LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

UNIT PENERIMA : PUSKESMAS BALEREJO

KECAMATAN : BALEREJO
KABUPATEN : MADIUN
PROPINSI : JAWA TIMUR

Penerimaa
NO. Kode Nama Obat Sediaan Stok Awal
n
(POLI AID) CHLORHEXIDINE GLUCONATE
1 13709 SOLUTION B.P 7,5% v\/v, CETRIMIDE B.P 15% BOTOL 0 0
b\/v 1 LITER
2 13317 20 TEST SINGLE USE DBS COLLECTION KIT PAKET 0 0
3 51 ACETYLCYSTEINE TABLET 200 MG TABLET 900 11200
4 108 ACYCLOVIR SALEP 5 % SALEP 0 0
5 119 ACYCLOVIR TABLET 200 MG TABLET 0 0
6 120 ACYCLOVIR TABLET 400 MG TABLET 2311 0
7 12530 ADSORBED DT VACCINE VIAL 0 0
8 12531 ADSORBED Td VACCINE VIAL 0 0
9 12717 AIR RAKSA DENTAL USE BOTOL 0 0
10 12676 ALAT SUNTIK 20 ML PIECES 0 0
11 12678 ALAT SUNTIK SEKALI PAKAI 0,05 ML PIECES 0 0
12 12677 ALAT SUNTIK SEKALI PAKAI 0,5 ML PIECES 0 1000

13 12742 ALAT SUNTIK SEKALI PAKAI 1 CC TUBERCULIN PIECES 195 0

27 G x 1\/2
14 13306 ALAT SUNTIK SEKALI PAKAI 1 ML PIECES 300 0
15 13310 ALAT SUNTIK SEKALI PAKAI 10 ML PIECES 0 0
16 13198 ALAT SUNTIK SEKALI PAKAI 3 ML PIECES 376 0
17 12666 ALAT SUNTIK SEKALI PAKAI 5 ML PIECES 1000 0
18 175 ALBENDAZOLE TABLET 400 MG TABLET 1513 0
19 13349 ALKOHOL 70% 1 LITER BOTOL 135 0
20 13355 ALKOHOL 70% 100 ML BOTOL 0 0
21 12460 ALKOHOL SWAB PIECES 270 500
22 247 ALLOPURINOL TABLET 100 MG TABLET 84 0
23 248 ALLOPURINOL TABLET 300 MG TABLET 1000 0
24 258 ALPRAZOLAM TABLET 0.5 MG TABLET 0 0
25 261 ALPRAZOLAM TABLET 1 MG TABLET 0 0
26 377 AMBROXOL SIRUP 15 MG/5 ML SIRUP 0 0
27 379 AMBROXOL TABLET 30 MG TABLET 0 0
28 12872 AMINOPHYLLINE INJEKSI 24 MG\/ML INJEKSI 0 0
29 417 AMINOPHYLLINE TABLET 200 MG TABLET 2 0
30 444 AMITRIPTYLINE TABLET 25 MG TABLET 1220 0
31 445 AMLODIPINE TABLET 10 MG TABLET 4492 0
32 446 AMLODIPINE TABLET 5 MG TABLET 7801 0
33 532 AMOXYCILLIN INJEKSI 1 G INJEKSI 0 0
34 540 AMOXYCILLIN SIRUP 125 MG/5 ML SIRUP 0 0
35 523 AMOXYCILLIN SIRUP 250 MG\/5 ML SIRUP 0 0
36 511 AMOXYCILLIN TABLET 500 MG TABLET 6897 0
37 706 AMPICILLIN INJEKSI 1 G\/VIAL INJEKSI 0 0
ANHYDROUS DEXTROSE|SODIUM CHLORIDE|
38 790 POTASSIUM CHLORIDE|SODIUM LACTATE INFUS 123 0
INFUS
39 804 ANTACIDA SIRUP 400 MG\/5 ML SIRUP 23 0
40 809 ANTACIDA TABLET 400 MG TABLET 7461 0
ANTI SPASMOLITIK (HYOSCINE
41 13771 TABLET 200 0
BUTYLBROMIDE) 10 MG TABLET
42 13094 ANTI-A MONOCLONAL 10 ML BOTOL 0 0
43 13095 ANTI-AB MONOCLONAL 10 ML BOTOL 0 0
44 13096 ANTI-B MONOCLONAL 10 ML BOTOL 0 0
45 13135 ANTI-D MONOCLONAL 10 ML BOTOL 0 0
ANTIFUNGI: ASAM SALICYLICUM 30 MG,
46 12633 POT 72 0
ASAM BENZOICUM 60 MG
47 13504 ANTI-HCV STRIP 25 TEST STRIP 0 0
SUPPOSITO
48 13623 ANTIHEMOROID DOEN SUPPOSITORIA 2 gr 24 0
RIA
49 13422 AQUA PRO INJEKSI 25 ML BOTOL 892 0
50 849 AQUA PRO INJEKSI LIQUID 20 ML LIQUID 0 0
51 12280 AQUADEST STERIL 0 0
52 12949 ASAM FOLAT 1 MG TABLET 0 0
53 12425 ASAM FOLAT 400 MCG TABLET 270 0
54 966 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0
55 13253 ASAM TRANEKSAMAT INJEKSI 50MG\/ML AMPUL 0 0

56 926 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 6434 0

57 928 ASCORBIC ACID (VITAMIN C) TABLET 500 MG TABLET 6318 0

58 13138 ASEPTAN 500 ML BOTOL 0 0

59 14242 ASEPTIC GEL 5 Lt LIQUID 4 0
60 12461 ASEPTIC GEL 500 CC PIECES 40 0
61 37 ASPIRIN (ASETOSAL) TABLET 100 MG TABLET 0 0
62 76 ASPIRIN (ASETOSAL) TABLET 80 MG TABLET 2620 0
63 1221 ATENELOL TABLET 50 MG TABLET 0 0
64 1274 ATROPINE SULPHATE INJEKSI 0.25 MG/ML INJEKSI 22 0
65 1277 ATROPINE SULPHATE TABLET 0.5 MG TABLET 0 0
66 1289 ATTAPULGITE TABLET 600 MG TABLET 0 0
67 1295 ATTAPULGITE TABLET 630 MG TABLET 1776 0
68 1296 ATTAPULGITE TABLET 650 MG TABLET 0 0
69 1300 ATTAPULGITE|PECTIN TABLET TABLET 0 0
70 13494 AZITHROMYCIN 500 + CEFIXIME 200 TABLET 0 0
 71 1363 BACITRACIN|POLYMYXIN B SULPHATE SALEP SALEP 0 0

72 14231 BAJU APD (DISPOSABLE PROTECTIVE COVER PIECES 200 0

ALL)
73 12322 BAJU PELINDUNG 0 0
BCG VACCINE SII SERBUK INJEKSI 1 ML (0,05
74 12575 VIAL 0 0
ML-20 DOSIS)
75 1438 BEDAK SALISIL SERBUK 2 % SERBUK 144 0

76 1463 BENZATHINE BENZYLPENICILLIN INJEKSI INJEKSI 0 0

240000 IU
77 1560 BETAHISTINE TABLET 6 MG TABLET 5537 0
78 1599 BETAMETHASONE SALEP 0.1% SALEP 239 0
SUPPOSITO
79 1690 BISACODYL SUPPOSITORIA 10 MG RIA 32 0

80 1693 BISACODYL TABLET 5 MG TABLET 330 0

81 1718 BISOPROLOL FUMARATE TABLET 5 MG TABLET 0 0
82 12513 BLOOD LANCET PIECES 0 0
83 AK0501003 Blood pressure computer 0 0 0
84 14246 BOTTLE SPRAY 60ml PIECES 0 0
85 AK9002009 BOX SLIDE 0 0 0

CALCIUM CHLORIDE DIHYDRATE|POTASSIUM

86 1989 CHLORIDE|SODIUM CHLORIDE|SODIUM INFUS 120 0
ACETATE TRIHYDRATE INFUS

87 2005 CALCIUM LACTATE TABLET 500 MG TABLET 3849 0

88 AK0101028 Calibrator 0 0 0
89 2073 CAPTOPRIL TABLET 12.5 MG TABLET 2470 0
90 2075 CAPTOPRIL TABLET 25 MG TABLET 4380 0
91 2084 CARBAMAZEPINE TABLET 200 MG TABLET 1320 0
92 AK9002709 CAT GUT CHROMIC 2 - 0 PCS 0 0
93 AK9002710 CAT GUT CHROMIC 3 - 0 PCS 0 0
CATGUT PLAIN 2\/0 (3,5 METRIC) WITH
94 13337 NEEDLE GT 1\/2 CIRCLE CURVED CUTTING 35 PIECES 0 0
MM 75 CM

CATGUT PLAIN 3\/0 (3 METRIC) WITH NEEDLE

95 13338 GT 1\/2 CIRCLE CURVED CUTTING 35 MM 75 PIECES 0 0
CM
96 2160 CEFADROXIL SIRUP 125 MG\/5 ML SIRUP 153 0
97 2176 CEFADROXIL TABLET 500 MG TABLET 3000 0
98 2252 CEFIXIME TABLET 100 MG TABLET 0 0
CEFTRIAXONE SODIUM SERBUK INJEKSI 1000
99 13537 MG VIAL 0 0

100 12494 CENDO LYTEERS Natrium Klorida 8.64 mg dan DROPS 0 0

Kalium Klorida 1.32 mg
101 2574 CHLORAMPHENICOL DROPS 0.5% DROPS 0 0
102 2620 CHLORAMPHENICOL KAPSUL 250 MG KAPSUL 0 0
103 2600 CHLORAMPHENICOL SALEP MATA 1% SALEP 15 0
104 2601 CHLORAMPHENICOL SALEP KULIT 2% SALEP 0 0
105 13427 CHLORHEXIDINE GLUCONATE 4% 5 LITER BOTOL 0 0
106 2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 7871 0
107 2762 CHLORPROMAZINE HCL TABLET 100 MG TABLET 0 0
108 2754 CHLORPROMAZINE INJEKSI 25 MG\/ML INJEKSI 0 0
109 2763 CHLORPROMAZINE TABLET 25 MG TABLET 5111 0
110 AK0101034 Cholesterol (total) test system 0 0 0
CHROMIC CATGUT WITH NEEDLE SURGICAL
111 14140 PIECES 84 0
SUTURES 2\/0 (SERENITY)
CHROMIC CATGUT WITH NEEDLE SURGICAL
112 14141 SUTURES 3\/0 (SERENITY) PIECES 0 0

CIPROFLOXACIN TABLET 500 MG (SEBAGAI

113 2828 HCL) TABLET 0 0

114 13767 CLAIR 3.1 Emergency Cleaner (60 ML) BOTOL 0 0

115 13765 CLEANER 3.1 (5 LITER) BOTOL 0 0
116 13766 CleanEZ 3.1 Shutdown (60 ML) BOTOL 0 0
117 AK0901011 Clinical electronic thermometer 0 0 0
118 3024 CLOBAZAM TABLET 10 MG TABLET 0 0
119 3136 CLOZAPINE TABLET 25 MG TABLET 1117 0
120 3157 CODEINE TABLET 10 MG TABLET 0 0
121 AK1105009 Condom 0 144 0
COTRIMOXAZOLE (DOEN I DEWASA) :
122 12525 Sulfametoxazole 400 mg + Trimetoprim 80 mg TABLET 6465 0
tablet

COTRIMOXAZOLE KOMBINASI :
123 13758 SULFAMETOXAZOLE 800 MG + KAPLET 0 0
TRIMETHOPRIM 160 MG KAPLET

COTRIMOXAZOLE SUSPENSI KOMBINASI:

124 12951 SULFAMETOXAZOLE 200 MG + TRIMETROPIN BOTOL 178 0
40 MG\/5 ML
125 14259 COVID-19 Ag TEST TEST 54 200

126 14240 COVID-19 ANTIBODY IgM\/IgG RAPID TEST TEST 0 0

127 3443 DEXAMETHASONE 0.5 MG TABLET TABLET 0 0

128 3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 140 0
129 3625 DIAZEPAM ENEMA 10 MG/2.5 ML ENEMA 15 0
130 3628 DIAZEPAM ENEMA 5 MG/2.5 ML ENEMA 15 0
131 13546 DIAZEPAM INJEKSI 5 MG\/ML AMPUL 0 0
132 3641 DIAZEPAM TABLET 2 MG TABLET 564 0
133 3642 DIAZEPAM TABLET 5 MG TABLET 0 0

134 3759 DIHYDROARTEMISININ|PIPERAQUINE TABLET 0 0

PHOSPHATE TABLET 40 MG|320 MG
135 3787 DILTIAZEM TABLET 30 MG TABLET 0 0
136 13763 DILUENT 3.1 (20 LITER) BOTOL 0 0
137 3794 DIMENHYDRINATE TABLET 50 MG TABLET 182 0
138 3859 DIPHENHYDRAMINE INJEKSI 10 MG/ML INJEKSI 1306 0

139 3890 DIPHENHYDRAMINE|PARACETAMOL| TABLET 2030 0

BROMHEXINE TABLET
DISINFECTING TOOL 500 ml BOTTLE
140 14120 BOTTLE 0 0
(TERRALIN PROTECT)
141 3964 DOMPERIDONE SIRUP 5 MG/5 ML SIRUP 44 0
142 3983 DOMPERIDONE TABLET 10 MG TABLET 2299 0
143 4030 DOXYCYCLINE TABLET 100 MG TABLET 100 0
144 4093 EFAVIRENZ TABLET 600 MG TABLET 90 0
145 4306 EPINEPHRINE INJEKSI 1 MG\/ML INJEKSI 2 0

146 4392 ERGOTAMINE TARTRATE|CAFFEINE TABLET TABLET 598 0

147 4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 0 0

148 4458 ERYTHROMYCIN TABLET 250 MG TABLET 40 0
149 4461 ERYTHROMYCIN TABLET 500 MG TABLET 0 0
150 13704 ETER ALKOHOL (1:4) 250 ML BOTOL 0 0
151 4663 EUGENOL LIQUID 10 ML BOTOL 0 0
152 12379 EXAMINATION GLOVES SIZE L 90 0
153 12380 EXAMINATION GLOVES SIZE M 0 0
154 12381 EXAMINATION GLOVES SIZE S 0 0
155 14241 FACE SHIELD UNTUK APD PIECES 0 0

156 12428 FITOMENADION (VIT. K) INJEKSI 10 MG\/ML INJEKSI 60 0

TABLET
157 12422 FITOMENADION (VIT. K1) 10 MG TABLET SALUT 1441 0
SALUT GULA
GULA
FITOMENADION (VITAMIN K) INJEKSI 2
158 9260 INJEKSI 0 0
MG\/ML
159 4932 FLUOXETINE TABLET 20 MG TABLET 0 0
FLUPHENAZINE DECANOATE INJEKSI 25
160 4934 INJEKSI 77 0
MG/ML
161 12686 FOLLEY CATHETER 2 WAY NO. 16 PIECES 50 0
162 13497 FORMOCRESOL 60 ML BOTOL 0 0
163 5074 FUROSEMIDE TABLET 40 MG TABLET 533 0
GARAM ORALIT SERBUK KOMBINASI
( NATRIUM 0,529+KALIUM KLORIDA
164 12407 SERBUK 1554 0
0,39+TRINATRIUM SITRAT DIHIDRAT
0,589+GLUKOSA ANHIDART 2,79)
165 5154 GEMFIBROZIL TABLET 300 MG TABLET 0 0
166 5160 GENTAMYCIN DROPS 0.3 % DROPS 249 0
167 5166 GENTAMYCIN SALEP 0.1 % SALEP 0 0
168 5167 GENTAMYCIN SALEP 0.3 % SALEP 74 0
169 5228 GENTIAN VIOLET LIQUID LIQUID 0 0
170 5252 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0
171 5264 GLIMEPIRIDE TABLET 1 MG TABLET 13348 0
172 5265 GLIMEPIRIDE TABLET 2 MG TABLET 460 0
173 5266 GLIMEPIRIDE TABLET 3 MG TABLET 4330 0
174 5273 GLIQUIDONE TABLET 30 MG TABLET 0 0
175 5291 GLUCOSE INFUS 10 % INFUS 0 0
176 5296 GLUCOSE INFUS 40 % INFUS 24 0
177 AK0101069 Glucose test system 0 30 0

178 5358 GLUCOSE|SODIUM CHLORIDE INFUS 5 %| INFUS 120 0

0.225 %
GLUCOSE|SODIUM CHLORIDE INFUS 5 %|0.45
179 5359 INFUS 0 0
%
180 5438 GLYCEROL LIQUID 100 ML LIQUID 0 0
181 5522 GRISEOFULVIN TABLET 125 MG TABLET 0 0
182 5539 GUAIFENESIN TABLET 100 MG TABLET 6043 0
185 5634 HALOPERIDOL DROPS 2 MG/ML DROPS 0 0
186 5635 HALOPERIDOL INJEKSI 5 MG\/ML INJEKSI 15 0
187 5633 HALOPERIDOL INJEKSI 50 MG\/ML INJEKSI 0 0
188 5636 HALOPERIDOL TABLET 0.5 MG TABLET 0 0
189 5638 HALOPERIDOL TABLET 1.5 MG TABLET 2173 0
190 5641 HALOPERIDOL TABLET 2 MG TABLET 0 0
191 5642 HALOPERIDOL TABLET 5 MG TABLET 0 0
192 13636 HAND SANITIZER BOTTLE 0 0

193 12462 HAND SCRUB 500 CC (ONESCRUB) PIECES 0 0

CHLORHEXIDINE GLUCONATE 4%
194 13719 HbA1c (TES DIABETES) 25 TESTS PIECES 0 0
195 AK0208009 Hematology quality control mixture 0 0 0

196 13542 HEPATITIS B IMMUNE GLOBULIN (HUMAN) SYRINGE 0 0

S\/D 220 IU\/ML
197 13212 HIDROGEN PEROKSIDA (H2O2) 1000 ML BOTOL 0 0
198 12950 HIDROKORTISON CREAM 2,5% TUBE 62 0
Human chorionic gonadotropin (HCG) test
199 AK0101029 0 0 0
system
HUMAN TETANUS IMMUNOGLOBULIN 1 ML
200 13313 (250 IU) SYRINGE 6 0

201 5788 HYDROCHLOROTHIAZIDE TABLET 25 MG TABLET 200 0

202 13020 IBUPROFEN SIRUP 200 MG\/5 ML BOTOL 0 0
203 12632 IBUPROFEN SUSPENSI BOTOL 24 0
204 5964 IBUPROFEN TABLET 200 MG TABLET 0 0
205 5966 IBUPROFEN TABLET 400 MG TABLET 5 1000
206 AK0903002 Ice bag 0 0 0
207 12738 INACTIVATED POLIOMYELITIS VACCINE VIAL 0 60
208 12749 INFUSION SET DEWASA (20 drops\/mL) PIECES 0 0
209 12283 IODINE 0 0
210 6230 IPRATROPIUM BROMIDE SPRAY 20 MCG SPRAY 0 0
 IPRATROPIUM BROMIDE|SALBUTAMOL
211 6237 LIQUID 0 0
SULPHATE LIQUID 0.50 MG|3 MG
212 6322 ISONIAZID TABLET 100 MG TABLET 115 0
213 6323 ISONIAZID TABLET 300 MG TABLET 100 0
214 6386 ISOSORBIDE DINITRATE TABLET 5 MG TABLET 95 0
215 12484 IV CATHETER NO. 24 PIECES 100 0
216 12433 IV CATHETER NO.18 PCS 71 0
217 12434 IV CATHETER NO.20 PCS 250 0
218 12435 IV CATHETER NO.22 PCS 35 0
219 12613 JARUM VACUTAINER PIECES 1550 0
220 14236 KACAMATA UNTUK APD PIECES 0 0
221 12917 KALSIUM GLUKONAT INJEKSI 100 MG\/ML AMPUL 10 0
222 1977 KALSIUM KARBONAT TABLET 500 MG TABLET 0 0
223 12726 KANTONG MAYAT SET 0 0
224 AK9005943 KAPAS PUTIH 250 G 0 1 10
225 AK90121071 KASA HYDROFIL 4 M X 15 CM 0 79 0
226 12376 KASA KOMPRES DRC 40cm x 40cm 0 0

227 12795 KASA PEMBALUT HIDROFIL 40 YDS X 80 CM ROLL 9 0

228 12464 KASA PEMBALUT HYDROFIL 4m x 3 cm ROLL 0 0

229 12627 KASA STERIL 16 X 16 CM PIECES 98 0
230 6535 KETOCONAZOLE SALEP 2% SALEP 51 0
231 6546 KETOCONAZOLE TABLET 200 MG TABLET 111 0

232 12431 KETOPROFEN SUPPOSITORIA 100 MG SUPPOSITO 0 0

RIA
233 6568 KETOROLAC INJEKSI 30 MG/ML INJEKSI 0 0
KOMBINASI BENSERAZID 25 MG|LEVODOPA
234 830 TABLET 0 0
100 MG TABLET 275 MG
LAMIVUDINE 30 MG, NEVIRAPINE 50 MG,
235 12498 TABLET 0 0
ZIDOVUDINE 60 MG TABLET
236 6697 LAMIVUDINE TABLET 150 MG TABLET 180 0
LARUTAN BUFFER PHOSPHATE PRO GIEMSA
237 13705 BOTOL 0 0
250 ML
238 12808 LARUTAN DRABKINS BOTOL 0 0
239 6877 LEVOTHYROXINE TABLET 50 MCG TABLET 0 0
240 13099 LIDI SWAB STERIL 100 PCS PIECES 0 0
241 6906 LIDOCAINE INJEKSI 2% INJEKSI 548 290
LIDOKAIN INJEKSI 2% HCL + EPINEPHRINE
242 6897 INJEKSI 300 0
INJEKSI 1:80.000 - 2 ML
243 12447 Lisol 1 0 0
244 6998 LOPERAMIDE TABLET 2 MG TABLET 0 0
245 7013 LORATADINE TABLET 10 MG TABLET 990 0
246 7026 LORAZEPAM TABLET 2 MG TABLET 0 0
247 13784 LUBRICANT GEL 5 ML 0 0
248 13764 LYSE 3.1 (500 ML) BOTOL 0 0
249 7153 MAGNESIUM SULFAT INJEKSI 20 % INJEKSI 10 0
250 7159 MAGNESIUM SULFAT INJEKSI 40 % INJEKSI 10 0
251 7161 MAGNESIUM SULPHATE SERBUK 30 G SERBUK 0 0
252 12390 MASKER (KARET) BMHP 6575 0
253 12389 MASKER (TALI) BMHP 1250 0
254 14150 MASKER EARLOOP HIJAB 3 PLY PIECES 2100 0
255 AK9006974 MASKER N95 0 674 0
256 14247 MASKER NON MEDIS PIECES 0 0

257 12669 MASKER PLUS (MASKER BISA DI TELINGA DAN PIECES 0 0

DI IKAT)

MDT COMBI MB ADULT : RIFAMPICIN 300 MG,

258 13127 TABLET 0 0
CLOFAZIMINE 100 MG | DAPSON 100 MG

259 7491 METFORMIN HCL TABLET 500 MG TABLET 23062 0

260 7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 200 0

261 7605 METHYLERGOMETRINE TABLET 0.125 MG TABLET 0 0

262 7585 METHYLPREDNISOLONE TABLET 4 MG TABLET 7937 0
263 7651 METOCLOPRAMIDE TABLET 10 MG TABLET 0 0
264 7652 METOCLOPRAMIDE TABLET 5 MG TABLET 0 0
265 7688 METRONIDAZOLE SIRUP 125 MG\/5 ML SIRUP 0 0
266 7695 METRONIDAZOLE TABLET 250 MG TABLET 0 0
267 7697 METRONIDAZOLE TABLET 500 MG TABLET 580 0
268 7727 MICONAZOLE SALEP 2% SALEP 29 0
269 13136 MICROSCOPE SLIDE HIJAU PIECES 0 0

270 12727 MICROSCOPE SLIDE OBJECT GLASS 25.4 X 76.2 PIECES 0 0

MM 1MM - 1.2 MM
271 7747 MINERAL MIX SERBUK 8 G SACHET 0 0
272 13699 MTB\/RIF (TB LINI 2) 10 CARTRIDGE PIECES 0 100
273 7908 MULTIVITAMIN SIRUP SIRUP 0 0

274 7945 MULTIVITAMIN, MULTIMINERAL TABLET MG TABLET 11740 0

275 12805 NASAL CANNULA DEWASA PIECES 100 0

276 12889 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 0 0
277 8031 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 16117 0
278 AK9007468 NEEDLE NO 23 0 0 0
279 8110 NEVIRAPINE TABLET 200 MG TABLET 180 0
280 8160 NIFEDIPINE TABLET 10 MG TABLET 0 0
281 AK9007578 NURSE CAP HD 0 0 0
282 13633 NYSTATIN OVULA 100000 IU\/G OVULA 100 0
283 12332 NYSTATIN TABLET SALUT 500.000 IU TABLET 0 0
284 12529 OAT KATEGORI II- (FDC) PAKET 0 0

285 12930 OBAT ANTI TUBERCULOSIS KOMBIPAK KAT I PAKET 0 0

286 8285 OBH SIRUP 100 ML SIRUP 218 0

287 8286 OBH SIRUP 60 ML SIRUP 0 0
288 13580 OIL EMERSI 250 ML BOTOL 0 0
289 8363 OMEPRAZOLE INJEKSI 40 MG/VIAL INJEKSI 0 0
290 8373 OMEPRAZOLE KAPSUL 20 MG KAPSUL 980 0
291 8392 ONDANSETRON INJEKSI 2 MG/ML INJEKSI 0 0
292 8451 OXYMETAZOLINE DROPS 25% DROPS 0 0
SALEP
293 8475 OXYTETRACYCLINE 3 % SALEP KULIT 0 0
KULIT

294 8464 OXYTETRACYCLINE SALEP MATA 1 % (HCL) TUBE 45 0

295 8481 OXYTOCIN INJEKSI 10 IU\/ML INJEKSI 0 0

296 AK9007744 PAKET APD 0 0 0
PAKET APD PENANGGULANGAN COVID-19
297 14299 UNTUK IMUNISASI PAKET 50 0

298 12527 PAKET STOP TB KATEGORI 1 PAKET 20 0

299 12528 PAKET STOP TB OAT ANAK PAKET 5 0
300 8544 PAPAVERINE TABLET 40 MG TABLET 0 0
301 AK9007778 PAPER POINT NO 45 - 80 0 0 0
302 8573 PARACETAMOL DROPS 100 MG/ML DROPS 0 0
303 8601 PARACETAMOL SIRUP 120 MG\/5 ML SIRUP 186 0
304 8572 PARACETAMOL TABLET 100 MG TABLET 0 0
305 8593 PARACETAMOL TABLET 500 MG TABLET 10436 10000
306 8660 PARACETAMOL TABLET 650 MG TABLET 0 0

307 8780 PARACETAMOL|CHLORPHENAMINE| TABLET 0 0

PSEUDOEPHEDRINE TABLET
308 12489 PARAFORMALDEHYDE TABLET 0 0
309 13909 PEMUTIH DESINFEKTAN 1000 ML 6 0
310 12816 VAKSIN DPT-HB-Hib (PENTABIO) BOTOL 0 30
311 9086 PERMETHRIN SALEP 5 % SALEP 19 0
312 9125 PHENOBARBITAL TABLET 30 MG TABLET 1809 0
313 9137 PHENOL GLYCEROL (TETES TELINGA) 10% LIQUID 26 0
PHENYLPROPANOLAMINE|
314 9216 CHLORPHENAMINE|PARACETAMOL| TABLET 0 0
GUAIFENESIN TABLET
315 9246 PHENYTOIN TABLET 100 MG TABLET 0 0
316 12413 PIRANTEL PAMOAT 125 MG TABLET 0 0
317 12415 PIRIDOKSIN HCL ( VIT. B6 ) 10 MG TABLET 3510 0
318 12900 PIRIDOKSIN HCL ( VIT. B6 ) TABLET 25 MG TABLET 0 0
PLAIN CATGUT WITH NEEDLE SURGICAL
319 14138 SUTURES 2\/0 (SERENITY) PIECES 0 0

PLAIN CATGUT WITH NEEDLE SURGICAL

320 14139 SUTURES 3\/0 (SERENITY) PIECES 0 0

321 12367 PLESTER 2.5 CM X 4.5 M ROLL ROLL 0 0

322 12368 PLESTER 5 CM X 4.5 M ROLL ROLL 0 0
 PLESTER ADHESIVE NON WOVEN FABRIC
323 13375 ROLL 10 0
10CM X 5M (FIXOMULL)

324 13002 PLESTER ADHESIVE NON WOVEN FABRIC 5CM ROLL 5 0

X 5M (FIXOMULL)
325 12587 PLESTER HYPOALERGENIC \/ KERTAS ROLL 0 0

326 12560 PLESTER LEUKOPLAST 7.5 CM X 4.5 M PIECES PIECES 0 0

327 9423 POLIOMYELITIS VACCINE DROPS DROPS 0 0

328 12559 POT SPUTUM PIECES 0 0
329 AK9008220 POT URINE LOKAL 0 0 0
POTASSIUM (KALIUM) PERMANGANATE
330 9485 SERBUK 5 0
SERBUK 5 G
331 12324 POVIDONE IODINE 10% 300ML CAIRAN 13 0
332 12325 POVIDONE IODINE 10% 30ML CAIRAN 0 0

333 13713 POWDERED EXAMINATION GLOVES SIZE M PIECES 950 0

334 13712 POWDERED EXAMINATION GLOVES SIZE S PIECES 0 0

335 9583 PREDNISONE TABLET 5 MG TABLET 2826 0

336 9597 PRIMAQUINE TABLET 15 MG TABLET 0 0
PROLINE TRULAB N KONTROL
337 13947 NORMAL\/KALIBRATOR NORMAL BOTOL BOTOL 0 0

338 9689 PROPRANOLOL TABLET 10 MG TABLET 100 0

339 9692 PROPYLTHIOURACIL TABLET 100 MG TABLET 0 0
340 10011 RANITIDINE INJEKSI 25 MG/ML INJEKSI 800 0
341 10014 RANITIDINE TABLET 150 MG TABLET 8590 0
342 12499 RAPID 1 HIV (SD) KIT 485 0
343 12500 RAPID 2 HIV (Intec) KIT 0 0
344 12501 RAPID 3 HIV (Oncoprobe) KIT 25 0

345 14091 RAPID ANTI-HIV (1&2) TEST CARD PAKET 0 0

(SERUM\/PLASMA) PAKET
RAPID DIAGNOSTIC SYPHILIS TEST (SD
346 13072 PIECES 0 0
BIOLINE)
RDT LEPTOSPIRA IgM 10 TEST + 1 BOTOL
347 13841 BUFFER TEST 0 0

348 13436 RDT SYPHILIS RPR 100 ANTIGEN TEST PIECES 0 0

349 13588 REAGEN GIEMSA 250 ML BOTOL 0 0
350 12502 REAGEN ZIEHL NEELSEN 100 ML BOTOL 1 0
351 13033 REAGENT KIMIA KLINIK ASAM URAT PIECES 0 0
352 13035 REAGENT KIMIA KLINIK CHOLESTEROL PIECES 0 0
353 13034 REAGENT KIMIA KLINIK GLUKOSA PIECES 0 0
354 13036 REAGENT KIMIA KLINIK GOT PIECES 0 0
355 13037 REAGENT KIMIA KLINIK GPT PIECES 0 0
356 13038 REAGENT KIMIA KLINIK KREATININ PIECES 0 0
357 13039 REAGENT KIMIA KLINIK TRIGLISERIDA PIECES 0 0
358 13040 REAGENT KIMIA KLINIK UREA PIECES 0 0
359 13672 REES ECKER 250 ML BOTOL 0 0
360 11896 RETINOL PALMITATE TABLET 100000 IU TABLET 200 0
361 11900 RETINOL PALMITATE TABLET 200000 IU TABLET 2250 0
362 12439 RINGER LAKTAT 500 ML BOTOL 286 0
363 10172 RISPERIDONE TABLET 1 MG TABLET 0 0
364 10173 RISPERIDONE TABLET 2 MG TABLET 337 0
365 13239 RIVANOL \/ ETAKRIDIN 300 ML BOTOL 0 0
366 12691 SAFETY BOX 5 L PIECES 84 19
367 10275 SALBUTAMOL SIRUP 2 MG/5 ML SIRUP 0 0
SALBUTAMOL TABLET 2 MG (SEBAGAI
368 10295 TABLET 3863 0
SULFAT)
SALBUTAMOL TABLET 4 MG (SEBAGAI
369 10307 SULFAT) TABLET 0 0

SALEP 2-4 KOMBINASI: ASAM SALISILAT 2% +

370 12954 BELERANG ENDAP 4% TUBE 45 0

SALMONELLA PARATYPHI AO WIDAL TEST 5

371 13303 ML VIAL 0 0

372 13304 SALMONELLA PARATYPHI BO TEST 5 ML VIAL 0 0

374 13301 SALMONELLA TYPHI H WIDAL TEST 5 ML VIAL 0 0
375 13302 SALMONELLA TYPHI O WIDAL TEST 5 ML VIAL 2 0
376 12626 SARUNG TANGAN GYNECOLOG PIECES 0 0
SARUNG TANGAN OBGYN PANJANG STERIL 56
377 13443 PIECES 0 0
CM
378 AK9008968 SARUNG TANGAN STERIL NO 6.5 0 0 0
379 12474 SARUNG TANGAN STERIL NO. 7 PIECES 100 0
380 12475 SARUNG TANGAN STERIL NO. 7.5 PIECES 0 0
381 AK9009214 SEPATU BOOT 0 0 0
SERUM ANTI BISA ULAR POLIVALEN (KUDA) 5
382 13760 VIAL 0 0
ML
383 13640 SERUM ATS INJEKSI 1.500 IU AMPULE 0 0
SIANOKOBALAMIN (VITAMIN B12) INJEKSI 500
384 12935 AMPUL 161 0
MCG
385 13280 SIANOKOBALAMIN TABLET 50 MCG TABLET 0 0
SILK BENANG NO. 3\/0 DENGAN JARUM
386 13242 BEDAH PIECES 0 0

SILK BRAIDED WITHOUT NEEDLE 3\/0

387 14142 SURGICAL SUTURES (SERENITY) PIECES 0 0

388 10482 SIMVASTATIN TABLET 10 MG TABLET 0 0

389 10484 SIMVASTATIN TABLET 20 MG TABLET 4590 0
390 10532 SODIUM CHLORIDE INFUS 0.9 % INFUS 472 0
391 12294 SPIRITUS 1000 ML 0 0
392 10734 SPIRONOLACTONE TABLET 25 MG TABLET 0 0
393 12599 STRIP HbsAg PIECES 0 0
394 13022 STRIP URIN 10 PARAMETER (LABSTRIP) PIECES 0 0
395 12622 STRIP URINALISIS 3 PARAMETER PIECES 0 0
396 AK9010867 STYROFOAM 40 X 30 X 8 0 0 0

397 14135 STYROFOAM DENGAN TALI SIZE P25 X L17 X PIECES 0 0

T17 CM
398 14136 STYROFOAM SIZE P26 X L20 X T11 CM PIECES 82 0
399 10853 SULFADIAZINE SILVER SALEP 10 MG/G SALEP 1 0
400 13707 SUTURE NEEDLE NO. GT 13 PIECES 0 0

401 12760 TABLET TAMBAH DARAH KOMBINASI Fe + TABLET 14705 0

ASAM FOLAT
TB\/HIV LANJUTAN: RIFAMPICIN 150 MG,
402 13717 TABLET 0 0
ISONIAZID 75 MG TABLETS
403 11007 TELMISARTAN TABLET 40 MG TABLET 0 0
TENOFOVIR DISOPROXIL FUMARATE TABLET
404 11022 300 MG TABLET 90 0

TENOFOVIR|LAMIVUDINE|EFAVIRENZ TABLET
405 12275 300 MG|300 MG|600 MG TABLET 90 0

TERBUTALINE SULPHATE RESPULES 2,5

406 13759 MG\/ML RESPULE 0 0

407 11115 TETRACYCLINE TABLET 250 MG TABLET 0 0

408 11116 TETRACYCLINE TABLET 500 MG TABLET 0 0
409 13077 THIAMINE (VITAMIN B1) 50 MG TABLET 10328 0
410 11625 TRIFLUOPERAZINE TABLET 5 MG TABLET 400 0
411 11636 TRIHEXYPHENIDYL TABLET 2 MG TABLET 3583 0
412 11716 TUBERCULIN PPD INFUS 2 TU/0.1 ML INFUS 0 0
413 12777 UNDERPAD 60 X 90 CM PIECES 0 0
414 11732 UREA SALEP 10 % SALEP 18 0
415 AK0101147 Uric acid test system 0 0 0

416 12756 URINE BAG STANDARD STERILE 2 Lt (T VALVE) PIECES 0 0

417 AK0209003 Vacuum-assisted blood collection system 0 0 0

419 12956 VAKSIN CAMPAK 10 DS VIAL 0 0

420 12815 VAKSIN HEPATITIS B REKOMBINAN VIAL 0 10
421 13377 VAKSIN MEASLES RUBELLA 10 DS VIAL 0 35
VAKSIN MENINGITIS 200 MCG DAN PELARUT
422 13499 0.5 ML VIAL 0 0

423 11776 VALPROATE SEMISODIUM TABLET 250 MG TABLET 0 0

424 11777 VALPROATE SEMISODIUM TABLET 500 MG TABLET 0 0
VIROTEC : DENGUE COMBO (IgG\/IgM dan
425 13969 NS1) TEST TEST 0 0

426 14238 VIRUS TRANSPORT MEDIA (VTM) KIT KIT 0 0

VITAMIN B KOMPLEKS: VITAMIN B1 2 MG,
427 13300 VITAMIN B2 2 MG, VITAMIN B6 2 MG, TABLET 6346 0
NICOTINAMIDE 20 MG, Ca PANTOTHENATE 10
MG
428 13117 WIPOL : PINE OIL 2,5% 800 ML BOTOL 113 0
429 12768 YELLOW TIPS 200 uL PIECES 0 0

430 12668 ZIDOVUDINE 300 MG + LAMIVUDINE 150 MG TABLET 180 0

435 13607 ZIDOVUDINE SIRUP 240 ML BOTOL 0 0

436 12160 ZIDOVUDINE TABLET 100 MG TABLET 180 0
437 13249 ZINC SULFATE SIRUP 20 MG BOTOL 60 ML BOTOL 166 0
438 12192 ZINC SULPHATE TABLET 20 MG TABLET 442 0
CORONAVAC COVID19 (VAKSIN COVID-19)
439 14306 VIAL 0 500

440 12803 NASAL CANNULA ANAK PIECES 20 0

441 13496 TEMEPHOS 1% 1 GR (ABATE) PIECES 10 0
442 1347 AZITHROMYCIN TABLET 500 MG TABLET 215 0
443 5300 GLUCOSE INFUS 5 % INFUS 100 0
444 8417 OSELTAMIVIR PHOSPHATE TABLET 75 MG TABLET 0 0
445 13714 POWDERED EXAMINATION GLOVES SIZE L PCS 2000 0
446 14320 VAKSIN CORONA MDV VIAL 0 20
ASTRAZENECA VACCINE COVID19 10 Dosis
447 14324 VIAL VIAL 0 0

448 14326 CORONAVAC COVID19 2 Dosis VIAL VIAL 0 300

449 14321 ASTRAZENECA VACCINE COVID19 8 Dosis VIAL VIAL 0 63

450 14274 FAVIPIRAVIR 200 MG TABLET TABLET 496 0

451 AK0403047 Portable liquid oxygen unit TABUNG 5 0
452 13699 MTB\/RIF (TB LINI 2) 10 CARTRIDGE PIECES 35 100

HerbaKOF (Reconyl TM, campuran ekstrak

yang setara dengan simplisia: Vitex trifolia
453 13757 folium 1 GR, Zingiber officinale rhizone 0.25 BOTOL 35 0
GR, Abrus precatorius folium 0.25 GR, Phaleria
macrocarpa fructus 0.20 GR) 100 ML

454 14319 VITAMIN D3 CHOLECALCIFEROL 1000 IU TABLET 0 0

TABLET
455 7939 MULTIVITAMIN TABLET MG TABLET 0 0

KEPALA PUSKESMAS PENANGGUNGJAWAB YANFAR PUSKESMAS

drg. RUCAMA TUNGGUL KUSWOYO,MKes DEWI PERMANASARI,S.Farm.,Apt.

NIP 19741213 200501 1 004 NIP 19920801202012 2 012

MENGETAHUI/MENYETUJUI
a/n KADINKES KABUPATEN MADIUN
KABID SUMBER DAYA KESEHATAN

TOMAS ADIWIBOWO,SKM,MMKes.
NIP 19660508 198812 1 003
BAR PERMINTAAN OBAT (LPLPO)

BULAN : OKTOBER
TAHUN : 2021

Pemakaia Stok Permintaa Keteranga stok

Persediaan Rusak/Ed Sisa Stok Pemberian optimum
n Optimum n n
=
pemakaia
0 0 0 0
n + Buffer
Permintaa
10%
n +
= stok
0 0 0 0 lead time -
optimum
12100 588 11512 705.6 10%stok
sisa
0 0 0 0
0 0 0 0
2311 100 2211 120
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1000 1000 0 1200

195 0 195 0

300 0 300 0
0 0 0 0
376 324 52 388.8 1200
1000 2 998 2.4
1513 0 1513 0
135 0 135 0
0 0 0 0
770 770 0 924 3000
84 84 0 100.8
1000 70 930 84
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
2 0 2 0
1220 130 1090 156
4492 1186 3306 1423.2
7801 2415 5386 2898 5000
0 0 0 0
 0 0 0 0
0 0 0 0
6897 1942 4955 2330.4 5000
0 0 0 0

123 0 123 0

23 7 16 8.4 15
7461 1424 6037 1708.8

200 0 200 0

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

72 0 72 0

0 0 0 0

24 23 1 27.6 30

892 35 857 42
0 0 0 0
0 0 0 0
0 0 0 0
270 0 270 0
0 0 0 0
0 0 0 0

6434 924 5510 1108.8

6318 90 6228 108

0 0 0 0
4 2 2 2.4
40 0 40 0
0 0 0 0
2620 425 2195 510
0 0 0 0
22 0 22 0
0 0 0 0
0 0 0 0
1776 199 1577 238.8
0 0 0 0
0 0 0 0 4000
0 0 0 0
 0 0 0 0

200 0 200 0

0 0 0 0

0 0 0 0

144 1 143 1.2

0 0 0 0

5537 290 5247 348

239 10 229 12

32 0 32 0

330 23 307 27.6

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

120 21 99 25.2

3849 727 3122 872.4

0 0 0 0
2470 550 1920 660
4380 578 3802 693.6
1320 0 1320 0
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

153 6 147 7.2

3000 50 2950 60
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
 0 0 0 0
15 0 15 0
0 0 0 0
0 0 0 0
7871 688 7183 825.6
0 0 0 0
0 0 0 0
5111 540 4571 648
0 0 0 0

84 0 84 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1117 30 1087 36
0 0 0 0
144 0 144 0

6465 0 6465 0

0 0 0 0

178 8 170 9.6

254 15 239 18

0 0 0 0

0 0 0 0
140 112 28 134.4
15 0 15 0
15 0 15 0
0 0 0 0 10
564 51 513 61.2
0 0 0 0

0 0 0 0

0 0 0 0
 0 0 0 0
182 0 182 0
1306 35 1271 42

2030 40 1990 48

0 0 0 0

44 1 43 1.2
2299 180 2119 216
100 0 100 0
90 0 90 0
2 0 2 0

598 10 588 12

0 0 0 0
40 40 0 48
0 0 0 0 500
0 0 0 0
0 0 0 0
90 90 0 108
0 0 0 0
0 0 0 0
0 0 0 0

60 0 60 0

1441 47 1394 56.4

0 0 0 0

0 0 0 0

77 0 77 0

50 11 39 13.2
0 0 0 0
533 25 508 30

1554 80 1474 96 500

0 0 0 0
249 21 228 25.2
0 0 0 0
74 3 71 3.6
0 0 0 0
 0 0 0 0
13348 4810 8538 5772 10000
460 50 410 60 10000
4330 330 4000 396
0 0 0 0
0 0 0 0
24 0 24 0
30 0 30 0

120 20 100 24

0 0 0 0

0 0 0 0
0 0 0 0
6043 580 5463 696
0 0 0 0
15 0 15 0
0 0 0 0
0 0 0 0
2173 573 1600 687.6 1000
0 0 0 0
0 0 0 0
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 9 53 10.8

0 0 0 0

6 0 6 0

200 0 200 0
0 0 0 0
24 3 21 3.6
0 0 0 0
1005 175 830 210
0 0 0 0
60 30 30 36
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0

115 15 100 18
100 0 100 0
95 0 95 0
100 0 100 0
71 0 71 0
250 0 250 0
35 0 35 0
1550 0 1550 0
0 0 0 0
10 0 10 0
0 0 0 0
0 0 0 0
11 0 11 0
79 0 79 0
0 0 0 0

9 0 9 0

0 0 0 0
98 20 78 24
51 8 43 9.6
111 0 111 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

180 0 180 0

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
838 0 838 0

300 0 300 0

0 0 0 0
0 0 0 0
990 90 900 108
0 0 0 0
0 0 0 0
0 0 0 0
 10 0 10 0
10 0 10 0
0 0 0 0
6575 2125 4450 2550 5000
1250 0 1250 0
2100 0 2100 0
674 90 584 108
0 0 0 0

0 0 0 0

0 0 0 0

23062 6395 16667 7674 10000

200 1 199 1.2

0 0 0 0
7937 1894 6043 2272.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
580 90 490 108
29 0 29 0
0 0 0 0

0 0 0 0

0 0 0 0
100 0 100 0
0 0 0 0

11740 1020 10720 1224

100 0 100 0
0 0 0 0
16117 3562 12555 4274.4 2000
0 0 0 0
180 0 180 0
0 0 0 0
0 0 0 0
100 0 100 0
0 0 0 0
0 0 0 0

0 0 0 0

218 38 180 45.6

 0 0 0 0
0 0 0 0
0 0 0 0
980 80 900 96
0 0 0 0
0 0 0 0

0 0 0 0

45 0 45 0

0 0 0 0
0 0 0 0

50 50 0 60

20 0 20 0
5 0 5 0
0 0 0 0
0 0 0 0
0 0 0 0
186 27 159 32.4
0 0 0 0
20436 4546 15890 5455.2 2500
0 0 0 0

0 0 0 0

0 0 0 0
6 0 6 0
30 0 30 0
19 4 15 4.8
1809 44 1765 52.8
26 3 23 3.6

0 0 0 0 10000

0 0 0 0
0 0 0 0
3510 272 3238 326.4
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
 10 2 8 2.4

5 0 5 0

0 0 0 0

0 0 0 0

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

5 0 5 0

13 13 0 15.6
0 0 0 0

950 950 0 1140 5000

0 0 0 0

2826 179 2647 214.8

0 0 0 0

0 0 0 0

100 0 100 0
0 0 0 0
800 102 698 122.4
8590 1063 7527 1275.6
485 485 0 582
0 0 0 0
25 25 0 30

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
1 1 0 1.2
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
200 0 200 0
2250 0 2250 0
286 81 205 97.2
0 0 0 0
337 75 262 90
0 0 0 0
103 0 103 0
0 0 0 0

3863 467 3396 560.4

0 0 0 0

45 15 30 18 24

0 0 0 0

0 0 0 0
0 0 0 0
2 0 2 0
0 0 0 0

0 0 0 0

0 0 0 0 50
100 100 0 120 500
0 0 0 0 500
0 0 0 0

0 0 0 0 1

0 0 0 0 5

161 4 157 4.8

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
4590 190 4400 228
472 60 412 72
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0

0 0 0 0

82 82 0 98.4
1 0 1 0
0 0 0 0

14705 1095 13610 1314

0 0 0 0

0 0 0 0

90 0 90 0

90 0 90 0

0 0 0 0

0 0 0 0
0 0 0 0
10328 1635 8693 1962
400 0 400 0
3583 660 2923 792
0 0 0 0
0 0 0 0 300
18 4 14 4.8
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
10 10 0 12
35 0 35 0

0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

6346 3537 2809 4244.4 8000

 113 4 109 4.8
0 0 0 0

180 0 180 0

0 0 0 0
180 0 180 0
166 9 157 10.8
442 60 382 72

500 500 0 600

20 0 20 0
10 0 10 0
215 0 215 0
100 0 100 0
0 0 0 0
2000 1700 300 2040 6500
20 20 0 24

0 0 0 0

300 300 0 360

63 63 0 75.6

496 0 496 0
5 0 5 0
135 0 135 0

35 0 35 0

0 0 0 0

0 0 0 0

MADIUN, 9 NOVEMBER 2021

YANG MELAPOR
NGJAWAB YANFAR PUSKESMAS PETUGAS YANFAR PUSKESMAS

ERMANASARI,S.Farm.,Apt. MARTINI,A.Md.Farm.
19920801202012 2 012 NIP 19770409 200501 2 010

YANG MENYERAHKAN
KEPALA GFK

INDRIANI,S.Farm.,Apt.
NIP 19850527 201101 2 025