PEMERINTAH KABUPATEN POLEWALI MANDAR

DINAS KESEHATAN
PUSKESMAS PAMBUSUANG
Alamat : Jln. Poros Majene Desa Pambusuang, Kec. Balanipa, Kode Pos 91354
Telepon : 0822 9268 1403, E-mail : puskesmas.pambusuang440@gmail.com
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
PUSKESMAS : PAMBUSUANG
KECAMATAN : BALANIPA
PUSTU / POSKESDES : SABANG SUBIK
PROVINSI : SULAWESI BARAT

TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN KEKURANGAN KEBUTUHAN STOK OPT
PERSEDIAAN

1 2 3 = 1+2 4 5 6=4+5 7 = 6 + 10%

A. Obat Poli Umum Dan Gigi
1 Air untuk injeksi amp 25 ml Amp
2 Ambroxol 30mg Tab 0 100 100 100 300 400 440
3 Amoksisilin Sirup kering 125mg/ml Tab 1 0 1 0 0 0 0
4 Amox syr 250mg Tab 0 0 0
5 Amoksisilin Kapsul 250 mg Tab 0 0 0
7 Amoksisilin kapsul 500 mg Tab 0 300 300 330
8 Antasida Doen Tablet kombinasi Tab 0 0 300 300 330
9 Antifungi Doen Salep Kombinasi Tab 0 0 0
10 Asam Askorbat (Vitamin C) Tab 50 Tab 100 100 100 100 110
11 Asam Mefenamat Tablet 500 mg Tab 0 100 100 100 200 300 330
12 Atapulgit 600 mg Tab 100 100 100 100 200 220
13 Bedak Salisil Serb 2% Box 0 5 5 5.5
14 Betametason Krim 0,1% Tube 10 10 11
15 Biocombin inj Amp 0 0 0
16 Deksametason tablet 0,5 mg Tab 0 0 0 0 300 300 330
17 Fitomenadion (Vitamin K) Inj 2 mg/ml Amp 0 0 0
18 Garam Oralit Kombinasi Sachet 6 5 11 11 20 31 34.1
19 Gentamisin Salep Mata Tube 0 0 0
20 Ibuprofen 400 mg Tab 0 0 0 0 300 300 330
21 Kaptopril Tab 25 mg Tab 0 0 0
22 Klorfeniramin Maleat Tab (CTM) 4 m Tab 0 100 100 100 200 300 330
23 Lidokain Injeksi Amp 4 4 2 2 2.2
24 Metilergometrin Inj 0,2 mg/ml Amp 0 0 0
25 Metilergometrin Tablet Salut 0,125 m Tab 10 0 10 0 0
26 Mikonazol Krim 2% Tube 0 0 0 10 10 11
27 Nifedipin Tab 10 mg Tab 0 0 0
28 Parasetamol Sirup 120 mg / 5 ml Btl 0 5 5 5.5
29 Parasetamol Tablet 500 mg Tab 100 100 100 300 400 440
30 Pirantel Pamoat Tablet 125 mg Tab 38 0 38 0 0
31 Piridoksin (Vitamin B6) Tab 10 mg Tab 100 300 400 400 300 700 770
32 Prednison Tablet 5 mg Tab 0 100 100 100 300 400 440
33 Ranitidin Tab 150 mg Tab 30 30 10 10 11
34 Ringer Laktat (RL) Btl 0 0 0
35 Salep 2-4 Kombinasi Pot 0 5 5 5.5
36 Sianokobalamin (Vit. B12) Inj 500 mc Amp 0 0 0
37 Sianokobalamin (Vit. B12) Tab 50 m Tab 100 300 400 400 400 440
38 Tiamin (Vit B1) Inj Amp 0 0 0
39 Tiamin (Vit B1) Tab 50 mg Tab 0 200 200 200 200 400 440
40 Vitamin B kompleks tablet Tab 200 200 200 300 500 550
41 Zink Sirup 20mg/15ml Btl 0 0 0
42 Zink Tab 0 100 100 100 200 300 330
B. POLI KIA DAN GIZI 0 0 0
B.1 Reguler 0 0 0
 1 Kombinasi: Ferro Fumarat 60 mg + A Tab 1200 1200 1200 1000 2200 2420
2 Kombinasi: Ferro Sulfat 200 mg + As Tab Sal 0 0 0
3 Kalium Laktat (Kalk) Tablet 500 mg Tab 200 200 200 300 500 550
C. BAHAN MEDIS HABIS PAKAI (BMHP) 0 0 0
1 Alat Suntik Sekali Pakai 1 ml Pcs 4 18 22 20 20 22
2 Alat Suntik Sekali Pakai 2,5 ml Pcs 6 0 0
3 Alat Suntik Sekali Pakai 3 ml Pcs 20 20 20 10 30 33
4 Alat Suntik Sekali Pakai 5 ml Pcs 17 0 17 0 0
5 Alat Suntik Sekali Pakai 10 ml Pcs 0 0 0
6 Alat Suntik Sekali Pakai 20 ml Pcs 0 0 0
7 Alkohol Swab Box/100 20 100 120 100 100 110
8 Bisturi Uk 10 Pcs 0 0 0
9 Bisturi Uk 22 Pcs 3 0 3 0 0
10 Blood Lancet Buah 0 0 0
11 Catgut/benang bedah no. 2.0 Box/24 5 5 0 0
12 Catgut/benang bedah no. 3.0 Box/25 0 0 0
13 Cuticell Classic (10 x 10) Sachet 0 0 0
14 Cutisorb (Absorbent Compress) Sachet 0 0 0
15 Dentorit Btl 0 0 0
16 Etakridin Larutan 0,1% (Rivanol) Btl 0 1 1 1.1
17 Etanol 70% (Alkohol) Btl 0 2 2 2.2
18 Ethyl Chloride Btl 0 0 0
19 Eugenol Cairan Btl 0 0 0
20 Fixomull Roll 0 0 0
21 Foley Catheter No. 14 Pcs 3 3 0 0
22 Foley Catheter No. 16 Euromed Pcs 0 0 0
23 Foley Catheter No. 18 Euromed Pcs 0 0 0
24 Glass Ionomer Btl 0 0 0
25 Infus Set Anak Pcs 0 0 0
26 Infus Set Dewasa Pcs 10 10 0 0
27 IV. Catheter No. 18 MF Pcs 1 1 2 1 1 1.1
28 IV. Catheter No. 20 Pcs 2 2 2 2 2.2
29 IV. Catheter No. 22 Pcs 2 2 2 2 2.2
30 IV. Catheter No. 24 Pcs 2 2 2 5 7 7.7
31 IV. Catheter No. 26 Pcs 0 5 5 5.5
32 Jarum Jahit Uk 8 Pcs 0 0 0
33 Jarum Jahit Uk 12 Pcs 0 0 0
34 Jarum Jahit Uk 15 Pcs 0 0 0
35 Kapas Pembalut 250 gr Roll 1 1 1 3 4 4.4
36 Kasa Hidrofil 16 X 16 cm Roll 1 1 0 0
37 Kasa Hidrofil 2 X 80 cm Roll 31-Dec 31-Dec 1 1 1.1
38 Kasa Kompres 36 m X 80 cm Roll 8 8 0 0
39 Masker Box/50 50 50 50 50 55
40 Sarung Tangan Non Steril Aximed Box/100 14 0 14 14 10 24 26.4
41 Sarung Tangan Obgyn 7,5 Pcs 0 0 0
42 Sarung Tangan Steril No. 6 Box/50 0 0 0
43 Sarung Tangan Steril No. 6.5 Box/50 0 5 5 5.5
44 Sarung Tangan Steril No. 7 Box/50 0 10 10 11
45 Slik (Benang Bedah Sutra) np 2/0 Pcs 0 0 0
46 Slik (Benang Bedah Sutra) np 3/0 Pcs 3 0 3 0 0 0
47 Umbilical Cord Pcs 0 0 0
48 Under Pad Pcs 0 0 0
49 Urine Bag Pcs 0 0 0
50 USG Gel Btl 0 0 2 2 2.2
51 Wing needle Pcs 0 0 0
52 Yodium Povidon Larutan 10% Btl 0 0 0
RAWAT JALAN RAWAT INAP JUMLAH
JUMLAH KUNJUNGAN RESEP UMUM JKN UMUM JKN UMUM JKN
7 109 7 109
Pengelola Obat Pu
Yang Mengetahui Yang Meminta/Melaporkan Apoteker Penangg
Plt. Puskesmas Puskesmas Bidan Desa Pustu / Poskesdes
(Hj. Yusnani, AMD.Keb., S.ST) Sitti Rahm Amd.keb Apt. Madaniah, S
NIP.19691001 198903 2 008 NIP. SIPA : 503/14/SIP/
PATEN POLEWALI MANDAR
KESEHATAN
AS PAMBUSUANG
Pambusuang, Kec. Balanipa, Kode Pos 91354
mail : puskesmas.pambusuang440@gmail.com
DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
PELAPORAN BULAN : APRIL 2024
PERMINTAAN BULAN : MEI 2024

SISA STOK
BULAN PERMINTAAN PEMBERIAN KET
BERJALAN

DAK HIBAH PROV LAIN Jumlah

8 9 = 7- 8 10

-
440
1 (1)
-
-
330
330
-
200 (90)
200 130
220
6
11
-
330
-
34
-
330
-
330
2 0
-
10 (10)
11
-
6
440
38 (38)
770
440
10 1
2 (2)
6
-
440
-
440
550
-
330
-
-
 2,420
-
550
-
2 20
-
33
17 (17)
-
-
20 90
-
3 (3)
-
5 (5)
-
-
-
-
1
2
-
-
-
3 (3)
-
-
-
-
10 (10)
1 0
2
2
8
6
-
-
-
4
1 (1)
1
8 (8)
55
26
-
-
6
11
-
3 (3)
-
-
-
2
-
-

Pengelola Obat Puskesmas

Apoteker Penanggungjawab Pengelola Gudang Obat Puskesmas
Apt. Madaniah, S.SI (Nur Ezza Zasmi, Amd. Farm)
SIPA : 503/14/SIP/DPMPTSP/V/2021 NIP. 19871223 201902 2 001
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