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LAPORAN PEMAKAIAN HARIAN OBAT BPJS BULAN MEI 2023

NO NAMA OBAT SATUAN


PEMAKAIAN JUMLAH JUMLAH

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CAIRAN
1 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

D OBAT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Allupurinol 100 mg Tablet Tab 0 0 5 0 0 20 0 6 10 0 20 0 10 0 0 10 0 0 0 27 0 10 10 6 3 0 0 0 3 10 0 150 0
2 Aminophylin tablet 200mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Amlodipin 10 mg Tab 0 20 46 46 25 35 0 58 25 30 70 5 15 0 0 25 20 0 20 60 0 45 30 5 170 25 10 0 40 25 30 880 0
4 Amoksisilin Kaplet 500 mg Kaplet 0 253 375 115 105 135 0 145 175 241 215 165 69 0 165 110 190 0 145 215 0 230 91 290 20 173 115 0 228 123 114 4202 0
5 Amoksisilin Kapsul 250 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 9 1 1 2 0 0 0 0 0 0 0 20
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0 5 1 0 0 1 0 1 0 3 2 1 2 0 1 2 4 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 27
8 Antasida Suspensi 60 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Antasida DOEN tablet kombinasi Tab 0 205 30 57 70 65 0 200 40 80 140 55 105 0 120 80 50 0 60 220 0 150 142 126 66 36 86 0 141 31 90 2445 0
10 Anti fungi DOEN komb sk tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Anti Hemoroid DOEN kombinasi supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0 3 0 0 0 8
12 Antimigren DOEN kombinasi Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 0 20 28 25 0 3 0 3 10 74 30 9 63 0 11 20 33 0 37 20 0 0 0 10 8 0 16 0 47 10 0 477 0
15 asam folat tablet 1 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 30 0
16 Asam mefenamat 500 mg Kaplet 0 120 70 150 40 70 0 10 50 30 30 50 20 0 80 76 20 0 100 40 0 60 70 40 70 80 40 0 70 70 90 1546 0
17 Asetyl sestein 200mg kapsul 0 142 80 50 59 88 0 75 56 84 115 44 77 0 104 95 144 0 103 63 0 84 57 91 94 44 66 0 131 44 82 2072 0
18 Asiklovir Tablet 400 mg Tab 0 0 0 0 0 0 0 70 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 24 104 0
19 Attalpugite tab 600 mg Tab 0 20 0 10 10 10 0 20 20 10 10 20 0 0 30 10 0 0 10 10 0 40 0 20 10 15 50 0 10 10 30 375 0
20 Betahistin maleat Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 6 0 0 0 0 0 9 0
21 Betametasone Krim 0.1% tube 0 2 0 3 0 2 0 3 0 1 0 2 1 0 1 5 1 0 1 2 0 4 2 2 1 4 1 0 7 2 3 50 0
22 Bisakodil Supp 10 mg supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 bisoprolol tablet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Captopril 12,5 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Captopril tablet 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Deksametasone tablet 0.5mg Tab 0 72 71 32 64 36 0 82 54 33 103 46 47 0 36 55 24 0 44 134 0 89 21 60 66 38 68 0 110 75 50 1510 0
27 Diasepam 2 mg tablet Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Diazepam Inj 5 ml/2ml ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Diazepam lar rektal 5mg/2,5ml tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Digoksin tablet 0,25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Doksisiklin 100 mg ampul 0 0 0 0 0 0 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 0
32 Domperidon tablet 10 mg Tab 0 10 0 0 10 0 0 0 20 13 0 0 0 0 10 0 0 0 5 10 0 30 5 9 0 10 5 0 33 0 5 175 0
33 Erytromycin 250 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Etambutol HCL 250 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 Fenitoin Na kaps 100 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Fenobarbital tablet 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0 0 0 0 0 6 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 7 0 0 28 0
39 Furosemid tablet 40 mg Tab 0 0 0 0 3 6 0 0 0 10 0 0 0 0 0 20 0 0 13 0 0 11 5 0 0 0 0 0 0 0 0 68 0
40 Gentamisin tetes mata Botol 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 7 0 0 0 0 0 0 0 0 1 11 0
41 Glibenklamid tablet 5 mg Tab 0 0 0 0 0 0 0 0 10 10 0 0 5 0 0 0 0 0 5 0 0 0 3 5 0 1 0 0 0 0 0 39 0
42 Glimepiride tab 0 0 15 0 0 0 0 10 0 0 0 15 0 0 35 0 0 0 0 0 0 55 0 30 0 0 20 0 20 10 0 210 0
NO NAMA OBAT SATUAN
PEMAKAIAN JUMLAH JUMLAH

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43 Griseofulvin tablet 125 mg, micronized Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Hidroklorotiazid (HCT) tablet 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Hidrokortison krim 2,5 % tube 0 1 4 1 1 2 0 0 0 2 0 1 2 0 0 0 8 0 1 1 0 20 1 0 3 1 0 0 1 0 2 52 0
46 Ibuprofen Suspensi 100mg 5ml botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Ibuprofen tablet 400 mg Tab 0 130 50 30 60 36 0 20 30 50 130 20 60 0 50 20 69 0 10 80 0 40 40 30 26 50 40 0 60 30 10 1171 0
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Kalsium lakate (kalk) tablet Tab 0 66 40 60 30 32 0 10 50 0 70 10 170 0 10 10 150 0 85 30 0 16 90 0 30 0 40 0 30 0 20 1049 0
50 Karbamazepin tablet 200 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30
51 Karbogliserin Tetes Telinga 10% Botol 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0
52 Ketokonazol krim 2 % tube 0 1 0 2 0 0 0 0 3 0 1 0 0 0 1 0 0 0 4 1 0 0 0 0 0 0 0 0 0 0 1 14 0
53 Ketokonazol Tablet 200 mg Tab 0 10 5 0 0 10 0 3 0 0 0 0 0 0 3 0 6 0 0 0 0 0 0 10 0 0 0 0 0 0 0 47 0
54 Klindamicin 150 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Kloramfenikol Kapsul 500 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Kloramfenikol salep kulit 2% (bufacetin) tube 0 2 5 0 2 3 0 1 0 1 0 0 1 0 0 1 3 0 20 4 0 5 3 4 5 1 2 0 4 2 3 72 0
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 0 164 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 174
59 Klorpromazin HCL tablet 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Kodein HCl 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Kotrimoksazol forte tablet Tab 0 43 0 0 5 9 0 9 6 11 5 50 0 0 5 3 3 0 10 10 0 8 20 13 23 10 9 0 16 3 10 281 0
62 Kotrimoksazol 480 tablet tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Kotrimoksazol suspensi kombinasi Botol 0 2 1 0 4 2 0 4 0 0 1 1 0 0 1 0 0 0 1 0 0 2 1 0 1 0 4 0 1 0 0 0 26
64 Lansoprazol 30 mg Tab 0 3 3 15 12 6 0 0 6 6 6 96 0 0 9 21 6 0 12 9 0 26 12 0 12 0 3 0 0 0 25 288 0
65 Loratadin tab 10 mg Tab 0 10 0 0 0 10 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0
66 Metformin tablet 500 mg Tab 0 30 102 40 35 25 0 105 20 90 80 50 75 0 55 30 30 0 15 30 0 120 55 125 70 10 0 0 72 10 0 1274 0
67 metil dopa tab 250 mg Tab 0 10 0 0 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25 0
68 Metilergometrin Maleat tablet salut 0,125 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Metronidazol tablet 500 mg Tab 0 2 0 20 0 0 0 0 0 0 0 10 6 0 10 0 6 0 15 0 0 0 12 0 0 10 0 0 10 0 0 101 0
70 Miconazol SK tube 0 1 1 1 0 0 0 1 1 1 0 0 1 0 1 0 1 0 0 1 0 0 0 1 0 0 0 0 0 1 0 12 0
71 Natrium bikarbonat tablet 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Natrium Diklofenac 50 mg Tab 0 26 138 26 58 102 0 194 54 82 120 80 128 0 92 32 56 0 96 112 0 0 56 102 134 24 52 0 134 42 42 1982 0
73 Nifedifin tablet 30 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Nistatin 100.000 IU/gram tablet vaginal supp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Nistatin tablet salut gula 500.000 IU/g Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
76 Oksitetrasiklin HCl salep 3% - 5 gram tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Omeprazol 20 mg Tab 0 0 24 0 0 0 0 42 12 12 0 18 6 0 12 0 3 0 18 0 0 22 6 0 6 6 30 0 6 6 6 235 0
78 Ondansentron tab 8 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
79 parasetamol drop Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Parasetamol Kaplet 500 mg Tab 0 446 432 288 444 149 0 192 396 414 424 407 333 0 349 315 460 0 416 351 0 422 379 377 361 409 414 0 414 444 401 9437 0
81 Parasetamol sirup Botol 0 0 0 0 0 1 0 0 0 0 0 1 2 0 0 0 0 0 0 1 0 0 0 0 2 0 0 0 0 0 0 7 0
82 Permetrin/scabimite krim 5 % tube 0 0 2 0 0 0 0 0 1 0 0 0 1 0 0 0 1 0 2 1 0 0 0 0 0 0 0 0 0 0 0 8 0
83 Pirantel Pamoat tablet 125 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 212 0 119 196 0 40 16 6 0 10 32 0 25 0 30 692 0
85 Prednison tablet 5 mg Tab 0 24 48 6 48 12 0 12 36 18 0 12 6 0 112 6 0 0 0 6 0 24 36 54 0 6 19 0 12 6 12 515 0
86 Propranolol HCl tablet 40 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
87 Ranitidin tablet 150 mg Tab 0 46 0 190 36 10 0 44 116 50 80 70 20 0 40 18 6 0 34 56 0 96 58 70 134 36 66 0 34 16 142 1468 0
88 Salbutamol tablet 2 mg Tab 0 0 10 0 0 0 0 6 0 0 0 0 0 0 0 1 0 0 0 4 0 0 10 0 0 0 0 0 0 0 0 31
89 Salep 2 - 4 kombinasi tube 0 2 1 1 1 1 0 1 0 2 0 0 3 0 1 0 0 0 1 3 0 5 0 2 0 1 3 0 3 0 8 39 0
NO NAMA OBAT SATUAN
PEMAKAIAN JUMLAH JUMLAH

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90 Setirizin sir 5 mg/ 5 ml Botol 0 0 3 0 4 0 0 0 1 3 0 1 1 0 0 1 0 0 2 1 0 5 0 0 2 1 0 0 1 0 0 26 0
91 Sianokobalamin (Vitamin B12) 50 mg Tab 0 35 30 42 90 40 0 46 36 20 140 10 30 0 35 40 0 0 40 60 0 116 20 20 176 20 75 0 35 20 40 1216 0
92 Simvastatin 20 mg Tab 0 5 0 13 10 0 0 0 0 0 5 0 0 0 8 0 0 0 5 5 0 0 0 10 0 0 0 0 5 3 15 84 10
93 Tetrasiklin HCl Kapsul 500 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0 30 0 40 20 50 0 10 100 30 0 20 0 0 20 80 80 0 40 50 0 50 30 10 20 40 40 0 40 40 120 960 0
95 Vitamin B komplek tablet Tab 0 80 38 130 51 94 0 89 60 120 100 83 23 0 56 90 35 0 134 146 0 130 60 104 113 108 43 0 186 52 90 2215 0

G KESEHATAN JIWA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Klobazam 10 mg tablet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Amitripilin HCL 25 mg tablet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Klorpromazin 100 mg tablet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Risperidon 2 mg Tablet tablet 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 60
6 Klozapin 25 mg tablet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 13 0 43
7 Trifluoperazine HCL 5 mg tablet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Haloperidol inj 5 mg/ml ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Imipramin HCL 25 mg tablet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Fluoksetin 10 mg tablet tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Triheksifenidil 2 mg tab tablet 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 30 30 0 30 0 0 0 20 0 60 0 0 0 0 0 30 0 230
12 Haloperidol 5 mg tablet tablet 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 10 30 0 10 0 0 0 10 0 30 0 0 0 0 0 0 0 100

I GIZI
Retinol (Vitamin A) 100.000 IU Kapsul Lunak
Bayi (6 - 11 bulan)
1 kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Retinol (Vitamin A) 200.000 IU Kapsul Lunak
Balita (11 - 59 bulan)
2 kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tablet Tambah Darah (Ibu Hamil) tablet 0 130 120 50 180 30 0 50 100 0 90 10 84 0 20 82 60 0 120 20 0 0 30 40 0 0 80 0 70 40 40 0 1446
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A BMHP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Kapas 250 gr Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Masker Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Handscoon non steril ukuran M Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Handscoon non steril ukuran S Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Handscoon steril 7 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B DESINFECTAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alkohol 70% - 1000 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Antiseptik Hand Rub 500 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Rivanol larutan 0,1% - 300 cc Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C TAMBAHAN OBAT DAN ALKES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Asiklovir krim Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Ciprofloksasin 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Domperidon sirup Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Garam Oralit Sacchet 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 12
5 Gemfibrozil 600 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
NO NAMA OBAT SATUAN
PEMAKAIAN JUMLAH JUMLAH

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6 Haloperidol 1,5 mg tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 30 0 60
7 Klindamicin 300 mg Kapsul 0 15 13 0 15 0 0 10 10 0 10 0 10 0 30 20 25 0 0 0 0 15 15 10 0 0 0 0 15 0 0 213 0
8 Metoklorpropamid 5 mg Tablet 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 20 0 0 10 0 0 0 0 0 0 0 0 10 50 0
9 Multivitamin sirup Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Multivitamin tablet/SUPRABION Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Natrium Diklofenak 25 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Nifedipin 20 mg/adalat oros Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Oksitetrasiklin salep mata 1% Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Propiltiourasil 100 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Ramipril 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Salisil Bedak Bungkus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Salbutamol 4 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Sefadroksil 500 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Sefadroksil sirup 250 mg Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Sefadroksil sirup 125 mg Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Setrizin tablet Tablet 0 120 181 167 21 50 0 36 55 39 33 27 42 0 38 52 107 0 48 78 0 58 36 42 33 30 37 0 39 34 27 1430 0
22 Zink kid 10 mg sirup Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Zink sirup 20 mg Btl 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 0 0 0 0 0 0 0 0 0 5 0
24 Zink tablet 20 mg Tablet 0 20 3 0 5 0 0 0 20 8 0 20 5 0 8 0 30 0 0 5 0 15 10 10 2 15 13 0 10 5 20 224 0
25 Kapas 500 gr Psc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Sikzonoate 25 mg/ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Masker earloop Psc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Hazmat Psc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Sanitizer Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Masker hijab Psc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Kloramfenicol Syr Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Akilen tetes telinga Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Eutyrox 50 µg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Ristonat Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 Pot obat Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Albendazol 400 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Amlodipin 5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 10 0 25 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 45
38 Simvastatin 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Kloramfenicol tetes telinga Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Gliseril Guaiacolate 100 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Klorpromazin 100 mg tablet Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Nifedipin tablet 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0
43 Propranolol HCl tablet 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Diazepam 5 mg Tablet 0 0 2 0 0 3 0 3 3 0 8 0 0 0 0 0 15 0 0 0 0 10 0 0 8 0 0 0 0 0 3 0 55
45 Neocenta gel Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Methil prednisolone Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3
47 Plester roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Kasa steril pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Kasa 2x80cm roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Betadine 30 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Diazepam Inj 5 ml/2ml (program) Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Infus set dewasa Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
NO NAMA OBAT SATUAN
PEMAKAIAN JUMLAH JUMLAH

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 bpjs umum umum yg dipakai bpjs


53 Infus set anak Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Epinefrin injeksi Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Difenhidramin injeksi Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Abocath no.20 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Abocath no.22 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Abocath n0,24 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Aqua pro injek Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Micropore 1/2 inch Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Nasal oksigen anak Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Metronidazol sirup Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Herbacof sirup btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Ranitidine inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Amoksisilin drops Botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Gentamisin salep mata 0,3% Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Plester Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
68 Stimuno forte Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Kloramphenikol 250 mg Kapsul 42 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 1
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RI

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 10 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 5 2 10 10 10 10 10 10 10 10 10 10 5 1 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 5 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 1 4 6 6 6 6 6 6 6 6 6 6 6 6 6 6 5
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 2 2 5 5 10 6 6 10 6 6 6 5 3
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 6 20 20
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab 5 5
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 2 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 10 10 10 10
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1
64 Lansoprazol 30 mg Tab 3
65 Loratadin tab 10 mg Tab 10
66 Metformin tablet 500 mg Tab 10 10 10
67 metil dopa tab 250 mg Tab 10
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 2
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 5 5 10 10 6 10 10 10 10 10 5 5 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6 6 6 6 6 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 5 10 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 30
12 Haloperidol 5 mg tablet tablet 10

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 20 30 10 30 10 20

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet 6
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 10 10 10 10 10 10 10 10 10 10 10 10
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 2

10 10 5 10 10 10 5 10 5 10 10 10 5

10 10 10 10

6 5 6 5 6 6 6 3 5
6 6 6 6 5 6 6 6 6 3 5 5

10 10 5 5 10 10 5 10 5 10 10 10 10 5 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

0
0
20
253
0
0
5
0
205
0
0
0
0
20
0
120
142
0
20
0
2
0
0
0
0
72
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
1
0
130
0
66
0
0
1
10
0
0
2
0
164
0
0
43
0
2
3
10
30
10
0
2
1
0
26
0
0
0
0
0
0
0
446 10
0
0
0
0
24
0
46
0
2
0
35
5
0
30
80

0
0
0
0
0
0
0
0
0
0
30
10

0
0
130

0
0
0
0
0

0
0
0
0
0
0
6
0
0
15
0
0
0
0
0
0
0
0
0
0
0
0
0
120
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 5


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 6 5 5 5 5 10 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 6 2
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 2 6 6 6 6 6 3 1 6 6 2
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 5 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 15
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol 1
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 5
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 7 10 20 10 15 10 20
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 6 10 10 10 10 10 10 6 10 10 10 10 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 5 5
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube 1 1
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6 6 6 6 6 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab 10
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab 3 3 10 10 6 3 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 20 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 3 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 10 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 3
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 2
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 3

5 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
3 10 10 10 10 10 5 10 10 1 10 3 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
6
10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

5
0
46
375
0
0
1
0
30
0
0
0
0
28
0
70
80
0
0
0
0
0
0
0
0
71
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15
0
0
4
0
50
0
40
0
1
0
5
0
0
5
0
0
0
0
0
0
1
3
0
102
0
0
0
1
0
138
0
0
0
0
24
0
0
432
0
2
0
6
48
0
0
10
1
3
30
0
0
0
38

0
0
0
0
0
0
0
0
0
0
0
0

0
0
120

0
0
0
0
0

0
0
0
0
0
0
0
0
0
13
0
0
0
0
0
0
0
0
0
0
0
0
0
181
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 3 3 5 5 5 5 5 10 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 5 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 6 6 10 10 10 5
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 5 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 2
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 20 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab 3 3 3 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 10 20
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10 10
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 6 10 10 10 6 10 10 10 2 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 2 10
92 Simvastatin 20 mg Tab 5 5 3
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 10 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 20

A BMHP

1 Kapas 250 gr Pcs


2 Masker earloop Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 10 10
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl 1 1
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop konector Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 4
1 5 10 10 10 10 6 10 10 10 2 10 10 10 10
10
10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

0
0
46
115
0
1
0
0
57
0
0
0
0
25
0
150
50
0
10
0
3
0
0
0
0
32
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
30
0
60
0
0
2
0
0
0
0
0
0
0
0
0
0
0
15
0
40
0
0
20
1
0
26
0
0
0
0
0
0
0
288
0
0
0
0
6
0
190
0
1
0
42
13
0
40
130

0
0
0
0
0
0
0
0
0
0
0
0

0
0
50

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
167
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 5 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 5 10 15 10 10 10 10 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 5 6 6 6 2 1 1 1 1 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 5 5 6 6 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab 3
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1
64 Lansoprazol 30 mg Tab 3 3 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 15 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 6 6 10 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 5 10 10 10 5 3 2 3 3 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6 6 6 6 6 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6 6 6 6 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10 10 10 10 10
92 Simvastatin 20 mg Tab 10
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10
95 Vitamin B komplek tablet Tab 6 10 10 10 10 5

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 5
10 10 5 10 10 10 6 10 10 10 2 10 10 10 10 20 10 10 10 10 10 10 20 10 10 10 20 10 10
JUMLAH

0
0

0
0
25
105
0
2
0
0
70
0
0
0
0
0
0
40
59
0
10
0
0
0
0
0
0
64
0
0
0
0
0
10
0
0
0
0
0
0
3
0
0
0
0
0
1
0
60
0
30
0
0
0
0
0
0
2
0
0
0
0
5
0
4
12
0
35
0
0
0
0
0
58
0
0
0
0
0
0
0
444
0
0
0
0
48
0
36
0
1
4
90
10
0
20
51

0
0
0
0
0
0
0
0
0
0
0
0

0
0
180

0
0
0
0
0

0
0
0
0
0
0
0
0
0
15
0
0
0
0
0
0
0
0
0
0
0
0
0
21
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 10 5 10 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 5 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 5 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 2 2 3 6 6 5 5 6 6 6 5 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 6
39 Furosemid tablet 40 mg Tab 6
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 6 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 6 10 10 6
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 10
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 6
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1
64 Lansoprazol 30 mg Tab 3 3
65 Loratadin tab 10 mg Tab 10
66 Metformin tablet 500 mg Tab 10 15
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 6 10 10 10 10 10 10 10 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 2 2 10 5 10 10 10 5 10 10 10 5 10 10 10 10
81 Parasetamol sirup Botol 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 3 6 6 10 6 10 3 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 5 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 3
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 6
JUMLAH

0
0

20
0
35
135
0
0
1
0
65
0
0
0
0
3
0
70
88
0
10
0
2
0
0
0
0
36
0
0
0
0
0
0
0
0
0
0
0
6
6
0
0
0
0
0
2
0
36
0
32
0
0
0
10
0
0
3
0
0
0
0
9
0
2
6
10
25
0
0
0
0
0
102
0
0
0
0
0
0
0
149
1
0
0
0
12
0
10
0
1
0
40
0
0
50
94

0
0
0
0
0
0
0
0
0
0
0
0

0
0
30

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN R

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 mg Tab
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
bb
RINCIAN PEMAKAIAN OBAT
TANGGAL 7
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 6


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 10 10 5 10 10 10 3
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 5 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 6 3 1 3 2 1 6 5
18 Asiklovir Tablet 400 mg Tab 40 30
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6 4 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg Kapsul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 10
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 3
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 6
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20 20 15 10 10 30
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 6 6 10 10 10 10 6 10 10 6
73 Nifedifin tablet 10 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 2
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 10 6 6 10 6
88 Salbutamol tablet 2 mg Tab 6
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 6
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10
95 Vitamin B komplek tablet Tab 3 10 10 3 3 3 3 10 5 6 10 10 10 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 20 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 handscoon non steril ukuran M Pcs
4 handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 3
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 8

10 10
10 10 10

5 10 10 10 5 10 10 10 10 10 10 10 2 3 10 5 10 10
JUMLAH

0
0

6
0
58
145
0
0
1
0
200
0
0
0
0
3
0
10
75
70
20
0
3
0
0
0
0
82
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
10
0
0
0
0
20
0
10
0
0
0
3
0
0
1
0
0
0
0
9
0
4
0
0
105
0
0
0
1
0
194
0
0
0
0
42
0
0
192
0
0
0
0
12
0
44
6
1
0
46
0
0
10
89

0
0
0
0
0
0
0
0
0
0
0
0

0
0
50

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
36
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 5 10 5
4 Amoksisilin Kaplet 500 mg Kaplet 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10 15 15
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 1 6 6 6 6 6 6 6 6 6 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 10 6 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg Kapsul
32 Domperidon tablet 10 mg Tab 10 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol 1
41 Glibenklamid tablet 5 mg Tab 10
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1 1 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 6
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab 3 3
65 Loratadin tab 10 mg Tab 5 5
66 Metformin tablet 500 mg Tab 20
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 6 6 6 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 5 1 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube 1
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6 6 6 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 10 10 10 10 10 10 10 10 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 6
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 20 30 30 20

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 3
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 9
10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
3
JUMLAH

0
0

10
0
25
175
0
0
0
0
40
0
0
0
0
10
0
50
56
0
20
0
0
0
0
0
0
54
0
0
0
0
0
20
0
0
0
0
0
0
0
1
10
0
0
0
0
0
30
0
50
0
0
3
0
0
0
0
0
0
0
0
6
0
0
6
10
20
0
0
0
1
0
54
0
0
0
0
12
0
0
396
0
1
0
0
36
0
116
0
0
1
36
0
0
100
60

0
0
0
0
0
0
0
0
0
0
0
0

0
0
100

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
55
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 10 5 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 5 10 10 5 10 10 10 10 1 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 10 3 3 10 5 10 10 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 2 6 6 6 5 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 3 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab 5 5
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 10
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 3 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20 30 30 10
67 metil dopa tab 250 mg Tab 15
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 6 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 2 10 10 10 10 10 10 10 10 10 10 10 10 5
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6 6 6 6 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10
95 Vitamin B komplek tablet Tab 6 10 6 6 10 10 10 6 6 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet 30
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 3 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 10

10 10 10 10 10 10 10 10
10 10 10 10 3 10 10 10 10 1 3 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

0
0
30
241
0
0
3
0
80
0
0
0
0
74
0
30
84
0
10
0
1
0
0
0
0
33
0
0
0
0
0
13
0
0
0
0
0
0
10
0
10
0
0
0
2
0
50
0
0
0
0
0
0
0
0
1
0
0
0
0
11
0
0
6
0
90
15
0
0
1
0
82
0
0
0
0
12
0
0
414
0
0
0
0
18
0
50
0
2
3
20
0
0
30
120

0
0
0
0
30
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
39
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 5 5 5 5 5 5 5 5 5 5 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 5 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 20
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 2 6 6 6 1 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 10 6 10 2 10 5 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol 1
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20 20 10 10 10 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10 10 10 10 10 10 2 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10 10 10 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet 10
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 8
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 11

10 10 10 10 10 10

6 6 6 1 6 3
10 10 2 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

20
0
70
215
0
0
2
0
140
0
0
0
0
30
0
30
115
0
10
0
0
0
0
0
0
103
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
130
0
70
0
0
1
0
0
0
0
0
0
0
0
5
0
1
6
0
80
0
0
0
0
0
120
0
0
0
0
0
0
0
424
0
0
0
0
0
0
80
0
0
0
140
5
0
0
100

0
0
0
0
0
0
0
0
0
0
0
0

0
0
90

0
0
0
0
0

0
0
0

0
0
0
0
0
0
10
10
0
0
0
0
0
0
0
0
0
0
0
0
33
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 5 5 10 10 5 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 6 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 1 1 6 3 3 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 2 2 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul 15
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride 4 mg tab 5 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10 10 10 10 10
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab 3 10 10 10 10 10 10 10 10 10 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 15 20 15
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 5 10 2 3 2 10 10 10 10 5 10 10 10 10 10 10
81 Parasetamol sirup Botol 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 6 10 10 10 6 6 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10
95 Vitamin B komplek tablet Tab 6 6 6 2 3 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
3 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet 10
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 12
10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

0
0
5
165
0
0
1
0
55
0
0
0
0
9
0
50
44
0
20
0
2
0
0
0
0
46
0
0
0
0
15
0
0
0
0
0
0
0
0
0
0
15
0
0
1
0
20
0
10
0
0
0
0
0
0
0
0
0
0
0
50
0
1
96
0
50
0
0
10
0
0
80
0
0
0
0
18
0
0
407
1
0
0
0
12
0
70
0
0
1
10
0
0
20
83

0
0
0
0
0
0
0
0
0
0
0
0

0
0
10

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
27
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 10 5
4 Amoksisilin Kaplet 500 mg Kaplet 4 5 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 5 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 3 7 6 10 3 14 10 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10
17 Asetyl sestein 200mg kapsul 1 6 6 6 5 6 6 5 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 5 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 5
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 60 10 10 30 30 20
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20 15 20 20
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 6
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 6 10 10 6 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 3 10 10 10 10 5 10 10 10 5 10 10 10 10 10 10 10 5
81 Parasetamol sirup Botol 1 1
82 Permetrin/scabimite krim 5 % tube 1
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 6 14 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab 10 3 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 7 30 3 14 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet 10
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 13
10 10 10 5 10 10 10 10 10 10 10 5 10 10 10 5 10 10 10
JUMLAH

0
0

10
0
15
69
0
0
2
0
105
0
0
0
0
63
0
20
77
0
0
0
1
0
0
0
0
47
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
2
0
60
0
170
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
75
0
0
6
1
0
128
0
0
0
0
6
0
0
333
2
1
0
0
6
0
20
0
3
1
30
0
0
0
23

0
0
0
0
0
0
0
0
0
0
0
0

0
0
84

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
42
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 handscoon non steril ukuran M Pcs
4 handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 14
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 5 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 3 2 3 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 1 6 6 6 6 1 6 6 6 6 6 6 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10 5 20
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab 3
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab 3 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20 15 10 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 6 10 10 6 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 4 10 10 5 3 3 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6 6 10 10 10 10 10 10 10 10 10 10
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6 6 6 10 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 5 10 10
92 Simvastatin 20 mg Tab 5 3
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 0
95 Vitamin B komplek tablet Tab 10 3 10 10 10 3 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 20

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 30
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 2
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 3 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet 5 10 10
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 15

6
10 10 10 10 4 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

0
0
0
165
0
0
1
0
120
0
0
0
0
11
0
80
104
0
30
0
1
0
0
0
0
36
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
35
0
0
0
0
50
0
10
0
0
1
3
0
0
0
0
0
0
0
5
0
1
9
0
55
0
0
10
1
0
92
0
0
0
0
12
0
0
349
0
0
0
0
112
0
40
0
1
0
35
8
0
20
56

0
0
0
0
0
0
0
0
0
0
0
0

0
0
20

0
0
0
0
0

0
0
0
0
0
0
0
0
0
30
0
0
0
0
0
0
0
0
0
0
0
0
0
38
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 10 10
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 6 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 3 6 6 6 6 6 6 6 6 6 6 6 6 1 2 2
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1 1 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 1 2 2 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab 20
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol 1
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab 3 3 3 3 3 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 10 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 6 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 5 10 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6 6
88 Salbutamol tablet 2 mg Tab 1
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 30
12 Haloperidol 5 mg tablet tablet 10

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 15 7

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 1
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 16

2 1
10 10 10 10 10 10 10 10 10 10 10 10 10 10
1
JUMLAH

0
0

10
0
25
110
0
0
2
0
80
0
0
0
0
20
0
76
95
0
10
0
5
0
0
0
0
55
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
20
0
10
0
1
0
0
0
0
1
0
0
0
0
3
0
0
21
0
30
0
0
0
0
0
32
0
0
0
0
0
0
0
315
0
0
0
0
6
0
18
1
0
1
40
0
0
80
90

0
0
0
0
0
0
0
0
0
0
30
10

0
0
82

0
0
0
0
0

0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
52
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 10 10
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 3 20
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10
17 Asetyl sestein 200mg kapsul 6 3 6 6 6 6 6 4 1 1 2 10 10 10 10 10 10 10
18 Asiklovir Tablet 400 mg Tab 10
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 9
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 30 30 30 30
50 Karbamazepin tablet 200 mg Tab 30
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 6
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 30
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 6
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 6 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 3
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube 1
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 2 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 20 10
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 20 10
95 Vitamin B komplek tablet Tab 10 10 6 6 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 30
12 Haloperidol 5 mg tablet tablet 30

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 10 10 10 10 10 10 10 10
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 15
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 17

10

10 10 7
10 10 10 10 20 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
10 10 10
JUMLAH

0
0

0
0
20
190
0
0
4
0
50
0
0
0
0
33
0
20
144
10
0
0
1
0
0
0
0
24
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8
0
69
0
150
30
0
0
6
0
0
3
0
0
0
0
3
0
0
6
0
30
0
0
6
1
0
56
0
0
0
0
3
0
0
460
0
1
0
212
0
0
6
0
0
0
0
0
0
80
35

0
0
0
0
0
0
0
0
0
0
30
30

0
0
60

0
0
0
0
0

0
0
0
0
0
0
0
0
0
25
0
0
0
0
0
0
0
0
0
0
0
0
0
107
0
0
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RI

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 18
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 5 10 10 10 10 10 5 5 5 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 7 20
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 5 1 6 6 1 6 6 6 6 1 5
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 4 4
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab 10 3
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 5
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 7 10 30 10 8
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1 1 1 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab 3 3 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 15
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 15
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 6 10 6 10 10 6 10 10 6 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10 5 5 10 10 6 5 5 5 5 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube 1 1
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10 10 10 10 10 10 10 10 10 10 9
85 Prednison tablet 5 mg Tab 6 6 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 6 6 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 4

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 30
12 Haloperidol 5 mg tablet tablet 10

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet 10 10
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl 1
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 19

2 4 2 4
1 1

10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

0
0
20
145
0
0
4
0
60
0
0
0
0
37
0
100
103
0
10
0
1
0
0
0
0
44
0
0
0
0
0
5
0
0
0
0
0
0
13
0
5
0
0
0
1
0
10
0
85
0
0
4
0
0
0
20
0
0
0
0
10
0
1
12
0
15
0
0
15
0
0
96
0
0
0
0
18
0
0
416
0
2
0
119
0
0
34
0
1
2
40
5
0
40
134

0
0
0
0
0
0
0
0
0
0
30
10

0
0
120

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
48
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10 7 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 10 5 10 10 10 15
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 15 10 5 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 3 5 2 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 1 6 6 6 6 6 1 6 5 1 1 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab 3
21 Betametasone Krim 0.1% tube 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 2 6 2 2 10 10 10 10 10 10 10 10 10
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol 1
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab 6 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 30
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 6 10 6 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 2 10 10 10 10 10 10 10 10 10 10 2 10 2
81 Parasetamol sirup Botol 1
82 Permetrin/scabimite krim 5 % tube 1
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 10 10 10 10 10 10 10 10 10 10 10 10 10 20 10 10 10
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 6 10 10
88 Salbutamol tablet 2 mg Tab 4
89 Salep 2 - 4 kombinasi tube 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 3 6 10 6 10 6 3 6 10 10 6 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 20

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
Stimuno forte Kapsul
68
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 20

10 15 10

10 10 10 10

2
10 5 10 10 10 5 3 10 10 10 10 10 10 10 10 10 10 10 10 10 10 2
10
3 3 2 10 3 3
JUMLAH

0
0

27
0
60
215
0
4
0
0
220
0
0
0
0
20
0
40
63
0
10
3
2
0
0
0
0
134
0
0
0
0
0
10
0
0
0
0
0
0
0
1
0
0
0
0
1
0
80
0
30
0
0
1
0
0
0
4
0
0
0
0
10
0
0
9
0
30
0
0
0
1
0
112
0
0
0
0
0
0
0
351
1
1
0
196
6
0
56
4
3
1
60
5
0
50
146

0
0
0
0
0
0
0
0
0
0
0
0

0
0
20

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
78
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 21
b

b
bb
b
o
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 10 10 10 10
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 5 10 10 10 5 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 1 1 1 1 1 1 6 6 6 6 6 6 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 2 5 6 6 6 6 5 6 6 6 6 6 6 5
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 10 10 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab 5 5 1
40 Gentamisin tetes mata Botol 1 1 1 1 1 1 1
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10 10 5 5 5 10 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 6
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 8
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1
64 Lansoprazol 30 mg Tab 3 3 20
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20 10 10 20 30 30
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 4 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 3 2 2 2 2 3 2 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 6 10 6 6 6
85 Prednison tablet 5 mg Tab 6 6 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 6 6 6 6 6 10 6 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 6
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10
95 Vitamin B komplek tablet Tab 3 1 10 10 10 3 5 10 6 10 10 6 6 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet 6
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15
8 Metoklorpropamid 5 mg Tablet 10
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl 1 1
24 Zink tablet 20 mg Tablet 10 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet 10
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 10
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 22

10 10 10 10 5 5 10

6
1 1

10 10 10 10 10 10 10 10 10 10 10 10 10 10 5 5 3 3 10 10 10 10 10 10 10 10 10 10 10 10 10 10
3 3
JUMLAH

0
0

10
0
45
230
0
9
0
0
150
0
0
0
0
0
0
60
84
0
40
0
4
0
0
0
0
89
0
0
0
0
0
30
0
0
0
0
0
0
11
7
0
55
0
0
20
0
40
0
16
0
0
0
0
0
0
5
0
0
0
0
8
0
2
26
0
120
0
0
0
0
0
0
0
0
0
0
22
0
0
422
0
0
0
40
24
0
96
0
5
5
116
0
0
50
130

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
6
0
0
15
10
0
0
0
0
0
0
0
0
0
0
0
0
58
0
2
15
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 10 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 15 5 10 10 10 10 5 5 1
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 6 10 6 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab 30
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 1 6 6 4 6 6 6 6 6 1 1 1 1 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 5 6 1 3
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab 5
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 3
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10 10 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10 10
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab 3 3 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20 20 15
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10 2
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 6 6 10 6 6 6 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 2 10 10 10 5 10 10 10 10 10 10 3 3 2
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 10
85 Prednison tablet 5 mg Tab 6 6 6 6 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 10 6 10 6 10 10
88 Salbutamol tablet 2 mg Tab 10
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 20
12 Haloperidol 5 mg tablet tablet 10

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof botol
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 23
3 5 2 10 10 10 10 10 10 10 10 10 10 10 10 2 10 10 10 10 10 10 10 10 10 10 2
JUMLAH

0
0

10
0
30
91
0
1
0
0
142
0
0
0
0
0
30
70
57
0
0
0
2
0
0
0
0
21
0
0
0
0
0
5
0
0
0
0
0
0
5
0
3
0
0
0
1
0
40
0
90
0
0
0
0
0
0
3
0
0
0
0
20
0
1
12
0
55
0
0
12
0
0
56
0
0
0
0
6
0
0
379
0
0
0
16
36
0
58
10
0
0
20
0
0
30
60

0
0
0
0
0
0
0
0
0
0
20
10

0
0
30

0
0
0
0
0

0
0
0
0
0
0
0
0
0
15
0
0
0
0
0
0
0
0
0
0
0
0
0
36
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 6


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 6 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 1 6 6 6 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 4 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 5
42 Glimepiride tab 10 10 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 10
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5 3 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 15 30 30 20 30
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 6 10 10 6 6 6 6 6 10 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 1 10 10 10 10 10 10 10 10 2 3 10 5
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6
85 Prednison tablet 5 mg Tab 6 6 10 10 6 6 10
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 10 10 6 6 10 6 6 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10
92 Simvastatin 20 mg Tab 5 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10
95 Vitamin B komplek tablet Tab 10 10 10 6 6 6 6 6 6 6 6 10 6 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 24

10 5 10 10 10 10 10 5 10 10 10 10
10 10 10 10 10 6 10 10 10 10 10 10 10 10 10 10 2 3 10 5 10 10 10 10 10
JUMLAH

0
0

6
0
5
290
0
1
0
0
126
0
0
0
0
10
0
40
91
0
20
0
2
0
0
0
0
60
0
0
0
0
0
9
0
0
0
0
0
0
0
0
5
30
0
0
0
0
30
0
0
0
0
0
10
0
0
4
0
0
0
0
13
0
0
0
0
125
0
0
0
1
0
102
0
0
0
0
0
0
0
377
0
0
0
6
54
0
70
0
2
0
20
10
0
10
104

0
0
0
0
0
0
0
0
0
0
0
0

0
0
40

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
42
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 3


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 5 10 10 10 10 10 10 5 5 10 10 10 5 5 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 6 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp 2
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 2 6
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 1 2 1 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 5
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 6 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10 3 10
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab 3 3 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20 30 20
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 6 6 10 10 6 6 6 10 10 10 6 6 10 10 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 2 3 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 10 10 10 10 10 10 10 6 6 6 10 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 6 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10
95 Vitamin B komplek tablet Tab 2 10 10 10 10 10 10 6 5 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet 30
6 Klozapin 25 mg tablet tablet 30
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 30 30
12 Haloperidol 5 mg tablet tablet 30

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 2
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 8
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 25

5 5 5 5 10 5
5 10 6 10 10 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

3
0
170
20
0
2
0
0
66
0
2
0
0
8
0
70
94
0
10
0
1
0
0
0
0
66
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
3
0
26
0
30
0
0
0
0
0
0
5
0
0
0
0
23
0
1
12
0
70
0
0
0
0
0
134
0
0
0
0
6
0
0
361
2
0
0
0
0
0
134
0
0
2
176
0
0
20
113

0
0
0
0
30
30
0
0
0
0
60
30

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
33
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN R

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 5 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 5 3 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 5 6 5
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 3 6 6 6 6 4 1 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 5
20 Betahistin maleat Tab 6
21 Betametasone Krim 0.1% tube 1 1 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg kapsul
32 Domperidon tablet 10 mg Tab 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 1
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 6 6 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 6 10 10 10 10 10 10 10 5 5 3 10 10 10 5 2 3
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 6 10 10 6 10 6 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 26

10 5
10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

0
0
25
173
0
0
0
0
36
0
0
0
0
0
0
80
44
0
15
6
4
0
0
0
0
38
0
0
0
0
0
10
0
0
0
0
0
0
0
0
1
0
0
0
1
0
50
0
0
0
0
0
0
0
0
1
0
0
0
0
10
0
0
0
0
10
0
0
10
0
0
24
0
0
0
0
6
0
0
409
0
0
0
10
6
0
36
0
1
1
20
0
0
40
108

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
0
0
15
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RI

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 5 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi tablet 6 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp 3
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 5 3 3 2 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 3 6 6 6 6 6 6 6 6 2 2 1 4
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10 10 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6 3 5
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 20
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 3 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1
64 Lansoprazol 30 mg Tab 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 10 10 10 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 10 10 6
85 Prednison tablet 5 mg Tab 6 6 5 2
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 6 10 10 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10 10 10 2 3
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10
95 Vitamin B komplek tablet Tab 6 10 3 10 10 4

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 30 20 20

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 2 3 3 1 1
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 3
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 27
10 10 5 10 10 10 10 10 5 5 10 2 3 3 3 3 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

0
0
10
115
0
0
0
0
86
0
3
0
0
16
0
40
66
0
50
0
1
0
0
0
0
68
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
20
0
0
0
0
40
0
40
0
0
0
0
0
0
2
0
0
0
0
9
0
4
3
0
0
0
0
0
0
0
52
0
0
0
0
30
0
0
414
0
0
0
32
19
0
66
0
3
0
75
0
0
40
43

0
0
0
0
0
0
0
0
0
0
0
0

0
0
80

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
37
0
0
13
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 28
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
TANGGAL 29

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 3


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 10 5 5 5 10 5
4 Amoksisilin Kaplet 500 mg Kaplet 2 2 1 2 10 10 10 10 3 3 10 10 10 10 10 10 10 10 10 10 10 10 10 15 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 5 10 10 10 10 10 6 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp 3
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 2 5 10 20 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 2 1 2 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1 1 1 1 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
TANGGAL 29
26 Deksametasone tablet 0.5mg Tab 3 5 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 3 10 10 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 7
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
TANGGAL 29
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5 5 3 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 12 10 30 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 6 10 10 10 6 10 10 6 10 10 10 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 5 10 10 10 10 10 5 5 10 2 3
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 6 3 10
85 Prednison tablet 5 mg Tab 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6 10 6 6
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
TANGGAL 29
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 5
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 6 4 10 6 6 10 10 6 10 10 10 10 10 10 6 10 10 10 6 6

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 10 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
TANGGAL 29
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet 30
7 Klindamicin 300 mg Kapsul 15
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
TANGGAL 29
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
TANGGAL 29
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
AN OBAT
JUMLAH
9

0
0

3
0
40
228 10
0
0
0
0
141
0
3
0
0
47
0
70
131
0
10
0
7
0
0
0
0
AN OBAT
JUMLAH
9
110
0
0
0
0
0
33
0
0
0
0
0
7
0
0
0
20
0
0
1
0
60
0
30
0
0
0
0
0
0
4
AN OBAT
JUMLAH
9
0
0
0
0
16
0
1
0
0
72
0
0
10
0
0
134
0
0
0
0
6
0
0
3 3 3 10 10 10 10 10 10 10 10 10 10 10 10 10 10 414
0
0
0
25
12
0
34
AN OBAT
JUMLAH
9
0
3
1
35
5
0
40
186

0
0
0
0
0
0
0
0
0
0
0
0

0
0
70

0
0
AN OBAT
JUMLAH
9
0
0
0

0
0
0

0
0
0
0
0
30
15
0
0
0
0
0
0
0
0
0
0
0
0
0
39
AN OBAT
JUMLAH
9
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
AN OBAT
JUMLAH
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN R

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 10 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 5 10 5 5 10 10 10 15 10 10 10 5 10 5 3
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 5 10 6 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 5 6 1 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 5 6 6 6 6 4 10 6 3 3 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 10 10 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10
92 Simvastatin 20 mg Tab 3
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 3 6 10 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 10 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 30
10 10 5 10 10 10 10 10 10 1 10 10 10 10 10 3 10 10 10 10 10 10 10 10 10 10 10 10 10 10
JUMLAH

0
0

10
0
25
123 3 2 2 4 4 2 2 4
0
0
0
0
31
0
0
0
0
10
0
70
44
0
10
0
2
0
0
0
0
75
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
30
0
0
0
0
0
0
0
0
2
0
0
0
0
3
0
0
0
0
10
0
0
0
1
0
42
0
0
0
0
6
0
0
444
0
0
0
0
6
0
16
0
0
0
20
3
0
40
52

0
0
0
0
0
0
0
0
0
0
0
0

0
0
40

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
34
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3 3 2 4 3
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab 5 5 5 5 5 5
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 2 2 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 2 2 2 2 6 6 6 2 6 6 6 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab 24
19 Attalpugite tab 600 mg Tab 10 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1 1 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 2 6 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol 1
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 10
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab 3 3 3 10 3 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 6 6 6 6 6 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10 10
85 Prednison tablet 5 mg Tab 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10 10 10 10 10 10 6 6 10 10 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1 1 1 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10
92 Simvastatin 20 mg Tab 5 5 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet 13
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 30
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 20 10

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet 30
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet 10
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 3
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup btl
63 Herbacof sirup
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
10 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 31
10 5 10 10 10 10 10 5 5 10 2 3 3 3 3 20 10 10 10 10 10 10 10 10 10 10 7
JUMLAH

0
0

0
0
30
114
0
0
0
0
90
0
0
0
0
0
0
90
82
24
30
0
3
0
0
0
0
50
0
0
0
0
0
5
0
0
0
0
0
0
0
1
0
0
0
0
2
0
10
0
20
0
0
1
0
0
0
3
0
10
0
0
10
0
0
25
0
0
0
0
0
0
0
42
0
0
0
0
6
0
0
401
0
0
0
30
12
0
142
0
8
0
40
15
0
120
90

0
0
0
0
0
13
0
0
0
0
30
0

0
0
40

0
0
0
0
0

0
0
0
0
0
0
0
0
30
0
10
0
0
0
0
0
0
0
0
0
0
0
0
27
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

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