PUSKESMAS : MARO SEBO ILIR

KECAMATAN : MARO SEBO ILIR

LAPORAN PEMA

NO NAMA OBAT SATUAN STOK AWAL

1 2 3 4
I OBAT SESUAI FORMULARIUM NASIONAL (FORNAS)
1 Air untuk injeksi Botol 12
2 Albendazol 400mg Tablet -
3 Albendazol susp 200 mg/5ml Botol -
4 Alopurinol tablet 100 mg Tablet -
5 Alupurinol Tab 300mg Tablet -
6 Aminofilin injeksi 24 mg/ml Amp -
7 Aminofilin tablet 200 mg Tablet -
8 Amitriptilin Tablet Salut 25 mg (HCl) Tablet -
9 Amlodipin tablet 10 mg Tablet -
10 Amlodipin tablet 5 mg Tablet -
11 Amoksisilin 250 mg Tablet -
12 Amoksisilin sir forte 250mg Botol -
13 Amoksisilin sir 125mg/5 ml Botol 3
14 Amoksisilin Tablet 500 mg Tablet 200
15 Ampisilin serb inj 1000 mg/vial Vial -
16 Antasida DOEN I Tablet Kunyah Kombinasi Tablet -
17 Antasida DOEN II Suspensi Kombinasi Botol 6
18 Antifungi DOEN Kombinasi Tube -
19 Antihemoroid Kombinasi sup Sup -
20 Antimalaria DOEN Kombinasi (Primetamin dan Sulfadoksin) Tablet -
21 Antimigren Komb ( Ergotamin 1mg + kafein 50 mg ) Tablet -
22 Asam asetil salisilat (asetosal) tablet80 mg Tablet -
23 Asam Askorbat (Vitamin C) Tablet 50 mg Tablet -
24 Asam Folat 1 mg Tablet -
25 Asam Mefenamat tablet 500 mg Tablet -
26 Asiklovir Tablet 200 mg Tablet 50
27 Asiklovir Tablet 400 mg Tablet -
28 Atapulgit Tablet Tablet 100
29 Atenolol 50 mg Tablet -
30 Atropin Injeksi . 0,25 mg/ml ( i.m./ i.v. / s.k) Amp -
31 Atropin Sulfat Tablet 0,5 mg Tab Tablet -
32 Bedak Salisil serbuk 2% Bks -
33 Betametason Krim 0,05 % Tube -
34 Bisakodil sup 5 mg Botol -
35 Bisaprolol 5mg Tablet -
36 Deksametason Injeksi 5 mg/ml (i.v/i.m) Amp 9
37 Deksametason Tablet 0,5 mg Tablet -
38 Devitalisasi Pasta (Non Arsen) Botol -
39 Diazepam Injeksi 5 mg/ml ( i.v/i.m) Amp -
40 Diazepam rektal 10mg/2 ,5ml Amp -
41 Diazepam rektal 5mg/2 ml Amp -
42 Diazepam Tablet 2 mg Tablet -
43 Diazepam Tablet 5 mg Tablet -
44 Dietilkarbamazin tab 100mg Tablet -
45 Difenhidramin Injeksi 10 mg / ml (i.v/i.m) Amp -
46 Digoksin Tablet 0,25 mg tablet -
47 Diltiazem hcl tab 30mg Tablet -
48 Doksisiklin Kapsul 100 mg Tablet -
49 Domperidon 10 mg Tablet Tablet -
50 Domperidon 5mg/5ml Sirup Botol -
51 Epinefrin (Adrenalin) Injeksi 0,1 % (i.v/s.k/i.m) Amp -
52 Ergotamin tab 1mg Tablet -
53 Eritromisin kapsul 250 mg Tablet -
54 Eritromisin Kapsul 500 mg Tablet -
55 Eritromisin Sirup 200 mg / 5 ml Botol -
56 Etanol cairan 70 % Botol 1
57 Etil Klorida Semprot 100 ml Botol -
58 Eugenol cairan Botol -
59 Fenitoin Na kaps Tablet -
60 Fenobarbital tablet 30 mg Tablet -
61 Fenoksimetil penisilin ( Penisilin V ) 250mg Tablet -
62 Fenoksimetil penisilin ( Penisilin V ) 500mg Tablet -
63 Fitomenadion (Vitamin K1) Injeksi 2mg/ml (i.m) Amp -
64 Fitomenadion (Vitamin K1) Tablet Salut 10 mg Tablet -
65 Flufenazin inj 25 mg/ml (i.m) Amp -
66 Fluor kaps 1 mg Kapsul -
67 Furosemid Injeksi 10 mg / ml ( i.v. / i.m) Amp -
68 Furosemid Tablet 40 mg Tablet -
69 Garam Oralit I Serbuk Kombinasi Bks -
70 Glass Ionomer Cement Art Lar. Botol -
71 Glibenklamida Tablet 5 mg Tablet 200
72 Glimepirid 2 mg Tablet 200
73 Griseofulvin Tablet 125 mg Tablet -
74 Griseril trinitrat tab sublingual 0,5 mg Tablet -
75 Haloperidol Tablet 0,5 mg Tablet -
76 Haloperidol Tablet 1,5 mg Tablet -
77 Hidroklorotiazida Tablet 25 mg Tablet 100
78 Hidrokortison Krim 2,5 % Tube -
79 Hyoscine -N-Butilbromide Tablet 10 mg Tablet -
80 Ibuprofen Sirup 100 mg/5 ml Botol -
81 Ibuprofen Tablet 200 mg Amp -
82 Ibuprofen Tablet 400 mg Tablet -
83 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet -
84 Kalsium glukonat inj 10% Botol -
85 Kalsium Hidroksida bubuk,Pasta Botol -
86 Kaptopril Tablet 12,5 mg Tablet -
87 Kaptopril Tablet 25 mg Tablet 100
88 Karbamazepin tab 100 mg Tablet -
89 karbo Gliserin tetestelinga 10 % Botol -
90 Ketokonazol tab 200 mg Tablet -
91 Klindamisin 300 mg Tablet -
92 Klindamisin kap 150mg Tablet -
93 Kloramfenikol kapsul 250 mg Tablet -
94 Kloramfenikol Salep Mata 1 % Tube -
95 Kloramfenikol susp 125mg/5ml Botol -
96 Kloramfenikol Tablet 500mg Tablet -
97 Kloramfenikol Tetes Mata 1 % Botol -
98 Kloramfenikol tetes telinga 1% Botol -
99 Klorfeniramin Tablet 4 mg Tablet -
100 Klorfenol Kamfer Menthol (CHKM) Botol -
101 Klorpromazin Tablet Salut 100 mg (HCl) Tablet -
102 Klorpromazin Tablet Salut 25 mg (HCl) Tablet -
103 Kodein tablet 10 mg Tablet -
104 Kotrimoksazol (Dewasa ) Sulfa - Trimetoprim tablet 480 mg Tablet -
105 Kotrimoksazol Sulfa - Trimetoprim suspensi 240 mg/5ml Botol -
106 Kuinin Tab Tablet -
107 Lidokain 2% + Epineprin 1 : 80.000 injeksi 2 ml Amp -
108 Loratadin 10 mg tablet Tablet -
109 Magnesium Sulfat Injeksi 20% Botol -
110 Magnesium Sulfat Injeksi 40% Botol -
111 Mebendazol sir 50mg/ml Botol -
112 Mebendazol tab 100 mg Tablet -
113 Mebendazol tab 500 mg Tablet -
114 Metformin 500 mg Kapsul 100
115 Metformin 850 mg Kapsul 350
116 Metilergometrin Maleat Injeksi 0.2 mg - 1ml Amp -
117 Metilergometrin Maleat Tablet Salut 0,125 mg Tab Tablet -
118 Metilprednisolon tab 4 mg Tablet -
119 Metoklopramid Tablet 10 mg Tablet -
120 Metrodinazol lar inf 5mg/ml Botol -
121 Metrodinazol sir 125mg/ml Botol -
122 Metronidazol Tablet 250 mg Tablet -
123 Metronidazol tablet 500 mg Tablet -
124 Mikonazol Krim 2% (Nitrat) Tube -
125 Natrium Bikarbonat Tablet 500 mg ( Meylon ) Tablet -
126 Natrium Diklofenak Tablet 25 mg Tablet -
127 Natrium Diklofenak Tablet 50 mg Tablet -
128 Natrium tiosulfat inj 25% (i.v) Amp -
129 Nifedipin Tablet 10 mg Tablet -
130 Nistatin Suspensi 100.000UI/ml Botol -
131 Nistatin Vagina 500.000 Tablet Tablet -
132 Nistatin Vaginal Tablet 100.000 IU /g Tablet -
133 Oksitosin Injeksi 10 iu/ml -1 ml Amp -
134 Omeprazol tablet 20 mg Tablet -
135 Parasetamol Sirup 120 mg / 5 ml Botol 5
136 Parasetamol Tablet 500 mg Tablet -
137 Parasetamol drops 100 mg / 1 ml Botol -
138 Perak sulfadiazin krim1% Tube -
139 Pirantel pamoat sus 125mg/5ml Botol -
140 Pirantel pamoat tab 125 mg Tablet -
141 Piridoksin (Vitamin B6) Tablet 10 mg (HCl) Tablet 100
142 Povidon Iodida 100 mg/ml 30 ml Botol -
143 Povidon Iodida 100 mg/ml 300 ml Botol -
144 Prednison Tablet 5 mg Tablet 100
145 Primakuin Tablet 15 mg Tablet -
146 Probenesid tab 500mg Tablet -
147 Prokain Benzil Penisilin G. Injeksi 3 Juta iu/Vial Vial -
148 Propanolol Tablet 10 mg (HCl) Tablet -
149 Propilitiourasil Tablet 100 mg Tablet -
150 Ranitidin Tablet 150 mg Tablet 30
151 Risperidon 2 mg Tablet -
152 Salbutamol Tablet 2 mg (Sebagai Sulfat) Tablet -
153 Salbutamol Tablet 4 mg (Sebagai Sulfat) Tablet 30
154 Salep 2 - 4 Kombinasi Tube -
155 Sefadroksil Kapsul 500 mg Tablet -
156 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I) Vial -
157 Serum Anti Tetanus Injeksi. 1.500 iu / 1 ml (ATS) Vial -
158 Sianokobalamin (Vitamin B12) Injeksi 500 mcg Amp -
159 Sianokobalamin (Vitamin B12) Tablet 50 mcg Tablet -
160 Simvastatin Tablet 10 mg Tablet -
161 Simvastatin Tablet 20 mg Tablet -
162 Siprofloksasin Tablet scored 500 mg Tablet -
163 Spironolakton 25 mg tablet Tablet -
164 Tetrakain HCl Tetes Mata 0,5 % Botol -
165 Tetrasiklin Kapsul 500 mg Tablet -
166 Tetrasiksin 250 mg Tablet -
167 Tiamin (Vitamin B1) Tablet 50 mg (HCl / Nitrat) Tablet 100
168 Valproat sir 250 mg/ml Botol -
169 Valproat tab sal 250mg Tablet -
170 Valproat tab sal 500 mg Tablet -
171 Verapamil 80mg Tablet -
172 Vitamin B Kompleks Tablet Tablet -
173 Zink sir 10 mg/ml Botol -
174 Zink tablet dispersi 20 mg Tablet -
II OBAT SESUAI FORMULARIUM NON NASIONAL (FORNAS)
1 Ambroxol Sirup 15 mg/ml Botol -
2 Ambroxol Tablet 30 mg Tablet -
3 Antalgin Injeksi 250 mg Amp -
4 Antibakteri DOEN Salep Kombinasi (Bacytrasin Salep) Tube -
 5 Asam asetil salisilat (asetosal) tablet500 mg Tablet -
6 Asetosal Tablet 100mg Tablet -
7 Asiklovir Krim 5% Tube -
8 Counterpain 15 mg Tube -
9 Duvadilan Tablet -
10 Efedrin Tablet 25mg ( HCL ) Tablet -
11 Ekstraks Belladona Tablet 10 mg Tablet -
12 Etakridin Larutan 0,1 Botol -
13 Famotidine Tablet 40 mg Tablet -
14 Fenobarbital inj Tablet -
15 Fenol Gliserol Tetes Telinga 10 % Botol -
16 Gentamisin Injeksi 40 mg/ml Amp -
17 Gentamisin Salep Kulit 0,1 % Botol -
18 Gliseril Guaiakolat Tablet 100 mg Tablet -
19 Glukosa Larutan Infus 10 % Steril Botol -
20 Glukosa Larutan Infus 5 % Steril Botol -
21 Imersi Oil Botol -
22 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 30
23 Ketorolac inj 30mg/ml Amp -
24 Kotrimoksazol DOEN II (Pediatrik) Kombinasi Tablet -
25 Larutan Asam Asetat Botol -
26 Larutan Asam Klorida 0,1 N Botol -
27 Larutan Benedict Botol -
28 Larutan Eosin 2% Botol -
29 Larutan Faucet Botol -
30 Larutan Giemsa Stalin Botol -
31 Larutan Natrium Sitrat 3,8% Botol -
32 Larutan Resserccer Botol -
33 Larutan Turk Botol -
34 Lisol Botol -
35 Natrium Klorida Larutan Infus 0,9% Botol -
36 Obat Batuk Hitam (OBH) 100 ml Cairan Botol -
37 Oksitetrasiklin HCl Injeksi. i.m. 50 mg/ml - 10 ml Amp -
38 Oksitetrasiklin HCl Salep Mata 1 % Tube -
39 Oksitetrasiklin Salep Kulit 3 % Tube -
40 Parasetamol 100 mg Tablet -
41 Pehacain inj Amp -
42 Piracetam Injeksi 1 g / 5 mL Amp -
43 Piroxicam 20mg Tablet 20
44 Propanolol tablet 40 mg Tablet -
45 Ranitidin Injeksi 25 mg / 2 ml Amp -
46 Reagen Golongan Darah Botol -
47 Reagen TB Botol -
48 Ringer Laktat Larutan Infus Steril Botol -
49 Semen Seng Fosfat Serbuk dan Cairan Botol -
50 Setirizin Sirup 5 mg/5ml Botol 4
51 Setirizin Tablet 10mg Tablet -
52 Simetidin Tablet 200 mg Tablet -
53 Sulfasetamida Natrium Tetes Mata 15 % Botol -
54 Tablet Tambah Darah Tablet -
55 Temporary Stopping Fletcher Serbuk dan Cairan Botol -
56 Tiamin (Vitamin B1) Injeksi 100 mg/ml Tablet 4
57 Trombophob Jeli 15 g Tube -
58 Ventolin Botol -
59 Betahistin Tablet -
60 Kandersartan 8 mg Tablet 150
61 Kandersartan 16 mg Tablet 50
III BAHAN MEDIS HABIS PAKAI (BMHP) Pcs
1 Alat Suntik Sekali Pakai 1 ml Pcs -
2 Alat Suntik Sekali Pakai 2,5 ml Pcs -
3 Alat Suntik Sekali Pakai 3 ml Pcs 98
4 Alat Suntik Sekali Pakai 5 ml Pcs 100
5 Catgut / Benang bedah No. 3/0 Dengan Jarum Bedah Pcs -
6 Elastis Verban 4 inci Pcs -
7 Foley Catheter No. 16 Pcs -
8 Foley Catheter No. 18 Pcs -
9 Hanscoond no 6,5 Pcs -
10 Hanscoond no 7,5 Pcs -
11 HCG test Pcs -
12 Infusion Set Anak Pcs -
13 Infusion Set Dewasa Pcs -
14 IV Catheter No. 18. G Pcs -
15 IV Catheter No. 20 G Pcs -
16 IV Catheter No. 22 G Pcs -
17 IV Catheter No. 24 G Pcs -
18 Jarum Jahit Kulit Pcs -
19 Jarum Jahit Otot Pcs -
20 Kapas Pembalut / Absorben 250 gr Pcs 1
21 Kasa Pembalut 2 m x 80 cm Rol -
22 Kasa Hidrofil 4 m x 15 cm Rol -
23 Kasa Hidrofil 4 m x 3 cm Rol -
24 Kasa Hidrofil Steril Uk. 16 cm x 16 cm Rol -
25 Kasa Hidrofil Uk. 36 m x 80 cm Rol -
26 Kasa Kompres 40/40 Steril Rol 10
27 Kasa Pembalut Hidrofil 4 m x 10 cm Rol -
28 Kasa Pembalut Hidrofil 4 m x 5 cm Rol -
29 Masker Rol -
30 Pembalut Gips 4 Inci Rol -
31 Plester 5 Yards x 2 inci Rol -
32 Silk (Benang Bedah Sutra) No. 3/0 Dengan Jarum Bedah Pcs -
33 Urine Bag Pcs -
34 Wing Needle No.27 G Pcs -
35 Handscoond 8 Pcs -
36 Handscoond 7 Pcs -
37 Plesterin Non Woven Pcs -
38 Kasa Hidrofil Uk. 40 m x 80 cm Pcs -
39 Poligyp 10 cm x 2,7 m Pcs -
40 Policrepe pembalut elastis 10 cm x 4,5 m Pcs -
41 Plester 5cm x 5m Pcs -
42 Fixomul Pcs -
43 Handscoond M Pcs 1
44 Handscoond L Pcs -
IV TAMBAHAN
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -

UMUM
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR

Kepala Dinas Kesehatan Kepala Puskesmas

Kabupaten Batang Hari Maro Sebo Ilir

Asri Yonalsyah, AP Ns. Inayah, S.Kep

NIP. 197603081995011001 NIP. 197804052005012008
CATATAN :
1 Harap mengisi laporan sesuai Format
2 Jumlah kunjungan harap di isi
3 Jika ada permintaan rangkap 3, tidak ada permintaan rangkap 1
4 jika ada tambahan item obat. Harap di isi di kolom tambahan setelah no. 44
 BULAN : 0 7
TAHUN : 2 0

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO. LB.2)

PEMBERIAN
PENERI- PERSE- STOK PERMIN-
PEMA-KAIAN SISA STOK
MAAN DIAAN OPTIMUM TAAN
JKN APBD

5 6 7 8 9 10 11 12

12 12
- -
- -
- - 100
- - 100
- -
- -
- -
100 100 100 - 200
300 300 200 100 300
- -
- -
3 3
100 300 100 200 100
- -
- - 300
6 6 5
- -
- -
- -
- -
- -
200 200 100 100 200
- -
- -
50 50
100 100 100
100 100
- -
- -
- -
3 3 3
- -
- -
- -
9 3 6
200 200 170 30 200
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- - 5
- -
- -
- -
- -
- -
- 1 - 1 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
200 200
200 200
- -
- -
- -
- -
100 100 - 100
5 5 3 2 5
- -
- -
- -
- - 200
- -
- -
 - -
- -
100 100
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- - 200
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
100 200 150 50 100
350 350
- -
- -
- -
- -
- -
- -
- -
- - 100
- -
- -
- -
- - 200
- -
- -
- -
- -
- -
 - -
200 200 180 20 200
5 5
300 300 260 40 300
- -
- -
- -
- -
100 200 200 - 200
- -
- -
100 200 150 50 200
- -
- -
- -
- -
- -
100 130 50 80 100
- -
100 100 100
100 130 20 110 100
- - 5
- -
- -
- -
- -
- -
- - 100
- - 100
- -
- -
- -
- -
- -
200 300 100 200 200
- -
- -
- -
- -
- - - 200
- - 5
- - 100

- - - 5
200 200 200 - 300
- -
- -
 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
3 3 2 1 5
200 200 100 100 200
- -
- -
- -
200 230 100 130 200
- - 5
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1 1 1
- -
- -
- -
- -
- -
- -
- -
20 20 - 200
- -
- -
- -
- -
- -
- -
4 2 2 5
- -
- -
 - -
- -
- -
4 3 1 5
- -
- -
- -
300 450 300 150 100
50 50 - 100

- - -
- - -
98 10 88
100 100
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1 1
- -
- -
- -
- -
- -
10 10
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
 - -
- -
- - 1
- -
- -
1 1 - 1
- -

- - -
- - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

UMUM
JAMKESDA JKN UKS KIR JUMLAH
TIDAK BAYAR

a Puskesmas Yang Melapor, Yang Menerima,

ro Sebo Ilir Dokter Tangguh Tim Tangguh

nayah, S.Kep dr. Alvin Alkhaliq dr. Alvin Alkhaliq

804052005012008 NIP. 202206 NIP. 202206
 LB.2

2 3

PEMBERIAN TAHUN TAHUN

NO. BATCH KET
LAIN JUMLAH PENGADAAN Exp

13 14 15 16 17
 JUMLAH

g Menerima,
m Tangguh

Alvin Alkhaliq
IP. 202206