NAMA PUSKESMAS : SIULAK MUKAI

KABUPATEN : KERINCI NO IZIN : P1501010202

PROVINSI : JAMBI
ALAMAT : MUKAI MUDIK KEC. SIULAK MUKAI BULAN : 2023

LAPORAN NARKOTIKA

TAHUN
NO NAMA SEDIAAN SATUAN
PEROLEHAN
1 2 3 3 PASSW : 1
1 Kodein Tablet 2020
2 Pethidin HCl 50mg/ml-2ml Injeksi 2020 PUSKESMAS : SIULAK MUKAI

LAPORAN PSIKOTROPIKA

TAHUN
NO NAMA SEDIAAN SATUAN
PEROLEHAN
1 2 3 4
1 Clobazam 10 mg Tablet

2 Clobazam 10 mg Tablet 2021

3 Diazepam enema 10 mg Tube 2022
4 Diazepam enema 10 mg
5 Diazepam enema 5 mg Tube 2022
6 Diazepam enema 5 mg
7 Diazepam injeksi 5 mg/ml Ampul 2020
8 Diazepam injeksi 5 mg/ml Ampul 2021
9 Diazepam tablet 2 mg Tablet 2020
10 Diazepam tablet 2 mg Tablet

11 Diazepam tablet 5 mg Tablet

12 Phenobarbital 100 mg Tablet

13 Phenobarbital 30 mg Tablet 2020

14 Phenobarbital 30 mg Tablet 2021
15 Phenobarbital inj Ampul 2020
16 Phenobarbital inj Ampul 2021
KERINCI
YANG MEMINTA / MELAPORKAN YANG MENERIMA :
KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

Hj. EFRIDAWATI ALI, SKM, S.Keb., Bd. Apt. SENJA MULIA H., S.Farm.
NIP. 19680329 198811 2 001 NIP. 19930316 202012 2 029

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NAMA PUSKESMAS : SIULAK MUKAI
KABUPATEN : KERINCI NO IZIN : P1501010202
PROVINSI : JAMBI BULAN : JANUARI - DESEMBER
ALAMAT : MUKAI MUDIK KEC. SIULAK MUKAI TAHUN :

LAPORAN NARKOTIKA

PENGELUARAN
NO NAMA SEDIAAN SATUAN STOK AWAL
Januari Februari Maret April Mei Juni Juli Agustus September Oktober November Desember Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kodein 2020 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
2 Pethidin HCl 50mg/ml-2ml 2020 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
0 0 0 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

LAPORAN PSIKOTROPIKA

PENGELUARAN
NO NAMA SEDIAAN SATUAN STOK AWAL
Januari Februari Maret April Mei Juni Juli Agustus September Oktober November Desember Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Clobazam 10 mg Tablet #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
2 Clobazam 10 mg Tablet #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
3 Diazepam enema 10 mg Tube #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
4 Diazepam enema 10 mg 0 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
5 Diazepam enema 5 mg Tube #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
6 Diazepam enema 5 mg 0 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
7 Diazepam injeksi 5 mg/ml Ampul #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
8 Diazepam injeksi 5 mg/ml Ampul #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
9 Diazepam tablet 2 mg Tablet #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

Page 2 of 5
 LAPORAN OBAT-OBAT TERTENTU

PENGELUARAN
NO NAMA SEDIAAN SATUAN STOK AWAL
Januari Februari Maret April Mei Juni Juli Agustus September Oktober November Desember Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

LAPORAN PREKURSOR

PENGELUARAN
NO NAMA SEDIAAN SATUAN STOK AWAL
Januari Februari Maret April Mei Juni Juli Agustus September Oktober November Desember Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
### Err:509 Err:509 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

Mengetahui :
KEPALA PUSKESMAS, Penanggung Jawab

Page 3 of 5
 0 0
Hj. EFRIDAWATI ALI, SKM, S.Keb., Bd. Apt. SENJA MULIA H., S.Farm.

Page 4 of 5
NAMA PUSKESMAS : SIULAK MUKAI BULAN : JANUARI 2023
KABUPATEN : KERINCI
PROVINSI : JAMBI
ALAMAT : MUKAI MUDIK KEC. SIULAK MUKAI

LAPORAN NARKOTIKA

TAHUN STOK
NO NAMA SEDIAAN SATUAN PEMASUKAN (IFK) PENGGUNAAN STOK AKHIR KET
PEROLEHAN AWAL
1 2 3 4 5 6 7 8 9
1 Kodein Tablet 2020 - - - -
2 Pethidin HCl 50mg/ml-2ml Injeksi 2020 - - - -
3 0 0 0

LAPORAN PSIKOTROPIKA

TAHUN STOK
NO NAMA SEDIAAN SATUAN PEMASUKAN (IFK) PENGGUNAAN STOK AKHIR KET
PEROLEHAN AWAL
1 2 3 4 5 6 7 8 9
1 Clobazam 10 mg Tablet 0 - -
2 Clobazam 10 mg Tablet 2021 100 - 100
3 Diazepam enema 10 mg Tube 2022 - -
4 Diazepam enema 10 mg 0 0 - -
5 Diazepam enema 5 mg Tube 2022 - -
6 Diazepam enema 5 mg 0 0 - -
7 Diazepam injeksi 5 mg/ml Ampul 2020 10 - 10
8 Diazepam injeksi 5 mg/ml Ampul 2021 - -
9 Diazepam tablet 2 mg Tablet 2020 500 200 300 400
10 Diazepam tablet 2 mg Tablet 0 - -
11 Diazepam tablet 5 mg Tablet 0 - -
12 Phenobarbital 100 mg Tablet 0 -
13 Phenobarbital 30 mg Tablet 2020 200 100 100
14 Phenobarbital 30 mg Tablet 2021 - -
15 Phenobarbital inj Ampul 2020
16 Phenobarbital inj Ampul 2021 - -
Mengetahui :
KEPALA PUSKESMAS, Penanggung Jawab

Hj. EFRIDAWATI ALI, SKM, S.Keb., Bd. Apt. SENJA MULIA H., S.Farm.
NIP. 19680329 198811 2 001 NIP. 19930316 202012 2 029