0 - - 0 -
91 Metronidazol tablet 500 mg 0 - - 0 -
92 Mikonazol Krim 8 25 33 23 10 30 20
93 Na. Diklofenak 25 mg 842 1000 1,842 1,142 700 1,485 800
94 Na. Diklofenak 50 mg 248 100 348 148 200 192
96 Nifedipin tablet 10 mg 0 - - 0 -
97 Nistatin susp 100.000 IU/mL 12 12 7 5 9
98 Nistatin Vaginal tablet salut 100.000 IU/g 30 0 30 - 30 -
99 OAT FDC Kategori 1 0 7 7 - 7 -
100 OAT FDC Kategori 2 0 - - 0 -
101 OAT FDC Kategori Anak 0 2 2 - 2 -
102 OAT FDC Kategori Sisipan 0 - - 0 -
103 Oksitetrasiklina Salep Mata 1% 0 - - 0 -
104 Oksitosin injeksi 10 10 - 10 -
108 Parasetamol drops 0 - - 0 - -
110 Permetrin Krim 5% 0 - - 0 -
112 Phytomenadion (Vit K1) Inj 10 mg/ml 0 - - 0 -
113 Phytomenadion (Vit K1) Inj 2 mg/ml 5 5 - 5 -
114 Pirantel Pamoat Tab.125 mg 0 - - 0 -
115 Prednison 5 mg Tablet 100's 0 - - 0 -
116 Primakuin Tablet 15 mg 0 - - 0 -
117 Propiltiourasil tablet 100 mg 0 - - 0 -
118 Pyridoksin (Vit B6) Tablet 10 mg 0 - - 0 -
119 Quinin tablet 0 - - 0 -
120 Ranitidin Tablet 127 0 127 127 0 165 -
121 Reserpina 0.25 mg Tablet 100's 0 - - 0 -
122 Ringer Laktat 0 13 13 1 12 1 -
123 Risperidon Tablet 2 mg 0 - - 0 -
124 Rivanol Lar 0.1% 100 ml 0 - - 0 -
125 Rivanol Lar 0.1% 300 ml 7 7 - 7 -
126 Sabu Inj. 5 ml 0 - - 0 -
127 Salbutamol cairan ih 0,1% 0 - - 0 -
131 Salisilat + Belerang Salep 4 5 9 2 7 3
133 Simvastatin tablet 20 mg 0 250 250 50 200 65 -
134 Spon Gelatin 0 - - 0 -
135 Sulfadiazin Silver Krim 1% 35 gr (Burnazin) 0 2 2 - 2 -
136 Tablet Tambah Darah 900 600 1,500 900 600 1,170 EXP
138 TKF Cairan 0 - - 0 -
140 Vitamin A 100.000 UI kapsul 0 - - 0 -
141 Vitamin A 200.000 UI kapsul 0 - - 0 -
142 Yodium Povidon Lar 10% 15 ml 3 0 3 - 3 -
143 Yodium Povidon Lar 10% 30 ml 0 - - 0 -
146 Yodium Povidon Lar 10% 1 liter 0 - - 0 -
147 Zinc Tab 20 mg 200 400 600 467 400 607 200

2 Bufacetin Salep Kulit / Fusycol Salep kulit 17 0 17 9 8 12 4
7 Histigo 6 mg 0 100 100 75 25 98 100
8 Livron B Plex 770 800 1,570 970 600 970 400
9 OBH Nellco 0 10 10 10 0 10 -
11 Reco Tetes Mata 0 - - 0 -
13 Vaksin Anti Rabies 19 0 19 7 12 9
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -
3 Stesolid rectal tube 5 mg 3 3 3 0 4 4

2 Haloperidol tablet 0,5 mg 137 137 137 0
3 Haloperidol tablet 1,5 mg - - -
4 Haloperidol tablet 5 mg 89 300 389 30 359 39
5 Triheksilfenidil HCl tablet 2 mg 39 39 39 0 51 -
7 Klorpromazina Tablet 25 mg 0 300 300 90 210 117 -
E. PREKURSOR
F. BMHP
2 Alkohol Swab 4 5 9 5 4 7 3
3 Apron 9 9 - 9 0
4 Aseptic Gel 500 cc + dispenser 5 5 - 5 0
5 Blood Lancet @100 3 3 2 1 3 2
6 Blood Tranfusion Set 3 5 8 2 6 3
7 Catgut Chromic 2/0 8 8 - 8 0
9 Catgut Plain 2/0 9 9 - 9 0
10 Catgut Plain 3/0 0 - - 0 0 -
11 Daryantullle 6 0 6 - 6 0
12 Dermafix-S IV 6 6 - 6 0
13 Disposible 1 cc 45 0 45 22 23 29
14 Disposible 10 cc 0 - - 0 0
15 Disposible 3 cc 160 200 360 145 215 189
16 Disposible 5 cc 38 38 10 28 13
17 Duo Band Series-12 (PINK) 25 25 - 25 0
18 Duo Band Series-18 (BLUE) 25 25 - 25 0
19 Folley Catheter No. 14 3 3 - 3 0
20 Folley Catheter No. 16 1 1 1 0 1
21 Folley Catheter No. 18 0 - - 0 0
22 H2O2 3% 0 - - 0 0
23 Handschoon Non Steril L @100 0 - - 0 0
24 Handschoon Non Steril M 0 - - 0 0
27 Handschoon Steril 6 3 4 7 1 6 1
28 Handschoon Steril 6,5 5 5 1 4 1
29 Handschoon Steril 7 4 2 6 2 4 3
30 HCG Test 1 1 - 1 0
31 Hibiscrup 1 1 - 1 0
32 Hypafix 10 x 5 1 1 - 1 0
33 Hypafix 15 x 5 1 2 3 - 3 0 -
34 Hypafix 5 x 5 1 0 1 - 1 0
35 Infus Set Anak 7 3 10 2 8 3
36 Infus Set Dewasa 3 3 3 0 4 4
37 Iodium Test 5 5 - 5 0
38 IV. Catheter No. 18 7 7 - 7 0
39 IV. Catheter No. 20 3 3 - 3 0
40 IV. Catheter No. 22 7 13 20 17 3 22 19
41 IV. Catheter No. 24 3 3 - 3 0 -
42 IV. Catheter No. 26 3 9 12 3 9 4
43 Jarum Heating No. 10 24 24 - 24 0
44 Jarum Heating No. 12 90 90 - 90 0
45 Jarum Heating No. 14 36 36 - 36 0
46 Jarum Heating No. 15 60 60 - 60 0
47 Jelly USG 2 2 - 2 0
48 Kapas Pembalut 250 gr 2 2 - 2 0
50 Kasa Kompres 40/40 Steril 0 - - 0 0
51 Kasa Kotak Steril 7 0 7 - 7 0
52 Kasa Pemb. Hid 4 M X 15 Cm 0 - - 0 0
53 Kasa Pemb. Hid 4 M X 3 Cm 9 9 - 9 0
54 Kasa Pembalut 2 x 80 cm 0 - - 0 0
55 Kasa Pembalut 40 x 80 cm 3 0 3 1 2 1
56 Leukoplast 2,5cm x 4,5 cm 1 1 - 1 0
57 Lisol 50% 2 2 - 2 0
58 Masker Hijab @50 0 - - 0 0
59 Masker Karet @50 0 - - 0 0
60 Masker Non Medis 3 Ply 0 - - 0 0
61 Nurse cap @100 50 50 - 50 0
62 Nylon No. 3/0 (Benang wajah) 0 - - 0 0
63 Nylon No. 6/0 (Benang Wajah) 27 27 - 27 0

0 - - 0 0

3 3 - 3 0
0 - - 0 0

2 2 - 2 0
68 Polyprepilene 3/0 D3 19 mm 10 0 10 - 10 0
69 Pot Salep 30gr 40 100 140 115 25 150 130
70 Pot Salep 50gr 0 - - 0 0
71 Selang Oksigen Bayi 6 6 - 6 6
72 Selang oksigen anak 2 3 5 3 2 4 2
73 Selang oksigen dewasa 5 5 10 2 8 3 -
74 Softaman 0 - - 0 0
75 Steril Surgical Blades (Aesculaps) 100's 200 200 - 200 0
76 Stomach Tube No. 12 6 6 - 6 0
78 Strip asam urat 0 - - 0 0
79 Strip glucose 0 - - 0 0
80 Strip kolesterol 0 - - 0 0
81 Strip trigliserid 0 - - 0 0
82 Suction Catheter No 10 4 4 - 4 0
85 Sungkup Nebu Dewasa 5 5 10 - 10 0
86 Suture Silk 2/0 0 - - 0 0 -
87 Suture Silk 3/0 0 - - 0 0
88 Umbilical Cord Clamps 35 0 35 - 35 0
89 Under Pad 18 5 23 10 13 13
90 Urine bag 3 3 - 3 0
OBAT PROGRAM
1 Ampicilin 1 gr 114 114 - 114 0
4 Euthyrox 250 250 - 250 0
6 MDT MB Adult 2 2 2 3
9 Albendazol Tablet 400 mg - - 0

1 Asam Askorbat 250 mg Tab 1000 0 1,000 600 400 780 400
3 Azitromycin 500 mg 18 0 18 - 18 0
5 Curcuma FCT 1840 0 1,840 - 1840 0
7 D Trivit 0 150 150 150 0
9 Erdostein 0 200 200 80 120 104
10 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
11 Imbost Kids Syrup 48 0 48 1 47 1
12 Imunivit Tablet 400 0 400 - 400 0
13 Livron B plex 0 0 - - 0 0
14 OBH Nelco Syrup 21 0 21 10 11 13
15 Pafivirapir 0 280 - - 280 0
17 Bionicom Zinc 3000 0 3,000 806 2194 1048
Vaksin
3 Vaksin Td 0 0 0 0 0
5 IPV 0 0 0 18 0
6 MR 0 0 0 16 0
7 Hep B1 ds/Buah 0 0 0 22 0
Vitamin Pegawai
1 HB VIT 500 0 1560 1560 1560 0 1560 1,560
Vitamin Proram KIA


OBAT & ABHP GIGI

1 1470A2 2250 XT REST SYR 3G 0 0 0 0 -
2 1470A3 2250 XT REST SYR 3G 0 0 0 0 -
3 Articulating Paper 0 0 0 0 -
4 Barbed Broach (Jarum Extepasi) 6's 0 0 0 0 -
5 Bur Fisure Diamond BB 79K-014 0 0 0 0 -
6 Bur Lurus Diamond C837-018 0 0 0 0 -
7 Cellulose Matrix Strip 0 0 0 0 -
8 CHKM (paramonochlorofenol) 20 ml 0 0 0 0 -
9 Cocoa Butter 10gr 0 0 0 0 -
10 Cotton Roll size 1 (12's) 0 0 0 0 -
11 Cresotin Liquid no.2 0 0 0 0 -
12 Cresotin Paste 0 0 0 0 -
13 Dentin Condotioner 25gr 0 0 0 0 -
14 Fuji VII White (powder + liquid) 0 0 0 0 -
15 Fuji IX EXT A3 (powder + liquid) 0 0 0 0 -
16 GC Gold Label IX Extra Capsul 30's 0 0 0 0 -
17 GC Gold Label VII Extra Capsul 30's 0 0 0 0 -
18 Iodotin paste 2 gr 0 0 0 0 -
19 Kalsium Hidroksida Pasta 0 0 0 0 -
20 Microbrush 0 0 0 0 -
21 Pasta Pengisi Saluran akar with iodorm 0 0 0 0 -
22 Saliva Ejector 100's 0 0 0 0 -
23 51202 Single Bond 2 RF LA/APAC 0 0 0 0 -
24 Xylestein-A (Lidocain HCL + Epineprine HCL) 0 0 0 0 -
25 Zinc Phospat 0 0 0 0 -
ABHP TBC
1 Masker Surgical @50 41 41 0 41 0 -
2 Masker Kain 3 ply 49 49 0 49 0 -
Obat BLUD
Obat Generik
9 Captopril 25mg 200 200 200 0 260
11 Ciprofloxacin 500 mg 0 0 0 0
14 Dexametason 0,5 mg 0 5000 5000 790 4210 1027
17 ISDN 5mg 100 100 0 100 0
18 Ibuprofen 400 mg 0 3000 3000 345 2655 449
21 Ketokonazole 200 mg 250 250 10 240 13
25 MGSO4 12 12 0 12 0
26 Nifedipin 10 mg Tab 300 300 0 300 0
30 Ranitidin 200 2000 2200 380 1820 494
33 Vitamin B 6 320 2000 2320 158 2162 205
Obat Non Generik

5 Farsycol Cream ( Kloramfenikol cream ) 80 80 15 65 26
ABHP
2 Foley Catheter no.18 0 30 30 27
4 Infuset Dewasa 0 50 50 3 47

/KADER Balikpapan,
Petugas IFK
354 1339 0 1693

Petugas Puskesmas
…………………………
…………………………… ……………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : JANUARI IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : FEBRUARI PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
1 Acyclovir tablet 200 mg 232 232 70 162 91
3 Albendazol Tablet 400 mg 0 200 200 - 200 -
4 Allopurinol tablet 100 mg 280 600 880 380 500 494
5 Allopurinol tablet 300 mg 82 82 12 70 16
6 Ambroxol 30mg Tablet 735 2,600 3,335 3,011 324 3,914 3,600
7 Ambroxol Syrup 0 - - -
9 Amlodipin tablet 5 mg 2250 750 3,000 485 2515 631 -
10 Amoksisilin 125 mg Sirup Kering 33 83 116 71 45 92
11 Amoksisilin 250 mg Sirup Kering 0 - - -
12 Amoksisilin Drop 2 2 - 2 -
13 Amoksisilin kaplet 500 mg 2070 600 2,670 1,735 935 2,256 1,300
14 Amoksisilin kapsul 250 mg 60 60 60 0 78 100 EXP
15 Antasida DOEN Tablet Komb.100's 1030 1,000 2,030 1,090 940 1,417 500
16 Antasida DOEN Suspensi 0 - - - 20
18 Aqua pro injeksi 25 ml 0 - - -
19 Asam Askorbat (Vit C) Tablet 50 mg 0 - - -
20 Asam Askorbat (Vit C) Tablet 250 mg 700 900 1,600 218 1382 283
21 Asam Folat 750 750 380 370 494 100
22 Asam Traneksamat 250 mg/5ml injeksi 0 - - -
23 Asetil Sistein kapsul 200 mg Kotak 60's 0 - - -
24 Atrofin Sulfas Injeksi 0,25 mg 3 3 - 3 -
25 Ats Inj. 1.500 IU 10 10 4 6 5
26 Attapulgit tablet 600 mg 130 250 380 140 240 182
27 Betahistin 0 - - -
29 Bisakodil 5 mg 25 25 - 25 -
30 Captopril tablet 12,5 mg 655 1,000 1,655 840 815 1,092 300
32 Captopril tablet 50 mg 0 - - -
33 Carbamazepin tablet 200 mg 0 - - -
34 Cetirizine Syrup 5mg/5ml 9 9 - 9 -
35 Cetirizine tablet 10 mg 0 - - -
36 Ciprofloksasin tablet 500 mg 480 480 170 310 221
37 Deksametason 0,5 mg tablet 100"s 2000 2,000 4,000 3,260 740 4,238 3,500
38 Deksametason Injeksi 26 26 10 16 13
39 Dextrose 5% 2 2 - 2 -
40 Difenhidramin Inj. 0 - - - 5
41 Diltiazem tablet 30 mg 0 - - -
42 Dimenhidrinat Tablet 50 mg 360 200 560 320 240 416 176
43 Domperidon Susp 53 53 53 0 69 69 EXP
45 Epinefrina Inj. 0,1% 1 ml 3 4 1 3 1
46 Eritromisin Sirup 0 - - -
47 Eritromisin tablet 250 mg 20 20 - 20 -
48 Etanol 70%/100 ml 0 - - -
49 Etanol 70%/1000 ml 0 - - -
50 Etanol 70%/ 5 liter 0
51 Etil Klorida Semprot 1 1 1 1
52 Fenol Gliserol Tetes Tlg. 10% 24 24 - 24 -
53 Fletcher Serbuk 0 - - -
54 Flukonazol Kapsul 150 mg 0 - - -
55 Furosemida tablet 40 mg 160 160 30 130 39
56 Garam Oralit 0 300 300 100 200 130
57 Gentamisin Tetes Mata 0,3% 0 - - 0 -
58 Glibenklamida tablet 5 mg 300 300 75 225 98
60 Glimepirid tablet 1 mg 300 300 30 270 30
61 Griseofulvin tablet 125 mg 130 130 - 0 - ED
62 Hidroklorotiazid tablet 25 mg 105 105 55 50 72
63 Hidrokortison Krim 2,5 % 48 52 100 43 57 56
64 Hyoscin N Tablet 10 mg 23 23 7 16 9
68 Ibuprofen tablet 400 mg 0 - - -
69 Isoniazid (INH) 100 mg Tablet 100's 0 - - -
70 Isosorbide dinitrat tablet 5 mg 120 120 - 120 -
71 Kalsium Laktat 500 mg Tablet 100's 210 2,000 2,210 1,120 1090 1,456 400
72 Ketokonazol krim 0 - - -
73 Ketokonazol tablet 200 mg 125 125 125 0 163 160
74 Ketorolac Injeksi 5 5 - 5 -
75 Kloramfenikol 0.5 % tetes mata 0 - - -
76 Kloramfenikol Salep Mata 1% 0 - - -
77 Kloramfenikol sirup 0 - - 0 - EXP
78 Kloramfenikol Tetes Telinga 3% 0 - - -
80 Kotrimoksazol Susp 6 6 4 2 5 3
81 Kotrimoksazol Tab 480 mg 66 66 66 0 86 100
82 Lidocain Injeksi 2% (HCl) 40 40 37 3 48 45
83 Lidocain Injeksi 2% (HCL) + Epinefrin 32 32 - 32 -
84 Loratadin tablet 620 620 410 210 533 300
85 Magnesium Sulfat Injeksi 20% 0 - - -
86 Magnesium Sulfat Injeksi 40% 0 - - -
87 Metformin tab 500 mg 1580 4,900 6,480 4,300 2180 5,590 3,400
88 Metil Prednisolon tablet 4 mg 480 400 880 600 280 780 500
89 Metoklorpramide tablet 5 mg 130 200 330 50 280 65
90 Metronidazol tablet 250 mg 0 - - -
91 Metronidazol tablet 500 mg 0 - - -
92 Mikonazol Krim 23 21 44 36 8 47 39
93 Na. Diklofenak 25 mg 300 1900 2,200 1,358 842 1,765 1,000
94 Na. Diklofenak 50 mg 378 378 130 248 169
96 Nifedipin tablet 10 mg 0 - - -
97 Nistatin susp 100.000 IU/mL 13 13 1 12 1
98 Nistatin Vaginal tablet salut 100.000 IU/g 28 5 33 3 30 4
99 OAT FDC Kategori 1 3 3 3 -
100 OAT FDC Kategori 2 0 - - -
101 OAT FDC Kategori Anak 1 1 1 1
102 OAT FDC Kategori Sisipan 0 - - -
103 Oksitetrasiklina Salep Mata 1% 0 - - -
104 Oksitosin injeksi 10 10 - 10 -
108 Parasetamol drops 29 29 29 0 38 38
110 Permetrin Krim 5% 0 - - -
111 Phytomenadion (Vit K) Tablet 10 mg 88 88 88 0 114 100
112 Phytomenadion (Vit K1) Inj 10 mg/ml 0 - - -
113 Phytomenadion (Vit K1) Inj 2 mg/ml 5 5 - 5 -
114 Pirantel Pamoat Tab.125 mg 0 - - -
115 Prednison 5 mg Tablet 100's 0 - - -
116 Primakuin Tablet 15 mg 0 - - -
117 Propiltiourasil tablet 100 mg 0 - - -
118 Pyridoksin (Vit B6) Tablet 10 mg 0 - - -
119 Quinin tablet 0 - - -
120 Ranitidin Tablet 484 200 684 557 127 724 600
121 Reserpina 0.25 mg Tablet 100's 0 - - -
122 Ringer Laktat 10 10 10 0 13 13
123 Risperidon Tablet 2 mg 0 - - -
124 Rivanol Lar 0.1% 100 ml 0 - - -
125 Rivanol Lar 0.1% 300 ml 7 7 - 7 -
126 Sabu Inj. 5 ml 0 - - -
127 Salbutamol cairan ih 0,1% 0 - - -
129 Salbutamol tablet 4 mg 620 620 380 240 494 200
131 Salisilat + Belerang Salep 4 4 - 4 -
132 Simvastatin tablet 10 mg 300 2300 2,600 950 1650 1,235
134 Spon Gelatin 0 - - -
135 Sulfadiazin Silver Krim 1% 35 gr 0 - - -
136 Tablet Tambah Darah 1350 1,350 450 900 585
137 Thiamin (Vit B1) Tablet 50 mg 75 75 75 0 98 100
138 TKF Cairan 0 - - -
140 Vitamin A 100.000 UI kapsul 0 - - -
141 Vitamin A 200.000 UI kapsul 0 - - -
142 Yodium Povidon Lar 10% 15 ml 0 3 3 - 3 -
143 Yodium Povidon Lar 10% 30 ml 0 - - -
146 Yodium Povidon Lar 10% 1 liter 0 - - -
147 Zinc Tab 20 mg 300 300 600 467 200 607 400

4 Dulcolax supp 10 mg 0 - - 0 - 10
5 Dulcolax/Bisacodyl tablet 5 mg 0 - - -
6 Guanistrep Syrup 0
7 Histigo 6 mg 90 0 90 90 0 117 100
8 Livron B Plex 266 1600 1,866 1,096 770 1,096 326
9 OBH Nellco 16 38 54 54 0 54 54
10 Reco Tetes Telinga 0 - - -
11 Reco Tetes Mata 0 - - -
12 Scabicid Krim 0 - - -
13 Vaksin Anti Rabies 8 20 28 9 19 12
C. PSIKOTROPIKA
1 Diazepam 2 mg 66 66 - 66 -
3 Stesolid rectal tube 5 mg 4 4 1 3 1

2 Haloperidol tablet 0,5 mg 137 137 - 137
3 Haloperidol tablet 1,5 mg - - -
4 Haloperidol tablet 5 mg 147 147 58 89 75
5 Triheksilfenidil HCl tablet 2 mg 99 99 60 39 78 100
7 Klorpromazina Tablet 25 mg 80 80 80 0 104 100
E. PREKURSOR
F. BMHP
2 Alkohol Swab 5 6 11 7 4 9 5
3 Apron 9 9 - 9 0
4 Aseptic Gel 500 cc + dispenser 6 6 1 5 1
5 Blood Lancet @100 5 5 2 3 3
6 Blood Tranfusion Set 5 5 2 3 3
8 Catgut Chromic 3/0 8 8 1 7 1
9 Catgut Plain 2/0 12 12 3 9 4
10 Catgut Plain 3/0 3 3 3 0 4 4
11 Daryantullle 3 3 6 - 6 0
12 Dermafix-S IV 6 6 - 6 0
13 Disposible 1 cc 10 50 60 15 45 20
14 Disposible 10 cc 0 - - 0 0
15 Disposible 3 cc 290 290 130 160 169
16 Disposible 5 cc 50 50 12 38 16
17 Duo Band Series-12 (PINK) 25 25 - 25 0
18 Duo Band Series-18 (BLUE) 25 25 - 25 0
21 Folley Catheter No. 18 0 - - 0 0
22 H2O2 3% 0 - - 0 0
23 Handschoon Non Steril L @100 0 - - 0
24 Handschoon Non Steril M 0 - - 0
25 Handschoon Non Steril S Powdered @100 0 13 13 13 0 17 17
26 Handschoon Non Steril S PF 0 - - 0
27 Handschoon Steril 6 3 3 - 3 0
28 Handschoon Steril 6,5 5 5 - 5 0
29 Handschoon Steril 7 4 4 - 4 0
30 HCG Test 1 1 - 1 0
31 Hibiscrup 1 1 - 1 0
32 Hypafix 10 x 5 1 1 - 1 0
33 Hypafix 15 x 5 3 3 2 1 3 2
34 Hypafix 5 x 5 0 1 1 - 1 0
35 Infus Set Anak 6 4 10 3 7 4
36 Infus Set Dewasa 4 4 1 3 1
37 Iodium Test 5 5 - 5 0
38 IV. Catheter No. 18 7 7 - 7 0
39 IV. Catheter No. 20 3 3 - 3 0
40 IV. Catheter No. 22 11 11 4 7 5
41 IV. Catheter No. 24 8 8 5 3 7 4
42 IV. Catheter No. 26 5 5 2 3 3
43 Jarum Heating No. 10 24 24 - 24 0
44 Jarum Heating No. 12 90 90 - 90 0
45 Jarum Heating No. 14 36 36 - 36 0
46 Jarum Heating No. 15 60 60 - 60 0
47 Jelly USG 2 2 - 2 0
50 Kasa Kompres 40/40 Steril 0 - - 0
51 Kasa Kotak Steril 2 8 10 3 7 4
52 Kasa Pemb. Hid 4 M X 15 Cm 0 - - 0
53 Kasa Pemb. Hid 4 M X 3 Cm 9 9 - 9 0
54 Kasa Pembalut 2 x 80 cm 0 - - 0
55 Kasa Pembalut 40 x 80 cm 0 4 4 1 3 1
56 Leukoplast 2,5cm x 4,5 cm 1 1 - 1 0
57 Lisol 50% 2 2 - 2 0
58 Masker Hijab @50 0 - - 0
59 Masker Karet @50 0 - - 0
60 Masker Non Medis 3 Ply 0 - - 0
61 Nurse cap @100 100 100 50 50 65
62 Nylon No. 3/0 (Benang wajah) 0 - - 0 0
63 Nylon No. 6/0 (Benang Wajah) 27 27 - 27 0

0 - - 0

3 3 - 3 0
0 - - 0

4 4 2 2 3
68 Polyprepilene 3/0 D3 19 mm 1 14 15 5 10 7
69 Pot Salep 30gr 25 125 150 110 40 143 100
70 Pot Salep 50gr 0 - - 0
71 Selang Oksigen Bayi 6 6 - 6 6
72 Selang oksigen anak 2 2 - 2 0
73 Selang oksigen dewasa 4 10 14 9 5 12 7
74 Softaman 0 - - 0
75 Steril Surgical Blades (Aesculaps) 100's 200 200 - 200 0
78 Strip asam urat 0 - - 0
79 Strip glucose 0 - - 0
80 Strip kolesterol 0 - - 0
81 Strip trigliserid 0 - - 0
82 Suction Catheter No 10 4 4 - 4 0
84 Sungkup Nebu Anak 10 10 7 3 9 6
85 Sungkup Nebu Dewasa 4 1 5 - 5 0
86 Suture Silk 2/0 9 9 9 0 12 12
87 Suture Silk 3/0 0 - - 0 0
88 Umbilical Cord Clamps 35 0 35 - 35 0
89 Under Pad 7 11 18 - 18 0
90 Urine bag 3 3 - 3 0
OBAT PROGRAM
1 Ampicilin 1 gr 114 114 - 114 0
4 Euthyrox 250 250 - 250 0
6 MDT MB Adult - - 0
9 Albendazol Tablet 400 mg - - 0

1 Asam Askorbat 250 mg Tab 1000 0 1,000 - 1000
2 Azitromycin 500 mg 18 0 18 - 18
3 Cholecalciferol 400 IU 38 0 38 - 38
4 Curcuma FCT 1840 0 1,840 - 1840
5 Demacolin Tablet 1300 0 1,300 - 1300
6 HB - VIT 500 Kaplet 9240 0 9,240 6,030 3210
7 Imbost Kids Syrup 48 0 48 - 48
8 Imunivit Tablet 753 0 753 353 400
10 OBH Nelco Syrup 32 0 32 11 21
11 Sucralfate Syrup 75 0 75 - 75
12 Bionicom Zinc 3000 0 3,000 - 3000
13 Erdosteine 300 mg Tab 0 0 - - 0 200
14 Favipiravir 0 0 - - 0 80
Vaksin
3 Vaksin Td 0 0 0 0
5 IPV 0 0 0 0
6 MR 0 0 0 0
Vitamin Pegawai
1 HB VIT 500 0 0 0 0
Vitamin Proram KIA

OBAT & ABHP GIGI

1 1470A2 2250 XT REST SYR 3G 0 0 0 0
2 1470A3 2250 XT REST SYR 3G 0 0 0 0
3 Barbed Broach (Jarum Extepasi) 6's 0 0 0 0
6 CHKM (paramonochlorofenol) 0 0 0 0
7 Cocoa Butter 10gr 0 0 0 0
8 Cresotin Liquid no.2 0 0 0 0
9 Cresotin Paste 0 0 0 0
10 Dentin Condotioner 25gr 0 0 0 0
11 Fuji VII White (powder + liquid) 0 0 0 0
12 Fuji IX EXT A3 (powder + liquid) 0 0 0 0
13 GC Gold Label IX Extra Capsul 30's 0 0 0 0
14 Kalsium Hidroksida Pasta 0 0 0 0
15 Pasta Pengisi Saluran akar with iodorm 0 0 0 0
16 Saliva Ejector 100's 0 0 0 0
17 51202 Single Bond 2 RF LA/APAC 0 0 0 0
18 Zinc Phospat 0 0 0 0
ABHP TBC
Obat BLUD
Obat Generik
1 Allopurinol 100 mg Tab 0 0 0
3 Amlodipin 10 mg 0 0 0
4 Amlodipin 5 mg 0 0 0
5 Asam Mefenamat 500 mg 0 0 0
8 Captopril 25mg 200 200 0 200 0
10 Ciprofloxacin 500 mg 0 0 0 0
13 Dexametason 0,5 mg 0 0 0 0
15 ISDN 5mg 100 100 0 100 0
16 Ibuprofen 400 mg 0 0 0 0
18 Loratadin 10 mg 700 700 700 910
21 MGSO4 12 12 0 12 0
22 Nifedipin 10 mg Tab 400 400 100 300 130
24 Phenol Glyserol 14 14 0 14 0
25 Ranitidin 200 200 0 200 0
28 Vitamin B 6 707 707 387 320 503
Obat Non Generik

7 Scabimite Salep 30 gr 0 0 0 0
8 Ventolin Nebulizer 0 0 0 0
ABHP
2 Handscoon Size S 0 0 0
3 Masker Earloop 0 0 0
4 Masker Headloop 0 0 0
6 Povidone Iodine 1 liter 1 1 0 0 0

/KADER Balikpapan,
Petugas IFK
487 1411 1 1899

Petugas Puskesmas
…………………………
…………………………… ……………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : DESEMBER IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : JANUARI PKM
PEMBERIAN
PERMIN
TAAN
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

A. OBAT GENERIK
10 Amoksisilin 125 mg Sirup Kering 47 - 47 - 47 - -
15 Antasida DOEN Tablet Komb.100's 0 1,300 1,300 500 800 650 -
16 Antasida DOEN Suspensi 0 - - - 0 - - RETUR
19 Aqua pro injeksi 100 ml 13 - 13 - 13 - -
22 Asam Folat 0,4 mg 385 300 685 405 280 527 200
25 Asetil Sistein kapsul 200 mg 60's 7304 - 7,304 3,394 3910 4,412 502
27 Ats Inj. 1.500 IU 15 - 15 9 6 12 6
29 Betahistin 6 mg 953 - 953 534 419 694 300
30 Betametason krim 56 - 56 32 24 42 18
31 Bisakodil 5 mg 100 - 100 44 56 57 -
36 Cefadroxil 500 mg 0 600 600 70 530 91
38 Cetirizine tablet 10 mg 760 - 760 400 360 520 200
42 Dextrose 5% 3 3 6 3 3 4 -
46 Domperidon Susp 0 - - - 0 - - RETUR
48 Epinefrina Inj. 0,1% 1 ml 2 1 3 - 3 - -
51 Etanol 70%/100 ml 0 - - - -
52 Etanol 70%/1000 ml 0 - - - -
59 Garam Oralit 200 100 300 100 200 130 -
63 Glimepirid tablet 2 mg 2880 - 2,880 1,780 1100 1,780 700
67 Hidrokortison Krim 2,5 % 64 - 64 43 21 56 35
72 Ibuprofen tablet 400 mg 1820 - 1,820 700 1120 910 -
76 Ketokonazol krim 52 - 52 16 36 21 -
88 Loratadin tablet 645 800 1,445 445 1000 579 -
91 Metformin tab 500 mg 0 2,700 2,700 2,700 0 3,510 4,000
92 Metil Prednisolon tablet 4 mg 1134 - 1,134 834 300 1,084 800
96 MGSO4 40% Injeksi 3 0 3 - 3 - -
97 Mikonazol Krim 15 24 39 - 39 - -
98 Na. Diklofenak 25 mg 3613 0 3,613 1,413 2200 1,837 -
99 Na. Diklofenak 50 mg 150 100 250 50 200 65 -
106 OAT FDC Kategori Anak -
112 Parasetamol 500 mg Tablet 100's 1885 4800 6,685 3,245 3440 4,219 800
113 Parasetamol drops 0 0 - - 0 - - RETUR
115 Permetrin Krim 5% 18 47 65 33 32 43 11
125 Ranitidin Tablet 1566 0 1,566 1,191 375 1,548 1,200
127 Ringer Laktat 0 25 25 5 20 7 -
129 Rivanol Lar 0.1% 100 ml 0 - - - -
130 Rivanol Lar 0.1% 300 ml 0 - - - -
131 Sabu Inj. 5 ml 1 0 1 - 1 - -
141 Tablet Tambah Darah 0 - - 0 -
143 TKF Cairan 0 - - - -
152 Zinc Tab 20 mg 645 800 1,445 467 930 607 -

4 Curcuma FCT 2640 0 2,640 - 2640 0 -
6 Dulcolax supp 10 mg 10 15 25 8 17 10 -
10 Herbakof Syrup 139 0 139 - 139 -
11 Histigo 6 mg 0 0 - - - -
12 Trifason 0,5 mg 984 3900 4,884 2,786 2098 3,622 1,500
14 Livron B Plex 1000 0 1,000 1,000 0 1,000 -
15 Lytacur Syrup 717 0 717 - 717 -
16 Novatusin Sirup 197 0 197 - 197 0
17 OBH Nellco 0 0 - - 0 -
18 Pulmicort 5 0 5 - 5 -
19 Ramvit C 500 mg 400 0 400 - 400 0
21 Reco Tetes Mata 7 25 32 22 10 22 12
23 Stimuno Syrup 78 0 78 - 78 0
C. PSIKOTROPIKA
1 Diazepam 2 mg 59 59 - 59 -

E. PREKURSOR
3 Metilergometrina Inj. 0.2 mg/ml 0 - - 0 - EXP
F. BMHP
2 Alkohol Swab 22 0 22 6 16 8 -
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 4 0 4 4 0 5 5
7 Catgut Chromic 2/0 8 0 8 - 8 0 -
8 Catgut Chromic 3/0 6 0 6 - 6 0 -
9 Catgut Plain 2/0 8 0 8 - 8 0 -
10 Catgut Plain 3/0 0 - - 0 -
11 Daryantullle 10 0 10 5 5 7 2
13 Disposible 1 cc 40 50 90 30 60 39 -
14 Disposible 10 cc 12 0 12 - 12 0 -
15 Disposible 3 cc 50 260 310 160 150 208 58
16 Disposible 5 cc 25 35 60 25 35 33 -
22 H2O2 3% 0 - - 0 -
31 HCG Test 1 0 1 - 1 0 -
32 Hibiscrup 1 0 1 - 1 0 -
33 Hypafix 10 x 5 0 0 - - 0 0 -
34 Hypafix 15 x 5 4 3 7 4 3 5 2
35 Hypafix 5 x 5 1 0 1 - 1 0 -
36 Infus Set Anak 4 0 4 - 4 0 -
38 Iodium Test 0 - - 0 0 -
39 IV. Catheter No. 18 5 0 5 - 5 0 -
40 IV. Catheter No. 20 5 0 5 - 5 0 -
41 IV. Catheter No. 22 7 14 21 3 18 4 -
42 IV. Catheter No. 24 2 0 2 - 2 0 -
43 IV. Catheter No. 26 4 0 4 - 4 0 -
44 Jarum Heating No. 10 24 24 - 24 0 -
45 Jarum Heating No. 12 90 90 - 90 0 -
46 Jarum Heating No. 14 36 36 - 36 0 -
47 Jarum Heating No. 15 60 60 - 60 0 -
48 Jelly USG 3 0 3 1 2 1 -
57 Kerta Puyer 0 0 - - 0 0 1
59 Lisol 50% 2 2 - 2 0 -
60 Masker Hijab @50 0 10 10 10 0 13 13
61 Masker Karet @50 0 10 10 10 0 13 13
63 Nurse cap @100 1 0 1 - 1 0 -
65 Nylon No. 6/0 (Benang Wajah) 0 - - 0 0 - EXP

0 - - 0 -

2 2 1 1 1 -

0 - - 0 -

3 0 3 - 3 0 -
71 Pot Salep 30gr 0 0 - - 0 0 -
72 Pot Salep 50gr 12 50 62 62 0 81 81
76 Softaman 5 5 - 5 0 -
84 Suction Catheter No 10 4 4 - 4 0 1 ED
88 Suture Silk 2/0 10 11 21 10 11 13 2
89 Suture Silk 3/0 12 0 12 12 0 16 16
91 Under Pad 13 29 42 10 32 13 -
92 Urine bag 5 0 5 - 5 0 -
OBAT PROGRAM
1 Albendazol Tablet 400 mg 0 0 - - 0 0 EXP
3 Alive Nutribion @100 100 100 200 100 100 130
4 Ampicilin 1 gr 111 111 - 111 0
7 Euthyrox 0 - - 0
9 Livron B Plex 2600 0 2,700 100 2600 130
11 MDT MB Adult 0 4 4 4 0 0
16 Taburia 0 0 - - 0 0
OBAT & ABHP P3K
1 Cefadroxil 500 mg 0 0 - - 0 0

3 Azitromycin 500 mg 35 0 35 - 35 0
6 Bionicom Zinc 1990 0 1,990 - 1990 0
8 Curcuma FCT 3000 0 3,000 - 3000 0
9 D Trivit 230 0 230 - 230 0
12 Erdostein 120 0 120 - 120 0
13 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
15 Imunivit Tablet 500 0 500 - 500 0
18 Momucil 200 mg 0 0 - - 0
19 OBH Nelco Syrup 0 0 - - 0 0 RETUR
21 Oseltamivir 20 0 20 - 20 0
22 Pafivirapir 0 0 - - 0 0 EXP
24 Zink Syrup 5 0 5 - 5 0
Vaksin
1 Vaksin BCG
3 Vaksin Td
4 Vaksin Polio
5 IPV
6 MR
7 Hep B1 ds/Buah
Vitamin Pegawai
1 Bionicom Zink 0 1740 1740 1740 0 1740 -
2 HB VIT 500 0 0 0 0 0 0 -
Vitamin Proram KIA
1 Ferbion 0 0 - - 0 0 -

3 Alkohol 70% 5 L 0 0 0 0 0 0
14 Obyek Glass Cat N0. 7105 0 0 0 0 0 0
18 Reagen HIV SD 0 0 0 0 0 0
25 Tabung EDTA 0 0 0 0 0 0
28 Test Urine 3P 0 0 - 0 0 0
29 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0 -
30 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
OBAT & ABHP GIGI

2 Alevo Gym 0 0 0 0 0
31
32
ABHP TBC
3 Masker N95 @20 500 0 500 0 500 0
Obat BLUD
Obat Generik
5 Asam Folat 100 0 100 0 100 0
10 Captopril 25mg 900 0 900 0 900 0
14 Etil Klorid 1 0 1 0 1 0
16 Dexametason 0,5 mg 600 0 600 0 600 0
19 ISDN 5mg 100 0 100 0 100 0
20 Ibuprofen 400 mg 0 0 0 0 0
25 Metformin 500 mg Tab 600 0 600 600 0 780
27 MGSO4 0 0 0 0 0
28 Nifedipin 10 mg Tab 100 0 100 0 100 0
32 Ranitidin 100 0 100 0 100 0
33 Salbutamol 2 mg 1912 0 1912 412 1500 536
36 Vitamin B 6 1050 0 1050 550 500 715
Obat Non Generik

7 Lecozinc 20 mg 0 0 0 0 0 0
12
ABHP
1 Bisturi no.11 80 0 80 0 80 0
3 Catgut Plain 3/0 24 0 24 0 24 0
5 H2O2 800 ml 4 0 4 0 4 0

420 1638 2058
Petugas IFK

Petugas Puskesmas
…………………………… …………………………… 2. Memeriksa : ………………..
…………………………
NO/TGL DOKUMEN
PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : DESEMBER IFK
KECAMATAN : BALIKPAPAN BARAT PERMINTAAN BULAN : JANUARI PKM
PEMBERIAN
PERMIN
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT
TAAN
APBD APBN BUFFER PROGRAM
1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13

A. OBAT GENERIK
1 Acyclovir tablet 200 mg Acyclovir tablet 200 mg 15 0 15 - 15 - -
2 Acyclovir tablet 400 mg Acyclovir tablet 400 mg 136 300 436 201 235 261 -
3 Albendazol Tablet 400 mg Albendazol Tablet 400 mg 85 100 185 - 185 - -
4 Allopurinol tablet 100 mg Allopurinol tablet 100 mg 995 0 995 637 358 828 500
5 Allopurinol tablet 300 mg Allopurinol tablet 300 mg 332 0 332 132 200 172 -
6 Ambroxol 30mg Tablet Ambroxol 30mg Tablet 0 0 - - - -
7 Ambroxol Syrup Ambroxol Syrup 0 - - - -
8 Amlodipin tablet 10 mg Amlodipin tablet 10 mg 2210 12,780 14,990 9,890 5100 12,857 7,770
9 Amlodipin tablet 5 mg Amlodipin tablet 5 mg 1660 5,370 7,030 2,440 4590 3,172 -
10 Amoksisilin 125 mg Sirup Kering Amoksisilin 125 mg Sirup Kering 47 - 47 - 47 - -
11 Amoksisilin 250 mg Sirup Kering Amoksisilin 250 mg Sirup Kering 0 - - - 0 - -
12 Amoksisilin Drop Amoksisilin Drop 0 - - - - -
13 Amoksisilin kaplet 500 mg Amoksisilin kaplet 500 mg 1788 1,000 2,788 188 2600 244 -
14 Amoksisilin kapsul 250 mg Amoksisilin kapsul 250 mg 0 - - - -
15 Antasida DOEN Tablet Komb.100's Antasida DOEN Tablet Komb.100's 0 1,300 1,300 500 800 650 -
16 Antasida DOEN Suspensi Antasida DOEN Suspensi 0 - - - 0 - -
17 Anti Hemoroid Supositoria Anti Hemoroid Supositoria 12 30 42 35 7 46 39
18 Aqua pro injeksi 25 ml Aqua pro injeksi 25 ml 0 - - - -
19 Aqua pro injeksi 100 ml Asam Askorbat (Vit C) Tablet 50 mg 13 - 13 - 13 - -
20 Asam Askorbat (Vit C) Tablet 50 mg Asam Askorbat (Vit C) Tablet 250 mg 845 2,000 2,845 1,155 1690 1,502 -
21 Asam Askorbat (Vit C) Tablet 250 mg Asam Folat 0 - - - 0 - -
22 Asam Folat 0,4 mg Asam Mefenamat kaplet 500 mg 385 300 685 405 280 527 200
23 Asam Mefenamat kaplet 500 mg Asam Traneksamat 250 mg/5ml injeksi 1002 2,400 3,402 1,752 1650 2,278 600
24 Asam Traneksamat 250 mg/5ml injeksi Asetil Sistein kapsul 200 mg Kotak 60's 0 - - - -
25 Asetil Sistein kapsul 200 mg 60's Atrofin Sulfas Injeksi 0,25 mg 7304 - 7,304 3,394 3910 4,412 502
26 Atrofin Sulfas Injeksi 0,25 mg Ats Inj. 1.500 IU 2 - 2 - 2 - -
27 Ats Inj. 1.500 IU Attapulgit tablet 600 mg 15 - 15 9 6 12 6
28 Attapulgit tablet 600 mg Betahistin 0 - - - 0 - -
29 Betahistin 6 mg Betametason krim 953 - 953 534 419 694 300
30 Betametason krim Bisakodil 5 mg 56 - 56 32 24 42 18
31 Bisakodil 5 mg Captopril tablet 12,5 mg 100 - 100 44 56 57 -
32 Captopril tablet 12,5 mg Captopril tablet 25 mg 0 - - - - 2,000
33 Captopril tablet 25 mg Captopril tablet 50 mg 1225 2,000 3,225 1,505 1720 1,957 200
34 Captopril tablet 50 mg Carbamazepin tablet 200 mg 0 - - - -
35 Carbamazepin tablet 200 mg Cetirizine Syrup 5mg/5ml 0 - - - -
36 Cefadroxil 500 mg Cetirizine tablet 10 mg 0 600 600 70 530 91
37 Cetirizine Syrup 5mg/5ml Ciprofloksasin tablet 500 mg 3 - 3 - 3 - -
38 Cetirizine tablet 10 mg Deksametason 0,5 mg tablet 100"s 760 - 760 400 360 520 200
39 Ciprofloksasin tablet 500 mg Deksametason Injeksi 401 - 401 161 240 209 -
40 Deksametason 0,5 mg tablet 100"s Dextrose 5% 0 - - - - -
41 Deksametason Injeksi Difenhidramin Inj. 11 2 13 4 9 5 -
42 Dextrose 5% Diltiazem tablet 30 mg 3 3 6 3 3 4 -
43 Difenhidramin Inj. Dimenhidrinat Tablet 50 mg 4 - 4 - 4 - -
44 Diltiazem tablet 30 mg Domperidon Susp 0 - - - -
45 Dimenhidrinat Tablet 50 mg Domperidon Tablet 1037 - 1,037 337 700 438 -
46 Domperidon Susp Epinefrina Inj. 0,1% 1 ml 0 - - - 0 - -
47 Domperidon Tablet Eritromisin Sirup 649 600 1,249 655 594 852 300
48 Epinefrina Inj. 0,1% 1 ml Eritromisin tablet 250 mg 2 1 3 - 3 - -
49 Eritromisin Sirup Etanol 70%/100 ml 0 - - - - -
50 Eritromisin tablet 250 mg Etanol 70%/1000 ml 0 - - - -
51 Etanol 70%/100 ml Etanol 70%/ 5 liter 0 - - - -
52 Etanol 70%/1000 ml Etil Klorida Semprot 0 - - - -
53 Etanol 70%/ 5 liter Fenol Gliserol Tetes Tlg. 10% 0 -
54 Etil Klorida Semprot Fletcher Serbuk 0 - - - -
55 Fenol Gliserol Tetes Tlg. 10% Flukonazol Kapsul 150 mg 3 28 31 5 26 7 -
56 Fletcher Serbuk Furosemida tablet 40 mg 0 - - - -
57 Flukonazol Kapsul 150 mg Garam Oralit 0 - - - -
58 Furosemida tablet 40 mg Gentamisin Tetes Mata 0,3% 0 - - - 0 - -
59 Garam Oralit Glibenklamida tablet 5 mg 200 100 300 100 200 130 -
60 Gentamisin Salep Mata Glimepirid tablet 2 mg 0 - - - 0 0 12
61 Gentamisin Tetes Mata 0,3% Glimepirid tablet 1 mg 0 - - - 0 - -
62 Glibenklamida tablet 5 mg Griseofulvin tablet 125 mg 40 - 40 - 40 - -
63 Glimepirid tablet 2 mg Hidroklorotiazid tablet 25 mg 2880 - 2,880 1,780 1100 1,780 700
64 Glimepirid tablet 1 mg Hidrokortison Krim 2,5 % 200 200 - 200 0 -
65 Griseofulvin tablet 125 mg Hyoscin N Tablet 10 mg 260 - 260 23 237 30 -
66 Hidroklorotiazid tablet 25 mg Ibuprofen Susp. 100 mg/5 ml 495 - 495 129 366 168 -
67 Hidrokortison Krim 2,5 % Ibuprofen Susp. 200 mg/5 ml 64 - 64 43 21 56 35
68 Hyoscin N Tablet 10 mg Ibuprofen tablet 200 mg 20 100 120 60 60 78 -
69 Ibuprofen Susp. 100 mg/5 ml Ibuprofen tablet 400 mg 0 - - - 0 - -
70 Ibuprofen Susp. 200 mg/5 ml Isoniazid (INH) 100 mg Tablet 100's 9 - 9 - 9 - -
71 Ibuprofen tablet 200 mg Isosorbide dinitrat tablet 5 mg 0 - - - 2,000
72 Ibuprofen tablet 400 mg Kalsium Laktat 500 mg Tablet 100's 1820 - 1,820 700 1120 910 -
73 Isoniazid (INH) 100 mg Tablet 100's Ketokonazol krim 0 - - - -
74 Isosorbide dinitrat tablet 5 mg Ketokonazol tablet 200 mg 67 67 - 67 - -
75 Kalsium Laktat 500 mg Tablet 100's Ketorolac Injeksi 1305 2,300 3,605 1,505 2100 1,957 -
76 Ketokonazol krim Kloramfenikol 0.5 % tetes mata 52 - 52 16 36 21 -
77 Ketokonazol tablet 200 mg Kloramfenikol Salep Mata 1% 555 - 555 75 480 98 -
78 Ketorolac Injeksi Kloramfenikol sirup 4 4 - 4 - -
79 Kloramfenikol 0.5 % tetes mata Kloramfenikol Tetes Telinga 3% 0 - - - 12
80 Kloramfenikol Salep Mata 1% Klorfeniramin Maleat tablet 4 mg 0 - - - 12
81 Kloramfenikol sirup Kotrimoksazol Susp 0 - - - -
82 Kloramfenikol Tetes Telinga 3% Kotrimoksazol Tab 480 mg 0 - - - -
83 Klorfeniramin Maleat tablet 4 mg Lidocain Injeksi 2% (HCl) 2300 2,300 4,600 3,160 1440 4,108 2,700
84 Kotrimoksazol Susp Lidocain Injeksi 2% (HCL) + Epinefrin 6 - 6 - 6 - -
85 Kotrimoksazol Tab 480 mg Loratadin tablet 42 - 42 22 20 29 100
86 Lidocain Injeksi 2% (HCl) Magnesium Sulfat Injeksi 20% 65 24 89 31 58 40 -
87 Lidocain Injeksi 2% (HCL) + Epinefrin Magnesium Sulfat Injeksi 40% 10 10 - 10 - -
88 Loratadin tablet Metformin tab 500 mg 645 800 1,445 445 1000 579 -
89 Magnesium Sulfat Injeksi 20% Metil Prednisolon tablet 4 mg 0 - - - -
90 Magnesium Sulfat Injeksi 40% Metoklorpramide tablet 5 mg 0 - - - 0 - -
91 Metformin tab 500 mg Metronidazol tablet 250 mg 0 2,700 2,700 2,700 0 3,510 4,000
92 Metil Prednisolon tablet 4 mg Metronidazol tablet 500 mg 1134 - 1,134 834 300 1,084 800
93 Metoklorpramide tablet 10 mg Mikonazol Krim 360 - 360 90 270 117 -
94 Metronidazol tablet 250 mg Na. Diklofenak 25 mg 0 - - - -
95 Metronidazol tablet 500 mg Na. Diklofenak 50 mg 0 0 - - - 1,000
96 MGSO4 40% Injeksi Natrium Klorida Infus 0.9% 3 0 3 - 3 - -
97 Mikonazol Krim Nifedipin tablet 10 mg 15 24 39 - 39 - -
98 Na. Diklofenak 25 mg Nistatin susp 100.000 IU/mL 3613 0 3,613 1,413 2200 1,837 -
99 Na. Diklofenak 50 mg Nistatin Vaginal tablet salut 100.000 IU/g 150 100 250 50 200 65 -
100 Natrium Klorida Infus 0.9% OAT FDC Kategori 1 9 29 38 17 21 22 1
101 Nifedipin tablet 10 mg OAT FDC Kategori 2 0 - - - -
102 Nistatin susp 100.000 IU/mL OAT FDC Kategori Anak 4 0 4 - 4 - -
103 Nistatin Vaginal tablet salut 100.000 IU/g OAT FDC Kategori Sisipan 19 0 19 12 7 16 9
104 OAT FDC Kategori 1 Oksitetrasiklina Salep Mata 1%
105 OAT FDC Kategori 2 Oksitosin injeksi -
106 OAT FDC Kategori Anak Omeprazol Injeksi 40mg /10ml -
107 OAT FDC Kategori Sisipan Omeprazol kapsul 20 mg -
108 Oksitetrasiklina Salep Mata 1% Parasetamol 500 mg Tablet 100's (Novagesic) 0 - - - 20
109 Oksitosin injeksi Parasetamol drops 5 16 21 5 16 7 -
110 Omeprazol Injeksi 40mg /10ml Parasetamol Sirup 120 mg/5 ml 2 0 2 2 0 3 3
111 Omeprazol kapsul 20 mg Permetrin Krim 5% 684 1480 2,164 1,564 600 2,033 1,400
112 Parasetamol 500 mg Tablet 100's Phytomenadion (Vit K) Tablet 10 mg 1885 4800 6,685 3,245 3440 4,219 800
113 Parasetamol drops Phytomenadion (Vit K1) Inj 10 mg/ml 0 0 - - 0 - -
114 Parasetamol Sirup 120 mg/5 ml Phytomenadion (Vit K1) Inj 2 mg/ml 155 0 155 - 155 - -
115 Permetrin Krim 5% Pirantel Pamoat Tab.125 mg 18 47 65 33 32 43 11
116 Phytomenadion (Vit K) Tablet 10 mg Prednison 5 mg Tablet 100's 207 0 207 - 207 - -
117 Phytomenadion (Vit K1) Inj 10 mg/ml Primakuin Tablet 15 mg 0 - - - -
118 Phytomenadion (Vit K1) Inj 2 mg/ml Propiltiourasil tablet 100 mg 18 0 18 8 10 10 -
119 Pirantel Pamoat Tab.125 mg Pyridoksin (Vit B6) Tablet 10 mg 88 0 88 16 72 21 -
120 Prednison 5 mg Tablet 100's Quinin tablet 0 - - - -
121 Primakuin Tablet 15 mg Ranitidin Tablet 0 - - - -
122 Propiltiourasil tablet 100 mg Reserpina 0.25 mg Tablet 100's 0 - - - -
123 Pyridoksin (Vit B6) Tablet 10 mg Ringer Laktat 0 - - - 1,000
124 Quinin tablet Risperidon Tablet 2 mg 0 - - - -
125 Ranitidin Tablet Rivanol Lar 0.1% 100 ml 1566 0 1,566 1,191 375 1,548 1,200
126 Reserpina 0.25 mg Tablet 100's Rivanol Lar 0.1% 300 ml 0 - - - -
127 Ringer Laktat Sabu Inj. 5 ml 0 25 25 5 20 7 -
128 Risperidon Tablet 2 mg Salbutamol cairan ih 0,1% 0 - - - -
129 Rivanol Lar 0.1% 100 ml Salbutamol tablet 2 mg 0 - - - -
130 Rivanol Lar 0.1% 300 ml Salbutamol tablet 4 mg 0 - - - -
131 Sabu Inj. 5 ml Salisil Bedak 2% 50 gram 1 0 1 - 1 - -
132 Salbutamol cairan ih 0,1% Salisilat + Belerang Salep 0 - - - -
133 Salbutamol tablet 2 mg Simvastatin tablet 10 mg 0 0 - - - 2,000
134 Salbutamol tablet 4 mg Simvastatin tablet 20 mg 0 0 - - - -
135 Salisil Bedak 2% 50 gram Spon Gelatin 4 0 4 4 0 5 5
136 Salisilat + Belerang Salep Sulfadiazin Silver Krim 1% 35 gr 0 3 3 3 0 4 4
137 Simvastatin tablet 10 mg Tablet Tambah Darah 2380 3000 5,380 3,230 2150 4,199 2,100
138 Simvastatin tablet 20 mg Thiamin (Vit B1) Tablet 50 mg 0 0 - - - -
139 Spon Gelatin TKF Cairan 0 - - - -
140 Sulfadiazin Silver Krim 1% 35 gr (Burnazin) Vit. B Kompleks tablet 0 0 - - - -
141 Tablet Tambah Darah Vitamin A 100.000 UI kapsul 0 - - 0 -
142 Thiamin (Vit B1) Tablet 50 mg Vitamin A 200.000 UI kapsul 0 - - - -
143 TKF Cairan Yodium Povidon Lar 10% 15 ml 0 - - - -
144 Vit. B Kompleks tablet Yodium Povidon Lar 10% 30 ml 2206 500 2,706 1,406 1300 1,828 500
145 Vitamin A 100.000 UI kapsul Yodium Povidon Lar 10% 300 ml 0 - - - -
146 Vitamin A 200.000 UI kapsul Yodium Povidon Lar 10% 60 ml 0 - - - -
147 Yodium Povidon Lar 10% 15 ml Yodium Povidon Lar 10% 1 liter 0 0 - - 0 - -
148 Yodium Povidon Lar 10% 30 ml Zinc Tab 20 mg 3 0 3 - 3 - -
152 Zinc Tab 20 mg 645 800 1,445 467 930 607 -

4 Curcuma FCT 2640 0 2,640 - 2640 0 -
6 Dulcolax supp 10 mg 10 15 25 8 17 10 -
10 Herbakof Syrup 139 0 139 - 139 -
11 Histigo 6 mg 0 0 - - - -
12 Trifason 0,5 mg 984 3900 4,884 2,786 2098 3,622 1,500
14 Livron B Plex 1000 0 1,000 1,000 0 1,000 -
15 Lytacur Syrup 717 0 717 - 717 -
16 Novatusin Sirup 197 0 197 - 197 0
17 OBH Nellco 0 0 - - 0 -
18 Pulmicort 5 0 5 - 5 -
19 Ramvit C 500 mg 400 0 400 - 400 0
21 Reco Tetes Mata 7 25 32 22 10 22 12
23 Stimuno Syrup 78 0 78 - 78 0
C. PSIKOTROPIKA
1 Diazepam 2 mg 59 59 - 59 -

E. PREKURSOR
3 Metilergometrina Inj. 0.2 mg/ml 0 - - 0 -
F. BMHP
2 Alkohol Swab 22 0 22 6 16 8 -
3 Apron 9 9 - 9 0 -
5 Blood Lancet @100 4 0 4 4 0 5 5
7 Catgut Chromic 2/0 8 0 8 - 8 0 -
8 Catgut Chromic 3/0 6 0 6 - 6 0 -
9 Catgut Plain 2/0 8 0 8 - 8 0 -
10 Catgut Plain 3/0 0 - - 0 -
11 Daryantullle 10 0 10 5 5 7 2
13 Disposible 1 cc 40 50 90 30 60 39 -
14 Disposible 10 cc 12 0 12 - 12 0 -
15 Disposible 3 cc 50 260 310 160 150 208 58
16 Disposible 5 cc 25 35 60 25 35 33 -
22 H2O2 3% 0 - - 0 -
31 HCG Test 1 0 1 - 1 0 -
32 Hibiscrup 1 0 1 - 1 0 -
33 Hypafix 10 x 5 0 0 - - 0 0 -
34 Hypafix 15 x 5 4 3 7 4 3 5 2
35 Hypafix 5 x 5 1 0 1 - 1 0 -
36 Infus Set Anak 4 0 4 - 4 0 -
38 Iodium Test 0 - - 0 0 -
39 IV. Catheter No. 18 5 0 5 - 5 0 -
40 IV. Catheter No. 20 5 0 5 - 5 0 -
41 IV. Catheter No. 22 7 14 21 3 18 4 -
42 IV. Catheter No. 24 2 0 2 - 2 0 -
43 IV. Catheter No. 26 4 0 4 - 4 0 -
44 Jarum Heating No. 10 24 24 - 24 0 -
45 Jarum Heating No. 12 90 90 - 90 0 -
46 Jarum Heating No. 14 36 36 - 36 0 -
47 Jarum Heating No. 15 60 60 - 60 0 -
48 Jelly USG 3 0 3 1 2 1 -
57 Kerta Puyer 0 0 - - 0 0 1
59 Lisol 50% 2 2 - 2 0 -
60 Masker Hijab @50 0 10 10 10 0 13 13
61 Masker Karet @50 0 10 10 10 0 13 13
63 Nurse cap @100 1 0 1 - 1 0 -
65 Nylon No. 6/0 (Benang Wajah) 0 - - 0 0 -

0 - - 0 -

2 2 1 1 1 -

0 - - 0 -

3 0 3 - 3 0 -
71 Pot Salep 30gr 0 0 - - 0 0 -
72 Pot Salep 50gr 12 50 62 62 0 81 81
76 Softaman 5 5 - 5 0 -
84 Suction Catheter No 10 4 4 - 4 0 1
88 Suture Silk 2/0 10 11 21 10 11 13 2
89 Suture Silk 3/0 12 0 12 12 0 16 16
91 Under Pad 13 29 42 10 32 13 -
92 Urine bag 5 0 5 - 5 0 -
OBAT PROGRAM
3 Alive Nutribion @100 100 100 200 100 100 130
4 Ampicilin 1 gr 111 111 - 111 0
7 Euthyrox 0 - - 0
9 Livron B Plex 2600 0 2,700 100 2600 130
11 MDT MB Adult 0 4 4 4 0 0
16 Taburia 0 0 - - 0 0
OBAT & ABHP P3K
1 Cefadroxil 500 mg 0 0 - - 0 0

3 Azitromycin 500 mg 35 0 35 - 35 0
6 Bionicom Zinc 1990 0 1,990 - 1990 0
8 Curcuma FCT 3000 0 3,000 - 3000 0
9 D Trivit 230 0 230 - 230 0
12 Erdostein 120 0 120 - 120 0
13 HB - VIT 500 Kaplet 3210 0 3,210 - 3210 0
15 Imunivit Tablet 500 0 500 - 500 0
18 Momucil 200 mg 0 0 - - 0
19 OBH Nelco Syrup 0 0 - - 0 0
21 Oseltamivir 20 0 20 - 20 0
22 Pafivirapir 0 0 - - 0 0
24 Zink Syrup 5 0 5 - 5 0
Vaksin
1 Vaksin BCG
3 Vaksin Td
4 Vaksin Polio
5 IPV
6 MR
7 Hep B1 ds/Buah
Vitamin Pegawai
1 Bionicom Zink 0 1740 1740 1740 0 1740 -
2 HB VIT 500 0 0 0 0 0 0 -
Vitamin Proram KIA
1 Ferbion 0 0 - - 0 0 -

3 Alkohol 70% 5 L 0 0 0 0 0 0
14 Obyek Glass Cat N0. 7105 0 0 0 0 0 0
18 Reagen HIV SD 0 0 0 0 0 0
25 Tabung EDTA 0 0 0 0 0 0
28 Test Urine 3P 0 0 - 0 0 0
29 1470A2 2250 XT REST SYR 3G 0 0 0 0 0 0 -
30 1470A3 2250 XT REST SYR 3G 0 0 0 0 0 0
OBAT & ABHP GIGI

2 Alevo Gym 0 0 0 0 0
31
32
ABHP TBC
3 Masker N95 @20 500 0 500 0 500 0
Obat BLUD
Obat Generik
5 Asam Folat 100 0 100 0 100 0
10 Captopril 25mg 900 0 900 0 900 0
14 Etil Klorid 1 0 1 0 1 0
16 Dexametason 0,5 mg 600 0 600 0 600 0
19 ISDN 5mg 100 0 100 0 100 0
20 Ibuprofen 400 mg 0 0 0 0 0
25 Metformin 500 mg Tab 600 0 600 600 0 780
27 MGSO4 0 0 0 0 0
28 Nifedipin 10 mg Tab 100 0 100 0 100 0
32 Ranitidin 100 0 100 0 100 0
33 Salbutamol 2 mg 1912 0 1912 412 1500 536
36 Vitamin B 6 1050 0 1050 550 500 715
Obat Non Generik

7 Lecozinc 20 mg 0 0 0 0 0 0
12
ABHP
1 Bisturi no.11 80 0 80 0 80 0
3 Catgut Plain 3/0 24 0 24 0 24 0
5 H2O2 800 ml 4 0 4 0 4 0

420 1638 2058
Pimpinan Puskesmas Kepala Instalasi Farmasi & Perbekkes
Yang Menerima
Petugas Puskesmas
…………………………… ……………………………
…………………………
DOKUMEN
JUMLAH KET
DAK
14 15 16
RETUR
RETUR
RETUR
EXP
EXP
ED
EXP
RETUR
EXP
Balikpapan,
Petugas IFK
1. Menyiapkan : ………………..
2. Memeriksa : ………………..

Recap Lplpo 2022

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Recap Lplpo 2022

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Available Formats

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESM

PUSKESMAS : PERAWATAN BARU ULU PELAPORAN BULAN : DESEMBER

1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7)

D. OBAT-OBAT TERTENTU (OOT)

66 Pembalut Elastis 10 cm x 4,55 m (PRO CREPE)

68 Pembalut Elastis 7,5 cm x 4,55 m (PRO CREPE)

69 Plesterin Bulat Non Woven 24mm x 24mm 200's

OBAT & VITAMIN COVID

REAGEN & ABHP LABORATORIUM

OBAT & ABHP GIGI

Obat Non Generik

JUMLAH KUNJUNGAN RESEP

420 1638 2058

Yang Meminta Mengetahui/ Menyetujui

Yang Menerima 1. Menyiapkan : ………………..

1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

B. OBAT NON GENERIK -

D. OBAT-OBAT TERTENTU (OOT)

65 Pembalut Elastis 10 cm x 4,55 m (PRO CREPE)

66 Pembalut Elastis 15 cm x 4,55 m (PRO CREPE)

67 Pembalut Elastis 7,5 cm x 4,55 m (PRO CREPE)

68 Plesterin Bulat Non Woven 24mm x 24mm 200's

OBAT & VITAMIN COVID

REAGEN & ABHP LABORATORIUM

OBAT & ABHP GIGI

Obat Non Generik

UMUM BPJS R. INAP JUMLAH

JUMLAH KUNJUNGAN RESEP

Yang Meminta Mengetahui/ Menyetujui

…………………………… …………………………… 2. Memeriksa : ………………..

1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

B. OBAT NON GENERIK -

D. OBAT-OBAT TERTENTU (OOT)

65 Pembalut Elastis 10 cm x 4,55 m (PRO CREPE)

66 Pembalut Elastis 15 cm x 4,55 m (PRO CREPE)

67 Pembalut Elastis 7,5 cm x 4,55 m (PRO CREPE)

68 Plesterin Bulat Non Woven 24mm x 24mm 200's

OBAT & ABHP P3K

OBAT & VITAMIN COVID

REAGEN & ABHP LABORATORIUM

OBAT & ABHP GIGI

Obat Non Generik

UMUM BPJS R. INAP JUMLAH

JUMLAH KUNJUNGAN RESEP

Yang Meminta Mengetahui/ Menyetujui

…………………………… …………………………… 2. Memeriksa : ………………..

1 2 3 4 5=(3+4) 6= (5-7) 7(5-6) 8(6+30%) 9(8-7) 10 11 12 13 14 15 16

B. OBAT NON GENERIK -

D. OBAT-OBAT TERTENTU (OOT)

65 Pembalut Elastis 10 cm x 4,55 m (PRO CREPE)

66 Pembalut Elastis 15 cm x 4,55 m (PRO CREPE)

67 Pembalut Elastis 7,5 cm x 4,55 m (PRO CREPE)

68 Plesterin Bulat Non Woven 24mm x 24mm 200's

OBAT & ABHP P3K

OBAT & VITAMIN COVID

2 Vaksin DPT/ DPT-HB/ DPT-HB-Hib

Vitamin Proram KIA

REAGEN & ABHP LABORATORIUM

OBAT & ABHP GIGI

Obat Non Generik

UMUM BPJS R. INAP JUMLAH

JUMLAH KUNJUNGAN RESEP

Yang Meminta Mengetahui/ Menyetujui

Yang Menerima 1. Menyiapkan : ………………..