LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN OBAT

( LPLPO )
UNIT PELAYANAN :
NAMA YANG MELAPOR : SISRI SARI ADHA, Amd. Keb

Kode Puskesmas : 13 Bulan : JUNI

Puskesmas : BUKIT SILEH Tahun : 2023
Kecamatan : Lembang Jaya :
Kabupaten : Solok Periode :
Propinsi : Sumatera Barat

Pemberian (Diisi
No. NAMA OBAT SATUAN Stok Awal Penerimaan Persediaan Pemakaian SISA STOK Permintaan Exp Date Ket
PJ Gudang )
1 2 3 4 5 6 = 4+5 7 8 = 6-7 9 10 11 12
1 Acetycystein 200 mg tablet 120 120 90 30 120
2 Acyclovir 400 Mg tablet 90 90 10 80 100
3 Acyclovir crem tube - - 5
4 Albendazol Syrup Botol - -
5 Albendazol tablet 400 MG tablet - -
6 Alopurinol tablet 100 MG tablet 100 100 10 90
7 Alprazolam Tablet 0,5 Mg tablet - -
8 Aminofilin Injeksi 24 MG/ML - l0 ML Ampul - -
9 Aminofilin tablet 200 MG tablet - -
10 Amitriptilin HCl tablet Salut 25 MG tablet - -
11 Amlodipin 5 MG tablet 20 100 120 50 70 100
12 Amoksisilin Kaplet 500 Mg tablet 200 200 170 30 300
13 Amoksisilin Kapsul 250 Mg tablet - -
14 Amoksisilin Sirup Kering l25 MG/5ML Botol 3 5 8 8
15 Antasida Sirup Botol - -
16 Antasida DOEN Tablet.Kombinasi tablet 200 200 40 160
17 Anti Bakteri DOEN Salep Kombinasi Buah -
18 Anti Fungi DOEN Kombinasi tablet - -
19 Anti Hemoroid DOEN Kombinasi Suppos - -
20 Anti Tuberkulosis Anak Paket - -
21 Anti Tuberkulosis Kategori I/FDC Paket - -
22 Anti Tuberkulosis Kategori II/FDC Paket - -
23 Anti Tuberkulosis Kategori III/FDC Paket - -
24 Anti Tuberkulosis Sisipan Paket - -
25 Asam Askorbat Tablet 50 MG tablet 200 200 50 150 200
26 Asam Folat 1 mg tablet 60 60 60 100
27 Asam Mefenamat Kapsul 500 mg tablet 200 200 50 150 200
28 Asetosal tablet 100 MG tablet - -
29 Asetosal tablet 80 MG (Miniaspi ) tablet - -
30 Atropin Sulfat Injeksi 0.25 MG/ML-1 ML Ampul - -
31 Atropin Sulfat Tablet 0.5 MG tablet - -
32 Betahistin Mesilat Tablet 6 mg tablet - - 100
33 Betametason Krem 0.1 % tube 5 5 5
34 Bisakodil 5 MG Suppos (Dulcolax) Suppos - -
35 Bisoprolol Tablet 5 mg tablet - -
36 Captopril 12, 5 mg tablet - -
37 Captopril 25 mg tablet 60 100 160 160
38 Carbamazepin 200 mg tablet - -
39 Cefixim syrup Botol - - 5
40 Cefixim tab tablet - - 100
41 Cetirizin tab tablet - - 200
42 Ciproflaksasin tablet 500 mg tablet - - 100
43 Clobazam Tablet 10 mg tablet - -
44 Dexametason Injeksi 5 MG/ML-1 ML Ampul - -
45 Dexametason Tablet 0.5 MG tablet - - 200
46 Diazepam injeksi 5 MG/ML-2 ML Ampul - -
47 Diazepam larutan rektal 5 MG /2.5 ML Suppos - -
48 Diazepam Tablet 2 MG tablet - -
49 Difenhidramin HCL Inj. 10 MG/ML-1 ML ampul - -
50 Digoksin Tablet 0.25 MG tablet - -
51 Diltiazem Tablet tablet - -
52 Dimenhidrinat Botol - - 100
53 Doksissiklin Kapsul tablet - -
54 Domperidon Tablet 10 mg tablet 60 60 30 30 100
55 Epinefrin HCL/Bitartrat Inj.0.1%-1 ML Ampul - -
56 Eritromisin kapsul 250 mg kapsul - -
57 Eritromisin Syrup Botol - -
58 Famotidin Tablet 40 mg tablet - -
59 Fenil Butason 200 mg tablet - -
60 Fenobarbital Injeksi 50 MG/ML-2 ML Ampul - -
61 Fenobarbital Tablet 30 MG tablet - -
62 Fenol Gliserol Tetes Telinga 10% Botol - -
63 Fitomenadion Inj.10 MG/ML-1 ML Ampul - -
64 Fitomenadion Inj.2 MG/ML-1 ML (Infant) Ampul - -
65 Fitomenadion Tablet Salut 10 MG tablet 70 70 70
66 Furosemid Tablet 40 mg tablet - -
67 Garam Oralit untuk 200 ML Air Buah 2 2 2 - 1 Kotak
68 Gentamycin inj Ampul - -
69 Gentamycin Salap Kulit tube - -
70 Gentamycin Tetes Mata Botol 4 4 1 3
71 Glibenklamid Tablet 5 MG tablet - -
 72 Glimepirid 2 MG tablet - - 100
73 Glukosa Larutan Infus 5 % Botol - -
74 Glukosa Larutan Infus 10 % Botol - -
75 Griseofulvin Tablet 125 Mg tablet 100 100 100
76 Haloperidol Injeksi 50 Mg/ 1 Ml Ampul - -
77 Haloperidol Tablet 1.5 MG tablet - -
78 Haloperidol Tablet 5 MG tablet - -
79 Hidroklorotiazid (HCT) Tablet 25 MG tablet - -
80 Hidrokortison Krim 2.5 % tube 5 5 1 4 5
81 Ibuprofen Syrup Botol - -
82 Ibuprofen Tablet 200 MG tablet - -
83 Ibuprofen Tablet 400 MG tablet 100 100 20 80 100
84 Iodiol Kapsul Lunak kapsul -
85 Isoniazid 100 mg tablet -
86 Isosorbid Dinitrat Tablet Subl. 5 MG tablet -
87 KA-EN 1B tablet -
88 Kalsium Laktat (Kalk) Tablet 500 MG tablet 200 200 20 180
89 Ketokonazol 200 mg tablet 10 200 210 10 200
90 Ketokonazol Cream tube 5 5 5
91 Kloramfenikol Kapsul 250 MG tablet -
92 Kloramfenikol Salaf kulit tablet -
93 Kloramfenikol Salaf Mata 1% tube -
94 Kloramfenikol Tetes Mata 0,5% Botol -
95 Kloramfenikol Tetes Telinga 3 % Botol -
96 Klorfeniramini Maleat (CTM) Tablet 4 mg tablet 200 200 120 80 200
97 Klorpromazin HCL Inj.5 MG/ML-2 ml Ampul - -
98 Klorpromazin HCL tablet Salut 100 mg tablet - -
99 Kodein HCL tablet 10 MG tablet - -
100 Kotrimoksazol Dewasa tablet tablet 100 100 100
101 Kotrimoksazol Pediatrik Tablet tablet - -
102 Kotrimoksazol Suspensi Botol 10 10 10
103 Lidokain Kompositum Injeksi Ampul 8 8 5 3 10
104 Loperamid tablet tablet 40 100 140 30 110 100
105 Loratadine 10 mg tablet
106 Magnesium Sulfat Inj.(IV) 20%-25 ML Botol -
107 Magnesium Sulfat Inj.(IV) 40%-25 ML botol - -
108 MDT-COMBI (Kusta) tablet - -
109 Metformin HCl tablet 500 mg tablet - -
110 Metformin HCl tablet 850 mg tablet - -
111 Metil Ergometrin Maleat Injeksi Ampul - -
112 Metil Ergometrin Maleat Tablet 0.125 MG tablet - -
113 Metilprednisolon tablet 100 100 100
114 Metoklopramid tablet - -
115 Metronidazol Syrup Botol - - 5
116 Metronidazol Tablet 250 MG / 500 mg tablet - - 100
117 Mikonazol Krim tube - - 5
118 Mp-Asi Paket - -
119 Natrium Bikarbonat Tablet 500 MG tablet - -
120 Natrium Diclofenac 25 MG tablet 10 100 110 20 90 100
121 Natrium Diclofenac 50 MG tablet - -
122 Natrium Fenitoin Kapsul 30 MG kapsul - -
123 Natrium Klorida Larutan Infus 0.9 % kolf 3 3 1 2 5
124 Nifedipin tab 10 MG tablet - -
125 Nistatin 500.000 IU/G Tablet Salut tablet - -
126 Obat Anti Malaria tablet - -
127 Oksitetrasiklin HCL Salep 3 % tube - -
128 Oksitetrasiklin HCL Salep Mata 1 % tube - - 5
129 Oksitosin Injeksi 10 IU/ML-1 mL Ampul 10 10 1 9 10
130 Omeprazol 20 MG tablet 50 100 150 10 140
131 Parasetamol drops Botol - -
132 Parasetamol syrup 120 mg/5 ml Botol 3 5 8 4 4 10
133 Parasetamol Tablet 500 MG tablet 200 200 200 - 300
134 Pirantel Pamoat Tablet 365 MG tablet - -
135 Piridoksin Tablet 10 MG tablet - -
136 Piroksikam 10 mg tablet - -
137 Prednison Tablet 5 MG ampul 100 100 90 10 200
138 Propanolol HCL Tablet 40 MG tablet - -
139 Propiltiourasil Tablet 100 MG tablet - -
140 Ranitidin Inj Ampul - - 5
141 Ranitidin tab 150 mg tablet - - 100
142 Retinol (Vit.A) Kapsul 200.000 IU kapsul - -
143 Retinol (Vit.A) Kapsul 100.000 IU kapsul - -
144 Ringer Laktas Larutan Infus Steril kolf 5 5 1 4 5
145 Risperidon 2 mg tablet - -
146 Salbutamol Tablet 2 MG tablet 50 100 150 10 140
147 Salep 2-4 Kombinasi buah 5 5 4 1 5
148 Salisil Bedak 2 % buah - -
149 Serum Anti Bisa Ular Polivalen Inj.5 ML. Ampul - -
150 Serum Anti Tetanus Inj.1.500 IU/Ampul Ampul - -
151 Sianokobalamin (Vit.B12) Tablet tablet 100 100 50 50 200
152 Simvastatin tablet 10 mg tablet 80 80 80
153 Tablet Tambah Darah Kombinasi tablet 200 200 80 120 300
154 Tetrasiklin Kapsul 500 MG kapsul - -
155 Tiamin HCL Mononitrat Tablet 50 MG tablet 200 200 10 190
156 Triheksifenidil HCL Tablet 2 MG tablet - -
157 Vitamin B.Komplek Tablet tablet 200 200 80 120 200
158 Yodium Povidon Larutan 10 % 30 ML Botol 1 1 1 5
159 Yodium Povidon Larutan 10 % 300 ML Botol - -
160 Yodium Povidon Larutan 10 % 60 ML Botol - -
161 Zinc Syrup Botol 5 5 2 3 5
162 Zinc tab. 20 mg tablet 10 100 110 10 100
163 Alat Suntik Sekali Pakai 0.05 ML Set 15 15 2 13
164 Alat Suntik Sekali Pakai 0.5 ML Set 5 5 5
165 Alat Suntik Sekali Pakai 10 ML Set - -
166 Alat Suntik Sekali Pakai 1ML set - -
167 Alat Suntik Sekali Pakai 2.5 ML/3 ML set 20 20 6 14 10
168 Alat Suntik Sekali Pakai 5 ML set 10
169 Alkohol Swab Ktk/100 1 Kotak
170 Anuscopy set - -
171 BD Vacuntainer set - -
172 Benecheck ( Gula Darah ) Ktk/50 - -
173 Benecheck ( Kolesterol ) Ktk/10 - -
174 Benecheck (Asam Urat ) Ktk/25 - -
175 Blood Lancet buah - -
176 Botol kaca Botol - -
177 Cartrid Tcm Set - -
178 Catgut Crome 2/0 set 1 3 4 1 3 5
179 Catgut Crome 3/0 set - -
180 Catgut Plan 3/0 set - -
181 Centrifuge set - -
182 Condom Buah - -
183 Devitalisasi Pasta (Non Arsen) Buah - -
184 Etakridin (Rivanol) Larutan 0.1 % Botol - -
185 Etanol 70 % 100 ML Botol - -
186 Etanol 70 % 1000 ML Botol - -
187 Etil Klorida Semprot Botol - -
188 Eugenol cairan Botol - -
189 Folley Catether SIZE 18 pcs - -
190 Gentian Violet Larutan 1 % buah - -
191 Glass Lonomer Cement (GC IX) Buah - -
192 Hansaplast Plester 5X4,5 rol - -
193 Hanschoon Non Steril Ktk/100 - -
194 Hanschoon Steril Ktk/100 10 10 1 9 10
195 HBsAg Ktk/100 - -
196 Infusion Set Anak set - -
197 Infusion Set Dewasa set 3 3 1 2 5
198 Intech set - -
199 Iodina Test set - -
200 IV Catheter No. 18 set - - 5
201 IV Catheter No. 20 set - - 5
202 IV Catheter No. 22 set - - 5
203 IV Catheter No. 24 set - -
204 IV Dressing 6 x 7 CM ( E-Care) Ktk - -
205 IV Dressing 6 x 7 CM (Semilas ) Ktk - -
206 IV Dressing 7 x 8 CM (E-Care) Ktk - -
207 IV Dressing 9 x 10 CM (Semilas) Ktk - -
208 Kaca Slide Buah - -
209 Kapas Pembalut/Adsorben 250 Gram rol - -
210 Kasa Pembalut 2 M x 80 CM rol - - 10
211 Kasa Pembalut 35 x 80 Cm rol - -
212 Kasa Pembalut Hidrofil 4 M X 15 CM rol - -
213 Kasa Pembalut Steril 16 Cm Ktk 3 3 1 2 5
214 Klorfenol Kanfer Mentol (CHKM) Buah - -
215 Kotak Slide Ktk - -
216 Lisol Botol - - 1
217 Masker Karet Ktk/50 - -
218 Masker N 95 Kotak - -
219 Masker Tali Ktk/50 - -
220 Mineral Mix Kotak - -
221 Nebulizer Mask Anak set - -
222 Nebulizer Mask Dewasa set - -
223 Oncoprobe Botol - -
224 Oxygen Mask Anak set - -
225 Oxygen Mask Dewasa set - -
226 Oxygen Nasal Canula Anak set - -
227 Oxygen Nasal Canula Dewasa set - -
228 Paduan OAT Kategori 1 Paket - -
229 Plester 10 CM X 100 CM (POLIFIX) rol - -
230 Plester 5 CM X 500 CM (SEMILLAS) rol - -
231 Plester ( Aximed. N.W Fixation ) 5x10 m rol - -
232 Policlean Handrub (vio-rex) Buah - -
233 Policrepe 15 CM x 4.5 CM rol - -
234 Pot Sputum pot - -
235 Provein 3/0 kotak - -
236 Provein 5/0 Kotak - -
237 RDT Malaria Buah - -
238 RDT Malaria Care Start Kuning Buah - -
239 RDT Sypilis Kotak - -
240 Reagen Gol.Darah A Kotak - -
241 Reagen Gol.Darah AB Kotak - -
242 Reagen Gol.Darah B Kotak - -
243 Reagen Gol.Darah O Kotak - -
244 RPR Spilis Kotak - -
245 Safety Box Buah - -
246 SD HIV vial - -
247 SD HIV / 1/2 Biomereux Vikia vial - -
248 Silk No. 3/0 vial - - 3
249 Silk No. 4/0 vial - - 3
250 Suction Cath No. 10 vial - -
251 Suction Cath No. 12 vial - -
252 Suction Cath No. 8 vial - -
253 Surgical Conecting Tube (SCT) vial - -
254 Termometer Klinik - -
255 Tree Way Stopcock - -
256 Under Pad 60 x 90 - - 1 Pac
257 Urine Bag - -
258 Ziehl Nelsen - -
259 HAZMAT - -
260 APD - -
261 vit c 500 mg - -
262 sitvit zink - -
263 Herbacold 60 60 18 42
264 Herbakof syr Botol - -
265 Stimuno Forte tablet 30 30 30
266 Stimuno Imun Anak saset - -
267 Stik Gula Darah (FORA) box - -
268 Lanzoprasole kapsul 100 100 100
269 Salaf Whifield's - -
270 Pengikat Tali Pusat 4 20 24 2 22
271 Kasa Gulung Kecil - -

GRATIS UMUM JUMLAH

JUMLAH KUNJUNGAN RESEP
73 6 79

Mengetahui/ Menyetujui Yang Menyerahkan Yang Melapor/meminta Yang Menerima

Kepala Dinas Kesehatan Kepala Instalasi Farmasi Kepala Puskesmas Pengelola Obat Puskesmas Yang Menerima

Zulhendri, SKM, M. Kes Barmintoni Yupardi, Amd Kep Ekawati Chaerudin. S. Farm
NIP. 19660604 198703 1 005 NIP. 19650720 199703 1 001 NIP. 19670605 1988903 1 010 NRPK. 93.7.0513535
 LAPORAN PELAYANAN KEFARMASIAN PUSKESMAS BUKIT SILEH
UNIT PELAYANAN :
YANG MELAPOR :

Kode Puskesmas : 13
Puskesmas : BUKIT SILEH Bulan : JUNI
Kecamatan : Lembang Jaya Tahun : 2023
Kabupaten : Solok
Provinsi : Sumatera Barat

Jemis Pelayanan
No Tanggal Rawat Jalan Rawat Inap KONSELING PIO
Resep Item Umum BPJS Resep Item Umum BPJS
1 5/19/2023 Rena 1 √ Rena
2 5/19/2023 Ome 1 √ Ome
3 5/19/2023 Amlo 1 √ Amlo
4 5/20/2023 B12 1 √ B12
5 5/20/2023 Dompe 1 √ Dompe
6 5/20/2023 Slf 24 1 √ Slf 24
7 5/22/2023 Slf 24 1 √ Slf 24
8 5/22/2023 Captopril 1 √ Captopril
9 5/22/2023 Lope 1 √ Lope
10 5/23/2023 Herbacold 1 √ Herbacold
11 5/23/2023 Pil KB 1 √ Pil KB
12 5/23/2023 B1, Calk 2 √ B1, Calk
13 5/24/2023 B1, Calk 2 √ B1, Calk
14 5/24/2023 B12, Pct 2 √ B12, Pct
15 5/24/2023 Calk 1 √ Calk
16 5/25/2023 Herbacold 1 √ Herbacold
17 5/25/2023 Amlo 1 √ Amlo
18 5/25/2023 Lope 1 √ Lope
19 5/26/2023 As folat 1 √ As folat
20 5/26/2023 Fe 1 √ Fe
21 5/26/2023 Herbacold 1 √ Herbacold
22 5/27/2023 Asmef 1 √ Asmef
23 5/27/2023 Acetyl 1 √ Acetyl
24 5/27/2023 Fe 1 √ Fe
25 5/29/2023 Asmef, Ctm 2 √ Asmef, Ctm
26 5/29/2023 Pct, Amox 2 √ Pct, Amox
27 5/29/2023 Dompe 1 √ Dompe
28 5/30/2023 Acetyl, Vit C 2 √ Acetyl, Vit C
29 5/30/2023 Amlo, B1 2 √ Amlo, B1
30 5/30/2023 Asmef, Vit C 2 √ Asmef, Vit C
31 5/31/2023 Amlo, Vit C 2 √ Amlo, Vit C
32 5/31/2023 Kondom 1 √ Kondom
33 5/31/2023 Ibu, Bcom 2 √ Ibu, Bcom
34 6/3/2023 Amlo 1 √ Amlo
35 6/3/2023 Vit C, Pct 2 √ Vit C, Pct
36 6/3/2023 Rena, Captopril 2 √ Rena, Captopril
37 6/5/2023 Rena 1 √ Rena
38 6/5/2023 Ctm, Pred 2 √ Ctm, Pred
39 6/5/2023 Asmef 1 √ Asmef
40 6/6/2023 Acetyl, Antsd 2 √ Acetyl, Antsd
41 6/6/2023 Acetyl 1 √ Acetyl
42 6/6/2023 Kondom 1 √ Kondom
43 6/7/2023 B12, Pct, Antsd 3 √ B12, Pct, Antsd
44 6/7/2023 Pct, Bc 2 √ Pct, Bc
45 6/7/2023 Alu, Rena, Dompe 3 √ Alu, Rena, Dompe
46 6/7/2023 Zink 1 √ Zink
47 6/8/2023 Pct, Antsd, Ctm, Dompe 4 √ Pct, Antsd, Ctm, Dompe
48 6/8/2023 Antsd, Pct, Ctm, B1 4 √ Antsd, Pct, Ctm, B1
49 6/8/2023 Depo 1 √ Depo
50 6/9/2023 As folat 1 √ As folat
51 6/9/2023 Pct, Amox, Vit C 3 √ Pct, Amox, Vit C
52 6/9/2023 Asmef, Amox 2 √ Asmef, Amox
53 6/9/2023 Amox, Pct, Pred 3 √ Amox, Pct, Pred
54 6/10/2023 Ctm, Pred 2 √ Ctm, Pred
55 6/10/2023 Depo 1 √ Depo
56 6/10/2023 Amox, Pct 2 √ Amox, Pct
57 6/12/2023 Amlo 1 √ Amlo
58 6/12/2023 Pct, Amox 2 √ Pct, Amox
59 6/12/2023 Lope 1 √ Lope
60 6/13/2023 Salbu, Ctm 2 √ Salbu, Ctm
61 6/13/2023 Pred, Ctm, Slf Whilfield 3 √ Pred, Ctm, Slf Whilfield
62 6/13/2023 Pct, Amox, Antsd 3 √ Pct, Amox, Antsd
63 6/13/2023 Calk, B12 2 √ Calk, B12
64 6/14/2023 Acetyl, Pct, Bc 3 √ Acetyl, Pct, Bc
65 6/14/2023 Acetyl, Ctm, Pct 3 √ Acetyl, Ctm, Pct
66 6/14/2023 B12, Calk 2 √ B12, Calk
67 6/15/2023 Acetyl, Vit C, Ctm, Pct 4 √ Acetyl, Vit C, Ctm, Pct
68 6/15/2023 Vit C, Pct syr 2 √ Vit C, Pct syr
 69 6/15/2023 B12, Pct 2 √ B12, Pct
70 6/15/2023 Depo, Pct, Ctm 3 √ Depo, Pct, Ctm
71 6/15/2023 Ctm, Pred, Slf 24 3 √ Ctm, Pred, Slf 24
72 6/15/2023 Pct, Amox, Acetyl 3 √ Pct, Amox, Acetyl
73 6/15/2023 Acetyl, Pct, Ctm, Vit C 4 √ Acetyl, Pct, Ctm, Vit C
74 6/15/2023 Amox, Pct 2 √ Amox, Pct
75 6/15/2023 Fe, Pct 2 √ Fe, Pct
76 6/15/2023 Hydro Slf, Pct 2 √ Hydro Slf, Pct
77 6/16/2023 Pred, Ctm, Slf 24 3 √ Pred, Ctm, Slf 24
78 6/16/2023 Acetyl 1 √ Acetyl
79 6/16/2023 Asmef, Amox 2 √ Asmef, Amox
TOTAL 0

Mengetahui Bukit Sileh, 20 Juni 2023

Kepala Puskesmas Bukit Sileh Penanggungjawab Gudang Penanggung Jawab Apotik

Yupardi, Amd. Kep Ekawati Chaerudin, S. Farm Asnida Kurniati, A.Md, Keb
NIP. 19670605 1988903 1 010 NRPK. 03.7.0513535