LAPORAN PEMAKAIAN DAN PERMINTAAN OBAT (LPLPO)

PUSTU/POSKESDES :
PELAPORAN BULAN/PERIODE :
PERMINTAAN BULAN/PERIODE :

NO NAMA OBAT SAT STOK PENERIMAA PERSEDIAAN PEMAKAIAN SISA PERMINTAAN PERMBERIAN EXP.
AWAL N STOK DATE
1 Allupurinol 100 mg Tablet
2 Allupurinol 300 mg Tablet
3 Amlodipin 5 mg Tablet
4 Amlodipin 10 mg Tablet
5 Amoksisilin 500 mg Kaplet
6 Amoksisilin 250 mg Kaplet
7 Amoksisilin sirup kering Botol
125 mg/5 ml
8 Amoksisilin sirup kering Botol
125 mg/5 ml
9 Antasida DOEN Tablet
10 Antasida sirup Botol
11 Antifungi DOEN Pot
Kombinasi krim
12 Asam Folat 1 mg Tab
13 Asam askorbat (Vit.C) 50 Tab
mg
14 Asam Mefenamat 500 Kaplet
mg
15 Asetil Sistein 200 mg Kapsul
16 Asiklovir 200 mg Tablet
17 Asiklovir 400 mg Tablet
18 Attapulgit 600 mg Tablet
19 Basitrasin krim Tube
20 Bedak Salisil 2% Kotak
21 Betametason krim 0,1 Tube
22 Cetirizine 10 mg tab Tablet
23 Cetirizine sirup 5 mg/5 Tablet
ml
24 Deksametason 0,5 mg Tablet
25 Domperidone 10 mg Tablet
26 Difenhindramin Inj 5
mg/ml
27 Domperidone suspensi 5 Botol
mg/5ml
28 Garam Oralit Sachet
29 Gentamisin salep kulit Tube
30 Gentamisin tetes mata Botol
31 Glibenklamid 5 mg Tablet
32 Glimepiride 1 mg Tablet
33 Glimepirid 2 mg Tablet
34 Griseofulvin 125 mg Tablet
35 Hidrokortison krim Tube
36 Ibuprofen 400 mg Tablet
37 Kalsium Laktat 500 mg Tablet
38 Kaptopril 12,5 ml Tablet
39 Kaptopril 25 mg Tablet
40 Ketokonazole 200 mg Tablet
41 Ketokonazole krim Tube
42 Kloramfenikol salep Tube
mata 1%
43 Kloramfenikol salep kulit Tube
2%
44 Klorfeniramin maleat Tablet
(CTM) 4 mg
45 Kotrimoksazol Tab Tablet
46 Kotrimoksazol sirup Botol
47 Lidokain inj Compositum Ampul
48 Metil Prednisolon 4 mg Tablet
49 Metformin 500 mg Tablet
50 Mikonazole krim Tube
51 Natrium Diclofenac 50 Tablet
mg
52 Nat. Klorida Lar Infus Botol
0,9% 500 ml
53 Omeprazole 20 mg Kapsul
54 Parasetamol 500 mg Tablet
55 Parasetamol sy 120 Botol
mg/5 ml
56 Paracetamol drop 100 Botol
mg/ml
57 Pirantel Palmoat 250 mg Tablet
58 Ranitidin tab 150 mg Tablet
59 Ringer Laktat lar infus Botol
500 ml
60 Salbutamol 2 mg Tablet
61 Salbutamol 4 mg Tablet
62 Salep 2-4 Kombinasi Pot
63 Sianokobalamin (B12) Tablet
tab 50 mcg
64 Sianokobalamin (B12) Inj Ampul
500 mcg
65 Simvastatin 10 mg Tablet
66 Simvastatin 20 mg Tablet
67 Tiamin (B1) tab 50 mg Tablet
68 Vitamin B-Complex Tablet
69 Zink Sulfat syr 20 Botol
mg/5ml
70 Zinc tab 20 mg Tablet
PERBEKALAN KESEHATAN
1 Alat Suntik 1 ml Pcs
2 Alat Suntik 2,5 ml Pcs
3 Alat Suntik 3 ml Pcs
4 Alcohol Swab Box
5 Alkohol 100 ml Botol
6 Alkohol 1000 ml Botol
7 Handscoon Non Steril Pcs
8 Handscoon Steril Pasang
9 Hand Rub 500 ml / Botol
Handsanitizer
10 Hand Scrub 500 ml Botol
(Sabun cuci tangan)
11 Kapas Pembalut/ Pcs
Absorben 250 ml
12 Kasa steril DRC 16 X 16 Box
CM
13 Kasa pembalut hidrofl 4 Roll
x 5 cm
14 Masker Jenis Tali Box
15 Plester 2,5 cm x 4.5 cm Roll
16 Povidon iodide lar 10% Botol
60 ml
17 Safety Box Pcs

Mengetahui,
Pengelola Obat UPT PKM Payung Penanggung Jawab Pustu/Poskesdes

apt. Risti Fathul Jannah, S.Farm ( )

NIP. 19951213 202012 2 024 (NIP. )