RENCANA KEBUTUHAN OBAT TAHUN 2025

NAMA PUSKESMAS : PRIMAPUN

SISA STOK PEMAKAIAN

TOTAL JUMLAH RENCANA
PER 31 RATA-RATA HARGA
NO NAMA OBAT Satuan DESEMBER
PEMAKAIAN
PER BULAN
KEBUTUHAN KEBUTUHAN
SATUAN
JUMLAH TOTAL KET
2023 TAHUN 2025 TAHUN 2025
2023 SELAMA 2023
a b c=bx12 d g h i
1 Albendazol 400mg tablet 0 1900 160 1920 2000 504.00 1,008,000.00 bs.provinsi 22

2 Alopurinol tab 100 mg tablet 500 5600 509 5609 10000 93.00 930,000.00 otsus kab'22
3 Alopurinol tab 300 mg tablet 200 1000 100 1000 0 - -
4 Alpara tablet 2250 13,050 1186 11982 15000 1,071.00 16,065,000.00 otsus kab'22
5 Ambroxol 30mg Tab tablet 0 500 250 3000 40000 180.00 7,200,000.00 rsud
6 Aminofilin inj 24 mg/ml ampul 19 5 5 41 50 3,520.00 176,000.00 dau 21
7 Aminofilin Tab 200 mg tablet 1200 8500 772 8064 20000 348.00 6,960,000.00 dau 21
8 Aminofilin Tabb 150 mg tablet 0 0 0 0 0 - -
9 Amitriptilin 25mg tablet 1200 300 300 2400 300 168.00 50,400.00 dak 20
10 Amlodipin tab 10 mg tablet 0 0 0 0 4000 - -
11 Amlodipin tab 5 mg tablet 500 520 74 391 4000 144.00 576,000.00 s provinsi 23/PPS
12 Amoksisilin 250mg tablet 900 15200 1267 14300 20000 778.00 15,560,000.00 otsus kab'22
13 Amoksisilin 500 mg tablet 1000 35000 3182 37182 72000 251.00 18,072,000.00 otsus kab'22
14 Amoksisilin sir kering 125 mg/5 ml botol 290 1424 129 1263 3600 2,600.00 9,360,000.00 dak 22
15 Ampicillin Inj 1000mg vial 0 20 20 240 200 1,329.40 265,880.00 rsud

Anestetik lokal gigi kombinasi : lidokain hcl 2% +

16 ampul 0 0 0 0 0 - -
epinefrin 1 : 80.000 inj 2 ml (Pehacain Inj)
Antasida, kombinasi : aluminium hidroksida 200 mg +
17 botol
magnesium hidroksida 200 mg Syrup 0 0 0 0 720 12,000.00 8,640,000.00 otsus kab'23
 Antasida, kombinasi : aluminium hidroksida 200 mg +
18 tablet 36900 2,240,000.00
magnesium hidroksida 200 mg Tablet 400 37300 3108 40000 56.00 otsus kab 22
Antibakteri kombinasi : Basitrasin 500 UI/g +
19 Polimiksin B 10.000 UI/g tube 275 2,355,600.00
25 225 25 300 7,852.00 dau 21

Antifungi salep, kombinasi : asam benzoat 6%+ asam

20 pot 177 600,000.00
salisilat 3% 35 212 18 600 1,000.00 dak 22

Antihemoroid, kombinasi: bismut subgalat 150 mg +

21 heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng suppo
oksida 120 mg + sup ad 2 g 20 4 4 28 20 7,612.00 152,240.00 dau 21
22 Aqua pro Inj 25ml botol 0 0 0 0 300 2,650.00 795,000.00 dau 21
23 Asam askorbat (vitamin C) tab 250 mg tablet 0 6000 750 9000 24000 52.00 1,248,000.00 otsus kab 22
24 Asam askorbat (vitamin C) tab 50 mg tablet 0 9300 775 9300 12000 52.00 624,000.00 dak 22
25 Asam Folat tab 1 mg tablet 400 100 100 800 800 264.00 211,200.00 rsud
26 Asam folat tab 5 mg tablet 0 0 0 0 0 - -
27 Asam Mefenamat kaps 500 mg tablet 0 23600 1967 23600 36000 133.00 4,788,000.00 otsus kab 22
28 Asiclovir Cream tube 0 50 16 192 120 6,446.00 773,520.00 dau 21
29 Asiklovir tab 200 mg tablet 0 500 125 1500 1500 759.60 1,139,400.00 otsus e-cat 23
30 Asiklovir tab 400 mg tablet 0 0 0 0 1000 1,145.00 1,145,000.00 otsus e-cat 23
31 Atapulgit 600 mg tablet 1400 3300 330 2560 5000 180.00 900,000.00 dak 22
32 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) ampul 9 10 10 111 10 1,718.00 17,180.00 dau 21
33 Bedak salisil serb 2% pot 10 76 7 73 100 8,000.00 800,000.00 otsus e-cat 23
34 Benzatin benzil Penisilin Inj 1.200.000 IU vial 0 5 5 60 10 39,424.00 394,240.00 dau 21
35 Benzatin benzil Penisilin Inj 2.400.000 IU vial 5 5 5 55 60 14,430.00 865,800.00 bs provinsi 23
36 Betahistin tab 6 mg tablet 0 200 200 2400 2500 1,500.00 3,750,000.00 otsus kab 22
37 Betametasone Cream 0.1% tube 15 288 28 321 325 1,765.00 573,625.00 dak 22
38 Bioplacenton Gel tube 0 0 0 0 200 - -
39 Bisakodil tab sal 5 mg tablet 0 500 100 1200 1200 109.00 130,800.00 dak 21
40 Carbamazepin 100mg tablet 0 0 0 0 0 - -
41 Carbamazepin 200mg tablet 0 0 0 0 0 - -
42 Cefixime 100mg kapsul 800 600 100 400 5000 - -
43 Cefixime Syr botol 0 0 0 0 300 13,331.00 3,999,300.00 otsus e-cat 23
44 Deksametason inj 5 mg/ml (i.v./i.m.) ampul 81 116 20 159 200 1,450.00 290,000.00 dak 21
45 Deksametason tab 0,5 mg tablet 0 18200 1517 18200 48000 90.00 4,320,000.00 otsus e-cat 23
46 Demacolin tablet tablet 2900 22400 1867 19500 48000 999.00 47,952,000.00 otsus kab 22
47 Diazepam 2mg tablet 0 0 0 0 100 - -
48 Diazepam inj 5 mg/ml ampul 0 15 5 60 100 2,250.00 225,000.00 dak 20
49 Diazepam 5mg tablet 500 15 15 -320 500 126.00 63,000.00 dak 20
50 Dietilcarbamazin 100mg tablet 0 0 0 0 5000 168.00 840,000.00 bs provinsi 22
51 Difenhidramin Inj. 10 mg/ml (vial isi 10ml) vial 0 6 1 12 20 4,023.00 80,460.00 dau 21
52 Dimenhidrinat 50mg tablet 700 1000 250 2300 1000 117.00 117,000.00 dak 21
53 Doksisiklin 100mg kapsul 1100 200 200 1300 1300 646.00 839,800.00 dau 21
54 Domperidon susp 5 mg/5 ml botol 0 0 0 0 600 19,000.00 11,400,000.00 otsus kab 23
55 Domperidon tab 10 mg tablet 0 7000 700 8400 10000 167.00 1,670,000.00 s provinsi 23/PPS
56 Epinefrin (adrenalin) inj 1 mg/ml vial 69 10 10 51 50 12,994.00 649,700.00 dau 21
57 Ergotamin 1mg tablet 0 0 0 0 0 - -
58 Eritromisin sir 200 mg/5 ml botol 145 5 5 -85 100 8,083.00 808,300.00 dak 21
59 Eritromisin tab 500 mg tablet 300 200 100 900 6000 980.00 5,880,000.00 dak 22
60 Etil klorida semprot 100 ml botol 0 0 0 0 10 371,000.00 3,710,000.00 otsus e-cat 23
61 Fenitoin 100mg kapsul 0 0 0 0 0 - -
62 Fenitoin Inj 50mg/ml ampul 0 0 0 0 0 - -
63 Fenobarbital 30mg tablet 100 0 0 -100 100 214.00 21,400.00 bs provinsi 20
64 Ferro Sulfat 300mg tablet 0 0 0 0 0 - -
65 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul 0 20 20 240 250 10,333.00 2,583,250.00 otsus kab 23
66 Fitomenadion (vitamin K 1) tab sal 10 mg tablet 0 100 100 1200 1200 295.00 354,000.00 dak 22
67 Fluoksetin 10mg tablet 0 0 0 0 0 - -
68 Furosemid tab 40 mg tablet 1100 180 80 -140 1000 124.00 124,000.00 dak 22

Garam oralit kombinasi : natrium klorida 0,52 g +

69 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + sachet
glukosa anhidrat 2,7 g 200 2500 227 2524 6000 1,200.00 7,200,000.00 otsus kab 22
70 Glibenklamid tab 5 mg tablet 400 400 133 1200 1500 69.00 103,500.00 dak 22
71 Gliceryl Guaicolate 100 mg (GG)/ Guaifenesin tablet 0 2500 625 7500 40000 128.75 5,150,000.00 otsus e-cat 23
72 Glimepirid tab 1 mg tablet 0 0 0 0 0 - -
73 Griseofulvin (micronized) tab 125 mg tablet 400 7700 642 7300 8000 400.00 3,200,000.00 otsus e-cat 23
74 Griseofulvin (micronized) tab 500 mg tablet 0 0 0 0 0 - -
75 Haloperidol 2mg tablet 0 0 0 0 0 - -
76 Haloperidol 5mg tablet 200 0 0 -200 500 54.00 27,000.00 bs provinsi 23
77 Haloperidol 5mg/ml Inj ampul 12 0 0 -12 12 17,000.00 204,000.00 p2ptm&keswa
78 Hidroklorotiazid tab 25 mg (HCT) tablet 70 30 30 290 100 140.00 14,000.00 dak 21
79 Hidrokortison krim 2,5% tube 0 114 23 274 300 7,535.00 2,260,500.00 dau 21
80 Ibuprofen sir 200 mg/5 ml botol 0 42 21 252 300 3,616.00 1,084,800.00 dak 21
81 Ibuprofen tab 200 mg tablet 0 6000 857 10286 24000 228.75 5,490,000.00 otsus e-cat 23
82 Ibuprofen tab 400 mg tablet 0 32300 2692 32300 48000 297.50 14,280,000.00 otsus e-cat 23
83 Isosorbid dinitrat tab 5 mg (ISDN) tablet 0 0 0 0 200 103.00 20,600.00 dak 21
84 Kalsium laktat (kalk) tab 500 mg tablet 0 4750 594 7125 12000 135.00 1,620,000.00 otsus e-cat 23
85 Kaptopril tab 12,5 mg tablet 500 1000 200 1900 2000 76.00 152,000.00 dak 22
86 Kaptopril tab 25 mg tablet 1000 1900 238 1850 2000 353.00 706,000.00 dau 21
87 Ketokonazol tab 200 mg tablet 1000 4200 420 4040 10000 989.00 9,890,000.00 otsus kab 22
88 Ketokonazole Cream 2% tube 0 0 0 0 360 - -
89 Klindamisin kaps 150 mg kapsul 550 1200 200 1850 6000 687.00 4,122,000.00 dau 21
90 Klindamisin kaps 300 mg kapsul 0 0 0 0 0 - -
91 Kloramfenikol Salep Mata 1% tube 0 118 24 283 600 11,274.00 6,764,400.00 otsus e-cat 23
92 Kloramfenikol Tetes Mata 0.5% botol 0 0 0 0 120 - -
93 Kloramfenikol Tetes Telinga 3% botol 0 0 0 0 100 -
94 Kloramfenicol 250mg kapsul 0 100 100 1200 0 - -
95 Klorfeniramin tab 4 mg (CTM) tablet 1800 17800 1483 16000 20000 80.00 1,600,000.00 dak 22
96 Klorpromazin 100mg tablet 100 0 0 -100 100 176.00 17,600.00 dak 20
97 Klorpromazin 25mg tablet 0 0 0 0 0 - -
98 Klorpromazin Inj 5mg/ml ampul 0 0 0 0 0 - -
99 Kodein 10mg tablet 1000 3900 780 8360 9000 607.00 5,463,000.00 dak 21
100 Kombinasi Ergotamin 1mg + Kafein 50mg tablet 0 0 0 0 100 - -
Kotrimoksazol (dewasa) kombinasi : sulfametoksazol
101 tablet 15200 9,624,000.00
400 mg+ trimetoprim 80 mg 1800 17000 1417 24000 401.00 otsus kab 22

Kotrimoksazol kombinasi tiap 5 ml suspensi :

102 botol 591 1,543,500.00
sulfametoksazol 200 mg + trimetoprim 40 mg 142 733 61 700 2,205.00 dak 21
103 Lidokain inj 2% (infiltr/p.v.) ampul 100 0 0 -100 100 979.00 97,900.00 dak 21
104 Loperamid tab 2 mg tablet 500 300 150 1300 1200 82.00 98,400.00 dak 21
105 Loratadin tab 10 mg tablet 0 300 300 3600 4800 356.00 1,708,800.00 dak 22
106 Magnesium sulfat inj MgSo4 40% botol 0 0 0 0 6 - -
107 Magnesium sulfat inj MgSo4 20% botol 6 0 0 -6 6 4,480.00 26,880.00 dak 22
108 Metformin tab 500 mg tablet 0 1600 533 6400 7000 300.00 2,100,000.00 otsus kab 23
109 Metilergometrin inj 0,2 mg/ml ampul 0 0 0 0 60 -
110 Metilergometrin tab salut 0,125 mg tablet 400 100 100 800 500 249.00 124,500.00 dak 22
111 Metilprednisolon 4mg tablet 0 0 0 0 48000 - -
112 Metilprednisolon inj 125 mg/2 ml vial 0 0 0 0 300 - -
113 Metoklopramid 5mg tablet 0 0 0 0 1000 70.00 70,000.00 dak 21
114 Metronidazol tab 500 mg tablet 0 2500 625 7500 24000 287.50 6,900,000.00 otsus e-cat 23
115 Mikonazol krim 2% tube 30 370 41 463 576 6,600.00 3,801,600.00 otsus kab 22
116 Natrium diklofenak tab 25 mg tablet 0 4350 483 5800 6000 520.00 3,120,000.00 otsus kab 23
117 Natrium diklofenak tab 50 mg tablet 0 500 250 3000 10000 - -
118 Nistatin tab vaginal 100.000 UI tablet 0 0 0 0 0 - -
119 Omeprazole 20mg kapsul 200 2090 190 2080 10000 650.00 6,500,000.00 otsus kab 22
120 Omeprazole 40mg Inj vial 18 12 6 54 120 5,655.00 678,600.00 dak 22
121 Ondansetron 4mg tablet 0 200 100 1200 5000 2,154.00 10,770,000.00 2154
122 Ondansetron Inj 2 mg / ml ampul 0 0 0 0 200 -
123 Parasetamol sir 120 mg/5 ml botol 153 2132 178 1979 4800 1,229.00 5,899,200.00 dak 22
124 Parasetamol tab 500 mg tablet 3200 71600 6509 74909 90000 499.00 44,910,000.00 dak 22
125 Perak Sulfadiazin Krim 1% tube 0 0 0 0 0 - -
126 Prednison tab 5 mg tablet 0 16300 1482 17782 36000 118.00 4,248,000.00 otsus e-cat 23
127 Propanolol tab 10 mg tablet 100 0 0 -100 100 208.73 20,873.00 otsus kab 19
128 Pyrantel Pamoat 125mg tablet 40 60 20 200 100 671.00 67,100.00 dak 20
129 Pyrantel Susp 125mg/5ml botol 0 4 2 24 24 23,834.00 572,016.00 otsus kab 19
130 Pyridoxin (Vit.B6) tablet 1250 4500 450 4150 5000 230.00 1,150,000.00 dau 21
131 Ranitidine 150mg tablet 0 0 0 0 48000 360.00 17,280,000.00 otsus kab 23
132 Salbutamol tab 2 mg tablet 100 16400 1367 16300 30000 118.80 3,564,000.00 otsus e-cat 23
133 Salbutamol tab 4 mg tablet 0 8300 922 11067 40000 165.00 6,600,000.00 rsud

Salep 2-4, kombinasi : asam salisilat 2 %+ belerang

134 pot 50 179 16 145 360 1,744.00 627,840.00 dak 22
endap 4 %
135 Sefadroksil kaps/tab 500 mg kapsul 1300 5700 475 4400 6000 1,200.00 7,200,000.00 otsus kab 22
136 Sefadroksil sir kering 125 mg/5 ml botol 0 0 0 0 250 15,000.00 3,750,000.00 otsus kab 23
137 Setirizin 10mg Tablet tablet 0 3000 429 5143 12000 1,207.00 14,484,000.00 otsus kab 19
138 Setirizin sir 5 mg/5 ml. botol 0 0 0 0 0 - -
139 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul 0 50 10 120 240 1,240.00 297,600.00 otsus kab 22
140 Sianokobalamin (vitamin B12) tab 50 mcg tablet 100 13600 1236 14736 24000 151.00 3,624,000.00 dak 22
141 Simvastatin tab sal 10 mg tablet 100 200 200 2300 3600 190.00 684,000.00 s provinsi 23/PPS
142 Simvastatin tab sal 20 mg tablet 0 0 0 0 0 - -
143 Siprofloksasin tab scored 500 mg tablet 1300 8100 675 6800 15000 254.00 3,810,000.00 dak 22
144 Sitikolin 500mg tablet 0 0 0 0 100 - -
145 Spironolacton 100mg tablet 0 0 0 0 0 - -
146 Spironolacton 25mg tablet 0 0 0 0 0 - -
147 Tiamin (vitamin B1) tab 50 mg tablet 0 11300 1256 15067 36000 337.00 12,132,000.00 dau 21
148 Triheksifenidil tab 2 mg tablet 0 30 30 360 500 63.00 31,500.00 s provinsi 23/PPS
149 Vitamin B kompleks tablet 0 10300 1288 15450 50000 166.80 8,340,000.00 otsus e-cat 23
150 Zinc tab disp 20 mg tablet 0 7100 789 9467 30000 246.60 7,398,000.00 otsus e-cat 23
Total 457,517,804.00
Agats, 12 Februari 2024

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Asmat

Yonathan Kambu, SKM., M.Kes.

NIP. 19741027 200012 1 001
 RENCANA KEBUTUHAN BAHAN MEDIS HABIS PAKAI (BMHP) TAHUN 2025
NAMA PUSKESMAS PRIMAPUN

SISA STOK PEMAKAIAN JUMLAH

TOTAL RENCANA
PER 31 RATA-RATA KEBUTUHA HARGA
NO NAMA OBAT Satuan PEMAKAIAN KEBUTUHAN JUMLAH TOTAL KET
DESEMBER PER BULAN N TAHUN SATUAN
2023 TAHUN 2025
2023 SELAMA 2023 2025
a b c=bx12 d g h i
1 Abbocath No. 18 unit 46 23 8 92 50 4,712.00 235,600.00 dak 20
2 Abbocath No. 22 unit 70 372 37 446 500 4,750.00 2,375,000.00 dak 21
3 Abbocath No. 24 unit 0 277 40 475 600 8,169.37 4,901,622.00 dau 23
4 Abbocath No. 26 unit 0 200 29 343 600 8,169.37 4,901,622.00 dau 23
5 Canula O2 Anak Steril unit 0 0 0 0 60 - -
6 Canula O2 Dewasa Steril unit 8 4 1 16 30 38,500.00 1,155,000.00 dak 20
7 Catgut Chromic 2/0 unit 24 0 0 0 72 6,500.00 468,000.00 dak 20
8 Catgut Plain 3/0 unit 24 24 24 288 48 6,500.00 312,000.00 dak 20
9 Disposyble syringe 1 cc (insulin) unit 200 0 0 0 200 920.00 184,000.00 dak 20
10 Disposyble syringe 10 cc unit 0 0 0 0 1200 - -
11 Disposyble syringe 3 cc unit 200 600 100 1200 2000 934.00 1,868,000.00 dak 20
12 Disposyble syringe 5 cc unit 400 1300 163 1950 2000 1,129.89 2,259,780.00 dak 20
13 Disposyble without syringe 20 cc unit 50 40 20 240 100 950.00 95,000.00 dau 18
14 Elastic verband 3 " roll 0 0 0 0 20 - -
15 Elastic verband 4 " roll 0 0 0 0 10 - -
16 Elastic verband 6 " roll 0 3 3 36 20 - -
17 Feeding tube Fr 5 unit 5 0 0 0 0 - -
18 Feeding tube Fr 10 unit 0 0 0 0 0 - -
19 Foley catheter 12 unit 5 0 0 0 5 12,143.25 60,716.25 dak 20
20 Foley catheter 16 unit 10 0 0 0 5 12,143.25 60,716.25 dak 20
21 Gypsona 4 inci roll 0 0 0 0 0 - -
22 Gypsona 3 inci roll 0 0 0 0 0 - -
23 Infus set anak unit 160 293 27 320 300 4,375.00 1,312,500.00 dak 22
24 Infus set dewasa unit 0 200 40 480 600 3,500.00 2,100,000.00 dak 20
25 Kaca Slide kotak/72 0 1800 600 7200 20000 809.17 16,183,400.00 dau 19
26 Kasa hydrophil 2 yard x 80 cm roll 0 0 0 0 100 - -
27 kassa hydrofil 40 yard x 80 cm roll 0 1 1 12 30 223,436.67 6,703,100.10 rsud
28 Kasa steril 16 x 16 kotak 0 10 3 40 120 6,000.00 720,000.00 dak 22
29 Kertas Perkamen lembar 0 0 0 0 2000 - -
30 Kertas puyer Press pak 0 0 0 0 50000 - -
31 Larutan Carbol Fuchsin botol 0 0 0 0 0 satu paket dengan
- - reagen ziehl nielsen
32 Larutan Giemsa 100 ml botol 0 4 1 16 20 374,998.00 7,499,960.00 bs provinsi 23
33 Leukoplast 7 cm x 4.5 cm roll 4 27 3 32 36 79,997.00 2,879,892.00 dak 22
34 Masker Medis unit 0 200 200 2400 2400 2,290.00 5,496,000.00 bs provinsi 20
35 Maxiflow Anak unit 0 0 0 0 30 - -
36 Maxiflow Dewasa unit 0 0 0 0 30 - -
37 Minyak Imersi botol 2 2 1 12 12 375,000.00 4,500,000.00 bs provinsi 23
38 Handscoon Steril 6,5 pasang 0 0 0 0 100 12,612.61 1,261,261.00 dau 23
39 Handscoon Steril 7 pasang 0 0 0 0 50 12,612.61 630,630.50 dau 23
40 Handscoon Steril 7.5 pasang 0 0 0 0 100 12,612.61 1,261,261.00 dau 23
41 Handscoon Steril 8 pasang 0 0 0 0 50 12,612.61 630,630.50 dau 23
42 Plastik obat 10 x 7 pak/100 0 0 0 0 24000 99.11 2,378,640.00 rsud
43 Plastik obat 15 x 10 pak/100 0 0 0 0 15000 147.40 2,211,000.00 rsud
44 Plastik obat 8 x 5 cm pak/100 0 0 0 0 24000 - -

45 Protein Urine isi 100 (merek verify unit 0

Urinalisis 10 parameter) 0 0 0 200 - -

46 Reagen Golongan Darah isi 100 (merek kotak 0

fortress) 0 0 0 200 - -
47 Sarung tangan L on kotak/100 0 4300 358 4300 3000 1,229.73 3,689,190.00 dau 23
48 Sarung tangan M on ktk/100 0 400 200 2400 3000 1,229.73 3,689,190.00 dau 23
49 Sarung tangan S on ktk/100 0 300 150 1800 1800 1,229.73 2,213,514.00 dau 23
50 Sarung tangan XL on ktk/100 0 100 100 1200 1000 1,229.73 1,229,730.00 dau 23
51 Silk 2/0 unit 36 108 36 432 432 4,333.34 1,872,002.88 dak 20
52 Stermit 18-A (Sarung Tangan Panjang) pasang 0 2 2 24 50 - -
53 Stomach tube no. 16 unit 0 0 0 0 3 26,950.00 80,850.00 dak 20
54 Stomach tube no. 18 unit 3 0 0 0 3 30,607.00 91,821.00 dak 20
55 Ultrasonic gel botol 0 0 0 0 20 -
56 Umbilical cord klem unit 0 0 0 0 100 - -
57 Underpad (isi 10) lembar 0 0 0 0 120 - -
58 Urine bag unit 10 0 0 0 120 11,981.98 1,437,837.60 dau 23
59 Wing needle 25 G unit 9 1 1 12 0 -
60 Wing needle 27 G unit 9 1 1 12 0 -
Total 88,949,467.08

Agats, 12 Februari 2024

Mengetahui
Kepala Dinas Kesehatan
Kabupaten Asmat

Yonathan Kambu, SKM., M.Kes.

NIP. 19741027 200012 1 001
 FORMULIR PENGUSULAN OBAT & BMHP PUSKESMAS SAWA ERMA TAHUN 2025

USULAN DARI dr. Ferry Mendila

NAMA PENANGGUNGJAWAB :

BENTUK
SUB KELAS TERAPI / NAMA
NO KELAS TERAPI SEDIAAN / ALASAN PENGUSULAN
GENERIK
KEKUATAN

ANALGETIK, PARACETAMOL IV 1GR/100 ML BOTOL INF HIPERPIREKSIA

1 ANTIPIRETIK
ANTI KONVULSAN, DIAZEPAM 5MG/2,5 ML RECTAL TUBE PENANGANAN PASIEN
2 BENZODIAZEPINE KEJANG DEMAM
ANTI KONVULSAN, DIAZEPAM 10MG/2,5 ML RECTAL TUBE PENANGANAN PASIEN
3 BENZODIAZEPINE KEJANG DEMAM
BRONCHODILATOR SALBUTAMOL NEBULIZER (Ventoline) AMPUL PENANGANAN DI UGD DAN
4 TERAPI PERAWATAN UTK
PASIEN ASMA, PPOK

ANTIPIRETIK TRAMADOL AMPUL PENANGANAN PASIEN NYERI

5 SKALA BERAT
ANTIBIOTIK AZITROMIZIN 500MG TABLET PENANGANAN ORAL UTK
6 MAKROLIDA PASIEN PNEUMONIA

7 ANTIBIOTIK CENDO XITROL TETES MATA TUBE KONJUNGTIVITIS

BURNAZIN SALEP TUBE PENANGANAN LUKA BAKAR
8 SKALA SEDANG - BERAT

Primapun, 20 MARET 2024

dr. Ferry Mendila

NIP. -
 FORMULIR PENGUSULAN OBAT & BMHP PUSKESMAS SAWA ERMA TAHUN 2025

USULAN DARI :SRI SULASTRI WULANDARI, Amd.Keb

NAMA PENANGGUNGJAWAB : ERY SUFIANTO, Amd.Farm

BENTUK
SUB KELAS TERAPI / NAMA
NO KELAS TERAPI SEDIAAN / ALASAN PENGUSULAN
GENERIK
KEKUATAN

ANTIBIOTIK GENTAMICIN SALEP KULIT TUBE PENANGANAN INFEKSI

1 AMINOGLIKOSIDA SUPERFISIAL PADA KULIT
ANTIBIOTIK GENTAMICIN SALEP MATA TUBE PEMBERIAN TERAPI UTK
2 AMINOGLIKOSIDA INFEKSI PADA MATA
ANTIBIOTIK GENTAMICIN INJ AMPUL TERAPI PENANGANAN
3 AMINOGLIKOSIDA PNEUMONIA
ANTIBIOTIK OXYTETRACICLIN 1 % SALEP MATA TUBE PEMBERIAN SALEP MATA
4 TOPIKAL UTK BAYI YANG BARU
LAHIR

SALBUTAMOL NEBULIZER (Ventoline) AMPUL PENANGANAN DI UGD DAN

5 BRONCHODILATOR TERAPI PERAWATAN UTK
PASIEN ASMA, PPOK
ANTI KONVULSAN, DIAZEPAM 5MG/2,5 ML RECTAL TUBE PENANGANAN PASIEN
6 BENZODIAZEPINE KEJANG DEMAM
ANALGETIK, PARACETAMOL IV 1GR/100 ML BOTOL INF HIPERPIREKSIA
7 ANTIPIRETIK
ANTAGONIS RANITIDINE INJ AMPUL PENANGANAN PASIEN
HISTAMIN H2 TERAPI RAWAT INAP TUKAK
8 LAMBUNG TANPA HARUS
OBAT DIENCERKAN
TERLEBIH DAHULU
9 BMHP DISPO 0,5 CC PICIES PENGGUNAAN VAKSIN
BMHP VENFLON 22, 24, 26 PICIES MEMPERMUDAH OBAT
10 MASUK TANPA PASIEN
HARUS DIINFUS
11 ALKES FLOW METER PICIES REGULATOR

Primapun, 20 MARET 2024

SRI SULASTRI WULANDARI S.Keb

NIP. 19821119 200605 2 001