LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LP2O)

PUSKESMAS PEMBANTU/POSKESDES HKSN

BULAN :
STOK PENERI PERSE PEMAK STOK PERMIN PENERI
NO NAMA OBAT SEDIAAN KET
AWAL MAAN DIAAN IAN AKHIR TAAN MAAN
1 2 3 4 5 6 7 8 9 10 11
SEDIAAN OBAT DAN LARUTAN
1 Acetyl Cysteine 200 mg kapsul
2 Allopurinol 100 mg tablet
3 Ambroksol 15 mg/ml syrup 60 ml botol
4 Ambroksol 30 mg Non-E tablet
5 Amlodipin 10 mg tablet
6 Amlodipin 5 mg tablet
7 Amoxicillin 500 mg tablet
8 Amoxicillin Drops SK 100 mg/5 ml botol
9 Amoxicillin SK 125 mg/5 ml botol
10 Amoxicillin SK Forte 250 mg/5 ml botol
11 Antasida Doen strip tablet
12 Antasida Doen Suspensi 60 ml botol
13 Anti Bakteri DOEN salep kombinasi 5 gram pot
14 Aqua Pro Inj Steril 25 ml vial
15 Asam Ascorbat 50mg (Vitamn C) tablet
16 Asam Mefenamat 500 mg tablet
17 Asam Traneksamat 100 mg/ml ampul
18 Asam Traneksamat 500 mg Tab tablet
19 Asiklovir 200 mg tablet
20 Asiklovir 400 mg tablet
21 Asiklovir 5% krim 5 graM tube
22 Azitromicyn 500 mg tablet
23 Betahistin Mesilat 6 mg tablet
24 Betametason krim 0,1% 5 gram tube
25 Bisacodil 10 mg suppo
26 Bisacodil 5 mg Supp suppo
27 Bromhexin HCl 4 mg/5 ml (Hustab P) Syrup botol
28 Bromhexin HCl 8 mg (Hustab P) Tablet tablet
29 Captopril tablet 12.5 mg tablet
30 Cefiksim 100 mg tablet
31 Cefiksim 100 mg/ 5 ml syrup 30 ml botol
32 Cetrizine 10 mg tablet
33 Cetrizine syrup 5 mg/5 ml botol
34 Cimetidine 200 mg tablet
35 Dexamethason 0,5 mg strip tablet
36 Dexamethason inj.5mg/ml-1ml ampul
37 Dimenhidrinat 50 mg tablet
38 Diphenhydramin HCl inj.10 mg/ml ampul
39 Domperidon 10 mg tab tablet
40 Domperidon 5mg/5ml syrup botol botol
41 Erytromisin 500mg tablet
42 Erytromisin syrup botol
43 Fenol Gliserol TT 10% 5ml botol
44 Fitomenadion (Vitamin K) 10 mg tablet
45 Fitomenadion 2 mg/ml-1 ml injeksi ampul
46 Furosemida 40mg tablet
47 Garam Oralit 200 ml sacchet
48 Gentamicin 0,1 % Salep Kulit 5 gram tube
49 Gentamicin tetes mata 0,3 % botol
50 Glibenklamid 5mg tablet
51 Gliseril Guaikolat 100 mg tablet
52 Glukonas Kalsikus 10 % inj ampul
53 Griseofulvin 125 mg tablet
54 Hydrokortison 2,5 % krim 5gram tube
55 Ibuprofen 400 mg tablet
56 Ibuprofen sirup 100 mg/5 ml botol
57 Isosorbid Dinitrat 5 mg tablet
58 Kalsium Laktat (kalk) 500 mg tablet
 STOK PENERI PERSE PEMAK STOK PERMIN PENERI
NO NAMA OBAT SEDIAAN KET
AWAL MAAN DIAAN IAN AKHIR TAAN MAAN
1 2 3 4 5 6 7 8 9 10 11
59 Ketokonazole 2% krim 2017 tube
60 Ketokonazole 200 mg (2020) tablet
61 Kloramfenikol 250 mg kapsul
62 Kloramfenikol Syrup botol
63 Kloramfenikol Tetes Mata 0,25 % 5 x 0,6 ml moni Dose botol
64 Klorfeniramin Maleat (CTM) 4 mg tablet
65 Kotrimoxazol 480 mg Adult tablet
66 Kotrimoxazol suspensi 60ml botol
67 Laktulosa syrup 3.335g/5 mL botol
68 Lansoprazole Kapsul 30 mg kapsul
69 Larutan infus KN3B 500 ml botol
70 Larutan Asering Infus 500 ml botol
71 Larutan Glukosa Infus 10% steril 500 ml botol
72 Larutan Glukosa Infus 5% steril 500 ml botol
73 Larutan Koloid HES BM 130.000 Infus 6 % botol
74 Larutan Natrium Klorida (NaCl) 0.9% Infus 500ml botol
75 Larutan Ringer Laktat (RL)Infus Steril 500ml botol
76 Lidokain 2% injeksi 2ml ampul
77 Lidokain Kompositum 2 % Injeksi 2 ml ampul
78 Loperamid 2 mg tablet
79 Loratadin 10 mg tablet
80 Meloxicam 15 mg tablet
81 Meloxicam 7.5 mg tablet
82 Metampiron (antalgin) 500 mg tablet
83 Metformin 500 mg Tablet tablet
84 Metilprednisolon 4 mg tablet
85 Metilprednisolon 8 mg tablet
86 Metoklorapamide 5mg/ml injeksi ampul
87 Metoklorperamide 10mg tablet
88 Metronidazol 500mg tablet
89 Miconazole 2% cream 10 gram tube
90 Natrium Diklofenat 25 mg tablet
91 Natrium Diklofenat 50 mg tablet
92 Nifedipine 10 mg tablet
93 Nistatin 100.000 IU tablet vaginal ovula
94 Nistatin 500.000 IU tablet salut tablet
95 Nistatin Suspensi 100.000 IU/ml botol
96 OBH Syrup botol
97 Oksitetrasiklin HCL SK 3 % 5 gram tube
98 Oksitetrasiklin HCL SM 1% 3.5 gram tube
99 Paracetamol 120 mg/5 ml syrup 60 ml botol
100 Paracetamol 500 mg tablet
101 Paracetamol Drops 15 ml botol
102 Perak sulfadiazin krim 1 % (burnazin) tube
103 Pirantel Pamoat 125 mg tableT tablet
104 Pirantel Pamoat 125mg/5 ml syrup 60 ml botol
105 Piridoksin 10mg (Vitamin B6) tablet
106 Piroksikam 10 mg tablet
107 Piroksikam 20 mg tablet
108 Prednison 5 mg tablet
109 Ranitidin 150 mg tablet
110 Salbutamol 2 mg tablet
111 Salbutamol 4 mg tablet
112 Salep 2-4 kombinasi pot
113 Salisil Bedak 2% 50 gram kotak
114 Sefadroksil 500 mg tablet
115 Sefadroksil 125mg/5ml SK 60ml botol
116 Sefadroksil SK 250 mg/5 ml syrup botol
117 Sianokobalamin (vit.B12) 500mcg injeksi 1ml ampul
118 Sianokobalamin [B12] 50 mg Tab tablet
119 Simvastatin 10mg tablet
120 Simvastatin 20 mg tablet
121 Siprofloksasin 500mg tablet
122 Sukralfat syrup botol
123 Tablet Tambah Darah Kombinasi tablet
 STOK PENERI PERSE PEMAK STOK PERMIN PENERI
NO NAMA OBAT SEDIAAN KET
AWAL MAAN DIAAN IAN AKHIR TAAN MAAN
1 2 3 4 5 6 7 8 9 10 11
124 Tetracyclin 500 mg kapsul
125 Thiamfenikol 500mg kapsul
126 Thiamin HCl (vit.B1) 50mg tablet
127 vitamin B Kompleks tablet
128 Zink Dispersal tablet
129 Zink syrup 10 mg/ml botol

ALKES DAN BMHAP

1 Abocath No. 18 pcs
2 Abocath No. 20 pcs
3 Abocath No. 22 pcs
4 Abocath No. 24 pcs
5 Alat Suntik 1 ml pcs
6 Alat Suntik ADS 5ml (STERA) pcs
7 Alat Suntik 2,5 ml pcs
8 Alat Suntik 3 ml pcs
9 Alat Suntik 3 ml Luer Lock with Needle 23 G x 1-1/4" pcs
10 Alat Suntik 5 ml Luer Lock with Needle 22 G x 1-1/2" pcs
11 Alkohol Swab Box
12 Bisturi 15 Pcs
13 Bisturi 21 Pcs
14 Blood Lancet Box
15 Cat Gut Chromic 2/0 + jarum 1/2 GT 35 mm (Onemed) pcs
16 Cat Gut Chromic 3/0 + jarum 1/2 GT 35 mm (Onemed) pcs
17 Cat Gut Plain without Needle No. 2/0 pcs
18 Cat Gut Plain without Needle No. 3/0 pcs
19 Cuticell Classic 10 cm x 10 cm pcs
20 Cutticell Classic 10 cm x 40 cm pcs
21 Dermafix T 10 X 8 cm pcs
22 Examination Gloves Size L (Aximed) pcs
23 I.V Catheter No.18 G x 32 mm (STERA) pcs
24 I.V Catheter No.20 G x 1 1/4 " (STERA) pcs
25 I.V Catheter No.22 G x 1 " (STERA) pcs
26 I.V Catheter No.22 G x 1 " (STERA) pcs
27 Infus Set Anak Pcs
28 Infusion Set Dewasa (STERA) set
29 IV Catheter no 24 set
30 Kapas Pembalut Hydrofil 250 gram roll
31 Kasa Hydrofil 2 m x 80 cm (DRC) roll
32 Kasa Hydrofil 36 x 80 cm DRC roll
33 Kasa Kompres 40/40 steril roll
34 Kasa Pembalut 4 m x 10 cm roll
35 Kasa Pembalut Hydrofil 4 m x 5 cm roll
36 Kasa Steril 16 x 16 cm 2017 box
37 Kotak Penyimpanan Jarum (Safety Box) kotak
38 Pembalut Elastis 10 cm X 4.5 m roll
39 Plester 2.5 cm x 4.5 m roll
40 Plester 7.5 cm x 4.5 m roll
41 Polifix 10 cm X 5 cm roll
42 Polifix 15 cm X 5 cm roll
43 Povidon Iodida Larutan 10% 300 ml botol
44 Povidon Iodida larutan10% 60ml botol
45 Sarung Tangan Obgyn pcs
46 Sarung Tangan Ukuran L Pcs
47 Sarung Tangan Ukuran M pcs
48 Sarung Tangan Ukuran S pcs
49 Silk (ben.bedah sutra)no.2/0 (ONEMED) pcs
50 Silk (ben.bedah sutra)no.3/0 (ONEMED) pcs
51 Surgical Mask Earloop Pcs
52 Surgical Mask Tie On Pcs
53 Surgical Masker 3 ply plus Earloop pcs
54 Surgical Masker With Visor Pcs
55 Test Kehamilan strip
 STOK PENERI PERSE PEMAK STOK PERMIN PENERI
NO NAMA OBAT SEDIAAN KET
AWAL MAAN DIAAN IAN AKHIR TAAN MAAN
1 2 3 4 5 6 7 8 9 10 11
56 Top Glove E-Care Surgi Glove 7.0 Powder Free pair
57 Top Glove E-Care Surgi Glove 7.0 Powdered pair
58 Top Glove E-Care Surgi Glove 7.5 Powdered pair
59 Top Glove E-Care Surgi Glove 7.5 Powdered Free pair
60 Top Glove E-Care Surgi Glove 8.0 Powdered pair
61 Top Glove E-Care Surgi Glove 8.0 Powdered Free pair

REAGENT BMHP
1 Etakridin (rivanol) lar.0,1% 300 ml botol
2 Etanol 70 % larutan 100 ml botol
3 Etanol 70 % larutan 300 ml botol
4 Etanol 70% larutan 1000 ml botol

OBAT KHUSUS & Branded Non-E

1 Amaropo Plus tablet
2 Becefort 60 ml Syrup botol
3 Betafort 60 ml Syrup botol
4 Bio ATP tablet
5 Bioron tablet
6 Dextamine syrup 60 ml botol
7 Hemafort Tab tablet
8 Hyoscine-N-butilbromida + Paracetamol (Buscopan) tablet
9 Neokaominal Suspensi botol
10 Noza tablet
11 Papaveri HCL, metamizole Na, Ekstrak belladone Tab (S tablet
12 Pebrinex Susp botol
13 Pehavral Tab tablet
14 Silex Syr botol

JUMLAH KUNJUNGAN JENIS KUNJUNGAN

TOTAL
BPJS KIS UMUM GRT

JUMLAH SETORAN Rp.

…………., ……………………..2021

Mengetahui Yang Menyerahkan Pelapor

Kepala Puskesmas Watubangga Petugas Gudang Obat Petugas PUSTU/POSKESDES

Musakkir, AMK Andriani, S.Si, Apt. ....................................

Nip. 19680815 198903 1 008 Nip.